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(If the following symptoms appear,) death ensues. The seventh is coughing with epistaxis, absence of sweating, or sweating that does not reach the feet; this indicates death. The eighth is heat in the marrow; this indicates death. The ninth is fever accompanied by spasms; this indicates death. (Manifestations include) opisthotonos and trismus.

None of these nine conditions should be treated with acupuncture.

The first is absence of sweating, which indicates that external pathogenic heat cannot be resolved through diaphoresis. The *Lunyu* (Discourse on Acupuncture for Heat) states: In liver heat disease, the left cheek reddens first; in heart heat disease, the forehead reddens first; in spleen heat disease, the nose reddens first; in lung heat disease, the right cheek reddens first; in kidney heat disease, the chin reddens first. If the entire zygomatic area and face are red, this indicates extreme excess of heat in the five Zang organs. "Hiccough" refers to hiccupping. Hiccoughing results from the contention between internal and external heat pathogens in the middle jiao, leading to the exhaustion of Stomach Qi. The second is diarrhea accompanied by severe abdominal fullness; this indicates the downward leakage of righteous Qi and Yin fluids, while external heat pathogens fill the interior. The third is blurred vision with persistent heat; this indicates extreme internal heat causing turbidity of internal and external Qi mechanisms. The fourth is fever with abdominal fullness in the elderly and infants; this indicates death. This is because the elderly have already declined in internal and external blood and Qi, while infants lack sufficient Yin and Yang at the exterior and interior. Abdominal fullness indicates heat pathogens rebelling in the middle jiao, unable to dissipate from the interior or exterior. The fifth is absence of sweating, accompanied by vomiting and hematochezia; this indicates unresolved external heat entering the Yin meridians. The sixth is ulceration of the root of the tongue with persistent heat; this indicates excessive internal heat rebelling upwards along the upper collaterals. The seventh is coughing with epistaxis and absence of sweating. Coughing is due to internal heat rebelling upwards to the Lung; epistaxis is due to exterior heat forcing its way outward through the meridians. The Lung governs the skin and hair and commands all meridians; internal and external heat should be resolved through sweating via Lung Qi. Absence of sweating indicates Lung Qi exhaustion at the upper burner; sweating failing to reach the feet indicates Kidney Qi exhaustion at the lower burner. The eighth is heat in the marrow; heat residing in the marrow is a fatal condition incurable by treatment. The ninth is fever with spasms, indicating the termination of Taiyang Qi. When Taiyang Qi terminates, Kidney Qi also fails, resulting in opisthotonos and trismus. Taiyang and Shaoyin are the root sources of Yin-Yang vital energy. Acupuncture is used to guide righteous Qi to expel pathogens. For these nine conditions, where pathogenic heat is extreme and righteous Qi is exhausted, acupuncture is of no benefit.

The so-called "Fifty-Nine Acupoints" refer to: three points on each side of the medial and lateral aspects of both hands, totaling twelve points; one point between each of the five fingers, totaling eight points; the same applies to the feet. At the head, one cun inside the hairline, three points on each side at a distance of three fen laterally, totaling six points; three cun inside the hairline, five points along the margin, totaling ten points; one point each at the front and back of the ears and below the ear, plus one point in the center of the nape, totaling six points; one point at the vertex, one point at Xinhui, one point at the hairline, one point at Lianquan, two points at Fengchi, and two points at Tianzhu. (" " refers to needle scars left by Ye Hui.)

This clarifies the fifty-nine acupoints mentioned above. The acupoints on the medial aspect of both hands are Shaoshang (LU-11) of the Lung Meridian, Shaochong (HT-9) of the Heart Meridian, and Zhongchong (PC-9) of the Pericardium Meridian, three on each side, totaling six points. The acupoints on the lateral aspect are Shangyang (LI-1) of the Large Intestine Meridian, Shaoze (SI-1) of the Small Intestine Meridian, and Guanchong (TE-1) of the Sanjiao Meridian, three on each side, totaling six points. Three points on the medial and lateral aspects of both hands total twelve points. One point between each of the five fingers totals eight points. The same applies to the feet, i.e., one point in the interphalangeal creases of the third phalanges of the hands and feet, totaling sixteen points. The three points at one cun inside the hairline and three fen laterally are Wuchu (BL-3), Chengguang (BL-38), and Tongtian (BL-39) of the Bladder Meridian of Foot-Taiyang, three on each side, totaling six points. The five points at three cun inside the hairline along the margin are Linqi (GB-15), Mucuang (GB-16), Zhengying (GB-17), Chengling (GB-18), and Naokong (GB-19) of the Gallbladder Meridian of Foot-Shaoyang, totaling ten points bilaterally. "Three fen laterally inside the hairline" means the Taiyang meridian is three cun away from the Du vessel running in the midline, divided into two halves. "Along the margin three cun inside the hairline" means the Shaoyang meridian is three cun away from the Du vessel on each side. One point each at the front and back of the ears: He'liao (TE-20) of the Sanjiao Meridian of Hand-Shaoyang is in front of the ear, and Fubai (GB-12) of the Gallbladder Meridian of Foot-Shaoyang is behind the ear. One point below the mouth is Chengjiang (CV-24) of the Ren vessel. One point in the center of the nape is Dazhui (GV-14) of the Du vessel. The four meridians around the ears, combined with the Ren and Du vessels, total six points. One point at the vertex is Baihui (GV-20) of the Du vessel. One point at Xinhui is Shangxing (GV-23) of the Du vessel. One point at the hairline: Shenming (GV-24) of the Du vessel is at the anterior hairline, and Fengfu (GV-16) of the Du vessel is at the posterior hairline. Lianquan is an acupoint of the Ren vessel, located four cun above the laryngeal prominence under the chin. Fengchi is an acupoint of the Gallbladder Meridian of Foot-Shaoyang, located in the depression between the hairline and the mastoid process behind the ears. Tianzhu is an acupoint of the Bladder Meridian of Foot-Taiyang, located in the depression lateral to the sternocleidomastoid muscle at the hairline of the nape. These fifty-nine acupoints are selected respectively for heat diseases of the exterior-interior, Yin-Yang, five Zang organs, and twelve meridians.

For chest fullness with wheezing and panting, select the acupoint at the tip of the big toe of the Foot-Taiyin Splein Meridian, approximately the width of a leek leaf from the nail corner. Retain the needle for cold patterns; insert and remove quickly for heat patterns. Stop when the Qi descends.

This chapter first discusses external pathogenic heat, then internal heat, then the contention between internal and external heat, all concerning the Qi level without involving the meridians. It then discusses internal diseases entering the Three Yin meridians and external diseases entering the Three Yang meridians, thus selecting the Jing-well points of the hands and feet and the blood collaterals. Taiyin resides in the center and belongs to Earth; rebellious Qi scatters from top to bottom. The Foot-Taiyin Spleen Meridian ascends through the diaphragm and injects into the Heart. Chest fullness with wheezing indicates rebellious Qi in the meridian ascending upwards; therefore, Yintang (SP-1) at the tip of the big toe of the Foot-Taiyin Spleen Meridian is selected to cause the rebellious Qi to descend, bringing relief.

For sudden pain of Xinshan (Heart Hernia), select the Foot-Taiyin and Foot-Jueyin meridians and puncture their blood collaterals to release blood.

Shan refers to diseases of the lower abdomen and scrotum. Xinshan is a disease originating in the lower part but affecting the upper part; thus, it is said that patients with Xinshan have palpable masses in the lower abdomen. The Foot-Taiyin Meridian ascends from the abdomen to inject into the Heart. The Foot-Jueyin Meridian connects with the genitalia, reaches the lower abdomen, ascends through the diaphragm, and injects into the Lung. This disease involves the Foot-Taiyin and Foot-Jueyin meridians and manifests upward as Xinshan; therefore, acupoints on the lower parts of these meridians are selected to remove their blood collaterals, stopping the heart pain.

For Bi syndrome of the throat, curled tongue, dry mouth, irritability, heart pain, and pain along the medial aspect of the arm extending to the inability to raise the hand to the head, select the area below the nails of the little finger and the ring finger, approximately the width of a leek leaf from the fingertip.

The Pericardium Meridian originates in the chest, emerges to connect with the Pericardium, communicates upward with the Heart, and connects downward with the Sanjiao. Therefore, it governs diseases generated by the vessels, such as irritability and heart pain. Ascending Ministerial Fire causes Bi syndrome of the throat, curled tongue, and dry mouth. Select the Jing-well points of the little and ring fingers, namely Guanchong (TE-1) of the Sanjiao Meridian of Hand-Shaoyang, to drain the Ministerial Fire, thereby resolving all symptoms.

For redness and pain in the eyes starting from the inner canthus, select the Yin Qiao Mai.

This discusses external pathogenic evils entering the Three Yang meridians, with manifestations appearing in the upper, middle, and lower regions. Redness and pain in the eyes starting from the inner canthus indicate a disease of the Foot-Taiyang Bladder Meridian located in the upper region. The Taiyang Meridian originates at the inner canthus and meets the Yin Qiao Mai and Yang Qiao Mai at Jingming (BL-1). Therefore, the Yin Qiao Mai should be selected to clear Yang heat.

For Fengjing (Wind Spasm) with opisthotonos, first select the Foot-Taiyang Meridian, Weizhong (BL-40), and release blood from the blood collaterals. If there is cold in the interior, select Zusanli (ST-36).

This describes wind pathogens entering the Taiyang Meridian with manifestations in the middle region. Yang diseases prevent flexion; Yin diseases prevent extension. The Taiyang Meridian runs along the back. Wind entering the interior causes stiffness and spasm of the sinews and tendons, resulting in opisthotonos. First, select Weizhong (BL-40) of the Foot-Taiyang Meridian to release blood from the collaterals. If there is cold in the interior, select Zusanli (ST-36) of the Foot-Yangming Stomach Meridian to tonify. This is because the Qi and blood of the meridians are generated by the water and grain essence of the Yangming.

For Long (difficulty in urination), select the Yin Qiao Mai, the hair tuft on the big toe (Sanmao), and release blood from the blood collaterals.

This describes a disease of the Foot-Taiyang Meridian located in the lower region. The lower shu points of the Sanjiao emerge at Weiyang (BL-39), merge with the main channel of the Taiyang, enter and connect with the Bladder, and constrain the Lower Jiao. Excess patterns result in urinary retention; therefore, the Yin Qiao Mai is also selected. Since the Yin Qiao and Yang Qiao intersect at Jingming (BL-1) of the Taiyang Meridian, Yang enters Yin and Yin emerges from Yang. The Yang Qiao is a branch of the Foot-Taiyang Meridian. Draining the Yin Qiao allows the pathogens of the Taiyang Meridian to exit through the Qiao meridians. Sanmao is Dadun (LR-1) of the Foot-Jueyin Liver Meridian; diseases generated by the Liver include urinary retention, hence the selection of the meridian containing Sanmao. Blood collaterals present above are used to release blood. Taiyang Qi governs the skin surface; pathogens attacking the human body begin at the skin and hair. Thus, pathogens from the skin and hair transfer into the Taiyang Meridian. According to the previous chapter, external and internal pathogens reside in the Qi level of the exterior Yang, recovering after seven days and repeating after eight days. Contention with the Qi of the five Zang organs leads to internal-external exchange. Here, it again discusses external and internal diseases transferring into the meridians.

External pathogens enter Yang; internal pathogens enter Yin, interfering with each other neither. Shen Liangchen stated: The *Four Seasons Chapter* discusses lower abdominal pain and swelling with inability to urinate, indicating pathogens constrained in the Sanjiao. Select the large collaterals of the Taiyang, observe the collateral vessels, and if they knot with the small collaterals of the Jueyin and contain blood, this indicates Long constrained in the Taiyang Sanjiao, also involving the collaterals of the Jueyin. This is because the Qi of the Jueyin is born from the water of the Bladder; the mother makes the son solid, and when solid, the son is drained. Note: This classic uses acupuncture to correspond with numerical principles, aligning humans with the Yin-Yang of heaven and earth, which is the fundamental principle for self-cultivation, governing the state, and managing the people. Regarding the relief of people's suffering, it distinguishes exterior-interior, Yin-Yang, pathogenic-righteous, deficiency-excess, Yin-Yang blood-Qi, meridians-Zang-Fu, Five Elements-Six Qi, generation-restriction, tonification-drainage, each having its own methods. Scholars who extend the principles of acupuncture to pharmacotherapy will find infinite subtleties. Alas, Huangfu Mi compiled them into the *Jia Yi Jing*, and Ma Shi followed the text sentence by sentence, merely stating that this disease belongs to this meridian and has this needling method, or this syndrome has this needling method, thereby obscuring profound truths and causing future generations to slight the sacred classics for a long time. How sad!

Men resemble those with Gu disease; women resemble those with menstrual obstruction. The body and lumbar spine feel as if dislocated; there is no desire for food and drink. First, puncture Yongquan (KI-1) until bleeding appears. Observe the dorsum of the foot for full blood vessels and release all blood.

The entire chapter discusses diseases caused by external and internal factors, and here concludes with the discussion of internal and external righteous Qi. Generally, external and internal diseases damage human Yin-Yang blood and Qi, which originate from congenital essence and are generated by postnatal grain essence, moving from the interior to the exterior. Congenital essence is governed by the Kidneys; grain essence is produced by the Stomach. The Dan Tian below the umbilicus is the Sea of Qi; the Bao Zhong (uterus/matrix) is the Sea of Blood. Men primarily govern Qi; women primarily govern Blood. Hence, men are described as resembling Gu disease, and women as resembling obstruction, describing the stagnation of blood and Qi internally. The sensation of the body and lumbar spine being dislocated describes the pathology of blood and Qi externally. The body is governed by the Spleen and Stomach; the lumbar spine is the mansion of the Kidneys; lack of appetite indicates rebellious Stomach Qi. This is how external and internal pathogens damage internal and external righteous Qi. Therefore, one should first select Yongquan of the Kidneys, then Duzhong (likely referring to Chongyang ST-42 or similar dorsal foot points, contextually implying Stomach meridian points on the dorsum) on the dorsum of the foot, releasing blood to unblock the meridians and allow blood and Qi to flow outward. The general meaning is that thousands of diseases do not exceed external and internal causes, and these diseases always damage human Yin-Yang blood and Qi. Knowing the origin of their generation, entry, and exit enables the harmonization of blood and Qi and the consolidation of Yin and Yang, preventing not only severe diseases but also promoting longevity. The education of the sages is truly great! "Women resembling obstruction" refers to menstrual obstruction. Men do not have menstrual obstruction, hence described as resembling Gu. The use of the word "resembling" (Ru) serves only to describe the pathology of internal and external blood and Qi; the distinction between men and women should also be viewed lightly. Refer to the sacred classics and do not let literary form obscure the meaning, which would be appropriate. Mo Yuncong stated: This shares the same profound significance as the intersection of Guan Yuan (CV-4) with the three meridians below the umbilicus discussed in the *Cold and Heat Chapter*.