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(The preceding text connects to the discussion on reversal and compliance, fatness and thinness; the following text connects to the Root and Junction.)

The Yellow Emperor asked: I wish to hear about the "natural" principle of acupuncture. Qibo replied: To apply the natural principle is like opening a channel from a deep height to let water flow out; without exerting excessive effort, the water can be drained completely.

(Proceeding to discuss the differences in needling depth and retention time for different constitutions)

Is there a fixed number for needling slender and ordinary people? It is said: If a person is young and strong, with abundant Qi and Blood, and firm skin, and has been affected by pathogenic factors, such persons should be needled deeply and retained for a long time. This refers to obese people: those with broad shoulders and armpits, wide necks, thin muscles but thick subcutaneous fat, dark complexion, and thick, drooping lips have dark and turbid Blood, and sluggish and slow-moving Qi. They tend to be greedy in taking and giving. Such persons should be needled deeply and retained for a long time, with increased stimulation frequency/duration.

Question: How to needle slender people? Answer: Slender people have thin skin, lackluster complexion, lean muscles, thin lips, and speak lightly. Their Blood is clear and thin, and their Qi is slippery and smooth. Their Zheng Qi is easily depleted, and their Blood is easily damaged. Such persons should be needled superficially and the needles withdrawn quickly.

Question: How to needle ordinary people? Answer: Observe their skin color (black or white) and adjust accordingly. Those with upright and pure/thick skin color have harmonious Qi and Blood. Such persons should be needled according to standard constants without deviation.

Question: How to needle robust individuals with solid bones? Answer: For robust individuals with solid bones, if their muscles are firm and joints relaxed, appearing steady/heavy, and if their constitution is heavy, their Qi is sluggish and Blood is turbid; they should be needled deeply and retained, with increased stimulation. If their constitution is vigorous, their Qi is slippery and Blood is clear; they should be needled superficially and the needles withdrawn quickly.

Question: How to needle infants? Answer: Infants have fragile flesh, little Blood, and weak Qi. Needles should be fine needles (Hao Zhen), inserted superficially and withdrawn quickly. Treatment twice a day is permissible.

Question: What does "opening a channel from a deep height to let water flow" metaphorize? Answer: It metaphorizes clear Blood with heavy turbid pathogens; rapid draining will deplete the pathogenic Qi.

Question: What does "digging a channel to break through accumulated water" metaphorize? Answer: It metaphorizes turbid Blood and sluggish Qi; rapid draining will unblock the Qi mechanism.

Question: The principles of reversal/compliance and the numbers of the Nine Constitutions and meridians apply to commoners; what about nobles who consume meat (referred to as "rulers who enjoy blood sacrifices" in *Jiuxu*)? Their bodies are hollow/empty, flesh is soft, and Qi and Blood are fierce, slippery, and agile. Can needling be the same? Answer: The taste of rich food (Gao Liang) and coarse grains (Shu Huo) cannot be compared. When Qi is slippery, the reaction upon withdrawal is fast; when Qi is sluggish, the reaction is slow. When Qi is fierce, use small needles and shallow insertion; when Qi is sluggish, use large needles and deep insertion. Deep insertion requires retention; shallow insertion requires quick withdrawal. Therefore, needling commoners involves deep insertion and retention; needling nobles involves subtle insertion and slow manipulation. This is all due to their Qi being fierce, slippery, and agile.

Question: What is the relationship between the reversal/compliance of Form and Zheng Qi? Answer: If Form is deficient but Pathogenic Qi is excess, this indicates pathogen dominance; urgent draining (Xie) is required. If Form is excess but Pathogenic Qi is deficient, urgent tonification (Bu) is required. If both Form and Pathogenic Qi are deficient, this indicates deficiency of both Yin and Yang; needling should not be performed again, as it would cause double deficiency. Double deficiency leads to exhaustion of both Yin and Yang; exhaustion of Qi and Blood results in emptiness of the Five Zang organs, withering of sinews, bones, and marrow. The elderly may die, and the strong may not recover. If both Form and Pathogenic Qi are excess, this indicates excess of both Yin and Yang; urgent draining of pathogens and regulation of deficiency/excess are required. Thus, it is said that excess is treated by draining, and deficiency by tonifying.

Therefore, it is said that ignorance of reversal/compliance in needling causes Zheng Qi and Xie Qi to clash. Tonifying an Excess pattern causes Yin-Yang, Qi, and Blood to overflow, leading to fullness and distension of the intestines and stomach, internal distension of the lungs and liver, and disorder of Yin and Yang. Draining a Deficiency pattern causes emptiness of the meridians, depletion of Qi and Blood, spasms of the intestines and stomach, thinning of the skin adhering tightly to the body, and withered hair and pores, thereby hastening death. Therefore, the essence of needling lies in knowing how to regulate: regulating Yin and Yang allows Jing Qi to fill; harmonizing Form and Qi allows Shen to remain within. Thus, it is said: superior physicians level Qi, average physicians disrupt meridians, and inferior physicians sever Qi and endanger life. One must be cautious. One must examine changes in the Five Zang organs, correspondences of the Five Pulses, deficiency/excess of meridians, and texture of the skin before selecting points.