大头瘟者，以天行邪毒客于三阳之经，所以憎寒发热，头目颈项或咽喉俱肿，甚至腮面
红赤，肩背斑肿，状如虾蟆，故又名为虾蟆瘟。大都此证多属风热，然亦有表里虚实之辨。
又外科有时毒证，亦即此也。方治具见本门，当参阅用之。
一、大头虾蟆瘟治法∶凡病在头目，内火未盛者，先当解散，宜正柴胡饮，或败毒散。
若时毒咽喉肿痛，内火不甚，而便利调和者，葛根牛蒡汤。时毒表里俱热，头目俱肿，宜清
宜散者，柴葛煎。若毒在阳明，表里俱热，多头痛鼻干，宜散者，柴葛解肌汤。若时毒三阳
，热极狂躁，咽喉肿痛，宜清兼散者，栀子仁汤。若时毒遍行，邪热上浮，头面俱肿，咽喉
不利者，普济消毒饮。若时毒风热上聚头面，宜升散者，犀角升麻汤。若时气盛行，宜清火
解毒者，羌活升麻汤。若时毒血热烦躁，兼赤斑者，犀角散、人参白虎汤。若时毒内外俱实
，当双解者，防风通圣散。若时毒 肿作痛，脉实便秘，宜下者，五利大黄汤，或漏芦
升麻汤，或连翘消毒散。若时毒虽盛，而外实内虚，脉弱神困，凡诸虚证有据者，必当救里
内托，宜参 托里散，或托里消毒散。其有阳虚假热，而兼呕恶泄泻者，如六味回阳饮之类
，皆所必用，不可疑也。若头项肿甚，疼痛难忍者，宜用清凉救苦散敷之。或取侧柏叶自然
汁，调蚯蚓泥敷之。
徐东皋曰∶大头虾蟆之候，因风热湿邪在于高颠之上，宜先用败毒散加羌活、黄芩、酒
浸大黄，随病加减，不可峻用降药，虽有硝黄之剂，亦必细细呷之。盖凡治大头瘟者，不宜
速攻，若攻之太峻，则邪气之在上者自如，而无过之中气反受其害而伤人也。且头乃空虚之
地，既着空虚，则无所不致，所以治法当先缓而后急，则邪伏也。缓治以清热消毒，虚者兼
益元气，胃虚食少者，兼助胃气；内实热甚，大便秘结者，以酒浸大黄下之，乃宣热而泄其
毒也，此为先缓后急之法。若先从鼻肿，次肿于目，又次肿于耳，渐至头上，络脑后结块则
止，不散，必出脓而后愈。又曰∶大头瘟太阳病，发于头上，并脑后下项，及目后赤肿者是
也，治宜荆防败毒散，羌活、 本行经。阳明病，发于鼻 ，并目不能开，及面部者是
也。或内热气喘，口干舌燥，咽喉肿痛不利，脉数大者，普济消毒饮。若内实而热者，防风通
圣散间服之。少阳病，发于耳之上下前后，并头角红肿者是也。若发热，或日晡潮热，或寒
热往来，口苦咽干，目痛，胸胁满闷者，小柴胡加消毒之药。
大头瘟，是由于天行邪毒侵袭三阳经脉所致，因此出现憎寒发热，头、目、颈项甚至咽喉全部肿胀，甚至腮面部红赤，肩背部出现斑肿，形状像虾蟆，所以又被称为虾蟆瘟。大多这类病证属于风热，然而也有表里虚实之辨。另外外科有时毒证，也就是此病。方剂治法详见本门，应当参考使用。
一、大头虾蟆瘟治法：凡是病位在头目，体内火气尚未旺盛的，应当先予解散，适宜用正柴胡饮，或者败毒散。如果是时毒导致咽喉肿痛，体内火气不盛，且二便调和的，用葛根牛蒡汤。如果时毒表里俱热，头目都肿胀，需要清解兼疏散的，用柴葛煎。如果毒邪在阳明经，表里俱热，多伴有头痛鼻干，需要疏散的，用柴葛解肌汤。如果时毒涉及三阳经，热极导致狂躁，咽喉肿痛，需要清解兼疏散的，用栀子仁汤。如果时毒遍行全身，邪热上浮，头面都肿胀，咽喉不利的，用普济消毒饮。如果时毒风热上聚头面，需要升散作用的，用犀角升麻汤。如果时气盛行，需要清火解毒的，用羌活升麻汤。如果时毒血热烦躁，兼有赤斑的，用犀角散、人参白虎汤。如果时毒内外俱实，应当表里双解的，用防风通圣散。如果时毒肿胀作痛，脉象实而便秘，需要攻下的，用五利大黄汤，或者漏芦升麻汤，或者连翘消毒散。如果时毒虽然盛大，但外实内虚，脉弱神疲，凡是有诸虚证依据的，必须救里并内托，适宜用参 托里散，或者托里消毒散。其中有阳虚假热，兼有呕吐恶心想吐泄泻的，如六味回阳饮之类，都是必须使用的，不可怀疑。如果头项肿胀严重，疼痛难以忍受的，适宜用清凉救苦散外敷。或者取侧柏叶自然汁，调蚯蚓泥外敷。
徐东皋说：大头虾蟆的病候，是因为风热湿邪位于人体最高处（头顶），应当先用败毒散加羌活、黄芩、酒浸大黄，根据病情加减，不可峻猛使用降下药，即使有含有硝石、大黄的方剂，也必须细细呷服。大概治疗大头瘟，不宜快速攻下，如果攻伐太峻猛，那么在上部的邪气虽然自如排出，但中气反而受到损害而伤人。而且头部是空虚之地，既然处于空虚之处，则邪气无所不至，所以治法应当先缓后急，使邪气伏留。缓治以清热消毒，虚者兼益元气，胃虚食少者，兼助胃气；内实热甚，大便秘结者，用酒浸大黄攻下，这是宣散热邪而泄出毒气的方法，这就是先缓后急的法度。如果先从鼻子肿胀，接着眼睛肿胀，再耳朵肿胀，逐渐到头上，络脑后结块才停止，不散开，必须出脓然后痊愈。又说：大头瘟太阳病，发于头上，以及脑后下项，和眼后赤肿的是；治宜荆防败毒散，羌活、藁本引经。阳明病，发于鼻部，以及眼睛不能睁开，和面部的是；或者内热气喘，口干舌燥，咽喉肿痛不利，脉数大的，用普济消毒饮。如果内实而热的，间服防风通圣散。少阳病，发于耳之上下前后，以及头角红肿的是；如果发热，或者日晡潮热，或者寒热往来，口苦咽干，目痛，胸胁满闷的，用小柴胡汤加消毒药物。
Da Tou Wen (Big Head Plague) is caused by epidemic pathogenic toxins invading the channels of the Three Yang meridians, resulting in aversion to cold and fever, swelling of the head, eyes, neck, and even the throat, with redness of the cheek and face, and macular swelling on the shoulders and back, resembling a toad; hence it is also called Xia Ma Wen (Toad Plague). Generally, this condition belongs to Wind-Heat, yet there are distinctions between exterior/interior and deficiency/excess. Additionally, in surgery, there is a condition called Shi Du (Seasonal Toxicity), which is essentially the same disease. The prescriptions and treatments are detailed in the relevant section and should be consulted for use.
1. Treatment Method for Da Tou Xia Ma Wen: For cases where the pathology is located in the head and eyes, and internal fire has not yet become excessive, dispersing treatment should be applied first. Zheng Chai Hu Yin (Correct Bupleurum Decoction) or Bai Du San (Detoxicate Powder) are suitable. If seasonal toxicity causes sore throat and swelling, with mild internal fire and harmonized bowel movements, Ge Gen Niu Bang Tang (Kudzu and Burdock Decoction) is indicated. If seasonal toxicity presents with heat in both the interior and exterior, and swelling of the head and eyes, requiring clearing and dispersing, Chai Ge Jian (Bupleurum and Kudzu Decoction) is used. If the toxin is in the Yangming channel, with heat in both interior and exterior, often accompanied by headache and dry nose, requiring dispersing, Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Resolve the Muscle Layer) is appropriate. If seasonal toxicity involves the Three Yang channels, with extreme heat causing mania and restlessness, and sore throat and swelling, requiring clearing combined with dispersing, Zhi Zi Ren Tang (Gardenia Seed Decoction) is used. If seasonal toxicity spreads throughout, with pathogenic heat floating upward, causing swelling of the head and face and difficulty in the throat, Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxins) is indicated. If wind-heat from seasonal toxicity gathers upward in the head and face, requiring ascending and dispersing, Xi Jiao Sheng Ma Tang (Rhinoceros Horn and Cimicifuga Decoction) is used. If epidemic qi prevails, requiring clearing fire and detoxifying, Qiang Huo Sheng Ma Tang (Notopterygium and Cimicifuga Decoction) is used. If seasonal toxicity involves blood heat with irritability and accompanying red macules, Xi Jiao San (Rhinoceros Horn Powder) or Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) are used. If seasonal toxicity presents with excess in both interior and exterior, requiring simultaneous resolution of both, Fang Feng Tong Sheng San (Saposhnikovia Powder to Unblock the Hui) is used. If seasonal toxicity causes painful swelling, with a surging pulse and constipation, requiring purgation, Wu Li Da Huang Tang (Five Benefits Rhubarb Decoction), or Lou Lu Sheng Ma Tang (Leuzea and Cimicifuga Decoction), or Lian Qiao Xiao Du San (Forsythia Powder to Eliminate Toxins) are used. If seasonal toxicity is severe but the exterior is excess while the interior is deficient, with a weak pulse and mental fatigue, and evidence of various deficiency syndromes, rescue of the interior and internal support are mandatory. Can Qi Tuo Li San (Ginseng and Internal Support Powder) or Tuo Li Xiao Du San (Internal Support and Toxin-Eliminating Powder) are suitable. In cases of false heat due to Yang deficiency, accompanied by vomiting, nausea, and diarrhea, Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Restore Yang) and similar formulas must be used without hesitation. If swelling of the head and neck is severe and pain is unbearable, Qing Liang Jiu Ku San (Cooling and Suffering-Saving Powder) should be applied externally. Alternatively, natural juice of Ce Bai Ye (Biota Tops) can be mixed with earthworm mud for external application.
Xu Donggao stated: The manifestation of Da Tou Xia Ma is due to wind-heat-damp pathogens residing at the highest point of the body (the vertex). One should initially use Bai Du San (Detoxicate Powder) added with Qiang Huo (Notopterygium Root), Huang Qin (Scutellaria Root), and wine-processed Da Huang (Rhubarb Root and Rhizome), adjusting according to the disease. Harsh descending medicines should not be used vigorously. Even if formulas containing Xiao Shi (Mirabilite) and Da Huang (Rhubarb Root and Rhizome) are employed, they must be sipped slowly. Generally, treating Da Tou Wen does not advocate rapid purgation. If purgation is too harsh, although the pathogenic factors above may be expelled freely, the Middle Qi will suffer damage and harm the person. Moreover, the head is a hollow area; since pathogens reside in this hollowness, they can reach anywhere. Therefore, the treatment method should be slow first and urgent later, allowing the latent pathogens to be addressed. Slow treatment involves clearing heat and eliminating toxins; for deficiency, supplementing Yuan Qi (Primal Qi) is added; for stomach deficiency with poor appetite, assisting Stomach Qi is added; for interior excess with severe heat and constipation, wine-processed Da Huang (Rhubarb Root and Rhizome) is used for purgation to vent heat and drain toxins. This is the method of "slow first, urgent later." If swelling starts from the nose, then spreads to the eyes, then to the ears, gradually reaching the head, and forms lumps behind the brain before stopping, if it does not disperse, pus must emerge before recovery. He also said: Da Tou Wen Taiyang Disease (Taiyang Disorder) manifests on the head, including the back of the head, lower neck, and redness/swelling behind the eyes; treatment should use Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Detoxicate Powder), with Qiang Huo (Notopterygium Root) and Ben Cao (Ligusticum Rhizome) guiding the meridian. Yangming Disease (Yangming Disorder) manifests in the nose, inability to open the eyes, and the face; if accompanied by internal heat, panting, dry mouth and tongue, sore throat and swelling with difficulty, and a rapid and large pulse, Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxins) is used. If there is interior excess and heat, Fang Feng Tong Sheng San (Saposhnikovia Powder to Unblock the Hui) can be taken intermittently. Shaoyang Disease (Shaoyang Disorder) manifests around the ears (upper, lower, front, back) and redness/swelling of the temporal region; if accompanied by fever, afternoon tidal fever, alternating chills and fever, bitter taste in the mouth, dry throat, eye pain, and fullness/stuffiness in the chest and hypochondrium, Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with detoxifying herbs is used.