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(From *Lingshu: Wuse Pian* [Spiritual Pivot: Chapter on Five Colors])
The manifestation of the five colors appears in their respective color regions. If the bone structure of a region is depressed, illness is inevitable.
If the color in a region shows mutual generation (Chengxi [Succession], referring to the color and region having a mutually generating relationship, such as seeing wood color in a water region), even if the illness is severe, death will not occur. (Chengxi refers to the color and region having a mutually generating relationship, for example, seeing wood color in a water region. The upper part of the bone is protruding.)
*Qianjin Fang* [Essential Prescriptions Worth a Thousand Gold] states: In observing the depression and protrusion of bones in various facial regions, illness must arise. The Shaoyang Gallbladder channel corresponds to the Liver's color region; the Taiyang Small Intestine channel corresponds to the Heart's color region; the Yangming Stomach channel corresponds to the Spleen's color region; the Yangming Large Intestine channel corresponds to the Lung's color region; alongside the Bladder and Taiyang channels corresponds to the Kidney's color region. If these regions are depressed, death is certain. Zang organ Qi connects internally, and external manifestations respond accordingly.
Deep and turbid color indicates internal disease; floating and clear color indicates external disease. If color moves from outside to inside, the illness originates externally, and the region protrudes. If color moves from inside to outside, the illness originates internally, and the region depresses. For internally originated illness, treat Yin first, then Yang; for externally originated illness, treat Yang first, then Yin.

Note: The specific locations of the so-called "Five Yang" color regions on the face are unclear. Compared with the previous diagram description, there are both matches and mismatches. If divided according to the previous diagram description: The Shaoyang Gallbladder/Liver color region is the nasal bridge; the Taiyang Small Intestine/Heart color region is the area connecting the Shan Gen [root of the nose] below both eyes; the Yangming Stomach/Spleen color region is the nasal tip; the Taiyang Bladder/Kidney color region is the perioral area; the Yangming Large Intestine/Lung color region seems to refer to the Que Zhong [between the eyebrows], not the Ren Zhong [philtrum]. With this interpretation, the theory becomes coherent and the facts verifiable.

Each of the five colors has corresponding Zang organ regions, divided into external and internal parts. If color moves from the external part to the internal part, the illness spreads from exterior to interior; if color moves from the internal part to the external part, the illness spreads from interior to exterior. For illnesses originating internally, treat Yin first, then Yang; reversing this order worsens the condition. For illnesses originating externally, treat the exterior first, then the interior; reversing this order worsens the condition. (This section discusses the division of external and internal regions.)

When all five colors—Green, Black, Red, White, Yellow—are present, they should be upright and full, and distinct from other regions (Bie Xiang [Different Region], referring to the distinction between internal and external regions). If the color is sharp at the top and hollow at the head (Shang Sheng [rising tone], indicating upward inclination), sharp at the bottom and downward inclined, it follows this pattern on the left and right. Left corresponds to the left side, right to the right side. If the color carries pathogenic factors, appearing scattered and not upright or full, this indicates the pathological signs shown by the facial complexion. If the color moves upward, the illness worsens. If the color moves downward like dissipating clouds, the illness is about to resolve. (This refers to "upward movement as adverse, downward movement as favorable." Duan Man [Upright and Full] means that humans naturally have a distribution of five colors; those with normal colors fully covering the face are not ill. When pathogenic, only the pathogenic color appears, either gathered or scattered, failing to be upright and full. Thus, there is a region where the color originates and a region it points to, known as Bie Xiang. Hua Tuo stated that balanced facial and eye colors indicate health; imbalance indicates illness. This refers to the color appearing uniquely, differing from other regions. Therefore, observation of color uses an initial size like a thumb as the standard. This section discusses dividing regions up, down, left, and right.)

When each of the five colors manifests in its respective region, observe its floating or sunken nature to know depth; observe its luster or dullness to judge prognosis; observe its dispersion or condensation to estimate duration; view the vertical movement of color to locate pain; concentrate your spirit to understand past and present conditions. Thus, without careful observation of Qi, one cannot discern right from wrong; maintaining focus allows one to distinguish new from old diseases. If the color is bright but not coarse, yet appears sunken and dull, the illness is severe. If the color is neither bright nor lustrous, the illness is mild. If the color is dispersed, moving lightly like a galloping horse without condensing, the illness is scattered with Qi pain, but no accumulation has formed yet. (This section covers floating/sunken, luster/dullness, condensation/dispersion, and new/old diseases.)

When Kidney Qi overacts on Heart Qi, the Heart falls ill first, and the Kidney provides the response; color changes follow this pattern. (Meaning: Kidney color appears in the Heart region first, followed by the Kidney region showing its own color; the same applies to other Zang organs.) In men, if the color (referring to blackness inheriting from the Kidney) appears at the Mian Wang [nose tip], it indicates abdominal pain (Shou Fu, meaning great abdomen); lower down, it indicates testicular pain. If round and straight, it indicates penile pain; high represents the root, low represents the head; this belongs to the category of Hu Han [fox hernia]. In women, if the color appears at the Mian Wang, it indicates bladder and uterus diseases. Dispersed color indicates pain; condensed color indicates accumulation. The shape (round, square, left, right) corresponds to the color's form. If the color descends to the Di [navel/lower abdomen], it indicates leukorrhea; if moist like paste, it results from gluttony and unclean food. (Gluttony leading to immediate expulsion of unclean matter, referred to as wind returning to the throat and vomiting out.)

Regarding all five colors—Green, Black, Red, White, Yellow—(here specifically mentioning the five colors because the previous text focused on black)—they should be upright and full, distinct from other regions. If the different region shows red, the color is red, (Note: "Yi" [also] is incorrect, should be "Chi" [red]), sized like a elm seed, appearing at the Mian Wang, indicating amenorrhea. (Original text says "Bu Ri" [not days]; annotators claimed it means recovery or death, both incorrect. This continues the discussion on women; since it is not the black of the Kidney, it is specially narrated, causing readers to confuse it with the preceding text.)

Wind is the beginning of all illnesses; Jue Ni [reversal cold] arises from cold-dampness. Usually observe the Que Zhong region: thin and luster indicates Wind; turbid indicates Bi Syndrome [obstruction]; located in the lower region indicates Jue. This is the general rule; diagnose based on color. Green and black indicate pain; yellow and red indicate heat; white indicates cold. These are called the Five Officials' diagnoses. If the color is coarse and bright, but sunken and dull, the illness is severe. Examining luster and dullness defines a skilled physician. Deep and turbid color indicates internal disease; floating and luster indicates external disease. Yellow and red indicate Wind; green and black indicate pain; white indicates cold. Yellow and greasy/lustrous indicates pus (i.e., phlegm); intense red indicates blood stasis; severe pain indicates spasms; severe cold indicates insensible skin. (These two sections outline the principles of physical signs and main diseases.)

Note: To accurately diagnose facial complexion, one must observe from a distance and glance briefly to grasp the truth. Hua Tuo stated that any change in the usual facial color indicates illness. Such changes are often unnoticed by people facing each other all day, but cause inner surprise to those meeting after a long separation. Furthermore, physiognomy requires observation at dawn, before washing or eating, similar to why pulse diagnosis is best done at dawn for healthy individuals. However, for bedridden patients whose color and pulse remain constant throughout the day, diagnosis can be done anytime, provided one asks if they have eaten. Food entering the stomach temporarily strengthens Wei Qi [defensive Qi] and fills the Yangming meridian Qi, resulting in strong luster. Yet, for chronic patients, this can also predict the life or death of Stomach Qi.

Furthermore: Duan Man [upright/full], Bie Xiang [different region], upward/downward orientation, and moving in/out, along with terms from the previous compilation like "Rong not yet intersecting" and "Jueyin Shaoyin pulses appearing simultaneously," are the fundamentals of color observation and must be studied. Duan Man refers to those with normal colors fully covering the face, which Hua Tuo said indicates health. If pathogenic color causes uniformity across face and eyes, how can it be called healthy? Bie Xiang refers to the region containing pathogenic color, differing from others. Red, for example, is red and large like an elm seed; using red as an example, others can be inferred. By observing the origin and direction of color in the upper/lower and internal/external regions, one predicts the depth and prognosis of the illness. Rong refers to the superficial visibility of color on the cheekbones, indicating the initial region of onset. Jiao [intersection] means color fills the original region and spills into others, e.g., starting at the cheekbone, spilling to the cheek, and intersecting back at the cheekbone; thus encircling the eyes, nose, mouth, and ears, hence termed entering the "door and well/stove" (internal organs). Zheng Jian [simultaneous appearance] means another region shows rising color corresponding to this region. Therefore, regions must be examined in detail, and the origin and direction of color must be observed. Without this knowledge, one cannot diagnose via color. The term "color" here refers to what is faintly visible beneath the skin, seemingly hidden yet apparent. Color floating on the skin surface is incorrect; it may be dust, sun exposure, or dry skin shedding scales, affecting only the superficial muscle layer, not the five Zang organs. It may also be caused by foul air attacking due to insufficient Yang Qi. Additionally, when pathogenic color dissipates, it must first retreat to the skin surface before dispersing. Hence, "concentrate your spirit to know past and present, maintain focus to know new and old," warning against mistaking dissolving color for newly arising color.