OBSERVATION OF THE COMPLEXION COLOUR

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).

Related posts:

  1. OBSERVATION OF THE GENITALIA
  2. MENSTRUAL SYMPTOMS
  3. DIAGNOSIS BY HEARING
  4. MENTAL AND EMOTIONAL SYMPTOMS

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Apr 15, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on OBSERVATION OF THE COMPLEXION COLOUR

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