Ling Shu Chapter 71 (The Retention of Evil)

Qi Bo: One must know the starting of the twelve channels, the belongings of the skin to cold and heat, the overabundant or the debilitated, and the smoothness or the choppiness of the pulse in advance. If the pulse is abundant and slippery, the condition will become worse day after day, when the pulse is weak and fine, the disease will be protracted, when the pulse is gigantic and choppy, it is the disease of arthralgia aggravated by cold. When the yin and yang aspects of the pulse can hardly be distinguished, the disease may not be curable. When the heat remains in the four extremities, chest and abdomen, the disease is continuing. When the heat is disappearing from the four extremities, chest and abdomen, the disease is resolving. Examine the radial-palmer part of the forearm to determine whether the skin is firm or crisp, whether the pulse is large or small, slippery or choppy and whether the disease belongs to cold, heat, wet or dryness.

This passage suggests prognostication using the pulse. More importantly, it suggests a composite diagnostic method that involves comparing the forearm with the pulse in order to determine the general balance between hot and cold, wet and dry. This is exactly the same set of considerations used in early Greek medicine where the focus relies upon balancing the humidity and the temperature of the tissues.

In this method there are four basic possibilities; hot and wet, hot and dry, cold and wet, cold and dry. For this analysis, choppy pulses are related to dryness, and slippery pulses are related to moisture while small pulses tend to be colder and the larger pulses tend to be warm. As for the forearm skin, the crisp nature is dry and the firm is moist. However, one must pay attention. Does the skin get warmer with pressure or cooler? If it gets warmer when pressing deep, there is heat in the blood. If it is warmer on the surface and cool deeper, it is wind heat, if the skin is colder on the surface and warmer in the depth, it is wind cold or an insufficiency of the yang qi at the surface and may be related to stagnation or deficiency of defensive qi.

For the hot and wet pattern, the forearm skin will be moist, warm and the pulse will be slippery and possibly large; the treatment principle is to drain damp heat. In a hot and dry pattern, the forearm skin is dry and possibly rough or crisp, the pulse is choppy, the treatment principles may include moisten yin, warm yang, or warm the interior.

Chapter 74 Lun Ji Zhen Chi (To Determine the Disease by Inspecting the Skin of the Anterolateral Side of the forearm)

Huang Do to Qi Bo: I wish to explain the reasons of disease and know the internal changes from outside without inspecting the complexion and palpating the pulse condition of the patient, but only examine the positions on the skin of the radial-palmer part of the forearm, how should I do it? Qi Bo: When examining the rapid or slow, large or small, slippery or choppy conditions of the skin of the forearm and the firm and crisp conditions of the muscle. The location of the disease can be determined. 

When the skin of the radial-palmer part of the forearm is warm soft, smooth and lusterous, it is disease of wind. When the muscle of the radial-palmer part of the forearm is crisp and weak, the patient has fatigue, sleeps excessively and has emaciated muscles, it is a consumptive disease due to cold and heat that can hardly be cured. When the skin of the radial-palmer part of the forearm is unsmooth without any lubrication, it is arthrlagia due to wind evil. When the skin of the radial/palmer part of the forearm is coarse like a fish scale, it is watery phlegm retention. When the skin of the radial/palmer part of the forearm is very hot and the pulse is surging and large, it is a seasonal febrile disease. If the pulse is large and slippery, the patient will soon be sweating. When the skin of the radial/palmer part of the forearm is very cold and the pulse is small and fine, it is a deficiency cold pattern. When the skin of the radial/palmer part of the forearm is hot like fire at first, and then becomes cold, it is a disease of both cold and heat, when it is the reverse and the sensation is cold at first and then it becomes hot, it is also a complex cold and hot condition.

When only the skin on the elbow is hot it is heat above the loins. When only the hand is hot, it is heat below the loins. When the only anterior aspect of the elbow is hot it indicates heat in the chest; when the only posterior aspect of the elbow is hot, it indicates heat in the back. When only the inside of the arm is hot, it indicates heat in the loins and abdomen when the area three inches below the posterior aspect of the elbow is hot, it suggests heat in the intestines. When the pal is hot, it suggests heat in the abdomen; when the pal is cold, there is cold in the abdomen, when the green collateral appears on the thenar flesh, it is cold in the stomach.

© 2007 NeoClassical Chinese Pulse Diagnosis