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Chapter 10 of 78
黄帝内经·素问
Overall Paraphrase
This chapter discusses the internal-external correspondence between the five viscera and the body, complexion, and five flavors, as well as the diagnostic methods based on these relationships.
The heart corresponds to the vessels (blood vessels), and its glory is manifested in the complexion; what restrains it is the kidney. The lung corresponds to the skin, and its glory is manifested in body hair; what restrains it is the heart. The liver corresponds to the sinews (tendons and ligaments), and its glory is manifested in the nails; what restrains it is the lung. The spleen corresponds to the flesh, and its glory is manifested in the lips; what restrains it is the liver. The kidney corresponds to the bones, and its glory is manifested in the hair; what restrains it is the spleen. Therefore, excessive consumption of salty flavors causes the blood vessels to stagnate and flow sluggishly, and the complexion to change😐; excessive consumption of bitter flavors causes the skin to dry and body hair to fall out; excessive consumption of pungent flavors causes the sinews to cramp and the nails to become brittle; excessive consumption of sour flavors causes the flesh to stiffen and the lips to crack; excessive consumption of sweet flavors causes bone pain and hair loss—these are the harms caused by overindulgence in the five flavors. Thus, the heart favors bitter, the lung favors pungent, the liver favors sour, the spleen favors sweet, and the kidney favors salty—this is the natural correspondence between the five flavors and the five viscera.
The qi of the five viscera manifests in the complexion with signs of fortune or misfortune. A complexion green like withered grass indicates death; yellow like a dried trifoliate orange (a hard, dry fruit) indicates death; black like soot indicates death; red like clotted, decaying blood indicates death; white like dried bones indicates death—these are the fatal signs revealed by the five colors. A complexion green like the feathers of a kingfisher radiates vitality; red like a cockscomb appears moist and lustrous with vitality; yellow like a crab's belly shows brightness and moisture with vitality; white like lard appears glossy with vitality; black like a crow's feathers shows luster with vitality—these are the vital signs revealed by the five colors. The ideal state of the five viscera's essential qi manifesting on the face is: the heart's color like white silk wrapping cinnabar, the lung's color like white silk wrapping pink, the liver's color like white silk wrapping verdant purple, the spleen's color like white silk wrapping trichosanthes fruit (yellow and moist), the kidney's color like white silk wrapping purple—these are the healthy appearances of the five viscera's essential qi on the face. Color and flavor each belong respectively to the five viscera: white belongs to the lung and corresponds to pungent flavor; red belongs to the heart and corresponds to bitter flavor; green belongs to the liver and corresponds to sour flavor; yellow belongs to the spleen and corresponds to sweet flavor; black belongs to the kidney and corresponds to salty flavor. Therefore, white also corresponds to the skin, red to the vessels, green to the sinews, yellow to the flesh, and black to the bones.
Each tissue of the body has its affiliation: all the channels converge at the eyes👁️, all the spinal cords connect to the brain🧠, all the sinews attach to the joints, all the blood is governed by the heart, and all the qi belongs to the lung—this is precisely the manifestation of the mutual interconnection of the four limbs and eight major joints in the cyclic flow of qi and blood during morning and evening.
When a person lies down to sleep, the blood returns to the liver. When the liver receives blood, the eyes can see clearly; when the feet receive blood, they can walk; when the palms receive blood, they can grip; when the fingers receive blood, they can grasp fine objects. If one goes out into the wind immediately upon waking, blood congealing in the skin causes bi syndrome (numbness and pain); congealing in the channels causes impeded blood flow; congealing in the feet causes jue syndrome (coldness and numbness). These three conditions all arise because blood cannot return properly after circulating, thus producing bi and jue. The body has twelve major joints and three hundred fifty-four minor acupoints (excluding the twelve back-shu points); these are places where defensive qi (the defensive qi that moves along the body surface) resides and where pathogenic qi easily invades, and can be treated by needling or stone needling to expel the pathogens.
The beginning of diagnosis takes the five determinations as its guiding principle. To understand the root of disease, one must first establish the fundamental of the five viscera pulse manifestations. The so-called "five determinations" refer to the pulse manifestations of the five viscera. Therefore: headache and disorders of the vertex belong to lower deficiency with upper excess, with the disease in the foot-shaoyin kidney channel and foot-taiyang bladder channel; in severe cases it transmits to the kidney. Dizziness, blurred vision, and deafness belong to lower excess with upper deficiency, with the disease in the foot-shaoyang gallbladder channel and foot-jueyin liver channel; in severe cases it transmits to the liver. Abdominal distension, chest and diaphragm support with discomfort, and counterflow qi rising from the lower burner, with the disease in the foot-taiyin spleen channel and foot-yangming stomach channel. Cough and counterflow qi involve the chest, related to the hand-yangming large intestine channel and hand-taiyin lung channel. Heart vexation and headache involve the chest and diaphragm, related to the hand-taiyang small intestine channel and hand-shaoyin heart channel.
The large and small, slippery and rough, floating and sinking qualities of the pulse can be distinguished by finger palpation; the signs of the five viscera can be grasped through analogical reasoning; the characteristic sounds of the five viscera can be comprehended by conscious awareness; the subtle changes of the five colors can be observed with the eyes. If one can combine pulse diagnosis with color inspection, the diagnosis becomes comparatively comprehensive. For example: if the complexion is red and the pulse is rapid and firm, the diagnosis is accumulation of qi in the middle burner, frequently impeding food intake, named heart bi, contracted from external pathogenic invasion combined with excessive anxiety weakening the heart qi, allowing pathogenic qi to take advantage of the deficiency. If the complexion is white and the pulse is rapid and floating, with upper deficiency and lower excess, prone to fright, with accumulation of qi in the chest, wheezing and deficiency, named lung bi, accompanied by chills and fever, contracted from intercourse after drunkenness.
If the complexion is green and the pulse is long with left-right flicking, with accumulation of qi below the heart supporting the ribs, named liver bi, contracted from cold-damp pathogens, treated by the same method as hernia disorder, accompanied by lumbar pain, cold feet, and headache. If the complexion is yellow and the pulse is large and deficient, with accumulation of qi in the abdomen and counterflow qi, named jue shan (reversal hernia), with the same diagnosis applicable to women, contracted from excessive exertion of the limbs followed by sweating in the wind. If the complexion is black and the pulse is firm and large in the upper position, with accumulation of qi in the lower abdomen and genital region, named kidney bi, contracted from lying down in cold after bathing.
To summarize the auspicious and inauspicious judgments of the five colors with the pulse: a yellow complexion with green conjunctiva, or yellow with red conjunctiva, or yellow with white conjunctiva, or yellow with black conjunctiva—none of these are fatal signs. A green complexion with red conjunctiva, a red complexion with white conjunctiva, a green complexion with black conjunctiva, a black complexion with white conjunctiva, a red complexion with green conjunctiva—these are all fatal signs.
The core of this chapter is the "viscera—manifestation—external sign" integrated diagnostic model. The five viscera are not isolated internal organs; rather, they establish systematic connections with the body surface through three dimensions: "correspondence" (associated tissues), "glory" (external manifestation), and "dominance" (restraining relationships): the heart corresponds to the vessels and is glorified in the complexion; the lung corresponds to the skin and is glorified in body hair; the liver corresponds to the sinews and is glorified in the nails; the spleen corresponds to the flesh and is glorified in the lips; the kidney corresponds to the bones and is glorified in the hair. The theoretical foundation of this system is the five phases generating and restraining cycle—each viscus has another that "dominates" it (i.e., the one that restrains it), forming an internal balancing mechanism.
On this foundation, the chapter develops three key inferences:
From a modern medical viewpoint, the rational core of this text lies in the correlation between body surface signals and internal organ conditions, which has parallels in clinical observation. For example: changes in complexion can indeed reflect circulatory status (pallor with anemia, cyanosis with hypoxia); nail morphology correlates with nutritional status; skin and hair conditions relate to endocrine and nutritional metabolism. This approach of "inferring the internal from the external" is essentially an empirical system of physical sign observation.
However, it must be honestly noted: the mechanical "five colors-five viscera" correspondence and the absolute judgments of "life or death by complexion" are far removed from the standards of modern evidence-based medicine. Complexion is influenced by multiple factors (baseline skin tone, lighting, emotions, diet, etc.), and judging "life" or "death" by color alone holds no modern diagnostic significance. The claim that "excessive consumption of a particular flavor necessarily harms a particular viscus" also lacks direct support from modern nutritional science and pathology.
Additionally, insights such as "all marrow belongs to the brain" and "all blood belongs to the heart" were advanced for their time—clarifying the connection between marrow and the brain, and between the heart and blood. These observations align with modern anatomy and physiology and deserve recognition.
This content is based on classic texts of traditional Chinese medicine and is provided solely for cultural learning and study. It does not constitute any medical diagnosis, medication, or treatment advice; please seek timely medical attention if unwell.