凡尿不在胞中。为胞屈僻。津液不通。以葱叶除尖头。纳阴茎孔中。深三寸。微用口吹
之。
夫三焦有名无形。主持诸气。以象三才之用。故呼吸升降。水谷往来。皆待此以通达。
是以
不纳
而分
病矣
乃冲
大。
以理
如沤
俾后
者何
有
然
夫三焦者。一名三关也。上焦名三管反射。中焦名霍乱。下焦名走哺。合而为一。有名
无形
间。
下三
也。上焦如雾。起于胃上管。并咽以上。贯膈布胸中走腋。循足太阴之分而行。还注手阳明。
上
周
其
内开腠理。卫气走之。固不得循其道。此气剽悍滑疾。见开而出。故不得从其道。名曰漏气
。其病则肘挛痛。食先吐而后下。其气不续。膈间厌闷。所以饮食先吐而后下也。寒则精神
不守。泄下便痢。语声不出。若实则上绝于心。若虚则引气于肺也。
中焦如沤起于胃中管。在上焦之后。此受气者。主化水谷之味泌糟粕。蒸津液。化其精
微。
阳
五
主脾胃之病。夫血与气。异形而同类。卫气是精。荣气是神。故血与气异形同类焉。而脱血
者无汗。此是神气。夺汗者无血。此是精气。故人有两死而无两生也。犹精神之气隔绝也。
若虚则补于胃。实则泻于脾。调其中和。其源万不遗一也。
下焦如渎。起胃下管。别回肠。注于膀胱。而渗入焉。故水谷常并居于胃中。成糟粕而
俱
则大
亦入
出也
三焦病者。腹胀气满。小腹尤坚。不得小便窘急。溢则为水。留则为胀。候在足太阳之
外大
小腹病肿痛。不得小便。邪在三焦约。取太阳大络。视其结脉与厥阴小络结而血者。肿
上及
三焦胀者气满在皮肤。壳壳然而不坚疼。尝观周子太极图曰。无极而太极。至哉斯言也。
天
妇
始
谓
皆由此而成。且有三焦一经。此经叔和以命门配。越人以手心主配。千载之贤哲。固不敢以
孰是孰非议。要之手心主则十二经之一。而命门于十二经无所与焉。且手心主厥阴之经。属
心包而络三焦。手少阳三焦经。则属三焦而络心包。表里互相属络。而三焦经则未尝络命门
。如此则越人为是。手心主其经则手厥阴。起于胸中。出属心包。下膈历络三焦。然后循胁
腋而下肘至臂。自小指次指出其端。手少阳三焦之经。起于小指次指。终耳前。过客主人。
穴名夹颊。至目锐 而出其端。此二经络之始终也。三十一难曰。上焦在心下下膈。在胃上
口。主内而不出。其治在膻中。玉堂下一寸六分。直两乳间陷者是。中焦在胃中脘。不上不
下。主腐熟水谷。其治在脐傍。下焦在脐下。当膀胱上口。主分别清浊。出而不纳。以传道
也。其治在脐下二寸。故名曰三焦。素问六节脏象论亦曰。胆胃大肠小肠膀胱三焦者。仓廪
之本。营之居也。能化糟粕转味而出者也。五脏别论亦曰。夫胃大肠小肠膀胱三焦。此五者
天气之所生也。其气象天。故泻而不藏。此受五脏浊气。名曰传化之腑。由是论之。圣人且
以三焦为有形矣。至陈无择作三因方。且曰三焦有脂膜如掌大。正与膀胱相对。有二白脉自
中
相
如
二
经
以
亦
古
脏
周
人
或
子
属
亦
窍
复
经
编
斤
决
上
又曰三焦者水谷之道路。气之所终始也。盖水谷之所入者。自上而中。自中而下。至于
糟粕
不
如
故经曰真心不受邪者。此也。愚未免臆度一说曰。心包络亦必有所指。今观诸兽之心上。有
黄脂缦包在其上。似脂非脂。似肉非肉。外则有细筋膜如丝。与心肺相连者。此则心包络也
。诸兽之内景。大概亦与人同。观其心形。亦可见矣。
三焦热用药大例
凡小便不在膀胱中，是因为膀胱位置偏斜扭曲，导致津液运行通道阻塞。取一根葱叶，去掉尖端，插入阴茎尿道口内，深入约三寸，然后用嘴轻轻向葱叶内吹气。
三焦虽然有名而无具体的固定形态，但它主持全身诸气的运行，其作用类似于天、地、人“三才”。因此，呼吸的升降出入、水谷的消化传输，都依赖三焦来通达。所以，如果三焦功能失常，就会分生出各种疾病。
三焦又被称为“三关”。上焦称为“三管反射”（此处原文可能有误或为特定古称，通常指上焦如雾），中焦称为霍乱（此处指中焦病变导致的呕吐下利等症），下焦称为走哺（此处指下焦病变导致的进食困难或反胃）。三者合而为一，是有名无形的存在。
上焦的功能如同雾露弥漫，起于胃的上口，沿着咽喉向上，穿过膈肌散布于胸中，沿腋下行走，循行于足太阴肺经的分野，然后回流注入手阳明大肠经。它向内开启腠理，卫气在其中运行。因为卫气性质剽悍滑疾，见到腠理开泄就随之而出，所以不能严格遵循固定的经脉通道，这种气被称为“漏气”。其病症表现为肘部拘挛疼痛，饮食先吐出而后下行，气息不接续，胸膈间烦闷压抑，这就是饮食先吐后下的原因。若寒邪侵袭，则精神不能守舍，出现腹泻痢疾，声音嘶哑不出；若实证，则气逆上绝于心；若虚证，则引动肺气。
中焦的功能如同沤渍发酵，起于胃的中部，位于上焦之后。它是受纳水谷的部位，主要功能是化分水谷的精微，分离糟粕，蒸腾津液，转化出精微物质。这主要涉及脾胃的疾病。血和气，形状不同但本质同类。卫气属阳精，营气属阴神，所以血与气异形同类。大量失血的人不会出汗，这是因为神气受损；大量出汗的人不会再生血液，这是因为精气耗损。所以人有两种死法（血脱、汗脱）而没有两种生法。这就好比精神和气机隔绝了一样。如果中焦虚，则补益胃；如果中焦实，则清泻脾。调和其中的中和之气，就能使万全之策无一遗漏。
下焦的功能如同沟渠排水，起于胃的下口，别出回肠，注入膀胱并渗入其中。所以水谷常常共同居住在胃中，经过消化形成糟粕后一起排出。
三焦发生病变时，会出现腹部胀满，小腹尤其坚硬，小便不通畅且急迫。溢出的成为水肿，停留的成为胀满。诊察部位在足太阳膀胱经外侧。小腹病肿痛，小便不通，这是邪气在三焦约束之处。应取足太阳经的大络，观察其结脉以及厥阴经的小络如果有瘀血结聚的情况。
三焦胀满时，气充满在皮肤之间，鼓胀然而不坚实，伴有疼痛。我曾观看周敦颐的太极图说：“无极而太极。”这句话真是妙极了。万物皆由此而成。关于三焦这一条经络，王叔和将其与命门相配，扁鹊（越人）将其与手心主（心包）相配。千年的贤哲，本来不敢轻易议论孰是孰非。但是，手心主是十二正经之一，而命门并不属于十二正经之列。手心主是厥阴经，隶属于心包而联络三焦；手少阳三焦经，隶属于三焦而联络心包。表里两经互相属络，但三焦经从未联络过命门。像这样看来，扁鹊的观点是正确的。手心主的经脉即手厥阴心包经，起于胸中，出来归属于心包，向下穿过膈肌，依次联络三焦。然后沿胁肋腋下，下行至肘部，到达手臂，从小指和次指的末端发出。手少阳三焦经，起于小指和次指的末端，终于耳前，经过客主人穴（上关穴），名称为夹颊穴，到目锐眦（外眼角）的末端结束。这两条经络的起止就是这样的。《难经·三十一难》说：上焦在心下，下膈，在胃上口，主受纳而不外出，治疗部位在膻中，玉堂穴下一寸六分，正对两乳之间的凹陷处。中焦在胃中脘，不上不下，主腐熟水谷，治疗部位在脐旁。下焦在脐下，正当膀胱上口，主分别清浊，排出而不纳入，以传导排泄。治疗部位在脐下二寸。所以叫做三焦。《素问·六节脏象论》也说：胆、胃、大肠、小肠、膀胱、三焦，是仓廪之本，营气所居之处，能化生糟粕、转输味道而排出的器官。《素问·五脏别论》也说：胃、大肠、小肠、膀胱、三焦，这五者是天气所生的，它们的形象像天一样，所以只泻而不藏。它们接受五脏的浊气，叫做传化之腑。由此而论，圣人已经将三焦视为有形的了。到了陈无择编写《三因方》时，却说三焦有脂膜如手掌大小，正对着膀胱，有两条白脉从中间...（原文此处有缺漏/错简，大致意为连接上下）。又说三焦是水谷运行的道路，气终结和起始的地方。大概水谷进入人体，从上到中，从中到下，直到变成糟粕排出。所以说“真心不受邪”，就是这个道理。我愚昧地揣测一种说法：心包络也必然有所指代。现在观察各种野兽的心脏上面，有一层黄脂包裹在上面，似脂非脂，似肉非肉，外面还有细筋膜如丝线般，与心肺相连，这就是心包络。各种野兽的内景，大体上也与人相同。看它们心脏的形状，也可以看出来。
三焦热证用药的大致原则如下：
Whenever urine is not in the bladder (Pangguang, Bladder), it is due to the bladder being displaced or twisted, causing a blockage in the flow of body fluids (Jinye). Take a scallion leaf, remove the tip, insert it into the urethral meatus, deepen it by three cun, and gently blow air into it with your mouth.
Although the Sanjiao (Triple Burner) has a name but no fixed form, it governs the movement of all Qi in the body, functioning analogously to the "Three Powers" (Heaven, Earth, and Humanity). Therefore, the ascent and descent of respiration, and the ingestion and transmission of food and drink, all rely on the Sanjiao for unimpeded passage. Thus, if the Sanjiao fails to function properly, various diseases arise.
The Sanjiao is also known as the "Three Passes." The Upper Jiao is referred to as "San Guan Fan She" (a specific ancient term, often associated with mist-like distribution); the Middle Jiao is referred to as Huoluan (typically indicating vomiting and diarrhea caused by middle jiao dysfunction); and the Lower Jiao is referred to as Zoubu (indicating difficulty in swallowing or regurgitation caused by lower jiao dysfunction). Together they form one entity, which is named but formless.
The function of the Upper Jiao is like mist and dew. It originates from the upper orifice of the Stomach, ascends along the pharynx, penetrates the diaphragm, and spreads in the chest. It travels along the axilla, follows the divisions of the Foot-Taiyin Lung Meridian, and then returns to inject into the Hand-Yangming Large Intestine Meridian. It opens the interstices (Couli) internally, allowing Defensive Qi (Wei Qi) to circulate. Because Wei Qi is fierce, rapid, and slippery, it exits when the interstices open and thus does not strictly follow a fixed meridian pathway; this type of Qi is called "Leakage Qi" (Lou Qi). Its pathological manifestations include spasmodic pain in the elbow, food being vomited before descending, discontinuous breath, and oppression/stuffiness in the chest and diaphragm, which explains why food is vomited first and then passes down. If cold invades, spirit and mind cannot remain anchored, leading to diarrhea and dysentery, and loss of voice. In excess conditions, Qi may cut off upwards affecting the Heart; in deficiency conditions, it draws Qi into the Lungs.
The function of the Middle Jiao is like fermentation (Ou). It originates from the middle part of the Stomach, located behind the Upper Jiao. It is the site where nutrients are received, primarily responsible for transforming the essence of food and drink, separating dregs, steaming body fluids, and refining essences. This mainly pertains to diseases of the Spleen and Stomach. Blood and Qi have different forms but share the same origin. Wei Qi belongs to Yang-Essence, and Ying Qi (Nutrient Qi) belongs to Yin-Spirit; thus, blood and Qi are distinct in form but similar in nature. Those who suffer massive blood loss do not sweat, because their Spirit-Qi is damaged; those who suffer massive sweating do not generate blood, because their Essence-Qi is depleted. Therefore, there are two ways to die (blood depletion, sweat depletion) but no two ways to live. This is akin to the separation of Spirit and Qi. If the Middle Jiao is deficient, tonify the Stomach; if excessive, drain the Spleen. By harmonizing the neutral Qi within, one ensures that nothing essential is lost.
The function of the Lower Jiao is like a drainage ditch. It originates from the lower orifice of the Stomach, diverges from the ileum, and pours into the Bladder, permeating through it. Thus, water and grain often reside together in the Stomach, becoming dregs after digestion, and are excreted together.
When the Sanjiao suffers disease, abdominal distension and fullness occur, with the lower abdomen being particularly hard. Urination is difficult, urgent, and incomplete. Overflow leads to edema; retention leads to distension. The diagnostic sign is found lateral to the Foot-Taiyang Bladder Meridian. Pain and swelling in the lower abdomen with inability to urinate indicate pathogenic factors constrained in the Sanjiao. One should select the major collaterals of the Foot-Taiyang Meridian and observe any collateral vessels or minor collaterals of the Jueyin Meridian that show blood stasis or knotting.
In cases of Sanjiao distension, Qi fills the skin, causing a drum-like, non-firm swelling accompanied by pain. I once observed Zhou Dunyi's Taiji Tu saying: "From Non-Being comes Taiji." How profound this statement is. All things originate from this. Regarding the Sanjiao meridian, Wang Shuhe paired it with the Mingmen (Gate of Life), while Bian Que (Yueren) paired it with the Shou-Xin-Zhu (Hand-Jueyin Pericardium). Ancient sages dared not easily debate who was right or wrong. However, the Shou-Xin-Zhu is one of the Twelve Regular Meridians, whereas the Mingmen is not among them. The Shou-Xin-Zhu is the Jueyin Meridian, belonging to the Pericardium and connecting to the Sanjiao; the Hand-Shaoyang Sanjiao Meridian belongs to the Sanjiao and connects to the Pericardium. These exterior-interior meridians connect mutually, yet the Sanjiao Meridian never connects to the Mingmen. In this regard, Bian Que was correct. The Shou-Xin-Zhu meridian is the Hand-Jueyin Pericardium Meridian, originating in the chest, emerging to belong to the Pericardium, descending through the diaphragm, and sequentially connecting to the Sanjiao. Then it follows the hypochondrium and axilla, descends to the elbow and arm, and ends at the tip of the ring finger and little finger. The Hand-Shaoyang Sanjiao Meridian originates at the tip of the ring finger and little finger, terminates anterior to the ear, passes through the Kegu Renzhu acupoint (Shangguan), passes through the Jiajia acupoint (likely referring to areas near the jaw/cheek), and ends at the outer canthus of the eye. These are the starting and ending points of these two meridians. *Nan Jing* Chapter 31 states: The Upper Jiao is below the heart, under the diaphragm, above the stomach opening; it receives but does not discharge; its treatment point is Danzhong (Zhongwan), one cun six fen below Yutang, in the depression between the nipples. The Middle Jiao is in the middle of the stomach (Zhongwan); neither high nor low; it rots and ripens food and drink; its treatment point is beside the umbilicus. The Lower Jiao is below the umbilicus, at the upper opening of the bladder; it separates clear from turbid, discharges but does not receive, serving for transmission; its treatment point is two cun below the umbilicus. Hence it is called Sanjiao. *Su Wen*, Chapter 6 (Six Jie Zang Xiang Lun) also states: The Gallbladder, Stomach, Large Intestine, Small Intestine, Bladder, and Sanjiao are the roots of the granaries, the residence of Ying Qi, capable of transforming dregs and transmitting flavors outwards. *Su Wen*, Chapter 8 (Wu Zang Bie Lun) also states: The Stomach, Large Intestine, Small Intestine, Bladder, and Sanjiao are generated by Heaven's Qi. Their images resemble Heaven; therefore, they discharge but do not store. They accept turbid Qi from the Five Zang organs and are called Fu organs of transmission and transformation. From this discussion, it appears the Sages considered the Sanjiao to have form. Later, Chen Wuyue in *San Yin Fang* stated that the Sanjiao has a fatty membrane the size of a palm, opposite the bladder, with two white veins... [Text fragment missing]. He also said the Sanjiao is the pathway for water and grain, the beginning and end of Qi. Generally, water and grain enter from top to middle, and from middle to bottom, until becoming dregs and exiting. Thus, the classics say: "The True Heart does not accept pathogenic factors," which refers to this. I humbly speculate another view: The Pericardium Luo must also refer to something tangible. Observing the hearts of various beasts, there is a layer of yellow fat wrapping the top, resembling fat but not quite, resembling meat but not quite. Externally, there are fine fibrous membranes like silk connecting to the heart and lungs; this is the Pericardium Luo. The internal anatomy of various beasts is largely similar to humans. Observing the shape of their hearts confirms this.
General principles for using herbs to treat Heat in the Sanjiao: