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The person of superior wisdom has seven heart orifices and three hairs; the person of average wisdom has five heart orifices and two hairs; the person of inferior wisdom has three heart orifices and one hair. The ordinary person has two heart orifices and no hairs; the foolish person has only one heart orifice. Without heart orifices, there is no gate for the Shen (Spirit) to enter or exit. ○ The seven heart orifices correspond to the Big Dipper stars, and the three hairs correspond to the Three Stars (Tai). If the Heart is sincere, it responds to everything without exception. (*Medical Beginner*)

The *Classic* states: "The Heart is the Official of the Sovereign, from which Shen (Spirit) emerges." It also states: "The Heart is the Great Master of the Five Zang and Six Fu organs." Shao Yong said: "The Heart is a Taiji, and the four limbs, hundred bones, zang-fu organs, yin and yang all receive orders from the Heart." This is what is meant by "When the Heavenly Lord is tranquil, the hundred bodies obey." In ordinary people, the Heart is covered above by the Lung's Huagai (Canopy), and protected below by the Pericardium (Xin Bao Luo), shaped like a round mirror, bright as still water, and is empty, spiritual, and unobscured. Within it reside Xing (Nature), Qing (Emotion), Shen (Spirit), and Ye (Fluids), which are also symbols of the Shuji (Pivot). If Shen does not dwell in its residence, the Xin Shuji (Heart Pivot) shakes; if thoughts are confused, the Xin Ji (Heart Mechanism) is blocked; if moved by the Seven Emotions, the Xin Shuji moves; if inverted and inconsistent, the Xin Ji is chaotic; if fluids are stored within, the Xin Shuji guards; if sweat reaches the exterior, the Xin Ji emits. One might ask: Do disorders of the Shuji occur only in the Heart? Why? Generally, various diseases of the Heart cannot go beyond the principles of Kai (Opening) and He (Closing). For example, insomnia is the Kai of the Heart; excessive sleepiness is the He of the Heart; laughter is the Kai; unhappiness is the He; absence of sweating is the He; spontaneous sweating is the Kai. Although disease manifestations vary, invisible changes cannot exceed the symbolism of the Shuji, and visible manifestations cannot transcend the principles of Kai and He. How can one fail to understand why the Heart is the Heart? (*Medical Ladder*)

The *Classic* says: "Beside the seventh vertebral segment, there is the Xiao Xin (Lesser Heart)." Some point to the Mingmen acupoint at the lower seventh segment as the Xiao Xin, which is incorrect. Wang Bing's commentary on Xiao Xin refers to the palace where the true Heart's Shen resides, because the Xin Mai (Heart Connection) connects to the spine and penetrates the spinal cord, lying exactly between the seventh segments. Since Yang Shangshan identified Xiao Xin as the Kidney Shen, counting down seven segments from the lower spine, later generations mistakenly equated Mingmen with Xiao Xin, leading to this error. Hua Borren in his *Commentary on the Heart Classic* stated: "There are two Xin Maires. One connects upward to the Lung; the other descends from the Lung connection, curves backward, penetrates the spinal cord, and lies exactly between the seventh segments." Furthermore, according to the diagram of the internal viscera, this is indeed the case. Based on this observation, Xiao Xin is the Pericardium (Xin Bao Luo). He Yiyang also stated that the origin of the Bao Luo is precisely beside the seventh segment below the fifth thoracic vertebra of the Heart, level with Danzhong (Shanzhong), and must not be confused. If counted inversely as they did, the Heart would be at the fifteenth vertebra, and the Lung at the nineteenth, which contradicts any method known since the *Suwen*. (*Remnants of Medical Intentions*)

Regarding the passage in the *Suwen*: "When food qi enters the Stomach, turbid qi returns to the Heart, and essence overflows into the vessels," the phrase "turbid qi returns to the Heart" is difficult to explain. I reflect that the Heart is the Official of the Sovereign, from which Shen emerges. If turbid qi returned to the Heart, how could it remain empty, spiritual, and unobscured, possessing all principles and responding to all matters? Upon examination, the character "Heart" here must be a typo for "Spleen." Consulting the *Lingshu*, it states: "Receiving grain results in turbidity; receiving qi results in clarity." It also states: "Ying Qi is the essence of water and grain, harmonized in the Five Zang and distributed to the Six Fu." And again: "Yin is clear, Yang is turbid; all Yins are clear, but the Foot Taiyin alone receives turbidity." Fu organs belong to Yang, Zang organs to Yin. Since all Yins are clear, it is known that the Heart receives clarity. Since the Foot Taiyin alone receives turbidity, it is known that outside of the Spleen receiving turbid qi, no other Zang organ receives turbidity. Thus, "turbid qi returns to the Spleen" aligns perfectly with the classic text. (*Collected Lectures of Wu Physicians*)

Small Intestine
The Small Intestine is the Official of Reception and Transformation, from which transformation products emerge. It attaches posteriorly to the spine and anteriorly to the umbilicus, looping leftward with sixteen curves. Its diameter is two cun and half, its circumference eight fen plus one-third fen, and its length three zhang and two chi. It receives two dou and four sheng of grain and six sheng and three he plus two-thirds he of water. The upper opening of the Small Intestine is two cun above the umbilicus near the spine, where water and grain enter. One cun below this, attaching externally to the umbilicus, is the Shuifen acupoint, which corresponds to the lower opening of the Small Intestine. Here, clear and turbid substances are separated; fluid seeps into the Bladder, while dregs flow into the Large Intestine. This meridian has abundant blood and scarce qi. The *Nanjing* states: "The Small Intestine weighs two jin and fourteen liang." (Li Shicai)

Bladder
The Bladder is the Official of the Prefecture, storing Jin-Ye (Body Fluids); only through Qi transformation can they be excreted. The Bladder is located at the nineteenth vertebra, below the Kidneys and anterior to the Large Intestine. It has a lower opening but no upper opening. Located at Shuifen acupoint, one cun above the umbilicus, it serves as the lower opening of the Small Intestine and the upper boundary of the Bladder. Fluid separates from the Hui Chang (Intestines) here and descends via Qi transformation. If the entering Qi fails to transform, water returns to the Large Intestine causing diarrhea. If the exiting Qi fails to transform, the lower orifice closes causing strangury. Various texts claim it has an upper opening but no lower, or both openings, all of which are incorrect. This meridian has abundant blood and scarce qi. The *Nanjing* states: "The Bladder weighs nine liang and two zhu, is nine cun long and wide, holds nine sheng and nine he of urine, and its opening is two cun and half wide." (Li Shicai)

Whether the Bladder has an upper opening is not mentioned in the *Lingshu* or *Suwen*. Later scholars who claimed it has an upper opening but no lower misunderstood the phrase "Qi transformation allows excretion." Without a lower opening, how could Qi transformation result in such free flow? Thus, the theory of having no lower opening need not be discussed. Others claim it has a lower opening but no upper opening; Zhang Jingyue and Li Shicai both support this view. However, if there were no upper opening, where would feces enter in cases of Jiao Chang (Cross-intestine) disorder where positions are reversed? Zhang Sanxi believed both openings exist, though his explanation was incomplete. Since water channels enter the Bladder from the lower opening of the Small Intestine, why is it common for clear and turbid mixtures to cause watery diarrhea via the Large Intestine, yet rare for feces to enter the Bladder? Careful consideration suggests the Bladder likely has an upper opening that remains normally closed. Water entering the Bladder comes from Sanjiao Qi transformation, not from the upper opening. If Fu Qi is severely deficient, weakness prevents the orifice from closing; if pathogenic heat injures the Fu, heat promotes leakage preventing closure, allowing feces to enter the Bladder's upper opening from the Small Intestine's lower opening and exit with urine. Just as external orifices like the navel, ears, and breasts are normally closed but open to discharge pus, blood, or milk when diseased, the Bladder's upper opening can be analogized similarly. People assume no upper opening because they revere Jingyue and Shicai, and observe that animal bladders have only a lower opening. They fail to realize that nature's creations vary: mammals have complete upper viscera, birds lack lungs and anterior orifices. Even humans differ: men have twenty-four ribs, women twenty-eight; men have eight skull bones, women six. If humans differ, how much more so do humans and animals? ○ The Bladder is the Official of the Prefecture, storing Jin-Ye; only through Qi transformation can they be excreted. Wang Taipu commented: "Receiving Qi from the Qi Sea enables transformation, leading to urination and defecation; if Qi transformation from the Qi Sea is insufficient, retention occurs." Hence, "Qi transformation allows excretion." Wang Taipu pioneered these commentaries, and subsequent generations followed, equating Jin-Ye with urine. They overlooked that "Qi transformation allows excretion" refers to Bladder Jin-Ye emerging from the skin/hair surface via Taiyang Qi, not downward excretion. Moreover, Jin and Ye are distinct from Xiao Bian (Urine). The *Lingshu* states: "When couli open and sweat pours forth, this is Jin; when grain fills the Qi, moistening the bones, aiding flexion, nourishing marrow, and moisturizing skin, this is Ye." It further states: "Jin depletion involves open couli and profuse sweating, with stiff joints." And: "Sanjiao Qi warms muscles and fills skin as Jin; flowing but stagnant fluid is Ye." Thus, Jin and Ye have specific definitions and should not be conflated with urine. Since ancient times, only Zhongshi (Zhang Zhongjing) inherited the *Neijing* orthodoxy to carry forward tradition. His treatment of Taiyang disease uses Mahuang Tang for no sweat and Guizhi Tang for sweating, proving Jin is stored in the Bladder and excreted via Qi transformation. The *Jingui Yaolue* uses Gualou Guizhi Tang for Rou Jing (Soft Spasm) and Gegen Tang for Gang Jing (Hard Spasm). Because pathogen injures Taiyang, Ye fails to nourish sinews, so assisting Taiyang Qi transformation circulates fluids to the skin, moistening sinews. This proves Ye is stored in the Bladder and excreted via Qi transformation. Using the Classic to interpret the Classic, and treatments aligning with the Classic's intent, leaves no doubt that Jin-Ye is not urine. Drinking enters the Stomach, rises to the Lung, and distributes via Sanjiao as Shui (Water). If Shui-Dampness stagnates, urination is obstructed, causing abdominal distension or edema; this is Shui in the Sanjiao before entering the Bladder. After entering the Bladder, water rising and sweating is Jin ("Downward transport to Bladder, water essence distributes everywhere"). Stored in the Bladder and excreted downward is Niao (Urine); obstruction causes Long Mi (Strangury/Retention). This corresponds to Bao Bi syndromes in the *Neijing*. The *Suwen* states: "Bladder dysfunction causes Long, lack of control causes Yi Niao (Enuresis)." The *Lingshu* states: "Excess causes Bi Long, deficiency causes Yi Niao." I surmise that Sanjiao failing to transform into the Bladder is mostly deficiency. Hence, treating edema generally focuses on Qi failing to transform Water. Conversely, obstruction of the urinary orifice causing Bladder distension is mostly excess. Reviewing the *Neijing*, Long-Bi involves excess, not deficiency. Also, Jin exits externally as sweat and internally as urine. Therefore, profuse sweating contraindicates promoting urination, fearing Yin loss from below. Urinary loss contraindicates inducing sweat, fearing Yang loss from above. Urine and sweat are both transformations of Jin, sharing origins but differing names. Ye is the essence of grain and water, i.e., Jin that flows but does not move, circulating via Qi to moisturize skin, benefit sinew-bone, nourish marrow, gather in the Bladder, and distribute in meridians; it should be stored, not expelled. Thus, while the Twelve Officials' Shen all "emerge," the Bladder alone "stores," referring to the storage of Ye. "Qi transformation allows excretion" applies only to Jin. If Ye exits via the urinary orifice, it becomes conditions like Gao Lin (Glandular Strangury), which cannot be called Qi transformation. (*Collected Lectures of Wu Physicians*)

Kidney
The Kidney is the Official of Strength and Ingenuity, from which skill and craft emerge. It attaches below the fourteenth thoracic vertebra of the spine. This meridian has scarce blood and abundant qi. It governs the bones, manifests in the hair, and opens into the two orifices (genitals and anus). The *Nanjing* states: "There are two Kidneys, weighing one jin and two liang, storing Jing (Essence) and Zhi (Will)." Hua Yuanhua said: "The Kidney is the dwelling of Spirit and Life, the root of existence." (Li Shicai)

The *Classic* states: "The Kidney governs Water, receiving and storing the Essence of the Five Zang and Six Fu organs; thus, only when the Five Zang are abundant can it discharge." This indicates Essence is stored in the Kidney, not generated by it. The Essence of the Five Zang and Six Fu is stored by the Kidney and regulated for discharge. Timely discharge ensures the continuous supply of Essence to the Five Zang and Six Fu, forming the Kan trigram position, ascending to connect with the Heart, filling then overflowing—the way of life. The *Classic* also states: "The source of Yin lies in the Five Flavors." Chu Cheng said: "Jing and Blood are the fruits of the five flavors of diet." Hence, Dong Yuan emphasized the Spleen and Stomach first. If Spleen and Stomach are deficient, the source of generation and transformation ceases, and how can Essence be produced? Even strong Kidney Qi will fail. It is strange that modern practitioners treating deficiency focus solely on tonifying the Kidney, ignoring the text "The Kidney governs Water." If Essence were exclusively governed by the Kidney, why say "When the Five Zang are abundant, it discharges" rather than "When Kidney Qi is abundant"? Outang Jushi said: "Storing grain and money in the treasury without spending it represents the people's fat and blood." To tonify the Kidney well, one must seek it in the Spleen and Stomach. (*Records from Yitang*)

Mingmen (Gate of Life)
Between the two Kidneys lies a point of brightness; reversing it creates the Elixir Mother, following it creates humanity. (*Immortal Classic*)

The Mingmen acupoint is not in the right Kidney, but between the Shu points of the two Kidneys. (*Bronze Man Diagram*)

Mingmen is the Sea of Jing and Blood; the Spleen and Stomach are the Sea of Grain and Water; both are the roots of the Zang-Fu. However, Mingmen is the root of Yuan Qi (Primal Qi) and the residence of Water and Fire. The Yin Qi of the Five Zang cannot nourish without it; the Yang Qi of the Five Zang cannot activate without it. The Spleen and Stomach, as Earth of the Central Region, cannot generate without Fire. Yet, Spring Qi begins below, so the Three Yang rise from the earth, allowing all things to generate and transform. Is this not because Mingmen's Yang Qi below is the mother of the Spleen and Stomach? ○ Mingmen has "fire intensity," which is Yuan Yang, the fire of creation. Constitution varies in strength, so Yuan Yang varies in abundance; Yin and Yang compete, so disease severity varies. Thus, fire intensity must be distinguished. ○ Mingmen has "vital Qi," the mechanism of endless Qianyuan (Heavenly Origin). Without generation, breath stops. Yang governs movement, Yin stillness; Yang ascends, Yin descends. Movement and ascent allow Yang to gain vital Qi; stillness and descent allow Yin to gain death-qi. Thus, Qianyuan Qi begins below and peaks above; ascending leads toward life. Kunyuan (Earthly Origin) Qi begins above and peaks below; descending leads toward death. ○ Mingmen has "doors and gates," the fortress of the body. The *Classic* states: "If the granary cannot store, the doors and gates are not secure; if water springs never stop, the Bladder cannot store." Thus, some suffer strangury due to Yin exhaustion and water drought; others suffer incontinence due to Yang deficiency and fire failure, lacking control. If Yin Essence is exhausted, strengthening Water is necessary for flow; if Yang Qi is deficient, benefiting Fire is necessary for consolidation. These are methods of consolidation. However, Essence cannot move without Qi, and Qi cannot transform without Water; there is a subtle interplay of separation and unity. ○ Mingmen Yin deficiency arises from pathogenic fire dominance, caused by insufficiency of True Water. Symptoms include thirst, bone-steaming fever, hemoptysis, hematemesis, strangury, turbid urine, and seminal emission. Though appearing as fire syndromes, they differ from Excess Heat. Excess Heat fire arises suddenly due to contact; Deficient Heat fire arises gradually due to accumulation and damage. (Zhang Jingyue)

Pericardium (Xin Bao Luo)
The Pericardium meridian is described as formless in the *Nanjing*. Hua Borren said: "The Pericardium is also called Hand Jueyin Xin Zhu. Comparing visceral images, above the horizontal membrane and below the vertical membrane, adhering to the horizontal membrane and wrapped in yellow fat, is the Heart. Outside the fat membrane, fine filaments connect to the Heart and Lung; this is the Pericardium." This view is correct; those claiming it is formless are wrong. The *Linglan Midian Lun* lists twelve officials but omits the Pericardium, adding instead the Shanzhong as the "Official of the Envoy." Examining this, the Pericardium resides above the diaphragm, exactly at Shanzhong, governing Xiang Huo (Ministerial Fire), acting on behalf of the Sovereign, truly serving as the Envoy. This official is undoubtedly the Pericardium. (Li Shicai)

The *Classic* states: "Shanzhong is the Official of the Envoy, from which joy and pleasure emerge." Li Shicai said: "Shanzhong is another name for the Pericardium." *Lei Jing* stated: "The Pericardium is the outer guard of the Sovereign, like the double walls of the imperial palace." Thus, the Heart has the Pericardium like a lotus has a pod; if the pod is empty, the seed shakes; if the Pericardium is full, Shen rests peacefully. Sound sleep and clear spirit indicate sufficient Heart Blood; palpitations and fright indicate insufficient Heart Blood. Insufficient blood makes the Heart dry and fiery. Essentially, low Pericardium blood fails to nourish the Heart, causing vexation and restlessness. Therefore, treating Heart diseases must prioritize nourishing the Pericardium. If the Pericardium is nourished, Shen is secure, and palpitations cease. (*Medical Ladder*)

Question: The *Nanjing* states there are six Zang organs, listing Heart, Liver, Spleen, Lung, and Kidney. The sixth is the Right Kidney. The Hand Jueyin Pericardium is one of the twelve meridians, paired with Shaoyang. Why is it not considered a Zang organ, but the Right Kidney is? Answer: The Pericardium is the fat membrane wrapping the Heart, unlike the Right Kidney which has substantial form. Due to its lack of specific form, it is not a distinct Zang organ. Question: If the Right Kidney is one of the six Zang, why doesn't the twelve meridials count its tangible form, but instead use Hand Jueyin? Answer: Although the *Nanjing* posits the Right Kidney/Mingmen as a Zang, it lacks associated meridians externally, and its Qi connects to the Kidney, meaning it is essentially just the Kidney. This is a unity of two and a duality of one. (*Remnants of Medical Intentions*)

Sanjiao (Triple Burner)
The Sanjiao is the Official of Ditches, from which waterways emerge. This meridian has scarce blood and abundant qi. The *Zhongzang Jing* states: "The Sanjiao is the Primordial Qi of Humanity." It commands the Qi of Zang-Fu, Ying-Wei, meridians, interior-exterior, left-right, and upper-lower. When Sanjiao is unblocked, all interior-exterior, left-right, and upper-lower areas are unblocked. (Li Shicai)

I have read discussions on Sanjiao by the *Nanjing*, He Huang, and Qiyuan, all stating it is named but formless. Reading the *Lingshu*: "Those with dense texture and thick skin have dense Sanjiao; those with coarse texture and thin skin have thin Sanjiao; brave men have transverse Sanjiao lines; timid men have longitudinal Sanjiao lines." This seems to imply form. Li Shicai stated: "Inside muscles, outside viscera is Sanjiao, which is also formless." Li criticized the formless view, using the *Lingshu*'s descriptions of density, thickness, mist, ditches, and foam to prove its form. So, is Sanjiao formless or formed? I add a word to clarify. Sanjiao is the three empty spaces within the chest, diaphragm, and abdomen. Scholars say "named but formless" to distinguish it from other organs with specific forms. It does not mean formless equals non-existent; pointing to emptiness, it is called formless. The *Lingshu*'s density and direction refer to the cavity inside the chest, diaphragm, and abdomen, not a separate form. The *Classic*'s metaphors of mist, foam, and ditch refer to water vapor in these empty spaces. Li Shicai admitted "inside muscles, outside viscera" has location but no form, yet criticized the formless view. Does he believe having location precludes being formless? Location and form differ. Having location explains the *Neijing*; having no form explains the scholars' conclusion. Ancient and modern sages differ in words but agree in intent. Chen Wuyue's claim that it is formed like fat membrane is questionable. Fat membrane is inherent in the body; if Sanjiao's form is like it, it becomes a false fat membrane. How to distinguish false from true fat membrane? Thus, I deem it inappropriate. (*Collected Lectures of Wu Physicians*)