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When the Qi of the Foot-Taiyin Spleen Meridian (Zú Tàiyīn Pí Jīng) is exhausted, the meridians fail to nourish the muscles, leading to tongue atrophy and fullness in the philtrum (Ren Zhong). If the philtrum is full, the lips will evert, indicating that the flesh is dying first. The condition worsens on a Jia day and leads to death on a Yi day. (From *Huangdi Neijing*.)

If the area below the patient's nose is flat, it indicates Stomach disease; if slightly red, an abscess (Yong) is developing; if slightly black, there is Heat; if blue/green, there is Cold; if white, it is difficult to treat.

(For sudden severe pain or syncope, if the philtrum is blue/green, it indicates Blood Excess, and pricking to bleed is appropriate. From *Maicheng*.)

In cases of Wind-Stroke, if the area below the nose is mixed with red and black, accompanied by foaming from the mouth and rigid body posture, death occurs within seven days.

Note: The philtrum internally corresponds to the Spleen and Stomach, and its lower part corresponds to the Bladder and Uterus. In patients suffering from damp-Heat rot in the Stomach and anterior yin, or pain caused by stagnant Blood accumulation, one often sees small red granular sores or common black spots on the philtrum, appearing dark like soot. This indicates a corresponding connection in the Qi collaterals.

In dysentery, if there is sudden severe pain below the umbilicus and the philtrum turns black, it indicates death. (Note: This is because Cold invades the Mingmen Gate of Vitality, causing the Blood in the Baozhong [Uterus/Bladder] to die. Zhu Danxi.)

The brilliance of the Spleen manifests in the skin around the lips (Chun Si Bai). Its diagnosis based on the five colors is the same as that of the face, but since the lip skin is thin and the color is prominent, it is particularly easy to observe. The specific diagnostic methods are listed below.

If the lips appear blue/green, yellow, red, white, or black, the disease is in the muscles. (From *Huangdi Neijing*.)

Lips that are scorched, dry, and cracked indicate Spleen Heat; swollen and red lips indicate Damp-Heat in the Stomach; bright red lips indicate Exuberant Fire; pale white lips indicate Qi Deficiency; pale white lips with a white halo around them indicate Loss of Blood; blue/black lips indicate Cold (leading to death of Blood. Shi Wan, *Yitong*).

Black lips indicate prior Stomach disease; if slightly dry and thirsty, it is treatable; if not thirsty, it is untreatable. (Thirst indicates consumption of Jin-Ye [Body Fluids] and stagnation of Blood; lack of thirst indicates collapse of Qi and death of Blood. Zhang Zhongjing. The following two sections follow the same logic.)

Sores inside the lower lip resembling millet grains are called "Hu," where worms erode the anus. Sores inside the upper lip resembling millet grains are called "Huo," where worms erode the throat (or viscera). Note: For those with abdominal pain who desire water, white patches on the face the size of coins, or pale lips with red dots in the center, it is undoubtedly due to intestinal worms biting into the blood.

If the corners of the mouth turn blue/green and the limbs twitch, it indicates Liver exhaustion. If the area around the mouth is blue/black, accompanied by soft sweat and yellow hair, it indicates Spleen exhaustion. If the nose is black and the lips are swollen, it indicates Lung failure. If there is Jue syndrome with blue lips and cold limbs, it indicates pathogen entering the Zang organs, leading to immediate death.

If dysentery is severe and the lips are vermilion red, it indicates death. (Note: All cases of blood loss are judged by this example. Zhu Danxi.)

The lips relate to the Hand and Foot Yangming meridians (Large Intestine, Stomach) and the Hand and Foot Taiyang and Spleen-Lung organs. Therefore, if the lips are red and moist, indicating no internal Heat, only acrid-warm exterior-dispersing methods should be used; if the lips are withered and dry, indicating existing internal Heat, clearing internal Heat is appropriate; if the lips are scorched black, with irritability, thirst, and excessive water intake, indicating extreme internal Heat, formulas such as Liangge San should be used. There are also cases of delirium, mania, and dry/scorched lips where heat does not subside after taking cooling herbs. This is due to Food Stagnation in the Middle Jiao, with Stomach Qi accumulating, causing jaundice and fever. Thus, cooling herbs fail to resolve the stagnation, and acrid-dispersing herbs exacerbate the internal Heat. It is appropriate to use Baohe San mixed with Bamboo Sap and Radish Juice, or Gardeniae and Fermented Soybean Decoction (Zhizi Chidao Tang) plus Immature Bitter Orange (Zhishi). The upper lip belongs to the Lung and Large Intestine; if scorched with thirst and water drinking, the Heat is above, primarily affecting the Lung; if scorched without thirst/water drinking, the Heat is below, primarily indicating Dry Feces in the Large Intestine. The lower lip belongs to the Spleen and Stomach; if scorched with thirst/water drinking, the Heat is in the Yangming Stomach; if scorched without thirst/water drinking, the Heat is in the Taiyin Spleen. Whether the scorched lips result from internal Heat, Food Stagnation, or latent Heat in the Blood level can be distinguished solely by whether there is thirst and water consumption. Additionally, long-standing Food Stagnation steaming and generating Heat can also cause thirst and water consumption; in such cases, the pulse must be consulted. If the pulse is slippery and large but not rapid, the food has not yet steamed into Heat, and there is no thirst; if the pulse is slippery, large, deep, and rapid, the food has steamed into Heat, and there is thirst. Therefore, for delirium and mania with a slippery, non-rapid pulse, and thirst without water consumption, treatment should focus on resolving Food Stagnation. If suppressed with cooling herbs, the delirium and mania will worsen, potentially leading to lockjaw and inability to speak. (Qin Huangshi, *Shanghan Dabai*.)

Neck swelling like a gourd, painful and hot to touch, eyes red as blood, cold feet, diarrhea, clear consciousness, fine and rapid pulses in all six positions, especially weak and empty upon slight pressure in the right hand. Shen Yaofeng said: This is Deficient Yang attacking upwards. A black streak on the upper lip looks dry and scorched; the tongue coating is white like powder; the tongue tip is white, not red. These are definitive signs of Deficient Cold. Moreover, with diarrhea, cold feet, and a soggy pulse, it is definitely not Wind-Fire. If it were Wind-Fire, there would necessarily be chest stuffiness, irritability, heat, dryness, thirst, and restlessness. How could there be such external swelling while the interior remains calm and peaceful like a healthy person?

Case Note: This corresponds to Yu Jiayan's description of Turbid Yin entering from the chest upwards, manifesting as throat swelling and bi-syndrome, tongue swelling, and protruding eyes; or entering from the back, manifesting as coarse neck, ice-cold head and neck, and death from whole-body cyanosis. The final sentence distinguishing symptoms is particularly precise. The most confusing aspect is the hot pain and red eyes. Without this analysis, even with cold feet, diarrhea, and a soggy, empty pulse, one might not decisively diagnose True Cold. Another note: People who recently smoke opium often have purple-dark lips because their Stomach Qi and Blood become turbid and foul. This is because Lung Qi is not clear, and Dryness transformation prevails.