欲知其内者,当以观乎外;诊于外者,斯以知其内。盖有诸内者形诸外。苟不以相参而
断其病邪之逆顺,不可得也。为工者深烛厥理,故望其五色,以青黄赤白黑,以合于五脏之
脉,穷其应与不应;切其五脉,急大缓涩沉,以合其五脏之色,顺与不顺。诚能察其精微之
色,诊其微妙之脉,内外相参而治之,则万举万全之功,可坐而致矣;《素问》曰∶能合色
脉,可以万全。其意如此。原夫道之一气,判而为阴阳,散而为五行,而人之所禀皆备焉。
夫五脉者,天之真,行血气,通阴阳,以荣于身;五色者,气之华,应五行,合四时,以彰
于面。惟其察色按脉而不偏废,然后察病之机,断之以寒热,归之以脏腑,随证而疗之,而
获全济之效者,本于能合色脉而已。假令肝色如翠羽之青,其脉微弦而急,所以为生;若浮
涩而短,色见如草滋者,岂能生乎?心色如鸡冠之赤,其脉当浮大而散,所以为顺;若沉濡
而滑,色见如 血者,岂能顺乎?脾色如蟹腹之黄,其脉当中缓而大,所以为从;若微弦而
急,色见如枳实者,岂能从乎?肺色如豕膏之白,其脉当浮涩而短,所以为吉;若浮大而散
,色见如枯骨者,岂能吉乎?以至肾色见如乌羽之黑,其脉沉濡而滑,所以为生;或脉来缓
而大,色见如 者死。死生之理,夫惟诊视相参。既以如此,则药证相对,厥疾弗瘳者,未
之有也。抑尝论之,容色所见,左右上下,各有其部;脉息所动,寸关尺中,皆有其位。左
颊者肝之部,以合左手关位,肝胆之分,应于风木为初之气;颜为心之部,以合于左手寸口
,心与小肠之分,应于君火为二之气;鼻为脾之部,合于右手关脉,脾胃之分,应于湿土为
四之气;右颊肺之部,合于右手寸口,肺与大肠之分,应于燥金为五之气;颐为肾之部,以
合于左手尺中,肾与膀胱之分,应于寒水为终之气。至于相火为三之气,应于右手,命门三
焦之分也。若夫阴阳五行,相生相胜之理,当以合之于色脉而推之也。是故《脉要精微论》
曰∶色合五行,脉合阴阳。《十三难》曰∶色之与脉,当参相应。然而治病万全之功,苟非
合于色脉者,莫之能也。《五脏生成篇》云∶心之合脉也,其荣色也。夫脉之大小滑涩沉浮
,可以指别,五色微诊,可以目察,继之以能合色脉,可以万全。谓夫赤脉之至也喘而坚,
白脉之至也喘而浮,青脉之至也长而左右弹,黄脉之至也大而虚,黑脉之至也上坚而大。此
先言五色,次言五脉,欲后之学人望而切之以相合也。厥后扁鹊明乎此,述之曰∶望而知之
谓之神,切脉而知之谓之巧,深得《内经》之理也。下迨后世,有立方者,目之曰神巧万全
,厥有旨哉。
想要了解体内的病变,应当通过观察体外的征象;诊察体外的表现,从而推知体内的状况。因为内在的病理变化必然反映在外部。如果不将内外征象相互参照来判断病邪的顺逆,是不可能准确的。高明的医生深刻洞察这一道理,所以通过望诊观察五色(青、黄、赤、白、黑),将其与五脏的脉象相合,探究其相应与否;通过切诊感知五脉(急、大、缓、涩、沉),将其与五脏的颜色相合,判断其顺逆。如果能细致观察精微的气色,诊察微妙的脉象,将内外征象相互参照进行治疗,那么万举万全的功效,就可以轻易达到了。《素问》说:“能结合色诊与脉诊,可以达到万全的境界。”意思正是如此。
追溯本源,道的“一气”分化而为阴阳,散布而为五行,人所禀受的生命要素都具备于此。五脏的脉象是天之真气,运行气血,沟通阴阳,以滋养全身;五色是气的荣华,对应五行,配合四时,以彰显于面部。只有同时考察气色和按摸脉象而不偏废任何一方,然后才能察知疾病的机理,以寒热来断证,归之于脏腑,随证施治,从而获得痊愈的效果,这根本在于能结合色诊与脉诊。
举例来说,肝之色如翠羽之青,其脉微弦而急,这是生机旺盛的表现;如果脉浮涩而短,面色像枯草一样晦暗,怎么可能生存呢?心之色如鸡冠之赤,其脉应当浮大而散,这是顺证;如果脉沉濡而滑,面色像血凝块一样晦暗,怎么能说是顺证呢?脾之色如蟹腹之黄,其脉应当中缓而大,这是从证;如果脉微弦而急,面色像枳实一样枯黄,怎么能说是从证呢?肺之色如猪脂之白,其脉应当浮涩而短,这是吉兆;如果脉浮大而散,面色像枯骨一样苍白,怎么能说是吉兆呢?至于肾之色如乌鸦羽毛之黑,其脉沉濡而滑,这是生机;如果脉来缓而大,面色像灰土一样死寂,则是死证。生死的道理,就在于诊视相互参照。既然这样,那么药证相对,疾病不愈的情况,是从来没有过的。
我曾论述过,容色所见,左右上下各有其部位;脉息所动,寸关尺中各有其位置。左颊是肝的部位,对应左手关位,肝胆之分野,应于风木,为初之气;颜面(额头)是心的部位,对应左手寸口,心与小肠之分野,应于君火,为二之气;鼻部是脾的部位,对应右手关脉,脾胃之分野,应于湿土,为四之气;右颊是肺的部位,对应右手寸口,肺与大肠之分野,应于燥金,为五之气;颐部(下巴)是肾的部位,对应左手尺中,肾与膀胱之分野,应于寒水,为终之气。至于相火为三之气,应于右手,是命门和三焦的分野。至于阴阳五行相生相克的道理,应当结合色脉来推演。因此《脉要精微论》说:“色合五行,脉合阴阳。”《难经·十三难》说:“色与脉,应当参合相应。”然而治病达到万全境界,如果不是结合色脉,是不能做到的。《五脏生成篇》说:“心合脉,其华在色。”脉的大小滑涩沉浮,可以用手指辨别;五色的细微诊断,可以用眼睛观察。继之以能结合色脉,可以达到万全。这里先讲五色,再讲五脉,是想让后来的学者通过望诊和切诊来相互印证。后来扁鹊明了此理,阐述道:“望而知之谓之神,切脉而知之谓之巧”,深得《内经》的道理。到了后世,有创立方剂的人,称之为“神巧万全”,这确实很有深意啊。
To understand internal conditions, one must observe external manifestations; by diagnosing the exterior, one can thereby know the interior. This is because what exists within manifests externally. If one does not cross-reference these signs to determine the progression or regression of pathogenic factors, accurate diagnosis is impossible. A skilled physician deeply comprehends this principle; thus, by observing the Five Colors (Qing, Huang, Chi, Bai, Hei) and correlating them with the pulses of the Zang organs, one investigates their correspondence; by palpating the Five Pulses (Ji, Da, Huan, Se, Chen) and correlating them with the colors of the Zang organs, one determines their harmony or disharmony. If one can meticulously examine the subtle nuances of complexion and diagnose the delicate characteristics of the pulse, treating based on the cross-reference of internal and external signs, then the achievement of perfect efficacy in every case can be readily attained. The *Suwen* states: "Able to combine color diagnosis and pulse diagnosis, one can achieve perfection." This is precisely its meaning.
Tracing back to the origin, the Qi of the Dao divides into Yin and Yang, scatters into the Five Elements, and all that humans are endowed with contains these elements. The pulses of the five Zang organs are the true Qi of Heaven; they circulate Blood and Qi, connect Yin and Yang, and nourish the body. The five colors are the brilliance of Qi; they correspond to the Five Elements, harmonize with the Four Seasons, and manifest on the face. Only by examining both color and pulse without bias can one discern the mechanism of disease, differentiate it as Cold or Heat, attribute it to specific Zang-Fu organs, treat according to the syndrome, and thereby achieve complete recovery. This fundamentally relies on the ability to combine color and pulse diagnosis.
For example, if the Liver's color resembles the green of a kingfisher's feather, and its pulse is slightly wiry and rapid, this indicates vitality. However, if the pulse is floating, choppy, and short, and the color appears like dead grass, how can life be sustained? If the Heart's color resembles the red of a rooster's comb, its pulse should be floating, large, and scattered, indicating a favorable condition. But if the pulse is deep, soft, and slippery, and the color appears like coagulated blood, how can it be considered favorable? If the Spleen's color resembles the yellow of a crab's belly, its pulse should be moderate, slow, and large, indicating compliance. Yet if the pulse is slightly wiry and rapid, and the color appears like the dark yellow of unripe citrus fruit (*Zhi Shi*), how can it be compliant? If the Lung's color resembles the white of pig fat, its pulse should be floating, choppy, and short, indicating auspiciousness. But if the pulse is floating, large, and scattered, and the color appears like dry bone, how can it be auspicious? As for the Kidney, if its color resembles the black of a crow's feather, and its pulse is deep, soft, and slippery, this indicates life; but if the pulse comes slowly and is large, and the color appears like ash, this indicates death. The principles of life and death depend entirely on the cross-reference of diagnosis and observation. Given this, when the medication corresponds accurately to the syndrome, there has never been a case where the severe illness was not cured.
I have previously discussed that facial complexions appear in specific regions on the left, right, upper, and lower parts; pulse movements occur at specific positions in the Cun, Guan, and Chi areas. The left cheek corresponds to the Liver region, aligning with the Guan position of the left hand, representing the Liver and Gallbladder, associated with Wind-Wood as the First Qi. The forehead (Yan) corresponds to the Heart region, aligning with the Cun-kou of the left hand, representing the Heart and Small Intestine, associated with Ministerial Fire as the Second Qi. The nose corresponds to the Spleen region, aligning with the Guan pulse of the right hand, representing the Stomach and Spleen, associated with Damp-Earth as the Fourth Qi. The right cheek corresponds to the Lung region, aligning with the Cun-kou of the right hand, representing the Lung and Large Intestine, associated with Dry-Metal as the Fifth Qi. The chin (Yi) corresponds to the Kidney region, aligning with the Chi position of the left hand, representing the Kidney and Bladder, associated with Cold-Water as the Final Qi. Regarding the Ministerial Fire as the Third Qi, it corresponds to the right hand, representing the Mingmen (Gate of Vitality) and Sanjiao (Triple Burner). The principles of Yin-Yang and the generation and restriction among the Five Elements should be deduced by correlating them with color and pulse. Therefore, the *Mai Yao Jing Wei Lun* states: "Color corresponds to the Five Elements, pulse corresponds to Yin and Yang." The *Nan Jing, Thirteenth Difficulty* states: "Color and pulse should correspond mutually." However, the perfect efficacy in treating diseases cannot be achieved unless one combines color and pulse diagnosis. The *Wang Zang Sheng Cheng Pian* says: "The Heart correlates with the pulse, and its brilliance is shown in the color." The size, slipperiness, roughness, floating, and sinking of the pulse can be distinguished by fingers; the subtle diagnosis of the five colors can be observed by eyes. Following this, by combining color and pulse diagnosis, one can achieve perfection. Here, the five colors are mentioned first, followed by the five pulses, intending for future scholars to use inspection and palpation to verify each other. Later, Bian Que understood this principle and stated: "Knowing through observation is called divine; knowing through pulse-taking is called skillful," which deeply grasps the principles of the *Neijing*. In later generations, those who formulated prescriptions termed their work "Divine Skill and Perfect Completeness," which indeed carries profound significance.