虚实。惟于气口可知之。因其无所隐也。若其他浮露在外而可见者。皆络脉而非经也。
诸络脉（止）皆见于外 张云。大节、大关节也。绝道、间道也。凡经脉所行。必由溪谷、大节之间。
络脉所行。乃不经大节。而于经脉不到之处。出入联系。以为流通之用。然络有大小。大者曰大络。小者曰孙
络。大络犹木之干。行有出入。孙络犹木之枝。散于肤腠。故其会皆见于外。志云。绝道者。别道也。
故诸刺络脉者（止）发为痹也 张云。凡刺络脉者。必刺其结上。此以血之所聚。其结粗突倍常。是
为结上。即当刺处也。若血聚已甚。虽无结络。亦必急取之。以去其邪血。否则发为痹痛之病。今西北之俗。
但遇风寒痛痹等疾。即以绳带紧束上臂。令手肘青筋胀突。乃用磁锋于肘中曲泽穴。次合络结上。砭取其血。
谓之放寒。即此节之遗法。勿谓其无所据也。
凡诊络脉（止）少气也 手鱼之下。甲乙有际字。留久痹、作久留痹。张云。诊、视也。此诊络脉之色。
可以察病。而手鱼之络。尤为显浅易见也。寒则气血凝涩。凝涩则青黑。故青则寒且痛。热则气血淖泽。淖泽
则黄赤。故赤则有热。手鱼者。大指本节间之丰肉也。鱼虽手太阴之部。而胃气至于手太阴。故可以候胃气。
五色之病。惟黑为甚。其暴黑者。以痹之留久而致也。其赤黑青色不常者。寒热气之往来也。其青而短者。青
为阴胜。短为阳不足。故为少气也。简案、汉艺文志师古注云。诊、视验。谓视其脉及色候也。
其小而短者（止）急坐之也 楼马志。小、作青。张云。
视其络脉之小而短者。气少故也。不可刺之。虚甚而泻其气。重虚必致昏闷。甚则运仆暴脱。不能出言。急扶
坐之。使得气转。以渐而苏。若偃卧则气滞。恐致不救也。简案、此即后世所谓针晕也。金针赋云。其或晕针
者。神气虚也。以针补之。以袖掩之。口鼻气回。热汤与之。略停少顷。根据前再施。诸注不及之者何。
手太阳之别（止）散入于鱼际 马云。此下十二节。详言十二络穴。而此先以肺经言之也。夫不曰络而
曰别者。以此穴由本经而别走邻经也。手太阴肺经之别穴。名曰列缺。（去腕侧上一寸半）起于腕上分肉之间。
并本经太阴之经。入手阳明大肠经。以直入掌中。而散入于鱼际。张云。人或有寸关尺三部脉不见。自列缺至
阳溪见者。俗谓之反关脉。此经脉虚而络脉满。千金翼谓阳脉逆。反大于气口三倍者是也。
其病甚（止）别走阳明也 甚、诸本作实。根据下节文例。当改作实。甲乙。锐下有骨字。半寸作一寸。
马云。KT 、 同。去腕半寸。当作寸半。张云。掌后高骨为手锐骨。欠KT 、张口伸腰也。通俗文曰。体倦
则伸。志倦则KT 也。治此者取列缺。谓实可泻之。虚可补之。后诸经皆准此。半寸当作寸半。此太阴之络。
别走阳明。而阳明之络曰偏历。亦入太阴。以其相为表里。故互为注络以相通也。他经皆然。简案、正、脉本
音注。KT 、音去。开口也。藏经音义引桂苑珠丛云。引气而张口曰欠KT 。
手少阴之别（止）属目系 马云。去腕一寸半。其半字衍。观下掌后一寸可见。此言心经之络穴也。
通里穴为络。去腕一寸。别而上行。循本经入于心中。系舌本。属目系。
支膈 马云。膈间若有所支而不畅也。
手心主之别（止）络心系 马云。此言心包络经之络穴也。
夫手厥阴心包络经。而谓之手心主者。以其代心经以行事也。（本经邪客篇云心者五脏六腑之大主诸邪之在心
者皆在心之包络包络者心主之脉也皆如手少阴心主之脉行也）其别名曰内关。去手腕上兼二寸之两筋间。循本
经以上。系于心包络。如心系间邪气盛而实。则心必痛。简案、张本心系下句。据前后文例。张注为是。
头强 甲乙作烦心。张云。此经系心包络心系。又出耳后。合少阳、完骨之下。故邪实则心痛。虚则
头强不利也。志云。此不曰别走少阳。或简脱也。
手太阳之别（止）络肩 马云。此言小肠经之络穴也。支正、上手腕外廉五寸。内注于手少阴心经。以
心于小肠为表里也。
节弛肘废 甲乙。节、作筋。张云。脉络壅滞。而节弛肘废。志云。手太阳小肠主液。实则津液留滞。
不能淖泽与骨。是以节弛肘废。
疣 马云。海篇释为赘。盖赘留之类。张云。疣、音尤。赘也。瘤也。简案、 、与瘤自别。巢源疣
目候云。疣目者。人手足边忽生如豆。粗强于肉。楼氏纲目云。疣、俗称鸡眼子。藏经音义。 、疣同。埤苍
云。皮上结也。庄子云。附赘悬疣。或作HT 。今俗谓之侯。志云。即 痤之类。误也。
如指痂疥 马云。小者为指间痂疥之类。张同。简案、此谓疣之多生。如指间痂疥之状。马张以为痂
疥。误也。
手阳明之别（止）合于宗脉 马云。此言大肠经之络穴也。偏历、去手腕后三寸。别走入于手太阴肺经。
其支别者。上循臂之温溜、下廉、上廉、三里、曲池。以乘肩 。上曲颊。入上齿缝中。又其支别者。入耳合
于宗脉。（玩各节皆腑合于脏脏合于腑则此宗脉宜是肺经之大脉犹言大气为宗气也本经口问篇有云目者宗脉之
所聚）张云。
按本经筋脉皆无入耳上目之文。惟此别络有之。宗脉者。脉聚于耳目之间者也。偏齿之偏。马本作遍。志同。
简案、此盖谓本经偏止于曲颊之处。而非言遍循上下齿也。马本恐非。
龋聋 甲乙作龋齿耳聋。说文。龋、齿蠹也。
痹隔 马云。为内痹。为隔塞不便。志云。痹闭阻隔也。
取之所别也 尚 云。谓遍齿入耳之别络。非偏历也。十二络皆同。
手少阳之别（止）合心主 马云。此言三焦经之络穴也。外关去手腕外廉二寸。外绕于臂。注于胸中。以
合手厥阴心主之脉。以三焦与心包络为表里也。
足太阳之别（止）别走少阴 马云。此言膀胱经之络穴也。飞扬去足外踝上七寸。别走少阴肾经。以膀胱
与肾为表里也。
窒 甲乙作窒鼻。张云。 、鼻塞也。此经起于目内 。络脑行头背。故其为病如此。
足少阳之别（止）下络足跗 马云。此言胆经之络穴也。光明穴去外踝上五寸。别走足厥阴肝经。以胆与
肝为表里也。下络足之跗面。即侠溪、地五会、临泣等处也。
足阳明之别（止）下络喉嗌 马云。此言胃经之经穴也。丰隆去外踝上八寸。别走足太阴脾经。以胃与脾
为表里也。循胫骨外廉之上下巨虚等穴。上至头项而络之。以合于诸经之气。盖胃为五脏六腑之大海也。其头
项之下。则络于喉嗌。张云。喉嗌、缺盆。为诸经之孔道。故合诸经之气。下络喉嗌。
瘁喑 马云。瘁、当作猝。张云。瘁、悴同。病乏也。志作卒痛。简案、马注是。
足太阴之别（止）入络肠胃 马云。此言脾经之络穴也。公孙去足大趾本节后一寸。别走足阳明胃经。以
脾与胃为表
里也。其别者。入络于肠胃之中。
足少阴之别止外贯腰脊 马云。此言肾经之络穴也。大钟穴当内踝后绕跟处。别走足太阳膀胱经。
以肾与膀胱为表里也。又其别者。并本经脉气之行。以上走于手厥阴心包络经之下。而外则贯于腰脊间。
足厥阴之别（止）结于茎 循胫、甲乙作循经。马云。此言肝经之络穴也。蠡沟去内踝上五寸陷中。
别走足少阳胆经。以肝与胆为表里也。经于足胫。以上于睾丸。（阴丸俗云阴子）结于茎垂。（见邪客篇有茎垂）
挺长 志云。茎、阴茎。乃前之宗筋。挺、即阴茎也。简案、此注似未允。经筋篇云。足厥阴伤于
寒。则阴缩入。伤于热。则纵挺不收。（治法详见医学纲目）盖此指睾丸而言。
任脉之别（止）取之所别也 志云。按任脉起于中极之下。以上毛际。循腹里。上关元。至咽喉。
上颐循面入目。所谓尾翳者。即鸠尾之上。盖任脉之别络。出于下极并经而上。复下于鸠尾。以散于腹络。气
实则肠皮急。虚则痒搔。当取之所别络也。简案、甲乙云。鸠尾、一名尾翳。一名 KT 。在臆前蔽骨下五分。
任脉之别。由此考之。尾翳即蔽骨。犹 KT 即蔽骨。而又为鸠尾。一名也。张改屏翳为会阴穴。非也。
督脉之别（止）入贯膂 马云。此言督脉经之有络穴也。长强（脊 骨端）挟膂上项。散于头上。下则
当于肩脾之左右。其别者。则走于足太阳膀胱经。以入贯于膂筋之间。
高摇之 甲乙注云。高以下九字九墟无。张云。头重高摇之谓。力弱不胜而颤掉也。
脾之大络（止）百节尽皆纵 张云。脾之大络。名大包。在渊腋下三寸。布胸胁。出九肋间。总统
阴阳诸络。由脾灌
溉五脏者也。故其为病如此。
此脉若罗络之血者 皆取之脾之大络脉也 马云。此脉若罗纹之络。其络中必有血。皆当取此穴以治之
耳。张云。罗络之血者。言此大络。包罗诸络之血。故皆取脾之大络以去之。大络即大包也。简案、据马注罗
字下句为是。
凡此十五络（止）络脉异所别也 张云。十二经共十二络。而外有任督之络。及脾之大络。是为十五络
也。凡人之十二经脉。伏行分肉之间。深不可见。其脉之浮而可见者。皆络脉也。然又必邪气盛者。脉乃壅盛。
故实则必见。正气虚者。脉乃陷下。而视之不见矣。故当求上下诸穴。以相印证而察之。何也。盖以人经有肥
瘦长短之不同。络脉亦异其所别。故不可执一而求也。愚按、本篇足太阴之别。脉曰公孙。而复有脾之大络。
脉曰大包。足阳明之别。名曰丰隆。而平人气象论。复有胃之大络。名曰虚里。然则诸经之络唯一。而脾胃之
络各二。盖以脾胃为脏腑之本。而十二经皆以受气者也。马云。按此篇以督之长强。任之尾翳。为十五络。难
经以阳跷、阴跷之络为十五络。殊不知督脉所以统诸阳。任脉所以统诸阴。还以灵枢为的也。
虚实，只有从气口（手腕桡动脉处）才能知晓。因为这里没有隐晦之处。至于其他浮露在外而可见的，都是络脉而不是经脉。
所有的络脉都显露在体表。张景岳注：大节、大关节。绝道、间道。凡是经脉所行的路径，必然经过溪谷、大关节之间。络脉所行的路径，不经过大关节，而是在经脉到达不到的地方，出入联系，起到流通的作用。然而络脉有大有小，大的叫做大络，小的叫做孙络。大络就像树木的主干，运行时有出入；孙络就像树木的枝条，散布在皮肤腠理之间。所以它们的交会点都显露在体表。张志聪注：绝道，指别道。
所以凡是针刺络脉的……会导致痹证的发生。张景岳注：凡是刺络脉，必须刺其结聚之上。这是血液聚集的地方，其结聚粗突程度比平常加倍，这就是所谓的“结上”，也就是应当针刺的部位。如果血液聚集已经很严重，即使没有明显的结聚，也必须紧急取血，以去除邪血，否则就会引发痹痛之病。如今西北地区的习俗，只要遇到风寒痛痹等疾病，就用绳带紧紧束缚上臂，使手肘处的青筋胀突，然后用磁锋针在肘部的曲泽穴以及旁边的络脉结聚处，砭刺放出血液。这叫做“放寒”，就是这一节的遗留方法，不要说它没有依据。
凡是诊察络脉的……是少气。手鱼部下方，《甲乙经》中有“际”字。“留久痹”作“作久留痹”。张景岳注：诊，即视。通过诊察络脉的颜色，可以察知病情，而手鱼部的络脉，尤其明显浅显易见。寒则气血凝涩，凝涩则呈现青黑色，所以青色主寒且痛。热则气血淖泽（润泽），淖泽则呈现黄赤色，所以赤色主热。手鱼部，是大拇指本节间的丰肉处。手鱼部虽然属于手太阴肺经的区域，但胃气通达于手太阴肺经，所以可以通过这里候察胃气。五色病变中，只有黑色最为严重。突然发黑的，是由于痹证停留日久所致。赤、黑、青色变化无常的，是寒热之气往来的表现。青色且短的，青为阴胜，短为阳不足，所以是少气。简案：《汉书·艺文志》颜师古注云：诊，即视验。谓观察其脉象及色泽征候。
那些细小而短的……应让其急坐。楼全善注：小，作青。张景岳注：视其络脉细小而短的，是因为气少。不可针刺。若虚甚而再泻其气，会造成重虚，必定导致昏闷，甚至晕倒暴脱，不能说话。此时应紧急扶其坐下，使其气机回转，逐渐苏醒。如果仰卧则气机滞塞，恐怕会导致无法救治。简案：这就是后世所说的“晕针”。《金针赋》云：如果出现晕针，是因为神气虚。用补法施针，用袖子遮挡，待口鼻气息恢复，给予热汤，稍停片刻，根据情况再次施治。各种注解都没有提到这一点的原因何在？
手太阳小肠经的别络……散布进入鱼际。马莳注：以下十二节，详细论述十二个络穴，而这里先讲述肺经。之所以不说“络”而说“别”，是因为这个穴位由本经别行走向邻近的经脉。手太阴肺经的别穴，名叫列缺。（距离腕侧上一寸半）起于腕上分肉之间，并同本经太阴经一起，进入手阳明大肠经，直接入掌中，散布进入鱼际。张景岳注：有人寸、关、尺三部脉象不见，从列缺到阳溪处可见，俗称为反关脉。这是经脉虚而络脉满盛，《千金翼方》说阳脉逆乱，反大于气口三倍的即是这种情况。
其病症严重时……别走阳明经。甚，各本作实。根据下节文例，应当改作实。《甲乙经》中，“锐”下有“骨”字。“半寸”作“一寸”。马莳注：KT（欠伸之欠），同“欠”。距离腕半寸，当作寸半。张景岳注：掌后高骨为手锐骨。欠KT，即张口伸腰。《通俗文》曰：体倦则伸，志倦则欠。治疗此病取列缺穴，谓实证可泻，虚证可补。后述各经皆以此为准。半寸当作寸半。这是太阴之络，别走阳明经，而阳明之络名叫偏历，也进入太阴经。因为它们互为表里，所以互为注络以相通。其他经脉都是这样。简案：正脉本音注：KT音去，开口也。《藏经音义》引《桂苑珠丛》云：引气而张口曰欠KT。
手少阴心经的别络……属目系。马莳注：距离腕一寸半，那个“半”字是衍文。观下文“掌后一寸”可知。这是讲心经的络穴。通里穴为络，距离腕一寸，别行而上行，循本经进入心中，系舌本，属目系。支膈。马莳注：膈间好像有支撑而不通畅。
手心主心包络经的别络……络心系。马莳注：这是讲心包络经的络穴。夫手厥阴心包络经，而称之手心主者，因为它代替心经行事。（本经《邪客篇》云：心者五脏六腑之大主，诸邪之在心者皆在心之包络。包络者，心主之脉也。皆如手少阴心主之脉行也。）其别名叫做内关，距离手腕上两筋间二寸处，循本经上行，系于心包络，如同心系之间。邪气盛而实，则心必痛。简案：张本在“心系”下句，据前后文例，张注是正确的。头强。《甲乙经》作“烦心”。张景岳注：此经系心包络、心系，又出耳后，合于少阳、完骨之下。所以邪实则心痛，虚则头强不利。张志聪注：这里不说是别走少阳，或许是文字简略脱落了。
手太阳小肠经的别络……络肩。马莳注：这是讲小肠经的络穴。支正穴，上手腕外廉五寸，内注于手少阴心经，以心与小肠为表里。节弛肘废。《甲乙经》：“节”作“筋”。张景岳注：脉络壅滞，而节弛肘废。张志聪注：手太阳小肠主液，实则津液留滞，不能淖泽与骨，是以节弛肘废。疣。马莳注：《海篇》解释为赘，大概是赘留之类。张景岳注：疣，音尤。赘也，瘤也。简案：瘤与疣自别。巢元方《诸病源候论·疣目候》云：疣目者，人手足边忽生如豆，粗强于肉。楼氏《纲目》云：疣，俗称鸡眼子。《藏经音义》：瘤、疣同。《埤苍》云：皮上结也。《庄子》云：附赘悬疣。或作HT。今俗谓之侯。张志聪注：即痤之类，误也。如指痂疥。马莳注：小者为指间痂疥之类。张景岳同。简案：此谓疣之多生，如指间痂疥之状。马、张以为痂疥，误也。
手阳明大肠经的别络……合于宗脉。马莳注：这是讲大肠经的络穴。偏历穴，距离手腕后三寸，别走入于手太阴肺经。其支别者，上循臂之温溜、下廉、上廉、三里、曲池，以乘肩髃，上曲颊，入上齿缝中。又其支别者，入耳合于宗脉。（玩味各节皆腑合于脏，脏合于腑，则此宗脉宜是肺经之大脉，犹言大气为宗气也。本经《口问篇》有云：目者宗脉之所聚。）张景岳注：按本经筋脉皆无入耳上目之文，惟此别络有之。宗脉者，脉聚于耳目之间者也。偏齿的偏，马本作遍，张志聪同。简案：这大概是指本经偏止于曲颊之处，而非言遍循上下齿。马本恐怕不对。龋聋。《甲乙经》作“龋齿耳聋”。《说文》：龋，齿蠹也。痹隔。马莳注：为内痹，为隔塞不便。张志聪注：痹闭阻隔也。取之所别也。尚志夔云：谓遍齿入耳之别络，非偏历也。十二络皆同。
手少阳三焦经的别络……合心主。马莳注：这是讲三焦经的络穴。外关穴，去手腕外廉二寸，外绕于臂，注于胸中，以合手厥阴心主之脉，以三焦与心包络为表里。
足太阳膀胱经的别络……别走少阴。马莳注：这是讲膀胱经的络穴。飞扬穴，去足外踝上七寸，别走少阴肾经，以膀胱与肾为表里。窒。《甲乙经》作“窒鼻”。张景岳注：窒，鼻塞也。此经起于目内眦，络脑行头背，故其为病如此。
足少阳胆经的别络……下络足跗。马莳注：这是讲胆经的络穴。光明穴，去外踝上五寸，别走足厥阴肝经，以胆与肝为表里。下络足之跗面，即侠溪、地五会、临泣等处。
足阳明胃经的别络……下络喉嗌。马莳注：这是讲胃经的经穴。丰隆穴，去外踝上八寸，别走足太阴脾经，以胃与脾为表里。循胫骨外廉之上下巨虚等穴，上至头项而络之，以合于诸经之气。盖胃为五脏六腑之大海也。其头项之下，则络于喉嗌。张景岳注：喉嗌、缺盆，为诸经之孔道，故合诸经之气，下络喉嗌。瘁喑。马莳注：瘁，当作猝。张景岳注：瘁，悴同，病乏也。志作卒痛。简案：马注是。
足太阴脾经的别络……入络肠胃。马莳注：这是讲脾经的络穴。公孙穴，去足大趾本节后一寸，别走足阳明胃经，以脾与胃为表里。其别者，入络于肠胃之中。
足少阴肾经的别络……止外贯腰脊。马莳注：这是讲肾经的络穴。大钟穴，当内踝后绕跟处，别走足太阳膀胱经，以肾与膀胱为表里。又其别者，并本经脉气之行，以上走于手厥阴心包络经之下，而外则贯于腰脊间。
足厥阴肝经的别络……结于茎。循胫，《甲乙经》作循经。马莳注：这是讲肝经的络穴。蠡沟穴，去内踝上五寸陷中，别走足少阳胆经，以肝与胆为表里。经于足胫，以上于睾丸。（阴丸俗云阴子）结于茎垂。（见《邪客篇》有茎垂）挺长。张志聪注：茎，阴茎，乃前之宗筋。挺，即阴茎也。简案：此注似未允。《经筋篇》云：足厥阴伤于寒，则阴缩入；伤于热，则纵挺不收。（治法详见《医学纲目》）盖此指睾丸而言。
任脉的别络……取之所别也。张志聪注：按任脉起于中极之下，以上毛际，循腹里，上关元，至咽喉，上颐循面入目。所谓尾翳者，即鸠尾之上。盖任脉之别络，出于下极并经而上，复下于鸠尾，以散于腹络。气实则肠皮急，虚则痒搔。当取之所别络也。简案：《甲乙经》云：鸠尾，一名尾翳，一名KT。在臆前蔽骨下五分。任脉之别，由此考之，尾翳即蔽骨，犹KT即蔽骨，而又为鸠尾，一名也。张景岳改屏翳为会阴穴，非也。
督脉的别络……入贯膂。马莳注：这是讲督脉经的有络穴。长强穴（脊骨端），挟膂上项，散于头上，下则当于肩脾之左右。其别者，则走于足太阳膀胱经，以入贯于膂筋之间。高摇之。《甲乙经》注云：高以下九字，《九墟》无。张景岳注：头重高摇之谓。力弱不胜而颤掉也。
脾之大络……百节尽皆纵。张景岳注：脾之大络，名大包，在渊腋下三寸，布胸胁，出九肋间，总统阴阳诸络，由脾灌溉五脏者也。故其为病如此。
此脉若罗络之血者……皆取之脾之大络脉也。马莳注：此脉若罗纹之络，其络中必有血，皆当取此穴以治之耳。张景岳注：罗络之血者，言此大络，包罗诸络之血，故皆取脾之大络以去之。大络即大包也。简案：据马注，罗字下句为是。
凡此十五络……络脉异所别也。张景岳注：十二经共十二络，而外有任督之络，及脾之大络，是为十五络也。凡人之十二经脉，伏行分肉之间，深不可见。其脉之浮而可见者，皆络脉也。然又必邪气盛者，脉乃壅盛，故实则必见。正气虚者，脉乃陷下，而视之不见矣。故当求上下诸穴，以相印证而察之。何也？盖以人经有肥瘦长短之不同，络脉亦异其所别，故不可执一而求也。愚按：本篇足太阴之别，脉曰公孙，而复有脾之大络，脉曰大包。足阳明之别，名曰丰隆，而《平人气象论》复有胃之大络，名曰虚里。然则诸经之络唯一，而脾胃之络各二。盖以脾胃为脏腑之本，而十二经皆以受气者也。马莳注：按此篇以督之长强、任之尾翳，为十五络。《难经》以阳跷、阴跷之络为十五络。殊不知督脉所以统诸阳，任脉所以统诸阴，还以《灵枢》为的也。
Deficiency and excess can only be known from the Qi Kou (pulse point at the wrist). Because there is no concealment here. As for those that are exposed on the surface and visible, they are all Luo vessels (collateral vessels) rather than Jing meridians (main meridians).
All Luo vessels manifest externally. Zhang Yun notes: "Da Jie" refers to major joints. "Jue Dao" and "Jian Dao" refer to pathways. Wherever Jing meridians travel, they must pass through Xi Gu (valleys between muscles) and major joints. The path of Luo vessels does not go through major joints but connects and enters/exits in areas where Jing meridians do not reach, serving a circulation function. However, Luo vessels vary in size; large ones are called Da Luo (major collaterals), and small ones are called Sun Luo (branching collaterals). Da Luo are like tree trunks, with flow having entry and exit points; Sun Luo are like branches, scattered in the skin and interstices. Thus, their intersections all manifest externally. Zhi Zhi Cong notes: "Jue Dao" means an alternative path.
Therefore, whenever puncturing Luo vessels... it may lead to Bi syndrome (obstruction syndrome). Zhang Yun notes: When puncturing Luo vessels, one must puncture above the knot/accumulation. This is where blood gathers; the accumulation is significantly thicker and more protruding than usual, which is called "the top of the knot," i.e., the site to be punctured. If blood accumulation is severe, even without a visible knot, blood must be urgently drained to remove pathogenic blood; otherwise, it will develop into painful Bi syndrome. Currently, in the northwest customs, when encountering diseases such as wind-cold painful Bi, tight ropes or bands are used to bind the upper arm tightly, causing the blue veins in the elbow to swell and protrude. Then, a magnetic blade is used to pierce the Quze acupoint in the elbow and the adjacent Luo vessel knots to bleed. This is called "releasing cold," which is a remnant method of this section. Do not say it lacks basis.
When diagnosing Luo vessels... it indicates Shao Qi (deficient Qi). Below the Shou Yu (fish mound), the *Jia Yi Jing* has the character "Ji". "Liu Jiu Bi" is written as "Zuo Jiu Liu Bi" in some texts. Zhang Yun notes: "Zhen" means observation. By observing the color of the Luo vessels, one can inspect the disease. The Luo vessels of the Shou Yu are particularly obvious, superficial, and easy to see. Cold causes Qi and blood to coagulate and stagnate; coagulation and stagnation result in cyanotic-black colors. Thus, cyanosis indicates cold and pain. Heat causes Qi and blood to become moist and lustrous; moisture and lustrousness result in yellow-red colors. Thus, redness indicates heat. Shou Yu refers to the fleshy area between the first metacarpal bone and the proximal phalanx of the thumb. Although Shou Yu belongs to the region of the Hand Taiyin Lung Meridian, Stomach Qi reaches the Hand Taiyin, so Stomach Qi can be observed here. Among the five colors of pathology, black is the most severe. Sudden blackness is caused by long-standing Bi syndrome. Fluctuating red, black, and cyanotic colors indicate the往来 (alternating presence) of cold and heat. Cyanosis with shortness indicates Yin excess and Yang deficiency, thus indicating Shao Qi. Jian An cites Yan Shigu's annotation on the *Han Shu: Yi Wen Zhi*: "Zhen" means visual inspection, referring to observing the pulse and color manifestations.
Those that are small and short... should be made to sit up urgently. Lou Ma Zhi notes: "Small" is written as "Cyanotic". Zhang Yun notes: Observing Luo vessels that are small and short indicates deficient Qi. They should not be punctured. If one drains Qi in a state of severe deficiency, it leads to double deficiency, inevitably causing dizziness and fainting, potentially leading to sudden collapse and inability to speak. One should urgently support the patient to sit up, allowing Qi to recover and gradually regaining consciousness. If lying supine, Qi stagnates, fearing it may become incurable. Jian An notes: This is what later generations call "needle syncope." The *Jin Zhen Fu* states: "If needle syncope occurs, it is due to deficiency of Shen Qi. Apply tonification, cover with sleeves, wait for breath to return at mouth and nose, give hot soup, pause briefly, then treat again according to prior conditions." Why did previous annotations fail to mention this?
The Luo-Connecting Vessel of the Hand Taiyang [Small Intestine]... scatters into the Shou Yu. Ma Shi notes: The following twelve sections detail the twelve Luo-Connecting points, starting here with the Lung Meridian. It is called "Bie" (separate branch) rather than "Luo" because this point diverges from the main meridian to connect with a neighboring meridian. The Luo-Connecting point of the Hand Taiyin Lung Meridian is named Lieque (1.5 cun above the wrist crease). It originates between the muscle layers above the wrist, travels along the Hand Taiyin Meridian, enters the Hand Yangming Large Intestine Meridian, goes directly into the palm, and scatters into the Shou Yu. Zhang Yun notes: In some people, the Cun, Guan, and Chi pulses are not palpable, but the pulse is visible from Lieque to Yangxi, commonly called "Fan Guan Mai" (Reverse Guan Pulse). This indicates deficiency of the Jing meridian and fullness of the Luo vessel. The *Qian Jin Yi Fang* states that when Yang pulses reverse and are three times larger than the Qi Kou, it is this condition.
When symptoms are severe... it diverges to the Yangming Meridian. "Shen" is written as "Shi" (Excess) in most editions. Based on the context of the next section, it should be corrected to "Shi". The *Jia Yi Jing* adds "Gu" (bone) after "Rui". "Ban Cun" (half cun) is written as "Yi Cun" (one cun). Ma Shi notes: "Kai Kou" (opening mouth/yawning) is synonymous with "Qian". Distance from wrist half cun should be 1.5 cun. Zhang Yun notes: The high bone behind the palm is the Hand Rui Bone. "Qian Kai" means opening the mouth and stretching the waist. The *Tong Su Wen* says: Body fatigue leads to stretching; mental fatigue leads to yawning. To treat this, select Lieque. Excess can be drained, deficiency can be tonified. The same applies to subsequent meridians. Half cun should be 1.5 cun. This is the Luo-Connecting vessel of Taiyin, diverging to Yangming. The Luo-Connecting vessel of Yangming is named Pianli, which also enters Taiyin. Because they are exterior-interior paired, they mutually connect via Luo vessels to communicate. Other meridians are the same. Jian An cites Zheng Mai Ben Yin Zhu: "Kai Kou" sounds like "Qu", meaning opening the mouth. *Cang Jing Yin Yi* cites *Gui Yuan Zhu Cong*: "Drawing Qi and opening the mouth is called Qian Kai."
The Luo-Connecting Vessel of the Hand Shaoyin [Heart]... attaches to the Eye System. Ma Shi notes: 1.5 cun from the wrist; the character "ban" (half) is superfluous. See "one cun behind the palm" below. This discusses the Luo-Connecting point of the Heart Meridian. Tongli is the Luo-Connecting point, 1 cun from the wrist. It diverges and ascends, follows the main meridian into the heart, ties to the root of the tongue, and attaches to the eye system. Zhi Ge (supporting the diaphragm). Ma Shi notes: A sensation of obstruction or discomfort in the diaphragm area.
The Luo-Connecting Vessel of the Xin Bao (Pericardium) [Hand Jueyin]... connects to the Xin Xi (Heart Connection). Ma Shi notes: This discusses the Luo-Connecting point of the Pericardium Meridian. The Hand Jueyin Pericardium Meridian is called Hand Xin Zhu (Master of the Heart) because it acts on behalf of the Heart Meridian. (*Xie Ke Pian* of this text states: The Heart is the great master of the five zang and six fu organs. All pathogens affecting the heart reside in the Pericardium. The Pericardium is the vessel of the Xin Zhu. Its course is similar to the Hand Shaoyin Heart Meridian.) Its alias is Neiguan, located 2 cun above the wrist between the two tendons. It follows the main meridian upward, connecting to the Pericardium, similar to the Xin Xi. If pathogenic Qi is excessive and excess, the heart will necessarily hurt. Jian An notes: Regarding Zhang's annotation under "Xin Xi", based on the context, Zhang's note is correct. Tou Qiang (stiff neck). *Jia Yi Jing* writes "Fan Xin" (vexed heart). Zhang Yun notes: This meridian connects the Pericardium and Xin Xi, emerges behind the ear, and combines with Shaoyang below Wangu. Thus, excess causes heart pain, while deficiency causes stiff and uncomfortable neck. Zhi Zhi Cong notes: It does not say it diverges to Shaoyang, perhaps due to textual omission.
The Luo-Connecting Vessel of the Hand Taiyang [Small Intestine]... connects to the Shoulder. Ma Shi notes: This discusses the Luo-Connecting point of the Small Intestine Meridian. Zhizheng is 5 cun lateral to the wrist, internally injecting into the Hand Shaoyin Heart Meridian, as Heart and Small Intestine are exterior-interior paired. Jie Chi Zhou Fei (relaxed joints and useless elbow). *Jia Yi Jing*: "Jie" is written as "Jin" (tendon). Zhang Yun notes: Meridian and vessel congestion leads to relaxed joints and useless elbows. Zhi Zhi Cong notes: Hand Taiyang Small Intestine governs fluids. Excess causes fluid retention, unable to moisten bones, hence relaxed joints and useless elbows. You (warts). Ma Shi notes: *Hai Pian* explains it as "Zhui" (growth/fleshy excrescence), likely a type of persistent growth. Zhang Yun notes: "You" sounds like "You". It means growth or tumor. Jian An notes: Tumor and wart are distinct. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: Wart eyes appear suddenly on hands or feet like beans, rougher and stronger than flesh. Lou Quan's *Gang Mu* states: Wart is commonly called chicken eye. *Cang Jing Yin Yi*: Tumor and wart are the same. *Pi Cang* states: Knotting on the skin. *Zhuangzi* states: Attached growths and hanging warts. Or written as HT. Commonly called Hou today. Zhi Zhi Cong notes: It is a type of acne, which is incorrect. Ru Zhi Jia Jie (like scabs and ringworm on fingers). Ma Shi notes: Small ones are like scabs and ringworm between fingers. Zhang agrees. Jian An notes: This refers to multiple warts appearing like scabs and ringworm between fingers. Ma and Zhang considering them scabs/ringworm is incorrect.
The Luo-Connecting Vessel of the Hand Yangming [Large Intestine]... combines with Zong Mai (Ancestral Vessels). Ma Shi notes: This discusses the Luo-Connecting point of the Large Intestine Meridian. Pianli is 3 cun behind the wrist, diverging into the Hand Taiyin Lung Meridian. Its branch ascends along the arm through Wenliu, Xia Lian, Shang Lian, Sanli, and Quchi, reaching the shoulder, ascending to the jaw angle, entering the upper gum line. Another branch enters the ear and combines with Zong Mai. (Considering all sections state Fu combines with Zang and Zang with Fu, Zong Mai here should be the major vessel of the Lung Meridian, akin to saying Zong Qi is the ancestor of Qi. *Kou Wen Pian* of this text states: Eyes are where Zong Mai gather.) Zhang Yun notes: According to this text, neither sinews nor vessels enter the ear or ascend to the eyes, except for this Luo-Connecting vessel. Zong Mai refers to vessels gathering around the eyes and ears. "Pian" (partial) in Pian Chi, Ma's edition writes "Bian" (all), Zhi agrees. Jian An notes: This likely means the meridian ends partially at the jaw angle, not traversing all upper and lower teeth. Ma's edition is likely incorrect. Qu Long (toothache and deafness). *Jia Yi Jing* writes "Qu Chi Er Long" (tooth decay and deafness). *Shuo Wen*: "Qu" means tooth worm/caries. Bi Ge (obstruction). Ma Shi notes: Internal Bi and blockage/inconvenience. Zhi Zhi Cong notes: Obstruction and blockage. Qu Zhi Suo Bie Ye (Take the divergent point). Shang Yun notes: Refers to the divergent vessel surrounding teeth and entering the ear, not Pianli. This applies to all twelve Luo vessels.
The Luo-Connecting Vessel of the Hand Shaoyang [Sanjiao]... combines with Xin Zhu (Master of the Heart). Ma Shi notes: This discusses the Luo-Connecting point of the Sanjiao Meridian. Waiguan is 2 cun lateral to the wrist, wrapping around the arm, injecting into the chest, combining with the Hand Jueyin Xin Zhu Meridian, as Sanjiao and Pericardium are exterior-interior paired.
The Luo-Connecting Vessel of the Foot Taiyang [Bladder]... diverges to Shaoyin. Ma Shi notes: This discusses the Luo-Connecting point of the Bladder Meridian. Feiyang is 7 cun above the lateral malleolus, diverging to the Shaoyin Kidney Meridian, as Bladder and Kidney are exterior-interior paired. Bi (nasal congestion). *Jia Yi Jing* writes "Bi Bi" (blocked nose). Zhang Yun notes: Bi means nasal congestion. This meridian originates at the inner canthus, connects to the brain, and travels over the head and back, hence these symptoms.
The Luo-Connecting Vessel of the Foot Shaoyang [Gallbladder]... descends to connect to the foot dorsum. Ma Shi notes: This discusses the Luo-Connecting point of the Gallbladder Meridian. Guangming is 5 cun above the lateral malleolus, diverging to the Foot Jueyin Liver Meridian, as Gallbladder and Liver are exterior-interior paired. Descending to connect to the dorsum of the foot, including Xiaxi, Di Wuhui, Linqi, etc.
The Luo-Connecting Vessel of the Foot Yangming [Stomach]... descends to connect to the throat/pharynx. Ma Shi notes: This discusses the Jing-River point of the Stomach Meridian. Fenglong is 8 cun above the lateral malleolus, diverging to the Foot Taiyin Spleen Meridian, as Stomach and Spleen are exterior-interior paired. Following the lateral edge of the tibia through Shang/Xia Ju Xu, ascending to the head and neck to connect, combining with Qi of all meridians. For the Stomach is the sea of the five zang and six fu organs. Below the head and neck, it connects to the throat/pharynx. Zhang Yun notes: Throat/pharynx and Quepen are passages for all meridians, thus combining Qi of all meridians, descending to connect to the throat/pharynx. Cui Yin (sudden aphonia). Ma Shi notes: Cui should be Cu (sudden). Zhang Yun notes: Cui is same as Cui (withered/sick), meaning illness weakness. Zhi writes Zu Tong (sudden pain). Jian An notes: Ma's note is correct.
The Luo-Connecting Vessel of the Foot Taiyin [Spleen]... enters to connect to the intestines and stomach. Ma Shi notes: This discusses the Luo-Connecting point of the Spleen Meridian. Gongsun is 1 cun posterior to the base of the big toe, diverging to the Foot Yangming Stomach Meridian, as Spleen and Stomach are exterior-interior paired. Its branch enters to connect within the intestines and stomach.
The Luo-Connecting Vessel of the Foot Shaoyin [Kidney]... stops externally piercing the loins and spine. Ma Shi notes: This discusses the Luo-Connecting point of the Kidney Meridian. Dazhong is located behind the medial malleolus, wrapping around the heel, diverging to the Foot Taiyang Bladder Meridian, as Kidney and Bladder are exterior-interior paired. Another branch travels with the main meridian Qi upward below the Hand Jueyin Pericardium Meridian, and externally pierces through the loins and spine.
The Luo-Connecting Vessel of the Foot Jueyin [Liver]... binds to the penis. Xun Jing, *Jia Yi Jing* writes Xun Jing (follow meridian). Ma Shi notes: This discusses the Luo-Connecting point of the Liver Meridian. Ligou is in the depression 5 cun above the medial malleolus, diverging to the Foot Shaoyang Gallbladder Meridian, as Liver and Gallbladder are exterior-interior paired. Traveling along the leg, ascending to the testicles (commonly called yanzi), binding to the pendulous penis (see *Xie Ke Pian* mentioning penile suspension). Ting Chang (protrusion and length). Zhi Zhi Cong notes: Jing refers to the penis, the ancestral tendon anteriorly. Ting refers to the penis itself. Jian An notes: This annotation seems inappropriate. *Jing Jin Pian* states: If Foot Jueyin is injured by cold, the yin retracts; if injured by heat, it becomes flaccid and cannot retract. (Treatment methods detailed in *Yi Xue Gang Mu*). This likely refers to the testicles.
The Luo-Connecting Vessel of the Ren Mai (Conception Vessel)... take the divergent point. Zhi Zhi Cong notes: According to the Ren Mai originating below Zhongji, ascending past the pubic hair, following inside the abdomen, passing Guanyuan, reaching the throat, ascending to the chin, following the face into the eyes. What is called Wei Yi is above Jiutui. The Luo-Connecting vessel of the Ren Mai emerges from Xia Ji, travels up, returns down to Jiutui, scattering into abdominal collaterals. Excess Qi causes intestinal skin tension; deficiency causes itching. One should take the divergent Luo vessel. Jian An notes: *Jia Yi Jing* states: Jiutui, also named Wei Yi, also named KT. Located 0.5 cun below the xiphoid process (bi gu). Investigating the Ren Mai's Luo vessel, Wei Yi is the bi gu, just as KT is the bi gu, and both are names for Jiutui. Zhang changed Ping Yi to Huiyin acupoint, which is incorrect.
The Luo-Connecting Vessel of the Du Mai (Governor Vessel)... enters and pierces the Spinal Muscles. Ma Shi notes: This discusses the Luo-Connecting point of the Du Mai. Changqiang (at the end of the sacrum), flanking the spinal muscles up to the neck, scattering on the head, downward corresponding to the left and right of the scapula. Its branch travels to the Foot Taiyang Bladder Meridian, entering and piercing between the spinal muscles. Gao Yao Zhi (shaking the head high). *Jia Yi Jing* annotation: The nine characters from "Gao" downwards are absent in *Jiu Xu*. Zhang Yun notes: Head heavy, shaking high. Weak strength unable to bear, trembling.
The Great Luo Vessel of the Spleen... all joints become completely flaccid. Zhang Yun notes: The Great Luo Vessel of the Spleen is named Dabao, located 3 cun below Yuanxia, spreading across the chest and hypochondrium, emerging from the nine intercostal spaces, commanding all Yin and Yang Luo vessels, irrigating the five zang organs from the Spleen. Hence its pathology manifests thus.
This vessel, if like net-like blood vessels... all should be treated by taking the Great Luo Vessel of the Spleen. Ma Shi notes: This vessel resembles net-like patterns; if there is blood in the vessels, all should be treated by selecting this acupoint. Zhang Yun notes: "Net-like blood vessels" means this Great Luo vessel encompasses the blood of all other Luo vessels, so one should take the Great Luo Vessel of the Spleen to remove it. The Great Luo vessel is Dabao. Jian An notes: Based on Ma's note, the sentence under "Luo" is correct.
These fifteen Luo vessels... the Luo vessels diverge from different locations. Zhang Yun notes: There are twelve Luo vessels for the twelve meridians, plus the Luo vessels of Ren and Du, and the Great Luo Vessel of the Spleen, totaling fifteen. The twelve Jing meridians of humans run deep between muscle layers, invisible. Those floating and visible are all Luo vessels. However, only when pathogenic Qi is abundant do the vessels become congested and visible; thus, excess is always visible. When healthy Qi is deficient, the vessels sink and are invisible. Therefore, one must seek various acupoints above and below to verify and observe. Why? Because human meridians vary in fat/thinness and length/shortness, and Luo vessels also diverge from different locations, so one cannot rigidly apply a single standard. I observe: In this section, the Foot Taiyin branch is Gongsun, yet there is also the Great Luo Vessel of the Spleen, Dabao. The Foot Yangming branch is Fenglong, yet *Ping Ren Qi Xiang Lun* mentions the Great Luo Vessel of the Stomach, Xuli. Thus, each meridian has only one Luo vessel, but Spleen and Stomach have two each. This is because Spleen and Stomach are the root of the zang-fu organs, and all twelve meridians receive Qi from them. Ma Shi notes: This section lists Changqiang of Du and Wei Yi of Ren as the fifteen Luo vessels. *Nan Jing* lists Yang Qiao and Yin Qiao as the fifteen Luo vessels. Little do they know that Du Mai commands all Yang, and Ren Mai commands all Yin; thus, *Ling Shu* should be the standard.