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(From *Ling Shu: Zhong Shi Pian*)

The principles of acupuncture are fully contained within the concept of "Zhong Shi" (Beginning and End). By clearly understanding Zhong Shi, one can take the Five Zang Organs as the guideline to determine Yin and Yang. ("Zhong Shi" is the title of this chapter, which details the Dao of Yin-Yang acupuncture; it is now classified across various chapters.) Yin meridians primarily govern the Five Zang Organs; Yang meridians primarily govern the Six Fu Organs. (The Three Yin meridians of the hand and foot all govern the Five Zang Organs. The Three Yang meridians of the hand and foot all govern the Six Fu Organs.) Yang Qi receives its essence at the four extremities, while Yin Qi receives its essence from the Five Zang Organs. (Yang governs the exterior, thus receiving essence at the four extremities. Yin governs the interior, thus receiving essence from the Zang Organs. The "four extremities" refer to the ends of the hands and feet.) Therefore, for reducing methods, one needles against the direction of the arriving Qi; for reinforcing methods, one needles following the departing Qi. Knowing both opposing and following allows the Qi to be harmonized. ("Opposing" means meeting the Qi as it arrives to drain it. "Following" means accompanying the Qi as it departs to support it.) The method for harmonizing Qi must penetrate Yin and Yang. The Five Zang Organs are Yin, and the Six Fu Organs are Yang. This is passed down to future generations with a blood oath: those who respect it will prosper, those who slight it will perish, and those who act against the Dao for selfish purposes will surely incur heavenly disaster. (Not understanding the supreme Dao yet pretending to know it is acting against the Dao for selfish purposes. Harming others' longevity brings disaster upon oneself; Heaven's Dao is impartial, so one should know reverence.) Respectfully adhering to the Dao of Heaven, let me speak of Zhong Shi. Zhong Shi takes the meridians as the guideline. (In the Dao of Heaven, Yin and Yang have the twelve earthly branches as their guideline; in the human body, Blood and Qi have the twelve meridians as their guideline. They circulate endlessly, ending only to begin again, hence called Zhong Shi.) By holding the Maikou (Cunkou) and Renying pulses, one can know whether Yin and Yang are in excess or deficiency, and whether they are balanced or unbalanced; thus, the Dao of Heaven is complete. (Maikou is on the hand, belonging to the Taiyin meridian, capable of observing the Yin of the Five Zang Organs. Renying is on the neck, belonging to the Yangming meridian, capable of observing the Yang of the Six Fu Organs. The human Blood and Qi meridians, which correspond to the waxing and waning of Heaven and Earth's Yin and Yang, are fully revealed here, hence it is said that the Dao of Heaven is complete.) A "Ping Ren" (Healthy Person) is one who does not get sick. One who does not get sick has Maikou and Renying pulses that correspond to the four seasons, with upper and lower pulses responding and moving together, without knotting or agitation in the Six Meridians, maintaining consistent cold and warmth between root and branch, and having proportional form, flesh, and Qi. This is called a Healthy Person. (In Spring and Summer, Renying is slightly larger; in Autumn and Winter, Cunkou is slightly larger, corresponding to the seasons. "Upper" refers to Renying, "Lower" to Maikou; responding and moving together means, as described later, moving together like a taut rope of equal size. Knotting and choppy pulses indicate deficiency; rapid and agitated pulses indicate excess; neither is a balanced pulse. Zang Qi is the root, the musculoskeletal system is the branch; if interior-exterior and cold-warmth are maintained without loss, then external form/flesh and internal Qi/Blood must be proportional, which is called a Healthy Person.) Those with "Shao Qi" (Deficient Qi) have Maikou and Renying pulses that are both weak and disproportionate in position/strength. In such cases, both Yin and Yang are deficient. Reinforcing Yang would exhaust Yin, and reducing Yin would cause Yang to collapse. Such individuals should be treated with sweet (Gan) medicines, not with potent/strong agents. Moxibustion should not be used; if the condition persists and one resorts to reducing methods, the Qi of the Five Zang Organs will deteriorate. ("Shao Qi" refers to deficiency of Yuan Qi, encompassing both Yin and Yang. Thus, Renying above and Maikou below are both weak and powerless, and the Cun and Chi positions on both hands are disproportionate. When both Yin and Yang Qi are deficient, acupuncture is contraindicated. If one needles and reinforces Yang, Yin exhausts; if one reduces Yin, Yang collapses. Such cases should only be managed with sweet medicines. The term "sweet medicine" holds deep meaning, implying that to tonify weakness, purely sweet substances are necessary. "Potent agents" refer to harsh or toxic drugs. Since righteous Qi is depleted, attacking methods are unsuitable. Not only attacking is unsuitable, but moxibustion is also contraindicated because fire injures Yin. Practitioners encountering this syndrome must not forget the significance of this passage.) If Renying is one-fold stronger, the disease is in the Foot Shaoyang meridian; if one-fold stronger and agitated, the disease is in the Hand Shaoyang meridian. If Renying is two-fold stronger, the disease is in the Foot Taiyang meridian; if two-fold stronger and agitated, the disease is in the Hand Taiyang meridian. If Renying is three-fold stronger, the disease is in the Foot Yangming meridian; if three-fold stronger and agitated, the disease is in the Hand Yangming meridian. (Renying belongs to the Foot Yangming meridian. "One-fold" or "two-fold" means one or two times larger than Qikou. Yangming governs the exterior and circulates Qi among the Three Yang meridians; thus, if Renying is one-fold stronger, the disease is in the Foot Shaoyang. If it is one-fold larger plus agitated, it represents Yang within Yang, manifesting in the Hand Shaoyang. For two-fold and three-fold strengths, the disease is in the foot meridians, but agitation indicates involvement of the hand meridians. The following follows this pattern.) If Renying is four-fold stronger, and large and rapid, it is named "Yi Yang" (Overflowing Yang). Yi Yang leads to "Wai Ge" (External Gridlock). (When Renying is four times stronger, large and rapid, it signifies extreme excess of the Six Yang meridians, overflowing into the Fu organs and blocking the Six Yin meridians, known as External Gridlock. Referencing the text below: "Yi Yin is Nei Guan; if Nei Guan is blocked, death is untreatable." Thus, External Gridlock is also undoubtedly fatal. See further analysis of Guan Ge in Pulse and Color Category 22, which should be cross-referenced.) If Maikou is one-fold stronger, the disease is in the Foot Jueyin meridian; if one-fold stronger and agitated, the disease is in the Hand Jueyin (Pericardium) meridian. If Maikou is two-fold stronger, the disease is in the Foot Shaoyin meridian; if two-fold stronger and agitated, the disease is in the Hand Shaoyin meridian. If Maikou is three-fold stronger, the disease is in the Foot Taiyin meridian; if three-fold stronger and agitated, the disease is in the Hand Taiyin meridian. (Maikou belongs to the Hand Taiyin meridian. Taiyin governs the interior and circulates Qi among the Three Yin meridians; thus, if Maikou is one-fold stronger, the disease is in the Foot Jueyin. If accompanied by agitation, it represents Yin within Yang, manifesting in the Hand Jueyin Pericardium. For two-fold and three-fold strengths, the disease is in the foot meridians, but agitation indicates involvement of the hand meridians.) If Maikou is four-fold stronger, and large and rapid, it is named "Yi Yin" (Overflowing Yin). Yi Yin leads to "Nei Guan" (Internal Closure); if Nei Guan is blocked, death is untreatable. (When Maikou is four times stronger, large and rapid, it signifies extreme excess of the Six Yin meridians, overflowing into the Zang organs, isolating interior and exterior, known as Internal Closure, which indicates fatal untreatability.) If both Renying and Taiyin Maikou are more than four-fold stronger, it is named "Guan Ge" (Gridlock). For Guan Ge, one may predict the time of death. (Renying governs Yang, Maikou governs Yin. If both exceed four-fold strength, each reaches extreme excess, and Yin and Yang do not intersect, hence called Guan Ge; one may discuss the time of death.) If Renying is one-fold stronger, reduce the Foot Shaoyang and reinforce the Foot Jueyin. Use two reductions and one reinforcement, needle once daily, verify by palpation, needle gently, and stop when the Upper Qi is harmonized. (Renying governs Fu organs; thus, one-fold strength indicates disease in the Gallbladder meridian. Liver and Gallbladder are interior-exterior pairs; Yang is excess and Yin is deficient. Therefore, reduce the Foot Shaoyang Fu organ and reinforce the Foot Jueyin Zang organ. Two reductions, one reinforcement; reduction is double the reinforcement. "Gentle needle" implies proceeding calmly, not hastily. "Upper Qi" refers to the arrival of Deqi. When Qi arrives and harmonizes, Gu Qi has arrived, so needling may cease. The following follows this example.) If Renying is two-fold stronger, reduce the Foot Taiyang and reinforce the Foot Shaoyin. Use two reductions and one reinforcement, needle every two days, verify by palpation, needle gently, and stop when the Upper Qi is harmonized. (Renying two-fold stronger indicates disease in the Bladder meridian. Bladder and Kidney are interior-exterior pairs; Exterior is excess and Interior is deficient. Therefore, reduce Foot Taiyang and reinforce Foot Shaoyin. The meaning of two reductions and one reinforcement is seen later. The meaning of gentle needling and Upper Qi is the same as before.) If Renying is three-fold stronger, reduce the Foot Yangming and reinforce the Foot Taiyin. Use two reductions and one reinforcement, needle twice daily, verify by palpation, needle gently, and stop when the Upper Qi is harmonized. (Renying three-fold stronger indicates disease in the Stomach meridian. Stomach and Spleen are interior-exterior pairs; Stomach is excess and Spleen is deficient. Therefore, reduce Foot Yangming and reinforce Foot Taiyin. [Note: Original text says 'reinforce Shaoyin' here, but context implies Taiyin based on Spleen/Stomach relationship and previous logic. However, strictly translating the source text provided: "reduce Foot Yangming, reinforce Foot Shaoyin" - wait, the source text says "补足太阴" in the main instruction line but "补足少阴" in the commentary? Let's check source: "泻足阳明而补足太阴... 故当泻足阳明，补足少阴". There is a contradiction in the source text provided. The instruction line says Taiyin, the commentary says Shaoyin. Given Spleen-Stomach pairing, Taiyin is correct. I will translate the instruction line accurately as per standard TCM logic derived from the first part, but note the source text inconsistency if necessary. Actually, looking closely at the provided text: "人迎三盛，泻足阳明而补足太阴... 故当泻足阳明，补足少阴". This is a typo in the original text provided by the user. I will translate the explicit instruction "补足太阴" as it appears in the treatment directive, as it aligns with the Spleen-Stomach pair mentioned immediately after.] All three Yang excess conditions use two reductions and one reinforcement.) If Maikou is one-fold stronger, reduce the Foot Jueyin and reinforce the Foot Shaoyang. Use two reinforcements and one reduction, needle once daily, verify by palpation, needle gently, and stop when the Upper Qi is harmonized. (Maikou governs Zang organs; thus, one-fold strength indicates disease in the Liver meridian. Liver is excess, Gallbladder is deficient. Reduce Foot Jueyin, reinforce Foot Shaoyang. Meaning of reinforcement/reduction seen later. Meaning of Upper Qi same as before.) If Maikou is two-fold stronger, reduce the Foot Shaoyin and reinforce the Foot Taiyang. Use two reinforcements and one reduction, needle every two days, verify by palpation, needle gently, and stop when the Upper Qi is harmonized. (Maikou two-fold stronger indicates disease in the Kidney meridian. Kidney meridian is excess, Bladder is deficient. Therefore, reduce Foot Shaoyin and reinforce Foot Taiyang.) If Maikou is three-fold stronger, reduce the Foot Taiyin and reinforce the Foot Yangming. Use two reinforcements and one reduction, needle twice daily, verify by palpation, needle gently, and stop when the Upper Qi is harmonized. (Maikou three-fold stronger indicates disease in the Spleen meridian. Spleen is excess, Stomach is deficient. Therefore, reduce Taiyin and reinforce Yangming.) The reason for needle twice daily is that Taiyin (referring to the Spleen/Stomach system here) governs the Stomach, which is rich in Gu Qi (Grain Qi), so it can tolerate twice-daily needling. (This explains the treatment of the Spleen and Stomach meridians mentioned above. "Tai" refers to Taiyin, "Yang" refers to Yangming. Spleen and Stomach are interior-exterior pairs, hence "Taiyin governs Stomach". Both meridians are rich in Gu Qi, stronger than other Zang organs, so twice-daily needling is permissible. Note: The treatment of Renying treats the Three Yang meridians, all using two reductions and one reinforcement. The treatment of Qikou treats the Three Yin meridians, all using two reinforcements and one reduction. This is because Three Yang govern the exterior; diseases in the exterior should have reduction double reinforcement. Three Yin are in the interior; diseases in the interior should have reinforcement double reduction. Priority is given to Zang Qi to avoid injury. For example, Jueyin and Shaoyang are Wood Zang (Liver/Gallbladder); the East tends toward excess, so twice-daily needling might be applicable. Taiyin and Yangming are Spleen and Stomach; Spleen and Stomach are rich in Gu Qi, so twice-daily needling is applicable. Only Shaoyin and Taiyang are needled every two days, likely because Kidney and Bladder are the Zang of Tian-Yi, the source of True Yin, requiring such caution. Does the Sage's care for the root apply only to acupuncture?) If both Renying and Maikou are more than three-fold stronger, it is named "Yin Yang Ju Yi" (Both Yin and Yang Overflowing). If such cases are not opened/unblocked, the Blood vessels become closed, Qi cannot move, flows loosely internally, and injures the Five Zang Organs. If such cases are treated with moxibustion, they will transform into other diseases. ([More than] three-fold stronger is equivalent to four-fold. "Yin Yang Ju Yi" is equivalent to Yi Yin and Yi Yang. "Not opening" refers to External Gridlock and Internal Closure. In such cases, Blood and Qi are blocked and cannot move, injuring the True Yin of the Five Zang internally. Acupuncture is already inadvisable; moxibustion would further deplete Yin and generate other diseases, leading to untreatability.)