（评门人吴玉纯稿）
或问白喉一书，养阴忌表，专以大剂甘凉镇润，然则治喉之法，果尽于此，而从前表散之方，皆可废弃
乎。曰、治病之要，在乎辨症，辨症之道，求其精确。凡喉症之宜暂表者，必头疼板痛，鼻塞流涕，音声重浊，
此为外寒包热，实喉症之轻浅者，辛凉散之即愈。近人以其辛散有效，于喉症之重者，亦必用之，用而
不效，以为辛凉尚轻，继以辛温，口耳相传，并无他法。考之于古，无是理也。医书之中，伤寒金匮，最为近
古，其论咽痛，独详于少阴之经，以少阴之脉，上循喉咙，为津液往还之道路也。首条症见胸满心烦，用
猪肤白蜜，清润甘养之意，毕露于此。其但咽痛而无烦满者，少阴之热不盛，则甘草汤平调之。挟有外
感不瘥者，加桔梗为桔梗汤。必不差而始加，其慎表之意若此也。其非少阴炽热，而由寒热杂沓为疮
者，方书所谓乳蛾之类，苦酒汤主之。其寒犯肾中之痛，则又有半夏散及汤之方。后贤详其证状，谓猝
然而起，不红不肿，但觉大痛异常，暴喑无音，脉多弦紧，或数疾无伦，此大寒犯肾也，用麻附细辛汤。然
此症百不得一，姑备其法而已。惟是猪肤汤一方，实与白喉书中养阴清肺汤后先相望，诚以白喉一
症，火热自内而发，燔灼于少阴经中，少阳之风，亦因之而动，火乘风势，风助火威，少阴天一之源，几乎
有涸绝之势。求其属以济之，非壮水之主，不足以制阳光，养阴清肺者，求其属以济之也。是故其初起
也，咽中干涩，咽物窒碍而痛，心中烦热，口鼻面上，皆觉烘热，绝无表寒之症象。然病犹在少阴本经，火
未得风，势未炽也。至盛极而动少阳之风，则目眩昏花，胸胁不和。经络焦灼，或作掣引之状，而风与火
相合而暴煽矣。煽及阳明，则蒸灼胃中之浊为腐，煽及肺金则熬炼阴中之液，尽化为痰。肺胃清旷之
区，已成燎原之势。肺败而鼻塞音喑，喘逆痰升矣。胃败而衄流臭腐，神明糊乱矣。病至此，虽有智者，不
能与谋。曰、不然。白喉之重者，其初起往往骨节疼痛，大寒大热，状类伤寒，苟不挟外感，何以若是。曰、白
喉之外感者，感冬春温热之邪，郁伏少阴而成温毒，非风寒也。即病起之时，或触微邪，只足以鼓动少
阳之风，少阳者，人身内生之风也，内风动而外风已不知何往，而少阴之火，乃因之愈炽矣。故伤寒之
寒热，必先凄清怯冷，肢节疲倦，由寒而生热。白喉之寒热，必先肢肤焦燥，肢节烦疼，热极而生寒。曰、热
极生寒，经训有之，然其理尚惝恍而无凭也。曰、阴阳之亢战，观于天地之风雷而知之矣。譬如盛夏之
令，炎 燔热，郁蒸不解，而后日月为之晦冥，万窍为之怒号，雷电为之大作。人身亦犹是也，阳亢之极，
一线之阴气，欲承而不得承，乃作寒热交战之象。安得与伤寒之寒热相提并论乎。然则喉痹缠喉二
症，果有异于此乎。曰、喉痹红肿为实火，厥阴之火也。缠喉肿闭为痰火，阳明之火也。白喉色带淡白，初
起不甚肿痛为虚火，少阴之火也。本书中猛将之类，神仙活命汤方，即可治厥阴阳明之火。此外又有
烂喉丹痧一症，其痧未透时，必须表散，本书除瘟化毒汤中有葛根薄荷，大可胜任。盖少阴伏邪，达于
少阳，必须归于阳明，从肌肉而出，故伤寒论云，阳明者土也，万物所归。若与麻桂羌防等类，必至毒热
四窜，奔腾莫制。况葛根薄荷辛凉甘润，与辛温燥烈之品，自有分别。伤寒论少阴篇中，先猪肤而次桔
梗，此书首生地而殿葛根，三方鼎峙，直追南阳心法，未可仅以乩谶之语观之也。苟凡有医书，皆能如
是之规绳划一，禁忌分明，庶几一病有一定之方，而无杂药妄投之虑矣。
条分缕析，推阐靡遗，是熟精南阳书而神于变化者，不独为白喉一症作功臣也。玉机微义论喉痹谓、
一言可了者火是也。又谓、君火者犹人火也，相火者犹龙火也，人火焚木其势缓，龙火焚木其势速。其
急于治火，同也。
（评门人吴玉纯稿）
有人问：关于白喉的医书，主张滋养阴液、忌用解表法，专门使用大剂量的甘凉滋润药物。那么治疗咽喉疾病的方法，难道真的只有这一种吗？从前那些解表发散的方法，都可以废弃了吗？回答说：治病的关键，在于辨证；辨证的原则，在于追求精确。凡是咽喉病症中适宜暂时使用解表法的，一定伴有头痛如裹、鼻塞流涕、声音嘶哑沉重等症状。这是外寒束表、内有郁热的表现，属于咽喉病症中病情较轻浅的类型，用辛凉性质的药物疏散即可痊愈。近代医生因为看到辛凉发散有效，便在病情较重的咽喉病症中也必须使用这种方法。使用后如果不奏效，便认为辛凉药力尚轻，接着改用辛温药物，这种观点口耳相传，并没有其他方法。考察古代医籍，没有这样的道理。医书中，《伤寒论》和《金匮要略》最为接近古法，其中论述咽痛的内容，唯独详细记载于少阴经（足少阴肾经），因为少阴经脉向上循行经过喉咙，是津液往还通行的道路。第一条症状表现为胸满心烦，使用猪肤汤加白蜜，其清润甘养的意图在此显露无遗。如果是仅仅咽痛而没有烦闷胀满感的，说明少阴的热邪不盛，则用甘草汤平调。如果兼有外感而病不愈的，加入桔梗成为桔梗汤。一定要在病情未好转时才考虑添加，其谨慎使用解表之意就是这样。如果不是少阴经炽热，而是由寒热错杂导致生疮的，即方书中所说的乳蛾（扁桃体炎）之类，用苦酒汤主治。如果是寒气侵犯肾脏引起的疼痛，则有半夏散及汤的方剂。后世医家详细分析其证状，说突然发作，咽喉不红不肿，但觉得剧烈疼痛，突然失音，脉象多弦紧，或数疾无比，这是大寒侵犯肾脏的表现，用麻黄附子细辛汤。然而这种症状百中无一，姑且保留这种方法罢了。只是猪肤汤一方，实际上与白喉书中养阴清肺汤前后呼应，诚然，白喉这一病症，火热自内而发，焚烧灼烧于少阴经中，少阳之风（肝风/内风）也因此而动，火借风势，风助火威，少阴天一之源（肾阴），几乎有枯竭断绝之势。寻求其所属以济助它，不是壮大水之主（肾阴），不足以制约阳光（虚火），养阴清肺汤，就是寻求其所属以济助它的方剂。因此，在初起时，咽喉干燥涩滞，吞咽受阻而痛，心中烦热，口鼻面部都感觉烘热，完全没有表寒的症状象。但是病还在少阴本经，火未得风助，势头还不猛烈。到了火势极盛而触动少阳之风时，则出现目眩昏花，胸胁不和。经络焦灼，或者出现牵引掣痛的状态，而风与火相合而暴烈煽动。煽动波及阳明经（胃经），则蒸灼胃中的浊气化为腐秽；煽动波及肺金（肺脏），则熬炼阴中之液，全部化为痰。肺胃清旷的区域，已成燎原之势。肺败则鼻塞失音，气喘逆乱痰升。胃败则鼻衄流出臭腐之物，神明糊乱。病到了这一步，虽然有智者，也不能与之谋划了。回答说：不对。白喉重症，初起往往骨节疼痛，大寒大热，状似伤寒，如果不夹杂外感，怎么会这样呢？回答说：白喉的外感，是感受冬春温热之邪，郁伏于少阴而成温毒，并非风寒。即使在发病之时，偶尔触碰到轻微的外邪，只足以鼓动少阳之风，少阳者，是人身体内生的风（内风），内风一动，外风已不知去向，而少阴的火，却因此更加炽盛了。所以伤寒的寒热，一定是先感到凄清怕冷，肢节疲倦，由寒而生热。白喉的寒热，一定是先感到肢体皮肤焦燥，肢节烦疼，热极而生寒。回答说：热极生寒，经典训诫中有此说法，但是其中的道理尚且恍惚而无凭据。回答说：阴阳的亢盛交战，观察天地间的狂风雷电就知道了。譬如盛夏的命令，炎热焚烧，郁结蒸腾不解，然后日月为之昏暗，万物孔窍为之怒号，雷电为之大作。人身也是如此，阳气亢盛到极点，一线阴气，想要承接却不得承接，于是产生寒热交战的景象。怎么能与伤寒的寒热相提并论呢？那么喉痹（咽喉红肿疼痛）和缠喉（咽喉肿胀闭塞）这两种病症，果然与此不同吗？回答说：喉痹红肿属实火，是厥阴经（肝经）的火。缠喉肿闭属痰火，是阳明经（胃经）的火。白喉颜色带淡白，初起肿痛不明显属虚火，是少阴经（肾经）的火。本书中的猛将类药物，神仙活命汤方，就可以治疗厥阴和阳明的火。此外又有烂喉丹痧这一病症，其痧疹尚未透发时，必须解表散发，本书除瘟化毒汤中有葛根、薄荷，完全可以胜任。盖因少阴伏邪，达于少阳，必须归于阳明，从肌肉而出，所以《伤寒论》说，阳明者土也，万物所归。如果使用麻黄、桂枝、羌活、防风等类辛温燥烈药物，必定导致毒热四处窜散，奔腾无法控制。况且葛根、薄荷辛凉甘润，与辛温燥烈的药物，自然有分别。《伤寒论》少阴篇中，先用猪肤汤而后用桔梗汤，本书首先生地而后殿后葛根，三方鼎立，直接追索张仲景的心法，不可以仅仅把它当作扶乩占卜的言语来看待。如果所有的医书，都能像这样规矩划一，禁忌分明，差不多一种病就有一定的方剂，而没有杂乱用药妄投的忧虑了。条理分明，推阐详尽无遗，这是熟精张仲景之书而善于变化的人，不只是为白喉这一病症做功臣啊。《玉机微义》论喉痹说：一言可了的，就是“火”而已。又说：君火就像人火，相火就像龙火，人火烧木头其势缓慢，龙火烧木头其势迅速。它们急于治火的道理，是一样的。
(Commentary on the manuscript by disciple Wu Yuchun)
Someone asked: Regarding medical texts on pseudodiphtheritic croup (Baihou, 白喉), it is advocated to nourish Yin and avoid exterior-releasing methods, specifically using large doses of sweet-cool moistening medications. Are the methods for treating throat diseases truly limited to this? Can all previous exterior-dispersing prescriptions be discarded? I reply: The key to treating disease lies in syndrome differentiation; the principle of syndrome differentiation lies in pursuing precision. For throat syndromes that are suitable for temporary exterior-releasing treatment, there must necessarily be symptoms such as headache with a heavy sensation, nasal congestion with runny nose, and hoarse or muffled voice. This indicates external cold enveloping internal heat, representing a mild and superficial stage of throat syndromes. Dispersing with acrid-cool medications will lead to recovery. Recent physicians, having observed the efficacy of acrid dispersal, insist on using these methods even for severe throat syndromes. When ineffective, they consider acrid-cool methods too mild and subsequently employ acrid-warm methods. This view has been passed down orally without alternative approaches. Examining ancient texts, there is no such rationale. Among medical books, *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) are closest to ancient traditions. Their discussion on sore throat focuses exclusively on the Shaoyin channel (Foot-Shaoyin Kidney Meridian), because the Shaoyin meridian ascends along the throat, serving as the pathway for the circulation of body fluids. The first symptom pattern presents chest fullness and mental restlessness, treated with Zhufu Tang (Pig Skin Decoction) plus white honey, revealing the intent of clearing, moistening, and sweetly nourishing. If there is only sore throat without fullness or restlessness, the Shaoyin heat is not intense, so Gancao Tang (Licorice Decoction) is used to harmonize gently. If accompanied by an exterior pathogen and the condition does not improve, Jiegeng (Platycodonis Radix) is added to form Jiegeng Tang (Platycodon Decoction). The addition is made only when the condition fails to improve, demonstrating such caution regarding the use of exterior-releasing methods. If the condition is not caused by blazing heat in the Shaoyin but by a mixture of cold and heat leading to ulceration, such as Ru'e (Mandibular tonsillitis/Tonsillar hypertrophy) described in formularies, Kujiu Tang (Vinegar Decoction) is the primary treatment. If the pain is caused by cold invading the Kidney, Banxia San Ji Tang (Pinellia Powder and Decoction) is available. Later scholars analyzed the symptoms, stating that it starts suddenly, with no redness or swelling, but extreme pain, sudden aphonia (loss of voice), and a pulse that is often wiry-tight or extremely rapid. This indicates severe cold invading the Kidney, treated with Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction). However, this syndrome occurs in less than one percent of cases; this method is merely recorded for reference. Nevertheless, Zhufu Tang (Pig Skin Decoction) stands in correspondence with Yangyin Qingfei Tang (Nourish Yin and Clear Lung Decoction) found in texts on pseudodiphtheritic croup. Indeed, pseudodiphtheritic croup originates from fire-heat arising internally, scorching within the Shaoyin channel, while wind from the Shaoyang channel (Liver Wind/Internal Wind) is stirred accordingly. Fire borrows the momentum of wind, and wind enhances the power of fire, putting the "Source of Tianyi" (Kidney Yin) of the Shaoyin into near desiccation. To seek its belonging to assist it, strengthening the master of water (Kidney Yin) is insufficient to control the sunlight (deficient fire); Yangyin Qingfei Tang seeks its belonging to assist it. Therefore, in the initial stage, there is dryness and astringency in the throat, obstruction and pain upon swallowing, mental restlessness and heat in the heart, and a feeling of baking heat in the mouth, nose, and face, with absolutely no signs of exterior cold. However, the disease remains in the original Shaoyin channel; without wind assistance, the fire's momentum is not yet intense. When the fire reaches extremity and stirs the Shaoyang wind, dizziness and blurred vision occur, along with disharmony in the chest and hypochondrium. The meridians become scorched, possibly presenting with pulling or twitching sensations, as wind and fire combine to blaze violently. Blazing affects the Yangming channel (Stomach Channel), steaming turbid qi in the stomach into putrefaction; blazing affects Metal of the Lung (Lung Organ), boiling the fluids within Yin into phlegm. The clear and spacious regions of the Lung and Stomach have become a prairie fire. Lung failure leads to nasal congestion, aphonia, panting, and rising phlegm. Stomach failure leads to epistaxis with foul-smelling discharge, and confusion of the spirit/mind. At this stage, even a wise person cannot devise a strategy. I say: Not so. Severe cases of pseudodiphtheritic croup often present with bone and joint pain, severe chills and high fever in the initial stage, resembling cold damage. If not complicated by an exterior pathogen, how could it be like this? I reply: The "exterior infection" in pseudodiphtheritic croup is contracting warm-heat pathogens in winter and spring, which lie dormant in the Shaoyin and transform into warm-toxin; it is not wind-cold. Even if slight external pathogens are touched at the onset, they only suffice to stir the Shaoyang wind. Shaoyang refers to the internally generated wind (Internal Wind) in the human body. Once internal wind moves, the external wind is lost, and the Shaoyin fire becomes even more intense. Thus, the chills and fever of cold damage begin with a chilling sensation and fear of cold, limb fatigue, generating heat from cold. The chills and fever of pseudodiphtheritic croup begin with scorched and dry skin and limbs, vexing pain in joints, generating cold from extreme heat. I say: Extreme heat generating cold is mentioned in classical teachings, but the rationale seems vague and unsubstantiated. I reply: The conflict of hyperactive Yin and Yang can be understood by observing wind and thunder in nature. For example, during midsummer, scorching heat lingers unresolved, causing the sun and moon to darken, all apertures to roar, and thunder and lightning to erupt violently. The human body is similar. When Yang hyperactivity reaches its peak, a thread of Yin Qi attempts to connect but fails, resulting in a phenomenon of chills and fever交战 (battle). How can this be compared to the chills and fever of cold damage? Then, do Houbi (Sore Throat) and Chanhou (Entangling Throat) differ from this? I reply: Houbi with redness and swelling is excess fire, belonging to the Jueyin channel (Liver Channel). Chanhou with swelling and closure is phlegm-fire, belonging to the Yangming channel (Stomach Channel). Pseudodiphtheritic croup appears pale white, with mild swelling and pain initially, indicating deficient fire, belonging to the Shaoyin channel (Kidney Channel). The fierce agents in this book, such as Shenxian Huoming Tang (Immortal Life-Saving Decoction), can treat the fire of Jueyin and Yangming. Additionally, there is the syndrome of Lanhou Dansha (Rotting Throat with Scarlet Rash). When the rash has not yet erupted, exterior release is necessary. Chuwen Huadu Tang (Eliminate Pestilence and Transform Toxin Decoction) in this book contains Gegen (Puerariae Radix) and Bohe (Menthae Haplocalycis Herba), which are fully competent. Because latent pathogens in Shaoyin reach Shaoyang and must return to Yangming to exit through the muscles, *Shanghan Lun* states: Yangming is Earth, the destination of all things. Using acrid-warm drying agents like Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), and Fangfeng (Saposhnikoviae Radix) would cause toxic heat to scatter everywhere, surging uncontrollably. Moreover, Gegen and Bohe are acrid-cool and sweet-moistening, distinct from acrid-warm drying agents. In the Shaoyin chapter of *Shanghan Lun*, Zhufu Tang precedes Jiegeng Tang; in this book, Shengdi (Rehmanniae Radix) precedes Gegen. These three formulas stand in tripartite balance, directly tracing Zhang Zhongjing's (Zhang Nan-yang) methodology. They should not be viewed merely as divination. If all medical books could adhere to such consistent rules and clear contraindications, each disease would have a fixed prescription, avoiding the worry of indiscriminate medication. Analyzing details meticulously and expounding thoroughly without omission, this demonstrates mastery of Zhang Zhongjing's works and divine adaptability. He is not only a merit-maker for the syndrome of pseudodiphtheritic croup. *Yuji Wei Yi* discusses Houbi, stating: "One word summarizes it: Fire." It further states: "Jun Fire (Monarch Fire) is like human fire; Xiang Fire (Minister Fire) is like dragon fire. Human fire burning wood is slow; dragon fire burning wood is fast." Their urgency in treating fire is the same.