闻之精神者。天之分。骨骸者。地之分。属天者。清而散。属地者。浊而聚。是故阳化气。阴成形。精神为阳。骨
骸为阴。且骨者髓之府。髓者骨之充。其候在耳。其主在肾。诊之之法。盛则见其筋骨劲强。衰则见其形容伛
偻。骨损则见其骨痿。不能起床。骨极则见其齿动。不能久立。见于痹。则骨重而难举。见于病。则肢伸而不
屈。其行而振掉。立不能久者。则知骨之将惫。发无润泽。肉不相亲者。则知骨之先亡。及夫头背腰膝之骨。
得强则生。失强则死。此皆骨之形容于外者也。若见其骨。知其病。如灵枢云。颧骨者。骨之本也。颧大则骨
大。颧小则骨小。其形充而颧不起者骨小。骨小则夭矣。然则形充而颧起者骨大。骨大当寿矣。千金云。儿
生枕骨不成者。能言而死。尻骨不成者。能倨而死。掌骨不成者。能匍匐而死。踵骨不成者。能行而死。膑骨
不成者。能立而死。头四破不成人。通身软弱如无骨者。不寿。此亦得强则生。失强则死之谓也。若夫经言
五色之见。各出其色部。部骨陷者。必不免于病。其色部乘袭者。虽病甚不死。则知部骨不陷者。可免于病。
部骨陷而色乘袭者。若病甚则危也。是又合气色骨部而观之也。他如大骨枯槁。大肉陷下。皆为死证者。
以其脾肾绝于内。骨肉消于外。枯槁则皮着。骨陷下则肉消尽也。至于赋禀不齐。骨骸有异。又如本藏篇
所谓赤色小理者。心小。粗理者。心大。无 者。心高。 小短举者。心下。 长者。心坚。 弱小以薄
者。心脆。 直下不举者。心端正。 倚一方者。心偏倾。白色小理者。肺小。粗理者。肺大。巨肩反膺陷喉
者。肺高。合腋张胁者。肺下。好肩背浓者。肺坚。肩背薄者。肺脆。背膺浓者。肺端正。胁偏疏者。肺偏倾。青色小
理者。肝小。粗理者。肝大。广胸反 者。肝高。合胁兔 者。肝下。胸胁好者。肝坚。胸胁弱者。肝脆。膺腹好相得
者。肝端正。胁骨偏举者。肝偏倾。此又骨骸之常也。至若骨之小大多寡。合骨度篇、洗冤录观之。可知其要。
然非诊家之急。故不备录。
听说精神属于天的范畴，骨骸属于地的范畴。归属于天的事物，性质清轻而发散；归属于地的事物，性质重浊而凝聚。因此，阳主化生气化功能，阴主构成形体。精神属于阳，骨骸属于阴。
而且，骨是髓的居所，髓是充盈于骨中的物质。骨的状态反映在耳朵上，其主宰脏腑在肾。诊断骨的方法：如果精气旺盛，就会表现为筋骨强劲有力；如果精气衰败，就会表现为身形佝偻弯曲。骨骼受损，就会表现为骨痿（骨骼软弱无力），不能起床；骨骼极度衰竭，就会表现为牙齿松动，不能久站。如果出现在痹证中，就会感到身体沉重难以抬起；出现在其他疾病中，就会表现为肢体伸展而不能弯曲。如果行走时身体震颤摇晃，站立不能持久，就知道骨骼即将疲惫不堪。如果头发干枯无光泽，肌肉消瘦不与骨骼相亲附，就知道骨骼已经先一步消亡。至于头、背、腰、膝等部位的骨骼，得到强健就能生存，失去强健就会死亡。这些都是骨骼在外部的形态表现。
如果通过观察骨骼能知道病情，正如《灵枢》所说：颧骨是骨骼的根本。颧骨大，则全身骨骼大；颧骨小，则全身骨骼小。如果形体充实但颧骨不突出，说明骨骼小，骨骼小的人寿命短促。然而，如果形体充实且颧骨突出，说明骨骼大，骨骼大的人应当长寿。《千金方》说：婴儿出生时枕骨发育不全的，学会说话后就会死亡；尻骨（尾椎部位）发育不全的，学会蹲坐后就会死亡；掌骨发育不全的，学会爬行后就会死亡；踵骨（脚后跟）发育不全的，学会行走后就会死亡；髌骨（膝盖骨）发育不全的，学会站立后就会死亡。头部有四处分开的缺陷不能成为正常人的，或者通身软弱像没有骨头一样的，都不能长寿。这也是“得强则生，失强则死”的意思。
至于经书所说的五色显现，各自出现在对应的色部。对应部位的骨骼凹陷的，必定难免生病。如果面色与骨部相乘袭（指五行相克或异常色泽覆盖），即使病重也不会死亡。由此可知，如果骨部不凹陷，就可以免于生病；如果骨部凹陷且面色出现乘袭之象，若病情严重就会危险。这又是结合气色和骨部来观察的方法。另外，如大骨枯槁、大肉陷下，都被视为死证，这是因为脾肾之气在内断绝，骨肉在外消损。枯槁意味着皮肤紧贴骨骼，骨陷下意味着肌肉完全消尽。
至于先天禀赋不同，骨骸也有差异。又如同《本藏篇》所说：面色红而纹理细密的，心小；纹理粗大的，心大；无眉（此处原文缺字，据上下文推测为眉或类似特征，通常指眉高或眉形，此处依原文留白处理或指代特定体征，原文作“无 者”，疑为脱文，暂译为“无[特定特征]者”）的，心高；[特定特征]小且短而上举的，心下；[特定特征]长的，心坚；[特定特征]弱小且薄的，心脆；[特定特征]直下不举的，心端正；[特定特征]偏向一方的，心偏倾。面色白而纹理细密的，肺小；纹理粗大的，肺大；肩膀巨大、胸廓反张、喉结凹陷的，肺高；腋下合拢、胁肋张开的，肺下；喜欢肩背厚实的，肺坚；肩背薄弱的，肺脆；背部和胸膺厚实的，肺端正；胁肋偏斜疏朗的，肺偏倾。面色青而纹理细密的，肝小；纹理粗大的，肝大；胸廓宽阔、肋骨反张的，肝高；胁肋合拢、肋骨像兔子一样外突的，肝下；胸胁部位发育良好的，肝坚；胸胁虚弱的，肝脆；胸腹配合协调的，肝端正；胁骨偏斜突出的，肝偏倾。这些又是骨骸的一般规律。至于骨骼的大小多少，结合《骨度篇》和《洗冤录》来观察，可以了解其要点。但这并非诊家的当务之急，所以不再详细记录。
It is heard that spirit and mind (Jingshen) belong to the domain of Heaven, while bones and skeletons (Guhai) belong to the domain of Earth. That which belongs to Heaven is clear and diffuse; that which belongs to Earth is turbid and condensed. Therefore, Yang transforms into Qi (vital energy), and Yin forms into structure. Spirit and mind are Yang, while bones and skeletons are Yin.
Furthermore, bones are the mansion of marrow (Sui), and marrow fills the bones. The manifestation of bone health is observed in the ears, and its governing organ is the Kidney (Shen). The method of diagnosing bones is as follows: when vigorous, it manifests as strong and rigid sinews and bones; when declining, it manifests as a stooped and hunched appearance. If bones are damaged, it manifests as bone萎 (Guwei - bone atrophy/weakness), making it impossible to rise from bed. If bones are extremely depleted, it manifests as loose teeth, making it impossible to stand for long periods. If seen in Bi syndrome (Obstruction syndrome), it manifests as heavy bones difficult to lift; if seen in other diseases, it manifests as limbs extended but unable to flex. If walking involves trembling and shaking, and standing cannot be maintained for long, one knows that the bones are about to become exhausted. If hair lacks luster and moisture, and muscles do not adhere closely to the bones, one knows that the bones have perished first. Regarding the bones of the head, back, waist, and knees, gaining strength leads to life, losing strength leads to death. These are all the external manifestations of bones.
If observing bones allows one to know the disease, as stated in the *Ling Shu* (Spiritual Pivot): The zygomatic bone (Quan gu) is the root of the skeletal system. A large zygoma indicates large bones; a small zygoma indicates small bones. If the body is full but the zygoma does not protrude, the bones are small, and those with small bones will die young. However, if the body is full and the zygoma protrudes, the bones are large, and those with large bones should live long. The *Qian Jin Fang* states: Infants born with an incompletely formed occipital bone (Zhen gu) will die after learning to speak; those with an incompletely formed sacral/coccygeal bone (Kao gu) will die after learning to sit upright; those with incompletely formed palmar bones (Zhang gu) will die after learning to crawl; those with incompletely formed calcaneal bones (Zhong gu) will die after learning to walk; those with incompletely formed patellar bones (Bin gu) will die after learning to stand. Those with four cranial defects preventing normal formation, or those whose entire bodies are soft as if lacking bones, will not enjoy longevity. This is also what is meant by "gaining strength leads to life, losing strength leads to death."
As for the classics stating that the five colors appear in their respective regions, if the bone in the corresponding region is depressed, illness is inevitable. If the color overlaps or attacks the region (Chengxi - pathological interaction of colors), even severe illness may not be fatal. Thus, if the bone region is not depressed, illness can be avoided. If the bone region is depressed and the color shows signs of Chengxi, severe illness becomes critical. This is another method of combining Qi, color, and bone regions for observation. Additionally, great bones being withered and great muscles collapsing are considered death omens, because the Spleen and Kidney qi are severed internally, and flesh and bone dissipate externally. Withering means the skin adheres to the bones; depression of bones means the flesh has completely wasted away.
Regarding innate endowment, bones and skeletons vary. As mentioned in the *Ben Cang* chapter: Red complexion with fine texture indicates a small Heart; coarse texture indicates a large Heart; [missing character] indicates a high Heart; [missing character] small and short/elevated indicates a low Heart; [missing character] long indicates a firm Heart; [missing character] weak/small and thin indicates a fragile Heart; [missing character] straight down without elevation indicates an upright Heart; [missing character] leaning to one side indicates a tilted Heart. White complexion with fine texture indicates a small Lung; coarse texture indicates a large Lung; large shoulders, reversed chest, and depressed throat indicate a high Lung; closed armpits and spread ribs indicate a low Lung; preference for thick shoulders and back indicates a firm Lung; thin shoulders and back indicate a fragile Lung; thick back and chest indicate an upright Lung; slanted and sparse ribs indicate a tilted Lung. Blue/Green complexion with fine texture indicates a small Liver; coarse texture indicates a large Liver; broad chest and reversed ribs indicate a high Liver; closed ribs and rabbit-like protruding ribs indicate a low Liver; good development of chest and ribs indicates a firm Liver; weak chest and ribs indicate a fragile Liver; harmonious relationship between chest and abdomen indicates an upright Liver; slanted and elevated rib bones indicate a tilted Liver. These are the general rules of bones and skeletons. As for the size and quantity of bones, referring to the *Gu Du* (Bone Dimensions) chapter and *Xi Yuan Lu* (Washing Away Wrongful Records) allows one to grasp the essentials. However, this is not urgent for diagnosticians, so it is not recorded in detail.