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[Ping An] This chapter, from the beginning to the end, is found in *Suwen* (Basic Questions), Volume 17, Chapter 62, "Tiaojing Lun" (Discourse on Regulating the Channels), connecting with the previous compilation. It also appears in *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), Volume 6, Chapter 3, also connecting with the previous compilation.

Huangdi said: I have heard of the manifestations of deficiency and excess, but do not know how they arise. (Xing refers to form or state. The states of deficiency and excess have been heard above, but the causes of their generation remain unknown, hence the further inquiry. Ping An: *Suwen* writes "wen" as "yi wen". *Jiayi Jing* lacks the three characters "yu yi wen".) Qibo replied: When Qi and Blood merge and crowd together, Yin and Yang incline towards each other; Qi becomes chaotic in the Wei (Defensive) level, while Blood stagnates in the Channels. (The Qi of the twelve channels becomes chaotic in the Wei Qi. The Blood of the twelve channels stagnates in the Ying (Nutritive) channels. Alternatively, it is said to be blood flow. Ping An: *Suwen* and *Jiayi Jing* write "xue liu" as "xue ni".) When Blood and Qi separate from their original locations, one becomes excess and the other deficiency. (When Blood and Qi merge, they leave their original dwellings, thus each having aspects of deficiency and excess. Blood and Qi, though named differently, are of the same origin and must harmonize to maintain balance. Now that they have merged, resulting in one excess and one deficiency, this is the source of deficiency and excess.) When Blood crowds into the Yin, (Crowding into the Foot Taiyin and Foot Shaoyin channels,) and Qi crowds into the Yang, (Crowding into the Foot Yangming and Foot Taiyang channels,) it leads to惊狂 (fright and mania). (Since both Blood and Qi are excessive, fright and mania occur.) When Blood crowds into the Yang, and Qi crowds into the Yin, it leads to Jiongzhong (Heat-in-the-Middle disease). (Blood crowds into Foot Yangming, Qi crowds into Foot Taiyin, forming Heat-in-the-Middle disease. Jiong means heat.) When Blood crowds into the Upper, and Qi crowds into the Lower, it results in vexation and irritability. (Excessive Blood rushes upward to the Heart, causing mental vexation and mood swings. [Character] is synonymous with men. Ping An: *Suwen* writes "wan", *Jiayi Jing* writes "men". Xi, *Suwen* and *Jiayi Jing* write "shan".) When Blood crowds into the Lower, and Qi crowds into the Upper, Qi becomes chaotic in the Heart, leading to forgetfulness. (Excessive Qi disturbs the Heart Spirit, causing forgetfulness. Ping An: "Qi chaotic in Heart and forgetfulness", *Jiayi Jing* writes "chaotic and prone to forgetting", with a note stating "*Suwen* writes 'prone to forgetting'." Current versions of *Suwen* still read "chaotic and prone to forgetting".) Huangdi asked: When Blood crowds into Yin and Qi crowds into Yang, causing Blood and Qi to separate from their dwellings, which is excess and which is deficiency? (Regarding the separation and merging of Blood and Qi, it is unclear how to determine the excess and deficiency of these two categories. Ping An: "Yu shi", *Suwen* and *Jiayi Jing* write "ru shi".) Qibo replied: Blood and Qi prefer warmth and dislike cold. Cold causes them to congeal and cease flowing, while warmth causes them to dissipate and move away. Therefore, where Qi crowds, Blood becomes deficient; where Blood crowds, Qi becomes deficient. (Both Blood and Qi dislike cold. Thus, when there is cold in the vessels, they congeal and do not flow; when warm, they dissipate. Hence, if Qi is cold, Blood moves to join it, resulting in Blood deficiency and Qi excess; if Blood is cold, Qi moves to join it, resulting in Qi deficiency and Blood excess. Ping An: "Shi gu", the character "gu" is written as "zhi" in Yuan's edition.) Huangdi said: What humans possess is merely Blood and Qi. Now you say that crowding of Blood leads to deficiency and crowding of Qi leads to deficiency; does this mean there is no excess? (Human life relies solely on Blood and Qi. You only speak of deficiency in Blood and Qi, not mentioning excess, implying that human Blood and Qi are insufficient. Please clarify your meaning.) Qibo replied: That which exists is Excess; that which is absent is Deficiency. Therefore, when Qi crowds, Blood is absent; when Blood crowds, Qi is absent. Since Blood and Qi are now separated and lost, it is called Deficiency. (When Blood crowds, Qi is absent; when Qi crowds, Blood is absent. Thus, speaking of deficiency does not negate the existence of excess, and discussing excess does not discard its deficiency. There is never a complete absence of Blood and Qi in the body. The term "deficiency" here refers to the state where Blood and Qi are merged yet separated/lost, whereas "excess" refers to their harmonious presence.) Collaterals and Sun collaterals all transport Qi and Blood into the Major Channels. (Large and small collaterals transport Blood and Qi into the major channels, making the Blood and Qi in the major channels excessive. Ping An: "Shu", *Jiayi Jing* writes "Zhu", note says: alternatively "Shu".) When Blood and Qi crowd together, it constitutes an Excess syndrome. If Blood and Qi both rush upward, it results in Da Jue (Great Reversal), characterized by sudden death-like collapse. If the Qi returns, the patient lives; if it does not return, the patient dies. (When Blood and Qi in the major channels are excessive and rush above the diaphragm, leaving nothing below, the limbs become cold and reverse, leading to sudden collapse. If the limbs warm up, the patient lives; if not, the patient dies. Ping An: "Fu fan shang", *Suwen* and *Jiayi Jing* include the character "Qi".) Huangdi asked: From what pathway does Excess come? From what pathway does Deficiency go? I wish to hear the principles behind deficiency and excess. (From what pathway do Blood and Qi enter this channel to become excess, and from what pathway do they leave to become deficiency?) Qibo replied: Yin and Yang both have Shu (Transporting) points and Hui (Meeting) points. Yang injects into Yin, and Yin overflows outward. (The meridians of Zang-Fu organs and Yin-Yang have distinct pathways connecting through Shu and Hui points. For example, Foot Yangming connects to Foot Taiyin via the Fenglong point, and Foot Taiyin connects to Foot Yangming via the Gongson point; thus it is called "outward".) When Yin and Yang are balanced, they fill the形体 (body form). (A cycle of ten days is called Xun. Xun means welcome. When the Yin and Yang meridians meet fifty times without excess or deficiency, it is called Xun Ping (Balanced Cycle). The harmonious Qi of Xun Ping fills the body. Ping An: "Xun Ping", *Suwen* writes "Yun Ping", *Jiayi Jing* writes "Ping".) When the Nine Palpations are consistent, the person is called a Ping Ren (Healthy Person). (The movements of the Nine Palpations are neither delayed nor contradictory, hence described as "one". With harmonious Qi being uniform, the person achieves peace. Ping An: Note "Jiu Hou", Yuan edition writes "Jiu Mai".) When pathogenic factors arrive, (Ping An: *Suwen* lacks the character "Zhi", *Jiayi Jing* writes "Suo".) they may originate from Yin or from Yang. Those originating from Yang result from Wind, Rain, Cold, and Summer-Heat. Those originating from Yin result from Diet, Lifestyle, and Emotional fluctuations (Joy and Anger). (Yin refers to the Five Zang organs. Yang refers to the Six Fu organs. Wind, rain, cold, and summer-heat are external pathogens that first reach the Six Fu organs from the exterior, hence called "originating from Yang". Diet, lifestyle, sexual activity, and emotions like joy and anger are internal pathogens generated within the Five Zang organs, hence called "originating from Yin".) Huangdi asked: How do wind, rain, cold, and summer-heat injure the human body? (Ping An: *Suwen* and *Jiayi Jing* lack the characters "Han Shu".) Qibo replied: Wind and rain injuries first lodge in the skin, then transmit to the Sun collaterals. When Sun collaterals are full, they transmit to the Luo collaterals. When Luo collaterals are full, they transport to the Major Channels. Blood and Qi merge with the pathogen and lodge between the Fen Cou (interstices). The pulse becomes firm and large, hence it is called Excess. (This first discusses the pathogens of Wind and Rain. Due to hunger, weakness, and sweating, the pores open. Wind and Qi lodge in the interstices, then enter Sun collaterals, then large collaterals, then major channels. When lodging in the interstices, the affected vessels become firm and large, thus termed Excess. Ping An: "Nai Shu", *Suwen* writes "Ze Shu", *Jiayi Jing* writes "Nai Zhu".) Excess syndromes present with external firmness and fullness; they cannot be pressed, and pressing causes pain. (The area where the pathogen lodges is externally firm; pressing causes pain because Qi is excessive. Ping An: "Bu ke an", *Suwen* writes "bu ke an zhi".) Huangdi asked: How does Cold-Dampness injure the human body? (Ping An: *Suwen* and *Jiayi Jing* lack the character "Qi".) Qibo replied: When Cold-Dampness invades the human body, the skin contracts, muscles become firm, Ying Blood congeals, and Wei Qi departs, hence it is called Deficiency. (Next, discussing Cold-Dampness. Rain Qi invades from above, Dampness enters from below; there is this difference, briefly omitting Summer-Heat. Cold-Dampness invading leads to four types of deficiency: Skin contraction means the skin tightens and gathers; Muscle firmness means muscles are hard and unyielding; Ying Blood congealing means pathogens have reached the vessels, causing Ying Blood to congeal; Wei Qi departing means pathogens have reached outside the vessels, causing Wei Qi to stop moving, hence called "departing". Where Wei Qi departs, there is Deficiency. Ping An: "Pi Fu Shou", *Suwen* writes "Pi Fu Bu Shou", Xin Zheng Jiao notes: "Quan Yuanqi says: Bu Shou means numbness. *Jiayi Jing* and *Taisu* write 'Pi Fu Shou', without 'Bu'. Below 'Jian', *Suwen* and *Jiayi Jing* have 'Jin'. Note 'Gu Yue Qu Ye', Yuan edition misprints 'Qu' as 'Se'.") Deficiency syndromes present with timidity and Qi insufficiency, with congealed Blood. (She, pronounced 'zhi zhe fan'. Lack of Wei Qi in the muscle intervals is called Qi insufficiency. Ping An: "She", *Suwen* writes "Nie", Xin Zheng Jiao notes: "*Jiayi Jing* writes 'She', *Taisu* writes 'She'. *Suwen* lacks 'Xue Qi' characters, *Jiayi Jing* writes 'Xue Se'.) Pressing generates sufficient Qi to warm the area, resulting in comfort and absence of pain. Huangdi said: Excellent. (Since there is no Wei Qi in the muscle intervals, it is cold. Pressing adds damage, so Qi becomes sufficient and warm, hence comfortable.)

Huangdi asked: How does Yin generate Excess? Qibo replied: Unregulated Joy and Anger cause Yin Qi to rebel upward. Upward rebellion causes deficiency in the Lower, and when the Lower is deficient, Yang Qi rushes to fill it, hence it is called Excess. (Humans cannot regulate their emotions. Anger causes Yin Qi to rise; rising Yin Qi rebels. This may cause vomiting blood or inability to eat. Once Yin Qi rises, the Lower becomes deficient. When the Lower is deficient, Yang Qi takes advantage, hence named Yin Excess. Ping An: *Suwen* Xin Zheng Jiao notes: "The text 'Unregulated Joy and Anger causes Yin Qi to rebel upward' likely has an extra 'Joy' character." Observing the later text 'Joy causes Qi to descend' clarifies this.) Huangdi asked: How does Yin generate Deficiency? Qibo replied: Joy causes Qi to descend. (In cold weather, Qi gathers; in warmth, Qi disperses. Anger causes Qi to rise; Joy causes Qi to descend. This is the natural law. Joy brings harmony to Qi and clarity to the Will, allowing Ying and Wei to flow freely, hence slowing and descending.) Sorrow causes Qi to dissipate. Dissipation leads to empty pulses. If combined with cold diet, cold Qi steams the Zang organs, causing Blood to congeal and Qi to depart, hence it is called Deficiency. (When a person is sorrowful, the Heart Tie tightens, Lung leaves elevate, causing blockage in the Upper and Middle Jiao, stopping Ying and Wei flow. Heat remains in the center, causing righteous Qi to dissipate and meridians to become empty. Additionally, cold drinks and food cause cold Qi to steam the Zang organs, congealing Zang Blood and displacing Qi, hence Deficiency. Ping An: "Mai Xu", *Suwen* and *Jiayi Jing* write "Mai Kong Xu". Xun Zang, *Suwen* writes "Xun Man", *Jiayi Jing* writes "Dong Zang". Note "Liang Jiao", the character 'Liang' is misprinted as 'Yu' in Yuan edition.) Huangdi said: The Classics state: Yang deficiency leads to external cold; Yin deficiency leads to internal heat. (The Classics refer to the eighty-one chapters. Deficiency in Fu organ pulses allows Yin Qi to invade, causing external cold. Deficiency in Zang organ pulses allows Yang Qi to invade, causing internal heat.) Yang excess leads to external heat; Yin excess leads to internal cold. I have heard this, but do not know the mechanism. (Six Fu organs govern the exterior and are Yang, hence Yang excess causes external heat. Five Zang organs govern the interior and are Yin, hence Yin excess causes cold. I have heard this before, but do not understand the reason.) Qibo replied: Yang receives Qi from the Upper Jiao to warm the skin and muscle intervals. Now, if cold Qi is outside, the Upper Jiao becomes blocked. Blockage causes cold to remain exclusively on the exterior, hence external cold. (Yang refers to Wei Qi. Wei Qi originates from the Upper Jiao and circulates twenty-five cycles during the day to warm the skin and muscles. Now, due to Yang deficiency, Yin invades and remains on the exterior, hence external cold. Ping An: Note "Jin Xing Er Shi Wu Zhou", referring to the earlier chapter *Wei Wu Shi Zhou*: Wei Qi circulates fifty cycles in a day and night, twenty-five during the day in Yang. Thus, the character "Jin" is suspected to be a transcription error for "Zhou" (Day).) Huangdi asked: How does Yin deficiency generate internal heat? Qibo replied: Fatigue and overwork cause the Form and Qi to decline, Grain Qi to become weak, the Upper Jiao fails to function, and the Lower Wan (stomach outlet) becomes blocked. Stomach heat steams the interior, hence internal heat. (There are five causes of internal heat: First, fatigue and overwork lead to deficiency; Second, Form and Qi are insufficient; Third, the stomach lacks food; Fourth, Upper Jiao Wei Qi does not circulate; Fifth, the intestines and stomach fail to communicate. Wan, pronounced 'gu huan fan', refers to the stomach腑. Lower Wan is the lower opening of the stomach. These five factors cause Wei heat to steam the interior, hence internal heat. Ping An: "Xia Wan", *Jiayi Jing* writes "Xia Jiao". Wei Re Xun Zhong, *Suwen* writes "Wei Qi Re Re Qi Xun Xiong Zhong", *Jiayi Jing* writes "Wei Qi Re Xun Xiong Zhong". Note "You Ci", Yuan edition writes "You Ci".) Huangdi asked: How does Yang excess generate external heat? Qibo replied: The Upper Jiao is not smooth, the skin is dense, and the Culi (pores) are closed and blocked. Wei Qi cannot vent and escape, hence external heat. (There are three causes of external heat: First, the exit of Qi from the Upper Jiao is not smooth; Second, the skin is dense and pores are closed; Third, Wei Qi cannot vent into the Culi. These causes result in external heat. Ping An: Below "Bi Sai", *Suwen* has the character "Xuan Fu". Xin Zheng Jiao notes: "*Jiayi Jing* and *Taisu* lack 'Xuan Fu'.") Huangdi asked: How does Yin excess generate internal cold? Qibo replied: Jue Qi rebels upward. Cold Qi accumulates in the chest and is not discharged. Without discharge, Warm Qi departs, leaving Cold alone. Blood becomes congealed, vessels become blocked, the pulse is large and choppy, hence internal cold. (There are four aspects of cold: First, Cold Jue accumulates in the chest; Second, Warmth departs and Cold remains; Third, Blood coagulates and vessels are obstructed; Fourth, the pulse is large and choppy. These causes result in internal cold. Ping An: Below "Ji", *Suwen* and *Jiayi Jing* lack "Liu". Qi, *Suwen* and *Jiayi Jing* write "Ning Qi". Mai Bu Tong, *Jiayi Jing* writes "Culi Bu Tong".) Huangdi asked: Regarding Yin and Yang, when Blood and Qi merge and the disease form is established, how should acupuncture be performed? (Asking about treating established diseases. Ping An: "Yin Zhi Yu Yang", *Suwen* writes "Yin Yu Yang Bing".) Qibo replied: To treat this, select the Jing Sui (Channel Tunnels), draw Blood from the Ying, and draw Qi from the Wei. Use the needle according to the body type, adjusting quantity and depth based on the seasons and the location of the disease. (There are three distinctions in treating established diseases: First, puncture the pathways of the major channels where they diverge; Sui means path, connecting Yin and Yang; Second, puncture the Ying Blood in the vessels; Third, puncture the Wei Qi outside the vessels. The use of the needle must follow the Qi of the four seasons, observe the severity of the disease to determine the number of needles, and measure the height/depth of the disease to ensure accurate placement, which differs from treating mild conditions. Ping An: "Jing Sui", *Jiayi Jing* writes "Jing Qu".) Huangdi asked: When Blood and Qi merge, the disease form is established, and Yin and Yang incline, how should tonification and sedation be applied? Qibo replied: To sedate Excess, insert the needle when the Qi is excessive. (Sedation is used because pathogenic Qi is excessive. One should press down before needling. Why sedate if not excessive? It is like attacking an enemy formation. Ping An: "Yi Bing", "Yi Cheng", *Jiayi Jing* writes "Yi" as "Yi".) Insert the needle along with the Qi, opening the gate like opening a door. Withdraw the needle along with the Qi, sparing the Essence Qi and expelling the Pathogenic Qi. Do not close the outer gate, allowing the disease to exit. Widen the pathway like clearing a road; this is called Great Sedation. Must press at the exit, and the excessive Qi will be subdued. (During inhalation, pores close and Qi gathers in Liver and Kidney; during exhalation, pores open and Qi exits from Heart and Lung, like a bellows. When inserting the needle, the patient inhales, so the needle enters with the Qi. After insertion, widen the acupoint and withdraw the needle during exhalation, so the needle and pathogenic Qi exit together, sparing the righteous Qi. Ping An: "Yi Chu Qi Bing", *Suwen* and *Jiayi Jing* write "Bing" as "Ji".) Huangdi asked: How to tonify Deficiency? Qibo replied: Hold the needle without placing it, to stabilize the mind. (Hold the needle without inserting it into the flesh; first calm the spirit and stabilize the mind before needling. If the practitioner's mind is scattered, one cannot perceive the deficiency or excess of Qi under the needle, hence stabilization is required. Ping An: Note "An Shen Ding Yi", Yuan edition writes "Zhi".) Wait for exhalation to insert the needle. (During exhalation, pores open and Qi exits. Insert the needle when Qi exits from the acupoint, intending to let Qi enter through the needle and prevent Qi leakage, hence waiting for exhalation to insert.) As Qi exits, the needle enters. Seal the needle hole on all sides, preventing Essence from escaping. (Inserting the needle during exhalation aims to seal the hole and prevent loss of righteous Qi. Ping An: Note "Ru Xue", Yuan edition writes "Kong".) When the Qi feels substantial, quickly withdraw the needle. As Qi enters, the needle exits. (Fang means correct/proper. Wait until the Qi feels proper and substantial, then quickly withdraw.) Prevent the heat from circulating. (Deficient patients often have cold; receiving heat is tonification. Huan means rotate. Quickly withdrawing prevents the heat under the needle from rotating. Ping An: *Suwen* and *Jiayi Jing* write "Huan" as "Huan".) Close the gate. Pathogenic Qi disperses, and Essence Qi is preserved. Movement is timely. (After withdrawing the needle, even if pathogenic Qi is not fully expelled, it naturally disperses and vanishes, leaving only Essence Qi, preventing future illness. Ping An: "Dong Wu Hou Shi", *Suwen* writes "Dong Qi Hou Shi".) Near Qi does not enter; Far Qi arrives. This is called Pursuit. (During tonification, if the tonification site is not near, Near Qi does not escape, and Far Qi comes to gather here. The already deficient Qi is guided to become substantial, hence called Pursuit.) Huangdi said: You mentioned ten types of deficiency and excess arising from the Five Zang organs, which correspond to the Five Pulses. However, the Twelve Primary Meridians give rise to hundreds of diseases. Now you only speak of the Five Zang. The Twelve Meridians connect to the 365 joints/acupoints. Diseases at the joints inevitably affect the meridians, and meridian diseases all have deficiency and excess. How do we reconcile this? (Joint refers to Qi Acupoint. The Twelve Meridians contain 365 acupoints, so the diseases generated at these 365 points are numerous, not just the ten types of deficiency and excess from the Five Zang and Five Pulses. Ping An: "Jie Sheng Bai Bing", *Suwen* writes "Jie Sheng Qi Bing". Xin Zheng Jiao notes: *Jiayi Jing* says "Jie Sheng Bai Bing". *Taisu* agrees.) Qibo replied: The Five Zang organs originally have the Six Fu organs as their interior-exterior pairs. The meridians, branches, and joints each generate deficiency and excess. (Inside are the Five Zang, outside are the Six Fu. The Zang-Fu meridians, interior-exterior relationships, and various branches/joints generate deficiency and excess, which are numerous and not contradictory.) Observe where the disease resides and adjust accordingly. If the disease is in Blood, adjust the Pulse; if in Qi, adjust the Wei; if in Flesh, adjust the Fen Rou (muscle intervals); if in Sinews, adjust the Sinews, using burning needle and rapid puncture below and at sites of tension. (Observe the diseases at the 365 joints, assess deficiency and excess, and adjust accordingly. Adjustment refers to regulating the pulses, Wei, Fen Rou, sinews, and bones governed by the Five Zang. Ping An: *Suwen* lacks "Shi" before "Qi Bing". "Bing Zai Xue Tiao Zhi Mai" is written as "Bing Zai Mai Tiao Zhi Xue". Xin Zheng Jiao notes: "Quan Yuanqi and *Jiayi Jing* write 'Bing Zai Xue Tiao Zhi Mai'." Checking current *Jiayi Jing*, it still reads "Bing Zai Mai Tiao Zhi Xue". Also, *Suwen* and *Jiayi Jing* have six characters "Bing Zai Xue Tiao Zhi Luo" before "Bing Zai Qi", and six characters "Bing Zai Gu Tiao Zhi Gu" after "Tiao Zhi Jin".) If the disease is in Bone, use deep needling and herbal moxibustion/warming. (Cu means exhaustive. Painful Bi in bone requires exhausting needling deeply to the bone. Withdraw the needle and apply herbal warming, because bone diseases are deep. Warming methods were discussed in previous chapters. Ping An: "Cu", *Suwen* and *Jiayi Jing* write " ".) If the disease location of pain is unknown, prioritize the Two Qiao (Vessels). (For bone diseases where the location is uncertain, select the two Yin Qiao vessels of Foot Shaoyin. The two Yin Qiao are branches of Foot Shaoyin, which governs bone. Shang means superior/victorious. Ping An: *Suwen* and *Jiayi Jing* lack "Qi". Note "Zhu Gu", the character 'Zhu' is misprinted as 'Tong' in Yuan edition.) If the body shape has pain but the Nine Palpations show no disease, use Miao Ci (Contralateral Puncture). (After examining the Three Parts and Nine Palpations and finding no pathological signs, yet the body has pain, this indicates pathology in the left and right collaterals, suitable for Contralateral Puncture. Ping An: *Suwen* and *Jiayi Jing* lack "Zhe".) If the disease is on the left but the pulse on the right is diseased, then Ju...