肾气通于耳，肾和、则耳能知五音矣。又心开窍于耳，耳藏精于心。（《内经》。）
少阳之经入于耳，故伤寒以耳聋时眩欲呕，脉弦细数者，
为少阳经病，是热菀津耗，三焦气结，不升降也。
耳中策策痛，而耳叶黄者，病名黄耳，类伤寒也。风入于肾，卒然发热恶寒，脊强背急如痉状。（《医
通》。按∶湿热下结于肾也。）
耳叶焦枯，如受尘垢者，病在骨。（《内经》。）
肝之华在爪，爪为筋之余。（《内经》。）
肝热者，色苍而爪枯。肝绝者，爪甲青而怒骂不休。（《内经》、《脉经》。）
肝应爪，爪浓色黄者，（色谓爪下血色。）胆浓。爪薄色红者，胆薄。爪坚色青者，胆急。爪濡
色赤者，胆缓。爪直色白、无约者，胆直。爪恶色黑多纹者，胆结也。（《内经》。）
身黄、目黄、爪甲黄者，疸也。爪甲青者，厥也。（《内经》、《脉经》。）
手太阴气绝，爪枯毛折。（《内经》。）
循衣撮空，心虚败证也。若执持有力者，内实也，宜清之泄之。（石顽。）
按∶爪内应筋，爪之枯润，可以占津液之虚实也。至于
爪下之血色，亦与面色同法。按之不散，与散而久不复聚者，血死之征也。
凡痛，按之痛剧者，血实也；按之痛止者，气虚血燥也；按之痛减，而中有一点不快者，虚中挟实也。
内痛外快为内实外虚，外痛内快为外实内虚也。按之不可得者阴痹也，按之酸疼者，寒湿在筋也。（石顽。）
凡按之，其血不散，与散而久不复聚者，血已死也；散而聚之速者，热也；聚之迟者，气滞与寒湿也。（添加。）
水胀者，足胫肿，腹乃大，以手按其腹，随手而起，如裹水之状。肤胀者，风寒客于皮肤， 然而不坚，
腹大身尽肿，按其腹， 而不起，腹色不变。鼓胀者，腹胀身大，与肤胀等，色苍黄，腹筋起也。（筋即
脉也。血与水相杂，而汁变坏也。《内经》。）
风湿相搏，骨节烦疼，不得屈伸，近之则痛剧，汗出短气恶风，或身微肿者，甘草附子汤主之。（近见一
病，饮食倍增，身肤加肥，惟骨节皮肤疼痛不能转侧，其皮肤虽以一指轻点之，亦即痛剧不可
耐矣，即此病也。仲景。）
凡身热，按之皮毛之分而热重，按久之不热者，热在表、在肺，又为劳倦之虚热也。（以热之微甚分虚实。）
按至肌肉血脉之分而热轻，重按之俱不见者，热在中焦、在心脾、在血分，邪已入里也。按至筋骨之分而
热者，为阴虚骨蒸，与湿热深入骨髓也。热病内陷于骨者，为肝肾阴绝也。（东垣。）
肌之滑涩，以征津液之盛衰；理之疏密，以征营卫之强弱；肉之坚 ，以征胃气之虚实；筋之粗细，以
征肝血之充馁；骨之大小，以征肾气之勇怯；爪之刚柔，以征胆液之清浊；指之肥瘦，以征经气之荣枯；掌
之浓薄，以征脏气之丰歉；尺之寒热，以征表里之阴阳。论疾诊尺篇论之详矣。前
卷形诊中，生形病形诸篇，多有以摩按得之者，不复琐具，可互观也。
肾气通达于耳，肾气调和，则耳朵能辨别五音。另外，心开窍于耳，耳中精气藏于心。（出自《黄帝内经》。）
少阳经的经脉进入耳中，所以伤寒病中出现耳聋、时而眩晕、想呕吐，脉象弦细数的，属于少阳经受邪的病证，这是热邪郁结、津液耗伤，导致三焦气机阻滞，升降失常所致。
耳朵里感到刺痛，且耳廓发黄的，病名叫做“黄耳”，症状类似伤寒。风邪侵入肾脏，突然发热恶寒，脊柱僵硬、背部拘急，像痉病一样。（出自《医宗金鉴·医学入门》，按语：这是湿热下注结聚于肾的缘故。）
耳廓干枯焦黑，像沾满灰尘污垢的样子，说明病位在骨骼。（出自《黄帝内经》。）
肝的精气外华表现在爪甲，爪甲是筋的余气所生。（出自《黄帝内经》。）
肝有热邪的人，面色青苍而爪甲枯槁。肝气绝的人，爪甲发青且愤怒骂人不止。（出自《黄帝内经》、《脉经》。）
肝对应爪甲，爪甲厚而颜色黄的，（黄色指指甲下的血色。）说明胆气浓盛。爪甲薄而颜色红的，说明胆气薄弱。爪甲坚硬而颜色青的，说明胆气急躁。爪甲柔软而颜色赤的，说明胆气缓弱。爪甲平直而颜色白、没有纹理约束的，说明胆气正直。爪甲形态恶劣、颜色黑且多纹路的，说明胆气郁结。（出自《黄帝内经》。）
身体发黄、眼睛发黄、爪甲发黄的，是黄疸病。爪甲发青的，是厥逆病。（出自《黄帝内经》、《脉经》。）
手太阴肺经的气血衰竭，爪甲枯槁、毛发折断。（出自《黄帝内经》。）
手指循摸衣被、抓取虚空，这是心气虚败的危重证候。如果手握持有力，则是体内实邪壅滞，适宜用清泄法治疗。（出自魏之琇《续名医类案》引张璐语。）
按语：爪甲内应合于筋，爪甲的干枯或润泽，可以判断津液的虚实。至于指甲下的血色，判断方法与观察面色相同。按压后血色不散开，或者散开后很久不能重新聚集的，是血液死瘀的征象。
凡是疼痛，按压时疼痛加剧的，是血实证；按压时疼痛停止的，是气虚血燥证；按压时疼痛减轻，但中间有一点不适感的，是虚证中夹杂实证。
内部疼痛外部舒缓的是内实外虚，外部疼痛内部舒缓的是外实内虚。按压也找不到痛点的是阴痹，按压感到酸痛的，是寒湿停留在筋脉中。（出自魏之琇《续名医类案》引张璐语。）
凡是按压时，血色不散开，或者散开后很久不能重新聚集的，说明血已死瘀；散开后很快聚集的，是有热邪；聚集缓慢的，是气滞与寒湿。（新增内容。）
水胀病，足胫浮肿，腹部胀大，用手按压腹部，手松开后腹部立即弹起恢复原状，像包裹着水的样子。肤胀病，风寒客居于皮肤之间，皮肤虽然肿胀但不坚实，腹部胀大全身浮肿，按压腹部凹陷不起，腹部肤色不变。鼓胀病，腹部胀大身体肿大，与肤胀相似，但肤色苍黄，腹壁静脉显露。（这里的“筋”即指脉络。血与水混杂，汁液变质腐败。出自《黄帝内经》。）
风湿相互搏结，骨节烦痛，不能屈伸，靠近触碰则疼痛剧烈，伴有出汗、气短、恶风，或者身体轻微浮肿的，用甘草附子汤主治。（近期见到一个病例，饮食倍增，身体皮肤更加肥胖，只有骨节和皮肤疼痛无法转身侧卧，其皮肤即使只用一根手指轻轻点触，也立刻疼痛剧烈难以忍受，就是这种病。出自张仲景《伤寒论》。）
凡是身体发热，按压皮毛部位感觉热势加重，长时间按压却不觉得热的，说明热在体表、在肺，这也是劳倦导致的虚热。（根据热势的轻重来区分虚实。）
按压到肌肉血脉部位感觉热势较轻，用力按压完全感觉不到热的，说明热在中焦、在心脾、在血分，邪气已经入里。按压到筋骨部位感觉热的，是阴虚骨蒸，或者是湿热深入骨髓。热病邪气内陷于骨的，是肝肾阴气竭绝。（出自李东垣。）
肌肉的滑润或涩滞，用来征验津液的盛衰；皮肤的纹理疏密，用来征验营卫之气的强弱；肌肉的坚紧或松弛，用来征验胃气的虚实；筋脉的粗细，用来征验肝血的充盈或亏虚；骨骼的大小，用来征验肾气的强弱；爪甲的刚硬或柔和，用来征验胆汁的清浊；手指的肥瘦，用来征验经络气血的荣枯；手掌的厚薄，用来征验脏腑之气的丰歉；尺肤（前臂内侧皮肤）的寒热，用来征验表里阴阳的状态。《灵枢·论疾诊尺》篇对此论述得很详细。前一卷形诊中的“生形”、“病形”等篇章，多有通过摩按得出的结论，不再琐碎列举，可以互相参照观看。
The Kidney Qi connects with the ears. When Kidney Qi is harmonious, the ears can perceive the five tones. Furthermore, the Heart opens into the ears, and the essence of the ears is stored in the Heart. (From *Huangdi Neijing* / *Yellow Emperor's Inner Classic*.)
The Shaoyang meridian enters the ear. Therefore, in Shanghan disease (Cold Damage), symptoms such as deafness, intermittent vertigo, and a desire to vomit, accompanied by a wiry, thin, and rapid pulse, indicate a Shaoyang meridian disease. This results from heat stagnation consuming body fluids and Qi stagnation in the Sanjiao (Triple Burner), leading to impaired ascending and descending functions.
A prickling pain in the ears with yellowing of the auricle indicates a condition named "Yellow Ear," which resembles Shanghan disease. Wind invading the Kidneys causes sudden fever and aversion to cold, with stiffness of the spine and tension of the back resembling Jing disease (spasm). (From *Yitong*; Note: This is due to damp-heat accumulating downward in the Kidneys.)
Dry, withered, and scorched auricles, looking like they are covered in dust or dirt, indicate that the pathology is in the bones. (From *Huangdi Neijing*.)
The luster of the Liver manifests in the nails; nails are considered the surplus of sinews. (From *Huangdi Neijing*.)
When the Liver has heat, the complexion is dark green/cyan and the nails are withered. When Liver Qi is exhausted, the nails turn cyan and the patient curses incessantly. (From *Huangdi Neijing*, *Maijing*.)
The Liver corresponds to the nails. Nails that are thick and yellow (yellow referring to the blood color under the nail) indicate strong Gallbladder Qi. Nails that are thin and red indicate weak Gallbladder Qi. Nails that are hard and blue indicate urgent/agitated Gallbladder Qi. Nails that are soft and crimson indicate slack Gallbladder Qi. Nails that are straight, white, and without texture/lines indicate upright Gallbladder Qi. Nails that are ugly, black, and have many lines indicate knotted/stagnant Gallbladder Qi. (From *Huangdi Neijing*.)
Jaundice is indicated by yellowing of the body, eyes, and nails. Cyan nails indicate Jue syndrome (cold reversal/extremity cold). (From *Huangdi Neijing*, *Maijing*.)
When the Qi of the Hand-Taiyin (Lung) meridian is exhausted, nails become withered and hair breaks. (From *Huangdi Neijing*.)
Fingers tracing clothes and grasping at empty air indicates a critical deficiency pattern of the Heart. If the grasp is strong and forceful, it indicates internal excess, and clearing/draining methods should be used. (Zhi Wan.)
Note: Nails internally correspond to sinews; the dryness or moisture of nails can predict the deficiency or excess of body fluids. The blood color under the nails follows the same diagnostic principles as facial complexion. If pressed blood does not disperse, or disperses but fails to re-aggregate for a long time, it is a sign of dead blood (blood stasis/death).
For all pain: if pressing exacerbates the pain, it is Blood Excess; if pressing stops the pain, it is Qi Deficiency with dry Blood; if pressing reduces the pain but leaves a specific point of discomfort, it is Deficiency mixed with Excess. Internal pain with external relief indicates Internal Excess and External Deficiency; external pain with internal relief indicates External Excess and Internal Deficiency. Pain that cannot be located by pressing indicates Yin Bi (obstruction); soreness upon pressing indicates Cold-Dampness in the sinews. (Zhi Wan.)
Regarding pressing: if blood does not disperse or takes a long time to re-aggregate after dispersing, the blood is dead; if it re-aggregates quickly, it indicates Heat; if it aggregates slowly, it indicates Qi stagnation and Cold-Dampness. (Added.)
Shui Zhang (Water Distension): swelling of the lower legs and calves, abdominal distension. Pressing the abdomen causes it to rise immediately upon releasing the hand, resembling a bag wrapped around water. Fu Zhang (Skin Distension): Wind-Cold lodging in the skin. The skin swells but is not firm. Abdomen is large and the whole body is swollen. Pressing the abdomen leaves an indentation that does not rebound, and the abdominal skin color remains unchanged. Gu Zhang (Drum Distension): Abdominal distension and body enlargement similar to Fu Zhang, but with a cyan-yellow complexion and visible subcutaneous veins on the abdomen. ("Sinew" here refers to vessels. Blood and water mix, and the fluid deteriorates. From *Huangdi Neijing*.)
Wind-Dampness combusting together causes severe bone-joint pain, inability to flex or extend, worsening pain upon touch, sweating, shortness of breath, aversion to wind, or slight body swelling. Gancao Fuzi Tang (Licorice and Aconite Decoction) is the primary treatment. (Recent case: A patient with doubled appetite, increased body fat, but severe bone-joint and skin pain preventing turning over. Even light touch with one finger caused unbearable pain. This is the disease described by Zhongjing.)
For general body heat: if pressing the skin/hair layer increases the sensation of heat, but prolonged pressing yields no heat, the heat is in the exterior and Lung, also indicating deficiency heat from overwork. (Differentiate deficiency/excess by the intensity of heat.) If pressing the muscle/vessel layer feels less hot, and deep pressing reveals no heat, the heat is in the Middle Jiao, Heart/Spleen, and Blood level, indicating the pathogen has entered the interior. If heat is felt when pressing to the bone/tendon level, it indicates Yin deficiency with bone-steaming fever, or Deeply Penetrating Damp-Heat in the marrow. Heat pathogens sinking into the bone indicate exhaustion of Liver-Kidney Yin. (Dongyuan.)
Muscle smoothness or roughness reflects the abundance or decline of body fluids; skin texture density reflects the strength of Ying and Wei Qi; muscle firmness reflects the deficiency or excess of Stomach Qi; tendon thickness reflects the fullness or emptiness of Liver Blood; bone size reflects the strength or weakness of Kidney Qi; nail rigidity or flexibility reflects the clarity or turbidity of Gallbladder juice; finger fatness or leanness reflects the flourishing or withering of Meridian Qi; palm thickness reflects the abundance or scarcity of Zang organ Qi; temperature of the Chi area (inner forearm) reflects the Yin-Yang status of the interior and exterior. These are discussed in detail in the *Lunji Zhenshi Pian* chapter. Previous volumes on shape diagnosis, such as chapters on "Generating Shapes" and "Disease Shapes," contain much derived from rubbing and pressing; these are not listed exhaustively here but can be cross-referenced.