凡欲知病色。必先知平色。盖平人之色。不浮不沉。不清不浊。不微不甚。不散不抟。光明润泽。血华其色也。
五脏生成篇曰。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。此五脏所生之外荣也。夫缟者。白绢也。绢之白。犹肤之白也。绢之光明润泽。犹肤之
光明润泽也。光明者。神气之着。润泽者。精血之充。其曰朱。谓其色之正赤也。曰红。谓其白之间赤也。曰绀。
谓其青之间赤也。曰栝蒌实。谓其黄之间赤也。曰紫。谓其黑之间赤也。赤者。血色也。缟者。肤色也。其青赤
黄白黑虽不同。要皆有血色之赤。以间乎其中焉。肤色之白。以包乎其外焉。惟此朱红绀紫者。隐于肤之
内。而光明润泽者。显于肤之外。故曰。如以缟裹。盖五色之着。欲其间见。不欲其独呈。欲其合于中。不欲其
露于外也。五脏之所生也。四时之所成也。气血华其色。精神彰于面焉。此所谓平人也。平人者何。无病者
也。知其平之为无病。可知其不平之为病矣。
盖闻博以穷理。约以知要。色脉之变。虽有万殊。理义之旨。初无二致。特不求其本。斯散而无纪矣。何则。灵
素论脉。以胃气为本。望色。以润泽为本。凡诊脉有胃气者生。无胃气者死。凡望色润泽者生。沉夭者死。然
则色之润泽。岂非犹脉之胃气乎。经言。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。此五色之见生也。以其血色虽变。而犹有润泽也。青如草滋者死。黄如枳实者死。黑如煤
者死。赤如 血者死。白如枯骨者死。此五色之见死也。以其血色已变。而更无润泽也。夫润泽之有无。犹
胃气之有无也。盖脉之胃气。脉之神也。色之润泽。色之神也。脉贵有神。色亦贵有神也。色脉虽殊。其源无
二。实决死生之大要。察病症之先务。因举一言以蔽之曰。色以润泽为本。盖润泽者。血气之荣光明者。润
泽之着。有血气即有润泽。有润泽即有光明也。夫光明润泽者。气也。青赤黄白黑者。色也。有气不患无色。
有色不可无气也。合言之。而气色之见不可离。分论之。而气色之辨不可混。何也。脉以胃气为本。色以润
泽为本。法异而理同也。
凡是想要了解病态的面色,必须先了解正常人的面色。大概正常人的面色,不浮露也不深沉,不浑浊也不清亮,不微弱也不过盛,不分散也不聚结,光明且润泽,这是血液荣华反映在面色的表现。
《素问·五脏生成篇》说:心脏的正常面色,像白绢包裹着朱砂;肺脏的正常面色,像白绢包裹着红色;肝脏的正常面色,像白绢包裹着青赤色(绀);脾脏的正常面色,像白绢包裹着栝蒌实(一种黄色果实);肾脏的正常面色,像白绢包裹着紫色。这是五脏精气外荣于面的表现。所谓“缟”,是白色的丝绢。丝绢的白色,就像皮肤的白色一样;丝绢的光明润泽,就像皮肤的光明润泽一样。所谓“光明”,是神气显露的表现;所谓“润泽”,是精血充盈的表现。所说的“朱”,是指纯正的红色;所说的“红”,是指在白色中透出红色;所说的“绀”,是指在青色中透出红色;所说的“栝蒌实”,是指在黄色中透出红色;所说的“紫”,是指在黑色中透出红色。红色,是血液的颜色;缟色,是肤色的颜色。虽然青、赤、黄、白、黑五色不同,但都必然有血液的红色夹杂在其中。肤色的白色,包裹在外部。只有这朱、红、绀、紫等色,隐于皮肤之内,而光明润泽之象,显现在皮肤之外。所以说“像白绢包裹着”。大概五色的显现,希望其中间杂可见,不希望单独呈现;希望它与内部相合,不希望显露于外表。这是五脏所生的本色,也是四时之气所成的色泽。气血荣华其面色,精神彰显于面部。这就是所谓的“平人”(健康人)。什么是平人?就是没有疾病的人。知道“平”代表无病,就可以知道“不平”代表有病了。
我听说广博地探究可以穷尽道理,简约地把握可以知晓要点。面色和脉象的变化,虽然有万种不同,但其内在的道理宗旨,起初并没有两样。只是如果不探求根本,就会散乱而没有条理。为什么呢?《灵枢》和《素问》论述脉象,以胃气为本;观察面色,以润泽为本。凡是诊察脉象有胃气的就生,没有胃气的就死。凡是观察面色有润泽的就生,沉滞枯夭的就死。既然这样,那么面色的润泽,难道不是类似于脉象的胃气吗?经文说:面色青得像翠鸟羽毛那样的是生证,赤得像鸡冠那样的是生证,黄得像蟹腹那样的是生证,白得像猪油那样的是生证,黑得像乌鸦羽毛那样的是生证。这是五色显现出生机的情形。因为虽然血色有所变化,但仍然还有润泽。面色青得像枯草那样的死证,黄得像枳实那样的死证,黑得像煤炭那样的死证,赤得像干血那样的死证,白得像枯骨那样的死证。这是五色显现出死机的情况。因为血色已经改变,而且更没有润泽了。润泽的有无,就像胃气的有无一样。脉象中的胃气,是脉的神气;面色中的润泽,是面色的神气。脉象贵在有神,面色也贵在有神。面色和脉象虽然不同,但它们的源头没有二致,确实是决定生死的关键,也是考察病症的首要任务。因此用一句话来概括它说:面色以润泽为根本。润泽,是血气荣华的表现;光明,是润泽显露的结果。有血气就有润泽,有润泽就有光明。所谓光明润泽,属于“气”的范畴;青、赤、黄、白、黑,属于“色”的范畴。有气不必担心没有色,有色不可以没有气。综合来说,气和色的显现不可分离;分别论述,气和色的辨别不可混淆。为什么呢?脉象以胃气为本,面色以润泽为本,方法不同但道理相同。
To understand pathological facial colors, one must first understand the normal facial color. Generally, the facial color of a healthy person (Ping Ren) is neither floating nor deep, neither turbid nor clear, neither faint nor excessive, neither scattered nor condensed; it is bright and lustrous, reflecting the flourishing of blood essence in the complexion.
The *Su Wen: Zang Xiang Sheng Cheng Pian* states: The heart's normal color is like white silk wrapping cinnabar; the lung's normal color is like white silk wrapping red; the liver's normal color is like white silk wrapping cyan-red (gan); the spleen's normal color is like white silk wrapping the fruit of Trichosanthes kirilowii (Gualou Shi); the kidney's normal color is like white silk wrapping purple. These are the external manifestations of the five zang organs' vitality. "Bo" refers to white silk. The whiteness of silk is akin to the whiteness of skin; the brightness and luster of silk are akin to the brightness and luster of skin. "Brightness" indicates the manifestation of Shen Qi (Spiritual Energy); "luster" indicates the fullness of Jing Xue (Essence and Blood). "Zhu" refers to pure red; "Hong" refers to red appearing within white; "Gan" refers to red appearing within cyan; "Gualou Shi" refers to red appearing within yellow; "Zi" refers to red appearing within black. Red is the color of blood; Bo is the color of skin. Although the five colors—cyan, red, yellow, white, and black—differ, they all contain the redness of blood essence interspersed within. The whiteness of the skin wraps around the exterior. Only these colors such as Zhu, Hong, Gan, and Zi are hidden within the skin, while the brightness and luster are displayed on the surface. Hence it is said, "like white silk wrapping." The manifestation of the five colors should be interspersed and visible, not presented alone; it should harmonize with the interior, not be exposed outwardly. This is what the five zang organs generate and what the four seasons complete. Qi and Xue (Vital Energy and Blood) flourish the complexion, and Jing Shen (Essence and Spirit) manifests on the face. This is called a "Ping Ren" (healthy person). What is a Ping Ren? It is a person without disease. Knowing that "Ping" signifies health allows one to know that "Bu Ping" signifies disease.
I have heard that extensive study exhausts principles, while concise grasp knows essentials. Although changes in facial color and pulse may vary infinitely, their underlying principles remain consistent. If one does not seek the root, matters become scattered and unorganized. Why? The *Ling Shu* and *Su Wen* discuss pulses, taking Wei Qi (Stomach Qi) as the root; observing facial color takes luster as the root. Pulses possessing Wei Qi indicate life; those lacking Wei Qi indicate death. Facial colors possessing luster indicate life; those that are dull and withered indicate death. Thus, is the luster of facial color not analogous to the Wei Qi of the pulse? The classics state: Cyan like the feathers of a kingfisher indicates life; red like the comb of a rooster indicates life; yellow like the belly of a crab indicates life; white like the fat of a pig indicates life; black like the feathers of a crow indicates life. These are the signs of life in the five colors. Although the blood color changes, there is still luster. Cyan like withered grass indicates death; yellow like the fruit of Aurantium aurantium indicates death; black like coal indicates death; red like dried blood indicates death; white like dry bones indicates death. These are the signs of death in the five colors. Because the blood color has changed and lacks luster entirely. The presence or absence of luster is like the presence or absence of Wei Qi. Wei Qi in the pulse is the Shen (Spirit) of the pulse; luster in the facial color is the Shen of the color. Pulses value Shen, and so do facial colors. Although facial color and pulse differ, their source is one. They are indeed the major criteria for determining life and death and the primary task in examining diseases. Therefore, I summarize it in one phrase: Facial color takes luster as its root. Luster is the flourishing of Qi and Xue; brightness is the manifestation of luster. Where there is Qi and Xue, there is luster; where there is luster, there is brightness. Brightness and luster belong to the category of Qi; cyan, red, yellow, white, and black belong to the category of Se (Color). Having Qi, one need not worry about lacking Color; having Color, one cannot lack Qi. In synthesis, the manifestation of Qi and Se cannot be separated; in analysis, the distinction between Qi and Se must not be confused. Why? Pulse takes Wei Qi as the root, and facial color takes luster as the root. The methods differ, but the principle is the same.