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The text mentions deficiency pathogenic factors (Xu Xie, 虚邪), excess pathogenic factors (Shi Xie, 实邪), thief pathogenic factors (Zei Xie, 贼邪), minor pathogenic factors (Wei Xie, 微邪), and correct pathogenic factors (Zheng Xie, 正邪). How are they distinguished? Generally, those coming from "after" are called deficiency pathogenic factors. For example, Lung disease (Bing of the Lung) caused by Spleen Earth pathogenic factors: since Metal is born from Earth, it comes from after; additionally, Metal contains Earth nature, and Earth can control Water. Without Water to control, Fire will ascend, thus it is called a deficiency pathogenic factor. Those coming from "before" are called excess pathogenic factors. For example, Lung disease caused by Kidney Water pathogenic factors: since Water is born from Metal, it comes from before; additionally, Metal contains Water nature, so Fire cannot reach. This is the son controlling the ghost (Zi Neng Zhi Gui, i.e., the son subduing the enemy of the father), thus it is called an excess pathogenic factor. Those coming from "that which I cannot overcome" (Ke Wo Zhe, i.e., the element that controls me) are called thief pathogenic factors. For example, Lung disease caused by Heart Fire pathogenic factors: since Fire controls Metal, it comes from the force that controls me to attack, thus it is called a thief pathogenic factor. Those coming from "that which I overcome" (Wo Ke Zhe, i.e., the element controlled by me) are called minor pathogenic factors. For example, Lung disease caused by Liver Wood pathogenic factors: since Metal controls Wood, it comes from the force controlled by me to attack; since it is already controlled by me, it cannot cause harm, thus it is called a minor pathogenic factor. If one merely suffers from the disease of the Lung itself without interference from external pathogenic factors, this is called a correct pathogenic factor. Taking one Zang organ as an example, the others can be inferred analogously.

For adults, pulse diagnosis (Qie Mai, 切脉) is emphasized; for infants, inspection (Wang Zhen, 望诊) and auscultation-olfaction (Wen Zhen, 闻诊) are emphasized. Therefore, the detailed discussion on Qi and color in the *Shen Ji Shu Pian* focuses solely on pediatrics.
The four essential diagnostic methods of medicine—inspection, auscultation-olfaction, inquiry, and palpation—are like the four limbs of a person; lacking one limb makes one incomplete as a human, and lacking one method makes one incomplete as a physician. The *Classic* states: To know through inspection is called divine; to know through auscultation-olfaction is called sage; to know through inquiry is called skilled; to know through palpation is called dexterous. Knowing through inspection involves observing the five colors to determine the location of the disease. Knowing through auscultation-olfaction involves listening to the five tones to distinguish the origin of the disease. Knowing through inquiry involves asking about preferences for the five flavors to understand the cause and location of the disease. Knowing through palpation involves examining the Cun Kou pulse to view excess or deficiency and determine which Zang-Fu organ is affected. Thus, upon first encountering a patient, one should inspect and listen first, then inquire and palpate; this is an unchangeable sequence. Today's patients only allow the doctor to feel the pulse to test their skill, not realizing that cold, heat, excess, and deficiency reside in the meridians and can be known through pulse taking; however, the cause of the disease and the specific meridians injured, how can these be fully known by diagnosis alone? Therefore, the physician must not fail to ask about the cause, and the patient must not fail to explain the history. Su Dongpo said: "I must tell my doctor everything about my illness, so that he understands clearly in his mind, and only then does he take my pulse; otherwise, doubt cannot confuse him." I only seek to cure my illness, why would I do it just to deal with the doctor? Moreover, infants' Qi and Blood are not yet settled, and their conditions change rapidly; the Cun Kou pulse is difficult to rely upon. Without combining all four diagnostic methods for assessment, how can one perceive the subtleties? I have compiled the essentials of inspection and auscultation in the following chapters. The *Classic* states: The bright and clear five colors are the brilliance of Qi. The essence of the five Zang organs manifests on the face; therefore, observe the five Zang organs above and below the nose, and the six Fu organs on both sides of the nose. Furthermore, the nose corresponds to the Lung, the eyes to the Liver, the tongue to the Heart, the lips to the Spleen, and the ears to the Kidney. The skin corresponds to the Large and Small Intestines, muscles to the Stomach, nails to the Gallbladder, and the interstices (Cou Li, 腠理) to the San Jiao and Bladder. The green color of the Liver, red of the Heart, white of the Lung, black of the Kidney, and yellow of the Spleen are the natural colors of each organ. The Liver prospers in Spring, the Heart in Summer, the Lung in Autumn, and the Kidney in Winter, each ruling for seventy-two days. The Spleen rules for eighteen days at the end of each season, which is its proper position. However, sometimes outside of Spring and Winter, if the face turns green or black, it is not necessarily a Liver or Kidney issue. Outside of Autumn and Summer, if the face turns red or white, it is not necessarily a Heart or Lung issue. This is because the Qi of the five Zang organs changes shape with symptoms and has no fixed pattern. For instance, sudden green-black indicates pain; sudden red indicates heat; sudden white indicates cold; sudden yellow indicates accumulation. Thus, it is not limited by time or position. For example, the Heart governs the forehead and hairline; the Liver governs the eyes, left cheek, and temporal region; the Spleen governs the upper and lower lips and the tip of the nose; the Lung governs the right cheek and Taiyin region; the Kidney governs the ear accessory areas and the chin. Colors may appear in their respective positions or manifest in other areas. Generally, obtaining the color of the corresponding position is favorable (Shun, 顺); even if it shifts to a non-clashing position, it is acceptable. If it appears in another position and clashes (e.g., one element overcoming another), it is unfavorable (Ni, 逆). For example, prolonged diarrhea and dysentery causing Spleen deficiency, with the upper and lower lips turning black, indicates Kidney Water overwhelming Spleen Earth (Water overcoming Earth), named as strong overcoming, which is unfavorable. Extending this, if all five regions show green, it indicates unsettled fright and accumulation, predisposing to wind syndromes, accompanied by unstable spirit and fluctuating expressions. If all five regions show red, it indicates abundant phlegm accumulation, restlessness and palpitations, accompanied by dull spirit and confusion. If all five regions show yellow, it indicates food accumulation and mass formation, accompanied by scattered spirit, lethargy, alternating chills and fever, poor appetite, coarse breathing, irritability, fullness, fatigue, preference for curling up, vomiting, belching, or diarrhea/dysentery. If all five regions show white, it indicates impaired Lung Qi, slippery discharge of the Large Intestine, indistinguishable water and grain, impending dysentery/vomiting, turbid gaze, loss of spirit, and haziness. If all five regions show urgent black, it indicates unfavorable transmission and reversal of symptoms, impending failure of Zang-Fu organs, lack of nourishment by Blood, lack of protection by Qi, great disorder of Ying and Wei, stagnation of meridian flow in the vessels, indicating critical danger. The spirit is confused and silent, indicating imminent death. Furthermore, red forehead indicates Wind-Heat in the Heart Meridian, restless sleep, fright, palpitations, and dry heat. Green-black forehead indicates internal evil, fright-wind, abdominal pain, convulsions, and crying. Severe green-black indicates severe heart/abdominal pain. Mild yellow with dry skin indicates night sweats. Soft, yellow, dry hair indicates fright-gan bone-steaming tidal fever and slight thirst. Dull black indicates abnormal bowel habits. Red left cheek indicates Liver Wind, body heat, and stiffness. Green-black left cheek indicates fright or abdominal pain. Light red left cheek indicates tidal fever. Red right cheek indicates Wind-Heat injury. Light red right cheek also indicates tidal fever, hard stool, coarse breath, congestive cough. Green-white right cheek indicates cough and nausea. Green-black right cheek indicates impending fright-wind, intestinal coiling pain, or abdominal pain. Red nose bridge indicates body heat and loss of appetite. Deep yellow nose bridge indicates urinary obstruction. Dry nostrils with coarse breathing and sound indicate epistaxis. Green nose bridge indicates spitting milk. Pale white nose bridge indicates diarrhea and anorexia. Dry nasal cavity indicates difficulty in urination and defecation. Black, dry, depressed nostrils indicate terminal Lung condition; combined with no lines on hands/feet and no lines in lips, it is untreatable. Red chin indicates Bladder Heat; since Bladder and Kidney are exterior-interior pairs, heat causes urinary obstruction. Red eyes indicate Heart-Liver Heat, Wind-Heat, and irritability. Yellow eyes indicate Spleen accumulation, bad breath, and anorexia. Green eyes indicate Liver Wind-Heat and fright. Swollen eyelids indicate chronic cough, nausea, or gan syndrome from food accumulation. Yellow-red sclera indicates morning/evening fever. Fine red lines at eye corners indicate internal fright-wind. Bright eyes indicate fright. Rubbing eyes/eyebrows indicates impending wind. Hazy eyes indicate Liver Heat, often changing to night blindness. Swollen eyes with facial edema morning/evening indicate Spleen accumulation. Green Yintang (between eyebrows) indicates fright. Green-purple-black Yintang indicates external invasion by evil spirits. Green-black Yintang indicates abdominal pain and frequent crying; combined with red indicates fright-heat; white indicates health. Green Shan Gen (root of nose) indicates fright. Purple Shan Gen indicates milk/food injury; black indicates critical condition. Red eyebrows indicate nocturnal crying. Pale white center of eyebrows indicates white stool diarrhea and undigested food; red in chronic illness indicates death. Red cheeks indicate crying, fright, and heat; combined with yellow indicates vomiting. Constantly red normal mouth area indicates no pain. Dry red indicates Spleen Heat. White indicates deficiency. Black Ren Zhong (philtrum) indicates abdominal pain and worm movement. Spotty black Ren Zhong indicates vomiting/dysentery. Yellow sides of Ren Zhong indicate food injury. Green top and bottom of Ren Zhong indicates undigested milk/food and green stool. Red lips and face indicate Cold Damage (Shang Han, 伤寒). White lips indicate vomiting, retching, and regurgitation, or hematemesis, hematochezia, epistaxis. Red, dry, wrinkled lips indicate thirst. Red, non-wrinkled lips indicate bad breath, constipation, nighttime irritability, insomnia, and manic shouting. Yellow lips with bad breath indicate Spleen accumulation. Red lips indicate epistaxis. Moving lips/mouth indicate fright-heat. Purple lips/mouth indicate salivation and worm pain. Blue lips indicate Spleen Cold, intermittent abdominal pain, and reduced milk intake. Sometimes Qi/Blood deficiency allows Cold to invade, causing blue lips. Clear saliva dripping indicates impending double tongue or mouth ulcers; sometimes due to Spleen Cold causing drooling. Cracked tongue, bleeding tongue, prickles on tongue indicate extreme heat and Yang toxicity. Mouth sores indicate Heart-Spleen Heat. Rolled tongue indicates fright. Dry, white, black, rough, coated, yellow, or swollen-red tongue indicates constipation; however, black tongue after prolonged diarrhea/dysentery indicates death. Slightly red front of ear indicates deafness. Slightly yellow front of ear indicates Kidney fright and teeth grinding during sleep. Dry ear lobes indicate bone-steaming fever. Green-white face indicates vomiting/diarrhea, impending fright-wind, or body crying. After observing color, one must also consider the season. For example, green face in spring illness is favorable; white face is difficult to treat because Metal overcomes Wood. Others follow this analogy. Generally, red indicates heat, green indicates fright, yellow indicates vomiting/dysentery or accumulation, black indicates critical illness. Rising colors indicate worsening disease; descending colors like dispersing clouds indicate recovery. Each of the five colors corresponds to Zang organs, with external and internal aspects. Color moving from outside to inside indicates disease entering from exterior to interior. Color moving from inside to outside indicates disease exiting from interior to exterior. Diseases originating internally should be treated by addressing Yin first, then Yang; reversing this worsens the condition. Diseases originating externally should be treated by addressing the exterior first, then interior; reversing this worsens the condition. Words are insufficient to exhaust the principles, which are infinite. Fixed patterns should be known as constants, but flexible application is valued according to circumstances. The divine, sage, skilled, and dexterous qualities of physicians lie in endless analogical reasoning.