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Difficulty 77 states: The classic texts say that excellent physicians treat diseases before they occur, while average physicians treat diseases after they have occurred. What does this mean? The answer is: Treating diseases before they occur means that when one observes a disease of the Liver, one knows that the Liver disease will transmit to the Spleen. Therefore, one first strengthens the Qi of the Spleen (Pi) so that it cannot receive pathogenic factors from the Liver. This is called treating diseases before they occur. Average physicians, upon observing a Liver disease, do not understand the theory of disease transmission and focus solely on treating the Liver. This is called treating diseases after they have occurred.

Difficulty 78 states: Acupuncture involves tonification and sedation techniques. What are these? The answer is: The methods of tonification and sedation do not necessarily depend on respiration during needle insertion or withdrawal. A skilled acupuncturist relies on the left hand; an unskilled one relies on the right hand. When ready to puncture, first use the left hand to press down on the Ying-Spring (Ying) and Shu-Stream (Shu) points to be needled, flick them to make them protrude, and mark them with fingernails. When the Qi arrives, feeling like a pulsating artery, insert the needle in accordance with this sensation. Upon obtaining Deqi (arrival of Qi), push the needle inward; this is tonification. Move and withdraw the needle slightly; this is sedation. If Deqi is not obtained, adjust technique based on gender (superficial for males, deep for females); if Deqi is still not obtained, it is considered one of the ten untreatable conditions.

Difficulty 79 states: The classic texts say, "To intercept and drain, how can there be no deficiency?" and "To follow and assist, how can there be no excess?" The changes between deficiency and excess seem as if one has gained something and then lost it; the states of excess and deficiency seem as if they exist and then vanish. What does this mean?
The answer is: "Intercepting and draining" refers to sedating the Son organ; "Following and assisting" refers to tonifying the Mother organ. For example, in Heart disease, sedating the Shu-Stream point of the Pericardium (Hand Jueyin) is called "intercepting and draining"; tonifying the Jing-Well point of the Pericardium is called "following and assisting."
Regarding "excess" and "deficiency," this refers to the sensation of firmness versus softness. A Qi response that feels firm and solid indicates successful acquisition of Qi; one that feels soft and empty indicates failure. Hence, it is said to seem as if gained and then lost.

Difficulty 80 states: The classic texts mention "inserting the needle when Qi arrives" and "withdrawing the needle when Qi dissipates." What does this mean? The answer is: "Inserting when Qi arrives" means waiting until the left hand perceives the arrival of Qi before inserting the needle. After insertion, wait until the Qi dissipates before withdrawing the needle. This is referred to as inserting when Qi arrives and withdrawing when Qi dissipates.

Difficulty 81 states: The classic texts warn against tonifying excess and sedating deficiency, thereby damaging what is insufficient and augmenting what is already excessive. Does this refer to the Cun Kou pulse, or does it refer to the inherent excess and deficiency of the disease itself? How should tonification and sedation be applied? The answer is: This does not refer merely to the Cun Kou pulse but to the inherent excess and deficiency of the disease itself. For instance, if the Liver is in excess and the Lung is deficient, since the Liver belongs to Wood and the Lung to Metal, Metal and Wood should mutually restrain each other to maintain balance. One should understand that Metal (Lung) should regulate Wood (Liver). Conversely, if the Lung is in excess and the Liver is deficient, manifesting as shortness of breath, failing to tonify the Liver with acupuncture and instead over-tonifying the Lung constitutes "tonifying excess and sedating deficiency," which damages the insufficient and augments the excessive. This error causes harm and is typical of average physicians.