Library

Qi stated: Shidu (Seasonal Toxic Disease) is caused by the contraction of pathogenic toxic qi from the four seasons. Its manifestations include redness and swelling without heads on the nose, face, ears, neck, and throat; or deep-seated nodules with roots. It causes aversion to cold, fever, headache, severe limb pain, mental confusion, and throat obstruction. Those unfamiliar with this condition may mistake it for Shanghan (Cold Damage). Historically, there were no specific formulas or discussions for this disease in ancient texts. The common people generally call it Danliu (Dan Nodule), and patients dislike the term "Shidu" due to fear of contagion. The Classics state: When the body suddenly turns red like applied cinnabar, it is called Dandu (Erysipelas/Dan Toxin). This is caused by wind-heat and malignant toxins, which differs from Shidu. Shidu results from contracting abnormal qi of the four seasons. Initially, symptoms resemble Shanghan; it can be fatal between the fifth and seventh days, but if it persists beyond ten days, it often resolves spontaneously. Therefore, treatment requires careful differentiation. First, examine the pulse. Slippery-rapid, floating-hong, deep-tight, wiry, or choppy pulses are all indicative signs. A floating-rapid pulse indicates the pathogen is at the exterior; a deep-choppy pulse indicates the pathogen is deep within. For severe toxicity, administer Huadu Dan (Toxin-Resolving Pill) urgently to attack the pathogen. For excess heat with constipation, use Dahuang Tang (Rhubarb Decoction) to purge. For exterior syndromes, use Xijiao Shengma Tang (Rhino Horn and Cimicifuga Decoction) to release the exterior. For elderly patients with deficient qi and stagnation, Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction) is indicated.

Additionally, blow Tongqi San (Air-Ventilation Powder) into the nostrils; achieving more than ten sneezes indicates efficacy. If no sneezing occurs after medication, the condition is considered incurable. If pus and blood are expelled via sneezing, the patient will surely recover. Caregivers should use the nasal powder daily to prevent contagion; this must be remembered. Patients should use the sneezing powder three to five times daily to vent heat and toxin; this is an excellent method for treating seasonal conditions.

If the condition persists for three to four days without resolution, strong purgation should be avoided; instead, harmonization is appropriate, using Xijiao San (Rhino Horn Powder), Qinlian Xiaodu Yin (Scutellaria and Coptis Detoxification Drink), or Lianqiao Tang (Forsythia Decoction) for severe cases. By the seventh or eighth day, if bowel and bladder movements are unobstructed but the head and face remain swollen and red, Tuoli San (Support-the-Interior Powder) or Tuoli Huangqi Tang (Support-the-Interior Astragalus Decoction) may be used. For severe swelling, phlebotomy (Bian) at the affected site to release evil blood is suitable to vent toxic vapors. If before the fifth day, the patient exhibits mental confusion, throat obstruction, inability to speak, red facial swelling, and loss of appetite, it is a death sign, and treatment will be ineffective. However, this disease has Yin and Yang aspects; some cases respond to sweating, others to purging. I have seen incompetent physicians attribute everything to heat-toxin and use only cold medicines, failing to recognize that diseases vary in severity and treatments must follow either contrary or conforming principles. Careful examination is essential.

Luo Qianfu said: In the second year of Taihe, when my master served as the tax supervisor of Jiyuan, many people suffered from epidemics in April. Initially, they felt aversion to cold and heaviness in the body, followed by head and facial swelling, eyes swollen shut, upward panting, throat dysfunction, dry tongue, and dry mouth. Commonly known as Datou Tianxing (Big Head Epidemic), relatives avoided contact, and most infected individuals did not survive. The nephew of Magistrate Zhang also contracted this disease. By the fifth or sixth day, doctors used Chengqi Tang (Chengqi Decoction) plus Banlangen (Isatis Root) to purge, providing slight relief. The next day, the condition remained unchanged; another purge provided slight relief, but the disease persisted and became critical. Someone suggested consulting Li Mingzhi, who was dedicated to medicine. Upon diagnosis and hearing the history, my master stated: "The upper half of the body corresponds to Heaven's Qi, and the lower half to Earth's Qi. This pathogenic heat resides between the Heart and Lung, attacking the head and eyes causing severe swelling. Using Chengqi Tang to purge stomach heat is punishing the innocent, ignoring the actual location of the pathology." He prescribed a formula: Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) as sovereign herbs to clear heat from the Heart and Lung with bitter-cold properties; Juhong (Tangerine Peel) with bitter-neutral, Xuanshen (Scrophulariae Radix) with bitter-cold, Sheng Gancao (Raw Licorice Root) with sweet-cool, and Renshen (Ginseng Radix) with sweet-neutral as minister herbs to clear fire and tonify Qi; Lianqiao (Forsythiae Fructus), Niubangzi (Arctii Fructus), Boheye (Menthae Haplocalycis Folium) with bitter-pungent-neutral, Banlangen (Isatidis Radix) with bitter-cold, Mabo (Amanitae Fructus) and Baijiangcan (Bombyx Batryticatus) with bitter-neutral to regulate Qi stagnation in the Shaoyang and Yangming meridians; Jiegeng (Platycodonis Radix) with pungent-warm as the boat-and-oar herb to prevent downward movement; Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) with bitter-pungent to disperse exterior pathogens. All were ground into fine powder. Half was mixed with water and taken frequently; the other half was formed into pills with honey for slow dissolution. After completing the course, the patient recovered. He sighed, "What is past cannot be retrieved, but what is future can be addressed." He wrote down the formula for others, saving many lives. People called it a heavenly-human creation, carved it on stone for posterity, and named it Puji Xiaodu Yin (Great Benefit Detoxification Drink).

Xue Lizhai stated: This results from contracting abnormal qi of the four seasons, with pathogens lodging in the Heart and Lung, attacking the head and eyes. It differs from heat accumulation due to rich diet. Agents like Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) should not be used unless there is solid constipation. Without examining the cause and differentiating exterior/interior and deficiency/excess, indiscriminate purging leads to error. Interior excess with constipation requires purging. Exterior excess with unresolved pathogens requires dispersing. Exterior and interior excess with unresolved pathogens require simultaneous exterior-releasing and interior-purging. If exterior and interior pathogens are resolved but swelling remains, harmonization is needed. Severe painful swelling requires phlebotomy to remove evil blood, followed by detoxification agents. Non-suppurating or non-ulcerating lesions require interior-supporting methods. During famines, when the disease is widespread, harsh purgatives should be avoided; treatment must be prudent.

The "Treatment Methods" text states: Floating pulse indicates exterior pathogens; use Gegen Niubang Tang (Pueraria and Arctius Decoction), Xijiao Shengma Tang, or Renshen Baidu San (Ginseng Rescue the Collapse Powder) to release the exterior. Deep-choppy pulse indicates interior pathogens; use Zhizi Ren Tang (Gardenia Seed Decoction) or Wuli Dahuang Tang (Five-Benefits Rhubarb Decoction) to purge. If exterior and interior are both diseased and swelling persists, use Xijiao Shengma Tang; for severe cases, perform phlebotomy and use Tongguan San (Passage-Pass Powder) nasally to induce sneezing and vent toxins. If exterior and interior are both unresolved and internal/external excess exists, use Fangfeng Tongsheng San (Saposhnikovia Unblocking the Interior Powder). To promote suppuration, use Tuoli Xiaodu San (Support-the-Interior Detoxification Powder). To promote healing/convergence, use Tuoli San. This approach is most reliable. Often, during famines, laborers suffer from this due to damaged Stomach Qi allowing pathogens to invade. Thus, for those afflicted by famine or overwork, stabilizing the interior is primary. Puji Xiaodu Yin is highly effective.

An elderly man presented with severe swelling and pain of the head, face, ears, and neck in winter, constipation, and a solid pulse, indicating exterior-interior excess. Fangfeng Tongsheng San was ineffective. Phlebotomy was performed to release black blood, after which the previous prescription became effective, followed by Jingfang Baidu San (Schizonepeta and Saposhnikovia Rescue the Collapse Powder). The initial failure was due to toxic blood coagulating in the upper meridians, preventing drug efficacy. Once evil blood was removed, the drugs worked. Some rigidly adhere to "avoid cold in cold seasons" and fear using Xiaoshi and Dahuang in the elderly, relying solely on interior-supporting or mild detoxifying agents without phlebotomy, rarely avoiding danger.

A male patient presented with head and facial swelling and pain, worsening after taking Xiaoshi and Dahuang detoxifying agents. His pulse was floating-rapid, indicating exterior pathogens unresolved. Jingfang Baidu San plus Xuanshen and Niubangzi was administered for two doses, reducing symptoms by half. Ge Gen Niubang Zi Tang (Pueraria and Arctius Seed Decoction) for four doses led to recovery. (Commentary by Xue Ji)