喻昌曰∶十二经脉，前贤论之详矣，而络脉则未之及，亦缺典也。经有十二，络亦有十二，络者兜络之义，即十二
经之外城也。复有胃之大络、脾之大络、及奇经之大络，则又外城之通界，皇华出入之总途也，故又曰络有十五焉。十
二经生十二络，十二络生一百八十系络，系络生一百八十缠络，缠络生三万四千孙络。自内而生出者，愈多则愈小，稍
大者在俞穴肌肉间，营气所主外廓，繇是出诸皮毛，方为小络，方为卫气所主。故外邪从卫而入，不遽入于营，亦以络
脉缠绊之也。至络中邪盛，则入于营矣。故曰∶络盛则入于经，以营行经脉之中故也。然风寒六淫外邪，无形易入，络
脉不能禁止，而盛则入于经矣。若营气自内所生诸病，为血为气，为痰饮，为积聚，种种有形，势不能出于络外。故经
盛入络，络盛返经，留连不已，是以有取于砭射，以决出其络中之邪。今医不用砭射，已不足与言至巧，而用药之际，
不加引经透络，功效羁迟，安得称为良工耶？至若三部九候，《内经》原有定位，王叔和以相络之故，大小二肠，候之于
上。心主之脉，候之于下，而不知络脉所主者外，所关者小，虽是系络表里相通，未可定其诊象。况水谷变化浊秽之府，
去膈上父母清阳之藏，重重脂膜遮蔽，其气迥不相通，岂可因外络连属，反谓右寸之清阳上浮者，为大肠脉，沉者为肺
脉。《经》所谓藏真高于肺者，乃藏真高于大肠矣，周身之治节，浑是大肠主之矣。左寸之浮者，为小肠脉，沉者为心脉。
水中污泥，反浮于莲花之上，有是理乎？夫心胞之脉，里撷乎心，代君主行事，正如宰相统摄政府，节当从左寸候之。
若分属右尺，与三焦同位，忽焉入阁办事，忽焉远窜遐荒，一日万几，舍樽俎而从事道路乎？切脉论中已定其诊，今再
论及，恐安常者不加深察耳。唯是经有十二，络有十五，《难经》以阳跷阴跷，脾之大络，共为十五络，遂为后世定名。
反遗《内经》胃之大络，名日虚里，贯膈络肺。吃紧一段，后人不敢翻越人之案，遂谓当增为十六络。是十二经有四大
络矣，岂不冤乎？昌谓阳跷阴跷，二络之名原误，当是共指奇经为一大络也。盖十二经各有一络，共十二络矣。此外有
胃之一大络，繇胃下直贯膈肓，统络诸络脉于上。复有脾之一大络，繇脾外横贯胁腹，统络诸络脉于中。复有奇经之一
大络，繇奇经环贯诸经之络于周身上下。盖十二络以络其经，三大络以络其络也。《难经》原有络脉满溢，诸经不能复拘
之文，是则八奇经出于十二经脉之外，经脉不能拘之，不待言矣。昌尝推奇经之义，督脉督诸阳而行于背。任脉任诸阴
而行于前，不相络也。冲脉直冲于胸中。带脉横束于腰际，不相络也。阳跷阴跷，同起于足跟，一循外踝，一循内踝，
并行而斗其捷，全无相络之意。阳维阴维，一起于诸阳之会，一起于诸阴之交，名虽曰维，乃是阳自维其阳，阴自维其
阴，非交相维络也。设阳跷、阴跷，可言二络；则阳维阴维，更可言二络矣。督、任、冲、带，俱可共言八络矣。《难经》
又云奇经之脉，如沟渠满溢，流于深湖。故圣人不能图，是则奇经明等之络，夫岂有江河大经之水，拟诸沟渠者哉？《难
经》又云∶人脉隆盛，入于八脉而不环周，故十二经亦不能拘之，溢蓄不能环流灌溉诸经者也，全是经盛入络，故溢蓄
止在于络，不能环溉诸经也。然则奇经共为一大络，夫复何疑。
【律一条】
凡治病不明脏腑经络，开口动手便错。不学无术，急于求售，医之过也。甚有文过饰非，欺人欺天，甘与下鬼同趣
者，此宵人之尤，不足罪也。
附答《内经》十问
问逆春气则伤肝，夏为寒变，此何病也？曰∶寒变者，夏月得病之总名也。缘肝木弗荣，不能生其心火，至夏心火
当旺反衰，北方肾水得以上陵。其候掩抑而不光明，收引而不发露，得食则饱闷，偶事则狐疑，下利奔迫，惨然不乐。
甚者战栗如丧神守，证与启玄子益火之源以消阴翳，似同而实大异。盖彼所谓益火之源者，主君相二火而言，非用黄连，
即用桂、附。而此所谓益火之源者，全在发舒肝木之郁遏，与黄连、桂、附，绝不相干也。
问逆秋气则伤肺，冬为飧泄。与春伤于风，夏生飧泄有别否？曰∶伤风而飧泄，以风为主，风者东方木也。伤肺而
飧泄，以肺为主，肺者西方金也。其候各异，安得比而同之。风邪伤人，必入空窍，而空窍惟肠胃为最，风既居于肠胃，
其导引之机，如顺风扬帆，不俟脾之运化，食入即出，以故飧已即泄也。不知者以为脾虚完谷不化，如长夏洞泄寒中，
及冬月飧泄之泄，反以补脾刚燥之药，助风性之劲，有泄无已，每至束手无策。倘知从春令治之，用桂枝领风从肌表而
出，一二剂而可愈也。而秋月之伤肺，伤于肺之燥也，与秋伤于燥，冬生咳嗽，同是一病。但在肺则为咳嗽，在大肠则
为飧泄，所谓肺移热于大肠，久为肠 者，即此病也。但使肺热不传于大肠，则飧泄自止，不知者惟务止泄，以燥益燥，
吾目中所见诸大老之误，历历可指也。冤哉！
问逆冬气则伤肾，春为痿厥，同一病乎？曰∶痿自痿，厥自厥，本是二病。然痿者必至于厥，厥者必至于痿，究竟
是一病也。但肝气可持，则痿病先见；筋脉未损，则厥病先见耳。肝主筋，肝病则筋失所养，加以夙有筋患，不觉忽然
而痿矣。肝气以条达为顺，素多郁怒，其气不条达而横格，渐至下虚上盛，气高不返，眩晕不知人而厥矣，厥必气通始
苏也。此皆冬时失养藏之道，正气不足之病，与治痰治风，绝不相干。治痰与风，虚者益虚矣。一味培补肾水，生津养
血，听其筋自柔和，肝自条达可也。若精枯气削，亦难为矣。
问秋伤于湿，上逆而咳，发为痿厥，与逆冬气则伤肾，春为痿厥有别否？曰∶此痿厥与春月之痿厥大异。秋伤于湿，
吾已力辨其为伤燥矣，伤于燥则肺先病也。咳者肺之本病，其候不一，上逆而咳，燥之征也。至发而为痿，则肺金摧乎
肝木，发而为厥，则肺气逆而不行，燥之极矣。此盖燥火内燔，金不寒，水不冷，秋冬不能收藏。与春月不能发生之故，
相去不亦远乎？
问逆春气则少阳不生，肝气内变；逆夏气则太阳不长，心气内洞；逆秋气则太阴不收，肺气焦满；逆冬气则少阴不
藏，肾气独沉。与前寒变等病，又不同者何也？曰∶前言逆春气而夏始病，此言逆春气而春即病也。春气属少阳木主生，
夏气属太阳火主长，秋气属太阴金主收，冬气属少阴水主藏。春未至而木先芽，夏未至而火先朗，此为休征。春已至而
木不生，夏已至而火不长，此为咎征。若春已过而不生，夏已过而不长，则死期迫矣。收藏亦然，肝气内变，即所谓不
条达而横格也。心气内洞，洞开也，心虚则洞然而开。有人觉心大于身，大于室，少顷方定者，正此病也。惟心洞开，
北方寒水得乘机窃入，为寒变之病。非心气内洞，别为一病也。
问寒变与煎厥，皆属夏月之病，究竟何别？曰∶寒变者，南方心火无权，为北方寒水所变也。煎厥者，北方肾水无
权，而南方心火亢甚无制也。两者天渊，不可同论。煎者火性之内燔；厥者火气之上逆，即《经》文阳气者，烦劳则张，
精绝辟积于夏之说。可见阳根于阴，深藏肾水之中。惟烦劳无度，则阳张于外，精绝于内，延至夏月火王，而煎厥之病
生矣。
问逆冬气则少阴不藏，肾气独沉；又云味过于甘，心气喘满色黑，肾气不衡，此何解也？曰∶此未经阐发之义，盖
少阴主藏者也，冬月水旺，肾藏甚富，源泉混混，盈科而进。若冬无所藏，新旧不相承接，有独沉而已。《太素》不解其
旨，至谓独沉为沉浊，何况后人乎？味过于甘，肾气不衡，注作不平，亦属肤浅。盖人身心肾相交，水火相济者其恒也。
味过于甘，肾气为土掩，而不上交于心，则心气亦不得下交于肾，所以郁抑而为喘满也。肾气不衡，即肾气独沉之变文，
见心肾交，则肾脉一高一下，犹权衡。然知独沉为有权无衡也。则不衡二字恍然矣。夫肾间之气，升灌于上，则为荣华；
独沉于下，则为枯谢。《难经》谓五脏脉平而死者，生气独绝于内，不满五十动一止者，肾气先尽。故知肾气独沉，非细
故也。
问味过于酸，肝气以津，脾气乃绝，此何解也？曰∶此人身消息之所在。王注牵强，不合乎道。夫人天真之气，全
在于胃，津液之多寡，即关真气之盛衰。而胃复赖脾以营运其津液，一藏一府，相得益彰，所以胃不至于过湿，脾不至
于过燥也。观下文味过于苦，脾气不濡，胃气乃浓，其为脾过燥，胃过湿可知。然终是相连脏腑。嘿相灌渗，所以脾气
但言不濡，病反在胃，且未甚也。至以过酸之故，助其曲直，将胃中津液，日渐吸引，注之于肝，转觉肝气津润有
余矣。肝木有余，势必克土，其脾气坐困，不至于绝不已耳。若胃中津液尚充，纵脾气不濡，有濡之者在也，亦安得坐
毙哉？
问味过于苦，胃气乃浓；味过于辛，精神乃央。注谓浓为强浓。央为久长。岂五味中酸咸甘多所损，苦与辛多所益
乎？曰∶二义原不作此解，王注与《经》文全相背谬。观于胃气乃浓，繇于脾气不濡，明系脾困，不为胃行津液，胃气
积而至浓也。胃气一浓，容纳遂少，反以有余成其不足，更难施治。今人守东垣一家之学，遇胃病者咸用补法，其有愈
补愈胀者，正坐此弊。如西北之人，喜食生硬面酪。迨至受病，投以牵牛、巴豆，乃始畅适。即香、砂、桔、半，用且
不应，况用参、术之补乎？《内经》有言胃气实则胀，虚则泄，盖可知矣。至精神乃央，上文既云筋脉沮弛，明是筋脉
得辛而缓散不收也。况人之精神，全贵收藏，不当耗散，宁有辛散既久，而不为殃害者耶？曰央则其为病，且有卒暴之
虞矣。相传多食辛令人夭，岂不然哉？
问味过于咸，大骨气劳，从前无解，请一明之。曰∶身中消息，有谓心未有不正，肾未有不邪者，以肾为作强之官
也。有谓肾未有不正，心未有不邪者，以心为情欲之府也。大骨气劳，心肾两有所涉，而实有不尽然者，尝见高僧高道，
栖真习定，忽焉气动精倾，乃知味过于咸，大骨气劳之说，不尽关于情欲耳。盖食咸过多，峻补其肾，腰骨高硕之所，
其气忽积，喜于作劳。气既勃勃内动，则精关勃勃欲开，虽不见可欲，而不觉关开莫制矣。《经》谓强力入房，肾气乃伤，
高骨乃坏。此固嗜欲无节者之本病，奈何清修卓练之士。每于菜蔬间，多食咸藏浓味，以亏道体。无有以《内经》之理，
一陈其前者。及病已成而食淡斋，长年累月自苦，亦足补偏救敝，然不如当日味勿过咸之超矣，因并及之。
喻昌说：十二经脉，前代贤人论述得很详细了，而络脉却未曾涉及，这也是缺失的典章制度。经有十二条，络也有十二条，“络”是兜绕联络的意思，也就是十二经的外层屏障。另外还有胃的大络、脾的大络，以及奇经的大络，这些又是外层屏障的交通边界，是使节（皇华）出入的总通道，所以又说络共有十五条。十二经生出十二条络脉，十二条络脉生出一百八十条系络，系络生出一百八十条缠络，缠络生出三万四千条孙络。从体内生发出的络脉，越多越小，稍大的位于腧穴肌肉之间，由营气主管的外廓；由此出于皮毛，才称为小络，由卫气主管。所以外邪从卫分进入，不会立刻进入营分，也是因为络脉缠绕绊阻的缘故。到了络中邪气盛极，就会进入营分了。所以说：络脉邪盛则传入经脉，这是因为营气运行在经脉之中的缘故。然而风寒等六淫外邪，无形易入，络脉不能禁止，邪气盛时就传入经脉了。如果是营气自内所生的各种疾病，表现为血、气、痰饮、积聚等种种有形之邪，势必要留在络外。所以经气盛传入络，络气盛又返回经，留连不止，因此需要用砭石刺破出血的方法，来决泄出络中的邪气。现在的医生不使用砭石刺法，已经不足以谈论医术的精巧，而在用药时，如果不加用引经透络的药物，功效就会迟缓，怎么能称为良医呢？至于三部九候，《内经》原有固定的定位，王叔和因为相表里络属的关系，将大小肠的脉候放在上部（寸口），心主之脉的脉候放在下部（尺中），却不知道络脉所主管的是外部，所关联的范围较小，虽然系络表里相通，但不能据此确定诊察的征象。况且大肠小肠是水谷变化产生浊秽的腑，距离膈肌以上的清阳之脏（心肺）很远，重重脂膜遮蔽，其气完全不相通，怎能因为外络连属，反而认为右寸部浮取的是大肠脉，沉取的是肺脉呢？《内经》所说的“藏真高于肺”，是指五脏的真气位置高于肺，而不是高于大肠，周身的气机治节，难道都是大肠主宰的吗？左寸部浮取的是小肠脉，沉取的是心脉。这就像水中的污泥反而浮在莲花之上，有这样的道理吗？心包络的脉，内部连结于心，代替君主行事，正如宰相统摄政府，应当从左寸部诊察。如果将其分属于右尺部，与三焦同位，一会儿进入朝廷办事，一会儿远窜荒僻之地，一天处理万机，舍弃宴席而从事道路奔波吗？切脉论中已经确定了诊法，现在再讨论这个，恐怕是安于常规的人不加深察罢了。只是经有十二条，络有十五条，《难经》以阳跷脉、阴跷脉、脾之大络，共作为十五络，于是成为后世定名。反而遗漏了《内经》中胃的大络，名为虚里，贯穿膈肌络属肺部。这是关键的一段，后人不敢超越前人的成案，于是说应当增加为十六络。这样十二经就有四大络了，岂不是很冤屈吗？我认为阳跷、阴跷二络的名称原本有误，应当是共同指奇经为一大络。大概十二经各有一条络，共十二条络了。此外有胃的一条大络，从胃下直贯膈肓，统络诸络脉于上。又有脾的一条大络，从脾外横贯胁腹，统络诸络脉于中。又有奇经的一条大络，从奇经环贯诸经之络于周身上下。大概是十二络用来络属经脉，三大络用来络属络脉。《难经》原有“络脉满溢，诸经不能复拘之”的文字，这说明八条奇经出于十二经脉之外，经脉不能拘束它们，是不言而喻的了。我曾推究奇经的意义，督脉总督诸阳而行于背部，任脉担任诸阴而行于前面，二者不相络属。冲脉直冲于胸中，带脉横束于腰际，也不相络属。阳跷、阴跷，同起于足跟，一条循行外踝，一条循行内踝，并行而争其敏捷，完全没有相互络属的意思。阳维、阴维，一起于诸阳之会，一起于诸阴之交，名称虽然叫“维”，其实是阳自我维系其阳，阴自我维系其阴，并非交互维络。假如阳跷、阴跷可以说成两条络，那么阳维、阴维更可以说成两条络了。督、任、冲、带，都可以共说成八条络了。《难经》又说奇经的脉，像沟渠满溢，流入深湖。所以圣人不能图绘，这说明奇经明明白白是络脉，哪里是用江河大经的水来比拟沟渠的呢？《难经》又说：人脉隆盛，进入八脉而不环周，所以十二经也不能拘束它，溢蓄不能环流灌溉诸经，完全是经盛入络，所以溢蓄只在于络，不能环溉诸经。既然如此，奇经共为一大络，又有什么可疑的呢？
【律一条】
凡是治病不明白脏腑经络，开口动手就错。不学无术，急于求售，是医生的过错。更有甚者文过饰非，欺人欺天，甘心与鬼魂同趣的，这是小人中的极端者，不值得怪罪。
附答《内经》十问
问：逆春气则伤肝，夏为寒变，这是什么病？答：寒变，是夏季得病的总称。因为肝木不荣，不能生心火，到了夏天心火当旺反而衰弱，北方肾水得以乘侮凌犯。其症状表现为压抑而不光明，收敛牵引而不发露，进食则饱闷，偶尔做事则狐疑不定，下利急迫，神情凄惨不乐。严重的出现战栗如同丧失神志守御，证候与启玄子（王冰）所说的“益火之源以消阴翳”似乎相同而实际上大不相同。因为那所谓“益火之源”，主要指君火和相火而言，不是用黄连，就是用桂枝、附子。而这个所谓“益火之源”，全在于发舒肝木的郁遏，与黄连、桂枝、附子完全无关。
问：逆秋气则伤肺，冬为飧泄。与春伤于风，夏生飧泄有区别吗？答：伤风而致飧泄，以风邪为主，风属于东方木。伤肺而致飧泄，以肺为主，肺属于西方金。其症状各异，怎么能混为一谈？风邪伤人，必入空窍，而空窍以肠胃为最，风既居于肠胃，其传导之机，如同顺风扬帆，不需要等待脾的运化，食物入口即出，所以吃下去很快就排泄出来。不知道的人认为是脾虚完谷不化，如长夏洞泄寒中，及冬季飧泄的泄泻，反而用补脾刚燥的药物，助长风性的劲烈，导致泄泻不止，每每束手无策。如果知道从春令治疗，用桂枝引领风邪从肌表而出，一二剂就可以痊愈。而秋季伤肺，是伤于肺的燥气，与秋伤于燥，冬生咳嗽，是同一种病。只是在肺则为咳嗽，在大肠则为飧泄，所谓“肺移热于大肠，久为肠澼”，就是这种病。只要肺热不传于大肠，则飧泄自然停止，不知道的人只致力于止泻，以燥药治燥病，我眼中所见各位老前辈的错误，历历可数。冤枉啊！
问：逆冬气则伤肾，春为痿厥，与前面的病是同一病吗？答：痿症自是痿症，厥症自是厥症，本是两种病。然而痿症必然发展到厥症，厥症必然发展到痿症，究竟是一种病。但肝气尚可维持，则痿病先显现；筋脉未受损，则厥病先显现。肝主筋，肝病则筋失所养，加上素来有筋疾，不知不觉忽然发生痿废。肝气以条达为顺，素多郁怒，其气不条达而横格，逐渐至下虚上盛，气高不返，眩晕不知人事而厥，厥症必须气通才能苏醒。这些都是冬天失去养藏之道，正气不足的病，与治疗痰、治疗风完全无关。治疗痰和风，虚证只会更加虚弱。一味培补肾水，生津养血，听任筋自柔和，肝自条达就可以了。如果精枯气削，也难以救治了。
问：秋伤于湿，上逆而咳，发为痿厥，与逆冬气则伤肾，春为痿厥有区别吗？答：这种痿厥与春季的痿厥大不相同。秋伤于湿，我已经极力辩驳其为伤燥，伤于燥则肺先病。咳嗽是肺的本病，其症状不一，上逆而咳，是燥的征象。至于发展为痿，则是肺金摧折肝木，发展为厥，则是肺气逆而不行，燥到了极点。这大概是燥火内焚，金不寒，水不冷，秋冬不能收藏。与春季不能发生的缘故，相距不也很远吗？
问：逆春气则少阳不生，肝气内变；逆夏气则太阳不长，心气内洞；逆秋气则太阴不收，肺气焦满；逆冬气则少阴不藏，肾气独沉。与前文寒变等疾病，有什么不同？答：前文说逆春气而夏季始病，这里说逆春气而春季即病。春气属少阳木主生，夏气属太阳火主长，秋气属太阴金主收，冬气属少阴水主藏。春未到而木先发芽，夏未到而火先明朗，这是吉兆。春已到而木不生，夏已到而火不长，这是凶兆。若春已过而不生，夏已过而不长，则死期逼近了。收藏也是如此。肝气内变，就是所谓不条达而横格。心气内洞，洞开也，心虚则洞然而开。有人觉得心大于身体，大于房间，片刻后才安定，正是这种病。只有心洞开，北方寒水得以乘机窃入，成为寒变的病。并非心气内洞，另外成为一种病。
问：寒变与煎厥，都属于夏季的病，究竟有什么区别？答：寒变，是南方心火无权，被北方寒水所改变。煎厥，是北方肾水无权，而南方心火亢盛无制。两者天壤之别，不可同论。煎是火性在内焚烧；厥是火气向上逆，即《内经》所说“阳气者，烦劳则张，精绝辟积于夏”的说法。可见阳根于阴，深藏于肾水之中。只有烦劳无度，则阳张于外，精绝于内，延至夏季火旺，而煎厥的病就产生了。
问：逆冬气则少阴不藏，肾气独沉；又说味过于甘，心气喘满色黑，肾气不衡，这是什么解释？答：这是未经阐发的义理，大概少阴主藏，冬月水旺，肾藏甚富，源泉混混，盈科而进。如果冬天无所藏，新旧不相承接，就只有独沉而已。《太素》不理解其旨意，甚至说独沉为沉浊，何况后人呢？味过于甘，肾气不衡，注解说为不平，也属肤浅。大概人心肾相交，水火相济是常态。味过于甘，肾气为土所掩，而不能上交于心，则心气也不能下交于肾，所以郁抑而为喘满。肾气不衡，即肾气独沉的变文，见心肾相交，则肾脉一高一低，犹如权衡。既然知道独沉是有权而无衡，那么“不衡”二字就恍然明白了。夫肾间之气，升灌于上，则为荣华；独沉于下，则为枯谢。《难经》说五脏脉平而死者，生气独绝于内，不满五十动一止者，肾气先尽。所以知道肾气独沉，不是小事。
问：味过于酸，肝气以津，脾气乃绝，这是什么解释？答：这是人身消息的关键所在。王冰的注解牵强，不合乎道。人的天真之气，全在于胃，津液的多寡，即关乎真气之盛衰。而胃又依赖脾来营运其津液，一脏一腑，相得益彰，所以胃不至于过湿，脾不至于过燥。看下文“味过于苦，脾气不濡，胃气乃浓”，可知是脾过燥，胃过湿。但这终究是相连的脏腑，默默互相灌渗，所以脾气只说“不濡”，病反在胃，且尚未严重。至于因过酸之故，助其曲直，将胃中津液日渐吸引，注入于肝，转觉肝气津润有余。肝木有余，势必克土，其脾气坐困，不到绝的地步不会停止。如果胃中津液尚充，纵然脾气不濡，有濡之者在，又怎能坐毙呢？
问：味过于苦，胃气乃浓；味过于辛，精神乃央。注解说浓为强浓，央为久长。难道五味中酸咸甘多所损，苦与辛多所益吗？答：这两种含义原本不作此解，王冰的注解与《经文》完全背谬。看“胃气乃浓”，由于脾气不濡，明显是脾困，不为胃行津液，胃气积而至浓。胃气一浓，容纳遂少，反以有余成其不足，更难施治。今人坚守东垣一家之学，遇胃病者都用补法，那些越补越胀的，正是犯了这种弊病。如西北之人，喜食生硬面酪。等到生病，投以牵牛、巴豆，才舒畅舒适。即使香附、砂仁、桔梗、半夏，使用都不见效，何况用人参、白术的补法呢？《内经》有言胃气实则胀，虚则泄，大概可以知道了。至于“精神乃央”，上文既说“筋脉沮弛”，明显是筋脉得辛而缓散不收。况且人的精神，全贵收藏，不当耗散，哪有辛散既久，而不为殃害的呢？说“央”则其为病，且有猝暴的忧虑了。相传多食辛令人夭折，难道不是这样吗？
问：味过于咸，大骨气劳，从前没有解释，请阐明一下。答：身中消息，有人说心无不正，肾无不邪，因为肾为作强之官。有人说肾无不正，心无不邪，因为心为情欲之府。大骨气劳，心肾两有所涉，而实在有不尽然的，曾见高僧高道，栖真习定，忽然气动精倾，才知道“味过于咸，大骨气劳”之说，不尽关于情欲。大概食盐过多，峻补其肾，腰骨高耸之处，其气忽积，喜好劳作。气既勃勃内动，则精关勃勃欲开，虽不见可欲之物，而不觉精关开启无法控制。《内经》说强力入房，肾气乃伤，高骨乃坏。这固然是嗜欲无节制者的本病，奈何清修卓练之士，往往在菜蔬间，多食咸藏浓味，以亏损道体。没有人用《内经》的道理，在前面陈述。等到病已成而食淡斋，长年累月自苦，也足以补偏救敝，但不如当日味勿过咸的高明了，因此一并提及。
Yu Chang said: The twelve meridians have been discussed in detail by former sages, but the collaterals (Luo Mai) have not been mentioned, which is also a missing canonical record. There are twelve meridians and twelve collaterals. "Collateral" implies encircling and connecting; they are the outer city of the twelve meridians. Additionally, there are the great collateral of the Stomach, the great collateral of the Spleen, and the great collaterals of the extraordinary vessels, which serve as the communication boundaries of the outer city and the main routes for the passage of envoys (Huanghua). Therefore, it is said that there are fifteen collaterals in total. The twelve meridians generate twelve collaterals; the twelve collaterals generate one hundred and eighty tied collaterals (Xi Luo); the tied collaterals generate one hundred and eighty entangled collaterals (Chan Luo); and the entangled collaterals generate thirty-four thousand sun collaterals (Sun Luo). Those generated from the interior become smaller as they multiply. The slightly larger ones are located between the Shu points and muscles, governed by Ying Qi (Nutritive Qi) in the outer perimeter. From here, they emerge into the skin and hair, becoming small collaterals governed by Wei Qi (Defensive Qi). Thus, external pathogens enter from the Wei level and do not immediately enter the Ying level because they are hindered by the entanglement of the collaterals. When pathogenic factors become excessive in the collaterals, they then enter the Ying level. It is therefore said: "When collaterals are full, pathogens enter the meridians," because Ying Qi circulates within the meridians. However, wind, cold, and other six excesses (Liuyin) are formless and easily enter; the collaterals cannot prevent this, and when they become excessive, they enter the meridians. If diseases arise internally from Ying Qi, manifesting as blood stasis, Qi stagnation, phlegm-fluid retention, or accumulations and masses—all of which are tangible—they cannot escape the collaterals. Therefore, when meridian Qi is excessive, it enters the collaterals; when collateral Qi is excessive, it returns to the meridians, lingering endlessly. Hence, the need arises to use bian stone therapy (Bian She) to lacerate and bleed out the pathogens in the collaterals. Modern physicians do not use bian stone therapy, making them unworthy of discussing subtle skills. Furthermore, when using herbs, if one does not add guiding and penetrating-collateral agents, efficacy will be delayed. How can such individuals be called skilled practitioners? Regarding the three positions and nine inspections (San Bu Jiu Hou), the *Nei Jing* originally had fixed locations. Wang Shuhe, due to the relationship of paired collaterals, placed the pulses of the Large Intestine and Small Intestine at the upper position (Cun) and the pulse of the Heart Conduit (Xin Bao) at the lower position (Chi), without realizing that collaterals govern the exterior and their scope is minor. Although tied collaterals connect interior and exterior, one cannot definitively determine diagnostic signs based on this. Moreover, the bowels of water and grain are fu organs where turbid waste changes occur, far from the clear yang storage above the diaphragm (Heart and Lung), covered by layers of fatty membranes, with qi completely不通 (not communicating). How can one, due to external collateral connections, claim that the floating pulse at the right Cun belongs to the Large Intestine and the deep pulse to the Lung? The *Jing* states that the "Zhen Zang (True Viscera) is higher than the Lung," meaning the true qi of the zang organs is higher than the Lung, not higher than the Large Intestine. Is the governance of the whole body's regulation entirely controlled by the Large Intestine? The floating pulse at the left Cun belongs to the Small Intestine, and the deep pulse to the Heart. Would muddy water in a pond float above lotus flowers? Such logic is absurd. The pulse of the Pericardium (Xin Bao) connects internally to the Heart and acts on behalf of the Sovereign, just as a prime minister directs the government; it should be inspected at the left Cun. If assigned to the right Chi, sharing the position with the San Jiao (Triple Burner), would it suddenly enter the court to handle affairs and then flee to remote wastelands, managing ten thousand matters a day, abandoning banquets to work on roads? The pulse diagnosis section has already established its inspection method; discussing it again now may cause those accustomed to routine to overlook deeper examination. Nevertheless, there are twelve meridians and fifteen collaterals. The *Nan Jing* designated the Yang Qiao, Yin Qiao, and the Great Collateral of the Spleen as the fifteen collaterals, establishing a name for later generations. This overlooked the Great Collateral of the Stomach mentioned in the *Nei Jing*, named Xuli, piercing the diaphragm and connecting to the Lung. This is a crucial point. Later generations dared not surpass previous commentaries, claiming it should be increased to sixteen collaterals. Thus, the twelve meridians would have four great collaterals, which is unjust! I argue that the names Yang Qiao and Yin Qiao as two separate collaterals are erroneous; they should collectively refer to the extraordinary vessels as one great collateral. Generally, each of the twelve meridians has one collateral, totaling twelve. Besides this, there is the Great Collateral of the Stomach, which goes straight down from the stomach through the diaphragm to the huang area, governing all collaterals above. There is also the Great Collateral of the Spleen, which crosses horizontally from the spleen through the flanks and abdomen, governing all collaterals in the middle. There is also the Great Collateral of the extraordinary vessels, which circles around the collaterals of all meridians throughout the body. Essentially, the twelve collaterals connect the meridians, while the three great collaterals connect the collaterals. The *Nan Jing* originally stated: "When collaterals are full and overflowing, the meridians cannot restrain them." This implies that the eight extraordinary vessels lie outside the twelve meridians, and the meridians cannot restrain them, which goes without saying. I have deduced the meaning of the extraordinary vessels: The Du Meridian (Governing Vessel) supervises all yang and runs along the back; the Ren Meridian (Conception Vessel) assumes all yin and runs along the front; they do not interconnect. The Chong Meridian (Penetrating Vessel) rushes straight into the chest. The Dai Meridian (Girdle Vessel) binds horizontally at the waist; they do not interconnect. Yang Qiao and Yin Qiao both originate from the heel; one follows the lateral malleolus, the other the medial malleolus, running parallel and competing in agility, with no intention of interconnecting. Yang Wei and Yin Wei both originate from the meeting of all yang and the intersection of all yin respectively. Although named "Wei" (Linking), it means Yang links its own yang and Yin links its own yin, not mutual linking. If Yang Qiao and Yin Qiao could be considered two collaterals, then Yang Wei and Yin Wei could certainly be considered two collaterals. Du, Ren, Chong, and Dai could collectively be called eight collaterals. The *Nan Jing* also says: "The pulses of the extraordinary vessels are like ditches overflowing into deep lakes." Thus, even sages cannot map them. This clearly shows that the extraordinary vessels are collaterals; how can they be compared to rivers and major meridians? The *Nan Jing* further states: "When human pulses are vigorous, they enter the eight vessels and do not circulate continuously, so the twelve meridians cannot restrain them. Overflowing accumulation cannot circulate and irrigate the meridians." This is entirely due to meridian excess entering collaterals, so overflow and accumulation remain only in the collaterals and cannot irrigate the meridians. Therefore, the extraordinary vessels collectively form one great collateral; what doubt remains?
[Law One]
Whenever treating disease, if one does not understand the zang-fu organs and meridians, any opening of the mouth or movement of the hand is wrong. Ignorance and lack of skill, yet eager to sell oneself, is the fault of the physician. Worse still are those who cover up faults and beautify mistakes, deceiving people and heaven, willingly following ghosts; these are the worst villains, not worth blaming.
Appendix: Ten Questions on the *Nei Jing*
Q: "Reversing the Qi of Spring injures the Liver, leading to Cold Transformation (Han Bian) in Summer." What disease is this?
A: Cold Transformation is a general term for diseases occurring in summer. Because Liver Wood fails to flourish, it cannot generate Heart Fire. By summer, when Heart Fire should be prosperous, it instead declines, allowing Northern Kidney Water to invade upwards. Symptoms include oppression and lack of brightness, contraction and lack of emergence, fullness and stuffiness after eating, hesitation in action, urgent diarrhea, and a miserable, unhappy demeanor. Severe cases present with tremors as if losing spiritual control. This presentation resembles Wang Bing's (Qixuanzi) concept of "benefiting the source of fire to eliminate yin shadows," but is actually very different. His "benefiting the source of fire" refers to Ministerial and Sovereign Fire, involving herbs like Cinnamon Twig (Guizhi) or Aconite Root (Fuzi), not Scutellaria Root (Huanglian). My "benefiting the source of fire" here focuses entirely on dispersing the depression of Liver Wood, having nothing to do with Huanglian, Guizhi, or Fuzi.
Q: "Reversing the Qi of Autumn injures the Lung, leading to Undigested Food Diarrhea (Sun Xie) in Winter." Is this different from "Injuring Wind in Spring, leading to Sun Xie in Summer"?
A: Wind-induced Sun Xie is dominated by Wind, which belongs to Eastern Wood. Lung-induced Sun Xie is dominated by Lung, which belongs to Western Metal. Their symptoms differ; how can they be equated? Wind pathogens enter orifices, primarily the intestines and stomach. Once wind resides in the bowels, the guiding mechanism acts like sailing with the wind; digestion does not wait for Spleen transformation. Food enters and exits immediately, causing immediate diarrhea after eating. Unknowing practitioners mistake this for Spleen deficiency with undigested food, similar to Hole Diarrhea (Dong Xie) in late summer or winter Sun Xie, and wrongly use drying, warming Spleen-tonifying herbs. This aids the forcefulness of wind, causing endless diarrhea until helplessness sets in. If treated according to Spring principles, using Cinnamon Twig Decoction (Guizhi Tang) to lead wind out from the muscle layer, one or two doses can cure it. Autumn injury to the Lung is an injury to Lung Dryness, same as "Autumn injury to Dryness, Winter cough." It manifests as cough in the Lung and Sun Xie in the Large Intestine, known as "Lung transferring heat to Large Intestine, long-term becoming intestinal discharge." If Lung heat does not transmit to the Large Intestine, Sun Xie stops naturally. Unknowing practitioners only seek to stop diarrhea, using drying herbs on a dry condition. I have seen many errors by senior doctors, clearly identifiable. How unjust!
Q: "Reversing the Qi of Winter injures the Kidney, leading to Flaccidity (Wei) and Reversal (Jue) in Spring." Is this the same disease?
A: Flaccidity and Reversal are originally two diseases. However, Flaccidity inevitably leads to Reversal, and Reversal inevitably leads to Flaccidity; ultimately, they are one disease. If Liver Qi is maintained, Flaccidity appears first; if sinews and vessels are intact, Reversal appears first. The Liver governs sinews; Liver disease causes sinews to lose nourishment. With pre-existing sinus issues, sudden flaccidity occurs unnoticed. Liver Qi prefers smooth flow; chronic anger causes Qi to stagnate and block horizontally, leading to lower deficiency and upper excess, rising Qi, dizziness, loss of consciousness, and Reversal. Reversal requires Qi connection to recover. These are diseases of insufficient Zheng Qi due to failing to follow winter storage principles, unrelated to Phlegm or Wind treatments. Treating Phlegm and Wind worsens deficiency. One should solely tonify Kidney Water, generate fluids, nourish blood, and allow sinews to soften and Liver Qi to flow smoothly naturally. If essence is exhausted and Qi depleted, it is difficult to treat.
Q: "Autumn injury to Dampness, reversing upward causing cough, developing into Flaccidity and Reversal." Is this different from "Winter injury leading to Spring Flaccidity and Reversal"?
A: This Flaccidity and Reversal is vastly different from Spring's. I have argued that Autumn injury to Dampness is actually injury to Dryness. Injury to Dryness affects the Lung first. Cough is the Lung's primary disease; upward-reversing cough is a sign of Dryness. Development into Flaccidity indicates Lung Metal destroying Liver Wood; development into Reversal indicates Lung Qi reversing and failing to move, extreme Dryness. This is Dry-Fire burning internally, Metal not cold, Water not cold, preventing Autumn/Winter storage. This contrasts greatly with Spring's failure to generate.
Q: "Reversing Spring Qi prevents Shaoyang from generating, causing internal change in Liver Qi; reversing Summer Qi prevents Taiyang from growing, causing internal hollowness in Heart Qi; reversing Autumn Qi prevents Taiyin from receiving, causing Lung Qi to scorch and fill; reversing Winter Qi prevents Shaoyin from storing, causing Kidney Qi to sink alone." How does this differ from previous diseases like Cold Transformation?
A: Previously, reversing Spring Qi caused disease starting in Summer; here, reversing Spring Qi causes disease immediately in Spring. Spring Qi belongs to Shaoyang Wood, governing generation; Summer Qi to Taiyang Fire, governing growth; Autumn Qi to Taiyin Metal, governing reception; Winter Qi to Shaoyin Water, governing storage. Sprouting before Spring arrives and brightness before Summer arrives are auspicious. Failure to generate/grow after arrival is inauspicious. Failure after the season passes approaches death. Storage is similar. Internal change in Liver Qi is stagnation and horizontal blocking. Internal hollowness in Heart Qi means opening; Heart deficiency leads to an open feeling. Some feel their heart is larger than their body or room, stabilizing after a moment; this is the disease. Only when Heart opens does Northern Cold Water infiltrate, causing Cold Transformation. It is not a separate disease from Heart Qi hollowness.
Q: Both Cold Transformation and Boiling Reversal (Jian Jue) are Summer diseases. What is the difference?
A: Cold Transformation is Southern Heart Fire lacking authority, transformed by Northern Cold Water. Boiling Reversal is Northern Kidney Water lacking authority, while Southern Heart Fire is hyperactive and uncontrolled. They are worlds apart. Boiling refers to internal fire burning; Reversal refers to upward reversal of Fire Qi, as stated in the *Jing*: "Yang Qi, when overworked, expands; essence is exhausted, accumulating in Summer." This shows Yang roots in Yin, hidden in Kidney Water. Excessive overwork causes Yang to expand externally and essence to deplete internally. Extending to Summer Fire prosperity generates Boiling Reversal.
Q: "Reversing Winter Qi prevents Shaoyin from storing, causing Kidney Qi to sink alone." Also, "Excessive Sweet taste causes Heart Qi to pant and feel full, complexion turns black, Kidney Qi becomes unbalanced." How to explain?
A: This is an unexplained principle. Shaoyin governs storage; Winter Water is prosperous, Kidney stores abundantly, springs flow continuously. If Winter lacks storage, old and new fail to connect, resulting only in sinking alone. *Tai Su* misunderstood this as "heavy/turbid sinking," let alone later generations. "Unbalanced Kidney Qi" annotated as "uneven" is superficial. Normally, Heart and Kidney interact, Water and Fire balance. Excessive Sweet taste buries Kidney Qi under Earth, preventing ascent to Heart; thus Heart Qi cannot descend to Kidney, causing depression, panting, and fullness. "Unbalanced Kidney Qi" is a variation of "Kidney Qi sinking alone." Seeing Heart-Kidney interaction, Kidney pulse rises and falls like a scale. Knowing "sinking alone" means having weight but no balance clarifies "unbalanced." Qi between Kidneys ascending to top brings glory; sinking alone brings withering. *Nan Jing* says if five organ pulses are flat but death occurs, vital Qi is cut off internally; stopping before fifty beats indicates Kidney Qi exhaustion first. Thus, Kidney Qi sinking alone is significant.
Q: "Excessive Sour taste makes Liver Qi moist/fluid, causing Spleen Qi to perish." How to explain?
A: This concerns bodily balance. Wang Bing's annotation is forced. True Qi relies on Stomach; fluid quantity relates to Qi strength. Stomach relies on Spleen to transport fluids; zang and fu complement each other, preventing Stomach dampness and Spleen dryness. Next text says "Excessive Bitter taste makes Spleen Qi not moist, Stomach Qi thick," indicating Spleen dryness and Stomach dampness. Connected organs silently permeate each other. Spleen "not moist" implies disease in Stomach, not severe yet. Excessive Sour aids flexibility, drawing Stomach fluids into Liver, making Liver Qi overly moist. Liver Wood excess attacks Earth, trapping Spleen Qi until perishing. If Stomach fluids are sufficient, even if Spleen is not moist, there is moisture available; why perish?
Q: "Excessive Bitter taste makes Stomach Qi thick; Excessive Pungent taste harms Spirit." Annotations say "thick" means strong and "harm" means long-lasting. Do Sour, Salty, Sweet harm, while Bitter and Pungent benefit?
A: These meanings are misinterpreted. Wang Bing contradicts the *Jing*. "Stomach Qi thick" results from Spleen failing to moisten and transport fluids, causing Stomach Qi accumulation and thickness. Thick Stomach Qi reduces capacity, turning excess into insufficiency, hard to treat. Modern doctors follow Li Dongyuan, using tonification for Stomach disease, causing bloating. Northwest people eat raw/hard foods; illness requires Cathartic Bean (Niuxi) or Croton Seed (Badou) for relief. Even aromatic/drying herbs fail; Ginseng and Atractylodes tonification is worse. *Jing* says Stomach excess causes bloating, deficiency causes diarrhea. "Spirit harmed" follows "sinews/vessels relaxed," meaning Pungent herbs relax sinews excessively. Spirit values storage, not dispersion. Long-term Pungent dispersion causes disaster. "Harm" implies sudden danger. Rumor says excessive Pungent shortens life; is this not true?
Q: "Excessive Salty taste causes Bone Qi labor." No prior explanation. Please clarify.
A: Views vary: some say Heart is upright, Kidney evil (Kidney is official of strength); others say Kidney is upright, Heart evil (Heart is palace of desire). Bone Qi labor involves both Heart and Kidney, but not entirely desire-related. I saw high monks/practitioners in meditation suddenly experiencing Qi movement and essence leakage. Thus, "Excessive Salty taste causes Bone Qi labor" is not solely about desire. Excessive Salt strongly tonifies Kidney; Qi accumulates in lumbar bones, promoting labor. Internal Qi agitation opens essence gate uncontrollably. *Jing* says forcing intercourse injures Kidney Qi and damages high bones. This is the root disease of unrestrained desire, yet ascetics often consume salty/preserved vegetables, damaging Daoist constitution. No one cited *Jing* principles earlier. Waiting until disease forms to eat bland diets is corrective but inferior to avoiding excess Salt initially. Thus mentioned.