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The syndrome of white putrefaction in the throat, commonly known as "white fungus" (Bai Jun), is what is referred to as "white winding throat" (Bai Chan Hou). Twenty years ago, patients with this condition were few; recently, however, many have contracted this disease, and countless have died due to misdiagnosis and mistreatment, which is deeply pitiable. For adults suffering from this syndrome, treatment is relatively easy; it is particularly difficult for children. This is because their constitution is young and weak, and their Spleen and Kidney essence are insufficient. Therefore, children suffer from white putrefaction more frequently than adults, and it is contagious. If treated improperly, it easily leads to sequential mortality, potentially affecting several members of a household. Note: This syndrome arises from Yin deficiency of the Lung and Kidney, compounded by exposure to the seasonal dryness-metal Qi, representing a manifestation of injury by dryness. Some claim it is latent Qi from Cold Damage (Shang Han); this is incorrect. Some say it is Slow Throat of the Shaoyin channel; this is also incorrect. Others claim it is epidemic rotting throat; this is even more incorrect. However, there is a distinction between initial fever and no fever at onset. Cases with fever are severe, while those without are mild. Even if fever occurs initially, dispersing the exterior (Fa Biao) must absolutely be avoided. If mistaken for exterior-contracting fever and treated with herbs such as Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Qin Jiao (Gentianae Macrophyllae Radix), or Jing Jie (Schizonepetae Herba), once the exterior is dispersed, the dryness will intensify, the white putrefaction will spread further, and the heat will become more blazing. The nostrils will inevitably become blocked, and symptoms such as hoarseness, choking cough, and wheezing may arise, rendering the condition incurable. Zhang Huiji stated: "Fire becomes more intense when allowed to ascend and disperse." Shen Jin'ao stated: "For all types of throat wind (Hou Feng) syndromes, exterior-dispersing methods are generally contraindicated, let alone for white putrefaction which belongs to dryness." Therefore, exterior-dispersing and cold-natured medications must not be used. If one stubbornly believes that Heat stagnation exists in the Lung and Stomach accompanied by Wind pathogen, and insists on using exterior dispersion as a preliminary step, it will surely cause significant delay and harm. For instance, Niu Bang Zi (Arctii Fructus), She Gan (Belamcandae Rhizoma), and Shan Dou Gen (Sophorae Tonkinensis Radix) are recorded in materia medica as capable of clearing and benefiting the throat and relieving sore throat; Sang Bai Pi (Morus Cortex) and Huang Qin (Scutellariae Radix) clear Lung Heat; Jie Geng (Platycodonis Radix) opens the Lung orifices; and Jiang Can (Bombyx Batryticatus) relieves throat obstruction pain. Although these are essential herbs for treating throat conditions, they are most unsuitable for white putrefaction. Misuse will inevitably lead to hoarseness, choking, and wheezing, becoming incurable. If one remains obstinate and unenlightened, believing it to be Lung Heat blockage, and administers Ma Huang (Ephedrae Herba), Pi Pa Ye (Loquat Leaf), Shi Gao (Gypsum Fibrosum), Xi Jiao (Rhinocerotis Cornu), Ling Yang Jiao (Capricornis Cornu), or Ma Dou Ling (Aristolochiae Fructus), it will result in stomach ulceration and death. Regarding discussions in throat specialties about fixed Wind-Heat attacking upward without descending, and the use of Zi Zheng San combined with emetics, or the use of Sheng Da Huang (Rhei Radix et Rhizoma) and Xuan Ming Fen (Mirabilite) for constipation to induce purgation, these actions only accelerate death, as they fail to investigate the root cause.

All syndromes have distinctions of Cold, Heat, Deficiency, and Excess. Only in the case of white putrefaction are cases of Cold, Heat, and Excess extremely rare, while Deficiency cases are common. If redness and swelling appear on both sides of the throat initially, followed by white patches, it indicates an Excess syndrome; if mixed with Deficiency, it is easier to treat. However, if exterior-dispersing or vomiting/purgative methods are mistakenly used, the illness will drag on for a long time. Only upon heavy use of Yin-nourishing drugs can gradual recovery occur. If it is a Deficiency syndrome, occurring during the period of Yangming Dryness-Metal dominance, and the sweating, vomiting, and purging methods, along with drastic agents like Xiong Huang Jie Du Wan (Realgar Detoxification Pill) or Zi Jin Ding (Purple Gold Tablet), are wrongly administered, it is indeed difficult to save the patient.

If white putrefaction appears without redness or swelling at onset, varying in thickness or resembling thick paste, accompanied by fever, it is the most critical presentation. The root lies in Lung and Kidney Yin deficiency. The pulse will be floating, rapid, and forceless; the fingertips will be cold. Exterior-dispersing and cold-natured drugs must absolutely not be used. Treatment must focus on nourishing Yin and clearing moistening. In short, recognizing "Dryness" as the primary governing principle is the secret method for saving lives. I often see patients misdiagnosed who develop hoarseness, choking, nasal congestion with rattling phlegm, and wheezing before dying, confirming the involvement of the Lung and Kidney. Knowing it is not Wind-Heat in the Lung and Stomach or external pathogens further clarifies this. Some argue that since it is caused by Lung Dryness, Yu Jiayan's Qing Zao Jiu Fei Tang (Clear Dryness Rescue Lung Decoction) and the ancient formula Xie Bai San (Drain White Powder) should be appropriate. However, Qing Zao Jiu Fei Tang contains Shi Gao (Gypsum Fibrosum), Pi Pa Ye (Loquat Leaf), and E Jiao (Donkey-Hide Gelatin), which clear excess Heat in the Lung; Xie Bai San drives rebellious Lung Qi downward to drain excess Qi. White putrefaction, however, arises from Lung Deficiency combined with Dryness pathogen, so neither formula is suitable. If Lung Qi were truly Excess, this affliction would not occur. Furthermore, observing this syndrome, it mostly occurs in Spring and Autumn when Yang energy is high, rarely in Summer heat, and sometimes in Winter dryness, always attributed to Dryness-Metal. Among the Six Qi, treating Dryness is the most difficult, especially Dryness manifesting as white putrefaction in the throat. One must know this Dryness differs from other Dryness-Fire syndromes. Books state: "Dryness is one of the Six Qi and is the original image of Metal-Lung." When exposed to Heat, Dryness transforms into Fire. Internal Dryness reduces fluids; upper irritability and thirst cause dry throat and nose. Since Metal is the source of Water generation, if Metal is scorched by Fire, Kidney Water loses its source, leading to internal steaming. Organs and bowels appear excessive but are actually deficient. The Classics say: "Autumn injury by Dryness causes upward rebellion and cough, developing into Phlegm Syncope." This shows upper Deficiency leads to lower depletion, and the mother-child relationship fails to generate each other. It also says: "Kidney suffers from Dryness; urgently eat Pungent substances to moisten it." And: "All astringency, withering, drying, and cracking belong to Dryness." Feng Chuzhan said: "He represents lack of fluid; Gan means lack of moisture; Jin means lack of softness; Cun means skin cracking; Se means stickiness when dry, contrasting with slipperiness when wet. These are transformations of Dryness-Metal." However, the superficial aspect of Dryness stems from Wind and Fire, while its root lies in the Spleen and Kidney. If Spleen Essence cannot transport and Yin Essence cannot ascend, the Lung loses its source of transformation, manifesting these signs. Thus, children with innate insufficiency of Spleen, Stomach, and Kidney contract this syndrome upon exposure to Dryness Qi. Treatment should prioritize generating fluids and nourishing Yin with moistening methods. How can one recklessly use exterior dispersion followed by cold drugs? Examining medical texts, there is originally no mention of white putrefaction or related theories. Recently, however, many suffer from it, and transmission is hard to stop. Like smallpox and chickenpox, which had no records before the Jianwu era of Han, until Qian Zhongyang established theories in Song dynasty, the current white putrefaction syndrome also emerges according to changing times, likely due to climatic disparities. Modern children often have weak constitutions, are pampered and fragile, possess congenital insufficiency, and lack sufficient Kidney Yin. Qian possessed unique insight, creating the Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to treat children, cultivating Yin to balance Yang, a profound meaning. If a child contracts white putrefaction, Lung and Kidney are necessarily both deficient, losing the source of life transformation. Water exhaustion leads to Kidney desiccation; Kidney desiccation means the lower spring does not nourish, causing Yang to flourish above, intensifying Dryness. Consequently, throat obstruction, hoarseness, phlegm accumulation, irritability, and choking arise.

Books state: "The Lung is the canopy of all organs; Clear Yang exits through upper orifices, Turbid Yin exits through lower orifices. The Pharynx governs Earth Qi, the Larynx responds to Heaven Qi, belonging to Metal, connected to the Lung. The Larynx receives Qi, thus connecting to Heaven; the Pharynx receives food, thus connecting to Earth. The Lung opens into the Nose; Lung Qi connects to the Nose, which governs Heaven Qi. Essence connects to Heaven; thus, when seasonal Dryness Qi dominates, it enters via the Nose, affecting the Lung first. Mildly, it causes persistent cough; severely, it causes white putrefaction. The Lung commands clear descent, favoring descent over ascent. Where pathogens gather, Qi is necessarily deficient. Those with solid Lung Qi do not suffer this. Know that Qi stagnation causes great Lung Qi deficiency. If one clings to the theory of Lung Heat and uses ascending or draining agents, it transforms into Fire, intensifying Dryness and leading to death swiftly. Therefore, Jie Geng (Platycodonis Radix) is strictly contraindicated. Although ancients used Gan Jie Tang (Licorice and Platycodon Decoction) for various throat ailments to vent Lung congestion, it was never intended for Dryness-induced throat syndromes. Modern people fail to understand this, blindly adhering to this formula as a throat remedy, not realizing this is not a throat disease but Lung Dryness manifesting in the throat. Using throat-wind medications for this will surely harm the people. This syndrome requires caution. One must study and comprehend the Dryness sections in Yu's works, Zhang's *Yi Tong*, and Feng's *Jin Nang* to avoid errors.

Some say: "Caused entirely by the Six Evils, it is inherently incurable." Others claim: "True white putrefaction is incurable; false white putrefaction is treatable." These are deceptive statements confusing public opinion. All diseases involving external factors are affected by the Six Qi, not just white putrefaction. If one claims the Six Evils accumulate internally to cause this, such a syndrome and theory do not exist. Why not simply treat based on the character "Dryness"? As for distinguishing true from false, it is absurd. Only feigned illness is false; true Cold with false Heat, and true Heat with false Cold are false categories. Apart from these and true headache, what else has true/false distinctions? Discussing Deficiency vs. Excess, one might consider Excess white putrefaction easier to treat and Deficiency white putrefaction harder, which is a valid perspective.

Some claim: "White putrefaction is blamed on Ministerial and Sovereign Fire, requiring Heart-draining and Liver-calming treatments." This is speculative and forced, unworthy of medical discussion. While Ministerial/Sovereign Fire may cause other throat issues, applying this to white putrefaction is a major error. Even if caused by Fire, it stems from Kidney Water insufficiency, which results from Lung Metal losing its source of transformation. Zhang Dairen said: "Knowing the root allows treating thousands without error." How can this be ignored! I have seen arrogant practitioners clinging to Ministerial/Sovereign Fire, recklessly using Deng Xin (Junci Medulla), Chuan Lian (Corydalis Rhizoma - *Note: Text says Chuan Lian but context implies Huang Lian/Coptis usually paired with Long Dan Cao, assuming Huang Lian based on 'Chuan Lian' typo or specific regional usage, but standard pairing is Huang Lian. Wait, text says 'Chuan Lian'. In TCM, Chuan Lian usually refers to Sichuan Melia Fruit (Meliae Toosendan Fructus). However, given the context of clearing fire/heat alongside Dragon Gallbladder and Rhinoceros horn, Huang Lian (Coptidis Rhizoma) is more likely intended, or perhaps the text implies a strong bitter-cold herb. I will translate as Coptidis Rhizoma (Huang Lian) assuming typo or common association, but strictly 'Chuan Lian' is Meliae Toosendan Fructus. Given 'Chuan Lian' is listed with Long Dan Cao and Xi Jiao, it is highly likely Huang Lian (Coptidis Rhizoma) due to phonetic similarity or textual corruption in some editions, but I must stick to the text. Actually, 'Chuan Lian' (川连) is a common abbreviation for Huang Lian (黄连). So I will use Coptidis Rhizoma.), Long Dan Cao (Gentianae Radix), Xi Jiao (Rhinocerotis Cornu), and Ling Yang Jiao (Capricornis Cornu), causing numerous deaths, yet they boast of their unique skills without regret, which is tragic.

Recently, many throat syndromes are caused by Dryness, not just white putrefaction. Without careful differentiation, using Wind-dispersing drugs makes mild cases severe and severe cases critical. Mistakes are common. My experience shows that using Clearing-Moistening and Yin-Nourishing methods yields broad efficacy. I rarely use Wind drugs, and my family formulas Zi Zheng Tang and Xin Wu San are unused because Excess cases are rare, while Yin insufficiency is common. Wang Tai Pu said: "Strengthen the master of Water to suppress the Sun." This principle is profoundly subtle. A question arises: "You discuss white putrefaction as caused by Dryness with Lung/Kidney insufficiency, prohibiting cold and pungent-dispersing/purgative methods. Yet I see cases cured by Qiang Huo (Notopterygii Rhizoma et Radix) and Gui Zhi (Cinnamomi Ramulus), effective with Fang Feng (Saposhnikoviae Radix), Niu Bang Zi (Arctii Fructus), Jing Jie (Schizonepetae Herba), Jie Geng (Platycodonis Radix), responding to Da Huang (Rhei Radix et Rhizoma) and Xuan Ming Fen (Mirabilite), stabilized by Huang Lian (Coptidis Rhizoma), Shi Gao (Gypsum Fibrosum), Xi Jiao (Rhinocerotis Cornu), and recovered with Fu Zi (Aconiti Lateralis Radix Praeparata) and Gan Jiang (Zingiberis Rhizoma). These are all throat treatments, why such disparity?" This is a good question. Syndromes vary in Cold, Heat, Deficiency, and Excess; one cannot generalize. Cases cured by Pungent-Warm exterior dispersion, purgative sweating, or cooling are Excess syndromes, characterized by tangible redness/swelling before white patches. This is distinct from intangible white spreading in the throat. Exposure to Wind-Cold, Summer-Heat, Dampness, or Fire causing throat swelling and white patches is considered "False White Putrefaction," which is easier to treat. Conversely, white putrefaction caused by Dryness and Kidney Yin insufficiency is "True White Putrefaction," which is extremely difficult to cure. If there were true/false distinctions, prescriptions should differ accordingly. Why cling to one formula? Are there not differences in Deficiency/Excess and Cold/Heat? Is it that Wind-Heat Excess white putrefaction is incurable, or that Lung-Kidney Yin Deficiency white putrefaction is incurable? They are not distinguished. However, for Lung-Kidney Yin Deficiency white putrefaction, if one ignores treatment methods, is ashamed to ask, and stubbornly uses rigid formulas for ordinary throat ailments, how can one avoid harming people?

Zhao Yangkui said: "People say Metal generates Water, but I say Water generates Metal. The Lung exhales Qi, the Kidney grasps Qi. When Qi rebels upward from below the navel, it is Kidney Deficiency failing to grasp Qi back to its origin. Do not merely treat the Lung; either strengthen the master of Water or benefit the source of Fire, and the Lung will be born from Water." Tang Lisan said: "Water generating Metal is the opposite of Metal generating Water. People know one side but not the other. By analogy, white putrefaction injuring Lung Dryness is logical." Those who are good at comprehending will grasp the essence.