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[Ping An Note]: This chapter, from the beginning to the end, is found in *Ling Shu* (Spiritual Pivot), Volume 11, Chapter 75, "Needling of Joint True Evil". Additionally, from "Huang Di said: I have heard that needling involves five types of evil" to "true qi remains", it is found in *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion), Volume 5, Section 2. From "Please allow me to explain and discuss" to "this is what is called leading it downwards", it is found in *Jia Yi Jing*, Volume 7, Section 3. From "Great heat pervading the body" to "this is what is called pushing and dispersing it", it is found in *Jia Yi Jing*, Volume 7, Section 2. From "Huang Di said: When one meridian gives rise to dozens of diseases" to the end, it is found in *Jia Yi Jing*, Volume 10, First Lower Compilation. Only from "At that time, those skilled in moving water" onwards to the end were missing in Yuan's edition and other manuscript copies. Here, they have been retrieved and supplemented from thirteen sheets of a fragmentary volume collected from the Imperial Palace of Reika-ji Temple in Japan. The original text and Yang Shangshan's annotations are complete again, which is truly precious.

Huang Di said: I have heard that needling addresses five types of evil (referring to five different natures of pathogenic factors: carbuncle, excessive enlargement, narrowing/shrinking, heat, and cold). What are these five types of evil? Qi Bo said: There are cases where the disease progresses rapidly and forms a carbuncle (Yong); there are cases where the pathogen is excessive and voluminous; there are cases where the pathogen is slight and contracted; there are cases dominated by Heat Evil; and there are cases dominated by Cold Evil. These are called the five types of evil. Huang Di said: How should one needle these five types of evil? Qi Bo said: The methods for needling the five types of evil can be divided into five chapters: Duan Re (severe heat) is eliminated, swelling and accumulation dissipate, Cold Bi (Cold obstruction) is warmed, the contracted type benefits from increased Yang, and the excessive type has its excess removed. Please allow me to elaborate on these methods. (These five methods must be treated as separate chapters. Duan refers to a heat disease, pronounced 'Dan'. Ping An: In *Ling Shu* and *Jia Yi Jing*, "Shi Yong" is written as "Chi Yong". In *Jia Yi Jing*, the characters "Rong" and "Xia" are absent in "You Rong Da Zhe" and "You Xia Xiao Zhe".)

When needling Carbuncle Evil, do not attack against its peak of Qi and Blood abundance (Long, meaning great abundance; when a carbuncle is at its peak and about to suppurate, one must not attack directly to drain it). One must change conventional practices to alter its nature, preventing suppuration, employing unorthodox methods, moving away from its location, making it unstable in its place so that it dissipates. (Change its customary laws and habits, alter its inherent cold-warm nature, re-evaluate the location of pus, adjusting up-down and center-periphery until the correct position is found. Thus it is said to leave its locality and become unstable in its place, causing the disease to dissipate. Ping An: The character "Gui" is written as "Cui" in *Ling Shu* and "Yue" in *Jia Yi Jing*. The character "Xing" is not repeated in *Ling Shu* and *Jia Yi Jing*. The character "Chu" is missing in Yuan's edition. The note "Chu Yi" is likely a scribal error for "Yi Chu".) For all Yin and Yang meridians passing through the site of the carbuncle, select the Shu (Stream) points and apply draining methods. (For all Yin and Yang meridians passing through the carbuncle site, one may select the Shu points associated with the carbuncle's pathway and drain them. Ping An: "Guo" is written as "Yu" in *Jia Yi Jing*. The character "Suo" is missing after "Yong" in *Ling Shu*.)

When needling Excessive Evil (Excess Pathogen), use minor draining techniques to reduce the excess, thereby benefiting the deficiency and restoring harmony. Master the technique of the needle to interact with the pathogen while keeping the muscle tissue close. (Excessive Evil is an Excess Pathogen; applying draining methods is easier, hence minor draining is used to reduce excess and restore harmony. Regarding needle technique, one must be cautious and solemn, using the needle to address the pathogen so that the pathogen leaves and the muscles adhere. "Qin" means adherence. Ping An: After "Da Xie", *Jia Yi Jing* adds "use Feng Zhen (Sharp Needle)". In *Ling Shu*, "Qi Dao" is written as "Piao Qi Tong". In *Jia Yi Jing*, a certain character is written as "Biao". *Ling Shu* and *Jia Yi Jing* lack the character "Gan"; Yuan's edition writes it as "Yu", consistent with the note.) Observe until no pathogen remains, then return to the true Qi and stop. (Observe that the pathogen is gone, and only when the true Qi returns should one stop. Ping An: "Fan Qi Zhen" is written as "Nai Zi Zhen Dao" in *Jia Yi Jing*.) Needle between the muscles of the Yang meridians. (This needles the location of the Excessive Evil.)

When needling Contracted Evil (Deficiency Pathogen), use major tonifying methods to supplement the deficiency, ensuring no harm. (Contracted Evil is a Deficiency Pathogen; applying tonifying methods is difficult, hence major tonification is used to make it substantial. Ping An: After "Xiao Xie", *Jia Yi Jing* adds "use Yuan Li Zhen (Round-Blunt Needle)". After "Bu", *Jia Yi Jing* adds "Yi".) Observe its location and meet its boundary; draw Qi from near and far until full, without allowing leakage outward. (Boundary refers to the edge. Observe the boundary of deficiency and excess, measure the distance of true Qi, and must guide it to the deficient area to make it substantial, preventing outward leakage. Ping An: The note originally lacked "Xu", but Yuan's edition mistakenly left four spaces blank.) If one invades beyond this point, it will self-damage. (Invade means exceeding limits. Tonification must be sufficient; stop when achieved. Over-tonification damages Zheng Qi. "Fei" means damage. Ping An: "Fei" is written as "Gui" in *Jia Yi Jing*, with the note saying: alternatively "Fei".) Needle between the muscles. (This needles the location of the Contracted Evil.)

When needling Heat Evil, use the "Yue Er Cang" method, allowing the heat to travel out and not return, resulting in no disease. Open the pathways for it. (The method for treating heat is to drain and let the Qi escape, feeling cool, so the heat does not return, and the disease heals. Ping An: After "Re Xie", *Jia Yi Jing* adds "use Pi Zhen (Needle-like Knife)". "Cang" is written as "Cang" in *Ling Shu*; "Kai Dao" is written as "Kai Tong". The note lacks "Zou"; Yuan's edition omits "Zou". One character was missing before "Jue", tentatively supplied as "Bian".) Open the gates, allowing the pathogen to exit quickly, and the disease ceases. ("Pi" means open. Ping An: "Pi" is written as a specific character in *Jia Yi Jing*.)

When needling Cold Evil, use daily warming methods. Enter slowly and withdraw quickly to preserve Shen (Spirit). Close the gates so Qi does not scatter, harmonizing deficiency and excess so true qi remains. (The method for treating cold is to warm daily, enter slowly, and once warmth is achieved, withdraw quickly to preserve Shen Qi. Ping An: After "Han Xie", *Jia Yi Jing* adds "use Hao Zhen (Horse Needle)". "Ji Qu" is written as "Xu Lai" in *Ling Shu*.)

Huang Di said: How are the Official Needles (Nine Needles) used? Qi Bo said: For carbuncles, use the Pi Zhen (Needle-like Knife); for excessive conditions, use the Feng Zhen (Sharp Needle); for contracted conditions, use the Yuan Li Zhen (Round-Blunt Needle); for heat conditions, use [missing character, likely a specific needle]; for cold conditions, use the Hao Zhen (Horse Needle). (Among the Nine Needles, using these five for the five evils is appropriate. Ping An: *Jia Yi Jing* lacks this paragraph.)

Please allow me to explain and discuss. This corresponds to Heaven and Earth, parallels the Four Seasons, and humans participate in Heaven and Earth, thus explanations are possible. (Humans follow Heaven and Earth, thus explanations are possible. Humans correspond to the numbers of Heaven and Earth, thus I ask to explain.) Where there is dampness below, reeds and rushes grow above; this indicates how to know the degree of Form and Qi. (Ru, pronounced 'Ru Ju'. Jian Ru refers to moist air. Observing the lushness or withering of reeds and rushes reveals the degree of moisture; observing the strength or weakness of human form reveals the prosperity or decline of Blood and Qi.)

Yin and Yang correspond to Cold and Heat. In heat, growth occurs upwards, and roots/stems have little juice. Human Qi moves outward; skin relaxes, pores open, Blood and Qi leak, sweat pours heavily, and flesh becomes soft and glossy. (Spring and Summer are Yang and Hot. Plant Yang Qi nourishes branches and leaves, leaving stems and roots with little juice. 'Jing' means stem. Some interpret root-stem as leaf, which is incorrect. Similarly in humans, Qi overflows outward, skin and pores open, heavy sweat is excreted, and internal Blood and Qi are depleted. Ping An: *Ling Shu* and *Jia Yi Jing* add "Yu" after "Zi". 'Jing' is written as 'Jing' in *Jia Yi Jing*, noting *Ling Shu* uses a different character.)

In cold, the ground freezes and water turns to ice. Human Qi moves inward; skin tightens, pores close, sweat does not appear, Blood and Qi become strong, and flesh becomes firm and dry. (Autumn and Winter are Yin and Cold. Yang Qi descends, Cold Qi stays on the ground. Ground freezes, water turns to ice; human Qi behaves similarly. Warm Qi enters the Zang organs, Yin Qi remains in the skin, so pores close, Blood... Qi... flesh becomes firm and dry. Ping An: The following section was retrieved and supplemented from a fragment.)

At that time, those skilled in moving water cannot flow over ice; those skilled in digging earth cannot drill frozen soil; those skilled in needling also cannot treat Si Jue (Four Extremities Cold); and if the vessels are knotted, firm, and pulsating without flow, they cannot immediately be made soft. (Water flows, hence 'moving'; water can move but ice cannot flow. In winter... cold pulse... flesh... thus needling is not performed... drilling causes cold to emerge... needling injures muscle and breaks flesh, adding other diseases, is this not sad! Si Jue refers to the four limbs... in winter. Ping An: "Chuan Di" is written as "Qiong Di" in *Jia Yi Jing*; "Si Jue" is written as "Si Ni". "Er Mai Ning Jie" is written as "Xue Mai Ning Jie" in *Ling Shu* and *Jia Yi Jing*. *Jia Yi Jing* writes "Wei Ke" as "Bu Ke".)

Therefore, those who move water must wait for warm weather, melting ice and thawing frost, so water can flow and earth can be dug. Human vessels are similar. To treat Jue, one must first moxa/heat-compress to harmonize the meridians, often treating the armpits, elbows, feet, neck, and spine to regulate them. Once Fire Qi passes and blood vessels flow, then observe the disease. If vessels are soft and glossy, needle to level them. (If moving water or digging earth, one must wait for Spring and Summer. In winter, if needling is necessary, use cloths soaked in ginger, pepper, cinnamon, and wine to heat-compress the meridians until they are soft and harmonious, then proceed. Key areas for heat-compression include both palms, armpits, elbows, knees, neck, spine, and other important meridian pathways. Ping An: *Jia Yi Jing* adds "Qiong Di Zhe Bi Dai" before "Dong Jie"; removes "Shui Ke Xing" after "Er"; writes "Chuan" as "Qiong"; adds "Huo Yi" after "Yu". "Chang" is written as "Zhang" in *Ling Shu* and *Jia Yi Jing*; based on the note, it should be "Zhang", likely a copying error. "Yi Tiao Zhi" is written as "Yi Tiao Qi" in *Jia Yi Jing*. "Huo Qi Tong" is written as "Huo Qi Yi Tong" in *Ling Shu* and "Da Dao Yi Tong" in *Jia Yi Jing*.) If firm and tight, break and disperse them. Stop when Qi descends; this is called resolving knots. (Disease firmness and tightness are due to... break and disperse... due to... meridian. Ping An: "San Zhi" is written as "Jue Zhi" in *Jia Yi Jing*.)

The essence of needling lies in regulating Qi. (If Qi is not regulated, disease arises; thus treatment lies in regulating Qi.) Qi accumulates in the Stomach to connect Ying (Nutrient) and Wei (Defensive) Qi, each following its own path. (Stomach receives water and grain, generating Qi, so water-grain Qi accumulates here. Wei Qi originates from... of the Stomach; Ying Qi originates from the inner opening of the Stomach. Ying circulates within the vessels, Wei circulates outside. Now, using needling to regulate Stomach Qi connects Ying and Wei, allowing each to follow its path.) Zong Qi (Gathering Qi) remains in the Sea (Chest). Its lower part flows into the Qi Street (Qichong). (Grain enters the Stomach; clear Qi ascends to the Lungs, turbid Qi flows down to the Stomach. Stomach Qi exits via the mouth as belching. Lung Zong Qi accumulates in the Qi Sea, which is the pulsating Qi in the chest. The descending pulsating Qi flows into the Qi Street, generating Lung vessels. Ping An: *Jia Yi Jing* writes "Liu Yu Hai" as "Liu Ji Zai Hai".) Its upper part travels to the Xi Dao (Respiratory Pathway). (Clear Qi of the Lungs accumulated in the Sea travels to the Respiratory Pathway for breathing. Ping An: *Jia Yi Jing* writes "Shang Xing Zhe Zhu Yu Xi Dao".)

Thus, if Jue is in the feet, Zong Qi does not descend, and Blood in the vessels coagulates and stops. Without Fire regulation, it cannot be treated. (Jue means cold extremities. Chest pulsating Qi does not circulate down to the feet via vessels, hence it coagulates and stops. In winter, without Fire regulation, one cannot needle. Ping An: "Ning Er Zhi" is written as "Ning Er Liu Zhi" in *Ling Shu* and *Jia Yi Jing*. *Jia Yi Jing* writes "Fu Neng Qu Zhi" as "Zhen Fu Neng Qu".)

One who needsles must first examine the deficiency and excess of the meridians, palpate and trace them, press and flick them, observe changes, and only then needle to drain. (The method of needling requires first examining meridian deficiency/excess. If excess, palpate and trace the pulse; if deficiency, press the needling site and flick with fingers, observe changes, then needle to drain. Ping An: "Qie Ru Xun Zhi" is written as "Qie Er Xun Zhi" in *Ling Shu* and *Jia Yi Jing*. "Bian Dong" is written as "Ying Dong" in *Ling Shu* and *Jia Yi Jing*. *Ling Shu* adds "Zhi" after "Qu Xia".)

If the Six Meridians are harmonious, it is called no disease. Even if diseased, it is called self-healing. (Three Yang and Three Yin Six Meridians are compatible; disease cannot arise. Even if external pathogens cause disease, it must self-heal.) If one meridian has excess above and deficiency below without connection, there must be transverse collaterals (Heng Luo) that are excessive and obstructing the main meridian, causing blockage. Observe and drain them; this is called resolving knots. (One meridian refers to any of the Twelve Meridians. Main meridians run up and down the body, hence "longitudinal". Collaterals branch sideways, hence "transverse". If the main meridian has excess above and deficiency below, it must be that transverse collaterals received pathogen, became excessive, and obstructed the main meridian. One must observe and drain them, hence resolving knots. Ping An: *Jia Yi Jing* adds "Tong Er Jue Zhi" after "Xie".)

Upper Cold and Lower Heat: First needle the Taiyang meridian of the neck, retain the needle for a long time. Then heat-compress the neck and shoulder blades, allowing heat to merge downward, then stop. This is called pushing upwards. (Upper Cold means cold above the waist. Lower Heat means heat below the waist. Neck Taiyang refers to the Taiyang meridian. Retaining the needle pushes heat upward. Since heat gathers in the shoulders and neck, it must be harmonized, hence heat-compress to push it down. Pushing heat up is called pushing upwards. Ping An: "Yi Ze Yu" is written as "Yi Ci Ze Yu" in *Ling Shu* and "Yi Ci Ze Huo Yu" in *Jia Yi Jing*. In *Jia Yi Jing* note, "He" is written as "Leng" in another version.)

Upper Heat and Lower Cold: Observe deficiency pulses sinking into the meridians and select them. Stop when Qi descends; this is called leading downwards. (Heat above waist, cold below waist. Observe deficiency pulses sinking into other meridians and collaterals below the waist. Retain needle to make Qi descend, then stop, hence leading downwards. Ping An: "Xian Xia" is written as "Xian Zhi" in *Ling Shu*.)

Great heat pervading the body, mania with hallucinations (seeing, hearing, speaking falsely): Observe Foot-Yangming and major collaterals and select them. (Foot-Yangming governs Qi, its Qi is strong. Mania and hallucinations often stem from this meridian, hence select Yangming main and collateral meridians to remove it. Ping An: "Kuang Er Wang Jian..." is written as "Gu Kuang Yan Er Wang Jian..." in *Jia Yi Jing*.)* Deficient types are tonified; Blood-excess types are drained. Have the patient lie supine, position yourself before their head, press the carotid artery (Renying) with four fingers of both hands for a long time, roll and press/push downwards to the Quepen (Clavicle fossa), then repeat upwards as before. Stop when heat dissipates; this is called pushing and dispersing. (...Foot-Yangming upper excess lower deficiency causes mania... tonify lower deficiency meridian. Upper blood collaterals are excessive and solid; one may needle to bleed and drain. Have patient lie supine, press Renying pulse... down to Quepen, then repeat up and down, exhausting heat, then stop, hence pushing and dispersing. Another version says "Fu Shang Ru Qian", likely an error. Ping An: "Xue Shi Zhe" is written as "Xue Er Shi Zhe" in *Ling Shu* and "Xue Ru Shi Zhe" in *Jia Yi Jing*. "Yin Ling Yan Wo" is written as "Yin Qi Yan Wo" in *Ling Shu*. "Xia An Jing Dong Mai" is written as "Xie An Jing Dong Mai" in *Ling Shu* and "An Qi Jing Dong Mai" in *Jia Yi Jing*. "Fu Shang" is written as "Fu Zhi" in *Ling Shu* and *Jia Yi Jing*.)

Huang Di said: When one meridian gives rise to dozens of diseases, such as pain, carbuncles, cold-heat sensations, itching-bi, or numbness, with infinite variations, what is the reason? Qi Bo said: These are all generated by pathogenic factors. (Previous texts state Twelve Meridians cause various diseases. This states one meridian causes dozens of diseases with infinite variations. The diseases caused by Twelve Meridians are not without... variations, also inexhaustible. Thus, seekers must examine carefully and not lightly determine right or wrong. Ping An: *Ling Shu* writes "Huo Han Re" as "Huo Han Huo Re", and "Huo Yang Bi" as "Huo Yang Huo Bi".)