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(Wu Kun's commentary titles this chapter "Discussion on Deficiency and Excess," placed after the "Discussion on Acupuncture Taboos.")

When Qi is excess, the form is solid; when Qi is deficient, the form is weak. This is the normal state. The opposite indicates disease.
When food intake is abundant, Qi is excess; when food intake is scanty, Qi is deficient. This is the normal state. The opposite indicates disease.
When the pulse is full, Blood is excess; when the pulse is empty, Blood is deficient. This is the normal state. The opposite indicates disease.

Excess of Qi with cold in the body is called "reversal."
Deficiency of Qi with heat in the body is called "reversal."
Abundant food intake but scanty Qi is called "reversal."
Scanty food intake but excessive Qi is called "reversal."
A surging pulse (Yang excess) with little Blood (Yin deficiency) is called "reversal."
A small pulse (Yang deficiency) with much Blood (Yin excess/deficiency context implies imbalance) is called "reversal."

Excess of Qi with cold in the body results from Cold Damage (Cold injuring the form).
Deficiency of Qi with heat in the body results from Summerheat Damage (Summerheat injuring Qi).
Abundant food intake but scanty Qi results from loss of Blood, with Dampness residing below (preventing Qi growth).
Scanty food intake but excessive Qi indicates pathogenic factors in the Stomach and Lung.
A small pulse with much Blood indicates heat within drinks (such as alcohol or beverages infected by heat).
A large pulse with little Blood indicates Wind Qi in the pulse and inability to ingest water/gruel. These explain the aforementioned principle that "reversal constitutes disease."

What is termed Excess is the entry of Evil Qi (pathogenic excess).
What is termed Deficiency is the exit of True Qi (leakage of healthy Qi).
Excess of Qi manifests as Heat (Yang excess).
Deficiency of Qi manifests as Cold (Yang deficiency).
In needling to drain Excess, the right hand opens the needle aperture (when treating excess, holding the needle and shaking it widens the channel to allow evil to exit).
In needling to tonify Deficiency, the left hand closes the needle aperture (when treating deficiency, pushing and closing the pore prevents true Qi from leaking. This section discusses acupuncture tonification and sedation methods).

(Placed after the "Discussion on Four Seasons' Adverse and Compliant Acupuncture.")

The East generates Wind; Wind generates Wood; Wood generates Sour; Sour generates Liver; Liver generates Sinews; Sinews generate Heart (explaining the generative principle of the East).
In Heaven, it is profound; in Humanity, it is Dao; in Earth, it is transformation. Transformation generates the Five Flavors; Dao generates Wisdom; Profoundness generates Spirit.
Spirit manifests as Wind in Heaven, as Wood in Earth, as Sinews in the Body, and as Softness in Qi (those receiving Wood Qi have soft Qi).
In the Zang organs, it corresponds to the Liver; its nature is warm; its virtue is harmony; its function is movement; its color is greenish-cyan; its transformation is flourishing (beautiful appearance of things); its associated insects are hairy insects (those obtaining Wood Qi); its administration is dispersion; its command is dissemination; its alteration is breaking and pulling (strong wind is the alteration of Wood, meaning breaking and destruction); its disaster is falling; its flavor is Sour; its emotion is Anger (this is the generation and transformation of the East).
Anger injures the Liver; Grief overcomes Anger (Grief and sorrow are the emotions of the Lung).
Wind injures the Liver; Dryness overcomes Wind (Metal Qi overcomes Wood).
Sour injures the Sinews; Pungent overcomes Sour (this addresses disease caused by excess Wood Qi of the East, balanced by the Metal command of the West).

The South generates Heat; Heat generates Fire; Fire generates Bitter; Bitter generates Heart; Heart generates Blood; Blood generates Spleen (explaining the generative principle of the South).
In Heaven, it is Heat; in Earth, it is Fire; in the Body, it is Vessels; in Qi, it is respiration (the Heart governs blood vessels).
In the Zang organs, it corresponds to the Heart; its nature is summer-heat; its virtue is illumination; its function is restlessness; its color is red; its transformation is luxuriance (abundance of all things); its associated insects are feathered insects (Fire nature flies high); its administration is brightness; its command is oppression and steaming; its alteration is scorching and withering (scorching and withering is the alteration of Fire); its disaster is burning; its flavor is Bitter; its emotion is Joy (this is the generation and transformation of the South).
Joy injures the Heart; Fear overcomes Joy.
Heat injures Qi; Cold overcomes Heat.
Bitter injures Qi; Salty overcomes Bitter (this addresses disease caused by excess Fire Qi of the South, balanced by the Water command of the North).

The Center generates Dampness; Dampness generates Earth; Earth generates Sweet; Sweet generates Spleen; Spleen generates Flesh; Flesh generates Lung (explaining the generative principle of the Center).
In Heaven, it is Dampness; in Earth, it is Earth; in the Body, it is Flesh; in Qi, it is fullness (Earth Qi is substantial).
In the Zang organs, it corresponds to the Spleen; its nature is quiet and firm (Earth nourishes all things); its virtue is moistening; its function is transformation; its color is yellow; its transformation is abundance (fullness of all things); its associated insects are naked insects (exposed bodies without hair or scales); its administration is tranquility; its command is clouds and rain; its alteration is pouring rain (wind moves and pours rain; dampness prevails combining with Wind-Wood transformation, following the principle of overcoming and bearing); its disaster is flooding and bursting (torrential rain collapse); its flavor is Sweet; its emotion is Pensiveness (this is the generation and transformation of the Center).
Pensiveness injures the Spleen; Anger overcomes Pensiveness.
Dampness injures Flesh; Wind overcomes Dampness.
Sweet injures the Spleen; Sour overcomes Sweet (this addresses disease caused by excess Earth Qi of the Center, balanced by the Wood command of the East).

The West generates Dryness; Dryness generates Metal; Metal generates Pungent; Pungent generates Lung; Lung generates Skin and Hair; Skin and Hair generate Kidney (explaining the generative principle of the West).
In Heaven, it is Dryness; in Earth, it is Metal; in the Body, it is Skin and Hair; in Qi, it is completion (Metal is white and firm/completed).
In the Zang organs, it corresponds to the Lung; its nature is cool; its virtue is clear; its function is consolidation; its color is white; its transformation is gathering/inward movement (things gather); its associated insects are shelled insects (hard shells); its administration is strength/firmness (Metal body is firm); its command is fog and dew; its alteration is solemn killing; its disaster is withering and falling (color fades and falls due to excessive solemn killing command); its flavor is Pungent; its emotion is Sorrow (this is the generation and transformation of the West).
Sorrow injures the Lung; Joy overcomes Sorrow.
Dryness injures Skin and Hair; Heat overcomes Dryness (Old text: Heat injures skin/hair, Cold overcomes Heat; Wu Kun's note changes to Heat overcomes Dryness).
Pungent injures Skin and Hair; Bitter overcomes Pungent (this addresses disease caused by excess Metal Qi of the West, balanced by the Fire command of the South).

The North generates Cold; Cold generates Water; Water generates Salty; Salty generates Kidney; Kidney generates Marrow; Marrow generates Liver (explaining the generative principle of the North).
In Heaven, it is Cold; in Earth, it is Water; in the Body, it is Bones; in Qi, it is hardness.
In the Zang organs, it corresponds to the Kidney; its nature is chilling (trembling); its virtue is cold; its function is storing/hiding (old text lacks "storing").
Its color is black; its transformation is solemnity; its associated insects are scaled insects; its administration is stillness; its command is sleet and snow (old text lacks two characters; Wu Kun adds "sleet, snow"; alternatively interpreted as closure).
Its alteration is freezing and biting cold (cold congeals and is severe); its disaster is hail; its flavor is Salty; its emotion is Fear (this is the generation and transformation of the North).
Fear injures the Kidney; Pensiveness overcomes Fear.
Cold injures Blood; Dryness overcomes Cold.
Salty injures Blood; Sweet overcomes Salty (this addresses disease caused by excess Water Qi of the North, balanced by the Earth command of the Center).

The Five Qi stand in turn, each having its precedence (Qi corresponding to the season).
If not in its proper position, it becomes Evil (e.g., Wood occupying Fire's position, Metal occupying Wood's position).
If in its proper position, it is Correct (original position).
If Qi are compatible, the effect is mild (Son occupies Mother's position, Mother occupies Son's position).
If Qi are incompatible, the effect is severe (those who overcome oneself and those whom one overcomes).
If Qi is in excess, it controls what it normally overcomes and insults what it cannot overcome (e.g., Wood overcomes Earth but also insults Metal).
If Qi is deficient, what normally overcomes it insults and exploits it, and what it normally overcomes lightly insults it (e.g., Metal normally overcomes Wood, but Earth insults Wood when Metal is weak).
Insulting others leads to suffering from Evil (starting by insulting others to seek victory, ultimately one suffers from Evil oneself).
Being insulted and suffering from Evil occurs due to a lack of fear/reverence (Fear here refers to restraint. The Qi of the Five Elements must have something they fear/revere to maintain their position, which aligns with the concept of control and subjugation in the "Great Treatise on the Six Micro-Axes").