bubble_chart Concept

Facial puffiness refers to a swollen and puffy face that rebounds when pressed.

If there is swelling in the head and face, with the area under the eyes resembling a reclining silkworm, and it becomes indented when pressed, it is one of the symptoms of edema. Facial puffiness is caused by qi deficiency leading to qi swelling, while edema is caused by water pathogen. The two are different; the former has a milder swelling, while the latter has more severe swelling. Edema is discussed in a separate section and is not covered in this discussion.

bubble_chart Pattern Analysis

1. Lung Qi Deficiency︰The face appears pale and puffy, with panting and shortness of breath, weak speech, breathlessness upon exertion, aversion to cold and wind, spontaneous sweating, and persistent chronic cough disease. The tongue texture is pale with thin white coating, and the pulse is weak and feeble. This condition is commonly seen in the elderly with weak constitution or those with unhealed chronic cough disease. In the elderly, lung qi deficiency and insufficiency, along with damage to lung qi from chronic cough disease, lead to dysfunction in regulation and failure in dispersing and descending functions. The lung governs qi, and lung deficiency results in the inability to control qi, hence the puffy and swollen appearance of the face. Jingui Yaolue states in "Lung Atrophy, Lung Abscess, Cough, Abnormal Rising of Qi, and Abnormal Pulse Syndrome Treatment": "Abnormal rising of qi, facial puffiness, raised-shoulder breathing, and a floating, large pulse are incurable." This indicates a poor prognosis. Patients often exhibit a pale and lusterless complexion, accompanied by symptoms of lung deficiency such as shortness of breath and panting, reluctance to speak due to qi deficiency, low and weak cough, spontaneous sweating, and aversion to wind. The treatment primarily focuses on tonifying the lung and replenishing qi, supplemented by resolving phlegm and relieving cough. The recommended formula is Bufe Donkey-hide Gelatin Decoction with modifications.
2. Spleen Yang Deficiency︰The complexion is shallow yellow, the limbs are not warm, there is a subjective feeling of facial swelling, fatigue and lack of strength, reduced appetite with abdominal distension and fullness, loose and thin stools, muscle wasting, the tongue texture is pale and tender with tooth marks, the coating is thin and white, and the pulse manifestation is weak. Due to overstrain, improper diet, chronic diarrhea, or other chronic diseases, spleen yang is injured, spleen qi is deficient and weak, transportation and transformation are impaired, clear yang fails to ascend, leading to facial puffiness. Key points for differentiation: the complexion is mostly shallow yellow and lacks luster, accompanied by symptoms of spleen deficiency such as reduced appetite with abdominal distension and fullness, loose stools or rectal prolapse, cold limbs, and fatigue—these two conditions are not difficult to distinguish. Treatment principle: it is advisable to tonify the spleen and replenish qi to uplift yang. The prescription selected is Middle-Tonifying Qi-Replenishing Decoction with the addition of Aconite Lateral Root, Dried Ginger, etc., which can yield effective results.

Facial puffiness is often one of the symptoms of sexually transmitted diseases. The swelling is not severe and can be felt upon pressing. The mechanism of the disease is mostly related to lung and spleen yang qi deficiency, which is considered as a type of qi swelling. However, qi swelling can also be caused by the invasion of external pathogens leading to lung qi stagnation, which is classified as an excess pattern. Treatment should primarily focus on diffusing the lung to downbear counterflow. The former is more common, while the latter is relatively rare.

bubble_chart Documentation

1. Yixue Xinwu: "The classic states: The meridian of the foot Yangming connects the face and descends to the nose. All facial swelling and pain are due to wind. The book states: Facial swelling is due to wind, and foot swelling is due to water. It is appropriate to use Cimicifuga and Pueraria Decoction, with the addition of Dahurian Angelica to treat it. If accompanied by dampness, add Five-Peel Decoction, which is most effective. However, there is also yellowish puffiness of the face, which is due to dampness-heat; and a sallow complexion with puffiness, which is due to spleen deficiency. For dampness-heat, Hezhong Pill is the main treatment; for spleen deficiency, Six Gentlemen Decoction is the main treatment."