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"Li He Zhen Xie" (Separating True and Pathogenic Qi) refers to the separation of True Qi (Zheng Qi, healthy vital energy) and Pathogenic Qi (Xie Qi, evil factors), ensuring they do not combine. When pathogenic qi invades the meridians, true qi and pathogenic qi will combine; at this time, one must carefully examine the pulse, striving to ensure that true qi is not depleted and pathogenic qi does not penetrate further. Generally, when pathogenic qi first invades the body, it has no fixed location; pushing it moves it forward, pulling it stops it. Upon encountering it, apply the reducing method, and the disease will be cured immediately. By using the reducing method to separate the combined true and pathogenic qi, it is called "Li He Zhen Xie" (Separating True and Pathogenic Qi).

The Yellow Emperor asked: I have heard that *Jiu Zhen* (Nine Needles) consists of nine chapters, and you have expanded them into eighty-one chapters through multiplication by nine. I have fully understood their meaning.
(This follows from the previous text, first understanding the intent of *Zhen Jing* (Classic of Acupuncture), stating that the way of the Nine Needles is detailed in the eighty-one chapters of *Zhen Jing*, which I have fully comprehended.)

The classic states: The fluctuation of qi's abundance and deficiency, shifting left and right, can be treated by addressing the lower for upper disorders and the right for left disorders. For conditions of excess and deficiency, tonification and reduction are applied to the Ying (Nutrient) and Shu (Stream) acupoints. I am aware of these principles.
(The general idea of *Zhen Jing* is as stated above, and I am aware of it.)

These refer to the shifting of Ying (Nutrient) and Wei (Defensive) qi, and the generation of deficiency and excess, not the invasion of pathogenic qi from outside into the meridians. I wish to hear about the situation when pathogenic qi is within the meridians; what are its clinical manifestations? How should points be selected for treatment?
(*Zhen Jing* discusses the deficiency and excess of healthy qi extensively but does not detail the invasion of pathogenic qi into meridians, hence this inquiry.)

Bai Hu replied: The establishment of human physiological measurements by sages must correspond to Heaven and Earth. Thus, Heaven has the degrees of the twenty-eight mansions, Earth has twelve major rivers, and humans have twelve main meridians.
("Qi" here means establishing. Sages established the measurements and pathways of human meridians, which must correspond to Heaven above and Earth below. Thus, Heaven has the degrees of the twenty-eight mansions, and humans have twelve main meridians to correspond to Heaven; Earth has twelve major rivers, and humans have twelve main meridians to correspond to Earth.)

When Heaven and Earth are mild and warm, the rivers remain calm; when Heaven is cold and Earth frozen, the rivers become sluggish and stagnant; when Heaven is hot and Earth scorching, the rivers boil and overflow; when sudden storms arise, the rivers surge with waves and rise in mounds.
("Qi" acts as "Se" (sluggish/stagnant). "Cu" sounds like "Cu" (sudden/abrupt), same for subsequent instances. The qi of Earth's rivers connects with Heaven; thus, when Heaven and Earth are mild and warm, the rivers are calm. If Heaven is cold and Earth frozen, the rivers become sluggish. Sluggishness means stagnation. When Heaven is hot and Earth scorching, the rivers boil and overflow. Overflowing means flooding. If Yin and Yang are discordant and sudden storms arise, wind blows and water disperses, causing the rivers to surge with waves and rise in mounds, similar to the effect on human meridians.)

When pathogenic qi enters the vessels, cold causes blood to coagulate and become sluggish, while heat makes qi fluid and lubricated. Deficient pathogens take advantage to invade, just as rivers react to wind. The arterial pulses of the meridians also rise in mounds intermittently; their movement within the vessels follows a sequence.
(Human meridians correspond to rivers, and their qi connects with Heaven. Regarding pathogenic qi entering the vessels: cold weather causes human blood to become sluggish, akin to frozen earth and sluggish rivers. Heat causes human qi to become fluid, akin to boiling rivers. Deficient pathogens invade due to vessel weakness, akin to sudden storms affecting rivers. "Arterial pulse of the meridian" implies wind entering the meridian and agitating the pulse. Its intermittent mound-like rising is like rivers surging with wind. Without pathogenic influence, blood and qi flow sequentially within the vessels, akin to calm rivers under mild weather. This is why human measurements correspond to Heaven and Earth.)

At the Cun Kou (Radial Artery) pulse point, the pulse may appear large or small. A large pulse indicates the arrival of pathogenic qi; a small pulse indicates peace/health. Pathogenic qi moves without a fixed location, existing in either Yin or Yang aspects, making it unpredictable. One must examine it according to its presence in Yin or Yang, using the Three Regions and Nine Palpations method. Upon suddenly detecting it, block its path early.
("Zhong" is pronounced with the departing tone. "Chu" is pronounced with the departing tone, same as below. The convergence of pulses is at Cun Kou. When the pulse reaches Cun Kou and is felt by hand, it varies in size. Large indicates excess pulse qi, signifying pathogenic arrival; small indicates solid/concentrated pulse qi, signifying health. Pathogenic qi has no fixed location, possibly in the Yin of blood or Yang of qi, defying fixed standards. Examine based on its Yin/Yang location, scrutinizing the Three Regions and Nine Palpations to find the pathogen. Upon sudden detection, prevent the combination of true and pathogenic qi by blocking its path early. This aligns with the later statement: 'Upon encountering it, reduce it, and the disease is cured immediately.')

Insert the needle during inhalation to avoid qi rebellion; retain the needle quietly for a long time to prevent the spread of pathogenic qi; rotate the needle during inhalation until De Qi (arrival of qi) is achieved; withdraw the needle during exhalation, removing it only after exhalation is complete, so that the accumulated "Da Qi" (major qi/vital force under the needle) exits. This is called the Reducing Method.
("Nei" sounds like "Na" (insert), same as below. "Wu" means reverse/rebel. "Da Qi" refers to the qi gathered under the needle. Inserting during inhalation allows qi to begin moving, preventing rebellion. Calm the mind and retain the needle to guide pathogenic qi out, preventing its dispersion. Rotating during inhalation aims to achieve De Qi and restore normalcy. Withdrawing during exhalation, removing upon completion, expels the gathered qi. This is the method for reducing pathogens, hence called Reducing.")

This section explains that human meridians correspond to Heaven and Earth; when pathogenic qi arrives suddenly, it must be urgently reduced to prevent the combination of true and pathogenic qi.

The Yellow Emperor asked: How should tonification be applied for deficiency?
(Pathogenic qi arriving suddenly requires urgent reduction; true qi deficiency requires tonification, hence this question.)

Bai Hu said: First, palpate and stroke the area, press and disperse, push and press, flick to distend the vessels, grasp and guide downward, unblock and select the point, pull the skin opening outward to close the spirit gate. Insert the needle at the end of exhalation, retain it quietly for a long time until De Qi is achieved. Wait as if for a honored guest, unaware of the passing day. Once qi arrives, adjust and protect it appropriately. Withdraw the needle during inhalation so qi cannot escape, remaining at the needle site. Push the skin pore closed to keep the spirit and qi inside, allowing the major qi under the needle to stay. This is called the Tonifying Method.
("Tui" is "Tui" (retreat/push), level tone. "Dan" is level tone. "Zhua" is like guiding. To tonify deficiency, one must know the meridian's deficiency. First, palpate and stroke to locate the true acupoint. Then press and disperse, push and press, separating the point to prevent displacement. Flick to distend vessels for insertion, guide downward to deepen penetration, unblock and select to regulate the meridian. Pull the skin opening to facilitate qi flow and close the spirit gate, retaining true qi internally. Needle retention times vary with respiration. After retention, insert again and retain quietly for De Qi. Waiting for qi is like awaiting a honored guest. Once qi arrives, adjust and protect. Previously, withdrawing during exhalation expelled qi; now, withdrawing during inhalation retains qi. Closing the pore keeps spirit and qi inside, retaining major qi. This is the method for tonifying true qi, hence called Tonifying.")

The Yellow Emperor asked: How should one wait for qi?
(Waiting as for a honored guest, unaware of time, until qi arrives and adjusting/protecting it—this is the method for waiting for qi. The Yellow Emperor asks again.)

Bai Hu said: When pathogenic qi moves from collateral vessels into meridians, it lodges in the blood vessels. Initially, its cold or warm nature has not yet harmonized with the body, resembling the rising of waves—coming and going, thus not staying long. Therefore, it is said: When it comes, press and stop it, then treat it. Do not attack when it is at its peak. True Qi is Meridian Qi. Since Meridian Qi is greatly deficient, it is said that one should not meet the incoming pathogen with reduction. This is what is meant.
(Pathogens enter humans via collaterals to meridians, then to vessels. Lodging in blood vessels, initially the pathogen hasn't formed distinct cold or warm diseases. When its nature hasn't harmonized, it resembles rising waves, coming and going, not staying long. Treatment should be timely. Thus, 'when it comes, press and stop it, then treat.' Avoid attacking when the pathogen is rushing/peaking. Attacking the peak damages Meridian Qi, harming True Qi. True Qi is Meridian Qi; reducing it causes great deficiency. Hence, *Jiu Zhen Shi Er Yuan* states: 'Do not meet the incoming [pathogen],' meaning do not attack the peak rush.)

Therefore, it is said: If monitoring the pathogen is imprecise and the accumulated major qi has already passed, applying reduction will cause True Qi to collapse. Once collapsed, it cannot recover. The pathogen will return, and the disease will accumulate further. Thus, it is said that once the pathogen has gone, it cannot be pursued. This is what is meant.
(The previous text discussed reducing when excessive; this discusses not reducing when the pathogen has passed. If monitoring is imprecise and the accumulated qi has passed, reducing it causes True Qi to collapse externally, unable to recover. The pathogen returns, and the disease worsens. Hence, *Jiu Zhen Shi Er Yuan* states: 'Once gone, do not pursue,' meaning do not reduce after the major qi has passed.)

The timing must not differ by a hair's breadth. Wait for the pathogen to arrive before inserting the needle to reduce. If one needles too early or too late, the blood and qi will be exhausted, and the disease cannot be resolved. Thus, it is said: Knowing when to needle is like firing a crossbow mechanism; not knowing when is like striking a wooden mallet. It is said: Those who understand the Dao of opportunity do not miss by a hair; those who do not understand strike without effect. This is what is meant.
(Acupuncture is subtle; timing is critical. Not missing by a hair means waiting for the pathogen's arrival to needle. Incorrect timing harms blood and qi, exhausting them and trapping the disease. 'Xia' means retreat/resolution. Selecting points requires correct timing. Knowing the right time is like a swift crossbow shot; not knowing is like a dull mallet strike. Hence, *Jiu Zhen Shi Er Yuan* states: 'Know the opportunity... strike without effect,' referring to knowing vs. not knowing the right time.)

The Yellow Emperor asked: How are tonification and reduction performed?
(The Yellow Emperor previously asked about tonifying deficiency, not reducing excess, hence this question.)

Bai Hu said: This refers to attacking the pathogen.
(Deficiency was addressed earlier; this question focuses on reduction, hence 'attacking the pathogen'.)

Withdraw the needle quickly to remove abundant blood, thereby restoring True Qi. This is because the pathogen is newly arrived, flowing without a fixed location. Pushing it moves it forward; pulling it stops it. Pricking against the direction of flow regulates the blood. Pricking to bleed cures the disease immediately.
("Rong Rong" means flowing. "Ni" means facing/opposing. "Wen" means regulating/unblocking. The method for attacking pathogens involves quick needle withdrawal to remove abundant blood and restore True Qi. This is because the new pathogen flows without a fixed location. Without a fixed location, pushing moves it forward, pulling stops it. Pricking against the flow regulates blood. Regulating and bleeding cures the disease immediately. This is the method for attacking pathogens, preventing the combination of true and pathogenic qi.)

The Yellow Emperor said: Excellent. However, if true and pathogenic qi have combined and there is no mound-like pulsation, how should one monitor it?
(Bai Hu mentioned arterial pulses rising in mounds and cold/warm disharmony resembling waves. But if true and pathogenic qi combine without mound-like pulsation, how to monitor?)

Bai Hu said: Carefully palpate and stroke the abundance and deficiency in the Three Regions and Nine Palpations to regulate. Observe if the left/right and upper/lower pulses are discordant or diminished. Examine the affected zang organs to predict the outcome.
(Not knowing the Three Regions means failing to distinguish Yin/Yang and Heaven/Earth. Earth monitors Earth, Heaven monitors Heaven, Human monitors Human. Regulate the Middle Palace (Stomach) to define the Three Regions. Thus, it is said: If one does not know the locations of the Three Regions and Nine Palpations, even if a fatal condition approaches, the physician cannot foresee it.)
("Bie" sounds like "Bi". If pathogen enters without mound-like pulsation, healthy qi is internally deficient, and pathogen sinks inward. Monitoring requires careful mental examination and manual palpation of the Three Regions/Nine Palpations' abundance/deficiency. Observe discordance/diminution in left/right/upper/lower. Examine affected zang organs to predict death/life timing. *San Bu Jiu Hou Lun* states: 'Discordance in upper/lower/left/right leads to death; diminution in middle leads to death.' 'Qi' means calculating life/death timing. Not knowing the Three Regions prevents regulation based on abundance/deficiency. Failing to distinguish Yin/Yang prevents observing left/right. Failing to distinguish Heaven/Earth prevents observing upper/lower. Earth/Heaven/Human monitoring fails to detect discordance. Regulating based on Three Regions requires regulating the Middle Palace (Stomach Qi as root). Within the Three Regions are Nine Palpations. Hence, not knowing the locations prevents examining zang organs for prediction. Even if death approaches, the physician cannot foresee it. 'Da Guo' means death term. 'Gong bu neng jin' means inability to predict.)

Punishing the innocent is called great confusion. It reverses and disrupts the Great Meridians, making True Qi irrecoverable. Treating excess as deficiency and pathogen as true qi renders acupuncture meaningless, turning the practitioner into a thief of qi, depriving people of healthy qi.
(Punishing without fault means improper pathogen attack, called great confusion. Disruption of Great Meridians injures healthy qi, making True Qi irrecoverable. Treating excess as deficiency obscures truth/excess. Treating pathogen as true qi confuses true/pathogen. Such treatment makes acupuncture meaningless, acting as a qi thief, depriving healthy qi.)

Treating compliance as reversal scatters Ying and Wei qi. True qi is lost, and pathogen lingers internally alone, cutting off long life and bringing premature death. Because the Three Regions and Nine Palpations are unknown, longevity cannot be ensured.
('Yu' is the same as 'Tong'. Meaningless acupuncture leads to treating compliance as reversal, scattering Ying/Wei. Acting as a qi thief leads to loss of True qi and internal lingering of pathogen. Depriving healthy qi cuts off long life and brings premature death. Ignorance of Three Regions/Nine Palpations prevents ensuring longevity in the world.)

Failing to integrate the Four Seasons and Five Elements leads to adding mutual overcoming relationships, releasing the pathogen while attacking the true qi, cutting off long life.
(Ignorance of human Three Regions/Nine Palpations leads to ignorance of Heaven's Four Seasons, Earth's Five Elements, and Heaven's Six Qi. Adding Earth's Five Movements' mutual overcoming releases the pathogen and attacks the true qi, cutting off long life.)

This section clarifies that monitoring qi and performing tonification/reduction requires knowledge of the Three Regions and Nine Palpations as methods for tonifying true qi and reducing pathogenic qi.

Pathogenic qi is newly arrived, without a fixed location. Pushing it moves it forward; pulling it stops it. Upon encountering it, apply reduction, and the disease is cured immediately.
(Repeated from earlier to emphasize that newly arrived pathogens require urgent treatment to prevent the combination of true and pathogenic qi.)