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Huangdi asked: I have heard the saying regarding acupuncture methods, that excess should be drained and deficiency should be tonified. What is meant by "excess"? What is meant by "deficiency"? Qibo replied: There are five types of excess and five types of deficiency. Which aspect do you wish to inquire about? Huangdi said: I wish to hear it in full detail. Qibo said: There is excess and deficiency of Shen (Spirit), Qi (Vital Energy), Blood, Xing (Form/Body), and Zhi (Will). These ten conditions all arise from an imbalance of Qi within the body. Huangdi said: Humans possess Jing Qi (Essential Energy) and Jin Ye (Body Fluids), four limbs, nine orifices, five Zang organs, sixteen regions, and three hundred and sixty-five acupoints, which give rise to myriad diseases. The generation of these diseases involves both deficiency and excess patterns. Now you speak of five types of excess and five types of deficiency; how do they arise? Qibo said: They all originate from the Five Zang Organs. The Heart stores Shen, the Lungs store Qi, the Liver stores Blood, the Spleen governs the muscles (text says "Spleen stores flesh"), and the Kidneys store Zhi, thereby forming the physical body. When Yi Zhi (Intent and Will) flows smoothly, connecting internally with the Marrow, it forms the shape and the Five Zang Organs. The pathways of the Five Zang Organs all emerge from the Jing Mai (Meridians) and Shu Mai (Collaterals), which circulate Blood and Qi. If Blood and Qi are disharmonious, myriad diseases arise through transformation; therefore, one must guard the Jing Mai (Meridian Channels).

Huangdi asked: How does excess and deficiency of Shen manifest? Qibo said: Excess of Shen leads to unceasing laughter; deficiency of Shen leads to sorrow. When Blood and Qi have not yet aggregated and the Five Zang Organs are stable, pathogenic factors lodge in the exterior, causing chills and goosebumps, but have not yet entered the meridians. This is termed a slight disorder of Shen. Huangdi asked: How should tonification and drainage be performed? Qibo said: For excess of Shen, drain the blood from the small collaterals. Allow bleeding without deep insertion or pushing, avoiding the major meridians, so that Shen Qi may return to balance. For deficiency of Shen, observe the deficient collaterals, press to guide Qi, insert the needle to facilitate flow, without causing bleeding or draining Qi, thereby unblocking the meridians so that Shen Qi may return to balance. Huangdi asked: How to treat slight disorders? Qibo said: Massage without releasing pressure; insert the needle without forceful pushing. Transfer Qi to the deficient area, and Shen Qi will recover. Huangdi said: Excellent. How do excess and deficiency of Qi manifest? Qibo said: Excess of Qi leads to panting, coughing, and rebellious Qi ascending; deficiency of Qi leads to smooth breathing but shortness of breath. When Blood and Qi have not yet aggregated and the Five Zang Organs are stable, there is a slight skin disorder, termed Wei Qi (White Qi) slight leakage. Huangdi asked: How should tonification and drainage be performed? Qibo said: For excess of Qi, drain the meridian channels without damaging the meridians themselves, without causing bleeding, and without draining Qi. For deficiency, tonify the meridian channels without draining Qi. Huangdi asked: How to treat slight disorders? Qibo said: Massage without releasing pressure; upon withdrawing the needle, gaze at the site. Say you will insert deeply; the patient will tense up, causing Essence Qi to settle and pathogenic Qi to scatter. As Qi leaks out through the Cou Li (interstices), True Qi will be restored. Huangdi said: Excellent. How do excess and deficiency of Blood manifest? Qibo said: Excess of Blood leads to anger; deficiency of Blood leads to fear. When Blood and Qi have not yet aggregated and the Five Zang Organs are stable, Sun Luo (branching collaterals) overflow, leading to stagnant Blood in the main meridians. Huangdi asked: How should tonification and drainage be performed? Qibo said: For excess of Blood, drain the full meridians and release blood. For deficiency, observe the deficient meridians, insert the needle into the vessel, retain it for a long time while observing. When the pulse becomes large, quickly withdraw the needle without allowing blood to escape. Huangdi asked: How to treat stagnant Blood in the meridians? Qibo said: Observe the blood vessels, puncture to release blood, preventing evil blood from entering the meridians and causing disease. Huangdi said: Excellent. How do excess and deficiency of Xing (Form) manifest? Qibo said: Excess of Xing leads to abdominal distension and difficulty in urination and defecation; deficiency of Xing leads to inability to use the four limbs. When Blood and Qi have not yet aggregated and the Five Zang Organs are stable, there is twitching of the muscles, termed Wei Feng (Light Wind). Huangdi asked: How should tonification and drainage be performed? Qibo said: For excess of Xing, drain the Yang meridians; for deficiency, tonify the Yang collaterals. Huangdi asked: How to treat slight disorders? Qibo said: Insert needles between the muscle bundles, avoiding the meridians and damaging the collaterals. When Wei Qi recovers, pathogenic Qi will dissipate. Huangdi said: Excellent. How do excess and deficiency of Zhi (Will) manifest? Qibo said: Excess of Zhi leads to abdominal distension and undigested stool diarrhea; deficiency of Zhi leads to cold extremities. When Blood and Qi have not yet aggregated and the Five Zang Organs are stable, there is movement in the bone joints. Huangdi asked: How should tonification and drainage be performed? Qibo said: For excess of Zhi, drain the blood at Ran Gu (KI2); for deficiency, tonify Fu Liu (KI7).

Huangdi asked: How to treat cases where Blood and Qi have not yet aggregated? Qibo said: Immediately select the points and needle them, avoiding the main meridians. Targeting the location of the pathogen can immediately weaken it. Huangdi said: Excellent. I have heard the forms of deficiency and excess, but I do not know how they are generated. Qibo said: When Blood and Qi contend with each other, Yin and Yang tilt against each other. Qi becomes chaotic in the Wei level, and Blood rebels in the meridians. Blood and Qi separate and reside apart, resulting in one area being excess and another deficiency. If Blood aggregates in Yin and Qi aggregates in Yang, it results in fright and mania. If Blood aggregates in Yang and Qi aggregates in Yin, it results in internal heat. If Blood aggregates in the upper part and Qi aggregates in the lower part, it results in vexation and irritability. If Blood aggregates in the lower part and Qi aggregates in the upper part, it results in confusion and forgetfulness. Huangdi asked: When Blood aggregates in Yin and Qi aggregates in Yang, as described above where Blood and Qi separate, what constitutes excess and what constitutes deficiency? Qibo said: Blood and Qi favor warmth and dislike cold. Cold causes stagnation and prevents flow; warmth promotes dissolution and dispersion. Therefore, where Qi aggregates, Blood is deficient; where Blood aggregates, Qi is deficient. Huangdi said: What humans possess is primarily Blood and Qi. Now you say that Blood aggregation leads to Qi deficiency and Qi aggregation leads to Blood deficiency. Does this mean there is no such thing as excess? Qibo said: Presence of pathogen is excess; absence of healthy Qi is deficiency. Thus, when Qi aggregates, Blood is absent; when Blood aggregates, Qi is absent. Since Blood and Qi have lost harmony, it manifests as deficiency. Collaterals and Sun Luo all transport to the Jing Mai. When Blood and Qi aggregate in the meridians, it manifests as excess. If Blood and Qi both rush upward, it results in Da Jue (Great Syncope), which causes sudden death. If Qi returns, life is preserved; if it does not return, death ensues. Huangdi asked: From where does excess come? To where does deficiency go? I wish to hear the principles behind deficiency and excess. Qibo said: Both Yin and Yang have Shu and Hui points. Yang Qi pours into Yin, and Yin fills the exterior. When Yin and Yang are balanced, the form is nourished, and the Nine Pulses are uniform, this is called a healthy person. Pathogens arise either from Yin or from Yang. Those arising from Yang result from wind, rain, cold, and summer heat. Those arising from Yin result from improper diet and lifestyle, and emotional fluctuations of joy and anger. Huangdi asked: How do wind and rain injure the body? Qibo said: Wind and rain first lodge in the skin, then transmit to the Sun Luo. When Sun Luo are full, they transmit to the Luo Mai. When Luo Mai are full, they transport to the major Jing Mai. Blood and Qi combine with pathogens and lodge in the Fen Rou (muscle intervals). The pulse becomes firm and large, hence termed "Excess." Excess patterns present with external hardness and fullness; they cannot be pressed, and pressing causes pain. Huangdi asked: How do cold and dampness injure the body? Qibo said: Cold and dampness cause the skin to relax and fail to contract, and the muscles to become tight. Ying Blood stagnates, and Wei Qi departs, hence termed "Deficiency." Deficiency patterns present with flaccidity and lack of Qi; pressing generates sufficient Qi to warm the area, bringing comfort and relieving pain. Huangdi asked: How does Yin generate excess? Qibo said: Unregulated joy and anger cause Yin Qi to rebel upward. Upward rebellion leads to deficiency below; deficiency below causes Yang Qi to rush downward to fill the void, thus the lower part is considered excess. Huangdi asked: How does Yin generate deficiency? Qibo said: Joy causes Qi to sink; grief causes Qi to dissipate. Dissipation leads to empty vessels. Combined with cold food and drink, cold Qi fills the interior, causing Blood stagnation and Qi departure, hence termed "Deficiency." Huangdi said: The classics state that Yang deficiency leads to external cold, Yin deficiency leads to internal heat, Yang excess leads to external heat, and Yin excess leads to internal cold. I have heard this, but I do not understand the mechanism. Qibo said: Yang receives Qi from the Upper Jiao to warm the skin and muscle intervals. Now, if cold Qi is outside, the Upper Jiao becomes blocked. If the Upper Jiao is blocked, cold Qi remains solely on the exterior, causing chills. Huangdi asked: How does Yin deficiency generate internal heat? Qibo said: Due to overwork and fatigue, the form and Qi decline, Grain Qi is insufficient, the Upper Jiao fails to function, and the Lower Wan (stomach outlet) is obstructed. Stomach Qi becomes hot, and hot Qi steams the chest, causing internal heat. Huangdi asked: How does Yang excess generate external heat? Qibo said: If the Upper Jiao is not unobstructed, the skin becomes dense, the Cou Li close, and the Xuan Fu (pores) block. Wei Qi cannot vent, causing external heat. Huangdi asked: How does Yin excess generate internal cold? Qibo said: Jue Qi rebels upward, and cold Qi accumulates in the chest without dispersing. Without dispersal, warming Qi departs, leaving only cold. Blood coagulates and stagnates, blocking the vessels. The pulse becomes large and choppy, causing internal cold.

Huangdi asked: When Yin and Yang combine, and Blood and Qi contend, and the disease form is established, how should one needle? Qibo said: Needle the Jing Mai channels. Extract Blood from the Ying level and Qi from the Wei level. Consider the patient's constitution and adjust according to the seasons, determining depth and quantity based on high and low positions. Huangdi asked: When Blood and Qi contend, disease form is established, and Yin and Yang tilt, how should tonification and drainage be performed? Qibo said: To drain excess, insert the needle during the patient's inspiration. The needle and Qi enter together, opening the gate like a door. Withdraw the needle and Qi together. Healthy Qi is not damaged, and pathogenic Qi descends. The external gate remains open to expel the disease. Widen the needle tract like clearing a path; this is called Great Drainage. Press firmly upon withdrawal to subdue the strong pathogenic Qi. Huangdi asked: How to tonify deficiency? Qibo said: Hold the needle without placing it down, stabilizing your mind. Insert the needle during expiration. As Qi exits, the needle enters. Seal the needle tract tightly so Essence Qi cannot escape. When the healthy Qi is substantial, quickly withdraw the needle. As Qi enters, the needle exits, preventing heat from returning. Close the gate, allowing pathogenic Qi to disperse and healthy Qi to be preserved. Move in accordance with the timing of Qi. Do not lose the nearby Qi, so distant Qi may arrive. This is called "Pursuing" (Zhui Zhi).

Huangdi said: You stated there are ten types of deficiency and excess, originating from the Five Zang Organs, corresponding to the five meridians. However, the Twelve Main Meridians all generate diseases. Why do you speak only of the Five Zang Organs? The Twelve Main Meridians connect with the three hundred and sixty-five acupoints. Disease in any point must affect the meridians, and meridian diseases all involve deficiency and excess. How should these be integrated? Qibo said: The Five Zang Organs naturally have a Exterior-Interior relationship with the Six Fu Organs. The meridians, collaterals, branches, and joints each generate deficiency and excess. According to the location of the disease, regulate it accordingly. Disease in the pulses, regulate the Blood; disease in the Blood, regulate the Collaterals; disease in the Qi, regulate the Wei; disease in the muscles, regulate the Muscle Intervals; disease in the sinews, regulate the Sinews; disease in the bones, regulate the Bones. Use burning needle therapy (Cao Ci) for lower body conditions and spasms. For bone diseases, use quenched needles combined with herbal compresses. If the painful location is unknown, prioritize the two Chong Mai (Yin and Yang Heel Vessels). If the body has pain but the Nine Pulses show no disease, employ Miao Ci (Lateral Puncture). If pain is on the left but the right pulse is diseased, employ Ju Ci (Cross Puncture). One must carefully examine the Nine Pulses; thus, the principles of acupuncture are complete.

Tiao Jing Lun: Sui (pronounced sui), Sun (pronounced sun), Fan (pronounced fan).