平按∶此篇自篇首至末，见《灵枢》卷六第三十六《五癃津液别》篇，又见《甲乙
经》卷一第十三。
黄帝问岐伯曰∶水谷入于口，输于肠胃，其液别为五，天寒衣薄，则为溺与气，天
热衣浓则为汗，悲哀气并则为泣，中热胃缓则为唾。邪气内逆，则气为之闭塞而不行，
不行则为水胀，余知其然也，不知其所由生，愿闻其说。（输，逆致也。水谷入于口，
逆于肠胃之中，化为津液，凡有五别，则五脏津液。凡所言液者，通名为津，经称津者，
不名为液，故液有五也。此略举五液，请解其义也。平按∶《甲乙》无余知其然也愿闻
其说九字。《灵枢》说作道。注逆致、逆于，别本逆均作送。）岐伯答曰∶水谷皆入于
口，其味有五，各注其海，（五味走于五脏四海，肝心二脏主血，故酸苦二味走于血海。
脾主水谷之气，故甘味走于水谷海。肺主于气，故辛走于膻中气海。肾主脑髓，故咸走
髓海也。平按∶《甲乙》各注作分注。）津液各走其道。（目为泣道，腠理为汗道，廉
泉为涎道，鼻为涕道，口为唾道也。）故上焦出气以温肌肉，充皮肤，为津；（上焦出
气，出胃上口，名曰卫气，温暖肌肉，润泽皮肤于腠理，故称为津也。平按∶上焦《灵
枢》作三焦。《甲乙》肤下有者字。《灵枢》为下有其字。）其留而不行者，为液；
（水谷精汁，注骨属节中，留而不去，谓之为液。平按∶《灵枢》留作流。）天暑衣浓
则腠理开，故汗出；（因热而腠理开而出者，谓之为汗。）寒留于分肉之间，沫聚则为
痛；（寒留分肉之间，津液聚沫，迫裂分肉，所以为痛。平按∶《灵枢》、《甲乙》沫
聚作聚沫。）天寒则腠理闭，气涩不行，水下溜于膀胱，则为溺与气。（此解溺气多之
所由也。平按∶《灵枢》涩作湿，下溜作下留，《甲乙》作下流。）五脏六腑，心为之
主，耳为之听，目为之候，肺为之相，肝为之将，脾为之卫，肾为之主水。（平按∶水
《灵枢》、《甲乙》作外。）故五脏六腑之津液尽上渗于目，
心悲气并则心系急，急则肺叶举，举则液上溢。夫心系举，肺不能常举，乍上乍下，故
而泣出矣。（ 音去。身中五官所管津液并渗于目，为泣。 者，泣出之时，引气张
口也。平按∶肺叶举举《灵枢》作肺举肺举。夫心系举肺，举字《灵枢》作与，《甲乙》
作急。《灵枢》 作咳，《甲乙》同。泣出《甲乙》作涎出。）中热则胃中消谷，谷消
则虫上下作，肠胃充郭故缓，缓则气逆，故唾出。（虫者，三虫也。郭者，胸臆也。谷
消之时，则虫动上下，肠胃宽，充郭中，故肠胃缓而气上，所以唾也。平按∶故缓《灵
枢》、《甲乙》作故胃缓。）五谷之津液和合而为膏者，内渗入于骨空，补益脑髓而下
流于阴。（平按∶阴《灵枢》、《甲乙》作阴股。）阴阳不和使，则液溢而下流于阴，
髓液皆减而下，下过度则虚，虚故骨脊痛而 。（补益脑髓者，谷之津液和合为膏，
渗入头骨空中，补益于脑；渗入诸骨空中，补益于髓；下流阴中，补益于精。若阴阳过
度，不得以理和使，则精液溢下于阴，以其分减髓液过多，故虚而腰痛及脚 也。平
按∶《灵枢》、《甲乙》使则作则使。）阴阳气道不通，四海闭塞，三焦不泻，津液不
化，水谷并于肠胃之中，别于回肠，留于下焦，不得渗膀胱，则下焦胀，水溢则为水胀，
（脏腑阴阳不得和通，则四海闭而不流，三焦壅而不泻，其气不得化为津液，水谷并于
肠胃不消，别于回肠而留下焦，不得入于膀胱，胀于下焦，溢入于身，故为水胀也。平
按∶并于《灵枢》作并行。）此津液五别之顺逆。（此上五别，是为津液顺逆之义。平
按∶顺逆《灵枢》作逆顺也。）
【平按】：本篇从开头到结尾，见于《灵枢》卷六第三十六篇《五癃津液别》，也见于《甲乙经》卷一第十三。
黄帝问岐伯说：水谷进入口中，输送到肠胃，其中的液体分为五种。天气寒冷、衣服单薄时，就变成小便和放屁；天气炎热、衣服厚实时，就变成汗；悲哀时气机郁结，就变成眼泪；体内有热且胃壁松弛时，就变成唾液。邪气在体内逆乱，就会导致气机闭塞不通，气机不通畅就会形成水肿胀满。我知道这是这样的，但不知道它是如何产生的，希望听听您的解释。（注：输，意为逆致。水谷入口，在肠胃中逆乱，化为津液，共有五种分别，即五脏的津液。凡是所说的液，通称为津，经文称津的，不称为液，所以液有五种。这里简略列举五种液，请解释其含义。平按：《甲乙经》没有“余知其然也愿闻其说”九个字。《灵枢》中“说”作“道”。注中的“逆致”、“逆于”，其他版本“逆”均作“送”。）
岐伯回答说：水谷都进入口中，味道有五种，各自注入相应的海。（五味走向五脏四海，肝心两脏主血，所以酸味和苦味走向血海。脾主水谷之气，所以甘味走向水谷海。肺主气，所以辛味走向膻中气海。肾主脑髓，所以咸味走向髓海。平按：《甲乙经》中“各注”作“分注”。）津液各自走不同的通道。（眼睛是泪液的通道，腠理是汗液的通道，廉泉穴是涎液的通道，鼻子是鼻涕的通道，嘴巴是唾液的通道。）所以上焦发出卫气来温暖肌肉，充实皮肤，这叫做津；（上焦发出的气，从胃的上口出来，名叫卫气，温暖肌肉，润泽皮肤和腠理，所以称为津。平按：《灵枢》中“上焦”作“三焦”。《甲乙经》中“肤”下有“者”字。《灵枢》中“为”下有“其”字。）那些停留而不流动的，叫做液；（水谷的精微汁液，注入骨骼关节中，停留而不离去，称之为液。平按：《灵枢》中“留”作“流”。）天气暑热、衣服厚实时，腠理开泄，所以出汗；（因为受热而腠理开泄排出的，称之为汗。）寒气停留在分肉之间，津液聚集成沫，就会疼痛；（寒气停留在分肉之间，津液聚集成沫，逼迫分裂分肉，所以产生疼痛。平按：《灵枢》、《甲乙经》中“沫聚”作“聚沫”。）天气寒冷时，腠理闭合，气机涩滞不通，水向下流入膀胱，就变成小便和放屁。（这是解释小便多和放屁多的原因。平按：《灵枢》中“涩”作“湿”，“下溜”作“下留”，《甲乙经》作“下流”。）五脏六腑中，心是主宰，耳是听觉器官，目是观察器官，肺是宰相，肝是将帅，脾是卫士，肾主管水液。（平按：《灵枢》、《甲乙经》中“水”作“外”。）所以五脏六腑的津液都向上渗透入眼睛。
心中悲伤，气机郁结，导致心系拘急，拘急则肺叶抬起，肺叶抬起则津液上溢。夫心系抬起，肺不能经常保持抬起的状态，忽上忽下，所以眼泪流出。（音去声。身体五官所管的津液都渗透入眼睛，成为泪。者是流泪时，引气张口的动作。平按：《灵枢》中“肺叶举举”作“肺举肺举”。夫心系举肺，“举”字《灵枢》作“与”，《甲乙经》作“急”。《灵枢》中“咳”作“咳”，《甲乙经》同。《甲乙经》中“泣出”作“涎出”。）体内有热则胃中消化食物过快，食物消化后寄生虫上下活动，肠胃扩张故松弛，松弛则气机上逆，所以唾液流出。（虫，指三虫。郭，指胸臆。食物消化时，虫子动上下，肠胃宽，充满胸臆中，所以肠胃松弛而气上逆，因此唾液流出。平按：《灵枢》、《甲乙经》中“故缓”作“故胃缓”。）五谷的津液调和结合成为膏状物，向内渗透入骨空，补益脑髓并向下流注于阴部。（平按：《灵枢》、《甲乙经》中“阴”作“阴股”。）如果阴阳不和，导致津液溢出并向下流注于阴部，髓液都会减少并下行，下行过度则虚，虚则骨头和脊柱疼痛以及脚弱无力。（补益脑髓，是指谷物的津液调和成为膏，渗入头骨的空隙，补益大脑；渗入各骨的空隙，补益骨髓；向下流注阴部，补益精液。如果阴阳过度失调，不能以理性和谐地调节，则精液溢下于阴，因为其分减髓液过多，所以虚而腰痛及脚弱无力。平按：《灵枢》、《甲乙经》中“使则”作“作则使”。）如果阴阳气道不通，四海闭塞，三焦不排泄，津液不化生，水谷都在肠胃之中，分别进入回肠，停留于下焦，不能渗透入膀胱，则下焦胀满，水液溢出则形成水肿胀满，（脏腑阴阳不能和谐通畅，则四海闭阻而不流动，三焦壅塞而不排泄，其气不能化为津液，水谷都在肠胃中不消化，分别进入回肠而留下焦，不能进入膀胱，胀于下焦，溢出进入身体，所以形成水肿胀满。平按：《灵枢》中“并于”作“并行”。）这就是津液五种分别的顺逆变化。（上面五种分别，就是津液顺逆的含义。平按：《灵枢》中“顺逆”作“逆顺”。）
[Ping An]: This chapter, from beginning to end, is found in Chapter 36 of Volume 6 of *Ling Shu* (Spiritual Pivot), titled "Differentiation of Five Obstructions and Fluids," and also in Volume 1, Chapter 13 of *Jia Yi Jing* (Systematic Classic of Acupuncture and Moxibustion).
The Yellow Emperor asked Qi Bo: When water and grain enter the mouth, they are transported to the stomach and intestines. Their fluids differentiate into five types. In cold weather with thin clothing, they become urine and flatus; in hot weather with thick clothing, they become sweat; when grief causes qi stagnation, they become tears; when internal heat relaxes the stomach wall, they become saliva. When pathogenic factors reverse internally, qi becomes obstructed and fails to circulate. Failure of circulation leads to edema and distension. I know this occurs, but I do not understand its origin. I wish to hear your explanation. (Note: "Shu" here means reversal or counter-flow. Water and grain enter the mouth, reverse within the stomach and intestines, and transform into Jin Ye (Body Fluids). There are five differentiations, corresponding to the fluids of the five Zang organs. Generally, all "Ye" are referred to as "Jin." The classics refer to "Jin" but not "Ye," hence there are five types of "Ye." This briefly lists the five fluids; please explain their meaning. Ping An: *Jia Yi Jing* lacks the nine characters "Yu zhi qi ran ye, yuan wen qi shuo" [I know it is so, but wish to hear the explanation]. *Ling Shu* uses "Dao" instead of "Shuo." In the notes, "Ni Zhi" and "Ni Yu," other versions write "Ni" as "Song".)
Qi Bo replied: Water and grain enter the mouth, and their flavors are fivefold, each flowing into its respective Sea. (The five flavors travel to the Four Seas of the five Zang organs. The Liver and Heart govern blood, so Sour and Bitter flavors travel to the Blood Sea. The Spleen governs the Qi of water and grain, so Sweet flavor travels to the Sea of Water and Grain. The Lung governs Qi, so Pungent flavor travels to the Dan Zhong Qi Sea. The Kidney governs brain marrow, so Salty flavor travels to the Marrow Sea. Ping An: *Jia Yi Jing* writes "Ge Zhu" as "Fen Zhu".) Jin Ye (Body Fluids) each follow their own pathways. (The eyes are the pathway for tears, the Cou Li (interstices) are the pathway for sweat, Lian Quan (CV23) is the pathway for saliva, the nose is the pathway for nasal mucus, and the mouth is the pathway for saliva.) Therefore, the Upper Jiao (Triple Burner) emits Wei Qi (Defensive Qi) to warm the muscles and fill the skin, which is called Jin (Thin Fluids); (The Qi emitted by the Upper Jiao exits from the upper orifice of the stomach, named Wei Qi, warming the muscles and moistening the skin and Cou Li, thus called Jin. Ping An: *Ling Shu* writes "Shang Jiao" as "San Jiao". *Jia Yi Jing* adds "Zhe" after "Fu". *Ling Shu* adds "Qi" after "Wei".) Those that remain and do not flow are called Ye (Thick Fluids); (The essence juices of water and grain are injected into the bones and joints, remaining without departing, termed Ye. Ping An: *Ling Shu* writes "Liu" as "Liu" [flow].) In hot weather with thick clothing, the Cou Li open, so sweat is excreted; (Excretion due to heat opening the Cou Li is termed sweat.) Cold staying between the Fen Rou (muscle intervals), where Jin Ye gathers into foam, causes pain; (Cold stays between the muscle intervals, Jin Ye gathers into foam, pressing and splitting the muscle tissue, thus causing pain. Ping An: *Ling Shu* and *Jia Yi Jing* write "Mo Ju" as "Ju Mo".) In cold weather, the Cou Li close, Qi becomes stagnant and does not flow, water flows down to the Bladder, becoming urine and flatus. (This explains the cause of excessive urine and flatus. Ping An: *Ling Shu* writes "Se" as "Shi", "Xia Liu" as "Xia Liu" [stay], *Jia Yi Jing* writes "Xia Liu" as "Xia Liu" [flow].) Among the five Zang and six Fu organs, the Heart is the ruler, the Ear is the listener, the Eye is the observer, the Lung is the minister, the Liver is the general, the Spleen is the guard, and the Kidney governs water. (Ping An: *Ling Shu* and *Jia Yi Jing* write "Shui" as "Wai".) Thus, the Jin Ye of the five Zang and six Fu organs all seep upward into the eyes.
When the heart feels sorrowful, Qi stagnates, causing the Xin Mai (Heart Vessel/Connection) to contract tightly. Tight contraction lifts the Fei Ye (Lung Lobes). When lifted, fluids overflow upwards. Since the Xin Mai lifting prevents the Lung from maintaining constant elevation, the fluid moves up and down intermittently, thus tears are produced. (Pronounced 'qu'. The fluids managed by the five sensory organs all seep into the eyes, becoming tears. 'Zhe' refers to the action of drawing Qi and opening the mouth during tear production. Ping An: *Ling Shu* writes "Fei Ye Ju Ju" as "Fei Ju Fei Ju". For "Fu Xin Mai Ju Fei", *Ling Shu* writes "Ju" as "Yu", *Jia Yi Jing* writes "Ju" as "Ji". *Ling Shu* writes "Ke" as "Ke", *Jia Yi Jing* agrees. *Jia Yi Jing* writes "Qi Chu" as "Xian Chu".) Internal heat causes rapid digestion of grain in the stomach. After digestion, parasites move up and down. The stomach and intestines expand, causing relaxation. Relaxation leads to rebellious Qi, thus saliva is excreted. (Parasites refer to the three worms. Guo refers to the chest/diaphragm. During digestion, worms move up and down, the stomach and intestenes are wide, filling the chest, causing relaxation and rebellious Qi, hence saliva. Ping An: *Ling Shu* and *Jia Yi Jing* write "Gu Huan" as "Gu Wei Huan".) The Jin Ye of the five grains harmonize and combine to form a paste-like substance. This penetrates inward into the bone cavities, nourishes the brain marrow, and flows downward to the Yin region. (Ping An: *Ling Shu* and *Jia Yi Jing* write "Yin" as "Yin Gu" [inner thigh]). If Yin and Yang are disharmonious, fluids overflow and flow downward to the Yin region. Marrow fluids decrease and flow downward. Excessive downward flow leads to deficiency. Deficiency causes pain in the bones and spine, and weakness in the legs. (Nourishing brain marrow involves grain fluids combining into paste, penetrating head bone cavities to nourish the brain; penetrating other bone cavities to nourish marrow; flowing to Yin to nourish essence. If Yin and Yang are excessively disordered and cannot be harmonized rationally, essence fluids overflow downward. Due to excessive reduction of marrow fluids, deficiency results in lower back pain and leg weakness. Ping An: *Ling Shu* and *Jia Yi Jing* write "Shi Ze" as "Zuo Ze".) If Yin-Yang Qi pathways are blocked, the Four Seas are closed, the San Jiao (Triple Burner) fails to drain, and Jin Ye fails to transform. Water and grain accumulate in the stomach and intestines, separate into the Hui Chang (Lower Intestine), stay in the Lower Jiao, and fail to渗 (seep) into the Bladder. This causes Lower Jiao distension. Overflowing water leads to edema/distension. (If Zang-Fu Yin-Yang cannot harmonize and circulate, the Four Seas close and stop flowing, the San Jiao becomes congested and fails to drain. Qi fails to transform into Jin Ye. Water and grain accumulate in the stomach/intestines without digesting, separate into the Hui Chang and stay in the Lower Jiao, failing to enter the Bladder. Distension occurs in the Lower Jiao, overflowing into the body, thus forming edema. Ping An: *Ling Shu* writes "Bing Yu" as "Bing Xing".) These are the smooth and reversed states of the five differentiations of Jin Ye. (The above five differentiations constitute the meaning of smooth and reversed Jin Ye. Ping An: *Ling Shu* writes "Shun Ni" as "Ni Shun".)