Epidemic throat sand

Also cinnabar sand; putrefying throat sand. A disease occurring in winter and spring, characterized by red sore swollen throat, ulceration of the throat nodes, and generalized sand shā speckles.

Epidemic throat sand is attributed to seasonal epidemic pestilential toxin that enters the lung and stomach via the mouth and nose. In the throat there is a spreading putrid white membrane that is easily wiped away. The soreness may be so acute as to make the swallowing of soup or water difficult. There is pronounced heat effusion and aversion to cold with generalized pain. Sand speckles appear dimly all over the body, and develop to a bright scarlet color forming brocade-like patterns. If the speckles are small and diffuse, the condition is called sand; if coalescing into clouds, it is called cinnabar. The sand speckles may disappear when pressed by the fingers and return when pressure is released. They spread swiftly from the neck over the chest and back, and then the limbs finally to cover the whole body. Only the face and forehead are unaffected. The area around the mouth is somber-white and free of speckles.

The tongue is red like meat, and smooth but for fine protruding granules that cover it, giving it the appearance of a red bayberry. An initially white fur gradually becomes thick and slimy. The eruption brings abatement of heat effusion and gives way to the sloughing of the bran-like scales.

Biomedical correspondence: scarlet fever (scarlatina).

Medicinal therapy: In the initial stage, treat by outthrusting toxin with coolness and acridity using variations of Lonicera and Forsythia Powder (银翘散 yín qiào sǎn). In the midstage, discharge heat and resolve toxin with Provisioning-Cooling Qì-Clearing Decoction (凉营清气汤 liáng yíng qīng qì tāng). In the final stages, enrich yīn and nourish humor with Yīn-Nourishing Lung-Clearing Decoction (养阴清肺汤 yǎng yīn qīng fèi tāng). Avoid using warm acrid exterior resolution or premature use of cold bitter draining-precipitants. Patients should be isolated.