诸本无篇字。
独调其尺 马云。邪气脏腑病形篇曰。脉急者。尺之皮肤亦急。脉缓者。尺之皮肤亦缓。脉小
者。尺之皮肤亦减而少气。脉大者。尺之皮肤亦贲而起。脉滑者。尺之皮肤亦滑。脉涩者。尺之皮肤亦涩。故
善调尺者。不待于寸。盖脉在内。肉在外。内外相应。故审其脉。验其肉。而病形自定也。愚谓诊人脉时。惟
臂至尺泽可验。难以周身知之。故止以尺言也。
视人之目窠上（止）风水肤胀也 马云。痈、壅同。 、窈同。张云。目窠、目下卧蚕处也。痈、壅也。
即新起微肿状。颈脉、人迎脉也。 而不起。按之有窝也。是即风水肤胀之外候。风水义见评热病论。肤胀义
见水胀篇。简案、此一节。与诊尺之义不相干。疑是他篇错简。
尺肤滑其淖泽者 志云。津液淖泽于皮肤。故尺肤滑其淖泽者。知风在于皮肤。而鼓动其津液也。
解 甲乙。 下有也字。张云。尺肉弱者。肌必消瘦。肉瘦阴虚。当为解 。解 者。身体因倦。
故欲安卧。简案、安卧下句。
安卧脱肉者寒热不治 简案、安卧脱肉。为阴阳亏败。乃寒热虚劳之候也。故不治。诸注恐非。
泽脂 马云。润泽如脂膏者。真为风也。张云。即前淖泽之谓。风者阳气。阳在肌肤。故滑而泽脂。
尺肤涩者 张云。尺肤涩者血少。血不能营。故为风痹。
水 饮也 脉经。 、作淡。张云。如枯鱼之鳞。干
涩甚也。以脾土衰而肌肉消。水得乘之。是为 饮。又邪气脏腑病形篇云。肝脉涩甚为溢饮。 饮同。
尺肤热甚（止）病且出也 脉经。甲乙。病且、作汗且。张云。尺肤热者。其身必热。脉盛躁者。阳
邪有余。故当为温病。若脉虽盛而兼滑者。是脉已不躁。而正气将复。故不久当愈。出、渐愈之谓。简案、病
且作汗且。义尤通。
尺肤寒者 甲乙。其、作甚。小、作急。张云。肤寒脉小。阳气衰也。故为泄为少气。
尺肤炬然（止）亦寒热也 脉经。炬、作 。甲乙。炬然、作烧炙人手四字。脉经。甲乙。久大、作
久持。张云。炬然、火热貌。或先热而后寒。或先寒而后热。皆寒热往来之候。简案、集韵。炬、束苇烧也。
肘所独热者（止）胃中有寒 甲乙。肘后粗、作肘后廉。马云。人之手自曲池以上为肘。自曲池以下
为臂。肘在上。应腰以上。手臂在下。应腰以下。张云。肘、臂 之节也。肘前、内廉也。手三阴之所行。故
应于膺前。肘后、外廉也。手太阳之所行。故应于肩背。肘下为臂。臂在下故应腰腹。肘后粗以下三四寸。谓
三里以下。内关以上之所。此阴分也。阴分有热。故应肠中有虫。掌中者三阴之所聚。故或热或寒。皆应于腹
中鱼上。脉青胃之寒也。经脉篇亦曰。胃中寒。手鱼之脉多青矣。志云。肘所独热者。腰以上热。手所独热者。
腰以下热。此诊尺肤以候形身之上下。故与脉候之上下。反其诊也。肘前乃手厥阴之尺泽处。肘后乃手少阳之
天井处。盖以两手下垂。上以候上。下以候下。前以候前。后以候后也。夫所谓肘所手所者。论手臂之背面。
臂中掌中鱼上。乃手臂之正面。背面为阳。故候形身之外。正面主阴。故候腰腹肠胃之内。即尺外以候季胁。
尺里以候腹中之大义（出脉要精微论）
相同也。简案、手所。即下文所谓臂中肘后独热者。肩背热。此乃与上文肘所独热者。腰以上热义相同。而肘
后粗以下三四寸。乃上文手所之地。后乃应背面。而云肠中有虫。则似与上文所指上下前后相乖错可疑。经脉
篇云。胃中寒。手鱼之脉多青矣。
尺炬然热（止）立死 甲乙。脉经。作尺肤 然热。志云。尺炬然热。人迎大者。三阳之气偏盛也。故当
主夺血。夫皮肤为阳。血脉为阴。尺坚大脉小甚者。阳盛而阴绝于外也。少气 有加者。阳盛而阴绝于内也。
简案、脉经作尺紧人迎脉小甚则少气。色白有加者立死。此盖与尺炬然热者相反。阳绝之候。
目赤色者（止）病在胸中 张云。五脏六腑。目为之候。故目之五色。各以其气而见本脏之病。脾应中州。
胸中者。脾肺之部也。志云。前节视目窠以知皮肤之水。此节视目色以知五脏之阴。皆从外以知内也。胸中、
膈中也。黄色不可名者。色黄而有黑白青赤之间色也。病在胸中者。五脏之气。皆从内膈而出。故所见之色若是。
诊目痛（止）少阳病 张云。足太阳经为目上纲。（出经筋篇）故赤脉从上下者。为太阳病。足阳明经
为目下纲。（出经筋篇）故赤脉从下上者。为阳明病。足少阳经外行于锐 之后。故从外走内者。为少阳病也。
诊寒热（止）三岁死 张云。此邪入阴分。而病为寒热者。当反其目以视之。中有赤脉。形如红线。下贯
瞳于。因其多少。以知其死之远近也。寒热篇文与此同。但彼专言瘰 之毒发为寒热。此节单以寒热为言。理
则同也。
诊龋齿（止）在上下热 张云。齿痛曰龋。上齿属手阳明大肠经。下齿属足阳明胃经。故按其阳脉之来
有过者。必为
独热。其脉在左右上下。则病热亦分左右上下也。张云。其脉太过者。其经必独热。
诊血脉（止）皆见者寒热 志云。此以皮部之色。而知血脉之寒热也。皮部论曰。凡十二经脉者。皮
之部也。其色多青则痛。多黑则痹。黄赤则热。多白则寒。五色皆见。则寒热也。
身痛面色微黄（止）不嗜食 马云。平人气象论云。溺黄赤。安卧者黄胆。已食如饥者胃疸。张云。
黄胆、黄病也。疸有阴阳。脉小而涩者为阴疸。阴疸者。脾土弱也。故不嗜食。
人病（止）病难已也 张云。气口候阴。人迎候阳。故春夏人迎微大。秋冬寸口微大。此阴阳表里之
分也。若寸口人迎。大小浮沉相等者。非偏于阴。则偏于阳。此病之所以难已。五色篇与此稍同。
女子手少阴脉动甚者妊子 马云。此与平人气象论所云相同。简案、王注平人气象云。盖指心经
之脉。即神门穴也。其说甚善。马张为左寸。志为两手之少阴肾脉。并非古之义也。马又以妊之为男子。亦误。
婴儿病（止）必死 马云。头毛逆上。则血枯而不润。如草之枯者相似。故以死拟之。然曰病。则无
病之时。尤宜忌也。志云。婴儿者。始生之儿。婴儿之头毛。从先天而生。毛发者血之余。少阴精血之所生也。
发复下垂。以应人之血气。从下而升。复从巅而下。若发上逆。是惟升而无降矣。升降息。故不免于死亡。千
金云。小儿发逆上。啼哭面暗色不变。是痫候。
耳间青脉起者掣痛 脉经。掣、作 。甲乙作 腹痛。张云。耳者少阳胆之经。青者厥阴肝之色。
肝胆本为表里。
青主痛。肝主筋。故为掣痛。马云。为身中牵掣而痛也。简案、千金云。耳后完骨上有青络盛。卧不静。是痫
候。青脉刺之。令血出也。以此推之。掣、 通。掣痛谓掣 。腹痛即痫病之候也。
大便亦辨（止）泄易已 脉经。甲乙。赤、作青。甲乙泄易已之泄。作者字。并是。马云。办、按海
篇。瓣、得苋切。瓜瓠瓣。则赤辨当作瓣。张云。赤办者。血秽成条成片也。赤办飧泄。火居血分。若脉小而
手足寒。是为相反。所以难已。若止于飧泄而无赤办。非火证也。脉虽小而手足温。以脾主四肢。而脾气尚和。
所以易已。办、当作瓣。瓜瓣之类也。简案、赤、作青。为是。盖小儿有便青乳瓣完出者。即青瓣也。此虚寒
之候。故手足寒难已。瓣、说文。瓜中实也。当据马注而改之。志云。辨别也。大便亦辨者。谓黄赤之间别也。
义难通。
四时之变（止）谓四时之序也 马云。此节与素问阴阳应象大论。第九节大义相同。张云。阴阳之气。
极则必变。故寒极则生热。热极则生寒。此天地四时消长更胜之道也。瘅、音丹。即温热之病。
各版本均无“篇”字。
单独调治尺肤（前臂内侧从腕横纹到肘横纹的皮肤）。马云说：《邪气脏腑病形》篇中说，脉象紧急的，尺肤也紧张；脉象缓软的，尺肤也缓软；脉象细小的，尺肤也减薄且少气；脉象大的，尺肤也充盛隆起；脉象滑利的，尺肤也滑利；脉象涩滞的，尺肤也涩滞。所以善于调治尺肤的人，不需要依赖寸口脉。因为脉在内，肌肉在外，内外相应，所以审察其脉象，验证其肌肉状态，而病形自然确定。我认为诊察人脉时，只有从手臂到尺泽穴处可以验证，难以通过全身来知晓，所以只以尺肤而言。
观察人眼下眼睑微肿（止），是风水肤胀病。马云说：“痈”与“壅”同义，“䐜”与“窈”同义。张云说：目窠就是眼下卧蚕的地方。“痈”、“壅”是指新起的轻微肿胀状。“颈脉”即人迎脉。如果按之不起，留有凹陷，这就是风水肤胀的外部征候。“风水”的含义见《评热病论》，“肤胀”的含义见《水胀》篇。简案：这一节，与诊察尺肤的意义不相干，怀疑是其他篇章的错简。
尺肤滑润且光泽润泽的。志云：津液在皮肤上滑润光泽，所以尺肤滑润光泽的，知道风邪在皮肤，并鼓动其津液。
解㑊（身体倦怠无力）。《甲乙经》下有个“也”字。张云说：尺肉弱的，肌肉必定消瘦，肉瘦则阴虚，应当出现解㑊的症状。解㑊，就是身体疲倦，所以想要安卧。简案：安卧下面的句子。
安卧且肌肉脱失的是寒热病，难以治疗。简案：安卧且肌肉脱失，是阴阳亏败，这是寒热虚劳的征候，所以难以治疗。诸家注释恐怕不对。
润泽如脂膏的。马云说：润泽如脂膏的，确实是风邪。张云说：就是前面所说的淖泽。风是阳气，阳在肌肤，所以滑润而像脂膏。
尺肤涩滞的。张云说：尺肤涩滞的是血少，血不能营养，所以为风痹。
水䐜（水饮停聚）。《脉经》说：“䐜”通作“淡”。张云说：像枯鱼的鳞片，非常干燥涩滞。因为脾土衰弱而肌肉消损，水湿得以乘虚而入，这就叫水䐜。又《邪气脏腑病形》篇说：肝脉涩甚为溢饮，“䐜饮”同义。
尺肤很热（止），病将要向外发散痊愈了。《脉经》、《甲乙经》中，“病且”写作“汗且”。张云说：尺肤热的，身体必然发热，脉象盛大躁动的，是阳邪有余，所以应当是温病。如果脉象虽然盛大但兼有滑象，说明脉已不躁动，而正气将要恢复，所以不久当痊愈。“出”，是逐渐痊愈的意思。简案：“病且”作“汗且”，意义尤其通顺。
尺肤寒冷的。《甲乙经》中，“其”作“甚”，“小”作“急”。张云说：肤寒脉小，是阳气衰微，所以为泄泻和少气。
尺肤灼热如火烧（止），也是寒热病。《脉经》中，“炬”作“燔”。《甲乙经》中，“炬然”作“烧炙人手”四字。《脉经》、《甲乙经》中，“久大”作“久持”。张云说：炬然，是火热的样子。或者先热后寒，或者先寒后热，都是寒热往来的征候。简案：《集韵》说：炬，是捆扎芦苇燃烧。
肘部单独发热的（止），胃中有寒。《甲乙经》中，“肘后粗”作“肘后廉”。马云说：人的手从曲池穴以上称为肘，从曲池穴以下称为臂。肘在上，对应腰以上；手臂在下，对应腰以下。张云说：肘、臂是关节之处。肘前，是内侧面，是手三阴经所行，所以对应胸膺前部。肘后，是外侧面，是手太阳经所行，所以对应肩背部。肘下为臂，臂在下所以对应腰腹部。肘后粗糙部位以下三四寸，谓三里穴以下、内关穴以上的区域，这是阴分。阴分有热，所以对应肠中有虫。手掌大鱼际处是三阴经汇聚的地方，所以或热或寒，都对应腹中。鱼际上脉色青，是胃寒的表现。《经脉》篇也说：胃中寒，手鱼部的脉多青色。志云：肘部单独发热，是腰以上热；手部单独发热，是腰以下热。这是通过诊察尺肤来候察形体身段的上下，所以与脉候察上下相反。肘前乃是手厥阴心包经的尺泽穴处，肘后乃是手少阳三焦经的天井穴处。大概是让两手下垂，上以候上，下以候下，前以候前，后以候后。所谓肘部、手部，是论述手臂的背面。臂中、掌中鱼际处，乃手臂的正面。背面为阳，所以候察形体身段的外侧；正面主阴，所以候察腰腹肠胃之内。即尺外侧以候季胁，尺内侧以候腹中的大义（出自《脉要精微论》）相同。简案：手部，即下文所说的臂中肘后单独发热的地方，肩背热，这与上文肘部单独发热、腰以上热的意义相同，而肘后粗糙部位以下三四寸，乃是上文手部的地域，后面却对应背面，而说肠中有虫，则似乎与上文所指上下前后相乖错可疑。《经脉》篇说：胃中寒，手鱼部的脉多青色。
尺肤灼热如火烧（止），立即死亡。《甲乙经》、《脉经》作“尺肤燔然热”。志云：尺肤灼热，人迎脉大的，是三阳之气偏盛，所以应当主夺血。因为皮肤为阳，血脉为阴，尺肤坚硬大脉小的严重情况，是阳盛而阴绝于外。少气如果有加重的，是阳盛而阴绝于内。简案：《脉经》作“尺紧人迎脉小甚则少气，色白有加者立死”。这大概与尺肤灼热者相反，是阳绝的征候。
眼睛颜色红的（止），病在胸中。张云说：五脏六腑，眼睛是其征候，所以眼睛的五种颜色，各自以其气而显现本脏的病。脾对应中州。胸中，是脾肺的部位。志云：前节通过观察目窠来知晓皮肤的水气，本节通过观察目色来知晓五脏的阴气，都是从外部来知晓内部。胸中，即膈中。黄色无法命名的，是色黄而有黑白青赤之间色。病在胸中，是五脏之气，都从内膈而出，所以所见之色如此。
诊察目痛（止），少阳病。张云说：足太阳膀胱经为目上纲（出自《经筋》篇），所以赤脉从上往下的，为太阳病。足阳明胃经为目下纲（出自《经筋》篇），所以赤脉从下往上的，为阳明病。足少阳胆经外行于锐眦之后，所以从外向内的，为少阳病。
诊察寒热（止），三岁死。张云说：这是邪气进入阴分，而病为寒热的，应当反过来观察眼睛。其中有赤脉，形状像红线，向下贯穿瞳孔。根据其多少，来知道死亡的远近。《寒热》篇的文字与此相同，但那篇专门谈论瘰疬毒发为寒热，本节单以寒热而言，道理则是相同的。
诊察龋齿（止），在上下热。张云说：齿痛叫做龋。上齿属于手阳明大肠经，下齿属于足阳明胃经，所以按其阳脉的到来有过盛的，必定是单独发热。其脉在左右上下，那么病热也分左右上下。张云说：其脉太过盛的，其经必定单独发热。
诊察血脉（止），都出现的为寒热。志云：这是通过皮部的颜色，来知晓血脉的寒热。《皮部论》说：凡是十二经脉，是皮肤的部位。其色多青则痛，多黑则痹，黄赤则热，多白则寒，五色都出现，则是寒热病。
身体疼痛面色微黄（止），不喜欢进食。马云说：《平人气象论》说：尿黄赤，安卧的是黄疸，已食如饥的是胃疸。张云说：黄疸，即黄病。疸有阴阳，脉小而涩的是阴疸，阴疸是脾土弱，所以不喜欢进食。
人患病（止），病难愈。张云说：气口候阴，人迎候阳，所以春夏人迎脉微大，秋冬寸口脉微大，这是阴阳表里的分别。如果寸口和人迎，大小浮沉相等，不是偏于阴，就是偏于阳，这就是病之所以难愈的原因。《五色》篇与此稍有相同。
女子手少阴脉动甚者，怀孕生子。马云说：这与《平人气象论》所说相同。简案：王注《平人气象论》说：大概指心经之脉，即神门穴。这种说法很好。马、张认为是左寸，志认为是两手之少阴肾脉，并不是古义。马又认为妊之是男子，也是错误的。
婴儿患病（止），必死。马云说：头毛逆上，则血枯而不润，像草枯萎一样，所以断定为死。然而说是病，那么在无病之时，尤其应当忌讳。志云：婴儿，是初生的孩子。婴儿的头毛，从先天而生。毛发是血的余绪，是少阴精血所生。头发下垂，以应人的血气，从下上升，再从头顶而下。如果头发上逆，是只有升而没有降了。升降停止，所以不免于死亡。《千金方》说：小儿头发逆上，啼哭面色暗不变，是痫证的征候。
耳间有青脉起的牵引痛。《脉经》中，“掣”作“𢘆”。《甲乙经》作“腹痛”。张云说：耳朵是少阳胆经，青是厥阴肝的颜色。肝胆本来互为表里，青主痛，肝主筋，所以为牵引痛。马云说：为身体中牵掣而痛。简案：《千金方》说：耳后完骨上有青络盛，卧不安静，是痫证征候。青脉刺之，令血出。以此推断，“掣”与“𢘆”通假，“掣痛”谓“𢘆痛”。“腹痛”即痫病的征候。
大便也有辨别（止），泄泻容易好。《脉经》、《甲乙经》中，“赤”作“青”。《甲乙经》“泄易已”的“泄”作“作者字”，都是对的。马云说：“办”，查《海篇》，“瓣”，音得苋切，瓜瓠瓣，那么“赤辨”当作“瓣”。张云说：赤瓣，是血秽成条成片。赤瓣飧泄，火居血分，如果脉小而手足寒，是为相反，所以难愈。如果只是飧泄而没有赤瓣，不是火证。脉虽小而手足温，因为脾主四肢，而脾气尚和，所以容易好。“办”，当作“瓣”，瓜瓣之类。简案：“赤”作“青”，是对的。大概小儿有大便青乳瓣完出的，即青瓣，这是虚寒的征候，所以手足寒难愈。“瓣”，《说文》：瓜中实也。应当依据马注而改。志云：辨别。大便亦辨，是说黄赤之间的分别。意义难通。
四时的变化（止），叫做四时的次序。马云说：这一节与《素问·阴阳应象大论》第九节大义相同。张云说：阴阳之气，极则必变，所以寒极则生热，热极则生寒，这是天地四时消长更胜的道理。“瘅”，音丹，即温热病。
All versions lack the character "Pian" (Chapter).
[Regarding] exclusively regulating the Chi skin (skin on the anterior aspect of the forearm from the wrist crease to the elbow crease). Ma Yun says: In the chapter *Xieqi Zangfu Bingxing* (Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations), it is stated: When the pulse is tight, the Chi skin is also tight; when the pulse is slow, the Chi skin is also lax; when the pulse is small, the Chi skin is also diminished and Qi is deficient; when the pulse is large, the Chi skin is also bulging and raised; when the pulse is slippery, the Chi skin is also slippery; when the pulse is choppy, the Chi skin is also rough. Therefore, one who excels in regulating the Chi skin does not need to rely on the Cun (radial) pulse. Because the vessels are internal and the flesh is external, they correspond internally and externally. Thus, by examining the pulse and verifying the state of the flesh, the disease manifestation becomes clear. I believe that when diagnosing the human pulse, verification can only be done from the arm to the Chize acupoint (LU-5); it is difficult to know through the whole body. Hence, it is referred to only as Chi.
Observing slight swelling above the eye sockets indicates Fengshui Fuzhang (Wind-water edema). Ma Yun says: "Yong" is synonymous with "Yong" (blockage/swelling), and "Dan" is synonymous with "Yao". Zhang Yun says: The eye socket refers to the area below the eyes where silkworm-like swelling occurs. "Yong" and "Yong" refer to a newly arisen slight swelling. The "Neck vessel" refers to the Renying acupoint (ST-9). If pressing leaves no indentation, this is an external sign of Fengshui Fuzhang. The meaning of "Fengshui" is seen in *Ping Re Bing Lun* (Discussion on Fever Diseases), and the meaning of "Fuzhang" is seen in *Shui Zhang Pian* (Chapter on Water Swelling). Brief Note: This section is unrelated to the significance of diagnosing the Chi skin; it is suspected to be a misplaced text from another chapter.
When the Chi skin is smooth and glossy: Zhi Yun says: Body fluids are glossy on the skin. Therefore, if the Chi skin is smooth and glossy, it indicates that Wind pathogen is in the skin, stirring up its body fluids.
Jie Xie (Body fatigue and weakness): *Jia Yi Jing* adds the character "Ye" at the end. Zhang Yun says: If the flesh of the Chi area is weak, the muscles must be emaciated. Emaciation indicates Yin deficiency, leading to Jie Xie. Jie Xie means the body feels tired, hence the desire to lie down quietly. Brief Note: The sentence following "lying down quietly".
Lying down quietly accompanied by muscle wasting indicates Cold-Heat disorder, which is difficult to treat. Brief Note: Lying down quietly with muscle wasting indicates the depletion of Yin and Yang, representing a sign of Cold-Heat consumptive disorder; thus, it is difficult to treat. The annotations by various commentators are likely incorrect.
Glossy like fat/grease: Ma Yun says: Glossy like fat/grease truly indicates Wind pathogen. Zhang Yun says: This refers to the previously mentioned "Nao Ze" (glossiness). Wind is Yang Qi; since Yang is in the skin and flesh, it is smooth and glossy like fat.
When the Chi skin is rough: Zhang Yun says: Roughness of the Chi skin indicates blood deficiency. Blood fails to nourish, resulting in Feng Bi (Wind Bi syndrome).
Shui Dan (Water retention/drink): *Mai Jing* states: "Dan" is written as "Dan". Zhang Yun says: Like the scales of a dried fish, extremely dry and rough. Due to the decline of Spleen Earth and emaciation of muscles, Water takes advantage of this, called Shui Dan. Also, *Xieqi Zangfu Bingxing Pian* states: A very choppy Liver pulse indicates Yi Yin (overflowing drink); "Dan Yin" is the same.
When the Chi skin is very hot, the disease will emerge (recover). *Mai Jing* and *Jia Yi Jing*: "Bing Qie" is written as "Han Qie" (sweat will come). Zhang Yun says: If the Chi skin is hot, the body must be hot. A large and restless pulse indicates excess Yang pathogen, so it should be a Wenbing (Warm disease). If the pulse is large but also slippery, the pulse is no longer restless, and Zheng Qi (Upright Qi) is about to recover, so recovery will occur soon. "Chu" (emerge) means gradual recovery. Brief Note: Writing "Bing Qie" as "Han Qie" makes the meaning even more coherent.
When the Chi skin is cold: *Jia Yi Jing*: "Qi" is written as "Shen" (very), "Xiao" is written as "Ji" (urgent/tight). Zhang Yun says: Cold skin and small pulse indicate decline of Yang Qi, resulting in diarrhea and shortness of breath.
When the Chi skin is burning hot, it is also a Cold-Heat disorder. *Mai Jing*: "Ju" is written as "Fan". *Jia Yi Jing*: "Ju Ran" is written as four characters "burning roasting hand person". *Mai Jing*, *Jia Yi Jing*: "Jiu Da" is written as "Jiu Chi" (holding for a long time). Zhang Yun says: "Ju Ran" describes a fiery appearance. It may be heat first then cold, or cold first then heat; all are signs of alternating Cold and Heat. Brief Note: *Ji Yun* states: "Ju" means burning bundled reeds.
If only the elbow is hot, there is Cold in the Stomach. *Jia Yi Jing*: "Zhou Hou Cu" is written as "Zhou Hou Lian" (edge of the back of the elbow). Ma Yun says: The part of the hand above Quchi (LI-11) is called the elbow; below Quchi is the arm. The elbow is upper, corresponding to above the waist; the arm is lower, corresponding to below the waist. Zhang Yun says: The elbow and arm are joints. The front of the elbow is the medial side, where the Three Hand-Yin meridians run, corresponding to the anterior chest. The back of the elbow is the lateral side, where the Hand-Taiyang meridian runs, corresponding to the shoulder and back. Below the elbow is the arm; being lower, it corresponds to the waist and abdomen. The three to four cun below the rough part of the back of the elbow refers to the area below Sanli (ST-36) and above Neiguan (PC-6), which is the Yin portion. Heat in the Yin portion corresponds to worms in the intestines. The Thenar eminence (Yu area) is where the Three Yin meridians gather, so it may be hot or cold, both corresponding to the interior of the abdomen. Blue veins on the Yu area indicate Cold in the Stomach. *Jingmai Pian* also states: Cold in the Stomach results in many blue veins in the hand Yu area. Zhi Yun says: Exclusive heat in the elbow indicates heat above the waist; exclusive heat in the hand indicates heat below the waist. This diagnoses the upper and lower parts of the body via the Chi skin, which is opposite to diagnosing the upper and lower parts via the pulse. The front of the elbow is the location of Chize (LU-5) of the Hand-Jueyin pericardium; the back of the elbow is the location of Tianjing (TE-10) of the Hand-Shaoyang sanjiao. Generally, letting the hands hang down allows the upper to diagnose the upper, the lower to diagnose the lower, the front to diagnose the front, and the back to diagnose the back. What is meant by elbow and hand refers to the dorsal aspect of the arm. The middle of the arm and the Yu area of the palm are the ventral aspect. The dorsal aspect is Yang, so it diagnoses the exterior of the body; the ventral aspect governs Yin, so it diagnoses the interior of the waist, abdomen, and intestines. That is, the outer Chi diagnoses the hypochondrium, and the inner Chi diagnoses the abdomen, which is the great principle (from *Mai Yao Jingwei Lun*). Brief Note: "Hand" refers to what is mentioned later as exclusive heat in the arm and elbow back, and shoulder/back heat. This has the same meaning as the previous section (exclusive elbow heat, heat above the waist). However, the three to four cun below the rough part of the elbow back is the region of the hand mentioned earlier, yet it corresponds to the back and mentions worms in the intestines, which seems inconsistent with the upper/lower/front/back indications mentioned earlier. *Jingmai Pian* states: Cold in the Stomach results in many blue veins in the hand Yu area.
If the Chi skin is burning hot and the Renying pulse is large, death will occur immediately. *Jia Yi Jing*, *Mai Jing*: Written as "Chi skin Fan Ran Re". Zhi Yun says: Burning hot Chi skin with a large Renying pulse indicates excessive dominance of the Three Yang Qi, leading to Blood loss. Since skin is Yang and blood vessels are Yin, firm and large Chi skin with a very small pulse indicates Yang excess and Yin exhaustion on the exterior. Shortness of breath with worsening indicates Yang excess and Yin exhaustion on the interior. Brief Note: *Mai Jing* writes: "Chi tight, Renying pulse very small leads to shortness of breath; color white with worsening leads to immediate death." This is contrary to the burning hot Chi skin case, representing a sign of Yang exhaustion.
Red eyes indicate disease in the Chest. Zhang Yun says: The five Zang and six Fu organs have the eyes as their indicators. Thus, the five colors of the eyes manifest the diseases of their respective organs according to their Qi. Spleen corresponds to the Central Region. The Chest is the region of the Spleen and Lung. Zhi Yun says: The previous section used the eye sockets to know skin water; this section uses eye color to know the Yin of the five Zang organs, both knowing the interior from the exterior. The Chest is the Diaphragm center. Yellow that cannot be named refers to yellow mixed with black, white, green, or red intermediate colors. Disease in the Chest means the Qi of the five Zang organs emerges from the internal diaphragm, hence the observed colors are like this.
Diagnosing eye pain indicates Shaoyang disease. Zhang Yun says: The Foot-Taiyang bladder meridian is the upper lid (from *Jingjin Pian*), so red veins going from top to bottom indicate Taiyang disease. The Foot-Yangming stomach meridian is the lower lid (from *Jingjin Pian*), so red veins going from bottom to top indicate Yangming disease. The Foot-Shaoyang gallbladder meridian runs externally behind the outer canthus, so red veins moving from outside to inside indicate Shaoyang disease.
Diagnosing Cold-Heat indicates death in three years. Zhang Yun says: This is pathogen entering the Yin portion, causing Cold-Heat. One should examine the eyes inversely. Red veins resembling red lines penetrating downward through the pupil indicate the proximity of death based on their quantity. The text in *Han Re Pian* is the same, but that chapter specifically discusses scrofula toxins causing Cold-Heat, while this section speaks solely of Cold-Heat; the principle is the same.
Diagnosing toothache indicates heat in the upper and lower parts. Zhang Yun says: Toothache is called Qu. Upper teeth belong to the Hand-Yangming Large Intestine meridian; lower teeth belong to the Foot-Yangming Stomach meridian. Therefore, palpating the Yang pulses for excess indicates exclusive heat. If the pulse is in the left/right/upper/lower positions, the heat disease also corresponds to left/right/upper/lower. Zhang Yun says: If the pulse is excessive, the meridian must be exclusively hot.
Diagnosing blood vessels indicates Cold-Heat if all are seen. Zhi Yun says: This knows the Cold-Heat of blood vessels by the color of the skin portions. *Pi Bu Lun* states: All twelve meridians are portions of the skin. Many blue indicates pain; many black indicates Bi obstruction; yellow/red indicates heat; many white indicates cold; seeing all five colors indicates Cold-Heat disease.
Body pain, slightly yellow complexion, and anorexia. Ma Yun says: *Pingren Qixiang Lun* states: Yellow urine and lying down indicate Huangdan (Jaundice); feeling hungry after eating indicates Weidan (Stomach Jaundice). Zhang Yun says: Huangdan is Yellow Disease. Dan has Yin and Yang types. Small and choppy pulse indicates Yin Dan, which is weak Spleen Earth, hence anorexia.
Human illness indicates the disease is difficult to resolve. Zhang Yun says: Qikou diagnoses Yin, Renying diagnoses Yang. Thus, in Spring and Summer, Renying is slightly larger; in Autumn and Winter, Cun Kou is slightly larger. This is the distinction of Yin/Yang and Interior/Exterior. If Cun Kou and Renying are equal in size, floating/sinking, it is either biased toward Yin or Yang; this is why the disease is difficult to resolve. *Wuse Pian* is slightly similar.
In women, if the Hand-Shaoyin pulse moves vigorously, she is pregnant. Ma Yun says: This is consistent with *Pingren Qixiang Lun*. Brief Note: Wang's annotation on *Pingren Qixiang Lun* says: It likely refers to the Heart meridian pulse, i.e., Shenmen acupoint (HT-7). This explanation is excellent. Ma and Zhang consider it the Left Cun; Zhi considers it the Hand-Shaoyin Kidney pulse on both hands, which is not the ancient meaning. Ma also incorrectly states that pregnancy implies a male child.
Infant illness indicates certain death. Ma Yun says: Hair growing upward indicates blood depletion and lack of moisture, similar withered grass; thus, it is predicted as death. However, since it is called illness, one should especially avoid this when healthy. Zhi Yun says: An infant is a newborn. Infant hair grows from congenital sources. Hair is the surplus of blood, generated by Shaoyin Essence-Blood. Hair hangs down, corresponding to human Qi and Blood rising from below and descending from the crown. If hair grows upward, there is only ascending without descending. When ascending and descending cease, death is inevitable. *Qianjin Fang* states: Children with upward-growing hair, crying with dark unchanged complexion, show signs of epilepsy.
Blue veins appearing between the ears cause pulling pain. *Mai Jing*: "Che" is written as "Xian". *Jia Yi Jing* writes "Abdominal Pain". Zhang Yun says: The ear belongs to the Shaoyang Gallbladder meridian; blue is the color of Jueyin Liver. Liver and Gallbladder are interior-exterior partners. Blue indicates pain; Liver governs sinews, hence pulling pain. Ma Yun says: Pulling pain throughout the body. Brief Note: *Qianjin Fang* states: Prominent blue collaterals behind the ear at Wanggu indicate restlessness during sleep, a sign of epilepsy. Pricking blue veins to bleed. Inferring from this, "Che" and "Xian" are interchangeable. "Che Tong" refers to "Xian Tong". "Abdominal pain" is a sign of epilepsy.
Stool also has distinctions; diarrhea is easy to cure. *Mai Jing*, *Jia Yi Jing*: "Chi" is written as "Qing". In *Jia Yi Jing*, "Xie Yi Yi" (diarrhea is easy to cure), "Xie" is written as "Zuo Zhe Zi", both are correct. Ma Yun says: "Ban", checking *Hai Pian*, "Ban" (petal/segment), sound De Xian Qie, Gua Hu Ban (gourd segment), then "Chi Bian" should be written as "Ban". Zhang Yun says: Chi Ban refers to blood impurities forming strips or pieces. Chi Ban Sun Xie (diarrhea with undigested food and bloody segments), Fire resides in the Blood portion. If the pulse is small and hands/feet are cold, it is contradictory, hence difficult to cure. If there is only Sun Xie without Chi Ban, it is not a Fire syndrome. If the pulse is small but hands/feet are warm, since Spleen governs the four limbs and Spleen Qi is still harmonious, it is easy to cure. "Ban" should be written as "Ban", like melon seeds. Brief Note: Writing "Chi" as "Qing" is correct. Probably infants have stool with Qing Ru Ban (green milk curds) completely excreted, i.e., Qing Ban. This is a deficiency-cold sign, hence cold hands/feet make it difficult to cure. "Ban", *Shuo Wen*: The solid part inside a melon. Should be corrected according to Ma's annotation. Zhi Yun says: Distinguish. "Da Bian Yi Bian" means distinguishing between yellow and red. The meaning is hard to understand.
Changes of the Four Seasons are called the order of the Four Seasons. Ma Yun says: This section has the same great principle as Section 9 of *Suwen: Yin Yang Ying Xiang Da Lun*. Zhang Yun says: Yin and Yang Qi, when extreme, must change; thus, extreme cold generates heat, and extreme heat generates cold. This is the way of waxing and waning among the Four Seasons of Heaven and Earth. "Dan" sounds like Dan, referring to Warm-Heat disease.