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Huangdi asked, saying: Regarding excess and deficiency, I have already heard of the forms of Xu (Deficiency) and Shi (Excess), but do not know how they arise. Qibo replied: When Qi and Xue (Blood) merge together, Yin and Yang incline against each other; Qi becomes chaotic in the Wei (Defensive) level, and Xue (Blood) rebels in the Jing (Main) channels. When Xue (Blood) and Qi separate from their proper residence, one part becomes Shi (Excess) and the other Xu (Deficiency). If Xue (Blood) merges into Yin and Qi merges into Yang, it results in Jing Kuang (Fright and Mania); if Xue (Blood) merges into Yang and Qi merges into Yin, it results in Jiong Zhong (Internal Heat); if Xue (Blood) merges upward and Qi merges downward, it causes Xin Fan Wan Nuxi (Mental restlessness, depression, anger, and joy); if Xue (Blood) merges downward and Qi merges upward, it causes Luan er Xi Wang (Confusion and forgetfulness). "Up and down" refers to above and below the Ge (Diaphragm).

The Emperor said: When Xue (Blood) merges into Yin and Qi merges into Yang, thus Xue (Blood) and Qi separate from their residence, which is Shi (Excess) and which is Xu (Deficiency)? Qibo said: Xue (Blood) and Qi prefer warmth and dislike cold. Cold causes them to congeal and fail to flow, while warmth causes them to dissipate and move away. Therefore, where Qi merges, Xue (Blood) is deficient; where Xue (Blood) merges, Qi is deficient.

The Emperor said: What humans possess are merely Xue (Blood) and Qi. Now you say that when Xue (Blood) merges it is Deficient, and when Qi merges it is also Deficient. Is there no Excess? Qibo said: That which is present is Excess, that which is absent is Deficient. Thus, when Qi merges, there is no Xue (Blood) [in that specific location], and when Xue (Blood) merges, there is no Qi [in that specific location]. Since Xue (Blood) and Qi have lost each other, it is considered Deficiency. However, Luo (Collateral) vessels and Sun (Fine) vessels all transport to the Jing (Main) channels; when Xue (Blood) and Qi merge together, it becomes Excess. If Xue (Blood) and Qi both rush upward, it results in Da Jue (Great Revulsion/Jue Syndrome), which can cause sudden death. If the Qi returns [downward], the patient lives; if it does not return, the patient dies.

The Emperor said: From what path does Excess come? From what path does Deficiency go? I wish to hear the reason for the essence of Excess and Deficiency. Qibo said: Both Yin and Yang have Shu Hui (Acupoints and Intersections). Yang flows into Yin, and Yin fills outwardly. When Yin and Yang are balanced and even, filling the form, and the Nine Palpations are uniform, this is called a Ping Ren (Healthy Person). The generation of Xie (Pathogenic factors) occurs either from Yin or from Yang. Those generated from Yang result from Wind, Rain, Cold, and Summer-Heat; those generated from Yin result from Diet and Dwelling, and emotions of Joy and Anger.

The Emperor said: How do Wind and Rain injure the human body? He replied: When Wind and Rain injure people, they first lodge in the Skin, transmit to the Sun (Fine) vessels; when Sun vessels are full, they transmit to the Luo (Collateral) vessels; when Luo vessels are full, they transport to the Da Jing (Large/Main) channels. Xue (Blood) and Qi merge with the Pathogen and lodge between the Fen Cou (Intervals of skin and flesh). The pulse is firm and large, hence it is called Excess. Excess manifests as external firmness and fullness; it cannot be pressed, and pressing causes pain.

The Emperor said: How do Cold and Dampness injure the human body? He replied: When Cold and Dampness strike people, the Skin fails to contract, the Muscles become firm and tight, Ying (Nutritive) Blood congeals, and Wei (Defensive) Qi departs; hence it is called Deficiency. Deficiency manifests as Nie Pi (Trembling and contraction) due to Qi insufficiency. Pressing it replenishes Qi to warm the area, so it feels comfortable and painless.

The Emperor said: How does Yin generate Excess? He replied: Unregulated Joy and Anger cause Yin Qi to rebel upward. Upward rebellion leads to Deficiency below; Deficiency below causes Yang Qi to rush toward it, hence it is called Excess.

The Emperor said: How does Yin generate Deficiency? He replied: Joy causes Qi to sink downward, Sorrow causes Qi to dissipate. Dissipation leads to empty and deficient pulses. Combined with consuming cold food, Cold Qi steams and fills, causing Blood to congeal and Qi to depart; hence it is called Deficiency.

The Emperor said: The Classics state: Yang Deficiency leads to external Cold, Yin Deficiency leads to internal Heat, Yang Excess leads to external Heat, and Yin Excess leads to internal Cold. I have heard this, but do not know its origin. Qibo said: Yang receives Qi from the Shang Jiao (Upper Burner) to warm the Skin and Fen Rou (Muscle intervals). Now, if Cold Qi is outside, the Shang Jiao (Upper Burner) becomes blocked. If the Shang Jiao (Upper Burner) is blocked, Cold Qi remains alone on the exterior, causing Han Li (Chills/Shivering).

The Emperor said: How does Yin Deficiency generate Internal Heat? He replied: Due to labor and fatigue, the Form and Qi decline, Gu Qi (Grain Qi) is insufficient, the Shang Jiao (Upper Burner) fails to circulate, and the Xia Wan (Lower Stomach/Epigastrium) fails to open. Wei Qi (Stomach Qi) becomes hot, and Hot Qi steams the Chest Center, thus generating Internal Heat.

The Emperor said: How does Yang Excess generate External Heat? He replied: If the Shang Jiao (Upper Burner) is not unobstructed, the Skin becomes dense, the Cou Li (Pores) close, and the Xuan Fu (Sweat Pores) are blocked. Wei (Defensive) Qi cannot vent and escape, thus generating External Heat.

The Emperor said: How does Yin Excess generate Internal Cold? He replied: Jue Qi (Revulsing Qi) rebels upward, and Cold Qi accumulates in the Chest Center without being discharged. Without discharge, Warm Qi departs, leaving Cold alone. This causes Blood to congeal and stagnate; stagnation blocks the Pulse. The pulse is large and rough, thus generating Internal Cold.

The Emperor said: When Yin and Yang merge, and Xue (Blood) and Qi merge, forming the disease pattern, how should acupuncture be applied? He replied: To treat this, utilize the Jing Sui (Channel tunnels), extract Xue (Blood) from the Ying (Nutritive) level, and regulate Qi from the Wei (Defensive) level. Use appropriate techniques based on the patient's constitution and adjust the depth and frequency according to the Four Seasons.

The Emperor said: You mentioned ten types of Excess and Deficiency, originating from the Five Zang Organs, corresponding to five pulses. The Twelve Jing Mai (Meridians) all generate diseases. Why do you only speak of the Five Zang Organs? The Twelve Jing Mai (Meridians) connect with the 365 Jie (Joints), and joint diseases must affect the meridians. Meridian diseases all have Excess and Deficiency. How do these combine? Qibo said: The Five Zang Organs naturally have the Six Fu Organs as their interior-exterior pairs. The Jing Luo (Meridians and Collaterals) and limbs/joints each generate Excess and Deficiency. According to the location of the disease, adjust it accordingly. Disease in the Pulse, regulate the Blood; disease in the Blood, regulate the Luo (Collaterals); disease in the Qi, regulate the Wei (Defensive); disease in the Flesh, regulate the Fen Rou (Muscle intervals); disease in the Sinews, regulate the Sinews; disease in the Bone, regulate the Bone. Use Fan Zhen (Fire-needling) to劫刺 (rapidly puncture/stimulate) the lower areas and sites of spasm. For bone diseases, use Cui Zhen (Quenched needles) combined with Yao Re (Medicated heat packs). If the body has pain but the patient cannot locate it, and the Nine Palpations show no abnormality, apply Miu Ci (Lateral Puncture). If pain is on the left but the right pulse is diseased, apply Ju Ci (Major Puncture). One must carefully observe the Nine Palpations; thus, the principles of needling are complete.