上智人心七窍三毛，中智人心五窍二毛，下智人心三窍一毛。常人心二窍无毛，愚人心只一窍。无窍则神
无出入之门。○心有七孔应七星，三毛应三台。心至诚则无所不应。（《医学入门》）
《经》云∶心者，君主之官，神明出焉。又云∶心者，五脏六腑之大主。邵子云∶心为一太极，而四肢百
骸、脏腑阴阳，尽皆禀命于心。所谓天君泰然，百体从命也。凡人之心，上有肺之华盖遮覆，下有包络橐 护
围，状如圆镜，明如止水，乃虚灵不昧者也。其间藏性、藏情、藏神、藏液，又为枢机之象。如神不守舍，心
枢摇也；神思迷惑，心机塞也；七情感触，心枢动也；颠倒无恒，心机乱也；液藏于中，心枢守也；汗达于外，
心机发也。或曰∶枢机之病，独心脏有之，何也？盖心家诸病，不能出开阖之理。如不寐，心之开也；善寐，
心之阖也；喜笑，心之开也；不乐，心之阖也；不汗，心之阖也；妄汗，心之开也。病情不一，而无形不能出
枢机之象，有形不能越开阖之理。岂可不知心之为心乎？（《医学阶梯》）
《经》曰∶七节之傍，中有小心。或指下第七节命门穴为小心者，非也。王注小心者，真心神灵之宫室，
以心系并脊膂贯脊髓，正当七节之间。自杨上善认小心为肾神，乃倒数脊骨下七节，致后人即以命门为小心，
由此误也。滑伯仁《心经注》云∶心系有二，其一上与肺相连；其一由肺系而下，曲折向后，贯脊髓，正当七
节之间。又按五内图，果如所云，据此观之，小心即心包络也。何一阳亦谓包络发原，正在心五椎下二节七节
之傍，正与膻中平对，井不可紊。设如彼逆数之，则心当在十五椎，肺在十九椎下矣。自《素问》以来，未闻
此倒数法也。（《医旨绪余》）
《素问》食气入胃，浊气归心，淫精于脉一节，此浊气归心，不得其解。因思心者，君主之官，神明出
焉。果浊气归心，焉得虚灵不昧，具众理而应万事者乎？按此心字，必脾字之误。考《灵枢》曰∶受谷者浊，
受气者清。又曰∶营者，水谷之精气也，调和于五脏，洒陈于六腑。又曰∶阴清而阳浊，诸阴皆清，足太阴独
受其浊。夫腑为阳，脏为阴。既曰诸阴皆清，则心之受清
可知。既曰足太阴独受其浊，则浊气归脾之外，更无一脏再受其浊可知。是浊气归脾，经文无不印合。（《吴医汇讲》）
小肠
小肠者，受盛之官，化物出焉。后附于脊，前附于脐，上左回叠，积十六曲，大二寸半，径八分，分之少
半，长三丈二尺，受谷二斗四升，水六升三合，合之大半，小肠上口，在脐上二寸近脊，水谷由此而入，复下
一寸，外附于脐，为水分穴，当小肠下口。至是而泌别清浊，水液渗入膀胱，滓秽流入大肠，是经多血少气。
《难经》曰∶小肠重二斤十四两。（李士材）
膀胱
膀胱者，州都之官，津液藏焉，气化则能出矣。膀胱当十九椎，居肾之下，大肠之前，有下口，无上口，
当脐上一寸水分穴处，为小肠下口，乃膀胱之际，水液由此别回肠，随气泌渗而下，其出其入，皆由气化。入
气不化，则水归大肠而为泻。出气不化，则闭塞下窍而为癃。诸书有言其有上口无下口，有言上下俱有口者，
皆非。是经多血少气。《难经》曰∶膀胱重九两二铢，纵广九寸，盛溺九升九合，口广二寸半。（李士材）
膀胱上口，《灵》、《素》未言有无，后世或言有上口而无下口者，乃以气化则能出之句而误会也。若无
下口，焉得气一化则遂若此通利哉！是无下口之说，不必论矣。或言有下口而无上口者，张景岳、李士材俱主
是说，第无上口，则交肠之易位而出者，粪从何处入乎？张三锡以为上下俱有口是也，但语焉而未详。夫水道
既从小肠下口以入膀胱，则清浊不分者，何独并于大肠之水泻人所常有，而粪入膀胱之交肠患者甚少乎？谛思
其故，必系膀胱有上口而常闭，乃为平人之常，水之人于膀胱者，乃是三焦化入，而非从上口以入者也。或腑
气大虚，则力乏而窍不能闭；或邪热伤腑，则热主开泄而窍亦不能闭，以致粪从小肠下口入于膀胱上口，并随
小便而出矣。譬如人身之外窍，亦有常闭而
不通者，脐孔与两耳、两乳，无故则常闭而不开，有故则或出脓血，或通乳汁，膀胱之上口，亦可以类推矣。
世人皆以为无上口者，一则宗景岳、士材之书，一则见兽脬之止有下口也。不思天地之生物，各有不同者，如
毛虫则上五脏俱全，羽虫则无肺而无前阴。即人身亦有不同者，男子肋骨二十有四，女子肋骨二十有八。男子
头骨八块，女子头骨六块。人与人尚有异焉，人与兽岂无异乎？○膀胱者，州都之官，津液藏焉，气化则能出
矣。王太仆注云∶得气海之气施化，则溲便注泄；气海之气化不及，则 隐不通。故曰气化则能出矣。王太仆
为注释之开山，历代诸家，各仍其说，莫不以津液即为溲便。殊不思气化则能出者，言膀胱之津液，得太阳之
气而后能出于皮毛，非津液下出之谓也。且津自津，液自液，小便自小便，逐字考之，《内经》各有明文，
《灵枢》曰∶腠理开泄，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，润泽皮肤，
是谓液。又曰∶津脱者，腠理开，汗大泄，骨属屈伸不利。又曰∶三焦出气，以温肌肉，充皮肤者为津；其流
而不行者为液。是津液二字，各有着实，不得以津液小便混而莫辨矣。自古以来，接《内经》之统，以继往开
来者，其惟仲师乎？其治太阳病无汗用麻黄汤，有汗用桂枝汤，此津藏于膀胱，气化则能出之一证也。《金匮》
用栝蒌桂枝汤，以治柔痉；葛根汤以治刚痉。因邪伤太阳，液不养筋，故助太阳之气化，以营运于皮毛，以流
通津液，则筋脉得以濡润，此液藏于膀胱，气化则能出之又一证也。以《经》注《经》，而治法又与《经》旨
符合，则津液之非小便，尚何疑哉！又饮入于胃，上升于肺，以下布于三焦者，谓之水。水湿壅而不通，则小
便不利，轻为腹膨，重为肿胀，此水在三焦而未入膀胱者也。其既入膀胱以后，水之上升而汗出溱溱者，谓之
津。所谓下输膀胱，水精四布也。贮于膀胱而下出者，则谓之溺，溺孔闭涩则为癃秘。《内经》之胞痹等证是
也。《素问》曰∶膀胱不利为癃，不约为
遗溺。《灵枢》曰∶实则闭癃，虚则遗溺。窃意三焦不能化入膀胱者，其病多虚。故历来治肿胀者，总以气不
化水为主也。因溺窍不通，膀胱之内水胀者，其病多实。故统观《内经》诸篇，癃闭则皆有实而无虚也。又按
津之外出者为汗，津之内出者为溺。故汗多不得利小便，恐其阴从下脱也。失小便者，亦不得发汗，虑其阳从
上脱也。小便之与汗，俱为津之所化，同出异名者也。液为水谷之精华，即津之流而不行，随气以运于周身，
则润皮肤，泽筋骨，补脑髓，聚于膀胱，布于经络，宜藏而不宜出。故十二官之神明等俱言出，而此独曰藏者，
言津液之液藏也。气化则能出者，但可指津而言也。若液从溺窍而出，则为膏淋等证矣。尚得谓之气化哉！
（《吴医汇讲》）
肾
肾者，作强之官，伎巧出焉。附于脊之十四椎下，是经少血多气，其合骨也，其荣发也，开窍于二阴。
《难经》曰∶肾有两枚，重一斤二两，藏精与志。华元化曰∶肾者，精神之舍，性命之根。（李士材）
《经》曰∶肾者主水，受五脏六腑之精而藏之，故五脏盛乃能泻。是精藏于肾，非生于肾也。五脏六腑之
精，肾藏而司其输泻，输泻以时，则五脏六腑之精，相续不绝。所以成其坎位，而上交于心，满而后溢，生生
之道也。《经》又曰∶阴之所生，本在五味。褚澄曰∶精血者，饮食五味之秀实也。故东垣立言，首重脾胃。
脾胃一亏，则生化之源绝矣，精何由生？肾气虽强，可坐而败也。可怪今之治虚损者，专以补肾为事，是不明
肾者主水之文。若以精为肾之所专主，则何不曰肾气盛，乃能泻，而曰五脏盛，乃能泻也？藕塘居士有云∶
钱粮贮在库中，库中不出钱粮，所谓民脂民膏者是也。善补肾者，当于脾胃求之。（《怡堂散记》）
命门
两肾中间一点明，逆为丹母顺为人。（《仙经》）
命门穴，不在右肾，而在两肾俞之中。（《铜人图》）
命门为精血之海，脾胃为水谷之海，均为脏腑之本，然命门为元气之根，为水火之宅，五脏之阴气，非
此不能滋，五脏之阳气，非此不能发。而脾胃以中州之土，非火不能生。然必春气始于下，则三阳从地起，而
后万物得以生化。岂非命门之阳气在下，正为脾胃之母乎？○命门有火候，即元阳之谓也，即生物之火也。然
禀赋有强弱，则元阳有盛衰；阴阳有胜负，则病治有微甚。此火候之所以宜辨也。○命门有生气，即干元不息
之机也。无生则息矣。盖阳主动，阴主静。阳主升，阴主降。惟动惟升，所以阳得生气；惟静惟降，所以阴得
死气。故干元之气，始于下而盛于上，升则向生也；坤元之气，始于上而盛于下，降则向死也。○命门有门户，
为一身巩固之关也。《经》曰∶仓廪不藏者，是门户不要也；水泉不止者，是膀胱不藏也。故有为癃闭不通者，
以阴竭水枯，干涸之不行也；有为滑泄不禁者，以阳虚火败，收摄之无主也。阴精既竭，非壮水则必不能行；
阳气既虚，非益火则必不能固。此固其法也，然精无气不行，气无水不化，此其中又有可分不可分之妙用。
○命门有阴虚，以邪火之偏胜也。邪火之偏胜，缘真水之不足也。故其为病，则或为烦渴，或为骨蒸，或为咳
血、吐血，或为淋、浊、遗泄。此虽明是火证，而本非实热之比。盖实热之火，其来暴而必有感触之故；虚热
之火，其来徐而必有积损之因。（张景岳）
心包络
心包络一经，《难经》言其无形。滑伯仁曰∶心包络一名手心主，以脏象较之，在心下横膜之上，竖膜
之下，其与横膜相粘，而黄脂裹者，心也。脂膜之外有细筋膜如丝，与心肺相连者，心包也。此说为是，言
无形者非。按《灵兰秘典论》十二官独少心包一官，而多膻中者臣使之官一段，今考心包藏居膈上，正值膻
中之所，位居相火，代君行事，实臣使也。此一官即心包无疑矣。（李土材）
《经》云∶膻中者，臣使之官，喜乐出焉。李士材云∶膻中即包络之别称。《类经》云∶包络为君主之外
卫，犹帝阙之重城。所以心之有包络，如莲花之有橐 ，橐 空虚，则莲子动摇；包络充足，则神明安逸。如
善寐神清，心血有余；怔忡惊悸，心血不足。血不足，则心如干涸， 似火炽矣。要之，包络血少，不能荣养
其心，致有心烦 杂等证。故治心病，必先以养包络为主。包络得养，则心神安足，何有惊悸怔忡之患耶？
（《医学阶梯》）
或问曰∶《难经》言脏有六，心、肝、脾、肺、肾五而已，余一脏，乃右肾也。手厥阴心包络，既是十二
经中之一经，与少阳为表里矣。乃不以包络为脏，而以右肾当之何也？答曰∶心包络，乃包心之脂膜，非若右
肾之有形质者比也。以其质无特形，故不得为特脏也。又问右肾既为六脏之一矣，何十二经中，不以右肾之有
形者足其数，乃以手心主当之。其故何哉？答曰∶《难经》虽有右肾命门为一脏之说，然外无经络所属，且云
其气与肾通，则亦皆肾而已矣。此二而一，一而二者也。（《医旨绪余》）
三焦
三焦者，决渎之官，水道出焉，是经少血多气。《中藏经》曰∶三焦者，人之三元之气也。总领脏腑、营
卫、经络、内外、左右、上下之气，三焦通，则内外、左右、上下皆通矣。（李士材）
尝读《难经》、叔和、启元诸贤三焦论，皆谓有名无形。又读《灵枢》曰∶密理浓皮者，三焦浓；粗理薄
皮者，三焦薄；勇士者，三焦理横；怯士者，三焦理纵。则似乎有形矣。及观李士材曰∶肌肉之内，脏腑之外，
为三焦，亦无形也。而士材又以无形为误，而以《灵枢》之浓薄纵横、如雾、如渎、如沤，以征其形，则三焦究属
有形耶？无形耶？谨赘一言以辨之。夫三焦者，即胸、膈、腹内三空处也。诸贤皆谓有名无形者，所以别其不同
于他脏他腑之自具一形耳。非曰无形，即无其处，正欲指空处，故曰无形也。《灵枢》浓薄谓纵横者，即指胸
膈腹之腔子里面为言，非另具一形而为浓薄纵横也。《经》又曰如雾、如沤、如渎，而中焦又有作余沥者，盖
即指胸膈腹内空处之水气为喻，即士材所谓肌肉之内，脏腑之外，虽有其处，原无其形，何反以无形为误？岂
其意以既有其处，即不得谓之无形耶？然处与形不同，有其处，《内经》所以云云；无其形，诸贤所以定论。
先圣后贤言似异而旨实同也。惟陈无择言有形如脂膜，疑未妥协。盖脂膜乃身中原有之物，三焦之形如之，则
又一层假脂膜也。假脂膜与真脂膜，其何以辨哉！故敢谓其未妥。（《吴医汇讲》）
上智之人，心窍七孔、毫毛三根；中智之人，心窍五孔、毫毛两根；下智之人，心窍三孔、毫毛一根。常人心窍两孔、无毫毛；愚人心窍仅一孔。若无心窍，则神气无出入之门。○心的七孔对应北斗七星，三根毫毛对应三台星。心若至诚，则无所不应。（《医学入门》）
《内经》说：心是君主之官，神明由此产生。又说：心是五脏六腑的大主。邵雍说：心是一太极，四肢百骸、脏腑阴阳，都禀受于心而听从指挥。这就是所说的“天君安泰，百体顺从”。凡人的心，上有肺的华盖遮覆，下有包络保护围护，形状像圆镜，明亮如止水，是虚灵不昧的器官。其中藏性、藏情、藏神、藏液，又是枢机的象征。如果神不守舍，是心枢动摇；神思迷惑，是心机阻塞；七情触动，是心枢发动；颠倒无常，是心机混乱；液藏于中，是心枢坚守；汗达于外，是心机发散。有人问：枢机的病变，唯独心脏有吗？为什么呢？大概心的各种病症，都离不开开阖的道理。如失眠，是心的开；嗜睡，是心的阖；喜笑，是心的开；不乐，是心的阖；无汗，是心的阖；妄汗，是心的开。病情不一，但无形的变化不能超出枢机的象征，有形的表现不能越过开阖的道理。怎能不了解心之所以为心呢？（《医学阶梯》）
《内经》说：第七节脊椎旁边，中有小心。有人指下第七节的命门穴为小心，这是不对的。王冰注解说的小心，是真心神灵居住的宫室，因为心系连着脊骨贯穿脊髓，正当第七节之间。自从杨上善将小心认作肾神，于是倒数脊骨下七节，导致后人就以命门为小心，这是由此产生的错误。滑伯仁在《心经注》中说：心系有两个，一个上与肺相连；一个由肺系而下，曲折向后，贯穿脊髓，正当第七节之间。又按五脏内景图，果然如此，据此看来，小心就是心包络。何一阳也说包络发源，正在心第五椎下两节即第七节旁边，正与膻中平对，不可错乱。假如像他们那样逆数，那么心就在第十五椎，肺在第十九椎下了。自《素问》以来，没听说过这种倒数法。（《医旨绪余》）
《素问》中“食气入胃，浊气归心，淫精于脉”这一节，对于“浊气归心”无法解释。我思考心是君主之官，神明由此产生。如果浊气归心，怎么能保持虚灵不昧，具备众理而应对万事呢？按这个“心”字，必然是“脾”字的误写。考证《灵枢》说：受谷者为浊，受气者为清。又说：营气，是水谷的精气，调和于五脏，洒陈于六腑。又说：阴清而阳浊，诸阴皆清，足太阴独受其浊。腑属阳，脏属阴。既然说诸阴皆清，那么心受清气可知。既然说足太阴独受其浊，那么浊气归脾之外，更无一脏再受其浊可知。所以浊气归脾，经文无不吻合。（《吴医汇讲》）
小肠
小肠是受盛之官，化物由此产生。后附于脊柱，前附于脐，向左回叠，共有十六个弯曲，直径二寸半，径八分又三分之一分，长三丈二尺，受纳谷物二斗四升，水六升三合又三分之二合。小肠上口，在脐上二寸近脊柱处，水谷由此进入，再下一寸，外附于脐，这里是水分穴，正当小肠下口。到了这里便泌别清浊，水液渗入膀胱，糟粕流入大肠，这条经脉多血少气。《难经》说：小肠重二斤十四两。（李士材）
膀胱
膀胱是州都之官，津液藏于此，气化后才能排出。膀胱位于第十九椎，居肾脏之下，大肠之前，有下口，无上口，当脐上一寸水分穴处，是小肠下口，也是膀胱的上际，水液由此别回肠，随气泌渗而下，其出和入，都由气化决定。入气不化，则水归大肠而为泄泻。出气不化，则闭塞下窍而为癃闭。各书有的说它有上口无下口，有的说上下都有口，都不对。这条经脉多血少气。《难经》说：膀胱重九两二铢，纵广九寸，盛尿九升九合，口广二寸半。（李士材）
膀胱上口，《灵枢》、《素问》未言有无，后世有人说有上口而无下口，乃是因为误解了“气化则能出”这句话。如果没有下口，怎么气一化就能如此通利呢！所以无下口的说法，不必讨论了。有人说有下口而无上口，张景岳、李士材都主张这种说法，但如果无上口，那么交肠病中易位而出的粪便，从哪里进入呢？张三锡认为上下都有口是对的，但说得不够详细。既然水道从小肠下口进入膀胱，那么清浊不分的情况，为什么只有并属于大肠的水泻是人所常见的，而粪入膀胱的交肠患者却很少呢？仔细思考其原因，必定是膀胱有上口而经常关闭，这才是常人的常态。水进入膀胱，乃是三焦气化而入，并非从上口进入。或者腑气大虚，则力乏而窍不能闭；或者邪热伤腑，则热主开泄而窍也不能闭，以致粪便从小肠下口进入膀胱上口，并随小便而出。譬如人身的外窍，也有经常关闭而不通的，如肚脐孔与两耳、两乳，无故则常闭不开，有病则或出脓血，或通乳汁，膀胱的上口，也可以这样类推。世人都以为没有上口，一则尊崇景岳、士材的书，二则看到兽膀胱只有下口。没想到天地生物，各有不同，如毛虫则上五脏俱全，羽虫则无肺且无前阴。即使人身也有不同，男子肋骨二十四根，女子肋骨二十八根。男子头骨八块，女子头骨六块。人与人尚有差异，人与兽难道没有差异吗？○膀胱是州都之官，津液藏于此，气化后才能排出。王太仆注释说：得气海之气施化，则溲便注泄；气海之气化不及，则隐涩不通。所以说气化则能排出。王太仆是注释的开山鼻祖，历代各家，都沿袭他的说法，没有不把津液等同于溲便的。殊不知“气化则能出”，是说膀胱的津液，得太阳之气后才能出于皮毛，并非指津液从下面排出。而且津自津，液自液，小便自小便，逐字考证，《内经》各有明文。《灵枢》说：腠理开泄，汗出溱溱，这叫津；谷入气满淖泽，注入骨中，骨属屈伸泄泽，补益脑髓，润泽皮肤，这叫液。又说：津脱者，腠理开，汗大泄，骨属屈伸不利。又说：三焦出气，以温肌肉，充皮肤的是津；流动而不停留的是液。所以津液二字，各有实指，不能把津液和小便混为一谈。自古以来，承接《内经》正统，继往开来的，唯有仲师吗？他治太阳病无汗用麻黄汤，有汗用桂枝汤，这是津藏于膀胱，气化则能出的一个证据。《金匮要略》用栝蒌桂枝汤治柔痉；葛根汤治刚痉。因邪伤太阳，液不养筋，所以助太阳之气化，以营运于皮毛，以流通津液，则筋脉得以濡润，这是液藏于膀胱，气化则能出的又一个证据。以《经》注《经》，而治法又与《经》旨符合，那么津液不是小便，还有什么可疑的呢！又饮入于胃，上升于肺，以下布于三焦的，叫水。水湿壅滞不通，则小便不利，轻则腹膨，重则肿胀，这是水在三焦而未入膀胱的。其既入膀胱以后，水之上升而汗出溱溱的，叫津。所谓下输膀胱，水精四布也。贮于膀胱而下出的，叫溺，溺孔闭涩则为癃秘。《内经》中的胞痹等证就是这样。《素问》说：膀胱不利为癃，不约为遗溺。《灵枢》说：实则闭癃，虚则遗溺。我推测三焦不能化入膀胱的病，多属虚证。所以历来治肿胀，总以气不化水为主。因溺窍不通，膀胱之内水胀的病，多属实证。所以统观《内经》诸篇，癃闭则都是有实而无虚。又按津之外出为汗，津之内出为溺。所以汗多不得利小便，恐其阴从下脱。失小便者，也不得发汗，虑其阳从上脱。小便与汗，都是津所化生，同出异名。液是水谷的精华，即津中流动而不行的部分，随气运于周身，则润皮肤，泽筋骨，补脑髓，聚于膀胱，布于经络，宜藏不宜出。所以十二官的神明等都言“出”，而这里独言“藏”，是说津液中的液藏。气化则能出，只可指津而言。如果液从溺窍而出，则为膏淋等证了，还能说是气化吗！（《吴医汇讲》）
肾
肾是作强之官，伎巧由此产生。附着于脊柱第十四椎下，这条经脉少血多气，其合在骨，其荣在发，开窍于二阴。《难经》说：肾有两枚，重一斤二两，藏精与志。华元化说：肾是精神之舍，性命之根。（李士材）
《内经》说：肾主水，受五脏六腑之精而藏之，所以五脏盛才能泻。这说明精藏于肾，而非生于肾。五脏六腑之精，肾藏而司其输泻，输泻有时，则五脏六腑之精，相续不绝。所以成其坎位，而上交于心，满而后溢，这是生生之道。《内经》又说：阴之所生，本在五味。褚澄说：精血，是饮食五味的秀实。所以东垣立论，首重脾胃。脾胃一亏，则生化之源绝矣，精从何而生？肾气虽强，也可坐而败坏。可怪现在治虚损的人，专以补肾为事，是不明白“肾者主水”的文义。如果把精当作肾所专主，那为什么不叫“肾气盛，乃能泻”，而叫“五脏盛，乃能泻”呢？藕塘居士有话说：钱粮贮存在库中，库中不出钱粮，所谓民脂民膏就是这种情况。善于补肾的人，应当从脾胃求之。（《怡堂散记》）
命门
两肾中间一点明，逆为丹母顺为人。（《仙经》）
命门穴，不在右肾，而在两肾俞之中。（《铜人图》）
命门是精血之海，脾胃是水谷之海，均为脏腑之本，然而命门是元气之根，是水火之宅，五脏的阴气，非此不能滋养，五脏的阳气，非此不能激发。而脾胃以中州之土，非火不能生。然而必须春气始于下，则三阳从地起，然后万物得以生化。这岂不是命门的阳气在下，正是脾胃之母吗？○命门有火候，即元阳的意思，即生物之火。然而禀赋有强弱，则元阳有盛衰；阴阳有胜负，则病治有微甚。这就是火候之所以需要辨别的原因。○命门有生气，即干元不息的机理。无生则息灭。盖阳主动，阴主静。阳主升，阴主降。惟动惟升，所以阳得生气；惟静惟降，所以阴得死气。故干元之气，始于下而盛于上，升则向生；坤元之气，始于上而盛于下，降则向死。○命门有门户，是一身巩固的关隘。《内经》说：仓廪不藏者，是门户不要也；水泉不止者，是膀胱不藏也。所以有为癃闭不通的，是因阴竭水枯，干涸而不行；有为滑泄不禁的，是因阳虚火败，收摄无主。阴精既竭，非壮水则必不能行；阳气既虚，非益火则必不能固。这是固摄的方法，然而精无气不行，气无水不化，这其中又有可分不可分的妙用。○命门有阴虚，是由于邪火偏胜。邪火偏胜，缘于真水不足。所以其病，或为烦渴，或为骨蒸，或为咳血、吐血，或为淋、浊、遗泄。这虽然是明显的火证，但根本不同于实热。盖实热之火，其来暴而必有感触的缘故；虚热之火，其来徐而必有积损的原因。（张景岳）
心包络
心包络一经，《难经》说它无形。滑伯仁说：心包络又名手心主，以脏象比较，在心下横膜之上，竖膜之下，其与横膜相粘，而黄脂包裹的是心。脂膜之外有细筋膜如丝，与心肺相连的是心包。这种说法是对的，说无形的是错的。按《灵兰秘典论》十二官独少心包一官，而多膻中者臣使之官一段，现在考证心包藏居膈上，正值膻中之所，位居相火，代君行事，实为臣使。这一官就是心包无疑了。（李士材）
《内经》说：膻中是臣使之官，喜乐由此产生。李士材说：膻中即包络的别称。《类经》说：包络为君主之外卫，犹如帝阙的重城。所以心有包络，如莲花有囊，囊空虚，则莲子动摇；包络充足，则神明安逸。如善寐神清，心血有余；怔忡惊悸，心血不足。血不足，则心如干涸，似火炽。总之，包络血少，不能荣养其心，导致有心烦等证。所以治心病，必先以养包络为主。包络得养，则心神安足，哪里有惊悸怔忡的患害呢？（《医学阶梯》）
有人问：《难经》说脏有六，心、肝、脾、肺、肾五而已，其余一脏，乃是右肾。手厥阴心包络，既然是十二经中的一经，与少阳为表里了。为何不以包络为脏，而以右肾当之呢？答曰：心包络，是包心的脂膜，不像右肾那样有形质可比。因为其质无特形，所以不得为特脏。又问：右肾既然为六脏之一，为何十二经中，不以右肾的有形者补足其数，而以手心主当之。这是什么缘故呢？答曰：《难经》虽有右肾命门为一脏之说，然而外无经络所属，且说其气与肾通，则也都是肾罢了。这是二而一，一而二的关系。（《医旨绪余》）
三焦
三焦是决渎之官，水道由此产生，这条经脉少血多气。《中藏经》说：三焦是人的三元之气。总领脏腑、营卫、经络、内外、左右、上下之气，三焦通，则内外、左右、上下皆通。（李士材）
曾经读《难经》、叔和、启元诸贤关于三焦的论述，都说有名无形。又读《灵枢》说：密理浓皮者，三焦浓；粗理薄皮者，三焦薄；勇士者，三焦理横；怯士者，三焦理纵。则似乎有形了。等到看李士材说：肌肉之内，脏腑之外，是三焦，也是无形的。而士材又以无形为误，而以《灵枢》的浓薄纵横、如雾、如渎、如沤，来征验其形，那么三焦究竟是有形还是无形？谨赘一言以辨之。夫三焦，就是胸、膈、腹内三空处。诸贤都说有名无形，是为了区别于其他脏腑各自具有一形。不是说无形就是无其处，正欲指空处，所以说无形。《灵枢》说的浓薄纵横，是指胸膈腹的腔子里面而言，并非另具一形而为浓薄纵横。《经》又说如雾、如沤、如渎，而中焦又有作余沥者，大概就是指胸膈腹内空处之水气为比喻，即士材所谓肌肉之内，脏腑之外，虽有其处，原无其形，为何反而以无形为误？难道他的意思是既有其处，就不得谓之无形吗？然而处与形不同，有其处，《内经》所以云云；无其形，诸贤所以定论。先圣后贤言似异而旨实同。只有陈无择说有形如脂膜，怀疑不恰当。盖脂膜是身中原有的物，三焦的形如之，则是又一层假脂膜。假脂膜与真脂膜，如何分辨呢！所以敢说这不妥当。（《吴医汇讲》）
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*)