囊缩，虽同系厥阴现证，要之舌属手，囊属足也。盖舌为心窍，包络代心用事，肾囊前后，皆肝经所
过，断不可以阴阳二厥混而为一，若陶节庵所云∶“冷过肘膝，便为阴寒”，恣用大热。再热厥之中亦
有三等∶有邪在络居多，而阳明证少者，则从芬香，本条所云是也；有邪搏阳明，阳明太实，上冲心包，
神迷肢厥，甚至通体皆厥，当从下法，本论加载中焦篇；有日久邪杀阴亏而厥者，则从育阴潜阳法，
本论加载下焦篇。
牛黄丸、紫雪丹方（并见前）
十八、温毒咽痛喉肿，耳前耳后肿，颊肿，面
正赤，或喉不痛，但外肿，甚则耳聋，俗名大头温、虾蟆温者，普济消毒饮去柴胡、升麻主之，初
起一、二日，再去芩、连，三四日加之佳。
瘟毒者，秽浊也。凡地气之秽，未有不因少阳之气而自能上升者，春夏地气发泄，故多有是证；秋冬地气，间有不
藏之时，亦或有是证；人身之少阴素虚，不能上济少阳，少阳升腾莫制，亦多成是证；小儿纯阳火多，阴未充长，亦多
有是证。咽痛者，经谓“一阴一阳结，谓之喉痹”。盖少阴少阳之脉，皆循喉咙，少阴主君火，少阳主相火，相济为灾
也。耳前耳后颊前肿者，皆少阳经脉所过之地，颊车不独为阳明经穴也。面赤者，火色也。甚则耳聋者，两少阳之脉，
皆入耳中，火有余则清窍闭也。治法总不能出李东垣普济消毒饮之外。其方之妙，妙在以凉膈散为主，而加化清气之马
勃、僵蚕、银花，得轻可去实之妙；再加元参、牛蒡、板蓝根，败毒而利肺气，补肾水以上济邪火；去柴胡、升麻者，
以升腾飞越太过之病，不当再用升也，说者谓其引经，亦甚愚矣！凡药不能直至本经者，方用引经药作
引，此方皆系轻药，总走上焦，开天气，肃肺气，岂须用升、柴直升经气耶？去黄芩、黄连者，芩连里药
也，病初起未至中焦，不得先用里药，故犯中焦也。
普济消毒饮去升麻柴胡黄芩黄连方
连翘（一两） 薄荷（三钱） 马勃（四钱） 牛蒡子（六钱）
芥穗（三钱） 僵蚕（五钱） 元参（一两） 银花（一两） 板蓝根（五钱） 苦梗（一两） 甘草（五钱）
上共为粗末，每服六钱，重者八钱。鲜苇根汤煎，去渣服，约二时一服，重者一时许一服。
十九、温毒外肿，水仙膏主之，并主一切痈疮。
按∶水仙花得金水之精，隆冬开花，味苦微辛
，寒滑无毒，苦能升火败毒，辛能散邪热之结，寒能胜热，滑能利痰，其妙用全在汁之胶粘，能拔毒外
出，使毒邪不致深入脏腑伤人也。
水仙膏方
水仙花根，不拘多少，剥去老赤皮与根须，入
石臼捣如膏，敷肿处，中留一孔出热气，干则易之，以肌肤上生黍米大小黄疮为度。
二十、温毒敷水仙膏后，皮间有小黄疮如黍米者，不可再敷水仙膏，过敷则痛甚而烂，三黄二香散主之。
三黄取其峻泻诸火，而不烂皮肤，二香透络中余热而定痛。
三黄二香散方（苦辛芳香法）
黄连（一两） 黄柏（一两） 生大黄（一两） 乳香（五钱） 没药（五钱）
上为极细末，初用细茶汁调敷，干则易之，继则用香油调敷。
二一、温毒神昏谵语者，先与安宫牛黄丸、紫雪丹之属，继以清宫汤。
安宫牛黄丸、紫雪丹、清宫汤（方法并见前）
阴囊收缩，虽然同样属于厥阴经的表现证候，但舌象归属于手经（心包），而阴囊归属于足经（肝）。因为舌是心的外窍，由心包代心行使职能；肾囊的前后部位，都是肝经所经过的地方。绝不能将阴阳两种厥证混淆为一谈，像陶节庵所说的：“冷过肘膝，就是阴寒”，就肆意使用大热药物。此外，热厥之中也有三种等级：有邪气在络脉居多，而阳明证较少的，则采用芳香开窍法，本条所述即是这种情况；有邪气搏结于阳明，阳明腑实严重，热气上冲心包，导致神志昏迷、四肢厥冷，甚至全身都出现厥冷，应当采用攻下法，本论记载在中焦篇；有病程日久，邪气伤及阴液导致阴亏而出现厥冷的，则采用滋阴潜阳法，本论记载在下焦篇。
第十八条：温毒引起的咽喉疼痛、喉部肿胀，耳前耳后肿胀，面颊肿胀，面色正红，或者咽喉不痛，只是外部肿胀，严重时甚至耳聋，俗称大头瘟、虾蟆瘟的，用普济消毒饮去掉柴胡、升麻来主治。初起一两天，再去掉黄芩、黄连，三四天后再加入黄芩、黄连较为适宜。
所谓瘟毒，是指秽浊之气。凡是地气的秽浊，没有不借助少阳之气而自然上升的，春夏季节地气发泄，所以多有这种证候；秋冬季节地气，偶尔也有不闭藏的时候，也可能会出现这种证候；人体如果少阴素来虚弱，不能上行资助少阳，导致少阳升腾之气失去制约，也多形成这种证候；小儿纯阳之体，火气多，阴气未充长，也多有这种证候。咽喉疼痛，医经中说“一阴一阳结，谓之喉痹”。因为少阴和少阳的经脉，都循行经过喉咙，少阴主君火，少阳主相火，两火相济为灾。耳前、耳后、面颊前部的肿胀，都是少阳经脉经过的地方，颊车穴不仅仅属于阳明经穴位。面色发红，是火的颜色。严重时耳聋，是因为两条少阳经脉都进入耳中，火气有余就会闭塞清窍。治疗方法总不能超出李东垣的普济消毒饮范围。这个方剂的妙处，妙在以凉膈散为主，加上化清气分的马勃、僵蚕、银花，得到轻可去实的妙用；再加上元参、牛蒡子、板蓝根，败毒并利肺气，补肾水以上济邪火；去掉柴胡、升麻的原因，是因为升腾飞越太过严重的病证，不应当再用升提的药物，评论者说它们是引经药，也非常愚昧！凡是不能直接到达本经的药物，方剂中使用引经药作为引导，此方都是轻扬的药物，总走上焦，开启天气，肃降肺气，哪里需要用升麻、柴胡直升经气呢？去掉黄芩、黄连的原因，是因为芩连是治里的药物，病初起尚未到达中焦，不得先用治里的药物，否则会侵犯中焦。
普济消毒饮去升麻、柴胡、黄芩、黄连方
连翘（一两） 薄荷（三钱） 马勃（四钱） 牛蒡子（六钱）
荆芥穗（三钱） 僵蚕（五钱） 玄参（一两） 金银花（一两） 板蓝根（五钱） 桔梗（一两） 甘草（五钱）
以上共研为粗末，每次服用六钱，病情重的服用八钱。用鲜苇根汤煎煮，去渣服用，大约每隔两小时服一次，病情重的约一小时服一次。
第十九条：温毒引起的外部肿胀，用水仙膏主治，同时也主治一切痈疮。
按语：水仙花得金水之精气，隆冬开花，味道苦微辛，性寒滑无毒，苦能降火败毒，辛能散邪热之结滞，寒能胜热，滑能利痰，其妙用全在于汁液的胶粘，能拔毒外出，使毒邪不至于深入脏腑伤害人。
水仙膏方
水仙花根，不拘多少，剥去老赤皮与根须，放入石臼中捣成膏状，敷在肿胀处，中间留一个孔以排出热气，干了就更换，直到肌肤上生出黍米大小的黄疮为止。
第二十条：温毒敷了水仙膏后，皮肤间有小黄疮如黍米大小的，不可再敷水仙膏，过度敷用则会疼痛剧烈且溃烂，用三黄二香散主治。
三黄取其峻泻各种火邪，而不损伤皮肤，二香透达络脉中的余热并定痛。
三黄二香散方（苦辛芳香法）
黄连（一两） 黄柏（一两） 生大黄（一两） 乳香（五钱） 没药（五钱）
以上研为极细末，初用时用细茶汁调敷，干了就更换，随后用香油调敷。
Contraction of the scrotum, although it is also a manifestation syndrome of the Jueyin (Jueyin Meridian) channel, essentially, the tongue belongs to the Hand (Heart Pericardium), while the scrotum belongs to the Foot (Liver). For the tongue is the orifice of the Heart, and the Pericardium acts on behalf of the Heart; the anterior and posterior parts of the renal scrotum are all areas traversed by the Liver meridian. One must absolutely not confuse Yin Jue (Yin Cold Reversal) and Yang Jue (Yang Heat Reversal) as one. If one follows Tao Jian'an's assertion: "Cold extending beyond elbows and knees indicates Yin Cold," and recklessly uses intensely hot medicines, this is erroneous. Furthermore, among Heat Jue (Heat Reversal), there are three grades: In cases where pathogenic factors reside mostly in the collaterals with few Yangming symptoms, aromatic methods should be employed; this is what the current clause refers to. In cases where pathogens contend with the Yangming, resulting in severe Yangming excess, with heat rushing upward to attack the Pericardium, causing mental confusion and limb reversal, even general body reversal, purgative methods should be used; this is recorded in the Middle Jiao Chapter of this treatise. In cases where the disease has persisted for a long time, damaging Yin fluids and leading to reversal due to Yin deficiency, nourishing Yin and subduing Yang methods should be adopted; this is recorded in the Lower Jiao Chapter of this treatise.
Niuhuang Wan (Calculus Bovis Pill) and Zixue Dan (Purple Snow Elixir) formulas (see previous sections).
Article 18: Wen Du (Warm Toxins) causing throat pain and swelling, swelling before and behind the ears, swelling of the cheeks, bright red complexion, or throat pain absent but external swelling present, and even deafness in severe cases—commonly known as Datou Wen (Big Head Plague) or Hamax Wen (Toad Plague)—should be treated primarily with Puji Xiaodu Yin (Universal Benefit Decoction to Eliminate Toxins) minus Chaihu (Bupleuri Radix) and Shengma (Ephedrae Herba or Cimicifugae Rhizoma, here referring to Cimicifugae Rhizoma). In the initial one or two days, Huangqin (Scutellariae Radix) and Lianlian (Coptidis Rhizoma) should also be removed; adding them back after three or four days is appropriate.
Wen Du refers to turbid miasma. Any turbidity from earthly qi naturally rises with the assistance of Shaoyang (Lesser Yang) qi. In spring and summer, when earthly qi exudes, such syndromes are common; in autumn and winter, when earthly qi occasionally fails to store, such syndromes may also occur. If the body's Shaoyin (Lesser Yin) is inherently deficient and cannot ascend to assist Shaoyang, causing unrestrained rising of Shaoyang qi, such syndromes often result. Children, possessing pure Yang and excessive fire with underdeveloped Yin, also frequently exhibit such syndromes. Throat pain is described in classics as "when one Yin and one Yang knot, it is called Hou Bi (throat obstruction)." The meridians of Shaoyin and Shaoyang both traverse the throat; Shaoyin governs Minister Fire (Jun Huo), and Shaoyang governs Executive Fire (Xiang Huo); their mutual exacerbation causes disaster. Swelling in front of and behind the ears and on the cheeks occurs in areas traversed by the Shaoyang meridian; Jiache (ST6) is not solely an acupoint of the Yangming meridian. A red face indicates the color of fire. Severe deafness occurs because both Shaoyang meridians enter the ears; excess fire closes the clear orifices. Treatment methods generally do not exceed Li Dongyuan's Puji Xiaodu Yin. The brilliance of this formula lies in using Liangge San (Cool the Diaphragm Powder) as the base, adding Mabo (Mortella Semen), Jiangcan (Bombyx Batryticatus), and Yinhua (Lonicerae Japonicae Flos) to transform Qi-level pathogens, achieving the subtlety of "light substances resolving substantiality"; further adding Yuanshen (Scrophulariae Radix), Niubangzi (Arctii Fructus), and Banlangen (Isatidis Radix) to defeat toxins, benefit Lung Qi, tonify Kidney Water to counteract pathogenic fire; removing Chaihu and Shengma because diseases characterized by excessive ascending and soaring flight should not use ascending agents again; commentators claiming they are guiding herbs are very foolish! Medicines that cannot directly reach their specific meridians require guiding herbs in formulas; however, this formula consists entirely of light substances acting on the Upper Jiao, opening Heaven's Qi, and肃降 (descending) Lung Qi, so why use Shengma and Chaihu to directly ascend meridian Qi? Removing Huangqin and Huanglian is because these are interior-treating drugs; since the disease is in its early stages and has not reached the Middle Jiao, using interior drugs prematurely would violate the Middle Jiao.
Puji Xiaodu Yin minus Shengma, Chaihu, Huangqin, Huanglian Formula:
Qiaoliao (Forsythiae Fructus) (1 liang), Bohe (Menthae Haplocalycis Herba) (3 qian), Mabo (Mortella Semen) (4 qian), Niubangzi (Arctii Fructus) (6 qian),
Jiesui (Schizonepetae Spica) (3 qian), Jiangcan (Bombyx Batryticatus) (5 qian), Yuanshen (Scrophulariae Radix) (1 liang), Yinhua (Lonicerae Japonicae Flos) (1 liang), Banlangen (Isatidis Radix) (5 qian), Kugeng (Platycodonis Radix) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma) (5 qian).
Grind all into coarse powder. Take 6 qian per dose, or 8 qian for severe cases. Decoct with fresh Reed Rhizome soup, strain, and drink. Administer approximately every two hours; for severe cases, every hour.
Article 19: External swelling caused by Wen Du is treated primarily with Shuixian Gao (Narcissus Ointment), which also treats all kinds of carbuncles and sores.
Note: Narcissus obtains the essence of Metal and Water, blooms in deep winter, tastes bitter and slightly pungent, is cold, slippery, and non-toxic. Bitterness descends fire and defeats toxins; pungency disperses stagnation of pathogenic heat; coldness overcomes heat; slipperiness promotes phlegm discharge. Its miraculous use lies entirely in the sticky nature of its juice, which draws toxins outward, preventing pathogenic toxins from deeply invading organs and harming humans.
Shuixian Gao Formula:
Narcissus bulb, any amount. Peel off old reddish skin and rootlets. Pound in a stone mortar until it forms a paste. Apply to the swollen area, leaving a central hole to allow heat to escape. Replace when dry. Continue until small yellow blisters the size of millet grains appear on the skin.
Article 20: After applying Shuixian Gao for Wen Du, if small yellow blisters the size of millet grains appear between the skin layers, do not continue applying Shuixian Gao. Over-application causes severe pain and ulceration. Treat with Sanhuang Erxiang San (Three Yellows and Two Fragrances Powder).
Sanhuang (Three Yellows) strongly drains various fires without damaging the skin; Erxiang (Two Fragrances) penetrates collaterals to clear residual heat and relieve pain.
Sanhuang Erxiang San Formula (Bitter-Pungent Aromatic Method):
Huanglian (Coptidis Rhizoma) (1 liang), Huangbai (Phellodendri Cortex) (1 liang), Sheng Dahuang (Rhei Radix et Rhizoma, raw) (1 liang), Ruxiang (Olibanum) (5 qian), Moyao (Myrrha) (5 qian).
Grind into extremely fine powder. Initially, mix with fine tea juice for topical application; replace when dry. Subsequently, mix with sesame oil for application.
Article 21: For Wen Du causing mental confusion and delirious speech, first administer An Gong Niu Huang Wan (An Gong Calculus Bovis Pill) or Zixue Dan (Purple Snow Elixir), followed by Qinggong Tang (Clear the Palace Decoction).
An Gong Niu Huang Wan, Zixue Dan, Qinggong Tang (methods see previous sections).