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[Tu Shicun's "Discussion on the Treatment of White Throat and Dan Sha"]

The syndrome of Dan Sha (Scarlet Fever-like rash) has not been detailed in medical formularies. I have devoted myself to investigating its origin, which is nothing more than the pathogenic factors of wind-cold, warm-heat, and epidemic pestilential qi. Therefore, methods for releasing the exterior and clearing heat each have their appropriate indications. If treated properly, recovery occurs swiftly; if treated improperly, disaster strikes instantly. There are essentially only two approaches: dispersing and clearing.

At the onset, the patient experiences severe aversion to cold with mild fever, or high fever accompanied by chills. Although there may be sore throat, restlessness, and thirst, the priority at this stage must be to release the exterior and promote eruption. Even if clearing and dispersing are combined, emphasis should always be placed on "dispersing," as stated in the principle of "treating fire stagnation by venting it." If cold-natured drugs are used indiscriminately, the exterior becomes further closed, and internal fire flares up, exacerbating the sore throat and worsening ulceration daily. Those who do not understand this logic might argue, "Even with such cooling medicines, the fire remains vigorous," failing to recognize the error of not dispersing first, and mistakenly believing that coldness has not yet dissipated. Consequently, excessive use of cooling agents leads to suppression, causing pathogens to sink inward, resulting in death in some cases.

Some argue that this syndrome requires exclusive use of dispersing methods. I consider this view biased. As mentioned earlier, when cold and heat coexist, dispersing is the primary task. Once sweating is profuse and the Dan Sha erupts, and symptoms like aversion to cold disappear, the external wind-cold obstruction is resolved, but the internal latent pathogenic fire is now flourishing. At this point, it is appropriate to administer cold-natured drugs to drain heat. Once the heat is exhausted, the disease resolves naturally. However, if one persists with acrid-warm dispersing formulas, the fire will intensify due to the wind, swelling will increase, and ulceration will spread, leading to extreme pain upon swallowing, described as cutting with a knife. Occasionally, those suggesting cooling remedies are criticized for causing stagnation. In reality, raging fire kills most violently; this represents the harm of bias towards dispersing while slandering the necessity of clearing.

One side advocates the appropriateness of dispersing, while the other highlights its dangers; one warns of the hazards of cold, while the other affirms its benefits. The key lies in adapting flexibly according to the sequence and timing, thereby hitting the mark in each case. Furthermore, after recovery from this syndrome, patients often experience soreness and pain in the four limbs, making movement difficult. This is due to fire scorching yin and damaging collaterals, which lose nourishment. It is appropriate to administer yin-nourishing herbs, distinguishing it from Bi-syndrome (obstruction syndrome). This is merely my limited insight, respectfully submitted for correction by experts.

[Zu Hongfan's "Discussion on the Indications for Treating Rotten Throat and Dan Sha"]

The syndrome of Bai Hou (White Throat/Diphtheria) is not discussed in dedicated sections in ancient formularies. Occasional mentions in chapters on macules and rashes fail to fully explore its depths. Currently, it frequently appears in warm-heat syndromes. Characterized by shapes curving like millet grains, white in color and pointed in form, it is called Bai Hou. Some appear at the onset, some resolve immediately upon appearance, some lead to critical conditions, and some persist even after prolonged illness, macules/rashes have appeared, and tonification/purging therapies have been applied, finally resolving upon its emergence. Generally attributed to seasonal qi, the etiology varies, and thus treatment methods differ. It must be carefully distinguished from macules and rashes.

Typically, in Cold Damage transmission, if sweat is not thorough during heat diseases, pathogenic heat transfers to the Yangming channel, which is rich in qi and blood. Heat may enter the fu organs, steaming and scorching, injuring the Ying level and causing blood heat stagnation, leading to interior excess and exterior deficiency. Pathogenic heat exploits this deficiency to emerge through the skin pores. Thus, sparse lesions resembling patterns or dense ones like cotton fibers are Ban (macules); purple-black indicates stomach rot, an untreatable condition. Seasonal wind-heat invading a body with lung deficiency and blood heat, if not cleared and vented properly, damages the Blood level of the Hand-Taiyin Lung channel. Exploiting deficiency, it emerges on the skin like sand or millet, red and fragmented, known as Ma (measles). Alternatively, if the annual elemental cycle is Fire, compounded by epidemic pestilential toxins, it causes sore throat, leading to Dan Sha or Rotten Throat Sha, the most severe forms.

Regarding Bai Hou, it is mostly associated with dampness in warm-heat and summerheat diseases. Internal latent pathogens emerge from within but require external triggers. The body's inherent dampness interacts with external pathogens, evaporating upwards, causing intense heat in the upper jiao. Initial treatment must employ clearing, venting, and leaching methods; otherwise, the lungs are damaged by heat, qi weakens internally, and cannot expel pathogens outward. Heat sinks into the Ying level. Switching to clearing Ying-level and nourishing fluids slows the progression and allows lung qi to recover. Residual dampness then exits via the Qi level of the upper jiao, manifesting as Bai Hou. Since the Lung governs qi, it often appears on the neck, shoulders, back, and chest. White corresponds to the Lung element; luster indicates residual dampness. Only then are pathogens fully expelled. Sometimes, after multiple rounds of tonification and purging without resolution, sudden eruption of Bai Hou leads to cure, as internal qi and fluids recover, allowing pathogens to exit externally, resulting in spontaneous healing. (Note: I have encountered cases of emaciated constitution with depleted qi and fluids, requiring nourishment but unable to tolerate heavy tonics. Using dew distilled from Sheng Di Huang (Rehmanniae Radix) and Mai Dong (Ophiopogonis Radix) in clay steamers proved effective. This is using qi-fluid substances to replenish qi-fluid deficiencies.)

If the root is empty with no qi to drive eruption, it may prolong into collapse. Thus, signs of intact yuan qi, moist luster, and spirit indicate good prognosis; dry, pale, lusterless, hollow, and sparse lesions indicate qi exhaustion and poor prognosis. Prognosis depends on the dryness/moisture of color and shape reflecting qi/fluid status. This syndrome is prevalent in late spring/early summer during damp-heat seasons, occasionally in autumn/winter. It involves the Hand meridians and exits via them, unlike Foot meridian pathogens which can be resolved downward. The Lung governs qi; abundant qi expels pathogens outward/upward for cure; deficient qi leads to simultaneous depletion of pathogen and healthy qi. Erupted lesions become dry, white, and spiritless, difficult to treat. Observing the *Neijing* grouping summerheat with dampness, and Zhang Zhongjing combining spasm, dampness, and sunstroke discussions, confirms that warm-heat pathogens often夹杂 (mix with) dampness. A faint light awaits correction by sages.

Note: There is another syndrome, "Epidemic White Throat," occurring seasonally, spreading rapidly, and being extremely critical. It presents mostly with heat signs, few cold signs. Some mistake whiteness for cold, unaware that the syndrome originates in the Lung (Metal, color white), the canopy of viscera located high. Toxins vaporize upward from below, damaging the Lung; as disease deepens, the true color manifests. Treatment should disperse wind-toxin and guide heat downward, preventing accumulation in the Lung. Mistaking whiteness for cold and administering Xi Xin (Asari Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), or Gui Zhi (Cinnamomi Ramulus) is like adding fuel to fire. Even if doctors recognize toxic fire and avoid ascending/dispersing herbs, using Liang Ge San (Cool the Chest Powder) or Xiao Bei Wan (Minor Purge Pill) with Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) is flawed. This syndrome has transmitted to the Upper Jiao Qi level, unrelated to Middle/Lower Jiao. Damaging the Upper Jiao Qi further with harsh purgatives injures Middle/Lower Jiao, depleting yuan qi and damaging both qi and yin, worsening the condition. This is a malignant transformation of plague, killing fastest. Unskilled physicians, lacking clear differentiation, prescribe bland formulas to avoid blame ("tolerating evil"), delaying matters. By day 5-6, toxins are heavy, yuan qi injured. Skilled practitioners must use potent drugs to save, but the patient is critical. Success brings no credit; failure brings blame. Families criticize potent drugs rather than acknowledging prior negligence. This is error originating early, not late.

However, there is also "Consumption-type White Throat" caused by yin deficiency and fire dryness, extreme pain, difficulty swallowing water/grains, progressing to ulceration, emaciation, and haggard appearance. Tonics are required to restore yuan qi, relieving throat pain. Mr. You Zhuwu stated: Acute throat obstruction with hoarseness indicates phlegm rattling in the throat like sawing wood; severe hoarseness signals Lung exhaustion. Urgently administer Ren Shen Gao (Ginseng Paste), mixed with Zhu Li (Bambusae Succus) and Jiang Zhi (Zingiberis Recens Juice), taken frequently. Without paste, Du Shen Tang (Single Ginseng Decoction) suffices. Early treatment yields 70-80% success; medium, 30-40%; late, less than 10%. Misdiagnosing yin-deficiency White Throat as epidemic throat disease leads to grave errors.

Another type of White Throat lacks exterior signs of aversion to cold/fever; pulse is variable, fine and minute; white powdery membrane in throat falls and regrows. This is truly yin-deficiency cold syndrome, cured only by Si Ni Tang (Frigid Extremities Decoction) or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) decoction taken cold. Mistakenly using wind-dispersing/toxin-resolving herbs causes little harm. Conversely, mistaking this cold syndrome for epidemic heat leads to溃败 (collapse), causing significant harm. Recently, "Yangmei Jiedu" (Syphilitic Chancre) throat ulcers cause tonsillar rot, voice changes, and dysphagia due to premature topical applications or fumigation suppressing sores, driving toxins into bone marrow. These require treating as syphilis. None of these above are White Throat caused by Sha. If throat pain arises from Sha, only disperse toxicity and vent Sha outward; throat pain will resolve. Bing Pian (Borneolum Syntheticum) and Zhu Huang (Margarita) are strictly forbidden; even Yu Yao Chi (Jade Key) is prohibited.