诸本无篇字。
卫于焉会 甲乙。于焉、作安从。
老壮 张云。五十以上为老。二十以上为壮。（见营气失常篇与曲礼所言异）
人受气于谷止皆以受气 张云。人之生由乎气。气者所受于天。与谷气并而充身者也。故谷食入胃。化
而为气。是为谷气。亦曰胃气。此气由自中焦传化于脾。上归于肺。积于胸中气海之间。乃为宗气。宗气之行。
以息往来。通达三焦。而五脏六腑。皆以受气。是以胃为水谷血气之海。而人所受气者。又唯谷而已。故谷不
入。半日则气衰。一日则气少矣。
其清者（止）卫在脉外 张云。谷气出于胃。而气有清浊之分。清者水谷之精气也。浊者水谷之悍气也。
诸家以上下焦言清浊者。皆非。清者属阴。其性精专。故化生血脉。而周行于经随之中。是为营气。浊者属阳。
其性 疾滑利。故
不循经络。而直达肌表。充实于皮毛分肉之间。是为卫气。然营气卫气。无非资藉于宗气。故宗气盛则营卫和。
宗气衰则营卫弱矣。营、营运于中也。卫、护卫于外也。脉者非气非血。其犹气血之橐 也。营属阴而主里。
卫属阳而主表。故营在脉中。卫在脉外。卫气篇曰。其浮气之不循经者为卫气。其精气之行于经者为营气。正
此之谓。
介按、卫在脉外者。谓卫气上输于肺。走于脏腑。外达皮毛。以为护卫营血之作用。故三十二难曰。心
者血。肺者气。血为营。气为卫。相随上下。谓之营卫。通行经络。营周于外。亦即此意也。
阳陇 马云。陇、当作隆。素问生气通天论。有日中而阳隆。盖古以隆、陇通用。张云。陇、盛也。
方以智通雅云。阳陇阴陇。子午之桥起关也。犹言拥起为陇。而过此渐平迤也。庄子曰。于是桥起。简案、素
离合真邪论。经之动脉。其至也亦时陇起。义正同。
太阴主内 太阳主外 张云。太阴手太阴也。太阳足太阳也。内言营气。外言卫气。营气始于手太
阴。而复会于太阴。故太阴主内。卫气始于足太阳。而复会于太阳。故太阳主外。营气周流十二经。昼夜各二
十五度。卫气昼则行阳。夜则行阴。亦各二十五度。营卫各为五十度。以分昼夜也。
夜半为阴陇（止）阴受气矣 张云。夜半后为阴衰。阳生于子也。日西而阳衰。阴生于午也。如金匮
真言论曰。平旦至日中。天之阳。阳中之阳也。日中至黄昏。天之阳。阳中之阴也。合夜至鸡鸣。天之阴。阴
中之阴也。鸡鸣至平旦。天之阴。阴中之阳也。故人亦应之。即此节之义。
夜半而大会（止）与天地同纪 张云。大会言营卫阴阳之会也。营卫之行。表里异度。故尝不相值。惟
于夜半子时。
阴气已极。阳气将生。营气在阴。卫气亦在阴。故万民皆瞑而卧。命曰合阴。合阴者。营卫皆归于脏。而会于
天一之中也。平旦阴尽而阳受气。故民皆张目而起。此阴阳消息之道。常如是无已。而与天地同其纪。所谓天
地之纪者。如天地日月。各有所会之纪也。
昼瞑 甲乙作夜寤。
昼精 熊氏俗解难经四十六难注云。精、清爽也。
相搏 甲乙。搏、作薄。
从来 甲乙。来、作始。
营出于中焦 卫出于下焦 张云。营气者。由谷入于胃。中焦受气。取汁。化其精微。而上注于肺。
乃自手太阴始。周行于经随之中。故营气出于中焦。卫气者。出其悍气之 疾。而先行于四末分肉皮肤之间。
不入于脉。故于平旦阴尽。阳气出于目。循头项下行。始于足太阳膀胱经。而行于阳分。日西阳尽。则始于足
少阴肾经。而行于阴分。其气自膀胱与肾由下而出。故卫气出于下焦。又云。卫气属阳。乃出于下焦。下者必
升。故其气自下而上。亦犹地气上为云也。营本属阴。乃自中焦而出于上焦。上者必降。故营气自上而下。亦
犹天气降为雨也。虽卫主气而在外。然亦何尝无血。营主血而在内。然亦何尝无气。故营中未必无卫。卫中未
必无营。但行于内者便谓之营。行于外者便谓之卫。此人身阴阳交感之道。分之则二。合之则一而已。志云。
下、当作上。决气篇曰。上焦开发。宣五谷味。熏肤充身泽毛。若雾露之溉。是谓气。五味篇曰。辛入于胃。
其气走于上焦。上焦者。受气而荣诸阳者也。卫者阳明水谷之悍气。从上焦而出。卫于表阳。故曰卫出上焦。
简案、千金方三焦病论云。荣出中焦。卫出上焦。荣者络脉之气道也。卫者经脉之气道
也。外台引删繁论。亦同。志注。不可言无据也。明理论引亦作上焦。
上焦出于胃上口（止）下足阳明 千金及外台引删繁作胃上脘。张云。胃上口即上脘也。咽为胃系。水谷
之道路也。膈上曰胸中。即膻中、也。其旁行者走两腋。出天池之次。循手太阴肺经之分。而还于手阳明。其
上行者至于舌。其下行者交于足阳明。以行于中下二焦。凡此皆上焦之部分也。志云。按金匮要略曰。若五脏
元真通畅。人即安和。病则无由入其腠理。腠者是三焦通会元真之处。为血气所注。理者是皮肤脏腑之文理也。
盖三焦乃初阳之气。营运于上下。通合于肌腠。不入于经俞。是以上焦之气。常与荣俱行阳二十五度。行阴二
十五度者。与充肤热肉之荣血。间行于皮肤脏腑之文理也。上焦出胃上口。上贯膈。布胸中。走腋下。至阳明。
上至舌。此论上焦气之所出。与经脉之循臂肘、上肩胛、入缺盆、出耳颊之不同也。
常与荣（止）大会于手太阴矣 张云。上焦者。肺之所居。宗气之所聚。营气者。随宗气以行于十四
经脉之中。故上焦之气。常与营气俱行于阳二十五度。阴亦二十五度。阳阴者。言昼夜也。昼夜周行五十度。
至次日寅时。复会于手太阴肺经。是为一周。然则营气虽出于中焦。而施化则由于上焦也。马云。难经营字下。
误多一卫字。简案、千金及外台引删繁。并有卫字。盖据难经矣。
其不循卫气之道而出何也 张云。卫气之道。昼行于阳。夜行于阴。有常度也。今有熟饮食者。
方入于胃。其气之留行未定。而汗辄外泄。出无方所。是不循卫气之道也。故以为问。
此外伤于风（止）命曰漏泄 张云。风为阳邪。有外热也。
热食气悍。因内热也。热之所聚。则开发腠理。所以毛蒸理泄。而卫气走之。故不循其常道也。此即热食之气
也。出不由度。故曰漏泄。志云。卫气者。水谷之悍气。其性 悍滑疾。如腠理不密。即见开而出。简案、志
以此气为卫气。是。外台引删繁。载疗上焦实热。饮食下胃。其气未定。汗出而背身中皆热。名曰漏气。通脉
泻热。泽泻汤。（泽泻生地骨皮甘草半夏石膏柴胡茯苓生姜竹叶人参桂心莲心右十二味）即为此证所立也。
中焦亦并胃中出上焦之后 千金及外台引删繁。作其气起于胃。中脘在上焦之后。甲乙、巢源作胃口。
此所受气者（止）命曰营气 者下千金有主化水谷之味六字。甲乙无肺脉之脉字。张云。胃中。中脘之
分也。后、下也。受气者。受谷食之气也。五谷入胃。其糟粕、津液、宗气、分为三隧。以注于三焦。而中焦
者泌糟粕。蒸津液。受气取汁。变化而赤。是谓血。以奉生身。而行于经隧。是为营气。故曰营出中焦。按下
文云。下焦者。别回肠。注膀胱。然则自膈膜之下。至脐上一寸。水分穴之上。皆中焦之部分也。隧、音遂。
伏道也。简案、泌、说文侠流也。奉、俸古通。养也。故马云。凡心中所生之血。赖此营气而化以奉养生活之身。
夫血之与气（止）无两生 张云。营卫之气。虽厘清浊。然皆水谷之精华。故曰荣卫者。精气也。血由
化而赤。莫测其妙。故曰血者神气也。然血化于液。液化于气。是血之与气。本为同类。而血之为汗。亦非两
种。但血主营。为阴为里。汗属卫。为阳为表。一表一里。无可并攻。故夺血者无取其汗。夺汗者无取其血。
若表里俱夺。则不脱于阴。必脱于阳。脱阳亦死。脱阴亦死。故曰人生有两死。然而人之生也。阴阳之气。皆
不可无。未有孤阳能生者。亦未有孤阴能
生者。故曰无两生也。志云。营卫者。水谷之精气也。血者中焦之精汁。奉心神而化赤。神气之所化也。血与
营卫。皆生于精。故异名而同类也。简案、外台引删繁论云。夫血与气。异形而同类。卫是精气。营是神气。
故血与气。异形而同类焉。夺血无汗。（此是神气）夺汗无血。（此是精气）故人有一死。而无再生也。（千
金再作两字）视之正文。觉稍明备。
下焦者（止）渗入膀胱焉 张云。回肠、大肠也。济、 同。犹酾滤也。（字典济古文作 酿酒也）泌、
如狭流也。别汁、分别清浊也。别回肠者。谓水谷并居于胃中。传化于小肠。当脐上一寸水分穴处。糟粕由此
别行回肠。从后而出。津液由此别渗膀胱。从前而出。膀胱无上口。故云渗入。凡自水分穴而下。皆下焦之部
分也。按、三十一难曰。下焦者当膀胱上口。主分别清浊。其言上口者。以渗入之处为言。非真谓有口也。如
果有口。则不言渗入矣。何后世不解其意。而争言膀胱有上口。其谬为甚。志云。回肠大肠也。有九回。因以
为名。简案、外台引删繁论云。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。
成糟粕而俱下于大肠。主足阳明。（千金作足太阳）灌渗津液。合膀胱。主出不主入。别于清浊。亦本节之义
也。但本节似脱起胃下管。三十一难云。下焦者。当膀胱上口。主厘清浊。亦可以见耳。介按、唐容川曰。近
说膀胱有上口。无下口。非也。内经明言下焦当膀胱上口。近人不知三焦实有其物。焦古作 。即人身之油膜。
西医名为连网。乃行水之路道。内经所谓三焦者。决渎之官。水道出焉。盖水之路道。全在三焦油膜之中。凡
人饮水入胃。胃之通体有微丝管。将水散出。走入油膜。其能散者。肺气布之也。故肺为水之上源。水散入油
膜。走入膀胱。其水未散尽者。至小肠中。又有微丝管将水散出。
走下焦。以入膀胱。膀胱上口。即在下焦连网之中。此皆下行之水。未化为气者也。
黄帝曰人饮酒（止）液出焉 马云。此言酒之所以先谷气而出也。承上文有渗膀胱之语。故遂以酒之先
谷而下者问之。正以酒为熟谷之液。其气至悍而清。故虽后谷而入。必先谷而下也。熟者腐也。
上焦如雾止此之谓也 张云。如雾者。气浮于上也。言宗气积于胸中。司呼吸而布 于经隧之间。如
天之雾。故曰上焦如雾也。沤者、水上之泡。水得气而不沉者也。言营血化于中焦。随气流行。以奉生身。如
沤处浮沉之间。故曰中焦如沤也。渎者、水所注泄。言下焦主出而不纳。逝而不反。故曰下焦如渎也。然而肺
象天而居上。故司雾之化。脾象地而在中。故司沤之化。大肠、膀胱象江河淮泗而在下。故司川渎之化也。千
金及外台引删繁论云。上焦如雾。（雾者霏霏起上也）中焦如沤。（沤者在胃中如沤也）下焦如渎。（渎者如
沟水决泄也）白虎通引礼运记云。三焦者。包络腑也。水谷之道路。气之所终始也。故上焦如窍。中焦如编。
下焦如渎。（俞氏续医说详解之当考参）张氏质疑录。载三焦有三。三焦之论云。灵枢云。上焦如雾。中焦如
沤。下焦如渎。此三焦为一气之所主。故三十一难因之曰。上焦在胃上口。主内而不出。其治在膻中。中焦在
胃中脘。主腐熟水谷。其治在脐旁。下焦在脐下。主分别清浊。出而不内。此三焦者。即灵枢所谓如雾如沤如
渎之三焦也。故难经又继言之。三焦为水谷之道路。气之所以终始。三焦者。原气之别使。原气在两肾中间之
动气。为人之生命。十二经之根本。主通行三气。经历于五脏六腑。此所谓三焦者。属之于气。正王叔和所谓
有名无状之三焦也。
各版本中均无“篇”字。
卫气在哪里会合？《甲乙经》作“于焉”，意为“从何处”。
关于年老与壮年：张隐庵云，五十岁以上为老，二十岁以上为壮。（这与《营气失常篇》及《曲礼》中的说法不同）
人通过饮食摄取精气，最终都依靠摄取精气来生存。张隐庵云，人的生存依赖于气。气是禀受于天的，并与谷气结合以充实身体。所以食物进入胃中，转化为气，这称为谷气，也称为胃气。这种气由中焦传化至脾，向上归于肺，积聚在胸中气海之间，就成为宗气。宗气的运行，随着呼吸的往来，通达三焦，从而使五脏六腑都能得到气的滋养。因此，胃是水谷和血气的海洋，而人所摄取的气，唯独来自谷物。所以如果谷物不进入体内，半天时间气就会衰弱，一天时间气就会减少。
其中清的部分（仅指）卫气行于脉外。张隐庵云，谷气出于胃，但气有清浊之分。清的是水谷的精微之气，浊的是水谷的剽悍之气。各家以上下焦来解释清浊的，都不对。清者属阴，性质精纯专一，所以能化生血脉，并在经脉之中周流运行，这就是营气。浊者属阳，性质剽疾滑利，所以不循行于经络，而是直达肌表，充实于皮毛和分肉之间，这就是卫气。然而，营气和卫气，无不借助于宗气。所以宗气旺盛则营卫调和，宗气衰弱则营卫虚弱。营，是在内部营运；卫，是在外部护卫。脉，既不是气也不是血，它就像气血的风箱一样。营属阴而主里，卫属阳而主表。所以营气在脉中，卫气在脉外。《卫气篇》说：“其浮行之气不循经络的为卫气，其精气之行于经络的为营气。”正是这个意思。
丹波元简按：所谓“卫在脉外”，是指卫气上输于肺，走窜于脏腑，外达皮毛，起到护卫营血的作用。所以《难经·三十二难》说：“心主血，肺主气，血为营，气为卫，相随上下，称为营卫，通行经络，营周于全身。”也是这个意思。
“阳陇”：马莳云，“陇”当作“隆”。《素问·生气通天论》中有“日中而阳隆”的说法。大概古时“隆”、“陇”通用。张隐庵云，“陇”，即盛的意思。方以智《通雅》云，“阳陇阴陇”，如同子午之交关起山岭一样，犹言拥起成为山陇，过了此点逐渐平缓延伸。《庄子》说：“于是桥起。”简案：《素问·离合真邪论》中说，经之动脉，到达时也时常隆起，意义完全相同。
“太阴主内，太阳主外”：张隐庵云，太阴指手太阴肺经，太阳指足太阳膀胱经。“内”指营气，“外”指卫气。营气始于手太阴，又复会于太阴，所以太阴主内。卫气始于足太阳，又复会于太阳，所以太阳主外。营气周流于十二经脉，昼夜各二十五度；卫气白天行于阳分，夜晚行于阴分，也各二十五度。营卫各五十度，以此划分昼夜。
“夜半为阴陇（仅指）阴气受气了”：张隐庵云，夜半之后为阴气衰退，阳气生于子时。日落西山则阳气衰退，阴气生于午时。如《金匮要略·金匮真言论》所说：平旦到中午，是天的阳气，阳中之阳；中午到黄昏，是天的阳气，阳中之阴；合夜到鸡鸣，是天的阴气，阴中之阴；鸡鸣到平旦，是天的阴气，阴中之阳。人也顺应这一规律，即本节的意思。
“夜半而大会（仅指）与天地同纪”：张隐庵云，“大会”指营卫阴阳的会合。营卫的运行，表里度数不同，所以常常不相遇。只有在夜半子时，阴气已极，阳气将生，营气在阴分，卫气也在阴分，所以万民都闭目睡觉，称为“合阴”。“合阴”是指营卫都归于脏，并会合于天一之中。平旦阴气尽而阳气受气，所以人们都睁眼起床。这是阴阳消长的道理，常是如此，而与天地共同遵循其规律。所谓“天地之纪”，就像天地日月各有其会合的规律一样。
“昼瞑”：《甲乙经》作“夜寤”。
“昼精”：熊氏在《俗解难经》第四十六难注中说：“精”，指清爽。
“相搏”：《甲乙经》中，“搏”作“薄”。
“从来”：《甲乙经》中，“来”作“始”。
“营出于中焦，卫出于下焦”：张隐庵云，营气，由谷物进入胃中，中焦接受谷气，提取汁液，化其精微，而上注于肺，才自手太阴开始，周行于经脉之中。所以营气出于中焦。卫气，出其剽悍之气，先行于四肢末端、分肉和皮肤之间，不入于脉。所以在平旦阴气尽、阳气出于目时，循头项下行，始于足太阳膀胱经，而行于阳分。日落西山阳气尽，则始于足少阴肾经，而行于阴分。其气自膀胱与肾由下而出，所以卫气出于下焦。又说，卫气属阳，乃出于下焦。下者必升，所以其气自下而上，也犹如地气上升为云。营本属阴，乃自中焦而出于上焦。上者必降，所以营气自上而下，也犹如天气下降为雨。虽然卫主气而在外，但何尝没有血？营主血而在内，但何尝没有气？所以营中未必没有卫，卫中未必没有营。只是行于内的便叫营，行于外的便叫卫。这是人身阴阳交感的道理，分之则为二，合之则为一罢了。张志聪云：“下”应当作“上”。《决气篇》说：“上焦开发，宣五谷味，熏肤充身泽毛，若雾露之溉，是谓气。”《五味篇》说：“辛入于胃，其气走于上焦。上焦者，受气而荣诸阳者也。卫是阳明水谷的剽悍之气，从上焦而出，卫护于表阳，所以说卫出上焦。”简案：《千金方·三焦病论》说：“营出中焦，卫出上焦。营是络脉的气道，卫是经脉的气道。”《外台秘要》引《删繁论》，也相同。志注不可说没有依据。《明理论》引文也作“上焦”。
“上焦出于胃上口（仅指）下足阳明”：《千金方》及《外台秘要》引《删繁》作“胃上脘”。张隐庵云，胃上口即上脘。咽为胃系，是水谷的道路。膈上曰胸中，即膻中也。其旁行者走两腋，出于天池穴附近，循手太阴肺经之分，而还于手阳明。其上行者至于舌，其下行者交于足阳明，以行于中下二焦。凡此皆上焦的部分。张志聪云：按《金匮要略》说，如果五脏元真通畅，人即安和，病则无由入其腠理。腠是三焦通会元真的地方，为血气所注。理是皮肤脏腑的纹理。盖三焦乃初阳之气，营运于上下，通合于肌腠，不入于经俞。所以上焦之气，常与营俱行阳二十五度，行阴二十五度者，是与充肤热肉的营血，间行于皮肤脏腑的纹理之中。上焦出胃上口，上贯膈，布胸中，走腋下，至阳明，上至舌。此论上焦气之所出，与经脉循臂肘、上肩胛、入缺盆、出耳颊的不同。
“常与营（仅指）大会于手太阴矣”：张隐庵云，上焦是肺所居之处，宗气所聚之处。营气，随宗气而行于十四经脉之中。所以上焦之气，常与营气俱行于阳二十五度，阴亦二十五度。阳阴，指昼夜。昼夜周行五十度，至次日寅时，复会于手太阴肺经，这是一周。然而营气虽出于中焦，而施化则由于上焦。马云：《难经》“营”字下，误多一“卫”字。简案：《千金方》及《外台秘要》引《删繁》，并有“卫”字，大概是依据《难经》。
“其不循卫气之道而出何也”：张隐庵云，卫气之道，昼行于阳，夜行于阴，有常规度数。现在如果有刚吃过热食的人，食物刚入胃，其气停留运行尚未定，汗就随即外泄，出无固定处所，这是不循卫气之道。所以以此发问。
“此外伤于风（仅指）命曰漏泄”：张隐庵云，风为阳邪，有外热。
热食气剽悍，因内有热。热所聚集，则开发腠理，所以毛孔蒸腾，腠理开泄，而卫气随之走散。所以不循其常道。这就是热食之气。出不由度，所以叫“漏泄”。张志聪云：卫气，是水谷的剽悍之气，其性剽悍滑疾。如果腠理不密，就见开而出。简案：志将此气视为卫气，是对的。《外台秘要》引《删繁》，记载治疗上焦实热，饮食下胃，其气未定，汗出而背身中皆热，名叫“漏气”。用通脉泻热法，泽泻汤（泽泻、生地、骨皮、甘草、半夏、石膏、柴胡、茯苓、生姜、竹叶、人参、桂心、莲心，右十二味），就是为此证设立的。
“中焦亦并胃中出上焦之后”：《千金方》及《外台秘要》引《删繁》作“其气起于胃，中脘在上焦之后”。《甲乙经》、巢元方作“胃口”。
“此所受气者（仅指）命曰营气”：“者”字下，《千金方》有“主化水谷之味”六字。《甲乙经》无“肺脉”的“脉”字。张隐庵云，胃中，是中脘的分野。后，指下方。受气者，受谷食之气。五谷入胃，其糟粕、津液、宗气，分为三条隧道，以注入三焦。而中焦者，泌出糟粕，蒸化津液，受气取汁，变化而赤，这就叫血。以奉养身体，而行于经隧，这就是营气。所以说营出中焦。按下文说：下焦者，别回肠，注膀胱。那么自膈膜之下，至脐上一寸水分穴之上，皆中焦的部分。隧，音遂，伏道也。简案：泌，说文解字释为狭流。奉，古通俸，养也。所以马云说，凡心中所生之血，赖此营气而化以奉养生活之身。
“夫血之与气（仅指）无两生”：张隐庵云，营卫之气，虽然分清浊，但都是水谷的精华。所以说营卫者，精气也。血由化而赤，莫测其妙，所以说血者神气也。然而血化于液，液化于气，是血与气，本为同类。而血化为汗，也非两种东西。只是血主营，为阴为里；汗属卫，为阳为表。一表一里，不可同时攻伐。所以夺血者无取其汗，夺汗者无取其血。如果表里俱夺，则不脱于阴，必脱于阳。脱阳亦死，脱阴亦死。所以说人生有两死。然而人之生也，阴阳之气，都不可无。未有孤阳能生的，也未有孤阴能生的。所以说无两生。张志聪云：营卫者，水谷之精气也。血者中焦之精汁，奉心神而化赤，神气之所化也。血与营卫，皆生于精，故异名而同类。简案：《外台秘要》引《删繁论》说：夫血与气，异形而同类。卫是精气，营是神气。故血与气，异形而同类焉。夺血无汗（此是神气），夺汗无血（此是精气）。故人有一死，而无再生也。（《千金方》再作两字）。视之正文，觉得稍明备。
“下焦者（仅指）渗入膀胱焉”：张隐庵云，回肠，即大肠。济，同，犹过滤也。（字典济古文作酿酒也）。泌，如狭流也。别汁，分别清浊也。别回肠者，谓水谷并居于胃中，传化于小肠。当脐上一寸水分穴处，糟粕由此别行回肠，从后而出；津液由此别渗膀胱，从前而出。膀胱无上口，所以说渗入。凡自水分穴而下，皆下焦的部分。按：《难经·三十一难》说：下焦者当膀胱上口，主分别清浊。其言上口者，以渗入之处而言，并非真谓有口。如果真有口，就不说渗入了。为何后世不解其意，而争言膀胱有上口，其谬误甚大。张志聪云：回肠大肠也，有九回，因以为名。简案：《外台秘要》引《删繁论》说：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，成糟粕而俱下于大肠，主足阳明。（《千金方》作足太阳）灌渗津液，合膀胱，主出不主入，别于清浊，亦本节之义也。但本节似脱“起胃下管”一句。《三十一难》云：下焦者，当膀胱上口，主厘清浊，亦可以见耳。丹波元简按：唐容川曰：近人说膀胱有上口，无下口，不对。《内经》明言下焦当膀胱上口。近人不知三焦实有其物。焦古作“𤇍”，即人身之油膜，西医名为连网，乃行水之路道。《内经》所谓三焦者，决渎之官，水道出焉。盖水之路道，全在三焦油膜之中。凡人饮水入胃，胃之通体有微丝管，将水散出，走入油膜，其能散者，肺气布之也。故肺为水之上源。水散入油膜，走入膀胱，其水未散尽者，至小肠中，又有微丝管将水散出，走下焦，以入膀胱。膀胱上口，即在下焦连网之中。此皆下行之水，未化为气者也。
黄帝说：人饮酒（仅指）液出焉。马云：此言酒之所以先谷气而出也。承上文有渗膀胱之语，故遂以酒之先谷而下者问之。正以酒为熟谷之液，其气至悍而清，故虽后谷而入，必先谷而下也。熟者腐也。
“上焦如雾止此之谓也”：张隐庵云，如雾者，气浮于上也。言宗气积于胸中，司呼吸而布于经隧之间，如天之雾，故曰上焦如雾也。沤者，水上之泡，水得气而不沉者也。言营血化于中焦，随气流行，以奉生身，如沤处浮沉之间，故曰中焦如沤也。渎者，水所注泄。言下焦主出而不纳，逝而不反，故曰下焦如渎也。然而肺象天而居上，故司雾之化；脾象地而在中，故司沤之化；大肠、膀胱象江河淮泗而在下，故司川渎之化也。《千金方》及《外台秘要》引《删繁论》说：上焦如雾（雾者霏霏起上也），中焦如沤（沤者在胃中如沤也），下焦如渎（渎者如沟水决泄也）。《白虎通》引《礼运记》说：三焦者，包络腑也，水谷之道路，气之所终始也。故上焦如窍，中焦如编，下焦如渎。（俞氏《续医说》详解之当考参）。张氏《质疑录》载三焦有三。三焦之论云：《灵枢》云：上焦如雾，中焦如沤，下焦如渎。此三焦为一气之所主，故《难经》因之曰：上焦在胃上口，主内而不出，其治在膻中；中焦在胃中脘，主腐熟水谷，其治在脐旁；下焦在脐下，主分别清浊，出而不内。此三焦者，即《灵枢》所谓如雾如沤如渎之三焦也。故《难经》又继言之：三焦为水谷之道路，气之所以终始。三焦者，原气之别使。原气在两肾中间之动气，为人之生命，十二经之根本，主通行三气，经历于五脏六腑。此所谓三焦者，属之于气，正王叔和所谓有名无状之三焦也。
All versions lack the character "Pian" (Chapter).
Where does Wei Qi meet? The *Jia Yi Jing* reads "Yu Yan," meaning "from where."
Regarding old age and prime of life: Zhang Yinzhan states that those over fifty are considered old, and those over twenty are considered strong. (This differs from the statements in the *Ying Qi Shi Chang Pian* and *Qu Li*).
Humans derive Qi from food and drink, ultimately relying on this intake for survival. Zhang Yinzhan explains that human life depends on Qi. Qi is received from Heaven and combines with Gu Qi (Grain Qi) to fill the body. Thus, when food enters the stomach, it transforms into Qi, known as Gu Qi or Wei Qi (Stomach Qi). This Qi is transmitted from the Middle Jiao to the Spleen, ascends to return to the Lung, and accumulates in the chest between the Qi Sea, becoming Zong Qi (Gathering Qi). The movement of Zong Qi follows the rhythm of respiration, penetrating the San Jiao (Triple Burner), thereby nourishing the Five Zang and Six Fu organs. Therefore, the Stomach is the sea of water and grain and blood and Qi, and the Qi humans receive comes solely from grains. Hence, if no grains enter, Qi weakens after half a day and diminishes after one day.
The clear portion (only) refers to Wei Qi moving outside the vessels. Zhang Yinzhan states that although Qi emerges from the Stomach, it has clear and turbid aspects. The clear part is the essence of water and grain; the turbid part is the fierce Qi of water and grain. Scholars who explain clear and turbid using the Upper and Lower Jiao are incorrect. The clear belongs to Yin, possessing a refined and dedicated nature, thus transforming into blood vessels and circulating within the meridians; this is Ying Qi (Nutrient Qi). The turbid belongs to Yang, possessing a swift and slippery nature, thus not following the meridians but reaching directly to the muscle surface, filling the space between skin, hair, and muscles; this is Wei Qi (Defensive Qi). However, both Ying and Wei Qi rely on Zong Qi. Therefore, when Zong Qi is robust, Ying and Wei are harmonious; when Zong Qi declines, Ying and Wei become weak. Ying operates internally; Wei guards externally. The vessel is neither Qi nor Blood; it is like an bellows for Qi and Blood. Ying belongs to Yin and governs the interior; Wei belongs to Yang and governs the exterior. Thus, Ying Qi is inside the vessels, and Wei Qi is outside. The *Wei Qi Pian* states: "The floating Qi that does not follow the meridians is Wei Qi; the essential Qi that travels within the meridians is Ying Qi." This is precisely what is meant here.
Danbo Yuanjian notes: "Wei Qi outside the vessels" means that Wei Qi ascends to the Lung, traverses the Zang-Fu organs, reaches the exterior skin and hair, and functions to protect Ying Blood. Thus, the *Nan Jing·Chapter 32* states: "The Heart governs Blood, the Lung governs Qi; Blood is Ying, Qi is Wei. They accompany each other up and down, called Ying and Wei, circulating through the meridians and encompassing the whole body." This conveys the same meaning.
"Yang Long": Ma Shi states that "Long" should be read as "Long" (prominent/swelling). The *Su Wen·Sheng Qi Tong Tian Lun* mentions "At midday, Yang swells." Generally, in ancient times, "Long" and "Long" were interchangeable. Zhang Yinzhan states that "Long" means flourishing. Fang Yizhi's *Tong Ya* says that "Yang Long and Yin Long" refer to the rise at the junction of Zi and Wu hours, akin to a mountain ridge rising and then gradually flattening. The *Zhuangzi* says, "Thus it rises like a bridge." Briefly, the *Su Wen·Li He Zhen Xie Lun* states that the arterial pulse of the meridians also rises periodically, which shares the same meaning.
"The Taiyin governs the interior, the Taiyang governs the exterior": Zhang Yinzhan states that Taiyin refers to the Hand-Taiyin Lung Meridian, and Taiyang refers to the Foot-Taiyang Bladder Meridian. "Interior" refers to Ying Qi, and "Exterior" refers to Wei Qi. Ying Qi begins at the Hand-Taiyin and returns to the Taiyin, so Taiyin governs the interior. Wei Qi begins at the Foot-Taiyang and returns to the Taiyang, so Taiyang governs the exterior. Ying Qi circulates through the Twelve Meridians, twenty-five cycles during the day and night respectively. Wei Qi travels through the Yang aspects during the day and the Yin aspects at night, also twenty-five cycles each. Ying and Wei each complete fifty cycles to divide the day and night.
"Midnight is the peak of Yin (only) Yin receives Qi": Zhang Yinzhan states that after midnight, Yin declines, and Yang is born at the Zi hour. At sunset, Yang declines, and Yin is born at the Wu hour. As stated in the *Jin Gui Yao Lue·Jin Gui Zhen Yan Lun*: From dawn to noon is Heaven's Yang, Yang among Yang; from noon to dusk is Heaven's Yang, Yin among Yang; from twilight to cockcrow is Heaven's Yin, Yin among Yin; from cockcrow to dawn is Heaven's Yin, Yang among Yin. Humans correspond to this, which is the meaning of this section.
"A great meeting at midnight (only) sharing the chronology with Heaven and Earth": Zhang Yinzhan states that "Great Meeting" refers to the convergence of Ying, Wei, Yin, and Yang. The circulation of Ying and Wei differs in table/interior degrees, so they often do not meet. Only at midnight (Zi hour), when Yin is at its extreme and Yang is about to arise, are both Ying Qi and Wei Qi in the Yin aspect. Thus, all people close their eyes and sleep, termed "He Yin" (Combined Yin). "He Yin" means Ying and Wei both return to the Zang organs and converge in the One Water (Kidney/Yin origin). At dawn, Yin exhausts and Yang receives Qi, so people open their eyes and rise. This is the way of Yin-Yang waxing and waning, constantly continuing, sharing the chronology with Heaven and Earth. The so-called "Chronology of Heaven and Earth" refers to the converging rhythms of Heaven, Earth, Sun, and Moon.
"Drowsy by day": The *Jia Yi Jing* reads "Awake by night."
"Crisp by day": In his commentary on Chapter 46 of the *Nan Jing*, Mr. Xiong states that "Jing" means crisp and refreshing.
"Contending": The *Jia Yi Jing* reads "Bo" as "Bo" (approaching).
"From beginning": The *Jia Yi Jing* reads "Lai" as "Shi" (beginning).
"Ying originates from the Middle Jiao, Wei originates from the Lower Jiao": Zhang Yinzhan states that Ying Qi enters the Stomach with food. The Middle Jiao receives Qi, extracts juices, transforms the essence, and pours it upward to the Lung, starting from the Hand-Taiyin, and circulating within the vessels. Thus, Ying Qi originates from the Middle Jiao. Wei Qi, being its fierce Qi, moves first between the four limbs, muscles, and skin, not entering the vessels. Therefore, at dawn when Yin exhausts and Yang emerges from the eyes, it descends along the head and neck, starting from the Foot-Taiyang Bladder Meridian, traveling through the Yang aspects. At sunset when Yang exhausts, it starts from the Foot-Shaoyin Kidney Meridian, traveling through the Yin aspects. Its Qi emerges from below via the Bladder and Kidney, so Wei Qi originates from the Lower Jiao. Furthermore, Wei Qi belongs to Yang and originates from the Lower Jiao. What is below must ascend, so its Qi moves upward, just as earth qi rises to form clouds. Ying originally belongs to Yin and emerges from the Middle Jiao to the Upper Jiao. What is above must descend, so Ying Qi moves downward, just as heaven qi descends to form rain. Although Wei governs Qi and is external, it certainly contains Blood. Although Ying governs Blood and is internal, it certainly contains Qi. Thus, Ying may contain Wei, and Wei may contain Ying. That which moves internally is called Ying; that which moves externally is called Wei. This is the principle of Yin-Yang interaction in the human body: divided, it is two; united, it is one. Zhang Zhicong states that "Lower" should be "Upper." The *Jue Qi Pian* says: "The Upper Jiao opens and develops, distributing the flavors of five grains, steaming the skin, filling the body, and moistening the hair, like mist and dew; this is called Qi." The *Wu Wei Pian* says: "Pungent substances enter the Stomach, and their Qi travels to the Upper Jiao. The Upper Jiao receives Qi and nourishes all Yang meridians. Wei is the fierce Qi of Yangming water and grain, emerging from the Upper Jiao to guard the exterior Yang; therefore, it is said that Wei emerges from the Upper Jiao." Briefly, the *Qian Jin Fang·San Jiao Bing Lun* states: "Ying emerges from the Middle Jiao, Wei emerges from the Upper Jiao. Ying is the Qi pathway of the collaterals; Wei is the Qi pathway of the main meridians." The *Wai Tai Mi Yao* citing the *Shan Fan Lun* agrees. Zhang's note cannot be said to be baseless. The *Ming Li Lun* citation also reads "Upper Jiao."
"The Upper Jiao emerges from the upper opening of the Stomach (only) descending to the Foot-Yangming": The *Qian Jin Fang* and *Wai Tai Mi Yao* citing the *Shan Fan* read "Upper Wan of the Stomach." Zhang Yinzhan states that the upper opening of the Stomach is the Upper Wan. The pharynx is the root of the Stomach, the path of water and grain. Above the diaphragm is the chest, i.e., the Danzhong. The path going sideways travels through both armpits, emerging near the Tianchi acupoint, following the Hand-Taiyin Lung Meridian, and returning to the Hand-Yangming. The path ascending goes to the tongue; the path descending intersects with the Foot-Yangming to travel through the Middle and Lower Jiao. All these are parts of the Upper Jiao. Zhang Zhicong states: According to the *Jin Gui Yao Lue*, if the primal true Qi of the Five Zang is unobstructed, the person is peaceful, and disease cannot enter the Couli (interstices). Couli is where the San Jiao connects with primal true Qi, where blood and Qi pour in. Li refers to the texture of skin and organs. The San Jiao is the initial Yang Qi, operating up and down, connecting with muscle interstices, not entering the acupuncture points. Thus, the Qi of the Upper Jiao often travels with Ying, twenty-five cycles in Yang and twenty-five in Yin, interspersed with the Ying Blood that nourishes the flesh and warms the muscles, moving through the textures of skin and organs. The Upper Jiao emerges from the upper opening of the Stomach, passes through the diaphragm, spreads in the chest, travels to the armpits, reaches the Yangming, and ascends to the tongue. This discusses the exit of Upper Jiao Qi, differing from the meridian pathways that go through arms and elbows, shoulders, clavicles, ears, and cheeks.
"Often with Ying (only) gathering at the Hand-Taiyin": Zhang Yinzhan states that the Upper Jiao is the residence of the Lung and the gathering place of Zong Qi. Ying Qi follows Zong Qi to travel through the Fourteen Meridians. Thus, the Qi of the Upper Jiao often travels with Ying, twenty-five cycles in Yang and twenty-five in Yin. Yang and Yin refer to day and night. Circulating fifty cycles throughout the day and night, at the next Yin hour, it meets again at the Hand-Taiyin Lung Meridian, completing one cycle. Although Ying Qi originates from the Middle Jiao, its transformation depends on the Upper Jiao. Ma Yun states that the *Nan Jing* erroneously adds a "Wei" character after "Ying." Briefly, the *Qian Jin Fang* and *Wai Tai Mi Yao* citing the *Shan Fan* include the "Wei" character, likely based on the *Nan Jing*.
"Why does it emerge without following the path of Wei Qi?" Zhang Yinzhan states that the path of Wei Qi travels through Yang during the day and Yin at night, having a fixed degree. Now, if someone has eaten hot food, and while its Qi remains unsettled in the Stomach, sweat suddenly leaks out without a fixed location, this is not following the path of Wei Qi. Hence the question.
"This is injured by wind externally (only) named Leaking Leakage": Zhang Yinzhan states that Wind is a Yang pathogen, bringing external heat.
Hot food has fierce Qi, causing internal heat. Where heat gathers, it opens the Couli, causing pores to steam and interstices to leak, so Wei Qi scatters. Thus, it does not follow its normal path. This is the Qi of hot food. Exiting without measure, it is called "Leaking Leakage." Zhang Zhicong states: Wei Qi is the fierce Qi of water and grain, with a fierce, slippery, and swift nature. If the Couli are not tight, it opens and exits. Briefly, Zhang considers this Qi to be Wei Qi, which is correct. The *Wai Tai Mi Yao* citing the *Shan Fan* records treating Upper Jiao Excess Heat: after food enters the Stomach and its Qi is unsettled, sweat appears and the back and body become hot, named "Leaking Qi." Using the method to unblock pulses and drain heat, the Ze Xie Tang (Ze Xie, Sheng Di, Gu Pi, Gan Cao, Ban Xia, Shi Gao, Chai Hu, Fu Ling, Sheng Jiang, Zhu Ye, Ren Shen, Gui Xin, Lian Xin, twelve ingredients) was established for this condition.
"The Middle Jiao also joins in the Stomach, emerging after the Upper Jiao": The *Qian Jin Fang* and *Wai Tai Mi Yao* citing the *Shan Fan* read "Its Qi arises from the Stomach, the Middle Wan is behind the Upper Jiao." The *Jia Yi Jing* and Chao Yuanfang read "Stomach mouth."
"What receives Qi here (only) named Ying Qi": Below the character "Zhe," the *Qian Jin Fang* has six characters: "Master transforms the flavors of water and grain." The *Jia Yi Jing* lacks the character "Mai" in "Fei Mai." Zhang Yinzhan states that "Stomach middle" refers to the Middle Wan region. "Behind" means below. Receiving Qi means receiving the Qi of grain. When five grains enter the Stomach, their dregs, fluids, and Zong Qi are divided into three tunnels to inject into the San Jiao. The Middle Jiao separates dregs, steams fluids, receives Qi, extracts juice, transforms it red, and this is called Blood. It nourishes the living body and travels through the vessel tunnels; this is Ying Qi. Thus, it is said that Ying emerges from the Middle Jiao. According to the following text: The Lower Jiao separates the Hui Chang (returning intestine) and pours into the Bladder. Therefore, from below the diaphragm to one cun above the umbilicus at the Shui Fen acupoint, all are parts of the Middle Jiao. Sui (tunnel) sounds like Sui, meaning a hidden path. Briefly, Mi (secrete) in the *Shuo Wen* means narrow flow. Feng (nourish) is anciently interchangeable with Fei, meaning to nourish. Thus, Ma Yun says that all blood generated in the heart relies on this Ying Qi to transform and nourish the living body.
"As for Blood and Qi (only) there is no dual generation": Zhang Yinzhan states that although Ying and Wei Qi are distinguished as clear and turbid, they are both essences of water and grain. Thus, it is said that Ying and Wei are Essence Qi. Blood transforms red, its wonder unfathomable, thus it is said that Blood is Spirit Qi. However, Blood transforms from Fluids, and Fluids transform from Qi; thus, Blood and Qi are originally of the same category. And Blood transforming into Sweat is not two different things. Blood governs Ying, is Yin and Interior; Sweat belongs to Wei, is Yang and Exterior. One exterior, one interior, they cannot be attacked simultaneously. Thus, those who lose Blood should not induce sweat; those who lose sweat should not deplete Blood. If both exterior and interior are depleted, one will not collapse from Yin but must collapse from Yang. Collapsing from Yang leads to death; collapsing from Yin leads to death. Thus, it is said that human life has two deaths. However, in human birth, neither Yin nor Yang Qi can be absent. There is no solitary Yang that can generate life, nor solitary Yin. Thus, it is said there is no dual generation. Zhang Zhicong states: Ying and Wei are the Essence Qi of water and grain. Blood is the refined juice of the Middle Jiao, offered to the Heart Spirit to transform red, the transformation of Spirit Qi. Blood, Ying, and Wei all originate from Essence, hence different names but same category. Briefly, the *Wai Tai Mi Yao* citing the *Shan Fan Lun* states: Blood and Qi have different forms but same category. Wei is Essence Qi, Ying is Spirit Qi. Thus, Blood and Qi have different forms but same category. Depleting Blood leaves no Sweat (this is Spirit Qi); depleting Sweat leaves no Blood (this is Essence Qi). Thus, a person has one death and no rebirth. (The *Qian Jin Fang* writes "Two" instead of "One"). Compared with the main text, it seems slightly clearer and more complete.
"The Lower Jiao (only) seeping into the Bladder": Zhang Yinzhan states that Hui Chang is the Large Intestine. Ji is synonymous, meaning filtering. (In ancient dictionaries, Ji written differently means brewing wine). Mi means narrow flow. Bie Zhi means separating clear and turbid. Separating the Hui Chang means that water and grain reside together in the Stomach and are transformed in the Small Intestine. At the Shui Fen acupoint, one cun above the umbilicus, dregs separately travel through the Hui Chang and exit from the rear; fluids separately seep into the Bladder and exit from the front. The Bladder has no upper opening, hence it is said to "seep." Everything below the Shui Fen acupoint is part of the Lower Jiao. Note: The *Nan Jing·Chapter 31* states: The Lower Jiao is at the upper opening of the Bladder, governing the separation of clear and turbid. When it speaks of the "upper opening," it refers to the place of seepage, not literally implying an opening. If there were truly an opening, it would not say "seep." Why do later generations fail to understand this and argue that the Bladder has an upper opening? Their error is severe. Zhang Zhicong states: The Hui Chang is the Large Intestine, with nine turns, hence the name. Briefly, the *Wai Tai Mi Yao* citing the *Shan Fan Lun* states: The Lower Jiao is like a ditch, starting from the lower tube of the Stomach, separating the Hui Chang, pouring into the Bladder, and seeping in. Thus, water and grain often reside together in the Stomach, forming dregs and descending together to the Large Intestine, governing the Foot-Yangming. (The *Qian Jin Fang* says Foot-Taiyang). Irrigating and seeping fluids, combining with the Bladder, governing output not input, separating clear and turbid, which is also the meaning of this section. But this section seems to miss the phrase "starting from the lower tube of the Stomach." The *Chapter 31* states: The Lower Jiao is at the upper opening of the Bladder, governing the separation of clear and turbid, which can also be seen. Danbo Yuanjian notes: Tang Rongchuan says: Recent theories claiming the Bladder has an upper opening but no lower opening are incorrect. The *Nei Jing* clearly states the Lower Jiao is at the upper opening of the Bladder. Recent scholars do not know that the San Jiao actually exists as a physical entity. The ancient character for Jiao (𤇍) refers to the oily membranes in the human body, known in Western medicine as the mesentery/connective tissue network, which are the pathways for water flow. The *Nei Jing* says the San Jiao is the official of dredging, where waterways emerge. Essentially, water pathways are entirely within the San Jiao oily membranes. When a person drinks water into the Stomach, the entire Stomach has micro-tubules that disperse the water into the oily membranes. The ability to disperse is due to the distribution of Lung Qi. Thus, the Lung is the source of water above. Water disperses into the oily membranes and enters the Bladder. For water that has not fully dispersed, upon reaching the Small Intestine, there are again micro-tubules that disperse the water, traveling to the Lower Jiao to enter the Bladder. The upper opening of the Bladder is located within the Lower Jiao connective tissue network. These are all descending waters that have not yet transformed into Qi.
Huangdi says: When a person drinks alcohol (only) fluids emerge. Ma Yun states: This explains why alcohol Qi emerges before grain Qi. Following the previous mention of seeping into the Bladder, he asks why alcohol descends before grain. Precisely because alcohol is the liquid of cooked grain, its Qi is extremely fierce and clear. Thus, although it enters after grain, it must descend before grain. Cooked means fermented/rotted.
"The Upper Jiao is like mist (only) this is what is meant": Zhang Yinzhan states: "Like mist" means Qi floats upward. It means Zong Qi accumulates in the chest, governs respiration, and distributes between the meridians, like the mist of Heaven; thus, it is said the Upper Jiao is like mist. Ou (fermenting/bubbles) refers to bubbles on water, water that does not sink when receiving Qi. It means Ying Blood is transformed in the Middle Jiao, flows with Qi to nourish the body, like bubbles floating and sinking; thus, it is said the Middle Jiao is like fermenting. Du (ditch/channel) refers to water flowing and draining. It means the Lower Jiao governs output not intake, departing without returning; thus, it is said the Lower Jiao is like a ditch. However, the Lung resembles Heaven and resides above, thus governing the transformation of mist; the Spleen resembles Earth and resides in the middle, thus governing the transformation of fermentation; the Large Intestine and Bladder resemble rivers and seas and reside below, thus governing the transformation of ditches. The *Qian Jin Fang* and *Wai Tai Mi Yao* citing the *Shan Fan Lun* state: Upper Jiao like mist (mist rises densely from above), Middle Jiao like fermenting (fermentation occurs in the Stomach), Lower Jiao like a ditch (ditch drains like ditch water). The *Bai Hu Tong* citing the *Li Yun Ji* states: The San Jiao is the Bao Luo Fu, the pathway of water and grain, the beginning and end of Qi. Thus, Upper Jiao like an aperture, Middle Jiao like weaving, Lower Jiao like a ditch. (Refer to Yu's *Xu Yi Shuo* detailed explanation for examination). Zhang's *Zhi Yi Lu* records three types of San Jiao. The theory of San Jiao states: The *Ling Shu* says: Upper Jiao like mist, Middle Jiao like fermenting, Lower Jiao like a ditch. This San Jiao is governed by one Qi, so the *Nan Jing* follows saying: Upper Jiao at the upper opening of the Stomach, governing intake not output, its treatment is at Danzhong; Middle Jiao at the Middle Wan of the Stomach, governing the ripening of water and grain, its treatment is beside the umbilicus; Lower Jiao below the umbilicus, governing the separation of clear and turbid, output not input. This San Jiao is exactly the San Jiao described in the *Ling Shu* as like mist, fermenting, and ditch. Thus, the *Nan Jing* continues: The San Jiao is the pathway of water and grain, the reason for the beginning and end of Qi. The San Jiao is the special envoy of Yuan Qi. Yuan Qi is the moving Qi between the two Kidneys, the life of humans, the root of the Twelve Meridians, governing the passage of Three Qi, experiencing the Five Zang and Six Fu organs. This San Jiao belongs to Qi, exactly as Wang Shuhe described as the San Jiao with name but no form.