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[Preface] Observation, listening/smelling, inquiry, and palpation are the four diagnostic methods known in ancient times. If one only knows pulse-taking but neglects the other three, it is like wanting to enter a room while closing the door; how can this be achieved? Bian Que was hailed as a sage physician, yet he stepped back upon seeing Duke Huan of Qi; this was because he first detected the condition through observation (Wang Zhen). I have based my exposition on the classics and clarified it item by item, appending the theories of Zhang Zhongjing, so that the methods of the four diagnostics are finally complete. Students should especially study them carefully and savor their profound meaning.

Those skilled in observing facial colors perceive their changes shifting one into another; the gain or loss of health depends on observation, allowing for undoubting judgment.
The *Su Wen: Yin Yang Ying Xiang Da Lun* states: "A skilled practitioner observes the complexion and feels the pulse." The *Su Wen: Yi Jing Bian Qi Lun* states: "Regulating color and pulse to understand the spirit, observing the shifting changes to perceive their subtleties." The *Su Wen: Yu Ji Zhen Zang Lun* states: "In treating any disease, one must observe the form, qi, and complexion. When form and qi are harmonious, it is called treatable; when the complexion is floating and lustrous, it is called easily curable; when form and qi are discordant, it is called difficult to treat; when the color is dull and lacks luster, it is called difficult to cure." Generally, abundant qi corresponds to robust form, and deficient qi corresponds to frail form; this harmony makes it treatable. Bright and lustrous qi and color indicate mutual nourishment between blood and qi, making recovery easy. If form and qi do not match, and the color is dull, withered, and lacking luster, how can survival be expected? The method of observing color requires gathering one's spirit and attention; reviewing past and present cases allows one to master the principles. The *Ling Shu: Se Wu Pian* states: "Gathering the spirit in the heart allows one to know the past and present; thus, if one does not observe qi minutely, one cannot discern right from wrong. Keeping one's attention fixed, one can distinguish new from old diseases." For all diseases, whether existing or future, new or old, they fundamentally begin with observing the complexion. This requires only calmness, stillness, and single-minded focus; did Bian Que possess any other skills?

Combining color diagnosis and pulse diagnosis is highly valued by sages and is the beginning of treatment. Color is seen by the eyes, and pulse is held by the hands; combining the two aligns them with the waxing and waning of the Five Elements (Wood, Fire, Earth, Metal, Water) below and corresponds to the cycles of the Four Seasons above. This knowledge cannot be discussed with those of average or inferior capacity. How is the combination done? The colors of the five zang organs appearing during their respective ruling seasons are: Green in Spring, Red in Summer, Yellow in Late Summer, White in Autumn, and Black in Winter. The normal external manifestations governed by the five zang organs are: White corresponds to the Lung and skin; Red to the Heart and vessels; Yellow to the Spleen and flesh; Green to the Liver and sinews; Black to the Kidney and bones. The pulses of the five zang organs are: Wiry (Xian) in Spring, Hook-like (Gou/Hong) in Summer, Hair-like (Mao/Fu) in Autumn, and Stone-like (Shi/Chen) in Winter. Excessively strong indicates excess, and excessively weak indicates deficiency. A pulse with Stomach Qi (a gentle, moderate quality) in the four seasons is considered Normal (Ping); less Stomach Qi indicates Disease; no Stomach Qi indicates Death. If there is Stomach Qi but the pulse of the conquering element appears, severe cases manifest illness immediately, while mild cases manifest illness when the conquering season arrives. Is this not clear and easy to deduce?

The five zang and six fu organs each have specific areas on the face. From the forehead to the Que Ting area (between the eyebrows and above), the upper part corresponds to the throat. Following the Que center down the nose tip corresponds to the five zang organs. From the inner canthus flanking the nose down to the Cheng Jiang point (center of the chin depression), it corresponds to the six fu organs. Exterior and interior are distinct. From below the cheekbones down to the cheeks, it corresponds to the shoulders, back, and hands. From below the Yache point (angle of the jaw) to the chin, it corresponds to the thighs, knees, and shins, with these parts corresponding to the feet.
The *Ling Shu: Se Wu Pian* states: "From the forehead down to the Que Ting area above, this is the region corresponding to the throat. From the center of the Que down the nose to the tip, this is the region corresponding to the five zang organs. From the inner canthus flanking the nose down to Cheng Jiang, this is the region corresponding to the six fu organs. From below the cheekbones down to the cheeks, this is the region corresponding to the shoulders, back, and hands. From below the Yache point to the chin, this is the region corresponding to the thighs, knees, and feet."

The colors of the zang and fu organs can be verified one by one. The Ting (forehead center) corresponds to the head and face. Above the Que corresponds to the throat. The center of the Que corresponds to the Lung. The Xia Ji (area between the eyes) corresponds to the Heart. Directly below (the nasal bridge) corresponds to the Liver. To the left of the Liver corresponds to the Gallbladder. Below the Liver corresponds to the Spleen. Fang Shang (beside the nose wing) corresponds to the Stomach. The Center (nose tip) corresponds to the Large Intestine. Flanking the Large Intestine corresponds to the Kidney (of the North). Opposite the Kidney corresponds to the Umbilicus. Above the Mian Wang (nose tip) corresponds to the Small Intestine. Below the Mian Wang corresponds to the Bladder and the Uterus (Zi Chu).
The *Ling Shu: Se Wu Pian* states: "Ting is the head and face region. Above Que is the throat region. Center of Que is the Lung region. Xia Ji is the Heart region. Directly below is the Liver region. Left of Liver is the Gallbladder region. Lower part is the Spleen region. Fang Shang is the Stomach region. Center is the Large Intestine region. Flanking Large Intestine is the Kidney region. Opposite Kidney is the Umbilicus region. Above Mian Wang is the Small Intestine region. Below Mian Wang is the Bladder and Uterus region."

Ting refers to the forehead, located highest and most critical; colors appearing here correspond to diseases of the head and face. Que is at the glabella; above the glabella, its position is also high, hence it corresponds to the throat. The glabella is the highest point of the middle section, hence it corresponds to the Lung. Xia Ji is between the two eyes; since the Heart resides below the Lung, Xia Ji corresponds to the Heart. Below Xia Ji is the nasal column; since the Liver is below the Heart, directly below corresponds to the Liver. The Gallbladder attaches to the short lobes of the Liver, hence the left of the Liver corresponds to the Gallbladder, located on either side of the nasal column. Below the nasal column is the Zhun Tou (nose tip), also called Mian Wang or Ming Tang. Zhun Tou belongs to Earth and is in the center of the face, hence it corresponds to the Spleen. Above the Ying Xiang points on both sides of Zhun Tou is the nasal tunnel. The Spleen and Stomach are exterior-interior pairs; the Spleen is central and the Stomach is peripheral, hence Fang Shang corresponds to the Stomach. In the center of the facial flesh, outside Ying Xiang and below the cheekbones, is the Large Intestine's correspondence. Flanking the Large Intestine is the upper cheek. The four zang organs are singular, but the Kidney is paired; the four zang reside in the abdomen, but the Kidney attaches to the spine. Thus, the four zang are arranged centrally, while the Kidney uniquely corresponds to both cheeks. The Kidney opposes the Umbilicus, hence the area opposite the Kidney below corresponds to the Umbilicus and governs the nose tip. The Small Intestine is a fu organ, corresponding to the areas flanking the cheekbones. Hence, above Mian Wang and inside the cheekbones is the Small Intestine's correspondence. Below Mian Wang is the Ren Zhong (philtrum), which is the correspondence for the Bladder and Uterus.

Furthermore, limbs and joints must be examined in detail. The cheekbones correspond to the shoulders. Behind the cheekbones correspond to the arms. Below the arms correspond to the hands. Above the inner canthus corresponds to the chest and breasts. Flanking the ear groove upwards corresponds to the back. Following the Yache point downwards corresponds to the thighs. The center corresponds to the knees. Below the knees correspond to the shins. Directly below the shins corresponds to the feet. Ju Fen corresponds to the inner thigh. Ju Qu corresponds to the knee patella.
The *Ling Shu: Se Wu Pian* states: "Cheekbones are the shoulder region. Behind cheekbones is the arm region. Below arms is the hand region. Above inner canthus is the chest and breast region. Flanking the groove upwards is the back region. Following Yache downwards is the thigh region. Center is the knee region. Below knees is the shin region. Below shins is the foot region. Ju Fen is the inner thigh region. Ju Qu is the knee patella region. These are the divisions of the five zang, six fu, and limbs."

Once the divisions are precise, one must combine color and pulse. The five colors appearing externally are the brilliance of Qi. Like silk wrapping cinnabar, this is the ideal red. If it resembles jasper, it is ominous and difficult to treat. White should resemble goose feathers, not salt. Green should resemble dark jade (Cang Bi); blue is repulsive. Like silk wrapping realgar, this is the correct central color. If it resembles yellow earth, it indicates collapse. Black should resemble heavy lacquer; what is feared is earthy gray. Do not miss the auspicious and inauspicious signs of the five colors.

Qi originates from the zang organs, and color follows the brilliance of Qi. Green, yellow, red, white, and black are colors. Silk wrapping cinnabar, goose feathers, dark jade, silk-wrapped realgar, heavy lacquer—whether bright and exposed or lustrous and contained—are all manifestations of Qi. When Qi arrives, color becomes prominent; this is called "Desired" (Yu) and indicates "Life" (Sheng). If red resembles jasper, white resembles salt, green resembles indigo, yellow resembles earth, and black resembles earth-gray; or even worse, green resembles withered grass, yellow resembles bitter orange fruit, black resembles charcoal, red resembles clotted blood, and white resembles dry bone; or if dull and lusterless, or emaciated and unprosperous, presenting mixed colors of decay, where is the Qi? Thus, it is called "Undesired" (Bu Yu) and indicates "Death" (Si). From this, we see that color and Qi cannot be separated for an instant. However, what is contained internally is better than what is exposed externally; internal containment means Qi is stored, while external exposure means Qi leaks. This is similar to the pulses of Wiry, Hook, Hair, and Stone; they should be subtle, not excessive. Therefore, as mentioned above, taking the subtle appearance of the five colors correctly represents the external brilliance of the five zang. Otherwise, if overly exposed, it differs little from the Wiry, Hook, Hair, and Stone pulses appearing exclusively without Stomach Qi, named True Zang Pulses!

White corresponds to the Lung and Pungent flavor; Red to the Heart and Bitter flavor; Green to the Liver and Sour flavor; Yellow to the Spleen and Sweet flavor; Black to the Kidney and Salty flavor. White corresponds to skin; Red to vessels; Green to sinews; Yellow to flesh; Black to bones.
This is recorded in the *Wu Zang Sheng Cheng Pian*, distributing the five colors to the five zang and skin, vessels, sinews, flesh, and bones. White corresponds to skin because the Lung color is white and the Lung governs skin and hair. The rest follow this pattern.

The colors of the five zang must be upright and full; if there are colors deviating to other areas, it is due to improper timing.
The *Ling Shu: Se Wu Pian* states: "Green, black, red, yellow, and white should all be upright and full, distinct from other areas. If red appears elsewhere, red as large as a elm seed, appearing at the Mian Wang, indicates illness within a few days." This speaks of the five colors being upright, full, and conforming to the season, which means no pathogenic factor. "Distinct from other areas" means that besides the ruling color, another color appears in a different region. For example, if red appears at the Mian Wang, it is not the appropriate region; it appears when it should not, and at a time when it should not.

If the color tapers sharply at the top, the disease moves upward toward the head; if it tapers downward, the disease moves downward; left and right follow the same rule.
The *Ling Shu* discusses observing trends from color. Whenever pathogenic factors appear with color, they have specific directions, and the sharp tip indicates the direction where the pathogen advances by exploiting deficiency. Thus, if the top is sharp, it is because the Zheng Qi (Upright Qi) of the head and face is empty, and the pathogen exploits this to move upward. The bottom is the same. Whether on the left or right, the method is identical.

The five colors of the five zang all appear on the face; corresponding to the pulse, the Cun and Chi positions verify this.
The *Nan Jing: Thirteenth Nan* states: "Color and pulse should correspond mutually; how is this done? Answer: The five zang have five colors, all visible on the face, and they should also correspond to the Cun and Chi areas of the wrist."

For instance, if the color is green, the pulse should be Wiry and rapid. If the color is red, the pulse is Floating, Large, and Scattered. If yellow, Slow and Large. If white, the sign is Floating, Choppy, and Short. If black, the pulse is Deep, Soft, and Slippery.
The *Thirteenth Nan* states: "If the color is green, the pulse should be Wiry and rapid. If red, Floating, Large, and Scattered. If yellow, Moderately Slow and Large. If white, Floating, Choppy, and Short. If black, Deep, Choppy, and Slippery." This explains knowing the pulse from the color. The zang organs are internal, color appears on the face, and pulse appears at the Cun and Chi areas. The physician's diagnosis involves viewing (observing color) and diagnosing (feeling pulse); these two must correspond.

If the color is green and the pulse is Floating and Choppy, or Large and Slow, it is named Mutual Conquest (Ke). If the pulse is Floating, Large, and Scattered, or Small and Slippery, it is named Mutual Generation (Sheng).
Green is the color of the Liver. Floating, Choppy, and Short is the pulse of the Lung. Large and Slow is the pulse of the Spleen. Floating, Large, and Scattered is the pulse of the Heart. Small and Slippery is the pulse of the Kidney.
If the Liver's color presents with the Lung's pulse, the pulse conquers the color (Metal overcomes Wood); if it presents with the Spleen's pulse, the color conquers the pulse (Wood overcomes Earth); if it presents with the Heart's pulse, the color generates the pulse (Wood generates Fire); if it presents with the Kidney's pulse, the pulse generates the color (Water generates Wood). For one zang's color, the interactions of conquest and generation are as described; the rest follow this logic.

Deep and turbid [pulse/color] indicates Interior; Floating and lustrous indicates Exterior.
Interior refers to Zang, Exterior to Fu, distinguished by Deep and Floating. However, in observing color, this cannot be grasped without mental comprehension.

Observe the Floating and Deep [pulse] to know the depth of the disease. Observe the Lustrous and Dull [color] to observe success or failure. Observe the Scattered and Congested [color] to know the duration. View the Upper and Lower [color distribution] to know the location of the disease.
Floating indicates superficial disease; Deep indicates deep disease. Lustrous indicates preservation/recovery; Dull indicates decay/death. Scattered indicates recent onset; Congested indicates long-standing. Upper indicates disease in the upper body; Lower indicates disease in the lower body. All are known through color and shape.

If the color is bright but not prominent, and Deep/Dull prevails, the disease is severe; if there is no Deep/Dull, the disease is not severe.
Bright and lustrous but not coarse/prominent, yet only Deep/Dull is seen, indicates severe disease. If there is no Deep/Dull, even if not bright/lustrous, the disease is not severe.

Yellow and Red indicate Wind; Green and Black indicate Pain; White indicates Cold; Yellow indicates Grease (lipid accumulation); Moisture indicates Pus; Excessive Red indicates Blood.
This combines the five colors with diseases. However, the *Ling Shu: Se Wu Pian* states: "If the color is scattered like a galloping foal, not yet gathered, the disease is scattered with Qi pain, but the gathering has not formed." It means 'foal' implies erratic movement; the color is scattered without fixed location, Qi gathers but pain has not taken shape. Therefore, in all diagnoses, as the depth of disease varies, the scattering or gathering of color is indefinite; one must never lightly dismiss or make rash statements.