When an Element is in balance, the face does not manifest the Elemental colour. When a colour is apparent, the associated Element is out of balance. The colour resonant with the Element appears on the face beside or under the eyes, in the laugh lines or around the mouth. Unlike the emotion or the sound in the voice, the colour is relatively constant.

The colour may change over time, for example, as the balance of an Element improves. It can also change very quickly after a shock, during an acute illness or while an emotion is intensely felt. In general, however, colour is the most constant of the four key resonances.

A person’s voice normally manifests different and appropriate tones. Different voice tones occur because a person has a variety of emotions. When the emotion is felt the qi moves and this affects the voice tone. For example, a person shouts because anger makes the qi rise and this gives added force to the voice. The practitioner is listening for the sound that stands out as inappropriate or incongruent.

As the patient and practitioner talk, the content of the conversation and the rest of the patient’s expression determine appropriateness. For example, if patients are speaking about events that gave them great pleasure the emotion they express would naturally be joy. It is therefore normal if the voice tone is laughing, the sound resonant with the Fire Element. If patients are talking about their grief about a loved one’s death, then the fitting sound would be weeping, the sound resonant with the Metal Element. A sound that is not appropriate to the context, for example, laughing when the current context is painful, is a sign of an Elemental imbalance.

The voice tone is revealed during conversations between the patient and practitioner, so the practitioner must have skill and determination to ensure that several different contexts and emotions arise in those conversations.

Ideally patients do not have a particular odour. When they do, the Element resonating with the odour is imbalanced. Odour is less constant than colour, but more constant than sound. Odours can change during a treatment by lessening or increasing. They are also more fragile than colour. A practitioner can look away from a colour and then return to it expecting it to still be there; on the other hand, practitioners easily habituate or become desensitised to an odour. Acutely ill or elderly patients tend to emit one or other of the odours strongly.

An appropriately expressed emotion fits the context it is expressed in. During the practitioner–patient interaction the ‘context’ arises mainly from the content of the conversation. The practitioner must decide which of the five emotions is the least appropriately expressed. Like voice tone, appropriateness is measured by assessing whether the emotion is appropriate to the context in which it is used and the movement of the qi is smooth and of appropriate intensity. Emotions do not have a clear definition in modern psychology. The Rebers say ‘Historically this term has proven utterly refractory to definitional efforts; probably no other term in psychology shares its combination of nondefinability and frequency of use’ (see Reber and Reber, 1985, pp. 236–237). We would say that an emotion usually involves three things: 1, bodily sensations (to which people can become habituated and hardly feel); 2, some cognitive element, for example, interpretative perception based on memory; and 3, motivational properties in that the emotion tends to play a role in impelling activity.

The practitioner notices which emotion is the least fluent and least appropriate of the five. To use the previous example, if a patient is describing pain but has a laugh in the voice and appears to feel joyful, she or he is expressing an inappropriate emotion. By contrast, someone describing an upcoming and genuinely threatening situation would normally show some signs of fear, however mild.

Observing an emotion is somewhat different from observing a colour. From the practitioner’s point of view, emotions are perceived as patterns that can be discerned from what the patient says, the tone of voice, the facial expression, the gestures and bodily stance. The emotion is not simple, like a colour, but is more complex and changes from one moment to the next. According to Ekman and Friesen (2003, p. 7), ‘Our studies of the body, published in professional journals, have explored the differences in what the face and the body tell us. Emotions are shown particularly in the face, not in the body. The body instead shows how people are coping with emotions.’

Table 7.1 suggests that there are just five emotions. In the language of everyday life, this is not true. The concept, set out in the Nei Jing, of five key emotions posits that there are five emotional areas, each resonating with an Element. The resonance table labels the main emotion, but that emotion is really part of a continuum that has various extremes. For example, joy is a natural and normal emotion. But here its use spans both a complete absence of joy or misery on the one hand to euphoria on the other. Both are extreme and usually ‘inappropriate’ expressions.

Another issue about emotion is the language patients use to express what they feel. Practitioners cannot necessarily trust the patient’s own perception of their emotions because emotional language was not primarily designed to describe feelings. For example, many patients who are obviously anxious and fearful in temperament do not perceive themselves to be that way at all. Verbal descriptions have their use, but even novelists when attempting to convey emotions rely less on the language of emotions and more on context, thoughts and the telltale, non-verbal signs of emotions.