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Tonification Method:
The left hand presses the acupoint, and the right hand places the needle on the point. Instruct the patient to cough once; insert the needle penetrating into the *Couli* (interstices between skin and muscle). Instruct the patient to exhale forcefully (blow air) once; advance the needle to a certain depth following the exhalation. When the needle feels heavy and tight, rotate the needle head and use the hand to follow and palpate (*Xun Men*) along the meridian. Once the arrival of *Qi* is felt, turn the needle head downward. When the needle again feels heavy and tight, instruct the patient to exhale forcefully once, then withdraw the needle following the inhalation, immediately closing the acupoint (i.e., rapidly pressing the needle hole with one hand). This method is used for patients with emaciation, weak Qi, and symptoms of itching or numbness.

Evacuation Method:
The left hand presses the acupoint, and the right hand places the needle on the point. Instruct the patient to cough once; insert the needle into the *Couli*. Then instruct the patient to inhale deeply; advance the needle to a certain depth following the inhalation. When the needle feels heavy and tight, rotate the needle head towards the diseased area. Once the arrival of *Qi* is felt and the pathogenic factor recedes, turn the needle head downward and use the hand to follow and palpate (*Xun Men*). When the needle feels heavy and dull, instruct the patient to exhale forcefully once, then slowly withdraw the needle without closing the acupoint. This is called Evacuation. This method is used for patients who are obese, have hard tissues, and experience pain.

The *Su Wen* states: "Evacuation must use 'Square'; Tonification must use 'Round'."
To say "Evacuation must use Square" means that at this time, the healthy Qi is flourishing, the moon is full, the day is warm, the body is stable, and the needle is inserted during the patient's inhalation. Later, when turning the needle, do so during inhalation; when withdrawing the needle, do so slowly during exhalation. Hence it is called Evacuation.
To say "Tonification must use Round," "Round" implies movement ("Xing"), and "Movement" implies shifting ("Yi"). "Movement" refers to circulating stagnant Qi and Blood; "Shifting" refers to restoring the pulse. Therefore, needling must penetrate to the *Rong* (Nutrient) level. Later, during inhalation, push the needle into the blood level. Thus, "Round" and "Square" do not refer to the shape of the needle. I do not understand the intent of the Sages; I leave it to future scholars to investigate in detail.

Shallow Needling in Spring and Summer, Deep Needling in Autumn and Winter
The *Nei Jing* states: Diseases may be superficial or deep; needling may be shallow or deep, each following its own principle, without a fixed rule. However, Spring and Summer belong to Yang, with Qi external; human Qi also floats outward. Therefore, in needling, one should generally take shallowly. Autumn and Winter belong to Yin, with Qi internal; human Qi resides in the Zang organs. Therefore, in needling, one should generally take deeply. It is also said: "In Spring and Summer, each elicit one Yin; in Autumn and Winter, each elicit one Yang."
What is meant by "eliciting one Yang in Autumn and Winter"? It means that although Spring and Summer are Yang, they nurture Yin; thus, needling should elicit one Yin. What is meant by "eliciting one Yin in Spring and Summer"? It means that although Autumn and Winter are Yin, they nurture Yang; thus, needling should elicit one Yang.
The method of eliciting one Yin in warm Spring and Summer involves inserting the needle deeply to the regions of the Kidney and Liver, obtaining *Qi*, and then withdrawing the needle. This guides Yin inward. The method of eliciting one Yang in cold Autumn and Winter involves inserting the needle shallowly to the regions of the Heart and Lung, obtaining *Qi*, pushing the needle deeper, retaining it for a long time, and then withdrawing. This pushes Yang inward. Thus, the *Su Wen* states: "Nourish Yang in Spring and Summer; nourish Yin in Autumn and Winter."

Respiratory Tonification and Evacuation
Tonification and Evacuation refer to methods based on respiratory inhalation and exhalation. During Tonification, Qi is taken from the *Wei* (Defensive) level. "Taking" implies acquiring. The *Su Wen* states: "First palpate and follow (*Xun*), cut and disperse, push and press, tap and stretch, mark with the fingernail, open the pathway, and acquire." Distinguish the gate to close the Spirit. Insert the needle at the end of exhalation, retain quietly for a long time. The goal is the arrival of *Qi*, like waiting for a distinguished guest, unaware of the passing day. When *Qi* arrives, protect it appropriately. Withdraw the needle during inhalation so that Qi does not escape, remaining in place. Close the gate, let the Spirit and Qi remain, and the Great Qi stay stopped. Hence it is called Tonification, taking Qi without allowing it to escape greatly.
During Evacuation, Qi is placed at the *Rong* (Nutrient) level, placing the Qi but not using it. The *Su Wen* states: "Insert the needle during inhalation, do not let Qi rebel; retain quietly for a long time, do not let evil accumulate. Turn the needle during inhalation until *Qi* arrives; draw the needle during exhalation, removing it completely at the end of exhalation. The Great Qi all exits. Hence it is called Evacuation." Evacuation means placing the Qi but not using it.
If Yang Qi is insufficient while Yin Blood is excessive, one should first Tonify Yang, then Evacuate Yin. If Yin Blood is insufficient while Yang Qi is excessive, one should first Tonify Yin, then Evacuate Yang. This harmonizes Yin and Yang, allowing Ying and Wei to circulate naturally. This is the essence of needling.

Cold-Heat Tonification and Evacuation
For example, to Tonify Cold (treat cold syndromes): First, have the patient cough once; insert the needle into the *Couli*. Then, have the patient exhale forcefully once; insert the needle following the exhalation to a depth of 6–7 fen, reaching the Kidney/Liver region. Retain the needle. Slowly withdraw it slightly (about the size of a bean), then twirl the needle, asking if the patient feels heat. Then re-insert to 3–4 fen, reaching the Heart/Lung region. Have the patient inhale to insert the needle, twirl to direct Qi downward to the disease site. Then twist outward to direct Qi upward, directly to 1–2 cun above the needled point. Finally, inhale while twisting outward to withdraw the needle, and quickly press the acupoint with the hand. This is Tonification.
For post-illness heat treated with cold methods: To induce a cooling sensation, first needle the Intestine region. After obtaining *Qi*, push deeper into the Yin region. Have the patient facilitate Earth Qi entering and Heaven Qi exiting. Carefully count the breaths according to the Generation-Number method. The patient will feel cool.
For aversion to cold treated with heat methods: To induce a warming sensation, first needle the Yin region. After obtaining *Qi*, slowly draw the needle to the Yang region. Have the patient facilitate Heaven Qi entering and Earth Qi exiting. Carefully count the breaths according to the Generation-Number method. The patient will feel warm.

Generation-Number Method (Sheng Wu Jia)
When Tonifying Cold, after directing Qi to the disease site, use the Generation-Number breaths. Have the patient inhale through the nose and exhale through the mouth (or vice versa depending on specific interpretation, text says "nose inhale out") to feel warmth.
When Evacuating Heat, after directing Qi to the disease site, use the Generation-Number breaths. Have the patient exhale through the nose and inhale through the mouth. Count according to the affected Zang-Fu organ numbers. The patient will feel cool.

Finger Manipulation for Tonification and Evacuation
The Classics state: Tonification and Evacuation do not necessarily rely on respiratory inhalation/exhalation, but depend on finger manipulation. What are these? They are: Move, Shake, Advance, Retreat, Rub, Plateau/Twirl, Tap, Twirl, Follow, Palpate/Close, Pinch, Press, Mark, and Cut. Briefly listed below:
Move: If Qi does not move, simply lift and lower the needle.
Retreat: When preparing to withdraw the needle for Tonification/Evacuation, first withdraw the needle slightly (bean-sized), then retain it before final withdrawal. This is Retreat.
Rub: To induce heat, rub the needle outward as if twisting thread, but not too tightly. For treating cold with internal needling, follow the previous turning method as rubbing.
Advance: If *Qi* has not arrived, or for gender-specific techniques (Male-External/Female-Internal), and considering seasonal advances/retreats, this is Advance.
Plateau/Twirl: For abdominal needling, gently rotate within the acupoint. This is Plateau.
Shake: For Evacuation, when withdrawing the needle, one must shake it while withdrawing.
Tap: For Tonification, lightly tap the needle with the thumbnail to accelerate Qi movement. Not used for Evacuation.
Twirl: Twisting the needle with fingers. Must distinguish left (External) and right (Internal). Remember carefully.
Follow: After inserting into the meridian region, use the hand to stroke up and down to promote Qi and Blood circulation. The Classic says: "Push to make it move, pull to stop it."
Palpate/Close: For Tonification, use the hand to cover/close the acupoint.
Pinch: If Qi is sluggish upon insertion, follow the meridian upward and pinch/cut the Qi and Blood with the thumbnail to restore flow.
Press: Hold the needle with fingers without advancing or retreating, resembling a pressing motion.
Mark: Use the finger to apply force when placing the needle to ensure accuracy.
Cut: Before needling, use the thumbnail to cut/pinch around the acupoint to disperse Qi and Blood, then insert. This prevents damaging Ying and Wei.

Following-Against Tonification and Evacuation
The Classics state: "East is Excess, West is Deficiency; Evacuate South, Tonify North." What does this mean? This is the method of tonifying the Mother and evacuating the Child, applicable beyond just one meridian. For example, if Liver Wood is Excess, evacuate the Child of Heart Fire, and tonify the Mother of Kidney Water. The Liver Meridian will naturally balance. All Five Zang organs follow this principle.