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。岐伯曰。审
其尺之缓急小大滑涩。肉之坚脆。而病形定矣。
此章以论疾诊尺。从外知内。论疾者。谓论其疾而知其证。诊、视也。诊尺者。谓视其尺肤而
知其内。不待视面王之色。持手太阴之脉。独调其尺。以知其病也。夫胃者。水谷血气之海也。故行
于脉中者。至于太阴之两脉口。持其脉以知脏腑之病。血气之行于脉外者。从手阳明之大络。循经脉
之五里。而散行于尺肤。故审其尺之缓急大小滑涩。肉之坚脆。而病形定矣。盖太阴主阴。阳明主阳。
脏腑雌雄相合。气血色脉之相应也。故脏腑邪气篇曰。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。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。闵士先曰。小儿视虎口纹。乃手阳明之色。与手太阴之脉相应者也。
视人之目窠上微
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。（壅痈同 窈同）
此论其疾而知其病也。足太阳之脉。起于两目。而下出于颈项。太阳之上。寒水主之。太阳之气。
营运于肤表。
此水随气而溢于皮肤之间。故目窠微肿。颈脉动而肤胀。咳者。水留于皮毛。而动其肺气也。风
水者。因外受于风。风行而水涣也。
尺肤滑其淖泽者。风也。尺肉弱者。解 安卧。脱肉者。寒热不治。尺肤滑而泽脂者。风也。尺肤涩者。
风痹也。尺肤粗如枯鱼之鳞者。水 饮也。尺肤热甚。脉盛躁者。病温也。其脉盛而滑者。病且出也。
尺肤寒。其脉小者。泄少气。尺肤炬然先热后寒者。寒热也。尺肤先寒。久大之而热者。亦寒热也。
此论诊尺而知外内之病也。夫津液淖泽于皮肤。故尺肤滑其淖泽者。知风在于皮肤。而鼓动其津
液也。脂者。肌肉纹理间之脂膜。尺肤滑而泽脂者。风在于肌肉间也。夫在外者。皮肤为阳。筋骨为
阴。病在阳者。名曰风病。在阴者。名曰痹。如尺肤涩者。此风痹于筋骨间也。此以尺肤之淖泽滑涩。
而知风邪之浅深也。肌肉者。五脏元真之所通会。脾土之所主也。故尺肉弱者。主脾土虚而解 安卧。
解者。懈惰也。脱肉者。形损也。寒热者。阴阳血气虚也。阳虚则发寒。阴虚则发热。阴阳形气。
皆已虚脱。故为不治。如枯鱼之鳞者。皮肤起寒粟也。寒者水之气。此水邪 饮于内。故寒色见于外
也。温病者。寒毒藏于肌肤。至春发为温病。故尺肤热甚而脉盛躁者。知其为病温也。其脉盛而滑者。
知病且出于外也。尺肤寒其脉小者少气。盖气者。所以温肤热肉。从阴而生。自内而外。故知其泄于
内而虚于外也。此诊其尺而知内因之病也。尺肤之先热后寒。先寒后热。而皆为寒热者。尺肤主三阴
三阳之气也。
肘所独热者。腰以上热。手所独热者。腰以下热。肘前独热者。膺前热。肘后独热者。肩背热。
臂中独热者。腰腹热。肘后粗以下三四寸热者。肠中有虫。掌中热者腹中热。掌中寒者腹中寒。鱼上
白肉有青血脉者。胃中有寒。
夫手太阴之脉。从指井之少商。过于输。行于经。而入于肘之尺泽。脉外之气血。从手阳明之
五里。走尺以上
鱼。相逆顺而行也。是以脉要精微篇。论两手之尺寸。上竟上者。胸喉中事也。下竟下者。少腹腰
股膝胫足中事也。盖以尺上寸。以候身半以上。寸下尺。以候身半以下。夫身半以上为阳。身半以下
为阴。故以寸之阳以候上。尺之阴以候下也。肘所。自寸而下尺也。手所。自尺而上寸也。肌所独
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
前乃手厥阴之曲泽处。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相同也。夫人生于天地六
合之内。其血气之流行升降出入。应天运之环转于上下四旁。是以脉要精微论。以寸尺之外内前后上
下。候形身之外内前后上下。此章以手臂皮肤之前后外内。候形身之上下前后外内。盖脉内之血气。
应地气之上腾于天。脉外之气血。应天气之下流于地。人与天地参也。
尺炬然热。人迎大者。当夺血。尺坚大。脉小甚。少气。 有加。立死。（ 闷同）
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。
目赤色者。病在心。白在肺。青在肝。黄在脾。黑在肾。黄色不可名者。病在胸中。
此以目色而候五脏之血气也。五脏之血气。行于脉中。而变见于寸口。五脏之气血。变见于色。
而出于目中。
盖五脏之精。皆上注于目而为之睛也。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。赤脉从上下者太阳病。从下上者阳明病。从外走内者少阳病。
太阳为目上纲。故目脉从上下者主太阳病。阳明为目下纲。故从下上者主阳明病。少阳之脉。
循目锐 。故从外走内者。主少阳病。上节视目色以知五脏之阴。此诊目脉以知三阳之气。夫色为阳。
脉为阴。此阴阳之变换。
诊寒热。赤脉上下至瞳子。见一脉。一岁死。见一脉半。一岁半死。见二脉。二岁死。见二脉半。
二岁半死。见三脉。三岁死。
此论血脉主于手少阴心主。而本于足少阴肾脏。寒热者。水火阴阳之气也。心主包络之气。发原
于肾。归于心下之部署。为一形脏而主脉。瞳子者。肾脏之骨精也。水脏之毒。上交于火脏。而火脏
之气复下交于阴。所谓阴阳交者死不治。朱卫公曰。此论水脏之毒瓦斯。随正气相交而死。故凡论疾。
皆当体会其正气焉。诊龋齿痛。按其阳之来有过者独热。在左左热。在右右热。在上上热。在下下热。
马仲化曰。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。
诊血脉者。多赤多热。多青多痛。多黑为久痹。多赤多黑多青皆见者寒热。
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。
身痛而色微黄。齿垢黄。爪甲上黄。黄胆也。安卧。小便黄赤。脉小而涩者不嗜食。
此论中土之病。统见于五脏之外合。土灌于四脏也。身痛。病见于肉也。色黄。病见于皮也。齿
垢黄。病见于骨也。爪甲上黄。病见于筋也。黄胆。脾家病也。脾病故解 安卧。小肠为赤肠。心之
腑也。心主血脉。小便赤黄。脉小而涩。病见于脉也。小便赤黄。下焦热也。不嗜食。上焦虚也。盖
土位中央。而上下四旁。皆为之应。
人病。其寸口之脉。与人迎之脉。小大等。及其浮沉等者。病难已也。
此论人迎气口。与手太阴两寸口之脉。各有所候也。寸口者。手太阴之两脉。分寸关尺三部。以
候脏腑之血气者也。人迎气口者。候三阴三阳之气也。人病。其寸口之脉。与人迎之脉。大小浮沉等
者。此表里阴阳血气留病。故为难已。按人迎气口。以左为阳而右为阴。手太阴之两脉以寸为阳而
尺为阴。是以宋崔紫虚四言举要曰。关前一分。人命之主。左为人迎。右为气口。盖亦有所本也。夫
寸口者。在太渊之分。关前一分者。寸关之间也。寸关尺三部。以候内之五脏六腑。人迎气口。以候外
之三阴三阳。所候不同。而所取之部位。亦有别也。是以手太阴之两寸曰寸口。人迎寸口。又曰脉
口。又曰气口。盖各有部位之分。故名亦有别也。五色篇曰。脉之浮沉。及人迎与寸口气小大等者。病
难已。盖左右三部之脉。以候血脉。左右之人迎气口。以候三阴三
阳之气。故曰气口。朱卫公曰。此篇论尺。故兼论人迎。盖尺肤与人迎气口之相应也。
女子手少阴脉动甚者妊子。
此论人之始生。本于先天之水火也。手少阴者。两手之少阴肾脉也。盖胞系于肾。故少阴之脉动
甚也。夫妊始成形。先生两肾。犹太极中之阴阳。阴阳分而五行备。五行备而形始成。是以女子手
少阴脉动甚者。主妊子也。闵士先曰。此篇论诊尺。若以手少阴心脉论之。则失其经旨矣。且本经云。
阴搏阳别。谓之有子。夫寸为阳。尺为阴。阴搏者。尺脉滑利也。阳别者。与寸关之有别也。赵庭
霞曰。动甚者。动脉也。厥厥动摇。状如小豆。与滑脉之流利如珠同形。盖有诸内而形诸外也。朱
卫公曰。动在左者。先感天一之气。故主男。动在右者。先感地二之气。故主女。越人以胞系于命门
者。谓气之所感。非着于右肾也。试按男子之胎。多偏于左。
婴儿病。其头毛皆逆上者必死。
此论人之血气。本于先天所生。而上下环转者也。婴儿者。始生之儿。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。
耳间青脉起者掣痛。
肾主骨而开窍于耳。故耳间青脉起者。当主筋骨掣痛。此承上文而言。人之血气始于先天肾脏
之所生。
大便赤办。飧泄。脉小者。手足寒难已。飧泄脉小。手足温。泄易已。（办叶辨内从力飧叶孙）
办、别也。大便赤办者。谓黄赤之间别也。盖中焦泌糟粕。蒸津液。乃化而为血。独行于经隧。
命曰营气。水谷常
并居于胃。成糟粕而俱下于大肠。济泌别汁。而参入于膀胱。如大便赤办。乃中焦之血。与糟粕并
下矣。飧泄大肠虚而不能济泌矣。此肠胃虚泄于下。中焦之汁。不能营于脉中。故脉小也。若手足温
者。得下焦之生气。故泄易已。此言中焦水谷之精微。有藉下焦之生气以合化。闵士先曰。本经凡
论针论。疾之中 括阴阳血气之生始出入。能明乎正气之所从来。然后知邪病之浅深外内。学人当
体认毋忽。
四时之变。寒暑之胜。重阴必阳。重阳必阴。故阴主寒。阳主热。故寒甚则热。热甚则寒。故曰
寒生热。热生寒。此阴阳之变也。
此言人之阴阳血气应四时之寒暑往来。而有寒热阴阳之变。盖变化者。阴阳之道也。邵子曰。少
不变而老变。故重阴必阳。重阳必阴。寒甚则热。热甚则寒。
故曰。冬伤于寒。春生瘅热。春伤于风。夏生飧泄肠 。夏伤于暑。秋生 疟。秋伤于湿。冬生
咳嗽。是谓四时之序也。
此承上文申明阴阳寒热之变。冬伤于寒。春生瘅热者。寒毒藏于肌肤。至春时。人之阳气外出。
寒随气而化热。故春发为瘅热之病。夏伤于暑。秋生 疟者。暑气藏于募原。至秋时。人之阴气外出。
邪随气而发为 疟。 疟者。阴疟也。此寒暑之伏邪。随人气之外内出入也。夫天之寒邪。化为瘅热。
天之暑邪。化为阴疟。此天之阴阳。又随人气之变化也。夫阳者。天气也。主上。阴者。地气也。主下
。风乃天之阳邪。故伤于风者。上先受之。湿乃地之阴邪。故伤于湿者。下先受之。阳病者上行极
而下。是以春伤于风。夏生飧泄。阴病者下行极而上。是
以秋伤于湿。冬生咳嗽。此天地之阴阳。又随四时之上下升降也。赵庭霞曰。人之阴阳出入。随四
时之寒暑往来。故曰四时者变。寒暑之胜。至于阴阳寒热之变。有因于天气者。有因于人气者。
闵士先曰。冬时阳气伏藏于内。里气实。故寒毒藏于肌肤。夏时阳气发越于外。里气虚。故暑热藏
于募原。长夏湿土主气。太阴之气。主七月八月。故秋伤于湿。募原者。脏腑之膏膜。在肠胃之外。
是疟邪盛而透发不出者。若流于空郭之中。则成鼓胀。近时多用断疟之法。其误人不浅矣。
黄帝向岐伯问道：我想不通过观察面色、把持脉象，仅通过诊察尺肤（前臂内侧从肘至腕的皮肤），来推断疾病情况，由外在表现了解内在病变。该怎么做呢？
岐伯回答说：仔细审察尺肤的缓急、大小、滑涩，以及肌肉的坚实与脆弱，那么疾病的形态就可以确定了。
这一章论述通过诊察尺肤来诊断疾病，由外知内。“论疾”，是指通过论述疾病而明确证候；“诊”，即视诊；“诊尺”，是指观察尺肤从而知晓体内情况，不需要观察鼻准（面王）的气色，也不需要切按手太阴肺经的脉搏，只需单独调察尺肤，就能知道病情。胃是水谷精微和血气的海洋，所以运行在脉管中的气血，到达手太阴肺经的两侧寸口脉时，通过切脉可以了解脏腑的病变；运行在脉管外的气血，从手阳明大肠经的大络出发，沿着经脉的五里穴，散布于尺肤。因此，审察尺肤的缓急、大小、滑涩，以及肌肉的坚脆，疾病的形态就确定了。大概手太阴肺经主阴，手阳明大肠经主阳，脏腑阴阳相合，气血、色泽、脉象相互对应。所以《脏腑邪气篇》说：脉象紧急的，尺肤皮肤也紧张；脉象缓和的，尺肤皮肤也松弛；脉象细小的，尺肤皮肤也瘦减变少；脉象洪大的，尺肤皮肤也隆起；脉象滑利的，尺肤皮肤也滑利；脉象涩滞的，尺肤皮肤也涩滞。闵士先说：小儿看虎口纹，就是手阳明大肠经的气色，与手太阴肺经的脉象是相应的。
观察人的眼窝上方微微浮肿，像刚睡醒的样子，颈部动脉搏动明显，时常咳嗽，按压其手足背部，凹陷不起的，这是风水肤胀病。（壅痈同义，窈同窕）
这一段论述通过病症来推断疾病。足太阳膀胱经的经脉，起始于两眼，向下出于颈项。太阳之上，由寒水之气主司。太阳经的气，营运于体表皮肤之间。这股水气随着阳气溢于皮肤之间，所以眼窝微肿，颈部动脉搏动且皮肤肿胀。咳嗽，是因为水气停留于皮毛，扰动肺气所致。所谓风水，是因为外受风邪，风性行散导致水湿涣散。
尺肤滑润且润滑的，是风病。尺部肌肉软弱无力的，是懈惰嗜卧。肌肉脱削的，是寒热病，难以治愈。尺肤滑润且有脂泽感的，是风病。尺肤涩滞的，是风痹。尺肤粗糙如枯鱼鳞片的，是水饮病。尺肤灼热，脉象盛大躁动的，是温病。脉象盛大而滑利的，病邪即将外出。尺肤寒冷，脉象细小的，是泄泻且气虚。尺肤先灼热后寒冷的，是寒热病。尺肤先寒冷，久按之后变热的，也是寒热病。
这一段论述通过诊察尺肤来知晓内外部的疾病。津液滋润于皮肤，所以尺肤滑润且润滑的，可知风邪在于皮肤，并鼓动了津液。脂，指肌肉纹理间的脂膜，尺肤滑润而有脂泽感的，说明风邪在于肌肉之间。在外者，皮肤属阳，筋骨属阴。病在阳分的，称为风病；在阴分的，称为痹。如尺肤涩滞的，这是风邪痹阻于筋骨之间。这是通过尺肤的润滑、滑利或涩滞，来判断风邪的深浅。肌肉，是五脏元气真精所通会的地方，由脾土所主。所以尺部肌肉软弱无力，主脾土虚弱导致的懈惰嗜卧。解，即懈怠懒惰。脱肉，指形体消瘦受损。寒热，指阴阳血气虚弱。阳虚则发冷，阴虚则发热。如果阴阳形气都已虚脱，所以属于难治之症。如枯鱼鳞片状，指皮肤起鸡皮疙瘩。寒是水的气化表现，这说明水邪饮停于内，所以寒色显现于外。温病，是寒毒潜伏于肌肤，到了春季发作成为温病。所以尺肤灼热且脉象盛大躁动，可知是温病。脉象盛大而滑利，可知病邪即将出于体表。尺肤寒冷且脉象细小，是气虚。盖气，是用来温暖皮肤、温热肌肉的，它从阴而生，由内向外发散，所以可知其内部泄泻而外部虚弱。这是通过诊察尺肤来知晓内因引起的疾病。尺肤先热后寒，或先寒后热，都表现为寒热病，是因为尺肤主司三阴三阳之气。
肘部单独发热的，腰部以上发热；手部单独发热的，腰部以下发热。肘前部单独发热的，胸膺前部发热；肘后部单独发热的，肩背部发热。手臂中部单独发热的，腰腹部发热。肘后粗线以下三四寸处发热的，肠中有虫。掌心发热的，腹中发热；掌心寒冷的，腹中寒冷。手掌大鱼际白肉上有青紫色血脉的，胃中有寒。
手太阴肺经的经脉，从手指井穴少商穴开始，经过输穴，运行于经脉之中，进入肘部的尺泽穴。脉管外的气血，从手阳明大肠经的五里穴，走向尺肤以上的鱼际部位，逆顺而行。所以《脉要精微论》中，论述两手寸关尺三部脉，上竟上（寸脉向上延伸部分），对应胸喉中的事情；下竟下（尺脉向下延伸部分），对应少腹、腰、股、膝、胫、足中的事情。大概是以尺上（靠近肘部）对应身半以上，寸下（靠近腕部）对应身半以下。身半以上为阳，身半以下为阴，所以用寸脉的阳位来候上部，用尺脉的阴位来候下部。肘部区域，是从寸脉向下到尺脉的区域；手部区域，是从尺脉向上到寸脉的区域。肌部（此处指尺肤特定区域）单独发热，是腰部以上发热；手部单独发热，是腰部以下发热。这是通过诊察尺肤来候应身体形体的上下部位，所以与脉诊候应上下是相反的。肘前是手厥阴心包经的曲泽穴所在，肘后是手少阳三焦经的天井穴所在。大概因为双手下垂，上部用来候应上部，下部用来候应下部，前面用来候应前面，后面用来候应后面。所谓肘部、手部，是指手臂背面及臂中、掌中、鱼际上方，乃手臂正面。背面属阳，所以候应形体之外；正面属阴，所以候应腰腹肠胃之内。这与“尺外侧以候季胁，尺内侧以候腹中”的大义相同。人生活在天地六合之内，其血气的流行升降出入，应合天运的环转于上下四旁。所以《脉要精微论》用寸尺的外内前后上下，来候应形身的外内前后上下。本章用手臂皮肤的前后外内，来候应形身的上下前后外内。大概脉内的血气，应合地气之上腾于天；脉外的气血，应合天气之下流于地。人与天地参合相应。
尺肤灼热，人迎脉（颈侧动脉）大的，应当出现夺血（失血）的情况。尺肤坚硬大，脉象却非常细小，是气少。如果有闷乱加剧的症状，立即死亡。（ 同闷）
尺肤灼热，人迎脉大的，是三阳之气偏盛。所以应当主司夺血。皮肤属阳，血脉属阴。尺肤坚硬大，脉象却非常细小的，是阳盛而阴绝于外。气少且伴有闷乱加剧的，是阳盛而阴绝于内。
眼睛发红，病在心；白色在肺；青色在肝；黄色在脾；黑色在肾。黄色无法明确命名的（混杂之色），病在胸中。
这是通过目色来候应五脏的血气。五脏的血气，运行于脉中，变化显现于寸口脉。五脏的气血，变化显现于面色，而出现在目中。大概五脏的精气，都上注于目而形成瞳神。前一节通过观察眼窝来知晓皮肤的水气，这一节通过观察目色来知晓五脏的阴气，都是从外在表现来了解内在情况。胸中，即膈中。黄色无法明确命名的，是指色黄而夹杂黑白青赤等间色。病在胸中的，是五脏之气都从内膈而出，所以所见颜色如此。
诊察目痛，赤脉从上往下的，是太阳病；从下往上的，是阳明病；从外向内的，是少阳病。
太阳经为目上纲，所以目脉从上往下的主太阳病。阳明经为目下纲，所以从下往上的主阳明病。少阳经的经脉，循行经过目锐眦（眼角），所以从外向内的，主少阳病。上一节通过目色来知晓五脏的阴气，这一节通过诊察目脉来知晓三阳之气。色属阳，脉属阴，这是阴阳的变换。
诊察寒热病，赤脉上下延伸至瞳子，见到一条脉，一年死；见到一条半脉，一年半死；见到两条脉，两年死；见到两条半脉，两年半死；见到三条脉，三年死。
这一段论述血脉主要归属于手少阴心主，而根本在于足少阴肾脏。寒热，是水火阴阳之气。心主包络之气，发源于肾，归于心下的部署，作为一个形脏而主司血脉。瞳子是肾脏的骨精。水脏的毒邪，上交于火脏，而火脏之气又下交于阴，所谓阴阳交争，死不治。朱卫公说：这是论述水脏的毒瓦斯，随正气相交而死。所以凡是论述疾病，都应当体会其正气所在。诊察龋齿痛，按其阳经脉络来路有异常独热之处，在左边左边热，在右边右边热，在上边上边热，在下边下边热。马仲化说：牙齿疼痛称为龋。上齿属于手阳明大肠经，下齿属于足阳明胃经。所以按其阳脉来路有异常的，必定是独热。其脉在左右上下，则病热也分左右上下。
诊察血脉，多赤色多热，多青色多痛，多黑色为久痹，多赤多黑多青都出现的，是寒热病。
这是通过皮部的颜色，来知晓血脉的寒热。《皮部论》说：凡十二经脉，都是皮肤的分区。颜色多青则痛，多黑则痹，黄赤则热，多白则寒，五色都出现的，则是寒热错杂。
身体疼痛而面色微黄，牙齿垢腻发黄，爪甲上发黄，是黄疸病。嗜睡，小便黄赤，脉象小而涩的，是不思饮食。
这一段论述中土（脾胃）的疾病，统见于五脏的外合。土灌养四脏。身体疼痛，病见于肉；面色黄，病见于皮；牙齿垢腻黄，病见于骨；爪甲上黄，病见于筋。黄疸，是脾家的病。脾病所以导致懈惰嗜卧。小肠为赤肠，是心的腑。心主血脉，小便赤黄，脉小而涩，病见于脉。小便赤黄，是下焦热。不思饮食，是上焦虚。大概土位中央，上下四旁都与之相应。
人患病，其寸口脉与人迎脉，大小相等，浮沉也相等，这种病难愈。
这一段论述人迎、气口与手太阴两寸口脉，各有所候。寸口，是手太阴肺经的两侧脉，分寸、关、尺三部，用来候应脏腑的血气。人迎、气口，用来候应三阴三阳之气。人患病，其寸口脉与人迎脉，大小浮沉都相等，这是表里阴阳血气留滞致病，所以难愈。按人迎气口，以左为阳右为阴；手太阴的两脉，以寸为阳尺为阴。所以宋代崔紫虚《四言举要》说：关前一分，是人命之主，左为人迎，右为气口。大概也有依据。寸口，在太渊穴部位，关前一分，是寸关之间。寸关尺三部，用来候应内部的五脏六腑；人迎气口，用来候应外部的三阴三阳。所候不同，所取部位也有区别。所以手太阴的两寸称为寸口，人迎寸口，又称脉口，又称气口，大概各有部位之分，所以名称也有区别。《五色篇》说：脉的浮沉，以及人迎与寸口气小大相等，病难愈。大概左右三部脉，用来候应血脉；左右的人迎气口，用来候应三阴三阳之气，所以称为气口。朱卫公说：本篇论述尺肤，所以兼论人迎，大概尺肤与人迎气口是相应的。
这一段论述人的始生，本于先天之水火的。手少阴，指两手的手少阴肾脉（注：此处张志聪认为手少阴指肾脉，或指心包/心脉与肾相关，原文语境倾向于强调肾气或特定脉动）。大概胞宫系于肾，所以少阴脉动甚。妊娠开始成形，先生两肾，犹如太极中的阴阳，阴阳分而五行具备，五行具备而形体始成。所以女子手少阴脉动甚的，主怀孕。闵士先说：本篇论述诊尺，如果以手少阴心脉论之，就失去了经文旨意了。况且《内经》说：“阴搏阳别，谓之有子。”寸为阳，尺为阴，阴搏，指尺脉滑利；阳别，指与寸关有别。赵庭霞说：动甚，指动脉。厥厥动摇，状如小豆，与滑脉流利如珠同形，大概是有诸内必形诸外。朱卫公说：动脉在左者，先感天一之气，所以主男；动脉在右者，先感地二之气，所以主女。越人（扁鹊）认为胞系于命门，是指气之所感，并非着于右肾。试按男子之胎，多偏于左。
婴儿生病，其头毛全都逆上的，必然死亡。
这一段论述人的血气，本于先天所生，而上下环转。婴儿，指初生之儿。毛发，是血的余绪，由少阴精血所生。头发下垂，以应人之血气，从下而升，复从头顶而下。如果头发上逆，是只有升没有降。升降停止，所以不免于死亡。
肾主骨而开窍于耳，所以耳间出现青色脉络的，应当主筋骨牵引疼痛。这是承接上文而言，人的血气始于先天肾脏所生。
大便红白相间，完谷不化的飧泄，脉象细小的，手足寒冷，难愈；飧泄脉小，手足温暖的，泄泻易愈。（办同辨，叶同裂，内从力，飧同孙音）
办，即分别。大便红白相间的，是指黄赤之间有别。大概中焦泌别糟粕，蒸化津液，乃化为血，独行于经隧，命为营气。水谷常并居于胃，成为糟粕而俱下于大肠，济泌别汁，而参入于膀胱。如大便红白相间，乃是中焦之血，与糟粕并下。飧泄是大肠虚而不能济泌。这是肠胃虚泄于下，中焦之汁，不能营于脉中，所以脉小。如果手足温暖，得下焦之生气，所以泄泻易愈。这是说中焦水谷的精微，有赖下焦之生气以合化。闵士先说：《内经》凡是论述针法论述疾病，其中包含阴阳血气的生始出入，能明白正气从何而来，然后才知道邪病的浅深内外，学人应当体认，不可疏忽。
四时的变化，寒暑的胜负，重阴必阳，重阳必阴。所以阴主寒，阳主热。所以寒甚则热，热甚则寒。所以说寒生热，热生寒，这是阴阳的变化。
这一段说人的阴阳血气应合四时的寒暑往来，而有寒热阴阳的变化。大概变化，是阴阳的道理。邵子说：少不变而老变，所以重阴必阳，重阳必阴。寒甚则热，热甚则寒。
所以说：冬伤于寒，春生瘅热；春伤于风，夏生飧泄肠 ；夏伤于暑，秋生 疟；秋伤于湿，冬生咳嗽。这叫做四时的次序。
这一段承接上文申明阴阳寒热之变。冬伤于寒，春生瘅热的，是寒毒潜伏于肌肤，到了春季，人的阳气外出，寒随气而化热，所以春季发为瘅热病。夏伤于暑，秋生 疟的，是暑气潜伏于募原，到了秋季，人的阴气外出，邪随气而发为 疟。 疟，是阴疟。这是寒暑的伏邪，随人气之外内出入。天的寒邪，化为瘅热；天的暑邪，化为阴疟。这是天的阴阳，又随人气之变化。阳，是天气，主上；阴，是地气，主下。风乃天之阳邪，所以伤于风的，上先受之；湿乃地之阴邪，所以伤于湿的，下先受之。阳病者上行极而下，所以春伤于风，夏生飧泄。阴病者下行极而上，所以秋伤于湿，冬生咳嗽。这是天地之阴阳，又随四时之上下升降。赵庭霞说：人的阴阳出入，随四时之寒暑往来，所以叫四时者变，寒暑之胜。至于阴阳寒热之变，有因于天气的，有因于人气的。闵士先说：冬季阳气伏藏于内，里气实，所以寒毒潜伏于肌肤。夏季阳气发越于外，里气虚，所以暑热潜伏于募原。长夏湿土主气，太阴之气，主七月八月，所以秋伤于湿。募原，是脏腑的膏膜，在肠胃之外，是疟邪盛而透发不出，若流于空郭之中，则成鼓胀。近时多用断疟之法，其误人不浅矣。
Huangdi asked Qibo: "I wish to diagnose without observing facial complexion or holding the pulse, but solely by regulating and examining the Chi skin (the skin on the inner forearm from elbow to wrist) to discuss the disease, knowing the interior from the exterior. How should this be done?"
Qibo replied: "Carefully examine the tension, size, smoothness, and roughness of the Chi skin, as well as the firmness or fragility of the flesh, and the form of the disease will be determined."
This chapter discusses diagnosing diseases by examining the Chi skin, knowing the interior from the exterior. "Discussing diseases" means discussing the illness to clarify the syndrome. "Zhen" (Diagnosis) refers to visual inspection. "Examining the Chi" means observing the Chi skin to know the internal state, without needing to observe the color at the tip of the nose (Mianwang) or hold the pulse of the Hand-Taiyin Lung Meridian. By solely regulating the Chi, one can know the disease. The Stomach is the sea of water and grain, blood, and Qi. Therefore, the blood and Qi circulating within the vessels reach the two pulse sites of the Hand-Taiyin Lung Meridian; holding the pulse allows one to know the diseases of the Zang-Fu organs. The blood and Qi circulating outside the vessels travel from the large Luo vessel of the Hand-Yangming Large Intestine Meridian, along the five Li acupoints of the meridians, and scatter into the Chi skin. Thus, by examining the tension, size, smoothness, and roughness of the Chi skin, and the firmness or fragility of the flesh, the form of the disease is determined. Generally, the Hand-Taiyin governs Yin, and the Hand-Yangming governs Yang. The Zang and Fu organs are paired in Yin and Yang, with corresponding blood, Qi, color, and pulse. As stated in the *Chapter on Pathogenic Factors of Zang and Fu*: "When the pulse is tense, the skin of the Chi is also tense; when the pulse is relaxed, the skin of the Chi is also relaxed; when the pulse is small, the skin of the Chi is diminished and reduced; when the pulse is large, the skin of the Chi is bulging and raised; when the pulse is slippery, the skin of the Chi is also slippery; when the pulse is choppy, the skin of the Chi is also choppy." Min Shixian said: "Observing the tiger's mouth lines in children corresponds to the color of the Hand-Yangming Meridian, which corresponds to the pulse of the Hand-Taiyin Meridian."
Observe if the area above the eye sockets is slightly swollen, resembling the appearance after just waking up, if the neck vessels are pulsating, if there is occasional coughing, and if pressing the dorsum of the hands and feet leaves an indentation that does not rise immediately; this indicates Fengshui Fuzhang (Wind-Water Skin Distension). (Yong and Chong are synonymous; Yao is synonymous with Tiao.)
This section discusses knowing the disease through its manifestations. The Foot-Taiyang Bladder Meridian originates from the eyes and descends to emerge at the neck and nape. Above the Taiyang, Cold Water governs. The Qi of the Taiyang circulates on the surface of the skin. This water overflows between the skin following the Qi, causing slight swelling of the eye sockets, pulsation of the neck vessels, and skin distension. Coughing occurs because water remains in the hair and skin, disturbing the Qi of the Lung. Fengshui (Wind-Water) arises from external wind exposure; wind moves and disperses water.
If the Chi skin is slippery and glossy, it indicates Wind. If the flesh at the Chi is weak, it indicates lethargy and a desire to lie down. If the muscles are wasted, it indicates refractory Cold-Heat disorders. If the Chi skin is slippery and has a greasy luster, it indicates Wind. If the Chi skin is rough, it indicates Wind-Bi (Obstruction). If the Chi skin is coarse like the scales of a dried fish, it indicates Water retention. If the Chi skin is very hot and the pulse is vigorous and restless, it indicates Warm Disease. If the pulse is vigorous and slippery, the pathogen is about to exit. If the Chi skin is cold and the pulse is small, it indicates diarrhea and deficiency of Qi. If the Chi skin is initially hot then becomes cold, it indicates Cold-Heat disorder. If the Chi skin is initially cold and becomes hot after prolonged pressure, it also indicates Cold-Heat disorder.
This section discusses knowing internal and external diseases by examining the Chi skin. Body fluids moisten the skin; thus, if the Chi skin is slippery and glossy, it indicates Wind affecting the skin and stirring the body fluids. 'Zhi' (fat/grease) refers to the fatty tissue between muscle fibers; if the Chi skin is slippery and greasy, it indicates Wind residing between the muscles. Externally, skin is Yang and sinews/bones are Yin. Diseases in the Yang aspect are called Wind diseases; those in the Yin aspect are called Bi syndromes. For example, rough Chi skin indicates Wind-Bi between the sinews and bones. This determines the depth of Wind pathogen based on the glossiness, slipperiness, or roughness of the Chi skin. Muscles are where the primordial Qi of the Five Zang organs converges, governed by Spleen Earth. Thus, weak Chi flesh indicates Spleen Earth deficiency leading to lethargy and lying down. 'Jie' means laziness/lethargy. Wasted muscles indicate physical depletion. Cold-Heat indicates deficiency of Yin-Yang and Blood-Qi. Yang deficiency causes cold; Yin deficiency causes heat. If Yin-Yang and Form-Qi are depleted, it is untreatable. Coarse skin like dried fish scales indicates goosebumps caused by cold. Cold is the qi of Water; this indicates Water pathogen retained internally, manifesting as cold signs externally. Warm Disease occurs when Cold toxicity hides in the skin and flesh, emerging in Spring as Warm Disease. Thus, very hot Chi skin and vigorous/restless pulse indicate Warm Disease. Vigorous and slippery pulse indicates the pathogen is about to exit the body. Cold Chi skin and small pulse indicate Qi deficiency. Qi warms the skin and flesh, arising from Yin and moving from inside out; thus, internal leakage leads to external deficiency. This diagnoses internal cause diseases via the Chi. Alternating hot/cold Chi skin reflects the Qi of the Three Yin and Three Yang.
Exclusive heat at the elbow indicates heat above the waist; exclusive heat at the hand indicates heat below the waist. Exclusive heat at the front of the elbow indicates heat in the chest/anterior; exclusive heat at the back of the elbow indicates heat in the shoulder/back. Exclusive heat in the middle of the arm indicates heat in the waist/abdomen. Heat three to four cun below the thick part of the posterior elbow indicates intestinal worms. Heat in the palm indicates abdominal heat; cold in the palm indicates abdominal cold. Blue-green blood vessels on the white flesh of the Thenar eminence indicate Cold in the Stomach.
The Hand-Taiyin Lung Meridian starts from the Jing-well point Shaoshang, passes through the Shu-stream point, travels along the meridian, and enters the Chi-se point at the elbow. Blood and Qi outside the vessels travel from the Wu-li point of the Hand-Yangming Large Intestine Meridian to the Yuji area above the Chi, moving in reverse and順顺 (smooth) directions. Thus, the *Chapter on Essential subtleties of Pulse Diagnosis* states regarding the Cun-Guan-Chi positions of both hands: "Upper end of the upper" (extension of Cun pulse) corresponds to the chest and throat; "Lower end of the lower" (extension of Chi pulse) corresponds to the lower abdomen, waist, thighs, knees, shins, and feet. Generally, the upper part of the Chi (near elbow) corresponds to the upper half of the body, and the lower part of the Cun (near wrist) corresponds to the lower half. Upper body is Yang, lower body is Yin; thus, Yang position of Cun probes the upper, and Yin position of Chi probes the lower. The 'Elbow region' spans from Cun down to Chi; the 'Hand region' spans from Chi up to Cun. Heat in specific muscle areas indicates heat above/below the waist. This uses Chi skin to probe the upper/lower body, opposite to pulse diagnosis. The front of the elbow is Quze (Pericardium); the back is Tianjing (Sanjiao). With arms hanging down, upper probes upper, lower probes lower, front probes front, back probes back. 'Elbow' and 'Hand' refer to the dorsal (Yang, probing exterior) and palmar (Yin, probing interior waist/abdomen/intestines) aspects of the arm, consistent with using the lateral Chi for hypochondrium and medial Chi for abdomen. Humans live within Heaven and Earth; blood and Qi circulation corresponds to heavenly rotation. Thus, *Essential Subtleties* uses Cun-Chi internal/external/front-back to probe the body. This chapter uses arm skin front-back/internal-external to probe body upper-lower/front-back/internal-external. Blood inside vessels corresponds to Earth Qi rising to Heaven; Qi/Blood outside vessels corresponds to Heaven Qi flowing to Earth. Man participates with Heaven and Earth.
Burning hot Chi skin with a large Renying pulse (carotid artery) indicates blood loss. Hard and large Chi skin with a very small pulse indicates Qi deficiency. If accompanied by stifling sensation worsening, death is imminent.
Burning hot Chi skin and large Renying pulse indicate excess of Three Yang Qi, leading to blood loss. Skin is Yang, vessels are Yin. Hard/large Chi with small pulse indicates Yang excess and Yin exhaustion externally. Qi deficiency with stifling sensation indicates Yang excess and Yin exhaustion internally.
Red eyes indicate Heart disease; white indicates Lung; green indicates Liver; yellow indicates Spleen; black indicates Kidney. Indistinct yellow indicates disease in the Chest (Diaphragm).
This probes Five Zang blood/Qi via eye color. Zang blood/Qi circulates in vessels, manifests at Cun Kou, changes in complexion, and emerges in the eyes. Essence of Five Zangs ascends to the eyes. Previous section used eye sockets for skin water; this uses eye color for Zang Yin, knowing interior from exterior. Chest refers to Diaphragm. Indistinct yellow implies mixed colors. Disease in Chest involves Zang Qi exiting from internal diaphragm, resulting in such colors.
Diagnosing eye pain: Red veins descending from top indicate Taiyang disease; ascending from bottom indicate Yangming disease; moving from outside inward indicate Shaoyang disease. Taiyang is the upper eyelid; Yangming is the lower eyelid. Shaoyang meridian runs through the outer canthus. Previous section used color for Zang Yin; this uses veins for Three Yang Qi. Color is Yang, Vein is Yin; this is Yin-Yang transformation.
Diagnosing Cold-Heat: Red veins extending to the pupil. One vein seen: death in one year. One and a half veins: death in 1.5 years. Two veins: death in two years. Two and a half veins: death in 2.5 years. Three veins: death in three years.
Blood vessels are governed by Hand-Shaoyin Pericardium, rooted in Foot-Shaoyin Kidney. Cold-Heat are Water-Fire Yin-Yang Qi. Pericardium Qi originates in Kidney, settles in Heart, forms a Form-Zang governing vessels. Pupil is Kidney bone essence. Water organ toxicity ascends to Fire organ, Fire Qi descends to Yin; this Yin-Yang intersection is fatal. Zhu Weigong said: This discusses Water organ toxicity interacting with righteous Qi leading to death. One must understand the source of righteous Qi. Diagnosing toothache (Qu): Press Yang meridians for unique heat. Left side heat = left pathology; Right side heat = right pathology; Upper heat = upper pathology; Lower heat = lower pathology. Ma Zhonghua said: Upper teeth belong to Hand-Yangming Large Intestine; lower teeth to Foot-Yangming Stomach. Abnormal heat in Yang pulses indicates heat pathology corresponding to location.
Diagnosing blood vessels: Many red indicates Heat; many green indicates Pain; many black indicates chronic Bi; mixed red/black/green indicates Cold-Heat.
This knows vessel Cold-Heat via skin zone color. *Skin Zones Chapter*: Twelve meridians correspond to skin zones. Green=Pain; Black=Bi; Yellow/Red=Heat; White=Cold; All five colors=Cold-Heat mix.
Body pain with slight yellow complexion, yellowish dental plaque, yellow nails indicates Jaundice. Lethargy, yellow-red urine, small/choppy pulse with poor appetite indicates Middle Earth (Spleen/Stomach) disease affecting all Zang extensions. Earth nourishes Four Zangs. Body pain affects flesh; yellow complexion affects skin; yellow plaque affects bone; yellow nails affect sinews. Jaundice is Spleen disease, causing lethargy. Small intestine is Red Intestine, Fu of Heart. Heart governs vessels; yellow-red urine and small/choppy pulse indicate vessel disease. Yellow-red urine indicates Lower Jiao Heat; poor appetite indicates Upper Jiao Deficiency. Earth is central, responding to all directions.
In disease, if Cun Kou and Renying pulses are equal in size and floating/sinking depth, the disease is difficult to cure.
Renying and Qikou correspond to Hand-Taiyin Cun Kou. Cun Kou (Hand-Taiyin) divides into Cun, Guan, Chi to probe Zang-Fu blood/Qi. Renying/Qikou probes Three Yin/Yang Qi. Equal pulses indicate stagnation of exterior-interior Yin-Yang blood/Qi, making cure difficult. Traditionally, Left is Yang, Right is Yin for Renying/Qikou; Cun is Yang, Chi is Yin for Hand-Taiyin. Cui Zixu's *Four Character Essentials* says: One fen before Guan is master of life; Left is Renying, Right is Qikou. Cun Kou is at Taiyuan. Cun/Guan/Chi probe internal Zang-Fu; Renying/Qikou probe external Three Yin/Yang. Different probes, different locations. Hence names differ. *Five Colors Chapter* states equal pulses mean difficult cure. Left/Right three positions probe blood vessels; Left/Right Renying/Qikou probe Three Yin/Yang Qi, hence 'Qi Kou'. Zhu Weigong said: This chapter focuses on Chi, so mentions Renying due to correspondence.
If the Hand-Shaoyin pulse beats vigorously in women, she is pregnant.
Human generation begins with innate Water-Fire. Hand-Shaoyin here refers to Kidney脉 (or related to Pericardium/Heart connected to Kidney). Uterus connects to Kidney, so Shaoyin pulse beats strongly. Pregnancy begins with Kidneys forming first, like Tai Yin-Yang. Yin-Yang divide, Five Elements prepare, form completes. Thus, vigorous Hand-Shaoyin pulse indicates pregnancy. Min Shixian noted: This chapter discusses Chi; interpreting Hand-Shaoyin as Heart pulse misses the point. *Neijing* says: "Yin pounding with Yang distinction indicates pregnancy." Cun is Yang, Chi is Yin. Yin pounding means slippery Chi pulse; Yang distinction means difference from Cun/Guan. Zhao Tingxia said: Vigorous beating is Dong Mai (Pulsating Pulse), like a bean, similar to Slippery pulse. Inner reality manifests externally. Zhu Weigong said: Pulsation on Left indicates receiving Heavenly 1 Qi (Male); Right indicates Earthly 2 Qi (Female). Bian Que attributed uterus to Mingmen, meaning Qi reception, not fixed in Right Kidney. Male fetuses often lean left.
If an infant's head hair stands upward, death is certain.
Blood/Qi stems from innate generation, circulating up/down. Infants' hair is surplus of Blood, generated by Shaoyang Essence/Blood. Hair hangs down, corresponding to Blood/Qi rising from below and descending from crown. Upward hair means only rising, no descending. Rise/Fall cease, leading to death.
Blue-green veins appearing between ears indicate pulling pain.
Kidney governs bones and opens into ears. Blue-green veins indicate Bone/Sinew pulling pain. Continues previous point: Blood/Qi starts from innate Kidney.
Stools with red and white separation, undigested food diarrhea (Sun Xie), with small pulse and cold hands/feet are difficult to cure. Sun Xie with small pulse but warm hands/feet is easily cured. (Ban = distinct; Ye = split; Sun = sound).
Ban means distinct. Red-white stool indicates separation of yellow/red. Middle Jiao separates dregs, steams fluids, transforms to Blood (Ying Qi) running in vessels. Food/water stay in Stomach, become dregs, enter Large Intestine, filter juices to Bladder. Red-white stool means Middle Jiao Blood mixes with dregs. Sun Xie indicates Large Intestine deficiency failing to filter. Internal/External deficiency leads to downward leakage; Middle Jiao fluids fail to nourish vessels, causing small pulse. Warm hands/feet indicate Lower Jiao Sheng Qi, aiding recovery. Middle Jiao essence relies on Lower Jiao Qi for transformation. Min Shixian emphasized understanding righteous Qi to know pathogen depth.
Changes in four seasons, victory of Cold/Heat: Heavy Yin becomes Yang, Heavy Yang becomes Yin. Yin governs Cold, Yang governs Heat. Extreme Cold generates Heat; extreme Heat generates Cold. This is Yin-Yang change.
Human Yin-Yang blood/Qi responds to seasonal Cold/Heat, causing variations. Change is the Way of Yin-Yang. Shao Zi said: Young does not change, old changes; thus Heavy Yin becomes Yang, etc.
Thus: Winter injury by Cold generates Chan Re (Intense Heat) in Spring; Spring injury by Wind generates Sun Xie (Undigested Diarrhea) in Summer; Summer injury by Summer-heat generates Nue (Intermittent Fever) in Autumn; Autumn injury by Dampness generates Cough in Winter. This is the order of four seasons.
Winter Cold hides in skin/flesh; Spring Yang exits, transforming Cold to Heat, causing Chan Re. Summer Summer-heat hides in Mu Yuan (Omental space); Autumn Yin exits, releasing pathogen as Nue (Yin Malaria). Heaven's Cold becomes Chan Re; Heaven's Summer-heat becomes Yin Malaria. Heaven's Yin-Yang changes with Human Qi. Yang is Heaven Qi, ruling Upper; Yin is Earth Qi, ruling Lower. Wind is Heaven Yang pathogen, affecting Upper first; Damp is Earth Yin pathogen, affecting Lower first. Yang diseases move up then down (Spring Wind -> Summer Diarrhea). Yin diseases move down then up (Autumn Damp -> Winter Cough). Heaven/Earth Yin-Yang follows seasonal rise/fall. Zhao Tingxia: Human Yin-Yang follows seasons. Changes depend on Heaven Qi or Human Qi. Min Shixian: Winter Yang hides internally, Interior is solid, Cold hides. Summer Yang vents externally, Interior is empty, Summer-heat hides. Late Summer Damp Earth governs; Taiyin governs 7th/8th months, hence Autumn Damp. Mu Yuan is fatty membrane outside intestines; Malaria pathogen stuck here causes distension if leaking. Modern malaria treatments often err.