A set of points is not yet useful. What makes elliptic curves interesting is that you can add two of their points and land on a third — and that this addition behaves like ordinary addition in every way that matters: it is associative, it has an identity, and every element has an inverse. That structure is called a group, and cryptography is built out of it.
The rule comes from geometry, and it is easiest to see over the real numbers before returning to the finite field. Draw the line through P and Q. A cubic and a line meet in exactly three places, so that line hits the curve at one further point. Reflect that third point across the horizontal axis, and the result is defined to be P + Q.
The reflection looks arbitrary and is not. It is what makes the operation associative: with it, the rule becomes “any three collinear points sum to zero”, which is a statement that does not care what order you take the points in. Without it, you would have a construction rather than an arithmetic.
The same rule as algebra
when P != Q when P = Q (doubling)
lambda = (y2 - y1) / (x2 - x1) lambda = (3*x1^2 + a) / (2*y1)
then, in both cases
x3 = lambda^2 - x1 - x2
y3 = lambda*(x1 - x3) - y1
everything reduced mod pTwo cases, because two points that coincide do not define a chord — the line through them is the tangent, whose slope comes from differentiating the curve equation. And one special case: if Q is the mirror image of P, the line through them is vertical, meets the curve nowhere else, and the sum is the point at infinity. That is precisely what it means for O to be the identity.
The word / in those formulas is the one thing that changes in a finite field. There are no fractions modulo 17. Dividing by 3 means multiplying by the number that turns 3 into 1 — here 6, because 3·6 = 18 = 1. That number is the modular inverse, it exists for every non-zero value precisely because 17 is prime, and it is found with the extended Euclidean algorithm in a handful of steps. Every division in the rest of this course is an inverse in disguise.