散。故病未有聚也。夫气伤痛。其病散于气分而痛者。聚未成于血脉也。若脏病不出于气分。如肾乘心则
心先病。而抟聚之赤色。出于两颧。大如拇指矣。肾即为应。而黑色出于庭。亦大如拇指矣。此藏邪聚于
脏。从血脉相乘。故色皆如是之聚而不散也。金匮要略云。血气入脏即死。入腑即愈。非为一病。百病皆然。
在外者可治。入里者即死。男子色在于面王。为小腹痛。下为卵痛。其圜直为茎痛。高为本。下为首。狐疝
阴之属也。女子在于面王。为膀胱子处之病。故为痛。抟为聚。方圆左右。各如其色形。其随而下至胝
为淫。有润如膏状。为暴食不洁。左为左。右为右。其色有邪。聚散而不端。面色所指者也。（圜圆同邪斜同）
此言外因之病色。见于腑部者。其病在腑。色虽抟聚。非死征也。面王以上者。小肠也。面王以下
者。膀胱子处也。故男子色见于面王。为小腹痛。其圆直为茎痛。夫外因之病。从外而内。其色从上而下。
故以高为本。下为所行之首。其病乃在下。狐疝阴 之属也。女子色见于面王。为膀胱子处之病。男
女之病。散在气分则为痛。
抟于血分则为聚。夫狐疝阴 之属。乃有形之证。其形之或方或圆。或左或右。各如其色形。盖病聚
于内。则见聚色于外。形方则色方。形圆则色圆。此病形而不病脏。虽有聚色。非死色也。此五脏六
腑。各有部分。有外内。能明乎部分。知其外内。万举万当矣。胝者。面王之下部也。其面王之色。
随而下至胝者。主有淫浊之证。其色润如膏状者。为暴食不洁之物。盖腑为阳而主外。主受纳水谷。
传导糟粕。是以或外受风寒。或内伤饮食。皆为病腑。而色见于腑部也。色见于左。则为病在左。色
见于右。则为病在右。其所见之色。或聚或散。皆斜而不端。其抟聚之面色。所谓如指者也。夫血脉
传溜。大邪入脏则为卒死。今腑病而为狐疝阴 之属。因邪抟而为聚病。故见其聚色。非入脏之死征也。
色者青黑赤白黄。皆端满。有别乡。别乡赤者。其色赤大如榆荚。在面王为不日。
此言色之抟聚而端满者。乃大气入脏。而为卒死矣。青黄赤白黑。五脏五行之色也。别乡者。如小
肠之部在面王。而面王者。乃心之别乡也。胆之部在肝左。胆部者。肝之别乡也。大如榆荚者。血分之
聚色。即如拇指之状也。不日者。不终日而卒死也。此言五脏之病色。见于本部。五脏之死色。见于
别乡。如心受外淫之邪而卒死者。其色见于面王。心受内因之病而卒死者。其色出于颧。皆非心脏之本
部。但在脏者。其色端满而不斜。在腑者。其色斜而不端。此脏腑死生之有别也。高士宗曰。脏真藏于
内。绝则从腑而脱于外。故色见于腑部。
其色上锐首空上向。下锐下向。在左右如法。
此承上文以申明端邪之色状也。锐、尖也。空、虚也。其色上行者。上锐首虚。浮而上行。其色
下行者。下锐首虚。浮而下行。盖病从内而外者。其本在下。其首在上。病从外而内者。其本在上。
其首在下。是以本沉实而首虚浮。此端满之色状也。有邪而不端者。其本在左。其首向右行。其本在右。
其首向左行。皆如上锐首空。下锐首空之法。此病在腑而抟为聚之聚色也。朱永年曰。榆荚上下皆锐。
但虚浮者。其锐形外见。所沉之本。不见其锐形也。故曰察其浮沉。以知浅深。
以五色命脏。青为肝。赤为心。白为肺。黄为脾。黑为肾。肝合筋。心合脉。肺合皮。脾合肉。肾
合骨也。
此总结五脏各具五色。而各有外内之形层也。上文言赤色出于两颧。黑色出于庭。赤色在面王。
此心肾之色也。若以五色命脏。则五脏各有五者之色矣。至于肩臂膺背膝胫手足之部。俱各有五脏所
合之皮脉肉筋骨。视其五色。则知病在内之五脏。在外合之形层。此五脏内合五行。外见五色。若外
因风寒暑湿之邪。而见于色者。六气之应于色也。倪冲之曰。病五脏于内。则外见五色。邪中外合
之皮脉肉筋骨。则内入于五脏。此外内出入之道也。按病传章曰。血脉传溜。大邪入脏。可以致死。不
可以致生。帝曰。大气入脏奈何。伯曰。病先发于心。一日而之肺。三日而之肝。盖血脉传溜。故先
发于心。若邪中皮而内入。则先发于肺矣。夫邪从形层次第而入于内者。先皮毛而肌腠。腠而络。络而
脉。脉而经。经而腑脏。此邪在外之皮脉。即中内合之五脏。故曰人不病而卒死。谓不病在外之形层。
而即入于脏也。
（病色）散开。所以疾病还没有形成积聚。气受伤则疼痛，如果病邪散在气分而疼痛，说明气血尚未在血脉中凝聚。如果是脏病而不表现在气分，例如肾邪侵犯心脏，那么心脏先发病，聚结的赤色出现在两颧，大小如拇指。肾脏的病气随即应验，黑色出现在天庭，也大小如拇指。这是脏邪聚集在脏，顺着血脉相克的关系传变，所以面色都这样聚结而不散开。《金匮要略》说：血气进入脏就会死亡，进入腑就会痊愈。这不单是一种病的情况，所有疾病都是如此。病在表浅的可以治愈，病入里深的就会死亡。
男子面色变化出现在面王（鼻准），主小腹痛，向下牵引睾丸疼痛。如果颜色呈圆形且直，是阴茎疼痛。颜色高起的部分是本部，低下的部分是首端，这属于狐疝、阴肿之类的病证。女子面色变化出现在面王，主膀胱和子宫的疾病，所以表现为疼痛。抟聚表示有积聚，颜色的形状方圆左右，各自对应其病变部位。如果颜色向下延伸到达胝（鼻下人中沟上部），主淫浊之证，如果有润泽如膏状的表现，是因为暴食不洁食物所致。左侧有病则色见于左，右侧有病则色见于右。如果面色带有邪气，聚散无常且不端正，这就是面色所指示的病征。（“圜”同“圆”，“邪”同“斜”）
这里说的是外因引起的病色，出现在腑的部位，说明病在腑。虽然颜色聚结，但不是死征。面王以上，是小肠的部位；面王以下，是膀胱和子宫的部位。所以男子面色见于面王，主小腹痛。如果颜色呈圆形且直，是阴茎疼痛。外因引起的疾病，从外向内传变，面色从上向下显现。所以以高起处为本部，低下处为病邪所行之首端。病位在下，属于狐疝、阴肿之类。女子面色见于面王，主膀胱和子宫的疾病。男女的疾病，散在气分则为疼痛，聚在血分则为积聚。像狐疝、阴肿这类病，是有形的证候，其形状或方或圆，或左或右，各自对应其面色形态。因为病邪聚集在内，所以外部出现聚结的面色。形体方则面色方，形体圆则面色圆。这是病在形层而不病在脏，虽然有聚结的面色，但不是死色。
五脏六腑，各有对应的面部区域，有内外的区别。能够明白这些部位，知道内外对应关系，诊治就能万无一失。“胝”是指面王下方的部位。如果面王的色泽向下延伸至胝，主要预示有淫浊之证。如果色泽润泽如膏状，是因为暴食不洁之物。腑属阳而主外，主管受纳水谷，传导糟粕。因此，无论是外受风寒，还是内伤饮食，都会导致腑病，从而在腑部出现相应的面色。面色见于左侧，则病在左侧；面色见于右侧，则病在右侧。所见到的面色，或聚或散，都偏斜而不端正。这种聚结的面色，就是前面所说的如拇指大小的样子。
如果血脉传变，大邪侵入脏，会导致突然死亡。现在腑病而出现狐疝、阴肿之类，是因为邪气抟聚而形成积聚病，所以见到聚结的面色，这并不是入脏的死征。
五色是青、黑、赤、白、黄，都呈现端正饱满的状态，且有别于本脏所属的部位。别乡出现的赤色，大小如榆荚，出现在面王，预示不久将死亡。
这里说的是面色聚结且端正饱满，是大邪侵入脏，导致突然死亡。青、黄、赤、白、黑，是五脏五行对应的颜色。所谓“别乡”，例如小肠的部位在面王，而面王实际上是心的别乡；胆的部位在肝的左侧，胆部也是肝的别乡。大小如榆荚，是指血分的聚色，就像拇指的大小一样。“不日”是指不到一天就突然死亡。这里说的是五脏的病色，出现在本部是正常的反映；五脏的死色，出现在别乡。例如心受外邪侵袭而突然死亡的，其面色出现在面王；心受内因致病而突然死亡的，其面色出现在颧部。这些都不是心脏的本部。但在脏的病，其面色端正饱满而不偏斜；在腑的病，其面色偏斜而不端正。这是脏腑生死预后的区别。
高士宗说：脏的真气藏于体内，一旦断绝，就会从腑脱逸于外。所以面色出现在腑部。
如果面色向上尖锐，头部空虚，向上倾斜；向下尖锐，头部空虚，向下倾斜；在左右两侧则符合上述规律。
这是承接上文来阐明端正与偏斜的面色形态。“锐”即尖，“空”即虚。面色上行者，上端尖锐，头部空虚，浮越而上行；面色下行者，下端尖锐，头部空虚，浮越而下行。一般来说，病从内向外发展的，其根本在下，其标在上；病从外向内发展的，其根本在上，其标在下。所以根本沉实而标头虚浮，这是端正饱满的面色形态。如果有邪气但不端正，其根本在左，其标向右行；其根本在右，其标向左行。都符合上面所说的上锐头空、下锐头空的法则。这是病在腑而抟聚形成的聚色。
朱永年说：榆荚上下皆尖锐，但只有虚浮的部分，其尖锐的形状才显露出来；沉实的根本部分，不显露其尖锐形状。所以说观察色的浮沉，可以知道病的深浅。
用五色来命名五脏：青色对应肝，赤色对应心，白色对应肺，黄色对应脾，黑色对应肾。肝合筋，心合脉，肺合皮，脾合肉，肾合骨。
这是总结五脏各具五色，并且各有内外对应的形层。上文提到赤色出于两颧，黑色出于庭，赤色在面王，这是心和肾的颜色。如果用五色命脏，那么五脏各有五种对应的颜色。至于肩、臂、膺、背、膝、胫、手足等部位，也都各有五脏所合的皮、脉、肉、筋、骨。观察这五色，就可以知道病在内在哪一脏，在外对应哪一形层。这是五脏内合五行，外现五色。如果是外感风寒暑湿之邪而表现在面色上的，是六气在面色上的应验。
倪冲之说：病在五脏内部，则外部出现五色；邪气中于外在的皮、脉、肉、筋、骨，则内部传入五脏。这是内外出入的途径。
按《病传章》所说：血脉传变，大邪入脏，可以致死，不可以致生。黄帝问：大气入脏是怎么回事？伯回答：病先发于心，一天后传到肺，三天后传到肝。这是因为血脉传变，所以先发于心。如果邪气中于皮部而内入，则先发于肺。邪气从形层次第内入，先由皮毛到肌腠，由肌腠到络脉，由络脉到经脉，由经脉到腑脏。这种邪气在外部的皮脉，即中于内在相合的五脏。所以说人没有表现出外在形层的病症，却突然死亡，是指邪气没有经过外在形层，直接进入了脏。
(Dispersed) Thus, the disease has not yet formed an accumulation. Qi injury causes pain; if the pathology is dispersed in the Qi level and causes pain, it indicates that the pathogen has not yet condensed in the blood vessels. If it is a Zang organ disease that does not manifest at the Qi level, such as Kidney evil invading the Heart, the Heart will be affected first, and the condensed crimson color will appear on both cheekbones, the size of a thumb. The Kidney's response follows, with black color appearing on the forehead (Ting), also the size of a thumb. This is because Zang evil accumulates within the Zang organs, transmitted via the mutual overcoming relationship of the blood vessels; therefore, the facial colors are condensed and do not disperse. The *Jin Gui Yao Lue* states: "When blood and qi enter the Zang, death ensues; when they enter the Fu, recovery occurs." This applies not to just one disease, but to all diseases alike. Diseases remaining exterior can be treated; those penetrating interior lead to death.
In men, color changes at the Mian Wang (tip of the nose) indicate lower abdominal pain, radiating downward to testicular pain. If the shape is round and straight, it indicates penile pain. The elevated part represents the root (Ben), and the lower part represents the head (Shou); this belongs to conditions like Hu Shan (fox hernia) and Yin swelling. In women, color changes at the Mian Wang indicate bladder and uterus diseases, manifesting as pain. Condensation (Tuan) signifies accumulation; the shapes—round, square, left, or right—correspond respectively to the color patterns. If the color extends downward to reach the Zhi (upper part of the philtrum), it indicates turbid discharge due to licentiousness; if it appears moist and paste-like, it results from gluttony and consumption of unclean food. Left-sided color indicates left-sided pathology; right-sided color indicates right-sided pathology. If the facial color carries evil qi, dispersing and gathering irregularly and lacking uprightness, these are the indications of facial diagnosis. ("Yuan" is synonymous with "Yuan" [round]; "Xie" is synonymous with "Xie" [slanting].)
This section discusses pathological colors caused by external factors appearing in the regions corresponding to the Fu organs, indicating that the disease resides in the Fu. Although the color may condense, it is not a sign of death. The area above the Mian Wang corresponds to the Small Intestine; the area below the Mian Wang corresponds to the Bladder and Uterus. Therefore, in men, color appearing at the Mian Wang indicates lower abdominal pain. If the shape is round and straight, it indicates penile pain. External pathogens enter from the outside inward, and their colors manifest from top to bottom. Thus, the high point is the root, and the low point is the leading edge of the pathogen's progression. The disease location is inferior, belonging to conditions like fox hernia and Yin swelling. In women, color appearing at the Mian Wang indicates bladder and uterus diseases. For both men and women, when pathology is dispersed in the Qi level, it manifests as pain; when condensed in the Blood level, it manifests as accumulation. Conditions like fox hernia and Yin swelling are tangible syndromes; their shapes—square, round, left, or right—correspond to the facial color patterns. Because the pathogen accumulates internally, condensed colors appear externally. A square shape yields a square color; a round shape yields a round color. This indicates pathology in the structural layers rather than the Zang organs; although there is condensed color, it is not a fatal color.
The Five Zang and Six Fu organs each have specific facial correspondences, distinguishing between interior and exterior. Understanding these regions and their internal-external correlations ensures accurate diagnosis and treatment. "Zhi" refers to the area below the Mian Wang. If the color at the Mian Wang extends downward to the Zhi, it primarily indicates turbid discharge syndromes. If the color appears moist and paste-like, it results from consuming excessive amounts of unclean food. The Fu organs are Yang and govern the exterior; they receive and digest food and fluids and transport waste. Therefore, whether affected by external wind-cold or internal dietary injury, the pathology affects the Fu organs, resulting in corresponding colors in the Fu regions. Color appearing on the left indicates left-sided pathology; color appearing on the right indicates right-sided pathology. The observed colors, whether condensed or dispersed, are slanted and not upright. Such condensed facial colors are what was previously described as being the size of a thumb.
If blood vessels transmit the pathogen, major evil entering the Zang leads to sudden death. Currently, Fu organ diseases manifesting as fox hernia or Yin swelling occur because the pathogen condenses to form an accumulation syndrome; thus, condensed colors appear, which is not a sign of death from Zang invasion.
The five colors are cyan, black, crimson, white, and yellow. When they appear upright and full, but distinct from their home region, a crimson color appearing in the "different region" (Bie Xiang), the size of a elm seed, located at the Mian Wang, indicates imminent death within a day.
This describes colors that are condensed, upright, and full, indicating major pathogenic qi entering the Zang, leading to sudden death. Cyan, yellow, crimson, white, and black are the colors corresponding to the Five Zang and Five Elements. "Bie Xiang" (different region) refers to areas not originally belonging to that organ; for example, the Small Intestine's region is at the Mian Wang, but the Mian Wang is actually the Bie Xiang of the Heart. The Gallbladder's region is on the left of the Liver, so the Gallbladder region is also the Bie Xiang of the Liver. The size of an elm seed refers to condensed color in the blood level, resembling the size of a thumb. "Bu Ri" means death occurring within the same day. This explains that the pathological color of the Five Zang appearing in its own region is a normal reflection; however, the death color of the Five Zang appears in the Bie Xiang. For instance, if the Heart is struck by external evil and dies suddenly, the color appears at the Mian Wang; if the Heart is diseased due to internal causes and dies suddenly, the color appears on the cheekbones. Neither of these is the Heart's proper region. Pathology in the Zang presents with upright and full colors without slanting; pathology in the Fu presents with slanted and non-upright colors. This distinguishes the prognosis of life and death between Zang and Fu.
Gao Shizong stated: The true Qi of the Zang is stored internally; when severed, it escapes outward through the Fu. Therefore, the color appears in the Fu regions.
If the color is sharp at the upper end and hollow/vacuous at the head, tilting upward; or sharp at the lower end and hollow/vacuous at the head, tilting downward; and similarly on the left and right sides according to these rules:
This elaborates on the morphology of upright versus slanted colors. "Rui" means sharp; "Kong" means vacuous. Colors moving upward are sharp at the top and vacuous at the head, floating and ascending. Colors moving downward are sharp at the bottom and vacuous at the head, floating and descending. Generally, when pathology moves from interior to exterior, the root is inferior and the branch is superior. When pathology moves from exterior to interior, the root is superior and the branch is inferior. Thus, the root is sunken and solid, while the head is vacuous and floating; this is the morphology of upright and full colors. If there is evil qi but it is not upright, the root is on the left and the head moves to the right; the root is on the right and the head moves to the left. All follow the method of being sharp at the ends and vacuous at the heads. This is the condensed color seen when pathology is in the Fu and forms an accumulation.
Zhu Yongnian stated: Elm seeds are sharp at both ends. Only the vacuous and floating parts reveal their sharp shape; the sunken root does not show its sharp shape. Hence, observing the floating and sinking of the color reveals the depth of the disease.
Assigning colors to Zang organs: Cyan corresponds to the Liver, Crimson to the Heart, White to the Lung, Yellow to the Spleen, and Black to the Kidney. The Liver harmonizes with tendons, the Heart with vessels, the Lung with skin, the Spleen with flesh, and the Kidney with bones.
This summarizes that each of the Five Zang possesses a specific color and has corresponding internal and external structural layers. The text previously mentioned crimson appearing on the cheekbones, black on the forehead, and crimson at the Mian Wang, representing the colors of the Heart and Kidney. By assigning colors to Zang organs, each Zang has its associated five colors. Regarding the shoulders, arms, chest, back, knees, shins, hands, and feet, each area corresponds to the skin, vessels, flesh, tendons, and bones harmonized with the Five Zang. Observing the five colors allows one to determine which internal Zang is diseased and which external structural layer is involved. This illustrates how the Five Zang internally harmonize with the Five Elements and externally manifest five colors. If the color changes result from external pathogens like wind, cold, summer-heat, or dampness, these are the manifestations of the Six Qi upon the complexion.
Ni Chongzhi stated: Disease within the Five Zang manifests externally as five colors. Evil attacking the external harmonized structures (skin, vessels, flesh, tendons, bones) penetrates internally into the Five Zang. This is the pathway of internal-external transmission.
According to the *Chuan Bing Zhang* (Chapter on Disease Transmission): "When blood vessels transmit the pathogen, major evil entering the Zang can cause death, but cannot generate life." The Emperor asked: "What happens when major atmospheric qi enters the Zang?" Bo Le replied: "If the disease originates in the Heart, it reaches the Lung after one day, and the Liver after three days." This is due to transmission via the blood vessels, hence originating in the Heart. However, if the pathogen strikes the skin layer and penetrates inward, it originates in the Lung. Pathogens entering step-by-step from the structural layers inward proceed from skin and hair follicles to muscle interstices, then to collaterals, then to meridians, then to the Fu and Zang organs. Thus, the external skin and vessels correspond to the internally harmonized Five Zang. Therefore, it is said that a person who shows no symptoms in the external structural layers may die suddenly, meaning the pathogen bypassed the external layers and entered directly into the Zang.