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Huangdi asked Qibo: I have learned the principles of acupuncture from the Master, and the content is comprehensive and complete. The Master's Dao seems easy to grasp yet elusive, without any firm or fixed point to hold onto. Did the Master acquire this through熟习 (shúxí, familiarity) of learning, or by examining things and achieving sudden comprehension in the heart?

This chapter discusses how human body constitution (thick or thin), blood and qi (clear or turbid) correspond to the Dao of Heaven and Earth, and operate according to the principles of reverse and smooth (ni shun). "The Master's Dao seems elusive" means the Dao is profound and distant, hard to find; "firm" refers to being definite or fixed. "Examining things" means investigating the principles of phenomena; "sudden comprehension in the heart" refers to a state of enlightened understanding. Generally, the Dao of sages connects with Heaven and Earth and conforms to the regularities of things. Yang said: "Elusive and firm" refers to Yan Hui's description: "Drilling into it makes it harder; looking at it ahead, it suddenly appears behind."

Qibo replied: The Dao established by sages corresponds above to Heaven, below to Earth, and in between to human affairs. There must be clear laws to establish measurements, standards, and rules, so that they can be transmitted. Therefore, a carpenter cannot judge length or width without rulers and measures, nor level water without a plumb line; a craftsman cannot draw circles without a compass or squares without a square ruler. Those who understand using these tools know they are natural instruments, easy-to-use teachings, and the constant principles of reverse and smooth operation. Huangdi said: I wish to hear what "natural" means. Qibo said: Opening a sluice on deep water requires no brute force, and the water can be drained; following a dug channel to break through allows meridians to become unobstructed. This illustrates the slipperiness or sluggishness of qi, the clarity or turbidity of blood, and their reverse or smooth flow.

Qibo discussed the Dao of Heaven and Earth, which arises naturally without coercion. Although profound and difficult to understand, it does not go beyond the principles of compass and square. "Opening a sluice on deep water" refers to letting water flow out; "following a dug channel to break through" refers to guiding water in. This is the operation of reverse and smooth. Yang said: Compass and square represent the images of Heaven and Earth. Reverse and smooth refer to Earth Qi moving left and Heavenly Dao rotating right. Using no brute force is the spontaneity of creation.

Huangdi said: I wish to know if people of different complexions, fatness, leanness, height, and stature have specific numerical patterns. Qibo said: For those who are young and strong, with abundant blood and qi, and firm skin and flesh, if pathogenic factors are added, needling should be deep and retained. This applies to obese individuals. They have broad shoulders and armpits, thin neck muscles, thick black skin, and protruding lips. Their blood is dark and turbid, and their qi is sluggish and slow. Such people tend to be greedy in giving and taking. When needling them, one should needle deeply, retain the needles, and increase the number of sessions.

This section discusses excessive physical constitution (obesity). Broad shoulders mean wider than the surroundings. The neck is governed by the Taiyang meridian; thin neck muscles with thick black skin indicate abundant Taiyang Water Qi. Lips are the external manifestation of Spleen Earth; protruding lips indicate strong Earth Qi. Black is the color of Water; dark and turbid blood indicates heavy and turbid Essence-Water. Sluggish and slow qi is due to dense muscles causing obstruction in the qi pathways. Excess leads to ability to give; deficiency leads to greed. Those greedy in giving and taking lack the Dao of harmony; excess is similar to deficiency. Yang Yuanru said: The previous chapter discussed the Qi of the Five Zang organs corresponding to the thickness of Earth and the clarity/coarseness of Qi color; this chapter discusses body fatness/leanness and blood clarity/turbidity, corresponding to excess and deficiency. Skin, flesh, vessels, sinews, and bones are external combinations of the Five Zang organs. Zhu Jigong said: The Five Movements govern the interior, the Six Qi govern the exterior. Humans are born inheriting the luck of Heaven and Earth, thus often exhibiting excess or deficiency.

Huangdi said: How should one needle lean individuals? Qibo said: Lean individuals have thin skin, pale complexion, emaciated muscles, thin lips, and soft speech. Their blood is clear and qi is slippery; qi is easily depleted, and blood is easily damaged. When needling them, one should needle shallowly and withdraw quickly.

This section discusses deficient physical constitution (leanness). Thin skin and pale complexion indicate insufficient inheritance of Heavenly Qi. "Lianlian" describes a lean and clean appearance. Emaciated muscles, thin lips, and soft speech indicate insufficient inheritance of Earthly Qi. Clear blood means clear and shallow fluids. Slippery qi is because thin muscles allow smooth qi pathways. Mo Zhongchao said: Voice relates to Late Summer and thin Earth Qi, hence soft speech. Zhu Jigong said: The slipperiness or sluggishness of qi pathways depends on muscle thickness, corresponding to the movement of Heavenly Qi within Earth.

Huangdi said: How should one needle ordinary people? Qibo said: Observe their white or black complexion and regulate accordingly. Those with upright and solid constitutions have harmonious blood and qi. When needling them, do not deviate from standard measurements.

This section discusses the harmony of peaceful individuals. White and black are colors of Water and Heaven. Upright and solid reflect the virtue of Kun (Earth). These individuals inherit the peaceful Qi of Heaven and Earth, hence their blood and qi are harmonious. Standard measurements refer to the constants of Heaven and Earth. Essentially, humans correspond to the Qi of Heaven and Earth, and needling should align with the numbers of Heaven, Earth, and Humanity.

Huangdi said: How should one needle robust individuals with solid bones? Qibo said: For robust individuals with solid bones, if muscles are loose and joints prominent, and the person is heavy, then qi is sluggish and blood is turbid; needle deeply and retain, increasing the number of sessions. If the person is vigorous, then qi is slippery and blood is clear; needle shallowly and withdraw quickly.

This discusses individuals in their prime, inheriting complete innate truth. Innate Yuan Qi resides in the Kidneys, which govern bones. With complete innate truth, flesh and bones become full. Solid bones, loose muscles, and prominent joints indicate harmony of sinews and bones with full muscles. "Jianjian" means standing upright without leaning. Heavy and turbid constitution leads to sluggish qi and turbid blood; light and vigorous constitution leads to slippery qi and clear blood. Yuan Zhen is undifferentiated Qi, but after birth, distinctions of heaviness/lightness and high/low arise. Deep needling with retention, and shallow needling with quick withdrawal, guide qi in and out.

Huangdi said: How should one needle infants? Qibo said: Infants have fragile flesh, little blood, and weak qi. Use fine needles, needle shallowly, and withdraw quickly. It can be done twice a day.

This discusses infants who have not yet inherited full innate vigor, with fragile flesh, little blood, and weak qi. "Ying" refers to nursing in swaddling clothes. Generally, boys at age eight and girls at age seven begin to have vigorous Kidney Qi, replacing teeth and growing hair. Boys at age thirty-two and girls at age twenty-eight reach peak bone and sinew development and full muscle strength. Form, flesh, blood, and qi rely on postnatal grain and water for nourishment, but originate from prenatal life source. Twice daily needling guides the growth of Yin-Yang, blood, and qi.

Huangdi said: What about opening a sluice on deep water? Qibo said: If blood is clear and qi is turbid, rapid draining will deplete the qi. Huangdi said: What about following a dug channel to break through? Qibo said: If blood is turbid and qi is sluggish, rapid draining will unblock the meridians.

Clear and turbid refer to the Qi of Heaven and Earth. Opening a sluice on deep water and following a dug channel to break through represent reverse and smooth operation. Blood and qi flowing in reverse or smooth order correspond to the rotation of Heaven and Earth.

Note: This chapter discusses the thickness, thinness, solidity, and fragility of form and flesh, and the quantity and clarity/turbidity of blood and qi, corresponding to excess and deficiency Qi. Therefore, the depth, shallowness, speed, and slowness of needling, as well as the quantity and tonification/reduction methods, all use needles to harmonize the human body. Thus, the term "pathogenic disease" does not appear in the chapter. Interpreting it merely as draining pathogens would stray far from the meaning of the Classic.

Huangdi said: What is the reverse and smooth flow of meridians? Qibo said: The Three Yin meridians of the Hand travel from the Zang organs to the hands; the Three Yang meridians of the Hand travel from the hands to the head; the Three Yang meridians of the Foot travel from the head to the feet; the Three Yin meridians of the Foot travel from the feet to the abdomen.

This discusses the reverse and smooth flow of Yin and Yang meridians of the hands and feet, up and down, outside and inside, corresponding to rivers on Earth.

Huangdi said: Why does only the Shaoyin meridian descend? Qibo said: Not so. The Chong Mai (Penetrating Vessel) is the Sea of the Five Zang and Six Fu organs; all Zang and Fu organs receive from it. Its ascending branch emerges from the pharynx (hangsang), seeps into the Yang meridians, and irrigates the essences. Its descending branch pours into the large collateral of Shaoyin, emerges at the Qichu (gas street), follows the medial aspect of the thigh, enters the popliteal fossa, runs deep within the bone, descends to behind the medial malleolus, branches off, and separates. The lower part runs parallel with the Shaoyin meridian, seeps into the Three Yin meridians. The anterior part runs deep, emerges at the dorsum of the foot, descends, follows the dorsum, enters between the great toe and second toe, seeps into various collaterals to warm the muscles. Therefore, if the collateral collides, the dorsum of the foot becomes immobile; immobility leads to cold limbs (Jue), and cold limbs lead to coldness. Huangdi said: How do we know this? Qibo said: By verbal guidance and pulse palpation verification; seeing the actual movement, one can then understand the reverse and smooth flow. Huangdi said: How profound! The Dao of sages is bright like the sun and moon, subtle to the finest detail. Without the Master, who could explain it?

This section discusses blood and qi flowing outside the vessels, corresponding to the Dao of Heaven. Si Tian (ruling Heaven) is above, Zai Quan (ruling Earth) is below; Water and Heaven Qi connect above and below, corresponding to human blood and qi filling the skin, warming the flesh, and seeping into the pores, making muscles full. If one feels timid and short of breath, water pathways fail, and form and Qi dissipate. The Chong Mai is the Sea of the Five Zang and Six Fu organs; the Qi of all Zang and Fu organs flows via the Chong Mai. Its ascending branch emerges from the pharynx, seeps into Yang meridians, irrigates Yin. Its descending branch pours into the large collateral of Shaoyin, emerging at Qichu. This means the blood and qi of the Five Zang and Six Fu organs seep and irrigate the skin outside the vessels from the Chong Mai, corresponding to water moving with Qi on the surface of Heaven. Shaoyin governs prenatal Water and Fire; Water and Fire are Essence and Qi. The Chong Mai runs with Shaoyin, seeps into the Three Yin, follows the dorsum of the foot, enters the great toe, seeps into collaterals to warm muscles. This is the Essence-Qi of Shaoyin, circulating in and out of the vessels and skin via the Chong Mai. Therefore, if collaterals collide, Shaoyin Qi cannot reach the dorsum of the foot, causing immobility. Immobility means Shaoyin Qi is reversed internally, leading to cold limbs and coldness. This is Qi and Blood stagnating inside the vessels, unable to communicate outside. Thus, guidance is needed: verbal guidance to move Qi outward, pulse verification to know Jing-Blood flow. Only when the dorsum of the foot is immobile can one understand the reverse and smooth flow. Reverse and smooth flow means the Essence-Qi of Shaoyin seeps into the skin surface and circulates back within the vessels, corresponding to Si Tian and Zai Quan Qi circling the earth and penetrating underground. Bright like sun and moon, subtle to the finest detail, means the Sage's Dao is like the sun and moon in the sky, circling according to degrees without error. Thus, the Sage's Dao corresponds above to Heaven, below to Earth, and in between to Human affairs, requiring clear laws and measurements for transmission.

Yang Yuanru said: The Five Zang and Six Fu organs correspond to the Five Movements in the interior. The Five Movements are the entry and exit of Shen Ji (Spirit Mechanism). Skin and meridians correspond to the Six Qi in the exterior. The Six Qi are the circular rotation and ascent/descent of left, right, up, and down. The Qi of the Five Zang and Six Fu organs inherits from the Chong Mai and circulates on the skin surface, corresponding to Earth Qi emerging outward. Mo Zhongchao said: The so-called Chong Mai moves forward and reverses inside and outside the meridians and skin, filling the body, reaching everywhere, hence called reverse and smooth operation. When meridian blood and qi flow smoothly, skin Qi and blood reverse, responding to the operational Dao of Heaven and Earth. Inherited from the Five Zang and Six Fu organs refers to blood and qi generated from grain and water, overflowing internally, distributed to the exterior of the skin via the Chong Mai. Shaoyin blood and qi are prenatal Essence-Qi, merging with Chong Mai to seep into the Three Yin, flowing within vessels, following the dorsum of the foot, seeping into toe collaterals, and exiting outside vessels. Thus, Yang Qi originates from the exterior of the five toes, and Yin Qi from the interior of the five toes, inheriting the prenatal Water and Fire of Foot Shaoyin. Human body fatness and thickness result from blood and qi generated by grain and water filling the skin, warming the flesh, and seeping into pores. Solid bones, loose muscles, and prominent joints inherit prenatal Essence-Qi. Skin, flesh, sinews, bones, Ying-Wei, blood, and qi all originate from prenatal and postnatal life-source blood and qi for nourishment, enabling strong sinews/bones and thick muscles. Thus, beginning with discussions of fatness/leanness and height/shortness, it concludes with the entry and exit of Chong Mai and Shaoyin.