余纂白喉条辨。自丁酉出版。迄今一纪矣。于前贤白喉诸书议论。间有未惬于心者。
莫不详加讨论。斟酌妥协。以期悉合病情治法而后已。顾独于忌表二字。尚嫌疏释。
未能尽致。心窃病之。盖白喉为太阴肺经伏燥。苟无时邪感触。自不宜无故表散。兆
成燎原之祸。若确属挟有时感表症者。则解表自难容缓。如前第五条所言挟温热者。
可加薄荷荷叶扁豆花之类。挟寒湿燥三气者。虽麻葛前苏香薷藿香等皆可酌用。或外感
里燥并重。亦须表里清疏。二者兼顾。但先使表邪得解。纵白发满喉。则施治亦自易
易矣。唯不得浪用姜桂辛热引邪入里之品耳。尝见时医未读白喉忌表抉微者。动辄表
散。为祸固烈。乃有已见此书。未能洞彻原理。往往坭守忌表二字。纵有外感甚厉。
开手即一味清滋。转使外邪陷入。里燥愈甚。卒成烂喉等病。毙命者所在皆有见之。
实堪痛悼。夫六淫病。邪气从外入者。无不以解表为要务。白喉虽为太阴伏燥。法宜
直从肺经清降。苟外感未去。辄先注意于此。且有于清降之中。再乱入苦重滋腻之
品。则外邪未有不被牵率而内陷。终致清疏两无所施。坐视殒命者。伤何如之。（仆）二少
女年甫十龄。曾于某年夏月往邻里观剧。时值溽暑郁蒸。（当数日前西风大作夏行秋令故有白喉
症发现）加之剧场
人气酝酿。归即寒热大作。肢体如废。腹痛餐泄。舌苔灰浊而喉间又复发白。（仆）权其
轻重。理宜解暑去湿为先。盖治白喉不外清滋之品。暑湿得解。则用药自无牵掣矣。
遂用香薷饮合正气散加减。再入石膏鲜苇茎二味。略顾肺中之燥。（石膏为治燥火主药其性兼能达表清里
熟读仲圣书者自能得其旨归故喉间一见白 白片此味即不容缓乃时医于冬地石斛元参等味习为故然浪用不
怪视石膏反不敢轻于一试识力不真往往坐失病机殊堪太息）二剂后表解体鬯。痛止泄愈。而喉中日
势转剧。几至满喉皆是。乃急转用西洋参石膏苇茎元参杏仁枇杷叶等
味。三剂白去八九。喉中唯觉燥痛。遂再加羚羊鲜生地二味。病遂全愈。使当初下手
时疑忌香薷藿香辛燥与白喉有碍。把握不定。不以全力专去暑湿。恐遗祸有不可胜言
矣。要之白喉病夹症颇伙。唯太阴伏燥独发者。自当以清降滋润为重。如辛散苦重。
皆在所禁。前已辨之详矣。若挟六淫时感。自当湿因湿治。寒因寒治。暑热因暑热
治。先解其表。则本症治法。自无顾虑。断不可坭守忌表二字。使外感与伏燥。互相
牵引。譬如观奕。一着错则全局输矣。吾愿世之治白喉者。因此意神而明之。或能与
吾民同跻寿域也。故不辞繁复。复补此篇于后。
宣统元年太岁己酉十月栗 甫再识于湫 斋
我编纂《白喉条辨》一书，自丁酉年出版以来，至今已经十年了。对于前贤关于白喉的各种书籍中的议论，我内心间或有觉得不够满意的地方。于是详细加以讨论，斟酌出最恰当的方案，以期完全符合病情和治疗法则才罢休。唯独对于“忌表”（禁忌使用解表发汗法）这两个字，我还嫌解释得不够透彻，未能详尽无遗，心中对此深感遗憾。
因为白喉是由于太阴肺经中潜伏的燥邪所致，如果没有时令邪气的感触，自然不应该无故使用解表发散的方法，否则会造成像星火燎原一样的灾祸。如果确实属于兼有时令外感表证的情况，那么解除表邪自然难以拖延。如前面第五条所言，如果是挟带温热邪气，可以加入薄荷、荷叶、扁豆花之类的药物；如果是挟带寒湿燥三种邪气，虽然麻黄、葛根、前胡、紫苏、香薷、藿香等药都可以酌情使用。或者是外感与里燥并重，也必须表里同治，清疏兼顾。但首先要使表邪得到解除，即使喉咙布满白膜，治疗起来也就容易了。只是不能滥用生姜、肉桂等辛热之品，以免引邪入里。
我曾见到一些当时的医生没有读过《白喉忌表抉微》这本书，动不动就使用解表发散法，造成的祸害固然猛烈；然而也有已经看过这本书，却未能透彻理解其原理的人，往往死板地坚守“忌表”这两个字，纵然有非常严重的外感症状，一开始就一味地使用清凉滋润的药物，反而导致外邪陷入体内，使里的燥邪更加严重，最终形成烂喉等病症，导致死亡的案例随处可见，见到这种情况实在令人痛心疾首。
大凡六淫病邪，从外部侵入人体的，无不以解除表邪为重要任务。白喉虽然是因为太阴伏燥所致，治法适宜直接从肺经进行清降，但如果外感尚未去除，就过早地专注于清降，并且在清降之中，再胡乱加入苦寒沉重、滋腻的药物，那么外邪没有不被牵制而内陷的，最终导致清法和疏法都无从施展，只能坐视病人死亡，伤害有多大呢？
我的两个小女儿年仅十岁，曾在某年夏天去邻里看戏。当时正值酷暑闷热蒸腾。（在几天前西风大作，夏季出现了秋季的气候特征，所以出现了白喉病例。）加上剧场人气聚集酝酿，回家后立刻出现严重的寒热交替，肢体僵硬如同瘫痪，腹痛且腹泻，舌苔灰暗浑浊，而且喉咙间又复发白膜。权衡病情的轻重，理应当先解暑祛湿。因为治疗白喉不外乎使用清凉滋润的药物，暑湿得以解除，用药自然就没有牵制了。于是使用香薷饮合正气散加减，再加入石膏、鲜苇茎两味药，略微顾护肺中的燥邪。（石膏是治疗燥火的主药，其性质兼能达表清里，熟读张仲景著作的人自然能领会其中的旨归，所以喉咙间一见白色白膜，这味药就不容迟缓。这是当时的医生对生地、石斛、玄参等药物习以为常地滥用而不觉得奇怪，反而不敢轻易尝试石膏，见识不真切，往往错失治病良机，实在令人叹息。）服用两剂后，表证解除，身体舒畅，疼痛停止，腹泻痊愈，但是喉咙中的病情转剧，几乎满喉都是白膜。于是紧急改用西洋参、石膏、苇茎、玄参、杏仁、枇杷叶等药物。三剂后，白膜消退八九成，喉咙只感觉干燥疼痛，于是再加羚羊角、鲜生地两味药，病便完全痊愈。如果当初下手时怀疑忌讳香薷、藿香等辛燥药物对白喉有害，把握不定，不以全力专门去除暑湿，恐怕留下的祸患将不可胜言。
总之，白喉病的夹杂症状很多，只有太阴伏燥单独发作的，自然应当以清降滋润为重，如辛散、苦重等药物，都在禁忌之列，前面已经辨析得很详细了。如果是挟带六淫时令外感，自然应当根据湿邪用治湿的方法，寒邪用治寒的方法，暑热用治暑热的方法，先解除表邪，那么本症的治疗法则，自然就没有顾虑了。绝对不可以死板地坚守“忌表”二字，使外感与伏燥互相牵引。譬如下棋，一步走错则全局皆输。我希望世上治疗白喉的医生，能由此意领悟并明察，或许能与百姓一同达到长寿的境界吧。所以不辞繁琐，再次补写此篇在后面。
宣统元年己酉十月，栗甫（陈葆善号）再次记于湫斋。
I compiled the book *Baihou Tiaobian* (Analysis of Diphtheria by Categories). Since its publication in the Dingyou year, ten years have passed. Regarding the discussions on diphtheria in the works of former sages, there were occasionally points that did not fully satisfy me. Therefore, I carefully discussed them and deliberated to find the most appropriate solutions, aiming to completely align with the disease conditions and treatment methods before stopping. However, I still felt that the explanation for the two characters "Ji Biao" (Taboo against Exterior-Releasing) was insufficient and had not been exhaustively detailed, which troubled me deeply.
This is because diphtheria is caused by latent dryness in the Taiyin Lung Meridian. If there is no contact with seasonal pathogens, it is naturally inappropriate to use exterior-releasing methods without cause, as this could lead to a disaster akin to a spark starting a prairie fire. If it is indeed a case complicated by seasonal exterior symptoms, then releasing the exterior cannot be delayed. As mentioned in Article 5 earlier, if complicated by warm-heat pathogens, herbs such as Bohe (Menthae Haplocalycis Herba), Heye (Nelumbinis Folium), and Biandouhua (Dolichoris Semen Flos) can be added. If complicated by cold-dampness and dryness, although Mahuang (Ephedrae Herba), Gegen (Puerariae Lobatae Radix), Qianhu (Peucedani Radix), Zisu (Perillae Folium), Xiangru (Moslae Herba), and Huoxiang (Agastaches Rhizoma et Radix) can be used at discretion, or if both exterior pathogen and interior dryness are severe, one must treat both the exterior and interior simultaneously, clearing and dispersing while considering both aspects. But first, the exterior pathogen must be resolved; even if the throat is covered with white membranes, treatment will become easy. One must simply avoid recklessly using acrid-hot substances like Jiang (Zingiberis Rhizoma) and Rougui (Cinnamomi Cortex) that might draw pathogens inward.
I have seen contemporary physicians who had not read *Baihou Ji Biao Juewei* (Subtle Distinctions on Taboo Against Exterior-Releasing in Diphtheria) frequently use exterior-releasing methods, causing severe harm. Conversely, there are those who have read this book but fail to thoroughly understand its principles, often rigidly adhering to the taboo against exterior-releasing. Even when facing severe exterior infections, they immediately resort solely to cooling and moistening agents, causing external pathogens to sink inward and exacerbating interior dryness, ultimately resulting in diseases like rotting throat, leading to death in numerous cases. Witnessing this is truly heartbreaking.
Generally, for diseases caused by the Six Excesses where pathogens enter from the outside, resolving the exterior is always a primary task. Although diphtheria stems from latent dryness in the Taiyin, the method should ideally focus directly on clearing and descending via the Lung Meridian. However, if the exterior infection has not yet been removed, focusing prematurely on clearing and descending, and further indiscriminately adding bitter, heavy, and cloying-nourishing herbs, will inevitably cause external pathogens to be dragged inward. This ultimately renders both clearing and dispersing methods ineffective, leaving one to watch the patient die helplessly—a tragedy of immense magnitude.
My two young daughters, aged only ten, once went to watch a play in the neighborhood during summer of a certain year. At that time, the heat was stifling and steaming. (A few days prior, strong west winds blew, bringing autumn-like weather in summer, which led to the appearance of diphtheria cases.) Coupled with the crowded atmosphere in the theater, upon returning home, they immediately developed severe chills and high fever, their limbs became stiff as if paralyzed, they suffered from abdominal pain and diarrhea, their tongue coating was gray and turbid, and white membranes reappeared in their throats. Weighing the severity, the proper approach was to first resolve summerheat and remove dampness. Since treating diphtheria generally involves cooling and nourishing agents, resolving summerheat and dampness would remove constraints on medication. Thus, I used Xiangru Yin (Mosla Decoction) combined with Zhengqi San (Righteous Qi Powder) with modifications, adding Shigao (Gypsum Fibrosum) and Xianweijing (Phragmitis Rhizoma) to slightly attend to the dryness in the lungs. (Shigao is the main herb for treating dry-fire; its nature can reach the exterior and clear the interior. Those who have studied Zhang Zhongjing's works thoroughly will grasp its essence. Therefore, upon seeing white patches in the throat, this herb cannot be delayed. Contemporary physicians are accustomed to recklessly using Dihuang (Rehmanniae Radix), Shihu (Dendrobii Caulis), and Yuanshen (Scrophulariae Radix) without surprise, yet dare not lightly try Shigao due to lack of insight, often missing the opportunity to treat the disease, which is lamentable.) After two doses, the exterior condition resolved, the body felt comfortable, pain ceased, and diarrhea stopped. However, the throat condition worsened, almost covering the entire throat. I urgently switched to Yangshengshen (Panacis Quinquefolii Radix), Shigao, Weijing, Yuanshen, Xingren (Armeniacae Semen Amarum), and Pipaye (Loquat Folium). After three doses, eight or nine-tenths of the white membranes disappeared, leaving only dryness and pain in the throat. I then added Lingyangjiao (Saigae Tataricae Cornu) and Xianshengdi (Rehmanniae Radix Recens), and the illness was completely cured. If, at the beginning, I had hesitated due to fears that Xiangru and Huoxiang (acrid-aromatic and drying herbs) might harm diphtheria, and failed to apply full force to resolve summerheat and dampness, the consequences could have been unimaginable.
In summary, diphtheria presents with many complicated symptoms. Only when latent dryness in the Taiyin manifests alone should the emphasis be on clearing, descending, and moistening; acrid-dispersing and bitter-heavy herbs are prohibited, as previously detailed. If complicated by the Six Excesses or seasonal infections, one should treat dampness with damp-resolving methods, cold with cold-resolving methods, and summerheat with summerheat-resolving methods. First, resolve the exterior; then, the treatment for the primary condition proceeds without worry. One must absolutely not rigidly adhere to the taboo against exterior-releasing, allowing external infections and latent dryness to interact detrimentously. It is like playing chess: one wrong move loses the whole game. I hope physicians treating diphtheria today can comprehend and apply these principles, perhaps enabling the people to share in longevity. Therefore, I do not shy away from verbosity and append this section hereafter.
Recorded again in the tenth month of the Jiyou year of the Xuantong Era, at Qiuzhai, by Lifu (Chen Baoshan).