TCM Diagnosis: Forearm Skin Analysis & Seasonal Pathogen Patterns

Yellow Emperor inquired: “How might one diagnose illnesses through forearm dermal examination alone—omitting visual inspection and pulse analysis—to deduce internal pathologies from external manifestations?”

Qibo elucidated:
“Assess the forearm’s skin for:

1. Tension vs. Flaccidity
2. Elevation vs. Atrophy
3. Smooth vs. Rough Texture
4. Muscular Robustness vs. Debility

Diagnostic Correlations:

• Periorbital Edema with cervical carotid pulsation and pitting limb edema → Wind-Water Edema (风水肤胀)
• Glossy Forearm Skin → Wind Syndromes
• Flaccid Musculature → Chronic Fatigue with Hypersomnia
• Greasy Cutaneous Texture → Wind-Phlegm Disorders
• Ichthyotic Scaling → Spleen Deficiency with Fluid Retention (痰饮)
• Thermal Asymmetry:
  • Elbow Heat → Upper Body Inflammation
  • Wrist Heat → Lower Body Inflammation
  • Dorsal Hand Heat → Abdominal Pathologies

Ocular Diagnostics:

• Subconjunctival Vasculature:
  • Descending Red Vessels → Taiyang Meridian Disorder
  • Ascending Red Vessels → Yangming Meridian Disorder
  • Medial Trajectory → Shaoyang Meridian Disorder
  • Pupil-Piercing Vessels: 1 vessel = 1-year prognosis, 3 vessels = 3-year mortality

Dental & Cutaneous Markers:

• Gingival Hyperemia along Yangming Meridian → Odontogenic Infection Localization
• Epidermal Chromaticity:
  • Erythema → Febrile Conditions
  • Cyanosis → Chronic Arthralgia
  • Xanthoderma → Jaundice with oliguria and hyporexia

Seasonal Pathogen Dynamics:
“Yin-Yang transformation governs climatic pathogenesis:

• Winter Cold → Spring Febrile Diseases
• Spring Wind → Summer Dysentery
• Summer Damp → Autumn Malaria
• Autumn Dryness → Winter Chronic Cough

This reflects the homoioses between macrocosmic cycles and microcosmic pathophysiology.”