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(Commentary by Yang)
Observing the Dao of acupuncture, its rapid methods are most extraordinary. One must master tonification and sedation to rescue critical conditions. First, distinguish the upper and lower aspects of the disease; second, determine the high and low points of the acupoints.
Disease in the head may be treated by selecting points on the feet; disease on the left side may be treated by selecting points on the right. For men, Qi (vital energy) is higher in the morning and lower in the evening; one must understand the principle when selecting points. For women, Qi is lower in the morning and higher in the evening; one must recognize the timing when applying treatment. Morning belongs to early Yang, afternoon belongs to late Yin. The distribution of Qi in men and women above and below is divided by the waist.
The three Yang meridians of the hands and feet flow from hand to head and from head to foot; the three Yin meridians of the hands and feet flow from foot to abdomen and from chest to hand. Yin ascends, Yang descends; this is the mechanism of entry and exit. Needling against the flow is sedation (Xie), known as "Ying" (meeting); needling with the flow is tonification (Bu), known as "Sui" (following). In spring and summer, needling should be shallow, suitable for thin individuals; in autumn and winter, needling should be deep, suitable for fat individuals. One must also observe the thickness or thinness of Yuan Qi (Source Qi).
The Classics state: Ying Qi (Nutritive Qi) circulates within the vessels, completing fifty cycles throughout the body day and night, meeting Wei Qi (Defensive Qi) at the Hand Taiyin Lung Meridian at dawn. Wei Qi circulates outside the vessels, moving through the Yang aspects twenty-five times during the day and the Yin aspects twenty-five times at night, meeting Ying Qi at the Hand Taiyin Lung Meridian at dawn. Thus, the movement of Wei Qi is divided only by day and night, not by upper/lower or male/female. The circulation of Qi and Blood in Zang-Fu organs and meridians is not different between men and women. What is the basis for distinguishing morning and evening now? This Fu (ode/poem) is currently favored by people, so it is recorded here for reference.

Regarding the methods of tonification and sedation, their subtlety lies in respiration and finger manipulation. For men, tonification involves advancing the thumb forward and turning left during exhalation; sedation involves retreating the thumb backward and turning right during inhalation. Lifting the needle generates heat; inserting the needle generates cold. For women, tonification involves retreating the thumb backward and turning right during inhalation; sedation involves advancing the thumb forward and turning left during exhalation. Inserting the needle generates heat; lifting the needle generates cold. Left and right directions differ; chest and back differ. The method described applies to before noon; after noon, it is reversed.
Therefore, pressing and cutting with fingernails is the method before inserting the needle; shaking and retreating is the method for removing the needle; moving and advancing is the method for urging Qi; circling and grasping is the method for circulating Qi. Rubbing removes disease; flicking tonifies deficiency; rotating around the abdomen closes the acupoint after needling. Pressing heavily (about the size of a bean) is called An (pressing); lifting lightly (about the size of a bean) is called Ti (lifting). These fourteen techniques comprise the essentials of needling. Tonification involves one retreat and three flights, causing True Qi to return naturally; sedation involves one flight and three retreats, causing Evil Qi to avoid naturally. Tonification supplements insufficiency; sedation drains excess. Excess manifests as swelling and pain, termed Shi (Excess); insufficiency manifests as itching and numbness, termed Xu (Deficiency). If Qi arrives quickly, effect is quick; if Qi arrives slowly, effect is slow. Vitality is robust and pulse is choppy/real; death is empty. If Qi does not arrive, death is certain. This section of technique is detailed in Volume 4.

Before inserting the needle, one must press and cut the acupoint heavily with fingernails, then ask the patient to cough once, inserting the needle following the cough. For tonification, during exhalation, insert the needle into the skin layer, called Tian Cai (Heaven Talent); pause slightly and advance into the muscle layer, called Ren Cai (Human Talent); pause again and advance to the bone/muscle junction, called Di Cai (Earth Talent). This is the deepest point; tonification should be performed here. After pausing for a long time, retreat the needle to the Ren Cai level. Wait for the sensation of Qi to become heavy and tight, invert the needle towards the disease site, move it back and forth. Techniques such as Fei Jing Zou Qi (Flying through meridians and moving Qi) are all included. For sedation, during inhalation, insert the needle to Tian level, pause slightly and advance directly to Di level. Upon obtaining Qi, perform sedation. Pause for a long time, then retreat the needle to Ren level. Wait for the sensation of Qi to become heavy and tight, invert the needle towards the disease site. The method is the same as before.
If syncope (Yun Zhen) occurs, it is due to deficiency of Shen Qi (Spirit Qi). Apply tonification. When breath returns to mouth and nose, provide hot soup. Pause briefly, then apply treatment according to previous methods.
If syncope occurs while needling Liver Meridian points, tonify the He-Sea point of the Liver. The patient will recover immediately upon insertion. Apply this analogy to other meridians. If syncope occurs due to Qi disturbance upon insertion, tonify Zusanli (ST36) or Renzhong (GV26). Generally, syncope arises from Heart deficiency. If the Heart is not fearful, where would syncope come from? Consider Guan Yu scraping bone to remove poison without changing color; this illustrates the point.

Regarding the method of regulating Qi: after inserting the needle to Di level, retreat to Ren level. To make Qi ascend, twist the needle to the right; to make Qi descend, twist the needle to the left. For tonification, exhale first then inhale; for sedation, inhale first then exhale. If Qi does not arrive, use hand circling, grasping, fingernail pressing, needle shaking, advancing, twisting, rubbing, and flicking until Qi arrives. Use the Long Hu Sheng Teng (Dragon and Tiger Ascending and Rising) method: pressing front makes Qi go back, pressing back makes Qi go front. Guide Qi to the painful area. Use Na Qi (Gathering Qi) method: hold the needle straight and insert, then push down to gather Qi and prevent it from dissipating. If joint obstruction causes Qi stagnation, use the Da Duan Fa (Major Method) of Long Hu Gui Feng (Dragon, Tiger, Turtle, Phoenix) to connect meridians and guide Qi. Drive and transport Qi, assisted by circling, grasping, and pressing. Nothing will fail. This is the wonder of Tong Xian (Immortal Connection).
Techniques like Long Hu Gui Feng are also noted in Volume 4.

Furthermore, regarding needle removal: if the disease trend has receded and needle Qi is loose, but the disease remains, the needle Qi is rooted. Pushing does not move it, turning does not shift it. This is because Evil Qi is sucking the needle. Even if True Qi arrives, do not remove the needle; doing so will cause the disease to recur. Perform tonification and sedation again, wait for the needle to feel slightly loose, then remove it slightly, shaking and pausing. For tonification, remove quickly during inhalation and immediately press the acupoint closed. For sedation, remove slowly during exhalation and leave the acupoint open. To make pores close tightly, inhale. Thus it is said: Insertion should be slow; too fast injures Blood. Removal should be slow; too fast injures Qi. The above summarizes the essentials.
*Yi Jing Guo Xiao* states: Do not remove the needle violently. Remove it in three or four stages, turning slowly to avoid bleeding. Violent removal causes bleeding. The commentary on *Su Wen* Supplemental Chapter states: Removing the needle immediately upon Qi arrival is violent removal. However, this differs from the current text. Generally, if there is coagulated blood in the meridians and major sedation is desired, violent removal is appropriate. For routine tonification and sedation, follow this text. This distinction must not be ignored.

Examining treatment methods, there are eight:
1. Shao Shan Huo (Fire Mountain Burning): Treats stubborn numbness and cold bi. Start shallow, go deep. Use Nine Yang numbers with three advances and three retreats. Slow lift, firm press. When heat arrives, close the skin and insert firmly. Reliable for dispelling cold.
2. Tou Tian Liang (Cooling Heaven Penetrating): Treats muscular heat and bone-steaming fever. Start deep, go shallow. Use Six Yin numbers with three withdrawals and three insertions. Firm lift, slow press. When cold arrives, slowly withdraw the needle. Reliable for reducing heat. Gently rub the handle; this is the standard for curing disease.
3. Yang Zhong Yin Yin (Yin Hidden within Yang): Cold first, then heat. Shallow to deep. Use Nine-Six method. Tonify first, then sedate.
4. Yin Zhong Yin Yang (Yang Hidden within Yin): Heat first, then cold. Deep to shallow. Use Six-Nine method. Sedate first, then tonify. For tonification, wait for heat; for sedation, wait for cold. Like twisting thread, turn the needle slowly. Use shallow method for shallow law, deep method for deep law. Do not mix them up.
5. Zi Wu Dao Jiu (Pestle of Midnight and Noon): Treats water distension and diaphragmatic qi. After entering the point, regulate Qi evenly. Move needle up and down. Nine insertions, six withdrawals. Rotate left and right. Ten cycles bring balance.
6. Jin Qi Zhi Jue (Secret of Advancing Qi): Treats pain in waist, back, elbow, knee, and wandering pain. Insert 9 cun. Perform nine tonifications. Lay the needle horizontally, count five to seven breaths. Wait for Qi to move up and down. Can also use Dragon-Tiger Battle method: twist left nine times, right six times. This is a pain-stopping needle.
7. Liu Qi Zhi Jue (Secret of Retaining Qi): Treats masses and growths. Insert 7 cun. Use pure Yang method. Then insert straight. When Qi arrives, deepen insertion, lift needle, and pause.
8. Chou Tian Zhi Jue (Secret of Drawing and Adding): Treats paralysis, sores, and leprosy. Select key points. Make Nine Yang obtain Qi. Lift, press, search. Majorly circulate Qi thoroughly. Hold needle straight, insert, then push down. Reverse Yang and Yin. Subtle under fingers, flexible in mind. If no response, repeat.

To cross passes and joints to urge Qi, use Fei Jing Zou Qi (Flying through meridians and moving Qi). There are four methods:
1. Qing Long Bai Wei (Green Dragon Wags Tail): Like steering a boat's rudder. No advance or retreat. Left and right, slowly拨动 (拨动 means to stir/move).
2. Bai Hu Yao Tou (White Tiger Shakes Head): Like shaking a bell. Retreat square, advance round. Left and right combined. Shake and vibrate.
3. Cang Gui Tan Xue (Grey Turtle Explores Cave): Like entering soil. One retreat, three advances. Drill and pick in four directions.
4. Chi Feng Ying Yuan (Red Phoenix Welcomes Source): Like spreading wings. Insert to Earth, lift to Heaven. Wait for needle to shake naturally. Return to origin. Fly around up, down, left, right. Disease above: retreat during inhalation. Disease below: advance during exhalation.
The above techniques are general outlines. Refer to Volume 4 for details.

For chronic hemiplegia, the method of connecting meridians and Qi has fixed distances per breath cycle. Hand and Foot Three Yang meridians: Upper 9, Lower 14, crossing meridian 4 cun. Hand and Foot Three Yin meridians: Upper 7, Lower 12, crossing meridian 5 cun. It depends on shaking, withdrawing, and inserting, synchronized with respiration. Drive and circulate Qi and Blood, flowing instantly throughout, connecting up and down. This can make cold warm and heat cool, stop pain and reduce distension. Like opening a canal to drain water, effect is immediate. How can critical conditions not be cured? Although diseases have three causes, all relate to Qi and Blood. Needles have eight methods, never leaving Yin and Yang. Meridians circulate day and night; respiration continues endlessly. Harmony brings health; disharmony breeds disease.
Like a country or region: mountains, seas, fields, rivers, valleys. If wind and rain are balanced in seasons, waterways are clear, people are safe, goods are abundant. If wind and rain are unbalanced in one place, suffering drought or flood, waterways surge, dry up, or block, leading to disaster. Human Qi and Blood, affected by three causes, are like regions facing drought or flood. Acupuncture and moxibustion therefore unblock meridians, balance Qi and Blood, eliminate evil, and support righteousness. Thus it is said that rapid methods are most extraordinary.
Alas! Xuanyuan (Yellow Emperor), Qibo, Ji, and Yuan are long gone; Lu Bian (Bian Que) has been dead for ages. This Dao is profound, not exhaustible in one word. This text is detailed; mastery comes from long practice. It is not common speech of the world nor superficial skill of mediocrities. Those who obtain it feel joy like passing imperial exams; those who use it hit the mark like archery. Passed down from ancient sages to later learners. Practitioners of needles who aspire to this, if they can penetrate the profound mysteries and exhaust the essence, then those lying in bed suffering, if they meet an acupuncturist with affinity, their diseases will be cured instantly.