\r手阳明足阳明应针穴道部位\p05-c8a1.bmp\r
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窃古有少阴甘桔汤治咽痛又仲景少阴病下利咽痛心烦者猪肤汤少阴病二三日咽痛者可与甘草汤不差者与桔梗汤少
阴病咽中伤生疮不能语言声不出者苦酒汤少阴病咽中痛半夏散及汤主之数方皆清利咽喉之要药今人见有喉症不审其源
即用之而无疑嗟乎此犹抱薪救火也非能愈其疾而且更加其病何以言之夫今时咽喉之症皆寒火不均或受天时不正之气风
火之毒上攻须以去风泻火为要甘草补中而不泻火中宫既受其补则火愈炽于病亦重桔梗能引诸药上行药既上行其痰火与
气亦引之而上行则喉间壅塞于病更重故小儿惊痰大人风痰痰火桔梗所以忌也本草云升麻可代犀角引胃气上升似乎可用
不知气一上行必挟痰火以俱上涌塞于咽喉间四肢厥冷喘急异常为害非浅若在他症犹或可用锁喉风服之则必不救故犹当
切忌之也半夏虽消痰之妙药若咽喉症痰重者误用之则伤生命盖半夏能消脾胃之寒痰非能消肺中之热痰故也生姜辛辣发
散然喉症亦不以发散为主用之则以火益火亦不宜用此数味关系喉症甚重不可不明言而谨戒之至他药中亦有禁忌者是在
临时时留意焉可也
张绍修曰白喉有时疫一症其发无时其传染甚速其病至危至险治者多束手无策予考之诸书临症日久窃以为其治有十难
焉
盖此症乃缠喉急痹缓治则死凡咽喉不利口渴舌燥颈肿目赤身痛唇红皆上攻头面之症邪客于心肺之间与他经无涉其有兼
及他经者体气虚弱邪气乘虚而入皆后之传变名曰越经时未传及他经不察其源治以他经之药其难一也大抵其症初起恶寒
发热头痛背胀精神倦怠遍身骨节疼痛喉内有极痛者有微痛者初无形迹可见似伤风伤寒表症若投以麻桂羌活防风辛苏之
类致毒涣散无可挽回其难二也彼其恶寒发热乃毒瓦斯初作于内至二三日喉内见白见后寒热自除或者不悟误以为表药有功
岂知白见后即不服表药而发热亦止初起误服麻桂非徒无益而又害之其难三也按此病热症多寒症少有以色白为寒者不思
此症初发于肺属金其色白为五脏六腑之华盖处至高之位毒瓦斯熏蒸自下而上肺病日深故其本色白着治宜解五脏之毒使之
下行勿令蓄积于肺若因色白疑为寒症投以桂附炮姜是犹抱薪救火愈炽愈烈其难四也即有知为火毒不敢轻用升提开散之品
辙以芷硝大黄攻伐太过此症已传至上焦气分与中下焦无涉既上气焦分受伤又以硝黄攻伐太过使中下焦有损元气愈伤其难
五也见症已确药当守方有火毒甚者初起用消风败毒引热下行治法良是乃日服三两剂而白不退连服十数剂而白愈加是犹
杯水车薪与事无济治者当详审病源或舌苔黄黑喉干唇焦小便短涩而黄大便泻泄带黑是谓火毒凝结内病不除白能何净愈
发白愈守方久久投之自有效验若另更别方必生变故其难六也察之既精图治不容缓瘟疫变症杀人最速过七日即不起庸医
辨症未明投以平淡之剂不求有功但求免过是谓优容养奸迨至五六日毒瓦斯重矣元气伤矣善治者不得不以猛剂攻之然病已
垂危成则无功一旦不起病家不咎优容之过反云猛剂非宜此非误于后而实误于前其难七也有非白喉而转为白喉者初起喉
红肿痛或恶寒发热或不恶寒发热一边肿名曰单蛾两边肿名曰双蛾治之稍缓则气闭不起宜用杜牛膝兜引热下行大便闭结
用大黄否则不必用此与白喉症异治同倘不预防转为白喉为祸甚烈其难八也又有劳症白喉阴虚火燥痛极而水米难下渐至
朽烂形容枯槁面目憔悴必须补剂使元气充满而喉痛自愈若以行疫症白喉误认阴处差之毫厘失之千里其难九也更有一种
白喉无恶寒发热等症喉内起白皮随落随长的是寒症非桂附不愈即误服消风败毒之药尚无损若以疫症白喉认为此症为害
非浅其难十也知此十难临审治余持此法十不失一难不终难也时疫流行而益不敢自秘非敢云济世之良方亦足为刀圭之一
助云尔
又曰白喉症治法浩渺无窍余自稽考以来时深讨论每临篇得其法未见其病临病见其症未必合其方可见病态多端惟贵
圆通而知要耳予曾立白喉症一篇以传于世奈白喉之症愈出愈奇有早发而夕死者沿街合巷互相传染治之不速十难全一噫
真可惨也窃此症乃瘟疫恶症必须详审外症细察脉情看明喉咙内外两关白多白少及大小浓薄方可下药否则以轻剂而治重
症其祸固烈以重剂而治轻病其害尤深过犹不及诚哉是言也其症初起憎寒壮热口渴喉干声音不出汤水不入痰涎壅塞胀闭
疼痛异常满口皆白脉来洪数甚者且无至数此乃时行厉气为病喉中最急者也或者谓咽喉病忌用寒凉谬妄殊甚每见投以荆
防败毒散大承气汤指不胜屈不知以硝黄泻胃中之实热是谓诛伐无过病遂乘之而危笃以羌防理太阳之游风乃致涣散其毒
病必渐入于膏盲余立除瘟化毒散神功辟邪散神仙活命汤已用之屡矣皆能立起沉 但恐病势太重犹嫌药方药力太轻再立
龙虎二仙汤日服二三剂连服数日不必更方纵食不下咽断不至寒凉过度胃气告匮所谓有病则病受也白退而药即止徐徐调
理元气不难充满惟症尤烈者实火为患脏腑积热太深堵塞咽喉隘地呼吸不通服雄黄解毒丸尤妙究系厉剂不可轻用慎之然
所论虽属详明治者尤宜达变道权兼以阅历方能随手应效活人之法无出于此若轻忽急玩耽搁日期使面青唇黑气急痰壅烦
躁神昏攻之不可达之不及虽灵扁复生不可为也白喉风初起用葛根僵蚕蝉衣以散风热以牛蒡子连翘银花土茯苓消肿败毒
元参天冬麦冬生地清金水黄芩黄连生栀仁山豆根生石膏泻火救火木通泽泻车前子引热下行薄荷射干散风消肿重者加
马勃龙胆草外用土牛膝兜或于末服药之先既服药之后煎水间服再以万年青根汁或服或噙病已危急非针吐之法不能救急
轻者以除瘟化毒散主之稍重者以神仙辟邪散或神仙活命汤主之轻则日服一二剂重则日服三四剂将疫毒由上焦引至中焦
由中焦引至下焦从大小肠胱膀而出大便泄泻火毒下行此为吉兆大便开塞少加熟大黄如仍开塞故用生军大便通即去以白
点退净为度其药味分量之加减剂数之多寡须临症制宜不必另更别方连日投之自然全愈屡试屡验同治丁卯冬日白喉险症
极多有渐至危笃者延予延医询前所服之药皆消风败毒引热下行之剂治法良是终莫能起不解何故予详审外症细察脉情再
三之想必是实火为患热毒凝结脏腑虽用泻火败毒之药仍是杯水车薪于病HT 济拟一龙虎二仙汤日服四剂痊愈者有之有
服二三十剂而白尚未退净用雄黄解毒丸一服仍服未龙虚二仙汤十余剂故遂处此方全活甚众看白点退完当用清凉之品以
清心条肺汤撤尽余毒再用养阴之品脾胃素虚者用四君子汤加银花总赖以圆机行活法也如遇牙关紧急不开闭而不能看症
治以开关散即开又或初起之时及服药之后痛不可忍神疲音哑急以针法按穴施之如喉内颈项肿甚以救急异功散传之以上
白喉治法除劳症白喉之外凡单蛾双蛾喉痈及喉内红肿均可根据法治之但药味须酌量加减慎之服药后忌风吹又有辨症未明
误投升提开散滋补辛温之剂视病之轻重以生绿豆研细末重者一茶碗轻者一酒杯冷水调服再酌用以后所列诸饮散煎出并
煮大麦粥一碗先服粥后服药则误服之剂立除矣如痰涎涌甚用生桐油灌下用鸡羽搅之呕出痰涎须陆续灌尽五六两方妙
白喉咙看法初起头痛寒热背胀遍身骨节疼痛或恶寒发热或喉内极痛或微痛或不痛而喉内微硬有随发而白随见者有
至二三日而白始见者或由白点白条白块渐至满喉皆白所治皆同服药后喉内或白收紧或白稀疏或白微小或白转黄久之必
然退净但此病非比他病贵在见机早尤贵在治者精若心粗气浮轻视此症有非白喉而妄称为白喉遽以猛药攻之者有真白喉
又不识为白喉仅以平剂投之者有胎产妇人幼孩老人大病后虚劳内伤皆难任攻伐者治不得当鲜有不轻者重重者危看喉内
要将病患向光明处坐正或箸按住舌心细看喉咙两边系白喉系单蛾双蛾系风火喉看的方好下药晚间则用油纸捻一照脑后
一焰口内方看得明不可空腹入患家看病或饮雄黄酒一杯或食大蒜亦可保不传染
火症寒症看法火症白喉白块浮于肉上起凸喉中红肿饮食喜冷恶寒舌苔黄黑甚至大小便不通痛无已时如系寒症虚
症则不红不肿饮食恶冷喜热天花板上红丝数条即间有白块亦陷于肉内凹而不凸大小便如平时喉中微痛或咽则痛不咽不
痛不得以白喉之法治之
手阳明经与足阳明经应当针刺的穴位部位
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古代有用少阴甘桔汤治疗咽痛，又有张仲景《伤寒论》中记载：少阴病出现下利、咽痛、心烦的症状，用猪肤汤；少阴病发病两三天后出现咽痛的，可以给予甘草汤；若症状未缓解，再给予桔梗汤；少阴病咽喉受伤生疮，不能说话、声音出不来的，用苦酒汤；少阴病咽喉疼痛的，用半夏散及汤主治。这几个方子都是清利咽喉的重要药物。如今的人见到有喉症，不审察病因根源，就毫不犹豫地直接使用这些方剂。唉！这就像是抱着柴草去救火一样，不仅不能治愈疾病，反而会使病情加重。为什么这么说呢？因为当今时代的咽喉病症，大多是寒火不均，或者受到天时不正之气（风火之毒）上攻所致，必须以祛风泻火为关键。甘草能补益中气但不能泻火，中焦既受其补益，则火势更加炽盛，对病情而言更为严重；桔梗能引导诸药上行，药物既然上行，它也会将痰火与气引之上行，导致喉间壅塞不通，对病情更是加重。所以，小儿惊痰、大人风痰、痰火等证，必须忌用桔梗。《本草》中说升麻可以代替犀角，引导胃气上升，似乎可以使用，但不知气一旦上行，必定挟带痰火一起上涌，堵塞于咽喉之间，导致四肢厥冷、喘急异常，危害非浅。如果在其他病症中或许还可以使用，但若是锁喉风服用此药，则必然无法救治，所以尤其应当切忌使用。半夏虽然是消除痰饮的妙药，但如果咽喉病症痰重的患者误用，则会损伤生命。这是因为半夏只能消除脾胃的寒痰，并不能消除肺中的热痰。生姜辛辣发散，然而咽喉病症也不以发散为主，使用它则是以火助火，也不宜使用。这几味药与咽喉病症关系重大，不可不明确说明并谨慎告诫。至于其他药物中也有禁忌的，在于临时留意即可。
张绍修说：白喉有时疫这一病症，发作没有固定时间，传染速度极快，病情极其危险险恶，治疗者大多束手无策。我考证了各种书籍，临证日久，私下认为其治疗有十大难点。
大概这个病症是缠喉急痹，治疗迟缓就会死亡。凡是咽喉不利、口渴、舌燥、颈部肿胀、眼睛发红、身体疼痛、嘴唇红润，都是邪气上攻头面的症状。邪气客居在心肺之间，与其他经络无关。如果有兼及其他经络的情况，是因为体质虚弱，邪气乘虚而入，这都是后来的传变，名叫“越经”。如果时间还未传及他经，却不审察根源，用治疗他经的药物，这是第一个难点。大抵该病初起时，恶寒、发热、头痛、背部胀满、精神倦怠、全身骨节疼痛，喉内有极度疼痛的，也有轻微疼痛的，初起时没有明显形迹可见，类似于伤风或伤寒的表证。如果投用麻黄、桂枝、羌活、防风、辛夷、紫苏之类发散药物，会导致毒气涣散，无可挽回，这是第二个难点。那种恶寒发热，是毒瓦斯最初在体内发作，到了二三日，喉内出现白色膜状物，之后寒热自然停止。如果不明白这一点，误以为发散表药有功，哪里知道白膜出现后即使不服发散药，发热也会停止。初起误服麻黄、桂枝，不仅无益，反而有害，这是第三个难点。按此病热证多，寒证少，有人因色白而认为是寒证，却不思考此病初发于肺，肺属金，其色白。肺为五脏六腑的华盖，处于最高位置，毒瓦斯熏蒸，自下而上，肺病日深，所以本色显白。治疗应当解除五脏的毒邪，使其下行，不要让毒邪蓄积于肺。如果因色白怀疑是寒证，投用肉桂、附子、炮姜等温热药，这就像抱薪救火，火势愈烈，这是第四个难点。即使有的医生知道是火毒，不敢轻用升提开散的药物，却往往用白芷、芒硝、大黄攻伐太过。此病已经传至上焦气分，与中下焦无关。既然上焦气分已受伤，又以硝石、大黄攻伐太过，使中下焦元气受损，这是第五个难点。见症已明确，用药应当守方。火毒严重的，初起用消风败毒散引热下行，治法是正确的。乃至于每天服用三两剂，而白膜不退，连续服用十几剂，白膜反而更多，这如同杯水车薪，于事无济。治疗者应当详细审察病源，如果舌苔黄黑、喉干唇焦、小便短涩且黄、大便泄泻带黑色，这叫火毒凝结。内病不除，白膜怎能干净？只要继续坚持原方投药，久久施用，自然有效验。如果另外更换别的方子，必然产生变故，这是第六个难点。观察既已精准，图谋治疗不容迟缓。瘟疫变症杀人最快，超过七天就不能存活。庸医辨症不明，投以平淡的药剂，不求有功，只求免过，这叫优容养奸。等到五六天，毒瓦斯重了，元气伤了。善于治疗的人不得不使用猛剂攻邪。然而病已垂危，治好了也无功，一旦不治，病家不责怪优容的过错，反而说猛剂不适宜。这不是误于后来，而是实误于前面，这是第七个难点。有不属于白喉而转为白喉的。初起喉部红肿疼痛，或者恶寒发热，或者不恶寒发热，一边肿名叫单蛾，两边肿名叫双蛾。治疗稍缓则气闭致死。应当用杜牛膝兜引热下行，大便闭结的用大黄，否则不必用。这与白喉症异治同。倘若不预防转为白喉，祸患非常猛烈，这是第八个难点。又有劳症引起的白喉，阴虚火燥，疼痛剧烈到水米难进，逐渐至腐烂，形容枯槁，面目憔悴。必须用补剂使元气充满，而喉痛自愈。如果把这种劳症白喉误认为是流行性白喉，差之毫厘，失之千里，这是第九个难点。更有一种白喉，没有恶寒发热等症状，喉内起白皮，随落随长，这是寒症，不用肉桂、附子不能痊愈。如果误服消风败毒散，尚且没有损害；如果把这种寒症白喉误认为是疫症白喉，危害就不浅了，这是第十个难点。知晓这十大难点，临证审察治疗，我持此法十不失一。难点终究是难点啊。当时疫流行，我更是不敢私藏秘方，不敢说是济世的良方，也足以作为医者的辅助罢了。
又说：白喉症的治疗方法浩渺无窍。我自稽考以来，时常深入讨论，每次阅读篇章得其法，未见其病；临病见其症，未必符合其方。可见病态多端，贵在圆通而知要领。我曾撰写白喉症一篇以传世，无奈白喉的病症愈出愈奇，有早上发病晚上死亡的，沿街合巷互相传染，治疗不迅速，十难全一。唉！真可惨痛啊。私下认为此症乃瘟疫恶症，必须详审外症，细察脉情，看明喉咙内外两关，白多白少及大小浓薄，方可下药。否则以轻剂治重症，祸患固然猛烈；以重剂治轻病，危害尤深。过犹不及，诚然如此。该病初起憎寒壮热，口渴喉干，声音不出，汤水不入，痰涎壅塞，胀闭疼痛异常，满口皆白，脉来洪数，严重者甚至无至数。这是时行厉气致病，喉中最急的病症。有人说咽喉病忌用寒凉，谬妄甚甚。每见投用荆防败毒散、大承气汤的，指不胜屈。不知道用硝石、大黄泻胃中之实热，这叫诛伐无过，病邪遂乘之而危笃；用羌活、防风理太阳之游风，乃致毒气涣散，病必渐入膏肓。我创立除瘟化毒散、神功辟邪散、神仙活命汤，已屡用屡效，都能立起沉疴。但恐怕病势太重，还嫌药方药力太轻，又创立龙虎二仙汤，每日服用二三剂，连服数日，不必更换方子。纵然食不下咽，断不至寒凉过度导致胃气告匮。所谓有病则病受也。白膜退去即停药，徐徐调理元气，不难充满。只有症状特别剧烈的，实火为患，脏腑积热太深，堵塞咽喉隘地，呼吸不通，服用雄黄解毒丸尤为奇妙。究系厉剂，不可轻用，慎之又慎。然而所论述虽属详细，治疗者尤其应当通达权变，兼以阅历，方能随手应效。活人之法，无出于此。若轻忽怠慢，耽搁日期，使面青唇黑，气急痰壅，烦躁神昏，攻之不可，达之不及，虽华佗、扁鹊复生，也不可为了。白喉风初起，用葛根、僵蚕、蝉衣以散风热，用牛蒡子、连翘、银花、土茯苓消肿败毒，元参、天冬、麦冬、生地清金水，黄芩、黄连、生栀仁、山豆根、生石膏泻火救焚，木通、泽泻、车前子引热下行，薄荷、射干散风消肿。重者加马勃、龙胆草。外用土牛膝兜，或在末服药之先、既服药之后，煎水间服。再以万年青根汁，或服或噙。病已危急，非针吐之法不能救急。轻者以除瘟化毒散主之；稍重者以神仙辟邪散或神仙活命汤主之。轻则日服一二剂，重则日服三四剂。将疫毒由上焦引至中焦，由中焦引至下焦，从大小肠膀胱而出。大便泄泻，火毒下行，此为吉兆。大便开塞，少加熟大黄；如仍开塞，故用生大黄。大便通即去之，以白点退净为度。其药味分量之加减、剂数之多寡，须临症制宜，不必另更别方，连日投之，自然全愈，屡试屡验。同治丁卯冬日，白喉险症极多，有渐至危笃者。延请我诊治，询问之前所服的药，皆是消风败毒、引热下行之剂，治法良是，终莫能起，不解何故。我详审外症，细察脉情，再三思之，想必是实火为患，热毒凝结脏腑。虽用泻火败毒之药，仍是杯水车薪，于病无济。拟一龙虎二仙汤，日服四剂，痊愈者有之。有服二三十剂而白尚未退净，用雄黄解毒丸一服，仍服未龙虚二仙汤十余剂，故遂处此方，全活甚众。看白点退完，当用清凉之品以清心条肺汤撤尽余毒，再用养阴之品。脾胃素虚者用四君子汤加银花。总赖以圆机行活法也。如遇牙关紧急不开，闭而不能看症，治以开关散即开。又或初起之时及服药之后，痛不可忍，神疲音哑，急以针法按穴施之。如喉内颈项肿甚，以救急异功散传之。以上白喉治法，除劳症白喉之外，凡单蛾、双蛾、喉痈及喉内红肿均可根据法治之。但药味须酌量加减，慎之。服药后忌风吹。又有辨症未明，误投升提、开散、滋补、辛温之剂，视病之轻重，以生绿豆研细末，重者一茶碗，轻者一酒杯，冷水调服。再酌用以后所列诸饮散，煎出并煮大麦粥一碗，先服粥后服药，则误服之剂立除矣。如痰涎涌甚，用生桐油灌下，用鸡羽搅之呕出痰涎，须陆续灌尽五六两方妙。
白喉咙看法：初起头痛寒热，背胀遍身骨节疼痛，或恶寒发热，或喉内极痛或微痛，或不痛而喉内微硬。有随发而白随见的，有至二三日而白始见的，或由白点、白条、白块渐至满喉皆白，所治皆同。服药后喉内或白收紧，或白稀疏，或白微小，或白转黄，久之必然退净。但此病非比他病，贵在见机早，尤贵在治者精。若心粗气浮，轻视此症，有非白喉而妄称为白喉，遽以猛药攻之者；有真白喉又不识为白喉，仅以平剂投之者；有胎产妇人、幼孩、老人大病后虚劳内伤，皆难任攻伐者，治不得当，鲜有不轻者重重，重者危。看喉内要将病患向光明处坐正，或用箸按住舌心，细看喉咙两边，系白喉、系单蛾双蛾、系风火喉，看的方好下药。晚间则用油纸捻一照脑后一焰口内，方看得明。不可空腹入患家看病，或饮雄黄酒一杯，或食大蒜，亦可保不传染。
火症寒症看法：火症白喉，白块浮于肉上，起凸，喉中红肿，饮食喜冷恶寒，舌苔黄黑，甚至大小便不通，痛无已时。如系寒症虚症，则不红不肿，饮食恶冷喜热，天花板上红丝数条，即间有白块，亦陷于肉内，凹而不凸，大小便如平时，喉中微痛，或咽则痛，不咽不痛。不得以白喉之法治之。
Parts and locations of acupoints to be needled corresponding to the Hand-Yangming and Foot-Yangming meridians.
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In ancient times, Shaoyin Ganjie Tang (Licorice and Platycodon Decoction) was used to treat sore throat. Additionally, Zhang Zhongjing's *Shanghan Lun* records: for Shaoyin disease presenting with diarrhea, sore throat, and restlessness, Zhufu Tang (Pig Skin Decoction) is indicated; for Shaoyin disease developing a sore throat within two to three days, Gancao Tang (Licorice Decoction) may be given; if symptoms do not improve, Jiegeng Tang (Platycodon Decoction) is administered; for Shaoyin disease where the throat is injured and sores form, preventing speech and voice production, Kujiu Tang (Bitter Wine Decoction) is used; for Shaoyin disease with sore throat, Banxia San Ji Tang (Pinellia Powder and Decoction) is the primary treatment. These formulas are all essential medicines for clearing and benefiting the throat. Nowadays, when physicians encounter throat disorders, they often fail to investigate the root cause and apply these formulas without hesitation. Alas! This is like carrying firewood to extinguish a fire; it not only fails to cure the disease but exacerbates it. Why is this? Because contemporary throat disorders are mostly caused by an imbalance of cold and heat, or by pathogenic factors such as wind-fire toxins attacking from above due to abnormal climatic conditions. The key treatment must be to dispel wind and purge fire. Licorice (Gancao) tonifies the middle jiao but does not purge fire; once the middle jiao receives this tonification, the fire becomes more intense, worsening the condition. Platycodon (Jiegeng) guides other herbs upward; since the herbs ascend, it also draws phlegm-heat and qi upward, causing obstruction in the throat and further aggravating the illness. Therefore, Platycodon is contraindicated in cases of pediatric fright-phlegm, adult wind-phlegm, and phlegm-heat. The *Bencao* states that Shengma (Cimicifugae Rhizoma) can substitute Xijiao (Rhinoceros Horn) to guide stomach qi upward, which seems applicable. However, once qi ascends, it inevitably carries phlegm-heat upwards, causing blockage in the throat, leading to cold limbs and extreme asthma, posing a severe threat. While it might be usable in other conditions, if used for Suohou Feng (Lock-Throat Wind), it will certainly be fatal; thus, it must be strictly avoided. Although Banxia (Pinelliae Rhizoma) is an excellent medicine for resolving phlegm, its misuse in severe throat phlegm cases can be life-threatening because Banxia resolves cold-phlegm in the spleen and stomach but cannot resolve heat-phlegm in the lungs. Ginger (Shengjiang) is pungent and dispersing, but throat disorders should not primarily rely on dispersion; using ginger adds fire to fire and is inadvisable. These few herbs have significant implications for throat disorders and must be clearly stated and cautiously warned against. As for other herbs with contraindications, one must pay attention at the time of treatment.
Zhang Xiuxiu stated: White membrane throat (Baihouteng) includes an epidemic syndrome. Its onset is unpredictable, transmission is rapid, and the condition is extremely critical and dangerous. Most practitioners find themselves helpless. After consulting various texts and gaining long-term clinical experience, I privately believe there are ten difficulties in treating it.
Generally, this syndrome is Chanhou Jibi (Throat-Wrapping Acute Bi). Delayed treatment leads to death. Symptoms include throat discomfort, thirst, dry tongue, neck swelling, red eyes, body pain, and red lips, all indicating pathogenic attack on the head and face. The pathogen lodges between the Heart and Lungs and does not involve other meridians. If other meridians are involved, it is due to weak constitution allowing pathogens to enter through deficiency, representing later transmission known as "Yuejing" (Crossing Meridians). If the disease has not yet transmitted to other meridians, failing to examine the root cause and treating with medications for other meridians constitutes the first difficulty. Generally, early stages present with aversion to cold, fever, headache, back distension, mental fatigue, and generalized joint pain. Throat pain ranges from severe to mild. Initially, there are no visible traces, resembling exterior syndromes of wind-cold or wind-heat. Administering diaphoretic herbs like Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Xinyi (Magnoliae Flos), or Zisu (Perillae Folium) causes the toxin to scatter irreversibly, constituting the second difficulty. The initial aversion to cold and fever result from internal toxin activity. By the second or third day, white membranes appear in the throat, after which chills and fever naturally cease. Misinterpreting this as the efficacy of diaphoretic herbs is erroneous; even without diaphoretics, fever stops once white membranes appear. Initial misuse of Mahuang and Guizhi is not only ineffective but harmful, constituting the third difficulty. This disease presents mostly with heat signs and rarely with cold signs. Some mistake the white color for cold, failing to realize the disease originates in the Lung, which belongs to Metal and corresponds to the color white. The Lung is the canopy of the five zang and six fu organs, located at the highest position. Toxin fumes rise from below, deepening lung pathology, hence the white appearance. Treatment should resolve five-zang toxins and guide them downward, preventing accumulation in the lungs. Suspecting cold due to whiteness and administering Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), or Paojiang (Zingiberis Rhizoma) is like adding fuel to the fire, intensifying the blaze, constituting the fourth difficulty. Even those who recognize fire-toxin avoid lifting and dispersing agents but may overuse Baizhi (Angelicae Dahuricae Radix), Xiaoshi (Natrii Sulfas), and Dahuang (Rhei Radix et Rhizoma) for purging. Since the disease has transmitted to the Upper Jiao Qi level and does not involve the Middle and Lower Jiao, excessive purging with Natrii Sulfas and Rhei Radix damages Yuan Qi in the Middle and Lower Jiao, constituting the fifth difficulty. Once symptoms are clear, the prescription should remain consistent. For severe fire-toxin, starting with Xiaofeng Baidu San (Wind-Dispersing and Toxin-Vanquishing Powder) to guide heat downward is correct. However, taking three taels daily with no reduction in white membranes, or continuing for over ten doses resulting in increased whiteness, is like pouring a cup of water on a cartload of burning wood—ineffective. Practitioners must carefully examine the source: yellow or black tongue coating, dry throat and lips, scanty dark yellow urine, and black diarrhea indicate condensed fire-toxin. Internal pathology must be resolved before the white membranes can clear. Persisting with the same formula yields results. Changing formulas arbitrarily causes complications, constituting the sixth difficulty. Precise observation requires urgent action. Epidemic transformations kill fastest; survival beyond seven days is unlikely. Incompetent doctors, failing to distinguish symptoms, prescribe bland remedies to avoid blame, nurturing evil. By days five or six, toxins are heavy and Yuan Qi damaged. Effective treatment requires potent agents. However, if the patient dies despite aggressive treatment, families blame the harsh drugs rather than the earlier delay, constituting the seventh difficulty. Non-white-membrane throat cases may transform into white-membrane throat. Early stages show red, swollen, painful tonsils (Dan'e: single tonsil; Shuang'e: double tonsils), with or without chills/fever. Delayed treatment causes airway closure. Using Duniuqi (Achyranthis Bidentatae Radix) to guide heat downward and Dahuang for constipation is appropriate. This differs from white-membrane throat in origin but shares treatment principles. Failure to prevent transformation causes severe harm, constituting the eighth difficulty. Labor-induced white-membrane throat involves yin deficiency and fire-dryness, causing extreme pain, inability to eat/drink, rotting, emaciation, and haggard appearance. Tonics are needed to replenish Yuan Qi, curing throat pain. Mistaking this for epidemic white-membrane throat leads to significant error, constituting the ninth difficulty. Another type lacks chills/fever; white peeling skin falls and regrows continuously. This is a cold syndrome cured by Rougui and Fuzi. Misusing Xiaofeng Baidu San causes little harm. Mistaking this cold-type for epidemic white-membrane throat causes shallow but serious damage, constituting the tenth difficulty. Understanding these ten difficulties allows for accurate diagnosis and treatment, with high success rates. Given the epidemic spread, I dare not keep this secret. It may not be a universal panacea but serves as a useful aid for practitioners.
Furthermore, treatment methods for white-membrane throat are vast and obscure. Despite extensive study, clinical application often reveals discrepancies between theory and practice. Disease manifestations vary greatly, requiring flexibility and grasp of essentials. I previously published a treatise on white-membrane throat, but new variations emerge frequently, including rapid fatalities and widespread contagion. Delayed treatment yields poor outcomes. Truly tragic. This is a malignant epidemic syndrome requiring careful examination of external signs, pulse, and throat interior/exterior, assessing the extent and thickness of white membranes before prescribing. Treating severe cases with mild agents causes disaster; treating mild cases with strong agents causes deep harm. Extremes are both detrimental. Early symptoms include severe chills, high fever, thirst, dry throat, hoarseness, inability to swallow fluids, phlegm obstruction, distension, excruciating pain, full-mouth whiteness, and surging, rapid pulse (possibly absent). This is caused by epidemic toxic qi, the most acute throat condition. Claims that throat diseases forbid cold-natured herbs are absurd. Frequent use of Jingfang Baidu San or Dachengqi Tang illustrates this error. Using Natrii Sulfas and Rhei Radix to purge stomach excess heat punishes the innocent, allowing pathogens to worsen the condition. Using Qianghuo and Fangfeng to treat Taiyang wandering wind scatters toxins, leading to incurable disease. I established Chuwen Huadu San (Plague-Dispelling and Toxin-Vanquishing Powder), Shengong Pixie San (Divine-Efficacy Evil-Expelling Powder), and Shenxian Huoming Tang (Immortal Life-Saving Decoction), achieving frequent success. However, for severe cases, these may lack potency. Thus, I created Longhu Erxian Tang (Dragon-Tiger Two Immortals Decoction), taken 2-3 doses daily for several days without changing formulas. Even if swallowing is impossible, gastric qi remains intact due to the principle "when diseased, the disease absorbs the medication." Stop medication once white membranes recede, then gradually restore Yuan Qi. For extreme cases with solid fire and deep organ heat blocking the throat, Xionghang Jiedu Wan (Realgar-Antidote Pill) is effective but potent and must be used cautiously. Detailed discussion requires practitioners to adapt flexibly based on experience. Neglecting timely treatment leads to cyanosis, dyspnea, phlegm obstruction, agitation, coma, and death, rendering even legendary healers powerless. Early white-membrane wind uses Gegen (Puerariae Lobatae Radix), Jiangcan (Bombyx Batryticatus), and Chenyi (Cicadae Periostracum) to disperse wind-heat; Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Yinhua (Lonicerae Japonicae Flos), and Tufuling (Smilacis Glabrae Rhizoma) reduce swelling and vanquish toxins; Yuanshen (Scrophulariae Radix), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), and Shengdi (Rehmanniae Radix) clear Lung and Kidney yin; Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shengzhiren (Gardeniae Semen), Shandougen (Millettiae Speciosae Radix), and Shengshigao (Gypsum Fibrosum) purge fire and save flames; Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), and Cheqianzi (Plantaginis Semen) guide heat downward; Bohe (Menthae Haplocalycis Herba) and Shegan (Belamcandae Rhizoma) disperse wind and reduce swelling. Severe cases add Mabo (Bletillae Rhizoma) and Longdancao (Gentianae Radix). Externally, Duniuqi decoction is applied before or after oral medication. Wannianqing Genzhi (Tradescantia Zebrina Root Juice) is ingested or held in the mouth. Critical cases require needle-induced vomiting. Mild cases use Chuwen Huadu San; moderate cases use Shengong Pixie San or Shenxian Huoming Tang. Dosages range from 1-2 to 3-4 daily. The goal is to draw epidemic toxins from Upper Jiao to Middle Jiao, then to Lower Jiao, excreting via intestines and bladder. Diarrhea indicates downward movement of fire-toxin, a favorable sign. If constipation persists, add cooked Dahuang; if still blocked, use raw Dahuang. Remove once bowels open, continuing until white spots disappear. Adjustments depend on clinical presentation; consistency ensures recovery. During the Dingmao year of Tongzhi, many severe cases failed despite proper initial treatment (Xiaofeng Baidu San). Upon detailed examination, I determined solid fire and condensed heat-toxin required stronger intervention. Longhu Erxian Tang yielded cures. Persistent cases responded to Xionghang Jiedu Wan followed by continued Longhu Erxian Tang. After white spots cleared, Qingliang agents like Qingxin Tiaofei Tang cleared residual toxins, followed by yin-nourishing formulas. Spleen-stomach deficiency patients received Sijunzi Tang plus Yinhua. Flexibility is key. For locked jaw, Kaiguan San opens the mouth. For severe pain, fatigue, and hoarseness post-medication, acupuncture is urgent. For severe neck/throat swelling, Jiuyi Yigong San is applied. Except for labor-induced white-membrane throat, this method applies to Dan'e, Shuang'e, Houyong (Throat Abscess), and general redness/swelling, with dosage adjustments. Avoid wind exposure post-medication. If misdiagnosed and treated with lifting, dispersing, tonifying, or warm-pungent herbs, administer raw Lvdou (Phaseoli Semen) powder mixed with cold water (one teacup for severe, one winecup for mild) to neutralize errors. Follow with prescribed drinks and barley porridge. For excessive phlegm, induce vomiting with Shengtongyou (Verniciae Oleum) and chicken feathers.
Examination of White-Membrane Throat: Early stage features headache, chills/fever, back distension, joint pain, varying throat pain levels, or hardness without pain. Whiteness appears immediately or after 2-3 days, progressing from spots/strips/blocks to full coverage. Treatment is uniform. Post-medication, whiteness tightens, thins, shrinks, or turns yellow before disappearing. Early detection and precise treatment are crucial. Careless practitioners may misdiagnose non-white-membrane cases as white-membrane and attack with harsh drugs, or miss true white-membrane cases and use mild drugs. Vulnerable groups (pregnant/postpartum women, children, elderly, post-illness deficiency) tolerate aggression poorly; improper treatment risks severity. Examination requires good lighting, patient seated upright, tongue pressed down to inspect sides for white-membrane, Dan'e/Shuang'e, or wind-fire throat. At night, use oil-paper torches. Do not visit patients on an empty stomach; consume realgar wine or garlic for protection.
Differentiating Fire vs. Cold Syndromes: Fire-type white-membrane throat shows floating, convex white patches, red/swollen throat, preference for cold foods, aversion to cold, yellow/black coating, and bowel/bladder obstruction with unceasing pain. Cold/deficiency types show no redness/swelling, preference for hot foods, red streaks on palate, sunken white patches, normal bowel/bladder function, and intermittent mild throat pain. Do not treat cold/deficiency types as standard white-membrane throat.