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Chen Shigong stated: Tianxing shiqi (epidemic seasonal pathogenic qi) invades the human body and causes disease. The initial symptoms are similar to wind-cold, but swelling in the head, face, ears, and neck is its true characteristic. If there are alternating chills and fever, stiffness of the body, dizziness, and a floating, tight, and rapid pulse, this indicates that the pathogen is at the exterior level; it is appropriate to use Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction) or Wanling Dan to induce sweating for release. If the eyes, nose, and face gradually become swollen, this indicates that the Foot Yangming Stomach Meridian is affected. The manifestations include local swelling, fever, constipation, more heat than cold, dry mouth, and a rapid and forceful pulse, indicating that the pathogen is at the interior level; it is appropriate to use Wuli Dahuang Tang (Five-Advantage Rhubarb Decoction) to purge downward. Furthermore, if there are nodular swellings at the temples and around both ears, this indicates that the Hand Shaoyang Triple Energizer Meridian is affected. The manifestations include tinnitus, tendon pain, alternating chills and fever, vomiting, bitter taste in the mouth, dry throat, and irritability that fluctuates in severity; one should use Zhimu Shigao Tang (Anemarrhena and Gypsum Decoction) or Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize. In cases of severe contagion during famines affecting entire neighborhoods, Pujie Xiaodu San (General Relief Detoxification Powder) or Huoxiang Zhengqi San (Patchouli and Magnolia Bark Powder) can be used to stabilize the condition. If the exterior and interior pathogens are resolved but swelling persists, it is appropriate to use Bianfa (stone-lancing) to remove evil blood; if the swelling and heat are severe, Yirui Jinhuang San (Ruyi Golden Yellow Powder) should be applied externally. If the swelling does not subside subsequently, suppuration is inevitable; Tuoli Xiaodu San (Support Interior and Detoxify Powder) with Baizhi (Angelicae Dahuricae Radix) and Zaojiaozhen (Gleditsiae Sinensis Spina) should be used to support the interior and expel pus. If purulent discharge causes nausea and vomiting due to food intake, Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) is indicated. There is also a condition where toxic pathogens invade the Three Yang meridians, causing swelling from the neck upwards, with skin shining like water, eyes tightly closed, lips swollen resembling a pig's snout, drooling from the corners of the mouth, persistent swelling and pain, loss of voice, inability to eat, swelling and closure of the throat, difficulty opening the jaw, and foul-smelling fluid draining from ruptures with continuous foul odor. All such cases are considered untreatable. (From *Waike Zhengzong*)

Li Dongyuan stated: Shi Du (Seasonal Toxicity) refers to the evil toxic qi of the four seasons infecting humans. Its manifestations occur on the nose, face, ears, neck, and throat, presenting as red swelling without heads or forming rooted nodules. It causes aversion to cold with high fever, headache, severe limb pain, and in severe cases, mental confusion and restlessness, along with throat obstruction. Those unfamiliar with this disease may mistake it for Shanghan (Cold Damage) and administer resolving medicines for one or two days, resulting in increased swelling and qi stagnation, before realizing the need to summon a physician. Originally, ancient texts lacked specific formulas and discussions for this disease. Secular people generally call it Danliu (Dan Nodule). Patients fear the term "Shidu" due to concerns about contagion. I have examined the classics which state: When the human body suddenly turns red, resembling painted cinnabar, it is called Dandu (Dan Toxin), caused by wind-heat and evil toxicity, termed Danliu, which is distinctly different from Shi Du. Shi Du arises from contracting the irregular qi of the four seasons. Initially, it resembles Shanghan, but can be fatal within five to seven days. Treatment requires precise differentiation. First, diagnose the pulse: slippery-rapid, floating-hong, deep-tight, wiry-choppy pulses are all indicators. A floating-rapid pulse indicates the pathogen is at the exterior; a deep-choppy pulse indicates the pathogen is deep. For Shi Du with excess qi and blood, use purgative methods; for those with exterior signs, use diaphoretic methods; for the elderly and weak, Lianqiao Tang (Forsythia Decoction) is the primary formula. Additionally, using Tongqi San (Ventilation Powder) intranasally, aiming for more than ten sneezes, indicates efficacy. If medication fails to induce sneezing, the condition is untreatable. If pus and blood are discharged, treatment will surely succeed. Caregivers who use sneeze-inducing medicine daily will not contract the disease. Patients using sneeze-inducing medicine three to five times daily to vent heat and toxin is an excellent method for treating Shi Du. If unresolved after three to four days, do not use strong purgatives; instead, use harmonizing methods. By the seventh or eighth day, if urination and defecation are smooth and the head and face are swollen, red, and elevated, Tuoli Huangqi San (Support Interior Astragalus Powder) can be taken, and needle-lancing or stone-lancing to bleed out toxins is appropriate. After ten days, even without treatment, it may resolve spontaneously. If, prior to the fifth day, the patient exhibits mental confusion, throat obstruction, loss of voice, massive head and face swelling, and loss of taste, these are signs of certain death, and treatment will be ineffective. However, this disease has Yin and Yang patterns, and can be treated with sweating or purging methods. One must never simply attribute it to heat toxin and treat indiscriminately with cold medicines. (From *Piwei Lun*)

Dou Hanqing stated: Shi Du often occurs during famines and hard labor, focusing on stabilizing the interior, and Pujie Xiaoyin (General Relief Decoction) is most effective. However, this syndrome has Yin and Yang patterns, and involves sweating or purging methods. Mistaking it for heat toxin and using cold medicines would be an error. (From *Waike Quanshu*)

*Xinfa* stated: Shi Du initially resembles Shanghan, sometimes accompanied by sore throat. Within one to two days, swelling appears on the cheeks, neck, and chin, without heads, gradually becoming red, painful, or resembling nodules with rooted diffuse red swelling. This is caused by contracting irregular qi of the four seasons, which lodges in the meridians and collaterals, fermenting and knotting together. It is not the chin toxicity occurring after illness. The key lies in the physician carefully observing the color of the sores and distinguishing deficiency and excess. The treatment method should involve dispersing and resolving; one must not abruptly use cold and cool medicines, which would prevent the toxin from being expelled outward and cause it to attack the throat internally, leading to danger.