下焦三处地位合而名之也，以手少阳经统而属之，以合十二经之数。人之有十二经，犹日之有十二时
，岁之有十二月也。上焦主纳而不出，其治在膻中；中焦主腐熟水谷，其治在脐旁；下焦分别清浊，
主出而不纳，其治在脐下。滑伯仁曰∶治，犹司也，犹郡县治之治，言三焦所治之地方在斯也。有以
呼上焦为三焦者，如云“三焦为气之父”，指上焦之气海而言也（是上焦亦可以三焦称也）。有以呼中
焦为三焦者，如云“三焦咳状，咳而腹满，不欲饮食，比皆聚于胃，关于肺”者是也（是中焦亦可以
三焦称也）。有以下焦呼为三焦者，如云“决渎之官”，“中渎之府”者是也（是下焦亦可以三焦称也）
。此三焦者，外有经而内无形，故曰外府，明非五脏五腑之有合应也；又曰孤府。袁淳甫《难经本旨》
曰∶所谓三焦者，于膈膜脂膏之内，五脏五腑之隙，水谷流化之关，其气融会于其间，熏蒸膈膜，发达
皮肤分肉，营运四旁，曰上中下各随部分所属而名之，实元气之别使也。是故虽无其形，倚内外之形而得名
；虽无其实，合内外之实而为位者也。
《灵枢经》曰∶“上焦出于胃上口，并咽以上，贯膈而布胸中，走腋，循太阴之分而行，还至阳
明，上至舌下，足阳明常与营俱，行阳二十五度，行于阴亦二十五度，一周也，故五十度而复大
会于手太阴。”观此，则秦越人谓作水谷之道路，气之所终始者，为不诬矣。“中焦亦并胃中，而
出上焦之后，此所受气者，泌糟粕，蒸津液，化其精微，上注于肺脉，乃化而为血”。“下焦者，
别回肠，注于膀胱而渗入焉。故水谷者，常并居于胃中，成糟粕，而俱下于大肠，而成下焦，渗而
俱下，济泌别汁，循下焦而渗入膀胱焉”。观此，下焦之文，则纯是决渎之事，马氏乃谓上中下之
三焦以气看，手少阳之三焦作有形府看，谓其惟司决渎之职而已，分三焦为二，何其谬哉！《灵兰
秘典》曰∶“三焦者，决渎之官，水道出焉。”渎，犹江、河、淮、济之渎。《尔雅》曰∶“渎者，
独也，各独出其所而入海也。”夫决渎本下焦之事，决渎之官，犹今之总督河道之职也。今以三焦之
名，而独任下焦之职，此其故何哉？盖以水渎在下，非气莫导，膀胱所藏之水，必待气海之气施化，
乃为泄便注泄，是故以三焦治之，谓赖其气而为之前导也，故曰“气化则能出矣”。若曰不必下焦之
气施化，而手少阳自能决而
出焉，则经不当复缴“气化则能出矣”之句。或曰∶三焦是六腑之一，故决渎由之，恐不可作下焦看
也。余曰∶此正是马氏所疑之处，马氏以手少阳三焦为腑，惟司决渎，下焦非腑也，故作气看。不思
《素问·宣明五气篇》曰；“胃为气逆，为哕，为恐。大肠小肠为泄。下焦溢为水。膀胱不利为癃；
不约为遗溺。胆为怒。”又《灵枢·九针篇》曰∶六气为病，“胆为怒。胃为气逆，哕。大肠、小肠
为泄。膀胱不约为遗溺。下焦溢为水”。据此二篇，则《灵》、《素》亦以下焦备六腑之数，是下焦与三
焦无彼此也，是故不分而为二也。王好古虽引《灵枢》谓有足三焦之说，缘足三焦乃太阳之别络（别
络乃支络），并太阳之正，入络膀胱，约下焦（约是约束也），实则闭癃，虚则遗溺，虽有足三焦之名，
实则足太阳之络脉也。盖下焦乃足经之所属，故即膀胱言之也。《本脏篇》言“肾合三焦膀胱”，亦以
此故。好古此问，不过欲人知此义尔，实无二质可分也。诸家言有形状，有俞穴者，皆不过即其经脉而言
，如奇经冲、任、督之类也。噫！夫《难经》、《灵》、《素》之翼也，《脉经》，诊候之宗也。《难经》
载心包络、命门、三焦者凡八篇，《脉经》阐《灵》、《素》之
要旨，推脉候之本原。噫！医学至秦越人亦神矣，至王叔和亦可称精思矣。二公殚心究竟，着述垂
训，亦可谓无渗漏矣。乃陈无择不信《难经》，而信龙川不核之方志，世人不宗王叔和《脉经》，而
宗高阳生之《脉诀》，且也妄肆讥弹，是何异河伯而议海若之汪洋，处蚁封而谈藐姑射之灵秘哉！
多见其不知量也。余为此辩，岂不知将益增哓哓之口，顾后之人惑于其说而莫之觉，愿为秦王忠臣也，
或毁或誉，何暇计哉。孔子曰∶“知我者，其惟《春秋》乎，罪我者，其惟《春秋》乎。”余私心窃欲
自附云。
下焦的三处部位合起来称为“三焦”，由手少阳经统领并归属于它，以符合十二经脉的数量。人拥有十二经脉，就像太阳有十二个时辰、一年有十二个月一样。上焦主管受纳而不排出，其功能调控中心在膻中；中焦主管消化腐熟水谷，其功能调控中心在脐旁；下焦主管分清泌浊，主管排出而不受纳，其功能调控中心在脐下。滑伯仁说：“治”，就是“司”的意思，就像郡县治理的“治”，意思是三焦所管辖的区域就在这里。有人把上焦称为三焦，比如常说“三焦为气之父”，指的是上焦的气海（元气汇聚之处）（这说明上焦也可以被称为三焦）。有人把中焦称为三焦，比如常说“三焦咳的症状，咳嗽且腹部胀满，不想饮食，这些都是邪气聚于胃，关联于肺”（这说明中焦也可以被称为三焦）。有人把下焦称为三焦，比如常说“决渎之官”、“中渎之府”（这说明下焦也可以被称为三焦）。这个三焦，外面有经络而内部没有具体形态，所以称为“外府”，明确说明它不是五脏五腑那样有表里配合关系的脏腑；又被称为“孤府”。袁淳甫在《难经本旨》中说：所谓的三焦，是在膈膜脂膏之内，五脏六腑之间的空隙，是水谷流转化生的关口，其气融会于其间，熏蒸膈膜，通达皮肤肌肉，运行于四周，分别以上、中、下各部分所属区域来命名，实际上是元气的别使（使者）。因此，虽然它没有具体的形态，但依托内外部的形体而得名；虽然它没有实质性的脏器，但结合内外的实际功能而确立位置。
《灵枢经》说：“上焦出于胃的上口，沿着咽喉向上，贯穿膈肌而分布于胸中，走向腋下，沿着手太阴肺经的分布区域运行，返回至足阳明胃经，上行至舌下。足阳明胃经常与营气一起，行于阳分二十五周次，行于阴分也是二十五周次，这是一周，所以五十周次后重新大会于手太阴肺经。”观察这段话，那么秦越人（扁鹊）说三焦是水谷的道路，气运行的终点和起点，这是不虚假的。“中焦也并行于胃中，而出于上焦之后，这里所受纳的水谷之气，分泌糟粕，蒸发津液，化生精微物质，向上注入肺脉，进而化生为血液”。“下焦，分别回肠，注入膀胱并渗入其中。所以水谷，常常共同居住在胃中，形成糟粕，一起下行进入大肠，从而构成下焦的功能，渗滤并一起下行，过滤分离汁液，沿着下焦渗入膀胱。”观察这段关于下焦的文字，完全是决渎（疏通水道）的事情，马氏却认为上、中、下的三焦是从“气”的角度来看，手少阳三焦是从有形的腑的角度来看，说它只负责决渎的职能，将三焦分为两部分，这多么荒谬啊！《灵兰秘典》说：“三焦者，决渎之官，水道出焉。”渎，就像江、河、淮、济等大河的河道。《尔雅》说：“渎，是独的意思，各自独自流出其所入海。”疏通水道本是下焦的事情，“决渎之官”，就像现在的总督河道的职务。现在用三焦的名字，唯独承担下焦的职能，这是什么原因呢？大概因为水道在下部，没有气就不能引导，膀胱所储藏的水，必须等待气海（丹田/元气）之气的施化，才能成为尿液排泄出去，所以用三焦来治理，说是依赖它的作为先导，所以说“气化则能出矣”。如果说不必依靠下焦之气的施化，而手少阳自己就能疏通排出，那么经文就不应当再补充“气化则能出矣”这句话了。有人说：三焦是六腑之一，所以决渎由它负责，恐怕不能把它看作下焦。我说：这正是马氏疑惑的地方，马氏认为手少阳三焦是腑，只负责决渎，下焦不是腑，所以把它当作气来看待。却不思考《素问·宣明五气篇》说：“胃导致气逆，产生呃逆，产生恐惧。大肠小肠导致泄泻。下焦溢出水液。膀胱不利索导致癃闭；不约束导致遗尿。胆导致发怒。”又《灵枢·九针篇》说：六气致病，“胆导致发怒。胃导致气逆，呃逆。大肠、小肠导致泄泻。膀胱不约束导致遗尿。下焦溢出水液”。根据这两篇，那么《灵枢》、《素问》也把下焦算作六腑之数，这说明下焦与三焦没有彼此之分，所以不分而为二。王好古虽然引用《灵枢》说有足三焦的说法，其实足三焦乃是足太阳膀胱经的别络（别络即支络），并入足太阳的正经，进入联络膀胱，约束下焦（约是约束的意思），实证时出现闭癃，虚证时出现遗尿，虽然有足三焦的名称，实际上只是足太阳的络脉罢了。大概下焦是足经所属的部位，所以就着膀胱来说。《本脏篇》说“肾合三焦膀胱”，也是因为这个缘故。王好古这个问题，不过是想要让人明白这个道理罢了，实际上并没有两个质体可以区分。各家学说中有形状、有腧穴的，都不过是指它的经脉而言，就像奇经中的冲脉、任脉、督脉之类一样。唉！《难经》是《灵枢》、《素问》的羽翼，《脉经》是诊候的宗师。《难经》记载心包络、命门、三焦的内容共有八篇，《脉经》阐发《灵枢》、《素问》的要旨，推究脉候的本原。唉！医学到了秦越人也就神妙了，到了王叔和也可以称得上精思了。这两位先生尽心穷究，著书立说垂训后人，可以说没有疏漏了。然而陈无择不信《难经》，却相信龙川未经核实的地方志，世人不尊崇王叔和的《脉经》，却尊崇高阳生的《脉诀》，而且妄加讥讽弹劾，这难道不是河伯去议论海若的汪洋广阔，处在蚂蚁洞边谈论藐姑射山的灵异神秘吗！这只是多见他们不自量力罢了。我进行这番辩解，难道不知道会增加许多喋喋不休的嘴吗？只是担心后世的人被这种说法迷惑而不能察觉，我愿做秦王的忠臣，或者被毁谤或者被赞誉，哪里有空闲去计较呢。孔子说：“了解我的，大概只有《春秋》吧；怪罪我的，大概也只有《春秋》吧。”我私下心里也想以此自比。
The three locations of the Lower Jiao (Lower Burner) are collectively named "San Jiao" (Triple Burner), governed and attributed to by the Hand-Shaoyang Meridian, to conform to the number of twelve meridians. Humans possess twelve meridians, just as the sun has twelve double-hours or a year has twelve months. The Upper Jiao (Upper Burner) is responsible for receiving but not discharging; its regulation center is at Danzhong (Chest Center). The Middle Jiao (Middle Burner) is responsible for rotting and ripening food and drink; its regulation center is beside the navel. The Lower Jiao (Lower Burner) separates the clear from the turbid, is responsible for discharge but not reception; its regulation center is below the navel. Hua Borren stated: "Zhi" (govern/regulate) means "Si" (manage/control), similar to the governance of commanderies and counties, indicating that the area regulated by the San Jiao lies here. Some refer to the Upper Jiao as San Jiao, such as saying "San Jiao is the father of Qi," referring to the Qi Sea of the Upper Jiao (this shows the Upper Jiao can also be called San Jiao). Some refer to the Middle Jiao as San Jiao, such as describing the symptoms of "San Jiao cough," where one coughs with abdominal fullness and loss of appetite, all gathering in the Stomach and affecting the Lung (this shows the Middle Jiao can also be called San Jiao). Some refer to the Lower Jiao as San Jiao, such as calling it the "Official of Decoupling and Dredging" or the "Middle Dredging Organ" (this shows the Lower Jiao can also be called San Jiao). This San Jiao has meridians externally but no distinct form internally, thus it is called an "External Organ," clearly indicating it does not have the paired correspondence like the Zang and Fu organs; it is also called the "Solitary Organ." Yuan Chunfu in *Nanjing Benzhi* said: The so-called San Jiao exists within the diaphragm and fatty tissue, in the gaps between the five Zang and six Fu organs, serving as the passageway for the flow and transformation of water and grain. Its Qi integrates within, steaming the diaphragm, penetrating the skin and muscles, circulating around, and is named according to the upper, middle, and lower sections respectively. It is actually the special envoy of Yuan Qi (Original Qi). Therefore, although it lacks specific form, it derives its name from relying on internal and external forms; although it lacks substantial substance, it establishes its position by combining internal and external realities.
*Ling Shu Jing* states: "The Upper Jiao originates from the upper opening of the Stomach, ascends along the pharynx, penetrates the diaphragm, and spreads in the chest, moving to the axilla, following the distribution of the Taiyin meridian, returning to the Yangming, ascending to under the tongue. The Foot-Yangming [Stomach] meridian often travels together with Ying Qi (Nutritive Qi), circulating twenty-five cycles in the Yang and twenty-five cycles in the Yin, constituting one cycle; thus, after fifty cycles, it reunites with the Hand-Taiyin [Lung] meridian." Observing this, Qin Yue Ren's (Bian Que) statement that the San Jiao is the pathway for water and grain and the beginning and end of Qi is not unfounded. "The Middle Jiao also runs alongside the Stomach, emerging after the Upper Jiao. The Qi received here separates dregs, evaporates fluids, transforms essence and fine substances, which are then poured upward into the lung vessels, thereby transforming into Blood." "The Lower Jiao separates from the ileum, pours into the Bladder, and seeps in. Thus, water and grain often reside together in the Stomach, become dregs, and descend together into the Large Intestine, forming the function of the Lower Jiao; they filter and descend together, separating juices, flowing through the Lower Jiao, and seeping into the Bladder." Observing this text on the Lower Jiao, it is purely about dredging waters. Master Ma claimed that the Upper, Middle, and Lower San Jiao should be viewed as Qi, while the Hand-Shaoyang San Jiao should be viewed as a有形 (formate) organ, stating it only manages the duty of dredging, thereby splitting the San Jiao into two parts. How erroneous is this! *Ling Lan Mi Dian* states: "The San Jiao is the Official of Dredging, from which waterways emerge." Du refers to rivers like the Yangtze, Yellow River, Huai, and Ji. *Erya* states: "Du means alone/independent, each flowing independently to enter the sea." Dredging is originally the affair of the Lower Jiao; the "Official of Dredging" is akin to the modern role of a River Conservancy Commissioner. Why is the name San Jiao used exclusively for the duties of the Lower Jiao? This is likely because waterways are located inferiorly, and without Qi, there is no guidance. The water stored in the Bladder must await the transformational power of the Qi of the Qi Sea (Yuan Qi) to become urine and be excreted. Therefore, it is governed by the San Jiao, relying on its Qi as a guide, hence it is said, "When Qi transforms, excretion occurs." If it were not necessary for the Lower Jiao Qi to transform, and the Hand-Shaoyang could dredge and discharge on its own, the classic would not reiterate the phrase "when Qi transforms, excretion occurs." Some say: Since San Jiao is one of the six Fu organs, dredging is its responsibility, so it cannot be viewed merely as the Lower Jiao. I reply: This is precisely where Master Ma had doubts. Master Ma considered the Hand-Shaoyang San Jiao as a Fu organ, solely managing dredging, and the Lower Jiao not as a Fu organ, thus viewing it as Qi. He failed to consider that *Su Wen · Xuan Ming Wu Qi Pian* states: "The Stomach leads to rebellious Qi, hiccups, and fear. The Large and Small Intestines lead to diarrhea. The Lower Jiao overflows with water. The Bladder's lack of free flow leads to strangury; lack of restraint leads to enuresis. The Gallbladder leads to anger." Also, *Ling Shu · Jiu Zhen Pian* states regarding diseases of the six Qi: "The Gallbladder leads to anger. The Stomach leads to rebellious Qi and hiccups. The Large and Small Intestines lead to diarrhea. The Bladder's lack of restraint leads to enuresis. The Lower Jiao overflows with water." Based on these two chapters, both *Ling Shu* and *Su Wen* include the Lower Jiao in the count of the six Fu organs, showing that the Lower Jiao and San Jiao are not separate entities, hence they are not divided into two. Wang Haogu, although citing *Ling Shu* regarding the existence of the Foot-San Jiao, actually refers to the Foot-San Jiao being the Bie Luo (Branch Collateral) of the Foot-Taiyang [Bladder] meridian. The Bie Luo is a branch collateral that merges with the main Foot-Taiyang meridian, enters and connects to the Bladder, and constrains the Lower Jiao (constrain means to restrict). In excess conditions, it causes strangury; in deficiency conditions, it causes enuresis. Although it bears the name Foot-San Jiao, it is essentially the collateral meridian of the Foot-Taiyang. Generally, the Lower Jiao belongs to the Foot meridians, so it is discussed in terms of the Bladder. *Ben Zang Pian* says "the Kidney combines with the San Jiao and Bladder," for this same reason. Wang Haogu's question was merely intended to make people understand this principle; in reality, there are no two distinct substances to divide. Various schools mentioning shapes and acupoints are merely referring to its meridians, similar to the Extraordinary Vessels like the Chong, Ren, and Du meridians. Alas! *Nanjing* serves as the wings to *Ling Shu* and *Su Wen*; *Mai Jing* is the ancestor of pulse diagnosis. *Nanjing* contains eight chapters on the Pericardium, Mingmen, and San Jiao; *Mai Jing* elucidates the essential principles of *Ling Shu* and *Su Wen*, tracing the origin of pulse diagnosis. Alas! Medicine reached divine heights with Qin Yue Ren, and Wang Shuhe can be praised for his profound thought. These two gentlemen devoted themselves to thorough research, writing works to instruct future generations, leaving no loopholes. Yet Chen Wuzhai did not believe *Nanjing* but trusted unverified local gazetteers of Longchuan. People of the world do not revere Wang Shuhe's *Mai Jing* but instead revere Gao Yangsheng's *Mai Jue*, and even rashly criticize them. Is this not like the River God discussing the vastness of the Sea God, or an ant in a mound talking about the mysteries of Mount Miaoguye? It merely shows their lack of self-awareness. My debate here, do I not know it will increase chatter? But I worry that future generations will be confused by these theories without realizing it. I wish to be a loyal minister to King Qin. Whether slandered or praised, what time is there to calculate? Confucius said: "Those who understand me, perhaps only through *Spring and Autumn Annals*; those who blame me, perhaps only through *Spring and Autumn Annals*." Privately, I desire to attach myself to this sentiment.