一谢 城明经有二孙。俱患白喉。季孙已死矣。长孙在危急间。医总用攻利解毒清润诸剂。不效。余用荆防败毒散。
重用羌活以散表邪而始效。继以参桂饮而夏效。适余他出。前医复用元麦地芍之类。喉内加生两蛾。蛾上见白点。
又内关复起白块两条。鼻塞出血。痰壅。两颧通红。右寸关脉浮数而散大。左缓弱。而两尺微。此皆为肾中阴寒
所逼。龙雷之火上乘也。若再清凉。则愈滋阴寒。寒愈盛而火愈升。肾脏几希之火。其为阴寒所灭甚速耳。故少阴脏
中。重在真阳。阳不回则邪不去。余以人参君主之药保元。肉桂辛温补火。入坎宫之命穴。但中宫为寒凉久困。更入
炮姜温中以助健行。少加柴胡以提外陷之邪。鼠粘僵虫利咽消核。果服一剂而平。但内关白块未退。痰与火未降。继
以参桂姜砂温补中下。南星法夏以消痰饮。鼠粘利咽。更入葱汁以通阳气。真火既归于中。而阴凝之毒自解。后以
术姜桂以收全功。
一杨君钧和有女三。长与季俱患白喉证毙。而仲女又患此证。延余往视。白块
将满。不甚疼痛。此虚寒证也。服理中汤。吹坎宫回生丹而愈。后其家传染者二。一服参艾饮。吹坎宫回生丹。一
服清咽利膈汤。吹离宫回生丹而皆愈。传染者虽一病源。而体气寒热攸分。所以又不可拘方也。
一湘潭胡君筠棠之子。小舌旁边一点白。痛甚。脉浮数而细。此病尚在表也。余用人参败毒散。其家恐药之
太轻也。别请医。以大承气汤加豆根元参二剂而病剧。既又延余转用荆防败毒散。三剂全愈。此轻证而用重剂之一戒也。
一湘潭马丈益卿六十余得一子。视若掌珠。凡食之稍寒者。必禁勿与。忽患白喉。色焦黄痛甚。余知其有积热
也。用清咽利膈汤。其家嫌药之苦寒。坚不与服。余因辞去。后医迎其意。以人参 术归地姜桂。其病转剧。次日声嘶
鼻血气喘。不三日而毙。此实热必用寒剂之一法也。
一常宁总戎周定安夫人病数日矣。杂证多端。尚不知为白喉。因不甚痛故也。一日偶言喉痛。延余往治。视内关白
块两条。色如凝膏。其家惧甚。余曰。幸而未服凉剂也。犹可以治。吹坎宫回生丹。服参桂饮二剂。白块减半。继以温
胃汤。不数剂而全愈。此寒证必用温剂之一法也。
一长沙清军府李兰生都转夫人忽患喉痛。发热恶寒头闷。心烦口渴。便涩鼻出
血丝。延余往医。见内关白块两条。色焦黄。肿痛异常。汤水难咽。舌苔边白中黄。诊右寸洪大。而左关浮数。
此足厥阴手太阴风火上冲而成也。余初用人参败毒散。吹离宫回生丹。肿痛俱减。次用四物甘桔汤。白块退。
诸证悉除。后用六味地黄汤加栝蒌壳丝茅根而全愈。
一长沙陈汉仙茂才喉痛数日。医用清润解毒诸剂而病愈剧。发热恶寒。痰涎上涌。声如拽锯。小便不通。汤
水不能下咽。已二日余矣。其家视变证蜂起。怆皇惧甚。延余往治。视喉内淡红微肿。内关白点已陷。舌苔白。
两手脉弦而紧。误以清凉凝闭风寒。阻滞经络。余用坎宫回生丹。合开关立效散。连吹二三次。立刻上下交通。
饮食即进。随以柴胡饮提已陷之邪。不数剂诸证悉除。后以加减六君子汤十剂而全愈。
一善化沈筱岚孝廉。大舌边起白泡数颗。医用元麦赤芍竹叶之类。连进三剂。一宵忽痰涎上涌。精神疲倦。
恶寒发热。胸结。饮食不能下咽。延余往治。诊两寸浮弦。右关沉紧。喉内白块已满。色如霜雪。痰涎稠粘不断。
此风寒在表。未经宣发。误以寒凉迭进。变成坏证也。余用荆防败毒散以驱表邪。吹
坎宫回生丹以祛恶毒。次日白块退净。而胸膈为风痰阻隔。食入少顷即吐。
不能直达中下二焦。证类关格。其家惧甚。复巫医杂投。百计罔效。余细察脉证。犹属风痰之毒阻隔。与喉无干。遂
用拔毒及引龙归海之法。始两耳颈项稍发红疹。再用艾叶皂角白酒炒热。布包熨之。随熨随发。遍体红疹无间。
其家以为变证。惧之尤甚。余曰此佳兆也。必欲提毒表出。始能开其阻隔。次日果胸膈豁然。饮食即进。随以人参败
毒散再提表以托毒。继以人参君主之药保元。鼠粘僵虫利咽。法夏陈皮以消痰饮。银花蝉蜕以清余毒。不数剂诸
证悉除。后用六君八珍以收全功。此风寒表证。必须宣发。不可辄用清凉之一戒也。
谢城明经有两个孙子，都患白喉。小孙子已经去世了。大孙子处于危急状态，医生一直使用攻下、利咽、解毒、清热滋润等方剂，但无效。我使用荆防败毒散，重用羌活以疏散表邪，才见效。随后用参桂饮调理而痊愈。恰逢我外出，前医又用了元参、麦冬、地黄、白芍之类的药物，导致咽喉内长出两个“蛾”（扁桃体红肿如蚕蛾状），“蛾”上出现白点。
又在内关穴处复起两条白块，鼻塞出血，痰液壅盛，两颧通红。右寸关脉浮数而散大，左脉缓弱，两尺脉微弱。这都是肾中阴寒逼迫所致，龙雷之火（相火）上乘于上。如果再使用清凉药，就会更加滋阴助寒，寒邪越盛，虚火越升，肾脏仅存的微弱真阳，很快就会被阴寒所灭。所以少阴脏病中，重在保护真阳，阳气不回复，邪气就不能去除。我以人参为君药来保元气，肉桂辛温补火，入坎宫（肾）之命门穴。只是中焦脾胃被寒凉药久困，再加入炮姜温中，以助运化健行。少加柴胡以提举外陷之邪，鼠粘子（牛蒡子）、僵蚕利咽消核。果然服一剂后病情平复。但内关处的白块未退，痰与火未降。继以参桂姜砂温补中下二焦，南星、法半夏以消除痰饮，鼠粘子利咽，再加入葱汁以通阳气。真火既归于中焦，阴凝之毒自然化解。后用白术、干姜、肉桂收全功。
杨钧和先生有三个女儿，长女和小女儿都因患白喉证去世，而次女又患此证。请我去诊治，见白块将满口，疼痛不甚严重。这是虚寒证。服用理中汤，吹坎宫回生丹而痊愈。后来家中传染了两人，一人服用参艾饮，吹坎宫回生丹；另一人服用清咽利膈汤，吹离宫回生丹，都痊愈了。虽然传染者病源相同，但体质有寒热之分，所以不可拘泥于固定方剂。
湘潭胡筠棠先生的儿子，小舌旁边有一点白，疼痛剧烈，脉浮数而细。此病尚在表。我用人参败毒散。其家人恐怕药力太轻，另外请医生，用大承气汤加豆根、元参，服两剂后病情加重。后又请我转用荆防败毒散，三剂后完全痊愈。这是轻证却用重剂的一个教训。
湘潭马益卿先生六十多岁得一子，视若掌上明珠。凡是食物稍偏寒的，必定禁止不给吃。忽然患白喉，颜色焦黄，疼痛剧烈。我知道他有积热，用清咽利膈汤。其家人嫌弃药性苦寒，坚决不肯服用。我因此辞去。后来的医生迎合其心意，用人参、白术、当归、地黄、干姜、肉桂等药，病情反而加重。第二天声音嘶哑，鼻出血，气喘，不到三天就死了。这是实热证必须用寒凉剂的一个法则。
常宁总戎周定安夫人患病数日，杂症多端，尚不知是白喉，因为疼痛不严重。一天偶然说喉咙痛，请我去治。查看内关有两道白块，颜色像凝固的膏脂。其家人非常恐惧。我说：幸好没有服用凉药，还可以治疗。吹坎宫回生丹，服用参桂饮两剂，白块减半。继用温胃汤，没几剂就完全痊愈。这是寒证必须用温剂的一个法则。
长沙清军府李兰生都转夫人忽然患喉咙痛，发热恶寒，头闷，心烦口渴，小便涩滞，鼻孔出血丝。请我去医治。见内关有两道白块，颜色焦黄，肿痛异常，汤水难以下咽。舌苔边白中黄。诊右寸脉洪大，左关脉浮数。这是足厥阴肝经、手太阴肺经风火上冲而成。我起初用人参败毒散，吹离宫回生丹，肿痛都减轻。接着用四物甘桔汤，白块消退，诸证悉除。后用六味地黄汤加瓜蒌壳、丝茅根而痊愈。
长沙陈汉仙茂才喉咙痛数日，医生用清润解毒等方剂，病情反而加重。发热恶寒，痰涎上涌，声音像拉锯一样，小便不通，汤水不能下咽，已经两天多了。其家人看到变证蜂起，惊慌恐惧。请我去治。看喉内淡红微肿，内关白点已凹陷，舌苔白，两手脉弦而紧。这是误用清凉药导致风寒凝闭，阻滞经络。我用坎宫回生丹，合开关立效散，连续吹二三次，立刻上下交通，饮食即可进服。随即用柴胡饮提举已陷入之邪，没几剂诸证悉除。后用加减六君子汤十剂而痊愈。
善化沈筱岚孝廉，大舌头边缘起几个白泡，医生用元参、麦冬、赤芍、竹叶等药，连进三剂。一夜之间忽然痰涎上涌，精神疲倦，恶寒发热，胸中结滞，饮食不能下咽。请我去治。诊两寸脉浮弦，右关脉沉紧，喉内白块已满，颜色如霜雪，痰涎稠粘不断。这是风寒在表，未经宣发，误用寒凉药接连进入，变成坏证。我用荆防败毒散以驱散表邪，吹坎宫回生丹以祛除恶毒。第二天白块退净，但胸膈被风痰阻隔，食入不久即吐，不能直达中下二焦，证候类似关格。其家人非常恐惧，又找巫医乱投药，百计无效。我仔细察脉证，仍属风痰毒邪阻隔，与喉部无直接关系。于是用拔毒及引龙归海的方法，开始两耳颈项稍微发红疹，再用艾叶、皂角、白酒炒热，布包熨烫。随熨随发，遍体红疹均匀。其家人以为是变证，尤其恐惧。我说这是佳兆，必须提毒透表，才能打开阻隔。第二天果然胸膈豁然开朗，饮食即进。随即用人参败毒散再提表以托毒，继以人参为君药的保元汤，鼠粘子、僵蚕利咽，法夏、陈皮以消痰饮，银花、蝉蜕以清余毒，没几剂诸证悉除。后用六君八珍汤收全功。这是风寒表证，必须宣发，不可轻易使用清凉药的一个教训。
Xie Chengmingjing had two grandsons, both suffering from diphtheria (Baihou). The younger grandson had already died. The elder grandson was in a critical condition. The physician continuously administered formulas for purgation, throat relief, detoxification, and cooling/moistening, but to no avail. I prescribed Jingfang Baidu San (Aurantium Decoction for Resisting Epidemic), heavily using Qianghuo (Notopterygii Rhizoma et Radix) to disperse the exterior pathogenic factor, which finally took effect. Subsequently, Shengui Yin (Ginseng and Cinnamon Twig Drink) was used, leading to recovery. Coincidentally, I was away, and the previous physician again used herbs such as Yuanshen (Scrophulariae Radix), Maidong (Ophiopogonis Radix), Dihuang (Rehmanniae Radix), and Baishao (Paeoniae Radix Alba). Consequently, "E" (tonsillar swelling resembling silkworm moths) grew inside the throat, with white spots appearing on them.
Furthermore, two strips of white patches reappeared at the Neiguan point (PC6), accompanied by nasal congestion, bleeding, phlegm obstruction, and flushed malar regions. The pulse at the right Cun and Guan positions was floating, rapid, scattered, and enlarged; the left pulse was slow and weak, while both Chi positions were faint. These symptoms are all caused by Yin-cold in the Kidney forcing the Dragon-Lei Fire (Ministerial Fire) to ascend upwards. If cooling medicines are used again, it will further nourish Yin and aid Cold. As Cold becomes more prevalent, the deficient fire rises higher, and the slight amount of true Yang remaining in the Kidney will be extinguished by Yin-Cold very quickly. Therefore, in Shaoyin Zang diseases, the focus is on True Yang. If Yang does not return, the pathogen cannot be expelled. I used Renshen (Ginseng Radix) as the sovereign herb to preserve Yuan Qi (Primal Qi), and Rougui (Cinnamomi Cortex) to warm and tonify Fire, entering the Mingmen acupoint (Gate of Life) in the Kan Palace (Kidney). However, since the Middle Jiao (Spleen/Stomach) had been confined by cold-cooling medicines for a long time, Paojiang (Zingiberis Rhizoma Preparatum) was added to warm the middle and assist digestion and movement. A small amount of Chaihu (Bupleuri Radix) was added to lift the pathogen that had sunk outward. Niubangzi (Arctii Fructus) and Jiangcan (Bombyx Batryticatus) were used to benefit the throat and dissipate nodules. Indeed, after one dose, the condition stabilized. However, the white patches at Neiguan did not recede, and phlegm and fire had not subsided. Subsequently, Shengui Jiangsha (Ginseng, Cinnamon Twig, Ginger, and Amomum) was used to warm and tonify the Middle and Lower Jiao, Tannan (Arisomatis Rhizoma) and Faxia (Pinelliae Rhizoma Preparata) to eliminate phlegm-fluids, Niubangzi to benefit the throat, and Congzhi (Allii Fistulosii Juice) to unblock Yang Qi. Once the True Fire returned to the Middle, the Yin-congealed toxin naturally resolved. Finally, Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), and Rougui were used to complete the treatment.
Yang Junhe had three daughters. The eldest and the youngest died from diphtheria, and the second daughter then contracted this disease. I was invited to examine her. The white patches were nearly filling the mouth, with mild pain. This is a deficiency-cold syndrome. She was given Lizhong Tang (Regulate the Middle Decoction), and Can Gong Huisheng Dan (Can Gong Revival Pill) was blown into the throat, resulting in recovery. Later, two others in the family were infected. One was treated with Shen'ai Yin (Ginseng and Mugwort Drink) and Can Gong Huisheng Dan; the other with Qingyan Lige Tang (Clear Throat and Purge Diaphragm Decoction) and Li Gong Huisheng Dan (Li Gong Revival Pill). Both recovered. Although the source of infection was the same, the constitutions differed in terms of cold and heat. Thus, one cannot rigidly adhere to a fixed formula.
The son of Hu Yuntang from Xiangtan had a small white spot beside the uvula, with severe pain. The pulse was floating, rapid, and fine. The disease was still at the exterior level. I prescribed Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxins). The family feared the prescription was too mild and consulted another physician, who administered Da Chengqi Tang (Major Order the Qi Decoction) plus Dougen (Millettiae Speciosae Caulis) and Yuanshen for two doses, causing the illness to worsen. They then invited me to switch to Jingfang Baidu San, which cured the patient completely after three doses. This serves as a warning against using heavy prescriptions for mild conditions.
Ma Yiqing from Xiangtan, over sixty years old, had a son whom he cherished like a pearl. He strictly forbade any slightly cold foods. Suddenly, the child developed diphtheria with scorched-yellow coloration and severe pain. Knowing there was accumulated heat, I prescribed Qingyan Lige Tang. The family disliked the bitter-cold nature of the medicine and refused to administer it. I therefore resigned. The subsequent physician catered to their preferences, prescribing Renshen, Baizhu, Danggui (Angelicae Sinensis Radix), Dihuang, Ganjiang, and Rougui. The condition deteriorated. The next day, hoarseness, epistaxis, and asthma appeared, and the child died within three days. This illustrates the principle that excess-heat syndromes must be treated with cold-cooling agents.
Madam Zhou Ding'an, wife of General Zhou from Changning, had been ill for several days with various complicated symptoms, yet diphtheria was not recognized due to the lack of severe pain. One day, she mentioned throat pain, and I was called to treat her. Two strips of white patches were observed at Neiguan, resembling congealed paste. The family was terrified. I said, "Fortunately, no cooling medicines have been taken; it can still be treated." Can Gong Huisheng Dan was blown into the throat, and Shengui Yin was administered for two doses, reducing the white patches by half. Wenwei Tang (Warm the Stomach Decoction) was then used, leading to full recovery after a few doses. This demonstrates the method that cold syndromes require warming agents.
Madam Li Lansheng, wife of Prefect Li from the Qing Army Headquarters in Changsha, suddenly suffered from throat pain, fever, aversion to cold, head heaviness, vexation, thirst, dysuria, and blood streaks from the nose. Upon examination, two strips of white patches were seen at Neiguan, scorched-yellow in color, with abnormal swelling and pain, making swallowing difficult. The tongue coating was white at the edges and yellow in the center. The right Cun pulse was surging and large, and the left Guan pulse was floating and rapid. This was caused by Wind-Fire ascending from the Foot Jueyin Liver Channel and Hand Taiyin Lung Channel. Initially, I used Ren Shen Bai Du San, blowing Li Gong Huisheng Dan into the throat, which reduced swelling and pain. Next, Siwu Ganjie Tang (Four Substances and Licorice-Kataver Decoction) was used, causing the white patches to recede and all symptoms to disappear. Finally, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Gualouqiao (Trichosanthis Pericarpium) and Simaogen (Imperatae Rhizoma) led to complete recovery.
Chen Hanxian from Changsha suffered from throat pain for several days. Physicians used cooling-moistening and detoxifying agents, worsening the condition. Symptoms included fever, aversion to cold, surging phlegm-saliva, a voice sounding like sawing wood, anuria, and inability to swallow liquids for over two days. The family was panicked by the sudden onset of complications. Upon examination, the throat interior was pale red and slightly swollen, with sunken white spots at Neiguan. The tongue coating was white, and both hands' pulses were wiry and tight. This resulted from the mistaken use of cooling medicines, which closed off Wind-Cold and blocked the meridians. I used Can Gong Huisheng Dan combined Kaiguan Lixiao San (Open Orifices and Instant Effect Powder), blown into the throat two or three times consecutively. Immediately, upper and lower communication was restored, and food could be ingested. Subsequently, Chaihu Yin (Bupleurum Drink) was used to lift the sunk pathogen, resolving all symptoms after a few doses. Finally, Jiajian Liujunzi Tang (Modified Six Gentlemen Decoction) for ten doses completed the cure.
Shen Xiaolan from Shan-hua had several white blisters on the edge of his tongue. Physicians prescribed Yuanshen, Maidong, Chishao (Paeoniae Radix Rubra), and Zhuye (Lophatheri Herba). After three doses, overnight, phlegm-saliva surged, spirit became fatigued, aversion to cold and fever appeared, chest oppression occurred, and swallowing was impossible. Examination revealed floating-wiry pulses at both Cun positions and deep-tight pulse at the right Guan position. White patches filled the throat, looking like frost and snow, with thick, sticky, continuous phlegm-saliva. This was Wind-Cold at the exterior, not yet released, transformed into a disastrous syndrome by the successive administration of cold-cooling medicines. I used Jingfang Baidu San to drive out the exterior pathogen and blew Can Gong Huisheng Dan to dispel malignant toxins. The next day, the white patches disappeared completely, but the chest and diaphragm were blocked by Wind-Phlegm. Food was vomited shortly after ingestion, unable to reach the Middle and Lower Jiao, resembling Guange (Obstruction and Reversal) syndrome. The family was terrified, and witch-doctors and miscellaneous physicians tried ineffective remedies. Careful observation of pulse and symptoms indicated that Wind-Phlegm toxin blockage remained, unrelated to the throat itself. I employed methods to extract toxins and guide the Dragon back to the Sea (returning Yang to its root). Red rashes appeared slightly around the ears and neck. Then, Aiye (Artemisiae Argyi Folium), Zaojiao (Gleditsiae Sinensis Spina), and Baijiu (White Wine) were stir-fried hot, wrapped in cloth, and applied as compresses. Rashes erupted uniformly across the body as compression continued. The family feared this as a complication. I stated this was a good omen, necessary to draw toxins to the surface to open the blockage. The next day, the chest felt clear, and eating resumed. Ren Shen Bai Du San was used again to lift the exterior and support the expulsion of toxins. This was followed by Baoyuan Tang (Preserve Origin Decoction) with Renshen as the sovereign herb, Niubangzi and Jiangcan for the throat, Faxia and Chenpi (Citri Reticulatae Pericarpium) for phlegm, and Yinhua (Lonicerae Japonicae Flos) and Chantui (Cicadae Periostracum) for residual toxins. All symptoms resolved after a few doses. Liu Jun Bazhen Tang (Six Gentlemen and Eight Treasures Decoction) was used to conclude the treatment. This serves as a warning that Wind-Cold exterior syndromes must be vented and should not be treated lightly with cooling agents.