Huangdi asked: I have heard of the nine needles and nine chapters, and you have expanded them to eighty-one chapters. I have fully understood their meaning. The classics speak of the rise and fall of qi, the shifting of left and right, regulating the upper to adjust the lower, and the left to adjust the right. I know about the excess and deficiency, and the tonification and drainage at the Ying and Shu points. These are all about the shifting of the nutritive and defensive qi, the generation of deficiency and excess, not the pathogenic qi entering the meridians from the outside. I wish to hear about how pathogenic qi in the meridians affects the patient and how to treat it. Qibo replied: The sages established their measures in accordance with heaven and earth. Thus, heaven has its constellations and degrees, earth has its Jingshui, and humans have meridians. When heaven and earth are warm and mild, the Jingshui is calm; when heaven is cold and earth is frozen, the Jingshui congeals and weeps; when heaven is hot and earth is scorching, the Jingshui boils over; when sudden storms arise, the Jingshui surges and mounds up. When pathogenic factors enter the vessels, cold causes the blood to congeal and weep, heat causes the qi to become turbid and moist, and deficiency-type pathogens thus enter and lodge, just as the Jingshui is affected by wind. The movement of the meridians' arteries also rises and mounds at times, moving through the vessels in an orderly manner. When it reaches the cus kou in the hand, it is sometimes large and sometimes small; large indicates the arrival of pathogens, small indicates calm. Its movement has no constant place, in yin or yang, and cannot be measured. Thus, observe it, and in the three regions and nine indicators, suddenly encounter it, and quickly block its path. Inhale and insert the needle, not letting the qi resist; remain still and leave it for a long time, not letting the pathogens spread; inhale and rotate the needle, aiming to obtain qi; wait for exhalation and withdraw the needle, exhale fully and then remove it, the great qi all exits, thus it is called drainage. Huangdi said: How to tonify the deficiency? Qibo said: First, feel and follow it, press and disperse it, push and press it, pluck and anger it, grasp and purge it, open and take it, externally draw its gate, to close its spirit. Exhale fully and insert the needle, remain still and leave it for a long time, aiming for the arrival of qi, as if waiting for a respected guest, unaware of the passage of time. When the qi has arrived, protect it appropriately. Wait for inhalation and withdraw the needle, the qi should not exit, each in its place, push and close its gate, let the spirit qi remain, the great qi stays, thus it is called tonification. Huangdi said: How to await the qi? Qibo said: When pathogens leave the collaterals and enter the meridians, they lodge in the blood vessels, their cold and warmth not yet in harmony, like the rise of surging waves, coming and going, thus not constant. Thus it is said: When it comes, press and stop it, stop and take it, do not meet its rush and drain it. Vital qi is the qi of the meridians, the qi of the meridians is too empty, thus it is said: "Its arrival cannot be met (1)", this is what it means. Thus it is said: If awaiting pathogens is not careful, the great qi has already passed, draining it will cause the vital qi to collapse, collapse and it will not recover, pathogens will return, and the disease will accumulate more, thus it is said: "Its departure cannot be pursued (2)", this is what it means. "Cannot be hung by a hair (3)" means, await the arrival of pathogens and then insert the needle to drain, if before or after, the blood and qi are already exhausted, the disease cannot be treated, thus it is said: Knowing when to take is like releasing a trigger, not knowing when to take is like striking a mallet, thus it is said: "Those who know the way of the trigger cannot be hung by a hair, those who do not know the way of the trigger strike and do not release (4)", this is what it means. Huangdi said: How to tonify and drain? Qibo said: This is to attack pathogens, quickly remove to eliminate excess blood, and restore the vital qi, these pathogens are newly arrived, floating and without a fixed place, push them and they move forward, pull them and they stop, oppose them and puncture, warm the blood. Puncture and remove the blood, the disease will immediately resolve.
The Emperor said: Good. However, when the true and evil qi have combined, and the waves and mounds do not rise, how can one observe it? Qibo replied: Examine and palpate the three regions and nine divisions to assess their excess or deficiency and regulate them accordingly. Observe the imbalances and reductions between the left and right, upper and lower parts, and determine the affected organs to anticipate the disease. If one does not understand the three regions, yin and yang cannot be distinguished, heaven and earth cannot be separated. Earth corresponds to earth, heaven corresponds to heaven, and humans correspond to humans. Regulate the Zhongfu (LU1) to determine the three regions. Therefore, it is said: If one does not know the locations of the disease pulses in the three regions and nine divisions, even if a major excess is about to occur, the physician cannot prevent it. Punishing without fault is called great confusion, which disrupts the major meridians, and the true qi cannot be restored. Treating excess as deficiency and evil as true, using needles without principle, instead harms the qi, depletes the healthy qi, and turns compliance into rebellion. The nutritive and defensive qi become scattered and disordered, the vital qi is lost, and evil qi remains internally, cutting off a person's longevity and bringing calamity. Not understanding the three regions and nine divisions leads to an inability to endure for long. Because one does not understand the harmony with the four seasons and the Five Phases, and instead adds mutual conquest, releasing evil to attack the true, it cuts off a person's longevity. When a new evil guest arrives, it has no fixed location. Pushing it forward and guiding it can stop it. Encountering and draining it will immediately resolve the illness.