咽与喉，会厌与舌，此四者，同在一门，而其用各异。喉以候气，故喉气通于天
；咽以咽物，故咽气通于地；会厌与喉，上下以司开合，食下则吸而掩，气上则呼而出，是
以舌抵上 ，则会厌能闭其咽矣。四者相交为用，阙一则饮食废而死矣！此四者，乃气与食
出入之门户最急之处。故《难经》言“七冲门”。而会厌之下为吸门，及其为病也，一言可
了。一言者何？曰火。《内经》曰∶一阴一阳结，谓之喉痹。王太仆注云∶一阴者，手少阴君火，
心主之脉气也；手少阳相火，三焦之脉气也。二火皆主脉，并络于喉。气热则内结，结甚则肿胀
，肿胀甚则痹，痹甚而不通则死矣！
夫足少阴，循喉咙，挟舌本，少阴上挟咽。此二者，诚是
也。至于足阳明，下人迎，循喉咙；足太阴，挟咽连舌本；手太阳，循咽下膈；足厥阴，循
喉咙之后。此数经皆言咽喉，独少阳不言咽喉。而《内经》言“一阴一阳，谓之喉痹。”何
也？盖人读十二经，多不读《灵枢经》中经别第十一篇，具载十二经之正。其文云∶足少阳之正，绕脾入
毛际，合于厥阴，别者入季胁间，循胸里属胆，散之，上肝贯心，以上挟咽，出颐颌，散于面，
系目系，合少阳于外 也，又手心主之正，别下渊腋三寸，入胸中，别属三焦，出循喉咙
，出耳后，合少阳完骨之下，是手少阳三焦之气，与手心主少阴之气相合，而行于喉咙也。
推十二经，惟足太阳别项下，其余皆凑于喉咙。然《内经》何为独言一阴一阳结为喉痹？盖君
相二火独胜，则热结正络，故痛且速也。
余谓一言可了者，火是也。故十二经中，言嗌干嗌痛
，咽肿颔肿，舌本强，皆君火为之也。唯喉痹急速，相火之所为也。夫君火者，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。《内经》之言喉痹，则咽与舌在其
间耳。以其病同是火，故不分也。后之医者，各详其状，强立八名，曰单乳蛾、双乳蛾、单
闭喉
、子舌胀、木舌胀、缠喉风、走马喉闭。热气上行，结薄于喉之两旁，近外肿作，以其形似
，是谓乳蛾。一为单，二为双也。其比乳蛾差小者，名闭喉。热结于舌下，复生一小舌子，
名曰子舌胀。热结于舌中，舌为之肿，名曰木舌胀。木者，强而不柔和也。热结于咽，项肿
绕于外，且麻且痒，肿而大者，名曰缠喉风。喉痹暴发暴死者，名走马喉痹。此八种之名虽
详，若不归之火，则相去远矣。
其微者可以咸软之，而大者以辛散之。今之医者，皆有其药
也，如薄荷、乌头、僵蚕、白矾、朴硝、铜绿之类也。至于走马喉痹，何待此乎？其生死人
，反掌之间
耳！其最不误人者，无如砭针出血，血出则病已。《易》曰∶血去惕出，良以此夫。昔余以
治一妇人
木舌胀，其舌满口，诸药不愈，余以
针小而锐者砭之
，五、七度，肿减，三日方平。计所出血，几至盈斗。又治一男子缠喉风肿，表里皆作，药不能
下，余以凉药灌于鼻中，下十余行，外以拔毒散敷之，阳起石烧赤，与伏龙肝各等分细末，
每日以新水扫百遍，三日热始退，肿始消。又尝治一贵妇喉痹，盖龙火也，虽用凉药而不可
使冷服，为龙火宜以火逐之。人火者，烹饪之火是也。乃使曝于烈日之中，登于高堂之上，
令侍婢携火炉，坐药铫于上，使药常极热，不至大沸，通口时时呷之，百余次，龙火自散。
此法以热行寒，不为热病 格故也。大抵治喉痹，用针出血，最为上策。但人畏针，委曲旁
求，瞬息丧命。凡用针而有针创者，宜捣生姜一块，调以热白汤，时时呷之，则创口易合。
《铜人》中亦有灸法，然痛微者可用，病速者，恐迟则杀人。故治喉痹之火，与救火同，不
容少待。《内经》∶火郁发之。发，谓发汗。然喉咽中，岂能发汗。故出血者，乃发汗之一端也
。后之君子，毋执小方，而曰吾药不动脏腑，又
妙于出血，若幸遇小疾而获功，不幸遇大病而死矣！毋遗后悔可矣！
咽与喉，会厌与舌，这四个部位虽然同处一个门户，但它们的功能各不相同。喉用来候纳气息，所以喉气与天相通；咽用来吞咽食物，所以咽气与地相通；会厌位于喉的上下方，主管开合功能，进食时吸气并掩闭咽部，呼气时气息向上排出，因此当舌尖抵住上颚时，会厌就能关闭咽部。这四个部位相互协作发挥作用，缺少任何一个就会导致饮食无法进行而死亡！这四个部位，是气息与食物进出的门户中最紧急的关键之处。所以《难经》中说“七冲门”。而在会厌之下称为吸门，当这些部位发生病变时，用一句话就可以概括清楚。这句话是什么呢？就是“火”。《内经》说：“一阴一阳结，谓之喉痹。”王太仆注释说：一阴，指的是手少阴君火，即心主之脉气；手少阳相火，即三焦之脉气。这两股火都主要主宰血脉，并联络于喉部。气热则内部郁结，郁结严重则肿胀，肿胀严重则闭塞不通，闭塞不通严重到极点就会死亡！
足少阴肾经，沿着喉咙，挟持舌根，少阴经上行挟持咽喉。这两条经脉的说法，确实是正确的。至于足阳明胃经，下行经过人迎穴，沿着喉咙；足太阴脾经，挟持咽喉连接舌根；手太阳小肠经，沿着咽部下行穿过膈肌；足厥阴肝经，沿着喉咙后方。这几条经脉都提到了咽喉，唯独足少阳胆经没有直接提到咽喉。而《内经》说“一阴一阳，谓之喉痹”，这是为什么呢？大概是因为人们学习十二经脉时，大多不读《灵枢经》中的《经别》第十一篇，该篇详细记载了十二经的正经。其中的文字说：足少阳的正经，环绕脾脏进入毛际，与厥阴经相合，分支进入季胁之间，沿着胸里属络于胆，散布后上行经过肝脏贯穿心脏，以上行挟持咽喉，出于颐颌部，散布于面部，系连目系，在外侧与少阳经相合；另外手厥阴心包经的正经，分支向下至渊腋三寸处，进入胸中，别行属络于三焦，出循喉咙，出于耳后，在完骨之下与少阳经相合，这说明手少阳三焦之气，与手厥阴心包（少阴）之气相合，而行于喉咙之中。推究十二经脉，只有足太阳膀胱经的别行支从项下分出，其余的都汇聚于喉咙。然而《内经》为什么独独说一阴一阳郁结导致喉痹呢？大概是因为君火和相火单独偏胜，导致热邪郁结在正经脉络中，所以疼痛且发病迅速。
我认为可以用一句话概括清楚的，就是“火”这个字。所以在十二经脉中，提到嗌干、嗌痛、咽肿、颔肿、舌本强等症状，都是君火造成的。唯独喉痹发病急速，是相火造成的。所谓君火，就像人的火一样；相火，就像龙火一样。人的火烧木头，火势缓慢；龙火烧木头，火势迅猛。《内经》所说的喉痹，咽与舌都在其中罢了。因为它们的病因同样是火，所以不加区分。后来的医生们，各自详细描述其症状，强行设立八种名称，叫做单乳蛾、双乳蛾、单闭喉、子舌胀、木舌胀、缠喉风、走马喉痹。热气上行，凝结薄弱于喉部两旁，靠近外部肿胀发作，因为其形状相似，所以称为乳蛾。一个是单侧，两个是双侧。比乳蛾稍小的，称为闭喉。热邪结聚于舌下，又生出一个小舌头，称为子舌胀。热邪结聚于舌中，舌头为之肿胀，称为木舌胀。木，是指僵硬而不柔和。热邪结聚于咽，颈部肿胀环绕外部，并且麻木发痒，肿胀较大的，称为缠喉风。喉痹突然发作突然死亡的，称为走马喉痹。这八种名称虽然详细，如果不归结于火，那就相差太远了。
病情轻微的可以用咸味药物软坚散结，病情严重的用辛味药物发散。现在的医生，都有相应的药物，比如薄荷、乌头、僵蚕、白矾、朴硝、铜绿之类的。至于走马喉痹，哪里还用得着这些呢？它让人生死，就在转念之间！其中最不误人的方法，没有比得上砭针刺血放血的，血出来病就好了。《易经》说：“血去惕出”，说的正是这个道理。过去我曾治疗一位妇女患木舌胀，她的舌头充满口腔，各种药物无效，我用小而锐利的针砭刺它，五到七次后，肿胀减轻，三天后才完全消退。计算所出的血，几乎有一斗之多。又曾治疗一名男子患缠喉风肿胀，表里都发作，药物无法服下，我用凉药灌入鼻中，下了十几道，外部用拔毒散敷贴，将阳起石烧红，与伏龙肝各取等分研成细末，每天用新水涂抹一百遍，三天后热势才退，肿胀才消。又曾治疗一位贵妇患喉痹，这是龙火所致，虽然使用凉药，但不能让药液冷服，因为龙火适宜用火来驱逐。人的火，是指烹饪用的火。于是让她暴露在烈日之中，登上高堂之上，让侍女携带火炉，将药铫放在火上，使药液始终保持极热，不至于大沸腾，让她通口时时小口饮用，一百多次后，龙火自然消散。这种方法是以热行寒，不被热病格拒的原因所在。大抵治疗喉痹，用针刺出血，是最上等的策略。但人们害怕针刺，曲折旁求其他方法，瞬息间就丧命。凡是使用针刺造成创口的，应该捣碎一块生姜，用热白开水调匀，时时小口饮用，那么创口容易愈合。《铜人腧穴针灸图经》中也有灸法，但对于疼痛轻微者可以使用，对于发病迅速的病症，恐怕拖延就会杀人。所以治疗喉痹的火，与救火相同，不容许丝毫等待。《内经》说：“火郁发之。”发，是指发汗。然而在喉咽之中，怎么能发汗呢？所以出血，就是发汗的一种表现。后来的君子们，不要拘执于小方剂，而说我的药不动脏腑，又妙于不出血，如果侥幸遇到小病而获得功效，不幸遇到大病就会死亡！不要留下后悔就可以了！
The pharynx (Yan) and larynx (Hou), the epiglottis (Huiyan) and tongue (She), these four structures share a common gateway but have distinct functions. The larynx is for receiving qi, thus its qi connects with Heaven; the pharynx is for swallowing food, thus its qi connects with Earth. The epiglottis, situated above and below the larynx, governs opening and closing: when eating, it inhales and covers the pharynx; when breathing out, qi rises and exits. Therefore, when the tip of the tongue presses against the upper palate, the epiglottis can close the pharynx. These four structures interact to function; if one is missing, eating and drinking will cease, leading to death! These four are the most critical and urgent points in the gateway for the entry and exit of qi and food. Thus, *Nan Jing* states "Seven Chong Gates." Below the epiglottis is called the Xi Gate (Xi Men). When diseases occur in these areas, they can be summarized in one word. What is this word? Fire. *Nei Jing* says: "When one Yin and one Yang knot, it is called Hou Bi (Laryngeal Obstruction)." Wang Taipu's commentary states: One Yin refers to Shao Yin Jun Huo (Ministerial Fire of Hand Shaoyin), which is the meridian qi of the Heart Master (Pericardium); Shao Yang Xiang Huo (Ministerial Fire of Hand Shaoyang) is the meridian qi of the San Jiao (Triple Burner). Both fires primarily govern the vessels and connect to the larynx. If qi becomes hot, internal knotting occurs; severe knotting leads to swelling; severe swelling leads to obstruction (Bi); severe obstruction leads to death due to blockage!
The Foot Shaoyin Kidney Meridian runs along the throat and flanks the root of the tongue, ascending to flank the pharynx. This understanding is indeed correct. As for the Foot Yangming Stomach Meridian, it descends through the Renying point (ST9) and runs along the throat; the Foot Taiyin Spleen Meridian flanks the pharynx and connects to the root of the tongue; the Hand Taiyang Small Intestine Meridian runs along the pharynx descending through the diaphragm; the Foot Jueyin Liver Meridian runs behind the throat. These meridians all mention the throat and pharynx, except for the Foot Shaoyang Gallbladder Meridian. Why does *Nei Jing* say "One Yin and One Yang [knot], called Hou Bi"? It is likely because students of the Twelve Meridians often neglect Chapter 11 of *Ling Shu*, "Jing Bie" (Divergent Meridians), which details the Zheng (Regular) pathways of the Twelve Meridians. The text states: The Zheng pathway of the Foot Shaoyang Gallbladder Meridian winds around the spleen, enters the pubic region, combines with the Jueyin, and its branch enters the interval between the costal margin and the hypochondrium, running inside the chest, connecting to the Gallbladder, dispersing upward through the Liver, piercing the Heart, ascending to flank the pharynx, emerging at the jawline, dispersing on the face, connecting to the eye system, and combining with the Shaoyang externally. Additionally, the Zheng pathway of the Hand Jueyin Pericardium Meridian branches downward three cun below Yuanye, enters the chest, connects to the San Jiao, emerges running along the throat, emerges behind the ear, and combines with the Shaoyang below the Wangu bone. This indicates that the Qi of the Hand Shaoyang San Jiao combines with the Qi of the Hand Jueyin Pericardium (Shao Yin) and travels through the throat. Examining the Twelve Meridians, only the divergent pathway of the Foot Taiyang Bladder Meridian separates from the nape, while the others converge at the throat. So why does *Nei Jing* specifically attribute Hou Bi to the knotting of one Yin and one Yang? It is because the independent excess of Jun Huo (Ministerial Fire) and Xiang Huo (Ministerial Fire) causes heat to knot in the regular collaterals, resulting in pain and rapid onset.
I maintain that the single word summary is "Fire." Therefore, among the Twelve Meridians, symptoms such as dryness and pain in the yi (pharynx/larynx area), swelling of the pharynx and chin, and stiffness of the tongue root are caused by Jun Huo. Only the rapid onset of Hou Bi is caused by Xiang Huo. Jun Huo is like human fire; Xiang Huo is like dragon fire. Human fire burning wood has a slow momentum; dragon fire burning wood has a fast momentum. In *Nei Jing*'s discussion of Hou Bi, the pharynx and tongue are included within the scope. Because their pathology is both due to fire, they are not distinguished. Later physicians, detailing various manifestations, arbitrarily established eight names: Dan Ru E (Single Tonsillar Swelling), Shuang Ru E (Double Tonsillar Swelling), Dan Bi Hou (Single Closed Throat), Zi She Zhang (Child Tongue Swelling), Mu She Zhang (Wood Tongue Swelling), Chan Hou Feng (Entangling Throat Wind), and Zou Ma Hou Bi (Running Horse Laryngeal Obstruction). When hot qi ascends and knots thinly on both sides of the throat, causing external swelling resembling a shape, it is called Ru E (Tonsil). Single refers to unilateral, double to bilateral. Those slightly smaller than Ru E are named Bi Hou. Heat knotting under the tongue, generating a small additional tongue-like structure, is named Zi She Zhang. Heat knotting in the middle of the tongue, causing the tongue to swell, is named Mu She Zhang. "Mu" implies stiffness and lack of flexibility. Heat knotting in the pharynx, causing neck swelling surrounding the exterior, accompanied by numbness and itching, with significant swelling, is named Chan Hou Feng. Sudden onset and sudden death of Hou Bi is named Zou Ma Hou Bi. Although these eight names are detailed, without attributing them to Fire, the explanation would be far off.
Mild cases can be treated with salty substances to soften hardness, and severe cases with pungent substances to disperse. Current physicians possess medicines for this, such as Bohe (Menthae Haplocalycis Herba), Wutou (Aconiti Radix), Jiangcan (Bombyx Batryticatus), Baifan (Alumen), Puxiao (Natrii Sulfas), and Tonglv (Chalcanthi Crystallizatum). But what use are these for Zou Ma Hou Bi? It causes life or death in the blink of an eye! The method least likely to harm patients is no other than Bianzhen (Bian needle) bloodletting; once blood flows, the disease resolves. The *I Ching* states: "When blood leaves, fear departs," which is precisely the reason. Once, I treated a woman with Mu She Zhang; her tongue filled her mouth, and various medicines failed. I used a small, sharp needle to pierce it five or seven times; after the swelling subsided, it took three days to fully resolve. The amount of blood let was nearly a dou. I also treated a man with Chan Hou Feng swelling, affecting both interior and exterior, where oral medication could not be taken. I administered cooling medicine into his nose, inducing over ten bowel movements, and applied Badu San (Detoxification-Extracting Powder) externally. I heated Yangqishi (Stylobitidis Spinae) until red, mixed it with Fulonggan (Caulis Longii Cineres) in equal parts to make a fine powder, and swept the area with fresh water a hundred times daily. After three days, the heat subsided and the swelling decreased. I once treated a noblewoman with Hou Bi, which was Dragon Fire. Although cooling medicines were used, they must not be taken cold, as Dragon Fire should be driven away by fire. Human fire refers to cooking fire. I had her stand in the scorching sun and ascend a high hall, with attendants carrying a stove upon which the medicine pot was placed, keeping the medicine extremely hot but not boiling, allowing her to sip it frequently throughout the day. After more than a hundred sips, the Dragon Fire dispersed naturally. This method uses heat to administer cold properties, avoiding the rejection caused by heat pathogens. Generally, for treating Hou Bi, using needles to bleed is the supreme strategy. However, people fear needles and seek alternative methods, dying in an instant. For any wound caused by needling, crush a piece of ginger, mix with hot plain water, and sip frequently to promote healing. The *Tong Ren* texts also describe moxibustion, which can be used for mild pain, but for rapid diseases, delay may be fatal. Thus, treating the fire of Hou Bi is like fighting a fire; there is no room for delay. *Nei Jing* states: "For fire stagnation, vent it." Venting refers to sweating. However, how can one induce sweating in the throat and pharynx? Therefore, bleeding is a form of venting/sweating. Future scholars, do not cling to minor prescriptions claiming they do not affect the Zang-Fu organs and are superior to bleeding. If you are lucky with minor illnesses, you may succeed; if unfortunate with major illnesses, you will cause death. Do not leave regrets!