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The physical form varies in laxity and tension, vital qi (Zheng Qi) differs in abundance and deficiency, bones vary in size, muscles differ in firmness and fragility, and skin ranges from thick to thin; these factors determine longevity. Therefore, when the physical form and vital qi are balanced (mutually supportive), one lives long; when they are unbalanced, life is short.

When the skin and muscles are tightly enveloped together, one lives long; when they are not, life is short. When blood and qi and the meridians are stronger than the physical form, one lives long; when they are weaker, life is short. Thus, a healthy person whose vital qi exceeds their physical form will live long. However, if a sick person has emaciated flesh but their vital qi still exceeds the physical form, they will die. If the physical form exceeds the vital qi, the condition is critical.

What is meant by the laxity and tension of the form? It is said: Those with a substantial body but lax skin and muscles will live long; those with a substantial body but tense skin and muscles will have a short life; those with a substantial body and firm, large pulses are in a favorable state. If the body is substantial but the pulse is small and weak, it indicates deficient vital qi, which is dangerous. If the body is substantial but the cheekbones are not prominent, it indicates small bones, leading to a short life. If the body is substantial and the large muscles (thighs) are firm with distinct separations, the muscles are firm, indicating longevity. ("Distinct separations" refers to longitudinal striations, i.e., lax skin and muscles as mentioned earlier). If the body is substantial but the large muscles lack texture and are not firm, the muscles are fragile, indicating a short life. These are innate principles of life, used to establish the form and observe qi to judge longevity. One must understand this clearly before treating patients and determining life and death. Therefore, if the "wall base" (lower jaw and surrounding bone structure) is low and does not reach the level of the ears, death occurs before thirty. If illness exacerbates the condition, death occurs before twenty.

Those who live to a hundred years have deep and long nasal passages (Shi Dao), high and square facial structures, smooth and regulated Ying and Wei (Nutritive and Defensive) qi, prominent pulses at the Three Regions and Sanli points, high bones, and full muscles, allowing them to complete their natural lifespan.

At ten years old, the Zang organs begin to stabilize, blood and qi circulate, and qi moves downward, so children like to run. At twenty, blood and qi become abundant, muscles grow, so youths like to walk briskly. At thirty, the Zang organs are fully established, muscles are firm, and blood vessels are full, so adults like to walk steadily. At forty, the Zang organs, Fu organs, and twelve meridians reach peak stability, pores begin to loosen, luster declines, hair turns gray, and the body becomes stable, so middle-aged people prefer sitting. At fifty, Liver qi begins to decline, liver leaves thin, bile decreases, and vision blurs. At sixty, Heart qi declines, sorrow and grief increase, blood and qi become sluggish, so elders prefer lying down. At seventy, Spleen qi is deficient, and skin dries. At eighty, Lung qi declines, Po (Corporeal Soul) disperses, and speech errors occur. At ninety, Kidney qi is exhausted, and the other four Zang organs and meridians are empty. At one hundred, all Zang organs are deficient, Shen (Spirit) departs, and only the corpse remains until death.

Those who do not complete their lifespan die because their Zang organs are not solid, nasal passages are short, external orifices are open, breathing is rapid, the facial base is low, pulses are thin with little blood, muscles are not solid, they frequently suffer wind-cold, blood and qi are deficient, meridians are blocked, true qi and pathogenic factors attack each other, causing chaos and mutual entanglement, leading to premature death.

Pulses manifest at the Qikou (Cunkou) point, colors appear at the Mingtang (nose area). The five colors change according to the five seasons, and the five facial features become distinguishable. When the Que Ting (glabella and forehead) expands, the Mingtang is established. A large Mingtang, visible fan-like coverings (cheeks/ears), square walls with high bases, and visible earlobes indicate harmonious five colors, a flat and broad face, and longevity up to a hundred years. Such individuals have abundant blood and qi and firm muscles, making them suitable for strong needle therapy. If facial features are indistinct, Que Ting is not expanded, Mingtang is small, coverings are hidden, walls are low without a base, and earlobes are outward, such individuals are precarious even when healthy, let alone when ill. (This discusses longevity and brevity of life.)

People vary in color (black/white), build (fat/thin), and size (tall/short). (Over 50 is old, over 20 is strong, under 18 is young, under 6 is small). Each type has specific characteristics.

For robust, strong individuals with abundant blood and qi and firm skin, if pathogenic factors invade, needles should be inserted deeply and retained. This applies to fat people: broad shoulders and necks, thin muscles but thick dark skin, thick lips, dark and turbid blood, and slow, stagnant qi. They tend to be greedy in giving and taking. Needling requires deep insertion, retention, and increased frequency.

Thin people have thin skin, pale complexion, lean muscles, thin lips, and soft speech. Their blood is clear and qi is slippery; qi is easily depleted, and blood is easily damaged. Needling should be shallow and quick.

For normal people, adjust based on black or white complexion. Those with upright and honest builds have harmonious blood and qi; follow standard needling protocols.

For strong individuals with solid bones, firm muscles, and relaxed joints: If heavy/turbid, qi is stagnant and blood is turbid; needle deeply with retention and increased frequency. If agile/firm, qi is slippery and blood is clear; needle shallowly and quickly. ("Heavy" means turbid; "Agile" means swift.)

Infants have fragile muscles, little blood, and weak qi. Use fine needles, insert shallowly, and withdraw quickly. Treatment can be performed twice daily. (This covers needling for fat, thin, normal, strong, and infant types.)

Tolerance or intolerance to pain depends on skin thickness, muscle firmness/fragility, and laxity/tension, not necessarily courage or timidity. Brave soldiers who cannot tolerate pain advance in danger but stop at pain. Timid soldiers who tolerate pain fear danger but remain still at pain. Brave soldiers who tolerate pain neither fear danger nor move at pain. Timid soldiers who cannot tolerate pain show shifting eyes, changing faces, fear, loss of qi, trembling, unstable complexion, and near-death states upon facing danger or pain.

Brave individuals have deep, fixed eyes, straight and raised nasal bridges, horizontal San Jiao textures, upright heart, large and firm liver, and full gallbladder. Anger causes qi to surge, chest to expand, liver to rise, gallbladder to extend, eyes to protrude, hair to stand, and face to turn cyan. This is the nature of bravery.

Timid individuals have large but unfocused eyes, yin-yang imbalance, vertical San Jiao textures, short trachea, loose liver ties, empty and sagging gallbladder, straight intestines, and hollow hypochondrium. Even in great anger, qi cannot fill the chest; although liver and lung qi rise, they quickly sink due to weakness, preventing prolonged anger. This is the nature of timidity. (This discusses pain tolerance and courage/timidity.)

Those with strong bones, weak sinews, lax muscles, and thick skin tolerate pain, including needle and fire therapy. Those with black skin and beautiful bones also tolerate fire. Those with firm muscles and thin skin do not tolerate needle or fire pain. In injuries, those with excess heat recover easily; those with excess cold recover slowly. (In trauma, slippery qi and abundant blood aid recovery; stagnant qi, little blood, and dampness cause lingering ulcers.)

Regarding tolerance to toxic drugs: Those with strong stomach qi, dark complexion, large bones, and obesity can tolerate toxins. Those who are thin with weak stomach qi cannot tolerate toxins. (Those who tolerate toxins can use extreme hot/cold or potent medicinal agents. This section on pain tolerance and drug tolerance is derived from the *Ling Shu*.)