病患大肉已落，为不可救药，盖以周身肌肉，瘦削殆尽也。余每以两手大指次指后，验大肉之落与不落，
以断病之生死，百不失一。病患虽骨瘦如柴，验其大指次指之后，有肉隆起者，病纵重可医。若他处肌肉
尚丰，验其大指次指之后，无肉隆起，而反见平陷者，病即不治矣。周慎斋三书云∶久病形瘦，若长肌肉，须
从内 眼下胞长起，以此属阳明胃，胃主肌肉故也。此言久瘦渐复之机也，不可不知。（赵晴初。）
目眶为足阳明所系，极与大肉相关。惟下利，专泄胃气，其目眶虽陷，而面色神光未改者，不足为虑。
若壮年无病，目眶忽陷，久而不复；咳嗽带红，而目眶常陷；诸病饮食倍增，身面加肥，而目眶独陷，皆脾
真暗败之先征。即面色神光未改，且觉难于挽回。补救及时，方药针对，仅可侥幸百一。若加见山根黯惨，
两角无光，短期速矣。再瘦人与高年，目眶虽陷而无虑者，盖陷之形有不同也。胞皮宽纵，
眶骨不至削如锋刃者，是乃常见之事。若胞皮吸入骨里凹成深坑，得不谓之非常之变乎。
营气霈然者，病在血脉。（是邪气激其血脉，光泽浮越于外也。邪气者，湿热也。）
五色精微象见矣，其寿不久也。（是五脏精华全越于外也。前为邪盛，此为真漓。故曰色明不粗沉
夭者，为病甚。）
尝贵后贱，虽不中邪，病从内生，名曰脱营。尝富后
贫，名曰失精。五气流连，病有所并。不在脏腑，不变躯形，身体日减，气虚无精，病深无气，洒洒然时惊。
病深者，以其外耗于卫，内夺于荣也。（脱营失精，精气外浮，其内愈竭，而毛发面色愈美，此为病在心，
心华在面，精气并于心故也。所谓并者，虚而相并也。故凡坐伤于忧愁思虑者，即肌肉消瘦，肢节酸软，而
毛发面色自美也。凡男女爱慕，功名抑郁者，多有此候。故《脉经》曰，忧恚思虑，心气内索；面色反好，
急求棺椁。上《素问》。）
女子竖，病伤脾，在死法中。而视其颜色不变，不以为意，至春果呕血死。其病得之流汗。流汗者
同法，病内重，毛发面色泽，脉不衰，此关内之病也。（流汗者，自汗也。内关之病，
不自知其所痛，心慧然若无苦，若见一病，即不及救。）
寒薄吾蛲瘕，腹大，上肤黄粗，循之戚戚（音瑟。）然。饮以芫花一撮，出蛲可数升，病已，三十日
如故。病得之于寒湿，寒湿气菀笃不发，化为虫矣。所以知然者，切其脉，循其尺，其尺索刺粗，而毛发
奉美，（奉即 字，茂也。原注当作秦，非。）是虫气也。其色泽者，中脏无邪气及重病也。（前案病内重而
毛发色泽，此脏无重病而亦然者，何也。读者宜深思其故。上仓公传。）
面色不变，肌肤日瘦，外如无病，内实虚亏，俗名桃花疰。其证必蒸热咳嗽，或多汗，或无汗，或多痰，
或无痰，或经闭，或泄精，或吐血，或衄血，或善食，或泄泻。此为阴火煎熬之证，男女婚嫁过时及少寡者多
有之。以阴火既乘阳位，消烁阳分之津液，而阴分津液亦随气而升，竭力以上供其消烁，故肢体日削，而
面色愈加鲜泽也。
按∶阴阳津液之说未莹。面色属心，心华于面，心神外驰，不能内守，是外有所慕，精神驰骛，故心之精
华，全浮于面，与忧菀于内者迥别。仓公前案流汗，汗为心液，亦与
心精外越之义符合，后案虫气，是正气未伤，而湿热内盛，
化生蛲虫，胃中转多一番生气，故上蒸头面而毛发奉美也。若至虫能饮血啮肠，则亦必渐变枯索矣。
传尸疰者，是恶虫啮人脏腑，其人沉沉嘿嘿，不知所苦，而无处不苦，经年累月，渐就羸瘦。其证蒸
热，咳嗽不止，腰背酸痛，两目不明，四肢无力，或面色脱白，或两颊时红，常怀忿怒，夜梦奇怪，或与
鬼交，最易传染，甚至灭门。（此面时红，阳浮无根也，非虫气矣。上张石顽《医通》。）
【病深而形色毛发有不变者篇】
当患者的大肉（指四肢肌肉丰厚处）已经消瘦塌陷时，这是不可救治的病症，因为全身的肌肉都已经瘦削殆尽了。我常用两手大拇指和食指后方（即合谷穴附近区域）来检验大肉是否塌陷，以此判断病人的生死，百发百中。如果病人虽然骨瘦如柴，但检查其大拇指和食指后方仍有肌肉隆起，那么即使病情严重也可以医治。如果身体其他部位的肌肉还比较丰满，但检查其大拇指和食指后方没有肌肉隆起，反而出现平坦凹陷的情况，那么病情就无法治好了。周慎斋在《三书》中说：久病导致形体消瘦，如果要恢复长肌肉，必须从眼下眼睑处开始生长，这是因为该部位属于足阳明胃经，而胃主司肌肉的缘故。这句话讲的是久病消瘦后逐渐恢复的机理，不可不知道。（赵晴初评注。）
眼眶与足阳明胃经相连，与大肉的状态密切相关。如果是下利（腹泻），专门耗泄胃气，虽然眼眶会凹陷，但如果面色和神光没有改变，就不必担忧。如果是壮年人原本无病，突然眼眶凹陷且长久不能恢复；或者咳嗽带血，且眼眶经常凹陷；或者各种疾病导致饮食倍增、身体面部更加肥胖，唯独眼眶凹陷，这些都是脾脏真气暗中败露的先兆。即使此时面色和神光尚未改变，也觉得难以挽回。如果能及时补救，方药对症，仅有一线生机侥幸存活。如果再见到山根（鼻根部）颜色黯惨，两眼眼角无光泽，那么死期就近了。另外，瘦人和高龄老人，虽然眼眶凹陷但不必担忧，这是因为凹陷的形态有所不同。如果眼皮皮肤松弛宽大，眶骨不至于削薄如锋刃，这是常见的情况。如果眼皮皮肤吸入骨内，凹成深坑，这能不称为异常的病变吗？
营气充沛外显的，病在血脉。（这是邪气激荡血脉，使光泽浮越于外表。这里的邪气，指的是湿热。）
五色中的精微之象显露出来了，寿命就不会长了。（这是五脏的精华全部外越于体表。前一种情况是邪气盛，这一种是正气淋漓外泄。所以说面色鲜明但不沉浊夭折的，是病情极重的表现。）
曾经尊贵后来卑贱，虽然没有受到外邪侵袭，但病从内生，名叫“脱营”。曾经富裕后来贫穷，名叫“失精”。五气滞留流连，病邪有所合并。病不在脏腑，外形躯干也没有明显变化，但身体日渐消瘦，气虚无精，病位深重而无气，时常感到洒洒然恶寒并受惊。
病位深重的原因，是因为精气在外耗损于卫气，在内被营气所夺。（脱营和失精，导致精气外浮，体内愈发枯竭，而毛发和面色却越发美好，这是因为病在心，心其华在面，精气汇聚于心所致。所谓的“并”，是指虚证相并。所以凡是因忧愁思虑而坐伤心神的人，就会出现肌肉消瘦、肢节酸软，但毛发和面色自然美好的症状。凡是男女爱慕不得、功名抑郁的人，多有这种证候。所以《脉经》说：忧恚思虑，心气内索；面色反而好，急求棺椁。出自《素问·疏五过论》。）
女子竖，病伤及脾，属于死法之列。但观察其颜色没有改变，不以为意，到了春天果然因呕血而死。这个病得之于流汗。流汗者（自汗），病势在内里很重，但毛发和面色润泽，脉象不衰，这是关格之内的病。（流汗者，即自汗。内关之病，病人自己不知道疼痛，心里似乎没有痛苦，但如果发现这种病，就来不及救治了。）
寒气迫近，形成蛲瘕（腹中结块），腹部胀大，上部皮肤发黄粗糙，用手抚摸感觉戚戚然（形容寒冷或不适的样子）。用芫花一撮煎服，排出蛲虫可达数升，病愈，三十天后恢复原状。这个病得之于寒湿，寒湿气郁结不通，化生为虫。之所以知道是这样，是因为切脉时，循按尺部，尺脉索然刺手且粗糙，而毛发茂密美好。（“奉”通“丰”字，意为茂密。原注认为当作“秦”字，非也。）这说明虫气存在。色泽正常，说明内脏没有邪气和重病。（前一个案例病在内里重而毛发色泽好，这个案例内脏无重病而也如此，为什么呢？读者应当深思其中的缘故。出自仓公传。）
面色没有改变，肌肤日渐消瘦，外表看起来像没病，实际上内部真正虚亏，俗名叫“桃花疰”。其症状一定有蒸热咳嗽，或多汗，或无汗，或多痰，或无痰，或闭经，或遗精，或吐血，或鼻衄，或食欲旺盛，或泄泻。这是阴火煎熬的证候，男女婚嫁延迟及早寡的人多有此病。因为阴火既占据阳位，消烁阳分的津液，而阴分的津液也随着气上升，竭力以上供其消烁，所以肢体日渐削瘦，而面色却越发鲜泽。
按语：关于阴阳津液的说法还不够透彻。面色属心，心其华在面，心神外驰，不能内守，这是外有所慕，精神驰骛，所以心的精华全部浮越于面部，这与忧闷郁结于内心的情况截然不同。仓公前面的案例中流汗，汗为心液，也与心精外越的意义相符；后面的案例中虫气，是正气未伤，而湿热内盛，化生蛲虫，胃中转多一番生气，所以上蒸头面而使毛发茂密美好。如果到虫子能饮血咬肠的地步，则也必然逐渐变得枯槁索然了。
传尸疰，是恶虫啃噬人的脏腑，其人神情沉闷沉默，不知道哪里痛苦，但无处不痛苦，经年累月，逐渐变得羸弱消瘦。其症状有蒸热，咳嗽不止，腰背酸痛，两目不明，四肢无力，或面色脱白，或两颊时而发红，常怀忿怒，夜间梦见奇怪之事，或与鬼交媾，最容易传染，甚至灭门。（此处面颊时而发红，是阳气浮越无根的表现，不是虫气了。出自张石顽《医宗金鉴》。）
[Chapter on Cases Where Complexion, Form, and Hair Remain Unchanged Despite Deep Disease]
When the "Da Rou" (the substantial muscles of the limbs) has already wasted away, it is an incurable condition, as the muscles of the entire body have become emaciated. I often examine the area behind the thumbs and index fingers to check for the wasting or preservation of Da Rou, thereby judging life and death with near-perfect accuracy. Even if a patient is as thin as firewood, if there is still flesh protruding behind the thumbs and index fingers, the disease, however severe, can be treated. Conversely, if muscles elsewhere are still plump, but the area behind the thumbs and index fingers shows no protrusion and instead appears flat or sunken, the disease is untreatable. Zhou Shenzhai stated in his *Three Books*: In chronic illness leading to emaciation, if muscles are to regrow, they must begin to grow from under the eyes. This region belongs to the Stomach Meridian of Foot-Yangming, and since the Stomach governs the muscles, this indicates the mechanism of gradual recovery from chronic emaciation, which one must not fail to understand. (Commentary by Zhao Qingchu.)
The eye orbits are connected to the Foot-Yangming Stomach Meridian and are closely related to the state of Da Rou. In cases of diarrhea (Li), which specifically drains Stomach Qi, although the eye orbits may sink, if the complexion and Shen Guang (spiritual luster) remain unchanged, there is no cause for concern. However, if a young adult, previously healthy, suddenly develops sunken eye orbits that do not recover over time; or if one suffers from coughing up blood with constantly sunken eye orbits; or if various diseases lead to increased appetite and obesity of the body and face, yet the eye orbits alone are sunken, these are all early signs of the hidden failure of Spleen True Qi. Even if the complexion and Shen Guang appear normal at this stage, recovery is difficult. Only with timely remedial measures and accurate prescription matching might there be a slim chance of survival. If dark and gloomy discoloration appears at the Shan Gen (root of the nose) and the corners of the eyes lose luster, death is imminent. Furthermore, in thin individuals and the elderly, sunken eye orbits need not be alarming, as the nature of the sinking differs. If the eyelid skin is loose and lax, and the orbital bones are not sharp as blades, this is a common occurrence. But if the eyelid skin sinks into the bone, forming a deep pit, this cannot be considered anything other than an abnormal pathological change.
When Ying Qi (Nutritive Qi) appears abundant and radiant, the disease lies in the blood vessels. (This indicates pathogenic factors agitating the blood vessels, causing luster to float to the exterior. Here, "pathogenic factors" refer to Damp-Heat.)
When the subtle images of the Five Colors manifest visibly, the lifespan will not be long. (This signifies that the essence of the Five Zang Organs is entirely leaking outward. The previous scenario described excess pathogenic factors; this one describes the depletion of True Essence. Hence, it is said: "Complexion bright but not coarse/sunken indicates terminal decline," signifying extreme severity of disease.)
One who was once noble but became lowly, though not struck by external pathogens, develops internal disease named Tuo Ying (Depletion of Ying). One who was once wealthy but became poor is named Shi Jing (Loss of Jing). The Five Qi linger and flow, and pathogens merge. The disease is not in the Zang-Fu organs, nor does it alter the physical form, yet the body wastes daily. Qi becomes deficient and Jing depleted; the disease is deep with no Qi, accompanied by aversion to cold and sudden fright.
The depth of the disease arises because the exterior is exhausted by Wei Qi (Defensive Qi) and the interior is robbed by Ying Qi. (In Tuo Ying and Shi Jing, Jing-Qi floats outward, causing the interior to become increasingly depleted, while hair and complexion appear remarkably beautiful. This is because the disease affects the Heart; the Heart's brilliance manifests in the face, and Jing-Qi converges in the Heart. The term "convergence" here refers to the convergence of deficiency states. Thus, those injured by sorrow and rumination suffer muscle wasting and limb soreness, yet their hair and complexion naturally appear beautiful. Both men and women experiencing unrequited love or frustration in official careers often present this pattern. Therefore, the *Mai Jing* states: "Sorrow and anger deplete Heart Qi internally; the complexion improves, hastening the search for coffins." From *Su Wen*).
Patient Nü Shou suffered damage to the Spleen, a fatal prognosis. However, observing that her color did not change, she was not concerned. She indeed died of hematemesis in spring. The disease originated from sweating. Sweating patients (spontaneous sweating) have severe internal pathology, yet their hair and complexion are lustrous, and the pulse is unweakened. This is a disease of the Inner Guan (Obstruction). (Spontaneous sweating indicates severe internal disease where the patient is unaware of pain, feeling mentally clear as if free of suffering. Once identified, it is too late to save them.)
Cold invading leads to Nuo Jia (worm-like masses in the abdomen), abdominal distension, yellowish and rough upper skin, which feels trembling upon palpation. Administration of a pinch of Yuan Hua (Genkwa Flos) expelled several sheng of worms, curing the disease; thirty days later, the patient returned to normal. The disease resulted from Cold-Dampness. The stagnation of Cold-Damp Qi transformed into worms. This was confirmed by palpating the pulse: the Chi position (Cun Kou) felt stringy, piercing, and coarse, while the hair was lush and beautiful. ("Feng" implies abundance/luxuriance. Original notes suggest it should be "Qin," not "Feng.") This indicates worm qi. The normal luster suggests no pathogenic factors or severe disease in the Zang organs. (Why did the previous case show severe internal disease with good hair/color, while this case showed no severe Zang disease with similar features? Readers should ponder this deeply. From *Cang Gong Zhuan*).
If the complexion remains unchanged while the skin and muscles waste daily, appearing externally healthy but internally truly deficient, it is commonly known as "Tao Hua Zhu" (Peach Blossom Transmission). Symptoms necessarily include steaming heat and cough, excessive sweating or lack thereof, excessive phlegm or lack thereof, amenorrhea, seminal emission, hemoptysis, epistaxis, polyphagia, or diarrhea. This is a syndrome of Yin Fire simmering. It is common among those who marry late or widows/widowers. Since Yin Fire occupies Yang positions, it consumes the fluids of the Yang division, while fluids of the Yin division also rise with Qi to supply this consumption. Consequently, the limbs waste daily, yet the complexion becomes increasingly radiant.
Note: The theory of Yin/Yang fluids is not fully elucidated. Complexion belongs to the Heart; the Heart's brilliance manifests in the face. When Shen (Spirit) wanders outward and cannot guard inward, it indicates external attachment and mental distraction. Thus, the Heart's essence floats entirely to the face, distinct from internal depression. Cang Gong's previous case of sweating aligns with the meaning of Heart Essence floating outward, as sweat is the fluid of the Heart. The subsequent case of worm qi indicates that Zheng Qi (Upright Qi) was not damaged, but Damp-Heat was abundant internally, generating worms. The Stomach generated extra vitality, which steamed upward to the head and face, making the hair lush. However, if worms begin to drink blood and gnaw intestines, the patient will inevitably become withered and desiccated.
Chuan Shi Zhu (Transmission Corpse Malaria) involves evil worms gnawing the Zang-Fu organs. The patient is lethargic and silent, knowing not where the pain lies, yet suffering everywhere. Over years, they gradually become emaciated. Symptoms include steaming heat, incessant cough, backache, blurred vision, limb weakness, pallor, or intermittent facial redness. They harbor frequent anger, dream strangely, or experience sexual encounters with spirits. It is highly contagious, even leading to family extinction. (Intermittent facial redness indicates floating Yang without root, not worm qi. From Zhang Shiweng's *Yi Tong*).