Inspection of Vitality and Color

Observation of vitality, or shen (

), is used to determine the body’s general condition of vigor and spirit and is done by examining various aspects of one’s appearance. While this principally entails the observation of a person’s mental activity and facial complexion, it also includes examining other exterior expressions of the body’s internal condition-such as the state of the voice, complexion, form and bearing, etc.

One aspect of evaluating vitality is the observation of complexion. This is done by examining the “Five Colors”: blue-green, red, yellow, white and black. Note that the complexion is not only observed on the face, but is also done on any part of the body where color and luster can be examined. This of course concerns the relative appearance of the colors, not the actual color in pure form. The complexion is an outward expression of the body’s nourishment and state of internal functions. As such, a healthy person has a complexion that is bright and smooth.

There are different aspects of the complexion that can be distinguished. The first is known as the “host” complexion, which refers to one’s intrinsic complexion that is given by race, habitat and heredity. This is the complexion one is born with and remains fixed throughout one’s lifetime. The other aspect is known as the “guest” complexion, which refers to the variable aspect of the complexion that can change in accordance with various lifestyle conditions (i.e., weather, diet, emotional state, etc.).

The “diseased” complexion will more significantly present with color changes, or can appear withered and/or dim. In general, the appearance of each of the five colors relates to a specific organ disorder and indicates particular disease syndromes:

Blue-green ():	liver disorders as well as cold syndrome, pain or stasis syndromes,and fright.
Red ():	heart disorders, heat-fire excess, yin deficiency-yang rising (yang rising as a result of yin insufficiency).
Yellow ():	spleen disorders, dampness and deficiency syndromes.
White ():	lung disorders, yang deficiency, blood loss, qi and blood deficiency.
Black ():	kidney disorders, blood stasis, fluid retention.

In addition to determining the actual color displayed in a diseased complexion, the nature of the color’s appearance must also be examined. For this purpose there are ten “observations” used to describe a quality to the appearance of color. The determined quality can then be related to a specific disease condition or syndrome. There are ten qualities in total that describe the appearance of color, which are summarized with their related pathologies in the following table:

COLOR QUALITY		DESCRIPTION		RELATED DISORDER/SYNDROME
Superficial ()	:	Distinct, prominent	→	Exterior disorders
Sunken ()	:	Concealed	→	Interior disorders
Clear ()	:	Bright	→	Yang syndromes
Turbid ()	:	Dark, dull	→	Yin syndromes
Faint ()	:	Light	→	Deficiency
Dark ()	:	Deep	→	Excess
Diffuse ()	:	Dispersed, scattered	→	Recent, new disorders
Concentrated ()	:	Dense	→	Chronic, long term disorders
Lustrous ()	:	Smooth, radiant	→	Mild disorders
Lifeless ()	:	Withered, dull	→	Serious, fatal disease

001 Presence of vitality in mild illness

Presentation

Alert mental faculties, alert gaze

Superficial, clear, bright, lustrous and diffuse red complexion

Red spots along the sides of the nose

Slightly red and yellow canthus

Primary disease diagnosis

Recent, acute disorder

Mild illness

Yang syndrome

Heat syndrome

Case example

Wind-heat skin rash due to external wind-heat contraction affecting the skin (allergic dermatitis)

002 Loss of vitality and disturbance of consciousness (i.e., coma)

Eyes sunken and clouded

Drooping of the eyelid and exposure of the eyeball

Facial complexion is dark, sunken, turbid

Inability to close the mouth

Unresponsive, dull and blank expression

Stiffness and spasm of the nape

Presentation

Exhaustion of essential qi

Coma

Condition with unfavorable prognosis

Primary disease diagnosis

Wind-phlegm convulsions

Exhaustion of qi and essence with liver wind and phlegm obstructing the heart orifice

Case example

003 Loss of vitality in serious illness

Cancer of the liver with metastasis to the brain

Presentation

Dull, dark eyes

Inability to close the mouth

Dull and indifferent expression

Emaciation of the face

Complexion lacks brilliance, but still relatively lustrous and supple

Primary disease diagnosis

Debilitation of yin and yang with insufficiency of the kidney and liver, with loss of mental alertness (while maintaining a relatively healthy complexion)

Deficiency and taxation induced convulsions

Case example

Deficiency and taxation type convulsions

Liver and kidney insufficiency with yin and yang exhaustion

Severe malnutrition with undetermined cause

004 Loss of vitality with atrophy of the major muscles-A

Parkinson’s disease

Urinary tract infection

Fracture of the femur bone

Presentation

Atrophy of the thenar and hypothenar muscles

Dry and shriveled fingers

Primary disease diagnosis

Exhaustion of qi and essence

Fluid consumption and damage

Yin and yang decline

Case example

005 Loss of vitality with atrophy of the major muscles-B

See case 003

Presentation

Muscles are atrophied to the extent that there appears to be only skin and bone

Shriveled and withered skin

Primary disease

Same as case 003

006 Loss of vitality with atrophy of the major muscles-C

diagnosis			Presentation
Case example	Same as case 003
		Dry and shriveled breasts Protrusion of the ribs Navicular abdomen	Primary disease diagnosis
		Same as case 003
			Case example

007 Slight presence of vitality due to a favorable turn in illness

Same as case 003

Presentation

Slight brightness and alertness of the eyes

Red facial complexion

Primary disease

Same as case 003

008 Slight presence of vitality due to deficiency syndrome (with expressionless eyes)

diagnosis	Depicts improvement in complexion post treatment	Presentation
Case example	Same as case 003
	Eyes lack expression, alertness Mental listlessness Pale white facial complexion Blue-black chin Slightly sunken and turbid complexion	Primary disease diagnosis
	Long term illness with yang deficiency Qi and blood depletion Damage to the heart and spleen due to excessive thinking	Case example

009 Slight presence of vitality due to deficiency syndrome (with drooping eyelids)

Yang deficiency gastric pain

Devitalized spleen yang with liver-wood overacting on spleen

Duodenal ulcer

Presentation

Dullness of the eyes

Low spirited

Drooping eyelids

Sunken, faint, dispersed and dull yellow facial complexion

Frayed hair

Flaccid muscles

Primary disease diagnosis

Spleen qi deficiency and weakness

Qi and blood depletion

010 Slight presence of vitality due to deficiency syndrome (with limp and flaccid tongue)

Case example	Drooping eyelids Spleen qi deficiency Myasthenia gravis	Presentation
	Pale red tongue Puffy, tender and limp tongue	Primary disease diagnosis
	Spleen qi deficiency
		Case example

011 Loss of vitality in severe illness

Same as case 009

Presentation

Forward-staring, expressionless eyes

Pallid, dull and dark facial complexion lacking luster

Dark, black colored lips and orbits

Primary disease diagnosis

Exhaustion of the kidney and liver

Qi and blood depletion

Yin and essence damage and consumption

Devitalized yang qi

Case example

Consumptive disease

012 False vitality in critical illness

Spleen and stomach deficiency and decline

Qi and blood exhaustion

Rheumatic heart disease

Cerebral embolism

Presentation

Lusterless eyes suddenly appearing bright

Sunken, turbid and pale facial complexion suddenly becoming slightly ruddy

Degeneration of the large muscles in entire body

Bluish colored abdominal sinews and dyspnea

Speech suddenly becoming loud and clear

Nose bleeding, producing fresh bloodstains on clothing

Primary disease diagnosis

“Last light of a dying candle” syndrome (in which there is a sudden return of energy before collapse)

Deficient yang floating astray due to inability of yin to restrain yang Poor prognosis

Case example

013 Mental confusion with dementia

Drum distention (tympanites)

Long term accumulation abdominal masses leading to decline and exhaustion of Essential

qi, as well as deficient yang floating astray

Liver cirrhosis concurrent with liver cancer

Presentation

Forward-staring eyes

Wide-distance between inner canthes

Turned up rima oculi

White complexion (slightly distorted due to reflection from photo flash)

Frayed hair

Primary disease

Dementia with impaired cognition

014 Mental confusion with visceral agitation and mental depression

diagnosis	Qi and blood insufficiency with lack of nourishment of the heart spirit	Presentation
Case example	Dementia due to insufficient kidney qi and heart blood depletion
	Congenital impaired cognitive development
	Tearful, blurry eyes Weeping expression Sallow, sunken and pale facial complexion that is at the same time lustrous Untidy appearance Unresponsive to questioning	Primary disease diagnosis
		Case example