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Upper excess and lower deficiency: palpate and follow the meridian, seek out the knotted collateral vessels, puncture to release blood, thereby observing the restoration of flow.

The *Ling Shu · Ci Jie Zhen Xie* (Needling to Resolve Knots and True/False Pathogens) states: When the six meridians are harmonious, it is called disease-free. If one meridian exhibits upper excess and lower deficiency with obstruction, this must be due to a flourishing transverse collateral (Heng Luo) pressing upon the main meridian, causing obstruction. Observing this and applying draining methods is what is termed "resolving knots." In cases of upper excess and lower deficiency here, there is a transverse collateral added outside the meridian; the exterior represents the upper, and the interior represents the lower, hence the presentation of upper excess and lower deficiency. "Palpating and following" refers to palpating the course of the meridian and treating along its direction. "Seeking the knotted collateral vessels" refers to identifying the knotting within the collateral vessels. "Puncturing to release blood to observe patency" means that once blood is released and the knot dissipates, the patency of the collateral vessels is observed, and the disease can be cured. All these methods involve observing the superficial or deep nature of the meridians and collaterals, following the principles of upward/downward and reverse/concordant flows for treatment.

Elevated eyeballs (Tong Zi Gao) indicate insufficiency of the Taiyang (Greater Yang); fixed upward gaze (Dai Yan) indicates exhaustion of the Taiyang. This is a critical factor in determining life and death, which must not be overlooked. Retain needles at the fingers and at the fifth digit above the lateral malleolus of the hand.

Meridian blood and Qi originate from the generation of innate Water and Fire. Therefore, citing the Taiyang meridian concludes the meaning of the meridians. Elevated eyeballs signify that the essence of Water and Fire of the Taiyang is insufficient in the upper part. Fixed upward gaze signifies that the generating Yang Qi of the Taiyang has exhausted in the lower part. Using the essence of innate Water and Fire to determine the critical factors of life and death, and using the Nine Palpations (Jiu Hou) to decide life and death, must be carefully examined.

When disease is in Yin, tonify Yang to treat it; when disease is in the feet, tonify the hands to treat it. This illustrates the principle of mutual exterior-interior relationships between Yin/Yang and upper/lower. Regarding retaining needles at the fingers and the fifth digit above the lateral malleolus of the hand: this indicates that when the Foot-Taiyang meridian is insufficient, one should tonify the Hand-Taiyang meridian to treat it. The Hand-Taiyang Small Intestine meridian originates at the tip of the little finger, follows the lateral aspect of the hand, and emerges at the wrist joint. Therefore, when Taiyang is insufficient, one should select the fingers, specifically the fifth digit above the lateral malleolus of the hand (the little finger), retain needles to tonify it, causing the Hand-Taiyang meridian to become abundant, thereby interacting with the Foot-Taiyang meridian. This is the method of treatment.

This section discusses the Nine Palpations and Seven Diagnostic Methods, the superficial or deep state of meridians, to determine life and death and locate the disease. It also emphasizes that one must point to and guide the Qi, which constitutes the true practice.