六十九难曰。经言虚者补之。实者泻之。不实不虚。以经取之。何谓也。然。虚者补其母。实者泻其子。当先补之。
然后泻之。不实不虚。以经取之者。是正经自生病。不中他邪也。当自取其经。故言以经取之。
丁曰。此经先立井荥俞经合配象五行。即以十二经中各有子母。递相生养。然后言用针补泻之法也。假令足厥阴肝
之络中虚。即补其足厥阴经合。是母也。实即泻足厥阴经荥。是子也。如无他邪。即当自取其经。故言以经取之也。杨
曰。春得肾脉为虚邪。是肾虚不能传气于肝。故补肾。肾有病则传之于肝。肝为肾子。故曰补其母也。春得心脉为实邪。
是心气盛实。逆来乘肝。故泻心。心平则肝气通。肝为心母。故曰泻其子也。不实不虚。是诸脏不相乘也。春得弦多及
但弦者。皆是肝脏自病也。则自于足厥阴少阳之经而补泻焉。当经有金木水火土。随时而取之也。
七十难曰。经言春夏刺浅。秋冬刺深者。何谓也。然。春夏者。阳气在上。人气亦在上。故当浅取之。秋冬者。阳
气在下。人气亦在下。故当深取之。
丁曰。春夏刺浅。秋冬刺深者。经言春夏剌井荥。从肌肉浅薄之处。秋冬刺经合。从肌肉深浓之处。此是因时随所
在刺之也。杨曰。经言春气在毫毛。夏气在皮肤。秋气在分肉。冬气在筋骨。此四时之气也。其四时受病。亦各随正气
之深浅。故用针者治病。各根据四时气之深浅而取之也。
春夏各致一阴。秋冬各致一阳者。何谓也。然。春夏温必致一阴者。初下针。沉之。至肾肝之部。得气引持之。阴
也。
虞曰。经言春夏养阳。言取一阴之气以养于阳。虑成孤阳。致者、都也。及也。言到于肾肝。引持一阴之气。肝肾
乃阴也。
秋冬寒必致一阳者。初内针。浅而浮之。至心肺之部。得气推内之。阳也。
虞曰。经言秋冬养阴。言至阴用事。无阳气以养其阴。故取一阳之气以养于阴。免成孤阴也。心肺。乃阳也。故言
至心肺之部也。
是谓春夏必致一阴。秋冬必致一阳。
杨曰。入皮三分。心肺之部。阳气所行也。入皮五分。肾肝之部。阴气所行也。阳为卫。阴为荣。春夏病行于阳。
故引阴以和阳。秋冬病行于阴。故内阳以和阴也。虞曰。杨氏所注言三分为心肺之部。五分为肝肾之部。此乃玄珠密语。
分天地气而言之。故有三分五分之说也。丁曰。人之肌肤。皆有浓薄之处。但皮肤之上。为心肺之部。阳气所行。肌肉
之下。为肾肝之部。阴气所行。其春夏阳气上胜。所用针沉。手内针至肾肝之部。得气引持阴气。以和其阳气。故春夏
必致一阴也。秋冬阴气下降。所用针浮。手至心肺之部。得气推内针入。引持阳气。以和其阴气也。故秋冬必致一阳也。
所以经云。春夏必致一阴。秋冬必致一阳也。
七十一难曰。经言刺荣无伤卫。刺卫无伤荣。何谓也。然。针阳者。卧针而刺之。刺阴者。先以左手摄按所针荥俞
之处。气散乃内针。是谓刺荣无伤卫。刺卫无伤荣也。
丁曰。人之荣为阴。卫为阳。二者为之表里。其卧针取之。恐伤于荣也。针荣先以左手摄按所刺之穴。令阳散而内
针者。盖恐伤于卫也。杨曰。入皮三分为卫气。病在卫。用针则浅。故卧针而刺之。恐其深伤荣气故也。入皮五分为荣
气。故先按所针之穴。待气散乃内针。恐伤卫气故也。虞曰。三阴三阳。各主气血。至有多少不同。故圣人说行针之道。
无令至有伤于荣卫也。血气形志篇曰。太阳多血少气。少阳少血多气。阳明多气多血。厥阴多血少气。少阴多气少血。
太阴多气少血。启玄子注曰。血气多少。天之常数。故用针之道。常泻其多也。
七十二难曰。经言能知迎随之气。可令调之。调气之方。必在阴阳。何谓也。然。所谓迎随者。知荣卫之流行。经
脉之往来也。随其逆顺而取之。故曰迎随。调气之方。必在阴阳者。知其内外表里。随其阴阳而调之。故曰调气之方。
必在阴阳。
丁曰。夫荣卫通流。散行十二经之内。即有始有终。其始自中焦注手太阴一经一络。然后手阳明注一经一络。其经
络有二十四。日有二十四时。皆相合。此凡气始至而用针取之。名曰迎而夺之。其气流注终而内针。出而扪其穴。名曰
随而济之。又补其母亦名曰随而补之。泻其子亦名曰迎而夺之。又随呼吸出内其针。亦曰迎随也。此者是调阴阳之法。
故曰必在阴阳也。杨曰。荣气者。常行不已。卫气者。昼行于身体。夜行于脏腑。迎者、逆也。随者、顺也。谓卫气逆
行。荣气顺行。病在阳。必候荣卫。行至于阳分而刺之。病在阴。必候荣卫行至于阴分而刺之。是迎随之意也。又迎者、
泻也。随者、补也。故经曰迎而夺之。安得无虚。言泻之则虚也。随而济之。安得无实。言补之则实也。调气之方。必
在阴阳者。阴虚阳实。则补阴泻阳。阳虚阴实。则补阳泻阴。或阳并于阴。阴并于阳。或阴阳俱虚。或阴阳俱实。皆随
病所往。而调其阴阳。则病无不已。虞曰。迎、取也。乃五行六气。各有胜复。假令木气有余之年。于王前先泻其化源。
玄珠密语曰。木之行胜也。苍埃先见于林木。木乃有声。宫音失调。 虫不滋。湿雨失合。先于十二月泻其化源。故曰
迎也。不足之年。补于化源。故曰随也。调气之方。必在阴阳者。言引外至内。引内至外也。谓月生无泻。月满无补。
定人之呼吸。观日之寒温。从阳引阴。从阴引阳。春夏致一阴。秋冬致一阳。故曰调气之方。必在阴阳也。知其内外表
里者。谓察脉之浮沉。识病之虚实。以外知内。视表如里。故曰。知其内外表里也。随其阴阳而调之者。谓各随病在何
阴阳脉中而调治之也。
七十三难曰。诸井者。肌肉浅薄。气少。不足使也。刺之奈何。然。诸井者、木也。荥者、火也。火者木之子。当
刺井者。以荥泻之。故经言补者不可以为泻。泻者不可以为补。此之谓也。
丁曰。诸井在手足指梢。故言肌肉浅薄也。井为木。是火之母。荥为火。是木之子。故肝木实。泻其荥。肝木气虚
不足。补其合。泻之复不能补。故言不可以为补也。杨曰。冬刺井。病在脏。取之应井。刺井者。则泻其荥。以去其病。
故经曰。冬阴气紧。阳气伏。故取井以下阴气。逆取荥以通阳气也。虞曰。不至而至。故春乃泻荥也。
七十四难曰。经言春刺井。夏刺荥。季夏刺俞。秋刺经。冬刺合者。何谓也。然。春刺井者邪在肝。夏刺荥者邪在
心。季夏刺俞者邪在脾。秋刺经者邪在肺。冬刺合者邪在肾。
丁曰。其言春刺井者。谓邪在肝。无令肝木邪害于脾土。故刺诸井也。夏刺荥者。谓邪在心。无令心火邪害于肺金。
故刺诸荥也。季夏刺俞者。谓邪在脾。无使脾土邪害于肾水。故刺诸俞也。秋刺经者。谓邪在肺。无令肺金邪害于肝木。
故刺诸经也。冬刺合者。谓邪在肾。无令肾水邪害于心火。故刺诸合也。此是断五邪之原法也。杨曰。用针微妙。法无
穷。若不深达变通。难以救疾者矣。至如此说。则是变通之义也。经云。冬刺井。春刺荥。此乃云春刺井。夏刺荥。理
极精奇。特宜留思。不可固守以一概之法也。虞曰。春刺井。夏刺荥。季夏刺俞。秋刺经。冬刺合。乃经之大法也。七
十三难。以言春刺于荥。此乃休王未毕。火夺木王。法曰实邪。故泻之于荥。所以经言泻者不可以为补也。
其肝、心、脾、肺、肾、而系于春夏秋冬者。何也。然。五脏一病辄有五也。假令肝病。色青者。肝也。臊臭者。
肝也。喜酸者。肝也。喜呼者。肝也。喜泣者。肝也。其病众多。不可尽言也。四时有数而并系于春夏秋冬者也。针之
要妙。在于秋毫者也。
丁曰。人之五脏系于四时。五脏一病辄有五者。谓五声、五色、五味、五液、五香、（按此二字疑衍。）五臭。若持
针者。皆能断其五邪。令中病原。故知针之要妙。在于秋毫。不可不通也。杨曰。五脏六腑病。各有形证。今略举肝家
一脏以为法尔。虽言春刺井。夏刺荥。若一脏有病。脉亦随之。诊而取之。假令肝自病。实则取肝中火泻之。虚则取肝
中木补之。余皆仿此。即秋毫微细之意也。言用针微细若秋毫矣。虞曰。五脏各有声色臭味液。以为形证。以合四时井
荥俞经合。而行补泻之法也。微妙之理。若秋毫之在目也。
七十五难曰。经言东方实。西方虚。泻南方。补北方。何谓也。然。金木水火土。当更相平。东方、木也。西方、
金也。木欲实。金当平之。火欲实。水当平之。土欲实。木当平之。金欲实。火当平之。水欲实。土当平之。东方肝也。
则知肝实。西方肺也。则知肺虚。泻南方火。补北方水。南方火。火者、木之子也。北方水。水者、木之母也。水胜火。
子能令母实。母能令子虚。故泻火补水。欲令金不得平木也。经曰。不能治其虚。何问其余。此之谓也。
丁曰。四方者。五行之正位也。其王应四时。即春应东方木。夏应南方火。秋应西方金。冬应北方水。长夏应中央
土。南方火实胜西方金。即北方水来复胜。火水且待争。反害于肺。今当先泻南方火。实即还北方水。肺金得平也。平
者、调四方虚实之法也。杨曰。五行以胜相加。故木胜土。金胜木。木、肝也。金、肺也。肺气虚弱。肝气强实。木反
凌金。金家不伏。欲来平木。金木若战。二脏则伤。故用针者。诊知其候。则须泻心。心气既通。肝气则复。又补于肾。
肾家得气。传而养肝。肝气已定。则肺不复来平肝。然后却补脾气。脾是肺母。母气传子。子便安定。故曰不能治其虚。
何问其余。此之谓也。一本说杨氏曰。金克木。今据肝家一条以例五脏。假令东方木肝实。西方金肺虚。肝木实凌肺金
虚。金本克木。木伏金。肝欲制肺。肺乃不伏。二脏争胜。反害于火。宜泻其心。心属火。火者木之子。子气既通。肝
虚则伏。肝气既复。则肺不复来。然后补其脾。脾是肺母。母气授子。子气便实。故言母能令子实。子能令母虚。不能
治其虚。何问其余。虞曰。五脏五行。更相平伏。宜凭补泻以调治之。素问曰。邪气盛则实。真气夺则虚。以下凡有虚
实。皆准此也。经言木实金虚。泻火补水也。夫木实者。谓木有余。则土遥畏之。土畏之。则金无所养而令金虚也。若
不泻火。火必盛而烁金。金乃仇雠于木。金木相胜。而致两相刑克。故泻火。火者木之子。子合母气。木亦不实。火亦
不平。金土亦无所畏。乃行气养于金也。金虚者。乃补水御火。补水养木。御火火不平金。养木木亦安复。故曰子能令
母实也。木有余。则土乃畏木。土不能传气与金。金乃虚。故曰母能令子虚也。
七十六难曰。何谓补泻。当补之时。何所取气。当泻之时。何所置气。然。当补之时。从卫取气。
虞曰。肺行五气。溉灌五脏。通注六经。归于百脉。凡取气须自卫取气。得气乃推内针于所虚之经脉浅深分部之。
所以补之。故曰。当补之时。从卫取气。此之谓也。
当泻之时。从荣置气。
虞曰。邪在荣分。故内针于所实之经。待气引针而泻之。故曰。当泻之时。从荣置气。置者、取也。迎也。
其阳气不足。阴气有余。当先补其阳。而后泻其阴。
虞曰。假令胆不足。肝有余。先补足少阳。而后泻足厥阴也。
阴气不足。阳气有余。当先补其阴。而后泻其阳。
虞曰。反于上法。
荣卫通行。此其要也。
杨曰。此是阴阳更虚更实之变。须通荣卫。病则愈也。丁曰。其当补之时。从卫取气。卫者、阳也。故从卫取气。
方其补也。当泻之时。从荣置气。荣者。阴也。故从荣置气。置荣而后泻之。阴阳有余不足。当先补其不足。然后泻其
有余。故得荣卫通行。即是持针之要妙。故言其要也。
七十七难曰。经言上工治未病。中工治已病者。何谓也。然。所谓治未病者。见肝之病。则知肝当传之与脾。故先
实其脾气。无令得受肝之邪。故曰治未病焉。中工治已病者。见肝之病。不晓相传。但一心治肝。故曰治已病也。
丁曰。素问曰。春胜长夏。长夏胜冬。冬胜夏。夏胜秋。秋胜春。此四时五行相胜之理也。人之五脏有余者行胜。
不足者受邪。上工先补不足。无令受邪。而后泻有余。此是治未病也。中工持针。即便泻有余。故言治已病也。杨曰。
五脏得病。皆传其所胜。肝病传脾之类是也。若当其王时。则不受传。即不须行此方也。假令肝病当传脾。脾以季夏王。
正王则不受邪。故不须实脾气也。若非季夏。则受肝邪。盒饭预令实脾气。勿令得受肝邪也。如此者。谓之上工。工、
犹妙也。言妙达病源者也。其中工未能全解。故止守一脏而已。
七十八难曰。针有补泻。何谓也。然。补泻之法。非必呼吸出内针也。
杨曰。补者呼则出针。泻者吸则内针。故曰呼吸出内针也。虞曰。谓用针补泻之法。呼吸取生成之数为之。
然知为针者信其左。不知为针者信其右。当刺之时。必先以左手厌按所针荣俞之处。弹而努之。爪而下之。其气之
Difficulty 69 states: The classic texts say that deficiency syndromes are treated with tonification, excess syndromes with sedation, and neither-deficiency-nor-excess syndromes are treated by selecting points from the affected meridian. What does this mean? The answer is: For deficiency, tonify its mother point; for excess, sedate its child point. One should tonify first, then sedate. "Neither-deficiency-nor-excess treated by selecting points from the affected meridian" means the meridian itself has become diseased without being invaded by external pathogenic factors. Therefore, one should directly select points from that meridian, hence the phrase "selecting points from the affected meridian."
Ding says: This difficulty first establishes the correspondence between the Five Shu points (Jing-Well, Ying-Spring, Shu-Stream, Jing-River, He-Sea) and the Five Elements. It explains that each of the Twelve Meridians has mother-child relationships governed by mutual generation. Only after this foundation is laid does it discuss acupuncture tonification and sedation techniques. For example, if the collateral of the Foot-Jueyin Liver Meridian is deficient, one should tonify the He-Sea point of the Foot-Jueyin Meridian, which is the mother point. If it is in excess, one should sedate the Ying-Spring point, which is the child point. If there are no other pathogens, one should treat the meridian itself, hence "selecting points from the affected meridian."
Yang says: In spring, obtaining a Kidney pulse indicates a false deficiency syndrome. This is because Kidney deficiency fails to transmit Qi to the Liver. Thus, one tonifies the Kidney. Since Kidney disease transmits to the Liver, and the Liver is the child of the Kidney, it is said "tonify its mother." In spring, obtaining a Heart pulse indicates a false excess syndrome. This is because Heart Qi is excessive and counter-attacks the Liver. Thus, one sedates the Heart. When Heart Qi is balanced, Liver Qi flows freely. Since the Liver is the mother of the Heart, it is said "sedate its child." Neither-deficiency-nor-excess means there is no pathological overacting among the Zang organs. In spring, a pulse that is predominantly wiry or merely wiry indicates a self-originating disease of the Liver. Treatment should involve tonification and sedation on the Foot-Jueyin and Foot-Shaoyang meridians. Since the meridians contain Metal, Wood, Water, Fire, and Earth energies, points should be selected according to the season.
Difficulty 70 states: The classic texts say that in spring and summer, needling should be shallow, while in autumn and winter, it should be deep. What does this mean? The answer is: In spring and summer, Yang Qi is superior and resides in the upper body, and human Qi also tends upward. Therefore, needling should be shallow. In autumn and winter, Yang Qi descends and resides in the lower body, and human Qi also tends downward. Therefore, needling should be deep.
Ding says: Shallow needling in spring/summer and deep needling in autumn/winter refers to the classic statement that in spring and summer, one needles the Jing-Well and Ying-Spring points at shallow muscular areas, while in autumn and winter, one needles the Jing-River and He-Sea points at deeper muscular areas. This is adapting to the time and the location of Qi.
Yang says: The classic texts state that Spring Qi is in the hair follicles, Summer Qi in the skin, Autumn Qi in the muscle layers, and Winter Qi in the sinews and bones. These are the characteristics of the Four Seasons' Qi. Diseases contracted during these seasons vary according to the depth of the healthy Qi. Therefore, when using acupuncture, one must select points based on the depth of the seasonal Qi.
"In spring and summer, one must introduce Yin Qi; in autumn and winter, one must introduce Yang Qi." What does this mean? The answer is: In the warm seasons of spring and summer, one must introduce Yin Qi. Upon initial insertion, press deeply to the level of the Kidney and Liver regions. Upon obtaining Deqi (arrival of Qi), hold and draw back slightly; this engages Yin Qi.
Yu says: The classic texts say "nourish Yang in spring and summer," meaning one takes Yin Qi to nourish Yang, preventing the formation of isolated Yang. "Zhi" (introduce/reach) means to arrive at or involve. Reaching the Kidney and Liver levels allows one to engage the Yin Qi, as the Liver and Kidneys belong to Yin.
In the cold seasons of autumn and winter, one must introduce Yang Qi. Upon initial insertion, press lightly and superficially to the level of the Heart and Lung regions. Upon obtaining Deqi, push the needle inward; this engages Yang Qi.
Yu says: The classic texts say "nourish Yin in autumn and winter." When Yin Qi is dominant, without Yang Qi to nourish it, isolated Yin may form. Therefore, one takes Yang Qi to nourish Yin. The Heart and Lungs belong to Yang, hence reaching their levels.
This is called "in spring and summer, one must introduce Yin Qi; in autumn and winter, one must introduce Yang Qi."
Yang says: Insertion to a depth of three fen corresponds to the Heart and Lung regions, where Yang Qi circulates. Insertion to five fen corresponds to the Kidney and Liver regions, where Yin Qi circulates. Yang represents Wei (Defensive) Qi, and Yin represents Ying (Nutritive) Qi. In spring and summer, diseases manifest in the Yang aspect, so one introduces Yin to harmonize Yang. In autumn and winter, diseases manifest in the Yin aspect, so one introduces Yang to harmonize Yin.
Yu says: Yang's annotation regarding three fen for Heart/Lung and five fen for Kidney/Liver comes from the *Xuanzhu Mi Yu* (Mysterious Pearl Secret Language), discussing the division of Heaven and Earth Qi, hence the theory of three and five fen.
Ding says: Human flesh and skin have varying thicknesses. Above the skin lies the Heart and Lung region, the pathway of Yang Qi. Below the muscle lies the Kidney and Liver region, the pathway of Yin Qi. In spring and summer, Yang Qi rises and dominates; the needle technique involves deep insertion ("chen") to the Kidney/Liver level. Upon obtaining Deqi, one draws back to engage Yin Qi to harmonize Yang Qi, hence "spring and summer must introduce Yin Qi." In autumn and winter, Yin Qi descends; the needle technique involves superficial insertion ("fu") to the Heart/Lung level. Upon obtaining Deqi, one pushes the needle in to engage Yang Qi to harmonize Yin Qi, hence "autumn and winter must introduce Yang Qi." Thus the classic text says: "Spring and summer must introduce Yin Qi; autumn and winter must introduce Yang Qi."
Difficulty 71 states: The classic texts say "Needle the Ying [Nutritive] without injuring the Wei [Defensive]; needle the Wei without injuring the Ying." What does this mean? The answer is: To needle Yang (Wei), use a horizontal (oblique) insertion. To needle Yin (Ying), first press the Ying-Stream or Shu-Stream point with the left hand until the Qi disperses, then insert the needle. This is "needling Ying without injuring Wei, and needling Wei without injuring Ying."
Ding says: Ying is Yin, Wei is Yang; they are exterior-interior pairs. Horizontal needling avoids injuring Ying. Pressing the acupoint with the left hand before needling Ying disperses Wei Qi to avoid injuring it.
Yang says: Three fen depth is where Wei Qi resides. If the disease is in Wei, needling should be shallow, hence horizontal insertion, to avoid deep injury to Ying Qi. Five fen depth is where Ying Qi resides. One presses the point first and waits for Qi to disperse before inserting, to avoid injuring Wei Qi.
Yu says: The Three Yin and Three Yang meridians govern Qi and Blood, but their quantities vary. Thus, the Sages taught needling methods to ensure no injury to Ying and Wei. The *Lingshu* chapter "Blood, Qi, Form, and Spirit" states: Taiyang has much blood and little Qi; Shaoyang has little blood and much Qi; Yangming has much Qi and much blood; Jueyin has much blood and little Qi; Shaoyin has much Qi and little blood; Taiyin has much Qi and little blood. Qixuanzi notes that the quantity of Qi and Blood is a constant of Heaven. Therefore, in needling, one often sedates the excess.
Difficulty 72 states: The classic texts say "To know the Qi of Ying (meeting/opposing) and Sui (following) allows for regulation." What does this mean? The answer is: "Ying Sui" refers to knowing the circulation of Ying and Wei and the flow of the meridians. Selecting points against or with the direction of flow is called Ying Sui. Regulation of Qi must lie in Yin and Yang. Knowing the interior/exterior and superficial/deep relationships, and regulating according to Yin and Yang, is why it is said "regulation of Qi must lie in Yin and Yang."
Ding says: Ying and Wei circulate through the Twelve Meridians, having a beginning and an end. Flow starts from the Middle Jiao into the Hand-Taiyin meridian, then to Hand-Yangming. There are twenty-four meridians corresponding to twenty-four hours of the day. Needling at the start of Qi flow is called "Ying Er Duo Zhi" (Opposing and Depriving/Sedating). Needling at the end of Qi flow, pressing the point upon withdrawal, is called "Sui Er Ji Zhi" (Following and Assisting/Tonifying). Tonifying the mother is also "Sui Er Bu Zhi"; sedating the child is "Ying Er Duo Zhi." Coordinating needle movement with respiration is also Ying Sui. This is the method of regulating Yin and Yang, hence "must lie in Yin and Yang."
Yang says: Ying Qi circulates continuously. Wei Qi travels the body by day and the Zang organs by night. "Ying" means opposing (against); "Sui" means following (with). Wei Qi moves against the flow, Ying Qi moves with the flow. If the disease is in Yang, wait for Ying and Wei to reach the Yang aspect before needling. If in Yin, wait for them to reach the Yin aspect. This is the meaning of Ying Sui. Furthermore, Ying means sedation, and Sui means tonification. Hence, "Ying Er Duo Zhi" leads to emptiness (sedation causes deficiency); "Sui Er Ji Zhi" leads to fullness (tonification causes excess). Regulating Qi lies in Yin and Yang: if Yin is deficient and Yang is excess, tonify Yin and sedate Yang; if Yang is deficient and Yin is excess, tonify Yang and sedate Yin. Whether Yang merges into Yin, Yin into Yang, both deficient, or both excess, one regulates Yin and Yang according to the disease's progression, ensuring recovery.
Yu says: "Ying" means to take. The Five Elements and Six Qi have winning and overcoming cycles. In a year of excess Wood Qi, one sedates the source of transformation before the ruling season. *Xuanzhu Mi Yu* states: When Wood overacts, dust appears on trees, wood makes sound, Gong pitch is discordant, insects fail to thrive, and rain is imbalanced. One sedates the source in the twelfth month, hence "Ying." In years of deficiency, one tonifies the source, hence "Sui." Regulating Qi lies in Yin and Yang, meaning guiding from outside to inside and inside to outside. Do not sedate during moon waxing; do not tonify during moon waning. Regulate breath, observe temperature, guide Yin from Yang and Yang from Yin, introduce Yin in spring/summer and Yang in autumn/winter. Knowing interior/exterior means observing pulse floating/sinking and disease deficiency/excess, knowing the inside from the outside, seeing the surface as the interior. Regulating according to Yin and Yang means treating based on which Yin/Yang meridian is affected.
Difficulty 73 states: The Jing-Well points are in thin flesh with little Qi, insufficient for treatment. How should they be needled? The answer is: Jing-Well points belong to Wood; Ying-Spring points belong to Fire. Fire is the child of Wood. When needling a Jing-Well point, one should sedate via the Ying-Spring point. Thus, the classic text says tonification cannot be used as sedation, nor sedation as tonification.
Ding says: Jing-Well points are at the tips of fingers and toes, hence thin flesh. Jing is Wood, mother of Fire; Ying is Fire, child of Wood. If Liver Wood is excess, sedate its Ying point. If Liver Wood is deficient, tonify its He-Sea point. Sedation cannot tonify, hence "cannot be used as tonification."
Yang says: Winter needling of Jing-Well points treats Zang diseases. Needling Jing requires sedating the Ying point to remove the disease. Winter Yin Qi is tight, Yang Qi is latent. Jing points descend Yin Qi; Ying points (counter-flow) open Yang Qi.
Yu says: "Not arriving yet arriving," hence sedating Ying in spring.
Difficulty 74 states: The classic texts say "Spring needle Jing-Well, Summer needle Ying-Spring, Late Summer needle Shu-Stream, Autumn needle Jing-River, Winter needle He-Sea." What does this mean? The answer is: Spring needling of Jing-Well targets pathogens in the Liver; Summer Ying-Spring targets the Heart; Late Summer Shu-Stream targets the Spleen; Autumn Jing-River targets the Lungs; Winter He-Sea targets the Kidneys.
Ding says: Spring Jing-Well prevents Liver Wood from harming Spleen Earth. Summer Ying-Spring prevents Heart Fire from harming Lung Metal. Late Summer Shu-Stream prevents Spleen Earth from harming Kidney Water. Autumn Jing-River prevents Lung Metal from harming Liver Wood. Winter He-Sea prevents Kidney Water from harming Heart Fire. This cuts off the origin of the Five Pathogens.
Yang says: Acupuncture is subtle and infinite. Without understanding variation, one cannot cure disease. This approach reflects adaptability. The classic text mentions "Winter Jing, Spring Ying," but here it says "Spring Jing, Summer Ying." The logic is exquisite; one must ponder it and not rigidly adhere to a single method.
Yu says: Spring Jing, Summer Ying, etc., are major principles. Difficulty 73 mentions sedating Ying in spring because the Wood ruling phase is ending and Fire is taking over (excess pathogen), so one sedates at Ying. Hence, sedation cannot be tonification.
Why are Liver, Heart, Spleen, Lung, and Kidney linked to Spring, Summer, Late Summer, Autumn, and Winter? The answer is: Each Zang organ disease manifests in five ways. For example, Liver disease: green color indicates Liver; fishy odor indicates Liver; craving sour taste indicates Liver; desire to shout indicates Liver; desire to weep indicates Liver. Diseases are numerous. The Four Seasons have fixed numbers linked to the seasons. The essence of needling lies in subtlety like an autumn down feather.
Ding says: The Five Zang are linked to the Four Seasons. "Five manifestations per disease" refer to voice, color, taste, fluid, fragrance, and smell. A skilled practitioner can diagnose the Five Pathogens and hit the source. Thus, the essence of needling is in the minutiae.
Yang says: Each Zang/Fu has specific signs. Taking Liver as an example: although Spring needles Jing and Summer needles Ying, if one Zang is diseased, the pulse changes accordingly. Diagnose and treat accordingly. If Liver is self-diseased, excess requires sedating Fire within Liver; deficiency requires tonifying Wood within Liver. This applies to others, reflecting the "autumn down feather" subtlety.
Yu says: The Five Zang have voice, color, smell, taste, and fluids as signs, corresponding to the Five Shu points across seasons for tonification/sedation. The profound principle is like seeing an autumn down feather clearly.
Difficulty 75 states: The classic texts say "East is Excess, West is Deficient; Sedate South, Tonify North." What does this mean? The answer is: Metal, Wood, Water, Fire, and Earth should balance each other. East is Wood; West is Metal. If Wood is excess, Metal should balance it. If Fire is excess, Water should balance it. If Earth is excess, Wood should balance it. If Metal is excess, Fire should balance it. If Water is excess, Earth should balance it. East is Liver (Excess); West is Lung (Deficient). Sedate South (Fire), Tonify North (Water). Fire is the child of Wood; Water is the mother of Wood. Water overcomes Fire. The child can make the mother excess; the mother can make the child deficient. Thus, sedating Fire and tonifying Water aims to prevent Metal from balancing Wood. The classic says: "If you cannot treat the deficiency, what else is there to ask?"
Ding says: The Four Directions are the proper positions of the Five Elements. Spring-East-Wood, Summer-South-Fire, Autumn-West-Metal, Winter-North-Water, Late Summer-Center-Earth. If South Fire is excess and overcomes West Metal, North Water should counter-act. Fire and Water contend, harming the Lung. Therefore, first sedate South Fire. Once excess is resolved, North Water returns, and Lung Metal is balanced. "Balancing" is the method of regulating directional excess/deficiency.
Yang says: Five Elements interact via overcoming. Wood overcomes Earth; Metal overcomes Wood. Metal (Lung) is weak; Wood (Liver) is strong. Wood bullies Metal. Metal refuses to submit and tries to balance Wood. If Metal and Wood war, both organs are injured. The acupuncturist diagnoses and sedates the Heart. Once Heart Qi flows, Liver Qi recovers. Then tonify the Kidney. Kidney Qi nourishes Liver. Once Liver is stable, Lung no longer attacks. Finally, tonify the Spleen. Spleen is Lung's mother; Mother transmits to Child, stabilizing the Child. Hence, "If you cannot treat the deficiency..."
Another version of Yang says: Metal overcomes Wood. Using Liver as an example: East Wood (Liver) is excess; West Metal (Lung) is deficient. Wood bullies Metal. Metal normally overcomes Wood, but Wood subdues Metal. Liver wants to control Lung, but Lung resists. They contend, harming Fire. Sedate Heart (Fire, child of Wood). Once Child Qi flows, Liver becomes deficient/subdued. Once Liver recovers, Lung stops attacking. Tonify Spleen (Mother of Lung). Mother transmits to Child, making Child excess. Hence, "Mother makes Child excess; Child makes Mother deficient."
Yu says: The Five Zang and Five Elements balance each other via tonification/sedation. *Suwen* states: "Excess of pathogenic Qi is Excess; loss of True Qi is Deficiency." All deficiency/excess follow this. "Wood excess, Metal deficient" means treating via sedating Fire and tonifying Water. Wood excess means Wood is surplus, causing Earth to fear it. Earth fears Wood, so Metal lacks nourishment and becomes deficient. If Fire is not sedated, it burns Metal. Metal becomes hostile to Wood. Metal and Wood clash, damaging both. Sedating Fire (child of Wood) combines with Mother Qi, reducing Wood's excess. Fire is no longer unbalanced. Metal and Earth are no longer feared, allowing Qi to nourish Metal. Metal deficiency requires tonifying Water to control Fire. Tonifying Water nourishes Wood. Controlling Fire prevents it from harming Metal; nourishing Wood stabilizes Wood. Hence, "Child makes Mother excess." Wood excess makes Earth fear Wood; Earth cannot transmit Qi to Metal, causing Metal deficiency. Hence, "Mother makes Child deficient."
Difficulty 76 states: What is tonification and sedation? When tonifying, where is Qi taken? When sedating, where is Qi placed? The answer is: When tonifying, take Qi from Wei (Defensive).
Yu says: Lung distributes Five Qi to nourish the Five Zang and six Fu meridians. Taking Qi must begin from Wei. Upon obtaining Deqi, push the needle into the deficient meridian at the appropriate depth for tonification. Hence, "When tonifying, take Qi from Wei."
When sedating, place Qi in Ying (Nutritive).
Yu says: Pathogens are in the Ying level. Insert the needle into the excess meridian. Wait for Qi to guide the needle to sedate. Hence, "When sedating, place Qi in Ying." "Zhi" means to take or oppose.
If Yang is deficient and Yin is excess, tonify Yang first, then sedate Yin.
Yu says: For example, Gallbladder deficiency and Liver excess: first tonify Foot-Shaoyang, then sedate Foot-Jueyin.
If Yin is deficient and Yang is excess, tonify Yin first, then sedate Yang.
Yu says: Reverse the above method.
The free circulation of Ying and Wei is the key.
Yang says: This is the variation of alternating Yin/Yang deficiency and excess. One must understand Ying and Wei for recovery.
Ding says: When tonifying, take Qi from Wei (Yang). When sedating, place Qi in Ying (Yin). Place in Ying then sedate. For Yin/Yang excess/deficiency, tonify deficiency first, then sedate excess. This ensures Ying and Wei circulation, the essence of holding the needle. Hence, "the key."
Difficulty 77 states: The classic texts say "Superior physicians treat disease before it arises; average physicians treat disease after it has arisen." What does this mean? The answer is: Treating before it arises means seeing Liver disease and knowing it will transmit to the Spleen, so one first strengthens Spleen Qi to prevent Spleen from receiving Liver pathogens. This is "treating before it arises." Average physicians see Liver disease, do not understand transmission, and only treat the Liver. This is "treating after it has arisen."
Ding says: *Suwen* states the cycle of Five Elements overcoming. Organs with excess overcome; organs with deficiency receive pathogens. Superior physicians tonify deficiency first to prevent pathogen reception, then sedate excess. This is treating before it arises. Average physicians immediately sedate excess, treating after it has arisen.
Yang says: Diseased Zang organs transmit to those they overcome (e.g., Liver to Spleen). If the target organ is in its ruling season, it does not receive transmission, and this method is unnecessary. If Liver disease transmits to Spleen, and Spleen rules in Late Summer, it is immune. If not Late Summer, Spleen receives Liver pathogens; one must pre-strengthen Spleen Qi. This is a "Superior Physician" (one who profoundly understands disease origins). Average physicians lack this understanding and treat only the affected Zang.
Difficulty 78 states: Acupuncture has tonification and sedation. What does this mean? The answer is: Tonification and sedation methods do not necessarily rely on respiration and needle withdrawal/insertion.
Yang says: Tonification involves withdrawing the needle on exhalation; sedation involves inserting the needle on inhalation. Hence, "respiration and needle movement."
Yu says: Respiration is used to determine the numerical values of generation and completion in needling techniques.
However, a skilled acupuncturist relies on the left hand, while an unskilled one relies on the right hand. At the time of needling, one must first press the Ying-Stream or Shu-Stream point with the left hand, tap and distend it, mark it with the nail, and then insert. The arrival of Qi...