是动则病手心热,肘臂挛急,腋肿,甚则胸胁〔支〕满,心中〔 〕大动,
〔面〕赤HT 黄,喜笑不休,〔是〕主脉所生病者,烦心,心痛,掌中热,治法与小肠同。
三焦者,人之三元〔之〕气也,号曰中清之腑,总领五脏六腑,荣卫经络,内
外左右上下之气也。三焦通,则上下内外左右皆通也。其于灌体周身,和内调外,荣养左
右,宣通上下,莫大于此也。又名玉海水道。上则曰三管,中则曰霍乱,下则曰走
泄,名虽三而归(其),有其名而〔无〕其形,亦号孤独之府。而卫〔出〕于
上,荣出于中,上者络脉之系也,中者经〔脉〕之系也,下者水道之系也,〔亦
又〕属膀胱之宗始,主通阴阳,〔调虚实〕,呼吸,有病则(善)腹胀气满,小
〔腹〕坚,〔溺〕而不得,(大便)窘迫也。溢则作水,留则作胀,手少阳是其经也。
又上焦实热,则额汗〔出〕而身无汗,能食而气不利,舌干、口焦、咽闭之类,腹
胀肋胁痛。寒则不入食,吐酸水,胸背引痛,嗌干,津不纳也。实则食已而还出,〔膨
膨〕然不乐。虚则不能〔制〕下,遗溺,头面肿也。中焦实热,则下上不通,腹
胀而喘,下气不上,上气不下,关〔格〕不利也。寒则下利不止,饮食不消,中满。
虚则肠鸣(膨膨)也。下焦实热,则小便不通,大便亦难,苦〔重〕痛也。虚寒
则〔大〕小便〔泄〕下不止也。三焦〔之气〕和则内外和,〔逆〕则内外逆也。
故云三焦者,人之三元〔之〕气也。此三焦虚〔实〕寒热,生死逆顺之法也。
《主治备要》云∶是动则病耳聋,浑浑 ,嗌肿喉〔痹〕。〔是〕主气所生病者,
汗出,目〔锐〕 〔痛〕,颊〔痛〕,耳后肩 肘臂外〔皆〕痛,小指次指不用。《脉诀》
云∶右尺三焦、命门脉之所出,先以轻手得之,是三焦,属表;后以重手得之,是命
门,属里也。上焦〔热〕,凉膈散、〔泻〕心汤;中焦热,〔调〕胃承气汤、〔泻〕脾
散;下焦热,大承气〔汤〕、三才封髓丹。气分热,柴胡饮子、白虎汤;血分热,桃
仁承气汤、清凉饮子;通治其热之气,三黄丸、黄连解毒汤是也。
当经脉发生异常变动时,会出现手心发热、肘部和手臂拘挛僵硬、腋下肿胀等症状;病情严重时,会出现胸胁部支撑胀满感,心脏剧烈跳动(心中大动),面色发红或发黄,以及不由自主地发笑不止。
这些症状属于“是动病”。而由本经气血病变直接引起的疾病(主脉所生病者),包括心烦、心痛、手掌心发热等。其治疗原则与小肠经相同。
三焦,是人体元气的汇聚之处,被称为“中清之腑”(指其内无浊物,清净通畅的脏腑)。它总领五脏六腑、营卫之气及经络,统管体内内外、左右上下所有的气机运行。三焦通畅,则上下内外左右的气机皆能畅通无阻。在灌溉身体周身、调和内外、滋养左右、宣通上下方面,没有比三焦更重要的了。三焦又被称为“玉海水道”。上焦病变称为“三管”,中焦病变称为“霍乱”,下焦病变称为“走泄”。三焦虽然名称分为三部分,但归根结底是一个整体;它有名称却没有具体的形态,因此也被称为“孤独之府”。
卫气出于上焦,营气出于中焦。上焦主要联系络脉,中焦主要联系经脉,下焦主要联系水道。三焦也归属于膀胱的根本源头,主管阴阳的贯通,调节虚实,主持呼吸功能。如果三焦有病,就会出现腹部胀满、气滞,小腹坚硬,小便不通畅,大便窘迫难解等症状。如果水液溢散,就会形成水肿;如果水液停留,就会引起胀满。手少阳三焦经是其所属的经脉。
若上焦实热,则表现为额头出汗而身体无汗,食欲正常但气机不利,伴有舌干、口焦、咽喉闭塞等症状,以及腹胀和肋胁疼痛。若上焦受寒,则不能进食,呕吐酸水,胸背部牵引作痛,咽喉干燥,津液无法吞咽。若上焦实证,则食物吃下去后又吐出来,腹部膨隆不舒,心情不快。若上焦虚证,则不能制约下部,出现遗尿,头面部浮肿。
若中焦实热,则上下气机不通,腹部胀满且气喘,下焦之气不上升,上焦之气不下行,导致关格不通利。若中焦受寒,则腹泻不止,饮食不消化,脘腹痞满。若中焦虚证,则肠鸣音亢进,腹部膨隆。
若下焦实热,则小便不通,大便也困难,伴有沉重的疼痛感。若下焦虚寒,则大小便失禁,持续不止。
三焦之气调和,则人体内外和谐;三焦之气逆乱,则人体内外失调。所以说,三焦是人体的三元之气。以上论述了三焦虚实寒热的病理变化,以及判断生死顺逆的方法。
《主治备要》记载:三焦经发生异常变动时,会出现耳聋,听力模糊不清,咽喉肿痛,喉痹。三焦经主治气分病变引起的疾病,包括汗出、目锐眦疼痛、脸颊疼痛、耳后、肩部、肘部、手臂外侧均疼痛,小指和无名指活动不便。
《脉诀》记载:右尺脉是三焦和命门脉气发出的部位。先用轻手按取得到的是三焦脉,属表;后用重手按取得到的是命门脉,属里。
对于上焦热证,使用凉膈散、泻心汤;中焦热证,使用调胃承气汤、泻脾散;下焦热证,使用大承气汤、三才封髓丹。气分热证,使用柴胡饮子、白虎汤;血分热证,使用桃仁承气汤、清凉饮子。通治各类热证的方剂,有三黄丸、黄连解毒汤等。
When the meridian undergoes pathological changes, symptoms include heat in the palm, spasm and stiffness of the elbow and arm, swelling of the axilla; in severe cases, there is a sensation of distension and fullness supporting the chest and hypochondrium, violent palpitations (heart moving greatly), red or yellow complexion, and uncontrollable laughter.
These symptoms belong to "diseases caused by movement" (Shi Dong Bing). The diseases primarily governed by the meridian's own qi and blood pathology (Zhu Mai Suo Sheng Bing) include vexation in the heart, heart pain, and heat in the palm. The treatment principles are the same as those for the Small Intestine Meridian.
The San Jiao (Triple Burner) is the convergence point of the body's Yuan Qi (Original Qi), known as the "Middle Clear Organ" (a zang-fu organ that is clean and free from turbid matter). It commands the five zang organs and six fu organs, Ying (Nutritive) and Wei (Defensive) qi, and meridians, governing the qi mechanism throughout the interior and exterior, left and right, and upper and lower. When the San Jiao is unobstructed, the qi mechanism in all directions flows freely. In terms of irrigating the whole body, harmonizing the interior and exterior, nourishing the left and right, and circulating the upper and lower, nothing is more important than the San Jiao. The San Jiao is also called the "Jade Sea Water Channel." Pathological changes in the Upper Jiao are called "Three Tubes," in the Middle Jiao "Huo Luan" (Cholera-like syndrome), and in the Lower Jiao "Zou Xie" (Leaking Downward). Although named in three parts, they ultimately constitute one entity; it has a name but no specific form, hence it is also called the "Lonely Organ."
Wei Qi (Defensive Qi) emerges from the Upper Jiao, and Ying Qi (Nutritive Qi) emerges from the Middle Jiao. The Upper Jiao mainly connects with collateral vessels, the Middle Jiao with main meridians, and the Lower Jiao with water passages. The San Jiao also belongs to the root source of the Bladder, governing the penetration of Yin and Yang, regulating deficiency and excess, and managing respiration. If the San Jiao is diseased, symptoms include abdominal distension and qi stagnation, hardness of the lower abdomen, difficulty in urination, and urgency/straining in defecation. If fluids overflow, edema results; if fluids remain stagnant, distension results. The Hand-Shaoyang San Jiao Meridian is its associated meridian.
If there is Excess-Heat in the Upper Jiao, symptoms include sweating on the forehead but no sweat on the body, normal appetite but obstructed qi mechanism, dry tongue, scorched mouth, closed throat, abdominal distension, and hypochondriac pain. If Cold affects the Upper Jiao, food intake is impaired, sour regurgitation occurs, pulling pain in the chest and back, dry throat, and inability to swallow fluids. If there is an Excess pattern in the Upper Jiao, food is vomited after eating, the abdomen is distended and uncomfortable, and mood is depressed. If there is a Deficiency pattern in the Upper Jiao, inability to control the lower part leads to enuresis, and swelling of the head and face.
If there is Excess-Heat in the Middle Jiao, the upper and lower qi mechanisms are blocked, leading to abdominal distension and panting, failure of lower qi to ascend and upper qi to descend, resulting in Guan Ge (Obstruction and Rejection) dysfunction. If Cold affects the Middle Jiao, continuous diarrhea occurs, food fails to digest, and epigastric fullness develops. If there is a Deficiency pattern in the Middle Jiao, borborygmus (intestinal rumbling) and abdominal distension occur.
If there is Excess-Heat in the Lower Jiao, urinary retention and difficult defecation occur, accompanied by heavy pain. If there is Deficiency-Cold in the Lower Jiao, continuous incontinence of urine and feces occurs.
When the Qi of the San Jiao is harmonious, the interior and exterior of the body are harmonious; when the Qi of the San Jiao is rebellious, the interior and exterior are disordered. Thus, it is said that the San Jiao is the Yuan Qi of the human body. This describes the methods for determining life and death, favorable and unfavorable outcomes based on the deficiency, excess, cold, and heat of the San Jiao.
*Zhu Zhi Bei Yao* states: When the San Jiao meridian undergoes pathological changes, symptoms include deafness, muffled hearing, swollen throat, and throat obstruction. The San Jiao governs diseases arising from qi disorders, including sweating, pain at the outer canthus of the eye, cheek pain, pain along the posterior ear, shoulder, elbow, and lateral aspect of the arm, and dysfunction of the little and ring fingers.
*Mai Jue* states: The Right Chi pulse is where the qi of the San Jiao and Ming Men (Gate of Life) emerges. Light pressure reveals the San Jiao pulse, which belongs to the Exterior; heavy pressure reveals the Ming Men pulse, which belongs to the Interior.
For Heat in the Upper Jiao, use Liang Ge San (Cool the Chest Powder) and Xie Xin Tang (Drain the Heart Decoction); for Heat in the Middle Jiao, use Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) and Xie Pi San (Drain the Spleen Powder); for Heat in the Lower Jiao, use Da Cheng Qi Tang (Great Direct Downward Decoction) and San Cai Feng Sui Dan (Three Talents Marrow-Sealing Pill). For Heat in the Qi Level, use Chai Hu Yin Zi (Bupleurum Drink) and Bai Hu Tang (White Tiger Decoction); for Heat in the Blood Level, use Tao Ren Cheng Qi Tang (Peach Kernel Direct Downward Decoction) and Qing Liang Yin Zi (Clearing and Cooling Drink). To treat heat generally across levels, formulas include San Huang Wan (Three Yellow Pill) and Huang Lian Jie Du Tang (Coptis Detoxification Decoction).