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(If anger again injures the Liver, one must be cautious.) Furthermore, if in the Earthly Jiazi cycle, the Yi-Wei year is lost (Shi Shou), meaning Yi as the Yin (Rou) stem, then the Heaven's Geng metal will dominate alone. This is also called "loss of position" (Shi Shou), indicating that the Heavenly Qi operates in isolation. After three years, it transforms into a pestilence named Metal Pestilence (Jin Li). (In the Geng-Chen year, the Qi descends to the Earthly Branch (Zai Quan), corresponding to the transformation of Taiyin Yi-Wei. If Yi-Wei cannot assume its proper position, and Geng-Chen dominates alone above, it is also termed loss of position. Three years later, the Qi will inevitably change into Metal Pestilence.) The arrival of the pestilence awaits its time; one must carefully examine the numerical differences of the Earthly branches and deduce the severity to know whether it arrives early or late. (When the pestilence arrives, its severity and timing follow the laws of Heaven similarly.) For all cases where Yi and Geng are lost at various positions, the acupuncture method is the same. (For all Yi-Geng years with loss of position above and below, the acupuncture methods are identical to those described previously.) The Liver desires balance; therefore, do not become angry. (This preserves Liver Qi and prevents excessive Metal influence.)

Suppose Ren-Wu experiences loss of Yang (Gang) and Yin (Rou). (Ding and Ren both govern Wood Qi. In Zi-Wu years, Shaoyin (Ministerial Fire) governs from Heaven, implying Yangming (Metal) governs from Earth. With Yangming combining with Wood Qi, Ding-Mao and Ding-You represent the Earthly transformations. If Yang and Rou are improper, both are lost.) If the upper Ren does not assume its position, and the lower Ding stands alone, even though it is a Yang year, the deficiency differs. (If the previous year Xin-Si had excess Tian Qi, and Jueyin did not withdraw, then this year's Ren-Ding combination fails. Wood Qi becomes too deficient; Yang is not upright above, and Rou stands isolated below. Although called a Yang year, the nature of the deficiency is different.) When upper and lower positions are lost, their convergence has a set time; the severity of the disease varies according to specific numbers. ("Zhao" means convergence. The day they assume their positions is the time of convergence. Mild cases arrive later, severe cases sooner; the numbers differ.) The Lv-Lu (Pitch Pipes) Jiao tones lose harmony; there will come a day when the tones match. (Yang Lu Tai-Jiao is the upper pipe for Wood tone; Yin Lv Shao-Jiao is the lower pipe for Wood tone. Ren-Ding loss causes disharmony between the two Jiao tones. Only on the days they assume their positions will the tones align.) Depending on severity, a great epidemic occurs after three years. (Mild cases manifest by Yi-You; severe cases by Jia-Shen; this is the onset of Wood Epidemic.) One should puncture the Shu-stream point of the Spleen. (Spleen Shu is located on the Foot-Taiyang Bladder Meridian. Upon the arrival of Wood Epidemic, fear of injury to the Earth organ arises; thus, tonify it first. Old commentary states: Use a Yuanli needle, warm the mouth, then puncture while chanting: "Wu Jing Zhi Jing, Liu Jia Xuan Ling, Di Fu Yuan Shou, Tai Shi Shou Zhen." Recite three times. Visualize Yellow Qi beneath the acupoint, then insert 2 cun. Upon obtaining Deqi, advance further until Dongqi is felt, advancing another 1 cun each time. Retain for five breaths, then slowly withdraw the needle, covering the point with the hand, instructing the patient to hold their breath three times and swallow saliva.) Three days later, one may puncture the Jing-well point (point of origin) of the Liver. (The Dadun point of the Foot-Jueyin Liver Meridian. As Wood pathogen arrives, this origin point should be punctured to drain Wood Qi. Old commentary states: Use a Yuanli needle, warm the mouth, then puncture while chanting: "Zhen Ling Zhi Xuan, Tian Dao Ming Ran, Wu Shen Ge Wei, Qi Shou San Tian." Recite, then insert 3 cun (same body inch), retain for ten breaths, and withdraw upon feeling Dongqi.) After needling, calm the spirit for seven days. Avoid heavy intoxication, singing, or music, lest Qi scatter again. Avoid overeating or consuming raw/cold foods. (All these precautions prevent Spleen injury.) To strengthen the Spleen, avoid Qi stagnation and fullness, avoid prolonged sitting, avoid overly sour foods, and avoid all raw/cold biological matter. Prefer sweet and bland flavors. (Fearing Wood invasion of the Spleen, protection is necessary in this manner.)

Alternatively, in the Earthly Jiazi cycle, if Ding-You loses its position and fails to receive the Central Authority, the Qi is misplaced, and the lower does not combine with Ren. This is also called loss of position, not "combined virtue" (He De). Thus, Yin does not attach to Yang, Earthly Qi is discordant, and after three years, it transforms into a pestilence. (If Ding-You fails to assume position below, it cannot serve Ren-Wu above. This is loss of position, not combined virtue. Three years later, Qi changes into Wood Pestilence.) The acupuncture method is exactly like that for Wood Epidemic. (For all Ding-Ren years with loss of position above and below, the methods are identical to those described previously.)

Suppose Wu-Shen experiences loss of Yang and Yin. (Wu and Gui both govern Fire Qi. In Yin-Shen years, Shaoyang (Ministerial Fire) governs from Heaven, and Jueyin governs from Earth. With Jueyin combining with Fire Qi, the rigid Gui-Hai represents the Earthly transformation. Wu-Shen's Yang is above, Gui-Hai's Yin is below; if either is improper, both are lost. Wu-Yin and Gui-Si share the same Qi.) Although Wu and Gui govern Fire, if it is a Yang year, it is not necessarily an excess condition. (Although Wu-Gui govern Fire, if Yang and Rou are lost, even in a Yang year, it is not excessive.) If the upper loses its Yang, the lower Yin dominates alone, making the Qi improper, allowing evil to interfere. (If the previous year Ding-Wei had excess Tian Qi, and Taiyin did not withdraw, then Wu-Shen is lost above, and Gui-Hai dominates alone below. Fire Qi is improper, so Water attacks it, causing evil interference.) Positions shift alternately, with errors varying in depth. When they are about to converge, the pitch pipes sound alike first. (Qi varies in severity, hence errors vary in depth. When Yang and Rou are about to converge, the pitch pipes synchronize. Wu-Shen corresponds to Yang Lu Tai-Zheng; Gui-Hai to Yin Lv Shao-Zheng. Their Qi harmonizes, and their tones match.) Thus, if Heavenly Qi loses its timing, a Fire Epidemic will occur within three years. (Wu-Gui loss leads to Fire Epidemic; fast onset in Geng-Xu, slow onset in Xin-Hai.) One should puncture the Shu-stream point of the Lung. (Lung Shu is on the Foot-Taiyang Bladder Meridian. Upon Fire Epidemic, fear of injury to the Metal organ arises; thus, tonify it first. Old commentary states: Use a Yuanli needle, warm the mouth, press the point with the hand, then puncture while chanting: "Zhen Xie Yong Bo, Qi Guan Yuan Shen, Di Fu Fan Ben, Wei He Qi Qin." Recite three times. Insert 2 cun. Wait for Qi arrival, visualize White Qi beneath the point, advance 1 cun, obtain Deqi, and slowly withdraw the needle, covering the point with the hand. Note: The text below likely omitted: "Three days later, puncture the Ying-Spring point of the Hand-Jueyin Pericardium Meridian.") After needling, calm the spirit for seven days. Do not grieve excessively, as grief moves the Lung and scatters True Qi. (Since needles tonify the Lung, grief is contraindicated.) To solidify Lung Qi, one must regulate breathing. (The Lung governs Qi; regulating breath tonifies the Lung, which is the method of holding breath and preserving spirit. Meaning seen previously.)

Alternatively, in the Earthly Jiazi cycle, if Gui-Hai is lost, it means Yin has lost its position, the upper has lost its Yang, and it is named "Wu-Gui failing to combine virtue." With Qi and Earth both deficient, after three years, it transforms into a pestilence named Fire Pestilence. (If Gui-Hai in the Earthly branch fails to assume position, the lower Yin loses its place, and the upper Yang has no partner. Although Wu is Yang Fire, it is also lost. Three years later, it manifests as disease, named Fire Pestilence.)

Therefore, establishing the five-year Earthly cycle clarifies loss of position and exhausts the principles of acupuncture. Thus, Yi (Epidemic) and Li (Pestilence) are merely names for the upper/lower Yang/Yin imbalance, ultimately returning to a single entity. The acupuncture methods for epidemics consist only of five techniques, summarizing all positional losses under the Five Elements. (The "five years" mentioned above implies Heaven is included within Earth. Although Yi comes from Heaven and Li from Earth, seemingly distinct, they are merely divisions of upper/lower Yang/Yin. Ultimately returning to pathology, they are one entity; thus, acupuncture methods are limited to these five. This chapter uses the five Yang years—Jia, Bing, Wu, Geng, Ren—as examples. If Yang/Gang is lost, Yin/Rou can be inferred; thus, they can be unified under the Five Elements. Below, there are methods for averting the Five Epidemics, found in Category XX of Treatment Theory.)