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The first half discusses the adverse and favorable conditions of diseases, while the second half discusses the errors in acupuncture methods according to the four seasons. If acupuncturists can understand the losses caused by incorrect needling, then needling might be performed without error.

When the Jueyin meridian qi is in excess, it causes Yin Bi (painful obstruction syndrome characterized by cold); [Bi refers to pain, Yin refers to cold, excess refers to the fullness of Jueyin qi, thus cold manifests externally as cold Bi.] When it is deficient, it causes Heat Bi; [Yin deficiency leads to Yang excess, thus causing Heat Bi. Note: The meaning of "Bi" mentioned in the *Treatise on Bi Syndrome* implies either insensitivity to pain and itch or blockage and stagnation. Wang Bing's commentary defining Bi solely as pain fails to grasp the original intent. The Bi syndromes caused by excess and deficiency in the six meridians here are complementary in meaning and should not be further interpreted separately.] A slippery pulse indicates Hu (Fox) Hernia Wind; a choppy pulse indicates accumulation of Qi in the lower abdomen. [The Jueyin meridian follows the medial aspect of the thigh, enters the pubic region, circles the genitalia, and reaches the lower abdomen. Its collateral branch ascends along the penis to the testis and knots at the penis. Hence these diseases occur. Note: The New Corrected Text states: Yang Shangshan said: Foxes cannot urinate at night but can after sunrise; humans suffering from this disease resemble foxes, hence called Fox Hernia. Another name is Gu (Solitary) Hernia, referring to the Sanjiao (Triple Burner), the solitary organ, developing hernia.]

When the Shaoyin meridian qi is in excess, it causes Pi (Skin) Bi with hidden rashes; [Kidney Water rebels and connects to the Lung mother.] The Foot Shaoyin meridian ascends from the Kidney, passes through the Liver and Diaphragm, and enters the Lung, hence such diseases occur. A slippery pulse indicates Lung Wind Hernia; a choppy pulse indicates accumulation and hematuria. [Because its main channel enters the Lung, passes through the Kidney, and connects to the Bladder, these diseases occur.]

When the Taiyin meridian qi is in excess, it causes Rou (Flesh) Bi and Cold Zhong (Cold striking the interior); [The Spleen governs flesh, hence this.] When it is deficient, it causes Pi (Spleen) Bi. A slippery pulse indicates Spleen Wind Hernia; a choppy pulse indicates accumulation and occasional fullness in the heart and abdomen. [The Taiyin meridian enters the abdomen, belongs to the Spleen, and connects to the Stomach. Its branch emerges from the Stomach, ascends through the diaphragm, and pours into the Heart. Hence these diseases occur.]

When the Yangming meridian qi is in excess, it causes Mai (Vessel) Bi with intermittent body heat; when deficient, it causes Xin (Heart) Bi. [Stomach excess Qi returns upward to the Heart; Stomach deficiency causes Bi obstruction below the Heart, hence this.] A slippery pulse indicates Heart Wind Hernia; a choppy pulse indicates accumulation and frequent fright. [The Heart master's meridian originates in the chest, emerges to belong to the Pericardium, descends through the diaphragm, and sequentially connects to the Sanjiao. Hence these diseases occur.]

When the Taiyang meridian qi is in excess, it causes Gu (Bone) Bi with heavy body; when deficient, it causes Shen (Kidney) Bi. [Taiyang and Shaoyin are exterior-interior pairs, so both excess and deficiency diseases return to the Kidney.] A slippery pulse indicates Kidney Wind Hernia; a choppy pulse indicates accumulation and frequent disorders of the vertex. [The Taiyang meridian intersects at the vertex, enters to connect with the Brain, descends along the back muscles, and connects to the Kidney, hence this.]

When the Shaoyang meridian qi is in excess, it causes Jin (Tendon) Bi with flank fullness; when deficient, it causes Gan (Liver) Bi. [Shaoyang and Jueyin are exterior-interior pairs, so the disease returns to the Liver.] A slippery pulse indicates Liver Wind Hernia; a choppy pulse indicates accumulation, frequent tendon stiffness, and eye pain. [The Liver governs tendons, hence frequent tendon stiffness. The Jueyin meridian ascends to emerge at the forehead and meets the Du meridian at the vertex. Its branch originates from the eye system, descends through the cheek interior, hence eye pain. Note: These six meridians are the Foot Three Yin and Three Yang meridians recorded in the *Treatise on Heat Disorders*. Although all twelve regular meridians can cause disease, only these six are mentioned here alongside the *Treatise on Heat Disorders* because they correspond to Wood, Earth, and Water, their Qi fears cold, and pathogens easily invade. Among external contractions, none is more severe than Cold Damage (Shanghan), whose transmission precisely involves these six meridians. This chapter also speaks from the perspective of severity. However, the *Treatise on Heat Disorders* focuses exclusively on external contractions, while this chapter discusses miscellaneous diseases, hence discussing both excess and deficiency together. Why are all excess and deficiency conditions termed Bi, and why are they differentiated by slippery and choppy pulses? Bi means numbness/stiffness and blockage. When pathogens enter the meridians, Blood and Qi stagnate, resulting either in numbness and insensitivity of flesh or blockage and Qi obstruction. Pathogen excess leads to disease of excess, with a floating pulse resembling slippery; Zhengqi (Upright Qi) deficiency leads to disease of deficiency, with a deep, sluggish pulse resembling choppy. Slippery and choppy are the forms of excess and deficiency, seemingly not necessarily implying that slippery denotes phlegm abundance and choppy denotes bloodlessness as stated in the *Pulse Classic*. Since slippery approaches excess, it governs Wind Hernia and meridian/sinus disorders; since choppy indicates deficiency, it governs Qi accumulation in zang-fu organs. Those skilled in interpreting classics value grasping the general idea and deducing from it.]

Therefore, Spring Qi resides in the Jingmai (Regular Meridians), Summer Qi in the Sunluo (Fine Collaterals), Late Summer Qi in the Muscles, Autumn Qi in the Skin, and Winter Qi in the Marrow. The Yellow Emperor said: I wish to hear the reason. Qibo said: In Spring, Heaven's Qi begins to open, Earth's Qi begins to diffuse, ice thaws, water flows, and meridians become clear; thus Human Qi resides in the vessels. In Summer, vessel Qi is full and overflows, Sunluo receive blood, and skin is filled. In Late Summer, both Jingmai and Luoluo Qi are abundant, overflowing internally into the muscles. In Autumn, Heaven's Qi begins to gather, pores close, and skin becomes tight. [Note: "Yin" means contraction/tightening, "Ji" means tension.] In Winter, storage prevails, Blood and Qi remain within, settling in the marrow and connecting to the Five Zang Organs. [Note: Humans obtain Qi from Heaven and Earth, thus constantly corresponding to the growth, flourishing, gathering, and storing of the four seasons.] Therefore, pathogenic Qi often enters and lodges following the changes of seasonal Blood and Qi. Its transformations are immeasurable, yet one must follow the meridian Qi to expel the pathogen; once the pathogen is removed, chaotic Qi will not arise. [Note: Pathogenic Qi is improper Qi. The four seasons have improper Qi that often exploits deficiencies in Human Blood and Qi. Deficiency varies in degree, so pathogens vary in severity, changing unpredictably. "Cong" (follow) means to comply; treating this requires complying with the subtle degrees of meridian deficiency and excess to apply tonification and sedation methods, thereby removing pathogens and restoring Zhengqi. Once Zhengqi is restored, how could chaos exist?]

The Yellow Emperor said: How does violating the four seasons generate chaotic Qi? Qibo said: Needling collaterals in Spring causes Blood and Qi to overflow outward, leading to shortness of breath; [Overflowing outward depletes interior Qi, hence shortness of breath. Note: The New Corrected Text states: From "Needling collaterals in Spring" to "causing blurred vision," the text differs from the *Treatise on Essential Acupuncture Termination* but shares the same meaning, where the annotation is detailed. That text divides by four seasons, this by five seasons; however, this includes Late Summer needling of muscles, while each season lacks mention of Autumn needling. It is suspected that the "muscle" section here corresponds to the "skin" section in Autumn there.] Needling muscles in Spring causes Blood and Qi to circulate reversely, leading to rebellious Qi ascending; [Huan means circulation, indicating chaotic and reverse Blood and Qi, causing Qi throughout the body to ascend rather than descend. New Corrected Text: "Scripture lacks 'Needling Autumn Equinox in Spring.'"] Needling sinews and bones in Spring causes Blood and Qi to lodge internally, leading to abdominal distension. [Internal lodging without dispersion causes distension.]

Needling vessels in Summer causes Blood and Qi to exhaust, leading to flaccidity; [Exhaustion of Blood and Qi leads to flaccidity.] Needling muscles in Summer causes Blood and Qi to retreat inward, leading to timidity; [Que means closure. Internal closure of Blood and Qi blocks Yang Qi, hence timidity. Note: New Corrected Text: "Scripture lacks 'Needling Autumn Equinox in Summer.'"] Needling sinews and bones in Summer causes Blood and Qi to rebel upward, leading to irritability. [Upward rebellion of Blood and Qi corresponds to anger, hence irritability.]

Needling vessels in Autumn causes Blood and Qi to rebel upward, leading to forgetfulness; [Upward rebellion fills the Lungs, hence forgetfulness.] Needling collaterals in Autumn prevents Qi from guarding the exterior, leading to lethargy and unwillingness to move; [Note: Wang Gao's edition reads "Qi does not move outward," while Quan Yuanqi's edition reads "Qi does not guard the exterior," which is correct. Now corrected to follow it. During Autumn's gathering phase, needling damages vessels, scattering Qi so it cannot guard the exterior, hence desire to lie down but inability to move. New Corrected Text: "Scripture lacks 'Needling Late Summer Solstice in Autumn.'"] Needling sinews and bones in Autumn causes Blood and Qi to scatter internally, leading to chills. [Internal scattering depletes Middle Qi, hence chills.]

Needling vessels in Winter causes depletion of both Blood and Qi, leading to blurred vision; [Blood and Qi fail to nourish.] Needling collaterals in Winter causes internal Qi to leak outward, remaining as major Bi; [Note: Outward leakage prevents internal movement, resulting in obstructive Bi.] Needling muscles in Winter causes exhaustion of Yang Qi, leading to forgetfulness. [Note: The annotation suggests Yang Qi fails to strengthen and exhausts by Spring, causing forgetfulness. I fear this interpretation is inaccurate; better to leave it as doubtful.] (New Corrected Text: "Scripture lacks 'Needling Autumn Equinox in Winter.'")

All these seasonal needling errors constitute major violations that must be avoided; reversing them generates chaotic Qi and mutual contamination leading to disease. [... "Yin" means disorderliness; acting out of sequence spreads like an infiltrating infection. Note: Cong treatment (following the disease nature) is originally set for major violation cases; thus, using congruent treatment instead of contrary treatment would merely disrupt Qi and fail to cure. "Cong" here refers to Miu Ci (Lateral Puncture). "Major violation disease" in Quan Yuanqi's edition is written as "Disease of the Six Meridians," which is incorrect.]

The Yellow Emperor said: Excellent! Needling the Five Zang Organs: Hitting the Heart causes death in one day, manifesting as belching; [Same as *Treatise on Acupuncture Taboos*.] Hitting the Liver causes death in five days, manifesting as excessive talking; (*Treatise on Essential Acupuncture Termination* omits this; *Treatise on Acupuncture Taboos* agrees. Note: *Jia Yi Jing* reads "qian" (yawn) instead of "yu".) Hitting the Lung causes death in three days, manifesting as cough; (*Treatise on Essential Acupuncture Termination* says: "Death in five days." *Treatise on Acupuncture Taboos* says: "Death in three days, manifesting as cough.") Hitting the Kidney causes death in six days, ([Note: *Jia Yi Jing* says three days.]) manifesting as sneezing and yawning; (*Treatise on Essential Acupuncture Termination* says: Death in seven days; *Treatise on Acupuncture Taboos* agrees. Note: Neither *Treatise on Acupuncture Taboos* nor *Jia Yi Jing* includes "yawn".) Hitting the Spleen causes death in ten days, ([Note: *Jia Yi Jing* says fifteen days.]) manifesting as swallowing. (*Treatise on Essential Acupuncture Termination* says: "Death in five days." *Treatise on Acupuncture Taboos* says: "Death in ten days, manifesting as swallowing.") Although these three treatises contain words of Qibo, the days of death and manifestations differ due to transmission errors. Needling and injuring the Five Zang Organs inevitably leads to death; the manifestations follow the transformations of the respective Zang Qi, allowing one to predict death. "Transformation" refers to Qi dynamic changes. From "Hitting the Heart" to here, these are repetitive texts regarding congruence and violation.