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9. The needle, Yuan needle (Round-pointed needle), Di needle (Blunt needle), Feng needle (Sharp needle), Pi needle (Sword needle), Yuanli needle (Round and sharp needle), Hao needle (Filiform needle), Chang needle (Long needle), and Da needle (Large needle) should also be used according to the suitability of the condition. If their regulation is lost, the disease will not respond. Today, the larger ones are like Yuan needles, and the smaller ones are like Hao needles; how can they treat stubborn diseases and sudden pathogenic qi? This is the ninth error. The major errors are already as described above, but the most crucial lies in spiritual concentration and rigorous manual technique. The *Classic* states: "The spirit is subtle as the autumn down; focus your intention on the patient, examine the blood vessels, and there will be no danger in needling." It also says: "When the Jing Qi has arrived, guard it carefully and do not lose it; depth is determined by your mind; distance and nearness are treated as one; act as if facing an abyss, hold the hand as if grasping a tiger, and let the spirit not be distracted by other things." It further says: "Be still like a drawn crossbow, strike like releasing the trigger; such is their specialization, agility, and subtlety." Today's physicians insert needles casually, without care. Even if the needle technique conforms to ancient methods, if the will is not concentrated and the timing is not grasped, efficacy is still doubtful, let alone when it completely contradicts ancient methods. Furthermore, there are sequences of priority, differences in Ying-Sui (following and opposing) manipulation, distinctions in constitution, divisions between labor and rest, degrees of fatness and thinness, and numbers of needles, which are difficult to enumerate. If one can devote oneself to observation and investigation to conform to the standards of the sages, miraculous effects will surely follow. However, people fear difficulty and seek ease, completely violating ancient methods. Therefore, the world regards acupuncture lightly, and the art cannot be practiced. Regarding moxibustion, the diseases it treats amount to only one-tenth or one-twentieth of those treated by acupuncture. Understanding the principles of acupuncture makes moxibustion even easier. This is why *Yixue Yuanliu* (Source Traces of Medicine) discusses these matters so solemnly and clearly, not sparing trouble, hoping earnestly that learners do not go astray and deviate from the orthodox transmission of the ancient sages.

The most strange and laughable aspect of the medical way is the division into internal and external departments; it is unknown when or by whom this began. Consider that the human body cannot exist without meridians, shell, bones, muscles, and zang-fu organs. All pathological changes arise from the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Pondering, Sorrow, Fear, Fright). Ask yourself: which external disease manifestation does not originate from meridians and zang-fu organs? Originally, there is no distinction between internal and external. Without a deep understanding of the boundaries of the Six Qi, Seven Emotions, Five Movements, and Six Channels, one cannot stand in either department. There is no one who can treat internal diseases but not external ones, nor one who can treat external diseases but not internal ones. The ancients divided them perhaps because the medical path is complex and difficult, and generalists are rare; dividing them was intended to foster specialization. Unexpectedly, practitioners today cling to their respective trades as if they were separate households, refusing to communicate, like drawing a border across the Hong River. Consequently, neither specialized experts nor famous masters can be found. It seems that those practicing internal medicine need not read much; merely holding *Yifang Hebian* (Collected Medical Prescriptions) as a secret text suffices to claim proficiency in internal principles. Those practicing external medicine need not even know many characters; merely knowing some trivialities and memorizing a few prescriptions for draining toxins, extracting pus, generating flesh, and closing wounds suffices to claim proficiency in external principles. Thus, obvious internal symptoms are treated internally, and obvious external symptoms are treated externally. But what if the disease is inside the abdomen, with no obvious internal or external signs, yet is deep and severe, such as so-called intra-abdominal abscesses? Who would handle such cases? Intra-abdominal abscesses include several types: Lung Abscess, Liver Abscess, Stomach/Epigastric Abscess, Large Intestine Abscess, Small Intestine Abscess, and Bladder Abscess. Only Lung Abscess, characterized by coughing up foul-smelling sputum, is relatively easy to identify. Others are mistaken for Pi Jie (obstruction and accumulation), Blood Stasis, Phlegm Accumulation, or Food Retention. Medicines are administered haphazardly, and ultimately, the disease remains unknown. By the time suppuration occurs, treatment is futile. Some die before suppuration even forms; patients and doctors alike remain ignorant of the cause of death, a common occurrence. Now, let us clarify the manifestations of Pi Jie, Blood Stasis, Phlegm Accumulation, and Food Retention. Both Pi Jie and Blood Stasis must have a cause and develop gradually. Phlegm Accumulation involves pain that shifts locations and must present with other phlegm symptoms. Food Retention must have a history of dietary injury, and usually resolves after bowel movement within three to five days. External diseases, however, feature fixed pain that worsens over time. The *Jin Gui Yao Lue* states: "When pulses are floating and rapid, fever should occur, but instead there is shivering aversion to cold. If there is a painful area, an abscess may develop. Pressing the swelling yields heat if pus is present, and no heat if absent." These sentences reveal the true essence of internal abscesses. It also states: "Intestinal Abscess presents with rough, scaly skin, tense abdominal wall, soft upon pressure resembling swelling, no abdominal masses, and no body heat." For Liver Abscess, there is dull pain in the hypochondrium, and eventually vomiting of pus and blood. Small Intestine Abscess is similar to Large Intestine Abscess but located slightly higher. Bladder Abscess causes pain in the lower abdomen near the pubic hair, tenderness upon touching the skin, and difficult, painful urination. Stomach/Epigastric Abscess has two types: excess and deficiency. Excess type is easily resolved; if suppuration occurs, vomiting large amounts of pus and blood leads to recovery. Deficiency type is mostly incurable; initially, there is stomach pain and distension, later a hard, stone-like elevation at the epigastrium, possibly with chills and fever, inability to eat, extreme tenderness upon pressure, and emaciation. This is a syndrome of spleen injury due to excessive thinking; death occurs before abscess formation. Therefore, any fixed abdominal pain accompanied by aversion to cold, curling up, and inability to eat requires careful examination to prevent internal abscesses. Do not delay seeking treatment from incompetent physicians, leading to rupture and self-harm. Other conditions include gangrene caused by pathogens lingering in meridians, or severe back and chest pain caused by cold damage and blood stasis in meridians. Do contemporary external medicine experts and Western physicians claiming expertise in external diseases understand this? Some argue that trauma and knife wounds belong to external medicine, which seems correct. However, immediately after trauma, it is an external condition; later, if ulceration disperses Qi, or if blood stasis and Qi stagnation persist, it belongs to internal medicine. The human body consists only of Qi and Blood; they cannot be strictly divided into internal and external. We hope those dividing professions into internal and external will unite them and pursue profound understanding. As for gynecology, it mainly concerns pregnancy and childbirth; pediatrics mainly concerns emotional disorders. Further subdivision by others achieves neither specialization nor reduction of complexity, leading to crudeness. Why do this?

In recent years, epidemic diseases have prevailed in Fujian and Guangdong, especially during the transition from spring to summer. Onset features alternating chills and fever, vomiting, coma, delirium, or sudden collapse with loss of consciousness. Malignant nodules often appear on the neck, axillae, and popliteal fossae. Some call it plague, some Biaoshe (a toxic sore), some smallpox toxin, others treat it as carbuncles and sores. Various false names are invented; out of thousands, hardly one or two survive. Patients infect each other household to household. Hearing of it causes panic and paranoia. Since doctors do not know the disease name, how can they know its source? They administer medicines indiscriminately—cold, hot, purgative, dispersing, draining, or releasing the exterior—all failing to match the condition. Western medicine is even more ridiculous: some press ice on the chest, some fumigate the body with yellow smoke, some sprinkle stinking pills and water in rooms, some cut open nodules, some use leeches to suck blood. Ultimately, none are effective, and accelerated deaths are countless. Even after death, they dare not dissect to determine the cause, fearing infection. There are also cases of vomiting, diarrhea, and muscle spasms resembling cholera but actually distinct, occurring periodically, similarly malignant and rapid. Rapid administration of warming, tonifying, and astringent agents occasionally saves one or two; delay means death. In reality, both diseases are the same entity: Hong Kong Jiao (Beriberi/Foot Qi), differing only in origin. When Hong Kong Jiao transmits to the Liver and Gallbladder, nodules develop; when it transmits to the Spleen and Stomach, vomiting and diarrhea occur. As long as the toxic vapor does not attack the Heart, all are treatable. Although classical formulas discuss Hong Kong Jiao, it was rare in ancient times (the term appears in *Jin Gui*, but patients were few). Since the Yongjia migration, many scholars suffered from it. Zhi Facun, Yang Daoren, and others studied classical formulas and excelled in treating it, saving many. During the Song and Qi dynasties, the monk Shenshi compiled twenty volumes of old formulas from various masters, including nearly a hundred prescriptions for Hong Kong Jiao. It was absent in the Wei and Zhou dynasties. Thus, Yao Gong’s *Jiyan Fang* did not emphasize it, and Xu Wang’s compilation ignored it. Specifically, during the tripartite division, customs were not unified, climate varied, and the disease was unknown in Guanzhong and Hebei. In the Tang Dynasty, expansion reached southern extremes, where it was common. In the second month of the 12th year of Yuanhe, Liu Zongyuan contracted this disease. At midnight, he suffered severe obstruction, nodules in both hypochondria as hard as stones, nearly died, confused and unconscious. Three days later, Zheng Xunmei of Xingyang administered Shanmu Tang (Cedar Wood Decoction). After half a meal's time, he had three bowel movements, Qi flowed, and nodules dispersed (see *Yiyi Yi Waibian* for details). This disease starts in the feet, very mildly, with normal diet. Shenshi called it "weak feet"; the *Neijing* calls it "wind-damp bi". Once erupted, it becomes a malignant disease. One asks: Wind-toxin affects everyone everywhere; why does it specifically attach to the feet? The answer is: Humans have five Zang organs. The meridians of the Heart and Lung originate in the ten fingers; the meridians of the other three Zang organs originate in the ten toes. Earth's cold, heat, wind, and dampness become vapors; feet constantly tread the ground. Thus, wind-cold-damp-toxin enters through the feet first. If lingering, it spreads to limbs, abdomen, back, head, and neck—the secondary and inter-transmission mentioned in the classics. All Hong Kong Jiao results from wind-damp toxicity. People rarely notice it immediately; it often erupts after another illness. Fujian and Guangdong are humid and hot regions. Upon encountering wind or summerheat pathogens in spring and summer, it erupts uncontrollably. Modern physicians, unable to read ancient books, fail to recognize disease names and treat them as other ailments, resulting in universal failure. During the Jiawu year, I was in Lingnan when this disease was rampant. I urgently wrote *Shiyi Bianzhi* (Differentiation and Treatment of Epidemics), shouting loudly, and compiled treatments for Lingnan malignant nodules from *Qianjin Yaofang* and *Waitai Miyao* to warn patients and doctors. They ignored me. Only those who followed proper methods after seeing competent doctors were saved. I wish future physicians would seek Hong Kong Jiao in such cases and stop inventing names to mislead people, thereby misleading themselves. Know that bizarre diseases always stem from the Six Qi and Six Channels.

Humans are born from the Qi of Heaven and Earth and fall ill due to the Qi of Heaven and Earth. Physicians who do not understand the correspondence of the Three Powers (Heaven, Earth, Man) and boast about medicine are like leaving home without using the door. Heaven and Earth possess only Yin and Yang, generating the Five Movements and Six Qi. The human body possesses only Yin and Yang, forming the Five Zang and Six Fu organs. All diseases arise from the Five Movements, Six Qi, Five Zang, and Six Fu. Not investigating the source of Qi transformation but clinging to Chinese-Western dichotomies is dreaming within a dream. Today, the world is united, and the five continents share tracks. Visions should merge, resources should exchange, dosages should be adjusted, and we should follow the Great Way. Since entering China, Western countries have boasted in acoustics, optics, electricity, and steam, and even disparage Chinese medicine. This is partly due to the mediocrity of modern Chinese physicians, but the precision of ancient Chinese sages is far beyond what Western medicine can imagine. Westerners have never heard of the *Neijing*, *Nanjing*, or Zhang Zhongjing’s works. They pride themselves on dissection and experiment but detail form while ignoring Qi transformation, thus capturing the coarse while missing the refined. Those who value Western medicine and study Western learning rely on hearsay and superficial observation. They ignore the Five Movements, Six Qi, Yin-Yang of the body, storage and governance of Zang organs, connections of Fu organs, openings of Zang organs to nine orifices, Tian Gui of men and women, meeting of Ying and Wei Qi, Six Channels and Six Qi, governance of Jing Qi, Twelve Regular Meridians, and Eight Extraordinary Vessels—all explicitly stated by ancient Chinese sages. Even post-Jin-Tang TCM physicians rarely discuss them, and modern physicians know little of them. How can one blame Western ignorance? Western medicine diagrams organs via dissection, appearing more detailed than old Chinese charts, but they know the "what" but not the "why," and sometimes not even the "what." They base theories on corpses, claiming humans are composed of carbon and fourteen elements. These elements are derived from dissected specimens; living humans are not merely inert matter. With life gone, how can one know Qi transformation? Westerners speak of the brain but do not know what transforms into it. They discuss marrow but do not know its origin. They claim nutrient fluid travels via lymphatic ducts to the thoracic duct, mixing with heart blood to become red. This "mixing" is erroneous; if mixed daily, why doesn't the red color dilute? Nutrient fluid entering the thoracic duct is Water interacting with Fire; turning red is transformation by Heart Fire into Blood. They claim blood has red and white circles, more red than white, not knowing white is the root of fluid/form, and red is Heart-transformed color. This matches the *Neijing*: "The Middle Jiao receives Qi, extracts juice, transforms it, and turns it red; this is called Blood." They claim the heart has efferent vessels guiding blood out and afferent vessels guiding blood in. Western "vessels" are Chinese "Mai" (Pulse/Vessels); they are one and the same. "Qi flows through meridians" means circulation returns regularly. They claim blood from the left atrium goes out via efferent vessels to the body; the heart beats continuously, causing pulse waves throughout. After circulating, blood enters afferent vessels, turns purple due to carbon dioxide absorption. Purple blood returns via afferent vessels to the thoracic duct, releases carbon dioxide via lung exhalation, turns red again, enters the right atrium, moves to the left atrium, and exits again. This is "Qi flowing through meridians." Contemporary physicians speak of large collaterals scattering into minor collaterals, then into sun collaterals, describing exit but not return, making "flowing through meridians" inaccurate. Hence, I cite Western theory to verify it. Western diagrams of vessels are detailed but fail to distinguish Twelve Regular and Eight Extraordinary Meridians, deeming them unreliable. *Yilin Gaicuo* agrees, not realizing dissection of corpses prevents meridian identification. They cannot determine when blood returns to the heart. TCM states: one exhalation, Qi moves three cun; one inhalation, Qi moves three cun. Over day and night, 13,500 breaths, Qi circulates fifty times, calculating blood flow timing precisely. Can Western dissection match the precision of ancient sages? Regarding Six Channels, Six Qi, and Jing Qi governance, Westerners know nothing, so their treatments cannot be accurate. Other absurdities are too numerous to list. Though their methods derive from the Five Animal Frolics, they are vastly inferior in subtlety. Tang Rongchuan Zonghai of Sichuan wrote *Zhongxi Huitong Yijing Jingyi* (Essence of Medical Classics in Chinese-Western Synthesis), analyzing and cross-verifying layer by layer, showing unique insight. Regrettably, it is not widely circulated, nor well-commented. Together with my *Yiyi Yi* trilogy and the *Neijing*, *Nanjing*, and Zhang Zhongjing’s classics, it should be introduced to Western countries, allowing Westerners to glimpse ancient Chinese precision, repent their errors, and promote cultural exchange for global health.

Treating disease is like governing the state. State chaos stems from external aggression and internal unrest; human illness stems from external contraction and internal injury. Diseases of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) are external aggression; harm from the Seven Emotions (Joy, Anger, Worry, Pondering, Sorrow, Fear, Fright) is internal unrest. To treat external aggression, send troops to quell border disturbances and drive them out quickly. Discussing rites and music at the Biyong (Imperial Academy) when the enemy is at the gate is inappropriate. Thus, using tonification abruptly while pathogenic Qi remains causes internal collapse and death. To treat internal injury, use nourishment. If discipline is lax, promote Confucianism and Dao slowly to guide transformation. Using punishment and execution deepens disaster. Thus, using attack lightly when Righteous Qi is insufficient leads to exhaustion and death. However, even in prosperous times, there are unruly people; punishment is not abolished, representing attack within tonification. Raising armies for minor bandits disturbs the people; thus, attack within tonification must not be excessive. In years of conquest, internal administration is also repaired; education and nurturing are not neglected, representing tonification within attack. Showing leniency to aggressors breeds enemies; thus, tonification within attack must not be mistaken. Great affairs require total national effort to succeed; small affairs require calm individual handling to avoid disturbance. Major diseases require strong medicine to eliminate pathogenic Qi completely; minor diseases require small formulas to protect Righteous Qi. Formulas must be sized appropriately, sequenced correctly, weighted properly, and applied with appropriate density, pure and orderly. Medicines must suit their nature (appropriate use of agents), and formulas must follow principles (superior scheduling). Ancient sages prevented disease by observing form and color, preparing defenses before chaos arises, securing the state before danger emerges. The medical way connects to the governing way; a good minister is a good physician, roughly speaking. Adapting to situations requires observing events, illuminating them spiritually, depending on the individual, not sticking to preconceptions as fixed conclusions. This is the justice of *Yixue Yuanliu*, extended here. If the court reforms, medical officials value medicine, and physicians master the *Yiyi Yi* trilogy’s prescriptions and follow the Dao, opening minds to outsiders, transforming Qi and Lu into the Dao, an era of benevolence and longevity, the Great Unity, will be visible! Yiyi Yi, yiyiyi!