此候大概非实热郁结肠胃。即肺阴枯涸已极。宜用宣白承气加入滋养药。否则用吴
鞠通增液承气汤。惟不可用峻利之品。
此候有因脾热所致。如内经所谓热争腹满泄是也。可用以上救误法。或因肝风大
煽。必须重用一甲煎。
此实危脱之候。多不可救。然间有因痰气壅结。气不得下者。可用鲜莱菔汁。或竟
用张氏消毒丸。以图万一。
此为白喉危脱时必有之候。可见此症必须揭重手太阴主治。如系痰火壅滞。可用大
辛凉加牛黄等味。或因误治。以致肺火太盛。聚液为痰。即牛黄亦觉苦燥。必须用
甘咸寒大剂。不可见痰而漫用辛燥也。
此症多因火毒蔓延。或过用大下所致。然亦有多获效。以上数症。余大女曾患此。
连服大剂三 降龙丹加一甲煎三剂获效。不可见此候即指为不治也。
此候多由火毒陷入足太阴。如内经所谓脾热病者。头重颊肿颜青是也。或肝火盛
极。本色发现者。亦有此候。
此真极重之候。多不可救。如系痰气壅结者。可竟用消毒丸。希图万一。
此系肺阴涸热。宜用泄火滋阴法。余长女亦然。因误用锡类散吹喉。实时音哑。及
后诸症全痊。半月余始觉渐渐清朗。如遇是候。须参入燕窝阿胶等味。
白喉病辨症既明。首讲用药。耐修所列正将猛将次将四层药表。井用药禁忌。抉择颇
为简当。然选药不多。未免印定后人眼目。且议论多不根于经典。尤难津逮后学。兹
取其意而详辨之。
耐修之言曰。治之之法。唯有以浓重之药镇其上层。以清凉之药润其次层。即此二
语。便觉大错。大凡医家用药。病在上焦宜轻清。病在下焦宜重浊。故上焦分两须
轻宜于散。下焦分两须重宜于丸。上焦药宜轻煎频服。下焦药宜浓煎顿服。岂有以
浓重镇上层。清凉润下层之理。此稍涉医学人。无不明析。不待精博群书也。唯所
收上层药中。如冬地为滋阴必用之药。石膏为燥火专门对症之药。胆草为足少阳泄
实火之药。川柏为手少阴泻实火之药。犀角为手少阴清虚火之专药。暗与病合。亦
非如伊芳之所谓镇也。如以为镇。则次将中之粉葛。极能升胃阳。行胃阴。为白喉最
忌之品。何镇之有。其次层药中如娄贝丹皮板蓝桑叶枇杷叶栀子木通等味。为此症
标本疏通经隧之要药。亦非如伊芳之所谓润也。倘以为润。则娄皮木通栀子兜铃皆苦
能助燥。何润之有。其中层下层之枳朴神曲查肉陈皮。或因平素脾胃湿痰蕴滞。或
因骤服寒凉腻药。中气不能健运。故亦可用。非常法也。否则炒麦芽亦能升发火
势。何可轻投。至硝黄更不易用。必须肠胃间积有实热。如古人所谓痞满燥实坚痛
诸候者。方可酌用。万不可轻易一试也。鄙意此症于初起时。或经误治。或已传
变。必须认明病源。（或燥火独病或风火兼病）详别经络。（或手太阴独病或少阳少阴兼病）
对症用药。自能丝丝入扣。不可模糊笼统。以寥寥数语。印定后人眼目也。
这种证候大抵不是实热郁结在肠胃，就是肺阴枯竭到了极点。适宜用宣白承气汤加入滋养药物；如果不适用，则使用吴鞠通增液承气汤。只是不可使用峻猛泻下的药物。
这种证候有因脾热引起的，如《内经》所说的“热争腹满泄”（邪热相争导致腹部胀满、腹泻）。可以使用上述纠正误治的方法。或者因为肝风剧烈煽动，必须重用一甲煎。
这实际上是危重脱失的证候，大多难以救治。然而偶尔也有因痰气壅结，导致气机不能下行的情况。可以使用鲜莱菔汁（萝卜汁），或者干脆使用张氏消毒丸，以图万一之效。
这是白喉病在危重脱失时必然出现的证候。由此可见，此症必须着重从手太阴肺经主治。如果是痰火壅滞，可用大辛凉方剂加牛黄等药味。或者因为误治，导致肺火过盛，聚津液为痰，此时即使牛黄也显得苦燥，必须使用甘咸寒的大剂量药物，不可见到痰就随意使用辛温燥烈的药物。
此症多因火毒蔓延，或过度使用峻下法所致。然而也有许多获得疗效的案例。以上几种证候，我的大女儿曾患此病，连续服用大剂量三降龙丹加一甲煎共三剂而获效。不可一见此证候就断定为不治之症。
这种证候多由火毒陷入足太阴脾经引起，如《内经》所说“脾热病者，头重颊肿颜青”。或者是肝火极盛，本色外露，也会有这种证候。
这是真正极其严重的证候，大多难以救治。如果是痰气壅结的情况，可以直接使用消毒丸，希图万一之效。
这是肺阴枯竭兼有内热的证候，适宜用泄火滋阴法。我的长女也是如此，因为误用锡类散吹喉，当时立即声音嘶哑，后来其他症状全部痊愈，半个月后才觉得逐渐清爽明朗。如果遇到这种证候，须加入燕窝、阿胶等药味。
对白喉病的辨证既然已经明确，首要讲究用药。耐修所列出的正将、猛将、次将四层药表以及用药禁忌，抉择颇为简明得当。但是选药不多，未免限制了后人的眼界，且议论多不基于经典，尤其难以引导后学。现在取其意旨而详细辨析。
耐修说：治疗的方法，只有用浓重的药物镇压上层，用清凉的药物滋润下层。仅凭这两句话，就觉得大错特错。大凡医家用药，病在上焦宜用轻清之品，病在下焦宜用重浊之品。所以上焦药物的分量须轻，宜于发散；下焦药物的分量须重，宜于丸剂。上焦药宜轻煎频服，下焦药宜浓煎顿服。哪里有以浓重药物镇压上层、清凉药物滋润下层的道理？这是稍微接触医学的人，没有不明白的，不需要精通博览群书也能知晓。只是他所收录的上层药物中，如冬地（麦冬）是滋阴必用的药物，石膏是清燥火的专门对症药物，胆草（龙胆草）是足少阳胆经泄实火的药物，川柏（黄柏）是手少阴心经泻实火的药物，犀角是手少阴心经清虚火的专用药物，暗合病情，也并非像他所说的“镇压”。如果说是镇压，那么次将中的粉葛根，极能升发胃阳、运行胃阴，是白喉最忌讳的药物，哪里谈得上镇压？其次层药物中如贝母、牡丹皮、板蓝根、桑叶、枇杷叶、栀子、木通等药味，是此症标本疏通经络隧道的要药，也并非像他所说的“滋润”。如果说是滋润，那么贝母皮、木通、栀子、紫菀都苦能助燥，哪里谈得上滋润？其中层和下层的枳壳、厚朴、神曲、山楂肉、陈皮，或者是因为平素脾胃湿痰蕴结停滞，或者是因为突然服用寒凉腻膈的药物，导致中气不能健运，所以也可以使用，但这并非常法。否则炒麦芽也能升发火势，怎么可以轻易投用？至于硝石、大黄更不容易使用，必须肠胃间积有实热，如古人所说的痞、满、燥、实、坚、痛诸种证候，方可酌情使用，万不可轻易尝试。我的意见是，此症在初起时，或者经过误治，或者已经传变，必须认清病源（或是燥火单独发病，或是风火兼病），详细辨别经络（或是手太阴肺经单独发病，或少阳、少阴经兼病），对症用药，自然能丝丝入扣，不可模糊笼统，用寥寥数语限制后人的眼界。
This syndrome generally is not due to excess heat stagnation in the intestines and stomach, but rather extreme dryness and depletion of Lung Yin (Lung Yin). It is appropriate to use Xuanbai Chengqi Tang (Chest White Purging Decoction) with added nourishing herbs; otherwise, use Wu Jutong's Zengye Chengqi Tang (Increase Fluids Purging Decoction). However, harsh purgatives must be avoided.
This syndrome may be caused by Spleen Heat, as described in the *Neijing* (Inner Canon): "Heat struggle leads to abdominal fullness and diarrhea." The aforementioned methods for correcting misdiagnosis can be used. Alternatively, it may be due to severe Liver Wind stirring internally, requiring heavy use of Yijia Jian (One Shell Decoction).
This is actually a critical condition of collapse and exhaustion, mostly incurable. However, occasionally there are cases where phlegm and Qi are congested and knotted, preventing Qi from descending. Fresh Radish Juice (Xian Laifu Zhi) can be used, or Zhang's Xiaodu Wan (Detoxification Pill) may be employed to attempt a remote possibility of success.
This is a necessary manifestation during the critical collapse stage of Diphtheria (Baihou). This indicates that treatment must focus heavily on the Hand-Taiyin Lung Meridian. If there is congestion of Phlegm-Fire, Da Xinliang (Great Acrid-Cool) formula with added Niuhuang (Calculus Bovis, Bezoar) etc. can be used. Or, due to mismanagement causing excessive Lung Fire, condensing fluids into phlegm, even Niuhuang may appear too bitter and drying. In such cases, large doses of Sweet, Salty, and Cold herbs must be used. One must not casually use Acrid-Drying herbs just because phlegm is present.
This syndrome often results from the spread of Fire-Toxin or overuse of drastic purgatives. Nevertheless, many cases have been effective. My eldest daughter suffered from these syndromes mentioned above; she took three doses of a large dose of Sanjianglong Dan (Three-Subduing Dragon Pill) combined with Yijia Jian and recovered. One must not declare this syndrome incurable simply upon seeing it.
This syndrome often arises when Fire-Toxin sinks into the Foot-Taiyin Spleen Meridian, as described in the *Neijing*: "Spleen Heat disease presents with heavy head, swollen cheeks, and bluish complexion." It may also occur when Liver Fire is extremely excessive, revealing its true color.
This is truly an extremely severe condition, mostly incurable. If it is due to congestion of phlegm and Qi, Xiaodu Wan (Detoxification Pill) can be used directly to hope for a remote possibility of success.
This is a syndrome of dried-up Lung Yin with internal heat, suitable for treating with Fire-Purging and Yin-Nourishing methods. My eldest daughter experienced this similarly; due to the misuse of Xilei San (Tin Category Powder) blown into the throat, her voice became hoarse immediately. Later, all other symptoms completely resolved, and only after more than half a month did she feel gradually clear and bright. When encountering this syndrome, herbs like Bird's Nest (Yanwo) and Donkey-Hide Gelatin (Ejiao) should be incorporated.
Having clarified the differentiation of symptoms for Diphtheria (Baihou), the primary emphasis is on medication. Naixiu's listed tables of Primary Generals, Fierce Generals, Secondary Generals, and four layers of medications, along with dietary and medicinal taboos, are chosen quite appropriately and concisely. However, the selection of herbs is limited, which inevitably restricts the perspective of later practitioners, and the discussions are largely not grounded in classics, making it difficult to guide students. Here, I take his intent and analyze it in detail.
Naixiu states: "The method of treatment lies only in using heavy and dense medicines to suppress the upper layer, and cooling medicines to moisten the lower layer." These two sentences alone reveal a major error. Generally, when physicians prescribe medicine, diseases in the Upper Jiao (Upper Burner) require light and clear herbs, while diseases in the Lower Jiao (Lower Burner) require heavy and turbid herbs. Therefore, dosages for the Upper Jiao should be light and suited for dispersion; dosages for the Lower Jiao should be heavy and suited for pills. Upper Jiao medicines should be lightly decocted and taken frequently; Lower Jiao medicines should be strongly decocted and taken in one dose. How can there be a principle of using heavy/dense medicines to suppress the upper layer and cooling/moistening medicines to lubricate the lower layer? Any person involved in medicine knows this clearly without needing to extensively study books. Among the upper-layer medicines he collected, such as Dongdi (Ophiopogonis Radix, Maidong) is essential for nourishing Yin; Shigao (Gypsum Fibrosum, Gypsum) is specifically for clearing dry fire; Danshen (though text says Danscao/Danshen context implies Longdan Cao Gentianae Radix, here interpreted as Gentianae Radix for Shaoyang) is for draining excess fire of the Foot-Shaoyang Gallbladder Meridian; Chuanbai (Phellodendri Cortex, Huangbai) is for draining excess fire of the Hand-Shaoyin Heart Meridian; Xijiao (Rhinocerotis Cornu, Rhinoceros Horn - note: modern substitutes used) is the specialized herb for clearing deficient fire of the Hand-Shaoyin Heart Meridian. These secretly match the pathology, but they are not "suppressing" as he claims. If considered suppression, then Fen Ge (Puerariae Lobatae Radix, Kudzu Root) in the secondary-general layer greatly raises Stomach Yang and moves Stomach Yin, which is the most contraindicated item for Diphtheria; how can this be called suppression? In the second-layer medicines, such as Loubei (Fritillariae Bulbus et Trichosanthis Fructus), Mudanpi (Moutan Cortex), Banlangen (Isatidis Radix), Sangye (Mori Folium), Pipaye (Loquat Leaf), Zhizi (Gardeniae Fructus), Mutong (Akebiae Caulis), etc., are key herbs for unblocking meridians to treat both root and branch of this syndrome; they are not "moistening" as he claims. If considered moistening, then Loupi (Trichosanthis Pericarpium), Mutong, Zhizi, and Doulou (Stemonae Radix) are bitter and assist dryness; how can this be called moistening? The Zhiqiao (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Shenqu (Medicated Leaven), Sharen (Ziziphi Spinosae Semen processed or Hawthorn fruit context implies Shanrou Crataegi Fructus), and Chenpi (Citri Reticulatae Pericarpium) in the middle and lower layers are either due to chronic damp-phlegm stagnation in the Spleen and Stomach, or due to sudden intake of cold/cloying medicines causing failure of Middle Qi transformation; thus they can be used, but this is not standard practice. Otherwise, Chaoya (Malto Fermented, Fried Malt) can also raise Fire potential; how can it be lightly administered? As for Xiaosh (Natrii Sulfas, Mirabilite) and Huanglian/Huangqin/Huangbo/Dahuang context implies Dahuang Rheum Radix et Rhizoma, here specifically Dahuang), they are even harder to use. They can only be considered if there is accumulated excess heat in the intestines and stomach, presenting the ancient signs of Pi (Glomus), Man (Fullness), Zao (Dryness), Shi (Solid), Jian (Hardness), and Tong (Pain). Only then can they be used cautiously. Never try them lightly. My opinion is that at the initial stage of this syndrome, or after mismanagement or transmission, one must clearly identify the disease source (whether Dry-Fire acts alone or Wind-Fire combines) and carefully differentiate the meridians (whether Hand-Taiyin acts alone or Shaoyang/Shaoyin combine). Prescribing according to the syndrome will naturally fit perfectly. One must not be vague or general, nor limit the perspectives of later generations with mere few words.