Counterflow and Order

The Yellow Emperor asked Bo Gao: I have heard that the movement of qi has favorable and adverse aspects, the pulse has conditions of exuberance and decline, and needling has great principles. Can you explain these to me? Bo Gao said: The favorable and adverse movement of qi corresponds to heaven and earth, yin and yang, the four seasons, and the five phases. The exuberance and decline of the pulse are used to examine the vacuity or repletion, excess or insufficiency of blood and qi. The great principles of needling must clearly discern when disease can be needled, when it cannot be needled, and when it is already beyond needling.

The Yellow Emperor asked: How does one examine these? Bo Gao said: In the art of war, it is said, do not meet the enemy when their qi is in full vigor, and do not attack troops that are well-arrayed. In the art of needling, it is said, do not needle a patient when heat is blazing, do not needle a patient with profuse sweating like flowing streams, do not needle a patient when the pulse is chaotic and unclear, and do not needle a patient when the disease contradicts the pulse.

The Yellow Emperor asked: How does one examine the opportune time for needling? Bo Gao said: A superior physician needles when disease has not yet arisen; a next-level physician needles when disease has not yet become exuberant; an inferior physician needles when disease has already declined. A poor physician needles when disease has just attacked, or needles when the patient's body is in full vigor, or needles when the disease contradicts the pulse. Therefore it is said: When disease is in full vigor, do not rashly attack and harm; wait until disease has declined before needling, and the matter will surely achieve great success. Therefore it is said: The superior physician treats disease before it arises, and does not treat disease after it has already manifested—this is the meaning of that principle.