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
者，不宜用峻利，当审而治之。
一男子患此，肿痛发热作渴，脉实便秘。以五利大黄汤下之，诸证悉退；以葛根牛蒡子
汤，四剂而痊。
一男子表里俱解，肿痛尚不退，以葛根升麻汤，二剂而消。
一男子肿痛，发寒热，脉浮数。以荆防败毒散，二剂少愈，以人参败毒散，二剂势减半
，又二剂而瘥。
一男子耳面赤肿作痛，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。
一妇人表邪已解，肿尚不消。诊之脉滑而数，乃瘀血欲作脓也。以托里消毒散，溃之而
愈。
一男子 肿，胀痛作渴，烦热便秘，脉数，按之尤实。用防风通圣散，一剂诸证顿退；
以荆防败毒散加玄参、牛蒡子、黄芩，二剂而瘥。
一老人冬月头面耳项俱肿，痛甚，便秘，脉实，此表里俱实病也。饮防风通圣散，不应
。遂
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。
一男子表里俱解，惟肿不消。以托里消毒散，四剂脓成，针之而愈。
一妇人肿痛，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。
一男子头面肿痛，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，
以下肿，地之气也。乃邪客心肺之间，上攻头目而为肿，此感四时不正之气为患，与夫膏粱
积
致有误。常见饥馑之际，刍荛之人多患之，乃是胃气有损，邪气从之为患，不可不察。余常
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；如肿甚者，砭患
处，出恶血以泄其毒，或用通气散，取嚏以泄其毒，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。五七日咽喉肿闭，言语不出
，头面不肿，食不知味者，不治。
一男子服表散药愈炽。发热便秘，诊其脉沉实，此邪在里也。以大黄汤下之，里证悉退
，以
毒之气，而感之于人也。其候发于鼻面耳项咽喉，赤肿无头，或结核有根，令人增寒发热，
头痛，或肢体痛甚者，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
增益，方悟，始求疮医。原夫此疾，古无方论，世俗通为丹瘤。病家恶言时毒，切恐传染。
考之于经曰∶人身忽经变赤，状如涂丹，谓之丹毒。此风热恶毒所为，与夫时毒，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。先诊其脉，滑数浮洪，沉紧弦涩
，皆其候也。盖浮数者，邪气在表也；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。其有表证者，解毒升麻汤以发之；或年高气软者，五香连翘汤主之
。又于鼻内 通气散，取十余嚏作效，若 药不嚏者，不可治。如嚏出脓血者，治之必愈。
左右看病之人，每日用 药嚏之，必不传染。其病患每日亦用嚏药三五次，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，服犀角连翘散之类。至七八日，大小便通利
，头
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。常见粗工，但云热毒，就用寒药，殊不知病
有微甚，治有逆从，不可不审矣
附方
五利大黄汤 治时毒 肿赤痛，烦渴便秘，脉实数。
大黄（煨） 黄芩 升麻（各二钱） 芒硝 栀子（各一钱二分） 作一剂，水一钟半，煎六
分，空心热服。
栀子仁汤 治时毒肿痛，大便秘结，脉沉数。
郁金 枳壳（麸炒去穣） 升麻 山栀仁（炒） 牛蒡子（炒） 大黄（煨，各等分） 上为细
末，每服三钱，蜜水调下。
荆防败毒散 治时毒肿痛发热，左手脉浮数。
即人参败毒散加防风、荆芥（方见溃疡发热门。）
葛根牛蒡子汤 治时毒，肿痛脉数而少力者。
葛根 贯众 甘草 江西豆豉 牛蒡子（半生杵炒，各二钱）作一剂，水一钟半，煎八
分，食后服。
防风通圣散 治时毒肿痛，烦躁，表里脉证俱实（方见疔疮门。）
人参败毒散（方见溃疡发热门）
托里消毒散 治时毒表里俱解，肿尚不退，欲其作脓（方见肿疡门。）
普济消毒饮 治时毒疫疠，初觉增寒体重，次传头面肿痛，或咽喉不利，舌干口
燥。
黄芩 黄连（各五钱） 人参（三钱） 橘红 玄参 甘草（各一钱） 柴胡 桔梗（炒，各
二钱）连翘 鼠粘子 板蓝根 马勃（各一钱） 白僵蚕（炒） 升麻（各七分） 作一剂，水二钟，煎
一钟，去渣，稍热，食后徐徐服之。如大便硬，加酒煨大黄一钱或二钱以利之。肿势甚者，
宜砭刺之，去恶血。
通气散 治时毒 肿，咽喉不利，取嚏以泄其毒。
玄胡索（一钱五分） 猪牙皂角 川芎（各一钱） 藜芦（五分） 羊踯躅花（二分半） 上
为细末，用纸捻蘸少许， 于鼻内，取嚏为效。
托里散（方见肿疡门。）
If the interior is excess and unrelieved by bowel movement, purge it; if the exterior is excess and unrelieved by sweating, disperse it; if both exterior and interior are excess and unrelieved, resolve the exterior and purge the interior; if both exterior and interior pathogens have resolved but swelling persists, harsh purgatives should not be used; instead, carefully examine the condition and treat accordingly.
A man suffered from this disease with swelling, pain, fever, thirst, a full pulse, and constipation. I administered Wu Li Da Huang Tang (Five-Advantage Rhubarb Decoction) to purge him, after which all symptoms subsided; subsequently, he took Ge Gen Niu Bang Zi Tang (Kudzu and Burdock Seed Decoction), and recovered after four doses.
A man had both exterior and interior pathogens resolved, yet swelling persisted. I treated him with Ge Gen Sheng Ma Tang (Kudzu and Cimicifuga Decoction), and the swelling subsided after two doses.
A man presented with swelling, pain, chills, fever, and a floating-rapid pulse. I prescribed Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction for Overcoming Toxins); after two doses, symptoms improved slightly. Then I administered Ren Shen Bai Du San (Ginseng Decoction for Overcoming Toxins); after two doses, the pathogenic force was halved; after another two doses, he recovered.
A man had red swelling and pain in his ears and face, dry throat, fever, and a floating-rapid pulse. First, I used Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction for Overcoming Toxins); after two doses, the pathogenic force receded by more than half. Then I used Ge Gen Niu Bang Zi Tang (Kudzu and Burdock Seed Decoction), and he recovered after four doses.
A woman’s exterior pathogen had already resolved, but swelling remained. Her pulse was slippery and rapid, indicating that blood stasis was about to suppurate. I treated her with Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Decoction), leading to suppuration and recovery.
A man had head and facial swelling, distending pain, thirst, irritability, fever, constipation, and a rapid pulse that felt particularly full upon deep palpation. I used Fang Feng Tong Sheng San (Saposhnikovia Powder to Unblock the Hinderance); after one dose, all symptoms suddenly subsided. Then I prescribed Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction for Overcoming Toxins) added with Xuan Shen (Scrophulariae Radix), Niu Bang Zi (Arctii Fructus), and Huang Qin (Scutellariae Radix); he recovered after two doses.
An elderly man suffered from swelling of the head, face, ears, and neck in winter, severe pain, constipation, and a full pulse; this was an excess condition of both exterior and interior. He drank Fang Feng Tong Sheng San (Saposhnikovia Powder to Unblock the Hinderance) without effect. This was because the collaterals were blocked, preventing the medicinal power from reaching the site. [If] the collaterals are first pricked to expel evil blood, the efficacy of the medicine will naturally manifest. If one adheres rigidly to the principle of "avoiding cold in cold seasons" or fears using Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) due to advanced age, opting instead for interior-supporting methods, or merely uses ordinary detoxifying agents, and does not use bian stone (砭石) to vent the toxin, relying solely on medicinal power, few will avoid danger.
A man had both exterior and interior pathogens resolved, but only the swelling persisted. I treated him with Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Decoction); after four doses, pus formed, and he recovered after puncture and drainage.
A woman had swelling and pain. After being purged with agents containing Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma), symptoms eased slightly, but pain returned the next day. Examination revealed that external pathogens had retreated, indicating blood stasis about to suppurate. I treated her with Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Decoction), leading to suppuration and recovery.
A man had head and facial swelling. After taking agents containing Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) for detoxification, the condition worsened. His pulse was floating and rapid, indicating the pathogen was in the exterior and had not yet resolved; thus, Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction for Overcoming Toxins) should be used. [The following text discusses how earth qi interacts with pathogens lodging between the Heart and Lung, attacking upward to cause head and facial swelling. This is caused by contracting abnormal qi of the four seasons, distinct from errors caused by accumulation of rich foods.] It is commonly seen during famines that people of low status often suffer from this, due to damage to Stomach Qi allowing pathogens to invade. This must be carefully examined. I often treat exterior pathogens with Ge Gen Niu Bang Zi Tang (Kudzu and Burdock Seed Decoction), Ren Shen Bai Du San (Ginseng Decoction for Overcoming Toxins), or Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxins); interior pathogens with Wu Li Da Huang Tang (Five-Advantage Rhubarb Decoction) or Zhi Zi Ren Tang (Gardenia Seed Decoction); unresolved exterior and interior with Fang Feng Tong Sheng San (Saposhnikovia Powder to Unblock the Hinderance); resolved exterior and interior with persistent swelling with Xi Jiao Sheng Ma Tang (Rhinoceros Horn and Cimicifuga Decoction); for severe swelling, use bian stone (砭石) on the affected area to release evil blood and vent toxin, or use Tong Qi San (Vent Qi Powder) to induce sneezing to vent toxin; self-healing occurs after ten days, or if pus and blood are sneezed out, healing is immediate. To promote suppuration, use Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Decoction); to promote contraction, use Tuo Li San (Support Interior Powder). This method is most secure. If after five to seven days there is throat swelling and closure, inability to speak, no head/facial swelling, and loss of taste, it is incurable.
A man’s condition intensified after taking exterior-dispersing medicines. He had fever and constipation; his pulse was deep and full, indicating the pathogen was in the interior. I purged him with Da Huang Tang (Rhubarb Decoction), resolving all interior symptoms. [The following text describes the nature of Shi Du (Seasonal Toxin) qi affecting humans.] Its manifestations occur on the nose, face, ears, neck, and throat: red swelling without a head, or nodules with roots, causing aversion to cold and fever, headache, severe limb pain, mental restlessness, throat closure. Those unfamiliar with it may mistake it for Shang Han (Cold Damage). Blindly taking resolving medicines causes swelling to increase within one to two days, at which point they realize their error and seek a surgeon. Originally, this disease had no ancient formulas or discussions; the common people call it Dan Liu (Red Swelling). Patients fear saying "Shi Du" due to contagion concerns. Examining classics: sudden reddening of the body, like painted rouge, is called Dan Du (Erysipelas). This is caused by wind-heat evil toxin, distinct from Shi Du. Shi Du initially resembles Shang Han (Cold Damage) but can kill within five to seven days; practitioners must distinguish it carefully. First, examine the pulse: slippery-rapid, floating-hong, deep-tight, wiry-slippery are all signs. Floating-rapid indicates pathogen in the exterior; deep-slippery indicates pathogen deep inside. For those with strong constitution, quickly administer Hua Du Dan (Toxin-Transforming Pill) to attack; for heat-excess with constipation, purge with Da Huang Tang (Rhubarb Decoction). For those with exterior signs, use Jie Du Sheng Ma Tang (Detoxify and Raise Yang Decoction) to disperse; for the elderly and weak, use Wu Xiang Lian Qiao Tang (Five-Aromatic Forsythia Decoction). Also, blow Tong Qi San (Vent Qi Powder) into the nose; inducing over ten sneezes is effective. If medication does not induce sneezing, it is incurable. If pus and blood are sneezed out, treatment will surely succeed. Caregivers should use the sneeze-inducing medicine daily to prevent contagion. Patients should use it three to five times daily to vent heat-toxin; this is an excellent method for treating Shi Du (Seasonal Toxin).
If unresolved after three to four days, do not purge heavily; still appropriate to harmonize, taking Xi Jiao Lian Qiao San (Rhinoceros Horn and Forsythia Powder). By seven to eight days, if urination and defecation are free... [text fragment]. If before the fifth day there is mental confusion, throat closure, inability to speak, no head/facial swelling, and loss of taste, death is certain, and treatment is futile. However, this disease has Yin and Yang aspects, and allows for sweating or purging. Crude physicians often simply say "heat-toxin" and use cold medicines, unaware that diseases vary in severity and treatments have counteracting or following approaches; this must be carefully considered.
Attached Formulas
Wu Li Da Huang Tang (Five-Advantage Rhubarb Decoction): Treats Shi Du (Seasonal Toxin) with red swelling, pain, irritability, thirst, constipation, and full-rapid pulse.
Da Huang (Rhei Radix et Rhizoma, baked), Huang Qin (Scutellariae Radix), Sheng Ma (Cimicifugae Rhizoma) (each 2 qian); Mang Xiao (Natrii Sulfas), Zhi Zi (Gardeniae Fructus) (each 1.2 qian). Make one dose, boil in 1.5 zhong of water to 0.6 zhong, take hot on an empty stomach.
Zhi Zi Ren Tang (Gardenia Seed Decoction): Treats Shi Du (Seasonal Toxin) swelling/pain, severe constipation, and deep-rapid pulse.
Yu Jin (Curcumae Radix), Zhi Ke (Aurantii Fructus, bran-fried, pith removed), Sheng Ma (Cimicifugae Rhizoma), Shan Zhi Ren (Gardeniae Semen, fried), Niu Bang Zi (Arctii Fructus, fried), Da Huang (Rhei Radix et Rhizoma, baked) (equal parts). Grind to fine powder, take 3 qian per dose, mixed with honey-water.
Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction for Overcoming Toxins): Treats Shi Du (Seasonal Toxin) swelling/pain/fever, left hand floating-rapid pulse.
Same as Ren Shen Bai Du San (Ginseng Decoction for Overcoming Toxins) plus Fang Feng (Saposhnikoviae Radix) and Jing Jie (Schizonepetae Spica) (Formula see Ulcer Fever Chapter).
Ge Gen Niu Bang Zi Tang (Kudzu and Burdock Seed Decoction): Treats Shi Du (Seasonal Toxin) with swelling/pain, rapid pulse, and weakness.
Ge Gen (Puerariae Lobatae Radix), Guan Zhong (Cyatheae Spina), Gan Cao (Glycyrrhizae Radix et Rhizoma), Jiangxi Dou Chi (Fermented Soybean), Niu Bang Zi (Arctii Fructus, half raw, half pounded and fried) (each 2 qian). Make one dose, boil in 1.5 zhong of water to 0.8 zhong, take after meals.
Fang Feng Tong Sheng San (Saposhnikovia Powder to Unblock the Hinderance): Treats Shi Du (Seasonal Toxin) swelling/pain, irritability, with full exterior-interior pulse/symptoms (Formula see Carbuncle Chapter).
Ren Shen Bai Du San (Ginseng Decoction for Overcoming Toxins) (Formula see Ulcer Fever Chapter).
Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Decoction): Treats Shi Du (Seasonal Toxin) where exterior-interior pathogens are resolved but swelling persists, aiming to promote suppuration (Formula see Swollen Ulcer Chapter).
Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxins): Treats Shi Du (Seasonal Toxin) epidemics, initial chills and heaviness, progressing to head/facial swelling/pain, or throat discomfort, dry tongue/mouth.
Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma) (each 5 qian); Ren Shen (Ginseng Radix et Rhizoma) (3 qian); Ju Hong (Citri Reticulatae Pericarpium), Xuan Shen (Scrophulariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) (each 1 qian); Chai Hu (Bupleuri Radix), Jie Geng (Platycodonis Radix, fried) (each 2 qian); Lian Qiao (Forsythiae Fructus), Shu Niu Zi (Arctii Fructus), Ban Lan Gen (Isatidis Radix), Ma Bo (Fly Agaric Mushroom) (each 1 qian); Bai Jiang Can (Bombyx Batryticatus, fried), Sheng Ma (Cimicifugae Rhizoma) (each 0.7 fen). Make one dose, boil in 2 zhong of water to 1 zhong, strain, take slightly warm slowly after meals. If stool is hard, add Jiu Wei Da Huang (Rhei Radix et Rhizoma, wine-baked) 1-2 qian to facilitate. For severe swelling, prick with needle to release evil blood.
Tong Qi San (Vent Qi Powder): Treats Shi Du (Seasonal Toxin) swelling, throat discomfort, induces sneezing to vent toxin.
Xuan Hu Suo (Corydalis Rhizoma) (1.5 qian), Zhu Ya Zao Jiao (Gleditsiae Sinensis Spina), Chuan Xiong (Ligustici Chuanxiong Rhizoma) (each 1 qian); Li Lu (Veratrum nigrum) (0.5 fen), Yang Zhi Zhu Hua (Daphne odora flower) (0.25 fen). Grind to fine powder, dip paper twist in small amount, blow into nose to induce sneezing.
Tuo Li San (Support Interior Powder) (Formula see Swollen Ulcer Chapter).