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Ping An: This chapter, from the beginning to the end, is found in *Ling Shu* (Spiritual Pivot), Volume XI, Chapter 74 "Discourse on Diagnosing Diseases by Observing the Forearm," and also in *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion), Volume IV, Part II Upper Compilation, with only slight differences in arrangement.

Huang Di asked Qi Bo: I wish to diagnose without observing facial colors or holding the Cun Kou pulse, but solely by adjusting/observing the Chi region (the forearm skin and pulse), to speak of the disease and know the interior from the exterior. How should this be done? (Meaning: Without observing the five colors of the face, and without holding the Cun Kou pulse, only diagnosing the Chi pulse and Chi skin, the Emperor wishes to understand the origin of internal diseases from external signs.) Qi Bo answered: Carefully examine the tension (slow/tight), size, and texture (slippery/choppy) of the Chi region, as well as the firmness or fragility of the flesh, and the disease manifestations will be determined. (The tension etc. of the Chi refers to six distinctions of the Chi pulse and Chi skin: slow, tight, small, large, slippery, choppy. Firmness or fragility of flesh refers to the firmness or fragility of the flesh in the Chi area. Knowing these eight aspects allows one to know the internal disease. Ping An: In the commentary, "ji nei bing" (then internal disease), the character "ji" was erroneously printed as "zhi" in Yuan's edition.) Observe if the upper eyelids are slightly swollen, resembling the state after just waking up; if the Ren Ying pulse at the neck is pulsating and there is frequent coughing; and if pressing the dorsum of the hands and feet leaves an indentation that does not rebound quickly, this is Feng Shui Fu Zhang (Wind-Water Skin Distension). (Mu Guo refers to the eyelids. Yong here means slight swelling. Jing Mai refers to the Ren Ying acupoint of the Foot-Yangming Stomach Meridian. Pulsation is visible upon pressing, not merely felt by hand. , pronounced 'yan liao', means deep. Bu qi refers to edema where pressing the hands and feet for a long time fails to restore the shape, like pressing mud. This indicates Wind-Water Skin Distension. Ping An: *Ling Shu* writes "Mu Ke" instead of "Mu Guo". *Jia Yi Jing* lacks the section from "Huang Di asked" to "Fu Zhang ye".) If the Chi skin is moist and glossy, it indicates Wind pathogen. (Moisture in the Chi area implies dampness. Nao Ze refers to glossiness. This is a sign of Wind. Ping An: *Ling Shu* and *Jia Yi Jing* have the character "Fu" (skin) after "Chi". *Ling Shu* writes "Hua" (slippery) instead of "Shi" (wet); *Jia Yi Jing* writes "Wen" (warm), with commentary stating "one version writes slippery." Based on *Ling Shu*, it is considered correct.) If the Chi flesh is weak, it indicates Xie Dai An Wo (Lethargy and desire to lie down). (Xie Dai means lethargy. Weak Chi flesh indicates bodily lethargy and a desire to rest quietly. Ping An: *Jia Yi Jing* adds the character "Ye" after .) If flesh is wasted away, it indicates Han Re (Cold-Heat) disease which is untreatable. (Bone Cold-Heat disease with emaciation and wasting flesh cannot be cured. Ping An: *Jia Yi Jing* has "Ye" after "Re", and lacks "Bu Zhi" (untreatable); commentary states another version has "Bu Zhi" at the end.) If the Chi skin is smooth, glossy, and fatty, it indicates Wind pathogen. (Smooth, glossy, and oily Chi skin indicates internal Wind. Ping An: *Ling Shu* has "Er" (and) after "Hua". *Jia Yi Jing* lacks "Hua Zhi" (smooth and fatty); "Bi" (obstruction) follows "Feng".) If the Chi skin is rough, it indicates Feng Bi (Wind-Bi Syndrome). (Rough Chi skin indicates internal cold, hence Wind-Bi. Ping An: *Jia Yi Jing* lacks this sentence.) If the Chi skin is rough like dried fish scales, it indicates Yin Yin (Water Retention/Drunkenness). (Yin Yin refers to excessive thirst and drinking, where water stays outside the intestines/stomach but within the skin, named Yin Yin. Rough, scale-like Chi skin serves as a sign.) If the Chi skin is very hot and the pulse is vigorous and restless, it is Shi Bing (Dampness Disease); (Very hot Chi skin, with a vigorous and restless Chi pulse within one cun, is a sign of Dampness. Ping An: "Shi" is written as "Wen" in *Ling Shu* and *Jia Yi Jing*. Based on the lower compilation *Chi Cun Zhen* saying "Chi heat indicates Wen disease," it should be "Wen"; Yuan's edition also uses "Wen".) If the pulse is vigorous and slippery, sweat will soon appear. (Within one cun, a vigorous and slippery Chi pulse indicates impending sweating. Ping An: *Ling Shu* writes "Bing" (disease) instead of "Han" (sweat).) If the Chi skin is very cold and the pulse is small, it indicates Xie (Diarrhea) and Shao Qi (Deficiency of Qi). (Cold Chi skin and small Chi pulse indicate diarrhea and Qi deficiency. Ping An: "Shen" (very) is written as "Qi" in *Ling Shu*. *Jia Yi Jing* writes "Mai Ji" (pulse urgent) instead of "Mai Xiao" (pulse small); commentary states one version is "Xiao".) If the Chi skin is scorching hot then becomes cold, it indicates Han Re (Cold-Heat) disease; (Pressing the Chi skin reveals heat followed by cold, indicating Cold-Heat disease. Ping An: HT Ran is written as "Ju Ran" in *Ling Shu*; *Jia Yi Jing* writes "Shao Jiu Ren Shou" (four characters meaning burning/moxa on human hand); commentary states one version is "Ju Ran".) If the Chi skin is initially cold and becomes hot after prolonged holding, it is also a sign of Han Re disease. (Initially cold Chi skin becoming hot after long pressure is also a Cold-Heat condition. Ping An: *Ling Shu* and *Jia Yi Jing* lack the character "Hou".) If only the elbow is hot, the upper body (waist and above) is hot; (Isolated heat at the elbow indicates heat from the waist up to the head.) If only the hand is hot, the lower body (waist and below) is hot; Isolated heat at the front of the elbow indicates heat in the anterior chest; (The part before the wrist is called the hand; isolated heat in the hand corresponds to lower body heat. The direction from elbow to hand is the front of the elbow; isolated heat here corresponds to anterior chest heat. Ping An: *Jia Yi Jing* writes "Waist Above" instead of "Waist Below"; commentary states one version is "Below".) If only the back of the elbow is hot, the back is hot; (The direction from elbow to shoulder is the back of the elbow; heat here corresponds to shoulder/back heat. Ping An: *Ling Shu* and *Jia Yi Jing* add "Jian" (shoulder) before "Bei" (back).) If only the middle of the arm is hot, the waist and abdomen are hot; (The middle between elbow and wrist is the arm; heat here corresponds to waist/abdominal heat.) If the skin is coarse and raised three to four cun below the back of the elbow, there are parasites in the abdomen. (Coarse, raised skin three to four cun down from the elbow indicates abdominal parasites. Ping An: "Cu" (coarse) is written as "Lian" in *Jia Yi Jing*. *Ling Shu* and *Jia Yi Jing* add "Re" (heat) after "Cun"; "Fu" (abdomen) is written as "Chang" (intestine).) Heat in the center of the palm indicates heat in the intestines; cold in the center of the palm indicates cold in the abdomen. (Palm heat/cold corresponds to upper/lower abdominal heat/cold. Ping An: "Chang" is written as "Fu" in *Ling Shu* and *Jia Yi Jing*.) Blue blood vessels on the white flesh above the Thenar eminence indicate cold in the stomach. (Blue vessels indicate cold, hence stomach cold. Ping An: "Yu Shang" is written as "Yu Ji" in *Jia Yi Jing*.) If the Chi skin is scorching hot and the Ren Ying pulse is large, it indicates Duo Xue (Blood Loss/Depletion). (Scorching Chi skin combined with an enlarged Ren Ying pulse at the throat indicates blood depletion. Ping An: *Jia Yi Jing* adds "Fu" (skin) after "Chi". HT is written as "Ju" in *Ling Shu* and *Jia Yi Jing*.) If the Chi skin is hard and distended, the pulse is small, and there is severe Qi deficiency compounded by other factors, death will occur immediately. (Hard and distended Chi skin with a surprisingly small Cun pulse indicates Qi deficiency and other symptoms; if further aggravated by Qi deficiency, death is imminent. Ping An: *Jia Yi Jing* adds "Ze" after "Shen". *Ling Shu* lacks "Yin"; "You Yin Jia" is written as "You Jia Zhe" in *Jia Yi Jing*. Commentary notes "Fan Shao" should be "Fan Xiao" based on the text.)