Library

Baihou (White Throat) is a type of epidemic disease. Its onset follows specific temporal patterns, and its transmission is extremely rapid. It may start with one individual and spread to the entire household, or even an entire village. This condition is extremely critical and perilous, representing one of the most urgent and malignant syndromes. If not treated immediately, it can be fatal. Physicians who fail to grasp the key principles are rendered helpless, though this knowledge is not inaccessible to those with sufficient clinical experience. There are ten difficulties in treating this syndrome.

Mr. Chen Yuchun previously stated: This syndrome involves the Foot Three Yin meridians (Foot Taiyin Spleen Meridian, Foot Shaoyin Kidney Meridian, Foot Jueyin Liver Meridian) being affected, with the pathology transmitting to the Lung, unrelated to other meridians. Cases involving other meridians are merely post-onset transmissions. Why is this so? Initially, the tongue feels slightly stiff, the tongue coating is yellow, the nasopharynx (hangsang) is slightly swollen, accompanied by panting, thirst, and irritability. Among the twelve meridians, only the Taiyin meridian passes through the diaphragm to connect with the throat, links to the root of the tongue, and spreads under the tongue; the Shaoyin meridian runs along the throat and flanks the root of the tongue; the Jueyin meridian runs behind the throat, enters the nasopharynx upwards, and connects to the root of the tongue downwards. Patients with this syndrome typically present with deep, rapid, and restless pulses at both Guan positions and the left Chi position. Thus, it is clear that the disease belongs to the Foot Three Yin meridians. At this stage, the pathology has not yet transmitted to other meridians. Failing to identify the source and using medications for other meridians constitutes the first difficulty.

Generally, at the onset, symptoms include aversion to cold, fever, headache, back distension, mental fatigue, and pain in all joints. Throat pain varies from severe to mild or absent. Initially, there are no obvious visible signs, closely resembling exterior syndromes of Wind-Cold or Cold Damage. Administering dispersing and releasing exterior agents such as Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), Xixin (Asari Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), or Zisuye (Perillae Folium) will cause the pathogenic toxins to scatter irreversibly. This constitutes the second difficulty.

The initial aversion to cold and fever result from pathogenic qi initially arising internally. By the second or third day, white spots or patches appear in the throat, and the chills and fever naturally subside. Physicians who do not understand this mistake the resolution of symptoms on the efficacy of exterior-releasing drugs. In reality, once Baihou manifests, the chills and fever resolve even without exterior-releasing medication. For phlegm-heat sore throats, exterior-releasing formulas like Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Eliminate Toxins) may be used cautiously. However, for Baihou specifically, exterior-releasing drugs are strictly contraindicated. This constitutes the third difficulty.

This disease presents predominantly as heat syndromes and rarely as cold syndromes. Some assume it is a cold syndrome due to the white coloration, unaware that the disease originates in the Lung. The Lung belongs to Metal and corresponds to the color white. As the "Canopy" protecting the five zang and six fu organs, situated at the highest level, pathogenic vapors steam upward from below. As lung pathology deepens, the whiteness becomes more pronounced. Treatment should focus on resolving toxins in the three relevant meridians and guiding them downward, preventing accumulation in the Lung. Prescribing hot herbs like Fuzi (Aconiti Lateralis Radix Praeparata), Rongui (Cinnamomi Cortex), or Paojiang (Zingiberis Rhizoma Praeparatum) based on the white coloration is akin to adding firewood to a fire, intensifying the heat. This constitutes the fourth difficulty.

Even if one recognizes Baihou as a fire-toxin syndrome and avoids ascending and dispersing agents that worsen congestion, using Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) for purgation at the onset is also inappropriate. The pathology has transmitted to the Upper Jiao Qi level, unrelated to the Middle and Lower Jiao. Using harsh purgatives damages the Middle and Lower Jiao further, injuring the Yuan Qi (Original Qi). This constitutes the fifth difficulty.

Once symptoms are confirmed, the prescription must be maintained. For severe fire-toxin cases, initial treatment with Xiaofeng Baidu San (Wind-Dispersing Toxin-Eliminating Powder) or similar heat-guiding-downward formulas is correct. However, taking one dose daily without reduction of white patches indicates insufficient potency. Continuing for several days with worsening symptoms is like pouring a cup of water on a cartload of burning wood—ineffective. The physician must carefully examine the source: yellow-black tongue coating, dry throat and lips, scanty dark-yellow urine, or blackish diarrhea indicate condensed fire-toxin that cannot be cleared internally, hence the persistence of whiteness. Delay allows progression. The method requires sticking to the formula and urgent rescue. Such malignant cases require three doses daily to be effective. Changing prescriptions due to urgency leads to unpredictable complications. This constitutes the sixth difficulty.

Observation must be precise, and treatment cannot be delayed. This is a variant of plague, killing rapidly; after seven days, rescue is difficult. Quack physicians, failing to differentiate clearly, prescribe bland agents, seeking neither merit nor fault, thereby nurturing evil. By five or six days, toxin load is heavy, and Yuan Qi is damaged. Skilled physicians must use potent agents. However, if the patient dies despite potent treatment, families blame the potent medicine rather than the prior delay. The error lies in the beginning, not the end. This constitutes the seventh difficulty.

Non-Baihou conditions may transform into Baihou. Initial symptoms include sore throat with redness and swelling, with or without chills and fever. Unilateral swelling is called Dan'e (Single Swallow), bilateral is Shuang'e (Double Swallow). Delayed treatment leads to qi closure and death. Tuniuxi (Achyranthis Bidentatae Radix) should be used to guide heat downward; Dahuang is added if constipated. This shares treatment principles with Baihou but differs in etiology. Failure to prevent transformation leads to severe consequences. This constitutes the eighth difficulty.

There is also Laozheng (Consumption Syndrome) presenting as Baihou, characterized by yin deficiency and fire dryness. Severe pain prevents intake of food and water, leading to ulceration, emaciation, and haggard appearance. Nourishing yin and tonifying formulas are required to replenish Yuan Qi, allowing spontaneous healing of the throat. Misdiagnosing epidemic Baihou as yin-deficiency consumption leads to significant errors. This constitutes the ninth difficulty.

Another type of Baihou lacks chills and fever. White membranes appear in the throat, growing rapidly, accompanied by nausea and retching. This is a true cold syndrome, requiring Fuzi and Rongui for cure. Mistakenly administering Xiaofeng Baidu San causes little harm. Conversely, mistaking epidemic Baihou for this cold type causes significant damage. This constitutes the tenth difficulty.

Understanding these ten difficulties ensures accurate diagnosis and treatment, with minimal error. The throat is vital to life; careful observation is essential. Following this method for decades has proven effective. During epidemics, I dare not keep these secrets. I hereby detail the diagnostic methods, treatment principles, and throat-powder preparations below. These may serve as a modest aid to practitioners.