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The essential principle of acupuncture lies in the optimal use of the Nine Needles. Each of the nine needles has specific indications and applications corresponding to their length and size. Failure to utilize them appropriately will prevent the resolution of disease.
If the pathology is superficial but the needle insertion is too deep, healthy tissue may be injured internally, potentially leading to skin abscesses (Yong). Conversely, if the pathology is deep but the needle insertion is too shallow, pathogenic Qi cannot be discharged, resulting in swelling and suppuration.
Using a large needle for a minor condition causes excessive dispersion of Healthy Qi, inevitably causing harm. Using a small needle for a major condition fails to discharge pathogenic factors, also leading to therapeutic failure.
Inappropriate needling results in an inability to drain excess or move deficiency. Having discussed these errors, we now proceed to describe the correct applications.

For diseases located in the skin without fixed sites, use the Di Needle (Di Zhen, blunt-pointed needle) at the affected area; avoid this method if the skin appears pale.
For diseases located between the muscle layers, use the Yuan Needle (Yuan Zhen, round-headed needle) at the affected area.
For diseases involving the meridians characterized by chronic Bi syndrome, use the Feng Needle (Feng Zhen, three-edged needle).
For conditions with deficient pulse Qi requiring tonification, use the Di Needle at the Jing-Well, Ying-Spring, and Shu-Stream points.
For severe cases forming large abscesses, use the Pi Needle (Pi Zhen, sword-shaped needle).
For acute onset of Bi syndrome, use the Yuanli Needle (Yuanli Zhen, fine and sharp needle).
For persistent Bi pain that does not resolve, use the Hao Needle (Hao Zhen, filiform needle).
For diseases located deeply within the body, use the Chang Needle (Chang Zhen, long needle).
For edema obstructing joint mobility, use the Da Needle (Da Zhen, large needle).
For diseases fixed within the Zang organs, use the Feng Needle to drain at the Jing-Well, Ying-Spring, and Shu-Stream points, selecting acupoints according to the four seasons.

"Guan" refers to standard methods. The methodology of the Nine Needles includes regulations on size and length, principles for depth and tonization/sedation, and techniques such as the Sanwu, Jiu, and Ershier Ci (35, 9, and 12-point punctures), each with specific applications. Misapplication leads to treatment failure and harm.

There are nine types of puncture techniques corresponding to nine variations:
1. **Shu Ci (Transport Puncture)**: Puncturing the Ying-Spring, Shu-Stream, and Back-Shu points of the meridians.
2. **Yuandao Ci (Distant Path Puncture)**: Treating upper body disorders by selecting lower body points, specifically the He-Sea points of the Fu organs.
3. **Jing Ci (Meridian Puncture)**: Puncturing collateral knots and divisions along major meridians.
4. **Luo Ci (Collateral Puncture)**: Puncturing small collateral blood vessels.
5. **Fen Ci (Muscle Separation Puncture)**: Puncturing between muscle layers.
6. **Da Xie Ci (Major Draining Puncture)**: Using the Pi Needle to drain large abscesses.
7. **Mao Ci (Hair Puncture)**: Superficial puncture for floating Bi syndrome in the skin.
8. **Ju Ci (Great Cross Puncture)**: Left-sided pathology treated by right-side needling, and vice versa.
9. **Fan Ci (Burning Needle Puncture)**: Using heated needles to treat Bi syndrome.

The previous section discussed the appropriateness of the nine needles; this section discusses the variations of the nine puncture techniques.
**Shu Ci**: Punctures the Shu points of the Five Zang organs, adhering to the principle "Ying-Spring and Shu points treat external meridians."
**Yuandao Ci**: Treats upper disorders by selecting He-Sea points below, adhering to "He-Sea points treat Six Fu organs." This is because the source Qi of the Hand and Foot Three Yang meridians originates in the foot and ascends to the neck and head.
**Jing Ci**: Addresses major collaterals where pathogens enter the skin and sun-collaterals, stagnate, and overflow into major meridians, causing unusual diseases. Puncturing these knots restores flow.
**Luo Ci**: Targets visible small collaterals on the skin surface.
**Fen Ci**: Targets the intersection of muscle fibers and valleys (acupoints), treating pathogens in the muscles.
**Da Xie Ci**: Drains large amounts of pus and blood.
**Mao Ci**: Superficial treatment for pathogens trapped in the skin, ensuring no injury to deeper tissues ("Puncture hair without injuring skin; puncture skin without injuring flesh").
**Ju Ci**: Treats pathogens in the Twelve Extraordinary Meridians via cross-limb needling.
**Fan Ci**: Uses fire needles to treat tendon Bi.

There are twelve categories of puncture techniques corresponding to the Twelve Primary Meridians:
1. **Ou Ci (Paired Puncture)**: Simultaneous anterior (chest) and posterior (back) needling opposite the pain site to treat Heart Bi, avoiding direct heart damage.
2. **Bao Ci (Reporting Puncture)**: For migrating pain without fixed location; insert needle, press surrounding area with left hand, withdraw, and re-insert.
3. **Hui Ci (Restoring Puncture)**: Vertical insertion with lateral manipulation to relax tight tendons in tendon Bi.
4. **Qi Ci (Uniform Puncture)**: One central vertical needle and two oblique needles for deep, localized cold Bi. Also called "San Ci" (Three Needles).
5. **Yang Ci (Spreading Puncture)**: One central needle and four surrounding superficial needles for extensive cold pathogens.
6. **Zhi Zhen Ci (Straight Needle Puncture)**: Pulling the skin taut before superficial puncture for shallow cold pathogens.
7. **Shu Ci (Transport Puncture - Variation)**: Deep, sparse needling with direct insertion and withdrawal for excess heat conditions.
8. **Duan Ci (Short Needle Puncture)**: Slightly shaking a short needle inserted deeply to the bone, rubbing against it to treat Bone Bi.
9. **Fu Ci (Floating Puncture)**: Oblique superficial insertion for muscle tension with cold.
10. **Yin Ci (Yin Puncture)**: Bilateral symmetrical needling for Cold-Jue syndrome, specifically targeting the Shaoyin meridian behind the ankle.
11. **Pang Zhen Ci (Side Needle Puncture)**: One vertical and one adjacent needle for chronic, stationary Bi syndrome.
12. **Zan Ci (Assisting Puncture)**: Rapid, shallow multiple pricks to bleed, treating carbuncles and swellings.

"Jie" refers to regulatory systems. Ou Ci pairs anterior (Yang) and posterior (Yin) points. Bao Ci repeats needling for migrating pain. Hui Ci expands and relaxes tendons. Qi Ci uses a central needle supported by two side needles for deep cold. Yang Ci spreads energy from center to periphery. Zhi Zhen Ci uses filiform needles vertically in the skin. Shu Ci mimics transport with direct deep insertion. Duan Ci uses short needles to reach bone for friction. Fu Ci is shallow and oblique. Yin Ci targets Shaoyin Cold-Jue. Pang Zhen Ci treats chronic Bi. Zan Ci assists the dispersal of swellings via bleeding. Among these, Shaoyin is highlighted as it governs先天 (Pre-heaven) Yin-Yang and Water-Fire, the origin of Wu Yun Liu Qi (Five Movements and Six Qi).

For deep, invisible pulses, insert the needle slightly and retain it for a long time to guide the empty pulse Qi. For superficial pulses, do not puncture directly; compress the vessel to stop flow before puncturing, allowing only pathogenic Qi to exit while preserving Essence.

This passage explains that meridians internally harmonize with the Five Elements and externally correspond to the Six Qi of Heaven. Meridians connect internally to Zang-Fu and externally to Six Qi. The Five Zang internally correspond to Five Elements (Wu Yun), named Shen Ji (Spirit Mechanism), governing ascent and descent. The Six Qi rotate externally, named Qi Li (Qi Establishment). The Six Qi of Heaven and Earth correspond to human Essence-Water, circulating on the body surface. Deep pulses connect to the Five Zang; retaining the needle brings Zang Shen Qi to the exterior. Superficial pulses correspond to external Six Qi; compressing prevents Essence loss while allowing Qi circulation. Master Yu states that guiding Zang Shen Ji relies not on Ying-Wei Blood-Qi, hence termed "Empty Pulse Qi."

The concept of "San Ci" (Three Stages of Puncture) yielding Gu Qi (Grain Qi):
1. Superficial puncture through the epidermis to expel Yang pathogens.
2. Slightly deeper puncture, reaching muscle but not the intermuscular space, to expel Yin pathogens.
3. Deep puncture into the intermuscular space to elicit Gu Qi.
Thus, initial shallow needling drives out pathogens and attracts Blood-Qi; deeper needling draws out Yin pathogens; deepest needling reaches Gu Qi. Practitioners must understand the annual climate influences (Nian Zhi Suo Jia), the waxing and waning of Qi (Qi Zhi Sheng Shuai), and the origins of deficiency and excess to be skilled physicians.

Gu Qi is the primordial truth integrated in muscle and tissue, governed by the Spleen and Stomach. Yin and Yang pathogens refer to imbalances in Qi levels. The progression of depth corresponds to the circulation of Three Yin and Three Yang Qi on the skin surface, mirroring the Six Qi of Heaven. Annual additions refer to the arrival of Six Qi; Qi waxing/waning refers to Wu Yun (excess/deficiency). These determine human deficiency/excess states.

There are five types of puncture techniques corresponding to the Five Zang:
1. **Ban Ci (Half Puncture)**: Superficial insertion and rapid withdrawal, resembling plucking hair, affecting skin Qi; corresponds to Lung.
2. **Bao Wen Ci (Leopard Pattern Puncture)**: Multiple punctures around the lesion intersecting vessels to release blood from meridians; corresponds to Heart.
3. **Guan Ci (Joint/Pivot Puncture)**: Vertical insertion at tendon attachments to treat Tendon Bi, avoiding bleeding; corresponds to Liver. Also known as Yuan Ci or Qi Ci.
4. **He Gu Ci (Valley Convergence Puncture)**: Chicken-foot shaped multi-directional needling between muscle layers to treat Muscle Bi; corresponds to Spleen.
5. **Shu Ci (Transport Puncture - Variation)**: Direct deep insertion to the bone to treat Bone Bi; corresponds to Kidney.

This section describes how Five Zang Qi externally correlates with Skin, Vessels, Flesh, Tendons, and Bone. Blood houses Shen Qi; Zang Shen Ji circulates in vessels corresponding to Wu Yun. Zang Qi externally correlates with tissues corresponding to Four Seasons. Master Yu notes: Nine Appropriatenesses/Variations correspond to Earth's Nine Regions/Nine Orifices; Twelve Categories correspond to Twelve Months; Three Stages correspond to Three Yin/Yang; Five Punctures correspond to Five Elements/Five Seasons. Acupuncture aligns with Heaven, Earth, and Humanity, wherein humans integrate with Heaven and Earth.