四海 书禹贡。四海会同。尔雅释地。九夷、八狄、七戎、六蛮。谓之四海。
胃者水谷之海（止）三里 张云。人受气于水谷。水谷入口。藏于胃。以养五脏气。故五脏六腑之气味。
皆出于胃。而胃为水谷之海也。其胃气营运之输。上者在气街。即气冲穴。下者至三里。在膝下三寸。（动脉
篇曰胃为五脏六腑之海太阴阳明论曰阳明者表也五脏六腑之海也痿论曰阳明者五脏六腑之海主润宗筋）
冲脉者（止）上下廉 张云。此即血海也。冲脉起于胞中。
其前行者。并少阴之经侠脐上行。至胸中而散。其后行者。上循背里。为经络之海。其上行者。出于颃颡。下
行者出于足。故其输。上在于足太阳之大杼。下在于足阳明之巨虚、上下廉。（顺逆肥瘦篇曰夫冲脉者五脏六
腑之海也）
膻中者（止）人迎 张云。膻中、胸中也。肺之所居。诸气者。皆属于肺。是为真气。亦曰宗气。宗
气积于胸中。出于喉咙。以贯心脉。而行呼吸。故膻中为之气海。柱骨项后。天柱骨也。恚忧无言论曰。颃颡
者。分气之所泄也。故气海营运之输。一在颃颡之后。即柱骨之上下。谓督脉之哑门、大椎也。一在颃颡之前。
谓足阳明之人迎也。
脑（止）风府 张云。凡骨之有髓。惟脑为最巨。故诸髓皆属于脑。而脑为髓之海。盖、脑盖骨也。
即督脉之囟会风府。亦督脉穴。此皆髓海之上下前后输也。志云。盖谓督脉之百会。督脉应天道之环转覆盖。
故曰盖。
气海有余者 马云。有余者。邪气有余而实也。不足者。正气不足而虚也。下文仿此。
息 甲乙作 急息。志云。膻中者宗气之所居。上出于喉。以司呼吸。故气海有余者。气满胸中。
气息 乱。气上逆。故面赤也。
不足以言 张云。声由气发。气不足则语言轻怯。不能出声。脉要精微论曰。言而微。终日乃复言者。
此夺气也。
血海有余（止）不知其所病 张云。形以血充。故血有余则常想其身大。怫、怫郁也。重滞不舒之貌。
血不足则常想其身小。狭、隘狭也。索然不广之貌。此皆血海不调之为病。病在血者。徐而不显。故茫然不觉
其所病。
自过其度 张云。自有过人之度。而无病也。志云。度、骨度也。简案、上古天真论曰。天寿过其
度。志注非是。
耳鸣 张云。以髓虚者精必衰。阴虚则耳鸣也。髓为精类。精衰则气去。而诸证以见矣。
审守其输（止）必败 张云。审守其输。谓审察其输穴。如上文也。无犯其害。无盛盛。无虚虚也。志
云。审其输。则知其四海之通于经。而经俞之外通于气也。调其虚实。则有余不足自和矣。害谓经气之逆。复
则反逆为顺也。
【四海】《尚书·禹贡》中提到“四海会同”。《尔雅·释地》记载：“九夷、八狄、七戎、六蛮，谓之四海。”
胃是水谷之海。张隐庵注：人从水谷中摄取精气。水谷入口后，贮藏于胃，以此滋养五脏之气。因此，五脏六腑的精微物质都来源于胃，所以胃被称为水谷之海。其胃气运行的输穴，上部在气街（即气冲穴），下部到达足三里，位于膝盖下三寸处。（《灵枢·动输篇》说胃是五脏六腑之海；《素问·太阴阳明论》说明阳明经属表，是五脏六腑之海；《素问·痿论》指出阳明经是五脏六腑之海，主要滋润宗筋。）
冲脉是血海。张隐庵注：这就是血海。冲脉起于胞中。其前行者，伴少阴经夹脐上行，至胸中而散开；其后行者，沿背部内侧上行，成为经络之海；其上行者，出于颃颡（鼻咽部）；下行者出于足。因此其输穴，上部在足太阳膀胱经的大杼穴，下部在足阳明胃经的巨虚上廉、巨虚下廉。（《灵枢·顺逆肥瘦篇》说冲脉是五脏六腑之海。）
膻中是气海。张隐庵注：膻中即胸中，是肺所在之处。各种气都归属于肺，这称为真气，也称为宗气。宗气积聚于胸中，出于喉咙，贯通心脉，推动呼吸。所以膻中被称为气海。柱骨指项后的天柱骨。关于“恚忧无言论”一句，张隐庵注：颃颡是分泄气的地方。所以气海运行的输穴，一个在颃颡之后，即柱骨的上下方，指督脉的哑门穴和大椎穴；另一个在颃颡之前，指足阳明胃经的人迎穴。
脑是髓海。张隐庵注：凡是骨头中有髓的，以脑最为巨大。所以所有的髓都属于脑，脑被称为髓之海。盖指脑盖骨，即督脉的囟会穴和风府穴，也是督脉穴位。这些都是髓海上下前后的输穴。张志聪注：所谓“盖”，指督脉的百会穴。督脉对应天道环转覆盖，所以称为盖。
气海有余（实证）。马莳注：有余是指邪气有余而表现为实证。不足是指正气不足而表现为虚证。下文仿照此例。
喘息急促。《甲乙经》作“急息”。张志聪注：膻中是宗气居住的地方，向上出于喉咙，主管呼吸。所以气海有余时，气充满胸中，气息紊乱，气机上逆，导致面红。
气不足以言语。张隐庵注：声音由气发出，气不足则语言轻弱怯懦，不能出声。《素问·脉要精微论》说：“说话声音微弱，整天才能再说一句话，这是夺气。”
血海有余（至不知其所病）。张隐庵注：形体靠血液充养，所以血有余时常觉得自己身体庞大，感到郁结不舒、沉重滞涩的样子。血不足时常觉得自己身体缩小，感到狭隘狭小、萧索不广的样子。这都是血海不调引起的疾病。病在血分的，表现缓慢而不明显，所以茫然不觉自己患病。
超过正常限度。张隐庵注：自有超过常人的度量，而没有疾病。张志聪注：度指骨度。按语：《素问·上古天真论》说“天寿过度”，张志聪的注释是不正确的。
耳鸣。张隐庵注：因为髓虚则精必衰，阴虚则耳鸣。髓属于精的一类，精衰则气去，各种症状就出现了。
审慎观察其输穴（至必败）。张隐庵注：审慎观察其输穴，指审查上述提到的输穴。不要犯伤害，不要实其实，不要虚其虚。张志聪注：审察其输穴，就知道四海与经脉相通，经俞之外通于气。调节虚实，那么有余和不足自然调和。害指经气逆乱，复正则反逆为顺。
[Four Seas] The *Book of Documents: Tribute of Yu* mentions "The Four Seas convene." The *Erya: Shi Di* records: "The Nine Yi, Eight Di, Seven Rong, and Six Man are called the Four Seas."
The Stomach is the Sea of Water and Grain. Zhang Yinan's commentary: Humans derive Qi from water and grain. After entering the mouth, water and grain are stored in the Stomach to nourish the Qi of the Five Zang organs. Therefore, the subtle essences of the Five Zang and Six Fu organs all originate from the Stomach, hence the Stomach is called the Sea of Water and Grain. Its transport points for the operation of Stomach Qi are located superiorly at the Qi Street (i.e., Qichong ST30) and inferiorly reaching Zusanli ST36, which is three cun below the knee. (*Ling Shu: Dong Shu* states that the Stomach is the Sea of the Five Zang and Six Fu organs; *Su Wen: Tai Yin Yang Ming Lun* explains that the Yangming channel belongs to the exterior and is the Sea of the Five Zang and Six Fu organs; *Su Wen: Wei Lun* indicates that the Yangming channel is the Sea of the Five Zang and Six Fu organs, primarily moistening the Zongjin.)
The Chong Mai (Penetrating Vessel) is the Sea of Blood. Zhang Yinan's commentary: This is the Sea of Blood. The Chong Mai originates from the Bao Zhong (uterus/pelvic cavity). Its anterior branch runs alongside the Shaoyin channel, flanking the umbilicus upwards to the chest where it disperses; its posterior branch ascends along the interior of the back, becoming the Sea of the Channels and Collaterals; its ascending branch emerges from the Hangsang (nasopharynx); its descending branch emerges from the foot. Therefore, its transport points are superiorly at Dazhu BL11 of the Foot-Taiyang Bladder channel, and inferiorly at Shangjuxu ST37 and Xiajuxu ST39 of the Foot-Yangming Stomach channel. (*Ling Shu: Shun Ni Fei Shou Pian* states that the Chong Mai is the Sea of the Five Zang and Six Fu organs.)
The Danzhong (Chest/Epigastrium) is the Sea of Qi. Zhang Yinan's commentary: Danzhong refers to the chest, the residence of the Lung. All Qi belongs to the Lung, which is referred to as True Qi or also as Zong Qi (Gathering Qi). Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart vessels, and governs respiration. Thus, Danzhong is called the Sea of Qi. Zhu Gu refers to the Tianzhu bone (cervical vertebrae) at the back of the neck. Regarding the phrase "anger and sorrow without speech," Zhang Yinan comments: The Hangsang is where Qi is distributed and excreted. Therefore, the transport points for the Sea of Qi are one behind the Hangsang, i.e., above and below the Zhu Gu, referring to Yamen GV15 and Dazhui GV14 of the Du Mai (Governor Vessel); the other is in front of the Hangsang, referring to Renying ST9 of the Foot-Yangming Stomach channel.
The Brain is the Sea of Marrow. Zhang Yinan's commentary: Among bones containing marrow, the brain is the largest. Therefore, all marrow belongs to the brain, and the brain is called the Sea of Marrow. "Gai" refers to the cranial vault, specifically Xinhui GV22 and Fengfu GV16 of the Du Mai, which are also Du Mai acupoints. These are the superior, inferior, anterior, and posterior transport points of the Sea of Marrow. Zhang Zhicong's commentary: The term "Gai" refers to Baihui GV20 of the Du Mai. The Du Mai corresponds to the circular rotation and covering of the Heavenly Dao, hence it is called "Gai."
Excess in the Sea of Qi. Ma Shi's commentary: Excess refers to an abundance of pathogenic Qi manifesting as a Full syndrome. Deficiency refers to a lack of Healthy Qi manifesting as an Empty syndrome. The following text follows this pattern.
Rapid breathing. *Jia Yi Jing* reads "rapid breathing." Zhang Zhicong's commentary: Danzhong is the residence of Zong Qi, which emerges upward from the throat to govern respiration. Therefore, when there is excess in the Sea of Qi, Qi fills the chest, breathing becomes disordered, Qi rebels upward, causing facial redness.
Insufficient Qi to speak. Zhang Yinan's commentary: Voice is generated by Qi. When Qi is insufficient, speech is weak and timid, unable to produce sound. *Su Wen: Mai Yao Jing Wei Lun* states: "Speaking with a faint voice, only able to speak again after a whole day, this is Loss of Qi."
Excess in the Sea of Blood (to the point of not knowing what is wrong). Zhang Yinan's commentary: The physical form is nourished by blood. Therefore, when blood is in excess, one often feels their body is large, experiencing a sensation of depression and heaviness. When blood is deficient, one often feels their body is small, experiencing a sensation of narrowness and desolation. These are all diseases caused by disharmony of the Sea of Blood. Diseases in the blood present slowly and subtly, so one remains unaware of being ill.
Exceeding normal limits. Zhang Yinan's commentary: Having natural capacity beyond ordinary people, yet free from disease. Zhang Zhicong's commentary: "Du" refers to bone measurements. Note: *Su Wen: Shang Gu Tian Zhen Lun* states "natural longevity exceeding limits"; Zhang Zhicong's annotation is incorrect.
Tinnitus. Zhang Yinan's commentary: Because deficiency of marrow leads to decline of Essence, and Yin deficiency leads to tinnitus. Marrow is a category of Essence; when Essence declines, Qi departs, and various symptoms appear.
Carefully observe their transport points (to inevitable failure). Zhang Yinan's commentary: Carefully observing their transport points means examining the transport points mentioned above. Do not cause harm; do not reinforce excess, and do not deplete deficiency. Zhang Zhicong's commentary: By examining the transport points, one understands how the Four Seas connect with the channels, and how the channel shu points connect externally with Qi. Regulating excess and deficiency will naturally harmonize the state of fullness and emptiness. Harm refers to rebellious channel Qi; restoring order turns rebellion into compliance.