Facial complexion

The color and sheen of the skin of the face, especially as a reflection of health or sickness. The state of blood and qì is intimately related to the facial complexion. The Magic Pivot (灵枢 líng shū, xié qì zàng fǔ bìng yīn piān) states, The qì and blood of the twelve primary channels and the three-hundred and sixty-five network vessels [all the channels of the body] ascend to the face. This statement emphasizes the importance of the complexion as a reflection of the general state of health. The color of the complexion is analyzed in terms of the five colors—blue-green, red, yellow, white, and black. When applied to the human complexion, they take on a relative significance. Thus, two people who have vastly different complexions when healthy, may both be described as having an white complexion when suffering from a certain disease, even though the actual color is different. White here refers to a relative paling compared with the normal complexion.

NB: Color names are retained in translation because of possible five-phase associations with the bowels and viscera that might be lost with more idiomatic translations such as pale for white, or sallow for yellow.

Basic morbid facial complexions and their significance are as follows:

White complexions usually indicate cold or vacuity. A bright-white (very white) complexion with facial vacuity edema generally indicates yáng qì vacuity and occurs after massive bleeding, in chronic nephritis, or in wheezing panting patterns. A lusterless pale-white complexion (a complexion slightly paler than normal), together with general and facial emaciation, normally points to blood vacuity. The Magic Pivot (灵枢 líng shū, jué qì piān) states, Blood desertion is characterized by a white complexion that is perished and sheenless. The sudden appearance of a somber-white complexion (white tinged with blue-green) in acute diseases is usually attributable to fulminant yáng qì desertion and is seen in various forms of shock. However, somber-white may also be observed in cases of external wind-cold diseases characterized by aversion to cold, shivering, and severe abdominal pain due to interior cold.

Green-blue complexions, that is, blue-green or bluish complexions, are principally associated with wind-cold, blood stasis, pain, and qì block patterns. Child fright-wind and epilepsy are characterized by a dark blue-green complexion. A grayish blue-green complexion with blue-green-purple lips is associated with inner body blood stasis and impaired flow of qì and blood, and occurs in diseases classified in Western medicine as cirrhosis of the liver and cardiac failure. In severe wind-cold headaches and abdominal pain due to interior cold, impeded flow of yáng qì may be reflected in a bluish somber-white complexion. In cases of lung qì block, a dark blue-green-purple complexion may result from obstructed flow of blood and qì. This corresponds to conditions such as pulmogenic heart disease and asphyxia in Western medicine.

Red complexions generally occur in heat patterns, with distinction being made between vacuity heat and repletion heat. Externally contracted wind-heat may be characterized by a red face and red eyes. Interior repletion heat patterns are characterized by tidal reddening of the face, excessive sweating, thirst, constipation, and other signs of repletion heat. A somber-white complexion with tidal reddening of the cheeks in the afternoon indicates yīn vacuity with effulgent fire. In severe illnesses characterized by cold sweating, reversal cold in the limbs, and a somber-white complexion with reddening of the cheeks that appear as if smeared with oil paint indicates upcast yáng or overfloating of vacuous yáng, i.e., it is a critical sign of imminent outward desertion of yáng qì. In addition, in some severe or enduring illnesses, signs such as those described in The Magic Pivot (灵枢 líng shū, wǔ sè piān) may appear: If red, thumb-sized flushes appear on the cheeks, although there may be slight improvement, death will ensue promptly.

Yellow is associated with dampness and vacuity. Yellowing of the whites of the eyes (sclerae) and generalized yellowing of the skin indicate jaundice. A vivid yellow indicates damp-heat and is known as yáng yellow. A dark yellow color points to cold-damp and is known as yīn jaundice. Yáng yellow is seen mostly in cases described in Western medicine as acute icteric infectious hepatitis, acute cholecystitis, cholelithiasis, and toxic hepatitis; yīn yellow occurs in cirrhosis of the liver and cancer of the head of the pancreas. A pale yellow skin that is dry and puffy, accompanied by pale lips but no yellowing of whites of the eyes (sclerae), is referred to as withered-yellow, which is a vacuity yellow. The condition characterized by this complexion is sometimes called yellow swelling and is normally caused by excessive loss of blood or depletion of blood and qì after major illnesses, or by spleen-stomach damage resulting from intestinal parasites. It may be seen in diseases known in Western medicine as ankylostomiasis (hookworm disease), anemia, and malnutrition due to poor assimilation.

Black Black is associated with kidney vacuity and blood stasis. A soot-black complexion, dark gray complexion, or purple-black complexion may occur in enduring diseases, patterns characterized by kidney essence depletion, or in static blood accumulation patterns. In Western medicine, a soot-black complexion may be seen in chronic hyperadrenocorticalism, or in the final stages of cirrhosis of the liver. A dark gray complexion may be seen in chronic kidney dysfunction, and a purple-black complexion may occur in chronic heart-lung dysfunctions. A black complexion indicates intractable or severe illness. Essential Prescriptions of the Golden Cabinet (金匮要略 jīn guì yào lüè) states that black jaundice is associated with kidney vacuity and blood stasis, and usually indicates that the condition is hard to cure. See ten-principle inspection of the complexion.