A facial boil is an acute suppurative lesion on any part of the face. The head is where all the Yang Meridians converge, so that the poisons of Fire readily accumulate there and illnesses can develop rapidly. If the condition is not treated promptly and properly or if the lesion is rashly squeezed, the poisons can spread and the lesion can spread to the adjacent areas, including the sinuses and beyond. Occasionally it may even lead to meningitis or septicemia.
Etiology, Pathology and Clinical Manifestation
The principal cause of facial boils is the poisons of Fire or Heat. Such poisons may arise in several circumstances. Overindulgence in rich, fatty, spicy or alcoholic foods and drinks may induce Heat accumulation in the visceral organs. Strong evil Qi of Fire or Heat may generate much poison. Injury due to insect bites or excoriation may break the skin barrier and permit invasion and lodging by exogenous evils, and these evils in turn steam the superficies and induce local Qi stagnation and blood stasis.
In the beginning stage, a facial boil is a firm grain-sized papule with a deep root, resembling the head of a nail. It soon transforms into a pustule with local and painful inflammation. In the middle stage, usually 5 to 7 days after onset, the pustule increases in size and the accompanying pain intensifies. There may be systemic symptoms such as fever. The boil develops a head, which may rupture and drain pus. In the late stage, as the pus drains the swelling subsides, pain resolves and healing proceeds. The systemic symptoms also resolve. In general, the overall course lasts 10-14 days.
If a facial boil is not treated properly or if it is improperly squeezed, the poisons can readily spread and induce complications, such as spread to adjacent areas and the sinuses, sometimes even further to the meninges. If the poisons manage to enter the channels, they may metastasize and produce abscesses throughout the somatic body and the viscera. If the poisons reach a bone they may induce osteomyelitis.
Herbal Treatment
Since the principal causative agents are Fire, Heat and their poisons, treatment emphasizes the purging of Fire and Heat and the detoxification of poisons. Herbs that induce diaphoresis are contraindicated, even if the patient has fever. Moxibustion is also contraindicated. The boil must not be cut or pricked prior to suppuration.
Internal Treatment
Main Symptoms. In the early stage, the lesion is a grain-sized pustule. Soon it enlarges and becomes inflamed with redness, swelling, heat and pain. As it worsens pain intensifies. There may then be such systemic symptoms as chills and fever, thirst with desire to drink, dark urine and constipation. The tongue is red, with dry yellow coating. The pulse is slippery and rapid.
Therapeutic Principle. Purge Heat and detoxify poisons.
Treatment. Wu Wei Xiao Du Yin (Five-Ingredient Detoxification Drink) combined with Huanglian Jie Du Tang (Coptis Detoxification Decoction). The combined composition is as follows: jinyinhua (Lonicera) 15 g, pugongying (Taraxacum) 30 g, wild juhua (Chrysanthemum) 15 g, zihuadiding (Viola) 15 g, tiankuizi (Semiaquilegia adoxoides) 10 g, huanglian (Coptis) 10 g, huangqin (Scutellaria) 10 g, huangbai (Phellodendron) 10 g, andzhizi (Gardenia) 10 g.
If fever is high, with much thirst, add zhuye (Phyllostachys nigra) 10 g, shigao (gypsum) 30 g and liangqiao (Forsythia) 15 g.
For constipation, add raw dahuang (Rheum palmatum) 10 g, decocted last.
If swelling and pain are severe, add banlangen (Isatis) 15 g, ruxiang (Boswellia) 9 g and moyao (Commiphora) 9 g.
If pus does not drain well following rupture, add chuanshanjia scales (Manis pentadactyla) 10 g and zaojiaoci (Gleditsia sinensis) 10 g.
Topical Treatment
In the beginning stage, apply wet compresses of Yu Lu San (Jade Dew Powder). Yu Lu San is prepared by grinding mufurong leaf (Hibiscus mutabilis) into powder.
In the middle stage, when the boil has formed a head, use tweezers to remove the pus core. If necessary, incise the boil to drain it.
In the later stage, following drainage of pus, cover with Huanglian Gao (Coptis Ointment) or Dahuang You (Rhubarb Lotion). Huanglian Gao is prepared as follows. Soak the following five herbs in 360 ml of sesame oil: huanglian (Coptis) 9 g, huangbai (Phellodendron) 9 g, jianghuang (Curcuma) 9g, danggui (Angelica) 15 g and shengdihuang (Rehmannia) 30 g. Let stand for 24 h, then heat over a low fire to brown the herbs. Filter. Add 120 g of medicinal wax to the supernatant and warm over a low fire to form an ointment. Dahuang You is prepared as follows. Boil 100 g of dahuang (Rheum palmatum) in 300 ml of water for 20 min. Save the decoction. Place the residual dahuang in another 300 ml of water and boil for 15 min. Combine the two decoctions and boil in another pot to reduce the volume to 100 ml. For application mix 30 ml of the dahuang decoction with 100 g of vaseline. (Note: both Huanglian Gao and Dahuang You may be sterilized using high temperature and pressure.)
Acupuncture Treatment
Body Acupuncture. Select the acupoints Hegu (LI-4), Weizhong (BL-40), Shenzhu (DU-12) and Lingtai (DU-10). If Fire is strong, add the acupoints Dazhui (DU-14), Quze (PC-3) and Dushu (BL-16).
Ear Acupuncture. Select the acupoints Shenmen, Adrenal, Occiput and other ear acupoints related to the affected area.
Moxibustion is contraindicated.
Case Study
The patient was a 27-year old woman who presented with a facial boil for 6 days and fever for 3 days. The lesion began as a grain-sized papule over the right zygoma. It was mildly itchy but not tender. She squeezed it, and it gradually enlarged, becoming inflamed and tender, and extended to the right cheek. For the last 3 days she had fever as well. She also developed a bitter taste in the mouth and anorexia. An injection of penicillin was ineffective.
On examination, the patient had a temperature of 38.4°C (101.1°F). There was red swelling around a grain-sized pustule overlying the right zygoma and spreading into the right face and involving the right eyelids. The tongue was red, with thin yellow coating. The pulse was slippery and rapid. White blood cell count was 16,400, with 82% neutrophils and 18% lymphocytes.
Diagnosis. Facial boil with cellulitis.
Therapeutic Principle. Cool Heat and detoxify poisons, complemented with drainage of pus.
Treatment and Course. The prescribed formula had the following composition: zihuadiding (Viola) 9 g, wild juhua (Chrysanthemum) 6 g, chishaoyao (Paeonia) 9 g, zaojiaoci (Gleditsia sinensis) 9 g, toasted chuanshanjia scales (Manis pentadactyla) 4.5 g, sigualuo (Luffa cylindrica) 9 g, qiyeyizhihua (Paris polyphylla) 9 g, chenpi (Citrus tangerina) 6g, and shenggancao (Glycyrrhiza) 3g.
Second Visit. She returned in 2 days for follow-up. After two daily doses, the swelling and pain diminished. The boil had come to a head and had ruptured, draining pus. The base under the boil remained hard. The same therapeutic principle was continued, with a different herbs. The composition was as follows: zihuadid-ing (Viola) 9g, wildjuhuia (Chrysanthemum) 6g, rendongteng (Lonicera japonica, twig) 9 g, lianqiao (Forsythia) 9 g, qiyeyizhihua (Paris polyphylla) 9 g, charred zhizi (Gardenia) 9 g, sigualuo (Luffa cylindrica) 9 g, and shenggancao (Glycyrrhiza) 3 g.
Third Visit. She returned in 2 days for follow-up. Following drainage of the pus, the swelling and induration resolved completely. The same prescription was continued for two more daily doses, after which she was completely cured.
