【纲】仲景曰。太阳病。得之八九日。如疟状。面色反有热色者。未欲解也。以其不得小汗出。
身必痒。宜桂枝麻黄合半汤。太阳病。医发汗。仍发热恶寒。复下之。心下痞。表里俱虚。阴阳
气并竭。无阳则阴独。复加烧针。得胸烦。面色青黄。肤 者。难治。今色微黄。手足温者。易愈。
太阳病。发汗太多。因致痉。脉沉而细。身热足寒。头项强急。恶寒。时头热。面赤。目脉赤。
独头面摇。卒口噤。背反张者。痉病也。
湿家病。身上疼痛。发热。面黄而喘。头痛。鼻塞而烦。其脉大。自能饮食。腹中和。无病。
病在头中寒湿。故鼻塞。纳药鼻中。则愈。
阳明病。面合赤色。不可下之。必发热。色黄。小便不利也。
【目】虞抟曰。凡看伤寒。必先察色。内经曰。声合五音。色合五行。声色符同。然后可以知
五脏之病也。然肝色青。其声呼。肺色白。其声哭。心色赤。其声笑。脾色黄。其声歌。肾色黑。
其声呻也。且四时之色。相生则吉。相克则凶。如青赤见于春。赤黄见于夏。黄白见于长夏。白黑
见于秋。黑青见于冬。此相生之色也。若肝病之色青而白。心病之色赤而黑。脾病之色黄而青。肺
病之色白面赤。肾病之色黑而黄。此相克之色。为难治矣。且以五脏之热色见于面者。肝热则左颊
先赤。肺热则右颊先赤。心热则额先赤。脾热则鼻先赤。肾热则颐先赤也。至于面黑者为阴寒。青
为风寒。青而黑。主风主寒主痛。黄而白。为湿为热为气不调。青而白。为风为气滞为寒为痛也。
大抵黑气见于面。多凶。为病最重。若黑气暗中明。准头年寿亮而滋润者生。黑而枯夭者死。此乃
略举其要。内经以五色微诊。可以自察。难经曰。望而知
之谓之神故色不可不察也。
杨士瀛曰。凡看伤寒。必先察其色。然后切脉审症。乃可合以决死生吉凶。夫色有青黄赤白黑。
见于面部皮肤之上。气有如乱丝乱发之状。隐于皮里也。盖五脏有五色。六经有六色。皆见于面。
以应五行。相生吉。相克凶。滋润生。桔夭死。自准头年寿命宫法令人中。皆有气色。其润泽而
明亮者吉。暗晦而枯燥者凶。又当分四时生克之理而通察之。庶无误也。
鳌按。面青之说。详于诸家。俱据论太阳阳明少阴。皆有面色可验。不独少阳也。当循各经验
之。诸经之说。独载于少阳者。从便耳。
【纲】仲景曰。得病五六日。脉迟浮弱。恶风。手足温。医二三下之。不能食。而胁下满痛。
面目及身黄。颈项强。小便难者。与柴胡汤后必下重。本渴。而饮水呕。食谷哕者。柴胡不中与也。
【目】王肯堂曰。青色属木。主风主寒主痛。乃厥阴肝经之色也。凡面青唇青者。阴极也。若
舌卷囊缩者。宜急温之。如夹阴伤寒。小腹痛。则面青也。内经曰。青如翠羽者生。青如草叶者死。
青而黑。青而红。相生者生。青白而枯燥。相克者死。脾病见青气多。难治。
黄色属土。主湿。乃足太阴脾经之色也。黄如橘子明者。热也。黄如熏黄而暗者。湿也。凡黄
而白。黄而红。相生则吉。黄而青。相克则凶。内经曰。黄如蟹膏者生。黄如枳实者死。若准头年
寿印堂有黄气明润者。病退而有喜兆也。若枯燥而夭者死。凡病欲愈。目 黄也。长夏见黄白则吉。
黄青刚凶。
赤色属火。主热。乃手少阴心经之色也。在伤寒见之。而有三阳一阴之分。如足太阳属水。寒
则本黑。热则红也。经曰。面色缘缘正赤者。阳气怫郁在表。汗出不彻故也。当发其汗。若脉浮数。
表热。不汗出者。面色红赤而光彩也。经言阳明病。面合赤色者。不可攻之。合者。通也。表未解。
不可攻里也。若阳明内热。恶热不恶寒。或蒸蒸发热。或日晡潮热。大便秘结。谵语面赤者。此实
热在里。可攻之也。如表里俱热。口燥舌干。饮水。脉洪。而赤。里未实者。且未可下。人参白虎
汤和之。如少阳经病热。半表半里。面赤脉弦者。小柴胡汤。不可下也。经言少阴病。下利清谷。
里寒外热。面赤者。四逆汤加葱白。此阴寒内极。逼其浮火上行于面。故发赤色。非热也。若误投
凉药。即死。又夹阴伤寒。虚阳泛上者。亦面赤。但足冷脉沉耳。又烦躁面赤。足冷脉沉。不能饮水
者。此阴极也。宜温之。若久病虚人。面两颧颊赤者。此阴火也。不可作伤寒治。然三阳之气。皆
会于头额。其从额上至巅顶。络脑后者。太阳也。从额至鼻。下于面者。阳明也。从头角下耳中。
耳之前后者。少阳也。但有红气。或赤肿者以分之。盖大头伤寒症。正要知此部分可也。内经曰。
心热则额赤。脾热则鼻先赤。肝热则左颊先赤。肺热则右颊先赤。肾热则颐先赤。若赤而青而黄。
为相生。则吉。如赤而黑。为相克。则凶。内经曰。赤如鸡冠者生。如衄血者死。盖准头印堂有赤
气。枯夭者死。明顺者生。如肺病见赤气者。难治。
白色属金。主气血不足。乃手太阴肺经之色也。肝病见之。难治。内经曰。白如猪膏者生。白
如枯桴者死。凡印堂年寿。白而枯夭者凶。光润者吉。若白而黑而黄。相生。吉也。白而赤。相克。
凶也。凡伤寒面白无神者。发汗过多。或脱血所致也。
黑色属水。主寒。乃足少阴肾经之色也。凡黑而白而青。相生则吉。黑而黄。相克则凶。内经
曰。黑如乌羽者生。黑如煤 者死。若准头年寿印堂。黑气枯夭者死。黑中明润者生。黑气自鱼尾
相牵入太阴者死。黑气自法令人中入口者死。耳目口鼻。黑气枯夭者死。凡面命宫准头。明润生。
枯暗死。凡心病见黑气在头者。死也。华佗曰。凡病患面色相等者吉。不相等者凶也。如面青目白。
面赤目青。面黄目青。面赤目白。面白目黑。面黑目白。面白目青。皆为不相等。故曰凶也。相
等者。面目俱青俱红之类也。以上五色。皆六经伤寒之要者。
【纲】张仲景说：太阳病，患病八九日，症状像疟疾一样寒热往来，面色反而发红，这是病邪尚未解除的表现。因为患者未能微微出汗，身体必然发痒，适宜使用桂枝麻黄各半汤。太阳病，医生用发汗法治疗，但发热恶寒的症状仍在，又误用攻下法，导致心下部痞塞不通，表里之气都虚弱，阴阳之气都衰竭。阳气竭绝则阴气独盛，如果再施用烧针疗法，会出现胸中烦闷，面色发青，皮肤干枯不泽的，属于难治之症；如果面色微黄，手足温暖的，容易痊愈。
太阳病，发汗过多，因而导致痉病（筋脉拘急抽搐）。脉象沉而细，身热足冷，头项强直紧急，恶寒，有时头部发热，面红，眼目脉络赤红，只有头面部摇动，突然牙关紧闭，角弓反张的，这是痉病。
患有湿病的病人，身体疼痛，发热，面色发黄且气喘，头痛，鼻塞且心烦，脉象大，饮食正常，腹部平和无病痛。这是因为病邪在头部感受了寒湿，所以鼻塞。将药物纳入鼻中，即可痊愈。
阳明病，面色通红，不可使用攻下法。否则必然会导致发热、身黄、小便不利。
【目】虞抟说：凡是诊治伤寒，必须先观察面色。《内经》说：声音对应五音，面色对应五行。声音和面色相符一致，然后才能知晓五脏的疾病。然而肝色青，其声呼；肺色白，其声哭；心色赤，其声笑；脾色黄，其声歌；肾色黑，其声呻。而且四季的面色，相生则为吉，相克则为凶。例如青色和赤色见于春季，赤色和黄色见于夏季，黄色和白色见于长夏，白色和黑色见于秋季，黑色和青色见于冬季，这是相生的面色。如果是肝病出现青色兼白色，心病出现赤色兼黑色，脾病出现黄色兼青色，肺病出现白色兼赤色，肾病出现黑色兼黄色，这是相克的面色，属于难治之症。并且以五脏的热色反映在面部的情况而言：肝热则左颊先红，肺热则右颊先红，心热则额头先红，脾热则鼻部先红，肾热则下巴先红。至于面色发黑主阴寒，发青主风寒，青而黑主风、主寒、主痛，黄而白主湿、主热、主气机不调，青而白主风、主气滞、主寒、主痛。大体上，黑色之气出现在面部，多主凶险，病情最重。如果黑色之气在暗中透出光明，鼻准、年寿、寿命宫明亮滋润的，可生；黑色枯槁夭折的，主死。这仅仅是略举其要点，《内经》认为通过五色细微诊察，可以自我察觉，《难经》说“望而知之谓之神”，所以面色不可不仔细观察。
杨士瀛说：凡是诊治伤寒，必须先观察其面色，然后切脉审症，才可以综合判断生死吉凶。面色有青、黄、赤、白、黑，显现于面部皮肤之上，气色有如乱丝乱发之状，隐伏于皮里。五脏有五色，六经有六色，都显现于面部，以应五行。相生为吉，相克为凶，滋润为生，枯槁为死。从鼻准、年寿、寿命宫到人中穴，都有气色显现。润泽明亮的为吉，暗晦枯燥的为凶。还应当区分四季生克的道理来通盘考察，这样才不会有误。
沈金鳌按语：关于面青的说法，各家论述详尽，都是依据太阳、阳明、少阴经，都有面色可以验证，不仅仅限于少阳经。应当遵循各经的经验来辨别。各经之说，唯独记载于少阳经的，是为了方便起见。
【纲】张仲景说：患病五六日，脉象迟浮弱，恶风，手足温暖，医生多次攻下，导致不能进食，胁下满痛，面目及全身发黄，颈项强直，小便困难的，给予柴胡汤后必然出现下坠感。本来口渴，饮水却呕吐，进食谷物则呃逆的，柴胡汤不宜使用。
【目】王肯堂说：青色属木，主风、主寒、主痛，是厥阴肝经的颜色。凡是面青唇青的，是阴极的表现。如果出现舌卷缩、睾丸上缩的，应当紧急温补。如夹阴伤寒，小腹痛，则面色发青。《内经》说：面色青如翠鸟羽毛光泽的为生，青如草叶枯黄的为死。青而黑、青而红，相生者为生；青白而枯燥，相克者为死。脾病见到青色气色，多数难治。
黄色属土，主湿，是足太阴脾经的颜色。黄如橘子明亮的，是热证；黄如熏黄而暗淡的，是湿证。凡是黄而白、黄而红，相生则为吉；黄而青，相克则为凶。《内经》说：黄如蟹膏光泽的为生，黄如枳实枯暗的为死。如果鼻准、年寿、印堂有黄色气色明润的，是病退而有喜兆。如果枯燥夭折的，主死。凡是疾病欲愈时，眼睛周围会发黄。长夏季节见到黄白色为吉，黄青色刚硬为凶。
赤色属火，主热，是手少阴心经的颜色。在伤寒病中看到赤色，有三阳和一阴的区别。如足太阳经属水，寒则本色黑，热则变红。经文说：面色缘缘正赤的，是阳气怫郁在表，汗出不透彻的缘故。应当发汗。如果脉浮数，表热，不出汗的，面色红赤而有光彩。经文说阳明病，面色通红的，不可攻下。“合”即通的意思，表证未解，不可攻里。如果阳明内热，恶热不恶寒，或蒸蒸发热，或日晡潮热，大便秘结，谵语面赤的，这是实热在里，可以攻下。如表里俱热，口燥舌干，饮水，脉洪大而赤，里证未实的，暂且不可攻下，用人参白虎汤调和。如少阳经病热，在半表半里，面赤脉弦的，用小柴胡汤，不可攻下。经文说少阴病，下利清谷，里寒外热，面赤的，用四逆汤加葱白。这是阴寒内极，逼迫浮火上行于面，所以发赤色，并非热证。如果误投凉药，立即死亡。又有夹阴伤寒，虚阳泛上的，也见面赤，只是足冷脉沉而已。还有烦躁面赤，足冷脉沉，不能饮水的，这是阴极的表现，应当温补。如果是久病虚人，面两颧颊赤的，这是阴火，不可当作伤寒治疗。然而三阳之气，都会聚于头额。从额上至巅顶，络脑后的是太阳经；从额至鼻，下于面的是阳明经；从头角下耳中，耳之前后的是少阳经。只要有红气，或赤肿的，以此区分。大概大头伤寒症，正要知晓这些部位的区别。《内经》说：心热则额赤，脾热则鼻先赤，肝热则左颊先赤，肺热则右颊先赤，肾热则颐先赤。如果赤而青而黄，为相生，则吉。如赤而黑，为相克，则凶。《内经》说：赤如鸡冠光泽的为生，如衄血枯暗的为死。大概鼻准、印堂有赤气，枯夭的死亡，明顺的生存。如肺病见到赤气的，难治。
白色属金，主气血不足，是手太阴肺经的颜色。肝病见到白色，难治。《内经》说：白如猪膏光泽的为生，白如枯木的为死。凡是印堂、年寿，白而枯夭的凶，光润的吉。如果白而黑而黄，相生，吉也。白而赤，相克，凶也。凡是伤寒面白无神的，是发汗过多，或脱血所致。
黑色属水，主寒，是足少阴肾经的颜色。凡是黑而白而青，相生则吉。黑而黄，相克则凶。《内经》说：黑如乌羽光泽的为生，黑如煤炭枯暗的为死。如果鼻准、年寿、印堂，黑气枯夭的死亡，黑中明润的生存。黑气自鱼尾牵引进入人中穴的死亡，黑气自法令纹入口中的死亡。耳目口鼻，黑气枯夭的死亡。凡是面命宫、鼻准，明润的生存，枯暗的死亡。凡是心病见到黑气在头部的，死亡。华佗说：凡是病患面色与目色相应的为吉，不相应的为凶。如面青目白，面赤目青，面黄目青，面赤目白，面白目黑，面黑目白，面白目青，都为不相等，所以说凶。相等者，是面目俱青、俱红之类。以上五色，都是六经伤寒的关键要点。
[Outline] Zhang Zhongjing stated: In Taiyang disease (Disease of the Bladder and Small Intestine channels), after eight or nine days, the symptoms resemble malaria (alternating chills and fever). If the facial complexion is reddish, it indicates that the pathogen has not yet resolved. This is because the patient has not sweated slightly. The body will likely feel itchy, and Guizhi Mahuang Ban Tang (Half-Combination Decoction of Cinnamon Twig and Ephedra) is appropriate. In Taiyang disease, if a physician induces sweating but fever and aversion to cold persist, and subsequently applies purgation, epigastric fullness (stagnation in the lower chest/upper abdomen) occurs. Both exterior and interior qi are depleted, and both yin and yang qi are exhausted. When yang is exhausted, yin stands alone. If moxibustion with burning needles is additionally applied, chest irritability ensues. A bluish-green facial complexion with dry skin indicates a difficult-to-treat condition. However, if the complexion is slightly yellow and the hands and feet are warm, recovery is easy.
In Taiyang disease, excessive sweating may lead to Jing disease (spasm disease characterized by muscle stiffness and convulsions). With a deep and fine pulse, fever in the body but cold feet, stiffness and tension in the head and neck, aversion to cold, occasional heat in the head, red face, red eye vessels, isolated shaking of the head, sudden lockjaw, and opisthotonos (arching of the back), this is diagnosed as Jing disease.
Patients suffering from Dampness diseases experience body pain, fever, yellowish complexion, wheezing, headache, nasal congestion, and irritability. The pulse is large, appetite is normal, and the abdomen is harmonious without pathology. The disease lies in cold-dampness obstructing the head, causing nasal congestion. Inserting medicinal herbs into the nose will cure it.
In Yangming disease (Disease of the Stomach and Large Intestine channels), if the face is entirely red, purgation must not be used. Doing so will inevitably cause fever, jaundice, and difficulty in urination.
[Commentary] Yu Tun stated: In diagnosing Shanghan (Cold Damage), one must first observe the complexion. The Neijing (Classic of Internal Medicine) states: Sounds correspond to the Five Tones, and complexions correspond to the Five Elements. Only when sound and color match can one understand diseases of the Zang organs. The Liver's color is green, its sound is a cry; the Lung's color is white, its sound is weeping; the Heart's color is red, its sound is laughter; the Spleen's color is yellow, its sound is singing; the Kidney's color is black, its sound is groaning. Furthermore, complexions according to the four seasons: generation brings auspiciousness, overcoming brings misfortune. For example, green and red appearing in Spring, red and yellow in Summer, yellow and white in Late Summer, white and black in Autumn, and black and green in Winter represent generating colors. Conversely, green with white in Liver disease, red with black in Heart disease, yellow with green in Spleen disease, white with red in Lung disease, and black with yellow in Kidney disease represent overcoming colors, indicating difficult-to-treat conditions. Regarding the manifestation of internal heat colors on the face: Liver heat causes redness first on the left cheek; Lung heat on the right cheek; Heart heat on the forehead; Spleen heat on the nose; Kidney heat on the chin. Black complexion indicates Yin cold; green indicates wind-cold; green and black indicate wind, cold, and pain; yellow and white indicate dampness, heat, and Qi disharmony; green and white indicate wind, Qi stagnation, cold, and pain. Generally, black Qi on the face portends凶 (misfortune/severity) and severe illness. If black Qi appears bright within darkness, and the nose tip (Zhuntou), Nianshou area, and Shoushu area are bright and moist, life is preserved; if dry and withered, death ensues. This merely outlines key points. The Neijing suggests that subtle diagnosis via five colors allows self-examination. The Nanjing states, "Knowing through observation is called Divine," thus complexion inspection is indispensable.
Yang Shiying stated: In diagnosing Shanghan, one must first inspect the complexion, then palpate the pulse and examine symptoms to determine life and death, auspiciousness and misfortune. Complexions include green, yellow, red, white, and black appearing on the facial skin, with Qi resembling tangled threads hidden beneath the skin. The Five Zang have five colors, the Six Channels have six colors, all manifesting on the face corresponding to the Five Elements. Generation is auspicious, overcoming is inauspicious; moistness indicates life, witheredness indicates death. The nose tip, Nianshou, Shoushu areas, and Renzhong (philtrum) all display Qi colors. Bright and moist colors are auspicious; dark and dry colors are inauspicious. One must also consider the principles of seasonal generation and overcoming for comprehensive examination to avoid errors.
Shen Jin'ao noted: Discussions on green complexion are detailed by various authors, relying on Taiyang, Yangming, and Shaoyin channels where facial colors serve as verification, not limited to Shaoyang. One should follow empirical experiences of each channel. The specific mention of Shaoyang is for convenience.
[Outline] Zhang Zhongjing stated: After five or six days of illness, with a slow, floating, and weak pulse, aversion to wind, and warm hands and feet, if a physician purges multiple times, leading to inability to eat, fullness and pain in the hypochondrium, yellowing of the face, eyes, and body, neck stiffness, and difficult urination, administering Chaihu Tang (Bupleurum Decoction) will likely cause a sensation of heaviness in the rectum. If the patient is thirsty but vomiting upon drinking water, or retching upon eating grains, Chaihu Tang is contraindicated.
[Commentary] Wang Kentang stated: Green belongs to Wood, governs wind, cold, and pain, and is the color of the Jueyin Liver channel. Green face and lips indicate extreme Yin. If tongue curling and testicular retraction occur, urgent warming is required. In Jiaoyin Shanghan (Cold damage involving Yin deficiency), with lower abdominal pain, the face turns green. The Neijing states: Green like a kingfisher's feather indicates life; green like grass leaves indicates death. Green with black or red (generating relationship) indicates life; pale green and dry (overcoming relationship) indicates death. Green Qi in Spleen disease is difficult to treat.
Yellow belongs to Earth, governs dampness, and is the color of the Foot-Taiyin Spleen channel. Yellow like a bright orange indicates heat; yellow like smoked tobacco and dark indicates dampness. Yellow with white or red (generating) is auspicious; yellow with green (overcoming) is inauspicious. The Neijing states: Yellow like crab roe indicates life; yellow like an unripe loquat indicates death. Bright and moist yellow Qi on the nose tip, Nianshou, and Yintang areas indicates disease retreat and good omens; dry and withered indicates death. Yellowing around the eyes often precedes recovery. Yellow-white in Late Summer is auspicious; yellow-green is rigid and inauspicious.
Red belongs to Fire, governs heat, and is the color of the Hand-Shaoyin Heart channel. In Shanghan, redness varies among the Three Yang and One Yin. Foot-Taiyang belongs to Water; cold makes it black, heat makes it red. The text states: Uniformly red face indicates Yang Qi stagnation at the exterior due to incomplete sweating. Sweating therapy is indicated. If the pulse is floating and rapid with exterior heat and no sweat, the face is red and lustrous. The text notes Yangming disease with entire redness prohibits purgation ("He" means connected); exterior unresolved means interior cannot be attacked. If Yangming interior heat exists with aversion to heat (not cold), steaming fever, afternoon tidal fever, constipation, delirium, and red face, this is excess heat in the interior, and purgation is applicable. If exterior and interior are both hot, with dry mouth/tongue, thirst, surging red pulse, but interior not yet solid, do not purge yet; use Renshen Baihu Tang (Ginseng and White Tiger Decoction) to harmonize. For Shaoyang channel heat, half-exterior/half-interior, with red face and wiry pulse, use Xiaochaihu Tang (Minor Bupleurum Decoction); do not purge. The text mentions Shaoyin disease with diarrhea of undigested food, interior cold/exterior heat, and red face; use Sini Tang (Frigid Extremity Decoction) plus Scallion White. This is extreme interior Yin cold forcing floating fire upward, causing redness, not true heat. Misusing cooling herbs leads to death. Jiaoyin Shanghan with floating Yang also presents red face but with cold feet and deep pulse. Irritability, red face, cold feet, deep pulse, and inability to drink indicate extreme Yin; warming is required. In chronic deficiency patients, red malar flush indicates Yin Fire, not Shanghan. The Three Yang Qi converge on the forehead. Taiyang runs from forehead to vertex behind the brain; Yangming from forehead to nose down the face; Shaoyang from temporal angle down past the ear. Redness or swelling distinguishes these. In Big Head Shanghan, knowing these regions is crucial. The Neijing states: Heart heat reddens the forehead; Spleen heat reddens the nose first; Liver heat reddens the left cheek first; Lung heat reddens the right cheek first; Kidney heat reddens the chin first. Red with green/yellow (generating) is auspicious; red with black (overcoming) is inauspicious. The Neijing states: Red like a rooster's comb indicates life; red like blood from nosebleed indicates death. Dry/withered red Qi on nose tip/Yintang indicates death; bright/smooth indicates life. Lung disease with red Qi is difficult to treat.
White belongs to Metal, governs Qi and Blood deficiency, and is the color of the Hand-Taiyin Lung channel. White in Liver disease is difficult to treat. The Neijing states: White like pig fat indicates life; white like dead wood indicates death. Dry/withered white on Yintang/Nianshou is inauspicious; lustrous is auspicious. White with black/yellow (generating) is auspicious; white with red (overcoming) is inauspicious. Pale, spiritless white face in Shanghan results from excessive sweating or blood loss.
Black belongs to Water, governs cold, and is the color of the Foot-Shaoyin Kidney channel. Black with white/green (generating) is auspicious; black with yellow (overcoming) is inauspicious. The Neijing states: Black like crow feathers indicates life; black like coal indicates death. Dry/withered black Qi on nose tip/Nianshou/Yintang indicates death; moist/bright indicates life. Black Qi pulling from the outer canthus into the Renzhong indicates death; black Qi entering from the Faleng lines into the mouth indicates death. Dry/withered black Qi in ears, eyes, mouth, nose indicates death. Bright/moist Minggong and nose tip indicate life; dry/dark indicates death. Black Qi on the head in Heart disease indicates death. Hua Tuo stated: Matching facial and eye colors is auspicious; mismatching is inauspicious. Examples of mismatch: green face/white eyes, red face/green eyes, yellow face/green eyes, red face/white eyes, white face/black eyes, black face/white eyes, white face/green eyes—all inauspicious. Matching colors (e.g., both face and eyes green or red) are auspicious. The above five colors are essential for Six Channel Shanghan diagnosis.