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In spring and summer, one must necessarily elicit a Yin qi; in autumn and winter, one must necessarily elicit a Yang qi. Why is this? The answer is: In spring and summer, when the climate is warm, one must elicit a Yin qi. This is because upon initial needle insertion, the needle is thrust deeply to the regions of the Kidney and Liver (Shèn Gān). Upon obtaining Deqi (arrival of Qi), the needle is held and drawn towards the Yin aspect. In autumn and winter, when the climate is cold, one must elicit a Yang qi. This is because upon initial needle insertion, the needle is inserted shallowly and floated to the regions of the Heart and Lung (Xīn Fèi). Upon obtaining Deqi, the needle is pushed inward to elicit the Yang aspect. This is what is meant by "in spring and summer, one must necessarily elicit a Yin qi; in autumn and winter, one must necessarily elicit a Yang qi."

The preceding text discusses the principle of obtaining Qi during needling; this text discusses the method of guiding Qi during needling, aiming to conform to the principles of Yin and Yang changes across the four seasons. It means that in spring and summer, the initial needle insertion should be deep, reaching the deep regions of the Kidney and Liver, to obtain their Yin Qi, after which the needle is held and guided to the superficial regions of the Heart and Lung for retention. In autumn and winter, the initial needle insertion should be shallow, reaching the superficial regions of the Heart and Lung, to obtain their Yang Qi, after which the needle is pushed into the deep regions of the Kidney and Liver for retention.

Difficulty 71 states: The medical classics say, "When penetrating Ying (Nutrient) vessels, do not injure Wei (Defensive) vessels; when penetrating Wei vessels, do not injure Ying vessels." What does this mean? The answer is: To needle Yang aspects (Wei vessels), the needle should be laid horizontally (oblique insertion). To needle Yin aspects (Ying vessels), use the left hand first to press and knead the acupoints of the Ying and Shu categories where the needle is to be inserted. Once the Qi has dispersed, insert the needle. This is called "penetrating Ying without injuring Wei, and penetrating Wei without injuring Ying."

This passage discusses the methods of needle depth. Horizontal needling implies an oblique angle, resulting in shallow insertion that does not injure Ying blood. Pressing with the left hand disperses Wei Qi before insertion, allowing for deep insertion that does not injure Wei Qi.

Difficulty 72 (erroneously listed as Difficulty 80) states: The medical classics mention "Ru You Ru Ru" (Entering as seen) and "Ru You Ru Chu" (Exiting as seen). What does this mean? The answer is: By "Ru You Ru Ru," it means that when the left hand perceives the arrival of Qi, the needle is inserted. After the needle is inserted, when it is perceived that the Qi has exhausted, the needle is withdrawn. This is called "Ru You Ru Ru" and "Ru You Ru Chu."

This explains the meaning of inserting the needle upon waiting for Qi to arrive and withdrawing it upon waiting for Qi to exhaust. The character "Ru" (as/if) was commonly used interchangeably with "Er" (and) in ancient times.

Difficulty 73 states: All Jing-Well points have thin muscle and scarce Qi, insufficient for treatment. How should they be needled? The answer is: All Jing-Well points belong to Wood, and all Ying-Spring points belong to Fire. Fire is the child of Wood. When one needs to needle a Jing-Well point, one should needle the Ying-Spring point to drain it. Thus, the classics say, "Tonification cannot be used as drainage, and drainage cannot be used as tonification." This refers to this principle.

Jing-Well points belong to Wood, which is the mother of Fire. Ying-Spring points belong to Fire, which is the child of Wood. For example, in cases of Kidney Excess, one should drain the Jing-Well Wood point. However, Jing-Well Wood points are located at the tips of the fingers and toes, where flesh is thin and Qi is scarce, making them unsuitable for direct treatment. Therefore, one needles the Ying-Spring point. This is known as "draining the child to make the mother deficient." If one were to abandon the Ying-Spring point and needle the Shu-Stream point instead, Earth Qi would become deficient and fail to control Water Qi, causing Kidney pathogenic factors to become even more excessive. If one were to needle the Jing-River point, Metal generates Water, and Kidney pathogenic factors would inevitably worsen. Hence, it is said that when needling a Jing-Well point, one should use the Ying-Spring point to drain it. Therefore, the classics state, "Tonification cannot be used as drainage, and drainage cannot be used as tonification."

Difficulty 74 states: The medical classics say, "In spring, needle Jing-Well; in summer, needle Ying-Spring; in late summer, needle Shu-Stream; in autumn, needle Jing-River; in winter, needle He-Sea." Why is this? The answer is: Spring needling of Jing-Well points addresses pathogens in the Liver; Summer needling of Ying-Spring points addresses pathogens in the Heart; Late Summer needling of Shu-Stream points addresses pathogens in the Spleen; Autumn needling of Jing-River points addresses pathogens in the Lung; Winter needling of He-Sea points addresses pathogens in the Kidney. Why are these five Zang organs (Liver, Heart, Spleen, Lung, Kidney) associated with spring, summer, late summer, autumn, and winter respectively? The answer is: A disease in one Zang organ often manifests with five signs. For instance, in Liver disease, a green complexion indicates the Liver; a fishy odor indicates the Liver; preference for sour taste indicates the Liver; a tendency to shout indicates the Liver; a tendency to weep indicates the Liver. There are many such symptoms, impossible to list entirely. The four seasons have their respective numbers and are all associated with spring, summer, late summer, autumn, and winter. The subtlety of needling lies in being as meticulous as observing the finest down of autumn.

This chapter discusses the needling of Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points according to the four seasons. It does not mean that one *only* needles Jing-Well points in spring, but rather that when the pathogen is in the Liver, one needles the Jing-Well point. Since Jing-Well points belong to Wood and correspond to Spring, it is said that "Spring needles Jing-Well." The same applies to other organs. The question arises why the Liver, Heart, Spleen, Lung, and Kidney correspond to spring, summer, late summer, autumn, and winter. Thus, the manifestations of Liver Wood—green color, fishy odor, sour taste, shouting, and weeping—are cited again to clarify that although diseases of the five Zang and six Fu organs are numerous, they are all unified under the Five Elements (Metal, Wood, Water, Fire, Earth), just as the four seasons have fixed numbers and are associated with spring, summer, late summer, autumn, and winter. However, the key subtlety lies in distinguishing the Zang organs, as clearly as observing autumn down. Therefore, the next chapter further clarifies the principles of Yin and Yang of the Zang organs.

Difficulty 75 (erroneously listed as Difficulty 51) states: Some patients desire warmth, some desire cold, some wish to see people, and some do not wish to see people. These desires differ. Which Zang or Fu organ is diseased? The answer is: Patients who desire cold and wish to see people have disease in the Fu organs. Patients who desire warmth and do not wish to see people have disease in the Zang organs. Why is this so? Fu organs belong to Yang; Yang diseases desire cold and wish to see people. Zang organs belong to Yin; Yin diseases desire warmth and wish to close doors and stay alone, detesting human voices. Thus, one distinguishes Zang and Fu diseases by these preferences.

The first three volumes distinguished Zang and Fu organs through pulse diagnosis, treating disease by palpating the pulse. This volume distinguishes Zang and Fu organs through patient desires, treating disease by inquiring about emotional states.

Difficulty 76 (erroneously listed as Difficulty 78) states: Needling involves tonification and drainage. What does this mean? The answer is: The methods of tonification and drainage do not necessarily depend on respiration during needle insertion and withdrawal.

(Insertion during exhalation and withdrawal during inhalation is tonification; insertion during inhalation and withdrawal during exhalation is drainage.) This chapter states that it is not merely about this, but primarily about obtaining Deqi. The meaning follows in the subsequent text.

The answer is: One who understands needling trusts the left hand; one who does not understand needling trusts the right hand. At the time of needling, one must first use the left hand to press and knead the Ying-Spring and Shu-Stream acupoints, flick the area to make it prominent, and mark it with fingernails. When Qi arrives, resembling the pulsation of an artery, insert the needle along its direction. Upon obtaining Deqi, push the needle inward; this is tonification. Shake and extend the needle outward; this is drainage. If Deqi is not obtained, apply different techniques for males and females. If Deqi is still not obtained, it indicates ten incurable conditions. ("Yan" is synonymous with "Ya," meaning press.)

One who understands needling is a skilled practitioner. Using the left hand to press Ying-Spring points allows knowledge of muscle thickness, bone-tendon structures, and clefts, ensuring accurate point selection. Then, using the right hand, the needle is inserted. One who does not understand needling does the opposite. Whenever needling, one must first flick with the left hand to gather Qi and pulses until they resemble arterial pulsation. Mark the true point with nails and insert the needle, waiting for Qi to respond.

Then, push the needle to the appropriate depth; this is tonification. If Deqi is obtained, immediately shake and lift the needle; this is drainage. If Qi does not arrive after prolonged retention, float the needle in the Wei level, rotate left to await Qi. If it still does not arrive, sink the needle into the Ying level, rotate right to await Qi. If it still does not arrive, it indicates exhaustion of both Yin and Yang Qi, which is incurable. The terms male and female here refer to left and right hands.

Difficulty 77 (erroneously listed as Difficulty 76) states: What are tonification and drainage? When tonifying, from where is Qi taken? When draining, where is Qi placed? The answer is: When tonifying, take Qi from the Wei level; when draining, place Qi from the Ying level. If Yang Qi is deficient and Yin Qi is excessive, one must first tonify Yang and then drain Yin. If Yin Qi is deficient and Yang Qi is excessive, one must first tonify Yin and then drain Yang. The free circulation of Ying and Wei Qi is the essence. (Yang Qi is equivalent to Wei Qi; Yin Qi is equivalent to Ying Qi.)

This discusses the methods of tonification and drainage in needling. To tonify, take Qi from the Wei level with shallow needling. Wait for Deqi, then push the needle into the deficient area. To drain, place Qi from the Ying level with deep needling into the excess area. Wait for Deqi, then withdraw the needle to release it. This is the major principle of tonification and drainage.

Difficulty 78 (erroneously listed as Difficulty 12) states: The medical classics say, "When the pulse of the five Zang organs is exhausted internally, the practitioner mistakenly reinforces the exterior. When the pulse of the five Zang organs is exhausted externally, the practitioner mistakenly reinforces the interior." How are internal and external exhaustion distinguished? The answer is: Internal exhaustion of the five Zang pulses refers to the exhaustion of Kidney and Liver pulses internally. If the physician mistakenly tonifies the Heart and Lung, and external exhaustion refers to the exhaustion of Heart and Lung pulses externally, if the physician mistakenly tonifies the Kidney and Liver, tonifying Yin when Yang is exhausted and tonifying Yang when Yin is exhausted, this is called "reinforcing excess and depleting deficiency," damaging what is insufficient and adding to what is already excessive. Death resulting from this is caused by the physician.

The "pulse" mentioned here refers to the meridians needled, not the Cun-Guan-Chi pulse positions. "Exhausted" means Qi does not arrive. "Internal and external" refer to Ying/Wei, Yin/Yang, upper/lower. This warns that ignorance of tonification and drainage methods can lead to death. The following text details these methods.

Difficulty 79 states: The medical classics say, "Attacking and seizing [pathogens], how can there not be deficiency? Following and assisting [Qi], how can there not be excess?" Also, "Deficiency and excess are like gaining or losing; excess and deficiency are like having or not having." What does this mean? (Meaning follows below.)

The answer is: "Attacking and seizing" refers to draining the Child element. "Following and assisting" refers to tonifying the Mother element. For example, in Heart disease, draining the Shu-Stream point of the Pericardium (Daling, PC-7) is called "attacking and seizing." Tonifying the Jing-Well point of the Pericardium (Zhongchong, PC-9) is called "following and assisting." The phrase "excess and deficiency" refers to the sensations of firmness and softness. A Qi response that is firm and solid indicates successful acquisition (Deqi); a soft and empty sensation indicates failure. Hence, it is said, "like gaining or losing."

Shu-Stream points belong to Earth; draining them in Heart disease drains the Child. Jing-Well points belong to Wood; tonifying them in Heart disease tonifies the Mother. "Ru" (soft) implies softness; "Lao" (firm) implies hardness. Gain and loss equate to having and not having. Heart disease here refers to Pericardium disease.

Difficulty 80 (erroneously listed as Difficulty 72) states: The medical classics say, "If one knows the Qi of Attacking and Following, regulation can be achieved. The method of regulating Qi must lie in Yin and Yang." What does this mean? The answer is: "Attacking and Following" means knowing the flow of Ying and Wei Qi and the course of the meridians. Taking points according to their reverse or forward directions is called Attacking and Following. The method of regulating Qi must lie in Yin and Yang means understanding internal/external and interior/exterior, and regulating according to Yin and Yang imbalances. Hence, it is said that the method of regulating Qi depends on Yin and Yang.

This discusses regulating Qi by needling according to reverse or forward directions. Regulating Qi involves examining Yin/Yang and interior/exterior to administer medication or treatment.

Difficulty 81 states: The medical classics say, "Do not reinforce excess, do not deplete deficiency; do not damage the insufficient and benefit the excessive." Does this refer to the Cun-Kou pulse, or does disease inherently possess excess and deficiency? How are these damages and benefits manifested? The answer is: This does not refer to the Cun-Kou pulse, but to the inherent excess and deficiency of the disease itself. For example, Liver Excess and Lung Deficiency. The Liver belongs to Wood, and the Lung belongs to Metal. Metal and Wood should balance each other. One must understand that Metal controls Wood. Suppose the Lung is Excess; thus, the Liver is known to be slightly deficient in Qi. If needling is used to tonify the Liver, but instead the Lung is heavily reinforced, this is called "reinforcing excess and depleting deficiency," damaging the insufficient and benefiting the excessive. This is the harm caused by average physicians.

Although this chapter continues the discussion on needling tonification and drainage, it actually summarizes the entire major principles, implying repeated caution. Specifically citing the classic warning against "reinforcing excess, depleting deficiency, damaging the insufficient, and benefiting the excessive" highlights the strictness of medical theory regarding excess and deficiency. Errors in excess and deficiency carry immediate dangers. Hence, this earnest admonition is provided. As discussed in earlier volumes regarding arterial convergence at Cun-Kou, the twelve meridians' Zang-Fu associations, Cun-Guan-Chi pulse positions, pulse qualities (string-like, hook, hair, stone) corresponding to seasonal fluctuations, and extensions to Mingmen, Sanjiao, extraordinary vessels, Yin/Yang invasions, Fu-Yi/Guan-Ge patterns, Six-Jia flourishing pulses, damage/reduction pulse symptoms, five evils/five turbidities, Shaoyang accumulation, Jue pain, mania, epilepsy, etc., are all detailed comprehensively. Yet, fearing that later generations may not understand the innate generation and restriction cycles of the five Zang organs, aiming for balance, it states, "This is not about the Cun-Kou pulse, but that disease has its own excess and deficiency." This phrase "disease has its own excess and deficiency" reveals a method beyond standard methods. Grasping this aligns with the classic principle of "treating disease before it arises." Generally, pulse excess/deficiency manifests due to disease; there is no case where disease shows excess/deficiency but the pulse does not reflect it. Now, saying "inherent excess and deficiency" refers to the mutual restraint dynamics within the five Zang organs, distinct from pulse-based excess/deficiency analysis. For instance, Liver Excess and Lung Deficiency imply Liver Wood is constrained by Lung Metal. Because Lung Deficiency fails to constrain Liver, Liver appears Excess. Treating Liver Excess directly would be wrong. The physician should tonify Lung Metal Deficiency, allowing the Lung to naturally constrain the Liver. Conversely, if Lung Excess and Liver Deficiency exist, the Lung (which constrains Liver) over-constrains the Liver. Merely tonifying Liver Deficiency without addressing its source is also incorrect. The physician should drain Lung Metal Excess, allowing Liver Wood to flourish freely. If one cannot address the source of deficiency, merely knowing excess and deficiency avoids major errors. However, those who ignore mutual restraint dynamics and mistakenly tonify excess while draining deficiency, damaging the insufficient and benefiting the excessive, will turn mild cases severe and severe cases fatal. This is the harm of average physicians. Using Liver and Lung as examples, other organs can be inferred. Should not students be vigilant and alert? Someone asks: Why does the *Nanjing* end at Difficulty 81? I reply: Bian Que fully embodies the intent of Xuanyuan (Yellow Emperor) and Qibo, respecting the classics. The *Suwen* (Nine Volumes) is divided into 81 chapters; the *Lingshu* (Nine Volumes) is also divided into 81 chapters, totaling 18 volumes. Later scholars split them into 12 or 24 volumes, disrupting the ancients' intent and disrespecting the classics. Verification with *Lingshu* and *Suwen* confirms this. In *Suwen: Li He Zhen Xie Lun*, the Yellow Emperor asks: "I heard of nine needles and nine chapters. Sir multiplied nine by nine, resulting in eighty-one chapters. I have understood their meaning." In *Lingshu: Jiu Zhen Lun*, Qibo says: "The sage establishes the numbers of heaven and earth. One becomes nine, establishing the Nine Fields. Nine times nine is eighty-one, initiating the number of Huangzhong." Thus, one knows that Heaven and Earth's great virtue is life, valuing the number nine repeatedly. Therefore, Xuanyuan and Qibo composed the *Neijing*, embodying the way of heavenly Yang birth, conforming to the number eighty-one. The eighty-one difficulties of the *Nanjing* integrate seamlessly with the *Neijing*, responding head to tail, possessing complete spiritual coherence. Is this not Bian Que fully embodying the intent of Xuanyuan and Qibo, respecting the classics?

Master Zhongfeng stated: I have seen many commentaries on the *Nanjing*, none of which probed the author's mind, merely elaborating on the text without mentioning the profound coherence. Reading this commentary, I realize Bian Que drew upon the meanings of the eighteen volumes of *Lingshu* and *Suwen*, respecting their order and summarizing their essentials, integrating them into these eighty-one difficulties. Students who study this thoroughly will find the eighteen volumes of *Lingshu* and *Suwen* logically consistent. Zhang Jibin of recent times classified the *Neijing* into sections named *Leijing* for easy reference, similar to儒家 classifications of the Five Classics for convenience. This aims to facilitate quick lookup for beginners, unaware that without continuous Qi and pulse connection, the threads are disjointed, offering little help during clinical practice. From this, I perceive the brilliance of the *Nanjing*: it preserves the *Neijing*'s sequence, utilizing its full spirit. It seems Xuanyuan and Qibo used Bian Que as a medium to create this complementary book. For three thousand years, no one had elucidated this until this commentary clarified it. Is this not also Bian Que using this master as a medium?