马云。痹病之痛。随脉以上下。则周身而为痹。故名。此篇当与素问痹。论参看。
此痛在血脉之中邪 张云。邪、耶同。
痛之时 不及定治 甲乙。 、作蓄。张云。 痛动而痛也。间不及下针。即不及定治之谓。言移易
之速也。简案、马融、广成、颂疏、越蕴 注。 、蓄通。蕴 、犹积聚也。盖 痛谓聚痛也。言其间时痛瘥。
不及下针。方其聚痛之时。痛剧甚。不及定治。倏忽而痛止也。
此众痹也 非周痹也 马云。众痹者病在一处。则痛亦在一处。随发随止。随止随起。特以左右之脉
相同。故左可应右。右可应左耳。非能周身而痛也。周痹者在于血脉之中。随脉以上。或随脉以下。非比众痹
之在于左右。各当一处者之有定所也。张云。各在其处。谓随聚而发也。不能周遍上下。但或左或右。更发更
休。患无定所。故曰众痹。能上能下。但随血脉而周遍于身。故曰周痹。非若众痹之左右移易也。志云。痹者
风寒湿邪。杂合于皮肤分肉之间。邪在于皮肤。血流溢于大络者。为众痹。在于分肉而厥逆于经脉者。为周痹。
帝以上下左右。血脉分肉。概而问之。然虽总
属于阴阳血气。而有皮肤肌肉之浅深。经脉络脉之缪处。故伯有周痹众痹之分焉。简案、楼氏纲目云。行痹即
走注疼痛。而其方载历节诸方。以本节文列于其后。知楼氏以众痹周痹。为历节风也。
以过之 甲乙过、作通。注。一作遏。下同。张云。过者去之之谓。志云。过者使邪气过在分肉皮肤
以外出。
以脱之 张云。脱者拔绝之谓。先刺以过之。去其标也。后刺以脱之。拔其本也。
黄帝曰 善 此痛安生（止）命曰周痹 楼氏移此一节于上文更发休也。下云。周痹当作众痹。夫周痹
邪在分肉血脉。今云邪独居分肉之间。而命曰周痹者。是众痹之误为周痹也明矣。神归之则热。热则痛。解者
所谓更止更居也。痛解则厥。厥则它痹发者。所谓更发更起也。自黄帝曰善此痛安生。至此一百十四字。元误
在后刺其下以脱之上。今移于此。且删帝曰善余已得其意矣九字。张云。九字乃下文之误。复于此者今删去之。
邪气客于肌表。渐入分肉之间。则迫切津液而为汁沫。沫得寒则聚而不散。故排裂肉埋为痛。痛则心注其处。
故神归之。神归即气归也。气归则热。热则寒散而痛暂解。然其逆气仍在。故痛虽解而厥未除。则别有所聚。
故或自上而下。或自下而上。他痹发矣。真气不能周。即气闭不行也。故曰痹者闭也。志云。帝曰。善。余已
得其意矣。此句宜衍。当以下文接上节。简案、马得其意矣。下注云。缺。岐伯曰非也。周痹诸方。见于圣济
总录二十卷中当参考。
其下之六经 甲乙作上下之大经。
其 坚 转引而行之 甲乙作其 紧者。转引而行之。马云。其行螈且坚者。乃转引而行之。张云。
其螈坚转者。 急转筋之谓。当针引其气而行之也。简案、志注同。马乃
与甲乙符矣。今从之。
九者 经巽之理 马云。九针为用最大。故叹九者乃至恒至顺之理。凡十二经之病。不可不用者也。
张云。意者病之情也。事者治之法也。九者针也。巽者具也。言其意其法在乎九针。而经具其理。凡十二经脉
阴阳之病。无不尽于是也。志云。经当巽顺之理。所以明十二经脉阴阳之病也。简案、巽训顺见于易疏。巽、
具也。出说文。
马云说：痹病的疼痛，随着经脉上下运行，导致周身都成为痹证，因此得名。这一篇应当与《素问·痹论》参照阅读。
疼痛发作时，来不及确定治疗方案。《甲乙经》中，“ ”字作“蓄”。张云说：这是指疼痛发作而移动，间隔时间短，来不及下针，也就是来不及确定治疗的意思，说的是病情变化迅速。简案：马融、广成、颂疏、越蕴的注解说，“ ”与“蓄”通假。“蕴 ”犹言积聚。大概“ ”痛是指聚集之痛。意思是说，在间歇期疼痛缓解，来不及下针；而在聚集疼痛之时，疼痛剧烈，来不及确定治疗方案，转瞬之间疼痛就停止了。
这是众痹，不是周痹。马云说：众痹的病位固定在一处，疼痛也固定在一处，随发随止，随止随起，只是因为左右两侧的经脉相同，所以左侧的症状可以反映在右侧，右侧的症状可以反映在左侧，并不是疼痛遍及全身。周痹的病位在血脉之中，随着经脉向上或向下运行，不像众痹那样固定在左右某一处。张云说：各在其处，是指随着邪气聚集而发作。不能周遍上下，只是时而左时而右，交替发作和休止，患病部位没有定所，所以叫众痹。周痹能上能下，但随血脉周遍全身，所以叫周痹，不像众痹那样在左右之间转移。志云说：痹证是风寒湿邪混杂于皮肤分肉之间。邪气在皮肤，血流溢于大络的，称为众痹；邪气在分肉，逆乱于经脉的，称为周痹。黄帝以上下左右、血脉分肉等概而言之进行提问，虽然总属于阴阳血气，但有皮肤肌肉的浅深不同，经脉络脉的交错之处，所以伯有周痹与众痹的区别。简案：楼氏《纲目》说，行痹即游走性疼痛，而其方书中记载了历节诸方，将本节文字列于其后，可知楼氏认为众痹、周痹就是历节风。
“以过之”，《甲乙经》中“过”作“通”，注解说一作“遏”。张云说：过，是去除的意思。志云说：过，是使邪气经过分肉皮肤之外排出。
“以脱之”，张云说：脱，是拔除断绝的意思。先刺以“过之”，去除其标症；后刺以“脱之”，拔除其本根。
黄帝说：好。这种疼痛是如何产生的呢？（此处原文标注“止”）命名为周痹。楼氏将此节移至上文“更发休也”之后，并说下文“周痹”当作“众痹”。夫周痹邪气在分肉血脉，现在却说邪气独居分肉之间，却命名为周痹，这显然是众痹误写为周痹。神气回归则发热，热则疼痛，解者所谓“更止更居”。疼痛缓解则厥逆，厥逆则其他痹证发作，所谓“更发更起”。从“黄帝曰善此痛安生”至此一百一十四字，原本错误地放在“后刺其下以脱之”之上，现在移到这里，并且删除了“帝曰善余已得其意矣”九个字。张云说：这九个字是下文的错误，重复在此处，现删去。邪气客居肌表，逐渐进入分肉之间，则逼迫津液变为汁沫，汁沫遇到寒则凝聚不散，从而排裂肌肉腠理造成疼痛。疼痛则心神专注于患处，所以神气回归。神归即气归，气归则热，热则寒散而疼痛暂时缓解。然而逆气仍在，所以疼痛虽缓解但厥逆未除，则气聚于别处，所以或自上而下，或自下而上，其他痹证发作了。真气不能周流，即气闭阻不行，所以叫痹，痹就是闭的意思。志云说：帝曰：善，余已得其意矣。这句可能是衍文，应当以下文接上节。简案：马注在“得其意矣”下注云“缺”。岐伯回答说：不对。周痹诸方，见于《圣济总录》第二十卷中，应当参考。
“其下之六经”，《甲乙经》作“上下之大经”。
“其 坚 转引而行之”，《甲乙经》作“其 紧者，转引而行之”。马云说：其行走抽搐且坚硬的，应当转引其气而行。张云说：其抽搐坚硬转动，是急迫转筋的意思，应当针刺引导其气而行。简案：志注与此相同，马云的说法与《甲乙经》相符，现在遵从它。
“九者”，指“经巽之理”。马云说：九针的作用最大，所以感叹九针是至恒至顺之理，凡十二经的疾病，不可不用九针。张云说：意者病之情状，事者治疗之法度，九者指九针，巽者具也。意思是病的情状和治疗的方法在于九针，而经脉具备其道理，凡十二经脉阴阳的疾病，无不包含于此。志云说：经当巽顺之理，以此来阐明十二经脉阴阳的疾病。简案：“巽”训为顺，见于《易疏》。“巽”意为具，出自《说文》。
Ma Yun stated: The pain of Bi syndrome (Obstruction Syndrome) moves up and down along the meridians, causing the entire body to be affected by Bi, hence the name. This chapter should be read in conjunction with the "Bi Lun" (Treatise on Bi Syndrome) in the *Su Wen* (Basic Questions).
Is this pain located within the blood vessels? Zhang Yun stated that "Xie" (Evil pathogenic factors) is synonymous with "Ye" (a particle indicating a question).
When the pain occurs, there is no time to determine the treatment plan. The *Jia Yi Jing* (A-B Classic) reads "Xu" (Accumulate) instead of the original character. Zhang Yun explained: This refers to the pain moving as it flares up; the interval is too short to insert a needle, meaning there is no time to decide on the treatment, indicating the rapid change of the condition. In my commentary: Ma Rong, Guang Cheng, Song Shu, and Yue Yun's annotations state that the original character is interchangeable with "Xu" (Accumulate). "Yun" implies accumulation. Thus, "pain" here refers to accumulated pain. It means that during the remission phase, there is no time to needle; but when the pain accumulates, it is severe, and there is no time to determine the treatment before it suddenly ceases.
This is Zhong Bi (Multifocal Bi), not Zhou Bi (Circulating Bi). Ma Yun stated: In Zhong Bi, the disease is localized in one area, and the pain remains in that same area. It flares up and subsides alternately. Because the meridians on the left and right are identical, symptoms on the left can correspond to the right, and vice versa. It does not cause pain throughout the whole body. Zhou Bi, however, resides within the blood vessels and follows the meridians upward or downward. Unlike Zhong Bi, which is fixed in specific locations on the left or right, Zhou Bi is not so limited. Zhang Yun stated: "Each in its place" means it flares up as the pathogen accumulates. It cannot circulate throughout the upper and lower body but appears alternately on the left or right, alternating between flare-ups and rest, with no fixed location, hence called Zhong Bi. Zhou Bi can move up and down, circulating throughout the body via the blood vessels, hence called Zhou Bi. It differs from Zhong Bi, which shifts between left and right. Zhi Yun stated: Bi syndrome is caused by Wind-Cold-Dampness pathogens mixing between the skin and muscle spaces. When the pathogen is in the skin and blood flow overflows into the large collaterals, it is called Zhong Bi. When the pathogen is in the muscle spaces and causes reversal in the main meridians, it is called Zhou Bi. The Yellow Emperor asked generally about the upper, lower, left, right, blood vessels, and muscle spaces. Although these all belong to Yin-Yang and Qi-Blood, there are differences in the depth of skin and muscles, and the interlacing points of main and collateral meridians. Therefore, Bo You distinguished between Zhou Bi and Zhong Bi. In my commentary: Lou Shi's *Gang Mu* states that Xing Bi (Wandering Bi) involves migratory pain. Since his book lists formulas for Li Jie (Joint Pain) after this section, it is known that Lou Shi considered Zhong Bi and Zhou Bi to be equivalent to Li Jie Feng (Wind affecting the joints).
"To pass through it": The *Jia Yi Jing* reads "Tong" (Through) instead of "Guo" (Pass), with notes saying it may also be "E" (Stop/Block). Zhang Yun stated: "Guo" means to remove. Zhi Yun stated: "Guo" means to make the pathogenic factors pass outside the muscle spaces and skin to exit.
"To detach it": Zhang Yun stated: "Tuo" means to extract and sever. First, needle to "pass through it," removing the branch/symptomatic aspect; subsequently, needle to "detach it," extracting the root cause.
The Yellow Emperor said: Excellent. How is this pain generated? (End of segment marked "Zhi") Named Zhou Bi. Lou Shi moved this section to follow "alternating flare-up and rest" in the previous text, stating that "Zhou Bi" in the following text should be read as "Zhong Bi." Since Zhou Bi involves pathogens in the muscle spaces and blood vessels, but here it says the pathogen dwells solely in the muscle spaces yet is named Zhou Bi, it is clear that Zhong Bi was mistakenly written as Zhou Bi. When Shen (Spirit/Mind) returns, heat arises; heat causes pain. Commentators refer to this as "alternating cessation and dwelling." When pain resolves, Reversal (Jue) occurs; Reversal leads to the emergence of other Bi syndromes, referred to as "alternating flare-up and arising." From "The Yellow Emperor said: Excellent, how is this pain generated" to here, totaling 114 characters, were originally misplaced after "subsequently needle below it to detach it." They are now moved here, and the nine characters "The Emperor said: Excellent, I have already grasped your meaning" are deleted. Zhang Yun stated: These nine characters are an error from the following text, repeated here, and are now deleted. Pathogens lodging in the exterior of the muscles gradually enter the muscle spaces, pressing upon Jin Ye (Body Fluids) to form juice and foam. When this foam encounters Cold, it aggregates and does not disperse, thereby splitting the muscle tissue and causing pain. Pain causes the Heart-Shen to focus on the affected area, so Shen returns. Shen returning is Qi returning. When Qi returns, heat is generated; heat disperses Cold, and pain temporarily resolves. However, the Reversed Qi remains, so although pain resolves, Reversal is not eliminated. Qi then gathers elsewhere, causing either upward or downward movement, and other Bi syndromes emerge. True Qi fails to circulate, meaning Qi is blocked and does not flow; thus, it is called Bi, and Bi means closure. Zhi Yun stated: The Emperor said, "Excellent, I have already grasped your meaning." This sentence may be a superfluous addition and should connect directly to the following section. In my commentary: Ma's note under "grasped your meaning" states "Missing." Qibo replied: Incorrect. The formulas for Zhou Bi are found in Volume 20 of the *Sheng Ji Zong Lu* and should be referenced.
"The six meridians below it": The *Jia Yi Jing* reads "The great meridians above and below."
"Its firmness, turn and guide to move it": The *Jia Yi Jing* reads "Its tightness, turn and guide to move it." Ma Yun stated: Where the movement is spasmodic and firm, one should turn and guide the Qi to move it. Zhang Yun stated: Spasmodic, firm, and turning refers to acute tendon contraction. One should needle to guide the Qi to move it. In my commentary: Zhi's annotation agrees. Ma's view aligns with the *Jia Yi Jing*, so we follow it.
"Nine": Refers to "The principle of Xun (Compliance)." Ma Yun stated: The Nine Needles have the greatest utility, hence praising them as embodying the principles of constancy and compliance. For diseases of the twelve meridians, the Nine Needles are indispensable. Zhang Yun stated: "Yi" refers to the condition of the disease; "Shi" refers to the method of treatment; "Jiu" refers to the needles; "Xun" means complete/comprehensive. This means the condition and method lie in the Nine Needles, and the meridians encompass their principles. All diseases of Yin and Yang in the twelve meridians are fully contained herein. Zhi Yun stated: The meridians follow the principle of Xun (compliance/submission) to clarify the diseases of Yin and Yang in the twelve meridians. In my commentary: "Xun" is defined as compliant/submissive in the *Yi Shu*. "Xun" means comprehensive, originating from the *Shuo Wen*.