〔丹〕面热火气因郁热。面寒因胃虚。
〔《灵》〕面热者，足阳明病。（邪气脏腑病形篇）
〔垣〕饮食不节则胃病，胃病则气短，精神少，而生大热，有时而火上行，独燎其面。《针经》云∶面热者，
足阳明病。
〔罗〕面热 杨郎中之内五十一岁，身体肥盛，己酉春患头目昏闷，面赤热多，服清上药不效，请予治之。
诊其脉洪大而有力。《内经》云∶面热者，足阳明病。《脉经》云∶阳明经气盛有余，则身以前皆热。况其人素
膏粱积热于胃．阳明经多血多气，木实则风热上行，诸阳皆会于头目，故面热之病生矣。先以调胃承气汤七钱，
加黄连三钱，犀角一钱，疏下三两行，彻其本热。次以升麻加黄连汤，去经络中风热上行。如此，则标本之邪
俱退矣。
升麻加黄连汤
升麻 葛根（各一钱） 白芷（七分） 甘草（炙，五分） 白芍（五分） 酒黄连（四分） 生犀末（三分） 川
芎（三分）
荆芥穗（三分） 薄荷（三分）
上锉，如麻豆大，用水半盏，先浸川芎、荆芥、薄荷外，都作一服，水二盏，煎至一盏，入先浸三味同煎，
至七分，去渣，食后温服，数服愈。忌酒湿面五辛之物。
咳逆停息不得卧，面热如醉，此为胃热上冲熏其面，茯苓桂枝五味甘草汤加大黄以利之。（前文方见喘不得卧。）
〔罗〕面寒。真定维摩院尼长老六十一岁，身体瘦弱，己酉十月间病头面不耐寒，气弱不敢当风行，诸治不
效。予诊之，其脉皆弦细而微。且其人年高素食茶果而已，阳明之经本虚，《脉经》云∶气不足则身以前皆寒
栗。又加看诵损气，由此胃气虚，经络之气亦虚，不能上荣头面，故恶风寒。先以附子理中丸温其中气，次以
升麻汤加附子主之。
升麻 葛根 白芷 黄 （各七分） 甘草（炙，五分） 黑附子（七分，炮） 人参 草豆蔻（各五分）
益智仁（三分）
上锉，如麻豆大，都作一服，水三盏，连须白葱头二茎，同煎一盏，去渣温服，食前，数服良愈。
升麻汤辨或曰∶升麻加黄连汤治面热，升麻加附子汤治面寒，有何根据？答曰∶出自仲景。云岐子注《伤寒
论》中辨葛根汤云∶尺寸脉俱长者，阳明受病也，当二三日发，以其脉夹鼻络于目，故身热目疼鼻干不得卧，
此阳明经受病也。始于鼻交 中，从头至足，行身之前，为表之里。阳明经标热本实，从标脉浮而长，从本脉
沉而实。阳明为病，蒸蒸而热，不恶寒，身热为标病。阳明本实者，胃中燥鼻干目疼为本病。阳明为肌肉之本，
禁不可发汗，在本者不禁下，发之则变黄症。太阳主表，荣卫是也。荣卫之下，肌肉属阳明。二阳并病，葛根
汤主之。卫者桂枝，荣者麻黄，荣卫之中，桂枝麻黄各半汤主之。荣卫之下，肌肉之分者，葛根汤主之，又名
解肌汤。故阳明为肌肉之本，非专于发汗止汗之治。桂枝麻黄两方，互并为一方，加葛根者，便作葛根汤。故
荣卫肌肉之次也。桂枝、芍药、生姜、甘草、大枣止汗，有麻黄、桂枝、甘草发汗，葛根味薄，独加一味者，
非发汗止汗也，从葛根以解肌，故名葛根汤。钱仲阳制升麻汤治伤寒瘟疫风热，壮热头痛，肢体痛，疮疹已发
未发用葛根为君，升麻为佐，甘草、芍药安其中气。朱奉议作《活人书》，将升麻列作阳明经解药。予诊杨氏
妇，阳明经标本俱实，先攻其里，后泻经络中风热，故用升麻汤加黄连，以寒治热也。尼长老阳明经标本俱虚，
先实其里，次行经络，故用升麻汤加附子，以热治寒也。仲景乃群方之祖，信哉。
【丹溪】面部发热，多因火气被郁而化热所致。面部发冷，多因胃气虚弱引起。
【《灵枢》】面部发热，是足阳明经发病。（出自《邪气脏腑病形篇》）
【李东垣】饮食不节制会损伤胃，胃受损则气短、精神不足，并产生大热；有时火热之气上冲，仅熏灼面部。《针经》说：“面部发热，是足阳明经发病。”
【罗天益】面部发热：杨郎中的妻子五十一岁，身体肥胖，己酉年春天患头目昏沉闷胀，面部发红发热较多，服用清上部热药无效，请我诊治。诊其脉象洪大而有力。《内经》说：“面部发热，是足阳明经发病。”《脉经》说：“阳明经气盛有余，则身体前部皆热。”况且此人平素喜食肥甘厚味，导致胃中积热。阳明经多血多气，肝木实则风热上行，诸阳经皆会聚于头目，因此产生面部发热的病症。先用调胃承气汤七钱，加黄连三钱、犀角一钱，疏泄通下三两行，彻底清除根本之热。再用升麻加黄连汤，祛除经络中风热上行之邪。这样，标与本之邪气都能退去。
升麻加黄连汤
升麻、葛根（各一钱）、白芷（七分）、甘草（炙，五分）、白芍（五分）、酒黄连（四分）、生犀角末（三分）、川芎（三分）、荆芥穗（三分）、薄荷（三分）。
以上药物切碎如麻豆大小，用水半盏，先浸泡川芎、荆芥、薄荷，其余药材作为一服，加水二盏，煎至一盏，加入先浸泡的三味药同煎，煎至七分，去渣，饭后温服，服几剂后痊愈。忌食酒、湿面及五辛之物。
咳嗽气逆，呼吸暂停不能平卧，面部发热如醉酒状，这是胃热上冲熏蒸面部所致，用茯苓桂枝五味甘草汤加大黄以通利之。（前文方剂见“喘不得卧”条。）
【罗天益】面部发冷：真定维摩院尼姑长老六十一岁，身体瘦弱，己酉年十月间患病，头面不耐寒冷，气弱不敢当风行走，各种治疗均无效。我诊察她，脉象皆弦细而微弱。且此人年高，平日只喝茶吃水果，足阳明经原本就虚，《脉经》说：“气不足则身体前部皆寒栗。”又加上诵经念佛耗损元气，由此导致胃气虚，经络之气也虚，不能上荣养头面，所以厌恶风寒。先用附子理中丸温补中焦之气，再用升麻汤加附子主治。
升麻汤（此处指加附子之方）
升麻、葛根、白芷、黄芪（各七分）、甘草（炙，五分）、黑附子（七分，炮制）、人参、草豆蔻（各五分）、益智仁（三分）。
以上药物切碎如麻豆大小，作为一服，加水三盏，连须白葱头两茎，同煎至一盏，去渣温服，饭前服用，服几剂后良愈。
升麻汤辨析：有人问：“升麻加黄连汤治疗面部发热，升麻加附子汤治疗面部发冷，有什么根据？”回答是：出自张仲景。云岐子在注释《伤寒论》中辨别葛根汤时说：寸关尺三部脉都长的，是阳明经受病，应当在二三天发作，因为该经脉夹鼻络于目，所以身体热、眼睛痛、鼻子干、不能平卧，这是阳明经受病。起始于鼻交頞中，从头到足，行于身体前面，属于表中之里。阳明经标热本实，从标看脉浮而长，从本看脉沉而实。阳明为病，蒸蒸发热，不恶寒，身体热是标病。阳明本实者，胃中干燥、鼻子干、眼睛痛是本病。阳明是肌肉的根本，禁止不可发汗，在本者不禁下法，发汗则会变成黄疸证。太阳主表，即营卫。营卫之下，肌肉属阳明。二阳并病，用葛根汤主治。卫分属桂枝，营分属麻黄，在营卫之中，用桂枝麻黄各半汤主治。在营卫之下，肌肉之分，用葛根汤主治，又名解肌汤。所以阳明是肌肉的根本，并非专门用于发汗或止汗的治疗。桂枝和麻黄两方，合并为一一方，加入葛根的，便成为葛根汤。所以在营卫肌肉的次序中，桂枝、芍药、生姜、甘草、大枣能止汗，有麻黄、桂枝、甘草能发汗，葛根气味轻薄，单独加入一味，并非为了发汗或止汗，而是通过葛根来解肌，所以名叫葛根汤。钱仲阳制作升麻汤治疗伤寒瘟疫风热，壮热头痛，肢体疼痛，疮疹已发或未发，用葛根为君药，升麻为佐药，甘草、芍药安其中气。朱奉议编写《活人书》，将升麻列为阳明经解表药。我诊治杨氏妇人时，阳明经标本俱实，先攻逐里实，后泻除经络中风热，所以用升麻汤加黄连，以寒治热。尼姑长老阳明经标本俱虚，先充实其里，再疏通经络，所以用升麻汤加附子，以热治寒。张仲景是群方之祖，确实可信啊。
[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.