Journal of Chinese Medicine | Issue 128 | February 2022

The Anatomy of Expression

The Anatomy of Expression

Michelle Gellis

Abstract

The human face is unique in its ability to display our emotions, desires
and intentions, as well as provide a diagnostic window into our health.
Acupuncturists are able to use the face as a diagnostic tool to understand and
treat underlying imbalances that may ultimately lead to disease. This article
explains the relationship between facial expressions, the physical muscles
and tissues, acupuncture points and channels of the face, and the inner world
of the human being. Two short case studies are included to illustrate how the
information presented can be used in the clinic.

Keywords
Acupuncture, Chinese medicine, cosmetic, facial rejuvenation, emotions, expression

The seven universal emotions and facial expressions

In the late 1800s, Charles Darwin suggested that facial expression). According to Su Wen Chapter 39, ‘Many
expressions of emotion are the same wherever you go diseases involve emotional disharmony’.4 When emotions
in the world. In the late 20th century Dr. Paul Ekman are prolonged, intense or unexpressed, they can inhibit
travelled the world to research facial expressions and proved the normal flow of qi. Thus each emotion has a specific
Charles Darwin’s theory was indeed correct.1 It is now identifiable effect on qi: grief and melancholy consume
widely supported within the scientific community that qi; fear causes qi to descend; fright disperses qi; anger
there are seven basic emotions, each of which has its own causes qi to rise or stagnate; joy slows qi; worry causes
unique and distinctive facial expression. These are: qi to knot. Each of the emotions runs along a continuum
Happiness, Sadness, Fear, Disgust, Anger, Contempt and from deficiency to excess, for example: lack of joy to mania,
Surprise.1 In addition to these seven basic emotional overly sympathetic to lack of sympathy, lack of assertiveness
expressions, there are 15 combined expressions: Happy, to rage, overly fearful to reckless.
Sad, Fearful, Angry, Surprised, Disgusted, Happily
Surprised, Happily Disgusted, Sadly Fearful, Sadly Angry, The face and the emotions
Sadly Surprised, Sadly Disgusted, Fearfully Angry, Fearfully
Surprised, Fearfully Disgusted, Angrily Surprised, Angrily There is a two-way feedback system between the face and
Disgusted, Disgustedly Surprised, Appalled, Hatred the internal organs. That is, when a person feels a specific
and Awed.2,3 emotion, it will typically be expressed on the face.5 As well
as moving from the inside outwards in this way, emotions
Chinese medicine and the emotions work from the outside in: studies have demonstrated that
if a person arranges their face into a certain expression,
According to the principles of five element acupuncture, they will feel the corresponding emotion.1,2 Speaking in
an individual’s health can be assessed by identifying colour relative terms, happiness may be as simple as ‘putting on a
(looking at the face), sound (listening to the voice), odour smile'. However, if an individual cannot or does not express
(smelling the body) and emotion (observing emotional emotions appropriately through their facial expressions,

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Journal of Chinese Medicine | Issue 128 | February 2022
The Anatomy of Expression

Figure 1: Action unit 4 - the brow lowerer 9 Figure 2 : Anger Figure 2a: Anger

the emotion will not be fully ‘processed’ through the Diagnosis of emotions
zang fu. An experiment that used Botox® to paralyse the
facial muscles involved in frowning identified a decrease The Facial Action Coding System (FACS) is a taxonomy of
of depressive symptoms in patients.6 This demonstrates human facial movements originally developed by a Swedish
that facial feedback modulates the neural processing anatomist named Carl-Herman Hjortst. It was later adopted
of emotions. This points to the idea that for a person to by Paul Ekman and Wallace V. Friesen, and published in
be healthy there must be a free flow of emotions to and 1978.8 These authors classified the facial movements into
from the face. what they referred to as
In health we feel ‘action units’ (AU). An
emotions appropriately By identifying blockages as they AU is a set of facial muscle
and do not react to the
presence of an emotion
manifest on the face and treating articulations that results in
a distinct visible expression.
in ourselves or in another. the acupuncture points responsible For example, action unit
However, if our response
to an event is excessive
for the relevant muscular movement, 4 (AU4) is what Ekman
and Friesen refer to as the
or repressed it can cause facial acupuncture can play an ‘brow lowerer’, made up of
obstruction of qi. This
obstruction will manifest
important role in promoting health. the corrugator supercilia,
procerus and depressor
on the face; therefore, over supercilii (see Figure 1).2
time habitual patterns of expression get ‘lodged’ in the face.7 In order to make the facial expression of anger, action units
This can be particularly problematic if we are unaware of 4+5+23+38 are used (see Figure 2). Action unit 5 is the upper
our habitual responses. Any impediment to qi and blood lid raiser, 23 is the lip tightener and 38 is the nostril dilator.
flow in the points and channels of the face will cause All of the movements involve muscular contraction, most
diminished function - both physical and emotional. One of noticeably tightening of the centre of the forehead, the lips
the most common patterns of disease involves obstruction pressing against the teeth, and flaring of the nostrils. Action
of the flow of qi caused by unexpressed emotions. One of units can also be used to describe more complex expression
our jobs as practitioners is to use our diagnostic skills and of emotion such as Happily Surprised or Happily Disgusted
treatment to create awareness within our patients of these (see Figure 3).
habitual responses and then guide them towards balance.
In this way, by identifying blockages as they manifest on the Anatomy of the emotions
face and treating the acupuncture points responsible for the
relevant muscular movement, facial acupuncture can play Anger
an important role in promoting health. When the muscles Frequent expression of anger can cause deep furrows in
return to normal function, the pathways between mind and between the eyebrows (See Figure 2a). The tight pursing
body open up and the person can return to health. of the lips and pulling up of the nasalis when one snarls

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Journal of Chinese Medicine | Issue 128 | February 2022
The Anatomy of Expression

Figure 3: The compound expression Happily Disgusted

with anger can cause lines on the sides and bridge of the
nose. In order to bring these muscles into proper function
acupuncture points in the muscles used to make the
expression can be needled. The muscles used to make the
expression of anger, along with the acupuncture points
that can be used to regulate the muscle (and therefore the
emotion) are: Figure 4: Joy
• Corrugator supercilli: Zanzhu BL-2
• Procerus: Yintang M-HN-3
• Depressor supercilli: Zanzhu BL-2 halfway between Dicang ST-4 and REN-24 Chengjiang
• Levator palpebrae: Yuyao M-HN-6 • Zygomaticus major: Quanliao SI-18
• Superior tarsal • Depressor labii inferioris: Jiachengjiang M-HN-18
• Nasalis: Yingxiang LI-20
• Orbicularis oris: two motor points at Kouheliao LI-19, Sadness
halfway between Dicang ST-4 and REN-24 Chengjiang Sadness pulls the medial edges of the eyebrows and the outer
• Mentalis: half a cun lateral to Chengjiang REN-24 corners of the mouth downward. This can result in creases
• Dilator naris anterior, depressor septi nasi: Suliao DU-25, between the eyebrows and a ‘marionette’ line from Dicang
DU-26 Renzhong ST-4 down to the jawline. The muscles used to express
sadness along with their associated acupuncture points are:
Joy • Frontalis: Yangbai GB-14
In Chinese medicine, excessive joy is thought to injure • Corrugator: Zanzhu BL-2
the Heart. The Chinese character for joy is comprised • Depressor supercilli: Zanzhu BL-2
of the characters for xi (elation) and le (contentment).  • Depressor anguli oris: motor point directly inferior
In the Su Wen (Basic Questions), xi is described as to Dicang ST-4 on a horizontal line lateral to
making the qi 'loose', ‘which implies agitation and a loss Chengjiang REN-24.
of control’.10 Excessive expression of joy can result in
deep nasolabial creases and ‘crow’s feet’ (wrinkles from Fear
the lateral part of the eye). A horizontal line can also By definition fear is an unpleasant emotion caused by the
form over the top lip from smiling. The muscles used belief that someone or something is dangerous, likely to cause
to express joy along with their associated acupuncture pain, or constitutes a threat. Fear is associated with the water
points are: element. Fear of lack of resources can cause an individual to
• Orbicularis oculi: Tongziliao GB-1, Zanzhu BL-2, Sibai overwork, thereby taxing the Kidneys, and over time can
ST-2, Qiuhou M-HN-8, Sizhukong SJ-23, Yuyao M-HN-6 deplete jing-essence. The muscles used to express fear along
(needled upwards) with their associated acupuncture points are:
• Orbicularis oris: two motor points at Kouheliao LI-19 and • Corrugator: Zanzhu BL-2

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Journal of Chinese Medicine | Issue 128 | February 2022
The Anatomy of Expression

Figure 5: Sadness Figure 6: Fear

• Zygomatic minor: motor point halfway between Sibai • Orbicularis oculi: Sibai ST-2, Qiuhou M-HN-8,
ST-2 and Juliao ST-3 motor point halfway between Tongziliao GB-1 and
• Depressor labii inferioris: Jiachengjiang M-HN-18 Sizhukong SJ-23
• Risorius: Dicang ST-4 • Depressor anguli oris: motor point directly inferior
• Platysma: Daying ST-5, Renying ST-9 to Dicang ST-4 on a horizontal line lateral to
Chengjiang REN-24.
Disgust • Mentalis: half a cun lateral to Chengjiang REN-24
The emotion of disgust involves loathing or repugnance
towards someone or something to which we have an aversion Contempt
or find offensive. The outward expression is similar to anger, Contempt is the only one-sided expression. Contempt
but the emotion itself is not well defined in Chinese medicine. describes a feeling of dislike for, and superiority (usually
It involves our relationship to what we take in through our moral) over, another person or group of people and/
senses (usually our eyes). If this goes against our values the or their actions.11 Feeling contempt asserts power or
disgust is likely related to the metal element (disdain, value), status. Those who are uncertain about their status may
but if it is a taste or smell it may be more connected to the manifest contempt to assert their superiority. Conversely,
earth element. The expression of the emotion causes our lips, someone with a higher ranking may feel contempt towards
nostrils and eyes to tighten in an effort to keep the offensive those with a lower ranking. Contempt is related to but
smell, sight or taste out. The muscles used to express disgust different from disgust. Contempt is directed toward
along with their associated acupuncture points are: people and their actions, whereas disgust can be aroused
• Corrugator: Zanzhu BL-2 by offensive objects. Another difference is our physical
• Procerus: Yintang M-HN-3 reaction: disgust causes us to move away from the source,
• Depressor supercilli: Zanzhu BL-2 whereas with contempt we do not necessarily want to
• Zygomatic minor: motor point halfway between Sibai remove ourselves from the situation. Also, disgust does
ST-2 and Juliao ST-3 not feel good, whereas contempt may not necessarily feel
• Levator labii superioris: motor point halfway between unpleasant, and may even feel good because it can assert
Yingxiang LI-20 and Sibai ST-2 a feeling of power. It is a very complex emotion and for

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Journal of Chinese Medicine | Issue 128 | February 2022
The Anatomy of Expression

Figure 7: Disgust Figure 8: Contempt

the Chinese medicine practitioner can be differentiated • Angrily surprised

according to the five elements:12 • Disgustedly surprised
– Water: Projections regarding ambition, feeling
contempt towards someone for having too much or not The muscles used to express surprise along with their
enough ambition associated acupuncture points are:
– Metal: The darkness in the depths of self; contempt about • Frontalis: Yangbai GB-14
lack of purity • Depressor Labii inferioris: Jiachengjiang M-HN-18
– Earth: Contempt around appetite and indulgence • Levator superioris: Motor point halfway between
– Fire: Contempt around sexuality or openness Yingxiang LI-20 and Sibai ST-2
– Wood: Contempt for lack of clarity; rigidity around • Superior tarsal & levator (only if lax): Yuyao M-HN-6
right and wrong • Lateral pterygoid muscles: Reached via Tinghui GB-2

The muscles used to express contempt along with their Treatment

associated acupuncture points are:
• Buccinator Treatment methods can be designed for each of the
• Zygomaticus Major - motor point halfway between Sibai imbalanced emotions based on the different AUs involved. In
ST-2 and Juliao ST-3 iao addition to treating the acupoints in the appropriate muscles,
• Orbicularis oculi - Qiuhou M-HN-8 and motor point one must look at the correlation of each acupuncture point
halfway between Tongziliao GB-1 and Sizhukong SJ-23 and its corresponding channel and organ system. For example,
if a patient has deep frown lines, which correspond to an
Surprise expression of anger, using distal points that treat stagnation
Surprise is a response to an unexpected or astonishing or heat (depending on diagnosis) in the Liver channel will
event, fact or thing. Surprise can take on many forms: create ease and relax the forehead. In turn, treating the
• Happily surprised appropriate face points will balance the Liver even further.
• Sadly surprised In addition to local and distal points, it is important to
• Fearfully surprised consider blocks to treatment as well as the patient’s spirit.

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Journal of Chinese Medicine | Issue 128 | February 2022
The Anatomy of Expression

Case 1 before and after treatment

be Parkinson’s or Alzheimer’s disease. He was having trouble

communicating, displayed diminished cognitive abilities and
was losing his coordination. She had been with her husband
since high school and the stress of watching his decline was
affecting her both physically and emotionally. She would
have to repeat herself over and over when speaking to her
husband and she could not leave him alone in the house.
Figure 9: Surprise She missed the partnership they had enjoyed. She was
deeply worried about the future, frustrated with her present
situation and grieving over the loss of her relationship with
The importance of clearing blocks was covered extensively her husband. Worry, grief and frustration were finding their
in my previous article ‘The Importance of Clearing Blocks way into the muscles between her eyebrows and causing
Prior to Facial Acupuncture Treatment’.13 Using acupuncture deep furrows. She was also experiencing headaches, which
points for their influence on the spirit can encourage healing were debilitating at times. Although outwardly she would
on a much deeper level than just the physical. Examples of smile and joke and say she was fine, when she spoke of her
points that I have found particularly useful for their effect on situation at home her eyebrows would pull in tight together
the patient’s spirit are: and the tension in her depressor supercilii, procerus and
• Dicang ST-4 and Chengjiang REN-24 for treating corrugator muscles was apparent. She would also purse her
bitterness and resentment resulting from over-nurturing lips tightly, which was causing lip wrinkles and dimples in her
(typically seen in individuals who feel forced to care for chin. This was indicative of anger and frustration.
others when they do not choose to). The depressor anguli After clearing initial blocks (aggressive energy, entry/
oris, mentalis and depressor labii inferioris are used to press exit14) I began a treatment plan to ease the signs of frustration
the lips together and pull the sides of the mouth down. in her forehead. This included submuscular needling of
• Daying ST-5 eases tightness in jaw in those who are the procerus and corrugator muscles, plus motor points
holding back speaking what they are thinking and treats associated with those muscle groups, just lateral to Zanzhu
excessively ingratiating behaviour. BL-2 for her furrowed brow plus Kouheliao LI-19 and
• GB-41 Zulinqi spreads stagnant qi in Liver and Gall halfway between Dicang ST-4 and Chengjiang REN-24
Bladder channels and allows for emotional release of for Orbicularis Oris, and half a cun lateral to Chengjiang
frustration/anger. REN-24 for the mentalis. I combined these points with
Xingjian LIV-2 and Taichong LIV-3 to relax the Liver, ear
Case studies Shenmen to calm her spirit and Jiache ST-6, Shuaigu GB-8
and Yangbai GB-14 to relax tension in her jaw and forehead,
Case 1 plus Yintang M-HN-3 and Baihui DU-20 to calm her mind.
DT was a 70 year-old, vivacious and engaging fire type. After her first treatment she reported feeling much less
When she first came to see me, her husband had recently stressed. By her fourth visit the lines between her eyebrows
retired and was showing early signs of what was believed to began to relax as well. She continued to see me on a weekly

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Journal of Chinese Medicine | Issue 128 | February 2022
The Anatomy of Expression

looked unhappy all the time. I also reviewed the ‘before

photos’ I had taken and confirmed. She only saw me a couple
more times before the coronavirus pandemic, but her results
have been maintained throughout the writing of this paper.

Conclusion

Facial expressions of emotion can be a useful tool for

diagnosis and treatment planning. Our entire history lives
in our face and is etched in our facial expressions.
Case 2 before and after treatment Recognising and treating the muscles involved in making
these expressions, treating the spirit and clearing energetic
blocks can bring forth emotional, spiritual and energetic
and then monthly basis for several years. Her forehead shifts in our patients.
relaxed considerably, and the tension she held in her
masseter dissipated as well.
Michelle Gellis is a licensed and Board Certified acupuncture
Case 2 physician. She served as a faculty member and clinic
SK, 67, was the primary caregiver for her mother for many supervisor at the Maryland University of Integrative Health
years until she passed, and subsequently the caregiver for her from 2004 to 2020 and holds the distinction of being one of
father until he also passed. When she arrived in my office, she the few acupuncturists in the U.S. certified to teach cosmetic
looked as if someone or something had sucked the joy and life acupuncture certification classes on a national level to other
out of her. She had travelled from home to care for her parent, acupuncturists. In addition to facial rejuvenation, Michelle
to work and then back to her parent every day for years, with teaches classes on facial cupping, gua sha and neuromuscular
little time for her own needs. The area of SK’s face where the facial conditions. She can be contacted through her website
grief was most apparent was in the corners of her mouth, at the at <https://www.facialacupunctureclasses.com>.
modiolus. Tension from the depressor anguli oris had pulled
the corners of her mouth down into deep crevices. SK had References
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SK came in after her third treatment with a picture of herself 12. Personal interview with Lonny Jarrett in June 2020.
from a month prior to show me how much different she looked. 13. Gellis, M. (2018). The Importance of Clearing Blocks Prior to Facial
Acupuncture Treatment, Journal of Chinese Medicine, 116: 69-74:
She said neighbours and friends had noticed that she no longer

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