《内经·刺热论》专论赤色所见部位，以决五脏吉凶，已录入面部首篇。又
热病顺逆色证，已录入形部顺逆篇，兹不复赘，以省繁文。
天地不外燥湿，病亦不外燥湿，色亦不外燥湿。燥属天气，色多有光而浮；湿属地气，色多有体而晦。（
光体义见前察色真诀篇。）风燥寒燥，由外搏来，主收敛，收敛则急，面多绷急而光洁。燥搏津液，痰饮外
溢于面，色多红润而浮，夹湿多红润而晦。燥邪化热，色多干红，苗窍干涩，多烦渴，甚则变枯而青黑。枯
而青黑则真阴亏极，而色无光体矣。寒湿内生，色必滞暗，变黄变黑，皆沉晦不明。湿兼风，色润
而浮，多自汗。湿与暑合，与热合，或湿土郁蒸之温邪，三者皆由口鼻吸入，三焦主蒸散，蒸散则缓，面色多
松缓垢晦，甚者浊邪由内蒸而外溢，如油腻烟熏者然。若由湿化燥，则又晦而且干，晦而干则湿邪未去，真阴
又亏，色由无光而无体矣。经言色见部位内应脏腑，外辨病证之说，不可枚举，
亦不能尽拘。所当权于其大，以燥湿二字为纲，以兼风、兼
寒、兼暑、化火、未化火为权衡，以色中之光体为神气，大道不外是矣。（《医原》。）
青色出于太阴太阳，（两额，左为太阳，右为太阴。）及鱼尾正面口角，如大青蓝叶，怪恶之状者，
肝气绝，主死。若如翠羽柏皮者，只是肝邪，有惊病、风病、目病之属。（以下五条出徐春甫《古今医统》。）
红色见于口唇，及三阴三阳上下，如马肝之色，死血之状者，心气绝，主死。若如橘红马尾色者，
只是心病，有怔忡，惊悸，夜卧不宁等证。
白色见于鼻准及正面，如枯骨及擦残汗粉者，为肺绝，丙丁日死。若如腻粉、梅花、白绵者，只是
肺邪，咳嗽之病，有孝服之忧。
黄色见于鼻，干燥如土偶之形，为脾气绝，主死。若如
桂花，杂以黑晕，只是脾病，饮食不快，四肢怠惰，妻外家之累。
黑色见于耳叶廓内外，命门悬壁，如污水烟煤之状，为肾气绝，即死。若如蜘蛛网眼，鸟羽之泽者，
只是肾虚，火邪乘水之病。
肺主气，气虚则色白。肾属水，水涸则面黧。青为怒气伤肝，赤为心火炎上。萎黄者内伤脾胃，紫浊
者外感客邪。惟悴黯黑，必悒郁而神伤；消瘦淡黄，乃久病而体惫。山根明亮，须知欲愈之 ；环口黧黑，
休治已绝之肾。（张三锡。）
面黑为阴寒，面青为风寒。青而黑，主风，主寒，主痛。
黄而白，为湿，为寒，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，为病最凶。若暗中有光，准头年寿亮而滋润者生，枯夭者死。（王宇泰。）
黄属脾胃。若黄而肥盛，胃中有痰湿也。黄而枯 ，胃中有火也。黄而色淡，胃中本虚也。黄而色黯，津
液久耗也。黄为中央之色，其虚实寒热之机，又当以饮食便溺消息之。
白属肺。白而薄泽，肺胃之充也。肥白而按之绵软，气虚有痰也。白而消瘦，爪甲鲜赤，气虚有火也。白
而夭然不泽，爪甲色淡，肺胃虚寒也。白而微青，或臂多青脉，气虚不能统血也；若兼爪甲色青，则为阴寒
之证矣。白为气虚之象，纵有失血发热，皆为虚火，断无实热之理。
苍黑属肝与肾。苍而理粗，筋骨劳 也。苍而枯槁，营血之涸也。黑而肥泽，骨髓之充也。黑而瘦削，
阴火内戕也。苍黑为下焦气旺，虽犯风寒，亦必蕴为邪热，绝少虚寒之候。
赤属心主三焦。深赤色坚，素禀多火也。赤而 坚，营血之充也。微赤而鲜，气虚有火也。赤而索泽，
血虚火旺也。赤为火炎之色，只虑津枯血竭，亦无虚寒之患。大抵火形之人，从未有肥盛多湿者，即有痰
嗽，亦燥气耳。（石顽。）
色贵明润，不欲沉夭。凡暴感客邪之病，不妨昏浊壅滞。病久气虚，只宜瘦削清 。若病邪方锐，而清白
少神。虚羸久困，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。唯黄色见于
面目，而不至索泽者，皆为向愈之候。若眼胞上下如烟煤者，寒痰也。眼黑颊赤者，热痰也。眼黑而行步
艰难，呻吟者，骨节疼痛，痰饮入骨也。眼黑而面带土色，四肢痿痹，屈伸不便者，风痰也。
病患见黄色，光泽为有胃气，干黄者是津液之槁。目睛黄者，
非瘅即衄。目黄大烦为病进。（《三昧》。仲景云∶脉和，其人大烦。目
重，睑内际黄者，为欲解也。不得遽指为病进。）
面目色同为顺，色异为逆。同者谓其如常而未改也，异者谓其一部独异于常也。
面色夭然不泽，其脉空虚，为夺血。伤寒汗不出，大颧发赤，哕者死。颧见青气者死。黄兼青紫，脉
芤者，瘀血在胃，或胁内有块。面上多白点，是虫积。面色青黄白不常，及有如蟹爪路，一黄一白者，主
食积。（亦有白斑如钱大。晕满额面者。）目睛黄者，酒疸；面黄白及肿连眼胞者，谷疸，其人必
心下痞；面黑者，女劳疸，一曰黑疸。明堂眼下青色，多欲劳伤，精神不爽，即夜未睡。（李士材。）
《黄帝内经·刺热论》专门论述赤色出现在面部不同部位，以此判断五脏的吉凶预后，相关内容已收录在本书“察色”首篇中。另外，热病的顺证与逆证的面色表现，也已收录在“形体部顺逆篇”，此处不再赘述，以节省繁冗文字。
天地之间不外乎燥与湿两种气候，疾病也不外乎燥病与湿病，面色变化也不外乎反映燥湿状态。燥属于天气，面色多表现为有光泽且浮露；湿属于地气，面色多表现为有实质感而晦暗。（关于“光”与“体”的含义参见前文“察色真诀篇”。）风燥和寒燥由外邪侵袭所致，主收敛之性，收敛则导致筋脉拘急，面部多呈现紧绷、急迫且光洁的状态。若燥邪搏结津液，导致痰饮外溢于面部，面色多红润且浮露；若兼夹湿气，则面色红润但晦暗。燥邪化热后，面色多呈干枯之红色，苗窍（如口鼻眼耳等孔窍）干涩，患者多烦躁口渴，严重时面色会变得枯槁并转为青黑色。若面色枯槁且现青黑，说明真阴亏损到了极点，此时面色既无光泽也无实质感了。寒湿内生，面色必然滞涩昏暗，变黄或变黑，都表现为沉滞晦暗不明。湿邪兼夹风邪，面色润泽且浮露，患者多自汗出。湿邪与暑邪相合，或与热邪相合，或是湿土郁蒸产生的温邪，这三种情况皆由口鼻吸入，三焦主管蒸腾发散，蒸散则导致肌表松弛，面色多显得松缓、垢浊晦暗；严重时浊邪由体内蒸腾外溢，如同被油腻或烟熏过一样。如果是由湿转化为燥，则面色既晦暗又干燥，晦暗而干燥说明湿邪未去，真阴又亏，面色因失去光泽和实质感而变得虚无。经典所言面色出现部位内应脏腑、外辨病证的理论，不可枚举，也不能完全拘泥。应当把握其大原则，以“燥”和“湿”二字为纲领，以兼夹风、寒、暑，以及是否化火、未化火作为权衡标准，以面色中的“光”与“体”来判断神气的存亡，大道不过如此罢了。（出自《医原》。）
青色出现在太阴、太阳部位（两额，左侧为太阳，右侧为太阴），以及眼角鱼尾处、正面、口角，形状像大青蓝叶那样怪异恶心的，是肝气绝的表现，主死。如果颜色像翠鸟羽毛或柏树皮那样，只是肝经受邪，属于惊病、风病、目病之类。（以下五条内容出自徐春甫的《古今医统》。）
红色出现在口唇，以及三阴三阳经脉循行的上下部位，颜色像马肝那样，呈现死血瘀阻状态的，是心气绝的表现，主死。如果颜色像橘红或马尾毛那样，只是心病，伴有怔忡、惊悸、夜间卧睡不宁等症状。
白色出现在鼻准头及面部正中，像枯骨或擦剩的汗粉那样，是肺绝的表现，死于丙丁日。如果颜色像腻粉、梅花或白绵那样，只是肺经受邪，属于咳嗽类疾病，可能有丧服之忧。
黄色出现在鼻子，干燥得像土偶的形状，是脾气绝的表现，主死。如果颜色像桂花，混杂着黑晕，只是脾病，表现为饮食不振，四肢倦怠，可能有妻族方面的拖累。
黑色出现在耳廓内外，命门悬壁（耳垂下方），像污水或烟煤那样，是肾气绝的表现，即死。如果颜色像蜘蛛网眼或鸟羽的光泽那样，只是肾虚，属于火邪乘袭水脏的病证。
肺主气，气虚则面色白。肾属水，水枯竭则面色黧黑。青色是怒气伤肝所致，红色是心火炎上所致。萎黄是内伤脾胃所致，紫浊是外感客邪所致。憔悴黯黑，必定是因为忧郁而损伤神气；消瘦淡黄，乃是久病导致身体疲惫。山根（鼻梁根部）明亮，须知是即将痊愈的迹象；环口黧黑，不可治疗已绝的肾气。（张三锡语。）
面黑属于阴寒，面青属于风寒。青而黑，主风、主寒、主痛。黄而白，属于湿、寒、热、气机不调。青而白，属于风、气滞、寒、痛。大抵黑色之气见于面部，病情最为凶险。如果在暗中有光泽，鼻准头和年寿部位明亮滋润者生，枯槁夭折者死。（王宇泰语。）
黄色属于脾胃。如果黄而肥盛，是胃中有痰湿。黄而枯瘦，是胃中有火。黄而色淡，是胃中本虚。黄而色黯，是津液长期耗损。黄色是中央之色，其虚实寒热的机理，又应当通过饮食和二便来斟酌判断。
白色属于肺。白而薄泽，是肺胃充盛的表现。肥白而按之绵软，是气虚有痰。白而消瘦，爪甲鲜红，是气虚有火。白而夭然无光泽，爪甲色淡，是肺胃虚寒。白而微青，或者手臂多青筋，是气虚不能统摄血液；如果兼见爪甲色青，则是阴寒之证。白色是气虚的象征，即使有失血发热，也都是虚火，绝无实热的道理。
苍黑属于肝与肾。苍而纹理粗糙，是筋骨劳损。苍而枯槁，是营血枯竭。黑而肥泽，是骨髓充盛。黑而瘦削，是阴火内伤。苍黑表示下焦气旺，即使遭受风寒，也必然蕴积为邪热，极少出现虚寒证候。
赤色属于心和三焦。深赤色坚实，素禀多火。赤而坚厚，是营血充盛。微赤而鲜艳，是气虚有火。赤而索泽（皮肤干枯无润），是血虚火旺。赤色是火炎上的表现，只担心津枯血竭，也没有虚寒的隐患。大抵火形之人，从未有过肥盛多湿的，即使有痰嗽，也是燥气所致。（石顽语。）
面色贵在明润，不希望沉滞夭折。凡是暴感客邪的疾病，不妨碍昏浊壅滞。病久气虚，只宜瘦削清瘦。如果病邪正锐利，却面色清白少神；或者身体虚弱羸困已久，却面色妩媚鲜泽，这些都不是正常的色泽。五色之中，青黑黯惨，无论疾病新久，总属于阳气不振。只有黄色见于面目，且不至干枯无润的，都是向愈的征候。如果眼睑上下像烟煤一样，是寒痰。眼睛黑脸颊红，是热痰。眼睛黑而行步艰难、呻吟的，是骨节疼痛，痰饮入骨。眼睛黑而面带土色，四肢痿痹，屈伸不便的，是风痰。
病患见到黄色，有光泽说明有胃气，干黄的是津液枯竭。目睛发黄，不是黄疸就是衄血。目黄伴有大烦渴，说明病情进展。（《三昧》。张仲景说：脉象平和，病人感到大烦渴，重看眼睑内部发黄，这是将要解除病邪的表现。不能立即指为病情进展。）
面目颜色相同为顺证，颜色不同为逆证。相同是指像平常一样没有改变，不同是指某一部单独异于平常。
面色夭然无光泽，脉象空虚，是夺血的表现。伤寒汗不出，大颧发赤，呃逆的，主死。颧部出现青气的，主死。黄兼青紫，脉象芤的，是瘀血在胃，或者胁内有肿块。面上多白点，是虫积。面色青黄白无常，以及有如蟹爪路纹路，一黄一白的，主食积。（也有白斑如铜钱大小，晕满额面的情况。）目睛发黄，是酒疸；面黄白及肿连眼胞的，是谷疸，其人必定心下痞塞；面黑的，是女劳疸，又称黑疸。明堂眼下青色，多是房劳损伤，精神不爽，即使夜里没睡也会这样。（李士材语。）
The *Neijing* (Yellow Emperor's Inner Classic) · *Ci Re Lun* (Treatise on Acupuncture for Heat Diseases) specifically discusses the locations where the red color appears on the face to determine the auspicious or inauspicious outcomes of the five Zang organs. This has been recorded in the first chapter on facial inspection. Furthermore, the facial signs of favorable and unfavorable courses of heat diseases have been recorded in the chapter on favorable and unfavorable signs of body shape; thus, there is no need to repeat them here to avoid redundancy.
Heaven and Earth are nothing but dryness and dampness; diseases are nothing but dryness and dampness; and facial colors reflect nothing but dryness and dampness. Dryness belongs to Heavenly Qi, and the color often appears lustrous and floating; Dampness belongs to Earthly Qi, and the color often appears substantial and dull. (For the meaning of "luster" and "substance," see the previous chapter on the True Principles of Facial Inspection.) Wind-dryness and Cold-dryness come from external invasion, governing contraction. Contraction leads to tension, so the face often appears tight, urgent, and smooth. If Dryness combines with Body Fluids, causing Phlegm-Fluids to overflow onto the face, the color tends to be ruddy and floating; if combined with Dampness, it is ruddy yet dull. When Dryness pathogen transforms into Heat, the color tends to be dry red, with dry and astringent orifices (Miao Qiao), accompanied by irritability and thirst. In severe cases, it changes to withered cyan-black. Withered cyan-black indicates extreme deficiency of True Yin, resulting in a loss of both luster and substance. Internal Cold-Dampness causes the color to be stagnant and dark; changes to yellow or black all appear deep, dull, and unclear. Dampness combined with Wind results in a moist and floating color, often with spontaneous sweating. Dampness combined with Summerheat or Heat, or Warm pathogens generated by the stagnation and steaming of Damp-Earth, are all inhaled through the mouth and nose. The San Jiao (Triple Burner) governs steaming and dispersing; this dispersion leads to relaxation, so the facial color often appears loose, greasy, and dull. In severe cases, turbid pathogens steam internally and overflow externally, resembling oil stains or smoke soot. If Dampness transforms into Dryness, the color becomes both dull and dry. Dullness and dryness indicate that the Damp pathogen remains while True Yin is also deficient, leading to a loss of luster and substance. The classic theory states that the location of facial color corresponds internally to the Zang organs and externally differentiates diseases. These theories are too numerous to enumerate and cannot be rigidly adhered to. One should grasp the general principles, using "Dryness" and "Dampness" as the main纲 (guiding principles), weighing factors such as combinations with Wind, Cold, Summerheat, transformation into Fire, or non-transformation into Fire, and using the luster and substance within the color to assess Shen Qi (Spiritual Energy). The Great Dao does not go beyond this. (From *Yi Yuan*.)
Cyan color appearing in the Taiyin and Taiyang areas (the two temples, left is Taiyang, right is Taiyin), as well as at the corners of the eyes (fish tail), forehead, and mouth corners, looking like large indigo leaves or having a grotesque and repulsive appearance, indicates Liver Qi exhaustion and signifies death. If the color resembles kingfisher feathers or cypress bark, it merely indicates Liver pathogen involvement, belonging to disorders of fright, wind, or eyes. (The following five items are from Xu Chunfu's *Gu Jin Yi Tong*.)
Red color appearing on the lips and throughout the three Yin and three Yang channels, resembling the color of horse liver or showing signs of dead blood stasis, indicates Heart Qi exhaustion and signifies death. If the color resembles orange-red or horsehair, it merely indicates Heart disease, accompanied by symptoms such as palpitations, fright, and restless sleep at night.
White color appearing on the tip of the nose and the center of the face, resembling bleached bones or leftover sweat powder, indicates Lung exhaustion and predicts death on Bing-Ding days. If the color resembles fine white powder, plum blossoms, or white cotton, it merely indicates Lung pathogen involvement, belonging to cough diseases, possibly associated with mourning attire (bereavement).
Yellow color appearing on the nose, dry and shaped like a clay idol, indicates Spleen Qi exhaustion and signifies death. If the color resembles osmanthus flowers mixed with dark halos, it merely indicates Spleen disease, characterized by poor appetite, lethargy of the four limbs, and burdens related to the wife's family.
Black color appearing inside and outside the ear cartilage and the hanging wall of Mingmen (below the earlobe), resembling muddy water or coal smoke, indicates Kidney Qi exhaustion and signifies immediate death. If the color resembles spider web holes or the gloss of bird feathers, it merely indicates Kidney deficiency, representing a disorder where Fire pathogen attacks Water.
The Lungs govern Qi; Qi deficiency leads to a white complexion. The Kidneys belong to Water; Water depletion leads to a dark complexion. Cyan color results from anger injuring the Liver; Red color results from Heart Fire flaring upward. Withered yellow results from internal injury to the Spleen and Stomach; Purple-turbid color results from external invasion by guest pathogens. Haggard and dark-black complexions must stem from depression damaging the Spirit; emaciated and pale-yellow complexions result from chronic illness exhausting the body. A bright Shangen (root of the nose) indicates impending recovery; a black ring around the mouth indicates irrecoverable Kidney exhaustion and should not be treated. (Zhang Sanxi.)
A black face indicates Yin-Cold; a cyan face indicates Wind-Cold. Cyan and black together indicate Wind, Cold, and Pain. Yellow and white together indicate Dampness, Cold, Heat, and Qi imbalance. Cyan and white together indicate Wind, Qi stagnation, Cold, and Pain. Generally, black Qi appearing on the face indicates the most ominous illness. However, if there is luster within the darkness, and the nose tip and Nianshou area are bright and moist, life is preserved; if withered and premature, death ensues. (Wang Yutai.)
Yellow belongs to the Spleen and Stomach. If yellow and fat, there is Phlegm-Dampness in the Stomach. If yellow and withered, there is Fire in the Stomach. If yellow and pale, the Stomach is originally deficient. If yellow and dark, Body Fluids have been long consumed. Yellow is the color of the Center; its mechanisms of deficiency/excess and cold/heat should be discerned through diet and urination/defecation.
White belongs to the Lungs. White and thin/lustrous indicates充盈 (fullness) of the Lungs and Stomach. Fat and white, soft to touch, indicates Qi deficiency with Phlegm. White and emaciated, with bright red fingernails, indicates Qi deficiency with Fire. White and prematurely aged without luster, with pale fingernails, indicates Lung and Stomach deficiency-cold. White with slight cyan, or many blue veins on the arms, indicates Qi deficiency failing to control Blood; if accompanied by cyan fingernails, it is a Yin-Cold syndrome. White is the sign of Qi deficiency; even with bleeding or fever, it is always Deficient Fire, never Excess Heat.
Cyan-black belongs to the Liver and Kidneys. Cyan and coarse texture indicates strain on sinews and bones. Cyan and withered indicates depletion of Ying Blood. Black and fat/lustrous indicates fullness of Marrow. Black and emaciated indicates internal damage by Deficient Fire. Cyan-black indicates vigorous Qi in the Lower Jiao; even if attacked by Wind-Cold, it inevitably transforms into Pathogenic Heat, rarely presenting as deficiency-cold.
Red belongs to the Heart and San Jiao. Deep red and firm indicates a constitution prone to Fire. Red and thick/firm indicates full Ying Blood. Slightly red and fresh indicates Qi deficiency with Fire. Red and dry/shriveled indicates Blood deficiency with hyperactive Fire. Red is the color of Fire flaring upward; one only fears depletion of fluids and exhaustion of blood, with no concern for deficiency-cold. Generally, individuals with a Fire constitution are never fat and damp; even if they have phlegm-cough, it is due to Dryness. (Shi Wan.)
Facial color values clarity and moisture, disliking stagnation and premature aging. For acute external invasions, turbidity and obstruction are acceptable. For chronic Qi deficiency, emaciation and clarity are appropriate. If the pathogen is sharp but the face is clear-white with little spirit, or if the patient is chronically weak and emaciated but the face is charmingly lustrous, these are not normal colors. Among the five colors, cyan, black, and dark/dull hues 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 without being dry and shriveled is it a sign of recovery. If the eyelids look like soot, it is Cold-Phlegm. Dark eyes and red cheeks indicate Hot-Phlegm. Dark eyes with difficulty walking and groaning indicate joint pain with Phlegm-Fluids entering the bones. Dark eyes with a earthy facial color, limb flaccidity, and difficulty bending/extending indicate Wind-Phlegm.
If a patient presents with yellow color, luster indicates the presence of Stomach Qi; dry yellow indicates exhaustion of Body Fluids. Yellow sclera indicates either Jaundice or Epistaxis. Yellow sclera with severe irritability indicates disease progression. (From *San Mei*. Zhang Zhongjing said: If the pulse is harmonious, the patient feels severe irritability, and upon close inspection, the inner eyelids are yellow, this indicates resolution of the disease. Do not hastily diagnose it as progression.)
Same color on face and eyes is a favorable sign (Shun); different colors are unfavorable (Ni). "Same" means unchanged from normal; "Different" means one part is abnormally different.
Prematurely aged and lusterless face with empty pulse indicates loss of Blood. In Shanghan (Cold Damage) with no sweat, red malar flush, and hiccups, death occurs. Cyan qi on the malar area indicates death. Yellow combined with cyan-purple and a knotted pulse indicates Blood stasis in the Stomach or masses in the hypochondrium. Many white spots on the face indicate intestinal parasites. Irregular cyan-yellow-white facial color, or patterns like crab claws, alternating yellow and white, indicates food stagnation. (There are also white spots the size of coins covering the forehead.) Yellow sclera indicates Wine Jaundice; yellow-white face with swelling extending to eyelids indicates Grain Jaundice, accompanied by epigastric fullness; black face indicates Female Labor Jaundice, also called Black Jaundice. Cyan color under the Mingtang (under the eyes) indicates sexual exhaustion, mental fatigue, or lack of sleep. (Li Shicai.)