白喉有时疫一症，其发有时，其传染甚速，或一人患发，竟至传染一家，甚至一乡一村
皆发，其症至危至险，最急最恶之症也。若不急治即能杀人，而治者不得其诀，以致束手无
策，然非临症日久莫能知。治此症者有十难焉。
昔陈雨春先生论云∶此症乃足三阴受病，传之于肺，与他经无涉，其有兼及他经者，亦
皆病后之传变者也。何者此症初起舌微硬，舌苔黄，颃颡微肿，喘渴心烦，夫十二经中，惟
太阴之脉上膈兵咽，连舌本，散舌下；少阴之脉循喉咙，挟舌本；厥阴之脉循喉咙之后，上
入颃颡，下络舌本。凡病此者，两关及左尺脉多沉数而躁，以此观之，病属足三阴明矣。时
未传及他经，不察其源，治以他经之药，其难一也。
大抵此症初起，恶寒发热，头痛背胀，精神倦怠，遍身骨节疼痛，喉内有极痛者，有微
痛者，或尚有不痛者，初无形迹可见，的似伤风、伤寒表症。若投以麻、桂、细辛、羌、防
、升、柴、苏散之类，致毒涣散，无可换回，其难二也。
彼其恶寒发热，乃毒瓦斯初作于内。至二三日，喉内业已现出白点或白块，寒热自是消除
。医者不悟，误以为表药有功，岂知白喉现出，即不服表药而寒热亦除。其风热喉症，尚可
稍用表药，或荆防败毒散之类，惟白喉一症，表药最所当忌，其难三也。
按此病热症多而寒症少。有以色白而指定为寒症者，不知此症初发于肺，肺属金，其色
白，为五脏六腑之华盖，处至高之位，毒瓦斯自下熏蒸而上，肺病日深，故其白色日着。治宜
解三经之毒，使之下行，勿令积蓄于肺。若因色白拟为寒症，以附、桂、炮姜热剂投之，一
遇火症，是谓抱薪救火，愈炽愈烈，其难四也。
即有知白喉为火毒，不可轻用开提升散之品，使之上升，愈加壅塞，而起初即以芒硝，
大黄下之，亦非所宜。不知此症已传至上焦气分，与中，下焦无涉，既上焦气分受伤又以硝
，黄攻发太过，使中，下焦有损，元气愈伤，其难五也。
见症已确，服药尤当守方。此种恶症，有火毒最甚者，初起用消风败毒、引热下行之剂
，治法良是，乃日服一剂，而白仍不退，药力太缓，连服数日只得数剂，而白愈见有加，是
犹杯水车薪，与事无济。治者当详审病源，或舌苔黄黑，或喉干唇焦，小便短涩微黄，大便
泄泻带黑，是为火毒凝结，内不能除，白何能退？迟延日久，以至愈发愈多，法当守方，急
急救之。似此恶症，每日必须三剂，方可有效。若病急乱投，另更别方，必致变生不测，其
难六也。
察之既精，图治不容稍缓，此乃瘟疫之变症，杀人最速，过七日不救。庸医辨症未明，
投以平淡之剂，不求有功，但求免过，是谓优容养奸。迨延至五六日，毒已重矣，元气伤矣
。善治者不得不以猛剂攻之，然病已垂危，成则无功，一旦不起，病家不归咎优容之过，而
反云猛剂非宜。此非误于后，而实误于前。其难七也。
有非白喉而转为白喉者，初起喉痛红肿，或恶寒发热，或不恶寒发热；或一边肿名曰单
蛾，或两边肿名曰双蛾，治之稍缓，则气闭不救。宜用土牛膝引热下行，大便闭用大黄，否
则不必用。此与白喉症异治同，倘不预防，转为白喉，为祸甚烈，其难八也。
又有劳症白喉，阴虚火燥，痛极而水米难下，甚至腐烂，形容枯槁，面目憔悴。必须养
阴补剂，使元气充满，而喉痛自愈。若以时行疫症白喉误认阴虚，差之毫厘，失之千里，其
难九也。
更有一种白喉，无恶寒发热等症，喉内起白皮，随发随长，时作恶心，干呕欲吐，的是
寒症，非附、桂不愈，即误服消风败毒之药，亦无大损。若以时行白喉疫症认作此症，为害
不浅。其难十也。
知此十难，临症审治，十不失一。咽喉系性命关系之处，务必细心详察，切不可忽略。
照此法行之数十年，无不效验。当兹时疫流行，不敢私秘，谨将治法、看法、方法以及吹喉
药散，一一开注于后，非敢云济世之良方，亦足为刀圭之一助云耳。
白喉是时行疫病中的一种病症，它发作有特定的时间规律，传染性极快。有时一人患病，竟能传染至全家，甚至整个乡、整个村的人都发病。这种病证极其危险险恶，是最紧急、最凶险的病症之一。如果不立即治疗就会致死，而医生若不得其要领，便会束手无策，但这并非临床经验不丰富就无法知晓。治疗此症有十大难点。
从前陈雨春先生论述说：此症是足三阴经（足太阴脾经、足少阴肾经、足厥阴肝经）受邪，病气传于肺，与其他经络无关。那些兼及其他经络症状的，也都是病后传变的结果。为什么这么说呢？因为此症初起时舌体微硬，舌苔黄，颃颡（鼻咽部）微肿，气喘口渴，心烦意乱。在十二经脉中，只有太阴经的脉路穿过膈肌连接咽喉，联系舌根，散布于舌下；少阴经的脉路沿着喉咙，夹持舌根；厥阴经的脉路沿着喉咙后方，向上进入颃颡，向下联络舌根。凡是患此病的人，两手关脉及左手尺脉多呈沉数且躁动之象，由此看来，病属足三阴经是明确的。此时病尚未传及其他经络，若不察明源头，却用治疗其他经络的药物，这是第一个难点。
大抵此症初起时，有恶寒发热、头痛背胀、精神倦怠、全身骨节疼痛等症状，喉内有的剧痛，有的微痛，还有的甚至不痛。初起时没有明显的特征可见，确实很像伤风或伤寒的表证（外感病初期症状）。如果误投麻黄汤、桂枝汤、细辛、羌活、防风、升麻、柴胡、苏叶等发散解表的药物，会导致毒气涣散，无法挽回，这是第二个难点。
患者之所以恶寒发热，是因为毒瓦斯（致病邪气）初发于体内。到了二三日，喉内已经出现白点或白块，寒热症状自然消除。医生不明白这一点，误以为是解表药起了作用，岂不知白喉显现出来，即使不服用解表药，寒热也会自行消除。对于风热引起的喉症，还可以稍微使用解表药，如荆防败毒散之类的方剂；唯独白喉这一病症，最忌讳使用解表药，这是第三个难点。
按此病多为热证而少为寒证。有人因其色白而断定其为寒证，却不知道此症初发于肺，肺属金，其色白，作为五脏六腑的华盖（比喻地位崇高或保护者），处于最高之位，毒瓦斯自下熏蒸而上，肺病日益加深，所以白色日益明显。治疗应当解除三经的毒邪，使其下行，不要让毒气积蓄在肺中。如果因色白就拟定为寒证，用附子、肉桂、炮姜等大热之剂投服，一旦遇到火证，这就叫抱薪救火，火势只会更加猛烈，这是第四个难点。
即使知道白喉是火毒，不可轻易使用开提升散的药物使其上升，从而加重壅塞，但起初就使用芒硝、大黄等泻下药，也不适宜。不知道此症已传至上焦气分（人体上部的气机运行层面），与中焦、下焦无关，既然上焦气分已受伤，再用硝石、大黄攻伐太过，会使中焦、下焦受损，元气更加受伤，这是第五个难点。
见到症状确切后，服药尤其应当坚守原方。这种恶症，若是火毒最严重的，初起时使用消风败毒、引热下行的药剂，治法是正确的。但如果每日服用一剂，而白色不退，说明药力太缓；连续服用数日只得几剂，而白色反而增多，这就像杯水车薪，对事情没有帮助。医生应当详细审察病源，若见舌苔黄黑，或喉干唇焦，小便短涩微黄，大便泄泻带黑，这是火毒凝结，内部不能清除，白色怎能消退？拖延日久，以致病情愈发严重，方法应当坚守原方，急切地急救。像这样的恶症，每天必须服用三剂，才能见效。如果因病急而乱投他方，更换别的处方，必定导致变故发生，难以预测，这是第六个难点。
观察既已精细，图谋治疗不容丝毫迟缓，这是瘟疫的变症，杀人最快，超过七日不救治便难挽回。庸医辨证不明，投以平淡的药剂，不求有功，但求免过，这叫优容养奸（宽容纵容坏人坏事）。等到拖延至五六天，毒气已重，元气已伤。善于治疗的人不得不使用猛剂攻邪，然而病已垂危，治好了也无功，一旦病人去世，家属不归咎于之前宽容延误的过错，反而指责猛剂不适宜。这并非错误在后，而是错误在前。这是第七个难点。
有不是白喉却转为白喉的情况，初起时喉痛红肿，或有恶寒发热，或无恶寒发热；有一边肿胀名为单蛾（扁桃体炎的一种），或两边肿胀名为双蛾。治疗稍慢，则气闭无法挽救。适宜用土牛膝引热下行，若大便闭塞用大黄，否则不必用。这与白喉症异治同（病因不同但治疗方法相似），倘若不预防，转为白喉，祸害非常剧烈，这是第八个难点。
又有劳损导致的白喉，阴虚火燥，疼痛极度严重以至于水米难进，甚至腐烂，形体枯槁，面目憔悴。必须使用养阴补剂的方药，使元气充满，而喉痛自然痊愈。如果把时行疫症白喉误认为阴虚劳损，差之毫厘，失之千里，这是第九个难点。
还有一种白喉，没有恶寒发热等症状，喉内起白皮，随发随长，时常恶心，干呕欲吐，确是寒症，非用附子、肉桂不能治愈，即使误服消风败毒的药物，也没有太大损害。如果把时行白喉疫症认作此症，危害不小。这是第十个难点。
知晓这十大难点，临症审慎治疗，十次不会失误一次。咽喉是关系到性命的关键部位，务必细心详察，切不可忽略。按照这种方法施行数十年，无不有效。当此时疫流行之际，不敢私藏秘方，谨将治法、看法、方法以及吹喉药散，一一开列注述在后面，不敢说是济世良方，也足以作为医者的一点点帮助罢了。
Baihou (White Throat) is a type of epidemic disease. Its onset follows specific temporal patterns, and its transmission is extremely rapid. It may start with one individual and spread to the entire household, or even an entire village. This condition is extremely critical and perilous, representing one of the most urgent and malignant syndromes. If not treated immediately, it can be fatal. Physicians who fail to grasp the key principles are rendered helpless, though this knowledge is not inaccessible to those with sufficient clinical experience. There are ten difficulties in treating this syndrome.
Mr. Chen Yuchun previously stated: This syndrome involves the Foot Three Yin meridians (Foot Taiyin Spleen Meridian, Foot Shaoyin Kidney Meridian, Foot Jueyin Liver Meridian) being affected, with the pathology transmitting to the Lung, unrelated to other meridians. Cases involving other meridians are merely post-onset transmissions. Why is this so? Initially, the tongue feels slightly stiff, the tongue coating is yellow, the nasopharynx (hangsang) is slightly swollen, accompanied by panting, thirst, and irritability. Among the twelve meridians, only the Taiyin meridian passes through the diaphragm to connect with the throat, links to the root of the tongue, and spreads under the tongue; the Shaoyin meridian runs along the throat and flanks the root of the tongue; the Jueyin meridian runs behind the throat, enters the nasopharynx upwards, and connects to the root of the tongue downwards. Patients with this syndrome typically present with deep, rapid, and restless pulses at both Guan positions and the left Chi position. Thus, it is clear that the disease belongs to the Foot Three Yin meridians. At this stage, the pathology has not yet transmitted to other meridians. Failing to identify the source and using medications for other meridians constitutes the first difficulty.
Generally, at the onset, symptoms include aversion to cold, fever, headache, back distension, mental fatigue, and pain in all joints. Throat pain varies from severe to mild or absent. Initially, there are no obvious visible signs, closely resembling exterior syndromes of Wind-Cold or Cold Damage. Administering dispersing and releasing exterior agents such as Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), Xixin (Asari Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), or Zisuye (Perillae Folium) will cause the pathogenic toxins to scatter irreversibly. This constitutes the second difficulty.
The initial aversion to cold and fever result from pathogenic qi initially arising internally. By the second or third day, white spots or patches appear in the throat, and the chills and fever naturally subside. Physicians who do not understand this mistake the resolution of symptoms on the efficacy of exterior-releasing drugs. In reality, once Baihou manifests, the chills and fever resolve even without exterior-releasing medication. For phlegm-heat sore throats, exterior-releasing formulas like Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Eliminate Toxins) may be used cautiously. However, for Baihou specifically, exterior-releasing drugs are strictly contraindicated. This constitutes the third difficulty.
This disease presents predominantly as heat syndromes and rarely as cold syndromes. Some assume it is a cold syndrome due to the white coloration, unaware that the disease originates in the Lung. The Lung belongs to Metal and corresponds to the color white. As the "Canopy" protecting the five zang and six fu organs, situated at the highest level, pathogenic vapors steam upward from below. As lung pathology deepens, the whiteness becomes more pronounced. Treatment should focus on resolving toxins in the three relevant meridians and guiding them downward, preventing accumulation in the Lung. Prescribing hot herbs like Fuzi (Aconiti Lateralis Radix Praeparata), Rongui (Cinnamomi Cortex), or Paojiang (Zingiberis Rhizoma Praeparatum) based on the white coloration is akin to adding firewood to a fire, intensifying the heat. This constitutes the fourth difficulty.
Even if one recognizes Baihou as a fire-toxin syndrome and avoids ascending and dispersing agents that worsen congestion, using Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) for purgation at the onset is also inappropriate. The pathology has transmitted to the Upper Jiao Qi level, unrelated to the Middle and Lower Jiao. Using harsh purgatives damages the Middle and Lower Jiao further, injuring the Yuan Qi (Original Qi). This constitutes the fifth difficulty.
Once symptoms are confirmed, the prescription must be maintained. For severe fire-toxin cases, initial treatment with Xiaofeng Baidu San (Wind-Dispersing Toxin-Eliminating Powder) or similar heat-guiding-downward formulas is correct. However, taking one dose daily without reduction of white patches indicates insufficient potency. Continuing for several days with worsening symptoms is like pouring a cup of water on a cartload of burning wood—ineffective. The physician must carefully examine the source: yellow-black tongue coating, dry throat and lips, scanty dark-yellow urine, or blackish diarrhea indicate condensed fire-toxin that cannot be cleared internally, hence the persistence of whiteness. Delay allows progression. The method requires sticking to the formula and urgent rescue. Such malignant cases require three doses daily to be effective. Changing prescriptions due to urgency leads to unpredictable complications. This constitutes the sixth difficulty.
Observation must be precise, and treatment cannot be delayed. This is a variant of plague, killing rapidly; after seven days, rescue is difficult. Quack physicians, failing to differentiate clearly, prescribe bland agents, seeking neither merit nor fault, thereby nurturing evil. By five or six days, toxin load is heavy, and Yuan Qi is damaged. Skilled physicians must use potent agents. However, if the patient dies despite potent treatment, families blame the potent medicine rather than the prior delay. The error lies in the beginning, not the end. This constitutes the seventh difficulty.
Non-Baihou conditions may transform into Baihou. Initial symptoms include sore throat with redness and swelling, with or without chills and fever. Unilateral swelling is called Dan'e (Single Swallow), bilateral is Shuang'e (Double Swallow). Delayed treatment leads to qi closure and death. Tuniuxi (Achyranthis Bidentatae Radix) should be used to guide heat downward; Dahuang is added if constipated. This shares treatment principles with Baihou but differs in etiology. Failure to prevent transformation leads to severe consequences. This constitutes the eighth difficulty.
There is also Laozheng (Consumption Syndrome) presenting as Baihou, characterized by yin deficiency and fire dryness. Severe pain prevents intake of food and water, leading to ulceration, emaciation, and haggard appearance. Nourishing yin and tonifying formulas are required to replenish Yuan Qi, allowing spontaneous healing of the throat. Misdiagnosing epidemic Baihou as yin-deficiency consumption leads to significant errors. This constitutes the ninth difficulty.
Another type of Baihou lacks chills and fever. White membranes appear in the throat, growing rapidly, accompanied by nausea and retching. This is a true cold syndrome, requiring Fuzi and Rongui for cure. Mistakenly administering Xiaofeng Baidu San causes little harm. Conversely, mistaking epidemic Baihou for this cold type causes significant damage. This constitutes the tenth difficulty.
Understanding these ten difficulties ensures accurate diagnosis and treatment, with minimal error. The throat is vital to life; careful observation is essential. Following this method for decades has proven effective. During epidemics, I dare not keep these secrets. I hereby detail the diagnostic methods, treatment principles, and throat-powder preparations below. These may serve as a modest aid to practitioners.