或问三焦既无形,何《气府篇》有少阳脉气所发者,三十二穴,《缪刺篇》有少阳之络,《经脉篇》有三
焦少阳之脉,《经别篇》有少阳心主之正,《经筋篇》有少阳心主之筋,《卫气篇》有少阳心主之本等语,似
涉有形。今曰无形,然则彼皆非耶?余曰∶所谓有形者,指其经根据附各属经络而流贯者言也。因有此经,故有
此病。云无形者,非若五腑称长若干,重若干,受盛若干云云,若独指其经脉起止俞穴主病等语,便谓有形,
不思奇经冲任督等脉,皆有起止,亦皆主病可指,如有形府例看否耶?有形之说不辨而其谬自明矣。(《医旨绪余》)
胆
胆者,中正之官,决断出焉。《难经》曰∶胆在肝之短叶间,重三两三铢,长三寸,盛精汁三合,是经
多气少血。按华元化曰∶胆者,中清之府,号曰将军,主藏而不泻。(李士材)
勇者气行则止,怯者着而为病。《经》言最宜旁通。凡人之所不畏者,皆是也。遇大风不畏,则不为风
伤。遇大寒大热不畏,则不为寒热中。饱餐非出于勉强,则必无留滞之患。气以胆壮,邪不能干。故曰十一脏
皆取决于胆。(《医参》)
肝
肝者,将军之官,谋虑出焉。肝居膈下,上着脊之九椎下,是经多血少气。其合筋也,其荣爪也;主藏魂,
开窍于目;其系上络心肺,下亦无窍。《难经》曰∶肝重二斤四两,左三叶,右四叶,凡七叶。(李士材)
附腔子、脂膜
常考《类经》,以三焦指腔子而言。但腔子未必尽属三焦,而实包罗乎三焦。如藏者为里之里,所谓心、
肝、脾、肺、肾是也;出者为里之表,所谓魂、魄、神、志、意是也。是腔子之内,尚有表里之别,而腔子之
阴阳,顾可不分晰乎?夫五脏所藏魂、魄、神、志、意及精、血等类,运于里而通于表,阴中有阳也。六腑所
藏水谷、溺秽、津液等类,泄于表而根于里,阳中有阴也。腔子内,其精者,为神、为气、为性、为情;其粗
者,为脂、为膜。所生者神,所运者气。禀于天,有刚、柔、纯、杂为性;触于感,有喜、怒、哀、乐为情。
医者审其神气,察其性情,不独因病别方,仍须因人别病。故有同一病而不同一治者,非偶然也。至于脂膜,
亦有分别。人止言腔子脏腑有阴阳,不言脂膜有表里。《内经》云∶心主身之血脉,肝主身之筋膜。《类经》
云∶三焦其体,有脂膜在腔子之内。景岳以三焦指腔子,余更以脂膜分表里。凡肥者为脂、为表,瘦者为膜、
为里。近肉者为脂、为表,裹骨包脉者为膜、为里也。苟不明脂膜之理,则脏自为脏,腑自为腑,肉之为肉,
骨之为骨。骨肉脏腑不相联系,则躯壳腔子岂不散乎?脂膜表里既已辨晰,则因其深浅、浓薄,而治法之次第,
可得而分矣。(《医学阶梯》)
膜者,非皮、非肉,与脂相附。五脏六腑,以此遮护。豕腹内版油贴处,即此物也。裹肠曰花油,贴腔子
曰版油,皆脂之谓也。膜在脂外肉内,形如薄皮,内护腔子,如纸糊壁,在人身半表里之间,与少阳为六经之
半表半里不同,故腔子上膜为疫邪所伏,疫邪从口鼻吸入,不能循经,又为后来真气所逼,故遇脂膜,即以少
休,因而潜伏膜原。邪入无所知觉,由乎此也。积久不安,以时发作。
或正气搜索及此而驱逐之,或外触时气而出,内外分传。惟其所向,谓其入里多而达表少者,外肉坚难走,内
脂柔易趋故也。(《医参》)
有人问:既然三焦没有具体的形态,为什么《气府篇》中记载了少阳脉气所发出的三十二个穴位,《缪刺篇》中有少阳的络脉,《经脉篇》中有三焦和少阳的经脉,《经别篇》中有少阳和心包的正经,《经筋篇》中有少阳和心包的经筋,《卫气篇》中有少阳和心包的根本等说法,这似乎涉及有形的实体。现在却说它无形,那么那些记载都不对吗?我说:所谓有形,是指它的经络依附于各所属的经络而流注贯通而言。因为有了这条经脉,所以才会产生相关的病证。说它无形,并不是像五脏六腑那样称其长度若干、重量若干、容量若干等等。如果仅仅指着它的经脉起止点、俞穴主治病症等说法,就认为是有形,那就不思考奇经八脉中的冲脉、任脉、督脉等,也都有起止点,也都主治病证,难道也要把它们当作有形的脏腑来看待吗?如果不辨析“有形”这一说法,其中的谬误自然就会显露出来。(出自《医旨绪余》)
胆
胆是中正之官,决断的功能由此产生。《难经》说:胆位于肝脏的短叶之间,重三两三铢,长三寸,容纳精汁三合,这条经脉是多气少血。据华元化说:胆是中清之府,号称将军,主要功能是贮藏精气而不泻出。(李士材评述)
勇敢的人,气机运行通畅则病邪自止;怯懦的人,气机郁滞就会成为病证。经典中的言论最宜旁通理解。凡是人们不畏惧的事物,都是如此。遇到大风而不畏惧,就不会被风邪伤害。遇到大寒或大热而不畏惧,就不会被寒热邪气侵袭。饱餐如果不是出于勉强,就一定不会有饮食停滞的祸患。气机因胆气壮盛而稳固,邪气就不能侵犯。所以说十一脏的功能都取决于胆。(出自《医参》)
肝
肝是将军之官,谋虑的功能由此产生。肝位于膈肌之下,向上附着在脊柱第九椎骨下方,这条经脉是多血少气。它与筋相合,其荣华表现在爪甲上;主要功能是贮藏魂,开窍于眼睛;它的系带向上联络心和肺,向下也没有孔窍。《难经》说:肝重二斤四两,左边有三叶,右边有四叶,总共七叶。(李士材评述)
附:腔子、脂膜
经常考证《类经》,是以三焦指代腔子(胸腔腹腔整体)。但腔子未必完全属于三焦,而是实际上包罗了三焦。如藏精气的是里中之里,所说的就是心、肝、脾、肺、肾;排出糟粕的是里中之表,所说的就是魂、魄、神、志、意。这样看来,腔子之内,还有表里的区别,而腔子的阴阳,难道可以不分析清楚吗?五脏所藏的魂、魄、神、志、意以及精、血等类物质,运化于里而通达于表,这是阴中有阳。六腑所藏的水谷、溺秽、津液等类物质,排泄于表而根源于里,这是阳中有阴。在腔子内部,其中精微的部分,表现为神、气、性、情;其中粗浊的部分,表现为脂、膜。所生成的是神,所运化的是气。禀受于先天,有刚、柔、纯、杂的区别而形成性;接触外界感应,有喜、怒、哀、乐的变化而形成情。医生审察患者的神气,观察其性情,不仅因病辨证选方,还必须因人制宜区分病情。所以有同样的病却采用不同的治疗方法,这不是偶然的。至于脂膜,也有分别。人们只说腔子内的脏腑有阴阳之分,不说脂膜有表里之别。《内经》说:心主身之血脉,肝主身之筋膜。《类经》说:三焦的形体,在腔子内有脂膜存在。张景岳以三焦指代腔子,我更以脂膜来分表里。凡肥厚者为脂、为表,瘦薄者为膜、为里。靠近肌肉的为脂、为表,包裹骨骼脉络的为膜、为里。如果不明白脂膜的道理,那么脏就是脏,腑就是腑,肉就是肉,骨就是骨。骨肉脏腑互不联系,那么躯壳腔子岂不会散乱吗?既然已经辨晰了脂膜的表里,那么根据其深浅、浓薄的不同,治疗方法的次第就可以分辨出来了。(出自《医学阶梯》)
膜,不是皮肤,也不是肌肉,与脂相连附。五脏六腑,以此遮护保护。猪腹部内版油贴附的地方,就是这个东西。包裹肠道的叫花油,贴附腔子的叫版油,都属于脂的范畴。膜在脂的外面、肉的里面,形状像薄皮,在内侧保护腔子,就像纸糊墙壁一样,在人身处于半表半里的位置,这与少阳作为六经的半表半里不同,所以腔子上的膜容易被疫邪潜伏,疫邪从口鼻吸入,不能循着经脉运行,又被后来的真气逼迫,所以在遇到脂膜时稍微休息,因而潜伏在膜原。邪气进入后无所知觉,就是由于这个原因。积累久了不安定,按时发作。
或者是正气搜索到此处并驱逐它,或者是外感时令之气而出,内外分传。随其所向,说是入里多而达表少,是因为外面的肉坚硬难以行走,里面的脂柔软容易趋向的缘故。(出自《医参》)
A question is raised: Since the Sanjiao (Triple Burner) has no specific form, why does the *Qifu Pian* (Chapter on Qi Gates) record thirty-two acupoints emitted by the Shaoyang (Lesser Yang) meridian qi? Why do the *Mici Pian* (Chapter on Mysterious Needling), *Jingmai Pian* (Chapter on Meridians), *Jingbie Pian* (Chapter on Divergent Meridians), *Jingjin Pian* (Chapter on Sinew Meridians), and *Weiqi Pian* (Chapter on Defensive Qi) mention the collaterals of Shaoyang, the meridians of the Sanjiao and Shaoyang, the regular meridians of Shaoyang and the Pericardium (Heart Master), the sinews of Shaoyang and the Pericardium, and the roots of Shaoyang and the Pericardium? These seem to imply tangible entities. Now it is said that it is formless; are all those records incorrect? I say: What is referred to as "having form" refers to its meridians attaching to and flowing through their respective associated meridians. Because this meridian exists, corresponding diseases arise. When we say it is "formless," we do not mean it lacks dimensions like length, weight, or capacity, as described for the Zang-Fu organs. If one were to consider only the starting and ending points of its meridians, the acupoints, and their disease management as evidence of form, one would fail to realize that the extraordinary vessels such as the Chong (Penetrating Vessel), Ren (Conception Vessel), and Du (Governor Vessel) also have starting and ending points and manage diseases. Should they be viewed as tangible Fu organs in the same manner? Without distinguishing the concept of "form," the fallacy becomes self-evident. (From *Yizhi Xuyu*)
Gallbladder
The Gallbladder is the Official of Integrity and Uprightness, from which decision-making arises. The *Nan Jing* (Classic of Difficult Issues) states: The Gallbladder is located between the short lobes of the Liver, weighs three taels and three zhu, is three cun long, and holds three he of essence juice. Its meridian is characterized by abundant Qi and scarce Blood. According to Hua Yuanhua: The Gallbladder is the Mansion of Pure Clarity, nicknamed the General, whose primary function is storing essence without draining. (Commentary by Li Shicai)
Those who are courageous allow Qi to flow freely, thereby preventing illness; those who are timid experience Qi stagnation, which leads to disease. The statements in the classics are best understood through broad association. Whatever a person does not fear applies here. One who does not fear strong wind will not be harmed by Wind pathogenic factors. One who does not fear extreme cold or heat will not be invaded by Cold or Heat pathogens. A full meal, if not forced, will certainly not result in food stagnation. When Qi is strengthened by the courage of the Gallbladder, pathogenic factors cannot invade. Thus it is said that the functions of the eleven Zang-Fu organs depend on the Gallbladder. (From *Yican*)
Liver
The Liver is the Official of the General, from which planning and strategizing arise. The Liver is located below the diaphragm, attaching upwards to the lower part of the ninth thoracic vertebra of the spine. Its meridian is characterized by abundant Blood and scarce Qi. It corresponds to the sinews, and its luster manifests in the nails. It primarily stores the Hun (Ethereal Soul), opens into the eyes, and its connecting tissues link upwards to the Heart and Lungs, while having no opening downwards. The *Nan Jing* states: The Liver weighs two jin and four liang, has three lobes on the left and four on the right, totaling seven lobes. (Commentary by Li Shicai)
Appendix: Qiangzi (Cavity/Thoracoabdominal Cavity) and Zhimo (Fatty Membrane)
In examining the *Leijing* (Classified Classic), the Sanjiao (Triple Burner) is referred to as the Qiangzi. However, the Qiangzi is not entirely synonymous with the Sanjiao, but rather encompasses it. The organs that store essence are the innermost interior, namely the Heart, Liver, Spleen, Lung, and Kidney. The substances that exit are the exterior of the interior, namely the Hun, Po, Shen, Zhi, and Yi. Thus, within the Qiangzi, there is still a distinction between interior and exterior. Can the Yin and Yang of the Qiangzi be ignored? The Hun, Po, Shen, Zhi, and Yi stored by the five Zang organs, along with essence and blood, circulate within the interior and connect to the exterior; this is Yang within Yin. The water, grain, urine, feces, and body fluids stored by the six Fu organs are excreted to the exterior but rooted in the interior; this is Yin within Yang. Within the Qiangzi, the refined aspects manifest as Shen (Spirit), Qi, Xing (Nature), and Qing (Emotion); the coarse aspects manifest as Zhi (Fat) and Mo (Membrane). What is generated is Shen, and what is transported is Qi. Endowed by Heaven, Nature varies in rigidity, flexibility, purity, and complexity; responding to external stimuli, Emotions vary in joy, anger, sorrow, and happiness. Physicians must examine the patient's Shen and Qi, and observe their Nature and Emotions. Not only should prescriptions be differentiated by disease, but conditions must also be differentiated by individual constitution. Therefore, identical diseases may require different treatments; this is not accidental. Regarding the fatty membrane, distinctions exist. People usually speak of Yin and Yang in the organs within the cavity, but not of interior and exterior in the fatty membrane. The *Nei Jing* (Inner Canon) states: The Heart governs the blood vessels of the body, and the Liver governs the fascia of the body. The *Leijing* states: The physical structure of the Sanjiao includes fatty membranes within the cavity. Zhang Jingyue identifies the Sanjiao with the cavity; I further distinguish the interior and exterior using the fatty membrane. Thick fat is Zhi (fat) and represents the exterior; thin membrane is Mo (membrane) and represents the interior. Tissue close to the muscle is Zhi and represents the exterior; tissue wrapping bones and vessels is Mo and represents the interior. If the principles of the fatty membrane are not understood, then Zang organs remain isolated from Fu organs, and muscles from bones. If bones, muscles, Zang, and Fu are not interconnected, how could the bodily cavity remain intact? Once the interior and exterior of the fatty membrane are clarified, the sequence of treatment methods can be determined based on their depth and thickness. (From *Yixue Jieti*)
Mo (Membrane) is neither skin nor muscle, but adheres to fat. It protects the five Zang and six Fu organs. The portion of pork belly oil attached to the abdominal wall is this substance. The fat wrapping the intestines is called "flower oil"; the fat attached to the cavity is called "slab oil"; both are types of fat. The membrane lies outside the fat and inside the muscle, shaped like a thin skin, protecting the cavity internally like paper pasted on a wall. It resides in the semi-exterior and semi-interior region of the human body. This differs from Shaoyang, which serves as the semi-exterior and semi-interior of the Six Meridians. Therefore, the membrane in the cavity can harbor epidemic pathogens. Epidemic pathogens inhaled through the mouth and nose cannot follow the meridians; pressured by subsequent healthy Qi, they rest briefly upon encountering the fatty membrane and thus lie latent in the Membrane Origin (Mo Yuan). The pathogen enters without being perceived due to this mechanism. After accumulating over time, it becomes unstable and attacks periodically.
It may be that healthy Qi searches this area and expels it, or that external seasonal Qi causes it to emerge, leading to transmission both inward and outward. Depending on the direction, it is said that invasion inward is more common than emergence outward because the outer muscle is firm and difficult to penetrate, while the inner fat is soft and easily traversed. (From *Yican*)