既讲声音合参之旨。当明脉象合参之诊。灵枢曰。色脉形肉。不得相失。色青者其脉弦。赤者其脉钩。黄者
其脉代。白者其脉毛。黑者其脉石。见其色而不得其脉。反得其相胜之脉。则死矣。得其相生之脉。则病已
矣。夫所谓相胜相生者。何也。脉胜色。色胜脉。谓之相胜。脉生色。色生脉。谓之相生。五色五脉。合之五行生
克。可类推也。假令色青。其脉当弦。今见青色而不得弦脉。反得毛脉者。脉胜色也。得代脉者。色胜脉也。此
相胜之谓也。得石脉者。脉生色也。得钩脉者。色生脉也。此相生之谓也。脉鉴云。色克脉者其死速。脉克色
者其死迟。色生脉者其愈速。脉生色者其愈迟。然以余观之。五脉有微甚。五色有浅深。五病有虚实。承制
之理。由是而窥。剥复之机。由是而测。约而言之。相胜者死。相生者生。相应而无过不及者平。相应而有过
不及者病。脏病多相胜。腑病多相生。太过属乎腑。不及属乎脏。脏腑相乘。可由是而推也。此皆色脉合参
之旨也。
既讲脉象合参之旨。当明病症合参之诊。十六难曰。假令得肝脉。其外证善洁。面青善怒。其内证脐左有
动气。按之牢若痛。其病四肢满闭。淋溲便难。转筋。有是者肝也。无是者非也。假令得心脉。其外证面赤口
干善笑。其内证脐上有动气。按之牢若痛。其病烦心。心痛。掌中热而 。有是者心也。无是者非也。假令得
脾脉。其外证面黄。善噫。善思。善味。其内证当脐上有动气。按之牢若痛。其病腹胀满。食不消。体重。节痛。怠
惰嗜卧。四肢不收。有是者脾也。无是者非也。假令得肺脉。其外证面白。善嚏。悲愁不乐。欲哭。其内证脐右
有动气。按之牢若痛。其病喘咳。洒淅寒热。有是者肺也。无是者非也。假令得肾脉。其外证面黑。善恐。善欠。
其内证脐下有动气。按之牢若痛。其病逆气。小腹急痛。泄如下重。足胫寒而逆。有是者肾也。无是者非也。
此皆相参之法也。由是而参之五官。五官其应也。参之五体。五体其应也。参之情志形容。声音臭味。与夫
毛发皮肉。经络筋骨。皆其应也。盖应者常也。不应者变也。知其常变。则知其病症矣。知其病症。则知其生
克矣。假如色青而得肾证。水生木也。色青而得心证。木生火也。此相生之谓也。又如色青而得肺证。金克
木也。色青而得脾证。木克土也。此相克之谓也。凡相生者顺。相克者逆。色生病者为虚邪。病生色者为实
邪。色克病者为贼邪。病克色者为微邪。色病相应者为正邪。太过者病在腑。不及者病在脏。脏腑相乘。可
由是而推也。然病症有三因。气色有十法。又当因诊以通其变焉。时日支干。孤虚旺相。亦可按法而合参
矣。由是而参之四时气候有异也。参之五方风土有殊也。参之气质强弱不齐也。参之老少盛衰不等也。
参之形志苦乐不均也。而况居移气。养移体。合乎七情六淫以为病。故见于形色。发于声音。显于症候。应
于脉息者。遂千变万化。种种不同。夫千变万化。种种不同。而究不能出乎四诊之范围者何哉。盖天以阴
阳五行。化生万物。有诸内。必形诸外。隐于此。必显于彼。月晕而风。础润而雨。一本而万殊。万殊而一本也。
既然已经阐述了声音与诊察合参的要旨，就应当明确脉象与诊察合参的方法。《灵枢》说：面色、脉象、形体和肌肉，不能相互背离。面色青的人，其脉象应呈弦象；面色赤的人，其脉象应呈钩象；面色黄的人，其脉象应呈代象；面色白的人，其脉象应呈毛象（浮象）；面色黑的人，其脉象应呈石象（沉象）。如果见到某种面色却得不到相应的脉象，反而得到相克制的脉象，则预后不良，可能致死；如果得到相生助的脉象，则疾病将愈。
所谓相胜（相克）和相生，是什么意思呢？脉象克制面色，或面色克制脉象，称为相胜；脉象生助面色，或面色生助脉象，称为相生。五色与五脉，结合五行生克理论，可以类推。例如，面色青，脉象应当是弦脉。现在见到青色却得不到弦脉，反而得到毛脉（金克木），这是脉胜色（脉克色）；得到代脉（火生土，此处原文逻辑可能有误，通常代脉属脾土，若色青属木，木克土为色胜脉，但原文后文解释得代脉为色胜脉，需依原文翻译：原文称“得代脉者，色胜脉也”，即木克土，色胜脉），这是色胜脉。以上称为相胜。得到石脉（水生木，脉生色），这是脉生色；得到钩脉（木生火，色生脉），这是色生脉。以上称为相生。《脉鉴》说：面色克制脉象的，死亡迅速；脉象克制面色的，死亡迟缓；面色生助脉象的，痊愈迅速；脉象生助面色的，痊愈迟缓。然而依我观察，五脉有微弱与盛大之分，五色有浅淡与深重之别，五病有虚证与实证之异。承制（制约与生化）的道理，由此可以窥见；剥复（消长转化）的机制，由此可以推测。简而言之，相胜者死，相生者生，相应且无太过不及者为平人（健康），相应而有太过不及者为病人。脏病多表现为相胜，腑病多表现为相生。太过属于腑病，不及属于脏病。脏腑之间的相乘关系，可以由此推演。这些都是色脉合参的要旨。
既然已经阐述了脉象合参的要旨，就应当明确病症与诊察合参的方法。《难经·十六难》说：假如诊得肝脉，其外在证候表现为爱清洁、面色青、易怒；其内在证候表现为脐左有动气，按压坚实且疼痛；其疾病表现为四肢胀满闭塞、小便淋漓困难、大便艰难、筋脉拘挛抽搐。具备这些症状的是肝病，不具备这些症状的就不是肝病。假如诊得心脉，其外在证候表现为面色红赤、口干燥、易笑；其内在证候表现为脐上有动气，按压坚实且疼痛；其疾病表现为心烦、心痛、手掌心发热且伴有轻微寒战（注：原文“而 ”处似缺字，据《难经》原文多为“而热”或“而悸”，此处依语境译为发热/不适，保留学术严谨性，暂译为掌心热且伴不适）。具备这些症状的是心病，不具备这些症状的就不是心病。假如诊得脾脉，其外在证候表现为面色黄、易嗳气、多思虑、味觉敏感；其内在证候表现为当脐上有动气，按压坚实且疼痛；其疾病表现为腹部胀满、食物不消化、身体沉重、关节疼痛、倦怠嗜卧、四肢无力收持。具备这些症状的是脾病，不具备这些症状的就不是脾病。假如诊得肺脉，其外在证候表现为面色白、易打喷嚏、悲伤忧愁不乐、想哭；其内在证候表现为脐右有动气，按压坚实且疼痛；其疾病表现为气喘咳嗽、洒淅恶寒发热。具备这些症状的是肺病，不具备这些症状的就不是肺病。假如诊得肾脉，其外在证候表现为面色黑、易恐惧、易呵欠；其内在证候表现为脐下有动气，按压坚实且疼痛；其疾病表现为气逆、小腹部急痛、泄泻且有下坠感、足胫寒冷且逆冷。具备这些症状的是肾病，不具备这些症状的就不是肾病。这些都是相互参验的方法。
由此可以参验五官，五官是其对应表现；参验五体，五体是其对应表现；参验情志、形态、声音、气味，以及毛发、皮肤、肌肉、经络、筋骨，都是其对应表现。一般来说，对应的表现是常态，不对应的表现是变态。知道了常态和变态，就知道疾病的症候了。知道了疾病的症候，就知道其中的生克关系了。例如，面色青却出现肾病的证候，因为水生木，这是相生；面色青却出现心证的证候，因为木生火，这也是相生。又如，面色青却出现肺病的证候，因为金克木，这是相克；面色青却出现脾病的证候，因为木克土，这也是相克。凡是相生的属于顺证，相克的属于逆证。面色生病（色生病）者为虚邪，病生气色（病生色）者为实邪，面色克病（色克病）者为贼邪，病克面色（病克色）者为微邪，色与病相应者为正邪。太过者病在腑，不及者病在脏。脏腑之间的相乘关系，可以由此推演。然而病症有三因（内因、外因、不内外因），气色有十法，又应当通过诊察来通晓其变化。日时的干支、孤虚旺相等，也可以按照法则进行合参。由此可以参验四时气候的差异；参验五方风土的殊异；参验体质强弱的不同；参验老少盛衰的不等；参验形志苦乐的不均。更何况居住环境改变气质，调养改变体质，合乎七情六淫而致病，所以表现在形色上，发于声音，显于症候，应于脉息，于是千变万化，种种不同。但是，千变万化、种种不同，终究不能超出望、闻、问、切四诊的范围，为什么呢？因为天以阴阳五行化生万物，内部有什么，必然在外表显现；隐藏在这里，必然显露在那里。月亮周围有晕圈就会刮风，柱础湿润就会下雨，这是一本万殊、万殊归一本的道理。
Having expounded the principle of integrating voice with diagnosis, one must clarify the diagnostic method of integrating pulse appearance. The *Ling Shu* (Spiritual Pivot) states: Facial color, pulse appearance, body form, and flesh should not contradict each other. When the facial color is blue/green, the pulse should be wiry (Xian); when red, hook-like (Gou); when yellow, intermittent (Dai); when white, floating/hairy (Mao); and when black, sunken/stony (Shi). If a certain facial color is observed but the corresponding pulse is absent, and instead a controlling (Ke) pulse is obtained, death ensues. If a generating (Sheng) pulse is obtained, the disease will resolve.
What is meant by controlling (Ke) and generating (Sheng)? When the pulse controls the color, or the color controls the pulse, it is called controlling (Xiang Sheng). When the pulse generates the color, or the color generates the pulse, it is called generating (Xiang Sheng). The five colors and five pulses, combined with the theory of Five Elements generation and restriction, can be deduced analogically. For example, if the facial color is blue/green, the pulse should be wiry. Now, if blue/green color is seen but the wiry pulse is absent, and instead a floating/hairy pulse (Metal controls Wood) is obtained, this is "pulse controls color" (Mai Ke Se). If an intermittent pulse (Wood controls Earth, i.e., color controls pulse) is obtained, this is "color controls pulse" (Se Ke Mai). This is referred to as controlling (Xiang Sheng). If a sunken/stony pulse (Water generates Wood, i.e., pulse generates color) is obtained, this is "pulse generates color" (Mai Sheng Se). If a hook-like pulse (Wood generates Fire, i.e., color generates pulse) is obtained, this is "color generates pulse" (Se Sheng Mai). This is referred to as generating (Xiang Sheng). The *Mai Jian* (Mirror of Pulse) states: When color controls pulse, death is rapid; when pulse controls color, death is delayed; when color generates pulse, recovery is rapid; when pulse generates color, recovery is delayed. However, in my observation, the five pulses have degrees of weakness and strength, the five colors have shades of lightness and darkness, and the five diseases have deficiency and excess patterns. The principles of mutual restraint and transformation can be inferred from this; the mechanisms of decline and resurgence can be predicted. In summary, controlling leads to death, generating leads to life, correspondence without excess or deficiency indicates health (Ping), while correspondence with excess or deficiency indicates disease. Zang organ diseases often manifest controlling relationships, while Fu organ diseases often manifest generating relationships. Excess belongs to Fu organs, deficiency belongs to Zang organs. The mutual multiplication (Cheng) between Zang and Fu organs can be deduced from this. These are the essential principles of integrating color and pulse.
Having expounded the principle of integrating pulse appearance, one must clarify the diagnostic method of integrating symptoms/diseases. The *Nan Jing* (Classic of Difficult Issues), Chapter 16, states: Suppose the Liver pulse is obtained. Its external manifestations include cleanliness, blue/green facial color, and irritability. Its internal manifestations include pulsation at the left of the umbilicus, which feels firm and painful upon pressure. Its diseases include fullness and obstruction of the four limbs, difficult urination and defecation, and tendon spasms. Those who have these signs have Liver disease; those who do not do not have Liver disease. Suppose the Heart pulse is obtained. Its external manifestations include red facial color, dry mouth, and excessive laughter. Its internal manifestations include pulsation above the umbilicus, which feels firm and painful upon pressure. Its diseases include vexation, heart pain, and heat in the palms accompanied by discomfort. Those who have these signs have Heart disease; those who do not do not have Heart disease. Suppose the Spleen pulse is obtained. Its external manifestations include yellow facial color, frequent belching, overthinking, and heightened taste sensitivity. Its internal manifestations include pulsation at the center of the umbilicus, which feels firm and painful upon pressure. Its diseases include abdominal fullness, indigestion, heavy body, joint pain, lethargy and desire to sleep, and inability to hold the four limbs. Those who have these signs have Spleen disease; those who do not do not have Spleen disease. Suppose the Lung pulse is obtained. Its external manifestations include white facial color, frequent sneezing, sadness and sorrow, and a desire to cry. Its internal manifestations include pulsation at the right of the umbilicus, which feels firm and painful upon pressure. Its diseases include wheezing and coughing, and aversion to wind and cold with fever. Those who have these signs have Lung disease; those who do not do not have Lung disease. Suppose the Kidney pulse is obtained. Its external manifestations include black facial color, fearfulness, and frequent yawning. Its internal manifestations include pulsation below the umbilicus, which feels firm and painful upon pressure. Its diseases include rebellious Qi, acute pain in the lower abdomen, diarrhea with a sensation of heaviness/prolapse, and coldness and reversal in the feet and shins. Those who have these signs have Kidney disease; those who do not do not have Kidney disease. These are all methods of mutual verification.
From this, one can verify the five sense organs, which are their corresponding manifestations; verify the five body tissues, which are their corresponding manifestations; verify emotions, demeanor, voice, odor, as well as hair, skin, muscle, meridians, and bones/joints, all of which are their corresponding manifestations. Generally, correspondence is the norm, and non-correspondence is the variation. Knowing the norm and variation allows one to know the disease symptoms. Knowing the disease symptoms allows one to know the generation and restriction relationships. For instance, if the facial color is blue/green but Kidney disease symptoms appear, since Water generates Wood, this is generating (Sheng). If the facial color is blue/green but Heart disease symptoms appear, since Wood generates Fire, this is also generating. Again, if the facial color is blue/green but Lung disease symptoms appear, since Metal controls Wood, this is controlling (Ke). If the facial color is blue/green but Spleen disease symptoms appear, since Wood controls Earth, this is also controlling. All cases of generation are favorable (Shun), and all cases of control are unfavorable (Ni). When color generates disease, it is Deficient Evil (Xu Xie); when disease generates color, it is Excess Evil (Shi Xie); when color controls disease, it is Robbing Evil (Ze Xie); when disease controls color, it is Slight Evil (Wei Xie); when color and disease correspond, it is Correct Evil (Zheng Xie). Excess indicates disease in the Fu organs, deficiency indicates disease in the Zang organs. The mutual multiplication between Zang and Fu organs can be deduced from this. However, there are three causes for diseases, and ten methods for analyzing qi and color. One must further understand their variations through diagnosis. The heavenly stems and earthly branches of time, as well as concepts like Gu Xu (Lonely/Void) and Wang Xiang (Prosperous/Strong), can also be integrated according to specific methods. From this, one can verify the differences in seasonal climates; verify the differences in regional winds and soils of the five directions; verify the inequalities in constitutional strength; verify the inequalities in the decline and vigor of the young and old; verify the inequalities in physical and mental suffering or joy. Moreover, living environments change temperament, and nourishment changes the physique. Diseases arise from conforming to the Seven Emotions and Six Evils. Thus, what appears in form and color, emanates in voice, manifests in symptoms, and responds in pulse and respiration becomes infinitely variable and diverse. Yet, why can these infinite variations and diversities not exceed the scope of the Four Diagnostic Methods (Wang, Wen, Wen, Qie)? It is because Heaven uses Yin-Yang and the Five Elements to generate all things. Whatever exists internally must manifest externally; whatever is hidden here must appear there. A halo around the moon predicts wind; moist pillars predict rain. This is the principle of "one root yielding many branches, and many branches returning to one root."