(次脉度篇之后)
营出于中焦。(胃之中脘)卫出于下焦(脐下一寸阴交为下焦)上焦出于胃上口。并咽以上
贯膈
而布胸中。(膻中之分)走腋。循太阴之分而行。还至阳明。上至舌。下足阳明。常与营俱行
于阳二十五度。行于阴办二十五度。一周也。故五十度而复大会于太阴矣 中焦亦。并胃中
。出上焦之后此所受气者。泌糟粕蒸津液。化其精微。上注于肺脉乃化而为血。以奉生身。
莫赀于此。故独得行于经隧。命曰营气。营卫者。精气也。血者神气也。故血之与气。异名
同类焉。故夺血者无汗。夺汗者无血。下焦者。别回肠。(大肠)注于膀胱面渗入焉。故水谷
者。常并居于胃中。成糟粕。而俱下于大肠而成下焦渗而俱下。济泌别汁。循下焦而渗入膀
胱焉(其浊气下行为二便。清气升于上中二焦为卫气)上焦如雾中焦如沤下焦如渎。
(次五乱篇之后)
其脉大坚以涩者胀也 夫胀者。皆属于脏腑之外。排脏腑而郭胸胁。胀皮肤故名曰胀。
营气循脉。卫气逆为脉胀。卫气并脉循分为肤胀(马注胀不在于营气。惟卫气逆行。并脉循分肉
。始为脉胀而成肤胀)三里而泻。近者一下。远者三下。无问虚实。工在疾泻。(病近一次泻
之。病远三次泻之。疾急也)心胀者。烦心短气卧不安。肺胀者虚满而喘咳。肝胀者。胁下
满而痛引小腹。脾胀者善哕四肢烦 体重不能胜衣。卧不安。肾胀者。腹满引背。央央然腰
髀痛。(此言五脏胀形)胃胀者。腹满。胃脘痛。鼻闻焦臭。妨于食。大便难。大肠胀者。肠
鸣而痛濯濯。冬日重感于寒。则飧泄不化。小肠胀者。少腹 胀引腰而痛。膀胱胀者。少腹
满而气癃。三焦胀者。气满于皮肤中。轻轻然而不坚。胆胀者。胁下痛胀。口中苦。善太息
（紧接在《脉度》篇之后）
营气产生于中焦。（中焦对应胃的中脘部位）卫气产生于下焦。（下焦对应脐下一寸的阴交穴）上焦出于胃的上口，并沿着咽喉向上，穿过膈肌，分布于胸中。（即膻中所在的区域），走向腋下，沿着手太阴肺经的循行路线运行，返回至手阳明大肠经，上行至舌部，下行连接足阳明胃经。营气常与卫气一同运行于阳分二十五周次，运行于阴分二十五周次，这构成了一周。因此，经过五十周次后，营卫二气再次在太阴经会合。
中焦也位于胃中，处于上焦功能发挥之后。这里受纳的水谷之气，通过泌别糟粕、蒸腾津液，将其转化为精微物质，向上输送到肺脉，进而化生为血液，以供养全身生命活动，没有比这更重要的了。所以营气能够独自行走于经脉隧道之中，被称为营气。营气和卫气都是精气，血是神气的载体，所以血和气虽然名称不同，但本质同类。因此，耗伤血液的人不能发汗，耗伤津液（汗）的人不能放血或过度利水。下焦将回肠（大肠）分开，注入膀胱并渗入其中。所以水谷常常共同居住在胃中，形成糟粕，一起向下进入大肠，进而渗入下焦并一起向下传导，经过过滤分离汁液，沿着下焦渗入膀胱。（其中浊气向下排出成为大小便，清气上升于上、中二焦化为卫气）。上焦的功能像雾露弥漫一样，中焦的功能像沤泡发酵一样，下焦的功能像沟渠排水一样。
（紧接在《五乱》篇之后）
如果脉搏大而坚涩，这是胀病的表现。大凡胀病，都发生在脏腑之外，排挤脏腑，扩张胸胁廓，胀满皮肤，所以称为胀。营气沿经脉运行，若卫气逆行则导致脉胀；若卫气并入经脉，沿着分肉间隙运行则导致肤胀。（马莳注：胀病不在于营气，只有卫气逆行，并入经脉，沿着分肉间隙运行，才会形成脉胀和肤胀）。治疗时取足三里穴进行泻法，病位近的泻一次，病位远的泻三次，不论虚实，关键在于迅速泻邪。（病位近的一次泻治，病位远的三次泻治，强调急迫之意）。心胀的症状是心烦、气短、睡眠不安。肺胀的症状是胸部虚满、气喘咳嗽。肝胀的症状是胁下胀满疼痛，并牵引小腹。脾胀的症状是频繁呃逆、四肢烦扰沉重、身体沉重连衣服的重量都承受不了、睡眠不安。肾胀的症状是腹部胀满牵引背部，腰部和大腿根部酸痛。（以上讲述五脏胀病的形态）。胃胀的症状是腹部胀满、胃脘疼痛、鼻子闻到焦臭味、妨碍进食、大便困难。大肠胀的症状是肠鸣且疼痛有声，如果在冬天再次感受寒邪，就会发生完谷不化的泄泻。小肠胀的症状是小腹胀满并牵引腰部疼痛。膀胱胀的症状是小腹胀满且小便不通畅。三焦胀的症状是气充满于皮肤之中，轻轻鼓胀但不坚硬。胆胀的症状是胁下疼痛胀满、口苦、喜欢叹气。
(Following the *Mai Du* Chapter)
Ying Qi (Nutritive Qi) originates from the Middle Jiao (Middle Burner). [The Middle Jiao corresponds to the Zhongwan point of the stomach.] Wei Qi (Defensive Qi) originates from the Lower Jiao (Lower Burner). [The Lower Jiao corresponds to the Yinjiao point, one cun below the umbilicus.] The Upper Jiao (Upper Burner) emerges from the upper orifice of the stomach, ascends along the pharynx, penetrates the diaphragm, and distributes in the chest. [This refers to the region of Danzhong (Conception Vessel 17)]. It moves to the axilla, follows the pathway of the Hand-Taiyin Lung Meridian, returns to the Hand-Yangming Large Intestine Meridian, ascends to the tongue, and descends to connect with the Foot-Yangming Stomach Meridian. Ying Qi and Wei Qi often travel together, circulating twenty-five cycles in the Yang aspect and twenty-five cycles in the Yin aspect, constituting one complete revolution. Thus, after fifty cycles, they meet again at the Taiyin meridian.
The Middle Jiao is also located within the stomach, functioning after the Upper Jiao has exerted its influence. Here, the qi derived from food and drink separates the dregs and steams the fluids, transforming them into fine essences. These essences ascend and pour into the lung vessels, where they transform into blood to nourish the living body. Nothing is more valuable than this. Therefore, only Ying Qi can circulate exclusively within the meridians and collaterals, hence it is named Ying Qi. Ying and Wei are both refined essences; blood is the carrier of Shen Qi (Spirit Qi). Thus, although blood and qi have different names, they share the same origin. Consequently, those who have lost blood should not be induced to sweat, and those who have lost sweat (fluids) should not undergo bloodletting or excessive fluid-draining therapies. The Lower Jiao separates the ileum (Large Intestine), pouring into the bladder and permeating through it. Therefore, food and drink often reside together in the stomach, forming dregs, which descend together into the large intestine, then permeate into the Lower Jiao and descend together. After filtration and separation of juices, they follow the Lower Jiao and permeate into the bladder. [The turbid qi descends to become urine and feces, while the clear qi ascends to the Upper and Middle Jiao to transform into Wei Qi.] The function of the Upper Jiao is like mist; the function of the Middle Jiao is like fermentation/soaking; the function of the Lower Jiao is like a ditch/drainage.
(Following the *Wu Luan* Chapter)
If the pulse is large, firm, and choppy, this indicates distension disease. Generally, distension diseases all occur outside the zang-fu organs, pressing against the organs, expanding the thoracic and hypochondriac regions, and swelling the skin, hence named "distension." Ying Qi circulates along the meridians; if Wei Qi rebels and flows inversely, it causes Mai Distension (Meridian Distension); if Wei Qi merges with the meridians and circulates along the muscle intervals, it causes Fu Distension (Skin Distension). [Ma Shi's commentary: Distension does not lie in Ying Qi, but solely in the reverse flow of Wei Qi, merging with the meridians and circulating along the muscle intervals, thereby forming Mai Distension and Fu Distension.] Treat by reducing the Zusanli point (ST36). For lesions near the surface, reduce once; for lesions far away, reduce three times. Regardless of deficiency or excess, the key lies in rapid reduction. [Treating near lesions once, distant lesions three times, emphasizing urgency.]
Symptoms of Xin Distension (Heart Distension): mental restlessness, shortness of breath, and restless sleep.
Symptoms of Fei Distension (Lung Distension): empty fullness in the chest, wheezing, and coughing.
Symptoms of Gan Distension (Liver Distension): fullness and pain in the hypochondrium radiating to the lower abdomen.
Symptoms of Pi Distension (Spleen Distension): frequent hiccups, heavy and irritable limbs, body heaviness such that even the weight of clothes cannot be borne, and restless sleep.
Symptoms of Shen Distension (Kidney Distension): abdominal fullness radiating to the back, and soreness/pain in the waist and thighs. [This describes the manifestations of the five zang organ distensions.]
Symptoms of Wei Distension (Stomach Distension): abdominal fullness, epigastric pain, olfactory hallucinations of burnt odors, difficulty eating, and difficult defecation.
Symptoms of Dachang Distension (Large Intestine Distension): borborygmus and gurgling pain. If exposed to cold again in winter, it leads to undigested diarrhea.
Symptoms of Xiaochang Distension (Small Intestine Distension): lower abdominal distension radiating to the back and pain.
Symptoms of Pangguang Distension (Bladder Distension): lower abdominal fullness and urinary retention/dysuria.
Symptoms of Sanjiao Distension (Triple Burner Distension): qi fills the skin, causing slight puffiness but not hardness.
Symptoms of Dan Distension (Gallbladder Distension): pain and distension in the hypochondrium, bitter taste in the mouth, and frequent sighing.