发于鼻额，红肿，以至两目肿盛而不开，额上面部皆赤而肿者，属阳明也。或
壮热气喘，口干舌燥，咽喉肿痛不利，脉来数大者，用普济消毒饮主之。如内实热
盛者，用通圣消毒饮。若发于耳之上下前后，并头角红肿，此属少阳也。或肌热日
晡热，寒热往来，口苦嗌干，目疼胁下满，宜小柴胡汤加花粉、羌活、荆芥、连翘、芩、
连主之。若发于头上，并脑后项下，及目后赤肿者，此属太阳也，宜荆防败毒散主
之。若三阳俱受邪，并于头面耳目鼻者，以普济消毒饮，外用清凉救苦散敷之。治法
当先缓后急，否则邪伏也。先缓者，宜退热消毒；虚人兼扶元气；胃虚食少者，宜
助胃气；候其大便内结热甚，方以大黄下之，拔其毒根，此先缓后急之法也。盖此
毒先肿于鼻额，次肿于目，又次肿于耳，从耳至头，上络后脑，结块则止，若不散必
成脓也。俗云∶大头天行，亲戚不相访问，染者多不救。泰和间多有病此者，医以承
气加蓝根下之稍缓，翌日如故，下之又缓，终莫能愈，渐至危笃。东垣视之曰∶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，上攻头面为肿盛，以
承气泻胃中之实热，是为诛伐无过，遂处普济消毒饮子，全活甚众。
伤寒汗下不彻，余部结在耳后一寸二三分，或两耳下俱硬肿者，名曰遗毒。宜
速消散，缓必成脓，以连翘败毒散治之。如项肿痛，加威灵仙；大便实，加大黄、穿
山甲。如发肿有脓不消，或已破未破者，但用内托消毒散加皂针、升麻、银花、甘草
之类。然古人方书之论如此，但实多由于久热伤阴。盖少阳、少阴，阴亏已极，乃
因虚火上冲，所以腮颊耳后肿痛也。经曰∶荣气不从，逆于肉里，乃生痈肿。况耳后
方圆一寸，皆属于肾，有何毒之谓欤！治宜以滋阴化痰，散郁和肝，而肿自愈。如
熟地、麦冬、土贝母、白芍、连翘、甘、桔之类，略佐青皮、柴胡少许足已。若尺脉
甚弱者，竟用上病疗下之法，投以引火归源之药，则肿不治而自散。若误认以毒为
事而攻之，不惟肿结愈固而愈甚，必致变生别病而危矣。当详酌之。
病发于鼻部和额头，出现红肿，甚至导致双眼肿胀严重而无法睁开，额头及整个面部都发红且肿胀的，属于阳明经病变。如果伴有高热、气促喘息、口干舌燥、咽喉肿痛且呼吸不畅，脉象快速而洪大的，使用普济消毒饮为主进行治疗。如果体内实热炽盛的，使用通圣消毒饮。如果病发于耳朵的上下前后部位，以及头角处红肿，这属于少阳经病变。如果伴有肌肉发热、傍晚时分发热加重、寒热往来（忽冷忽热）、口苦咽干、眼睛疼痛、胁下胀满，适宜用小柴胡汤加入天花粉、羌活、荆芥、连翘、黄芩、黄连来主治。如果病发于头顶，以及脑后项部下方，和眼后赤肿的，这属于太阳经病变，适宜用荆防败毒散为主治疗。如果三阳经同时受邪气侵袭，并集中在头面耳目鼻部的，使用普济消毒饮，外用清凉救苦散敷贴。治疗方法应当先采取缓和的手段，后采取急迫的手段，否则邪气会潜伏体内。所谓“先缓”，适宜采用退热解毒的方法；对于体质虚弱的人，兼以扶助元气；对于胃气虚弱、饮食减少的人，适宜助益胃气；等到患者大便内部结滞、热势极盛时，才使用大黄进行泻下，以拔除毒根，这就是“先缓后急”的治疗方法。大概这种毒邪先在鼻额部肿胀，其次在眼部肿胀，再次在耳部肿胀，从耳部蔓延至头部，向上联络后脑，结成硬块则停止，如果不消散必然化脓。俗话常说：大头天行瘟（大头瘟），亲戚之间不相往来看望，感染的人大多无法救治。金泰和年间多有患此病的人，医生用承气汤加板蓝根进行泻下，症状稍见缓解，第二天又恢复原状，再次泻下后症状稍缓，但最终未能痊愈，病情逐渐变得危重。李东垣诊治时说：身体上半部，是天之气所主；身体下半部，是地之气所主。这是邪热客居在心肺之间，向上攻冲头面导致肿胀盛大，如果用承气汤泻除胃中的实热，这是诛伐没有过错的部位（因为病位不在胃），于是开具普济消毒饮子，保全了众多患者的生命。
伤寒经过发汗或泻下治疗后不彻底，余留的病邪结聚在耳后一寸二三分处，或者双耳下方都坚硬肿胀的，名叫遗毒。应当迅速消散，拖延必定化脓，用连翘败毒散治疗。如果颈部肿胀疼痛，加入威灵仙；如果大便干结，加入大黄、穿山甲。如果发生肿胀且有脓液但不消退，或者已经破溃或未破溃的，只使用内托消毒散加入皂角刺、升麻、金银花、甘草之类的药物。然而古人的方书论述如此，但实际情况多是由于长期发热损伤阴液所致。大概是因为少阳、少阴经阴液亏损到了极点，导致虚火上冲，所以腮颊和耳后出现肿痛。医经说：营气运行不畅，逆乱于肌肉纹理之中，就会生成痈肿。况且耳后方圆一寸的区域，都归属于肾，哪里有什么毒邪可言呢！治疗适宜采用滋阴化痰、疏散郁结、调和肝脏的方法，肿胀自然痊愈。如熟地黄、麦冬、土贝母、白芍、连翘、甘草、桔梗之类的药物，稍微佐以少量的青皮、柴胡就足够了。如果尺脉非常微弱，竟可采用“上病疗下”的方法，投用引火归源的药物，那么肿胀不用专门治疗也会自行消散。如果错误地认为这是毒邪而进行攻伐，不仅会使肿块更加坚固且严重，必然导致产生其他疾病而危及生命。应当仔细斟酌处理。
The disease manifests on the nose and forehead with redness and swelling, extending to severe swelling of both eyes that prevents them from opening, with the entire forehead and face becoming red and swollen; this belongs to the Yangming channel. If accompanied by high fever, panting, dry mouth and tongue, painful and obstructed throat, and a rapid and large pulse, Puji Xiaodu Yin (General Relief Detoxification Decoction) should be used as the primary treatment. If there is excessive internal excess heat, Tongsheng Xiaodu Yin (Universal Protection Detoxification Decoction) is indicated. If the onset occurs around the ears (above, below, front, and back) along with redness and swelling at the temporal regions, this belongs to the Shaoyang channel. If accompanied by muscle heat, worsening heat in the late afternoon, alternating chills and fever, bitter taste in the mouth, dry throat, eye pain, and fullness in the hypochondrium, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Huatufen (Tetracentrae Semen), Qianghuo (Notopterygii Rhizoma et Radix), Jingjie (Schizonepetae Spica), Lianqiao (Forsythiae Fructus), Huangqin (Scutellariae Radix), and Lianzi (Coptidis Rhizoma) is appropriate. If the onset occurs on the vertex, the nape of the neck, and behind the eyes with redness and swelling, this belongs to the Taiyang channel, and Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxins) is suitable. If all three Yang channels are affected simultaneously, concentrating on the head, face, ears, eyes, and nose, Puji Xiaodu Yin should be used, with Qingliang Jiuku San (Cooling and Suffering-Relieving Powder) applied externally. The treatment principle should proceed from mild to urgent measures; otherwise, the pathogenic factor will lie latent. "Mild" measures include reducing fever and detoxifying; for deficient individuals, supporting Yuan Qi (Original Qi) is necessary; for those with weak Stomach Qi and poor appetite, assisting Stomach Qi is required. Only when fecal impaction and intense internal heat are present should Dahuang (Rhei Radix et Rhizoma) be used to purge, thereby extracting the root of the toxin; this constitutes the method of "mild first, then urgent." Generally, this toxin first swells on the nose and forehead, then on the eyes, then on the ears, spreading from the ears to the head and connecting to the posterior brain; if it forms a lump and does not dissipate, it will inevitably suppurate. Folk wisdom states: "In cases of Da Tou Tian Xing (Big Head Epidemic), relatives do not visit each other; those infected often cannot be saved." During the Taihe era, many suffered from this disease. Physicians used Chengqi Tang (Chengqi Decoction) plus Lan Gen (Isatidis Radix) to purge, resulting in slight relief, but the condition returned the next day. Repeated purging provided temporary relief, yet the disease was never cured, gradually becoming critical. Li Dongyuan examined the patient and said: "The upper half of the body is governed by Heaven Qi; the lower half by Earth Qi. Here, evil heat lodges between the Heart and Lung, attacking upward to cause severe swelling of the head and face. Using Chengqi Tang to purge excess heat from the Stomach would be punishing the innocent (treating the wrong organ). Therefore, I prescribe Puji Xiaodu Yin Zi, which has saved many lives."
After Han (sweating) or Xia (purging) treatments for Shanghan (Cold Damage) are incomplete, residual pathogens may knot one cun two fen three li behind the ear, or cause hardness and swelling under both ears; this is named Wei Du (Residual Toxicity). It must be dissipated quickly; delay will lead to suppuration. Lianqiao Baidu San (Forsythia Powder to Overcome Toxins) is indicated. If the neck is swollen and painful, add Weilingxian (Akebiae Caulis); if the stool is hard, add Dahuang (Rhei Radix et Rhizoma) and Chuanshanjia (Manis Squama). If swelling with pus fails to resolve, or if it is broken or unbroken, use Neituo Xiaodu San (Internal Support Detoxification Powder) added with Zaosen (Gleditsiae Spina), Shengma (Cimicifugae Rhizoma), Yinhua (Lonicerae Japonicae Flos), and Gancao (Glycyrrhizae Radix et Rhizoma). Although ancient medical texts discuss these methods, the reality is often due to prolonged heat damaging Yin. Specifically, extreme deficiency of Yin in the Shaoyang and Shaoyin channels leads to deficient fire rushing upward, causing swelling and pain in the cheeks and behind the ears. The Classics state: "When Ying Qi (Nutritive Qi) does not flow smoothly and reverses within the flesh, abscesses and swellings arise." Moreover, the area one cun square behind the ear belongs to the Kidney; what toxicity could there be? Treatment should focus on nourishing Yin, resolving phlegm, dispersing stagnation, and harmonizing the Liver, after which the swelling will heal spontaneously. Herbs such as Shudi (Rehmanniae Radix Praeparata), Maidong (Ophiopogonis Tuber), Tubei Mu (Fritillariae Thunbergii Bulbus), Baishao (Paeoniae Radix Alba), Lianqiao (Forsythiae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma), and Jiegeng (Platycodonis Radix) can be used, slightly assisted by small amounts of Qingpi (Citri Reticulatae Pericarpium Viride) and Chaihu (Bupleuri Radix). If the Chi pulse (radial pulse position corresponding to the Kidney/Lower Jiao) is very weak, the method of "treating the lower to cure the upper" should be employed, using herbs that guide fire back to its source, causing the swelling to dissipate without direct treatment. If mistakenly treated as a toxic accumulation and attacked with purgatives, the swelling will become more hardened and severe, likely leading to other diseases and endangering life. Careful deliberation is required.