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Book: Youke Leicui (Essentials of Pediatrics) Author: Wang Luan Dynasty: Ming Chapter: Discussion on the Subjugation, Opposition, Preference, and Injury of the Five Viscera / Formula for Observing Children's Complexion and Form / Pulse and Complexion Theory Category: Comprehensive

The Heart is subjugated by the Kidney, opposed by the Lung, and prefers salty flavor. If injured, it corresponds to the viscera of the third transformation and eighth steaming. When harmonious, the temperament is joyful and happy; when diseased, it primarily manifests as jingxian (startle epilepsy), fear, palpitations, deficiency dryness, crying, delirious speech, mania, and salivation at the corners of the mouth; in variola (smallpox), it presents with red spots.

The Liver is subjugated by the Lung, opposed by the Spleen, and prefers sour flavor. If injured, it corresponds to the viscera of the first transformation and sixth steaming. When harmonious, the Hun (Ethereal Soul) is robust and wisdom arises; when diseased, it primarily manifests as wind-induced spasms, convulsions, swelling, redness, and pain of the eyes; in variola, it presents with vesicles (water blisters).

The Lung is subjugated by the Heart, opposed by the Liver, and prefers pungent flavor. If injured, it corresponds to the viscera of the second transformation and seventh steaming. When harmonious, there is a tendency to laugh, breath is regulated, spirit is clear, and the Hun is strong; when diseased, it primarily manifests as wheezing and fullness, cough, cold damage transforming into deficiency syndrome, and excessive phlegm obstruction; in variola, it presents with suppuration (pus formation).

The Spleen is subjugated by the Liver, opposed by the Kidney, and prefers sweet flavor. If injured, it corresponds to the viscera of the fourth transformation and ninth steaming. When harmonious, digestion of grains is efficient, and diet is palatable; when diseased, it primarily manifests as vomiting and hiccups, ganji (infantile malnutrition), deficiency dysentery, abdominal masses and accumulations, tidal fever, and loss of appetite for milk and food; in variola, it presents with scabbing.

The Kidney is subjugated by the Spleen, opposed by the Heart, and prefers salty flavor. If injured, it corresponds to the viscera of the fifth transformation and tenth steaming. When harmonious, one can walk, sit, lie down, play, speak, and laugh; when diseased, it primarily manifests as blackened teeth resembling broken sand, teeth grinding, teeth chattering, and purulent discharge from the ears; in variola, it presents with black depression (blackening and sinking of lesions).

*Quan Ying Fang* (Complete Infant Formula) states: Infants cannot yet speak, so diseases are indeed difficult to know; one must only observe their complexion and form. Generally, complexion and form have five colors corresponding to the five viscera. The five colors are green, yellow, red, white, and black; the five viscera are Heart, Liver, Spleen, Lung, and Kidney. The Heart color is red, Liver green, Spleen yellow, Lung white, and Kidney black. These are what the five viscera govern; what is stored internally must manifest externally. Therefore, disease in children first appears on the face. If the physical symptoms do not correspond with the complexion, one must further palpate the pulse and listen to the voice.

Danxi stated: To know what is inside, one should observe what is outside; by diagnosing the outside, one can know the inside. For whatever exists within manifests without. If one does not cross-reference and judge the reversal or smoothness of pathogenic factors, it is impossible. A practitioner must illuminate the principles. Thus, observing the five colors—green, yellow, red, white, black—to match the pulses of the five viscera, exhausting whether they correspond or not; palpating the pulse for urgency, largeness, slowness, choppy quality, and depth to match the colors of the five viscera, examining smoothness or roughness. Indeed, carefully observing the subtle colors and diagnosing the subtle pulses, combining internal and external references for treatment, then the merit of ten thousand successful attempts can be achieved effortlessly. *Suwen* says: "One who can combine color and pulse can achieve perfection," which is the meaning here. Tracing back to the Dao, the two qi of Yin and Yang separate into Yin and Yang, scatter into the Five Phases, and what humans inherit includes all of these. The five pulses are the true qi of Heaven, circulating blood and qi, connecting Yin and Yang to nourish the body; the five colors are the brilliance of Qi, corresponding to the Five Phases and harmonizing with the Four Seasons to manifest on the face. Only by observing color and pressing pulse without bias can one then examine the mechanism of disease, determine it by cold and heat, attribute it to the viscera, treat according to the syndrome, and thereby achieve complete salvation. This originates from the ability to combine color and pulse. For example, if the Liver color is like the green of kingfisher feathers, and the pulse is slightly wiry and urgent, this indicates life. But if the pulse is floating, choppy, and short, and the color is like grass growing weeds, how can life be sustained? If the Heart color is like the red of a rooster's comb, and the pulse is mostly floating, large, and scattered, this indicates auspiciousness. But if the pulse is deep, soft, and slippery, and the color appears like dried blood, how can it be smooth? If the Spleen color is like the yellow of a crab's belly, and the pulse is floating and large in the middle, this indicates compliance. But if the pulse is slightly wiry and urgent, and the color appears like the fruit of the Styrax tree, how can it comply? If the Lung color is like the white of pig fat, and the pulse should be floating, choppy, and short, this indicates auspiciousness. But if the pulse is floating, large, and scattered, and the color is like dead bones, how can it be auspicious? If the Kidney color is like the black of crow feathers, and the pulse is deep, soft, and slippery, or comes slow and large, but the color appears like coal, death ensues. The principle of life and death is such that only when diagnosis and observation are combined, as described above, can it be said that when medicine matches the syndrome, a serious illness will not fail to heal. I have previously discussed that visible facial colors have specific locations on the left, right, upper, and lower; pulse movements have specific positions in the Cun, Guan, and Chi areas. The left cheek is the region of the Liver, corresponding to the Guan position of the left hand, belonging to the Liver and Gallbladder divisions, associated with Wind-Wood, representing the initial qi. The forehead is the region of the Heart, corresponding to the Cun kou of the left hand, belonging to the Heart and Small Intestine divisions, associated with Ministerial Fire, representing the second qi. The nose is the region of the Spleen, corresponding to the Guan pulse of the right hand, belonging to the Spleen and Stomach divisions, associated with Damp-Earth, representing the fourth qi. The right cheek is the region of the Lung, corresponding to the Cun pulse of the right hand, belonging to the Lung and Large Intestine divisions, associated with Scorching Metal, representing the fifth qi. The chin is the region of the Kidney, corresponding to the Chi below the left hand, belonging to the Kidney and Bladder divisions, associated with Cold-Water, representing the final qi. As for the principles of mutual generation and overcoming among Yin-Yang and the Five Phases, they should be deduced by combining color and pulse. Thus, *Mai Yao Jing Wei Lun* says: "Color combines with the Five Phases, pulse combines with Yin and Yang." *Nanjing* Thirteen Difficulty says: "Color and pulse should correspond and verify each other." However, the merit of perfect treatment in curing diseases cannot be achieved unless color and pulse are combined. Regarding the lustrous color, the size, slipperiness/choppiness, and floating/sinking of the pulse can be felt by fingers and seen by eyes; subsequently, if color and pulse can be combined, perfection can be achieved. When the Red pulse arrives, it is rapid and firm; when the White pulse arrives, it is rapid and floating; when the Green pulse arrives, it is long and wiry; when the Yellow pulse arrives, it is large and deficient; when the Black pulse arrives, it is firm and large. This speaks of the five colors first, then the five pulses. Those who wish to learn should combine inspection and palpation. Later, Bian Que clarified and narrated this: "Knowing through observation is called Divine; knowing through palpation is called Skillful," deeply grasping the principles of *Neijing*. Later generations who created formulas called them "Divine Skill and Ten Thousand Perfections," which has profound significance.

According to *Nanjing*: The five colors of the five viscera all appear on the face. *Suwen* says: "The change of Shen (Spirit) manifests its brilliance on the face." Observing the five colors: yellow and red indicate Heat, white indicates Cold, green and black indicate Pain. This is what is visible to the eye. Qian Yi said: The left cheek belongs to the Liver, the right cheek to the Lung, the forehead to the Heart, the nose to the Spleen, and the chin to the Kidney. Red indicates Heat, treat according to the syndrome. *Quan Ying Fang* states: The left cheek belongs to the Liver, Eastern position. In spring, slight green is normal, deep green is pathological, white is terminal, red indicates body heat and stiffness, Liver heat generating wind, green-black indicates startle palpitations and abdominal pain, light red indicates tidal fever occurring at night and resting at noon, red and dry lips indicate tight and rapid pulse. The right cheek belongs to the Lung, Western position, located on the right. In autumn, slight white is normal, deep white is pathological, red is terminal, light color indicates tidal fever or hard stool with coarse breathing and cough, green-white indicates cough and nausea, green indicates wind entering the Lung causing frequent cough, green-black indicates impending convulsions or abdominal cramping/intestinal colic. The forehead belongs to the Heart, Southern position. Fire flares upward, so it resides above. In summer, slight red is normal, deep red is pathological, black is terminal, red indicates Wind-Heat in the Heart channel causing dryness, startle palpitations, and restless sleep, green-black indicates evil in the Heart causing startle convulsions and abdominal pain, twitching of hands and feet with crying, severe green-black causes heart and abdominal pain, yellow indicates Ganji with bone heat, thirst, dry skin and hair, night sweats, and yellow brittle hair. The nose belongs to the Spleen, Central position, so it resides in the middle. In the four seasons, slight yellow is normal, deep yellow is pathological, green is terminal, red indicates body heat and loss of appetite for milk/food, deep yellow indicates urinary retention, dry nostrils, coarse breathing, epistaxis, and frequent crying at night, pale white indicates diarrhea and undigested food, green indicates spitting up milk, dry mouth and nose, and difficulty urinating/defecating. The chin belongs to the Kidney, Northern position. Water moistens downward, so it resides below. In winter, slight black is normal, deep black is pathological, yellow is terminal, red indicates exterior-interior relationship between Bladder and Kidney with Heat causing urinary obstruction.

Jiegu said: In general, Liver disease shows white face, Lung disease shows red face, Spleen disease shows green face, Kidney disease shows yellow face, Heart disease shows black face. If Liver disease involves convulsions accompanied by white face, phlegm-saliva, wheezing, and urgency, these are difficult to treat. Infer the rest similarly.

He Chao said: Obtaining the Autumn pulse in Spring definitely indicates death; this is the same meaning.

Qian Yi said: In general, reddish inner canthus in children indicates Heart Heat, treated with Daochi San (Guide Out Red Powder); pale red indicates Heart Deficiency Heat, tonified with Shengxi San (Fresh Rhinoceros Horn Decoction); green indicates Liver Heat, treated with Xieqing Wan (Drain Green Pill); pale/light indicates Deficiency, to be tonified; yellow indicates Spleen Heat, treated with Xiehuang San (Drain Yellow Powder); lack of luster in eyes indicates Kidney Deficiency, treated with Dihuang Wan (Rehmannia Pill). If facial and ocular edema appears, it indicates chronic cough due to Spleen affected by Ganji accumulation. White lips in children indicate spitting saliva, vomiting, hematemesis, or hematochezia; red lips with thirst, drinking, and irritability, especially after prolonged diarrhea where lips remain red, indicate Deficiency syndrome, cool herbs should not be used; yellow lips indicate Spleen affected by accumulation, followed by swelling; purple lips/mouth with spitting saliva indicate worm pain; without spitting saliva indicates accumulation pain; yellow lips/mouth edges like orange indicate bad breath, due to Spleen accumulation heat; blue/cyan lips indicate Blood Deficiency and Spleen Cold, invaded by cold. Lips belong to the Spleen; Wood overcomes Earth, indicating weak Spleen unable to digest food. Dry, white, parched, coated, yellow, or swollen/red tongue in children all indicate constipation, or if bowel movement occurs, the stool will be scorched yellow; cracked tongue, prickles on tongue, or bleeding from tongue all indicate extreme Heat and Yang Toxicity; sores on tongue indicate Heat in Heart and Spleen; curled tongue indicates Startle; black tongue in chronic diarrhea must be moist, do not mistake for Heat, as chronic illness causes Upper Jiao Deficiency Heat; black tongue in chronic dysentery indicates certain death.