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The essence of acupuncture is easy to state but difficult to master. The mediocre practitioner guards the form, while the superior practitioner guards the Shen (Spirit/Mind). Profound is the Shen; the pathogen enters through a gate. Without perceiving the disease, how can one know its origin? The subtlety of needling lies in the speed and slowness (timing). The mediocre guard the acupoints (Guan), while the superior guard the Ji (Opportunity/Key moment). When the Ji does not move, it does not leave the Kong (Acupoint); the Ji within the Kong is clear, quiet, and subtle. Its arrival cannot be met with forceful supplementation, its departure cannot be chased with draining. One who knows the Dao of Ji cannot be mistaken by even a hair's breadth. One who does not know Ji, though struck, will not respond. Knowing the coming and going, one must seize the appropriate time. The mediocre are dark to this; the profound Dao is possessed only by the superior. What goes is Ni (Reverse), what comes is Shun (Smooth). Clearly knowing reverse and smooth, one proceeds correctly without hesitation. Meeting and draining it, how could it not become Deficient? Following and assisting it, how could it not become Excess? Meeting and following it, harmonizing with intention—this completes the Dao of needling.

In general, when using needles: for Deficiency, use Tonification to make it solid; for Fullness, use Draining to empty it; for Stagnation and old accumulation, remove it; for Pathogenic Excess, weaken it. The *Da Yao* says: Slow insertion and rapid withdrawal constitute Tonification (Shi/Solid); rapid insertion and slow withdrawal constitute Draining (Xu/Empty). Speaking of Solid and Empty, it seems as if there were something or nothing. Observing the sequence, it seems as if present or absent. Creating Deficiency or Solidity, it feels like gaining or losing. The key to Deficiency and Solidity lies in the Nine Needles. The timing of Tonification and Draining is achieved through the needle. Draining is called "Ying" (Meeting). The intent of Ying is to hold firmly and insert, then release and withdraw. Discharging and raising the needle allows the rapid pathogenic Qi to escape. Pressing and guiding the needle out is called "Nei Wen" (Internal Warming/Closing). Blood does not scatter, Qi does not exit. Tonification is called "Sui" (Following). The intent of Sui is as if forgetting. Moving and pressing lightly, like a mosquito bite. Like staying, like a circle; withdrawing like a broken string. Letting the left hand secure and the right hand push, the Qi stops disturbing. The external gate is closed, the internal Qi becomes solid. There must be no retained blood; urgent cases require immediate treatment. The way of holding the needle: firmness makes it solid. Point straight and pierce vertically, do not deviate left or right. Focus your Shen on the finest detail, direct your attention to the patient, examine the blood vessels, and determine the piercing location. If inspection shows fullness alone, palpation shows hardness alone. Regarding Qi in the meridians: Pathogenic Qi is in the upper part, Turbid Qi is in the middle, Clear Qi is in the lower part. Therefore, needling the superficial vessels expels Pathogenic Qi; needling the middle vessels expels Turbid Qi; needling too deeply causes Pathogenic Qi to sink further, worsening the disease. Thus, skin, flesh, sinews, and vessels each have their proper places. Diseases have their abodes, needling has its appropriateness. Forms differ, each should follow its appropriate method. Do not tonify Excess or drain Deficiency, do not damage what is insufficient nor add to what is excessive; this leads to severe illness and worsening condition. Taking from the Five Pulses causes death; taking from the Three Pulses... Depriving Yin causes Jue (Fainting/Cold extremities); depriving Yang causes Kuang (Mania). The harms of needling are complete here.

Know the patient's suffering. The diaphragm has upper and lower parts; know where the Qi resides. First grasp the principle, spread and dredge the Qi (Tai Su reads "Xi and Shu"), penetrate slightly deeper and retain the needle, thus allowing slow entry. For great Heat in the upper part, push downwards to guide it out; for conditions rising from below, lead upwards to dispel them; for previous pain sites, often treat them first. For great Cold on the exterior, retain the needle to follow the Yang. If both Yin and Yang are deficient, apply Moxibustion. For Jue with severe cold, sunken bone margins, cold exceeding the knees, take Xia Ling (Zusanli, ST36), where the Yin collaterals pass, where cold stays and stops; push and move the Qi. For collapsed meridians, apply Moxibustion. For knotted and tight collaterals, apply Moxibustion. If unaware of the suffering, at the lower ends of the two Qiao vessels, Yang Qiao for men, Yin Qiao for women—this is forbidden by skilled practitioners. The discussion on needling concludes. Generally, tonifying deficiency and draining fullness is known by all craftsmen. But regarding emulating Heaven and Earth, responding flexibly, harmonizing like an echo, following like a shadow—the Dao has no ghosts or gods, it comes and goes alone. The true essence of needling requires first governing the Shen. Once the Five Zang organs are assessed and the Nine Pulse positions are understood, then consider the needle. When common pulses show no abnormality and common ominous signs are unheard, when internal and external accord, not relying solely on form, one may study the coming and going before applying it to the person. The key to Deficiency and Solidity: do not approach Five Xu patterns closely (avoid blind tonification), do not stay away from Five Shi patterns (avoid blind draining). When the time to needle arrives, allow no interval for hesitation. Hand movement must be focused, the needle bright and even. Quietly observe the meaning, watch for changes in adaptation; this is called "Ming Ming" (Obscure/Subtle), where the form is unknown. Seeing Wu Wu (gathering), seeing Ji Ji (abundant); following the sight of flying, not knowing who. Lying still like a crossbow, rising like releasing the trigger. To needle Deficiency, ensure it becomes Solid; to needle Excess, ensure it becomes Empty. Once Jing Qi arrives, guard it carefully and do not lose it. Depth is in the mind, distance feels uniform. Face the abyss like a deep pool, hold the hand like grasping a tiger, let the Shen not be distracted by many objects.

Yellow Emperor asked: I wish to hear about the number of contraindications? Qibo replied: The Zang organs have vital points that must be examined. Liver Qi arises on the left, Lung Qi stores on the right. Heart governs the exterior, Kidney manages the interior, Spleen acts as the envoy, Stomach acts as the market. Above the diaphragm and Huang, there are Parents (Heart and Lung). Beside the seventh vertebra, there is the Zhi Xin (Mind-Heart) (*Su Wen* reads Xiao Xin). Following brings fortune, opposing brings blame. Draining must use Fang (Square/Upright) (*Tai Su* reads Yuan). Palpate and rotate, then Qi flows. Rapid insertion, slow withdrawal, so Pathogenic Qi exits. Extend and meet the Qi, widen the aperture, so Qi escapes quickly. Tonification must use Yuan (Round/Circular) (*Tai Su* reads Fang). Draw the skin outward, aligning with the gate. Left hand draws the pivot, right hand pushes the skin, slight rotation and slow pushing. Must be upright and correct, calm and quiet, firm heart without relaxation. Desire slight retention, then after Qi descends, withdraw rapidly. Push the skin, cover the external gate, so True Qi remains. The essence of using needles is not to forget nourishing the Shen. Draining is done when Qi is flourishing, Moon is full, Day is warm, Body is stable, Breath is inhaling. Insert the needle, wait for inhalation to rotate, wait for exhalation to slowly withdraw. Tonification is Xing (Movement). Xing is Yi (Transference). Needle must hit the Ying-Spring point, then withdraw during inhalation. Must know the fatness and thinness of the body, the decline and abundance of Ying and Wei Qi and Blood Qi. Blood Qi is the Shen of man, must be carefully nourished. Form upon form, eyes dim. Palpate the pain (*Su Wen* reads ask the pain), search in the meridians, clearly visible before, but unobtainable by touch, not knowing the condition, thus called Xing (Form). Profound is the Shen, ears do not hear. Eyes bright, heart open, will shines, clearly aware alone, mouth cannot speak, seeing together but perceiving alone, image seems dim, yet clearly illuminates alone, like wind blowing clouds, thus called Shen. The Three Parts and Nine Positions are the source; the theory of Nine Needles need not be rigidly kept. If needling does not bring Qi, do not count the repetitions; if needling brings Qi, stop and do not repeat. Needles have their appropriateness, forms differ, each performs its function. The essence of needling is Qi arrival leading to effect; the certainty of effect is like wind clearing clouds, manifest in heaven. The Dao of needling is complete. Intersections of joints, three hundred and sixty-five Hui (Assemblies). One who knows the essence finishes in one word; one who does not knows endless dispersion. The "Jie" mentioned refers to the places where Shen Qi travels and enters/exits, not skin, flesh, sinew, or bone. Observe color, inspect eyes, know scattering and returning. Unify the form, listen to movement and stillness, know pathogenic and righteous Qi. Right hand pushes, left hand holds and defends; when Qi arrives, withdraw. Before using needles, first observe the severity and ease of Mai Qi, then one can treat diseases. If Qi of Five Zang is exhausted internally, but the practitioner tonifies externally, this is called Chong Jie (Double Exhaustion). Chong Jie leads to death, death is quiet; the practitioner reverses the Qi, taking from Fu organs and chest. If Qi of Five Zang is exhausted externally, but the practitioner tonifies internally, this is called Ni Jue (Reverse Jue). Ni Jue leads to death, death is restless; the practitioner takes from the four limbs. Harms of needling: hitting the target but not stopping causes Jing leakage; harming the target but stopping causes Qi stagnation; Jing leakage worsens the disease... Qi stagnation generates abscesses. Needling must be solemn; shaking the needle for swelling, not shaking for meridian needling—this is the way of needling. Needling various Heat conditions is like probing hot water; needling Cold conditions is like a person unwilling to walk. Needling Deficiency targets the departing Qi; needling Excess targets the arriving Qi. Needling Shang Guan prevents opening the mouth; needling Xia Guan prevents closing the mouth. Needling Dubi prevents bending; needling Neiguan prevents extending. For high disease located internally, start by taking Yin Ling Quan.