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[Ping An]: This chapter, from the beginning to "Renying awaits Yang," is found in *Ling Shu* (Spiritual Pivot), Volume 4, Chapter 19, "Si Shi Qi" (Qi of Four Seasons). From "Ci jia bu zhen" (Acupuncturists do not diagnose) to the end, it is found in *Su Wen* (Basic Questions), Volume 14, Chapter 55, "Chang Ci Jie Lun" (Discourse on Long Acupuncture Techniques). Also, from the beginning to "Bi shen yi liu zhi" (Must be deep and retained), it is found in *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion), Volume 5, Chapter 1. From "Feng shui fu zhang" (Wind edema and skin distension) to "Jin qu zhi" (Extract all), it is found in *Jia Yi Jing*, Volume 8, Chapter 4. From "Sun xie" (Undigested diarrhea) to "Re xing nai zhi" (Stop when heat circulates), it is found in *Jia Yi Jing*, Volume 11, Chapter 4. From "Wen nue" (Warm malaria) to "Wu shi jiu ci" (Fifty-nine acupuncture points), it is found in *Jia Yi Jing*, Volume 7, Chapter 5. From "Zhuan jin yu yang" (Tendon cramp in Yang) to "Jie cu zhen" (All sudden acupuncture), it is found in *Jia Yi Jing*, Volume 11, Chapter 4. From "Tu shui" (Empty water/edema) to "Bai san shi wu ri" (One hundred thirty-five days), it is found in *Jia Yi Jing*, Volume 8, Chapter 4. From "Zhuo bi" (Fixed Bi syndrome) to "Qu qi li gu" (Take its inner bone), it is found in *Jia Yi Jing*, Volume 10, Chapter 1. From "Wei [blank] zhang zhong" (Distension in the middle) to "Xu bu zhi" (Deficiency tonify it), it is found in *Jia Yi Jing*, Volume 9, Chapter 7. From "Li feng zhe" (Those with Leprosy) to "Wu shi ta shi" (Do not eat other foods), it is found in *Jia Yi Jing*, Volume 11, Chapter 9. From "Fu zhong chang ming" (Abdomen often sounds) to "San li" (Zusanli), it is found in *Jia Yi Jing*, Volume 9, Chapter 7. From "Shao fu kong gao" (Lower abdomen pulling testicles) to "Yi tiao zhi" (To regulate it), it is found in *Jia Yi Jing*, Volume 9, Chapter 8. From "Shan ou" (Prone to vomiting) to "Yi qu qi xie" (To remove the pathogen), it is found in *Jia Yi Jing*, Volume 9, Chapter 5. From "Yin shi bu xia" (Food and drink cannot go down) to "Ze san er qu zhi" (Then scatter and remove it), it is found in *Jia Yi Jing*, Volume 9, Chapter 7. From "Shao fu bing zhong" (Lower abdominal swelling disease) to "Qu san li" (Take Zusanli), it is found in *Jia Yi Jing*, Volume 9, Chapter 9. From "Zhi yong zhong zhe" (Treating carbuncles and swellings) to "Wei gu zhi" (As the standard stop), it is found in *Jia Yi Jing*, Volume 11, Chapter 9. From "Bing zai xiao fu" (Disease in the lower abdomen) to "Jiong bing yi ye" (Heat disease is cured), it is found in *Jia Yi Jing*, Volume 9, Chapter 9. From "Bing zai jin" (Disease in tendons) to "Gu re bing yi" (Bone heat disease is cured), it is found in *Jia Yi Jing*, Volume 10, Chapter 1. From "Bing zai zhu yang mai" (Disease in all Yang meridians) to "Bing yi zhi" (Disease stops when cured), it is found in *Jia Yi Jing*, Volume 11, Chapter 2. From "Bing feng" (Disease wind) to "Bai ri er yi" (Cured in a hundred days), it is found in *Jia Yi Jing*, Volume 7, Chapter 1, Middle Section. From "Bing da feng" (Disease severe wind) to the end, it is found in *Jia Yi Jing*, Volume 10, Chapter 2.

Huang Di asked Qi Bo: The Qi of the four seasons has different forms; the onset of all diseases arises from specific causes. Regarding the methods of moxibustion and acupuncture, which principle is most precious? (First, the four seasons differ; second, illnesses vary. Summarizing acupuncture and moxibustion, what is most valuable?) Qi Bo replied: The Qi of the four seasons resides in specific locations. In acupuncture and moxibustion, obtaining the Qi at the acupoints (Xue Wei) is precious. (What is valued in acupuncture and moxibustion is aligning with the Qi of the four seasons.) Therefore, in Spring, select the Jing Meridians, blood vessels, and spaces between muscles; for severe cases, needle deeply; for mild cases, needle superficially. (In Spring, human Qi resides in the meridians, specifically within the Jing Meridians and muscle spaces, hence selecting these areas.) In Summer, select the full Jing Meridians and Sun Collaterals (fine collaterals); target the interstices while avoiding penetrating the skin. (In Summer, human Qi fills the meridians and overflows into Sun Collaterals, making the skin full; thus, selecting full Jing Meridians and Sun Collaterals, and targeting the interstices without breaking the skin.) In Autumn, select the Shu Points (Transport Points); if the pathogen is in the Fu Organs, select the He-Sea Points. (In Autumn, heavenly Qi begins to收 (gather), pores close, and skin tightens; thus, selecting Shu Points of the Zang organs to drain Yin pathogens, and He-Sea Points of the Fu meridians to drain Yang pathogens.) In Winter, select the Jing-Well and Ying-Spring points; needle must be deep and retained. (In Winter, there is closure; Qi and Blood are internal, residing in the marrow and connecting to the Zang organs; thus, Jing-Well points descend rebellious Yin Qi, and Ying-Spring points tonify Yang Qi.)

For Feng Shui (Wind Edema) and Fu Zhang (Skin Distension), use the Fifty-Nine Acupuncture Points method; for blood stasis in the abdominal subcutaneous vessels, extract all. (Below are miscellaneous acupuncture techniques. This is the first case of Wind Edema acupuncture. For Wind Edema and Skin Pulse, use the Fifty-Nine Water Points, and also extract all blood from abdominal subcutaneous collaterals.) For Sun Xie (Undigested Diarrhea), tonify the upper part of the Three Yin Meridians and Yinlingquan (SP9); retain the needles for a long time until warmth circulates, then remove. (This is the second case. Sun Xie is due to deficiency and cold; tonify the Three Yin Meridians, upper points like Guanyuan, and lower point Yinlingquan.) For Wen Nue (Warm Malaria) with no sweat, use the Fifty-Nine Acupuncture Points. (This is the third case. Warm Malaria is a cold-heat disorder; thus, needle the Heat Transport points, totaling fifty-nine.) For tendon cramps in the Yang meridians, regulate the Yang meridians and needle immediately; for tendon cramps in the Yin meridians, regulate the Yin meridians and needle immediately. (This is the fourth case. For cramps in the Six Yang meridians, use burning needles on Yang tendons; for Yin meridians, use burning needles on Yin tendons.) For Tu Shui (Edema without skin swelling), first needle three cun below Huangu (the umbilicus), i.e., Guanyuan (CV4), using a Pi Needle (sword-shaped needle). After needling, insert a tube, withdraw it repeatedly to drain all water. Bind the body tightly; if loose, feel vexed; if tight, feel calm. Needle every other day until water is exhausted. Drink astringent medicine during needling; do not eat after drinking medicine, or drink after eating; avoid other foods. Recovery takes one hundred thirty-five days. (This is the fifth case. Huangu refers to the umbilicus. Three cun below is Guanyuan. Using a tube draws out water, leaving the body deficient; bind the body firmly, then drink tonic medicine. Alternate food and drink, needle every other day, do not drain water all at once. Abstinence rules apply like medication. 'Tu' means empty; empty stomach for drinking.) For Zhuo Bi (Fixed Bi Syndrome due to Dampness) that persists with chronic cold, immediately needle the Li Gu (Inner Bone) point. (This is the sixth case. 'Cu zhen' refers to burning needles. Li Gu refers to the bone associated with the fixed Bi; since the Bi is deep, this bone is selected.) For [Blank] Zhang (Leg Swelling) with difficulty in defecation, take Zusanli (ST36); sedate excess, tonify deficiency. (This is the seventh case. [Blank] refers to the calf. Cold in the calf causes swelling; regulating ST36 via sedation or tonification is key.) For Li Feng (Leprosy), disperse and needle the swelling, use a sharp needle to prick the area, press to expel evil Qi, stop when swelling resolves. Eat normally, avoid other foods. (This is the eighth case. 'Suo' means disperse. Prick the swelling, then use a sharp needle to prick the site, press to expel bad Qi/Evil Blood. Dietary restrictions apply.) For frequent abdominal rumbling, Qi rushing to the chest causing panting and inability to stand long, with Pathogen in the Large Intestine, needle the Yuan-Source point of Ben (Jiuwei CV15), Shangjuxu (ST37), and Zusanli (ST36). (This is the ninth case. The Large Intestine Hand-Yangming meridian connects to the Lung, passes through the diaphragm, and belongs to the Large Intestine. Pathogen here follows the meridian up to the chest. Ben refers to the diaphragm; its Yuan source is Jiuwei. Shangjuxu combines with the Large Intestine; Foot-Yangming connects to Hand-Yangming, so select Shangjuxu and Zusanli.) For lower abdominal pain pulling to the testicles, drawing the lumbar spine, rushing up to the heart, with Pathogen in the Small Intestine connecting to the testicular ligament, attaching to the spine, piercing the Liver and Lungs, and linking to the Heart system: if Qi is excessive, there is reversal, rushing up to the Stomach and Intestines, disturbing the Liver, dispersing into the Huang (Membrane), and knotting at the umbilicus. Therefore, select the Huang Yuan (Umbilical Source, 1.5 cun below umbilicus) to disperse it. (This is the tenth case. The Small Intestine meridian connects to the Heart, passes through the throat, diaphragm, and stomach. Pathogen here causes Qi reversal. Select Huang Yuan, also known as Boren, located 1.5 cun below the umbilicus.) Needle the Taiyin (Hand-Taiyin/Lung) to give support; select Jueyin (Foot-Jueyin/Liver) to descend; select Xiajuxu (ST39) to remove it; regulate the meridians passed by adjusting tonification and sedation. (The Small Intestine meridian pierces the Lung, so select Hand-Taiyin Five-Shu points. It pierces the Liver, so select Foot-Jueyin Five-Shu points. Xiajuxu combines with the Small Intestine. Regulate the meridians involved.)

For those prone to vomiting with bitter taste, sighing frequently, feeling anxious and fearful as if being chased, with Pathogen in the Gallbladder and Rebellion in the Stomach: bile leakage causes bitterness, Stomach Qi rebellion causes vomiting of bitter fluid. This is called Vomiting Gallbladder. Take Zusanli (ST36) to descend Stomach Qi rebellion; needle Shaoyang blood collaterals to close the Gallbladder; adjust deficiency and excess to remove the pathogen. (This is the eleventh case. Frequent sighing indicates long exhalation. Gallbladder heat causes fear. Pathogen in Gallbladder means heat overflowing bitter juice, causing Stomach rebellion and vomiting bitter fluid, named Dan Dan. Take ST36 to descend Stomach Qi, and Shaoyang meridian to adjust and remove heat.)

For inability to swallow food and drink, blockage in the diaphragm, with Pathogen in the Stomach Tube: if in the upper tube, needle to suppress and direct downward; if in the lower tube, scatter and remove it. (This is the twelfth case. Pathogen in the Stomach tube causes diaphragmatic blockage. Upper tube refers to the upper opening of the Stomach; needle to suppress. Lower tube refers to the lower opening; needle to scatter.)

For lower abdominal swelling and inability to urinate, with Pathogen in the Sanjiao (Triple Burner) constriction: take the Great Collateral of Foot-Taiyang; observe collaterals where Taiyang and Jueyin small collaterals knot with blood; needle the swelling, the Stomach tube area, and Zusanli (ST36). (This is the thirteenth case. Pathogen in Sanjiao causes constriction, leading to lower abdominal swelling and urinary retention. Needle Foot-Taiyang Great Collateral, knot-blood in Foot-Jueyin fine collaterals, swelling area, Stomach tube, and ST36.)

Observe the complexion, inspect the eyes, knowing dispersion and return allows one to judge survival or demise by eye color. (This is the fourteenth case. Dispersion implies death; return implies survival.) Unify the form, listen to movement and stillness, hold the Qikou (Cunkou/Radial Artery) and Renying (Carotid Artery). (Focus without scattering unifies the form; shifting spirit to the pulse listens to movement. Qikou is Hand-Taiyin Cunkou; Renying is Foot-Yangming Renying.) If the pulse is firm, full, and slippery, the disease progresses daily; if soft, the disease remains static; if all lower meridians are excess, the disease cures in three days. Qikou awaits Yin; Renying awaits Yang. (Qikou stores meridians, awaiting Yin. Renying is Fu meridian, awaiting Yang.)

Acupuncturists who do not diagnose listen to the patient's description. For head pain, use Cang Zhen (Hidden Needle) technique, needle to the bone, cure the disease, do not injure bone, flesh, or skin. Skin is the pathway. Yang Ci (Yang Needling): insert one centrally, four peripherally. (This is the fifteenth case. The patient knows the location, so no diagnosis is needed; this is Cang Zhen. Technique needles to bone without injuring surrounding tissue. Head is Yang; severe cold entering brain causes pain. Yang Ci involves one central needle and four peripheral needles to treat broad Qi disorders. 'Yin Ci' in some texts is likely an error.) For deep and specialized cold-heat disorders, needle Da Zang (Large Zang, i.e., Lung), approaching the Zang, needle Back-Shu points. (This is the sixteenth case. Lung is large like four Zang organs combined. Approach the Zang by needling Back-Shu. 'Po' means near.) Needling near the Zang allows Zang Qi to meet in Zhongwan (CV12); stop when cold-heat Qi leaves. Also needle the waist to release Zang Qi and bleed. (Needling Back-Shu approaches the Zang, allowing Qi to connect to Zhongwan. Stop when pathogenic Qi leaves. Also needle the waist to shallowly release Zang Qi and bleed.)

For treating carbuncles and swellings, needle above the lesion. Observe size and depth. For large lesions with much blood, needle deeply but beware of causing panting; insert and retain until bleeding stops as the goal. (This is the seventeenth case. Needle above the carbuncle. Large/deep vs. small/shallow. Deep needling may cause panting. Retain needle until bleeding occurs, which is the goal.)

For accumulation in the Small Intestine, needle from the umbilicus down to the lower abdomen, needle beside the spine, between the fourth vertebrae on both sides, and between the iliac bones, hypochondrium, and ribs. Guide heat from the intestines downward to resolve. (This is the eighteenth case. Iliac bones are lateral waist bones. Small Intestine connects to spine and testicular ligament, extending to umbilicus. Accumulation here requires needling around the umbilicus, lower abdomen, spine, and hypochondrium.)

For disease in the lower abdomen, pain with inability to pass stool or urine, named Shan (Hernia), caused by cold: needle between the lower abdomen and thighs, between the lumbar and hip bones. Needle multiple times until heat pervades, then the disease is cured. (This is the nineteenth case. 'Jiong' means heat. Caused by cold, needling these five areas brings heat and cure.)

For disease in tendons causing cramps and joint pain preventing walking, named Jin Bi (Tendon Bi): needle above the tendons as the goal, needle between muscle spaces, do not hit the bone. When heat arises in the tendons, stop when the disease is cured. (This is the twentieth case. Tendons connect joints; cramps and pain occur. Do not needle bone. Heat in tendons indicates cure.)

For disease in skin and muscle causing widespread pain, Tong Bi (Painful Bi) injured by cold-damp: needle large and small muscle divisions, use many needles deeply, aim for heat as the goal. (This is the twenty-first case. Cold-damp in muscles is Ji Bi. Needle between large and small muscle divisions.) Do not injure sinews and bones; injury leads to carbuncles. If all divisions become hot, stop when the disease is cured. (When needling muscle divisions, do not injure sinews/bones, which causes carbuncles. Stop when heat pervades and disease resolves.)