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The Classic says: "If one cannot treat deficiency, what is the point of discussing other conditions?" This refers to this principle. (It means that the method for treating Lung Metal deficiency should be as follows; one should not merely focus on tonifying or draining a single meridian. If this principle is not understood, then one cannot even master the methods for treating deficiency, let alone other diseases. These two sentences from the classic text are untraceable.)

Difficulty 76 asks: What are tonification and sedation? When tonifying, where should one draw Qi from? When sedating, where should one disperse the Qi? (This refers to drawing which Qi for tonification; and where the sedated Qi should be dispersed.)

The answer is: When tonifying, draw Qi from the Wei (Defensive) level; when sedating, disperse Qi into the Ying (Nutritive) level. (Wei governs Qi, so Qi is drawn from Wei. The method is detailed in Difficulty 78 below. Dispersing Qi into Ying means dissipating the pathogenic Qi within the Ying level.) If Yang Qi is insufficient and Yin Qi is excessive, one should first tonify Yang and then sedate Yin; if Yin Qi is insufficient and Yang Qi is excessive, one should first tonify Yin and then sedate Yang. (This continues the discussion on tonification and sedation methods, emphasizing the need to carefully assess the excess and deficiency of Yin and Yang. Wei is Yang, Ying is Yin. If Wei is deficient and Ying is excess, tonify Yang and sedate Yin; if Ying is deficient and Wei is excess, tonify Yin and sedate Yang. The order of tonification and sedation has precedence. The *Ling Shu · Zhong Shi Pian* states: "When Yin is excess and Yang is deficient, first tonify Yang, then sedate Yin to harmonize; when Yin is deficient and Yang is excess, first tonify Yin, then sedate Yang to harmonize." This theory is based on this principle.) The free circulation of Ying and Wei Qi is the key. (When Yin and Yang are balanced, the Qi of Ying and Wei flows smoothly. "Key" refers to the essential method.)

Difficulty 77 asks: The classics state that superior physicians treat disease before it arises, while average physicians treat disease after it has arisen. What does this mean?

The answer is: Treating disease before it arises means seeing Liver disease and knowing that the Liver will transmit the pathogen to the Spleen. (Excessive Liver Wood insults Spleen Earth.) Therefore, one first strengthens the Spleen Qi to prevent it from receiving the Liver pathogen. (Tonifying Spleen Qi enables it to resist Liver overacting.) Thus, it is called treating disease before it arises. Average physicians treat disease after it has arisen by seeing Liver disease but failing to understand the transmission between organs, focusing solely on treating the Liver. (Specializing only in treating the Liver allows Liver pathogen to enter the Spleen, causing Spleen disease, which is what the classics refer to as "the old disease is not yet resolved, a new disease arises.") Thus, it is called treating disease after it has arisen.

Difficulty 78 asks: Acupuncture has tonification and sedation methods. What do they mean?

The answer is: The methods of tonification and sedation do not necessarily rely on respiration for inserting and withdrawing the needle. (*Su Wen · Li He Zhen Xie Lun* states: "Insert the needle during inhalation... withdraw during exhalation... this is called sedation... Insert during exhalation... retain quietly until Qi arrives... withdraw during inhalation... this is called tonification." Yu Bo Yue considered that the method of respiration-based insertion/withdrawal was not exhaustive and should follow the description below.) Those who understand acupuncture trust the left hand; those who do not understand acupuncture trust the right hand. (Trusting the left hand means the technique relies entirely on skillful use of the left hand, as described below. Trusting the right hand refers to the respiration-based method mentioned above. Holding the needle with the right hand is why it is called trusting the right hand.) At the time of needling, (some versions have the character "bi" [must]) first press the Ying and Shu points with the left hand, flick and rub them, (Flick means tapping. Rub means kneading.) press down with fingernails, (pressing nails into the flesh.) The arrival of Qi feels like a pulsating artery, (Stirring blood and Qi causes Qi to gather like a pulse at the wrist, which is the Qi sensed by the left hand.) insert the needle along this direction, obtain Deqi, (Qi arriving at the needle, which is the Qi sensed under the needle.) then push the needle inward, (Pushing the needle in, Qi enters with it.) this is called tonification; move and extend the needle, (Shaking and withdrawing to draw out Qi,) this is called sedation. If Deqi is not obtained, differentiate by gender; (For men, await Qi outside the Wei level; for women, await Qi inside the Ying level.) If Deqi is still not obtained, it is termed "ten deaths, untreatable." (If Qi does not arrive upon awaiting, Ying and Wei Qi have departed, and acupuncture will be ineffective. "Ten deaths" implies no chance of survival.)

Difficulty 79 asks: The classics say "Attack and deprive," how can it not result in deficiency? "Follow and assist," how can it not result in excess? Deficiency and excess seem like gaining and losing; excess and deficiency seem like existing and non-existing. What does this mean?

The answer is: "Attack and deprive" refers to sedating the Son element; "Follow and assist" refers to tonifying the Mother element. (The meaning of Follow and Attack is explained in Difficulty 72. The classic quote is from *Ling Shu · Jiu Zhen Er Shi Yuan Pian*. Note that here, Mother and Son refer to the Five Elements generation and restriction relationships of the Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea points of the same meridian, unlike Difficulty 75 which refers to the Mother-Son relationship between Zang organs.) For example, in Heart disease, sedating the Shu point of the Pericardium meritory is called "Attack and deprive"; tonifying the Jing-Well point of the Pericardium meridian is called "Follow and assist." (Heart disease belongs to Fire, and typically the Ying-Spring point should be selected. Yin Qi is received by the Zang organs, and its meridian Qi flows from Shu to Ying-Spring to Jing-Well. Sedating the Shu point attacks the source of incoming Qi; Shu belongs to Earth, the Son of Heart Fire. Tonifying the Jing-Well point follows the outgoing Qi; Jing-Well belongs to Wood, the Mother of Heart Fire.)

The terms "excess" and "deficiency" refer to the sensation of firmness or softness under the needle. A firm and solid Qi sensation indicates success (Deqi); a soft and weak sensation indicates failure. Hence, it is said to be like gaining and losing. (Qi refers to the sensation under the needle. Firm and solid Qi arrival is success; soft and weak Qi arrival is failure. Discussing gain and loss encompasses existence and non-existence.)

Difficulty 80 asks: The classics mention "See and enter, see and exit." What does this mean? (These two sentences from the classic text are untraceable.)

The answer is: "See and enter" means that when the left hand senses the arrival of Qi, the needle is inserted. (This is the "pulsating artery" sensation mentioned in Difficulty 78. Hua Shi stated: "Under 'see and enter,' the four characters 'see and exit' should be missing.") After the needle is inserted, when the Qi sensation dissipates, the needle is withdrawn. (Qi dissipation means the Qi comes and then scatters.) This is called "see and enter, see and exit." (Hua Shi's *Ben Yi*: "'Ru' is read as 'Er', interchangeable in ancient texts.)

Difficulty 81 asks: The classics say "Do not tonify excess, do not sedate deficiency; do not damage insufficiency and do not benefit surplus." (Meaning: Excess conditions should be sedated, but are mistakenly tonified; deficiency conditions should be tonified, but are mistakenly sedated; insufficiency is damaged, and surplus is increased. All are mis-treatments. The classic quote is from *Ling Shu · Jiu Zhen Er Shi Yuan Pian*.) Does this refer to the Cun Kou pulse, or does the disease itself possess excess and deficiency? (Some versions have "ye". It asks whether "excess and deficiency" refers to the pulse or the disease.) How should the tonification and sedation be applied? (Asking how the methods of tonification and sedation should be correctly applied.)

The answer is: This refers to the disease, not the Cun Kou pulse; it refers to the inherent excess and deficiency of the disease itself. For example, if Liver is excess and Lung is deficient, Liver is Wood, Lung is Metal. Metal and Wood should balance each other. (Detailed explanation in Difficulty 75.) One must understand that Metal controls Wood. (Note: Xu Lingtai's commentary suggests regulating via South/North elements, but the core principle is balancing Metal and Wood). For instance, if Lung is excess and Liver is deficient, with slight Qi deficiency, using acupuncture without tonifying the Liver but instead heavily tonifying the Lung, (this makes Lung more excess and Liver more deficient.) Thus, it is called tonifying excess and sedating deficiency, damaging insufficiency and benefiting surplus. This is the harm caused by average physicians. (Harm means not only failing to cure the disease but also harming the patient.)