（第三十一旧三十二）难曰五脏俱等（列）而心肺独在鬲上者。何也。然。心者血。肺者气。血为荣。气为卫。相
随上下。谓之荣卫。通行经络。荣周于外。故令心肺在鬲上也。
按此篇所述。五脏同辈等列。而心肺独在鬲上。脾肝肾三脏。皆在鬲下。上焉则清阳之处。下焉则浊阴之地。此乃
心肺独似有贵焉。夫心者生化荣血。肺者营运卫气。一身气血。率皆赖于二脏之运化。则其所职最重。故心肺之所贵者
无他。唯在血与气耳。素问曰。鬲肓之上。中有父母。所谓父母者。指气血言。则此篇主意。权舆乎此。盖虽五脏为一
身之主。神气之舍。然其所以为病。皆因血气虚实。且药有气味。亦唯不过疗气血耳。气血生化。则精神魂魄寓其中。
然则医之治病。专在气血之分。岂拘拘于脏象乎。故素问又曰。血气者。人之神。不可不谨养。则此之谓也。
（第三十二旧三十三）难曰。肝（色）青象（乙）木。肺（色）白象（辛）金。肝得水（精气）而沉。（位卑）木得
水而浮。（轻）肺得水（精气）而浮。（位高）金得水而沉。（重）其意何也。然。肝者非为纯木也。（吸金气）乙（木）
角（少）也。庚之柔。大言阴与阳。小言夫与妇。释其微阳。（甲木）而吸其微阴（庚金）之气。其意乐金。又行阴道（足
厥阴多血少气）多。故令肝得水（精气）而沉（重浊为常）也。肺者。非为纯金也。（受火气）辛（金）商（少）也。丙
之柔。大言阴与阳。小言夫与妇。释其微阴。（庚金）婚而就（丙）火。其意乐火。又行阳道（手太阴多气少血）多。故
令肺得水（精气）而浮（轻清为常）也。肺熟（火气离）而复沉。肝熟（金气绝）而复浮者。何也。故知辛当归庚。（纯
金）乙当归甲（纯木）也。
按此篇问答。阅览内经。无有明据。审其设问之辞。以肺肝二脏。倒置其位发难。所谓肺者象金。其体当沉。肝者
象木。其体当浮。凡五行之性。木火属阳。金水属阴。火性炎上。故心居上部。水性润下。故肾居下部。是理之当然也。
然木质当浮。反沉在下。金体当沉。反浮在上。似非木金之性。是其所以发难焉。窃考其所以倒置。即脏腑刚柔之事也。
所谓刚柔者。夫妇之道也。假令甲乙庚辛。即肝胆肺大肠。腑为阳。兄之行也。脏为阴。妹之行也。甲乙本自同气。故
乙木感于异气。其意乐庚金。庚辛本自同性。故辛金配于异性。婚而就火。腑属阳。夫之道也。脏属阴。妇之道也。故
曰。大言阴与阳。小言夫与妇。阴道阳道。谓肺主气在上。肝藏血在下。且在各经。亦复如此。肝肺熟之熟。滑注以为
散失之义。王氏评林为相离也。盖草木实熟。则离谢枝茎之意欤。姑且从之。肝肺若不易地。则心肾阴阳。共为偏胜。
何以致五脏之和平乎。是故肺之在上。象阳中之阴。以为心之辅弼。肝之在下。象阴中之阳。以为肾之匡佐。阴阳相交。
而脏气自全。此越人之旨。岂非阐发轩岐之蕴奥邪。
（第三十三旧四十一）难曰。肝独有两叶。（左三右四）以何（象）应也。然。肝者东方木也。木者春也。（主发生
气）万物始生。其尚幼少。意无所亲。去太阴尚近。离太阳不远。犹有两心。故有两叶。（脏象）亦应木叶（甲析）也。
按此承前篇重言肝脏者。盖肝比诸他脏。犹有幼稚之象。而意无所亲。故其有两叶。亦犹草木甲析。左右相分。恰
有两心也。去太阴尚近。离太阳不远二句。此篇之大旨。谓太阴者湿土。即谓脾。太阳者寒水。即谓肾。滑注以太阴为
肾。太阳为心。其义亦通。盖脾气健。则肝血能收。肾精固。则木气舒达。辟犹木籍培育于土。滋资润于水焉。盖越人
视治肝病。特有深意者如此。何者。肝已为幼少。则谓太阴太阳者。父母之谓也。近看滑氏所注辨真。与余意符。
（第三十四旧三十六）难曰。脏各有一耳。肾独有两（犹两轮之两相顺为用）者。何也。然肾两（枚）者。非皆肾
也。其左者为肾。（阴）右者为命门。（阳）命门者。（此与上命门字同而旨异上则姑别属右肾此则其位暗寓两肾中间。）
诸神（气）精（水）之所舍。原气之所系也。（肾间动气）男子以藏精。（两肾）女子以系胞。（子宫）故知肾有一也。
按分肾为左右脏。内经无明文。且命门在灵素。则指为目也。或以名太阳睛明穴。又素问十二官论中。有分心与包
络为二脏。而未见肾有左右之分。又有后篇。言肾有两枚语。因考此篇大意。分肾为两脏。以配六脏之数。其意以谓凡
心既且二脏象。则肾亦有含蓄一原气于左右阴精中间。故左为肾。右为命门。实知一脏中寓阴阳二气焉。然则其分左右
之名。亦偶然耳。何则。命门者。诸神精之所舍云云数语。全迁其位于中间者。明矣。由是观之。虽肾有两枚。然其气
相通。固一水脏。唯使后人知阴中有命门之阳已。然则灵枢谓目者指其标。此难特举其本。以示内经未发之旨尔。
（第三十五旧三十四）难曰。五脏各有声色臭味液。（旧本脱液字今从滑氏补之）皆可晓知以不。然。十变（古书篇
目今内经无所见）言。肝色青。（大敦井）其臭臊。（曲泉合）其味酸。（中封经）其声呼。（大冲俞）其液泣。（行间荣）
心色赤。（少府荣）其臭焦。（少冲井）其味苦。（少海合）其声言。（灵道经）其液汗。（神门俞）脾色黄。（大白俞）其
臭香。（大都荣）其味甘。（隐白井）其声歌。（阴陵泉合）其液涎。（商丘经）肺色白。（经渠经）其臭腥。（大渊俞）其
味辛。（鱼际荣）其声哭。（少商井）其液涕。（尺泽合）肾色黑。（阴谷合）其臭腐。（复溜经）其味咸。（大溪俞）其声
呻。（然谷荣）其液唾。（涌泉井）是五脏声色臭味液也。
按以声色臭味液。配当五脏。其义有二焉。如第四十九篇所言五邪病。谓肺主五声。肝主五色。心主五臭。脾主五
味。肾主五液。综合言之。如此篇。则五物分发于各脏。交错言之。凡脏有五。病或一脏独病。或二三脏并病。各缘其
所主五物。以知病从何脏传来。古之义也。盖审其治病之旨。则五色皆治其经本行。五臭治其母行。五味治其所不胜行。
五声治其所胜行。五液治其子行。十变者。疑是内经古篇目。而今则亡矣。
五脏有七神。各何所藏耶。然。脏者。人之神气所舍藏也。故肝藏魂。（随心往来）肺藏魄。（并精出入）心藏神。（两
精相薄）脾藏意（心之发）与智。（志之化）肾藏精（两神相薄）与志（肾间原气）也。
神与精。对阴阳之体。魂与魄。配血气之因。故神精主体。魂魄主动。魂动则神气能阅七窍。各各不失其职。所谓
随神往来是也。魄运则精气周布支体。以知把抓痛痒。所谓并精出入是也。故人寐而魂魄各归其脏。则视听不务。痛痒
不识。神精俱静。则坎离守位。水火既济。当得长生久视。故摄养之道。在心焉则曰收。曰内观。在肾焉。则曰八益。
曰封藏。是所以使神精守静者。然脾寓意与智。意者心之发也。智者志之化也。素问云。肾者伎巧出焉。谓智之主也。
脾者中州心肾二气之枢。故藏意与智。肾又言志者。即肾间原气是也。脾肾各有二神者。盖由脾乃生化荣卫之本。肾乃
阴中含蓄真元之气故尔。
（第三十六旧三十五）难曰。五脏各有所。腑皆相近。（脾肝肾三脏与腑相接）而心肺独去大肠小肠远者。何也。然。
经言心荣（血）肺卫（气）通行阳气。（指血气）故居在上。（鬲上）大肠小肠。传阴气（指二便）而下。故居在下。（齐
下）所以相去而远也。（比他腑则去其脏位霄壤）
按此一节。因前篇所谓心肺独在鬲上。再发难。余三脏腑皆相近。而心肺之腑。甚相远者何。盖心肺主血气。以行
十二经络。不居至高之位。则何缘致令于一身哉。大小肠虽为其腑。然其所职者。传送糟粕。泌别水液。不居至下之地。
则何能导气于二阴哉。各由其贵贱。而位有崇卑者如此。所谓阴阳二气。即指血气与二便。非气为阳。血为阴之谓也。
又诸腑者。皆阳也。清净之处。今大肠小肠。胃与膀胱。皆受不净。其意何也。然。诸腑者谓是。（清净之处）非也。
经言小肠者。受盛之腑也。大肠者。传泻行道之腑也。胆者。清净之腑也。胃者。水谷之腑也。膀胱者。津液之腑也。
一腑犹无两名。故知非也。（小肠者心之腑大肠者肺之腑胆者肝之腑胃者脾之腑膀胱者肾之腑以上二十八字与后一节文异
义同疑是旧注误入正文者故今细书以别之）小肠谓赤（心色）肠。大肠谓白（肺色）肠。胆者谓青（肝色）肠。胃者谓
黄（脾色）肠。膀胱者谓黑（肾色）肠。下焦之所治也。（一句总括）
此节采摘素问十二官论中六腑之职掌。以设难。而其所主。专在清净二字。何者。素问既云胆者中正之腑。此难乃
谓清静之腑。审其所以为问答之意。则六腑皆可以为清净之处。然举各腑所掌言。一腑犹无两名。而清净之名。专归诸
胆。则十一脏取决于胆之谓邪。然则清净之名。诸腑之所禀。而非独胆也。然寓诸胆者。盖有深意存焉。窃考六腑皆水
谷之道路。而胃病则肠虚。肠满则胃虚。其所常有者。唯谷与糟粕耳。何清净之有。故胆独统之。岂非诸腑取决于胆乎。
是故不受水谷之浊秽。而盛清汁也。可以见已。小肠谓赤肠云云一节。实是古言。何以知之。五腑皆以肠名。故云尔。
下焦之所治也一句。滑注以属膀胱。非是。盖自胃而下。皆以为下焦所治。故属诸腑为可。
（第三十七旧三十八）难曰。脏唯有五。腑独有六者。何也。然。所以腑有六者。谓三焦也。有原气之别（使）焉。
主持诸气。有名而无形。其经属手少阴。此外腑（灵枢言孤腑同）也。故言腑有六焉。
按腑脏止有五者。五行之道为然。二五合为十者。生成之数是备。演而为六者。乃是六气之应。配为十二。则支律
之对。皆合天地自然之符焉。盖三焦者。虽非正腑。然诸腑非藉其气。则不能以为出纳运化之用焉。唯其非正腑。故薰
蒸肓膜之内。游行腑脏之间。宛如外郭然。故谓外腑。灵枢谓之孤腑。亦与此义同。滑注三焦外有经而内无形。故曰外
腑。非是。旧本第二十五篇。谓三焦心包。相为表里。此篇则谓原气之别焉者。彼以心包三焦为相火脏腑配合而言。此
乃以命门三焦为本末而言。其义各异。此与下编互相为义。顺连读。
（第三十八旧三十九）难曰。经言腑有五。脏有六者。何也。然。六腑者。正（张本作止）有五腑也。（除去三焦）
五脏亦有六脏者。谓肾有两脏也。其左为肾。右为命门。命门者。精神之所舍也。男子以藏精。女子以系胞。其气与肾
通。（前篇有原气所系一句而无此句义互相发）故曰脏有六也。腑有五者。何也。然五脏各一腑。（有形）三焦亦是一腑。
（无形）然不属于五脏。（独属心包亦无形）故言腑有五焉。
按五行之气。唯大有二。君相是也。内经分心与包络以为六脏。此篇则以肾有两枚。岐为二脏。左肾与命门是也。
后人误认此难。遂为三焦命门表里之说。余谓三焦既配心包以为表里。已见第二十五难。此则示命门三焦有本末之理。
兼发内经未发之旨。何者。五脏中唯心与肾抗对。无有轩轾。心包为二。则肾亦有此象。岂唯脏有两形乎。盖以阴中有
阳。故乃有为二脏理。命门之义。详见第三十四篇。
（第三十九旧三十一）难曰。三焦者。何禀何生。何始何终。其（主）治常在何许。可晓以不。然。三焦者。水谷
之道路。（其气属诸腑）气（肾间原气）之所终始也。上焦者。在心下下鬲。（ KT 而上为胸博）在胃上口。（贲
门）主内而不出。（饮食自咽入胃不妄出）其治在膻中。（玉堂下一寸六分直两乳间陷者是十四字疑是古来注语误入正文
中者故细书以别之且膻中本处名总称两乳间岂拘任脉一穴乎）中焦者。在胃中脘。（腹部中央）不上不下。（饮食蓄积）
主腐熟水谷。其治在脐旁。（总脐左右诸穴）下焦者。当膀胱上口。（小腹）主分别清浊。（二便）以传道。（三字旧本误
在出而不入之下今移此）主出而不内也。（二便快通不秘涩）其治在齐下。（总小腹诸经穴旧本有一寸二字亦疑注语）故
名曰三焦。其腑（气府）在气街。（言十二经皆以俞为原则手足俞原亦为三焦主治之穴可知也）
按内经言三焦者多端。或由宗营卫之所化而言之。或缘内外经脉之所属而言之。又或连膀胱言之。及言其理之横直
浓薄者。率皆因其有名而无形故也。盖此篇虽发问于禀生始终。然其所主专在位与治。盖饮食常凭其气。而出入运化。
以养生气之原。故云水谷之道路。气之所终始也。上焦之主内而不出者。此其职也。失职则噎鬲胸满。随时便生。中焦
之不上不下者。辗磨水谷。此其职也。失职则翻胃腹胀痞积。往往而成。下焦之出而不纳者。泌水液。转糟粕。此其职
也。失职则癃闭秘结溺数泻痢等证。立而蜂起。故其为主治也。膻中齐旁及齐下。是由其位为治矣。然三焦之治。岂止
（第三十一难，旧本为第三十二难）问：五脏的位置大体相等，唯独心脏和肺脏位于膈肌之上，这是为什么呢？答：心主血，肺主气。血属于营气，气属于卫气。营卫之气相随上下运行，称为营卫，通行于经络之中，营气周流全身。因此让心肺位于膈肌之上。
按语：本篇所述，五脏地位等同，而心肺独自在膈肌之上，脾、肝、肾三脏都在膈肌之下。向上则是清阳所在之处，向下则是浊阴聚集之地。这似乎显示心肺有特殊的尊贵地位。心能生化营血，肺能营运卫气，一身的气血都依赖这两脏的运化功能，所以它们的职责最为重要。因此心肺之所以尊贵，没有其他原因，仅仅在于它们主宰血与气罢了。《素问》说：“膈肓之上，中有父母。”所说的“父母”，指的就是气血。那么本篇的主旨，根源就在这里。虽然五脏都是身体的主宰，是神气的居所，但它们之所以生病，都是因为气血的虚实变化。而且药物的气味，也不过是用来调理气血罢了。气血生化，精神魂魄就寄寓其中。既然这样，医生治病，关键在于调理气血，哪里会拘泥于脏腑的表象呢？所以《素问》又说：“血气是人体的神机，不可不谨慎调养。”说的就是这个道理。
（第三十二难，旧本为第三十三难）问：肝脏色青，象征乙木；肺脏色白，象征辛金。肝得到水（精气）反而下沉；木得到水反而上浮；肺得到水反而上浮；金得到水反而下沉。这是什么意思呢？答：肝脏并不纯粹属木。（它吸纳了金气）乙（木）是角音（少阳）。它是庚金的柔配。从大的方面说是阴阳关系，从小的方面说是夫妻关系。它舍弃微弱的阳气（甲木），而吸纳微弱的阴气（庚金）。它的意向喜好金，又多行阴道（足厥阴肝经多血少气），所以使得肝得到水（精气）而沉（重浊为常态）。肺脏也不纯粹属金。（它受火气影响）辛（金）是商音（少阴）。它是丙火的柔配。从大的方面说是阴阳关系，从小的方面说是夫妻关系。它舍弃微弱的阴气（庚金），亲近并配合（丙）火。它的意向喜好火，又多行阳道（手太阴肺经多气少血），所以使得肺得到水（精气）而浮（轻清为常态）。肺受热（火气分离）后又变沉，肝受热（金气断绝）后又变浮，为什么呢？由此可知辛应当回归庚（纯金），乙应当回归甲（纯木）。
按语：本篇问答，查阅《内经》，没有明确的依据。仔细推敲其设问的言辞，是因为肺肝二脏的位置颠倒而提出疑问。所谓肺象金，其体应当下沉；肝象木，其体应当上浮。大凡五行的性质，木火属阳，金水属阴。火性炎上，所以心居上部；水性润下，所以肾居下部。这是理所当然的道理。然而木质应当上浮，却反常地沉在下部；金体应当下沉，却反常地浮在上部，似乎不符合木金的本性，这就是它提出疑问的原因。我考察其颠倒的原因，就是脏腑刚柔的关系。所谓刚柔，就是夫妇之道。假如甲乙庚辛，分别对应肝胆肺大肠。腑属阳，是兄长的行为；脏属阴，是妹妹的行为。甲乙本来同气，所以乙木感应异气，意向喜好庚金；庚辛本来同性，所以辛金配合异性，亲近并配合火。腑属阳，是夫之道；脏属阴，是妇之道。所以说：从大的方面说是阴阳，从小的方面说是夫妇。阴道阳道，是指肺主气在上，肝藏血在下。而且在各经脉中，也是如此。肝肺的“熟”字，滑寿注解释为散失的意思，王冰评林解释为相离。大概是草木果实成熟后，脱离枝茎的意思吧。暂且依从这种说法。如果肝肺不交换位置，那么心肾的阴阳就会偏胜，怎么能达到五脏的平和呢？因此肺在上，象征阳中之阴，作为心的辅佐；肝在下，象征阴中之阳，作为肾的匡助。阴阳相交，脏气自然完备。这是扁鹊（越人）的宗旨，难道不是阐发黄帝岐伯深奥的理论吗？
（第三十三难，旧本为第四十一难）问：肝脏唯独有两叶，以什么（象征）相应呢？答：肝属东方木。木属春。（主生发之气）万物开始生长，尚且幼小，心意无所亲附。距离太阴还近，离开太阳不远，犹如有两颗心，所以有两叶。（脏象）也对应木叶（甲木析分）的样子。
按语：这里承接前篇再次说明肝脏。大概肝与其他脏器相比，还有幼稚的形象，心意无所亲附，所以它有两叶，也就像草木甲壳分裂，左右分开，恰好像有两颗心一样。“距离太阴还近，离开太阳不远”这两句，是本篇的大旨。意思是太阴是湿土，即指脾；太阳是寒水，即指肾。滑寿注以太阴为肾，太阳为心，其义也通顺。大概脾气健运，则肝血能收敛；肾精固密，则木气舒展。这就好比树木依靠土壤培育，滋润来源于水。大概越人看待治疗肝病，特别有深意如此。为什么呢？肝已经算是幼少了，那么所谓的太阴太阳，就是指父母。我看滑氏所注的《辨真》，与我的意思相符。
（第三十四难，旧本为第三十六难）问：各个脏器都只有一个，唯独肾脏有两个（像车轮的两个轮子互相顺应用），为什么呢？答：肾两枚，并不都是肾。左边的是肾。（属阴）右边的是命门。（属阳）命门。（这个字与上面的命门字相同但旨意不同，上面那个姑且归属于右肾，这个则其位置暗含在两肾中间。）是诸神（气）精（水）的居所，原气所系的地方。（肾间动气）男子用它来藏精。（两肾）女子用它来系胞宫。（子宫）所以知道肾其实只有一个。
按语：将肾分为左右两脏，《内经》没有明文记载。且在《灵枢》《素问》中，命门指的是眼睛。有人以此命名太阳睛明穴。另外《素问·六节藏象论》中，有将心与心包络分为两个脏器的说法，但没有见到肾分左右的情况。又有后篇提到肾有两枚的话。因此考察本篇大意，是将肾分为两脏，以配合六脏的数量。其意图认为，既然心已经有两种脏象，那么肾也应该在左右阴精中间含蓄一种原气。所以左为肾，右为命门，实际上知道一脏中寓含阴阳二气。然而将其区分为左右之名，也是偶然的罢了。为什么呢？命门是诸神精的居所等几句话，完全将其位置迁移到中间，是很明显的。由此看来，虽然肾有两枚，但其气相通，原本是一个水脏，只是让后人知道阴中包含着命门的阳罢了。然而《灵枢》说眼睛是指其标，这篇特举出命门是指其本，用来表示《内经》未曾阐发的旨意罢了。
（第三十五难，旧本为第三十四难）问：五脏各有声、色、臭、味、液。（旧本脱漏“液”字，现在根据滑寿注补上）都可以知晓知道吗？答：《十变》（古书篇目，今《内经》中未见）说：肝色青。（井穴大敦）其臭臊。（合穴曲泉）其味酸。（经穴中封）其声呼。（俞穴大冲）其液泣。（荣穴行间）心色赤。（荣穴少府）其臭焦。（井穴少冲）其味苦。（合穴少海）其声言。（经穴灵道）其液汗。（俞穴神门）脾色黄。（俞穴大白）其臭香。（荣穴大都）其味甘。（井穴隐白）其声歌。（合穴阴陵泉）其液涎。（经穴商丘）肺色白。（经穴经渠）其臭腥。（俞穴大渊）其味辛。（荣穴鱼际）其声哭。（井穴少商）其液涕。（合穴尺泽）肾色黑。（合穴阴谷）其臭腐。（经穴复溜）其味咸。（俞穴大溪）其声呻。（荣穴然谷）其液唾。（井穴涌泉）这就是五脏的声、色、臭、味、液。
按语：将声、色、臭、味、液配当五脏，其义理有两种。如第四十九篇所言的五邪病，说肺主五声，肝主五色，心主五臭，脾主五味，肾主五液。综合来说，像本篇这样，五种事物分发在各脏，交错而言。凡是脏有五个，病或者是一脏单独患病，或者是二三脏同时患病，各自依据其所主的五种事物，来知道病是从哪个脏传来的。这是古人的义理。大概审视其治病的宗旨，那么五色都治疗其经的本行，五臭治疗其母行，五味治疗其所不胜行，五声治疗其所胜行，五液治疗其子行。《十变》，怀疑是《内经》的古篇目，现在已经亡佚了。
五脏有七神，各藏在什么地方呢？答：脏，是人体神气所舍藏的地方。所以肝藏魂。（随心往来）肺藏魄。（并精出入）心藏神。（两精相薄）脾藏意（心的发动）与智。（志的转化）肾藏精（两神相薄）与志（肾间原气）啊。
神与精，对应阴阳之体；魂与魄，配合血气之因。所以神精主体，魂魄主动。魂动则神气能视察七窍，各自不失其职，这就是所谓的“随神往来”。魄运则精气周布四肢，用以感知把握、抓取、痛痒，这就是所谓的“并精出入”。所以人睡觉时魂魄各自归藏于脏，那么视听就不忙碌，痛痒也不识别，神精都安静，那么坎离守位，水火既济，应当能够长生久视。所以摄养之道，在心那里叫做收、叫做内观；在肾那里，叫做八益、叫做封藏。这就是使神精保持安静的原因。然而脾寓意与智，意是心的发动，智是志的转化。《素问》说：肾者伎巧出焉。说的是智的主宰。脾是中州，是心肾二气的枢纽，所以藏意与智。肾又言志，就是肾间原气。脾肾各有两个神，大概是因为脾是生化营卫的根本，肾是阴中含蓄真元之气的原因。
（第三十六难，旧本为第三十五难）问：五脏各有所对应的腑，腑都相近。（脾肝肾三脏与腑相接）而心肺唯独远离大肠小肠，为什么呢？答：经上说心主营（血），肺主卫（气），通行阳气。（指血气）所以居在上部。（膈上）大肠小肠，传导阴气（指二便）而下，所以居在下部。（脐下）因此相距遥远。（比其他腑则距离其脏位相差悬殊）
按语：这一节，因为前篇所说心肺独在膈上，再次提出疑问。其余三脏腑都相近，而心肺的腑，非常远，为什么呢？大概心肺主管血气，以运行十二经络，如果不居至高之位，凭什么能让它们统领一身呢？大小肠虽然是它们的腑，然而它们的职责，是传送糟粕，泌别水液，如果不居至下之地，凭什么能在二阴引导气机呢？各自因为其贵贱，而位置有崇高卑下的区别如此。所谓阴阳二气，即指血气与二便，不是说气为阳、血为阴的意思。另外诸腑都是阳，是清净之处。现在大肠小肠、胃与膀胱，都接受不洁净之物，这是什么意思呢？答：说诸腑是（清净之处），是不对的。经上说小肠是受盛之腑，大肠是传泻行道之腑，胆是清净之腑，胃是水谷之腑，膀胱是津液之腑。一个腑还没有两个名字，所以知道不对。（小肠谓之心之腑，大肠谓之肺之腑，胆谓之肝之腑，胃谓之脾之腑，膀胱谓之肾之腑。以上二十八字与后一节文异义同，怀疑是旧注误入正文，所以现在用小字书写以区别之）小肠称为赤（心色）肠，大肠称为白（肺色）肠，胆称为青（肝色）肠，胃称为黄（脾色）肠，膀胱称为黑（肾色）肠。这是下焦所治理的。（一句总括）
这一节采摘《素问·六节藏象论》中六腑的职掌，来设立疑问，而其主旨专门在“清净”二字。为什么呢？《素问》既然说胆是中正之腑，这篇乃说是清净之腑。仔细推敲其问答的意思，那么六腑都可以成为清净之处。然而列举各腑所掌管的事情，一个腑还没有两个名字，而清净的名字，专门归属于胆，那就是“十一脏取决于胆”的说法吗？然而清净的名字，是诸腑所禀受的，而不是唯独胆。然而寄托在胆上，大概有深意存在。我考察六腑都是水谷的道路，而胃病则肠虚，肠满则胃虚。它们所常有的，只有谷与糟粕罢了，有什么清净的呢？所以唯独胆统率它。难道不是诸腑取决于胆吗？因此不接受水谷的浊秽，而盛放清汁。可以看到了。小肠称为赤肠等一节，实际上是古语。怎么知道的呢？五腑都以肠为名，所以这么说。“下焦之所治也”一句，滑寿注归属膀胱，是不对的。大概从胃以下，都认为是下焦所治理，所以归属诸腑是可以的。
（第三十七难，旧本为第三十八难）问：脏唯有五个，腑独有六个，为什么呢？答：所以腑有六个，是说有三焦。有原气的别使（分支），主持诸气，有名而无形。其经属于手少阴（注：此处原文有误，三焦经属手少阳，但古籍常有此争议或笔误，此处依原文翻译），这是外腑（《灵枢》称为孤腑，同理）。所以说是腑有六个。
按语：腑脏只有五个，是五行之道的必然。二五合为十，生成之数具备。演变为六，乃是六气的应验。配为十二，则与地支律吕相对，都符合天地自然的符契。大概三焦，虽然不是正腑，然而诸腑不借助其气，就不能发挥出纳运化的作用。正因为不是正腑，所以熏蒸肓膜之内，游行腑脏之间，宛如外郭一般。所以称为外腑。《灵枢》称之为孤腑，也与这个意义相同。滑寿注解说三焦外有经而内无形，所以叫外腑，是不对的。旧本第二十五篇，说三焦与心包相为表里。这篇则说它是原气的别使。前者是以心包三焦为相火脏腑配合而言，后者是以命门三焦为本末而言。其意义各异。这与下编互相为义，顺连阅读。
（第三十八难，旧本为第三十九难）问：经上说腑有五个，脏有六个，为什么呢？答：六腑，实际上只有五个腑。（除去三焦）五脏也有六个脏，是说肾有两个脏。左边是肾，右边是命门。命门，是精神所舍藏的地方。男子用它来藏精，女子用它来系胞宫。其气与肾相通。（前篇有“原气所系”一句而没有这句，意义互相发明）所以说是脏有六个。腑为什么只有五个呢？答：五脏各有一个腑。（有形）三焦也是一个腑。（无形）但是它不属于五脏。（独属心包也是无形）所以说是腑有五个。
按语：五行之气，唯有大有二，君火与相火是也。《内经》将心与心包络分为六脏，这篇则以肾有两枚，歧分为二脏，左肾与命门是也。后人错误理解这篇难经，于是有了三焦命门表里的说法。我认为三焦既然配心包以为表里，已经在第二十五难中见到。这篇则是示现命门三焦有本末的道理，兼发《内经》未曾阐发的旨意。为什么呢？五脏中唯独心与肾对抗相当，没有高低之分。心包为二，那么肾也有这种形象。岂止是脏有两形吗？大概因为阴中有阳，所以才有成为两脏的道理。命门的含义，详见第三十四篇。
（第三十九难，旧本为第三十一难）问：三焦，禀受什么而生？从哪里开始到哪里结束？它的主要治疗部位常在何处？可以知晓吗？答：三焦，是水谷的道路。（其气属于诸腑）气（肾间原气）所终始的地方。上焦，在心下膈肌之上。（KT 而上为胸博，疑为衍文或注语）在胃上口。（贲门）主纳而不妄出。（饮食自咽入胃不妄出）其治疗部位在膻中。（玉堂下一寸六分，直两乳间陷者是十四字疑是古来注语误入正文中者故细书以别之且膻中本处名总称两乳间岂拘任脉一穴乎）中焦，在胃中脘。（腹部中央）不上不下。（饮食蓄积）主腐熟水谷。其治疗部位在脐旁。（总脐左右诸穴）下焦，当膀胱上口。（小腹）主分别清浊。（二便）以传道。（三字旧本误在出而不入之下今移此）主出而不纳。（二便快通不秘涩）其治疗部位在脐下。（总小腹诸经穴旧本有一寸二字亦疑注语）所以名叫三焦。其腑（气府）在气街。（言十二经皆以俞为原则手足俞原亦为三焦主治之穴可知也）
按语：《内经》关于三焦的说法多种多样。有的是由宗气营卫所化而言之，有的是缘内外经脉所属而言之，有的又连膀胱言之。以及谈论其理之横直浓薄的，大都是因为有名而无形的缘故。大概这篇虽然发问于禀赋生死的始终，然而其主旨专门在于位置与治疗。大概饮食常凭借三焦之气，而出入运化，以滋养生气之原。所以说是水谷的道路，气所终始的地方。上焦主纳而不妄出，这是它的职能。失职则出现噎膈胸满，随时发生。中焦不上不下，辗磨水谷，这是它的职能。失职则翻胃腹胀痞积，往往形成。下焦出而不纳，泌水液，转糟粕，这是它的职能。失职则癃闭秘结溺数泻痢等证，立刻蜂拥而起。所以其主要治疗部位，膻中、脐旁及脐下，是由其位置决定的治疗区域。然而三焦的治疗，难道只……
(Difficulty 31, Old Difficulty 32) Question: The five Zang organs are generally equal in status, yet the Heart and Lung alone are located above the diaphragm. Why is this so? Answer: The Heart governs Blood, and the Lung governs Qi. Blood belongs to Ying (Nutritive Qi), and Qi belongs to Wei (Defensive Qi). Ying and Wei circulate up and down together, referred to as Ying-Wei, flowing through the meridians, with Ying circulating throughout the body. Therefore, the Heart and Lung are placed above the diaphragm.
Commentary: This passage states that while the five Zang organs are of equal rank, the Heart and Lung are uniquely situated above the diaphragm, whereas the Spleen, Liver, and Kidney are below it. Above lies the realm of clear Yang, and below lies the domain of turbid Yin. This seems to indicate a special nobility for the Heart and Lung. The Heart generates Nutritive Blood, and the Lung circulates Defensive Qi; the Qi and Blood of the entire body rely on the transformation and transportation functions of these two organs. Thus, their duties are the most significant. The reason for the nobility of the Heart and Lung lies solely in their governance over Blood and Qi. As stated in the *Su Wen* (Basic Questions): "Above the diaphragm and huang, there are Parents." The term "Parents" refers to Qi and Blood. Thus, the main theme of this difficulty originates here. Although the five Zang organs are the masters of the body and the dwellings of Shen (Spirit), diseases arise from the deficiency or excess of Qi and Blood. Moreover, the flavors and odors of herbs are used merely to regulate Qi and Blood. When Qi and Blood are generated and transformed, the Spirit, Hun, Po, and Yi reside within them. Therefore, medical treatment focuses on regulating Qi and Blood, rather than being confined to the manifestations of the Zang organs. Hence, the *Su Wen* also states: "Qi and Blood are the spirit of humans; they must be carefully nourished." This is what is meant.
(Difficulty 32, Old Difficulty 33) Question: The Liver is green and corresponds to Yi Wood; the Lung is white and corresponds to Xin Metal. However, when Liver receives Water (essence), it sinks; when Wood receives Water, it floats; when Lung receives Water, it floats; when Metal receives Water, it sinks. What is the meaning behind this? Answer: The Liver is not purely Wood. (It absorbs Metal Qi.) Yi (Wood) is Jue (Shao Yang). It is the yin counterpart of Geng (Metal). In grand terms, it discusses Yin and Yang; in small terms, it discusses husband and wife. It releases its slight Yang (Jia Wood) and absorbs the slight Yin Qi (Geng Metal). Its inclination favors Metal, and it predominantly follows the Yin pathway (Foot Jueyin Liver Meridian has more blood and less Qi); thus, the Liver receives Water (essence) and sinks (heavy and turbid is the norm). The Lung is not purely Metal. (It is influenced by Fire Qi.) Xin (Metal) is Shang (Shao Yin). It is the yin counterpart of Bing (Fire). In grand terms, it discusses Yin and Yang; in small terms, it discusses husband and wife. It releases its slight Yin (Geng Metal) and marries into (Bing) Fire. Its inclination favors Fire, and it predominantly follows the Yang pathway (Hand Taiyin Lung Meridian has more Qi and less blood); thus, the Lung receives Water (essence) and floats (light and clear is the norm). Why does the Lung become heavy after heating (separation of Fire Qi) and the Liver become light after heating (extinction of Metal Qi)? From this, we know that Xin should return to Geng (Pure Metal), and Yi should return to Jia (Pure Wood).
Commentary: In this dialogue, consulting the *Nei Jing* reveals no explicit basis. Examining the phrasing of the question, it raises a difficulty based on the inverted positions of the Liver and Lung. It is said that the Lung corresponds to Metal, whose nature should sink; the Liver corresponds to Wood, whose nature should float. Generally, the properties of the Five Elements are such that Wood and Fire belong to Yang, while Metal and Water belong to Yin. Fire flares upward, so the Heart resides in the upper part; Water moistens downward, so the Kidney resides in the lower part. This is natural logic. However, Wood should float but sinks in the lower part; Metal should sink but floats in the upper part, seemingly contradicting the nature of Wood and Metal. This is the source of the difficulty. I investigate that the inversion is due to the gang-rou (hard-soft/yang-yin) relationship of the Zang organs. Gang-rou refers to the way of husband and wife. For example, Jia, Yi, Geng, and Xin correspond to Gallbladder, Liver, Large Intestine, and Lung. Fu organs are Yang, representing the behavior of elder brothers; Zang organs are Yin, representing the behavior of younger sisters. Jia and Yi share the same Qi, so Yi Wood is influenced by different Qi and favors Geng Metal; Geng and Xin share the same nature, so Xin Metal pairs with a different nature and marries into Fire. Fu belongs to Yang, the way of the husband; Zang belongs to Yin, the way of the wife. Thus, it is said: "In grand terms, Yin and Yang; in small terms, husband and wife." Yin and Yang pathways refer to the Lung governing Qi above and the Liver storing Blood below. This applies to the meridians as well. The term "shu" (ripe/mature) for Liver and Lung is interpreted by Hua Shou as scattering or loss, and by Wang Bing as separation. It likely means that when fruit ripens, it detaches from the branch. I tentatively accept this view. If the Liver and Lung did not exchange positions, the Yin and Yang of the Heart and Kidney would be imbalanced, preventing the harmony of the five Zang organs. Therefore, the Lung above symbolizes Yin within Yang, assisting the Heart; the Liver below symbolizes Yang within Yin, supporting the Kidney. Through the interaction of Yin and Yang, Zang Qi becomes complete. This is the intent of Yue Ren (Bian Que), elucidating the profound mysteries of Xuanyuan and Qibo.
(Difficulty 33, Old Difficulty 41) Question: The Liver uniquely has two lobes. What does this correspond to (symbolize)? Answer: The Liver belongs to East Wood. Wood corresponds to Spring. (It governs the generating Qi.) All things begin to grow, remaining young and immature, with no specific attachment. It is still close to Taiyin and not far from Taiyang, resembling having two hearts; hence, it has two lobes. (Zang imagery) Also corresponds to the leaves of wood (splitting of Jia Wood).
Commentary: This continues the previous discussion on the Liver. Compared to other Zang organs, the Liver retains an image of infancy and lacks specific attachment, hence its two lobes, similar to the splitting of plant husks, dividing left and right, like having two hearts. The phrases "close to Taiyin" and "not far from Taiyang" constitute the main point of this passage. Taiyin is damp Earth, referring to the Spleen; Taiyang is cold Water, referring to the Kidney. Hua Shou interprets Taiyin as Kidney and Taiyang as Heart, which is also acceptable. Generally, if Spleen Qi is robust, Liver Blood can be contained; if Kidney Essence is secure, Wood Qi can expand freely. It is like trees relying on soil for cultivation and water for nourishment. Yue Ren's deep insight into treating Liver disease is evident here. Since the Liver is considered young, Taiyin and Taiyang refer to parents. My view aligns with Dr. Hua's commentary in *Bian Zhen*.
(Difficulty 34, Old Difficulty 36) Question: Each Zang organ has only one, yet the Kidneys come in pairs (like two wheels working in coordination). Why? Answer: The two Kidneys are not both Kidneys. The left is the Kidney. (Yin) The right is the Mingmen (Gate of Life). (Yang) Mingmen. (This character is the same as above but with a different meaning; the above was tentatively assigned to the right Kidney, whereas this implies a position between the two Kidneys.) It is the residence of all spirits (Qi) and essences (Water), and the connection point of Yuan Qi. (Kidney-interior moving Qi) Men use it to store essence. (Both Kidneys) Women use it to anchor the Bao (uterus). Therefore, we know there is essentially only one Kidney.
Commentary: Dividing the Kidney into left and right Zang organs has no explicit text in the *Nei Jing*. In *Ling Shu* and *Su Wen*, Mingmen refers to the eyes. Some name the Bladder Meridian Jingming acupoint by this name. Furthermore, in the *Su Wen*'s discourse on the Twelve Officials, the Heart and Pericardium are divided into two Zang organs, but there is no mention of the Kidney being divided into left and right. Later passages mention the Kidneys coming in two pieces. Investigating the gist of this passage, the division of the Kidney into two Zang organs serves to match the number of six Zang organs. The intent is that since the Heart already has two Zang images, the Kidney should also contain a Yuan Qi between the left and right Yin essences. Thus, the left is Kidney, and the right is Mingmen, implying that one Zang contains both Yin and Yang Qi. However, the distinction of left and right names is somewhat arbitrary. Why? The phrase "Mingmen is the residence of spirits and essences" clearly shifts its location to the center. From this perspective, although there are two Kidney pieces, their Qi connects, forming a single Water Zang, merely informing later generations that Yang exists within Yin. *Ling Shu* points to the eyes as the manifestation (biao), while this difficulty highlights the root (ben) to reveal insights not fully expounded in the *Nei Jing*.
(Difficulty 35, Old Difficulty 34) Question: Each Zang organ has associated sound, color, odor, taste, and fluid. (The character 'fluid' was missing in old editions, now added according to Hua Shou's note.) Can these be known? Answer: The *Shi Bian* (ancient book chapter, not seen in current *Nei Jing*) states: Liver color is green. (Well acupoint Dazhun) Odor is fishy. (He-sea Ququan) Taste is sour. (Jing-medium Zhongfeng) Sound is shouting. (Shu-stream Dachong) Fluid is tears. (Ying-spring Xingjian) Heart color is red. (Ying-spring Shaofu) Odor is scorched. (Well Shaochong) Taste is bitter. (He-shaohai) Sound is speaking. (Jing-medium Lingdao) Fluid is sweat. (Shu-shenmen) Spleen color is yellow. (Shu-dabai) Odor is fragrant. (Ying-dadu) Taste is sweet. (Well Yinbai) Sound is singing. (He-yinlingquan) Fluid is saliva. (Jing-shangqiu) Lung color is white. (Jing-jingqu) Odor is raw/fishy. (Shu-dayuan) Taste is pungent. (Ying-yuji) Sound is crying. (Well shaoshang) Fluid is mucus. (He-chize) Kidney color is black. (He-yingu) Odor is putrid. (Jing-fuliu) Taste is salty. (Shu-taixi) Sound is groaning. (Ying-rangu) Fluid is spittle. (Well yongquan) These are the sounds, colors, odors, tastes, and fluids of the five Zang organs.
Commentary: Associating sound, color, odor, taste, and fluid with the five Zang organs has two interpretations. As mentioned in Difficulty 49 regarding the five pathogenic factors, the Lung governs five sounds, Liver governs five colors, Heart governs five odors, Spleen governs five tastes, and Kidney governs five fluids. Synthesizing this, as in this passage, the five items are distributed among the Zang organs in a cross-referencing manner. There are five Zang organs; disease may affect one Zang exclusively or multiple Zangs simultaneously. By observing the five items governed by each, one can determine the origin of the disease. This is the ancient principle. Examining the therapeutic intent, five colors treat the original line of the meridian; five odors treat the mother line; five tastes treat the line that overcomes it; five sounds treat the line it overcomes; five fluids treat the child line. *Shi Bian* is suspected to be an ancient chapter of the *Nei Jing*, now lost.
The five Zang organs house seven Shen (Spirits). Where are they stored? Answer: Zang organs are the dwellings of human Shen Qi. Thus, the Liver stores Hun. (Coming and going with the Heart) The Lung stores Po. (Entering and exiting with Jing) The Heart stores Shen. (Interaction of two Jing) The Spleen stores Yi (expression of the Heart) and Zhi. (Transformation of ambition/will) The Kidney stores Jing (interaction of two Shen) and Zhi (Yuan Qi in the kidney area).
Shen and Jing correspond to the bodies of Yin and Yang; Hun and Po accompany the causes of Blood and Qi. Thus, Shen and Jing govern the substance, while Hun and Po govern movement. When Hun moves, Shen Qi inspects the seven orifices, each fulfilling its duty without error—this is "coming and going with Shen." When Po operates, Jing Qi distributes throughout the limbs, enabling perception of grasping, pain, and itching—this is "entering and exiting with Jing." Therefore, when humans sleep, Hun and Po return to their respective Zang organs; vision and hearing cease activity, and pain/itch sensations are unrecognized. Shen and Jing remain tranquil, Kan and Li maintain their positions, and Water and Fire achieve balance, leading to long life. Thus, preservation methods involve "gathering" and "inner observation" for the Heart, and "eight benefits" and "sealing/storing" for the Kidney. This keeps Shen and Jing tranquil. The Spleen houses Yi and Zhi; Yi is the expression of the Heart, and Zhi is the transformation of Ambition. The *Su Wen* states: "The Kidney produces dexterity and skill," indicating it governs Zhi. The Spleen is the central pivot between Heart and Kidney Qi, hence housing Yi and Zhi. The Kidney's mention of Zhi refers to Yuan Qi in the kidney area. The Spleen and Kidney each have two Shen because the Spleen is the root of generating Ying and Wei, and the Kidney contains true Yuan Qi within Yin.
(Difficulty 36, Old Difficulty 35) Question: Each Zang organ has a corresponding Fu organ, and the Fu organs are generally close. (The Spleen, Liver, and Kidney connect directly with their Fu organs.) Yet the Heart and Lung are uniquely distant from the Large and Small Intestines. Why? Answer: The Classics state that the Heart governs Ying (Blood) and the Lung governs Wei (Qi), circulating Yang Qi. (Referring to Blood and Qi) Therefore, they reside above. (Above the diaphragm) The Large and Small Intestines transmit Yin Qi. (Referring to feces and urine) downward; therefore, they reside below. (Below the navel) Hence, they are far apart. (Compared to other Fu organs, the distance from their Zang counterparts is vast.)
Commentary: This section reiterates the difficulty raised in the previous passage regarding the Heart and Lung being above the diaphragm. Why are the Fu organs of the Heart and Lung so distant compared to the others? The Heart and Lung govern Blood and Qi, circulating through the twelve meridians. If they did not occupy the highest position, how could they command the whole body? Although the Small and Large Intestines are their Fu organs, their duties are to transport waste and separate fluids. If they did not occupy the lowest position, how could they guide Qi through the two orifices? Their positions reflect their hierarchy of importance. The term "Yin and Yang Qi" here refers to Blood/Qi and feces/urine, not simply Qi as Yang and Blood as Yin. Additionally, all Fu organs are Yang and should be pure/clean places. Yet the Large Intestine, Small Intestine, Stomach, and Bladder receive impure substances. Why? Answer: Saying all Fu organs are "pure/clean places" is incorrect. The Classics state: The Small Intestine is the Palace of Reception; the Large Intestine is the Palace of Transmission; the Gallbladder is the Palace of Purity/Cleanliness; the Stomach is the Palace of Water and Grain; the Bladder is the Palace of Fluids. One Fu organ does not have two titles; thus, the statement is incorrect. (Note: "Small Intestine is the Fu of the Heart, Large Intestine is the Fu of the Lung, Gallbladder is the Fu of the Liver, Stomach is the Fu of the Spleen, Bladder is the Fu of the Kidney." These twenty-eight characters differ in wording but share the same meaning as the following paragraph. Suspected to be an old annotation mistakenly entered into the main text, so written in smaller font to distinguish.) Small Intestine is called Red Intestine (Heart color); Large Intestine is called White Intestine (Lung color); Gallbladder is called Green Intestine (Liver color); Stomach is called Yellow Intestine (Spleen color); Bladder is called Black Intestine (Kidney color). This is governed by the Lower Jiao. (A summarizing sentence.)
This section extracts the functions of the Six Fu organs from the *Su Wen*'s discourse on the Twelve Officials to raise a difficulty, focusing specifically on the concept of "purity/cleanliness." The *Su Wen* calls the Gallbladder the "Neutral Official," while this difficulty calls it the "Clean/Pure Official." Analyzing the intent, all Six Fu organs can be considered clean places. However, listing their specific duties, one Fu organ has only one title, and the title "Clean/Pure" is exclusively attributed to the Gallbladder, implying the saying "All eleven Zang organs depend on the Gallbladder." Yet, the attribute of purity is shared by all Fu organs, not just the Gallbladder. Entrusting it to the Gallbladder holds deep significance. Investigating, all Six Fu organs are pathways for water and grain; Stomach disease leads to empty intestines, and full intestines lead to Stomach deficiency. They commonly contain only grain and waste. Where is the purity? Thus, the Gallbladder alone embodies purity. Is this not why all Fu organs depend on the Gallbladder? It does not receive the turbidity of water and grain but holds clear juice. This confirms it. The section calling the Small Intestine the "Red Intestine," etc., is actually ancient terminology. How do we know? Because five Fu organs are named with "Intestine." The sentence "Governed by the Lower Jiao" is interpreted by Hua Shou as referring only to the Bladder, which is incorrect. Generally, everything from the Stomach downward is governed by the Lower Jiao, so attributing it to all Fu organs is appropriate.
(Difficulty 37, Old Difficulty 38) Question: There are only five Zang organs, yet there are six Fu organs. Why? Answer: The reason there are six Fu organs is the Sanjiao (Triple Burner). It acts as a distinct branch of Yuan Qi, governing all Qi. It has a name but no form. Its meridian belongs to Hand Shaoyin. (Note: Textual error in original, traditionally Hand Shaoyang, but translated as per source) It is an external Fu organ (*Ling Shu* calls it the Solitary Fu, same meaning). Hence, it is said there are six Fu organs.
Commentary: The fact that there are only five Zang and five Fu organs is consistent with the Way of the Five Elements. Two fives combine to ten, completing the numbers of generation and transformation. Evolving into six corresponds to the Six Qi. Pairing with twelve aligns with the Earthly Branches and musical pitches, conforming to the patterns of Heaven and Earth. Although the Sanjiao is not a "proper" Fu organ, the other Fu organs cannot perform their functions of intake, output, and transformation without its Qi. Precisely because it is not a proper Fu organ, it steams within the huangmo membranes and travels between the Fu and Zang organs, acting like an outer wall. Hence, it is called an External Fu organ. *Ling Shu* calls it the Solitary Fu, agreeing with this meaning. Hua Shou's note that "Sanjiao has an external meridian but no internal form, hence External Fu" is incorrect. Old Edition Difficulty 25 states Sanjiao and Pericardium are exterior-interior pairs. This passage describes it as a branch of Yuan Qi. The former discusses them as paired organs of Ministerial Fire; the latter discusses them in terms of Root and Branch (Mingmen and Sanjiao). Their meanings differ. This connects with the following difficulties and should be read sequentially.
(Difficulty 38, Old Difficulty 39) Question: The Classics say there are five Fu organs and six Zang organs. Why? Answer: The Six Fu organs actually consist of only five Fu organs. (Excluding Sanjiao) The five Zang organs also have six Zang organs, referring to the two Kidneys. The left is the Kidney, and the right is the Mingmen. Mingmen is where Spirit and Essence reside. Men use it to store Essence; women use it to anchor the Bao. Its Qi connects with the Kidney. (Previous difficulty had "connected to Yuan Qi" but lacked this sentence; meanings complement each other) Hence, it is said there are six Zang organs. Why are there only five Fu organs? Answer: Each of the five Zang organs has one Fu organ. (Has form) Sanjiao is also one Fu organ. (Formless) But it does not belong to any of the five Zang organs. (Uniquely paired with Pericardium, which is also formless) Hence, it is said there are five Fu organs.
Commentary: Among the Qi of the Five Elements, there are only two great ones: Ruler Fire and Ministerial Fire. The *Nei Jing* divides the Heart and Pericardium into six Zang organs. This difficulty divides the two Kidneys into two Zang organs: Left Kidney and Mingmen. Later generations misunderstood this difficulty, leading to theories of Sanjiao-Mingmen exterior-interior relationships. I argue that since Sanjiao is paired with Pericardium as exterior-interior, this was already covered in Difficulty 25. This passage reveals the Root-Branch relationship between Mingmen and Sanjiao, further elucidating insights not fully expressed in the *Nei Jing*. Why? Among the five Zang organs, only Heart and Kidney are balanced and equal. If Pericardium is two, then Kidney should also have this duality. It is not just about having two forms. It is because Yang exists within Yin that there are two Zang organs. The meaning of Mingmen is detailed in Difficulty 34.
(Difficulty 39, Old Difficulty 31) Question: What does the Sanjiao inherit and generate? Where does it begin and end? Where is its primary site of treatment? Can this be known? Answer: The Sanjiao is the pathway of water and grain. (Its Qi belongs to all Fu organs) It is where Qi (Yuan Qi in the kidney area) begins and ends. The Upper Jiao is below the Heart, above the diaphragm. (KT er shang wei xiong bo - likely annotation error) At the upper opening of the Stomach. (Cardia) It governs intake and does not allow reckless exit. (Food and drink enter the Stomach via the throat and do not exit recklessly) Its treatment site is Danzhong. (One cun and six fen below Yutang, in the depression between the nipples. These fourteen characters are suspected to be ancient annotations mistakenly entered into the main text, so written in smaller font to distinguish. And Danzhong is a general term for the area between the nipples, not limited to one Renmai acupoint.) The Middle Jiao is at the middle of the Stomach. (Center of the abdomen) Neither rising nor falling. (Food accumulates) It governs the rotting and ripening of water and grain. Its treatment site is beside the navel. (General term for acupoints around the navel) The Lower Jiao is at the upper opening of the Bladder. (Lower abdomen) It governs the separation of clear and turbid. (Feces and urine) To transmit. (Three characters were misplaced in old editions under 'exit not enter', now moved here) It governs exit and does not accept. (Feces and urine pass freely without obstruction) Its treatment site is below the navel. (General term for meridians/acupoints in the lower abdomen. Old edition has 'one cun', also suspected to be annotation.) Hence, it is named Sanjiao. Its Fu (Qi-Fu) is at Qichong. (Stating that all twelve meridians take acupoints as principles, it is known that hand and foot Yuan acupoints are also treated by Sanjiao.)
Commentary: The *Nei Jing* mentions the Sanjiao in various ways: sometimes derived from the transformation of Zong, Ying, and Wei Qi; sometimes based on internal and external meridian affiliations; sometimes linked with the Bladder. Discussions on its horizontal/vertical structure and thickness largely stem from its "having a name but no form." Although this passage asks about inheritance and birth/ending, its focus is on location and treatment. Food and drink rely on its Qi for intake, output, and transformation to nourish the source of vital Qi. Hence, it is the pathway of water and grain and the beginning/end of Qi. The Upper Jiao's function of intake without reckless exit is its duty; failure leads to dysphagia, chest fullness, etc. The Middle Jiao's function of neither rising nor falling is to grind water and grain; failure leads to vomiting, abdominal distension, and masses. The Lower Jiao's function of exit without acceptance is to separate fluids and transform waste; failure leads to strangury, constipation, frequent urination, diarrhea, etc. Thus, its primary treatment sites—Danzhong, beside the navel, and below the navel—are determined by its location. However, the treatment of Sanjiao is not limited to...