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The five Zang organs each have specific functions, such as those related to the Five Elements, five colors, and five flavors; these are standard discussions. However, where there is a norm, there must be variation. Huangdi and Qibo extensively investigated and thoroughly elucidated these principles. This is similar to the principle of Yin and Yang, which has both normal and abnormal states; thus, this chapter is named "Bie Lun" (Distinct Discussion).

Huangdi asked: I have heard that some physicians consider the brain and marrow to be Zang organs, others consider the stomach and intestines to be Zang organs, and still others consider them to be Fu organs. May I ask why these views contradict each other yet all claim to be correct? I do not understand the rationale and wish to hear your explanation.

Qibo replied: The brain, marrow, bones, vessels, gallbladder, and uterus (in women) are generated by Earth Qi. They store Yin and correspond to the Earth; therefore, they store essence but do not excrete, and are called the Qi Heng Fu (Extraordinary Fu Organs). Although the brain, marrow, bones, and vessels are named Fu, they do not have exterior-interior relationships with the Shen Zang (Spirit Zang organs). The gallbladder harmonizes with the Liver but differs from the six regular Fu organs in its transmission and excretion functions. The uterus has functions of receiving and discharging; it receives essence and discharges changes in appearance, but its function differs from the six regular Fu organs, hence it is described as storing without excreting, and is named an Extraordinary Fu organ. The stomach, large intestine, small intestine, San Jiao (Triple Burner), and bladder are generated by Heaven Qi. Their nature corresponds to Heaven; therefore, they transmit and excrete but do not store, accepting turbid Qi from the five Zang organs. These are called the Chuan Hua Fu (Transmitting and Transforming Fu Organs). These organs cannot retain contents for long but serve to transport and excrete. When food and water enter, residues change and are excreted; they cannot stay long inside but must be transformed and discharged immediately. Since they accept only turbid Qi from the Zang organs, they must excrete and cannot retain. The Po Men (anus) also serves as the envoy for the five Zang organs, and food residues cannot be stored for long. The Po Men refers to the anus, which connects internally to the Lung, hence the name. It accepts digested substances and performs excretory functions for the Zang organs. However, food residues cannot remain long in the body. Why does the anus connect to the Lung? The anus is the terminal orifice of the Large Intestine, and the Large Intestine harmonizes with the Lung. The six Fu organs accept turbid Qi from the Zang organs, transport it downward, and it must exit via the anus. Thus, they excrete without storing; this applies not only to the six Fu organs but also to the Po Men. The so-called five Zang organs store essence and do not excrete, so they are full [of essence] but not solid [with food]. The six Fu organs transmit and transform substances but do not store, so they can be solid [with food] but not full [of essence]. Essence is precious and hard to fill physically, while transformed food is filthy and cannot stay long; their storage and excretion represent the wonderful natural operation of creation. Transformed food refers to substances derived from food and water. This is because when food enters the mouth, the stomach becomes solid and the intestines empty; when food moves down, the intestines become solid and the stomach empties. Thus, it is said that Fu organs are "solid but not full," and Zang organs are "full but not solid." Here, "solid" refers to the presence of food, and "empty" refers to its absence, specifically regarding the stomach and intestines. Although the tone seems continuous, careful analysis shows each section has distinct meanings. The first part discusses the brain, marrow, bones, vessels, gallbladder, and uterus as Extraordinary Fu organs outside the regular Zang-Fu system. The gallbladder, though a Fu organ of the Liver, is grouped here because unlike the other five Fu organs which transmit downward and excrete, the gallbladder stores without excreting. The second part discusses the five excretory Fu organs accepting turbid Qi from Zang organs, implying food and water without explicitly stating them. The third part elaborates on storage and excretion using the concepts of fullness and solidity. The fourth part uses the position of food and water to explain solidity and emptiness, focusing only on the stomach and intestines, leaving out the San Jiao and bladder. In works like Su Wen, chapters on annual cycles, acupoints, and acupuncture have clear meanings accessible through literal study. However, the principles of Yin-Yang transformation, diagnostic treatments, and subtle Zang-Fu functions, whether orthodox or extraordinary, require spiritual understanding. Reading the previous four sections carefully reveals the flexibility of the text; readers should not be rigid.

Huangdi asked: Why is the Qi Kou (Radial Pulse) alone capable of serving as the master for diagnosing the five Zang organs? The Qi Kou is the collective term for the Cun, Guan, and Chi pulse positions. Diagnosing diseases through the pulse implies that Zang organ pathologies manifest in the pulse.

Qibo answered: The Stomach is the sea of water and grain and the great source of the six Fu organs. Humans have four seas, one of which is the sea of water and grain. After receiving water and grain, it nourishes the surroundings. As the source of transformation, it is the great source of the six Fu organs. The five flavors entering the mouth are stored in the Stomach to nourish the Qi of the five Zang organs. The Qi Kou also belongs to the Taiyin meridian. The Stomach is the Fu organ of the Foot-Taiyin Spleen, while the Qi Kou is the point of the Hand-Taiyin Lung meridian. The Spleen transforms food in the Stomach into Qi, which fills the Zang organs and manifests at the Qi Kou via the Lung; thus, it is said to belong to Taiyin. Therefore, the Qi and flavor of the five Zang and six Fu organs all originate from the Stomach and manifest at the Qi Kou. If interpreted as "entering," it would merely refer to the five flavors. However, the Stomach nourishes the Qi of the Zang and Fu organs, while the Qi Kou verifies their Qi. Changes necessarily manifest, hence "bian jian" (manifestation of change). "Jian" is pronounced with the falling tone. Thus, the five Qi inhaled through the nose are stored in the Heart and Lung; if the Heart or Lung are diseased, the nose will become obstructed. This is one aspect of external signs.

Those constrained by beliefs in ghosts and gods cannot be spoken to regarding the highest virtue (Dao); medical Dao is profound, termed the Highest Virtue, but those confused by evil beliefs will not trust words. Those who dislike needle and stone therapy cannot be spoken to regarding supreme skill; if one dislikes needles and stones, skill cannot be applied. Patients who do not permit treatment will surely not be cured, and forced treatment will yield no merit. If a patient's mind rejects treatment, death is inevitable; forcing treatment will fail. "Not permitting treatment" does not mean forbidding doctors, but includes cases where patients demand quick results for deep diseases, misuse medications due to ignorance, indulge desires and diet, or ignore medical advice. For such people, forced treatment will also fail. The ancient sages' warnings were indeed profound.