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In spring, the heavenly qi begins to ascend, and the earthly qi begins to disperse. The frozen earth thaws, ice melts, water flows freely, and the meridians become unobstructed. Therefore, the human *zhengqi* (Upright Qi) resides in the *jingmai* (Meridians). In summer, the meridian qi is full and overflows into the *sunluo* (Sun Collaterals, fine collateral vessels). The sunluo receive blood, and the skin becomes firm and filled (at this time, human qi resides in the sunluo). In late summer, both the meridians and collaterals are abundant; the qi overflows inward into the muscles (at this time, human qi resides in the muscles). In autumn, the heavenly qi begins to contract, the *coulī* (Pores and interstices) close, and the skin becomes tight and contracted (at this time, human qi resides in the skin). In winter, things are covered and stored; blood and qi remain within, settling in the bone marrow and connecting with the five zang organs (at this time, human qi resides in the bone marrow).

Thus, pathogenic qi often follows the changes of the four seasons' blood and qi to invade and reside in the body. Regarding its transformations, there is no fixed measure. However, one must follow the meridian qi to dispel the pathogen. Once the pathogen is removed, chaotic qi will not arise.

If one punctures the collaterals in spring, blood and qi overflow outward, causing *shaoqi* (Deficiency of Qi/Shortness of breath) (This is because one mistakenly punctures the region governed by summer before the qi has arrived, resulting in shaoqi). If one punctures the muscles in spring, the blood and qi circulate in reverse, causing *shangqi* (Rebellious Qi/Uplifted Qi) (When Wood qi is excessive, Earth qi is deficient; puncturing the muscles constitutes a double deficiency. The blood and qi circulate reversely without nourishing each other, hence shangqi). If one punctures the sinews and bones in spring, the blood and qi settle internally, causing abdominal distension (Spring qi is expansive; deep puncture of sinews and bones damages Yin, causing blood and qi to settle internally and result in abdominal distension).

If one punctures the meridians in summer, the blood and qi become exhausted, causing *xiechuo* (Laziness and lethargy) (Since the qi is not in the meridians, mistaken puncture causes internal exhaustion of blood and qi, manifesting as physical fatigue and lethargy). If one punctures the muscles in summer, the blood and qi retreat inward, causing timidity/fear (Before late summer arrives, prematurely depleting the qi causes it to retreat and weaken, leading to fear). If one punctures the sinews and bones in summer, the blood and qi rebel upward, causing irritability/anger (Puncturing the region governed by winter in summer causes Yin deficiency internally and Yang excess externally, so blood and qi rebel, leading to anger).

If one punctures the meridians in autumn, the blood and qi rebel upward, causing forgetfulness (The Heart governs the vessels; mistaken puncture of the meridians weakens Heart Qi, leading to forgetfulness). If one punctures the collaterals in autumn, the defensive qi fails to protect the exterior, causing drowsiness and reluctance to move (The qi has already left the collaterals; further puncture causes Qi deficiency and inability to defend the exterior, hence drowsiness and reluctance to move). If one punctures the sinews and bones in autumn, the blood and qi scatter internally, causing chills and trembling (Puncturing before the qi reaches the sinews and bones causes internal scattering of blood and qi and deficiency of Middle Qi, leading to chills and trembling).

If one punctures the meridians in winter, both blood and qi are depleted, causing blurred vision (Depleting the qi before it arrives causes depletion of blood and qi, leading to poor vision). If one punctures the collaterals in winter, internal qi leaks outward, remaining as a major *bi* syndrome (Major Obstruction/Painful Obstruction) (When Yang qi is hidden, puncturing the Yang aspect causes Yang qi to leak outward and meridians to stagnate, generating major bi syndrome). If one punctures the muscles in winter, Yang qi is exhausted, causing forgetfulness (Puncturing the region governed by summer in winter exhausts Yang qi. Yang qi, when refined, nourishes the spirit; Yang deficiency leads to spirit decline, hence forgetfulness).

All these cases of mistiming punctures according to the seasons constitute major rebellious diseases and must be strictly avoided. Violating them generates chaotic qi that mutually invades and causes disease. One who does not understand the meridians of the four seasons and treats by following incorrect methods acts against nature. This causes internal disorder of upright qi, which contends with essence. ("Cong" means to follow/comply; "Bo" means contention/clashing between pathogenic and upright qi.) One must carefully examine the nine pulses (Nine Palpation Positions) to ensure upright qi remains orderly and essence does not undergo pathological transformation.