平按∶此篇自篇首至末，见《灵枢》卷九第六十《玉版》篇。自黄帝曰病生之时至末，又见
《甲乙经》卷十一第九。
黄帝曰∶余以少针为细物也，夫子乃上合之于天，下合之于地，中合之于人，余以为过针之
意矣，愿闻其说。（九针微细之道，以合三才之大，余恐太过也。物，道也。平按∶少针《灵枢》
作小针，乃下有言字。）岐伯曰∶何物大于针者乎？夫大于针者，唯五兵者焉。五兵者，死备也，
非生之备也。且夫人者，天地之镇塞也，其可不参乎？夫治人者，亦唯针焉。夫针与五兵，其孰
小乎？（夫人之为天地镇塞，贵莫大焉。兵有五者，一弓、二 、三矛、四戈、五戟，死之之具
也。九针虽小，生人之器也，圣人用之，理于百姓，孰为小道？故大之无外，小之无内，细入无
间，令人久寿者，其惟九针乎。平按∶非生之备也《灵枢》作非生之具。天地之镇塞也，《灵枢》
无塞字。注五兵，《周礼·夏官》司兵掌五兵，郑司农云∶“五兵者，戈、 、戟、酋矛、夷矛。”
又步卒之五兵，无夷矛而有弓矢。与此略异。）黄帝曰∶病生之时，有喜怒不测，饮食不节，阴气
不足，阳气有余，营气不行，乃发为疽痈。（痈生所由，凡有四种。测，度也。喜怒无度，争气
聚，生痈一也。饮食不根据节度，纵情不择寒温，为痈二也。脏阴气虚，腑阳气实，阳气实盛，生
痈三也。邪客于血，聚而不行，生痈四也。痈疽一也，痈之久者败骨，名曰疽也。平按∶《灵枢》、
《甲乙》病生之时作生病之时。）阴阳气不通，两热相薄，乃化为脓，针小能取之乎？（以下言生
脓所由也。邪客于皮肤之中，寒温二气不和，内
外两热相击，腐肉故生于脓，恐小针不能取之。平按∶不通上《灵枢》无气字。《甲乙》两热作
而热。）岐伯曰∶圣人不能使化者，为邪之不可留也。故两军相当，旗帜相望，白刃陈于中野者，
此非一日之谋也。能使其人，令行禁止，卒无白刃之难者，非一日之务也，须久之方得也。（平
按∶《灵枢》邪之作之邪，须久之方得也作须臾之得也。自圣人不能使化者至须久之方得也，《甲
乙》无此一段。）夫至使身被痈疽之病、脓血之聚者，不亦离道远乎？夫痈疽之生也，脓血之成
也，不从天下，不从地出，积微之所生也。故圣人之治，自于未有形也，愚者遭其已成也。（帜，
昌志反，幡也。圣人不能使身化为病者，以圣人理之未乱，其邪不可留于身也。故譬白刃陈于中
野，谋之在久，士卒无难，习之日远，痈疽不生，调中多日，故身遭痈疽之病，去和性之道远矣。
夫积石成山，积水成川，积罪成祸，积气成痈，非从天下地出，皆由不去脆微，故得斯患也。圣
人不尔，于国理之未乱，于身约之于未病，不同愚人，渴而掘井，斗方铸兵也。平按∶《甲乙》
无不从天下不从地出八字，积微作积聚。故圣人之治自于未有形也《灵枢》作故圣人自治于未有形
也，《甲乙》作自治于未形。注白刃，袁刻刃字作仞。圣人不尔，尔误作亦。斗方铸兵，方作而。）
黄帝曰∶其以有形不子遭，脓以成不子见，为之奈何？（遭，逢也。子，百姓，帝以百姓如子者
也。言不逢者，痈之有形，百姓不能逢知也，痈之有脓，百姓亦不见，为之奈何也。平按∶“其
以有形不子遭，脓以成不子见”《灵枢》作“其已形不予遭，脓已成不予见”，《甲乙》作“其
已有形，脓已成”。）岐伯曰∶脓以成，十死一生，（痈生于节、背及腹内，脓成不可疗，故十
死一生。平按∶以《灵枢》、《甲乙》作已。）故圣人不使以成而明为良方，（故圣人明为良方，
痈微之
时疗之，弗使成也。平按∶不使以成《灵枢》作弗使已成。）着之竹帛，使能者踵之，传之后世，
无有终时者，为其不遭子也。（着之竹帛，为于百姓不能逢知痈疽者。平按∶踵之《灵枢》作踵
而，子作予。自上文故圣人不使至遭子也《甲乙》无。）黄帝曰∶其以有脓血而后遭子，可造以
小针治乎？（痈之生于背及节与腹内，已有脓血后，百姓逢知，小针可得疗否也。平按∶其以有
脓血，《灵枢》以作已，《甲乙》作已成二字。而后遭子《灵枢》作而后遭乎，《甲乙》无此四
字。可造《灵枢》作不导之三字，《甲乙》无造字。）岐伯曰∶以小治小者其功小，以大治大者
多害，故其以成脓者，其唯砭石排锋之所取也。（以小针疗痈之小，难瘥，故曰其功小也。以大
针疗脓成大，伤以处多，故得出脓。害，伤也。是以脓成唯须砭 也。平按∶“以大治大多害”
《甲乙》作“以大治大者其功大，以小治大者多害大”。以成脓者《灵枢》、《甲乙》作已成脓
血者。砭石《灵枢》、《甲乙》作砭石。 《灵枢》、《甲乙》作铍。注难瘥袁刻作难愈。）黄
帝曰∶多害者，其不可全乎？（多害者，砭 之伤，即至死也。）岐伯曰∶其在逆顺焉。（逆者
多伤至死，顺者出脓得生也。）黄帝曰∶愿闻逆顺。岐伯曰∶以为伤者，白眼青黑，眼小，是一
逆也；内药而呕，是二逆也；腹痛渴甚，是三逆也；肩项中不便，是四逆也；音嘶色脱，是五逆
也。除此者，为顺矣。（先有五伤，后行 者，为逆也。先无五伤，脓成行 ，为顺也。嘶，先妻
反，声破也。平按∶白眼《甲乙》作白睛。欧《灵枢》、《甲乙》作呕，“除此”下有“五”字。）
平按：本篇从开头到结尾，见于《灵枢》卷九第六十《玉版》篇。从“黄帝曰病生之时”到结尾，又见于《甲乙经》卷十一第九。
黄帝说：我认为小针是微小的器物，先生却上合于天，下合于地，中合于人，我认为这超出了小针的本意，希望听听您的说法。（九针细微的道理，用来契合天地人三才的大道，我担心太过分了。物，指道理。平按：《灵枢》中“少针”作“小针”，下面有“言”字。）岐伯说：什么东西比针大呢？比针大的，只有五种兵器罢了。五种兵器，是用于死亡的装备，不是用于生存的装备。况且人，是天地之间的镇守者，怎么能不参悟它呢？治疗人的疾病，也只靠针罢了。针与五兵相比，哪个更小呢？（人在天地间作为镇守者，尊贵没有比这更大的了。兵器有五种，一是弓，二是殳，三是矛，四是戈，五是戟，都是致死工具。九针虽然小，却是救生的器具，圣人使用它，治理百姓，谁说是小道呢？所以大到无外，小到无内，细入无间，使人长寿的，大概只有九针吧。平按：“非生之备也”在《灵枢》中作“非生之具”。天地之镇塞也，《灵枢》中没有“塞”字。注五兵，《周礼·夏官》司兵掌管五兵，郑司农说：“五兵是戈、殳、戟、酋矛、夷矛。”另外步兵的五兵，没有夷矛而有弓矢。与此略有不同。）
黄帝说：疾病产生的时候，有喜怒无常，饮食不节制，阴气不足，阳气有余，营气运行不畅，于是发为疽痈。（痈产生的原因，共有四种。测，是度量的意思。喜怒没有节制，争气聚集，产生痈，这是一；饮食不根据节度，纵情不顾寒温，产生痈，这是二；脏阴气虚，腑阳气实，阳气实盛，产生痈，这是三；邪气客居在血中，聚结而不运行，产生痈，这是四。痈和疽是一回事，痈久了败坏骨头，名叫疽。平按：《灵枢》、《甲乙》中“病生之时”作“生病之时”。）阴阳之气不通，两热相互搏结，于是化为脓，小针能取出它吗？（以下讲生脓的原因。邪气客居在皮肤之中，寒温二气不和，内外两热相互撞击，腐肉因此生于脓，恐怕小针不能取出它。平按：“不通”上《灵枢》没有“气”字。《甲乙》中“两热”作“而热”。）
岐伯说：圣人不能让已经化脓的病消散，是因为邪气不可滞留。所以两军相对，旗帜相望，白刃陈列在原野中间，这不是某一天的谋划。能让这个人令行禁止，士兵没有白刃之难的，也不是某一天的事务，需要很长时间才能做到。（平按：《灵枢》中“邪”作“之邪”，“须久之方得也”作“须臾之得也”。从“圣人不能使化者”到“须久之方得也”，《甲乙》没有这一段。）以至于让身体遭受痈疽之病、脓血积聚，不也是离大道远了吗？痈疽的产生，脓血的形成，不从天下掉下来，不从地里长出来，是积累微小而成的。所以圣人的治理，是在还没有形成时就处理，愚者则等到已经形成了才遭遇。（帜，昌志反，是幡旗的意思。圣人不能让身体化为疾病，是因为圣人治理未乱之时，邪气不可留在身上。所以比喻为白刃陈列在原野，谋划在于久远，士兵没有灾难，练习的日子远，痈疽不生，调和内部多天，所以身体遭受痈疽之病，是和性之道远矣。积石成山，积水成川，积罪成祸，积气成痈，不是从天上下下来或从地里长出来的，都是因为不去除脆弱微小，所以得了这种祸患。圣人不是这样，在国家治理未乱时，在身体未病时约束自己，不同于愚人，渴了才掘井，打仗才铸造兵器。平按：《甲乙》没有“不从天下不从地出”八字，“积微”作“积聚”。故圣人之治自于未有形也《灵枢》作“故圣人自治于未有形也”，《甲乙》作“自治于未形”。注白刃，袁刻“刃”字作“仞”。圣人不尔，“尔”误作“亦”。斗方铸兵，“方”作“而”。）
黄帝说：如果已经有形体而没有遇到，脓已经形成而没有看见，该怎么办呢？（遭，是逢遇的意思。子，指百姓，皇帝把百姓当作子女。说不逢遇的人，是说痈有形体时，百姓不能察觉知道；痈有脓时，百姓也看不见，该怎么办呢？平按：“其以有形不子遭，脓以成不子见”在《灵枢》中作“其已形不予遭，脓已成不予见”，《甲乙》作“其已有形，脓已成”。）
岐伯说：脓已经形成，十死一生，（痈生在关节、背部及腹内，脓成后不可治疗，所以十死一生。平按：“以”在《灵枢》、《甲乙》中作“已”。）所以圣人制定良方，不让病情发展到已成脓的地步，（所以圣人明确制定良方，在痈刚微小时治疗它，不让它发展成脓。平按：“不使以成”在《灵枢》中作“弗使已成”。）把它写在竹帛上，让有能力的人跟随它，传给后世，没有终结的时候，是为了那些没有遇到（早期治疗时机）的百姓。（写在竹帛上，是为了因为百姓不能察觉知悉痈疽。平按：“踵之”在《灵枢》中作“踵而”，“子”作“予”。从上文“故圣人不使”到“遭子也”，《甲乙》没有。）
黄帝说：如果已经有脓血然后遇到百姓，可以用小针治疗吗？（痈生在背部及关节与腹内，已有脓血后，百姓逢遇知晓，小针可以治疗吗？平按：“其以有脓血”在《灵枢》中“以”作“已”，《甲乙》作“已成”二字。“而后遭子”在《灵枢》中作“而后遭乎”，《甲乙》没有这四字。“可造”在《灵枢》中作“不导之”三字，《甲乙》没有“造”字。）
岐伯说：用小针治疗小病，功效小；用大针治疗大病，伤害多，所以对于已经成脓的，只能用砭石和铍锋来取脓。（用小针治疗小的痈，难痊愈，所以说功效小。用大针治疗脓成大，损伤的地方多，所以能排出脓。害，是损伤的意思。所以脓成后只需要砭石。平按：“以大治大多害”在《甲乙》中作“以大治大者其功大，以小治大者多害大”。“以成脓者”在《灵枢》、《甲乙》中作“已成脓血者”。“砭石”在《灵枢》、《甲乙》中作“砭石”。《灵枢》、《甲乙》中“ ”作“铍”。注难瘥，袁刻作“难愈”。）
黄帝说：伤害多的，难道就不能保全吗？（伤害多的，是指砭石的损伤，甚至导致死亡。）
岐伯说：这取决于逆证还是顺证。（逆证的多伤害至死，顺证的排出脓就能生存。）
黄帝说：希望听听什么是逆证和顺证。岐伯说：如果出现眼睛白睛青黑、眼裂变小，这是一逆；服药后呕吐，这是二逆；腹痛且极度口渴，这是三逆；肩项部活动不便，这是四逆；声音嘶哑、面色脱失，这是五逆。除了这些情况，就是顺证。（先有五伤症状，后进行排脓治疗的，称为逆证。先没有五伤症状，脓成后进行排脓治疗的，称为顺证。嘶，先妻反，声音破碎的意思。平按：白眼在《甲乙》中作“白睛”。欧在《灵枢》、《甲乙》中作“呕”，“除此”下有“五”字。）
Ping An: This chapter, from the beginning to the end, is found in Volume 9, Chapter 60 "Yu Ban" (Jade Tablet) of *Ling Shu* (Spiritual Pivot). From "Huang Di said: When disease arises..." to the end, it is also found in Volume 11, Chapter 9 of *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion).
Huang Di said: I considered the small needle (Xiao Zhen, a minor acupuncture needle) to be a minute instrument. Yet Master, you align it with Heaven above, Earth below, and Humanity in between. I believe this exceeds the intent of the small needle. I wish to hear your explanation. (The subtle principle of the Nine Needles (Jiu Zhen, nine types of ancient acupuncture needles) aligns with the great Dao of the Three Powers (San Cai, Heaven, Earth, and Humanity). I fear it is too much. 'Wu' here refers to the Dao. Ping An: In *Ling Shu*, "Shao Zhen" is written as "Xiao Zhen", and there is an additional character "Yan" below.)
Qi Bo said: What is greater than the needle? What is greater than the needle are only the Five Weapons (Wu Bing, ancient weapons including bow, shu, spear, ge, and ji). The Five Weapons are instruments for death, not for life. Moreover, humanity serves as the stabilizer between Heaven and Earth; how can one fail to comprehend this? To treat humans, we rely solely on the needle. Compared to the Five Weapons, which is smaller? (Humanity, as the stabilizer between Heaven and Earth, holds supreme nobility. There are five weapons: first the Bow (Gong), second the Shu (a blunt weapon), third the Spear (Mao), fourth the Ge (dagger-axe), and fifth the Ji (halberd); these are tools of death. Although the Nine Needles are small, they are instruments of life. The Sage uses them to benefit the people; who would call this a trivial path? Thus, it is vast without outer limit, minute without inner boundary, fine enough to enter no space, and capable of granting long life—this is surely the Nine Needles. Ping An: "Fei Sheng Zhi Bei Ye" in *Ling Shu* is written as "Fei Sheng Zhi Ju". "Tian Di Zhi Zhen Sai Ye" in *Ling Shu* lacks the character "Sai". Note on Five Weapons: In *Zhou Li · Xia Guan*, the Officer of Weapons manages the Five Weapons. Zheng Sinong states: "The Five Weapons are Ge, Shu, Ji, Qiu Mao, and Yi Mao." Additionally, the infantry's five weapons include Bow and Arrow but lack Yi Mao. This differs slightly from the current text.)
Huang Di said: When disease arises, there may be unpredictable anger or joy, irregular diet, deficiency of Yin Qi (Vital Energy associated with cooling/moistening functions), excess of Yang Qi (Vital Energy associated with warming/activating functions), and stagnation of Ying Qi (Nutritive Qi circulating in the vessels). Consequently, Ju (deep abscesses) and Yong (superficial sores) develop. (There are four causes for the development of Yong. 'Ce' means measure. Unregulated anger and joy cause competitive Qi to gather, leading to Yong—this is the first cause. Irregular diet, indulgence without regard for cold or warmth, leads to Yong—this is the second cause. Deficiency of Yin Qi in the Zang organs and excess of Yang Qi in the Fu organs, with flourishing Yang Qi, leads to Yong—this is the third cause. Pathogenic factors lodging in the Blood, accumulating and failing to circulate, lead to Yong—this is the fourth cause. Yong and Ju are essentially the same; if Yong persists and destroys bone, it is called Ju. Ping An: In *Ling Shu* and *Jia Yi Jing*, "Bing Sheng Zhi Shi" is written as "Sheng Bing Zhi Shi".)
When Yin and Yang Qi do not flow freely, and two heats clash, pus is formed. Can the small needle extract it? (This section explains the origin of pus formation. Pathogenic factors lodge in the skin; disharmony between Cold and Warmth causes internal and external heats to strike each other, rotting flesh into pus. One might fear the small needle cannot extract it. Ping An: In *Ling Shu*, there is no "Qi" after "Bu Tong". In *Jia Yi Jing*, "Liang Re" is written as "Er Re".)
Qi Bo said: Even the Sage cannot resolve a condition that has already transformed [into pus], because pathogenic factors cannot remain stagnant. Therefore, when two armies face each other, banners visible, and white blades arrayed in the open field, this was not planned in a single day. To enable a person to obey orders and prohibit actions, ensuring soldiers suffer no blade-related disasters, is not a task accomplished in a day; it requires prolonged effort. (Ping An: In *Ling Shu*, "Xie" is written as "Zhi Xie"; "Xu Jiu Zhi Fang De Ye" is written as "Xu Yu Zhi De Ye". From "Sheng Ren Bu Neng Shi Hua Zhe" to "Xu Jiu Zhi Fang De Ye", this passage is absent in *Jia Yi Jing*.)
To allow the body to suffer from Ju/Yong diseases and the accumulation of pus and blood—is this not far from the Great Dao? The birth of Ju/Yong, the formation of pus and blood, does not fall from the sky nor emerge from the earth; it arises from the accumulation of the minute. Therefore, the Sage’s governance addresses conditions before they take shape, while fools encounter them only after they have fully formed. (‘Zhi’ is pronounced Changzhi fan, meaning a banner. The Sage cannot let the body transform into disease because the Sage governs before chaos arises, preventing pathogenic factors from lingering. Thus, likened to white blades arrayed in the field, planning takes time, soldiers face no disaster due to long-term training, and Ju/Yong do not arise. Harmonizing the interior takes many days; thus, suffering from Ju/Yong indicates being far from the Dao of Harmony. Accumulated stones form mountains, accumulated water forms rivers, accumulated crimes bring disaster, accumulated Qi forms abscesses. These do not come from heaven or earth but result from failing to eliminate fragility and minuteness. The Sage acts differently: governing the state before chaos arises, regulating the body before disease manifests, unlike fools who dig wells only when thirsty or forge weapons only when fighting. Ping An: *Jia Yi Jing* lacks the eight characters "Bu Cong Tian Xia Bu Cong Di Chu"; "Ji Wei" is written as "Ji Ju". "Gu Sheng Ren Zhi Zhi Zi Yu Wei You Xing Ye" in *Ling Shu* is written as "Gu Sheng Ren Zi Zhi Yu Wei You Xing Ye", and in *Jia Yi Jing* as "Zi Zhi Yu Wei Xing". Note on White Blades: Yuan edition writes "Ren" as "Ren". "Sheng Ren Bu Er": "Er" is a typo for "Yi". "Dou Fang Zhu Bing": "Fang" is written as "Er".)
Huang Di said: If the condition has taken shape but is not encountered, and pus has formed but is not seen, what should be done? ('Zao' means encounter. 'Zi' refers to the common people, whom the Emperor treats as children. Not encountering means that when the abscess has taken shape, the people cannot perceive it; when pus has formed, they cannot see it. What then should be done? Ping An: "Qi Yi You Xing Bu Zi Zao, Nong Yi Cheng Bu Zi Jian" in *Ling Shu* is written as "Qi Yi Xing Bu Yu Zao, Nong Yi Cheng Bu Yu Jian", and in *Jia Yi Jing* as "Qi Yi You Xing, Nong Yi Cheng".)
Qi Bo said: Once pus has formed, ten out of ten cases die, with only one surviving. (Yong arising at joints, back, or within the abdomen becomes incurable once pus forms, hence ten deaths to one survival. Ping An: "Yi" in *Ling Shu* and *Jia Yi Jing* is written as "Yi".) Therefore, the Sage establishes effective prescriptions to prevent the condition from reaching the stage of pus formation. (Thus, the Sage clearly establishes effective prescriptions to treat Yong when it is still minute, preventing it from forming pus. Ping An: "Bu Shi Yi Cheng" in *Ling Shu* is written as "Fu Shi Yi Cheng".) These are inscribed on bamboo slips and silk, enabling those with ability to follow them and transmit them to future generations without end, for the sake of those who do not encounter [early treatment]. (Inscribing on bamboo and silk is because the common people cannot perceive or recognize early-stage Ju/Yong. Ping An: "Zhong Zhi" in *Ling Shu* is written as "Zhong Er"; "Zi" is written as "Yu". From "Gu Sheng Ren Bu Shi" to "Zao Zi Ye", this passage is absent in *Jia Yi Jing*.)
Huang Di said: If pus and blood have already formed and then are encountered by the people, can they be treated with the small needle? (Yong arising at the back, joints, or within the abdomen: once pus and blood have formed and are recognized by the people, can the small needle cure it? Ping An: "Qi Yi You Nong Xue" in *Ling Shu* has "Yi" written as "Yi"; in *Jia Yi Jing* as "Yi Cheng". "Er Hou Zao Zi" in *Ling Shu* is written as "Er Hou Zao Hu"; *Jia Yi Jing* omits these four characters. "Ke Zao" in *Ling Shu* is written as "Bu Dao Zhi"; *Jia Yi Jing* omits "Zao".)
Qi Bo said: Using small methods to treat small conditions yields small results; using large methods to treat large conditions causes much harm. Therefore, for those with formed pus, only Bian Shi (stone lancets) and Pi Feng (lancet knives) should be used to drain it. (Treating small Yong with small needles is difficult to heal, hence "small results". Treating large pus with large needles causes extensive damage, hence "much harm". Thus, once pus forms, only Bian Shi is needed. Ping An: "Yi Da Zhi Da Duo Hai" in *Jia Yi Jing* is written as "Yi Da Zhi Da Zhe Qi Gong Da, Yi Xiao Zhi Da Zhe Duo Hai Da". "Yi Cheng Nong Zhe" in *Ling Shu* and *Jia Yi Jing* is written as "Yi Cheng Nong Xue Zhe". "Bian Shi" in *Ling Shu* and *Jia Yi Jing* is written as "Bian Shi". In *Ling Shu* and *Jia Yi Jing*, the character for lance is written as "Pi". Note on difficult healing: Yuan edition writes "Nan Yu".)
Huang Di said: If there is much harm, can preservation still be achieved? (Much harm refers to the injury caused by Bian Shi, which can even lead to death.)
Qi Bo said: It depends on whether the case is Ni (Rebellious/Ominous) or Shun (Smooth/Favorable). (Ni cases involve much harm leading to death; Shun cases allow pus drainage and survival.)
Huang Di said: I wish to hear about Ni and Shun. Qi Bo said: If the patient presents with white sclera showing blue/black discoloration and small palpebral fissures, this is the First Ni; vomiting after taking medicine is the Second Ni; abdominal pain with extreme thirst is the Third Ni; inability to move the shoulders and neck is the Fourth Ni; hoarseness and loss of complexion are the Fifth Ni. Apart from these, the case is Shun. (If the Five Injuries [symptoms] appear first, followed by drainage, it is Ni. If the Five Injuries are absent initially, and drainage occurs after pus formation, it is Shun. 'Si' is pronounced Xianqi fan, meaning broken voice. Ping An: "Bai Yan" in *Jia Yi Jing* is written as "Bai Jing". Ou in *Ling Shu* and *Jia Yi Jing* is written as "Ou"; there is an additional character "Wu" after "Chu Ci".)