足太阴气绝，则脉不荣肌肉，舌萎，人中满。人中满，则唇反，肉先死也。甲笃乙死。（《内经》。）
病患鼻下平者，胃病也；微赤者，病发痈；微黑者，有热；青者，有寒；白者不治。
（凡急痛暴厥，人中青者，为血实，宜决之。《脉经》。）
凡中风，鼻下赤黑相兼，吐沫而身直者，七日死。
按∶人中内应脾胃，下应膀胱子户。凡人胃中与前阴，病湿热腐烂，或瘀血凝积作痛者，往往人中见赤
颗小粟疮，或常见黑斑，如烟煤晦暗者，知其气络有相应也。
下痢，脐下忽大痛，人中黑色者死。（按∶此寒中于命门，而胞中之血死也。丹溪。）
脾之华，在唇四白，其五色之诊与面色同，而唇皮薄色显，尤为易见。其专诊列下。
唇色青黄赤白黑者，病在肌肉。（《内经》。）
唇焦干燥裂为脾热，唇赤肿为胃湿热，鲜红为火盛，淡白为气虚，淡而四绕起白晕为亡血，青黑
为寒。（为血死。石
顽《医通》。）
唇黑者胃先病，微燥而渴者可治，不渴者不可治。（渴为
津耗血滞，不渴为气脱血死也，仲景。下二节同。）
唇下内有疮如粟名狐，虫蚀其肛。唇上内有疮如粟名惑，虫蚀其咽（一作脏。按∶凡腹痛喜渴，面有白
斑如钱大，或唇色淡白，而中有红点者，其为肠胃有虫啮血无疑矣。）
唇吻反青，四肢 习者，肝绝。环口青黧，柔汗发黄者，脾绝。鼻黑唇肿者，肺败。厥而唇青肢冷者，
为入脏即死。
凡下痢病剧而唇如朱红者死。（按∶凡脱血病，皆以此例决之。丹溪。）
凡口唇，关手足阳明肠胃二经，又关手足太阳脾肺二脏。故验唇色红润，里未有热，但宜辛温散表；唇
色枯干，里已有热，宜清里；唇色焦黑，烦渴消水，里热已极，当用凉膈散等。又有谵语发狂、唇色干焦，服
寒凉而热不减，此食滞中焦，胃气蕴蓄，发黄发热，是以服寒凉则食滞不消，用辛散则又助里热，宜以保和
散冲竹沥、萝菔汁，或栀子豆豉汤加枳实治之。上唇，属肺与大肠，若焦而消渴饮水，热在上，
主肺；若焦而不消渴饮水，热在下，主大肠有燥粪。下唇，属脾与胃，若焦而消渴饮水，热在阳明胃，若
焦而不消渴饮水，热在太阴脾。夫里热唇焦、食滞唇焦、积热伏于血分而唇焦、惟以渴不渴，消水不消水
别之。又有食滞已久，蒸酿发热，亦能作渴消水，又当参以脉象。若脉滑大不数，食未蒸热，口亦不渴；若滑
大沉数，食已蒸热，口亦作渴。故凡谵语发狂，脉滑不数，渴不消水者，亦以食滞治之。若以寒
凉抑遏，则谵狂益盛，甚且口噤不语也。（秦皇士《伤寒大白》。）
项肿如匏，按之热痛，目赤如血，而足冷便泄，人事
清明，六脉细数，右手尤软，略按即空。沈尧封曰∶此虚阳上攻也。唇上黑痕一条如干焦状，舌苔白如敷粉，
舌尖亦白，不赤，是皆虚寒确据，况便泻足冷脉濡，断非风火，若是风
火，必痞闷烦热，燥渴不安，岂有外肿如此，而内里安贴如平人者乎。
案按∶按此即喻氏浊阴从胸上入，即咽喉肿痹，舌胀睛突；从背上入，即颈项粗大，头项若冰，浑身
青紫而死之类也。末句辨症尤为精切不易。最眩人者，在热痛目赤，若非此着，虽足冷便泻脉濡而空，犹未
能决为真寒也。又按∶近日吸洋烟者，唇色多紫黯，以其胃中血气浊恶也。所以然者，肺气不清，而燥化胜也。
足太阴脾经之气衰竭，则经脉不能滋养肌肉，导致舌体萎缩，人中部位饱满肿胀。如果人中饱满肿胀，就会出现嘴唇外翻，这是肌肉先坏死的征象。病情在甲日加重，到乙日就会死亡。（出自《黄帝内经》。）
病人鼻下部位平坦的，是胃病；微红的，病发为痈疽；微黑的，体内有热；发青的，体内有寒；发白的，属于难治之症。
（凡是突发剧烈疼痛或暴厥，人中部位发青的，属于血实证，适宜用刺络放血的方法治疗。出自《脉经》。）
凡是中风病人，鼻下颜色赤黑相间，口吐白沫且身体僵直的，七天后会死亡。
按语：人中内部对应脾胃，下部对应膀胱和子宫。凡是胃中与前阴部位患有湿热腐烂，或者瘀血凝积引起疼痛的病人，往往在人中部位见到红色的小颗粒疮疡，或者常见黑色斑点，像烟煤一样晦暗不明，这说明气络之间存在相应的联系。
患痢疾，脐下突然剧烈疼痛，人中部位发黑的，预后不良，主死。（按语：这是因为寒气侵入命门，导致胞宫中的血液坏死。朱丹溪所言。）
脾的精气荣华表现在口唇四周的肤色（唇四白），其五色诊法与面色的诊法相同，而唇皮薄、色泽显露，尤其容易观察。其专门的诊察方法列述如下。
嘴唇呈现青、黄、赤、白、黑五种颜色的，病位在肌肉。（出自《黄帝内经》。）
嘴唇焦躁干燥开裂，是脾热；嘴唇红肿，是胃中有湿热；颜色鲜红，是火邪亢盛；颜色淡白，是气虚；颜色淡白且四周环绕起白色晕圈，是失血所致；颜色青黑，是寒证（会导致血液死亡。石顽《医宗必读》）。
嘴唇发黑的，说明胃先受病；如果嘴唇微燥且有口渴感，可以治疗；如果不口渴，则不可治疗。（口渴是因为津液耗伤、血液停滞；不口渴是因为阳气脱失、血液死亡。张仲景所言。以下两节同理。）
嘴唇内侧有像粟米大小的疮疡，名为“狐”，虫子侵蚀肛门；嘴唇上部内侧有像粟米大小的疮疡，名为“惑”，虫子侵蚀咽喉（另一种说法是侵蚀内脏。按语：凡是腹痛喜欢喝水，面部有像铜钱大小的白斑，或者嘴唇颜色淡白但中间有红点的，这肯定是肠胃里有虫子啃食血液无疑了。）
嘴唇周围发青，四肢抽搐颤动的，是肝气衰竭。嘴巴周围颜色青黑，出冷汗且头发枯黄的，是脾气衰竭。鼻子发黑、嘴唇肿大的，是肺气败绝。出现厥逆、嘴唇发青、四肢冰冷的，是病邪入脏，立即死亡。
凡是痢疾病情严重而嘴唇像朱砂红一样的，主死。（按语：凡是失血的病症，都以此例来判断预后。朱丹溪所言。）
凡是口唇，关联手足阳明经（大肠、胃）以及手足太阳经（小肠、膀胱）和脾肺二脏。所以验看唇色红润，说明体内没有热邪，只适宜用辛温药物发散表邪；唇色枯干，说明体内已有热邪，适宜清解里热；唇色焦黑，烦躁口渴大量饮水，说明里热已极，应当使用凉膈散等方剂。又有出现胡言乱语、发狂、唇色干焦的情况，服用寒凉药物后热势不减，这是食滞在中焦，胃气蕴结蓄积，导致发黄发热，因此服用寒凉药则食滞不消，用辛散药又会助长里热，适宜用保和散冲服竹沥、萝卜汁，或者栀子豉汤加枳实来治疗。上唇，归属于肺和大肠，如果焦黑且口渴想喝水，热邪在上，主治肺；如果焦黑但不口渴想喝水，热邪在下，主治大肠有燥屎。下唇，归属于脾和胃，如果焦黑且口渴想喝水，热邪在阳明胃；如果焦黑但不口渴想喝水，热邪在太阴脾。凡是里热导致的唇焦、食滞导致的唇焦、积热伏于血分导致的唇焦，只通过是否口渴、是否消耗水分来辨别。又有食滞时间已久，蒸酿发热，也能导致口渴消耗水分，这时又应当参考脉象。如果脉象滑大但不数，说明食物尚未蒸腾发热，口也不渴；如果脉象滑大沉数，说明食物已经蒸腾发热，口也会作渴。所以凡是胡言乱语、发狂，脉象滑而不数，口渴但不消耗水分的，也按照食滞来治疗。如果用寒凉药抑制遏制，那么谵语发狂会更加严重，甚至会出现牙关紧闭不能说话的情况。（秦皇士《伤寒大白》。）
颈部肿胀像匏瓜，按压时发热疼痛，眼睛红得像血，脚冷腹泻，神志清醒，六脉细数，右手脉尤其软弱，稍微按压就空虚。沈尧封说：这是虚阳上攻。嘴唇上方有一条黑色痕迹，像干枯焦灼的样子，舌苔白得像敷了一层粉，舌尖也是白的，不红，这些都是确凿的虚寒证据，何况大便泻利、脚冷、脉濡，断然不是风火之证。如果是风火，必然会有痞闷烦热、燥渴不安的症状，怎么会有外部肿胀如此严重，而内部安适平静如常人呢？
案语：此即喻嘉言所说的浊阴从胸上入，表现为咽喉肿痛痹阻、舌头肿胀眼睛突出；从背上入，表现为颈项粗大、头项冰冷、浑身青紫而死之类的情况。最后一句对症状的辨析尤为精切不易。最迷惑人的地方，在于热痛和目赤，如果不是这篇论述，虽然脚冷便泻脉濡而空，还未能决断为真寒证。又按：近日吸食鸦片的人，嘴唇颜色多呈紫暗色，因为他们的胃中气血浑浊恶劣。之所以这样，是因为肺气不清，燥化胜出的缘故。
When the Qi of the Foot-Taiyin Spleen Meridian (Zú Tàiyīn Pí Jīng) is exhausted, the meridians fail to nourish the muscles, leading to tongue atrophy and fullness in the philtrum (Ren Zhong). If the philtrum is full, the lips will evert, indicating that the flesh is dying first. The condition worsens on a Jia day and leads to death on a Yi day. (From *Huangdi Neijing*.)
If the area below the patient's nose is flat, it indicates Stomach disease; if slightly red, an abscess (Yong) is developing; if slightly black, there is Heat; if blue/green, there is Cold; if white, it is difficult to treat.
(For sudden severe pain or syncope, if the philtrum is blue/green, it indicates Blood Excess, and pricking to bleed is appropriate. From *Maicheng*.)
In cases of Wind-Stroke, if the area below the nose is mixed with red and black, accompanied by foaming from the mouth and rigid body posture, death occurs within seven days.
Note: The philtrum internally corresponds to the Spleen and Stomach, and its lower part corresponds to the Bladder and Uterus. In patients suffering from damp-Heat rot in the Stomach and anterior yin, or pain caused by stagnant Blood accumulation, one often sees small red granular sores or common black spots on the philtrum, appearing dark like soot. This indicates a corresponding connection in the Qi collaterals.
In dysentery, if there is sudden severe pain below the umbilicus and the philtrum turns black, it indicates death. (Note: This is because Cold invades the Mingmen Gate of Vitality, causing the Blood in the Baozhong [Uterus/Bladder] to die. Zhu Danxi.)
The brilliance of the Spleen manifests in the skin around the lips (Chun Si Bai). Its diagnosis based on the five colors is the same as that of the face, but since the lip skin is thin and the color is prominent, it is particularly easy to observe. The specific diagnostic methods are listed below.
If the lips appear blue/green, yellow, red, white, or black, the disease is in the muscles. (From *Huangdi Neijing*.)
Lips that are scorched, dry, and cracked indicate Spleen Heat; swollen and red lips indicate Damp-Heat in the Stomach; bright red lips indicate Exuberant Fire; pale white lips indicate Qi Deficiency; pale white lips with a white halo around them indicate Loss of Blood; blue/black lips indicate Cold (leading to death of Blood. Shi Wan, *Yitong*).
Black lips indicate prior Stomach disease; if slightly dry and thirsty, it is treatable; if not thirsty, it is untreatable. (Thirst indicates consumption of Jin-Ye [Body Fluids] and stagnation of Blood; lack of thirst indicates collapse of Qi and death of Blood. Zhang Zhongjing. The following two sections follow the same logic.)
Sores inside the lower lip resembling millet grains are called "Hu," where worms erode the anus. Sores inside the upper lip resembling millet grains are called "Huo," where worms erode the throat (or viscera). Note: For those with abdominal pain who desire water, white patches on the face the size of coins, or pale lips with red dots in the center, it is undoubtedly due to intestinal worms biting into the blood.
If the corners of the mouth turn blue/green and the limbs twitch, it indicates Liver exhaustion. If the area around the mouth is blue/black, accompanied by soft sweat and yellow hair, it indicates Spleen exhaustion. If the nose is black and the lips are swollen, it indicates Lung failure. If there is Jue syndrome with blue lips and cold limbs, it indicates pathogen entering the Zang organs, leading to immediate death.
If dysentery is severe and the lips are vermilion red, it indicates death. (Note: All cases of blood loss are judged by this example. Zhu Danxi.)
The lips relate to the Hand and Foot Yangming meridians (Large Intestine, Stomach) and the Hand and Foot Taiyang and Spleen-Lung organs. Therefore, if the lips are red and moist, indicating no internal Heat, only acrid-warm exterior-dispersing methods should be used; if the lips are withered and dry, indicating existing internal Heat, clearing internal Heat is appropriate; if the lips are scorched black, with irritability, thirst, and excessive water intake, indicating extreme internal Heat, formulas such as Liangge San should be used. There are also cases of delirium, mania, and dry/scorched lips where heat does not subside after taking cooling herbs. This is due to Food Stagnation in the Middle Jiao, with Stomach Qi accumulating, causing jaundice and fever. Thus, cooling herbs fail to resolve the stagnation, and acrid-dispersing herbs exacerbate the internal Heat. It is appropriate to use Baohe San mixed with Bamboo Sap and Radish Juice, or Gardeniae and Fermented Soybean Decoction (Zhizi Chidao Tang) plus Immature Bitter Orange (Zhishi). The upper lip belongs to the Lung and Large Intestine; if scorched with thirst and water drinking, the Heat is above, primarily affecting the Lung; if scorched without thirst/water drinking, the Heat is below, primarily indicating Dry Feces in the Large Intestine. The lower lip belongs to the Spleen and Stomach; if scorched with thirst/water drinking, the Heat is in the Yangming Stomach; if scorched without thirst/water drinking, the Heat is in the Taiyin Spleen. Whether the scorched lips result from internal Heat, Food Stagnation, or latent Heat in the Blood level can be distinguished solely by whether there is thirst and water consumption. Additionally, long-standing Food Stagnation steaming and generating Heat can also cause thirst and water consumption; in such cases, the pulse must be consulted. If the pulse is slippery and large but not rapid, the food has not yet steamed into Heat, and there is no thirst; if the pulse is slippery, large, deep, and rapid, the food has steamed into Heat, and there is thirst. Therefore, for delirium and mania with a slippery, non-rapid pulse, and thirst without water consumption, treatment should focus on resolving Food Stagnation. If suppressed with cooling herbs, the delirium and mania will worsen, potentially leading to lockjaw and inability to speak. (Qin Huangshi, *Shanghan Dabai*.)
Neck swelling like a gourd, painful and hot to touch, eyes red as blood, cold feet, diarrhea, clear consciousness, fine and rapid pulses in all six positions, especially weak and empty upon slight pressure in the right hand. Shen Yaofeng said: This is Deficient Yang attacking upwards. A black streak on the upper lip looks dry and scorched; the tongue coating is white like powder; the tongue tip is white, not red. These are definitive signs of Deficient Cold. Moreover, with diarrhea, cold feet, and a soggy pulse, it is definitely not Wind-Fire. If it were Wind-Fire, there would necessarily be chest stuffiness, irritability, heat, dryness, thirst, and restlessness. How could there be such external swelling while the interior remains calm and peaceful like a healthy person?
Case Note: This corresponds to Yu Jiayan's description of Turbid Yin entering from the chest upwards, manifesting as throat swelling and bi-syndrome, tongue swelling, and protruding eyes; or entering from the back, manifesting as coarse neck, ice-cold head and neck, and death from whole-body cyanosis. The final sentence distinguishing symptoms is particularly precise. The most confusing aspect is the hot pain and red eyes. Without this analysis, even with cold feet, diarrhea, and a soggy, empty pulse, one might not decisively diagnose True Cold. Another note: People who recently smoke opium often have purple-dark lips because their Stomach Qi and Blood become turbid and foul. This is because Lung Qi is not clear, and Dryness transformation prevails.