What kind of “beast” is the green-faced beast, and what kind of “ghost” is the red-haired ghost?

This is the 5229th article of Da Yi Xiao Hu

Each of the 108 heroes of Liangshan Marsh has a distinctive nickname. Many of these nicknames reflect the physical characteristics of the characters. For example, Li Kui and Song Jiang were called Black Whirlwind and Black Sanlang respectively because they were dark-skinned, while Zhang Shun, the White Jumper in the Waves, and Zheng Tianshou, the White-Faced Young Man, had much whiter skin. Du Qian, the Touching Heaven, and Song Wan, the King Kong in the Clouds, are tall and high center forwards, and are definitely more stylish than the short-legged tiger Wang Ying. As for Du Xing, the Ghost Face, I really don't know how ugly a person's face must be to earn this "nickname". Today, from the perspective of modern medicine, let's talk about the facial features of two of the most well-known characters, Yang Zhi, the Green-Faced Beast, and Liu Tang, the Red-Haired Ghost.

Yang Zhi's first appearance was in the 12th chapter of Water Margin. It is said that Lin Chong was forced to go to Liangshan Mountain when he had nowhere else to go. He was harassed by Wang Lun, the first generation leader of Liangshan Mountain, who asked him to kill an innocent passerby within three days as a "letter of surrender". Then Lin Chong ran into Yang Zhi at the foot of Liangshan Mountain. The two fought for thirty or fifty rounds without a clear winner. The Water Margin describes Yang Zhi's appearance as "a big blue mark on his face, and a little red beard on his cheek". Judging from the location and color of this blue mark, it should be diagnosed as Ota nevus.

Nevus of Ota is a benign melanocytic proliferative lesion common in East Asians. It is caused by the accumulation of melanin in the dermis and was first described by the Japanese Ota in 1938. Nevus of Ota mainly affects the facial area along the ophthalmic and maxillary branches of the trigeminal nerve, such as the periorbital area, forehead, and zygomatic area, and appears as brown, blue or blue skin patches with clear borders. Nevus of Ota is a congenital birthmark. About half of them appear as blue-gray spots on the skin around one eye in infancy, and a few are bilateral, and can even spread to the mouth and nose. Nevus of Ota grows slowly in the early stages and is relatively stable after puberty. It may deepen in color with age, but rarely becomes cancerous.

Nevus of Ota needs to be differentiated from another blue-blue birthmark, Mongolian spot. Mongolian spots mostly grow on the waist, back, and buttocks of newborns, and are rarely seen on the head and face. The pigment cells of Mongolian spots are distributed deeper than those of Nevus of Ota, mostly in the deep dermis, but the color will generally lighten and fade away 3 to 5 years after birth, so treatment is usually not required. Nevus of Ota will not fade on its own. Larger lesions can be treated with pulsed dye laser, which can restore the normal color of the skin without leaving marks or scars.

Yang Zhi naturally had no conditions to accept this kind of treatment. After leaving Liangshan, he started the "Lost on Journey" mode. After a series of bad luck such as buying an official position, selling a knife, killing Niu Er in anger, and being exiled to Daming Mansion, Yang Zhi finally met the Red-haired Ghost Liu Tang in the "Huangnigang Incident" that changed his fate. Unlike Lin Chong and Yang Zhi, who had the status of civil servants within the system, Liu Tang, the initiator of "stealing the birthday gift", was a professional robber. Just because he "had a cinnabar mark on his temples, people called him the Red-haired Ghost". It can be seen that the origin of the "Red-haired Ghost" is not because of the red hair, but because of the cinnabar mark on his face.

In Chinese classical literature, cinnabar often plays the role of a "mascot" that helps the hero and heroine to get married. In fact, it is a red birthmark. The most common red birthmark in adults is port-wine stains, also known as port-wine stains, which are a congenital telangiectasia malformation. Port-wine stains often appear at birth and are prone to occur on the head and face. They appear as skin erythema with clear and irregular edges. They are generally located in the superficial layer of the skin, do not protrude from the skin, and can fade when pressed. With age, port-wine stains gradually deepen in color, increase in area, thicken in texture, and even develop nodular hyperplasia, resulting in local enlargement and deformation, which seriously affects the appearance. Generally, laser or photodynamic therapy can be used to treat port-wine stains based on the principle of selective photothermal action of hemoglobin.

References:

1. Shi Naian, Luo Guanzhong. Water Margin. People's Literature Publishing House, April 1997, second edition.

2. Zhang Disheng. Zhang Disheng Plastic Surgery. Shanghai Science and Technology Press, January 2002.

3. Guidelines for the diagnosis and treatment of hemangiomas and vascular malformations (2016 edition). Hemangioma and vascular malformation group of the Plastic Surgery Branch of the Chinese Medical Association.

Author: Shanghai Tenth People's Hospital

Plastic Surgery Liu Guangpeng, deputy chief physician