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The *Classic of Internal Medicine* states: "To know through observation is called 'Shen' (Spirit/Divine)." Since it is termed "Shen," one must be able to use one's own Shen to resonate with the patient's Shen. The human Shen Qi (Spirit and Vital Energy) resides in the two eyes and permeates the entire body; therefore, it is essential to observe the whole body comprehensively. By observing its clarity or turbidity, one distinguishes between dryness and dampness; by observing its stillness or movement, one distinguishes between Yin and Yang; by observing its presence or absence, one determines life or death. Only in this way is inspection complete, and only then does inspection reach a state of mastery. Mr. Chunshan said: "Human Shen Qi is most authentically revealed in moments of intention or unintention. The physician must clear the mind and concentrate the spirit, perceiving it instantly upon meeting. One should not be overly rigid; rigidity gives rise to subjective bias, causing the physician's and patient's Shen Qi to mix, resulting in ambiguity and difficulty in grasping the condition. This is the profound principle of using Shen to comprehend Shen." Let us discuss complexion based on color. The classics state that the five colors correspond internally to the five Zang organs: Green belongs to Liver Wood, Red to Heart Fire, Yellow to Spleen Earth, White to Lung Metal, and Black to Kidney Water. This describes the normal state. However, in disease, there are variations, and sometimes the five colors do not correspond to the five Zang organs; this is a variation within variation. In summary, regardless of the color, there must be Shen Qi. What is meant by Shen Qi is having both "Guang" (Luster/Brightness) and "Ti" (Substance/Moisture). Guang refers to external brightness; Ti refers to internal moistness. Guang is formless, governing Yang and Qi; Ti has form, governing Yin and Blood. When Qi and Blood are harmonious and Yin and Yang do not contend, naturally both Guang and Ti are present. The classics say: "The healthy Heart color is like cinnabar wrapped in white silk; the healthy Lung color is like red wrapped in white silk; the healthy Liver color is like cyan-red wrapped in white silk; the healthy Spleen color is like a trichosanthes fruit wrapped in white silk; the healthy Kidney color is like purple wrapped in white silk." This is because when the five Zang organs are harmonious in healthy individuals, their colors derive from Stomach Qi and manifest between the skin and hair. Stomach Qi color is yellow, skin/hair color is white, essence and Qi are contained internally, and precious luster radiates externally. It is neither floating/exposed nor muddy/confused, hence described as "wrapped in white silk." It also says: "The bright and clear manifestation of the five colors is the splendor of Qi." Red should be like white wrapping cinnabar, not like jasper (dark red); White should be like goose feathers, not like salt (pale/dull); Green should be like the luster of dark green jade, not like indigo (dull); Yellow should like silk wrapping realgar (bright/moist), not like yellow earth (dry); Black should be like heavy lacquer (shiny), not like earthy soil (dull). Repeating this emphasizes the meaning of having Shen Qi. Essentially, having Shen Qi means having Stomach Qi. It also says: "Green like dead grass indicates death; Yellow like dried zhi shi fruit indicates death; Black like soot indicates death; Red like clotted blood indicates death; White like dry bone indicates death." These represent the loss of Qi and Blood, lacking both Guang and Ti, where Shen Qi has departed. It also says: "Green like kingfisher feathers indicates survival; Red like chicken comb indicates survival; Yellow like crab belly indicates survival; White like pig fat indicates survival; Black like crow feathers indicates survival." These indicate that although Qi and Blood are diseased, Shen Qi is not injured; there is Guang and Ti, but the essence cannot be fully contained and leaks outward. Observing the discussion on color in the *Inner Canon*, it is divided into three levels: normal, diseased, and terminal. Although "Shen Qi" is not explicitly stated, it is implied within.

Someone asks: "Diseases vary infinitely; how can complexions be distinguished?" I reply: "Heaven and Earth are nothing but dryness and dampness; diseases are nothing but dryness and dampness; complexions are nothing but dryness and dampness. Dryness belongs to Heaven Qi, and complexions often have luster and appear floating; Dampness belongs to Earth Qi, and complexions often have substance and appear dull. Wind-dryness and Cold-dryness, caused by external pathogenic binding, govern contraction. Contraction leads to tension, so facial complexions are often tight and bright; Dryness combining with body fluids and phlegm-fluids overflowing onto the face results in complexions that are reddish and floating; if combined with dampness, they are reddish and dull; if Dryness transforms into Heat, complexions are often dry and red, with orifices being dry and rough, accompanied by irritability and thirst. Severe cases may turn dry and cyan-black; dry and cyan-black indicates extreme deficiency of True Yin, resulting in a complexion lacking both Guang and Ti. Internal Cold-Dampness causes complexions to be stagnant and dark; changes to yellow or black are all deep, dull, and unclear. Dampness combined with Wind results in moist and floating complexions, often with spontaneous sweating; Dampness combined with Summer-heat or Heat, or Warm pathogens generated by Damp-Earth stagnation and steaming—all these enter via the mouth and nose. The San Jiao (Triple Burner) governs steaming and dispersing. Dispersal leads to relaxation, so facial complexions are often loose, greasy, and dull. In severe cases, turbid pathogens steam internally and overflow externally, resembling oil or smoke stains. If Dampness transforms into Dryness, the complexion becomes both dull and dry; dull and dry indicates that Dampness remains while True Yin is deficient, resulting in a complexion lacking both Guang and Ti.

Someone asks: "How do locations correspond?" I reply: "The classics state that Heart Heat disease causes the forehead to redden first; if cyan-black appears, it indicates sudden illness. Lung Heat disease causes the nose to redden first. A green nose indicates abdominal pain; slightly black indicates fluid retention. A yellow nasal tip indicates difficult urination; white indicates Qi deficiency; fresh red indicates retained fluids. It also says: Lung Heat disease causes the right cheek to redden first; Liver Heat disease causes the left cheek to redden first; Kidney Heat disease causes the chin to redden first, and also indicates Bladder Heat accumulation with urinary obstruction. Liver disease manifests as cyan around the eyes; Red indicates Heat; Yellow sclera indicates Jaundice; Yellow eyeballs indicate recovery. It also says: Heart disease manifests as red cheeks; Kidney disease manifests as black-yellow on the cheeks and forehead (Yan refers to the Tian Ting area above the eyebrows). Redness appearing on both cheeks, the size of a thumb, indicates sudden death. It also says: Complexions mostly cyan indicate pain; Black indicates Bi syndrome (e.g., cold-type cholera with obstruction, where complexion and collaterals appear black); Yellow-Red indicates Heat; Mostly White indicates Cold; Appearance of all five colors indicates mixed Cold and Heat. The classics' statements on location corresponding to Zang-Fu organs and distinguishing diseases by five colors are too numerous to list. Students must know them but not adhere rigidly (since transmission between exterior-interior and Yin-Yang is rapid, rigidity is inadvisable). One should weigh the general principles, using Dryness and Dampness as the outline, considering combinations with Wind, Cold, Summer-heat, transformation into Fire, or non-transformation as variables, and using the Guang and Ti of the complexion as indicators of Shen Qi. The Great Dao essentially encompasses only Yin and Yang.

After inspecting the complexion, one must examine the form and orifices. The head is the convergence of all Yang meridians. Due to Dampness, the head feels wrapped, and the eyes seem obscured; Phlegm-Fluids attacking the head cause dizziness and vomiting of phlegm-water; Blood Dryness generating Wind also causes dizziness, scalp itching, and hemi-cephalic headache. There is also Kidney Water deficiency leading to Dryness, Yin failing to anchor Yang, and rebellious Qi ascending—this is what the classics call Headache and Cephalic Disease, characterized by deficiency below and excess above. There is also Liver-Gallbladder Dryness-Heat, excessive Wood generating Wind, leaving the ears and eyes without Blood nourishment—this is what the classics call Xun Meng Zhao You (dizziness and tinnitus/deafness), closed eyes, deafness, excess below and deficiency above. (The word "Excess" here refers to Deficient Fire, not true Excess.) There is also Head Drooping relative to the body, named "Tian Zhu Bone Collapse," indicating failure of Yuan Qi (Original Qi); this is a lack of Shen Qi in the head.

The Liver opens into the Eyes (the Liver meridian connects to the eye system). Dryness diseases result in bright, piercing eyes; Dampness diseases result in dim, obscured eyes. Extreme Dryness leads to tearlessness and dryness; extreme Dampness leads to yellow, ulcerated eyeballs, or eyelids swollen like sleeping silkworms. Yangming Fu-organ Excess presents with delirium and hallucinations. Heat entering the Blood Chamber, consuming Blood and injuring Yin, presents with clarity during the day but whispering to oneself at night, as if seeing ghosts. Opening eyes to see people indicates Yang disease; closing eyes and avoiding people indicates Yin disease. Loss of Yang leads to seeing ghosts; Loss of Yin leads to blindness; Loss of both Yin and Yang indicates critical illness. Eyes with discharge and tears, containing inner brilliance, possess Shen Qi; eyes without discharge or tears, with blue whites, dull pupils, lost inner brilliance, or exposed floating light, lack Shen Qi. Generally, if a patient can recognize people with their eyes, the condition is mild. If eyes are dim and unable to recognize people, or exhibit fixed gaze, oblique gaze, small eyes, staring eyes, perfectly round eyeballs, upward deviation (Dai Yan), opisthotonos, or sunken eyelids, Shen Qi has departed, and the condition is mostly incurable. Fixed, oblique, or upward gazes, or slight movement after a period of fixation, may be due to Phlegm obstruction and cannot be universally deemed incurable.

The Lungs open into the Nose. Dryness diseases cause a dry nose; Dampness diseases cause a moist nose. Clear rhinorrhea indicates Wind-Cold; turbid rhinorrhea indicates Heat. Dry nostrils resembling soot indicate extreme Yang Toxic Heat; cold, slippery, black nostrils indicate extreme Yin Toxic Cold. Phlegm-Fluids obstructing Lung Qi cause noisy breathing; Lung-Kidney collapse causes faint respiration, or panting with raised shoulders and flaring nares. Faint respiration and flaring nares indicate the dispersion of Shen Qi.

The Kidneys open into the Ears; the Heart has an orifice in the ears; the Gallbladder meridian connects to the ears. Sudden deafness, ear swelling, ear pain, and redness around the ears belong to Shaoyang Wind-Heat-Dryness pathogens, or Liver-Gallbladder Heat combined with turbid Dampness rising and obstructing. Chronic deafness belongs to Qi deficiency or Essence depletion. If ears are dry, shriveled, and covered in dust, it indicates extreme Kidney Water deficiency; this is also a case of internal lack of Essence and external lack of Shen Qi.

The Spleen opens into the Mouth. Bitter taste indicates Dryness-Heat; sweet taste indicates Damp-Heat. Red, swollen, dry lips and mouth indicate extreme Heat; cyan-black and moist indicate extreme Cold. Scorched and red is treatable; scorched and black is difficult to treat. Pale white indicates Qi deficiency; pale white and lusterless indicates fluid deficiency. Cyan lips with inversion, black ring around the mouth, continuous trembling of lips and tongue, mouth like a fish's gape, and breath that does not return indicate death, due to the departure of Shen Qi.

The Heart opens into the Tongue; the large collateral of the Spleen ties to the root of the tongue; Liver and Kidney meridians also connect to the root of the tongue. Wooden tongue, double tongue, and tongue bleeding belong to Heart Meridian Dryness-Heat. Tongue fungus, tongue pad, and tongue swelling blocking the mouth belong to Spleen Meridian Damp-Heat combined with Heart Fire rising. Stiff tongue root indicates Heat combined with Phlegm. Rolled, short, flaccid, or shriveled tongue indicates exhaustion of Liver-Kidney Yin and lack of Shen Qi in the tongue. Tongue coating is like ground moss. Ground moss grows from moisture rising; tongue coating grows from Spleen-Stomach fluids rising. Thus, healthy individuals usually have a layer of floating white or floating yellow coating on the tongue. In summer, when Damp-Earth governs, the coating is often thicker and slightly yellow, but not full or stiff. Those with chronic Spleen-Stomach Damp-Heat often have thick white coating year-round, or gray-yellow in the center. When ill, Spleen-Stomach fluids are constrained by pathogens, or due to diarrhea/dysentery causing Spleen Qi sinking, the tongue may lack coating or be thinner than usual. Those with insufficient Stomach-Kidney fluids often have red tongues without coating, a red line in the center, or red dots on the tip and sides. This is the general overview of healthy tongue coatings. When diseased, the tongue always shows coating; disease hides inside, coating manifests outside, providing reliable evidence. Physicians rely heavily on this! This must not be ignored.

Wind-Cold is a Cold-Dryness pathogen; Wind-Warmth is a Warm-Dryness pathogen. Wind-Cold initially affects the exterior; Wind-Warmth first injures the Lung Qi level. Thus, the tongue often lacks coating; even if yellow-white coating exists, it is thin and slippery. Gradually transmitting inward, combining with Stomach Fu waste matter, the coating becomes thick, changing from white to yellow, black, and dry, appearing stiff and unventilated. After purgation, the coating begins to rot (become loose and not stiff). As it recedes, a new thin floating coating grows, indicating complete resolution of pathogens. Some have initial white coating dry as white sand, named "White Sand Coating," indicating severe Warm-Dryness pathogen; rapid purgation with sweet-cool fluids rescue is indicated. Some have black coating but not dry, or yellow-black coating with one or two white strips, or dry front but thick white root; these are due to combined Dampness or Phlegm-Fluids. Some have yellow-black coating but thin and lacking "geological base" (substance underneath), indicating Stomach Yin deficiency. Whether coating has a geological base is a major distinction between Excess and Deficiency.

Dampness is a turbid pathogen with many complications. Wind-Damp injuring the exterior results in slippery, thin white coating; Cold-Damp injuring the interior results in greasy, thick white coating. Summer-Warmth, Damp-Warmth, Warm Epidemic, and Warm-Thermal diseases are all vapors of Damp-Earth stagnation and steaming. Winter-Warmth, due to Yang failing to hide, is also residual vapor of Damp-Earth steaming. These all enter via mouth/nose into the Lung-Stomach membrane source, emerging from the interior. Spring-Warmth results from winter Cold injury; Cold stagnates and transforms into Heat over time. Cold-Dryness binds fluids and water-Phlegm, hiding in the membrane source, mixing with Heat, emerging from the interior. Late-onset Summer-Dampness is named "Hidden Summer-Heat," resulting from summer Summer-Heat/Dampness hiding in the membrane source, triggered in autumn by cool-dryness constraining the internal Summer-Heat/Dampness; this is exterior pathogen triggering interior pathogen. Summer-Dampness Malaria also arises thus. According to the Six Qi pathogens, there are Thief Pathogens, Seasonal Pathogens, and Hidden Pathogens. Sudden Wind-Cold infection is called Thief Pathogen. Thief Pathogens are sharp, acting immediately upon infection, unable to hide. Wind-Warmth, Warm-Thermal, Summer-Warmth, Damp-Warmth, Warm Epidemic, and Winter-Warmth are all infections of seasonal qi, such as spring Wind-Yang transforming into Heat or summer Damp-Earth steaming qi, hence called Seasonal Pathogens. (Wind-Yang transforming into Heat is still righteous Qi; Damp-Earth steaming is often unrighteous Qi.) Seasonal Pathogens may hide before acting but cannot stay long. Spring-Warmth and Hidden Summer-Heat are called Hidden Pathogens. As classics say: "Winter Cold injury leads to Spring Warmth; Summer Heat injury leads to Autumn Malaria." These act out of season. Someone asks: "Why do Cold and Heat pathogens hide and act later?" I reply: "Hidden Pathogens are Righteous Pathogens. Cold is the normal Qi of Winter; Heat is the normal Qi of Summer. Normal Qi affecting humans enters gradually, often unnoticed. The *Ling Shu* says: 'Righteous Pathogens affect people as if present yet absent, existing yet gone.' This makes people unaware of the infection at the time, allowing it to hide. Both Hidden and Seasonal Pathogens emerge from the interior and often combine with Dampness. Thus, initially, the tongue has white coating, thick not thin, greasy not slippery, or coarse like accumulated powder, or pale yellow. When transmitting to Stomach and transforming into Fire, combining with waste matter, it changes from white to yellow, black, and dry. Summer-Warmth and Damp-Warmth pathogens are often mixed yellow-white, looking like yellow or white, or greasy yellow, or gray-yellow, but never dry. For such coatings, even if purgation indications exist, or constipation/unsmooth stool, ripe Da Huang should be used gently for purgation. Since the coating is not dry, there is likely no dry feces in the intestines, often resembling fermented bean curd residue; thus, harsh purgation is unsuitable.

This is the general overview of tongue coatings for Dryness, Dampness, and mixed Dryness-Dampness pathogens. Let us elaborate on Ye Tianshi's discussions. Initial white coating lacking tightness: use Sang Ye (Mulberry Leaf), Lou Pi (Trichosanthes Peel) to lightly clear Dryness-Heat; assist with Shan Zhi Pi (Gardenia Peel), Lian Qiao Qiao (Forsythia Husk) which are slightly bitter and dry, as Dryness belongs to Metal, and slight bitterness can overcome it. White coating with crimson base indicates Dampness suppressing Heat; prevent drying, use pungent-light and clear methods to drain Dampness and vent Heat, ensuring Dampness does not suppress Heat. Example: San Ren Tang replacing Kou Ren with Kou Pi, assisting with Hua Shi (Talc), Dan Zhu Ye (Lophatherum Leaf), Lu Gen (Reed Rhizome) to clear and transform. Initial disease with thin, dry white coating indicates Stomach-Kidney Yin deficiency. If spirit is not confused, use Xiao Sheng Di (Rehmannia), Yuan Shen (Scrophularia), Mai Dong (Ophiopogon) to save Yin (dosage should not be too large, lest it suppress hidden pathogens). Yin Hua (Honeysuckle), Zhi Mu (Anemarrhena), Lu Gen, Zhu Ye (Bamboo Leaf) to resolve pathogens; especially add Pungent-Moist agents to vent. If spirit is confused, add opening-closing agents like Pu Ji Dan (Universal Relief Pill) or Ning Shang Wan (Calm Upper Pill); delay leads to internal closure and external collapse, untreatable. Thick, dry white coating: purge with Tiao Wei Cheng Qi Tang, assist with clearing-moistening Yin-nourishing agents like Xian Sheng Di (Fresh Rehmannia), Yuan Shen, Li Zhi (Pear Juice), Lu Gen (take their clearing-moistening property to avoid stagnating pathogens). White, greasy, non-dry coating with extreme stuffiness indicates heavy Spleen Dampness; use Jia Jian Zheng Qi San or San Ren Tang, remove Yi Yi Ren, Lu Gen, Hua Shi, add Xing Tou Cao, Shen Qu, use pungent-light to open-transform, aromatic to expel turbidity. Tongue swollen and unable to retract indicates extreme Spleen Dampness-Stomach Heat stagnation, toxin spreading to mouth; add raw Da Huang juice to the previous method to benefit, reducing swelling. White, thick, sticky-greasy coating with sweet taste and turbid saliva indicates Pi Dan (Spleen Sweetness), caused by Spleen-Stomach Damp-Heat gathering and combining with Grain Qi, overflowing upwards; use Jia Jian Zheng Qi San with Xing Tou Cao and Shen Qu. Coating like alkali color, or white coating with one or two yellow strips, indicates old stagnation combined with turbid pathogens; add middle-opening and stagnation-resolving drugs to the previous method, otherwise fear closure preventing emergence from membrane source. White coating thick like accumulated powder with purple-crimson tongue edges indicates Warm pathogen from Damp-Earth steaming, developing into Warm Epidemic; imitate Da Yuan Yin or San Ren Tang modified to vent pathogens, preventing transmission. White coating not dry, or mixed yellow-white, or gray-white without thirst: carefully avoid bitter-draining purgation. This indicates Dampness stagnation not yet reached, or chronic Phlegm-Fluids; even with epigastric fullness-pain, do not attack; use opening-transforming agents like Xing (Apricot Seed), Kou (Cardamom), Zhi (Immature Bitter Orange), Jie (Platycodon), Chen Pi (Tangerine Peel), Fu Ling (Poria), Tong Cao (Rice Paper Stem). Yellow-turbid coating with chest-diaphragm tenderness or spontaneous pain/fullness indicates mixed Damp-Heat; use bitter-descending and pungent-unblocking agents like Lou Bei Wen Dan Tang, Xiao Xian Xiong Tang, Ban Xia Xie Xin Tang, Huang Qin Hua Shi Tang. However, yellow must have a geological base to use bitter-pungent heavy agents; if smooth yellow, it is formless Damp-Heat showing deficiency signs; use Lou, Bei, Zhi, Qiao with slight pungent-bitter to lightly open-transform; strictly avoid bitter-pungent heavy agents. Old yellow or gray-yellow like agarwood coating, with geological base, not slippery but rough, or with cracks, or thick center coating, indicates pathogen transmitted to interior (Stomach/Intestine Fu) combining with old stagnation; epigastrium/abdomen must be full and painful; purgation is required. If this coating is not seen, fear Dampness gathering in Taiyin causing fullness, Cold-Heat-Damp mixture causing pain, or Dampness blocking Qi mechanism causing distension; still follow pungent-light-warm method to open-transform. Thin, dry yellow coating treated same as thin, dry white coating. Heat pathogen transmitting to Ying level results in crimson tongue without coating. Crimson tongue with mixed yellow-white coating, or coating-like appearance, indicates Qi-level suppressed Heat scorching fluids, not Blood level. Use previous Pungent-Moist pathogen-venting, light-clear Heat method; strictly avoid Bitter-Cold ice-freezing and Yin-soft greasy agents, which cause Qi-level pathogens to suppress and sink inward, resulting in pure crimson without coating. Pure crimson, bright, glossy tongue with confusion (not due to ice-freezing) indicates pathogen transmitting to Pericardium; use Xi Jiao (Rhinoceros Horn - substitute with Buffalo Horn), Xian Di Huang, Yin Qiao, Yu Jin, Xian Shi Chang Pu, Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice) to clear-transform, assisting with Pungent-Moist opening-closing. If person chronically has Phlegm, external Heat sinking closes interior collaterals; must combine Ning Shang Wan, Pu Ji Dan pills; delay risks extreme closure, convulsions. Crimson tongue looks dry but feels moist indicates chronic fluid deficiency, Damp-Heat steaming, turbid Phlegm obscuring Pericardium; use light-clear Heat, assist with Ning Shang Wan to open. Purple-dark tongue feeling moist indicates chronic Blood stasis in chest-diaphragm combining with Heat; use Xian Di Huang, Xi Jiao, Dan Pi, Dan Shen, Chi Shao, Yu Jin, Hua Fen, Tao Ren, Ou Zhi to cool-blood and resolve stasis; otherwise stasis-Heat combine, blocking orifices, leading to mania. Purple and swollen tongue indicates Wine Toxic rushing Heart; add raw Da Huang juice to previous method. Crimson tongue wanting to extend but hitting teeth indicates Phlegm blocking tongue orifice, internal Liver Wind stirring; add Zhu Li, Jiang Zhi, Dan Xing (Arisaema with Ginger), Chuan Bei (Fritillaria) to clearing-transform agent to resolve Phlegm-Heat; strictly avoid greasy agents suppressing Fire. Crimson and dry tongue indicates Evil Fire injuring Ying; use Xi Jiao Di Huang Tang. Cases suppressed by Cold-Cool Yin-Soft agents often become drier with clearing and drier with nourishing; use sweet-neutral/sweet-moist agents assisting with Pungent-Moist to vent pathogens, restoring fluids. Crimson tongue with yellow-white spots indicates impending aphthae; white mold-like coating or erosion points in mouth/tongue named Kou Mi (Mouth Ulceration), due to Stomach-Kidney Yin deficiency, lack of central pillar, Damp-Heat dominance, mixed steaming; condition is difficult to treat;酌情 use Dao Chi San, Xi Jiao Di...