丙寅中秋后，接到刘华封自济南寄赠所着《烂喉痧证治辨异》一书。细阅一过，其辩证之精，用药之妙，
立论之通，于喉证一门实能令人起观止之叹。咽喉为人身紧要之处，而论喉证之书向无善本。自耐修子托
之鸾语，着《白喉忌表抉微》，盛行于一时，初则用其方效者甚多，继而用其方者有效有不效，更有用
之不惟不效而病转增剧者。于斯议论纷起，有谓白喉不忌表散，但宜表以辛凉，而不可表以温热者。又有谓
白喉原宜表散，虽麻黄亦可用，但不可与升提之药并用者。按其人或有严寒外束不得汗，咽喉疼而不肿者，原
可用麻黄汤解其表。然麻黄可用，桂枝不可用。若用麻黄汤时，宜去桂枝，加知母、连翘。至升提之药，惟忌
用升麻。若桔梗亦升提之药，而《伤寒论》有桔梗汤治少阴病咽痛，因其能开提肺气散其咽喉郁热也。若
与凉药并用，又能引凉药之力至咽喉散热。惟咽喉痛而且肿者，似不宜用。又有于《白喉忌表抉微》一书痛
加诋毁，谓其毫无足取者。而刘华封则谓白喉证原分两种，耐修子所谓白喉忌表者，内伤之白喉也。其病因
确系煤毒、纸烟及过服煎炒辛热之物，或贪色过度，以致阴液亏损虚火上炎所致，用药养阴清肺原为正治。
其由外感传染者，为烂喉痧，喉中亦有白腐，乃系天行时气入于阳明，上
蒸于肺，致咽喉溃烂，或兼有疹子，正是温热欲出不得所致，正宜疏通发表使毒热外出。二证之辨∶白喉则
咽中干，喉痧则咽中多痰涎。白喉止五心烦热，喉痧则浑身大热云云。诚能将此二证，一内因，一外因，
辨别极精。及至后所载治喉痧诸方，详分病之轻重浅深，而措施咸宜，洵为喉科之金科玉律也。惟其言今日
之好人参难得，若用白虎加人参汤及小柴胡汤，方中人参可以沙参代之，似非确论。盖小柴胡汤中之人参或
可代以沙参，若当下后小柴胡汤证仍在者，用小柴胡汤时，亦不可以沙参代人参。至白虎加人参汤，若其
热实脉虚者，以沙参代人参其热必不退，此愚由经验而知，非想当然尔之谈也。且古方中人参即系今之党参，
原非难得之物。若恐人工种植者不堪用，凡党参之通体横纹者（若胡莱菔之纹）皆野生之参也。至其后论
喉证原有因下焦虚寒迫其真阳上浮致成喉证者，宜治以引火归原之法，洵为见道之言。
丙寅年中秋节后，我收到了刘华封从济南寄赠的他所著的《烂喉痧证治辨异》一书。仔细翻阅一遍，其辨证之精妙、用药之巧妙、立论之通达，对于喉科这一门类，确实能让人发出赞叹不已的感叹。咽喉是人体紧要之处，但论述喉证的书籍向来没有好的版本。自从耐修子通过扶乩（托之鸾语）著成《白喉忌表抉微》，在当时非常盛行，起初使用他的方子有效的很多，后来使用他的方子的，有的有效有的无效，更有使用之后不仅无效反而病情加重的人。于是各种议论纷纷兴起，有人说白喉不忌讳解表发散，只适宜用辛凉解表，而不可用温热药解表。又有人说白喉原本就适宜解表发散，即使麻黄也可以用，只是不可与升提类药物同时使用。考察其人如果有严寒外束导致无法出汗，咽喉疼痛但不肿胀的情况，原本可以使用麻黄汤来解除表邪。然而麻黄可以用，桂枝则不可用。如果使用麻黄汤时，应当去掉桂枝，加入知母、连翘。至于升提类药物，只有升麻是禁忌使用的。如果桔梗也是升提类药物，但《伤寒论》中有桔梗汤治疗少阴病咽痛，是因为它能开提肺气以疏散咽喉部的郁热。如果与凉性药物同时使用，又能引导凉药之力到达咽喉散热。只有当咽喉疼痛且肿胀时，似乎才不宜使用。又有人对《白喉忌表抉微》一书痛加诋毁，认为它毫无可取之处。而刘华封则认为白喉证原本分为两种，耐修子所说的白喉忌表，指的是内伤引起的白喉。其病因确切是由于煤毒、纸烟以及过服煎炒辛热之物，或贪色过度，导致阴液亏损、虚火上炎所致，用药养阴清肺原本是正治法。由外感传染引起的，称为烂喉痧，喉中也有白腐，这是天行时气侵入阳明经，向上蒸腾于肺，导致咽喉溃烂，或者兼有疹子，这正是温热毒邪欲出而不能出的表现，正宜疏通发表使毒热外出。这两种证的辨别：白喉则咽喉干燥，喉痧则咽喉多痰涎。白喉仅见五心烦热，喉痧则全身大热等等。如果能将这两种证，一为内因，一为外因，辨别得极其精确，等到后面所载的治疗喉痧的各个方剂，详细区分病的轻重浅深，而施治措施都适宜得当，确实是喉科的金科玉律。只是他说现在的好人参难得，如果使用白虎加人参汤及小柴胡汤，方中的人参可以用沙参代替，这似乎不是确切的结论。大概小柴胡汤中的人参或许可以代以沙参，如果是攻下之后小柴胡汤证仍在者，使用小柴胡汤时，也不可以用沙参代替人参。至于白虎加人参汤，如果其热实而脉虚者，用沙参代替人参，其热必定不退，这是我由经验得知的，并非想当然的谈论。况且古方中的人参即系现在的党参，原本不是难得之物。如果担心人工种植的不堪使用，凡是党参通体具有横纹的（像胡萝卜那样的纹路），都是野生的参。至于他后面论述喉证原有因为下焦虚寒逼迫真阳上浮而导致形成喉证的情况，适宜用引火归原的方法治疗，这确实是见识到大道的言论。
After the Mid-Autumn Festival in the Bingyin year, I received a copy of *Lanhou Sha Zhengzhi Bianyi* (Differentiation of Diagnosis and Treatment for Rotten Throat and Sand Disease), authored by Liu Huafeng and sent to me from Jinan. After reading it carefully, its precision in differentiation of syndromes (Bianzheng), ingenuity in prescription, and comprehensiveness in theoretical arguments truly evoke admiration for the field of throat diseases. The throat is a critical part of the human body, yet there have historically been no excellent texts dedicated to throat diseases. Since Naixiu Zi composed *Baihou Ji Biao Juewei* (Unveiling the Secrets of Avoiding Exterior-Resolving Methods for White Throat) through spirit writing, it became widely popular at the time. Initially, many patients were cured using his prescriptions; later, however, while some were effective, others showed no effect, and some even experienced worsening conditions after use. Consequently, various debates arose. Some argued that white throat should not avoid exterior-resolving methods but should only be treated with acrid-cool exterior-resolving agents, avoiding acrid-warm ones. Others claimed that white throat originally required exterior resolution, and even Ephedrae Herba (Mahuang, 麻黄) could be used, provided it was not combined with ascending-drifting herbs. In cases where external cold constrains the body preventing sweating, accompanied by sore throat without swelling, Mahuang Tang (Ephedra Decoction) can indeed be used to release the exterior. However, while Mahuang may be used, Cinnamon Twig (Guizhi, 桂枝) should not. When using Mahuang Tang, Guizhi should be removed, and Anemarrhenae Rhizoma (Zhimu, 知母) and Forsythiae Fructus (Lianqiao, 连翘) should be added. Regarding ascending herbs, only Cimicifugae Rhizoma (Shengma, 升麻) is strictly contraindicated. Although Platycodonis Radix (Jiegeng, 桔梗) is also considered an ascending herb, *Shanghan Lun* (Treatise on Cold Damage Disorders) mentions Jiegeng Tang for treating Shaoyin disease sore throat because it can open and lift Lung Qi to dissipate stagnant heat in the throat. When combined with cooling herbs, it can also guide their efficacy to the throat to dissipate heat. It is only when the throat is painful and swollen that its use seems inappropriate. Some fiercely criticized *Baihou Ji Biao Juewei*, claiming it had no merit whatsoever. Liu Huafeng, however, stated that white throat syndrome is originally divided into two types. The "white throat avoiding exterior resolution" mentioned by Naixiu Zi refers to internal-injury white throat. Its etiology is precisely due to coal dust toxicity, cigarette smoking, excessive consumption of fried and pungent-hot foods, or sexual excess, leading to yin fluid deficiency and defluxion of deficient fire upward. Therefore, nourishing yin and clearing lung heat is the correct treatment. The type caused by external infectious transmission is called Lanhou Sha (Rotten Throat and Sand Disease). Although there is white decay in the throat, it results from epidemic qi entering the Yangming channel and steaming upward into the Lungs, causing throat ulceration, possibly accompanied by rashes. This indicates warm-heat pathogenic factors attempting to emerge but failing to do so; thus, unblocking and releasing the exterior to allow toxic heat to exit is appropriate. The differentiation between these two syndromes: in white throat, the throat is dry; in Sha disease, there is much phlegm-saliva in the throat. White throat presents with five-palm heat (worrying heat in the palms, soles, and chest), whereas Sha disease presents with high fever throughout the body. If these two syndromes, one due to internal causes and the other to external causes, are differentiated with such precision, and the subsequent prescriptions for treating Sha disease are detailed according to the severity and depth of the illness, making every therapeutic measure suitable, this truly serves as the golden rule for throat specialists. However, his statement that good Ginseng Radix et Rhizoma (Renshen, 人参) is hard to obtain today, and that Codonopsis Radix (Dangshen, 党参) can replace Renshen in Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) and Xiaochaihu Tang (Minor Bupleurum Decoction), seems inaccurate. Perhaps Codonopsis Radix can replace Renshen in Xiaochaihu Tang, but if the Xiaochaihu Tang syndrome persists after purgation, Codonopsis Radix should not replace Renshen when administering Xiaochaihu Tang. As for Baihu Jia Renshen Tang, if the heat is substantial but the pulse is deficient, replacing Renshen with Codonopsis Radix will likely fail to reduce the heat, a conclusion drawn from my own experience, not mere speculation. Moreover, Renshen in ancient formulas refers to what is now Dangshen, which was originally not a rare item. If one fears that artificially cultivated varieties are unsuitable, any Dangshen with transverse striations throughout (resembling those of Daikon radish) is wild-grown ginseng. Regarding his later discussion that some throat conditions arise from deficiency-cold in the lower jiao forcing true yang to float upward, requiring treatment with the method of guiding fire back to its source, this is indeed insightful commentary.