经曰。肺内主气。外司。皮毛。若肺气虚则腠理不密。皮毛不泽。肺受伤则皮毛错纵。
肺痈。肺痿。肠痈。必致皮毛如此。以其气不能荣养而然也。亦有服表药。见邪不解。又复
发表。殊不知邪不解者。非邪不能解。多因腠理不密而邪复入也。专用发表则腠理愈虚。邪
愈易入。反为败症矣。宜胗其脉。邪在表者。止当和解而实腠理。乘虚复入者。亦当和解。
兼实腠理。故用托里益气之药。若小便赤涩为肺热所传。小便短少为肺气虚盖肺为母。肾为
子。母虚不能生子故也。亦有小便频数者。亦为肺虚不能约制耳。大抵劳伤血气。则腠理不
密。风邪乘肺。虚风热相抟。郁滞结不散。以致喘嗽。若误汗下过度。则津液重亡。遂成肺
痈、肺痿之症矣。
桷按以上一十五条。原系后病案中互发挥者。虽非外科。以其议论有切于杂症。不敢脱
略。故采附诸论之后。俾学人以便观览。
（时毒发于面鼻耳项者是）
里实而不利者。下之。
表实而不解者。散之。
表里俱实而不解者。解表攻里。
表里俱解而不消者。和之。
肿甚 痛者。砭去恶血。更用消毒之剂。
不作脓或不溃者。托之。
饥年普患者。不宜用峻利。当审而治之。
时毒者。为四时邪毒之气感之于人也。其候发于面、鼻、耳、项、咽喉。赤肿无头。或
有根。令人增寒。发热。头痛。或肢体痛。恍惚不宁。咽喉闭塞。人不识者将为伤寒。便服
解药。一二日肿气益增。方悟。始求疮医。原夫此疾古无方论。世俗通为丹瘤。病家恶言时
。切恐传染。考之经曰。人身忽经变赤。状如涂丹。谓之丹毒。此风热恶毒所为。与时毒特
不同耳。盖时毒初状如伤寒。五七日间乃能杀人。治者宜精辨之。先论其脉、滑、数、浮、
洪、沉、紧、弦、涩、皆其候。盖浮数者邪在表也。沉涩者邪气深也。气实之人急服化毒丹
以攻之。热实不利。大黄汤下之。有表证者。解毒升麻汤以发之。年高气软者。五香连翘
主之。又于鼻内搐。通气散。取十余嚏作效。若搐药不嚏者。不可治。如嚏出脓者。治之必愈
。左右之人。每日用嚏药搐之。必不传染。其病患亦每日用嚏药三五次以泄热毒。此治时毒
之良法也。经三四日不解者。不可大下。犹宜和解之。犀角连翘散之类。至七八日大小便通
利。头面肿起高赤者。可服托里散。黄 散。宜针镰出血。泄其毒瓦斯。十日外不治自愈也。
此病若五日以前。精神昏乱。咽喉闭塞。语声不出。头面不肿。食不知味者必死。治之无功
矣。然而此疾有阴有阳。有可汗。有可下。粗工但云热毒。就用寒药。殊不知病有微甚。治
有逆从。不可不审也。
一人头面肿痛。服硝黄败毒之剂愈甚。诊之脉浮数。邪在表尚未解。用荆防败毒散二剂
。势退大半。更以葛根牛蒡子汤。四剂而痊。（此凭脉发表。）
经云。身半以上肿。天之气也。身半以下肿。地之气也。乃邪客心肺之间。上攻头目而
。此感四时不正之气也。与膏粱积热之症不同。硝黄之剂。非大便秘实不可用。若不审其因
。及辨其虚实表里。概用攻之。必致有误。常见饥馑之际。刍荛之人多患之。乃是胃气有损
。邪气从之。不可不察。予常治邪在表者。用葛根牛蒡子汤。人参败毒散。或普济消毒饮子
。邪在里者。五利大黄汤。栀子仁汤。表里俱不解者。防风通圣散。表里俱解而肿不退者。
犀角升麻汤。肿甚者砭患处。出恶血以泄其毒。十日外自愈。若嚏出脓血即愈。欲其作脓者
。用托里消毒散。欲其收敛者。用托里散。此法最为稳当。五七日咽喉不闭。言语不出。头
面不肿。食不知味者。不治。
一人患此。肿痛发热。作渴。脉实便闭。以五利大黄汤下之。诸症悉退。以葛根牛蒡
子汤四剂而痊。（此凭脉攻里。）
一人表里俱解。肿痛尚不退。以葛根升麻汤二剂而消。（此凭症也。）
一人肿痛发寒热。脉浮数。以荆防败毒散二剂。少愈。再人参败毒散二剂。势减半。又
二剂而瘥。（此凭脉发表。）
一人耳面赤肿作痛。咽干发热。脉浮数。先以荆防败毒散二剂。势退大半。又以葛根牛
蒡子汤四剂而痊。（凭脉发表）
一妇表邪已解。肿尚不消。诊之脉滑而数。乃瘀血作脓也。以托里消毒散溃之而愈。（
此凭脉也。）
一人 肿胀痛。作渴烦热。便秘脉数。按之尤实。用防风通圣散一剂。诸症顿退。以荆
防败毒散加玄参牛蒡黄芩。二剂而瘥。（此凭症凭脉。发表攻里。）
一老冬月头面耳项俱肿。痛甚。便秘脉实。此表里俱实也。饮防风通圣散不应。遂砭患
出黑血。仍投前药。即应。又以荆防败毒散而瘳。盖前药不应者。毒血凝聚上部经络。药力
难达故也。恶血既去。其药自效。或拘用寒远寒。及年高畏用硝黄。而用托里与夫寻常消毒
之剂。或不砭泄其毒。专假药力。鲜不危矣、（此舍时从症。）
一人表里俱解。惟肿不消。以托里消毒散四剂。脓成。针之而愈。（此凭症而治。）
一妇肿痛。用硝黄之剂攻之。稍缓。翌日复痛。诊。之外邪已退。此瘀血欲作脓也。用
托里消毒散溃之而愈。（此凭脉与症也。）
一人表散药愈炽。发热便秘。诊脉沉实。此邪在里也。以大黄汤下之。里症悉退。以葛
根牛蒡子汤。浮肿亦消。惟赤肿尚存。更以托里药溃之而愈。（此凭脉与症也。）
一人冬月病头面赤肿。耳前后尤甚。痛不可忍。发热恶寒。牙关紧急。涕唾稠粘。饮食
。不得安卧。医砭肿上四五十针。肿赤不减。痛益甚。予诊其脉浮紧。按之洪缓。知为寒覆
皮毛。郁遏经络。热不得升。聚而赤肿。且夫天冷寒凛之时。腠理闭。汗不出。血气强。肉
坚涩。善用针者不得取四厥。必待天温。又云。冬月闭脏。用药多。少针石也。宜以苦温之
剂。温经散寒。所谓寒致腠理。以苦发之。以辛散之。
方名托里温经汤
麻黄（苦温发之为君去根节二钱） 防风（辛温散之去芦二分） 升麻（苦辛四钱） 葛根（
解肌出汗专治阳明经邪故以为臣） 白芷归身（血流不行则痛白芷归身辛温以和血散滞各二钱
）苍术（湿热则肿苍术甘温体轻浮力雄壮能泄肤腠间温热一钱） 人参（去芦一钱） 甘草（甘
温） 白芍药（酸微寒调中益气使托其里为佐各钱半）
上锉。每服一两。水二盏。先煎麻黄令沸。去沫。再下余药。同煎至一盏。去渣。大温
。以薄衣覆首。浓被覆身。卧暖处。使经血温。腠理开。寒乃散。阳气升。大汗出。肿减七
八分。再服去麻黄、防风。加连翘、鼠粘子。肿痛悉愈。经言汗之则。疮已。信哉。
或曰。仲景言疮家虽身痛不可汗。何也。予曰。此言营气不从。逆于肉理。乃主痈肿而
痛。非外感寒邪作痛。故戒不可汗。汗之则成 。又问。仲景言鼻衄者不可汗。复言脉浮紧
者以麻黄汤发之。衄血自止。何也。予曰。血与汗异名同类。夺汗者无血。夺血者无汗。今
血妄行。为热所逼。更发其汗。反助邪热。重竭津液。必变凶症。故不可汗。若脉浮为在表
。紧则为寒。寒邪郁遏。阳不得伸。热伏荣中。迫血妄行。上出于鼻。故用麻黄汤散其寒邪
。阳气得舒。其衄自止。洁古之学。可谓知其要矣。
泰和二年四月。民多疫疠。初觉增寒体重。次传头目。肿盛目不能开。上喘。咽喉不利
。舌干口燥。俗云大头天行。亲戚不通。染之多殆。
一人病此五六日。医以承气加蓝根下之。稍缓。翌日其病如故。下之又缓。终莫能愈。
困笃。予曰。身半以上。天之气也。身半以下。地之气也。此邪热客于心肺之间。上攻头目
肿盛。以承气泻胃中之实热。是诛罚无过。不知适其至所为。故遂用
黄连 黄芩（味苦寒各半两泄心肺间热为君） 橘红（苦平） 玄参（苦寒） 生甘草（甘寒
）人参（三钱泄火补气为臣） 连翘 鼠粘子 薄荷叶（苦辛平） 板蓝根（苦寒） 马勃（各一
钱） 白僵蚕（炒七分） 升麻 柴胡（苦平各二钱行少阳阳明二经气不得伸） 桔梗（辛温为舟
楫不使下行）
共为细末。半用汤调。时时服之。半用蜜丸噙化。服尽良愈。
凡他处有病此者。书方贴之。名曰
普济消毒饮。或加川芎、归身。 咀如麻豆。每服五钱。水二钟。煎至一钟。去滓。食
后稍热时时服。如大便硬。加大黄（酒煨一钱或二钱）以利之。肿势甚。宜砭刺之。
按时行疫疾。虽由热毒所染。有气实人下之可愈。气虚者概下之。鲜不危矣。故东垣制
此方救斯人。其惠博哉。
一人年逾三十。肩患毒。服人参败毒散一剂。更服十宣散去参、桂。加金银花、天花粉
而溃。因怒动肝火。风热上壅。头面赤肿。 痛。饮冷。以荆防败毒散。加芩、连、薄荷。
二剂不应。急砭患处。出黑血盏许。仍以一剂。势退大半。再服人参败毒散四剂而愈。
夫病有表里、上下之殊。治有缓急攻补之异。若不砭刺。气血结为肉理。药不能及。肿
日盛。使峻利之药。则上热未除。中寒已作。必伤命矣。
升麻牛蒡子散 治时毒疮发头面胸膈。脉浮洪在表者。
升麻 牛蒡 甘草 桔梗 葛根 玄参 麻黄 连翘（各一钱） 锉。作一服。姜三片。
水二盏煎。一黄门腮赤肿痛。此胃经风热上攻。以犀角升麻汤（三八）二剂而平。
又一大理患此。用前汤为人所惑。谓汤内白附子性温故也。另用荆防败毒散愈盛。后用
此汤尚去白附子。不应。再用全方。三剂而愈。
本草云。白附子。味甘辛。气温。无毒。主面上百病。及一切风疮。乃风热之主药。经
曰。有是病。用是药。苟不用主病之药。安得而愈。
一人腮颊肿 至于牙龈。右关脉数。此胃经风热上攻也。治以犀角升麻汤（三八）而消。
The *Yellow Emperor's Inner Classic* states: The Lung governs Qi internally and controls the skin and hair externally. If Lung Qi is deficient, the couli (skin texture and pores) will not be dense, and the skin and hair will lose luster; if the Lung is injured, the skin and hair will appear disordered and withered.
Lung abscess (pulmonary suppurative lesion), Lung flaccidity (atrophy of lung lobes), and intestinal abscess will inevitably lead to such conditions in the skin and hair. This is because Qi cannot nourish and moisten them. There are also cases where, after taking exterior-releasing medicines, the pathogenic factor remains unresolved, and exfoliation methods are used again. Little do they know that the failure to resolve the pathogen is not due to the inability to expel it, but often because the couli are not dense, allowing the pathogen to re-enter. Exclusively using exfoliation methods will further weaken the couli, making it easier for pathogens to enter, resulting in a deteriorating condition. One should examine the pulse: if the pathogen is at the exterior, one should only employ harmonizing methods and strengthen the couli; if the pathogen re-enters due to vacuity of the couli, one should also use harmonizing methods while strengthening the couli. Therefore, medicines that support the interior and tonify Qi are used. If urine is red and dysuric, this is transmitted from Lung heat; if urine is scanty, it is due to Lung Qi deficiency. Since the Lung is the Mother organ and the Kidney is the Child organ, maternal deficiency fails to generate the child. There are also cases of frequent urination, which is also due to Lung deficiency failing to control water passages. Generally, labor injury to Blood and Qi leads to loose couli; Wind pathogen attacks the Lung; Deficient Wind and Heat struggle together, stagnating and condensing without dispersing, leading to asthma and cough. If mistaken sweating or purging is excessive, Body Fluids are severely depleted, forming Lung abscess or Lung flaccidity.
Jue notes: The above fifteen discussions originally served to elaborate on each other in subsequent medical cases. Although not strictly surgical, their arguments are pertinent to miscellaneous diseases, so I dare not omit them. Thus, they are collected and attached after the various discussions for students' convenience.
(When Shidu [Seasonal Toxin] occurs on the face, nose, ears, and neck:)
If Interior Excess exists with constipation, purge it.
If Exterior Excess exists with unresolved pathogen, disperse it.
If both Exterior and Interior are Excess and unresolved, release the exterior and attack the interior simultaneously.
If both Exterior and Interior pathogens are resolved but swelling persists, harmonize it.
If swelling is severe and painful, use bian stone to puncture and remove evil blood, then apply detoxifying agents.
If no pus forms or it does not ulcerate, use interior-supporting methods to promote suppuration.
If prevalent during famine years, harsh purgatives should not be used; treatment must be cautious and differentiated.
"Shidu" refers to toxic qi of the four seasons infecting humans. Symptoms include onset on the face, nose, ears, neck, and throat, with redness and swelling without heads, sometimes with roots, causing chills, fever, headache, limb pain, restlessness, and throat obstruction. Those unfamiliar with this disease may mistake it for Cold Damage and take exterior-releasing medicines. After one or two days, swelling increases, and they seek a surgeon. Originally, ancient texts had no formulas for this disease; laypeople generally call it Dan Liu (Dan Tumor). Patients dislike the term "Shidu" due to fear of contagion. Examining classics: sudden redness on the body resembling cinnabar is called Dan Du (Red Poison), caused by Wind-Heat toxicity, distinct from Shidu. Shidu initially resembles Cold Damage but can be fatal within five to seven days. Practitioners must differentiate carefully. Pulse signs include Slippery, Rapid, Floating, Surging, Deep, Tight, Wiry, and Choppy. Floating-Rapid indicates pathogen at the exterior; Deep-Choppy indicates deep pathogen. For robust individuals, Huadu Dan should be taken urgently to attack the pathogen; if Heat Excess with constipation, Dahuang Tang (Rhubarb Decoction) should be used to purge; if Exterior signs exist, Jiedu Shengma Tang (Detoxification and Cimicifuga Decoction) should be used to release; for elderly and weak individuals, Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction) is primary. Nasal insufflation with Tongqi San (Unblocking Qi Powder) is effective if more than ten sneezes occur. If no sneezing occurs, it is incurable. If pus is sneezed out, cure is certain. Companions should use nasal insufflation daily to prevent contagion. Patients should use it three to five times daily to vent Heat-Toxin. This is an excellent method for treating Shidu. If unresolved after three to four days, do not purge heavily; instead, harmonize, e.g., Xijiao Lianqiao San (Rhino Horn and Forsythia Powder). By seven to eight days, if urination and defecation are smooth and head/face swelling is high and red, Tuoli San (Interior-Supporting Powder) and Huangqi San (Astragalus Powder) can be taken. Needle-lancing to bleed and vent toxic gas is appropriate. It may heal spontaneously after ten days. If before the fifth day, there is mental confusion, throat obstruction, voice loss, no head/face swelling, and loss of taste, death is inevitable, and treatment is futile. However, this disease has Yin and Yang aspects, and allows for sweating or purging. Incompetent doctors merely label it Heat-Toxin and use cold medicines. They fail to realize that disease severity varies and treatment requires adherence or counteraction; caution is essential.
One patient had head and face swelling and pain, worsening after taking Xiaoshi and Dahuang (Mirabilite and Rhubarb) detoxifying agents. Pulse was Floating-Rapid, indicating unresolved Exterior pathogen. Two doses of Jingfang Baidu San (Schizonepeta and Saposhnikovia Detoxification Powder) reduced symptoms by half. Four doses of Gegen Niuziqi Tang (Pueraria and Arctium Decoction) cured him. (Treatment based on pulse indicating Exterior pathogen.)
The Classics state: Swelling in the upper half of the body is due to Heavenly Qi (Wind); swelling in the lower half is due to Earthly Qi (Dampness). This is pathogen lodging between Heart and Lung, attacking head and eyes, caused by improper seasonal qi. It differs from accumulation-heat from rich food. Xiaoshi and Dahuang should not be used unless there is solid constipation. Without examining etiology and differentiating Empty/Full and Exterior/Interior, indiscriminate purging causes error. Often seen among poor people during famines, it stems from damaged Stomach Qi allowing pathogen invasion. I often treat Exterior pathogen with Gegen Niuziqi Tang, Renshen Baidu San (Ginseng Detoxification Powder), or Puji Xiaodu Yinzi (Universal Benefit Detoxification Drink). For Interior pathogen, Wuli Dahuang Tang (Five-Advantage Rhubarb Decoction) or Zhizi Ren Tang (Gardenia Seed Decoction). For unresolved Exterior and Interior, Fangfeng Tongsheng San (Saposhnikovia Unobstructed Defense Powder). For resolved Exterior/Interior but persistent swelling, Xijiao Shengma Tang (Rhino Horn and Cimicifuga Decoction). For severe swelling, bian stone puncture to vent evil blood. Healing occurs after ten days. If pus/blood is sneezed out, healing occurs. To promote suppuration, use Tuoli Xiaodu San (Interior-Supporting Detoxification Powder). To promote convergence, use Tuoli San. This method is most stable. If after five to seven days, throat is not closed, speech is absent, head/face is not swollen, and taste is lost, it is incurable.
One patient had swelling, pain, fever, thirst, solid pulse, and constipation. Purged with Wuli Dahuang Tang; all symptoms subsided. Cured with four doses of Gegen Niuziqi Tang. (Treatment based on pulse indicating Interior pathogen.)
One patient had resolved Exterior/Interior but persistent swelling. Reduced with two doses of Gesheng Ma Tang (Pueraria and Cimicifuga Decoction). (Treatment based on symptoms.)
One patient had swelling, pain, chills, fever, and Floating-Rapid pulse. Two doses of Jingfang Baidu San improved slightly. Two doses of Renshen Baidu San halved the intensity. Two more doses cured him. (Treatment based on pulse indicating Exterior pathogen.)
One patient had red/swollen/painful ears/face, dry throat, fever, and Floating-Rapid pulse. Two doses of Jingfang Baidu San reduced intensity by half. Four doses of Gegen Niuziqi Tang cured him. (Treatment based on pulse indicating Exterior pathogen.)
A woman had resolved Exterior pathogen but persistent swelling. Pulse was Slippery-Rapid, indicating Blood stasis turning to pus. Cured with Tuoli Xiaodu San to ulcerate. (Treatment based on pulse.)
One patient had cheek swelling/pain, thirst, irritability, constipation, Rapid pulse, and tenderness on pressure. One dose of Fangfeng Tongsheng San rapidly subsided symptoms. Two doses of Jingfang Baidu San plus Xuanshen, Niuziqi, Huangqin cured him. (Treatment based on symptoms and pulse, releasing Exterior and attacking Interior.)
An elderly man had winter-onset head/face/ear/neck swelling, severe pain, constipation, and Solid pulse. This is Exterior/Interior Excess. Fangfeng Tongsheng Tang was ineffective. Bian stone puncture released black blood; previous medicine then worked. Jingfang Baidu San cured him. Previous ineffectiveness was due to toxic blood coagulating in upper meridians, blocking drug action. Once evil blood was removed, drugs became effective. Adhering to "avoid cold in cold season" or fearing laxatives in the elderly, relying solely on interior-supporting/detoxifying drugs without puncturing, rarely avoids danger. (Treatment prioritizing symptoms over seasonal taboos.)
One patient had resolved Exterior/Interior but persistent swelling. Four doses of Tuoli Xiaodu San formed pus; needle drainage cured him. (Treatment based on symptoms.)
A woman had swelling/pain, treated with Xiaoshi/Dahuang, temporarily relieved, then returned. Pulse showed resolved Exterior pathogen, indicating Blood stasis turning to pus. Cured with Tuoli Xiaodu San. (Treatment based on pulse and symptoms.)
One patient worsened with exterior-releasing drugs, having fever and constipation. Pulse was Deep-Solid, indicating Interior pathogen. Purged with Dahuang Tang; Interior symptoms subsided. Gegen Niuziqi Tang reduced edema. Only red swelling remained; treated with interior-supporting drugs to ulcerate and cure. (Treatment based on pulse and symptoms.)
One patient had winter-onset head/face red swelling, worse around ears, unbearable pain, fever/chills, trismus, thick sputum, difficulty eating/sleeping. Doctor punctured forty to fifty times with bian stone, but swelling/redness persisted and pain increased. My pulse diagnosis was Floating-Tight, surging-slow upon pressure. This indicated Cold covering skin/hair, obstructing meridians, preventing Heat ascent, condensing into red swelling. In cold weather, couli close, sweat stops, Blood/Qi strengthens, muscles become firm/rigid. Skillful acupuncturists avoid extremities in winter cold, waiting for warmth. Winter is when Zang organs close; use more medicine, less acupuncture. Bitter-Warm medicines should warm meridians and scatter Cold. As stated, Cold closes couli; scatter with Bitter, disperse with Pungent.
Formula Name: Tuoli Wenjing Tang (Interior-Supporting Meridian-Warming Decoction)
Mahuang (Ephedrae Herba, Bitter-Warm, Sovereign for sweating, remove root nodes, 2 qian)
Fangfeng (Saposhnikoviae Radix, Pungent-Warm, Assistant for dispersion, remove rhizome, 2 fen)
Shengma (Cimicifugae Rhizoma, Bitter-Pungent, 4 qian)
Gegen (Puerariae Lobatae Radix, Releases muscle layer and induces sweat, treats Yangming channel pathogen, Assistant, dosage implied)
Baizhi (Angelicae Dahuricae Radix) & Danggui (Angelicae Sinensis Radix) - Blood stasis causes pain; these are Pungent-Warm to harmonize Blood and dissipate stasis, 2 qian each)
Cangzhu (Atractylodis Rhizoma, Damp-Heat causes swelling; Sweet-Warm, light/floating, strong power to vent Heat-Heat in couli, 1 qian)
Renshen (Ginseng Radix, remove rhizome, 1 qian)
Gancao (Glycyrrhizae Radix, Sweet-Warm)
Baishao (Paeoniae Radix Alba, Sour-Slightly Cold, regulates Middle, boosts Qi, supports Interior, Deputy, 1.5 qian each)
Crush ingredients. Take 1 liang per dose, 2 zhan water. Boil Mahuang first, skim foam, add remaining herbs, boil to 1 zhan, strain. Drink warm. Cover head with thin cloth, body with thick quilt, sleep in warm place. Warm Blood/Qi, open couli, scatter Cold, raise Yang, induce heavy sweat. Swelling reduces by 70-80%. Next dose, remove Mahuang/Fangfeng, add Lianqiao and Niuziqi. Pain/swelling fully healed. Classics say: Sweating cures sores. True indeed.
Question: Zhang Zhongjing says "Chuangjia [sores patients] even with body pain should not be sweated." Why?
Answer: This refers to Ying Qi not following its course, reversing in muscle tissue, causing pain from carbuncles/swellings, not external Cold-Damage pain. Hence, sweating is forbidden. Sweating leads to deterioration.
Question: Zhang Zhongjing says "Nosebleed patients should not be sweated," yet also says "Floating-Tight pulse uses Mahuang Tang to sweat, and nosebleed stops." Why?
Answer: Blood and Sweat are different names for the same substance. Depriving sweat leaves no blood; depriving blood leaves no sweat. Now, blood flows recklessly due to Heat forcing it. Sweating again aids Evil Heat and depletes fluids, causing凶症 (ominous symptoms). Hence, forbidden. If pulse is Floating (Exterior) and Tight (Cold), Cold obstructs Yang, Heat hides in Ying, forcing blood up the nose. Mahuang Tang scatters Cold, frees Yang, and nosebleed stops. Jiegu's learning grasped the essence.
In the second year of Taihe (April), many suffered epidemic pestilence. Initially chills and heaviness, then spreading to head/eyes, severe swelling closing eyes, upward panting, throat obstruction, dry tongue/mouth. Commonly called "Big Head Epidemic." Relatives avoided contact; infection was often fatal.
One patient suffered for 5-6 days. Doctor used Chengqi Tang + Lan Gen (Isatis Root) to purge. Slight relief. Next day, same illness. Purged again, slight relief. Never cured. Critical condition. I said: Upper body is Heavenly Qi; lower body is Earthly Qi. This is Evil Heat lodging between Heart/Lung, attacking head/eyes causing severe swelling. Using Chengqi Tang to purge Stomach excess heat punishes the innocent. It misses the target. So I used:
Huanglian (Coptidis Rhizoma) & Huangqin (Scutellariae Radix) - Bitter-Cold, 0.5 liang each, vents Heart/Lung Heat as Sovereign)
Juhong (Citri Reticulatae Pericarpium, Bitter-Ping)
Xuanshen (Scrophulariae Radix, Bitter-Cold)
Sheng Gancao (Raw Glycyrrhizae Radix, Sweet-Cold)
Renshen (Ginseng Radix, 3 qian, vents Fire, boosts Qi as Assistant)
Lianqiao (Forsythiae Fructus), Niuziqi (Arctii Fructus), Bohe Ye (Menthae Haplocalycis Folium) - Bitter-Pungent-Ping)
Banlangen (Isatidis Radix, Bitter-Cold)
Mabo (Fly Agaric Mushroom, dosage implied)
Bai Jiangcan (Bombyx Batryticatus, stir-fried, 7 fen)
Shengma (Cimicifugae Rhizoma) & Chaihu (Bupleuri Radix) - Bitter-Ping, 2 qian each, moves Shaoyang/Yangming Qi obstruction)
Jiegeng (Platycodonis Radix, Pungent-Warm, acts as boat/oar to prevent downward movement)
Grind to fine powder. Half mixed with water, taken frequently. Half made into honey pills for sucking. Cure achieved.
For other locations, write formula and paste. Named Puji Xiaodu Yin (Universal Benefit Detoxification Drink). Add Chuanxiong and Danggui if needed. Crush like hemp seeds. Take 5 qian per dose, 2 zhong water, boil to 1 zhong, strain. Take warm after meals. If stool hard, add Dahuang (wine-baked 1-2 qian) to unblock. If swelling severe, use bian stone puncture.
Seasonal epidemics, though caused by Heat-Toxin, can be purged in Qi-Excess persons. Purging Qi-Deficient persons rarely avoids danger. Hence, Dongyuan (Li Gao) created this formula to save people. His benevolence is vast.
One patient, over thirty, had shoulder toxin. Took one dose of Renshen Baidu San, then Shixuan San removing Renshen/Guizhi, adding Jinyinhua and Tianhuafen, leading to suppuration. Anger stirred Liver Fire, Wind-Heat congested upward, causing head/face red swelling and pain, craving cold drinks. Used Jingfang Baidu San + Huangqin/Huanglian/Bohe. Two doses ineffective. Urgently punctured site, released about one cup of black blood. One more dose reduced intensity by half. Four doses of Renshen Baidu San cured him.
Diseases differ in Exterior/Interior and Upper/Lower; treatments differ in Slow/Fast, Attack/Support. Without puncturing, Blood/Qi knots in tissue, drugs cannot reach, swelling grows. Harsh purgatives leave Upper Heat while creating Middle Cold, endangering life.
Shengma Niuziqi San (Cimicifuga and Arctium Powder) treats Shidu sores on head/face/chest/diaphragm with Floating-Surging pulse at Exterior.
Shengma, Niuzi, Gancao, Jiegeng, Gegen, Xuanshen, Mahuang, Lianqiao (1 qian each). Crush. One dose. 3 slices ginger, 2 zhan water, boil.
A eunuch had red/swollen/painful cheeks due to Stomach Channel Wind-Heat attacking upward. Cured with Xijiao Shengma Tang (Rhino Horn and Cimicifuga Decoction) in two doses.
Another official had this disease. Used previous decoction but was misled, claiming Baifuzi (Typhonii Rhizoma) is too warm. Used Jingfang Baidu San, worsening condition. Later used previous decoction but removed Baifuzi, ineffective. Used full formula, cured in three doses.
Bencao states: Baifuzi is Sweet-Pungent, Warm, non-toxic. Treats hundred diseases on face and all wind-sores. It is the chief medicine for Wind-Heat. Classics say: Have the disease, use the medicine. Without chief medicine, how can one heal?
One patient had cheek/jaw swelling extending to gums, Right Guan pulse Rapid. This is Stomach Channel Wind-Heat attacking upward. Cured with Xijiao Shengma Tang.