bubble_chart Concept

Complexion red refers to the patient's facial color being redder than normal. It is usually a sign of internal heat. Lingshu．Chapter on Five Colors states: "The five colors correspond to the organs... red corresponds to the heart"; it also says: "Yellow and red indicate heat." Complexion red is closely related to heat, so in the Treatise on Cold Damage Diseases, complexion red is referred to as "heat color," and there are records such as "facial redness," "complexion uniformly red," and "face combined with red color."

Zhengzhi Zhunsheng{|105|}．Summary of Color Observation says: "Red color belongs to fire, indicates heat, and is the color of the Hand Shaoyin Heart Meridian." {|106|}Complexion red can be distinguished as a flushed face, flushed cheeks, or a face red as if painted. As for complexion red with local swelling and pain, or "facial redness like brocade," these are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Wind-heat External Contraction︰The main manifestations include a red complexion, severe fever with mild aversion to cold, thirst, sweating, red and swollen sore throat, red tongue edges and tip, thin yellow tongue coating, and a floating rapid pulse. The red complexion due to external contraction of wind-heat is caused by the invasion of wind-heat at the exterior and obstruction of the lung-defense, hence accompanied by fever and chills, sweating, red and swollen sore throat, and other signs of an exterior heat pattern. Treatment should focus on releasing the exterior with pungent-cool herbs, using Modified Lonicera and Forsythia Powder.
2. Yangming Channel Heat︰The main manifestations include a flushed complexion, persistent high fever or late afternoon tidal fever, profuse sweating, absence of aversion to cold but presence of aversion to heat, intense thirst with a desire to drink, a red tongue with yellow and dry coating, and a surging or strong, rapid, and forceful pulse. The flushed complexion in Yangming channel heat is caused by external pathogens transforming into heat upon entering the interior, leading to exuberant Yangming pathogenic heat. This results in high fever, sweating, absence of aversion to cold but presence of aversion to heat, and thirst with a desire to drink. The treatment should focus on clearing heat and promoting fluid production, using White Tiger Decoction with modifications.
3. Heat Entering the Nutritive and Blood Levels︰The main manifestations include a flushed face, fever aggravated at night, dry mouth but not excessive thirst, restlessness and insomnia, occasional delirious speech, skin macula and papule, and even hematemesis, epistaxis, bloody stool, hematuria, a crimson-red tongue texture, and a thin, rapid pulse manifestation. The flushed complexion due to heat entering the nutrient-blood is one of the manifestations of warm-heat pathogens invading the nutrient-blood, disturbing the mind, and causing excessive heat to stir the blood. Hence, symptoms such as fever aggravated at night, skin macula and papule, a crimson-red tongue texture, a thin, rapid pulse manifestation, and even bleeding phenomena occur. Fever worsening at night, dry mouth but not excessive thirst, accompanied by skin macula and papule or bleeding, a crimson-red tongue texture with little or no coating, and a thin, rapid pulse should be treated by clearing the nutrient aspect and cooling the blood. The recommended formulas are Nutrient-Clearing Decoction or Rhinoceros Horn and Rehmannia Decoction with modifications.
4. Yin Deficiency︰The clinical manifestations include flushed cheeks in the afternoon, emaciation, dry mouth and throat, vertigo, insomnia, tidal fever, night sweats, vexing heat in the chest, palms, and soles, a red tongue with scant coating, and a thready rapid pulse. This is due to yin deficiency failing to restrain yang, resulting in deficiency fire flaming upward, leading to a pattern of deficiency heat. Thus, symptoms such as flushed cheeks appear, especially in the afternoon when deficient yang is exuberant, accompanied by tidal fever, night sweats, vexing heat in the chest, palms, and soles, a red tongue with little moisture, and a thready rapid weak pulse. The treatment should focus on enriching yin and subduing yang, with modifications of the Duqi Pill as the prescription.
5. Floating of Deficient Yang︰The main manifestations include a {|###|}complexion{|###|} that is pale with flushed cheeks as if wearing makeup, fever yet a desire to cover oneself with clothing, {|###|}thirst{|###|} with a preference for hot drinks, shortness of breath, {|###|}cold sweating{|###|}, cold limbs, clear urine, {|###|}loose stool{|###|}, pale lips and {|###|}tongue color{|###|}, a white or grayish-black and moist tongue coating, and a faint pulse on the verge of disappearing. The characteristic of floating yang with a flushed {|###|}complexion{|###|} is the appearance of bright red cheeks as if painted, usually occurring after prolonged illness when the {|###|}healthy qi{|###|} has declined, {|###|}yang deficiency{|###|} coexists with {|###|}yin exuberance{|###|}, and {|###|}exuberant yin repelling yang{|###|} causes the floating of deficient yang. Thus, the cheeks appear red as if coated with greasepaint, superficial and shifting, accompanied by shortness of breath, sweating, cold limbs, and a faint pulse on the verge of disappearing—signs of {|###|}yang qi{|###|} on the verge of collapse. As stated in Lingshu, Chapter "Five Colors": "If red appears on both cheeks, as large as a thumb, even if the illness seems slightly improved, sudden death will inevitably follow." Treatment should focus on suppressing yin and {|###|}restoring yang{|###|}, using methods to unblock the interior and exterior. Prescriptions such as Vessel-Unblocking Cold-Extremities Decoction are selected. As mentioned in {|###|}cold-damage disease{|###|} theory, "Discussion on Identifying {|###|}shaoyin disease{|###|} Pulse Patterns and Treatment": "In {|###|}shaoyin disease{|###|}, with {|###|}diarrhea{|###|} of undigested food, {|###|}interior cold{|###|} and exterior heat, {|###|}reversal cold of limbs{|###|}, a faint pulse on the verge of disappearing, yet the body does not show aversion to cold, the patient's {|###|}complexion{|###|} is red, or there may be {|###|}abdominal pain{|###|}, {|###|}retching{|###|}, sore throat, or cessation of diarrhea with no pulse returning—{|}Vessel-Unblocking Cold-Extremities Decoction{|} is the primary treatment."

Complexion redness has distinctions of interior deficiency, excess, cold, and heat. A complexion that is red, bright, moist, and subtle is considered favorable, while a complexion that is red, withered, and overly exposed indicates a lack of stomach qi, as mentioned in Suwen. The chapter "Generation of the Five Zang-Organs" states: "A complexion as red as clotted blood indicates death;... a complexion as red as a rooster's comb indicates life." Suwen．Maiyao Jingwei Lun says: "Red should resemble white wrapped in cinnabar, not like ochre." Therefore, in clinical practice, the differentiation of a red complexion must be closely combined with the patient's symptomatic characteristics for comprehensive consideration and prognosis judgment.

bubble_chart Documentation

1. Suwen．Cire Discussion: "For liver heat disease, the left cheek turns red first; for heart heat disease, the face turns red first; for spleen heat disease, the nose turns red first; for lung heat disease, the right cheek turns red first; for kidney heat disease, the chin turns red first."
2. Jingui Yaolue．zang-fu organs meridians and collaterals abnormal pulse and symptoms: "A pale complexion indicates blood loss; if there is a slight redness at an inappropriate time, it signifies death."
3. 《Four Examinations Essentials．Inspection》: "If lung disease shows redness, it indicates heart fire punishing metal, and the condition is difficult to treat."
4. 《External Contraction Warm Heat Chapter》: "For wind-warmth syndrome, symptoms include body heat, spontaneous sweating, red face, mental confusion, heavy body making it difficult to turn, excessive sleepiness, snoring, difficulty speaking, and rapid pulse. This is due to warm evil internally forcing the Yangming, seizing the essence and fluids, and impairing the movement of the spirit. Use Gypsum, Anemarrhena, Ophiopogon Tuber, Pinellia, Bamboo Leaf, and Liquorice Root to clear heat and rescue fluids."