明堂望法。五色既可互参。六部亦当合论。试举阴阳相乘之诊为例。而凡五色六部。仿此类推。假如上部。
阳位也。黑色。阴色也。黑色见于上部。阴乘阳也。下部。阴位也。赤色。阳色也。赤色见于下部。阳乘阴也。阴乘
阳位。为阴盛阳虚。阳乘阴位。为阳盛阴虚。若阳色见于阳位。为重阳。阴色见于阴位。为重阴。中藏经曰。热
发于上。阳中之阳邪也。热发于下。阴中之阳邪也。寒起于上。阳中之阴邪也。寒起于下。阴中之阴邪也。脉
经云。阳乘阴者。腰以下至足热。腰以上寒。栀子豉汤吐以升之。阴气上争。心腹满者死。阴乘阳者。腰以上
至头热。腰以下寒。桂苓丸利以导之。阳气上争。得汗者生。此相乘之旨也。然病有表里。色有浮沉。病有虚
实。色有浅深。又当参伍十法。以通其变焉。举一反三。庶乎可矣。
尝谓诊视明堂。察其气色。分其部位。则脏腑之病着。症候之变明。盖部位者。体也。气色者。用也。气色见于
脏部者。病在脏。见于腑部者。病在腑。见于枝节之部者。病在枝节。由是而观。有相应者焉。有相乘者焉。合
五行而推之。变在其中矣。所谓相应者。如青为风。青见肺部者。风中肺也。青见心部者。风中心也。青见脾
部者。风中脾也。青见肾部者。风中肾也。气色部位。皆当相应也。所谓相乘者。如青属肝。青见肺部者。肝乘
肺也。青见心部者。肝乘心也。青见脾部者。肝乘脾也。青见肾部者。肝乘肾也。气色部位。皆可相乘也。抑又
闻之。本部见本色。浅淡为不及。深浓为太过。不得其平。则皆病也。假如鼻者脾之部。黄者脾之色。脾部见
黄色。则本经自病。正邪也。若见白色。则子盗母气。虚邪也。若见赤色。则母助子气。实邪也。若见青色。则彼
能克我。贼邪也。若见黑色。则我能克彼。微邪也。太过者属乎腑。不及者属乎脏。脏腑相乘。可由是而推矣。
第气色有散抟。则病症有轻重。气色有泽夭。则病症有生死。气色有清浊。则病症有阴阳。浮沉之表里不
同。微甚之虚实亦异。合之四时。参之四诊。变在其中矣。吾故曰。察其气色。分其部位。则脏腑之病着。症候
之变明。明堂如此。面貌亦然。面貌如此。五官亦然。后之学人。仿此而推之可也。
望诊中观察明堂(鼻部)的方法。五色可以互相参照,六部的色诊也应当结合论述。试以阴阳相乘的诊法为例,凡是关于五色和六部的诊断,都可以仿照此类推演。
假如上部,属于阳位;黑色,属于阴色。如果黑色出现在上部,这是阴气侵犯阳位。下部,属于阴位;赤色,属于阳色。如果赤色出现在下部,这是阳气侵犯阴位。阴气侵犯阳位,表现为阴盛阳虚;阳气侵犯阴位,表现为阳盛阴虚。如果阳色的病色出现在阳位,称为重阳;阴色的病色出现在阴位,称为重阴。《中藏经》说:热邪发于上部,是阳中的阳邪;热邪发于下部,是阴中的阳邪;寒邪起于上部,是阳中的阴邪;寒邪起于下部,是阴中的阴邪。《脉经》说:阳乘阴的情况,症状是腰部以下至足部发热,腰部以上寒冷,可用栀子豉汤(Gardenia and Fermented Soybean Decoction)通过催吐的方法使邪气上升;如果出现阴气上争、心腹胀满的症状,则预后不良,主死。阴乘阳的情况,症状是腰部以上至头部发热,腰部以下寒冷,可用桂苓丸(Cinnamon and Polyporus Pill)通过利水渗湿的方法引导邪气下行;如果出现阳气上争、能够出汗的症状,则预后良好,主生。这就是相乘的道理。
然而疾病有表里之分,病色有浮沉之别;疾病有虚实之异,病色有浅深之差。又应当综合运用“参伍十法”来通晓其变化规律。举一反三,大概就可以掌握要领了。
我曾说,诊视明堂,观察其气色,分辨其部位,那么脏腑的疾病就会显现,症候的变化就会明晰。因为部位是体(本体),气色是用(表现)。气色出现在脏部,说明病在脏;出现在腑部,说明病在腑;出现在肢节部位,说明病在肢节。由此观察,有的情况是相应的,有的是相乘的。结合五行理论进行推演,变化就在其中了。
所谓“相应”,例如青色对应风邪,青色出现在肺部区域,是风邪伤肺;青色出现在心部区域,是风邪伤心;青色出现在脾部区域,是风邪伤脾;青色出现在肾部区域,是风邪伤肾。气色与部位应当相互对应。
所谓“相乘”,例如青色归属于肝,青色出现在肺部区域,是肝木乘肺金;青色出现在心部区域,是肝木乘心火;青色出现在脾部区域,是肝木乘脾土;青色出现在肾部区域,是肝木乘肾水。气色与部位也可以发生相乘关系。
我又听说,在本部见到本色,颜色浅淡为不及(虚弱),颜色深浓为太过(亢盛)。不得平和状态,都是疾病。例如鼻子是脾的部位,黄色是脾的颜色。如果在脾部见到黄色,是本经自病,属于正邪。如果见到白色,则是子盗母气,属于虚邪。如果见到赤色,则是母助子气,属于实邪。如果见到青色,则是彼能克我,属于贼邪。如果见到黑色,则是我能克彼,属于微邪。太过者归属于腑,不及者归属于脏。脏腑之间的相乘关系,可以由此推演。
只是气色有散漫与聚结的区别,病症就有轻重的不同;气色有润泽与枯夭的区别,病症就有生死的不同;气色有清朗与浑浊的区别,病症就有阴阳的不同。浮沉反映表里的差异,微甚反映虚实的区别。结合四时气候,参考四诊合参,变化就在其中了。所以我常说,观察气色,分辨部位,那么脏腑的疾病就会显现,症候的变化就会明晰。明堂如此,整个面部也是如此;面部如此,五官也是如此。后世的学人,仿照此理推演即可。
Methods of observing the Mingtang (nose) in inspection. The five colors can be cross-referenced, and the six regions should also be discussed in combination. Let us take the diagnosis of Yin-Yang mutual invasion as an example; for all matters regarding the five colors and six regions, one may infer by analogy.
For instance, the upper part is a Yang region; black is a Yin color. If black appears in the upper part, it indicates Yin invading Yang. The lower part is a Yin region; red is a Yang color. If red appears in the lower part, it indicates Yang invading Yin. When Yin invades a Yang region, it manifests as excess Yin and deficiency of Yang; when Yang invades a Yin region, it manifests as excess Yang and deficiency of Yin. If a Yang-colored pathological sign appears in a Yang region, it is called "Chong Yang" (Double Yang); if a Yin-colored pathological sign appears in a Yin region, it is called "Chong Yin" (Double Yin). *Zhong Zang Jing* (Classic of the Middle Viscera) states: Heat originating from above is the Yang pathogen within Yang; heat originating from below is the Yang pathogen within Yin; cold arising from above is the Yin pathogen within Yang; cold arising from below is the Yin pathogen within Yin. *Mai Jing* (Pulse Classic) states: In cases of Yang invading Yin, symptoms include heat from the waist down to the feet, and cold above the waist. This may be treated with Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) to induce vomiting and raise the pathogenic factor upward. If there is contention of Yin Qi ascending accompanied by fullness in the heart and abdomen, death ensues. In cases of Yin invading Yang, symptoms include heat from the waist up to the head, and cold below the waist. This may be treated with Guiling Wan (Cinnamon and Polyporus Pill) to promote urination and guide the pathogenic factor downward. If there is contention of Yang Qi ascending accompanied by sweating, survival ensues. This is the principle of mutual invasion.
However, diseases have exterior and interior distinctions, and pathological signs have floating and sunken characteristics; diseases have deficiency and excess variations, and pathological signs have light and deep shades. One must further employ the "Canwu Ten Methods" to comprehend their transformations. By grasping one principle, one can infer others, and mastery may be achieved.
I have said that inspecting the Mingtang, observing its Qi-colors, and distinguishing its regions allows one to clarify diseases of the Zang-Fu organs and manifest changes in syndromes. Regions constitute the substance (Ti), while Qi-colors constitute the function (Yong). If Qi-colors appear in Zang regions, the disease is in the Zang organs; if they appear in Fu regions, the disease is in the Fu organs; if they appear in limb regions, the disease is in the limbs. From this perspective, some situations are corresponding, while others involve mutual invasion. Deduced through the Five Elements, changes are inherent therein.
What is meant by "correspondence"? For example, green corresponds to Wind pathogen. If green appears in the Lung region, it is Wind attacking the Lungs; if it appears in the Heart region, it is Wind attacking the Heart; if it appears in the Spleen region, it is Wind attacking the Spleen; if it appears in the Kidney region, it is Wind attacking the Kidneys. Qi-colors and regions should correspond to each other.
What is meant by "mutual invasion"? For example, green belongs to the Liver. If green appears in the Lung region, it is Liver Wood invading Lung Metal; if it appears in the Heart region, it is Liver Wood invading Heart Fire; if it appears in the Spleen region, it is Liver Wood invading Spleen Earth; if it appears in the Kidney region, it is Liver Wood invading Kidney Water. Qi-colors and regions can also exhibit mutual invasion.
Furthermore, I have heard that when the original color appears in its own region, a pale shade indicates insufficiency (deficiency), and a deep, dense shade indicates excess (hyperactivity). Deviation from balance constitutes disease. For instance, the nose is the region of the Spleen, and yellow is the color of the Spleen. If yellow appears in the Spleen region, it is a disease of the meridian itself, classified as "Zheng Xie" (Proper Pathogen). If white appears, it indicates the child stealing from the mother, classified as "Xu Xie" (Deficient Pathogen). If red appears, it indicates the mother assisting the child, classified as "Shi Xie" (Excess Pathogen). If green appears, it indicates the other overcoming me, classified as "Ze Xie" (Robber Pathogen). If black appears, it indicates me overcoming the other, classified as "Wei Xie" (Minor Pathogen). Excess pertains to the Fu organs, while insufficiency pertains to the Zang organs. Mutual invasion between Zang and Fu organs can be deduced thus.
Nevertheless, scattered versus condensed Qi-colors indicate light versus severe conditions; lustrous versus withered Qi-colors indicate life versus death outcomes; clear versus turbid Qi-colors indicate Yin versus Yang distinctions. Floating versus sunken reflect differences in exterior versus interior; subtle versus pronounced reflect differences in deficiency versus excess. Combined with the Four Seasons and referenced against the Four Diagnostic Methods, changes are inherent therein. Therefore, I say: observing Qi-colors and distinguishing regions clarifies Zang-Fu diseases and syndrome changes. The same applies to the Mingtang, the entire face, and the five sense organs. Future students may apply this reasoning by analogy.