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Hemiplegia (Pian Gu) manifests as paralysis and pain on one side of the body. The patient's speech remains unchanged, and their mind is not confused, indicating that the disease is located between the muscles and interstices (fen cou). Treatment should employ a large needle to tonify deficiency and reduce excess, thereby restoring health.

Fei disease (Wind Fei) is characterized by the absence of body pain but with flaccidity and inability to control the four limbs. (Note: Fei also belongs to wind pathogens, meaning "uselessness". The previous section described hemiplegia with pain; this section describes lack of pain sensation with limb flaccidity, which distinguishes Pian Gu from Fei. ○ Fei is pronounced like "fei" or "fei".) If mental confusion is slight and speech is partially intelligible, it is treatable. (Because the spirit qi has not completely departed.) If severe enough to cause aphasia, it is untreatable. (Because the spirit qi is lost, rendering treatment ineffective.)

If a disease originates in the Yang aspect first and then enters the Yin aspect, treatment should first target the Yang meridians and subsequently the Yin meridians, using superficial needling. (One should needle the exterior. If the disease originates in the Yin and directly affects the zang organs, it is mostly untreatable, so it is not discussed further.)

Wind Jing (spasticity), manifesting as opisthotonos (body bent backward). This indicates a wind syndrome affecting the Bladder Meridian. First, needle Jinggu (BL64) and Weizhong (BL40) of the Foot-Taiyang Meridian, along with blood vessels for bleeding. (Also needle superficial collaterals to release blood.) For Cold invasion, needle Zusanli (ST36). (If there is cold in the middle jiao, needle Zusanli of the Foot-Yangming Meridian to warm and tonify stomach qi, eliminating wind-cold. ○ This section originally appeared later.)

In Heat Disease after three days, if the Qi Kou pulse is calm while the Ren Ying pulse is restless, (indicating the disease is in the Three Yang meridians), apply the Fifty-Nine Acupoints for needling from all Yang meridians to drain heat and induce sweating, while filling the Yin to tonify deficiency. (This drains the excess of Yang pathogens and tonifies the deficiency of the Three Yin meridians. The method of the Fifty-Nine Acupoints is detailed below.) If body heat is severe but both Yin and Yang pulses are calm, do not needle. For cases suitable for needling, act urgently; if sweating does not occur, use purgation. The instruction "do not needle" refers to signs of death. (Yang symptoms with Yin pulses are unsuitable for needling. If judged treatable, urgent needling is required; even without sweating, pathogens will be drained. Here, "do not needle" implies contradictory pulse and symptoms indicating death. The same applies to subsequent sections.)

In Heat Disease after seven or eight days, if the Pulse Kou is rapid and wiry, needle urgently to induce spontaneous sweating, superficially needling the space between the thumb and index finger (Shaoshang, LU11). (Note: Some versions read "short" instead of "wiry".) In Heat Disease after seven or eight days, if the pulse is minute and small, (indicating deficiency of righteous qi), and the patient has hematuria and dry mouth, (indicating Yin injury), they will die within one and a half days. If a Dai pulse (intermittent pulse) appears, they will die within one day. (Commentary from Wu on *Mai Yao Jing Wei Lun*: A pulse stopping every five beats or every seven beats is called Dai.)

In Heat Disease, if sweat has been produced but the pulse remains restless, accompanied by panting and recurrent fever, do not needle the skin. (Needling would severely damage qi.) Severe panting leads to death. In Heat Disease after seven or eight days, if the pulse is no longer restless, or if restless but not scattered or rapid, sweat may appear after three days. If no sweat occurs after three days, death ensues on the fourth day. For those who have never sweated, do not needle the cuticle. (A restless pulse indicates impending sweating. By the seventh or eighth day of Heat Disease, if the pulse is not restless, or lacks strength/scattering/rapidity, it signifies deficiency of righteous qi unable to drive pathogens out. Thus, wait three more days hoping for sweat. If still no sweat after three days, exceeding four days means Yin and Yang fail to correspond, leading to death. In such cases, since sweating is absent, qi must be deficient; therefore, avoid needling the cuticle.)

If Heat Disease begins with skin pain, nasal obstruction, and facial flushing, needle the skin layer using the first type of needle (Chan needle) at the Fifty-Nine Acupoints. (Pathogen is in the skin and interstices, involving the Lung Meridian. Use the Chan needle to needle the skin regions of the Fifty-Nine Acupoints.) For stubborn rashes on the nose, seek treatment in the Lung (skin). If ineffective, seek treatment in the Heart Fire. (Rashes on the nose belong to the Lung. Seeking the skin seeks the Lung. If due to pathogenic fire destroying Metal, treating the Lung fails, so drain Heart Fire to clear heat.)

If Heat Disease begins with a sensation of stiffness, weakness leaning on support, fever, irritability, and dry lips/throat, needle the vessels using the first type of needle (Chan needle) at the Fifty-Nine Acupoints. If skin distension, dry mouth, and cold sweat occur, seek treatment in the Heart (vessels). If ineffective, seek treatment in Kidney Water. (Stiffness indicates dryness; weakness indicates inability to stand. Fever, irritability, and dry lips/throat indicate pathogen in blood vessels, involving the Heart Meridian. Use the Chan needle to needle the vessel divisions of the Fifty-Nine Acupoints. Skin distension, dry mouth, and sweating are vessel diseases. Seeking vessels seeks the Heart. If ineffective, seek Water, as Water controls Fire, cooling the Heart.)

If Heat Disease involves dry throat, polydipsia, frequent fright, and inability to rise from bed, needle the flesh using the sixth type of needle (Yuanli needle) at the Fifty-Nine Acupoints. If the eyes appear blue/green, seek treatment in the Spleen (flesh). If ineffective, seek treatment in Liver Wood. (Pathogen in flesh involves the Spleen Meridian. Use the Yuanli needle to needle the flesh divisions of the Fifty-Nine Acupoints. Blue/green eyes indicate Wood overacting on Earth, also a Spleen issue. Seeking flesh seeks the Spleen. If ineffective, tonify Liver Wood, as Wood controls Earth, calming Spleen heat.)

If Heat Disease presents with a blue face (Liver color), headache (Jueyin Liver Meridian meets Du Mai at the vertex), and restlessness of hands/feet (Wood disease in extremities), needle between the tendons using the fourth type of needle (Feng needle) for Si Ni conditions. If legs cannot walk and tears flow uncontrollably, seek treatment in the Liver (tendons). If ineffective, seek treatment in Lung Metal. (These are Liver diseases, associated with tendons. Seeking tendons seeks the Liver. If ineffective, tonify Lung Metal, as Metal controls Wood, calming Liver heat.)

If Heat Disease involves frequent惊悸 (palpitations/fright), convulsions, and mania, needle the vessels using the fourth type of needle (Feng needle) to urgently drain excess. If Epilepsy occurs with hair loss, seek treatment in the Heart (blood). If ineffective, seek treatment in Kidney Water. (These are Heart Meridian diseases. Extreme Yang and Yin deficiency causing Epilepsy and hair loss. Heart governs blood vessels; seeking blood seeks the Heart. If ineffective, tonify Kidney Water to control Fire, restoring True Yin.)

If Heat Disease involves heavy body, bone pain, deafness, and desire to keep eyes closed, needle the bones using the fourth type of needle (Feng needle) at the Fifty-Nine Acupoints. If bone disease causes anorexia, teeth grinding, and blue ears, seek treatment in the Kidney (bones). If ineffective, seek treatment in Spleen Earth. (Kidney Meridian disease. Anorexia indicates excessive Yin evil. Teeth grinding and blue ears are Kidney signs. Kidney belongs to Water, associated with bones. Seeking bones seeks the Kidney. If ineffective, tonify Spleen Earth, as Earth controls Water, calming Kidney pathogens.)

If Heat Disease involves unknown pain location, deafness, inability to self-control, dry mouth, extreme Yang heat, and significant Yin cold (excess Yin), Heat entering the Marrow leads to death and is untreatable.

If Heat Disease involves headache, temporal pain, eye twitching/pain (Shao Yang meridian connects to eyes, causing pulling pain), and frequent epistaxis, this is Jue Re Bing (Heat reversing upward). Use the third type of needle (Di needle) based on excess or deficiency patterns.

If Heat Disease involves heavy body and intestinal heat, use the fourth type of needle at Shu points (Taibai SP3, Xianggu ST41) and between toes. (Also Shugu BL65, Linqi GB41, see below.) Seek Qi in the Stomach Collateral (Fenglong ST40) to obtain De Qi.

If Heat Disease involves urgent pain around the navel (Kidney Meridian pathway) and chest/hypochondriac fullness (Spleen Meridian pathway), needle Yongquan (KI1) and Yinlingquan (SP9) using the fourth type of needle. Needle Lianquan (CV23) inside the throat. (Shaoyin and Taiyin meridians connect to the throat.)

If Heat Disease involves impending sweat and favorable pulses, inducing sweat is appropriate. Needle Yuji (LU10), Taiyuan (LU9), Dadu (SP2), Taibai (SP3). Reducing these clears heat; tonifying them induces sweat. If sweat is excessive, needle the transverse vessel above the medial malleolus (Sanyinjiao SP6) to stop it. (*Han Re Bing* chapter notes Arm Taiyin can induce sweat; refer to that section.)

If Heat Disease has produced sweat but the pulse remains rapid and strong, this is the extreme of Yin pulses, leading to death. If sweat occurs and the pulse calms, survival is indicated. If Heat Disease patients have strong, restless pulses but cannot sweat, this is the extreme of Yang pulses, leading to death. If pulses are strong/restless but calm after sweating, survival is indicated.

There are nine types of Heat Disease unsuitable for needling:
1. No sweat, red cheeks, and hiccups indicate death. (Lack of sweat and facial flushing indicate Yin deficiency. Pathogen attacks Yangming, severe stomach deficiency.)
2. Diarrhea with severe abdominal fullness indicates death. (Spleen failure.)
3. Unclear vision with persistent heat indicates death. (Unclear vision indicates exhaustion of organ essence; persistent heat indicates exhaustion of Yin in interior/exterior.)
4. Elderly or infants with Heat Disease and abdominal fullness indicate death. (Pathogen damages Spleen.)
5. No sweat, vomiting blood, or bloody stool indicate death. (Excess pathogen damaging Yin.)
6. Ulcerated tongue root with persistent heat indicates death. (Heart, Liver, Spleen, Kidney meridians connect to the tongue root. Ulceration plus persistent heat indicates damage to all Three Yin.)
7. Cough with epistaxis, no sweat, or sweat not reaching the feet indicate death. (Collapse of True Yin.)
8. Marrow heat indicates death. (Pathogen penetrates deepest, causing Marrow heat and Kidney Qi exhaustion.)
9. Heat with spasm indicates death. (Extreme heat generates wind.) Opisthotonos, convulsions, trismus (closed jaw), and teeth grinding are spasms.

The "Fifty-Nine Acupoints" include:
- Twelve points on the inner and outer sides of both hands (Six Jing-Well points).
- Eight points between the fingers of both hands. Feet follow similarly. (Specifically: Hand Shaoyang Houxi SI3, Shaoyang Zhongzhu TE3, Yangming Sanjian LI3, Shaoyin Shaofu HT8; Left/Right total 8. Foot Shaoyang Shugu BL65, Shaoyang Linqi GB41, Yangming Xianggu ST41, Taiyin Taibai SP3; Left/Right total 8.)
- Six points on the head, one cun into the hairline, three fen lateral to midline (Wuchu EX-HN4, Chengguang BL3, Tongtian BL3).
- Ten points three cun into the hairline, five fen lateral (Linqi GB41, Mucuang GB15, Zhengying GB17, Chengling BL9, Naokong GB13; Left/Right total 10).
- One point each in front of ear, behind ear, and below mouth (Tinghui GB2, Wanggu BL1, Chengjiang CV24; Total 5).
- One point in the neck (Yamen GV15). Total 6 including top of head.
- One point on the vertex (Baihui GV20).
- One point at Xinhui GV22, one at hairline (Shenting GV24, Fengfu GV16; Total 2).
- One point Lianquan (CV23), two Fengchi (GB20), two Tianzhu (BL10).
(Note: The 59 points in this chapter overlap with only 18 points in *Su Wen: Shui Re Xue Lun*. This chapter focuses on limbs (root of draining heat), while *Shui Re Xue Lun* focuses on pathogen location (branch of draining heat). Combine meanings and apply appropriately.)

For Qi fullness in chest with panting, needle Yinbai (SP1) at the tip of the great toe. Retain needle for Cold, quick withdraw for Heat. Stop when Qi descends.
For acute Heart疝 (Cold contraction) pain, needle Guanchong (TE1).
For pain too severe to lift the head, needle Zhaohai (KI6, Yin Qiao Mai).
For red painful eyes starting from the inner canthus, needle Yin Qiao Mai (Zhaohai KI6).
For strangury (Long), needle Yin Qiao Mai (Zhaohai KI6) and Dachun (LR1) on the pubic hair area. Also bleed blood vessels. (Kidney/Bladder are exterior-interior; Liver meridian runs through lower abdomen. Bleed collaterals if present.)
For men resembling Gu disease (abdominal distension/toxic swelling) and women resembling fetal disease (or abscess), with body/waist/spine feeling loose/uncontrolled and anorexia, first needle Yongquan (KI1) until blood appears. Observe dorsal foot vessels; bleed all prominent ones. (Gu resembles toxic swelling. Body/spine loose indicates fatigue/disarray. Dorsal foot relates to Yangming. Bleed all full vessels.)