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Chapter 49 of 81
黄帝内经·灵枢
Holistic Paraphrase
(The original text contains a few misarranged bamboo slips and missing characters. The following is a paraphrase based on the standard edition of Huangdi's Inner Classic: Spiritual Pivot - Five Colors.)
I. General Principles of Facial Inspection
Lei Gong asked the Yellow Emperor: In the diagnostic method of the five colors, does it depend solely on the Mingtang (nose)? I do not understand the reasoning behind this. The Yellow Emperor said: The Mingtang is the nose, Que is the region between the eyebrows, Ting is the forehead, Fan is the outer sides of the cheeks, and Bi is the area in front of the ears. These regions should be broad, upright, and clearly visible from a distance of ten paces; a person with such features may often live to one hundred years of age.
Lei Gong asked: What is the method for distinguishing the five sense organs (here referring to the diagnostic regions governed by the five colors on the face, not the anatomical sense organs in the modern understanding)? The Yellow Emperor said: The bone of the Mingtang should be high and prominent, level and upright. The five viscera correspond sequentially to the center of the face, while the six bowels flank the sides; the head and face correspond to the upper forehead and the area above Que; the heart corresponds to the Xiaji (lower polar region) between the two eyes. When the five viscera are at peace within the chest, and essence-qi is sufficient, the normal true colors will manifest, and pathological colors will not appear; when the Mingtang is glossy and clear, how could the five sense organs fail to be distinguished?
Lei Gong said: Could you explain to me those cases that are difficult to distinguish? The Yellow Emperor said: When the five colors manifest, they each appear in their respective color regions. If the bone of the corresponding region is sunken, disease is inevitable. If there is "inheritance" (the sequential transmission relationship among the five colors according to the generating and controlling cycles of the five phases) between color regions, even if the disease is severe, it will not lead to death. Lei Gong asked: What diseases do the five colors each govern? The Yellow Emperor said: Green and black indicate pain; yellow and red indicate heat; white indicates cold. These are the regular patterns governed by the five sense organs.
II. Integration of Color and Pulse Diagnosis
Lei Gong asked: How does one determine whether a condition is progressively worsening or about to decline? The Yellow Emperor said: Both the interior and exterior should be examined together. Palpating the Mai Kou (the inch-pass pulse at the wrist, governing the interior) reveals slippery, small, tight, and deep qualities, indicating interior disease that is progressing; when the Renying (the Renying pulse beside the neck, governing the exterior) is large, tight, and floating, it indicates exterior disease that is progressing.
If the Mai Kou pulse is floating and slippery, the disease advances day by day; if the Renying pulse is deep and slippery, the disease diminishes day by day. When the Mai Kou pulse is slippery and deep, disease in the interior progresses daily; when the Renying pulse is slippery, full, and floating, disease in the exterior progresses daily. When the floating and sinking of the pulse, as well as the qi of Renying and Cun Kou being equal in magnitude, the disease is often difficult to cure. When disease is in the viscera and the pulse is deep and large, recovery is easy; when the pulse is small, it is adverse. When disease is in the bowels and the pulse is floating and large, recovery is easy. When the Renying pulse is full and firm, it indicates injury from cold; when the Qi Kou pulse is full and firm, it indicates injury from improper food intake.
Lei Gong asked: How does one judge the severity of disease from facial color? The Yellow Emperor said: When the facial color is bright and lustrous, the disease is superficial; when it is deep, murky, and dull, the disease is severe. When color spreads upward, the disease is progressing; when color descends and dissipates like clouds parting, the disease is about to resolve. The five colors each have belonging color regions for the viscera and bowels, with external and internal aspects. When color moves from external to internal, it indicates disease entering from the exterior to the interior; when color moves from internal to external, it indicates disease emerging from the interior to the exterior. For disease arising internally, the ancients believed in first regulating yin (interior) and then regulating yang (exterior); reversing this order worsens the disease. For disease arising externally, one first regulates the exterior and then the interior; reversing the order also worsens the condition. When the pulse is slippery, large, and accompanied by intermittent or long qualities, the disease has come from without, manifesting with visual disturbances, aversion to certain things, and other mental-emotional symptoms. This is caused by the combining of yang qi and can still be regulated and treated.
III. Wind, Bi, Jue, and Sudden Death
Lei Gong said: I have heard that wind is the beginning of all diseases; jue reversal is caused by cold and dampness. How are they distinguished? The Yellow Emperor said: Always observe the Quezhong (between the brows). When the color is thin and lustrous, it indicates wind; when the color is turbid and thick, it indicates Bi (bi syndrome); when the color is deep and visible at the chin area, it indicates jue reversal. These are the regular patterns, each judged according to the color region and luster.
Lei Gong asked: If a person has no obvious signs of illness but dies suddenly, how can this be predicted beforehand? The Yellow Emperor said: When da qi (violent pathogenic qi) penetrates deeply into the viscera, sudden death can occur without obvious symptoms. Lei Gong asked: If a person appears to be recovering but then dies suddenly, how can this be predicted? The Yellow Emperor said: When red appears on both cheekbones, large as the thumb, though the disease temporarily improves, sudden death is still possible; when black appears on the forehead, large as the thumb, even if no obvious illness is apparent, sudden death may still occur. Lei Gong bowed repeatedly and said: Excellent! Is there a time limit for death? The Yellow Emperor said: By observing the floating or sinking of the facial color, and its luster or dryness, one can infer the approximate time. Lei Gong said: Excellent! I desire to hear the full details.
IV. Facial Distribution of Viscera, Bowels, and Extremities
The Yellow Emperor said: Ting (forehead) corresponds to the head and face; above Que corresponds to the throat; Quezhong corresponds to the lungs; Xiaji (between the eyes) corresponds to the heart; directly below the nose bridge corresponds to the liver; to the left of the liver region is the gallbladder; the tip of the nose corresponds to the spleen; the "square regions" on either side of the nose tip correspond to the stomach; the center of the face corresponds to the large intestine; the regions beside the large intestine area correspond to the kidneys; directly below the kidney region corresponds to the navel; above the nose tip corresponds to the small intestine; below the nose tip corresponds to the urinary bladder and uterus.
The cheekbones correspond to the shoulders; behind the cheekbones corresponds to the arms; below the arms corresponds to the hands; above the inner canthi corresponds to the chest and breasts; along the outer edge of the cheeks going upward corresponds to the back; along the angle of the mandible and below corresponds to the thighs; the center between the upper and lower jaws corresponds to the knees; below the knees corresponds to the shins; below the shins corresponds to the feet; the large creases at the corners of the mouth correspond to the inner thighs; the curved bone below the cheeks corresponds to the patella. These are the distributions of the five viscera, six bowels, limbs, and joints on the face, each with its corresponding region.
Understanding these regions, harmonizing yin with yang, harmonizing yang with yin, and clarifying the distributions, one can achieve success in all endeavors; being able to distinguish left from right is to grasp the great Dao. The facial manifestations of men and women differ, hence it is said that yin and yang are distinct. Carefully examining luster and dryness qualifies one as a good physician. Deep and turbid color indicates interior disease; floating and lustrous indicates exterior disease; yellow and red indicate wind; green and black indicate pain; white indicates cold; yellow with a glossy, moist quality indicates pus; deep red indicates blood; severe pain indicates tendon contraction; severe cold indicates numbness of the skin.
V. Prognosis by Color Inspection and the Correspondence of Five Colors to Five Viscera
The five colors each appear in their corresponding regions. Observing floating and sinking determines the depth of the disease location; observing luster and dryness determines the prognosis of success or failure; observing dispersion and gathering determines the duration of the disease; observing whether the color is above or below determines the location of the disease; concentrating one's spirit and observing carefully allows one to infer past conditions and current changes. Therefore, if one's observation of qi and color is not sufficiently refined, one cannot clearly distinguish right from wrong; focusing one's mind with full dedication allows one to know whether a disease is new or old.
When the color is bright but not coarse, if it is deep, murky, and dull, the disease is severe; when the color is not bright nor lustrous, the disease is not severe. When the color is dispersed and not gathered, moving about like a young colt without fixed location, the disease qi is also dispersed, often presenting as qi pain, with accumulation not yet formed. When kidney pathogen attacks the heart, the heart is first affected, and the black color of the kidney will correspondingly manifest on the face; other viscera follow the same pattern.
When a man's pathological color appears at the tip of the nose, it indicates lower abdominal pain, radiating downward to testicular pain; when the color is round and straight, it indicates penile pain; the upper part represents the root and the lower part represents the extremity, belonging to conditions like狐疝 (funicular hernia) and 㿉疝 (swelling of the scrotum). When a woman's pathological color appears at the tip of the nose, it indicates diseases of the urinary bladder and uterus; dispersed color indicates pain, gathered color indicates accumulations; the squareness, roundness, left, and right of the pathological color are each judged according to their shape and color. When color extends downward to the gums around the lips, it indicates licentious turbidity; when glossy and ointment-like, it indicates sudden excessive eating of unclean food. Left corresponds to left; right corresponds to right; when color is deviated, gathered or dispersed without rectitude, the direction indicated by the facial color is the location of the disease.
The five colors — green, black, red, white, and yellow — should all be upright, fully distributed, and each returned to its proper position. If red appears in another location, sized like an elm seed, at the tip of the nose it indicates irregular menstruation (the original text's "不回" is suspected to be "不月", meaning amenorrhea). When the upper end of the color shape is sharp, it indicates emptiness of the head with pathogen attacking upward; when the lower end is sharp, it indicates pathogen attacking downward; the same applies to left and right. Correlating the five colors with the five viscera: green is the liver, red is the heart, white is the lungs, yellow is the spleen, and black is the kidneys. The liver governs the sinews, the heart governs the vessels, the lungs govern the skin, the spleen governs the flesh, and the kidneys govern the bones.
Facial Holographic Distribution
This chapter presents a system that projects the five viscera, six bowels, and extremities onto specific facial regions centered on the nose, forming a systematic facial color diagnosis map. The core idea is that "whatever exists internally will necessarily manifest externally": changes in internal viscera, qi-blood, and channels will reveal themselves through color, luster, floating-sinking, and dispersion-gathering in corresponding facial regions.
Five Colors Governing Disease and Five-Phase Correspondence
The five colors — green, red, yellow, white, and black — correspond respectively to the liver, heart, spleen, lungs, and kidneys. This chapter also provides concise rules for what each color indicates: green and black indicate pain, yellow and red indicate heat, and white indicates cold. This is the foundation of color-based diagnosis, but the ancients did not view colors in isolation; they emphasized luster versus dryness, which often matters more than the color itself in determining prognosis.
Integrating Color and Pulse, Corroborating Interior and Exterior
This chapter repeatedly pairs facial color diagnosis with Mai Kou and Renying pulse findings: Mai Kou governs the interior, Renying governs the exterior; whether color moves from exterior to interior or from interior to exterior must be cross-validated with pulse qualities of floating, sinking, slippery, and rough. This reflects the Huangdi Neijing's consistent advocacy for integrating all four diagnostic methods, rather than relying solely on "reading the face."
Judging Disease Trends Through Floating/Sinking, Dispersion/Gathering, Upward/Downward, and Luster/Dryness
Color inspection is not merely about seeing the color; one must also examine:
Facial Appearance Does Correlate with Health but Cannot Replace Modern Diagnosis
A ruddy, pale, jaundiced, or cyanotic complexion can indeed suggest abnormalities in circulation, respiration, hepatobiliary function, or nutrition. For example, jaundice, anemia, and hypoxia may all manifest in facial appearance. However, the holographic correspondence between specific facial points and specific internal organs described in this chapter belongs to empirical observation from antiquity; modern anatomy and physiology have not confirmed such point-to-point correspondences.
The Description of "Sudden Death" Has Phenomenological Value but Lacks Scientific Predictive Power
The ancients observed that some people died suddenly without apparent illness, or relapsed suddenly after improvement, and attempted to use specific facial discolorations as early warnings. This can be seen as an early acknowledgment of sudden cardiac death or similar phenomena, but specific predictive methods such as "red as large as a thumb" or "black emerging from the forehead" lack modern evidence-based medical validation and cannot be used to predict time of death.
The Approach of Integrating Multiple Indicators Is Worth Emulating
Although the specific facial holographic map should not be used directly as a diagnostic basis, the methodological approach of "cross-validating multiple indicators, observing dynamically, and inferring the internal from the external" shares common ground with modern medicine's comprehensive analysis of history, physical findings, and auxiliary examinations.
Related Concepts
Further Reading
This content is based on classical Chinese medicine texts and is provided solely for the study and research of traditional culture. It does not constitute any medical diagnosis, medication prescription, or treatment advice. Please consult a qualified healthcare provider promptly if you feel unwell.