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[Danxi] Facial heat is often caused by fire qi being constrained and transforming into heat. Facial coldness is often caused by deficiency of stomach qi.

[Ling Shu] Facial heat indicates disease of the Foot-Yangming meridian. (From "Chapter on Disease Forms of Qi-Evil and Zang-Fu")

[Li Dongyuan] Irregular diet damages the stomach; when the stomach is damaged, there is shortness of breath, lack of spirit, and generation of intense heat. Sometimes fire qi ascends, scorching only the face. The *Zhen Jing* states: "Facial heat indicates disease of the Foot-Yangming meridian."

[Luo Tianyi] Facial Heat: The wife of Physician Yang, aged 51, was obese. In the spring of the Jiyi year, she suffered from dizziness and oppression in the head and eyes, with significant facial redness and heat. Medications for clearing upper-heat were ineffective. I treated her. Her pulse was surging (Hong) and large, yet forceful. The *Nei Jing* states: "Facial heat indicates disease of the Foot-Yangming meridian." The *Mai Jing* states: "When Qi of the Yangming meridian is excessive and surplus, the anterior part of the body becomes hot." Moreover, this person habitually consumed rich and sweet foods, leading to accumulated heat in the stomach. The Yangming meridian is abundant in blood and qi; when Liver Wood becomes excessive, wind-heat ascends. All Yang meridians converge at the head and eyes; thus, the pathology of facial heat arises. First, administer Tiaowei Chengqi Tang (Regulate the Stomach Purge Down Decoction) 7 qian, plus Huanglian (Coptidis Rhizoma) 3 qian and Xijiao (Rhinocerotis Cornu) 1 qian, to purge downward three times thoroughly, eliminating the root heat. Subsequently, use Shengma Jia Huanglian Tang (Cimicifugae Rhizoma with Coptis Decoction) to dispel wind-heat ascending through the collaterals. In this way, both branch and root pathogens will recede.

Shengma Jia Huanglian Tang (Cimicifugae Rhizoma with Coptis Decoction)
Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix) (each 1 qian); Baizhi (Angelicae Dahuricae Radix) (7 fen); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (5 fen); Shaoyao (Paeoniae Radix Alba) (5 fen); Jiuhuanglian (Coptidis Rhizoma, wine-treated) (4 fen); Shengxi mo (Rhinocerotis Cornu powder, raw) (3 fen); Chuanxiong (Ligustici Chuanxiong Rhizoma) (3 fen); Jingjiesui (Schizonepetae Spica) (3 fen); Bohe (Menthae Haplocalycis Herba) (3 fen).
Crush the herbs to the size of hemp seeds. Soak Chuanxiong, Jingjie, and Bohe separately in half a cup of water. Combine the remaining herbs as one dose, add two cups of water, and decoct until one cup remains. Add the three previously soaked herbs and decoct together until seven-tenths remain. Strain and take warm after meals. Several doses will cure. Avoid alcohol, damp noodles, and the five pungent spices.

Cough with air retention, inability to lie flat, and facial heat resembling drunkenness indicate stomach heat rushing upward to steam the face. Use Fuling Guizhi Wuwei Gancao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction) plus Dahuang (Rhei Radix et Rhizoma) to promote purgation. (See previous text under "Wheeze and Inability to Lie Flat" for the formula.)

[Luo Tianyi] Facial Coldness: The Abbess of Weimo Temple in Zhending, aged 61, was emaciated. In October of the Jiyi year, she suffered from intolerance to cold in the head and face, weak qi, and fear of facing the wind. Various treatments failed. Upon diagnosis, her pulse was wiry (Xian), thin, and faint. Being elderly, she subsisted mainly on tea and fruits, indicating inherent deficiency of the Foot-Yangming meridian. The *Mai Jing* states: "When Qi is insufficient, the anterior part of the body experiences cold and shivering." Additionally, chanting scriptures consumes Qi, leading to deficiency of Stomach Qi and collateral Qi. Unable to nourish the head and face, she dislikes wind and cold. First, use Fuzi Lizhong Wan (Aconite Pill to Regulate the Middle) to warm the middle Qi. Then, treat with Shengma Tang (Cimicifuga Decoction) added with Fuzi (Aconiti Lateralis Radix Praeparata).

Shengma Tang (Modified with Aconite)
Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Baizhi (Angelicae Dahuricae Radix), Huangqi (Astragali Radix) (each 7 fen); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (5 fen); Hei Fuzi (Prepared Black Aconite Root, processed) (7 fen); Renshen (Ginseng Radix); Caodoukou (Amomi Fructus Rotundus) (each 5 fen); Yizhiren (Alpiniae Oxyphyllae Fructus) (3 fen).
Crush the herbs to the size of hemp seeds. Combine as one dose, add three cups of water and two white onion bulbs with roots intact. Decoct until one cup remains. Strain and take warm before meals. Several doses will lead to good recovery.

Discussion on Shengma Tang: One might ask: What is the basis for using Shengma Jia Huanglian Tang for facial heat and Shengma Tang added with Fuzi for facial coldness? The answer is: It originates from Zhang Zhongjing. Yun Qizi, in his commentary on Gegen Tang (Kudzu Decoction) in the *Shanghan Lun*, stated: If the pulses at Cun, Guan, and Chi are all long, it indicates disease of the Yangming meridian, which should manifest on the second or third day. Because this meridian connects the nose and orbits the eyes, symptoms include body heat, eye pain, nasal dryness, and inability to lie flat. This is disease of the Yangming meridian. It begins at the intersection of the nose and bridge of the nose, running from head to foot along the anterior body, representing the interior of the exterior. Yangming meridian has superficial heat and internal excess. From the superficial aspect, the pulse is floating and long; from the internal aspect, it is deep and solid. Yangming disease presents with steaming heat, aversion to cold is absent, and body heat is the superficial disease. Internal excess in Yangming involves dry stomach, nasal dryness, and eye pain, constituting the root disease. Yangming is the root of muscles; sweating is strictly prohibited. For internal excess, purgation is not prohibited; inducing sweat would transform the condition into jaundice. Taiyang governs the exterior, comprising Ying and Wei. Below Ying and Wei, muscles belong to Yangming. When Taiyang and Yangming diseases combine, Gegen Tang is indicated. Wei corresponds to Guizhi Tang aspects, Ying corresponds to Mahuang Tang aspects. Within Ying and Wei, Guizhi Mahuang Gemban Tang (Half-Guizhi Half-Mahuang Decoction) is used. Below Ying and Wei, in the muscle layer, Gegen Tang is used, also known as Jiemi Tang (Muscle-Releasing Decoction). Thus, Yangming is the root of muscles, and its treatment is not solely focused on inducing or arresting sweat. Combining Guizhi and Mahuang formulas creates a single entity; adding Gegen forms Gegen Tang. Therefore, it occupies the position between Ying/Wei and muscles. Guizhi, Shaoyao, Shengjiang, Gancao, and Dazao arrest sweat; Mahuang, Guizhi, and Gancao induce sweat. Gegen has a light flavor; adding it alone does not aim to induce or arrest sweat but to release the muscles via Gegen, hence the name Gegen Tang. Qian Zhongyang created Shengma Tang to treat Shanghan plague wind-heat, high fever, headache, limb pain, and eruptive diseases (whether erupted or not), using Gegen as the Sovereign herb, Shengma as the Assistant, and Gancao and Shaoyao to stabilize the middle Qi. Zhu Fengyi, in writing the *Huo Ren Shu* (Book for Saving People), listed Shengma as a resolving agent for the Yangming meridian. When I treated Lady Yang, both the superficial and root aspects of the Yangming meridian were excess. I first attacked the interior, then drained wind-heat from the collaterals, thus using Shengma Tang added with Huanglian, treating heat with cold. The Abbess had both superficial and root deficiency in the Yangming meridian. I first fortified the interior, then circulated the collaterals, thus using Shengma Tang added with Fuzi, treating cold with heat. Zhang Zhongjing is the ancestor of all formulas; this is indeed true.