大头瘟者，系天行邪热疫毒之气而感之于人也。一名时毒，一名疫毒。其候发于鼻面、
耳项、咽喉，赤肿无头，或结核有根，初起状如伤寒，令人憎寒发热头疼，肢体甚痛，恍惚
不宁，咽喉闭塞，五、七日乃能杀人。若至十日之外，则不治自愈矣。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，犀角升麻汤发之。沉涩者，
邪气深也，察其毒之盛者，急服化毒丹以攻之；实热便秘者，大黄汤下之；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，此治时疫之良法也。凡经三、四日不解者，不可太下
，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，可与托里散、托里黄 汤；如肿甚者，宜砭患处出恶血，以泄其毒。凡病
若五日以前，精神昏乱，咽喉闭塞，语言不出，头面赤肿，汤水难入者，必死之候，治之无
功矣。须知此疾有阴有阳，有可汗者，有可下者，粗工但云热毒只用寒药，殊不知病有微甚
，治有逆从，不可不审也。陶节庵曰∶大头伤风之证，若先发于鼻额红肿，以致两目盛肿不
开，并面部 赤而肿者，此属阳明也。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；如内实热甚者，用通圣消毒饮。若发于耳之上下前后，并头角红肿者
，此属少阳也。或肌热，日晡潮热，往来寒热，口苦咽干目疼，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，与普济消毒饮；外用清凉救苦散敷
之。大抵治法不宜太峻，峻则邪气不服而反攻内，必致伤人。且头面空虚之分，邪既着空处
，则无所不至，治当先缓后急，则邪自服。先缓者，宜退热消毒。虚人，兼扶元气；胃气弱
，食少者，兼助胃气。候其大便热结，方以大黄下之，拔其毒根，此先缓后急之法也。盖此
毒先肿鼻额，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，染多不救。泰和间多有病此者，医以承气加板兰根，下
之稍缓，翼日其病如故；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，遂制普济消毒饮子与之，全活甚众。
抱头火丹毒者，亦中于天行热毒而发，较大头瘟证为稍轻。初起身发寒热，口渴舌干，脉
洪数，头面 赤有晕。治以犀角地黄汤，或羚羊、地丁、银花、黄芩、山栀、石斛、元参、
丹皮、知母、连翘之属。若舌腻有白苔者，宜黄连解毒汤；外以如意金黄散，蜜水调涂即愈
。此证不传染。
大头瘟，是由于感受了天地间流行的邪热疫毒之气而使人患病。它又名叫时毒，也叫疫毒。其症状发作在鼻部、面部、耳部、颈部和咽喉部位，表现为红肿且没有明显的脓头，或者出现有根底的硬结肿块。初起时的症状类似伤寒，让人怕冷发热、头痛，肢体非常疼痛，神志恍惚不安，咽喉闭塞不通，如果拖延到五、七天，可能会导致死亡。但如果病程超过十天，往往不药而愈。治疗应当仔细辨证，先诊察脉象，凡是滑数、浮洪、沉紧、弦涩的脉象，都是该病的征候。如果是浮数脉，说明邪气在表，可用犀角升麻汤来发散邪气；如果是沉涩脉，说明邪气深入，观察毒势盛者，急服化毒丹以攻逐毒邪；若是实热便秘者，用大黄汤泻下；或者是年老体弱、气机郁滞者，主用五香连翘汤。另外，将通气散吹入鼻内，以打出十几个喷嚏为见效标准；如果用药后不打喷嚏的，属于难治之症；如果打喷嚏时排出脓血，治疗必能痊愈。凡是在旁边照顾病人的人，每天用药粉吹鼻取嚏，必定不会被传染，务必记住这一点。病患每天使用取嚏药三到五次，以泄出热毒，这是治疗时疫的好方法。凡是经过三、四天病情未解的，不可过度使用泻下药，仍宜采用和解法，可用犀角散、黄芩黄连消毒饮，重症者用连翘汤之类。到了第七、八天，大小便通畅，但头面依然肿胀高突发红者，可用托里散、托里黄芪汤；如果肿胀严重，适宜用砭石刺破患处放出恶血，以泄出毒邪。凡是发病在五日之前，精神昏乱，咽喉闭塞，不能言语，头面赤肿，连汤水都难以咽下的，是必死的征候，治疗无效了。必须知道此病有阴证阳证之分，有的可以用发汗法，有的可以用泻下法，庸医只知道热毒就用寒凉药，殊不知疾病有轻重之分，治疗有逆从之法，不可不审慎。陶节庵说：大头伤风的证候，如果先发于鼻部和额头红肿，导致两眼肿胀睁不开，并且面部发红肿胀的，这属于阳明经病变。如果有高热气喘，口干舌燥，咽喉肿痛不利，脉象来势数而大的，用普济消毒饮主治；如果体内实热严重的，用通圣消毒饮。如果发于耳朵上下前后以及头角红肿的，这属于少阳经病变。或者有肌肉发热，下午定时发热，忽冷忽热，口苦咽干眼痛，胁下胀满，宜用小柴胡汤加天花粉、羌活、荆芥、连翘、黄芩、黄连主治。如果发于头部，以及脑后项下和眼后红肿的，这属于太阳经病变，宜用荆防败毒散主治。如果三阳经同时受邪，并侵犯头面耳目鼻部的，给予普济消毒饮；外用清凉救苦散敷贴。大抵治疗方法不宜过于峻猛，峻猛则邪气不服而从内部反攻，必然致人受伤。况且头面部位属空虚之处，邪气既然附着在空虚处，就会无所不至，治疗应当先缓和后急切，这样邪气自然屈服。先缓和的方法，宜退热解毒。对于虚人，兼以扶助元气；胃气虚弱、饮食减少者，兼以助益胃气。等到患者大便热结，才用大黄泻下，拔除毒根，这就是先缓后急的方法。大概这种毒邪先使鼻额肿胀，其次使眼睛肿胀，再次使耳朵肿胀，从耳朵蔓延至头部，上行联络后脑，结成块状则停止；如果不消散，必定化脓。俗话常说：大头天行病，亲戚之间不相往来探视，因为感染多且无法救治。泰和年间多有患此病的人，医生用承气汤加板蓝根，泻下后病情稍缓，第二天病如故；再次泻下后稍缓，最终未能痊愈，逐渐变得危重。李东垣诊治时说：身体半以上是天的清气，身体半以下是地的浊气，此邪热客居在心肺之间，上攻头面导致肿胀盛大，如果用承气汤泻胃中的实热，这是诛伐无罪（误伤正气），于是创制了普济消毒饮子给他服用，保全了很多人的生命。
抱头火丹毒，也是感受了天行的热毒而发作，比大头瘟的证候稍微轻一些。初起时身体发冷发热，口渴舌干，脉象洪数，头面发红且有红晕。治疗用犀角地黄汤，或者用羚羊角、地丁草、金银花、黄芩、山栀、石斛、玄参、丹皮、知母、连翘等药物。如果舌苔腻且有白苔的，宜用黄连解毒汤；外用以如意金黄散，用蜂蜜水调匀涂抹即可痊愈。此证不具有传染性。
Dadouwen (Big Head Plague) is a disease contracted by humans due to the influence of epidemic heat-toxin qi circulating in nature. It is also known as Shidu (Seasonal Toxin) or Yidu (Epidemic Toxin). Its symptoms manifest on the nose, face, ears, neck, and throat, presenting as redness and swelling without distinct abscess heads, or as hard nodules with deep roots. In the early stage, it resembles Taiyang disease (disease of the Bladder and Small Intestine channels), causing aversion to cold, fever, headache, severe limb pain, mental restlessness, and throat obstruction. If left untreated for five to seven days, it can be fatal. However, if the condition persists beyond ten days, it often resolves spontaneously. Treatment requires careful differentiation. First, examine the pulse: slippery-rapid, floating-vast, deep-tight, or wiry-choppy pulses are all indicative signs. A floating-rapid pulse indicates pathogenic factors at the exterior; Xijiao Shengma Tang (Rhino Horn and Cimicifuga Decoction) should be used to release them. A deep-choppy pulse indicates deep-seated pathogens; if the toxin is vigorous, Huadu Dan (Toxin-Transforming Pill) should be taken urgently to attack the toxin. For cases with excess heat and constipation, Dahuang Tang (Rhubarb Decoction) is used for purgation. For elderly patients with deficient qi and stagnation, Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction) is the primary formula. Additionally, Tongqi San (Air-Vent Powder) can be insufflated into the nostrils; producing more than ten sneezes indicates efficacy. If no sneezing occurs after medication, the case is difficult to treat; if pus and blood are expelled through sneezing, recovery is certain. Caregivers should use the sneeze-inducing powder daily to prevent transmission; this must be remembered. Patients should use the sneeze-inducing medicine three to five times daily to vent heat-toxin; this is an excellent method for treating epidemic diseases. If the condition does not resolve after three to four days, excessive purgation should be avoided; instead, harmonizing methods should be employed, using Xijiao San (Rhino Horn Powder), Qinlian Xiaodu Yin (Scutellaria and Coptis Toxin-Clearing Drink), or Lianqiao Tang (Forsythia Decoction) for severe cases. By the seventh or eighth day, if bowel movements are clear but head and facial swelling remains high and red, Tuoli San (Support Interior Powder) or Tuoli Huangqi Tang (Support Interior Astragalus Decoction) may be given. If swelling is severe, phlebotomy with a bi stone (stone lancet) on the affected area to release evil blood is appropriate to vent the toxin. If, within five days of onset, the patient exhibits mental confusion, throat obstruction, inability to speak, red and swollen head and face, and difficulty swallowing liquids, it is a sign of inevitable death, and treatment will be futile. One must understand that this disease has Yin and Yang patterns; some are suitable for diaphoresis, others for purgation. Incompetent physicians merely claim that heat-toxin requires cold medicines, failing to realize that diseases vary in severity and treatments have contrary and compliant approaches. Tao Jie'an stated: In cases of Big Head Wind-cold, if redness and swelling start on the nose and forehead, causing both eyes to swell shut, along with facial redness and swelling, it belongs to the Yangming channel. With high fever, panting, dry mouth and tongue, painful and obstructed throat, and a rapid-large pulse, Puji Xiaodu Yin (Universal Benefit Toxin-Clearing Drink) is indicated; for severe internal excess heat, Tongsheng Xiaodu Yin (Unimpeded Success Toxin-Clearing Drink) is used. If swelling occurs around the ears (upper, lower, front, back) and temporal regions, it belongs to the Shaoyang channel. With muscle heat, afternoon tidal fever, alternating chills and fever, bitter taste, dry throat, eye pain, and hypochondriac fullness, Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Tianhua Fen (Trichosanthes Root), Qianghuo (Notopterygium Rhizome), Jingjie (Schizonepeta Spike), Lianqiao (Forsythia Fruit), Huangqin (Scutellaria Root), and Huanglian (Coptis Rhizome) is appropriate. If swelling affects the top of the head, back of the neck, and behind the eyes, it belongs to the Taiyang channel; Jingfang Baidu San (Schizonepeta and Saposhnikovia Detoxifying Powder) is indicated. If all three Yang channels are affected, involving the head, face, ears, eyes, and nose, Puji Xiaodu Yin is administered, with Qingliang Jiuku San (Cooling and Suffering-Relieving Powder) applied externally. Generally, treatment should not be too harsh; harshness causes pathogenic factors to resist and counterattack internally, harming the patient. Since the head and face are hollow areas where pathogens easily settle, treatment should begin gently and become urgent later, ensuring the pathogen submits. The gentle approach involves clearing heat and detoxifying. For deficient individuals, support the Yuanqi (Primal Qi); for those with weak stomach qi and poor appetite, assist the stomach qi. Only when fecal heat accumulation occurs should Dahuang (Rhubarb) be used for purgation to extract the root of the toxin; this is the method of "gentle first, urgent later." This toxin typically swells the nose and forehead first, then the eyes, then the ears, spreading from the ears to the head and connecting to the occiput, stopping when nodules form; if unresolved, suppuration will occur. Folk wisdom says: During Big Head Epidemics, relatives do not visit each other because infection rates are high and mortality is great. During the Taihe era, many suffered from this. Physicians used Chengqi Tang (Chengqi Decoction) with Banlangen (Isatis Root) for purgation, which provided slight relief, but the next day the illness remained; repeated purgation offered little relief, and the condition worsened until critical. Li Dongguan examined the patient and said: The upper half of the body corresponds to Heaven's Qi, and the lower half to Earth's Qi. This heat-toxin lodges between the Heart and Lung, attacking the head and face causing massive swelling. Using Chengqi Tang to purge Stomach excess heat would be punishing the innocent (damaging healthy Qi). Thus, he formulated Puji Xiaodu Yin Zi (Universal Benefit Toxin-Clearing Decoction), saving many lives.
Baotou Huodan Du (Head-Binding Fire-Dan Toxicity) is also caused by contracting epidemic heat-toxin, but its presentation is slightly milder than Dadouwen. Early symptoms include chills and fever, thirst, dry tongue, a rapid-large pulse, and redness with halos on the head and face. Treatment uses Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction), or herbs such as Lingyangjiao (Antelope Horn), Didengcao (Vincetoxicum Herb), Yinhua (Honeysuckle Flower), Huangqin (Scutellaria Root), Zhizi (Gardenia Fruit), Shihu (Dendrobium Stem), Xuanshen (Scrophularia Root), Danpi (Moutan Bark), Zhimu (Anemarrhena Rhizome), and Lianqiao (Forsythia Fruit). If the tongue coating is greasy with white fur, Huanglian Jiedu Tang (Coptis Detoxification Decoction) is indicated; externally, Ruyi Jinhuang San (Ruyi Golden Yellow Powder) mixed with honey water should be applied for cure. This condition is not contagious.