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(Yang's Annotation)
Among the methods of saving lives, the subtle application of acupuncture is paramount.
In terms of efficacy in dispelling disease, nothing is more rapid than acupuncture and moxibustion. Therefore, it is recorded as the primary subject in classics such as *Suwen* (Basic Questions). Figures such as Qin Yueren, Chunyu Yi, Bian Que, and Hua Tuo were all renowned as divine physicians due to this skill.
Once a needle accurately penetrates an acupoint, the patient recovers immediately; this is indeed the foremost skill that medical practitioners must master. In recent times, this discipline has nearly been lost, which is truly lamentable! The classic states: "One who is bound by ghosts and spirits cannot be spoken to regarding profound virtue; one who detests stone needles (Bianshi) cannot be spoken to regarding exquisite techniques." This refers to the situation described. There is also a saying: "First rely on needles, second on moxa, third on herbal medicine." Thus, the subtle utility of acupuncture and moxibustion is evident. How can those engaged in healing not urgently study this?

Observing the seasons and years according to the Heavenly Dao.
The human body possesses twelve meridians and 360 joints, corresponding to the twelve months and 360 days of a year. The term "seasons and years" refers to the warm spring, hot summer, cool autumn, and cold winter—the correct qi of the four seasons. If spring should be warm but turns cold, summer should be hot but turns cool, autumn should be cool but turns hot, or winter should be cold but turns warm, then specific pathologies arise: Cold injured in winter leads to Warm diseases in spring; Wind injured in spring leads to undigested stool diarrhea (Sunxie) in summer; Summerheat injured in summer leads to Malaria in autumn; Dampness injured in autumn leads to counterflow cough. Qibo stated: "In all needling methods, one must await the qi of the sun, moon, stars, and the eight correct seasonal influences; only when the qi is stable should one needle." Thus, when the weather is warm and sunny, human blood flows smoothly and Wei Qi floats superficially, so blood is easily drained and qi moves easily; when the weather is cold and cloudy, human blood coagulates and Wei Qi sinks deep. When the moon begins to wax, blood and qi begin to clear, and Wei Qi begins to move; when the moon is full, blood and qi are substantial, and muscles are firm; when the moon wanes, muscles diminish, meridians become empty, Wei Qi departs, and only the form remains. Therefore, one adjusts blood and qi according to heavenly timing. Do not needle when cold, do not moxa when warm, do not use reducing methods when the moon waxes, do not use tonifying methods when the moon is full, and do not treat when the moon is empty; this is called adjusting according to heavenly timing. If one uses reducing methods when the moon waxes, it causes organ deficiency; if one uses tonifying methods when the moon is full, blood and qi overflow, and collateral stasis occurs, named "Heavy Excess." Treating when the moon is empty disrupts the meridians. Yin and Yang become confused, true and evil qi are indistinguishable, pathogens sink and stagnate, causing external deficiency and internal chaos, allowing pernicious pathogens to arise. It is also said: Heaven has Five Movements (Wu Yun): Metal, Water, Wood, Fire, Earth; Earth has Six Qi: Wind, Cold, Summerheat, Dampness, Dryness, Heat.

Determining Form and Qi within one's mind.
The classic states: "In all needling, one must first measure the patient's fat or thinness to adjust the excess or deficiency of their qi. Excess is reduced, deficiency is tonified. One must first determine the state of the blood vessels before regulating." A robust form with a fine pulse and shortness of breath indicating insufficient respiration is critical. A emaciated form with a large pulse and excessive chest qi indicates death. When form and qi are harmonious, life prevails; when disharmonious, disease arises; when completely discordant, death ensues. Therefore, if complexion and pulse are incompatible, do not needle. Guard against this! Guard against this!

In spring and summer, for thin individuals, needle shallowly; in autumn and winter, for fat individuals, needle deeply.
The classic states: "Diseases have depth and superficiality; needling has shallowness and depth. Each must reach its proper principle without exceeding the limit. Exceeding causes internal injury; falling short causes external obstruction. Obstruction allows hostile pathogens to enter. Improper depth becomes a great harm. Internal injury to the five zang organs later generates major diseases. Thus, spring diseases are in the hair follicles and interstices; summer diseases are in the skin. Therefore, in spring and summer, yang qi is light and floating, muscles are thin, and blood/qi are not yet abundant, so shallow needling is appropriate; in autumn, diseases are in flesh and vessels; in winter, diseases are in sinews and bones. In autumn and winter, yang qi is stored, muscles are thick, and blood/qi are full, so deep needling is appropriate." It is also said: "Spring: needle the Twelve Jing-Well points; Summer: needle the Twelve Ying-Spring points; Late Summer: needle the Twelve Shu-Stream points; Autumn: needle the Twelve Jing-River points; Winter: needle the Twelve He-Sea points," matching Wood, Fire, Earth, Metal, and Water. The principles are found in the Ziwu Liuzhu theory.

Failing to exhaustively understand meridian yin-yang often leads to violating needling prohibitions.
There are twelve meridians: Hand-Taiyin Lung, Hand-Shaoyin Heart, Hand-Jueyin Pericardium, Hand-Taiyang Small Intestine, Hand-Shaoyang Sanjiao, Hand-Yangming Large Intestine; Foot-Taiyin Spleen, Foot-Shaoyin Kidney, Foot-Jueyin Liver, Foot-Taiyang Bladder, Foot-Shaoyang Gallbladder, Foot-Yangming Stomach. There are fifteen collaterals: Lung collateral Lieque, Heart collateral Tongli, Pericardium collateral Neiguan, Small Intestine collateral Zhizheng, Sanjiao collateral Waiguan, Large Intestine collateral Pianli, Spleen collateral Gongson, Kidney collateral Dazhong, Liver collateral Ligou, Bladder collateral Feiyang, Gallbladder collateral Guangming, Stomach collateral Fenglong, Yin Qiao collateral Zhaohai, Yang Qiao collateral Shenmai, Great Collateral of Spleen Dabao, Du Meridian collateral Changqiang, Ren Meridian collateral Weiyi (Jiuwei).
Yin and Yang refer to heavenly yin-yang: From dawn to noon is heavenly yang, yang among yang; from noon to dusk is heavenly yang, yin among yang; from twilight to rooster crow is heavenly yin, yin among yin; from rooster crow to dawn is heavenly yin, yang among yin. Humans correspond to this. Regarding the human body: exterior is yang, interior is yin; back is yang, abdomen is yin; hands and feet are divided by red and white flesh boundaries. Five Zang are yin, Six Fu are yang; diseases in spring/summer are in yang, diseases in autumn/winter are in yin. The back is yang; among yang, yang is Heart, yin is Lung. The abdomen is yin; among yin, yin is Kidney, yang is Liver, extreme yin is Spleen. These are yin-yang, interior-exterior, male-female relationships, mutually responding, thus corresponding to heavenly yin-yang. Learners who do not understand these meridians, yin-yang ascension/descension, and left-right differences—for example, attacking Jueyin when the disease is in Yangming, or attacking Taiyin when the disease is in Taiyang—will fail to remove hostile pathogens, obscure the root qi, labor in vain, and violate needling prohibitions.

Having discussed zang-fu excess and deficiency, one must seek them in the meridians.
To know zang-fu excess or deficiency, one must first diagnose the pulse's prosperity or decline. Knowing the pulse, one must distinguish the upper and lower pathways of the meridians. Zang organs are Heart, Liver, Spleen, Lung, Kidney. Fu organs are Gallbladder, Stomach, Large Intestine, Small Intestine, Sanjiao, Bladder. If the pulse is weak, qi is deficient, manifesting as itching or numbness. If the pulse is strong, blood is excess, manifesting as swelling or pain. Although zang-fu reside internally, meridians spread externally. Deficiency requires tonifying the mother; excess requires reducing the child. For Heart disease, deficiency requires tonifying Liver Wood; excess requires reducing Spleen Earth. Even within a single meridian, there are mother-child relations. For Heart deficiency, select Benjing point Shaochong to tonify; Shaochong is Jing-Well Wood, Wood generates Fire. For Heart excess, select Shenmen to reduce; Shenmen is Shu-Stream Earth, Fire generates Earth. All meridians follow this, rooted in the generation cycle of the Five Elements; reflect carefully!

Qi originates in the Middle Jiao, like water leaking initially, starting with Taiyin and ending with Jueyin; acupoints emerge from Yunmen and conclude at Qimen.
This describes qi and blood circulating through the twelve meridians as one cycle. Excluding Ren and Du, there are 393 acupoints. A day and night comprise 100 Ke (time units), divided into 12 Shi (two-hour periods). Each Shi has 8 Ke and 2 Fen; each Ke is 60 Fen, totaling 500 Fen per Shi. At Yin hour, Hand-Taiyin Lung Meridian originates at Zhongjiao's Zhongfu acupoint, emerging from Yunmen, ending at Shaoshang. At Mao hour, Hand-Yangming Large Intestine Meridian starts at Shangyang, ending at Yingxiang. At Chen hour, Foot-Yangming Stomach Meridian starts at Touwei, ending at Lidui. At Si hour, Foot-Taiyin Spleen Meridian starts at Yinbai, ending at Dabao. At Wu hour, Hand-Shaoyin Heart Meridian starts at Jiquan, ending at Shaochong. At Wei hour, Hand-Taiyang Small Intestine Meridian starts at Shaoze, ending at Tinggong. At Shen hour, Foot-Taiyang Bladder Meridian starts at Jingming, ending at Zhiyin. At You hour, Foot-Shaoyin Kidney Meridian starts at Yongquan, ending at Shufu. At Xu hour, Hand-Jueyin Pericardium Meridian starts at Tianchi, ending at Zhongchong. At Hai hour, Hand-Shaoyang Sanjiao Meridian starts at Guanchong, ending at Ermen. At Zi hour, Foot-Shaoyang Gallbladder Meridian starts at Tongziliao, ending at Qiaoyin. Chou hour, Foot-Jueyin Liver Meridian starts at Dadun, ending at Qimen.
It cycles endlessly, differing not from water-clock timing.

Twelve regular meridians; collateral branches travel over three hundred limbs;
The twelve regular meridians are the three Yin and three Yang of hands and feet. Collaterals, excluding the fifteen main collaterals, include Hengluo and Sunluo, countless in number, scattering into over three hundred branch vessels.

Upright, side, supine, prone positions; blood and qi have over six hundred observations.
This refers to meridians being upright, lateral, supine, or prone. Blood and qi circulate through acupoints, completing one cycle around the body. Ying Qi travels inside vessels for over 300 observations; Wei Qi travels outside vessels for over 300 observations.

Hand and Foot Three-Yang: Hands go to Head, Head goes to Feet; Hand and Foot Three-Yin: Feet go to Abdomen, Chest goes to Hands.
This describes the mechanism of meridian flow: Yin ascends, Yang descends; qi and blood enter and exit. This applies equally to men and women.

To understand Ying and Suic, one must clearly grasp Reverse and Follow.
Ying and Suic require knowing the flow of Ying and Wei and the direction of meridians. Clarify the Yin/Yang meridians; reverse is Ying, follow is Suic. Ying means the needle head faces the source against the flow; Suic means the needle head follows the flow. Thus, reversing is Reducing/Ying; following is Tonifying/Suic. Knowing Ying and Suic harmonizes qi. Harmonizing qi lies in Yin and Yang, ascending and descending, source and stream. The principles of reverse and follow become clear.

Moreover, Yin and Yang, and the abundance/scarcity of blood and qi are most critical. Jueyin and Taiyang: little qi, much blood; Taiyin and Shaoyin: little blood, much qi; Shaoyang: much qi, little blood; Yangming: abundant qi, abundant blood.
This discusses the differences in blood/qi abundance among the Three Yin and Three Yang. Remembering this is crucial for selection.

First detail the appropriateness of abundance/scarcity; second observe the arriving qi.
In all needling, first clarify the blood/qi abundance mentioned above, then observe the arrival of needle qi.

Light, slippery, slow indicates qi has not arrived; heavy, choppy, tight indicates qi has arrived.
Light, floating, slippery, deficient, slow, and delayed sensations after insertion indicate true qi has not arrived. Heavy, choppy, tight, and solid sensations indicate righteous qi has arrived.

Once arrived, retain or withdraw quickly based on Cold or Heat.
"Retain" means staying; "Quick" means fast. This states that once righteous qi arrives, one must assess Cold/Heat. The classic says: "For heat needling, wait until cold sensation; retain needle until Yin qi peaks, exhale upon withdrawal, leave slowly, keep aperture open. For cold needling, wait until heat sensation; Yang qi peaks, needle feels hot, inhale upon withdrawal, withdraw quickly, press aperture shut immediately."

Not yet arrived, await qi based on Excess or Deficiency.
If qi has not arrived, advance or retreat, press or lift, guide and draw qi until it reaches the acupoint before applying tonification/reduction. Classic: "Deficiency: push in and rotate forward to tonify; Excess: stroke, pat, flick, and tense to draw qi."

Arrived qi feels like fish biting a hook, rising and sinking; unarrived qi feels like sitting in a deep, quiet hall.
When qi arrives, the needle feels tight/choppy, like a fish biting a hook, moving up and down. When qi does not arrive, the needle feels light/slippery, like sitting in a quiet room, silent and unheard.

Fast arrival brings fast effect; slow arrival brings poor prognosis.
If qi arrives quickly after insertion, the disease heals easily and effects are rapid. If qi arrives slowly, the disease is hard to cure, with risk of untreatability. The Fu states: "Fast qi, fast effect; slow qi, slow effect. If qi does not arrive, death is certain."

Observing the Nine Needles, the Filiform Needle (Haozhen) is finest, corresponding to the Seven Stars, governing many acupoints.
Of the Nine Needles, the Filiform Needle is most refined, corresponding to the Seven Stars, and is used for the 360 acupoints.

Its form is Metal, possessing the way to dispel evil and support righteousness;
Form refers to the needle. Needles originate from Metal; ancients used Bi stones, now iron substitutes. Juan means eliminate. When evil qi is excess, needles eliminate it. Fu means assist. When righteous qi is deficient, needles assist it.

Length/Shortness is Water, possessing the mechanism to resolve stagnation and open blockage.
Needles vary in length, like water. Human qi/blood stagnation is like blocked water. Blocked water is diverted to lakes/seas; blocked qi/blood is circulated via needles through meridians; thus needles correspond to Water.

Fixing the puncture resembles Wood, oblique or straight;
Wood has oblique and straight orientations; needling also varies. Needling Yang meridians requires oblique insertion to spare Wei Qi; needling Yin divisions requires vertical insertion to spare Ying Qi; thus needles correspond to Wood.

Mouth-holding compares to Fire, advancing Yang and tonifying weakness.
Mouth-holding means warming the needle in the mouth. The warmth is like fire. Lei means emaciation. Warming the needle ensures Ying/Wei connection, advances one's own Yang qi, and tonifies the patient's weakness; thus needles correspond to Fire.

Following the mechanism and pressing to seal resembles Earth;
Xun means stroking up/down with hand to move qi/blood. Ji Men means pressing the aperture shut after needling, like filling with earth; thus needles correspond to Earth.

Excess corresponds to the Five Elements and can be known.
Five Elements: Metal, Water, Wood, Fire, Earth. This summarizes that needles correspond to the logic of the Five Elements.

Though only three cun six fen long, it contains profound principles;
Though only 3.6 cun long, it skillfully manipulates divine mechanisms, containing Water/Fire, reversing Yin/Yang, with profound mystery.

Though slender as a hair, it connects multiple branches.
Zhen refers to the needle shaft. Qi refers to paths of qi/blood flow. Though the shaft is tiny as a hair, it connects various meridians' qi/blood.

It can balance Cold/Heat of Five Zang, regulate Excess/Deficiency of Six Fu.
Ping means treat; Tiao means regulate. Needles treat zang-fu diseases: Cold is warmed, Heat is cleared, Deficiency is tonified, Excess is reduced. Sinew spasm/blockage drives out Eight Evils; Cold-Heat Bi pain is resolved by opening Four Gates.
Spasm is sinew constraint; blockage is qi/blood stagnation. Eight Evils monitor Eight Winds' deficient pathogens; spasms/blockages require dispersing Eight Winds. Cold is trembling chills; Heat is tidal fever. Four Gates refer to the Twelve Yuan sources of Six Zang, emerging at Four Gates: Taichong and Hegu.
Thus, on days of Taiyi shifting palaces, ruling Eight Winds, humans suffer Cold/Heat. Spring Equinox: Zhen Palace Cangmen, East wind is favorable. Summer Solstice start Xun Palace Yinluo, SE wind favorable. Summer Solstice start Li Palace Shangtian, South wind favorable. Autumn Equinox start Kun Palace Xuanwei, SW wind favorable. Autumn Equinox start Dui Palace Cangguo, West wind favorable. Start of Winter start Qian Palace Xinluo, NW wind favorable. Winter Solstice start Kan Palace Yezhe, North wind favorable. Favorable winds refresh spirit, remove chronic ailments. Adverse winds are toxic vapors, causing illness named "Seasonal Qi Stagnation." Entering muscle/bone/organs, though not immediate, combined with severe Cold/Heat/Summerheat/Dampness and internal dietary/labor/excess factors, causes internal-external dual infection chronic diseases, requiring needle regulation of meridians and herbal decoctions to guide Ying/Wei to resolve. Central Palace is Zhaoyao, total Nine Palaces. Favorable Eight Winds cause no disease; adverse winds cause disease.

In all needling, ensure the Spirit (Shen) is present before inserting; once inserted, ensure Shen is settled and qi follows. If Shen is absent, do not needle; if Shen is settled, apply treatment.
In all needling, ensure patient's spirit is focused before insertion. Once inserted, ensure spirit settles before manipulating qi. If spirit is absent, needle feels light/slippery, patient feels no pain (like inserting tofu); do not proceed, wait. If spirit arrives, needle feels tight/choppy; proceed with method based on excess/deficiency.

At the fixed point, prioritize blood and qi;
When preparing to needle, prioritize the abundance/scarcity of Yin/Yang blood/qi, as detailed above.

At the moment of action, recognize Water and Wood as the foundation.
Action refers to needling. Water is Mother, Wood is Child; Water generates Wood. Thus, nourish Mother to supplement deficiency, drain Child to balance excess. This states needling must recognize mother-child generation. Mentioning Water/Wood excludes Earth/Metal/Fire for brevity.

Heaven, Earth, Man (Three Powers): Yongquan corresponds to Xuanji and Baihui;
Baihui (one point on head) corresponds to Heaven; Xuanji (one point on chest) corresponds to Man; Yongquan (one point on sole) corresponds to Earth. These are Upper, Middle, Lower parts. Dabao corresponds to Tianshu and Dijii.
Dabao (two points behind breast) is Upper; Tianshu (two points beside navel) is Middle; Dijii (two points on foot) is Lower. These are the Three Parts.

Yang Qiao, Yang Wei, Du, and Dai meridians govern shoulder/back/waist/leg exterior diseases;
Yang Qiao starts at heel, follows lateral malleolus, enters Fengchi, connects Foot-Taiyang Bladder, Shenmai is key. Yang Wei maintains gathering of Yang, connects Hand-Shaoyang Sanjiao, Waiguan is key. Du starts at lower extremity, runs along spine, ascends to Fengfu, passes brain, follows forehead, enters nose at Yingjiao, connects Hand-Taiyang Small Intestine, Houxi is key. Dai starts at hypochondrium, circles body like a belt, connects Foot-Shaoyang Gallbladder, Linqi is key. These four odd meridians are Yang, governing exterior shoulder/back/waist/leg diseases.

Yin Qiao, Yin Wei, Ren, and Chong meridians resolve doubts of interior heart/abdomen/hypochondrium diseases (Doubt = Disease).
Yin Qiao starts at heel, follows medial malleolus, ascends to throat, intersects Chong, connects Foot-Shaoyin Kidney, Zhaohai is key. Yin Wei maintains intersection of Yin, connects Hand-Jueyin Pericardium, Neiguan is key. Ren starts below Zhongji, ascends abdomen to throat, connects Hand-Taiyin Lung, Lieque is key. Chong starts at Qichong, runs with Foot-Shaoyin, flanks navel, ascends to chest and scatters, connects Foot-Taiyin Spleen, Gongson is key. These four odd meridians are Yin, treating interior heart/abdomen/hypochondrium diseases.

Er Ling, Er Qiao, Er Jiao seem continuous and connect the Five Bodies;
Er Ling: Yinlingquan, Yanglingquan. Er Qiao: Yin Qiao, Yang Qiao. Er Jiao: Yin Jiao, Yang Jiao. Xu means connect. Wu Ti means Five Bodies. These six acupoints connect sequentially at two hands, two feet, and head.

Liang Jian, Liang Shang, Liang Jing rely on each other and separate into two branches.
Liang Jian: Erjian, Sanjian. Liang Shang: Shaoshang, Shangyang. Liang Jing: Tianjing, Jianjing. These six acupoints rely on each other and separate into two hand branches.

Generally, acupoint selection requires precise measurement; first examine your intent, then observe flesh distribution;
Acupoint measurement uses the middle finger and thumb bent into a ring (male left, female right); the inner crease angle equals one Cun. Measure according to individual size; this is "Same-Body Cun." First determine the disease, meridian, and acupoint in your mind; then observe patient's thin/fat, long/short, flesh distribution, bone joints, and hairline to measure and select.