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Huangdi asked: The acupuncture methods state, "Excess is drained, deficiency is tonified." What does this mean? Qibo replied: Shen (Spirit) has excess and deficiency; Qi (Vital Energy) has excess and deficiency; Xue (Blood) has excess and deficiency; Xing (Form/Body) has excess and deficiency; Zhi (Will) has excess and deficiency. The Heart stores Shen, the Lungs store Qi, the Liver stores Xue, the Spleen governs the muscles (Flesh), and the Kidneys store Zhi. When Zhi and Yi (Intent) are connected and unobstructed, they link internally to the Marrow and complete the Form. The pathways of the Five Zang Organs all emerge from Jingqu (Meridian Channels), to circulate Xue and Qi. If Xue and Qi are not harmonious, myriad diseases arise from changes within; therefore, one must guard the Jingqu.

Shen in excess manifests as incessant laughter; Shen in deficiency manifests as sorrow (Suwen reads 'grief'; Wang Bing stated that reading 'sorrow' is an error). When Xue and Qi have not yet converged, and the Five Zang Organs are stable, pathogenic factors invade the Form, causing chills (Suwen reads 'shivering') starting from the hair follicles, but not yet entering the Meridians. This is termed the slight stage of Shen. For Shen excess, drain the blood from its small collaterals; allow bleeding without deep pressing, avoiding injury to the major meridians, so that Shen Qi becomes balanced. For Shen deficiency, observe the deficient collaterals, palpate to guide Qi, then needle to harmonize; do not cause bleeding, do not drain Qi, thereby unblocking the meridians, so that Shen Qi becomes balanced. Asked: How to needle the slight stage? Answer: Massage without releasing, insert the needle without pressing deeply, transfer Qi to the feet (Suwen reads 'deficiency'), and Shen Qi will recover.

Qi in excess manifests as panting, coughing, and rebellious Qi ascending; Qi in deficiency manifests as smooth breathing but shortness of breath. When Xue and Qi have not yet converged, and the Five Zang Organs are stable, the skin suffers slightly, termed a slight leakage of White Qi (Metal Qi). For Qi excess, drain the Jingqu point; do not injure the meridian itself, do not cause bleeding, do not drain Qi. For Qi deficiency, tonify the Jingqu point; do not drain Qi. Asked: How to needle the slight stage? Answer: Massage without releasing, withdraw the needle and observe. It is said: Although intending to needle deeply, upon encountering the patient's reaction, Essence and Qi naturally subside, pathogenic factors scatter chaotically, having no place to rest, Qi leaks through the Couli (interstices), and True Qi achieves harmony.

Xue in excess manifests as anger; Xue in deficiency manifests as fear (Suwen reads 'fear'). When Xue and Qi have not yet converged, and the Five Zang Organs are stable, Sunluo (Sun Collaterals) overflow, resulting in retained blood in the collaterals. For Xue excess, needle the full meridians and release blood. For Xue deficiency, observe the deficiency, insert the needle into the vessel, retain it for a long time until blood arrives (Suwen reads 'and observe'); if the pulse is large, quickly withdraw the needle without allowing blood to leak. Asked: How to needle retained blood? Answer: Observe the blood collaterals, needle them to release blood, preventing evil blood from entering the meridians to form disease.

Xing (Form) in excess manifests as abdominal distension and difficult urination and defecation; Xing in deficiency manifests as inability to use the four limbs. When Xue and Qi have not yet converged, and the Five Zang Organs are stable, muscles twitch (one version reads 'overflow'), named Wind Micro. For Xing excess, drain the Yang meridians; for deficiency, tonify the Yang collaterals. Asked: How to needle the slight stage? Answer: Select the space between muscles, do not needle the meridians, do not injure the collaterals, Wei Qi (Defensive Qi) recovers, and pathogenic factors dissipate.

Zhi in excess manifests as abdominal distension and undigested diarrhea; Zhi in deficiency manifests as cold extremities. When Xue and Qi have not yet converged, and the Five Zang Organs are stable, there is injury to the bone joints. For Zhi excess, drain it. Regarding Jin (Tendons) and Xue, release their blood; for Zhi deficiency, tonify Fuliu (KI7). Asked: How to needle when Xue and Qi have not yet converged? Answer: Immediately select the points without injuring the meridians, to eliminate pathogenic factors, thereby achieving immediate emptiness of the pathogen.

Asked: From where do the forms of excess and deficiency arise? Answer: When Xue and Qi have already converged, Yin and Yang incline towards each other, Qi becomes chaotic in the Wei level, and Xue rebels in the meridians. Xue and Qi separate and reside apart, one becoming excess and the other deficiency. If Xue converges in Yin and Qi converges in Yang, it results in fright and mania. If Xue converges in Yang and Qi converges in Yin, it results in internal heat (Jiong Zhong). If Xue converges above and Qi converges below, it causes heart vexation, stifling sensation, and irritability. If Xue converges below and Qi converges above, it causes confusion and forgetfulness (Su reads 'prone to forgetfulness'). Asked: When Xue converges in Yin and Qi converges in Yang, such that Xue and Qi are separated, which is excess and which is deficiency? Answer: Xue and Qi prefer warmth and dislike cold. Cold causes stagnation and non-flow; warmth causes dissolution and elimination. Therefore, where Qi converges, Xue is deficient; where Xue converges, Qi is deficient. Asked: What humans possess is merely Xue and Qi. You say Xue convergence is deficiency and Qi convergence is deficiency; is there no excess? Answer: That which is present is excess; that which is absent is deficiency. Thus, Qi convergence means absence of Xue; Xue convergence means absence of Qi. Now that Xue and Qi have lost each other, it is termed deficiency. The Luo vessels and Sunluo both transport into the meridians; when Xue and Qi converge, it is termed excess. If Xue and Qi move together upwards, it results in Great Jue (Syncope); Jue leads to sudden death. If Qi returns, life is preserved; if it does not return, death occurs. Asked: From where does excess come? To where does deficiency go? Answer: Yin and Yang both have Shu (Transport) and Hui (Assemblage) points. Yang injects into Yin, Yin fills outwardly; Yin and Yang are balanced (Suwen reads 'equally balanced'), filling the Form. If the Nine Pulses are uniform, it is called a Healthy Person. Pathogens arise either from Yang or from Yin. Those arising from Yang result from wind, rain, cold, and summer-heat; those arising from Yin result from diet, daily routine, and emotional extremes of joy and anger. Asked: How do wind and rain injure the body? Answer: Wind and rain first lodge in the skin, transmit to Sunluo; when Sunluo are full, they transmit to Luomai (Collateral Vessels); when Luomai are full, they pour into the Major Meridians. Xue and Qi combine with pathogenic factors and lodge between the Fenrou (muscle intervals). The pulse is firm and large, hence termed Excess. Excess is externally firm and full, cannot be pressed, and pressing causes pain. Asked: How do cold and dampness injure the body? Answer: When cold and dampness attack humans, the skin contracts (Suwen reads 'does not contract'), muscles become firm and tight, Ying Blood becomes stagnant, and Wei Qi departs, hence termed Deficiency. Deficiency involves contraction and closure, Qi insufficiency, and blood stagnation. Pressing generates sufficient Qi and warmth, bringing comfort without pain.

Asked: How does Yin generate excess? Answer: Unregulated joy and anger cause Yin Qi to rebel upward. Upward rebellion causes lower deficiency; lower deficiency causes Yang Qi to rush to the lower part, hence termed Excess. Asked: How does Yin generate deficiency? Answer: Joy causes Qi to descend; grief causes Qi to dissipate. Dissipation makes the pulses empty. Combined with cold food and drink, cold Qi disturbs the Zang organs (one version reads 'heavy fullness'), causing blood to stagnate and Qi to depart, hence termed Deficiency. Asked: Yang deficiency leads to external cold; Yin deficiency leads to internal heat; Yang excess leads to external heat; Yin excess leads to internal cold. I do not understand the reason? Answer: Yang receives Qi from the Upper Jiao to warm the skin and muscle intervals. Now, if cold qi is outside, the Upper Jiao becomes obstructed. Obstruction causes cold to remain alone outside, hence chills. If there is labor and fatigue, the Form and Qi decline, Grain Qi is insufficient, the Upper Jiao fails to circulate, and the Lower Jiao (Suwen reads 'Lower Wan') fails to communicate. Stomach Qi becomes hot, steaming the chest, hence internal heat. If the Upper Jiao is not unblocked, the skin is dense, the Couli are closed (Suwen adds 'Xuanfu/Pores'), and Wei Qi cannot vent, hence external heat. Rebellious Qi moves upward, cold qi accumulates in the chest and cannot discharge. Lack of discharge causes Warm Qi to depart, leaving cold alone. This causes blood to coagulate and stagnate; coagulation blocks the Couli. The pulse is large and choppy, hence internal cold.

Asked: When Yin and Yang converge, and Xue and Qi converge, and the disease form is established, how should one needle? Answer: Needle these cases by selecting Jingqu, drawing blood from Ying, and regulating Qi from Wei. Use the body constitution and adjust according to the Four Seasons, considering quantity, depth, and location. Asked: When Xue and Qi have converged, the disease form is established, and Yin and Yang incline, what are the tonification and sedation methods? Answer: To sedate excess, insert the needle when Qi is abundant. The needle and Qi enter together, opening the gate like opening a door. The needle and Qi exit together; Essence and Qi are not injured, pathogenic factors descend, the outer gate remains open to expel the illness. Shake the needle to widen the channel, like clearing a road; this is called Great Sedation. One must press and withdraw; the grand Qi will be subdued. Asked: How to tonify deficiency? Answer: Hold the needle without placing it down, stabilize the mind. Insert the needle during exhalation; as Qi exits, the needle enters. The needle cavity is sealed, Essence cannot escape. When the needle feels substantial, quickly withdraw it; as Qi enters, the needle exits. Heat cannot return. Seal the gate, disperse pathogenic factors, and preserve Essence. After movement (Suwen reads 'movement of Qi after time'), local Qi is not lost, distant Qi arrives; this is called Pursuing. Asked: There are ten types of excess and deficiency, arising from the Five Zang and Five Mai (Pulses/Meridians). The Twelve Main Meridians generate hundred diseases (Suwen reads 'their diseases'); why speak only of the Five Zang? The Twelve Main Meridians connect with the 365 Jie (acupoints/joints). Disease at the Jie must affect the meridians; disease in the meridians has both excess and deficiency. How to combine them? Answer: The Five Zang and Six Fu organs are exterior-interior pairs. The meridians and limbs/joints each generate excess and deficiency. Observe where the disease resides and regulate accordingly. Disease in the Mai, regulate Xue; disease in Xue, regulate Luo; disease in Qi, regulate Wei; disease in Rou (Muscles), regulate Fenrou; disease in Jin (Tendons), regulate Jin; disease in Gu (Bones), regulate Gu. Use Fire Needles (Candle Needles) to劫刺 (seize and prick) below, and for conditions of spasm. Disease in bones, use Cui needles and herbal compresses. Disease with unknown pain location, select the two Qiao vessels. If the body has pain but the Nine Pulses show no disease, use Miao Ci (Lateral Puncture). If disease is on the left but the right pulse is diseased, use Ju Ci (Cross Puncture). Must carefully examine the Nine Pulses; the Dao of needling is complete.