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True Qi (Zhenqi, 真气) and Pathogenic Factors (Xieqi, 邪气) have both separation and combination, as mentioned in other chapters. However, this chapter is specifically named after this concept because it emphasizes that the function of acupuncture lies solely in eliminating pathogenic factors and preserving true Qi. To remove disease-causing pathogens, one must thoroughly investigate why they combine with the body and why they separate; only then can treatment be effective. The text of this chapter appears repetitive and complex, seemingly compiled from various sources.

The Yellow Emperor asked: I have heard that the Nine Needles are divided into nine chapters, and you further multiplied them by nine to create eighty-one chapters, which I have fully understood. The Classics state that the fluctuation of Qi's abundance and deficiency, and its shifting left and right, can be regulated by treating the upper to affect the lower, or the left to affect the right. For conditions of excess and deficiency, tonification and sedation are applied at the Ying-Spring (Yingxue, 荥穴) and Shu-Stream (Shuxue, 输穴) points, all of which I know. These refer to the shifting of Ying (Nutritive) Qi (Yingqi, 营气) and Wei (Defensive) Qi (Weiqi, 卫气), arising from deficiency and excess, not from external pathogens entering the meridians. I wish to hear about the presence of pathogenic factors within the meridians: what are their clinical manifestations? How should they be treated?

Qibo replied: The sage establishes medical principles corresponding to Heaven and Earth. Thus, Heaven has celestial degrees (stars and movements), Earth has major rivers, and humans have twelve primary meridians. (Note: 'Su' refers to the Twenty-Eight Mansions; 'Du' refers to the 365 degrees of the celestial sphere. 'Jingshui' refers to major rivers such as the Sea, Du, Wei, Hu, Mian, Ru, Yangtze, Huai, Luo, Yellow River, Zhang, and Ji waters. They are called 'Meridian Waters' because they correspond internally to the human meridians. The meridians refer to the three Yin and three Yang meridians of the hands and feet. This analogy is used because internal and external aspects correlate, and human Qi resonates with nature.) When Heaven and Earth are mild and warm, the meridian waters are calm; when cold and frozen, the meridian waters become stagnant and sluggish; when hot and scorching, the meridian waters boil and overflow; when sudden storms arise, the meridian waters surge and rise like waves. (Human meridians respond similarly. Note: Stagnation implies coldness and blockage; boiling implies floating and movement. 'Long' means mound or hillock. Water agitation and earth mounds are caused by violent winds.)

When pathogenic factors enter the vessels, cold causes blood to coagulate and stagnate, while heat makes Qi fluid and lubricated. Deficient pathogens take advantage of this to invade, similar to how wind affects meridian waters. The arterial pulse in the meridines may occasionally rise like a wave. Within the vessels, it moves subtly and invisibly. At the Cun Kou (Inch Port, 寸口) pulse point, the pulse may appear large or small; a large pulse indicates the arrival of pathogenic factors, while a small pulse indicates peace/normality. Pathogens move without fixed location, alternating between Yin and Yang, defying standard measurement. (Note: Water moves with wind; the pulse changes with pathogens. 'Cun Kou' refers to the radial pulse positions. 'Zhong shou' means the pulse responds to touch, varying in size to distinguish presence of pathogens. Since pathogens move unpredictably, pulse images shift with Yin-Yang dynamics.) Therefore, one must examine carefully using the Three Regions and Nine Palpations (Sanbu Jiuhou, 三部九候). If pathogenic invasion is detected suddenly, its pathway must be blocked early. (The physician must use the Nine Palpations to detect pathogens spreading along meridians, akin to travelers on roads of varying distances. Early intervention prevents deep penetration, reflecting the principle of "treating disease before it arises.")

During inhalation, insert the needle without causing Qi rebellion. Retain the needle quietly for a period to prevent pathogenic spread. During inhalation, rotate the needle until De Qi (arrival of Qi, 得气) is achieved. During exhalation, withdraw the needle, removing it completely only after exhalation ends. The major pathogenic Qi exits, hence this is called Sedation (Xie, 泻). (Note: 'Yin' means withdrawal; 'Qu' means leaving the acupoint. Withdrawing during exhalation allows pathogenic Qi to exit freely. 'Da Qi' here refers to major pathogenic factors disrupting Yin-Yang balance. This describes sedation technique: first eliminate excess pathogens, then tonify deficiency.)

The Yellow Emperor asked: How to tonify deficiency? Qibo said: First, palpate and stroke along the meridian, press and disperse, push and compress, flick to engorge vessels, scratch to guide Qi downward, unblock to obtain Qi, draw outward to close the spirit gate. (Note: Palpation soothes Qi; pressing disperses stagnation; pushing compresses skin; flicking engorges vessels; scratching prepares insertion; closing the gate retains Shen/Spirit. This sequence prepares the area for tonification.) Insert the needle at the end of exhalation, retain quietly until De Qi is achieved. Wait patiently as if for a noble guest, ignoring the passage of time. Once Qi arrives, maintain appropriate care. (Note: Tonification relies on Qi arrival, not just breath count. As stated in the Classic: if Qi does not arrive, continue needling; if it arrives, stop. 'Shi hu' means careful guarding. This preserves balanced Qi.) Withdraw the needle during inhalation so Qi does not escape. Push the skin to close the acupoint, retaining Spirit and Qi. Major Qi remains inside, hence this is called Tonification (Bu, 补). (Note: Closing the pore prevents leakage of healthy Qi, fulfilling the purpose of tonification.)

The Yellow Emperor asked: How to monitor Qi arrival? Qibo said: When pathogens move from collaterals to meridians and reside in blood vessels, their temperature sensation is inconsistent, rising and falling like waves, thus not staying in one place. (Note: Early pathogenic invasion shifts depth; symptoms fluctuate.) Therefore, when the pathogen arrives, press to stop its momentum and treat immediately. Do not attack when the pathogen is at its peak. True Qi is Meridian Qi; if Meridian Qi is too deficient, do not confront the pathogen aggressively. (Note: Textual corruption suspected here. The meaning implies avoiding strong sedation when True Qi is weak.) If monitoring is imprecise and the major pathogenic Qi has passed, sedation will deplete True Qi, making recovery difficult. Pathogens will return, worsening the condition. Hence, once pathogens depart, do not chase them. (Note: Late sedation harms True Qi. Early intervention is crucial.)

The Yellow Emperor asked: How to perform tonification and sedation? Qibo said: This is an attack on pathogens. Withdraw the needle quickly to remove stagnant blood and restore True Qi. (Note: Here, removing blood is urgent to restore Qi, differing from previous emphasis on De Qi.) For newly arrived pathogens, which flow like water without fixed position, pushing advances them, pulling stops them. Pierce against their flow to release warm blood. Removing this blood cures the disease immediately. (Note: 'Rong rong' describes flowing water. New pathogens are like warm, flowing blood, not yet congealed. Piercing against the flow releases this blood, curing the disease.)

The Yellow Emperor said: Excellent! But when True Qi and pathogens combine, and no wave-like pulse elevation occurs, how to monitor? Qibo said: Carefully assess the fullness and emptiness of the Three Regions and Nine Palpations to regulate treatment. Observe discrepancies in left/right and upper/lower pulses, identify the affected Zang organs, and predict recovery timing. (Note: Subtle pathogenic integration requires detailed physical examination and pulse diagnosis to locate the organ involved.) Punishing the innocent (healthy tissue/Qi) is called great confusion. It disrupts the Great Meridians, making True Qi irrecoverable. Mistaking excess for deficiency, or pathogens for True Qi, renders acupuncture meaningless. It becomes a thief of Qi, scattering Ying and Wei, losing True Qi, allowing pathogens to dominate, shortening life, and causing premature death. All result from ignorance of the Three Regions and Nine Palpations, leading to poor longevity. (Note: Reiteration of the dangers of neglecting comprehensive pulse diagnosis.)