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Huangdi asked, "What is called Miao Ci (缪刺, Contralateral Puncture)?" Qibo replied, "When pathogenic factors invade the body, they first lodge in the skin and hair. If they remain there without being expelled, they enter the Luo vessels (collaterals). If they continue to remain, they enter the Jing meridians (main channels), internally connecting to the Zang organs and dispersing into the stomach and intestines. When both Yin and Yang are affected by pathogens, the Zang organs are injured. This is the sequence of pathogens entering from the skin and hair and reaching the extreme depth of the Zang organs. In such cases, one should treat the Jing meridians."

"Now, when pathogens lodge in the skin and hair, they enter the Sun Luo vessels (fine collaterals). If they remain there without being expelled, causing blockage and obstruction, they cannot enter the Jing meridians but instead overflow into the Da Luo vessels (major collaterals), generating strange diseases. When pathogens lodge in the Da Luo vessels, Qi from the left flows to the right, and Qi from the right flows to the left, interacting with the Jing meridians above and below, on the left and right, and distributing to the four extremities. Their Qi has no fixed location and does not reach the Shu points (transport points) of the meridians. This method is called Miao Ci."

"Someone asked, 'Miao Ci involves treating the left for right-sided ailments and the right for left-sided ailments. How does it differ from Ju Ci (巨刺, Major Contralateral Puncture)?' The answer is: 'When pathogens lodge in the Jing meridians, excess on the left causes disease on the right, and excess on the right causes disease on the left. There are also cases where the condition shifts or migrates; for example, pain on the left persists while the pulse on the right shows pathology first. In such cases, one must use Ju Ci, ensuring the needle penetrates the Jing meridian, not the Luo vessel. Therefore, when a Luo vessel is diseased, its pain location differs from that of the Jing meridian, hence it is called Miao Ci.' (Ju Ci punctures the Jing meridians, while Miao Ci punctures the Luo vessels.)"

"Another question was raised, 'How are acupoints selected for Miao Ci?' The answer is: 'When pathogens lodge in the Luo vessel of the Foot Shaoyin Kidney Meridian, it causes sudden heart pain, acute distension, and fullness/supporting sensation in the chest and hypochondrium. If there is no accumulation, puncture the area anterior to Ran Gu (KI2) until bleeding occurs. After about the time it takes to eat a meal, the condition resolves. Treat the left side by needling the right, and the right side by needling the left. For newly onset diseases, recovery occurs within five days.'"

"When pathogens lodge in the Luo vessel of the Hand Shaoyang Sanjiao Meridian (alternatively read as Hand Shaoyin Heart Meridian), it causes throat obstruction, tongue retraction, dry mouth, mental restlessness, pain along the lateral aspect of the arm, and inability to raise the hand to the head. Puncture the areas on the nails of the middle finger (should be little finger) and the next finger, at a distance from the tip like the width of a leek leaf, needling each point once. Those with strong constitution recover immediately; those who are elderly recover after a short while. Treat the left side by needling the right, and the right side by needling the left. This is a new disease, which will resolve in a few days."

"When pathogens lodge in the Luo vessel of the Foot Jueyin Liver Meridian, it causes sudden hernia and acute pain. Puncture the area on the nail of the big toe where the nail meets the flesh, needling each side once. Men recover immediately; women recover after a short while. Treat the left side by needling the right, and the right side by needling the left."

"When pathogens lodge in the Luo vessel of the Foot Taiyang Bladder Meridian, it causes pain in the head and neck, and shoulder pain. Puncture the area on the nail of the little toe where the nail meets the flesh, needling each side once. Recovery is immediate. If not resolved, puncture three cun above the lateral malleolus. Treat the left side by needling the right, and the right side by needling the left. Recovery occurs after about the time it takes to eat a meal."

"When pathogens lodge in the Luo vessel of the Hand Yangming Large Intestine Meridian, it causes Qi fullness in the chest, rapid breathing, a feeling of support and weakness in the chest, and heat in the chest. Puncture the areas on the nails of the big toe and the next finger, at a distance from the tip like the width of a leek leaf, needling each point once. Treat the left side by needling the right, and the right side by needling the left. Recovery occurs after about the time it takes to eat a meal."

"When pathogens lodge between the arm and palm, causing inability to flex, puncture the posterior aspect of the ankle. First press with the finger; when pain is elicited, then puncture. Use the waxing and waning of the moon to determine the number of needles. On the first day of the waxing moon, use one needle; on the second day, two needles; on the fifteenth day, fifteen needles; on the sixteenth day, fourteen needles."

"When pathogens lodge in the Foot Yangqiao Vessel, it causes eye pain starting from the inner canthus. Puncture half a cun below the lateral malleolus, needling each side twice. Treat the left side by needling the right, and the right side by needling the left. Recovery occurs after the time it takes to walk ten li."

"If a person suffers a fall, causing evil blood to stagnate internally, leading to abdominal distension and inability to urinate or defecate, first administer purgative medicines. This injury damages the Jueyin vessel above and the Shaoyin Luo vessel below. Puncture the area below the medial malleolus and anterior to Ran Gu (KI2) to bleed the blood vessels. Then puncture the arterial pulse on the dorsum of the foot. If not resolved, puncture the hair tufts on the big toe (Dadun, LR1), needling each side once until bleeding appears. Recovery is immediate. Treat the left side by needling the right, and the right side by needling the left. If accompanied by palpitations, sadness, and unhappiness, apply the same needling method."

"When pathogens lodge in the Luo vessel of the Hand Yangming Large Intestine Meridian, it causes deafness and intermittent loss of hearing. Puncture the areas on the nails of the big toe and the next finger, at the tip like the width of a leek leaf, needling each point once. Hearing is restored immediately. If not resolved, puncture the area on the nail of the middle finger where it meets the flesh. Hearing is restored immediately. If the deafness is chronic and unresponsive, do not puncture. If wind is felt in the ears, apply this method as well, treating the left side by needling the right, and the right side by needling the left."

"For all Bi syndromes that move around without a fixed location, puncture where the pain is located between the muscle layers. Use the waxing and waning of the moon to determine the number of needles. The practitioner must adjust the number of needles according to the prosperity and decline of Qi. Needling beyond the prescribed number depletes Qi; needling fewer than the prescribed number fails to expel pathogens. Treat the left side by needling the right, and the right side by needling the left. If the disease persists, repeat the treatment according to the method, using the moon's phases. On the first day of the waxing moon, one needle; on the second day, two needles, increasing gradually. On the fifteenth day, fifteen needles; on the sixteenth day, fourteen needles, decreasing gradually."

"When pathogens lodge in the Luo vessel of the Foot Yangming Stomach Meridian (Suwen reads 'Jing meridian'; Wang Bing notes: 'Because its meridians cross on the face, citing meridian diseases clarifies the category of Miao Ci'), it causes nasal congestion, epistaxis, and coldness in the upper teeth. Puncture the area on the nail of the middle toe (Suwen note: puncture the big toe and next finger) where the nail meets the flesh, needling each point once. Treat the left side by needling the right, and the right side by needling the left."

"When pathogens lodge in the Luo vessel of the Foot Shaoyang Gallbladder Meridian, it causes hypochondriac pain, difficulty breathing, coughing, and sweating. Puncture the area on the nail of the little toe (Suwen includes 'next finger') where the nail meets the flesh, needling each point once. Difficulty breathing resolves immediately; sweating stops immediately. For coughing, keep warm with clothing and diet; recovery occurs in one day. Treat the left side by needling the right, and the right side by needling the left. The disease resolves immediately. If not resolved, repeat the treatment."

"When pathogens lodge in the Luo vessel of the Foot Shaoyin Kidney Meridian, it causes sore throat, inability to swallow food, spontaneous anger, and Qi rushing upward to the贲门 (cardia). Puncture the Luo vessels in the center of the foot, needling each side three times, totaling six punctures. Recovery is immediate. Treat the left side by needling the right, and the right side by needling the left."

"When pathogens lodge in the Luo vessel of the Foot Taiyin Spleen Meridian, it causes lower back pain radiating to the lower abdomen and hip, making it impossible to breathe while lying supine. Puncture the gap in the sacrum, above the two gluteal muscles, which is Yaoshu (BL23). Use the waxing and waning of the moon to determine the number of needles. Recovery is immediate upon withdrawing the needle. Treat the left side by needling the right, and the right side by needling the left."

"When pathogens lodge in the Luo vessel of the Foot Taiyang Bladder Meridian, it causes spasms, stiffness of the back, pain radiating to the hypochondrium, internal pain radiating to the heart. Start needling from the nape, counting vertebrae along the spine. Press quickly to find the tender spot; puncture obliquely three times. Recovery is immediate."

"When pathogens lodge in the Luo vessel of the Foot Shaoyang Gallbladder Meridian, it causes pain in the pivot region (hip joint) and inability to lift the thigh (or lack of Qi in the thigh). Use a filiform needle to puncture the pivot region. In cold patterns, retain the needle. Use the waxing and waning of the moon to determine the number of needles. Recovery is immediate."

"For needling various meridians, if the pathway is not diseased, use Miao Ci. For deafness, puncture the Hand Yangming meridian; if ineffective, puncture the meridian passing before the ear. For dental caries pain, puncture the Hand Yangming meridian; recovery is immediate. If ineffective, puncture the meridian entering the teeth; recovery is immediate."

"When pathogens lodge between the five Zang organs, the disease manifests as pulling pain in the meridians, coming and going intermittently. Observe the pathological pulses and apply Miao Ci on the hands and feet near the nails. Observe the vessels and release blood. Puncture every other day. If one session is ineffective, five sessions will suffice. If Miao transmission causes pulling pain in the upper teeth and coldness of the teeth and lips (Suwen adds 'pain'), observe the blood vessels on the dorsum of the hand and remove stasis. Puncture one needle on the nail of the middle toe of the Foot Yangming meridian, and one needle each on the nails of the big toe and next finger of the hand. Recovery is immediate. Treat the left side by needling the right, and the right side by needling the left. For swelling in the throat, inability to swallow saliva, or inability to expectorate saliva, apply Miao Ci by bleeding anterior to Ran Gu (KI2). Recovery is immediate. Treat the left side by needling the right, and the right side by needling the left. (From 'self-swelling' to these 29 characters, Wang Bing's note in Suwen originally followed 'pathogens lodge in Foot Shaoyin Luo', now moved here.)"

"When pathogens lodge in the Luo vessels of the Hand and Foot Shaoyin, Taiyin (alternatively Yang), and Foot Yangming meridians, these five Luo vessels all converge in the ear and ascend to connect with the left corner of the head. If all five Luo vessels are exhausted, (the rescue order is:) first puncture the hair tufts on the big toe, one needle each; then puncture the middle toe nail, one needle each; then puncture the medial end of the big toe nail like the width of a leek leaf (Suwen states that puncturing Pericardium later is incorrect); then puncture the sharp bone end of the Hand Shaoyin Heart meridian, one needle each. Recovery is immediate. If not resolved, blow air into both ears with a bamboo tube, shave a square inch of hair from the left corner of the head, burn it to ash, and drink a cup of fine wine. If unable to drink, force-feed; recovery is immediate."

"The general principle of needling is to first observe the meridians, palpate and trace them, assess their deficiency and excess, and regulate them. If regulation fails, use Jing Ci (meridian needling). If there is pain but the meridian itself is not diseased, use Miao Ci. Observe the skin regions for blood vessels; puncture all visible blood vessels. This is the principle of Miao Ci."