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Shidu (Seasonal Toxic Disease) is caused by the invasion of pathogenic toxic qi from the four seasons. Its manifestations include redness, swelling, and pain in the nose, face, ears, and eyes; in severe cases, the throat and neck also swell. Some present as diffuse swelling without a head, while others present as nodules with roots. It causes aversion to cold and fever, headache or limb pain, mental restlessness, and throat obstruction. If physicians do not recognize this disease and mistakenly diagnose it as Shanghan (Cold Damage), administering heat-clearing agents will cause the swelling to worsen within one or two days, leading to the realization of medication error. Originally, ancient texts lacked formulas for this disease. Initially resembling Shanghan, it can be fatal within five to seven days; however, if it persists beyond ten days, it may resolve spontaneously without treatment. Symptoms appearing before the fifth day, such as mental confusion, throat obstruction, inability to speak, worsening facial swelling, and loss of taste, indicate a fatal prognosis where treatment is ineffective. However, this disease has Yin and Yang patterns, and treatments may involve sweating or purging methods. Inexperienced physicians often misattribute it solely to heat toxicity and use only cold-cooling herbs, failing to appreciate that diseases vary in severity and treatments must follow either counteracting or following principles. A floating and rapid pulse indicates pathogenic factors in the exterior; treat with Gegen Niuzi Tang (Kudzu and Burdock Decoction), Jiedu Shengma Tang (Detoxifying Cimicifuga Decoction), or Shengma Niuzi San (Cimicifuga and Burdock Powder) to release the exterior. A deep, solid pulse with constipation indicates pathogenic factors in the interior; treat with Zhizi Ren Tang (Gardenia Seed Decoction). A deep and choppy pulse indicates deep penetration of pathogenic factors; treat with Loulu Tang (Euphorbia Fissurata Decoction) or Dahuang Tang (Rhubarb Decoction). For exterior excess with unresolved pathogens, use Qinlian Baidu San (Scutellaria and Coptis Detoxification Powder) to disperse. For interior excess with unrelieved constipation, use Wuli Dahuang Tang (Five-Advantage Rhubarb Decoction) to purge. For simultaneous exterior and interior excess, use Tongsheng Xiaodu San (Universal Salvation Detoxification Powder) to release the exterior and purge the interior. If both exterior and interior are resolved but swelling persists, harmonize using Jiezhao Xiaodu Yin (Miasma-Clearing Detoxification Decoction). For severe swelling and pain, use Bianfa (Bleeding Therapy) to remove bad blood, followed by Xiaodu therapy using Puji Xiaodu Yin (Comprehensive Protection Detoxification Decoction) and then Shishen San (Ten-God Powder). For redness, swelling, and pain in the head, face, ears, and neck, with dry throat, fever, and a floating-rapid pulse, use Huanglian Baidu San (Coptis Detoxification Powder), followed by Jiezhao Xiaodu San and Qishen San. For swelling, pain, fever, thirst, solid pulse, and constipation, use Wuli Dahuang Tang, followed by Zhuoding Duoming Tang (Furuncle-Chasing Life-Saving Decoction), and finally water-boiled tender roots mixed with wine. For swelling, pain, fever, and a floating-rapid pulse, use Qinlian Baidu San, followed by Tuire Xiaodu Yin (Heat-Reducing Detoxification Decoction), and then Qishen San. For swelling, pain, thirst, alternating chills and fever, constipation, and a rapid pulse that feels especially solid upon pressure, use Tongsheng Xiaodu San, followed by Qinlian Xiaodu San, and then Qishen San. When swelling is severe with high fever and a solid pulse, first use Bianfa to remove bad blood, then wash with Xizhao San (Miasma-Washing Powder) and apply Xiaozhong San (Swelling-Reducing Powder). Apply a paste of Shebujian Gen (Root of *Serpent's Unseen*) and white plum to the gums to reduce saliva. First take Zhuoding Duoming Tang, then Qishen Wan (Seven-God Pill) and Wanbing Jiedu Wan (Myriad-Disease Detoxification Pill). If exterior pathogens are resolved but swelling persists with a slippery-rapid pulse, it indicates stasis transforming into pus; use Tuoli Xiaodu San (Supporting Interior Detoxification Powder) to promote suppuration. If the pulse is floating-rapid or flooding-rapid, do not use supporting methods; instead, dissipate using Wu Baozi Gen (Root of *Blackberry*) decocted in water. Another formula uses Guteng Gen (Root of *Valeriana*) decocted in water, along with Quzao San (Miasma-Expelling Powder). Also, insufflate Tongqi San (Ventilation Powder) into the nose until more than ten sneezes occur; lack of response to insufflation is untreatable. If pus is expelled via sneezing, cure is certain. Daily insufflation for contacts prevents transmission; patients should insufflate three to five times daily to vent heat toxicity. This is an excellent method for treating Shidu. If unresolved after three to four days, avoid harsh purgation; use Hejie (Harmonizing and Resolving) methods like Xijiao Lianqiao San (Rhinoceros Horn and Forsythia Powder). By the seventh or eighth day, if urination and defecation are free and facial swelling is high and red, use Tuoli San (Interior-Supporting Powder) or Huang San.

[Releasing the Exterior]
A patient with head and face swelling and pain worsened by Xiaohe (Mirabilite) and Dahuang (Rhubarb) detoxification agents. Pulse was floating and rapid, indicating unresolved exterior pathogens. Two doses of Jingfang Baidu San (Schizonepeta and Saposhnikovia Detoxification Powder) reduced symptoms significantly; four doses of Gegen Niuzi Tang completed recovery. The Classic states: Swelling above the waist is due to Heaven's Qi; below the waist, Earth's Qi. This condition results from pathogens lodging between the Heart and Lung, attacking the head and eyes, caused by irregular seasonal Qi, distinct from accumulation heat from rich foods. Xiaohe and Dahuang are contraindicated unless there is severe constipation. Failure to differentiate deficiency/excess and exterior/interior leads to errors. During famines, laborers often suffer this due to damaged Stomach Qi allowing pathogen invasion. Another patient with swelling, pain, chills, fever, and floating-rapid pulse improved slightly with two doses of Jingfang Baidu San, halved further with two doses of Renshen Baidu San (Ginseng Detoxification Powder), and recovered after two more doses. Another patient with ear and face redness, swelling, pain, dry throat, fever, and floating-rapid pulse improved significantly with two doses of Jingfang Baidu San and recovered after four doses of Gegen Niuzi Tang.

A patient in winter suffered severe head and face redness and swelling, especially around the ears, unbearable pain, fever, aversion to cold, trismus, thick sputum, difficulty swallowing, and insomnia. Previous Bianfa on forty to fifty points failed to reduce swelling or pain. My diagnosis revealed a floating-tight pulse, flooding-slow upon pressure, indicating cold covering the skin and hair, obstructing collaterals, preventing heat dispersion. In cold weather, pores close, sweat does not emerge, blood and Qi are strong, and muscles are firm. Skilled acupuncturists avoid treating extremity coldness in winter; wait for warmth. Winter is a time of storage; use more medicine, less acupuncture. Use bitter-warm herbs to warm meridians and scatter cold. Formula: Tuoli Wenjing Tang (Supporting Interior and Warming Meridian Decoction). Mahuang (Ephedrae Herba, bitter-warm, sovereign herb, 2 qian) disperses cold; Fangfeng (Saposhnikoviae Radix, pungent-warm, 2 qian) scatters; Shengma (Cimicifugae Rhizoma, bitter-pungent, 4 qian); Gegen (Puerariae Lobatae Radix, sweet-flat, minister herb) resolves muscle layer and treats Yangming channel pathogens; Baizhi (Angelicae Dahuricae Radix); Danggui Shen (Angelicae Sinensis Radix, 2 qian each) warms blood and disperses stasis; Cangzhu (Atractylodis Rhizoma, 1 qian) drains damp-heat from skin and pores; Renshen (Ginseng Radix, 1 qian); Gancao (Glycyrrhizae Radix et Rhizoma, sweet-warm); Baishao (Paeoniae Radix Alba, sour-slightly cold, assistant herb) regulates middle and supports interior (1.5 qian each). Decoct with 2 cups of water; boil Mahuang first, skim foam, add other herbs, boil to 1 cup, strain, take warm. Cover head with thin cloth and body with thick blanket in a warm room to induce profuse sweating, opening pores and scattering cold. Swelling reduces by 70-80%. Next dose removes Mahuang and Fangfeng, adds Lianqiao (Forsythiae Fructus) and Niu Bang Zi (Arctii Fructus). Cure confirmed.

Guoshi Shengma Niuzi San (Guo's Cimicifuga and Burdock Powder) treats Shidu sores/rashes with floating-flooding pulses in the exterior, affecting head, face, chest, and diaphragm. Shengma, Niuzi (fried, ground), Gancao, Jiegeng, Gegen, Xuanshen, Mahuang (1 qian each), Lianqiao (2 qian). Decoct with 3 slices of ginger and 2 cups of water.

Another formula for Shidu: Shengma, Chishao, Gange, Qingmuxiang, Gancao, Fangfeng, Baizhi, Jingjie, Niuzi, Jiegeng, Yinhua, Xuanshen, Mahuang, Lianqiao, Lanye. Decoct with Bohe.

Qinlian Baidu San treats Shidu swelling/pain/fever with left floating-rapid pulse. Fangfeng, Jingjie, Huanglian, Huangqin, Lianqiao, Qianghuo, Duhuo, Chaihu, Qianhu, Chuanxiong, Jiegeng, Lanye, Xuanshen, Niuzi, Shengma, Chishao, Yinhua, Baizhi, Gancao, Gange, Qingmuxiang. Decoct with Shengjiang and Bohe. Add Mahuang if fever with no sweat.

Gegen Niuzi Tang treats Shidu swelling/pain with normal bowel/bladder function. Gegen, Guanzhong, Gancao (Guolao), Douchi, Niuzi (half raw, half fried, 2 qian each). Decoct in water.

Fanhun Dan treats Shidu miasma, Dingchuang (furuncles), and malignant sores. Zhusha, Xionghuang, Xuejie, Huandan, Shanjia (fried), Baifan (calcined), Tongqing, Ruxiang, Moyao, Qingfen, Chansu (1 qian each), Shexiang (0.25 qian). Make powder, pill with wheat paste boiled in wine, size of pepper corns. Take 2 pills chewed with green onion white, swallowed with warm wine.

[Purging the Interior]
A patient with swelling, pain, fever, thirst, solid pulse, and constipation was treated with Wuli Dahuang Tang to purge; symptoms resolved, cured by Gegen Niuzi Tang. Another patient worsened by exterior-releasing drugs, with fever, constipation, and deep-solid pulse (interior pathogen). Purged with Dahuang Tang; interior symptoms resolved, edema cleared with Gegen Niuzi Tang, leaving only redness/swelling, cured by interior-supporting drugs.

Loulu Tang treats Shidu head/face redness/swelling, throat obstruction, inability to swallow water/medicine, or internal organ heat causing swelling/nodules/malignant sores with constipation. Loulu, Shengma, Dahuang, Huangqin, Gancao, Lanye, Niuzi, Xuanshen, Jiegeng, Lianqiao, Qingmuxiang, Kushen. Decoct with Bohe.

Wuli Dahuang Tang is highly effective for Shidu redness/swelling/pain, irritability/thirst, constipation, solid-rapid pulse. Adding Lianqiao, Xuanshen, Daqing, Gancao creates Zhizi Ren Tang. Dahuang, Huangqin, Shengma, Zhizi, Mangxiao. Decoct with Bohe.

Jiajian Jiedu Wan treats Shidu, Dingchuang, miasma, carbuncles, back abscesses, unnamed swellings; antidote for arsenic, lead powder, rat poison, snake/dog bite, centipede, termite, bee/wasp sting, mushroom, malignant sores. Can be taken or applied. Wubeizi (3 liang), Shancigu (2 liang), Daji (1.5 liang), Zhusha, Xionghuang (3 qian each), Shexiang (2 qian), Xuisui Zi (dehusked, 1 liang). Powder, pill with millet flour paste, mold into cakes, dry in shade. Take 1 cake ground in well water (or mint tea in winter). For all swellings, grind with rice washing water or fresh Hibiscus leaf juice. Best prepared on Dragon Boat Festival, Qixi, or Double Ninth, or auspicious days. Prepare in clean room with incense; avoid widows, chickens, dogs.

Luo's Shidu Geda Loulu San treats internal heat causing swelling, epidemic nodules, severe head/face swelling, throat blockage, inability to swallow, and malignant epidemics. Loulu, Shengma, Dahuang, Huangqin (1 liang each), Lanye, Xuanshen (2 liang each). Coarse powder, 2 qian per dose, decoct. Add Mangxiao (2.5 qian) if severe heat/swelling.

Xiaodu Wan treats malignant Shidu nodules. Dahuang, Muli (burnt), Baijiangcan (fried, 1 liang each). Fine powder, honey pills size of bullet. Dissolve one pill in new water anytime. Adding Jiegeng and Niu Bang Zi decoction is superior.

[Releasing Exterior and Purging Interior]
A patient with swelling, pain, thirst, irritability, constipation, and solid-rapid pulse took Fengwang Tongsheng San once; symptoms vanished. Cured by Jingfang Baidu San plus Xuanshen, Niuzi, Huangqin. An elderly man with winter head/face/ear/neck swelling, severe pain, constipation, and solid pulse (exterior-interior excess) did not respond to Fengwang Tongsheng San. After Bianfa removed black blood, he responded to the same drug, then cured by Jingfang Baidu San. Lack of initial response was due to toxic blood stagnating in upper collaterals blocking drug action; removing bad blood restored efficacy. Adhering strictly to "avoid cold in cold season" or fearing purgatives in the elderly leads to danger. Haizang says: For epidemic head swelling, Ganjie Tang plus Niu Bang Zi, Dahuang, Mangxiao.

Fengwang Tongsheng San treats Shidu heat-toxin, constipation, dryness. Caution in famine victims with damaged Stomach Qi; use only for full/solid excess. Fangfeng, Danggui, Chuanxiong, Shaoyao, Dahuang, Mangxiao, Lianqiao, Bohe, Mahuang, Jiegeng, Shigao, Huangqin (1 liang each), Baizhu, Shanzhi, Jingjie (2.5 qian each), Gancao (2 liang), Huashi (1 liang). Decoct or powder with hot water, adjusting for deficiency/excess.

Tongsheng Xiaodu San treats Shidu swelling/pain with exterior-interior excess. Fangfeng, Jingjie, Lianqiao, Chishao, Danggui Xu, Huangqin, Mahuang, Zhizi, Qingmuxiang, Huanglian, Huangbai, Shigao, Huashi, Dahuang, Puxiao, Niuzi, Chuanxiong, Jiegeng, Xuanshen, Lanye, Gancao. Decoct with Bohe. Remove Dahuang and Puxiao if stool is loose.

[Half-Exterior Half-Interior]
Zhonghe Tang treats Shidu with floating pulse, located half-exterior half-interior. Changpu, Niuzi, Chuanxiong, Qianghuo, Fangfeng, Loulu, Jingjie, Maidong, Qianhu, Gancao (equal parts). Coarse powder, 1 liang per dose, decoct. Note: Derived from Taiyang-Yangming protocols.

[Interior Supporting]
A woman with head/face redness/swelling, severe pain, floating-rapid pulse had exterior signs but weak Stomach Qi; exterior-releasing drugs were contraindicated. Used Jiegu's interior-supporting method with Neituo Fujian San (Internal Support Double-Decoction Powder) for one dose, drunk throughout the day, resolved in two days. See previous general formulas.

[Interior Dissolution]
During Taihe era, Dongyuan managed taxes in Jiyuan. Summer epidemics caused chills, heaviness, facial swelling, inability to open eyes, asthma, throat obstruction, dry tongue/mouth. Known as "Big Head Epidemic," relatives avoided sufferers, often fatal. Magistrate Zhang suffered this; Chengqi Tang plus Lan Gen provided slight relief initially, but relapsed. Li Mingzhi diagnosed: Upper body relates to Heaven, lower to Earth. Heat lodged in Heart/Lung attacks head. Using Chengqi Tang to purge Stomach heat harms the innocent. Prescribed: Huanglian, Huangqin (bitter-cold, sovereign) clear Heart/Lung heat; Juhong, Xuanshen (bitter-cold), Sheng Gancao (sweet-cold) clear fire/nourish Qi (minister); Lianqiao, Niu Bang Zi, Bohe Ye (bitter-pungent-flat), Banlangen (sweet-cold), Mapibo, Baijiangcan (bitter-flat) dissipate swelling/toxin (assistant); Shengma, Chaihu (bitter-flat) move urgency. Prior mild agents pushed pathogens inward; now urgent removal is needed to prevent Yin damage. Treating primary illness requires slow action; treating secondary (guest) pathogens requires speed. For Shaoyang/Yangming diseases: Ear/face swelling (Shaoyang) vs. Head/Face swelling (Yangming). First, stir-fry Huangqin, Huanglian, Gancao, decoct, sip frequently. Then, use Dahuang (wine-soaked or roasted) and fried Niu Bang Zi, decoct, add Mangxiao equally, sip slowly after meals until mild diarrhea clears pathogens. Stop purgatives, continue clearing herbs. Add Shigao for Yangming thirst, Gualou Gen for Shaoyang thirst. Add Chishao, Gegen, Shengma for Yangming channel; Qianghuo, Fangfeng, Jingjie for Taiyang channel. Combine carefully; do not use powders alone. (Dongyuan's formula: Puji Xiaodu Yinzi, see Headache section.)

Qinlian Xiaodu Yin treats Shidu with chills/fever, head/neck swelling/pain, flooding-rapid pulse. Fangfeng, Jingjie, Lianqiao, Chaihu, Huangqin, Chuanxiong, Qianghuo, Jiegeng, Lanye, Shegan, Baizhi, Niuzi, Huanglian, Gancao, Qingmuxiang, Yinhua. Decoct with Bohe.

[Harmonizing Ying and Wei]
A woman with resolved exterior pathogens but persistent swelling had slippery-rapid pulse, indicating stasis turning to pus. Cured by Tuoli Xiaodu San. Another woman with swelling/pain improved slightly with purgatives but relapsed; external pathogens gone, stasis turning to pus; cured by same method. A man with resolved exterior/interior but persistent swelling cured by Tuoli Xiaodu San, then punctured when pus formed. Minister Li Puting, weakened by exterior-releasing drugs, had non-resolving swelling, fatigue, chills, poor appetite, dry mouth. Cured by Buzhong Yiqi Tang plus Jiegeng and Tuoli Xiaodu San. Chen Tongye, weak Qi, faint/deep pulse, deficiency pattern. Used Renshen, Baizhu, Chuanxiong, Danggui, Chenpi, Chaihu, Shengma, Zhi Gancao to raise Yang; Niuzi, Xuanshen, Lianqiao, Jiegeng to clear toxin. Swelling subsided, pulse returned. Mistaking faint pulse for Yin and redness for Yang leads to error. A woman with post-ulcer redness/swelling, poor appetite, fatigue, clear pus had Spleen/Lung Qi deficiency. Treated with Liu Jun Zi Tang plus Jiegeng, Chuanxiong, Danggui, then Yiqi Tang plus Jiegeng to consolidate.

[Nasal Insufflation]
Tongqi San treats Shidu swelling, throat obstruction; induces sneezing to vent toxin. Xuanshen (1.5 qian), Zhuya Zaojiao, Chuanxiong (1 qian each), Beixixin, Lilu, Caowutou, Yangzhizhu Hua. Powder. Dip paper twist in small amount, insert into nose to induce sneezing. Twice daily.