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Huangdi asked: "What are the key points of diagnosis?" Qibo replied: "In the first and second months, the Qi of Heaven begins to generate, and the Qi of Earth begins to sprout; the Qi of Humanity is in the Liver. In the third and fourth months, the Qi of Heaven is fully vigorous, and the Qi of Earth stabilizes and disperses; the Qi of Humanity is in the Spleen. In the fifth and sixth months, the Qi of Heaven is abundant, and the Qi of Earth rises high; the Qi of Humanity is in the Head. In the seventh and eighth months, Yin Qi begins to wither (kill); the Qi of Humanity is in the Lungs. In the ninth and tenth months, Yin Qi begins to freeze, and the Qi of Earth begins to close; the Qi of Humanity is in the Heart. In the eleventh and twelfth months, ice returns, and the Qi of Earth combines/closes completely; the Qi of Humanity is in the Kidneys. Therefore, in Spring, needle the San Shu acupoints (Scattered Shu points) and the interstices (fascial planes), stopping when blood appears. For severe cases, transmit the Qi; for mild cases, wait for one cycle of the meridians. In Summer, needle the Luo Shu acupoints (Luo-Shu points), stopping when blood appears. Exhaust the pathogenic Qi and close the loop; painful diseases will surely subside. In Autumn, needle the skin, following the grain/texture, applying the same method above and below, stopping when the Shen (Spirit/Qi) changes. In Winter, needle the Shu apertures within the interstices; for severe cases, insert straight down; for mild cases, disperse the insertion."

"Spring, Summer, Autumn, and Winter each have their specific needling methods, which should follow the location of the Qi. If one needles the Summer region in Spring, it causes loss of appetite and shortness of Qi. If one needles the Autumn region in Spring, it causes frequent fright and crying. If one needles the Winter region in Spring, it causes abdominal distension, the disease does not heal, and there is a desire to speak excessively. If one needles the Spring region in Summer, it causes lassitude and lethargy. If one needles the Autumn region in Summer, it causes a desire for silence in the heart, feeling fearful as if someone were about to capture them. If one needles the Winter region in Summer, it causes shortness of Qi and frequent anger. If one needles the Spring region in Autumn, it causes sudden fright, a desire to do something, but forgetting upon standing up. If one needles the Summer region in Autumn, it increases the desire to sleep and leads to vivid dreams. If one needles the Winter region in Autumn, it causes shivering and chills. If one needles the Spring region in Winter, it causes insomnia. If one needles the Summer region in Winter, it causes Qi to rise upward, leading to various Bi syndromes (painful obstruction). If one needles the Autumn region in Winter, it causes excessive thirst."

Huangdi asked: "I wish to hear about the number of contraindications." Qibo said: "The Zang organs have vital areas that must be carefully examined. The Liver's Qi arises on the left, the Lungs' Qi stores on the right, the Heart's Qi distributes on the exterior, the Kidneys' Qi governs the interior, the Spleen is called the Envoy, and the Stomach is called the Market. Above the diaphragm and huang (membrane), there are the Parents (Heart and Lung). Beside the seventh vertebral segment, there is the 'Small Heart' (Mingmen or Pericardium), which is referred to as the Shen of the Kidney. Following this brings fortune; opposing it brings disaster."

"If the Heart is pierced, death occurs in one day, with the manifestation being belching (Yi). If the Liver is pierced, death occurs in five days, with the manifestation being speech disorders (or yawning). If the Kidneys are pierced, death occurs in six days, with the manifestation being sneezing (or three days). If the Lungs are pierced, death occurs in three days, with the manifestation being coughing. If the Spleen is pierced, death occurs in ten days, with the manifestation being swallowing movements. If the Gallbladder is pierced, death occurs in one and a half days, with the manifestation being vomiting. Piercing the large vessel on the dorsum of the foot, with unceasing bleeding, leads to death. Piercing the flowing vessels in the face, unfortunately, causes blindness. Piercing the Naohu acupoint (Brain Door) in the head, entering the brain, leads to immediate death. Piercing the vessels under the tongue too deeply, with unceasing bleeding, causes aphonia. Piercing the distributed collateral vessels under the feet, without blood coming out, causes swelling. Piercing the large vessel in the popliteal fossa causes the person to collapse and lose color. Piercing the vessel in the Qie Street (inguinal region), without blood coming out, causes swelling in the groin resembling a crouching rat. Piercing the space between the vertebrae and damaging the spinal marrow causes kyphosis (hunchback). Piercing the upper breast area and damaging the mammary gland causes root erosion and abscess. Piercing the Quepen acupoint (Collarbone Depression) too deeply, causing Qi leakage, leads to wheezing, coughing, and rebellious Qi. Piercing the inner part of the Yuji acupoint (Fish Border) too deeply causes swelling."

"Piercing the large vessel in the medial thigh, with unceasing bleeding, leads to death. Piercing the Keren Zhu (Guest Master/Shangguan) acupoint too deeply and damaging the vessel causes internal leakage and deafness. Releasing fluid from the patella causes limping. Needling the Taiyin vessel of the arm with excessive bleeding leads to immediate death. Needling the Shaoyin vessel of the foot, adding deficiency to deficiency with bleeding, causes a stiff tongue and difficulty speaking. Piercing the Yingzhong (Chest) area too deeply and damaging the Lung causes wheezing, rebellion, and仰息 (breathing with the head thrown back). Piercing the Zhongzhou (Elbow Center) area too deeply, trapping the Qi, causes inability to flex and extend. Piercing three cun below the medial thigh too deeply causes enuresis. Piercing the axillary and hypochondriac regions too deeply causes coughing. Piercing the lower abdomen and damaging the Bladder, causing urine to leak, leads to lower abdominal fullness. Piercing the intestines too deeply causes swelling. Piercing the vessel in the supraorbital depression causes fistula or blindness. Releasing fluid from the joints causes inability to flex and extend."

"Do not needle when greatly intoxicated, as this causes Qi chaos (or Pulse chaos). Do not needle when greatly angry, as this causes Qi rebellion. Do not needle greatly fatigued persons. Do not needle persons who have just eaten heavily. Do not needle persons who are greatly hungry. Do not needle persons who are greatly thirsty. Do not needle persons who have been greatly startled. After sexual intercourse, do not needle; after needling, do not have intercourse. After intoxication, do not needle; after needling, do not drink alcohol. After anger, do not needle; after needling, do not become angry. After fatigue, do not needle; after needling, do not exert oneself. After eating, do not needle; after needling, do not eat heavily. After hunger, do not needle; after needling, do not remain hungry. After drinking. After thirst, do not needle; after needling, do not remain thirsty. Those who arrived by cart should lie down and rest for the time it takes to eat one meal before needling. Those who arrived by walking should sit down and rest for the time it takes to walk ten li before needling. For those greatly startled or terrified, ensure their Qi is stabilized before needling."

"The Five Deprivations Must Not Be Purged. Qibo said: 'Emaciation and depletion of form is the First Deprivation. Massive hemorrhage is the Second Deprivation. Profuse sweating is the Third Deprivation. Severe diarrhea is the Fourth Deprivation. Postpartum massive hemorrhage is the Fifth Deprivation. All these must not be purged.'"

"The Four Seasons Have Contraindicated Areas. Qibo said: 'In the first, second, and third months, the Qi of Humanity is on the left; do not needle the Yang meridians of the left foot. In the fourth, fifth, and sixth months, the Qi of Humanity is on the right; do not needle the Yang meridians of the right foot. In the seventh, eighth, and ninth months, the Qi of Humanity is on the right; do not needle the Yin meridians of the right foot. In the tenth, eleventh, and twelfth months, the Qi of Humanity is on the left; do not needle the Yin meridians of the left foot.'"

"Dying Periods Are Contraindicated for Needling. Qibo said: 'If a disease originates in the Heart, causing chest pain, it transmits to the Lungs in one day, causing coughing; to the Liver in three days, causing hypochondriac distension and pain; to the Spleen in five days, causing blockage, body pain, and heaviness. If it persists for three days beyond this, death ensues. Death occurs at midnight in winter and noon in summer.

If a disease originates in the Lungs, causing wheezing and coughing, it transmits to the Liver in three days, causing hypochondriac distension and pain; to the Spleen in one day, causing body heaviness and pain; to the Stomach in five days, causing distension. If it persists for ten days beyond this, death ensues. Death occurs at sunset in winter and sunrise in summer.

If a disease originates in the Liver, causing headache and dizziness, and hypochondriac distension, it transmits to the Spleen in three days, causing body heaviness and pain; to the Stomach in five days, causing distension; to the Kidneys in three days, causing lumbar, spinal, and lower abdominal pain, and calf soreness. If it persists for three days beyond this, death ensues. Death occurs at sunset in winter and breakfast time in summer.

If a disease originates in the Spleen, causing body pain and heaviness, it transmits to the Stomach in one day, causing distension; to the Kidneys in two days, causing lower abdominal, lumbar, and spinal pain, and calf soreness; to the Bladder in three days, causing back muscle pain and urinary retention. If it persists for ten days beyond this, death ensues. Death occurs at dusk in winter and dinner time in summer.

If a disease originates in the Kidneys, causing lower abdominal, lumbar, and spinal pain, and calf soreness, it transmits to the Bladder in three days, causing back muscle pain and urinary retention; to the Heart in three days, causing cardiac distension; to the Small Intestine in three days, causing bilateral hypochondriac pain. If it persists for three days beyond this, death ensues. Death occurs at early dawn in winter and dusk in summer.

If a disease originates in the Stomach, causing distension and fullness, it transmits to the Kidneys in five days, causing lower abdominal, lumbar, and spinal pain, and calf soreness; to the Bladder in three days, causing back muscle pain and urinary retention; to the Spleen in five days, causing body heaviness. If it persists for six days beyond this, death ensues. Death occurs at midnight in winter and dusk in summer.

If a disease originates in the Bladder, causing urinary retention, it transmits to the Kidneys in five days, causing lower abdominal distension, lumbar and spinal pain, and calf soreness; to the Small Intestine in one day, causing abdominal distension; to the Spleen in one day, causing body heaviness. If it persists for two days beyond this, death ensues. Death occurs at cockcrow in winter and afternoon in summer.

When diseases transmit sequentially in this manner, there is always a fixed time of death, and needling is contraindicated. Only if the pathology involves one Zang organ, or two or three Zang organs without complete transmission, is needling permissible.'"