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(Quoted from *Ling Shu: Nine Needles and Twelve Origins Chapter*, *Small Needle Explanation Chapter*, *Four Seasons Qi Chapter*, and *Ends and Beginnings Chapter*)

If the Deqi sensation (arrival of Qi) does not occur after needling, do not be concerned with the number of insertions (*Ling Shu: Nine Needles and Twelve Origins Chapter*). The phrase "do not be concerned with the number" means that one must take the arrival of Qi as the standard. It is like waiting for a noble guest, unaware that evening has fallen.) When the Deqi sensation arrives, remove the needle; do not needle again. (Do not needle again once Deqi arrives, to avoid depleting the Zhen Qi (True Qi). For detailed meanings regarding waiting for Qi, see Part 14 earlier.) Each type of needle has its specific indications, different shapes, and respective functions. (Diseases in the skin, flesh, sinews, and bones have their specific locations, and the use of needles has specific appropriateness.) The essence of needling lies in the arrival of Qi for efficacy; the confirmation of efficacy is like wind blowing away clouds, clearly revealing the blue sky. Thus, the way of needling is complete. (Needling relies on Qi as the key and efficacy as proof; obtaining the essence leads to efficacy, hence like wind blowing clouds. When pathogenic Qi departs, healthy Qi appears, thus clear as seeing the blue sky.)

Observe the complexion, inspect the eyes, and know whether Shen (Spirit) is scattered or restored; unify the body posture, listen to movements and sounds, and know whether it is pathogenic or healthy. (Detailed meanings are seen below.) Push the needle forward with the right hand, hold and control it with the left hand, and remove it when Qi arrives. (Pushing with the right hand is for insertion; holding with the left hand is for protection. When pathogenic Qi departs and Gu Qi (Grain Qi, here referring to normal meridian Qi) arrives, then the needle can be removed.)

The *Small Needle Explanation* states: Observing complexion, inspecting eyes, knowing the scattering and restoration of Shen, unifying the form, and listening to movements and sounds means that an expert physician knows how to observe the five colors, has insight into the eyes, and regulates the Cun Kou (Radial Pulse) and Ren Ying (Carotid Pulse) sizes, speeds, and qualities (slippery/rough) to diagnose the disease. (Observing form and color externally reveals the scattering and restoration of Shen; observing pulses internally reveals the movement and stillness of Qi.) Knowing pathogenic versus healthy refers to discussing Wind of Deficient Pathogen and Wind of Healthy Pathogen.

Pushing with the right hand and holding with the left hand refers to the manipulation of inserting and withdrawing the needle. Removing the needle upon Qi arrival refers to tonifying deficiency and draining excess until Qi is harmonized. (Tonify insufficiency, drain excess, must achieve balance; this is Qi harmony, only then can the needle be removed.) Regulating Qi lies in the *Zhong Shi* (Ends and Beginnings) chapter. "One" refers to maintaining mental focus. (*Zhong Shi* is a chapter name in this classic, seen below. "One" refers to mental focus, explaining the previous text "unify the form." Listening to movements and knowing pathogenic/healthy states are all governed by the mind.)

The three hundred and sixty-five junction points of the meridians are where collateral vessels seep and irrigate various joints. (This sentence is detailed in Meridian Category 14.) The reason for observing the eyes is that the Five Zang organs cause the five colors to circulate brightly; when bright, the voice becomes prominent. A prominent voice means the speech sound differs from one's usual state. (The essence of the Five Zang and Six Fu organs all ascend to the eyes to form vision, thus causing the five colors to circulate brightly. Generally, if color is bright externally, it is due to Qi being abundant internally, so the voice must also be loud and distinct, differing from the usual state.)

The *Four Seasons Qi Chapter* states: Observing complexion and inspecting eyes to know the scattering and restoration of Shen involves viewing eye color to know the survival or demise of the disease. (When Shen is complete, Qi restores; when Shen is lost, Qi scatters. Thus, observing eye color allows one to know the disease's status.) Unifying form and listening to movements refer to holding the Cun Kou and Ren Ying pulses to observe them. If the pulse is firm, large, and slippery, the disease progresses daily; if the pulse is soft, the disease will recede. (A firm, large, and slippery pulse indicates blazing pathogenic Qi, so the disease progresses daily. A soft and harmonious pulse indicates the arrival of Yuan Qi (Original Qi), so the disease will recede. "Recede" means to retreat.) For excess conditions in the meridians, the disease will resolve in three days. (For unresolved pathogenic Qi, a weak and powerless pulse is most taboo. As stated in *Ping Ren Qi Xiang Lun*: Disease inside with a deficient pulse. *Yu Ji Zhen Zang Lun*: Disease outside with a pulse that is not solid and firm is difficult to treat. *Xie Ke Pian*: Deficient and fine pulses persisting for a long time. All refer to non-solid pulses. If the disease is in the meridians but the pulse is solid and forceful, pathogenic Qi is about to reach the exterior, so it can resolve in three days.) The Cun Kou pulse inspects Yin, and the Ren Ying pulse inspects Yang. (Cun Kou is at the wrist, belonging to the Hand Taiyin Lung Meridian; Cun Kou alone is the master of the Five Zang, thus used to inspect Yin. Ren Ying is at the neck, belonging to the Foot Yangming Stomach Meridian; the Stomach is the great source of the Six Fu, thus used to inspect Yang. Detailed discussion of Ren Ying and Cun Kou is in Zang Xiang Category 11.)

In general, the way of needling stops when Qi is harmonized (*Ling Shu: Ends and Beginnings Chapter*). Tonify Yin and drain Yang, and the voice and breath become more prominent, with ears and eyes becoming sharp; the opposite results in blocked Blood and Qi flow. (Here, Yin and Yang refer to interior and exterior. Since healthy Qi resides in the interior, it should be tonified, hence "Tonify Yin." Since pathogenic Qi enters from the exterior, it should be drained, hence "Drain Yang." When Yang pathogen departs and True Yin restores, voice and breath become prominent, and ears and eyes become sharp.) Regarding "efficacy upon Qi arrival," draining should further reduce excess; in a deficient patient, the pulse may be large but not firm as before; if it remains firm, although it appears unchanged, the disease has not departed. (The effect of Qi arrival via draining aims for emptiness; after draining, even if the pulse size is like before, if it becomes soft and not firm, it is effective. If the pulse remains firm like before, despite appearances, the disease is not removed.) Tonifying should further increase solidity; in an excess patient, the pulse may be large but firmer than before; if it is not firm as before, although the patient feels comfortable, the disease has not departed. ("Large" in these two sections generally refers to the advancement or retreat of the pulse body, not specifically to a洪大 (Surging/Large) pulse.) Therefore, tonification leads to solidity, drainage leads to emptiness; even if pain does not cease immediately with the needle, the disease will surely diminish. (Tonification leads to solidity, so the pulse must be firm. Drainage leads to emptiness, so the pulse must not be firm. If there is pain, although it may not heal immediately with the needle, it will gradually disappear.) One must first understand the diseases generated by the Twelve Primary Meridians, and only then can one transmit the meaning of *Zhong Shi*. (The Twelve Primary Meridians have left and right, upper and lower; the sites of disease have sequence. One must treat the origin of the disease to understand the meaning of ends and beginnings. *Zhong Shi* is the chapter name, meaning root and branch.) Therefore, when Yin and Yang do not shift, and deficiency and excess do not compromise each other, select points from their respective meridians. ("Shift" means change; "Compromise" means harm. Yin or Yang undergoes no change, they do not shift. Deficiency is self-deficient, excess is self-excess, they do not compromise. This implies the disease arises independently without cross-contamination, so one seeks the meridian and selects points.)

Regarding all types of needling, three insertions reach Gu Qi. When pathogenic factors combine recklessly, Yin and Yang exchange positions, reverse and contrary states occur, floating and sinking differ in location, and Four Seasons pulse patterns are lost, with pathogenic Qi lingering and overflowing, needles are required to remove them. (The meaning of "Three Insertions" is below. The six phrases regarding reckless combination etc. detail pathological changes. All such cases require needles, treating with the Three Insertion method, so various diseases can be removed.) Thus, the first insertion expels Yang pathogen, (The first insertion is shallow, thus expelling Yang branch pathogens.) the second insertion expels Yin pathogen, (The second insertion is deeper, thus expelling Yin branch pathogens.) and the third insertion brings Gu Qi. Stop when Gu Qi arrives. What is meant by Gu Qi arriving is that after tonification, the condition becomes solid; after drainage, it becomes empty. Thus, we know Gu Qi has arrived. (The third insertion waits for Gu Qi. Gu Qi is Yuan Qi. "Stop" means removing the needle. Pathogenic Qi comes tight and rapid; Gu Qi comes slow and harmonious. Only after pathogenic Qi departs does Gu Qi arrive. Thus, after tonification, the previously empty becomes firm; after drainage, the previously firm becomes soft. Hence, we know Gu Qi has arrived.) If only pathogenic Qi departs while Yin and Yang are not yet harmonized, the disease is known to be healing. Therefore, it is said: Tonification leads to solidity, drainage leads to emptiness; even if pain does not cease immediately with the needle, the disease will surely diminish. (The arrival of Gu Qi indicates the departure of pathogenic Qi. Although Yin and Yang meridian Qi may not be immediately harmonized, the disease is already healing. Hence the previous text says: Tonification leads to solidity, drainage leads to emptiness, and the disease will surely diminish.)