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The Yang meridians of the left hand belong to Yang within Yang; the Yin meridians of the left hand belong to Yin within Yang; the Yang meridians of the right hand belong to Yang within Yin; the Yin meridians of the right hand belong to Yin within Yin. The Yin meridians of the right foot belong to Yin within Yin; the Yang meridians of the right foot belong to Yang within Yin; the Yin meridians of the left foot belong to Yin within Yang; the Yang meridians of the left foot belong to Yang within Yin. Now, subdividing further: for the patient's left-hand Yang meridians, when the practitioner advances the right thumb forward (while the index finger recedes), exhalation constitutes the *Sui* (Following) method; in the afternoon, receding the thumb backward is considered *Sui*, which is opposite to the morning practice. "Advancing forward" refers to the meridian moving from the exterior; "receding backward" refers to the meridian moving from the interior. Receding backward during inhalation constitutes the *Ying* (Opposing) method.

For the patient's left-hand Yin meridians, receding the right thumb backward while inhaling is *Sui*; advancing forward while exhaling is *Ying*. For the patient's right-hand Yang meridians, receding the right thumb backward while inhaling is *Sui*; advancing forward while exhaling is *Ying*. For the patient's right-hand Yin meridians, advancing the right thumb forward while exhaling is *Sui*; receding backward while inhaling is *Ying*. For the patient's right-foot Yang meridians, advancing the right thumb forward while exhaling is *Sui*; receding backward while inhaling is *Ying*. For the patient's right-foot Yin meridians, receding the right thumb backward while inhaling is *Sui*; advancing forward while exhaling is *Ying*. For the patient's left-foot Yang meridians, receding the right thumb backward while inhaling is *Sui*; advancing forward while exhaling is *Ying*. For the patient's left-foot Yin meridians, advancing the right thumb forward while exhaling is *Sui*; receding backward while inhaling is *Ying*. This applies to men before noon; in the afternoon, it is reversed for women.

On the hands, Yang meridians advance and Yin meridians recede; on the feet, Yang meridians recede and Yin meridians advance, conforming to the starting and ending points of the Six Meridians. When lifting the needle at a point, the needle tip pointing upward indicates the direction of smooth Qi flow; when stopping the needle at a point, the needle tip pointing downward indicates where the Qi stops. Operating towards the left exterior and right interior causes Qi to ascend; operating towards the right exterior and left interior causes Qi to descend. One might ask: why are tonification and reduction opposite in the morning versus the afternoon, and why do they differ between men and women? This is because men's Qi is higher in the morning and lower in the evening, whereas women's Qi is lower in the morning and higher in the evening. The division of upper and lower between men and women is at the waist. As for breathing, whether male or female, doctor or patient, it is the same; why is there still a distinction of Yin and Yang? Because there is natural breathing and artificial breathing. Advancing and withdrawing the needle involves artificial breathing. Turning the needle requires caution as if awaiting a noble guest or holding a tiger's tail, waiting for natural breathing. If turning the needle on the left hand and foot during exhalation first, then one must wait for inhalation to turn the needle on the right hand and foot; if turning the right hand and foot during inhalation first, then one must wait for exhalation to turn the left hand and foot. This is the subtle mechanism of true Yin and Yang ascending and descending. Therefore, for men's Yang meridians, exhalation is tonification and inhalation is reduction in the morning; for Yin meridians, inhalation is tonification and exhalation is reduction, reversed in the afternoon. For women's Yang meridians, inhalation is tonification and exhalation is reduction in the morning; for Yin meridians, exhalation is tonification and inhalation is reduction, also reversed in the afternoon. Some say: tonification and reduction must rely on breathing. What if one encounters coma (*Shi Jue*) or stroke where the patient cannot control breathing? The answer is: wait for natural breathing to turn the needle; if inhalation is required but not occurring, another person can cover the patient's mouth and nose with their hand to stimulate Qi movement. Alas! The principles of tonification, reduction, lifting, and thrusting divided by gender and time are profound. Originally, this complexity arises because the Extraordinary Vessels do not strictly follow the regularities of the Twelve Regular Meridians. For Flowing Points (*Liu Zhu Xue*), one only needs to distinguish left/right and Yin/Yang. I once admired the *Xue Xin Ge* saying: Why are there two methods for tonification and reduction? Because meridians originate from both sides; ancients distinguished tonification/reduction by left/right, while moderns distinguish by gender. Men and women have identical meridians, circulating day and night without pause. This secret comes from Zi Sang Jun; I now impart it to you, clearing your mind like snow. This completes the combination of Zi-Wu and the Eight Methods.

However, tonification and reduction methods do not necessarily require breathing for needle insertion and withdrawal; some are determined by depth.

If the disease is in the vessels, puncture the vessels without injuring the skin; if in the skin, puncture the skin without injuring the flesh; if in the flesh, puncture the flesh without injuring the sinews; if in the sinews, puncture the sinews without injuring the bones; if in the bones, puncture the bones without injuring the sinews.

The classics state that shallow needling is suitable for Spring and Summer, and deep needling for Autumn and Winter.

In Spring and Summer, Yang Qi is above, and human Qi is also above, so shallow extraction is appropriate. However, due to warm weather, for tonification, insert the needle five fen, sinking to the Kidney and Liver levels. Once *De Qi* (arrival of Qi) is obtained, draw the needle back to the Heart and Lung levels, extracting Yin to harmonize Yang, thereby reducing fever. In Autumn and Winter, Yang Qi is below, and Fire Qi is also below, so deep extraction is appropriate. Due to cold weather, initially insert the needle three fen, floating lightly at the Heart and Lung levels. Once *De Qi* is obtained, push the needle deeper to the Kidney and Liver levels, extracting Yang to harmonize Yin, thereby alleviating cold.

Some distinctions are made based on Ying (Nutritive) and Wei (Defensive) Qi. The classics state: extract Qi from Wei, deposit Qi into Ying.

Tonification extracts Qi from Wei; use light, shallow needling, following the Wei Qi to supplement deficiency. Reduction discards Qi from Ying; use heavy, deep needling, opposing the Ying Qi to drain excess. Tonification should not make the condition too excess, nor reduction should it cause deficiency; the goal is balance. Additionally, for men, lightly press the acupoint and needle shallowly to await the Wei Qi level; for women, heavily press the acupoint and needle deeply to await the Ying Qi level.

Some distinctions are made based on Deficiency and Excess. The classics state: tonify the Mother in deficiency, reduce the Child in excess. This is the general principle of *Ying Sui* (Opposing and Following).

For example, in Heart disease, needling the Shu (Transport) point of the Pericardium reduces its Child; needling the Jing-Well point tonifies its Mother. If Wood is excessive and hot, generating Wind, reduce the South (Fire) to tonify the North (Water). If Water is excessive and cold, generating Qi issues, tonify Wood to suppress Water. If the Lungs are Excess and the Liver is Deficient, using needles to tonify the Liver but instead reinforcing the Lungs is called "making Excess more Excess and Deficiency more Deficient." Tonifying what is insufficient while adding to what is already excessive will surely kill. Grand Tutor Dou said: Needling against the flow to oppose and drain is reducing the Child. For Heat diseases of the Heart, one must reduce at the Spleen and Stomach levels. Needling with the flow to follow and supplement is tonifying the Mother. For Deficiency diseases of the Heart, one must tonify at the Liver and Gallbladder levels.

Flying through the Meridians and Moving Qi does not go beyond Zi-Wu Ying Sui.

Whenever "Nine" is mentioned, it refers to Zi-Yang; whenever "Six" is mentioned, it refers to Wu-Yin. The quantity of Nine and Six varies, applying equally to tonification/reduction and lifting/thrusting. "Initial Nine" refers to one-nine, but it does not stop there. Proceed to one-nine, pause slightly, proceed to one-nine again, pause slightly, proceed to one-nine a third time, totaling three nines (27 counts), or four nines (36 counts). "Lesser Yang" refers to seven sevens (49 counts), pausing slightly every seven counts. "Greater Yang" refers to nine nines (81 counts), pausing slightly every twenty-seven counts, performed three times. "Initial Six" refers to one-six, but does not stop there. Proceed to one-six, pause, proceed to one-six, pause, proceed to one-six a third time, totaling three sixes (18 counts). "Greater Yin" refers to six sixes (36 counts), pausing slightly every eighteen counts, performed twice. "Lesser Yin" refers to eight eights (64 counts), pausing slightly every eight counts. Some say: after Zi hour, use nine counts to tonify Yang; after Wu hour, use six counts to tonify Yin. On Yin days needling Yang meridians, use six counts to tonify Yin; on Yang days needling Yin meridians, use nine counts to tonify Yang. This is correct reasoning. However, reducing for Heat syndromes and tonifying for Cold syndromes, disregarding celestial timing to follow the patient's pathology, is a flexible adaptation.

The classics state: He who knows acupuncture trusts his left hand; he who does not know acupuncture trusts his right hand. At the time of needling, first measure the acupoint using the patient's body inch method and mark it with ink; then have the patient eat and drink, sit upright, or lie supine. Chronic illnesses should be treated only when the weather is warm and clear, so Qi moves easily; acute illnesses should not be treated during heavy thunderstorms. Non-acute illnesses should not be treated at night. Needling while standing on an empty stomach in a side-lying position may cause fainting.

One must first press down on the Ying-Shu points to be needled with the left hand.

For Yang points, pressing the depression on the bone side causing soreness and numbness identifies the true point; for Yin points, pressing until a pulsating artery is felt under the fingers identifies the true point.

Cutting and dispersing:

"Cutting" means using fingernails to pinch and press around the acupoint above, below, and to the sides, causing Qi and Blood to disperse.

Clawing and inserting:

"Clawing" means first using the left thumb's nail to press heavily on the acupoint, also to disperse Qi and Blood. Then, use the right index finger to hold the needle butt, the middle finger to firmly grasp the needle shaft, and the ring finger to slightly support the needle tip. Ask the patient to cough ten times, and insert the needle with the cough. Upon entering the skin, release the hand and pause the needle for ten breaths, called "Heavenly Talent." After a short while, advance the needle into the flesh, pausing for ten breaths, called "Earthly Talent." This is the extreme depth. Pause again, then ask the patient to take one deep breath, and withdraw the needle to the Human level while inhaling. Examine if Qi has arrived. If the needle feels heavy, tight, and full, Qi has arrived; if the patient feels pain, it is Excess; if they feel soreness, it is Deficiency. If the needle feels light, floating, and loose, Qi has not yet arrived. Use subsequent methods of flicking, pushing, rubbing, and guiding. If guiding fails and the needle feels like inserting into tofu, death ensues. To eliminate Chills and Fever, move Qi at the Heaven level; for Meridian diseases, move Qi at the Human level; for numbness and pain, move Qi at the Earth level.

Flicking and Pushing:

"Flicking" is a tonification method. Interlock the nails of the thumb and index finger. For diseases above, flick lightly upward with the thumb; for diseases below, flick lightly upward with the index finger, accelerating Qi movement so it arrives quickly. "Pushing" (Nu) means twisting the needle with the thumb and index finger, rubbing three times rapidly, resembling a hand tremor, called "Flying." For tonification, after inserting the needle, perform the Flying technique, ask the patient to hold their breath for one moment, and apply forceful pushing. For reduction, lift the needle, perform the Flying technique, ask the patient to exhale, without applying force. One method, two applications: if Qi arrives naturally, these techniques are unnecessary.

Rubbing and Guiding:

"Rubbing" (Men) means massaging. If pain persists, massage the painful area to disperse pain, then use the Flying needle to guide Qi away. Also, pressing the acupoint upon needle withdrawal is called Rubbing. "Guiding" (Xun) means using the hand to rub up and down along the meridian at the needled site, promoting Qi circulation; pushing makes it move, guiding brings it forth.

Moving and Extending, Pushing and Pressing:

"Moving" means rotating; "Pushing" means pushing rotation. Rotating the needle too quickly causes pain; too slowly fails to dispel disease. "Pushing and extending" refers to the methods of dividing Yin and Yang by rotating left and right. "Extending" means lifting; "Pressing" means thrusting. If tonification/reduction does not elicit Qi movement, lift the needle slightly (empty space like a bean) or flick two or three times to tonify. If the needle feels tight and trembling, use the Flying technique three times; if the needle feels tight and full, Qi moves easily, then use the Unblocking method. If Evil is abundant and Qi is stagnant, use lifting and thrusting first to remove the pathogen, then unblock True Qi. Lifting goes from Earth level to Human/Heaven levels; Thrusting goes from Heaven level to Human/Earth levels. For mild diseases, perform initial nine counts of lifting/thrusting; for severe diseases, perform three nines (27 counts) or Greater Yang counts (more is better). One asks: Treatment relies entirely on lifting and thrusting. It is said: "Quick lift, slow press like cold water" (Reduction); "Slow lift, quick press like fire burning the body" (Tonification). It is also said: For men, lifting in the morning generates Heat, thrusting generates Cold; lifting in the afternoon generates Cold, thrusting generates Heat. Women are reversed. Why? Lifting and thrusting for tonification/reduction simply follow Yin and Yang. In the morning, following Yang nature, lifting to Heaven level generates Heat; in the afternoon, following Yin nature, thrusting to Earth level generates Heat. The *Qi Xiao Liang Fang* poem explains this best. Flexible methods of tonification/reduction/lifting/thrusting: For tonification, insert shallowly then deeply; for reduction, insert deeply then shallowly. Regarding lifting/thrusting: Quick lift/slow press is Cold/Water (Reduction); Slow lift/quick press is Fire/Body Heat (Tonification). One may lift/thrust first then tonify/reduce, or tonify/reduce first then lift/thrust, or combine them. For chronic paralysis, stubborn numbness/cold bi, wandering pain, leprosy, wind-cold malaria, and all Cold syndromes: insert shallowly, then gradually deepen, tonifying with Greater Yang counts. When Qi moves and the needle feels tight/full, and the body feels hot, combine tonification with slow lift/quick press using Greater Yang counts (or 27 counts), then use the Unblocking method. Tilt the needle head, ask the patient to inhale five times to raise Qi, returning Yang and retreating Yin. This is called the "Entering Qi Method," also known as "Burning Mountain Fire." For Wind disorders with phlegm obstruction, stroke, throat wind, epilepsy, malaria with single heat, and all Heat syndromes: insert deeply, then temporarily withdraw shallowly, reducing with Lesser Yin counts. When *De Qi* brings coolness, combine reduction with quick lift/slow press using Initial Six counts (or 18 counts), repeat reduction and lifting, then use the Unblocking method. Withdraw slowly until the disease is cured. This is called "Penetrating Heaven Cool." For malaria with chills preceding heat, and all Upper Excess/Lower Deficiency syndromes: insert shallowly, perform four nines (36 counts); when Qi moves and heat is felt, insert deeply and perform three sixes (18 counts). For malaria with heat preceding chills, and all Half-Deficient/Half-Excess syndromes: insert deeply and perform six Yin counts; when Qi moves and coolness is felt, gradually withdraw and perform nine Yang counts. This is the "Dragon-Tiger Battle" method, ensuring Yin contains Yang and Yang contains Yin. Pathogenic Qi often follows Healthy Qi; without battle, pathogens do not retreat and Healthy Qi cannot prevail, leading to recurrence. For abdominal masses: insert needle seven fen, perform Greater Yang counts; when Qi moves, insert one cun deeper, slightly extend and lift, then return to original spot. Once Qi arrives, apply previous methods again. This is called "Retaining Qi Method." For Ascites, Diaphragmatic Qi, and bloating: after inserting, balance tonification/reduction and regulate Qi. Move the needle up/down nine inserts and six withdrawals, rotating left/right a thousand times until balanced. This is called "Zi-Wu Pestle." For damaged meridians with red eyes, early-stage carbuncles/swellings: advance thumb forward to twist left, then retreat thumb backward to twist right, alternating left-right for three nines (27 counts). When Qi arrives, push forward and inward, flick the needle butt with the thumb to attract Yang Qi, press and lift to calm Qi. If ineffective, repeat. This is the "Dragon-Tiger Interaction" method. For miscellaneous diseases needing single-point needling, apply this after *De Qi*, or upon needle withdrawal.

Unblocking and Extracting:

"Unblocking" means unblocking Qi, used after lifting and thrusting. For patient's left-hand Yang meridians: advance right thumb forward nine counts, tilt the needle head, apply tonification by exerting effort with the thumb, aim the needle mouth toward the disease site (up, down, left, or right), hold firmly until the patient feels heat. If Qi remains blocked, use Dragon, Tiger, Turtle, Phoenix flying-through-meridian connecting-Qi methods to drive and circulate it. For patient's left-hand Yin meridians: retreat right thumb backward nine counts, tilt the needle head, apply tonification by exerting effort with the thumb, aim needle toward disease, hold until patient feels heat. Right-hand Yang meridians follow Left-hand Yin method; Right-hand Yin meridians follow Left-hand Yang method; Left-foot Yang meridians follow Right-hand Yang method; Left-foot Yin meridians follow Right-hand Yin method; Right-foot Yang meridians follow Left-hand Yang method; Right-foot Yin meridians follow Left-hand Yin method. Like receding tide, each cycle tonifies six then reduces nine, regardless of count, until the tide recedes. Pain relief uses this same method. Numbness/itching treated by tonifying Deficiency; pain treated by reducing Excess. These are deductions by sages from the *Nei Jing* unblocking Qi methods, including Taking Qi, Doubling Qi, and Connecting Qi. "Taking" means taking from Left to Right, Right to Left, Hand to Foot, Foot to Head, Head to Hand/Foot Yang meridians, Chest/Abdomen to Hand/Foot Yin meridians. The healthy side is the Main, the diseased side is the Response. For curled spasms in both hands, use both feet as Response. For curled spasms in both feet, use both hands as Response. Insert Main needle first, then Response needle; after Main needle Qi moves, insert Response needle. Left side (Left hand/foot) follows Hand method; Right side is similar. First Double Qi and Connect Qi, then Take Qi. Hands tonify/reduce, Feet reverse (tonify hand/reduce foot), like twisting a rope. For chronic hemiplegia and severe curling spasms, this method must be used after lifting/thrusting. Mr. Xu said: Unblocking and Connecting Qi methods have fixed breath-inch measurements. Hand/Foot Three Yang meridians: up nine, down fourteen, crossing meridians four cun; Hand/Foot Three Yin meridians: up seven, down twelve, crossing meridians five cun. Depending on insertion/extraction, breathing is the same method. Up/down connection yields immediate results. Fixed breath-inch measurements: Hand Three Yin from chest to hand, 3 chi 5 cun long, total 2 zhang 1 chi; Hand Three Yang from hand to head, 5 chi long, total 3 zhang; Foot Three Yang from head to foot, 8 chi long, total 4 zhang 8 chi; Foot Three Yin from foot to abdomen, 6 chi 5 cun long, total 3 zhang 9 chi; Yin/Yang Qiao meridians from foot to eye, 7 chi 5 cun long, total 1 zhang 5 chi; Du Mai 4 chi 5 cun; Ren Mai 4 chi 5 cun. All meridians total 16 zhang 2 chi. They circulate Blood and Qi, connect Yin and Yang to nourish the body, while collateral vessels transmit continuously without cessation.

First is Green Dragon Swinging Tail: hold needle head tilted toward disease with two fingers, like steering a ship's wheel, holding firm without rotating, swing left and right slowly for nine counts, or three nines (27 counts), allowing Qi to circulate throughout the body. Second is White Tiger Shaking Head: hold needle butt with two fingers, lightly rotate the needle head inside the flesh, like an oar in a boat going downstream, shake for six counts, or three sixes (18 counts). To move Qi forward, press behind; to move Qi backward, press in front. Both methods can be used for mild diseases to agitate Qi and Blood. Dragon represents Qi, Tiger represents Blood. On Yang days, perform Dragon then Tiger; on Yin days, perform Tiger then Dragon. Third is Grey Turtle Probing Cave: hold needle head tilted with two fingers, one retreat and three advances, drill upward once, downward once, leftward once, rightward once, starting top-down, left-right, like digging into earth. Fourth is Red Phoenix Welcoming Source: hold needle with two fingers, insert to Earth level, lift to Great (Heaven?) level, wait for needle to shake naturally, advance to Human level, fly and rotate around up/down/left/right, like spreading wings. For diseases above, withdraw on inhalation; for diseases below, advance on exhalation. Also, scrape from needle butt to shaft with thumb nail (Scraping method). Can relieve unbearable pain, dissipate accumulated wind. In the afternoon, scrape from shaft to butt. Also said: for diseases above, scrape upward; for diseases below, scrape downward. For spasms, frequently scrape, cut, guide, and grasp. These two methods must be performed 3-5 times consecutively; Qi and Blood follow meridians, the wonder of flying and moving lies here, and pathogens retreat. Leave the needle for half a shichen (one hour). Lift the needle head, examine if needle feels very heavy and tight; if so, reduce nine, tonify six. If not very tight, reduce six, tonify nine. After tonification/reduction, if needle is loose, shake and withdraw. "Grasping" means using the thumb nail to cut up and down along the meridian, allowing Qi to pass freely.

Shaking and Withdrawing, opening the exterior gate to close the spirit.

"Shaking" means withdrawing. Hold needle butt with two fingers, shake up/down/left/right five to seven times, lift fourteen times, to disperse various Winds. Withdraw needle only when slightly loose, leaving a bean-sized hole. If pathogen sucks the needle and Healthy Qi has not recovered, wait after tonification/reduction. If difficult, frequently add scraping/cutting; after scraping, reduce three times, then use Searching method, no specific count. Horizontal searching: like Dragon-Tiger interaction, left-right, but faster hand movement. Vertical searching: up-down, like twisting without rotating, reduction/scraping same as before. Next, Plate Needle: rotate left nine times, right six times, reduction/scraping same as before. Next, Zi-Wu Pestle: after Zi hour, lift slowly; after Wu hour, lift slightly faster, slowly lift/thrust, shake out Response needle, then withdraw Main needle. For tonification, inhale...