bubble_chart Concept

A patient's face lacking color and appearing pale is referred to as a white complexion, which is caused by nutrient-blood not nourishing the face. This is mainly seen in the pattern of deficiency cold and blood deficiency pattern. Suwen．Chapter on the Generation of the Five Zang-Organs: "Colors and flavors correspond to the five zang-organs; white corresponds to the lungs and pungency." Lingshu．Chapter on Five Colors: "White represents cold." "Using the five colors to name the organs, ... white represents the lungs." Lingshu．Jueqi Chapter: "In cases of blood desertion disease, the color is white, naturally lacking luster." Zhengzhi Zhunsheng．Summary of Observing Colors: "White color belongs to the lung metal, indicating insufficient dominant qi and blood, which is the color of the hand Taiyin lung meridian." These discussions essentially summarize the clinical significance of a white complexion. Due to different reasons causing nutrient-blood to fail to nourish the face, a white complexion can be further distinguished as pale white, dull white, or pallid white.

bubble_chart Pattern Analysis

1. Blood Deficiency︰complexion pale, emaciated physique, dizziness and blurred vision, palpitation and insomnia, numbness in hands and feet, scanty menstrual flow in women, pale lips and tongue, weak pulse. Mostly caused by spleen-stomach weakness, insufficient generation and transformation, or excessive loss of blood, resulting from blood deficiency cervical malignancy with cachexia. Jingui Yaolue. zang-fu organs, meridians and collaterals, abnormal pulse syndromes states: "A white complexion indicates blood loss." This syndrome manifests as pale and lusterless complexion, accompanied by emaciation, vertigo, palpitation, insomnia, limb numbness, pale lips and tongue, weak pulse, etc. Treatment should focus on tonifying blood, and the recommended formula is Four Ingredients Decoction with modifications.
2. Yang Deficiency︰The complexion is pale and dull, with fatigue and lack of strength, shortage of qi, reluctance to speak, cold body and limbs, spontaneous sweating, bland taste in the mouth, absence of thirst, clear urine, loose stool, pale lip and tongue color, and weak pulse. If accompanied by scanty urine and edema, the face appears pale and puffy. This is caused by insufficient yang qi, which fails to promote blood circulation. The distinguishing features are: a pale and dull complexion, accompanied by fatigue, lack of strength, cold body and limbs, clear urine, loose stool, and other manifestations of yang deficiency with internal cold. If yang deficiency leads to water-dampness retention, it may also present with puffiness, or even scanty urine and edema. Treatment should focus on warming and tonifying yang qi, with the formula selection being Right-Restoring Decoction with modifications. For cases with water-dampness retention, the treatment should aim to warm yang and promote water excretion, with the formula selection being Life-Relieving Kidney Qi Pill with modifications.
3. Internal Abundance of Yin Cold︰The complexion is pale, abdominal pain is severe, aversion to cold with a preference for warmth, bland taste in the mouth without thirst, cold limbs and curled-up lying posture, clear urine and loose stool, pale tongue with white and slippery coating, and deep slow pulse. Pudendal coldness indicates an interior cold pattern. Cold causes contraction, the channels become congealed and stagnant, hence accompanying symptoms such as severe abdominal pain, clear urine and loose stool, and deep slow pulse. The treatment should focus on warming the middle and dissipating cold, and the formula Aconite Middle-Regulating Decoction can be modified accordingly.
4. External Contractionwind-cold︰The complexion is pale, aversion to cold is severe, fever is mild, without sweating, headache and body pain, tongue coating is thin and white, and the pulse is floating and tight. The pattern of wind and cold attacking the external is caused by the invasion of external cold and the stagnation of defensive yang, thus accompanied by symptoms such as aversion to cold with fever, headache and body pain, and a floating and tight pulse. The treatment should focus on releasing the exterior with pungent-warm herbs, and the formula selection is Ephedra Decoction with modifications.
5. Collapse of Yang Qi︰complexion pale, great dripping sweating, sweat thin and cold, limbs cold, no thirst or preference for hot drinks, curled up lying with mental fatigue, pulse faint and on the verge of disappearing. This is caused by severe deficiency and sudden collapse of yang qi, hence accompanied by symptoms such as great dripping sweating, sweat thin and cold, curled up lying with mental fatigue, pulse faint and on the verge of disappearing. Treatment should focus on restoring yang to save from collapse, with prescriptions such as Cold-Extremities Decoction or Ginseng and Aconite Decoction modified as appropriate.
6. True Heat with False Cold︰complexion pale, cold limbs, aversion to heat, thirst with preference for cold drinks, scanty dark urine, dry stool accumulation, red crimson tongue with yellow dry coating, deep rapid and forceful pulse. True heat with false cold. The pale complexion is caused by excessive internal heat, with yang qi stagnated internally and unable to reach the body surface, manifesting as "exuberant yang repelling yin" syndrome. Therefore, besides the false manifestations of pale complexion and reversal cold of hands and feet, there are also true internal heat symptoms such as absence of aversion to cold but aversion to heat, thirst with preference for cold drinks, scanty dark urine, dry stool accumulation, red crimson tongue with yellow dry coating, and deep rapid forceful pulse. Treatment should focus on clearing heat and promoting fluid production. The recommended formula is White Tiger Decoction with modifications.

In the diagnosis of a pale complexion, in addition to the aforementioned differential criteria, attention must also be paid to its luster. A complexion that is pale yet bright and moist, with a subtle sheen, is considered favorable, whereas a complexion that is pale, withered, and overly exposed indicates a deficiency of stomach qi. As stated in Suwen．Chapter on the Generation of the Five Zang-Organs: "A complexion as white as dry bones signifies death; ... a complexion as white as lard signifies life." Furthermore, Suwen．Maiyao Jingwei Lun states: "A white complexion should resemble goose feathers, not salt." Therefore, in clinical practice, the differentiation of a pale complexion must take into account both the color and the luster.

bubble_chart Documentation

1. Jingui Yaolue．palpitation due to fright, hematemesis, epistaxis, hematochezia, chest fullness, static blood, abnormal pulse, syndrome and treatment: "If the patient's face is pale, without signs of cold or heat, and the pulse is deep and wiry, it indicates epistaxis; if the pulse is floating and weak, and disappears upon pressing, it indicates hematochezia; if there is vexation and cough, hematemesis is certain."
2. Zhengzhi Zhunsheng．Essentials of Observing Complexion: "White complexion... if seen in liver disease, it is difficult to treat... If white is mixed with black or yellow, it indicates mutual generation and is auspicious; if white is mixed with red, it indicates mutual overcoming and is ominous. In cases of cold-damage disease, a pale and spiritless complexion is caused by excessive sweating or loss of blood."
3. 《Four Examinations Juewei．Inspection》: "The liver governs the west, belongs to metal, and its color is white. White indicates deficiency and cold. If there is sorrow and lack of joy, the complexion will be white; if there is loss of blood, depletion of qi, or loss of body fluids, the complexion will be white."
4. 《Chinese Medicine Linzheng Beiyao》: "If the complexion is as white as paper, it indicates that the heart qi is critically endangered."