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According to the *Illustrated Notes on the Nan Jing* (Classic of Difficult Issues): The three Hand-Yang meridians run from the hand to the head. Inserting the needle with the point facing outward and upward is called "Following" (Sui), while inserting with the point facing inward and downward is called "Opposing" (Ying). The three Foot-Yang meridians run from the head to the foot. Inserting with the point facing inward and downward is "Following," while inserting with the point facing outward and upward is "Opposing." The three Foot-Yin meridians run from the foot to the abdomen. Inserting with the point facing outward and upward is "Following," while inserting with the point facing inward and downward is "Opposing." The three Hand-Yin meridians run from the chest to the hand. Inserting with the point facing inward and downward is "Following," while inserting with the point facing outward and upward is "Opposing." The general principle relies on Zi-Wu (midnight and noon). The left side represents Yang (from Zi hour to Wu hour, moving the needle to the left constitutes tonification); the right side represents Yin (from Wu hour to Zi hour, moving the needle to the right constitutes sedation; Yang governs advancement, Yin governs retreat). The hands represent Yang (the left hand is pure Yang), and the feet represent Yin (the right foot is pure Yin). The Yang meridians of the left hand are Yang within Yang; the Yin meridians of the left hand are Yin within Yang. The Yang meridians of the right hand are Yang within Yin; the Yin meridians of the right hand are Yin within Yin (Note: Text says Yang within Yin, but context implies Yin within Yin or follows specific classification). The Yin meridians of the right foot are Yin within Yin; the Yang meridians of the right foot are Yang within Yin. The Yin meridians of the left foot are Yin within Yang; the Yang meridians of the left foot are Yang within Yin.

Now, in detail: For the patient's left-hand Yang meridians, the practitioner uses the right thumb to advance the needle forward (retreating the index finger) during exhalation for "Following" (afternoon practice reverses this: retreating is Following, advancing is Opposing; advancing corresponds to the meridian flowing from outside to inside, retreating from inside to outside), and withdrawing during inhalation for "Opposing." For the patient's left-hand Yin meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's right-hand Yang meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's right-hand Yin meridians, the practitioner advances the right thumb during exhalation for "Following," and withdraws during inhalation for "Opposing." For the patient's right-foot Yang meridians, the practitioner advances the right thumb during exhalation for "Following," and withdraws during inhalation for "Opposing." For the patient's right-foot Yin meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's left-foot Yang meridians, the practitioner retreats the right thumb during inhalation for "Following," and advances during exhalation for "Opposing." For the patient's left-foot Yin meridians, the practitioner advances the right thumb during exhalation for "Following," and withdraws during inhalation for "Opposing." These rules apply to men before noon; after noon, they are reversed for women.

On the hands, Yang meridians advance and Yin meridians retreat; on the feet, Yang meridians retreat and Yin meridians advance, conforming to the starting and ending points of the six meridians. When initiating needling at an acupoint, pointing the needle upward aligns with the direction of Qi flow. When stopping needling, pointing the needle downward indicates where Qi stops. Needling the left exterior and right interior promotes ascending Qi; needling the right exterior and left interior promotes descending Qi. One might ask why morning and afternoon techniques differ, and why male and female techniques differ. This is because men's Qi is higher in the morning and lower in the evening, while women's Qi is lower in the morning and higher in the evening, divided by the waist. Regarding respiration, it is the same for men, women, self, and others, yet there is a distinction of Yin and Yang. There is natural respiration and artificial respiration. Needle insertion and withdrawal utilize artificial respiration. Turning the needle requires reverence like treating a noble person and caution like holding a tiger's tail, waiting for natural respiration. If turning the needle on the left hand/foot upon exhalation, one must wait for inhalation to turn the right hand/foot; if turning the right hand/foot upon inhalation, one must wait for exhalation to turn the left hand/foot. This reflects the subtle rise and fall of Yin and Yang. Thus, for men, Yang meridians before noon use exhalation for tonification and inhalation for sedation; Yin meridians use inhalation for tonification and exhalation for sedation, reversing after noon. For women, Yang meridians before noon use inhalation for tonification and exhalation for sedation; Yin meridians use exhalation for tonification and inhalation for sedation, also reversing after noon. Some ask: If tonification and sedation rely on respiration, what about patients with corpse-like coma or stroke who cannot control respiration? Answer: Wait for natural respiration to turn the needle. If inhalation is required but not performed, cover the patient's mouth and nose with your hand to stimulate their Qi. Alas! The principles of tonification/sedation and lifting/thrusting, distinguishing gender and time, are profound and originally applied to the Extraordinary Vessels, not strictly bound by the twelve Regular Meridians, hence their complexity. For Flowing-Transfusion points, simply distinguishing left/right and Yin/Yang suffices. I once admired the *Xue Xin Ge*: "Why are there two methods for tonification and sedation? Because meridians originate from both sides. Ancients distinguished left and right; moderns distinguish men and women. Men's and women's meridians develop identically, circulating day and night without rest. This secret comes from Master Zisang; I now impart it to you, clearing your mind like snow." This completes the Zi-Wu Flowing-Transfusion combined with the Eight Methods. However, tonification and sedation do not necessarily require respiration for needle entry/exit. Some focus on depth: The Classic states, "Spring and summer suit shallow needling; autumn and winter suit deep needling." Some focus on Ying and Wei: The Classic states, "Take Qi from Wei, place Qi in Ying." Tonification takes Qi from Wei, using light, shallow needling to follow Wei Qi and assist deficiency. Sedation targets Ying, using heavy, deep needling to meet Ying Qi ahead and drain excess. Tonification should not cause excessive fullness; sedation should not cause deficiency; the goal is balance. Additionally, men are needled lightly and shallowly to await Wei Qi; women are needled heavily and deeply to await Ying Qi.

Some focus on Deficiency and Excess: The Classic states, "Tonify the Mother in deficiency, sedate the Child in excess." This is the general principle of Ying-Sui. Opposing the meridian flow to drain is sedating the Child (e.g., sedating Spleen/Stomach for Heart heat). Following the meridian flow to assist is tonifying the Mother (e.g., tonifying Liver/Gallbladder for Heart deficiency). Fei-Jing-Zou-Qi (Flying through Meridians and Moving Qi) also adheres to Zi-Wu Ying-Sui.

The number nine represents Zi-Yang; six represents Wu-Yin. The quantity varies, but lifting/thrusting applies similarly. "Initial Nine" means 1x9, pause, 1x9, pause, 1x9, totaling 27, or 4x9=36. "Lesser Yang" is 7x7=49, 7 per session with pauses. "Greater Yang" is 9x9=81, 27 per session, paused, repeated three times. "Initial Six" means 1x6, pause, 1x6, pause, 1x6, totaling 18. "Lesser Yin" is 6x6=36, 18 per session, paused, repeated once. "Greater Yin" is 8x8=64, 8 per session, paused. Some say: After Zi hour, use nine numbers to tonify Yang; after Wu hour, use six numbers to tonify Yin. On Yin days needling Yang meridians, use six numbers to tonify Yin. On Yang days needling Yin meridians, use nine numbers to tonify Yang. This is correct theory, but adapting to heat/cold symptoms is flexible application. The Classic states: "Know the needle practitioner trusts the left hand; unknown practitioners trust the right hand." First, measure the acupoint using Cun, mark it with ink. Have the patient sit upright or lie down after eating. For chronic conditions, wait for warm, clear weather for Qi to move. Do not needle during severe storms or at night unless urgent. Never needle standing on an empty stomach due to fainting risk.

When needling, first press the Ying-Shu points with the left hand. True Yang points are found in bony depressions, feeling sour/numb when pressed. True Yin points have a palpable pulse under pressure. "Cut and scatter": Use fingernails to press around the acupoint to disperse Qi and Blood. "Claw and descend": Press firmly with the left thumb nail to disperse Qi and Blood. Then, use the right index finger to hold the needle handle, middle and thumb fingers to grip the shaft, and ring finger to support the tip. Ask the patient to cough, and insert the needle into the skin upon the cough. Hold for ten breaths, called "Heaven Talent." Advance slightly, hold for ten breaths, called "Human Talent." Advance to muscle/bone junction, hold for ten breaths, called "Earth Talent." This is the deepest level. Pause longer, then ask the patient to inhale and withdraw to the Human level. Check for arrival of Qi: heaviness and tightness indicate arrival. Pain indicates Excess; soreness indicates Deficiency. Lightness indicates Qi has not arrived. Use plucking, thrusting, rubbing, and guiding to move Qi, preferably at the Earth level.

"Pluck and Thrust, Rub and Follow": Plucking is tonification. Interlock thumb and index nails. For upper body, pluck upward with thumb; for lower body, pluck downward with index. For tonification, insert and "fly" the needle, asking the patient to hold breath and exert force. For sedation, lift and fly the needle, asking the patient to exhale without force. If Qi arrives naturally, these maneuvers are unnecessary. Rubbing (Men) soothes pain. Guiding (Xun) involves stroking along the meridian to promote Qi flow.

"Move and Extend, Push and Press": Moving is rotating. Too fast causes pain; too slow fails to remove disease. Extending is lifting; pressing is thrusting. If Qi does not move, lift the needle slightly or pluck again. If the needle feels tight, use the "Passing" method. If pathogenic Qi is strong, use lifting/thrusting to expel pathogens first. Lifting moves from Earth to Human to Heaven; Thrusting moves from Heaven to Human to Earth. Light illness uses Initial Nine; severe illness uses Lesser/Greater Yang numbers. Why do morning/afternoon and male/female lifting/thrusting differ? It follows Yin/Yang. Morning follows Yang nature; lifting to Heaven creates heat. Afternoon follows Yin nature; thrusting to Earth creates heat.

Lifting/Thrusting Techniques: Tonification inserts shallow then deep; sedation inserts deep then shallow. Fast lifting/slow pressing feels cold (sedation); slow lifting/fast pressing feels hot (tonification). Order can vary. For paralysis, cold bi, wind-cold malaria (Cold syndromes): Insert shallow, deepen gradually, use Greater Yang numbers (tonification). When Qi arrives and warmth is felt, use slow lifting/fast pressing (Greater Yang or 27 counts). Turn the needle head, ask patient to inhale five times to ascend Yang and retreat Yin. This is "Entering Qi" or "Burning Mountain Fire." For phlegm-wind, stroke, throat wind, mania, malaria, single heat (Heat syndromes): Insert deep, lighten gradually, use Lesser Yin numbers (sedation). When coolness is felt, use fast lifting/slow pressing (Initial Six or 18 counts). Repeat until cured. This is "Penetrating Heaven Coolness."

For malaria with initial chills then fever (Upper Excess/Lower Deficiency): Shallow insert, 36 counts (heat), then deep insert, 18 counts. For malaria with initial fever then chills (Half-Deficiency/Half-Excess): Deep insert, 6 Yin counts (coolness), then 9 Yang counts. This is "Dragon-Tiger Battle," balancing Yin and Yang. Pathogens follow healthy Qi; battle prevents recurrence.

For abdominal masses: Insert 0.7 cun, use Greater Yang numbers. Upon Qi arrival, insert to 1 cun, lift slightly, return. If no Qi, repeat. This is "Retaining Qi." For ascites and bloating: Balance tonification/sedation, move needle up/down, 9 inserts/6 withdrawals, rotate left/right many times. This is "Zi-Wu Pestle."

For red eyes and early abscesses: Twist left (advance thumb), then right (retreat thumb), 27 counts. Guide Qi forward, push inward, pluck needle tail to attract Yang, press and lift. This is "Dragon-Tiger Interaction." For single-point treatment, apply after Qi arrival or at withdrawal.

"Passing" promotes Qi after lifting/thrusting. For left-hand Yang meridians: Advance right thumb 9 counts, tilt needle toward disease, apply tonification effort, hold until patient feels heat. If blocked, use Dragon/Turtle/Green Phoenix/Flying methods. Similar protocols apply to other limbs/hands/feet. For "Tide Retreat" (pain relief): Tonify 6, sedate 9 repeatedly until tide recedes. Itching/numbness treated by tonification; pain by sedation. These derive from *Nei Jing*. "Taking Qi" involves cross-needling (left-right, hand-foot, etc.), using healthy areas as primary and diseased as response. For curled limbs, needle opposite limbs. Primary needle first, then response needle. "Fighting Qi" and "Connecting Qi" involve hand/foot combinations. Xu Shi said: Qi movement has fixed Cun per breath. Hand/Yang meridians: Upper 9, Lower 14, passing 4 cun. Hand/Yin meridians: Upper 7, Lower 12, passing 5 cun. Respiration matches Qi movement. Lengths: Hand-Yin 3.5 chi, Hand-Yang 5 chi, Foot-Yang 8 chi, Foot-Yin 6.5 chi, Yin/Yang Heel 7.5 chi, Du Mai 4.5 chi, Ren Mai 4.5 chi. One breath moves Qi 3 cun. Calculate based on meridian length until Qi reaches disease site.

1. Green Dragon Tail Swing: Tilt needle toward disease, hold like a rudder, swing left/right 9 or 27 counts. Qi circulates.
2. White Tiger Head Shake: Lift needle tail, rotate tip lightly like an oar, shake 6 or 18 counts. To move Qi forward, press behind; backward, press front. Moves blood and Qi. Dragon is Qi, Tiger is Blood. Yang days: Dragon then Tiger. Yin days: Tiger then Dragon.
3. Grey Turtle Exploring Cave: Tilt needle, retreat once, advance thrice. Drill up, down, left, right. Like entering earth.
4. Red Phoenix Welcoming Source: Lift needle, insert to Earth, lift to Heaven, wait for vibration, advance to Human. Rotate around like wings. Disease above: withdraw on inhalation. Disease below: advance on exhalation. Scrape from tail to waist (or waist to tail in afternoon). For spasms, use scraping/guiding 3-5 times. Leave needle for half an hour. If tight, sedate 9/tonify 6; if loose, sedate 6/tonify 9. Shake out. "She" involves cutting along meridian with thumb.

Shake and Withdraw: Shake needle 5-7 times up/down/left/right, lift 14 times. Dispels wind. Withdraw when loose. If pathogen holds needle, re-tonify/sedate. If difficult, scrape and sedate 3 times. Search horizontally like Dragon-Tiger interaction. Plate left 9, right 6. Zi-Wu Pestle: Slow lift after Zi, faster after Wu. Withdraw response needle, then primary needle. Tonification: Inhale, quick withdrawal, press hole with left thumb to seal spirit and prevent bleeding. Sedation: Exhale, slow withdrawal, do not press. Quick withdrawal or long retention leads to relapse.

Fainting: Caused by deficient spirit/Qi. Do not withdraw immediately. Tonify with another needle, cover mouth/nose with sleeve to restore Qi, give hot water. Revive, wait, then needle. Severe cases: Needle Xingxing point on arm or Zusanli. Withdrawing needle harms the patient.