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Xie Chengmingjing had two grandsons, both suffering from diphtheria (Baihou). The younger grandson had already died. The elder grandson was in a critical condition. The physician continuously administered formulas for purgation, throat relief, detoxification, and cooling/moistening, but to no avail. I prescribed Jingfang Baidu San (Aurantium Decoction for Resisting Epidemic), heavily using Qianghuo (Notopterygii Rhizoma et Radix) to disperse the exterior pathogenic factor, which finally took effect. Subsequently, Shengui Yin (Ginseng and Cinnamon Twig Drink) was used, leading to recovery. Coincidentally, I was away, and the previous physician again used herbs such as Yuanshen (Scrophulariae Radix), Maidong (Ophiopogonis Radix), Dihuang (Rehmanniae Radix), and Baishao (Paeoniae Radix Alba). Consequently, "E" (tonsillar swelling resembling silkworm moths) grew inside the throat, with white spots appearing on them.

Furthermore, two strips of white patches reappeared at the Neiguan point (PC6), accompanied by nasal congestion, bleeding, phlegm obstruction, and flushed malar regions. The pulse at the right Cun and Guan positions was floating, rapid, scattered, and enlarged; the left pulse was slow and weak, while both Chi positions were faint. These symptoms are all caused by Yin-cold in the Kidney forcing the Dragon-Lei Fire (Ministerial Fire) to ascend upwards. If cooling medicines are used again, it will further nourish Yin and aid Cold. As Cold becomes more prevalent, the deficient fire rises higher, and the slight amount of true Yang remaining in the Kidney will be extinguished by Yin-Cold very quickly. Therefore, in Shaoyin Zang diseases, the focus is on True Yang. If Yang does not return, the pathogen cannot be expelled. I used Renshen (Ginseng Radix) as the sovereign herb to preserve Yuan Qi (Primal Qi), and Rougui (Cinnamomi Cortex) to warm and tonify Fire, entering the Mingmen acupoint (Gate of Life) in the Kan Palace (Kidney). However, since the Middle Jiao (Spleen/Stomach) had been confined by cold-cooling medicines for a long time, Paojiang (Zingiberis Rhizoma Preparatum) was added to warm the middle and assist digestion and movement. A small amount of Chaihu (Bupleuri Radix) was added to lift the pathogen that had sunk outward. Niubangzi (Arctii Fructus) and Jiangcan (Bombyx Batryticatus) were used to benefit the throat and dissipate nodules. Indeed, after one dose, the condition stabilized. However, the white patches at Neiguan did not recede, and phlegm and fire had not subsided. Subsequently, Shengui Jiangsha (Ginseng, Cinnamon Twig, Ginger, and Amomum) was used to warm and tonify the Middle and Lower Jiao, Tannan (Arisomatis Rhizoma) and Faxia (Pinelliae Rhizoma Preparata) to eliminate phlegm-fluids, Niubangzi to benefit the throat, and Congzhi (Allii Fistulosii Juice) to unblock Yang Qi. Once the True Fire returned to the Middle, the Yin-congealed toxin naturally resolved. Finally, Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), and Rougui were used to complete the treatment.

Yang Junhe had three daughters. The eldest and the youngest died from diphtheria, and the second daughter then contracted this disease. I was invited to examine her. The white patches were nearly filling the mouth, with mild pain. This is a deficiency-cold syndrome. She was given Lizhong Tang (Regulate the Middle Decoction), and Can Gong Huisheng Dan (Can Gong Revival Pill) was blown into the throat, resulting in recovery. Later, two others in the family were infected. One was treated with Shen'ai Yin (Ginseng and Mugwort Drink) and Can Gong Huisheng Dan; the other with Qingyan Lige Tang (Clear Throat and Purge Diaphragm Decoction) and Li Gong Huisheng Dan (Li Gong Revival Pill). Both recovered. Although the source of infection was the same, the constitutions differed in terms of cold and heat. Thus, one cannot rigidly adhere to a fixed formula.

The son of Hu Yuntang from Xiangtan had a small white spot beside the uvula, with severe pain. The pulse was floating, rapid, and fine. The disease was still at the exterior level. I prescribed Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins). The family feared the prescription was too mild and consulted another physician, who administered Da Chengqi Tang (Major Order the Qi Decoction) plus Dougen (Millettiae Speciosae Caulis) and Yuanshen for two doses, causing the illness to worsen. They then invited me to switch to Jingfang Baidu San, which cured the patient completely after three doses. This serves as a warning against using heavy prescriptions for mild conditions.

Ma Yiqing from Xiangtan, over sixty years old, had a son whom he cherished like a pearl. He strictly forbade any slightly cold foods. Suddenly, the child developed diphtheria with scorched-yellow coloration and severe pain. Knowing there was accumulated heat, I prescribed Qingyan Lige Tang. The family disliked the bitter-cold nature of the medicine and refused to administer it. I therefore resigned. The subsequent physician catered to their preferences, prescribing Renshen, Baizhu, Danggui (Angelicae Sinensis Radix), Dihuang, Ganjiang, and Rougui. The condition deteriorated. The next day, hoarseness, epistaxis, and asthma appeared, and the child died within three days. This illustrates the principle that excess-heat syndromes must be treated with cold-cooling agents.

Madam Zhou Ding'an, wife of General Zhou from Changning, had been ill for several days with various complicated symptoms, yet diphtheria was not recognized due to the lack of severe pain. One day, she mentioned throat pain, and I was called to treat her. Two strips of white patches were observed at Neiguan, resembling congealed paste. The family was terrified. I said, "Fortunately, no cooling medicines have been taken; it can still be treated." Can Gong Huisheng Dan was blown into the throat, and Shengui Yin was administered for two doses, reducing the white patches by half. Wenwei Tang (Warm the Stomach Decoction) was then used, leading to full recovery after a few doses. This demonstrates the method that cold syndromes require warming agents.

Madam Li Lansheng, wife of Prefect Li from the Qing Army Headquarters in Changsha, suddenly suffered from throat pain, fever, aversion to cold, head heaviness, vexation, thirst, dysuria, and blood streaks from the nose. Upon examination, two strips of white patches were seen at Neiguan, scorched-yellow in color, with abnormal swelling and pain, making swallowing difficult. The tongue coating was white at the edges and yellow in the center. The right Cun pulse was surging and large, and the left Guan pulse was floating and rapid. This was caused by Wind-Fire ascending from the Foot Jueyin Liver Channel and Hand Taiyin Lung Channel. Initially, I used Ren Shen Bai Du San, blowing Li Gong Huisheng Dan into the throat, which reduced swelling and pain. Next, Siwu Ganjie Tang (Four Substances and Licorice-Kataver Decoction) was used, causing the white patches to recede and all symptoms to disappear. Finally, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Gualouqiao (Trichosanthis Pericarpium) and Simaogen (Imperatae Rhizoma) led to complete recovery.

Chen Hanxian from Changsha suffered from throat pain for several days. Physicians used cooling-moistening and detoxifying agents, worsening the condition. Symptoms included fever, aversion to cold, surging phlegm-saliva, a voice sounding like sawing wood, anuria, and inability to swallow liquids for over two days. The family was panicked by the sudden onset of complications. Upon examination, the throat interior was pale red and slightly swollen, with sunken white spots at Neiguan. The tongue coating was white, and both hands' pulses were wiry and tight. This resulted from the mistaken use of cooling medicines, which closed off Wind-Cold and blocked the meridians. I used Can Gong Huisheng Dan combined Kaiguan Lixiao San (Open Orifices and Instant Effect Powder), blown into the throat two or three times consecutively. Immediately, upper and lower communication was restored, and food could be ingested. Subsequently, Chaihu Yin (Bupleurum Drink) was used to lift the sunk pathogen, resolving all symptoms after a few doses. Finally, Jiajian Liujunzi Tang (Modified Six Gentlemen Decoction) for ten doses completed the cure.

Shen Xiaolan from Shan-hua had several white blisters on the edge of his tongue. Physicians prescribed Yuanshen, Maidong, Chishao (Paeoniae Radix Rubra), and Zhuye (Lophatheri Herba). After three doses, overnight, phlegm-saliva surged, spirit became fatigued, aversion to cold and fever appeared, chest oppression occurred, and swallowing was impossible. Examination revealed floating-wiry pulses at both Cun positions and deep-tight pulse at the right Guan position. White patches filled the throat, looking like frost and snow, with thick, sticky, continuous phlegm-saliva. This was Wind-Cold at the exterior, not yet released, transformed into a disastrous syndrome by the successive administration of cold-cooling medicines. I used Jingfang Baidu San to drive out the exterior pathogen and blew Can Gong Huisheng Dan to dispel malignant toxins. The next day, the white patches disappeared completely, but the chest and diaphragm were blocked by Wind-Phlegm. Food was vomited shortly after ingestion, unable to reach the Middle and Lower Jiao, resembling Guange (Obstruction and Reversal) syndrome. The family was terrified, and witch-doctors and miscellaneous physicians tried ineffective remedies. Careful observation of pulse and symptoms indicated that Wind-Phlegm toxin blockage remained, unrelated to the throat itself. I employed methods to extract toxins and guide the Dragon back to the Sea (returning Yang to its root). Red rashes appeared slightly around the ears and neck. Then, Aiye (Artemisiae Argyi Folium), Zaojiao (Gleditsiae Sinensis Spina), and Baijiu (White Wine) were stir-fried hot, wrapped in cloth, and applied as compresses. Rashes erupted uniformly across the body as compression continued. The family feared this as a complication. I stated this was a good omen, necessary to draw toxins to the surface to open the blockage. The next day, the chest felt clear, and eating resumed. Ren Shen Bai Du San was used again to lift the exterior and support the expulsion of toxins. This was followed by Baoyuan Tang (Preserve Origin Decoction) with Renshen as the sovereign herb, Niubangzi and Jiangcan for the throat, Faxia and Chenpi (Citri Reticulatae Pericarpium) for phlegm, and Yinhua (Lonicerae Japonicae Flos) and Chantui (Cicadae Periostracum) for residual toxins. All symptoms resolved after a few doses. Liu Jun Bazhen Tang (Six Gentlemen and Eight Treasures Decoction) was used to conclude the treatment. This serves as a warning that Wind-Cold exterior syndromes must be vented and should not be treated lightly with cooling agents.