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(Dispersed) Thus, the disease has not yet formed an accumulation. Qi injury causes pain; if the pathology is dispersed in the Qi level and causes pain, it indicates that the pathogen has not yet condensed in the blood vessels. If it is a Zang organ disease that does not manifest at the Qi level, such as Kidney evil invading the Heart, the Heart will be affected first, and the condensed crimson color will appear on both cheekbones, the size of a thumb. The Kidney's response follows, with black color appearing on the forehead (Ting), also the size of a thumb. This is because Zang evil accumulates within the Zang organs, transmitted via the mutual overcoming relationship of the blood vessels; therefore, the facial colors are condensed and do not disperse. The *Jin Gui Yao Lue* states: "When blood and qi enter the Zang, death ensues; when they enter the Fu, recovery occurs." This applies not to just one disease, but to all diseases alike. Diseases remaining exterior can be treated; those penetrating interior lead to death.

In men, color changes at the Mian Wang (tip of the nose) indicate lower abdominal pain, radiating downward to testicular pain. If the shape is round and straight, it indicates penile pain. The elevated part represents the root (Ben), and the lower part represents the head (Shou); this belongs to conditions like Hu Shan (fox hernia) and Yin swelling. In women, color changes at the Mian Wang indicate bladder and uterus diseases, manifesting as pain. Condensation (Tuan) signifies accumulation; the shapes—round, square, left, or right—correspond respectively to the color patterns. If the color extends downward to reach the Zhi (upper part of the philtrum), it indicates turbid discharge due to licentiousness; if it appears moist and paste-like, it results from gluttony and consumption of unclean food. Left-sided color indicates left-sided pathology; right-sided color indicates right-sided pathology. If the facial color carries evil qi, dispersing and gathering irregularly and lacking uprightness, these are the indications of facial diagnosis. ("Yuan" is synonymous with "Yuan" [round]; "Xie" is synonymous with "Xie" [slanting].)

This section discusses pathological colors caused by external factors appearing in the regions corresponding to the Fu organs, indicating that the disease resides in the Fu. Although the color may condense, it is not a sign of death. The area above the Mian Wang corresponds to the Small Intestine; the area below the Mian Wang corresponds to the Bladder and Uterus. Therefore, in men, color appearing at the Mian Wang indicates lower abdominal pain. If the shape is round and straight, it indicates penile pain. External pathogens enter from the outside inward, and their colors manifest from top to bottom. Thus, the high point is the root, and the low point is the leading edge of the pathogen's progression. The disease location is inferior, belonging to conditions like fox hernia and Yin swelling. In women, color appearing at the Mian Wang indicates bladder and uterus diseases. For both men and women, when pathology is dispersed in the Qi level, it manifests as pain; when condensed in the Blood level, it manifests as accumulation. Conditions like fox hernia and Yin swelling are tangible syndromes; their shapes—square, round, left, or right—correspond to the facial color patterns. Because the pathogen accumulates internally, condensed colors appear externally. A square shape yields a square color; a round shape yields a round color. This indicates pathology in the structural layers rather than the Zang organs; although there is condensed color, it is not a fatal color.

The Five Zang and Six Fu organs each have specific facial correspondences, distinguishing between interior and exterior. Understanding these regions and their internal-external correlations ensures accurate diagnosis and treatment. "Zhi" refers to the area below the Mian Wang. If the color at the Mian Wang extends downward to the Zhi, it primarily indicates turbid discharge syndromes. If the color appears moist and paste-like, it results from consuming excessive amounts of unclean food. The Fu organs are Yang and govern the exterior; they receive and digest food and fluids and transport waste. Therefore, whether affected by external wind-cold or internal dietary injury, the pathology affects the Fu organs, resulting in corresponding colors in the Fu regions. Color appearing on the left indicates left-sided pathology; color appearing on the right indicates right-sided pathology. The observed colors, whether condensed or dispersed, are slanted and not upright. Such condensed facial colors are what was previously described as being the size of a thumb.

If blood vessels transmit the pathogen, major evil entering the Zang leads to sudden death. Currently, Fu organ diseases manifesting as fox hernia or Yin swelling occur because the pathogen condenses to form an accumulation syndrome; thus, condensed colors appear, which is not a sign of death from Zang invasion.

The five colors are cyan, black, crimson, white, and yellow. When they appear upright and full, but distinct from their home region, a crimson color appearing in the "different region" (Bie Xiang), the size of a elm seed, located at the Mian Wang, indicates imminent death within a day.

This describes colors that are condensed, upright, and full, indicating major pathogenic qi entering the Zang, leading to sudden death. Cyan, yellow, crimson, white, and black are the colors corresponding to the Five Zang and Five Elements. "Bie Xiang" (different region) refers to areas not originally belonging to that organ; for example, the Small Intestine's region is at the Mian Wang, but the Mian Wang is actually the Bie Xiang of the Heart. The Gallbladder's region is on the left of the Liver, so the Gallbladder region is also the Bie Xiang of the Liver. The size of an elm seed refers to condensed color in the blood level, resembling the size of a thumb. "Bu Ri" means death occurring within the same day. This explains that the pathological color of the Five Zang appearing in its own region is a normal reflection; however, the death color of the Five Zang appears in the Bie Xiang. For instance, if the Heart is struck by external evil and dies suddenly, the color appears at the Mian Wang; if the Heart is diseased due to internal causes and dies suddenly, the color appears on the cheekbones. Neither of these is the Heart's proper region. Pathology in the Zang presents with upright and full colors without slanting; pathology in the Fu presents with slanted and non-upright colors. This distinguishes the prognosis of life and death between Zang and Fu.

Gao Shizong stated: The true Qi of the Zang is stored internally; when severed, it escapes outward through the Fu. Therefore, the color appears in the Fu regions.

If the color is sharp at the upper end and hollow/vacuous at the head, tilting upward; or sharp at the lower end and hollow/vacuous at the head, tilting downward; and similarly on the left and right sides according to these rules:

This elaborates on the morphology of upright versus slanted colors. "Rui" means sharp; "Kong" means vacuous. Colors moving upward are sharp at the top and vacuous at the head, floating and ascending. Colors moving downward are sharp at the bottom and vacuous at the head, floating and descending. Generally, when pathology moves from interior to exterior, the root is inferior and the branch is superior. When pathology moves from exterior to interior, the root is superior and the branch is inferior. Thus, the root is sunken and solid, while the head is vacuous and floating; this is the morphology of upright and full colors. If there is evil qi but it is not upright, the root is on the left and the head moves to the right; the root is on the right and the head moves to the left. All follow the method of being sharp at the ends and vacuous at the heads. This is the condensed color seen when pathology is in the Fu and forms an accumulation.

Zhu Yongnian stated: Elm seeds are sharp at both ends. Only the vacuous and floating parts reveal their sharp shape; the sunken root does not show its sharp shape. Hence, observing the floating and sinking of the color reveals the depth of the disease.

Assigning colors to Zang organs: Cyan corresponds to the Liver, Crimson to the Heart, White to the Lung, Yellow to the Spleen, and Black to the Kidney. The Liver harmonizes with tendons, the Heart with vessels, the Lung with skin, the Spleen with flesh, and the Kidney with bones.

This summarizes that each of the Five Zang possesses a specific color and has corresponding internal and external structural layers. The text previously mentioned crimson appearing on the cheekbones, black on the forehead, and crimson at the Mian Wang, representing the colors of the Heart and Kidney. By assigning colors to Zang organs, each Zang has its associated five colors. Regarding the shoulders, arms, chest, back, knees, shins, hands, and feet, each area corresponds to the skin, vessels, flesh, tendons, and bones harmonized with the Five Zang. Observing the five colors allows one to determine which internal Zang is diseased and which external structural layer is involved. This illustrates how the Five Zang internally harmonize with the Five Elements and externally manifest five colors. If the color changes result from external pathogens like wind, cold, summer-heat, or dampness, these are the manifestations of the Six Qi upon the complexion.

Ni Chongzhi stated: Disease within the Five Zang manifests externally as five colors. Evil attacking the external harmonized structures (skin, vessels, flesh, tendons, bones) penetrates internally into the Five Zang. This is the pathway of internal-external transmission.

According to the *Chuan Bing Zhang* (Chapter on Disease Transmission): "When blood vessels transmit the pathogen, major evil entering the Zang can cause death, but cannot generate life." The Emperor asked: "What happens when major atmospheric qi enters the Zang?" Bo Le replied: "If the disease originates in the Heart, it reaches the Lung after one day, and the Liver after three days." This is due to transmission via the blood vessels, hence originating in the Heart. However, if the pathogen strikes the skin layer and penetrates inward, it originates in the Lung. Pathogens entering step-by-step from the structural layers inward proceed from skin and hair follicles to muscle interstices, then to collaterals, then to meridians, then to the Fu and Zang organs. Thus, the external skin and vessels correspond to the internally harmonized Five Zang. Therefore, it is said that a person who shows no symptoms in the external structural layers may die suddenly, meaning the pathogen bypassed the external layers and entered directly into the Zang.