FACE

Chapter 35


imageFACE





WHY WE ASK


Energetically, the face is an area of concentration of Yang channels. Pure Yang needs to rise to the face to brighten the orifices so as to promote clear vision, smell, hearing and taste. When clear Yang-Qi fails to ascend to the face, Dampness or Phlegm often accumulate in this area, obstructing the sense orifices and the sinuses. Dampness and Phlegm are extremely common pathogenic factors and, not infrequently, facial symptoms (e.g. sinus problems) are their only manifestation. For this reason, I nearly always ask about facial symptoms to confirm or exclude the diagnosis of Dampness or Phlegm.


Another reason for asking about facial symptoms is to confirm or exclude a diagnosis of Heat or Empty-Heat by asking if the patient has experienced a feeling of heat in the face, which is the main area where Heat or Empty-Heat manifests.



WHEN WE ASK


I generally always ask about any feeling of heat in the face whenever a pattern of Heat or Empty-Heat emerges from the interrogation. It is important to remember that we should ask about feelings of heat in the face even when the patient presents with all the symptoms of Yang deficiency because there are many situations when contradictory Hot and Cold symptoms appear. A common example of this situation is in menopausal women who suffer from hot flushes of the face occurring against a background of a simultaneous Kidney-Yang and Kidney-Yin deficiency, with a predominance of the former. For other causes of simultaneous hot and cold feeling, see Chapter 43.


I also ask about facial symptoms if I suspect a pattern of Dampness or Phlegm. In such a case I always question the patient about nasal symptoms (e.g. runny or blocked nose), and about facial ache.




FACE



Feeling of heat of the face


Symptoms and Signs, Chapter 55


It is important to ask if patients suffer from a feeling of heat in the face, even if they feel cold in general. Especially in women, the two symptoms often coexist.


A feeling of heat in the face may be due to either Full- or Empty-Heat of any organ. Full-Heat will manifest with a feeling of heat in the face occurring either mostly in the daytime or throughout the day, whereas Empty-Heat manifests with a feeling of heat in the face occurring mostly in the afternoon and evening. (See Part 5, Chapter 55).



Women


In women, more than men, a feeling of heat in the face is often associated with contradictory Cold symptoms or signs in other parts of the body; for example, women frequently experience a feeling of heat in the face when their feet feel cold or they need to urinate frequently. Women’s pathology differs from that of men and a feeling of heat in the face with contradictory Cold symptoms may be due to four main causes.


First of all, it may be due to a simultaneous deficiency of Kidney-Yang and Kidney-Yin with some Empty-Heat – a situation that is very common in menopausal women. In this case, the woman will experience hot flushes and a feeling of heat of the face and other Empty-Heat signs, such as night sweating and five-palm heat, but also Cold symptoms such as cold feet and frequent urination, which derive from Kidney-Yang deficiency. Of course, a simultaneous deficiency of Kidney-Yin and Kidney-Yang may occur in men too, but it is far more frequent in women; indeed in my experience, especially in women over 40, this situation is the norm rather than the exception.


The second cause of a feeling of heat in the face with contradictory Cold symptoms in women is a deficiency of Blood giving rise to some Empty-Heat; the Blood deficiency may cause some Cold symptoms, especially cold hands, and the Empty-Heat deriving from it may cause a feeling of heat in the face. This pattern (i.e. Empty-Heat from Blood deficiency) occurs only in women.


The third cause of a feeling of heat in the face with contradictory Cold symptoms in women is a disharmony of the Penetrating Vessel. When the Qi of the Penetrating Vessel rebels upwards, it rushes to the face causing a feeling of facial heat and, since it fails to descend to the legs through the descendent branch, it causes cold feet. Again, such pathology of the Penetrating Vessel may occur in men too but it is far more common in women.


The fourth cause of a feeling of heat in the face with contradictory Cold symptoms is Yin Fire. Of course, Yin Fire may occur in men as well as women.




Facial pain


Symptoms and Signs, Chapter 55


The five main causes of facial pain are invasion of Wind-Heat, invasion of Wind-Cold, Damp-Heat, Liver-Fire and Qi deficiency with Blood stasis.


The facial pain due to invasion of Wind-Heat is characterized by an acute onset, a severe pain on the cheeks or jaws, a feeling of heat of the face, face feeling hot on palpation, headache, sore throat and an aversion to cold and fever.


The facial pain due to invasion of Wind-Cold is characterized by a spastic pain of the cheeks and jaws with sudden onset, sneezing, runny nose, aversion to cold, fever and a Floating-Tight pulse.


The facial pain due to Damp-Heat is characterized by a severe pain in the cheeks and forehead, and accompanied by red cheeks, greasy skin, a sticky yellow or greenish nasal discharge and a sticky yellow tongue coating.


The facial pain due to Liver-Fire is characterized by pain in the cheeks and forehead, redness of the cheeks, thirst, bitter taste, a Red tongue with redder sides and a Wiry-Rapid pulse.


The facial pain due to Qi deficiency and Blood stasis is characterized by an intense, often unilateral, pain of the cheeks, which is boring in nature and long in duration and accompanied by a dark complexion and a Purple tongue.


Trigeminal neuralgia is, of course, a type of facial pain; it is usually due to Liver-Fire combined with Liver- and Kidney-Yin deficiency.


Box 35.1 summarizes the patterns underlying facial pain.



BOX 35.1   FACIAL PAIN




• Invasion of Wind-Heat: acute onset, severe pain of the cheeks or jaws, feeling of heat of the face, face feels hot on palpation, headache, sore throat, aversion to cold, fever


• Invasion of Wind-Cold: acute onset, spastic pain of cheeks and jaws, sneezing, aversion to cold, dorsum of hands hot, runny nose, Floating-Tight pulse


• Damp-Heat: severe pain in the cheeks and forehead, red cheeks, greasy skin, sticky yellow or greenish nasal discharge, sticky yellow tongue coating


• Liver-Fire: pain in the cheeks and forehead, red cheeks, thirst, bitter taste, Red tongue with redder sides, Wiry-Rapid pulse


• Qi deficiency and Blood stasis: intense, often unilateral pain of the cheeks, boring in nature and long in duration, dark complexion, Purple tongue


• Liver-Fire with Liver- and Kidney-Yin deficiency: trigeminal neuralgia



Feeling of numbness/tingling of the face


Symptoms and Signs, Chapter 55


The five main causes of numbness or tingling in the face are invasion of external Wind, internal Liver-Wind, Stomach-Fire, internal Wind with Phlegm and Blood deficiency.


Numbness or tingling in the face caused by invasion of external Wind is characterized by a sudden onset and short duration and is accompanied by deviation of eye and mouth.


Numbness or tingling in the face caused by internal Liver-Wind is accompanied by headache, giddiness, tremors and a Wiry pulse.


Numbness or tingling in the face caused by Stomach-Fire is accompanied by intense thirst, epigastric pain and a yellow tongue coating.


Numbness or tingling in the face caused by internal Wind and Phlegm is accompanied by deviation of the mouth, slurred speech and hemiplegia.


Numbness or tingling in the face caused by Blood deficiency is accompanied by a dull-pale complexion, blurred vision, dizziness, a Pale tongue and a Choppy pulse.


Box 35.2 summarizes the patterns underlying numbness and tingling in the face.



BOX 35.2   FEELING OF NUMBNESS AND TINGLING IN THE FACE





NOSE


The nose was called in Chinese medicine Ming Tang, which means ‘Bright Hall’, signifying that it is an area of concentration of Yang-Qi and a place through which the clear Yang ascends to the head. The Song dynasty’s Chen Wu Ze says: ‘The nose is the opening of the Lungs through which the five odours are detected; it is the place where the Yin and Yang descend and ascend and through which the Clear Qi flows.’1 The nose is the external orifice of the Lungs and it is therefore closely related to breathing, smell and sound (of the voice). The organs influencing the nose are the Lungs, Kidneys, Spleen, Stomach, Gall-Bladder and Governing Vessel. External Wind-Heat invades the body via the nose and mouth. The nose can reflect pathological changes of many different organs, the balance of Yin and Yang, Heat and Cold, Deficiency and Excess, and stasis of Blood.



Blocked nose


Symptoms and Signs, Chapter 58


Excluding acute invasions of Wind, a blocked nose is usually caused by Dampness stagnating in the nose occurring against a background of Lung- and Spleen-Qi deficiency. In this case, the nose is often also swollen and pale and the problem is intermittent. This is a very common symptom in Western patients and it often leads to chronic sinusitis.


A blocked nose may also be caused by Qi and Blood stagnation, in which case the nose would be swollen, purple and with an uneven surface.


Gall-Bladder Heat may also cause a blocked nose, in which case the nose membranes are red and swollen and there is a sticky yellow nasal discharge.


In a newborn baby, a blocked nose (which may affect its ability to breast-feed) is usually due to invasion of Wind-Cold.


Box 35.3 summarizes the patterns underlying a blocked nose.



BOX 35.3   BLOCKED NOSE



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  2. MENSTRUAL SYMPTOMS
  3. DIGESTIVE SYSTEM AND TASTE
  4. MENTAL AND EMOTIONAL SYMPTOMS

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Apr 15, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on FACE

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