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This chapter discusses the examination of symptoms and Qi dynamics, as well as the methods of needle insertion for tonification (Bu) and sedation (Xie). The content is extremely detailed and comprehensive, serving as a foundational model for later generations of acupuncturists. It is therefore recorded here to serve as an example.

The Yellow Emperor asked: I have heard that the *Nine Needles* consists of nine chapters, and you have expanded this by multiplying by nine, resulting in eighty-one chapters. I have thoroughly understood their meanings. The classics state that regarding the excess or deficiency of Qi, and its shifting tendencies to the left or right, one can regulate the lower through the upper, and the right through the left. For conditions of excess and deficiency, tonification and sedation are applied at the Ying-Spring (Yingxue) and Shu-Stream (Shuxue) points. I am aware of these principles. However, these refer only to the shifting of Ying (Nutritive) and Wei (Defensive) Qi, arising from deficiency and excess, not to pathogenic factors invading the meridians from the exterior. I wish to hear about the presence of pathogenic factors within the meridians; what are the clinical manifestations? How should they be treated?

Qibo replied: The sage establishes medical standards corresponding to Heaven and Earth. Thus, Heaven has the degrees of stars, Earth has the flowing waters of rivers, and humans have the meridian channels. When Heaven and Earth are mild and warm, the river waters remain calm; when Heaven is cold and Earth frozen, the river waters become stagnant; when Heaven is hot and Earth scorching, the river waters boil and overflow; when sudden storms arise, the river waters surge and rise in waves. Similarly, when pathogenic factors enter the vessels, cold causes blood to stagnate, while heat makes Qi fluid and lubricated. Deficient pathogens take advantage of this to invade, just as river water reacts to wind. The arterial pulses of the meridians also rise and fall periodically. Within the vessels, they move steadily. When reaching the Cun Kou pulse position, the sensation under the fingers varies—sometimes large, sometimes small. A large pulse indicates the arrival of pathogenic factors; a small pulse indicates peace/normality. Their movement has no fixed location, oscillating between Yin and Yang, defying standard measurement. By observing according to this pattern, using the Three Regions and Nine Palpations (Sanbu Jiuhou) method, if one encounters them suddenly, one should block their path early. During inhalation, insert the needle, ensuring the Qi does not rebel. Leave it quietly for a long time to prevent the spread of pathogens. During inhalation, rotate the needle until Deqi (arrival of Qi) is achieved. During exhalation, withdraw the needle, removing it completely at the end of exhalation. The "Great Qi" (pathogenic Qi) exits, hence this is called Sedation (Xie).

The Yellow Emperor asked: How should deficiency be tonified? Qibo said: First, palpate and follow the meridian, press and disperse, push and press the area, flick to distend the vessels, grasp and guide downward, unblock to obtain Qi, draw open the external aperture to close the Shen (Spirit), and insert the needle at the end of exhalation. Leave it quietly for a long time until Qi arrives, waiting as if for a honored guest, unaware of the passing day. Once Qi arrives, protect it appropriately. Insert the needle during inhalation so Qi cannot escape, keeping it in place. Push and close the skin aperture to retain Shen and Qi, stopping the "Great Qi." Hence, this is called Tonification (Bu).

The Yellow Emperor asked: How does one wait for Qi? Qibo said: When pathogenic factors move from collaterals into meridians and lodge in the blood vessels, their cold or warm nature has not yet harmonized with the body's Qi. Like rising waves, they come and go, thus lacking a fixed presence. Therefore, it is said that when they arrive, one must press to stop their advance and treat immediately. Do not sedate when they are surging violently. The True Qi is the Meridian Qi. If Meridian Qi is too deficient, it is said "do not meet the arriving [pathogen] with sedation," which refers to this situation. It is also said that if one fails to carefully observe the pathogen, and the main wave of the pathogen has passed, sedation will cause the True Qi to leak. Once leaked, it cannot recover; the pathogen returns, and the disease accumulates further. Thus, it is said "do not chase the departing [pathogen]," referring to this. The timing must not be off by a hair. One must wait for the pathogen to arrive before inserting the needle for sedation. If one acts too early or too late, the Blood and Qi are exhausted, and the disease cannot be cured. Therefore, knowing the correct time to treat is like triggering a crossbow; not knowing it is like striking a wooden mallet without effect. Those who understand the Dao of mechanism do not miss the slightest opportunity; those who do not understand strike but get no response. This is what is meant.

The Yellow Emperor asked: How exactly are tonification and sedation performed? Qibo said: This is attacking the pathogen. Withdraw the needle quickly to remove excessive blood and restore True Qi. Since the pathogen is newly arrived and fluid/unsettled, pushing it moves it forward, pulling it stops it. Puncture against its direction to release warm blood (stasis). Removing the blood cures the disease immediately.

The Yellow Emperor said: Excellent. But when True Qi and Pathogen mix, and no wave-like pulse arises, how should one observe? Qibo said: Carefully palpate and examine the excess or deficiency in the Three Regions and Nine Palpations to regulate accordingly. Observe where the left/right and upper/lower aspects are discordant or diminished. Examine the affected Zang-Fu organs to predict the outcome. One who does not know the Three Regions distinguishes neither Yin nor Yang, nor Heaven nor Earth. The Earth region observes the lower body, the Heaven region observes the upper body, and the Human region observes the middle body. Harmonize the Central Fu organs (Stomach) to define the Three Regions. Therefore, it is said that if an acupuncturist does not know the locations of the Three Regions and Nine Palpations pulse sites, even if major errors occur, they cannot prevent them. Punishing the innocent (tonifying when empty/sedating when full incorrectly) is called great confusion. It disrupts the Great Meridians, making True Qi irrecoverable. Treating excess as deficiency, or pathogen as True Qi, using needles without principle, becomes a thief of Qi, depriving the person of righteous Qi. Turning compliance into rebellion, scattering Ying and Wei, losing Qi, allowing pathogen to lodge alone, cuts short life and brings disaster. This is due to ignorance of the Three Regions and Nine Palpations, leading to short life. Furthermore, failing to integrate the Four Seasons and Five Elements leads to exacerbating mutual overcoming relationships. Abandoning the pathogen to attack the righteous Qi cuts short life. When a pathogen is newly arrived and unsettled, pushing moves it forward, pulling stops it. Meeting it with sedation cures the disease immediately.