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To fill the form, once the form is filled, then the three regions and nine examinations of the body's pulse will be consistent above and below, which is called a "Ping Ren" (Normal Person). A Ping Ren is a person with harmonious Blood and Qi. From this, we know that the coming and going of Yin and Yang occur through the Shu points and Hui points; if they do not pass through these points, but rather if Blood and Qi contend with each other, there will be deficiency and excess in Yin and Yang.

The generation of pathogenic factors may originate from the Yin aspect or the Yang aspect. Those originating from the Yang are caused by external wind, rain, cold, and heat. Those originating from the Yin are caused by internal injuries such as diet, living conditions, and emotions like joy and anger.

The previous text discussed the intermingling of Blood and Qi, and the deficiency and excess of Yin and Yang, referring to the imbalance of meridians, not specifically to the six exogenous pathogens or seven internal emotions. Therefore, it continues to discuss diseases of exogenous and endogenous origin, as well as those characterized by Yin-Yang and cold-heat. The generation of pathogenic factors causing disease may originate from the Yin aspect or the Yang aspect. Those originating from the Yang are due to external wind, rain, cold, and heat; those originating from the Yin are due to internal injuries from diet, living conditions, and emotions. Mentioning wind, rain, cold, and heat covers the Six Qi; mentioning joy and anger covers the Seven Emotions. Any specific example suffices; it is not necessary to list all. Thus, sometimes it mentions wind, rain, cold, and heat; sometimes wind, rain, cold, and dampness; sometimes joy and anger; sometimes joy and sorrow, as seen in the Q&A below.

The Yellow Emperor asked: How do wind and rain injure the human body?

The Yellow Emperor, following Qi Bo's words, wished to further elucidate the meaning, so he asked repeatedly to understand in detail.

Qi Bo said: When wind and rain injure a person, they first lodge in the skin, then transmit to the Sun vessels (fine branches of collateral vessels). When the Sun vessels are full, they transmit to the Luo vessels (collateral vessels). When the Luo vessels are full, they transport to the large Jing vessels (main meridians). Blood and Qi combine with the pathogen and reside between the Fen Li (muscle intervals) and Cou Li (interstices). The pulse becomes firm and large, hence it is called "Shi" (Excess). Excess manifests as external firmness and fullness; it cannot be pressed, and pressing causes pain.

Whenever wind and rain injure a person, the invasion proceeds from shallow to deep. Thus, it first lodges in the skin, transmits to the Sun vessels from the skin; when the Sun vessels are full, they transmit to the Luo vessels; when the Luo vessels are full, they transport to the large Jing vessels. Moving from outside to inside, Blood and Qi combine with the pathogen and reside between the Fen Li and Cou Li, so the pulse becomes firm and large. The pulse refers to the Sun, Luo, and Jing vessels. Because the pulse is firm and large, it is called Excess. Excess means fullness. What is meant by Excess is that the exterior is firm, large, and full, so it cannot be pressed, and pressing causes pain. This is what is described.

The Yellow Emperor asked: How do cold and dampness injure the human body? Qi Bo said: When cold and dampness invade a person, the skin loses its ability to contract and close, the muscles become hard and tight, Ying Blood (Nutritive Blood) flows sluggishly, and Wei Qi (Defensive Qi) dissipates and departs. Hence, it is called "Xu" (Deficiency). Deficiency manifests as trembling and opening/closing irregularly (Nie Pi), with insufficient Qi. Upon pressing, the Qi is sufficient to warm the body, so one feels comfortable and pain-free.

When cold and dampness invade a person, they affect the area between the skin and muscles. Thus, the skin does not contract tightly, and the muscles become hard and tight. "Not contracting" means sweat escapes without closing tightly. "Hard and tight" means sluggish and lacking flexibility. Therefore, hard and tight muscles cause Ying Blood to flow sluggishly. "Sluggish" means congealed and slow. Skin failing to contract means Wei Qi departs. "Depart" means losing its post/guarding function.

With sluggish Blood and departing Qi, it is called Deficiency. In Deficiency, both Blood and Qi are deficient, leading to Nie Pi, which describes the muscle and skin trembling and moving irregularly. "Insufficient Qi" means Qi is insufficient to internally warm the Blood. The previous text stated that Excess is full and firm, cannot be pressed, and causes pain upon pressing. Here, because Blood and Qi are insufficient, pressing allows Qi to sufficiently warm the blood. Since Qi sufficiently warms the blood internally, one feels comfortable and pain-free. The previous text mentioned that things originating from the Yang are due to wind, rain, cold, and heat, so wind, rain, and cold/dampness were cited to illustrate that exogenous diseases originating from the Yang can present as either Excess or Deficiency.

The Yellow Emperor said: Excellent. How does the Yin aspect generate Excess?

Things originating from the Yang are due to wind, rain, cold, and heat; things originating from the Yin are due to diet, living conditions, and emotions like joy and anger. The Yang aspect was already discussed in detail above. Here, the generation of Excess and Deficiency in the Yin aspect is raised to clarify the significance of emotions and diet.

Qi Bo said: If joy and anger are unregulated, Yin Qi will rebel upwards. Upward rebellion leads to deficiency in the lower part. When the lower part is deficient, Yang Qi rushes to fill it. Hence, it is called Excess.

Joy and anger are normal human emotions. Unregulated joy and anger internally injure the Yin, causing Yin Qi to rebel upwards. Upward rebellion of Yin Qi leads to deficiency in the lower part. When the lower part is deficient, Yang Qi rushes to join the Yin. Hence, it is called Excess. This explains how the Yin aspect generates Excess.

The Yellow Emperor asked: How does the Yin aspect generate Deficiency? Qi Bo said: Joy causes Qi to descend, and sorrow causes Qi to dissipate. Dissipation leads to emptiness in the meridians. Combined with cold food and drink, the cold Qi steams and fills the interior, causing Blood to flow sluggishly and Qi to depart. Hence, it is called Deficiency.

Extreme joy leading to anger causes Qi to rise; extreme joy leading to sorrow causes Qi to descend. Thus, joy causes Qi to descend, and sorrow causes Qi to dissipate. Dissipation leads to emptiness in the meridians. Furthermore, due to cold food and drink, cold Qi steams and fills the interior, causing Ying Blood to flow sluggishly and Wei Qi to depart. Hence, it is called Deficiency. This explains how the Yin aspect generates Deficiency. The previous text stated: Things originating from the Yin are due to diet, living conditions, and emotions. Therefore, joy, anger, sorrow, cold, and diet are cited to illustrate that endogenous diseases originating from the Yin can present as either Excess or Deficiency.

The Yellow Emperor said: The classic states 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 know the reason behind it.

Qi Bo said: Pathogens may originate from the Yin aspect or the Yang aspect. Yang governs the exterior, and Yin governs the interior. Yang Deficiency and Yin Deficiency involve external and internal cold/heat; Yang Excess and Yin Excess also involve external and internal cold/heat. Thus, citing the classic helps explore the reasons.

Qi Bo said: Yang receives Qi from the Upper Jiao (Upper Burner) to warm the skin and muscle intervals. Now, if cold pathogen is on the exterior, the Upper Jiao becomes obstructed. If the Upper Jiao is obstructed, cold pathogen remains alone on the exterior, causing chills.

What is meant by "Yang Deficiency leads to external cold" is that Yang receives Qi from the Upper Jiao. The Upper Jiao opens and disseminates to warm the skin and muscle intervals. Now, if cold pathogen is on the exterior, the Upper Jiao becomes obstructed. If the Upper Jiao is obstructed, cold pathogen remains alone on the exterior, causing chills and external cold.

The Yellow Emperor asked: How does Yin Deficiency generate internal heat? Qi Bo said: Due to fatigue and overwork, the form and Qi decline and become scarce. Grain Qi does not fill adequately. The Upper Jiao fails to circulate, and the Lower Wan (Lower Stomach) fails to communicate. The Stomach Qi becomes hot, and hot Qi steams the chest cavity, thus generating internal heat.

"Zhong" is pronounced with the falling tone, same for subsequent instances. What is meant by "Yin Deficiency generates internal heat" is that fatigue and overwork cause the form and Qi to decline. Grain Qi in the stomach is insufficient. With less grain intake, the Upper Jiao cannot disseminate the flavors of the five grains, so the Upper Jiao fails to circulate. The Lower Wan cannot transform the essence of the grain, so the Lower Wan is obstructed. The Middle Earth is deficient, and Stomach Qi becomes hot. Hot Qi steams the chest cavity, so Yin Deficiency leads to internal heat.

The Yellow Emperor asked: How does Yang Excess generate external heat? Qi Bo said: If the Upper Jiao is not smooth and unobstructed, the skin becomes dense, the Cou Li (interstices) close, and the Xuan Fu (pores) are blocked. Wei Qi cannot diffuse and escape, thus generating external heat.

What is meant by "Yang Excess generates external heat" is that Yang governs the upper and the exterior. If the Upper Jiao is not smooth, the skin on the exterior becomes dense, and consequently, the Cou Li inside close, and the Xuan Fu are blocked. Cou Li refers to the texture of the muscle layers. Xuan Fu refers to the pores/sweat ducts. If the Xuan Fu, skin, and Cou Li are not interconnected, Wei Qi becomes stagnant and cannot diffuse and escape. Thus, Yang Excess leads to external heat.

The Yellow Emperor asked: How does Yin Excess generate internal cold? Qi Bo said: Jue Qi (Rebellious Qi) rebels upwards. Cold Qi accumulates in the chest cavity and cannot be discharged. If not discharged, the warming Qi departs, leaving only cold Qi. The cold Qi causes Blood to congeal and flow sluggishly. Congealing leads to obstruction in the vessels. The pulse becomes large and choppy/sluggish, thus resulting in internal cold.

"Zhong" is taken literally. What is meant by "Yin Excess generates internal cold" is that Yin governs the lower and the interior. Jue Qi rebels upwards; the cold Jue Qi reverses from the lower part upwards. Since Yin is within, cold Qi accumulates in the chest cavity and cannot be discharged. If cold Qi is not discharged, the warming Qi departs, leaving only cold Qi. Remaining cold Qi causes Blood to congeal and flow sluggishly. Congealing leads to obstruction in the vessels. Obstruction in the vessels means the pulse is large and choppy/sluggish. Thus, Yin Excess leads to internal cold. "Zhong" here is equivalent to "internal".

The Yellow Emperor asked: When Yin and Yang merge, and Blood and Qi merge, and the disease manifestation has formed, how should acupuncture be performed?

This again follows the previous discussion on Yin-Yang, Blood-Qi, and disease manifestations, asking about tonifying and reducing acupuncture methods for deficiency and excess, as a method for regulating the meridians.

Qi Bo said: To treat this, select the Jing Sui (meridian tunnels). Take Blood from the Ying (Nutritive) level, and take Qi from the Wei (Defensive) level. Use the body's form [as a guide], and adjust according to the four seasons, varying the depth and number of needles.

The previous text stated: The pathways of the Five Zang organs all emerge from the Jing Sui to circulate Blood and Qi. Therefore, to treat this, one should select the Jing Sui, take Blood from the Ying level, and take Qi from the Wei level, to circulate their Blood and Qi. Ying, Wei, Blood, and Qi circulate throughout the body and harmonize with the four seasons. Now, selecting the Jing Sui, although it involves using the body's form, one must base it on the heavenly four seasons to determine the number and depth of the needles. The *Miao Ci Lun* (Treatise on Miao Acupuncture) states: Use the waxing and waning of the moon as the basis for quantity. This refers to "more or fewer." The *Jin Gui Zhen Yan Lun* (Treatise on True Words in the Golden Cabinet) states: Spring Shu points are in the neck and nape; Summer Shu points are in the chest and hypochondrium; Autumn Shu points are in the shoulders and back; Winter Shu points are in the waist and thighs. This refers to "high or low."

The Yellow Emperor asked: When Blood and Qi merge, the disease manifestation forms, and Yin and Yang tilt against each other, how should tonification and reduction be applied?

When Blood and Qi merge, the disease forms, and Yin and Yang tilt against each other, there are naturally tonification and reduction methods, which need not necessarily depend on the four seasons, so he asks again.

Qi Bo said: To reduce Excess, insert the needle when the Qi is abundant. Insert the needle along with the Qi. Open the gate, like opening a door. Withdraw the needle along with the Qi. The Essence Qi is not injured, and the Pathogenic Qi is expelled. The outer gate remains open to let the disease out. Widen the channel, like clearing a road. This is called Great Reduction. One must press at the point upon withdrawal, so that the great Pathogenic Qi yields.

Merging constitutes Excess; separation constitutes Deficiency. Reducing Excess means reducing the merging of Blood and Qi. Therefore, insert the needle when Qi is abundant. Inserting when Qi is abundant is to reduce Excess. Inserting the needle along with the Qi means driving the needle deep along with the merged Qi to open the gate for reduction, like opening a door, which is Great Reduction. Once opened and cleared, withdraw the needle along with the Qi. This means withdrawing the needle while the merged Qi also exits, expelling external pathogens without injuring healthy Qi. Thus, Essence Qi is not injured, and Pathogenic Qi is expelled. "Opening the gate" means keeping the outer gate open to expel the disease. "Clearing the door" means widening the channel, like clearing a road. Opening the gate to expel disease is reduction; clearing the road is Great Reduction. "Qie" means to press. Pressing upon withdrawal means holding the needle with the right hand while the left hand presses the acupoint to facilitate outward withdrawal, after which the great Pathogenic Qi yields. "Da Qi" (Great Qi) refers to the abundant Qi of the merger.

The Yellow Emperor asked: How should Deficiency be tonified? Qi Bo said: Hold the needle without placing it down, to stabilize your intention. Wait for exhalation to insert the needle. As Qi exits, the needle enters. The needle hole closes on all sides, preventing Essence from escaping. When Qi gathers and becomes solid, quickly withdraw the needle. As Qi enters, the needle exits. Heat cannot return. Close the gate. Pathogenic Qi disperses, and Essence Qi is preserved. Observe the movement of Qi at the acupoint and align with the season. Do not lose the nearby Qi, so that distant Qi may arrive. This is called "Zhui" (Pursuing).

"Kong" means pore. Tonification means restoring the loss of Blood and Qi. Therefore, hold the needle without placing it down to stabilize the intention to tonify. Inhalation brings Qi in; exhalation sends Qi out. Waiting for exhalation to insert the needle means inserting as Qi exits. After insertion, the needle hole should close on all sides, preventing Essence from escaping. For withdrawal, wait until Qi gathers and becomes solid, then quickly withdraw the needle. As Qi enters, the needle exits. Upon needle exit, heat cannot return. As Qi enters, it closes the gate. Heat not returning causes Pathogenic Qi to disperse. Closing the gate preserves Essence Qi. Holding the needle without placing it down stabilizes the intention. Observing the movement of Qi at the acupoint means waiting for the appropriate time. Waiting for the time ensures nearby Qi is not lost, allowing distant Qi to arrive. This is called "Zhui" (Pursuing). Pursuing is used for tonification. This is the method for tonifying Deficiency.

The Yellow Emperor said: You spoke of ten types of Excess and Deficiency, originating from the Five Zang organs. The Five Zang correspond to five pulses. However, the twelve Jing meridians can all produce disease. Why do you only speak of the Five Zang? The twelve Jing meridians connect with 365 joints. Disease in a joint must affect the meridian. Meridian diseases all have Excess and Deficiency. How do we reconcile this?

In the previous text, Qi Bo said: There are five types of Surplus and five types of Insufficiency, all originating from the Five Zang. The Yellow Emperor reasoned that the Five Zang have only five pulses, so how do the Excess and Deficiency of these five pulses relate to the twelve Jing meridians and the 365 joints? He raises this question again.

Qi Bo said: The Five Zang originally have the Six Fu organs as their interior-exterior pairs. The meridians and joints each generate Excess and Deficiency diseases. Adjust them according to where the disease resides.

The human body's Five Zang belong to the Five Elements. The Five Elements combine with the Six Qi. Thus, the Five Zang have the Six Fu organs as interior-exterior pairs. The Five Zang and Six Fu correspond to the twelve meridians. The twelve meridians extend to the limbs and joints. Therefore, the meridians and joints each generate Excess and Deficiency diseases. Treat them according to the location of the disease.

If the disease is in the pulse, regulate the Blood. If the disease is in the Blood, regulate the Luo vessels. If the disease is in the Qi, regulate the Wei Qi. If the disease is in the flesh, regulate the Fen Rou (muscle intervals). If the disease is in the sinews, regulate the sinews. If the disease is in the bone, regulate the bone.

Among the Five Elements, there are two Fires combining with the Six Qi. Thus, the pulse governed by the Pericardium, the Blood governed by the Heart, the Qi governed by the Lungs, the Flesh governed by the Spleen, the Sinews governed by the Liver, and the Bones governed by the Kidneys are cited to illustrate that the Five Zang and Six Fu correspond to the twelve meridians. The Pericardium governs the pulse; the Heart governs Blood. Pulse and Blood are undivided. So, if the disease is in the pulse, regulate the Blood; if in the Blood, regulate the Luo vessels. Luo vessels are essentially pulses. The Lungs govern Qi and protect the exterior. So, if the disease is in the Qi, regulate the Wei Qi. The rest are regulated according to the location of the disease.

Use burning needles (Candle Needles) to rapidly puncture below the affected area, and for cases of spasm/tightness. For bone diseases, use quenched needles and herbal compresses. For diseases where the pain location is unknown, prioritize the Two Qiao vessels. If there is bodily pain but no abnormality in the Nine Pulses, use Miao Acupuncture. If pain is on the left but the pulse on the right is diseased, use Ju Acupuncture. One must carefully examine the Nine Pulses; then the principles of acupuncture are complete.

This section lists bi-syndrome (painful obstruction) of the meridians and joints, located in the upper/lower and left/right of the body, combined with the Three Regions and Nine Pulses, as a method for regulating the meridians. Using burning needles to rapidly puncture below is for treating Bi-syndrome. The *Ling Shu: Jing Jin* chapter lists twelve tendon Bi-syndromes, all treated with burning needles and rapid puncture. Bi originating from Yin is treated by puncturing below. Cases of spasm refer to tendon Bi. The *Jing Jin* chapter states: Abdominal tendon spasm pulls to the clavicle and cheek, causing sudden facial paralysis. Cheek tendon cold causes spasm pulling the cheek and deviating the mouth; treat with horse fat plaster and white wine mixed with cinnamon. Bone disease is Bone Bi. If Bi is in the bone, use quenched needles. If Bi is in the sinews, use herbal compresses. Bi affecting the exterior connections of the Five Zang definitely causes pain. If Bi causes no known pain, ascend via the extraordinary meridians, hence "Two Qiao vessels are primary." The Two Qiao refer to the Foot Yang Qiao and Foot Yin Qiao. "Primary" means ascending via the Qiao meridians. Yang Qiao disease causes Yin slackness and Yang tension; Yin Qiao disease causes Yang slackness and Yin tension. Thus, even with disease, pain may not be felt. If Bi is in the muscles, there is bodily pain unrelated to meridians, so the Nine Pulses show no disease. Treat with Miao Acupuncture. The *Miao Ci Lun* states: For Bi pain in the muscle intervals, puncture left to right, right to left. If pain is on the left but the right pulse is diseased, the pathogen is in the meridian. Treat with Ju Acupuncture. Ju Acupuncture uses long needles for deep insertion to extract deep pathogens and distant Bi. All these Bi-pain syndromes are located in the body's upper/lower and left/right. Therefore, one must carefully examine the Nine Pulses. The Nine Pulses refer to the Upper, Middle, and Lower regions, three examinations each. The Three Regions and Nine Pulses correspond to the meridians, observing form and spirit. Carefully examining this completes the principles of acupuncture.