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When Qi circulates in the meridians, pathogenic factors tend to affect the upper part of the body. (Wind-cold pathogens invade the human body, affecting high and upper regions.) Turbid Qi stagnates in the middle. (The *Xiao Zhen Jie* [Explanation of the Small Needle] states: Food and drink enter the Stomach; their essence ascends to the Lung, while only the dregs remain in the intestines and stomach. If there is improper regulation of cold and heat, or irregular diet, disease arises between the intestines and stomach; this is what is meant by turbid Qi remaining in the middle.) Clear Qi (here referring to damp-turbid Yin pathogens) sinks to the lower part. (This refers to cold and damp earthy pathogens invading the body, necessarily starting from the lower part, beginning at the feet.) Therefore, needling the sunken vessels expels pathogenic factors from above. (Most acupoints of the twelve meridians are located in depressions; thus, needling the sunken vessels of each meridian promotes the flow of meridian Qi and expels pathogenic factors, which is the method for treating Yang pathogens located in the upper part.) Needling the middle vessels expels turbid Qi from the middle. (The *Xiao Zhen Jie* states: Treating the Yangming Meridian is sufficient. Needling the Zusanli [ST-32] acupoint can clear stagnation in the intestines and stomach. ○ The explanation for "Clear Qi in the lower part" is missing below, possibly due to loss of text.) If needled too deeply, pathogenic factors sink back into the interior, and the illness worsens. (This means that if a superficial disease is treated with deep needling, pathogenic factors follow the needle inward and sink deeper, causing the illness to become more severe.) Thus it is said that skin, flesh, sinews, and vessels each have their appropriate locations, and diseases each have their appropriate treatments. (Meridian and collateral diseases each have their specific locations.) The nine needles differ in shape, so their application should be chosen according to what is appropriate. (This means that because the nine needles have different shapes, their usage also has specific appropriateness.) Do not tonify excess, and do not drain deficiency. (i.e., do not reinforce excess and do not deplete deficiency.) Damaging what is insufficient and augmenting what is excessive leads to severe illness, making the condition even worse. (Treating in reverse merely aggravates the disease.) Draining the five pulses causes death. (The five pulses correspond to the five Zang organs. If one does not discern excess and deficiency and drains all of them, the person becomes emaciated and weak.) Depriving Yin Qi causes death. (The *Ben Shu* chapter states: The pulse at the Chi position moves at the Wuli [LI-24] acupoint; this is why Wuli is contraindicated. It means repeatedly draining the Wuli acupoint near the Chi position deprives the body of Yin Qi, leading to the exhaustion of Yin Qi in all five Zang organs. Hence, depriving Yin Qi causes death.) Depriving Yang Qi causes mania. (As mentioned above regarding taking Qi from the three Yang meridians.) The harms of needling are now concluded.

If upon needling the Qi has not arrived, do not limit the number of manipulations. (One must wait until the Qi arrives as the standard.) Once the Qi has arrived, remove the needle and do not needle again. (Once the Qi has arrived, no further needling is necessary, as the treatment has taken effect.) The essence of needling lies in the arrival of Qi for efficacy; the sign of efficacy is like wind blowing away clouds, clearly revealing the blue sky. The principles of needling are now complete. (Needling relies on the arrival of Qi as the key and efficacy as the proof. Grasping the key yields efficacy, just as wind blows away clouds; when pathogenic factors are removed, healthy Qi appears, thus clearly revealing the blue sky.)

Each of the five Zang organs has five Shu points, totaling twenty-five Shu points. Each of the six Fu organs has six Shu points, totaling thirty-six Shu points. (Shu points refer to the major acupoints. The five Shu points of the Zang organs are the Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points of each meridian. The Fu organs have one additional Yuan-Source point, hence six points each.) There are twelve main meridians and fifteen collaterals, totaling twenty-seven Qi pathways circulating up and down. (There are five Zang and six Fu organs, plus the Hand-Jueyin Pericardium meridian, making twelve meridians. Each of the twelve meridians has a collateral; for example, the Luo-connecting vessel of the Hand-Taiyin Lung meridian is at Lieque [LU-7]. Additionally, the collateral of the Ren Mai is Pingyi, the collateral of the Du Mai is Changqiang [GV-1], and the great collateral of the Spleen is Dabao [SP-21], totaling fifteen collaterals. These twenty-seven Qi pathways connect the entire body up and down.) What emerges is the Jing-Well point; what flows is the Ying-Spring point. (Rapid flow is called Liu.) What pours is the Shu-Stream point. (Pouring implies irrigation.) What travels is the Jing-River point; what enters is the He-Sea point. The circulation of the twenty-seven Qi pathways all occurs within these five Shu points. (According to Zhang Jingyue's interpretation of Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea: Jing-Well is like water emerging from a well, its Qi deep, corresponding to Water in the North. Ying-Spring is small flowing water, with faint Qi, corresponding to Wood in the East. Shu-Stream means transport, where Qi is transported from here to there, its Qi flourishing, corresponding to Fire in the South. Jing-River means the Qi of the meridian flows largely, peaking here, corresponding to Earth in the late summer. He-Sea means Qi flows inward from here and merges with the Zang-Fu organs, corresponding to Metal in the West. This aligns with the principles in chapters such as *Ben Shu* and *Shui Re Xue*. Others, such as *Nan Jing* Chapter 65, state: Jing-Well governs Spring, He-Sea governs Winter. Mr. Xiang stated: Jing-Well resembles spring water, Ying-Spring resembles a pond, Shu-Stream resembles a pit, Jing-River resembles a stream, and He-Sea resembles the return of water. This does not fully align with the principles of *Ling Shu* and *Su Wen*.) Intersections of joints, numbering three hundred and sixty-five meetings. (These are where collaterals seep and irrigate various joints.) The term "joint" refers to the places where Shen-Qi (Spiritual Qi) travels and exits; it does not refer to skin, flesh, sinews, or bones. (A joint is where Spiritual Qi travels and exits; here, it refers to acupoints.)

Whenever using needles, one must first diagnose the pulse and observe the severity and ease of the Qi before proceeding with treatment. If the internal Qi of the five Zang organs is exhausted, but the practitioner instead tonifies the exterior, this is called double exhaustion (Chong Jie). Double exhaustion leads to death, and the deceased dies quietly. (Internal Zang Qi is exhausted, indicating Yin deficiency. Tonifying the exterior erroneously reinforces Yang. Reinforcing Yang further damages Yin, constituting double exhaustion. Exhaustion of Yin leads to death, characterized by quietness.) The practitioner, however, acts against the pathology, selecting the axilla and chest. (The axilla and chest are sites where Zang meridian Qi emerges. Taking these points when internal Qi is exhausted drives Qi outward, causing further depletion of Yin.) If the external Qi of the five Zang organs is exhausted, but the practitioner instead tonifies the interior, this is called inverted reversal (Ni Jue). Inverted reversal leads to death, and the deceased dies restlessly. (External Zang Qi is exhausted, indicating Yang deficiency. Tonifying the interior erroneously reinforces Yin. Reinforcing Yin further exhausts Yang, leading to cold limbs and reversal. Reversal leads to death, characterized by restlessness.) The practitioner, however, acts in reverse, selecting the four extremities. (The four extremities are the root of all Yang Qi. When external Qi is exhausted, taking the root allows Yin Qi to arrive and causes Yang Qi to sink further.)

The Four Passes (Si Guan) treat diseases of the five Zang organs. When the five Zang organs are diseased, one should select the Twelve Yuan-Source points. (The Four Passes refer to the two elbows and two knees, which are the major joints of the body. Therefore, all Jing-Well, Ying-Spring, Shu-Stream, Yuan-Source, Jing-River, and He-Sea points of the hands do not exceed the elbow, and those of the feet do not exceed the knee. The Twelve Yuan-Source points: This chapter states the Lung Yuan is Taiyuan [LU-9]; the Heart Yuan is the Shu-Stream of the Pericardium, Tailing [PC-7]; the Liver Yuan is Taichong [LR-3]; the Spleen Yuan is Taibai [SP-3]; the Kidney Yuan is Taixi [KI-3], two on each side. Together with the Yuan of the Gao [Gao Yuan] Jiugwei [CV-15] and the Yuan of the Huang [Huang Yuan] Bozhi [CV-17? Note: Text says 'Bo Ye' likely typo for Boren/Bozhong area or specifically Neck-Throat region, traditionally ST-9 or CV-22 depending on interpretation, but text says 'Neck Throat'], totaling twelve Yuan-Source points. The Qi of the Zang and Fu, interior and exterior, all connect here, allowing treatment of Zang organ diseases. Furthermore, consulting *Nan Jing* Chapter 66, there are also the Heart Yuan Shenmen [HT-7], Gallbladder Yuan Qiuxu [GB-40], Stomach Yuan Chongyang [ST-42], Sanjiao Yuan Yangchi [TE-4], Bladder Yuan Jinggu [BL-64], Large Intestine Yuan Hegu [LI-4], and Small Intestine Yuan Wanggu [SI-4]. Combined with the Yuan points of Lung, Pericardium, Liver, Spleen, and Kidney, there are twelve Yuan-Source points in total, excluding the Yuan of Gao and Huang.) For distension, select the three Yang meridians. (Stomach, Gallbladder, Bladder) For undigested food diarrhea (Sun Xie), select the three Yin meridians. (Spleen, Liver, Kidney)