诸本无篇字。
胸中大 在杼骨之端 马张志。胸、作背。是。马
云。五脏之俞。皆在于背。故背中大 。在杼骨之端。大 者大杼穴也。去中行督脉经大椎穴左右各开一寸半。
肺 在三焦之间（止）乃其 也 马云。焦、当作憔。后世作椎。 、俞、输通用。张云。焦即椎之义。
指脊骨之节间也。古谓之焦。亦谓之憔。后世作椎。此自大 至肾 左右。各相去脊中一寸五分。故云挟脊相
去三寸所也。愚谓诸焦字义。非专指骨节为言。盖谓脏气自节间而出。以行于肉理脉络之分。凡自上至下。皆
可言焦。所以三焦之义。本以上中下通体为言。固可因此而知彼也。按其处应中而痛解。所以验取穴之法也。
但按其 穴之处。必痛而且解。即其所也。解 软解散之谓。志云。先言大杼者。乃项后大骨之端。督脉循于
脊骨之第一椎也。问五脏而言三焦之膈俞者。五脏之气。皆从内膈而出。故曰七节之旁。中有小心。中膈者皆
为伤中。其病虽愈。不过一岁必死。简案、张焦字之解。殆属傅会。张亦至晚年知其不允。当详见质疑录。三
焦有几章。
介按、唐氏谓三焦之根。起于肾中。肾系贯脊通髓。名曰命门。故曰三焦根于命门。从命门而发出膜网。
是生胁下之两大板油。又生脐上之网油。又曰脐下之气。上于肺而为呼吸。并外达皮毛。为卫气。夫唐氏之言
如是。则肺 在三焦之间。此语信而有征也。
灸之则可（止）须其火灭也 张云。此言五脏之 。但可灸而不可刺也。不惟针有补泻。而灸亦有补泻。
凡欲以火补者。勿吹其火。致令疾速。必待其从容自灭可也。凡欲以火泻者。必疾吹其火。欲其迅速即传易其
艾。须其火之速灭可也。此用火补泻之法。高武针灸聚英云。按血气形志篇。载五脏俞刺。而此云可灸不可灸。
故沧州翁谓素问非出于一时之言。非成于一人之手。焦当作椎。又按华佗传。彭城樊阿。
皆从佗学。凡医咸言背及胸脏之间。不可妄针。针之不过四分。而阿针背入一二寸。巨阙胸脏。乃五六寸。而
病皆瘳。是知素问立言致谨之道。而明医纵横变化。不拘于常法。而卒与法会矣。
各版本中均无“篇”字。
胸中的大腧穴，位于脊柱的顶端。马莳认为，“胸”字应作“背”字，这是正确的。马莳说：五脏的背俞穴，都位于背部。所以背部的大腧穴，在脊柱的顶端。所谓“大腧”，指的是大杼穴。它距离人体正中线督脉经的大椎穴，左右各旁开一寸半。
肺俞穴位于三焦之间（此处文本有残缺）。马莳说：“焦”字，应当作“憔”。后世写作“椎”。“腧”与“俞”、“输”通用。张景岳说：“焦”即“椎”的意思，指脊骨的节间。古代称之为“焦”，也称之为“憔”，后世写作“椎”。这从大杼穴到肾俞穴，左右两侧，各自距离脊骨中线一寸五分。所以说，夹脊两侧相距约三寸。我认为，文中所有的“焦”字含义，并非专指骨节而言。大概是指脏气从节间发出，运行于肌肉纹理和脉络的分野。凡是自上而下的部位，都可以称为“焦”。因此，“三焦”的含义，本意是指上、中、下贯通的整体。确实可以通过这一点来推知其他道理。按压穴位处，如果疼痛缓解，这就是验证取穴正确的方法。但是按压腧穴之处，必须感到疼痛且随之缓解，这才是正确的穴位。这里的“解”，意为松软、解散。马莳说：先提到大杼穴，是因为它是项后大骨的顶端，督脉循行于脊骨的第一椎处。询问五脏时提及三焦的膈俞穴，是因为五脏之气，都是从内膈发出的。所以说“第七椎的旁边，中有小心”。中膈受损都会导致伤中，即使病情暂时痊愈，不过一年必定死亡。（简案：张景岳对“焦”字的解释，恐怕属于牵强附会。张景岳到了晚年也知道这种解释不妥当，详见《质疑录》。关于三焦的内容有几章。）
介按：唐氏认为三焦的根本，起于肾中。肾系贯穿脊柱连通骨髓，名为命门。所以说三焦根源于命门。从命门发出膜网，由此生成胁下的两大块板油，又生成脐上的网油。又说脐下的气，上行至肺成为呼吸，并外达皮毛，成为卫气。既然唐氏的话是这样说的，那么“肺俞在三焦之间”这句话，就是确凿可信的了。
施灸是可以的（此处文本有残缺）必须等艾火自然熄灭。张景岳说：这里说的是五脏的背俞穴，只可施灸而不可针刺。不仅针刺有补泻之分，艾灸也有补泻之别。凡是想要用火进行补法操作的，不要吹火，以免火势过急。一定要等待它从容地自然熄灭才可以。凡是想要用火进行泻法操作的，必须快速吹火，希望火势迅速传递并更换艾炷，必须让火迅速熄灭。这是用火进行补泻的方法。高武在《针灸聚英》中说：按照《灵枢·血气形志篇》，记载了五脏俞穴的刺法，而这里却说只可灸不可针。所以沧州翁认为，《素问》并非出自一时之言，也不是由一人之手完成。另外，根据《华佗传》，彭城的樊阿，都跟随华佗学习。凡医生都说背部及胸脏之间，不可妄自针刺，针刺深度不超过四分。而樊阿针刺背部深入一二寸，针刺巨阙穴（位于胸脏）深入五六寸，但病都治好了。这说明《素问》立言谨慎的道理，同时也表明高明的医生能够纵横变化，不拘泥于常规方法，但最终仍与法度相合。
All versions lack the character "Pian" (Chapter).
The major Shu point in the chest [back] is located at the end of the vertebral column. Ma Shi [Ma Jizhi] stated that the character "Xiong" (Chest) should be read as "Bei" (Back), which is correct. Ma said: The Back-Shu points of the Five Zang organs are all located on the back. Therefore, the major Shu point on the back is at the end of the vertebral column. The term "Da Shu" refers to the Dazhu (BL11) acupoint. It is located 1.5 cun lateral to the Dazhui (GV14) acupoint of the Du Meridian (Governing Vessel) along the midline.
The Fei Shu (BL13) point is located between the San Jiao [Triple Burner]. [Text fragment ends]. Ma said: The character "Jiao" should be written as "Qiao". Later generations wrote it as "Zhui". "Shu", "Yu", and "Shu" are used interchangeably. Zhang Jingyue said: "Jiao" means "Zhui", referring to the interspace between the vertebrae. In ancient times, it was called "Jiao" or "Qiao", and later generations wrote it as "Zhui". From the Dazhu (BL11) point to the Shenshu (BL23) point, the left and right sides are each 1.5 cun away from the midline of the spine. Hence, it is said that they are separated by about three cun across the spine. I believe that the meaning of the character "Jiao" in this text does not specifically refer to bone joints. Rather, it implies that the Qi of the Zang organs emerges from the interspaces and travels through the muscle textures and meridian networks. Any area from top to bottom can be referred to as "Jiao". Thus, the concept of the San Jiao (Triple Burner) originally referred to the entire body divided into upper, middle, and lower sections. Indeed, one can infer other principles from this. Pressing the acupoint where pain is relieved serves as a method to verify the correct location of the point. However, when pressing the Shu point, there must be a sensation of pain that subsequently dissipates; this indicates the correct location. Here, "Jie" (relief/dissipation) refers to softening and dispersing. Ma said: The reason Dazhu (BL11) is mentioned first is because it is at the end of the large bone at the back of the neck, where the Du Meridian runs along the first thoracic vertebra. When discussing the Five Zang organs, the Ge Shu (BL17) point of the San Jiao is mentioned because the Qi of the Five Zang organs all emanate from the diaphragm internally. Hence, it is said: "Beside the seventh vertebra, there is the 'Small Heart'." Injury to the diaphragm leads to internal injury; even if the disease appears to heal, death will occur within a year. [Commentary: Zhang's interpretation of the character "Jiao" seems forced. Zhang himself realized its inadequacy late in life; see *Zhi Yi Lu* for details. There are several chapters concerning the San Jiao.]
Jie noted: Tang believed that the root of the San Jiao originates in the Kidneys. The renal system penetrates the spine and connects to the marrow, named Mingmen (Gate of Life). Therefore, it is said that the San Jiao roots in the Mingmen. From the Mingmen, membranous networks emerge, generating the two large plates of fat under the ribs, and the omental fat above the umbilicus. It is also said that the Qi below the umbilicus ascends to the Lungs to facilitate respiration and extends outward to the skin and hair, becoming Wei Qi (Defensive Qi). Since Tang's statement is as such, the phrase "Fei Shu is between the San Jiao" is indeed credible and well-supported.
Moxibustion is permissible [Text fragment ends] wait until the fire extinguishes itself. Zhang Jingyue said: This passage refers to the Back-Shu points of the Five Zang organs, which can only be treated with moxibustion and not needling. Not only do needles have tonifying and sedating methods, but moxibustion also has tonifying and sedating techniques. For tonification using fire, do not blow on the fire to avoid rapid burning; wait for it to extinguish naturally and calmly. For sedation using fire, blow vigorously to accelerate the heat transmission and replace the moxa cone quickly, ensuring the fire extinguishes rapidly. These are the methods for tonifying and sedating with fire. Gao Wu in *Zhen Jiu Ju Ying* stated: According to the *Blood, Qi, Form, and Will Chapter*, the needling of the Five Zang Back-Shu points is recorded, yet here it says moxibustion is allowed but needling is not. Therefore, Weng from Cangzhou argued that *Su Wen* was not spoken at one time nor written by one person. Additionally, regarding Hua Tuo's biography, Pengcheng Fan A studied under Hua Tuo. All physicians stated that the back and the area between the chest and viscera should not be needled recklessly, with a depth not exceeding 0.4 cun. However, Fan A needled the back to a depth of 1-2 cun and the Juque (CV14) point in the chest to 5-6 cun, curing the diseases. This demonstrates the cautious nature of the statements in *Su Wen*, while also showing that skilled physicians can vary their techniques flexibly without adhering strictly to conventional methods, ultimately aligning with the principles.