六十一难曰。经言望而知之谓之神。闻而知之谓之圣。问而知之谓之工。切脉而知之谓之巧。何谓也。然。望而知
之者望见其五色以知其病。
杨曰。望色者、假令肝部见青色者。肝自病。见赤色者。心乘肝。肝亦病。故见五色知五病也。
闻而知之者。闻其五音以别其病。
杨曰。五音者、谓宫、商、角、征、羽也。以配五脏。假令病患好哭者。肺病也。好歌者。脾病也。故云闻其音知
其病也。
问而知之者。问其所欲五味。以知其病所起所在也。
杨曰。问病患云好辛味者。则知肺病也。好食冷者。则知内热。故云知所起所在。
切脉而知之者。诊其寸口。视其虚实。以知其病。病在何脏腑也。
丁曰。视当作持字。为以手循持其寸口也。杨曰。切、按也。谓按寸口之脉。若弦多者。肝病也。洪多者。心病也。
浮数则病在腑。沉细则病在脏。故云在何脏也。（按脏下似脱腑字。）
经言以外知之曰圣。以内知之曰神。此之谓也。
丁曰。夫脉合五色。色合五味。味合五音。故有此望闻问切之法。经内前篇具说。习之者能知此。乃是神圣工巧之
良医也。杨曰。视色听声、切脉。皆在外而知内之病也。
六十二难曰。脏井荥有五。腑独有六者。何谓也。然。腑者阳也。三焦行于诸阳。故置一俞名曰原。腑有六者。亦
与三焦共一气也。
丁曰。三焦者、臣使之官。位应相火。宣行君火命令。使行于诸阳经中。见置一俞名曰原。所以腑有六。亦是三焦
之一气。故三焦共一气也。杨曰。五脏之脉。皆以所出为井。所流为荥。所注为俞。所行为经。所入为合。是谓五俞。
以应金木水火土也。六腑亦并以所出为井。所流为荥。所注为俞。所过为原。所行为经。所入为合。其俞亦应五行。惟
原独不应五行。原者、元也。元气者、三焦之气也。其气尊大。故不应五行。所以六腑有六俞。亦以应六合于干道也。
然五脏亦有原。则以第三穴为原。所以不别立穴者。五脏法地。地卑。故三焦之气经过而已。所以无别穴。六腑既是阳。
三焦亦是阳。故云共一气也。虞曰。天以六气司下。地以五行奉上。六气者、风寒暑燥湿火也。五行者、金木水火土也。
十一之气相因而成。人应之。乃六腑法六气。五脏法五行。亦十一之气相因而成也。天得六。谓天属阳。以阴数配之。
地得五。谓地属阴。以阳数配之。而成阴阳也。人腑脏亦然。六腑配六气者。谓胆木配风。膀胱水配寒。小肠火配暑。
大肠金配燥。胃土配湿。三焦少阳配火。三焦为原气。在六腑阳脉中。自立一为原也。五脏配五行者。肝木。心火。脾
土。肺金。肾水。五脏法阴无原。一穴者。谓五行阴脉穴中原气暗主之。故原并俞同一穴也。（按五脏以俞为原。此井字
疑衍。）故曰。三焦共一气。其理明矣。详此经义前后问答。文理有阙。
六十三难曰。十变言五脏六腑荥合。皆以井为始者。何也。然。井者、东方春也。
虞曰。经言井者、东方春也。春者、施化育无求其报。春者、仁也。在五常。仁乃法水。水之有仁者。井水也。井
水济人亦无求报。故经云。井者、东方春也。易曰。井养而不穷。可象春仁也。
万物之始生。
虞曰。万物始生。由春气之化育也。
诸 行喘息。 飞蠕动。当生之物。莫不以春而生。
虞曰。井有仁焉。故圣人涉春育物以象于井也。夫葭灰方飞。蛰虫始振。所以 虫行。喘虫息。 虫飞。蠕虫动。
皆因春气而生故也。 乃井中虫。
故岁数始于春。
虞曰。春木也。下文甲亦木。井有仁。仁亦木也。今以井为始者。谓仁道至大。在岁春为首。在日甲为首。在经脉
井为首故也。
日数始于甲。故以井为始也。
杨曰。凡脏腑皆以井为始。井者、谓谷井尔。非谓掘作之井。山谷之中。泉水初出之处。名之曰井。井者、主出之
义也。泉水既生。留停于近。萦迂未成大流。故名之曰荥。荥者、小水之状也。留停既深。便有注射输文之处。故名之
曰俞。俞者、委积逐流行。经历而成渠径。经者、径也。亦经营之义也。经行既达。合会于海。故名之曰合。合者、会
也。此是水行流转之义。人之经脉。亦法于此。故取名焉。所以井为始春者。以其所生之义也。岁数始于春者、正月为
岁首故也。日数始于甲者、谓东方甲乙也。正月与甲乙。皆属于春也。
丁曰。十二经气穴三百六十五穴。皆以井为始。各有其终矣。
第六十一难说：医经上讲，通过观察就能诊断疾病称为“神”，通过听声音就能诊断疾病称为“圣”，通过询问就能诊断疾病称为“工”，通过切脉就能诊断疾病称为“巧”。这是什么意思呢？回答说：所谓通过观察就能诊断疾病，是指观察患者面部的五色变化从而知道其患病情况。
杨氏说：望面色时，假如在肝部区域见到青色，这是肝脏自身的病变；见到赤色，是心脏乘袭肝脏（心火克肝木），肝脏也处于病态。所以通过观察五色可以知道五种不同的疾病。
所谓通过听声音就能诊断疾病，是指听取患者的五音变化来辨别疾病。
杨氏说：五音是指宫、商、角、徵、羽这五种音调，它们分别配属五脏。假如患者喜欢哭泣，这是肺脏的病变；喜欢唱歌，这是脾脏的病变。所以说通过听声音可以知道疾病所在。
所谓通过询问就能诊断疾病，是询问患者对五味（酸、苦、甘、辛、咸）的偏好，从而知道疾病的起因和所在部位。
杨氏说：询问患者如果喜欢吃辛辣食物，就知道是肺脏病变；喜欢吃冷食，就知道体内有热邪。所以说能知道疾病的起因和所在。
所谓通过切脉就能诊断疾病，是诊察寸口脉象，观察其虚或实的状态，从而知道患病情况以及疾病位于哪个脏腑。
丁氏说：“视”字应当作“持”字解，意思是用手循按持守寸口脉。杨氏说：切，就是按压的意思。指按压寸口脉，如果弦脉多见，是肝脏病变；洪脉多见，是心脏病变。浮数脉表示病在六腑，沉细脉表示病在五脏。所以说能知道疾病在哪个脏腑。（按语：此处“脏”字下似乎脱漏了“腑”字。）
医经上说：从外部征象推断内部病变称为“圣”，从内部机理推断外部表现称为“神”，说的就是这个道理。
丁氏说：脉象与五色相合，五色与五味相合，五味与五音相合，因此有了望、闻、问、切这四种诊断方法。医经前篇已经详细论述过。习医者若能掌握这些，就是具备“神圣工巧”技艺的优秀医生。杨氏说：观察面色、聆听声音、切按脉象，都是从外部征象来了解内部病变的方法。
第六十二难说：五脏的井穴、荥穴只有五个，而六腑独有六个穴位，这是什么意思呢？回答说：六腑属阳，三焦之气运行于各阳经之中，所以设置一个原穴，名叫原穴。六腑之所以有六个穴位，也是因为与三焦共有一气。
丁氏说：三焦是臣使之官，位应相火，宣行君火的命令，使气运行于各阳经中。现在设置一个穴位名为原穴，所以六腑有六个穴位，这也是三焦的一气所致，所以说三焦共有一气。杨氏说：五脏的经脉，以所出之处为井穴，所流之处为荥穴，所注之处为俞穴，所行之处的为经穴，所入之处为合穴，这叫做五输穴，对应金、木、水、火、土五行。六腑也同样以所出为井，所流为荥，所注为俞，所过为原穴，所行为经，所入为合。其腧穴也对应五行，唯独原穴不直接对应五行。原，就是元的意思。元气，就是三焦之气。此气尊贵宏大，所以不直接对应五行。因此六腑有六个腧穴，也是对应六合与天道。然而五脏也有原穴，只是将第三个穴位作为原穴。之所以不单独设立穴位，是因为五脏法地，地势卑下，所以三焦之气经过而已，没有单独的穴位。六腑既然是阳，三焦也是阳，所以说共有一气。虞氏说：天以六气司管下方，地以五行奉上。六气是指风、寒、暑、燥、湿、火。五行是指金、木、水、火、土。十一气相互因应而成，人顺应之，于是六腑效法六气，五脏效法五行，也是由十一气相互因应而成。天得六，谓天属阳，以阴数配之；地得五，谓地属阴，以阳数配之，从而形成阴阳。人的脏腑也是如此。六腑配六气，是指胆木配风，膀胱水配寒，小肠火配暑，大肠金配燥，胃土配湿，三焦少阳配火。三焦为原气，在六腑阳脉中，自立一穴为原穴。五脏配五行，即肝木、心火、脾土、肺金、肾水。五脏法阴而无独立原穴，其中一个穴位的意思是五行阴脉中的原气暗中主事，所以原穴并同俞穴在同一位置。（按语：五脏以俞穴为原穴，此处的“井”字可能是衍文。）所以说三焦共有一气，道理就很明白了。详细考察此经义前后的问答，文理有所缺失。
第六十三难说：《十变》中说五脏六腑的荥穴、合穴都以井穴为起始，为什么呢？回答说：井穴，对应东方春季。
虞氏说：医经讲井穴对应东方春季。春季，施行化育之功而不求回报。春季，象征仁德。在五常中，仁德效法水。具有仁德的水，就是井水。井水救济世人也不求回报，所以医经说：井穴对应东方春季。《易经》说：井水滋养万物而没有穷尽，可以象征春天的仁德。
万物开始生长。
各种行走的动物呼吸吐纳，飞翔爬行的昆虫，所有应当生存的生物，没有不是依靠春天而生存的。
虞氏说：井穴含有仁德，所以圣人效法春天养育万物来象征井穴。当葭灰飞扬时，冬眠的虫子开始震动，所以行走的虫、喘息的虫、飞翔的虫、蠕动的虫，都因为春气而生发。那些是在井中的虫子。
所以岁数始于春季。
虞氏说：春属木。下文提到的“甲”也属木。井穴含有仁德，仁也属木。现在以井穴为起始，是说仁道至大，在一年中春季为首，在一日中甲日为首，在经脉中井穴为首的缘故。
杨氏说：凡是脏腑都以井穴为起始。井穴，指的是山谷中的泉眼，不是指挖掘出来的水井。在山谷之中，泉水刚刚涌出的地方，称之为井。井，主要表达“流出”的意义。泉水产生后，停留附近，萦绕迂回尚未形成大水流，所以称之为荥穴。荥，是小水的形态。停留既深，便有注入输送的地方，所以称之为俞穴。俞，是积聚随后流行，经历而形成渠道。经，就是路径，也有经营的意思。经气运行到达，汇合于大海，所以称之为合穴。合，就是汇合。这是水流动转的含义。人体的经脉，也效法于此，所以取这个名字。之所以说井对应春季，是因为它有“生发”的意义。岁数始于春季，是因为正月是岁首。日数始于甲日，是指东方甲乙日。正月与甲乙日，都属于春季。
Difficulty 61 states: The classic texts say, "To know through observation is called 'Shen' (Divine); to know through listening and smelling is called 'Sheng' (Sage); to know through inquiry is called 'Gong' (Skillful); to know through palpation of the pulse is called 'Qiao' (Adroit)." What does this mean? The answer is: To know through observation means observing the five colors of the face to ascertain the disease.
Master Yang says: When inspecting facial colors, if a bluish color appears in the Liver area, it indicates a primary disease of the Liver; if a reddish color appears, it indicates the Heart overcoming the Liver (Heart Fire insulting Liver Wood), meaning the Liver is also diseased. Thus, by observing the five colors, one can know the five diseases.
To know through listening and smelling means distinguishing the disease by hearing the five tones.
Master Yang says: The five tones refer to Gong, Shang, Jue, Zhi, and Yu, which correspond to the five Zang organs. For example, if a patient tends to cry, it indicates a Lung disease; if they tend to sing, it indicates a Spleen disease. Hence, it is said that knowing the disease through sound.
To know through inquiry means asking about the patient's preference for the five flavors (sour, bitter, sweet, pungent, salty) to determine the origin and location of the disease.
Master Yang says: If the patient expresses a preference for pungent flavors, one knows it is a Lung disease; if they prefer cold food, one knows there is internal heat. Hence, it is said that one can know the origin and location.
To know through palpation of the pulse means examining the Cun Kou (Radial Pulse), observing its deficiency or excess, to ascertain the disease and which Zang-Fu organ is affected.
Master Ding says: The character "Shi" (observe/look at) should be read as "Chi" (hold/support), meaning to hold the Cun Kou pulse with the hand. Master Yang says: "Qie" (cut/palpate) means to press. It refers to pressing the Cun Kou pulse. If the Xian (Wiry) pulse predominates, it is a Liver disease; if the Hong (Surging) pulse predominates, it is a Heart disease. A Fu Shuo (Floating and Rapid) pulse indicates disease in the Fu organs; a Chen Xi (Deep and Fine) pulse indicates disease in the Zang organs. Hence, it is said that one can know which Zang organ is involved. (Note: It seems the character "Fu" is missing after "Zang".)
The classic texts state: "To know from the exterior is called 'Sheng'; to know from the interior is called 'Shen.' This is what is meant."
Master Ding says: The pulse corresponds to the five colors; the colors correspond to the five flavors; the flavors correspond to the five tones. Therefore, the methods of Observation, Listening/Smelling, Inquiry, and Palpation exist. These are fully explained in the previous chapters of the classics. Those who study them and understand these principles are excellent physicians possessing the skills of Shen, Sheng, Gong, and Qiao. Master Yang says: Observing colors, listening to sounds, and palpating pulses are all methods of knowing the interior disease from external signs.
Difficulty 62 states: The Jing-Well and Ying-Spring points of the Zang organs are five in number, but the Fu organs have six uniquely. What is the reason? The answer is: The Fu organs belong to Yang. The San Jiao (Triple Burner) Qi circulates among the Yang meridians, so an additional Yuan-Source point is established, named the Yuan point. The Fu organs have six points because they share one Qi with the San Jiao.
Master Ding says: The San Jiao is the official of the messenger, corresponding to Ministerial Fire, executing the commands of Sovereign Fire, causing Qi to circulate among the Yang meridians. The establishment of a point named Yuan explains why the Fu organs have six points; it is also due to the one Qi of the San Jiao, hence "sharing one Qi." Master Yang says: The meridians of the Five Zang organs take the exit point as Jing-Well, the flowing point as Ying-Spring, the pouring point as Shu-Stream, the passing point as Jing-River, and the entering point as He-Sea. These are called the Five Shu points, corresponding to Metal, Wood, Water, Fire, and Earth. The Six Fu organs similarly take the exit as Jing-Well, the flowing as Ying-Spring, the pouring as Shu-Stream, the passing as Yuan-Source, the passing-through as Jing-River, and the entering as He-Sea. Their points also correspond to the Five Elements, except the Yuan point, which does not directly correspond to the Five Elements. "Yuan" means "Yuan" (Original). Original Qi is the Qi of the San Jiao. This Qi is noble and grand, thus it does not correspond to the Five Elements. Therefore, the Fu organs have six Shu points, also corresponding to the Six Harmonies and the Way of Heaven. However, the Zang organs also have Yuan points, using the third point as the Yuan point. They do not establish separate points because the Zang organs emulate Earth, and Earth is low, so the Qi of the San Jiao merely passes through without a separate point. Since the Fu organs are Yang and the San Jiao is also Yang, it is said they share one Qi. Master Yu says: Heaven governs the lower with Six Qi, and Earth offers up the Five Elements. The Six Qi are Wind, Cold, Summer Heat, Dryness, Dampness, and Fire. The Five Elements are Metal, Wood, Water, Fire, and Earth. The eleven Qi interact to form existence, and humans respond to them. Thus, the Six Fu organs emulate the Six Qi, and the Five Zang organs emulate the Five Elements, formed by the interaction of the eleven Qi. Heaven obtains six, meaning Heaven belongs to Yang and pairs with Yin numbers; Earth obtains five, meaning Earth belongs to Yin and pairs with Yang numbers, thereby forming Yin and Yang. Human Zang-Fu are the same. The Six Fu organs pair with the Six Qi: Gallbladder Wood pairs with Wind, Bladder Water pairs with Cold, Small Intestine Fire pairs with Summer Heat, Large Intestine Metal pairs with Dryness, Stomach Earth pairs with Dampness, and San Jiao Shaoyang pairs with Fire. The San Jiao is Original Qi, and within the Yang meridians of the Six Fu organs, it establishes one point as the Yuan point. The Five Zang organs pair with the Five Elements: Liver Wood, Heart Fire, Spleen Earth, Lung Metal, Kidney Water. The Zang organs emulate Yin and have no independent Yuan point; the meaning of having one point is that the Original Qi within the Yin meridians of the Five Elements secretly governs it. Therefore, the Yuan point and Shu-Stream point occupy the same location. (Note: The Zang organs use the Shu-Stream point as the Yuan point; the character "Jing" here may be a scribal error.) Thus, it is said that the San Jiao shares one Qi, and the principle is clear. Examining the questions and answers before and after this passage, there are gaps in the text.
Difficulty 63 states: The "Ten Transformations" states that the Ying-Spring and He-Sea points of the Five Zang and Six Fu organs all begin with the Jing-Well point. Why? The answer is: The Jing-Well point corresponds to the East and Spring.
Master Yu says: The classic states that the Jing-Well point corresponds to the East and Spring. Spring represents bestowing transformation and nurturing without seeking reward. Spring represents Ren (Benevolence). Among the Five Constants, Ren emulates Water. Water that possesses Benevolence is Well Water. Well Water benefits people without seeking reward, hence the classic says: "The Jing-Well point corresponds to the East and Spring." The I Ching says: "The Well nourishes and never runs out," which can symbolize the Benevolence of Spring.
All things begin to grow.
Master Yu says: The beginning of all things grows due to the transformation and nurturing of Spring Qi.
All walking creatures breathing, flying insects, and all living beings that ought to exist, none do not arise through Spring.
Master Yu says: The Jing-Well contains Benevolence. Thus, the sage emulates the nurturing of things in Spring to symbolize the Jing-Well. When reed ash flies and hibernating insects begin to stir, the crawling insects move, the panting insects breathe, the flying insects soar, and the wriggling insects move; all are born due to Spring Qi. These are insects in the well.
Therefore, the count of years begins in Spring.
Master Yu says: Spring is Wood. The character "Jia" below is also Wood. The Jing-Well contains Benevolence, and Benevolence is also Wood. Now, taking the Jing-Well as the beginning means that the Way of Benevolence is great; it is first in the year (Spring), first in the day (Jia), and first in the meridians (Jing-Well).
The count of days begins with Jia, hence the Jing-Well is taken as the beginning.
Master Yang says: All Zang and Fu organs begin with the Jing-Well point. The Jing-Well refers to a valley spring, not a dug well. In the mountains, where spring water first emerges, it is called a Well. "Well" primarily signifies the meaning of "emerging." Once spring water is generated, it stays nearby, winding and not yet forming a large flow, so it is called the Ying-Spring point. "Ying" describes the shape of small water. After staying deep enough, there are places of pouring and transporting, so it is called the Shu-Stream point. "Shu" means accumulating and then flowing, forming channels through experience. "Jing" means path, and also implies management/circulation. When Jing Qi reaches its destination and converges into the sea, it is called the He-Sea point. "He" means convergence. This is the meaning of water flowing and circulating. Human meridians also emulate this, hence the names are derived. The reason Jing corresponds to Spring is due to its meaning of "generating." The count of years begins in Spring because the first month is the start of the year. The count of days begins with Jia, referring to the East Jia-Yi days. The first month and Jia-Yi days both belong to Spring.
Master Ding says: The acupoints of the Twelve Meridians, totaling three hundred and sixty-five, all begin with the Jing-Well point and each has its end.