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Yin and yang qi both tend to converge and unite in autumn and winter, which appears similar on the surface. However, the former discusses the laws of rising and falling of yin and yang across the four seasons, while the latter discusses the method of increase and decrease of qi and blood in a specific meridian. When yang qi is insufficient and yin qi is in excess, one should first tonify yang and then drain yin, etc., as stated in the *Ling Shu* (Spiritual Pivot): when yin is excessive and yang is deficient, first tonify yang, then drain yin to harmonize; when yin is deficient and yang is excessive, first tonify yin, then drain yang to harmonize. The principle of "first deficiency, then repletion" refers to the manipulation techniques of tonification and reduction used by acupuncturists. If one erroneously applies tonification (to make righteous qi substantial) first and then reduction, it may secretly deplete righteous qi; therefore, it is warned that the sequence must be strictly followed.

(Chapter 74, Old Chapter 78) Question: Acupuncture has methods of tonification (Bu) and reduction (Xie). What do they mean? Answer: The methods of tonification and reduction do not necessarily depend on respiration during needle insertion and withdrawal. One who understands needle manipulation relies on the left hand, while one who does not understand relies solely on the right hand. At the time of insertion, first press the intended Ying-Shu point with the left hand, flick it to make the area protrude, and then use the fingernail to mark the spot for downward insertion. When the arrival of qi is felt, resembling the pulsation of an artery, insert the needle following this flow. Upon obtaining De Qi (needle sensation), push the needle deeper along its path; this is called tonification. Shake and draw the needle outward; this is called reduction. If De Qi is not obtained, apply different strategies based on gender: for males, target the Wei (Defensive) level (Yang, exterior); for females, target the Ying (Nutritive) level (Yin, interior). (This is a method to retrieve qi again). If De Qi is still not obtained, it is termed a critical condition of "ten deaths, untreatable."

Commentary: Inserting the needle upon inhalation and withdrawing upon exhalation is called reduction; inserting upon exhalation and withdrawing upon inhalation is called tonification. This refers to the method of needle movement related to respiration. The *Nei Jing* (Inner Canon) mentions this frequently in various chapters. Thus, this chapter focuses only on left-hand and right-hand techniques to distinguish tonification and reduction. Pressing the point, flicking to cause protrusion, and marking with nails refer to the use of the left hand. After such manipulation, if qi arrives, insert directly and slowly deepen the needle as De Qi is achieved; this is the method of tonification. Shaking and drawing out is reduction. There seems to be a textual omission here. Why? The discussion on tonification mentions insertion but not withdrawal; the discussion on reduction mentions withdrawal but not insertion. Investigating this, the withdrawal for tonification should involve no shaking or drawing (rapid withdrawal without disturbance); the insertion for reduction certainly does not require the left-hand pressing technique. This is not a loss but a rhetorical device known as "mutual text" (Hu Wen). If De Qi is not obtained, distinguish between male/female and interior/exterior. The *Ling Shu* states: "For males, retain internally; for females, release externally," holding firm without letting out, guarding without letting in, which constitutes obtaining qi. The terms "interior" and "exterior" are reversed here compared to the *Ling Shu* because the *Ling Shu* implies "males prohibited from internal retention, females prohibited from external release." This can be seen in the following sentences. In this chapter, "interior" and "exterior" literally mean giving or administering. For males, hold the needle at the exterior of the Wei level to await qi; for females, push the needle into the interior of the Ying level to await qi. The wording differs, but the meaning is the same. If qi still does not arrive despite this, death is certain, hence "ten deaths, untreatable."

The Classic states: "There is seeing as entering, there is seeing as exiting." What does this mean? Answer: "Seeing as entering, seeing as exiting" means that after the left hand presses and sees the arrival of qi, the needle is inserted; after the needle is inserted and sees the qi (at its peak/end) dissipate, the needle is withdrawn. This is called "seeing as entering, seeing as exiting."

This reiterates the principles of needle insertion and withdrawal for tonification from the previous section. The previous mention of tonification only covered insertion, not withdrawal, so the Classic is cited to clarify. "Seeing qi with the left hand" was detailed earlier. Waiting for the qi obtained under the needle to reach its end before withdrawing is explained here. As for reduction, since the previous text mentioned shaking and drawing out, why wait to see the qi arrive and exhaust? Probably because tonification in acupuncture is difficult, leading figures like Wang Tao and Yu Bo to doubt the existence of "reduction without tonification." This chapter repeatedly emphasizes tonification because of its difficulty, while briefly mentioning reduction due to its ease. This section originates from Old Chapter 80; its meaning complements the preceding paragraph, so they are combined.

(Chapter 75, Old Chapter 72) Question: The Classic says, "Knowing the direction of Ying and Sui qi allows for regulation. The method of regulating qi must lie in Yin and Yang." What does this mean? Answer: "Ying and Sui" refers to knowing the flow of Ying qi within the vessels and Wei qi outside the vessels, and the circulation of meridians (starting from Taiyin and ending at Jueyin). Following or opposing the flow of qi determines Ying (draining/subduing) and Sui (supporting/nourishing). Regulating qi lies in Yin and Yang, meaning knowing the interior (female/yin), exterior (male/yang), superficial (shallow), and deep (deep) aspects, and harmonizing Qi and Blood according to Yin or Yang meridians. Hence, "the method of regulating qi must lie in Yin and Yang."

Commentary: "Ying and Sui" refers to the techniques of tonification and reduction. However, these methods vary. Harmonizing the flow of Ying and Wei and the circulation of meridians means Ying qi flows within the vessels, circulating fifty times day and night according to water clocks and breaths; Wei qi travels through Yang meridians by day and Yin meridians by night. Hand-Yang meridians go from hand to head; Foot-Yang meridians from head to foot; Hand-Yin from chest/abdomen to hand; Foot-Yin from foot to abdomen. Slip's commentary treating these two phrases as one meaning is too simplistic. "Following or opposing the flow": For example, Foot-Yang meridians descend from head to foot. To reduce, direct the needle tip against the flow upward (Ying); to tonify, follow the flow downward (Sui). For Hand-Yang meridians ascending from hand to head, to reduce, direct against the flow downward (Ying); to tonify, follow the flow upward (Sui). The rest can be inferred. This chapter describes this reverse/forward Ying-Sui method. Regulating qi lies in Yin and Yang, referring to the previous discussion on male/female interior/exterior and concepts from *Su Wen: Yin Yang Ying Xiang Da Lun* such as "knowing the interior through the exterior, drawing from Yang to Yin, treating left via right." These are all methods of regulating qi, specifically "knowing interior/exterior and shallow/deep, regulating according to Yin/Yang." *Su Wen* states: "The method of regulating qi must distinguish Yin and Yang, determine interior and exterior, each keeping to its place. Interior is treated internally, exterior externally." Xie Fangde's citation by Slip is correct and should be referenced.

(Chapter 76, Old Chapter 79) Question: The Classic (*Ling Shu* Ch. 1) says, "Ying and draining it, how can it not become deficient? Sui and supporting it, how can it not become replete? Deficiency and repletion, if obtaining [righteous qi], if losing [pathogenic qi]; repletion and deficiency, seeming to have [pathogen] yet seeming to not have [righteous qi]." What does this mean? Answer: "Ying and draining" means reducing the Child element (taking from the anterior point); "Sui and supporting" means tonifying the Mother element (taking from the posterior point). For instance, in Heart disease, draining the Shu point of the Pericardium (Tailing, Earth) is Ying and draining; tonifying the Jing-Well point of the Pericardium (Zhongchong, Wood) is Sui and supporting. "Repletion and deficiency" refers to both righteous and pathogenic states, implying the pulse qualities of Firm (Lao) and Soft (Ru). (This refers to the repletion/deficiency of meridian qi, not just pulse quality). If the qi arriving under the needle is Firm and solid (if righteous qi was deficient, tonification makes it firm), this is "Obtaining" (successful tonification). If it is Soft and weak (if pathogenic qi was firm, reduction makes it soft), this is "Losing" (successful reduction). Hence, "seeming to obtain, seeming to lose."

Commentary: *Ling Shu: Xiao Zhen Jie* states: "Speaking of repletion and deficiency, seeming to have and not having, means repletion has qi, deficiency lacks qi. Speaking of deficiency and repletion, seeming to obtain and lose, means tonification feels like gaining something, reduction feels like losing something." "Having/not having" refers to the location of the disease: pathogenic repletion is "having," righteous deficiency is "not having." "Obtaining/losing" refers to the needle manipulation: deficiency gathers qi (obtaining), repletion scatters pathogens (losing). This chapter discusses Mother-Child Ying-Sui, differing from the previous chapter's meaning, aligning with *Ling Shu*'s "observe posterior/anterior, seeming to exist and seem to vanish," discussing the sequence of tonification/reduction based on qi repletion/deficiency. The terms "repletion and deficiency" here carry deep meaning, akin to changing "three in the morning, four in the evening" to "four in the morning, three in the evening"; the fundamental contradiction remains unresolved arbitrarily. Thus, "repletion and deficiency" implies Firm and Soft. Firm indicates pathogenic repletion and righteous deficiency; Soft indicates pathogenic deficiency and righteous repletion. Read carefully, do not overlook.

(Chapter 77, Old Chapter 69) Question: The Classic (*Ling Shu* Ch. 10) says, "Tonify deficiency, reduce repletion, and for neither deficient nor replete, treat via the Meridian." What does this mean? Answer: Righteous deficiency: tonify the Mother point. Pathogenic repletion: reduce the Child point. First tonify, then reduce. "Neither deficient nor replete, treat via the Meridian" means the disease originates in the Primary Meridian itself, not affecting other meridians. One should directly select points from this meridian. Hence, "treat via the Meridian."

Commentary: This continues the previous chapter's Q&A to interpret "neither deficient nor replete, treat via the Meridian" from *Ling Shu* and *Su Wen*. The intent seems to question if there is a distinct "Meridian Needling" method beyond tonification/reduction. Tonification is Sui, reduction is Ying. "Treating via the Meridian" involves needling points belonging to the meridian itself, not Mother-Child points. If "Mother makes Child empty," tonifying the Mother treats the root (disease transmitting from Mother to Child). If "Child makes Mother full," reducing the Child treats the branch (disease adding from Child to Mother). These are caused by external pathogens. Primary Meridian self-disease arises from abnormal qi flow and disorder; thus, needling regulates the meridian qi. It is neither deficiency nor repletion, so Ying-Sui is not applied. I observe that in our country in recent times, acupuncture mostly uses this "Meridian Needling" method, rarely employing full Ying-Sui Mother-Child techniques. Even the Five Shu point selection mentioned earlier is scarcely used, nearly extinct. Tragic! Ancient sages taught earnestly for millennia, yet their teachings remain only in books, damaged by worms. Alas!

(Chapter 78, Old Chapter 75) Question: The Classic says, "East is Replete, West is Deficient; Drain South, Tonify North." What does this mean? Answer: Metal, Wood, Water, Fire, Earth should mutually balance. (Listing standard mutual restraint). East is Liver Wood, West is Lung Metal. If Wood becomes replete, Metal should restrain it (Metal overcomes Wood). If Fire becomes replete, Water should restrain it (Water overcomes Fire). If Earth becomes replete, Wood should restrain it (Wood overcomes Earth). If Metal becomes replete, Fire should restrain it (Fire overcomes Metal). If Water becomes replete, Earth should restrain it (Earth overcomes Water). East is Liver, so Liver is Replete (not ordinary repletion). West is Lung, so Lung is Deficient (not ordinary deficiency). Drain South (Heart Fire), Tonify North (Kidney Water). South Fire is the Child of Wood; North Water is the Mother of Wood. (These two sentences initiate the key discussion on etiology and treatment). Child (Heart) can make Mother (Liver) replete; Mother (Kidney) can make Child (Liver) deficient. Water overcomes Fire. Therefore, drain Heart Fire and Tonify Kidney Water, intending to prevent Lung Metal from restraining Liver Wood. The Classic says, "Cannot treat such deficiency... what need to ask about the rest?" This is the meaning.

Commentary: "East Replete, West Deficient" means Liver Wood Replete and Lung Metal Deficient, indicating the disease location. "Drain South, Tonify North" means draining Heart Fire and tonifying Kidney Water, indicating the treatment goal. This initiates the query. The answer first lists mutual restraint to show normal patterns. "Fire is Child of Wood, Water is Mother of Wood" is the key to analyzing etiology and treatment. Liver hyperactivity stems from Heart Fire excess; the Child does not consume Mother qi, causing Liver Wood to flourish. Kidney failure relates to Lung Metal deficiency; the Mother cannot assist the Child, causing Lung Metal to be severely deficient. By standard mutual restraint, treatment should tonify Lung and drain Liver. Instead, abandoning East/West to treat South/North is non-standard, like strategic flexibility in Confucianism or warfare. "Child makes Mother replete" refers to pathology: Child (Heart) causes Mother (Liver) repletion. "Mother makes Child deficient" refers to treatment: Mother (Kidney) makes Child (Liver) deficient. Question: If Heart excess makes Liver replete, shouldn't Liver excess make Kidney replete? Why is Kidney deficient? Answer: Heart making Liver replete involves rebellious Qi becoming pathogenic. Wood generating Fire is natural. Here, Heart excess fails to consume Mother qi, causing Wood qi to fail to reach and rebel, becoming pathogenic. Kidney deficiency loses Mother qi. Water generating Wood is natural, but insufficient Qi cannot transmit effectively, lacking rebellion. Transmission from Heart to Liver is pathogenic; transmission from Kidney to Liver is righteous. Like water flow: blockage at the end causes backflow and turbulence, churning the source—this is not water's nature, explaining Liver repletion. A thin source leads to short flow; even with dams downstream, the weak force dries up mid-course, depositing silt, lacking turbulence—explaining Kidney deficiency. Question: Are draining fire and tonifying water simultaneous or sequential? Answer: No. With needles, tonify Yin and drain Yang suffices. With herbs, it is not necessarily so; focus on tonifying Yin. "Water overcomes Fire" clarifies this. This is a crucial point. Analyzing the cause: Middle Qi deficiency prevents Spleen from distributing essence to Lung; Lung lacks governing Qi. Lung deficiency leads to Lung Qi stagnation, causing Kidney Yin insufficiency. Yin insufficiency triggers Yang within Yin, causing Liver Wood to rebel upward and merge with Heart. Liver repletion leads to extreme Heart excess, failing to consume Mother qi, blocking transmission, intensifying Liver pathogen. Liver repletion and Heart excess oppress Lung, causing severe Lung deficiency. Treatment ignores Lung deficiency (like ignoring a request for tribute to glorify a declining dynasty). Tonifying Kidney increases Yin, weakening Heart; relying on Mother reduces Liver repletion (like Jin borrowing passage from Yu to attack Guo; Jin targets Yu, not Guo). "Preventing Metal from restraining Wood" and "cannot treat such deficiency" refer to this. My interpretation synthesizes Chen Tingzhi, Wang Andao, and Sun Yikui. Wang gained insight recently but erred by deleting "not." Chen and Sun retained "not," capturing the true intent. This chapter discusses adaptive treatment, supplementing deficiencies to achieve dual benefits. Chapter 80 discusses standard tonifying Lung/draining Liver. Deleting "not" would confuse constant and variable methods, contrary to Bian Que's intent. Scholars should examine this carefully.

(Chapter 79, Old Chapter 77) Question: The Classic (*Ling Shu: Ni Shun*) says, "Superior doctors treat disease before it arises; average doctors treat disease after it arises." What does this mean? Answer: Treating before it arises means seeing Liver disease, knowing it will transmit to the Spleen, and thus first strengthening Spleen Qi to prevent receiving Liver pathogen (the overcoming relationship). Hence, "treating before it arises." Average doctors, seeing Liver disease, do not understand transmission and focus solely on treating the Liver (where the disease is). Hence, "treating after it arises."

Commentary: "Before arising" refers to areas not yet affected by pathogen; "after arising" refers to diseased areas. Visceral diseases often transmit to what they overcome. Superior doctors, treating before arising, inspect horizontal and vertical transmissions to prevent encroachment, preparing early. Average doctors lack foresight, addressing only immediate symptoms, being rigid. *Ling Shu* Ch. 55 states: "Superior doctors needle where disease has not yet arisen; inferior doctors needle where disease is attacking." This chapter follows this logic. *Su Wen* Ch. 2 defines "before/after arising" differently (healthy vs. sick), which should not be confused. Draining South/Tonifying North is superior treatment of "before arising." Thus, superior and average doctors have distinct levels.

(Chapter 80, Old Chapter 81) Question: The Classic says, "Do not replete repletion, do not vacate deficiency; do not damage insufficiency and benefit excess." Is this seen in Cun Kou pulse, or is it natural repletion/deficiency in symptoms? How does damaging insufficiency and benefiting excess occur? Answer: This disease (some note "two characters" as redundant, Sun Yikui argues it's ancient phrasing, accepted here) does not refer to Cun Kou pulse (which reveals true repletion/deficiency) but to false deficiency and false repletion in the disease presentation. For example, if Liver is truly Replete and Lung is truly Deficient, Wood and Metal should balance (standard). One should know Metal restrains Wood (standard treatment). But if Lung is truly Replete and Liver is truly Deficient (here Lung shows false deficiency, Liver shows false repletion), using needles without tonifying Liver (true deficiency) and instead heavily reinforcing Lung (true repletion), one says "replete repletion, vacate deficiency, damage insufficiency, benefit excess." This is the harm caused by average doctors.

Commentary: Diseases have repletion and deficiency, which have true and false aspects. True aspects are known via pulse, so they are excluded here. False aspects often lead to misdiagnosis by average doctors, hence the warning: do not "replete repletion, vacate deficiency," i.e., do not treat false as true. If replete repletion/vacate deficiency occurs with mixed true/false, insufficiency is further damaged, excess further benefited. Cun Kou pulse clearly shows true repletion/deficiency, minimizing error. Hence, "not referring to Cun Kou pulse," but to disease manifestations. "Repletion and deficiency" here refer to false repletion and false deficiency. If...