Nasal swelling refers to the redness and swelling of the nasal cavity, often occurring in the anterior nasal aperture. Chen Shifeng's "Stone Chamber Records" specifically documents "nasal swelling," commonly seen in the initial stages of conditions such as nasal vestibulitis, nasal furuncle, nasal vestibulitis, and glanders, and is related to symptoms like epistaxis and nasal discharge. For those with nasal redness and swelling due to rosacea, refer to relevant surgical entries.

bubble_chart Pattern Analysis

1. Heat Toxin Obstructing the Lung︰The nasal orifice is swollen, initially resembling a foxtail millet grain, or presenting as small white blisters or redness, with a burning sensation. The swelling has a raised top and a firm base, accompanied by pain or numbness and itching. After 3-5 days, a yellow pus point appears at the top of the swelling, the base softens, and the pus drains and resolves on its own, accompanied by chills, high fever, headache, a red tongue with yellow coating, and a rapid pulse. This condition is often caused by excessive consumption of rich, greasy, spicy, and hot foods, leading to accumulated heat in the lungs and stomach that ascends along the meridians to invade the nasal orifice. This syndrome is commonly seen in nasal furuncle, nasal vestibulitis, nasal boil, or nasal glanders. The clinical manifestations include significant redness, swelling, and intense pain in the nasal orifice, with a high, pointed swelling and a firm base. Subsequently, heat toxin damages and rots the flesh and blood, forming pus, which drains and subsides. Due to the intense heat toxin, systemic symptoms such as fever, chills, and headache often occur, and it is prone to spreading yellow toxin, with the toxin entering the nutrient-blood level. Treatment should focus on clearing heat and removing toxin to reduce swelling. The prescription may include Five-Ingredient Toxin-Eliminating Decoction or Coptis Detoxification Decoction with modifications, along with internal or topical application of Wake-Up Subsiding Pill made from rhinoceros bezoar.
2. Heat Toxin Invading the Nutrient-blood Level︰It often develops from the aforementioned conditions, with swelling inside the nasal cavity, a sunken top without pus, diffuse margins, and a purplish-dark sore head. In severe cases, the nose may swell like a bottle, extending to the lips, cheeks, and eyelids, accompanied by intense pain and a burning sensation. High fever, irritability, nausea, thirst, and constipation may also occur, and in extreme cases, unconsciousness, delirious speech, limb convulsions, and opisthotonos may manifest. The tongue appears deep red with thick, dry yellow coating, and the pulse is rapid. This is caused by heat toxin congesting the lung and nasal swelling, which then invades inward, or by nasal furuncle discharging yellow pus, leading to heat toxin invading the nutrient-blood level. The clinical symptoms are acute, and without prompt treatment, danger is imminent. Waike Qixuan states: "Nasal furuncle with alternating chills and fever, toxic qi attacking the heart, swelling of the head and face, vomiting, and unconsciousness—nine out of ten cases are incurable." The manifestations include nasal swelling like a bottle, extending to the lips, cheeks, and eyelids, with a sunken, pus-less swelling and diffuse margins. Heat toxin invades the nutrient-blood level, affecting the pericardium, hence high fever, dysphoria, nausea, thirst, and constipation, even unconsciousness and delirious speech. If it disturbs liver wind, limb convulsions and opisthotonos may occur. The tongue texture is deep red, and the pulse is rapid. Treatment should focus on clearing the nutrient aspect, cooling blood, and removing toxins. The formula Nutrient-Clearing Decoction is recommended. For unconsciousness, add Peaceful Palace Bovine Bezoar Pill and Purple Snow Bolus. In cases where heat toxin congesting the lung remains at the qi aspect, the tongue is usually not deep red, and symptoms like unconsciousness are absent. Further differentiation can be made by observing local swelling, the presence or absence of pus, and the height or depression of the swelling's apex.
3. Gan Heat Attacking the Lung︰The nasal passage is swollen, resembling foxtail millet grains, with mild pain, dryness, itching, and burning heat, followed by erosion, dry scabbing, rhagades, and bleeding, recurring without healing, sometimes accompanied by fever, headache, and constipation. The tongue is red with a yellow coating, and the pulse is rapid. $Heat toxin congesting the lung and nasal swelling versus malnutrition-heat attacking the lung and nasal swelling! Both are caused by excess heat in the lung meridian and stagnation of qi and blood, manifesting as nasal swelling, burning heat, fever, a red tongue with a yellow coating, and a rapid pulse—all signs of heat. However, the severity of symptoms, disease progression, and prognosis differ. Heat toxin congesting the lung and nasal swelling often results from excessive consumption of rich, greasy, spicy, and hot foods, leading to accumulated heat in the lung and stomach that ascends along the meridian to invade the nasal passage. This pattern is commonly seen in nasal furuncle, nasal vestibulitis, nasal boil, and nasal anthrax. The clinical presentation features pronounced redness, swelling, and severe pain in the nasal passage, with a high, pointed swelling and a hard base. Subsequently, the heat toxin damages and rots the flesh, forming pus, which drains and subsides. Due to the intense heat toxin, systemic symptoms such as fever, chills, and headache often occur, and it is prone to spreading yellow pus, with toxins entering the nutrient-blood level. Treatment should focus on clearing heat and removing toxins to reduce swelling. The formula Five-Ingredient Toxin-Eliminating Decoction or Coptis Detoxification Decoction can be modified, supplemented with Wake-Up Subsiding Pill taken orally or applied externally. In contrast, malnutrition-heat attacking the lung and nasal swelling is more common in malnourished children with nasal vestibulitis (also known as nasal sore). Its clinical manifestations are less severe than the above pattern, without spreading yellow pus or toxins entering the nutrient-blood level. However, it often features persistent and recurrent evil toxins. The nasal swelling is mild with little pain, and systemic symptoms may be absent. It may involve wind or dampness: wind predominance causes itching and dry cracking, while dampness predominance leads to yellow discharge and erosion. The condition lingers and may result in dampness-heat steaming and nasal swelling. Treatment should focus on clearing heat and removing toxins, using Qingjin Powder. For wind predominance, add cicada slough and Stiff Silkworm; for dampness predominance, add Sophora and Red Poria. Externally, wash the affected area with a decoction of Chinaberry leaves.
4. Dampness-heat︰Swelling and redness of the nasal cavity, erosion with yellow discharge, itching and pain, occasional dryness and cracking with bleeding, nasal congestion. The swelling and erosion may spread to the nasal wings and lips, accompanied by poor appetite, abdominal distension and fullness, loose stools, irritability, and frequent crying and fussiness. The tongue coating is yellow and greasy, and the pulse is slippery and rapid. Prolonged nasal swelling due to gan-heat attacking the lungs, with increasing heat toxin combined with dampness. The stagnation and steaming of dampness-heat lead to nasal swelling, erosion with yellow discharge, dryness and cracking with bleeding, itching and pain, nasal congestion, and even spreading to the nasal wings and lips, causing erosion and swelling. The spleen and stomach are chronically oppressed by dampness-heat, disrupting the ascending and descending functions, resulting in abdominal distension and fullness, loose stools, and poor appetite. In children, spleen deficiency leads to liver hyperactivity, causing irritability, crying, and fussiness. A yellow, greasy tongue coating and a slippery, rapid pulse are also signs of dampness-heat. Treatment should focus on clearing heat and draining dampness, using the Dampness-Resolving Decoction.