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问曰：血痹病从何得之？师曰：夫尊荣人，骨弱肌肤盛重，因疲劳，汗出，卧不时动
摇，加被微风，遂得之。但以脉自微涩，在寸口关上小紧，宜针引阳气，令脉和紧去
则愈。
【注】
历节属伤气也，气伤痛，故疼痛也。血痹属伤血也，血伤肿，故麻木也。前以明邪气
聚于气分，此以明邪气凝于血分，故以血痹名之也。尊荣人，谓膏粱之人，素食甘肥
，故骨弱肌肤盛重，是以不任疲劳，疲劳则汗出，汗出则腠理开。亦不胜久卧，卧则
不时动摇，动摇即加被微风，亦遂得以干之。此言膏粱之人，外盛内虚，虽微风小邪
，易为病也。然何以知病血痹也？但以身体不仁，脉自微涩，则知邪凝于血故也。寸
口关上小紧，亦风寒微邪应得之脉也。针能导引经络取诸痹，故宜针引气血，以泻其
邪，令脉不涩而和，紧去邪散，血痹自通也。
【集注】
周扬俊曰：天下惟尊荣人为形乐志苦，形乐故肌肤盛，志苦故骨弱，骨弱则不耐劳，
肌盛则气不固，稍有劳困，即汗出也，汗出而阳气虚，虽微风且得以袭之，则血为之
痹。故一见脉微，则知其阳之不足，一见脉涩，则知其阴之多阻，此血痹之本脉也。
而其邪入之处，则自形其小紧，小为正气拘抑之象，紧为寒邪入中之征。然仲景明言
微风，何以反得寒脉也？盖邪随血脉上下，阻滞汁沫，未有不痛者，故痛为紧脉也。
针以泄之，引阳外出，则邪去而正自伸也。
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血痹，阴阳俱微，寸口关上微，尺中小紧，外证身体不仁，如风痹状，黄耆桂枝五物
汤主之。
【注】
此承上条互详脉证，以明其治也。上条言六脉微涩，寸口关上小紧，此条言阴阳寸口
关上俱微，尺中亦小紧。合而观之，可知血痹之脉浮沉，寸口、关上、尺中俱微、俱
涩、俱小紧也。微者虚也，涩者滞也，小紧者邪也，故血痹应有如是之诊也。血痹外
证，亦身体顽麻，不知痛痒，故曰：如风痹状。但不似风痹历关节流走疼痛也。主黄
耆桂枝五物汤者，调养荣卫为本，祛风散邪为末也。
【集注】
周扬俊曰：此申上条既痹之后，未能针引以愈，遂令寸口微者，今则阴阳俱微，且寸
关俱微矣，且尺中小紧矣。夫小紧既见于尺，则邪之入也，愈深而愈不得出，何也？
正虚之处，便是容邪之处也。脉经内外，谓之阴阳，上下亦谓之阴阳，今尺既小紧，
则微属内外也明矣。若言证以不仁概之，则疼痛麻木，每与我相阻，其为不仁甚矣，
故以风痹象之，非真风痹也。于是以黄耆固卫，芍药养阴，桂枝调和荣卫，托实表里
，驱邪外出，佐以生姜宣胃，大枣益脾，为至当不易之治也。
问：血痹病是如何得的？老师说：那些养尊处优的人，骨骼柔弱而肌肉丰盛，因为疲劳出汗，睡觉时身体不时翻动，再加上被微风侵袭，于是就得病了。只要脉象微涩，在寸口和关上部位出现轻微紧象，适宜用针刺引导阳气，使脉象调和、紧象消失，病就能痊愈。
【注释】
历节病属于气分受伤，气伤则痛，所以表现为疼痛。血痹属于血分受伤，血伤则肿（此处指气血凝滞导致的麻木感），所以表现为麻木。前文阐明邪气聚集于气分，这里阐明邪气凝滞于血分，所以称之为血痹。所谓“尊荣人”，是指饮食精细肥甘的人，平时素食甘甜油腻之物，因此骨骼柔弱而肌肉丰盛，不能耐受疲劳；疲劳就会出汗，出汗则腠理（皮肤毛孔）开放；也不能久卧，卧睡时身体不时翻动，翻动时就容易受到微风的侵袭，从而致病。这是说膏粱之人，外表丰盛而内部虚弱，即使是微风小邪，也容易致病。然而怎么知道是血痹呢？只要身体麻木不仁，脉象微涩，就知道是邪气凝滞在血分。寸口和关上的轻微紧象，也是风寒小邪应当出现的脉象。针刺能够导引经络治疗各种痹证，所以适宜用针刺引导气血，以泻除邪气，使脉象不再涩滞而变得调和，紧象消失、邪气散去，血痹自然通畅。
【集注】
周扬俊说：天下只有养尊处优的人才是形体安逸而精神困苦。形体安逸所以肌肉丰盛，精神困苦所以骨骼柔弱。骨骼柔弱就不能耐受力劳，肌肉丰盛则卫气不固，稍有劳累困倦，就会出汗。出汗后阳气虚弱，即使是微风也能侵袭它，从而使血液痹阻。所以一见脉微，就知道阳气不足；一见脉涩，就知道阴血多有阻滞，这是血痹的根本脉象。而邪气侵入的部位，则表现出轻微紧象，“小”是正气被拘束抑制的征象，“紧”是寒邪侵入体内的标志。然而张仲景明确说是微风，为什么反而得到寒脉呢？大概是因为邪气随着血脉上下运行，阻滞津液汁沫，没有不痛的，所以疼痛表现为紧脉。针刺用来泄除邪气，引导阳气外出，那么邪气去除而正气自然伸展。
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血痹病，阴阳脉象都微弱，寸口和关上脉微，尺中脉轻微紧，外在症状是身体麻木不仁，像风痹的样子，用黄芪桂枝五物汤主治。
【注释】
这一段承接上一条详细阐述脉证，以说明治疗方法。上一条说六脉微涩，寸口和关上轻微紧，这一条说阴阳寸口和关上都微，尺中也轻微紧。综合来看，可以知道血痹的脉象在浮沉、寸口、关上、尺中各处都呈现微、涩、小紧的特点。微代表虚，涩代表滞，小紧代表邪气，所以血痹应当有上述诊察表现。血痹的外在症状，也是身体顽麻，不知痛痒，所以说“像风痹的样子”。只是不像风痹那样关节流走性疼痛。主治用黄芪桂枝五物汤，是以调养营卫为本，祛风散邪为标。
【集注】
周扬俊说：这是对上一条所述已经发生痹阻之后，未能通过针刺引导而痊愈的情况的补充说明。现在寸口脉微，进而发展为阴阳俱微，且寸部和关部都微，尺部也轻微紧。既然小紧出现在尺部，说明邪气侵入得越深就越难排出，为什么呢？正气虚弱的地方，就是邪气容纳的地方。脉经内外称为阴阳，上下也称为阴阳，现在尺部既见小紧，那么微象属于内外皆虚就明确了。如果说症状以“不仁”概括，那么疼痛和麻木往往相互排斥，这里的“不仁”非常严重，所以用风痹来比喻其状，并非真正的风痹。于是用黄芪巩固卫气，芍药滋养阴血，桂枝调和营卫，充实表里，驱赶邪气外出，佐以生姜宣通胃气，大枣补益脾气，这是恰当且不可改变的治疗方法。
Q: How is the disease of Blood Bi (Blood Obstruction) contracted? The Master said: Those who live in luxury and ease have weak bones but abundant flesh. Due to fatigue and sweating, combined with restless tossing during sleep, exposure to slight wind leads to this condition. If the pulse is subtly choppy (Se), with a slight tightness (Jin) at the Cunkou (Radial Artery proximal segment) and Guan (Middle segment) positions, it is appropriate to use acupuncture to guide Yang Qi. When the pulse becomes harmonious and the tightness disappears, the patient will recover.
[Annotation]
Li Jie (Joint Pain Disease) belongs to injury of Qi; Qi injury causes pain, hence the manifestation of pain. Blood Bi belongs to injury of Blood; Blood injury causes swelling/stasis, hence the manifestation of numbness. The previous section clarified that pathogenic factors gather in the Qi level; this section clarifies that pathogenic factors coagulate in the Blood level, thus named Blood Bi. "Those in luxury" refers to people accustomed to rich and fatty foods. Because they consume sweet and greasy foods, their bones are weak while their muscles are abundant. Consequently, they cannot tolerate fatigue. Fatigue leads to sweating, and sweating opens the Cou Li (pores). They also cannot endure prolonged lying down; restlessness during sleep exposes them to slight wind, leading to illness. This describes how individuals with rich diets have an exterior abundance but interior deficiency, making them susceptible even to slight wind pathogens. How do we know it is Blood Bi? By body numbness and a subtle choppy pulse, indicating pathogenic coagulation in the Blood. The slight tightness at Cunkou and Guan is also the pulse corresponding to slight Wind-Cold pathogens. Acupuncture can guide meridians to treat various Bi syndromes; thus, acupuncture should be used to guide Qi and Blood to drain the pathogen, making the pulse smooth and harmonious. As the tightness vanishes and the pathogen disperses, Blood Bi naturally unblocks.
[Collected Annotations]
Zhou Yangjun stated: Among all people, only those living in luxury experience physical comfort but mental distress. Physical comfort leads to abundant flesh; mental distress leads to weak bones. Weak bones mean poor endurance of labor; abundant flesh means insecure Wei Qi (Defensive Qi). Slight fatigue or exhaustion leads to sweating. Sweating depletes Yang Qi, allowing even slight wind to invade, causing Blood obstruction. A subtle pulse indicates insufficient Yang; a choppy pulse indicates obstructed Yin/Blood. These are the fundamental pulses of Blood Bi. At the site of pathogen entry, a slight tightness appears. "Slight" reflects the constraint of healthy Qi; "Tight" signifies the invasion of Cold pathogen. However, Zhang Zhongjing explicitly mentions "slight wind," yet why is there a Cold pulse? Pathogens follow the blood vessels up and down, obstructing fluids and juices, inevitably causing pain; thus, pain manifests as a Tight pulse. Acupuncture drains the pathogen and guides Yang outward, allowing the pathogen to leave and healthy Qi to extend.
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In Blood Bi, both Yin and Yang pulses are subtle. The Cunkou and Guan pulses are subtle, while the Chi (distal segment) pulse is slightly tight. The external symptom is body numbness and insensitivity, resembling Feng Bi (Wind Bi). Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary formula.
[Annotation]
This passage elaborates on the pulse and symptoms from the previous section to clarify treatment. The previous section mentioned six pulses being subtle and choppy, with slight tightness at Cunkou and Guan. This section states that both Yin and Yang, as well as Cunkou and Guan, are subtle, and the Chi position is also slightly tight. Synthesizing these, we understand that in Blood Bi, the pulses at floating/sinking levels and at Cunkou, Guan, and Chi positions all exhibit subtlety, choppy quality, and slight tightness. Subtle indicates Deficiency; Choppy indicates Stagnation; Slight Tight indicates Pathogen. Thus, these are the diagnostic signs for Blood Bi. The external symptom of Blood Bi is body stiffness/numbness and loss of pain/temperature sensation, described as "resembling Feng Bi." However, unlike Feng Bi which features wandering joint pain, this does not present such symptoms. Huangqi Guizhi Wuwu Tang is prescribed to nourish Ying (Nutritive) and Wei (Defensive) Qi as the root, and to dispel Wind and scatter pathogens as the branch.
[Collected Annotations]
Zhou Yangjun stated: This supplements the previous section regarding cases where Bi syndrome has occurred but failed to resolve via acupuncture guidance. Now, the Cunkou pulse is subtle, progressing to both Yin and Yang being subtle, with both Cun and Guan positions subtle, and Chi slightly tight. Since slight tightness appears at Chi, the pathogen has penetrated deeper and is harder to expel. Why? Where healthy Qi is deficient, there is room for pathogens. Internal/external pulses are called Yin/Yang; upper/lower positions are also called Yin/Yang. With Chi showing slight tightness, the subtlety clearly indicates deficiency internally and externally. Regarding symptoms, if summarized by "insensitivity," pain and numbness are distinct; here, insensitivity is severe, so it is likened to Feng Bi, though it is not true Feng Bi. Therefore, Huangqi consolidates Wei Qi, Shaoyao (Peony) nourishes Yin, Guizhi (Cinnamon Twig) harmonizes Ying and Wei, strengthens the interior and exterior, and drives pathogens out. Ginger (Shengjiang) promotes Stomach Qi, and Jujube (Dazao) benefits the Spleen. This is the appropriate and unchangeable treatment.