其病，至详至备。因《经》旨浩繁，不能遍载，此不过分大小之筋，以发软短、弛长之意云尔。（《医学阶梯》）
筋有刚柔，刚者所以束骨，柔者所以相维。亦犹经之有络，纲之有纪，故手足顶背直行附骨之筋皆坚大；
而胸腹头面支别横络之筋皆柔细也。但手足十二经之筋，又各有不同者，如手足三阳行于外，其筋多刚；手足
三阴行于内，其筋多柔。而足三阴阳明之筋，皆聚于阴器。故曰前阴者，宗筋之所聚。此又筋之大会也。（《类经》）
附爪
《经》云∶肝之合，筋也；其荣，爪也。盖爪为筋之芽，乃肝之余气。又云∶多食酸，则筋急而爪枯。酸
固入肝，过酸则爪
枯，节酸则爪润，润则肝气有余，枯则肝气涸竭也。又云∶胆应爪，爪浓色黄者，胆浓；爪薄色红者，胆薄；
爪坚色青者，胆急；爪濡色赤者，胆缓；爪直色白无纹者，胆直；爪恶色黑多纹者，胆结。又云∶足少阳之上
感于寒湿，则善痹、骨痛、爪枯。盖足少阳属胆，肝胆同宫，故其征皆如此。（《医学阶梯》）
附皮
《灵枢》云∶肺应皮，皮浓者，大肠浓；皮薄者，大肠薄；皮缓腹里大者，大肠大而长；皮急者，大肠急
而短；皮滑者，大肠直；皮肉不相离者，大肠结。心应脉，皮浓者，脉浓；皮薄者，脉薄；皮缓者，脉缓。肾
应骨，密理浓皮者，三焦膀胱浓；粗理薄皮者，三焦膀胱薄；皮急而无毫毛者，三焦膀胱急。又云∶人有肥、
有膏、有肉， 肉坚皮满者肥， 肉不坚皮缓者膏，皮肉不相离者肉。由此推之，相皮亦自有道矣。据方土而
论，南方生人，皮肤柔脆；北方生人，皮肤坚强。是皮以风土分也。据地位而论，王公大人，身体柔脆；贫贱
作苦，皮肤坚浓。是皮以颐养分也。学人明此，则形气逆、顺，有余不足之间，可得而论矣。（《医学阶梯》）
树木之精气得以上行者，皮壳为之也；人身之精气得以外达者，腠理为之也。形惟皮易死，亦易生。汗
不透则皮死，故病后则皮褪，甚则毛脱。又甚则换爪甲，肉落骨痿，皆大病所有事也。皮易生，故褪皮者，虽
轻病亦然。皮褪者，不治自复；毛脱爪换者，调理而复，肉落骨痿者，非峻补不复。（《医参》）
附肌
《经》云∶阳明主肌肉之表。又云∶气血盛则充肤热肉，血独盛则淡渗皮肤，生毫毛。肌肉之分，自有
别也。凡人一身，不过外而皮毛，内而肌肤，以至经络、脂膜、筋骨之类。所谓脂者，即近肉之膏也。肌者，
连皮之嫩膏也。而脂渗于中，其质肥而虚；肌连于皮，其质嫩而实。实则肤坚，嫩则皮润。盖美躯
华壳者，在润肌泽肤，而润泽之功，在荣养气血。故有肌粟、肌瘦、肌寒、肌热，肌虽在表，病各有因。人只
言病在肌肤为表证何哉！（《医学阶梯》）
筋骨、脂膜、肌肉、皮肤、毫毛十者，人之所借以为形者也。骨为本，筋束骨，膜裹筋，脂固膜，肉卫脂，
肌泽肉，肤统肌，皮荣肤，毛护皮，毫辅毛。譬居室然，骨也者，以为梁柱也；筋也者，以为关键也；脂膜
肌肉者，以为墙垣也，皮肤毫毛者，以为门户窗牖，所以弥缝墙垣之隙者也。一有损坏则屋敝，一有伤缺则屋
颓矣。（《医参》）
附肉
《经》云∶脾主肉。在体为肉，在脏为脾。凡人一生体浓，由禀赋有余，自幼羸瘦，属天真不足。中年
发胖，乃颐养太过；晚年不衰，缘谨守真元。皆以肉为征。《经》所谓肉为墙者，不信可验乎？至于治病，各
审所因。湿伤肉，风胜湿，甘伤肉，酸胜甘。久坐伤肉。形乐志乐，病生于肉。邪在脾胃，则病肌肉痛；邪溢
气壅，脉热肉败。由此言之，调摄盖亦多术矣。（《医学阶梯》）
附腠理
《灵枢》云∶腠理发泄，汗出溱溱。又云∶卫气者，所以温分肉，充皮肤，肥腠理，司开阖者也。故有
元府、鬼门之称。又有腠理开、汗大泄之论。汗垢从此而出，风邪从此而入。凡人周身毫毛皆有孔窍，即腠理
分际。腠理闭，外邪不能入；元府疏，汗易出。南方人好洁，元府、鬼门易开，北方人不常浴，所以垢腻护围
腠理，邪不轻犯，汗不易出。然各人赋质不同，南北间或相反，亦不必株守一说。（《医学阶梯》）
附窍
人有九窍，实十三窍。舌为心窍，廉泉为津窍，鬼门为汗窍，茎为精窍，并九窍为十三窍。（《医参》）
人身之痞泰，与《易》理相同。地天则泰，天地则痞。耳两
窍，目两窍，鼻两窍，合为坤象。鼻之下，人之中也。口一窍，前阴一窍，后阴一窍，合为干象。头至唇不动，
地道也。口至足皆动，天道也。头之上天，足之下地，人身上下合之，故能中立。逆之则泰，顺之则痞，理所
当然。人自不察耳。○王氏曰∶凡窍横者，皆有出入往来之气；窍竖者，皆有阴阳升降之气。上下九窍，外而
八万四千毛孔，皆其门户也。（《吴医汇讲》）
其病症表现，记载得极为详尽完备。因为《内经》的宗旨深奥广博，无法全部收录，这里只是区分大筋与小筋，来阐明短缩拘急、松弛延长的病机罢了。（出自《医学阶梯》）
筋有刚强与柔和之分，刚强的筋用来约束骨骼，柔和的筋用来相互维系连接。这也就像经脉中有络脉，纲纪中有细目一样，所以手足及头顶背部沿直线附着于骨骼的筋都坚实粗大；而胸腹部头面部分支横向分布的筋都柔嫩纤细。但是手足十二经的筋，又各有不同之处，例如手足三阳经行于身体外侧，其筋多属刚强；手足三阴经行于身体内侧，其筋多属柔和。而足三阴经和足阳明经的筋，都汇聚于外生殖器部位。所以说前阴部，是宗筋汇聚的地方。这又是筋的大会合之处。（出自《类经》）
附：爪甲
《内经》说：肝所合的是筋；其荣华表现在爪甲上。大概爪甲是筋的萌芽，乃是由肝之余气所化生。又说：多吃酸味食物，会导致筋脉拘急而爪甲枯槁。酸味固然入肝，但过食酸味则导致爪甲枯槁，适量食酸则爪甲润泽；润泽说明肝气有余，枯槁说明肝气枯竭。又说：胆对应爪甲，爪甲厚而颜色黄者，表示胆厚；爪甲薄而颜色红者，表示胆薄；爪甲坚硬而颜色青者，表示胆气急迫；爪甲濡软而颜色赤者，表示胆气弛缓；爪甲平直而颜色白无纹理者，表示胆气正直；爪甲恶浊而颜色黑多纹理者，表示胆气郁结。又说：足少阳经上部感受寒湿邪气，则容易患痹证、骨痛、爪甲枯槁。因为足少阳属于胆，肝胆同处一宫（互为表里），所以其征象都是如此。（出自《医学阶梯》）
附：皮肤
《灵枢》说：肺对应皮肤，皮肤厚者，大肠也厚；皮肤薄者，大肠也薄；皮肤松弛且腹部膨大者，大肠大而长；皮肤紧绷者，大肠急而短；皮肤光滑者，大肠形态正直；皮肉紧密结合不分离者，大肠郁结。心对应血脉，皮肤厚者，血脉厚；皮肤薄者，血脉薄；皮肤松弛者，血脉弛缓。肾对应骨骼，纹理致密且皮肤厚者，三焦和膀胱也厚；纹理粗糙且皮肤薄者，三焦和膀胱也薄；皮肤紧绷且无毫毛者，三焦和膀胱急迫。又说：人有肥、膏、肉三种体质，肌肉坚实且皮肤饱满的是“肥”，肌肉不坚实且皮肤松弛的是“膏”，皮肉紧密结合不分离的是“肉”。由此推断，观察皮肤也有其道。从地域来看，南方出生的人，皮肤柔嫩脆弱；北方出生的人，皮肤坚强厚实。这是皮肤因风土环境不同而有差异。从社会地位来看，王公大人，身体柔嫩脆弱；贫贱劳苦之人，皮肤坚强厚实。这是皮肤因营养供养不同而有差异。学者明白这些道理，那么形体与气机的逆顺，有余与不足的情况，就可以进行论述了。（出自《医学阶梯》）
树木的精气能够向上输送，是因为有皮壳的作用；人体的精气能够向外达表，是因为有腠理的作用。形体中只有皮肤最容易死亡，也最容易再生。汗液不透发则皮肤受损，所以大病之后会出现皮肤脱屑，严重时甚至毛发脱落。更严重的会出现更换爪甲、肌肉萎缩、骨骼痿弱，这些都是大病才会出现的情况。皮肤容易再生，所以脱皮者，即使是轻病也是如此。皮肤脱落后，不治也能自行恢复；毛发脱落、爪甲更换者，经过调理可以恢复；肌肉萎缩、骨骼痿弱者，非用峻猛补益之法不能恢复。（出自《医参》）
附：肌肉
《内经》说：阳明经主司肌肉的表面。又说：气血旺盛则充盈肌肤、温暖肌肉，若血独盛则淡渗于皮肤，生长毫毛。肌肉的分界，自然有别。凡人全身，不外乎外在的皮毛，内在的肌肤，以及经络、脂膜、筋骨之类。所谓“脂”，就是靠近肌肉的膏油。所谓“肌”，就是连接皮肤的嫩膏。脂渗透在内部，质地肥腻而虚松；肌连接在皮肤下，质地柔嫩而坚实。坚实则皮肤坚固，柔嫩则皮肤润泽。大概美化躯干华美的外壳，在于滋润肌肉、光泽皮肤，而润泽的功效，在于荣养气血。所以有肌粟、肌瘦、肌寒、肌热等症，肌虽然位于体表，但病因各不相同。人们只说病在肌肤属于表证，为什么呢！（出自《医学阶梯》）
骨、筋、脂膜、肌肉、皮肤、毫毛这十者，是人借以构成形体的材料。骨为根本，筋约束骨骼，膜包裹筋，脂巩固膜，肉护卫脂，肌滋养肉，肤统领肌，皮荣华肤，毛保护皮，毫辅助毛。这就好比居室一样，骨相当于梁柱；筋相当于关键枢纽；脂膜肌肉相当于墙垣；皮肤毫毛相当于门户窗牖，是用来填补墙垣缝隙的。一旦有损坏，房屋就破旧；一旦有伤缺，房屋就坍塌了。（出自《医参》）
附：肉
《内经》说：脾主司肉。在形体表现为肉，在脏腑对应脾。凡人一生体型粗壮，是由于禀赋有余；自幼消瘦羸弱，属于先天真气不足。中年发胖，是因为调养过度；晚年不衰，是因为谨守真元。都是以肉的状态作为征象。《内经》所说的“肉为墙”，难道不值得验证吗？至于治病，必须审察病因。湿邪伤肉，风胜湿；甘味伤肉，酸胜甘。久坐伤肉。形体安逸、精神愉悦，病生于肉。邪气在脾胃，则病见肌肉疼痛；邪气溢出、气机壅滞，脉热肉败。由此而言，调摄养生也有很多方法。（出自《医学阶梯》）
附：腠理
《灵枢》说：腠理发泄，汗出淋漓。又说：卫气，是用来温煦分肉、充实皮肤、肥满腠理、主管开阖的。所以有元府、鬼门的称呼。又有腠理开泄、大汗淋漓的说法。汗垢从此排出，风邪从此进入。凡人周身毫毛都有孔窍，这就是腠理的界限。腠理闭合，外邪就不能侵入；元府疏泄，汗液容易排出。南方人爱干净，元府、鬼门容易开启；北方人不常洗澡，所以污垢油脂包围保护着腠理，邪气不易侵犯，汗液不易排出。然而每个人的体质禀赋不同，南北之间有时相反，也不必固执坚守一种说法。（出自《医学阶梯》）
附：九窍
人有九窍，实际上是十三窍。舌是心窍，廉泉是津液之窍，鬼门（汗孔）是汗窍，茎（生殖器）是精窍，加上原有的九窍，共为十三窍。（出自《医参》）
人身的气机痞塞或通泰，与《易经》的道理相同。地天交泰则为“泰”，天地不交则为“痞”。耳两窍、目两窍、鼻两窍，合起来象征坤卦（地）。鼻子之下，人体之中部。口一窍、前阴一窍、后阴一窍，合起来象征乾卦（天）。头部到嘴唇不动，代表地道。口到脚都能动，代表天道。头在上为天，足在下为地，人身上下相合，所以能中立。违背这个规律则通泰，顺应这个规律则痞塞，这是理所当然的。只是人们自己不加考察罢了。○王氏说：凡是横着的窍，都有出入往来的气机；竖着的窍，都有阴阳升降的气机。上下的九窍，外加八万四千毛孔，都是气的门户。（出自《吴医汇讲》）
The manifestations of its diseases are recorded in extreme detail and completeness. Because the purport of the *Classic* (Neijing) is profound and extensive, it cannot be fully recorded here; this merely distinguishes between large and small tendons to elucidate the pathogenesis of shortening with spasm and relaxation with elongation. (From *Yixue Jieti*)
Tendons possess both rigidity and flexibility. The rigid ones bind the bones, while the flexible ones provide mutual support and connection. This is analogous to collaterals within meridians or threads within a net. Therefore, the tendons running straight along the limbs, vertex, and back that attach to the bones are firm and large; whereas the tendons branching horizontally across the chest, abdomen, head, and face are soft and fine. However, the tendons of the twelve meridities of the hands and feet differ from one another. For instance, the three Yang meridians of the hands and feet run on the exterior, so their tendons are mostly rigid; the three Yin meridians of the hands and feet run on the interior, so their tendons are mostly flexible. The tendons of the Foot Three Yin and Foot Yangming meridians all converge at the external genitalia. Thus it is said: "The anterior yin is the gathering place of the Zongjin (Major Tendons)." This represents the great convergence of tendons. (From *Leijing*)
Appendix: Nails
The *Classic* states: "The Liver harmonizes with the tendons; its flourishing manifests in the nails." Essentially, nails are the sprouts of the tendons, formed from the surplus Qi of the Liver. It is also stated: "Excessive consumption of sour flavor leads to tendon spasm and nail withering." Although sour flavor enters the Liver, excessive sourness causes nails to wither, while moderate sourness keeps them moist. Moisture indicates excess Liver Qi, while withering indicates depletion of Liver Qi. It is further stated: "The Gallbladder corresponds to the nails. Thick nails with yellow color indicate a thick Gallbladder; thin nails with red color indicate a thin Gallbladder; hard nails with blue-green color indicate urgent Gallbladder Qi; soft nails with red color indicate relaxed Gallbladder Qi; straight nails with white color and no lines indicate upright Gallbladder Qi; ugly nails with black color and many lines indicate knotted Gallbladder Qi." It is also stated: "When the upper part of the Foot Shaoyang Meridian is affected by cold-dampness, it predisposes to Bi syndrome, bone pain, and nail withering." Since the Foot Shaoyang belongs to the Gallbladder, and the Liver and Gallbladder share the same palace (interior-exterior relationship), their signs are thus similar. (From *Yixue Jieti*)
Appendix: Skin
The *Ling Shu* states: "The Lung corresponds to the skin. Thick skin indicates thick Large Intestine; thin skin indicates thin Large Intestine; loose skin with a distended abdomen indicates a large and long Large Intestine; tight skin indicates an urgent and short Large Intestine; smooth skin indicates a straight Large Intestine; skin and flesh firmly adhered without separation indicate a knotted Large Intestine. The Heart corresponds to the vessels. Thick skin indicates thick vessels; thin skin indicates thin vessels; loose skin indicates relaxed vessels. The Kidney corresponds to the bones. Dense texture with thick skin indicates thick Sanjiao and Bladder; coarse texture with thin skin indicates thin Sanjiao and Bladder; tight skin without hair indicates urgent Sanjiao and Bladder." It is also stated: "Humans have three constitutions: Fei (Fat), Gao (Pasty), and Rou (Muscular). Firm muscle with full skin is Fei; non-firm muscle with loose skin is Gao; skin and flesh firmly adhered without separation is Rou." From this, we can deduce that observing the skin has its own principles. Geographically, people born in the South have soft and fragile skin; people born in the North have strong and thick skin. Thus, skin varies by local environment. Socially, nobles and officials have soft and fragile bodies; the poor and laborers have strong and thick skin. Thus, skin varies by nourishment. Scholars who understand this can discuss the reversal or smoothness of form and Qi, and the conditions of excess or deficiency. (From *Yixue Jieti*)
Just as the essence and Qi of trees ascend through the bark, the essence and Qi of the human body reach the exterior through the Couli (interstices). Among the forms, only the skin is prone to death but also quick to regenerate. If sweat does not penetrate, the skin dies; hence, after illness, the skin peels, and severely, hair falls out. Even more severely, nails may shed, muscles waste away, and bones become flaccid, which are events associated with severe diseases. Skin regenerates easily; thus, even in mild cases of skin peeling, it occurs. Peeling skin heals spontaneously without treatment; fallen hair and shed nails recover with conditioning; wasted muscles and flaccid bones require potent tonification to recover. (From *Yican*)
Appendix: Muscles
The *Classic* states: "The Yangming Meridian governs the surface of the muscles." It also states: "Abundant Qi and Blood fill the skin and warm the muscles; if Blood alone is abundant, it渗 (seeps) into the skin, generating hair." There are distinct differences among muscle layers. The entire human body consists externally of hair and skin, internally of muscle and flesh, and further includes meridians, fatty membranes, bones, and tendons. What is called 'Zhi' (fat) is the grease near the muscle. What is called 'Ji' (muscle proper) is the tender grease connected to the skin. Zhi permeates the interior, being fatty and void; Ji connects to the skin, being tender and solid. Solidity makes the skin firm; tenderness makes the skin moist. Generally, beautifying the body's magnificent shell lies in moistening the muscle and shining the skin, and the function of moistening and shining depends on nourishing Ying and Wei Qi. Therefore, there are conditions such as rice-grain-like bumps in muscle, emaciated muscle, cold muscle, and hot muscle. Although muscle is superficial, each disease has its specific cause. Why do people simply say that diseases in muscle and skin are exterior syndromes! (From *Yixue Jieti*)
Bone, tendon, fatty membrane, muscle, skin, and hair—these ten elements are what humans borrow to form their shape. Bone is the root; tendons bind the bones; membranes wrap the tendons; fat consolidates the membranes; muscles guard the fat; muscle nourishes the meat; skin governs the muscle; skin flourishes the skin; hair protects the skin; fine hair assists the hair. It is like a house: bone serves as beams and pillars; tendons serve as hinges; fatty membranes and muscles serve as walls; skin and hair serve as doors and windows, filling the gaps in the walls. Any damage leads to a dilapidated house; any injury leads to collapse. (From *Yican*)
Appendix: Flesh/Muscle
The *Classic* states: "The Spleen governs the flesh. In the body, it manifests as flesh; in the zang organs, it corresponds to the Spleen." A person's robust physique throughout life stems from sufficient endowment; congenital emaciation belongs to insufficient innate True Yuan. Middle-aged obesity results from excessive nourishment; late-life vitality arises from guarding the True Yuan. All these are evidenced by the state of the flesh. Does not the *Classic*'s statement that "flesh acts as a wall" warrant verification? Regarding treatment, one must examine the cause. Dampness injures the flesh; Wind overcomes Dampness. Sweet flavor injures the flesh; Sour overcomes Sweet. Prolonged sitting injures the flesh. Physical ease and mental joy lead to diseases arising in the flesh. Pathogenic factors in the Spleen and Stomach result in muscle pain; overflowing pathogens and stagnant Qi cause heat in the pulse and failure of the flesh. Thus, regulation and maintenance involve many methods. (From *Yixue Jieti*)
Appendix: Couli (Interstices)
The *Ling Shu* states: "Couli vent, causing profuse sweating." It also states: "Wei Qi warms the fenrou (divided muscles), fills the skin, plumps the Couli, and controls opening and closing." Hence, they are called Yuanfu (Original Gates) and Guimen (Ghost Gates). There is also discussion of open Couli and massive sweating. Sweat and grime exit here; wind pathogens enter here. Every hair follicle on the body has an orifice, which is the boundary of the Couli. Closed Couli prevent external pathogens from entering; open Yuanfu facilitate sweating. Southerners value cleanliness, so their Yuanfu and Guimen open easily; Northerners bathe infrequently, so grime and oil protect the Couli, preventing easy invasion by pathogens and making sweating difficult. However, individual constitutions vary, and sometimes North and South are reversed; one need not rigidly adhere to a single theory. (From *Yixue Jieti*)
Appendix: Orifices
Humans have nine orifices, actually thirteen. The tongue is the Heart orifice; Lianquan is the fluid orifice; Guimen (sweat pores) is the sweat orifice; the penis is the essence orifice. Combined with the nine standard orifices, there are thirteen. (From *Yican*)
The obstruction or smoothness of Qi in the human body is consistent with the principles of the *I Ching*. Earth over Heaven constitutes Tai (Peace); Heaven over Earth constitutes Pi (Stagnation). Two ear orifices, two eye orifices, and two nasal orifices combine to symbolize the Kun trigram (Earth). Below the nose lies the middle of the human body. One mouth orifice, one anterior yin orifice, and one posterior yin orifice combine to symbolize the Qian trigram (Heaven). From the head to the lips is motionless, representing the Earthly Dao. From the mouth to the feet is mobile, representing the Heavenly Dao. The head is above as Heaven, the feet are below as Earth; the upper and lower parts of the human body combine, allowing for upright standing. Going against this leads to Tai (smoothness/peace), following it leads to Pi (stagnation/blockage), which is the natural order. People simply fail to observe this. ○ Master Wang said: Horizontal orifices have Qi moving in and out; vertical orifices have Yin and Yang ascending and descending. The nine upper and lower orifices, plus eighty-four thousand external hair pores, are all gates for Qi. (From *Wu Yi Hui Jiang*)