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Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Not affected by rain), the evil enters through the mouth and nose, directly affecting the lungs and stomach, leading to the formation of yin-tormenting yang-entrapment and small lesions.

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Ten Things. Feeling Fatigue III. People recognize it as a pathway for foot-related ailments, with salty heat in the heart, and a sense of fullness in the chest.

2. The poison of the disease is felt, directly affecting the lungs and stomach, flowing through the meridians and ultimately reaching the upper part of the body. At that time, the pathogen's toxins cause inflammation and lead to false connections, forming a blocked or obstructed pathway. The toxin resides within the internal organs, causing damage to the heart and bones, resulting in yin deficiency and yang weakness—approximately equivalent to diphtheria-induced myocarditis. As the heat-toxin flows, yin is damaged and the meridians are injured, leading to paralysis. The toxin causes phlegm and turbidity to accumulate in the throat and trachea, disrupting the normal ascending and descending functions of lung qi. In mild cases, patients may experience fever, wheezing, cough, dry cough like barking, hoarseness, and other symptoms of phlegm and turbidity; in severe cases, they may develop pale complexion, noisy phlegm, cyanosis of the lips, difficulty breathing, and other signs of airway obstruction. Some scholars believe that diphtheria often occurs in late autumn and early spring, falling under the category of latent heat illness or latent heat triggered by new infections. The root cause of diphtheria lies in the Hand Taiyin Lung Meridian, while its manifestations originate from the Hand Shaoyin Heart and Foot Shaoyang Gallbladder Meridians; these meridians are also involved in the process of fire-toxin spreading and transforming into five internal organs and six viscera. If the dry fire in the lungs persists without being resolved, and the three meridians remain unbalanced, it can further lead to overall organ deficiency. Therefore, the entire course of diphtheria can be divided into two stages: the stage of excess evil and the stage of deficiency of righteous qi. The first two stages represent excess evil, while the latter two stages indicate deficiency of righteous qi. However, in recent years, diphtheria has tended to become milder, and severe cases are becoming less common.

(3) Traditional Chinese Medicine Differentiation and Classification, and Herbal Formulas

1. Epidemic Toxin Affecting the Lungs The primary symptoms include fever, chills, headache, sore throat, the presence of pseudomembranes in the throat, red tongue with a thin, white, slightly dry coating, and a floating, rapid pulse. Treatment focuses on dispersing wind, clearing heat, detoxifying, and relieving throat discomfort. The formula chosen is “Shu Feng Qing Re, Jie Du Li Yan,” with modifications: 10g of Rou Ye, 30g of Ge Gen, 20g of Sheng Di, 15g of Shan Dou Gen, 12g of Huang Qin, 12g of Bei Mu, 12g of Niu Xi, 12g of Sha Shen. Brew the herbs in water and take one dose per day.

2. Epidemic Toxin Transforming into Fire The primary symptoms include intense heart palpitations and restlessness, dry throat and pain, rapid spread of pseudomembranes, dark-colored lesions, significant neck swelling (“ox neck”), red tongue with yellow coating, and a slippery, rapid pulse. Treatment should focus on detoxifying, clearing heat, reducing fire, and restoring yin. The formula chosen is “Bai Hu, Xi Di He Pu Ji Xiao Du Yin,” with modifications: 20g of Sheng Shi Gao, 12g of Zhi Mu, 20g of Sheng Di, 10g of Shui Niu Jiao, 12g of Chi Shu, 12g of Ban Lan Gen, 15g of Xuan Shen, 15g of Jin Yin Hua, 15g of Shan Dou Gen, 12g of Niu Bang Zi, 10g of Gan Cao. Brew the herbs in water and take one dose per day.

3. Lung Qi Obstruction The primary symptoms include rapid growth of pseudomembranes, dry throat and tightness in the throat, barking-like cough, phlegm in the throat, rapid breathing, red tongue with a yellowish, greasy coating, and a slippery, rapid pulse. Treatment focuses on eliminating phlegm, clearing obstruction, detoxifying, relieving throat discomfort, and clearing heat from the lungs. The formula used is “Ma Xing Shi Gan Tang Jia Wei,” with modifications: 6g of Ma Xing, 12g of Xing Ren, 15g of Shi Gao, 9g of Gan Cao, 12g of Zhe Bei Mu, 15g of Shan Dou Gen, 10g of Yi Li Zi, 10g of Sheng Da Huang (added later), 15g of Tuo Niu Xi. Brew the herbs in water and take one dose per day. It can also be combined with Zhu Li Gao or fresh bamboo juice.

4. Yin Deficiency and Lung Dryness The primary symptoms include dry throat and mouth, dry, yellow pseudomembranes, constipation, red tongue with a thin yellow coating, and a fine, rapid pulse. Treatment involves modifying the “Yang Yin Clear Lung Decoction”: 20g of Sheng Di, 15g of Xuan Shen, 12g of Mai Dong, 12g of Chi Shu, 12g of Dan Pi, 12g of Zhe Bei Mu, 12g of Huang Qin, 15g of Shan Dou Gen, 15g of Niu Xi, 15g of Ban Lan Gen. Brew the herbs in water and take one dose per day.

5. Heart and Kidney Deficiency The primary symptoms include pale complexion, palpitations, chest tightness, pale tongue with white coating, and a weak, irregular, or rapidly beating pulse. Treatment focuses on nourishing yin, restoring pulse, replenishing qi, and consolidating depletion—using modified Zhi Gan Cao Tang: 15g of Dang Shen, 15g of Zhi Gan Cao, 12g of A Jiao (dissolved in warm water), 12g of Mai Dong, 20g of Sheng Di, 15g of Ma Ren, 15g of Gua Ling, 12g of Xie Bai, 10g of Wu Wei Zi. Brew the herbs in water and take one dose per day.

6. Toxicity Spreading Through the Meridians: The primary symptoms include speech impairment, throat obstruction, choking cough, or facial asymmetry, limb paralysis, pale red tongue with white coating, and a fine pulse. Treatment focuses on nourishing blood, replenishing qi, relaxing muscles, and activating the meridians—using modified Yang Zheng Tang: 20g of Sheng Di, 15g of Shou Wu, 12g of Yu Zhu, 12g of Mai Dong, 30g of Shan Yao, 12g of Bai Shao, 10g of Rong Zhi, 12g of Mu Gua, 15g of Jie Teng Teng, 20g of Dan Shen. Brew the herbs in water and take one dose per day.

In the above classification-based treatments, although there have been historical views stating that “diphtheria should avoid external exposure,” when external symptoms are prominent, treatment should focus on releasing exterior patterns, often adding Mulberry Leaves and Kudzu Root; for high fever, add Stone Nettle and Motherwort; for those with rapidly spreading pseudomembranes and neck swelling, add Ban Lan Gen, Tuo Niu Xi, and Shan Dou Gen; for those with a strong need to clear heat, add Motherwort and Chrysanthemum; for those with constipation, add Rhubarb, Magnesium Sulfate, or Hemp Seeds; for those with difficulty breathing, add Eupatorium and fresh Bamboo Juice; for those who are weak, add Ginseng and Astragalus; for severe dryness of the mouth, add Shashan and Mai Dong; for severe cough, add Beimu; for those with severe pain, add Chicken Blood and Shen Qu.

(4) Traditional Chinese Medicine Resources on Diphtheria Differentiation and Treatment Different regions have developed various classifications of diphtheria based on different criteria. Summarizing these classifications, we find three main types: ① Classifying according to the internal organs and meridians into five types:

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Practical Internal Medicine Combined with Western Medicine | Such as | Zhu Hu Hua Du Tang: For the type of lung qi obstruction, treatment focuses on clearing heat, resolving stagnation, and harmonizing qi—this is the main formula. Heat-clearing and detoxification methods, with the main formula being Blue… | > 18g of Le, 30g each of Dajing and Huang Lian, 12g of Ba Dou Shuang; Yin-deficiency lung hardening—two types | > (Kidney Meridian Syndrome) Treatment (Realgar, Zhe Bei Mu, Ban Dian… | > Treats by strengthening the spleen and eliminating phlegm, using modified Si Jun and Er Chen Tang as the main formulas; for the spleen, | > Focuses on nourishing yin and clearing the lungs with for the spleen, and tonifying the kidneys with Tian Fu Mei Tang; For the heart and kidney deficiency type (heart meridian syndrome), treat with wind-clearing and heat-clearing methods, focusing on resolving heat and detoxifying, and using Tian Fu Mei Tang, or Ma Xing Shi Gan Tang, with modifications; for the heart and kidney deficiency type (heart meridian syndrome), use Tian Fu Mei Tang, combined with the use of “Chu Yao San” for treating the condition; for the heart and kidney deficiency type (heart meridian syndrome), use modified Tian Fu Mei Tang, combining with “Chu Yao San.” Qin Bo Wei and others believed that cases leaning toward wind-heat often present with both cold and heat, accompanied by headache and a floating, rapid pulse. Treatment begins with dispersing the exterior and clearing heat and detoxifying, using Sang Ge Tang in combination with “Chu Yao San”; after the exterior symptoms subside, continue with Yang Yin Clear Lung Decoction, combined with Tuo Niu Xi for treatment. For cases leaning toward yin deficiency, initial treatment does not involve exterior symptoms, but rather a rapid, weak pulse—these cases should focus on nourishing yin and clearing heat, using Yang Yin Clear Lung Decoction combined with Tuo Niu Xi, along with “Chu Yao San.” Both formulas are used to cool and clear the throat. There are also formulas that focus on clearing heat, detoxifying, nourishing yin, and resolving phlegm—such as Ma Xing Shi Gan Tang. Sang Ge Tang, Yin Qiao San, Yang Yin Clear Lung Decoction (also used in conjunction with Bing Xiong San to cool the throat). ② Classifying according to the relationship between defensive qi and pathogenic qi: For example, in cases of defensive qi (wind-heat), add Sheng Xi; in cases of qi-deficiency, reduce the amount of Dafu Chi, add Niu Xi, Chan Yi, Xuan Shen, Shan Dou Gen; for cases of wind-heat, use Sang Ju Yin; for cases of yin deficiency, treat with clearing heat and detoxifying, using Xian Fang Huo Ming Tang, or Ma Xing Shi Gan Tang, with modifications; for cases of yin deficiency (dry heat), treat with nourishing yin, clearing the lungs, and detoxifying—using Yang Yin Clear Lung Decoction combined with Niu Xi. Qin Bo Wei and others believed that cases leaning toward wind-heat often present with both cold and heat, accompanied by headache and a floating, rapid pulse. Treatment begins with dispersing the exterior and clearing heat and detoxifying, using Sang Ge Tang in combination with “Chu Yao San”; after the exterior symptoms subside, continue with Yang Yin Clear Lung Decoction combined with Tuo Niu Xi for treatment. For cases leaning toward yin deficiency, initial treatment does not involve exterior symptoms, but rather a rapid, weak pulse—these cases should focus on nourishing yin and clearing heat, using Yang Yin Clear Lung Decoction combined with Tuo Niu Xi, along with “Chu Yao San.” Both formulas are used to cool and clear the throat. There are also formulas that focus on clearing heat, detoxifying, nourishing yin, and resolving phlegm—such as Ma Xing Shi Gan Tang. Sang Ge Tang, Yin Qiao San, Yang Yin Clear Lung Decoction (also used in conjunction with Bing Xiong San to cool the throat). ③ Classifying according to the relationship between pathogenic qi and righteous qi: For example, classifying into three types: pathogenic qi dominant, righteous qi dominant, and righteous qi dominant with pathogenic qi. Nantong Medical College classified this disease into two types: “Excess Evil” and “Deficiency of Essence.” The excess evil type is further divided into dry heat type, wind-heat type, wind-cold type, and wind-toxin type; “Deficiency of Essence” primarily refers to complications and secondary conditions of diphtheria, such as myocarditis and nerve paralysis. Myocarditis is classified into heart-yin deficiency type and heart-yang deficiency type. Changshu Traditional Chinese Medicine Hospital classified this disease into types such as “epidemic diphtheria,” “latent diphtheria,” “diphtheria transforming into fire,” “diphtheria with heat,” “Yang Ming,” and “diphtheria with heat disturbing the pericardium.” Other classifications include those based on “etiology,” “Three Jiao,” and “disease stage,” though their meanings and treatment approaches are similar. Some scholars have offered differing perspectives on earlier discussions, pointing out that “diphtheria should avoid external exposure; improper sweating can be dangerous” (Diphtheria Treatment: Avoid External Exposure and Support Microscopic Qi), referring to cases where no external pathogens were present, nor were there any secondary complications; “Epidemic diphtheria should be treated externally; sweating can lead to complications” (“Hou Sha Zheng”) – meaning that during the early stages of epidemic diphtheria, when the rash has not yet broken through, it is crucial to grasp the stage of the disease and the underlying pathogenesis, and to treat appropriately to achieve effective results. Some recommend that for cases where external symptoms are present at the onset of diphtheria, use modified Dajing Tang, Zhu Hu Hua Du Tang, or Shen Dong Bi Xie San for treatment; for cases leaning toward wind-heat, use modified Yin Qiao San; for cases of lung heat and yin burning, use Yang Yin Clear Lung Decoction; for cases of lung and stomach heat accumulation, use Xian Fang Huo Ming Tang combined with Clear Throat and Diaphragm Decoction; if there is no high fever but residual toxins have not yet been cleared, use Qing Xin Ti Tan Tang, Yang Zheng Tang, or modified Four Gentlemen’s Decoctions with Jin Yin Hua. Ouyang Qi pointed out that the key issue in treating diphtheria is: ① controlling and managing respiratory distress caused by diphtheria; it is advisable to use products like Peppermint Seed, Almond, White Mustard Seed, and Bamboo Juice to descend qi and clear phlegm, while avoiding medicines that elevate qi such as Ascendancy, Kudzu Root, or Dajing; it is also recommended to employ methods that promote vomiting (if necessary, perform tracheostomy). ② Regarding the prevention and treatment of myocarditis, see below for details—combining control of myocarditis with detoxification and supporting righteous qi. For cases with concurrent complications, such as myocarditis, which often result from heat-toxin invading the heart and kidneys, exhausting the heart, liver, and kidneys, and causing yin deficiency, yang weakness, and blood loss, treatment focuses on nourishing yin, replenishing blood, benefiting qi, strengthening yang, and restoring pulse and consolidating depletion—common formulas include Eight Flavor Rehmannia Decoction, modified Repulse Tang, Three-Element Repulse Tang, Fuzi Lizhong Tang, Shenfu Tang, Gui Pi Tang, Sheng Mai San, and Zhi Gan Cao Tang, Du Can Tang, among others. For cases of throat obstruction or throat paralysis, treatment for throat obstruction focuses on eliminating phlegm, clearing obstruction, and purging toxins—using products like “Realgar Detoxification Pill” (Realgar 30g, Yujin 3g, Ba Dou 14 seeds with skin removed and oil extracted, ground into fine powder and made into vinegar paste pills, 1.5g per dose, halved for children, taken with hot water), “Jie Bai San” (7 Ba Dou red seeds, Realgar, Zhe Bei Mu, Dajing each 15g, ground into fine powder, 1–8 years old, 1–2g per dose), Di Li San, Xi Yan San, Soap Tree Bitter Wine Decoction, Dajing White Powder. In recent years, there have been reports of late-stage diphtheria cases developing nerve paralysis—recently, Xia Yue Wen reported a specialized formula for treating soft palate paralysis in diphtheria: 6–12g of Chan Yi, 6–15g of Jiang Can, 10–20g of Ren Dong, 10–15g of Sheng Di, 6–18g of Si Gua Luo, 6–18g of Dan Pi, 3–6g of Quan Xie, 6–10g of Gan Cao, taken in water once daily, with 22 cases recovering, and 3 cases discontinuing treatment (Shanghai Journal of Traditional Chinese Medicine, 1987.1). Additionally, during the recovery phase, 30g of Sheng Di, 15g of Mai Dong, 15g of Xuan Shen, 15g of Fresh Dendrobium, 15g of Huang Ling, 15g of Jin Yin Hua, plus 9g of Tianma, 15g of Xuduan, 15g of Sang Ji Sheng, 6g of Tian Nan Xing—some used the post-recovery Yang Zheng Tang to treat soft palate paralysis, using Yu Zhu, Shan Yao, Sheng Di, Sheng Di, Sheng Di, and Tian Zhong, Dazhui, Ying Xiang, Yin Tang, Tian Ding, Fei Yu, Yun Men, He Gu. Some used Yin Tang, Tian Zhong, Shao Shang as primary acupoints, and He Gu, Shao Shang as auxiliary points. Others used Tian Zhong, Tian Zhong, Shao Shang as primary acupoints, paired with Xiao Tu, Fu, Tian Rong, Tian Jing, Zu San Li, Zhao Hai. Some used Yin Tang, Tian Zhong, Shao Shang as primary acupoints, paired with Xiao Tu, Tian Zhong, Shao Shang, and supported the acupoints with Fu.

Additionally, some used Tian Zhong, Tian Zhong, Shao Shang as primary acupoints, paired with He Gu, Feng Chi, Feng Fu, Ya Men (with moxibustion after acupuncture).

Various localities have reported many specialized, single, and experimental formulas for treating diphtheria. Here, we will list the most commonly used and representative examples: