Lingshu · Discussing Illness by Examining the Forearm

The text

The Yellow Emperor asked Qi Bo: I wish, without looking at color or holding the pulse, to assess the forearm alone, and thereby speak of the illness — to know the inside from the outside. How is this done? Qi Bo said: Examine the slackness and tightness, the smallness and largeness, the slipperiness and astringency, of the forearm, and the firmness and brittleness of the flesh — and the form of the illness is then settled. Look at the person's eye-sockets: a slight swelling as if newly risen from sleep; the neck vessels moving; coughing at times; press the backs of the hands and feet, and they stay dented and do not rise — this is wind-water, the skin swollen. If the skin of the forearm is slippery and moist-glossy, it is wind. If the flesh of the forearm is weak, it is slack-weariness; if one lies at ease and the flesh is lost, it is cold and heat, and is not treated. If the skin of the forearm is slippery and glossy as if oiled, it is wind. If the skin of the forearm is astringent, it is wind-impediment. If the skin of the forearm is coarse like the scales of a dried fish, it is overflowing water-rheum. If the skin of the forearm is very hot and the pulse is abundant and restless, the illness is warmth. If the pulse is abundant and slippery, the illness is about to go out. If the skin of the forearm is cold and the pulse is small, it is discharge and little qi. If the skin of the forearm is torch-like, first hot then cold, it is cold and heat. If the skin of the forearm is first cold, and after a long holding grows hot, it is also cold and heat. If the elbow alone is hot, there is heat above the waist. If the hand alone is hot, there is heat below the waist. If the front of the elbow alone is hot, there is heat in front of the chest. If the back of the elbow alone is hot, there is heat in the shoulder and back. If the middle of the arm alone is hot, there is heat in the waist and abdomen. If from the coarse part behind the elbow downward three or four inches is hot, there are worms 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 the white flesh above the thenar has green blood vessels, there is cold in the stomach. If the forearm is torch-hot and renying is large, blood is about to be seized. If the forearm is hard and large and the pulse is extremely small, little qi and tightness increasing — death at once. If the eye is red, the illness is in the heart; white, in the lung; green, in the liver; yellow, in the spleen; black, in the kidney. If the yellow cannot be named, the illness is in the chest. In examining pain of the eye: red vessels from above downward are a taiyang illness; from below upward, a yangming illness; from without running inward, a shaoyang illness. In examining cold and heat: red vessels running up and down to the pupil — see one vessel, death in one year; see one vessel and a half, death in a year and a half; see two vessels, death in two years; see two vessels and a half, death in two years and a half; see three vessels, death in three years. In examining the pain of decayed teeth: press the coming of yang; where there is excess, that place alone is hot — on the left, heat on the left; on the right, heat on the right; above, heat above; below, heat below. In examining the blood vessels: much red, much heat; much green, much pain; much black is long impediment. If much red, much black, and much green are all seen, it is cold and heat and pain of the body. If the complexion is slightly yellow, the teeth stained yellow, the nails yellow above — it is yellow-dan. If one lies at ease, the urine is yellow-red, the pulse small and astringent — there is no relish for food. If a person is ill and the pulse at the inch-opening and the pulse at renying are equal in smallness and largeness, and also equal in floating and sinking, the illness is hard to finish. If a woman's hand shaoyin pulse moves strongly, she is with child. If an infant is ill and the hair of the head all runs against and upward, death is certain. If a green vessel rises between the ears, there is tugging pain. If the stool is red-clotted with undigested diarrhea, and the pulse is small, the hands and feet are cold and it is hard to finish. Undigested diarrhea, the pulse small, the hands and feet warm — the discharge is easy to finish. The change of the four seasons, the overcoming of cold and heat: doubled yin must become yang; doubled yang must become yin. Thus yin governs cold, yang governs heat. Thus when cold is severe there is heat; when heat is severe there is cold. Therefore it is said: cold gives birth to heat, heat gives birth to cold — this is the change of yin and yang. Therefore it is said: injured by cold in winter, in spring there arises dan-heat. Injured by wind in spring, in summer there arises undigested diarrhea and intestinal flush. Injured by summer-heat in summer, in autumn there arises intermittent heat. Injured by damp in autumn, in winter there arises coughing. This is called the sequence of the four seasons.

The line

Qi Bo said: Examine the slackness and tightness, the smallness and largeness, the slipperiness and astringency, of the forearm, and the firmness and brittleness of the flesh — and the form of the illness is then settled.

The note

Without looking at color or holding the pulse, only assess the forearm. The skin of the chi is a person reduced to one foot. To know the inside from the outside, sometimes this one foot of skin is still willing to speak.