《黃帝內經素問補註釋文》Vol. 19

The nineteenth and final scroll of Supplementary Commentary on the Plain Questions of the Yellow Emperor’s Inner Classic

Treatise on the Eight Directions and the Spirit’s Illumination

The Yellow Emperor asked, “The practice of acupuncture must have rules and standards. What rules should we follow and what standards should we observe?”

“Practice” means to undertake or carry out; “rule” means to take as a model or emulate; “standard” means a measure or guiding principle.

Qibo replied, “Take Heaven as your model, use Earth as your measure, and take account of the light and patterns of the celestial bodies.” That is, align treatment with the movements of the Sun, Moon, and stars.

The Yellow Emperor said, “I would like to hear you explain this in detail.”

Qibo said, “Whenever acupuncture is performed, one must observe the Sun and Moon, the stars, the four seasons, and the Qi of the eight directions. Only after these conditions have been determined may one insert the needles.

“To observe the Sun and Moon means to attend to the changes in cold and warmth brought by the Sun, and to the Moon’s waxing and waning. To observe the stars means first to understand the celestial regions corresponding to each of the twenty-eight lunar lodges, then to use the water clock to determine their positions.

“In broad terms, the Sun’s position in a particular lunar lodge is used to judge whether the body’s Qi has reached the Taiyang channel. Each time the Sun moves through one lodge, the body’s Qi moves to the corresponding locations in the three Yang channels and the Yin division.

“In more detail, the fourteen lodges from Fang to Bi correspond to about fifty ke, or half a day; the fourteen lodges from Mao to Xin also correspond to about fifty ke, or the other half of a full day and night. Thus, the lodges from Fang to Bi belong to Yang, while those from Mao to Xin belong to Yin: Yang governs daytime, and Yin governs nighttime.

“Each time the Sun moves through one lodge, about three and four-sevenths ke pass on the water clock. The Ling Shu Jing says: when one ke has passed, the body’s Qi reaches the Taiyang channel; at two ke, it reaches the Shaoyang channel; at three ke, it reaches the Yangming channel; and at four ke, it reaches the Yin division. As the water clock continues to measure time, the body’s Qi moves accordingly.

“The Ling Shu Jing also says: when the Sun moves through one lodge, the body’s Qi circulates through the whole body once and eight-tenths more; through two lodges, it circulates three times and six-tenths more; through three lodges, five times and four-tenths more; through four lodges, seven times and two-tenths more; and through five lodges, nine times. When the Sun has passed through all twenty-eight lodges, the body’s Qi has circulated through the whole body fifty times and four-tenths more. Therefore, before acupuncture is performed, one must observe the Sun and Moon, the stars…”

“Chen” refers to a time of day. The proper qi of the four seasons and the winds that blow at the eight seasonal nodes are the healthy qi of the four seasons and the winds that arise at each of the eight nodes. These winds blow toward Taiyi, an important divine name or celestial designation in ancient astronomical and Daoist texts. Physicians should carefully observe where these qi are located and wait for the climate to stabilize before needling. “Needle only when the qi has settled” means that the channels should be needled to regulate deficiency and excess only after the winds of the eight nodes have subsided and become steady. Accordingly, calendar taboos say that needling and moxibustion should be avoided for five days before and after each of the eight seasonal nodes, because the climate has not yet stabilized and treatment is unsuitable. The “Newly Corrected Edition” notes that the account of the winds of the eight nodes blowing toward Taiyi is discussed in detail in the Tianyuan Yuce.

When the weather is warm and the sunlight bright, blood flows freely through the body, and defensive qi (the qi that circulates to protect the body) moves along the surface. Blood is therefore readily released, and qi circulates easily. When the weather is cold and overcast, blood congeals and flows poorly, while defensive qi sinks and lies hidden within. “Qi” here describes congealing and obstruction, like ice and snow forming in water. “Nao,” pronounced “nu-jiao,” means soft, loose, and flowing.

When the moon begins to wax at the start of the month, qi and blood begin to grow full, and defensive qi starts to circulate. At the full moon, qi and blood are abundant and the muscles firm. As the moon wanes, the muscles diminish, the channels become empty, defensive qi withdraws from the body’s surface, and a person becomes weak and exposed. One should therefore regulate qi and blood in accordance with the seasons: do not needle in cold weather, when blood congeals and defensive qi sinks within; in warm weather, blood flows and qi circulates easily. Do not drain at the beginning of the month, tonify at the full moon, or treat during the waning moon. This is treatment in accord with the right time.

Follow the changes of the seasons and discern when qi and blood wax and wane. Observe the movement of the sun, stand upright and wait, and note the direction in which the qi is located. Face south and wait for the qi to arrive, then treat accordingly.

Thus, draining just as the moon begins to wax further weakens the qi and blood stored within. “The stores are empty” means that qi and blood are weak. The “Newly Corrected Edition” points out that in the Quan Yuanqi edition, the character for “stores” is written as “diminish”; that reading should be adopted here.

Tonifying at the full moon makes qi and blood excessive and leaves stagnant blood lodged in the collaterals. This is called “double excess.” The word “collaterals” here may be a corruption of “channels.” In some editions, “remain” is written as “flow,” but “flow” is not the intended meaning here.

Treating during the waning moon disrupts the channels and throws Yin-Yang into disorder, making it difficult to distinguish true qi from pathogenic qi. Stagnant qi remains lodged and does not depart; weakness on the outside and disorder within give pathogenic qi an opportunity to arise. In other words, when the circulation of qi loses its regular pattern, pathogenic qi develops.

The Yellow Emperor asked, “What can be observed through the stars and the qi of the eight directions?” Qibo replied, “The stars are used to grasp the regular patterns of the sun and moon. By observing the stars, one can understand the order governing the sun and moon’s movements.”

Broadly speaking, when a person’s Qi completes one circuit of the heavens—circling once along the celestial course—it corresponds to the Twenty-Eight Lunar Mansions, the twenty-eight groups of stars by which the ancients divided the sky. This circuit is divided into thirty-six parts. When Qi circulates through the whole body, it travels a total of sixteen zhang and two chi.

This corresponds both to the Twenty-Eight Lunar Mansions and to the water clock. In the time it takes the water clock to mark one hundred ke, Qi travels eight hundred and ten zhang through the body, a span used to divide day and night. Thus, with every ten breaths, Qi travels six chi and the sun advances two fen. After two hundred and seventy breaths, Qi has traveled sixteen zhang and two chi, completing one circuit of the whole body. By then, two ke have passed on the water clock, and the sun has advanced twenty fen. After five hundred and forty breaths, Qi has completed two circuits of the body; four ke have passed, and the sun has advanced forty fen. After two thousand seven hundred breaths, Qi has completed ten circuits; twenty ke have passed, and the sun has advanced five lunar mansions and twenty fen. After thirteen thousand five hundred breaths, Qi has completed fifty circuits; one hundred ke have passed, and the sun has advanced through all twenty-eight lunar mansions.

A more precise calculation adds one fen for every ten circuits, plus another six tenths of a fen. Only then are the fractional amounts fully accounted for. The degrees of the stars’ movement can therefore be used to measure the courses of the sun and moon.

The New Editorial Commentary says: The passage from “one circuit of the heavens and the Twenty-Eight Lunar Mansions” to “the sun advances through the Twenty-Eight Lunar Mansions” originally appears in the Ling Shu Jing and is also included in the Jia Yi Jing.

The Eight Correct Times are used to observe whether the harmful influences carried by the Eight Winds arrive at their appointed times. The Eight Correct Times refer to the proper Qi of the eight seasonal nodes. The Eight Winds are the Wind of the Infant in the east, the Great Weak Wind in the south, the Strong Wind in the west, the Great Strong Wind in the north, the Fierce Wind in the northeast, the Weak Wind in the southeast, the Scheming Wind in the southwest, and the Breaking Wind in the northwest. “Empty and harmful influences” are pathogenic forces that enter and cause illness when the body is weakened. “Arrive at their appointed times” means that as the celestial Taiyi—the ruling force in ancient conceptions of the star deity or celestial movements—shifts position at the eight seasonal nodes, the winds also come toward the central palace from their respective directions around those times.

The New Editorial Commentary says: The meaning of “Taiyi shifts position, and the winds approach the central palace” is explained in the Tianyuan Yuce.

The four seasons distinguish where the Qi of spring, summer, autumn, and winter resides, so that one may nourish the body in accordance with the season. One should avoid the empty and harmful influences that appear at the Eight Correct Times and not expose oneself to them.

The statement about where the Qi of the four seasons resides means that in spring it is in the meridians, in summer in the finer collateral vessels, in autumn in the skin, and in winter in the bones and marrow. Coming into contact with or being struck by empty and harmful influences damages the body’s true Qi. By avoiding them and not exposing oneself to them, one will not fall ill.

Sages avoid pernicious influences as they would flying arrows and rolling stones, because such influences can injure the true Qi.

When the body’s upright Qi is weak and it encounters the vacuous, pernicious Qi of Heaven and Earth, these two forms of weakness resonate with each other. The pernicious Qi then penetrates deep into the marrow; once inside the body, it can also injure the five zang organs. Weak Qi and vacuous, pernicious Qi meet as like responds to like, so pernicious influences can readily take advantage of weakness and enter.

If a physician can detect them promptly and provide treatment, pernicious influences cannot cause harm. If they are detected and their invasion stopped in time, there will be no injury. This is why one must understand the taboos of Heaven and Earth. The human body is affected by changes in the seasons and the heavens; going against their timing can cause illness. These taboos must therefore be understood.

The Yellow Emperor said, “I have heard about following the principles of the stars. I would like to hear how one takes the ancients as a model.”

Qibo replied, “To take the ancients as a model, one must first understand the Zhen Jing (Classic of Acupuncture). To use it to assess conditions in the present, one must also first understand the changes in warmth and cold during the day, and the waxing and waning of Qi that correspond to the moon’s phases. On this basis, observe the rising and sinking of Qi and treat the body. By observing in this way, one can see the effects of treatment.”

Because observations of the climate and the movement of Qi are accurate, the effects of treatment become evident.

“Observing the subtle” means that the body’s form and Qi, and the Qi of Ying and Wei—which sustains the body’s life activities and protects it against external influences—do not show on the body’s surface, yet the physician can perceive them alone.

An earlier chapter says that a physician should quiet the mind, focus attention, examine the underlying principles, and observe changes in the illness. This is called “observing the subtle”: seeing what has no discernible form. Though the body’s form and Qi, and the Qi of Ying and Wei, do not appear outwardly, the physician can discern their waxing and waning through clear insight of mind and spirit, and distinguish whether the illness is improving or worsening. The New Collation notes that the “earlier chapter” referred to here is “On Preserving Life in Accordance with the Mandate” (Baoming Quanxing Lun). It says that one should consider together the day’s changes in warmth and cold, the waxing and waning of the moon, and the seasonal rising and sinking of Qi, then compare them and use them as a basis for treatment. Physicians can often detect changes in advance, though these changes do not show outwardly; hence the phrase “observing the subtle.”

Why can physicians so often detect an illness before others do? Because they follow the principles and their minds and spirits are clear and perceptive.

Only by understanding the endless changes can one pass the methods on to later generations. This is what sets a physician apart from ordinary people.

When the principles are clear, they can be passed on to later generations. As those generations continue to apply them, the methods can be used without limit. Physicians can perceive changes that ordinary people cannot see, and this is why they differ from others.

Yet changes in an illness do not show outwardly, so ordinary people cannot see them. What distinguishes a physician from a crude practitioner is that the latter cannot see these changes.

They cannot be seen in form or discerned by taste; this is why they are called “subtle,” as though mysterious and unfathomable. The body’s form and Qi, and the Qi of Ying and Wei, do not show outwardly and cannot be seen directly; hence it is said that they have no visible form and no discernible taste. When Qi lies hidden, it is like a crossbow held at the ready; when it surges forth, it is like an arrow released from the bowstring. It is deep and elusive, difficult to perceive.

When people do not understand its fundamental governing principle, they find it like a wondrous, mysterious transformation: vague and hard to grasp.

“Empty evil” refers to the pathogenic Qi brought by the eight seasonal directions—the eight positions associated with the solar terms. As these directions change with the seasons, it enters from a vulnerable part of the body and causes illness. Hence it is called “empty evil from the eight directions.”

“Regular evil” refers to pathogenic Qi entering the body when someone is physically exhausted and sweating from exertion, with the skin’s pores and texture open, and happens to encounter an empty wind. This Qi enters only slightly, so people do not understand its nature or see its traces.

Regular evil does not come from a vulnerable part of the body. Because it enters only slightly, people do not understand its nature or see its traces.

A skilled physician treats illness as soon as pathogenic influence begins to emerge. First, the physician examines the Qi and pulse at the three regions and nine indicators—a method of assessing the pulse at such places as the cun-kou, head, and feet—and treats the patient promptly while the pulses are still harmonious and have not deteriorated. This is why such a physician is called a “superior practitioner.” A less skilled physician waits until the illness has taken shape and worsened before treating it. “Treating what has already formed” means that the physician does not recognize that the pulses at the three regions and nine indicators have become irregular, allowing the illness to progress and the body to suffer harm.

The related principles are explained in detail in the Treatise on the Separation and Convergence of True and False Pathogenic Influences.

“To know where the pathogenic Qi is” means examining the three regions and nine indicators, locating the affected pulse, and treating accordingly. This is why one must keep watch over its gateways. If one does not understand the nature of the pathogenic Qi, one can only see its traces. The three regions and nine indicators are gateways for observing pathogenic Qi; by watching these gateways, one can detect its traces. Because the pathogenic Qi enters the body only slightly, its precise nature remains difficult to understand.

The Yellow Emperor said, “I have heard about tonifying and reducing methods, but I still do not understand what they mean.”

Qibo said, “To apply the reducing method, one must seize the right moment. ‘Timely’ means when the Qi is at its height, the moon is full, the daytime is warm, and the patient is calm in body and mind. Insert the needle as the patient inhales. Then observe the next inhalation and turn the needle; observe the exhalation and slowly withdraw it. Thus, applying the reducing method requires choosing the right moment, so that the pathogenic Qi can move outward and leave the body.”

“Timely” means proper and well-timed. Once the pathogenic Qi has been expelled, the body’s healthy Qi can flow freely.

To apply the tonifying method, one must use the “round” method. “Round” refers to movement, and movement also means transformation. Movement allows Qi that has become blocked to flow freely; transformation brings a pulse that has not yet recovered back to harmony.

The needle must enter the “nutritive” level, where nutritive blood circulates, and then be withdrawn during inhalation to expel the pathogenic Qi. When the needle enters and reaches the blood level, this is called “reaching the nutritive level.”

Thus, “round” and “timely” do not refer to the shape of the needle. Here, “timely” and “round” refer to movement and transformation.

Therefore, those who cultivate the spirit must understand that people’s bodies differ in stoutness and thinness, and that the nutritive and defensive Qi, as well as the blood and Qi, may be abundant or deficient.

Blood and Qi are the foundation on which a person’s mental activity depends, so they must be carefully nurtured. When the spirit is settled, a person can live a long life; when the spirit disperses, the body declines. For this reason, it must be nurtured with care.

The Yellow Emperor said, “How subtle this account is! It brings together the correspondences between the human body and Yin-Yang, the four seasons, and changes between deficiency and excess, while also discerning signs that are hidden and difficult to detect. Who could understand these principles if not you, Master? Yet you have spoken many times of form and spirit. What is meant by spirit, and what is meant by form? I would like to hear you explain them in detail.”

Qibo replied, “Spirit is a person’s capacity for wisdom and understanding; form is the condition of the body that can be observed through examination.

“First, form. Signs of illness in the body may at times be faint and obscure, with the location of the illness impossible to see with the eyes. Yet when one investigates the meridians, the signs seem to appear clearly; when one palpates for them, however, they cannot be located consistently, and it is difficult to predict when they will appear. This is what is meant by form.

“The signs of illness are faint and formless on the surface, so the eyes cannot see them. But they manifest within the body, and so they can be sought by examination along the meridians. The saying that the signs appear clearly yet cannot be felt means that the pathogenic Qi suddenly appears among the Three Regions and Nine Indicators—the method of examining the pulse at places such as the wrist, neck, and instep—at a time that cannot be predicted in advance. The Treatise on the True Meaning of Separation and Union says that pathogenic Qi moves in and out between Yin and Yang and cannot be measured by a fixed standard. One must observe it continually, and as soon as pathogenic influence is encountered among the Three Regions and Nine Indicators, its path must be blocked promptly. That is precisely what this means.”

The Yellow Emperor asked, “What is meant by spirit?”

Qibo replied, “Now, spirit. Its workings are wondrous and difficult to fathom: the ears seem not to hear, yet the eyes grow bright; the mind suddenly opens, and thought understands before words or actions arise. One suddenly grasps the principle alone, but cannot express it in words. When watching together with others, one alone sees something new. At first it seems unclear; then it becomes perfectly clear in the heart, as though wind had swept open the clouds. This kind of capacity is called spirit.

“To say ‘the ears do not hear’ refers to the subtle, profound workings of spirit. To say ‘the eyes grow bright, the mind opens, and thought comes first’ means that the mind is clear and penetrating, as though a book were opened in the darkness, or a clouded veil lifted from before the eyes. Though spirit comes together and finds understanding within the heart, thought has already grasped it a step ahead.

“‘Suddenly understanding alone’ means that the heart is clear and open, yet its understanding cannot be expressed in words. ‘Everyone watches together, but only oneself sees; at first it seems dark’ conveys the wonder of a discovery that comes suddenly: though everyone is looking at the same thing, one alone suddenly sees something new, at first as if still in darkness. Once understanding comes, the heart and eyes become clear and bright, as though wind had swept away the clouds and the sun had appeared in the sky. The workings of spirit are profound and difficult to describe.”

As for the Three Regions and Nine Indicators, they are the basis for examining the body and its signs of illness. The discussion of acupuncture in the Treatise on the Nine Needles need not necessarily be included here.

By taking the “three regions and nine indicators” as the foundation—examining the pulse in the head, hands, and feet, with three pulse positions in each region—and considering the channels and vessels, one can understand the subtle principles of medicine. If all the theories concerning the nine needles were included in the discussion, its scope would become very broad, and the knowledge gained would reach further. Thus, the three regions and nine indicators are the foundation; there is no need to include all the theories of the nine needles here.

Treatise on the Separation and Union of True Qi and Pathogenic Factors

The Yellow Emperor asked: “I have heard that the Nine Needles has nine chapters, and that you have divided each chapter into nine, making a total of eighty-one chapters. I have fully understood their meaning. The text says that Qi waxes and wanes, and that the Qi in the left and right pulses may shift out of balance; one may treat the lower part by regulating the upper, or treat the right side by regulating the left. Excess or deficiency of Qi may be addressed with draining or reinforcing techniques at the Ying-spring and Shu-stream points. I understand that these are cases of deficiency and excess arising when Ying Qi and Wei Qi shift out of place, rather than from pathogenic factors invading the channels from outside. I would like to ask: when pathogenic factors enter the channels, what symptoms appear, and which points should be selected for treatment?”

Qibo replied: “When the sages established laws and measures, they made them correspond to Heaven and Earth. Heaven has its constellations and degrees; Earth has its channels of water; human beings have their channels and vessels.”

Here, “constellations” refers to the twenty-eight lunar lodges, and “degrees” to the 365 divisions of the celestial circuit. “Channels of water” refers to the sea, the Jing, Wei, Hu, Mian, Ru, Yangtze, Huai, Luo, Yellow, Zhang, and Ji rivers. These waterways correspond within the human body to the channels and vessels, and so they are called “channels of water.” “Channels and vessels” refers to the pathways of the three Yin and three Yang channels of the hands and feet. This is said because Heaven and Earth correspond to one another, inwardly and outwardly, and the Qi of the human body is connected with them.

The Newly Collated Edition says that, according to the Classic of Acupuncture and Moxibustion, the channels correspond to the waterways and the organs as follows: the Foot Yangming channel corresponds externally to the sea and internally to the Stomach; the Foot Taiyang channel corresponds to the Jing River and belongs to the Bladder; the Foot Shaoyang channel corresponds to the Wei River and belongs to the Gallbladder; the Foot Taiyin channel corresponds to Lake Hu and belongs to the Spleen; the Foot Jueyin channel corresponds to the Mian River and belongs to the Liver; the Foot Shaoyin channel corresponds to the Ru River and belongs to the Kidneys; the Hand Yangming channel corresponds to the Yangtze River and belongs to the Large Intestine; the Hand Taiyang channel corresponds to the Huai River and belongs to the Small Intestine; the Hand Shaoyang channel corresponds to the Luo River and belongs to the Triple Burner; the Hand Taiyin channel corresponds to the Yellow River and belongs to the Lungs; the Hand Jueyin Heart-Master channel corresponds to the Zhang River and belongs to the Pericardium; and the Hand Shaoyin channel corresponds to the Ji River and belongs to the Heart.

When the climate of heaven and earth is mild, the qi and blood in the channels of the human body are calm and settled. When the sky is cold and the ground frozen, the qi and blood in the channels congeal and flow poorly. When the weather turns scorching, the qi and blood seethe and overflow as if boiling. When a violent wind suddenly rises, the qi and blood surge like waves on the surface of water, swelling and rolling. The great channels of the human body respond in the same way.

Pathogenic qi entering the vessels follows the same principle. In cold, the blood congeals; in heat, the qi and blood grow thin and slack. Deficiency evil (a disease-causing pathogen that invades by taking advantage of the body's weakness) enters at such an opportunity, like a river meeting a great wind. As the pathogenic qi moves through the channels, the pulse rises from moment to moment, and its advance within the vessel is "xunxun ran" (循循然).

A note explains: "xunxun ran" describes following the motion of the pulse. It means that the pathogenic qi moves along with the pulsation of the channels and the coming and going of the breath, though its outward form may differ slightly. In some editions "xunxun" is written as "輴輴," pronounced by the fanqie spelling of the characters 敕 and 倫.

When the pathogenic qi reaches the cunkou (the radial artery at the wrist, where the pulse is taken), the sensation under the fingers is sometimes large and sometimes small. A large pulse means the pathogenic qi has arrived; a small pulse is a sign of harmony. The pathogenic qi has no fixed position as it moves.

The note explains: the "large" spoken of here means markedly larger than the usual pulse. The "small" does not mean thin or fine; it is called small only in comparison with "large," and without a large pulse to compare it to, it is simply the ordinary channel qi. The pathogenic qi follows yin qi into the yin channels and follows yang qi into the yang vessels, so it has no fixed trace.

Whether the pathogenic qi lies in a yin channel or a yang channel cannot be measured by any fixed standard, because it travels with the circulation of the channels.

At this point one should examine carefully through the sanbu jiuhou (the three regions of pulse diagnosis, each divided into upper, middle and lower positions, making nine in all). Once the pathogenic qi is suddenly encountered, its path of retreat should be cut off early.

The note explains: "feng" (逢) means to meet, and "e" (遏) means to cut off. If pathogenic qi is suddenly encountered at any of the nine positions, one should press down to stop it and then immediately drive it out by the draining method. With its path cut off, the great pathogenic qi can no longer cause disorder. The draining method is the one described in the scripture below.

The scripture says: Insert the needle as the patient inhales, taking care not to let the qi turn chaotic. Retain the needle quietly for a long time, so that the pathogenic qi does not spread. Rotate the needle as the patient inhales, with the aim of obtaining qi (deqi, the sensations of soreness, numbness and distension under the needle). Draw the needle out as the patient exhales, and withdraw it completely only when the exhalation is finished. In this way the great pathogenic qi can all be expelled, and so it is called "draining."

The annotator remarks that, according to the essential meaning of the scripture, one should first replenish the genuine qi and only then drain the pathogenic qi. The reasoning is this: in the tonifying method described below, the needle is inserted when the exhalation is exhausted and retained quietly for a long time, whereas in the draining method here, the needle is inserted on the inhalation and likewise retained quietly for a long time. Inhalation follows immediately after exhalation is complete, and when inhalation arrives it no longer coincides with exhalation. Although the timing of insertion differs, the principle of long retention is the same, and it also accords with the meaning of tonifying first and draining afterward, which makes the point clear. The Zhenjing (Classic of Acupuncture, that is, the Lingshu) also discusses the draining method.

The draining method should “meet” the Qi: the practitioner focuses the mind and inserts the needle, then relaxes while withdrawing it. As the needle comes out, the skin is drawn apart, allowing Yang Qi to flow outward. The movement should be quick, so that pathogenic Qi can be expelled. The reinforcing method should “follow” the Qi: the practitioner’s attention is barely there, as if forgotten; the needle seems to move, then hesitate, like a mosquito settling lightly on the skin. It seems to remain, then return. For this reason, the needle must be retained for a long time during reinforcement.

Wang Bing’s commentary explains that reinforcement comes first because when the body’s vital Qi (the body’s upright Qi) is deficient, draining first leaves the meridians unfilled, with nowhere for pathogenic Qi to escape. The vital Qi must therefore be replenished before pathogenic Qi is drained. “Draw” means to guide the needle out, and “leave” means to withdraw it from the acupuncture point. Wait until the patient exhales, then guide the needle to the entrance of the point; withdraw it only as the exhalation is ending. This settles the Qi of the meridians, leaving pathogenic Qi nowhere to linger, so the great pathogenic Qi departs with the needle. “Exhalation” means Qi going out, “inhalation” means Qi coming in, and “turn” means rotating the needle. “Great Qi” refers to a major pathogenic force that disrupts Yin-Yang.

The Yellow Emperor asked: How should deficient vital Qi be reinforced? Qibo replied: First stroke and palpate the acupuncture point with the hand to ease the Qi; then press it with the fingers to spread the Qi in the meridian. Push and press the skin to gather it together, flick the point to fill the pulse Qi, and press with the fingernail to mark the precise place for insertion. Then insert the needle and obtain Qi according to the usual method. During needling, first draw the skin outside the point outward, thereby “sealing in the spirit.” The commentary explains that after needling, the skin is released and covers the needle hole. The entrance to the point remains closed, allowing Shen (spirit) and Qi to stay within the body; this is why the method is called “sealing in the spirit.” The “Treatise on Regulating the Meridians” likewise says, “Draw the skin outward to align it with the entrance,” and “Push the entrance closed so that Shen and Qi remain within,” which accords with this explanation. The New Corrected Text notes that the passage Wang Bing quotes is not from this chapter but appears in the “Methods of Needling” chapter of the Jia Yi Jing; only the text beginning with “It also says” comes from this chapter.

Finally, it says to insert the needle as the patient’s exhalation is ending, then leave it undisturbed for a long time, using the arrival of Qi as the guide. Inserting at the end of an exhalation is the same as the procedure used during inhalation. The point is that the needle should be withdrawn only when Qi has been obtained; it should not be withdrawn hastily based only on the number of breaths. This explanation comes from the Zhen Jing.

This passage discusses how to determine the timing of "Qi arrival" (Qi Zhi) and apply supplementation or drainage techniques during acupuncture treatment.

When performing acupuncture, if Qi hasn't arrived after needle insertion, continue manipulating the needle without strict adherence to counting techniques. Once Qi arrives, withdraw the needle immediately without repeated insertions. The key is to determine needle retention time based on actual Qi response rather than mechanically counting breaths. One should await Qi with focused attention, like waiting for an honored guest, regardless of the time of day.

When Qi mechanisms have achieved harmony, carefully maintain this balanced state to prevent symptom recurrence. As the Classic of Acupuncture states: "When channel Qi has arrived, guard it carefully without loss." The specific preservation methods are as follows: while awaiting Qi, gently manipulate the needle to prevent channel Qi from dissipating, keeping the needle in the acupoint while pressing the insertion point to retain Shen (spirit) internally and maintain the flow of major Qi (referring to the nutritive and defensive Qi circulating in the channels) - these constitute the essentials of supplementation techniques. When the external gate (needle hole) closes, Shen can be preserved; by gently manipulating the needle to prevent major Qi from leaking, the principle of supplementation becomes clear.

The Yellow Emperor asked how to detect channel Qi. Qibo replied: When pathogenic Qi enters channels from the collaterals and lingers in the blood vessels, its cold or warm nature remains unstable, coming and going like waves. Thus it continuously moves along the sixteen zhang and two chi (ancient measurement) circulatory pathway of the channels without settling in one place. Therefore, when pathogenic Qi first arrives, press the acupoint to intercept it and apply timely needling treatment, but avoid drainage techniques when channel Qi is at its peak (the "chong" refers to the cyclical waxing and waning of channel Qi corresponding to temporal rhythms - the Ling Shu Jing records how Qi and blood flow through different channels every quarter-hour).

(Note: The "water clock divisions" mentioned refer to ancient timekeeping dividing a day into 100 ke, here indicating the pattern of Qi-blood circulation through the Taiyang, Shaoyang and other channels at different times.)

When the Yin qi reaches the Taiyang channel, the qi of the Taiyang channel becomes exuberant on its own; when it reaches the Shaoyang channel, the qi of the Shaoyang channel becomes exuberant on its own. If one sees a channel’s qi exuberant and assumes that pathogenic qi has invaded, then immediately uses acupuncture to drain it, one will instead injure the body’s true qi. That is why the passage below says: “True qi is the qi of the channels. The channel qi is already very weak, so when pathogenic qi first arrives, one must not meet it with draining needling.” This is what it means.

Channel qi moves according to its proper timing, yet is mistaken for pathogenic qi: this is a failure of medical skill. To apply a draining method as a result is a serious error in treatment. That is why it says: “When pathogenic qi first arrives, one must not meet it with draining needling.”

If one does not carefully discern the comings and goings of pathogenic qi, and applies a draining method only after it has passed, true qi will be depleted and escape. Before true qi has recovered from this depletion, pathogenic qi arrives again, and the illness worsens and accumulates. The physician fails to recognize the pathogenic qi and instead mistakenly injures the innocent true qi, causing it to leak away. When pathogenic qi invades again, the channel qi becomes even weaker, and the illness accumulates and grows more severe. That is why it says: “Once pathogenic qi has departed, do not pursue it.” This is what it means. Pathogenic qi has already moved along the channels and departed; it cannot be caught up with or forcibly summoned back. When pathogenic qi arrives, it is so faint that it is scarcely perceptible, yet the physician should wait for the moment when it truly arrives before needling to drain it.

Pathogenic qi arrives so faintly that one must still be alert to detect it. How much more so when it comes surging like waves: how could one fail to discern when it arrives?

If needling is performed too early or too late, and Qi and blood have already been depleted, the illness can no longer be treated by attacking and draining pathogenic qi. This means that one must not force treatment when the proper moment has not come, or continue to treat after the moment has passed. The New Collation says that, according to Quan Yuanqi’s edition, the character “depleted” in “Qi and blood are depleted” should be “weak”; “depleted” is a copying error.

Thus, knowing when treatment is appropriate is like releasing a crossbow trigger at precisely the right moment. Not knowing when to treat is like striking with a wooden mallet: however much one strikes, it will not set things in motion. Those who understand the timing of acupuncture can grasp subtle signs and apply the needle as soon as the moment arrives. Those who do not understand it may strike again and again, yet still fail to treat appropriately. This is the principle being described. “Trigger” refers to the subtle signs that appear before something is set in motion; the key is being able to perceive these minute changes.

The Yellow Emperor asked, “How should tonification and draining be applied?” Qibo replied, “They are used to drive out pathogenic qi. Withdraw the needle quickly, allowing excessive blood to flow out so that true qi can recover. Needle to draw blood only where you see blood stasis.”

This is because when pathogenic qi has only just invaded, it has not yet settled in any one place and moves about like flowing water. After needling, if one pushes the needle, the pathogenic qi will move forward with it; if one draws the needle, the pathogenic qi will remain behind. If one does not pierce to release the excessive blood and instead warms the area, the pathogenic qi will grow stronger within the body, increasing the harm. That is why the passage below says: “Pierce it to release its blood, and the illness will immediately improve.”

The Yellow Emperor said, “Good. Then when true qi and pathogenic qi come together, it is like waves…”

When the pulse signs are not apparent, how should one examine the patient? Qibo replied: Carefully examine the three regions and nine indicators—that is, assess the pulse at different parts and levels of the body—to determine whether the pulse Qi is abundant or deficient, then treat accordingly. If the pulse Qi is excessive, use reducing methods; if it is deficient, use tonifying methods. If it is neither excessive nor deficient, choose the appropriate treatment according to the condition of the meridian itself.

Observe whether the pulses on the left and right, above and below, are out of balance or weakened. Then carefully determine which organ or bowel is affected, and use this to judge the condition and the right moment for needling. If pathogenic Qi is in the Yin aspect, locate it there and needle; if it is in the Yang aspect, locate it there and needle. This is called seizing the right moment. The Lingshu Jing says that, as a water clock measures time, after one quarter of an hour the body’s Qi reaches the Taiyang meridian; after four quarters, it reaches the Yin aspect. As time passes, Qi moves with it, circulating again and again. Therefore, determine which organ or bowel is affected, and needle when the Qi reaches the corresponding region.

If you do not understand the three regions and nine indicators, you cannot distinguish Yin from Yang or Heaven from Earth, nor correctly discern the pulse signs associated with Earth, Heaven, and humanity. The three regions must be determined in conjunction with the condition of the body’s internal organs. Thus, if one does not understand the three regions and nine indicators or where the diseased pulse lies, one cannot restrain the pathogenic influence, even when it is excessive. Here, “restrain” means to stop it; if one cannot even locate the pathogenic influence, how could one stop it?

To treat a condition without fault as though it were an illness is called “great delusion.” It disrupts the major meridians and leads to improper treatment: mistaking an excess condition for deficiency, or pathogenic Qi for true Qi, leaves no sound basis for needling and instead depletes the body’s vital Qi. Mistaking a favorable condition for an unfavorable one further disrupts the nutritive and defensive Qi—the Qi and blood circulating within and outside the vessels—so that true Qi is damaged and pathogenic Qi remains lodged in the body, endangering the person’s life. This happens because one does not understand the three regions and nine indicators, and so cannot maintain health over time.

Imprecise diagnosis and unclear understanding disrupt the major meridians and deplete Qi and blood. Such conduct causes harm; how could health last? If one also fails to understand the seasonal changes and sequence of movement of the Qi of the Four Seasons and Five Phases, and instead treats by mistakenly relying on the relationships of mutual overcoming, driving out pathogenic Qi may injure the body’s vital Qi and endanger life. This shows that ignorance of the Four Seasons and Five Phases can likewise be fatal.

When pathogenic Qi first enters, it has not yet settled in any one place. Push it, and it moves onward; draw it in, and it comes to rest. If one needles at this stage to disperse the pathogenic influence, the illness often improves at once. The scripture states this point again to emphasize that the treatment works in this way.