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Diseases present with superficial or deep locations, and acupuncture needling involves shallow or deep insertion. The needle must reach the appropriate anatomical level without exceeding the proper depth. Exceeding the depth causes internal injury; falling short leads to external stagnation (Wai Yong). Stagnation allows pathogenic factors to invade. Improper depth becomes a major toxin, disturbing the Zang-organs internally and subsequently giving rise to severe diseases. Thus, it is said that pathogens may reside in the hair follicles and Couli (pores and interstitial spaces), in the skin, in the muscles, in the vessels, in the sinews, in the bones, or in the marrow. Therefore, when needling the hair follicles and Couli, do not injure the skin. If the skin is injured, the Lung (Fei) is disturbed internally. Disturbance of the Lung leads to Warm-Malaria (Wen Nue) in autumn, characterized by shivering and aversion to cold. When needling the skin, do not injure the flesh. If the flesh is injured, the Spleen (Pi) is disturbed internally. Disturbance of the Spleen leads to abdominal distension, vexation, and loss of appetite during the last eighteen days of each season (totaling seventy-two days). When needling the flesh, do not injure the vessels. If the vessels are injured, the Heart (Xin) is disturbed internally. Disturbance of the Heart leads to heart pain in summer. When needling the vessels, do not injure the sinews. If the sinews are injured, the Liver (Gan) is disturbed internally. Disturbance of the Liver leads to heat and flaccidity of the sinews in spring. When needling the sinews, do not injure the bones. If the bones are injured, the Kidney (Shen) is disturbed internally. Disturbance of the Kidney leads to abdominal distension and lower back pain in winter. When needling the bones, do not injure the marrow. Injury to the marrow results in emaciation, soreness, and a sense of bodily slackness and weakness that does not resolve. (The term "bu qu" refers to slackness and weakness, indicating deficiency of Yin. Yin deficiency leads to Qi deficiency; Qi deficiency prevents movement, hence it is called "not resolving." ○ "Jie" is pronounced like "Xie," meaning slackness. "Shuo" is pronounced like "Ji.")

(The term "Qi" implies that needling has specific appropriate depths.)

"To needle the bone without injuring the sinew" means the needle should reach the level of the sinew but not stop there if the target is the bone. (For conditions such as bone marrow soreness and pain, one should needle directly to the bone. If the needle stops at the level of the sinew without reaching the bone, or stops at the level of the muscle without reaching the sinew, this constitutes injury to the muscle.) "To needle the muscle without injuring the vessel" means the needle should reach the level of the vessel but not stop there if the target is the muscle. (For conditions such as generalized pain of the skin and flesh, needling the muscle is appropriate. If the needle stops at the level of the vessel without reaching the muscle, this constitutes injury to the vessel.) "To needle the vessel without injuring the skin" means the needle should reach the level of the skin but not stop there if the target is the vessel. (For conditions involving obstruction of blood vessels, needling the vessel is appropriate. If the needle stops at the level of the skin without reaching the vessel, this constitutes injury to the skin. ○ These four sections discuss the harm caused by failing to needle deeply enough.) "To needle the skin without injuring the muscle" means the disease is in the skin, so do not injure the muscle. (Do not needle too deeply into the muscle.) "To needle the muscle without injuring the sinew" means the disease is in the muscle, so do not pass through the muscle to injure the sinew. (If the disease is in the muscle, do not needle past the muscle to injure the sinew.) "To needle the sinew without injuring the bone" means the disease is in the sinew, so do not pass through the sinew to injure the bone. (If the disease is in the sinew, do not needle past the sinew to injure the bone. ○ These three sections discuss the harm caused by needling too deeply when unnecessary.) This is referred to as acting contrary to the principle.