The appearance of a white, putrid membrane in the throat is called throat diphtheria. In severe cases, it can spread to the nose. Zhonglou Yuyao states: "The condition of a white, putrid membrane forming in the throat is very harmful and progresses rapidly. Before the 40th year of the Qianlong era, this condition was rare, and even when it occurred, it was infrequent. However, in the past twenty years, many have suffered from it, especially children... This condition, known as diphtheria, has not been discussed in many texts." It is also referred to as acute throat obstruction or categorized into seasonal epidemic diphtheria, tonsillar diphtheria, consumptive diphtheria, and cold deficiency diphtheria. Generally, seasonal epidemic diphtheria is caused by epidemic toxins, has a pestilential nature, and is more common in children; the other types are not pestilential and can affect both children and adults.

bubble_chart Pattern Analysis

1. Epidemic Toxin︰In the initial stage [first stage] of seasonal epidemic diphtheria, there is throat pain and swelling, with localized gray-white pseudomembranes appearing in small areas, presenting as dots or patches with clear edges. The pseudomembranes adhere tightly to the throat, are difficult to wipe off, tough and thick, and bleeding occurs upon removal. It is accompanied by fever and chills, headache, body aches, a thin white or slightly yellow tongue coating, and a floating, rapid pulse. The epidemic toxin invades the lung-defense system at the onset of the illness, hence the exterior pattern is characterized by fever and chills, headache, body aches, a white or slightly yellow tongue coating, and a floating, rapid pulse. Treatment should focus on dispersing wind, clearing heat, and removing toxins. The recommended formula is Lonicera and Forsythia Powder supplemented with Achyranthes Root, Stiff Silkworm, Cicada Slough, Vietnamese Sophora Root, Scrophularia Root, and other ingredients.
2. Epidemic Toxin Exuberance︰This is the intermediate stage (second stage) of seasonal epidemic diphtheria, characterized by severe redness, swelling, and dryness of the throat with intense pain. The white necrotic patches extend beyond the tonsils, forming tough, firmly attached membranes on the throat wall that bleed when scraped. Symptoms include high fever with sweating, flushed face, red eyes, intense thirst, restlessness, parched lips, dry stools, scanty dark urine, or yellow-black diarrhea. The tongue is red with a yellow coating, which may become charred and prickly. The epidemic toxin has penetrated internally, leading to excessive heat in the Yangming qi aspect, marked by high fever, sweating, flushed face, red eyes, thirst, and a surging, rapid pulse. The extensive white necrotic patches in the throat result from intense Yangming heat, causing restlessness, parched lips, scanty yellow urine, and dry stools. Alternatively, impaired qi movement may lead to diarrhea with yellow-black watery stools. The tongue coating is thick and yellow, possibly charred and prickly. Treatment involves clearing heat, removing toxins, and reducing swelling. The recommended formula is Shenxian Huoming Yin (Immortal Life-Saving Decoction) with the addition of Stiff Silkworm, cicada slough, and Glabrous Greenbrier. For constipation, Rhubarb Rhizome should be added.
3. Phlegm-Turbidity Blockage and Obstruction︰It is the deteriorated pattern of seasonal epidemic diphtheria, where the putrid membrane persists with slight regression and occasionally sheds spontaneously. The complexion is pale, lips cyanotic, accompanied by dysphoria and restlessness, wheezing with phlegm rales, dyspnea, or even gasping with raised shoulders, episodes of dry cough sounding like a barking dog, hoarseness, sweating, cyanotic tongue, and rapid pulse. This is the deteriorated pattern of seasonal epidemic diphtheria, often critical. Due to the spontaneous shedding of the putrid membrane in the throat, obstructing the airway, combined with phlegm turbidity stagnation, the characteristic symptoms include wheezing with phlegm rales, dyspnea, or even gasping with raised shoulders, episodes of dry cough, hoarseness, and a barking-like sound. The narrowed airway impedes qi flow, leading to blood stasis, which fails to nourish the head and face, resulting in a pale complexion. Qi stagnation causes blood stasis, hence the cyanotic lips and tongue. Phlegm turbidity obstructs and blocks, while yang qi is on the verge of collapse, leading to dysphoria, restlessness, sweating, and a rapid pulse. If not urgently treated during deficiency, symptoms of epidemic toxin invasion will inevitably arise, causing heart yang collapse. Treatment should focus on expelling phlegm and relieving obstruction while removing toxins, using the "Three Categories of Disease Cause" Removing Toxin Realgar Pill.
4. Epidemic Toxin Invading the Heart︰It is a critical condition of seasonal epidemic diphtheria, where the necrotic membrane persists for a long time or occasionally falls off spontaneously; symptoms include labored breathing with shoulder lifting, oily sweating, a complexion as pale as paper, fixed staring eyes, cold limbs, cyanotic lips, dysphoria and restlessness, and even convulsions, opisthotonos, a pale tongue texture, and a pulse that is deep, faint, and barely perceptible, or irregular, or rapid and disordered. The epidemic toxin is excessively internalized and overwhelms the heart, leading to heart yang collapse and the disconnection of yin-yang. Hence, the characteristics include labored breathing with shoulder lifting, oily sweating, a complexion as pale as paper, reversal cold of limbs, and a pulse that is deep, faint, and barely perceptible, or irregular, or rapid and disordered. This seasonal epidemic toxin not only invades the heart internally but often stirs up liver wind, manifesting as fixed staring eyes, convulsions of the limbs, opisthotonos, and other symptoms. Treatment should focus on warming yang and stemming collapse, replenishing qi to restore the pulse. The prescription used is Cold-Extremities Decoction combined with Pulse-Reinforcing Powder. If liver wind disturbs upward, add antelope horn, nacre, and oyster shell to calm the wind and soothe the liver.
5. Lung-kidney Yin Deficiency︰In the late stage [third stage] of seasonal epidemic diphtheria, sore throat is not severe, with white necrotic patches appearing as spots or plaques tightly adhered to the pharyngeal wall, difficult to wipe off, and bleeding upon removal. The affected area may extend beyond the tonsils. Accompanying symptoms include low-grade fever, dry mouth and tongue, thirst with a desire to drink, a red tongue with scant coating, and a thin, rapid pulse. In the late stage [third stage] of seasonal epidemic diphtheria, epidemic toxins linger in the lungs and kidneys, leading to yin deficiency and internal heat. This manifests as low-grade fever, dry mouth and tongue, thirst with a desire to drink, a red tongue with scant coating, and a thin, rapid pulse. The pattern belongs to a deficiency-type pathogen lingering. As Zhonglou Yuyao states: "The condition of white patches in the throat... belongs to the Shaoyin channel, where pathogenic heat lurks, stealing the mother-element/phase qi of the lung metal, hence the white patches arise in the throat." The Foot Shaoyin Kidney Channel traverses the throat. Even as the epidemic toxins recede, they inevitably damage yin, leading to kidney water insufficiency. This results in a disorder of the child-organ affecting the mother-organ, manifesting as lung-kidney yin deficiency. The treatment principle should focus on nourishing yin and clearing heat, using the formula Enriching Yin and Clearing the Lung Decoction.
6. Lung-stomach Heat Exuberance︰The throat is severely red and swollen, especially the tonsils, with intense pain; yellowish-white pus spots appear on the tonsils and gradually merge into a necrotic membrane, but the affected area remains localized, easily wiped off without bleeding. Subcutaneous nodules are present under the jaw and are painful, accompanied by high fever, thirst, cough with yellow phlegm, fetid mouth odor, abdominal distension and fullness, constipation, dark yellow urine, a red tongue with thick yellow coating, and a surging, rapid pulse. This condition is also referred to as "tonsillitis" or "diphtheria-like moth wind." It arises when heat toxin stagnates in the lung and stomach, ascends along the meridians to damage and necrotize the throat's muscular membrane, even leading to the accumulation of flesh and blood transforming into yellowish-white pus that oozes out. Since this syndrome resembles the symptoms of epidemic toxin congesting the throat with white necrotic membrane—both presenting with throat necrosis, high fever, sweating, thirst, dysphoria, constipation, dark urine, a thick yellow tongue coating, and a surging, rapid pulse—it belongs to the interior heat excess pattern. The key diagnostic features include the necrotic membrane not extending beyond the tonsils, being easily wiped off without bleeding, appearing yellowish-white, prone to suppuration, non-infectious, and rarely progressing to a deteriorated pattern, which helps differentiate it. Treatment should focus on {|###|}clearing heat and removing toxin{|###|} to reduce swelling. Prescriptions such as Universal Relief Decoction for Eliminating Toxin or Diaphragm-Cooling Powder may be modified for use.
7. Yin Deficiency︰The throat shows patchy or plaque-like white necrotic membranes, but the affected area is generally small, usually not extending beyond the tonsils. The necrotic membranes are thin and loosely attached, easily falling off and quickly reforming, often recurring repeatedly. The tonsils have protruding wart-like growths that are grayish-white and difficult to remove. Symptoms include sore throat, excessive saliva, difficulty swallowing, and even throat ulceration. Accompanying symptoms include lower back soreness, mental fatigue, night sweats, vexing heat in the chest, palms, and soles, a red tongue texture, and a thin, rapid pulse. The treatment should focus on nourishing yin and reducing fire, using the Anemarrhena, Phellodendron, and Rehmannia Decoction supplemented with Scrophularia Root and Ophiopogon Tuber.
8. Kidney Yang Deficiency︰The local symptoms are similar to yin deficiency with effulgent fire, but accompanied by a {|###|}pale complexion{|###|}, fatigue and soreness in the waist, {|###|}fear of cold{|###|}, a {|###|}pale tongue texture{|###|}, and deep, slow pulses. The treatment should focus on {|###|}warming the interior and dissipating cold{|###|}, using the formula Guifu Bawei Wan (Cinnamon and Aconite Eight-Ingredient Pill).

bubble_chart Documentation

1. "Newly Revised Miraculous Throat Diagnosis and Differentiation, Seasonal Epidemic Diphtheria": "Seasonal epidemic diphtheria is a condition of acute throat obstruction, extremely dangerous and critical. Children, whose blood and qi are not yet fully developed, are especially susceptible to pestilence. Initially, the pulse is rapid and full, while the left chi pulse is deep, rapid, and agitated. Symptoms include aversion to cold with fever, headache, back distension, and generalized joint pain, resembling cold-damage disease, with no visible signs at first. The only signs are a slightly stiff tongue with a yellow coating, slight swelling of the nasopharynx, and the throat may be extremely painful, slightly painful, or not painful at all, but slightly stiff inside, which differs from cold-damage disease. Some cases show white patches immediately upon onset, while others may take two to three days for the white patches to appear. The white spots, streaks, or patches may gradually cover the entire throat, and the treatment methods are the same."
2. "Newly Revised Miraculous Throat Diagnosis and Differentiation, Differentiation of Diphtheria Complications": "In cases of diphtheria, symptoms such as loss of voice, falling off of white patches, dry throat without saliva, darkening of the forehead, staring eyes, blue lips and face, opisthotonos, phlegm congestion and panting, profuse sweating, inability to swallow medicine, failure of white patches to recede after seven days, constipation after taking medicine, diarrhea before taking medicine, continuous diarrhea, unrelieved swelling under the chin, or continuous vomiting after taking medicine, all indicate difficult-to-treat conditions."