身轻，自能转侧者可治。沉重，不能转侧者难治。足冷恶寒，蜷卧向壁，为阴
证。阳病者，不能俯，阴病者，不能仰。身目齿爪俱黄者，疸病也。脾病者，色黄
而肉蠕动。肺病者，色白而毛败。头重视身，此天柱骨倒也，死。摇头，以手扪腮
者，齿痛也。坐而伏者，短气也。身汗如油，形体不仁，乍静乍乱，喘而不休者，
死。肉形脱者，脉虽调，亦死。皮肤润泽者生，枯燥者死。皮肤着者死。（皮肤枯燥着
骨也。）
手足冷，名厥。在伤寒则有寒有热。初病即手足冷者，直中寒证也。爪甲青冷，
或过肘膝，且常冷。若先发热，以渐入内，而手足乃冷者，传经热证也。爪甲红，
乍冷乍温，不过肘膝，此仲景之说也。在杂证，则手足冷者名寒厥，手足热者名热
厥，此《内经》之说也。详厥逆门。但足冷，手不冷，身发热者，为外感夹阴，宜
五积散。不可汗下及小柴胡，以有黄芩苦寒也。又夏暑病湿温，人必足冷手温，
多汗妄语，宜苍术白虎合五苓，不可用五积助热。有两手逆冷，而两足热如火烙者，
此阴气衰于下，（则阳下乘之而足热。）阳气衰于上，则阴上干而手冷。阴阳痞隔之兆也。若初起
而脚膝 弱，或足胫赤热肿痛，当从香港脚治之。手足冷至节，而心痛甚者，名真心
痛，旦发夕死。循衣摸床，撮空理线，扬手掷足，此神去而魂乱也，死。坐而下一
脚者，腰痛也。（坐久腰痛，故下一脚以伸之。）行迟者，表强也。（风邪束其筋络，
故步履不随。）肝热
者，色苍而爪枯。搐搦者，肝邪也。搐，抽搐，手足频频伸缩也。搦，十指频频开
合，拳紧握也。（经曰∶肝病变动为握。）螈 者，虚而有风也。（螈，筋脉收引。 ，筋脉弛
纵。）脉急
者，尺之皮肤亦急。（急，紧急也。）脉缓者，尺之皮肤亦缓。（缓，纵缓也。）脉小者，尺之皮
肤亦减而少气。脉大者，尺之皮肤亦贲（音忿，大而沸起也）而起。脉滑者，尺之皮肤
亦滑。脉涩者，尺之皮肤亦涩。尺肤滑而泽脂者，风也。（热风鼓其血液外见，故滑泽。）尺肤
涩者，风痹也。（血少则内热，热则生风。）尺肤粗，如枯鱼之鳞者，水 （同溢）饮也。（脾
土衰而肌
肉消，水反乘之也。）尺肤热甚，脉盛燥者，温病也。尺肤寒甚，脉小者，泄、少气。掌中
热者胸中热，寒者胸中寒。（掌中为三阴脉所聚，其脏皆在胸中。）臂多青脉，曰脱血。（张景岳
云∶血脱则气去寒凝，故色见青黑，言臂则他可知，即诊尺之义。愚按此说，乃血脱后方见青脉
也。然有先见青脉
而后脱血者，则气虚寒凝，不能摄血耳。）
身体轻便，能够自行翻转侧卧的，属于可治之症。身体沉重，无法翻转侧卧的，属于难治之症。足部寒冷且恶寒，蜷缩身体面向墙壁躺卧，这是阴证的表现。阳病（阳经受邪的病证）患者，身体不能前俯；阴病（阴经受邪的病证）患者，身体不能后仰。全身、眼睛、牙齿和指甲都发黄，这是疸病（黄疸）。脾脏病变的人，面色发黄且肌肉跳动。肺脏病变的人，面色发白且毛发枯败。头重脚轻，感觉头部支撑不住身体，这是天柱骨（指脊柱上部及颈部支撑力）倒伏的表现，预后不良，主死。摇头并用手抚摸腮部的，是牙痛所致。坐着时身体前倾伏案的，是短气（呼吸短促）的表现。身体出汗如油，形体麻木不仁，时而安静时而躁乱，喘息不止的，预后不良，主死。肌肉严重消瘦脱失的，即使脉象调和，也预后不良，主死。皮肤润泽的有生机，干枯的预后不良，主死。皮肤干枯紧贴骨骼的预后不良，主死。（所谓皮肤着骨，是指皮肤极度干枯紧贴骨头。）
手足寒冷，称为厥逆。在伤寒病中，既有寒厥也有热厥。发病初期即出现手足寒冷的，是直中寒证（寒邪直接侵犯脏腑经络）。如果爪甲青紫冰冷，或者寒冷超过肘部和膝盖，并且持续寒冷，这是寒证。若先有发热，随后热邪逐渐传入体内，导致手足变冷的，是传经热证（热邪由表入里传变至他经）。爪甲红润，手足忽冷忽热，寒冷不超过肘膝，这是张仲景所说的热厥表现。在杂病中，手足寒冷称为寒厥，手足发热称为热厥，这是《黄帝内经》的说法。详细内容请参见“厥逆”章节。但如果仅足部寒冷而手部不冷，且身体发热，这是外感夹阴（外感病兼有肾阳不足或阴寒内盛），适宜使用五积散。不可使用发汗、攻下法及小柴胡汤，因为小柴胡汤中含有黄芩，性味苦寒。另外，夏季暑湿病中的湿温证，患者必然足冷手温，多汗且胡言乱语，适宜用苍术白虎汤合五苓散治疗，不可使用五积散以免助热。如果有两手逆冷，而两足热如火烙的情况，这是因为下部阴气衰微（则阳气下乘占据下部导致足热），上部阳气衰微（则阴气上干占据上部导致手冷），这是阴阳痞隔（阴阳之气不相交通阻隔）的先兆。如果在初起时就出现脚膝软弱无力，或者足胫部赤红、发热、肿痛，应当从香港脚（脚气病）来治疗。手足寒冷达到关节，且心痛剧烈的，称为真心痛，早晨发作晚上死亡，或晚上发作早晨死亡。循衣摸床（手指无意识地抓摸衣物和床沿）、撮空理线（手指在空中虚抓似理线状）、扬手掷足（手脚挥舞挣扎），这是神气离去而魂志混乱的表现，预后不良，主死。坐着时垂下一只脚的，是腰痛。（久坐导致腰痛，所以垂下一只脚以舒展腰部。）行走迟缓的，是表强（体表筋脉拘急僵硬）。（风邪束缚其筋络，所以步履不灵活。）肝脏有热的人，面色青苍且指甲枯槁。抽搐痉挛的，是肝邪作祟。搐，指抽搐，手足频繁伸缩。搦，指十指频繁开合，拳头紧握。（《内经》说：肝病变动表现为握拳。）螈（yáo yè，指肢体抽搐），是虚证兼有风邪。（螈，指筋脉收缩牵引；爧，指筋脉弛缓纵伸。）脉搏紧急的，尺部（手腕内侧高骨后方尺泽穴以下的皮肤）的皮肤也紧急。（紧急，指紧张有力。）脉搏缓和的，尺部的皮肤也缓和。（缓和，指松弛舒缓。）脉搏细小的，尺部的皮肤也显得薄弱且少气。脉搏洪大的，尺部的皮肤也贲起（音忿，指大而沸起隆起的样子）且隆起。脉搏滑利的，尺部的皮肤也滑利。脉搏涩滞的，尺部的皮肤也涩滞。尺部皮肤滑润且有油脂光泽的，是风邪。（热风鼓动血液外现，所以滑润。）尺部皮肤涩滞的，是风痹。（血少则内生热，热则生风。）尺部皮肤粗糙，像枯鱼的鳞片一样的，是水饮溢满体内。（脾土衰败而肌肉消减，水湿反而乘虚侵袭。）尺部皮肤非常热，脉搏盛大燥数的，是温病。尺部皮肤非常寒冷，脉搏细小的，是泄泻、少气。手掌中心发热的，胸中也热；手掌中心发冷的，胸中也冷。（手掌中心是三阴脉汇聚之处，其对应的脏腑都在胸中。）手臂上有很多青色脉络的，称为脱血。（张景岳说：血脱则气去寒凝，所以颜色呈现青黑，说到手臂，其他部位也就可知了，这也就是诊察尺肤的意义。我认为这种说法，是在血脱之后才见到青脉的。然而也有先见到青脉而后发生血脱的，那是气虚寒凝，不能统摄血液的缘故。）
The body is light and agile, capable of turning over independently; this indicates a treatable condition. The body is heavy and stiff, incapable of turning over; this indicates a difficult-to-treat condition. Cold feet with aversion to cold, curling up in bed facing the wall, characterizes Yin Syndrome (a syndrome characterized by internal excess of Yin-cold). In Yang diseases (diseases affecting Yang meridians or characterized by hyperactive Yang-heat), patients cannot bend forward; in Yin diseases, patients cannot lie on their backs. Yellowing of the whole body, eyes, teeth, and nails indicates Jaundice Disease (Huangdan). Spleen disease manifests as yellowish complexion and twitching muscles. Lung disease manifests as pale complexion and brittle hair. A heavy head with blurred vision indicates collapse of the Tianzhu Bone (cervical vertebrae supporting the head and neck); this is a fatal sign. Shaking the head and touching the cheeks with hands indicates toothache. Sitting while leaning forward indicates Shortness of Breath (Duanqi). Sweating like oil, numbness of the body, alternating between quietness and restlessness, and unceasing panting indicate a fatal prognosis. Emaciation and loss of muscle mass indicate death, even if the pulse appears harmonious. Lustrous skin indicates survival; dry and rough skin indicates death. Skin adhering tightly to the bones indicates death. (Skin adhering to bones refers to extreme dryness where the skin clings tightly to the skeleton.)
Cold hands and feet are termed Jue Ni (Reversal Cold). In Shanghan (Cold Damage) diseases, there are both Cold Jue and Heat Jue. If hands and feet are cold from the onset, it is Direct Invasion Cold Syndrome (Zhi Zhong Han Zheng, where cold pathogen directly invades organs and meridians). Cyanotic and cold fingernails, or cold extending beyond elbows and knees, persistently cold. If fever occurs first, gradually transmitting inward before hands and feet become cold, it is Transmitted Meridian Heat Syndrome (Chuan Jing Re Zheng, heat transmitted from exterior to interior). Reddish fingernails, with hands and feet alternating between cold and warm, not exceeding elbows and knees, follows Zhang Zhongjing's theory. In miscellaneous diseases, cold hands and feet are named Cold Jue, and hot hands and feet are named Heat Jue, following the Nei Jing. See the "Jue Ni" section for details. However, if only feet are cold while hands are not, accompanied by body fever, it is External Contraction with Internal Yin (Wai Gan Jia Yin, external contraction complicated by internal Yin-cold), suitable for Wu Ji San. Diaphoresis, purgation, and Xiao Chai Hu Tang should be avoided due to the bitter-cold nature of Huang Qin (Scutellariae Radix). Furthermore, in summer heat-dampness diseases such as Wen Wen (Warm-Dampness), patients inevitably have cold feet and warm hands, profuse sweating, and delirious speech. Cang Zhu Bai Hu Tang combined with Wu Ling San is suitable; Wu Ji San should not be used as it aids heat. If both hands are reversely cold while both feet are hot as if branded, this indicates deficiency of Yin Qi below (leading to Yang Qi descending and causing foot heat) and deficiency of Yang Qi above (leading to Yin Qi ascending and causing hand cold). This is a sign of Yin-Yang Pi Ge (obstruction/blockage between Yin and Yang). If initially the legs and knees are weak, or the shins are red, hot, painful, and swollen, it should be treated as Hong Xiang Jiao (Foot Qi disease/Jamaican Itch). Cold hands and feet extending to the joints with severe heart pain is named Zhen Xin Tong (True Heart Pain), fatal if occurring in the morning and dying in the evening. Grasping at clothes and bedclothes (Xun Yi Mo Chuang), picking at empty air as if arranging threads (Cuo Kong Li Xian), waving hands and kicking feet (Yang Shou Zhi Zu) indicate that the Shen (Spirit) has departed and Hun (Ethereal Soul) is chaotic; this is fatal. Sitting with one leg hanging down indicates Lower Back Pain (Yao Tong). (Sitting for long periods causes back pain, so one leg is lowered to stretch the tendons.) Slow walking indicates Exterior Stiffness (Biao Qiang). (Wind pathogen binds the sinews and collaterals, causing uncoordinated gait.) Liver Heat manifests as dark green/cyan complexion and withered nails. Twitching and spasms indicate Liver Pathogen involvement. "Chu" refers to convulsions, frequent extension and flexion of hands and feet. "Nuo" refers to frequent opening and closing of ten fingers, tight fist clenching. (The Classics state: Liver disease changes manifest as grasping/clenching.) Chi Zong (spasmodic jerking with alternating contraction and relaxation of muscles) indicates deficiency with Wind. (Chi refers to tendon contraction; Zong refers to tendon relaxation.) An urgent pulse corresponds to urgent skin at the Cun position. (Urgent means tense and forceful.) A slow/relaxed pulse corresponds to relaxed skin at the Cun position. (Relaxed means loose and slack.) A small pulse corresponds to diminished Qi and thin skin at the Cun position. A large pulse corresponds to bulging and raised skin at the Cun position. A slippery pulse corresponds to slippery skin at the Cun position. A choppy pulse corresponds to choppy skin at the Cun position. Smooth and lustrous skin at the Cun position indicates Wind. (Hot wind agitates blood to the surface, causing smoothness and luster.) Rough skin at the Cun position indicates Feng Bi (Wind-Bi obstruction). (Blood deficiency leads to internal heat, which generates wind.) Rough skin at the Cun position, resembling scales of a dead fish, indicates Water Yin Overflow (Shui Yi Yin). (Spleen Earth declines and muscles waste away; water dampness overcomes the deficiency.) Very hot skin at the Cun position with a vigorous and dry pulse indicates Wen Bing (Warm Disease). Very cold skin at the Cun position with a small pulse indicates Diarrhea and Qi Deficiency. Heat in the center of the palm indicates heat in the chest; cold in the center of the palm indicates cold in the chest. (The center of the palm is the convergence point of three Yin meridians, corresponding to organs within the chest.) Many blue veins on the arms indicate Blood Loss (Tuo Xue). (Zhang Jingyue stated: When blood is lost, Qi departs and cold coagulates, resulting in cyan/black coloration. What applies to the arms applies elsewhere, which is the principle of inspecting Cun skin. I observe that this view suggests blue veins appear after blood loss. However, there are cases where blue veins appear prior to blood loss; this is due to Qi deficiency and cold coagulation failing to control the blood.)