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(From *Ling Shu: Nine Needles and Twelve Origins*, *Xiao Zhen Jie*, *Su Wen: Bao Ming Quan Jiao Lun*)

In all cases of using acupuncture, for deficiency patterns (Xu Zheng), apply tonification to make them solid; for fullness patterns (excess of pathogenic factors), apply sedation to drain them.
(From *Ling Shu: Nine Needles and Twelve Origins*). This chapter discusses the essentials of acupuncture, relying entirely on determining deficiency and excess to decide between tonification and sedation. "Solidifying" refers to tonification, and "draining" refers to sedation.) For stagnation and old blood, remove it; for overwhelming pathogenic factors, weaken them. ("Wan" is synonymous with "Yu," meaning stagnation; "Chen" means accumulation. Removing it eliminates internal stasis; weakening it drains the pathogenic factors.) The general principle states: Slow insertion and rapid withdrawal with immediate pressure constitutes tonification (making deficiency solid); rapid insertion and slow withdrawal without immediate pressure constitutes sedation (making excess empty). (Slow withdrawal with rapid pressing belongs to tonification, thus deficiency can become solid; rapid withdrawal with slow pressing belongs to sedation, thus excess can become empty.) Discussing tonification and sedation, the sensation may seem present or absent. (The application of tonification and sedation lies in perceiving the presence or absence of Jing Qi. Since Jing Qi is formless, the sensation seems present or absent. Those skilled in observation can grasp this through spiritual insight between existence and non-existence.) Observe the sequence of treatment, the sensation may seem lingering or gone. (Observing the sequence involves seeking the urgency of the disease to determine the order of treatment; the sensation seeming lingering or gone involves observing whether Jing Qi is moving or not, thereby deciding whether to retain or withdraw the needle.) Determine deficiency and excess, the feeling may be one of gain or loss. (Desiring to make deficiency deficient [corrected context: making deficiency solid] and excess excess [corrected context: making excess empty] indicates mastering the method. Crude practitioners act recklessly and lose the correct method.) The essence of deficiency and excess lies in the Nine Needles being most excellent, (as each has its specific suitability.) The timing of tonification and sedation is manifested through the needle. (Whether to tonify or sedate depends on the timing, specifically at the moment when Qi converges. Details follow below.) When applying sedation, hold the needle firmly and insert it steadily, release and withdraw it, push aside the Yang aspect to allow entry, so that pathogenic Qi can be drained. (When applying sedation, one must hold the needle firmly and insert it sharply. Releasing and withdrawing implies taking advantage of the arrival of Qi, withdrawing rapidly and pressing slowly. Thus, one can open the Yang channels to drain pathogenic Qi.) After withdrawing the needle, press the acupoint and guide the needle out; this is called "Nei Wen" (internal warming), ensuring blood does not scatter and Qi does not escape. (When applying tonification, one must press the acupoint and draw back the needle, which is called Nei Wen, so that blood remains undisturbed and Qi does not escape, thereby transforming deficiency into solidity.) When applying tonification, follow the flow of Qi; mentally, it should feel as if no manipulation is occurring; movements should be like walking or pressing, light as a mosquito or horsefly landing. (The following describes tonification methods. "Following" means chasing and assisting the departing Qi. "Wang" means illusory or traceless. Mental state of Wang implies understanding between existence and non-existence. Like walking or pressing refers to promoting Qi flow and pressing the site. Like a mosquito landing implies techniques should be light, traceless, and precise.) Retain the needle appropriately, withdraw it quickly; withdrawal should be swift like a breaking bowstring. (Retain refers to retaining the needle; Huan refers to withdrawing the needle. Qu Ru Xian Jue describes swiftness and agility, achieving tonification without damage.) Let the left hand assist the right, stopping the leakage of Qi; the external gate closes, and the central Qi becomes solid. (Withdrawing with the right hand while the left immediately presses and covers the point is "Left belonging to Right." Thus, the external gate closes, and internal Central Qi solidifies.) Do not leave behind stagnant blood; take urgent measures to eliminate it. (When treating collateral vessels, do not allow stagnant blood to remain; it should be removed promptly.) The principle of holding the needle values firmness and strength; point straight and pierce directly, avoiding deviation left or right. (Firm and strong force reaches the disease site directly. Straight and unslanted ensures hitting the acupoint accurately.) Focus spirit on the finest details (autumn down), attend to the patient, examine the blood vessels carefully, and acupuncture will be free from danger. (The physician's spiritual perception focuses on minute details, requiring precision and attention to the patient, carefully examining blood vessels before needling, thus avoiding peril.) During needling, one must elevate the Spirit (Xuan Yang) and protect the Two Wei (Defensive Qi). (Xuan means to raise; Yang refers to Spirit/Qi. In needling, one must first elevate the Spirit. The Two Wei refer to Defensive Qi protecting the muscle-surface (Yang) and Spleen Qi protecting the organs (Yin). Both are dwellings of Spirit and must not be harmed; practitioners must prioritize guarding these, hence "Two Wei." The *Shi Chuan* chapter states: The Spleen governs Defense. See Zang-Xiang Category 29.) Keep the spirit focused and do not depart, knowing whether the disease will survive or perish. (This is the meaning of Xuan Yang; thus, survival or demise depends on it.) Blood vessels lie horizontally under the skin; they appear clear upon inspection and feel firm upon palpation. (The above discussed the dwelling of Spirit; this discusses the location of blood vessels. "Clear upon inspection" requires searching for hidden aspects; "firm upon palpation" requires addressing the root cause.)

The Yellow Emperor asked: How does one make excess empty? How does one make deficiency solid? (From *Su Wen: Bao Ming Quan Jiao Lun*. The following discusses treatments for deficiency and excess, along with precautions.) Qibo replied: To treat deficiency, ensure solidity is achieved; to treat excess, ensure emptiness is achieved. Once Jing Qi arrives, guard it carefully and do not lose it. Depth and distance are governed by intention, consistent in principle regardless of location. Be like facing an abyss, hold the needle like grasping a tiger, let the spirit not be distracted by other things. (Detailed notes for this section are below.)

*Xiao Zhen Jie* states: "Making deficiency solid" means the pulse at the Cun Kou is weak and requires tonification. "Draining fullness" means the pulse at the Cun Kou is vigorous and requires sedation. (This and the following *Zhen Jie* chapter explain the previous chapter. Here, deficiency and excess are discussed via the Cun Kou pulse, whereas there, they are discussed via the arrival of Qi under the needle. Although the meanings seem different, they complement each other and should both be examined.) "Removing stagnation and old blood" means removing blood from the vessels. "Weakening overwhelming pathogens" means draining excess in any meridian. (Saying "drain the pathogen" here is consistent with the meaning of not pressing after withdrawal in the text below.) "Slow insertion and rapid withdrawal makes solid" means slow insertion and rapid withdrawal. "Rapid insertion and slow withdrawal makes empty" means rapid insertion and slow withdrawal. (These two phrases seem contradictory in explanation; the interpretation in the *Zhen Jie* chapter below is preferred.) "Discussing excess and deficiency as if present or absent" means excess has Qi, while deficiency lacks Qi. "Observing sequence as if lingering or gone" refers to the sequence of tonification and sedation based on the deficiency or excess of Qi, observing whether Qi has retreated or persists. ("Retreated" means subsided.) "For deficiency and excess, feeling gain or loss" means tonification feels like gaining something, while sedation feels like losing something. (This explanation differs from the lower compilation but both interpretations are valid. Bi sound bì, from *Shi Jing*: Wei Yi Di Di.)

*Zhen Jie Chapter*: The Yellow Emperor asked: I wish to hear the explanation of the Nine Needles and the way of deficiency and excess. (From here to "timing of tonification and sedation" and the names of the Nine Needles, all explain the meaning of the previous *Nine Needles and Twelve Origins* chapter.) Qibo answered: Treating deficiency to make it solid results in heat under the needle, as excess of Yang Qi produces heat. Draining fullness results in cold under the needle, as deficiency of Qi produces cold. (Heat under the needle changes from cold to hot; heat indicates the arrival of healthy Qi, transforming deficiency into solidity, hence tonification. Cold under the needle changes from hot to cold; cold indicates the departure of pathogenic Qi, transforming excess into emptiness, hence sedation. This explanation should be read in conjunction with the above commentary.) "Removing stagnation and old blood" means evacuating foul blood. "Weakening overwhelming pathogens" means not pressing the needle hole after withdrawal. (Not pressing after withdrawal is draining the pathogen. In the classic, Wan and Wan are interchangeable, commonly written as Yu.) "Slow insertion and rapid withdrawal makes solid" means slow withdrawal and rapid pressing. "Rapid insertion and slow withdrawal makes empty" means rapid withdrawal and slow pressing. (Withdrawing slowly after Qi arrival prevents meridian injury; pressing rapidly prevents leakage of True Qi. This is tonification, hence solidifying. Withdrawing rapidly after reaching the disease site and pressing slowly allows stagnation to move and pathogens to depart. This is sedation, hence emptying.) "Discussing excess and deficiency" refers to the degree of cold/warmth and the amount of Qi. (Cold represents deficiency, warmth represents excess; less Qi is deficiency, more Qi is excess.) "As if present or absent" means the change is too fast to perceive. (The presence or absence of Qi arrival, and the deficiency or excess under the needle, are indeed difficult to know. Because it is fast, it seems absent; because it can be observed clearly, it seems present.) "Observing sequence" means knowing the priority of the disease. (Disease has root and branch; the primary/earlier aspect is the root, the secondary/later aspect is the branch.) "For deficiency and excess" the practitioner must not lose the method. "Feeling gain or loss" means deviating from the method. (Deficiency requires tonification, excess requires sedation; the method cannot be lost. Feeling gain or loss indicates crude practitioners acting recklessly and deviating from the method.) "The essence of deficiency and excess, the Nine Needles are best" because each is suitable for specific situations. (The use of the Nine Needles varies by suitability. See the first two chapters.) "Timing of tonification and sedation" harmonizes with the opening and closing of Qi. (Qi arrival at the appropriate time is Opening; past or not yet arrived is Closing. The timing of tonification and sedation relates to the daily circulation of Qi through the meridians, which occurs fifty times a day, with specific times for each meridian, as described in the Circulation of Ying and Wei Qi chapters. Thus, the *Wei Qi Xing* chapter says: Carefully await the location of Qi to needle, this is called meeting the time. This is the timing of tonification and sedation. Also, Qi arrival under the needle is Opening, allowing迎 (meeting) and sedation; Qi departure is Closing, allowing 随 (following) and tonification. These are the meanings of needle and Qi opening/closing harmony.) The Nine Needles have different names and shapes because they exhaust the possibilities for tonification and sedation. (Different shapes mean different applications for tonification and sedation.)

To make excess empty, retain the needle until Yin Qi arrives abundantly, then remove the needle. To make deficiency solid, wait until Yang Qi arrives abundantly and the needle feels hot, then remove the needle. (From here to "spirit not distracted by many things" explains the *Bao Ming Quan Jiao Lun*. Abundant Yin Qi arrival causes cold under the needle; Yang pathogens retreat, excess becomes empty. Abundant Yang Qi arrival causes heat under the needle; Yuan Qi recovers, deficiency becomes solid. Thus, the needle can be removed in both cases.) "Jing Qi has arrived, guard carefully and do not lose it" means do not change the treatment plan. (Guarding carefully and not changing warns against indecision and confusion, which brings harm rather than benefit.) "Depth in intention" means knowing if the disease is internal or external. (Internal diseases require deep needling, external diseases require shallow needling; this must be kept in mind and not ignored.) "Near and far as one" means the criteria for obtaining Qi are equal regardless of depth. (Deep needling obtains Qi from afar, shallow needling from near; although distances differ, the criterion of obtaining Qi is the same.) "Like facing an abyss" means not being negligent. (Conduct yourself with reverence and caution during needling.) "Hand like grasping a tiger" means desiring strength. (Holding the needle like a tiger implies firmness and strength.) "Spirit not distracted by other things" means quietly observing the patient, not looking left or right. (If the spirit is unsettled, it starts with the eyes; quiet eyes lead to quiet spirit, quiet spirit leads to focused will. Observing the disease quietly prevents error, hence no looking left or right.) "Meaning no oblique insertion" means desiring uprightness. (This corresponds to the previous chapter's meaning of pointing straight and piercing directly without deviation.) "Must rectify the spirit" means gazing at the patient's eyes to control their spirit, facilitating Qi movement. (The eyes are the orifices of the spirit. To rectify the patient's spirit, gaze at their eyes, restrain their mental scattering, so that Qi is guided by spirit and the vessel pathways move easily.)

Regarding "San Li" (Three Mile), it is three cun below the knee. (There are two San Li points; this refers to Zusanli, an acupoint of the Foot-Yangming Stomach Meridian. Note: The following content discusses acupoint selection methods, which does not fit the context of this chapter; it is likely a textual error where text from another chapter was misplaced here.) Regarding "Fu Zhi" (Foot Top), lifting the knee makes it visible. ("Fu Zhi" should be "Fu Shang," referring to Chongyang, an acupoint of the Foot-Yangming Stomach Meridian. Since Zusanli and Chongyang are on the same continuous meridian, pressing heavily below Zusanli while lifting the knee makes the Chongyang pulse disappear, so lifting the knee crease makes it easy to see.) Regarding "Ju Xu" (Great Void), it is found in the depression when raising the foot. (There are two Ju Xu points: Shang Lian and Xia Lian. Qiao means to raise. This states that Shang Lian of Ju Xu is located in the distinct depression on the lateral side of the fibula when the foot is raised.) Regarding "Xia Lian" (Lower Lian), it is in the lower depression. (This refers to Xia Lian of Ju Xu, located below the distinct depression mentioned above; the distance between Shang Lian and Xia Lian is approximately three cun.)