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Capítulo 74 de 81
黄帝内经·灵枢
The Yellow Emperor asked Qi Bo: I wish to determine disease without observing the complexion or palpating the pulse, only by examining the Chi skin (the skin of the medial forearm), knowing the internal from the external—how can this be done? Qi Bo said: Examine the relaxation-tension, size, slipperiness-roughness of the Chi skin, as well as the firmness or weakness of the muscles, and the disease pattern can be determined.
Observe if the area beneath the patient's eye sockets is slightly swollen, as if just waking from sleep, if the neck vessels (carotid arteries) pulsate visibly, with occasional coughing, and if pressing on the skin of the hands and feet leaves depressions that do not rebound—this is wind-water cutaneous swelling (edema caused by wind pathogen contending with dampness) 🌊.
When the Chi skin is moist and glossy like grease, it mostly indicates wind pathogen 💨. When the Chi skin is soft, the muscles are weak, the body is languid and fatigued, with drowsiness and muscle wasting, it mostly indicates severe cold-heat conditions, which the ancients considered difficult to treat. When the Chi skin is moist and lustrous, it mostly indicates wind pathogen; when the Chi skin is rough and stagnant, it mostly indicates wind-bi (impediment caused by wind pathogen obstructing the channels). When the Chi skin is rough like dried fish scales, it mostly indicates internal water retention 🌊. When the Chi skin is scalding hot 🔥 and the pulse is large and agitated, it is warm disease (externally contracted heat disease); if the pulse is large and slippery, it suggests that the pathogenic factor has a tendency to move outward.
When the Chi skin is cold and the pulse is small, it mostly indicates diarrhea and qi deficiency 💨. When the Chi skin is scalding hot, with heat first followed by cold, it belongs to alternating chills and fever; when the Chi skin is cold at first but gradually becomes warm with prolonged pressure, it also belongs to alternating chills and fever.
When the elbow alone is hot, it indicates heat above the waist 🔥; when the hand alone is hot, it indicates heat below the waist. When the anterior elbow is hot, it indicates heat in the chest and breast region; when the posterior elbow is hot, it indicates heat in the shoulders and back. When the middle of the arm is hot, it indicates heat in the lower abdomen and lumbar region. When the area three to four cun below the posterior elbow margin is hot, the ancients believed it indicated intestinal worms. When the center of the palm is hot, it indicates heat in the abdomen; when the center of the palm is cold, it indicates cold in the abdomen. When blue blood vessels are seen in the white fleshy area of the thenar eminence, it indicates cold in the stomach. When the Chi skin is scalding hot and the Renying pulse (carotid pulse point) is large, it indicates blood loss. When the Chi skin is hard and large, yet the pulse is extremely small, with shortness of breath and worsening chest oppression, the ancients believed the prognosis was extremely poor.
When the eye color is red, the disease is in the heart; when white, in the lungs; when green-blue, in the liver; when yellow, in the spleen; when black, in the kidneys. When the yellow color is difficult to describe, the disease is in the chest. When examining eye pain: if red vessels (red blood streaks in the eye) run from above downward, it belongs to Greater Yang disease; from below upward, to Bright Yang disease; from the outer canthus inward, to Lesser Yang disease. When examining cold-heat diseases, if red vessels extend upward and downward to the pupil, the ancients believed that seeing one red vessel meant death within a year… The idea of determining the time of death according to the number of red vessels belongs to historical experience and should be viewed rationally.
Examining dental caries pain: press along the Bright Yang channel pathway—the affected side will alone be hot—if the left side is diseased, the left is hot; if the right side is diseased, the right is hot; if the upper teeth are affected, the upper is hot; if the lower teeth are affected, the lower is hot 🩺. Examining blood vessels on the body surface: when the color is predominantly red, there is much heat 🔥; predominantly green-blue, much pain; predominantly black, prolonged bi (long-standing impediment); when red, black, and green-blue appear together, it is mixed cold and heat. When the body is painful with a slightly yellow complexion, yellow dental calculus, and yellow nails, it is jaundice.
When the patient is drowsy, has scant yellow urine, and a small, rough pulse, it is often accompanied by poor appetite. When the patient's Cunkou pulse (radial artery at the wrist) and Renying pulse are equal in size and depth-fulness, the ancients believed the disease is difficult to cure. When the Hand Lesser Yin pulse of a woman is distinctly moving, the ancients believed it indicated pregnancy. When an infant's hair stands up in reverse direction, the ancients believed the prognosis was poor; when green-blue vessels are visibly prominent in the ear region, it indicates convulsive pulling pain. When the stool contains reddish mucus, or there is sunshe (diarrhea with undigested food) with 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 into yang; when yang reaches its extreme, it transforms into yin. Therefore, extreme cold generates heat, and extreme heat generates cold—cold and heat mutually transform, which is the change of yin and yang. Thus: injury by cold in winter gives rise to warm-heat disease in spring; injury by wind in spring gives rise to sunshe and intestinal affliction in summer; injury by summer heat 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": judging the nature of pathogenic factors and disease location through the relaxation-tension, size, slipperiness-roughness, cold-heat, moisture-dryness, and firmness-fragility of the forearm skin. Its ideological foundation is inferring the internal from the external—the human body's interior and exterior are connected through the channels and vessels and qi-blood, so internal organ disorders can be reflected in specific external regions. This bears resemblance to modern medicine's observation of skin temperature, elasticity, edema, and color. At the same time, this chapter combines eye examination, blood vessel examination, localized heat areas, and pulse diagnosis, and uses the waxing and waning of yin and yang to explain cold-heat transformation and the sequence of seasonal affliction, reflecting Traditional Chinese Medicine's holistic view.
Objective changes in the temperature, moisture, elasticity, and edema of the forearm skin can indeed provide certain pathological clues, such as rough skin possibly indicating dehydration or malnutrition, or localized fever potentially being associated with inflammation or circulatory changes. However, correlating the various subtle manifestations of the forearm skin with specific organ diseases lacks rigorous evidence-based support and should not be used as a modern diagnostic standard. Claims such as determining the time of death by counting "red vessels reaching the pupil" in the eye, or that an infant with "reversed standing hair will surely die," are ancient experiential judgments without sufficient scientific basis and should be viewed rationally. Seasonal affliction and seasonal diseases have some phenomenological correlation, but the concept of "latent pathogen" cannot be simply equated with modern pathology.
In daily life, one can pay attention to skin moisture and warmth of the extremities, avoiding prolonged residence in cold-damp environments 🌧️. Align daily rhythms with the four seasons—guard against cold in winter, wind in spring, heat in summer, and dampness in autumn. Eat and drink with moderation, avoiding raw and cold foods that may lead to diarrhea. Maintain emotional balance to avoid disharmony of cold and heat. Pregnant women should undergo modern prenatal care, and infants exhibiting abnormal signs should be seen by a doctor promptly, rather than relying on prognostic judgments from ancient texts.
BuGua Note: This content is based on classical Chinese medicine texts and is provided solely for traditional cultural learning and research. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek medical attention promptly if you feel unwell.