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Chapter 78 asks: Acupuncture has tonification (Bu) and sedation (Xie) methods. What does this mean?

The response states: The methods of tonification and sedation do not necessarily require coordinating with respiration for needle insertion and withdrawal. One who understands acupuncture relies on the left hand; one who does not understand acupuncture relies only on the right hand. At the time of needling, one must first use the left hand to press and suppress the Ying-Spring and Shu-Acupoints to be needled, flick them to make them distend, and use fingernails to mark and guide downwards. When the Qi arrives, resembling the pulsation of an artery, one inserts the needle following this direction. Upon obtaining Deqi (arrival of Qi), pushing the needle inward is called tonification; shaking the needle and withdrawing it outward is called sedation. If Deqi is not obtained, one must differentiate by gender: for men, seek Qi in the Wei (Defensive) layer (exterior); for women, seek Qi in the Ying (Nutritive) layer (interior). If Qi is still not obtained, it is termed one of the ten incurable conditions.

Regarding acupuncture tonification and sedation, inserting the needle during exhalation and withdrawing it during inhalation constitutes tonification; inserting during inhalation and withdrawing during exhalation constitutes sedation. The *Su Wen · Li He Zhen Xie Lun* (Treatise on Separating and Combining True Pathogens) states: Insert the needle during inhalation, do not let the Qi rebel, keep it still and retained for a long time, do not allow the pathogen to spread, rotate the needle during inhalation until Deqi is achieved, then draw out the needle during exhalation, removing it completely when exhalation ends. Thus, the major pathogenic factors are expelled, hence it is named sedation. Insert the needle when exhalation ends, keep it still and retained for a long time until Qi arrives, as if waiting for a honored guest, unaware of the passing day. Once Qi arrives, protect it appropriately, withdraw the needle during inhalation so that Qi does not escape, each remaining in its place, push and close the acupoint gate, allowing Shen-Qi to remain and major Qi to stay, hence it is named tonification. This is the standard method in the *Nei Jing* regarding respiratory coordination for needle insertion/withdrawal and Qi monitoring for tonification/sedation.

Yue Ren (Bian Que) held that acupuncture methods are not limited to this. A skilled acupuncturist, upon needling, first determines the acupoint, then uses the left hand to press the area, flicking and rubbing to induce distension, and using nails to guide downwards, thereby attracting Qi. When Qi arrives, resembling arterial pulsation, insert the needle along this flow. Upon obtaining Deqi, pushing the needle deeper is tonification; shaking the needle and extending it outward is sedation. If Qi does not arrive after prolonged waiting, for men, seek it in the Wei Qi division (superficial); for women, seek it in the Ying Qi division (deep). If further searching yields no result, the Ying and Wei Qi have depleted, acupuncture will be ineffective, and this belongs to incurable cases.

Commentary: Hua Shi (Hua Shou) stated: "Flicking to make distend" is to encourage courage/vigor of Qi; "Nu" is pronounced like "Nu" (anger). "Guiding down with nails" involves slightly heavier pressing, all aiming to bring Qi to arrival. When Qi reaches under the fingers, resembling arterial pulsation, one needles while taking advantage of its arrival. "Shun" means following or taking advantage of. Stopping the needle to wait for Qi, where the needle moves upon Qi arrival, is obtaining Deqi. Pushing the needle in is tonification; moving and withdrawing the needle is sedation. This is Yue Ren's core technique, distinct from respiratory needle manipulation, which is indeed so. Regarding stopping the needle to wait for Qi, if it does not arrive for a long time, one should lightly manipulate for men in the Wei Qi division and heavily manipulate for women in the Ying Qi division. If Qi is still not obtained thus, the disease is ultimately incurable. The two instances of "Qi" in the chapter have different meanings and must be distinguished. The former "Qi" refers to the sensation of Qi arriving like an artery, which is the Qi monitored by the left hand before needling. The latter "obtaining/not obtaining Qi" refers to the Qi monitored under the needle after insertion; these are two separate stages.

Zhou Zhongli claimed: Whenever monitoring Qi, the left hand should press slightly heavier; if Qi is not found, one should lightly handle for men in the Wei Qi division and heavily handle for women in the Ying Qi division. Such an approach lacks distinction between preceding and subsequent stages and misunderstands the principle of stopping the needle to await Qi. On what basis can tonification and sedation be determined then!