六十八难曰∶五脏六腑，各有井荥输经合，皆何所主？
然∶经言所出为井，所流为荥，所注
为输，所行为经，所入为合。井主心下满，荥主身热，输主体重节痛，经主喘咳寒热，合主逆气
而泄，此五脏六腑井荥输经合所主病也。
主，主治也。经言，《灵枢·九针十二原篇》文也。井，山谷中泉水之所出也。荥，小水尚
未能流利者也。输，输泻之所注也。经，由输而经过之径也。合，水流而会合之处也。井主心
下满者，井应木，木者肝，肝主满重节痛也。荥应火，火者心，心主身热也。输应土，土者脾，
脾主体重也。经主咳嗽寒热者，经应金，金者肺，肺主寒热也。合主气逆而泄者，合应水，水
者肾，肾主泄也。此论五脏为病之一端耳。不言六腑者，举脏足以该腑也。然《内经》辨病取
穴之法，实不止此，不可执一说而不知变通也。
按∶此七难论输穴也。然某穴至某穴之一寸者，将谓周尺耶，秦尺耶，汉尺耶，抑近世之尺
耶？聚讼纷纭，莫衷一是，皆为不明同身取寸之义也。或以患人之中指中节取寸，便为独得心
传，殊不知瘦人指长而身小，则背腹之横寸，岂不太阔，肥人指短而身长，则背腹之横寸，岂
不太狭，有身长指长而头小者，则头间之寸，岂不嫌长，有身短指短而头大者，则头间之寸，
岂不嫌短，似此肥瘦长短之差讹，安能准的。所谓同身取寸者，必同其身体而取之也。考其法
以《灵枢·骨度篇》尺寸为主，再量人身尺寸，随取而折之，自无长短肥瘦之差讹。假如骨度
篇云∶肩至肘，长一尺七寸，量患人由肩至肘，长一尺三寸六分，以八折合之，所云某穴至某
穴一寸者，仅得八分，余可类推。此同身取寸之活法，针灸之要事，不可不知也。
附《灵枢·骨度篇》
黄帝问于伯高曰∶脉度言经之长短，何以立之？伯高曰∶先度其骨节之大小广狭长短，而
脉度定矣。黄帝曰∶愿闻众人之度，人长七尺五寸者，其骨节之大小长短各几何？伯高曰∶头
之大骨，围二尺六寸，胸围四尺五寸，腰围四尺二寸，发所覆者，颅至项，尺二寸。《甲乙经》
“尺”字上有“一”字。发以下至颐，长一尺。君子终折。《甲乙经》“君子”作“男子”。
结喉以下至缺盆中，长四寸。缺盆以下至 KT ，长九寸，过则肺大，不满则肺小。 KT 以下
至天枢，长八寸，过则胃大，不及则胃小。天枢以下至横骨，长六寸半，过则回肠广长，不满则
狭短。横骨长六寸半，横骨上廉以下，至内辅之上廉，长一尺八寸。内辅之上廉以下至下廉，长
三寸半，内辅下廉下至内踝，长一尺三寸。内踝以下至地，长三寸。膝 以下至跗属长一尺六寸。
跗属以下至地，长三寸。故骨围大则太过，小则不及。角以下至柱骨，长一尺。行腋中不见者，
长四寸。腋以下至季胁，长一尺二寸，季胁以下至髀枢，长六寸。髀枢以下至膝中，长一尺九寸。
膝以下至外踝，长一尺六寸。外踝以下至京骨，长三寸。京骨以下至地，长一寸。耳后当完骨者，
广九寸。耳前当耳门者，广一尺三寸。两颧之间，相去七寸。两乳之间，广九寸半。《甲乙经》
作广八寸。
两髀之间，广六寸半。足长一尺二寸，广四寸半。肩至肘，长一尺七寸，肘至腕，长一尺二
寸半。腕至中指本节，长四寸。本节至其末，长四寸半。项发以下至背骨，长二寸半。膂骨以
下至尾 二十一节，长三尺。上节长一寸四分分之一，奇分在下，故上七节至于膂骨，九寸八
分分之七。此众人骨之度也。所以立经脉之长短也。是故视其经脉之在于身也，见其浮而坚，
其见明而大者多血，细而沉者多气也。
上第五卷，六十二难至六十八难，论 穴。
第六十八难问道：五脏和六腑，各自都有井、荥、输、经、合五类穴位，它们分别主治什么病症呢？
回答说：医经中说，脉气初出之处为井穴，脉气流动之处为荥穴，脉气灌注之处为输穴，脉气运行之处为经穴，脉气深入汇聚之处为合穴。井穴主治心下痞满，荥穴主治身体发热，输穴主治肢体沉重和关节疼痛，经穴主治咳嗽气喘和寒热往来，合穴主治气逆上冲和泄泻，这就是五脏六腑的井、荥、输、经、合五穴所主治的病症。
所谓“主”，即主治之意。上述经文出自《灵枢·九针十二原篇》。井穴，如同山谷中泉水涌出的地方；荥穴，如同细小的水流尚不能畅流的地方；输穴，是气血输注灌注的地方；经穴，是气血由输穴经过运行的路径；合穴，是水流汇入会合的地方。井穴主治心下痞满，是因为井穴对应五行中的木，木对应肝脏，肝主司胀满、身体沉重和关节疼痛。荥穴对应火，火对应心脏，心主司身体发热。输穴对应土，土对应脾脏，脾主司肢体沉重。经穴主治咳嗽和寒热，是因为经穴对应五行中的金，金对应肺脏，肺主司寒热。合穴主治气逆和泄泻，是因为合穴对应五行中的水，水对应肾脏，肾主司泄泻。这里论述的是五脏发病的一个方面罢了。没有单独论述六腑，是因为列举了五脏就足以涵盖六腑了。然而，《黄帝内经》中辨别病症选取穴位的方法，实际上并不止于此，不能拘泥于这一种说法而不知变通。
按语：这一节（指第七难）论述的是腧穴的问题。然而，从某穴到某穴之间的一寸距离，究竟是指周代的尺、秦代的尺、汉代的尺，还是近世的尺呢？众说纷纭，莫衷一是，这都是因为不明白“同身寸”取穴的意义所致。有的人认为用患者中指中节的长度作为一寸，便自以为独得心传，却不知道瘦人手指长而身体小，那么背部和腹部的横向一寸岂不显得太宽？胖人手指短而身体长，那么背部和腹部的横向一寸岂不显得太窄？有身体长、手指长但头小的，那么头部的横向一寸岂不嫌太长？有身体短、手指短但头大的，那么头部的横向一寸岂不嫌太短？像这样因肥瘦长短差异造成的误差，怎么能准确呢？所谓的“同身寸”，必须是依据患者自身的身体比例来取定。考证其方法，应以《灵枢·骨度篇》的尺寸为标准，再测量患者的身体尺寸，随时折算，自然就没有长短肥瘦的误差了。例如《骨度篇》记载：肩至肘的长度为一尺七寸，如果测量患者从肩到肘的长度为一尺三寸六分，以八折的比例进行折算，那么文中所说的某穴到某穴的一寸，实际仅得八分，其余可类推。这是同身寸取穴的灵活方法，是针灸的重要事项，不可不知道。
附录《灵枢·骨度篇》内容：
黄帝问伯高说：脉度篇讲述了经脉的长短，如何确定它呢？伯高回答说：先测量骨骼关节的大小、宽窄、长短，那么经脉的长度就确定了。黄帝说：我想听听常人的度量标准，身高七尺五寸的人，其骨骼关节的大小长短各是多少？伯高回答说：头部大骨（颅骨）的周长为二尺六寸，胸部周长四尺五寸，腰部周长四尺二寸，头发覆盖的部分，从头顶到项部，长一尺二寸。（《甲乙经》在“尺”字上有“一”字）。头发以下到下巴颏，长一尺。成年男子的平均折算法。（《甲乙经》中“君子”作“男子”）。喉结以下到缺盆穴中间，长四寸。缺盆穴以下到胸窝（KT，此处疑为胸或腋相关部位，原文作KT），长九寸，超过这个尺寸则肺大，不足则肺小。胸窝以下到天枢穴，长八寸，超过则胃大，不足则胃小。天枢穴以下到横骨，长六寸半，超过则回肠宽大且长，不足则狭短。横骨长六寸半，横骨上缘以下到内辅骨（胫骨内侧髁）上缘，长一尺八寸。内辅骨上缘以下到下缘，长三寸半，内辅骨下缘到内踝，长一尺三寸。内踝以下到地面，长三寸。膝盖以下到足背连接处，长一尺六寸。足背连接处以下到地面，长三寸。所以骨骼围度大则太过，小则不及。肩部角以下到柱骨（第一胸椎棘突），长一尺。行走时腋下看不见的部分，长四寸。腋下到季胁，长一尺二寸，季胁到髀枢（股骨大转子），长六寸。髀枢以下到膝中，长一尺九寸。膝以下到外踝，长一尺六寸。外踝以下到京骨穴，长三寸。京骨穴以下到地面，长一寸。耳后当完骨处的宽度为九寸。耳前当耳门处的宽度为一尺三寸。两颧骨之间，相距七寸。两乳之间，宽度为九寸半。（《甲乙经》作八寸）。两髀（大腿）之间，宽度为六寸半。脚长一尺二寸，宽四寸半。肩到肘，长一尺七寸，肘到腕，长一尺二寸半。腕到中指尖本节（掌指关节），长四寸。本节到指尖，长四寸半。颈部头发以下到背脊骨，长二寸半。脊柱以下到尾骨二十一节，长三尺。上节长一寸又十四分之一，奇数部分在下，所以上七节直到脊柱骨，共九寸八分分之七。这是常人的骨骼度量标准。用来确立经脉的长短。因此观察人体内的经脉，看到浮起而坚硬的，显现明亮而粗大的多血，细小而沉伏的多气。
以上是第五卷，从第六十二难到第六十八难，论述腧穴的内容。
Difficulty 68 states: The five Zang organs and six Fu organs each have Jing-River, Ying-Spring, Shu-Stream, Jing-River (Jing), and He-Sea points. What are their respective indications?
The answer is: The classic texts state that where the Qi emerges is the Jing-River point; where it flows is the Ying-Spring point; where it pours in is the Shu-Stream point; where it travels is the Jing-River (Jing) point; and where it enters and gathers is the He-Sea point. The Jing-River point indicates fullness below the heart; the Ying-Spring point indicates fever of the body; the Shu-Stream point indicates heaviness of the body and pain in the joints; the Jing-River (Jing) point indicates cough, asthma, cold, and heat; the He-Sea point indicates rebellious Qi and diarrhea. These are the diseases indicated by the Jing-River, Ying-Spring, Shu-Stream, Jing-River (Jing), and He-Sea points of the five Zang and six Fu organs.
"Indicates" means "treats." This text comes from the *Ling Shu: Chapter on Nine Needles and Twelve Origins*. The Jing-River point is like the source of spring water emerging from a valley. The Ying-Spring point is like small streams that are not yet flowing freely. The Shu-Stream point is where Qi is transported and poured in. The Jing-River (Jing) point is the path through which Qi passes after the Shu-Stream point. The He-Sea point is where the water flows and converges. The Jing-River point treats fullness below the heart because the Jing-River point corresponds to Wood, and Wood corresponds to the Liver, which governs fullness, heaviness, and joint pain. The Ying-Spring point corresponds to Fire, and Fire corresponds to the Heart, which governs body fever. The Shu-Stream point corresponds to Earth, and Earth corresponds to the Spleen, which governs bodily heaviness. The Jing-River (Jing) point treats cough and cold/heat because the Jing-River point corresponds to Metal, and Metal corresponds to the Lung, which governs cold and heat. The He-Sea point treats rebellious Qi and diarrhea because the He-Sea point corresponds to Water, and Water corresponds to the Kidney, which governs diarrhea. This discussion covers only one aspect of diseases arising from the five Zang organs. It does not separately discuss the six Fu organs because listing the five Zang organs is sufficient to encompass the six Fu organs. However, the methods for differentiating diseases and selecting acupoints in the *Huang Di Nei Jing* are actually not limited to this; one cannot stick rigidly to this single theory without flexibility.
Commentary: This section (referring to Difficulty 7) discusses acupoints. However, regarding the distance of one Cun between certain acupoints, should it be measured with the Zhou chi, Qin chi, Han chi, or modern chi? Opinions vary widely, and no consensus has been reached, all due to a lack of understanding of the concept of "Tong Shen Cun" (body-proportional measurement). Some believe that using the middle segment of the patient's middle finger as one Cun constitutes exclusive transmission of the art. They fail to realize that in thin individuals, whose fingers are long but bodies small, the horizontal Cun across the back and abdomen would appear too wide. In obese individuals, whose fingers are short but bodies tall, the horizontal Cun across the back and abdomen would appear too narrow. For those with long bodies and long fingers but small heads, the Cun across the head would seem too long. For those with short bodies and short fingers but large heads, the Cun across the head would seem too short. Given such discrepancies caused by differences in fatness, leanness, length, and shortness, how can accuracy be achieved? The so-called "Tong Shen Cun" must be determined based on the patient's own body proportions. Examining the method, it should primarily rely on the measurements in the *Ling Shu: Chapter on Bone Measurements*, measuring the patient's body dimensions and scaling them accordingly, thereby eliminating errors due to length and weight. For example, the *Bone Measurements* chapter states that the distance from shoulder to elbow is one chi seven cun. If the patient's shoulder-to-elbow distance measures one chi three cun six fen, applying an eight-fold reduction ratio, the stated "one Cun" between specific acupoints would actually equal only eight fen. The rest can be inferred similarly. This flexible application of Tong Shen Cun is a crucial matter in acupuncture and moxibustion and must be understood.
Appendix: *Ling Shu: Chapter on Bone Measurements*
Yellow Emperor asked Bo Gao: The Pulse Measurement chapter discusses the lengths of the meridians; how are they established? Bo Gao replied: First measure the size, width, and length of the bone joints, and then the length of the meridians can be determined. Yellow Emperor said: I wish to hear the standard measurements for ordinary people. For a person seven chi five cun tall, what are the sizes and lengths of their bone joints? Bo Gao replied: The circumference of the large bones of the head is two chi six cun; the chest circumference is four chi five cun; the waist circumference is four chi two cun; the area covered by hair, from the crown to the nape, is one chi two cun. (*Jia Yi Jing* adds "one" before "chi"). From below the hairline to the chin is one chi. This is the average proportion for adult men. (*Jia Yi Jing* reads "adult men" instead of "gentlemen"). From the Adam's apple to the center of the Quepen (ST12) is four cun. From Quepen to the [chest pit/axilla] is nine cun; exceeding this indicates a large lung, falling short indicates a small lung. From the [chest pit/axilla] to Tianshu (ST25) is eight cun; exceeding this indicates a large stomach, falling short indicates a small stomach. From Tianshu to the Henggu (pubic symphysis) is six and a half cun; exceeding this indicates a wide and long transverse colon, falling short indicates a narrow and short one. The Henggu is six and a half cun wide. From the upper border of the Henggu to the upper border of the inner condyle is one chi eight cun. From the upper border of the inner condyle to its lower border is three and a half cun. From the lower border of the inner condyle to the medial malleolus is one chi three cun. From the medial malleolus to the ground is three cun. From the knee to the dorsum pedis connection is one chi six cun. From the dorsum pedis connection to the ground is three cun. Therefore, if the bone circumference is large, it is excessive; if small, it is deficient. From the corner of the shoulder to the pillar bone (first thoracic vertebra spinous process) is one chi. The part hidden in the armpit during walking is four cun. From the armpit to the costal margin is one chi two cun. From the costal margin to the hip pivot (greater trochanter) is six cun. From the hip pivot to the middle of the knee is one chi nine cun. From the knee to the lateral malleolus is one chi six cun. From the lateral malleolus to the Jinggu (BL64) is three cun. From Jinggu to the ground is one cun. The width behind the ear at the Wanggu point is nine cun. The width in front of the ear at the Ermen point is one chi three cun. The distance between the two cheekbones is seven cun. The width between the two breasts is nine and a half cun. (*Jia Yi Jing* reads eight cun). The width between the two thighs is six and a half cun. The foot is one chi two cun long and four and a half cun wide. From shoulder to elbow is one chi seven cun; from elbow to wrist is one chi two and a half cun. From the wrist to the proximal phalanx of the middle finger is four cun. From the proximal phalanx to the tip is four and a half cun. From the neck hairline to the dorsal spine is two and a half cun. From the spinal column to the twenty-one coccygeal vertebrae is three chi. The upper segments are one and one-fourteenth cun long, with the remainder at the bottom; thus, the upper seven segments up to the spinal column total nine and seven-ninety-eighths cun. These are the bone measurements of ordinary people, used to establish the lengths of the meridians. Therefore, when observing the meridians in the body, those that appear floating and firm, bright and large, indicate abundant blood; those that are fine and deep indicate abundant Qi.
This concludes Volume Five, Difficulties 62 to 68, discussing acupoints.