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》）
【经典论述】
女子三十五岁左右，阳明脉气开始衰退，面部开始变得枯槁。○面部浮肿称为风病。○心是生命的根本，神志变化的所在；心的精气外现于面部。（《素问》）
黄帝问道：头部和面部与身体其他部分相连，骨骼连接筋脉，血液与气相合。天气寒冷时，大地开裂、冰凌凝结，突然受寒，有时手足会懈怠无力，然而面部却不穿衣服保暖，这是为什么呢？岐伯回答说：十二经脉和三百六十五络穴，它们的血气都上行于面部。而且面部皮肤厚实，肌肉坚实，所以即使天气非常寒冷，也不能伤害它。○面部发热，是足阳明经发病的表现。（《灵枢》）
人的面部唯独能耐寒，为什么呢？回答是：人的头是诸阳经汇聚的地方。所有的阴经都只到达颈部就返回了。只有诸阳经都上行至头部，所以使面部能够耐寒。（《难经》）
【哲人言论】
面部不怕冷而怕热，这是因为血气汇聚于此；肘部、膝部、臀部不怕热而怕冷，这是因为血气不汇聚于此。其中血气特别旺盛的，面部甚至能同时感到热而不畏寒。所以医经认为面部的皮肤特别厚，寒暑都不能伤害它。（《医参》）
风邪侵入皮肤，痰饮积聚在脏腑，会导致面色晦暗。脾经和肺经的风湿搏结化为热邪，所以面部生疮。（《张氏医通》）
饮食不节制会导致胃病，胃病则导致气短，精神减少并产生大热。有时火气上炎，单独灼烧面部。（李东垣）
凡是病人面部发红都属于火证。如果面色红赤且气势盛，这无疑是火证。如果颧骨处红如手指或丝线状，而周围肤色不红，这是阴虚。张仲景说：面色赤红如戴阳（虚阳上浮），是因为下焦虚损。面色红不退的，说明邪气盛、病情进展，难以治愈。面色白的，是气虚。白兼淡黄且气不足的，是失血所致。白而枯槁的，是气血俱败。青兼白的，是阳虚阴盛。久病后面色转为黄苍色的，这是将要痊愈的表现。病人面色黄润而微红的，主湿热。黄兼青色的，这是木邪侵犯土脏，难以治疗。面色青苍的，主痛证。病愈后面色像煤一样黑且不舒展的，最终不吉利。普通人面色如灰尘，眼下青黑的，必定重病。女人面色发青的，必定肝强脾弱，多怒少食，或者月经不调。颧颊鲜红的，名叫“桃花色”。这是阴中有虚火，容易导致淫欲过度而无子嗣。（张景岳）
【补编】
咳嗽气逆倚靠呼吸不能平卧，如果面部发热像喝醉了一样，这是胃热上冲，熏蒸面部。用桂苓五味甘草汤加大黄来通利之。（《金匮要略》）
面部疼痛属于火证，因为诸阳经都汇聚于面部。火，属于阳类。心是生命的根本，神志变化的所在，其精气外现于面部。心，是君火。突发疼痛多属实证，久痛多属虚证。位置高的要抑制它，郁结的要疏通它。血热的要凉血，气虚的要补气。不能专门以苦寒泻火为唯一手段。（《证治准绳》）
面部浮肿有虚实之分：肿实的是实证，浮软的是虚证。实证浮肿，或有热、或痛，是由于风火上炎，这是邪气有余。脉象必然紧数，症状必有寒热。风邪则疏散它，火邪则清解它，壅滞秘结则通利它。邪气去除而浮肿自然消退。○虚证浮肿，无痛、无热，而面目浮肿。这可能是因为脾肺阳虚，输布转化失常，或者肝肾阴虚，水邪泛溢。然而浮肿向上发展，形态虚软的，多由气引起；浮肿向下发展，按压成窝的，多由水引起。治疗气的病变，必须从脾肺入手，虚则补益，实则顺气；治疗水的病变，必须从脾肾入手，虚则化气行水，实则泻下水邪。○凡是虚浮在气分的，虽然说是气虚，但也有虚实之别。虚而浮肿的多因于脾。这可能是由于劳累倦怠，或者房事过度，或者腹泻痢疾，或者中寒，脉象必然微弱，气机必然虚弱不足。虚而肿胀的多因于胃，或者是水火炽盛而湿热上浮，或者纵酒暴食导致阳明经壅滞。这脉象必然滑数，症状必然多热。虚实既然辨别清楚，那么或补、或泻、或利、或清，详细斟酌后进行治疗。（张景岳）
面部浮肿称为风病，两颊赤肿像沸腾一样。用酒调服消风散，或者用羌活、防风、升麻、白芷、牛蒡子、葱白、豆豉发汗。○风热导致的面部肿痛，用升麻汤加白芷、连翘、薄荷、荆芥。○面部寒冷是由阳虚阴寒郁遏所致，用升麻汤加附子。○面部发红是邪气郁滞在经络，宜用解表法不宜用攻下法。○面戴阳（虚阳上浮），是下焦虚损。伤寒病用四逆汤，杂病用地黄饮子。○面白、喜欢打喷嚏、脉紧的，是寒证。用羌活、防风、细辛发散足太阳经邪气，少加附子以通脉。○面色忽然变黑，是因为臭气冲击，只用一味香附末，盐汤送服三钱。○面上有痘痕或斑点，用密陀僧末，人乳调和敷贴。（《张氏医通》）
【选案】
有一人上厕所，被臭气熏触，满面黑色，一个多月不散。相士说：必死无疑。孙兆先生教他用沉香、檀香各一两，锉碎，放在炉中燃烧熏帐内，让病人闭目静坐，等香燃尽才可以出帐。第二天，拿着镜子照看，黑色已经消散了。（《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)