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(Also known as Da Tou Wen [Great Head Plague]. Commonly called Da Tou Feng [Great Head Wind]. Generally referred to as Feng Wen Shi Du [Wind-Warmth Seasonal Toxin].)

[Etiology] When Wind-Warmth is about to erupt, if one additionally contracts the seasonal toxic pathogen, this constitutes the epidemic pestilential qi of heaven and earth. Contracting this qi causes the disease, hence it is named Da Tou Tian Xing Bing [Great Head Epidemic Disease]. Because it is also caused by wind-toxin, it is named Da Tou Feng [Great Head Wind]. Its presentation resembles Shang Han [Cold Damage], hence it is named Da Tou Shang Han [Great Head Cold Damage]. This disease is often contagious, with similar symptoms in both young and old, thus generally called Da Tou Wen [Great Head Plague]. It occurs frequently in spring, winter, and rainy seasons; occasionally, summer-wind carrying damp-heat steaming upward can also trigger this disease. Among the six meridians of the hands and feet in the human body, only the three Yang meridians and the Jue Yin meridian all ascend to the clear orifices of the head and face. One must first differentiate whether it is Tai Yang [Greater Yang] seasonal toxin, Shao Yang [Lesser Yang] seasonal toxin, Yang Ming [Bright Yang] seasonal toxin, or Jue Yin [Terminal Yin] seasonal toxin. If the three Yang meridians are simultaneously affected by seasonal toxin, or if Shao Yang and Jue Yin are jointly affected, the boundaries become clear.

[Symptoms] Tai Yang seasonal toxin: At onset, there is stiffness and pain in the head and neck, feverish sensation with heaviness of the body, aversion to cold and wind. Subsequently, the head and neck swell and enlarge, along with redness and swelling behind the ears. Shao Yang seasonal toxin: From the beginning, there is alternating chills and fever, bitter taste in the mouth, dry throat, fullness and oppression in the chest and hypochondrium, faint rashes appear, hardness and swelling with pain above and below, front and back of both ears, and redness and swelling on both sides of the forehead angles. In severe cases, there is difficulty in the throat, swelling and obstruction of the larynx. Yang Ming seasonal toxin: From the beginning, there is high fever with panting, dry mouth and tongue, sore throat and swollen larynx, redness and swelling of the forehead and facial area, or development of sores with faint spots, eyes swollen difficult to open. Jue Yin seasonal toxin: From the beginning, there is headache with salivation, especially pain at the vertex, chills and fever resembling malaria, spasms of tendons throughout the body, slight coldness of hands and feet, bluish complexion, red eyes, deafness, swollen cheeks, hardness and pain in the parotid and submandibular regions, chest fullness with vomiting and reflux, and in severe cases, a state resembling convulsive epilepsy with occasional twitching (Yu Jin), leading upwards to throat obstruction (Hou Bi) and downwards to pus and blood in stool. If the three Yang meridians are simultaneously affected by seasonal toxin, then the head, face, ears, eyes, nose, and throat all develop redness, swelling, heat, and pain. If Shao Yang and Jue Yin are jointly affected, then the vertex and areas above, below, front, and back of both ears are particularly red, swollen, and painful, with vomiting of sour and bitter fluids, or concomitant vomiting of roundworms. In severe cases, severe pain in both hypochondria leads to cold extremities (Jue), followed by spasms after the cold extremities.

Regarding tongue coating: In Tai Yang seasonal toxin, although the coating is thin and white, the tongue body is actually red, or the white coating is thin and dry with prickles, with red edges and tip. In Shao Yang, the red color predominates over white, or it mixes with gray-yellow colors, even appearing white like accumulated powder, with red and purple edges. In Yang Ming, the tongue coating is distinctly yellow, thin and greasy, or deeply yellow and thick/greasy, interspersed with gray-black, or old yellow scorched black, often with prickles. When the three Yang meridians are simultaneously affected, the tongue is red with yellow coating, or mixed with gray dots and black prickles. When Shao Yang and Jue Yin are jointly affected, the tongue color is more likely purple-red, or even scorched purple with prickles.

[Pulse] Left pulse floating, wiry, and vigorous indicates Tai Yang meridian affected by seasonal toxin. Left pulse floating, wiry, rapid, and forceful indicates Shao Yang meridian affected by seasonal toxin. Right pulse not very floating, but forceful and rapid upon pressure, with right larger than left, indicates Yang Ming meridian affected by seasonal toxin. Both left and right pulses floating and sinking, vigorous, wiry, forceful, and rapid indicate the three Yang meridians simultaneously affected by seasonal toxin. Left pulse floating, wiry, rapid, and forceful; right pulse forceful, slippery, and rapid indicates Shao Yang and Jue Yin meridians jointly affected by seasonal toxin. This is what Li Dongyuan referred to as Da Tou Shang Han [Great Head Cold Damage], where wind-toxin and evil heat lodge between the Heart and Lung, attacking upwards to the head and face causing swelling. However, classics state that wind qi connects to the Liver, and the Liver meridian goes straight up to the vertex. Often, Shao Yang fire flares up, agitating Liver wind. Wind assists fire, fire borrows wind's power; external wind triggers internal wind, creating a critical condition where life and death hang in the balance.

[Treatment] The method should be internal and external treatment combined. If treated promptly, seven or eight out of ten recover; if not treated promptly, nine or ten out of ten die. Internal treatment focuses on acrid-cool dispersing, promoting Qi circulation, and detoxification. For mild cases, Cong Chi Jie Geng Tang (Scallion and Fermented Soybean Decoction with Platycodon) is used, adding Niu Bang Zi (Arctii Fructus), Yin Hua (Lonicerae Japonicae Flos), Da Qing Ye (Isatidis Folium) (each 3 qian), Chan Tui (Cicadae Periostracum) (1.5 qian). First, use San Dou Tang (Three Bean Decoction: Raw Green Bean 1 liang, Large Black Bean 6 qian, Red Adzuki Bean 4 qian, Green Lotus Leaf 1 circle) to decoct the medicine instead of water. For severe cases, Tong Sheng Xiao Du San (Tongsheng Detoxifying Powder) is modified (Jing Jie, Fang Feng, Chuan Xiong, Bai Zhi each 1 qian; Yin Hua, Lian Qiao, Niu Bang Zi, Bo He, Jiao Zhi Zi, Hua Shi each 2 qian; Feng Hua Xiao, Wine-fried Sheng Da Huang, Ku Jie Geng, Sheng Gan Cao each 0.5 qian. First, use Xi Jiao Jian (Rhinoceros Horn Tip) 1 qian, Da Qing Ye 5 qian, Fresh Cong Bai 3 stalks, Dan Dou Chi 4 qian, Huo Lu Sun 2 liang, Fresh Zi Bei Fu Ping 3 qian, decocted in Wax Snow Water as a substitute for water. Severe cases take two doses daily and one dose nightly; medicines need slight boiling in boiling water). Dispel wind and release the exterior to ventilate the upper jiao. After upper jiao ventilation, if heat-toxin remains strong with constipation and dysuria, continue with Jie Du Cheng Qi Tang (Detoxifying Purging Decoction) to drain toxins via the three jiaos. Once toxin is removed and heat reduced, finally use Qing Zao Yang Ying Tang (Clear Dryness and Nourish Ying Decoction) with fresh Mao Gen (Imperatae Rhizoma) 1 liang and Xi Yang Shen (Panacis Quinquefolii Radix) 2 qian to clear and nourish Qi and fluids for recovery. If Shao Yang and Jue Yin are jointly affected, with excessive seasonal toxin, intertwining wind-fire, and concurrent spasms and syncope, quickly administer Ling Jiao Gou Teng Tang (Antelope Horn and Uncaria Decoction) with added Xi Jiao Zhi (Rhinoceros Horn Juice) 2 piao, Jin Zhi (Gold Juice) 2 liang, Tong Bian (Children's Urine) 1 cup (mixed in), and Zi Xue 0.5-0.8 fen to purge fire and extinguish wind to detoxify. Then use Qi Xian Yu Yin Tang (Seven Fresh Fluid-Nourishing Decoction) to clear and moisten fluids for recovery.

External treatment involves pricking the swollen areas with fine needles (prepare 36 extremely fine embroidery needles tied into one large, hollow, circular bundle, which doctors must prepare). First release purple blood, then yellow saliva, draining blood-toxin to reduce swelling. Immediately apply Qing Liang Jiu Ku San (Cooling and Suffering-Saving Powder): Fu Rong Ye, Er Sang Ye (Mulberry Leaves), Bai Zhi, Bai Ji, Bai Lian, Sheng Jun (Da Huang), Chuan Lian (Coptidis Rhizoma), Chuan Bai (Phellodendri Cortex), Yao Huang, Ru Xiang, Mo Yao, Du Chi Dou, Cao He Che, Zhi Yue Shi (each 2 qian), ground into powder, mixed with honey water, and frequently swept onto the swollen area. Apply to reduce fire. For sore throat and throat obstruction, urgently mix raw Tong You (Verniciae Oleum) with a little Sao Jiao Mo (Gleditsiae Sinensis Fructus Powder), dip a white goose feather, sweep the throat, induce vomiting of phlegm-saliva to open obstruction. Then blow Jia Wei Bing Peng San (Modified Ice and Borax Powder) to reduce swelling. Finally, mix Tu Niu Xi Juice 2 piao with one bowl of boiling water, add Zhi Yue Shi 2 qian and Zi Xue 2 fen, wait until melted, and frequently gargle to remove putrefaction. In summary, this toxin first swells the nose, then the ears, from ears to head, connecting behind the neck. If it forms a lump, it stops; if it does not dissipate, it must suppurate. Therefore, internal and external treatment combined is necessary for resolution. Avoid sudden use of bitter-cold herbs, such as using both Qin and Lian in Dongyuan's Pu Ji Xiao Du Yin. Also prohibit reckless use of acrid-hot herbs, such as Qiang Huo, Du Huo, and Er Huo in Jie An's Jing Fang Bai Du San, which has caused many delays. Scholars must not rigidly adhere to established formulas.

[Commentary by Xiu] In the second month of the fourth year of Taihe (Yuan Dynasty), many people suffered from epidemics. Initially feeling aversion to cold, high fever, and body heaviness, subsequently developing severe head and face swelling, inability to open eyes, throat obstruction, rebellious Qi with panting, dry mouth and tongue. Commonly called Great Head Cold Damage; infections were mostly fatal. Doctors used Cheng Qi Tang with Lan Gen (Bupleuri Radix/Isatidis Radix), but repeated purgation failed. Li Dongyuan then created a formula named Pu Ji Xiao Du Yin (Universal Benefit Detoxifying Decoction). Applying this formula saved many lives. The formula explanation states: The upper half of the body is governed by Heaven's Qi. Since epidemic toxin lodges between Heart and Lung and attacks upwards to cause head/face swelling, use Huang Qin and Huang Lian (each 5 qian) to bitterly coldly purge Heart/Lung fire; Xuan Shen 2 qian; Lian Qiao, Ma Bo, Niu Niu Zi (Niu Bang Zi), Ban Lan Gen (each 1 qian) to bitterly-acrid-ping clear fire, scatter swelling, and detoxify; Jiang Can 7 fen to clear phlegm and benefit diaphragm; Gan Cao 2 qian to moderate; Jie Geng 3 fen to carry Qi upwards; Sheng Ma 7 fen to raise Qi on the right; Chai Hu 5 fen to raise Qi on the left. For Qi deficiency with stagnation, use Ren Shen 2 qian to tonify deficiency, assisted by Chen Pi 2 qian to diffuse Qi. For constipation, add wine-baked Da Huang. Grind into fine powder; half taken as decoction, administered frequently; half made into honey pills to be held in the mouth, adapting to the disease location. The formula's intent and administration are clever, worthy of stone carving for posterity. Later, Luo Qianfu imitated this to create Ji Ji Jie Du Tang (Jiji Detoxifying Decoction), adding only Dang Gui, removing Xuan Shen, Ma Bo, Niu Bang Zi, Ban Lan Gen. It differs slightly from Li's formula. Following the *Nan Jing* principle "accumulation causes swelling and heat," he applied injection/acupuncture methods to the swelling, making about ten punctures. Purple-black blood emerged like dewdrops, and swelling/pain dissipated instantly, serving as a model for later learners. Indeed worthy of emulation. Thus, Master Yu advocates internal and external combination for faster results.

[Review by Lian] Wu Jutong modified Pu Ji Xiao Du Yin by removing Sheng Ma, Chai Hu, Huang Qin, Huang Lian, adding Yin Hua, and setting new dosages for internal use (Yin Hua, Lian Qiao, Xuan Shen, Jie Geng each 1 liang; Ban Lan Gen, Jiang Can, Sheng Gan Cao each 5 qian; Jing Jie, Bo He each 3 qian; Niu Bang Zi 6 qian; Ma Bo 4 qian. Coarse powder, mild case 6 qian, severe case 8 qian, decocted in fresh Lu Gen tea soup, strained, taken every two hours). External use uses Shui Xian Gao (Narcissus Paste: peel old red skin and roots of Narcissus bulb, pound in stone mortar into paste, apply to swelling leaving a hole for heat release, change when dry, until millet-sized yellow sores appear on skin). San Huang Er Xiang San (Chuan Lian, Chuan Bai, Sheng Da Huang each 1 liang; Ru Xiang, Mo Yao each 5 qian, fine powder. Initially mix with aged tea juice for application, change when dry; subsequently mix with sesame oil for application to purge fire and relieve pain). For coma and delirium, first use An Gong Niu Huang Wan or Zi Xue Dan, then Qing Gong Tang (Xuan Shen Xin, Lian Xin Mai Dong each 3 qian; Zhu Ye Juan Xin, Lian Qiao Xin, Xi Jiao Juice each 2 qian; Lian Zi Xin 5 fen; for heavy heat-phlegm add Zhu Li and Li Zhi each 5 spoons; for unclear cough-phlegm add Gua Lou Pi 1.5 qian; for heavy heat-toxin add Jin Zhi 1 liang, Ren Zhong Huang 1.5 qian; for impending coma add Yin Hua 3 qian, He Ye 2 qian, Xian Shi Chang Pu 1 qian). Cheng Zhongling stated that wind-fire郁热 (stagnant heat) causes Great Head Plague. Initial stage should use Jia Wei Gan Jie Tang (Gan Cao, Jie Geng, Jing Jie, Bo He, Niu Bang, Bei Mu, Chai Hu, Dan Pi) to clear and disperse. If dispersion fails, use Pu Ji Xiao Du Yin to clear. If swelling is extreme, combine with Bian Fa (bloodletting). These two views offer stable treatments, but are not as concise and comprehensive as Yu's method, nor as fast-acting.

[Commentary by Rongzhai] In this section, Master Yu repeatedly mentions San Yang seasonal toxin, Jue Yin seasonal toxin, simultaneous San Yang seasonal toxin, and concurrent Shao-Jue seasonal toxin in the "Etiology," "Symptoms," and "Pulse" sections. However, regarding treatment, he only divides it into internal and external methods, with internal treatment summarized as acrid-cool dispersing and separate-clearing/purging, without specifying drugs for San Yang or Jue Yin. This reflects his principle of flexible prescription based on symptoms. Here, I believe treating "Great Head Cold Damage" should focus on etiology and symptoms, avoiding unnecessary complexity regarding San Yang and Jue Yin. Chen Shigong's *Wai Ke Zheng Zong* outlines "View" and "Treatment" clearly, which is worth referencing. Regarding nomenclature, *Bing Yuan Lun*, *Qian Jin Yi*, and *Wai Tai Mi Yao* call it "Dan Du" [Erysipelas]. They describe it as starting on the nasal bridge or cheek skin, spreading from nose to cheek, eyelid, ear wing, entire face, then to chin, stopping at the hairline, termed "Facial Erysipelas." If scalp is involved, affecting the whole head, it is called "Head Erysipelas." What we now call "Da Tou Wen," Liu Hejian called "Da Tou," Dongyuan called "Da Tou Tian Xing," Zhu Danxi called "Da Tou Bing," Li Chan, Yu Jiayan, Shen Jin'ao all called "Da Tou Wen," and Chen Shigong called "Shi Du." Essentially, they are all Head Erysipelas. There are signs to confirm, so no further elaboration here.

[Another Commentary] Wu Kun'an's *Shang Han Zhi Zhang* states: "Initial aversion to cold, high fever, body heaviness, followed by massive head/face swelling, inability to open eyes, or throat obstruction, commonly known as 'Great Head Cold Damage.' Treatment should avoid harsh medicines; harshness exceeds the disease severity, described as 'upper heat not removed, middle cold arises,' leading to faster death. Administer small amounts frequently. Formula: Wine-processed Qin Lian, Ren Zhong Huang to detoxify; Jing Jie, Fang Feng, Bo He to dispel wind; Lian Qiao, Tian Chong, Jie Geng, Niu Bang to scatter nodules; for headache, aversion to cold, no sweat, add Er Huo to dispel cold."