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One, in cases of mild severity, the white putrefaction (white membrane) appears slightly on the sides of the throat; in severe cases, it spreads over the throat and trachea; in extremely severe cases, it entangles the entire lung system (respiratory tract) and even fills the interior of the lungs, not merely manifesting at the throat level. Therefore, coughing with a choking sensation, hoarseness, nasal congestion, and asthma occur simultaneously, all due to the obstruction caused by the sticky white putrefaction inside. This is what is meant by "what exists internally must manifest externally." One should ask: can methods such as acrid-warm exterior-releasing or purgative cold-clearing be applied? Once wrongly administered, the internal white putrefaction will spread and intensify, further depleting Lung Qi, accelerating death, leading to fatal asthma within seven days. Regarding white putrefaction, one must absolutely avoid scraping or blindly applying acupuncture, as this originally belongs to deficiency patterns caused by internal factors, which cannot be compared to excess patterns of Wind-Heat. I have seen practitioners use dental tools to forcibly scrape off the white putrefaction to achieve immediate results, hoping to boast of their miraculous skills. Little do they know that after scraping, although the white putrefaction is temporarily removed, it soon regrows, often more severely than before. Moreover, scraping often causes bleeding, increasing pain at the ulcerated site and worsening the condition. Deaths resulting from such scraping are not uncommon, yet these practitioners remain obstinate, unable to understand where such ideas come from, and refuse to abandon this "miraculous" method. Even for tongue ulcers and erosion, they resort to scraping; what kind of mindset is this? Do they believe scraping is effective, faster than decoction therapy, and superior to saving lives with a single dose? How great would that merit be? Unfortunately, after scraping, many patients cannot be saved. Alas! To err and not correct it is called an error. Should benevolent physicians act thus?

White putrefaction without mixed symptoms is relatively easy to treat. However, if accompanied by other symptoms, such as urticaria, erysipelas, macules, or papules, along with high fever that does not subside, it becomes most difficult to manage. It must be understood that erysipelas, rashes, macules, and papules have distinctions of Yin/Yang and Deficiency/Excess. One must not rigidly assume Wind-Heat Excess Fire and indiscriminately use herbs like Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Huafen (Trichosanthis Radix), and Xijiao (Rhinocerotis Cornu). Once wrongly used, the pathogen may sink inward, inevitably leading to critical signs such as grasping at bedclothes, staring fixedly, and delirious speech, presenting various failure syndromes, which are indeed hard to save. If the constitution is Excess, characterized by thirst with desire to drink, constipation, scanty urine, rapid and forceful pulse, and careful examination confirms the syndrome matches the pulse with scorched yellow tongue coating, while the white putrefaction in the throat is mild but the systemic rash is severe and red like cinnabar, treatment should nourish Yin and add Gypsum, Gardenia, and stir-fried Scutellaria to clear heat. If the constitution is deficient with Liver and Kidney insufficiency, the white putrefaction is heavier than the rash, pulses are deficient, rapid, and weak, mouth is not thirsty or thirst is present but without desire to drink, and tongue coating is tender without scorched yellow color, this represents floating fire surging upward, not excess fire. The classics state: "Excess of Fire indicates Insufficiency of Water." Do not focus solely on treating the rash; instead, prioritize nourishing Yin and adding moistening clearing agents, achieving two benefits with one move.

Erysipelas often arises from throat diseases. Initially, there may be fever and aversion to cold. If physicians fail to investigate the cause and misdiagnose it as seasonal influenza, they may wrongly use herbs like Ziyeh (Perilla Folium), Guizhi (Cinnamon Twig), Ganjiang (Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Qianghuo (Notopterygii Rhizoma et Radix), and Houpo (Magnoliae Officinalis Cortex). These herbs scorch the Yin fluids, agitate floating fire, and create dryness upon dryness, forcing out erysipelas. This belongs to rootless fire. If cold-natured herbs are wrongly applied, extreme water transforms into fire, causing significant error.

When white putrefaction occurs in severe cold, it is because Cold pathogen accumulates and transforms into Heat. Initially, unaware of the cause, it is mistaken for Cold invasion, and Ganjiang Congtang (Dry Ginger and Scallion Decoction) is wrongly taken, leading to sore throat and white putrefaction. If the nose is not congested, it is treatable. If nasal congestion and chest/hypochondriac oppression occur, it is truly difficult to treat, as Lung Heat damages the Lung itself. If during fever, both sides of the throat are red, swollen, and have white putrefaction, initially use Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), and Niubangzi (Arctii Fructus) to mildly release the exterior, then apply treatments for white putrefaction, and the illness will subside. Frequent administration of Wind-dispelling, Cold-resolving, and Acrid-Warm agents may not remove the white putrefaction and may generate other symptoms, such as chest distress, rattling phlegm, and asthma.

White putrefaction is colloquially called "White Fungus." In rural areas, children suffering from this are sometimes treated by locals who boil wet fungi growing on trees for washing and oral administration. Mild cases may occasionally respond, but severe cases are often worsened. It is lamentable that this method of using fungus to treat fungus persists without knowing its origin.

The book *Wu Yi Hui Jiang* (Compilation of Wu Physicians' Discussions), recently published near Suzhou, contains discussions on Lanhou Dansha (Rotting Throat Erysipelas), which likely refers to the Bai Fu (White Putrefaction) prevalent in my hometown. There are three essays: one by Tang Zi Yingchuan, one by Zu Jun Hongfan, and one by Li Zi Chunxiu. All note that recent patients are numerous, deaths are frequent, and it is highly contagious. Medical texts lack detailed descriptions, and treatment approaches are unclear. Tang stated: Some advocate Acrid-Dispersing, some Cool-Releasing, some Bitter-Cold, all acting subjectively and sticking to specialties without exploring the root cause. He cited Zhang Zhongjing's *Jin Gui Yao Lue* regarding Yang Du (Yang Toxicity), advocating Shengma Biejia Tang (Cimicifugae Rhizoma and Testudinis Carapax Decoction). He also cited the *Nei Jing* principle: "Heat rampant inside is treated with Salty-Cold, assisted by Bitter-Sweet." Zu Jun argued that the origin of this disease lies in Wind, Cold, Damp, Heat, and epidemic qi. Exterior-releasing and Heat-clearing have their appropriate uses; proper treatment leads to quick recovery, while improper treatment brings disaster instantly. Indiscriminate use of Cold herbs closes the exterior and exacerbates internal fire, worsening throat pain and ulceration. Those ignorant of this logic complain that even with cooling herbs, fire remains vigorous, assuming insufficient cold nature, leading to further suppression and internal sinking death. Others suggesting cooling are accused of causing stagnation. Fire raging like a prairie kills most brutally; this bias towards dispersing slanders the harm of cooling. He spoke of the disaster of dispersing, he spoke of the disaster of cooling, I speak of the appropriateness of cooling. The key lies in sequence and timing, adapting flexibly to hit the mark accurately. Li's argument compares it to objects baked by intense fire: only dryness is seen, ignoring Damp-Heat stagnation causing rot. Lesions white as flour paste, or rotting to the uvula, with nasal congestion and blurred vision, are untreatable. In summary, infection by abnormal Qi of Heaven and Earth leads to different constitutions (Deficiency/Excess) and varying severity. My commentary: The three scholars discussed Wind-Heat-Damp-Cold as Excess patterns, failing to recognize injury from Dryness or Rotting Throat due to Lung-Kidney Yin Deficiency. Thus, external Excess patterns are easy to understand, while internal Deficiency faults are often ignored. Tang's citation of *Jin Gui*'s Shengma Biejia Tang to distinguish Yang/Yin Du is also not entirely adequate.

White putrefaction has divisions of Cold/Heat and Deficiency/Excess, not limited to Dryness alone. It can arise from Wind-Cold accumulation, Wind-Heat invasion, consumption of roasted/spicy/hot foods causing burning, Excess with Deficiency, Deficiency with Excess, seemingly Deficient but actually Excess, or seemingly Excess but actually Deficient. Syndromes vary, so treatment must differentiate. One cannot stick to rigid methods. Whether to disperse exterior, use Acrid-Warm, Cool, Warm-Nourish, or Nourish-Yin depends on clinical flexibility and spiritual understanding. Only then can success be achieved.