腹满是诸多疾病的一个常见症状，其久久不愈者，辨之诚难，然若结合昼夜阴阳．五行之变，常可迎刃而解。例如：赵××，女，成。腹胀不适，下肢浮肿，日渐肥胖三年多。中西药久治不效。细察其体重三年增加25千克以上，走路弯腰均感气短、心烦，午后至夜间腹满尤甚。舌苔白，脉沉滑。综合脉证，诊为痰湿气滞。治拟木香顺气汤加减理气化痰，温阳化湿。服药20剂后，腹满气短明显好转；60剂后，腹满消失七八，体重下降10千克，精神增加。陈××，男，40岁。肝硬化2年，肝硬化腹水反复出现一年多。第一次腹水经中、西药治疗2个多月，腹水消失。第二次腹水出现后2个多月来，频用中、西药治疗，一直无效。细察其腹大如鼓，腹胀尤以夜间为甚，齿衄鼻衄，目珠黄染，面色黧黑。舌苔白，舌质红，脉弦紧而大。综合脉证，诊为气阴两虚，湿热蕴结，肾阳亏损。治拟芪脉地黄汤补气养阴，燥湿清热，佐以温肾。服药4剂后，腹满、衄血均减；30剂后，诸证俱失。
其他诸证(尤其是疑难复杂病证)，亦多如此。详细论述参见拙著《天人相应与辨证论治》一书。
缓中补虚
予读《金匮要略·血痹虚劳病脉证并治第六》“五劳虚极赢瘦，腹满不能食，食伤，忧伤，饮伤，房室伤，饥伤，劳伤，经络营卫气伤，内有干血，肌肤甲错，两目黯黑。缓中补虚。大黄廑虫丸主之”中的“缓中补虚”句与“大黄庶虫丸方：大黄十分(蒸)、黄芩二两、甘草三两，桃仁一升，杏仨一升，芍药四两，干地黄十两，干漆一两，虻虫一升，水蛭百枚，蛴螬一升，廑虫半升”的药物组成。久久不得而解。其补虚之药方何故无补虚之药而云其为补虚。及至检读一些医家之注文更使我昏昏矇矇如坠万丈深渊。程林《金匮要略直解》：“此条单指内有干血而言。夫人或因七情，或因饮食，或因房劳，皆令正气内伤，血脉凝积，致有干血积于中，而虚赢见于外也。血积则不能以濡肌肤，故肌肤甲错，不能以营于目，则两目黯黑，与大黄廑虫丸以下干血，干血去，则邪除正旺，是以谓之缓中补虚，非大黄廑虫丸能缓中补虚也。”尤在泾《金匮要略心典》：“虚劳证有夹外邪者，如上所谓风气百疾是也。有夹瘀郁者，则此所谓五劳诸伤，内有干血者是也。夫风气不去，则足以贼正气而生长不荣；干血不去，则足以留新血而渗灌不周，故去之不可不早也。此方润以濡其干，虫以动其瘀，通以去其闭，而仍以地黄、芍药、甘草和养其虚，攻血而不专主于血，一如薯蓣丸之去风而不着意于风也。喻氏日：此世俗所称干血劳之良治也。血瘀于内，手足脉相失者宜之，兼入琼玉膏补润之剂尤妙。”张璐玉《张氏医通》：“举世皆以参芪归地等为补虚，仲景独以大黄廑虫等补虚，苟非神圣不能行是法也。夫五劳七伤，多缘劳动不节，气血凝滞，郁积生热，致伤其阴，世俗所称干血劳是也。所以仲景乘其元气未漓，先用大黄、廑虫、水蛭、虻虫、蛴螬等蠕动瞰血之物；佐以干漆、生地，桃、杏仁，行去其血，略兼甘草、芍药以缓中补虚；黄芩以开通热瘀，酒服以行药势，待于血行尽然后纯行缓中补虚收功。”更有甚者，把“大黄廑虫丸”称为补虚活血化瘀之剂，如李克光主编之《金匮要略讲义》称“大黄廑虫丸是补虚活血化瘀的方剂。”及至读到江苏省中医学校著《金匮释义》云之“是大黄廑虫丸之去瘀破积，对于虚劳干血症，买有其缓中补虚的作用。”始称有悟。此所谓缓中补虚乃大法耳，非所谓大黄廑虫是补虚活血化瘀的方剂意也。
曾治患者杜××，女，72岁。失眠健忘，心悸怔忡五六年。近两年来日渐加重。经常昼夜难于入睡1～2小时，且头晕头胀，脑鸣耳鸣，形钫骨立，难进饮食，神疲难动，面色萎黄，说话乏力。医予归脾、建中、十全大补、天王补心、龟鹿二仙诸汤丸法治之，诸证反甚。邀余诊治。审其除上诸证之外，并见胃脘满痛，食之更甚，按之益加，舌苔黄白，脉弦细而涩。思之，此气血阴阳大衰为本，寒实中阻为标之证耳。治宜宗《金匮》“病痼疾加以卒病，当先治其卒病，后乃治其痼疾”法。处方：枳实10克，厚朴10克，大黄4克，干姜4克，草果10克，陈皮10克，木香10克。
服药2剂，胃脘胀痛好转，饮食稍进。惟头晕耳鸣，失眠乏力，心悸心烦更加严重，思之：前用诸方补则胃脘满痛有加，消之而正气虚而难支。难治之证也。又思仲景《金匮要略》虚劳篇曾有治虚劳用缓中补虚法(即缓消其实而即有补虚之意法)，缓缓攻之，微祛其邪，何不用之。乃处枳实l克，厚朴1克，大黄0．2克，草果l克，陈皮1克，木香1克。
服药2剂，脘痛大减，精神倍增。继服上药1月，诸证竞消六七。
宋××，女，56岁。
皮肤瘙痒，抓之呈条、块隆起，稍着湿冷之气即大片大片隆起丘疹数十年。医诊荨麻疹。先用西药治疗数年不效，后以中药养血活血、补气温阳之剂，以及秘方、验方数千剂亦无功。细审其舌脉：皮肤划痕试验阳性，隆起皮肤之色不变，舌苔薄白，脉弦紧稍缓。综合脉证，思之：此寒湿风邪所致也。治宜祛风散寒除湿。处方：羌活10克，防风10克，荆芥10克，厚朴lO克，党参10克，僵蚕10克，蝉蜕10克，藿香10克，清茶1撮，川芎10克，陈皮10克，甘草lO克，茯苓10克。
服药2剂。全身奇痒加剧，到处是连片的皮疹隆起。思之：药证合拍耳，何其诸证反而更剧?久病正气大虚也。虚不任攻伐，故病更甚也。宜宗缓祛其邪即寓扶正补虚之意的缓中补虚法。处方：
羌活l克，防风l克，荆芥1克，川芎1克，厚朴l克，党参l克，茯苓1克，陈皮l克，甘草l克，蝉蜕1克，僵蚕1克，藿香1克，清茶2片。
服药2剂。皮疹明显减少，且瘙痒消减近80％，继服15剂，诸证消失，愈。
少阳属肾，肾上连肺，故将两脏
予在讲授《内经》至《灵枢·本输》：“少阳属肾，肾上连肺，故将两脏”一段时，经常遇见医家有两种意见，其一日少阳属肾之少阳一词即少阳，并注云：“少阳，三焦也。”例如：张景岳《类经》云：“少阳，三焦也。三焦之正脉指天，散于胸中，而肾脉亦上连于肺，三焦之下腧属于膀胱，而膀胱为肾之合，故三焦亦属乎肾也。然三焦为中渎之府，膀胱为津液之府，肾以水脏而领水府，理之当然，故肾得兼将两脏……中渎者，谓如川如渎，源流皆出其中也，即水谷入于口，出于便，自上而下，必历三焦，故日中渎之府，水道出焉。膀胱受三焦之水，而当其疏泄之道，气本相依，体同一类，故三焦之下腧出于委阳，并太阳之正入络膀胱约下焦也。然于十二脏之中惟三焦独大，诸脏无与匹者，故名日是孤之府也……惟三焦者虽为水渎之府，而实总护诸阳，亦称相火，是又水中之火府，故在本篇日三焦属膀胱，在血气形志篇日少阳与心主为表里，盖其在下者为阴，属膀胱而合肾水；在上者为阳，合包络而通心火，此三焦所以际上极下，象同六合，而无所不包也。观本篇六府之别，极为明显，以其皆有盛贮，因名为府。而三焦者日中渎之府，是孤之府，分明确有一府，盖即脏腑之外，躯体之内，包罗诸脏，一腔之大府也，故有中渎是孤之名，而亦有大府之形。”马莳云：“手少阳三焦者，属于右肾，而肾又上连于肺。本经经脉篇谓：肾脉从肾上贯肝膈，入肺中，正肾之上连于肺也。故左肾合膀胱，右肾合三焦，而将此两脏，必皆以肾为主耳。然此三焦者，为中渎之府，乃水道之所由出也。《素问·灵兰秘典论》日：三焦者，决渎之官：水道出焉。正以下焦如渎，而此有以聚之决之，故日决渎之官。又日中渎之府也。彼膀胱合于左肾，即此三焦合于右肾然三焦虽与膀胱为类，其实膀胱与肾为表里，而三焦不与肾为表里，乃与手厥阴心包络经为表里，非腑之孤者而何?由前观之，凡六腑之所与合者盖如此。”张志聪云：“少阳，三焦也。水热穴论日：肾者，至阴也，至阴者，盛水也。肺者，太阴也，少阴者，冬脉也。故其本在肾，其末在肺，皆积水也。是一肾配少阳而主火，一肾上连肺而主水，故肾将两脏也。三焦之脉，出于中胃，人络膀胱，约下焦而主决渎，故为中渎之府，水道出焉，而下属膀胱。夫三焦者，少阳之气，水中之生阳也。手厥阴包络之相火，出于右肾，归于心下之包络而为一脏，三焦为之腑，是两肾以膀胱为腑，三焦归于中，胃为包络之腑，故为孤之腑也。夫两肾者，主天一之水，地二之火，分而论之，犹两仪也，故少阳属肾，肾上连肺而为两脏。合而论之，阴阳相贯，水火互交，并主藏精而为生气之源，故皆以膀胱为腑，三焦上合包络，故乃为孤之腑也。再按三焦乃少阳之气，发于肾脏，进行于上下，通会于腠理，乃无形之气也。上焦出胃上口，中焦亦并胃中，下焦别回肠，此三焦所归之部署也。故平脉篇日：三焦不归其部，上焦不归者，噫而酢吞，中焦不归者，不能消谷引食，下焦不归者，则遗溲。是三焦之气，生于肾脏，而归于中焦之间。本经论三焦所出之处，即平脉篇所归之部属也。本无形之气，故能进行出入，归于有形之部，故为一腑而有经穴也。手厥阴包络之气，地二之阴火也，发原于肾脏，而归于包络，包络正在心下包裹心主所生之血，为君主之相，代君行血于脉中，其气本于肾，心下有形之包络，亦所归之部署也。故以先天之气论之，则少阳属肾，肾将两脏。以后天有形之脏腑论之，包络正在心下，三焦居中胃之间，而为一脏一腑也。”
其二日：少阳属肾，肾上连肺，故将两脏之少阳字乃少阴之误。如《甲乙经》云：“少阴属肾，上连肺。”《黄帝内经太素》云：“少阴属肾，肾上连肺，故将两脏矣。”并注云：“足少阴脉贯肝入肺中，故日上连也。肾受肺气，肾便有二，将为两脏。八十一难曰：五脏亦有六者，谓肾有两脏也。”贾得道著《黄帝内经选编》认为：“《甲乙》作少阴属肾，上连肺似更妥。”程士德编《内经讲义》更将少阳属。肾之少阳字改为少阴属肾句，更明确地说：“少阴，原本误作少阳，今依《太素》改之。”并注释云：“将，统率的意思。这是说少阴经脉属于肾，从脏腑相合来说，肾合膀胱，而又上连于肺，故日其将两脏也。《素问·水热穴论》说：少阴者，冬脉也，故其本在肾，其末在肺。”
两种意见，何者正确?何者谬误?久思不解。因为如果按程士德、贾得道之见，虽可说明少阴之将两脏为肾与肺，但不能说明为什么在原文中讲相合的同时，接着出现了少阴属肾，肾上连肺，故将两脏一句，且紧接着又补充出了三焦者，中渎之府也，水道出焉，属膀胱，是孤之府也，是六府之所与合者一句。又且很难说明为什么在治疗水、饮阻滞所引起的疾病时，不但要治肺、治肾、治膀胱，而且同时必须兼顾三焦，兼顾少阳的升发，否则很难取得应有的效果，这种现象尤其是在疑难的水、饮疾病中更为多见。如果按杨上善《黄帝内经太素》之见，虽可说明少阴即指两肾，但其不能说明《内经》中并无两肾之说，且亦不能说明临床上为什么在治疗水、饮疾病时，不但要治肺、治肾，而且必须兼顾三焦，否则很难取得应有的疗效。如果按张景岳《类经》所注少阴是少阳，少阳即三焦，三焦能总护诸阳，包罗诸脏，非且上连肺，亦且下连肾与膀胱之解释，不但能说明《灵枢·本输篇》原文之先后次序的含义，亦且能说明临床治疗水饮病必须遵循的规律。根据实践是检验真理的标准这一科学定论来看，张景岳的注释应是正确的。至于马莳所注“左肾合膀胱，右肾合三焦，而将此两脏，必皆以肾为主耳。”之左、右肾说，颇有不符《内经》之义，但其所云少阳即三焦却与张景岳之说相同。
曾治患者卞××，女，26岁。咳而微喘7个多月。某院诊为支气管炎。先予抗生素、中药止咳化痰、宣肺定喘之剂不效。邀余诊治。询其咳嗽微喘，阵发性加剧，尤以夜间平卧时为甚，口苦而干。思之：夜间平卧时加剧者，痰饮蕴于肺也，治以宣肺化饮。小青龙汤加减。处方：麻黄6克，干姜6克，桂枝6克，白芍6克，甘草6克，细辛3克，半夏6克，五味子6克。服药4剂，寸效未见。再寻其脉弦而稍涩。因思病程已久，非仅病肺，亦且及肾，非但治肺所能得愈。再询其证，咳重之时亦且腰背酸痛。且夫《灵枢·本输篇》云：“少阳属肾，肾上连肺，故将两脏。三焦者，中渎之府也，水道出焉，属膀胱，是孤之府也，是六府之所与合者。”因拟化饮止咳的同时，佐用调理三焦，且兼敛肺敛肾之法。处方：柴胡10克，半夏10克，黄芩10克，于姜3克，五昧子10克，丝瓜络10克，紫菀10克。服药2剂，咳嗽大减，继服4剂，诸证消失，愈。
腹满是许多疾病的一个常见症状，那些长期不愈的，辨证确实很难，但如果结合昼夜阴阳、五行变化的规律，往往可以迎刃而解。例如：赵某，女性，成年。腹胀不适，下肢浮肿，身体日渐肥胖三年多。中西药久治不效。仔细检查发现其体重三年增加25千克以上，走路弯腰均感到气短、心烦，午后至夜间腹满尤其严重。舌苔白，脉沉滑。综合脉象和症状，诊断为痰湿气滞。治疗拟定木香顺气汤加减，以理气化痰，温阳化湿。服药20剂后，腹满和气短明显好转；60剂后，腹满消失七八成，体重下降10千克，精神增加。陈某，男性，40岁。肝硬化2年，肝硬化腹水反复出现一年多。第一次腹水经中、西药治疗2个多月，腹水消失。第二次腹水出现后2个多月来，频繁使用中、西药治疗，一直无效。仔细检查发现其腹部大如鼓，腹胀尤其在夜间严重，牙龈出血、鼻出血，眼球黄染，面色黧黑。舌苔白，舌质红，脉弦紧而大。综合脉证，诊断为气阴两虚，湿热蕴结，肾阳亏损。治疗拟定芪脉地黄汤补气养阴，燥湿清热，佐以温肾。服药4剂后，腹满、衄血均减轻；30剂后，诸证全部消除。
其他各种病症（尤其是疑难复杂病证），也多如此。详细论述参见拙著《天人相应与辨证论治》一书。
缓中补虚
我阅读《金匮要略·血痹虚劳病脉证并治第六》中“五劳虚极赢瘦，腹满不能食，食伤，忧伤，饮伤，房室伤，饥伤，劳伤，经络营卫气伤，内有干血，肌肤甲错，两目黯黑。缓中补虚。大黄廑虫丸主之”里的“缓中补虚”一句，以及“大黄廑虫丸方：大黄十分(蒸)、黄芩二两、甘草三两，桃仁一升，杏仁一升，芍药四两，干地黄十两，干漆一两，虻虫一升，水蛭百枚，蛴螬一升，廑虫半升”的药物组成。久久不得其解。其中的补虚药物为何没有补虚的药却称之为补虚？等到检读一些医家的注文更使我昏昏沉沉如坠万丈深渊。程林《金匮要略直解》：“此条单指内有干血而言。人或许因为七情，或许因为饮食，或许因为房劳，都会导致正气内伤，血脉凝积，致使有干血积于中，而虚羸见于外。血积则不能濡润肌肤，所以肌肤甲错，不能滋养眼睛，则两目黯黑，用大黄廑虫丸以下除干血，干血去，则邪除正旺，所以称之为缓中补虚，并非大黄廑虫丸能直接缓中补虚。”尤在泾《金匮要略心典》：“虚劳证有夹外邪的，如上所说风气百疾是也。有夹瘀郁的，则此所谓五劳诸伤，内有干血是也。风气不去，则足以贼害正气而生长不荣；干血不去，则足以留滞新血而渗灌不周，所以去除它不可不早。此方用滋润以濡养其干燥，用虫类药以动其瘀血，用通利以去除闭塞，而仍以地黄、芍药、甘草调和养护其虚，攻血而不专主于血，一如薯蓣丸之去风而不着意于风。喻嘉言说：这是世俗所称干血劳的良好治疗方法。血瘀于内，手足脉相失者适宜用之，兼入琼玉膏补润之剂尤其妙。”张璐玉《张氏医通》：“举世皆以参芪归地等为补虚，仲景独以大黄廑虫等补虚，如果不是神圣之人不能行此法。五劳七伤，多缘劳动不节，气血凝滞，郁积生热，致伤其阴，世俗所称干血劳是也。所以仲景乘其元气未漓，先用大黄、廑虫、水蛭、虻虫、蛴螬等蠕动噬血之物；佐以干漆、生地，桃、杏仁，行去其血，略兼甘草、芍药以缓中补虚；黄芩以开通热瘀，酒服以行药势，待血行尽然后纯行缓中补虚收功。”更有甚者，把“大黄廑虫丸”称为补虚活血化瘀之剂，如李克光主编之《金匮要略讲义》称“大黄廑虫丸是补虚活血化瘀的方剂。”及至读到江苏省中医学校著《金匮释义》云之“是大黄廑虫丸之去瘀破积，对于虚劳干血症，实有其缓中补虚的作用。”始称有悟。此所谓缓中补虚乃大法耳，非所谓大黄廑虫是补虚活血化瘀的方剂意也。
曾治疗患者杜某，女性，72岁。失眠健忘，心悸怔忡五六年。近两年来日渐加重。经常昼夜难于入睡1～2小时，且头晕头胀，脑鸣耳鸣，形销骨立，难进饮食，神疲难动，面色萎黄，说话乏力。医生给予归脾、建中、十全大补、天王补心、龟鹿二仙诸汤丸法治之，诸证反而加重。邀请余诊治。审察其除上述诸证之外，并见胃脘满痛，进食后更甚，按压时益加疼痛，舌苔黄白，脉弦细而涩。思考认为，此气血阴阳大衰为本，寒实中阻为标之证。治疗宜宗《金匮》“病痼疾加以卒病，当先治其卒病，后乃治其痼疾”之法。处方：枳实10克，厚朴10克，大黄4克，干姜4克，草果10克，陈皮10克，木香10克。
服药2剂，胃脘胀痛好转，饮食稍进。惟头晕耳鸣，失眠乏力，心悸心烦更加严重，思考：前用诸方补则胃脘满痛有加，消之而正气虚而难支。难治之证也。又思仲景《金匮要略》虚劳篇曾有治虚劳用缓中补虚法(即缓消其实而即有补虚之意法)，缓缓攻之，微祛其邪，何不用之。乃处枳实1克，厚朴1克，大黄0.2克，草果1克，陈皮1克，木香1克。
服药2剂，脘痛大减，精神倍增。继服上药1月，诸证竟消六七。
宋某，女性，56岁。
皮肤瘙痒，抓之呈条、块隆起，稍着湿冷之气即大片大片隆起丘疹数十年。医生诊为荨麻疹。先用西药治疗数年不效，后以中药养血活血、补气温阳之剂，以及秘方、验方数千剂亦无功。仔细审查其舌脉：皮肤划痕试验阳性，隆起皮肤之色不变，舌苔薄白，脉弦紧稍缓。综合脉证，思考：此寒湿风邪所致也。治疗宜祛风散寒除湿。处方：羌活10克，防风10克，荆芥10克，厚朴10克，党参10克，僵蚕10克，蝉蜕10克，藿香10克，清茶1撮，川芎10克，陈皮10克，甘草10克，茯苓10克。
服药2剂。全身奇痒加剧，到处是连片的皮疹隆起。思考：药证合拍耳，为何诸证反而更剧？久病正气大虚也。虚不任攻伐，故病更甚也。宜宗缓祛其邪即寓扶正补虚之意的缓中补虚法。处方：
羌活1克，防风1克，荆芥1克，川芎1克，厚朴1克，党参1克，茯苓1克，陈皮1克，甘草1克，蝉蜕1克，僵蚕1克，藿香1克，清茶2片。
服药2剂。皮疹明显减少，且瘙痒消减近80％，继服15剂，诸证消失，痊愈。
少阳属肾，肾上连肺，故将两脏
我在讲授《内经》至《灵枢·本输》：“少阳属肾，肾上连肺，故将两脏”一段时，经常遇见医家有两种意见，其一曰少阳属肾之少阳一词即少阳，并注云：“少阳，三焦也。”例如：张景岳《类经》云：“少阳，三焦也。三焦之正脉指天，散于胸中，而肾脉亦上连于肺，三焦之下腧属于膀胱，而膀胱为肾之合，故三焦亦属乎肾也。然三焦为中渎之府，膀胱为津液之府，肾以水脏而领水府，理之当然，故肾得兼将两脏……中渎者，谓如川如渎，源流皆出其中也，即水谷入于口，出于便，自上而下，必历三焦，故日中渎之府，水道出焉。膀胱受三焦之水，而当其疏泄之道，气本相依，体同一类，故三焦之下腧出于委阳，并太阳之正入络膀胱约下焦也。然于十二脏之中惟三焦独大，诸脏无与匹者，故名日是孤之府也……惟三焦者虽为水渎之府，而实总护诸阳，亦称相火，是又水中之火府，故在本篇日三焦属膀胱，在血气形志篇日少阳与心主为表里，盖其在下者为阴，属膀胱而合肾水；在上者为阳，合包络而通心火，此三焦所以际上极下，象同六合，而无所不包也。观本篇六府之别，极为明显，以其皆有盛贮，因名为府。而三焦者日中渎之府，是孤之府，分明确有一府，盖即脏腑之外，躯体之内，包罗诸脏，一腔之大府也，故有中渎是孤之名，而亦有大府之形。”马莳云：“手少阳三焦者，属于右肾，而肾又上连于肺。本经经脉篇谓：肾脉从肾上贯肝膈，入肺中，正肾之上连于肺也。故左肾合膀胱，右肾合三焦，而将此两脏，必皆以肾为主耳。然此三焦者，为中渎之府，乃水道之所由出也。《素问·灵兰秘典论》日：三焦者，决渎之官：水道出焉。正以下焦如渎，而此有以聚之决之，故日决渎之官。又日中渎之府也。彼膀胱合于左肾，即此三焦合于右肾然三焦虽与膀胱为类，其实膀胱与肾为表里，而三焦不与肾为表里，乃与手厥阴心包络经为表里，非腑之孤者而何?由前观之，凡六腑之所与合者盖如此。”张志聪云：“少阳，三焦也。水热穴论日：肾者，至阴也，至阴者，盛水也。肺者，太阴也，少阴者，冬脉也。故其本在肾，其末在肺，皆积水也。是一肾配少阳而主火，一肾上连肺而主水，故肾将两脏也。三焦之脉，出于中胃，人络膀胱，约下焦而主决渎，故为中渎之府，水道出焉，而下属膀胱。夫三焦者，少阳之气，水中之生阳也。手厥阴包络之相火，出于右肾，归于心下之包络而为一脏，三焦为之腑，是两肾以膀胱为腑，三焦归于中，胃为包络之腑，故为孤之腑也。夫两肾者，主天一之水，地二之火，分而论之，犹两仪也，故少阳属肾，肾上连肺而为两脏。合而论之，阴阳相贯，水火互交，并主藏精而为生气之源，故皆以膀胱为腑，三焦上合包络，故乃为孤之腑也。再按三焦乃少阳之气，发于肾脏，进行于上下，通会于腠理，乃无形之气也。上焦出胃上口，中焦亦并胃中，下焦别回肠，此三焦所归之部署也。故平脉篇日：三焦不归其部，上焦不归者，噫而酢吞，中焦不归者，不能消谷引食，下焦不归者，则遗溲。是三焦之气，生于肾脏，而归于中焦之间。本经论三焦所出之处，即平脉篇所归之部属也。本无形之气，故能进行出入，归于有形之部，故为一腑而有经穴也。手厥阴包络之气，地二之阴火也，发原于肾脏，而归于包络，包络正在心下包裹心主所生之血，为君主之相，代君行血于脉中，其气本于肾，心下有形之包络，亦所归之部署也。故以先天之气论之，则少阳属肾，肾将两脏。以后天有形之脏腑论之，包络正在心下，三焦居中胃之间，而为一脏一腑也。”
其二曰：少阳属肾，肾上连肺，故将两脏之少阳字乃少阴之误。如《甲乙经》云：“少阴属肾，上连肺。”《黄帝内经太素》云：“少阴属肾，肾上连肺，故将两脏矣。”并注云：“足少阴脉贯肝入肺中，故日上连也。肾受肺气，肾便有二，将为两脏。八十一难曰：五脏亦有六者，谓肾有两脏也。”贾得道著《黄帝内经选编》认为：“《甲乙》作少阴属肾，上连肺似更妥。”程士德编《内经讲义》更将少阳属。肾之少阳字改为少阴属肾句，更明确地说：“少阴，原本误作少阳，今依《太素》改之。”并注释云：“将，统率的意思。这是说少阴经脉属于肾，从脏腑相合来说，肾合膀胱，而又上连于肺，故日其将两脏也。《素问·水热穴论》说：少阴者，冬脉也，故其本在肾，其末在肺。”
两种意见，何者正确?何者谬误?久思不解。因为如果按程士德、贾得道之见，虽可说明少阴之将两脏为肾与肺，但不能说明为什么在原文中讲相合的同时，接着出现了少阴属肾，肾上连肺，故将两脏一句，且紧接着又补充出了三焦者，中渎之府也，水道出焉，属膀胱，是孤之府也，是六府之所与合者一句。又且很难说明为什么在治疗水、饮阻滞所引起的疾病时，不但要治肺、治肾、治膀胱，而且同时必须兼顾三焦，兼顾少阳的升发，否则很难取得应有的效果，这种现象尤其是在疑难的水、饮疾病中更为多见。如果按杨上善《黄帝内经太素》之见，虽可说明少阴即指两肾，但其不能说明《内经》中并无两肾之说，且亦不能说明临床上为什么在治疗水、饮疾病时，不但要治肺、治肾，而且必须兼顾三焦，否则很难取得应有的疗效。如果按张景岳《类经》所注少阴是少阳，少阳即三焦，三焦能总护诸阳，包罗诸脏，非且上连肺，亦且下连肾与膀胱之解释，不但能说明《灵枢·本输篇》原文之先后次序的含义，亦且能说明临床治疗水饮病必须遵循的规律。根据实践是检验真理的标准这一科学定论来看，张景岳的注释应是正确的。至于马莳所注“左肾合膀胱，右肾合三焦，而将此两脏，必皆以肾为主耳。”之左、右肾说，颇有不符《内经》之义，但其所云少阳即三焦却与张景岳之说相同。
曾治疗患者卞某，女性，26岁。咳而微喘7个多月。某院诊为支气管炎。先予抗生素、中药止咳化痰、宣肺定喘之剂不效。邀请余诊治。询问其咳嗽微喘，阵发性加剧，尤以夜间平卧时为甚，口苦而干。思考：夜间平卧时加剧者，痰饮蕴于肺也，治以宣肺化饮。小青龙汤加减。处方：麻黄6克，干姜6克，桂枝6克，白芍6克，甘草6克，细辛3克，半夏6克，五味子6克。服药4剂，寸效未见。再寻其脉弦而稍涩。因思病程已久，非仅病肺，亦且及肾，非但治肺所能得愈。再询其证，咳重之时亦且腰背酸痛。且夫《灵枢·本输篇》云：“少阳属肾，肾上连肺，故将两脏。三焦者，中渎之府也，水道出焉，属膀胱，是孤之府也，是六府之所与合者。”因拟化饮止咳的同时，佐用调理三焦，且兼敛肺敛肾之法。处方：柴胡10克，半夏10克，黄芩10克，干姜3克，五味子10克，丝瓜络10克，紫菀10克。服药2剂，咳嗽大减，继服4剂，诸证消失，痊愈。
Abdominal fullness is a common symptom of many diseases. For those that persist for a long time, differentiation and diagnosis are indeed difficult; however, if combined with the variations of Yin and Yang between day and night, as well as the Five Phases (Wu Xing), it can often be resolved readily. For example: Patient Zhao XX, female, adult. Abdominal distension and discomfort, edema of the lower limbs, and gradual obesity for over three years. Treatment with both Chinese and Western medicines was ineffective for a long time. Careful examination revealed that her weight increased by more than 25 kg over three years; walking and bending caused shortness of breath and irritability. Abdominal fullness was particularly severe from afternoon to night. The tongue coating was white, and the pulse was deep and slippery. Integrating the pulse and symptoms, the diagnosis was Phlegm-Dampness Qi Stagnation (Tan Qi Shi Zhi). The treatment plan was Muxiang Shunqi Tang (Aucklandia Decoction to Regulate Qi) modified to regulate Qi, resolve Phlegm, warm Yang, and transform Dampness. After taking 20 doses, abdominal fullness and shortness of breath improved significantly; after 60 doses, abdominal fullness disappeared by 70-80%, weight decreased by 10 kg, and spirit increased. Patient Chen XX, male, 40 years old. Liver cirrhosis for 2 years, recurrent ascites due to liver cirrhosis for over one year. The first episode of ascites disappeared after over 2 months of Chinese and Western medicine treatment. After the recurrence of ascites, frequent treatment with Chinese and Western medicines for over 2 months remained ineffective. Careful examination showed an abdomen large as a drum, abdominal distension especially severe at night, gingival bleeding, epistaxis, scleral icterus, and dark complexion. The tongue coating was white, the tongue body red, and the pulse wiry, tight, and large. Integrating the pulse and symptoms, the diagnosis was Qi and Yin Deficiency, Damp-Heat Accumulation, and Kidney Yang Deficiency. The treatment plan was Qimai Dihuang Tang (Astragalus and Polygonatum Rehmannia Decoction) to tonify Qi and nourish Yin, dry Dampness and clear Heat, assisted by warming the Kidney. After taking 4 doses, abdominal fullness and bleeding reduced; after 30 doses, all symptoms disappeared.
Other various conditions (especially difficult and complex diseases) are also mostly like this. For detailed discussion, please refer to my book "Correspondence between Heaven and Man and Syndrome Differentiation and Treatment".
"Relaxing the Middle and Tonifying Deficiency"
When reading the sentence "Five types of fatigue leading to extreme deficiency and emaciation, abdominal fullness and inability to eat, injury from food, injury from sorrow, injury from drinks, injury from sexual activity, injury from hunger, injury from labor, injury to the meridians, Ying and Wei Qi, internal dry blood, rough skin resembling fish scales, dark eyes. Relax the middle and tonify deficiency. Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) governs it" in Chapter 6 of *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) on Pulse, Symptoms, and Treatments of Blood Bi and Xu Lao Diseases, along with the composition of the formula "Da Huang Zhe Chong Wan Formula: Da Huang (Rhubarb) 10 parts (steamed), Huang Qin (Scutellaria Root) 2 liang, Gan Cao (Licorice Root) 3 liang, Tao Ren (Peach Seed) 1 sheng, Xing Ren (Apricot Seed) 1 sheng, Bai Shao (White Peony Root) 4 liang, Gan Di Huang (Prepared Rehmannia Root) 10 liang, Gan Qi (Dried Lacquer) 1 liang, Meng Chong (Blue Bottle Fly Larva) 1 sheng, Shui Zhi (Leech) 100 pieces, Qi Luo (Ground Beetle Larva) 1 sheng, Zhe Chong (Ground Beetle) 0.5 sheng", I could not understand it for a long time. Why does the section mention "tonifying deficiency" when there are no herbs specifically for tonifying deficiency? Upon reading annotations by some physicians, I became even more confused, feeling as if falling into an abyss. Cheng Lin's *Jin Gui Yao Lue Zhi Jie* (Direct Explanation of Jin Gui Yao Lue): "This passage refers solely to internal dry blood. People may suffer from internal injury to righteous Qi due to seven emotions, diet, or sexual excess, causing blood vessels to coagulate and accumulate, resulting in dry blood accumulating internally while deficiency and emaciation appear externally. Blood accumulation cannot moisten the skin, hence rough skin resembling fish scales; it cannot nourish the eyes, hence dark eyes. Using Da Huang Zhe Chong Wan to purge the dry blood, once the dry blood is removed, evil is eliminated and righteous Qi flourishes, thus it is called 'relaxing the middle and tonifying deficiency'. It does not mean Da Huang Zhe Chong Wan itself directly relaxes the middle and tonifies deficiency." You Zaijing's *Jin Gui Yao Lue Xin Dian* (New Canon of Jin Gui Yao Lue): "Xu Lao (Deficiency Fatigue) syndromes may have external pathogens mixed in, such as the aforementioned 'hundred illnesses caused by wind qi'. They may also have stasis and depression mixed in, which is what is meant by 'five types of fatigue and various injuries, with internal dry blood'. If wind qi is not removed, it will harm righteous Qi and hinder growth and flourishing; if dry blood is not removed, it will retain new blood and hinder proper circulation, so removing it should not be delayed. This formula uses moistening to nourish dryness, insects to move stasis, and unblocking to remove closure, while still using Di Huang (Rehmannia Root), Bai Shao (White Peony Root), and Gan Cao (Licorice Root) to harmonize and nourish deficiency. It attacks blood without focusing solely on blood, just as Shuyu Wan (Asaretus Pill) removes wind without focusing solely on wind. Yu Jiayan said: This is the excellent treatment for the secularly known 'Dry Blood Labor'. When blood is stasis internally and pulses of hands and feet are discordant, this is suitable; combining it with Qiongyu Gao (Jade Elixir Paste) for moistening and tonifying is especially wonderful." Zhang Luzhu's *Zhang Shi Yi Tong* (Zhang's Medical Secrets): "The world generally considers Shen (Ginseng), Qi (Astragalus), Dang Gui (Angelica Sinensis), and Di Huang (Rehmannia) as tonifying deficiency, but Zhong Jing (Zhang Zhongjing) uniquely uses Da Huang (Rhubarb) and Zhe Chong (Ground Beetle) to tonify deficiency. Only a sage could practice this method. Five labors and seven injuries often stem from irregular labor, causing Qi and Blood stagnation, depression generating heat, and injuring Yin, which is the secularly known 'Dry Blood Labor'. Therefore, Zhong Jing, taking advantage of the fact that Yuan Qi has not yet dissipated, first uses Da Huang, Zhe Chong, Shui Zhi, Meng Chong, Qi Luo, etc., creeping creatures that feed on blood; assisted by Gan Qi, Sheng Di Huang (Raw Rehmannia Root), Tao Ren, and Xing Ren to move and eliminate blood, slightly combining Gan Cao and Bai Shao to relax the middle and tonify deficiency; Huang Qin (Scutellaria Root) to open up heat and stasis, taken with wine to promote the action of the medicine, waiting until blood flow is complete before purely practicing relaxing the middle and tonifying deficiency to conclude." Even worse, some call "Da Huang Zhe Chong Wan" a formula for tonifying deficiency and activating blood resolving stasis, such as Li Keguang's edited *Jin Gui Yao Lue Jiang Yi* (Lecture Notes on Jin Gui Yao Lue) stating "Da Huang Zhe Chong Wan is a formula for tonifying deficiency and activating blood resolving stasis." It was only when I read *Jin Gui Shi Yi* (Explanation of Jin Gui) published by Jiangsu Provincial Traditional Chinese Medicine School, saying "Da Huang Zhe Chong Wan's removal of stasis and breaking of accumulation truly has the effect of relaxing the middle and tonifying deficiency for Xu Lao Dry Blood Syndrome," that I finally gained insight. This so-called "relaxing the middle and tonifying deficiency" is a grand principle, not the meaning that Da Huang Zhe Chong Wan is merely a formula for tonifying deficiency and activating blood resolving stasis.
I once treated patient Du XX, female, 72 years old. Insomnia and poor memory, palpitations and fright for 5-6 years. Worsened gradually over the past two years. Often unable to fall asleep for 1-2 hours day and night, accompanied by dizziness and head distension, tinnitus and brain buzzing, emaciation, difficulty eating, mental fatigue and reluctance to move, sallow complexion, and weak voice. Doctors treated her with Guipi Tang (Restore the Spleen Decoction), Jianzhong Tang (Establish the Middle Decoction), Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction), Tianwang Buxin Dan (Emperor of Heaven's Heart-Nourishing Pill), Guilu Erxian Wan (Tortoise and Deer Two Immortals Pill), etc., but all symptoms worsened. Invited me for consultation. Examining her, besides the above symptoms, she also had epigastric fullness and pain, worsening after eating, and increasing upon pressure. Tongue coating was yellow and white, pulse was wiry, fine, and choppy. Thinking about it, this syndrome has great deficiency of Qi, Blood, Yin, and Yang as the root, and Cold-Excess obstructing the middle as the branch. The treatment should follow the principle in *Jin Gui*: "When a chronic disease is complicated by an acute disease, treat the acute disease first, then treat the chronic disease." Prescription: Zhi Shi (Immature Bitter Orange) 10g, Hou Po (Magnolia Bark) 10g, Da Huang (Rhubarb) 4g, Gan Jiang (Dried Ginger) 4g, Cao Guo (Black Cardamom) 10g, Chen Pi (Tangerine Peel) 10g, Mu Xiang (Costus Root) 10g.
After 2 doses, epigastric distension and pain improved, and diet intake slightly increased. However, dizziness, tinnitus, insomnia, fatigue, palpitations, and irritability became more severe. Thinking: Previous formulas for tonification increased epigastric fullness and pain; formulas for purging left righteous Qi too deficient to support. A difficult case. Then I recalled that in the Xu Lao chapter of *Jin Gui Yao Lue*, Zhong Jing used the method of "relaxing the middle and tonifying deficiency" (i.e., slowly eliminating excess thereby implying tonifying deficiency). Why not use this method to slowly attack and gently dispel evil? Thus, I prescribed: Zhi Shi 1g, Hou Po 1g, Da Huang 0.2g, Cao Guo 1g, Chen Pi 1g, Mu Xiang 1g.
After 2 doses, epigastric pain greatly reduced, and spirit doubled. Continuing this medication for 1 month, most symptoms disappeared by 60-70%.
Patient Song XX, female, 56 years old.
Skin itching, scratching resulted in linear and block-like elevations. Exposure to slight damp-cold air caused large patches of papules to rise for decades. Diagnosed with Urticaria. Treated with Western medicines for several years with no effect. Later treated with thousands of doses of Chinese medicines for nourishing blood and activating blood, tonifying Qi and warming Yang, as well as secret recipes and empirical prescriptions, all without merit. Carefully examining tongue and pulse: Skin scratch test positive, color of elevated skin unchanged, tongue coating thin and white, pulse wiry, tight, and slightly slow. Integrating pulse and symptoms, thinking: This is caused by Cold-Dampness Wind Pathogen. Treatment should dispel Wind, scatter Cold, and drain Dampness. Prescription: Qiang Huo (Notopterygium Rhizome) 10g, Fang Feng (Saposhnikovia Root) 10g, Jing Jie (Schizonepeta Spike) 10g, Hou Po (Magnolia Bark) 10g, Dang Shen (Codonopsis Root) 10g, Jiang Can (Bombyx Batryticatus) 10g, Chan Tui (Cicada Slough) 10g, Huo Xiang (Patchouli Herb) 10g, Qing Cha (Green Tea) 1 pinch, Chuan Xiong (Ligusticum Rhizome) 10g, Chen Pi (Tangerine Peel) 10g, Gan Cao (Licorice Root) 10g, Fu Ling (Poria) 10g.
After 2 doses, whole-body itching intensified, with widespread patchy rash elevations everywhere. Thinking: The prescription matches the syndrome, why did symptoms worsen? Long-standing illness leads to great deficiency of righteous Qi. Deficiency cannot withstand aggressive purging, hence the disease worsens. Should follow the method of "relaxing the middle and tonifying deficiency," which implies supporting righteous Qi and tonifying deficiency while slowly dispelling evil. Prescription:
Qiang Huo 1g, Fang Feng 1g, Jing Jie 1g, Chuan Xiong 1g, Hou Po 1g, Dang Shen 1g, Fu Ling 1g, Chen Pi 1g, Gan Cao 1g, Chan Tui 1g, Jiang Can 1g, Huo Xiang 1g, Qing Cha 2 slices.
After 2 doses, rashes significantly reduced, and itching decreased by nearly 80%. Continuing for 15 doses, all symptoms disappeared, cured.
Shaoyang Belongs to the Kidney, the Kidney Connects Upward to the Lung, Thus Governing Two Organs
When teaching the passage "Shaoyang belongs to the Kidney, the Kidney connects upward to the Lung, thus governing two organs" from *Ling Shu · Ben Shu* (Spiritual Pivot · Original Acupoints) in *Nei Jing* (Inner Canon), I often encounter two opinions among physicians. The first opinion states that "Shaoyang" in "Shaoyang belongs to the Kidney" refers to Shaoyang, annotated as: "Shaoyang is the San Jiao (Triple Burner)." For example, Zhang Jingyue's *Lei Jing* (Classified Classic) says: "Shaoyang is the San Jiao. The main meridian of the San Jiao points heavenward, dispersing in the chest, while the Kidney meridian also connects upward to the Lung. The lower Shu point of the San Jiao belongs to the Bladder, and the Bladder is the interior-exterior pair of the Kidney, thus the San Jiao also belongs to the Kidney. However, the San Jiao is the Fu Organ of mid-level channels, and the Bladder is the Fu Organ of fluids. The Kidney, as a Water Zang Organ, governs the Water Fu Organ, which is logical, thus the Kidney can simultaneously govern two organs... 'Mid-level channels' means like rivers and ditches, sources and flows all emerge from within, i.e., water and grain enter the mouth and exit via excretion, passing through the San Jiao from top to bottom, thus it is called the Fu Organ of mid-level channels, and water passages emerge from it. The Bladder receives water from the San Jiao and serves as its drainage pathway; Qi naturally relies on each other, and their forms are of the same category, thus the lower Shu point of the San Jiao emerges at Weiyang, joining the main line of Taiyang to connect to the Bladder and constrain the Lower Jiao. Among the twelve Zang-Fu organs, only the San Jiao is uniquely large, with no other organ matching it, hence named the 'Lonely Fu Organ'... Although the San Jiao is the Fu Organ of water channels, it actually protects all Yang Qi and is also called Ministerial Fire, making it the Fire Fu Organ within water. Thus, in this chapter, it says the San Jiao belongs to the Bladder; in the Blood-Qi-Form-Meridian chapter, it says Shaoyang and Pericardium are exterior-interior pairs. Essentially, the part below is Yin, belonging to the Bladder and combining with Kidney Water; the part above is Yang, combining with Pericardium and connecting to Heart Fire. This is why the San Jiao spans from top to bottom, mirroring the Six Directions, encompassing everything. Observing the distinctions of the six Fu organs in this chapter is very clear, as they all have storage capacity, hence named Fu. The San Jiao is called the Fu Organ of mid-level channels and the Lonely Fu Organ, clearly having one Fu organ, which is essentially outside the Zang-Fu organs, inside the body, encompassing all organs, a large Fu organ of one cavity, hence the name 'Lonely due to mid-level channels' and also the form of a large Fu organ." Ma Shi said: "Hand-Shaoyang San Jiao belongs to the right Kidney, and the Kidney again connects upward to the Lung. The Meridian Chapter of this classic states: The Kidney meridian passes from the Kidney upward through the Liver and Diaphragm, entering the Lung, which is exactly the Kidney connecting upward to the Lung. Thus, the left Kidney combines with the Bladder, the right Kidney combines with the San Jiao, and these two organs must both be primarily governed by the Kidney. However, this San Jiao is the Fu Organ of mid-level channels, the source of water passages. *Su Wen · Ling Lan Mi Dian Lun* says: The San Jiao is the Official of Drainage; water passages emerge from it. Precisely because the Lower Jiao is like a ditch, and here there is a way to gather and drain it, hence called the Official of Drainage. Also called the Fu Organ of mid-level channels. That Bladder combines with the left Kidney, just as this San Jiao combines with the right Kidney. Although San Jiao is similar to Bladder, actually Bladder and Kidney are exterior-interior pairs, while San Jiao is not exterior-interior with Kidney, but with Hand-Jueyin Pericardium Meridian, how else could it be the lonely Fu organ? From the above, the combinations of the six Fu organs are roughly like this." Zhang Zhicong said: "Shaoyang is the San Jiao. *Shu Re Xue Lun* says: The Kidney is Extreme Yin; Extreme Yin stores water. The Lung is Taiyin; Shaoyin is the Winter pulse. Thus, its root is in the Kidney, its end is in the Lung, both storing water. One Kidney pairs with Shaoyang and governs Fire, one Kidney connects upward to the Lung and governs Water, thus the Kidney governs two organs. The San Jiao meridian emerges from the middle Stomach, enters and connects to the Bladder, constrains the Lower Jiao and governs drainage, thus is the Fu Organ of mid-level channels, water passages emerge from it, and it belongs inferiorly to the Bladder. The San Jiao is the Qi of Shaoyang, the generated Yang within water. The Ministerial Fire of Hand-Jueyin Pericardium emerges from the right Kidney, returns to the Pericardium below the heart to form one Zang organ, and the San Jiao is its Fu organ. Thus, the two Kidneys take the Bladder as their Fu organ, the San Jiao returns to the middle, and the Stomach is the Fu organ of the Pericardium, hence it is the lonely Fu organ. The two Kidneys govern the Water of Heavenly One and the Fire of Earthly Two; discussed separately, they are like the Two Powers (Yin and Yang), thus Shaoyang belongs to the Kidney, the Kidney connects upward to the Lung forming two organs. Discussed together, Yin and Yang interpenetrate, Water and Fire interact, both governing essence storage and serving as the source of vital Qi, thus both take the Bladder as their Fu organ, the San Jiao connects superiorly to the Pericardium, hence it is the lonely Fu organ. Furthermore, the San Jiao is the Qi of Shaoyang, originating from the Kidney, moving up and down, communicating through the interstices, it is formless Qi. The Upper Jiao exits the upper opening of the Stomach, the Middle Jiao also runs alongside the Stomach, the Lower Jiao separates from the ileum, these are the destinations of the San Jiao. Thus, the Ping Mai chapter says: If the San Jiao does not return to its sector, if the Upper Jiao does not return, there is belching and acid regurgitation; if the Middle Jiao does not return, it cannot digest grains and draw in food; if the Lower Jiao does not return, there is urinary incontinence. Thus, the Qi of the San Jiao is born in the Kidney and returns to the area of the Middle Jiao. The place where this classic discusses the emergence of the San Jiao is the same as the destination sectors in the Ping Mai chapter. Being originally formless Qi, it can move in and out, returning to formed sectors, thus becoming one Fu organ with meridians and acupoints. The Qi of Hand-Jueyin Pericardium is the Yin Fire of Earthly Two, originating from the Kidney and returning to the Pericardium. The Pericardium is exactly below the heart, wrapping the blood generated by the Heart Master, acting as the Minister to the Sovereign,代行 blood movement in the vessels on behalf of the Sovereign. Its Qi originates from the Kidney. The formed Pericardium below the heart is also a destination. Thus, discussing from the perspective of Prenatal Qi, Shaoyang belongs to the Kidney, and the Kidney governs two organs. Discussing from the perspective of Postnatal formed Zang-Fu organs, the Pericardium is exactly below the heart, the San Jiao is between the middle Stomach, forming one Zang and one Fu organ."
The second opinion states that the character "Shaoyang" in "Shaoyang belongs to the Kidney, the Kidney connects upward to the Lung, thus governing two organs" is a mistake for "Shaoyin". As stated in *Jia Yi Jing*: "Shaoyin belongs to the Kidney, connects upward to the Lung." And in *Huang Di Nei Jing Tai Su*: "Shaoyin belongs to the Kidney, the Kidney connects upward to the Lung, thus governing two organs." Annotated as: "Foot-Shaoyin meridian passes through the Liver and enters the Lung, hence called connecting upward. The Kidney receives Lung Qi, the Kidney becomes two, thus governing two organs. *Nan Jing* Chapter 81 says: There are also six Zang organs among the five, meaning the Kidney has two organs." Jia Dedao's *Selected Compilation of Huang Di Nei Jing* believes: "*Jia Yi* writing Shaoyin belongs to the Kidney, connects upward to the Lung seems more appropriate." Cheng Shide's edited *Nei Jing Lecture Notes* further changed "Shaoyang belongs to the Kidney" to "Shaoyin belongs to the Kidney", explicitly stating: "Shaoyin was originally mistakenly written as Shaoyang, now corrected according to *Tai Su*." And annotated: "'Jiang' means to command or govern. This says the Shaoyin meridian belongs to the Kidney. From the perspective of Zang-Fu pairing, the Kidney pairs with the Bladder, and also connects upward to the Lung, thus it is said to govern two organs. *Su Wen · Shui Re Xue Lun* says: Shaoyin is the Winter pulse, thus its root is in the Kidney, its end is in the Lung."
Which of the two opinions is correct? Which is erroneous? I pondered for a long time without resolution. Because if following the views of Cheng Shide and Jia Dedao, although it explains that Shaoyin governing two organs refers to the Kidney and Lung, it cannot explain why, after mentioning pairing in the original text, the sentence "Shaoyin belongs to the Kidney, the Kidney connects upward to the Lung, thus governing two organs" appears immediately, followed by the supplementation "San Jiao is the Fu Organ of mid-level channels, water passages emerge from it, belongs to the Bladder, is the Lonely Fu Organ, is what the six Fu organs combine with." Furthermore, it is hard to explain why, when treating diseases caused by Water and Fluid retention obstruction, one must not only treat the Lung, Kidney, and Bladder, but also simultaneously consider the San Jiao and the ascending nature of Shaoyang; otherwise, the desired effect is hard to achieve. This phenomenon is especially common in difficult Water and Fluid diseases. If following Yang Shangshan's view in *Huang Di Nei Jing Tai Su*, although it explains that Shaoyin refers to the two Kidneys, it cannot explain that *Nei Jing* does not speak of two Kidneys, nor can it explain why clinically, when treating Water and Fluid diseases, one must not only treat the Lung and Kidney but also must consider the San Jiao; otherwise, the desired efficacy is hard to achieve. If following Zhang Jingyue's annotation in *Lei Jing* that "Shaoyin is Shaoyang, Shaoyang is San Jiao, San Jiao can protect all Yang Qi, encompass all organs, not only connecting upward to the Lung but also downward to the Kidney and Bladder," this explanation not only clarifies the sequential meaning of the original text in *Ling Shu · Ben Shu*, but also explains the laws that must be followed in clinical treatment of Water-Fluid diseases. According to the scientific conclusion that practice is the criterion for testing truth, Zhang Jingyue's annotation should be correct. As for Ma Shi's annotation "Left Kidney combines with Bladder, Right Kidney combines with San Jiao, and these two organs must both be primarily governed by the Kidney," the Left/Right Kidney theory somewhat contradicts the meaning of *Nei Jing*, but his statement that Shaoyang is San Jiao is consistent with Zhang Jingyue's view.
I once treated patient Bian XX, female, 26 years old. Cough with slight wheezing for over 7 months. Diagnosed with Bronchitis at a certain hospital. First treated with antibiotics, Chinese medicines for stopping cough and resolving phlegm, and diffusing Lung and calming wheezing agents with no effect. Invited me for consultation. Inquired about cough and slight wheezing, paroxysmal exacerbation, especially severe when lying flat at night, bitter and dry taste in mouth. Thinking: Exacerbation when lying flat at night indicates Phlegm-Fluid retention in the Lung. Treatment should diffuse Lung and transform Fluid. Xiao Qing Long Tang (Minor Blue Dragon Decoction) modified. Prescription: Ma Huang (Ephedra Stem) 6g, Gan Jiang (Dried Ginger) 6g, Gui Zhi (Cinnamon Twig) 6g, Bai Shao (White Peony Root) 6g, Gan Cao (Licorice Root) 6g, Xi Xin (Asarum Root) 3g, Ban Xia (Pinellia Tuber) 6g, Wu Wei Zi (Schisandra Fruit) 6g. After 4 doses, no effect seen. Further checking, the pulse was wiry and slightly choppy. Thinking: The course of disease has been long; it is not only a Lung disease but also involves the Kidney. Treating only the Lung cannot lead to cure. Further inquiry revealed that during severe cough, there was also soreness and pain in the lower back. Moreover, *Ling Shu · Ben Shu* says: "Shaoyang belongs to the Kidney, the Kidney connects upward to the Lung, thus governing two organs. San Jiao is the Fu Organ of mid-level channels, water passages emerge from it, belongs to the Bladder, is the Lonely Fu Organ, is what the six Fu organs combine with." Therefore, I planned to transform Fluid and stop cough, while assisting with regulating the San Jiao, and combining methods to astringe the Lung and Kidney. Prescription: Chai Hu (Bupleurum Root) 10g, Ban Xia (Pinellia Tuber) 10g, Huang Qin (Scutellaria Root) 10g, Gan Jiang (Dried Ginger) 3g, Wu Wei Zi (Schisandra Fruit) 10g, Si Gua Luo (Luffa Fruit Fiber) 10g, Zi Wan (Aster Root) 10g. After 2 doses, cough greatly reduced. Continuing for 4 doses, all symptoms disappeared, cured.