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(Su Wen: Tiao Jing Lun, continuing from the previous chapter)
The Yellow Emperor asked: The medical classics state: When Yang Qi is deficient, there is cold on the exterior; when Yin Qi is deficient, there is heat in the interior; when Yang Qi is excessive, there is heat on the exterior; when Yin Qi is excessive, there is cold in the interior. I have heard of this, but do not understand the mechanism behind it. (The statement "the medical classics say" refers to quoting ancient texts. Yang governs the exterior and its Qi is hot; Yin governs the interior and its Qi is cold. Therefore, deficiency of Yang leads to cold, excess of Yang leads to heat, deficiency of Yin leads to heat, and excess of Yin leads to cold.)
Qi Bo replied: Yang Qi receives its energy from the Upper Jiao (Upper Burner), which warms the skin and muscles. Now, if cold pathogen remains on the exterior, the Upper Jiao becomes obstructed. Obstruction of the Upper Jiao causes the cold pathogen to remain solely on the exterior, resulting in chills. (Cold pathogen on the exterior blocks the pathway of Yang Qi, causing obstruction of the Upper Jiao. Wei Qi (Defensive Qi) fails to warm the surface, allowing cold pathogen to remain alone, leading to chills. This is what is meant by "Yang deficiency leads to exterior cold".)
The Yellow Emperor asked: How does Yin deficiency generate interior heat?
Qi Bo replied: Due to overexertion, the form and Qi become weak and diminished, the Qi of grain and water (Gu Qi) is insufficient, the Upper Jiao cannot function, and the lower Stomach Guan (gate) is blocked. The Stomach Qi becomes hot, and the heat steams the chest cavity, thus generating interior heat. (Xing Qi refers to Yin Qi. The Qi of the Upper Jiao is transformed from the essence of food and drink. Now, due to imprudent labor and fatigue, Xing Qi becomes weak and diminished, injuring Spleen Yin. Thus, insufficient Gu Qi leads to dysfunction of the Upper Jiao; failure of the Upper Jiao leads to blockage of the lower Stomach Guan, resulting in stagnant heat in the Stomach Fu organ steaming the chest. This is what is meant by "Yin deficiency generates interior heat." Note: The section mentioned above regarding labor injury affecting form refers to the Spleen and Stomach. If sexual desire is unregulated, the Five Zang organs lose their control and essence is injured. Essence injury leads to Water deficiency, making evil fire prone to arise. Yin deficiency with interior heat is particularly severe in this case.)
The Yellow Emperor asked: How does Yang excess generate exterior heat?
Qi Bo replied: When the Upper Jiao is not smooth and patent, the skin becomes dense, the Cou Li (interstices) close, and the Xu Fu (pores) are blocked. Wei Qi cannot vent and diffuse, thus generating exterior heat. (The Qi of the Upper Jiao governs the Yang aspect. Therefore, external invasion by cold pathogen causes obstruction of the Upper Jiao, closure of the muscle surface, and stagnation of Wei Qi without circulation, resulting in exterior heat. This is referred to as "When a person is injured by cold, the disease manifests as heat," which belongs to exterior syndrome.)
The Yellow Emperor asked: How does Yin excess generate interior cold?
Qi Bo replied: Jue Qi (Rebellious Qi) moves upward against the normal flow, and cold pathogen accumulates in the chest without dissipating. Without dissipation, the warming Qi departs, leaving only cold. Cold remaining alone causes blood to coagulate and stagnate. Coagulation leads to obstruction of the vessels. The pulse becomes large and choppy, thus generating interior cold. (Jue Qi refers to cold Jue Qi. It may be caused by cold pathogen damaging the Zang organs or by consuming cold food and drink. Cold remains in the Middle Jiao, causing Yang Qi to depart and meridians to stagnate, hence the pulse is large and choppy. Generally, Yang pulses are fluid and slippery; lack of slipperiness indicates absence of Yang. This belongs to interior injury syndrome.)

The Yellow Emperor asked: When Yin and Yang combine, and Blood and Qi combine, forming pathological manifestations, how should they be needled?
Qi Bo replied: To needle these conditions, select the Jing Mai (Meridian) tunnels. Obtain blood from Ying (Nutrient) level and Qi from Wei (Defensive) level. Consider the patient's physical constitution and adjust according to the four seasons, determining the number and depth/location of needles accordingly. (This section continues from the previous two chapters to generally discuss needling methods. Obtaining blood from Ying involves needling Yin Qi. Obtaining Qi from Wei involves needling Yang Qi. Furthermore, human bodies vary in length, fat/thinness, and size; the four seasons vary in cold, heat, warmth, and coolness. Therefore, whenever needling these conditions, one must use the patient's physique and follow the heavenly sequence to determine the number and high/low placement of needles.)
The Yellow Emperor asked: When Blood and Qi combine, pathological forms are established, and Yin and Yang clash, how should tonification and sedation be applied?
Qi Bo replied: For sedating excess, insert the needle when the patient's Qi is at its peak (during inhalation). Insert the needle along with the Qi, opening the gate like a door. Withdraw the needle along with the Qi. This prevents injury to Essence Qi and allows Evil Qi to exit. The outer gate remains open to let the disease out. Widen the needle tract like widening a road; this is called major sedation. One must press the point accurately before withdrawing, so that the great Qi is subdued. (Inserting the needle when Qi is abundant means inserting during the patient's inhalation. Withdrawing the needle along with Qi means withdrawing during exhalation. Since Qi is abundant upon insertion, we intercept and drain it. Opening the gate and facilitating passage, withdrawing with the Qi ensures evil Qi is exhausted. Therefore, one must accurately hit the disease site before withdrawing, so the major evil Qi can be subdued. This is the method of sedation.)
The Yellow Emperor asked: How is deficiency tonified?
Qi Bo replied: Hold the needle without placing it down, stabilizing your mind. Insert the needle upon exhalation; as Qi exits, the needle enters. Seal the needle space on all sides so Essence cannot escape. When the Qi feels full, quickly withdraw the needle; as Qi enters, the needle exits. Heat cannot return. Close the gate tightly. Evil Qi disperses, and Essence Qi is preserved. Monitor the arrival of Qi and the timing. Do not lose the nearby Qi, so distant Qi will arrive. This is called "chasing and assisting." (Holding the needle without placing it down, stabilizing the mind, means carefully examining the tonification method before needling. Such as palpating and stroking, pressing and dispersing, pushing and pressing, flicking to engorge, and grasping to descend. Inserting upon exhalation, i.e., Qi exits and needle enters, means assisting while the pathogen is empty. Quickly withdrawing when Qi feels full means withdrawing upon inhalation. As Qi enters and needle exits, the Qi induced by the needle gathers and does not retreat, so heat cannot return. "Moving Qi" refers to the arrival of Deqi. "Waiting for time" means waiting patiently as if for a noble guest, unaware of the passing day. Only then can the arrived nearby Qi be preserved, and the unarrived distant Qi summoned. This "chasing and assisting" is the tonification method. These two sections should be cross-referenced with *Li He Zhen Xie Lun* (Treatise on Separating True and False Pathogens); see Needling Category 14 for details. Kong is synonymous with Kong (hole).)
The Yellow Emperor asked: You stated that there are ten types of deficiency and excess, originating from the Five Zang organs, corresponding to the five meridians. However, the twelve Jing Mai (Meridians) all produce diseases. Why do you speak only of the Five Zang now? The twelve meridians connect to three hundred and sixty-five joints. Disease at the joints must affect the meridians, and meridian diseases all have deficiency and excess. How do they all correspond to the Five Zang? (The term "joints" refers to points where Shen Qi converges, specifically acupoints, hence three hundred and sixty-five joints. Bei means to reach/affect. "How do they correspond?" asks why they all integrate with the Five Zang.)
Qi Bo replied: The Five Zang organs naturally have the Six Fu organs as their interior-exterior pairs. Meridians and collaterals branch into joints, each producing deficiency or excess. Where the disease resides, regulate it accordingly. (Zang and Fu are interior-exterior pairs, forming the twelve meridians. Meridians branch into joints, forming three hundred and sixty-five joints. Qi and vessels are connected, so they all integrate with the Five Zang. Within them, deficiency and excess arise separately, so diseases have specific locations. Regulate them according to their location as described below.)
Disease in the Mai (Vessels/Meridians): Regulate the Blood. (Mai is the residence of Blood. Vessel excess indicates Blood excess; vessel deficiency indicates Blood deficiency. Thus, vessel diseases require regulating Blood.)
Disease in the Blood: Regulate the Luo (Collaterals). (*Yong Ju Pian* states: When Blood is harmonious, Sun Mai (Fine Collaterals) fill first, then pour into Luo Mai, and finally into Jing Mai. *Bai Bing Shi Sheng Pian* states: Injury to Yang Luo causes external bleeding; injury to Yin Luo causes internal bleeding. *Ben Lun* states: Overflow from Sun Mai leaves residual Blood in Jing Mai. Thus, blood diseases require regulating Luo.)
Disease in the Qi: Regulate the Wei (Defensive Qi). (Wei primarily governs Yang Qi.)
Disease in the Rou (Muscles): Regulate the Fen Rou (Intermuscular spaces). (Select points between the intermuscular spaces according to the location.)
Disease in the Jin (Sinews/Tendons): Regulate the Jin. (Observe tension or flaccidity; apply moxibustion/warming and needling.)
Disease in the Gu (Bones): Regulate the Gu. (As stated in *Zhong Shi Pian*: Flexion without extension indicates disease in Jin; extension without flexion indicates disease in Gu. Treat Gu by focusing on Gu, treat Jin by focusing on Jin. Although using the hand as an example, diseases in Jin and Gu can be understood through this analogy. See also meanings of Jin Bi, Ji Bi, and Gu Bi in Needling Category 50.)
Use Fan Zhen (Fire-needles) for Jie Ci (rapid puncturing) at the affected area and sites of spasm. (This is the method for treating Jin diseases. Cold in Jin causes spasm, so use fire-needles for rapid puncturing. Meaning of Fan Zhen is found later in this category, item 69. Fan sounds like 'fan'.)
For disease in the Gu (Bone), use Cui Zhen (Red-hot needling) and herbal compresses. (Disease in bone is deep, requiring needling and application of pungent-warm herbs for compresses to disperse cold. Note: The previously mentioned Fan Zhen involves heating the needle after insertion. Here, Cui Zhen involves heating the needle red-hot before insertion, providing more than just warmth. For solidified cold-toxin, this is essential. However, diseases vary in depth, so the Sages distinguish by severity. Meaning of Cui Zhen is found in Needling Category 5. Cui sounds like 'cui'.)
If pain location is unknown, prioritize the two Qiao Mai (Odd Vessels). (Unknown pain location refers to descriptions in *Bi Lun*; see later item 67. The two Qiao Mai: Yang Qiao Mai emerges from Shen Mai (BL62) of Foot Taiyang; Yin Qiao Mai emerges from Zhao Hai (KI6) of Foot Shaoyin. Both should be selected, hence termed primary.)
If the body has pain but the Nine Pulses (Jiu Hou) show no abnormality, use Miao Ci (Mimetic Puncture). (Body pain with normal Nine Pulses indicates disease is in Luo Collaterals, not Jing Meridians. Mimetic Puncture involves needling Luo points. Pain on the left is treated by needling the right; pain on the right by the left.)
If pain is on the left but the pulse on the right is diseased, use Ju Ci (Giant Puncture). (Pain manifesting in the pulse indicates disease in the Jing Meridian. Giant Puncture involves needling Jing points. Also involves needling the opposite side for contralateral pain. Meanings of Ju Ci and Miao Ci are detailed in Needling Category 30.)
Must carefully examine the Nine Pulses. The principles of needling are complete. (Diseases located in Blood, Qi, Meridians, Collaterals, Sinews, Bones, and Muscles fall within the scope of the Three Regions and Nine Pulses. Accurate examination without error completes the art of needling.)