马云。别、彼劣切。内论五液而病为水胀。则必为癃。故名篇。
张云。五液者。阴精之总称也。本篇以溺、汗、泣、唾、水。故名曰五。宣明五气篇曰。五脏化液。心为汗。
肺为涕。肝为泪。脾为涎。肾为唾。是为五液。决气篇曰。精、气、津、液、血、脉。其辨有六。又道家曰。
涕、唾、精、津、汗、血、液。其名则七。皆无非五液之属耳。志云。水谷所生之津液。各走其道。别而为五。
如五道癃闭。则为水胀。五别者。为汗、为溺、为唾、为泪、为髓。五癃者。液不渗于脑而下流。阴阳气道不
通。四海闭塞。三焦不泻。而津液不化。水谷留于下焦。不得渗于膀胱。则水溢而为水胀。因以名篇。上章论
气胀之因。此章论水胀之因。得其因则知所以治矣。简案、本篇末云。此津液五别之顺逆也。甲乙载本篇文。
亦云津液五别。此云五癃。未详所取义。疑文本差讹。
为溺与气 马云。天寒则腠理闭。内之气与湿俱不行。其水下留于膀胱。则为前溺与后气耳。
各走其道 张云。五常四海。各因经以受水谷之气味。故津液随化而各走其道。
其流而不行者 甲乙。流、作留。张云。周流于血脉之间。而不散行于外。注于脏腑。益于精髓
而为之液。志云。流者淖泽注于骨。补益脑髓。灌精而濡空窍者也。
聚沫则痛 张云。或为寒邪所感。则液凝留于肌肉之间。故汁沫聚而为痛。简案、与周痹同义。
为溺其气 张云。腠理闭密。则气不外泄。故气化为水。水必就下。故留于膀胱。然水则气也。水
聚则气生。气化则水注。故为溺与气。志云。气者膀胱为州都之官。津液藏焉。气化而出者为溺。藏于膀胱者。
化生太阳之气。简案、气未详何气。马为失气。近是。见前。
五脏六腑（止）肾为之主外 张云。此二节言津液之为涕泣也。心总五脏六腑。为精神之主。故耳
目肺肝脾肾。皆听
命于心。是以耳之听。目之视。无不由乎心也。肺朝百脉而主治节。故为心之相。肝主谋虑决断。故为心之将。
脾主肌肉而护养脏腑。故为心之卫。肾主骨而成立其形体。故为心之主外也。
故五脏六腑（止）泣出矣 甲乙。与肺、作急肺。似是。泣、作涎。张云。心为脏腑之主。故五脏之系。
皆入于心。心之总系。复上贯于肺。通于喉而息由以出。故心悲则系急而肺叶举。液即随之而上溢。然心系与
肺。本不常举。故有乍上乍下。当其气举而上。则为咳为泣也。凡人之泣甚而继以嗽者。正以气并于上。而奔
遏于肺耳。按、口问篇曰。心者。五脏六腑之主也。目者。宗脉之所聚也。上液之道也。口鼻者。气之门户也。
故悲哀愁忧则心动。心动则五脏六腑皆摇。摇则宗脉感。液道通。故涕泣出焉。
中热（止）故唾出 张云。此津液之为唾也。虫为湿热所化。常居肠中。胃热则消谷中空。虫行就食。故
或上或下。动作于肠胃之间。充郭者。纵满之谓。肠郭则胃缓。胃缓则气逆上行。涎随而溢。故多唾也。按、
宣明五气篇曰。肾为唾而出曰胃为唾。是胃之与肾。皆主为唾。盖土郁之唾在胃。水泛之唾在肾也。
和合而为膏者 膏、诸本作高。但赵府本吴本同此。马云。当作膏。张直改作膏。注云。此津液之为
精髓也。膏、脂膏也。简案、志以高字释之。义不通。
阴阳不和（止）胫 甲乙。虚故、作虚则。腰背、作腰脊。张云。阴阳不和。则精气俱病。气病则不
摄。精病则不守。精气不相统摄。故液溢于下。而流泄于阴窍。精髓皆减。输泄过度。则真阴日虚。故为腰痛
胫等病。此劳瘵之所由作也。
阴阳气道（止）为水胀 下泻诸本作不泻。此字误。当改。张云。此津液之为水胀也。三焦为决渎之官。
膀胱为津液之腑。气不化则水不行。所以三焦不能泻。膀胱不能渗而肿胀也。知病所由。故治此皆当以气化为
主。试观水潦为灾。使非太阳照临。则阴凝终不能散。泥泞终不能干。能知此义。则知阴阳气化之道矣。
此津液五别之逆顺也 张云。阴阳和。则五液皆精而充实于内。阴阳不和。则五精皆泄而流溢于外。
此其所谓逆顺也。
马云说：“别”，读音为“彼劣切”。《内经》本篇论述五种津液，若病变导致水液停聚形成水胀病，则必然伴随小便不通（癃闭），因此以“五癃”命名此篇。
张景岳说：所谓“五液”，是阴精的总称。本篇列举溺、汗、泪、唾、水（此处指髓或广义津液分布）这五种，所以称为“五”。《素问·宣明五气篇》说：五脏化生五液，心化汗，肺化涕，肝化泪，脾化涎，肾化唾，这就是五液。《素问·决气篇》说：精、气、津、液、血、脉，其辨析有六种。另外道家说法中，有涕、唾、精、津、汗、血、液七种名称，但都不外乎属于五液的范畴。《灵枢·营卫生会》说：由水谷所化生的津液，各自运行于不同的通道，分别化为五种。如果这五条通道发生闭塞不通（癃闭），就会导致水液停聚形成水胀病。所谓的“五别”，是指汗、溺、唾、泪、髓。所谓的“五癃”，是指津液不能渗入脑窍而向下流注，阴阳之气与经络通道不通畅，四海（髓海、气海、血海、水谷之海）闭塞，三焦不能通调水道，导致津液无法正常气化，水谷精微停滞在下焦，不能渗入膀胱，于是水液泛滥而形成水胀病。因此以此命名此篇。上一章论述气胀的原因，本章论述水胀的原因，明白了原因就知道如何治疗了。简案：本篇末尾说：“这是津液五别的顺逆变化。”《甲乙经》收录本篇文字时，也写作“津液五别”。这里写作“五癃”，不清楚取义何在，怀疑原文存在讹误。
关于“为溺与气”：马云说：天气寒冷时，腠理（皮肤毛孔及肌肉间隙）闭合，体内的气与湿气一同不能向外发散，水分下留于膀胱，这就形成了前部的溺尿和后部的排气（矢气）。
关于“各走其道”：张景岳说：五行五常与四海，各自通过经络接受水谷的精微气味，所以津液随着气化作用而各自运行于不同的通道。
关于“其流而不行者”：《甲乙经》中，“流”字作“留”。张景岳说：在血脉之间周流循环，而不散行于体表，注入脏腑，补益精髓从而成为液。张志聪说：流注的是滋润的物质，注入骨骼，补益脑髓，灌注精气并濡养空窍。
关于“聚沫则痛”：张景岳说：若是被寒邪侵袭，津液就会凝结滞留于肌肉之间，所以汁沫聚集而产生疼痛。简案：这与周痹的病机意义相同。
关于“为溺其气”：张景岳说：腠理密闭，气就不向外泄散，所以气转化为水，水性就下，因此停留于膀胱。然而水即是气的载体，水聚集则气生，气推动则水流注，所以形成溺尿与气的关系。张志聪说：气方面，膀胱被称为州都之官，津液藏于此，经过气化作用排出的就是溺尿。藏于膀胱中的津液，能化生太阳经之气。简案：这里的“气”具体指什么气尚不明确，马云认为是失气（放屁），比较接近，见前文解释。
关于“五脏六腑……肾为之主外”：张景岳说：这两节论述津液化为涕和泪的情况。心统摄五脏六腑，是精神的主宰，所以耳、目、肺、肝、脾、肾都听从心的命令。因此耳朵的听觉、眼睛的视觉，没有不依赖于心的。肺朝会百脉并主治节，所以作为心的辅佐；肝主谋虑决断，所以作为心的将领；脾主肌肉并护养脏腑，所以作为心的卫护；肾主骨并确立形体，所以作为心的外在主宰。
关于“故五脏六腑……泣出矣”：《甲乙经》中，“与肺”作“急肺”，似乎是对的。“泣”作“涎”。张景岳说：心是脏腑的主宰，所以五脏的联系脉络都进入心中。心的总系，又向上贯通于肺，连通喉咙，呼吸由此而出。所以人心悲时，心系紧张导致肺叶上举，津液随之而上溢。然而心系与肺本不会经常上举，所以有时上有时下。当气机上举时，就会表现为咳嗽和流泪。凡是人哭泣严重继而出现咳嗽的，正是因为气机并聚于上部，奔涌遏制于肺部所致。按：《灵枢·口问》说：心是五脏六腑的主宰，眼睛是宗脉汇聚之处，也是上液通行的道路，口鼻是气的门户。所以悲哀愁忧会导致心动，心动则五脏六腑皆动摇，动摇则宗脉受感应，液道通畅，所以鼻涕眼泪流出。
关于“中热……故唾出”：张景岳说：这是论述津液化为唾的情况。虫是由湿热化生的，常居住在肠道中。胃中有热则消化食物快且空虚，虫子移动寻找食物，所以在肠胃之间上下动作。充郭，意思是充满膨胀。肠管充盈扩张则胃壁松弛，胃缓则气逆上行，涎液随之溢出，所以多唾。按：《素问·宣明五气篇》说：肾为唾，但也有说法认为胃为唾。这说明胃与肾都主管唾液的生成。大概土郁（脾胃湿热）导致的唾在胃，水泛（肾虚水泛）导致的唾在肾。
关于“和合而为膏者”：膏，诸本多作“高”，只有赵府本和吴本与此同。马云说：应当作“膏”。张介宾直接改为“膏”，注释说：这是论述津液化为精髓的情况。膏，即脂膏。简案：张志聪用“高”字来解释，意义不通。
关于“阴阳不和……胫”：《甲乙经》中，“虚故”作“虚则”，“腰背”作“腰脊”。张景岳说：阴阳不和，则精气都生病。气病则不能固摄，精病则不能守持。精气不能相互统摄，所以津液溢出于下部，从阴窍流泄。精髓都减少，输泄过度，导致真阴日益虚弱，所以产生腰痛、小腿不适等疾病。这就是劳瘵（虚损性疾病）产生的原因。
关于“阴阳气道……为水胀”：下泻，诸本多作“不泻”，这个字有误，应当改正。张景岳说：这是论述津液化为水胀的情况。三焦是决渎之官，膀胱是津液之腑。气不化则水不行，所以三焦不能通泻，膀胱不能渗透，从而导致肿胀。知道疾病产生的缘由，所以治疗这些病症都应当以恢复气化为主。试看水涝成灾，如果不是太阳照耀，那么阴凝之水终究不能消散，泥泞终究不能变干。能明白这个道理，就懂得阴阳气化的道理了。
关于“此津液五别之逆顺也”：张景岳说：阴阳调和，则五液都精纯充实于体内；阴阳不和，则五精都外泄流溢于体外。这就是所说的逆与顺。
Ma Yun states: "Bie" (separation/distinction) is pronounced as "bi lie qie". The *Neijing* discusses the five fluids in this chapter; when pathology leads to fluid retention forming edema, it inevitably involves urinary obstruction (long), hence the chapter is named "Five Longs and Separation of Fluids".
Zhang Jingyue states: The so-called "five fluids" are a general term for yin essence. This chapter lists urine, sweat, tears, saliva, and water (referring to marrow or generalized fluid distribution) as five types, thus called "five". The *Suwen · Xuanming Wuqi Pian* states: The five zang organs transform into five fluids: the heart transforms sweat, the lungs transform mucus, the liver transform tears, the spleen transforms drool, and the kidneys transform saliva; these are the five fluids. The *Suwen · Jueqi Pian* states: Essence, qi, jin, ye, blood, and vessels have six distinctions. Additionally, Daoist texts mention seven names: mucus, saliva, essence, jin, sweat, blood, and ye, but all fall under the category of the five fluids. The *Lingshu · Yingweishenghui* states: Fluids generated from food and drink travel through different pathways and separate into five. If these five pathways become obstructed (long), water accumulation leads to edema. The so-called "five separations" refer to sweat, urine, saliva, tears, and marrow. The so-called "five long" refers to fluids failing to seep into the brain and flowing downward, with unblocked channels between yin and yang, closure of the four seas, failure of the Sanjiao to drain, and inability of fluids to transform. Water and grain remain in the lower jiao, unable to seep into the bladder, causing water overflow and edema. Thus, the chapter is named accordingly. The previous chapter discussed the causes of qi distension; this chapter discusses the causes of water edema. Understanding the cause reveals the treatment method. Commentary: The end of this chapter states: "This is the compliance and rebellion of the five separations of fluids." The *Jiayi Jing* records this text also as "five separations of fluids". Here it is written as "five long"; the rationale is unclear, suggesting a textual error.
Regarding "Urine and Qi": Ma Yun states: When the weather is cold, the couli (pores and interstices) close, preventing internal qi and dampness from dispersing outward. Water settles in the bladder, resulting in anterior urine and posterior flatulence.
Regarding "Each travels its own path": Zhang Jingyue states: The Five Constants and Four Seas receive the qi and flavor of food and drink via their respective meridians. Thus, fluids transform and travel along their specific pathways according to qi transformation.
Regarding "Those that flow but do not disperse": The *Jiayi Jing* reads "liu" (flow) as "liu" (stay). Zhang Jingyue states: Circulating within the blood vessels without dispersing to the exterior, injecting into the zang-fu organs, benefiting the essence and marrow to become ye. Zhang Zhicong states: Flowing substances are moistening, injecting into bones, supplementing brain marrow, irrigating essence, and moistening cavities.
Regarding "Accumulated foam causes pain": Zhang Jingyue states: If affected by cold pathogens, fluids coagulate and stay in the muscles. Thus, juice and foam accumulate, causing pain. Commentary: This has the same meaning as Zhou Bi (chronic widespread bi syndrome).
Regarding "Urine and its Qi": Zhang Jingyue states: When couli are dense and closed, qi does not escape outward, so qi transforms into water. Water flows downward, staying in the bladder. However, water carries qi; where water gathers, qi arises; where qi moves, water flows. Hence, urine and qi are related. Zhang Zhicong states: Regarding qi, the Bladder is the official of the capital, storing fluids. After qi transformation, what is excreted is urine. The fluids stored in the bladder generate Taiyang qi. Commentary: The specific "qi" here is unclear. Ma Yun's interpretation as flatulence is closer, see previous notes.
Regarding "The Six Zang and Five Fu... Kidney governs the exterior": Zhang Jingyue states: These two sections discuss fluids transforming into mucus and tears. The Heart commands the five zang and six fu organs and is the master of spirit. Therefore, ears, eyes, lungs, liver, spleen, and kidneys obey the Heart. Thus, hearing and vision depend on the Heart. The Lungs meet all vessels and govern regulation, acting as the Heart's assistant. The Liver governs planning and decision-making, acting as the Heart's general. The Spleen governs muscles and protects organs, acting as the Heart's guard. The Kidneys govern bones and establish the body form, acting as the Heart's external governor.
Regarding "Therefore, the Six Zang and Five Fu... Tears were produced": The *Jiayi Jing* reads "yu fei" (with lung) as "ji fei" (urgent lung), which seems correct. "Qi" (tears) should be read as "xian" (drool). Zhang Jingyue states: The Heart is the master of organs, so connections of the five zang enter the Heart. The main connection of the Heart passes up to the Lungs, connecting to the throat for respiration. Thus, when the Heart is sad, the connection tightens, lifting the lung leaves, and fluids overflow upward. However, the heart connection and lungs do not constantly rise, so they move up and down. When qi rises, it causes coughing and tearing. Severe crying followed by coughing occurs because qi converges upward and rushes against the lungs. Note: The *Lingshu · Kouwen* states: The Heart is the master of the five zang and six fu. The eyes are the gathering place of major vessels and the pathway for upper fluids. The mouth and nose are gates for qi. Sadness and worry move the Heart; moving the Heart shakes the five zang and six fu. Shaking stimulates major vessels, opens fluid pathways, and produces mucus and tears.
Regarding "Internal heat... thus saliva is produced": Zhang Jingyue states: This discusses fluids transforming into saliva. Worms are transformed by damp-heat and reside in the intestines. Stomach heat digests food quickly and empties the gut; worms move to find food, acting up and down in the intestines. "Chongguo" means full and expanded. Intestinal expansion relaxes the stomach wall; stomach relaxation causes rebellious qi rising, carrying drool upward, resulting in excessive salivation. Note: The *Suwen · Xuanming Wuqi Pian* states the Kidneys produce saliva, but some say the Stomach produces saliva. Both Stomach and Kidneys govern saliva. Generally, saliva due to earth stagnation (spleen-stomach damp-heat) comes from the Stomach, while saliva due to water flooding (kidney deficiency) comes from the Kidneys.
Regarding "Harmonized to become paste/marrow": Paste (gao), most editions read as "Gao" (high), but Zhao Mansion edition and Wu edition agree here. Ma Yun states: It should be "Gao" (paste/fat). Zhang Jibing directly changed it to "Gao", noting: This discusses fluids transforming into essence and marrow. Gao refers to fat. Commentary: Zhang Zhicong interpreted "Gao" (high) as meaning, which is nonsensical.
Regarding "Yin and Yang disharmony... shins": The *Jiayi Jing* reads "xu gu" (because of deficiency) as "xu ze" (if deficient), and "yao bei" (waist and back) as "yao ji" (waist and spine). Zhang Jingyue states: Yin and Yang disharmony causes disease in both qi and essence. Qi disease fails to control; essence disease fails to hold. Lack of mutual control causes fluids to overflow downward and leak from yin orifices. Essence and marrow decrease; excessive leakage causes daily depletion of true yin, leading to waist pain and shin discomfort. This is how lao zhai (consumptive disease) arises.
Regarding "Yin and Yang qi channels... becomes water edema": "Xia xie" (downward draining), most editions read as "bu xie" (not draining); this character is erroneous and should be corrected. Zhang Jingyue states: This discusses fluids transforming into water edema. The Sanjiao is the official of drainage; the Bladder is the vessel of fluids. Without qi transformation, water does not move. Thus, the Sanjiao cannot drain, and the Bladder cannot permeate, leading to swelling. Knowing the origin of disease, treatment must focus on restoring qi transformation. Consider flood disasters: without the sun's irradiation, condensed yin water would never dissipate, and mud would never dry. Understanding this reveals the way of yin-yang qi transformation.
Regarding "This is the compliance and rebellion of the five separations of fluids": Zhang Jingyue states: When Yin and Yang are harmonious, the five fluids are pure and filled internally. When Yin and Yang are disharmonious, the five essences leak and overflow externally. This is what is meant by compliance (shun) and rebellion (ni).