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Parts and locations of acupoints to be needled corresponding to the Hand-Yangming and Foot-Yangming meridians.
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In ancient times, Shaoyin Ganjie Tang (Licorice and Platycodon Decoction) was used to treat sore throat. Additionally, Zhang Zhongjing's *Shanghan Lun* records: for Shaoyin disease presenting with diarrhea, sore throat, and restlessness, Zhufu Tang (Pig Skin Decoction) is indicated; for Shaoyin disease developing a sore throat within two to three days, Gancao Tang (Licorice Decoction) may be given; if symptoms do not improve, Jiegeng Tang (Platycodon Decoction) is administered; for Shaoyin disease where the throat is injured and sores form, preventing speech and voice production, Kujiu Tang (Bitter Wine Decoction) is used; for Shaoyin disease with sore throat, Banxia San Ji Tang (Pinellia Powder and Decoction) is the primary treatment. These formulas are all essential medicines for clearing and benefiting the throat. Nowadays, when physicians encounter throat disorders, they often fail to investigate the root cause and apply these formulas without hesitation. Alas! This is like carrying firewood to extinguish a fire; it not only fails to cure the disease but exacerbates it. Why is this? Because contemporary throat disorders are mostly caused by an imbalance of cold and heat, or by pathogenic factors such as wind-fire toxins attacking from above due to abnormal climatic conditions. The key treatment must be to dispel wind and purge fire. Licorice (Gancao) tonifies the middle jiao but does not purge fire; once the middle jiao receives this tonification, the fire becomes more intense, worsening the condition. Platycodon (Jiegeng) guides other herbs upward; since the herbs ascend, it also draws phlegm-heat and qi upward, causing obstruction in the throat and further aggravating the illness. Therefore, Platycodon is contraindicated in cases of pediatric fright-phlegm, adult wind-phlegm, and phlegm-heat. The *Bencao* states that Shengma (Cimicifugae Rhizoma) can substitute Xijiao (Rhinoceros Horn) to guide stomach qi upward, which seems applicable. However, once qi ascends, it inevitably carries phlegm-heat upwards, causing blockage in the throat, leading to cold limbs and extreme asthma, posing a severe threat. While it might be usable in other conditions, if used for Suohou Feng (Lock-Throat Wind), it will certainly be fatal; thus, it must be strictly avoided. Although Banxia (Pinelliae Rhizoma) is an excellent medicine for resolving phlegm, its misuse in severe throat phlegm cases can be life-threatening because Banxia resolves cold-phlegm in the spleen and stomach but cannot resolve heat-phlegm in the lungs. Ginger (Shengjiang) is pungent and dispersing, but throat disorders should not primarily rely on dispersion; using ginger adds fire to fire and is inadvisable. These few herbs have significant implications for throat disorders and must be clearly stated and cautiously warned against. As for other herbs with contraindications, one must pay attention at the time of treatment.

Zhang Xiuxiu stated: White membrane throat (Baihouteng) includes an epidemic syndrome. Its onset is unpredictable, transmission is rapid, and the condition is extremely critical and dangerous. Most practitioners find themselves helpless. After consulting various texts and gaining long-term clinical experience, I privately believe there are ten difficulties in treating it.

Generally, this syndrome is Chanhou Jibi (Throat-Wrapping Acute Bi). Delayed treatment leads to death. Symptoms include throat discomfort, thirst, dry tongue, neck swelling, red eyes, body pain, and red lips, all indicating pathogenic attack on the head and face. The pathogen lodges between the Heart and Lungs and does not involve other meridians. If other meridians are involved, it is due to weak constitution allowing pathogens to enter through deficiency, representing later transmission known as "Yuejing" (Crossing Meridians). If the disease has not yet transmitted to other meridians, failing to examine the root cause and treating with medications for other meridians constitutes the first difficulty. Generally, early stages present with aversion to cold, fever, headache, back distension, mental fatigue, and generalized joint pain. Throat pain ranges from severe to mild. Initially, there are no visible traces, resembling exterior syndromes of wind-cold or wind-heat. Administering diaphoretic herbs like Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Xinyi (Magnoliae Flos), or Zisu (Perillae Folium) causes the toxin to scatter irreversibly, constituting the second difficulty. The initial aversion to cold and fever result from internal toxin activity. By the second or third day, white membranes appear in the throat, after which chills and fever naturally cease. Misinterpreting this as the efficacy of diaphoretic herbs is erroneous; even without diaphoretics, fever stops once white membranes appear. Initial misuse of Mahuang and Guizhi is not only ineffective but harmful, constituting the third difficulty. This disease presents mostly with heat signs and rarely with cold signs. Some mistake the white color for cold, failing to realize the disease originates in the Lung, which belongs to Metal and corresponds to the color white. The Lung is the canopy of the five zang and six fu organs, located at the highest position. Toxin fumes rise from below, deepening lung pathology, hence the white appearance. Treatment should resolve five-zang toxins and guide them downward, preventing accumulation in the lungs. Suspecting cold due to whiteness and administering Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), or Paojiang (Zingiberis Rhizoma) is like adding fuel to the fire, intensifying the blaze, constituting the fourth difficulty. Even those who recognize fire-toxin avoid lifting and dispersing agents but may overuse Baizhi (Angelicae Dahuricae Radix), Xiaoshi (Natrii Sulfas), and Dahuang (Rhei Radix et Rhizoma) for purging. Since the disease has transmitted to the Upper Jiao Qi level and does not involve the Middle and Lower Jiao, excessive purging with Natrii Sulfas and Rhei Radix damages Yuan Qi in the Middle and Lower Jiao, constituting the fifth difficulty. Once symptoms are clear, the prescription should remain consistent. For severe fire-toxin, starting with Xiaofeng Baidu San (Wind-Dispersing and Toxin-Vanquishing Powder) to guide heat downward is correct. However, taking three taels daily with no reduction in white membranes, or continuing for over ten doses resulting in increased whiteness, is like pouring a cup of water on a cartload of burning wood—ineffective. Practitioners must carefully examine the source: yellow or black tongue coating, dry throat and lips, scanty dark yellow urine, and black diarrhea indicate condensed fire-toxin. Internal pathology must be resolved before the white membranes can clear. Persisting with the same formula yields results. Changing formulas arbitrarily causes complications, constituting the sixth difficulty. Precise observation requires urgent action. Epidemic transformations kill fastest; survival beyond seven days is unlikely. Incompetent doctors, failing to distinguish symptoms, prescribe bland remedies to avoid blame, nurturing evil. By days five or six, toxins are heavy and Yuan Qi damaged. Effective treatment requires potent agents. However, if the patient dies despite aggressive treatment, families blame the harsh drugs rather than the earlier delay, constituting the seventh difficulty. Non-white-membrane throat cases may transform into white-membrane throat. Early stages show red, swollen, painful tonsils (Dan'e: single tonsil; Shuang'e: double tonsils), with or without chills/fever. Delayed treatment causes airway closure. Using Duniuqi (Achyranthis Bidentatae Radix) to guide heat downward and Dahuang for constipation is appropriate. This differs from white-membrane throat in origin but shares treatment principles. Failure to prevent transformation causes severe harm, constituting the eighth difficulty. Labor-induced white-membrane throat involves yin deficiency and fire-dryness, causing extreme pain, inability to eat/drink, rotting, emaciation, and haggard appearance. Tonics are needed to replenish Yuan Qi, curing throat pain. Mistaking this for epidemic white-membrane throat leads to significant error, constituting the ninth difficulty. Another type lacks chills/fever; white peeling skin falls and regrows continuously. This is a cold syndrome cured by Rougui and Fuzi. Misusing Xiaofeng Baidu San causes little harm. Mistaking this cold-type for epidemic white-membrane throat causes shallow but serious damage, constituting the tenth difficulty. Understanding these ten difficulties allows for accurate diagnosis and treatment, with high success rates. Given the epidemic spread, I dare not keep this secret. It may not be a universal panacea but serves as a useful aid for practitioners.

Furthermore, treatment methods for white-membrane throat are vast and obscure. Despite extensive study, clinical application often reveals discrepancies between theory and practice. Disease manifestations vary greatly, requiring flexibility and grasp of essentials. I previously published a treatise on white-membrane throat, but new variations emerge frequently, including rapid fatalities and widespread contagion. Delayed treatment yields poor outcomes. Truly tragic. This is a malignant epidemic syndrome requiring careful examination of external signs, pulse, and throat interior/exterior, assessing the extent and thickness of white membranes before prescribing. Treating severe cases with mild agents causes disaster; treating mild cases with strong agents causes deep harm. Extremes are both detrimental. Early symptoms include severe chills, high fever, thirst, dry throat, hoarseness, inability to swallow fluids, phlegm obstruction, distension, excruciating pain, full-mouth whiteness, and surging, rapid pulse (possibly absent). This is caused by epidemic toxic qi, the most acute throat condition. Claims that throat diseases forbid cold-natured herbs are absurd. Frequent use of Jingfang Baidu San or Dachengqi Tang illustrates this error. Using Natrii Sulfas and Rhei Radix to purge stomach excess heat punishes the innocent, allowing pathogens to worsen the condition. Using Qianghuo and Fangfeng to treat Taiyang wandering wind scatters toxins, leading to incurable disease. I established Chuwen Huadu San (Plague-Dispelling and Toxin-Vanquishing Powder), Shengong Pixie San (Divine-Efficacy Evil-Expelling Powder), and Shenxian Huoming Tang (Immortal Life-Saving Decoction), achieving frequent success. However, for severe cases, these may lack potency. Thus, I created Longhu Erxian Tang (Dragon-Tiger Two Immortals Decoction), taken 2-3 doses daily for several days without changing formulas. Even if swallowing is impossible, gastric qi remains intact due to the principle "when diseased, the disease absorbs the medication." Stop medication once white membranes recede, then gradually restore Yuan Qi. For extreme cases with solid fire and deep organ heat blocking the throat, Xionghang Jiedu Wan (Realgar-Antidote Pill) is effective but potent and must be used cautiously. Detailed discussion requires practitioners to adapt flexibly based on experience. Neglecting timely treatment leads to cyanosis, dyspnea, phlegm obstruction, agitation, coma, and death, rendering even legendary healers powerless. Early white-membrane wind uses Gegen (Puerariae Lobatae Radix), Jiangcan (Bombyx Batryticatus), and Chenyi (Cicadae Periostracum) to disperse wind-heat; Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Yinhua (Lonicerae Japonicae Flos), and Tufuling (Smilacis Glabrae Rhizoma) reduce swelling and vanquish toxins; Yuanshen (Scrophulariae Radix), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), and Shengdi (Rehmanniae Radix) clear Lung and Kidney yin; Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shengzhiren (Gardeniae Semen), Shandougen (Millettiae Speciosae Radix), and Shengshigao (Gypsum Fibrosum) purge fire and save flames; Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), and Cheqianzi (Plantaginis Semen) guide heat downward; Bohe (Menthae Haplocalycis Herba) and Shegan (Belamcandae Rhizoma) disperse wind and reduce swelling. Severe cases add Mabo (Bletillae Rhizoma) and Longdancao (Gentianae Radix). Externally, Duniuqi decoction is applied before or after oral medication. Wannianqing Genzhi (Tradescantia Zebrina Root Juice) is ingested or held in the mouth. Critical cases require needle-induced vomiting. Mild cases use Chuwen Huadu San; moderate cases use Shengong Pixie San or Shenxian Huoming Tang. Dosages range from 1-2 to 3-4 daily. The goal is to draw epidemic toxins from Upper Jiao to Middle Jiao, then to Lower Jiao, excreting via intestines and bladder. Diarrhea indicates downward movement of fire-toxin, a favorable sign. If constipation persists, add cooked Dahuang; if still blocked, use raw Dahuang. Remove once bowels open, continuing until white spots disappear. Adjustments depend on clinical presentation; consistency ensures recovery. During the Dingmao year of Tongzhi, many severe cases failed despite proper initial treatment (Xiaofeng Baidu San). Upon detailed examination, I determined solid fire and condensed heat-toxin required stronger intervention. Longhu Erxian Tang yielded cures. Persistent cases responded to Xionghang Jiedu Wan followed by continued Longhu Erxian Tang. After white spots cleared, Qingliang agents like Qingxin Tiaofei Tang cleared residual toxins, followed by yin-nourishing formulas. Spleen-stomach deficiency patients received Sijunzi Tang plus Yinhua. Flexibility is key. For locked jaw, Kaiguan San opens the mouth. For severe pain, fatigue, and hoarseness post-medication, acupuncture is urgent. For severe neck/throat swelling, Jiuyi Yigong San is applied. Except for labor-induced white-membrane throat, this method applies to Dan'e, Shuang'e, Houyong (Throat Abscess), and general redness/swelling, with dosage adjustments. Avoid wind exposure post-medication. If misdiagnosed and treated with lifting, dispersing, tonifying, or warm-pungent herbs, administer raw Lvdou (Phaseoli Semen) powder mixed with cold water (one teacup for severe, one winecup for mild) to neutralize errors. Follow with prescribed drinks and barley porridge. For excessive phlegm, induce vomiting with Shengtongyou (Verniciae Oleum) and chicken feathers.

Examination of White-Membrane Throat: Early stage features headache, chills/fever, back distension, joint pain, varying throat pain levels, or hardness without pain. Whiteness appears immediately or after 2-3 days, progressing from spots/strips/blocks to full coverage. Treatment is uniform. Post-medication, whiteness tightens, thins, shrinks, or turns yellow before disappearing. Early detection and precise treatment are crucial. Careless practitioners may misdiagnose non-white-membrane cases as white-membrane and attack with harsh drugs, or miss true white-membrane cases and use mild drugs. Vulnerable groups (pregnant/postpartum women, children, elderly, post-illness deficiency) tolerate aggression poorly; improper treatment risks severity. Examination requires good lighting, patient seated upright, tongue pressed down to inspect sides for white-membrane, Dan'e/Shuang'e, or wind-fire throat. At night, use oil-paper torches. Do not visit patients on an empty stomach; consume realgar wine or garlic for protection.

Differentiating Fire vs. Cold Syndromes: Fire-type white-membrane throat shows floating, convex white patches, red/swollen throat, preference for cold foods, aversion to cold, yellow/black coating, and bowel/bladder obstruction with unceasing pain. Cold/deficiency types show no redness/swelling, preference for hot foods, red streaks on palate, sunken white patches, normal bowel/bladder function, and intermittent mild throat pain. Do not treat cold/deficiency types as standard white-membrane throat.