停针十分钟内。如针下有胀痛（一）之感觉。见针四围有红晕。即知邪气已至针
下。立用正手法泻之。
如停针十分钟以上而针不胀不痛。见针四围亦无红晕。即知邪气未至针下。当用催
气法催之。
催气法。阳日用偶。阴日用奇数。内转令病患吸气。外转令病患呼气。阳日用至六
数时。即令病患颠倒呼吸。呼气时针内转。吸气时针外转。颠倒重用六数。乃停针候
气。如邪气不至。如法再催。或三催。顷刻针下胀痛。即知邪气已至。勿须再催。即用
补泻正法。
补泻寒热升降。正手法用毕时。针下轻松。病患痛苦轻减。将出针时。先用调和营
卫手法。先和营（一）气。后再调卫（一）气。和营气针在地部。不分阴日阳日。和营
皆用六数。调卫皆用九数。和营用口呼吸。调卫用鼻呼吸。先吸后呼。吸气针内转。呼
气针外转。和营六数时。针在地部。不必轻提。和营六数用毕。顷刻即令病患用鼻呼
吸。仍先吸气后呼气。吸气针内转。呼气针外转。外转时注意将针徐徐提至天部。调卫
九数用毕。再停针顷刻即出针。出针时。再令病患用口轻轻吸气数口。不拘奇偶。将针
左右轻轻旋转出针。
出针后。如血分有瘀滞。针下微见黑血。令病者勿疑。帮助病理。以手按挤左右。
令黑血尽出。见红血即自止。
出针时邪气有余。针之周遭红晕不尽。皮肤微觉高起。微觉胀痛。则将针摇大其
孔。出针后。不必用闭门法。
出针时如邪气已尽。正气不足。病患头部觉昏晕。针周遭皮肤色白。针下轻松者。
右手出针。速用左手大指按其孔穴揉和之。使正气不致消耗。
灵枢经云。泻曰必持内之。放而出之。排阳得针。邪气得泄。补曰如留而还。去如
弦绝。令左属右。其气故止。外门已闭。中气乃实。必勿留血。即取诛之。此出针当按
不当按之理。
在留针十分钟以内。如果患者在针下有胀痛的感觉，且看到针周围出现红晕，就知道邪气已经到达针下。立即使用正规的补泻手法进行泻法操作。
如果留针超过十分钟，但针下没有胀感或痛感，针周围也没有红晕，就知道邪气尚未到达针下。此时应当使用催气法来促使经气到来。
催气法中，阳日使用偶数，阴日使用奇数。向内旋转针体时让患者吸气，向外旋转针体时让患者呼气。在阳日操作至第六个数字（即六次循环）时，即让患者颠倒呼吸节奏：呼气时针向内转，吸气时针向外转。颠倒呼吸时要重用“六”这个数，然后停针等待气至。如果邪气仍未到达，按照上述方法再次催气。或者进行三次催气，片刻之后针下出现胀痛感，就知道邪气已经到了，不需要再催气，直接使用正规的补泻手法。
在进行补泻、寒热、升降等正规手法结束后，针下感觉轻松，患者的痛苦减轻。在准备出针时，先使用调和营卫的手法。先调和营气，然后再调卫气。调和营气时，针停留在地部（皮下浅层），不分阴日还是阳日，调和营气都使用“六”数，调卫气都使用“九”数。调和营气时用口呼吸，调卫气时用鼻呼吸。都是先吸气后呼气，吸气时针向内转，呼气时针向外转。调和营气操作六个次数时，针在地部，不必轻轻提针。调和营气六个次数用完后，立刻让患者改用鼻呼吸，仍然先吸气后呼气，吸气时针向内转，呼气时针向外转。向外旋转时，注意将针徐徐提至天部（最表层）。调卫气九个次数用完后，再停针片刻即可出针。出针时，再让患者用口轻轻吸气几口，不拘泥于奇数或偶数，然后将针左右轻轻旋转拔出。
出针后，如果血分有瘀滞，针下微微见到黑血，要让患者不要怀疑，这是帮助病理排出的表现，用手按压挤压两侧，让黑血全部流出，见到红血自然就会停止。
出针时如果邪气有余，针周围的红晕没有完全消退，皮肤微微觉得高起，微微感到胀痛，就将针摇大其孔洞。出针后，不必使用闭合穴位的“闭门法”。
出针时如果邪气已尽，正气不足，患者头部感觉昏晕，针周围皮肤色白，针下感觉轻松者，右手出针，迅速用左手大拇指按住穴位并揉和它，使正气不至于消耗。
《灵枢经》说：“泻法一定要持针深入，放出邪气，推排阳气以得针，使邪气得以泄出；补法要像留住正气一样，去针时要像弓弦断绝一样快，令左手属右手，经气因此止息，外门已闭，中气乃实，务必不留瘀血，即刻取走诛伐邪气。”这就是出针时应当按压和不应当按压的道理。
Within ten minutes of needle retention. If a sensation of distension and pain (1) is felt under the needle, and a red halo is seen around the needle, it indicates that the pathogenic factor has arrived at the needle site. Immediately apply the standard tonification or sedation technique for sedation.
If more than ten minutes have passed since needle retention, yet there is no distension or pain under the needle, and no red halo appears around the needle, it indicates that the pathogenic factor has not yet arrived. In this case, the Qi-urging method should be employed to urge the arrival of Qi.
In the Qi-urging method, even numbers are used on Yang days, and odd numbers on Yin days. Rotating the needle inward corresponds to patient inhalation; rotating outward corresponds to exhalation. On Yang days, when reaching the number six, instruct the patient to reverse their breathing rhythm: rotate the needle inward during exhalation and outward during inhalation. The reversed breathing technique emphasizes the number six, after which the needle is retained to await Qi arrival. If the pathogenic factor does not arrive, repeat the urging method as described. Alternatively, perform three rounds of urging. Within a short period, if a sensation of distension and pain arises under the needle, it confirms the arrival of the pathogenic factor, and further urging is unnecessary. Proceed directly with the standard tonification or sedation techniques.
After completing the standard techniques for tonification/sedation, cold/heat, and ascending/descending, the area under the needle feels relaxed, and the patient's suffering is alleviated. Before withdrawing the needle, first employ the Ying-Wei harmonizing technique. First harmonize Ying (Nutritive) Qi (1), then adjust Wei (Defensive) Qi (1). To harmonize Ying Qi, the needle remains in the Earth level (superficial layer), regardless of whether it is a Yin or Yang day. Harmonizing Ying Qi always uses the number six, while adjusting Wei Qi always uses the number nine. Harmonizing Ying Qi involves mouth breathing, whereas adjusting Wei Qi involves nasal breathing. Both follow the sequence of inhalation followed by exhalation: inhale while rotating the needle inward, exhale while rotating outward. When performing six repetitions for harmonizing Ying Qi, the needle stays at the Earth level and need not be slightly lifted. Upon completion of the six repetitions for harmonizing Ying Qi, immediately instruct the patient to switch to nasal breathing, maintaining the sequence of inhalation followed by exhalation: inhale while rotating inward, exhale while rotating outward. During outward rotation, carefully lift the needle slowly to the Heaven level (most superficial layer). After completing nine repetitions for adjusting Wei Qi, retain the needle briefly before withdrawal. At the time of withdrawal, instruct the patient to take several gentle breaths through the mouth, without regard for odd or even numbers, and gently rotate the needle left and right while withdrawing it.
After withdrawal, if there is blood stasis in the blood aspect, slight black blood may appear under the needle site. Reassure the patient not to worry, as this assists in pathological discharge. Use fingers to press and squeeze from both sides until all black blood is expelled; bleeding will stop naturally once red blood appears.
If, upon withdrawal, excess pathogenic factors remain, indicated by persistent red halos around the needle site, slight skin elevation, and mild distension/pain, enlarge the needle hole by shaking the needle. Do not use the "closing door" method (pressing the acupoint) after withdrawal.
If, upon withdrawal, pathogenic factors are exhausted but Zheng Qi (Upright Qi) is insufficient, manifested by dizziness in the patient, white skin color around the needle site, and a relaxed sensation under the needle, withdraw the needle with the right hand and immediately press and massage the acupoint with the thumb of the left hand to prevent consumption of Zheng Qi.
The *Ling Shu* states: "For sedation, one must hold and insert the needle, release and expel [the pathogen], push away Yang to obtain the needle, allowing the pathogenic Qi to be discharged. For tonification, retain the needle as if preserving [Qi]; withdraw it swiftly like a breaking bowstring. Let the left hand belong to the right, so that Qi ceases [from escaping], the external gate is closed, and the central Qi becomes solid. Ensure no blood remains; immediately remove [the pathogen]." This explains the principle of when to press and when not to press during needle withdrawal.