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(Pei Zi's Remarks on Medicine)
Acupuncture and moxibustion for various diseases have never been restricted by seasonal timing. However, worldly people are exclusively fixated on the months of "Fu" (dog days/summer heat), failing to consider that the depth of disease contraction varies from shallow to deep, and treatment urgency ranges from slow to rapid. How can one uniformly wait until the Fu months to perform acupuncture and moxibustion? Examining texts such as *Su Wen* (Basic Questions), *Ling Shu* (Spiritual Pivot), and *Yue Ling Jin Ji* (Monthly Prohibitions), there is no assertion that acupuncture and moxibustion should only begin during the Fu months. It is unclear on what basis worldly people claim this. Yet, within a year, the period most strictly forbidden for violation is around the Winter Solstice. At this time, Yin is at its peak and Yang is beginning to regenerate; Yin is abundant while Yang is微弱 (weak). A gentleman should, during this period, remain deeply concealed and meticulous, protecting the微弱 Yang, rather than allowing it to leak out. The *I Ching* states that the former kings closed the gates on the solstice, merchants did not travel, and rulers did not inspect their domains. *Su Wen* states that hibernating insects are sealed tight, gentlemen stay indoors, avoid cold and seek warmth, and do not allow the skin pores to open. All these principles align with this meaning. During this time, one must also consult acupuncture prohibitions, such as Taiyi Renshen (Taiyi Human Spirit), Zhou Shen Xueji (Whole Body Blood Taboo), Nián Shen (Annual Buttock Spirit), Zhu Ri Renshen (Daily Human Spirit), where men taboo the "Chu" day and women taboo the "Po" day, men taboo Xu days, and women taboo Si days. If physicians fail to know and avoid these taboos, they may cause Qi deficiency and Spirit injury, making the disease difficult to cure; this is indeed the principle. However, in acute conditions such as sudden collapse, Phlegm Jue (syncope due to phlegm), lip carbuncles, or throat bi (obstruction), acupuncture and moxibustion should be used immediately. If one hesitates due to taboo deities, it may lead to untreatable situations. Xue Lizhai treated a carbuncle patient on the Full Moon day (15th of the lunar month) with acupuncture, and the condition healed. Generally speaking, even if it is a taboo day for Niushen, in acute cases, one must not hesitate.

[Image: Nine Palaces Niushen Chart]
This Niushen prohibition starts from Kun position in the first year, moves to Zhen position in the second year, flying sequentially through the Nine Palaces annually in a cycle. Wherever the annual star travels, that direction is prone to damage and ruin; acupuncture is strictly contraindicated. Accidental violation may cause other diseases to arise.

(*Zhen Jiu Da Cheng*)
Question: Acupuncture seems to be purely draining (Xie) without tonifying (Bu). The ancients used it to guide Qi and treat diseases of excess. Now, few people use it. Is it because they know it lacks tonification and thus avoid it? Or because their Yuan Qi (Original Qi) constitution is thin? Or because excessive depletion makes acupuncture ineffective? Or because they are unskilled in its use? The Classics state: For insufficiency of Yang Qi, warm it with Qi; for insufficiency of Essence, tonify it with Flavor. Needles are made from Bian stones; they possess neither Qi nor Flavor. They pierce skin and flesh, opening apertures on the body, causing Qi to exit through these apertures. How can this be considered tonification? The Classics further state: When Qi, Blood, Yin, and Yang are all insufficient, do not use needles; harmonize with sweet medicines. It also says: When Form-Qi and Disease-Qi are both insufficient, this indicates an insufficiency of both Yin and Yang; do not needle. Needling will severely exhaust Qi; the elderly will perish, and the robust will fail to recover. Such statements imply that acupuncture has draining effects but no tonifying effects.

Question: Diseases exist in the Qi level and the Blood level. Do acupuncturists distinguish between Qi and Blood? Answer: Acupuncturists must understand diseases of the Qi and Blood levels. Diseases in the Qi level are migratory and unstable; diseases in the Blood level are fixed and immovable. Taking accumulations (Ji Kuai) as an example: masses in the abdomen that move up or down, appearing or disappearing, belong to the Qi level. Masses located in the hypochondrium, below the heart, or above/below/left/right of the umbilicus that are fixed and grow gradually belong to the Blood level. Regarding wind diseases: symptoms moving from left hand to right hand, or right foot to left foot, changing frequently, belong to the Qi level. Symptoms fixed in the left foot or right hand, adherent and stationary, belong to the Blood level. This applies to all diseases. One must know that for Qi-level diseases, take points below for upper ailments, above for lower ailments, right for left, and left for right. For Blood-level diseases, select points corresponding to the location of the blood and the disease. If one drains Qi when treating Blood disease, or drains Blood when treating Qi disease, this is punishing the innocent; who bears the blame?

Question: What about diseases of the skin, flesh, sinews, bones, and vessels? Answer: The origin of all diseases begins with Ying (Nutritive) and Wei (Defensive) Qi, then spreads to the skin, flesh, sinews, and vessels. Thus, the Classics state that "Shi Dong" (Is Moving) diseases pertain to Qi, and "Suo Sheng" (So Produces) diseases pertain to Blood. "Shi Dong" occurs first, followed by "Suo Sheng." By inference, diseases of the skin, flesh, vessels, and sinews are later manifestations. The needling method focuses on the reversal and smooth flow of Ying and Wei Qi, thereby encompassing the treatment of skin, bone, flesh, and sinews.

Question: What is the principle of respiration? Answer: This is a method to harmonize Yin and Yang. The Classics state: Exhalation follows Yang going out; inhalation follows Yin entering. Although respiration divides Yin and Yang, it is actually based on one Qi as the substance. Generally, exhalation expels Qi, and inhalation admits Qi. To tonify: insert the needle upon exhalation, withdraw upon inhalation. To drain: insert the needle upon inhalation, withdraw upon exhalation. Exhalation should not exceed three breaths, following the Yang of the San Jiao externally; inhalation should not exceed five breaths, welcoming the Yin of the Five Zang internally. Exhaling first then inhaling constitutes Yin within Yang; inhaling first then exhaling constitutes Yang within Yin. These methods are applied according to the Yin-Yang, Cold-Heat nature of the pathogenic Qi.

Question: How many cun deep should the needle be inserted, and how many breaths should it be retained? Answer: One should not be so rigidly bound. Muscles vary in depth, and disease resolution varies in speed. In thick muscle areas, deep insertion is appropriate; in thin areas, shallow insertion is suitable. If the disease resolves quickly, remove the needle promptly; if the disease lingers, retain the needle longer.

Question: Tonification and drainage are often not performed at Jing-Well, Ying-Spring, Shu-Stream, Jing-River, or He-Sea points. How is this handled? Answer: For example, Jingming and Tongziliao treat eye pain; Tinggong, Sizhukong, and Tinghui treat deafness; Yingxiang treats nasal diseases; Dicang treats facial deviation; Fengchi and Touwei treat head and neck disorders. The ancients also did not restrict themselves to Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points. This is because the disease is located superiorly, so points are selected accordingly.

Question: Regarding the flow and transmission of acupoints, if a disease affects specific meridians, can timed tonification and drainage cure it? Answer: When a disease attaches to a meridian, that meridian itself exhibits deficiency or excess. Tonifying deficiency and draining excess can lead to self-healing. Li Dongguan had patients cured in one dose, and others in dozens of doses. Modern practitioners, if one needle fails, stop needling. Moreover, diseases do not arise from just one meridian or collateral; their onset necessarily involves combined influences of the Six Qi and differences in root (Ben) and branch (Biao). One needle might cure the branch while the root remains, or targeting only the root might cause the branch to recur. Multiple sessions are required to completely eradicate the disease.

Question: In the *Nei Jing*, treatments relied more on acupuncture and less on decoctions. Why? Answer: In ancient times, labor did not lead to exhaustion, and rest did not lead to lethargy. Diet was not rich or fatty to damage the interior; clothing was not insulating to harm the exterior. Daily routines were regulated, cold and heat were avoided appropriately, the mind was tranquil and empty, and Spirit was preserved internally. How could disease arise? Even if exposed to treacherous winds and false pathogens, they could not penetrate deeply, merely causing stagnation and depression of Qi in the skin and meridians. Using needles to circulate Qi and moxa to disperse depression would resolve the disease immediately, why wait for decoctions? Today, morality declines; wine is consumed like water, irregularity is treated as normal, desires are indulged to exhaust essence, and worries scatter true Qi. People do not maintain fullness or control their Spirit, seeking only pleasure, being overly leisurely, lacking routine, and ignoring climate changes. Thus, diseases arise internally, and external pathogens easily invade. The Classics state: Acupuncture treats the exterior; decoctions treat the interior. Since the disease is internal, only decoctions can remedy it. After Bian Que and Qin Yueren, herbal medicine became prevalent while acupuncture was used concurrently. This is partly because the world is not like antiquity, and times have changed, but also because acupuncture techniques were not refined and transmission was improper. It is not that ancients used more acupuncture and moderns less, nor that decoctions suit modern times better than ancient times.

One should not rigidly adhere to the saying that acupuncture and moxibustion are suitable in all four seasons, as this harms the Harmony of Heaven (Tian He).