太阴阳明者，脾与胃也。脾胃者，土也。土为万物之母，性命托之以为基，脏腑资之以为养，所系至重，非
他脏腑之可比，故特为之合论焉。
黄帝问曰∶太阴阳明为表里，脾胃脉也，生病而异者，何也？岐伯对曰∶阴阳异位，更虚更实，更逆更从，
或从内，或从外，所从不同，故病异名也。（按∶杨上善云∶“春夏阳明为实，太阴为虚，秋冬太阴为实，阳明
为虚，即更虚更实也。春夏太阴为逆，阳明为从，秋冬阳明为逆，太阴为从，即更逆更从也。”最为明确。）
帝曰∶愿闻其异状也。岐伯曰∶阳者天气也，主外；阴者地气也，主内。（是所谓阴阳异位也。）故阳道实，阴
道虚。（按∶以言其体，则阳以奇而实，阴以偶而虚。以言其用，则阳以动而实，阴以静而虚。）故犯贼风虚
邪者，阳受之；食饮不节，起居不时者，阴受之。（是所谓或从内，或从外也。）阳受之则入六腑，阴受之则入
五脏。入六腑则身热，不时卧，上为喘呼；入五脏则 满闭塞，下为飧泄，久为肠 。（是所谓所从不同，病异名也。
按∶风自外来，故属阳，饮食起居伤于内，故属阴。阳入六腑，六腑者阳经也；阴入五脏，五脏者，阴经也。阴
有阴病，阳有阳病。飧泄，利水谷也。肠 ，痢也。既利水谷，何以更痢？盖泄利既久，则阴血大伤，故痢也。）
故喉主天气，咽主地气。故阳受风气，阴受湿气。
（按∶喉司呼吸，故主天；咽司饮食，故主地。风为阳邪，在上故也；湿为阴邪，在下故也。）故阴气从足上
行至头，而下行循臂至指端；阳气从手上行至头，而下行至足。（按∶灵枢经曰∶“手之三阴，从脏走手；手
之三阳，从手走头。足之三阳，从头走足；足之三阴，从足走腹。”与此相合。盖言六阴六阳经行之脉络，为一
定不易之常道。惟经行之道路不同，故患病自尔有异也。）故曰∶阳病者上行极而下，阴病者下行极而上。（此
言其大凡尔。然足少阴脉下行，则不同诸阴之气也。按∶阳上阴下，病之常也；极则相反，病之变也。即如阳
证似阴、阴证似阳之类，总是病极之所致，易之所以少不变而老变也。）故伤于风者，上先受之；伤于湿者，
下先受之。（按∶风湿中人，何处不到，但原其始，则有先受之不相同耳。）
帝曰∶脾病而四肢不用，何也？（按∶本篇原以太阴阳明命名，乃此节以前，但泛论阴阳上下内外之常道，
岐伯盖止对帝问生病而异之意而已。自此以下，始正论脾胃要旨，凡三段，而所主之病不与焉。）岐伯曰∶四
肢皆禀气于胃，而不得至经，（按∶胃以水谷资养四肢，然不能遽至于四肢。至经谓至手足之经也，太素作经
至，反蛇足矣。必因于脾，乃得禀也，按∶四肢固借水谷为资养，而水谷非脾不能运化，是故脾化水谷，而
后四肢乃得其养也。）今脾病不能为胃行其津液，四肢不得禀水谷气，气日以衰，脉道不利，筋骨肌肉皆无气
以生，故不用焉。（按∶厥论篇曰∶“脾主为胃行其津液者也。”津液不行，则一身失其所养矣。）帝曰∶脾
不主时，何也？岐伯曰∶脾者土也，治中央，常以四时长四脏，各十八日寄治，不得独主于时也。（按∶万物
生于土，木火金水所不能外也。故虽分王于四季，而实为四时之总司，是故五运首尊甲己也。）脾脏者，常着
胃土之
精也。土者，生万物而法天地，故上下至头足，不得主时也。（按∶着，着见也。胃主受，脾主运，胃受水谷
而脾为之运化，使之着见于一身，是胃土之精，实由脾着也。设令脾亦专主一时，岂能彻上彻下如是哉。着，
陟虑切。）
帝曰∶脾与胃以膜相连耳，而能为之行其津液，何也？岐伯曰∶足太阴者，三阴也，其脉贯胃，属脾，络嗌，
故太阴为之行气于三阴。阳明者，表也，（胃是脾之表也。）五脏六腑之海也，亦为之行气于三阳。脏腑各因
其经而受气于阳明，故为胃行其津液。（按∶脾脏胃腑，阴阳相配。分而言之，各能行气于阴阳。合而言之，
胃受水谷，变化津液，非脾不能运。其经，即脾经也。言五脏六腑，必借脾之运化，而后得受胃气以为养。胃
之津液，亦必借脾之运化，而后得遍及于五脏六腑也。注俱略而不言，何也？！）四肢不得禀水谷气，日以益
衰，脉道不利，筋骨肌肉无气以生，故不用焉。（又复明脾主四肢之义也。）
太阴经和阳明经，分别对应脾脏和胃腑。脾与胃属土。土是万物的母亲，生命的依托以此为根基，脏腑的滋养依靠它，关系极其重大，不同于其他脏腑，所以特别将它们合在一起论述。
黄帝问道：太阴和阳明互为表里，分别是脾和胃的经脉，但它们生病时症状却不同，这是为什么呢？岐伯回答说：阴阳所处的位置不同，虚实状态交替变化，气机逆顺也相互转换，有的病邪从体内产生，有的从体外侵入，来源不同，所以疾病名称也不同。（按语：杨上善说：“春夏季节阳明经实、太阴经虚，秋冬季节太阴经实、阳明经虚，这就是虚实交替。春夏季节太阴经为逆、阳明经为从，秋冬季节阳明经为逆、太阴经为从，这就是逆从交替。”解释得非常明确。）
黄帝说：我想听听它们不同的表现。岐伯说：阳对应天气，主司体表；阴对应地气，主司体内。（这就是所说的阴阳位置不同。）所以阳气的运行规律多表现为充实，阴气的运行规律多表现为虚弱。（按语：从形体来说，阳以奇数为实，阴以偶数为虚。从功能来说，阳主动而实，阴主静而虚。）所以遭受贼风虚邪侵袭的，阳经受之；饮食不节制、起居无规律的，阴经受之。（这就是所说的有的从外，有的从内。）阳经受邪则病入六腑，阴经受邪则病入五脏。病入六腑则出现身体发热、不能按时睡眠、气逆喘呼；病入五脏则出现胸腹痞满闭塞、下部泄泻完谷不化，日久则发展为痢疾。（这就是所说的来源不同，疾病名称不同。按语：风自外来，故属阳；饮食起居损伤于内，故属阴。阳邪入六腑，六腑属阳经；阴邪入五脏，五脏属阴经。阴有阴病，阳有阳病。飧泄是指大便中夹杂未消化的食物。肠澼是指痢疾。既然已经泄泻完谷，为什么又说痢疾呢？大概是因为泄利日久，导致阴血大伤，所以转为痢疾。）
所以说喉主司天气（呼吸），咽主司地气（饮食）。所以阳经受风气，阴经受湿气。（按语：喉主管呼吸，故主天；咽主管饮食，故主地。风为阳邪，在上部；湿为阴邪，在下部。）所以阴气从足上行至头，再下行沿手臂至手指末端；阳气从手上行至头，再下行至足。（按语：《灵枢经》说：“手之三阴经，从内脏走向手部；手之三阳经，从手部走向头部。足之三阳经，从头部走向足部；足之三阴经，从足部走向腹部。”这与上述说法相吻合。这是说六阴六阳经运行的脉络，是固定不变的常道。正因为经络运行的道路不同，所以患病自然也就不同。）所以说：阳病者，向上发展到极点则向下传变；阴病者，向下发展到极点则向上传变。（这是说一般情况。然而足少阴肾经下行，与其他阴经之气不同。按语：阳病向上、阴病向下，是病的常态；发展到极点则相反，是病的变局。就像阳证似阴、阴证似阳之类，都是病情发展到极致的结果，《易经》所谓“少变老不变”的道理。）所以被风邪所伤的，上部先受病；被湿邪所伤的，下部先受病。（按语：风湿中人，无处不到，但追溯其初始，则有先后受病的不同之处。）
黄帝说：脾生病会导致四肢不能使用，为什么呢？（按语：本篇原以太阴阳明命名，此前只是泛论阴阳上下内外的常道，岐伯仅针对黄帝关于生病症状不同的提问作答。从此以下，才开始正式论述脾胃的要旨，共三段，所主的病症与此前不同。）岐伯说：四肢都依赖胃气来滋养，但胃气不能直接到达四肢的经脉，（按语：胃以水谷滋养四肢，但不能立即到达四肢。至经指到达手足的经脉，《太素》作“经至”，反而成了蛇足。必须依靠脾的转输，才能得以禀受，按语：四肢固然借水谷作为资养，但水谷非脾不能运化，所以脾运化水谷后，四肢才能得到滋养。）现在脾生病不能为胃输送津液，四肢得不到水谷之气的滋养，正气日益衰退，脉道不通畅，筋骨肌肉都没有气来生成，所以四肢就不能使用了。（按语：《厥论篇》说：“脾主为胃行其津液。”津液不行，则全身失去滋养。）
黄帝说：脾不单独主令一个季节，为什么呢？岐伯说：脾属土，治理中央，常在四季中滋养四脏，每季最后十八天由脾寄治，所以不能单独主令一个季节。（按语：万物生于土，木火金水都不能脱离土。所以虽然分王于四季，但实际上是四季的总司，因此五运之首尊崇甲己土运。）脾脏，常常显现出胃土的精微物质。土能生万物并效法天地，所以精气上下通达从头到足，不能单独主令一个季节。（按语：着，显现的意思。胃主受纳，脾主运化，胃受纳水谷而脾为之运化，使之显现于全身，这是胃土的精微，实际上是由脾来显着的。假如脾也专门主令一时，怎么能彻上彻下如此呢？着，音zhù。）
黄帝说：脾与胃通过膜相连罢了，却能互相输送津液，为什么呢？岐伯说：足太阴脾经属于三阴经，它的经脉贯穿胃，连接脾，联络咽喉，所以太阴脾经为三阴经输送气机。阳明胃经属于表，（胃是脾的表里配合）是五脏六腑的海，也为三阳经输送气机。脏腑各因各自的经脉从阳明接受气机，所以（脾）能为胃输送津液。（按语：脾脏与胃腑，阴阳相配。分开来说，各自能在阴阳间行气。合起来说，胃受纳水谷，变化津液，非脾不能运化。其经脉即脾经。意思是五脏六腑，必须借助脾的运化，然后才能接受胃气作为滋养。胃的津液，也必须借助脾的运化，然后才能遍及于五脏六腑。之前的注解都简略没讲清楚，为什么呢？！）四肢得不到水谷之气的滋养，日益衰弱，脉道不通畅，筋骨肌肉没有气来生成，所以四肢就不能使用了。（再次阐明脾主四肢的意义。）
Taiyin and Yangming refer to the Spleen and Stomach, respectively. The Spleen and Stomach belong to Earth. Earth is the mother of all things; life relies on it as a foundation, and the Zang-Fu organs depend on it for nourishment. Its significance is extremely profound, incomparable to other Zang-Fu organs, hence they are discussed together specifically.
The Yellow Emperor asked: Taiyin and Yangming are exterior-interior pairs, corresponding to the Spleen and Stomach meridians, yet they manifest different diseases. Why? Qibo replied: Yin and Yang occupy different positions; they alternate between deficiency and excess, and between reversal and compliance. Some pathogens originate internally, others externally. Since their origins differ, the disease names differ accordingly. (Annotation: Yang Shangshan stated: "In spring and summer, Yangming is excess and Taiyin is deficiency; in autumn and winter, Taiyin is excess and Yangming is deficiency. This is the alternation of deficiency and excess. In spring and summer, Taiyin is reversal and Yangming is compliance; in autumn and winter, Yangming is reversal and Taiyin is compliance. This is the alternation of reversal and compliance." This explanation is most clear.)
The Yellow Emperor said: I wish to hear about their differing manifestations. Qibo said: Yang corresponds to Heavenly Qi and governs the exterior; Yin corresponds to Earthly Qi and governs the interior. (This is what is meant by Yin and Yang occupying different positions.) Thus, the pathway of Yang tends toward fullness, while the pathway of Yin tends toward emptiness. (Annotation: Regarding form, Yang is full due to odd numbers, Yin is empty due to even numbers. Regarding function, Yang is full due to movement, Yin is empty due to stillness.) Therefore, when attacked by treacherous winds and empty pathogens, the Yang meridians receive them; when injured by irregular diet and improper daily routine, the Yin meridians receive them. (This refers to some originating from outside, some from inside.) When received by Yang, the pathogen enters the Six Fu organs; when received by Yin, it enters the Five Zang organs. Entering the Six Fu organs results in fever, inability to sleep at proper times, and upward rebellion causing panting and calling; entering the Five Zang organs results in abdominal fullness and obstruction, downward diarrhea of undigested food, and over time, dysentery. (This refers to different origins leading to different disease names. Annotation: Wind comes from outside, thus belongs to Yang; diet and routine injure from within, thus belong to Yin. Yang pathogens enter the Six Fu organs, which are Yang meridians; Yin pathogens enter the Five Zang organs, which are Yin meridains. Yin has Yin diseases, Yang has Yang diseases. Sundun (diarrhea with undigested food) refers to stool containing uncooked grains. Changpi (dysentery) refers to bloody or mucoid stools. If there is already diarrhea of undigested food, why mention dysentery? It is likely that prolonged diarrhea severely damages Yin blood, leading to dysentery.)
Thus, the throat governs Heavenly Qi (respiration), and the pharynx governs Earthly Qi (swallowing). Therefore, Yang meridians receive wind pathogens, and Yin meridians receive dampness pathogens. (Annotation: The throat controls breathing, thus governing Heaven; the pharynx controls eating, thus governing Earth. Wind is a Yang pathogen, located superiorly; Dampness is a Yin pathogen, located inferiorly.) Therefore, Yin Qi ascends from the feet to the head, then descends along the arms to the fingertips; Yang Qi ascends from the hands to the head, then descends to the feet. (Annotation: The *Ling Shu* states: "The three Yin meridians of the hand travel from the Zang organs to the hands; the three Yang meridians of the hand travel from the hands to the head. The three Yang meridians of the foot travel from the head to the feet; the three Yin meridians of the foot travel from the feet to the abdomen." This aligns with the above. It describes the fixed pathways of the six Yin and six Yang meridians. Because these pathways differ, the diseases naturally differ.) Thus it is said: Yang diseases, upon reaching their extreme upward progression, reverse downward; Yin diseases, upon reaching their extreme downward progression, reverse upward. (This describes general principles. However, the Foot Shaoyin Kidney meridian descends, differing from other Yin Qi. Annotation: Yang ascending and Yin descending are the normal state of disease; reversing at the extreme is the pathological variation. Similar to Yang syndromes resembling Yin, or Yin syndromes resembling Yang, these are caused by the extremity of the disease, akin to the principle in the *I Ching* that change occurs in old lines but not young ones.) Therefore, those injured by wind suffer first in the upper body; those injured by dampness suffer first in the lower body. (Annotation: Wind and dampness can affect anywhere in the human body, but tracing back to the origin, there are differences in which part is affected first.)
The Yellow Emperor asked: Why does Spleen disease lead to the inability to use the four limbs? (Annotation: This chapter is originally named after Taiyin and Yangming. Prior sections merely discussed the general principles of Yin-Yang, upper-lower, and internal-external. Qibo only answered the question regarding differing disease manifestations. From here onward, the essential principles of the Spleen and Stomach are formally discussed, comprising three segments, addressing different diseases.) Qibo said: The four limbs all derive Qi from the Stomach, but cannot reach the meridians directly. (Annotation: The Stomach nourishes the four limbs via water and grain, but cannot immediately reach the limbs. 'Reaching the meridians' means reaching the meridians of the hands and feet. *Tai Su* reads 'meridian reaches,' which is redundant. One must rely on the Spleen to transmit it, so that it can be received. Annotation: The four limbs certainly rely on water and grain for nourishment, but water and grain cannot be transformed without the Spleen. Thus, after the Spleen transforms water and grain, the four limbs receive nourishment.) Now, if the Spleen is diseased and cannot transport fluids for the Stomach, the four limbs do not receive Qi from water and grain. Vital energy declines day by day, the vessel pathways become obstructed, and sinews, bones, muscles, and flesh lack Qi to sustain themselves, hence they do not function. (Annotation: The *Jue Lun* chapter states: "The Spleen governs transporting fluids for the Stomach." If fluids do not circulate, the whole body loses its nourishment.)
The Yellow Emperor asked: Why does the Spleen not govern a specific season? Qibo said: The Spleen belongs to Earth, governs the Center, and constantly nourishes the Four Zang organs throughout the four seasons. It governs for eighteen days during each season's transition, and thus cannot exclusively govern one season. (Annotation: All things are born from Earth; Wood, Fire, Metal, and Water cannot exist apart from it. Although it rules during the four seasons, it is essentially the master of all seasons. Hence, in the Five Movements, Jia-Ji Earth is honored first.) The Spleen organ constantly manifests the essence of Stomach Earth. Earth generates all things and models Heaven and Earth; thus, its essence extends from head to foot, and it cannot exclusively govern one season. (Annotation: 'Zhuo' means to manifest. The Stomach receives, the Spleen transforms. The Stomach receives water and grain, and the Spleen transforms them, making them manifest throughout the body. This is the essence of Stomach Earth, actually manifested by the Spleen. If the Spleen also exclusively governed one season, how could it permeate from top to bottom like this? 'Zhuo' is pronounced zhù.)
The Yellow Emperor asked: The Spleen and Stomach are connected only by membranes, yet they can transport fluids for each other. Why? Qibo said: The Foot-Taiyin (Spleen) meridian belongs to the Three Yin meridians. Its vessels penetrate the Stomach, connect to the Spleen, and link to the pharynx. Therefore, Taiyin transports Qi to the Three Yin meridians. Yangming (Stomach) is the exterior (the Stomach is the exterior partner of the Spleen); it is the Sea of the Five Zang and Six Fu organs, and it also transports Qi to the Three Yang meridians. The Zang and Fu organs each receive Qi from Yangming through their respective meridians. Therefore, [the Spleen] transports fluids for the Stomach. (Annotation: The Spleen Zang and Stomach Fu are paired by Yin and Yang. Separately, each can transport Qi within Yin and Yang. Together, the Stomach receives water and grain and transforms fluids, but cannot do so without the Spleen's transformation. The 'meridians' mentioned refer to the Spleen meridian. It means the Five Zang and Six Fu organs must rely on the Spleen's transformation to receive Stomach Qi for nourishment. The Stomach's fluids must also rely on the Spleen's transformation to spread to the Five Zang and Six Fu organs. Previous annotations were brief and omitted this detail; why?) If the four limbs do not receive Qi from water and grain, they decline increasingly day by day, vessel pathways become obstructed, sinews, bones, muscles, and flesh lack Qi to generate, and thus they do not function. (This reiterates the meaning that the Spleen governs the four limbs.)