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(Shu and Shu points are often used interchangeably in ancient texts.)

In spring, needle the collaterals, various Ying-Spring points, and between the muscles of the main meridians. For severe conditions, needle deeply; for mild conditions, needle superficially. (This is because the Shaoyang Qi governs in spring. The Yang Qi is about to rise but has not yet risen, so the Qi is located in the middle [half-exterior/half-interior]. Therefore, needling depth can be deep or shallow. "Collaterals" refer to the great collaterals of the twelve meridians, such as Lieque (LU7); "various Ying-Spring points" refer to the Ying-Spring points of the meridians, such as Yuji (LU10).)

In summer, needle the various Sun-Luo (branch collaterals) on the skin and muscles above. (This is because the Lao-Yang [Extreme Yang] Qi governs in summer. Yang Qi is abundant externally, so it is appropriate to needle superficially at various Shu points, such as Taiyuan (LU9). Detailed discussions on Sun-Luo can be found in the subsequent chapter "Jing-Mai".)

In autumn, needle the various He-Sea points. (Such as Chize (LU5).) Follow the method of spring otherwise. (This is because the Shaoyin Qi governs in autumn. The Qi is about to descend but has not yet descended, so the Qi is located in the middle. Therefore, it is also appropriate to needle at a medium depth between the muscles of the main meridians, either shallow or deep.)

In winter, needle the Jing-Well points and the areas of the Shu points. Needle deeply and retain the needle for a long time. (This is because the Lao-Yin [Extreme Yin] Qi governs in winter. Yang Qi is hidden and stored internally. Various Jing-Well points, such as Shangyang (LI1), and "various Shu points" refer to the Back-Shu points of the Zang-Fu organs, such as Feishu (BL13). Their Qi is deep and all correspond to Winter Qi. Hence, it is said to needle deeply and retain.)

These are the sequence of the four seasons, the location of the Qi, where the pathogenic factors reside, and what is suitable for the Zang organs. (This section discusses the depth of the meridians and assigns various Shu points to the four seasons. Its meaning should be understood by cross-referencing with the *Suwen: Treatise on Four Seasons Needling Reversals and Conformities*.)

Tight pulses indicate much cold. (Tight pulses are mostly due to wind-cold, and the Qi transformation relates to the Liver.) Lax pulses indicate much heat. (Lax pulses indicate dampness obstruction, and the Qi transformation relates to the Spleen and Stomach.) Large pulses indicate excess Qi and deficient Blood. (A large pulse indicates excess Yang Qi, excess Qi, and deficient Blood, and the Qi transformation relates to the Heart.) Small pulses indicate deficiency of both Qi and Blood. (Small pulses are close to minute and fine. In the Yang aspect, it is Yang deficiency; in the Yin aspect, it is Yin weakness. The pulse body belongs to Yin, and the Qi transformation relates to the Kidney.) Slippery pulses indicate abundance of Yang Qi with slight heat. (Slippery pulses belong to Yang, and the Qi transformation relates to the Stomach.) Choppy pulses indicate much blood deficiency and Qi stagnation with slight cold. (Choppy pulses indicate Qi stagnation and blood deficiency. When both Qi and Blood are deficient, Yang Qi is insufficient, hence slight cold. Zhang Zhongjing said, "Choppy means Ying Qi is insufficient, which is also called blood deficiency." But here it says "much blood," which must be an error. Looking at the following text regarding needling choppy pulses: "do not let blood come out, because blood is already scarce," this confirms it. Choppy pulses are near the hair level, so the Qi transformation relates to the Lung.)

Therefore, when needling tight pulses, insert deeply and retain for a long time. When needling lax pulses, insert superficially and withdraw quickly to dispel heat. When needling large pulses, slightly drain the Qi without releasing blood. When needling slippery pulses, insert quickly and superficially to drain Yang Qi and remove heat. When needling choppy pulses, one must accurately hit the vessel, follow the direction of flow (with or against), and retain for a long time. First, press and massage along the meridian. After withdrawing the needle, press the acupoint quickly to prevent bleeding and harmonize the meridian. For all small pulses, where Yin-Yang, Form, and Qi are all deficient, do not use needles; instead, regulate with sweet medicines.

Ying-Spring and Shu points treat diseases of the exterior meridians; He-Sea points treat diseases of the interior Fu organs. (The Qi and vessels of Ying-Spring and Shu points are superficial and can treat exterior meridian diseases. The Qi and vessels of He-Sea points penetrate deeply and can treat interior Fu organ diseases.)

The He-Sea point of the Stomach is Zusanli. (Foot-Yangming Stomach Meridian. Zusanli is the He-Sea point.) The lower He-Sea point of the Large Intestine is Shangliu (ST36). (Hand-Yangming Large Intestine Meridian. Its own He-Sea point is Quchi (LI11), but its lower He-Sea point is Shangliu on the Foot-Yangming Stomach Meridian.) The lower He-Sea point of the Small Intestine is Xiabai (ST37). (Hand-Taiyang Small Intestine Meridian. Its own He-Sea point is Xiaohai (SI8), but its lower He-Sea point is Xiabai on the Foot-Yangming Stomach Meridian.) The lower He-Sea point of the Sanjiao enters Weiyang (BL39). (Hand-Shaoyang Sanjiao Meridian. Its own He-Sea point is Tianjing (SJ10), but its lower He-Sea point is Weiyang on the Foot-Taiyang Bladder Meridian.) The lower He-Sea point of the Bladder enters Weizhong (BL40). (Foot-Taiyang Bladder Meridian. Weizhong is the He-Sea point.) The He-Sea point of the Gallbladder is Yanglingquan (GB34). (Foot-Shaoyang Gallbladder Meridian. Yanglingquan is the He-Sea point.)

Heat in the face indicates disease of the Foot-Yangming Meridian. (Its meridian runs over the face.) Blood in the collaterals of the fish margin (thenar eminence) indicates disease of the Hand-Yangming Meridian. (Its meridian runs on the surface of the hand fish margin.) Vertical depression of the pulses on both dorsum pedis indicates disease of the Stomach meridian. (This refers to the Stomach meridian, combined with the following content on the Hand-Yangming meridian.)

Disease of the Large Intestine involves cutting pain in the intestines with gurgling sounds. If exposed to cold again in winter, diarrhea occurs, pain is around the umbilicus, and the patient cannot stand for long. This shares symptoms with Stomach disease; treat by taking Shangliu (ST36). (Large Intestine is paired with Stomach, so take the acupoint of the Foot-Yangming Stomach Meridian.)

Disease of the Stomach involves abdominal distension, pain in the epigastrium centered at the heart, radiating upward to support both hypochondriac regions, blockage in the diaphragm and pharynx, and inability to eat or drink. Treat by taking Zusanli (ST36).

Disease of the Small Intestine involves pain in the lower abdomen, pain radiating from the lumbar spine to the testicles, frequent urgency to defecate. Heat in front of the ears, or severe cold, or excessive heat only in the shoulder, or heat between the little finger and ring finger of the hand, or depressed pulses are all signs. (If the pulse is depressed, it is a sign.) This is disease of the Hand-Taiyang Small Intestine Meridian; treat by taking Xiabai (ST37).

Disease of the Sanjiao involves abdominal fullness, especially hardness in the lower abdomen, inability to urinate, urgency. Overflow leads to water retention causing distension. Signs appear in the great collateral outside the Foot-Taiyang meridian. The great collateral is between the Taiyang and Shaoyang meridians and may also be seen in the pulse. Treat by taking Weiyang (BL39).

Disease of the Bladder involves unilateral swelling and pain in the lower abdomen. Pressing with the hand creates the urge to urinate but results in none. Heat in the shoulder, or depressed pulses. (For acupoints like Dazhu, if the pulse is depressed...) Heat in the lateral side of the little toe of the foot, and behind the ankle of the leg, or depressed pulses. (Meaning as above.) Treat by taking Weizhong (BL40).

Disease of the Gallbladder involves frequent sighing, bitter taste, vomiting of old bile, palpitations in the chest, fear that people will capture them, sound in the throat, frequent spitting. The disease is at the root and extremity of the Foot-Shaoyang meridian. Also observe if there are depressed pulses; if so, apply moxibustion. For cases with alternating chills and fever, take Yanglingquan (GB34).

When needling these points, one must accurately hit the Qi Acupoint. (Where the meridian Qi arrives.) Do not hit the flesh joints. Hitting the Qi Acupoint allows the needle sensation to travel freely through the channels. (A "lane" implies connected pathways.) Hitting the flesh joint causes skin pain. If tonification and sedation are reversed, the disease worsens. Hitting the tendon causes flaccidity. Pathogenic factors will not exit; they contend with the healthy Qi, become chaotic and remain, and then attach internally. Unprudent needling, treating compliance as rebellion, leads to error.