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(Hand Techniques in Twelve Steps and Song)

1. Nail Press: When inserting the needle, use the nail of the left thumb to press firmly on the acupuncture point, dispersing the Qi and Blood, then insert the needle to avoid damaging Ying (Nutritive) Wei (Defensive).
When selecting the point, press deeply with the nail; instruct the patient to keep their mind focused so that Ying and Wei are not harmed, allowing the practitioner to perform exquisite needling.

2. Finger Hold: When inserting the needle, hold it with the right hand, applying force to rotate and insert into the point until reaching the interstices (Cou Li). Take three breaths, lift the needle to the Heaven level, and proceed slowly based on the previous breath. As stated, holding the needle should be like grasping a tiger or capturing a dragon, with a focused mind, as if awaiting a noble person.
The holder must have a bold spirit, with momentum like grasping a tiger and capturing a dragon. To understand the mysteries of the three levels (Heaven, Man, Earth), one must thoroughly investigate this principle.

3. Mouth Warming: When inserting the needle, it must be warmed in the mouth before insertion to harmonize Qi and Blood, preventing conflict between cold and heat.
The principle of warming the needle is excellent; harmonize it in the mouth before inserting into the point. Do not allow cold and heat to contend; only when Ying and Wei flow freely is auspiciousness achieved.

4. Needle Advancement: When inserting the needle, ensure the patient’s Shen (Spirit) is calm and breathing is even; the practitioner must also remain calm and not rush. Examine which part the point belongs to: if in Yang parts, select the depression between sinews and bones; if in Yin parts, [text missing, implied muscle/flesh], where arterial pulse corresponds. Press the meridians heavily with the nail and wait a moment before proceeding.
The method of advancement lies in grasping the key mechanism; treating points off the meridian is futile. For Yang meridians, select depressions; for Yin meridians, think carefully and reconsider.

5. Finger Circling: If Qi does not arrive upon insertion, use fingers to circle along the meridian path of the relevant area, up and down, left and right, to circulate Qi and Blood evenly. The needle will naturally feel heavy and tight as Qi arrives; this is the reason for draining after obtaining De Qi.
Why is circling effective? Because the needle head is not yet heavy or tight. Pushing moves it, pulling stops it; harmonizing Blood and Qi brings them together.

6. Nail Pinching: If evil Qi stagnates and the needle feels obstructed, pinch along the meridian up and down with the thumb nail to unblock the Qi.
One must know that pinching addresses meridian stagnation; do not press too lightly with the nail. Follow the meridian up and down to ensure free flow; thus, students must pursue precision.

7. Needle Withdrawal: When withdrawing the needle, count in even numbers (Yin), clearly distinguishing the functions of the three levels. Be sincere and careful to avoid confusion between tonification and drainage. Withdraw the needle slowly, section by section.
Who knows the logic of withdrawal techniques? The Three Powers formula contains the mystery: six Yin counts per section, three inhalations; diseases can heal swiftly.

8. Finger Rubbing: Rotate the needle as if rubbing a thread, but not too tightly; follow the Qi. If rotated too tightly, flesh may wrap around the needle, causing severe pain. If Qi is stagnant, apply the sixth technique (Nail Pinching) first.
Rubbing the needle to drain Qi is miraculous; do not move quickly if the needle is wrapped by flesh. Rotate gently like rubbing a thread; rapid rotation causes flesh adherence.

9. Finger Twisting: When inserting, twist outward with the left thumb for upper body conditions, and inward for lower body conditions. Outward twisting directs Qi upward to treat disease; inward twisting directs Qi downward. If withdrawn to the Man level, inward twisting is tonification, directing the needle head toward the pathology to draw true Qi there. At the Man level, outward twisting is drainage, directing the needle head toward the pathology to expel evil Qi. This is a secret principle of needling.
Twisting techniques differ; though performed with the same hand, internal and external twists move Qi up and down, leaving no room for evil pathogens.

10. Finger Retention: When withdrawing to the Heaven level, leave the needle tip slightly under the skin (the size of a bean) for a moment before complete removal.
Retention allows monitoring of Qi floating and sinking; exit leaves space for a bean, entry matches it, causing Ying and Wei to scatter纵横 (crisscross); the subtle mystery lies in the fingertips.

11. Needle Shaking: When withdrawing through the three levels for drainage, shake once per level, totaling six shakes. Twist the needle with fingers as if shaking a person's head, to open the acupoint widely.
Shake the needle through three levels, six times total, applied sequentially via fingers. The acupoint opens wide without obstruction, allowing evil Qi to exit rapidly.

12. Finger Pulling: When preparing to withdraw, wait until the sensation under the needle becomes light and slippery rather than heavy and tight. Use fingers to twist and pull the needle as if pulling a tiger's tail.
Pulling is an excellent method; observe floating, sinking, rough, and smooth sensations. The momentum resembles pulling a tiger's tail; who knows this secret hidden in the brocade bag?

General Song: Many secrets and formulas exist in needling; despite many techniques, they boil down to these: pressing points, holding needles, warming in mouth, advancing, circling, pinching, withdrawing, rubbing, twisting, retaining, shaking to open points, and pulling like a shuttle. Physicians must emphasize these methods; memorize these twelve songs.

Formula: Burning Mountain Fire removes cold; three advances, one retreat, heat surges. Inhale once through nose, exhale five times ("He" sound).
Burning Mountain Fire dispels cold; one retreat, three flights bring peace. Start at five fen, end at one cun; three entries and exits, slow lifting.
When using the needle, manipulate into the five-fen depth, performing nine Yang counts. One cun implies shallow to deep. If De Qi is obtained, proceed with manipulation. For men, rotate left; for women, right. Gradually move to one cun, three exits and three entries, slow lift, firm press. If the needle feels heavy and tight, heat generates, cold dissipates. If ineffective, repeat.
Limbs are hard to control like water; aversion to cold comes constantly. Physician activates Burning Mountain Fire, patient finds peace immediately.

Formula: Penetrating Heaven Coolness removes heat; three retreats, one advance, ice-cold cool. Inhale once through mouth, exhale five times through nose.
When needling, advance to one cun, perform six Yin counts. Five fen implies deep to shallow. If De Qi is obtained, retreat and extend. Retreat to five fen, three entries and three exits, firm lift, slow press. If needle feels heavy and tight, slowly lift to generate coolness, removing heat. If ineffective, repeat.
Body burns like fire; heat rises uncontrollably. Add cooling method, and heat toxins vanish instantly.

Formula: Yang Hiding Yin treats initial chills followed by fever; shallow to deep.
Yang hides Yin; patient has initial chills then fever. Five fen uses nine Yang counts; one cun uses six Yin counts.
When needling, first manipulate to five fen, perform nine Yang counts. If slight heat is felt, move to one cun, perform six Yin counts to obtain De Qi. This is Yang Hiding Yin, treating initial chills then fever, tonifying first then draining.
Initial chills then fever resemble malaria; physicians must distinguish excess and deficiency. Heed the advice to use Yin-Yang needling to remove cold and heat disasters.

Formula: Yin Hiding Yang treats initial fever followed by chills; deep to shallow.
When needling, first manipulate to one cun, perform six Yin counts. If slight coolness is felt, retreat to five fen, perform nine Yang counts to obtain De Qi. This is Yin Hiding Yang, treating initial fever then chills, draining first then tonifying.
Initial fever then chills resemble malaria; Yin then Yang is called "Through Heaven." Physician activates cloud and rain methods, harmonizing Ying and Wei for recovery.

Tonification requires heat arrival; drainage requires cold invasion. Like rubbing thread, turn needle slowly. Method depends on shallow or deep; do not mix them.

Formula: Retaining Qi Method breaks Qi stagnation; extend nine, lift six.
Retain Qi by manipulating to seven fen, pure Yang obtains Qi at ten fen depth. Extend using nine, lift using six; masses and Qi lumps dissolve.
When needling, manipulate to seven fen, perform pure Yang counts. If De Qi is obtained, deepen to one cun, slightly extend and lift, then return to original position. If no De Qi, repeat. Treats abdominal masses.
Abdominal masses should cease; rely on physician's intent. Fingertip technique is Retaining Qi; body is relieved of pain.

Formula: Moving Qi Method drains; initially straight then horizontal.
Moving Qi uses pure Yin; when Qi arrives, invert the needle. Patient inhales five times; pain root is removed.
When needling, perform pure Yin counts first. If fullness under needle is felt, invert the needle. Patient inhales five times to drive needle force to pathology. This is Moving Qi method, treating pain.
Moving Qi needling is skillful; widespread pain vanishes suddenly. This secret method saves lives, worth thousands of gold.

Formula: Lifting Qi Method lifts Qi from Yin with slight lifting; eliminates cold and numbness instantly.
When needling, start with Yin counts. When Qi arrives, slightly lift the needle to gather Qi in meridians under the needle. Treats cold and numbness.
Lifting Qi follows Yin six counts; effective for stubborn bi syndrome. Know the master's secret; mechanisms are in your palm.

Formula: Middle Qi Method removes accumulation; initially straight then horizontal, draining.
When needling, first use Moving Qi method, either Yang or Yin, then lay the needle horizontally. If pain occurs, raise the needle vertically, not engaging internal Qi.
Middle Qi shares logic with Moving Qi; same creation, different function. Carefully use qi movement in hand; subtle principles revive fatigue and edema.
If joints are blocked and Qi does not flow, use Dragon and Tiger major methods to connect meridians and drive Qi. Also use circling, pinching, rubbing, and massage; all respond. Perform pressing, palpating, rubbing, flexing, extending, and guiding.

Formula: Green Dragon Wagging Tail Technique, Tonification.
Green Dragon wags tail at joints; gently guide the needle back and forth. Like a rudder on a boat in the river, Qi flows universally throughout the body.
If tonification yields De Qi, purely tonify; if not, use drainage. This is flexibility.
When inserting, fly Qi to joints. Guide the needle back and forth like a rudder, following Qi left and right. Qi interacts naturally; moving slowly left and right distributes Qi throughout the body without loss.
Green Dragon wagging circulates Qi; Blood and Qi spread throughout. No matter how many symptoms, one insertion cures the disease.

Formula: Red Phoenix Nodding Head Technique, Drainage.
After obtaining De Qi, if directing Qi upward, block below; if downward, block above. Advance continuously from Chen to Si hours, withdraw from Si to Wu hours. Point left by tilting left, point right by tilting right. It is merely left-right movement, like shaking a bell. Withdraw square, advance round. Combined with left-right shaking like an oar, resembling Red Phoenix nodding head. Distinguish welcoming, following, opposing, and conforming; do not act against principles.

Formula: Dragon and Tiger Fighting Technique, one tonification and one drainage in each of the three levels.
Dragon and Tiger fight; apply left and right. Yin and Yang hide mutually; nine and six stop pain.
When needling, first perform Left Dragon (left twist) nine times (odd/Yang number). Then perform Right Tiger (right twist) six times (even/Yin number). Fight Dragon then Tiger to obtain De Qi and tonify. Thus, Yang hides Yin, Yin hides Yang. Left twist nine, right twist six; this stops pain, following the way of repetition. Called Dragon and Tiger Fighting, exhausting evil to find its source; this is advancing and retreating Yin and Yang.
Blue Dragon turns left in Nine Yang Palace; White Tiger rotates right through Six Yin. Repetitive mystery follows method; manage Yin and Yang within Nine and Six.

Formula: Dragon and Tiger Rising and Falling Technique.
Needling method: First, right thumb presses forward. After entering, left thumb twists forward. When meridian Qi moves, rotate needle left and right to raise Yang Qi, press and lift. Qi moves on its own. If Qi is insufficient, repeat.
Dragon and Tiger rising twisting is wonderful; Qi moves up and down combining. Following master's clear instructions, cure diseases now.

Formula: Five Zang Meridian Crossing.
Five Zang crossing requires Qi overflow. Wait for Qi and Blood to disperse and circulate. Apply Green Dragon Wagging Tail east and west; remember Five Elements fixed points.
When inserting, when Qi overflows, wait for dispersion, then apply Green Dragon left-right waving.
Five Elements fixed points divide meridians; like untangling a ship's cable, it flows smoothly. Creation divides at the needle head; Qi and Blood must cross and crisscross.

Formula: Pass-Opening Meridian Crossing. Pass-opening, Green Dragon Wagging Tail, Red Phoenix Nodding Head; tonification and drainage are logical.
First use Green Dragon Wagging Tail, then Red Phoenix Nodding Head. Manipulate into joints. Then use tonification techniques for tonification, drainage techniques for drainage, allowing Qi to cross in its meridian.
First Green Dragon wags tail, then Red Phoenix nods head. Again apply eight finger techniques up and down; joints open, Qi flows freely.

Formula: Diaphragm-Horn Meridian Crossing. Diaphragm-Horn crossing involves mutual generation and restriction.
When needling, to achieve mutual generation/restriction of Qi, or tonify then drain, or drain then tonify, follow the deficiency/excess of disease and cold/heat. Evil Qi drains away, true Qi generates.
Diaphragm-Horn requires generation; Water and Fire depend on you. Take points directly for symptoms; practice hands when healthy. Lie supine steadily; method ensures balanced Qi. Flying meridians enter horns; one lift is worth gold.

Formula: Joint Meridian Crossing. Joint crossing: when Qi reaches joint, raise needle and apply Middle Qi method.
When needling, if Qi travels to joints, raise the needle and apply Middle Qi method to store it.
Joint crossing is great merit; ensure Qi enters meridians. Manipulate techniques three to five times; Qi naturally flows.

Formula: Zi-Wu Tonification and Drainage General Song.
Tonification requires tapping needle; nail press should be light. Drainage is strictly forbidden; do not let disease invade again.
When needling, warm needle in mouth first. Press point with left hand. Tap and distend at insertion site, press with nail, palpate and circle, open and take. Ask patient to cough once. Insert with right hand. Spring/Summer: 24 breaths; Autumn/Winter: 36 breaths. Slow exit, slow entry. Qi arrives like arterial pulse, needle slightly tight. Wait for Qi arrival, then use tonification/drainage as before.
Movement and shaking seem similar but differ; movement is Qi for tonification, shaking is for drainage peace.

Formula: Zi-Wu Pestle Method, Water Distension and Diaphragmatic Qi.
Zi-Wu Pestle: needle moves up and down; nine entries, six exits, left and right non-stop.
When inserting, balance Qi. Move needle up and down, nine entries, six exits, rotating left and right endlessly. Follow Yin-Yang principles. Zi-Wu Pestle is divine mechanism; few know nine entries and six exits. Ten thousand diseases fit the great number; make patient smile.

Formula: Zi-Wu Front-Back Meridian Crossing and Qi Exchange Song.
After Zi hour, know cold and heat: left turn is tonification, right is drainage; lifting needle brings heat, inserting brings cold. Women reverse this. After Wu hour, know cold and heat: right turn is tonification, left is drainage; clockwise is left, counter-clockwise is right. This is immortal secret.

Formula: Zi-Wu Tonification and Drainage Song.
Peel skin before noon like boiling soup melting snow. To seek cold, look inside skin; don't hurt skin in vain. How to know Yin-Yang reversal? Differentiate deficiency/excess temporarily. Needle head like crossbow trigger; do not share casually.

Formula: Zi-Wu Inclining Needle.
Zi-Wu Inclining Needle: know Pulse Classic, which Zang organ is diseased, apply tonification/drainage.
When inserting, take six-finger rules, know meridians, identify diseased Zang. Use previous tonification/drainage, enter/exit inside/outside. Why might it fail? Answer: Within a day, there is Yin and Yang, Yang hiding Yin, Yin hiding Yang. Day is Yang, Night is Yin. One quarter past Zi, one Yang is born; one quarter past Wu, one Yin is born. From Zi to Wu, hence Zi-Wu method.
Left turn is male tonification Qi; right turn is female drainage record. Women reversing this is not true; this is Yin-Yang tonification/drainage meaning. Heat disease not cured requires drainage; cold disease纏身 (entangling body) benefits from tonification. Asthma/wheezing Qi determines tonification/drainage; do not rush if Qi does not arrive.
Tonification: Follow meridian, insert and press. Close point with left hand, exit slowly, press quickly. Drainage: Oppose meridian movement, extend. Open point with left hand, exit quickly, enter slowly. Classics say: Following and assisting is tonification. Opposing and seizing is drainage. Su Wen says: For excess, retain needle until Yin Qi arrives to empty it. For deficiency, retain needle until Yang Qi prepares to fill it.

Formula
For diseases of twelve meridians, when needling: excess drain, deficiency tonify, heat hasten, cold retain, sinking moxa, neither excess nor deficiency treat via meridian. Classics say: Tonify mother for deficiency, drain son for excess. Tonify first, then drain. Example: Lung Qi in Foot Taiyang Bladder Meridian. Deficiency tonifies Yang; emerging Jing point belongs to Metal. Obtain De Qi, follow and assist. Right hand takes needle, exit slowly, press quickly; this is tonification. Excess drains Yang; flowing Shu point belongs to Wood. Obtain De Qi, oppose and seize. Left hand opens point, exit quickly, enter slowly; this is drainage.

Zang-Fu Yin-Yang, Respiration Inside-Out, Twisting Needle Tonification/Drainage Techniques.
External twist following exhalation tonifies Zang deficiency; internal turning during inhalation drains excess fat. Six Fu diseases reverse usage; just follow respiration to cure. Women tonify deficiency by "He" sound internal turn; inhalation external turn drains excess. Follow meridian three times to adjust Qi; do not neglect respiration.
Men tonify deficiency by "He" sound external turn; inhalation internal turn drains excess. Women tonify deficiency by "He" sound internal turn; inhalation external turn drains excess.

Fire Advancement: Tonification. Initial advance one fen, exhale once. Retreat three, advance three. Patient inhales nose, exhales mouth three times. Shake needle; naturally hot. If ineffective, follow previous guidance.
Water Advancement: Drainage. Initial advance one fen, inhale once. Advance three, retreat three. Patient exhales nose, inhales mouth three times. Shake needle; naturally cold. If ineffective, follow previous guidance; if still ineffective, follow generating/resting breath counts, according to diseased Zang-Fu numbers, starting from hand techniques.

Eight Methods Formula
Palpation: Palpate to seek. When marking points, palpate with hand. In Yang parts beside sinews/bones, depression is true. In Yin parts, corresponding arterial pulse. Flesh thickness, extension/flexion, flat/straight, select by method, press and correct, cut with thumb nail.