七十四难曰。从其首系其数。
间象 在表 五化叠元 以应望闻
肝 青(大敦水井)臊(白泉水合)酸(中封金经)呼(大冲土俞)泣(行间水荥)
心 赤(少府火荣)焦(少冲木井)苦(少海水合)言(灵道金经)汗(神门土俞)
脾 黄(太白土俞)香(大都火荣)甘(隐白水井)歌(阴陵泉水合)涎(商丘金经)
肺 白(经渠金经)腥(大渊土俞)辛(鱼际火荣)哭(少商水井)涕(天泽水合)
肾 黑(阴谷水合)腐(复溜金经)咸(太溪土俞)呻(然谷火荣)液(涌泉水井)
六十八难曰。元证脉合。复生五象。
井(心下满)胆(元证) 身热 体重(节痛)喘嗽(寒热)逆气(泄)荣(身热)心下满(小肠)元
证体重 寒热 逆气
俞(体重节痛)心下满(胃)身热 元证 寒热 逆气
经(喘咳寒热)心下满(大肠)身热 体重 元证 逆气
合(逆气而泄)心下满(膀胱)身热 体重 寒热 元证
假令胆病善洁。面青善怒。(元证)得弦脉。(脉合)又病心下满。(当刺胆井)如见善洁面
青善
怒。脉又弦又病身热。(当利胆荣)又病体重节痛。(当刺胆俞)如见善洁面青善怒。脉又弦又
病喘咳寒热。(当刺胆合)余经例仿此。假令肝经淋溲便难转筋。春刺井。夏刺荣。秋刺经。
冬刺合。
【五音五色五化对应表】
位于体表的征象,通过五行之气的叠加变化来对应望诊和闻诊的内容:
肝脏:青色(井穴大敦属水),臊味(合穴泉门属水),酸味(经穴中封属金),呼出声(俞穴大冲属土),哭泣声(荥穴行间属水)。
心脏:赤色(荥穴少府属火),焦味(井穴少冲属木),苦味(合穴少海属水),言语声(经穴灵道属金),汗液(俞穴神门属土)。
脾脏:黄色(俞穴太白属土),香味(荥穴大都属火),甘味(井穴隐白属水),歌声(合穴阴陵泉属水),涎液(经穴商丘属金)。
肺脏:白色(经穴经渠属金),腥味(俞穴太渊属土),辛味(荥穴鱼际属火),哭声(井穴少商属水),涕液(合穴尺泽属水)。
肾脏:黑色(合穴阴谷属水),腐味(经穴复溜属金),咸味(俞穴太溪属土),呻吟声(荥穴然谷属火),尿液/津液(井穴涌泉属水)。
《难经》第六十八难说:五输穴的主证与脉象相合,进而衍生出五种征象。
井穴主证:心下痞满;胆经井穴主证为……;身体发热;体重沉重(或关节疼痛);气喘咳嗽(或寒热往来);气逆(或泄泻);营分病变表现为身体发热;心下痞满与小肠有关;……
体重沉重、寒热往来、气逆等症状也出现在其他穴位的主治中。
俞穴主证:体重沉重、关节疼痛;心下痞满与胃有关;身体发热;……寒热往来、气逆。
经穴主证:气喘咳嗽、寒热往来;心下痞满与大肠有关;身体发热;体重沉重;……气逆。
合穴主证:气逆且伴有泄泻;心下痞满与膀胱有关;身体发热;体重沉重;寒热往来;……
举例来说,如果患有胆病,表现为爱干净、面色发青、容易发怒(这是胆病的典型征象),切得弦脉(这是脉象相符),并且伴有心下痞满的症状(应当针刺胆经的井穴)。如果见到患者爱干净、面色发青、容易发怒,脉象又呈弦象,并且伴有身体发热的症状(应当清利胆经的荥穴)。如果又出现体重沉重、关节疼痛的症状(应当针刺胆经的俞穴)。如果见到患者爱干净、面色发青、容易发怒,脉象又呈弦象,并且伴有气喘咳嗽、寒热往来的症状(应当针刺胆经的合穴)。其他经脉的情况都仿照这个例子。
再比如肝经病变,出现小便淋漓不畅、排便困难、筋脉拘挛抽搐等症状。春季应针刺井穴,夏季应针刺荥穴,秋季应针刺经穴,冬季应针刺合穴。
The Seventy-fourth Difficulty states: Determine the acupoints for acupuncture based on the location of the disease.
[Correspondence Table of Five Sounds, Five Colors, and Five Transformations]
Manifestations at the exterior are matched with observation (Wang) and listening/smelling (Wen) through the overlapping changes of the Five Elements (Wu Xing):
Liver: Green color (Jing-Well point Dazhun [LR1], Water element); Fishy odor (He-Sea point Quanmen [GB24? Note: Text says Baiquan Shui He, likely a specific textual variant or error in source, usually GB24 is He-Sea but belongs to Gallbladder. Here attributed to Liver context in text structure, but anatomically Dazhun is LR1. The text lists "Baiquan Shui He" which might refer to a specific point or is a typo for a Gallbladder point, but strictly translating the text's attribution]: White water spring He-Sea point, Water element); Sour taste (Jing-River point Zhongfeng [LR4], Metal element); Shouting sound (Shu-Stream point Dachong [LR3], Earth element); Crying sound (Ying-Spring point Xingjian [LR2], Water element).
Heart: Red color (Ying-Spring point Shaofu [HT8], Fire element); Scorched odor (Jing-Well point Shaochong [HT9], Wood element); Bitter taste (He-Sea point Shaohai [HT3], Water element); Speech sound (Jing-River point Lingdao [HT4], Metal element); Sweat (Shu-Stream point Shenmen [HT7], Earth element).
Spleen: Yellow color (Shu-Stream point Taibai [SP3], Earth element); Fragrant odor (Ying-Spring point Dabu [SP2], Fire element); Sweet taste (Jing-Well point Yinbai [SP1], Water element); Singing sound (He-Sea point Yinlingquan [SP9], Water element); Saliva/Drool (Jing-River point Shangqiu [SP5], Metal element).
Lung: White color (Jing-River point Jingqu [LU8], Metal element); Raw/Fishy odor (Shu-Stream point Taiyuan [LU9], Earth element); Pungent taste (Ying-Spring point Yuji [LU10], Fire element); Crying sound (Jing-Well point Shaoshang [LU11], Water element); Nasal discharge (He-Sea point Chize [LU5], Water element).
Kidney: Black color (He-Sea point Yinggu [KI10], Water element); Rotten odor (Jing-River point Fuliu [KI7], Metal element); Salty taste (Shu-Stream point Taixi [KI3], Earth element); Moaning sound (Ying-Spring point RanGu [KI2], Fire element); Urine/Essence (Jing-Well point Yongquan [KI1], Water element).
The Sixty-eighth Difficulty states: The indications of the Five Shu points correspond with the pulse, thereby generating five manifestations.
Jing-Well points indicate: Fullness below the heart; Gallbladder Jing-Well indication...; Fever; Heavy body (or joint pain); Asthma and cough (or alternating cold and heat); Rebellious Qi (or diarrhea); Ying-level pathology manifests as fever; Fullness below the heart relates to the Small Intestine...
Heavy body, alternating cold and heat, and rebellious Qi also appear in the indications of other points.
Shu-Stream points indicate: Heavy body and joint pain; Fullness below the heart relates to the Stomach; Fever... Alternating cold and heat, rebellious Qi.
Jing-River points indicate: Asthma, cough, alternating cold and heat; Fullness below the heart relates to the Large Intestine; Fever; Heavy body... Rebellious Qi.
He-Sea points indicate: Rebellious Qi accompanied by diarrhea; Fullness below the heart relates to the Bladder; Fever; Heavy body; Alternating cold and heat...
For example, if one suffers from Gallbladder disease, manifesting as a preference for cleanliness, a greenish complexion, and irritability (typical signs of Gallbladder disease), and the pulse is wiry (pulse matches), and there is accompanying fullness below the heart (one should needle the Jing-Well point of the Gallbladder channel). If one observes a preference for cleanliness, greenish complexion, irritability, a wiry pulse, and accompanying fever (one should drain the Ying-Spring point of the Gallbladder). If there is additionally heavy body and joint pain (one should needle the Shu-Stream point of the Gallbladder). If one observes a preference for cleanliness, greenish complexion, irritability, a wiry pulse, and accompanying asthma, cough, and alternating cold and heat (one should needle the He-Sea point of the Gallbladder). Other meridians follow this pattern.
Another example: If Liver channel pathology presents with dribbling dysuria, difficult defecation, and tendon spasm/cramps. In Spring, one should needle the Jing-Well point; in Summer, the Ying-Spring point; in Autumn, the Jing-River point; and in Winter, the He-Sea point.