Facial Assessment Systems: Chinese Medicine and Beyond

March 11, 2015

 By Mary Kay Ryan

Copyright 2015 Mary Kay Ryan

Anyone who looks at complexion and knows the illness may be called enlightened.”  -Ling Shu – Han Dynasty 2nd c BCE

A spirit [superior doctor] looks [at the patient] and knows [his illness]; he does not have to ask him, listen to him or feel his pulse.”  -Chang Shih Hsien c. 1510 BC

First study the patient’s facies (the many faces of one person); whether it has a healthy look and in particular whether it be exactly as it normally is.  If the patient’s normal appearance is preserved, this is best; just as the more abnormal he is, the worse it is.”  -Hippocratic Corpus 5th c BCE

A physiognomist draws his data from movement, shapes and colours, and from habits as appearing in the face, from the hair, from the smoothness of the skin, from voice, the condition of the flesh, parts of the body and from the general character of the body.”  -Aristotle (Theophrastus) 3rd c CE

A man’s wisdom maketh his face to shine and the boldness of his face shall be changed”  -Ecclesiastes 8: I

Does not the physician pay more attention to the physiognomy of the sick than to the accounts brought to him of his patient?”  -Lavater 18th c CE

All ancient medical systems defined a truly superior doctor as one who could look at the patient and know what the illness was. Asking questions was considered an inferior way of gleaning information because the patient did not usually have enough knowledge of disease to be able to provide the most useful or correct answers. Sometimes patients were mistaken. Sometimes they did not or could not tell the truth. But a doctor’s many years of experience with disease in all kinds of people and situations provided him or her with the background to know what s/he was looking at in an instant.

To practitioners of modern Western medicine, mechanical testing has replaced even asking the patient about the details of illness. For many, if not most, practitioners of traditional medical systems such as Chinese medicine, asking has replaced looking. There are many reasons for this. It is not an art that is well understood in the modern world. Indeed, we do not even look at each other in a day to day social context as much as people did as recently as the 19th century.

“Sin [or for our purposes, sickness] is a thing that writes itself across a man’s face. It cannot be concealed. People talk sometimes of secret vices. There are no such things. If a wretched man has a vice, it shows itself in the lines of the mouth, the droop of the eyelid, the moulding (sic)” -Oscar Wilde, Portrait of Dorian Grey

It is also a very difficult subject to teach being dependent upon having access to sick people just at the right moment to point out the moment for instruction. Also much of what is being taught is very subtle and not always easy to point out or see. Teachers are often dependent upon photographs, an inferior second to actual faces in the moment. From ancient times to the present across vastly distant cultures, it has been agreed that learning to observe the face and what it is communicating is an art based on many years of experience. In fact, in some places it was thought to be such a difficult and esoteric practice that it was considered a gift from the divine. As this Sufi writer of the 12 c. put it,

“Physiognomical intuition is the light transmitted by the word of the Prophet, the Guide, the chosen Envoy. Whoever possesses this intuition receives it from the eyes and ears of God himself, who is the One, the Original and the Initiator. The result is that it allows one to contrast the things that are known in the invisible and in the visible.”

Finally, as it is a somewhat lost art, there is a lack of knowledge about the kinds facial assessment systems that have existed and the purposes to which they were put. Many modern practitioners of Chinese and other traditional medical systems were not themselves taught facial assessment in any useful way. Additionally, most instructors have not have been able to make an extensive study of the practices involved. Thus, many teachers have not had the experience or training themselves needed to teach facial assessment effectively.

Kinds of Facial Reading Systems

The most commonly encountered name used for facial assessment is ‘physiognomy,’ a term that comes from the Greek and meant originally ‘knowledge or study of the physis’ or life force discerned by observation of the face and body. The idea was that the inner person or spirit was visible on the person’s outer surfaces.

Physiognomy has been put to many purposes over the centuries, including medical ones. However, it is most often associated with assessment of inborn personality and the divination of fate. Physiognomic systems concern themselves primarily with facial morphology and structure (facial shape, shape of features, relationship of one feature to another) to make statements about a person’s character and the future (or past) of the client. This is only a general statement as physiognomists from China to Greece have concerned themselves to a lesser degree with issues such as health and emotions, but physiognomy is not primarily medical. The practice has tended to be discounted in the modern world since the 19th century. Most of us just do not believe that the shape of your eye or your nose is related to anything significant about your personality or fate. (Although if we are truthful, we are making judgments based on peoples’ appearance all the time, as many studies have shown.)

Physiognomy has also been used in highly judgmental and offensive ways against people of races different than the physiognomist and against women. In physiognomy from India, for instance, it was thought that a woman of questionable moral tendencies could be discerned by characteristics of her feet and on her face. Such prognostication could be highly detrimental to her ability to make a good marriage. Irish people’s faces were compared to people of African origin who were in turn compared to apes in a highly insulting manner. However, physiognomists do sometimes demonstrate amazing insights into people. The question to our modern sensibilities would be precisely how they are accomplishing these feats.

Medical assessment systems are, as one would expect, focused on health and disease. They were used to diagnose disease and come up with appropriate treatment regimens. But In days gone by they had a second, equally important function. They were used to make a prognosis as to the likely outcome of a particular illness. In this way, then, they were also concerned with ‘fate’ but in a medical sense. Doctors in ancient times relied heavily on reputation to build their practices. If a doctor had a significant number of patients die under his care, this was not good thing for the ‘prognosis’ of his own careers. So one reason to be able to make an accurate patient prognosis, was to avoid treating those for whom there was no hope. This was often done via facial assessment.

Medical facial assessment systems turn their attention to more changeable aspects of the face than do physiognomy, especially changes in color, quality of skin, newly developed markings, shadow and to a lesser extent, facial lines.

There is an overlap between physiognomic and medical facial assessment which lies in the assessment of a patient’s ‘constitution.’ The term, constitution, may be used in a variety of ways. But simply put, constitution is that which is seen to be relatively inborn and unchangeable in a person. For a physiognomist this related to the client’s personality whereas to a doctor, it was about the tendencies in health and ways disease was likely to manifest in the long run. A modern and somewhat extreme example might be the tendency of persons with Downs syndrome to manifest respiratory illness because of a malformation of the sinuses that can be seen in a Downs shaped face. But much more subtle distinctions were part of traditional constitutional systems. Constitutional systems, like physiognomy, tend to focus on that which is more structural and unvarying on the face, although they might also take into account chronic emotional states to which we will return presently.

Another way that people have evaluated the face is by looking at the expression of emotion on it. Although this has become popular in recent times because of the work of Paul Eckman and the program Lie to Me, it is actually a practice that dates back to ancient times.

“Form and affections (emotions) appearing in the face are considered according to their likeness to the affection. For when one suffers anything, one becomes as if one has the expression.” -Aristotle/Theophrastus

Renaissance artists such as Di Vinci, Durer, and della Porta were particularly interested in emotion and how it might be expressed in their works. But Darwin also wrote extensively on the expression of emotion which he thought had developed as a survival mechanism long before we had become fully human. To be able to determine the good or bad intentions of strangers, he thought, might keep one alive to reproduce. These emotion reading systems turn their attention to the rapidly changing lines and expressions that occur while one is experiencing the emotions of the moment. There is a final way that one may assess the face. The signs of long term, chronic affective states may also be read.

“Physiogonomy discerns internal motives, distinguishes what is permanent in the character from what is habitual and what is habitual from what is accidental.” -Lavater

What I have called ‘chronic affect’ may be seen by a combination of permanent (or semi-permanent) lines, color, shadow, glow and “energy,” as it appears on the face. According to one study, these may show up so early in life that one can predict the long term emotional life of someone from their high school year book. Perhaps reading this chronic emotional stance in its early stages is one way that physigonomists are able to make such accurate predictions about fate.

Of course, there are also multiple systems throughout the world that claim to read the energy field or aura of the face. These are probably the most difficult to learn in any systematic way. But in my experience, if one turns her attention to the more mundane aspects we have discussed in this article, more exoteric levels will reveal themselves spontaneously of their own accord. Perhaps this is why true artistry in facial assessment has always been associated with many long years of practice. But the journey of a thousand miles begins with a single step.

For a doctor truly concerned with the welfare of his/her patients, any one of these systems may have something to offer, even if we do not accept everything precisely as the system asserts it. These methods can, for instance, be seen as ‘levels’ of the face. In any case, embedded in all of these approaches are profound insights and thousands of years of clinical experience from which we may now learn. And looking at each other again is an enjoyable experience that has the potential to teach us to pay better attention and improve our care for one another whether we are doctors or not.

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