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Practitioners of needle manipulation must differentiate between floating and sinking pulses, clarify deficiency and excess, distinguish between meridians and collaterals, and differentiate between Great Puncture (Juci) and Counter Puncture (Miaoci). If meridians are obstructed, Bian stones (stone needles) must be used for dredging.

The cold and heat conditions of the Zang-Fu organs must be clearly understood; the depth of insertion and the techniques of tonification and sedation follow fixed laws. The flow of Jing-Qi through the meridians follows a cycle of fifty rounds over one hundred water drops (an ancient timekeeping method), with each meridian's qi flow corresponding to specific times. First, diagnose based on the *Mai Jue* (Pulse Classic), then select acupoints to eliminate pathogenic factors.

With the left hand pressing the acupoint, the right hand inserts the needle. When puncturing the Ying (Nutrient) level, do not injure the Wei (Defensive) level; when puncturing the Wei level, do not injure the Ying level. If the Qi is vigorous and rapid, use a small needle and shallow insertion; if the Qi is stagnant and slow, use a large needle and deep insertion. If the Qi is smooth, withdraw the needle quickly; if the Qi is stagnant, withdraw slowly. When waiting for the arrival of Jing-Qi, one must carefully discern: slow insertion and quick withdrawal apply to Excess patterns; slow withdrawal applies to Deficiency patterns. Tonify Deficiency to make it solid; sedate Excess to drain it; remove stasis and old blood; weaken excessive pathogens. For Deficiency patterns, ensure the Qi becomes solid; for Excess patterns, ensure the Pathogen becomes deficient. Once Jing-Qi has arrived, guard it cautiously, adhere strictly to the method, and do not change it arbitrarily.

For newly invading "Thief-Pathogens" that have not yet settled in a fixed location, pushing them causes them to move forward, drawing them causes them to gather. Their approach should not be met with attack (sedation); their retreat should not be pursued with tonification. Damage what is in excess, supplement what is deficient. First remove blood stasis from the vessels, then regulate the whole body. Regardless of the disease, aim for balance.

The sensation may seem present yet absent, as if obtained yet lost. Once the condition of the Five Zang organs is determined and the Three Positions and Nine Pulses are clearly diagnosed, and the disease is understood, needle manipulation can lead to recovery. When abnormal pulse manifestations disappear and ominous signs cease, it indicates internal and external harmony. Do not rely solely on external appearance; observe the coming and going of Qi before treating the person.

Focus your mind; the needle should be bright and uniform. Insertion is like a drawn crossbow ready to fire; withdrawal is swift like an arrow leaving the bow. Seeing the arrival of Qi is like a flock of crows gathering or millet piling up; from afar it looks like flying birds, but you cannot see who they are. Contemplate the meaning quietly, observe the subtle changes of Qi. This is called the "Hidden Realm," where the form is unknown.

Be cautious as if standing at the edge of an abyss; hold the hand steady as if grasping a tiger; wait attentively as if awaiting prey. The virtue lies in losing track of time until the Qi arrives, then protect yourself appropriately. Do not leave patients with Five Deficiencies for long; do not delay treatment for Five Excesses. Use techniques such as palpating, rubbing, pressing, dispersing, pushing, connecting, flicking, tensing, clawing, and descending to guide and obtain the effect. Yin Mu points are on the abdomen; Yang Shu points are on the back. For Zang diseases, select Yuan-Source points; for Fu diseases, select He-Sea points. To treat Zang diseases, use the Mu points of the corresponding Fu organs; to treat Fu diseases, use the Mu points of the corresponding Zang organs. Guide Qi through entry and exit; master the essence of tonification and sedation. One skilled in managing water cannot pour ice into it; one skilled in digging earth cannot drill frozen ground. Balance the Qi using weights/measures; decide life and death by the Cun Kou pulse.

When food enters the Stomach, its refined essence floats up and is transported to the Spleen; the Spleen scatters the essence upward to the Lungs; the Lungs regulate the water passages, transporting it downward to the Bladder. Food entering the Stomach scatters essence to the Liver, nourishing the sinews with abundant Qi. Food entering the Stomach sends turbid Qi to the Heart, and refined essence to the Lungs.

Five Labors, Five Bi syndromes, Nine Qi variations, Seven Emotions, Six Exogenous Pathogens, Six Fu organs, Nine Orifices, Nine Provinces, Four Qi phases, Three Causes, Wind Strike, Cold Damage, Miscellaneous Diseases, Strange Diseases, Women's Diseases, and Children's Diseases: Excess patterns are drained; Deficiency patterns are tonified; patterns that are neither excess nor deficiency are treated by selecting points from the affected meridian itself.