奇邪 张云。即缪刺论所论奇病也。在络不在经。行无常苦。故曰奇邪。
血络 志云。血络者。外之络脉、孙脉。见于皮肤之间。血气有所留积。则失其外内出入之机。
血少黑 甲乙。少、作出。是。
苍苍者 甲乙。者上有然字。是。
烦悦 诸本悦作 。此本误。当改。
脱气则仆 张云。气虽盛而血则虚者。若泻其气。则阴阳俱脱。故为仆倒。
久则为肿 志云。其不新饮者。身中有水。久而为肿。盖言血乃水谷之津液所化。若不新饮而出为
汗者。乃身中之水也。简案、此答上文半为汁者之问也。肿、乃水肿之谓。
气先行故肿 简案、此答上文发针而肿者之问也。肿乃针痕肿起之谓。与上节异义。
刺之血出多色不变 甲乙无血出多色四字。简案、此答上文。而色不变。而烦 者之问也。乃血出
多三字衍文。
故烦闷 张本。闷、作 。
阴阳俱有余 张云。经络之病。俱有余。
相之奈何 马云。相、视也。
血脉者（止）各如其度 甲乙无者字。则而、作刺而。马云。此言视血络之法也。则、侧同。必侧其针。
以迎而泻之。志云。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。张云。若失其数。而反其法。则为仆为脱。为虚为肿
等证。各如刺度以相应也。
肉着 马云。着、着同。张云。肉着者。吸着于针也。针入而热。肉必附之。故紧涩难转而坚不可拔也。
奇邪：张云指出，所谓“奇邪”，即《缪刺论》中所论述的奇病。病位在络脉而不在经脉，运行没有固定的规律和痛苦表现，因此称为奇邪。
血络：志氏认为，血络是指位于皮肤之间的外周络脉和孙脉。如果气血在此处留滞积聚，就会失去其内外出入的正常机能。
血色少且黑：据《甲乙经》，此处“少”字应作“出”字，这是正确的。
颜色苍白：据《甲乙经》，在“者”字上面应有“然”字，这是正确的。
烦闷：各版本中“悦”字均作“闷”（注：原文此处可能有误或指通假，结合上下文及医理，通常指烦闷不适），此版本有误，应当改正。
气脱则仆倒：张云指出，若患者虽然气盛但血虚，此时若泻其气，会导致阴阳俱脱，从而发生仆倒。
日久则形成肿胀：志氏认为，那些不是新近饮水的人，身体中有水湿停留，时间久了就会形成肿胀。这是因为血液是由水谷津液化生的，如果不通过新饮入的水转化为汗液排出，那就是体内的水湿。简案按语：这是对上文“半为汁”这一疑问的回答。这里的“肿”，指的是水肿。
气先行故肿胀：简案按语：这是对上文“发针后出现肿胀”这一疑问的回答。这里的“肿”，指针刺部位的痕迹肿起。这与上一节的含义不同。
针刺出血多但颜色不变：据《甲乙经》，没有“血出多色”这四个字。简案按语：这是对上文“色不变而烦闷”这一疑问的回答。“血出多”三字是衍文（多余的字）。
因此感到烦闷：据张本，“闷”字写作某字（原文缺省或异体，意指烦闷之意）。
如何诊察？马云指出，“相”意为视、观察。
血脉的情况（止）：各如其度：据《甲乙经》，没有“者”字，“则而”作“刺而”。马云指出，这是在讲述观察血络的方法。“则”同“侧”，必须将针侧向，以迎而泻之。志氏认为，血脉盛大、坚硬、横向且发红，说明血盛于脉中；上下无常处的，是血气流行的表现；小的如针尖大小的，是瘀血留在孙络中；大的如筋脉粗细的，是瘀血留在经隧中。“数”指血脉出入的度数。张云指出，如果失去了这些度数规律，反而违背了刺法，就会导致仆倒、脱证、虚证、肿胀等病症，必须按照针刺的度数来相应操作。
肌肉附着：马云指出，“着”同“著”。张云指出，“肉着”是指肌肉吸附在针上。针进入后产生热感，肌肉必然附着于针，所以紧涩难转，坚硬不可拔除。
Qi Xie (Odd Pathogens): Zhang Yun states that "Qi Xie" refers to the odd diseases discussed in the *Miao Ci Lun* (Treatise on Miraculous Puncture). The pathology is located in the Luo vessels (collateral vessels) rather than the Jing vessels (main meridians), and its movement lacks fixed patterns or consistent suffering; hence it is called Qi Xie.
Xue Luo (Blood Collaterals): Zhi Shi asserts that Xue Luo refers to the external Luo vessels and Sun vessels (fine collateral vessels) visible between the skin. When Qi and Blood stagnate and accumulate here, they lose their normal mechanism of entering and exiting internally and externally.
Scanty and Dark Blood: According to the *Jia Yi Jing*, the character "Shao" (scanty) should be read as "Chu" (exit/emerge); this correction is accurate.
Pale Complexion: According to the *Jia Yi Jing*, there should be the character "Ran" above "Zhe"; this correction is accurate.
Vexation and Oppression: In various editions, the character "Yue" is written as "Men" (oppression/stifling sensation); this edition contains an error and should be corrected.
Qi Collapse Leads to Falling: Zhang Yun explains that if a patient has abundant Qi but deficient Blood, draining the Qi will cause both Yin and Yang to collapse, resulting in falling or fainting.
Chronic Stagnation Leads to Swelling: Zhi Shi notes that for those who have not recently drunk fluids, water-dampness remains within the body and eventually manifests as swelling. This is because blood is transformed from the essence of food and drink; if it does not transform into sweat via newly ingested fluids, it becomes internal water-dampness. Jian An's commentary: This answers the previous question regarding "half becoming fluid." Here, "swelling" refers to edema.
Qi Moves First, Thus Swelling Occurs: Jian An's commentary: This answers the previous question regarding "swelling after needle withdrawal." Here, "swelling" refers to swelling at the puncture site. This differs in meaning from the previous section.
Profuse Bleeding with Unchanged Color: The *Jia Yi Jing* omits the four characters "blood exits profusely, color unchanged." Jian An's commentary: This answers the previous question regarding "color unchanged yet vexed." The phrase "blood exits profusely" is a superfluous insertion.
Therefore Vexation and Oppression: According to Zhang's edition, the character "Men" is written differently (indicating oppression/stifling sensation).
Excess in Both Yin and Yang: Zhang Yun states that pathological conditions of the meridians manifest as excess in both Yin and Yang.
How to Examine? Ma Yun explains that "Xiang" means to observe or look.
The State of Blood Vessels (End): Each according to its measure: The *Jia Yi Jing* omits the character "Zhe," and reads "Ze Er" as "Ci Er." Ma Yun states this describes the method of observing blood collaterals. "Ze" is synonymous with "Ce" (side/oblique); one must insert the needle obliquely to welcome and drain the pathogen. Zhi Shi notes: If the vessel is full, hard, transverse, and red, it indicates excessive blood within the vessel; if it varies in location up and down, it indicates the circulation of Qi and Blood; small ones like needles indicate retained blood in the Sun vessels; large ones like tendons indicate retained blood in the Jing tunnels. "Shu" refers to the degrees of entry and exit of blood vessels. Zhang Yun adds: If these degrees are lost and the needling technique is reversed, it leads to symptoms such as falling, collapse, deficiency, and swelling; one must correspondingly adhere to the proper needling measures.
Muscle Adhesion: Ma Yun states that "Zhuo" is the same as "Zhuo" (adhere). Zhang Yun explains that "Rou Zhuo" refers to muscle adhering to the needle. After needle insertion, heat arises, causing the muscle to attach tightly to the needle, making it tight, difficult to rotate, hard, and impossible to withdraw easily.