Jin Kui Yao Lue
The Jin Kui Yao Lue is a section of the Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases) written by the famous Eastern Han physician Zhang Zhongjing. It is also the earliest existing specialized book in China discussing the diagnosis and treatment of miscellaneous diseases. The Jin Kui Yao Lue contains both foundational theories of Traditional Chinese Medicine (TCM) and clinical characteristics. Studying the Jin Kui Yao Lue plays a unique role in broadening clinical thinking and enhancing the ability to analyze and treat difficult diseases, making it an essential classical text for learning TCM.
【Original Text】
Question: When a patient is ill, the color of their face changes. I would like to hear your thoughts on this. Teacher: If the tip of the nose is blue, and there is abdominal pain with a strong aversion to cold, the patient is likely to die; another saying is that if there is abdominal cold and pain, the patient is likely to die. If the tip of the nose is slightly black, there is water retention; if the color is yellow, there is cold in the chest; if the color is white, it indicates blood loss; if there is slight redness out of season, the patient is likely to die; if the eyes are perfectly round, it indicates convulsions, which are difficult to treat. Additionally, blue indicates pain; black indicates exhaustion; red indicates wind; yellow indicates difficulty in defecation; and bright colors indicate water retention. (Three)
【Notes】
① Water retention: A disease name indicating the accumulation of water in the body.
② Water retention: A disease name belonging to phlegm and fluid diseases, see the section on Phlegm and Cough Diseases in this book.
【Translation】
Question: “When a person is ill, their facial color changes accordingly. Could you elaborate on this?”
Teacher replied: “The nose is the ‘king of the face’, corresponding to the central spleen and earth. Therefore, the nose is the most important area for facial diagnosis. The liver corresponds to the color blue; if the tip of the nose appears blue, it indicates that the liver is overpowering the spleen, generally leading to abdominal pain; if there is also a strong aversion to cold, it indicates spleen yang deficiency, with excess yin and cold, suggesting a critical condition and poor prognosis. Black is the color of the kidney; if the tip of the nose appears slightly black, it indicates that kidney water is counteracting the spleen, suggesting water retention. Yellow corresponds to the spleen; if the face appears yellow, it indicates that spleen yang is not functioning, leading to dampness and fluid accumulation, suggesting cold and dampness in the chest. If the face appears pale, it indicates excessive blood loss, as the blood color cannot nourish the face, thus indicating blood loss; if a person with blood loss shows slight redness and it is not during the hot season, it indicates the loss of yin blood and the floating of deficient yang, generally suggesting a poor prognosis. If the eyes are wide open and cannot move, it indicates convulsions, which are difficult to treat.”
“Furthermore, if the face appears blue, it indicates excess cold and blood stasis, generally indicating pain; if the face appears black, it indicates kidney deficiency, commonly seen in exhaustion; if the face appears red, it indicates wind-heat transformation, commonly seen in wind-heat syndrome. If the face appears yellow, it indicates stagnation of spleen dampness and heat accumulation, generally leading to difficulty in defecation. If the face is swollen and has a bright color, it indicates water retention, rising to the head and face, thus indicating water retention.”
【Summary】
This article discusses diagnosing diseases and predicting prognosis through facial color observation.
【Selected Notes】
Especially in Jing: This differentiation of facial color is what is meant by ‘knowing by observation’. The tip of the nose corresponds to the spleen; blue is the color of the liver. Abdominal pain indicates that the earth is being harmed by wood; if cold is present, yang is lost and cold water assists evil, thus leading to death. The kidney governs water, and black is the color of water; if the nose appears black, it indicates water retention. Yellow indicates a yellow face, which is a disease of the spleen; if the spleen is diseased, it leads to fluid accumulation, thus indicating cold in the chest. Cold indicates cold fluid. White also indicates a pale face; blood loss does not nourish the color, thus appearing white. If blood is lost, yang cannot rise; if slight redness appears out of season, it indicates floating deficient yang, leading to death. If the eyes are perfectly round, it indicates the end of yin; convulsions are a strong wind disease, with yin exhausted and yang strong, thus difficult to treat. Pain indicates blood stagnation and does not flow, thus appearing blue; exhaustion harms the kidney, thus appearing black; as the classics say, ‘those with kidney deficiency have a face like lacquered wood’. Wind is a yang evil, thus appearing red. Spleen disease does not function, leading to difficulty in defecation. Bright colors indicate water retention; as the classics say, ‘patients with water retention have dark circles under their eyes and a bright complexion.’
The Yi Zong Jin Jian: The observation of facial color to know life and death is based on the five qi entering the nose and being stored in the five organs, with their essence externally nourishing the face. When the qi and color are harmonious, there is vitality; when the color is pale or deep, and the qi is either clear or obscure, it indicates the patient’s condition. The classics say: ‘Blue like a peacock feather, red like a rooster’s comb, yellow like a crab’s belly, white like pig fat, black like bird feathers indicate life.’ When the qi and color are discordant, the color may be dull or bright, and the qi may be evident or obscure, indicating the patient’s condition. The classics say: ‘Floating luster is external, while turbid is internal; observe the floating and sinking to know the depth; observe the luster to see success or failure; observe the dispersion and gathering to know the new or old; observe the color above and below to know the location of the disease; coarse color indicates clarity; turbid and dull indicates severity; unclear and dull indicates less severity. A color without qi indicates a dry and dull color, which is the color of death. The nose is the bright hall; if the bright hall is luminous, there is no disease. It is said that blue indicates abdominal pain, and if the nose is extremely cold, the patient will die; black indicates water and exhaustion; yellow indicates cold above and heat below, with difficulty in urination; bright face indicates internal water retention; white indicates blood loss; red indicates heat and wind; if seen in winter, it is out of season and the patient will die; if the eyes are straight and round and do not move like fish eyes, it indicates convulsions and is difficult to treat. This facial color indicates the general condition of the disease, and all details are recorded in the Nei Jing.
【Analysis】
The nose corresponds to the spleen; blue is the color of the liver. If the nose appears blue, it indicates that the liver is overpowering the spleen, which can lead to abdominal pain; if there is also a strong aversion to cold, it indicates yang deficiency and a poor prognosis. Black is the color of the kidney; if the nose appears slightly black, it indicates that kidney water is counteracting the spleen, suggesting water retention. Yellow corresponds to the spleen; if the face appears yellow, it indicates insufficient central yang, leading to stagnation of dampness and fluid accumulation, affecting the chest; if the face appears white, it indicates that blood color cannot nourish the face, commonly seen in blood loss; if a person with blood loss shows slight redness and it is not during a hot season, it indicates the loss of yin blood and the floating of deficient yang, suggesting a poor prognosis; if the eyes are perfectly round and cannot move, it indicates the loss of essence and qi, unable to nourish the face, commonly seen in critical convulsive diseases. Blue indicates stagnation of blood vessels, thus the face appears blue, indicating pain; black indicates kidney deficiency, and the color is exposed, thus the face appears black; wind is a yang evil, often transforming into fire, thus the red color indicates wind. Yellow corresponds to the spleen; if the spleen is not functioning, it can lead to difficulty in defecation; bright colors indicate internal water retention, rising to the face, resulting in facial swelling and a bright, moist appearance. The term ‘death’ or ‘difficult to treat’ often indicates that the disease has reached a critical stage, not an absolute indication of untreatability.
Each of the five organs has its corresponding color, and each has its respective observation area on the face. When observing the face, one should examine the color of each area, as well as the shape and dynamics, integrating the four examinations to comprehensively understand the condition for diagnosis. Regarding the yellow color indicating cold in the chest and difficulty in defecation, the Yi Zong Jin Jian considers yellow to indicate cold above and heat below, with difficulty in urination; the Jin Kui Ji Shi considers that yellow facial color can indicate two situations: spleen deficiency with fluid retention and pale yellow face; or damp-heat accumulation with stagnation of spleen qi, leading to bright yellow and difficulty in defecation.
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