黄帝问于岐伯曰。周痹之在身也。上下移徙随脉。其上下左右相应。间不容空。愿问此痛在血脉
之中耶。将在分肉之间乎。何以致是。其痛之移也。间不及下针。其 痛之时。不及定治。而痛已
止矣。何道使然。愿闻其故。岐伯答曰。此众痹也。非周痹也。
此篇论经脉与络脉之缪处也。经脉者。脏腑之十二经脉。循行于上下者也。络脉者。脏腑之十
二大络。阴走阳而阳走阴。左之右而右之左者也。痹者。风寒湿邪。杂合于皮肤分肉之间。邪在于
皮肤。而流溢于大络者为众痹。在于分肉而厥逆于经脉者为周痹。帝以上下左右血脉分肉概而问之。
然虽总属于阴阳血气。而有皮肤肌肉之浅深。经脉络脉之缪处。故伯有周痹众痹之分焉。 痛。动而
痛也。不及定治者。邪客于左则右病。右盛则左病。左右移易。故不及下针也。按、玉版篇曰。人之
所受气者。谷也。谷之所注者。胃也。胃者。水谷血气之海也。海之所以行云气者。天下也。胃之
所出血气者。经隧也。经隧者。五脏六腑之大络也。此言胃腑所出之血气。从大络而布于皮肤。犹
海之行云气于天下。故邪客于皮肤。流溢于大络者。名曰众痹。谓邪在天下之广众也。
黄帝曰。愿闻众痹。岐伯对曰。此各在其处。更发更止。更居更起。以右应左。以左应右。非
能周也。更发更休也。黄帝曰善。刺之奈何。岐伯对曰。刺此者。痛虽已止。必刺其处。勿令复起。
各在其处者。邪隘于大络。与经脉缪处也。更发更止。更居更起者。左痛未已。而右脉先病也。
以右应左。以左应右者。左盛则右病。右盛则左病也。更发更休。故非能周也。病在左而右痛。病在
右而左痛。故刺其痛处。而
病虽已止。然必刺其所病之处。而勿令复起也。
帝曰善。愿闻周痹何如。岐伯曰。周痹者。在于血脉之中。随脉以上。随脉以下。不能左右。各
当其所。黄帝曰。刺之奈何。岐伯对曰。痛从上下者。先刺其下以过之。后刺其上以脱之。痛从下
上者。先刺其上以过之。后刺其下以脱之。
手足三阴三阳之脉。从下而上。从上而下。交相往还。故周痹在于血脉之中。随脉气上下。而不
能左之右而右之左也。各当其所者。与络脉各居其所也。过者。使邪气过在分肉皮肤以外出。脱者。使
病本之更脱于脉中也。沈亮宸曰。经脉之上下。络脉之左右。应司天在泉。左右间气。盖脏腑之经
脉络脉。总合于天之六气也。后刺以脱之。与必刺其处同义。
黄帝曰善。此痛安生。何因而有名。岐伯对曰。风寒湿气。客于外分肉之间。迫切而为沫。沫得寒
则聚。聚则排分肉而分裂也。分裂则痛。痛则神归之。神归之则热。热则痛解。痛解则厥。厥则他
痹发。发则如是。
此言周痹之因。乃邪客于分肉之间。而厥逆于脉也。分肉。肌肉之腠理。沫者。风湿相搏。迫切而
为涎沫也。沫得寒则聚。聚则排分肉而分裂其腠理。故痛。痛则心专在痛处。而神亦归之。神归之
则热。热则痛解。解则厥逆于脉中。厥于脉中。则彼之周痹发。发则如是之随脉上下也。此内不在
脏。而外未发于皮。独居分肉之间。真气不能周。故命曰周痹。
帝曰善。余已得其意矣。（此句宜衍当以下文接上节）此内不在脏。而外未发于皮。独居分肉之间。
真气不能周。故命曰周痹。故
刺痹者。必先切循其下之六经。视其虚实。及大络之血。结而不通。及虚而脉陷空者而调之。熨而
通之。其 坚。转引而行之。（ 音掣）
夫邪之客于形也。必先舍于皮毛。留而不去。则腠理开。开则抵深而入于分肉。留而不去。入舍
于络脉。留而不去。入舍于经脉。内连五脏。此邪在于分肉。而厥逆于脉中。故内不在脏。而外未
出于皮。独居分肉之间。真气不能周。故命曰周痹。真气者。五脏元真之气。三焦通会于肌腠之间。
所受于天。与谷气并而充身者也。邪沫凝聚于腠理。则真气不能充身。故曰周。谓因痹而不周也。
下之六经。谓脏腑十二经脉。本于足而合于六气也。夫邪在于分肉。则分肉实而经脉虚。厥逆于脉中。
则经脉实而分肉虚。故当视其虚实而取之。此刺周痹之法也。大络之血。结而不通。邪在于大络也。
及虚而脉陷空者。络气虚而陷于内也。熨而通之。启其陷下之气通于外也。 坚者。络结而掣 坚实。
故当转引而行之。此调治众痹之法也。张开之曰。邪在分肉。内则入于脉中。外则出于皮肤。故曰外
未发于皮。谓经脉分肉之邪。当仍从皮毛而出。
黄帝曰善。余已得其意矣。亦得其事也。九者经巽之理。十二经脉阴阳之病也。
事者。谓揆度奇恒之事。盖邪在于皮肤。留而不去。不得入于经。流溢于大络。而生奇恒之病。
故帝曰余已得其意矣。谓得其邪在分肉经脉之意矣。亦得其事也。言亦得知其邪在大络之事也。九针者。
乃经常巽顺之理。所以明十二经脉阴阳之病也。沈氏曰。观帝所言。谓九针之论。乃经巽之理。所以
明人之阴阳血气。终始出入。应天地之大道。学人当于针中求理。勿以至理反因针而昧之。圣人立
言之意。其庶几乎。
黄帝向岐伯问道：周痹存在于身体中，疼痛部位上下移动，跟随经脉的走向，左右上下相互呼应，间隙极小。我想问这种痛是在血脉之中呢，还是在肌肉之间？它是如何导致这种情况的？当疼痛转移时，来不及下针；当疼痛发作时，来不及确定治疗方案，而疼痛已经停止了。是什么道理使得这样呢？我希望听听其中的原因。
这一篇论述的是经脉与络脉交错分布的情况。所谓经脉，是指脏腑的十二正经，它们循行于身体的上下部位。所谓络脉，是指脏腑的十二大络，阴经走向阳经，阳经走向阴经，左侧影响右侧，右侧影响左侧。痹症，是风、寒、湿邪混杂在皮肤和肌肉之间。如果邪气停留在皮肤，并流溢到大络，就称为众痹；如果邪气停留在肌肉之间，并逆乱于经脉，就称为周痹。黄帝将上下左右的血脉和肌肉笼统地提问，虽然总归属于阴阳气血，但存在皮肤、肌肉的深浅不同，以及经、络脉交错分布的差异，所以岐伯区分了周痹和众痹。“痛”，是指变动而引发的疼痛。“不及定治”，是因为邪气客居在左侧则右侧发病，右侧盛实则左侧发病，左右交替变化，所以来不及下针。按《玉版》篇所说：人所受的气，来源于谷物；谷物所注之处，在于胃。胃是水谷精微和气血的海洋。海洋之所以能像云气一样运行，是因为天下的关系。胃所输出的气血，通过经隧（即五脏六腑的大络）布散。这里说的是胃腑所出的气血，从大络布散到皮肤，就像海洋的云气遍布天下一样。所以邪气客居在皮肤，流溢在大络的，叫做众痹，意思是邪气在广阔众多的地方。
岐伯回答说：众痹各自位于其特定的部位，交替发作又停止，交替潜伏又兴起，右边对应左边，左边对应右边，不能遍及全身，是交替发作又休息。
岐伯回答说：针刺这种病，虽然疼痛已经停止，也必须针刺其疼痛的部位，不要让病情复发。
“各自位于其特定部位”，是说邪气闭塞于大络，与经脉交错分布。“交替发作又停止，交替潜伏又兴起”，是说左边的疼痛还没结束，右边的脉先发病了。“右边对应左边，左边对应右边”，是说左侧盛实则右侧发病，右侧盛实则左侧发病。因为交替发作又休息，所以不能遍及全身。病在左边而右边痛，病在右边而左边痛，所以要针刺疼痛的部位，虽然病已停止，但必须针刺其患病的地方，以防止复发。
岐伯回答说：周痹，存在于血脉之中，随着经脉向上或向下移动，不能向左或向右扩散，各自位于其特定的位置。
岐伯回答说：疼痛从上往下移动的，先针刺下部以阻断邪气，后针刺上部以祛除病根；疼痛从下往上移动的，先针刺上部以阻断邪气，后针刺下部以祛除病根。
手足三阴三阳经脉，从下向上，从上向下，往返交错。所以周痹存在于血脉之中，随着脉气上下移动，而不能向左或向右扩散。各自位于其特定位置，是说与络脉各自居于其位不同。“过”，是指使邪气越过并排出到分肉和皮肤之外；“脱”，是指使病本从经脉中解脱出来。沈亮宸说：经脉的上下、络脉的左右，应当顺应司天在泉及左右间气的规律。脏腑的经络脉，总合于天的六气。后针刺以“脱”之，与“必须针刺其处”意义相同。
黄帝说：好。这种痛是怎么产生的？因什么而得名？
岐伯回答说：风、寒、湿气，客居在外部分肉之间，逼迫津液成为涎沫。涎沫遇到寒气则凝聚，凝聚则排挤分肉使其分裂。分裂则产生疼痛。疼痛时精神集中于此处，精神集中则产生热感。热感则疼痛缓解。疼痛缓解则出现厥逆，厥逆则其他痹症发作，发作情况就是这样。
这里说的是周痹的成因，乃是邪气客居在分肉之间，并逆乱于经脉。分肉，指肌肉的腠理。沫，指风湿相搏，逼迫而成的涎沫。涎沫遇到寒气则凝聚，凝聚则排挤分肉使其腠理分裂，所以疼痛。疼痛时心神专注于痛处，神也归于此处。神归则生热，热则疼痛解除。解除后则发生厥逆于脉中。厥逆于脉中，则其他的周痹发作，发作时就表现为随经脉上下移动。此病内不在脏，外未发于皮肤，独居在分肉之间，真气不能周流，所以命名为周痹。
黄帝说：好。我已经明白了其中的意思。（这句话可能有衍文，应当以下文接续上节）此病内不在脏，外未发于皮肤，独居在分肉之间，真气不能周流，所以命名为周痹。
治疗痹症，必须先切按循摸其下方的六经，观察其虚实，以及大络中是否有血液结滞不通，或者虚损导致脉陷空虚的情况，然后进行调理。用熨法来疏通它，对于坚硬掣引的，要转动引导使其运行。
邪气客居在人体，必定先停留于皮毛。停留不去，则腠理开泄，开泄则深入进入分肉。停留不去，则进入络脉。停留不去，则进入经脉，内连五脏。这里说的邪气在分肉，并逆乱于脉中，所以内不在脏，外未出于皮肤，独居在分肉之间，真气不能周流，所以命名为周痹。真气，是指五脏的元真之气，三焦通会于肌腠之间，禀受于天，与谷气合并而充养全身。邪气涎沫凝聚于腠理，则真气不能充养全身，所以说“周”，意为因痹阻而不能周流。
“下之六经”，是指脏腑的十二经脉，本源于足，合于六气。邪气在分肉，则分肉实而经脉虚；逆乱于脉中，则经脉实而分肉虚。所以应当观察虚实而取穴治疗。这是治疗周痹的方法。大络的血，结滞不通，是邪气在大络。以及虚损而脉陷空的，是络气虚而陷入内部。用熨法来疏通，是开启陷入内部的气使其通达外部。坚硬的掣引，是络脉结聚而变得坚实，所以应当转动引导使其运行。这是调治众痹的方法。张开之说：邪气在分肉，内则进入脉中，外则出于皮肤，所以说“外未发于皮”，意思是经脉和分肉的邪气，应当仍然从皮毛而出。
黄帝说：好。我已经明白了其中的意思，也掌握了其中的要领。九针是经络顺应的道理，用于阐明十二经脉阴阳的疾病。
“事”，是指衡量异常情况的诊疗事务。大概邪气在皮肤，停留不去，不得进入经脉，流溢于大络，而产生奇恒之病。所以黄帝说“我已经明白了其中的意思”，是指明白了邪气在分肉和经脉的意思；“也掌握了其中的要领”，是指也知道了邪气在大络的事务。九针，乃是经常顺应自然的道理，用来阐明十二经脉阴阳的疾病。沈氏说：看黄帝所说的话，认为九针的理论，是经络顺应的道理，用来阐明人的阴阳气血，终始出入，应合天地的大道。学习者应当在针法中探求医理，不要因为至高无上的医理反而被针法所蒙蔽。圣人立言的本意，大概就在于此吧。
Huangdi asked Qibo: "When Zhou Bi (Generalized Bi Syndrome) exists in the body, the pain migrates up and down following the meridians. The pain on the upper and lower, left and right sides corresponds to each other with minimal gaps. I wish to ask: Is this pain located within the blood vessels (Xue Mai), or between the muscles (Fen Rou)? How does it cause such a condition? When the pain shifts, there is not enough time to insert the needle; when the pain occurs, there is not enough time to determine the treatment, yet the pain has already ceased. What principle causes this? I wish to hear the reason."
Qibo replied: "This is Zhong Bi (Clustered Bi Syndrome), not Zhou Bi."
This chapter discusses the interlacing distribution of Jing Mai (Primary Meridians) and Luo Mai (Collaterals). The Primary Meridians refer to the twelve regular meridians of the Zang-Fu organs, which circulate through the upper and lower parts of the body. The Collaterals refer to the twelve major collaterals of the Zang-Fu organs; Yin meridians connect to Yang, and Yang meridians connect to Yin; the left side influences the right, and the right side influences the left. Bi syndrome refers to Wind, Cold, and Dampness pathogens mixing between the skin and muscles. If the pathogen remains in the skin and overflows into the major collaterals, it is called Zhong Bi; if the pathogen remains in the muscles and rebels against the primary meridians, it is called Zhou Bi. Huangdi asked generally about the blood vessels and muscles above and below, left and right. Although all belong to Yin and Yang and Qi and Blood, there are differences in the depth of skin and muscle, and the interlacing of meridians and collaterals. Therefore, Qibo distinguished between Zhou Bi and Zhong Bi. "Tong" (Pain) refers to pain caused by movement. "Not enough time to determine treatment" means that when the pathogen lodges on the left, the right becomes diseased; when the right is excess, the left becomes diseased. Due to this shifting between left and right, there is not enough time to insert the needle. According to the *Yu Ban* chapter: "The Qi received by humans comes from grain; grain enters the Stomach. The Stomach is the sea of water-grain, Qi, and Blood. Just as the sea moves cloud-like Qi across the world, so too does the Stomach output Qi and Blood through the Jing Sui (Meridian Channels). The Jing Sui are the major collaterals of the five Zang and six Fu organs. This states that the Qi and Blood exiting the Stomach organ spread to the skin via the major collaterals, just as the sea's clouds spread across the world. Thus, when pathogens lodge in the skin and overflow into the major collaterals, it is named Zhong Bi, meaning the pathogen is in a vast, numerous area."
Huangdi said: "I wish to hear about Zhong Bi."
Qibo responded: "Zhong Bi resides in specific locations. It alternately erupts and ceases, alternately rests and rises. The right responds to the left, and the left responds to the right. It cannot circulate throughout the whole body; it alternates erupting and resting."
Huangdi said: "Excellent. How should it be needled?"
Qibo said: "To needle this condition, even if the pain has ceased, one must still needle the affected site to prevent recurrence."
"Residing in specific locations" means the pathogen is blocked in the major collaterals, interlacing with the primary meridians. "Alternately erupting and ceasing, alternately resting and rising" means that while pain persists on the left, the pulse on the right first becomes diseased. "Right responds to left, left responds to right" means that when the left is excess, the right becomes diseased; when the right is excess, the left becomes diseased. Because it alternates erupting and resting, it cannot circulate throughout the whole body. Disease on the left causes pain on the right, and disease on the right causes pain on the left. Therefore, needle the painful site. Although the disease has ceased, one must needle the site of the pathology to prevent recurrence.
Huangdi said: "Excellent. I wish to hear about Zhou Bi."
Qibo said: "Zhou Bi resides within the blood vessels. It follows the meridians upward or downward but cannot move left or right. It stays in its respective location."
Huangdi said: "How should it be needled?"
Qibo said: "If the pain moves from top to bottom, first needle the lower part to intercept the pathogen, then needle the upper part to eliminate the root. If the pain moves from bottom to top, first needle the upper part to intercept the pathogen, then needle the lower part to eliminate the root."
The three Yin and three Yang meridians of the hands and feet move upward from below and downward from above, intersecting and returning. Thus, Zhou Bi resides within the blood vessels, moving up and down with the meridian Qi, but cannot move left or right. "Staying in its respective location" means it differs from collaterals, which each occupy their own spots. "Guo" (Intercept/Pass) means causing the pathogen to pass beyond the muscles and skin to exit. "Tuo" (Eliminate/Shed) means causing the root of the disease to detach from within the meridians. Shen Liangchen stated: "The up and down of meridians, and the left and right of collaterals, should correspond to the Si Tian (Heavenly Command) and Zai Quan (Earthly Authority) and the intervening Qi. The meridians and collaterals of the Zang-Fu organs collectively integrate with the Six Qi of Heaven. Needling later to 'Tuo' (eliminate) has the same meaning as 'must needle the site.'"
Huangdi said: "Excellent. How is this pain generated? Why is it named so?"
Qibo said: "Wind, Cold, and Dampness pathogens lodge between the outer muscles, pressing tightly to form phlegm-fluids (Mo). When these fluids encounter Cold, they condense. Condensation pushes against the muscles, causing them to split. Splitting causes pain. When there is pain, the Spirit (Shen) returns to it. When the Spirit returns, heat is generated. Heat resolves the pain. Resolution leads to Jue (Reversal/Cold extremities). Jue causes other Bi syndromes to erupt. Eruption occurs thus."
This explains the cause of Zhou Bi: the pathogen lodges between the muscles and rebels within the meridians. "Fen Rou" refers to the interstices of the muscles. "Mo" refers to saliva/phlegm formed by the struggle between Wind and Dampness under pressure. When Mo encounters Cold, it condenses; condensation pushes against the muscles, splitting their interstices, thus causing pain. When there is pain, the Heart focuses on the painful spot, and the Shen also gathers there. Shen gathering generates heat; heat resolves the pain. Resolution leads to Jue rebellion within the meridians. Jue within the meridians causes the Zhou Bi to erupt, manifesting as movement up and down along the meridians. This disease is internally not in the Zang organs, externally not erupted on the skin, but resides solely between the muscles. Because the True Qi (Zhen Qi) cannot circulate fully, it is named Zhou Bi.
Huangdi said: "Excellent. I have grasped its meaning. (This sentence may be an interpolation and should connect to the following text.) This disease is internally not in the Zang organs, externally not erupted on the skin, but resides solely between the muscles. Because the True Qi cannot circulate fully, it is named Zhou Bi."
To treat Bi syndrome, one must first palpate and trace the six meridians below, observing their deficiency or excess, and check the major collaterals for blood stagnation and blockage, or for deficiency where the pulse sinks into emptiness. Then regulate them. Use moxibustion/warming therapy to unblock them. For those that are hard and pulling, rotate and guide the Qi to promote circulation.
When pathogens lodge in the body, they first settle in the hair follicles and skin. If they remain, the interstices open; if they remain, they penetrate deeply into the muscles. If they remain, they enter the collaterals. If they remain, they enter the primary meridians, connecting internally to the five Zang organs. Here, the pathogen is in the muscles and rebels within the meridians. Thus, it is internally not in the Zang, externally not out of the skin, residing solely between the muscles, preventing the True Qi from circulating fully, hence named Zhou Bi. True Qi refers to the primal Qi of the five Zang organs. The San Jiao (Triple Burner) communicates through the muscle interstices. It is received from Heaven and combines with Grain Qi to nourish the body. When pathogenic fluids condense in the interstices, the True Qi cannot nourish the body. Hence, "Zhou" means unable to circulate due to obstruction.
"The six meridians below" refers to the twelve primary meridians of the Zang-Fu organs, originating from the feet and integrating with the Six Qi. When the pathogen is in the muscles, the muscles are excess and the meridians are deficient. When rebelling within the meridians, the meridians are excess and the muscles are deficient. Therefore, one must observe deficiency and excess to select points. This is the method for needling Zhou Bi. Blood stagnation in the major collaterals indicates the pathogen is in the major collaterals. Deficiency with sunken pulses indicates collateral Qi deficiency sinking inward. Warming therapy opens the sunken Qi to communicate outward. Hardness and pulling indicate collateral knotting becoming firm; thus, one must rotate and guide to promote circulation. This is the method for regulating Zhong Bi. Zhang Kaizhi said: "The pathogen is in the muscles; internally it enters the meridians, externally it exits the skin. Hence 'externally not erupted on the skin' means the pathogen in the meridians and muscles should still exit through the skin."
Huangdi said: "Excellent. I have grasped its meaning and also its principles. The Nine Needles follow the logic of the meridians, explaining the diseases of Yin and Yang in the twelve primary meridians."
"Principles" (Shi) refers to the matter of assessing normal and abnormal conditions. Generally, if the pathogen is in the skin and remains without entering the meridians, overflowing into the major collaterals, it produces strange and constant diseases. Thus, Huangdi said, "I have grasped its meaning," referring to understanding the pathogen in the muscles and meridians; "and also its principles," referring to knowing the matters of the pathogen in the major collaterals. The Nine Needles follow the constant logic of compliance, used to clarify the diseases of Yin and Yang in the twelve primary meridians. Shen Shi said: "Observing what Huangdi said, he considers the theory of the Nine Needles to be the logic of meridian compliance, used to clarify human Yin and Yang, Qi and Blood, beginnings and endings, entry and exit, corresponding to the Great Dao of Heaven and Earth. Students should seek principles within needling techniques and not let supreme principles be obscured by the needles themselves. The intent of the sages in establishing words is likely here."