表证偏胜者。膜原之伏邪发时。传表之邪多。传里之邪少。当治其表。里证兼之。
邵评∶膜原附近于胃。为表里之分界。邪伏膜原。出表者多。入里者少。则表证偏
胜。乃七表三里之候。当先治表。而略兼治里。
若里证多而表证少。但当治其里。而表证自愈。
邵评∶膜原之邪。入里者多。出表者少。则里症偏胜。乃七里三表之候。但治其里。里通。则邪外出而愈。
即大头天行。宜普济消毒饮。
邵评∶风热湿浊。扰乱清阳之境。故伤高巅之上。从上越者生。下行者死。初起寒热体重。头面
肿痛。或红或紫。或青或黄。目不能开。咽喉不利。不速治。十死八九。甚者砭针刺之。如大便硬。
加酒蒸大黄三钱缓下之。若额上面部肿赤者属阳明。本方加石膏。耳之上下前后并额旁红肿者属少阳。
本方加柴胡、花粉。项下耳后赤肿者属太阳。本方加荆防、羌活。盖大头瘟肿赤之处。分三阳经部位。
故药亦分三阳经加法。但邪在上焦。药宜轻清。频进而缓服。急则过其病所矣。
头与咽中肿胀。喉痛。声不出。即虾蟆瘟。宜荆防败毒散。
邵评∶邪伤上焦。蕴于肺胃。喉痹失音等象。较大头瘟之肿在肌表者。更深一层矣。此症邪干
肺胃。当用射干以发肺邪。石膏以泻肺热。犀角以解胃毒。大黄以疏胃壅。方为正治。此方先用羌活、
独活、荆芥、防风、柴胡、前胡。燥烈而专达表。与秽邪之在上焦肺胃者。似不相值。须斟酌用为妥。
When the exterior syndrome predominates. This occurs when latent pathogens in the Mo Yuan (Membrane Source) manifest; there is much pathogen transmitting to the exterior and little transmitting to the interior. Treatment should focus on the exterior, addressing any concurrent interior syndromes.
Commentary by Shao: The Mo Yuan is adjacent to the Stomach, serving as the boundary between the exterior and interior. When pathogens are latent in the Mo Yuan, those emerging to the exterior are numerous, while those entering the interior are few, resulting in a predominance of exterior syndrome. This constitutes a "Seven Exterior, Three Interior" pattern. One should first treat the exterior, with slight attention to treating the interior.
If the interior syndrome is predominant and the exterior syndrome is minor, treatment should focus solely on the interior, and the exterior syndrome will resolve spontaneously.
Commentary by Shao: When pathogens from the Mo Yuan enter the interior frequently and emerge to the exterior rarely, the interior syndrome predominates. This constitutes a "Seven Interior, Three Exterior" pattern. By treating the interior alone, once the interior qi flows freely, the pathogen will exit outward and the patient will recover.
In cases of Da Tou Tian Xing (Great Head Epidemic / Plague), Pu Ji Xiao Du Yin (Universal Benefit Decoction for Resolving Toxicity) is appropriate.
Commentary by Shao: Wind-heat and damp-turbidity disrupt the realm of clear yang, thereby damaging the high peaks of the head. Those that vent upward from the upper jiao survive; those that sink downward perish. Initially, there is aversion to cold, fever, and heaviness of the body, with swelling and pain in the head and face, which may be red, purple, blue, or yellow. The eyes cannot open, and the throat feels obstructed. If not treated promptly, eight or nine out of ten patients will die. In severe cases, bloodletting with Bian stones or needles is indicated. If the stool is hard, add three qian of wine-steamed Da Huang (Rhei Radix et Rhizoma) to gently purge. If swelling and redness are located on the forehead and facial surface, it belongs to the Yangming channel; add Shi Gao (Gypsum Fibrosum) to this formula. If swelling and redness occur around, above, below, and in front of/behind the ears and on the sides of the forehead, it belongs to the Shaoyang channel; add Chai Hu (Bupleuri Radix) and Hua Fen (Trichosanthis Radix) to this formula. If redness and swelling occur below the neck and behind the ears, it belongs to the Taiyang channel; add Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), and Qiang Huo (Notopterygii Rhizoma et Radix) to this formula. Since the swollen and red areas of Great Head Plague correspond to the territories of the three Yang channels, the modifications to the prescription also follow the specificities of the three Yang channels. However, since the pathogen is in the upper jiao, the herbs should be light and clear, administered frequently in small doses. If taken too hastily, they may overshoot the site of the disease.
Swelling of the head and throat, sore throat, and loss of voice constitute Xia Ma Wen (Toad Plague / Mumps-like illness). Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Powder to Resolve Toxicity) is appropriate.
Commentary by Shao: Pathogens damage the upper jiao and accumulate in the Lung and Stomach, presenting with symptoms such as throat obstruction and aphonia. This condition is deeper than the swelling on the skin surface seen in Great Head Plague. Here, pathogens invade the Lung and Stomach; proper treatment requires She Gan (Belamcandae Rhizoma) to disperse Lung pathogens, Shi Gao (Gypsum Fibrosum) to drain Lung heat, Xi Jiao (Rhino Ceratoss) to resolve Stomach toxicity, and Da Huang (Rhei Radix et Rhizoma) to unblock Stomach stagnation. This represents the correct therapeutic approach. This formula initially uses Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), Chai Hu (Bupleuri Radix), and Qian Hu (Peucedani Radix). These herbs are drying, acrid, and specifically target the exterior. They seem mismatched with turbid pathogens accumulated in the upper jiao Lung and Stomach; therefore, their use must be carefully considered for appropriateness.