In Traditional Chinese Medicine (TCM), the practitioner uses visual observation to purposefully examine all visible signs of the human body and its excretions to understand health or disease status, a practice known as wang zhen (望诊).The content of wang zhen mainly includes: observing the patient’s spirit, color, shape, posture, tongue appearance, pulse, skin, and the conditions of the five senses, as well as excretions and secretions, including their form, color, and quality. Wang zhen can be divided into five categories: overall observation, local observation, tongue observation, excretion observation, and observation of children’s fingerprints.Tongue diagnosis and facial color diagnosis, although part of the five senses, reflect internal organ changes more accurately.This has high practical value.
1. Overall Observation
Overall observation involves understanding disease conditions by observing changes in the spirit, color, shape, and posture of the entire body.
(1) Observing Spirit
Observing spirit refers to examining the external manifestations of life activities in the human body, specifically the mental and functional state of the person. The term spirit encompasses both broad and narrow meanings: broadly, it refers to the external manifestations of life activities, essentially equating spirit with life; narrowly, it refers to mental activities, equating spirit with consciousness. Observing spirit should include both aspects. Spirit is a function based on the essence and qi, and is the external manifestation of the five organs. Observing spirit can reveal the vitality of the five organs and the severity and prognosis of the disease. Key observations should focus on the patient’s mental state, awareness, facial expressions, physical movements, and responsiveness, particularly the changes in the eyes. The content of observing spirit includes gaining spirit, losing spirit, and false spirit, as well as insufficient spirit and abnormal consciousness.
1. Gaining Spirit
Gaining spirit, also known as having spirit, is a manifestation of abundant essence and qi, indicating that although the patient is ill, the righteous qi remains intact, suggesting a mild condition and a good prognosis.
Manifestations of gaining spirit include: clear consciousness, coherent speech, a rosy and moist complexion, rich and natural expressions; bright eyes with inner vitality; quick responses, agile movements, and a relaxed posture; steady breathing, and well-toned muscles.
2. Losing Spirit
Losing spirit, also known as having no spirit, is a manifestation of depleted essence and qi, indicating a severe condition with a poor prognosis.
Manifestations of losing spirit include: lethargy, unclear speech, or a dazed state, groping for clothes or furniture, or collapsing with closed eyes and open mouth; a dull complexion, indifferent or stiff expressions; dull eyes and a vacant gaze; slow responses, awkward movements, and forced postures; weak or labored breathing; and significant muscle atrophy.
3. False Spirit
False spirit is a temporary improvement in the mental state of critically ill patients, a sign of impending death rather than a good omen.
Manifestations of false spirit include: a long-term ill person who has lost spirit suddenly appearing more spirited, with bright eyes and excessive chatter, wanting to see loved ones; or a patient whose voice, previously weak and intermittent, suddenly becomes loud; or a person whose complexion, previously dull, suddenly appears flushed; or a patient who had no appetite suddenly showing increased appetite.
The distinction between false spirit and genuine improvement lies in the suddenness of false spirit, where the “improvement” does not align with the overall condition, being only temporary and localized. Transitioning from no spirit to having spirit indicates a genuine improvement in the overall condition, which occurs gradually.
False spirit arises from extreme depletion of essence and qi, where yin fails to contain yang, leading to a temporary “improvement” that reveals the imminent separation of yin and yang, likened by ancient practitioners to a “flickering lamp” or “returning light”.
4. Insufficient Spirit
Insufficient spirit is a mild form of losing spirit, differing only in degree. It lies between having spirit and losing spirit, commonly seen in patients with deficiency syndromes.
Clinical manifestations of insufficient spirit include: lack of energy, forgetfulness, drowsiness, low voice, reluctance to speak, lethargy, and sluggish movements. This is often associated with deficiency of both heart and spleen, or insufficient kidney yang.
5. Abnormal Consciousness
Abnormal consciousness is also a manifestation of losing spirit, but fundamentally differs from losing spirit due to essence and qi depletion. It generally includes symptoms of restlessness, as well as conditions like epilepsy, mania, and other mental disorders. These are determined by specific pathological mechanisms and disease patterns, and their manifestations of losing spirit do not necessarily indicate the severity of the condition.
Restlessness refers to feelings of heat and agitation in the heart, with restless hands and feet. Restlessness differs from agitation; the former is a subjective symptom, while the latter is an objective symptom, such as mania or hyperactivity, often related to heat in the heart. It can be seen in conditions of internal heat, phlegm-heat disturbing the heart, or yin deficiency with excess heat.
Epilepsy manifests as apathy, reduced speech, unhappiness, mental dullness, and incoherent speech, often due to phlegm and qi stagnation obstructing the spirit, or due to the spirit not residing in the heart and spleen deficiency.
Mania often presents as wild outbursts, violent behavior, and incessant actions, with little sleep and no appetite, and may escalate to singing loudly or running away without clothes.
This is often due to liver qi stagnation transforming into fire, with phlegm-heat disturbing the spirit.
Seizures manifest as sudden loss of consciousness, drooling, and limb convulsions, returning to normal afterward. This is often due to liver wind with phlegm obstructing the clear orifices, or phlegm-heat disturbing the heart, triggering liver wind.
(2) Observing Color
Observing color involves the practitioner examining the patient’s facial color and luster. Color refers to hue changes, while luster refers to brightness changes. Ancient practitioners categorized colors into five types: green, red, yellow, white, and black, known as the five-color diagnosis. The areas for five-color diagnosis include both the face and the entire body, hence the terms facial five-color diagnosis and overall five-color diagnosis, but due to the most obvious changes in the face, facial color observation is often used to explain the content of five-color diagnosis.
When observing facial color, it is important to distinguish between normal and pathological colors.
1. Normal Color
Normal color refers to the facial complexion during a normal physiological state. Normal color can be further divided into primary and secondary colors.
(1) Primary Color
The primary color refers to the basic skin tone and facial color that does not change throughout a person’s life. Due to differences in ethnicity, constitution, and physique, each person’s skin tone is not entirely uniform. The people of China belong to the yellow race, and generally, their skin tone is slightly yellow, which ancient practitioners considered the correct color. Based on this, some individuals may have slight variations such as being slightly whiter, darker, or redder.
(2) Secondary Color
Secondary color refers to changes in facial and skin color due to variations in living conditions, corresponding to the natural environment. For example, with changes in seasons, day and night, and weather conditions, the facial color also changes. Additionally, variations in age, diet, lifestyle, temperature, and emotions can also cause changes in facial color, which are considered secondary colors.
In summary, normal color can be divided into primary and secondary colors, with the common characteristic of being bright and moist, subtly concealed.
2. Pathological Color
Pathological color refers to the facial color and luster of the body in a diseased state, which can be considered as any abnormal color outside of the normal colors mentioned above. Pathological colors include green, yellow, red, white, and black. The main diseases associated with the five colors are as follows:
(1) Green
Indicates cold syndromes, pain syndromes, blood stasis syndromes, convulsions, and liver diseases.
Green color indicates stagnation of the meridians, with qi and blood not flowing smoothly. Cold causes contraction and stagnation; when cold is severe and remains in the blood vessels, qi stagnates and blood stasis occurs, resulting in a green complexion. When the meridians are obstructed, pain can also present as green. Liver diseases often involve qi stagnation and blood stasis, which can also present as green. If the liver fails to nourish the tendons, it can lead to internal wind, hence convulsions (or the potential for convulsions) also present as green.
For example, a complexion that is dark green or pale blue often indicates internal excess of yin-cold; a grayish-green complexion with cyanotic lips often indicates blood stasis obstructing the heart, leading to poor blood circulation; in children with high fever, a cyanotic complexion, particularly around the nose, between the eyebrows, and around the lips, is a sign of impending convulsions.
(2) Yellow
Indicates dampness syndromes and deficiency syndromes.
Yellow color is a manifestation of spleen deficiency and damp accumulation. The spleen governs transformation and transportation; if the spleen fails to function properly, water and dampness cannot be transformed; or if the spleen is deficient, the essence of food cannot be transformed into qi and blood, leading to insufficient nourishment of the skin, resulting in a yellow complexion.
For example, a pale yellow and sallow complexion is termed “withered yellow,” often indicating spleen and stomach qi deficiency, where the nutrients cannot nourish the face; a yellow complexion that is swollen and floating is termed “yellow and puffy,” often indicating spleen deficiency with dampness accumulation; a bright yellow complexion resembling orange peel indicates yang jaundice, caused by damp-heat accumulation; a dark yellow complexion resembling smoke indicates yin jaundice, caused by cold-damp obstruction.
(3) Red
Indicates heat syndromes.
When qi and blood are heated, they flow vigorously, and when heat is excessive, the blood vessels become engorged, resulting in a red complexion.
Heat syndromes can be divided into excess and deficiency. In excess heat syndromes, the entire face appears red; in deficiency heat syndromes, only the cheeks are flushed. Additionally, if a patient in critical condition has a face that is red as if painted, it often indicates a yang deficiency, where the essence and qi are depleted, and yin fails to contain yang, leading to excessive yang rising.
(4) White
Indicates deficiency-cold syndromes and blood deficiency syndromes.
White color is a manifestation of weakness in qi and blood that cannot nourish the body. Insufficient yang qi leads to weak circulation of qi and blood, or excessive loss of qi and blood, resulting in a pale complexion.
For example, a pale and floating complexion often indicates insufficient yang qi; a pale complexion with emaciation often indicates deficiency of nutrients and blood; a pale complexion often indicates severe yang deficiency or excessive blood loss.
(5) Black
Indicates kidney deficiency syndromes, water retention syndromes, cold syndromes, pain syndromes, and blood stasis syndromes.
Black is the color of excess yin and cold. Due to kidney yang deficiency, water retention cannot be transformed, leading to internal excess of cold, and blood loses warmth, resulting in a dark complexion.
A dark and dry complexion often indicates long-term depletion of kidney essence, with deficiency fire scorching yin; dark circles around the eyes often indicate kidney deficiency with water retention; a dark complexion with severe pain often indicates cold stagnation and blood stasis.
(3) Observing Body Shape
Observing body shape involves examining the macro appearance of the body, including strength, fatness, thinness, body type characteristics, trunk, limbs, skin, muscles, and bones. The body’s structure is closely related to the five organs, so observing body shape can provide insights into the vitality of the internal organs. When internal vitality is strong, the external appearance is robust; when internal vitality is weak, the external appearance is frail.
Individuals with a strong physique typically exhibit large bones, a broad chest, strong muscles, and moist skin, reflecting sufficient vitality of the internal organs. Even if they are ill, their righteous qi remains intact, indicating a favorable prognosis.
Individuals with a weak physique often exhibit small bones, a narrow chest, thin muscles, and dry skin, reflecting insufficient vitality of the internal organs, making them prone to illness, and if they become ill, the prognosis is often poor.
Being overweight with little appetite indicates a condition of excess body and deficient qi, often with pale skin and lack of vitality. Such patients may also experience damp accumulation due to yang deficiency, leading to phlegm formation, hence the saying “overweight individuals often have dampness.”
If a person is thin with little appetite, it indicates spleen and stomach weakness. A thin body with dry skin and often accompanied by flushed cheeks, tidal fever, night sweats, and five-center heat indicates deficiency of yin and blood, with internal heat. In severe cases, extreme thinness may lead to a state of “extreme muscle loss,” where the patient is bedridden, indicating a critical state of internal organ vitality depletion.
(4) Observing Posture
Normal posture is comfortable and natural, with smooth movements and quick responses, where sitting, standing, walking, and lying down are all done as desired. In disease, due to the fluctuations of yin, yang, qi, and blood, posture may also exhibit abnormal changes, with different diseases producing different pathological postures. Observing posture mainly involves examining the patient’s static and dynamic postures, abnormal movements, and position changes related to the disease. For example, if a patient’s eyelids, face, lips, or fingers (toes) tremble frequently, in cases of external pathogens, this often indicates a sign of spasms; in cases of internal injuries or miscellaneous diseases, this often indicates blood deficiency and yin depletion, leading to insufficient nourishment of the meridians.
Convulsions or rigidity of the limbs, stiffness of the neck and back, and arching of the back are indicative of spasms, commonly seen in conditions of extreme heat generating internal wind, high fever in children, or heat entering the blood. Additionally, conditions like epilepsy, tetanus, and rabies can also cause spasms. Trembling is often seen during malaria attacks or as a sign of external pathogens and internal resistance. Weakness and lack of strength in the limbs, with difficulty in movement and no pain, indicate atrophy. Swelling or pain in the joints, leading to difficulty in limb movement, indicates obstruction. If the limbs are non-functional, numb, or rigid, or if they are weak, it indicates paralysis. If a person suddenly loses consciousness but continues to breathe, it often indicates a condition of syncope.
Pain syndromes also have specific postures. For example, if a patient protects their abdomen with their hands and leans forward while walking, it often indicates abdominal pain; if a patient protects their waist with their hands, keeping their back straight and having difficulty moving, it often indicates lower back pain; if a patient suddenly stops while walking, protecting their heart and hesitating to move, it often indicates true heart pain. Frowning and holding the head often indicate headache.
If a patient is bundled up in many clothes, they likely dislike cold and prefer warmth, indicating either exterior cold or interior cold; if a patient often wants to uncover their clothes, it indicates they dislike heat and prefer coolness, indicating either exterior heat or interior heat. If a patient bends their head and is sensitive to light, it often indicates eye diseases; if a patient tilts their head back and enjoys light, it often indicates heat diseases, with yang conditions preferring coolness and wanting to be around people; yin conditions prefer warmth and solitude, disliking noise.
From a sitting posture perspective, if a patient prefers to lean forward while sitting, it often indicates lung deficiency; if a patient prefers to lean back while sitting, it often indicates lung excess with qi counterflow; if a patient cannot lie down, as lying down causes qi counterflow, it often indicates cough and asthma due to lung distension or water retention in the chest and abdomen. If a patient cannot tolerate sitting but feels fatigued or dizzy when sitting, it often indicates deficiency of both qi and blood or excessive blood loss. If a patient does not want to get up from a sitting position, it often indicates yang deficiency. Restlessness in sitting or lying down is a sign of agitation or abdominal fullness and pain.
From a lying position perspective, if a patient often lies outward, can easily turn to the side, it indicates a yang condition, heat condition, or excess condition; conversely, if a patient prefers to lie inward, feels heavy and cannot turn, it often indicates a yin condition, cold condition, or deficiency condition; if a patient is so ill that they cannot turn themselves, it often indicates extreme depletion of qi and blood, with a poor prognosis. Curling up into a ball often indicates yang deficiency with cold or severe pain; conversely, lying flat with legs extended indicates a yang condition with excessive heat and aversion to heat.
Selected key points from the “Observational Diagnosis” to supplement the important aspects often overlooked in modern TCM observation diagnosis.
Outline of the Ten Methods of Observing Qi
In general, when observing, one should first divide the body into regions, then observe the qi and color. To understand the subtleties of the five colors, one must know the principles of the ten methods. The ten methods are: floating, sinking, clear, turbid, subtle, intense, scattered, concentrated, moist, and dry. What is meant by floating and sinking? Colors that are apparent on the skin are termed floating, while those hidden beneath the skin are termed sinking. Floating indicates a superficial disease, while sinking indicates an internal disease. Initially floating and then sinking indicates a disease that has progressed from the surface to the interior. Initially sinking and then floating indicates a disease that has progressed from the interior to the surface. This is how floating and sinking differentiate between superficial and internal conditions.
What is meant by clear and turbid? Clear refers to clarity and brightness, while turbid refers to dullness and darkness. Clear indicates a disease in the yang, while turbid indicates a disease in the yin. Transitioning from clear to turbid indicates a yang disease entering the yin, while transitioning from turbid to clear indicates a yin disease transforming into yang. This is how clear and turbid differentiate between yin and yang.
What is meant by subtle and intense? Colors that are light and faint are termed subtle, while those that are deep and rich are termed intense. Subtle indicates deficiency of righteous qi, while intense indicates excess of pathogenic qi. Transitioning from subtle to intense indicates a progression from deficiency to excess, while transitioning from intense to subtle indicates a progression from excess to deficiency. This is how subtle and intense differentiate between deficiency and excess.
What is meant by scattered and concentrated? Scattered indicates looseness, while concentrated indicates blockage. Scattered indicates a disease that is about to resolve, while concentrated indicates a disease that has been lingering and gradually accumulating. Initially concentrated and then scattered indicates a disease that, although chronic, is about to resolve. Initially scattered and then concentrated indicates a disease that, although acute, is gradually accumulating. This is how scattered and concentrated differentiate between chronic and acute conditions.
What is meant by moist and dry? Moist indicates a luster in the qi and color, while dry indicates a lack of luster. Moist indicates vitality, while dry indicates death. Transitioning from dry to moist indicates a revival of spirit, while transitioning from moist to dry indicates a decline in blood and qi. This is how moist and dry differentiate between life and death.
The ten methods are used to discern the quality of the color’s qi, while the five colors are used to discern the color’s qi. Qi is the change of color, while color is the constant of qi. Qi begins to clarify due to color, while color becomes evident due to qi. When viewed separately, the subtle principles become clear; when viewed together, the changes in disease symptoms become apparent. This is the outline of qi and color. The classics state that if the observation of qi is not subtle, one cannot discern right from wrong, and if one does not focus on the essence, one cannot know the new from the old.
General Principles of Yin and Yang Observation
Observing color in the bright hall, using the organs and their locations as the body, and using qi and color diagnosis as the method, one can distinguish the normal from the abnormal. By integrating these observations, one can understand the changes. However, to understand the normal and abnormal, one must not stray from the principles of yin and yang. Yin and yang are the principles of heaven and earth, the framework of all things, the parents of change, the source of life and death, and the abode of spirit. Therefore, when discussing the five colors, green belongs to the lesser yang, flourishing in spring; red belongs to the greater yang, flourishing in summer; white belongs to the lesser yin, flourishing in autumn; black belongs to the greater yin, flourishing in winter; yellow belongs to the central earth, corresponding to all seasons, flourishing in late summer. When discussing the six divisions, the external, upper, and left are all yang, while the internal, lower, and right are all yin. When discussing the ten methods, floating, clear, intense, and scattered are yang, while sinking, turbid, subtle, and dry are yin. Thus, when qi and color are observed together, and locations are mutually examined, yin and yang are interwoven, with yin within yang and yang within yin. This is the general principle of yin and yang.
Regarding the principles of yin and yang, yang is clear and yin is turbid; yang rises and yin descends; yang is hot and yin is cold; yang is active and yin is still; yang is external and yin is internal; yang is above and yin is below; yang is left and yin is right; yang is substantial and yin is insubstantial; yang is often in excess while yin is often deficient. Therefore, colors that appear in yang are easier to treat, while those appearing in yin are more difficult to treat. External pathogens causing yin diseases that show yang colors are easier to treat, while yang diseases showing yin colors are more difficult to treat. Internal injuries with yang diseases showing yin colors are easier to treat, while yin diseases showing yang colors are more difficult to treat. All these principles of yin and yang can be combined with qi and color, as well as with organ and disease symptoms for mutual verification. The Book of Changes states, “One yin and one yang is called the Dao; the unmeasurable yin and yang is called the spirit.” The Inner Canon states, “Those who gain spirit thrive; those who lose spirit perish.” The changes of yin and yang are unified.
Observational Methods Corresponding to the Four Seasons
When observing the differences in the five colors, one must also consider the changes in the four seasons. The classics state that spring qi resides in the meridians, summer qi in the collaterals, late summer qi in the muscles, autumn qi in the skin, and winter qi in the bone marrow. The internal and external qi are influenced by the seasons, and the floating and sinking of colors are influenced by the qi. Therefore, one can understand the floating and sinking of colors through the internal and external qi, and vice versa. When the floating and sinking are as described, what about the qi and color? It is said that heaven has five elements, dividing time and nurturing all things. In spring, the liver is strong, and its color should be green. If it is excessively floating and clear, it indicates an external disease; if it is subtle and turbid, it indicates an internal disease. Spring is based on moisture; in spring, the color is green. If the green is too much and lacks moisture, it indicates disease; if the green has no moisture, like grass, it indicates death. In summer, the heart fire is strong, and its color should be red. If it is excessively floating and clear, it indicates an external disease; if it is subtle and turbid, it indicates an internal disease. Summer is based on moisture; in summer, the color is red. If the red is too much and lacks moisture, it indicates disease; if the red has no moisture, like blood, it indicates death. In late summer, the spleen earth is strong, and its color should be yellow. If it is excessively floating and clear, it indicates an external disease; if it is subtle and turbid, it indicates an internal disease. Late summer is based on moisture; in late summer, the color is yellow. If the yellow is too much and lacks moisture, it indicates disease; if the yellow has no moisture, like bitter fruit, it indicates death. In autumn, the lung metal is strong, and its color should be white. If it is excessively floating and clear, it indicates an external disease; if it is subtle and turbid, it indicates an internal disease. Autumn is based on moisture; in autumn, the color is white. If the white is too much and lacks moisture, it indicates disease; if the white has no moisture, like dry bones, it indicates death. In winter, the kidney water is strong, and its color should be black. If it is excessively floating and clear, it indicates an external disease; if it is subtle and turbid, it indicates an internal disease. Winter is based on moisture; in winter, the color is black. If the black is too much and lacks moisture, it indicates disease; if the black has no moisture, like coal, it indicates death. In summary, if the colors of the four seasons are balanced, there is no disease; if they are unbalanced, it indicates disease, similar to how excessive pulse strength indicates an external disease, while insufficient pulse indicates an internal disease. However, observing colors at the appropriate time is normal, while observing colors at inappropriate times indicates change. Changes may appear earlier and then recede, indicating excess; or appear later and then recede, indicating deficiency. Excess indicates that the weak is overcome, while deficiency indicates that the strong is overwhelmed. In terms of generation and overcoming, colors that arise from time are considered deficient pathogens, while colors that arise from qi are considered excess pathogens. Colors that overcome time are considered thief pathogens, while colors that are overcome by time are considered subtle pathogens. When colors and time correspond, it indicates correct and incorrect pathogens. The appearance of the five colors can be compared and inferred. The time and day can also be analyzed according to the principles. There are three causes of disease, ten methods of qi and color, and they should be combined to understand their changes.
Day and Night Correspondence
Having discussed the differences between spring, summer, autumn, and winter, one must also understand the distinctions between day and night, as humans are influenced by the exchange of qi and the climate, much like shadows following the body or water reflecting shapes. Therefore, day is yang, with defensive qi circulating in the yang; night is yin, with defensive qi circulating in the yin. When the weather is warm during the day, the blood flows and the defensive qi rises; when the weather is cold during the day, the blood congeals and the defensive qi sinks. The interaction between blood, qi, and the defensive qi can be observed in the colors. The pulse corresponds to the moon, while the color corresponds to the sun. During the day, qi circulates in the yang, and the colors are visible, reflecting brightness; at night, qi circulates in the yin, and the colors are visible, reflecting moisture. When it is sunny, the qi is hot; when it is hot, the qi is moist; when it is moist, the colors are yellow and red; when it is cloudy, the qi is cold; when it is cold, the blood congeals; when it congeals, the colors are green and black. These are the responses of colors to day and night. Normal responses to day and night indicate health, while abnormal responses indicate disease. Many diseases worsen in the morning, improve during the day, worsen in the evening, and peak at night. The colors should correspond to the patient’s condition in the morning, during the day, in the evening, and at night. If the condition is lighter in the evening and heavier in the morning, or if it decreases at night and increases during the day, it indicates that the issue is not with the defensive qi but rather with the organ qi. The qi that is not overcome is the one that is excessive, while the qi that is overcome is the one that is deficient. The day is divided into four seasons, and each season corresponds to the five organs: the liver corresponds to the day of Jia and Yi, during the hours of Yin and Yang; the heart corresponds to the day of Bing and Ding, during the hours of Si and Wu; the lung corresponds to the day of Geng and Xin, during the hours of Shen and You; the kidney corresponds to the day of Ren and Gui, during the hours of Hai and Zi; the spleen corresponds to the day of Wu and Ji, during the hours of Xu and Chou. By correlating the days and times of the five organs with their corresponding colors, one can understand the principles of generation and overcoming, as well as the timing of life and death. However, within a single day, there may be imbalances in temperature and humidity, leading to variations in responses. Additionally, the conditions of the environment, such as temperature and humidity, can also affect the severity of diseases and the appearance of colors. Although not strictly governed by day and night, these factors can still be observed in terms of yin and yang.
Correspondence of the Five Directions
Humans are endowed with this body, originating from heaven and nourished by earth, receiving essence and qi to form their shape, and relying on yin and yang to fulfill their destiny. However, heaven and earth have five distinct directions, and thus the qi transforms into five different elements. The climate and terrain influence these transformations, leading to variations in qi and color. The classics state that people from the east tend to have a green complexion, those from the south tend to have a red complexion, those from the west tend to have a white complexion, those from the north tend to have a black complexion, and those from the center tend to have a yellow complexion. This is the correspondence of colors. However, correspondence indicates normal colors, while non-correspondence indicates abnormal colors. Whether normal or abnormal, if there is no excess or deficiency, it indicates a balanced color; if there is excess or deficiency, it indicates a pathological color. In summary, heaven encompasses the earth, and the earth is within heaven. When the qi of heaven overcomes the qi of earth, it is considered harmonious; when the qi of earth overcomes the qi of heaven, it is considered discordant. The appearance of the five colors may not align with the correct colors of the five directions, but may correspond to the balanced colors of the four seasons, indicating health. When the qi of heaven and earth is in harmony, it nurtures all things. If the colors do not align with the four seasons, but correspond to the symptoms of the pulse, it indicates a favorable condition; if they do not align with the four seasons and correspond to symptoms that conflict with the pulse, it indicates an unfavorable condition. The variations in the five colors can be compared and observed. Analyzing the terrain, the elevation and depression of the land, the climate can be cold or warm, and the terrain can be dry or moist, leading to variations in qi and color. Therefore, the strong individuals from solid earth are often robust, while the weak individuals from soft earth are often gentle. Those from clay soil are often large, while those from sandy soil are often delicate. Those from fertile soil are often beautiful, while those from barren soil are often unattractive. Mountain dwellers are often rough and square, as they receive abundant wood qi; those from river valleys are often dark and moist, as they receive abundant water qi; those from hilly areas are often slender and tall, as they receive abundant fire qi; those from burial mounds are often pale and thin, as they receive abundant metal qi; those from plains and marshes are often plump, as they receive abundant earth qi. Observing their appearance and color, those who are close may show slight differences, while those who are far may show significant differences, all of which can be understood through the influence of climate on their color and pulse.
Correspondence of Age
The inability of colors to be consistent is due to variations in qi and constitution, and there are also distinctions between the young and the old. In youth, blood and qi are abundant, muscles are smooth, the pathways are open, and the circulation of qi and blood is rapid. In old age, blood and qi decline, muscles become withered, the pathways become obstructed, and the circulation of qi and blood slows. Therefore, the colors of the elderly often appear sallow, while the colors of the young often appear moist and vibrant. The classics state that at ten years of age, the five organs begin to stabilize, and blood and qi become connected, leading to a preference for running; at twenty years of age, blood and qi begin to flourish, and muscles begin to grow, leading to a preference for walking; at thirty years of age, the five organs are well established, muscles are firm, and blood vessels are full, leading to a preference for walking; at forty years of age, the five organs, six bowels, and twelve meridians are all flourishing, and the body stabilizes, leading to a loosening of the pores, a decline in vitality, and graying hair; at fifty years of age, liver qi begins to decline, liver lobes begin to thin, bile production begins to decrease, and vision begins to deteriorate; at sixty years of age, heart qi begins to decline, leading to increased worry and sadness, and blood and qi become sluggish, leading to a preference for lying down; at seventy years of age, spleen qi becomes deficient, leading to dry skin; at eighty years of age, lung qi declines, leading to a separation of the soul; at ninety years of age, kidney qi becomes exhausted, leading to emptiness in the five organs and meridians; at one hundred years of age, all five organs are deficient, and the spirit departs, leaving only the body to end its journey. Generally, before fifty, the five organs support growth, while after fifty, the five organs decline. This is the natural order of life. However, some individuals may be old yet still robust, while others may be young yet frail. Despite differences in strength and weakness, there are also variations in vitality. In summary, those who are strong internally will show externally, while those who are weak internally will show externally. Therefore, by observing the changes in color and shape, one can understand the vitality of the internal organs. The shape and color of the organs are akin to the roots and branches of a tree, reflecting the differences between the young and the old.
Integration of the Five Colors and Ten Methods
The methods of observation involve the interplay of the five colors, as previously described, and the integration of the ten methods will be discussed later. By examining the qi and color, one can discern the relationships of generation and overcoming, thus understanding the nature of the disease and its symptoms. By integrating the method of floating and sinking, one can understand the internal and external nature of the disease; by integrating the method of clear and turbid, one can understand the yin and yang nature of the disease; by integrating the method of subtle and intense, one can understand the deficiency and excess nature of the disease; by integrating the method of scattered and concentrated, one can understand the proximity of the disease; by integrating the method of moist and dry, one can understand the success or failure of the disease. Furthermore, when considering the colors, for example, if the color is red, it indicates heat; if it is slightly red, it indicates deficiency heat; if it is intense red, it indicates excess heat; if it is slightly red and floating, it indicates deficiency heat on the surface; if it is slightly red and sinking, it indicates deficiency heat internally; if it is intensely red and floating, it indicates excess heat on the surface; if it is intensely red and sinking, it indicates excess heat internally. If one further integrates the clear and turbid methods, one can understand the organ involvement in the disease. By integrating the scattered and concentrated methods, one can understand the severity of the disease. By integrating the moist and dry methods, one can understand the prognosis of the disease. All five organs and six parts, along with the four seasons and five colors, can be intricately observed together. In this way, the transmission and transformation of diseases become evident. However, the complexity of disease conditions and the subtlety of observation methods may sometimes lead to hidden symptoms in one area while being evident in another. Therefore, it is essential to integrate pulse diagnosis and symptoms, cross-reference with sounds, and conduct thorough inquiries to accurately determine the disease.