经义
五七阳明脉衰，面始焦。○面肿曰风。○心者，生之本，神之变也；其华在面。（《素问》）
黄帝问曰∶首面与身形也，属骨连筋，同血合于气耳。天寒则裂地凌冰，其卒寒，或手足懈惰，然其面
不衣，何也？岐伯答曰∶十二经脉，三百六十五络，其血气皆上于面。而皮又浓，其肉坚，故天气甚寒，不能
败之也。○面热者足阳明病。（《灵枢》）
人面独能耐寒者，何也？然，人头者，诸阳之会也。诸阴脉皆至颈而还。独诸阳脉皆上至头耳，故令面
耐寒也。（《难经》）
哲言
面不畏寒而畏热，血气之所凑也；肘膝臀 不畏热而畏寒，血气之所不凑也。其血气尤甚者，面能并热不
畏。故经以为其皮独浓，寒暑不能伤也。（《医参》）
风邪入皮肤，痰饮积腑脏，则面 黯。脾、肺二经风湿搏而为热，故面生疮。（《张氏医通》）
饮食不节则胃病，胃病则气短，精神少而生大热。有时而火上炎，独燎其面。（李东垣）
凡病患面赤皆属火。若面红气盛者，此火证无疑也。若颧赤如指、如缕而余地不赤者，此阴虚也。仲景
曰∶面赤戴阳者，下虚故也。面红不退者，邪盛病进为难愈。面白者，气虚也。白兼淡黄而气不足者，失血也。
白而枯者，血气俱败也。青兼白者，阳虚阴胜也。久病面转黄苍者，此欲愈也。病患面黄润而
微赤者，主湿热。黄兼青者，此木邪犯土，不治。面色青苍者，主痛。病愈而面色如煤不开者，终不吉。平人
面色如灰尘，眼下青黑者，必病重。女人面色青者，必肝强脾弱，多怒少食，或经脉不调，颧颊鲜红，名带桃
花。此阴中有虚火，多淫无子。（张景岳）
补编
咳逆倚息不得卧，若面热如醉，此为胃热上冲，熏其面。用桂苓五味甘草汤加大黄以利之。（《金匮》）
面痛属火，盖诸阳皆会于面。火，阳类也。心者，生之本，神之变，其华在面。心，君火也。暴痛多实，
久痛多虚，高者抑之，郁者开之。血热者凉血，气虚者补气。不可专以苦寒泻火为事。（《证治准绳》）
面肿有虚实∶肿者为实，浮者为虚。实肿者，或热、或痛，乃因风火上炎，此以邪之有余也。脉必紧数，
证必寒热。风则散之，火则清之，壅滞秘结则通之、利之。邪去而肿自消也。○虚浮者，无痛、无热，而面目
浮肿。此或以脾肺阳虚，输化失常，或以肝肾阴虚，水邪泛溢。然浮而就上，其形虚软者，多由乎气；肿而
就下，按而成窝者，多由乎水。治气者，须从脾肺，虚则补之，实则顺之；治水者，须从脾肾，虚则化之，实
则泻之。○凡虚浮在气者，虽曰气虚，然亦有虚实之异。盖虚而浮者，多因于脾。此或以劳倦，或以色欲，或
以泻痢，或以中寒，而脉必微弱，气必虚馁者是也。虚而肿者，多因于胃，或水火炽盛而湿热上浮，或纵酒纵
食而阳明壅滞。此其脉必滑数，证必多热者是也。虚实既辨，则或补、或泻、或利、或清，详酌而为之治也。（张景岳）
面肿曰风，两颊赤肿如沸。酒调消风散，或羌、防、升、芷、牛蒡、葱、豉汗之。○风热面肿痛，升麻汤
加白芷、连翘、薄荷、荆芥。○面寒为阳虚阴寒郁遏所致，升麻汤加附子。○面赤为邪气怫郁在经，宜表不宜下。
○面戴阳，下虚也。伤寒用四逆
汤，杂证用地黄饮子。○面白、善嚏、脉紧者，寒也。羌、防、辛、 泻足太阳，少加附子以通其脉。○面色
忽黑，因臭气所冲，一味香附末，盐汤下三钱。○面上豆痕或斑 ，蜜陀僧末，人乳调敷。（《张氏医通》）
选案
一人登厕，臭气熏触，满面黑色，月余不散。相士云∶必死。孙兆先生教以沉、檀香各一两，锉碎，安炉
中烧熏帐内，令病者瞑坐，候香尽方可出帐。明日，引鉴照之，黑色散矣。（《赤水玄珠》）
[Classic Discourses]
Around the age of thirty-five in women, the Qi of the Yangming Meridian begins to decline, and the face starts to become withered. ○ Facial edema is termed Wind disease. ○ The Heart is the root of life and the seat of spiritual transformation; its luster manifests on the face. (Su Wen)
The Yellow Emperor asked: The head and face are connected to the body, bones link to sinews, and blood combines with Qi. When the weather is cold, the earth cracks and ice forms; sudden exposure to cold may cause the limbs to become flaccid and weak, yet the face remains uncovered by clothing. Why is this? Qibo replied: The Twelve Primary Meridians and the three hundred and sixty-five Luo points, their blood and Qi all ascend to the face. Moreover, the skin of the face is thick and the muscles firm, so even in extreme cold, it cannot be damaged. ○ Heat in the face indicates pathology of the Foot-Yangming Meridian. (Ling Shu)
Why is the human face uniquely able to resist cold? The answer is: The head is the convergence point of all Yang meridians. All Yin meridians reach only the neck and then return. Only the Yang meridians ascend to the head, thus enabling the face to resist cold. (Nan Jing)
[Philosophical Remarks]
The face fears heat but not cold, because this is where blood and Qi gather; the elbows, knees, and buttocks fear cold but not heat, because blood and Qi do not gather there. Where blood and Qi are particularly abundant, the face can feel heat without fearing it. Thus, the classics state that the facial skin is uniquely thick, protecting it from harm by cold or heat. (Yi Can)
When Wind pathogen invades the skin, and Phlegm-Fluid accumulates in the Zang-Fu organs, the complexion becomes dark. Damp-Wind combining with Heat in the Spleen and Lung meridians causes facial sores. (Zhang Shi Yi Tong)
Irregular diet leads to Stomach disease; Stomach disease leads to shortness of Qi, reduced spirit, and generation of intense Heat. Sometimes Fire Qi flares upward, burning only the face. (Li Dongyuan)
Facial redness in patients generally belongs to Fire syndrome. If the face is red with vigorous Qi, it is undoubtedly a Fire syndrome. If only the malar region is red like a finger mark or thread, while the rest of the face is not red, this indicates Yin Deficiency. Zhang Zhongjing said: Facial redness resembling "floating Yang" (deficient Yang floating upward) is due to deficiency in the lower Jiao. Persistent facial redness indicates excess pathogen and advancing disease, making it difficult to cure. A white complexion indicates Qi Deficiency. White mixed with pale yellow and insufficient Qi indicates blood loss. White and withered indicates exhaustion of both Qi and Blood. Blue-green mixed with white indicates Yang Deficiency with Yin Excess. In chronic illness, if the complexion turns yellowish-gray, recovery is imminent. Patients with a moist, slightly reddish-yellow complexion have Damp-Heat. Yellow mixed with blue-green indicates Wood pathogen invading Earth, which is difficult to treat. A cyan complexion indicates Pain syndromes. If the complexion remains black like coal and unrelieved after recovery, the prognosis is poor. In healthy individuals, a dusty complexion with dark circles under the eyes indicates severe illness. In women, a bluish complexion indicates strong Liver and weak Spleen, frequent anger, poor appetite, or irregular menstruation. Bright red cheeks are named "Peach Blossom." This indicates deficient Fire within Yin, often leading to excessive sexual desire and infertility. (Zhang Jingyue)
[Supplement]
Cough with inverted breathing, unable to lie flat; if the face feels hot as if drunk, this is Stomach Heat rushing upward, steaming the face. Use Guiling Wuwei Gancao Tang (Guizhi, Poria, Cinnamon Twig, Licorice Decoction) plus Rhubarb to promote drainage. (Jin Gui Yao Lue)
Facial pain belongs to Fire, as all Yang meridians converge on the face. Fire is of the Yang category. The Heart is the root of life and the seat of spirit, manifesting on the face. The Heart is Ministerial Fire. Sudden pain is mostly Excess; chronic pain is mostly Deficiency. High lesions should be suppressed; stagnated lesions should be opened. Blood Heat requires cooling blood; Qi Deficiency requires tonifying Qi. One should not rely solely on bitter-cold herbs to purge Fire. (Zheng Zhi Zhun Sheng)
Facial edema has Excess and Deficiency types: Solid swelling is Excess; pitting/soft swelling is Deficiency. Excess swelling, accompanied by heat or pain, is caused by Wind-Fire flaming upward, indicating excess pathogen. The pulse must be tight and rapid, with symptoms of chills and fever. For Wind, disperse it; for Fire, clear it; for obstruction and constipation, unblock and drain it. Once the pathogen is removed, the edema subsides naturally. ○ Deficient puffiness presents without pain or heat, but with swollen face and eyes. This may be due to Spleen-Lung Yang Deficiency causing failure of transportation and transformation, or Liver-Kidney Yin Deficiency allowing Water pathogen to overflow. However, swelling that rises upward and is soft likely stems from Qi; swelling that sinks downward and pits upon pressure likely stems from Water. Treating Qi disorders requires addressing the Spleen and Lung: tonify if Deficient, regulate if Excess. Treating Water disorders requires addressing the Spleen and Kidney: transform if Deficient, drain if Excess. ○ Regarding puffiness in the Qi level, although termed Qi Deficiency, there are differences between Excess and Deficiency. Deficient puffiness often originates from the Spleen, due to fatigue, excessive sexual activity, diarrhea/dysentery, or Cold invasion, presenting with a faint pulse and deficient Qi. Deficient swelling often originates from the Stomach, due to blazing Water-Fire with floating Damp-Heat, or overindulgence in alcohol and food causing Yangming congestion. These present with slippery-rapid pulses and heat symptoms. Once Excess and Deficiency are distinguished, treatment involves tonifying, draining, promoting, or clearing, carefully deliberated. (Zhang Jingyue)
Facial edema is termed Wind; red and swollen cheeks resemble boiling water. Administer Xiaofeng San (Eliminate Wind Powder) with wine, or induce sweating with Qianghuo, Fangfeng, Shengma, Baizhi, Niubangzi, Congbai, and Douchi. ○ For Wind-Heat causing facial swelling and pain, use Shengma Tang plus Baizhi, Lianqiao, Bohe, and Jingjie. ○ Facial coldness is caused by Yang Deficiency with constrained Yin-Cold; use Shengma Tang plus Fuzi. ○ Facial redness is due to pathogen constraint in the meridians; release the exterior is indicated, purgation is contraindicated. ○ "Floating Yang" (facial redness) indicates lower deficiency. For Taiyang Cold Damage, use Sini Tang (Four Reversal Decoction); for miscellaneous diseases, use Dihuang Yinzi (Rehmannia Infusion). ○ White face, frequent sneezing, and tight pulse indicate Cold. Use Qianghuo, Fangfeng, and Xixin to disperse Foot-Taiyang, adding a small amount of Fuzi to unblock the pulse. ○ Sudden blackening of the face due to foul odor impact: administer only Xiangfu powder, taken with salt water, 3 qian. ○ For acne scars or spots on the face, apply Ledou Meng powder mixed with human milk. (Zhang Shi Yi Tong)
[Selected Cases]
A person entered a latrine, was exposed to foul odors, and his face turned black, remaining so for over a month. A physiognomist predicted death. Mr. Sun Zhao instructed him to take Chenxiang (Agarwood) and Tánxiang (Sandalwood), one liang each, chop them finely, burn them in a censer inside a tent, and have the patient sit quietly with eyes closed until the incense was consumed. The next day, upon looking in the mirror, the blackness had dispersed. (Chishui Xuanzhu)