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The Yellow Emperor asked: What is the relationship of reversal and順 (shun, smooth/normal) between Xingqi (Form-Qi) and Bingqi (Pathogenic-Qi)?

Qibo replied: When Xingqi (Form-Qi, the body's constitutional energy) is insufficient while Bingqi (Pathogenic-Qi, the pathogenic factor's strength) is excessive, this indicates an excess of pathogenic factors; one should urgently apply the reducing method (Xie). When Xingqi (Form-Qi) is excessive while Bingqi (Pathogenic-Qi) is insufficient, one should urgently apply the reinforcing method (Bu).

If both Xingqi (Form-Qi) and Bingqi (Pathogenic-Qi) are insufficient, this signifies a deficiency of both Yin and Yang. Needling should not be performed. If needled, it will cause severe deficiency. Severe deficiency leads to the exhaustion of both Yin and Yang, the depletion of blood and Qi, emptiness of the five Zang organs, and withering of sinews, bones, marrow, and tendons. The elderly will perish, and even the robust will fail to recover.

If both Xingqi (Form-Qi) and Bingqi (Pathogenic-Qi) are excessive, this is termed an excess of both Yin and Yang. One should urgently reduce the pathogenic factors and regulate the excesses and deficiencies. Thus it is said: "For excess, use reduction; for deficiency, use reinforcement." This is what is meant (from *Ling Shu*).

If one does not understand the principles of reversal and shun (smooth/normal) in needling, pathogenic factors will contend with each other. Applying reinforcement to an excess condition causes Yin and Yang energies to scatter excessively, leading to distension and fullness of the intestines and stomach, and internal disorder of Yin and Yang in the liver and lungs. Applying reduction to a deficiency condition causes emptiness in the meridians, depletion of blood and Qi, stagnation in the intestines and stomach, thinning of the skin, withering of hair and pores, and accelerates death. Therefore, the key to using needles lies in knowing how to harmonize Yin and Yang. Harmonizing Yin and Yang makes Jingqi (Essential-Qi) bright; combining form and Qi allows Shen (Spirit) to be stored within. Thus it is said: The superior physician regulates Qi; the average physician regulates pulses; the inferior physician cuts off Qi and endangers life. Therefore, the inferior physician must be extremely cautious (from *Ling Shu*).

The Yellow Emperor asked: What are the "Five Deprivations" (Wu Duo)?

Qibo replied: Emaciation and loss of flesh and muscle constitute the first deprivation. Following massive blood loss constitutes the second deprivation. Following profuse sweating constitutes the third deprivation. Following severe diarrhea constitutes the fourth deprivation. Postpartum bleeding constitutes the fifth deprivation. In all these cases, needle reduction (Xie) must not be used (from *Ling Shu*).

Although needling possesses methods of reinforcement and reduction, I fear that in practice there may only be reduction without true reinforcement. The classics state that reduction involves meeting the incoming Qi of the meridian and seizing it; by inserting the needle against the direction of the meridian's incoming Qi and withdrawing it, one can indeed reduce excess. It is said that reinforcement involves following the outgoing Qi of the meridian and retaining the needle; however, by following the meridian's outgoing Qi and retaining it, one may not necessarily tonify deficiency. Otherwise, why does the *Nei Jing* (Inner Canon) say: Do not needle when there is high fever; do not needle when the pulse is chaotic and confused; do not needle when there is profuse dripping sweat; do not needle after great labor; do not needle when greatly hungry; do not needle when greatly thirsty; do not needle immediately after a full meal; do not needle after great fright? It also states: "When Xingqi (Form-Qi) is insufficient and Bingqi (Pathogenic-Qi) is insufficient, this means both Yin and Yang are deficient, and needling is contraindicated. Needling will cause further exhaustion of Qi; the elderly will perish, and the robust will not recover." Such statements refer to the concept of having reduction but no reinforcement. Generally, patients with deficiency, critical illness, or chronic disease are not suitable for needling (from *Yi Men Ru Men*).