In Traditonal Chinese Medicine there are 4 primary methods of diagnosis, viz looking, asking, listening and smelling (traditionally written as one chinese character) and feeling (palpation). In modern TCM practice this involves looking at the basic constitution of the patient, observing the patients movement and manner as well as the nature of of any skin lesions and also the tongue. Asking involves elucidating the symptoms being experienced, while listening/smelling involves the detection of tell-tale sounds and smells that can corroborate a pattern. Feeling or palpation involves pulse diagnosis, feeling for ah-shi(tender) points as well as other more specialised disciplines such as abdominal diagnosis. Within each of these there are many more specialised methods and one of these is facial diagnosis.
Basic TCM theory teaches us to look for pallor (indicating blood/qi deficiency, redness (indicating heat), a “sooty” complexion (indicating blood stasis), a bright shiny complexion (indicating yang deficiency), a qing (blue/green) appearance (indicating liver disorders) or a yellow complexion indicating the presence of dampness. But just as with the other methods there is more to facial diagnosis than these basic indicative signs.
Facial diagnosis can also be used to establish fertility, identify the health of specific organs and organ systems and also give insight into personality traits such as a quick temper, leadership ability etc. While space does not allow us to explore this topic in detail, I will describe some aspects of advanced facial diagnosis that are useful in clinical practice.
We can determine kidney function by looking at the ears and underneath the eyes. The ears tell us more about the fundamental or inherited aspects of kidney strength and also tell us about the jing aspect of the constitution. Strong Jing is seen in firm yet flexible cartilage. Major changes in the structure of the ear indicate a weak Jing. Current kidney function is seen in the area underneath the eyes. Any depression between the cheekbone and this area is a sign of dehydration or kidney yin vacuity, bags underneath the eyes of any swelling is a sign of water retention due to kidney yang vacuity. If the entire eye socket looks dark and shadowy/sooty then this is a sign of more severe kidney disorders. Patients who are on dialysis often have extreme darkness under and around the eyes
Constitutional liver strength is seen in the eyebrows. Thick, coarse eyebrows indicate a powerful liver but is also associated with anger and occasional aggression, this may be due to hyperactive liver yang, liver qi stagnation etc, but this person will be more able to manage this anger because of the strong liver qi. If the eyebrows are naturally sparse/thin then there is not much liver qi to begin with, this individual does not manage anger well, it exhausts them and they tend to be timid instead. The next area to look at is the sclera in order to determine the health of the liver. Normally it should be a clean, off-white color. If it is bluish-white this is a sign of a cold liver. If the sclera is red, veined and dry, this is a sign of liver dryness or heat duet o blood or yin deficiency and is often due to overwork. A Yello-grey-green appearance that resembles the colors of a hardboiled egg-yolk are a sign of liver toxicity and may correlate to damp-heat affecting the liver.
To assess the heart we look at the tip of the nose. If it is pale there is blood deficiency or lack of blood flow in the heart. A red or pale red indicates heat either due to yin deficiency or excess heat. A purplish color is a dangerous sign as it indicates blood stasis in the heart. Sometimes one can observe an artifical puffiness indicating a possible congestion in the heart and lungs
Digestive function (Spleen/Stomach)
The health of the spleen and stomach is seen in a number of different areas including the mouth, upper eyelid, cheeks and bridge of the nose, keeping in the mind that spleen has a tendency for becoming cold and damp while the stomachs tendency is to become dry and hot, any swelling or redness/dryness in these areas correlates with these patholigies of either the spleen or stomach. Puffy upper eyelids are often seen in the case of spleen dampness issues while a red and dry bridge of the nose or dry lips are very indicative of heat in the stomach due to yin deficiency and in some cases stomach fire.
To determine the health of the lungs we look at the nose in general. A large nose relative to the face indicates healthy lung capacity. A heavily marked or fissured nose indicates constitutional lung weakness. Because the lungs and heart are so close together they share the same area on the face and often share similar TCM patterns as they are both in the same Jiao.
For more detailed information on Facial Diagnosis read Lillian Bridges book on the subject available at Amazon: