黄帝曰。愿闻其奇邪而不在经者。岐伯曰。血络是也。
此承上章少阴之大络。而复统论其脏腑之十二络焉。玉版论曰。人之所受气者谷也。谷之所注者
胃也。胃者。水谷血气之海也。海之所行云气者。天下也。胃之所出血气者。经隧也。经隧者。五
脏六腑之大络也。夫谷入于胃。乃传之肺。流溢于中。布散于外。精专者。行于经隧。是水谷所生
之血气。营行于脉中者也。水谷之精气。从胃之大络。注于脏腑之经隧。通于孙络出于皮肤。以温
肌肉。此水谷所生之气血。散于脉外者也。夫大络与经脉缪处。故奇邪而不在经者。血络是也。上章
论五脏六腑之血气。少阴肾脏之精气。从冲脉而出于皮肤。此章论胃腑所生之气血。从脏腑之大络
而出于皮肤。杨元如曰。按素问缪刺篇云。邪客于皮毛。入舍于孙络。留而不去。闭塞不通。不得
入于经。流溢于大络而生奇病。故曰奇邪者血络是也。
黄帝曰。刺血络而仆者何也。血出而射者何也。血少。黑而浊者何也。血出清而半为汁者何也。
发针而肿者何也。血出若多若少。而面色苍苍者何也。发针而面色不变。而烦 者何也。多出血而
不动摇者何也。愿闻其故。血络者。外之络脉孙络。见于皮肤之间。血气有所留积。则失其外内出
入之机。
岐伯曰。脉气盛而虚者。刺之则脱气。脱气则仆。
此言经脉之血气。皮肤之气血。皆出于胃腑水谷之精。而分走其道。所当和平者也。若经脉之
脉气盛。而皮肤之血气虚者。刺之则脱气。脱气则仆矣。朱济公曰。三阳之气。主于皮肤肌腠之间。
血虚则脱气者。血为气之守也。阴阳应象论曰。阴在内。阳之守也。
血气俱盛。而阴气多者其血滑。刺之则射。阳气蓄积久留而不泻者。其血黑以浊。故不能射。
此言经脉之内。皮肤之间。皆有此血气。而有阴阳之分焉。经脉为阴。皮肤为阳。俱盛者。经
藏外内之血气俱盛也。如脉中之阴气多者其血滑。故刺之则射。如皮肤之阳气蓄积。久留而不泻者。
其血黑以浊。故不能射也。朱济公曰。阳气留积。其血黑浊。血随气行者也。
新饮而液渗于络。而未合和于血也。故血出而汁别焉。其不新饮者。身中有水。久则为肿。
此言络脉之血。由水谷之津液所化。津液注于皮肤肌腠。渗于孙络。与血和合而化赤者也。痈
疽章曰。中焦出气如露。上注 谷。而渗孙脉。津液和调。变化赤而为血。血和则孙脉先满溢。乃
注于络脉皆盈。乃注于经脉。阴阳已张。因息乃行。盖水谷入胃。其津液随三焦出气。以温肌肉。
充皮肤。复渗于孙络。于络脉之血和合。变化而赤为血。故新饮而液渗于络。未和合于血。是津液
未变而赤。故刺之血出清而半为汁也。其不新饮者。身中有水。久则为肿。盖言血乃水谷之津液所
化。若不新饮而出为汁者。乃身中之水也。按奇邪而不在经者。谓皮肤之气血。从别络而出于孙络
皮肤。与经脉缪处。此节论津液注于皮肤。渗于络脉。与经脉之血和合。是皮肤孙络。又与经脉相通。
而皮肤络脉之气血所从来。又有一道。盖此篇假针以明阴阳血气之生始出入。学人当于针刺之外。
细体认其义焉。
阴气积于阳。其气因于络。故刺之血未出而气先行。故肿。
此言阳分之气血。因于大络孙络而出也。脏腑经脉为阴。皮肤肌腠为阳。脏腑之阴气。积于皮肤
之阳分者。其气因于大络孙络而出。血未出而气先行者。谓脏腑之气先行。而血随气出者也。上节
论脉络之血。乃皮
肤之津液。渗入孙脉络脉而化赤。此言皮肤之血。因于大络孙络而出。是皮肤脉络之血气。外内相
通。故下文曰。阴阳之气。其新相得而未和合。
阴阳之气。其新相得而未和合。因而泻之。则阴阳俱脱。表里相离。故脱色而苍苍然。
此承上文。总结阴阳外内之相合也。皮肤为表。经脉为里。肤表之阳。得脉内之阴气以和之。经
脉之阴。得肤表之阳气以和之。阴阳表里之相合也。如阴阳之气。其新相得而未和合。因而泻之。
则阴阳俱脱。表里相离。故脱色而苍苍然。苍苍、青色也。平脉篇曰。营气不足。面色青。阴阳俱
脱者。经脉外内之营气脱也。
刺之血出多。色不变而烦 者。刺络而虚经。虚经之属于阴者。阴脱故烦闷。
此言阴阳俱脱而色变者。皮肤络脉之血脱也。如血出多而色不变者。刺其络而虚其经也。经虚
之属。则阴脱矣。心主脉而包络主血。阴脏之血脱。故烦闷也。盖言在外之血气。由脏腑之阴而出
于经。经而脉。脉而络也。
阴阳相得而合为痹者。此为内溢于经。外注于络。如是者。阴阳俱有余。虽多出血。而弗能虚也。
夫内在阴。外在阳。经络为阴。皮肤为阳。此总结血气之外内出入。相得而和合者也。自外而
内者。从皮肤渗于孙脉络脉。而内溢于经。自内而外者。从脏腑之阴而出于经。从经脉而外注于络
脉皮肤。外内之相得也。如阴阳俱有余。相合而痹闭于外内之间。虽多出血。而弗能虚也。朱济公
曰。阴阳相得而合为痹。与上文之阴阳相得同义。盖阴阳和合而流行则调。阴阳相得而留滞则痹。
痹者。闭也。通篇论经脉血气之生始出
入。故帝只问血出多而不动摇。伯曰。阴阳相得而合为痹。是非邪病之痹明矣。
黄帝曰。相之奈何。岐伯曰。血脉者。盛坚横以赤。上下无常处。小者如针。大者如筋。则而
泻之万全也。故无失数矣。失数而反。各如其度。
此申明血气之在经脉而外内出入也。相、视也。盛坚横以赤者。血盛于脉中也。上下无常处者。
血气之流行也。小者如针。留血之在孙络也。大者如筋。留血之在经隧也。数者。血脉出入之度数。
留血之在经络。则而泻之。故无失其所出之度数矣。所出之度。从经而脉。脉而络。络而孙。如失其
所出之数而反者。又从孙而络。络而脉。脉而经。各如其度而外内出入者也。杨元如曰。万全者。
谓血气流行。外内相贯。如环无端。莫知其纪。
黄帝曰。针入而肉着何也。岐伯曰。热气因于针。则针热。热则肉着于针。故坚焉。
三阳之气。主于肤表。热气。阳气也。热气因于针则针热。热则肉着于针。故针下坚而不可拔也。
按、此篇论血气出入于络脉之间。故篇名血络。论有所留积。皆因于络。则而泻之万全也。若取之肉。
则肉着于针。而针下坚矣。
黄帝说：我想了解那些奇异之邪，且不在经脉中的情况。岐伯回答说：那就是血络（分布于体表的细小脉络）。
这段文字承接上一章关于少阴经大络的论述，进而综合讨论脏腑的十二络脉。《素问·玉版论要》说：人从饮食中摄取的气来源于谷物。谷物所汇聚的地方是胃。胃是水谷化生的血气的海洋。海洋中流动的云气，对应于天下的气流。胃所输出的血气，通过经隧（经络通道）运行。经隧，就是五脏六腑的大络。当谷物进入胃后，其精气传送给肺，在体内流溢，布散于体表。其中精纯的部分，运行于经隧之中。这是由水谷化生的血气，营气行于脉管之中的情况。而水谷的精微之气，从胃的大络注入脏腑的经隧，通达孙络（最细小的络脉），出于皮肤，以温养肌肉。这是由水谷化生的气血，散布于脉管之外的情况。大络与经脉交错分布，所以那些奇异之邪不在经脉而在别处的，就是指血络。上一章论述了五脏六腑的血气以及少阴肾脏的精气，从冲脉出于皮肤；这一章论述的是胃腑所生的气血，从脏腑的大络出于皮肤。杨元如说：按《素问·缪刺论》记载：“邪气客于皮毛，进入并停留于孙络，滞留不去，闭塞不通，不能进入经脉，而是流溢于大络从而产生奇病。”所以说，所谓的“奇邪”，就是指血络。
黄帝说：针刺血络时，患者为什么会昏倒？为什么有的出血呈喷射状？为什么有的血色黑而浑浊？为什么有的血出清稀且一半像汁液？为什么拔针后出现肿胀？为什么有的出血量或多或少，但面色却发青苍暗？为什么有的拔针后面色没有变化，却感到烦闷？为什么有的大量出血后身体却不摇动？我想了解其中的原因。所谓血络，是指外部的络脉和孙络，显露在皮肤之间。如果血气在此有所留积，就会失去其内外出入的正常机能。
岐伯说：如果脉气盛而体表血气虚，针刺就会导致气脱。气脱就会使人昏倒。
这里讲的是经脉的血气和皮肤的气血，都来源于胃腑水谷的精微，并分别循行其道，本应处于平和状态。如果经脉的脉气盛，而皮肤的血气虚，针刺就会导致气脱。气脱就会使人昏倒。朱济公说：三阳之气，主要主管皮肤肌腠之间。血虚则导致气脱，是因为血是气的守持者。《素问·阴阳应象大论》说：阴在内，是阳的守持者。
如果血气都旺盛，且阴气偏多，血液就滑利，针刺时血液会喷射而出。如果阳气蓄积，久留而不泻，血液就会黑而浑浊，所以不能喷射。
这里讲的是经脉之内、皮肤之间，都有血气存在，且有阴阳之分。经脉属阴，皮肤属阳。所谓“俱盛”，是指经脉藏府内外的血气都旺盛。如果脉中的阴气多，血液就滑利，所以针刺时会喷射。如果皮肤的阳气蓄积，久留而不泻，血液就会黑而浑浊，所以不能喷射。朱济公说：阳气留积，血液就会黑浊，因为血是随气运行的。
刚喝下水液，津液渗入络脉，尚未与血融合调和。所以刺破后，血出而汁液分离。如果没有新饮水，但体内有水湿停留，时间久了就会形成水肿。
这里讲的是络脉的血，是由水谷的津液化生而来。津液注入皮肤肌腠，渗入孙络，与血融合而化为赤色。《灵枢·痈疽》篇说：“中焦发出的气像露水一样，上注于五谷，渗入孙脉。津液调和，变化赤色而成血。血调和后，孙脉先充满，然后注入络脉，络脉充盈后再注入经脉。阴阳扩张，随着呼吸运行。”大概水谷入胃，其津液伴随三焦之气，以温养肌肉，充实皮肤，再渗入孙络，与络脉之血融合，变化为赤色血液。所以新饮之水，津液渗入络脉，尚未与血融合，因此刺破后血出清稀且半为汁液。如果没有新饮水，但体内有水湿，时间久了就会肿胀。这大概是说血乃水谷津液所化，如果不因新饮水而出汁液，那就是体内的水湿。按前文所说“奇邪而不在经”，是指皮肤的气血，从别络出于孙络皮肤，与经脉交错分布。本节论述津液注入皮肤，渗入络脉，与经脉之血融合。这说明皮肤孙络又与经脉相通，而皮肤络脉之气血的来源，又有另一条途径。这篇假借针刺来阐明阴阳血气的生成、起始、出入，学习者应当在针刺技术之外，仔细体会其中的义理。
阴气积聚在阳分，其气滞留在络脉。所以针刺时，血未出而气先行，导致肿胀。
这里讲的是阳分的气血，因大络和孙络而出泄。脏腑经脉属阴，皮肤肌腠属阳。脏腑的阴气，积聚在皮肤的阳分，其气因大络和孙络而出泄。血未出而气先行，是指脏腑之气先行外出，而血随气而出。上一节论述脉络之血，乃是皮肤之津液渗入孙络、络脉而化为赤色。这里讲的是皮肤之血，因大络和孙络而出泄。这说明皮肤脉络之血气，内外相通。所以下文说：“阴阳之气，其新相得而未和合。”
阴阳之气，刚刚相遇配合但尚未调和，此时如果进行泻法，就会导致阴阳俱脱，表里分离。所以会出现面色脱失而呈现青苍色的现象。
这段承接上文，总结阴阳在外内的相合关系。皮肤为表，经脉为里。肤表的阳，得到脉内阴气的调和；经脉的阴，得到肤表阳气的调和，这就是阴阳表里的相合。如果阴阳之气刚刚相遇配合但尚未调和，此时如果进行泻法，就会导致阴阳俱脱，表里分离。所以会出现面色脱失而呈现青苍色的现象。“苍苍”即青色。《素问·平人气象论》说：营气不足，面色发青。阴阳俱脱，是指经脉内外的营气脱失。
如果针刺出血多，但面色不变，反而感到烦闷，这是因为刺络导致经脉空虚。经脉空虚属于阴脱，阴脱故烦闷。
这里讲的是阴阳俱脱且面色改变的情况，是皮肤络脉之血脱失。如果出血多而面色不变，是因为刺络导致经脉空虚。经脉空虚若归属于阴，则是阴脱。心主脉，心包络主血。阴脏之血脱失，所以感到烦闷。大概意思是：在外的血气，由脏腑之阴出于经脉，再由经至脉，由脉至络。
阴阳之气相互契合结合而形成痹阻，这是因为气血内溢于经脉，外注于络脉。像这种情况，阴阳都有余，即使大量出血，也不能使其实质变虚。
内在属阴，外在属阳。经络属阴，皮肤属阳。这里总结了血气在外内的出入，相互契合而和谐。从外而内，是从皮肤渗入孙络、络脉，然后内溢于经脉；从内而外，是从脏腑之阴出于经脉，再从经脉外注于络脉和皮肤。这是外内的相得。如果阴阳都有余，相互结合而痹闭于外内之间，即使大量出血，也不能使其变虚。朱济公说：“阴阳相得而合为痹”，与上文的“阴阳相得”意义相同。大概阴阳调和流行则通畅，阴阳相得但留滞则成痹。痹，就是闭塞的意思。通篇论述经脉血气的生成、起始、出入，所以黄帝只问为何出血多而身体不摇动，岐伯回答：阴阳相得而合为痹，这就不是邪气致病之痹，而是明证了。
黄帝说：如何诊察呢？岐伯说：观察血脉，如果盛大、坚硬、横张且颜色红赤，上下位置不固定，小的如针尖，大的如筋脉，就可以依此泻之，这是万全之法。所以不要失误了针刺的法则。如果失误了法则反而加重病情，其程度各不相同。
这里申述血气在经脉中外内出入的道理。“相”，即视诊。盛大、坚硬、横张且红赤，说明血盛于脉中。上下无常处，说明血气流行不定。小的如针，说明留血在孙络。大的如筋，说明留血在经隧。“数”，指血脉出入的度数或规律。对于停留在经络中的留血，依此规律泻之，就不会失去其出入的度数。其出入的度数是：从经到脉，从脉到络，从络到孙。如果失去了其出入的度数而反向操作，又会从孙到络，从络到脉，从脉到经，各自按照其度数进行外内出入。杨元如说：所谓“万全”，是指血气流行，外内贯通，如环无端，不知其终结。
黄帝说：为什么针刺后肌肉附着在针上呢？岐伯说：热气依附于针，使针发热。热则肌肉附着在针上，所以感觉坚硬。
三阳之气，主要主管肤表。热气，即阳气。热气依附于针则针热，热则肌肉附着在针上，所以针下感觉坚硬而难以拔出。
按：本篇论述血气出入于络脉之间，所以篇名《血络》。论述有所留积，皆因于络，依此规律泻之即可万全。如果取穴不当伤及肌肉，则肉会附着在针上，针下就会感觉坚硬。
Huangdi said: I wish to hear about the strange pathogens that are not in the meridians. Qibo replied: They are the blood collaterals (fine vessels distributed on the body surface).
This passage continues from the previous chapter's discussion on the great collateral of the Shaoyin meridian, and further comprehensively discusses the twelve collaterals of the zang-fu organs. The *Suwen: Yubian Lunyao* states: The qi received by humans comes from grain. The place where grain gathers is the Stomach. The Stomach is the sea of blood and qi generated from water and grain. The clouds and qi flowing in the sea correspond to the airflow in the world. The blood and qi output from the Stomach travel through the Jing-Sui (meridian channels). The Jing-Sui refers to the great collaterals of the five zang and six fu organs. When grain enters the stomach, its essence is transmitted to the Lungs, flows and overflows within, and spreads outward. The purest part travels within the Jing-Sui. This describes the blood and qi generated from water and grain, with Ying Qi (Nutritive Qi) circulating inside the vessels. The fine essence of water and grain, from the great collateral of the stomach, pours into the Jing-Sui of the zang-fu organs, connects with the Sun-Luo (finest collaterals), emerges from the skin, and warms the muscles. This describes the blood and qi generated from water and grain, scattered outside the vessels. The great collaterals intersect with the main meridians; therefore, those strange pathogens that are not in the meridians but elsewhere refer to the blood collaterals. The previous chapter discussed the blood and qi of the five zang and six fu organs, as well as the fine essence of the Shaoyin Kidney, emerging from the skin via the Chong Mai (Penetrating Vessel). This chapter discusses the blood and qi generated by the Stomach organ, emerging from the skin via the great collaterals of the zang-fu organs. Yang Yuanru stated: According to the *Suwen: Miuci Pian*, "When pathogenic factors lodge in the skin and hair, they enter and stay in the Sun-Luo. If they remain without departing, they cause blockage and cannot enter the meridians, instead overflowing into the great collaterals and generating strange diseases." Thus, it is said that the so-called 'strange pathogens' refer to the blood collaterals.
Huangdi said: Why do patients faint after puncturing blood collaterals? Why does some blood shoot out? Why is some blood dark and turbid? Why is some blood clear with half of it being fluid? Why does swelling occur after removing the needle? Why does the complexion turn pale and cyan despite varying amounts of bleeding? Why is there no change in complexion but a feeling of vexation after removing the needle? Why is there no physical instability despite significant blood loss? I wish to understand the reasons. The so-called blood collaterals refer to the external collaterals and Sun-Luo visible between the skin. If blood and qi accumulate there, their normal mechanism of internal and external exchange is lost.
Qibo said: If the meridian qi is abundant while the superficial blood and qi are deficient, puncturing will lead to Qi collapse. Qi collapse causes fainting.
This explains that the blood and qi of the meridians and the skin all originate from the fine essence of water and grain in the stomach and follow their respective pathways, ideally remaining in a harmonious state. If the meridian qi is abundant but the superficial blood and qi are deficient, puncturing leads to Qi collapse. Qi collapse results in fainting. Zhu Jigong stated: The Qi of the Three Yang meridians primarily governs the skin and muscle layers. Blood deficiency leads to Qi collapse because blood serves as the anchor for Qi. The *Suwen: Yin-Yang Yingxiang Dalun* states: Yin resides within, serving as the anchor for Yang.
If both blood and qi are abundant, and Yin Qi predominates, the blood is slippery, causing it to shoot out upon puncture. If Yang Qi accumulates and remains stagnant without being released, the blood becomes dark and turbid, thus unable to shoot out.
This explains that blood and qi exist both within the meridians and between the skin, with distinctions between Yin and Yang. The meridians belong to Yin, and the skin belongs to Yang. "Both abundant" means the blood and qi inside and outside the meridian-zang organs are both abundant. If the Yin Qi within the vessels is predominant, the blood is slippery, causing it to shoot out upon puncture. If the Yang Qi of the skin accumulates and remains stagnant without being released, the blood becomes dark and turbid, thus unable to shoot out. Zhu Jigong stated: Accumulation of Yang Qi makes the blood dark and turbid because blood follows the movement of Qi.
Freshly consumed fluids seep into the collaterals before merging with the blood. Therefore, upon puncture, blood comes out separated from the fluid. In cases without recent fluid intake, if water-dampness remains in the body for a long time, edema develops.
This explains that the blood in the collaterals is transformed from the fluids of water and grain. Fluids pour into the skin and muscle layers, seep into the Sun-Luo, and merge with blood to transform into red blood. The *Lingshu: Yongju* chapter states: "The Qi emitted from the Middle Jiao is like dew, pouring upwards into the grain, and seeping into the Sun-Mai. When fluids are harmonized, they transform into red blood. When blood is harmonized, the Sun-Mai fills first, then pours into the Luo-Mai, which fill up before pouring into the Jing-Mai. With Yin and Yang expanded, movement occurs with respiration." Generally, when water and grain enter the stomach, their fluids accompany the Qi of the Sanjiao to warm the muscles and fill the skin, then seep into the Sun-Luo, merging with the blood in the Luo-Mai to transform into red blood. Therefore, freshly consumed fluids seep into the collaterals before merging with blood; thus, upon puncture, the blood is clear and half-fluid. If there is no recent fluid intake but fluid is expelled, it indicates internal water-dampness. As mentioned earlier regarding "strange pathogens not in the meridians," this refers to the blood and qi of the skin emerging from the distinct collaterals into the Sun-Luo and skin, intersecting with the meridians. This section discusses fluids pouring into the skin, seeping into the collaterals, and merging with the blood in the meridians. This shows that the skin's Sun-Luo communicates with the meridians, and the source of blood and qi in the skin's collaterals has another pathway. This chapter uses acupuncture to elucidate the generation, origin, and entry/exit of Yin-Yang blood and qi. Students should carefully contemplate these principles beyond just the techniques of acupuncture.
Yin Qi accumulates in the Yang aspect, stagnating in the collaterals. Therefore, upon puncture, Qi moves forward before blood, causing swelling.
This explains that the blood and qi of the Yang aspect emerge due to the great collaterals and Sun-Luo. The zang-fu and meridians belong to Yin, while the skin and muscle layers belong to Yang. The Yin Qi of the zang-fu accumulates in the Yang aspect of the skin, emerging due to the great collaterals and Sun-Luo. "Qi moving before blood" means the Qi of the zang-fu moves out first, followed by the blood. The previous section discussed how the blood in the collaterals is transformed from the fluids of the skin seeping into the Sun-Luo and Luo-Mai to become red. This section discusses how the blood of the skin emerges due to the great collaterals and Sun-Luo. This shows that the blood and qi of the skin's collaterals communicate internally and externally. Hence, the following text states: "The Qi of Yin and Yang meets newly but has not yet harmonized."
When the Qi of Yin and Yang meets newly but has not yet harmonized, applying draining methods will cause both Yin and Yang to collapse, separating the exterior and interior. Consequently, the complexion loses its luster and appears cyan.
This continues from the previous text, summarizing the harmony of Yin and Yang internally and externally. The skin is the exterior, and the meridians are the interior. The Yang of the skin surface is harmonized by the Yin Qi within the vessels; the Yin of the meridians is harmonized by the Yang Qi of the skin surface. This is the harmony of Yin-Yang and interior-exterior. If the Qi of Yin and Yang meets newly but has not yet harmonized, applying draining methods will cause both Yin and Yang to collapse, separating the exterior and interior. Consequently, the complexion loses its luster and appears cyan. "Cang-cang" refers to the color cyan. The *Suwen: Pingren Qixiang Lun* states: When Ying Qi is insufficient, the complexion turns green. Collapse of both Yin and Yang refers to the depletion of Ying Qi inside and outside the meridians.
If significant blood is lost but the complexion remains unchanged, accompanied by vexation, it is because puncturing the collaterals empties the meridians. Emptiness of the meridians belongs to Yin collapse, leading to vexation.
This discusses the scenario where both Yin and Yang collapse and the complexion changes, referring to the depletion of blood in the skin's collaterals. If blood is lost significantly but the complexion remains unchanged, it is because puncturing the collaterals empties the meridians. If the emptiness of the meridians belongs to Yin, it constitutes Yin collapse. The Heart governs the vessels, and the Pericardium governs the blood. Depletion of blood in the Yin organs leads to vexation. Essentially, this means that the blood and qi outside originate from the Yin of the zang-fu, emerging into the meridians, then from meridians to vessels, and from vessels to collaterals.
When the Qi of Yin and Yang matches and combines to form Bi (obstruction), it is because the blood and qi overflow internally into the meridians and externally into the collaterals. In such cases, both Yin and Yang are in excess. Even with significant blood loss, the condition cannot be considered truly deficient.
Internally belongs to Yin, externally belongs to Yang. The meridians belong to Yin, and the skin belongs to Yang. This summarizes the entry and exit of blood and qi externally and internally, matching and harmonizing. From outside to inside, it seeps from the skin into the Sun-Luo and Luo-Mai, then overflows internally into the meridians. From inside to outside, it emerges from the Yin of the zang-fu into the meridians, then from the meridians externally pours into the collaterals and skin. This is the mutual attunement of outside and inside. If both Yin and Yang are in excess, combining to cause obstruction between the inside and outside, even significant blood loss cannot render it deficient. Zhu Jigong stated: "Yin and Yang matching and combining to form Bi" has the same meaning as the earlier "Yin and Yang matching." Essentially, when Yin and Yang harmonize and flow, it is regulated; when Yin and Yang match but stagnate, it forms Bi. Bi means closure. Throughout the chapter, the generation, origin, and entry/exit of blood and qi in the meridians are discussed. Therefore, Huangdi only asked why significant blood loss did not cause physical instability. Qibo answered: Yin and Yang matching and combining to form Bi clarifies that this is not Bi caused by pathogenic factors.
Huangdi said: How should one observe them? Qibo said: Observe the blood vessels. If they are full, hard, transverse, and red, with no fixed location, small like a needle or large like a tendon, draining according to this pattern ensures complete safety. Do not lose the correct method. Losing the method reverses the effect, with degrees of severity varying.
This elaborates on the entry and exit of blood and qi in the meridians. "Xiang" means observation. Full, hard, transverse, and red indicates an abundance of blood in the vessels. No fixed location indicates the circulation of blood and qi. Small like a needle indicates retained blood in the Sun-Luo. Large like a tendon indicates retained blood in the Jing-Sui. "Shu" refers to the measure or rule of entry and exit in the blood vessels. For retained blood in the meridians and collaterals, draining according to this rule prevents losing the correct degree of exit. The degree of exit proceeds from Jing to Mai, from Mai to Luo, and from Luo to Sun. If one loses this degree and acts in reverse, it proceeds from Sun to Luo, from Luo to Mai, and from Mai to Jing, each following its respective degree of internal and external exchange. Yang Yuanru stated: "Complete safety" means that blood and qi circulate, penetrating internally and externally, like a circle without end, unknown in its termination.
Huangdi said: Why does the flesh adhere to the needle after insertion? Qibo said: Heat attaches to the needle, making the needle hot. Heat causes the flesh to adhere to the needle, making it feel firm.
The Qi of the Three Yang meridians primarily governs the skin surface. Heat refers to Yang Qi. Heat attaching to the needle makes the needle hot, causing the flesh to adhere, making the needle feel firm and difficult to withdraw.
Note: This chapter discusses the entry and exit of blood and qi in the collaterals, hence the title "Blood Collaterals." It discusses retention due to collaterals; draining according to the pattern ensures complete safety. If the muscle is targeted incorrectly, the flesh adheres to the needle, making it feel firm underneath.