经义
望而知之谓之神。○凡治病察其形气、色泽∶形气相得，谓之可治；色泽以浮，谓之易已，形气相失，
谓之难治；色夭不泽，谓之难已。○生于心，如以缟裹朱；生于肺，如以缟裹红；生于肝，如以缟裹绀；生于脾，
如以缟裹栝蒌实；生于肾，如以缟裹紫。○赤欲如白裹朱，不欲如赭；白欲如鹅羽，不欲如盐；青欲如苍璧之
泽，不欲如蓝；黄欲如罗裹雄黄，不欲如黄土；黑欲如重漆色，不欲如地苍。○青如草滋者死，黄如枳实者死，
黑如 者死，赤如 血者死，白如枯骨者死。青如翠羽者生，赤如鸡冠者生，黄如蟹腹者生，白如豕膏者生，
黑如乌羽者生。○肺热病者，色白而毛败；心热病者，色赤而络脉溢；肝热病者，色苍而爪枯，脾热病者，色
黄而肉蠕动；肾热病者，色黑而齿槁。○面黄目青，面黄目赤，面黄目白，面黄目黑者，皆不死也。面青目赤，
面赤目白，面青目黑，面黑目白，面赤目青。皆死也。（《素问》）
黑色出于天庭，大如拇指者，必不病而卒死。赤色出于两颧，大如拇指者，病虽小愈必卒死。○肝热病
者，左颊先赤；心热病者，额先赤；脾热病者，鼻先赤；肺热病者，右颊先赤；肾热病者，颐先赤。（《灵枢》）
哲言
鼻头色青，腹中痛苦冷者死。鼻头色微黑者，有水气。色黄者，胸中有寒。色白亡血，设微赤，非时者死。
又色青为痛，色黑为劳，色赤为风，色黄者便难，色鲜明者有留饮。（《金匮》）
人之五官百骸，赅而存者，神居之耳。色者，神之旗也，神旺则色旺，神衰则色衰，神藏则色藏，神露
则色露。帝王之色，龙文凤彩；神仙之色，岳翠山光；荣华之色，珠明玉润；寿者之色，柏古松苍。乃至贫夭
之色，重浊晦滞，枯索垩黧，莫不显呈于面也。○察色之妙，全在察神。血以养气，气以养神。失睡之人，神有
饥色；丧亡之子，神有呆色。气索自神失所养耳。（喻嘉言）
赤属心。深赤色坚，禀多火也，赤而 坚，营血充也；微赤而鲜，气虚有火也；赤而索泽，血虚火旺也。
赤为火色，只虑津枯血竭，无虚寒之患。大抵火形之人，未有多湿者。即有痰嗽，亦燥气耳。○面赤多热，而有
表里虚实之殊。午后面赤为阴火，两颧赤色如妆为阴火亢极，虽愈必死。○黄属脾胃，黄而肥盛，胃有痰湿也；
黄而枯 ，胃有火也；黄而色淡，胃虚也；黄而色暗，津液耗也。其虚实寒热之机，又当以饮食便溺消息之。
○白而淖泽，肺胃充也；肥白绵软，气虚有痰也；白而消瘦，爪甲鲜赤，气虚有火也；白而不泽，爪甲色淡，
肺胃虚寒也；白而微青臂多青脉，气不统血也，若兼爪甲色青，则为阴寒之证。白为气虚之象，纵有火热，皆
为虚火，无实热之理。○苍黑属肝与肾。苍而理粗，筋骨劳 也；苍而枯槁，营血涸也。黑而肥泽，髓充也；
黑而瘦削，阴火内戕也。苍黑为下焦气旺，虽犯客寒，亦蕴为热，无虚寒之候。（张路玉）
凡人病见青黑诸色者凶，惟黄色为吉。黄为胃气，故面黄者不死，然必黄而有神乃可，若久病枯黄，岂
有生乎？（邹丹源）
色赤为热，人所易知。然有寒郁而赤者，《经》云∶太阳司天，寒淫所胜，民病面赤。又当治以热剂。
（《金匮直指》）
面色黄中见青，肝木乘脾土也，用四君汤加升、柴治之。
(吴篁池)
凡诊病不知察色之要，如舟子不识风汛，动罹覆溺。卤莽粗疏，医之过也。（《医门法律》）
【经典论述】
通过观察面色就能诊断疾病，这被称为“神”（高超的诊断境界）。○大凡治病时观察患者的形体、气息、气色和光泽：如果形体与气息相协调，称为可治；如果气色明润浮露，称为容易痊愈；如果形体与气息不相协调，称为难治；如果面色枯槁无光泽，称为难以痊愈。○心气旺盛的面色，像白绢包裹着朱砂；肺气旺盛的面色，像白绢包裹着红色；肝气旺盛的面色，像白绢包裹着青紫色；脾气旺盛的面色，像白绢包裹着栝楼实（瓜蒌）；肾气旺盛的面色，像白绢包裹着紫色。○赤色应当像白绢裹着朱砂那样红润，不应当像赭石那样暗红；白色应当像鹅羽毛那样洁白，不应当像盐那样惨白；青色应当像青玉那样润泽，不应当像蓝草那样暗沉；黄色应当像丝绸包裹着雄黄那样鲜明，不应当像黄土那样枯黄；黑色应当像多层漆色那样黑亮，不应当像地苍（一种矿物或深色土）那样枯暗。○面色青得像死草一样的是死证，黄得像枳实一样枯黄的是死证，黑得像……（原文缺字，通常指煤炭或漆黑无光）的是死证，赤得像凝血一样暗滞的是死证，白得像枯骨一样干枯的是死证。面色青得像翠鸟羽毛那样鲜活的是生证，赤得像鸡冠那样鲜红的是生证，黄得像蟹腹那样明亮的是生证，白得像猪油那样润泽的是生证，黑得像乌鸦羽毛那样光亮的是生证。○肺热病的人，面色白且毫毛败落；心热病的人，面色赤且络脉充盈溢出；肝热病的人，面色青且指甲枯槁；脾热病的人，面色黄且肌肉跳动；肾热病的人，面色黑且牙齿干枯。○面黄目青，面黄目赤，面黄目白，面黄目黑的，都不会死。面青目赤，面赤目白，面青目黑，面黑目白，面赤目青的，都会死。（出自《素问》）
黑色出现在天庭（前额正中），大小如拇指者，即使没有明显病症也会突然死亡。赤色出现在两颧，大小如拇指者，即使病情轻微好转也必然突然死亡。○肝热病的人，左颊先变红；心热病的人，额头先变红；脾热病的人，鼻子先变红；肺热病的人，右颊先变红；肾热病的人，下巴（颐）先变红。（出自《灵枢》）
【哲人言论】
鼻头颜色发青，伴有腹部疼痛且感觉寒冷的是死证。鼻头颜色微黑的人，体内有水饮邪气。面色发黄的人，胸中有寒邪。面色苍白是失血的表现，如果微微发红且非正常时节出现的，是死证。另外，青色主痛，黑色主劳损，赤色主风邪，黄色主大便困难，面色鲜明有光泽的体内有留饮（水液停滞）。（出自《金匮要略》）
人的五官百骸中，能够统摄存在的是“神”。面色是神的旗帜，神旺则面色旺，神衰则面色衰，神藏则面色含蓄，神露则面色外露。帝王的面色，如龙纹凤彩般华丽；神仙的面色，如山岳翠绿、山光明媚般清奇；荣华富贵者的面色，如珍珠明亮、玉石温润般光泽；长寿者的面色，如古柏苍松般深沉苍劲。至于贫贱夭折者的面色，沉重浑浊晦暗滞涩，干枯索然如涂白灰或黧黑，无不显现在面上。○观察面色的奥妙，全在于观察“神”。血用来养气，气用来养神。失眠的人，神带有饥色（憔悴之色）；丧子的人，神带有呆色（木然之色）。气散则是神失去了滋养。（喻嘉言）
赤色属于心。深赤色且坚实，禀赋多火；赤色且……（原文缺字，推测为坚或类似义）坚实，营血充盛；微赤且鲜艳，气虚而有火；赤色且干枯无泽，血虚火旺。赤色是火的颜色，只担心津液枯竭血液耗尽，不会有虚寒的病患。大体上火形体质的人，很少有湿气重的。即使有痰嗽，也是燥气所致。○面赤多属热证，但有表里虚实的区别。午后面赤是阴火，两颧赤色如化妆般鲜艳是阴火亢极，即使暂时痊愈也必死。○黄色属于脾胃，黄而肥胖，胃中有痰湿；黄而枯瘦，胃中有火；黄而色淡，胃虚；黄而色暗，津液耗伤。其虚实寒热的机理，又应当根据饮食和二便来推断。○白色且润泽，肺胃充盛；肥白绵软，气虚有痰；白而消瘦，爪甲鲜红，气虚有火；白而无光泽，爪甲色淡，肺胃虚寒；白而微青，手臂多青筋，气不统血，如果兼有爪甲色青，则是阴寒之证。白色是气虚的表现，纵有火热，都是虚火，没有实热的道理。○苍黑色属于肝与肾。苍色且纹理粗糙，筋骨劳损；苍色且枯槁，营血枯竭。黑色而肥泽，髓海充盛；黑色而瘦削，阴火内伤。苍黑色代表下焦气旺，即使遭受客寒侵袭，也会蕴积化为热，没有虚寒的征候。（张路玉）
凡人患病出现青黑等颜色大多凶险，只有黄色为吉。黄色代表胃气，所以面黄的人不死，但必须黄而有神才行，如果是久病后的枯黄，怎么会有生机呢？（邹丹源）
面色赤红为热证，这是人们容易知道的。然而也有因寒邪郁闭而致面赤的，《内经》说：太阳司天之年，寒邪过胜，百姓发病面赤。此时又应当用热性药物治疗。（《金匮直指》）
面色黄中见青，是肝木乘克脾土，用四君子汤加升麻、柴胡治疗。（吴篁池）
凡是诊病不知道观察面色的要领，就像船夫不认识风向潮汐，动不动就遭遇翻船溺水之灾。鲁莽粗疏，是医生的过错。（《医门法律》）
[Classical Discourse]
Diagnosing disease through observation is called "Shen" (divine perception). ○ When treating diseases, observe the patient's form, qi, color, and luster: If form and qi are harmonious, it is termed treatable; if the complexion is bright and floating, it is termed easily curable; if form and qi are discordant, it is termed difficult to treat; if the complexion is withered and lacks luster, it is termed difficult to cure. ○ The healthy complexion of the Heart is like white silk wrapping cinnabar; that of the Lung is like white silk wrapping red; that of the Liver is like white silk wrapping cyan-purple; that of the Spleen is like white silk wrapping Trichosanthis Fructus (Gualou); that of the Kidney is like white silk wrapping purple. ○ Red should be like white silk wrapping cinnabar (lustrous), not like jasper (dull dark red); White should be like goose feathers (pure white), not like salt (pale white); Cyan should be like the luster of green jade, not like indigo (dull blue); Yellow should like silk wrapping Realgar (bright), not like yellow earth (withered yellow); Black should be like layered lacquer (shiny black), not like di cang (dull dark mineral/earth). ○ A complexion like dead grass indicates death; one like Zhi Shi (Immature Bitter Orange) indicates death; one like [missing character, typically coal or pitch-black] indicates death; one like clotted blood indicates death; one like dry bones indicates death. A complexion like a kingfisher feather indicates life; one like a rooster comb indicates life; one like a crab belly indicates life; one like pig fat indicates life; one like a crow's feather indicates life. ○ In Lung Heat Disease, the complexion is white and hair follicles deteriorate; in Heart Heat Disease, the complexion is red and collateral vessels overflow; in Liver Heat Disease, the complexion is cyan and nails wither; in Spleen Heat Disease, the complexion is yellow and muscles twitch; in Kidney Heat Disease, the complexion is black and teeth become dry. ○ Those with a yellow face and cyan eyes, yellow face and red eyes, yellow face and white eyes, yellow face and black eyes will not die. Those with a cyan face and red eyes, red face and white eyes, cyan face and black eyes, black face and white eyes, red face and cyan eyes will die. (From *Su Wen*)
Black appearing on the Tian Ting (center of the forehead), the size of a thumb, indicates sudden death even without apparent illness. Red appearing on both cheeks, the size of a thumb, indicates sudden death even if the illness seems slightly improved. ○ In Liver Heat Disease, the left cheek turns red first; in Heart Heat Disease, the forehead turns red first; in Spleen Heat Disease, the nose turns red first; in Lung Heat Disease, the right cheek turns red first; in Kidney Heat Disease, the chin (Yi) turns red first. (From *Ling Shu*)
[Philosophical Remarks]
A cyan color at the tip of the nose, accompanied by abdominal pain and coldness, indicates death. A slightly black color at the tip of the nose indicates Water Qi (fluid retention). A yellow color indicates Cold in the Chest. A pale white color indicates Blood loss; if slightly red and occurring out of season, it indicates death. Furthermore, Cyan indicates Pain, Black indicates Exhaustion/Labor, Red indicates Wind, Yellow indicates Difficult Defecation, and a bright/shiny complexion indicates Retained Fluids (Liuyin). (From *Jin Gui Yao Lue*)
Among the five sense organs and hundred bones of humans, what encompasses and sustains them is Shen (Spirit). Complexion is the flag of Shen: when Shen is vigorous, the complexion is vigorous; when Shen is declining, the complexion declines; when Shen is hidden, the complexion is reserved; when Shen is exposed, the complexion is overt. The complexion of emperors resembles dragon patterns and phoenix colors; that of immortals resembles verdant mountains and mountain light; that of the prosperous resembles bright pearls and moist jade; that of the long-lived resembles ancient cypresses and pines. As for those of poverty and short life, their complexions are heavy, turbid, dull, and stagnant, dry and withered like whitewash or sallow, all manifesting on the face. ○ The subtlety of observing complexion lies entirely in observing Shen. Blood nourishes Qi, and Qi nourishes Shen. Those who lose sleep have a complexion of spiritual hunger (haggardness); those who mourn children have a complexion of spiritual呆 (stunnedness). Scattered Qi means Shen has lost its nourishment. (Yu Jiayan)
Red belongs to the Heart. Deep red and firm indicates an abundance of Fire constitution; Red and ... [missing char, likely firm] indicates abundant Ying Blood; Slightly red and fresh indicates Qi deficiency with Fire; Red and dry/lusterless indicates Blood deficiency with hyperactive Fire. Red is the color of Fire; one only fears dried fluids and exhausted blood, not deficiency-cold. Generally, individuals with a Fire constitution rarely have dampness. Even if there is phlegm-cough, it is due to Dryness Qi. ○ Facial redness mostly indicates Heat, but differs by exterior-interior and deficiency-excess. Afternoon facial redness is Yin Fire; redness on the malar eminences like makeup indicates extreme Yin Fire, which leads to death even if temporarily cured. ○ Yellow belongs to the Spleen and Stomach. Yellow and plump indicates Phlegm-Dampness in the Stomach; Yellow and withered indicates Fire in the Stomach; Yellow and pale indicates Stomach deficiency; Yellow and dark indicates consumption of body fluids. The mechanisms of deficiency/excess and cold/heat should be deduced from diet and urination/defecation. ○ White and moist indicates fullness of the Lung and Stomach; Fat, white, and soft indicates Qi deficiency with Phlegm; White and thin with bright red nails indicates Qi deficiency with Fire; White and lusterless with pale nails indicates Cold-deficiency of the Lung and Stomach; White with slight cyan and many blue veins on arms indicates Qi failing to control Blood; if combined with cyan nails, it is a Yin-Cold syndrome. White is the sign of Qi deficiency; even if there is heat, it is always deficient heat, never excess heat. ○ Cyan-Black belongs to the Liver and Kidney. Cyan and coarse texture indicates strain on sinews and bones; Cyan and withered indicates exhaustion of Ying Blood. Black and plump/moist indicates full Marrow; Black and emaciated indicates internal damage by Yin Fire. Cyan-Black indicates vigorous Qi in the Lower Jiao; even if attacked by external Cold, it transforms into Heat, showing no signs of deficiency-cold. (Zhang Luyu)
When patients exhibit cyan or black colors, it is ominous; only Yellow is auspicious. Yellow represents Stomach Qi, so a yellow-faced person does not die, provided the yellow is vibrant and spirited. If it is withered yellow after a long illness, how can there be life? (Zou Danyuan)
Facial redness indicates Heat, which is commonly known. However, some cases involve redness due to Cold stagnation. The Classics state: "When Taiyang governs the year, excessive Cold causes people to suffer from facial redness." In such cases, hot-natured medicines should be used. (*Jin Gui Zhi Zhi*)
A yellow complexion with hints of cyan indicates Liver Wood overacting on Spleen Earth; treat with Si Jun Zi Tang (Four Gentlemen Decoction) plus Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix). (Wu Huangchi)
Those who diagnose diseases without understanding the essentials of observing complexion are like boatmen who do not recognize wind and tides, inevitably suffering capsizing and drowning. Recklessness and carelessness are the faults of physicians. (*Yi Men Fa Lv*)