三十难曰。荣气之行。常与卫气相随。不。然。经言人受气于谷。谷入于胃。乃传与五脏六腑。五脏六腑皆受于气。
其清者为荣。浊者为卫。荣行脉中。卫行脉外。荣周不息。五十而复大会。阴阳相贯。如环之无端。故知荣卫相随也。
丁曰。夫人之生。禀天真之气后。饮水谷食入胃。传于五脏六腑。化为精血。其精血各有清浊。其精中清者。归肺
以助天真。其浊者。坚强骨髓。故血中之清者。归心。荣养于神血中之浊者。外华于肌肉。而清者行于脉内。浊者行于
脉外。而卫者、卫护之义也。杨曰。营行作荣。荣者、荣华之义也。言人百骸九窍所以得荣华者。由此血气也。营者、
经营也。言十二经脉常行不已。经纪人身。所以得长生也。二义皆通焉。卫者、护也。此是人之 悍之气。行于经脉之
外。昼行于身。夜行于脏。卫护人身。故曰卫气。凡人阴阳二气。皆会于头手足。流转无穷。故曰如环之无端也。心荣
血。肺卫气。血流据气。气动根据血。相凭而行。故知荣卫相随也。虞曰。经言人受气于谷。谷入胃。乃传与五脏六腑者。
谓水谷入口。下至于胃。胃化谷为气。上传与肺。肺乃主气。气乃为卫。胃化水上传与心。心乃生血。血乃为荣。气为
表。行于脉外。血为里。行于脉内。二者相根据而行。故一日一夜五十周于身。复会于手太阴。如环之无端。转相溉灌也。
经言清气为荣。浊气为卫。详此清浊之义。倒言之为正。恐传写误也。阴阳应象论曰。清阳实四肢。浊阴归六腑。即其
义也。
三十一难曰。三焦者。何禀何生。何始何终。其治常在何许。可晓以不。然。三焦者。水谷之道路。气之所终始也。
杨曰。焦、元也。天有三元之气。所以生成万物。人法天地。所以亦有三元之气。以养人身形。三焦皆有其位。而
无正脏也。虞曰。天有三元。以统五运。人有三焦。以统五脏也。今根据黄庭经配八卦属五脏法三焦。以明人之三焦法象
三元也。心肺在上部。心法离卦。肺法兑卦乾卦。主上焦。干为天。所以肺行天气。脾胃在中部。脾胃属土。统坤卦。
艮亦属土。艮为运气。主治中焦。肾肝在下部。肾法坎卦。肝法震卦。巽卦。主下焦。主通地气。行水道。夫如是。乃
知坎离震兑坤以法五脏。干艮巽乃法三焦。以合八卦变用。乃如下说。
上焦者。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。杨曰。自膈以上。
名曰上焦。主出阳气。温于皮肤分肉之间。若雾露之溉焉。胃上口穴在鸠尾下二寸五分也。虞曰。膻中者、穴名也。直
两乳中是穴。任脉气之所发。素问曰。膻中为臣使之官。以主气布阴阳。气和志远。喜乐由生。谓布气也。故治其中矣。
上焦主入水谷。内而不出。其为病止言冷热。虚则补其心。实则泻其肺。如此治者。万无一失。灵枢经曰。上焦如雾。
谓行气如露溉灌诸经也。言胃气自膻中布气。与肺下溉灌诸脏。经曰。肺行天气。即此义也。
中焦者。在胃中脘。不上不下。主腐熟水谷。其治在齐旁。
杨曰。自齐以上。名曰中焦。变化水谷之味。生血以荣五脏六腑。及于身体。中脘穴在鸠尾下四寸也。虞曰。中焦
乃脾胃也。中焦为病。止言冷热。虚则补其胃。实则泻其脾。如此治者。万无一失。灵枢经曰。中焦如沤。谓腐熟水谷
也。其治在齐旁。齐旁左右各一寸。乃足阳明胃脉所发。挟齐乃天枢穴也。中焦主脾胃。故治在此经中。故曰齐旁也。
下焦者。（按史记正义引。此下有在脐下三字。）当膀胱上口。主分别清浊。主出而不内以传导也。其治在齐下一寸。
杨曰。自齐以下。名曰下焦。齐下一寸。阴交穴也。主通利溲便以时下而传。故曰出而不内也。虞曰。下焦为病。
止言冷热。虚则补其肾。实则泻其肝。如此治者。万无一失。灵枢经曰。下焦如渎。谓膀胱主水也。素问曰。三焦为决
渎之官。水道出焉。齐下一寸。乃足三阴任脉之会。其治在兹。乃下纪也。
故名曰三焦。其腑在气街。一本曰冲。
丁曰。灵兰秘典论曰。三焦者。决渎之官。引导阴阳水谷。故言三焦者、水谷之道路也。布气于胸中。故治在膻中
穴也。其腑在气街而或曰冲者。二义俱通。言气街者、即阴阳道路也。言气冲者、气冲脉也。气冲者、十二经根本诸经
行气之腑也。故言腑在气冲也。杨曰。气街者、气之道路也。三焦既是行气之主。故云腑在气街。街、衢也。衢者、四
达之道焉。一本曰冲。此非扁鹊之语。盖吕氏再录之言。别本有此言。于义不可用也。虞曰。气街在少腹毛中两旁各二
寸。是穴。乃足阳明脉气所发。言其三焦主三元之气。其腑在气街。其气街者、针经本名气冲。冲者。通与四达之义不
殊。两存之亦可也。以气街为腑者。何也。谓足阳明胃。化谷为气。三焦又主三元之气。故以气街为腑也。
第三十难说：营气（营养之气）的运行，总是与卫气（护卫之气）相随。不对。经文说人从谷物中摄取精气，谷物进入胃后，便传送给五脏六腑。五脏六腑都接受这些精气。其中清轻的部分成为营气，重浊的部分成为卫气。营气运行在脉管之中，卫气运行在脉管之外。营气周流不息，每昼夜循环五十周后再次会合于手太阴肺经。阴阳二气相互贯通，像圆环一样没有起点和终点。因此可知营卫是相随运行的。
丁氏说：人的生存，禀受了先天真气之后，饮水进食入胃，传送到五脏六腑，化为精血。精血各有清浊之分。其中精微中的清者，归并于肺以助长先天真气；其浊者，用于坚固骨髓。所以血液中的清者，归并于心，滋养神志；血液中的浊者，外显于肌肉。而清者行于脉内，浊者行于脉外。所谓“卫”，就是护卫的意思。
杨氏说：“营”通作“荣”，“荣”是荣华的意思。说人的百骸九窍之所以能得到荣华滋润，是因为有血气的作用。“营”也是经营的意思，说十二经脉常行不止，经纪全身，从而得以长生。这两种解释都说得通。“卫”就是护守的意思。这是人体剽悍滑利的气，运行在经脉之外，白天行于体表，夜晚行于内脏，护卫人身，所以叫卫气。凡是人的阴阳二气，都会汇聚于头手足，流转无穷，所以说像圆环一样没有端点。心主营血，肺主卫气，血流依附于气，气运动依靠于血，相互凭借而行，所以知道营卫是相随的。
虞氏说：经文说人从谷物中摄取精气，谷物入胃，便传送给五脏六腑，是说水谷入口，下至于胃，胃将谷物化为气，上传给肺，肺主气，气就成为卫气；胃将水液上传给心，心生血，血就成为营气。气属表，运行在脉外；血属里，运行在脉内。二者相互依靠而行，所以一天一夜在周身循环五十周，重新会合于手太阴肺经，像圆环一样没有端点，互相灌溉。经文说清气为营，浊气为卫，详细考察这清浊的含义，倒过来说才是正确的，恐怕是传抄错误。《阴阳应象大论》说：清阳充实四肢，浊阴归于六腑，就是这个道理。
第三十一难说：三焦，禀受什么而生？从哪里开始到哪里结束？它的病治常在何处？可以说明吗？回答说：三焦是水谷运行的道路，也是气运行的终始之处。
杨氏说：“焦”即“元”。天有三元之气，用来生成万物。人效法天地，所以也有三元之气，来养育人的身形。三焦都有它的位置，但没有对应的正脏。
虞氏说：天有三元，统摄五运；人有三焦，统摄五脏。现在根据《黄庭经》配合八卦归属五脏的方法，将三焦配属以阐明人的三焦效法三元之象。心肺在上部，心效法离卦，肺效法兑卦、乾卦，主管上焦。乾为天，所以肺行天气。脾胃在中部，脾胃属土，统摄坤卦，艮也属土，艮为运气，主治中焦。肾肝在下部，肾效法坎卦，肝效法震卦、巽卦，主管下焦，主通地气，行水道。像这样，就知道坎、离、震、兑效法五脏，乾、艮、巽效法三焦，以符合八卦的变化运用，如下所述。
上焦，位于心下、横膈之上，在胃的上口。主要功能是纳受水谷而不外出。它的病治部位在膻中穴、玉堂穴下一寸六分，直对两乳之间的凹陷处。杨氏说：自横膈以上，名叫上焦。主要功能是发出阳气，温煦于皮肤肌肉之间，像雾露灌溉一样。胃上口穴在鸠尾穴下二寸五分。虞氏说：膻中是穴位名，直对两乳中间即是该穴，是任脉之气所发。《素问》说：膻中是臣使之官，主司布散气机以调和阴阳。气机和顺则志向远大，喜乐由此产生，这就是布散气机的意思。所以治疗在上焦中部。上焦主要摄入水谷，内藏而不外泄。其病变只涉及冷或热两种情况，虚证则补心，实证则泻肺。这样治疗，万无一失。《灵枢经》说：上焦如雾，是说气行如露水灌溉诸经。指胃气从膻中布散气机，与肺向下灌溉各脏腑。经文说“肺行天气”，就是这个意思。
中焦，位于胃的中脘部位，不上不下。主要功能是腐熟水谷。它的病治部位在肚脐旁。杨氏说：自肚脐以上，名叫中焦。变化水谷的味道，生成血液以滋养五脏六腑及身体。中脘穴在鸠尾穴下四寸。虞氏说：中焦就是脾胃。中焦生病，只涉及冷或热两种情况，虚证则补胃，实证则泻脾。这样治疗，万无一失。《灵枢经》说：中焦如沤，是说腐熟水谷。它的病治部位在肚脐旁。肚脐旁左右各一寸，是足阳明胃经所发之处，夹脐的是天枢穴。中焦主脾胃，所以治疗在此经中，所以说在肚脐旁。
下焦，（按《史记正义》引用，此下有“在脐下”三字。）位于膀胱上口。主要功能是分别清浊，主要功能是排出废物而不纳入，起传导作用。它的病治部位在肚脐下一寸。杨氏说：自肚脐以下，名叫下焦。肚脐下一寸是阴交穴。主要功能是通利大小便，按时向下传导，所以说“出而不内”。虞氏说：下焦生病，只涉及冷或热两种情况，虚证则补肾，实证则泻肝。这样治疗，万无一失。《灵枢经》说：下焦如渎，是说膀胱主司水液。《素问》说：三焦是决渎之官，水道由此而出。肚脐下一寸，是足三阴经与任脉的交会处，治疗就在这里，称为下纪。
丁氏说：《灵兰秘典论》说：三焦是决渎之官，引导阴阳水谷，所以说三焦是水谷运行的道路。在胸中布散气机，所以治疗在膻中穴。其腑在气街，或者说在冲脉，两种说法都通。说气街，就是阴阳的道路；说气冲，就是气冲脉。气冲，是十二经的根本，是各经行气的腑。所以说腑在气冲。
杨氏说：气街，是气运行的道路。三焦既然是行气的主宰，所以说腑在气街。街，就是衢道。衢，是四通八达的道路。另一版本说是“冲”。这不是扁鹊的话，大概是吕氏再次记录的话，别本有此言，但在义理上不可用。
虞氏说：气街穴在小腹毛际两旁各二寸处，是穴位，是足阳明脉气所发。说三焦主司三元之气，其腑在气街。所谓气街，即《针经》原本叫气冲穴。“冲”的意思是通达，与四通八达的意义没有不同。两者并存也可以。为什么说以气街为腑呢？因为足阳明胃将谷物化为气，三焦又主司三元之气，所以以气街为腑。
The Thirtieth Difficulty states: The movement of Ying Qi (Nutritive Qi) always accompanies Wei Qi (Defensive Qi). This is incorrect. The Classics state that humans derive Qi from grain. Once grain enters the stomach, it is transmitted to the Zang and Fu organs. All Zang and Fu organs receive this Qi. The clear and light portion becomes Ying Qi, while the turbid and heavy portion becomes Wei Qi. Ying Qi circulates within the vessels, whereas Wei Qi circulates outside the vessels. Ying Qi flows ceaselessly, completing fifty cycles daily before reconvening at the Lung Meridian of Hand-Taiyin. Yin and Yang Qi interpenetrate each other like a circle without beginning or end. Thus, it is known that Ying and Wei Qi move in conjunction.
Master Ding says: Upon birth, humans inherit Primordial True Qi. After drinking water and eating food, these enter the stomach and are transmitted to the Zang and Fu organs, transforming into Essence and Blood. Essence and Blood have clear and turbid distinctions. The clear aspect of Essence returns to the Lung to assist Primordial True Qi, while the turbid aspect strengthens the bone marrow. Therefore, the clear part of blood returns to the Heart to nourish the Spirit; the turbid part manifests externally on the muscles. The clear portion moves within the vessels, and the turbid portion moves outside the vessels. "Wei" implies protection.
Master Yang says: "Ying" is interchangeable with "Rong" (Glory/Nourishment), meaning flourishing. It refers to how the body's hundred bones and nine orifices attain nourishment through Blood and Qi. "Ying" also means management/operation, referring to the Twelve Primary Meridians circulating continuously throughout the body to sustain life. Both interpretations are valid. "Wei" means guarding. This is the fierce and agile Qi moving outside the meridians, traveling through the body during the day and through the viscera at night, protecting the human body; hence it is called Wei Qi. Yin and Yang Qi converge in the head and extremities, flowing endlessly, thus described as a circle without end. The Heart governs Ying Blood, and the Lung governs Wei Qi. Blood flow relies on Qi, and Qi movement relies on Blood; they depend on each other for motion, confirming that Ying and Wei Qi move together.
Master Yu says: When the Classics state that humans derive Qi from grain, which enters the stomach and transmits to the Zang and Fu organs, it means water and grain enter the mouth, descend to the stomach, where the stomach transforms grain into Qi, transmitting it upward to the Lung. The Lung governs Qi, which becomes Wei Qi. The stomach transforms water, transmitting it upward to the Heart, which generates Blood, becoming Ying Qi. Qi belongs to the Exterior, moving outside the vessels; Blood belongs to the Interior, moving inside the vessels. They rely on each other for movement, completing fifty cycles around the body in one day and night, reconvening at the Lung Meridian of Hand-Taiyin, like an endless circle, irrigating each other. The Classics state clear Qi is Ying and turbid Qi is Wei. Examining the meaning of clear and turbid, stating it inversely is correct; likely a transcription error. The Chapter on Yin-Yang Correspondences states: Clear Yang fills the four limbs, Turbid Yin returns to the Six Fu organs. This illustrates the principle.
The Thirty-First Difficulty asks: What does the San Jiao (Triple Burner) inherit and generate? Where does it begin and end? Where is its treatment located? Can this be explained? The answer is: The San Jiao is the pathway for water and grain, and the starting and ending point of Qi.
Master Yang says: "Jiao" means "Yuan" (Origin). Heaven has three Yuan Qi that generate all things. Humans emulate heaven and earth, possessing three Yuan Qi to nourish the physical form. The San Jiao has its locations but no corresponding solid Zang organ.
Master Yu says: Heaven has three Yuan governing the Five Movements; humans have the San Jiao governing the Five Zang organs. Following the *Huang Ting Jing* method of assigning Eight Trigrams to the Five Zang organs, we assign the San Jiao to clarify how human San Jiao models the Three Yuan. The Heart and Lung are in the upper region; the Heart models the Li Trigram, and the Lung models the Dui and Qian Trigrams, governing the Upper Jiao. Qian represents Heaven, so the Lung conducts Heavenly Qi. The Spleen and Stomach are in the middle region; belonging to Earth, they govern the Kun Trigram, and Gen also belongs to Earth, representing transporting Qi, governing the Middle Jiao. The Kidney and Liver are in the lower region; the Kidney models the Kan Trigram, and the Liver models the Zhen and Xun Trigrams, governing the Lower Jiao, conducting Earthly Qi and managing water pathways. Thus, Kan, Li, Zhen, and Dui model the Five Zang organs, while Qian, Gen, and Xun model the San Jiao, aligning with the transformations of the Eight Trigrams as follows.
The Upper Jiao is below the Heart and above the diaphragm, at the upper opening of the stomach. Its function is reception without excretion. Its therapeutic point is Shanzhong (Chest Center) and Yutang (Jade Hall), one cun and six fen below, directly between the two breasts in the depression. Master Yang says: Above the diaphragm is named the Upper Jiao. Its function is to emit Yang Qi, warming the skin and muscle layers like mist and dew. The upper opening of the stomach is 2.5 cun below Jiutwei (Giant Bell). Master Yu says: Shanzhong is an acupoint name, located directly between the two breasts, where the Qi of the Ren Mai (Conception Vessel) emerges. The *Su Wen* states: Shanzhong is the Official of the Envoy, governing the distribution of Qi to harmonize Yin and Yang. Harmonious Qi leads to broad-mindedness and joy, which is the distribution of Qi. Hence, treatment is in the center of the Upper Jiao. The Upper Jiao receives water and grain, keeping them internal without excretion. Pathologies here involve only cold or heat. Deficiency requires tonifying the Heart; Excess requires draining the Lung. Such treatment ensures success. The *Ling Shu* states: The Upper Jiao is like a mist, meaning Qi moves like dew irrigating the meridians. This refers to Stomach Qi distributing Qi from Shanzhong and the Lung irrigating the viscera downward. The Classic states "the Lung conducts Heavenly Qi," which is this meaning.
The Middle Jiao is at Zhongwan (Middle Palace) in the stomach, neither rising nor falling. Its function is the decomposition and ripening of water and grain. Its therapeutic location is beside the umbilicus. Master Yang says: Above the umbilicus is named the Middle Jiao. It transforms the flavors of water and grain, generating Blood to nourish the Zang and Fu organs and the body. Zhongwan is 4 cun below Jiutwei. Master Yu says: The Middle Jiao is the Spleen and Stomach. Pathologies of the Middle Jiao involve only cold or heat. Deficiency requires tonifying the Stomach; Excess requires draining the Spleen. Such treatment ensures success. The *Ling Shu* states: The Middle Jiao is like a fermenting vat, meaning the decomposition of water and grain. Its therapeutic location is beside the umbilicus. One cun left and right of the umbilicus are points where the Foot-Yangming Stomach Meridian emerges. Beside the umbilicus is Tianshu (Heavenly Pivot). Since the Middle Jiao governs the Spleen and Stomach, treatment is in this meridian, hence "beside the umbilicus."
The Lower Jiao (according to *Zhengyi* commentary on *Shi Ji*, there are three characters "below the umbilicus" here) is at the upper opening of the bladder. Its function is to separate clear from turbid, primarily expelling waste without receiving, serving as a conduit. Its therapeutic location is one cun below the umbilicus. Master Yang says: Below the umbilicus is named the Lower Jiao. One cun below the umbilicus is Yinjiao (Yin Intersection). Its function is to promote urination and defecation, transmitting downward timely, hence "expelling without receiving." Master Yu says: Pathologies of the Lower Jiao involve only cold or heat. Deficiency requires tonifying the Kidney; Excess requires draining the Liver. Such treatment ensures success. The *Ling Shu* states: The Lower Jiao is like a ditch, meaning the Bladder governs water. The *Su Wen* states: The San Jiao is the Official of Ditches, from which waterways emerge. One cun below the umbilicus is the convergence of the Foot-Sanyin Meridians and the Ren Mai. Treatment is here, known as Xiaji (Lower Record).
Thus it is named the San Jiao. Its Fu organ is located at Qijie (Qi Street). Another version says Chong (Penetrating Vessel).
Master Ding says: The *Ling Lan Mi Dian Lun* states: The San Jiao is the Official of Ditches, guiding Yin-Yang water and grain; thus, the San Jiao is the pathway for water and grain. It distributes Qi in the chest, so treatment is at the Shanzhong acupoint. Its Fu organ is at Qijie, or some say Chong; both meanings are acceptable. "Qijie" refers to the pathway of Yin and Yang Qi. "Qichong" refers to the Qichong Pulse. Qichong is the root of the Twelve Meridians and the Fu organ for Qi circulation of all meridians. Hence, it is said the Fu organ is at Qichong.
Master Yang says: Qijie is the pathway of Qi. Since the San Jiao is the master of Qi movement, it is said the Fu organ is at Qijie. "Jie" means thoroughfare. A thoroughfare is a road leading in four directions. Another version says "Chong." This is not Bian Que's words but likely recorded by Lu Shi from another edition; it cannot be used doctrinally.
Master Yu says: The Qijie acupoint is two cun lateral to the pubic hairline, where the Qi of the Foot-Yangming Meridian emerges. It is said the San Jiao governs the Qi of the Three Yuan, and its Fu organ is at Qijie. The term Qijie is originally called Qichong in the *Zhen Jing*. "Chong" means penetration, similar to the meaning of four-way access. Keeping both is acceptable. Why is Qijie considered the Fu organ? Because the Foot-Yangming Stomach transforms grain into Qi, and the San Jiao governs the Qi of the Three Yuan; therefore, Qijie is designated as the Fu organ.