\r察面图\p01-e19a1.bmp\r
庭(即天庭)以候首面,阙(即眉心)以候肺,阙以
上候咽喉,下极(即山根)以候心,年寿(即鼻柱)以候
肝,其左右以候胆,面王(即准头)以候脾,方上
(即鼻隧)以候胃,人中以候膀胱、子宫,
面中央(颧骨之下,迎香之外)以候大肠,大肠之旁(颊
之上也)以候肾,面王以上(两颧内,鼻准旁)以候小肠。
上本《内经》,后人又以天庭候心,左颊候肝,
右颊候肺,鼻候脾,颏候肾,参而查之可也。
面有青黄赤白黑,以应五脏。岐伯曰∶生于心,如以缟(素帛也)裹朱;生于肺,如
以缟裹红;(红,谓淡红。)生于肝,如以缟裹绀;(青含赤色。)生于脾,如以缟裹栝蒌实;
(黄含赤色。)生于肾,如以缟裹紫,(黑含赤色。按五色俱带赤,乃血之本色。然色为精
神所发现,欲
藏不欲露,故如缟裹。若露则为脏气失守,精气外浮,中脏告竭矣。)此为无病之色。若
病而色见,则
以相生者吉,相克者凶;(如脾病泄泻,而见赤色,为相生,见青色为相克。又秋见黄色∶为相
生,见赤色为相克也。)滋润而明亮者吉,枯槁而晦滞者凶。(即《内经》所谓赤欲如白裹朱,不
欲如赭之意。面不润责之水,无光责之火。)晦滞之色,上行者,病益甚,(审其色之
尖锐向上,知
为上行,向下知为下行。下文内走外走等仿此。)下行如云散者,病渐已。女子色见右为逆,左为
从,男子反此。色散未聚,病亦未聚。(凡色明显者为新病,浊晦者为久病。)色从面内走面外,
病亦自内走外。左右上下,以此推之。
青色属肝,主风,主惊,主寒,主痛。面唇青者,寒极也。青而脱色,(脱色,谓
面无血色,神采脱也。)惊恐也。青而黑者,多寒痛。青而白者,多虚风。(以上皆寒证。盖肝阳
不足,阴寒内凝,脾失其营运之权,故多腹中冷痛,吐泄之疾。)青而赤者,为肝火。
青赤而晦滞
者,为郁火。(以上热证。)
赤色属心,主热。心热者,庭先赤。脾热者,鼻先赤。肺热者,右颊先赤。肾热者,颐颏先
赤。肝热者,左颊先赤。面色缘缘正赤者,阳气怫郁在表,汗不彻故也。(此伤寒太阳经表热证。)面
赤而潮热谵语者,胃实也。(此伤寒阳明腑实热证。)面赤如微酣,或两颧浅红娇嫩,游移不定,
(不尽面通红。)乃阴证戴阳,必下利清谷,或小便清白,(或淡黄。)脉沉细,或浮数无力,按之欲散。
虽或烦躁发热,欲坐卧泥水中,(外热甚也。)渴欲饮水,或咽喉痛,证似实热,而索水置前却不能
饮,肌表虽大热,而重按之则不热,或反觉冷,且两足必冷,须审。(此伤寒直中寒证。)
又有面赤
烦躁,遍舌生疮生刺,舌敛缩如荔枝状,或痰涎涌盛,喘急,小便频数,口干引饮,
两唇焦裂,喉间如烟火上攻,两足心如烙,脉洪数无论,按之有力,扪其身烙手,
此肾虚火不归元所致,证最难辨。但病由内伤,其来以渐,是乃干柴烈火,不戢自
焚,与上所列三证,固自不同也。又有久病虚人,两颧至午后带赤者,此
则阴虚火动之常证,虽未至如上证之烈,亦内伤也。(以上二证皆虚热。)赤色出于两
颧,(状若装朱。)大如拇指者,病虽愈必死。(又热病无汗颧赤死,盖颧以骨为主,
骨属肾,水恶反克也。)
黄色属脾,主湿热,食积。黄而明如橘子者,湿少热多也。黄如烟熏,暗
浊不明,湿多热少也。(湿土瘀浊。)黄而黯淡者,则为寒湿。黄而枯 者,胃中有火。
黄而色淡,胃气虚。黄而青黑者,为木克土,(肝阳不升,脾为寒滞。)水无制。(脾不运则水停。)
白色属肺,主气血虚寒,纵有虚火,断无实热。白而无神者,为肝泄脱血。白
而青者,气寒血凝。白而淖泽,肺胃之充也。白而肥,有痰。白而瘦,爪甲鲜赤,
气虚有火也。
黑色属肾,主寒,主痛。青黑为阴寒,焦黑齿槁,为肾热。黑而枯夭,见于耳
目口鼻,不论何处,俱不吉。若见于天庭,大如拇指,必不病而卒死。(阴晦之色,加于
阳之高位,故死。)
面惨不光者,阴寒也。面光不惨者,阳热也。面如锦纹者,阳毒也。面垢如油,
喘促者,暑病也。
凡暴感客邪之色,不妨昏浊壅滞,病久气虚,只宜瘦削清 。若病邪方锐,而
青白少神,气羸久困,而妩媚鲜泽,咸非正色,五色之中,青黑黯惨,无论病
之新久,总属阳气不振。惟黄色见于面目,而明润者,向愈之候也。此经所以谓面
黄,目青或赤,或白或黑,皆不死。(以黄色在也。)面青,目赤或黑;面赤,目白或青;
面黑,目白,皆死。(以无黄色也。按面目色同,为顺,色异为逆,说本华佗。则此所谓不死者,
但不死耳,非顺也。)
察面图
庭(即天庭)用于诊察头面部,阙(即眉心)用于诊察肺,阙的上方用于诊察咽喉,下极(即山根)用于诊察心,年寿(即鼻柱)用于诊察肝,其左右两侧用于诊察胆,面王(即准头,鼻尖)用于诊察脾,方上(即鼻隧,鼻翼旁)用于诊察胃,人中用于诊察膀胱和子宫,面中央(颧骨之下,迎香穴之外)用于诊察大肠,大肠的旁边(脸颊之上)用于诊察肾,面王以上(两颧内侧,鼻准旁)用于诊察小肠。
上述内容依据《黄帝内经》,后人又提出以天庭诊察心,左颊诊察肝,右颊诊察肺,鼻子诊察脾,下巴诊察肾,可以参照综合考察。
面色有青、黄、赤、白、黑五种,分别对应五脏。岐伯说:心脏正常的色泽,如同用素帛包裹朱砂;肺脏正常的色泽,如同用素帛包裹红色;(这里的红,指淡红色。)肝脏正常的色泽,如同用素帛包裹绀色;(绀色是青中泛赤的颜色。)脾脏正常的色泽,如同用素帛包裹栝楼实;(栝楼实黄色中泛赤。)肾脏正常的色泽,如同用素帛包裹紫色。(紫色是黑中泛赤的颜色。按五色都带有赤色,这是血液的本色。然而面色是精神的外在表现,应当藏而不露,所以像被素帛包裹一样。如果显露出来,就是脏气失守,精气外浮,内脏精气衰竭了。)这是无病的正常面色。如果生病时出现面色,则相生者为吉,相克者为凶;(例如脾病泄泻,若见到赤色,为火生土,属相生,见到青色为木克土,属相克。又如秋季见到黄色,为相生,见到赤色为相克。)滋润而明亮者吉,枯槁而晦暗滞涩者凶。(这就是《黄帝内经》所说的赤色想要像白布裹着朱砂那样含蓄,不想要像赭石那样暴露的意思。面色不润泽责之于水不足,没有光泽责之于火不足。)晦暗滞涩的面色,向上蔓延的,病情加重;(观察其色尖锐向上,知道是上行,向下则知为下行。下文内走外走等道理仿照此例。)向下消散如云散开的,病情逐渐好转。女子面色显现于右侧为逆证,左侧为顺证,男子与此相反。面色散漫未凝聚,说明病邪也未凝聚。(凡是颜色明显的为新病,浑浊晦暗的为久病。)面色从面部内部走向外部,病邪也自内向外传变。左右上下,依此类推。
青色属于肝,主风,主惊,主寒,主痛。面和嘴唇发青,是寒极的表现。青色且脱色,(脱色,指面无血色,神采丧失。)是惊恐的表现。青色带黑色,多因寒痛。青色带白色,多因虚风。(以上皆属寒证。因为肝阳不足,阴寒内凝,脾失去运化转输的功能,所以多有腹中冷痛、呕吐泄泻的疾病。)青色带赤色,为肝火。
青赤色且晦暗滞涩,为郁火。(以上属热证。)
赤色属于心,主热。心热者,天庭先发红。脾热者,鼻子先发红。肺热者,右颊先发红。肾热者,颐部和下巴先发红。肝热者,左颊先发红。面色整个持续通红,是阳气怫郁在表,汗出不透的缘故。(这是伤寒太阳经表热证。)面赤且潮热谵语,是胃腑实证。(这是伤寒阳明腑实热证。)面赤像微醉,或两颧浅红娇嫩,游移不定,(并非满面通红。)这是阴证戴阳,必然伴有下利清谷,或小便清白,(或淡黄色),脉沉细,或浮数无力,重按欲散。虽然有时烦躁发热,想坐在泥水中,(外表热甚),口渴想喝水,或咽喉痛,证候看似实热,但索要水放在面前却不能喝,肌表虽大热,但重按却不热,或反而觉得冷,且两脚必定寒冷,必须仔细审察。(这是伤寒直中寒证。)
又有面赤烦躁,满舌生疮生刺,舌头收缩如荔枝状,或痰涎涌盛,喘急,小便频数,口干引饮,两唇焦裂,喉间如火烟上攻,两足心如烙铁烫,脉洪数无论有力无力,触摸身体烫手,这是肾虚火不归元所致,证候最难辨别。但病由内伤引起,其来势缓慢,这是干柴烈火,不收敛就会自焚,与上面列出的三种证候,自然不同。又有久病体虚之人,两颧到午后带红色的,这是阴虚火动的常见证候,虽然未达到上述证候的剧烈程度,但也属于内伤。(以上两种证候都属于虚热。)赤色出现在两颧,(形状像涂了胭脂。)大如拇指的,即使病愈也必死。(另外热病无汗而颧赤者死,因为颧骨以骨为主,骨属肾,水恶反克也。)
黄色属于脾,主湿热,食积。黄而明亮如橘子皮,是湿少热多。黄如烟熏,暗淡浑浊不明,是湿多热少。(湿土瘀浊。)黄而黯淡,则是寒湿。黄而枯槁,是胃中有火。黄而色淡,是胃气虚。黄而青黑,是木克土,(肝阳不升,脾为寒滞。)水无制约。(脾不运化则水停。)
白色属于肺,主气血虚寒,纵有虚火,断无实热。白而无神,是肝血耗脱。白而青,是气寒血凝。白而润泽,是肺胃充盛。白而肥胖,有痰。白而消瘦,爪甲鲜红,是气虚有火。
黑色属于肾,主寒,主痛。青黑为阴寒,焦黑齿枯,为肾热。黑而枯夭,出现在耳目口鼻,不论何处,都不吉利。如果出现在天庭,大如拇指,必定不发病而突然死亡。(阴晦之色,加于阳之高位,所以死。)
面色惨淡不光亮的,是阴寒。面色光亮不惨淡的,是阳热。面色如锦纹的,是阳毒。面色垢腻如油,喘促的,是暑病。
凡是突然感受外邪的面色,不妨昏浊壅滞,病久气虚,只宜瘦削清润。如果病邪正锐利,而面色青白少神,元气虚弱久困,而面色妩媚鲜泽,都不是正色,五色之中,青黑黯惨,无论病的新久,总属阳气不振。只有黄色见于面目,且明润的,是向愈的征兆。所以经典中说面黄,目青或赤,或白或黑,都不死。(因为有黄色的缘故。)面青,目赤或黑;面赤,目白或青;面黑,目白,都死。(因为没有黄色的缘故。按面目色同,为顺,色异为逆,说法源自华佗。那么这里所谓的不死,只是不死罢了,并不是顺证。)
Facial Inspection Diagram
The Ting (forehead) is used to inspect the head and face; the Que (between the eyebrows) is used to inspect the Lungs; above the Que is used to inspect the throat; the Xiaji (root of the nose) is used to inspect the Heart; the Nianshou (nasal bridge) is used to inspect the Liver; its left and right sides are used to inspect the Gallbladder; the Mianwang (tip of the nose) is used to inspect the Spleen; the Fangshang (sides of the nasal alae) is used to inspect the Stomach; the Renzhong (philtrum) is used to inspect the Bladder and Uterus; the center of the face (below the zygomatic bones, outside the Yingxiang acupoint) is used to inspect the Large Intestine; beside the Large Intestine area (upper cheeks) is used to inspect the Kidneys; above the Mianwang (inside the zygomatic arches, beside the nasal tip) is used to inspect the Small Intestine.
The above content is based on the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Later authors proposed using the forehead to inspect the Heart, the left cheek to inspect the Liver, the right cheek to inspect the Lungs, the nose to inspect the Spleen, and the chin to inspect the Kidneys. These can be referred to and examined comprehensively.
The facial complexion has five colors: cyan, yellow, red, white, and black, corresponding to the Five Zang Organs. Qibo said: The normal color of the Heart is like cinnabar wrapped in plain silk; the normal color of the Lungs is like red [light red] wrapped in plain silk; the normal color of the Liver is like gan [cyan with a reddish hue] wrapped in plain silk; the normal color of the Spleen is like the fruit of Trichosanthes kirilowii [yellow with a reddish hue] wrapped in plain silk; the normal color of the Kidneys is like purple [black with a reddish hue] wrapped in plain silk. [Note: All five colors contain red, which is the true color of blood. However, facial color is the manifestation of spirit and essence; it should be concealed rather than exposed, hence the analogy of being wrapped in silk. If it is exposed, it indicates that the Qi of the Zang organs has lost its holding function, essence and Qi are floating outward, and the internal Zang organs are exhausted.] This represents the complexion of health. If a complexion appears during illness, those generated by mutual generation are auspicious, while those subjected to mutual restriction are ominous. [For example, in Spleen disease with diarrhea, seeing a red color indicates Fire generating Earth (mutual generation), while seeing a cyan color indicates Wood restricting Earth (mutual restriction). Similarly, in autumn, seeing yellow indicates mutual generation, while seeing red indicates mutual restriction.] Moist and bright complexions are auspicious; dry, dull, and stagnant complexions are ominous. [This refers to the statement in the *Neijing*: Red should resemble white silk wrapping cinnabar [subtle], not resembling hematite [exposed]. Lack of moisture blames Water deficiency; lack of luster blames Fire deficiency.] A dull and stagnant complexion moving upward indicates worsening disease; [Observe if the color is sharp and pointing upward to know it is moving up; downward indicates moving down. The following descriptions of inward/outward movement follow this logic.] moving downward and dispersing like clouds indicates gradual recovery. For women, a complexion appearing on the right side is contrary (ni), and on the left is compliant (cong); for men, it is the reverse. A dispersed but uncondensed complexion indicates that the pathogenic factor has also not condensed. [Generally, obvious colors indicate new diseases, while turbid and dull colors indicate chronic diseases.] A complexion moving from the interior to the exterior of the face indicates the pathogen moving from inside to outside. The same logic applies to left/right and up/down.
Cyan belongs to the Liver, governing Wind, fright, Cold, and pain. Cyan face and lips indicate extreme Cold. Cyan with loss of color [loss of luster and vitality] indicates fright or terror. Cyan mixed with black indicates much Cold pain. Cyan mixed with white indicates much Deficient Wind. [All the above are Cold syndromes. Because Liver Yang is insufficient, Yin-Cold coagulates internally, and the Spleen loses its transportive power, thus often causing cold pain in the abdomen, vomiting, and diarrhea.] Cyan mixed with red indicates Liver Fire.
Cyan and red with dullness and stagnation indicate constrained Fire. [The above are Heat syndromes.]
Red belongs to the Heart, governing Heat. In Heart Heat, the forehead turns red first. In Spleen Heat, the nose turns red first. In Lung Heat, the right cheek turns red first. In Kidney Heat, the chin and jaw turn red first. In Liver Heat, the left cheek turns red first. A face that is uniformly and persistently red indicates Yang Qi constrained at the exterior due to incomplete sweating. [This is an exterior Heat syndrome of the Taiyang Meridian in Shanghan.] Face redness with tidal fever and delirious speech indicates Fullness in the Stomach Fu-organ. [This is a Fu-organ Fullness Heat syndrome of the Yangming Meridian in Shanghan.] Face redness resembling slight intoxication, or pale red and delicate on both zygomatic arches, shifting unpredictably [not full-face redness], indicates Yin syndrome with Floating Yang (Dai Yang). This must be accompanied by diarrhea with undigested food, or clear and white urine [or pale yellow], a deep and fine pulse, or superficial and rapid but weak pulse that dissipates upon heavy pressure. Although there may be irritability, fever, desire to sit in mud/water [severe external heat], thirst for water, or sore throat, resembling Excess Heat, the patient may ask for water but cannot drink it when placed before them. The skin surface feels very hot, but heavy pressure reveals no heat or even coldness, and the feet are certainly cold; this must be carefully examined. [This is a direct invasion Cold syndrome in Shanghan.]
There is also a case of face redness with irritability, sores and prickles all over the tongue, tongue retraction resembling a lychee, profuse phlegm-saliva, panting, frequent urination, dry mouth desiring drinks, cracked lips, sensation of fire/smoke attacking the throat, soles of feet feeling like burning irons, a flooding and rapid pulse regardless of strength, and a body that feels hot to the touch. This is caused by Kidney Deficiency with Fire failing to return to its source. This syndrome is the most difficult to distinguish. However, since the disease arises from internal injury and develops gradually, it is like dry wood and fierce fire, self-immolating without restraint, which is naturally different from the three syndromes listed above. There is also a case of chronically ill and deficient persons whose zygomatic arches become red after noon; this is a common syndrome of Yin Deficiency with Fire stirring. Although not as severe as the aforementioned syndrome, it is still an internal injury. [The above two syndromes are both Deficient Heat.] Redness appearing on the zygomatic arches, [resembling applied rouge], large as a thumb, indicates death even if the disease seems cured. [Also, in Heat diseases, no sweat with red zygomatic arches indicates death, because the zygoma is governed by bone, bone belongs to the Kidney, and Water fears counter-restriction.]
Yellow belongs to the Spleen, governing Damp-Heat and Food Retention. Yellow and bright like an orange peel indicates little Dampness and much Heat. Yellow like smoke-stained, dark and turbid, indicates much Dampness and little Heat. [Turbid Damp-Earth.] Yellow and dull indicates Cold-Damp. Yellow and withered indicates Fire in the Stomach. Yellow and pale indicates Stomach Qi Deficiency. Yellow with cyan/black indicates Wood restricting Earth, [Liver Yang fails to ascend, Spleen is stagnant with Cold], and Water is uncontrolled. [Spleen failure to transport leads to Water retention.]
White belongs to the Lung, governing Qi and Blood Deficiency and Cold. Even if there is Deficient Fire, there is certainly no Excess Heat. White without spirit indicates Liver Blood depletion. White with cyan indicates Qi Cold and Blood coagulation. White and moist indicates abundance in the Lungs and Stomach. White and plump indicates Phlegm. White and thin with bright red nails indicates Qi Deficiency with Fire.
Black belongs to the Kidney, governing Cold and pain. Cyan-black indicates Yin-Cold; scorched black with withered teeth indicates Kidney Heat. Black and withered/dead-looking, appearing in the ears, eyes, mouth, or nose, anywhere, is inauspicious. If it appears on the forehead, large as a thumb, sudden death will occur without prior illness. [Yin-dull color added to the high Yang position causes death.]
A face that is gloomy and lacks luster indicates Yin-Cold. A face that is lustrous and not gloomy indicates Yang-Heat. A face patterned like brocade indicates Yang-Toxin. A face greasy like oil with panting indicates Summerheat disease.
For complexions from sudden external pathogenic invasion, turbidity and obstruction are acceptable. For chronic illness with Qi Deficiency, only emaciation and clarity are appropriate. If the pathogen is sharp but the complexion is cyan/white lacking spirit, or if Qi is depleted and long-confined yet the complexion is charming and fresh, these are not correct colors. Among the five colors, cyan, black, dark, and gloomy always indicate failure of Yang Qi to rise, regardless of whether the disease is new or old. Only when yellow appears on the face and eyes and is bright and moist does it indicate recovery. Thus, the classics state that a yellow face with green, red, white, or black eyes will not die. [Because Yellow is present.] A cyan face with red or black eyes; a red face with white or cyan eyes; a black face with white eyes, all indicate death. [Because Yellow is absent. Note: Same color in face and eyes is Shun [smooth/compliant]; different colors is Ni [contrary]. This theory originates from Hua Tuo. Thus, "not dying" here merely means survival, not necessarily Shun.]