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The principles of needling. These are used to treat lesions of varying depths in the skin, flesh, sinews, and bones. Since the weather undergoes changes with the four seasons, and the human body has layers of Yin and Yang constitution, treatment must be regulated according to the seasonal timing.

The five Zang organs correspond to five specific regions on the body: 1) Futu (ST32); 2) The calf region (associated with the Spleen); 3) The back; 4) The Shu points of the five Zang organs; 5) The neck. If carbuncles or sores develop in any of these five regions, the prognosis is poor and death may ensue.

In external diseases, the skin is considered Yang, while the sinews and bones are considered Yin. Carbuncles and sores arise within the layers of skin, flesh, sinews, and bones. This passage indicates that each of the five Zang organs has corresponding external regions; if Yin and Yang become disharmonious in any one of these regions, stagnation occurs, leading to the formation of a carbuncle. Futu (ST32) is the pathway for Kidney Qi; the calf region is the domain of the Spleen; the back is the location of the Lung's Shu points; the "Shu points of the five Zang" refers specifically to Xinshu (BL15) located beside the fifth thoracic vertebra; and the neck is the location of the Liver's Shu points. The Classic states: "Carbuncles and sores do not fall from the sky nor emerge from the earth; they arise from the gradual accumulation of minor factors." Therefore, carbuncles occurring in these five regions result from the gradual accumulation of toxic stagnation within the five Zang organs, manifesting externally as disharmony of Qi and Blood. Consequently, the appearance of such conditions in these five regions indicates a fatal prognosis. As discussed in the previous chapter, pathogenic factors of the Zang organs manifest externally in the skin, flesh, sinews, and bones. Here, it is stated that each Zang organ has five corresponding regions, within which the flow of Yin, Yang, Qi, and Blood circulates. This illustrates the principle that "Yin contains Yang, and Yang contains Yin."

Yu Borong stated: The onset of carbuncles and sores may be caused by external invasion of Wind-Cold, or by unregulated emotions (excessive anger or joy), irregular diet, and disharmony of Ying and Wei (Defensive and Nutritive Qi), causing rebellion within the muscle tissue. This leads to the formation of carbuncles. When Yin and Yang pathways are blocked, and two types of Heat contend with each other, pus is formed. However, some cases originating in the thighs or arms result in death, while those originating in the neck or back may result in recovery. This distinction depends on the severity of the pathogenic toxin and the deficiency or excess of the healthy Qi. Nevertheless, if the disease involves the five Zang organs, death is inevitable. Therefore, for diseases caused by external pathogens, skilled practitioners treat the skin and hair layer first, and the muscle layer secondarily. For diseases caused by internal injury, the goal is to disperse the stagnant Qi of the Zang organs into the skin, preventing the carbuncle from localizing in a single region. This embodies the principle that "early intervention can save the patient, but once pus has formed, it is difficult to cure." This represents the approach of master physicians in treating disease before it arises ("Zhi Wei Bing").

If the disease begins in the arm, first select points from the Hand-Yangming Large Intestine Meridian and the Hand-Taiyin Lung Meridian to induce sweating. If the disease begins in the head, first select points in the neck from the Foot-Taiyang Bladder Meridian to induce sweating. If the disease begins in the lower leg, first select points from the Foot-Yangming Stomach Meridian to induce sweating.

This differentiates the Yin and Yang meridians governing the upper and lower parts of the body. The upper half of the body is governed by the Hand-Taiyin Lung and Hand-Yangming Large Intestine meridians; thus, for diseases beginning in the arm, points from the Hand-Yangming and Hand-Taiyin meridians are selected to induce sweating. Taiyang Qi originates in the Bladder and ascends to the head and neck; therefore, for diseases beginning in the head, points in the neck from the Foot-Taiyang meridian are selected to induce sweating. The lower half of the body is governed by the Foot-Taiyin Spleen and Foot-Yangming Stomach meridians; thus, for diseases beginning in the lower leg, points from the Foot-Yangming meridian are selected to induce sweating. The term "beginning" implies that if a disease starts below, it descends to its extreme and then ascends; if it starts above, it ascends to its extreme and then descends. The term "first" implies that although the Yin and Yang meridians of the hands and feet have their respective dominions, the Qi of the Three Yin and Three Yang meridians ascends and descends, moves internally and externally, and communicates with one another.

The Taiyin Meridian of the arm can induce sweating, and the Yangming Meridian of the foot can also induce sweating. Therefore, if excessive sweating results from selecting points on Yin meridians, regulation should be sought in the Yang meridians; if excessive sweating results from selecting points on Yang meridians, regulation should be sought in the Yin meridians.

Sweat is a Yin fluid, generated from the Yangming stage. The Taiyin Meridian governs Qi, which circulates on the surface of the skin. Water fluids are distributed throughout, facilitated by the transformation and transportation of Qi; hence, the Taiyin Meridian of the arm can induce sweating. The fluids from food and drink are excreted through the interstices (couli), resulting in profuse sweating; hence, the Foot-Yangming Meridian can induce sweating. However, the discharge of sweat relies on the dissemination of Qi. Qi requires fluids to fill the body and nourish the hair and skin. Therefore, if excessive sweating results from selecting points on Yin meridians, regulation should be sought in the Yang meridians; if excessive sweating results from selecting points on Yang meridians, regulation should be sought in the Yin meridians. This is because Yang acts as the guardian of Yin, and Yin acts as the anchor of Yang.

Shen Liangchen stated: This chapter discusses cold-heat syndromes caused by the disharmony of Yin and Yang, which are appropriately resolved through diaphoresis (sweating). Thus, several principles regarding the sweating method are summarized.

The harm of needling lies in this: if the needle strikes the target but is retained too long, essence will be depleted; if the needle does not strike the target and is withdrawn immediately, pathogenic Qi will accumulate. Depletion of essence leads to worsening of the disease and debility. Accumulation of pathogenic Qi leads to the formation of carbuncles and sores.

"Depletion of essence" refers to the fact that Yin, Yang, Qi, and Blood all originate from Essence; excessive injury damages the root source. "Carbuncles and sores" refer to the condition where Yin, Yang, Qi, and Blood circulate nutritively between the skin, flesh, sinews, and bones. When pathogenic factors linger and lodge, causing healthy Qi to stagnate, carbuncles and sores arise. This chapter discusses Yin-Yang and cold-heat syndromes arising from the excess or deficiency of pathogenic and healthy Qi. Therefore, this section is repeated at the end of the chapter, serving as a warning to practitioners: beware of exacerbating an excess condition or further weakening a deficient one ("making the excess more excess and the deficiency more deficient").