一白点在外关者。（小舌旁边。）多属热。在内关者。（小舌内。）多属寒。
一热证必肿。寒证不肿。喉内反大而空。（亦有虚肿者。其形必润。）
一热证必痛。痛无止息。（略痛者轻。痛甚者重。）寒证不甚痛。或时痛时止。
一热证喝水不甚痛。吃饭则痛。寒证喝水痛。吃饭不甚痛。
一热证必渴。喜喝水。（喜温者轻。喜冷者重。少喝者轻。多喝者重。）寒证不渴。虽渴不多喝水。（
喜温者轻。喜极热者重。）
一热证不思食。亦不能食。（一由肿痛。一由不知味。）寒证能食。而不甚思食。（一由脾虚。一由脾绝。
一由过服寒剂。）
一热证有风涎。（涎少者轻。涎多者重。宜解表。从凉散。）寒证则断无风涎。（若风寒相兼。亦有风涎。
宜解表。从温散。）
一热证白点必干涩。或一边一点。或一边数点。大小不一。寒证白点必明润或成点。或成块。甚者满喉俱
白。状如凝膏。或如霜雪。
一热证白点外皆深红色。或红丝。（红丝者轻。）寒证白点外皆淡红色。或红丝。（红丝者轻。）
一热证舌苔。或黄或黑。宜察其润燥。燥者是实热。宜下之。润者是假热。宜清之。寒证舌苔必白。或间有黑黄
色。（水极似火之象。）亦宜察其润燥。燥者寒轻。宜微温。润者寒重宜大温。（鼻孔口唇。俱宜察其润燥。但有火烁
肺而鼻燥者。有肺气绝而鼻燥者。有肺火伏而唇燥者。有胃气不升而唇燥者。有脾气绝
而唇燥者。有伤食而唇燥者。俱宜详察。眼目但察其畏风与否。畏火与否而已。）
一热证小便必赤。赤而热。且短数者。是实热。宜导之。赤而不热。且长而多者。是假热。
宜清之。若清长。则的是寒证矣。
一热证大便必燥。燥而腹中坚满。欲解不能。或解如羊矢者。为实热。宜下之。燥而不结。或先结后溏。或旬日
不解。而全无胀意者。为虚热。宜清之。若大便纯溏。则的系是寒证。宜温之。至滑泄不守。宜温而补
之。即兼有热证亦不可妄议攻下。
一辨证宜相天时。度地势。审人事。大约夏秋多热。春冬多寒。住平阳之地者多热。住深山冷浸之地者多寒。体
强者多热。体弱者多寒。好酒者多热。好色者多寒。少壮者多热。年老者多寒。虽不尽然。此其大较也。
一白喉无论寒热证。如汗出似油者。不治。失音动痰气喘者。不治。目光直视者。不治。用针无血者。不治。吹药
无涎者。不治。吹药即刻痛止白落。过日复患者。不治。满喉白满喉肿者。惟热证不治。医者如遇此等证候。切勿轻与
用药。
A white spot located at the outer gate (i.e., beside the uvula) mostly belongs to Heat syndrome. A white spot located at the inner gate (i.e., inside the uvula) mostly belongs to Cold syndrome.
Heat syndrome necessarily presents with swelling. Cold syndrome does not present with swelling; instead, the interior of the throat appears enlarged and hollow. (There are also cases of deficiency swelling, where the shape must be moist.)
Heat syndrome necessarily involves pain, with no cessation of the pain. (Mild pain indicates a light condition; severe pain indicates a heavy condition.) Cold syndrome involves little pain, or pain that comes and goes intermittently.
In Heat syndrome, drinking water causes little pain, but eating food exacerbates the pain. In Cold syndrome, drinking water causes pain, while eating food causes little pain.
Heat syndrome necessarily involves thirst, with a preference for drinking water. (Preference for warm water indicates a light condition; preference for cold water indicates a heavy condition; drinking less indicates a light condition; drinking more indicates a heavy condition.) Cold syndrome involves no thirst. Even if thirsty, there is little desire to drink water. (Preference for warm water indicates a light condition; preference for extremely hot water indicates a heavy condition.)
In Heat syndrome, there is no appetite and an inability to eat. (One reason is due to swelling and pain; another is due to loss of taste.) In Cold syndrome, one can eat but has little desire to eat. (One reason is due to Spleen deficiency; another is due to Spleen exhaustion; another is due to excessive use of cold-natured medicines.)
Heat syndrome involves wind-phlegm saliva. (Little saliva indicates a light condition; much saliva indicates a heavy condition; it is appropriate to release the exterior and disperse from the cool method.) Cold syndrome absolutely does not involve wind-phlegm saliva. (If Wind-Cold combines, wind-phlegm saliva may occur; it is appropriate to release the exterior and disperse from the warm method.)
The white spots in Heat syndrome are necessarily dry and rough, or appearing as a single spot on one side, or several spots on one side, varying in size. The white spots in Cold syndrome are necessarily bright and moist, appearing as dots or clumps. In severe cases, the entire throat is covered in white, resembling solidified paste or frost/snow.
Surrounding the white spots in Heat syndrome is deep red color, or red threads. (Red threads indicate a light condition.) Surrounding the white spots in Cold syndrome is pale red color, or red threads. (Red threads indicate a light condition.)
For Heat syndrome tongue coating, it may be yellow or black; one should observe whether it is moist or dry. Dryness indicates Excess-Heat, for which purgation is appropriate. Moisture indicates False-Heat, for which clearing is appropriate. For Cold syndrome, the tongue coating is necessarily white, or occasionally mixed with black/yellow colors (a sign of extreme Water resembling Fire). One should also observe moisture or dryness. Dryness indicates mild Cold, requiring slight warming. Moisture indicates severe Cold, requiring strong warming. (The nostrils and lips should also be observed for moisture or dryness. However, nasal dryness may result from fire scorching the Lung, Lung Qi exhaustion, latent Lung fire, non-rising Stomach Qi, Spleen Qi exhaustion, or food stagnation; all require detailed examination. For the eyes, one only needs to observe fear of wind and fear of fire.)
In Heat syndrome, urine is necessarily red. If red, hot, short, and frequent, it is Excess-Heat, for which draining/guiding is appropriate. If red but not hot, long, and abundant, it is False-Heat, for which clearing is appropriate. If clear and copious, it is definitely Cold syndrome.
In Heat syndrome, stool is necessarily dry. If dry with hardness and fullness in the abdomen, difficulty defecating, or stool like sheep droppings, it is Excess-Heat, for which purgation is appropriate. If dry but not bound, or initially bound then loose, or unpassed for ten days without any feeling of fullness, it is Deficiency-Heat, for which clearing is appropriate. If the stool is purely loose, it is definitely Cold syndrome, for which warming is appropriate. Regarding slippery incontinence, warming and tonifying are appropriate. Even if Heat syndrome coexists, one must not rashly discuss purgation.
Syndrome differentiation should consider the timing of heaven (seasons), estimate the terrain, and examine human affairs. Generally, Summer and Autumn have more Heat syndromes, while Spring and Winter have more Cold syndromes. Those living in flat, sunny areas tend to have Heat syndromes; those living in deep mountains and cold, damp areas tend to have Cold syndromes. Those with strong constitutions tend to have Heat syndromes; those with weak constitutions tend to have Cold syndromes. Those who enjoy alcohol tend to have Heat syndromes; those who indulge in lust tend to have Cold syndromes. The young and vigorous tend to have Heat syndromes; the elderly tend to have Cold syndromes. Although not absolute, this is the general rule.
Regardless of whether Diphtheria (Bai Hou) presents as Cold or Heat syndrome, if sweating occurs like oil, it is incurable. Hoarseness, phlegm agitation, and asthma are incurable. Fixed staring gaze is incurable. No blood when pricked with a needle is incurable. No saliva production after blowing medicine is incurable. If pain stops and white membrane falls off immediately after blowing medicine, but recurs the next day, it is incurable. If the entire throat is white and swollen, only Heat syndrome is incurable. When doctors encounter such syndromes, they must not lightly administer medication.