灵枢经·小针解 Explanation of the Fine Needle
所谓易陈者，易言也。难入者，难著于人也。粗守形者，守刺法也。上守神者，守人之血气有馀不足可补写也。神客者，正邪共会也。神者，正气也，客者邪气也。在门者，邪循正气之所出入也。未睹其疾者，先知邪正何经之疾也。恶知其原者，先知何经之病所取之处也。
刺之微在数迟者，徐疾之意也。粗守关者，守四肢而不知血气正邪之往来也。上守机者，知守气也。机之动不离其空中者，知气之虚实，用针之徐疾也。空中之机，清净以微者，针以得气，密意守气勿失也。其来不可逢者，气盛不可补也。其往不可追者，气虚不可写也。不可挂以发者，言气易失也。扣之不发者，言不知补写之意也。血气已尽而气不下也。
知其往来者，知气之逆顺盛虚也。要与之期者，知气之可取之时也。粗之暗者，冥冥不知气之微密也。妙哉！工独有之者，尽知针意也。往者为逆者，言气之虚而小，小者逆也。来者为顺者，言形气之平，平者顺也。明知逆顺正行无间者，言知所取之处也。迎而夺之者，写也；追而济之者，补也。
所谓虚则实之者，气口虚而当补之也。满则泄之者，气口盛而当写之也。宛陈则除之者，去血脉也。邪胜则虚之者，言诸经有盛者，皆写其邪也。徐而疾则实者，言徐内而疾出也。疾而徐则虚者，言疾内而徐出也。言实与虚若有若无者，言实者有气，虚者无气也。察后与先若亡若存者，言气之虚实，补写之先后也，察其气之已下与常存也。为虚为实，若得若失者，言补者佖然若有得也，写则恍然若有失也。
夫气之在脉也，邪气在上者，言邪气之中人也高，故邪气在上也。浊气在中者，言水谷皆入于胃，其精气上注于肺，浊溜于肠胃，言寒温不适，饮食不节，而病生于肠胃，故命曰浊气在中也。清气在下者，言清湿地气之中人也，必从足始，故曰清气在下也。针陷脉，则邪气出者取之上，针中脉则浊气出者，取之阳明合也。针太深则邪气反沉者，言浅浮之病，不欲深刺也。深则邪气从之入，故曰反沉也。皮肉筋脉各有所处者，言经络各有所主也。取五脉者死，言病在中气不足，但用针尽大写其诸阴之脉也。取三阳之脉者，唯言尽写三阳之气，令病人恇然不复也。夺阴者死，言取尺之五里五往者也。夺阳者狂，正言也。
睹其色，察其目，知其散复，一其形，听其动静者，言上工知相五色于目。有知调尺寸小大缓急滑涩以言所病也。知其邪正者，知论虚邪与正邪之风也。右主推之，左持而御之者，言持针而出入也。气至而去之者，言补写气调而去之也。调气在于终始一者，持心也。节之交三百六十五会者，络脉之渗灌诸节者也。
所谓五藏之气，已绝于内者，脉口气内绝不至，反取其外之病处，与阳经之合，有留针以致阳气，阳气至则内重竭，重竭则死矣。其死也，无气以动，故静。所谓五藏之气，已绝于外者，脉口气外绝不至，反取其四末之输，有留针以致其阴气，阴气至则阳气反入，入则逆，逆则死矣。其死也，阴气有馀，故躁。
所以察其目者，五藏使五色循明。循明则声章。声章者，则言声与平生异也。
What is meant by "easy to state" is that it is easy to put into words. What is meant by "difficult to enter" is that it is difficult to make it take hold in a person. "The unskilled practitioner guards the form" means that he adheres only to the technique of puncturing. "The superior practitioner guards the spirit" means that he attends to whether a person's blood and qi are in excess or deficient, so that he may know when to supplement or drain. "Spirit and guest meeting together" means that the true qi and the evil qi converge together. "Spirit" refers to the true qi; "guest" refers to the evil qi. "At the gate" means that the evil qi follows the very pathway by which the true qi goes out and comes in. "Not yet having seen the illness" means that one must first know in which channel the evil qi or the true qi has caused the illness. "How could one know its origin" means that one must first know in which channel the disease lies, in order to know where to select the point of treatment.
The subtlety of needling lying in speed and slowness means the intention of moving the needle swiftly or slowly. "The unskilled practitioner guards the joints" means that he attends only to the four limbs, without knowing the coming and going of blood and qi, of true qi and evil qi. "The superior practitioner guards the pivot" means that he knows how to hold and attend to the qi. "The movement of the pivot never departs from the point's aperture" means that he knows the deficiency and excess of the qi, and applies the needle swiftly or slowly accordingly. "The pivot within the aperture is pure, tranquil, and subtle" means that once the needle has obtained the qi, one must attend closely and hold the qi without letting it be lost. "What is coming cannot be met head-on" means that when the qi is exuberant, one must not supplement it. "What is departing cannot be pursued" means that when the qi is deficient, one must not drain it. "It cannot be suspended by a single hair" means that the qi is easily lost. "Tapping and yet it does not respond" means that the practitioner does not understand the proper intent of supplementing and draining — the blood and qi are already exhausted, and the qi will not descend.
"Knowing its coming and going" means knowing whether the qi is moving contrary to or in accord with its course, and whether it is exuberant or deficient. "One must engage it at the proper moment" means knowing the precise moment when the qi may be seized. "The unskilled practitioner is in the dark" means he is benighted and does not perceive the subtlety and secrecy of the qi. How marvelous — that the skilled practitioner alone possesses this, for he fully understands the intent of the needle. "What is departing is contrary" means that when the qi is deficient and diminished, this diminishment is contrary to its proper course. "What is coming is accordant" means that when the form and qi are level and balanced, this levelness is in accord with its proper course. "Clearly knowing the contrary and the accordant, and applying the needle correctly without error" means knowing precisely where to select the point of treatment. "To meet the qi head-on and seize it" is to drain; "to pursue the qi and reinforce it" is to supplement.
What is meant by "when deficient, replenish it" is that when the qi opening (the radial pulse) is deficient, one ought to supplement it. "When full, drain it" means that when the qi opening is exuberant, one ought to drain it. "When there is stagnant old blood, remove it" means clearing away the stagnant blood in the vessels. "When evil qi prevails, deplete it" means that in any channel where there is exuberance, one must drain out the evil qi. "Insert slowly and withdraw swiftly, and this brings about replenishment" means inserting the needle slowly and withdrawing it swiftly. "Insert swiftly and withdraw slowly, and this brings about depletion" means inserting the needle swiftly and withdrawing it slowly. Speaking of excess and deficiency as "as if present, as if absent" means that in excess there is qi present, while in deficiency there is no qi. "Examining what comes after and what came before, as if lost, as if preserved" means observing the deficiency and excess of the qi, and the proper sequence of supplementing and draining, examining whether the qi has already descended or still remains constant. "Being deficient, being excess, as if gained, as if lost" means that in supplementing, one feels a sense of fullness as though something had been gained, while in draining, one feels a vague sense as though something had been lost.
Now, as for the qi within the vessels: "evil qi lies in the upper part" means that when evil qi strikes a person, it strikes high, and so evil qi is said to lie in the upper part. "Turbid qi lies in the middle" means that water and grain both enter the stomach, and their essential qi rises to be poured into the lung, while the turbid portion flows into the intestines and stomach; it means that when one fails to adapt to cold and warmth, and is intemperate in eating and drinking, disease arises in the intestines and stomach — hence this is called turbid qi lying in the middle. "Clear qi lies in the lower part" means that when the clear, damp qi of the earth strikes a person, it must begin from the feet — hence it is said that clear qi lies in the lower part. "Needling the collapsed vessel so that evil qi is expelled" means selecting points in the upper part of the body. "Needling the central vessel so that turbid qi is expelled" means selecting the He-Sea point of the Yangming. "If the needle is inserted too deeply, the evil qi is instead driven deeper" means that in illnesses that are shallow and superficial, one should not needle deeply, for if one needles deeply, the evil qi will follow the needle inward — hence it is said the evil qi is instead driven deeper. "The skin, flesh, sinews, and vessels each have their own location" means that the channels and network vessels each govern their own particular region. "Selecting the five yin vessels causes death" means that when the disease lies within and the central qi is insufficient, if one nonetheless uses the needle to drain heavily all the yin vessels, the patient will die. "Selecting the three yang vessels" means draining entirely the qi of the three yang, causing the patient to become enfeebled and unable to recover. "Robbing the yin causes death" refers to needling the Wuli point of the forearm repeatedly, five times in succession. "Robbing the yang causes madness" is stated exactly as it is.
"Observing the complexion, examining the eyes, knowing whether the spirit is scattered or restored, unifying the physical form, and listening to the patient's movement and stillness" means that the superior practitioner knows how to read the five colors in the eyes. There is also the knowledge of adjusting the chi and cun pulse positions — their smallness and largeness, slowness and rapidity, smoothness and roughness — in order to determine the nature of the disease. "Knowing the evil and the true" means understanding the distinction between the vacuous evil wind and the true evil wind. "The right hand governs the thrusting, the left hand holds and controls it" means holding the needle as it is inserted and withdrawn. "When the qi arrives, withdraw the needle" means that once supplementing or draining has regulated the qi, one withdraws the needle. "Regulating the qi lies in making the beginning and the end as one" means holding the mind steady throughout. "The three hundred and sixty-five meeting places at the joints" refers to the places where the network vessels seep into and irrigate all the joints.
What is meant by "the qi of the five viscera already cut off within" is that the qi at the vessel opening is cut off internally and does not arrive; if, contrary to proper practice, one instead selects the diseased site on the exterior and the He-Sea points of the yang channels, retaining the needle so as to summon the yang qi, then when the yang qi arrives, the interior becomes doubly exhausted, and this double exhaustion brings death. In such death, there is no qi to stir movement, and so the body remains still. What is meant by "the qi of the five viscera already cut off without" is that the qi at the vessel opening is cut off externally and does not arrive; if, contrary to proper practice, one instead selects the transport points at the four extremities, retaining the needle so as to summon the yin qi, then when the yin qi arrives, the yang qi is instead driven inward; once driven inward it becomes rebellious, and this rebellion brings death. In such death, the yin qi is in excess, and so the body is restless.
The reason for examining the eyes is that the five viscera cause the five colors to follow their proper brightness. When they follow their proper brightness, the voice becomes distinct. When the voice is distinct, this means the voice differs from what it was in ordinary health.