平按∶此篇自篇首至末，见《灵枢》卷六第三十九《血络论》篇，又见《甲乙经》卷一第十
四。
黄帝曰∶愿闻奇邪而不在经者。岐伯曰∶血络是也。（邪在血络奇络之中，故曰奇邪也。平
按∶经者下《甲乙》有何也二字。）黄帝曰∶刺血络而仆者，何也？血出而射者，何也？血出黑
而浊者，何也？血清半为汁者，何也？发针而肿者，何也？血出多若少而面色苍苍然者，何也？
发针面色不变而烦闷者，何也？多出血而不动摇者，何也？愿闻其故。（刺络有此八种之异，请
解所以也。平按∶《灵枢》血出黑作血少黑。血清半为汁者《灵枢》、《甲乙》作血出清而半为
汁者。血出多若少《灵枢》、《甲乙》作若多若少。烦闷《灵枢》作烦 。多出血《甲乙》作出
血多。）岐伯曰∶脉气盛而血虚者，刺之则脱气，脱气则仆。（脉中气多血少，血持于气，刺之
气血俱出，其血先虚而复脱气，气血俱夺，故仆也。平按∶盛《灵枢》、《甲乙》作甚。）血气
俱盛而阴气多者，其血滑，刺之则射之。（阳气多者其血滑，刺之血射。此为阴气多者，阴多为
涩，故阴字错也。平按∶射下《灵枢》、《甲乙》无之字。）阳气蓄积，久留而不泻者，其血黑
以浊，故不能射。（热气久留痈蒸，故血黑而浊也。平按∶蓄积《灵枢》作畜积，《甲乙》作积
蓄。）新饮而液渗于络，而未合和血也，故血出而汁别焉。其不新饮者，身中有水，久则为肿。
（新水未变为血，所以别行。旧水留而不泻，以为水肿。平按∶未合和血《甲乙》作未和合于血。）
阴气积于阳，则其气因于络，故刺之血未出而气先行，故肿。（阴气久积阳络之中，刺之阴血涩而未
行，阳气先行，故肿。）阴阳之气，新相得而未和合，因而泻，则阴阳俱脱，表里相离，故脱色
面苍然。（得，遇也。阴阳成和则表里相持，未合刺之，故俱脱离，所以脱色面色青。平按∶泻
下《灵枢》、《甲乙》有之字。《甲乙》写作泻。苍然《灵枢》作苍苍然。注成袁刻作咸，亦通。）
刺之血多、色不变而烦闷者，刺络中虚经，虚经之属于阴者阴脱，故烦闷。（刺络血者，邪尽血
变。血多其色不变，其心闷者，以其刺属脏虚经，阴气有脱，致使心闷也。平按∶血多《灵枢》
作血出多。《甲乙》无血多色三字。中虚经《灵枢》、《甲乙》作而虚经。）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，弗能虚也。（阴阳相共受邪为痹，
是为阴阳俱盛，故出血不虚也。平按∶外注于络，《甲乙》外上有而字。）黄帝曰∶相之奈何？
岐伯曰∶血脉盛者，坚横以赤，上下无处，小者如针，大者如 ，即而泻之万全。（相，候也。
阴阳俱盛，其候如何？阴阳内经盛溢，必注于络，故候坚横盛络泻之，万全者也。平按∶《灵枢》、
《甲乙》无处作无常处，如 作如筋。即而泻之《甲乙》作刺而泻之。）地无失数，失数而反，
各如其度。（数，理也。若失理而反取者，各如前之度。平按∶地《灵枢》、《甲乙》作故。反
《甲乙》作返。）黄帝曰∶针入如肉着者，何也？岐伯曰∶热气因于针则针热，热则肉着针，故
坚焉。（肤肌气热，故令针热，则肉着转之为难，可动针久留，热去针寒，自然相离也。平按∶
针入如肉着者《灵枢》作针入而肉着者，《甲乙》作针入肉着。注肉着袁刻误作内着。）
平按：本篇从篇首到结尾，见于《灵枢》卷六第三十九《血络论》篇，又见于《甲乙经》卷一第十四。
黄帝说：我想了解那些奇异且不在经脉中的邪气。岐伯说：那就是血络。（邪气在血络和奇络之中，所以称为奇邪。平按：下文的《甲乙经》中有“何也”二字。）黄帝说：针刺血络后导致患者昏倒的，是什么原因？出血呈喷射状的，是什么原因？血液颜色黑而浑浊的，是什么原因？血液清稀且一半像汁液的，是什么原因？拔针后出现肿块的，是什么原因？无论出血多还是少，面色都变得青苍色的，是什么原因？拔针后面色没有变化却感到烦闷的，是什么原因？大量出血但身体没有动摇的，是什么原因？我想听听其中的缘故。（刺络有这八种不同的表现，请解释其原因。平按：《灵枢》中“血出黑”作“血少黑”。关于“血清半为汁者”，《灵枢》、《甲乙经》作“血出清而半为汁者”。关于“血出多若少”，《灵枢》、《甲乙经》作“若多若少”。关于“烦闷”，《灵枢》作“烦惋”。关于“多出血”，《甲乙经》作“出血多”。）
岐伯说：脉气盛而血虚的人，针刺会导致气脱，气脱就会昏倒。（脉中气多血少，血依附于气，针刺时气血俱出，血先虚而后气脱，气血两伤，所以昏倒。平按：“盛”字，《灵枢》、《甲乙经》作“甚”。）血气都盛而阴气多的人，其血液滑利，针刺时血液会喷射。（阳气多的人血液滑利，针刺时血液喷射。这里说是阴气多，阴气多通常表现为涩滞，所以这里的“阴”字是错字。平按：“射”字下，《灵枢》、《甲乙经》没有“之”字。）阳气蓄积，长久停留而不宣泄，其血液就会黑而浑浊，所以不能喷射。（热气长久停留蒸灼，所以血液黑而浑浊。平按：“蓄积”，《灵枢》作“畜积”，《甲乙经》作“积蓄”。）刚喝过水，津液渗入络脉，还未与血液融合调和，所以血液流出时汁液分离。如果不刚喝水，体内有水湿，长久停留就会形成水肿。（新饮入的水尚未变为血，所以单独运行。旧有的水湿留滞不泄，就形成水肿。平按：“未合和血”，《甲乙经》作“未和合于血”。）阴气积聚在阳分（体表/阳络），则气机阻滞于络脉，所以针刺时血未流出而气先行，因此出现肿胀。（阴气长久积聚在阳络之中，针刺时阴血涩滞而未行，阳气先行，所以肿胀。）阴阳之气，刚刚相遇但未调和，此时如果泻法不当，则阴阳俱脱，表里分离，所以面色脱失而呈现青色。（得，就是遇的意思。阴阳和谐则表里相持，未调和就针刺，所以两者都脱离，因此面色脱失而发青。平按：“泻”字下，《灵枢》、《甲乙经》有“之”字。《甲乙经》写作“写”。苍然，《灵枢》作“苍苍然”。注文中“成”字，袁刻本作“咸”，也通。）
针刺后出血多、面色不变却感到烦闷的，是因为刺到了络脉中属于虚经的部分，属于阴的虚经导致阴气脱失，所以烦闷。（刺络放血，邪气尽去则血变。如果出血多而面色不变，心中闷乱，是因为所刺的是属脏的虚经，阴气有脱失，致使心闷。平按：“血多”，《灵枢》作“血出多”。《甲乙经》无“血多色”三字。“中虚经”，《灵枢》、《甲乙经》作“而虚经”。）阴阳之气相互结合而成为痹证的，这是邪气内溢于经脉，外注于络脉，像这样的情况阴阳都有余，即使大量出血，也不能使正气虚弱。（阴阳共同受邪成为痹证，这是阴阳都盛实，所以出血不会导致正气虚弱。平按：“外注于络”，《甲乙经》在“外”上有“而”字。）
黄帝说：如何诊察呢？岐伯说：血脉充盛的，血管坚硬横突且发红，上下无常处，小的如针尖，大的如筋脉，立即泻之可保万全。（相，就是候望观察的意思。阴阳都盛实，其征象如何？阴阳内经盛实溢满，必然注于络脉，所以观察坚横充盛的络脉进行泻法，即可万全。平按：《灵枢》、《甲乙经》“无处”作“无常处”，“如 ”作“如筋”。“即而泻之”，《甲乙经》作“刺而泻之”。）治疗不要失去规律，如果失误反而加重，各自符合之前的程度。（数，就是理法。如果违背理法反向取治，结果各自符合前述的严重程度。平按：“地”，《灵枢》、《甲乙经》作“故”。“反”，《甲乙经》作“返”。）
黄帝说：进针后感觉像肉附着在针上一样，是什么原因？岐伯说：热气附着在针上则针发热，热则肌肉附着在针上，所以感觉坚硬。（肌肤气热，所以令针发热，肌肉附着转动困难，可以动针久留，热去针寒，自然分离。平按：“针入如肉着者”，《灵枢》作“针入而肉着者”，《甲乙经》作“针入肉着”。注文中“肉着”，袁刻本误作“内着”。）
Ping An: This section, from the beginning to the end of the chapter, is found in Volume 6, Chapter 39 "Lun Xueluo" (Discussion on Blood Collaterals) of the *Ling Shu* (Spiritual Pivot), and also in Volume 1, Chapter 14 of the *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion).
Huang Di said: I wish to hear about strange pathogens that are not located in the meridians. Qi Bo said: They are located in the blood collaterals. (Pathogens are within the blood collaterals and extraordinary collaterals, thus they are called strange pathogens. Ping An: The *Jia Yi Jing* below contains the two characters "he ye" [what is it?].) Huang Di said: What causes a patient to faint after needling the blood collaterals? What causes the blood to spray out? What causes the blood to be dark and turbid? What causes the blood to be clear with half of it resembling fluid/juice? What causes swelling after removing the needle? What causes the complexion to appear pale/cyan regardless of whether the bleeding is excessive or insufficient? What causes vexation and oppression without a change in complexion after removing the needle? What causes no physical tremor despite significant blood loss? I wish to understand the reasons for these phenomena. (There are eight distinct variations when needling collaterals; please explain their causes. Ping An: In the *Ling Shu*, "blood comes out black" is written as "blood is little and black." Regarding "clear blood with half becoming juice," both the *Ling Shu* and *Jia Yi Jing* write "blood comes out clear and half becomes juice." Regarding "blood comes out much or little," both texts write "if much if little." Regarding "vexation/oppression," the *Ling Shu* writes "fan wan." Regarding "much blood loss," the *Jia Yi Jing* writes "chuxue duo" [bleeding is much].)
Qi Bo said: In individuals where meridian qi is abundant but blood is deficient, needling will cause qi depletion; qi depletion leads to fainting. (When there is more qi than blood in the vessels, blood relies on qi. Needling causes both qi and blood to exit; since blood is first depleted, qi subsequently depletes, leading to the exhaustion of both qi and blood, hence the fainting. Ping An: The character "sheng" [abundant] is written as "shen" [very/extreme] in the *Ling Shu* and *Jia Yi Jing*.) In individuals where both blood and qi are abundant, but yin qi predominates, their blood is slippery; needling causes the blood to spray. (When yang qi is abundant, the blood is slippery, causing it to spray upon needling. The text mentions yin qi predominance here; however, yin predominance usually presents with sluggishness/stasis, so the character "yin" here is likely an error. Ping An: The character "zhi" [particle] after "she" [spray] is absent in the *Ling Shu* and *Jia Yi Jing*.) When yang qi accumulates and remains stagnant for a long time without being vented, the blood becomes dark and turbid, and thus cannot spray. (Heat pathogen lingering for a long time steams and cooks, causing the blood to become dark and turbid. Ping An: "Xu ji" [accumulate] is written as "xu ji" in the *Ling Shu* and "ji xu" in the *Jia Yi Jing*.) If one has recently drunk water, the fluids seep into the collaterals before mixing and harmonizing with the blood; therefore, when blood flows out, the fluid separates. If one has not recently drunk water, but there is water retention in the body, prolonged stagnation leads to edema. (Newly ingested water has not yet transformed into blood, so it circulates separately. Old water retention that is not vented forms edema. Ping An: "Wei he he xue" [not yet harmonized with blood] is written as "wei he he yu xue" in the *Jia Yi Jing*.) When yin qi accumulates in the yang aspect (superficial/yang collaterals), the qi mechanism becomes obstructed in the collaterals; thus, upon needling, the qi moves forward before the blood emerges, resulting in swelling. (Yin qi has accumulated long-term within the yang collaterals; upon needling, the yin blood is sluggish and does not flow, while the yang qi moves ahead, causing swelling.) When yin and yang qi have just met but are not yet harmonized, inappropriate draining methods will cause both yin and yang to deplete, separating the interior from the exterior; consequently, the complexion loses its luster and appears cyan. ("De" means encounter. When yin and yang are harmonious, the interior and exterior support each other. Needling before harmony causes them to detach, leading to loss of color and a cyan appearance. Ping An: The character "zhi" [particle] after "xie" [drain] is present in the *Ling Shu* and *Jia Yi Jing*. The *Jia Yi Jing* uses the character "xie" [write/excrete] instead of "xie" [drain]. "Cang ran" [cyan-looking] is written as "cang cang ran" in the *Ling Shu*. In the commentary, "cheng" is printed as "xian" in the Yuan edition, which is also acceptable.)
If there is significant blood loss, the complexion remains unchanged, yet the patient feels vexated and oppressed, it is because the needle entered a collateral connected to a deficient meridian; deficiency in the yin meridians leads to yin qi depletion, causing mental oppression. (When needling collaterals to release blood, once the pathogen is exhausted, the blood quality changes. If there is much blood loss but the complexion does not change, and the heart feels stifled, it is because the puncture site belongs to a deficient meridian associated with the zang organs; yin qi depletion results in heart stifling. Ping An: "Xue duo" [blood is much] is written as "xue chu duo" [blood comes out much] in the *Ling Shu*. The *Jia Yi Jing* omits the three characters "xue duo se" [blood much color]. "Zhong xu jing" [middle deficient meridian] is written as "er xu jing" [and deficient meridian] in the *Ling Shu* and *Jia Yi Jing*.) When yin and yang qi interact and combine to form Bi syndrome (obstruction), this indicates that pathogens 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 righteous qi will not become deficient. (Yin and yang jointly suffer from pathogens forming Bi syndrome, indicating that both yin and yang are flourishing/excess, so blood loss does not lead to deficiency. Ping An: "Wai zhu yu luo" [externally pours into collaterals], the *Jia Yi Jing* adds the character "er" [and] before "wai".)
Huang Di said: How should one inspect/diagnose this? Qi Bo said: When the blood vessels are full, they appear hard, transverse, and red, with no fixed location; small ones resemble needle points, large ones resemble sinews. Immediate draining ensures complete safety. ("Xiang" means to observe/wait and see. How are the signs of excess yin and yang manifested? Internal excess and overflow inevitably pour into the collaterals; thus, observing the hard, full, transverse collaterals and draining them ensures safety. Ping An: "Wu chu" [no place] is written as "wu chang chu" [no fixed place] in the *Ling Shu* and *Jia Yi Jing*; "ru " [like ] is written as "ru jin" [like sinew] in the *Jia Yi Jing*. "Ji er xie zhi" [immediately drain it] is written as "ci er xie zhi" [needle and drain it] in the *Jia Yi Jing*.) Do not deviate from the principles/rules; if you err and reverse the treatment, the outcome will correspond to the severity described previously. ("Shu" refers to principle/method. If one violates the principles and treats in reverse, the result will match the degrees mentioned earlier. Ping An: "Di" is written as "gu" [therefore] in the *Ling Shu* and *Jia Yi Jing*. "Fan" is written as "fan" [return/reverse] in the *Jia Yi Jing*.)
Huang Di said: Why does the needle feel as if the flesh is adhering to it upon insertion? Qi Bo said: Heat pathogen attaches to the needle, making the needle hot; heat causes the flesh to adhere to the needle, creating a sensation of firmness/resistance. (The qi of the skin and muscles is hot, causing the needle to heat up; the flesh adheres and rotation is difficult. One can manipulate the needle and retain it for a long time; once the heat dissipates and the needle cools, separation occurs naturally. Ping An: "Zhen ru ru rou zhe zhe" [needle enters like flesh sticking] is written as "zhen ru er rou zhe zhe" [needle enters and flesh sticks] in the *Ling Shu* and "zhen ru rou zhe" [needle enters flesh sticks] in the *Jia Yi Jing*. In the commentary, "rou zhe" [flesh sticks] was erroneously printed as "nei zhe" [inside sticks] in the Yuan edition.)