一是证轻者，微发于咽旁；重者，其白蔓于喉及喉管；至极重者，其白缠满肺系，以及肺内皆有，非仅现形
于喉部也。是以打呛音喑，鼻塞气喘齐作，皆由白腐粘塞于内之故，所谓有诸内必形诸外者也。试思辛温表散，
攻下寒凉等法，可施否乎？一经妄投，其白在内，浸淫愈甚，肺气益亏，更速其殆，不过七日发喘而毙矣。一白
腐，切不可动手用刮及妄施针灸，此原属内因虚候，非风热实症之可伦。尝见有用牙片将白腐强刮以为立时取效，
希夸
妙手之名，殊不知动刮之后，其白虽去，旋复萌发，必较前更剧，且刮时每致伤出血，而腐处痛益甚，症亦增重
矣。因刮伤而致殒者，盖亦不少，然犹执而不改，不识从何处得来，如此神奇，竟不肯舍，即如舌疮糜烂，亦动
刮之，是诚何心哉！将谓刮法易效，效捷于汤液之治，胜于一匕活人，其功岂不大哉？无如动刮之后，每多不救，
吁！过而不改，是谓过矣，为仁术者，当如是乎。一白腐不挟杂证犹易施治，倘兼他症，或发瘾疹流丹斑瘭，又
壮热不退等候，最难着手，须知丹疹斑瘭有阴阳之别及虚实之分，不得执定风热实火，使用石膏、黄连、黄芩、
花粉、犀角等味，一经妄投，转为内陷，必致循衣摸床，直视谵语，诸败症现矣，洵难救治。若体质属实，或口
渴引饮，大便闭结，小便短少，脉数有力，审明证与脉合，舌胎焦黄，其喉间白腐势轻，而浑身丹斑之势重，色
赤如丹砂，亦须养阴中或加石膏、山栀、炒芩之类清之可也。倘本质虚弱肝肾不足，其白腐重于丹疹，两脉虚数
无力，口不渴，或渴不喜饮，舌苔柔嫩无焦黄色，此乃浮游之火腾越，非实火也。书云∶火之有余，即水之不足，
切勿徒从事于丹疹，只须注重养阴，兼以清润，斯一举而两得矣。一丹疹每因喉患，初起有发热恶寒之作，医者
不察所因，拟为时感之症，辄误用苏叶、桂枝、干姜、附子、羌活、浓朴之类，阴液为其所灼，鼓动浮游之火，
燥中加燥，以致逼出丹疹，此乃属无根之火。假使妄施寒凉，则水极反从火化，其误不浅。一白腐发于严寒者，
因寒邪蕴而为热，起初不知病由，认作感受寒邪，误服干姜葱汤，以致喉痛，发为白腐，其鼻不塞可治。若鼻塞
及胸胁筑闷，则诚难治。缘肺热还伤肺也，如发热时，喉内两旁红肿而有白腐者，宜先用荆防、薄荷、牛蒡子之
类微疏解之，再用治白腐法，而患自平。若频进祛风散寒及辛温之剂，白腐未必能除，即变生他症，或且胸筑痰
鸣气喘等候作矣。一白腐俗呼白菌。凡乡隅小儿患此者，土人尝取树上所生湿菌煎洗，及与菌汤服之，其
轻者间或有验，重者每多致误，第不识从何处传来以菌，治菌诚可叹也。
一苏郡近出《吴医汇讲》一书，内有烂喉丹痧，论盖即吾乡所患之白腐症也。其论三则∶一唐子迎川，一祖
君鸿范，一李子纯修，皆云近来患者甚多，患而死者亦复不少，并易传染，方书未详言，及治亦无从措手。唐氏
云∶或言辛散，或言凉解，或言苦寒，俱师心自用，各守专门，未尝探其本源，乃引仲师《金匮》书阳毒之为病，
以升麻鳖甲汤主之。指《内经》热淫于内治以咸寒，佐以苦甘之旨，而祖君则论是症之所来，不外乎风寒湿热，
时厉之气，解表清热，各有所宜，治之得宜，当愈不移时，治失其宜祸生反掌。若漫用寒凉，则外益闭而内火益
焰，咽痛益剧溃烂日甚。不明是理者，反云如此凉药，尚且火势勃然，犹谓寒之未尽，于是愈凉愈遏，以致内陷
而毙者有之。或有议用清凉者，乃以郁遏诽之，炎热燎原，杀人最暴，此偏于散而谤诽清者之为害也。彼言散之，
宜此方散之祸，彼言寒之祸。此言寒之宜要惟于先后次第之间，随机权变，斯各中其 耳。李氏之言，则云譬之
于物以盛火 之，只见干燥而不知湿热郁蒸，所以致腐耳。其患之处色白如粉皮样，或腐至小舌，鼻塞合眼朦胧
者，皆不治之症。总之，因天地不正之气，感而受之，故体有虚实之不同，即症有轻重之各异。瀚按∶三子所论，
皆指风热湿寒属实症而言，未尝悟及伤燥，与夫肺肾阴虚之烂喉也。是故外因诸实症易晓，而内因不足之咎人每
多忽略焉。至唐氏引《金匮》升麻鳖甲汤，法分阳毒阴毒之义，亦尚未妥善也。一白腐固有寒热虚实之分，不尽
属于燥之一端，有因风寒蕴蓄而发者，有受风热侵越而致者，有嗜食炙 辛热之味熏灼而患者，有实中兼虚者，
亦有虚中兼实者，有似虚而属实者，亦有似实而属虚者，证各不同，治当分辨，未可拘执呆法，至于宜表散，宜
辛温、宜清凉、宜温补、宜养阴，贵在乎临证之际，机巧权变，神而明之，庶几其可耳。
一是病情较轻者，白腐仅微微出现在咽喉旁边；病情较重者，白腐蔓延至喉部及气管；到了极重程度时，白腐缠绕满布肺系（呼吸系统），甚至肺内部也都有，不仅仅表现在喉部。因此呛咳、声音嘶哑、鼻塞、气喘等症状同时出现，都是因为白腐粘滞堵塞在内部的缘故，这就是所谓“有诸内必形诸外”的道理。试问辛温解表、攻下寒凉等方法，可以使用吗？一旦误用，体内的白腐会浸淫扩散，更加严重，肺气更加亏损，加速死亡，不过七天就会因喘息而毙命。对于白腐，切不可动手刮除或盲目施针，这原本属于内因导致的虚证候，不能与风热实证相提并论。曾见到有人用牙片强行刮除白腐以图立即见效，希望夸耀自己妙手回春的名声，却不知道刮除之后，白腐虽然暂时去除，但随即又会萌发，而且比之前更剧烈，并且刮除时往往导致出血，使得腐烂处疼痛更加严重，病症也随之加重。因为刮伤而导致死亡的，大概也不在少数，然而这些人仍然固执不改，不知这种观念从何而来，竟不肯舍弃如此“神奇”的方法，就像舌疮糜烂，也要去刮它，这究竟是何居心！难道认为刮法容易见效，疗效快于汤药治疗，胜过一匕救人的功效，其功劳岂不是很大吗？无奈刮除之后，往往多无法挽救，唉！有过错而不改正，这就叫过错，作为施行仁术的医生，应当这样做吗？
白腐如果不夹杂其他病症，还比较容易治疗；倘若兼有其他症状，或者并发瘾疹、流丹、斑瘭等，又伴有壮热不退等情况，就最难着手。必须知道丹疹斑瘭有阴阳的区别和虚实的分别，不能固执地认为是风热实火，就使用石膏、黄连、黄芩、花粉、犀角等药物，一旦误用，病邪转为内陷，必然导致循衣摸床、直视谵语等败症出现，确实难以救治。如果体质属实，或者口渴想喝水，大便闭结，小便短少，脉象数而有力，仔细审察证候与脉象相符，舌苔焦黄，此时喉间白腐之势较轻，而浑身丹斑之势较重，颜色赤红如丹砂，也须在养阴的基础上，加入石膏、山栀、炒黄芩之类来清热即可。如果本质虚弱，肝肾不足，白腐重于丹疹，两脉虚数无力，口不渴，或者口渴但不喜欢喝水，舌苔柔嫩没有焦黄色，这是浮游之火腾越，并非实火。医书说：“火之有余，即水之不足”，切勿只专注于治疗丹疹，只需注重养阴，兼以清润，这样一举两得。
丹疹每因喉部疾病引起，初起时有发热恶寒的表现，医生不考察病因，将其拟为时感（季节性流行感冒）之症，辄误用苏叶、桂枝、干姜、附子、羌活、浓朴等药物，阴液被这些药物灼伤，鼓动浮游之火，燥上加燥，以致逼出丹疹，这属于无根之火。假使妄施寒凉药物，则水极反从火化，错误就不小了。
白腐发于严寒季节者，是因为寒邪蕴积化为热，起初不知道病因，误认为感受寒邪，误服干姜葱汤，以致喉痛，发为白腐，如果鼻子不塞是可以治疗的。如果鼻塞以及胸胁胀闷，那就确实难治。这是因为肺热反过来伤害肺脏。如果在发热时，喉内两旁红肿且有白腐者，宜先用荆芥、防风、薄荷、牛蒡子之类轻微疏解，再用治疗白腐的方法，病患自然平复。如果频繁进用祛风散寒及辛温的药物，白腐未必能消除，反而变生他症，或者出现胸中筑痛、痰鸣气喘等情况。
白腐俗称为白菌。凡是乡里小儿患此病的，当地人常取树上生长的湿菌煎水清洗，以及给患儿服用菌汤，轻的偶尔有效，重的往往导致误治。只是不知道这种方法从何传来，用菌治菌，实在令人叹息。
苏州郡最近出版了《吴医汇讲》一书，其中有烂喉丹痧的论述，大概就是我家乡所患的白腐症。其中有三篇论述：一篇是唐子迎川写的，一篇是祖君鸿范写的，一篇是李子纯修写的，都说近来患者很多，患病死亡的也不少，而且容易传染，方书里没有详细记载，治疗也无从下手。唐氏说：有人说用辛散，有人说用凉解，有人说用苦寒，都是主观臆断，各守专门，未曾探求本源，于是引用张仲景《金匮要略》中关于阳毒病的论述，主张用升麻鳖甲汤主治。引用《内经》“热淫于内，治以咸寒，佐以苦甘”的宗旨。而祖君则论述此症的发生，不外乎风寒湿热及时行厉气，解表清热各有适宜之处，治疗得当，当时即可痊愈；治疗失当，祸患转瞬即生。如果漫用寒凉，则外部更加闭塞，内部火势更加旺盛，咽痛更加剧烈，溃烂日益严重。不明白这个道理的人，反而说如此凉药，尚且火势勃然，还认为寒凉不够，于是愈凉愈遏阻，导致病邪内陷而死的案例也有。或者有建议用清凉药的，却被指责为郁遏，火热燎原，杀人最暴，这是偏重于发散而诽谤清凉药的危害。他说发散之祸，他说寒凉之祸，我说寒凉之宜，关键在于先后次第之间，随机应变，这样才能各中肯綮。李氏的话，则是比喻如同物体被盛火烘烤，只见干燥而不知湿热郁蒸，所以导致腐烂。患处颜色白如粉皮样，或者腐烂至小舌，鼻塞、眼睛朦胧者，都是不治之症。总之，因天地不正之气，感染而致病，所以人体有虚实不同，病症也就有轻重各异。我按语道：三位先生的论述，都指风热湿寒属于实证而言，未曾领悟到伤燥，以及肺肾阴虚导致的烂喉。因此外因诸实证容易理解，而内因不足的罪过人们往往多忽略。至于唐氏引用《金匮》升麻鳖甲汤，区分阳毒阴毒的意义，也尚未妥善。
白腐固然有寒热虚实之分，不尽属于燥这一端，有因风寒蕴蓄而发的，有受风热侵越而致的，有嗜食炙烤辛辣热味熏灼而患病的，有实中兼虚的，亦有虚中兼实的，有似虚而属实的，亦有似实而属虚的，证候各不相同，治疗应当分辨，不可拘执呆板的方法，至于宜表散、宜辛温、宜清凉、宜温补、宜养阴，贵在临证之际，机巧权变，神而明之，差不多就可以了。
One, in cases of mild severity, the white putrefaction (white membrane) appears slightly on the sides of the throat; in severe cases, it spreads over the throat and trachea; in extremely severe cases, it entangles the entire lung system (respiratory tract) and even fills the interior of the lungs, not merely manifesting at the throat level. Therefore, coughing with a choking sensation, hoarseness, nasal congestion, and asthma occur simultaneously, all due to the obstruction caused by the sticky white putrefaction inside. This is what is meant by "what exists internally must manifest externally." One should ask: can methods such as acrid-warm exterior-releasing or purgative cold-clearing be applied? Once wrongly administered, the internal white putrefaction will spread and intensify, further depleting Lung Qi, accelerating death, leading to fatal asthma within seven days. Regarding white putrefaction, one must absolutely avoid scraping or blindly applying acupuncture, as this originally belongs to deficiency patterns caused by internal factors, which cannot be compared to excess patterns of Wind-Heat. I have seen practitioners use dental tools to forcibly scrape off the white putrefaction to achieve immediate results, hoping to boast of their miraculous skills. Little do they know that after scraping, although the white putrefaction is temporarily removed, it soon regrows, often more severely than before. Moreover, scraping often causes bleeding, increasing pain at the ulcerated site and worsening the condition. Deaths resulting from such scraping are not uncommon, yet these practitioners remain obstinate, unable to understand where such ideas come from, and refuse to abandon this "miraculous" method. Even for tongue ulcers and erosion, they resort to scraping; what kind of mindset is this? Do they believe scraping is effective, faster than decoction therapy, and superior to saving lives with a single dose? How great would that merit be? Unfortunately, after scraping, many patients cannot be saved. Alas! To err and not correct it is called an error. Should benevolent physicians act thus?
White putrefaction without mixed symptoms is relatively easy to treat. However, if accompanied by other symptoms, such as urticaria, erysipelas, macules, or papules, along with high fever that does not subside, it becomes most difficult to manage. It must be understood that erysipelas, rashes, macules, and papules have distinctions of Yin/Yang and Deficiency/Excess. One must not rigidly assume Wind-Heat Excess Fire and indiscriminately use herbs like Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Huafen (Trichosanthis Radix), and Xijiao (Rhinocerotis Cornu). Once wrongly used, the pathogen may sink inward, inevitably leading to critical signs such as grasping at bedclothes, staring fixedly, and delirious speech, presenting various failure syndromes, which are indeed hard to save. If the constitution is Excess, characterized by thirst with desire to drink, constipation, scanty urine, rapid and forceful pulse, and careful examination confirms the syndrome matches the pulse with scorched yellow tongue coating, while the white putrefaction in the throat is mild but the systemic rash is severe and red like cinnabar, treatment should nourish Yin and add Gypsum, Gardenia, and stir-fried Scutellaria to clear heat. If the constitution is deficient with Liver and Kidney insufficiency, the white putrefaction is heavier than the rash, pulses are deficient, rapid, and weak, mouth is not thirsty or thirst is present but without desire to drink, and tongue coating is tender without scorched yellow color, this represents floating fire surging upward, not excess fire. The classics state: "Excess of Fire indicates Insufficiency of Water." Do not focus solely on treating the rash; instead, prioritize nourishing Yin and adding moistening clearing agents, achieving two benefits with one move.
Erysipelas often arises from throat diseases. Initially, there may be fever and aversion to cold. If physicians fail to investigate the cause and misdiagnose it as seasonal influenza, they may wrongly use herbs like Ziyeh (Perilla Folium), Guizhi (Cinnamon Twig), Ganjiang (Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Qianghuo (Notopterygii Rhizoma et Radix), and Houpo (Magnoliae Officinalis Cortex). These herbs scorch the Yin fluids, agitate floating fire, and create dryness upon dryness, forcing out erysipelas. This belongs to rootless fire. If cold-natured herbs are wrongly applied, extreme water transforms into fire, causing significant error.
When white putrefaction occurs in severe cold, it is because Cold pathogen accumulates and transforms into Heat. Initially, unaware of the cause, it is mistaken for Cold invasion, and Ganjiang Congtang (Dry Ginger and Scallion Decoction) is wrongly taken, leading to sore throat and white putrefaction. If the nose is not congested, it is treatable. If nasal congestion and chest/hypochondriac oppression occur, it is truly difficult to treat, as Lung Heat damages the Lung itself. If during fever, both sides of the throat are red, swollen, and have white putrefaction, initially use Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), and Niubangzi (Arctii Fructus) to mildly release the exterior, then apply treatments for white putrefaction, and the illness will subside. Frequent administration of Wind-dispelling, Cold-resolving, and Acrid-Warm agents may not remove the white putrefaction and may generate other symptoms, such as chest distress, rattling phlegm, and asthma.
White putrefaction is colloquially called "White Fungus." In rural areas, children suffering from this are sometimes treated by locals who boil wet fungi growing on trees for washing and oral administration. Mild cases may occasionally respond, but severe cases are often worsened. It is lamentable that this method of using fungus to treat fungus persists without knowing its origin.
The book *Wu Yi Hui Jiang* (Compilation of Wu Physicians' Discussions), recently published near Suzhou, contains discussions on Lanhou Dansha (Rotting Throat Erysipelas), which likely refers to the Bai Fu (White Putrefaction) prevalent in my hometown. There are three essays: one by Tang Zi Yingchuan, one by Zu Jun Hongfan, and one by Li Zi Chunxiu. All note that recent patients are numerous, deaths are frequent, and it is highly contagious. Medical texts lack detailed descriptions, and treatment approaches are unclear. Tang stated: Some advocate Acrid-Dispersing, some Cool-Releasing, some Bitter-Cold, all acting subjectively and sticking to specialties without exploring the root cause. He cited Zhang Zhongjing's *Jin Gui Yao Lue* regarding Yang Du (Yang Toxicity), advocating Shengma Biejia Tang (Cimicifugae Rhizoma and Testudinis Carapax Decoction). He also cited the *Nei Jing* principle: "Heat rampant inside is treated with Salty-Cold, assisted by Bitter-Sweet." Zu Jun argued that the origin of this disease lies in Wind, Cold, Damp, Heat, and epidemic qi. Exterior-releasing and Heat-clearing have their appropriate uses; proper treatment leads to quick recovery, while improper treatment brings disaster instantly. Indiscriminate use of Cold herbs closes the exterior and exacerbates internal fire, worsening throat pain and ulceration. Those ignorant of this logic complain that even with cooling herbs, fire remains vigorous, assuming insufficient cold nature, leading to further suppression and internal sinking death. Others suggesting cooling are accused of causing stagnation. Fire raging like a prairie kills most brutally; this bias towards dispersing slanders the harm of cooling. He spoke of the disaster of dispersing, he spoke of the disaster of cooling, I speak of the appropriateness of cooling. The key lies in sequence and timing, adapting flexibly to hit the mark accurately. Li's argument compares it to objects baked by intense fire: only dryness is seen, ignoring Damp-Heat stagnation causing rot. Lesions white as flour paste, or rotting to the uvula, with nasal congestion and blurred vision, are untreatable. In summary, infection by abnormal Qi of Heaven and Earth leads to different constitutions (Deficiency/Excess) and varying severity. My commentary: The three scholars discussed Wind-Heat-Damp-Cold as Excess patterns, failing to recognize injury from Dryness or Rotting Throat due to Lung-Kidney Yin Deficiency. Thus, external Excess patterns are easy to understand, while internal Deficiency faults are often ignored. Tang's citation of *Jin Gui*'s Shengma Biejia Tang to distinguish Yang/Yin Du is also not entirely adequate.
White putrefaction has divisions of Cold/Heat and Deficiency/Excess, not limited to Dryness alone. It can arise from Wind-Cold accumulation, Wind-Heat invasion, consumption of roasted/spicy/hot foods causing burning, Excess with Deficiency, Deficiency with Excess, seemingly Deficient but actually Excess, or seemingly Excess but actually Deficient. Syndromes vary, so treatment must differentiate. One cannot stick to rigid methods. Whether to disperse exterior, use Acrid-Warm, Cool, Warm-Nourish, or Nourish-Yin depends on clinical flexibility and spiritual understanding. Only then can success be achieved.