黄帝问于岐伯曰。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。愿闻其道。
吴氏曰。此章论水谷所生之津液。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。
岐伯曰。水谷皆入于口。其味有五。各注其海。津液各走其道。故三焦出气。以温肌肉。充皮肤。
为其津。其流而不行者为液。
吴氏曰。此论水谷之精。别而为津为液也。胃者。五脏六腑之海也。水谷皆入于胃。五脏六腑。皆
禀气于胃。五味各归其所喜。其津液各走其道。随三焦出气以温肌肉。充皮肤者为津。其流而不行
者为液。流者淖泽注于骨。补益脑髓。灌精而濡空窍者也。
天暑衣浓。则腠理开。故汗出。寒留于分肉之间。聚沫则为痛。
此言津之为汗也。腠理者。分肉之纹理。津随三焦出气。淖注于皮肤肌肉之间。故腠理开则汗
大泄。如有寒而留聚于分肉之间。则排裂分肉而为痛。沫者。津聚而为沫也。
天寒则腠理闭。气湿不行。水下流于膀胱。则为溺与气。
姚氏曰。此言津之为溺也。天寒则腠理闭。三焦之气。因湿而不行。津水下流于膀胱。则为溺
与气。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。愚按、为
汗为溺为血为髓。皆水谷津液之化。伯因帝问而分别答之。言津随寒暑之气。而外内出入。然一日
之中有四时。而饮食衣服。亦有寒温浓薄。读者不以文害义。庶为得之。
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。肾为之主外。
故五脏六腑之津液。尽上渗于目。心悲气并。则心系急。心系急则肺举。肺举则液上溢。夫心系与
肺不能尽举。乍上乍下。故咳而泣出矣。
此论五脏六腑之津液。上渗于目而为泣。由心悲肺举而出也。心为君主之官。乃五脏六腑之主。
耳目者。上之空窍。津液之所注也。将相卫者。为君主之臣使也。肾主外者。肾主藏津液。所以灌精
濡空窍者也。心悲气并者。心悲则脏腑之气。皆上并于心。听令于君主也。气并于心。则心系急。心
系急则肺举。肺乃心之盖也。肺举则液上溢。肺主气而水随气行也。心系与肺不能尽举。乍上乍下。
下则为咳。上则泣出矣。
中热。则胃中消谷。消谷则虫上下作。肠胃充郭。故胃缓。胃缓则气逆。故唾出。
姚氏曰。此言液之为唾也。按口问篇曰。胃缓则廉泉开。故涎下。补足少阴。盖任脉起于足
少阴之阴中。而上出于廉泉。胃缓则少阴之气。不与阳明相合。反上逆于廉泉。则水液随之。故涎
唾也。
五谷之精液。和合而为高者。内渗入于骨空。补益脑髓。而下流于阴股。
此言精液之为髓也。夫肾主藏精而主骨。和合而高者。五谷之液。与肾脏之精。相和合而渗入
于骨空。上行而高者。从骨空而补益脑髓。复从髓空而下流阴股。此精液淖注于骨而为髓。先上益
于脑而复下流。故曰五脏之精液。和合而为高者。姚氏曰。本经云。谷入气满。淖泽注于骨。骨
属屈伸。补益脑髓。是谓液。又曰肾者。精之处也。其华在发。其充在骨。是谷之液。肾之精。并
注于骨而为髓。髓者以脑为主。故曰和合而高者。
阴阳不和。则使液溢而下流于阴。髓液皆减而下。下过度则虚。虚故腰背痛而胫 。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。此津液五别之逆顺也。
此五液闭癃而为腰痛水胀诸病也。阴阳不和者。少阴与阳明之不和也。阴阳之气不和。则液与
精不合。使液溢于骨外。而下流于阴矣。液溢于外。则髓液皆减而下。是不能为高矣。下流过度。
则骨虚而腰痛胫 矣。此髓道之闭癃也。阴阳气道不通。则津液不得注于海。而四海闭塞矣。三焦之
气。不能通泻于肌腠。而津液不化矣。济泌之汁。不得渗于膀胱。而下焦胀矣。水溢于下。则上逆
而为水胀矣。此津液五别之逆顺也。
黄帝向岐伯问道：饮食水谷进入口中，输送到肠胃。其中的液体分为五种。天气寒冷、衣服单薄时，就转化为尿液和气体；天气炎热、衣服厚实时，就转化为汗液。悲哀情绪导致气机郁结，就转化为眼泪。体内有热且胃气弛缓时，就转化为唾液。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。我知道它是这样的，但不知道它产生的原理。希望听您讲讲其中的道理。
吴氏说：这一章论述水谷所生成的津液，各自走不同的通道，分别化为五种。如果这五种通道发生癃闭（排尿或排泄不畅），就会形成水肿。所谓“五别”，是指汗、尿、唾、泪、髓。所谓“五癃”，是指津液不能渗入脑部而向下流注，阴阳气道不通畅，四海闭塞，三焦不能通泻，从而津液无法化生。水谷停滞在下焦，不能渗入膀胱，于是水液外溢而形成水肿。因此用这个名称作为篇名。上一章论述气胀的原因，这一章论述水胀的原因。找到原因就知道如何治疗了。
岐伯说：饮食水谷都从口进入，味道分为五种，各自注入相应的“海”（指气血汇聚之处）。津液各自走不同的通道。所以三焦发出阳气，用来温煦肌肉，充实皮肤，这就是“津”。那些流动缓慢而不轻易外泄的，称为“液”。
吴氏说：这里论述水谷的精微物质，分别化为津和液。胃是五脏六腑的大海，水谷都进入胃中，五脏六腑都依赖胃气滋养。五味各归其所喜好的脏腑。津液各自走不同的通道，随着三焦发出的阳气来温煦肌肉、充实皮肤的，就是津。那些流动而不轻易外泄的，就是液。流动的津液滋润并注入骨骼，补益脑髓，灌注精气并濡润空窍。
天气炎热、衣服厚实，腠理（皮肤纹理及汗孔）就会张开，所以出汗。寒气停留在分肉（肌肉间隙）之间，积聚成沫，就会引起疼痛。
这是论述津液化为汗液的情况。腠理，就是分肉的纹理。津液随着三焦发出的阳气，滋润并注入皮肤肌肉之间。所以腠理张开，汗液就会大量流出。如果有寒气停留并积聚在分肉之间，就会排裂分肉而引起疼痛。沫，就是津液积聚而成的。
天气寒冷，腠理闭合，气机湿气运行不畅，水液向下流入膀胱，就转化为尿液和气体。
姚氏说：这是论述津液化为尿液的情况。天气寒冷，腠理闭合，三焦的气机因为湿滞而不能运行。津液向下流入膀胱，就转化为尿液和气体。气，是因为膀胱被称为州都之官，津液藏在这里，经过气化作用排出的就是尿液。藏在膀胱里的津液，化生出太阳经之气。我认为，化为汗、尿、血、髓，都是水谷津液的转化。岐伯因为黄帝的提问而分别作答，讲述津液随着寒暑之气，向外向内出入。然而一天之中也有四季的变化，饮食和衣服也有寒暖厚薄的区别，读者不要拘泥于文字而损害原意，这样才算真正理解了。
五脏六腑中，心是主宰，耳是听觉器官，目是视觉器官，肺是宰相，肝是将帅，脾是卫护，肾主司外部功能。
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，就会使心系（连接心脏的组织）紧张。心系紧张就会牵动肺脏上举。肺脏上举，津液就会向上溢出。由于心系和肺脏不能完全一直上举，而是忽上忽下，所以会出现咳嗽和流泪的现象。
这是论述五脏六腑的津液，向上渗透入眼睛而成为眼泪，是由心中悲伤、肺气上举而导致的。心是君主之官，是五脏六腑的主宰。耳目是上部的空窍，是津液灌注的地方。将、相、卫，是君主的臣僚使者。肾主外，是因为肾主收藏津液，用来灌注精气、濡润空窍。心中悲伤导致气机郁结，是因为心中悲伤时，脏腑的气机都会向上汇聚于心，听从君主的号令。气机汇聚于心，就会使心系紧张。心系紧张就会牵动肺脏上举。肺是心的覆盖物。肺脏上举，津液就会向上溢出。肺主气，水随气而行。心系和肺脏不能完全一直上举，而是忽上忽下，向下则引起咳嗽，向上则流出眼泪。
体内有热，就会消化食物。消化食物后，肠道内的虫体上下活动，肠胃充满扩张，所以胃壁弛缓。胃壁弛缓会导致气机上逆，所以吐出唾液。
姚氏说：这是论述津液化为唾液的情况。按《口问》篇所说：胃缓则廉泉穴开启，所以涎水下流，应补足少阴经。任脉起于足少阴经的阴中，而上出于廉泉穴。胃缓则少阴经的气机，不与阳明经相合，反而上逆于廉泉穴，水液随之而上，所以成为涎唾。
五谷的精微津液，调和融合后成为高者（指精华部分），向内渗入骨空，补益脑髓，并向下流注到大腿内侧。
这是论述精液化为骨髓的情况。肾主藏精而主骨。调和融合后成为高者的，是五谷的津液与肾脏的精气，相互调和融合后渗入骨空，向上运行以补益脑髓，再从髓空向下流注到大腿内侧。这种精液滋润注入骨骼而化为髓，先向上补益脑部，再向下流注，所以说五脏的精微津液，调和融合后成为高者。姚氏说：本经云：“谷入气满，淖泽注于骨，骨属屈伸，补益脑髓，是谓液。”又说：“肾者，精之处也，其华在发，其充在骨。”这是谷之液与肾之精，共同注入骨骼而化为髓。髓是以脑为主的，所以说“调和融合后成为高者”。
阴阳不和，就会导致津液外溢并向下流注于阴部。髓液都减少并向下流失。向下流失过度就会造成虚损，虚损所以出现腰痛和小腿酸软无力。阴阳气道不通畅，四海闭塞，三焦不能通泻，津液无法化生。水谷混杂在肠胃之中，在回肠处被区分，停滞在下焦，不能渗入膀胱，所以下焦胀满。水液外溢就形成水肿。这就是津液五种分流途径的逆顺变化。
这五种津液闭阻癃塞，就会形成腰痛、水肿等各种疾病。阴阳不和，是指少阴经与阳明经的不和。阴阳之气不和，津液与精气就不能相合，导致津液溢出骨外，并向下流注于阴部。津液溢出体外，髓液就会减少并向下流失，就不能向上补益了。向下流失过度，骨头就会空虚，导致腰痛和小腿酸软无力。这是髓道的闭阻癃塞。阴阳气道不通畅，津液就不能注入四海，导致四海闭塞。三焦的气机，不能通泻于肌腠，导致津液无法化生。过滤后的汁液，不能渗入膀胱，导致下焦胀满。水液溢出于下，向上逆乱就形成水肿。这就是津液五种分流途径的逆顺变化。
Huangdi asked Qibo, saying: "Food and drink enter the mouth and are transported to the stomach and intestines. Their fluids are differentiated into five types. When the weather is cold and clothing is thin, they transform into urine and qi; when the weather is hot and clothing is thick, they transform into sweat. Sorrow causes qi to merge, transforming into tears. Internal heat with a relaxed stomach transforms into saliva. When pathogenic factors reverse internally, qi becomes obstructed and fails to circulate. Failure of circulation leads to water swelling (Shuizhang). I know that this is so, but I do not understand its origin. I wish to hear the principle."
Wu stated: "This chapter discusses the fluids generated from food and drink, which each follow their own pathways and differentiate into five. If these five pathways experience Long (obstruction/stagnation), water swelling results. The 'Five Differentiations' refer to sweat, urine, saliva, tears, and marrow. The 'Five Obstructions' refer to fluids failing to seep into the brain and instead flowing downward, causing obstruction of yin-yang qi pathways, closure of the Four Seas, failure of the Sanjiao to drain, and inability to transform fluids. Food and drink remain in the Lower Jiao, unable to seep into the Bladder, causing water to overflow and form edema. Hence the chapter title. The previous chapter discussed the causes of Qi distension; this chapter discusses the causes of Water swelling. Understanding the cause reveals the treatment."
Qibo said: "Food and drink all enter through the mouth, and their flavors are divided into five, each entering its respective 'Sea'. Jin (thin fluid) and Ye (thick fluid) each follow their own pathways. Thus, Qi emanating from the Sanjiao warms the muscles and fills the skin, constituting Jin. That which flows slowly and does not easily disperse constitutes Ye."
Wu stated: "This discusses how the essence of food and drink differentiates into Jin and Ye. The Stomach is the Sea of the Five Zang and Six Fu organs; all food and drink enter the Stomach, and the Five Zang and Six Fu organs receive Qi from it. The five flavors each return to their preferred organs. Jin and Ye follow their respective pathways. Those that accompany the Qi of the Sanjiao to warm the muscles and fill the skin are Jin. Those that flow without easily dispersing are Ye. Flowing Jin moistens and pours into the bones, supplements the brain and marrow, irrigates the essence, and moistens the orifices."
When the weather is hot and clothing is thick, the Couli (pores and interstitial spaces) open, leading to sweating. Cold lingering between the Fenrou (muscle intervals) gathers into foam, causing pain.
This explains the transformation of Jin into sweat. Couli refers to the texture of the muscle intervals. Jin follows the Qi of the Sanjiao, moistening and pouring into the skin and muscle layers. Therefore, when Couli open, sweat is discharged in large amounts. If cold lingers and gathers in the muscle intervals, it splits the muscles, causing pain. Foam is gathered Jin.
When the weather is cold, Couli close, and Qi with dampness fails to move. Water flows down to the Bladder, transforming into urine and Qi.
Yao stated: "This explains the transformation of Jin into urine. When the weather is cold, Couli close, and the Qi of the Sanjiao fails to move due to dampness. Jin and water flow down to the Bladder, transforming into urine and Qi. Qi refers to the fact that the Bladder is the Officer of the Capital, storing fluids; those transformed by Qiization are excreted as urine. Fluids stored in the Bladder generate the Qi of the Taiyang channel. I observe that transformation into sweat, urine, blood, and marrow are all transformations of food and drink fluids. Qibo answered separately in response to the Emperor's inquiry, discussing how Jin enters and exits externally and internally according to cold and hot Qi. However, within a single day there are four seasonal changes, and diet and clothing also vary in cold/heat and thickness/thinness. Readers should not let the text obscure the meaning; only then will they truly understand."
Among the Five Zang and Six Fu organs, the Heart is the ruler, the ears provide hearing, the eyes provide sight, the Lung is the minister, the Liver is the general, the Spleen is the guard, and the Kidney governs the exterior.
Thus, the fluids of the Five Zang and Six Fu organs all seep upward into the eyes. Sorrow causes Qi to merge, tightening the Xinmai (Heart vessels/connective tissue). Tightening of the Xinmai lifts the Lung. Lifting of the Lung causes fluids to overflow upward. Since the Xinmai and Lung cannot remain fully lifted constantly, rising and falling alternately, coughing and tearing result.
This discusses how fluids of the Five Zang and Six Fu organs seep upward into the eyes to become tears, caused by Heart sorrow and Lung lifting. The Heart is the Ruler of the Officers, the master of the Five Zang and Six Fu. The eyes and ears are upper orifices, where fluids pour. The General, Minister, and Guard are ministers and messengers to the Ruler. The Kidney governing the exterior exists because the Kidney stores fluids to irrigate essence and moisten orifices. Sorrow causing Qi merging occurs because sorrow causes Qi of the zang-fu to converge on the Heart, obeying the Ruler. Qi converging on the Heart tightens the Xinmai. Tightening of the Xinmai lifts the Lung. The Lung is the canopy of the Heart. Lifting of the Lung causes fluids to overflow upward. The Lung governs Qi, and water follows Qi. The Xinmai and Lung cannot remain fully lifted; descending causes coughing, ascending causes tearing.
Internal heat causes digestion of grain in the Stomach. Digestion of grain causes worms to move up and down, filling and expanding the intestines, thus relaxing the Stomach wall. Relaxation of the Stomach wall causes Qi to rebel, resulting in the expulsion of saliva.
Yao stated: "This explains the transformation of Ye into saliva. According to the Kouwen Chapter: 'Relaxation of the Stomach opens the Lianquan acupoint, causing saliva to flow down; tonify Shaoyin.' The Ren Mai originates from the Yinzhong of Foot-Shaoyin and emerges at Lianquan. Relaxation of the Stomach means Shaoyin Qi does not combine with Yangming but rebels upward to Lianquan, carrying fluids with it, thus becoming saliva."
The refined fluids of the five grains harmonize and combine to form the 'high' (essence), seeping inward into bone cavities, supplementing the brain and marrow, and flowing downward into the inner thighs.
This discusses the transformation of refined fluids into marrow. The Kidney stores essence and governs bones. Harmonizing and combining to form the 'high' refers to the fluids of grains combining with the essence of the Kidneys, seeping into bone cavities, moving upward to supplement the brain and marrow, and then flowing downward from the marrow cavities into the inner thighs. This refined fluid moistens and pours into bones to become marrow, first benefiting the brain upward, then flowing downward. Hence it is said that the refined fluids of the Five Zang harmonize and combine to form the 'high'. Yao stated: "The Classic says: 'Grain enters, Qi fills, moist fluids pour into bones, bone joints flex and extend, supplementing brain and marrow; this is called Ye.' It also says: 'The Kidney is the residence of essence; its brilliance appears in hair, its substance fills bones.' This is grain fluid and Kidney essence jointly pouring into bones to become marrow. Marrow is headed by the brain, hence 'harmonizing and combining to form the high'."
When Yin and Yang are discordant, fluids overflow and flow downward into the yin regions. Marrow fluids decrease and flow downward. Excessive downward flow leads to deficiency; deficiency causes lower back pain and weak shins. Obstruction of yin-yang qi pathways, closure of the Four Seas, and failure of the Sanjiao to drain prevent fluid transformation. Food and drink mix within the intestines, separate at the Hui Chang (returning intestine), stagnate in the Lower Jiao, and fail to seep into the Bladder, causing Lower Jiao distension. Overflowing water forms edema. This is the reversal and normalcy of the five differentiations of fluids.
These five fluids obstructed and stagnant cause diseases such as lower back pain and edema. Yin-Yang discordance refers to the discord between Shaoyin and Yangming. Discord of Yin-Yang Qi prevents fluids and essence from harmonizing, causing fluids to overflow outside the bones and flow downward into the yin regions. Overflowing fluids lead to decreased marrow and downward flow, preventing upward supplementation. Excessive downward flow causes bone deficiency, resulting in lower back pain and weak shins. This is obstruction of the marrow pathways. Obstruction of yin-yang qi pathways prevents fluids from pouring into the Four Seas, causing closure of the Four Seas. Qi of the Sanjiao fails to vent through muscle and cutaneous layers, preventing fluid transformation. Filtered juices fail to seep into the Bladder, causing Lower Jiao distension. Water overflowing below rebels upward, forming edema. This is the reversal and normalcy of the five differentiations of fluids.