OBSERVATION OF THE COMPLEXION COLOUR

Published on 22/06/2015 by admin

Filed under Complementary Medicine

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 2094 times

Chapter 3

imageOBSERVATION OF THE COMPLEXION COLOUR

INTRODUCTION

The colour and lustre of the complexion are the outward manifestations of the internal organs and of Yin, Yang, Qi and Blood. If the internal organs function normally and if Yin, Yang, Qi and Blood are abundant and balanced, the complexion will have normal colour and proper lustre; conversely, when Qi, Blood, Yin and Yang are weakened and the internal organs affected, the complexion acquires an abnormal colour.

The chapter ‘On observation of the colour’ in ‘Principle and Prohibition for the Medical Profession’ (Yi Men Fa Lu) says: ‘When the five Yin organs are exhausted, the complexion colour becomes dark and lustreless … So the complexion colour is like a flag of the Spirit, and the Yin organs are the residences of the Spirit. When the Spirit is gone, the Yin organs are worn out, and the complexion colour becomes dark and lustreless.’1 As the above passage indicates clearly, observation of complexion colour is a very important diagnostic tool to assess the condition not only of Qi, Blood, Yin and Yang and of the internal organs, but also of the Mind and Spirit. Indeed from a Five-Element perspective, the facial complexion as a whole is a manifestation of the Heart and therefore the Mind and Spirit; this should never be forgotten in practice. Thus, if a woman has a very dull, sallow complexion it does indicate a Spleen-Qi deficiency and Dampness and possibly also Blood deficiency, but, at the same time, it also indicates that the Mind and Spirit are affected and suffering.

Yu Chang in ‘Principles of Medical Practice’ (1658) calls the complexion the ‘banner of the Mind and Spirit’ and he says: ‘When the Mind and Spirit are flourishing, the complexion is glowing; when the Mind and Spirit are declining, the complexion withers. When the Mind is stable the complexion is florid …’.2

The normal complexion should have ‘lustre’ and ‘moisture’. ‘Lustre’ means that the complexion colour should be bright, glowing and with a shine to it; ‘moisture’ means that the complexion should look moist and the skin firm, indicating that there is moisture underneath it. There is a correspondence between these two aspects of the complexion and two of the attributes of the normal pulse: the lustre of the complexion corresponds to the spirit of the pulse, whereas the moisture of the complexion corresponds to Stomach-Qi of the pulse. Thus, we can say that if the complexion has lustre there is spirit; if it has moisture there is Stomach-Qi.

Observation of the complexion must be closely linked to the feeling of the pulse. The pulse shows the state of Qi, the complexion the state of the Mind and Spirit. If the pulse shows changes but the complexion is normal, this indicates that the problem is recent. If both the pulse and the complexion show pathological changes, this indicates that the problem is long standing.

The lustre of the complexion should also be checked against the lustre of the eyes. A change in the complexion always indicates a deeper or more long-standing problem. For example, a sustained period of overwork and inadequate sleep may cause the eyes to lack lustre (and the pulse to be Weak); if the complexion has not changed, this is not too serious and the person can recover easily by resting. If, however, the eyes lack lustre and the complexion is dull, without lustre, or dark, it indicates that the problem is not transient but deeper rooted.

Thus, in terms of time scale, the pulse changes first, the eyes second and the complexion last. Accordingly, if the pulse is affected but the eyes and the complexion are not, the problem is very recent; if pulse and eyes are affected (lacking in lustre), the problem is older (some months); if the pulse, eyes and complexion are all affected, the problem is even older (over 1 year).

DOMINANT AND GUEST COLOURS

Dominant colours

The normal complexion colour varies, of course, according to racial group but also according to Elemental types as described in Chapter 1. Wood types have a subtle greenish hue to their complexion, Earth types a subtle yellowish hue, Fire types a red hue, Metal types a white hue, and Water types a dark hue.

Therefore, the normal complexion colour is determined by race and prenatal influences and, in health, remains the same throughout life. In disease, the complexion colour becomes pathological and will vary, obviously according to the racial group, but also according to Element type; for example, a pathological yellow colour in someone of the Wood type will be subtly different from that in someone of the Fire type. Such differences in pathological colours are, of course, even more evident in different racial groups; for example, the paleness of a Caucasian patient will differ from that of an Asian patient.

The basic inherited complexion colours, determined by race and Elemental type, are called ‘dominant colours’. The chapter ‘Keys to the Four Diagnostic Methods’ in the ‘Golden Mirror of Medicine’ (Yi Zong Jin Jian) says: ‘The colours of the five Yin organs manifest in people according to their body shape based on the Five Elements. Such colours never change throughout life. They are known as dominant colours.’3

In addition, there are other factors related to environment and season which influence the complexion colour. Environmental conditions and lifestyle have an important influence on complexion colour so that what is a normal complexion colour for one person may not be so for another, even within the same racial group and Element type; this should be taken into account when diagnosing patients. For example, the normal complexion of a farmer who spends most of his life outdoors will obviously be different from that of an office worker: inevitably, the farmer’s ‘normal’ complexion will be redder than the office worker’s.

Chapter 12 of the ‘Simple Questions’ discusses environmental influences on the complexion:

Obviously, the geographical references in the above passage refer to China and the dietary references refer to ancient China: however, the principle that the environment influences the complexion colour is still valid.

Box 3.1 summarizes the dominant colour.

BOX 3.1   DOMINANT COLOURS

Guest colours

‘Guest’ colours are those appearing on the Connecting channels of the face and limbs. The colours of the Yin Connecting channels follow those of the Main channels; that is, if the Main channels manifest with red colour, the Yin Connecting channel will also manifest with a red colour. The Yang Connecting channels are on the Yang surfaces and, being more superficial, they are more readily influenced by seasonal factors. Thus, the complexion may assume a certain colour owing to the seasonal and climatic influence on the Yang Connecting channels and such colour may contradict what one might expect from the Element type or pathological condition. For example, a patient with a pathological condition of the Heart (such as Heat) should have a reddish complexion; if the seasonal and climatic influence (e.g. spring) on the Yang Connecting channels predominates then the complexion may instead be greenish. This is called ‘guest’ colour and we should be able to recognize it in order to explain the anomaly.

Chapter 57 of the ‘Simple Questions’ says:

The Yellow Emperor asks: ‘The Connecting channels are exposed to the exterior and manifest with five different colours which are green, yellow, red, white and black. What is the reason?’ Qi Bo answers, ‘The main channels have their regular colours, but the colours of the Connecting channels change according to the four seasons.’ The Yellow Emperor asks, ‘What are the normal colours of the main channels?’ Qi Bo answers, ‘Red for the Heart, white for the Lungs, green for the Liver, yellow for the Spleen and black for the Kidneys.’ The Yellow Emperor asks, ‘Do the colours of the Yin and Yang Connecting channels correspond to the regular colours of the related main channels?’ Qi Bo answers, ‘The colours of the Yin Connecting channels correspond to the regular colours of their related main channels, while those of the Yang connecting channels change in accordance with the four seasons. In cold weather, the circulation of Qi and Blood slows down and there is often a green or black colour. In warm and hot weather, Qi and Blood circulation is free and smooth, and there is usually a yellow or red colour. All these are normal phenomena, indicating the body is in a normal condition.’5

When the above passage talks about the ‘normal colours of the main channels’, it refers to the five main pathological colours of the face which are produced by the influence of the main Yin channels. For example, a pathological condition of the main channel of the Heart may produce a reddish complexion (of course this is seen strictly from a Five-Element point of view as, for example, Heart-Blood deficiency would manifest with a pale rather than red complexion). The passage then explains that, while the colour of the Yin Connecting channels accords with the predominant face colour, that of the Yang Connecting channels is influenced by the seasons and climate. Bearing in mind that the limbs are richly supplied by the Yang Connecting channels, one needs to observe the colour of the limbs as well as the face to gauge the seasonal influence of these channels. Such colours, compared with those deriving from racial group and Elemental type, are temporary and reversible and are known as the ‘guest colours’, which are not pathological.

It is important to differentiate between ‘guest colours’ due to environmental and climatic influences and actual abnormal colours due to pathological conditions.

Clinical significance

Observation of the complexion colour and lustre helps us to determine the pathology, location, nature and prognosis of a disease. When observing the complexion colour, attention should be paid to distinguishing the dominant colours, the guest colours and the abnormal colours. It is, of course, necessary to refer to the pulse, tongue and symptoms and also to take into account the patient’s Element type.

For example, if someone of the Wood type has a slightly greenish complexion, this is in keeping with that type; if this person’s complexion develops a reddish tinge (perhaps a superficial redness over the underlying greenish colour) during the summer, this is a ‘guest’ colour and is also normal. However, if the same person’s complexion is very red and ‘deep’ (see below), it indicates not a ‘guest’ colour but a pathological condition of Heat.

Box 3.2 summarizes guest colours.

BOX 3.2   GUEST COLOURS

OBSERVATION OF DIFFERENT ASPECTS OF COMPLEXION COLOUR

The main aspects of complexion colour to observe are:

Superficial or deep colour

Observation

The differentiation between superficial and deep colour is based on the ‘depth’ of the complexion’s colour. A colour is defined as ‘superficial’ (see Plate 3.1 on p. P2) when it is seen clearly on the surface of the complexion, while it is defined as ‘deep’ when it appears to be on a level below the surface (see Plate 3.2 on p. P3).

Chapter 49 of the ‘Spiritual Axis’ says: ‘The five colours are present in certain areas of the face. Recognizing whether the colours are superficial or deep helps us to understand the shallow or deep location of the pathogenic factors.’6 The chapter ‘Keys to the Four Diagnostic Methods’ in the ‘Golden Mirror of Medicine’ (Yi Zong Jin Jian) says:

The chapter ‘Outline of the Ten Methods for Recognizing Qi’ of ‘Wang Zhen Zun Jing’ says:

Clinical significance

If the abnormal complexion colour is superficial and light, it indicates that the disease is mild and is located in the Exterior or in the Yang organs. It can be easily treated, and the prognosis is good. If the abnormal complexion colour is dark and deep, it means that the disease is severe and is located deep in the Interior or in the Yin organs. The treatment is relatively difficult, and the disease cannot be cured within a short time.

Chapter 15 of the ‘Simple Questions’ says:

If there are changes of the colours in the upper, lower, left and right regions of the face, efforts should be made to understand the location and prognosis of the diseases indicated by the respective colours. If the abnormal colour is light, it implies that the diseases are mild. Such patients can be treated with soups to nourish the body. They will recover in 10 days. If the abnormal colour is deep, it indicates that the disease is severe. Such patients should be treated with a herbal decoction. They will recover in 21 days. If the abnormal colour is even deeper, it means that the disease is much more severe. They must be treated with a herbal tincture to regulate the circulation in the channels. They will recover in 100 days. If the colour of the complexion is dark, haggard, vigourless and emaciated, it shows that the Spirit is gone, the disease cannot be treated and such patients will die in 100 days.9

Box 3.3 summarizes superficial and deep colour.

BOX 3.3   SUPERFICIAL OR DEEP COLOUR

Distinct or obscure colour

Observation

The differentiation between a ‘distinct’ or ‘obscure’ colour refers to the quality of the complexion colour: a distinct colour is bright and clear and manifests itself readily while an obscure colour is darkish, dull and lifeless as if ‘trapped’ inside the complexion. It is important to note that the differentiation between the distinct colour and the obscure colour of the complexion applies to any shade of pathological colour and both the distinct and obscure colours are abnormal; for example, a pathological, dull, yellow complexion may be either ‘distinct’ or ‘obscure’ (see Plates 3.3 and 3.4 on p. P3).

The chapter ‘Outline of Ten Methods for Recognizing Qi’ of ‘Wang Zhen Zun Jing’ says:

Clinical significance

If an abnormal complexion looks distinct and bright, it indicates that the disease is of the Yang type, the location of the disease is superficial and the Upright Qi is not exhausted yet. If an abnormal complexion colour looks dark and obscure, it indicates that the disease is of the Yin type, the location of the disease is deep in the Interior, the Upright Qi is deficient and the disease is severe.

If in the course of a disease the complexion colour changes from distinct to obscure, it indicates that the disease is progressing from the Yang to the Yin organs, which is a poor sign. If it changes from obscure to distinct, it indicates that the disease is progressing from the Yin to the Yang organs, which is a good sign.

In treatment, for patients with an abnormal but distinct complexion colour, the emphasis of the treatment should be on eliminating pathogenic factors. For patients with an abnormal but obscure complexion colour, equal emphasis should be put on eliminating pathogenic factors and strengthening the Upright Qi.

Box 3.4 summarizes distinct and obscure colours.

BOX 3.4   DISTINCT OR OBSCURE COLOUR

Scattered or concentrated colour

Observation

When considering abnormal complexion colours, another differentiation is that between ‘scattered’ and ‘concentrated’. The scattered colour is thinly distributed and sparse, while the concentrated colour is densely distributed and aggregated (see Plates 3.5 and 3.6 on p. P3).

Chapter 49 of the ‘Spiritual Axis’ says: ‘The observation whether the colour is scattered or concentrated tells us whether the disease is a long way off or imminent.’11

The chapter ‘Outline of ten methods for recognizing Qi’ in ‘Wang Zhen Zun Jing’ gives a different interpretation of the clinical significance of the scattered or concentrated colours:

Thin or thick colour

Lustrous or lustreless colour

Clinical significance

If an abnormal complexion colour is lustrous, it denotes that the Spirit is not affected, pathogenic factors are not too strong, the condition is mild, the treatment relatively easy and the prognosis good. If an abnormal complexion colour is lustreless, it indicates that the Spirit has been affected, pathogenic factors are relatively strong, the Upright Qi is very deficient, the condition is severe, the treatment relatively difficult and the prognosis poor.

Chapter 49 of the ‘Spiritual Axis’ says: ‘Observation of the lustre or lack of lustre of the complexion colour allows us to judge whether the prognosis is good or bad.’13

If an abnormal colour of complexion acquires lustre, this indicates that the condition is improving, Upright Qi is returning, the Spirit is recovering and the prognosis is good; vice versa, if an abnormal lustrous colour of the complexion loses its lustre, this indicates that the Spirit is affected, the condition is worsening, Upright Qi is weakening and the prognosis is poor.

Box 3.7 summarizes lustrous and lustreless colour.

BOX 3.7   LUSTROUS OR LUSTRELESS COLOUR

Conforming or opposing colour

Observation

The differentiation between a ‘conforming’ colour and an ‘opposing’ colour is based on two distinct aspects: the first is whether the complexion colour accords with the prevailing disharmony; the second is whether the complexion colour accords with the prevailing disharmony according to the Five Elements and specifically according to the Generating and Overacting cycles.

Conforming or opposing colour according to pattern

According to the first aspect, a ‘conforming’ colour is in accordance with the condition of the patient; for example the patient has a Heat pattern and the complexion is red. An ‘opposing’ colour contradicts the patient’s prevailing pattern; for example the patient has a clear Heat pattern but the complexion is pale. There can be several different explanations of a contradiction between the prevailing disharmony and the complexion colour, as follows:

• The complexion colour may contradict the main disharmony simply because the patient suffers from several different patterns and the complexion reflects one of them. For example, it would not be unusual for a person to suffer from chronic Spleen-Qi deficiency and therefore have a dull, pale-yellowish complexion but also to suffer from Heart-Fire.

• The complexion colour is influenced by seasonal influences; thus, a person may have a reddish complexion in the summer but suffer from chronic Spleen-Qi deficiency.

• The complexion colour strongly reflects the state of the Mind and Spirit and it may occasionally contradict the prevailing pattern. For example, a person may suffer from Liver-Fire but if this developed from the accumulated stagnant Qi deriving from deep emotional problems such as shock and guilt, the complexion may not be red but pale-bluish or greenish. In such cases, the complexion usually shows the deep, underlying emotional cause of the disharmony.

• In rare cases, there may be a ‘false’ complexion colour when there is a total separation of Yin and Yang and the patient suffers from ‘false Yang’ (red face, very cold limbs and slow pulse) or from ‘false Yin’ (very pale face, feeling of heat and red tongue).

Conforming or opposing colour according to the Five Elements

According to the second aspect, the conforming or opposing complexion colour is also decided on the basis of the Five Elements and one can distinguish four different situations when the complexion does not accord with the prevailing Element pattern. A practical example is the best way of describing these four possible situations. If a patient suffers from a Liver pattern but the complexion reflects the colour of the Mother Element (i.e. Water), this is called ‘conforming colour’; if the complexion reflects the colour of the Child Element (i.e. Fire) this is called the ‘slightly opposing colour’ (Chinese books refer to it as ‘opposition within conformity’); if the complexion reflects the colour of the Element overacted upon (i.e. Earth) this is called ‘opposing colour’ (Chinese books refer to it as ‘conformity within opposition’); if the complexion reflects the colour of the Element overacting on that of the prevailing pattern (i.e. Metal) this is called ‘strongly opposing colour’ (Table 3.1). The last scenario (i.e. when the complexion colour belongs to the Element that overacts on the Element of the prevailing pattern) is the most serious one. For example, if a patient suffers from a severe Spleen-Qi deficiency (Earth) but the complexion is green (Wood), this is a bad sign and it means that the condition will be more difficult to treat.

The conforming and opposing colours for diseases of the Five Elements are illustrated in Figures 3.1–3.5.

Clinical significance

The differentiation between a conforming or an opposing colour, whether according to pattern or the Five Elements, helps us to gauge the severity of the disease, the relative strength of pathogenic factors and Upright Qi and therefore the prognosis. If the complexion colour conforms with the disease condition, it indicates that the disease is mild, pathogenic factors are not strong, Upright Qi is still relatively intact, the treatment will be relatively easy and the prognosis is good. If the complexion colour opposes the disease condition, it indicates that the disease is severe, pathogenic factors are strong, Upright Qi is weak, the treatment will be relatively difficult and the prognosis is bad.

Of course, the conformity or opposition of the complexion colour according to the Five Elements is only one of the aspects to be considered in colour diagnosis. All other factors should be taken into account and, with regard to complexion in particular, the presence or absence of lustre overrides the others. In other words, if the complexion is dark, dull and without lustre, this indicates a poor prognosis even if the colour is conforming. Conversely, if the complexion has lustre the prognosis is good even if the colour is opposing.

Prognosis according to complexion colour

Observation

Complexion colour is used to determine prognosis in four ways: first by determining the presence or absence of lustre, secondly by paying attention to the ‘thickness’ of the colour, thirdly, by analysing the ‘conforming’ or ‘rebellious’ nature of the colour according to its movement between areas of the face, and fourthly by analysing the complexion colour in its conformity to or deviation from the seasonal influence. Thus, four aspects will be discussed:

1. Presence or absence of lustre

If a pathological complexion colour is bright, lustrous and contained, this is a sign of good prognosis; if it is dark, lustreless and fully revealed, it indicates poor prognosis. Shi Pa Nan in the ‘Origin of Medicine’ (1861) says: ‘The shen of the complexion consists in lustre and body. Lustre means that the complexion appears clear and bright from the outside; body means that it is moist and with lustre in the inside.’14 If a complexion has such attributes, even if the colour is pathological, this indicates that the Mind and Spirit are stable and unaffected and therefore the prognosis is good.

Chapter 10 of the ‘Simple Questions’ differentiates between a good prognosis and a poor prognosis by observation of the five main pathological colours, comparing them with various objects that were in common daily use in ancient China (some of which will be unfamiliar to Westerners). The colours are given in Table 3.2.15

Table 3.2

Descriptions of pathological complexion colours in the ‘Simple Questions’

Pathological colour Good prognosis Poor prognosis
Green feather of a kingfisher dead grass
Red rooster comb stagnant blood
Yellow abdomen of a crab bitter orange
White pig’s fat dead bone
Dark crow’s feathers coal ash

The same chapter also describes the five main healthy complexion colours, again comparing them with various objects (Table 3.3).16

Table 3.3

Descriptions of healthy complexion colours in the ‘Simple Questions’

Organ Healthy complexion colour
Liver thin piece of white silk covering a dark purple one
Heart thin piece of white silk covering cinnabar
Spleen thin piece of white silk covering snakegourd (Gua Lou) fruit
Lungs thin piece of white silk covering a pink one
Kidneys thin piece of white silk covering a purple one

It is interesting to note that the normal, healthy colours are described as being covered by a thin piece of white silk, which means that they should be rather subdued and subtle; it is also interesting that pathological colours are latent and manifest themselves when the ‘thin piece of white silk’ is removed.

Chapter 17 of the ‘Simple Questions’ describes the look of pathological colours with or without lustre in a slightly different way:

Dr Chen Shi Duo in ‘Secret Records of the Stone Room’ (1687) goes as far as saying: ‘If the complexion is dark but with shen, the person will live even if the disease is serious. If the complexion is bright but without shen, the person will die even if there is no disease.’18

If the complexion colour is bright, lustrous and contained, it indicates that, even though there is a pathological state, the Internal Organs are not weakened, pathogenic factors are not too strong, Stomach-Qi is still relatively intact, the disease is mild and the prognosis is good. If the complexion colour is dark, lustreless and fully revealed, it shows that the Internal Organs are weakened, pathogenic factors are strong, Stomach-Qi is exhausted, the disease is severe and the prognosis is poor.

2. Conforming or rebellious colour according to area of the face

The conformity or rebellious nature of a colour must also be related to any movement of the colour from one area of the face to another.

A movement of a pathological facial colour from the top to the bottom part of the face indicates an improvement of the condition and is called ‘conforming’ movement; by contrast, a movement of a pathological colour from the bottom to the top part of the face indicates a worsening of the condition and is called ‘rebellious’ movement.

The ‘Simple Questions’ in Chapter 15 relates the conforming or rebellious movement of a facial colour (and therefore the prognosis) also to the left or right side of the face, making a distinction according to sex: ‘In women, [a colour] on the right side indicates a rebellious [colour], while on the left side it is conforming. In men, [a colour] on the left side indicates a rebellious [colour], while on the right side it is conforming.’19 This passage correlates the prognosis to the location of a pathological colour on the right or left side of the face in men and women: for example, in a woman, an excessively red colour is always pathological whether it is on the right or left but it is worse if it is on the right cheek; the reverse applies to a man.

4. Conformity or deviation of colour according to season

The complexion colour should be assessed carefully in the light of seasonal influences: if the influence of climatic factors of the seasons exceeds that of the pathology of the five Yin organs, it is a sign of a good prognosis; if the influence of the pathology of the five Yin organs exceeds that of the climatic factors of the seasons (the ‘Guest Qi’), it is a sign of a bad prognosis.

The chapter ‘Keys to the Four Diagnostic Methods’ in the ‘Golden Mirror of Medicine’ (Yi Zong Jin Jian) says:

The Qi of the five Yin organs manifests with the five different [physiological] colours in accordance with the five different types of body shapes. Such colours will never change and are called Dominant Colours. The colours influenced by the climatic factors of the four seasons will change accordingly and are not the same all the time: they are called the Guest Colours. The climate in Spring corresponds to the Liver, and the complexion colour is relatively green. The climate in Summer corresponds to the Heart, and the complexion colour is relatively red. The climate in Autumn corresponds to the Lungs, and the complexion colour is relatively white. The climate in Winter corresponds to the Kidneys, and the complexion colour is relatively dark. The climate in Late Summer corresponds to the Spleen, and the complexion colour is relatively yellow. These colours are seen when the climatic changes in the seasons are normal. The Dominant Colours are a [physiological] manifestation of the five Yin organs, while the Guest Colours are produced by the climatic changes of the seasons. Therefore, [when observing] the complexion colour, if the influence of the climatic factors of the seasons exceeds that of the five Yin organs, it indicates a good prognosis. That is why it is said that the Guest colour replacing the Dominant colours is a sign of good prognosis. If the influence of the five Yin organs exceeds that of the climatic factors of the seasons, it is a sign of poor prognosis. That is why it is said that the Dominant Colours overtaking the Guest Colours is a sign of poor prognosis. The so-called replacing of the colours is found in the following situations: the complexion colour should be green [in Spring] but is white instead; the complexion colour should be red [in Summer] but is black instead; the complexion colour should be white [in Autumn] but is red instead; the complexion colour should be black [in Winter] but is yellow instead; and the complexion colour should be yellow [in Late Summer] but is green instead.20

Reading the above quotation, it should be noted that a poor prognosis is indicated when the dominant colour becomes pathological, when it manifests in the ‘wrong’ season and, specifically, when it belongs to the Element that overacts, along the Overacting cycle, on the Element of that particular season. For example, having a yellow (instead of greenish) complexion in springtime indicates a poor prognosis but the prognosis would be even worse if the complexion were white (because Metal overacts on Wood).

Box 3.8 summarizes the factors that affect prognosis.

BOX 3.8   FACTORS AFFECTING PROGNOSIS ACCORDING TO COMPLEXION

Changes in complexion colour during a disease

Observation

When observing complexion colour, in addition to the above-mentioned aspects (i.e. whether the abnormal colour is superficial or deep, distinct or obscure, lustrous or lustreless, scattered or concentrated, conforming or opposing), attention should be paid also to observing any changes in the complexion in the course of a chronic disease.

Chapter 49 of the ‘Spiritual Axis’ says:

Clinical significance

The changes occurring in the complexion colour in the course of a disease reflect the changes in the relative strength of pathogenic factors and Upright Qi. Changes in the complexion colour indicating a worsening of the condition are as follows: from conforming to opposing, from thin to thick, from superficial to deep, from distinct to obscure, from scattered to concentrated, and from lustrous to lustreless. All these indicate that the disease is moving from the Exterior to the Interior, pathogenic factors are growing stronger, Upright Qi is getting weaker, the disease is becoming more severe and the treatment given is not effective. Changes in the complexion colour indicating an improvement in the condition are as follows: from opposing to conforming, from thick to thin, from deep to superficial, from obscure to distinct, from concentrated to scattered, and from lustreless to lustrous. All these signs indicate that the disease is moving from the Interior to the Exterior, pathogenic factors are subsiding, the Upright Qi is becoming stronger, the disease is getting better and the treatment received is effective.

Complexion colours and emotions

Specific signs in the complexion may indicate various emotions.

Anger usually manifests with a greenish tinge on the cheeks or under the eyes. If there is such a tinge on the forehead, it means that Liver-Qi has invaded the Stomach; if on the tip of the nose, that Liver-Qi has invaded the Spleen. Being prone to anger may also be manifested by eyebrows that meet in the centre. In some cases, if the anger is bottled up inside as resentment leading to long-standing depression, the complexion may be pale. This is due to the depressing effect of stagnant Liver-Qi on Spleen- or Lung-Qi. In such cases, the Wiry quality of the pulse will betray the existence of anger rather than sadness or grief (indicated by the pale complexion) as a cause of disease.

Excess joy may manifest with a red colour on the cheekbones.

Worry causes a greyish complexion and a skin without lustre because it knots Lung-Qi and affects the Corporeal Soul, which manifests on the skin.

Pensiveness may manifest with a sallow complexion because it depletes Spleen-Qi.

Fear shows with a bright-white complexion on the cheeks and forehead. If chronic fear causes deficiency of Kidney-Yin and the rising of Empty-Heat of the Heart, there will be a malar flush, with the underlying colour being bright-white.

Shock also causes a bright-white complexion. Shock early in childhood may manifest with a bluish tinge on the forehead. Such a bluish tinge there or around the mouth indicates a prenatal shock (while in the uterus).

Hatred often shows with a greenish complexion on the cheeks.

Craving shows with a reddish colour on the cheeks.

Guilt shows with a dark-ruddy complexion.

Box 3.9 summarizes the complexion colours associated with the emotions.

BOX 3.9   EMOTIONS AND COMPLEXION COLOURS

COMPLEXION COLOURS

The complexion colours are:

Normal complexion colour

Observation

As ‘normality’ obviously varies from race to race, it is impossible to define a universal normal colour. We can, however, identify and define four essential characteristics of a normal complexion:

The presence of lustre is an essential part of a normal complexion. Such a complexion is slightly shiny, vibrant in colour, lively, relatively bright and glowing. The presence of lustre in the complexion indicates that the Upright Qi is intact (even though there may be a pathology) and that the Mind and Spirit are healthy. The lustre of the complexion is equivalent to the spirit of the pulse (one of the attributes of the normal pulse) or of the eyes; they all indicate a good state of the Mind and Spirit.

The normal complexion should have a subtle, slightly reddish hue because the facial colour as a whole reflects the state of the Heart and a reddish hue indicates a good supply of Heart-Blood (and by implication, a good state of the Mind).

The colour of the facial complexion should be ‘contained’ as if there was a very thin, white silk veil over it. The book ‘Wang Zhen Zun Jing’ describes the normal complexion colour as being bright and lustrous and says: ‘The complexion is bright because of the embodiment of the Spirit. It is lustrous because of the nourishment of the Essence and Blood.’22

The normal complexion should be moist and look firm (because of the fluids underneath); a dry complexion is always a poor prognostic sign. The moisture of the complexion is equivalent to the Stomach-Qi of the pulse (one of the attributes of the normal pulse); they therefore both indicate that the patient’s Stomach-Qi is intact (even though there may be pathogenic factors).

Apart from these four basic aspects of a normal complexion, the actual colour of course varies enormously according to race and even within the same racial group. The normal complexion colour for Caucasian people is a mixed white and slightly reddish colour which is lustrous, bright and contained. Within the Caucasian race, however, there can be considerable variations in normal complexion: for example, the normal complexion of a Norwegian person will be quite different from that of a Spaniard as the Mediterranean complexion is naturally slightly darker and of a more earthy colour than that of the northern European. The complexion of Chinese people is described in Chinese books as a mixed red and yellow colour, shown slightly, which is bright, lustrous and reserved.

The same wide variations may be observed in Asian, African and Afro-American people. For example, the complexion of people in north India is much lighter than that of Indians from the south.

Apart from racial differences, there can be wide variations in normal complexion in people of the same race due to other factors such as the influence of prenatal constitution, the profession, the area people come from and their working or living environment. However, complexion colour changes caused by the above-mentioned factors are not regarded as abnormal. For example, the normal complexion of a farmer will be rosier and redder than that of an office worker (see Plate 3.9 on p. P4).

Clinical significance

A bright, lustrous, white-reddish and ‘contained’ complexion colour in Caucasian people indicates strong Stomach-Qi, normal Internal Organs, ample Blood and good Spirit. This is regarded as a normal complexion colour. If such a complexion colour is observed in the process of a disease, it means that the duration of the disease is short, the pathogenic factors are weak, the Upright Qi is still strong, the treatment will be easy and the prognosis is good. Chapter 17 of the ‘Simple Questions’ says:

This highlights the connection between complexion colour and the duration of a disease.

Box 3.10 summarizes the attributes of a normal complexion.

BOX 3.10   ATTRIBUTES OF A NORMAL COMPLEXION

White complexion colour

Symptoms and Signs, Chapter 56

There are several shades of white complexion:

Sallow white

Yellow complexion colour

Symptoms and Signs, Chapters 56 and 68

There are several types of yellow complexion:

Bright yellow (jaundice)

Observation

Patients with jaundice have yellow conjunctiva and a yellow complexion colour, which may be either bright yellow, orangey yellow or dark yellow as if smoked, yellow scanty urine, general weakness, listlessness and a greasy tongue coating.

Chapter 18 of the ‘Simple Questions’ says: ‘Symptoms such as deep yellow urine and lethargy indicate jaundice… yellow conjunctiva indicates jaundice.’24 Chapter 74 of the ‘Spiritual Axis’ says: ‘If the face is slightly yellow, the teeth filthy yellow, the nails yellow, this indicates jaundice. (If there are also symptoms and signs such as lethargy, deep yellow urine, poor appetite and a Small-Choppy pulse, it then indicates that it is the disease of the Spleen.)’25

Clinical significance

The aetiology of jaundice, manifesting with yellow conjunctiva and a yellow complexion colour, is often related to poor diet and invasion by pathogenic factors such as Damp, Heat and Toxic Heat. It is often located in the Liver, Gall-Bladder, Spleen and Stomach. The nature of the disease is often one of either Damp-Heat, Cold-Damp, Toxic Heat, or Qi and Blood deficiency. Signs and symptoms such as a bright-yellow colour like an orange (called ‘Yang yellow’), a Red tongue with a thick coating, yellow urine and abdominal distension indicate that the disease is caused by the accumulation of Damp-Heat in the Liver, Gall-Bladder, Spleen and Stomach. Signs and symptoms such as a dark-yellow, smoky colour (called ‘Yin yellow’) and a light-Red tongue body with a thick white coating indicate that the disease is caused by Cold-Damp being retained in the Liver, Gall-Bladder, Spleen and Stomach.

Box 3.13 summarizes the types of yellow complexion colour.

BOX 3.13   YELLOW COMPLEXION COLOUR

Red complexion colour

Symptoms and Signs, Chapter 56

A red complexion always indicates Heat, which may be Full or Empty; it indicates Empty-Heat particularly when only the cheeks are red. Redness of the complexion also indicates Empty-Heat when it is somewhat ‘thin’ or ‘superficial’ as defined above.

The clinical significance of the red complexion depends also on the location of the redness. There are three main types of red complexion:

Red cheekbones

Clinical significance

Red cheekbones always indicate Empty-Heat, which may affect various organs and especially the Lungs, Heart, Stomach and Kidneys. The clinical significance may be further differentiated according to the type of redness and to the time of day when it appears.

A relatively thin red colour that looks like makeup and appears in the afternoon indicates Blood deficiency; if both cheekbones are deep red this indicates Empty-Heat; if both cheekbones are fresh red like threads it indicates Yin deficiency; if both cheekbones are pale red it indicates ‘steaming from the bones’ due to chronic Yin deficiency.

!Note: do not assume that red cheekbones always indicate Yin deficiency; they may also indicate Blood deficiency especially if obvious in the afternoon (common in women).

Floating red

Clinical significance

The floating red colour generally indicates Empty-Heat. It is seen also in the pattern characterized by false Heat and true Cold, which means that the patient suffers from severe internal Cold and the separation of Yin and Yang which makes Yang ‘float’ to the top giving the false appearance of Heat. In fact, apart from the redness of the face, all the other signs and symptoms point to internal Cold (cold limbs, a desire to curl up, weak breathing, Pale and Short tongue and Slow pulse). However, this situation is rather rare.

Plates 3.26–3.31 on p. P7 Plate 3.27 Plate 3.28 Plate 3.29 Plate 3.30 Plate 3.31 illustrate thin/thick, superficial/deep and distinct/obscure red complexion colours.

Box 3.14 summarizes the types of red complexion colour.

BOX 3.14   RED COMPLEXION COLOUR

Bluish/greenish complexion colour

Symptoms and Signs, Chapter 56

‘Bluish/greenish’ is a translation of the Chinese word qing which can mean both blue and green. In the context of the Five Elements, it is the colour associated with Wood and it therefore makes more sense to translate it as green. In the context of facial diagnosis, qing can mean either bluish or greenish; for example, the qing colour may indicate a Liver pattern, in which case it would be greenish, or interior Cold, in which case it would be bluish (see Plate 3.32 on p. P8).

There are various types of bluish/greenish colour:

Greenish

Clinical significance

The greenish complexion always indicates a Liver pattern, which may be Liver-Qi stagnation, Liver-Blood stasis, Cold in the Liver channel or Liver-Wind.

A green complexion with a red tinge is seen in the Lesser-Yang syndrome. A green complexion with red eyes indicates Liver-Fire. Yellowish green cheeks indicate Phlegm with Liver-Yang rising often causing headaches.

A green nose indicates stagnation of Qi often causing abdominal pain. A dark, reddish-green complexion indicates stagnant Liver-Qi turning into Heat. A pale-green colour under the eyes indicates Liver-Blood deficiency. A grass-green indicates collapse of Liver-Qi.

Box 3.15 summarizes bluish/greenish complexion colour.

BOX 3.15   BLUISH/GREENISH COMPLEXION COLOUR

Dark complexion colour

Symptoms and Signs, Chapter 56

There are several types of dark complexion:

Purple complexion colour

Symptoms and Signs, Chapter 56

There are two types of purple complexion colour:

NOTES

1. Cited in Sheng, Zhang Shu. Great Treatise of Diagnosis by Observation in Chinese Medicine (Zhong Hua Yi Xue Wang Zhen Da Quan image). Taiyuan: Shanxi Science Publishing House, 1995; 82.

2. Principles of Medical Practice 1658, cited in Wang Ke Qin 1988 Theory of the Mind in Chinese Medicine (Zhong Yi Shen Zhu Xue Shuo image), Ancient Chinese Medical Texts Publishing House, p. 56.

3. Cited in Great Treatise of Diagnosis by Observation in Chinese Medicine, p. 82

4. The Yellow Emperor’s Classic of Internal Medicine – Simple Questions (Huang Di Nei Jing Su Wen image). People’s Health Publishing House: Beijing, 1979:80 First published c. 100BC

5. The Yellow Emperor’s Classic of Internal Medicine – Simple Questions (Huang Di Nei Jing Su Wen image). People’s Health Publishing House: Beijing, 1979; 291.

6. Spiritual Axis (Ling Shu Jing image). People’s Health Publishing House: Beijing, 1981:96 First published c. 100BC

7. Qian, Wu. Golden Mirror of Medicine (Yi Zong Jin Jian image); vol. 2. People’s Health Publishing House, Beijing, 1977:872. [First published in 1742].

8. Cited in Great Treatise of Diagnosis by Observation in Chinese Medicine, p. 85

9. Simple Questions, p. 89.

10. Cited in Great Treatise of Diagnosis by Observation in Chinese Medicine, p. 85

11. Spiritual Axis, p. 98

12. Cited in Great Treatise of Diagnosis by Observation in Chinese Medicine, p. 86

13. Spiritual Axis, p. 98

14. Shi Pa Nan 1861 Origin of Medicine (Yi Yuan image), cited in Wang Ke Qin 1988 Theory of the Mind in Chinese Medicine, p. 55.

15. Simple Questions, pp. 71–2.

16. Simple Questions, pp. 72.

17. Simple Questions, pp. 99.

18. Chen Shi Duo 1687 Secret Records of the Stone Room (Shi Shi Mi Lu image), cited in Wang Ke Qin 1988 Theory of the Mind in Chinese Medicine, p. 56.

19. Simple Questions, p. 90.

20. Golden Mirror of Medicine, vol. 2, pp. 866–867

21. Spiritual Axis, p. 97

22. Cited in Zhang Shu Sheng 1995 Great Treatise of Diagnosis by Observation in Chinese Medicine, p. 89

23. Simple Questions, p. 98.

24. Simple Questions, p. 114.

25. Spiritual Axis, p. 134

Share this:

Related posts:

OBSERVATION OF THE HEARTBEAT THROAT AND NECK STOOLS AND URINE ANUS MENTAL DIFFICULTIES MENTAL AND EMOTIONAL SYMPTOMS