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(Luoshu · Genjie Chapter)

Huangdi asked: Regarding the "reverse and smooth five bodies," this refers to the size of bone joints, the firmness or fragility of muscles, the thickness of skin, the clarity or turbidity of blood, the slipperiness or roughness of Qi, the length of pulses, the quantity of blood, and the number of meridians. I already know these; these all apply to commoners (Bu Yi, people of cloth clothing). However, kings, dukes, and great officials, who are rulers enjoying meat and grain, have bodies that are soft and fragile, with weak muscles. Their Qi and blood are fierce, rapid, and slippery. Can their acupuncture treatment—specifically the speed, depth, and amount of needle insertion—be handled in the same way as for commoners? (The "five bodies" refer to five types of physical constitutions. Therefore, their bones, joints, skin, flesh, Qi, blood, and meridians vary in endowment, and their acupuncture treatments differ accordingly, leading to variations in reverse and smooth conditions; the differences between nobles and commoners are even more pronounced, hence the need for detailed distinction.) Ciqi answered: How can the dietary tastes of rich fats and fine grains be compared to those of beans and coarse leaves? (Gao refers to animal fat. Liang refers to millet, a high-quality grain. Shu refers to beans. Huo refers to bean leaves. Nobles consume gao and liang, while commoners consume shu and huo; the richness of diet leads to different constitutions.) When Qi is slippery, withdrawal should be rapid; when Qi is rough/stagnant, withdrawal should be slow. When Qi is fierce, small needles should be used and inserted shallowly; when Qi is rough/stagnant, large needles should be used and inserted deeply. Deep insertion requires retention, while shallow insertion requires quick withdrawal. (Slippery Qi moves easily, so withdrawal should be fast. Rough Qi is difficult to stimulate, so withdrawal should be slow. Fierce Qi arrives vigorously, so small needles and shallow insertion are appropriate. Rough Qi arrives slowly and with difficulty, so large needles and deep insertion are appropriate. Thus, deep insertion requires retention, and shallow insertion requires quick withdrawal.) From this, we see that treating commoners requires deep insertion and retention, while treating nobles requires slight/mild insertion and slow withdrawal. This is due to the fierce, rapid, and slippery nature of the nobles' Qi and blood. (Commoners have rough Qi, suitable for deep insertion and retention. Nobles have slippery Qi, suitable for mild/slight and slow techniques. The Qi of nobles is fierce, rapid, and slippery, differing from that of commoners.)

Huangdi asked again: How can one judge the reverse and smooth conditions of Xing (Form/Structure) and Qi? Ciqi said: If Xing Qi is insufficient but Bing Qi (Pathogenic Qi) is excessive, this indicates an excess of pathogen, requiring urgent sedation (Xie). (Although the appearance suggests insufficiency, the Shen Qi and Bing Qi are excessive; this is exterior deficiency with interior excess caused by pathogens, requiring urgent sedation.) If Xing Qi is excessive but Bing Qi is insufficient, urgent tonification (Bu) is required. (Although the form appears robust, the Bing Qi and Shen Qi are insufficient; this is exterior excess with interior deficiency due to weakened Zheng Qi, requiring urgent tonification.) If both Xing Qi and Bing Qi are insufficient, this indicates a deficiency of both Yin and Yang Qi. Acupuncture should not be used; if needled, it causes double deficiency. Double deficiency leads to the exhaustion of Yin and Yang, depletion of blood and Qi, emptiness of the five Zang organs, and withering of sinews, marrow, and bones. The elderly will perish, and even the strong will not recover. (Yang governs the exterior, Yin governs the interior. If both Xing and Bing Qi are insufficient, there is deficiency in both exterior and interior, Yin and Yang. It is most inadvisable to needle. Further needling exacerbates the deficiency, leading to exhausted blood/Qi and withered sinews/marrow. The elderly become more depleted and die. The strong decline and cannot restore their Yuan Qi.) If both Xing Qi and Bing Qi are excessive, this is called dual excess of Yin and Yang. Urgently sedate the pathogen and regulate the deficiency and excess. (Both Xing and Bing Qi being excessive indicates pathogenic excess, requiring urgent sedation. Since urgent sedation is needed, the excess is certain. Why mention regulating deficiency/excess? Before needling, guard against false excess; after needling, guard against sudden collapse into deficiency; thus, regulation is appropriate.) Therefore, it is said: Excess is treated by sedation, insufficiency by tonification. This is the principle. (In acupuncture, deficiency is filled, and fullness is drained. Thus, the key to deficiency and excess lies in the nine needles. Tonification and sedation are performed via the needle. It is said that tonifying deficiency means the pulse at the Qi Kou is deficient and should be tonified. Draining fullness means the pulse at the Qi Kou is vigorous and should be drained. This is the major method of acupuncture, suggesting all deficiencies can be tonified. Yet, earlier it was stated that when Xing and Bing Qi are both insufficient (Yin/Yang dual deficiency), acupuncture is contraindicated. *Baoming Quanxing Lun* states: In cases of deficiency and excess, do not approach the Five Deficiencies, do not distance from the Five Excesses. *Wuyue Wushi Pian* states: When blood and Qi are sufficient and muscles are firm and delicate, bitter/cold needles may be used. *Qibing Lun* states: One must not harm the insufficient; a emaciated person does not benefit from bi-shi (stone lancets). *Benshen Pian* states: The acupuncturist must observe the patient's state to understand the survival or loss of spirit, soul, etc. If the five internal organs are injured, needles cannot treat them. *Xiaozhen Jie* states: Taking the five pulses leads to death; this means if the disease is in the middle jiao and Qi is insufficient, draining all Yin pulses with needles causes death. *Maidu Pian* states: Vigorous pulses are drained, deficient pulses are supplemented with medicine. *Xieqi Zangfu Binxing Pian* states: For small pulses where Yin/Yang, Form, and Qi are all insufficient, do not use needles; instead, regulate with sweet medicines. All such texts state that deficiency is unsuitable for needles. Upon detailed examination of the classic chapters, diseases indicated for needling generally involve pathogens lingering in meridians or Qi rebellion in organs, mostly treating excess syndromes. This clearly shows needles are beneficial for sedation but not for tonification. Then why do some texts say to tonify insufficiency? Because the flow of blood and Qi through meridians allows for tonifying Yin to balance Yang, or securing one area to attack another. The goal is to harmonize Yin and Yang, regulate blood and Qi, prevent imbalance, and achieve equilibrium. This is the essence of tonification and sedation. Those who do not understand the root and branch, or the true meaning of tonifying deficiency, and attempt to use needles to tonify all conditions of Ying-Wei depletion, emaciation, Jing-Qi exhaustion, etc., will damage the True Yuan and likely die immediately. Thus, it is said that needles only have a sedating effect, not a tonifying one, as evidenced by these chapters. Acupuncturists must understand this fundamental principle.) Therefore, it is said: If one does not know the reverse and smooth conditions during needling, Zhen Qi and Pathogenic Qi will clash. (Reversing tonification and sedation constitutes "reverse." Not knowing reverse and smooth leads to the clash of True Qi and Pathogenic Qi, worsening the disease.) Tonifying excess causes Yin and Yang to overflow, intestines and stomach to distend, and liver and lungs to be compressed, causing Yin-Yang disorder. (Adding to what is already excessive causes such pathology.) Sedating deficiency causes meridians to become empty, blood and Qi to dry up, intestines and stomach to contract abnormally, skin to become thin and adhere to bones, and hair/coarse follicles to wither and break, hastening death. (Damaging what is insufficient causes such pathology. HT: fear/timidness. Pi: abnormal/deviant. Bozhe: thin and adherent. Yao: short/broken. Yu: same as "give." HT: pronunciation chou-she. Pi: same as pi. : same as jiao.) Therefore, it is said: The essence of needling lies in knowing how to regulate Yin and Yang. Regulating Yin and Yang makes Jing Qi radiant, unites Form and Qi, and keeps Shen stored within. Therefore, it is said: Superior practitioners (Shanggong) level the Qi, intermediate practitioners (Zhonggong) disrupt the pulses, and inferior practitioners (Xiagong) sever the Qi and endanger life. Thus, inferior practitioners must be extremely cautious. (Shanggong understands Yin/Yang deficiency/excess and can level disordered Qi. Zhonggong lacks precise insight and often disrupts meridians. Xiagong mistakes false for true and wrong for right, severing Qi and endangering life.) One must carefully examine diseases of the five Zang changes, the correspondence of the five pulses, the excess/deficiency of meridians, and the roughness/smoothness of the skin before selecting points. (Five pulses refer to the pulse correspondences of the five Zang organs.)