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I compiled the book *Baihou Tiaobian* (Analysis of Diphtheria by Categories). Since its publication in the Dingyou year, ten years have passed. Regarding the discussions on diphtheria in the works of former sages, there were occasionally points that did not fully satisfy me. Therefore, I carefully discussed them and deliberated to find the most appropriate solutions, aiming to completely align with the disease conditions and treatment methods before stopping. However, I still felt that the explanation for the two characters "Ji Biao" (Taboo against Exterior-Releasing) was insufficient and had not been exhaustively detailed, which troubled me deeply.

This is because diphtheria is caused by latent dryness in the Taiyin Lung Meridian. If there is no contact with seasonal pathogens, it is naturally inappropriate to use exterior-releasing methods without cause, as this could lead to a disaster akin to a spark starting a prairie fire. If it is indeed a case complicated by seasonal exterior symptoms, then releasing the exterior cannot be delayed. As mentioned in Article 5 earlier, if complicated by warm-heat pathogens, herbs such as Bohe (Menthae Haplocalycis Herba), Heye (Nelumbinis Folium), and Biandouhua (Dolichoris Semen Flos) can be added. If complicated by cold-dampness and dryness, although Mahuang (Ephedrae Herba), Gegen (Puerariae Lobatae Radix), Qianhu (Peucedani Radix), Zisu (Perillae Folium), Xiangru (Moslae Herba), and Huoxiang (Agastaches Rhizoma et Radix) can be used at discretion, or if both exterior pathogen and interior dryness are severe, one must treat both the exterior and interior simultaneously, clearing and dispersing while considering both aspects. But first, the exterior pathogen must be resolved; even if the throat is covered with white membranes, treatment will become easy. One must simply avoid recklessly using acrid-hot substances like Jiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex) that might draw pathogens inward.

I have seen contemporary physicians who had not read *Baihou Ji Biao Juewei* (Subtle Distinctions on Taboo Against Exterior-Releasing in Diphtheria) frequently use exterior-releasing methods, causing severe harm. Conversely, there are those who have read this book but fail to thoroughly understand its principles, often rigidly adhering to the taboo against exterior-releasing. Even when facing severe exterior infections, they immediately resort solely to cooling and moistening agents, causing external pathogens to sink inward and exacerbating interior dryness, ultimately resulting in diseases like rotting throat, leading to death in numerous cases. Witnessing this is truly heartbreaking.

Generally, for diseases caused by the Six Excesses where pathogens enter from the outside, resolving the exterior is always a primary task. Although diphtheria stems from latent dryness in the Taiyin, the method should ideally focus directly on clearing and descending via the Lung Meridian. However, if the exterior infection has not yet been removed, focusing prematurely on clearing and descending, and further indiscriminately adding bitter, heavy, and cloying-nourishing herbs, will inevitably cause external pathogens to be dragged inward. This ultimately renders both clearing and dispersing methods ineffective, leaving one to watch the patient die helplessly—a tragedy of immense magnitude.

My two young daughters, aged only ten, once went to watch a play in the neighborhood during summer of a certain year. At that time, the heat was stifling and steaming. (A few days prior, strong west winds blew, bringing autumn-like weather in summer, which led to the appearance of diphtheria cases.) Coupled with the crowded atmosphere in the theater, upon returning home, they immediately developed severe chills and high fever, their limbs became stiff as if paralyzed, they suffered from abdominal pain and diarrhea, their tongue coating was gray and turbid, and white membranes reappeared in their throats. Weighing the severity, the proper approach was to first resolve summerheat and remove dampness. Since treating diphtheria generally involves cooling and nourishing agents, resolving summerheat and dampness would remove constraints on medication. Thus, I used Xiangru Yin (Mosla Decoction) combined with Zhengqi San (Righteous Qi Powder) with modifications, adding Shigao (Gypsum Fibrosum) and Xianweijing (Phragmitis Rhizoma) to slightly attend to the dryness in the lungs. (Shigao is the main herb for treating dry-fire; its nature can reach the exterior and clear the interior. Those who have studied Zhang Zhongjing's works thoroughly will grasp its essence. Therefore, upon seeing white patches in the throat, this herb cannot be delayed. Contemporary physicians are accustomed to recklessly using Dihuang (Rehmanniae Radix), Shihu (Dendrobii Caulis), and Yuanshen (Scrophulariae Radix) without surprise, yet dare not lightly try Shigao due to lack of insight, often missing the opportunity to treat the disease, which is lamentable.) After two doses, the exterior condition resolved, the body felt comfortable, pain ceased, and diarrhea stopped. However, the throat condition worsened, almost covering the entire throat. I urgently switched to Yangshengshen (Panacis Quinquefolii Radix), Shigao, Weijing, Yuanshen, Xingren (Armeniacae Semen Amarum), and Pipaye (Loquat Folium). After three doses, eight or nine-tenths of the white membranes disappeared, leaving only dryness and pain in the throat. I then added Lingyangjiao (Saigae Tataricae Cornu) and Xianshengdi (Rehmanniae Radix Recens), and the illness was completely cured. If, at the beginning, I had hesitated due to fears that Xiangru and Huoxiang (acrid-aromatic and drying herbs) might harm diphtheria, and failed to apply full force to resolve summerheat and dampness, the consequences could have been unimaginable.

In summary, diphtheria presents with many complicated symptoms. Only when latent dryness in the Taiyin manifests alone should the emphasis be on clearing, descending, and moistening; acrid-dispersing and bitter-heavy herbs are prohibited, as previously detailed. If complicated by the Six Excesses or seasonal infections, one should treat dampness with damp-resolving methods, cold with cold-resolving methods, and summerheat with summerheat-resolving methods. First, resolve the exterior; then, the treatment for the primary condition proceeds without worry. One must absolutely not rigidly adhere to the taboo against exterior-releasing, allowing external infections and latent dryness to interact detrimentously. It is like playing chess: one wrong move loses the whole game. I hope physicians treating diphtheria today can comprehend and apply these principles, perhaps enabling the people to share in longevity. Therefore, I do not shy away from verbosity and append this section hereafter.

Recorded again in the tenth month of the Jiyou year of the Xuantong Era, at Qiuzhai, by Lifu (Chen Baoshan).