2 Inspection of complexion
Inspection of complexion includes the changes of the colour and luster of the facial skin. The visceral essence flows to the face. So the facial colour and luster are the signs of visceral essence. The facial skin is soft and thin,the luster is visible and easy to observe. Therefore the inspection of complexion is an important part of inspection examination.
The colours of the facial skin are red, white, blue,yellow and black. The changes of these colours can reveal pathological changes of viscera of different nature. The lustre of skin refers to the bright, moist or dull and dry manifestations which can reveal the states of the visceral essence. So inspection of the changes of facial luster can enable one to understand the states of visceral essence,the nature of diseases, the conditions and development of diseases.
1.1.1.2.1 Normal complexion
The normal and healthy complexion is ruddy and lustrous, indicating exuberance of visceral essence and normal functions of the viscera. Due to difference in constitution and the influence of climatic and environmental factors, the normal complexion is further divided into dominant complexion and varied complexion.
Dominant complexion refers to the colour of the skin and face that never changes due to racial and constitutional factors.
Varied complexion refers to the changes of the facial and skin color in correspondence to the variations of the seasons and climates. For example, the complexion is slightly bluish in the spring, reddish in the summer, yellowish in the late summer, whitish in the autumn and blackish in the winter. Varied complexion is temporary and unclear.
Besides, drinking liquor, excitement and sports activity may also lead to the changes of complexion. But these changes are not morbid.
1.1.1.2.2 Morbid complexion
Facial colour during the course of disease is called morbid complexion marked by dry and dull colour, or obvious bright colour, or a single colour alone.
The key point in inspecting morbid complexion is to differentiate favourable and unfavourable manifestations of the five kinds of colour and the diseases manifested by these five kinds of colour.
Favourable and unfavourable manifestations of the five kinds of colour: Bright and moist colour, no matter what colour it is, indicates mild illness, normal
condition of the visceral essence, easiness to cure and better prognosis. While dull and dry colour is malignant colour and indicates serious illness, impairment of the
visceral essence, difficulty to cure and unfavourable prognosis.
Diseases indicated by the five kinds of colour. According to the theory of TCM and clinical experience,the five kinds of colour correspond to disorders of the five zang organs, i.e. blue colour corresponding to the liver,red colour to the heart, white colour to the lung, yellow colour to the spleen, and black colour to the kidney. The disorders of the five zang organs are manifested in correspondence to the kinds of complexion related to them.While the five kinds of colour also demonstrate different nature of diseases. The following is the detailed description:
Red colour: Red colour indicates heat syndrome, alsseen in real cold and false heat syndrome.
Red colour results from sufficient blood circulating in the meridians and skins. With heat, blood flows fast.Since heat tends to rise and disperse, the meridians and vessels are dilated and become full. That is why the complexion appears red.
Flushed face is a sign of sthenic heat syndrome due to hyperactivity of visceral yang heat resulting from exogenous fever. Flushed and delicate cheeks indicates asthenia heat syndrome due to endogenous heat resulting from yin asthenia. Pale complexion with occasional migratory reddish luster like makeup in the patient with prolonged illness and serious disease indicates real cold and false heat syndrome due to upward floating of yang caused by predominant yin rejecting yang.
White colour: Indicating asthenia syndrome and cold syndrome.
White colour indicates decline of qi and blood. Pale complexion is caused by insufficiency of qi and blood in the ace due to failure of insufficient yangqi to transport blood to nourish the face, or due to failure of the asthenia of qi and blood to fill the vessels, or due to coaguhtion of cold in the meridians and vessels which prevent qi and blood to circulate freely.
Floating whitish complexion and facial dropsy are usually due to insufficiency of yangqi. Light whitish complexion and emaciation are often caused by consumption of qi and blood. Pale complexion is often seen in sthenic cold syndrome, such as interior cold syndrome with sharp abdominal pain. Sudden pale complexion with profuse cold sweating, cold limbs and indistinct pulse is a sign of sudden loss of yangqi.
Yellow colour: Indicating asthenia syndrome and dampness syndrome.
Yellow colour indicates asthenia of the spleen and accumulation of dampness. Yellow complexion may be caused either by malnutrition of muscles due to insufficiency of qi and blood resulting from failure of the spleen to transport, or due to internal accumulation of dampness.
Light yellow, dry and lusterless complexion is called sallow complexion due to gastrosplenic qi asthenia and insufficiency of qi and blood, also seen in chronic hemorrhage, ascariasis and malnutrition, etc. Yellowish complexion with facial dropsy is called yellowish obesity, usually caused by asthenia of splenic qi and internal accumulation of dampness. The state of yellow complexion, eyes and skins is called jaundice due to failure of bile to flow in its normal duct and extravasates in the skins. If the colour is as yellow as tangerine peel, it is called yang jaundice due to steaming of accumulated damp heat and dysfunction of the liver and gallbladder. Sudden onset of disease with deep yellow face, eyes and body, high fever and coma, or even with vomiting, nosebleed and macules, is called acute jaundice or pestilent Jaundice, usually caused by invasion of damp heat and pestilence deep into blood which steams the liver and gallbladder. Yellowish complexion like being fumigated is called yin jaundice, usually caused by stagnation of cold and dampness or prolonged stagnation of the liver and gallbladder.
Bluish complexion. Indicating cold syndrome, pain syndrome, blood stasis syndrome and convulsive syndrome.
Bluish colour is a sign of inhibited flow of qi and blood and stagnation of vessels and meridians. The invasion of cold factors causes contraction and stagnation, leading to spasm of meridians and vessels and stagnation of qi and blood. It may be caused either by deficiency of yangqi which fails to warm and transport qi and blood, or by qi stagnation and blood stasis which block meridians and vessels, or by exuberance of pathogenic heat which stagnates blood vessels. Besides, the stagnation of qi and blood in the meridians and vessels will inevitably result in pain.
Therefore clinically stagnation of qi and blood is often accompanied by pain syndrome.
Pale and bluish complexion, or accompanied by chest pain and abdominal pain, is often due to invasion of cold or yang asthenia and cold exuberance. Bluish and grayish complexion with purplish black lips and chest pain is usually caused by inaction of heart yang and stagnation of heart blood. Cyanotic complexion and lips with asthmatic breath is usually due to stagnation of pulmonary qi, or asthenia of cardiopulmonary qi, or asthenia of pulmonary and kidney qi. Yellowish complexion mingled with bluish colour is called dull jaundice, usually seen in subjugation of the spleen by the liver, tympanites and infantile malnutrition.Cyanotic colour over the part between infantile brows,nose bridge and lips accompanied by high fever is the premonitory signs of convulsion, usually due to exuberance of pathogenic heat.
Blackish complexion. Indicating kidney asthenia syndrome, cold syndrome, blood stasis syndrome and fluid retention syndrome.
Blackish complexion is the sign of kidney asthenia, yin predomination and exuberance of water or stagnation of qi and blood. The kidney is the organ associating closely with water and fire and is the source of yangqi. Asthenia of kidney yang and retention of fluid will lead to internal exuberance of water cold, loss of warmth ill blood, spasm of vessels and meridians and inhibited flow of qi and blood. Blackish complexion may also be caused by consumption of yin by asthenic fire and failure of essence to nourish the face, or by prolonged stagnation of blood in
the body.
Light blackish complexion is often caused by asthenia of kidney yang. Dry blackish complexion is usually due to prolonged consumption of kidney essence and asthenic fire consuming yin. Blackish complexion with squamous and dry skin often results from internal retention of blood stasis. Blackish colour of the area around the eye socket indicates retention of fluid due to kidney asthenia and fluid extravasation or leukorrhagia due to downward migration of cold dampness.
