伤寒面赤色，虽有表热里热之分，然表症居多，故身热少汗，六脉浮数，发汗乃解。若太阳
见症，无汗脉浮紧者，加减羌活汤。有汗脉浮缓，加减防风汤。阳明见症，无汗发热脉浮紧
者，葛根汤。有汗脉洪长者，干葛石膏汤。少阳见症，无汗恶寒，脉浮紧，羌活柴胡汤。有
汗脉弦，小柴胡汤。若里热面赤，汗多不恶寒，渴而饮水，六脉沉数，知母石膏汤，凉膈
散。阳明里热面赤，大便实者，凉膈散加酒蒸大黄，以清血分之热。失用大黄，有衄血之
患。若风温症，有汗发热面赤色，宜防风干葛石膏汤。若初起不发热，口不渴，唇不焦，脉
沉迟，面赤色，即阴极发躁等症，另用四逆汤。
太阳病，得之八九日，如疟状，发热恶寒，热多寒少，其不呕清便，欲自可，一日二三度
发，脉微缓者，为欲愈也。脉微而恶寒者，此阴阳俱虚，不可更发汗、更下、更吐也。面色
反有热色者，未欲解也，以其不能小汗出，身必痒，宜桂枝麻黄各半汤。
此条表邪面赤热。详注似疟。
又云太阳病，脉浮而迟，面热赤而战栗者，六七日当汗出而解。反发热者瘥。迟为无阳，不
能作汗，其身必痒。
此阳微难作汗，故面热赤。至六七日作汗之期，若战栗，当汗出而解。发热者，则阳气复
而症瘥。若因脉迟无阳，不能战惕发热作汗，其身必痒。
阳明病，合面赤色，不可攻。攻之，必发热色黄，小便不利也。
面合赤色，此表邪作汗之征。若误攻下，则表热不散。热瘀于上，必蒸黄色于皮毛；热瘀
于下，必热结膀胱而小便不利。此条不立方法，既曰阳明病，当用防风干葛汤，解在表发
热之黄。既曰小便不利，当用猪苓汤，分利下焦。
并病篇曰∶二阳合病，太阳初得病，时发其汗，汗先出不彻，因转属阳明，续自微汗出，不
恶寒。若太阳病不罢者，不可下，下之为逆，如此可小发汗。设面色缘缘正赤者，阳气怫郁
在表，当解之熏之。若发汗不彻，不足言，阳气怫郁不得越，当汗不汗，其人躁烦，不知痛
处，乍在腹中，乍在四肢，按之不可得，其人短气，但坐以汗出不彻故也，更发汗则愈。何
以知其汗出不彻，以脉涩故知也。
曰太阳初得病时，发其汗不彻，因转属阳明，虽名合并病，实病也。然必得表邪尽解，方
可下，若太阳症未罢，下之则为逆，如此尚可小发其汗。设若面色连连赤色，此是邪汗未
出，则非小发汗，急当以药解表，以汤熏汗。若汗原不透彻，语言不能完全，此阳邪不得
发越，其人必烦躁，呻吟叫痛，乍云在腹，乍云四肢，按之不得痛处，其人喘逆短气，但
当坐以汗出不彻，更出汗则愈。何以知汗出不彻，以其脉涩滞模糊，尚是表汗未出。
少阴病，下利清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面赤色，或腹痛，
或干呕，或咽痛，或利止，脉不出者，通脉四逆汤主之。其脉即出者愈。
厥阴下利，脉沉而迟，其人面少赤，身有微热，下利清谷者，必郁而冒汗出而解，病患必微
厥。所以然者，其人面戴阳下虚故也。又曰下利清谷，里寒外热，汗出而厥者，通脉四逆汤主之。
以上二条，皆阴症似阳之面赤，故皆用四逆汤。
《金匮》云∶病者身热足寒，颈项强急，恶寒，时头热面赤目赤，独头动摇，卒口噤，背反张
者，痉病也。若发其汗者，寒湿相得，其表益虚，即恶寒甚。发其汗已，其脉如蛇。
此痉病门面赤色。仲景论痉，专主血虚液燥，故即身热足寒，颈项强急，恶寒面赤，尚禁
发汗。详痉病加减羌活汤。
羌活 独活 防风 荆芥 柴胡 干葛 广皮 甘草
色赤表热，欲汗之候，又见浮大急数之表脉，故用此方。
加减防风汤 见头痛。
面赤自汗，身热不减，脉见浮缓者，以此方治之。
葛根汤 见恶寒。
阳明病，禁用麻、桂，今以无汗脉浮紧，故用此方，然亦北方冬月治法。
干葛石膏汤 见寒热。
同一阳明面赤，前条无汗脉浮紧，则用干葛汤。今有汗脉洪长，则用此方。
柴胡羌活汤 即小柴胡汤加羌活。
面赤之症，不特太阳阳明，即少阳表邪不散亦有，故以柴胡汤加羌活、防风。
小柴胡汤 见寒热。
前方治少阳太阳表邪者，此方治少阳表里兼见者。
知母石膏汤
知母 石膏 门冬 竹叶 粳米
仲景面色赤，皆以表邪主治。然亦有阳明里热、上冲头面，汗多口渴而面赤者，故以此方治之。
凉膈散 见发狂。
阳明里热、口渴消水之面赤，则用知母石膏汤。若胃热上冲而刑肺金，则用此方。大便
结，加玄明粉。腹胀不得大便，有下症者，大、小承气汤。
防风石膏汤 即干葛石膏汤加防风。
阳明风热面赤色，故用此方。
四逆汤 见身痛。
面赤色皆是阳邪，然阴症中又有虚阳上浮者，故用此方。
伤寒病出现面色发红，虽然有表热和里热的区别，但大多数属于表证，所以身体发热、出汗少，六脉浮数，通过发汗治疗才能痊愈。如果呈现太阳病的症状，无汗且脉象浮紧的，使用加减羌活汤；有汗且脉象浮缓的，使用加减防风汤。如果呈现阳明病的症状，无汗、发热且脉象浮紧的，使用葛根汤；有汗且脉象洪大长直的，使用干葛石膏汤。如果呈现少阳病的症状，无汗、恶寒且脉象浮紧的，使用羌活柴胡汤；有汗且脉象弦的，使用小柴胡汤。如果是里热导致的面色发红，出汗多且不恶寒，口渴想喝水，六脉沉数，使用知母石膏汤或凉膈散。如果是阳明里热导致的面色发红，大便干结的，在凉膈散中加入酒蒸大黄，以清除血分的熱邪。如果不及时使用大黄，会有流鼻血的祸患。如果是风温病症，有汗、发热且面色发红，适宜使用防风干葛石膏汤。如果初起时不发热，口不渴，嘴唇不焦黑，脉象沉迟，面色发红，这是阴极发躁等症候，另外使用四逆汤。
太阳病，患病八九天后，症状像疟疾一样，发热恶寒，热多寒少，如果没有呕吐和大便清稀的情况，说明病情有望自愈。一天发作两三次，脉象微缓的，是快要痊愈的表现。脉象微弱且恶寒的，这是阴阳俱虚，不可以再发汗、攻下或催吐。面色反而发红发热的，说明病未解除，因为不能微微出汗，身体必定发痒，适宜使用桂枝麻黄各半汤。
又说太阳病，脉象浮而迟，面部发热发红且战栗的，经过六七天应当出汗而痊愈。如果反而发热，则病愈。脉迟表示阳气不足，不能作汗，身体必定发痒。
这是因为阳气微弱难以作汗，所以面部发热发红。到了六七天作汗的时候，如果出现战栗，应当出汗而痊愈。如果发热，则是阳气恢复而病愈。如果因为脉迟无阳，不能战栗发热作汗，身体必定发痒。
阳明病，伴有面色发红，不可使用攻下法。如果误用攻下，必然会出现发热、面色发黄、小便不利的症状。
面色全红，这是表邪欲作汗出的征兆。如果误用攻下，表热就不能消散。热邪郁结在上部，必然会在皮毛上蒸出黄色；热邪郁结在下部，必然会导致热结膀胱而小便不利。这一条没有列出具体方剂，既然说是阳明病，应当使用防风干葛汤，来解除在表的发热引起的黄疸。既然说小便不利，应当使用猪苓汤，分利下焦湿热。
并病篇中说：二阳合病，太阳病刚得病时，有时发汗不彻底，因此转属阳明，继续自发出微汗，不恶寒。如果太阳病症状未罢，不可攻下，攻下为逆治，这种情况下可以轻微发汗。假设面色持续正红，这是阳气怫郁在体表，应当用解表熏蒸的方法治疗。如果发汗不彻底，不足以言说，阳气怫郁不得发散，应当出汗却不出汗，病人烦躁，不知道疼痛的具体位置，一会儿在腹部，一会儿在四肢，按压也找不到痛点，病人短气，只是由于汗出不彻底的原因，再次发汗就会痊愈。怎么知道汗出不彻底呢？从脉涩就可以知道。
说太阳病刚得病时，发汗不彻底，因此转属阳明，虽然名叫合并病，实际上是病邪传变。但是必须等到表邪完全解除，才可以攻下，如果太阳病症状未罢，攻下就是逆治，这种情况下还可以轻微发汗。假设若面色连连发红，这是邪气因发汗不彻而未出，这就不是轻微发汗能解决的，急当用药解表，用汤药熏蒸取汗。如果原本发汗就不透彻，言语不能完全表达，这是阳邪不得发散，病人必定烦躁，呻吟叫痛，一会儿说在腹部，一会儿说在四肢，按压找不到痛处，病人喘逆短气，只是因为汗出不彻底，再次出汗就会痊愈。怎么知道汗出不彻底呢？因为脉象涩滞模糊，还是表汗未出的表现。
少阴病，下利完谷不化，里寒外热，手足厥冷，脉微细欲绝，身体反而不恶寒，病人面色发红，或者腹痛，或者干呕，或者咽痛，或者腹泻停止但脉搏摸不到，由通脉四逆汤主治。如果脉搏随即复出者痊愈。
厥阴病下利，脉象沉而迟，病人面部微红，身体有微热，下利完谷不化的，必然郁冒而出汗而解，病人必定手脚微冷。之所以这样，是因为病人面戴阳（虚阳上浮）且下元虚故也。又说下利完谷不化，里寒外热，出汗且四肢厥冷的，由通脉四逆汤主治。
以上两条，都是阴证似阳的面赤，所以都使用四逆汤。
《金匮要略》说：病人身体发热足部寒冷，颈项强直僵硬，恶寒，有时头部发热、面色红、眼睛红，只有头部摇动，突然牙关紧闭，角弓反张的，是痉病。如果发汗，寒湿相搏，表气更虚，就会极度恶寒。发汗后，脉象如蛇行般扭曲。
这是痉病导致的面赤。仲景论述痉病，专门主张血虚液燥，所以即使身体发热足寒，颈项强直，恶寒面赤，仍然禁止发汗。详细参考痉病加减羌活汤。
面色赤红属表热，是想要出汗的征候，又见到浮大急数的表脉，所以使用这个方子。
加减防风汤 见头痛章节。
面色发红、自汗、身体发热不退，脉象浮缓的，用此方治疗。
阳明病禁用麻黄、桂枝，现在因为无汗且脉象浮紧，所以使用此方，但这也是北方冬季的治疗方法。
干葛石膏汤 见寒热章节。
同样是阳明病面赤，前一条无汗脉浮紧，则用干葛汤。现在有汗脉洪长，则用此方。
面赤的症状，不仅见于太阳、阳明，即使是少阳表邪不散也会出现，所以用柴胡汤加羌活、防风。
小柴胡汤 见寒热章节。
前方治疗少阳太阳表邪，此方治疗少阳表里兼见的情况。
仲景认为面色赤，多以表邪为主治。但也有阳明里热、上冲头面，出汗多口渴而面赤的，所以用此方治疗。
凉膈散 见发狂章节。
阳明里热、口渴饮水的面赤，则用知母石膏汤。如果胃热上冲克制肺金，则用此方。大便干结，加玄明粉。腹胀不能大便，有下证情况的，用大承气汤或小承气汤。
阳明风热导致的面赤，所以使用此方。
四逆汤 见身痛章节。
面色赤多是阳邪，但在阴证中又有虚阳上浮的情况，所以使用此方。
In Taiyang disease (Disease of the Taiyang Channel), facial redness may be attributed to either exterior heat or interior heat, but it predominantly stems from exterior syndromes. Consequently, the patient presents with fever and scanty sweating, with floating and rapid pulses throughout all six positions; treatment via diaphoresis (inducing sweating) leads to resolution. If Taiyang symptoms are present with anhidrosis (absence of sweating) and a floating-tight pulse, Jiajian Qianghuo Tang (Modified Notopterygium Decoction) is indicated. If there is sweating and a floating-slow pulse, Jiajian Fangfeng Tang (Modified Saposhnikovia Decoction) is used. For Yangming disease (Disease of the Yangming Channel) presenting with anhidrosis, fever, and a floating-tight pulse, Gegen Tang (Pueraria Decoction) is prescribed. If there is sweating and a surging-long pulse, Gange Shigao Tang (Kudzu and Gypsum Decoction) is employed. In Shaoyang disease (Disease of the Shaoyang Channel), if there is anhidrosis, aversion to cold, and a floating-tight pulse, Qianghuo Chaihu Tang (Notopterygium and Bupleurum Decoction) is used; if there is sweating and a wiry pulse, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
If facial redness results from interior heat, accompanied by profuse sweating, absence of aversion to cold, thirst with desire to drink, and deep-rapid pulses, Zhimu Shigao Tang (Anemarrhena and Gypsum Decoction) or Liangge San (Cooling the Diaphragm Powder) should be administered. In cases of Yangming interior heat with facial redness and constipation, Jiuhuang Dahuang (Wine-processed Rhizoma Rhei Preparatio) is added to Liangge San to clear heat from the blood level. Failure to use Dahuang promptly may lead to epistaxis (nosebleed). For Wind-Warmth syndromes characterized by sweating, fever, and facial redness, Fangfeng Gange Shigao Tang (Saposhnikovia, Kudzu, and Gypsum Decoction) is appropriate. If the onset lacks fever, thirst, or dry lips, yet features a deep-slow pulse and facial redness, this indicates "Yin extremity causing restlessness" (Ji Yin Fa Zao); in such cases, Sini Tang (Frigid Extremities Decoction) is separately prescribed.
When Taiyang disease persists for eight or nine days, resembling malaria with alternating fever and chills where heat predominates over cold, and without vomiting or loose stools, spontaneous recovery is likely. If episodes occur two or three times daily and the pulse becomes slightly slow, healing is imminent. A faint pulse with aversion to cold indicates deficiency of both Yin and Yang; diaphoresis, purgation, or emesis must be avoided. Facial flushing with heat suggests the pathogen has not yet resolved due to the inability to produce slight sweating, resulting in pruritus; Guizhi Mahuang Ge Ban Tang (Combined Decoction of Cinnamon Twig and Ephedra in Half Dosage) is suitable.
This section addresses facial redness and heat caused by exterior pathogens, detailing symptoms similar to malaria.
Furthermore, in Taiyang disease, a floating-slow pulse with facial heat/redness and tremors indicates that after six to seven days, sweating should occur leading to resolution. If fever persists instead, the condition improves. A slow pulse signifies deficient Yang, preventing sweating and causing pruritus.
Because Yang Qi is weak and unable to generate sweat, facial heat and redness occur. By the sixth or seventh day, when sweating should occur, tremors indicate impending resolution through sweating. Fever implies the restoration of Yang Qi and recovery. However, if the slow pulse reflects deficient Yang, preventing the trembling and febrile response necessary for sweating, pruritus will persist.
In Yangming disease, facial redness contraindicates purgation. Misapplication of purgatives will inevitably cause fever, jaundice (yellow discoloration), and dysuria (difficult urination).
Facial redness is a sign that the exterior pathogen seeks to resolve through sweating. Erroneous purgation prevents the dispersion of exterior heat. Heat stagnating upward steams yellow color onto the skin; heat stagnating downward binds in the Bladder, causing dysuria. Although no specific formula is listed here, given it is Yangming disease, Fangfeng Gange Tang (Saposhnikovia and Kudzu Decoction) should be used to resolve exterior heat-induced jaundice. Given dysuria, Zhuling Tang (Polyporus Decoction) should be used to separate and drain damp-heat from the Lower Jiao.
The Chapter on Combined Diseases states: In combined diseases of two Yang channels, if Taiyang disease was initially treated with incomplete sweating, the pathogen transfers to Yangming, manifesting as continuous mild sweating and absence of aversion to cold. If Taiyang symptoms remain unresolved, purgation is contraindicated as it constitutes adverse treatment; instead, mild diaphoresis is indicated. If the face shows persistent bright redness, this indicates Yang Qi constrained in the exterior; treatment should involve resolving the exterior through fumigation. If sweating was insufficient, leading to constrained Yang Qi unable to vent, and the patient fails to sweat despite the need, they will experience irritability, unknown pain locations shifting between abdomen and limbs, shortness of breath, and restlessness. This is solely due to incomplete sweating; repeating diaphoresis will cure the condition. How is incomplete sweating diagnosed? Through a choppy pulse.
Initially, during Taiyang disease, incomplete sweating causes transfer to Yangming. Although termed combined disease, it involves pathogen transmission. Purgation is only permissible after complete resolution of exterior pathogens. If Taiyang symptoms persist, purgation is adverse; mild diaphoresis remains an option. Persistent facial redness indicates unexpelled pathogen due to failed sweating; this requires urgent exterior-resolving medication and herbal steam therapy. If initial sweating was inadequate, causing speech difficulties, this reflects unvented Yang pathogen, leading to irritability, groaning, shifting pain sensations, panting, and shortness of breath. Resolution comes from inducing proper sweating. Diagnosis of incomplete sweating relies on a choppy, blurred pulse indicating unexpressed exterior pathogens.
In Shaoyin disease, diarrhea with undigested food, interior cold with exterior heat, cold extremities, and faint-to-absent pulses, yet without aversion to cold and with facial redness, possibly accompanied by abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse, is treated with Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction). Recovery occurs if the pulse reappears.
In Jueyin diarrhea with deep-slow pulses, slight facial redness, mild fever, and diarrhea with undigested food, the patient will experience mental cloudiness followed by sweating and resolution, accompanied by slight cold extremities. This occurs because the patient exhibits "floating Yang on the face" (Dai Yang) with lower deficiency. Additionally, in diarrhea with undigested food, interior cold with exterior heat, sweating, and cold extremities, Tongmai Sini Tang is indicated.
Both preceding cases describe facial redness in Yin syndromes mimicking Yang, hence both utilize Sini Tang.
The *Jin Gui Yao Lue* states: When a patient presents with body heat, cold feet, neck stiffness, aversion to cold, intermittent head heat, facial redness, eye redness, isolated head tremor, sudden lockjaw, and opisthotonos (backward arching of the back), this is Spasm Disease (Jing Bing). Inducing sweating in such cases combines cold and dampness, further depleting the exterior, exacerbating aversion to cold. Post-sweating, the pulse becomes winding like a snake.
This describes facial redness in Spasm Disease. Zhang Zhongjing attributes Spasm Disease primarily to Blood deficiency and fluid dryness; thus, even with body heat, cold feet, neck stiffness, aversion to cold, and facial redness, diaphoresis is strictly prohibited. Refer to Jiajian Qianghuo Tang for Spasm Disease modifications.
Herbs: Qianghuo (Rhizoma Notopterygii), Duhuo (Radix Angelicae Pubescentis), Fangfeng (Radix Saposhnikoviae), Jingjie (Cacumen Schizonepetae), Chaihu (Radix Bupleuri), Gange (Radix Puerariae Lobatae), Guangpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae).
Reddish complexion with exterior heat indicates a state desiring sweating, accompanied by floating-large-rapid-tight exterior pulses; thus, this formula is used.
Jiajian Fangfeng Tang (Modified Saposhnikovia Decoction) - See Headache.
Indicated for facial redness, spontaneous sweating, persistent fever, and floating-slow pulses.
Gegen Tang (Pueraria Decoction) - See Aversion to Cold.
Although Ma Huang Tang and Guizhi Tang are contraindicated in Yangming disease, this formula is used here due to anhidrosis and floating-tight pulses, representing a method for winter in northern regions.
Gange Shigao Tang (Kudzu and Gypsum Decoction) - See Alternating Fever and Chills.
For Yangming facial redness: if anhidrous with floating-tight pulse, use Gange Tang; if sudorous with surging-long pulse, use this formula.
Chaihu Qianghuo Tang (Bupleurum and Notopterygium Decoction) - i.e., Xiaochaihu Tang plus Qianghuo.
Facial redness occurs not only in Taiyang and Yangming but also when Shaoyang exterior pathogens remain unresolved; thus, Chaihu Tang is modified with Qianghuo and Fangfeng.
Xiaochaihu Tang (Minor Bupleurum Decoction) - See Alternating Fever and Chills.
The previous formulas treat Shaoyang-Taiyang exterior pathogens; this formula treats Shaoyang conditions involving both exterior and interior aspects.
Zhimu Shigao Tang (Anemarrhena and Gypsum Decoction)
Herbs: Zhimu (Rhizoma Anemarrhenae), Shigao (Gypsum Fibrosum), Mendong (Tuber Ophiopogonis), Zhuye (Folium Bambusae), Jingsmi (Seminis Orizae).
Zhang Zhongjing generally treats facial redness as exterior pathogen-related. However, Yangming interior heat rushing upward to the head and face, causing profuse sweating, thirst, and redness, is treated with this formula.
Liangge San (Cooling the Diaphragm Powder) - See Mania.
For Yangming interior heat with thirst and drinking water causing facial redness, use Zhimu Shigao Tang. If Stomach heat rushes upward affecting Lung Metal, use this formula. For hard stool, add Xuanmingfen (Mirabilite). For abdominal distension and constipation with purgative indications, use Dachengqi Tang (Major Order the Qi Decoction) or Xiaochengqi Tang (Minor Order the Qi Decoction).
Fangfeng Shigao Tang (Saposhnikovia and Gypsum Decoction) - i.e., Gange Shigao Tang plus Fangfeng.
Used for Yangming wind-heat causing facial redness.
Sini Tang (Frigid Extremities Decoction) - See Body Pain.
While reddish complexion usually indicates Yang pathogen, in Yin syndromes, it can result from floating deficient Yang; thus, this formula is used.