(论喉间发白症)
喉间发白之症。予经历十余俱已收功。此症属少阴一经。热邪伏其间。盗其肺金之母气。故喉间起白。缘少阴
之脉循喉咙系舌本。治法必以紫正地黄汤为主,方除紫荆皮茜草二味。此二药开结破肝血之燥热。今喉间之白。因
邪伏于少阴肾经蓄久而发。肝失水养。非喉本症。风热结于血分可比。故此二药最不相宜用之。复伤其阴。而白反
弥漫不解。只用紫正汤。微加细辛清解少阴之邪。初服一二剂。其白不增不减。略转微黄色。十有九治。若服药后。
白反蔓延呛喉。是邪伏肾经。肾阴已伤。元气无从送邪。即不治矣。此症服药。大便解出结粪。地道通。而肺气行。
邪从大便出。其白即转黄色。七日后愈矣。可知邪伏少阴。盗其母气。非臆度也。
喉间起白如腐一症。其害甚速。乾隆四十年前无是症即有亦少。自二十年来患此者甚多。惟小儿尤甚。且多传
染。一经误治。遂至不救。虽属疫气为患。究医者之过也。按白腐一证。即所谓白缠喉是也。诸书皆未论及。惟医
学心悟言之。至于论治之法。亦未详备。缘此症发于肺肾。凡本质不足者。或遇燥气流行。或多食辛热之物。感触
而发。初起者发热。或不发热鼻干唇燥或咳或不咳。鼻通者轻。鼻塞者重。音声清亮气息调匀易治。若音哑气急即
属不治。近有好奇之辈。一遇此症。即用象牙片动手于喉中。妄刮其白。益伤其喉。更速其死。岂不哀哉。余与既
均三弟疗治以来。未尝误及一人。生者甚众。经治之法。不外肺肾。总要养阴清肺。兼辛凉而散为主。
(论述喉间发白症)
喉间出现白色病变的症状,我经历过的十余例都已治愈。此症属于少阴经(足少阴肾经),热邪潜伏在其中,盗取肺金之母气(即肾水),导致喉间起白。因为少阴经脉循行经过喉咙并联系舌根。治疗方法必须以紫正地黄汤为主方,去掉方中的紫荆皮和茜草这两味药。这两味药能开结破瘀,清除肝血的燥热。如今喉间的白色病变,是因为邪气潜伏在少阴肾经中蓄积日久才发作的,此时肝失肾水滋养,并非喉部本脏的原发病,不能简单类比于风热结于血分的情况。因此,这两味药最不适合使用,否则会进一步损伤阴液,导致白色病变反而弥漫扩散无法解除。只使用紫正汤,稍微加入细辛以清解少阴经的邪气。初服一两剂后,如果白色病变没有增加也没有减少,略微转为微黄色,十有八九可以治愈。如果服药后,白色病变反而蔓延并呛咳咽喉,这是邪气潜伏在肾经,肾阴已经受损,元气无力驱除邪气,这就属于不治之症了。治疗此症时,若大便排出干结粪便,肠道通畅,肺气得以宣降,邪气随大便排出,喉间的白色病变就会转为黄色,七日后即可痊愈。由此可见,邪气潜伏少阴、盗取母气的说法,并非凭空臆测。
喉间出现如腐肉般的白色病变这一症状,危害非常迅速。乾隆四十年前没有这种病,即使有也很少。过去二十年来患此病的人很多,其中小儿尤为严重,且多具有传染性。一旦误治,就会导致无法挽救的后果。虽然这属于疫气致病,但究其根源,也是医者的过错。根据记载,白腐一证,就是所谓的“白缠喉”。各种医书都没有详细论述,只有《医学心悟》中提到过。至于治疗方法,也不够详尽完备。因为此症发于肺肾,凡是体质虚弱不足的人,或者遇到燥气流行,或多食辛辣热物,感触邪气而发病。初起时发热,或者不发热,伴有鼻干唇燥,或者咳嗽或者不咳嗽。鼻腔通畅的病情轻,鼻塞的病情重。声音清亮、气息调匀的容易治疗。如果声音嘶哑、呼吸急促,就属于不治之症。近来有一些好奇之人,一遇到此症,就用象牙片动手在喉中,胡乱刮除白色病变,更加损伤喉部,加速患者死亡,岂不可悲?我与既均三弟从开始治疗以来,从未误治一人,救活的人很多。经治的方法,不外乎调理肺肾,总要以太养阴清肺、兼用辛凉发散为主。
(Discussion on the Syndrome of White Lesions in the Throat)
Regarding the syndrome characterized by white lesions in the throat, I have successfully treated more than ten cases. This syndrome belongs to the Shaoyin (Lesser Yin) channel (the Foot-Shaoyin Kidney Meridian). Heat pathogen lies latent within it, stealing the mother qi of Metal-Lung (i.e., Kidney-Water), thus causing whiteness in the throat. This is because the Shaoyin meridian runs along the throat and connects to the root of the tongue. The treatment method must primarily utilize Zizheng Dihuang Tang (Purple Correct Rehmannia Decoction), excluding the two herbs: Broussonetiae Cortex (Zijingpi, 紫荆皮) and Rubia Cordifolia Root (Qiancao, 茜草). These two herbs resolve stagnation and break blood stasis, clearing dryness-heat from Liver-blood. Currently, the whiteness in the throat occurs because the pathogen has lain latent in the Shaoyin Kidney meridian for a long time before manifesting; at this stage, the Liver loses nourishment from Kidney-Water. It is not an original disease of the throat organ itself and cannot be simply compared to wind-heat knotting in the Blood level. Therefore, these two herbs are most unsuitable for use, as they would further damage Yin fluids, causing the white lesion to spread diffusely and become unresolvable. One should only use Zizheng Tang (Purple Correct Decoction), adding a small amount of Asarum (Xixin, 细辛) to clear and resolve the Shaoyin pathogen. After taking one or two doses initially, if the white lesion neither increases nor decreases but slightly turns yellowish, nine out of ten cases will be cured. However, if after taking medicine the white lesion spreads further and causes choking coughs, this indicates that the pathogen is latent in the Kidney meridian and Kidney-Yin is already damaged, while Yuan Qi (Original Qi) lacks the strength to expel the pathogen; such cases are incurable. When treating this syndrome, if hard feces are passed in the stool, the intestinal pathway becomes unobstructed, Lung Qi descends freely, and the pathogen exits via the large intestine; the white lesion in the throat will then turn yellow, and recovery will occur within seven days. Thus, it can be seen that the concept of pathogen lying latent in Shaoyin and stealing the mother qi is not mere speculation.
The syndrome where white lesions in the throat appear like putrid flesh is extremely harmful and progresses rapidly. Before the fortieth year of Qianlong, this disease did not exist, or was very rare. In the past twenty years, however, many people have suffered from it, especially children, and it is often contagious. Once misdiagnosed or mistreated, it leads to untreatable conditions. Although it is caused by epidemic toxic qi, the fault ultimately lies with the physician. According to records, the syndrome of white putrefaction is what is known as "White Entangling Throat" (Baitan Hou). Various medical texts do not discuss it in detail; only *Yixue Xinwu* (Medical Insights) mentions it. Furthermore, the discussion on treatment methods there is not comprehensive enough. This syndrome originates in the Lungs and Kidneys. It affects individuals with inherent constitutional deficiency, or those exposed to prevailing dryness qi, or who consume excessive spicy and hot foods, thereby contracting the pathogen. In the early stage, there may be fever or no fever, accompanied by dry nose and lips, and either cough or no cough. Cases with a patent nasal passage are mild, while those with nasal congestion are severe. Patients with clear voice and regular breathing are easy to treat. If hoarseness and rapid breathing occur, it is considered incurable. Recently, some curious practitioners, upon encountering this syndrome, use ivory slices to manually scrape the white lesions inside the throat, further damaging the throat and accelerating death. How tragic! Since my brother Ji Jun and I began treating this condition, we have never made a mistake, saving many lives. The treatment principles revolve around regulating the Lungs and Kidneys, primarily focusing on nourishing Yin and clearing Lung heat, combined with acrid-cool dispersing methods.