者从目系下颊里环唇内其支者复从肝别贯膈上注肺是动则病腰痛不可以俯仰丈夫 疝妇人少腹肿甚则嗌干面尘脱色是肝
所生病者胸满呕逆飧泄狐疝遗溺闭癃(灵经脉篇)别者另分一支也合者本经两脉相合也会者与他经相会也交者或本经左
右两脉相交或与他经相交也加者加于上不相通也挟者夹也约者约束也环者环绕也散者非一络也循者根据傍而行也贯者穿过
也夫经络如织营卫如环而欲一一写出纤悉无遗不亦难哉经独以数活字钩清之宛似绘一生人模样垂示来兹较之禹贡浚川图
史记天官书更胜一筹非作者之圣其孰能之
治病犹治贼必先识贼之所在斯不劳而获倘贼在此界而反于彼境捕之则彼境无辜之民徒增扰动而此界真贼且不治而日
炽矣十二经脉所经之处即十二经所辖无异省治之分界也如某处痛某处痒某处热肿某处寒栗即可知何经受病又宁有误治之
虑哉然则此篇经文洵为大小内外诸科一刻不可离之法也
督脉者起于下极之俞并于脊里上至风府入属于脑任脉者起于中极之下以上毛际循腹里上关元至咽喉冲脉者起于气冲
并足阳明之经(今内经俱作少阴)挟脐上行至胸中而散带脉者起于季胁回身一周阳 脉者起于跟中循外踝上行入风池阴
脉者亦起于跟中循内踝上行至咽喉交贯冲脉阳维阴维维络于身溢蓄不能环流灌溉诸经者也阳维起于诸阳会阴维起于诸
阴交也(二十八难)
阳维维于阳阴维维于阴阴阳不能自相维则怅然失志溶溶不能自收持阳维为病苦寒热阴维为病苦心痛阴 为病阳缓而
阴急阳跷为病阴缓而阳急冲之为病逆气里急督之为病脊强而厥任之为病其内苦结男子为七疝女子为瘕聚(内经男子内结
七疝女子带下瘕聚)带之为病腹满腰溶溶如坐水中此奇经八脉之为病也(二十九难)(彭)按奇经八脉经文错乱定系后人
传写之误越人时所读不若是也故所述明晰谨遵录之
人焉受气阴阳焉会何气为营何气为卫营安从生卫于焉会老壮不同气阴阳异位愿闻其会曰人受气于谷谷入于胃以传于
肺五脏六腑皆以受气其清者为营浊者为卫营在脉中卫在脉外营周不休五十而复大会阴阳相贯如环无端卫气行于阴二十五
度行于阳二十五度分为昼夜故气至阳而起至阴而止故曰日中而阳陇为重阳夜半而阴陇为重阴故太阴主内太阳主外各行二
十五度分为昼夜夜半为阴陇夜半后为阴衰平旦阴尽而阳受气矣日中而阳陇日西为阳衰日入阳尽而阴受气矣夜半而大会万
民皆卧命曰合阴平旦阴尽而阳受气如是无已与天地同纪壮者气血盛肌肉滑气道通营卫之行不失其常故昼精而夜瞑老者气
血衰肌肉枯气道涩其营气衰少而卫气内伐故昼不精夜不眠营出于中焦卫出于上焦(刻本误作下)上焦出于胃上口并咽以
上贯膈而布胸中走腋循太阴之分而行还至阳明上至鼻(刻本误作舌)下足阳明常与营俱行于阳二十五度行于阴亦二十五
度一周也故五十度而复大会于手太阴矣中焦亦并胃中出上焦之后此所受气者泌糟粕蒸津液化其精微上注于肺脉乃化而为
血以奉生身莫贵于此故独得行于经隧命曰营气营卫者精气也血者神气也血之与气异名而同类焉故夺血者无汗夺汗者无血
下焦者别回肠注于膀胱而渗入焉水谷者常并居于胃中成糟粕而下于大肠济泌别汁循下焦而渗入膀胱焉上焦如雾中焦如沤
下焦如渎此之谓也(灵枢经营卫生会篇)
(彭)按三焦即三个管子非有名无象也若果有名无象如何并咽并胃
又按卫气出于上焦者水谷入胃胃底之阳蒸气上腾若雾露之溉此即卫气也由上焦出于胃上口尚在膈膜之下于是贯膈
散布胸中然后循太阴分肉之间而行于脉外故曰上焦如雾经文本自明白如果出于下焦则清阳之气与便溺同出有是理乎越人
读经未察卫气出于下焦之误遂谓上焦主内而不出几令卫气全无出路
分肉腠理字义当晓肉必丝丝成理故谓之理有数十百理聚而为纵者有数十百理聚而为横者有数十百理聚而为斜者或纵
或横或斜数块并作一块其并处必有穴从并处说到外面谓之分谓其肉由此而分也从外面说到并处谓之腠谓其数肉并腠也脉
在其中卫即行乎脉外气穴论云肉之大会为谷肉之小会为溪肉分之间溪谷之会以行营卫以会大气是也循太阴之分而行之分
字当作是解其言上焦出于胃上口并咽以上贯膈到此则上焦之管子已尽卫气在膈上既出上焦管子即散布胸中此乃如烟如雾
之物逢空则走故循太阴之分肉而行乎脉外根据次循手阳明至足阳明是明明指卫气言若云指上焦言岂上焦直至足乎问何以知
上焦是管子曰若无管子则并咽以上者何物何以知管子到膈上即尽曰到此不尽卫亦行乎脉中矣手太阴脉从胸走手手阳明脉
从手走头故曰还至阳明
手阳明脉尽处上挟鼻孔足阳明脉起于鼻之交 中故曰还至阳明上至鼻下足阳明刻本鼻字误作舌字没解(彭)擅改正
营气出于中焦者水谷在胃渐渐腐化如造酒然有泡微起其汁若酒浆者即是营气从中焦上注肺脉脉乃心火主之营在脉中
藉心火 炼成赤即是血故曰中焦如沤又曰营卫者精气也血者神气也盖阳之精为神而藏神者心非藉心火 炼而何下焦者水
之出路也水谷在胃渐渐变化下至小肠尚未分别直至小肠下口与回肠会处有一管直对膀胱即是下焦水从此渗入焉故曰下焦
如渎脐上一寸为水分穴即是分水处
卫气昼行于阳夜行于阴最为难解其曰营行脉中卫行脉外五十而复大会又曰常与营俱行阳二十五度行阴二十五度一周
也是营卫同行固属无疑但营出于中焦由手太阴注手阳明手阳明注足阳明足阳明注足太阴顺十二经之贯注则阴经阳经相间
而行营既如此卫亦宜然岂有昼止行阳经夜止行阴经哉然而经则明明言卫气昼日行于阳夜行于阴其故何与
(彭)谓阴阳者
数之可十推之可至百千万也昼行阳夜行阴此阴阳非指经络言乃指外内言也盖脉在分肉之间营行脉中卫即行乎脉外无论阴
经阳经卫气浮上而行者即行于阳也沉伏而行者即行于阴也行于阳则表实故昼日体耐风寒行于阴则表虚故夜卧不耐风寒此
其验也太阴为阴中之至阴故主内太阳为表故主外夫卫犹日也营犹月也虽日有黄赤道月有四游仪总不越乎东升西降之常耳
至若灵枢卫气行一篇手三阳经倒行足三阳经无还路不可为训素经脉别论论食气入胃一言散精于肝一言浊气归心灵邪客篇
论谷入于胃宗气积于胸中卫气先行皮肤与此论营卫同起于手太阴迥然不同则无容信为两是矣但此篇越人仲景俱各引用而
别论邪客从无一言论及故皆不录
女子七岁肾气盛齿更发长二七而天癸至任脉通太冲脉盛月事以时下故有子三七肾气均平故真牙生而长极七七任脉虚
太冲脉衰少天癸竭地道不通故形坏而无子也丈夫八岁肾气实发长齿更二八肾气盛天癸至精气溢泻阴阳和故能有子三八肾
气均平筋骨劲强故真牙生而长极八八则齿发去五脏皆衰筋骨懈惰天癸竭故发鬓白身体重行步不正而无子耳(素上古天真
论)
(彭)按天癸是女精由任脉而来月事是经血由太冲而来 经言二七而天癸至缘任脉通斯时太冲脉盛月事亦以时下
一
顺言之一逆言之耳故月事不调不来及崩是血病咎在冲脉波脉隶阳明带下是精病咎在任脉任脉隶少阴盖身前中央一条是任
脉背后脊里一条是督脉皆起于前后两阴之交会阴穴难经明晰灵素传误带脉起于季胁似束带状人精藏于肾肾系于腰背精欲
下泄必由带脉而前然后从任脉而下故经言任脉为病女子带下
两神相搏合而成形常先身生是为精上焦开发宣五谷味熏肤充身泽毛若雾露之溉是谓气腠理发泄汗出溱溱是谓津谷入
气满淖泽注于骨骨属屈伸泄泽补益脑髓皮肤润泽是谓液中焦受气取汁变化而赤是谓血壅遏营气令无所避是谓脉精脱者耳
聋气脱者目不明津脱者腠理开汗大泄液脱者骨属屈伸不利色夭脑髓消胫 耳数鸣血脱者色白夭然不泽其脉空虚(灵决
气)
肺气通于鼻肺和则鼻能知臭香矣心气通于舌心和则舌能知五味矣肝气通于目肝和则目能辨五色矣脾气通于口脾和则
口能知五谷矣肾气通于耳肾和则耳能闻五音矣(灵脉度)
人卧血归于肝肝受血而能视足受血而能步掌受血而能握指受血而能摄(素五脏生成)
心恶热肺恶寒肝恶风脾恶湿肾恶燥(素宣明五气)
五脏之精气皆上注于目骨之精为瞳子筋之精为黑眼血之精为络气之精为白眼肌肉之精为约束裹撷筋骨血气之精而与
脉并为系上属于脑后出于项中故邪中于项因逢其身之虚其入深则随眼系以入于脑则脑转脑转则引自系急目系急则目眩以
转矣精散则视岐视岐见两物目者五脏六腑之精也营卫魂魄之所常营也神气之所生也故神劳则魂魄散志意乱卒然见非常处
(灵大惑论)
肝生于左肺藏于右心部于表肾治于里脾为之使胃为之市膈肓之上中有父母七节之旁中有小心(灵刺禁论)胃者水谷
之海冲脉为十二经之海膻中为气之海脑为髓之海(灵海论)
唇至齿长九分口广二寸半齿至会厌深三寸半舌长七寸广二寸半咽门广二寸半至胃长一尺六寸胃纡曲屈伸之长二尺六
寸大一尺五寸径五寸大容三斗五升小肠后附脊左环回周叠积其注于回肠者外附于脐上回运环十六曲大二寸半径八分分之
少半长三丈三尺回肠当脐左(难经作右)环回周叶积而下回运环反十六曲大四寸径一寸寸之少半长二丈一尺广肠傅脊以
受回肠左环叶积上下辟大八寸径二寸寸之大半长二尺八寸(灵肠胃篇)
此同身寸也不必疑为周尺盖周以古之八寸为尺中人长七尺五寸故五尺之童六尺之孤皆言其小同身寸者屈本人中指中
节横纹头为寸十寸为尺中人亦长七尺五寸适与周尺相合耳若果为周尺则此经伪矣
肝凡七叶左三右四心中有七孔三毛盛精汁三合脾扁广三寸大五寸有散膏半斤主裹血温五脏肺六叶两耳凡八叶肾有两
枚胆在肝之短叶间盛精汁三合膀胱纵广九寸(四十二难)
唇为飞门齿为户门会厌为吸门胃为贲门太仓下口为幽门大肠小肠会为阑门下极为魄门此七冲门也(四十四难)
那些经脉从目系下行至颊里,环绕口唇内侧。其支脉又从肝脏分出,贯穿膈肌,向上注入肺中。当经气发生变动时,会出现腰痛,身体不能前俯后仰;男子患疝气,女子少腹部肿胀,严重时咽喉干燥,面色如蒙尘垢、失去光泽。这是肝经所生的疾病。(出自《灵枢·经脉》篇)
“别”是指另分出一支,“合”是指本经的两条脉络相汇合,“会”是指与其他经脉相交结,“交”是指或是本经左右两条脉络相交,或是与其他经脉相交,“加”是指加于上方而不相通,“挟”是指夹持,“约”是指约束,“环”是指环绕,“散”是指不局限于一条络脉,“循”是指沿着旁边而行,“贯”是指穿过。
经络如同织布般纵横交错,营卫之气如同圆环般循环往复,如果想要一一写出所有细节而无遗漏,难道不是很难吗?经文唯独用几个活字将其梳理清晰,宛如图画出一个活人的模样,留示给后世,这比《禹贡》中的治水图、《史记·天官书》还要高明一筹,如果不是作者圣明,谁能做到这样呢?
治病就像抓贼一样,必须先识别贼寇所在的地方,这样才能不费力而获得成果。倘若贼寇在这一区域,却反而去另一区域抓捕,那么无辜的百姓只会徒增骚扰,而真正的贼寇不仅得不到治理,反而会日益猖獗。十二经脉经过的地方,就是十二经所辖的范围,无异于省治的分界线。如果某处疼痛、某处瘙痒、某处红肿、某处发冷战栗,就可以知道是哪一经受了病邪,又怎么会有误治的忧虑呢?既然如此,这篇经文确实是内、外、大、小各科医生一刻也不能离开的准则。
督脉起于下极之俞(长强穴),并行于脊柱内部,上至风府穴,进入属于脑部。任脉起于中极穴之下,向上经过阴毛际,沿着腹部内侧上行至关元穴,再至咽喉。冲脉起于气冲穴,并足阳明胃经(现在的《内经》多作足少阴肾经),挟脐上行至胸中而分散。带脉起于季胁,环绕身体一周。阳跷脉起于脚跟中部,沿外踝上行入风池穴。阴跷脉也起于脚跟中部,沿内踝上行至咽喉,与冲脉相交贯。阳维脉和阴维脉维系联络全身,若溢满蓄积则不能环流灌溉诸经。阳维脉起于诸阳经交会之处,阴维脉起于诸阴经交会之处。(出自《难经·二十八难》)
阳维脉维系诸阳经,阴维脉维系诸阴经。如果阴阳不能互相维系,就会感到惆怅失意,身体软弱无力,不能自我收持。阳维脉发病,苦于寒热往来;阴维脉发病,苦于心痛;阴跷脉发病,表现为阳侧松弛而阴侧拘急;阳跷脉发病,表现为阴侧松弛而阳侧拘急。冲脉发病,表现为气逆、腹中急迫;督脉发病,表现为脊背强直、厥逆;任脉发病,表现为体内苦结,男子患七疝,女子患瘕聚(《内经》记载:男子内结七疝,女子带下瘕聚)。带脉发病,表现为腹部胀满,腰部松软无力,如同坐在水中。这就是奇经八脉的疾病。(出自《难经·二十九难》)
(沈又彭按语:奇经八脉的经文错乱,必定是后人传抄书写时的错误。越人(扁鹊)当时阅读的经文并非如此。所以他所述说的内容清晰明了,我谨遵原文记录。)
人从哪里受气?阴阳在哪里交会?什么气成为营气?什么气成为卫气?营气从哪里产生?卫气在哪里交会?老壮之气不同,阴阳位置各异,我希望听听其中的道理。回答说:人受气于水谷,水谷进入胃中,以此传送给肺,五脏六腑都由此接受水谷之气。其中清轻的部分成为营气,重浊的部分成为卫气。营行于脉中,卫行于脉外。营气周流不息,运行五十周次后再次大会,阴阳相互贯通,如圆环般没有端点。卫气在阴分运行二十五周次,在阳分运行二十五周次,分为昼夜。所以气到达阳分时人醒来,到达阴分时人入睡。因此说,中午时阳气隆盛为重阳,夜半时阴气隆盛为重阴。所以太阴主内守,太阳主外御,各运行二十五周次,分为昼夜。夜半是阴气隆盛,夜半之后阴气衰退,平旦时阴气尽而阳气受气;中午时阳气隆盛,日西时阳气衰退,日入时阳气尽而阴气受气。夜半时气血大会,万民皆卧,称为“合阴”。平旦时阴气尽而阳气受气,像这样无休止地与天地同步。
壮年人气血旺盛,肌肉滑利,气道通畅,营卫的运行不失其常度,所以白天精神饱满,夜晚睡眠安稳。老年人气血衰弱,肌肉枯槁,气道涩滞,营气衰少而卫气内伐(干扰),所以白天不精神,夜晚不眠。营气出于中焦,卫气出于上焦(刻本误作下焦)。上焦出于胃的上口,并咽以上,贯穿膈肌,散布于胸中,走腋下,沿手太阴肺经的分部而行,返回至手阳明大肠经,上至鼻,下接足阳明胃经,常与营气一起行于阳分二十五周次,行于阴分二十五周次,一周完毕。所以五十周次后再次在手太阴肺经大会。
中焦也在胃中,出在上焦之后,这里所受的水谷之气,泌别糟粕,蒸化津液,化生精微,向上注于肺脉,进而化为血液,以奉养身形,没有比这更宝贵的了,所以独得行于经脉隧道,称为营气。营卫是精气,血是神气。血与气异名而同类。所以夺血的人不能再发汗,夺汗的人不能再放血。
下焦分别回肠,注入膀胱而渗入其中。水谷常并居于胃中,化成糟粕而下传于大肠,济泌别汁,循下焦而渗入膀胱。上焦如雾,中焦如沤,下焦如渎,说的就是这个道理。(出自《灵枢·营卫生会》篇)
(沈又彭按语:三焦就是三个管子,并不是有名而无形象。如果真的有名无象,怎么会说“并咽”、“并胃”呢?)
又按:卫气出于上焦,是因为水谷入胃,胃底之阳蒸气上腾,如雾露之灌溉,这就是卫气。由上焦出于胃上口,尚在膈膜之下,于是贯穿膈肌,散布胸中,然后沿太阴分肉之间而行于脉外,所以说“上焦如雾”。经文本来明白,如果说出于下焦,那么清阳之气与便溺同出,哪有这个理呢?越人读经未察觉卫气出于下焦的错误,于是说上焦主内而不出,几乎让卫气全无出路。
“分肉”、“腠理”的字义应当知晓。肉必须丝丝成理,所以称为“理”。有数十百个理聚而为纵行的,有数十百个理聚而为横行的,有数十百个理聚而为斜行的。或纵或横或斜,数块并作一块,其并处必有穴位。从并处说到外面,称为“分”,意思是肉由此而分开;从外面说到并处,称为“腠”,意思是数肉并合的缝隙。脉在其中,卫即行乎脉外。《灵枢·气穴论》说:“肉之大会为谷,肉之小会为溪。”肉分之间,溪谷之会以行营卫,以会大气,就是这个意思。沿手太阴肺经分部而行,“分”字应当这样解释。它说上焦出于胃上口,并咽以上,贯穿膈肌,到此为止,上焦的管子已尽。卫气在膈上既出上焦管子,即散布胸中,此乃如烟如雾之物,逢空则走,所以沿太阴之分肉而行乎脉外。根据次序,循手阳明大肠经至足阳明胃经,这明明是指卫气而言。如果说是指上焦而言,难道上焦能直达足部吗?问:怎么知道上焦是管子?答:如果没有管子,那么并咽以上的东西是什么?问:怎么知道管子到膈上即尽?答:到此不尽,卫气也就行乎脉中了。手太阴肺经从胸走手,手阳明大肠经从手走头,所以说“还至阳明”。
手阳明大肠经尽头处,上挟鼻孔;足阳明胃经起于鼻之交(睛明穴)中,所以说“还至阳明,上至鼻,下足阳明”。刻本将“鼻”字误作“舌”字,无法解释。(沈又彭擅自改正)
营气出于中焦,是因为水谷在胃中渐渐腐化,如造酒一般,有泡微起,其汁若酒浆者,即是营气。从中焦上注肺脉,脉乃心火主之。营在脉中,藉心火锻炼成赤色,即是血。所以说“中焦如沤”。又说“营卫者精气也,血者神气也”。盖阳之精为神,而藏神者心,非藉心火锻炼而成什么呢?下焦是水之出路。水谷在胃中渐渐变化,下至小肠尚未分别,直至小肠下口与回肠会处有一管直对膀胱,即是下焦,水从此渗入焉。所以说“下焦如渎”。脐上一寸为水分穴,即是分水处。
卫气昼行于阳、夜行于阴,最为难解。经文说“营行脉中,卫行脉外,五十而复大会”,又说“常与营俱行,阳二十五度,行阴二十五度,一周”。这也是营卫同行,固属无疑。但营出于中焦,由手太阴注入手阳明,手阳明注入足阳明,足阳明注入足太阴,顺十二经之贯注,则阴经阳经相间而行。营既如此,卫亦宜然,岂有昼只行阳经、夜只行阴经的道理呢?然而经文则明明说卫气昼日行于阳,夜行于阴,这是什么缘故呢?
(沈又彭认为:所谓阴阳,数之可十,推之可至百千万。昼行阳、夜行阴,这里的阴阳不是指经络,而是指内外。脉在分肉之间,营行脉中,卫即行乎脉外。无论阴经阳经,卫气浮上而行的即行于阳,沉伏而行的即行于阴。行于阳则表实,所以白天身体耐风寒;行于阴则表虚,所以夜晚卧睡不耐风寒。这是验证。太阴为阴中之至阴,故主内;太阳为表,故主外。夫卫犹日也,营犹月也,虽日有黄赤道、月有四游仪,总不越乎东升西降之常耳。至于《灵枢·卫气行》一篇说手三阳经倒行、足三阳经无还路,不可作为训诫。《素问·经脉别论》论食气入胃,一言散精于肝,一言浊气归心;《灵枢·邪客》篇论谷入于胃,宗气积于胸中,卫气先行皮肤。与此论营卫同起于手太阴迥然不同,则无需相信两者都是正确的。但这篇经文,越人、仲景都各自引用,而《别论》、《邪客》从无言论及,所以都不收录。)
女子到了七岁,肾气盛,牙齿更换,头发生长。十四岁(二七),天癸至,任脉通,太冲脉盛,月经按时来潮,所以能有子。二十一岁(三七),肾气平均,真牙生而长极。四十九岁(七七),任脉虚,太冲脉衰少,天癸竭,地道不通,所以形体衰老而没有子。
男子到了八岁,肾气实,头发生长,牙齿更换。十六岁(二八),肾气盛,天癸至,精气溢泻,阴阳和,所以能有子。二十四岁(三八),肾气平均,筋骨劲强,真牙生而长极。六十四岁(八八),则齿发脱落,五脏皆衰,筋骨懈惰,天癸竭,所以鬓发白,身体沉重,行走不正,而没有子。(出自《素问·上古天真论》)
(沈又彭按语:天癸是女精,由任脉而来;月事是经血,由太冲而来。经文说“二七而天癸至”,是因为任脉通,此时太冲脉盛,月事亦以时下。一顺言之,一逆言之罢了。所以月经不调、不来及崩漏,是血病,过错在冲脉;带下是精病,过错在任脉。冲脉隶于阳明,带脉隶于少阴。盖身前中央一条是任脉,背后脊里一条是督脉,皆起于前后两阴之交会。《难经》明晰,《灵》、《素》传误。带脉起于季胁,似束带状。人精藏于肾,肾系于腰背,精欲下泄必由带脉而前,然后从任脉而下。所以经文说任脉为病,女子带下。)
两神相搏,合而成形,常先身生,是为精。上焦开发,宣五谷味,熏肤充身泽毛,若雾露之溉,是谓气。腠理发泄,汗出溱溱,是谓津。谷入气满,淖泽注于骨,骨属屈伸,泄泽,补益脑髓,皮肤润泽,是谓液。中焦受气取汁,变化而赤,是谓血。壅遏营气,令无所避,是谓脉。精脱者耳聋,气脱者目不明,津脱者腠理开,汗大泄,液脱者骨属屈伸不利,色夭,脑髓消,胫酸,耳数鸣,血脱者色白,夭然不泽,其脉空虚。(出自《灵枢·决气》)
肺气通于鼻,肺和则鼻能知臭香矣。心气通于舌,心和则舌能知五味矣。肝气通于目,肝和则目能辨五色矣。脾气通于口,脾和则口能知五谷矣。肾气通于耳,肾和则耳能闻五音矣。(出自《灵枢·脉度》)
人卧血归于肝,肝受血而能视,足受血而能步,掌受血而能握,指受血而能摄。(出自《素问·五脏生成》)
心恶热,肺恶寒,肝恶风,脾恶湿,肾恶燥。(出自《素问·宣明五气》)
五脏之精气皆上注于目。骨之精为瞳子,筋之精为黑眼,血之精为络,气之精为白眼,肌肉之精为约束,裹撷筋骨血气之精而与脉并为系,上属于脑后,出于项中。故邪中于项,因逢其身之虚,其入深则随眼系以入于脑,则脑转,脑转则引目系急,目系急则目眩以转矣。精散则视岐,视岐见两物。目者,五脏六腑之精也,营卫魂魄之所常营也,神气之所生也。故神劳则魂魄散,志意乱。卒然见非常处。(出自《灵枢·大惑论》)
肝生于左,肺藏于右,心部于表,肾治于里,脾为之使,胃为之市,膈肓之上中有父母,七节之旁中有小心。(出自《灵枢·刺禁论》)
胃者水谷之海,冲脉为十二经之海,膻中为气之海,脑为髓之海。(出自《灵枢·海论》)
唇至齿长九分,口广二寸半。齿至会厌深三寸半,舌长七寸,广二寸半。咽门广二寸半,至胃长一尺六寸。胃纡曲屈伸之长二尺六寸,大一尺五寸,径五寸,大容三斗五升。小肠后附脊,左环回周叠积,其注于回肠者,外附于脐上,回运环十六曲,大二寸半,径八分分之少半,长三丈三尺。回肠当脐左(《难经》作右),环回周叶积而下,回运环反十六曲,大四寸,径一寸寸之少半,长二丈一尺。广肠傅脊,以受回肠,左环叶积上下辟,大八寸,径二寸寸之大半,长二尺八寸。(出自《灵枢·肠胃》篇)
这是同身寸,不必怀疑为周尺。盖周代以古之八寸为尺,中人长七尺五寸,所以五尺之童、六尺之孤皆言其小。同身寸者,屈本人中指中节横纹头为寸,十寸为尺,中人亦长七尺五寸,适与周尺相合耳。如果果真是周尺,那么这部经文就是伪作了。
肝凡七叶,左三右四。心中有七孔三毛,盛精汁三合。脾扁广三寸,大五寸,有散膏半斤,主裹血温五脏。肺六叶两耳,凡八叶。肾有两枚。胆在肝之短叶间,盛精汁三合。膀胱纵广九寸。(出自《难经·四十二难》)
唇为飞门,齿为户门,会厌为吸门,胃为贲门,太仓下口为幽门,大肠小肠会为阑门,下极为魄门。此七冲门也。(出自《难经·四十四难》)
Those meridians descend from the eye system to the interior of the cheek, encircling the inner aspect of the lips. The branch meridian diverges from the Liver, pierces through the diaphragm, and ascends to pour into the Lung. When the meridian qi is disturbed, it causes lower back pain with inability to bend or extend; in men, it causes hernia (Shan); in women, swelling of the lower abdomen, and when severe, dryness of the throat, a dusty complexion, and loss of luster. These are diseases generated by the Liver Meridian (Liver Jing). (From *Ling Shu: Jing Mai* Chapter)
"Bie" refers to another branch dividing off; "He" refers to two vessels of the same meridian converging; "Hui" refers to meeting with other meridians; "Jiao" refers to either the left and right vessels of the same meridian intersecting or intersecting with other meridians; "Jia" refers to adding above without connection; "Xia" refers to flanking; "Yue" refers to constraining; "Huan" refers to encircling; "San" refers to not being confined to one collateral; "Xun" refers to following along the side; "Guan" refers to piercing through.
The meridians and collaterals are interwoven like fabric, while Ying (Nutrient) and Wei (Defensive) Qi circulate like a ring. To write out every detail exhaustively would indeed be difficult. The Classic uniquely uses a few dynamic characters to clarify them, resembling a drawing of a living person to instruct future generations. This surpasses the river maps in *Yu Gong*, the astronomical records in *Shi Ji: Tian Guan Shu*, and more. If not for the sagacity of the author, who could achieve this?
Treating disease is like catching thieves; one must first identify where the thief is located to succeed effortlessly. If the thief is in this territory but one searches in another, innocent people in that territory will only suffer disturbance, while the true thief remains untreated and grows stronger daily. The areas traversed by the Twelve Primary Meridians are their jurisdictions, no different from provincial boundaries. If there is pain, itching, heat, swelling, cold, or shivering in a specific area, one can know which meridian is diseased, eliminating the worry of misdiagnosis. Thus, this chapter's text is indeed an indispensable principle for all internal, external, major, and minor specialties.
The Du Meridian (Governor Vessel) originates at the lower extreme Shu point (Changqiang, GV1), runs parallel within the spine, ascends to Fengfu (GV16), and enters to connect with the brain. The Ren Meridian (Conception Vessel) originates below Zhongji (CV3), ascends past the pubic hair line, follows the interior of the abdomen to Guanyuan (CV4), then to the throat. The Chong Meridian (Penetrating Vessel) originates at Qichong (ST30), runs alongside the Foot-Yangming Stomach Meridian (modern *Nei Jing* often cites Foot-Shaoyin Kidney Meridian), ascends flanking the umbilicus to scatter in the chest. The Dai Meridian (Girdle Vessel) originates at the costal margin and encircles the body once. The Yang Qiao Meridian (Yang Heel Vessel) originates in the middle of the heel, ascends along the lateral malleolus, and enters Fengchi (GB20). The Yin Qiao Meridian (Yin Heel Vessel) also originates in the middle of the heel, ascends along the medial malleolus to the throat, and intersects with the Chong Meridian. The Yang Wei Meridian (Yang Linking Vessel) and Yin Wei Meridian (Yin Linking Vessel) link and network the body; if they overflow and accumulate, they cannot circulate and irrigate the primary meridians. The Yang Wei Meridian originates at the intersection of all Yang meridians, and the Yin Wei Meridian originates at the intersection of all Yin meridians. (From *Nan Jing: Twenty-Eighth Difficulty*)
The Yang Wei Meridian links the Yang meridians, and the Yin Wei Meridian links the Yin meridians. If Yin and Yang cannot mutually link, one feels despondent and weak, unable to control oneself. Disease of the Yang Wei Meridian involves aversion to cold and fever; disease of the Yin Wei Meridian involves heart pain; disease of the Yin Qiao Meridian presents with slackness on the Yang side and tension on the Yin side; disease of the Yang Qiao Meridian presents with slackness on the Yin side and tension on the Yang side. Disease of the Chong Meridian involves rebellious Qi and abdominal urgency; disease of the Du Meridian involves stiffness of the spine and cold extremities; disease of the Ren Meridian involves internal knotting, causing seven types of hernia in men and mass accumulation in women (*Nei Jing*: Men have internal knotting of seven hernias, women have leukorrhea and masses). Disease of the Dai Meridian involves abdominal fullness and a loose, sinking sensation in the waist, as if sitting in water. These are diseases of the Eight Extraordinary Vessels. (From *Nan Jing: Twenty-Ninth Difficulty*)
(Shen Youpeng notes: The text regarding the Eight Extraordinary Vessels is disordered, undoubtedly due to errors in later copying. The text Yue Ren read was not like this. His descriptions were clear and precise. I record it faithfully.)
Where does man receive Qi? Where do Yin and Yang meet? Which Qi becomes Ying (Nutrient) Qi? Which Qi becomes Wei (Defensive) Qi? From where does Ying Qi arise? Where does Wei Qi meet? Why is Qi different in old and young, and why are Yin and Yang in different positions? I wish to hear the explanation. The answer is: Man receives Qi from grain and water. Grain and water enter the stomach and are transmitted to the Lung, so that all Zang and Fu organs receive Qi. The pure and light part becomes Ying Qi, and the turbid and heavy part becomes Wei Qi. Ying Qi moves within the vessels, and Wei Qi moves outside the vessels. Ying Qi circulates endlessly, completing fifty cycles before meeting again, with Yin and Yang interweaving like a circle without end. Wei Qi travels twenty-five cycles in Yin and twenty-five cycles in Yang, dividing day and night. Thus, when Qi reaches Yang, one awakens; when it reaches Yin, one sleeps. Therefore, at noon, Yang Qi is abundant, constituting "Double Yang"; at midnight, Yin Qi is abundant, constituting "Double Yin". Thus, Taiyin governs the interior, and Taiyang governs the exterior, each traveling twenty-five cycles to divide day and night. Midnight is Double Yin; after midnight, Yin declines. At dawn, Yin is exhausted, and Yang receives Qi. Noon is Double Yang; at sunset, Yang declines. At dusk, Yang is exhausted, and Yin receives Qi. At midnight, there is a great meeting; all people sleep, called "He Yin" (Combining Yin). At dawn, Yin is exhausted, and Yang receives Qi. This continues endlessly, synchronized with Heaven and Earth.
In vigorous adults, Qi and Blood are abundant, muscles are smooth, and Qi pathways are open. Ying and Wei Qi move normally, so one is energetic during the day and sleeps soundly at night. In the elderly, Qi and Blood decline, muscles wither, and Qi pathways become obstructed. Ying Qi is deficient, and Wei Qi invades internally, causing daytime lethargy and nighttime insomnia. Ying Qi arises from the Middle Jiao, and Wei Qi arises from the Upper Jiao (incorrectly printed as Lower Jiao in some editions). The Upper Jiao originates from the upper opening of the stomach, passes up the pharynx, pierces the diaphragm, spreads in the chest, travels down the axilla, follows the distribution of the Hand-Taiyin Lung Meridian, returns to the Hand-Yangming Large Intestine Meridian, ascends to the nose, and descends to the Foot-Yangming Stomach Meridian. It commonly travels with Ying Qi, twenty-five cycles in Yang and twenty-five cycles in Yin, completing one cycle. Thus, after fifty cycles, it meets again at the Hand-Taiyin Lung Meridian.
The Middle Jiao is also in the stomach, emerging after the Upper Jiao. The Qi received here separates dregs, steams fluids, transforms essence, pours it upward into the Lung vessels, and transforms it into blood to nourish the body. Nothing is more precious than this, so it alone travels in the vessel tunnels, called Ying Qi. Ying and Wei are Essence Qi; Blood is Spirit Qi. Blood and Qi have different names but the same substance. Therefore, those who lose blood should not sweat, and those who lose sweat should not bleed.
The Lower Jiao separates the ileum and pours into the bladder, seeping in. Grain and water usually reside in the stomach, transform into dregs, and descend to the large intestine. They filter and separate juices, follow the Lower Jiao, and seep into the bladder. The Upper Jiao is like mist, the Middle Jiao like fermentation, and the Lower Jiao like a ditch. This is what is meant. (From *Ling Shu: Ying Wei Sheng Hui* Chapter)
(Shen Youpeng notes: The San Jiao are three tubes, not formless entities. If they were formless, how could they "pass the pharynx" or "pass the stomach"?)
Furthermore, Wei Qi arises from the Upper Jiao because the Yang vapor from the bottom of the stomach rises like fog and dew, irrigating the body. This is Wei Qi. Arising from the Upper Jiao at the stomach's upper opening, it is still below the diaphragm, then pierces the diaphragm, spreads in the chest, and travels between the Taiyin muscle layers outside the vessels. Hence, "Upper Jiao is like mist." The text is clear. If it arose from the Lower Jiao, clear Yang Qi would exit with urine and feces, which makes no sense. Yue Ren failed to notice the error of Wei Qi arising from the Lower Jiao and claimed the Upper Jiao governs the interior and does not exit, leaving Wei Qi with no outlet.
The meaning of "Fen Rou" (separated meat) and "Cou Li" (clefts and pores) should be understood. Meat must have distinct lines, hence "Li" (lines). There are hundreds of longitudinal, transverse, and oblique lines. Where multiple lines converge, there are acupoints. Speaking from the convergence outward is "Fen" (division), meaning meat divides here. Speaking from the outward inward is "Cou" (cleft), meaning the cleft where meat converges. Vessels are within; Wei Qi travels outside the vessels. *Ling Shu: Qi Kou Lun* states: "Large convergence of meat is Gu, small convergence is Xi." Between muscle divisions, the Xi-Gu intersections transport Ying and Wei Qi and gather Great Qi. Traveling along the Taiyin distribution, "distribution" means this. It says the Upper Jiao originates from the stomach's upper opening, passes the pharynx, and pierces the diaphragm. Here, the Upper Jiao tube ends. Wei Qi, having exited the Upper Jiao tube above the diaphragm, spreads in the chest. Being like smoke and mist, it seeks empty spaces, thus traveling along the Taiyin muscle layers outside the vessels. Following the sequence, it goes to the Hand-Yangming and then Foot-Yangming. This clearly refers to Wei Qi. If it referred to the Upper Jiao, could the Upper Jiao reach the foot? Question: How do we know the Upper Jiao is a tube? Answer: Without a tube, what is it that passes the pharynx? Question: How do we know the tube ends at the diaphragm? Answer: If it doesn't end here, Wei Qi would travel within the vessels. The Hand-Taiyin Lung Meridian goes from chest to hand; the Hand-Yangming Large Intestine Meridian goes from hand to head. Hence, "returns to Yangming."
The Hand-Yangming Large Intestine Meridian ends beside the nostrils; the Foot-Yangming Stomach Meridian begins at the bridge of the nose (Jingming). Hence, "returns to Yangming, ascends to the nose, descends to Foot-Yangming." Some editions mistakenly print "tongue" instead of "nose," making no sense. (Shen Youpeng corrected it.)
Ying Qi arises from the Middle Jiao. Grain and water in the stomach slowly rot and ferment, like brewing wine, with bubbles rising. The juice, like wine, is Ying Qi. It pours from the Middle Jiao into the Lung vessels. The vessels are governed by Heart Fire. Ying is within the vessels, refined by Heart Fire into red blood. Hence, "Middle Jiao is like fermentation." Also, "Ying and Wei are Essence Qi; Blood is Spirit Qi." The essence of Yang is Spirit, stored in the Heart. Without Heart Fire refinement, how could it be formed? The Lower Jiao is the outlet for water. Grain and water change in the stomach, descend to the small intestine, and until the lower mouth of the small intestine meets the ileum, there is a tube facing the bladder, which is the Lower Jiao. Water seeps in here. Hence, "Lower Jiao is like a ditch." One cun above the umbilicus is the Shuifen point (CV9), the dividing place.
Wei Qi traveling in Yang by day and Yin by night is hardest to understand. The text says "Ying travels in vessels, Wei travels outside vessels, meeting after fifty cycles," and "commonly travels with Ying, twenty-five cycles in Yang, twenty-five in Yin, one cycle." This confirms Ying and Wei travel together. Ying arises from the Middle Jiao, flows from Hand-Taiyin to Hand-Yangming, to Foot-Yangming, to Foot-Taiyin, following the twelve meridians' sequence, alternating Yin and Yang. Since Ying does so, Wei should too. How could Wei only travel Yang meridians by day and Yin meridians by night? Yet the text explicitly states Wei travels Yang by day and Yin by night. Why?
(Shen Youpeng argues: Yin and Yang, when counted, can be ten, hundred, thousand, or million. Day/Yang and Night/Yin here do not refer to meridians but to exterior/interior. Vessels are between muscles; Ying travels in vessels, Wei travels outside. Regardless of Yin or Yang meridians, Wei Qi floating upward travels in Yang; Wei Qi sinking downward travels in Yin. Traveling in Yang makes the exterior solid, so the body resists wind-cold by day. Traveling in Yin makes the exterior deficient, so the body cannot resist wind-cold by night. This is the verification. Taiyin is the utmost Yin within Yin, governing the interior; Taiyang is the exterior, governing the exterior. Wei is like the sun, Ying is like the moon. Although the sun has ecliptic paths and the moon has four游 instruments, they always follow the constant of rising east and setting west. As for *Ling Shu: Wei Qi Xing*, stating Hand-San-Yang meridians reverse and Foot-San-Yang meridians have no return path is not authoritative. *Su Wen: Jing Mai Bie Lun* discusses food entering the stomach, scattering essence to the Liver, and turbid Qi returning to the Heart. *Ling Shu: Xie Ke* discusses grain entering the stomach, Zong Qi accumulating in the chest, and Wei Qi preceding in the skin. These differ significantly from the theory that Ying and Wei both originate at Hand-Taiyin. Thus, there is no need to believe both are correct. However, Yue Ren and Zhang Zhongjing cited this chapter, while *Bie Lun* and *Xie Ke* never mentioned it, so neither is recorded.)
At age seven, girls' Kidney Qi flourishes, teeth change, and hair grows. At fourteen (two sevens), Tian Gui arrives, the Ren Meridian opens, the Chong Meridian flourishes, menstruation comes on time, and conception is possible. At twenty-one (three sevens), Kidney Qi is balanced, wisdom teeth grow, and growth peaks. At forty-nine (seven sevens), the Ren Meridian is deficient, the Chong Meridian declines, Tian Gui is exhausted, the earth pathway closes, the body deteriorates, and conception is impossible.
At age eight, boys' Kidney Qi becomes substantial, hair grows, and teeth change. At sixteen (two eights), Kidney Qi flourishes, Tian Gui arrives, essence overflows, Yin and Yang harmonize, and conception is possible. At twenty-four (three eights), Kidney Qi is balanced, sinews and bones are strong, wisdom teeth grow, and growth peaks. At sixty-four (eight eights), teeth and hair fall out, all Zang organs decline, sinews and bones become lax, Tian Gui is exhausted, beard and eyebrows turn white, the body feels heavy, gait is unsteady, and conception is impossible. (From *Su Wen: Shang Gu Tian Zhen Lun*)
(Shen Youpeng notes: Tian Gui is female essence coming from the Ren Meridian; menstruation is menstrual blood coming from the Chong Meridian. The text says "at two sevens, Tian Gui arrives" because the Ren Meridian opens; at this time, the Chong Meridian flourishes, and menstruation also comes on time. It is stated in one direction and reversed in another. Thus, irregular menstruation, amenorrhea, or metrorrhagia are blood diseases, fault lying with the Chong Meridian. Leukorrhea is an essence disease, fault lying with the Ren Meridian. The Chong Meridian belongs to Yangming; the Dai Meridian belongs to Shaoyin. The central anterior line is the Ren Meridian; the posterior spinal line is the Du Meridian. Both originate at the junction of the anterior and posterior yin openings. *Nan Jing* is clear; *Ling Shu* and *Su Wen* have transmission errors. The Dai Meridian originates at the costal margin, like a belt. Essence is stored in the Kidneys, which are connected to the lower back. If essence desires to descend, it must pass through the Dai Meridian anteriorly, then descend via the Ren Meridian. Hence, the text says disease of the Ren Meridian causes leukorrhea in women.)
When two spirits interact, they combine to form shape, often existing before the body, called Essence. The Upper Jiao opens and develops, distributing the flavors of grain and water, warming the skin, filling the body, and moistening hair, like fog and dew irrigation; this is called Qi. When cou li open and sweat pours profusely, this is called Jin (Fluids). When grain enters and Qi fills, moisture nourishes the bones, aiding flexion and extension, supplementing the brain marrow, and moisturizing the skin, this is called Ye (Thick Fluids). The Middle Jiao receives Qi, extracts juice, transforms it red, and this is called Blood. Confining Ying Qi so it has nowhere to escape is called Mai (Vessels). Loss of Essence causes deafness; loss of Qi causes blurred vision; loss of Jin causes open cou li and profuse sweating; loss of Ye causes difficulty in joint flexion and extension, sallow complexion, brain marrow depletion, leg soreness, and frequent tinnitus; loss of Blood causes sallow, dull complexion and empty pulses. (From *Ling Shu: Jue Qi*)
Lung Qi connects to the nose; when Lung is harmonious, the nose perceives odors. Heart Qi connects to the tongue; when Heart is harmonious, the tongue perceives five flavors. Liver Qi connects to the eyes; when Liver is harmonious, the eyes distinguish five colors. Spleen Qi connects to the mouth; when Spleen is harmonious, the mouth perceives five grains. Kidney Qi connects to the ears; when Kidney is harmonious, the ears perceive five tones. (From *Ling Shu: Mai Du*)
When sleeping, blood returns to the Liver. The Liver receives blood and enables vision; the feet receive blood and enable walking; the palms receive blood and enable grasping; the fingers receive blood and enabling holding. (From *Su Wen: Wu Zang Sheng Cheng*)
The Heart dislikes heat; the Lung dislikes cold; the Liver dislikes wind; the Spleen dislikes dampness; the Kidney dislikes dryness. (From *Su Wen: Xuan Ming Wu Qi*)
The essence of all five Zang organs pours upward into the eyes. The essence of bone forms the pupil; the essence of sinew forms the dark part of the eye; the essence of blood forms the networks; the essence of Qi forms the whites; the essence of muscle forms the eyelids. Wrapping and gathering the essence of sinew, bone, blood, and Qi, merging with the vessels to form the optic nerve, it ascends to the back of the head and emerges from the neck. Thus, if evil strikes the neck, coinciding with bodily deficiency, and penetrates deeply, it follows the optic nerve into the brain. Brain rotation pulls the optic nerve tight, causing dizziness and spinning. Scattered essence causes diplopia (seeing double). The eyes are the essence of the five Zang and six Fu organs, the constant dwelling of Ying, Wei, Hun, and Po, and the birthplace of Shen Qi. Thus, mental fatigue scatters Hun and Po and confuses will and intent. Suddenly seeing unusual places... (From *Ling Shu: Da Huo Lun*)
The Liver generates on the left; the Lung stores on the right; the Heart distributes to the exterior; the Kidney governs the interior; the Spleen acts as its envoy; the Stomach acts as its market. Above the diaphragm and huang, there are parents; beside the seventh vertebra, there is a careful mind. (From *Ling Shu: Ci Jin Lun*)
The Stomach is the Sea of Grain and Water; the Chong Meridian is the Sea of the Twelve Meridians; the Danzhong is the Sea of Qi; the Brain is the Sea of Marrow. (From *Ling Shu: Hai Lun*)
From lip to tooth is nine fen; mouth width is two cun and half. From tooth to epiglottis is three cun and half; tongue length is seven cun, width two cun and half. Pharyngeal gate width is two cun and half; to stomach is one chi and six cun. Stomach length, coiled and extended, is two chi and six cun; diameter one chi and five cun; circumference five cun; capacity three dou and five sheng. Small intestine attaches posteriorly to the spine, looping left around the umbilicus. Its entry into the ileum attaches externally above the umbilicus, looping sixteen times, diameter two cun and half, radius eight fen minus a third, length three zhang and three chi. Ileum is at the umbilicus left (Nan Jing says right), looping sixteen times downward, diameter four cun, radius one cun plus a third, length two zhang and one chi. Large intestine attaches to the spine, receiving the ileum, looping left and right, diameter eight cun, radius two cun plus two-thirds, length two chi and eight cun. (From *Ling Shu: Chang Wei* Chapter)
These are "Tong Shen Cun" (same-body inches), not Zhou Chi (Zhou dynasty chi). Zhou used eight ancient cun as one chi. A normal person is seven chi five cun tall. Thus, a five-chi child or six-chi orphan is considered small. Tong Shen Cun uses the middle segment of the middle finger's transverse crease as one cun. Ten cun make one chi. A normal person is seven chi five cun tall, matching Zhou Chi exactly. If it were truly Zhou Chi, this classic would be apocryphal.
The liver has seven lobes: three on the left, four on the right. The heart has seven holes and three hairs, containing three he of bile juice. The spleen is flat, three cun wide, five cun long, with half a jin of scattered pancreas, governing enclosing blood and warming the five Zang organs. The lung has six lobes and two ears, totaling eight lobes. The kidneys are two. The gallbladder is between the short lobes of the liver, containing three he of bile juice. The bladder is nine cun long and wide. (From *Nan Jing: Forty-Second Difficulty*)
The lips are the Flying Gate; teeth are the Door Gate; epiglottis is the Inhaling Gate; stomach is the Receiving Gate; lower opening of the Tai Cang is the Hidden Gate; junction of large and small intestines is the Filter Gate; anus is the Corporeal Gate. These are the Seven Rush Gates. (From *Nan Jing: Forty-Fourth Difficulty*)