亦所以行荣卫者也。夫肉有大分小分。大分者。如股肱之肉。各有界畔。小分者。肌肉之内。皆有纹理。然理路虽分。
而交相会合。是大分处即是大会处。小分处即是小会处也。分会之间。以行荣卫之气。故名之曰溪谷。易曰山泽通气。
如山泽之气。从溪谷以相通。大气。宗气也。愚按荣气生于中焦水谷之精。流溢于脉中。布散于脉外。专精者。行于经
隧。经隧者。胃之大络。与五脏六腑之大络也。是荣气之有行于脉中。有行于脉外。有同宗气出于胃之经隧。注于脏腑
之大络。而出于肌腠之间。三者之气。交相会合。故曰以行荣卫。以会大气。是以上节论脉中之荣气。与卫气交通于孙
络之间。此论布散之荣气。与卫气宗气。大会于分肉之外。是卫气之通于脉中。而荣气之行于脉外者也。王芳侯曰。皮
肤有血。当知脉外有荣。卫气先行皮肤。先充络脉。是脉中之有卫。故曰。脉荣荣如蜘蛛丝者。阳气衰也。)邪溢气壅。
脉热肉败。荣卫不行。必将为脓。内销骨髓。外破大 。留于节凑。必将为败。(此邪客于溪谷之间而为热也。夫气为阳
邪。留于肌腠之气分。邪正相搏。则为病热。故有壅脓消破之败证矣。邪气淫溢。则正气自壅。溪谷之气。与脉相通。
是以脉热于内。而肉败于外也。荣卫不行。则血气留滞。而为壅脓。 、足之股肉也。节凑、筋骨相连之处。邪留其间。
则筋骨必将为败矣。此论邪因气以化热。故上言热证而不曰热邪。下节论寒邪所客。故曰积寒。莫仲超曰。经云。溪
谷属骨。盖骨生筋而筋生肉。故溪谷之邪。留而不去。必致节凑败而骨髓销。)积寒留舍。荣卫不居。卷内缩筋。肋肘不
得伸。内为骨痹。外为不仁。命曰不足。大寒流于溪谷也。(此寒邪留于溪谷之间。而不为病热者也。积寒留舍。致荣卫
不能居其间。寒邪凝滞。又不得正气以和之。以致肉卷而筋缩也。肋肘乃筋骨之机关。故不得伸舒。邪闭于外。故内为
骨痹。荣卫内逆。故外为不仁。命曰不足。盖热邪淫溢。是属有余。寒性凝涩。故为不足。此大寒之邪。流于溪谷之间。
以致筋骨皆为病也。张兆璜曰。皮肤为之不仁。缘荣卫不居于外。不居于外者。逆于脉内也。故此节无脉病。莫仲
超曰。居、止也。热邪流行。则荣卫不行。寒邪留舍。则荣卫不居。邪正之不相合也。)溪谷三百六十五穴会。亦应一岁。
其小痹淫溢。循脉往来。微针所及。与法相同。(溪谷之间。亦有三百六十五穴会。以应一岁。与孙络之相同。可以微针
刺取。以泻其邪。小痹者。谓邪始入于皮肤。未伤筋骨。脉、谓孙络脉也。邪在皮肤。循脉往来。见而泻之。与治孙络
之法相同。而亦不必问其穴会之所在也。此言邪之客于人也。必先始于皮肤。次于孙络。入于肌内。以及于筋骨。在浅
之时。微针所及。易于散解。无使其入深而为大痹也。)帝乃辟左右而起。再拜曰。今日发蒙解惑。藏之金匮。不敢复出。
乃藏之金兰之室。署曰气穴所在。(色脉者。上帝之所贵也。故藏之金匮。贮之金兰之室焉。张兆璜曰。金兰之室。藏之
于心也。)岐伯曰。孙络之脉别经者。其血盛而当泻者。亦三百六十五脉。并注于络。传注十二脉络。非独十四脉络也。
(此复申明孙络之与大络相通也。夫经脉之支别曰络脉。络脉之支别曰孙络。而孙络之脉。又有与经脉相别而与大络相
通者。亦三百六十五脉。并注于大络。复传注于十二脉络。非独十四脉络也。盖言十四脉络之外而又有十二脉络。十四
脉络者。十二脏腑与任督之别。共十四大络也。十二脉络者。十二脏腑之经正也。是十二经正与十四大络相通。十四大
络复与三百六十五络相通。是以邪舍于孙络。留而不去闭塞不通。不得入于经。流溢于大络而生奇病。故曰以溢奇邪。
以通荣卫。)内解泻于中者十脉。(十脉者。谓五脏之脉也。此言孙络三百六十五脉。与十二脉络。十四大络。设有邪客
于其间者。当从五脏之经脉以泻解之。盖诸络之原。本于五脏也。故缪刺篇曰。凡刺之数。先治其经脉。切而从之。审
其虚实而调之。不调者经刺之。有痛而经不病者缪刺之。因视其皮部有血络者尽取之。张兆璜曰。上节云。以痹淫溢。
循脉往来。微针所及。末结曰内解于中者十脉。是从外而循于内也。缪刺篇曰。先治其经脉。因视其皮部。有血络者尽
取之。是从内而循于外也。盖邪之中人。始于皮肤孙络。入于筋骨经脉。有留舍于外者。有流溢于内者。有从浅而入深
者。有从里而复出之表者。邪气浮溢。无有恒常。是以经旨错综。学人皆当体会。)
这也是为了运行营气和卫气的作用。人体的肌肉有大分和小分之分。大分,指的是如大腿和上臂这样界限分明的肌肉部位;小分,指的是肌肉内部具有纹理的部分。虽然纹理路径分明,但彼此之间相互交汇连接,因此大分处就是大会合之处,小分处就是小会合之处。在分会之间,用来运行营卫之气,所以称之为“溪谷”。《易经》说“山泽通气”,就像山与泽的气通过溪谷相互贯通一样。这里所说的“大气”,指的是宗气。我按:营气产生于中焦水谷的精微物质,流溢于脉管之中,布散于脉管之外。其中精专的部分,运行于经隧(胃的大络及五脏六腑的大络)。经隧,是胃的大络,也是五脏六腑的大络。这说明营气有的行于脉中,有的行于脉外,有的同宗气一起从胃的经隧注入脏腑的大络,而出现在肌腠之间。这三种气相互交汇,所以说能够运行营卫,以会合大气。所以上一节论述的是脉中的营气与卫气在孙络之间交通;这一节论述的是布散的营气与卫气、宗气在分肉之外大会合。这是卫气通行于脉中,而营气运行于脉外的情况。王芳侯说:“皮肤中有血,应当知道脉外有营气。卫气先行于皮肤,先充盈络脉,所以脉中有卫气。因此说‘脉中营气微弱如蜘蛛丝’,这是阳气衰弱的表现。”
邪气充溢导致气机壅滞,脉热肉败,营卫运行不畅,必然化为脓液。向内消蚀骨髓,向外破溃大块肌肉,停留在关节屈伸之处,必然导致败坏。(这是邪气客居在溪谷之间而产生热证。气属阳邪,停留在肌腠的气分,邪正相搏,就形成病热,所以出现壅积、化脓、消蚀、破溃等败坏证候。邪气淫溢,则正气自然壅滞。溪谷之气与脉相通,所以脉内发热,而肌肉在外败坏。营卫不行,则血气留滞,从而形成壅脓。髀(bì),指大腿部的肌肉。节凑,指筋骨相连之处。邪气停留在那里,筋骨必然败坏。这一段论述邪气因气而化热,所以上面说热证而不称热邪;下一节论述寒邪所客,所以称为积寒。莫仲超说:“经文说‘溪谷属骨’,大概是因为骨生筋,筋生肉,所以溪谷的邪气停留不去,必然导致关节败坏而骨髓消蚀。”)
积寒留驻,营卫不能安居其中,导致身体蜷缩、筋脉拘急,肋部和肘部不能伸展。在内表现为骨痹,在外表现为麻木不仁,命名为“不足”,这是大寒之邪流注于溪谷所致。(这是寒邪留在溪谷之间,而不表现为热证。积寒留驻,致使营卫不能安居其间。寒邪凝滞,又得不到正气的调和,从而导致肌肉卷缩、筋脉拘急。肋部和肘部是筋骨的机关,所以不能伸展。邪气闭塞于外,所以在内形成骨痹;营卫内逆,所以在外形成麻木不仁。命名为“不足”,因为热邪淫溢属于有余,而寒性凝涩属于不足。这种大寒之邪流注于溪谷之间,导致筋骨都发生病变。张兆璜说:“皮肤之所以麻木不仁,是因为营卫不居于体表。不居于体表,是因为逆乱于脉内。所以这一节没有提到脉的病状。”莫仲超说:“居,即止的意思。热邪流行,则营卫不行;寒邪留驻,则营卫不居。这是邪气与正气不相融合的表现。”)
溪谷对应三百六十五个穴会,也对应一年三百六十五天。那些细小的痹症淫溢,循着脉道往来流动,可以用微针治疗,方法与常规相同。(溪谷之间也有三百六十五个穴会,以对应一年,这与孙络的情况相同,可以用微针刺取,以泻除邪气。所谓小痹,是指邪气刚刚侵入皮肤,尚未伤及筋骨。脉,指孙络。邪气在皮肤,循着脉道往来,发现后予以泻治,与治疗孙络的方法相同,而且也不必问其穴会的具体所在。这一段是说邪气客居人体,必定先从皮肤开始,其次进入孙络,再深入肌内,进而到达筋骨。在邪气浅表的时候,微针即可触及,容易使其消散解除,不要让它深入而形成大痹。)
黄帝于是屏退左右起身,拜了两拜说:“今天您启发了我的蒙昧,解除了我的疑惑,我将把它藏在金匮之中,不敢再随意拿出来。于是把它藏在金兰之室,题名为‘气穴所在’。”(色脉诊法,是上帝所重视的,所以藏在金匮,贮存在金兰之室。张兆璜说:“金兰之室,是藏在心中的意思。”)
岐伯说:“从经脉别出的孙络,其中血液充盛应当泻除的,也有三百六十五条,它们都注入络脉,并传注到十二脉络,不仅仅是十四大脉络。(这是再次申明孙络与大络相通。经脉的分支叫做络脉,络脉的分支叫做孙络,而孙络中又有与经脉相别而与大大络相通的,也有三百六十五条,都注入大络,再传注于十二脉络,不仅仅是十四大脉络。意思是说在十四大络之外还有十二脉络。十四大络,是十二脏腑与任督二脉的别络,共十四条大络。十二脉络,是十二脏腑的正经。所以十二正经与十四大络相通,十四大络又与三百六十五条络脉相通。因此邪气舍于孙络,停留不去,闭塞不通,不能进入经脉,而是流溢于大络从而产生奇病,所以说‘以溢奇邪,以通荣卫’。)
内部的解泻作用在于十脉。(十脉,指五脏的经脉。这里说孙络三百六十五条,与十二脉络、十四大络,如果有邪气客居在其中,应当从五脏的经脉进行泻解。因为所有络脉的根源本于五脏。所以《缪刺篇》说:“凡针刺的原则,先治疗其经脉,切按并从之,审察其虚实而调治它。不调的用经刺法,有痛感但经脉无病的用缪刺法。观察其皮部有血络的,全部取之。张兆璜说:‘上一节说“痹症淫溢,循脉往来,微针可及,末结者内解于中”,这是从外循行到内。《缪刺篇》说“先治其经脉,观察皮部,有血络的全部取之”,这是从内循行到外。大概邪气中人,始于皮肤孙络,入于筋骨经脉,有留滞在体外的,有流溢于体内的,有从浅入深的,有从里复出于表的。邪气浮溢,没有恒定常态,所以经旨错综复杂,学习的人都应当体会。’”)
This is also to facilitate the circulation of Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi). Flesh has large divisions (Da Fen, major muscle groups with distinct boundaries, such as those in the thighs and arms) and small divisions (Xiao Fen, internal textures within muscles). Although the pathways are distinct, they intersect and merge. Thus, the place of large division is the place of great convergence, and the place of small division is the place of minor convergence. Between these divisions, Ying and Wei Qi circulate, hence they are named "Xi Gu" (Valleys/Depressions). The *I Ching* states that "Mountain and Marsh communicate through Qi," similar to how Qi from mountains and marshes communicates through valleys. The "Great Qi" mentioned here refers to Zong Qi (Pectoral Qi/Gathering Qi). Commentary: Ying Qi originates from the essence of water and grain in the Middle Jiao (Middle Burner), flows within the vessels, and spreads outside the vessels. Its refined and concentrated portion travels through Jing Sui (Meridian Tunnels, referring to the major collaterals of the Stomach and the major collaterals of the Five Zang and Six Fu organs). This indicates that Ying Qi travels both inside and outside the vessels; some combines with Zong Qi, exiting the Jing Sui of the Stomach, entering the major collaterals of the Zang-Fu organs, and emerging between the muscle layers (Ji Cou). These three types of Qi intersect and converge, thus it is said that they facilitate the circulation of Ying and Wei Qi and gather Great Qi. Therefore, the previous section discussed Ying Qi in the vessels communicating with Wei Qi between the Sun Luo (Fine Collaterals); this section discusses dispersed Ying Qi meeting with Wei Qi and Zong Qi in a great convergence outside the muscle fibers. This describes Wei Qi circulating within the vessels while Ying Qi circulates outside them. Wang Fanghou stated: "There is blood in the skin; one should know that there is Ying Qi outside the vessels. Wei Qi first moves into the skin and first fills the collaterals, so there is Wei Qi in the vessels. Hence, when 'Ying Qi in the vessels is faint like a spider's thread,' it indicates the decline of Yang Qi."
When pathogenic factors overflow and Qi becomes stagnant, the vessels become hot and flesh deteriorates. If Ying and Wei Qi fail to circulate, pus will inevitably form. Internally, it consumes the bone marrow; externally, it ruptures large areas of flesh. If it remains at the joints (Jie Cou, places where bones and sinews connect), it will inevitably lead to degeneration. (Commentary: This describes heat generated by pathogens lodging in the Xi Gu. Qi belongs to Yang; when it stays in the Qi aspect of the Ji Cou, the struggle between pathogen and healthy Qi results in pathological heat, leading to degenerative symptoms such as stagnation, suppuration, consumption, and rupture. When pathogenic factors overflow, healthy Qi naturally becomes stagnant. Since the Qi of Xi Gu connects with the vessels, internal vessel heat leads to external flesh deterioration. Stagnant Ying and Wei Qi causes blood and Qi to remain static, forming pus. Bi refers to the thigh muscles. Jie Cou refers to joint areas. Pathogens lingering here cause degeneration of bones and sinews. This section discusses how pathogens transform into heat via Qi; hence, heat syndromes are described without explicitly calling them "heat pathogens." The next section discusses cold pathogens, referred to as "accumulated cold." Mo Zhongchao stated: "The classic says 'Xi Gu belongs to bone.' Bone generates sinew, and sinew generates flesh. Therefore, if pathogens in Xi Gu linger and do not depart, they will inevitably cause joint degeneration and bone marrow consumption.")
Accumulated cold lodges, and Ying and Wei Qi cannot reside there. This leads to curling inward, retraction of sinews, and inability to extend the ribs and elbows. Internally, it manifests as Bone Bi (Bone Impediment); externally, as numbness and insensitivity. It is termed "Insufficiency," caused by severe cold flowing into the Xi Gu. (Commentary: This describes cold pathogens remaining in the Xi Gu without manifesting as heat. Accumulated cold prevents Ying and Wei Qi from residing there. Cold pathogens are congealing and stagnant, lacking harmonization by healthy Qi, leading to curled flesh and contracted sinews. The ribs and elbows are the mechanisms of sinews and bones, hence they cannot extend. Pathogens closing off the exterior cause internal Bone Bi; reversed Ying and Wei Qi internally cause external numbness. It is termed "Insufficiency" because overflowing heat pathogens belong to Excess, whereas cold is congealing and stagnant, belonging to Deficiency. This severe cold flowing into Xi Gu causes disease in both sinews and bones. Zhang Zhaohuang stated: "Skin becomes numb because Ying and Wei Qi do not reside on the exterior. Not residing on the exterior means they are reversed within the vessels. Hence, this section does not mention vessel pathology." Mo Zhongchao stated: "'Ju' means to stop/reside. When heat pathogens circulate, Ying and Wei Qi do not move; when cold pathogens lodge, Ying and Wei Qi do not reside. This is the incompatibility of pathogen and healthy Qi.")
The 365 Xi Gu correspond to the 365 acupoint convergences, mirroring the 365 days of a year. For minor Bi syndromes that overflow and travel along the vessels, fine needles can be used, following the same methods. (Commentary: There are 365 acupoint convergences within the Xi Gu, corresponding to the year, similar to the Sun Luo. Fine needles can be used to puncture and drain the pathogens. "Minor Bi" refers to pathogens initially entering the skin without damaging sinews or bones. "Vessels" here refer to Sun Luo. When pathogens are in the skin and travel along the vessels, they should be drained upon detection, using the same method as treating Sun Luo, without needing to identify specific acupoints. This explains that pathogens invading the body start at the skin, then enter the Sun Luo, penetrate the interior of the muscles, and reach the sinews and bones. When shallow, fine needles can address them easily, dispersing them before they deepen into Major Bi.)
The Emperor dismissed his attendants, stood up, and bowed twice, saying, "Today you have enlightened me and resolved my doubts. I will store this in the Golden Casket and dare not reveal it again. Thus, I have stored it in the Chamber of Golden Orchids, titled 'Where the Qi Acupoints Are Located.'" (Commentary: Pulse and complexion diagnosis are highly valued by Heaven and Earth, hence stored in the Golden Casket and the Chamber of Golden Orchids. Zhang Zhaohuang stated: "The Chamber of Golden Orchids refers to storing it in the heart.")
Qibo said: "Among the Sun Luo branches diverging from the main meridians, those with abundant blood requiring drainage number 365. They all flow into the collaterals and transmit to the Twelve Meridian Collaterals, not just the Fourteen Major Collaterals. (Commentary: This reiterates the connection between Sun Luo and the Major Collaterals. Branches of the Main Meridians are called Collaterals; branches of Collaterals are called Sun Luo. Some Sun Luo diverge from the main meridians and connect to the Major Collaterals, numbering 365, flowing into the Major Collaterals and transmitting to the Twelve Meridian Collaterals, not merely the Fourteen Major Collaterals. This implies that besides the Fourteen Major Collaterals, there are Twelve Meridian Collaterals. The Fourteen Major Collaterals consist of the divergent collaterals of the Twelve Zang-Fu organs plus Ren and Du meridians. The Twelve Meridian Collaterals refer to the primary meridians of the Twelve Zang-Fu organs. Thus, the Twelve Primary Meridians connect with the Fourteen Major Collaterals, which in turn connect with the 365 collaterals. Therefore, if pathogens lodge in Sun Luo and remain, causing blockage and preventing entry into the main meridians, they overflow into the Major Collaterals, generating strange diseases. Hence, it is said 'to overflow strange pathogens and to facilitate Ying and Wei Qi circulation.')
Internal resolution and drainage act through the Ten Vessels. (Commentary: "Ten Vessels" refers to the meridians of the Five Zang organs. This states that among the 365 Sun Luo, Twelve Meridian Collaterals, and Fourteen Major Collaterals, if pathogens invade, they should be drained via the meridians of the Five Zang organs, as all collaterals originate from the Five Zang. Thus, the *Miu Ci Pian* (Chapter on Counter-Needling) states: "In acupuncture, first treat the main meridians. Palpate and follow them, assess their excess or deficiency, and regulate them. If unregulated, use Meridian Needling. If there is pain but the meridian itself is not diseased, use Miu Ci (Counter-Needling). Observe the skin regions for blood-filled collaterals and drain them all. Zhang Zhaohuang stated: 'The previous section mentioned "Bi syndrome overflows, traveling along vessels, accessible by fine needles, ending with internal resolution via the Ten Vessels," which is moving from exterior to interior. The *Miu Ci Pian* states "First treat the main meridians, observe the skin regions, and drain all blood-filled collaterals," which is moving from interior to exterior. Generally, pathogens enter humans starting from the skin and Sun Luo, penetrating sinews, bones, and meridians. Some lodge externally, some overflow internally, some go from shallow to deep, and some emerge from interior to exterior. Pathogenic factors float and overflow without constancy, making the canonical teachings complex. Students must deeply comprehend this.')"