灵枢：五阅五使第三十七

Spiritual Pivot: Five Observations and Five Envoys, Chapter 37

Overall Paraphrased Meaning

This chapter, Five Observations and Five Envoys, discusses the method of observing the qi of the five viscera through the five sense organs. The Yellow Emperor asks: In the theory of acupuncture, there is a saying about "five observations via the five sense organs," used to observe the qi of the five viscera. The so-called five qi are the "envoys" dispatched by the five viscera to the body's surface, and they are also the external manifestations corresponding to the five seasons (spring, summer, late summer, autumn, winter). I wish to inquire from which sites the qi of the five viscera manifests. Qi Bo answers: The five sense organs are the external indicators of the five viscera.

The Yellow Emperor further asks: I wish to understand where they emerge from, in order to establish this as a routine diagnostic method. Qi Bo says: The pulse manifestation appears at the qi opening (the radial pulse at the wrist), and the complexion manifests at the mingtang (the nose). The five colors appear in sequence, corresponding to the five seasons, each with its own normal coloration. If the qi of the channels has already penetrated deeply into the viscera, one must regulate the interior. After the Yellow Emperor expresses admiration, he asks: Is the five-color observation based solely on the mingtang? Qi Bo says: One must first look at whether the five sense organs are clearly defined, then examine whether the quetting (the glabellum and forehead) is spacious, and only then establish the observation of the mingtang. If the mingtang is broad and elevated, the fanbi (the cheeks lateral to the nose and the ear region) are exposed outwardly, the cheekbones are square, the lower jaw is thick and high like a wall's foundation, the earlobes extend openly, the five colors are normal, and the face is level and full—a person with such features may be expected to live a hundred years. When one sees such a physical appearance and complexion, acupuncture treatment is also easy to effect results, because such a person's blood and qi are in surplus, the muscles are firm and dense, and the body can withstand needling.

The Yellow Emperor says: I wish to hear the specific referents of the five sense organs. Qi Bo says: The nose is the organ of the lung; the eyes are the organ of the liver; the lips are the organ of the spleen; the tongue is the organ of the heart; the ears are the organ of the kidney. The Yellow Emperor asks: What can be observed from these organs? Qi Bo says: They observe the five viscera. Thus, when the lung is diseased, there is panting and flaring of the nasal alae; when the liver is diseased, the inner corners of the eyes turn cyanotic; when the spleen is diseased, the lips turn yellow; when the heart is diseased, the tongue curls and shortens, and both cheekbones turn red; when the kidney is diseased, both cheekbones and the forehead turn black.

The Yellow Emperor asks: How do the five pulses manifest, how do the five colors appear, and how should normal coloration be distinguished from critical and failing coloration? Qi Bo says: If the five sense organs cannot be clearly distinguished, the quetting is not spacious, the mingtang is narrow, the fanbi are hidden and not exposed, the facial muscles appear sunken, the lower jaw lacks a foundation, and the earlobes and ear ridges curl outward—such a person, even in ordinary times, already shows a critical appearance of insufficient blood and qi, let alone when disease is added on top of that.

The Yellow Emperor further asks: The five colors manifest at the mingtang and are used to observe the qi of the five viscera—do they each have their own form in terms of left-right and high-low positioning? Qi Bo says: The viscera and bowels reside within the body, each with a fixed order and position, and their reflections on the left-right and upper-lower regions of the face each follow correspondingly established patterns.

🧠 Deep Understanding

Core Principles 💡

• What is within necessarily manifests without: The five viscera are hidden within the body, and their qi and blood surfeit or depletion are manifested through external sites such as the sense organs and facial complexion. The sense organs act as the "windows" of the five viscera.
• Mingtang as the core of color diagnosis: The nose (mingtang) is the center of facial observation, but it must not be viewed in isolation. It must be considered together with the quetting, fanbi, cheekbones, lower jaw, earlobes, and other overall features to comprehensively assess qi, blood, and constitution.
• Five colors correspond to five seasons: Normal coloration varies slightly with seasonal changes. Observation of color must be combined with the seasonal timing, distinguishing between "normal color" and "pathological color."
• Unity of form and qi: Those with open, full facial structure and distinct sense organs have surplus qi and blood and firm muscles—not only do they live long, but they also better tolerate acupuncture and other treatments. This provides clinical criteria for assessing constitution.
• Abnormal external signs indicate internal disease: When the qi and color of the sense organs are clearly abnormal, it suggests disease has already penetrated deeply into the viscera. One should not merely treat superficial manifestations but regulate from within.

Modern Perspective 🌟

• Modern medicine equally values the association between facial appearance and internal disease, such as jaundice manifesting as yellowing of the sclera and skin, hypoxia manifesting as cyanotic lips, mitral valve disease showing flushed cheekbones, and chronic liver disease showing a dull, dark complexion. The ancients' method of "observing the viscera through the organs" has some empirical basis.
• However, traditional facial diagnosis assigning specific sense organs to specific viscera incorporates五行 (five-element) categorization and philosophical deduction, which cannot be equated with modern anatomy or laboratory diagnostics. For example, "the tongue is the organ of the heart" is a visceral-manifestation model, not the anatomical sense of the tongue belonging to the heart.
• Modern research on facial morphology and longevity or constitution also suggests that facial symmetry and skin luster correlate with overall health, but asserting lifespan or treatment efficacy solely based on facial features is not rigorous.
• The phrase "even in ordinary times already shows critical signs, let alone when disease is added" in this chapter reflects an early awareness of "treating before disease arises," yet the specific criteria are historically limited and should not be over-applied.

Health Insights ⚡

• In daily life, one may moderately pay attention to one's own complexion, lip color, and eye spirit. If there is persistent dullness, pallor, yellowish discoloration, or other apparent abnormalities, this suggests possible imbalance in rest, diet, or emotions. One should adjust one's lifestyle promptly and seek professional examination.
• The fundamental way to maintain a "spirited" face lies in regular sleep patterns, moderate diet, and emotional balance, so that qi and blood are abundant and muscles are firm—not merely through external skincare.
• As the four seasons change, note the variations in your own complexion and adapt accordingly: stretch and expand in spring, nourish the heart in summer, moisten dryness in autumn, and store essence in winter.
• Please note: The above provides only general health observations and does not target any specific disease; if persistent discomfort occurs, seek medical attention promptly.

📚 Related Knowledge

• Related Concepts: Visceral manifestation (zang-xiang), mingtang, quetting, fanbi, five-color diagnosis, facial regional diagnosis, radial pulse diagnosis at the qi opening, five seasons, longevity and constitution types
• Further Reading: Spiritual Pivot · Five Colors, Plain Questions · Essential Subtleties of the Pulse, Plain Questions · On Heat Needling, Plain Questions · Five Viscera Manifestation

This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek medical attention promptly if you feel unwell. — Bu Gua

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