三十七难曰∶五脏之气，于何发起，通于何许，可晓以不？
然∶五脏者，当上关于九窍也。故
肺气通于鼻，鼻和则知香臭矣；肝气通于目，目和则知黑白矣；脾气通于口，口和则知谷味矣；
心气通于舌，舌和则知五味矣；肾气通于耳，耳和则知五音矣。
此节乃《灵枢·脉度篇》文，稍有增易，大意谓五脏和则七窍通，不和则七窍不通。经言上
阅七窍，此言九窍，当是简误。若洁古认真九窍，添“三焦之气通于喉，喉和则声鸣矣”二句，
未免蛇足。谢氏曰∶本篇问五脏之气，于何发起，通于何许，答文止言五脏通九窍之义，而不
及五脏之起发，恐有缺文。
五脏不和，则九窍不通，六腑不和，则留结为痈。
五脏神气之所舍，不和则气不得上达，故七窍不通。若六腑不和，则血气留滞于皮腠，有形
之物，积聚而为痈矣。此结上起下之辞也。
邪在六腑；则阳脉不和，阳脉不和，则气留之，气留之则阳脉盛矣。邪在五脏，则阴脉不和，
阴脉不和，则血留之，血留之则阴脉盛矣。阴气太盛，则阳气不得相荣也，故曰格。阳气太盛，则
阴气不得相荣也，故曰关。阴阳相盛，不得相荣也，故曰关格。关格者，不得尽其命而死矣。
阳邪中于六腑，则阳脉不和，阳脉不和，则气壅而邪实，邪实则不和之脉转而盛矣。阴邪中
于五脏，则阴脉不和，阴脉不和，则血滞而邪实，邪实则不和之脉转而盛矣。阴阳之脉俱盛，则
成关格之证死矣。此亦《灵枢·脉度篇》文，惟“关格”二字，与经文相反，当是错简。若夫覆
溢关格之脉证，可与三难参观。
按∶《灵枢·脉度篇》曰∶阴气太盛，阳气不能荣，故曰关。阳气太盛，阴气不能荣，故曰
格。终始篇曰∶人迎四盛，且大且数，名曰溢阳，溢阳为外格。脉口四盛，且大且数，名曰溢
阴，溢阴为内关。《素问·六节脏象论》曰∶人迎四盛以上为格阳，寸口四盛以上为关阴。仲景
《伤寒论》云∶寸口脉浮而大，浮为虚，大为实，在尺为关，在寸为格。斯皆以阴气盛为关，阳
气盛为格，故知此节“关格”二字倒置，为错简也。
经言气独行于五脏，不荣于六腑者，何也？
然∶夫气之所行也，如水之流，不得息也。故阴
脉荣于五脏，阳脉荣于六腑，如环之无端，莫知其纪，终而复始，其不覆溢，人气内温于脏腑，
外濡于腠理。
滑氏曰∶此因上章“营”字之意，而推及之也。亦《灵枢》十七篇文，大同小异。所谓气行
于五脏，不营六腑者，非不营行六腑，谓在阴经，则营于五脏，在阳经，则营于六腑。脉气周流，
如环无端，则无关格覆溢之患，而人气内得以温于脏腑，外得以濡于腠理矣。
第三十七难问道：五脏之气，是从哪里发起的，通达于何处，可以说明白吗？
回答说：五脏之气，应当向上联系九窍。所以肺气通于鼻，鼻气调和就能辨别香臭；肝气通于目，目气调和就能分辨黑白；脾气通于口，口气调和就能知晓五谷的味道；心气通于舌，舌气调和就能辨别五味；肾气通于耳，耳气调和就能听懂五音。
这一节内容源自《灵枢·脉度篇》，文字略有增减改动。大意是说五脏调和则七窍通畅，不调和则七窍闭塞。经文说“上阅七窍”，这里说“九窍”，应该是简略或笔误。如果像金代医家张元素（洁古）那样认真追究九窍之说，增添“三焦之气通于喉，喉气调和则声音鸣响”这两句话，未免画蛇添足。谢氏说：本篇询问五脏之气从何处发起、通达何处，回答的文字只讲了五脏通达九窍的道理，而没有涉及五脏之气的发起之处，恐怕有缺文。
五脏是神气寄居的地方，如果不和，气就不能上行到达头面，所以七窍不通。如果六腑不和，则血气留滞在皮肤腠理之间，形成有形的积聚物，从而结成痈肿。这是总结上文并开启下文的辞句。
邪气在六腑，则阳脉不和；阳脉不和，则气机留滞；气机留滞则阳脉盛大。邪气在五脏，则阴脉不和；阴脉不和，则血行留滞；血行留滞则阴脉盛大。阴气太盛，阳气就不能与之相互荣养，所以称为“格”。阳气太盛，阴气就不能与之相互荣养，所以称为“关”。阴阳两者都太盛，不能相互荣养，所以称为“关格”。患有关格病的人，无法享尽天年而死。
阳邪侵入六腑，则阳脉不和；阳脉不和，则气机壅塞而邪气实盛；邪气实盛则原本不和的脉象转而盛大。阴邪侵入五脏，则阴脉不和；阴脉不和，则血行停滞而邪气实盛；邪气实盛则原本不和的脉象转而盛大。阴阳之脉都盛大，就会形成关格的证候而死亡。这也是《灵枢·脉度篇》的文字，只是“关格”二字与经文意思相反，应该是竹简错乱所致。至于覆脉、溢脉以及关格的脉证，可以参考第三难的内容。
按语：《灵枢·脉度篇》说：阴气太盛，阳气不能荣养，所以叫“关”。阳气太盛，阴气不能荣养，所以叫“格”。《灵枢·终始篇》说：人迎脉大四倍且大且数，名叫“溢阳”，溢阳属于外格。脉口脉大四倍且大且数，名叫“溢阴”，溢阴属于内关。《素问·六节脏象论》说：人迎脉大四倍以上为格阳，寸口脉大四倍以上为关阴。张仲景《伤寒论》说：寸口脉浮而大，浮表示虚，大表示实，在尺部出现为关，在寸部出现为格。这些都是以阴气盛为关，阳气盛为格，因此知道这一节中“关格”二字位置颠倒，是错简。
回答说：气的运行，就像水流一样，不会停止。所以阴脉荣养五脏，阳脉荣养六腑，如圆环一样没有端点，不知其起止，循环往复，永不停止。只要不出现覆脉和溢脉，人气就能在内温煦脏腑，在外濡润腠理。
滑寿（滑氏）说：这是因为上一章提到“营”字的含义，从而推演至此。这也出自《灵枢》第十七篇，大体相同只有细微差别。所谓气行于五脏而不营于六腑，并不是说不营行六腑，而是指在阴经时，就营养五脏；在阳经时，就营养六腑。脉气周流全身，如环无端，就不会有关格、覆溢的祸患，而人气就能在内温煦脏腑，在外濡润腠理了。
Chapter 37 asks: From where does the Qi of the Five Zang Organs originate, and through which pathways does it connect? Can this be explained?
The answer is: The Qi of the Five Zang Organs should connect upwards to the Nine Orifices. Therefore, Lung Qi connects to the nose; when nasal Qi is harmonious, one can distinguish fragrant from foul odors. Liver Qi connects to the eyes; when eye Qi is harmonious, one can distinguish black from white. Spleen Qi connects to the mouth; when oral Qi is harmonious, one can perceive the flavors of grains. Heart Qi connects to the tongue; when lingual Qi is harmonious, one can discern the five flavors. Kidney Qi connects to the ears; when auricular Qi is harmonious, one can perceive the five musical tones.
This section is derived from the "Mai Du" (Vessel Length) chapter of the *Ling Shu* (Spiritual Pivot), with slight additions and alterations. The main idea is that when the Five Zang Organs are harmonious, the Seven Orifices are unobstructed; when they are disharmonious, the Seven Orifices are blocked. The classic text mentions "Seven Orifices," while here it mentions "Nine Orifices," which is likely an omission or scribal error. If one were to rigorously adhere to the concept of Nine Orifices, as Zhang Yuansu (Jiegu) did by adding the sentence "San Jiao Qi connects to the larynx; when laryngeal Qi is harmonious, voice resonates," it would be superfluous. Xie states: This chapter asks where the Qi of the Five Zang Organs originates and where it connects, but the response only discusses the connection between the Five Zang Organs and the Nine Orifices, omitting the origin of the Qi. There may be missing text.
When the Five Zang Organs are disharmonious, the Nine Orifices become obstructed; when the Six Fu Organs are disharmonious, stagnation and knotting occur, leading to carbuncles.
The Five Zang Organs are the abodes of the Shen (Spirit) and Qi. When disharmonious, Qi cannot ascend to the head and face, resulting in obstruction of the Seven Orifices. If the Six Fu Organs are disharmonious, Blood and Qi stagnate in the skin and interstitial spaces (Cou Li), forming tangible accumulations that develop into carbuncles. This serves as a transition summarizing the previous point and introducing the next.
When pathogenic factors reside in the Six Fu Organs, the Yang Mai (Yang Vessels) become disharmonious. Disharmony in Yang Mai leads to Qi stagnation; Qi stagnation causes the Yang Mai to become excessive. When pathogenic factors reside in the Five Zang Organs, the Yin Mai (Yin Vessels) become disharmonious. Disharmony in Yin Mai leads to Blood stagnation; Blood stagnation causes the Yin Mai to become excessive. When Yin Qi is excessively strong, Yang Qi cannot mutually nourish it, thus it is called Ge (Rejection). When Yang Qi is excessively strong, Yin Qi cannot mutually nourish it, thus it is called Guan (Obstruction). When both Yin and Yang are excessively strong and cannot mutually nourish each other, it is called Guan Ge (Obstruction and Rejection). Those suffering from Guan Ge will not live out their natural lifespan and will die.
When Yang pathogens invade the Six Fu Organs, Yang Mai becomes disharmonious; disharmony in Yang Mai leads to Qi congestion and excess pathogens; excess pathogens cause the previously disharmonious pulse to become excessive. When Yin pathogens invade the Five Zang Organs, Yin Mai becomes disharmonious; disharmony in Yin Mai leads to Blood stasis and excess pathogens; excess pathogens cause the previously disharmonious pulse to become excessive. When both Yin and Yang pulses become excessive, the condition of Guan Ge develops, leading to death. This passage is also from the "Mai Du" chapter of the *Ling Shu*, except that the terms "Guan" and "Ge" are reversed compared to the original text, suggesting a bamboo slip misordering. Regarding the pulses of Fu (Overturning) and Yi (Overflowing) and the manifestations of Guan Ge, one may refer to Chapter 3 for comparison.
Commentary: The "Mai Du" chapter of the *Ling Shu* states: When Yin Qi is excessively strong and Yang Qi cannot nourish, it is called Guan. When Yang Qi is excessively strong and Yin Qi cannot nourish, it is called Ge. The "Zhong Shi" chapter of the *Ling Shu* states: When the Ren Ying pulse is four times larger and rapid, it is named Yi Yang (Overflowing Yang), which constitutes External Ge. When the Mai Kou pulse is four times larger and rapid, it is named Yi Yin (Overflowing Yin), which constitutes Internal Guan. The "Liu Jie Zang Xiang Lun" chapter of the *Su Wen* (Plain Questions) states: A Ren Ying pulse four times larger indicates Ge Yang; a Cun Kou pulse four times larger indicates Guan Yin. Zhang Zhongjing's *Shang Han Lun* (Treatise on Cold Damage) states: A Cun Kou pulse that is floating and large indicates deficiency (floating) and excess (large); if found at the Chi position, it is Guan; if found at the Cun position, it is Ge. All these sources define Guan as excess Yin Qi and Ge as excess Yang Qi. Therefore, it is known that the terms "Guan Ge" in this chapter are inverted due to textual corruption.
The classic text asks: Why does Qi circulate exclusively within the Five Zang Organs and not nourish the Six Fu Organs?
The answer is: The movement of Qi is like flowing water; it never ceases. Therefore, Yin Mai nourishes the Five Zang Organs, and Yang Mai nourishes the Six Fu Organs. Like a circle without beginning or end, its cycle is endless, returning to the start continuously. As long as there is no Fu (Overturning) or Yi (Overflowing), the vital Qi internally warms the Zang and Fu Organs and externally moistens the Cou Li (skin and interstices).
Hua Shou (Master Hua) states: This extends the meaning of the term "Ying" (Nourishing/Defensive) from the previous chapter. It is also derived from Chapter 17 of the *Ling Shu*, with minor variations. The statement that Qi circulates in the Five Zang Organs but does not nourish the Six Fu Organs does not mean it fails to circulate in the Six Fu Organs. Rather, it means that when in the Yin meridians, it nourishes the Five Zang Organs; when in the Yang meridians, it nourishes the Six Fu Organs. Since the pulse Qi flows cyclically without end, there is no risk of Guan Ge, Fu, or Yi, allowing vital Qi to internally warm the Zang and Fu Organs and externally moisten the Cou Li.