灵枢经·论疾诊尺 Discourse on Diagnosing Disease by the Cubit Skin

Huangdi asked Qibo: "I wish to diagnose illness without observing complexion or holding the pulse, relying solely on examining the cubit skin (chi fu — the skin of the forearm between wrist and elbow), so as to know what lies within the body from what appears without. How is this done?" Qibo replied: "By examining whether the cubit skin is slack or tense, small or large, smooth or rough, and whether the flesh beneath it is firm or frail, the pattern of the disease can be determined."

When one observes a person whose eye sockets are slightly swollen, as though he had just risen from sleep, whose neck vessel throbs visibly, who coughs from time to time, and when the hands and feet are pressed the depression left behind does not spring back — this is wind-water skin distension.

If the cubit skin is smooth and moist, this is wind. If the flesh of the cubit is weak and frail, this is jieyi — a languor disorder marked by generalized weakness, lassitude, and wasting; if the patient lies quietly at ease and yet the flesh wastes away, this is a cold-heat disorder, and it cannot be treated. If the cubit skin is smooth and glossy as though oiled, this is wind. If the cubit skin is rough, this is wind impediment. If the cubit skin is coarse like the scales of a withered fish, this is water-overflow with fluid retention. If the cubit skin is very hot and the pulse is full and restless, this is warm disease; if the pulse is full and also slippery, the disease is about to break out. If the cubit skin is cold and the pulse is small, this is diarrhea with depleted qi. If the cubit skin burns like a torch, hot at first and turning cold afterward, this is a cold-heat disorder; if the cubit skin is cold at first, and after being held for a long while grows warm, this too is a cold-heat disorder.

If heat is localized to the elbow alone, there is heat above the lower back; if heat is localized to the hand alone, there is heat below the lower back. If heat is localized in front of the elbow, there is heat in the chest; if heat is localized behind the elbow, there is heat in the shoulder and back. If heat is localized in the mid-forearm, there is heat in the lower back and abdomen; if heat is felt three or four inches below the coarse skin behind the elbow, there are parasites in the intestines. If the palm is hot, there is heat in the abdomen; if the palm is cold, there is cold in the abdomen. If, on the white flesh above the thenar eminence (the "fish" region at the base of the thumb), greenish blood vessels appear, there is cold in the stomach.

If the cubit skin burns like a torch and the Renying pulse is large, there ought to be blood loss; if the cubit skin is hard and large while the pulse is very small, the qi depleted, and the oppressive distress increases, the patient will die at once.

If the eyes show a red color, the disease is in the heart; white, in the lung; green-blue, in the liver; yellow, in the spleen; black, in the kidney. If the yellow color cannot be clearly named, the disease is in the chest.

In diagnosing eye pain: if a red vessel runs from above downward, this is Taiyang disease; if it runs from below upward, this is Yangming disease; if it runs from the outer canthus toward the inner, this is Shaoyang disease.

In diagnosing cold-heat disorders, when a red vessel extends up and down as far as the pupil: if one such vessel is seen, the patient will die within a year; if one and a half vessels are seen, within a year and a half; if two vessels, within two years; if two and a half vessels, within two years and a half; if three vessels, within three years.

In diagnosing toothache from caries, press along the course of the yang channels as they arrive: wherever there is excess, heat is localized there alone — if on the left, the left is hot; if on the right, the right is hot; if above, the upper part is hot; if below, the lower part is hot.

In diagnosing the blood vessels: much redness indicates much heat; much green-blue indicates much pain; much black indicates a longstanding impediment disorder; if redness, black, and green-blue all appear together, this is a cold-heat disorder.

When the body aches and the complexion is faintly yellow, the teeth are coated with a yellow film, and the nails are yellow, this is jaundice. When the patient lies quietly at ease, the urine is dark yellow-red, and the pulse is small and rough, the patient has no appetite.

When a person is ill, if the pulse at the Cunkou is equal in size to the pulse at Renying, and equal also in depth, whether floating or sunken, the disease will be difficult to resolve.

In a woman, if the pulse of the Hand Shaoyin channel beats vigorously, she is pregnant.

When an infant is ill, if all the hair on the head stands up reversed, the infant will certainly die. If a green-blue vessel rises up between the ears, this indicates pulling pain. If the stool contains red flecks together with diarrhea of undigested food, and the pulse is small while the hands and feet are cold, this is difficult to resolve; if there is diarrhea of undigested food with a small pulse but the hands and feet are warm, the diarrhea is easily resolved.

In the transformations of the four seasons and the ascendancy of cold and heat, doubled yin must turn into yang, and doubled yang must turn into yin. Thus yin governs cold and yang governs heat; hence when cold reaches its extreme it turns to heat, and when heat reaches its extreme it turns to cold. Thus it is said: cold gives rise to heat, and heat gives rise to cold — this is the transformation of yin and yang.

Thus it is said: if one is injured by cold in winter, in spring one will develop warm disease; if injured by wind in spring, in summer one will develop diarrhea with undigested food and dysenteric disorders; if injured by summer-heat in summer, in autumn one will develop malarial fevers; if injured by dampness in autumn, in winter one will develop cough. This is called the sequence of the four seasons.