A particularly well-developed aspect of visual diagnosis in Greek Medicine and other traditional healing systems is facial diagnosis. This is also called the art of physiognomy.
The chief function of the face is expression, which is the giving of visible outer form or manifestation to inner states of feeling or being. Everyone is familiar with the facial expressions of various emotions and sentiments like happiness, joy, sorrow and grief, but the face can also give outer expression to inner states of health or disease. As with other forms of visual diagnosis, there is a discernment between that which is innate, and of the constitutional makeup of the individual, and that which indicates acquired conditions and imbalances. In general, those parts of the facial structure and anatomy that are more solid and durable, such as the bone structure, are the most reliable indicators of constitutional makeup, whereas those aspects of facial anatomy that are most subject to change, principally the fleshy parts and soft tissue, are the most prone to indicate acquired conditions and imbalances. Here, too, the physician must not only be a keen observer of the patient’s facial features as they are, but also, he must be able to visualize how the patient’s face would look in a state of perfect health and balance.
In our study of facial diagnosis in Greek Medicine, we will start from a general study of the face as a whole, and proceed to the various parts of the face and their specific diagnostic signs and indicators.
The Spirit and Countenance
The countenance is a traditional medical term for the overall presentation of the face and the spirit that radiates from it. From the countenance, the physician gets his initial impressions of the general, overall mental, emotional and spiritual state of the patient.
Emotionally, the countenance can reflect the patient’s habitual or predominant emotional state(s). Mentally, the countenance can reflect the patient’s predominant thoughts and habits of mind. Spiritually, the basic spiritual state of the patient can be seen in the aura or radiance of the countenance. For the physician, developing perception and awareness of these factors is as much an intuitive process as it is an objective or rational one, and can’t be taught through any set formula or repertory of signs; it comes only through clinical experience.
The basic distinction to be made by the physician in judging or divining the countenance is between bright or radiant on the one hand, and dull, cloudy or confused on the other. If the patient’s countenance is bright and radiant, his/her overall spirit and vitality are good, and the prognosis will also be good. If the patient’s countenance is dull, muddled or obscure, his/her spirit and vitality levels will be poor, or low, and the prognosis will also be poor. In addition, a dull, muddled or confused countenance will also be seen in those who are suffering from mental and emotional disorders.
Temperament and Facial Structure
Generally, one of the most reliable basic indicators of someone’s constitutional nature and temperament is the overall structure of their head and face. Included in this are certain facial features and signs as typical indicators of temperament.
Each of the Four Temperaments has certain basic facial structures, or shapes, associated with it. These shapes can also be symbolic expressions of a temperament’s predominant element. Certain other facial signs and structures have planetary and astrological correlations as well.
Choleric (Fire): The most common basic facial shape is triangular, with a narrow forehead and a broad, angular jaw. A prominent, jutting chin can also be part of the picture, and often indicates being emotionally volatile , supercharged, or high strung. A pointed, prominent nose is also Choleric, and is a Martian sign, as are high, prominent cheekbones. Arched eyebrows and pointed, angular features are common. The facial complexion is often ruddy or reddish, or sometimes sallow.
Another commonly seen Choleric subtype is the Apollonian face, associated with the Sun god Apollo, and the solar-ruled astrological sign of Leo. The basic shape of the head and face is oval, which can be a bit elongated, with a long, prominent aquiline nose. The eyes are big and prominent, but the face as a whole is pleasing and well-proportioned, and is often framed by wavy, brilliant golden locks of hair.
Sanguine (Air): Since the Sanguine temperament is basically the most equable and balanced of all, it’s not surprising that the Sanguine facial types are also quite balanced, aesthetic and pleasing. The basic shape of the face and head is oval, or egg-shaped, with a tapering, delicate chin, mouth and lips. The eyes tend to be brown, limpid and almond shaped, quite beautiful in appearance; the rest of the facial features are pleasing and well-proportioned.. The hair is usually brown or chestnut colored, luxuriant and wavy. Dimples are common, and the neck tends to be long and elegant. This basic facial type is called Venusian, and is often associated with the sign Libra.
A variation on this basic face shape is the acorn shaped face, with a large head, forehead and upper face, and a relatively small and tapering cheeks, chin, mouth and lower face. The nose tends to be short and compressed, but can also be angular and prominent, or like and eagle’s beak. The ears tend to be large and long-lobed, the eyebrows full, and the hair curly or wavy. This type of face is associated with the planet Jupiter, and often indicates a philosophical disposition, as well as a tendency towards liver problems and congestion.
Melancholic (Earth): The earth element’s basic shape is a square; so, too, is the Melancholic face typically square or rectangular in shape. The balanced, well-nourished, earthy Melancholic individual will have a broad, solid, square face, with a well-developed bone structure; all the facial features will similarly be broad, squarish, and well-formed. The neck will be broad, stout and strong. This type is commonly associated with the sign Taurus.
If the Melancholic individual isn’t so balanced and well-nourished, the face will be narrower and rectangular in shape, often with hollowed out cheeks, thin lips and small, beady eyes. Another common Melancholic face is the inverted triangular face, with a broad forehead and head and a narrow, elongated, tapering chin and jaw; it shows someone of an analytical, cerebral, nervous temperament, also with a tendency to liver problems. It is the Melancholic counterpart to the more healthy and robust Sanguine Jupiter type.
The Mercurial face is a Melancholic subtype that shows a nervous temperament. The basic shape of the head and face are of a considerably elongated oval; the Mercurial face ages well, and looks perennially youthful. The nose is long and thin, and the eyes large, sparkling and dark. The head hair is generally wiry and wavy, and men with this facial type often find that a mustache and/or goatee suits them well. The Mercurial face is associated with the signs Gemini and Virgo.
The Saturnine face is another Melancholic subtype that is generally associated with the sign Capricorn. It is generally long and thin, with the complexion often pasty or sallow. There is usually a prominent aquiline nose, which may point sharply downwards towards the chin, which is often prominent. The back of the head, from the occiput to the crown, may be flattened, and the chin may be tucked down into a ramrod-straight neck and spine in a military posture, showing rigidity and inflexibility.
Phlegmatic (Water): The basic shape of the Phlegmatic face and its features is round. The eyes are large, watery and limpid, often blue or gray in color, with thick, luxuriant lashes. The cheeks are full, and may be dimpled. There is usually a small pug nose or button-shaped nose. The chin will be rounded, not prominent, and may even be receding; double chins are common, especially with weight gain. The head and facial hair are usually light, and eyebrows wispy. The hairline is often high, and the forehead prominent.
The round Phlegmatic face is most closely associated with the sign of Cancer, and, to a lesser extent, with Pisces. Scorpio, due to its classical Mars rulership, is a mixture of Phlegmatic and Choleric in its facial type.
These are the descriptions of the basic facial types and subtypes. I’m sure that you can see them in many famous people, or people you know. Most of us, however, are of mixed types.
The forehead is that part of the face which is primarily responsible for the spiritual radiance of the countenance. That’s because, in the subtle astral body, the Third Eye, also called the spiritual eye, is located here.
The forehead is also an extension or projection of the frontal lobe of the brain. And so, cerebral types – intellectuals, philosophers and great thinkers – have a prominent forehead.
On the forehead, especially of older people, are typically found various wrinkles, lines or creases. Each one of them has its own special meaning.
Transverse lines, or wrinkles, on the upper forehead indicate many worries and anxieties. More medially, over the nose, they indicate anxieties; more laterally, over the eyebrows, they indicate worries.
Some people have vertical lines on the lower forehead, between the eyebrows. On the right side, going up from the medial end of the eyebrow, a vertical wrinkle indicates liver problems; on the left side, such a wrinkle indicates spleen problems. If the vertical line or wrinkle runs straight down the middle, it indicates a tendency towards skepticism. A horizontal wrinkle or crease across the bridge of the nose can indicate prostate problems in men, and cervical problems in women.
The temples are the hollows or indentations on the lateral sides of the forehead, above and lateral to the eyebrows. They give a number of important diagnostic signs and indications.
Temples that are unduly sunken or hollowed out can indicate dehydration, consumption, or a general state of malnutrition and emaciation.
Prominent veins and blood vessels in the temples indicate a tendency towards high blood pressure. Sometimes, there is even a visible pulsation of these blood vessels.
Red, inflamed temples can be a sign of migraines. Sometimes, the temples will even be hot to the touch.
The eyebrows are the rooftops of the eyes. They help the eyes express themselves, and help shield them from the sunlight and the elements.
Thick, heavy eyebrows are a sign of a strong, robust constitution. Eyebrows that are missing in their lateral one-third indicate a tendency towards blood sugar problems and diabetes. A heavy, prominent “beetle brow”, combined with prominent cheekbones and an elongated chin and facial structure is called acromegaly, and is typical of giantism and an excess of growth hormone.
The eyes are the windows of the soul, which governs the body. The eyes have it. The eyes are therefore very rich sources of diagnostic information.
Red, bloodshot eyes are usually a sign of excess heat and choler flaring upwards from the liver to affect the head and eyes. They are often seen in those of a Choleric temperament, or those suffering from a Choleric imbalance, like infection or inflammation.
Bags under the eyes, particularly with dark circles under them, indicate weak, run-down, devitalized kidneys and adrenals. Transverse wrinkles right underneath the lower eyelid indicate adrenal weakness.
Bags below the eyes indicate kidney problems, but bags above the eyes indicate congestion of the liver, particularly with fats and cholesterol.
A broken crease above the upper eyelid indicates a tendency towards ovarian problems in women. These can involve painful ovulation or a history of ectopic pregnancies.
The sclera are the whites of the eyes. Yellow sclera are an indication of jaundice. Brown or opal colored rings around the outside of the sclera indicate a tendency towards high cholesterol. Redness of the sclera can indicate fever, allergies, hay fever, measles, bleeding, skull fractures or rheumatoid arthritis. In such cases, the conjunctiva are also inflamed. A bluish sclera can indicate either a cold temperament or intestinal parasites.
If the lower part of the sclera, underneath the iris is showing and the lower eyelid is drooping, this indicates a profound exhaustion of the Psychic Force and the autonomic nervous system.
The conjunctiva, or inner mucosal surfaces of the eyelids, which can be observed by pulling downwards on the lower eyelid, also provide valuable diagnostic information. Pale conjunctiva are a classic sign of anemia, or blood deficiency. If the pale conjunctiva should also be moist and swollen, Phlegmatic conditions of swelling and edema, often due to low protein levels in the blood, or poor venous return, are indicated. Conjunctiva that are red and inflamed are a sign of conjunctivitis, or an infection and inflammation of the mucosa of the eye. In addition, inflamed conjunctiva are often seen in conjunction with a red inflamed sclera in the conditions mentioned above.
Eyeballs that are too prominent, popping out of their sockets, are called exopthalmia, and are a classic sign of hyperthytoidism; they can also indicate the presence of a swelling, tumor or growth that is pushing them outwards. The opposite condition, or sunken eyeballs, often with swelling and puffiness in the orbital tissues surrounding the eyelids, is a common sign of myxedema and hypothyroidism. In addition, wasting or consumptive diseases like tuberculosis can cause the eyes to sink back into their sockets, along with hollow cheeks and sunken temples, due to a depletion of serous fluids and the Radical Moisture.
A cornea that is dull or cloudy can indicate the beginning stages of a cataract. With a full-blown cataract, white, cloudy patches will form on the cornea.
A blurred or clouded over border between the sclera and the cornea, the clear covering over the iris, is often associated with high cholesterol, high triglycerides, hyperlipidemia, arteriosclerosis and plaque formation. If this white, cloudy covering is prominent over the top of the iris, it is called the arca senilis, or arc of senility, and is often associated with senility and plaque deposits in the brain.
In general, the Four Basic Qualities are reflected in the eyes in the following ways:
Hot: Red, bloodshot or inflamed eyes and conjunctiva. Sensitivity and irritation of the eyes. Yellow sclera indicates jaundice, and yellowish streaks or discolorations in the iris indicate Choleric conditions and bilious deposits.
Cold: Bluish sclera. Pale, bluish or cyanotic conjunctiva.
Wet: Easy tearing; moist, limpid eyes. Pale, swollen conjunctiva and eyelids. Puffiness and swelling of the tissues surrounding the eyelids.
Dry: A dry eyeball can indicate lacrimation disorders or deficiency, and is also associated with a depletion of the vital fluid essences and Radical Moisture of the liver. In consumptive conditions of deficient serous fluids and Radical Moisture, the eyes will often be sunken and hollow.
Greek Medicine and Iridology
The jury is still out on iridology; it has its proponents as well as its detractors. Nevertheless, some aspects of iridology do seemingly have relevance to Greek medicine, although iridology is not one of its traditional practices. I’ll leave you to be the judge.
Iridology sees different constitutional types associated with the basic structure of the iris and its fibers. These appear to have some loose correspondence with the Four Temperaments, or constitutional types, of Greek Medicine.
Basically, dense, tightly woven iris fibers indicate a strong, solid, robust constitution. Conversely, loosely woven iris fibers with many gaps between them tend to indicate a frail, delicate constitution.
The Four Temperaments, or basic constitutional types of Greek Medicine, and their associated acquired humoral conditions and imbalances, are indicated by the following iris colors, structures and signs:
Sanguine: The Sanguine iris type is called hematogenic by iridologists. The iris color is usually brown or hazel, and its fibers tightly or densely woven; as the Sanguine is considered to be the most balanced and equable of temperaments in Greek Medicine, so the densely woven hematogenic type is considered to be the most desirable by iridologists. However, this type is vulnerable to toxic and metabolic disorders of the blood.
Red flecks or discolorations on the iris indicate congested or hot, toxic blood. The densely woven hematogenic iris is also most commonly affected by concentric circular waves or striations that resemble the growth marks on a tree; such striations are associated with deeply held nervous tension and spasmodic conditions by iridologists, as a sort of Nervous / Melancholic counterpoint or undercurrent to the Sanguine.
Phlegmatic: The lymphatic iris type is characterized by light, airy, loosely woven iris fibers, reflecting the generally loose, lax tone of the muscles, organs and tissues in those of a Phlegmatic temperament. The color of the lymphatic iris is usually blue or gray.
This iris type is the most prone to white discolorations on its fibers, which show an accumulation or congestion of excess phlegm or stagnant lymph. A lymphatic rosary is when a necklace or garland of interconnected white, cloudy spots encircles the outer edge of the iris; it’s associated with lymphatic congestion and obstruction. A scurf rim, or dark outer margin of the iris, also commonly seen in the lymphatic iris, indicates a tendency towards toxic congestion of the skin and poor elimination of toxins through perspiration, which throws an extra toxic load on the lungs, liver and kidneys.
Choleric: The mixed type of iris, midway between the hematogenic and the lymphatic, is most closely associated with the Choleric temperament. The texture is also mixed, with alternating dense and loose patches of fibers.
According to iridologists, there are only two basic kinds of iris colors – the brown – hazel hematogenic and the blue – gray lymphatic. Those of a Choleric temperament often have green eyes, but upon closer examination, this is shown to be nothing more than blue or gray mixed with yellow discolorations. In any type of iris, yellowish discolorations indicate inflammatory conditions or bilious deposits.
Melancholic: In my opinion, the Melancholic temperament also usually corresponds to the mixed iris type. Dark black or brown spots or discolorations indicate deposits of black bile or charred, oxidized forms of black or yellow bile. Nervous stress rings, mentioned earlier under the Sanguine iris type, are another Melancholic sign.
The key premise of iridology, and also its most controversial assertion, is that the iris can be mapped out into various reflex zones, corresponding to different organs, tissues and parts of the body. And so, a nebulous white cloud, or white patch, in the liver zone would indicate a Phlegmatic congestion of the liver; a yellowish discoloration in that same spot would indicate an inflammatory or bilious condition of the liver, and so on.
As I said earlier, iridology is controversial; I leave it to you to decide on its accuracy and reliability. My presentation of the iridology material here must be understood to be tentative and experimental. To view an iridology chart, or investigate iridology further, there are several fine sites you can google up on the web.
Constitutional strength and robustness is generally indicated by larger, fleshier, more developed ears. In particular, ear lobes that are large, fleshy, and fully detached from the neck indicate a healthy, robust, well-developed endocrine system and a generous endowment of the Radical Moisture.
The tissues of the ear are richly endowed with capillaries, and receive a good perfusion of blood. These fine capillaries may be especially visible and profuse in those of a Sanguine temperament, or those suffering from an excess or congestion of blood. If these capillaries are purplish, it indicates blood stagnation and/or cyanosis. In certain kinds of low grade fevers and consumptive heat conditions, the edges and lobes of the ears may get red or rosy.
A profuse amount of hair growing inside the ear canal often indicates a tendency towards high cholesterol or a family history of heart disease. Wrinkles or creases on the upper part of the earlobes can also indicate high cholesterol. A foul discharge from the ear indicates the presence of an inner ear infection, as does a swollen or tender mastoid prominence behind the ear.
The nose is the centerpiece of the face. There are several different basic facial types, as we saw, and each one has its own characteristic type of nose, which is central to the structure and shape of that face.
The nose, being the organ of the sense of smell, has, basically speaking, a Choleric nature and temperament. Its basic shape is pointed and phallic, giving it a correspondence with the planet Mars, as well as with the male sexual organ.
The nose, being the external opening of the respiratory tract, has a reflex relationship with the lungs, and also with the heart, the principal organ of the Vital Faculty. The nose, especially its tip, is rich in capillaries and receives a rich perfusion of blood; and so, the overall state of the heart and circulation is reflected in the nose.
Prominent, visible capillaries on the tip of the nose indicate a Sanguine temperament or a congestion of blood; if these capillaries should also be purplish, it indicates blood stagnation and/or cyanosis. Alcoholism will often produce a nose tip that is swollen and red, with visible capillaries; alcohol has unduly excited the blood circulation and dilated the peripheral blood vessels.
Sometimes there may be rosacea, which is a butterfly-like pattern of red patches over the nose and cheeks. It is commonly seen in alcoholism, allergies, and Systemic Lupus Erythematosus (SLE). It can also indicate a condition of Choleric excess.
If the nasal patches are obstructed and there is breathing through the mouth and a nasal sounding voice, rhinitis and nasal allergies are indicated. The ala nasi, or the wing-like coverings of the nostrils, are often flared or dilated in asthma. A deep groove lateral to the ala nasi indicates respiratory weakness, and a deep, prominent naso-labial wrinkle or groove indicates a malabsorption of nutrients.
Dentists routinely examine the mouth, teeth and gums. But these parts of the body can also give signs and diagnostic information about the health of other parts of the body as well, including the organism as a whole.
Red, tender gums that bleed easily are not only a sign of gingivitis, or gum inflammation, but also of excessive heat and choler in the blood. Soft, spongy gums can either indicate a Choleric condition or scurvy. Pale gums can indicate anemia. Receding gums indicate the presence of periodontal disease. Hypertrophy of the gums is a sign of epilepsy.
A yellowish-brown discoloration of the teeth is found in Choleric conditions, as well in those who chew tobacco, consume excessive coffee or caffeine, or in those who vomit a lot, usually due to bulimia or other eating disorders. A dry mouth indicates extreme thirst, which can be present in diabetes, or in dehydration due to diarrhea or fever; mouth breathers can also have dry mouths, which can also occur as the side effect of some medications.
Smokers will often have teeth that are stained a yellowish brown. They will also often have lips, gums, and oral mucosa that are tinted a characteristic bluish-brownish purple. Increased salivation and drooling are often seen in stomatitis, Parkinson’s disease, or in intestinal parasites. A greenish yellow exudation from the gums can indicate either oral sepsis and pyorrhea, or a chronic lung condition.
The lips are the extreme upper end of the digestive tract. And so, the lips most closely portray the condition of the digestive organs, although signs and indications of other conditions can also be present in them. The upper lip is most closely associated with the stomach, liver and spleen, as well as with the heart and lungs – the organs of the thorax and epigastrium lying above the navel. The lower lip is associated with the intestines.
A large, swollen lower lip is commonly found in those with chronic constipation. Thick lips can also be a sign of Phlegmatic excess and a hypoactive thyroid.
The lips receive a large perfusion of blood, which makes them a good barometer for the health and overall condition of the blood and Vital Faculty. Pale lips usually indicate anemia. Bluish or purple lips can indicate either cyanosis, extreme cold and deficiency of the Innate Heat, or the nicotine habit, which will color the lips a characteristic brownish purple.
Lips that are unusually large and thick can be a sign of Down’s syndrome, or they can be due to cosmetic alteration. Puckered lips that are brownish in color are a sign of scleroderma. Frequent canker sores can be a sign of a lung or respiratory infection. White spots on the lips can be due to intestinal parasites. Brownish colored lips can also be seen in adrenal failure and Addison’s disease. Angular stomatitis, or the inflammation and erosion of the corners of the lips, can be seen in vitamin B12 deficiency, or pernicious anemia.
The Chin, Cheeks and Jowls
The cheeks and jowls, as well as underneath the chin, are the areas of the face where the tissues most begin to sag as one ages, and where systemic metabolic imbalances lead to the buildup of deposits of excess or morbid humors and adipose tissue.
Phlegmatic conditions and excesses stored in the cheeks, jowls and under the chin are the most common, and are characterized by pale or pallid discoloration, sagging loose tissues, bags under the chin, or a double chin; these signs are also often associated with a hypothyroid condition. Goiter, or an iodine deficiency of the thyroid gland, will swell that gland, giving an enlarged neck over the Adam’s Apple.
Sanguine conditions and excesses stored in the cheeks, jowls and under the chin will be swollen and fleshy, due to the moisture of the Sanguine temperament, but there won’t be as much looseness and sagging of the tissues, and better tone. The color complexion will be rosy or blushing, and visible fine capillaries are often seen.
Choleric conditions and excesses will be stored in the cheeks and jowls, but not so much under the chin. There will be visible swelling and enlargement associated with these deposits, and the tone of these excess tissues will will be firmer than either the Phlegmatic or the Sanguine. Typically, a sallow discoloration is present, but the skin can also be ruddy or bright red with excess heat.
Melancholic excesses and deposits will be much like the Choleric, except the discoloration will be olive colored or dull yellow. Dark liver spots are also common, and generally indicate the presence of morbid charred or oxidized forms of black and yellow bile.
The Hippocratic Face
One of the typical diagnostic signs that Hippocrates is known for is the Hippocratic face, also known as Facies Hippocraticus. It is usually seen when death is imminent after a long and debilitating struggle with a grave disease.
The clinical picture presented by the Facies Hippocraticus is one of a sharp nose, a pinched facial expression, hollow eyes, collapsed hollowed out temples, cold and contracted ears with earlobes turned outwards, rough distended skin above the forehead, and a greenish, ashen, livid or lead colored complexion.
Medicine Throughout Antiquity by Benjamin Lee Gordon, MD – pp. 522 – 523
on Facies Hippocraticus.
Textbook of Ayurveda: A Complete Guide to Clinical Assessment by Dr. Vasant Lad
pp. 63 – 70
Typology in Homeopathy by Leon Vannier, MD – the whole book – on facial types
Eyes are the windows to the liver.
The nose is connected to the heart.
Lungs are connected to cheeks..