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Yellow Emperor asked: I have heard that the Nine Needles consist of nine chapters, and you have expanded them into eighty-one chapters through multiplication. I have comprehended their general meaning. The classics discuss the flourishing and declining states of Qi, the shifting tendencies to the left and right, regulating the lower by the upper, and the right by the left. For conditions of excess or deficiency, tonification and sedation are applied to the Ying (Spring) and Shu (Stream) acupoints; I understand this. These all arise from the shifting of Ying and Wei (Defensive) Qi and the generation of deficiency and excess, not from pathogenic factors entering the meridians from the exterior. I wish to inquire about pathogenic factors residing within the meridians: what are the symptoms they produce? How should they be treated?

Qibo replied: The sage establishes acupuncture principles in accordance with Heaven and Earth. Thus, as there are celestial degrees in the sky, so there are river waters on earth, and meridians in humans. When Heaven is mild and warm, the river waters remain calm; when Heaven is cold and the earth freezes, the river waters become stagnant; when Heaven is hot and the earth is dry, the river waters boil and overflow; when sudden storms arise, the river waters surge and rise in waves. Similarly, when pathogenic factors enter the vessels, cold causes blood to stagnate, while heat makes Qi fluid and moist. Deficient pathogens invading thus resemble wind affecting river water. The arterial pulse in the meridians may also rise in waves at times. As it moves within the vessels, it proceeds steadily. When it reaches the Cun Kou (Radial Artery), the pulse feels large or small at different times. A large pulse indicates the arrival of pathogenic factors; a small pulse indicates peace/normalcy. The movement of pathogens has no fixed location, appearing in Yin or Yang, without a constant measure. Therefore, one must observe along the pulse using the Three Regions and Nine Palpations method. If encountered suddenly, block its path early.

During inhalation, insert the needle, ensuring the Qi does not rebel. Leave it quietly for a long time to prevent the spread of pathogens. During inhalation, rotate the needle until De Qi (arrival of Qi) is achieved. During exhalation, draw out the needle, removing it completely upon the end of exhalation. The excessive pathogenic Qi exits, hence this is called "Sedation" (Xie).

The Yellow Emperor said: How should deficiency be treated? Qibo said: First, palpate and stroke the area, press and disperse, push and press, flick to engorge the vessels, grasp and guide downwards, unblock and select the point. Externally open the gate to close the Shen (Spirit). Insert the needle at the end of exhalation. Leave it quietly for a long time until Qi arrives. Wait as if expecting a noble guest, forgetting the passing of days. Once Qi arrives, protect it appropriately. Withdraw the needle during inhalation so that Qi cannot escape. Each remains in its place. Push and close the gate (skin pore) to let Shen and Qi remain, retaining the excessive Qi. Hence, this is called "Tonification" (Bu).

The Yellow Emperor said: How should one wait for the Qi? Qibo said: When pathogens move from collateral vessels into the main meridians and reside in the blood vessels, their cold or warm nature has not yet harmonized with the body, rising like waves, coming and going, thus not staying constantly. Therefore, it is said: When they come, press to stop them, then treat. Do not sedate when the pathogen is surging. True Qi is Meridian Qi. If Meridian Qi is too deficient, it is said that one should not meet the incoming pathogen (with sedation); this is what is meant. It is said that if one fails to carefully observe the pathogen, and the excessive pathogenic Qi has already passed, sedation will cause True Qi to leak. Once leaked, it cannot recover; the pathogen returns, and the disease accumulates further. Thus, it is said that once the pathogen has gone, it cannot be pursued; this is what is meant. The timing must not deviate by a hair's breadth. One must wait for the pathogen to arrive before inserting the needle to sedate. If done too early or too late, the Blood and Qi are exhausted, and the disease cannot be cured. Therefore, knowing the correct time to treat is like the release of a crossbow mechanism; not knowing it is like striking a wooden mallet without response. Thus, those who know the Way of the Mechanism do not miss the slightest opportunity; those who do not know strike but get no reaction. This is what is meant.

The Yellow Emperor said: How exactly are Tonification and Sedation performed? Qibo said: This is attacking the pathogen. Withdraw the needle quickly to remove abundant/stagnant blood, thereby restoring True Qi. Since this pathogen has newly invaded, it flows freely without a fixed location. Pushing it moves it forward; pulling it stops it. Puncturing against its direction releases warm blood. After puncturing and releasing the blood, the disease is immediately resolved.

The Yellow Emperor said: Excellent. However, when True Qi and Pathogenic Qi combine, and waves do not rise, how should one observe? Qibo said: Carefully palpate and examine the flourishing and deficient states of the Three Regions and Nine Palpations to regulate them. Observe where the Left, Right, Upper, and Lower pulses are discordant or diminished. Carefully determine the affected Zang-Fu organs to predict the outcome. One who does not know the Three Regions distinguishes neither Yin nor Yang, nor Heaven nor Earth. The Upper Region corresponds to Heaven, the Middle to Humanity, and the Lower to Earth. Harmonize the Central Fu organs to define the Three Regions. Therefore, it is said: If one does not know the locations of the pathological pulses in the Three Regions and Nine Palpations, even if major pathogens approach, the physician cannot prevent harm. Punishing the innocent is called great confusion; it disrupts the Great Meridians, making True Qi irrecoverable. Treating excess as deficiency, and pathogen as true Qi, using needles without principle, becomes a thief of Qi, depriving people of their righteous Qi, treating compliance as rebellion, causing Ying and Wei Qi to scatter, True Qi to be lost, and pathogenic Qi to dwell alone inside, cutting off life and bringing disaster. This is because one does not know the Three Regions and Nine Palpations, thus failing to maintain longevity. Furthermore, not combining with the Four Seasons and Five Elements leads to adding mutual overcoming factors, abandoning the pathogen to attack the righteous Qi, cutting off life. When a pathogen newly arrives, it has no fixed location; pushing moves it forward, pulling stops it. Meeting it and sedating it resolves the disease immediately.