（若身黄面黑于黑疸求之）
〔《难》〕肾外证，面黑善恐欠。（十六难）
〔罗〕阴出乘阳。一妇人年几三十，忧思不已，饮食失节，脾胃有伤，面色黧黑不泽，环唇尤甚，心悬如饥
状，又不欲食，气短而促。大抵心肺在上，行荣卫而光泽于外，宜显而藏。肾肝在下，养筋骨而强于内，当隐
而不见。脾胃在中，主传化精微以灌四旁，冲和而不息，其气一伤，则四脏失所，忧思不已，气结而不行。
饮食失节，气耗而不足，使阴气上溢于阳中，故黑色见于面。又经云∶脾气通于口，其华在唇，今水反来侮
土，故黑色见于唇，此阴阳相反，病之逆也。上古天真论云∶阳明脉衰于上，面始焦。故知阳明之气不足，
非助阳明生发之剂，无以复其色，故以冲和顺气汤主之。
升麻（一钱） 葛根（一钱半） 甘草（四分） 芍药（三分） 白芷（一钱） 黄 （八分） 防风（一钱）
人参（七分） 苍术（三分）
〔《内经》〕曰∶上气不足，推而扬之。以升麻苦平，葛根甘温，自地升天，通行阳明之气为君。人之气以天地
之风名之，气留而不行者，以辛散之。防风辛温，白芷甘辛温，以散滞气为臣。苍术苦辛，蠲除阳明经之寒。
白芍药之温酸，安太阳经之怯弱。《十剂》云∶补可去弱。人参、羊肉之属。人参、黄 、甘草甘温，补益正
气为佐。至真要大论云∶辛甘发散为阳，生姜辛热，大枣甘温，和荣卫，开腠理，致津液以复其阳气，故以为使。
上件 咀，都作一服，水二盏，姜三片，枣二枚，同煎至一盏，去渣，温服。早饭后，午饭前，取阳升之
时，使人之阳气易达故也。数服而愈。
〔孙〕樊楼有店家刘三，一日满面皆黑色，有相者断云，不过月余死。既过月，且安。孙入店与客饮酒，
遂拜孙述说其病状。孙特与诊之曰∶非病也，乃为臭气所熏，秽气蓄于面部不散，故有此色。问刘曰∶汝一月
前闻甚一阵非常臭气不能避耶。刘曰∶一日登溷，其厕臭气不可闻，隐忍良久，下厕，明日遂有此疾。孙曰∶
去至臭无过至香，我家有南人将至售香，可用沉、檀二香各一两，碎掰焚于炉中，安帐内以熏，绢被盖定，勿
令香气散，可端坐香边，瞑目静坐，候香气散方可出帐。明日，引鉴照之。刘根据其言，面色渐变，旬日如故。
（肾臭腐属水，脾臭香属土，今夫厕臭者腐臭也，故闻之则入肾而面黑，沉香者香臭也，故熏之则睥土胜肾水
而色还也。）
针灸 面黑有二法∶
其一取胃。经云∶胃足阳明之脉是动，则病洒洒振寒，颜黑。
其二取肾。经云∶足少阴之脉是动，则病饥不欲食，面如漆柴，视盛虚热寒陷下取之也。
少阴终者，面黑齿长而垢，腹胀闭。（全文见诊生死，下同。）
太阴终者，腹胀闭不得息，善噫呕逆则面赤，不逆则面黑，皮毛黑。
(If the body is yellow and the face is black, seek the etiology from Black Jaundice [Hei Dan].)
[From *Nan Jing*] The external manifestations of Kidney disorders include: a dark complexion, predisposition to fear, and frequent yawning. (Chapter 16)
[Luo Tianyi's Discussion] Yin pathogenic factors attacking Yang. A woman, nearly thirty years old, suffered from incessant worry and overthinking, with irregular diet leading to Spleen-Stomach injury. Her complexion was dark and lusterless, especially around the lips. She experienced a sensation of emptiness in the heart as if hungry, yet had no desire to eat, accompanied by shortness of breath and rapid respiration. Generally, Heart and Lung reside superiorly, circulating Ying and Wei Qi to provide luster to the exterior; they should be manifest yet hidden internally. Liver and Kidney reside inferiorly, nourishing sinews and bones to strengthen the interior; they should be concealed and not visible. Spleen and Stomach reside centrally, governing the transformation and transportation of refined essences to irrigate the four directions, maintaining harmonious Qi without cessation. Once Spleen-Stomach Qi is injured, the other four Zang organs lose their support. Incessant worry causes Qi stagnation and failure to circulate; irregular diet causes Qi consumption and deficiency. This allows Yin Qi to overflow into the Yang aspect, resulting in black color appearing on the face. Furthermore, the Classics state: "The Spleen opens into the mouth, and its brilliance manifests in the lips." Now, Water Qi rebels against Earth Qi, hence black color appears on the lips. This represents an inversion of Yin and Yang, indicating a contrary disease progression. *Shanggu Tianzhen Lun* states: "When the Maiyang [Stomach] channel declines above, the face begins to wither." Thus, it is known that Maiyang Qi is insufficient. Without agents that assist the generation and rising of Maiyang Qi, one cannot restore the complexion. Therefore, Chonghe Shunqi Tang is used as the principal formula.
Shengma (Cimicifugae Rhizoma, 1 qian), Gegen (Puerariae Lobatae Radix, 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 4 fen), Shaoyao (Paeoniae Radix Alba, 3 fen), Baizhi (Angelicae Dahuricae Radix, 1 qian), Huangqi (Astragali Membranacei Radix, 8 fen), Fangfeng (Saposhnikoviae Radix, 1 qian), Renshen (Panacis Ginseng Radix, 7 fen), Cangzhu (Atractylodis Rhizoma, 3 fen).
[From *Nei Jing*] It says: "When Qi in the upper part is insufficient, push and elevate it." Shengma, being bitter and neutral, and Gegen, being sweet and warm, ascend from earth to heaven, circulating the Qi of the Yangming channels, serving as the Sovereign drug. Human Qi is named after the wind of Heaven and Earth; when Qi remains stagnant and fails to circulate, it should be dispersed with acrid substances. Fangfeng, acrid and warm, and Baizhi, sweet, acrid, and warm, disperse stagnant Qi, serving as the Minister drugs. Cangzhu, bitter and acrid, eliminates Cold in the Yangming channel. The warm and sour nature of Baishao (White Peony Root) calms the weakness of the Taiyang channel. *Shi Ji* states: "Tonification can remove weakness," such as Renshen and mutton. Renshen, Huangqi, and Gancao are sweet and warm, tonifying righteous Qi, serving as the Assistant drugs. *Zhizhen Yao Da Lun* states: "Acrid and sweet diffuse and are Yang." Shengjiang (Fresh Ginger), acrid and hot, and Dazao (Jujubae Fructus), sweet and warm, harmonize Ying and Wei, open the Couli (pores), promote fluid production to restore Yang Qi, thus serving as the Envoy drugs.
Chop the above ingredients together for one dose. Add two zhan of water, three slices of ginger, and two jujubes. Decoct until one zhan remains, strain, and take warm. Take this after breakfast but before lunch, selecting the time when Yang Qi rises, so that human Yang Qi can easily reach the exterior. After several doses, the patient recovered.
[Sun Simiao's Record] There was a shopkeeper named Liu San at Fanlou. One day, his entire face turned black. A physiognomist predicted he would die within a month. However, after a month passed, he remained safe. Sun Simiao entered the shop to drink with guests, and Liu San bowed to Sun, recounting his condition. Sun examined him and said: "This is not a disease, but rather薰熏 (smoke/fume) damage from foul odors. Filthy Qi has accumulated on the face and failed to dissipate, causing this color." He asked Liu: "Did you smell a very unusual foul odor about a month ago that you could not avoid?" Liu replied: "One day I went to the latrine; the stench was unbearable. I endured it for a long time before entering. The next day, this ailment appeared." Sun said: "To remove extreme filth, nothing surpasses extreme fragrance. My home has Southerners coming to sell incense. Use Chenxiang (Aquilaria Lignum Resinatum) and Tanshen (Santalum Album Lignum) each one liang. Crush them and burn them in a censer, place it inside a tent to fumigate, cover tightly with silk quilts to prevent fragrance from escaping. Sit upright beside the incense, close your eyes, and meditate quietly. Only exit the tent when the fragrance dissipates. The next day, look in a mirror." Liu followed these instructions. His complexion gradually changed, and within ten days, it returned to normal.
(The Kidney corresponds to putrefactive odor and belongs to Water; the Spleen corresponds to fragrant odor and belongs to Earth. The latrine odor is putrefactive; smelling it enters the Kidney causing black face. Agarwood is fragrant; fumigating with it strengthens Spleen Earth over Kidney Water, restoring the complexion.)
Acupuncture treatment for facial blackness involves two methods:
First, select Stomach channel points. The Classics state: "When the Foot-Yangming Stomach channel moves abnormally, it causes shivering chills and blackening of the face."
Second, select Kidney channel points. The Classics state: "When the Foot-Shaoyin Kidney channel moves abnormally, it causes hunger without desire to eat, and a face as black as lacquered wood. Treat based on observation of excess/deficiency, heat/cold, or sinking/depression."
When the Shaoyin channel Qi terminates, the face turns black, teeth appear elongated with垢 (dirt/plaque), and abdominal distension with closure occurs. (See full text in Diagnosis of Death/Life section, same below.)
When the Taiyin channel Qi terminates, there is abdominal distension and closure preventing breathing, frequent belching and vomiting leading to red face; if no vomiting occurs, the face turns black, and hair/skin becomes black.