黄帝问曰。余闻九针九篇。夫子乃因而九之。九九八十一篇。余尽通其意矣。（此承上章而言九针之道。备载针经八
十一篇。余已悉会其意。）经言气之盛衰。左右倾移。以上调下。以左调右。有余不足。补泻于荣 。余知之矣。（帝言
针经之大略若此。而余已知之。）此皆荣卫之倾移。虚实之所生。非邪气从外入于经也。余愿闻邪气之在经也。其病患
何如。取之奈何。（言针经多论正气之虚实。未详言邪气之入经。朱永年曰。邪气入于血脉之中。真气与邪气。有离有合。
故以名篇。）岐伯对曰。夫圣人之起度数。必应于天地。故天有宿度。地有经水。人有经脉。（起度数者。论身形之有三
百六十五度也。宿谓二十八宿。度谓周天之度数。经水谓清水、渭水、海水、湖水、汝水、渑水、淮水、漯水、江水、
河水、济水、漳水。以合人之十二经脉。天之二十八宿。房至毕为阳。昴至心为阴。地之十二经水。漳以南为阳。海以
北为阴。宿度经水之相应也。上章论日月星辰四时八正之气。以应人之荣卫气血。此复论地之经水。以应人之经脉。斯
天地合气。而为三部九候焉。徐公遐曰。身形之应天地阴阳也。身半以上为天。身半以下为地。左为阳。右为阴。背为
阳。腹为阴。）天地温和。则经水安静。天寒地冻。则经水之凝泣。天暑地热。则经水沸溢。卒风暴起。则经水波涌而陇
起。（此言人之经脉。应地之经水。经水之动静。随天气之寒温。所谓地之九州。人之九脏。皆通天气。陇隆同。涌起貌。）
夫邪之入于脉也。寒则血凝泣。暑则气淖泽。虚邪因而入客。亦如经水之得风也。经之动脉。其至也。亦时陇起。其行
于脉中。循循然。此言邪入于经。寒则血如经水凝泣。暑则气如经水之沸溢而淖泽。虚风、虚乡之邪风也。经之动脉。
谓经血之动于脉也。言虚风之邪。因而入客于经。亦如经水之得风。其至于所在之处。亦波涌而陇起。循循、次序貌。
言邪在于经。虽有时陇起。而次序循行。无有常处。其至寸口中手也。时大时小。大则邪至。小则平。（此以寸口之脉。
而候邪之起伏也。夫邪之入于脉也。如经水之得风。亦时陇起。故有时而脉大。有时而脉小。大则邪至而陇起。小则邪
平而不起也。）其行无常处。在阴与阳。不可为度。（此即以寸口之脉。而候其邪之在阴在阳也。盖邪在于经。次序循行。
无有常处。或在于阴。或在于阳。寸口者。左右之两脉口。概寸尺而言也。如邪在阳分。则两寸大而两尺平。邪在阴分。
则两尺大而两寸平。然只可分其在阴与阳。而不可为度数。盖言以寸口分其阴阳。以九候而分其度数也。）从而察之。三
部九候。卒然逢之。早遏其路。（即从其邪之在阴在阳而察之。则三部九候之中。卒然逢之矣。早遏其路者。知气之所在。
而守其门户焉。朱永年曰。神脏为阴。形脏为阳。知在阳分。即从阳之诸经而察之。三部之中。有独大独盛者。病之所
在矣。知在阴分。即从诸阴经而察之。三部之中。有独大独盛者。病之所在矣。即从所在之处。迎而取之。则遏其行路
矣。）吸则纳针。无令气忤。（纳叶讷。此以下论刺邪之法。以息方吸而纳针。无令其气逆也。）静以久留。无令邪布。（针
解篇曰。刺实须其虚者。留针。阴气隆至。乃去针也。故当静以久留。以候气至。真阴之气至。则阳邪无能传布矣。）吸
则转针。以得气为故。（盖吸则气入。易于得气。故复候其方吸而转针。以欲其得气故也。）候呼引针。呼尽乃去。大气
皆出。故命曰泻。（呼则气出。故复俟其方呼。而徐引针。俟呼尽。乃去其针。则大邪之气。随气而出。故命曰泻。徐公
遐曰。风乃六气之首。为百病之长。故曰大气。）帝曰。不足者补之。奈何。岐伯曰。必先扪而循之。（先以手扪循其处。
欲令血气循行也。盖邪之所凑。其正必虚。故又当补其真气之不足。）切而散之。（次以指切捺其穴。欲其气之行散也。）
推而按之。（再以指推按其肌肤。欲针道之流利也。）弹而怒之。（以指弹其穴。欲其意有所注。则气必随之。故络脉填满。
如怒起也。）抓而下之。（用法如前。然后以左手爪甲掏其正穴。而右手方下针也。）通而取之。（下针之后。必令气通。
以取其气。）外引其门。以闭其神。（门者。气至之门也。外引其门者。徐往徐来也。以闭其神者。闭其门户。以致其
神焉。）呼尽纳针。静以久留。以气至为故。（呼尽则气出。气出纳针。追而济之也。故虚者可实。所谓刺虚者。刺其去
也。徐公遐曰。故补曰随之。随其气去而追之。追其陷下之阳。复随气而隆至。）如待所贵。不知日暮。（静以久留。以
俟气至。如待贵人。不敢厌忽。）其气以至。适而自护。（以已同。适、调适。护、爱护也。宝命全角论曰。经气已至。
慎守勿失。此之谓也。）候吸引针。气不得出。各在其处。推阖其门。令神气存。大气留止。故命曰补。（候吸引针。则
气充于内。推阖其门。则气固于外。神存气留。故谓之补。九针十二原篇曰。外门已闭。中气乃实。）帝曰。候气奈何。
（谓候邪气之至。）岐伯曰。夫邪去络入于经也。舍于血脉之中。其寒温未相得。如涌波之起也。时来时去。故不常在。
（邪气由浅而深。故自络而后入于经脉。寒温欲相得者。真邪未合也。故邪气波陇而起。来去于经脉之中。而无有常处。
徐公遐曰。真邪已合。如真气虚寒。则化而为寒。真气盛热。则化而为热。邪随正气所化。故曰寒温未相得。）故曰。方
其来也。必按而止之。止而取之。（方其来者。三部九候。卒然逢之。即按而止之。以针取之。早遏其路。）无逢其冲而
泻之。（逢、迎也。冲者。邪盛而隆起之时也。兵法曰。无迎逢逢之气。无击堂堂之阵。故曰。方其盛也。勿敢毁伤。刺
其已衰。事必大昌。）真气者。经气也。经气大虚。故曰。其来不可逢。此之谓也。（真气者。荣卫血气也。邪盛于经。
则真气大虚。故曰其来不可逢。言邪方盛。虽经气虚而不可刺也。针经曰。其来不可逢者。气盛不可补也。言邪气方盛。
虽正气大虚。而亦不可补。故曰。迎而夺之。恶得无虚。言迎夺其邪气。恶得不反虚其正气乎。）故曰。候邪不审。大气
已过。泻之则真气脱。脱则不复。邪气复至。而病益蓄。故曰。其往不可追。此之谓也。（此言发针之不可太迟也。大气、
风邪之气也。候邪而不详审其至。使邪气已过其处。而后泻之。则反伤其真气矣。真气已脱。而不能再复。邪气循序而
复至。正气已虚。则邪病益留蓄而不能去。故曰其往不可追。谓邪气已过。不可泻也。盖言邪气方来。不可逢迎。邪气
已过。不可追迫。）不可挂以发者。待邪之至时。而发针泻矣。（挂 同。承上文而言。待邪之至。及时而发针。不可差
迟于毫发之间。斯可谓之泻矣。）若先若后者。血气已尽。其病不可下。（若先者。邪气之盛也。若后者。邪气之已过也。
若差之毫厘。则反伤其血气。真气虚。则邪病益蓄而不可下。）故曰。知其可取如发机。不知其取如扣椎。（机、弩机也。
知其可取者。当其可取之时。用针取之。如发机之迅速。不知其取者。朴钝如椎。扣之不发。）故曰。知机道者。不可挂
以发。不知机者。扣之不发。此之谓也。（此甚言其知机之妙。既无逢其冲。又无使其过。不可迟早于毫发之间。知机之
道其神乎。）帝曰。补泻奈何。（夫邪气盛则精气夺。将先固正气而补之乎。抑先攻邪气而泻之耶。）岐伯曰。此攻邪也。
疾出以去盛血。而复其真气。（伯言此宜先攻其邪也。疾出其针。以去其盛满之血。则邪病自去。邪病去而真气即复矣。）
此邪新客。溶溶未有定处也。推之则前。引之则止。逆而刺之。温血也。（此言若先补之。则血不得散。而邪不得出也。
溶溶、流貌。言邪之新客于经脉之中。溶溶流转。未有定处。推之则前。引之则止。盖流动而易泻者也。若逆而刺之。
是谓内温。血不得散。气不得出。）刺出其血。其病立已。（此甚言其泻邪之妙。刺出其血。其病立已。邪病已去。而真
气即复矣。同观子曰。此节可救时下名医之病。）帝曰。善。然真邪已合。波陇不起。候之奈何。（此言真邪之有离合
也。真气者。所受于天与谷气。并而充于经脉者也。虚邪者。虚乡之风邪。贼伤人者也。邪新客于经脉之中。真邪未合。
则如波涌之起。时来时去。无有常处。如真邪已合。而波陇不起矣。盖邪正已合。则正气受伤。荣卫内陷。邪随正而入
深。是以经脉无波陇之象。而三部九候之脉。相失而相减矣。）岐伯曰。审扪循三部九候之盛虚而调之。（审者。审其病。
扪者。切其脉。盛者。邪气盛。虚者。正气虚。调之者。补其正而却其邪也。）察其左右上下相失及相减者。审其病脏以
期之。（左右上下。谓左右手足。膺喉头首。腰尻以下也。邪气入深。则伤五脏。九候之脉。九脏之神气也。脏气受伤。
是以脉气减失。审其病在神脏形脏。而以死生期之。盖在形脏者生。在神脏者。有生而有死期也。朱卫公曰。九候之相
应也。上下若一。不得相失。减者。脉细也。）不知三部者。阴阳不别。天地不分。地以候地。天以候天。人以候人。（经
云。用针之要。在于知调阴与阳。调阴与阳。精气乃光。合神与气。使神内藏。夫天为阳。地为阴。人则参天两地者也。
故身半以上为天。身半以下为地。然阴中有阳。阳中有阴。是以上部有地。下部有天。不知三部者。阴阳不别。天地不
分。以上为天。以下为地。以中为人。）调之中腑。以定三部。（中腑、胃腑也。盖三部阴阳之脉。皆阳明水谷之所资生。
太阴为之行气于三阴。阳明为之行气于三阳。阳者天气。阴者地气。阴气从足上行至头。阳气从头下行至足。阴阳异位。
外内逆从。土者生万物而法天地。故当调之中腑。以定三部之脉焉。徐公遐曰。是以三部之中。皆有阳明之胃气。详
三部九候论。）故曰。刺不知三部九候。病脉之处。虽有大过且至。工不能禁也。（大过且至者。岁运之气至也。盖用针
之道。当知三部九候。合之四时五行。加临相胜。而各治之。不知三才之合气。九候之交通。虽有太过之气且至。而五
治不分。邪僻内生。工不能禁也。按帝问曰。平气何如。伯曰。无过者也。盖太过不及之岁。皆胜气妄行。故曰太过。
平气之岁。为无过也。）诛罚无过。命曰大惑。反乱大经。真不可复用。实为虚。以邪为真。用针无义。反为气贼。夺人
正气。以从为逆。荣卫散乱。真气已失。邪独内着。绝人长命。予人夭殃。不知三部九候。故不能久长。（此言不知三部
九候者。不分真邪。不知虚实。不审逆从。贼害真气。与人夭殃。盖用针之道。有如用兵。务在杀贼。不害良民。无义
之兵。征伐无过。反乱大经。）因不知合之四时五行。因加相胜。释邪攻正。绝人长命。（此言不知三部九候者。因而不
知合于四时五行之道。六气之加临。五运之相胜。邪反释之。正反攻之。则绝人长命矣。）邪之新客来也。未有定处。推
之则前。引之则止。逢而泻之。其病立已。（再言之者。言乘风邪新客未定之时。即当逢而泻之。慎勿使真邪之相合也。）
Huangdi asked, "I have heard that there are nine chapters on the Nine Needles. The Master expanded upon this by multiplying it by nine, resulting in eighty-one chapters. I have thoroughly understood their meaning." (This follows up on the previous chapter regarding the principles of the Nine Needles, which are comprehensively recorded in the eighty-one chapters of the *Classic of Acupuncture*. I have fully grasped their intent.) The Canon states: "Regarding the flourishing and declining states of Qi, its shifting to the left or right, one regulates the lower through the upper, and the right through the left. For conditions of excess and deficiency, tonification and sedation are applied at the Ying (Nutrient) level. I am aware of this." (The Emperor says that this is the general outline of the *Classic of Acupuncture*, and I already know it.) These are all shifts in Ying and Wei (Defensive) Qi, arising from deficiency and excess, not from pathogenic factors entering the meridians from outside. I wish to hear about pathogenic factors residing within the meridians. What symptoms do they produce? How should points be selected for treatment? (The *Classic of Acupuncture* discusses much about the deficiency and excess of healthy Qi but does not detail the entry of pathogenic factors into the meridians. Zhu Yongnian stated: When pathogenic factors enter the blood vessels, Healthy Qi and Pathogenic Qi separate and combine; hence the name of this chapter.)
Qibo replied, "When the Sages established measurement standards, they corresponded them to Heaven and Earth. Thus, Heaven has the degrees of the stellar mansions, Earth has the major rivers, and Humans have the meridian channels." (Establishing measurements refers to discussing the 365 acupoints on the body. 'Mansions' refer to the Twenty-Eight Lunar Mansions, and 'degrees' refer to the degrees of the celestial sphere. 'Major rivers' refer to the Qing, Wei, Hai, Hu, Ru, Mian, Huai, Luo, Jiang, He, Ji, and Zhang rivers, corresponding to the twelve primary meridians of humans. Among the twenty-eight lunar mansions, Fang to Bi belong to Yang, while Mao to Xin belong to Yin. Regarding the twelve major rivers on Earth, those south of the Zhang River belong to Yang, and those north of the sea belong to Yin; this represents the correspondence between celestial degrees and earthly waters. The previous chapter discussed the Qi of the sun, moon, stars, and the eight correct winds of the four seasons, corresponding to human Ying and Wei Qi. This chapter further discusses earthly rivers corresponding to human meridians. This is how Heaven and Earth combine their Qi to form the theory of Three Regions and Nine Palpations. Xu Gongxia stated: The human body corresponds to the Yin and Yang of Heaven and Earth. The upper half of the body is Heaven, the lower half is Earth; the left is Yang, the right is Yin; the back is Yang, the abdomen is Yin.)
When Heaven and Earth are mild and warm, the rivers remain calm. When Heaven is cold and Earth frozen, the rivers congeal and flow sluggishly. When Heaven is hot and Earth scorching, the rivers boil and overflow. When sudden storms arise, the rivers surge and swell. (This illustrates that human meridians correspond to earthly rivers. The movement and stillness of rivers follow the cold and warmth of the weather. It is said that the nine provinces of Earth correspond to the nine viscera of humans, all communicating with Heavenly Qi. 'Long' is synonymous with 'long' (swelling), describing the appearance of surging waves.)
When pathogenic factors enter the vessels, cold causes blood to congeal and flow sluggishly, while heat makes Qi fluid and lubricated. Deficient pathogens take advantage of this to invade and reside within, just as rivers react to wind. The arterial pulses of the meridians, when reaching the cun kou (radial artery), also swell intermittently. Their movement within the vessels follows a sequence. (This explains that when pathogens enter the meridians, cold makes blood like congealed river water, while heat makes Qi like boiling, fluid river water. 'Xu xiang' refers to deficient winds/pathogenic winds. The 'artery of the meridian' refers to the movement of blood within the vessel. It means that when deficient wind pathogens invade the meridians, it is like river water encountering wind; where they arrive, they surge and swell like waves. 'Xun xun' describes an orderly sequence. It means that although pathogens in the meridians may swell intermittently, they move in order without a fixed location. When they reach the cun kou, the pulse may be large or small. A large pulse indicates the arrival of pathogens; a small pulse indicates peace/absence of pathogens.)
Pathogens move without a fixed location, sometimes in Yin, sometimes in Yang, and cannot be measured by fixed degrees. (Here, the cun kou pulse is used to observe whether pathogens are in Yin or Yang. Generally, pathogens in the meridians move in order without a fixed location, sometimes in Yin, sometimes in Yang. 'Cun kou' refers to the pulse positions on both left and right wrists, generally encompassing both Cun and Chi positions. If pathogens are in the Yang aspect, both Cun pulses are large and both Chi pulses are flat. If pathogens are in the Yin aspect, both Chi pulses are large and both Cun pulses are flat. However, one can only distinguish between Yin and Yang, not determine specific degrees. This implies using the cun kou to distinguish Yin/Yang, and the Three Regions/Nine Palpations method to determine specific degrees.) By observing accordingly, within the Three Regions and Nine Palpations, one will suddenly encounter the pathogen. One must block its path early. (By observing according to whether the pathogen is in Yin or Yang, one will suddenly encounter it within the Three Regions and Nine Palpations. To 'block the path early' means to know the location of the Qi and guard its gateway. Zhu Yongnian stated: Spirit Viscera are Yin, Form Viscera are Yang. Knowing the pathogen is in the Yang aspect, one observes the Yang meridians. Within the three regions, if one pulse is uniquely large or vigorous, that is the location of the disease. Knowing the pathogen is in the Yin aspect, one observes the Yin meridians. Within the three regions, if one pulse is uniquely large or vigorous, that is the location of the disease. Then, from that location, one attacks and treats it, thereby blocking the path of the pathogen.)
Insert the needle during inhalation, ensuring no counter-flow of Qi. (Na sounds like 'ne'. The following discusses methods for puncturing pathogens: insert the needle when the patient inhales, preventing Qi rebellion.) Retain the needle quietly for a long time, preventing the spread of pathogens. (The *Needle Resolution Chapter* states: To treat excess, wait for deficiency; retain the needle until Yin Qi arrives abundantly before removing it. Therefore, one should retain the needle quietly to await Qi arrival. When True Yin Qi arrives, Yang pathogens cannot spread.) Rotate the needle during inhalation, aiming for De Qi (arrival of Qi). (Since Qi enters during inhalation, it is easier to achieve De Qi. Thus, one waits for inhalation to rotate the needle to obtain Qi.) Guide the needle out during exhalation, removing it only after exhalation is complete, so that major Qi exits; this is called Sedation. (Qi exits during exhalation. Thus, one waits for exhalation to slowly withdraw the needle, removing it only after exhalation is complete. Then, the major pathogenic Qi exits with the breath, hence called Sedation. Xu Gongxia stated: Wind is the head of the Six Qi and the leader of hundred diseases, hence called Major Qi.)
The Emperor asked, "For deficiency, how should one Tonify?" Qibo replied, "One must first palpate and stroke the area." (First, use the hand to palpate and stroke the area to promote blood and Qi circulation. Where pathogens gather, Healthy Qi is necessarily deficient; thus, one must also tonify the deficiency of True Qi.) Press and disperse. (Next, press the acupoint with fingers to disperse Qi.) Push and press. (Then, push and press the skin/muscle to ensure smooth needle passage.) Flick and engorge. (Flick the acupoint with fingers to focus intention; Qi will follow, filling the collaterals like swelling veins.) Scratch and insert. (Using the previous method, then use the left hand's fingernail to scratch the main acupoint while the right hand inserts the needle.) Unblock and capture Qi. (After insertion, ensure Qi flows freely to capture it.) Externally draw the gate to close the Spirit. ('Gate' refers to the gate of Qi arrival. Externally drawing the gate means moving the needle slowly. Closing the Spirit means closing the gate to attract Spirit/Qi.) Insert the needle after exhalation is complete, retain quietly until Qi arrives. (Exhalation empties Qi; inserting after exhalation chases and supplements it. Thus, deficiency becomes sufficiency. This is treating deficiency by chasing departing Qi. Xu Gongxia stated: Tonification is called 'Following', following the departing Qi to chase it, recovering sunken Yang Qi, and following it to rise abundantly.) Wait as if for a noble guest, unaware of the passing day. (Quietly retain the needle awaiting Qi arrival, like waiting for a noble person, without impatience.) When Qi arrives, adjust and protect it appropriately. ('Yi' is same as 'already'. 'Shi' means adjust; 'Hu' means protect. The *Treasure Life Complete Angle Chapter* states: When Jing Qi arrives, guard it carefully and do not lose it. This is what is meant.) Await inhalation to insert the needle, preventing Qi from exiting, keeping it in place. Push and close the gate, allowing Spirit and Qi to remain and Major Qi to stay; this is called Tonification. (Awaiting inhalation to insert fills Qi internally. Pushing and closing the gate secures Qi externally. Spirit remains, Qi stays, hence called Tonification. The *Nine Needles Twelve Origins Chapter* states: When the external gate is closed, internal Qi becomes solid.)
The Emperor asked, "How does one await Qi?" (Referring to awaiting the arrival of pathogenic Qi.) Qibo replied, "When pathogens leave the collaterals and enter the meridians, they reside in the blood vessels. Their cold and warmth have not yet harmonized, resembling rising waves, coming and going, thus not staying in one place." (Pathogens go from shallow to deep, entering meridians from collaterals. 'Cold and warmth seeking harmony' means True Qi and Pathogenic Qi have not yet combined. Thus, pathogens surge and come/go within meridians without a fixed location. Xu Gongxia stated: Once True and Pathogenic Qi combine, if True Qi is deficient/cold, it transforms into cold; if True Qi is abundant/hot, it transforms into heat. Pathogens transform according to True Qi, hence 'cold and warmth have not yet harmonized.') Therefore, it is said: When the pathogen comes, press and stop it, then treat it immediately. (When the pathogen arrives, suddenly encounter it in the Three Regions/Nine Palpations, press to stop it, and treat with needles to block its path early.) Do not attack when it is at its peak. ('Feng' means meet/attack. 'Chong' refers to the time when pathogens are most abundant and swelling. Military strategy says: Do not attack fierce armies or well-ordered formations. Thus, when pathogens are strong, do not harm them. Treat them when they decline, and success is assured.) True Qi is Jing Qi. When Jing Qi is greatly deficient, it is said: Do not meet the pathogen when it arrives. This is what is meant. (True Qi refers to Ying, Wei, Blood, and Qi. When pathogens are abundant in meridians, True Qi is greatly deficient. Thus, 'do not meet when arriving' means even though Jing Qi is deficient, one should not puncture when pathogens are strong. The *Classic of Acupuncture* states: 'Do not meet when arriving' means Qi is abundant and cannot be tonified. It means when pathogens are strong, even if Healthy Qi is greatly deficient, one should not tonify. Thus, 'attack and deprive'—how could it not cause deficiency? Attacking and depriving pathogens inevitably damages Healthy Qi.)
Therefore, it is said: If one fails to examine pathogens carefully, and the Major Qi has passed, sedating will cause True Qi to escape. If it escapes, it cannot recover. Pathogens return, and the disease accumulates further. Hence, it is said: Do not pursue once the pathogen has gone. This is what is meant. (This warns against delaying needle removal. 'Major Qi' refers to wind pathogens. Failing to carefully observe the arrival of pathogens allows them to pass before sedation, injuring True Qi. Once True Qi escapes, it cannot recover. Pathogens return sequentially; with depleted Healthy Qi, pathogens accumulate and cannot be expelled. Hence 'do not pursue', meaning once pathogens pass, do not sedate. It means: Do not meet when pathogens arrive; do not pursue when they have passed.) Do not miss by a hair's breadth. Wait for the pathogen to arrive, then insert the needle to sedate. (Gu is similar to 'jie', meaning minute. Following the above, wait for the pathogen's arrival to insert the needle promptly. Missing by a hair's breadth constitutes proper sedation.) If one acts too early or too late, blood and Qi are exhausted, and the disease cannot be cured. ('Too early' refers to when pathogens are strong; 'too late' refers to when pathogens have passed. A slight error injures blood and Qi. With deficient True Qi, pathogens accumulate further and become untreatable.) Therefore, it is said: Knowing the opportune moment to treat is like triggering a crossbow; not knowing it is like striking a wooden mallet. (Ji refers to the trigger mechanism. Knowing the opportune moment means treating at the right time, swift as a trigger release. Not knowing means being dull as a mallet, ineffective when struck.) Therefore, it is said: Those who know the Way of the Mechanism do not miss by a hair; those who do not know strike but get no response. This is what is meant. (This emphasizes the subtlety of knowing the mechanism: neither attack at peak nor after passing; do not delay by a hair. The Way of the Mechanism is truly divine.)
The Emperor asked, "How are Tonification and Sedation performed?" (When pathogens are strong, Essence and Qi are depleted. Should one first secure Healthy Qi and tonify, or attack pathogens and sedate?) Qibo replied, "This is attacking pathogens. Withdraw the needle quickly to remove abundant blood, thereby restoring True Qi." (Qibo says one should first attack pathogens. Quickly withdrawing the needle removes stagnant blood, eliminating pathogens and restoring True Qi.) This applies when pathogens are newly arrived, flowing without a fixed location. Pushing moves them forward; pulling stops them. Puncture against the flow to release warm blood. (This explains that if one tonifies first, blood cannot disperse and pathogens cannot exit. 'Rong rong' means flowing. New pathogens in meridians flow without fixed location. Pushing moves them forward, pulling stops them; they are fluid and easy to sedate. Puncturing against the flow is called 'internal warming', causing blood to stagnate and Qi to fail to exit.) Puncture and bleed; the disease resolves immediately. (This highlights the efficacy of sedating pathogens. Bleeding resolves the disease immediately; pathogens leave, and True Qi restores. Tong Guanzijue stated: This section can cure the faults of contemporary famous doctors.)
The Emperor asked, "Excellent. But when True and Pathogenic Qi have combined, and waves do not rise, how does one observe?" (This discusses the separation and combination of True and Pathogenic Qi. True Qi is received from Heaven and combined with Grain Qi to fill the meridians. Deficient pathogens are winds from deficient directions, harming humans. When new pathogens enter meridians and True/Pathogenic Qi have not combined, they resemble surging waves, coming and going without fixed location. If True and Pathogenic Qi have combined, waves do not rise. Generally, when combined, Healthy Qi is injured, Ying/Wei sink inward, and pathogens follow True Qi deeper. Thus, meridians show no swelling, and the Nine Palpations pulses weaken and deviate.) Qibo replied, "Carefully palpate and stroke the Three Regions and Nine Palpations to assess fullness and deficiency, then regulate." (Shen means examine disease; Men means palpate pulse. Fullness means pathogen abundance; deficiency means Healthy Qi deficiency. Regulating means tonifying Healthy Qi and expelling pathogens.) Observe discrepancies and weakening in the left/right and upper/lower pulses. Examine the affected Zang organs to predict prognosis. (Left/right/upper/lower refer to limbs, chest/throat/head, waist/sacrum below. Deep pathogens injure the Five Viscera. The Nine Palpations correspond to the Spirit Qi of the Nine Viscera. Injury to Visceral Qi causes pulse weakening. Examine whether the disease is in Spirit Viscera or Form Viscera to predict life/death. Disease in Form Viscera is curable; disease in Spirit Viscera has varying prognoses. Zhuweigong stated: The Nine Palpations should correspond, upper and lower alike, without deviation. Weakening means thin pulse.)
Not knowing the Three Regions means failing to distinguish Yin/Yang and Heaven/Earth. Use Earth region to observe Earth changes, Heaven region for Heaven changes, Human region for Human changes. (The Canon states: The essence of acupuncture lies in knowing how to harmonize Yin and Yang. Harmonizing Yin and Yang illuminates Essence and Qi. Uniting Spirit and Qi keeps Spirit contained. Heaven is Yang, Earth is Yin; Humans embody both Heaven and Earth. Upper body is Heaven, lower body is Earth. Yet Yin contains Yang, and Yang contains Yin, so the upper region has an Earth aspect, and the lower region has a Heaven aspect. Not knowing the Three Regions leads to failure in distinguishing Yin/Yang and Heaven/Earth. Upper is Heaven, lower is Earth, middle is Human.) Regulate the Middle Fu (Stomach Fu) to stabilize the Three Regions. (Middle Fu refers to the Stomach. The pulses of the Three Regions' Yin and Yang all depend on the nourishment provided by Yangming Grain/Water. Taiyin circulates Qi among the Three Yin; Yangming circulates Qi among the Three Yang. Yang is Heavenly Qi, Yin is Earthly Qi. Yin Qi rises from feet to head; Yang Qi descends from head to feet. Yin and Yang occupy different positions, with external/internal reversals. Earth generates all things and models Heaven and Earth. Therefore, one must regulate the Middle Fu to stabilize the pulses of the Three Regions. Xu Gongxia stated: Thus, all three regions contain the Stomach Qi of Yangming. See *Three Regions Nine Palpations Chapter*.)
Therefore, it is said: If one does not know the Three Regions, Nine Palpations, and locations of disease pulses, even if excessive climatic Qi arrives, the physician cannot prevent harm. (Excessive Qi refers to annual climatic influences. Acupuncture requires knowing the Three Regions/Nine Palpations, integrating Four Seasons/Five Elements, and addressing overcoming relationships. Not knowing the integration of Three Realms and communication of Nine Palpations, even with excessive Qi, if treatments are not differentiated, internal pathology arises, and physicians cannot control it. Note: The Emperor asked, "What is a Balanced Qi?" Qibo answered, "It is without excess." Years of excess or deficiency involve rampant overcoming Qi, hence 'excess'. Balanced years are 'without excess'.) Punishing the innocent is called great confusion. It disrupts the Great Meridians, making True Qi unrecoverable. Treating excess as deficiency, and pathogens as True Qi, renders acupuncture meaningless. Instead of helping, one becomes a thief of Qi, stealing Healthy Qi, reversing順逆 (shun/nì), scattering Ying/Wei, losing True Qi, leaving pathogens alone inside, shortening life, and bringing premature death. Not knowing the Three Regions/Nine Palpations prevents longevity. (This warns that not knowing the Three Regions/Nine Palpations leads to failing to distinguish True/Pathogenic, deficiency/excess, and reversal/compliance. It harms True Qi and brings premature death. Acupuncture is like warfare: aim to kill thieves, not harm civilians. Meaningless warfare against the innocent disrupts the Great Meridians.) Because one does not integrate with the Four Seasons and Five Elements, one adds overcoming relationships, releases pathogens, and attacks Healthy Qi, cutting off long life. (This warns that not knowing the Three Regions/Nine Palpations leads to ignoring the Way of Four Seasons/Five Elements, the addition of Six Qi, and the overcoming of Five Movements. Pathogens are released, and Healthy Qi is attacked, leading to premature death.) When pathogens are newly arrived and have no fixed location, pushing moves them forward, pulling stops them. Meet and sedate them; the disease resolves immediately. (Repeated emphasis: When wind pathogens are newly arrived and unsettled, one must meet and sedate them immediately, carefully avoiding the combination of True and Pathogenic Qi.)