Loading...
Chapter 74 of 81
黄帝内经·灵枢
The Yellow Emperor asked Qi Bo: I wish to judge disease not by observing the complexion or taking the pulse, but solely by examining the Chi skin (the skin of the medial forearm) — to know the internal from the external. How can this be done? Qi Bo said: Examine the slackness-tension, size, slipperiness-roughness of the Chi skin, as well as the firmness or weakness of the muscles, and the pattern of disease can be determined.
If the patient's lower eyelids are slightly swollen, as if just waking from sleep, the cervical vessels (carotid arteries) beat prominently, there is occasional coughing, and pressing on the skin of the limbs leaves depressions that do not quickly rebound — this is wind-water cutaneous distention (edema caused by wind evil contending with dampness) 🌊.
If the Chi skin is moist and glossy like grease, it is mostly due to wind evil 💨. If the Chi skin shows soft and weak muscles, the body is lethargic and debilitated, with a fondness for lying down and wasting of the flesh, this mostly indicates severe cold-heat conditions, which the ancients considered difficult to treat. If the Chi skin is moist and lustrous, it is mostly wind evil. If the Chi skin is rough and stagnant, it is mostly wind impediment (wind evil blocking the channels and collaterals). If the Chi skin is rough like dried fish scales, it mostly indicates retained water and rheum 🌊. If the Chi skin is burning hot 🔥 with a large and agitated pulse, this is warm disease (externally-contracted febrile illness). If the pulse is large and slippery, it suggests that the pathogenic evil has a tendency to exit outward.
If the Chi skin is cold with a small pulse, this is mostly diarrhea or qi deficiency 💨. If the Chi skin is burning hot, first hot then cold, this indicates alternating chills and fever. If the Chi skin is first cold and gradually becomes warm with prolonged pressure, this also indicates alternating chills and fever.
If the elbow alone is hot, this indicates heat above the waist 🔥. If the hand alone is hot, this indicates heat below the waist. Heat in the front of the elbow indicates heat in the chest region. Heat behind the elbow indicates heat in the shoulder and back region. Heat in the middle of the arm indicates heat in the lower abdomen and lumbar region. Heat at three to four cun below the posterior border of the elbow was believed by the ancients to indicate intestinal worms. Heat in the center of the palm indicates heat in the abdomen. Cold in the center of the palm indicates cold in the abdomen. If bluish vessels are seen in the pale flesh of the thenar eminence, this indicates cold in the stomach. If the Chi skin is burning hot while the Renying pulse (carotid artery pulsation) is large, this indicates blood loss. If the Chi skin is hard and large but the pulse is extremely small, with scant qi and worsening chest oppression, the ancients considered this an extremely poor prognosis.
Red coloration of the eyes indicates disease in the heart; white indicates disease in the lungs; blue-green indicates disease in the liver; yellow indicates disease in the spleen; black indicates disease in the kidneys. Yellow that is difficult to describe indicates disease in the chest. In examining eye pain, red vessels (visible blood vessels in the eye) traveling from above downward indicate Greater Yang disease; from below upward indicate Bright Yang disease; from the outer canthus inward indicate Lesser Yang disease. In examining cold-heat disease, if red vessels extend vertically to reach the pupil, the ancients believed that one red vessel signified death within one year... This method of determining the time of death based on the number of red vessels belongs to historical experience and should be viewed rationally.
In examining dental caries pain: press along the course of the Yang Bright channel — the affected side will be hot alone. Disease on the left manifests as heat on the left; disease on the right manifests as heat on the right; disease in the upper teeth manifests as heat above; disease in the lower teeth manifests as heat below 🩺. In examining superficial blood vessels of the skin: predominantly red coloration indicates much heat 🔥; predominantly blue-green indicates much pain; predominantly black indicates chronic impediment (bi syndrome of long duration); the combination of red, black, and blue-green indicates mixed cold and heat. Body pain accompanied by a slightly yellow complexion, yellow tooth grime, and yellow nail beds indicates jaundice.
A fondness for lying down, yellow and reddish urine, and a small, rough pulse are usually accompanied by poor appetite. If the patient's Cunkou pulse (radial artery at the wrist) and Renying pulse are equal in size and in floating-sinking depth, the ancients considered the disease difficult to cure. If the pulse of the Hand Lesser Yin channel in women is markedly dynamic, the ancients considered this a sign of pregnancy. In infants, if the hair stands up stiffly in reverse direction, the ancients considered this a poor prognosis. If blue-green vessels are visibly prominent in the ear region, this indicates convulsions and pain. If the stool contains reddish mucoid material, or there is wheat-like diarrhea (rice-water stools with undigested food) accompanied by a small pulse and cold hands and feet, the diarrhea is difficult to cure. If the pulse is small but the hands and feet are warm, the diarrhea is easy to cure.
The four seasons alternate between cold and heat; when yin reaches its extreme, it transforms toward yang, and when yang reaches its extreme, it transforms toward yin. Therefore, extreme cold generates heat, and extreme heat generates cold — cold and heat mutually transform, which is the change of yin and yang. Hence: injury by cold in winter gives rise to warm febrile disease in spring; injury by wind in spring gives rise to wheat-like diarrhea and dysentery in summer; injury by summerheat in summer gives rise to malaria in autumn; injury by dampness in autumn gives rise to cough in winter. This is the order of disease onset across the four seasons.
The core of this chapter is the "Chi skin diagnostic method": determining the nature of pathogenic evil and disease location through the slackness-tension, size, slipperiness-roughness, cold-heat, moistness-dryness, and hardness-softness of the forearm skin. The foundational concept is inferring the internal from the external — the body's interior and exterior are connected through the channels and collaterals and qi and blood, so internal organ disease can be reflected in specific external body regions. This shares certain similarities with modern medical observation of skin temperature, elasticity, edema, and color. Additionally, this chapter integrates eye diagnosis, blood vessel diagnosis, localized fever regions, and pulse examination, while using waxing and waning of yin and yang to explain cold-heat transformation and the seasonal order of disease onset, embodying the holistic view of Chinese medicine.
The objective changes in temperature, humidity, elasticity, and edema of the Chi skin can indeed provide certain pathological clues — for example, rough skin may suggest dehydration or malnutrition, and localized fever may be related to inflammation or changes in circulation. However, the one-to-one correspondence between subtle skin variations and specific organ diseases lacks rigorous evidence-based support and should not be used as modern diagnostic criteria.
Ancient empirical judgments such as predicting the time of death by the number of "red vessels reaching the pupil" in eye examination, or the belief that "infants with hair standing upward must die," lack scientific validity and should be viewed with reason. The correlation between seasonal pathogenic influence and seasonal diseases shows some phenomenological association, but the mechanism of "latent evil" cannot be simplistically equated with modern pathology.
In daily life, one can pay attention to skin moisture and warmth of the limbs, and avoid prolonged exposure to cold-damp environments 🌧️. Adapt daily routines to the four seasons — protect against cold in winter, wind in spring, heat in summer, and dampness in autumn. Maintain dietary moderation, avoiding raw and cold foods that may cause diarrhea. Preserve emotional balance to prevent disharmony of cold and heat. Pregnant women should receive modern prenatal care, and infants presenting abnormal signs should receive timely medical attention — ancient prognostic statements should not be relied upon.
Bu Gua Note: This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication recommendation, or treatment advice. Please seek timely medical attention if you feel unwell.