The wording of this section is very confusing and misleading.
It seems that this would be a very common installation scenario - running a feeder to a separate building, is a main needed at the separate building or not?
Its not clear at all
Generally, yes, a main is needed at the separate building. If you don't want to get into the qualifications and exceptions, that's the simplest way to comply. Provide a main breaker subpanel instead of a main lug subpanel.
You're right it's a common installation scenario. In my experience, the requirement for a main disconnect (or no more than 6, etc. etc.) is also frequently overlooked and not enforced.
That said, I don't agree the code isn't clear. It has a lot of words, sure, but read them carefully and the requirement is quite clear, at least for a typical situation where the outbuilding has one subpanel. It's as you initially said, with Wayne's clarification. "a sub-panel in a detached building cannot have more than 6 circuits without requiring a main breaker [unless it's downstream of another disconnect that's also at the detached building]."