小序 望闻问切,古所谓四诊也。知切矣而略于三者,犹欲入户而阖门,其可得哉!扁鹊称圣医,
见齐桓而却步,先得于望也。予本于经而条晰之,附以仲景之说,四诊之法始全。学人尤当熟玩而深味焉。
善诊察色,变化相移;得失在望,断之不疑。
《素问·阴阳应象大论》曰∶“善诊者,察色按脉。”《素问·移精变气论》曰∶“理色脉而通神明,变化
相移,以观其妙。”《素问·玉机真藏论》曰∶“凡治病察其形气色泽。形气相得,谓之可治;色泽已浮,谓
之易已;形气相失。谓之难治;色夭不泽,谓之难已。”大都气盛形盛,气虚形虚,是相得也,故可治。气色
明润,血气相营,故易已。若形与气两不相得,色夭枯而不明润,何以图存乎?视色之道,积神属意;往今
新故,可以自必。《灵枢·五色篇》曰∶“积神于心,以知往今,故相气不微,不知是非,属意勿去,乃知新
故。”凡已往来今新病故疾,先本乎视色,不过凝静精一,扁鹊岂有他技乎。
合色脉之法,圣神所最重,治病之权舆也。色者目之所见,脉者手之所持,而两合之,下合五行休旺,上
副四时往来,要未可与中人以下者道也。合之维何?五脏之色在王时见者,春苍,夏赤,长夏黄,秋白,冬
黑。五脏所主外荣之常,白当肺当皮,赤当心当脉,黄当脾当肉,青当肝当筋,黑当肾当骨。五脏之脉,春
弦,夏钩,秋毛,冬石,强则为太过,弱则为不及。四时有胃曰平,胃少曰病,无胃曰死。有胃而反见所胜之
脉,甚者今病,微者至其所胜之时而病,此非显明易推者乎?
五脏六腑,各有部分,额至阙庭,上属咽喉。阙循鼻端,五脏之应。内 挟鼻,下至承浆,属于六
腑。表里各别。自颧下颊,肩背所主,手之部分。牙车下颐,属股膝胫,部分在足。
《灵枢·五色篇》曰∶“自额而下阙庭上,属咽喉之部分也。自阙中循鼻而下鼻端,属五脏之部分也。
自内 挟鼻而下至承浆,属六腑之部分也。自颧而下颊,属肩背手之部分也。自牙车以下颐,属股膝
足之部分也。”
脏腑色见,一一可征。庭者首面。阙上咽喉。阙中者肺。下极为心。直下者肝。肝左为胆。肝下属
脾。方上者胃。中央大肠。挟大肠者,北方之肾。当肾者脐。面王以上,则为小肠。面王以下,膀胱、
子处。
《灵枢·五色篇》曰∶“庭者,首面也。阙上者,咽喉也。阙中者。肺也。下极者,心也。直下者,肝也。肝左者,
胆也。下者,脾也。方上者,胃也。中央者,大肠也。挟大肠者,肾也。当肾者,脐也。面王以上者,小肠也。面王以
下者,膀胱、子处也。”
庭者,颜也,额也,天庭也,位最高危,见于此者,上应首面之疾,阙在眉心,眉心之上,其位亦高,故应咽喉。
眉心,中部之最高者,故应肺。下极者,在两目之间,心居肺之下,故下极应心。下极之下为鼻柱,肝在心
之下,故直下应肝。胆附于肝之短叶,故肝左应胆,在鼻柱左右。鼻柱之下,即准头也,是为面王,亦曰明
堂。准头属土,居面之中央,故以应脾。准头两旁迎香之上,鼻隧是也。脾与胃为表里,脾居中而胃居外,
故方上应胃。面肉之中央,迎香之外,颧骨之下,大肠之应也。挟大肠,颊之上也。四藏皆一,惟肾有两;四
藏居腹,惟肾附脊。故四藏次于中央,而肾独应于两颊。肾与脐对,故当肾之下应脐而主鼻准也。小肠
为府,应挟两颧。故面王之上,两颧之内,小肠之应也。面王以下者,人中也,是为膀胱、子处之应。
更有肢节,还须详察。颧应乎肩。颧后为臂。臂下者手。目内 上,属于膺乳。挟绳而上,为应乎
背。循牙车下,为股之应。中央者膝。膝下为胫。当胫下者,应在于足。巨分者股。巨屈膝膑。
《灵枢·五色篇》曰∶“颧者,肩也。颧后者,臂也。臂下者,手也。目内 上者,膺乳也。挟绳而上者。背也。循
牙车以下者,股也。中央者,膝也。膝以下者,胫也。当胫以下者,足也。巨分者,股里也。巨屈者,膝膑也。此五
脏六腑肢节之部也。”
部分已精,须合色脉。五色外见,为气之华。如帛裹朱,赤色所尚。若使如赭,其凶难治。白如鹅
羽,不欲如盐。青如苍璧,蓝色可憎。罗裹雄黄,中央正色。设如黄土,败绝之应。黑如重漆,所虑
地苍。五色吉凶,求之勿失。
夫气由脏发,色随气华。如青、黄、赤、白、黑者,色也。如帛裹朱,如鹅羽,如苍璧,如罗裹雄黄,如重漆,或
有鲜明外露,或有光润内含者,皆气也。气至而色彰,故曰欲,曰生。若赤如赭,白如盐,青如蓝,黄如土。黑如地
苍;甚则青如草兹,黄如枳实,黑如 ,赤如 血,白如枯骨,或晦黯不泽,或悴槁不荣,败色杂呈,气于何
有?故曰不欲,且曰死。由此观之,则色与气固不可须臾离也。然而外露者不如内含,内含则气藏,外露
则气泄。亦犹脉之弦钩毛石,欲其微,不欲其甚。故如上文所云,正取五色之微见,方是五脏之外荣。否
则过于彰露,与弦钩毛石之独见而无胃气,名曰真藏者,何以异乎!
白当肺辛,赤当心苦,青当肝酸,黄当脾甘,黑当肾咸。白则当皮,赤则当脉,青则当筋,黄则当
肉,黑则当骨。
此《五脏生成篇》所载,以五色分发五脏及皮、脉、筋、肉、骨也。白则当皮者,以肺色属白,肺主皮毛。余仿此。
五脏之色。皆须端满;如有别乡,非时之过。
《灵枢·五色篇》曰∶“青黑赤黄白,皆端满有别乡。别乡赤者,其色赤大如榆荚,在面王为不日。”此言
五色之正端满合时日者,是谓无邪。有别乡者,犹言王色之外,别部又见一色也。如赤见于面王,则非
其部;不当见而见,又非其时矣。
其色上锐,首空上向;下锐下向,左右如法。
《灵枢》论从色观向。凡邪随色见,各有所向,而尖锐之处,即其乘虚所进之方。故上锐者,以首面正气
之空虚,而邪则乘之上向也。下锐亦然。其在左在右,皆同此法。
五脏五色。皆见于面;相应于脉,寸尺是践。
《难经·十三难》曰∶“色之与脉,当参相应,为之奈何?然,五脏有五色,皆见于面,亦当与寸口尺内相
应。”
假令色青,脉当弦急。如色见赤,浮大而散。色黄缓大。色白之征,浮涩而短。其色黑者,沉濡而滑。
《十三难》曰∶“假令色青,其脉当弦而急。色赤,其脉浮大而散。色黄,其脉中缓而大。色白,其脉浮涩而
短。色黑,其脉沉涩而滑。”此言见其色而知其脉也。脏位于内,色见于面,脉见于寸口尺内。夫医者之
言诊视也,视者视其色,诊者诊其脉,二者当参相应。
色青浮涩,或大而缓,名为相胜。浮大而散,若小而滑,名为相生。
青者,肝色也。浮涩而短者,肺之脉也。大而缓者,脾之脉也。浮大而散者,心之脉也。小而滑者,肾之脉也。
假令肝之色而得肺之脉,脉胜色矣;得脾之脉,色胜脉矣;得心之脉,色生脉矣;得肾之脉,脉生色矣。一
脏之色,其相胜相生,有如是夫余仿此。
沉浊为内浮泽为外。
内为脏,外为腑,以沉浮别之。然在色上看,非心领不能得。
察其浮沉,以知浅深。察其泽夭,以观成败。察其散抟,以知远近。视色上下,以知病处。
浮则病浅,沉则病深。泽则成全,夭则败亡。散解者新近,抟聚者久远。上则在上,下则在下。皆以色形知
病也。
色明不显,沉夭为甚;若无沉夭,其病不甚。
明泽不粗显而但见沉夭,病必甚也。若无沉夭,虽不明泽,病亦不甚。
黄赤为风,青黑为痛,白则为寒,黄则为膏,润则为脓,赤甚为血。
此以五色合病也。然《灵枢·五色篇》曰∶“其色散驹驹然未有聚,其病散而气痛,聚未成也。”盖言驹
为小马奔逸不定,其色散无定所,气虽聚而痛未成形。故凡诊视者,病之浅深或殊,则色之聚散靡定,
万不可轻视妄言也。
【小序】望、闻、问、切,是古代所说的四种诊断方法。如果只知道切脉而忽略其他三种方法,就像想要进入房间却关上了门,这怎么可能做到呢!扁鹊被称为神医,他在见到齐桓公时却止步不前,这是因为他首先通过望诊发现了病情。我依据经典医籍将其条理清晰地阐述出来,并附上张仲景的论述,这样四诊的方法才算完备。学习的人尤其应当仔细研读并深刻体会。
善于诊察面色,其变化相互推移;病情的得失取决于望诊,判断起来不应有疑虑。
《素问·阴阳应象大论》说:“善于诊治的医生,要观察面色并按摸脉搏。”《素问·移精变气论》说:“理顺色脉以通晓神明之道,观察其变化的推移,以探究其中的奥妙。”《素问·玉机真藏论》说:“凡是治病都要观察病人的形体、气息、色泽。形体与气息相协调,称为可治;色泽浮露光亮,称为容易痊愈;形体与气息不相协调,称为难治;色泽枯槁无光泽,称为难以痊愈。”大体上,气盛则形盛,气虚则形虚,这是相协调的表现,所以可治。气色明润,血气相互滋养,所以容易痊愈。如果形体与气息互不协调,色泽枯槁不明润,怎么能指望生存呢?观察面色的方法,在于聚精会神;纵观古今新旧病例,就可以自己把握规律。《灵枢·五色篇》说:“将精神凝聚在心中,以了解过去和现在的情况,因此观察气色如果不细微,就不知道是非曲直,注意力不能离开,才能知晓病情的新旧。”凡是已经发生或未来可能发生的、新的或旧的疾病,都首先基于观察面色,不过只要凝神静气、专心致志,扁鹊难道有什么其他的技巧吗?
结合色诊与脉诊的方法,是圣人所最重视的,也是治疗的开端。面色是眼睛所看到的,脉象是手指所触摸的,将两者结合起来,下合五行(木火土金水)的旺衰,上合四季(春夏秋冬)的更替,这大概不能跟中等资质以下的人谈论。如何结合呢?五脏的面色在当令之时出现,春季为青色,夏季为红色,长夏为黄色,秋季为白色,冬季为黑色。五脏所主并在外荣华于体表的常态是:白色对应肺和皮,红色对应心和脉,黄色对应脾和肉,青色对应肝和筋,黑色对应肾和骨。五脏的脉象,春季为弦脉,夏季为钩脉(洪脉),秋季为毛脉(浮脉),冬季为石脉(沉脉),过于强劲则为太过,过于微弱则为不及。四季脉象中有胃气(从容和缓之象)称为平脉,胃气少称为病脉,无胃气称为死脉。有胃气却反而见到克己之脏的脉象,严重的当下发病,轻微的等到被克之时才发病,这不是很明显容易推断的吗?
五脏六腑在面部各有对应的部位,从额头到阙庭(两眉之间及上方),上部对应咽喉。从阙中沿鼻梁向下至鼻端,对应五脏。从内眦挟鼻孔向下至承浆穴(下巴中央凹陷处),对应六腑。表里各有所属。从颧骨下方向脸颊延伸,对应肩背和手部。从牙车穴(下颌角)下方至下巴,对应大腿、膝盖和小腿,这些部位对应足部。
《灵枢·五色篇》说:“从额头下到阙庭以上,是咽喉对应的部位。从阙中沿鼻梁向下到鼻端,是五脏对应的部位。从内眦挟鼻孔向下到承浆,是六腑对应的部位。从颧骨下方向脸颊延伸,是肩背和手对应的部位。从牙车穴以下到下巴,是大腿、膝盖和足对应的部位。”
脏腑的面色表现,一一可以验证。天庭(前额正中)对应头部和面部。阙上(眉心上方)对应咽喉。阙中(两眉之间)对应肺。下极(两目之间)对应心。直下(鼻梁)对应肝。肝的左侧对应胆。肝下属位对应脾。方上(鼻翼旁)对应胃。中央(鼻尖)对应大肠。挟持大肠两侧的部位,对应北方的肾。正对肾脏的面部区域对应肚脐。面王(鼻尖)以上,对应小肠。面王以下,对应膀胱和子宫。
《灵枢·五色篇》说:“天庭,是头面的部位。阙上,是咽喉的部位。阙中,是肺的部位。下极,是心的部位。直下,是肝的部位。肝左,是胆的部位。下部,是脾的部位。方上,是胃的部位。中央,是大肠的部位。挟大肠,是肾的部位。当肾,是脐的部位。面王以上,是小肠的部位。面王以下,是膀胱和子宫的部位。”
天庭,就是颜、额、天庭,位置最高且危重,出现在这里的色泽,上应头部和面部的疾病。阙在眉心,眉心的上方,位置也高,所以对应咽喉。眉心是中部最高的地方,所以对应肺。下极在两目之间,心位于肺之下,所以下极对应心。下极之下是鼻柱,肝在心之下,所以直下对应肝。胆附着在肝的短叶上,所以肝左对应胆,位于鼻柱左右。鼻柱之下,就是准头,也就是面王,也叫明堂。准头属土,位于面部中央,所以对应脾。准头两旁迎香穴之上,是鼻隧。脾与胃互为表里,脾居中而胃居外,所以方上对应胃。面肉中央,迎香穴之外,颧骨之下,是大肠对应的部位。挟持大肠,是颊的上部。四脏都是单一的,只有肾有两个;四脏位于腹部,只有肾附着在脊柱。所以四脏依次排在中央,而肾单独对应两颊。肾与脐相对,所以当肾之下的部位对应脐而主管鼻准。小肠为府,对应挟持两颧的部位。所以在面王之上,两颧之内,是小肠对应的部位。面王以下是人中,这是膀胱和子宫对应的部位。
还有肢体关节,还需要详细察验。颧骨对应肩膀。颧骨后方对应手臂。手臂下方对应手。目内眦上方,对应胸膺和乳房。挟持耳前绳纹向上,对应背部。沿牙车穴向下,对应大腿。中央对应膝盖。膝盖下方对应小腿。正当小腿下方的部位,对应足部。巨分对应大腿内侧。巨屈对应膝盖髌骨。
《灵枢·五色篇》说:“颧骨,是肩膀的部位。颧骨后方,是手臂的部位。手臂下方,是手的部位。目内眦上方,是胸乳的部位。挟持绳纹向上,是背部的部位。沿牙车穴向下,是大腿的部位。中央,是膝盖的部位。膝盖下方,是小腿的部位。正当小腿下方,是足的部位。巨分,是大腿内侧的部位。巨屈,是膝盖髌骨的部位。这是五脏六腑和肢节的分部。”
分部已经精确,必须结合色脉。五色外露,是气的精华。像丝绸包裹着朱砂,是赤色所崇尚的。如果像赭石一样,那是凶险难治的征象。白色像鹅毛,不喜欢像盐一样惨白。青色像苍璧(青玉),蓝色令人厌恶。像罗纱包裹着雄黄,是中央的正色。如果像黄土一样,是败绝的征象。黑色像重漆,令人担忧的是地苍(黑中带灰)。五色的吉凶,探求时不要失误。
气由脏腑发出,色随气而荣华。如青、黄、赤、白、黑,是色。如丝绸包裹朱砂,如鹅毛,如苍璧,如罗裹雄黄,如重漆,或者有鲜明外露,或者有光润内含的,这些都是气。气至而色显,所以称为“欲”,称为“生”。如果赤色像赭石,白色像盐,青色像蓝靛,黄色像泥土,黑色像地苍;甚至青色像草兹(枯草),黄色像枳实,黑色像炭,赤色像凝血,白色像枯骨,或者晦暗无光泽,或者憔悴干枯不荣,败色杂呈,气在哪里呢?所以称为“不欲”,并且称为“死”。由此看来,色与气确实不可片刻分离。然而外露的不如内含,内含则气藏,外露则气泄。这也如同脉象的弦、钩、毛、石,希望其微见,不希望其过甚。所以像上文所说,正是取五色微微显现的样子,这才是五脏的外在荣华。否则过于显露,与弦钩毛石独见而无胃气,名为真脏脉的,有什么区别呢!
白色对应肺和辛味,红色对应心和苦味,青色对应肝和酸味,黄色对应脾和甘味,黑色对应肾和咸味。白色对应皮,红色对应脉,青色对应筋,黄色对应肉,黑色对应骨。
这是《五脏生成篇》所载,将五色分别配属五脏及皮、脉、筋、肉、骨。白色对应皮,是因为肺色属白,肺主皮毛。其余仿照此理。
五脏的面色,都必须端正饱满;如果有偏向他处的颜色,是非时之过。
《灵枢·五色篇》说:“青、黑、赤、黄、白,都应当端正饱满而有别于他处。如果别处出现赤色,其色赤大如榆荚,出现在面王部位,预示不久将病。”这是说五色端正饱满符合时令的,叫做无邪。有别乡的,就是说在当令之色之外,另一部位又出现一种颜色。比如赤色出现在面王,就不是该部位应有的颜色;不该出现而出现,又不是当时的季节了。
如果色泽上部尖锐,表示病势向上向首面发展;下部尖锐,表示病势向下发展;左右同理。
《灵枢》论述从色泽观察病势趋向。凡是邪气随色泽显现,各有其趋向,而尖锐之处,就是邪气乘虚而入的方向。所以上部尖锐,是因为头面正气空虚,邪气便乘机上向。下部亦然。在左在右,都遵循同样的法则。
五脏五色都见于面部;与脉象相应,寸口和尺内的脉象可以验证。
《难经·十三难》说:“面色与脉象,应当参合相应,怎么做呢?回答说,五脏有五色,都见于面部,也应当与寸口尺内的脉象相应。”
假如面色青,脉应当弦急。如果面色见赤,脉浮大而散。面色黄,脉缓大。面色白的征象,脉浮涩而短。面色黑的脉,沉濡而滑。
《十三难》说:“假如面色青,其脉应当弦而急。面色赤,其脉浮大而散。面色黄,其脉中缓而大。面色白,其脉浮涩而短。面色黑,其脉沉涩而滑。”这是说看到其色就知道其脉。脏腑位于体内,面色见于面部,脉象见于寸口尺内。医生的诊视,视是看面色,诊是把脉,这两者应当参合相应。
面色青而脉浮涩,或者大而缓,名为相胜(相克)。脉浮大而散,或者小而滑,名为相生。
青色,是肝的颜色。浮涩而短,是肺的脉象。大而缓,是脾的脉象。浮大而散,是心的脉象。小而滑,是肾的脉象。
假如肝的颜色却得到肺的脉象,是脉胜色(金克木);得到脾的脉象,是色胜脉(木克土);得到心的脉象,是色生脉(木生火);得到肾的脉象,是脉生色(水生木)。一脏之色,其相胜相生,就是这样,其余仿照此理。
脉沉浊为病在内,脉浮泽为病在外。
内指脏,外指腑,用沉浮来区分。然而在色泽上看,不是用心领会是不能得到的。
观察脉象的浮沉,以知道病位的浅深。观察色泽的光泽与枯夭,以观察病情的成败。观察色泽的散漫与聚结,以知道病程的远近。观察色泽出现的上下部位,以知道病变的位置。
浮脉则病浅,沉脉则病深。润泽则成全(预后好),枯夭则败亡(预后差)。散漫解离的是新近病,聚结不散的是久病。上部出现病在上,下部出现病在下。都是通过色形来知道病情。
色泽明润但不明显,如果兼见沉夭,病情就很严重;如果没有沉夭,病情就不算严重。
明润但不粗显,只见到沉夭,病一定很重。如果没有沉夭,虽然不明润,病也不算重。
黄赤色主风,青黑色主痛,白色主寒,黄色主膏(脂膏积聚),润泽主脓,赤色甚主血。
这是将五色与病症结合。然而《灵枢·五色篇》说:“其色散漫如小马奔跑不定,尚未聚结,其病散而气痛,聚结尚未形成。”是说驹为小马奔逸不定,其色散无定所,气虽聚而痛未成形。所以凡诊视者,病的浅深或许不同,则色的聚散没有定规,万万不可轻视妄言。
[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.