膜以达膀胱故三焦者决渎之府水道出焉曰孤府者谓五藏各配一府而三焦司肾之决渎独成一府故此云气行于府留于四藏也
气口即寸口脉口手太阴经脉内经与结喉两旁人迎对举张注已详别见扁仓传补注中权衡不差累黍故曰平气口无长短太过不
及故曰成寸
饮入于胃游溢精气上输于脾
王冰曰水饮流下至于中焦水化精微上为云雾云雾散变乃注于脾灵枢经上焦如雾中焦如沤此之谓也吴昆曰游流行也溢
涌溢也灵枢所谓中焦如沤是也精气饮之精气也输转输传运之名也张志聪曰入胃之饮精气上输于脾脾气散精上归于肺盖脾
主为胃行其津液者也肺应天而主气故能通调水道而下输膀胱所谓地气升而为云天气降而为雨也马莳曰所食之谷其精微气
游溢升腾上输于脾张介宾曰游浮游也溢涌溢也水饮入胃则其气化精微必先输运于脾是谓中焦如沤也骥案以上言食食本于
地阴主化血之物以下言饮饮本于天阳主化气之物气乃水之所化凡饮水皆属化气之物礼经饮以养阳食以养阴是也饮主汤液
醪醴言食统五谷五菜五果五肉言
脾气散精上归于肺通调水道下输膀胱
王冰曰水土合化上滋肺金金气通肾故调水道转注下焦膀胱禀化乃为溲矣灵枢经下焦如渎此之谓也吴昆曰脾虽具坤静
之德而有干健之运既得水谷精气则散而升之上归于肺灵枢所谓上焦如雾是也肺虽为清虚之藏而有治节之司主行营卫通阴
阳故能通调水道下输膀胱灵枢所谓下焦如渎是也马莳曰脾附于胃之右比胃为上故脾气散精上归于肺而肺行百脉通调水道
下输膀胱张介宾曰脾乃散气上如云雾而归于肺是谓上焦如雾也肺气营运水随而注故肺能通调水道下输膀胱是谓水出高原
下焦如渎也骥案五藏相使篇三焦者决渎之官水道出焉水道注见上行气于府条
水精四布五经并行合于四时五藏阴阳揆度以为常也
王冰曰从是水精布经气行筋骨成血气顺配合四时寒暑证符五藏阴阳揆度盈虚用为常道度量也以用也新校正云按一本
云阴阳动静吴昆曰夫既上升下降由是水谷之精四散而布五经之气一机流行合于四时寒暑符于五藏阴阳揆度于造化盈虚则
为常道也张志聪曰水精四布者气化则水行故四布于皮毛五经并行者通灌于五藏之经脉也平脉篇谷入于胃脉道乃行水入于
经而血乃成故先论食而后论其饮焉五藏五行之气也揆度度数也总结上文而言经脉之道合于四时五行之次序阴阳出入之度
数以为经脉之常马莳曰水精分布于四藏五藏并行乎水精真有合于四时五藏及古经阴阳揆度等篇之常义也按饮入于胃以下
乃言饮而不言食李东垣脾胃论朱丹溪纂要书不考上文为食乃改为饮食入胃则于下输膀胱水精四布之义大背矣殊不知上文
之食含有饮义而下文之饮必难以兼食也何诸医书皆宗李朱而不考经旨者皆缪矣张介宾曰水因气生气为水母凡肺气所及则
水精布焉然水名虽一而清浊有厘清者为精清如雨露浊者为水水如江河故精归五藏水归膀胱而五经并行矣五经五藏之经络
也若是则食饮精气皆得其滋养升降之宜故四时五藏皆合阴阳揆度以为常也
素问评热病论岐伯曰人所以汗出者皆生于谷谷生于精
王冰曰言谷气化为精精气胜乃为汗吴昆曰言谷气变化为阴精泄之于表为汗出耳张志聪曰汗生于水谷之精水谷之精由
精气之所化故曰谷生于精夫汗之发源有二一出于水谷之精一出于肾藏之精而曰皆生于谷者言肾藏之精亦水谷之所生也马
莳曰精气盛而谷气消谷气消而汗能自出张介宾曰谷气内盛则生精精气外达则为汗骥案灵枢痈疽篇肠胃受谷上焦出气以温
分肉而养骨节通腠理通腠理即汗出也然谷有五五味篇谷味酸先走肝谷味苦先走心谷味甘先走脾谷味辛先走肺谷味咸先走
肾谷有五味五味走五藏五藏生五汁经脉别论饮食饱甚汗出于胃惊而夺精汗出于心持重远行汗出于肾疾走恐惧汗出于肝摇
体劳苦汗出于脾精五谷之精气又凿也对物之粗者言论语食不厌精离骚精琼靡以为 均训凿张注水谷之精其说为长金匮真
言论东方味酸其谷麦生肝南方味苦其谷黍生心中央味甘其谷稷生脾西方味辛其谷稻生肺北方味咸其谷豆生肾
今邪气交争于骨肉而得汗者是邪却而精胜也
王冰曰言初汗也吴昆曰若果是精胜邪却则当能食不复发热张志聪曰交争于骨肉者邪气伏匿于骨肉之间至春时与正气
交争而发为温病得汗是精气胜而邪当共并而出矣倪冲之曰胃主肉肾主骨谷精之汗出于胃血液之汗原于肾邪在肉者得水谷
之汗而解邪在骨者得肾精之汗而后解马莳曰邪气交争而得汗是邪却而精胜也
精胜则当能食而不复热复热者邪气也汗者精气也今汗出而辄复热者是邪胜也不能食者精无俾也
王冰曰无俾言无可使为汗也谷不化则精不生精不化流故无可使吴昆曰俾使也精衰无以役使运化故不能食马莳曰是精
气不能使之食也所以其寿可倾也张介宾曰惟精胜邪所以能汗邪从汗散则当能食不复热矣俾使也精阴气也五藏所以藏精藏
气虚则不能使人饮食故曰精无俾也
病而留者其寿可立而倾也
王冰曰如是者若汗出疾速留着而不去则其人寿命立至倾危也新校正云详病而留者按王注病当作疾又按甲乙经作热而
留者吴昆曰言病邪留而不去必至损命也张志聪曰此言水谷之精由肾藏精气之所化所谓谷生于精也夫肾为水藏受水谷之精
而藏之其精气上与阳明相合戊癸合而化火火土之气消水谷之精微而复生此精是先后二天互相资生者也今汗出而邪留不去
则热邪复伤其阴精矣精气受伤则不能与阳明合化而使之食是精气之生原并绝其寿命可立而倾也董帷园曰互相生长之道旋
转如环张介宾曰病气留而不退则元气日败必致损命骥案汗出伤精是一死复热邪胜是二死不能食而精无俾俾说文益也是三
死有三死无一生寿命之倾可立而待
素问厥论篇岐伯曰酒入于胃则络脉满而经脉虚脾主为胃行津液者也阴气虚则阳气入阳气入则胃不和胃不和则精气竭
精气竭则不营其四肢也
王冰曰前阴为太阴阳明之所合故胃不和则精气竭也内精不足故四肢无气以营之吴昆曰此言酒之为患络与经不能两实
故络脉满则经脉虚阴五藏之阴阳四肢之阳精气竭阴气竭也营充养也张志聪曰此言热厥之因因伤中焦所生之阴气也灵枢经
饮酒者卫气先行皮肤先充络脉夫胃气者谷之悍气也酒亦水谷悍热之液故从卫气先行于皮肤从皮肤而充于络脉是不从脾气
而行于络脉故络脉满而经脉虚也夫饮入于胃其津液上输于脾脾气散精于肺通调于经脉四布于皮毛是从经脉而行于络脉从
络脉而散于皮肤自内而外也酒入于胃先行于皮肤先充于络脉是从皮肤而入于络脉反从外而内矣不从皮气通调于经脉则阴
气虚矣悍热之气反从外而内则阳气入矣阳明乃燥热之府藉太阴中见之阴化阴气虚而阳热之气入内则胃气不和矣胃不和则
所生之精气竭精气竭则不能营于四肢而为热厥矣马莳曰肾属足少阴者以欲而虚胃属足阳明者以酒而盛阴气虚则阳气入阳
气入则胃气下陷而不和胃不和则脾气亦衰谷气不得化为精微之气而运之以行于四肢矣张介宾曰酒入于胃必归于脾湿热在
脾则脾阴虚阳独亢而胃不和矣脾胃俱病则精气竭故不能营经络四肢骥案衍义引吕氏春秋仪狄造酒战国策帝女仪狄造酒进
之于禹然本草已着酒名素问以酒为浆则自黄帝始非仪狄也医家用惟醪醴义详内经方汤液醪醴篇饮家所用惟取其味罔顾入
药如何陶隐居云大寒凝海惟酒不冰明其性热药家多有以行其势人饮之使体弊神昏是其有毒故也陈藏器云通血脉润皮肤又
云诸米酒有毒灵枢营卫生会篇人饮酒亦入胃酒者熟谷之液也其气悍以清经脉篇诸脉之浮而常见者皆络脉也脉度篇支而横
者为络酒入于胃其气迅疾 悍外而皮肤络脉内而五藏阴阳无所不走其流弊如此
此人必数醉若饱以入房气聚于脾中不得散酒气与谷气相薄热盛于中故热遍于身内热而若赤也夫酒气盛而 悍肾气有
衰阳气独胜故手足为之热也
王冰曰醉饱入房内亡精气中虚热入由是肾衰阳盛阴虚故热主于手足也吴昆曰 悍强暴也肾气
阴气也张志聪曰夫饮酒数醉则悍热之气反从外而内而酒气聚于脾中饱以入房则谷食留于胃中脾气不能转输其精液而谷气
聚于脾中矣气聚于中而不得散酒气与谷气交相侵薄则热盛于中中土之热灌于四旁故热遍于身入胃之饮食不能游溢精气下
输膀胱故内热而溺赤夫肾为水藏受水谷之精而藏之酒气热盛而 悍则肾藏之精气日衰阴气衰于下而阳气独胜于中故手足
为之热张兆璜曰寒厥因失其所藏之阳而致中气日损热厥因伤其所生之阴而致肾气日衰当知中下二焦互相资生者也张应略
曰上古之人饮食有节起居有常不妄作劳今时之人以酒为浆以妄为常醉以入房是人所当调养者阴阳精气耳苟得其养可同归
于生长之门苟失其养则为暴仆卒厥马莳曰醉饱以入房下气上争聚于脾中脾胃既受谷气又受酒气热盛于中故热遍于身自内
形外也其内热以溺赤为验夫酒气本盛而 悍惟肾阴既衰胃阳独胜手足皆为之热者宜也张介宾曰数醉若饱入房者既伤其脾
复伤其肾皆阴虚也故手足为热骥案酒既内外阴阳无所不走又饱以入房轻则致疾重则戕生史记仓公传御史成病痈疽得之酒
且内死山跗病肺消瘅得之内死潘满如病少腹痛得之酒且内死赵章病 风得之酒死司空命妇出于病风入中得之接内济北王
阿母病热厥得之饮酒大醉阳虚候病痹得之内成开方病HT 风得之数
大醉公乘项处病牡疝得之内仓公治验凡二十一案凡得之
酒色者多不治此肾气有衰阳气独盛所谓孤阴不生独阳不长不生不长亡可立待此酒色之所以垂戒万世也
灵枢五癃津液别篇五谷之精液和合而为高者内渗入于骨空补益脑髓而下流于阴股
张志聪曰此言精液之为髓也夫肾主藏精而主骨和合而高者五谷之液与肾藏之精相和合而渗入于骨空上行而高从骨空
而补益脑髓复从髓空而下流阴股此精液淖注于骨而为髓先上益于脑而复下流故曰五谷之精液和合而为高者姚氏曰本经曰
谷入气满淖泽注于骨骨属屈伸补益脑髓是谓液又曰肾者精之处也其华在发其充在骨是谷之液肾之精并注于骨而为髓髓者
以脑为主故曰和合而高者马莳曰高当作膏此原水胀之所成也五谷精液和而成为膏者渗入于骨空之中及补益脑髓以下流于
阴股张介宾曰此津液为精髓也膏脂膏也精液和合为膏以填补于骨空之中则为脑为髓为精为血故上至巅顶得以充实下流阴
股得以交通骥案马注高当作膏素问腹中论热中消中不可服高梁芳草石药禁高梁是不合其心通评虚实论消痹甘肥贵人则高
梁之疾也膏皆作高高膏通用王充论衡五谷之于人也食之皆饱稻梁之味甘而多腴故能和合精液为膏也骨空骨节交会之空隙
处神气之所游行出入者也素问第六十篇内论各证之治法当取刺于骨空故以骨空名篇脑之为状形椭圆正中有沟分为左右两
部色灰白充满于头盖之中下连脊髓为感觉运动之主宰中有汁浆又有脑筋西医之说知脑髓之作用而不知脑髓之来历所谓脑
筋但言其去路而不知髓之来路所以无治髓之药不知背脊一路髓筋是髓入于脑之路内经明言肾藏精精生髓以肾气贯脊而生
脊髓脊髓上循入脑为髓脑是脑非生髓之所乃聚髓之所髓之生既由于肾欲补脑者即从肾治又肝脉入脑交巅目系贯髓凡神魂
晕迷风狂皆从肝治脑气通鼻可从肺治脑筋入心可从心治脑筋聚在胃又可从胃治是五谷之精补五藏五藏之系连于髓而胃尤
为髓筋所聚故为高以补髓也脑髓之义采自吾乡唐氏书中又案经云脑髓骨脉胆女子胞此六者存于阴象于地名奇恒之府是脑
髓骨三者三而一者也肾主骨骨中有髓肾系贯脊通于脊髓肾精足则入脊化髓上循入脑而为脑髓阴股肾之部故流阴股也
灵枢论勇篇黄帝曰怯士之得酒怒不避勇士者何藏使然少俞曰酒者水谷之精熟谷之液也其气 悍其入于胃中则胃胀气
上逆满于胸中肝浮胆横当是之时固比于勇士气衰则悔与勇士同类不知避之名曰酒悖也
朱氏曰此复申明人之勇怯本于气之弱壮气之壮盛由胃府水谷之所生也酒者水谷之精熟谷之液其气 悍故能助气之充
满而使肝胆浮横然酒散则气衰气衰则悔矣故善养乎气者饮食有节起居有常则形气充足暴喜伤阳暴怒伤阴和其喜怒则阴阳
不相失形气壮盛虽遇烈风豪雨无由入其腠理而况四时之虚风乎倪氏曰气之敢勇本于心之端直肝之大坚胆之汁满是气生于
形也气满胸中而使肝浮胆横是形本乎气也形不离乎气气不离乎形此天之性命所以立形定气以观人之寿夭者也高士宗曰怯
士之得酒与勇士同类即虽方大怒肝肺举而气衰复下相同盖因酒因怒以壮其气酒散气衰则复怯矣故无暴其气此善养乎大勇
者也马莳曰酒为水谷之精熟谷之液此语又见营卫生会篇张介宾曰酒为水谷之液血为水谷之精酒入中焦必求同类故先归血
分凡饮酒者身面皆赤即其征也然血属阴而性和酒属阳而气悍血欲静而酒动之血欲藏而酒乱之血无气不行故血乱气亦乱气
散血亦散扰乱一番而血气能无损者未之有也又若人之禀赋藏有阴阳而酒气之质亦有阴阳盖酒成于酿其性则热汁化于水其
质则寒故阳藏得之则愈热阴藏得之则愈寒所以纵酒不节者无论阴阳均为害凡热盛而过饮者阳日胜则阴日消每成风瘅肿胀
膜原之气通达膀胱,所以三焦是决渎之官(疏通水道的脏腑),水道由此而出。称它为“孤府”,是因为五脏各配一个腑,而三焦单独主管肾脏的决渎功能,独自成为一个腑,所以说气行于腑,留滞于四脏。
气口即寸口、脉口,属于手太阴肺经。《内经》中常将其与结喉两侧的人迎穴相对举。张注已详细说明,另见《扁仓传补注》中。只要权衡不差分毫,就称为平气;气口没有过长或过短,就称为成寸。
饮水进入胃中,游溢出的精气向上输送到脾。
王冰说:水饮流下到达中焦,水化为精微,上升如云雾。云雾散变,才注入脾。《灵枢经》说上焦如雾,中焦如沤,说的就是这个道理。吴昆说:游,流行也;溢,涌溢也。《灵枢》所谓中焦如沤,正是此意。精气,指饮中的精气。输,转输、传运的名称。张志聪说:进入胃的饮水,其精气上输于脾,脾气散布精微,上归于肺。大概脾主为胃运行津液。肺应天而主气,所以能通调水道,向下输送到膀胱。这就是所谓地气上升变为云,天气下降变为雨。马莳说:所吃的食物,其精微之气游溢升腾,向上输送到脾。张介宾说:游,浮游也;溢,涌溢也。水饮入胃,则气化精微必先输运于脾,这叫做中焦如沤。骥案:以上讲的是食,食本于地阴,主化血之物;以下讲的是饮,饮本于天阳,主化气之物。气乃水所化,凡是饮水都属于化气之物。《礼经》说饮以养阳,食以养阴,正是这个意思。饮主要指汤液醪醴,言食统括五谷、五菜、五果、五肉。
脾气散布精微,上归于肺,通调水道,向下输送到膀胱。
王冰说:水土合化,上滋肺金。金气通肾,所以调水道,转注下焦膀胱,禀受变化成为小便。《灵枢经》说下焦如渎,说的就是这个道理。吴昆说:脾虽然具备坤静之德,但具有乾健之运。既得到水谷精气,则散布而上升,上归于肺。《灵枢》所谓上焦如雾,正是此意。肺虽然是清虚之脏,但有治节之司,主行营卫,通阴阳,所以能通调水道,向下输送到膀胱。《灵枢》所谓下焦如渎,正是此意。马莳说:脾附在胃的右边,比胃位置高,所以脾气散布精微,上归于肺,而肺行百脉,通调水道,向下输送到膀胱。张介宾说:脾乃散气,上如云雾而归于肺,这叫上焦如雾。肺气营运,水随之注入,所以肺能通调水道,向下输送到膀胱,这叫水出高原,下焦如渎。骥案:《五脏相使篇》说三焦是决渎之官,水道由此而出。水道注见上行气于府条。
水精四布,五经并行,配合四时,五脏阴阳,揆度以为常道。
王冰说:从此水精布散,经气运行,筋骨成血,气顺配合四时寒暑,证候相符,五脏阴阳,揆度盈虚,用为常道。度量,指运用。新校正说:按另一版本作“阴阳动静”。吴昆说:既然上升下降,由此水谷之精四散而布,五经之气一机流行,合于四时寒暑,符于五脏阴阳,揆度于造化盈虚,则为常道。张志聪说:水精四布,是气化则水行,所以四布于皮毛。五经并行,是通灌于五脏之经脉。《平脉篇》说谷入于胃,脉道乃行,水入于经而血乃成,所以先论食而后论饮。五脏是五行之气。揆度,指数数。总结上文而言,经脉之道合于四时五行之次序,阴阳出入之度数,作为经脉之常。马莳说:水精分布于四脏,五脏并行乎水精,真有合于四时五脏及古经阴阳揆度等篇的常义。按从“饮入于胃”以下乃是言饮而不言食,李东垣《脾胃论》、朱丹溪《纂要书》不考上文为食,乃改为“饮食入胃”,则于“下输膀胱,水精四布”之义大背矣。殊不知上文之食含有饮义,而下文之饮必难以兼食也。为何诸医书皆宗李朱而不考经旨者皆谬误呢?张介宾说:水因气生,气为水母。凡肺气所及,则水精布焉。然水名虽一,而清浊有分。清者为精,清如雨露;浊者为水,水如江河。故精归五脏,水归膀胱,而五经并行。五经即五脏之经络。若是则食饮精气皆得其滋养升降之宜,故四时五脏皆合阴阳揆度以为常。
《素问·评热病论》岐伯说:人之所以汗出,都生于谷,谷生于精。
王冰说:言谷气化为精,精气胜乃为汗。吴昆说:言谷气变化为阴精,泄之于表为汗出耳。张志聪说:汗生于水谷之精,水谷之精由精气之所化,所以说谷生于精。夫汗的发源有二:一出于水谷之精,一出于肾藏之精。而说“皆生于谷”,是说肾藏之精亦由水谷所生。马莳说:精气盛而谷气消,谷气消而汗能自出。张介宾说:谷气内盛则生精,精气外达则为汗。骥案:《灵枢·痈疽篇》说肠胃受谷,上焦出气以温分肉而养骨节,通腠理。通腠理即汗出。然而谷有五味,《五味篇》说谷味酸先走肝,谷味苦先走心,谷味甘先走脾,谷味辛先走肺,谷味咸先走肾。谷有五味,五味走五脏,五脏生五汁。《经脉别论》说饮食饱甚,汗出于胃;惊而夺精,汗出于心;持重远行,汗出于肾;疾走恐惧,汗出于肝;摇体劳苦,汗出于脾。精是五谷之精气,又凿对物之粗者而言。《论语》“食不厌精”,《离骚》“精琼靡以为粻”,均训为凿。张注认为水谷之精的说法更合理。《金匮真言论》说东方味酸,其谷麦,生肝;南方味苦,其谷黍,生心;中央味甘,其谷稷,生脾;西方味辛,其谷稻,生肺;北方味咸,其谷豆,生肾。
如今邪气交争于骨肉,而得汗的是邪却而精胜。
王冰说:言初汗。吴昆说:若果是精胜邪却,则当能食,不复发热。张志聪说:交争于骨肉者,邪气伏匿于骨肉之间,至春时与正气交争而发为温病。得汗是精气胜而邪当共并而出。倪冲之说:胃主肉,肾主骨。谷精之汗出于胃,血液之汗原于肾。邪在肉者得水谷之汗而解,邪在骨者得肾精之汗而后解。马莳说:邪气交争而得汗,是邪却而精胜。
精胜则当能食而不复热。复热者,邪气也;汗者,精气也。今汗出而辄复热,是邪胜也。不能食者,精无俾也。
王冰说:无俾,言无可使为汗也。谷不化则精不生,精不化流,故无可使。吴昆说:俾,使也。精衰无以役使运化,故不能食。马莳说:是精气不能使之食也,所以其寿可倾。张介宾说:惟精胜邪,所以能汗。邪从汗散,则当能食,不复热。俾,使也。精,阴气也。五脏所以藏精,脏气虚则不能使人饮食,故曰精无俾。
病而留者,其寿可立而倾也。
王冰说:如是者,若汗出疾速留着而不去,则其人寿命立至倾危。新校正说:详“病而留者”,按王注“病”当作“疾”。又按《甲乙经》作“热而留者”。吴昆说:言病邪留而不去,必至损命。张志聪说:此言水谷之精由肾藏精气之所化,所谓谷生于精。夫肾为水藏,受水谷之精而藏之,其精气上与阳明相合,戊癸合而化火,火土之气消水谷之精微而复生,此精是先后二天互相资生者也。今汗出而邪留不去,则热邪复伤其阴精。精气受伤,则不能与阳明合化而使之食,是精气之生原并绝,其寿命可立而倾。董帷园说:互相生长之道旋转如环。张介宾说:病气留而不退,则元气日败,必致损命。骥案:汗出伤精是一死,复热邪胜是二死,不能食而精无俾,“俾”《说文》益也,是三死。有三死无一生,寿命之倾可立而待。
《素问·厥论篇》岐伯说:酒入于胃,则络脉满而经脉虚。脾主为胃行津液者也。阴气虚则阳气入,阳气入则胃不和,胃不和则精气竭,精气竭则不营其四肢也。
王冰说:前阴为太阴阳明之所合,故胃不和则精气竭也。内精不足,故四肢无气以营之。吴昆说:此言酒之为患,络与经不能两实,故络脉满则经脉虚。阴,五脏之阴阳;四肢之阳。精气竭,阴气竭也。营,充养也。张志聪说:此言热厥之因,因伤中焦所生之阴气。《灵枢经》饮酒者,卫气先行皮肤,先充络脉。夫胃气者,谷之悍气也。酒亦水谷悍热之液,故从卫气先行于皮肤,从皮肤而充于络脉,是不从脾气而行于络脉,故络脉满而经脉虚。夫饮入于胃,其津液上输于脾,脾气散精于肺,通调于经脉,四布于皮毛,是从经脉而行于络脉,从络脉而散于皮肤,自内而外。酒入于胃,先行于皮肤,先充于络脉,是从皮肤而入于络脉,反从外而内。不从脾气通调于经脉,则阴气虚。悍热之气反从外而内,则阳气入。阳明乃燥热之府,藉太阴中见之阴化。阴气虚而阳热之气入内,则胃气不和。胃不和则所生之精气竭,精气竭则不能营于四肢而为热厥。马莳说:肾属足少阴者,以欲而虚;胃属足阳明者,以酒而盛。阴气虚则阳气入,阳气入则胃气下陷而不和。胃不和则脾气亦衰,谷气不得化为精微之气而运之以行于四肢。张介宾说:酒入于胃,必归于脾。湿热在脾,则脾阴虚阳独亢而胃不和。脾胃俱病,则精气竭,故不能营经络四肢。骥案:《衍义》引《吕氏春秋》仪狄造酒,《战国策》帝女仪狄造酒进之于禹。然本草已著酒名,《素问》以酒为浆,则自黄帝始,非仪狄也。医家用惟醪醴义,详《内经·方汤液醪醴篇》。饮家所用惟取其味,罔顾入药如何。陶隐居云:“大寒凝海,惟酒不冰”,明其性热。药家多有以行其势,人饮之使体弊神昏,是其有毒故也。陈藏器云:“通血脉,润皮肤”,又云:“诸米酒有毒”。《灵枢·营卫生会篇》说人饮酒亦入胃,酒者熟谷之液也,其气悍以清。《经脉篇》说诸脉之浮而常见者皆络脉。《脉度篇》说支而横者为络。酒入于胃,其气迅疾悍,外而皮肤络脉,内而五脏阴阳无所不走,其流弊如此。
此人必数醉若饱以入房,气聚于脾中不得散,酒气与谷气相薄,热盛于中,故热遍于身,内热而溺赤。夫酒气盛而 悍,肾气有衰,阳气独胜,故手足为之热。
王冰说:醉饱入房,内亡精气,中虚热入,由是肾衰阳盛阴虚,故热主于手足。吴昆说: 悍,强暴也。肾气,阴气。张志聪说:夫饮酒数醉,则悍热之气反从外而内,而酒气聚于脾中。饱以入房,则谷食留于胃中,脾气不能转输其精液,而谷气聚于脾中。气聚于中而不得散,酒气与谷气交相侵薄,则热盛于中。中土之热灌于四旁,故热遍于身。入胃之饮食不能游溢精气,下输膀胱,故内热而溺赤。夫肾为水藏,受水谷之精而藏之。酒气热盛而 悍,则肾藏之精气日衰。阴气衰于下而阳气独胜于中,故手足为之热。张兆璜说:寒厥因失其所藏之阳而致中气日损,热厥因伤其所生之阴而致肾气日衰。当知中下二焦互相资生。张应略说:上古之人饮食有节,起居有常,不妄作劳。今时之人以酒为浆,以妄为常,醉以入房。是人所当调养者,阴阳精气耳。苟得其养,可同归于生长之门;苟失其养,则为暴仆卒厥。马莳说:醉饱以入房,下气上争,聚于脾中。脾胃既受谷气,又受酒气,热盛于中,故热遍于身,自内形外。其内热以溺赤为验。夫酒气本盛而 悍,惟肾阴既衰,胃阳独胜,手足皆为之热,宜也。张介宾说:数醉若饱入房,者既伤其脾,复伤其肾,皆阴虚也,故手足为热。骥案:酒既内外阴阳无所不走,又饱以入房,轻则致疾,重则戕生。《史记·仓公传》御史成病痈疽,得之酒且内死;山跗病肺消瘅,得之内死;潘满如病少腹痛,得之酒且内死;赵章病 风,得之酒死;司空命妇出于病风入中,得之接内;济北王阿母病热厥,得之饮酒大醉;阳虚候病痹,得之内成;开方病HT 风,得之数大醉;公乘项处病牡疝,得之内。仓公治验凡二十一案,凡得之酒色者多不治。此肾气有衰,阳气独盛,所谓孤阴不生,独阳不长。不生不长,亡可立待。此酒色之所以垂戒万世。
《灵枢·五癃津液别篇》五谷之精液和合而为高者,内渗入于骨空,补益脑髓,而下流于阴股。
张志聪说:此言精液之为髓。夫肾主藏精而主骨,和合而高者,五谷之液与肾藏之精相和合,而渗入于骨空,上行而高,从骨空而补益脑髓,复从髓空而下流阴股。此精液淖注于骨而为髓,先上益于脑而复下流,故曰五谷之精液和合而为高者。姚氏说:《本经》说谷入气满,淖泽注于骨,骨属屈伸,补益脑髓,是谓液。又说肾者精之处也,其华在发,其充在骨,是谷之液、肾之精并注于骨而为髓。髓者以脑为主,故曰和合而高。马莳说:高当作膏。此原水胀之所成。五谷精液和而成为膏者,渗入于骨空之中,及补益脑髓,以下流于阴股。张介宾说:此津液为精髓。膏脂膏也。精液和合为膏,以填补于骨空之中,则为脑为髓为精为血,故上至巅顶得以充实,下流阴股得以交通。骥案:马注“高”当作“膏”。《素问·腹中论》热中消中不可服高梁芳草石药,禁高梁,是不合其心。《通评虚实论》消痹甘肥贵人则高梁之疾。膏皆作高,高膏通用。王充《论衡》五谷之于人也,食之皆饱,稻梁之味甘而多腴,故能和合精液为膏。骨空,骨节交会之空隙处,神气之所游行出入。《素问》第六十篇内论各证之治法,当取刺于骨空,故以骨空名篇。脑之为状,形椭圆,正中有沟分为左右两部,色灰白,充满于头盖之中,下连脊髓,为感觉运动之主宰。中有汁浆,又有脑筋。西医之说知脑髓之作用,而不知脑髓之来历。所谓脑筋,但言其去路,而不知髓之来路,所以无治髓之药。不知背脊一路髓筋是髓入于脑之路。《内经》明言肾藏精,精生髓,以肾气贯脊而生脊髓,脊髓上循入脑为髓。脑是脑非生髓之所,乃聚髓之所。髓之生既由于肾,欲补脑者即从肾治。又肝脉入脑交巅,目系贯髓,凡神魂晕迷风狂皆从肝治。脑气通鼻可从肺治,脑筋入心可从心治,脑筋聚在胃又可从胃治。是五谷之精补五脏,五脏之系连于髓而胃尤为髓筋所聚,故为高以补髓。脑髓之义采自吾乡唐氏书中。又案经云:脑髓骨脉胆女子胞,此六者存于阴象于地,名奇恒之府。是脑髓骨三者三而一。肾主骨,骨中有髓,肾系贯脊通于脊髓。肾精足则入脊化髓,上循入脑而为脑髓。阴股,肾之部,故流阴股。
《灵枢·论勇篇》黄帝曰:怯士之得酒怒,不避勇士者,何藏使然?少俞曰:酒者,水谷之精,熟谷之液也,其气 悍。其入于胃中则胃胀,气上逆,满于胸中,肝浮胆横。当是之时,固比于勇士,气衰则悔。与勇士同类,不知避之,名曰酒悖。
朱氏说:此复申明人之勇怯本于气之弱壮。气之壮盛由胃府水谷之所生。酒者水谷之精,熟谷之液,其气 悍,故能助气之充满而使肝胆浮横。然酒散则气衰,气衰则悔。故善养乎气者,饮食有节,起居有常,则形气充足。暴喜伤阳,暴怒伤阴,和其喜怒则阴阳不相失。形气壮盛,虽遇烈风豪雨,无由入其腠理,而况四时之虚风。倪氏说:气之敢勇本于心之端直,肝之大坚,胆之汁满是,气生于形。气满胸中而使肝浮胆横,是形本乎气。形不离乎气,气不离乎形,此天之性命,所以立形定气以观人之寿夭。高士宗说:怯士之得酒与勇士同类,即虽方大怒,肝肺举而气衰复下相同。盖因酒因怒以壮其气,酒散气衰则复怯。故无暴其气,此善养乎大勇。马莳说:酒为水谷之精,熟谷之液,此语又见《营卫生会篇》。张介宾说:酒为水谷之液,血为水谷之精。酒入中焦,必求同类,故先归血分。凡饮酒者身面皆赤,即其征。然血属阴而性和,酒属阳而气悍。血欲静而酒动之,血欲藏而酒乱之。血无气不行,故血乱气亦乱,气散血亦散。扰乱一番,而血气能无损者未之有。又若人之禀赋藏有阴阳,而酒气之质亦有阴阳。盖酒成于酿,其性则热;汁化于水,其质则寒。故阳藏得之则愈热,阴藏得之则愈寒。所以纵酒不节者,无论阴阳均为害。凡热盛而过饮者,阳日胜则阴日消,每成风瘅肿胀。
The Qi of the membrane network reaches the Bladder; therefore, the Sanjiao (Triple Burner) is the official responsible for dredging (unblocking water passages), and water channels emerge from it. It is called the "solitary palace" because while the Five Zang organs each pair with one Fu organ, the Sanjiao independently manages the dredging function of the Kidney, forming a unique palace on its own. Thus, it is said that Qi travels through the palaces and remains in the four Zang organs.
The Qikou (Qi Mouth), also known as the Cun Kou or Maikou, is the pulse point of the Hand Taiyin Lung Meridian. In the *Neijing*, it is often contrasted with the Yingqiang acupoint located on both sides of the larynx. Zhang's commentary has already detailed this, which can be found separately in the supplement notes of the *Bi Cang Biography*. As long as the measurement does not deviate by even a hair's breadth, it is called "Ping Qi" (Balanced Qi); since the Qikou is neither too long nor too short, it is referred to as "Cheng Cun" (Forming an Inch).
When fluids are ingested, they enter the Stomach; their floating and overflowing essence is transported upward to the Spleen.
Wang Bing stated: Water and drinks flow down to reach the Middle Jiao, where water transforms into subtle essences, rising like mist and clouds. When these mists and clouds disperse and change, they are then transmitted to the Spleen. The *Lingshu Jing* states that the Upper Jiao is like mist and the Middle Jiao is like fermentation (steeping); this is what is meant. Wu Kun explained: "You" means circulating; "Yi" means surging. This corresponds to the Lingshu's description of the Middle Jiao being like fermentation. "Jingqi" refers to the essence within the drink. "Shu" denotes the name for transmission and transport. Zhang Zhicong said: The drink entering the stomach, its essence is transported upward to the Spleen; the Spleen scatters the essence upward to return to the Lung. Essentially, the Spleen governs transporting the body fluids for the Stomach. The Lung corresponds to Heaven and governs Qi, thus it can regulate water passages and transport downward to the Bladder. This is described as earthly Qi rising to become clouds and heavenly Qi descending to become rain. Ma Shi said: The subtle essence of consumed food floats, overflows, ascends, and is transported upward to the Spleen. Zhang Jiebin said: "You" means floating; "Yi" means surging. When water and drinks enter the Stomach, their transformed subtle essences must first be transported to the Spleen, which is termed "Middle Jiao like fermentation." Ji An: The above discusses food, which originates from Earth Yin and primarily transforms blood substances; the following discusses drinks, which originate from Heaven Yang and primarily transform Qi substances. Qi is derived from water; all drinking belongs to transforming Qi substances. The *Book of Rites* states that drinks nourish Yang and food nourishes Yin, which is correct. Drinks mainly refer to decoctions and fermented wines, whereas "food" generally encompasses the five grains, five vegetables, five fruits, and five meats.
The Spleen scatters the essence upward to return to the Lung; it regulates water passages and transports downward to the Bladder.
Wang Bing stated: Earth and water combine and transform, nourishing Metal (Lung) from above. Metal Qi connects to the Kidney, thereby regulating water passages and transferring them to the Lower Jiao Bladder, receiving transformation to become urine. The *Lingshu Jing* states that the Lower Jiao is like a ditch; this is what is meant. Wu Kun said: Although the Spleen possesses the stillness of Kun (Earth), it has the strength of Qian (Heaven). Upon obtaining the essence of food and drink, it scatters and rises, returning to the Lung. The *Lingshu* says the Upper Jiao is like mist; this is so. Although the Lung is a clear and empty viscera, it has the function of governance, managing Ying and Wei, and connecting Yin and Yang; thus, it can regulate water passages and transport downward to the Bladder. The *Lingshu* says the Lower Jiao is like a ditch; this is so. Ma Shi said: The Spleen attaches to the right side of the Stomach and is positioned higher than the Stomach; therefore, the Spleen scatters essence upward to return to the Lung, while the Lung circulates through the hundred vessels, regulates water passages, and transports downward to the Bladder. Zhang Jiebin said: The Spleen scatters Qi, rising like mist to return to the Lung, which is called "Upper Jiao like mist." Lung Qi circulates, and water follows to pour forth; thus, the Lung can regulate water passages and transport downward to the Bladder, which is called "Water originating from highlands" and "Lower Jiao like a ditch." Ji An: The *Five Viscera Mutual Assistance Chapter* states that the Sanjiao is the official of dredging, and water channels emerge from it. See the entry for "Ascending Qi to the Palace" for details on water channel injection.
Water essence distributes in four directions, the five meridians run together, conforming to the four seasons and the Yin-Yang of the five Zang organs, measured as the constant norm.
Wang Bing stated: From here, water essence spreads, meridian Qi moves, sinews and bones form blood, Qi flows smoothly, coordinating with the four seasons' cold and heat, matching symptoms, measuring the fullness and emptiness of the five Zang Yin-Yang, using this as the constant way. "Measure" implies application. The New Correction notes: According to another version, it reads "Yin-Yang movement and stillness." Wu Kun said: Since ascending and descending occur, the essence of food and drink scatters in four directions, and the Qi of the five meridians flows through one mechanism, conforming to the four seasons' cold and heat, matching the five Zang Yin-Yang, and measuring creation's fullness and emptiness, becoming the constant way. Zhang Zhicong said: Water essence distributing in four directions means that when Qi transforms, water moves, thus distributing to the skin and hair. The five meridians running together means irrigating the meridians of the five Zang organs. The *Pulse Diagnosis Chapter* states that when grain enters the Stomach, the pulse pathway begins to move; when water enters the meridians, blood forms. Therefore, food is discussed before drinks. The five Zang organs represent the Qi of the five elements. "Kuidu" refers to numerical degrees. Summarizing the above, the path of the meridians conforms to the sequence of the four seasons and five elements, and the degrees of Yin-Yang entry and exit serve as the constancy of the meridians. Ma Shi said: Water essence distributes among the four Zang organs, and the five Zang organs circulate water essence together, truly aligning with the constant principles of the four seasons, five Zang organs, and ancient texts on Yin-Yang measurement. Note that from "Drink enters the Stomach" onwards, it discusses drinks but not food. Li Dongyuan's *Pi Wei Lun* and Zhu Danxi's *Zuan Yao Shu* failed to examine the preceding text regarding food and changed it to "Food and drink enter the Stomach," which greatly contradicts the meaning of "transporting downward to the Bladder, water essence distributing in four directions." Little did they know that the "food" mentioned earlier contains the meaning of drink, while the "drink" mentioned later cannot easily encompass food. Why do all medical books follow Li and Zhu without examining the classic intent, resulting in errors? Zhang Jiebin said: Water is generated by Qi, and Qi is the mother of water. Wherever Lung Qi reaches, water essence distributes. Although water shares one name, there is a distinction between clear and turbid. The clear part is essence, clear as rain and dew; the turbid part is water, like rivers. Thus, essence returns to the five Zang organs, and water returns to the Bladder, while the five meridians run together. The five meridians are the collaterals of the five Zang organs. In this case, the essence of food and drink receives appropriate nourishment and ascending-descending regulation, so the four seasons and five Zang organs all conform to Yin-Yang measurement as the constant norm.
In the *Suwen Ping Re Bing Lun* chapter, Qibo said: The reason humans sweat is that it all originates from grain, and grain originates from essence.
Wang Bing stated: This means Grain Qi transforms into Essence; when Essence prevails, sweat is produced. Wu Kun said: This means Grain Qi changes into Yin Essence, which is excreted to the exterior as sweat. Zhang Zhicong said: Sweat is born from the essence of water and grain; the essence of water and grain is transformed by Essence Qi, hence it is said that grain generates essence. There are two sources of sweat: one emerges from the essence of water and grain, and the other from the essence stored in the Kidney. Saying "all originates from grain" means that the essence stored in the Kidney is also generated by water and grain. Ma Shi said: When Essence Qi is abundant and Grain Qi diminishes, sweat can naturally emerge. Zhang Jiebin said: When Grain Qi is internally abundant, it generates Essence; when Essence reaches the exterior, it becomes sweat. Ji An: The *Lingshu Yong Ju Chapter* states that the intestines and stomach receive grain, and the Upper Jiao emits Qi to warm the muscle layers, nourish bone joints, and open the interstices. Opening the interstices is equivalent to sweating. However, grain has five flavors. The *Wu Wei Chapter* states that sour grain flavor first travels to the Liver, bitter to the Heart, sweet to the Spleen, pungent to the Lung, and salty to the Kidney. Grain has five flavors, and the five flavors travel to the five Zang organs, which generate five juices. The *Jing Mai Bie Lun* states: After eating until full, sweat comes from the Stomach; after fright depleting essence, sweat comes from the Heart; after carrying heavy loads and traveling far, sweat comes from the Kidney; after running fast and fearing, sweat comes from the Liver; after shaking the body and laboring bitterly, sweat comes from the Spleen. Essence is the refined essence of the five grains, further distinguishing coarse objects. The *Analects* say "food should not be too refined," and the *Li Sao* says "refined jade powder as provisions," both interpreting "refined" as polished/chiseled. Zhang's note considers the explanation of "essence of water and grain" more reasonable. The *Jinkui Zhenyan Lun* states: East, sour flavor, grain wheat, generates Liver; South, bitter flavor, grain millet, generates Heart; Center, sweet flavor, grain foxtail millet, generates Spleen; West, pungent flavor, grain rice, generates Lung; North, salty flavor, grain beans, generates Kidney.
Now, when evil Qi contends in the flesh and bones, obtaining sweat indicates that the evil recedes and essence prevails.
Wang Bing stated: This refers to initial sweating. Wu Kun said: If indeed essence prevails and evil recedes, one should be able to eat and fever should not recur. Zhang Zhicong said: Contending in flesh and bones means evil Qi hides between flesh and bones; during spring, it contends with righteous Qi, manifesting as warm diseases. Obtaining sweat means essence prevails, and evil should emerge together. Ni Chongzhi said: The Stomach governs flesh, the Kidney governs bones. Sweat of grain essence comes from the Stomach; sweat of blood essence originates from the Kidney. When evil is in the flesh, it resolves with sweat of water and grain essence; when evil is in the bones, it resolves only with sweat of Kidney essence. Ma Shi said: Evil Qi contending and obtaining sweat means evil recedes and essence prevails.
If essence prevails, one should be able to eat and fever should not recur. Recurring fever is due to evil Qi; sweat is essence Qi. Now, if sweat occurs and fever immediately recurs, it means evil prevails. Inability to eat means essence lacks assistance.
Wang Bing stated: "Wubi" means there is nothing to enable sweat production. If grain is not digested, essence is not generated; if essence does not transform and flow, there is nothing to enable [sweat]. Wu Kun said: "Bi" means to enable. When essence is depleted, it cannot drive transformation and digestion, hence inability to eat. Ma Shi said: This means Essence Qi cannot enable eating, so life expectancy can be overturned. Zhang Jiebin said: Only when essence prevails over evil can sweat occur. When evil dissipates through sweat, one should be able to eat and fever should not recur. "Bi" means to enable. Essence is Yin Qi. The five Zang organs store essence; if Zang Qi is deficient, it cannot enable eating, hence "Essence lacks assistance."
If the disease remains lingering, life expectancy can be overturned immediately.
Wang Bing stated: In such cases, if sweat is produced rapidly but lingers and does not depart, the person's lifespan will immediately face peril. The New Correction notes: Regarding "Disease remains lingering," Wang's commentary suggests "disease" should be "illness." Also, according to the *Jia Yi Jing*, it reads "Heat remains lingering." Wu Kun said: This means if pathogenic factors remain and do not depart, it will inevitably damage life. Zhang Zhicong said: This discusses how the essence of water and grain is transformed by the essence and Qi stored in the Kidney, i.e., "grain generates essence." The Kidney is a Water organ, receiving and storing the essence of water and grain. Its essence Qi combines with Yangming; Wu and Gui combine to transform Fire. The Qi of Fire and Earth consumes the subtle essence of water and grain and regenerates it. This essence represents the mutual support of the Pre-Heaven and Post-Heaven origins. Now, if sweat occurs and evil lingers without departing, Heat evil re-injures Yin essence. Once Essence Qi is injured, it cannot combine and transform with Yangming to enable eating; thus, the origin of Essence Qi generation is cut off, and life expectancy can be overturned immediately. Dong Weiyuan said: The way of mutual growth rotates like a ring. Zhang Jiebin said: If pathogenic Qi lingers and does not retreat, Yuan Qi declines daily, inevitably leading to death. Ji An: Sweating injuring essence is the first death; recurring fever due to evil prevalence is the second death; inability to eat and essence lacking assistance ("Bi" means benefit in *Shuowen*) is the third death. With three deaths and no chance of life, the overturning of lifespan can be expected immediately.
In the *Suwen Jue Lun Pian* chapter, Qibo said: When wine enters the Stomach, the Luo vessels fill while the Jing vessels become empty. The Spleen governs transporting body fluids for the Stomach. When Yin Qi is deficient, Yang Qi enters; when Yang Qi enters, the Stomach becomes disharmonious; when the Stomach is disharmonious, Essence Qi is exhausted; when Essence Qi is exhausted, it fails to nourish the four limbs.
Wang Bing stated: The anterior yin is the convergence of Taiyin and Yangming; thus, when the Stomach is disharmonious, Essence Qi is exhausted. Internal essence is insufficient, so the four limbs lack Qi to nourish them. Wu Kun said: This discusses the harm of wine; the Luo and Jing vessels cannot both be full, so when Luo vessels fill, Jing vessels become empty. "Yin" refers to the Yin-Yang of the five Zang organs and the Yang of the four limbs. Exhaustion of Essence Qi refers to exhaustion of Yin Qi. "Ying" means nourishment. Zhang Zhicong said: This discusses the cause of Heat Jue, which is injury to the Yin Qi generated in the Middle Jiao. The *Lingshu Jing* states that when one drinks wine, Wei Qi first travels through the skin and first fills the Luo vessels. The Stomach Qi is the fierce Qi of grain. Wine is also a fierce and hot liquid of water and grain, so it follows Wei Qi, traveling first through the skin and filling the Luo vessels from the skin. It does not follow Spleen Qi to travel through the Luo vessels; thus, Luo vessels fill and Jing vessels become empty. When drinks enter the Stomach, their body fluids are transported upward to the Spleen; the Spleen scatters essence to the Lung, regulates through the Jing vessels, and distributes to the skin and hair. This is from Jing vessels to Luo vessels, from Luo vessels to skin, moving from interior to exterior. Wine entering the Stomach travels first through the skin and fills the Luo vessels, moving from skin to Luo vessels, reversing from exterior to interior. Not regulating through Spleen Qi via Jing vessels leads to deficiency of Yin Qi. Fierce and hot Qi reversely entering from the exterior leads to entry of Yang Qi. Yangming is a dry-heat palace relying on the Yin transformation of Taiyin's intermediate presentation. When Yin Qi is deficient and Yang-heat Qi enters inward, Stomach Qi becomes disharmonious. When Stomach Qi is disharmonious, the generated Essence Qi is exhausted. When Essence Qi is exhausted, it cannot nourish the four limbs, causing Heat Jue. Ma Shi said: The Kidney belongs to Foot Shaoyin, becoming deficient due to lust; the Stomach belongs to Foot Yangming, becoming excessive due to wine. When Yin Qi is deficient, Yang Qi enters; when Yang Qi enters, Stomach Qi sinks and becomes disharmonious. When Stomach Qi is disharmonious, Spleen Qi also declines, and Grain Qi cannot transform into subtle Qi to be transported to the four limbs. Zhang Jiebin said: Wine entering the Stomach must return to the Spleen. Damp-heat in the Spleen causes Spleen Yin deficiency and independent Yang hyperactivity, leading to Stomach disharmony. When both Spleen and Stomach are diseased, Essence Qi is exhausted, hence failing to nourish the Jing vessels and four limbs. Ji An: *Yanyi* cites *Lüshi Chunqiu* stating Yi Di created wine; *Zhanguo Ce* states Empress Yi Di created wine and presented it to Yu. However, materia medica already records wine names, and *Suwen* mentions wine as a beverage starting from the Yellow Emperor, not Yi Di. Physicians use the meaning of fermented wine, detailed in *Neijing Fang Tangye Laoli Pian*. Drinkers only seek its flavor, disregarding medicinal properties. Tao Hongjing said: "Great cold freezes the sea, only wine does not freeze," indicating its hot nature. Many herbalists use it to promote momentum; people drinking it suffer bodily decline and mental confusion, proving its toxicity. Chen Cangqi said: "It unifies blood vessels and moistens skin," and also "All grain wines are toxic." The *Lingshu Yingwei Shenghui Pian* states that human drinking also enters the Stomach; wine is the liquid of cooked grain, its Qi is fierce and clear. The *Jing Mai Pian* states that all floating and visible pulses are Luo vessels. The *Mai Du Pian* states that branching and horizontal ones are Luo vessels. Wine entering the Stomach has swift, fierce Qi, traveling externally to skin and Luo vessels and internally to the Yin-Yang of the five Zang organs without obstruction; its detrimental effects are thus.
This person must frequently get drunk or engage in sexual activity after being full. Qi gathers in the Spleen and cannot disperse; Wine Qi and Grain Qi clash, Heat becomes excessive in the center, so Heat pervades the body, causing internal heat and dark urine. Wine Qi is vigorous and fierce; Kidney Qi is declining, while Yang Qi alone prevails, so the hands and feet become hot.
Wang Bing stated: Drunkenness and fullness followed by sexual activity deplete internal Essence Qi, causing central deficiency and Heat invasion, leading to Kidney decline, Yang excess, and Yin deficiency; thus, Heat dominates the hands and feet. Wu Kun said: "Han" means violent/forceful. Kidney Qi is Yin Qi. Zhang Zhicong said: Drinking heavily makes fierce-hot Qi reverse from exterior to interior, gathering Wine Qi in the Spleen. Being full and engaging in sex leaves grain food in the Stomach; the Spleen Qi cannot transport its fluids, causing Grain Qi to gather in the Spleen. Qi gathering centrally and unable to disperse, Wine Qi and Grain Qi mutually invade and clash, making Heat excessive in the center. Central Earth Heat pours to the four sides, so Heat pervades the body. Food and drink entering the Stomach cannot float and overflow essence to transport downward to the Bladder, causing internal heat and dark urine. The Kidney is a Water organ, receiving and storing the essence of water and grain. Wine Qi is hot and fierce, causing the essence and Qi stored in the Kidney to decline daily. Yin Qi declines below while Yang Qi prevails alone in the center, so the hands and feet become hot. Zhang Zhaohuang said: Cold Jue results from loss of stored Yang causing daily decline of Middle Qi; Heat Jue results from injuring generated Yin causing daily decline of Kidney Qi. One must understand the mutual support of the Middle and Lower Jiao. Zhang Yinglue said: Ancient people had regulated diet and routine, avoiding undue labor. Modern people treat wine as water and recklessness as normal, getting drunk and having sex. What humans should nurture is Yin-Yang and Essence Qi. If nurtured properly, one can return to the gate of growth; if neglected, one suffers sudden collapse or syncope. Ma Shi said: Drunkenness and fullness followed by sex cause lower Qi to contend upward, gathering in the Spleen. Having received both Grain Qi and Wine Qi, Heat becomes excessive in the center, so Heat pervades the body, manifesting from interior to exterior. Internal heat is verified by dark urine. Wine Qi is inherently vigorous and fierce; only when Kidney Yin is depleted and Stomach Yang prevails alone do the hands and feet become hot, which is appropriate. Zhang Jiebin said: Frequently drunk or full before sex injures both the Spleen and the Kidney, both resulting in Yin deficiency, hence the hands and feet become hot. Ji An: Wine travels through Yin-Yang internally and externally without obstruction; combined with sex after fullness, it lightly causes disease and heavily kills. *Records of the Grand Historian: Canggong Biography*: Physician Cheng suffered carbuncles and died due to wine and sex; Shanfu suffered lung consumption and died internally; Pan Manru suffered lower abdominal pain and died due to wine and sex; Zhao Zhang suffered wind and died due to wine; Commoner Mingfu's wife suffered wind entering the middle and died from intercourse; King Jibei's mother suffered Heat Jue from heavy drinking; Yangxu Hou suffered bi syndrome from sex; Kaifang suffered wind from frequent drunkenness; Gongcheng Xiangchu suffered male hernia from sex. Canggong treated twenty-one cases, most involving wine and sex were untreatable. This is Kidney Qi declining and Yang Qi prevailing alone, described as "Solitary Yin does not grow, solitary Yang does not lengthen." Growth and lengthening failing, death can be expected immediately. This is why wine and sex are warned against for ten thousand generations.
In the *Lingshu Wu Long Jin Ye Bie Pian* chapter: The essence fluids of the five grains combine to form "Gao" (high/fat), penetrating internally into the bone spaces, supplementing the brain marrow, and flowing downward to the inner thighs.
Zhang Zhicong said: This discusses essence fluid becoming marrow. The Kidney governs storing essence and bones. Combining and rising, the liquids of the five grains merge with the essence stored in the Kidney, penetrating into the bone spaces, rising upward to the high points, supplementing the brain marrow from the bone spaces, and flowing downward to the inner thighs from the marrow spaces. This essence fluid lubricates the bones to form marrow, first benefiting the brain and then flowing downward, hence "The essence fluids of the five grains combine to form Gao." Yao Shi said: The *Benjing* states that when grain enters, Qi fills, and lubrication pours into the bones; bones belong to flexion and extension, supplementing the brain marrow, which is called "Ye." It also states the Kidney is the residence of essence, its brilliance is in the hair, and its substance is in the bones. Thus, grain liquids and Kidney essence pour into the bones to form marrow. Marrow is centered on the brain, hence "combining and rising." Ma Shi said: "Gao" should be read as "Gao" (fat/paste). This originates from the formation of water swelling. The essence fluids of the five grains combine to form paste, penetrating into the bone spaces, supplementing the brain marrow, and flowing downward to the inner thighs. Zhang Jiebin said: This describes Jin Ye becoming essence and marrow. "Gao" refers to fat/paste. Essence fluids combine to form paste, filling the bone spaces, becoming brain, marrow, essence, and blood, thus reaching the vertex to be solid and flowing to the inner thighs to communicate. Ji An: Ma's note says "Gao" should be "Gao." The *Suwen Fuzhong Lun* states that in Heat Zhong and Xiao Zhong, one should not take high-liang (rich food), fragrant grass, or stone medicines; prohibiting high-liang is incompatible with the heart. The *Tongping Xu Shi Lun* states that Xiao Bi affects wealthy people who eat rich foods, which are diseases of high-liang. "Gao" and "Gao" are used interchangeably. Wang Chong's *Lunheng* states that for humans, grain fills the stomach; rice and sorghum have sweet flavors and are rich, thus combining essence fluids to form paste. "Bone space" refers to the gaps at bone joint intersections, where divine Qi travels in and out. Chapter 60 of the *Suwen* discusses treatment methods for various syndromes, taking acupuncture at bone spaces, hence naming the chapter "Bone Space." The brain is oval-shaped, divided into left and right halves by a central groove, gray-white in color, filling the skull, connected inferiorly to the spinal cord, serving as the master of sensation and movement. It contains fluid and nerves. Western medicine knows the function of brain marrow but not its origin. Nerves only describe the exit path, ignoring the source of marrow, hence no medicine treats marrow. They do not know that the spinal cord is the path for marrow to enter the brain. The *Neijing* clearly states the Kidney stores essence, essence generates marrow, and Kidney Qi penetrates the spine to generate spinal marrow, which ascends into the brain to become brain marrow. The brain is not the generator of marrow but the collector. Since marrow generation depends on the Kidney, to tonify the brain, one must treat the Kidney. Additionally, the Liver meridian enters the brain, crosses the vertex, and the eye system penetrates the marrow; all disorders of spirit, dizziness, mania, and wind are treated from the Liver. Brain Qi connects to the nose and can be treated from the Lung; nerves enter the Heart and can be treated from the Heart; nerves gather in the Stomach and can be treated from the Stomach. Thus, the essence of the five grains tonifies the five Zang organs, whose systems connect to the marrow, with the Stomach being particularly the gathering point of marrow nerves, hence "Gao" is used to tonify marrow. The concept of brain marrow was borrowed from the works of Mr. Tang from my hometown. Furthermore, the classics state: Brain, marrow, bones, vessels, Gallbladder, and Uterus—these six exist in Yin and manifest in Earth, named the Extraordinary Fu organs. Brain, marrow, and bones are three yet one. The Kidney governs bones; bones contain marrow; the Kidney system penetrates the spine and connects to spinal marrow. When Kidney essence is sufficient, it enters the spine, transforms into marrow, ascends into the brain to become brain marrow. The inner thigh is the region of the Kidney, hence it flows there.
In the *Lingshu Lun Yong Pian* chapter, Huangdi asked: Why does a timid person, upon drinking wine and angering, dare not avoid brave warriors? Which organ causes this? Shaoyu replied: Wine is the essence of water and grain, the liquid of cooked grain, and its Qi is fierce. When it enters the Stomach, the Stomach distends, Qi rebels upward, filling the chest, causing the Liver to float and the Gallbladder to protrude. At this time, one is certainly comparable to a brave warrior; when the Qi declines, regret follows. Being similar to a brave warrior but unaware of avoidance is called "Jiu Bei" (Wine Rebellion).
Zhu Shi said: This reiterates that human bravery and timidity depend on the strength of Qi. Strong Qi is generated by the Stomach Fu from water and grain. Wine is the essence of water and grain, the liquid of cooked grain, and its Qi is fierce, thus it can assist Qi to become full and make the Liver and Gallbladder float and protrude. However, when wine dissipates, Qi declines, and Qi decline brings regret. Therefore, those who nurture Qi well have regulated diet and routine, ensuring sufficient Form and Qi. Sudden joy injures Yang, sudden anger injures Yin; harmonizing joy and anger prevents Yin-Yang imbalance. With robust Form and Qi, even severe winds and rains cannot penetrate the interstices, let alone the vacuous winds of the four seasons. Ni Shi said: Courageous Qi originates from the uprightness of the Heart, the firmness of the Liver, and the fullness of the Gallbladder juice; Qi is born from Form. Qi filling the chest makes the Liver float and Gallbladder protrude; this shows Form is based on Qi. Form does not separate from Qi, nor Qi from Form; this is the Mandate of Heaven establishing Form and stabilizing Qi to observe human longevity. Gao Shizong said: A timid person under wine and anger becomes similar to a brave warrior; even if furious, with Liver and Lung Qi rising and then declining, it is the same. Relying on wine and anger to strengthen Qi, once wine dissipates and Qi declines, one becomes timid again. Thus, do not violently expend Qi; this is nurturing great courage. Ma Shi said: Wine is the essence of water and grain, the liquid of cooked grain; this phrase appears again in the *Yingwei Shenghui Pian*. Zhang Jiebin said: Wine is the liquid of water and grain, Blood is the essence of water and grain. Wine entering the Middle Jiao seeks similarity, thus first entering the Blood aspect. Those who drink wine always have red faces and complexions, which is the sign. Blood belongs to Yin and is gentle; Wine belongs to Yang and is fierce. Blood desires stillness, but wine agitates it; Blood desires storage, but wine disrupts it. Blood cannot move without Qi, so when Blood is disrupted, Qi is also disrupted; when Qi scatters, Blood also scatters. After such disturbance, it is rare for Blood and Qi to remain undamaged. Furthermore, human constitution has Yin and Yang in the Zang organs, and the quality of wine also has Yin and Yang. Wine is formed by fermentation, its nature is hot; juice transforms from water, its quality is cold. Thus, those with Yang constitutions become hotter, and those with Yin constitutions become colder. Therefore, regardless of Yin or Yang, unrestrained drinking is harmful. For those with excessive heat who drink too much, Yang increases daily while Yin decreases, often resulting in wind jaundice and swelling.