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Facial Inspection Diagram
The Ting (forehead) is used to inspect the head and face; the Que (between the eyebrows) is used to inspect the Lungs; above the Que is used to inspect the throat; the Xiaji (root of the nose) is used to inspect the Heart; the Nianshou (nasal bridge) is used to inspect the Liver; its left and right sides are used to inspect the Gallbladder; the Mianwang (tip of the nose) is used to inspect the Spleen; the Fangshang (sides of the nasal alae) is used to inspect the Stomach; the Renzhong (philtrum) is used to inspect the Bladder and Uterus; the center of the face (below the zygomatic bones, outside the Yingxiang acupoint) is used to inspect the Large Intestine; beside the Large Intestine area (upper cheeks) is used to inspect the Kidneys; above the Mianwang (inside the zygomatic arches, beside the nasal tip) is used to inspect the Small Intestine.
The above content is based on the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Later authors proposed using the forehead to inspect the Heart, the left cheek to inspect the Liver, the right cheek to inspect the Lungs, the nose to inspect the Spleen, and the chin to inspect the Kidneys. These can be referred to and examined comprehensively.
The facial complexion has five colors: cyan, yellow, red, white, and black, corresponding to the Five Zang Organs. Qibo said: The normal color of the Heart is like cinnabar wrapped in plain silk; the normal color of the Lungs is like red [light red] wrapped in plain silk; the normal color of the Liver is like gan [cyan with a reddish hue] wrapped in plain silk; the normal color of the Spleen is like the fruit of Trichosanthes kirilowii [yellow with a reddish hue] wrapped in plain silk; the normal color of the Kidneys is like purple [black with a reddish hue] wrapped in plain silk. [Note: All five colors contain red, which is the true color of blood. However, facial color is the manifestation of spirit and essence; it should be concealed rather than exposed, hence the analogy of being wrapped in silk. If it is exposed, it indicates that the Qi of the Zang organs has lost its holding function, essence and Qi are floating outward, and the internal Zang organs are exhausted.] This represents the complexion of health. If a complexion appears during illness, those generated by mutual generation are auspicious, while those subjected to mutual restriction are ominous. [For example, in Spleen disease with diarrhea, seeing a red color indicates Fire generating Earth (mutual generation), while seeing a cyan color indicates Wood restricting Earth (mutual restriction). Similarly, in autumn, seeing yellow indicates mutual generation, while seeing red indicates mutual restriction.] Moist and bright complexions are auspicious; dry, dull, and stagnant complexions are ominous. [This refers to the statement in the *Neijing*: Red should resemble white silk wrapping cinnabar [subtle], not resembling hematite [exposed]. Lack of moisture blames Water deficiency; lack of luster blames Fire deficiency.] A dull and stagnant complexion moving upward indicates worsening disease; [Observe if the color is sharp and pointing upward to know it is moving up; downward indicates moving down. The following descriptions of inward/outward movement follow this logic.] moving downward and dispersing like clouds indicates gradual recovery. For women, a complexion appearing on the right side is contrary (ni), and on the left is compliant (cong); for men, it is the reverse. A dispersed but uncondensed complexion indicates that the pathogenic factor has also not condensed. [Generally, obvious colors indicate new diseases, while turbid and dull colors indicate chronic diseases.] A complexion moving from the interior to the exterior of the face indicates the pathogen moving from inside to outside. The same logic applies to left/right and up/down.
Cyan belongs to the Liver, governing Wind, fright, Cold, and pain. Cyan face and lips indicate extreme Cold. Cyan with loss of color [loss of luster and vitality] indicates fright or terror. Cyan mixed with black indicates much Cold pain. Cyan mixed with white indicates much Deficient Wind. [All the above are Cold syndromes. Because Liver Yang is insufficient, Yin-Cold coagulates internally, and the Spleen loses its transportive power, thus often causing cold pain in the abdomen, vomiting, and diarrhea.] Cyan mixed with red indicates Liver Fire.
Cyan and red with dullness and stagnation indicate constrained Fire. [The above are Heat syndromes.]
Red belongs to the Heart, governing Heat. In Heart Heat, the forehead turns red first. In Spleen Heat, the nose turns red first. In Lung Heat, the right cheek turns red first. In Kidney Heat, the chin and jaw turn red first. In Liver Heat, the left cheek turns red first. A face that is uniformly and persistently red indicates Yang Qi constrained at the exterior due to incomplete sweating. [This is an exterior Heat syndrome of the Taiyang Meridian in Shanghan.] Face redness with tidal fever and delirious speech indicates Fullness in the Stomach Fu-organ. [This is a Fu-organ Fullness Heat syndrome of the Yangming Meridian in Shanghan.] Face redness resembling slight intoxication, or pale red and delicate on both zygomatic arches, shifting unpredictably [not full-face redness], indicates Yin syndrome with Floating Yang (Dai Yang). This must be accompanied by diarrhea with undigested food, or clear and white urine [or pale yellow], a deep and fine pulse, or superficial and rapid but weak pulse that dissipates upon heavy pressure. Although there may be irritability, fever, desire to sit in mud/water [severe external heat], thirst for water, or sore throat, resembling Excess Heat, the patient may ask for water but cannot drink it when placed before them. The skin surface feels very hot, but heavy pressure reveals no heat or even coldness, and the feet are certainly cold; this must be carefully examined. [This is a direct invasion Cold syndrome in Shanghan.]
There is also a case of face redness with irritability, sores and prickles all over the tongue, tongue retraction resembling a lychee, profuse phlegm-saliva, panting, frequent urination, dry mouth desiring drinks, cracked lips, sensation of fire/smoke attacking the throat, soles of feet feeling like burning irons, a flooding and rapid pulse regardless of strength, and a body that feels hot to the touch. This is caused by Kidney Deficiency with Fire failing to return to its source. This syndrome is the most difficult to distinguish. However, since the disease arises from internal injury and develops gradually, it is like dry wood and fierce fire, self-immolating without restraint, which is naturally different from the three syndromes listed above. There is also a case of chronically ill and deficient persons whose zygomatic arches become red after noon; this is a common syndrome of Yin Deficiency with Fire stirring. Although not as severe as the aforementioned syndrome, it is still an internal injury. [The above two syndromes are both Deficient Heat.] Redness appearing on the zygomatic arches, [resembling applied rouge], large as a thumb, indicates death even if the disease seems cured. [Also, in Heat diseases, no sweat with red zygomatic arches indicates death, because the zygoma is governed by bone, bone belongs to the Kidney, and Water fears counter-restriction.]
Yellow belongs to the Spleen, governing Damp-Heat and Food Retention. Yellow and bright like an orange peel indicates little Dampness and much Heat. Yellow like smoke-stained, dark and turbid, indicates much Dampness and little Heat. [Turbid Damp-Earth.] Yellow and dull indicates Cold-Damp. Yellow and withered indicates Fire in the Stomach. Yellow and pale indicates Stomach Qi Deficiency. Yellow with cyan/black indicates Wood restricting Earth, [Liver Yang fails to ascend, Spleen is stagnant with Cold], and Water is uncontrolled. [Spleen failure to transport leads to Water retention.]
White belongs to the Lung, governing Qi and Blood Deficiency and Cold. Even if there is Deficient Fire, there is certainly no Excess Heat. White without spirit indicates Liver Blood depletion. White with cyan indicates Qi Cold and Blood coagulation. White and moist indicates abundance in the Lungs and Stomach. White and plump indicates Phlegm. White and thin with bright red nails indicates Qi Deficiency with Fire.
Black belongs to the Kidney, governing Cold and pain. Cyan-black indicates Yin-Cold; scorched black with withered teeth indicates Kidney Heat. Black and withered/dead-looking, appearing in the ears, eyes, mouth, or nose, anywhere, is inauspicious. If it appears on the forehead, large as a thumb, sudden death will occur without prior illness. [Yin-dull color added to the high Yang position causes death.]
A face that is gloomy and lacks luster indicates Yin-Cold. A face that is lustrous and not gloomy indicates Yang-Heat. A face patterned like brocade indicates Yang-Toxin. A face greasy like oil with panting indicates Summerheat disease.
For complexions from sudden external pathogenic invasion, turbidity and obstruction are acceptable. For chronic illness with Qi Deficiency, only emaciation and clarity are appropriate. If the pathogen is sharp but the complexion is cyan/white lacking spirit, or if Qi is depleted and long-confined yet the complexion is charming and fresh, these are not correct colors. Among the five colors, cyan, black, dark, and gloomy always indicate failure of Yang Qi to rise, regardless of whether the disease is new or old. Only when yellow appears on the face and eyes and is bright and moist does it indicate recovery. Thus, the classics state that a yellow face with green, red, white, or black eyes will not die. [Because Yellow is present.] A cyan face with red or black eyes; a red face with white or cyan eyes; a black face with white eyes, all indicate death. [Because Yellow is absent. Note: Same color in face and eyes is Shun [smooth/compliant]; different colors is Ni [contrary]. This theory originates from Hua Tuo. Thus, "not dying" here merely means survival, not necessarily Shun.]