喉间白腐一证，俗名白菌，即白缠喉是也。廿年以前，此症患者尚少，迩来染是疾者甚多，每为误治而夭者，
不知凡几，深可悯也。凡大人患此症，犹易施治，惟小儿为尤难。盖因其幼小体质薄弱，脾肾不足故也。是以小
儿之白腐证，多于大人，必且传染，若治之不善，易于次第夭伤，甚至一家数口皆遭是 。按∶此症由肺肾阴虚，
因以感受天时，燥金之气，即伤燥之候也。或云∶伤寒伏气者，非也。有云少阴慢喉者，亦非也。又云疫疠烂喉
者，更非也。但初起有发热与不发热之别，有热者重不热者轻，即起初发热，亦切不可发表，若认作外感发热，
用羌独活、秦艽、荆芥之类，一经表散，而燥当更盛，其白腐愈蔓，其热亦愈炽，
鼻孔必转塞不通，甚至音哑，打呛气喘等症俱作，而不可救矣。张会稽曰∶火得升散而愈炽。沈金鳌曰∶凡喉风
诸症，总不宜发表，何况白腐之属燥乎？是以发表与寒凉之品，毫不可犯，执认肺胃蕴热，又兼风邪，必先表散
以为层次治法，定然贻误不浅。即如牛蒡子、射干、山豆根，本草虽载其能清利咽喉，解喉痛，桑白皮、黄芩泻
肺热，桔梗开提肺窍，僵蚕解喉痹痛，以上诸品，皆系疗咽喉要药，惟白腐一症，最不相宜，倘妄用之，必变音
哑打呛气喘而不救若执而不悟，复认为肺热闭塞，再投麻黄、枇杷叶、石膏、犀角、羚羊角、马兜铃等味，即变
胃烂发 而毙矣。至于喉科所论，拦定风热，攻上不下之语，及用紫正散以角药探吐，又有因未大解，遂用生大
黄、玄明粉以下之，更速其死，是皆未探其源也。
凡症有寒热虚实之别，惟有白腐一症，虽有寒热属实者绝少，而属虚者多。若初起见喉两旁红肿而后起白者
属实，中兼虚为易治，或误用表散及吐下法，其症必淹缠日期，及至重用养阴而后得渐痊可。若属虚证，值阳明
燥金之令而汗吐下三法及雄黄解毒丸、紫金锭等劫夺之剂，一经妄投，诚难救矣。
凡初起喉间不红肿即有白腐，或浓或薄，或有如稠糊及发热者，乃最重之候。其源责在肺肾阴虚，其脉必浮
数无力，手尖必冷，切不可投以表散及寒凉之品而治，法务须养阴清润，始不致误。总之，认定一燥字主治，乃
活人心法也。每见误治者，必变音哑打呛，鼻塞痰响，气喘而殒，其为肺肾之属可知。知非肺胃风热，外因之邪，
益可知也。或论既属肺燥而致，则喻嘉言之清燥救肺汤，与夫古方之泻白散，最该对症，殊不知救肺汤中有石膏、
枇杷叶、阿胶，乃清肺实之热，其泻白散系驱肺气之逆而泻气之有余，惟是白腐症，乃由肺虚感受燥气而发，故
此二方俱不相宜。若果肺气实者，无是患也。且历按是症，发于春秋二季，值天时亢阳之际居多，当炎暑夏令竟
少而冬燥亦有之，总由燥金之为患。然六气之中，惟治
燥最难，而况发于咽喉白腐之燥乎？当知此燥之为患，与他燥火诸症不同。书云∶燥为六气之一，肺金之本象也。
受热则燥更从火化也。燥在内则津少，烦渴在上则咽焦鼻干，盖金为生水之源，金被火烁，肾水失其源矣安得不
五内炎蒸？脏腑燥烈，虽似有余，实为不足。经云∶秋伤于燥，上逆而咳，发为痰厥。可见上虚必亏于下，子母
不能相生故也。又曰∶肾苦燥，急食辛以润之。又曰∶诸涩枯涸，干劲皴揭，皆属于燥。冯楚瞻曰∶涸者无水液
也。干者，不滋润也。劲者，不和柔也。皴者，皮肤启裂也。涩者如诸物湿，则滑泽，干则涩滞，是皆爆金之化。
然燥之标由于风与火，而燥之本实根于脾与肾，盖脾精不能转输，而阴精不能上奉，所以肺失化源，自见其象耳。
故幼稚本质，脾胃及肾不足，感燥气而发是症也。是以治宜生津养阴，滋润为主，岂可妄施表散，而继以寒凉者
乎？稽之方书本无白腐之证，尚无是症论说，迩来患此者甚多，及至传染难已。犹之痘疹，汉建武以前，并无论
到，至宋钱仲阳立说，相传而今之白腐证，亦如痘疹，随时感召而发，此亦天气悬殊之故也耶！惟是今时幼稚，
禀受怯弱，娇养柔脆，先天不足，肾阴未充者，恒居多数，钱氏独具卓识，创论以六味，调治小儿，培阴以配阳，
其义甚为深远。若小儿一患白腐，肺肾必然两虚，生化之源遂失，水竭则肾涸，肾涸则下泉不钟，而阳盛于上，
其燥益炽，斯喉痹音哑痰结烦躁打呛等证作矣。
书云∶肺为诸脏之华盖，清阳出上窍，浊阴出下窍，咽主地气，喉应天气，属干金，为肺之系。喉以纳气，
故喉气通于天，咽以纳食，故咽气通于地。又肺开窍于鼻，肺气通于鼻，鼻主天气。又精气通于天，故值天时燥
气之令即从鼻入而肺先受之，轻则发咳不已，重则发为白腐之患也。且肺为清肃之令，宜降而不宜升，况邪之所
凑，其气必虚，凡肺气充实者，故无是患也。要知诸气 郁则肺气必大虚，若泥于肺热之说，投以升提及泻利之
剂，反从火化而燥愈炽亡，可立待耳。是以桔梗一味，首在
切忌，古人虽以甘桔汤治诸喉患，是取其宣肺之壅实，断非指燥气之喉症也。今人不思其法，徒执此方为治喉要
药，殊不知是症非喉病也，乃肺燥发现于喉也，若泥以喉风诸药治之，安得不误苍生者乎？第此症不易冒昧从事，
务于喻氏及张氏《医通》与冯氏《锦囊》所论燥症门条中参究而领会焉，庶几无舛误耳。
或曰∶尽系六淫之气为患，本属不治之症。又云∶真白腐症亦不可治。假白腐可疗，此掩饰之，词混入听闻
之语耳。凡病兼外因无不感于六气，非独白腐一症也。若谓六淫之气皆蕴蓄于内而发，则无是症，亦无是理也。
盍专指一燥字施治，则得之矣。至于真假之辨，尤属荒唐，惟有诈病为假，真寒假热，真热假寒为假，除此及真
头痛之外，病何真假之有哉？或分虚实言之，未尝不可以实症白腐为易治，而虚白腐为难治是或一道焉。
有云∶白腐一症，责在君相二火，必须以泻心平肝兼治，此臆度牵强之语，乌足以言医！夫二火或发于咽喉
他症者，尚有之，若执此以论白腐，则大谬矣，即谓二火为患，亦由肾水之不足，肾水之不足，则由肺金失生化
之源也。张戴人曰∶识中标只治本，治千人无一损，斯言也，安可忽诸！尝见师心自用者，泥于君相二火，每纵
用灯心、川连、龙胆草、犀角、羚羊角等味致使夭枉者比比，而犹自矜，独得之妙，终不悔误，良可悲夫。
即近来患诸喉症亦由感燥者多，非独白腐为然也。临症若不审辨，泥用风剂治之，轻则致重，重则致危，而
不误者鲜矣。余经治以来，每用清润养阴法，获效甚广，遇用风药者，间或有之，而家传之紫正汤、辛乌散等方，
则未尝用及，奈属实症甚稀，而阴常不足者恒多也。王太仆云∶壮水之主，以镇阳光，斯义诚深妙哉！或问曰∶
所论白腐，由伤于燥，兼值肺肾不足，当禁用寒凉及辛散攻下等法，第见有用羌活、桂枝而愈者，有用防风、牛
蒡子、荆芥、桔梗而效者，或用大黄、玄明粉而应者，或用川连、石膏、犀角而平者，复有用附子、干姜乃
痊者，此亦皆治喉之法，何其相悬之若是耶，诚哉问也。凡症有寒热虚实之不同，原不可执一而论，其用辛温表
散，攻下发汗，清凉而愈者，俱是属实之症，乃喉内红肿有形而后起白腐之类，断非咽间无形之白蔓延缠喉可比，
而六气之中，凡感受风寒暑湿与火之邪而发喉患者亦所时有，非止白腐伤于燥也。其感受风寒暑湿，与火发诸喉
肿而起白腐者，此即妄言假白腐证，易治是也。至于伤燥及肾阴不足而发白腐者即其称真白腐证，万无一治是也。
如果白腐有真假之别，则经治之间，即当分真假立方才是，何得概泥一方而统治之耶？其间岂无虚实寒热之别辨
乎！试问究属风热实症之真，白腐不能治乎？抑属肺肾阴亏之真，白腐不能治乎。何尝分别而言焉？然肺肾阴亏
之白腐，既不知治法，又耻下问，乃固执自是之呆方，照寻常诸喉患疗治，安得不误苍生者乎！
赵养葵曰∶世人皆曰金生水，而予独曰水生金。夫肺出气也，肾纳气也，凡气从脐下逆奔而上者，此肾虚不
能纳气归元也。毋徒从事于肺，或壮水之主，或益火之源，肺向水中生矣。唐笠三曰∶水生金，乃金生水之对面，
曰世人但知其一面，而不知又有彼一面也。由是类推，而白腐之伤于肺燥，不亦宜乎！善悟者，当更得其旨矣。
喉间出现白腐的病症，俗称“白菌”，也就是所谓的“白缠喉”。二十年前，患这种病的人还很少，近来感染此疾的人非常多，常常因为误治而夭折，不知有多少，实在令人怜悯。凡是成年人患此症，还比较容易治疗，唯独小儿最为困难。这是因为小儿体质幼小薄弱，脾肾精气不足的缘故。因此，小儿患白腐证比成人更多，且具有传染性，如果治疗不当，容易依次导致夭折伤害，甚至一家数口都遭受此祸。按：此症由肺肾阴虚引起，进而感受天时燥金之气，这是伤于燥气的表现。有人说这是伤寒伏气所致，不对；有人说这是少阴慢喉，也不对；又有人说这是疫疠烂喉，更不对。只是初起时有发热与不发热的区别，有热证的病情重，无热证的病情轻，即使起初发热，也绝不可使用发汗解表法，如果误认为是外感发热，使用羌活、独活、秦艽、荆芥等药物，一旦发散，燥邪会更加旺盛，白腐蔓延更广，热势也更加炽盛，鼻孔必然转为堵塞不通，甚至声音嘶哑、呛咳气喘等症状全部发作，就无法救治了。张会稽说：“火性得到升散就会更加炽盛。”沈金鳌说：“凡是喉风诸症，总不宜使用发汗解表法，何况是白腐属于燥邪呢？”因此，发汗解表和寒凉性质的药物，丝毫不能触犯，如果固执地认为肺胃蕴热，兼有风邪，必须先通过发汗解表作为治疗的层次步骤，必然会延误病情且后果严重。就像牛蒡子、射干、山豆根，本草书中虽然记载它们能清利咽喉，解除喉痛，桑白皮、黄芩泻肺热，桔梗开提肺气，僵蚕解除喉痹疼痛，以上这些药物，都是治疗咽喉的要药，唯独对于白腐这一症状，最不相适宜，如果妄加使用，必然会导致声音嘶哑、呛咳气喘而无法救治。如果固执己见不醒悟，又认为是肺热闭塞，再投用麻黄、枇杷叶、石膏、犀角、羚羊角、马兜铃等药物，就会导致胃烂出血而死。至于喉科所论述的，固定认为风热攻上不下，以及使用紫正散配合药物探吐，又有因为大便未通，于是使用生大黄、玄明粉来泻下的，更是加速死亡，这些都是没有探究病因根源的表现。
凡是病症都有寒热虚实的区别，只有白腐一症，虽然有寒热属实的情况极少，而属虚证的多。如果初起时看到喉咙两旁红肿而后出现白腐的，属于实证，中间兼有虚象的还容易治疗；或者误用发汗解表及催吐泻下法，病情必定拖延时日，等到重用养阴药物后才逐渐痊愈。如果属于虚证，正值阳明燥金当令之时，若使用汗、吐、下三法以及雄黄解毒丸、紫金锭等劫夺正气之剂，一旦妄加投用，确实难以救治。
凡是初起时喉咙不红肿即有白腐，或浓或薄，有的像稠糊状并伴有发热的，是最严重的征候。其根源在于肺肾阴虚，脉象必然浮数无力，指尖必冷，绝不可投用发汗解表和寒凉性质的药物来治疗，治疗方法必须以养阴清润为主，才不会出错。总之，认定一个“燥”字作为主治原则，才是救人的心法。常见误治者，必然变为声音嘶哑、呛咳、鼻塞痰鸣、气喘而死亡，这可知病变归属于肺肾。知道这不是肺胃的风热和外因邪气，也就更加明白了。有人论述既然属于肺燥所致，那么喻嘉言的清燥救肺汤，以及古方的泻白散，最应该对症，殊不知救肺汤中含有石膏、枇杷叶、阿胶，那是用来清泻肺实之热的，而泻白散是用来驱除肺气上逆而泻气之有余的，唯独白腐症，是由肺虚感受燥气而发的，所以这两个方剂都不适宜。如果确实是肺气实者，就不会有这个病患。况且历次观察此症，多发于春秋两季，正值天气亢阳之际居多，在炎暑夏令竟然很少，冬季干燥也有发生，总归是由燥金之气为患。然而六气之中，唯独治疗燥邪最难，何况是发于咽喉白腐的燥邪呢？应当知道这种燥邪为患，与其他燥火诸症不同。书上说：“燥是六气之一，是肺金的本象。”受热则燥更从火化。燥在内则津液少，烦渴在上则咽焦鼻干，盖因金为生水之源，金被火烁，肾水失去了源头，怎能不五脏内热蒸腾？脏腑燥烈，虽然看似有余，实为不足。经书说：“秋伤于燥，气上逆而咳嗽，发为痰厥。”可见上虚必然亏于下，子母不能相生。又说：“肾苦燥，急食辛味以润之。”又说：“各种涩滞枯涸，皮肤干裂，都属于燥。”冯楚瞻说：“涸是没有水液。”干，是不滋润。劲，是不和柔。皴，是皮肤启裂。涩，如同各种物体湿润则滑泽，干燥则涩滞，这都是燥金的变化。然而燥的标象由于风和火，而燥的根本实则根源于脾与肾，盖因脾精不能转输，阴精不能上奉，所以肺失去化源，自然显现出这种象。因此幼儿本质，脾胃及肾不足，感受燥气而发此症。所以治疗宜生津养阴，以滋润为主，岂可妄施发汗解表，继而又用寒凉药物呢？查考方书原本没有白腐这一证，尚无对此症的论述，近来患此病的人很多，且传染难止。就像痘疹，汉建武以前，并没有相关论述，到了宋代钱仲阳立说，相传至今，现在的白腐证，也像痘疹一样，随时感召而发，这也是天气悬殊的缘故吧！只是现今的幼儿，禀受怯弱，娇养柔脆，先天不足，肾阴未充的，恒居多数，钱氏独具卓识，创立以六味地黄丸调治小儿，培补阴精以配阳，其义非常深远。如果小儿一旦患上白腐，肺肾必然两虚，生化之源遂失，水竭则肾涸，肾涸则下泉不钟，而阳盛于上，其燥益炽，于是喉痹、音哑、痰结、烦躁、打呛等证发作。
书上说：“肺为诸脏之华盖，清阳出上窍，浊阴出下窍，咽主地气，喉应天气，属金，为肺之系。喉以纳气，故喉气通于天，咽以纳食，故咽气通于地。又肺开窍于鼻，肺气通于鼻，鼻主天气。又精气通于天，故值天时燥气当令时，燥气就从鼻入而肺先受之，轻则发咳不已，重则发为白腐之患。且肺为清肃之令，宜降而不宜升，何况邪气聚集之处，其气必虚，凡肺气充实者，故无此患。要知诸气郁结则肺气必大虚，如果拘泥于肺热的说法，投用升提及泻利的药剂，反而从火化而燥愈炽亡，可以立刻等待死亡。因此桔梗一味药，首先切忌使用，古人虽然用甘桔汤治疗各种喉患，是取其宣通肺之壅实，绝非指燥气引起的喉症。今人不思考其法度，徒然执着此方为治疗喉症的要药，殊不知此症不是喉病，而是肺燥表现在喉部，如果拘泥用治疗喉风的药物治疗，怎么能不误害百姓呢？只是此症不易冒昧从事，务必在喻氏及张氏《医宗金鉴》与冯氏《锦囊》所论燥症门条中参究而领会，才几乎没有差错。
有人说：“全是六淫之气为患，本属不治之症。”又说：“真白腐症也不可治，假白腐可疗。”这是掩饰的词句，混入听闻之语罢了。凡是病兼外因无不感受于六气，并非独独白腐一症如此。如果说六淫之气都蕴蓄于内而发，则没有这个症，也没有这个理。何不专指一个“燥”字来施治，就对了。至于真假之辨，尤其荒唐，只有诈病为假，真寒假热，真热假寒为假，除此及真头痛之外，病有什么真假之分呢？或者分虚实来说，未尝不可以将实证白腐视为易治，而虚证白腐为难治，这也是一种道理。
有人说：“白腐一症，责任在君相二火，必须以泻心平肝兼治。”这是臆测牵强的话，怎么足以谈论医学！夫二火或许发于咽喉其他病症者，还有的，如果执着此来论述白腐，那就大谬了，即使说是二火为患，也是由肾水不足引起，肾水不足，则由肺金失去生化之源。张戴人说：“识中标只治本，治千人无一损。”这话怎么可以忽视呢！曾见那些师心自用的人，拘泥于君相二火，每每放纵使用灯心、川连、龙胆草、犀角、羚羊角等药物，致使夭折枉死者比比皆是，却还自我夸耀独得之妙，始终不后悔误人，真是可悲啊。
即近来患各种喉症的人也多由感受燥邪引起，并非独独白腐是这样。临症如果不审辨，拘泥使用风药治疗，轻则加重，重则致危，而不误治的很少。我经治以来，每用清润养阴法，获效甚广，遇到用风药的，间或有之，而家传的紫正汤、辛乌散等方，则未曾使用，无奈属实症很少，而阴常不足的恒多。王太仆说：“壮水之主，以镇阳光。”这个义理确实深妙啊！有人问：“所论白腐，由伤于燥，兼值肺肾不足，应当禁用寒凉及辛散攻下等法，只见有用羌活、桂枝而痊愈的，有用防风、牛蒡子、荆芥、桔梗而有效的，或用大黄、玄明粉而应验的，或用川连、石膏、犀角而平复的，复有用附子、干姜乃痊愈的，这些也都是治疗喉症的方法，为何相差如此之大呢？”这确实是个好问题。凡是病症有寒热虚实之不同，原不可执一而论，其用辛温表散，攻下发汗，清凉而愈的，俱是属于实症，乃是喉内红肿有形而后起白腐之类，断非咽间无形之白蔓延缠喉可比，而六气之中，凡感受风寒暑湿与火之邪而发喉患者也时有发生，并非只是白腐伤于燥。其感受风寒暑湿，与火发诸喉肿而起白腐者，这就是妄言的假白腐证，易治的是这类。至于伤燥及肾阴不足而发白腐者，就是所称的真白腐证，万无一治（意指极难治）的是这类。如果白腐真有真假之别，则在经治之间，就应当分真假立方才是，何必一概拘泥一方而统治之呢？其间难道没有虚实寒热的区别辨别吗！试问究属风热实症的白腐不能治乎？还是属肺肾阴亏的真白腐不能治乎？何尝分别而言焉？然而肺肾阴亏的白腐，既然不知道治法，又耻于下问，乃固执自是的呆板方子，照寻常诸喉患治疗，怎么能不误害百姓呢！
赵养葵说：“世人皆曰金生水，而我独曰水生金。夫肺出气也，肾纳气也，凡气从脐下逆奔而上者，此肾虚不能纳气归元也。不要只从事于治肺，或壮水之主，或益火之源，肺向水中生矣。”唐笠三说：“水生金，乃金生水之对面，说世人只知道其中一面，而不知道还有彼一面也。由此类推，而白腐之伤于肺燥，不也是理所当然的吗！”善于领悟的人，应当更能得其旨意了。
The syndrome of white putrefaction in the throat, commonly known as "white fungus" (Bai Jun), is what is referred to as "white winding throat" (Bai Chan Hou). Twenty years ago, patients with this condition were few; recently, however, many have contracted this disease, and countless have died due to misdiagnosis and mistreatment, which is deeply pitiable. For adults suffering from this syndrome, treatment is relatively easy; it is particularly difficult for children. This is because their constitution is young and weak, and their Spleen and Kidney essence are insufficient. Therefore, children suffer from white putrefaction more frequently than adults, and it is contagious. If treated improperly, it easily leads to sequential mortality, potentially affecting several members of a household. Note: This syndrome arises from Yin deficiency of the Lung and Kidney, compounded by exposure to the seasonal dryness-metal Qi, representing a manifestation of injury by dryness. Some claim it is latent Qi from Cold Damage (Shang Han); this is incorrect. Some say it is Slow Throat of the Shaoyin channel; this is also incorrect. Others claim it is epidemic rotting throat; this is even more incorrect. However, there is a distinction between initial fever and no fever at onset. Cases with fever are severe, while those without are mild. Even if fever occurs initially, dispersing the exterior (Fa Biao) must absolutely be avoided. If mistaken for exterior-contracting fever and treated with herbs such as Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Qin Jiao (Gentianae Macrophyllae Radix), or Jing Jie (Schizonepetae Herba), once the exterior is dispersed, the dryness will intensify, the white putrefaction will spread further, and the heat will become more blazing. The nostrils will inevitably become blocked, and symptoms such as hoarseness, choking cough, and wheezing may arise, rendering the condition incurable. Zhang Huiji stated: "Fire becomes more intense when allowed to ascend and disperse." Shen Jin'ao stated: "For all types of throat wind (Hou Feng) syndromes, exterior-dispersing methods are generally contraindicated, let alone for white putrefaction which belongs to dryness." Therefore, exterior-dispersing and cold-natured medications must not be used. If one stubbornly believes that Heat stagnation exists in the Lung and Stomach accompanied by Wind pathogen, and insists on using exterior dispersion as a preliminary step, it will surely cause significant delay and harm. For instance, Niu Bang Zi (Arctii Fructus), She Gan (Belamcandae Rhizoma), and Shan Dou Gen (Sophorae Tonkinensis Radix) are recorded in materia medica as capable of clearing and benefiting the throat and relieving sore throat; Sang Bai Pi (Morus Cortex) and Huang Qin (Scutellariae Radix) clear Lung Heat; Jie Geng (Platycodonis Radix) opens the Lung orifices; and Jiang Can (Bombyx Batryticatus) relieves throat obstruction pain. Although these are essential herbs for treating throat conditions, they are most unsuitable for white putrefaction. Misuse will inevitably lead to hoarseness, choking, and wheezing, becoming incurable. If one remains obstinate and unenlightened, believing it to be Lung Heat blockage, and administers Ma Huang (Ephedrae Herba), Pi Pa Ye (Loquat Leaf), Shi Gao (Gypsum Fibrosum), Xi Jiao (Rhinocerotis Cornu), Ling Yang Jiao (Capricornis Cornu), or Ma Dou Ling (Aristolochiae Fructus), it will result in stomach ulceration and death. Regarding discussions in throat specialties about fixed Wind-Heat attacking upward without descending, and the use of Zi Zheng San combined with emetics, or the use of Sheng Da Huang (Rhei Radix et Rhizoma) and Xuan Ming Fen (Mirabilite) for constipation to induce purgation, these actions only accelerate death, as they fail to investigate the root cause.
All syndromes have distinctions of Cold, Heat, Deficiency, and Excess. Only in the case of white putrefaction are cases of Cold, Heat, and Excess extremely rare, while Deficiency cases are common. If redness and swelling appear on both sides of the throat initially, followed by white patches, it indicates an Excess syndrome; if mixed with Deficiency, it is easier to treat. However, if exterior-dispersing or vomiting/purgative methods are mistakenly used, the illness will drag on for a long time. Only upon heavy use of Yin-nourishing drugs can gradual recovery occur. If it is a Deficiency syndrome, occurring during the period of Yangming Dryness-Metal dominance, and the sweating, vomiting, and purging methods, along with drastic agents like Xiong Huang Jie Du Wan (Realgar Detoxification Pill) or Zi Jin Ding (Purple Gold Tablet), are wrongly administered, it is indeed difficult to save the patient.
If white putrefaction appears without redness or swelling at onset, varying in thickness or resembling thick paste, accompanied by fever, it is the most critical presentation. The root lies in Lung and Kidney Yin deficiency. The pulse will be floating, rapid, and forceless; the fingertips will be cold. Exterior-dispersing and cold-natured drugs must absolutely not be used. Treatment must focus on nourishing Yin and clearing moistening. In short, recognizing "Dryness" as the primary governing principle is the secret method for saving lives. I often see patients misdiagnosed who develop hoarseness, choking, nasal congestion with rattling phlegm, and wheezing before dying, confirming the involvement of the Lung and Kidney. Knowing it is not Wind-Heat in the Lung and Stomach or external pathogens further clarifies this. Some argue that since it is caused by Lung Dryness, Yu Jiayan's Qing Zao Jiu Fei Tang (Clear Dryness Rescue Lung Decoction) and the ancient formula Xie Bai San (Drain White Powder) should be appropriate. However, Qing Zao Jiu Fei Tang contains Shi Gao (Gypsum Fibrosum), Pi Pa Ye (Loquat Leaf), and E Jiao (Donkey-Hide Gelatin), which clear excess Heat in the Lung; Xie Bai San drives rebellious Lung Qi downward to drain excess Qi. White putrefaction, however, arises from Lung Deficiency combined with Dryness pathogen, so neither formula is suitable. If Lung Qi were truly Excess, this affliction would not occur. Furthermore, observing this syndrome, it mostly occurs in Spring and Autumn when Yang energy is high, rarely in Summer heat, and sometimes in Winter dryness, always attributed to Dryness-Metal. Among the Six Qi, treating Dryness is the most difficult, especially Dryness manifesting as white putrefaction in the throat. One must know this Dryness differs from other Dryness-Fire syndromes. Books state: "Dryness is one of the Six Qi and is the original image of Metal-Lung." When exposed to Heat, Dryness transforms into Fire. Internal Dryness reduces fluids; upper irritability and thirst cause dry throat and nose. Since Metal is the source of Water generation, if Metal is scorched by Fire, Kidney Water loses its source, leading to internal steaming. Organs and bowels appear excessive but are actually deficient. The Classics say: "Autumn injury by Dryness causes upward rebellion and cough, developing into Phlegm Syncope." This shows upper Deficiency leads to lower depletion, and the mother-child relationship fails to generate each other. It also says: "Kidney suffers from Dryness; urgently eat Pungent substances to moisten it." And: "All astringency, withering, drying, and cracking belong to Dryness." Feng Chuzhan said: "He represents lack of fluid; Gan means lack of moisture; Jin means lack of softness; Cun means skin cracking; Se means stickiness when dry, contrasting with slipperiness when wet. These are transformations of Dryness-Metal." However, the superficial aspect of Dryness stems from Wind and Fire, while its root lies in the Spleen and Kidney. If Spleen Essence cannot transport and Yin Essence cannot ascend, the Lung loses its source of transformation, manifesting these signs. Thus, children with innate insufficiency of Spleen, Stomach, and Kidney contract this syndrome upon exposure to Dryness Qi. Treatment should prioritize generating fluids and nourishing Yin with moistening methods. How can one recklessly use exterior dispersion followed by cold drugs? Examining medical texts, there is originally no mention of white putrefaction or related theories. Recently, however, many suffer from it, and transmission is hard to stop. Like smallpox and chickenpox, which had no records before the Jianwu era of Han, until Qian Zhongyang established theories in Song dynasty, the current white putrefaction syndrome also emerges according to changing times, likely due to climatic disparities. Modern children often have weak constitutions, are pampered and fragile, possess congenital insufficiency, and lack sufficient Kidney Yin. Qian possessed unique insight, creating the Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to treat children, cultivating Yin to balance Yang, a profound meaning. If a child contracts white putrefaction, Lung and Kidney are necessarily both deficient, losing the source of life transformation. Water exhaustion leads to Kidney desiccation; Kidney desiccation means the lower spring does not nourish, causing Yang to flourish above, intensifying Dryness. Consequently, throat obstruction, hoarseness, phlegm accumulation, irritability, and choking arise.
Books state: "The Lung is the canopy of all organs; Clear Yang exits through upper orifices, Turbid Yin exits through lower orifices. The Pharynx governs Earth Qi, the Larynx responds to Heaven Qi, belonging to Metal, connected to the Lung. The Larynx receives Qi, thus connecting to Heaven; the Pharynx receives food, thus connecting to Earth. The Lung opens into the Nose; Lung Qi connects to the Nose, which governs Heaven Qi. Essence connects to Heaven; thus, when seasonal Dryness Qi dominates, it enters via the Nose, affecting the Lung first. Mildly, it causes persistent cough; severely, it causes white putrefaction. The Lung commands clear descent, favoring descent over ascent. Where pathogens gather, Qi is necessarily deficient. Those with solid Lung Qi do not suffer this. Know that Qi stagnation causes great Lung Qi deficiency. If one clings to the theory of Lung Heat and uses ascending or draining agents, it transforms into Fire, intensifying Dryness and leading to death swiftly. Therefore, Jie Geng (Platycodonis Radix) is strictly contraindicated. Although ancients used Gan Jie Tang (Licorice and Platycodon Decoction) for various throat ailments to vent Lung congestion, it was never intended for Dryness-induced throat syndromes. Modern people fail to understand this, blindly adhering to this formula as a throat remedy, not realizing this is not a throat disease but Lung Dryness manifesting in the throat. Using throat-wind medications for this will surely harm the people. This syndrome requires caution. One must study and comprehend the Dryness sections in Yu's works, Zhang's *Yi Tong*, and Feng's *Jin Nang* to avoid errors.
Some say: "Caused entirely by the Six Evils, it is inherently incurable." Others claim: "True white putrefaction is incurable; false white putrefaction is treatable." These are deceptive statements confusing public opinion. All diseases involving external factors are affected by the Six Qi, not just white putrefaction. If one claims the Six Evils accumulate internally to cause this, such a syndrome and theory do not exist. Why not simply treat based on the character "Dryness"? As for distinguishing true from false, it is absurd. Only feigned illness is false; true Cold with false Heat, and true Heat with false Cold are false categories. Apart from these and true headache, what else has true/false distinctions? Discussing Deficiency vs. Excess, one might consider Excess white putrefaction easier to treat and Deficiency white putrefaction harder, which is a valid perspective.
Some claim: "White putrefaction is blamed on Ministerial and Sovereign Fire, requiring Heart-draining and Liver-calming treatments." This is speculative and forced, unworthy of medical discussion. While Ministerial/Sovereign Fire may cause other throat issues, applying this to white putrefaction is a major error. Even if caused by Fire, it stems from Kidney Water insufficiency, which results from Lung Metal losing its source of transformation. Zhang Dairen said: "Knowing the root allows treating thousands without error." How can this be ignored! I have seen arrogant practitioners clinging to Ministerial/Sovereign Fire, recklessly using Deng Xin (Junci Medulla), Chuan Lian (Corydalis Rhizoma - *Note: Text says Chuan Lian but context implies Huang Lian/Coptis usually paired with Long Dan Cao, assuming Huang Lian based on 'Chuan Lian' typo or specific regional usage, but standard pairing is Huang Lian. Wait, text says 'Chuan Lian'. In TCM, Chuan Lian usually refers to Sichuan Melia Fruit (Meliae Toosendan Fructus). However, given the context of clearing fire/heat alongside Dragon Gallbladder and Rhinoceros horn, Huang Lian (Coptidis Rhizoma) is more likely intended, or perhaps the text implies a strong bitter-cold herb. I will translate as Coptidis Rhizoma (Huang Lian) assuming typo or common association, but strictly 'Chuan Lian' is Meliae Toosendan Fructus. Given 'Chuan Lian' is listed with Long Dan Cao and Xi Jiao, it is highly likely Huang Lian (Coptidis Rhizoma) due to phonetic similarity or textual corruption in some editions, but I must stick to the text. Actually, 'Chuan Lian' (川连) is a common abbreviation for Huang Lian (黄连). So I will use Coptidis Rhizoma.), Long Dan Cao (Gentianae Radix), Xi Jiao (Rhinocerotis Cornu), and Ling Yang Jiao (Capricornis Cornu), causing numerous deaths, yet they boast of their unique skills without regret, which is tragic.
Recently, many throat syndromes are caused by Dryness, not just white putrefaction. Without careful differentiation, using Wind-dispersing drugs makes mild cases severe and severe cases critical. Mistakes are common. My experience shows that using Clearing-Moistening and Yin-Nourishing methods yields broad efficacy. I rarely use Wind drugs, and my family formulas Zi Zheng Tang and Xin Wu San are unused because Excess cases are rare, while Yin insufficiency is common. Wang Tai Pu said: "Strengthen the master of Water to suppress the Sun." This principle is profoundly subtle. A question arises: "You discuss white putrefaction as caused by Dryness with Lung/Kidney insufficiency, prohibiting cold and pungent-dispersing/purgative methods. Yet I see cases cured by Qiang Huo (Notopterygii Rhizoma et Radix) and Gui Zhi (Cinnamomi Ramulus), effective with Fang Feng (Saposhnikoviae Radix), Niu Bang Zi (Arctii Fructus), Jing Jie (Schizonepetae Herba), Jie Geng (Platycodonis Radix), responding to Da Huang (Rhei Radix et Rhizoma) and Xuan Ming Fen (Mirabilite), stabilized by Huang Lian (Coptidis Rhizoma), Shi Gao (Gypsum Fibrosum), Xi Jiao (Rhinocerotis Cornu), and recovered with Fu Zi (Aconiti Lateralis Radix Praeparata) and Gan Jiang (Zingiberis Rhizoma). These are all throat treatments, why such disparity?" This is a good question. Syndromes vary in Cold, Heat, Deficiency, and Excess; one cannot generalize. Cases cured by Pungent-Warm exterior dispersion, purgative sweating, or cooling are Excess syndromes, characterized by tangible redness/swelling before white patches. This is distinct from intangible white spreading in the throat. Exposure to Wind-Cold, Summer-Heat, Dampness, or Fire causing throat swelling and white patches is considered "False White Putrefaction," which is easier to treat. Conversely, white putrefaction caused by Dryness and Kidney Yin insufficiency is "True White Putrefaction," which is extremely difficult to cure. If there were true/false distinctions, prescriptions should differ accordingly. Why cling to one formula? Are there not differences in Deficiency/Excess and Cold/Heat? Is it that Wind-Heat Excess white putrefaction is incurable, or that Lung-Kidney Yin Deficiency white putrefaction is incurable? They are not distinguished. However, for Lung-Kidney Yin Deficiency white putrefaction, if one ignores treatment methods, is ashamed to ask, and stubbornly uses rigid formulas for ordinary throat ailments, how can one avoid harming people?
Zhao Yangkui said: "People say Metal generates Water, but I say Water generates Metal. The Lung exhales Qi, the Kidney grasps Qi. When Qi rebels upward from below the navel, it is Kidney Deficiency failing to grasp Qi back to its origin. Do not merely treat the Lung; either strengthen the master of Water or benefit the source of Fire, and the Lung will be born from Water." Tang Lisan said: "Water generating Metal is the opposite of Metal generating Water. People know one side but not the other. By analogy, white putrefaction injuring Lung Dryness is logical." Those who are good at comprehending will grasp the essence.