齐氏曰∶时毒者，为四时邪毒之气而感之于人也。其候发于鼻面耳项咽喉，赤肿无头，或
结极有根，令人憎寒发热头痛，肢体甚痛，恍惚不守，咽喉闭塞。人不识者，将谓伤寒。原
夫此疾，古无方论，世俗通谓丹瘤，病家恶言时毒，切恐传染。经曰∶人身忽经变赤，状如
涂丹，谓之丹毒。此风热恶毒所为，自与时毒不同。盖时毒者，感四时不正之气，初发状如
伤寒，五七日之间乃能杀人，若至十日之外，则不治自愈也治宜辨之。先诊其脉，凡滑数
浮洪、沉紧弦涩皆其候也。但浮数者，邪在表也；沉涩者，邪气深也。察其毒之甚者，急服化
毒丹，以攻之。实热便秘者，大黄汤下之。其有表证者，犀角升麻汤以发之。或年高气郁者
，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，不可治之。若嚏出脓血者，治
之必愈。凡左右看病之人，日日用 药嚏之，必不传染，切须记之。其病患每日用嚏药三五次
，以泄热毒，此治时证之良法也。
凡经三四日不解者，不可大下，犹宜和解之，以犀角散、芩连消毒饮，甚者连翘汤之类
。至七八日，大小便通利，而头面肿起高赤者，可服托里散、托里黄 汤。如肿甚者，宜砭
患处，出恶血，以泄其毒瓦斯。此病若五日以前，精神昏乱，咽喉闭塞，语言不出，头面赤肿，
食不知者，必死之候，治之无功矣。然而此疾有阴有阳，有可汗者，有可下者，尝见粗工但
云热毒，只用寒药，殊不知病有微甚，治有逆从，不可不审矣。
罗谦甫云∶泰和二年，先师监济源税时，四月民多疫疠。初觉憎寒体重，次传头面肿，
盛目不能开，上喘，咽喉不利，舌干口燥。俗云大头天行，亲戚不相访问，染之多不救。张
县令侄亦得此病。至五六日，医以承气加板蓝根下之，稍缓。翌日，其病如故，下之又缓，
终莫能愈，渐至危笃。或曰∶李明之存心于医，可请治之。遂请诊视，具说其由。先师曰∶
夫身半以上天之气也，身半以下地之气也。此邪热客于心肺之间，上攻头目而为肿盛，用承
气下之以泻胃中之实热，是诛伐无过也，殊不知适其病所为故。遂处一方，用黄芩、黄连苦
苦寒泻心肺间热以为君；橘红苦平，玄参苦寒，生甘草甘寒，人参甘平，泻火补气以为臣；连翘
、鼠粘子、薄荷叶苦辛平，板蓝根味苦寒，马勃、白僵蚕味苦平，行少阳阳明二经气不得伸
，桔梗味辛温为舟楫不令下行，升麻、柴胡苦辛以散表邪。共为细末，半用汤调，时时服之
，半蜜为丸噙化之，服尽良愈。因叹曰，往者不可追，来者犹可及，凡他所有病者，皆书方
以贻之，全活甚众。时人皆曰，此方天人所制，遂刊于石，以传永久，命曰普济消毒饮。
薛立斋曰∶此感四时不正之气，邪客心肺之间，上攻头目而为患，与膏粱积热之证不同
，硝黄之剂，非大便秘实者不可用，若不审其因，不辨表里虚实而概用攻，必致有误。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。
表里俱解而不消者，和之。肿甚 痛者，砭去恶
血，更用消毒之剂。不作脓或不溃者，托之。饥年普患者，不宜用峻利药，当审而治之。
又《治法》曰∶若脉浮者，邪在表也，用葛根牛蒡汤、犀角升麻汤、人参败毒散之类以
发之。脉沉涩者，邪在里也，用栀子仁汤、五利大黄汤之类以下之。表里俱病而肿不退者，
用犀角升麻汤，甚者砭出恶血，并用通关散 鼻内取嚏，以泄其毒。表里俱不解而内外俱实
者，防风通圣散。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。常
见饥馑之际，刍荛之人，多患之，乃是胃气有损，邪气从之为患也。故凡以凶荒劳役而患此
者，多宜安里为主。或用普济消毒饮最善。
一老人，冬月头面耳项俱肿痛甚，便秘，脉实，此表里俱实病也，与防风通圣散不应。
遂砭患处出黑血，仍投前药即应，又以荆防败毒散而 。盖前药不应者，毒血凝聚上部经络
，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，头面肿痛，服硝黄败毒之剂愈甚。诊之脉浮数，其邪在表尚未解散，用荆防败
毒散加玄参牛蒡子二剂，势退大半，以葛根牛蒡子汤四剂而痊。（薛按）
齐氏说：时毒，是由于感受四时不正的邪毒之气而使人患病。其症状表现为发作于鼻、面、耳、项、咽喉部位，红肿且无脓头，或者结聚极深且有根脚，令人憎寒发热、头痛，肢体非常疼痛，神志恍惚不能自主，咽喉闭塞不通。人们如果不认识这种病，会误认为是伤寒。追溯这种疾病的本源，古代没有专门的方论记载，世俗普遍称之为“丹瘤”，病人厌恶听到“时毒”这个词，担心被传染。医经说：人身突然变红，状如涂抹丹砂，称为丹毒。这是由风热恶毒引起的，自然与时毒不同。大概时毒是感受四时不正之气所致，初发时症状像伤寒，在五到七天之间可能致死，如果超过十天，则不治疗也能自愈，因此治疗应当仔细辨别。先诊察脉象，凡是滑数、浮洪、沉紧、弦涩的脉象都是其征候。但如果是浮数脉，说明邪气在表；如果是沉涩脉，说明邪气深入。观察毒势严重的，急忙服用化毒丹来攻逐邪毒。实热便秘的，用大黄汤泻下。有表证的，用犀角升麻汤发散。或者是年高体弱、气机郁滞的，以五香连翘汤为主治。
又在鼻腔内吹入通气散，取打喷嚏十余次作为疗效标准，如果用药后不打喷嚏的，属于不可治之症。如果嚏出脓血的，治疗必定痊愈。凡是左右照顾病人的护理人员，每天用药粉吹鼻取嚏，必定不会传染，务必记住这一点。病患每天使用嚏药三到五次，以泄散热毒，这是治疗时证的好方法。
凡是经过三四天病情未解的，不可猛烈攻下，仍宜采用和解法，使用犀角散、芩连消毒饮，毒势重的用连翘汤之类。到了七八天，大小便通利，而头面部肿起高赤的，可以服用托里散、托里黄芪汤。如果肿胀严重的，适宜用砭石刺破患处，放出恶血，以泄解毒瓦斯。此病如果在五天以前，出现精神昏乱、咽喉闭塞、不能言语、头面赤肿、饮食不知味的，是必死的征候，治疗也无效了。然而此疾有阴证和阳证之分，有的可用发汗法，有的可用攻下法，我曾见到庸医只说是热毒，只用寒凉药物，却不知道疾病有轻重深浅，治疗有逆治顺治的区别，不可不审慎。
罗谦甫说：泰和二年，我的老师担任济源税务监官时，四月间百姓多患瘟疫。起初感觉憎寒身体沉重，随后传变为头面肿胀，眼睛肿得睁不开，向上喘息，咽喉不利，舌干口燥。俗称为“大头天行”，亲戚不敢互相探访，染上的人大多无法救治。张县令的侄子也得了这个病。到了五六天，医生用承气汤加板蓝根攻下，病情稍缓。第二天，病势依旧，再次攻下后稍缓，最终未能痊愈，逐渐变得危重。有人说：“李明之专心于医学，可以请他治疗。”于是请他诊治，详细说明了病因。老师说：“身半以上是天的清气，身半以下是地的浊气。这邪热客居在心肺之间，向上攻冲头目导致肿胀盛满，如果用承气汤攻下以泻胃中实热，这是诛伐无罪之处，不知道要顺应病情的所在。”于是开一方子，用黄芩、黄连苦寒之性清泻心肺间的热作为君药；橘红苦平，玄参苦寒，生甘草甘寒，人参甘平，泻火补气作为臣药；连翘、鼠粘子（牛蒡子）、薄荷叶苦辛平，板蓝根味苦寒，马勃、白僵蚕味苦平，通行少阳、阳明二经郁滞的气机，桔梗味辛温作为舟楫防止药力下行，升麻、柴胡苦辛以疏散表邪。共研为细末，一半用水调服，时时服用，一半用蜂蜜做成丸剂含化。服完即痊愈。于是感叹道：“过去的无法追回，未来的还可以赶上。”凡是有其他患病的人，都写下方子送给他们，保全活了很多众人。当时人都说，这个方子是上天和人共同制定的，于是刻在石头上，以流传永久，命名为普济消毒饮。
薛立斋说：这是感受四时不正之气，邪气客居在心肺之间，向上攻冲头目而致病，与膏粱厚味积热之证不同，硝石、大黄之类的药剂，不是大便秘结坚实的不可使用，如果不审察病因，不辨别表里虚实而一概使用攻下法，必然会导致错误。里实证而大便不通的，用攻下法。表实证而表邪不解的，用发散法。表里俱实证而邪不解的，解表攻里并用。表里邪气已解但肿胀不消的，用和解法。肿胀严重疼痛的，用砭石去除恶血，再用消毒药剂。不化脓或不溃破的，用托里法。饥荒年份普遍患病的，不宜使用峻猛利下的药物，应当审慎治疗后施治。
又《治法》中说：如果脉浮，说明邪气在表，用葛根牛蒡汤、犀角升麻汤、人参败毒散之类发散。脉沉涩，说明邪气在里，用栀子仁汤、五利大黄汤之类攻下。表里俱病而肿胀不退的，用犀角升麻汤，严重的砭刺放出恶血，并配合通关散吹鼻取嚏，以泄解毒毒。表里俱不解且内外俱实的，用防风通圣散。想要它化脓的，用托里消毒散。想要它收敛愈合的，用托里散。这种方法最为稳妥得当。常常见到饥荒之际，底层百姓多患此病，这是因为胃气受损，邪气趁机作祟。所以凡是因凶年饥荒或劳役而患此病的，大多适宜以安固里气为主。或者使用普济消毒饮最好。
有一位老人，冬天头面耳项都肿痛严重，便秘，脉象实，这是表里俱实的病，给予防风通圣散却无效。于是用砭石刺破患处放出黑血，仍然投予前面的药物就见效了，后来又用荆防败毒散调理。因为前面药物无效的原因，是毒血凝聚在上部经络，药力难以到达。恶血既去，药物自然生效。有人拘泥于“寒远寒”（冬季慎用寒药）以及年老畏惧使用硝石、大黄，而使用托里法或寻常消毒药剂，或者不砭刺泄毒，专门依赖药力，很少有不危险的。
有一位男子，头面肿痛，服用硝石、大黄等败毒药剂后病情加重。诊察其脉浮数，邪气在表尚未解散，用荆防败毒散加玄参、牛蒡子，两剂后，病势退去大半，再用葛根牛蒡子汤四剂而痊愈。（薛己按语）
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)