五脏各有专司，如五行五色五味等，论之常也。然有常必有变，轩岐为之旁搜而曲尽其义。亦如阴阳之理，
有正有变，并以别论名篇焉。
黄帝问曰∶余闻方士，或以脑髓为脏，或以肠胃为脏，或以为腑。敢问更相反，皆自谓是，不知其道，愿
闻其说。岐伯对曰∶脑、髓、骨、脉、胆、女子胞，此六者地气之所生也，皆藏于阴而象于地，故藏而不泻，
名曰奇恒之府。（脑髓骨脉，虽名为府，不正与神脏为表里。胆与肝合，而不同六腑之传泻。胞虽出纳，纳则
受纳精气，出则化出形容，然出纳之用有殊于六腑，故言藏而不泻，名曰奇恒之府也。）夫胃、大肠、小肠、
三焦、膀胱，此五者天气之所生也，其气象天，故泻而不藏，此受五脏浊气，名曰传化之府，此不能久留，输
泻者也。（言水谷入已，糟粕变化而泄出，不能久久
留住于中，但当化已输泻，令去而已，传泻诸化，故曰传化之府也。按∶惟所受皆五脏之浊气，故不得不输
泻而不能久留也。）魄门亦为五脏使，水谷不得久藏。（谓肛之门也。内通于肺，故曰魄门。受已化物，故为
五脏行使。然水谷亦不得久藏于中。按∶肛何以通于肺？肛为大肠之尽窍，而大肠与肺合故也。六腑受五脏之
浊气，转输而下，必由肛出。故泻而不藏，不特六腑，即魄门亦然也。）所谓五脏者，藏精气而不泻也，故满而
不能实。六腑者，传化物而不藏，故实而不能满也。（按∶精气至贵而难实，化物至秽而不可久留，其藏其泻，
真造化自然之妙用乎。化物，水谷所化之物也。）所以然者，水谷入口，则胃实而肠虚；食下，则肠实而胃虚。
故曰实而不满，满而不实也。（按∶食入于胃而未至于肠，故胃实而肠虚；食离于胃而转入于肠，故肠实而胃
虚。此以食之所在为实，食之所不在为虚，单指肠胃而言也。然就上文观之，语气虽似一意承转而下，确求其
义，则逐节又各不同。首言脑髓骨脉胆胞六者，在脏腑之外，名曰奇恒。盖脏腑为正，而此为奇也。胆为肝腑，
宜与胃大小肠等同言，而附于此者，以肠胃等五腑，俱上入而下出，皆泻而不藏，而胆则实藏而不泻，故并列
于此也。次言五腑主泻者，以受五脏之浊气，故不能久留。不言水谷而水谷自在其中。然泻而不藏，不特五腑，
更有魄门。魄门出糟粕，故单言水谷也。第三段虽是申论藏泻之义，乃其所言，则仅以满实为解。四段则以水
谷之上下为虚实，专指肠胃而言，而三焦膀胱之义又缺也。余谓素问一书，如岁运、经穴、针灸、诸篇，辞义
明显，学人可以字句求之。若夫阴阳变化之理，证治逆从之妙，脏腑职司之微，或离或合，或正或奇，是必神
而明之乃可耳。如以前四节细阅之，方知文义甚活，读者幸毋拘执也。）
帝曰∶气口何以独为五脏主？（按∶气口，寸关尺之总名。所以诊脉而知脏腑之病者，谓脏腑有病，何以
必诊于脉而知也。）岐伯曰∶胃者水谷之海，六腑之大源也。（人有四海，水谷之海则其一也。受水谷已，荣
养四旁，以其当运化之源，故为六腑之
大源也。）五味入口，藏于胃以养五脏气，气口亦太阴也。（按∶胃之所以为六腑之大源者，以五脏之气，
皆借之以养也。胃为足太阴之腑，气口乃手太阴之经。饮食入胃而能运化为气者脾也，气充于五脏而使之着见
于气口者则是肺，故云亦太阴也。）是以五脏六腑之气味，皆出于胃，变见于气口。（按∶全元起本，出作入，
谬矣。盖人得饮食之味以为养，而后脏腑之气充，是五脏六腑之气味，皆从胃出也。若作入解，是仍言五味矣。
然养脏腑之气者，胃也。而验脏腑之气者，气口也。有变必见，故曰变见。见，去声。）故五气入鼻，藏于心
肺，心肺有病而鼻为之不利也……。（按∶亦外候之一端也。）
拘于鬼神者，不可与言至德；（按∶医道精微，是为至德，既惑于邪，言必不信。）恶于针石者，不可与
言至巧；（恶于针石则巧不能施。）病不许治者，病必不治，治之无功矣。（心不许人治之，是其必死，强为
治者，功亦不成。按∶不许治，非不令人治也，如病本深而责效速，不知医而妄自用，及纵欲恣食，不遵教戒，
皆不许治之类也。如是之人，强与之治，亦必无功，至哉先圣，为戒深矣。）
五脏各有其专门职能，例如五行、五色、五味等理论，是论述中的常规内容。然而有常规就必然有变化，黄帝与岐伯对此进行了广泛搜集并详尽阐明了其中的义理。这也如同阴阳的道理，既有正常状态也有异常变化，因此用“别论”来命名这一篇章。
黄帝问道：我听说方士们，有的认为脑髓属于脏，有的认为肠胃属于脏，有的则认为它们属于腑。敢问这些说法相互矛盾，却都自认为是正确的，我不明白其中的道理，希望听听您的解说。
岐伯回答说：脑、髓、骨、脉、胆、女子胞（子宫），这六者是由地气所生成的，都藏纳于阴分而象征大地，所以只贮藏精气而不向外排泄，被称为奇恒之府（形态似腑但功能似脏的特殊器官）。（脑、髓、骨、脉，虽然名称上称为府，但并不像神脏那样有表里配合关系。胆与肝相合，但不同于六腑的传化排泄功能。女子胞虽然有出纳作用，纳时接受精气，出时化生形体容貌，但其出纳的功能不同于六腑，所以说它只藏不泻，被称为奇恒之府。）至于胃、大肠、小肠、三焦、膀胱，这五者是由天气所生成的，它们的性质象征天，所以只传导排泄而不贮藏精气，这是接受五脏浊气的地方，被称为传化之府（传导和变化水谷的器官），这些器官不能长久停留食物残渣，而是负责输送和排泄。（意思是水谷进入体内后，糟粕经过变化而排出体外，不能在体内久久停留，应当消化完毕后立即输泻出去，传导排泄各种变化后的物质，所以叫作传化之府。按：正因为接受的皆是五脏产生的浊气，所以不得不输泻而不能久留。）魄门（肛门）也是五脏行使功能的使者，水谷糟粕不能在体内久藏。（所谓魄门即肛门。内通于肺，所以叫魄门。受纳已消化的物质，所以为五脏行使排泄职能。然而水谷糟粕也不能在体内久藏。按：肛门为何通于肺？肛门是大肠的末端窍道，而大肠与肺相合，所以相通。六腑接受五脏的浊气，转输向下，必须经由肛门排出。所以只泻不藏，不仅六腑如此，魄门也是如此。）所说的五脏，是贮藏精气而不向外排泄的，所以充满精气但不能被实物填塞。六腑，是传导变化水谷而不贮藏精气的，所以可以被实物填塞但不能充满精气。（按：精气极其珍贵且难以实填，水谷化物极其秽浊且不可久留，它们的贮藏与排泄，真是造化自然的神奇功用啊。化物，指由水谷转化而成的物质。）之所以这样，是因为水谷入口，则胃充实而肠道空虚；食物下行，则肠道充实而胃空虚。所以说六腑是“实而不满”，五脏是“满而不实”。（按：食物进入胃中尚未到达肠道，所以胃实而肠虚；食物离开胃转入肠道，所以肠实而胃虚。这里以食物所在之处为“实”，食物不在之处为“虚”，仅指肠胃而言。然而从上文来看，语气虽似一脉相承，但仔细推敲其义，每一节又各不相同。第一段讲脑、髓、骨、脉、胆、胞这六者，在脏腑之外，名为奇恒。盖脏腑为正统，而这六者为奇异。胆本为肝之腑，应与胃、大小肠等同论，而附于此的原因，是因为胃、大肠、小肠、三焦、膀胱这五腑，都是上入下出，皆泻而不藏，而胆则是实藏而不泻，所以并列在此处。第二段讲主司排泄的五腑，因为接受五脏的浊气，所以不能久留。虽然没有明说水谷，但水谷之意自在其中。然而只泻不藏，不仅限于五腑，还有魄门。魄门排出糟粕，所以单独提到水谷。第三段虽然是申述藏与泻的意义，但其所言，仅以满和实来解释。第四段则以水谷的上下位置来解释虚实，专指肠胃而言，而三焦和膀胱的意义又缺失了。我认为《素问》一书，如岁运、经穴、针灸等篇，辞义明显，学者可以逐字逐句探究。至于阴阳变化的道理，证治逆从的奥妙，脏腑职司的精微之处，或离或合，或正或奇，必须神而明之才能理解。如仔细阅读前四节，方知文义非常灵活，读者切勿拘泥固执。）
黄帝说：为什么气口（寸口脉）唯独能作为诊断五脏病变的主宰？（按：气口，是寸、关、尺三部脉的总称。通过诊脉来了解脏腑疾病的方法，是说脏腑有病，为什么一定要通过诊脉才能知道呢？）
岐伯说：胃是水谷汇聚的海洋，是六腑的大源头。（人有四海，水谷之海就是其中之一。接受了水谷之后，滋养四周，因为它处于运化的源头地位，所以成为六腑的大源头。）五味入口，储藏于胃中以滋养五脏之气，气口也属于太阴经脉。（按：胃之所以成为六腑的大源头，是因为五脏之气都借助它来滋养。胃是足太阴脾经所属的腑，气口是手太阴肺经的穴位。饮食进入胃中能运化为气的是脾，气充盈于五脏并使其表现于气口的是肺，所以说气口也属于太阴。）因此五脏六腑的气味，都源于胃，变化显现于气口。（按：全元起注本中，“出”写作“入”，是错误的。人依靠饮食的味道来滋养身体，然后脏腑之气才充盛，所以五脏六腑的气味，都是从胃产生的。如果解释为“入”，那就仍然是在讲五味了。然而滋养脏腑之气的是胃，而验证脏腑之气的是气口。有变化必定会显现，所以叫变见。“见”读去声。）所以五气从鼻吸入，储藏于心肺，心肺有病则鼻子会出现不通利的症状……。（按：这也是外在征象的一个方面。）
对于迷信鬼神的人，不可以与他谈论高深的医德；（按：医道精微，称为至德，既然被邪念迷惑，说的话他一定不信。）厌恶针石治疗的人，不可以与他谈论高超的技巧；（厌恶针石，那么巧妙的医术也无法施展。）病人不允许治疗的，病一定治不好，强行治疗也不会见效。（心里不允许别人治疗，说明病情必死无疑，强行治疗，功效也不会成功。按：不许治，并不是不让人治疗，比如病根深重却要求速效，不懂医学而乱用药物，以及放纵欲望、恣意饮食、不遵守医嘱告诫等情况，都属于不许治的范畴。对于这样的人，强行给予治疗，也必定没有效果，先圣的告诫真是深远啊。）
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.