平按∶此篇自篇首至末，见《灵枢》卷十一第七十四《论疾诊尺》篇，又见《甲乙经》卷四
第二上编，惟编次小异。
黄帝问于岐伯曰∶余欲无视色持脉，独调其尺，以言其病，从外知内，为之奈何？（无视面
之五色，无持寸口之脉，唯诊尺脉及尺皮肤，帝欲从外知内病生所由。）岐伯答曰∶审其尺之缓急
小大滑涩，肉之坚脆，而病形定矣。（尺之缓急等，谓尺脉及尺皮肤缓、急、小、大、滑、涩六种
别也。肉坚脆者，谓尺分中肉之坚脆也。知此八者，即内病可知也。平按∶注即内病，即字袁刻误
作知。）视人之目果上微痈，如新卧起状，其颈脉动时咳，按其手足上 而不起者，风水肤胀也。
（目果，眼睑也。痈，微肿起也。颈脉，足阳明人迎也。动不以手，按之见其动也。 ，焉蓼反，
深也。不起者，手足肿脉按之久而不起，如按泥也。此为风水肤胀者。平按∶目果《灵枢》作目
窠。《甲乙》无自黄帝问至肤胀也一段。）尺湿以淖泽，风也。（尺分之中有润，故湿也。淖泽，
光泽也。此风之候也。平按∶尺下《灵枢》、《甲乙》有肤字。湿《灵枢》作滑，《甲乙》作温，
注云∶“一作滑。”以《灵枢》作其。）尺肉弱者，解 安卧。（解 ，懈惰也。尺肉 弱者，
身体懈惰而欲安卧。平按∶ 下《甲乙》有也字。）脱肉者，寒热不治。（骨寒热病，羸瘦脱肉，
不可疗也。平按∶《甲乙》热下有也字，无不治二字，注云∶一本下作不治。）尺肤滑泽脂者，
风也。（尺之肤滑而润泽有脂者，内有风也。平
按∶《灵枢》滑下有而字。《甲乙》无滑脂二字，风下有痹字。）尺肤涩者，风痹。（尺肤涩者
内寒，故有风痹也。平按∶《甲乙》无此句。）尺肤粗如枯鱼之鳞者，水 饮也。（ 饮，谓是
甚渴暴饮，水 肠胃之外、皮肤之中，名曰 饮。尺分之肤，粗如鱼鳞者，以为候也。）尺肤热
甚，脉盛躁者，病湿也；（尺分皮肤甚热，其一寸之内，尺脉盛躁，湿病候也。平按∶湿《灵枢》、
《甲乙》作温，根据下编《尺寸诊》云尺热曰病温，应作温，袁刻亦作温。）其脉盛而滑者，汗且
出也。（一寸之内，尺脉盛而滑者，汗将出。平按∶《灵枢》汗作病。）尺肤寒甚，脉小者，泄、
少气也。（尺肤冷、尺脉小者，其病泄利，又少气也。平按∶甚《灵枢》作其。《甲乙》脉小作
脉急，注云∶一作小。）尺肤HT 然先热后寒者，寒热也；（按尺皮肤，先热后冷，病寒热也。平
按∶HT 然《灵枢》作炬然，《甲乙》作烧灸人手四字，注云∶一作炬然。）尺肤先寒，久持之而热
者，亦寒热候者也。（尺皮肤先冷，久持乃热，亦是寒热之病也。平按∶《灵枢》、《甲乙》无
候字。）肘所独热者，腰以上热；（当肘皮肤独热者，即腰以上至头热也。）手所独热者，腰以
下热；肘前独热者，膺前热；（腕以前为手也，手之独热，主腰以下热。从肘向手为肘前，独热
者，主胸前热也。平按∶腰以下《甲乙》作腰以上，注云∶一作下。）肘后独热者，背热；（从肘
向肩为肘后，肘后皮肤热者，主肩背热也。平按∶背上《灵枢》、《甲乙》有肩字。）臂中独热者，
腰腹热；（从肘至腕中间为臂，当臂中央热，腰腹热也。）肘后粗以下三四寸者，腹中有虫。（从
肘后下向臂三四寸许，皮肤粗起，是腹中有虫之候也。 平按∶粗《甲乙》作廉。《灵枢》、《甲乙》
寸下有热字，腹均作肠。）掌中热者，肠中热；掌中寒者，腹中寒。（掌中冷热，主大腹小腹冷
热。平按∶肠《灵枢》、《甲
乙》作腹。）鱼上白肉有青血脉者，胃中有寒。（青脉主寒，故胃中寒。平按∶鱼上《甲乙》作
鱼际。）尺HT 然热人迎大者，当夺血。（尺之皮肤HT 然而热，喉边人迎复大于常者，夺血之候也。
平按∶《甲乙》尺下有肤字。HT 《灵枢》、《甲乙》作炬。）尺坚大，脉小，甚少气 有因加，
立死。（尺之皮肤坚而贲大，寸脉反少，主于少气而 ，若更因加少气 者，立当死也。平按∶甚
下《甲乙》有则字。《灵枢》无因字，有因加《甲乙》作有加者。注反少，根据经文应作反小。）
平按：此篇从篇首到末尾，见于《灵枢》卷十一第七十四《论疾诊尺》篇，又见于《甲乙经》卷四第二上编，只是编排次序略有不同。
黄帝问岐伯说：我想不看面色、不切寸口脉，只通过诊察尺部（前臂内侧从肘横纹至腕横纹的皮肤及脉搏），来推断疾病，由外在表现了解内在病变，该怎么做呢？（即不看面部五色变化，不切寸口脉，仅诊察尺脉及尺肤，这是皇帝想要通过外在征象了解内在病因。）岐伯回答说：仔细审察尺部的缓急、大小、滑涩，以及肌肉的坚脆，那么病形就能确定了。（尺部的缓急等，是指尺脉和尺皮肤呈现缓、急、小、大、滑、涩六种区别。肌肉坚脆，是指尺部区域肌肉的坚硬或脆弱。知晓这八种情况，就能知道内在的疾病了。平按：注文中“即内病”，“即”字在袁刻本中误作“知”。）观察人的眼睑上方微微肿胀，像刚睡醒的样子，颈部人迎脉跳动且时常咳嗽，按压手足背部凹陷处久久不能复原的，是风水肤胀病。（目果，即眼睑。痈，指微肿起。颈脉，指足阳明胃经的人迎穴。动不以手触而知其动，是按之可见其搏动。 ，音焉蓼反，意为深。不起者，指手足浮肿，按压后久不回弹，如同按泥潭一般。这是风水肤胀的表现。平按：《灵枢》中“目果”写作“目窠”。《甲乙经》没有从“黄帝问”到“肤胀也”这一段。）尺部皮肤湿润且有光泽的，是风病。（尺部区域有润泽感，所以称为湿。淖泽，指光泽。这是风病的征候。平按：《灵枢》和《甲乙经》在“尺”下有“肤”字。《灵枢》中“湿”写作“滑”，《甲乙经》写作“温”，注文说：“一作滑。”以《灵枢》版本为准。）尺部肌肉瘦弱的，身体懈惰嗜卧。（解 ，即懈惰。尺肉弱者，指身体懈怠懒惰而想安静躺卧。平按：《甲乙经》在 下有个“也”字。）肌肉消瘦脱落的，属于寒热病，难以治愈。（骨寒热病，身体羸瘦肌肉脱落，不可治疗。平按：《甲乙经》在“热”下有“也”字，没有“不治”二字，注文说：另一版本下作“不治”。）尺部皮肤光滑润泽且有脂膏感的，是风病。（尺部皮肤滑润且有油脂感，说明内有风邪。平按：《灵枢》在“滑”下有“而”字。《甲乙经》没有“滑脂”二字，“风”下有“痹”字。）尺部皮肤粗糙的，是风痹。（尺部皮肤粗糙是因为内有寒邪，所以有风痹。平按：《甲乙经》没有这句话。）尺部皮肤粗糙像枯鱼鳞片一样的，是饮停水气。（ 饮，指极度口渴暴饮，水液停留在肠胃之外、皮肤之中，名叫 饮。尺部的皮肤，粗糙如鱼鳞，以此作为征候。）尺部皮肤非常热，脉象盛大躁动的，是湿病；（尺部分皮肤很热，其中一寸之内，尺脉盛大躁动，这是湿病的征候。平按：“湿”在《灵枢》、《甲乙经》中作“温”，根据下编《尺寸诊》所说“尺热曰病温”，应作“温”，袁刻本也作“温”。）如果脉象盛大而滑利的，汗将要出来。（在一寸之内，尺脉盛大而滑利，表示汗即将排出。平按：《灵枢》中“汗”作“病”。）尺部皮肤非常寒冷，脉象细小的，是泄泻、少气病。（尺部皮肤冷、尺脉细小，其病为泄利，又是少气。平按：“甚”在《灵枢》中作“其”。《甲乙经》中“脉小”作“脉急”，注文说：一作“小”。）尺部皮肤灼热先热后冷的，是寒热病；（按压尺部皮肤，先热后冷，是寒热病。平按：HT然在《灵枢》中作“炬然”，《甲乙经》作“烧灸人手”四字，注文说：一作“炬然”。）尺部皮肤先冷，长时间持按后才热的，也是寒热病的征候。（尺部皮肤先冷，久按才变热，这也是寒热之病。平按：《灵枢》、《甲乙经》没有“候”字。）肘部单独发热的，腰以上发热；（当肘部皮肤单独发热，即腰部以上至头部发热。）手部单独发热的，腰以下发热；肘前单独发热的，胸膺前部发热；（手腕以前称为手，手部单独发热，主司腰以下发热。从肘向手方向为肘前，单独发热者，主司胸前发热。平按：《甲乙经》中“腰以下”作“腰以上”，注文说：一作“下”。）肘后单独发热的，背部发热；（从肘向肩方向为肘后，肘后皮肤发热者，主司肩背发热。平按：《灵枢》、《甲乙经》在“背”上有“肩”字。）手臂中间单独发热的，腰腹部发热；（从肘至腕中间称为臂，当臂中央发热，主司腰腹发热。）肘后下方三四寸处皮肤粗起的，腹中有虫。（从肘后向下至手臂三四寸许，皮肤粗糙突起，是腹中有虫的征候。平按：“粗”在《甲乙经》中作“廉”。《灵枢》、《甲乙经》在“寸”下有“热”字，“腹”均作“肠”。）手掌中心发热的，肠中发热；手掌中心发冷的，腹中寒冷。（掌中冷热，主司大腹小腹冷热。平按：“肠”在《灵枢》、《甲乙经》中作“腹”。）大鱼际上部白色肌肉中有青色血脉的，胃中有寒。（青脉主寒，所以胃中寒。平按：“鱼上”在《甲乙经》中作“鱼际”。）尺部皮肤灼热且人迎脉大的，应当是夺血病。（尺部皮肤灼热，喉边人迎脉又大于常态，是失血的征候。平按：《甲乙经》在“尺”下有“肤”字。HT在《灵枢》、《甲乙经》中作“炬”。）尺部皮肤坚硬膨大，脉象细小，且非常少气并伴有其他症状加重，会立即死亡。（尺部皮肤坚硬而贲张膨大，寸脉反而小，主司少气并伴有其他症状，如果再因加重的少气症状出现，将会立即死亡。平按：“甚”下《甲乙经》有“则”字。《灵枢》无“因”字，“有因加”在《甲乙经》中作“有加者”。注中“反少”，根据经文应作“反小”。）
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.)