十三难曰∶经言见其色而不得其脉，反得相胜之脉者即死，得相生之脉者，病即自已。色之与脉，
当参相应，为之奈何？
《灵枢·邪气脏腑病形篇》曰∶夫色脉与尺之相应也，如桴鼓影响之相应也，不得相失也，此
亦本末根叶之出候也，故根死则叶枯矣。色脉形肉，不得相失也，故知一则为工，知二则为神，知三
则神且明矣。色青者，其脉弦也；赤者，其脉钩也；黄者，其脉代也；白者，其脉毛；黑者，其脉石。
见其色而不得其脉，反得其相胜之脉则死矣；得其相生之脉，则病已矣。已，愈也。参，合也。经言，
即此篇之义也。
然∶五脏有五色，皆见于面，亦当与寸口尺内相应。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，其脉沉濡而滑。此所谓五色之与脉，
当参相应也。
此论色与脉当参合相应也。色指五色之见于面者而言，脉指诊言，谓营血之所循行也。尺指皮
肤言，谓脉外之气血，从手阳明之络，而变见于尺肤，脉内之血气，从手太阴经而变见于尺寸，此
皆胃腑五脏所生之气血，本末根叶之出候也。故见其色，得其脉矣。
脉数，尺之皮肤亦数；脉急，尺之皮肤亦急；脉缓，尺之皮肤亦缓；脉涩，尺之皮肤亦涩；脉
滑，尺之皮肤亦滑。
《灵枢·邪气脏腑病形篇》曰∶调其脉之缓急大小滑涩，而病变定矣。脉急者，尺之皮肤亦急；
脉缓者，尺之皮肤亦缓；脉小者，尺之皮肤亦减而少气；脉大者，尺之皮肤亦贲而起；脉滑者，尺之
皮肤亦滑；脉涩者，尺之皮肤亦涩。凡此变者，有微有甚。故善调尺者，不待于寸；善调脉者，不，
待于色。能参合而行之者，可以为上工，上工十全九；行二者为中工，中工十全七；行一者为下工，
下工十全六。此节即其义也。夫尺肤之气血，出于胃腑水谷之精，注于脏腑经隧，而外布于皮肤，寸
口尺脉之血气，出于胃腑水谷之精，营行于脏腑经脉之中，变见于手太阴之两脉口，皆五脏之血气
所注，故缓急大小滑涩，如桴鼓之相应也。徐氏谓以大小而易数字，数者一息六七至之谓，若皮肤则
如何能数，不知《素问·奇病论》曰∶人有尺脉数甚，
筋急而见，是则尺肤亦有数之候也。
五脏各有声色臭味，当与寸口尺内相应，其不相应者病也。假令色青，其脉浮涩而短，若大而
缓，为相胜，浮大而散，若小而滑，为相生也。
五脏各有声色臭味，当与寸口尺内相应，其不相应者病也。答辞但言色脉相参，不言声臭味，
殆阙文欤？虞氏云∶肝脉弦，其色青，其声呼，其臭臊，其味酸，心脉洪，其色赤，其声笑，其臭
焦，其味苦，脾脉缓，其色黄，其声歌，其臭香，其味甘；肺脉涩，其色白，其声哭，其臭腥，其
味辛；肾脉沉，其色黑，其声呻，其臭腐，其味咸；此即相应之谓也。若不相应者，举肝木为例。
如青者肝之色，见浮涩而短之肺脉，金克木，为贼邪；见大而缓之脾脉，为木克土，此相胜也。见
浮大而散之心脉，为木生火；见小而滑之肾脉，为水生木；心为肝之子，肾为肝之母，故为相生也。
若肝病而色白多哭，好腥喜辛，此声色臭味，皆肺之见证，亦属贼邪，病必重也。
经言知一为下工，知二为中工，知三为上工。上工十全九，中工十全八，下工十全六，此之谓也。
上工能洞悉色脉、皮肤、臭味三法，相生、相胜之顺逆，故治病十全其九。中工知二，谓不能
全收，故治病十全其八。下工仅能知一，故治病十全其六。此即前《灵枢·邪气脏腑病形篇》之义也。
第十三难说：医经上讲，看到病人的面色却切不到相应的脉象，反而得到相克（相胜）的脉象，病人就会死亡；如果得到相生（相旺）的脉象，疾病就会痊愈。面色与脉象，应当相互参照、彼此对应，这是为什么呢？
《灵枢·邪气脏腑病形篇》说：面色、脉象与尺肤（前臂内侧从肘至腕的皮肤）之间的相应关系，就像鼓槌敲击鼓面、回声应和身影一样紧密，不能有所偏差。这也是根本与枝叶所呈现的征候，所以根部死亡则枝叶枯槁。面色、脉象、形体肌肉，不能互相背离。因此，懂得其中一项的医生算是高明，懂得两项的算是神妙，懂得三项的则既神妙又英明。面色青的，其脉象应当是弦脉（端直以长，如按琴弦）；面色赤的，其脉象应当是钩脉（来盛去衰，如钩之曲）；面色黄的，其脉象应当是代脉（动而中止，不能自还，因而复动）；面色白的，其脉象应当是毛脉（轻虚以浮，如按羽毛）；面色黑的，其脉象应当是石脉（沉而搏指，如石之沉）。看到面色却切不到相应的脉象，反而得到相克的脉象，病人就会死亡；得到相生的脉象，疾病就会痊愈。“已”就是痊愈的意思。“参”就是合验、参照的意思。医经上的话，就是这个篇章的含义。
然而：五脏各有对应的五色，都显现于面部，也应当与寸口（桡动脉腕后段）及尺内（尺泽穴至太渊穴之间或尺肤）的脉象相应。假如面色青，其脉象应当是弦而急；面色赤，其脉象应当是浮大而散；面色黄，其脉象应当是中缓而大；面色白，其脉象应当是浮涩而短；面色黑，其脉象应当是沉濡而滑。这就是所说的五色与脉象，应当相互参照、彼此对应。
这段论述讲的是色与脉应当参照合验、彼此对应。“色”指的是面部显现的五种颜色，“脉”指的是诊察脉象，即营血循行的状态。“尺”指的是皮肤，即脉外的气血，从手阳明大肠经的络脉变化显现于尺肤；脉内的血气，从手太阴肺经变化显现于寸口和尺部。这些都是胃腑和五脏所化生的气血，是根本与枝叶所呈现的征候。所以看到面色，切得脉象，就能判断病情了。
脉数（快），尺部的皮肤也感觉急促；脉急（紧张），尺部的皮肤也感觉紧张；脉缓（慢），尺部的皮肤也感觉松弛；脉涩（不畅），尺部的皮肤也感觉粗糙；脉滑（流利），尺部的皮肤也感觉光滑。
《灵枢·邪气脏腑病形篇》说：调察脉象的缓急、大小、滑涩，病变就可以确定了。脉急的，尺部皮肤也急；脉缓的，尺部皮肤也缓；脉小的，尺部皮肤也减退且少气；脉大的，尺部皮肤也贲起；脉滑的，尺部皮肤也滑；脉涩的，尺部皮肤也涩。所有这些变化，有轻微也有严重。所以善于诊察尺肤的，不需要依赖寸口脉；善于诊察脉象的，不需要依赖面色。能够综合参合这三者并加以运用的，可以称为上工（最高明的医生），上工治病十次能治愈九次；运用两项的称为中工，中工治病十次能治愈七次；仅运用一项的称为下工，下工治病十次能治愈六次。这一节阐述的就是这个含义。尺肤的气血，源于胃腑水谷的精微，注入脏腑经络，外布于皮肤；寸口尺脉的血气，也源于胃腑水谷的精微，在脏腑经脉中营行，变化显现于手太阴肺经的两个脉口。这都是五脏血气灌注之处，所以脉象的缓急、大小、滑涩，就像鼓槌与鼓声一样相应。徐氏认为将“大”字改为数字，所谓“数”是指一息跳动六七次的脉象，如果是皮肤，怎么能说“数”呢？这是不知道《素问·奇病论》中说：“有人尺脉数甚，筋脉拘急而显现”，这说明尺肤也有“数”的征候。
五脏各有对应的声、色、臭、味，应当与寸口及尺内的脉象相应，如果不相应，就是生病。假如面色青，其脉象却是浮涩而短，或者大而缓，这是相克（相胜）的关系；如果是浮大而散，或者小而滑，这是相生的关系。
五脏各有对应的声、色、臭、味，应当与寸口及尺内的脉象相应，如果不相应，就是生病。回答的话只说了色脉相互参照，没有提到声、臭、味，难道是缺文吗？虞氏说：肝脉弦，其色青，其声呼，其臭臊，其味酸；心脉洪，其色赤，其声笑，其臭焦，其味苦；脾脉缓，其色黄，其声歌，其臭香，其味甘；肺脉涩，其色白，其声哭，其臭腥，其味辛；肾脉沉，其色黑，其声呻，其臭腐，其味咸；这就是所谓的相应。如果不相应，以肝木为例。比如青色是肝的颜色，如果出现浮涩而短的肺脉，金克木，称为贼邪；出现大而缓的脾脉，是木克土，这也属于相克（相胜）。出现浮大而散的心脉，是木生火；出现小而滑的肾脉，是水生木；心是肝的子脏，肾是肝的母脏，所以属于相生。如果是肝病而面色发白、多哭、喜好腥味、喜欢辛辣味，这些声、色、臭、味都是肺的见证，也属于贼邪，病情一定很重。
医经上说，懂得一项的是下工，懂得两项的是中工，懂得三项的是上工。上工治病十次能治愈九次，中工治病十次能治愈八次，下工治病十次能治愈六次，说的就是这个道理。上工能透彻了解色脉、皮肤、臭味三种方法，以及相生、相克的顺逆规律，所以治病十次能治愈九次。中工只懂两项，谓不能完全收效，所以治病十次能治愈八次。下工仅懂一项，所以治病十次能治愈六次。这也就是前面《灵枢·邪气脏腑病形篇》的含义。
Chapter 13 states: The classics say that if one observes the facial complexion but fails to find the corresponding pulse, and instead finds a pulse of the overcoming (controlling) relationship, death will ensue; if a pulse of the generating (promoting) relationship is found, the disease will resolve. Facial complexion and pulse should be cross-referenced and correspond with each other; how should this be understood?
The *Ling Shu* (Spiritual Pivot), Chapter "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations," states: The correspondence among facial complexion, pulse, and Cun-Chi skin (the skin on the inner forearm from elbow to wrist) is as inseparable as the striking of a drumstick against a drum or the immediate echo of a shadow; they must not deviate from one another. This is also the manifestation of the root and the branches; thus, if the root dies, the branches wither. Facial complexion, pulse, body form, and flesh must not contradict each other. Therefore, a physician who understands one aspect is considered skilled; one who understands two aspects is considered divine; and one who understands all three is both divine and enlightened. When the complexion is cyan (blue-green), the pulse should be Xian (String-like); when red, the pulse should be Gou (Hook-like); when yellow, the pulse should be Dai (Intermittent); when white, the pulse should be Mao (Feather-like); and when black, the pulse should be Shi (Stone-like). If the complexion is observed but the corresponding pulse is not found, and instead an overcoming-pulse is detected, death will occur; if a generating-pulse is found, the disease will heal. "Yi" (resolve/heal) means recovery. "Can" (cross-reference) means to combine and verify. The statement in the classics refers to the meaning of this chapter.
However: The Five Zang organs each have five corresponding colors, all of which manifest on the face, and they should also correspond with the pulses at the Cun-kou (radial artery at the wrist) and within the Chi region. For example, if the complexion is cyan, the pulse should be Xian and rapid; if red, the pulse should be Fu (Floating), large, and scattered; if yellow, the pulse should be moderate, slow, and large; if white, the pulse should be Floating, Choppy (Se), and short; if black, the pulse should be Chen (Deep), Soft (Ru), and Slippery (Hua). This is what is meant by the five colors and the pulse needing to be cross-referenced and corresponded.
This discussion addresses the principle that color and pulse must be cross-referenced and corresponded. "Color" refers to the five colors manifesting on the face; "Pulse" refers to palpation, indicating the circulation of Ying-Blood (Nutritive Blood); "Chi" refers to the skin, specifically the Qi and Blood outside the vessels, which change and manifest on the Cun-Chi skin via the Luo-connecting vessels of the Hand-Yangming Large Intestine channel, while the Qi and Blood inside the vessels change and manifest at the Cun and Chi positions via the Hand-Taiyin Lung channel. These are all manifestations of the Qi and Blood generated by the Stomach Fu organ and the Five Zang organs, representing the signs of the root and branches. Thus, by observing the color and feeling the pulse, one can determine the condition.
If the pulse is Shuo (Rapid), the Cun-Chi skin also feels tense/rapid; if the pulse is Ji (Tense), the Cun-Chi skin also feels tense; if the pulse is Huan (Slow/Relaxed), the Cun-Chi skin also feels relaxed; if the pulse is Se (Choppy/Rough), the Cun-Chi skin also feels rough; if the pulse is Hua (Slippery), the Cun-Chi skin also feels smooth.
The *Ling Shu*, Chapter "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations," states: By regulating the pulse's characteristics of Slowness/Tension, Size, and Slipperiness/Roughness, the pathological changes can be determined. If the pulse is Tense, the Cun-Chi skin is Tense; if Slow, the skin is Relaxed; if Small, the skin is diminished and lacks Qi; if Large, the skin bulges; if Slippery, the skin is Smooth; if Choppy, the skin is Rough. All these variations range from mild to severe. Therefore, a physician skilled in examining the Cun-Chi skin does not need to rely on the Cun-kou pulse; a physician skilled in palpating the pulse does not need to rely on the facial complexion. One who can integrate and apply all three methods can be called a Shang-Gong (Superior Physician), who cures nine out of ten cases; one who applies two methods is a Zhong-Gong (Middle Physician), curing seven out of ten; one who applies only one method is a Xia-Gong (Inferior Physician), curing six out of ten. This section elucidates this meaning. The Qi and Blood of the Cun-Chi skin originate from the essence of water and grain in the Stomach Fu, are injected into the Zang-Fu and meridians, and spread externally to the skin. The Qi and Blood of the Cun-Kou and Chi pulses also originate from the essence of water and grain in the Stomach Fu, circulate nutritively within the Zang-Fu and meridians, and manifest at the two pulse ports of the Hand-Taiyin Lung channel. These are all sites where the Qi and Blood of the Five Zang organs pour forth; thus, the pulse's slowness/tension, size, and slipperiness/roughness correspond like a drumstick and its sound. Mr. Xu argued that changing "Large" to a number implies that "Shuo" (Rapid) refers to a pulse beating six or seven times per breath cycle, asking how skin could be "rapid." This demonstrates ignorance of the *Su Wen* (Basic Questions), Chapter "Rare Diseases," which states: "There are people whose Chi pulse is extremely rapid, presenting with tense sinews," proving that the Cun-Chi skin also has signs of rapidity.
Each of the Five Zang organs has corresponding sounds, colors, odors, and tastes, which should correspond with the pulses at the Cun-kou and within the Chi region; if they do not correspond, it indicates disease. For instance, if the complexion is cyan but the pulse is Floating, Choppy, and Short, or Large and Slow, this represents an overcoming (controlling) relationship; if the pulse is Floating, Large, and Scattered, or Small and Slippery, this represents a generating relationship.
Each of the Five Zang organs has corresponding sounds, colors, odors, and tastes, which should correspond with the pulses at the Cun-kou and within the Chi region; if they do not correspond, it indicates disease. The response only mentions cross-referencing color and pulse, omitting sound, odor, and taste; is this a missing text? Yu Shi stated: The Liver pulse is Xian (String-like), its color is Cyan, its sound is Hu (calling/shouting), its odor is Sao (fishy/pungent), and its taste is Sour; the Heart pulse is Hong (Surging), its color is Red, its sound is Xiao (laughing), its odor is Jiao (burnt), and its taste is Bitter; the Spleen pulse is Huan (Slow/Relaxed), its color is Yellow, its sound is Ge (singing), its odor is Xiang (fragrant), and its taste is Sweet; the Lung pulse is Se (Choppy), its color is White, its sound is Ku (crying), its odor is Xing (raw fishy), and its taste is Pungent; the Kidney pulse is Chen (Deep), its color is Black, its sound is Shen (groaning), its odor is Fu (rotten), and its taste is Salty; this is what is meant by correspondence. If there is no correspondence, taking Liver Wood as an example: Cyan is the color of the Liver; if a Floating, Choppy, and Short Lung pulse (Metal) appears, Metal overcomes Wood, termed Ze-Xie (Thief Evil); if a Large and Slow Spleen pulse (Earth) appears, Wood overcomes Earth, which is also an overcoming relationship. If a Floating, Large, and Scattered Heart pulse (Fire) appears, Wood generates Fire; if a Small and Slippery Kidney pulse (Water) appears, Water generates Wood; since the Heart is the Son of the Liver and the Kidney is the Mother of the Liver, this constitutes a generating relationship. If Liver disease presents with a white complexion, frequent crying, preference for raw fishy smells, and liking for pungent tastes, these sounds, colors, odors, and tastes are all manifestations of the Lung, belonging to Ze-Xie (Thief Evil), and the disease will necessarily be severe.
The classics state that knowing one aspect makes one a Xia-Gong, knowing two makes one a Zhong-Gong, and knowing three makes one a Shang-Gong. A Shang-Gong cures nine out of ten, a Zhong-Gong eight out of ten, and a Xia-Gong six out of ten; this is what is meant. A Shang-Gong thoroughly understands the three methods of color/pulse, skin, and odor/taste, as well as the favorable and unfavorable dynamics of generating and overcoming relationships, thus curing nine out of ten cases. A Zhong-Gong knows two aspects and cannot fully achieve efficacy, thus curing eight out of ten. A Xia-Gong knows only one aspect, thus curing six out of ten. This reiterates the meaning of the earlier *Ling Shu*, Chapter "Pathogenic Factors, Zang-Fu Organs, and Disease Manifestations."