《黃帝內經素問補註釋文》Vol. 36

The Yellow Emperor asked, “I have heard that the method of needling is to drain what is excessive and supplement what is deficient. What do ‘excess’ and ‘deficiency’ mean here?”

Qibo replied, “There are five kinds of excess and five kinds of deficiency. Which would you like to ask about?”

The Yellow Emperor said, “I would like to know about all of them.”

Qibo said, “Shen (spirit), Qi (vital energy), blood, the body, and the will can each be excessive or deficient, making ten conditions in all. They function and manifest in different ways.”

[Commentary] Here, “Shen” refers to the mental activity stored by the heart; “Qi” refers to the Qi governed by the lungs; “blood” refers to the blood stored by the liver; “the body” refers to the physical form governed by the spleen; and “the will” refers to the will stored by the kidneys. Each belongs to a different organ, so these conditions are not all alike.

The Yellow Emperor asked, “People have Jing (essence), Qi, fluids, and humors; the four limbs, nine orifices, five viscera, sixteen divisions, and 365 joints. As a result, they develop many kinds of illness. Every illness involves deficiency or excess. You now say there are five kinds of excess and five kinds of deficiency. How do these conditions arise?”

[Commentary] The “nine orifices” are the two eyes, two ears, two nostrils, mouth, and the front and rear orifices. “Fluids and humors” are the body’s fluids in their different forms. The “sixteen divisions” and “365 joints” in the classic have specific meanings within the theory of the channels and vessels; they should not be understood simply as anatomical parts or joints in the modern sense.

The Needle Classic says, “The two spirits of Yin and Yang interact and combine to form the body. Jing is often present before the body takes shape; this is Jing. The Upper Burner, the body’s upper region of Qi transformation, distributes the flavors of the five grains, warming and moistening the skin, filling out the body, and nourishing the hair, like mist and dew watering all things. This is Qi. The interstices between skin and muscle open and close, allowing sweat to emerge; this is Jin (thin fluids). When the fluids seep into the orifices and remain there without flowing, they are called Ye (thick humors).”

[Commentary] The “Upper Burner” is a traditional Chinese medicine division of the body’s Qi transformation functions, not the name of a particular organ.

The classic also says, “The sixteen divisions are sixteen categories formed by the nine orifices of the hands and feet together with the five viscera. The 365 joints do not mean the joints of the bones; they are places where Shen and Qi enter and leave. The Needle Classic says that ‘the meeting points of the joints’ are the 365 places where things converge. They are all places through which Shen and Qi enter, leave, and move, not joints of the bones.”

The classic goes on to explain that the body contains many parts, while only a few are listed in this summary. Illnesses also arise in many different ways, so how could these numbers alone account for them?

Qibo replied, “These illnesses all arise from the five viscera.”

[Commentary] Here, “the five viscera” also includes the mental activities stored within them.

Qibo continued, “The heart stores Shen, the lungs store Qi, the liver stores blood, the spleen stores flesh, and the kidneys store the will. Together, these make up the human body.”

In other words, all illnesses are related to the five viscera because they store Shen, Qi, blood, flesh, and will—the vital activities that together sustain the human body.

The will and intentions reach inward, connect with the bone marrow, and form the human body and its five viscera. Here, “will and intentions” refers broadly to the five spirits; “bone marrow” refers broadly to the processes of generation and transformation throughout the body. Once the five spirits flow freely, the bone marrow gives rise to bodily substance, and the body takes shape, the five viscera can coordinate and interact with one another.

The activity of the five viscera begins in the channels, the pathways through which the meridians flow, and serves to transport blood and Qi. When blood and Qi do not circulate properly, the changes that follow give rise to all kinds of illness. The channels must therefore be valued and guarded. The word “channel” here carries the sense of a hidden passage: the meridians run unseen within the body, hence the term “channels.” Blood and Qi sustain a person’s mental activity. When pathogenic Qi enters, blood and Qi fall out of balance, leading in turn to various illnesses. The meridians bear on life and death; they allow one to diagnose all illnesses and regulate deficiency and excess. For this reason, the channels must be guarded.

The Yellow Emperor asked, “What signs appear when the spirit Qi is excessive or deficient?” Qibo replied, “When the spirit Qi is excessive, a person laughs without stopping; when it is deficient, the person feels sorrow.”

The heart governs the storage of the vessels, and the spirit is lodged within them. When heart Qi is weak, a person feels sorrow; when heart Qi is excessive, the person laughs without stopping. The commentary notes that the word “sorrow” here may be an error for “worry.” The Jia Yi Jing, the Tai Su, and the version with commentary by Quan Yuanqi all have “worry.” Huangfu Shian says that heart deficiency brings sorrow, and sorrow in turn gives rise to worry; heart excess brings laughter, and laughter in turn gives rise to joy. The heart can affect the lungs, and the spleen can affect the heart: joy arises from the heart and can also affect the lungs, while thought and worry arise from the spleen and can also affect the heart. When an emotion exceeds its proper measure, both of the related viscera are harmed. Yang Shangshan holds that “worry” in the heart is an abnormal change in the heart, whereas “worry” in the lungs is the emotion governed by the lungs. The lungs govern autumn, and worry corresponds to the lungs; the heart governs summer, and worry may also arise when it undergoes an abnormal change.

Before blood and Qi have joined with pathogenic Qi, the five viscera remain settled. When pathogenic Qi has just entered the body, a person feels intermittent chills, with cold rising from the skin and hair, but the pathogenic Qi has not yet entered the meridians. This condition is therefore called “the subtle stirring of the spirit.” “Join” means to come together; since blood and Qi have not yet joined with pathogenic Qi, it is said that they “have not joined.” “Chills and shivers” describes the sensation of cold and trembling. At this point, pathogenic Qi has only arisen from the skin and hair and remains in the shallow collateral vessels. The illness is mild, so it is called “the subtle stirring of the spirit.”

This passage primarily discusses acupuncture techniques in Traditional Chinese Medicine for regulating Shen (the spiritual aspect of Jing-Qi-Shen) and Qi, as well as methods for addressing pathogenic invasion.

When pathogenic Qi invades the body, it infiltrates through the skin's interstices (couli) like water flowing backward. The Yellow Emperor asked Qibo about applying supplementation and drainage techniques in treatment. Qibo replied: When Shen-Qi is excessive, one may prick the minor collaterals (xiao luo) to let blood, but without penetrating too deeply to damage the major channels (da jing). This restores Shen-Qi balance. Since pathogenic Qi resides only in the minor collaterals, shallow needling that releases blood from these collaterals naturally pacifies the Shen-Qi.

For cases of Shen-Qi deficiency, practitioners should identify the weakened collaterals, applying pressure before needling to promote Qi-blood circulation—without bloodletting or Qi drainage—simply ensuring channel patency will balance the Shen-Qi. This emphasizes regulation through pressure and gentle needling, as deficient Shen-Qi cannot endure further Qi-blood depletion.

When the Yellow Emperor inquired about treating mild pathogenic conditions (ci wei), Qibo advised continuous massage pressure during needling without forceful needle manipulation, allowing the patient's Shen-Qi to naturally gather at the needle site. This method mobilizes Qi-blood to deficient areas, restoring Shen-Qi. The massage facilitates Qi movement to the heels (zhong), aiding Qi-blood circulation.

Finally, regarding Qi excess and deficiency (the classic text here is incomplete), Qibo explained the corresponding treatments. The passage meticulously records acupuncture techniques and principles for various conditions, emphasizing tailored supplementation or drainage methods based on the specific states of Shen and Qi.

Counterflowing Qi with wheezing and coughing, and Qi surging upward, are signs of Qi deficiency. Thus, breathing is unobstructed, yet the breath is short.

The lungs govern breathing. When the movement of Lung Qi is impeded, wheezing occurs. The Zhenjing says: “When Lung Qi is deficient, the nostrils are unobstructed but the breath is short. When Lung Qi is excessive, breathing is rapid and labored, the mouth is open, the chest feels tight, and the person can breathe only with the head raised.”

When Blood and Qi have not become concentrated unevenly, and the Five Viscera are settled, but there is a slight disorder of the skin, this is called “a slight discharge of White Qi.”

The lungs correspond with the skin, and the color associated with the lungs is white. Therefore, a slight disorder of the skin is called “a slight discharge of White Qi.”

The Yellow Emperor asked, “How should one tonify and drain?” Qibo replied, “When Qi is excessive, drain the channels along which it moves, but do not injure the channels themselves, cause blood to flow, or deplete Qi. When Qi is deficient, tonify the channels along which it moves, without allowing Qi to escape.”

Here, “Qi” refers to Nutritive Qi. If the channels are injured during needling to drain, blood will flow out and Nutritive Qi will be depleted along with it. One should therefore neither cause bleeding nor let Qi escape, but drain only Defensive Qi. When needling to tonify, carefully seal the acupoints, and do not allow Defensive Qi to leak out. Yang Shangshan holds that “the channels along which Qi moves” refers to the route by which a collateral branch of the Hand Taiyin channel connects to the Hand Yangming channel. Both tonification and draining are carried out along the collateral vessels branching from the main channels, regulating Yin-Yang in the viscera and bowels. In draining, one drains the pathways branching from the Yin channels without injuring the main channels.

The Yellow Emperor asked, “How should one use acupuncture to treat a mild disorder?”

This continues the discussion of the “slight discharge of White Qi” mentioned above.

Qibo replied, “Massage without stopping. As you withdraw the needle, observe the patient and say to them, ‘I am about to insert the needle deeply.’ The patient will certainly undergo a change: Jing and Qi will naturally become concealed, while pathogenic Qi will scatter and have nowhere to remain. Qi will disperse through the Couli—the skin’s texture and the spaces between the muscles—and genuine Qi will then unite with it.”

This too refers to massaging the affected area. “Ge” means to change. The practitioner says, “I am about to insert the needle deeply,” but actually inserts it only shallowly; this makes the patient comply and cooperate. The patient consequently feels apprehension, and Jing and Qi become concealed. After massage harmonizes the skin, Jing and Qi lie dormant; pathogenic Qi loses its support, scatters, and cannot remain. It disperses through the Couli. Once the pathogenic Qi has been expelled, genuine Qi can unite with the skin and Couli. Yang Shangshan explains that “Ge” means change: hearing pleasant music makes a person feel at ease in body and mind, while hearing about pain or experiencing pain changes one’s emotions. When a person feels at ease, the body relaxes; when the emotions change, the mind resists. This resistance causes pathogenic Qi to disperse and lie dormant.

The Yellow Emperor said, “Very good. What happens when the blood is excessive or deficient?”

Qibo replied, “When the blood is excessive, a person becomes angry; when it is deficient, a person is prone to fear. The liver stores the blood. The Needle Classic says that when Liver Qi is weak, a person becomes fearful; when Liver Qi is abundant, a person becomes angry.” The textual editors note that the Quan Yuanqi edition has “sorrow” instead of “fear,” as do the Jia Yi Jing and the Tai Su.

Before Qi and blood have gathered, when the functions of the five viscera are stable, if blood from the tiny collateral vessels spills outward, it forms stagnant blood in the channels. Pathogenic Qi that has grown excessive in the collateral vessels can also enter the channels. This is why an outward spill from the tiny collaterals leaves stagnant blood in the channels.

The Yellow Emperor asked, “How should one tonify or drain?”

Qibo replied, “If the blood is excessive, drain the channel where it is abundant and release the blood within it. If the blood is deficient, examine the weakened channel, insert the needle into the vessel, leave it in place for a longer time, and observe the pulse.”

The textual editors note that both the Jia Yi Jing and the Tai Su read, “Leave the blood in place for a long time.” If the pulse is large and rapid, withdraw the needle promptly so that blood is not lost. A full, abundant pulse indicates excess blood, so blood should be released. Deficient channel Qi indicates insufficient blood, so blood must not be allowed to escape. Leaving the needle in for a long time and then withdrawing it promptly is called the tonifying method. The Treatise on Understanding Needling says, “Slow insertion and quick withdrawal make it replete,” which means the same thing.

The Yellow Emperor asked, “How should one needle to treat stagnant blood?”

Qibo replied, “Examine the collaterals where blood has collected. Puncture them and release the blood within, so that foul blood does not enter the channels and worsen the condition.”

When blood fills the collateral vessels, puncturing them and pressing out the stagnant blood prevents discolored, foul blood from flowing into the channels.

The Yellow Emperor said, “Very good. What happens when the body is excessive or deficient?”

Qibo replied, “When the body is excessive, the abdomen becomes distended and bowel and bladder functions are obstructed. When the body is deficient, the limbs cannot move. The spleen governs the transformation and movement of the muscles. The Needle Classic says that weak Spleen Qi makes the limbs unable to move and leaves the five viscera unsettled; abundant Spleen Qi causes abdominal distension and obstructed bowel and bladder functions. The term “jing sou” usually refers to defecation and urination. The textual editors cite Yang Shangshan’s view that “jing” should be “jing,” meaning a woman’s menstruation.

Before Qi and blood have gathered, when the five viscera are stable, slight twitching of the muscles is called “subtle wind.” This occurs when pathogenic Qi enters the spaces between the muscles, defensive Qi cannot flow smoothly, and Yang Qi surges within the body, causing the muscles to twitch. The textual editors note that the Quan Yuanqi edition and the Jia Yi Jing read “overflowing movement” instead of “crawling movement,” while the Tai Su reads “moist movement.”

The Yellow Emperor asked, “How should one tonify or drain?”

Qibo replied, “If the body is excessive, drain the Yang channels; if the body is deficient, tonify the Yang collaterals.” Channels and collaterals together are called the channel network.

The Yellow Emperor asked, “How should one needle to treat subtle wind?”

Qibo replied, “Needle between the muscle boundaries, taking care not to pierce the channels.”

Do not injure the collateral vessels. This allows Defensive Qi to recover, and the pathogenic Qi will disperse.

Defensive Qi warms the muscles, nourishes the skin, fills out the interstices—the skin’s texture and its pores—and governs the opening and closing of the pores. When the muscles twitch, needle only between the muscle fibers. Separate them slightly to let the pathogenic Qi escape; do not pierce the channels or damage the collateral vessels. In this way, Defensive Qi returns to its normal state and the pathogenic Qi disperses completely.

The Yellow Emperor asked, “What should be done when the will and Qi are excessive or deficient?” Qibo replied, “When the will and Qi are excessive, the abdomen swells, and food is excreted before it has been digested. When the will and Qi are deficient, counterflow reversal occurs.”

This passage refers to the kidneys. The Needle Classic says that the kidneys store Jing (essence), and that the will is contained within Jing. When kidney Qi is weak, counterflow reversal occurs; when kidney Qi is congested and full, the abdomen swells. “Swelling” means that the abdomen distends; “reversal” means that Qi flows upward against its normal course. The Foot Shaoyin Kidney Channel normally runs downward. If kidney Qi is deficient, it follows the Chong Vessel upward in counterflow.

Before Blood and Qi have joined together, the Five Zang organs are settled, yet the joints may feel as if they are moving. The kidneys correspond with the bones, so when pathogenic Qi presses close to the bones, the joints may twitch; one may also feel something throbbing inside them.

The Yellow Emperor asked, “How should supplementation and drainage be applied?” Qibo replied, “When the will and Qi are excessive, drain Rangu. When they are deficient, supplement Fuliu.”

Rangu is the Ying-Spring point of the Foot Shaoyin Kidney Channel, located in the hollow in front of the medial malleolus, below the prominent bone. Ying-Spring points are places where the channel’s Qi and Blood flow relatively close to the surface and can be used for treatment. If the blood vessels are engorged, they may be bled to drain the pathogenic influence. The needle should be inserted about three fen by proportional body measurement and retained for three breaths. If moxibustion is used, apply three cones. Fuliu is the Jing-River point of the Foot Shaoyin Kidney Channel, located in a hollow about two cun above the medial malleolus. The needle should be inserted about three fen by proportional body measurement and retained for three breaths. If moxibustion is used, apply five cones.

The Yellow Emperor asked, “How should needling be done before Blood and Qi have joined together?” Qibo replied, “Treat the place where the pathogenic Qi is located, without piercing the channels. This will quickly disperse the pathogenic Qi from the place where it has settled.”

“Treat it directly” here means that one need not be bound by the established acupuncture points, but may needle the place where the pathogenic Qi has lodged. The textual editors note that the Jia Yi Jing reads, “to remove the pathogenic Qi,” meaning “to drive it out.”

The Yellow Emperor said, “Good. I now understand the signs of deficiency and excess, but I do not know how deficiency and excess arise. Qibo…”

Qibo said: When the movement of Qi and blood falls out of balance and Yin and Yang become unevenly strong, the Defensive Qi is disturbed and the flow of blood becomes disordered. Defensive Qi leaves its usual course and moves chaotically outside the vessels, while blood flows within the channels but turns back against its proper direction. When Qi and blood cannot work in harmony, one becomes deficient while the other becomes excessive.

When blood gathers predominantly in Yin and Qi gathers predominantly in Yang, a person may become frightened and delirious. When Qi gathers in Yang, Yang Qi is excessive on the outside, causing fright and delirium. When blood gathers in Yang and Qi in Yin, “heat in the center” occurs, meaning that the body becomes hot internally. When blood gathers in the upper body and Qi in the lower body, the person feels vexed and is prone to anger. When blood gathers in the lower body and Qi in the upper body, the person becomes confused and prone to forgetfulness. Here, “upper” means above the diaphragm, and “lower” means below it.

The Yellow Emperor asked: When blood gathers in Yin and Qi in Yang, each has shifted away from its proper place. Which is considered excessive, and which deficient?

Qibo replied: Blood and Qi both favor warmth and recoil from cold. When chilled, blood congeals and cannot flow freely; when warmed, the congealing disperses. The word “seize” here describes something like snow falling onto water and freezing in place.

Thus, when Qi gathers predominantly on the side of blood, blood becomes insufficient; this is called blood deficiency. When blood gathers predominantly on the side of Qi, Qi becomes insufficient; this is called Qi deficiency.

The Yellow Emperor asked: The body contains nothing but blood and Qi, yet you say that when Qi gathers, it causes deficiency, and when blood gathers, that too causes deficiency. Can there be no pattern of excess?

Qibo replied: What is present is excess; what is absent is deficiency. When Qi gathers on the side of blood, Qi becomes insufficient. When blood gathers on the side of Qi, blood becomes insufficient. Thus, when Qi gathers, blood becomes insufficient; when blood gathers, Qi becomes insufficient. Qi and blood lose their harmony with one another, and deficiency results. When Qi gathers with blood, blood loses the support of Qi; when blood gathers with Qi, Qi loses the support of blood. That is why we say that Qi and blood have become separated from one another.

The Qi and blood in the collateral vessels and finer branches all flow into the channels. If Qi and blood become congested and gather together, an excess pattern results. If Qi and blood surge upward together in a counterflow, this may produce “Great Reversal”—a severe faint caused by the sudden upward reversal of Qi and blood—and may lead to sudden death. If Qi resumes its normal course, the person can regain consciousness; if it does not, the person will die.

The Yellow Emperor then asked: By what process does an excess pattern arise, and by what process does a deficiency pattern subside? What is the key to understanding excess and deficiency?

Qibo replied: Yin and Yang each have points where Qi is conveyed and where it meets. Yang Qi flows into the Yin aspect; when Yin Qi is full, it spreads outward. When Yin and Yang are in harmony, they nourish the body. If examination of the nine diagnostic pulses—the nine pulse locations assessed in pulse diagnosis—finds them all even and uniform, the person is called healthy: their physical state is balanced.

An ordinary person is someone whose Qi and blood are balanced and who has no evident illness.

Evil Qi may arise at times from Yin and at times from Yang. When it arises from Yang, it is usually caused by invasion from wind and rain, cold and heat. When it arises from Yin, it is usually related to food and drink, one’s living environment, an imbalance of Yin and Yang, and unrestrained emotions.

The Yellow Emperor asked, “How do wind and rain harm the body?”

Qibo replied, “When wind and rain invade the body, they first lodge in the skin and then pass into the Sunmai, the tiny vessels. Once the Sunmai are full, the evil Qi passes into the network vessels. When the network vessels are full, it passes into the major channels. Qi and blood then stagnate together with the evil Qi between the skin and the interstices of the flesh. The pulse becomes firm and enlarged, so this is called ‘excess.’ Excess means that the exterior is hard and full, resisting pressure; pressing on it causes pain.”

The Yellow Emperor asked, “How do cold and damp harm the body?”

Qibo replied, “After cold and damp enter the body, the skin can no longer contract normally, the muscles become tense, the movement of nutritive blood is impeded, and defensive Qi disperses. This is called ‘deficiency.’ Deficiency means that the skin and flesh are slack and wrinkled, with insufficient Qi. When pressed, Qi can reach and warm the affected area, bringing relief without pain.”

“Nie” means wrinkled and contracted; “pi” means folded or bunched up. In its collation notes, the New Corrected Edition cites the Jia Yi Jing and the Tai Su, which give “she pi” in place of “nie pi.”

The Yellow Emperor asked, “How can an excess condition arise in the Yin aspect?”

Excess means that evil Qi is flourishing.

Qibo replied, “Unrestrained joy and anger cause Yin Qi to surge upward. When Yin Qi rises in counterflow, the lower part of the body becomes weak. Once it is weak, Yang Qi flows there, and an excess condition forms.”

The New Corrected Edition observes that, judging from the meaning of the passage, the word “joy” in “unrestrained joy and anger” may be an interpolation.

The Yellow Emperor asked, “How can a deficiency condition arise in the Yin aspect?”

Deficiency means that the essence Qi has been damaged and depleted.

Qibo replied, “Joy sends Qi downward, while grief disperses it. When Qi disperses, the vessels become empty. If cold food and drink then cause cold to fill the body, the flow of blood becomes sluggish and Qi also disperses, producing a deficiency condition.” The New Corrected Edition notes that the Jia Yi Jing reads “moves the Zang organs” here.

The Yellow Emperor said, “The ancient medical classics say that Yang deficiency makes the body’s exterior cold, while Yin deficiency makes the interior hot; Yang excess makes the exterior hot, while Yin excess makes the interior cold. I have heard these statements, but I do not understand why.”

Here, “the classics” refers to medical works handed down from ancient times.

Qibo replied, “Yang Qi is received and distributed by the Upper Jiao—the part of the body above the diaphragm, associated with breathing and the movement of Qi—and warms the space between the skin and muscles. Now, when cold lodges at the body’s surface, it blocks the Upper Jiao; when the Upper Jiao is blocked, the cold Qi…”

Cold pathogenic energy remains only at the body’s surface, so it causes a person to feel cold and shiver.

“Li” means bodily shivering.

The Yellow Emperor asked: “When Yin is deficient and internal heat arises, what causes it?”

Qibo replied: “Excessive exertion weakens both the body and Qi, reduces food intake, and leaves the Qi derived from food and drink insufficient. The Upper Burner, the channel through which Qi moves in the upper part of the body, cannot function properly, and the lower part of the stomach becomes obstructed. Stomach Qi then stagnates and generates heat. This heat steams the chest, producing internal heat.

“Here, ‘fatigue from overwork’ means exhaustion caused by excessive effort. When someone is so eager to work that they neglect to eat, the Qi derived from food and drink becomes insufficient.

“The Yellow Emperor asked: ‘When Yang is excessive and external heat arises, what causes it?’

“Qibo replied: ‘When the Upper Burner is obstructed, the skin becomes dense, the pores between its lines close, and the sweat pores become blocked. Defensive Qi, the Yang energy that protects the body’s surface, cannot spread outward, and external heat arises.

“When cold pathogenic energy attacks the body’s surface and presses inward against Yang energy, intense cold tightens the skin, causing the pores to close. Defensive Qi then accumulates and cannot circulate. Cold presses inward from outside, while Yang within the body struggles against it. The resulting stagnation transforms into heat, which is why external heat appears.

“The Yellow Emperor asked: ‘When Yin is excessive and internal cold arises, what causes it?’

“Qibo replied: ‘Cold Yin energy rises in counterflow and gathers in the chest, where it cannot escape. As the cold persists, warm Yang energy withdraws, leaving only cold behind. When cold stagnates, the flow of blood also becomes sluggish, and the blood vessels can no longer circulate freely.’

“A commentary notes that the Jia Yi Jing reads, ‘the pores are obstructed.’ When cold stagnates, the pulse feels full and rough, producing internal cold. Here, ‘warm energy’ refers to Yang energy. When cold Yin energy rises in counterflow and fills the interior, Yang energy withdraws from the body’s surface.

“The Yellow Emperor asked: ‘When Yin and Yang combine, Blood and Qi gather, and a pattern of illness has already formed, where should acupuncture be applied?’

“Qibo replied: ‘To treat this pattern, select the channels: address Blood in relation to nutritive Qi, which governs Blood and belongs to Yin, and regulate Qi in relation to defensive Qi, which governs Qi and belongs to Yang. Acupuncture must also take the patient’s build into account and consider the changes of the four seasons, judging the number of needles, their depth, and the height of the sites to be needled.

“‘Nutritive Qi governs Blood and is Yin; defensive Qi governs Qi and is Yang. Before needling, one must first assess the patient’s height and build, as well as the width of the bones, and measure the body according to the relevant standards. The sites and dimensions for needling are then determined from these measurements. This is what it means to “take the body’s build into account.” The specific guidance on the number of needles and the height of needling sites in each season appears in a later chapter.’

“The Yellow Emperor asked: ‘When Blood and Qi combine and a pattern of illness has formed, how should tonification and drainage be applied when Yin and Yang are out of balance?’

“Qibo replied: ‘To drain an excess condition, insert the needle when the pathogenic energy is strong, so that the needle enters together with it and opens a path for it to leave. When withdrawing the needle, let it leave together with the pathogenic energy. In this way, the body’s vital essence will not be harmed.’”

The evil qi that reaches the acupoint openings on the body surface will leave through them if the openings have not closed. In this case, the needling passage should be enlarged quickly so the evil qi can drain out smoothly. This is called "great draining" (da xie). The needle should be placed close to the point and withdrawn quickly, so that the strong evil qi recedes. Here, qie means swift, and qu means to recede. Da qi refers to strong evil qi.

Huangdi (the Yellow Emperor) asked, "How should one supplement weakened qi?"

Qibo replied, "Concentrate while holding the needle, and do not set it down carelessly. Insert the needle when the patient exhales. Once qi has entered the needle hole, press firmly around the hole so that the needling site closes tightly and the jing qi is not lost. When the upright qi is full, withdraw the needle quickly. At this point qi follows the needle in and the needle follows qi out, so the heat cannot return and the opening closes behind it. Only after the evil qi has dispersed can the jing qi be preserved. Treatment must follow the timing of qi's movement."

The Xin Jiaozheng (New Collation) notes that, according to the Jiayi Jing (Classic of Categories), the phrase dong qi hou shi here is written as dong wu hou shi.

Qi that is "near" does not scatter, and qi that is "far" will then arrive. This is called "pursuing qi" (zhui qi). The meaning is that the point must be closed tightly so that qi does not escape. "Near qi" refers to qi that has already arrived, and "far qi" refers to qi that has not yet arrived. To make channel qi move and achieve supplementation, one must wait for the right moment and needle according to where the qi is located. This is called grasping the timing and harmonizing channel qi. Zhui describes the supplementing method. The Zhenjing (Needle Classic) says, "pursue and aid it" (zhui er ji zhi), meaning that the supplementing method is used to aid channel qi. If this is done, how could a deficient person not be made full? This is the meaning the passage intends.

Huangdi asked, "You said there are ten kinds of deficiency and excess, arising from the five zang organs and their vessels. But all twelve channels can produce disease. Now you speak only of the five zang. The twelve channels connect the 365 joints, and when any joint falls ill, it must affect the channels. Channel diseases also have patterns of deficiency and excess. How do these accounts correspond to one another?"

The Xin Jiaozheng notes that, according to the Jiayi Jing, this passage reads "all give rise to the hundred diseases," and the Taisu (Great Plain) has the same wording.

Qibo replied, "The five zang and six fu organs are interiorly and exteriorly related, and the channels, network vessels, and joints each also show deficiency and excess. Wherever the disease arises, treat it according to its location."

In other words, treatment should follow the disease along the left and right channels, the channel qi, and the joints where it lies.

"When the disease is in the vessels, regulate the blood." The vessels are the pathways through which blood gathers and circulates. Vessel excess means blood excess, and vessel deficiency means blood deficiency. Therefore, when the vessels are diseased, treatment should begin with the blood.

The Xin Jiaozheng notes that, according to the Quan Yuanqi edition and the Jiayi Jing, this passage reads "when the disease is in the blood, treat it."

"When the disease is in the blood, regulate the luo vessels." When the blood is diseased, the luo vessels are easily affected, so treatment should begin with the luo vessels.

When the illness lies in the qi aspect, one regulates the defensive qi (weiqi). The defensive qi governs the qi of the body, so treatment for an illness in the qi aspect begins with regulating the defensive qi.

When the illness lies in the muscles, one regulates the intermuscular spaces (fenrou), the regions between the muscles. One should observe the patterns of cold and heat and then select the corresponding method.

When the illness lies in the sinews, one regulates the sinews. Depending on whether the sinews are slack or contracted, one uses acupuncture or hot compresses.

When the illness lies in the bone, one regulates the bone. One should assess the severity of the condition and then apply the appropriate treatment. Heated needles (burning needles, shaozhen) may be inserted quickly into the affected area, and the sinew sites may also be treated. This is the method for regulating the sinews: when the sinews are contracted, the needle is heated first and then inserted quickly.

When the illness lies in the bone, one may use the cuizhen (fire needle, heated after being applied) or hot compresses with medicinal preparations. This is the method for regulating the bone. The cuizhen is the fire needle.

When the whole body aches and no definite site of pain can be found, one should give priority to the two qiao vessels, the Yin Qiao and the Yang Qiao. The Yin Qiao vessel originates at Zhaohai, and the Yang Qiao vessel originates at Shenmai. Shenmai lies in the depression below the outer ankle of the foot. The New Collation annotation states that the point lies five fen below the outer ankle, that the needle may be inserted three fen, and that it should be retained for six breaths; moxibustion may be applied for three cones. Zhaohai lies below the inner ankle of the foot. The needle may be inserted four fen and retained for six breaths; moxibustion may be applied for three cones.

When pain occurs in one part of the body and the nine pulse positions (jiuhou, the nine sites for examining the pulse) show no abnormality, one uses miuci (crossed needling of the luo vessels): pain on the left is treated by needling the right, and pain on the right is treated by needling the left.

When pain is on the left while the pulse on the right shows pathological change, one uses juci (crossed needling of the jing channels): pain on the left is treated by needling the right, and pain on the right is treated by needling the left.

Only when the nine pulse positions have been carefully examined are the principles of needling complete.