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Huangdi asked, saying: The qi of the four seasons each has a different form. The onset of myriad diseases all arises from specific causes. In the methods of moxibustion and acupuncture, what is considered the most precious principle? Qibo replied, saying: The qi of the four seasons each resides in specific locations. In the methods of moxibustion and acupuncture, the Qi points (acupoints on the meridians) are considered the most precious.

Therefore, in spring, acupuncture should target the collateral vessels (Luo Mai), the Ying-Spring points (Ying-Xue, one of the Five Shu points governing heat), the major meridians, and the spaces between muscles. For severe cases, deep insertion is used; for mild cases, shallow insertion is used. *Su Wen* states: In spring, needle the San-Shu points (dispersed acupoints) and the muscle fissures, stopping when bleeding occurs. It also states: Spring is when Wood qi begins to govern. Liver qi begins to generate. Liver qi becomes urgent, and wind qi moves swiftly. The meridians are located deeply, while the spring qi is insufficient to penetrate deeply. Therefore, one should select the collateral vessels and the spaces between muscles. *Jiu Juan* (i.e., *Ling Shu*) states that needling Ying-Spring points in spring follows the same principle, which is correct in theory. It further states: In spring, treat the collateral vessels to address skin-level disorders. It also states: In spring, select Jing-River points and the spaces between muscles and veins. These two statements have roughly similar meanings. It also states: The qi of spring resides in the main meridians.

In summer, select the Shu-Stream points and Sun-Luo vessels (fine collateral vessels) for needling above the muscles and skin. It also states: In spring [Note: Text likely implies Summer based on context], needle the Shu points. These two statements are identical and correct in theory. During the late summer season, needle the Jing-Emergent points. It also states: Select the Sheng-Jing (abundant qi-blood meridians) and Sun-Luo vessels, target the interstices, and pierce through the skin. It also states: In summer, target the Fen-Cou (muscle intervals) to treat disorders at the muscle level. These two statements have roughly similar meanings. *Su Wen* states: In summer, needle the Luo-Shu points, stopping when bleeding occurs. It also states: Summer is when Fire qi begins to govern. Heart qi begins to grow. The pulse channels are slender, and qi strength is weak. Yang qi flows and overflows; blood warms the Cou-Li (pores and interstices) and penetrates inward to the meridians. Therefore, one selects the Sheng-Jing and Fen-Cou, piercing the skin to expel the pathogen, because the pathogen resides superficially. The so-called Sheng-Jing refers to the Yang meridians. These two statements have roughly similar meanings. It also states: The qi of summer resides in the Sun-Luo vessels, and the qi of late summer resides in the muscles.

In autumn, needle the He-Sea points (one of the Five Shu points governing rebellious qi). The remaining methods are similar to those in spring. In autumn, select Jing-River and Shu-Stream points. If the pathogen is in the Fu organs, select the He-Sea points for treatment. *Su Wen* states: In autumn, needle the skin following the grain patterns, applying the same method above and below. It also states: Autumn is when Metal qi begins to govern. Lung qi begins to gather and肃 (purify). Metal qi will overcome Fire qi. Yang qi gathers in the He-Sea points. Yin qi initially prevails, and dampness affects the body. Yin qi is not yet strong and cannot penetrate deeply. Therefore, select Shu-Stream points to drain Yin pathogens, and select He-Sea points to empty Yang pathogens, because Yang qi is beginning to decline. Thus, one selects the He-Sea points. This is called the variation in treatment for early autumn. It also states: The qi of autumn resides in the skin, characterized by closed Cou-Li. *Jiu Juan* also states: In autumn, select the Qi-Kou (Cunkou pulse) to treat tendons and vessels. This differs in meaning from the above.

In winter, select the Jing-Well points (the first of the Five Shu points governing fullness below the heart) and the divisions of various Shu points. One should insert deeply and retain the needle. It also states: In winter, select Jing-Well and Ying-Spring points. *Su Wen* states: In winter, select the apertures of Shu points and the muscle fissures. For severe cases, insert directly and deeply; for mild cases, insert dispersively. The meaning of Shu apertures and the divisions of Shu points is roughly the same. It also states: Winter is when Water qi begins to govern. Kidney qi begins to close and store. Yang qi is weak and declining, while Yin qi is firm and abundant. Ju-Yang (Taiyang Meridian) sinks and hides. Yang meridians depart. Select Jing-Well points to descend rebellious Yin qi, and select Ying-Spring points to unblock qi (or to tonify Yang qi, according to another reading). It says: Selecting Jing-Well and Ying-Spring points in winter prevents nasal epistaxis (nosebleeds) in spring. This is called the variation in treatment for late winter. It also states: The qi of winter resides in the bone marrow. It also states: In winter, needle Jing-Well points; if the disease is in the Zang organs, select the Jing-Well points. These two statements are identical and correct in theory. It also states: In winter, select Jing-River and Shu-Stream points to treat bone marrow and the five Zang organs. Regarding the Zang organs, they are consistent; however, there is doubt regarding Jing-River and Shu-Stream points.

If one needles the areas corresponding to summer during spring, the pulse will become chaotic and qi weak. Pathogens will invade the bone marrow, the disease will not heal, appetite will be lost, and qi will be deficient. If one needles the areas corresponding to autumn during spring, tendons will spasm and qi will rebel. Coughing will encircle the throat. The disease will not heal, causing frequent fright and laughter (or crying, according to another reading). If one needles the areas corresponding to winter during spring, pathogens will adhere to the Zang organs, causing abdominal distension. The disease will not heal, and the patient will desire to speak.

If one needles the areas corresponding to spring during summer, the disease will not heal, causing lethargy and flaccidity. If one needles the areas corresponding to autumn during summer, the disease will not heal, causing chest oppression, muteness, and a sense of terror as if being pursued. If one needles the areas corresponding to winter during summer, the disease will not heal, causing qi deficiency and frequent anger.

If one needles the areas corresponding to spring during autumn, the disease will not heal, causing anxiety and restlessness. The patient may wish to act but forget upon standing. If one needles the areas corresponding to summer during autumn, the disease will not heal, causing increased somnolence and vivid dreaming (referring to after Liqiu/Start of Autumn). If one needles the areas corresponding to winter during autumn, the disease will not heal, causing shivering and chills.

If one needles the areas corresponding to spring during winter, the disease will not heal, causing insomnia despite the desire to lie down, with visual hallucinations during sleep (referring to before mid-December). If one needles the areas corresponding to summer during winter, the disease will not heal, causing rebellious qi and manifesting as various Bi syndromes. If one needles the areas corresponding to autumn during winter, the disease will not heal, causing excessive thirst.

The Yang meridians of the foot are Shaoyang within Yin. The Yin meridians of the foot are Taiyin within Yin. The Yang meridians of the hand are Taiyang within Yang. The Yin meridians of the hand are Shaoyin within Yang.

In the first, second, and third months, human qi resides in the left side; do not needle the Yang meridians of the left foot.
In the fourth, fifth, and sixth months, human qi resides in the right side; do not needle the Yang meridians of the right foot.
In the seventh, eighth, and ninth months, human qi resides in the right side; do not needle the Yang meridians of the right foot.
In the tenth, eleventh, and twelfth months, human qi resides in the left side; do not needle the Yin meridians of the left foot.

The needling method states: Do not needle when there is high fever. Do not needle when sweating profusely. Do not needle when the pulse is chaotic and turbid. Do not needle when the disease presentation contradicts the pulse. Superior physicians needle before the disease arises. Next best is to needle before the disease forms. Next is to needle after the disease has declined. Inferior physicians needle when the pathogen is actively attacking, when the constitution is robust, or when the disease contradicts the pulse. Therefore, it is said: When the pathogen is vigorous, do not harm the healthy qi. Needle when the pathogen has declined, and success is assured. Therefore, it is said: Superior physicians treat disease before it arises, not after it has formed. Do not needle in extreme cold. Do not use tonification in extreme warmth. Do not use draining methods when the moon is waxing. Do not use tonifying methods when the moon is full. Do not treat when the moon is new (waning). Do not needle immediately after sexual intercourse. Do not engage in intercourse after needling. Do not needle when extremely angry. Do not become angry after needling. Do not needle when extremely fatigued. Do not exert yourself after needling. Do not needle when extremely drunk. Do not drink alcohol after needling. Do not needle when overly full. Do not eat heavily after needling. Do not needle when extremely hungry. Do not starve after needling. Do not needle when extremely thirsty. Do not drink excessively after needling. For patients arriving by carriage, let them lie down and rest for about the time it takes to eat a meal before needling. For patients arriving on foot, let them sit and rest for about the time it takes to walk ten li before needling. For patients suffering from sudden fright or anger, stabilize their qi before needling.

All contraindications involve chaotic pulses and scattered qi, violating the circulation of Ying and Wei, and disrupting the order of Jing qi. If needled under these conditions, Yang diseases enter Yin, and Yin diseases emerge as Yang, causing pathogens to regenerate. Unskilled physicians fail to observe this, which is termed damaging the form. The body becomes flaccid and exhausted, bone marrow is consumed, fluids fail to transform, and the essence of the five flavors is depleted. This is termed loss of qi.

Someone asked: I wish to hear about the distinctions in needling depth. The response was: When needling bone, do not injure the tendon. When needling tendon, do not injure the flesh. When needling flesh, do not injure the vessel. When needling vessel, do not injure the skin. When needling skin, do not injure the flesh. When needling flesh, do not injure the tendon. When needling tendon, do not injure the bone. Someone asked: I do not understand what you mean; please explain in detail. The response was: Needling bone without injuring tendon means the needle reaches the tendon and stops, not penetrating to the bone. Needling tendon without injuring flesh means the needle reaches the flesh and stops, not penetrating to the tendon. Needling flesh without injuring vessel means the needle reaches the vessel and stops, not penetrating to the flesh. Needling vessel without injuring skin means the needle reaches the skin and stops, not penetrating to the vessel. Needling skin without injuring flesh means the pathology is in the skin; the needle enters the skin without reaching the flesh. Needling flesh without injuring tendon means passing through the flesh to reach the tendon. Needling tendon without injuring bone means passing through the tendon to reach the bone. These are referred to as errors of reversal.

Needling the heart results in death within one day, manifested by belching. Needling the lung results in death within three days, manifested by coughing. Needling the liver results in death within five days, manifested by yawning (*Su Wen* records as speech disturbances). Needling the spleen results in death within fifteen days (*Su Wen* records as ten days, or alternatively five days), manifested by swallowing movements. Needling the kidney results in death within three days (*Su Wen* records as six days, or alternatively seven days), manifested by sneezing. Needling the gallbladder results in death within one and a half days, manifested by vomiting. Needling the diaphragm causes injury to the middle jiao; although the illness may seem to resolve, death will occur within one year. Needling the large artery on the dorsum of the foot with uncontrolled hemorrhage leads to death. Needling the large artery in the medial thigh with uncontrolled hemorrhage leads to death. Needling flowing vessels in the face may unfortunately cause blindness. Needling the Keymaster point (Shangguan, GB19) with deep penetration into the vessel causes ear leakage and deafness. Needling the Brain House point (Naohu, GV17) with excessive depth entering the brain causes immediate death. Needling the knee patella region with effusion leads to limping.

Excessive needling of the sublingual vessels causing uncontrolled hemorrhage leads to aphonia. Excessive bleeding from the Taiyin vessel of the kidney meridian leads to immediate death. Needling the vessels in the network of collaterals on the sole of the foot without bleeding causes swelling. Needling the Foot Shaoyin meridian in a state of double deficiency with bleeding leads to tongue stiffness and difficulty speaking. Needling the large artery in the thigh causes collapse and pallor. Needling the chest wall (Ying Zhong).

Needling floating vessels above the breast causes swelling with root erosion. Needling the axilla and intercostal space with deep penetration causes coughing. Needling the Clavicle Fossa (Quepen, LI15) with deep penetration causes qi leakage, leading to wheezing, coughing, and rebellious qi. Needling the bladder in the lower abdomen causes urination and lower abdominal fullness. Deep penetration into the Fish Center (Yuji, LU10) on the hand causes swelling. Deep penetration into the Large Intestine area causes swelling. Needling the vessel in the supraorbital depression causes eye leakage and blindness. Needling the joint with effusion leads to inability to flex or extend.