白喉险症也。灵素以来。未详着录。国朝道光间湖南陈氏雨春始着白喉咙证论。(见白喉捷
要常叙)其乡人浏阳张善吾绍修本其意作白喉捷要。大旨言足三阴受病。传之于肺。已失
白喉本来面目。而用药又不出风火喉痹之范围。与手太阴燥火了无关涉。郑氏梅涧所
着重楼玉钥。言此症或遇燥气流行而发。用药以清肺养阴为主。颇为中的。然语焉不
详。得失参半。似未能洞彻源流者。(如既言或遇燥气流行而发又言此症在少阴一经热邪伏其间盗肺
金之母气云云用药既以养阴清肺为主又言只宜紫正散夫紫正散之荆芥防风荆皮细辛与养阴清肺汤之冬
地白芍丹皮奚啻冰炭何郑氏竟相提并论也)光绪戊子京师是症大发。有耐修子者。以戚串中多遭
其厄。悉心讲求。托之神道。采二家之言。着白喉治法忌表抉微。选择颇为简要。然
此君非素业岐黄之术者。于受病之源流经络。用药之色味气性。茫无真知灼见。故语
多不根。尤不足以津逮后学。癸巳春余及二女一子于数日间次第传染。(壬辰秋冬之交天久不雨燥气
盛行冬至后大霜雪寻常湖溆冰浓寸许瓯郡地气极暖不见此气候者已六七十年至立春后雨水骤至是症辄
大发闻郡城医者多以辛温表散从事小儿遭厄者甚伙)长女以张氏法治之。几至不起。幸以大辛凉合甘
咸寒法日进三大剂获效。(张氏所列无治之症十一条已居其八)次女少子遂悉用养阴法。
次女愈而少子夭。此中疑团。几不可破。甲午秋季少女(时才周岁)患伏暑病。身热痉厥。痰
嗽而喘。投以清热化痰。通络息风剂。痉厥愈而诸症不减。至日晡时痰喘愈甚。与白
喉病将绝时形象。宛然无异。急用前方加入西洋参石膏大辛凉法与之。痰喘顿止。而
身热亦愈。始恍然于白喉病之标本传变。从前医治之或得或失。一一了如指掌。且深
悉张氏郑氏耐修氏三先生之书。虽各有心得。实未能穷极源流也。于是潜心探索。汇
集众长。证以经谊。参以阅历。迟之数年。作白喉订正论一卷。呈政于蛰庐主讲。主
讲曰。是论虽详。然头绪繁多。篇幅长冗。恐阅者未易贯彻。盍仿吴鞠通氏着温病例
为白喉条辨。庶几纲举目张。作者既易于发明。阅者复易于寻绎。余曰。善。退而作
条辨一十五条。稿既脱。因为叙其大旨。虽当仁不让。于张氏郑氏耐修氏三先生之
言。间多指摘。然非三先生开先河之功。余亦安能遽集其成也。后有作者。倘能阐发
微旨。匡兹不逮。岂特余与三先生之幸。抑天下生灵有浓望焉。
光绪二十三年岁丁酉夏月
白喉是一种危险的病症。自《灵枢》、《素问》以来,对此病没有详细的记载。清朝道光年间,湖南陈氏雨春开始撰写《白喉咙证论》(见于《白喉捷要·常叙》)。他的同乡浏阳人张善吾绍修在此基础上,依据其意旨编写了《白喉捷要》。该书的大旨认为此病源于足三阴经受邪,进而传变至肺,但这已经失去了白喉病的本来面目,而且用药范围未超出风火喉痹的范畴,与手太阴肺经的燥热病机无关。郑梅涧所著的《重楼玉钥》中提到,此症有时因燥气流行而发作,用药以清肺养阴为主,颇为切中要害。然而论述不够详尽,得失参半,似乎未能透彻探究疾病的源流。(例如:既然说可能因燥气流行而发作,又说此症在少阴一经有热邪潜伏其中,盗取肺金之母气;用药既然以养阴清肺为主,又说只宜用紫正散。夫紫正散中的荆芥、防风、荆皮、细辛,与养阴清肺汤中的冬花、地黄、白芍、丹皮,岂止是冰炭不相容?郑氏竟然将二者相提并论。)光绪戊子年(1888年),京城此症大规模爆发。有一位自称“耐修子”的人,因为亲戚串门中多人遭受此病折磨,便悉心研究,托辞神道启示,采纳前两家之言,撰写了《白喉治法忌表抉微》,选材颇为简要。然而此人并非精通岐黄之术的专业医生,对于受病的源流经络、用药的色味气性,缺乏真知灼见,所以言论多无根据,尤其不足以引导后学。癸巳年(1893年)春季,我和两个女儿、一个儿子在几天内依次被传染。(壬辰年秋冬之交,天久不雨,燥气盛行,冬至后大霜雪,寻常湖溆冰层厚达寸许,温州地区地气极暖,已有六七十年未见此气候,直到立春后雨水骤至,此症便大发,听说郡城医者多以辛温解表法治疗,小儿受害甚多。)长女采用张氏的方法治疗,几乎无法挽救,幸好采用大辛凉合甘咸寒法,每日进服三大剂,才获得疗效。(张氏所列不可治的十一条症状,我家孩子已占了八条。)次女和最小的儿子完全采用养阴法治疗,结果次女痊愈而小儿子夭折。其中的疑团,几乎无法破解。甲午年(1894年)秋季,小女儿(当时仅一周岁)患伏暑病,身体发热、痉挛抽搐、昏厥,痰嗽且气喘。投以清热化痰、通络息风的药剂,痉挛抽搐虽愈但其他症状不减,到了傍晚时分痰喘更加严重,这与白喉病临终时的形象毫无二致。急忙用前方加入西洋参、石膏,采用大辛凉法给予服用,痰喘顿时停止,身体发热也随之痊愈。这才恍然大悟于白喉病的标本传变规律,从前医治的或得或失,一一了然于心。并且深知张氏、郑氏、耐修氏三位先生的著作,虽然各有心得,但实际上都未能穷尽疾病的源流。于是潜心探索,汇集众长,结合经典医理,参考临床经验,经过数年努力,撰写了《白喉订正论》一卷,呈请蛰庐主讲先生指正。主讲先生说:“这篇论述虽然详细,但头绪繁多,篇幅冗长,恐怕读者不易贯通理解。何不模仿吴鞠通氏撰写《温病例》的方式,写成《白喉条辨》?这样就能纲举目张,作者易于阐发,读者也易于寻绎。”我说:“好。”退而撰写了十五条条辨。稿成之后,因此叙述其大旨。虽然当仁不让,对张氏、郑氏、耐修氏三位先生的言论多有指摘,但若没有三位先生开先河之功,我又怎能集其大成呢?后来的作者,如果能阐发其中的精微旨意,弥补我的不足,这不仅是我和三位先生的幸运,也是天下百姓的期望啊。
光绪二十三年岁丁酉夏月
Baihou (White Throat) is a perilous condition. Since the *Ling Shu* and *Su Wen*, there has been no detailed record of it. During the Daoguang reign of the Qing Dynasty, Chen Yuchun from Hunan began to write *Treatise on White Throat Symptoms* (see *Chang Xu* in *Jie Yao Bai Hou*). His fellow townsman Zhang Shanwu Shaoxiu from Liuyang, based on this intent, compiled *Jie Yao Bai Hou*. The main thesis argues that the disease originates from the three Yin meridians of the foot being affected and transmitting to the Lung, which has already lost the true nature of Baihou. Furthermore, the medication used does not go beyond the scope of Wind-Fire Sore Throat (Feng Huo Hou Bi), having no relation to the Dryness-Heat of the Hand-Taiyin (Lung). Zheng Meijian's *Zhong Lou Yu Qiao* states that this condition may occur due to the prevalence of Dryness Qi, and treatment should focus mainly on Clearing the Lung and Nourishing Yin, which is quite accurate. However, the discussion is not detailed enough, with pros and cons mixed, seemingly failing to thoroughly understand the source and evolution of the disease. (For instance, while stating it may be triggered by Dryness Qi, it also claims heat pathogen hides in the Shaoyin meridian, stealing the Mother Qi of Metal (Lung); while advocating Nourishing Yin and Clearing Lung, it also recommends Zizheng San. Jingjie, Fangfeng, Jingpi, and Xixin in Zizheng San are as incompatible as ice and charcoal compared to Donghua, Dihuang, Baishao, and Danpi in Yangyin Qingfei Tang. How can Zheng list them together?) In the Wuzi year of Guangxu (1888), this disease broke out widely in Beijing. A person calling himself "Naixiu Zi," whose relatives suffered greatly from this illness during visits, studied it meticulously, attributing insights to divine revelation. He adopted views from the previous two authors and wrote *Jie Biao Jue Wei Bai Hou Zhi Fa*, selecting materials concisely. However, this gentleman was not a professional practitioner of Qi-Huang medicine; he lacked true insight into the source, evolution, and meridians of the disease, as well as the color, flavor, aroma, and properties of medicinal substances. Thus, his words were often baseless and insufficient to guide future scholars. In the spring of the Guisi year (1893), I, along with my two daughters and one son, were successively infected within a few days. (In the transition between autumn and winter of the Renshen year, it had not rained for a long time, and Dryness Qi prevailed. After the Winter Solstice, heavy frost and snow occurred, with ice layers on ordinary lakes and streams reaching an inch thick. Oujun (Wenzhou) has very warm local climate conditions, and such weather had not been seen for 60-70 years. After the Start of Spring, sudden rains caused the disease to erupt wildly. It was heard that many doctors in the prefecture treated it with Acrid-Warm exterior-releasing methods, resulting in many pediatric casualties.) My eldest daughter was treated using Zhang's method, nearly dying. Fortunately, by administering large doses of Da Xin Liang combined with Gan Xian Han methods three times daily, she recovered. (Eight of the eleven untreatable symptoms listed by Zhang were present in her case.) My second daughter and youngest son were treated entirely with Nourishing Yin methods. The second daughter recovered, but the youngest son died. The doubts involved were almost insurmountable. In the autumn of the Jiawu year (1894), my youngest daughter (then only one year old) suffered from Fu Shu (Hidden Summerheat) disease, presenting with fever, spasms, convulsions, phlegm-cough, and wheezing. She was given formulas to Clear Heat, Resolve Phlegm, Unblock Collaterals, and Extinguish Wind. Although the spasms and convulsions ceased, other symptoms persisted. By late afternoon, the phlegm and wheezing worsened significantly, resembling the terminal stage of Baihou perfectly. Urgently, I added Xiyangshen (American Ginseng) and Shigao (Gypsum) to the previous formula, applying the Da Xin Liang method. The phlegm and wheezing stopped immediately, and the fever subsided. Only then did I suddenly realize the root and branch transmission changes of Baihou, understanding clearly why previous treatments had varying degrees of success or failure. I deeply realized that although the works of Mr. Zhang, Mr. Zheng, and Mr. Naixiu each had their merits, none had exhausted the source and evolution of the disease. Therefore, I devoted myself to exploration, synthesizing strengths, verifying with classic theories, and referencing clinical experience. After several years, I composed *Baihou Dingzheng Lun* (Corrected Treatise on Baihou), one volume, and submitted it to Principal Zhelu for correction. The Principal said: "Although this treatise is detailed, it has too many threads and is lengthy, making it difficult for readers to grasp fully. Why not imitate Wu Jutong's style in writing *Wenbing Anli* (Cases of Warm Diseases) to create *Baihou Tiaobian*? This way, principles will be clear and details organized, making it easier for the author to expound and for readers to follow." I agreed. Subsequently, I drafted fifteen articles (*Tiaobian*). Upon completion, I wrote this preface to outline the main ideas. While I dare not yield my responsibility and have pointed out flaws in the works of Mr. Zhang, Mr. Zheng, and Mr. Naixiu, without their pioneering efforts, how could I have achieved this synthesis? May future authors elucidate its subtle meanings and correct my deficiencies. This would be not only a blessing for me and the three gentlemen but also a hope for all living beings under heaven.
Summer of the Dingyou Year, 23rd Year of Guangxu