马云。别。如字。此乃五脏之别是一论。故名篇。吴同。
方士 文选七发。方术之士。李善注。孔安国论语注云。方。道也。
女子胞 张云。子宫。是也。简按汉外戚传。善臧我儿胞。师古注。谓胎之衣也。此即胞衣。又仓
公传。风瘅客脬。正义。脬。亦作胞。此即膀胱。而其为子宫之义者。史传无所考。然胞衣每儿化成。膀胱不
限女子。明是子宫矣。质疑录云。阴阳别论云。女子胞。气厥论云。胞移热于膀胱。五味篇云。冲脉任脉。皆
起于胞中。凡此胞字。皆音包。以子宫为言也。灵枢云。膀胱之胞薄以懦。音抛。以溲脬为言也。
奇恒之腑 高云。奇。异也。恒。常也。言异于常腑也。
其气象天 张云。转输运动。象天之气。高云。传导水谷。变化而出。犹之天气之所生也。从上
而下。故其气象天。从上而下。故泻不藏。
魄门 魄。粕通。庄子天道篇。古人之糟魄已夫。音义。司马云。烂食曰魄。一云。糟烂为魄。本
又作粕。盖肛门传送糟粕。故名魄门。王注恐凿矣。
气口 张云。气口之义。其名有三。手太阴肺经脉也。
肺主诸气。气之盛衰见于此。故曰气口。肺朝百脉。脉之大会聚于此。故曰脉口。脉出太渊。其长一寸九分。
故曰寸口。是名虽三。而实则一耳。简按仓公传。太阴之口。亦谓寸口。
为五脏主 经脉篇曰。经脉者。常不可见也。其虚实也。以气口知之。经脉别论曰。权衡以平。气口
成寸。以决死生之分。难经。一难曰。十二经皆有动脉。独取寸口。以决五脏六腑死生吉凶之法。何谓也。然。
寸口者。脉之大会。五脏六腑之所终始。故法取于寸口也。
六腑之大源也 灵五味篇云。胃者。五脏六腑之海也。玉版论云。胃者。水谷气之海也。甲乙林亿等
注云。称六腑。虽少错于理。相发为佳。
气口亦太阴也 马云。五味入口藏于胃。而得脾以为之运化。致五脏之气。无不藉之资养。则是脾者
足太阴也。肺者手太阴也。其气本相为流通。而气口亦手太阴耳。张云。气口属肺。手太阴也。布行胃气。则
在于脾。足太阴也。经脉别论曰。饮入于胃。游溢精气。上输于脾。脾气散精。上归于肺。然则胃气必归于脾。
脾气必归于肺。而后行于脏腑营卫。所以气口虽为手太阴。而实即足太阴之所归。故曰气口亦太阴也。简按马
张所解。其理虽详备。而考之经文。似不太明。李中梓诊家正眼。删亦字。
出于胃变见于气口 吴云。五脏六腑之气味。皆出于胃。熏蒸于肺。肺得诸脏腑之气。转输于经。故
变见于寸口。高云。五脏六腑之气味。始则五味入口藏于胃。继则脾气转输气味。皆出于胃。循经脉而变见于
气口。简按出字。全本作入。而王注亦云。谷入于胃。然据吴高注意。不必改入字。其义自明。
五气入鼻藏于心肺 张云。上文言五味入口藏于胃者。味为阴也。此言五气入鼻藏于心肺者。气为阳
也。鼻为肺之窍。故心肺有病。而鼻为之不利。观此两节。曰味曰气。皆出于胃。而达于肺。既达于肺。亦必
变见于气口。故气口独为五脏主。简按吴云。风暑湿燥寒。天之五气也。误。
察其下适其脉 吴云。下。谓二便也。张云。适。测也。简按当从太素。补上字候字。下文其病下。补能字。
拘于鬼神者 史记。扁鹊云。信巫不信医。六不治也。
Ma Yun states: "Bie" (differentiation/separation), interpreted literally. This chapter discusses the differentiation of the Five Zang organs, hence its title. Wu Kun states:
Fangshi (Practitioners of Arts/Methods): From "Seven Stimuli" in *Wen Xuan*. Li Shan's commentary notes that Kong Anguo, in his commentary on the *Analects*, said "Fang" means Dao (Way/Path).
Nüzibao (Female Uterus): Zhang Jingyue identifies it as the uterus. Jian An (the editor/commentator) notes: In *Book of Han: Biographies of the Empresses and Consorts*, there is a phrase "Shan zang wo er bao" (Carefully hide my child's bao). Yan Shigu's commentary explains this refers to the placenta or fetal membrane (baoyi). Similarly, in *Records of the Grand Historian: Biography of Master Cang*, the phrase "Feng dan ke pao" appears. The *Zhengyi* commentary explains that "Pao" is also written as "Bao", referring here to the bladder. However, historical records do not provide definitive evidence for the meaning of "bao" as uterus. Nevertheless, *Zhiyi Lu* points out that in *Suwen: Yin Yang Bie Lun*, it says "Nüzi bao"; in *Suwen: Qi Jue Lun*, it says "Bao yi re yu pao guang" (Heat transfers from the bao to the bladder); and in *Suwen: Wu Wei Pian*, it says "Chong Mai, Ren Mai, jie qi yu bao zhong" (The Chong and Ren meridians both originate from the bao). In all these instances, "bao" is pronounced like "bao" (package/wrap) and refers to the uterus. Conversely, in *Ling Shu*, it says "Pang guang zhi bao bo yi nuo", pronounced like "pao", referring to the urinary bladder (su pao).
Qiheng zhi Fu (Extraordinary Fu Organs): Gao Shishi states: "Qi" means strange or unusual; "Heng" means ordinary. Thus, they are different from the ordinary Fu organs.
Qi xiang tian (Its image resembles Heaven): Zhang Jingyue explains: Transport and movement resemble the Qi of Heaven. Gao Shishi explains: Conducting and transforming food and fluids, emerging like what Heaven generates. Moving from top to bottom, thus its image resembles Heaven. Because it moves from top to bottom, it discharges but does not store.
Pomen (Gate of Po/Essence): "Po" is interchangeable with "Po" (dregs/feces). In *Zhuangzi: Tian Dao*, it says "Gu ren zhi cao po yi fu". The phonetic and semantic commentary states: Sima Bao says rotten food is called "Po"; another view says dregs and rot constitute "Po". It was originally written as "Po" (grain waste). Presumably, because the anus transmits dregs and feces, it is named Pomen. Wang Bing's annotation is likely overly forced.
Qikou (Qi Cleft/Pulse Position): Zhang Jingyue states: The term Qikou has three names. First, it is the pulse position of the Hand-Taiyin Lung Meridian. Second, the Lung governs all Qi; the abundance or deficiency of Qi manifests here, hence called Qikou. Third, the Lung faces all vessels; the great convergence of pulses occurs here, hence called Maikou. Fourth, the pulse emerges at Taiyuan (LU-9), measuring one cun and nine fen, hence called Cun Kou. Although the names differ, they refer to the same entity. Jian An notes: In *Records of the Grand Historian: Biography of Master Cang*, "Taiyin zhi kou" is also referred to as Cun Kou.
Wei Wuzhu (Master of the Five Zang): The *Jing Mai Pian* states: "Meridian vessels are usually invisible. Their excess or deficiency is known via the Qikou." The *Jing Mai Bie Lun* states: "When balance is achieved, the Qikou forms the Cun, allowing one to determine the division of life and death." *Nan Jing: Chapter 1* asks: "All twelve meridians have pulsating arteries, yet we exclusively take the Cun Kou to determine the life, death, auspiciousness, and inauspiciousness of the Five Zang and Six Fu organs. What is the reason?" The answer is: "The Cun Kou is the great convergence of pulses, the beginning and end of the Five Zang and Six Fu organs; therefore, the method takes the Cun Kou."
Liufu zhi Dayuan ye (The Great Source of the Six Fu Organs): *Ling Shu: Wu Wei Pian* states: "The Stomach is the Sea of the Five Zang and Six Fu organs." *Ling Shu: Yu Ban Lun* states: "The Stomach is the Sea of Water and Grain Qi." Lin Yi et al.'s annotations on *Jia Yi Jing* state: Calling it the great source of the Six Fu organs is slightly theoretically inaccurate, but it serves as a good point for mutual inspiration.
Qikou yi Taiyin ye (The Qikou is also Taiyin): Ma Yun states: Flavors enter the mouth and are stored in the Stomach, relying on the Spleen for transformation and transportation. Thus, the Qi of the Five Zang organs relies on this for nourishment. The Spleen is Foot-Taiyin, and the Lung is Hand-Taiyin. Their Qi naturally circulates together, and the Qikou belongs to the Hand-Taiyin. Zhang Jingyue states: The Qikou belongs to the Lung, which is Hand-Taiyin. Distributing Stomach Qi depends on the Spleen, which is Foot-Taiyin. The *Jing Mai Bie Lun* states: "Drinks enter the Stomach, floating and overflowing with essence Qi, transported upward to the Spleen. The Spleen scatters essence, returning it upward to the Lung." Therefore, Stomach Qi must return to the Spleen, and Spleen Qi must return to the Lung, before circulating to the Zang-Fu and Ying-Wei. Thus, although the Qikou is Hand-Taiyin, it is essentially the destination of Foot-Taiyin. Hence, it is said that the Qikou is also Taiyin. Jian An notes: While Ma and Zhang's explanations are detailed and complete, they seem unclear when examined against the original text. Li Zhongzi's *Zhenjia Zhengyan* deletes the character "Yi" (also).
Chu yu wei bian jian yu qikou (Emanating from the Stomach, manifesting variably at the Qikou): Wu Kun states: The Qi and flavors of the Five Zang and Six Fu organs all emanate from the Stomach, steaming into the Lung. The Lung receives the Qi of all organs, transports it through the meridians, and thus changes manifest at the Cun Kou. Gao Shishi states: The Qi and flavors of the Five Zang and Six Fu organs begin with five flavors entering the mouth and storing in the Stomach; subsequently, the Spleen transforms and transports these flavors, all emanating from the Stomach, following the meridians to manifest variably at the Qikou. Jian An notes: The character "Chu" (emanate/out) is originally "Ru" (enter) in the complete text, and Wang Bing's commentary also says "Grain enters the Stomach." However, based on Wu and Gao's interpretations, there is no need to change "Ru" to "Chu"; the meaning remains clear.
Wuqi ru bi cang yu xin fei (Five Qi enter the nose and are stored in the Heart and Lung): Zhang Jingyue states: The previous section discussed five flavors entering the mouth and storing in the Stomach, where flavor is Yin. This section discusses five Qi entering the nose and storing in the Heart and Lung, where Qi is Yang. The nose is the orifice of the Lung; thus, when the Heart and Lung are diseased, the nose becomes obstructed. Observing these two sections, both flavor and Qi emanate from the Stomach and reach the Lung. Once reaching the Lung, they inevitably manifest variably at the Qikou. Therefore, the Qikou alone serves as the master of the Five Zang organs. Jian An notes: Wu Kun's statement that Wind, Summer Heat, Dampness, Dryness, and Cold are the Five Qi of Heaven is incorrect.
Cha qi xia shi qi mai (Examine the lower [excretions] and assess the pulse): Wu Kun states: "Xia" refers to urination and defecation. Zhang Jingyue states: "Shi" means to measure or estimate. Jian An notes: Following *Tai Su*, the character "Hou" (observe/examine) should be added above, and "Neng" (can/able) should be added below in the phrase "Qi bing xia".
Ju yu guishen zhe (Those constrained by ghosts and spirits): *Records of the Grand Historian* records Bian Que saying: "Believing in shamans and not in physicians is one of the six untreatable conditions."