七十八难曰∶针有补泻，何谓也？
然∶补泻之法，非必呼吸出内针也。知为针者，信其左；
不知为针者，信其右。当刺之时，必先以左手厌按所针荥输之处，弹而努之，爪而下之，其气之
来，如动脉之状，顺针而刺之。得气，因推而内
之，是谓补；动而伸之，是谓泻。不得气，乃与男外女内；不得气，是谓十死不治也。
针法之补泻，候呼内针，候吸出针者，补也；候吸内针，候呼出针者，泻也。《素问·离合真
邪论》曰∶吸则内针，无令气忤，静以久留。无令邪布，吸则转针，以得气为故，候呼引针，呼尽
乃去，大气皆出，故命曰泻。呼尽内针，静以久留，以气至为故，如待所贵，不知日暮，其气以至，
适而自护，候吸引针，气不得出，各在其处，推阖其门，令神气存，大气留止，故命曰补。此《内经》
呼吸出内，补泻候气之常法也。越人以针法不仅乎此，善于用针者，凡下针之时，先定其穴，便以
左手厌按所针之处，以指弹击而努揉之，以爪掐引而下之，以致其气。其气之来，如动脉之状，顺针
而刺之，针得气，推其针而内入之，是谓补。摇动其针而引伸之，是谓泻。若候气久而不至，于男
子则候之于卫外，女子则候之于营内。若再求之不得，则营卫之气已脱，针必无功，是属不治之证也。
按∶滑氏曰∶弹而努之，鼓勇之也，努，读若怒。爪而下之，掐之稍重，皆欲致其气之至也。
气至指下，如动脉之状，乃乘其至而刺之。顺，犹循也，乘也，停针待气，气至针动，是得气也。
因推针而内之，是谓补。动针而伸之，是谓泻。此越人心法，非呼吸出内者也，是固然矣，若停针
候气，久而不至，乃与男子则浅其针而候之卫气之分，女子则深其针而候之营气之分，如此而又不
得气，是谓其病终不可治也。篇中前后二“气”字不同，不可不辨。前言气之来如动脉状，未刺之
前，左手所候之气也。后言得气不得气，针下所候之气也，此是两节。周仲立
乃云∶凡候气左手宜略重之，候之不得，乃与男则少轻其手于卫气之分候之，女则重其手于营
气之分候之，如此则既无前后之分，又昧停针待气之道，尚何所据为补泻耶！
回答说：补泻的方法，不一定非要配合呼吸来进出针。懂得针刺的人，信赖左手（辅助操作）；不懂针刺的人，只信赖右手（持针操作）。在应当进针的时候，必须先用左手按压所针刺的荥穴、输穴部位，用手指弹击使局部充血隆起，用指甲掐切定位向下引导。此时若感觉到经气到来，就像动脉搏动一样的形状，便顺着这个方向进针。如果取得了“得气”的感觉，就顺势将针推进去，这叫做补法；如果摇动针身并向外提引，这叫做泻法。如果没有取得“得气”的感觉，就要根据男女区别对待：对男子在卫分（浅层/外侧）候气，对女子在营分（深层/内侧）候气；如果始终不得气，这就称为十种无法治愈的死证之一。
关于针法的补泻，如果在呼气时进针，吸气时出针，这是补法；如果在吸气时进针，呼气时出针，这是泻法。《素问·离合真邪论》说：吸气时进针，不要使正气逆乱，安静地长时间留针，不要让邪气扩散，吸气时转动针具，以取得气感为目的，等到呼气时引出针具，呼尽时才完全拔出，这样大部的邪气都会排出，所以称之为泻法。呼气尽时进针，安静地长时间留针，以气至为度，如同等待尊贵的客人一样，不知时间流逝，当气至之后，适当保护正气，等到吸气时拔针，使正气不致随针外出，各守其位，推合针孔，使神气留存，大气（正气）留止，所以称之为补法。这是《内经》中关于呼吸进出针、候气补泻的常规方法。
越人（秦越人，即扁鹊）认为针刺的方法不仅仅局限于此。善于用针的人，凡是在下针的时候，先确定穴位，就用左手按压所针刺的部位，用手指弹击并揉按努胀，用指甲掐引向下引导，以此来招致经气。当经气到来时，形状如同动脉搏动，便顺着进针。针下取得气感后，推动针身向内深入，这叫做补法。摇动针身并向外伸展提引，这叫做泻法。如果候气很久而气不至，对于男子则在卫气之分（浅表）候气，对于女子则在营气之分（深层）候气。如果再寻找仍不得气，那么营卫之气已经脱失，针刺必然没有功效，这属于不治之证。
按语：滑寿（滑氏）说：“弹而努之”，是为了鼓舞经气，“努”字读音同“怒”。爪而下之，是指掐切稍重，都是想要促使经气到来。经气到达指下，像动脉搏动的样子，于是趁着经气到来之时进针。“顺”，就是遵循、趁势的意思。停针等待经气，经气至则针下感觉变动，这就是得气。顺势推针深入，这叫补法。摇动针身向外提引，这叫泻法。这是越人的心法，不在于呼吸进出针，这确实是这样的。至于停针候气，如果很久不到，就对男子稍微减轻手法在卫气之分候气，对女子加重手法在营气之分候气。如果这样做仍然不得气，就说这个病终究不可治了。篇中前后两个“气”字含义不同，不能不辨别。前一个“气”指经气到来像动脉状，是未进针之前，左手所候得的经气。后一个“得气”或“不得气”，是进针后针下所候得的经气，这是两个不同的阶段。
周仲立却说：凡是候气，左手宜略重一些，如果候不到，就对男子稍微轻手在卫气之分候气，对女子重手在营气之分候气。像这样，既没有了前后的区分，又违背了停针待气的道理，那还依据什么来进行补泻呢！
Chapter 78 asks: Acupuncture has tonification (Bu) and sedation (Xie) methods. What does this mean?
The response states: The methods of tonification and sedation do not necessarily require coordinating with respiration for needle insertion and withdrawal. One who understands acupuncture relies on the left hand; one who does not understand acupuncture relies only on the right hand. At the time of needling, one must first use the left hand to press and suppress the Ying-Spring and Shu-Acupoints to be needled, flick them to make them distend, and use fingernails to mark and guide downwards. When the Qi arrives, resembling the pulsation of an artery, one inserts the needle following this direction. Upon obtaining Deqi (arrival of Qi), pushing the needle inward is called tonification; shaking the needle and withdrawing it outward is called sedation. If Deqi is not obtained, one must differentiate by gender: for men, seek Qi in the Wei (Defensive) layer (exterior); for women, seek Qi in the Ying (Nutritive) layer (interior). If Qi is still not obtained, it is termed one of the ten incurable conditions.
Regarding acupuncture tonification and sedation, inserting the needle during exhalation and withdrawing it during inhalation constitutes tonification; inserting during inhalation and withdrawing during exhalation constitutes sedation. The *Su Wen · Li He Zhen Xie Lun* (Treatise on Separating and Combining True Pathogens) states: Insert the needle during inhalation, do not let the Qi rebel, keep it still and retained for a long time, do not allow the pathogen to spread, rotate the needle during inhalation until Deqi is achieved, then draw out the needle during exhalation, removing it completely when exhalation ends. Thus, the major pathogenic factors are expelled, hence it is named sedation. Insert the needle when exhalation ends, keep it still and retained for a long time until Qi arrives, as if waiting for a honored guest, unaware of the passing day. Once Qi arrives, protect it appropriately, withdraw the needle during inhalation so that Qi does not escape, each remaining in its place, push and close the acupoint gate, allowing Shen-Qi to remain and major Qi to stay, hence it is named tonification. This is the standard method in the *Nei Jing* regarding respiratory coordination for needle insertion/withdrawal and Qi monitoring for tonification/sedation.
Yue Ren (Bian Que) held that acupuncture methods are not limited to this. A skilled acupuncturist, upon needling, first determines the acupoint, then uses the left hand to press the area, flicking and rubbing to induce distension, and using nails to guide downwards, thereby attracting Qi. When Qi arrives, resembling arterial pulsation, insert the needle along this flow. Upon obtaining Deqi, pushing the needle deeper is tonification; shaking the needle and extending it outward is sedation. If Qi does not arrive after prolonged waiting, for men, seek it in the Wei Qi division (superficial); for women, seek it in the Ying Qi division (deep). If further searching yields no result, the Ying and Wei Qi have depleted, acupuncture will be ineffective, and this belongs to incurable cases.
Commentary: Hua Shi (Hua Shou) stated: "Flicking to make distend" is to encourage courage/vigor of Qi; "Nu" is pronounced like "Nu" (anger). "Guiding down with nails" involves slightly heavier pressing, all aiming to bring Qi to arrival. When Qi reaches under the fingers, resembling arterial pulsation, one needles while taking advantage of its arrival. "Shun" means following or taking advantage of. Stopping the needle to wait for Qi, where the needle moves upon Qi arrival, is obtaining Deqi. Pushing the needle in is tonification; moving and withdrawing the needle is sedation. This is Yue Ren's core technique, distinct from respiratory needle manipulation, which is indeed so. Regarding stopping the needle to wait for Qi, if it does not arrive for a long time, one should lightly manipulate for men in the Wei Qi division and heavily manipulate for women in the Ying Qi division. If Qi is still not obtained thus, the disease is ultimately incurable. The two instances of "Qi" in the chapter have different meanings and must be distinguished. The former "Qi" refers to the sensation of Qi arriving like an artery, which is the Qi monitored by the left hand before needling. The latter "obtaining/not obtaining Qi" refers to the Qi monitored under the needle after insertion; these are two separate stages.
Zhou Zhongli claimed: Whenever monitoring Qi, the left hand should press slightly heavier; if Qi is not found, one should lightly handle for men in the Wei Qi division and heavily handle for women in the Ying Qi division. Such an approach lacks distinction between preceding and subsequent stages and misunderstands the principle of stopping the needle to await Qi. On what basis can tonification and sedation be determined then!