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Capítulo 49 de 81
黄帝内经·灵枢
Overall Paraphrase
(The original text contains a few misplaced bamboo slips and missing characters; the following is a paraphrase based on the standard version of Huangdi Neijing · Lingshu · Wuse.)
I. General Principles of Facial Color Diagnosis
Leigong asked the Yellow Emperor: In the five-color diagnostic method, is it determined solely by the Mingtang (nose)? I do not understand its principle. The Yellow Emperor said: Mingtang is the nose, Que is the space between the eyebrows, Ting is the forehead, Fan is the outer sides of the cheeks, and Bi is in front of the ears. These areas should be broad and upright; if they can still be clearly seen from ten paces away, such a person may live to be a hundred years old.
Leigong asked: What is the method for distinguishing the five organs (here referring to the diagnostic signs of the five colors on the face, not the anatomical five organs in the modern sense)? The Yellow Emperor said: The bone of the Mingtang should be high and raised, level and straight. The five viscera correspond in sequence to the center of the face; the six bowels flank the sides; the head and face correspond to the upper forehead and above Que; the heart corresponds to the lower pole between the two eyes. When the five viscera are at peace in the chest, and essence-qi is sufficient, the normal true color will be revealed, and disease colors will not appear. If the Mingtang is moist and clear, how could the five organs fail to be distinguished?
Leigong said: Cases that are difficult to distinguish—could you tell me about them? The Yellow Emperor said: When the five colors manifest, each appears in its own color region. If the bone in the corresponding region is sunken, illness is inevitable. If there is "encroachment and inheritance" between color regions (the orderly transmission of the five colors according to the generating cycle of the five phases), even if the disease is severe, death will not result. Leigong asked: What diseases do the five colors each govern? The Yellow Emperor said: Green and black indicate pain, yellow and red indicate heat, and white indicates cold—these are the regular rules of the five organs.
II. Combining Color and Pulse Diagnosis
Leigong asked: How can one judge whether a disease is gradually worsening or about to decline? The Yellow Emperor said: Both the interior and exterior must be examined together. When palpating the radial pulse (at the wrist, governing the interior), if it is slippery, small, tight, and deep, it indicates interior disease that is worsening; when the carotid pulse (at the neck, governing the exterior) is large, tight, and floating, it indicates exterior disease that is worsening.
If the radial pulse is floating and slippery, the disease advances day by day; if the carotid pulse is deep and slippery, the disease declines day by day. If the radial pulse is slippery and deep, the disease is internal and gradually worsening; if the carotid pulse is slippery, full, and floating, the disease is external and gradually worsening. When the floating or sinking of the pulse, and the qi force of the carotid and radial pulses are equal, the disease is often difficult to cure. When the disease is in the viscera, if the pulse is deep and large, recovery is easy; if the pulse is small, it is adverse. When the disease is in the bowels, if the pulse is floating and large, recovery is easy. If the carotid pulse is full and firm, it indicates injury from cold; if the radial pulse is full and firm, it indicates injury from food.
Leigong asked: How does one judge the severity of disease from the complexion? The Yellow Emperor said: If the complexion is coarse and bright-moist, the disease is shallow; if it is heavy, dull, and dark, the disease is severe. If the color spreads upward, the disease is worsening; if the color moves downward like clouds dispersing, the disease is about to heal. The five colors each have a color region belonging to the viscera, with external and internal aspects. When the color moves from external to internal, it indicates disease entering from the exterior to the interior; when the color moves from internal to external, it indicates disease moving from the interior to the exterior. For diseases born internally, the ancients held that one should first regulate yin (interior) and then yang (exterior); reversing the order will worsen the disease. For diseases born externally, one should first regulate the exterior and then the interior; reversing the order will also worsen it. If the pulse is large, and slippery with intermittent or long beats, the disease comes from outside, manifesting as seeing things and having aversions in the mind—these are symptoms of yang-qi combining, and it can still be treated.
III. Wind, Bi, Jue, and Sudden Death
Leigong said: I have heard that wind is the beginning of all diseases; Jue reversal is caused by cold-dampness. How are they distinguished? The Yellow Emperor said: Always observe the Quezhong (between the eyebrows). If the color is thin and moist, it indicates wind; if the color is turbid and thick, it indicates Bi (blockage); if the color is deep and visible at the lower chin, it indicates Jue reversal. These are the regular rules, judging diseases according to each color region and luster.
Leigong asked: Some people die suddenly without obvious illness—how can this be predicted? The Yellow Emperor said: Great qi (violent pathogenic qi) penetrating deeply into the viscera can cause sudden death without obvious symptoms. Leigong asked: When a disease has slightly improved but the patient dies suddenly, how can this be predicted? The Yellow Emperor said: If red appears on both cheekbones, as large as a thumb, even if the disease has temporarily improved, sudden death may still occur; if black appears on the forehead, as large as a thumb, even without obvious illness, sudden death may also occur. Leigong bowed twice and said: Excellent! Is there a time limit for death? The Yellow Emperor said: Observing the floating-sinking and moist-dry quality of the complexion, one can infer an approximate time. Leigong said: Good! I wish to hear the details fully.
IV. Facial Divisions of Viscera, Bowels, and Limbs
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; the bridge of the nose directly below corresponds to the liver; the area to the left of the liver corresponds to the gallbladder; the tip of the nose corresponds to the spleen; the areas beside the tip of the nose (the "sides of the square") correspond to the stomach; the center of the face corresponds to the large intestine; the areas flanking the large intestine correspond to the kidneys; directly below the kidney region corresponds to the navel; above the tip of the nose corresponds to the small intestine; below the tip of the nose corresponds to the 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 of the eyes corresponds to the chest and breasts; along the outer edges of the cheeks upward corresponds to the back; along below the angle of the jaw corresponds to the thighs; the center of the upper and lower jaw 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 divisions of the five viscera, six bowels, and limb joints on the face, each with its corresponding region.
Understanding these regions, using yin to harmonize yang, and yang to harmonize yin, clarifying the divisions, one will succeed in all cases; being able to distinguish left and right is mastering the great way. The complexions of men and women differ, so it is said that yin and yang are distinct. Examining moisture and dryness, one may be called a superior practitioner. Deep and turbid color indicates interior disease; floating and moist indicates exterior disease. Yellow and red indicates wind; green and black indicates pain; white indicates cold. Yellow with a moist, glossy quality indicates presence of pus; deep red indicates presence of blood; severe pain indicates sinew spasm; severe cold indicates numbness of the skin.
V. Prognosis by Color and the Five Colors Matching the Five Viscera
The five colors each appear in their corresponding regions. Observing floating and sinking determines the depth of the disease; observing moisture and dryness determines the prognosis of success or failure; observing dispersion and gathering determines the proximity or distance of the disease course; observing the upper and lower of the color determines the location of the disease; concentrating the spirit on observation allows one to infer past and present changes. Thus, if one's observation of qi-color is not meticulous, one cannot clearly distinguish right from wrong; with focused intention, one can know new from old diseases.
If the color is bright but not coarse, and if it is heavy, dull, and dark, the disease is severe; if the color is not bright and not moist, the disease is not severe. If the color is dispersed and not gathered, moving about like a wandering foal, the disease qi is also dispersed—mostly qi pain, with accumulation not yet formed. When the kidneys' pathogenic qi attacks the heart, the heart is affected first, and the black color of the kidneys will manifest correspondingly on the face; other viscera follow the same pattern.
In men, when disease color appears at the tip of the nose, it indicates pain in the lower abdomen, radiating downward to the testicles; if the color is round and straight, it indicates pain in the penis; the upper part is the root, the lower part is the branch—belonging to狐疝 or 㿉疝 conditions. In women, when disease color appears at the tip of the nose, it indicates diseases of the bladder and uterus; scattered color indicates pain; gathered color indicates accumulations; the square, round, left, and right of the disease color are each judged according to their shape and hue. If the color extends downward to the lips and gums, it indicates licentious turbidity; if it is moist like ointment, it indicates sudden overeating with impurity. Left corresponds to the left; right corresponds to the right; if the color is deviant, gathered or dispersed and not upright, the direction indicated by the facial color is the location of the disease.
The five colors—green, black, red, white, yellow—should all be upright, fully distributed, and each in its own position. If red appears elsewhere, as large as an elm seed, at the tip of the nose it indicates irregular menstruation (the original "不回" is suspected to be "不月"). If the upper end of the color is sharp, it indicates emptiness of the head with pathogenic qi invading upward; if the lower end is sharp, it indicates pathogenic qi moving downward; the left and right are the same. Matching the five colors to 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 sinews, the heart governs vessels, the lungs govern skin, the spleen governs flesh, and the kidneys govern bones.
Facial Holographic Divisions
This chapter proposes a system that projects the five viscera, six bowels, and limbs onto specific facial regions centered on the nose, forming a systematic facial color diagnostic map. The core idea is that "what is within inevitably manifests without": changes in internal viscera, qi-blood, and meridians will reveal themselves through color, luster, floating-sinking, and gathering-dispersion 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 a concise rule for disease indication: green and black indicate pain, yellow and red indicate heat, and white indicates cold. This is the foundation of color-based pattern differentiation, but the ancients did not isolate color alone; they emphasized moisture and dryness—whether the complexion is lustrous or withered—which often matters more than color itself in assessing prognosis.
Combining Color and Pulse, Internal and External Cross-Validation
This chapter repeatedly pairs facial color diagnosis with radial and carotid pulse findings: the radial pulse governs the interior, the carotid pulse governs the exterior; color moving from exterior to interior or interior to exterior must also be cross-validated with pulse floating-sinking and slippery-rough qualities. This reflects the Huangdi Neijing's consistent principle of four-diagnosis synthesis, not simply "reading the face."
Judging Disease Trends through Floating-Sinking, Dispersion-Gathering, Upper-Lower, and Moisture-Dryness
Observing color is not just about hue but also pattern:
Complexion is Linked to 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 show recognizable facial signs. However, the specific "point-to-point" holographic mapping of internal organs to facial regions in this chapter is based on ancient empirical observation and has not been confirmed by modern anatomy or physiology.
Descriptions of "Sudden Death" Have Phenomenological Value but Lack Scientific Predictive Power
The ancients observed that some people die suddenly without obvious illness, or worsen abruptly after apparent improvement, and attempted to issue warnings through specific facial discolorations. This reflects early attention to sudden death, but specific methods such as "red as large as a thumb" or "black emerging at the forehead" lack evidence-based validation and cannot be used to predict death in clinical practice.
The Thinking Mode of Multi-Metric Cross-Validation Is Worth Emulating
Although the specific facial hologram should not be used directly as a diagnostic tool, the methodological principles—cross-validating multiple indicators, dynamic observation, and inferring the interior through the exterior—are consistent with modern medicine's emphasis on synthesizing history, signs, and ancillary tests.
Associated Concepts
Further Reading
This content is based on classic Chinese medicine texts and is provided solely for traditional cultural learning and study. It does not constitute any medical diagnosis, prescription, or treatment advice. Please consult a qualified healthcare provider if you are unwell.