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Self-effort is limited. One who is skilled in managing water cannot chisel through ice; one who is skilled in acupuncture cannot forcibly resolve Si Jue (Four Coldness, a condition characterized by cold extremities). This implies that Qi (vital energy) enters and exits following the seasonal changes of heaven and earth, which cannot be forced by human effort alone.

To treat Jue syndrome (cold extremities), one must first apply warming moxibustion or hot compresses to unblock the Qi. Harmonizing the meridians serves to unblock them. The Jing Qi (Essence Qi received from heaven) circulates inside and outside the meridians. Regulation involves the palms, axillae, elbows, feet, neck, and spine, indicating that Blood and Qi circulate throughout the upper, lower, and four sides, reaching every part of the body. If the flow is overly slippery and abundant (Nao Ze), it should be regulated via needling to bring it to balance. If the flow is tight and choppy (Jin Se), indicating stagnation and blockage, it should be broken and dispersed. This is referred to as using needles to untie knots.

The essence of needling lies in regulating Qi. Qi accumulates in the Stomach to facilitate the circulation of Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi), each following its own pathway. Zong Qi (Gathering Qi) flows into the Sea of Qi (Dan Zhong/Ren Zhong area); its descending branch pours into the Qi Street (Qi Jie), while its ascending branch travels through the respiratory tract (Xi Dao). Therefore, when Jue manifests in the feet, it is because Zong Qi fails to descend, causing the blood within the vessels to coagulate and stagnate. Without fire therapy (such as moxibustion or warming) for regulation, this condition cannot be resolved.

This passage discusses how postnatal grain Qi transforms into Ying Qi, Wei Qi, and Zong Qi, each traveling distinct pathways to fill the upper and lower parts of the body. Jue in the feet is due to the reversal of Shao Yin (Kidney) Qi. Cold Qi reverses upward from below, preventing Zong Qi from descending, leading to coagulation and stagnation of blood in the vessels. Without fire therapy, it cannot be unblocked. The Essence Qi of the Lower Jiao constitutes Yin and Yang, Water and Fire, which require heat to warm the cold water. What is "received from heaven" is the Essence Qi of the Shao Yin Kidney. The Chong Mai (Penetrating Vessel) and the large collaterals of the Shao Yin meridian originate in the Kidney, emerge at the Qi Street, and follow the medial aspect of the thigh. If pathogenic factors invade here, causing foot Jue and failure of Zong Qi to descend, it means Zong Qi descends to merge with Shao Yin Qi. The so-called "merging to fill the body" refers to the congenital Qi of the Lower Jiao merging with the Grain Qi of the Yang Ming (Stomach) to enter and exit between joints and muscle fissures. Meanwhile, the postnatal Zong Qi also descends to merge with the Essence Qi of Shao Yin, pouring into the Qi Street and entering the interior, circulating inside and outside the meridians and skin.

When using needles, one must first examine the excess or deficiency of the meridians. Palpate, trace, press, and flick the areas to observe where pulsations respond, then select these points for needling to drain excess.

This clarifies the circulation of Blood and Qi within the vessels. The *Nei Jing* states: If collaterals are full and meridians are deficient, drain the Yang (collaterals) and tonify the Yin (meridians); if meridians are full and collaterals are deficient, drain the Yin (meridians) and tonify the Yang (collaterals). This is because internal meridians are Yin and external collaterals are Yang. Blood and Qi flow from meridians to vessels, from vessels to collaterals, and from collaterals to sun-collaterals (fine branches). Thus, one must first assess the excess or deficiency of the meridians before needling.

If the Six Meridians (Six Channels) are harmonious, the person is considered disease-free; even if illness occurs, it will resolve spontaneously. If one channel exhibits excess above and deficiency below with obstruction, there must be an overabundance of transverse collaterals pressing upon the main meridians, causing blockage. Observing this and applying draining methods is called "untie the knot."

This clarifies the circulation of Blood and Qi outside the vessels. The Six Meridians refer to the twelve divergent channels of the hands and feet. The main meridians are the meridional tunnels, which are the large collaterals of the five zang and six fu organs. The Qi and Blood derived from the Stomach fill the space between skin and muscles, exiting from the large meridians of the zang-fu to the skin. Transverse collaterals are branches of the meridians. If one channel shows excess above and deficiency below with obstruction, it is due to transverse collaterals being excessive and pressing on the main meridians. Observing this and draining them is called "untie the knot." These two sections discuss how Blood and Qi generated from food and drink nourish the interior of the vessels and fill the skin and muscle fissures, each having its own pathway. Min Shixian stated that placing these two sections in the middle distinguishes and merges the true Qi filling the body, suggesting they be understood in the context of self-nourishment principles.

For symptoms of cold above and heat below, first needle the Tai Yang points at the neck and retain the needles for a long time. After needling, apply hot compresses to the neck and shoulder blades until the heat descends and merges with the Yang Qi below, then stop. This is called "pushing upward."

This discusses Qi generated in the Lower Jiao moving upward. Tai Yang governs the Qi of all Yang channels, and Tai Yang Qi is born from Bladder water. In cases of cold above and heat below, Tai Yang Qi is retained below and fails to ascend. Therefore, one needles the neck Tai Yang points and retains them to await Qi arrival. Post-needling, hot compresses are applied to the neck and shoulders to allow the fire heat to merge with the Yang Qi below. This is "pushing upward." Min Shixian noted that whenever "neck Tai Yang" is mentioned in this classic, it is viewed from the perspective of Qi distribution to capture surface Qi, hence specific acupoints are not named. Zhao Tingxia stated that Shao Yin and Tai Yang are the root and branch of Water and Fire, respectively, so fire methods are used to warm the Qi in both cases.

For symptoms of heat above and cold below, observe the deficient pulses sinking into the meridians and needle them. Stop when the Qi descends. This is called "drawing downward."

This discusses Qi generated in the Upper Jiao moving downward. The Upper Jiao opens and disseminates, spreading the flavors of grains to steam the skin, fill the body, and moisten hair; this is Qi. When Upper Jiao Qi moves downward, but symptoms present as heat above and cold below, one should observe the deficient pulses sinking into the meridians and needle them. This occurs because vessel deficiency causes Qi to sink within the vessels, unable to steam the skin and warm the flesh, resulting in cold below. Therefore, one needles the meridians and stops when the Qi descends. This is "drawing downward."

For widespread high fever accompanied by mania, hallucinations, and delirious speech, examine the Foot Yang Ming meridian and its large collaterals for needling. Tonify deficiency; drain blood excess. With the patient lying supine, position yourself at the head. Use four fingers of both hands to clamp and press the carotid artery in the neck, holding firmly for a long time. Then rotate and press downwards to the Supraclavicular Fossa (Que Pen) and stop again. Continue until the heat dissipates. This is called "pushing and dispersing."

This discusses Qi generated in the Middle Jiao emerging from the center and dispersing upward and downward. The Qi of the Middle Jiao is the fierce and rapid Qi from Yang Ming grain digestion. Widespread fever, mania, hallucinations, and delirium result from Yang Ming Qi reversing into heat and madness. Therefore, examine the skin regions of the Foot Yang Ming and its large collaterals. Tonify deficiency; if Qi reverses in the blood vessels causing blood excess, drain it. The Qi of the Middle Jiao emerges from large collaterals to the skin. Its fierce Qi rushing upward follows the throat to the orifices, exits the face, descends to the Guest Master point (Shang Guan), follows the jaw angle, re-joins the Yang Ming pulse, passes down through the Ren Ying point, and continues from the chest to the dorsum of the foot. Thus, with the patient supine, you sit at the head, clamping the Ren Ying pulse in the neck with four fingers for a long time. This ensures the fierce heat disperses outside the vessels rather than merging inside. This is "pushing and dispersing."

These three sections clarify that surface Qi emerges through three pathways: upper, middle, and lower. This represents the two types of Qi—congenital Qi received from heaven and postnatal Grain Qi—that merge to fill the body. If students can understand the principles of separation, union, entry, and exit of Yin-Yang, Blood, and Qi, they will have grasped more than half of the essential meaning of the entire classic.

Huang Di asked: Why does one meridian give rise to dozens of diseases, such as pain, abscesses, heat, cold, itching, numbness, or anesthesia, with infinite variations? What is the cause?

Qi Bo replied: These are all generated by pathogenic factors.

The following section discusses how pathogenic factors injure Ying Qi, Wei Qi, and Zong Qi, causing True Qi to depart while pathogens remain alone. Pathogens spread widely, causing infinite variations, hence one meridian produces dozens of diseases.

Huang Di asked: I have heard of True Qi, Regular Qi, and Pathogenic Qi. What is True Qi? Qi Bo said: True Qi is what is received from heaven and merged with Grain Qi to fill the body. Regular Qi is Zheng Feng (Regular Wind), coming from one direction, neither Shi Feng (Solid/Excess Wind) nor Xu Feng (Empty/Deficient Wind). Pathogenic Qi is Xu Feng, which贼ingly injures humans. It penetrates deeply and cannot expel itself. Regular Qi penetrates shallowly and expels itself upon merging with the body's Qi. Its approach is gentle and cannot overcome True Qi, so it dissipates naturally.

What is received from heaven is congenital Essence Qi; Grain Qi is postnatal Essence Qi from food and drink; they merge to fill the body. Regular Qi is the breath of the great earth, named wind, coming from one direction, neither solid nor empty wind; this is the Regular Qi of heaven and earth. Xu Feng is thief-wind coming from empty directions, injuring Regular Qi. It penetrates deeply and cannot expel itself. Regular Qi penetrates shallowly, merges with True Qi, and dissipates. Because its approach is gentle, it cannot overcome True Qi, so it dissipates. Min Shixian stated: Humans are born inheriting the Regular Qi of heaven and earth; thus, heavenly Regular Qi merges with human True Qi. Heavenly Regular Qi cannot overcome human True Qi because the merged Qi is vigorous. Zhu Weigong stated: Wind originates from underground tunnels, hence its approach is gentle.

Shi Feng is the anger of heaven.

When Xu Xie (Deficient Evil) invades, it causes shivering and bodily agitation, raising goosebumps and opening the cou li (skin and muscle interstices). If it penetrates deeply and internally clashes with bone, it becomes Gu Bi (Bone Bi); with sinew, Jin Luan (Sinew Spasm); within vessels, Xue Bi (Blood Blockage); obstruction leads to Yong (Abscess); with flesh, clashing with Wei Qi, Yang excess causes heat, Yin excess causes cold. Cold causes True Qi to depart; departure leads to deficiency; deficiency allows cold to clash in the skin. Qi erupts outward in the cou li, opening hair follicles. Errant Qi moving causes itching; staying without departing causes Bi syndrome. If Wei Qi does not move, it causes An Ren (loss of sensation).

This describes how Xu Xie damages form. Shivering agitates the body, so it clashes with skin, vessels, flesh, sinews, and bones, causing Bi, spasm, abscess, etc. Yin excess causes cold; cold causes True Qi to depart. Injury to Wei Qi causes loss of sensation. All these are produced by pathogenic factors.

If Xu Xie lodges偏侧ally in half the body, penetrating deeply and residing within Ying and Wei, slight decline of Ying and Wei causes True Qi to depart, leaving pathogens alone, resulting in Pian Ku (hemiplegia). If pathogens are shallow, it causes偏侧al vessel pain.

This describes pathogens lodging偏侧ally in form, injuring Ying and Wei, causing True Qi to depart and leading to hemiplegia. Shallow pathogens cause偏侧al vessel pain. Hemiplegia results from pathogens directly injuring sinews and bones. Min Shixian stated: When Ying and Wei decline, True Qi departs. One must know that Ying, Wei, and True Qi share the same origin but travel different paths; they can separate and merge.

When Xu Xie enters deeply, cold and heat clash, lingering internally. If cold exceeds heat, bones ache and flesh withers; if heat exceeds cold, flesh rots and muscles decay into pus. Internal injury to bone is called Gu Shi (Bone Erosion). If prior disease affects sinews, sinews contract and cannot extend; pathogens remain without returning, forming Jin Liu (Sinew Tumor). If结聚 occurs, Qi gathers there, Wei Qi stays and cannot return, fluids linger, forming Chang Liu (Intestinal Tumor), taking years to develop, soft to touch. If结聚 occurs, Qi gathers, fluids linger, pathogens invade, condensation worsens daily, clustering together, forming Xi Liu (Old Tumor), hard to touch. If结聚 reaches deep into bone, Qi attaches to bone, bone and Qi merge, enlarging daily, forming Gu Ju (Bone Abscess). If结聚 is in flesh, Zong Qi gathers there; pathogens stay without departing. With heat, it turns to pus; without heat, it forms Rou Ju (Flesh Abscess). All these qi disorders arise in no fixed location but have fixed names.

This describes Xu Xie injuring Qi and manifesting in form. Cold and heat clash represent Yin and Yang Qi in form. Form houses Qi; Qi returns to form; this is the union of form and Qi. Thus, injuring form affects Qi; injuring Qi affects form. "Qi gathering" refers to the clashing Qi of cold and heat returning to the form where pathogens linger. These disorders arise in no fixed place but have fixed names like flesh withering, bone erosion, sinew tumor, and old tumor. The final chapter discusses pathogenic diseases of form, noting True Qi departs and Ying/Wei are injured. True Qi enters and exits at joint intersections and wanders between skin and muscle fissures.