喉在咽前,其系坚空,连接肺本,为气息之路。呼吸出入,由肺橐龠。肺居
胸上,覆诸脏腑,故称华盖。虚如蜂窠,下无透窍,吸气则满,呼气则虚。肺气上
通鼻窍,故谓肺开窍于鼻也。肺下为心,心有系络,上系于肺。心中有窍,
与肺不同。心气上通于舌,故谓心开窍于舌。(按舌之腠理,即窍也。《原病式》注云∶
古知味,不可云无窍,但细微,不似耳目等窍之大耳。故守真曰∶玄腑者,玄微腑也
。脏腑皮毛骨肉筋膜,无处不有,乃气出入升降之门路。以此推之,则心窍在舌,
可默会矣。若泥耳目等窍求之,固矣。)心外有心包络,即
膻中也。形如仰盂,以包裹此心,使邪不能犯。犯者,包络当之。若犯至心即死
矣。脾、胃、肝、胆、肾、膀胱各有一系,系于包络之旁,以通于心。此三者,皆
在膈上。膈者,隔也。有膜与脊胁周回相着,遮蔽膈下浊气,使不得上熏
心肺。膈膜之下为肝,肝气上通于目,故谓肝开窍于目。肝叶中有胆,胆中有
汁,藏而不泻。以上肺、心、心包络、肝、胆,皆从喉之一路而下者也。咽在喉后,
咽系柔空,下接胃本,为饮食之路,水谷由此入胃,与喉之气道不相犯。盖喉窍有
一会厌覆之,如皮如膜发声则开,咽食则闭。故水谷下咽,了不犯喉。若当食
而发声,则会厌忽开,食错入喉,喉不容物,遂呛而出矣。胃在膈膜之下,其上之
左有脾,形如刀镰,能动而磨食使消化。脾气上通于口,故谓脾开窍于口也。胃之
下口连小肠,小肠后附脊膂,前附脐之上,左环周回叠积,共盘十六曲。小肠
之下口,右接大肠,(亦名回肠。)当脐左回周叠积,亦盘十六曲。其下为广肠,附
脊左环叠积。其下名直肠,出肛门,为粪道。(广肠,即大肠下节之更大者。直肠,
又广肠之末节耳。)广肠之左侧为膀胱,膀胱上无窍,只有下口出尿。饮食入胃,得脾消
运,其精华之气,上升于肺。肺布之周身,以充血液,其余下入小肠。小肠受三焦
之气化,泌别清浊,糟粕趋大肠以出,水饮渗入膀胱,(小肠与膀胱,虽皆无窍相通,而得
气运化,腠理可以渗灌。)为尿以出。此全赖三焦气化施行,若气不施化,则闭塞不通而
病矣。以上脾、胃、小肠、大肠、膀胱,皆从咽之一路而下者也。肾有两,形如豆,左右
相对,而附于脊,各有二系,上系系于心,下系系于脊。肾气上通于耳,故谓肾开窍
于耳也。心、肺、脾、肝、肾为五脏。脏者,藏也,所藏惟精气,藏而不泻者也。胆、胃、
大小肠、膀胱为腑,腑如库之贮物。胆所贮者汁,亦藏而不泻。余所贮者水谷,则
泻而不藏。虽有泻、不泻之殊,而均有所贮,则均谓之腑。但胆所贮者乃精汁,
与水谷之滓秽不同,故胆独名为清净之腑也。心属火,肾属水,肝属木,肺
属金,脾属土。而小肠与心经脉相连,故从心属火;膀胱与肾经脉相连,故从肾
属水;胆与肝经脉相连,故从肝属木;大肠与肺经脉相连,故从肺属金;胃与脾经
脉相连,故从脾属土。而脏属阴,则配乙、丁、己、癸、辛之阴干。故肝称乙木,
心称丁火,脾称己土,肾称癸水,肺称辛金。腑为阳,则配甲、丙、戊、
庚、壬之阳干。故胆称甲木,小肠称丙火,胃称戊土,大肠称庚金,膀胱称壬水也。
五脏五腑,两其五行而为十干止矣。而益以心包络与三焦为十二,何也?此千古所
未明,而不可不言者,说见后篇。
咽喉位于咽部的前方,其结构坚实中空,连接肺的根本,是气息进出的通道。呼吸的出入,依赖于肺如同风箱般的运动。肺位于胸部上方,覆盖在所有脏腑之上,因此被称为“华盖”。肺内部空虚如同蜂巢,下方没有透气的孔窍,吸气时充满,呼气时虚空。肺气向上通达鼻窍,所以说肺开窍于鼻。
肺的下方是心,心有脉络相连,向上系连于肺。心脏中有孔窍,这与肺不同。心气向上通达于舌,所以说心开窍于舌。(按:舌表面的纹理,就是孔窍。《原病式》注释说:古代认为舌头能辨别滋味,不能说没有孔窍,只是孔窍细微,不像耳朵、眼睛等孔窍那样大罢了。所以刘完素(守真)说:玄腑,是指玄妙微细的腑。脏腑、皮毛、骨肉、筋膜,无处不有,都是气出入升降的门路。由此推论,心窍在舌,可以默会领悟了。如果拘泥于像耳、目那样的孔窍去寻找,那就固陋不通了。)心的外面有心包络,也就是膻中穴所在之处。形状像倒扣的盂,用来包裹心脏,使邪气不能侵犯。如果邪气侵犯,由心包络抵挡。如果邪气直接侵犯到心,人就会死亡。
脾、胃、肝、胆、肾、膀胱各有一条系带,系带在心包络的旁边,以连通心脏。这六个脏器都在膈膜的上方。膈,就是隔断的意思。有一层膜与脊柱和肋骨周围相连,遮蔽膈膜下方的浊气,使其不得向上熏蒸心肺。
膈膜之下是肝,肝气向上通达于目,所以说肝开窍于目。肝脏叶片中有胆囊,胆囊中有胆汁,贮藏而不排泄。以上提到的肺、心、心包络、肝、胆,都是从喉咙这一条路径向下分布的。
咽部在喉部的后方,咽的结构柔嫩中空,向下连接胃的根本,是饮食进入的通道,水谷由此进入胃中,与喉部的气道互不干扰。大概是因为喉部口窍处有一会厌覆盖,它像皮膜一样,发声时张开,吞咽食物时闭合。所以水谷下咽时,完全不会侵入喉部。如果在进食时发声,会厌突然张开,食物误入喉部,喉部不容纳食物,就会呛咳出来。
胃位于膈膜之下,其左上侧有脾,形状像刀镰,能够蠕动磨碎食物使其消化。脾气向上通达于口,所以说脾开窍于口。
胃的下口连接小肠,小肠后附脊柱,前附肚脐上方,左侧环绕重叠堆积,共有十六个弯曲。小肠的下口,右侧连接大肠(也称为回肠),在肚脐左侧环绕重叠堆积,也有十六个弯曲。大肠的下端是广肠,附着于脊柱左侧环绕重叠堆积。再往下是直肠,通向肛门,作为排泄粪便的通道。(广肠,就是大肠下端较大的部分。直肠,又是广肠的最末端。)
广肠的左侧是膀胱,膀胱上部没有孔窍,只有下口排出尿液。饮食进入胃中,得到脾的消化运化,其中精华之气,上升到肺。肺将精气布散到全身,以充盈血液,其余部分向下进入小肠。小肠接受三焦的气化作用,分别清浊,糟粕趋向大肠排出,水液渗入膀胱(小肠与膀胱,虽然都没有直接的孔窍相通,但通过气化运行,腠理可以渗透灌注),形成尿液排出。这完全依赖三焦的气化施行,如果气不能施化,就会闭塞不通而生病。以上提到的脾、胃、小肠、大肠、膀胱,都是从咽部这一条路径向下分布的。
肾有两个,形状像豆子,左右相对,附着于脊柱,各有两条系带,上端系连于心,下端系连于脊柱。肾气向上通达于耳,所以说肾开窍于耳。
心、肺、脾、肝、肾称为五脏。“脏”的意思是贮藏,所贮藏的只是精气和神气,贮藏而不排泄。胆、胃、小肠、大肠、膀胱称为六腑,“腑”就像仓库一样贮存物品。胆所贮存的是胆汁,也是贮藏而不排泄。其余腑所贮存的是水谷,则是排泄而不贮藏。虽然有排泄和不排泄的区别,但都有一定的贮存量,所以都称为腑。但是胆所贮存的是精汁,与水谷的渣滓秽物不同,所以胆单独被称为“清净之腑”。
心属火,肾属水,肝属木,肺属金,脾属土。而小肠与心的经脉相连,所以从属于心,属火;膀胱与肾的经脉相连,所以从属于肾,属水;胆与肝的经脉相连,所以从属于肝,属木;大肠与肺的经脉相连,所以从属于肺,属金;胃与脾的经脉相连,所以从属于脾,属土。
脏属阴,所以配属乙、丁、己、癸、辛这些阴干。所以肝称为乙木,心称为丁火,脾称为己土,肾称为癸水,肺称为辛金。腑属阳,所以配属甲、丙、戊、庚、壬这些阳干。所以胆称为甲木,小肠称为丙火,胃称为戊土,大肠称为庚金,膀胱称为壬水。
五脏五腑,配合五行成为十个天干就止于此了。再加上心包络和三焦成为十二个,为什么呢?这是千古以来未曾阐明,但不能不说的内容,说法见后篇。
The larynx (throat) is located anterior to the pharynx, with a firm and hollow structure connecting to the root of the Lung, serving as the pathway for breath. Respiration enters and exits through the movement of the Lung, which acts like a bellows. The Lung resides in the upper chest, covering all other zang-fu organs, hence it is called the "Canopy" (Hua Gai). Its interior is hollow like a honeycomb, with no perforations at the bottom; it fills upon inhalation and becomes empty upon exhalation. Lung Qi connects upward to the nasal orifices, thus it is said that the Lung opens into the nose.
Below the Lung is the Heart. The Heart has meridians and collaterals connecting it upward to the Lung. The Heart possesses an orifice, which differs from the Lung. Heart Qi connects upward to the tongue, thus it is said that the Heart opens into the tongue. (Note: The texture on the surface of the tongue constitutes the orifice. The commentary in *Yuan Bing Shi* states: In ancient times, it was known that the tongue perceives taste, so one cannot say it lacks an orifice; it is merely minute, not as large as the orifices of the ears and eyes. Therefore, Liu Wansu (Zishou) stated: The Xuan Fu refers to the subtle and profound fu organ. There are no places without qi pathways for entry, exit, ascent, and descent within the zang-fu, skin, hair, flesh, bones, and sinews. By this reasoning, the Heart's orifice being in the tongue can be intuitively understood. If one rigidly seeks it by analogy to the ear and eye orifices, it would be inflexible.) Outside the Heart lies the Pericardium (Xin Bao Luo), also known as the Shanzhong area. It is shaped like an inverted bowl, wrapping around the Heart to prevent pathogenic factors from invading. If invasion occurs, the Pericardium bears the brunt. If pathogens reach the Heart directly, death ensues.
The Spleen, Stomach, Liver, Gallbladder, Kidney, and Bladder each have a ligamentous connection situated beside the Pericardium, linking them to the Heart. These six organs are all located above the diaphragm. The diaphragm serves as a partition. A membranous layer attaches circumferentially to the spine and ribs, shielding the turbid qi below the diaphragm from ascending to harass the Heart and Lung.
Below the diaphragm lies the Liver. Liver Qi connects upward to the eyes, thus it is said that the Liver opens into the eyes. Within the liver lobes lies the Gallbladder, which stores bile but does not discharge it. The aforementioned Lung, Heart, Pericardium, Liver, and Gallbladder are all distributed downward along the pathway of the throat.
The pharynx is located posterior to the larynx. Its structure is soft and hollow, connecting downward to the root of the Stomach, serving as the pathway for food and drink. Water and grain enter the Stomach through here, distinct from the airway of the larynx. This is because the laryngeal orifice is covered by the epiglottis, which resembles a membrane; it opens during phonation and closes during swallowing. Thus, when food and drink pass down, they do not interfere with the larynx. However, if one speaks while eating, the epiglottis may suddenly open, allowing food to mistakenly enter the larynx. Since the larynx cannot accommodate solids, choking occurs.
The Stomach is located below the diaphragm. To its upper left is the Spleen, shaped like a sickle, capable of peristalsis to grind and digest food. Spleen Qi connects upward to the mouth, thus it is said that the Spleen opens into the mouth.
The lower outlet of the Stomach connects to the Small Intestine. The Small Intestine attaches posteriorly to the spine and anteriorly above the umbilicus, coiling and stacking on the left side with sixteen curves. The lower outlet of the Small Intestine connects on the right to the Large Intestine (also called Hui Chang), which coils and stacks on the left side of the umbilicus, also having sixteen curves. Below this is the Guang Chang (broad intestine), attaching to the left side of the spine in a coiled stack. Below that is the Zhi Chang (straight intestine), exiting through the anus as the fecal passage. (The Guang Chang is the larger lower segment of the Large Intestine. The Zhi Chang is the terminal segment of the Guang Chang.)
To the left of the Guang Chang is the Bladder. The Bladder has no upper orifice, only a lower outlet for urination. When food and drink enter the Stomach, the Spleen digests and transports them. The essence qi rises to the Lung. The Lung distributes it throughout the body to nourish blood, while the remainder descends into the Small Intestine. The Small Intestine undergoes the qi transformation of the San Jiao (Triple Burner), separating the clear from the turbid. Waste moves toward the Large Intestine for excretion, while fluids seep into the Bladder. (Although the Small Intestine and Bladder lack direct orificial connections, qi transformation allows permeation through the interstices.) Urine is formed and expelled. This relies entirely on the qi transformation of the San Jiao; if qi fails to transform, obstruction and disease occur. The aforementioned Spleen, Stomach, Small Intestine, Large Intestine, and Bladder are all distributed downward along the pathway of the pharynx.
There are two Kidneys, bean-shaped, positioned opposite each other and attached to the spine. Each has two ligaments, the upper ones connecting to the Heart and the lower ones to the spine. Kidney Qi connects upward to the ears, thus it is said that the Kidney opens into the ears.
The Heart, Lung, Spleen, Liver, and Kidney are the Five Zang Organs. "Zang" means storage; they store essence and qi, retaining rather than discharging. The Gallbladder, Stomach, Small Intestine, Large Intestine, and Bladder are the Six Fu Organs. "Fu" is like a warehouse storing substances. The Gallbladder stores bile, which is retained and not discharged. The others store food and drink, which are discharged and not retained. Although there is a difference between discharging and not discharging, since all store substances, they are all termed Fu. However, the substance stored in the Gallbladder is pure juice, different from the dregs of food and drink; therefore, the Gallbladder is uniquely named the "Clear and Pure Fu."
The Heart belongs to Fire, the Kidney to Water, the Liver to Wood, the Lung to Metal, and the Spleen to Earth. The Small Intestine connects via meridians to the Heart, so it follows the Heart and belongs to Fire; the Bladder connects to the Kidney, so it follows the Kidney and belongs to Water; the Gallbladder connects to the Liver, so it follows the Liver and belongs to Wood; the Large Intestine connects to the Lung, so it follows the Lung and belongs to Metal; the Stomach connects to the Spleen, so it follows the Spleen and belongs to Earth.
Zang organs belong to Yin and correspond to the Yin Heavenly Stems: Yi, Ding, Ji, Gui, Xin. Thus, the Liver is called Yi Wood, the Heart Ding Fire, the Spleen Ji Earth, the Kidney Gui Water, and the Lung Xin Metal. Fu organs belong to Yang and correspond to the Yang Heavenly Stems: Jia, Bing, Wu, Geng, Ren. Thus, the Gallbladder is called Jia Wood, the Small Intestine Bing Fire, the Stomach Wu Earth, the Large Intestine Geng Metal, and the Bladder Ren Water.
The Five Zang and Five Fu organs, combined with the Five Elements, result in ten Heavenly Stems. Why add the Pericardium and San Jiao to make twelve? This is a matter unclarified since antiquity but must be discussed; the explanation appears in the following chapter.