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In individuals where the Qi of the pulse is abundant but the Blood is deficient, needling may lead to Qi depletion (Qi Tuop), resulting in collapse. In those where both Blood and Qi are abundant, with an excess of Yin Qi, the Blood flows smoothly; needling may cause the Blood to jet out, potentially damaging Yang Qi.

If pathogenic factors have accumulated and remained stagnant for a long time without being drained, the Blood becomes dark and turbid, thus unable to jet out. If one has recently drunk fluids, the essence seeps into the collateral vessels before harmonizing with the Blood; consequently, when bleeding occurs, the fluid separates from the Blood. If no recent drinking occurred, water-dampness remains in the body, which over time leads to edema. When Yin Qi accumulates in the Yang aspect and stagnates in the collaterals, needling may result in swelling before any Blood emerges, as the Qi moves first. If the Qi of Yin and Yang has just met but not yet harmonized, applying a draining method at this stage will cause both Yin and Yang to deplete, separating the interior from the exterior. This results in a pale complexion and excessive bleeding. If the complexion does not change but the patient feels vexed, it is because needling the collaterals empties the meridians; emptiness in the Yin meridians leads to Yin depletion, causing vexation. When Yin and Yang Qi interact and combine to form Bi syndrome (obstruction), it is due to pathogens overflowing into the main meridians and pouring into the collaterals. In such cases, both Yin and Yang have excess pathogens; even if significant amounts of Blood are released, it cannot effectively reduce the excess (i.e., it fails to achieve the desired therapeutic voiding). The Yellow Emperor asked: How should one identify these conditions? Bo Zi replied: The blood vessels are full, hard, transverse, and red. Their location varies above and below; some are small like needle points, others large like sinews. Following these signs to apply draining methods ensures complete safety. Therefore, do not deviate from these principles. Deviating will yield results corresponding to the severity of the condition. The Yellow Emperor asked: Why does the flesh adhere to the needle after insertion? Bo Zi replied: Heat attaches to the needle, making it hot; the heat causes the flesh to adhere tightly, making it feel firm. Misuse of bian stones (lithic therapy) leaves lasting harm on the body; this constitutes two errors made by physicians. "Piercing the door" refers to superficial needling, associated with death at home (metaphorically indicating minor error or mild outcome); "entering the gate" refers to deep needling, associated with death in the hall (metaphorically indicating major error or severe outcome).

The Yellow Emperor said: I learned about the Nine Needles from my master and applied them to the common people. The Blood and Qi of different people vary in form. Sometimes Shen (Spirit) moves and Qi precedes the needle; sometimes Qi meets the needle upon insertion; sometimes Qi follows only after the needle is withdrawn; sometimes multiple insertions are needed before effect is felt; sometimes Qi rebels after needle withdrawal; sometimes symptoms worsen after multiple insertions. These six scenarios differ in manifestation. I wish to hear the explanation. Bo Zi replied: Individuals with excessive Yang have spirits that are easily aroused and Qi that moves forward readily. Such individuals often display haughty behavior, speak quickly, and lift their feet high. They have excess Qi in the Heart and Lungs, with smooth, vigorous, and soaring Yang Qi; thus, when the Spirit moves, the Qi advances first. If an individual with excessive Yang does not have Qi advancing first, they possess considerable Yin. Those with more Yang tend to be joyful; those with more Yin tend to be irritable. Frequent angerers are quick to calm down, hence described as having considerable Yin. Their Yin and Yang are difficult to separate and combine, so their Spirit cannot advance first. When Yin and Yang are harmonious, and Blood and fluids are moist and smooth, Qi exits rapidly upon needle insertion, meeting the needle. In those with more Yin and less Yang, where Yin sinks and Yang floats within the five Zang organs, Qi follows only after the needle is withdrawn, moving independently. In individuals with much Yin and little Yang, the Qi sinks and moves forward with difficulty, requiring multiple insertions before effect is felt. Cases where Qi rebels upon insertion, or where symptoms worsen after multiple insertions, are not due to the natural floating and sinking trends of Yin and Yang Qi. These are failures caused by incompetent physicians, errors in technique, while the patient's physical constitution and Qi were not at fault.