素问五脏别论篇水谷入口则胃实而肠虚
王冰曰以未下也马莳曰实而不满者方其水谷入口之时上之为胃者实而下之为肠者尚虚及其时下下脘之后则下之为肠
者实而上之为胃者已虚故一有所实 则不能有所满而必至于泻也故曰实而不满者以此彼五脏无水谷之出入特其精微之气
焉耳故虽至于满而不至于有所实自不必有所泻也故曰满而不实者以此骥案胃巢也水谷巢聚之所也肠畅也通畅水谷之道也
有大肠小肠之别灵枢海论胃者水谷之海师传篇六府者胃为之海广颏大颈张胸五谷乃容又平人绝谷篇胃大一尺五寸径五寸
长二尺五寸受水谷三斗五升素问灵兰秘典篇小肠者受盛之官化物出焉大肠者传道之官变化出焉脾胃者仓廪之官五味出焉
胃主受纳水谷故入口则胃实小肠上接于胃凡胃所纳之物皆受盛于小肠之中小肠中物至大肠精汁尽化变糟粕而出故胃实肠
虚肠实胃虚实而不满满而不实也
食下则肠实而胃虚
王冰曰水谷下也
故曰实而不满满而不实也五味入口藏于胃以养五藏气气口亦太阴也
王冰曰气口在手鱼际之后同身寸之一寸气口之所候脉动者是手太阴脉气所行故言气口亦太阴也张志聪曰气口手太阴
之两脉口五藏之气皆变见于气口故为五藏主盖水谷之清者荣于五藏水谷之浊者出于六府清中之清者荣于经脉清中之浊者
复传化于肠胃膀胱此节论饮食入胃有气味清浊上下出入之分当知奇恒之府亦受清中之清者也马莳曰此即五味入口之语以
明五气入鼻之义气口者右手之寸口脉即手太阴肺经太渊穴也此篇与经脉别论灵枢五色四时气篇皆名之曰气口灵枢终始篇
名之曰脉口以脉气必会于此也六节藏象论灵枢禁服名之曰寸口以此部即太渊穴去鱼际仅一寸也其左手寸部则内经诸篇皆
谓之人迎耳经脉别论谓气口成寸以决生死故帝问气口何以独为五藏主而可以决脉之动静气之盛衰人之死生有如是也伯言
脉虽见于气口而实本之于脾胃也胃足阳明脾足太阴足阳明为六府之先足太阴为五藏之本胃主纳受凡水谷以是为市为六府
之大源五味入口藏于胃而得脾以为之运化致五藏之气无不借以资养则是脾者足太阴也肺者手太阴也其气本相为流通而气
口亦手太阴耳是以五脏六腑之气味皆出于胃变见于气口惟其出于胃变见于气口故凡胃脾积聚痰物其气口必大而滑凡胃脾
之虚者其气口脉必虚张介宾曰气口之义其名有三手太阴肺经脉也肺主诸气气之盛衰见于此故曰气口肺朝百脉脉之大会聚
于此故曰脉口脉出太渊其长一寸九分故曰寸口是名虽三而实则一愚按气口寸口脉口之义乃统两手而言非独指右手为气口
也如经脉篇手太阴之脉入寸口上循鱼际又经者常不可见也其虚实也则以气口知之经筋篇手太阴之筋结于鱼行寸口外侧经
脉别论权衡以平气口成寸以决死生平人气象论欲知寸口太过与不及小针解气口虚而当补盛而当泻本篇气口何以独为五藏
主难经十二经皆有动脉独取寸口以决五脏六腑死生吉凶之法何谓也曰寸口者脉之大会五脏六府之所终始故取法于寸口诸
如此者岂独指右手为言耶而王叔和未详经旨谓左为人迎右为气口左手寸口大迎以前右手寸口气口以前等说自晋及今以讹
传讹莫可解救甚至以左候表以右候里无稽之言其谬为甚肝心居左岂不可为里肠胃在右岂不可为表如仲景为伤寒之主但曰
大浮数滑动者此名阳也沉涩弱弦微者此名阴也又曰表有病脉当浮而大里有病脉当沉而细又如其上取寸口太阴脉也下取趺
阳阳明脉也是皆阴阳表里之谓初未闻以左为人迎而候表右为气口而候里脉体自有阴阳诸经皆具表里凡今之习讹者但见左
强便曰外感而攻其表但见右盛便曰内伤而攻其里焉知藏气有不齐脉候有禀赋或左脉素大于右或右脉素大于左孰者为常孰
者为变或于偏弱中略见有力已隐虚中之实或于偏盛中稍觉无神便是实中之虚设不如此而欲以左右分表里岂左无里右无表
乎故每致攻伐无过颠倒阴阳非为大失经旨而遗害于人不小无怪乎脉之日难也此不得不为辨正骥案灵枢五味篇水谷皆入于
胃又谷始入于胃其精微者出于胃之两焦以溉五藏别出两行荣卫之道其大气之抟而不行者积于胸中名曰气海出于肺循喉咙
故呼则出吸则入又胃五窍者闾门也上窍主纳水谷下窍入小肠旁窍入三焦膜油之中主行水之余沥中通脾一窍主化水谷上输
肺一窍主布精汁故云五窍曰闾门其养五藏以此唐宋以后此事难知西人剖解只言形体吾乡唐容川先生发之有功医学不少
是以五脏六腑之气味皆出于胃变见于气口
王冰曰荣气之道内谷为实新校正云详此注出灵枢实作宝谷入于胃气传与肺精专者循肺气行于气口故云变见于气口也
新校正云按全元起本出作入张志聪曰足太阴转输水谷之精而手太阴亦为胃以养五藏气是以五藏之气皆见于气口也马莳曰
盖谷入于胃气传于肺而肺气行于气口故云变见于气口也玉机真藏论五藏者皆禀气于胃胃者五藏之本也藏气者不能自致于
手太阴必因于胃气乃至于手太阴也张介宾曰人有四海而胃居其一是为水谷之海脏腑之属阳为府阴为藏胃属阳而为六府之
本故云六府之大源然五味入口藏于胃以养五藏气故又曰胃为五脏六腑之海气口本属太阴而曰亦太阴者何也盖气口属肺手
太阴也布行胃气则在于脾足太阴也营卫生会篇谷入于胃以传于肺五脏六腑皆以受气厥论脾为胃行其津液者也然则胃气必
归于脾脾气必归于肺而后行其脏腑营卫所以气口虽为手太阴而实即足太阴之所归故曰气口亦太阴也是以五脏六腑之气味
皆出于胃而变见于气口故胃为脏腑之大源然无不由脾达肺也骥案胃为五脏六腑之海五脏六腑皆禀气于胃胃五窍者为闾门
故脏腑之气味皆出于胃也胃五窍中有一窍上输于肺以布精汁故能变见于气口
故五气入鼻藏于心肺心肺有病而鼻为之不利也
吴昆曰风暑湿燥寒天之五气也无形之气由鼻而入故不藏于胃而藏于肺凡心肺有病则鼻为气窍因之不利张志聪曰肺居
上为阳肺乃心之盖而主气开窍于鼻故引藏象论而言味归阴而气归阳也道书鼻为天门口为地户马莳曰六节藏象论天食人以
五气 焦香腥腐地食人以五味酸苦甘辛咸五气入鼻藏于心肺上使五色修明音声能彰五味入口藏于肠胃胃有所藏以养五气
气和而生津液相成神乃自生故五味入口入于府五气入鼻入于藏然五藏惟心肺居于膈上受此五气故心肺有病而鼻为之不利
矣张介宾曰气味之化在天为气在地为味上文言五味入口藏于胃者味为阴此言五气入鼻藏于心肺者气为阳也鼻为肺之窍故
心肺有病而鼻为之不利观此两节曰味曰气皆出于胃而达于肺既达于肺亦必变见于气口故气口独为五藏主骥案经云上部法
天天气通于肺肺开窍于鼻天食人以五气温凉寒热是也故心肺病而鼻不利
素问经脉别论食气入胃散精于肝淫气于筋
王冰曰肝养筋故胃散谷精之气入于肝则浸淫滋养于筋络矣吴昆曰精五谷之精张志聪曰肝者土之胜制则生化故散精于
肝肝者筋其应故淫气于筋经曰谷入于胃脉道乃通血气乃行是荣卫气血皆水谷之所资生而水谷入胃各有淫散输转之道故又
必先知经脉生始之原而后知病脉也骥案西医谓胃有肝膈大筋内经筋为肝之合
食气入胃浊气归心淫精于脉
王冰曰浊气谷气也心居胃上故谷气归心淫溢精微入于脉也何者心主脉吴昆曰浊气上焦氤氲之气也归于心则为
血淫其精者
于脉是为十二经也张志聪曰经曰受谷者浊胃之食气故曰浊气胃络上通于心故入胃之食气归于心子令母实也心气通于脉故
淫精于脉伯高曰谷始入于胃其精微者先出于胃之两焦以溉五藏别出两行荣卫之道其大气之抟而不行者积于胸中命曰气海
出于肺循喉咙而司呼吸又曰谷入于胃乃传之肺五脏六腑皆以受气所谓先出于胃之两焦者入胃之谷气先下淫于肝上归于心
肺以养五藏气此章论经脉之道由水谷之精以养府脏腑藏之精淫于经脉气口成寸以决生死所谓五藏皆禀气于胃而至于手太
阴也其别出两行之荣卫与宗气又当别论张介宾曰浊言食气之浓者也阴阳清浊篇受谷者浊受气者清是也骥案西医说胃之肝
膈大筋循脊上通心窍心之合脉容川唐氏谓食者有形之阴质故主化汁变血胃与脾为表里胃得胆之健运肝胆疏利则化汁液浊
非渣秽乃稠浓之意阴汁稠浓上归于心则化为血淫溢精汁而散行于脉管与西医出血管回血管之说同第西医言管中医言脉
二而一也
脉气流经经气归于肺肺朝百脉输精于皮毛
王冰曰言脉气流运乃为大经经气归宗上朝于肺肺为华盖位复居高治节由之故受百脉之朝会也平人气象论藏真高于肺
以行荣卫阴阳由此故肺朝百脉然乃布化精气输于皮毛吴昆曰言脉气流于诸经经气上归心肺肺居诸脏腑之上为百脉之所朝
宗其精输之于皮毛也张志聪曰脉气者水谷之精气而行于经脉中也经大经也言入胃之谷气先淫气于脉百脉之经气总归于大
经经气归于肺是以百脉之气皆朝会于肺也肺合皮毛故复输精于皮毛张介宾曰精淫于脉脉流于经经脉流通必由于气气主于
肺故为百脉之朝会皮毛为肺之合故肺精输焉骥案容川唐氏谓脉淫流经者流行于各经络而回复有常也西医言心左房之血由
出血管导行于周身心体跳动不休每一跳则周身之脉应之而跳血既行遍周身则转入回血管其色变紫以受炭气也紫血由回管
递传复返颈会管得肺气呼吸则炭气出而紫色退复变为赤入心右房转至左房而又出矣以为脉气流经之证与谷入于胃脉道乃
行水入于经其血乃成之旨略同
毛脉合经行气于府
王冰曰府谓气之所聚处也是谓气海在两乳间名曰膻中也吴昆曰毛属肺气脉属心血毛脉合其精则行气于玄府是为卫气
玄府腠理也张志聪曰经云血独盛则淡渗皮肤生毫毛夫皮肤主气经脉主血毛脉合精者血气相合也六府为阳故先受气马莳曰
肺曰毛心曰脉毛脉合经而精气行于府府者膻中也灵枢五味篇大气积于胸中邪客篇宗气积于胸中刺节真邪论宗气流于海者
是也张介宾曰肺主毛心主脉肺藏气心生血一气一血称为父母二藏独居胸中故曰毛脉合精行气于府府者气聚之府也
府精神明留于四藏气归于权衡
王冰曰膻中之布气者分为三隧气下者走于气街上者走于息道宗气流于海积于胸中命曰气海如是分化乃四藏安定三焦
平均中外上下各得其所吴昆曰玄府之气精明神气常留止于四藏四藏形之四藏一头角二耳目三口齿四胸中也气归于权衡言
其平等而无低昂也张志聪曰府精神明者六府之津液相成而神乃自生也谷气入于胃淫精于脉乃传之肺肺气散精行气于府府
精留于四藏以养五藏六气故曰谷入于胃乃传之肺五脏六腑皆以受气马莳曰膻中为府其精气宗气最为神明而司呼吸行经隧
始行于手太阴肺经通于心肝脾肾之四藏而四藏之精皆其所留是气也平如权衡张介宾曰宗气积于肺神明出于心气盛则神王
故气府之积为神明神王则藏安以故肺肝脾肾四藏无不赖神明之留以为主宰然后藏气咸得其平而归于权衡权衡平也故曰主
明则下安主不明则十二官危
权衡以平气口成寸以决死生
王冰曰三世脉法皆以三部为寸关尺之分故中外高下气绪均平则气口之脉而成寸也夫气口者脉之大要会也百脉尽朝
故以其分决死生也吴昆曰持权衡之法以取平于气口分其三部成其尺寸以决病之死生张志聪曰权衡平也言脉之浮沉出入阴
阳和平故曰权衡以平气口手太阴之两脉口成寸者分尺为寸也言五脏六腑受气于谷淫精于脉变见于气口以决其生死马莳曰
气口者手太阴经之太渊穴也与鱼际相去一寸又成寸口之名真可以诊吉凶而决死生也灵枢小针解篇以气口虚为当补气口盛
则当泻则凡病皆以气口为主张介宾曰脏腑之气既得其平则必变见于气口而成寸尺也气口者脉之大会百脉俱朝于此故可以
决其生死凡如上文所言者皆食气之所化而食气之化又必由于胃气故上文言食气入胃下文言饮入于胃也骥案食气入胃以下
各节是言胃气淫肝归心流肺行府而留于四藏如权衡之平可于气口决死生也经曰水谷入口其味有五各注其海津液各走其道
胃者水谷之海海之所行云气者天下也胃之所出气血者经隧也经隧者五脏六腑之大络也五谷入胃其糟粕津液宗气分为三隧
宗气积于胸中出于喉咙以贯心肺而行呼吸此归心流肺之说也又荣气者泌其津液注之于肺化而为血以荣四末卫气者中焦之
所出亦并胃中出上焦之后此所谓受气者泌糟粕生津液化为精微上注于肺脉乃化而为血以奉生身此淫肝流肺之说也又胃有
五窍上通于肺有肝膈大筋胸膈大筋为通心肺肝之路心合脉肝合筋肺合皮毛言其外应也行气于府府三焦也三焦孤之府也故
独言府周礼医师九藏心肝脾肺肾五者为正藏合胃膀胱大小肠为九藏疏引八十一难胃为水谷之府小肠为受盛之府大肠为行
道之府膀胱为津滴三焦为孤府不入于藏故此曰四藏三焦少阳水中之阳是为相火属于肾中命门也命门即肾系由肾系下生连
网油膜是为下焦中生板油为中焦上生膈膜为上焦其根源实出于肾肾上连肺金水相生肾主水而行水之府实为三焦三焦即人
身膜油连肠胃及膀胱食入于胃由肠而下饮入于胃则胃之微管将水吸出散走膜膈即三焦也水由上焦历肝膜透肾系入下焦油
《素问·五脏别论》篇中提到：“水谷入口，则胃实而肠虚。”
王冰注释说：这是因为食物尚未下行。马莳解释说：所谓“实而不满”，是指在水谷刚刚入口的时候，上部作为受纳之器的胃是充实的，而下部作为传导之器的肠还是空虚的；等到食物下行到下脘之后，下部作为传导之器的肠变得充实，而上部作为受纳之器的胃就已经空虚了。所以，一旦某处充实，就不能同时充满，必然会导致排泄。因此说“实而不满”就是这个意思。至于五脏，没有水谷的直接出入，只有精微之气的运行，所以即使充盈也不会像六腑那样因容纳实物而充实，自然也不需要排泄。因此说“满而不实”就是这个意思。张骥按语：胃是巢穴，是水谷聚集的地方；肠是通畅的，是水谷通行的道路。大肠和小肠有所区别。《灵枢·海论》说胃是“水谷之海”。《灵枢·师传》篇说六腑以胃为海，如果颏部宽大、颈部粗壮、胸部开阔，就能容纳五谷。又《灵枢·平人绝谷》篇记载：胃大一尺五寸，直径五寸，长二尺五寸，能容纳水谷三斗五升。《素问·灵兰秘典论》篇说：小肠是“受盛之官”，负责化物；大肠是“传道之官”，负责变化；脾胃是“仓廪之官”，五味由此出。胃主受纳水谷，所以入口时胃充实；小肠上接于胃，凡胃所接纳的食物都受盛于小肠中。小肠中的物质到大肠时，精汁已完全化尽，变成糟粕排出，所以表现为“胃实肠虚”、“肠实胃虚”、“实而不满”、“满而不实”。
食物咽下后，则肠实而胃虚。
王冰注释说：因为水谷已经下行。
所以说“实而不满”、“满而不实”。五味入口，藏于胃中，用来滋养五脏之气。“气口”也就是太阴脉。
王冰注释说：气口位于手鱼际后方一寸的同身寸处，气口所候察的脉动之处，是手太阴肺经脉气运行的地方，所以说气口也属于太阴。张志聪解释说：气口是手太阴肺经的两处脉口，五脏之气都变化显现于气口，所以它是五脏的主宰。大概水谷中清轻的部分荣养五脏，浊重的部分出于六腑；清中之清者荣养经脉，清中之浊者再传化于肠胃膀胱。这一节论述饮食入胃后，有气味清浊、上下出入的区别，应当知道奇恒之府也接受清中之清的部分。马莳解释说：这就是引用“五味入口”的话，来说明五气入鼻的道理。气口就是右手的寸口脉，即手太阴肺经的太渊穴。这篇与《经脉别论》、《灵枢·五色》、《四时气》篇都称之为“气口”，《灵枢·终始》篇称之为“脉口”，是因为脉气必定会聚于此。《六节藏象论》、《灵枢·禁服》称之为“寸口”，因为这个部位就是太渊穴，距离鱼际仅一寸。左手寸部则在《内经》各篇中都称为“人迎”。《经脉别论》说“气口成寸，以决生死”，所以黄帝问气口为什么唯独能成为五脏的主宰，并且可以决断脉动的动静、气的盛衰以及人的生死，人的生死竟然如此重要啊！伯言（此处指代医家观点或误植，原文语境似在讨论脉理）说脉虽见于气口，但根本源于脾胃。胃属足阳明，脾属足太阴。足阳明是六腑的先导，足太阴是五脏的根本。胃主受纳，凡是水谷以此为市场，是六腑的大源。五味入口藏于胃，依赖脾来运化，致使五脏之气无不借此资养。那么脾就是足太阴，肺就是手太阴，它们的本气本来相互流通，而气口也属于手太阴。因此，五脏六腑的气味都出于胃，变化显现于气口。正因为出于胃并变化显现于气口，所以凡是胃脾有积聚痰湿之物，气口脉必大而滑；凡是胃脾虚弱的人，气口脉必虚。张介宾解释说：气口的含义有三名：一是手太阴肺经之脉，肺主诸气，气的盛衰显现于此，所以叫气口；二是肺朝百脉，脉的大会聚于此，所以叫脉口；三是脉出于太渊，长度一寸九分，所以叫寸口。这三个名字虽然不同，实则是一回事。我按语认为，“气口”、“寸口”、“脉口”的含义是统括双手而言的，并非单独指右手为气口。如《经脉》篇说手太阴之脉进入寸口，上行至鱼际……其虚实通过气口来知晓。《经筋》篇说手太阴之筋结于鱼际，行于寸口外侧。《经脉别论》说权衡以平气口，成寸以决生死。《平人气象论》说欲知寸口太过与不及。《小针解》说气口虚当补，盛当泻。本篇问气口何以独为五脏主。《难经·十二难》说十二经皆有动脉，唯独取寸口以决五脏六腑死生吉凶之法，为什么呢？回答说：寸口是脉的大会，是五脏六腑之所终始，所以取法于寸口。诸如此类，难道仅仅指右手而言吗？而王叔和未能详究经旨，谓左为人迎，右为气口，左手寸口大迎以前，右手寸口气口以前等说法，自晋代至今以讹传讹，无法解救，甚至有人说左候表、右候里，这是无稽之谈，谬误极大。肝心居左，难道不可为里吗？肠胃在右，难道不可为表吗？如张仲景为伤寒之主，只说大浮数滑动者为阳，沉涩弱弦微者为阴。又说表有病脉当浮大，里有病脉当沉细。又如上面取寸口太阴脉，下面取趺阳阳明脉。这些都是讲阴阳表里的关系，起初并未听说以左为人迎而候表，右为气口而候里。脉体自有阴阳，诸经皆具表里。如今那些习于错误说法的人，只见左脉强盛便说是外感而攻其表，只见右脉盛便说是内伤而攻其里。哪里知道脏气有不齐，脉候有禀赋差异，或者左脉素来大于右，或者右脉素来大于左，哪一个是常，哪一个是变？或者在偏弱中略见有力，已是隐伏的虚中之实；或者在偏盛中稍觉无神，便是实中之虚。如果不这样辨析，而想要以左右分表里，难道左边就没有里证、右边就没有表证吗？所以往往导致攻伐无过，颠倒阴阳，这不仅大大违背经旨，而且遗害于人不小，难怪脉学日益难以掌握。这里不得不加以辨正。张骥按语：《灵枢·五味》篇说水谷皆入于胃。又说谷物刚入于胃，其精微部分出于胃的两焦，以灌溉五脏，另外分出两行，即营卫之道。其中大气搏结而不行的，积聚在胸中，名叫气海，出于肺，循喉咙，所以呼则出，吸则入。又说胃有五窍，名为闾门。上窍主纳水谷，下窍入小肠，旁窍入三焦膜油之中，主行水之余沥；中通脾一窍主化水谷，上输肺一窍主布精汁。所以说五窍曰闾门，以此养育五脏。唐宋以后此事难知，西医解剖只讲形体，我的同乡唐容川先生对此有功，医学界不少受益。因此，五脏六腑的气味都出于胃，变化显现于气口。
王冰注释说：营气的道理，以内谷为实。新校正云：详细考证此注出自《灵枢》，原文“实”作“宝”。谷入于胃，气传给肺，精专者循肺气行于气口，所以说变化显现于气口。新校正云：按全元起本，“出”作“入”。张志聪解释说：足太阴脾转输水谷之精，而手太阴肺也为胃以养五脏气，所以五脏之气都见于气口。马莳解释说：大概谷入于胃，气传给肺，而肺气行于气口，所以说变化显现于气口。《玉机真脏论》说五脏都禀气于胃，胃是五脏的本源。脏气不能自己到达手太阴，必须借助于胃气才能到达手太阴。张介宾解释说：人有四海，而胃居其一，是为水谷之海。脏腑属阳的为腑，属阴的为脏。胃属阳而为六腑之本，所以说六腑的大源。然而五味入口藏于胃以养五脏气，所以又说胃为五脏六腑之海。气口本属太阴，为什么说“亦”太阴呢？大概气口属肺，为手太阴；布行胃气则在于脾，为足太阴。《营卫生会》篇说谷入于胃以传于肺，五脏六腑皆以受气。《厥论》说脾为胃行其津液。既然这样，胃气必归于脾，脾气必归于肺，然后行于脏腑营卫。所以气口虽然是手太阴，实则即是足太阴的归宿，所以说气口亦太阴。因此，五脏六腑的气味都出于胃而变化显现于气口，所以胃为脏腑之大源，然而无不通过脾达于肺。张骥按语：胃为五脏六腑之海，五脏六腑皆禀气于胃。胃的五窍为闾门，所以脏腑的气味都出于胃。胃的五窍中有一窍上输于肺以布散精汁，所以能变化显现于气口。
吴昆解释说：风暑湿燥寒是天之五气，无形之气由鼻而入，所以不藏于胃而藏于肺。凡是心肺有病，鼻作为气窍因此不通利。张志聪解释说：肺居上为阳，肺乃心的覆盖物，主气，开窍于鼻，所以引用《藏象论》来说味归阴而气归阳。道书说鼻为天口，口为地户。马莳解释说：《六节藏象论》说天食人以五气（焦香腥腐），地食人以五味（酸苦甘辛咸）。五气入鼻藏于心肺，上面使五色修明，声音能够彰显；五味入口藏于肠胃，胃有所藏以养五气，气和而生津液，神乃自生。所以五味入口入于腑，五气入鼻入于脏。然而五脏中只有心肺居于膈上，接受这五气，所以心肺有病而鼻子就不通利。张介宾解释说：气味的化生，在天为气，在地为味。上文说五味入口藏于胃，味为阴；这里说五气入鼻藏于心肺，气为阳。鼻为肺之窍，所以心肺有病而鼻子不通利。观察这两节，说味和气都出于胃而达于肺，既达于肺，也必变化显现于气口，所以气口独为五脏主。张骥按语：经文说上部法天，天气通于肺，肺开窍于鼻，天食人以五气（温凉寒热等）。所以心肺病而鼻不利。
王冰注释说：肝养筋，所以胃散谷精之气入于肝，则浸淫滋养于筋络。吴昆解释说：精指五谷之精。张志聪解释说：肝是土的胜气，制约则生化，所以散精于肝。肝应筋，所以淫气于筋。经文说谷入于胃，脉道乃通，血气乃行。这说明营卫气血都是水谷所资生的，而水谷入胃各有淫散输转的道路，所以必须先知道经脉生成的本源，而后才知道病脉。张骥按语：西医认为胃有肝膈大筋，《内经》认为筋为肝之合。
王冰注释说：浊气指谷气。心居胃上，所以谷气归心，淫溢精微入于脉。为什么呢？因为心主脉。吴昆解释说：浊气是上焦氤氲之气，归于心则为血，淫其精者于脉，是为十二经。张志聪解释说：经文说受谷者浊，胃之食气故曰浊气。胃络上通于心，所以入胃之食气归于心，子令母实也。心气通于脉，所以淫精于脉。伯高说：谷始入于胃，其精微者先出于胃之两焦，以溉五脏，别出两行，荣卫之道。其大气搏结而不行的，积聚在胸中，命曰气海，出于肺，循喉咙而司呼吸。又说谷入于胃，乃传之肺，五脏六腑皆以受气。所谓先出于胃之两焦者，是入胃之谷气先下淫于肝，上归于心肺以养五脏气。这一章论述经脉之道，由水谷之精以养府脏腑，藏之精淫于经脉，气口成寸以决生死，所谓五脏皆禀气于胃而至于手太阴。其别出两行的荣卫与宗气又当别论。张介宾解释说：浊指食气之浓者也。《阴阳清浊》篇说受谷者浊，受气者清。张骥按语：西医说胃之肝膈大筋循脊上通心窍。心之合脉。唐容川氏说食者是有形之阴质，故主化汁变血。胃与脾为表里，胃得胆之健运，肝胆疏利则化汁液。浊非渣秽，乃稠浓之意。阴汁稠浓上归于心则化为血，淫溢精汁而散行于脉管，与西医出血管回血管之说相同。只是西医言管，中医言脉，二而一也。
王冰注释说：言脉气流运乃为大经，经气归宗上朝于肺。肺为华盖，位复居高，治节由之，故受百脉之朝会。《平人气象论》说脏真高于肺，以行营卫阴阳，由此故肺朝百脉，然乃布化精气输于皮毛。吴昆解释说：言脉气流于诸经，经气上归心肺。肺居诸脏腑之上，为百脉之所朝宗，其精输之于皮毛。张志聪解释说：脉气是水谷的精气而行于经脉中。经是大经。言入胃之谷气先淫气于脉，百脉之经气总归于大经，经气归于肺，是以百脉之气皆朝会于肺。肺合皮毛，故复输精于皮毛。张介宾解释说：精淫于脉，脉流于经，经脉流通必由于气，气主于肺，故为百脉之朝会。皮毛为肺之合，故肺精输焉。张骥按语：唐容川氏说脉淫流经者，流行于各经络而回复有常。西医言心左房之血由出血管导行于周身，心体跳动不休，每一跳则周身之脉应之而跳。血既行遍周身，则转入回血管，其色变紫以受炭气。紫血由回管递传复返颈会管，得肺气呼吸则炭气出而紫色退，复变为赤，入心右房转至左房而又出矣。以为脉气流经之证，与“谷入于胃，脉道乃行，水入于经，其血乃成”的宗旨略同。
毛脉合经，行气于府。
王冰注释说：府谓气之所聚处，是谓气海在两乳间，名曰膻中。吴昆解释说：毛属肺气，脉属心血。毛脉合其精则行气于玄府，是为卫气。玄府即腠理。张志聪解释说：经文云血独盛则淡渗皮肤生毫毛。夫皮肤主气，经脉主血。毛脉合精者，血气相合也。六腑为阳，故先受气。马莳解释说：肺曰毛，心曰脉。毛脉合经而精气行于府，府者膻中也。《灵枢·五味》篇说大气积于胸中，《邪客》篇说宗气积于胸中，《刺节真邪》论说宗气流于海，是也。张介宾解释说：肺主毛，心主脉。肺藏气，心生血。一气一血称为父母，二脏独居胸中，故曰毛脉合精，行气于府。府者气聚之府也。
府精神明，留于四脏，气归于权衡。
王冰注释说：膻中之布气者分为三隧，气下者走于气街，上者走于息道。宗气流于海，积于胸中，命曰气海。如是分化乃四脏安定，三焦平均，中外上下各得其所。吴昆解释说：玄府之气精明，神气常留止于四脏。四脏形之四脏：一头角，二耳目，三口齿，四胸中也。气归于权衡，言其平等而无低昂。张志聪解释说：府精神明者，六府之津液相成而神乃自生也。谷气入于胃，淫精于脉，乃传之肺。肺气散精，行气于府，府精留于四脏以养五脏六气，故曰谷入于胃乃传之肺，五脏六腑皆以受气。马莳解释说：膻中为府，其精气宗气最为神明而司呼吸，行经隧，始行于手太阴肺经，通于心肝脾肾之四脏，而四脏之精皆其所留。是气也平如权衡。张介宾解释说：宗气积于肺，神明出于心。气盛则神王，故气府之积为神明。神王则藏安，以故肺肝脾肾四脏无不赖神明之留以为主宰，然后脏气咸得其平而归于权衡。权衡平也，故曰主明则下安，主不明则十二官危。
王冰注释说：三世脉法皆以三部为寸关尺之分，故中外高下气绪均平，则气口之脉而成寸也。夫气口者脉之大要会也，百脉尽朝，故以其分决死生。吴昆解释说：持权衡之法以取平于气口，分其三部成其尺寸，以决病之死生。张志聪解释说：权衡平也，言脉之浮沉出入阴阳和平，故曰权衡以平。气口手太阴之两脉口成寸者，分尺为寸也。言五脏六腑受气于谷，淫精于脉，变见于气口，以决其生死。马莳解释说：气口者手太阴经之太渊穴，与鱼际相去一寸，又成寸口之名，真可以诊吉凶而决死生。《灵枢·小针解》篇以气口虚为当补，气口盛则当泻，则凡病皆以气口为主。张介宾解释说：脏腑之气既得其平，则必变见于气口而成寸尺。气口者脉之大会，百脉俱朝于此，故可以决其生死。凡如上文所言者，皆食气之所化，而食气之化又必由于胃气，故上文言食气入胃，下文言饮入于胃。张骥按语：食气入胃以下各节是言胃气淫肝、归心、流肺、行府而留于四脏，如权衡之平，可于气口决死生。经文说水谷入口，其味有五，各注其海，津液各走其道。胃者水谷之海，海之所行云气者天下也。胃之所出气血者经隧也，经隧者五脏六腑之大络也。五谷入胃，其糟粕津液宗气分为三隧。宗气积于胸中，出于喉咙，以贯心肺而行呼吸，此归心流肺之说。又荣气者泌其津液，注之于肺，化而为血，以荣四末。卫气者中焦之所出，亦并胃中，出上焦之后，此所谓受气者泌糟粕生津液化为精微，上注于肺脉乃化而为血，以奉生身，此淫肝流肺之说。又胃有五窍，上通于肺，有肝膈大筋，胸膈大筋为通心肺肝之路。心合脉，肝合筋，肺合皮毛，言其外应也。行气于府，府三焦也。三焦孤之府也，故独言府。《周礼·医师》九藏：心肝脾肺肾五者为正藏，合胃膀胱大小肠为九藏。疏引八十一难：胃为水谷之府，小肠为受盛之府，大肠为行道之府，膀胱为津滴，三焦为孤府，不入于藏，故此曰四藏。三焦少阳水中之阳，是为相火，属于肾中命门。命门即肾系，由肾系下生连网油膜，是为下焦；中生板油为中焦；上生膈膜为上焦。其根源实出于肾。肾上连肺，金水相生。肾主水而行水之府，实为三焦。三焦即人身膜油，连肠胃及膀胱。食入于胃，由肠而下；饮入于胃，则胃之微管将水吸出，散走膜膈，即三焦也。水由上焦历肝膜透肾系入下焦油。
In the chapter "Discourse on the Distinctions of the Five Zang Organs" from the *Suwen* (Basic Questions), it is stated: "When food and water enter the mouth, the Stomach becomes full (solid) while the Intestines are empty."
Wang Bing commented: This is because the food has not yet descended. Ma Shi explained: The term "full but not solid" refers to the state when food and water first enter the mouth; at this time, the upper part, functioning as the Stomach for reception, is full (solid), while the lower part, functioning as the Intestines for transmission, is still empty. Once the food descends to below the Lower Wrist (Xiawan), the lower part, functioning as the Intestines, becomes full (solid), while the upper part, functioning as the Stomach, has already become empty. Therefore, once one part is full (solid), it cannot simultaneously be completely filled with essence, and must lead to discharge. Thus, it is said that "full but not solid" means this. As for the Five Zang Organs, there is no direct entry or exit of food and water, only the movement of subtle Qi. Therefore, even if they are full, they do not become "solid" in the sense of containing gross matter, and naturally do not require discharge. Thus, it is said that "full but not solid" means this. Zhang Ji's note: The Stomach is a nest, a place where food and water gather; the Intestines are channels of communication, the pathways for food and water. There are distinctions between the Large Intestine and Small Intestine. The *Ling Shu: Sea Theory* states that the Stomach is the "Sea of Food and Water." The *Ling Shu: Teacher-Student Transmission* chapter states that among the Six Fu Organs, the Stomach is the sea; if the chin is large, the neck thick, and the chest broad, five grains can be contained. Furthermore, the *Ling Shu: Normal Person Without Grain* chapter records: The Stomach is one chi five cun wide, five cun in diameter, two chi five cun long, and can hold three dou five sheng of food and water. The *Suwen: Secret Canon of Ling Lan* chapter states: The Small Intestine is the "Official of Reception and Storage," responsible for transforming substances; the Large Intestine is the "Official of Transmission," responsible for changes; the Spleen and Stomach are the "Officials of Granaries," from which the five flavors emerge. The Stomach governs the reception of food and water, so upon entry, the Stomach is full (solid); the Small Intestine connects above to the Stomach, and all things received by the Stomach are stored in the Small Intestine. When contents reach the Large Intestine, the essential juices have been fully transformed into waste, which is then discharged. Hence, the manifestation is "Stomach full/Intestines empty," "Intestines full/Stomach empty," "Full but not solid," and "Solid but not full."
After food is swallowed, the Intestines become full (solid) and the Stomach becomes empty.
Wang Bing commented: Because the food and water have descended.
Therefore, it is said "full but not solid" and "solid but not full." The five flavors enter the mouth, are stored in the Stomach, and nourish the Qi of the Five Zang Organs. The "Qi Kou" (Pulse Port) is also Taiyin.
Wang Bing commented: The Qi Kou is located one cun distal to the radial styloid process (Yuji). The pulsation observed at the Qi Kou is where the Qi of the Hand-Taiyin Lung Meridian travels; hence, it is said that the Qi Kou also belongs to Taiyin. Zhang Zhicong explained: The Qi Kou refers to the pulse ports of the Hand-Taiyin Lung Meridian; the Qi of the Five Zang Organs manifests at the Qi Kou, making it the master of the Five Zang Organs. Generally, the clear and light parts of food and water nourish the Five Zang Organs, while the turbid/heavy parts exit through the Six Fu Organs; the clear within the clear nourishes the meridians, while the turbid within the clear is further transmitted to the intestines, stomach, and bladder. This section discusses the differences in clarity/turbidity and ascending/descending movements of food and drink after entering the Stomach. One should understand that the Extraordinary Fu Organs also receive the clear within the clear. Ma Shi explained: This cites the phrase "five flavors enter the mouth" to explain the meaning of the five Qi entering through the nose. The Qi Kou is the Cun Kou pulse on the right hand, specifically the Taiyuan acupoint of the Hand-Taiyin Lung Meridian. This chapter, along with *Meridian Differences*, *Ling Shu: Five Colors*, and *Four Times Qi*, calls it "Qi Kou"; the *Ling Shu: End and Beginning* chapter calls it "Mai Kou" (Pulse Port) because Qi converges here. *Six Section Zang Xiang Theory* and *Ling Shu: Forbidden Service* call it "Cun Kou" because this location is Taiyuan, only one cun from Yuji. The left hand's Cun position is referred to as "Ren Ying" in various chapters of the *Neijing*. *Meridian Differences* states "Qi Kou forms the Cun to determine life and death," prompting the Yellow Emperor to ask why the Qi Kou alone serves as the master of the Five Zang Organs and can determine the dynamics of pulses, the abundance/lack of Qi, and human life and death. Bo Yan (referring to a medical perspective) stated that although pulses appear at the Qi Kou, their root lies in the Spleen and Stomach. The Stomach belongs to Foot-Yangming, and the Spleen to Foot-Taiyin. Foot-Yangming is the pioneer of the Six Fu Organs, and Foot-Taiyin is the root of the Five Zang Organs. The Stomach governs reception; all food and water rely on it as a market, being the great source of the Six Fu Organs. The five flavors enter the mouth and are stored in the Stomach, relying on the Spleen for transportation and transformation, thereby nourishing the Qi of all Five Zang Organs. Thus, the Spleen is Foot-Taiyin, and the Lung is Hand-Taiyin. Their Qi naturally circulates mutually, and since the Qi Kou also belongs to Hand-Taiyin, the Qi and flavor of all Five Zang and Six Fu Organs originate from the Stomach and manifest at the Qi Kou. Because they originate from the Stomach and manifest at the Qi Kou, whenever there are accumulations or phlegm-dampness in the Stomach and Spleen, the Qi Kou pulse will be large and slippery; whenever the Stomach and Spleen are deficient, the Qi Kou pulse will be weak. Zhang Jiebin explained: The term "Qi Kou" has three meanings: 1. It is the meridian of the Hand-Taiyin Lung; the Lung governs all Qi, and the abundance or deficiency of Qi appears here, hence "Qi Kou." 2. The Lung receives all vessels; the great convergence of pulses occurs here, hence "Mai Kou." 3. The pulse emerges from Taiyuan, measuring one cun nine fen, hence "Cun Kou." Although the names differ, they refer to the same thing. My note holds that "Qi Kou," "Cun Kou," and "Mai Kou" collectively refer to both hands, not just the right hand as "Qi Kou." For instance, the *Meridian* chapter states the Hand-Taiyin meridian enters the Cun Kou and ascends to Yuji... its deficiency or excess is known via the Qi Kou. The *Meridian Sinews* chapter states the Hand-Taiyin sinew knots at Yuji and runs along the lateral side of the Cun Kou. *Meridian Differences* states "weighing and balancing levels the Qi Kou, forming the Cun to determine life and death." *Normal Person Meteorology* states "to know if the Cun Kou is excessive or insufficient." *Small Needle Explanation* states "deficient Qi Kou requires tonification, excess requires sedation." This chapter asks why the Qi Kou alone masters the Five Zang Organs. *Nan Jing: Difficulty 12* states all twelve meridians have moving arteries, yet only the Cun Kou is taken to determine the life, death, auspiciousness, and inauspiciousness of the Five Zang and Six Fu Organs. Why? It answers: The Cun Kou is the great convergence of pulses, the beginning and end of the Five Zang and Six Fu Organs, hence the method derives from the Cun Kou. Do such references imply only the right hand? Wang Shuhe failed to thoroughly understand the classics, claiming the left is Ren Ying and the right is Qi Kou, and other such erroneous theories propagated from the Jin dynasty onwards, leading to baseless claims like "left reflects exterior, right reflects interior," which is highly erroneous. The Liver and Heart are on the left; could they not be interior? The Intestines and Stomach are on the right; could they not be exterior? Zhang Zhongjing, the master of Cold Damage, simply classified pulses as Yang (large, floating, rapid, sliding, surging) or Yin (deep, choppy, weak, string-taut, minute). He stated exterior disease pulses should be floating and large, interior disease pulses should be deep and fine. He also mentioned taking the Cun Kou (Hand-Taiyin) above and the Foot-Yangming (Duyang) below. These discuss Yin-Yang and Exterior-Interior relationships, never stating left is Ren Ying for exterior and right is Qi Kou for interior. Pulse bodies inherently possess Yin-Yang, and all meridians possess Exterior-Interior. Those who follow erroneous theories see a strong left pulse and assume exterior pathogen, attacking the exterior; seeing a strong right pulse, they assume internal injury, attacking the interior. They fail to realize that organ Qi may be uneven, and pulse conditions depend on constitution; some have naturally stronger left pulses, others stronger right pulses. Which is normal, which is abnormal? A slight strength in a weak pulse may indicate hidden excess within deficiency; a lack of spirit in an excessive pulse may indicate deficiency within excess. Without such differentiation, attempting to divide Exterior-Interior by left-right would imply the left has no interior and the right has no exterior, which is absurd. This often leads to unjustified attacks and inversion of Yin-Yang, greatly violating the classics and harming patients, explaining why pulse diagnosis is difficult today. Correction is necessary. Zhang Ji's note: The *Ling Shu: Five Flavors* chapter states all food and water enter the Stomach. It also says grain entering the Stomach releases its essence from the two Jiaos of the Stomach to irrigate the Five Zang Organs, separating into two paths: the Way of Ying and Wei Qi. The large Qi that gathers and does not move accumulates in the chest, named the Qi Sea, emerging from the Lung, following the throat, exiting on exhalation and entering on inhalation. It also states the Stomach has five orifices, called Lumens. The upper orifice receives food and water; the lower orifice enters the Small Intestine; the lateral orifices enter the San Jiao membranes/oils, governing residual water drainage; the central orifice connecting to the Spleen transforms food and water; the upper orifice connecting to the Lung distributes essence. Thus, the five orifices are called Lumens, nourishing the Five Zang Organs. After Tang and Song dynasties, this knowledge was lost; Western anatomy only describes form. My fellow townsman Dr. Tang Rongchuan contributed significantly to this field. Therefore, the Qi and flavor of all Five Zang and Six Fu Organs originate from the Stomach and manifest at the Qi Kou.
Wang Bing commented: The way of Ying Qi involves internal grain becoming solid. New Corrections note: This annotation comes from *Ling Shu*, where "solid" is written as "treasure." Grain enters the Stomach, Qi transmits to the Lung, the refined essence follows Lung Qi to travel to the Qi Kou, hence it is said to manifest at the Qi Kou. New Corrections note: According to Quan Yuanqi's edition, "out" is written as "in." Zhang Zhicong explained: Foot-Taiyin transports the essence of food and water, while Hand-Taiyin (Lung) also nourishes the Five Zang Organs via the Stomach, so the Qi of the Five Zang Organs appears at the Qi Kou. Ma Shi explained: Grain enters the Stomach, Qi transmits to the Lung, and Lung Qi travels to the Qi Kou, hence it is said to manifest at the Qi Kou. *Jade Machine True Viscera Theory* states all Five Zang Organs derive Qi from the Stomach; the Stomach is the root of the Five Zang Organs. Visceral Qi cannot reach the Hand-Taiyin on its own but must rely on Stomach Qi to reach the Hand-Taiyin. Zhang Jiebin explained: Humans have four Seas, and the Stomach is one of them, the Sea of Food and Water. Organs belonging to Yang are Fu, those belonging to Yin are Zang. The Stomach belongs to Yang and is the root of the Six Fu Organs, hence the great source of the Six Fu Organs. However, since the five flavors enter the mouth and are stored in the Stomach to nourish the Five Zang Organs, it is also said that the Stomach is the Sea of the Five Zang and Six Fu Organs. The Qi Kou originally belongs to Taiyin; why say "also" Taiyin? The Qi Kou belongs to the Lung (Hand-Taiyin); distributing Stomach Qi depends on the Spleen (Foot-Taiyin). *Ying Wei Sheng Hui* states grain enters the Stomach to transmit to the Lung, and all Five Zang and Six Fu Organs receive Qi. *Jue Lun* states the Spleen transports fluids for the Stomach. Thus, Stomach Qi must return to the Spleen, Spleen Qi must return to the Lung, and then circulate through the organs and Ying-Wei. Therefore, although the Qi Kou is Hand-Taiyin, it is essentially the destination of Foot-Taiyin, hence "Qi Kou also Taiyin." Consequently, the Qi and flavor of all Five Zang and Six Fu Organs originate from the Stomach and manifest at the Qi Kou, making the Stomach the great source of the organs, yet all must pass through the Spleen to reach the Lung. Zhang Ji's note: The Stomach is the Sea of the Five Zang and Six Fu Organs; all derive Qi from it. The five orifices of the Stomach are Lumens, so the Qi and flavor of the organs originate from the Stomach. One of the five orifices transmits upward to the Lung to distribute essence, allowing it to manifest at the Qi Kou.
Thus, the five Qi enter the nose and are stored in the Heart and Lung. If the Heart and Lung have disease, the nose becomes obstructed.
Wu Kun explained: Wind, summer-heat, dampness, dryness, and cold are the five Qi of Heaven. Formless Qi enters through the nose, so it is not stored in the Stomach but in the Lung. Whenever the Heart and Lung are diseased, the nose, as the orifice of Qi, becomes obstructed. Zhang Zhicong explained: The Lung resides superiorly as Yang; it covers the Heart, governs Qi, and opens into the nose. Thus, citing *Zang Xiang Theory*, flavor returns to Yin and Qi returns to Yang. Daoist texts state the nose is the Heavenly Gate and the mouth is the Earthly Door. Ma Shi explained: *Six Section Zang Xiang Theory* states Heaven feeds humans with five Qi (scorched, fragrant, fishy, putrid) and Earth feeds humans with five flavors (sour, bitter, sweet, pungent, salty). Five Qi enter the nose and are stored in the Heart and Lung, causing the five colors to shine and voice to resonate; five flavors enter the mouth and are stored in the intestines and stomach, where the Stomach stores them to nourish the five Qi. When Qi harmonizes, body fluids form, and Spirit arises. Thus, five flavors enter the Fu organs, and five Qi enter the Zang organs. However, among the Five Zang Organs, only the Heart and Lung reside above the diaphragm to receive these five Qi; therefore, if the Heart and Lung are diseased, the nose becomes obstructed. Zhang Jiebin explained: The transformation of Qi and Flavor exists as Qi in Heaven and Flavor on Earth. The previous text stated five flavors enter the mouth and are stored in the Stomach (Flavor is Yin); this text states five Qi enter the nose and are stored in the Heart and Lung (Qi is Yang). The nose is the orifice of the Lung; thus, Heart and Lung disease causes nasal obstruction. Observing these two sections, both Flavor and Qi originate from the Stomach and reach the Lung; having reached the Lung, they must also manifest at the Qi Kou, hence the Qi Kou alone masters the Five Zang Organs. Zhang Ji's note: The classic states the upper part corresponds to Heaven, and Heavenly Qi communicates with the Lung. The Lung opens into the nose, and Heaven feeds humans with five Qi (warmth, coolness, cold, heat). Therefore, Heart and Lung disease causes nasal obstruction.
The *Suwen: Meridian Differences* chapter states: "Food Qi enters the Stomach, scatters essence to the Liver, and overflows Qi into the tendons."
Wang Bing commented: The Liver nourishes the tendons; thus, the Stomach scatters grain essence Qi into the Liver, which then infiltrates and nourishes the tendon collaterals. Wu Kun explained: Essence refers to the essence of the five grains. Zhang Zhicong explained: The Liver is the controlling element of Earth; regulation allows for generation and transformation, so essence is scattered to the Liver. The Liver corresponds to tendons, so Qi overflows into the tendons. The classic states that when grain enters the Stomach, the vessel pathways open, and Blood and Qi flow. This shows that Ying, Wei, Blood, and Qi are all generated from food and water, which have specific paths of infiltration, scattering, and transport after entering the Stomach. Therefore, one must first know the origin of meridian generation to understand pathological pulses. Zhang Ji's note: Western medicine posits that the stomach has liver-diaphragm large tendons; the *Neijing* considers tendons as the combination of the Liver.
Food Qi enters the Stomach, turbid Qi returns to the Heart, and overflows essence into the vessels.
Wang Bing commented: Turbid Qi refers to grain Qi. The Heart sits above the Stomach, so grain Qi returns to the Heart, overflowing essence into the vessels. Why? Because the Heart governs the vessels. Wu Kun explained: Turbid Qi is the misty Qi of the Upper Jiao; returning to the Heart becomes Blood, overflowing its essence into the vessels, forming the twelve meridians. Zhang Zhicong explained: The classic states those receiving grain are turbid; gastric food Qi is thus called turbid Qi. The Stomach collateral connects upward to the Heart, so food Qi entering the Stomach returns to the Heart (Son generating Mother). Heart Qi connects to the vessels, so it overflows essence into the vessels. Bo Gao stated: Grain first enters the Stomach; its essence first emerges from the two Jiaos of the Stomach to irrigate the Five Zang Organs, separating into two paths, the Way of Ying and Wei Qi. The large Qi that gathers and does not move accumulates in the chest, named the Qi Sea, emerging from the Lung, following the throat to govern respiration. It also states grain enters the Stomach and transmits to the Lung, so all Five Zang and Six Fu Organs receive Qi. What is meant by "first emerging from the two Jiaos of the Stomach" is that grain Qi entering the Stomach first infiltrates downward to the Liver and upward to the Heart and Lung to nourish the Five Zang Organs. This chapter discusses the pathway of meridians, where the essence of food and water nourishes the Fu and Zang organs, and the essence of the Zang organs overflows into the meridians. The Qi Kou forms the Cun to determine life and death, meaning the Five Zang Organs all derive Qi from the Stomach and reach the Hand-Taiyin. The separate Ying and Wei Qi and Zong Qi discussed elsewhere should be treated separately. Zhang Jiebin explained: "Turbid" refers to the dense nature of food Qi. *Yin Yang Qing Zhuo* states those receiving grain are turbid, those receiving Qi are clear. Zhang Ji's note: Western medicine states the stomach's liver-diaphragm large tendons run along the spine to connect to the heart orifices. The Heart combines with the vessels. Dr. Tang Rongchuan stated that food is tangible Yin substance, thus primarily transforming juice into Blood. The Stomach and Spleen are exterior-interior pairs; the Stomach relies on the Gallbladder's vigorous movement, and the smooth flow of Liver and Gallbladder transforms juices. "Turbid" does not mean dregs but implies density. Dense Yin juice returns upward to the Heart to transform into Blood, overflowing essence and dispersing into the vessel tubes, consistent with the Western concept of arterial and venous circulation. The difference is that Western medicine speaks of "tubes" while Chinese medicine speaks of "vessels" (Mai); they are two aspects of one reality.
Vessel Qi flows through the meridians, meridian Qi returns to the Lung, the Lung receives all vessels, and transmits essence to the skin and hair.
Wang Bing commented: Vessel Qi flows and moves to become the major meridians; meridian Qi returns to the source and ascends to the Lung. The Lung is the Huagai (Canopy), residing high, governing regulation, thus receiving the assembly of all vessels. *Ping Ren Qi Xiang Lun* states the Zang Zhen is highest in the Lung to circulate Ying and Wei, Yin and Yang; thus, the Lung receives all vessels, disseminating and transforming essence to transmit to the skin and hair. Wu Kun explained: Vessel Qi flows through the various meridians, and meridian Qi ascends to the Heart and Lung. The Lung resides above all other organs, serving as the gathering point for all vessels, transmitting its essence to the skin and hair. Zhang Zhicong explained: Vessel Qi is the essence of food and water circulating in the meridians. "Jing" refers to the major meridians. Grain Qi entering the Stomach first infiltrates into the vessels; the meridian Qi of all vessels totals into the major meridians, and meridian Qi returns to the Lung, so the Qi of all vessels assembles at the Lung. The Lung combines with the skin and hair, thus transmitting essence to them. Zhang Jiebin explained: Essence overflows into vessels, vessels flow into meridians; the circulation of meridians depends on Qi. Qi is governed by the Lung, hence it is the gathering point of all vessels. Skin and hair are the combination of the Lung, so Lung essence is transmitted there. Zhang Ji's note: Dr. Tang Rongchuan stated that vessel Qi flowing through meridians circulates through various collaterals and returns regularly. Western medicine states blood from the left atrium of the heart is guided by arteries throughout the body. The heart beats continuously; each beat causes the pulses throughout the body to respond. After blood circulates the whole body, it enters the veins, turning purple due to carbon absorption. Purple blood is transmitted back via veins to the jugular vein, gets lung Qi for respiration, expels carbon, loses purple color, turns red again, enters the right atrium of the heart, transfers to the left atrium, and exits again. This serves as evidence for "vessel Qi flows through meridians," aligning roughly with the principle "Grain enters the Stomach, vessel pathways open; water enters the meridians, blood forms."
Hair and vessels combine through meridians, transporting Qi to the Fu.
Wang Bing commented: Fu refers to the place where Qi gathers, known as the Qi Sea located between the two breasts, named Danzhong. Wu Kun explained: Hair belongs to Lung Qi, vessels belong to Heart Blood. When hair and vessels combine their essence, Qi travels to the Xuan Fu (Mysterious Gates), which is Wei Qi. Xuan Fu refers to the cou li (interstices). Zhang Zhicong explained: The classic states that when Blood is abundant, it渗 (seeps) into the skin, producing hair. Skin governs Qi, meridians govern Blood. The combination of hair and vessels represents the union of Blood and Qi. The Six Fu Organs are Yang, so they receive Qi first. Ma Shi explained: The Lung is associated with hair, the Heart with vessels. When hair and vessels combine through meridians, essence and Qi travel to the Fu, which is Danzhong. *Ling Shu: Five Flavors* states large Qi accumulates in the chest; *Xie Ke* chapter states Zong Qi accumulates in the chest; *Ci Zhen Zhen Ye* treats Zong Qi flowing into the Sea. Zhang Jiebin explained: The Lung governs hair, the Heart governs vessels. The Lung stores Qi, the Heart generates Blood. One Qi and one Blood are called parents; these two organs reside uniquely in the chest, hence "hair and vessels combine essence, transporting Qi to the Fu." The Fu is the repository of gathered Qi.
The Fu's essence and spirit remain in the Four Zang Organs, and Qi returns to balance (Quan Heng).
Wang Bing commented: The Qi distributed by Danzhong divides into three tunnels: Qi descending goes to the Qi Street, Qi ascending goes to the respiratory tract. Zong Qi flows into the Sea, accumulating in the chest, named the Qi Sea. Through such differentiation, the Four Zang Organs stabilize, the San Jiao averages out, and the interior/exterior, upper/lower all find their proper places. Wu Kun explained: The clear and bright Qi of the Xuan Fu remains in the Four Zang Organs. The physical representation of the Four Zang Organs includes: head/horns, ears/eyes, mouth/teeth, and chest. "Qi returns to balance" means equality without elevation or depression. Zhang Zhicong explained: "Fu's essence and spirit" refers to the mutual formation of fluids in the Six Fu Organs giving rise to Spirit. Grain Qi enters the Stomach, overflows essence into vessels, transmits to the Lung. Lung Qi scatters essence, transports Qi to the Fu, Fu essence remains in the Four Zang Organs to nourish the Five Zang and Six Fu Qi, hence "Grain enters the Stomach, transmits to the Lung, and all Five Zang and Six Fu Organs receive Qi." Ma Shi explained: Danzhong is the Fu; its essence and Zong Qi are most spiritual and govern respiration, traveling through meridians, starting from the Hand-Taiyin Lung Meridian, connecting to the Heart, Liver, Spleen, and Kidney. The essence of these Four Zang Organs is retained by this Qi. This Qi is level like a balance. Zhang Jiebin explained: Zong Qi accumulates in the Lung, Spirit originates from the Heart. Abundant Qi leads to vigorous Spirit; thus, the accumulation in the Qi Fu constitutes Spirit. Vigorous Spirit ensures organ stability; therefore, the Lung, Liver, Spleen, and Kidney all rely on the retention of Spirit as their master, allowing all organ Qi to achieve balance and return to Quan Heng (balance). Quan Heng means balance; hence, "If the Master is clear, the subordinates are safe; if the Master is unclear, the Twelve Officials are in danger."
Balance levels the Qi, the Qi Kou forms the Cun, to determine life and death.
Wang Bing commented: In the Three Generations Pulse Method, the three positions are divided into Cun, Guan, and Chi. Thus, when the Qi distribution in the interior/exterior and high/low is uniform, the pulse at the Qi Kou forms the Cun. The Qi Kou is the great convergence of pulses, where all vessels assemble, hence its divisions determine life and death. Wu Kun explained: Using the method of weighing and balancing to level the Qi Kou, dividing it into three parts to form Cun and Chi, to determine the life and death of diseases. Zhang Zhicong explained: Quan Heng means balance, referring to the floating/sinking, exiting/entering, Yin/Yang peace of the pulse, hence "balance levels the Qi Kou." The Qi Kou, the two pulse ports of Hand-Taiyin, forming the Cun, means dividing Chi into Cun. It states that the Five Zang and Six Fu Organs receive Qi from grain, overflow essence into vessels, manifest at the Qi Kou, to determine life and death. Ma Shi explained: The Qi Kou is the Taiyuan acupoint of the Hand-Taiyin Meridian, one cun away from Yuji, thus forming the name Cun Kou, truly capable of diagnosing auspiciousness/misfortune and determining life and death. *Ling Shu: Small Needle Explanation* states deficient Qi Kou requires tonification, excess requires sedation; thus, all diseases are primarily determined by the Qi Kou. Zhang Jiebin explained: Once the Qi of the Zang and Fu organs achieves balance, it must manifest at the Qi Kou as Cun and Chi. The Qi Kou is the great convergence of pulses, where all vessels assemble, hence it can determine life and death. All the aforementioned points involve the transformation of food Qi, which in turn depends on Stomach Qi. Hence, the previous text mentions "food Qi enters the Stomach," and the next section mentions "drink enters the Stomach." Zhang Ji's note: The sections following "Food Qi enters the Stomach" describe how Stomach Qi infiltrates the Liver, returns to the Heart, flows to the Lung, travels to the Fu, and remains in the Four Zang Organs, achieving balance like a scale, allowing life and death to be determined at the Qi Kou. The classic states that when food and water enter the mouth, there are five flavors, each pouring into its respective Sea, and body fluids each follow their pathways. The Stomach is the Sea of food and water; what moves in the Sea is Qi, just as Qi moves in the world. What the Stomach produces is Blood and Qi, which are the vessel pathways; the vessel pathways are the great collaterals of the Five Zang and Six Fu Organs. When five grains enter the Stomach, their dregs, fluids, and Zong Qi divide into three tunnels. Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart and Lung to govern respiration; this is the theory of returning to the Heart and flowing to the Lung. Ying Qi secretes its fluids, injects into the Lung, transforms into Blood, and nourishes the four extremities. Wei Qi originates from the Middle Jiao, also mixes in the Stomach, emerging after the Upper Jiao. This is what is meant by the receiver secreting dregs, generating fluids, transforming into essence, injecting upward into the Lung vessels to transform into Blood, sustaining life; this is the theory of infiltrating the Liver and flowing to the Lung. Furthermore, the Stomach has five orifices, connecting upward to the Lung, with liver-diaphragm large tendons. The thoracic-diaphragm large tendons are the pathways connecting the Heart, Lung, and Liver. The Heart combines with vessels, the Liver with tendons, the Lung with skin and hair, indicating their external correspondences. Transporting Qi to the Fu; the Fu is the San Jiao. The San Jiao is the solitary Fu, hence only the Fu is mentioned. *Rites of Zhou: Physicians* lists Nine Organs: Heart, Liver, Spleen, Lung, Kidney are the five correct Zang, combined with Stomach, Bladder, Large Intestine, Small Intestine to make nine. Commentary cites *Nan Jing 81*: Stomach is the Fu of food and water, Small Intestine is the Fu of reception and storage, Large Intestine is the Fu of transmission, Bladder is the Fu of fluids, San Jiao is the solitary Fu, not entering the Zang category, hence this text mentions Four Zang. The San Jiao is Shaoyang Yang within Water, acting as Minister Fire, belonging to the Mingmen within the Kidney. Mingmen is the Kidney system; from the Kidney system grows downward connected net-oil membranes, forming the Lower Jiao; middle plate-oil forms the Middle Jiao; upper diaphragm membrane forms the Upper Jiao. Its root actually lies in the Kidney. The Kidney connects upward to the Lung; Metal and Water generate each other. The Kidney governs Water and acts as the organ for transporting water, truly being the San Jiao. The San Jiao is the body's membranous oils, connecting the intestines, stomach, and bladder. When food enters the Stomach, it goes down through the intestines; when drink enters the Stomach, the micro-tubes of the Stomach absorb the water and scatter it through the membranous septa, which is the San Jiao. Water travels from the Upper Jiao through the Liver membrane, penetrates the Kidney system, and enters the Lower Jiao oil.