咽喉之证，有内伤外感，或凉或热，或虚或实，或有传染或无传染之殊。今试逐条详论之于下。
伤寒病恒兼有咽喉之证。《伤寒论》阳明篇第二十节云∶“阳明病但头眩，不恶寒，故能食而咳，其
人必咽痛。若不咳者，咽亦不痛。”按此节但言咽痛，未言治法。乃细审其文义，是由太阳初传阳
明，胃腑之热犹未实（是以能食），其热兼弥漫于胸中（胸中属太阳当为阳明病连太阳），
上熏肺脏，所以作咳，更因咳而其热上窜，所以咽痛。拟治以白虎汤去甘草加连翘、川贝母。
少阴篇第三节，“病患脉阴阳俱紧，反汗出者，亡阳也，此属少阴，法当咽痛。”此节亦未列治法。
按少阴脉微细，此则阴阳俱紧，原为少阴之变脉。紧脉原不能出汗，因其不当出汗者而反自汗，所以知其
亡阳。其咽痛者，无根之阳上窜也。拟用大剂八味地黄汤，以芍药易丹皮，再加苏子、牛膝，收敛元阳归根以
止汗，而咽痛自愈也。
【加减八味地黄汤】
大怀熟地（一两） 净萸肉（一两） 生怀山药（八钱） 生杭芍（三钱） 大云苓片（二钱） 泽泻（
钱半） 乌附子（二钱） 肉桂（二钱去粗皮后入） 怀牛膝（三钱） 苏子（二钱研炒）
煎汤盅半，分两次温服。
少阴篇第三十节云∶“少阴病，下利、咽痛、胸满、心烦者，猪肤汤主之。”按此证乃少阴之热弥漫于
三焦也。是以在上与中，则为咽痛烦满，因肾中真阴不能上升与阳分相济，所以多生燥热也；在下，则为
下利，因脏病移热于腑，其膀胱瘀滞，致水归大肠而下利也。至治以猪肤汤者，以猪为水蓄，其肤可熬胶，
汁液尤胜，原能助肾阴上升与心阳调剂以化燥热。而又伍以白蜜之凉润，小粉之冲和，熬之如粥，服后能
留恋于肠胃，不致随下利泻出，自能徐徐敷布其气化，以清三焦弥漫之热也。
少阴篇第三十一节云∶“少阴病二、三日，咽痛者，可与甘草汤。不瘥者与桔梗汤。”此亦少阴病之
热者也。用甘草汤取其能润肺利咽，而其甘缓之性又能缓心火之上炎，则下焦之燥热可
消也。用桔梗汤者，取其能升提肾中之真阴，俾阴阳之气互相接
续，则上焦之阳自不浮越以铄肺熏咽，且其上达之力又善散咽喉之郁热也。按后世治咽喉证者皆忌用桔梗，
然果审其脉为少阴病之微细脉，用之固不妨也。况古所用之桔梗皆是苦桔梗，其性能升而兼能降，实具有开通之力也。
少阴篇第三十二节云∶“少阴病，咽中伤生疮，不能言语，声不出者，苦酒汤主之。”按少阴之脉原络
肺上循喉咙，是以少阴篇多兼有咽喉之病。至治以苦酒汤，唐氏为苦酒与半夏同用可
使咽中之疮速破。苦酒即今之醋，醋调生半夏末外敷原可消疮，不必皆攻之使破之。
厥阴篇第九节云∶“伤寒先厥后发热，下利必自止，而反汗出，咽中痛，其喉为痹。”按此节之咽痛，
以多亡阴也，与少阴篇之汗出亡阳者原互相对照。盖其人之肝脏蕴有实热，因汗出过多耗其阴液，其热遂上
窜郁于咽中而作痛，故曰其咽为痹。痹者热与气血凝滞不散也。仲师当日未言治法，而愚思此证当用酸敛
之药以止其汗，凉润之药以复其液，宣通之药以利其咽，汇集为方，庶可奏功。爰将所拟之方详录于下。
【敛阴泻肝汤】
生杭芍（两半） 天花粉（一两） 射干（四钱） 浙贝母（四钱捣碎） 酸石榴（一个连皮捣烂）
同煎汤一盅半，分两次温服下。
上所录伤寒兼咽喉病者六节，伤寒中之咽喉证大略已备。而
愚临证多年，知伤寒兼病咽喉又有出于六节之外者，试举治验之案一则明之。
愚在奉时治一朱姓学生，患伤寒三四日，蜷卧昏昏似睡，间作谵语，呼之眼微开，舌上似无苔，而
舌皮甚干，且有黑斑，咽喉疼痛，小便赤而热，大便数日未行，脉微细兼沉，心中时觉发
热，而肌肤之热度如常。此乃少阴伤寒之热证，因先有伏气化热，乘肾脏虚损而窜入少阴，遏抑肾气不能
上达，是以上焦燥热而舌斑咽痛也，其舌上有黑斑者，亦为肾虚之现象。至其病既属热而脉微细者，诚以脉
发于心，肾气因病不能上达与心相济，其心之跳动即无力，此所以少阴伤寒无论或凉或热其脉皆微细也。
遂为疏方∶生石膏细末二两，生怀山药一两，大潞参六钱，知母六钱，甘草二钱，先用鲜茅根二两煮水，以
之煎药，取清汤三盅，每温服一盅调入生鸡子黄一枚。服药一次后，六脉即起。服至二次，脉转洪大。服至
三次，脉象又渐和平，精神亦复，舌干咽痛亦见愈。翌日即原方略为加减，再服一剂，诸病全愈。按上
所用之方，即坎离互根汤。方之细解详于本方后，兹不赘。
至于温病，或温而兼疹，其兼咽喉证者尤多。方书名其证为烂喉痧，其证多系有传染之毒菌。治之者，
宜注意清其温热，解其疹毒，其咽喉之证亦易愈。试举治验之案以明之。
戌辰在津，有宋××长子××患温疹兼喉证。医者皆忌重用凉药，服其药数剂，病转增剧。继延愚为
诊视，其脉洪长有力，纯乎阳明胃腑蕴有实热；其疹似靥未靥；视其咽喉两旁红，微有烂处；心中自觉热甚；
小便短赤；大便三日未行。为开大剂白虎汤，加连翘四钱，薄荷叶钱半以托疹外出。方中石膏重用生者四
两，将药煎汤三盅，分三次温饮下，病大见愈，而脉仍有力，咽喉食物犹疼。继又用原方，先取鲜白茅根
二两煮水以煎药，仍分三次服下，尽剂而愈，大便亦通下。后其次子亦患温疹喉证，较其兄尤剧。仍治以
前方，初次即用茅根汤煎药，药方中生石膏初用三两，渐加至五两始愈。继其幼女年七岁亦患温疹喉证，较其
两兄尤重，其疹周身成一个，肉皮皆红（俗谓此等疹皆不能治愈）。亦治以前方，为其年幼方中生石膏初用
二两，后加至六两，其热稍退而喉痛不减，其大便六日未行，遂单用净芒硝俾淬水服下，大便即
通，其热大减，喉痛亦愈强半。再诊其脉虽仍有力，实有浮而还
表之象，遂用西药阿斯匹林一瓦，因病机之外越而助其出汗。果服后周身得汗，霍然全愈。
温疹之证。西人名为猩红热，有毒菌传染，原不易治，而兼咽喉证者治之尤难。仲景所谓“阳毒为病，面
赤斑斑如锦纹，咽喉痛，唾脓血”者，当即此证。近世方书中又名为烂喉痧，谓可治以《伤寒论》麻杏甘
石汤。然麻杏甘石汤中石膏之分量原为麻黄之二倍。若借用其方则石膏之分量当十倍于麻黄（石膏一两麻黄一
钱）；其热甚者，石膏之分量又当二十倍于麻黄（石膏二两麻黄一钱），然后用之无弊。
沧州友人董××，年过三旬，初则感冒发颐，继则渐肿而下延至胸膺，服药无效。时当中秋节后，淋
雨不止，因病势危急，冒雨驱车迎愚。既至，见其颔下连颈，壅肿异常，抚之硬而且热，色甚红，纯是一
团火毒之气，下肿已至心口；其牙关不开，咽喉肿疼，自牙缝进水半口，必以手掩口，十分用力始能下
咽；且痰涎填满胸中，上至咽喉，并无容水之处，进水少许，必换出痰涎一口；且觉有气自下上冲，常作
呃逆；其脉洪滑而长，重按有力，一分钟约近九十至；大便数日未行。愚曰∶“此俗所称虾蟆瘟也。其毒热
炽盛，盘踞阳明之府，若火之燎原，必重用生石膏清之，乃可缓其毒热之势。”从前医者在座，谓曾用生石
膏一两，毫无功效。愚曰∶“石膏乃微寒之药，《神农本草经》原有明文，仅用两许何能清此炽盛之热毒。”
遂为疏方，用生石膏四两，清半夏四钱，金线重楼三钱，连翘二钱，射干二钱。煎服后，觉药停胸间不下，其
热与肿似有益增之势。知其证兼结胸，火热无下行之路，故益上冲也。复急取生石膏四两，赭石三两，又
煎汤服下，仍觉停于胸间。又急取赭石三两，蒌仁二两，芒硝八钱，又煎汤饮下，胸中仍不开通。此时
咽喉益肿，再饮水亦不能下咽，病家惶恐无措。愚晓之曰∶“余所以连次亟亟用药者，正
为此病肿势浸长，恐稍缓则药不能进。今其胸中既贮如许多药，断无不下行之理。药下行则结开便通，毒
火随之下降，而上焦之肿热必消矣。”时当晚十点钟，至夜半觉药力下行，黎明下燥粪若干，上焦肿热觉轻，
水浆可进，晨饭时牙关亦微开，服茶汤一碗。午后肿热又渐增，抚其胸，热又烙手，脉仍洪实。意其燥粪
必未尽下，遂投以大黄四钱，芒硝五钱，又下燥粪，兼有溏粪，病遂大愈。而肿处之硬者仍不甚消，胸间
抚之犹热，脉象亦仍有余热。又用生石膏四两，金银花、连翘各五钱，煎汤一大碗，分数次温饮下，日服
一剂，三日全愈。按此病实温疫（疫有寒温两种而寒者甚少），确有传染至猛至烈之毒菌，是以难治。又
按此证当二次用药时，若加硝、黄于药中，早通其大便，或不至以后如此危险，而当时
阅历未深，犹不能息息与病机相赴也。
有白喉证，其发白或至腐烂，实为传染病之一端。其证大抵先有蕴热，则易受传染。为其证内伤为重，宜
用凉润滋阴清火之品，而忌用表散之剂。然用辛凉之药以散其火郁，若薄荷、连翘诸药固所不忌也。《白喉
忌表抉微》中之养阴清肺汤、神仙活命汤二方，原为治白喉良方。而神仙活命汤中宜加连翘三钱；热甚者可
将方中生石膏加倍，或加两倍；若大便不通者，大黄、芒硝皆可酌加。白喉之病，又恒有与烂喉痧相并者（
参观医案中温疹兼喉痧治沈姓学生病案）。
又《灵枢》痈疽篇谓∶“痈发于嗌中，名曰猛疽，猛疽不治，化为脓，脓不泻，塞咽，半日死。”按
此证即后世所谓截喉痈。初起时，咽喉之间红肿甚剧，宜用消疮之药散之，兼用扁针刺之
使多出血。若待其脓成而后泻之，恐不容待其成脓即有危险也。
【消肿利咽汤】
天花粉（一两） 连翘（四钱） 金银花（四钱） 丹参（三钱）
射干（三钱） 玄参（三钱） 乳香（二钱） 没药（二钱）
炙山甲（钱半） 薄荷叶（钱半）
脉象洪实者加生石膏一两，小便不利者加滑石六钱，大便不通者加大黄三钱。
咽喉之证热者居多，然亦间有寒者（参观“论喉证治法”内治刘姓童子一案）。又咽
喉两旁微高处，西人谓之扁桃腺，若红肿西人谓之扁桃腺炎。若其处屡次红肿，渐起疙瘩，服清火药则微消，
或略有感冒，或稍有内热复起者，此是扁桃腺炎已有根蒂，非但服药所能愈，必用手术割去之，再投以清
火消肿之药，始能除根。若不割去，在幼童可累其身体之发达。
《金匮》谓妇人咽中如有炙脔（吐之不出吞之不下俗谓之梅核气病），此亦咽喉证
之一也。按∶此证注疏家谓系痰气阻塞咽喉之中，然此证实兼有冲气之冲也。原方半夏浓朴汤主之，是以半夏
降冲，浓朴开气，茯苓利痰，生姜、苏叶以宣通其气化。愚用此方时，恒加赭石数
钱，兼针其合谷，奏效更速（此证不但妇人男子亦间有之）。
咽喉部位的病证，有内伤和外感之分，性质或凉或热，或虚或实，有的具有传染性，有的则没有。现在尝试逐条详细论述如下。
伤寒病常常兼有咽喉方面的症状。《伤寒论》阳明篇第二十节说：“阳明病仅见头晕目眩，不恶寒，因此能进食且咳嗽，此人必定咽痛。如果不咳嗽，咽部也不会痛。”考察这一节只提到了咽痛，没有提及治疗方法。仔细推敲其文义，这是由太阳经初传至阳明经，胃腑的热邪尚未结实（所以还能进食），热邪同时弥漫于胸中（胸中本属太阳经范围，此处应为阳明病兼涉太阳经），向上熏蒸肺脏，所以引起咳嗽；又因为咳嗽导致热邪上窜，所以出现咽痛。拟用白虎汤去掉甘草，加入连翘、川贝母来治疗。
少阴篇第三节说：“患者脉象寸关尺三部都紧，反而出汗的，是亡阳的表现，这属于少阴病，按照法度应当出现咽痛。”这一节也没有列出治疗方法。考察少阴病的脉象通常是微细的，这里却是阴阳三部俱紧，原本是少阴病的变脉。紧脉本来不应出汗，因为在不该出汗的情况下反而自汗，所以知道这是亡阳。其中的咽痛，是由于无根之阳气上窜所致。拟用大剂量的八味地黄汤，以芍药代替丹皮，再加苏子、牛膝，收敛元阳使其归根以止汗，而咽痛自然痊愈。
【加减八味地黄汤】
大怀熟地（一两） 净萸肉（一两） 生怀山药（八钱） 生杭芍（三钱） 大云苓片（二钱） 泽泻（一钱半） 乌附子（二钱） 肉桂（二钱，去粗皮后放入） 怀牛膝（三钱） 苏子（二钱，研炒）
煎取汤盅一半，分两次温服。
少阴篇第三十节说：“少阴病，出现下利、咽痛、胸满、心烦的症状，用猪肤汤主治。”考察此证乃是少阴之热邪弥漫于三焦。所以在上与中焦表现为咽痛烦闷，这是因为肾中的真阴不能上升与阳分相济，所以多生燥热；在下焦表现为下利，这是因为脏腑病变将热邪移于腑，膀胱瘀滞，导致水液归入大肠而下利。至于用猪肤汤治疗，是因为猪为水畜，其皮肤可熬制成胶，汁液尤其丰富，原本就能帮助肾阴上升与心阳调剂以化解燥热。再加上白蜜的凉润，小粉（米粉）的冲和，熬煮如粥，服用后能在肠胃中留恋停留，不会随着下利泻出，自然能徐徐敷布其气化功能，以清除三焦弥漫的热邪。
少阴篇第三十一节说：“少阴病两三天，出现咽痛的，可以给予甘草汤。如果不好转，再给予桔梗汤。”这也是少阴病的热证。使用甘草汤是取其能润肺利咽，而其甘缓的性质又能缓解心火的上炎，那么下焦的燥热便可消除。使用桔梗汤是取其能升提肾中的真阴，使阴阳之气互相接续，那么上焦的阳气自然不再浮越以灼烧肺脏熏蒸咽喉，而且其上达的力量又善于疏散咽喉的郁热。考察后世治疗咽喉病的人大多忌讳使用桔梗，但如果确实诊察到脉象为少阴病的微细脉，使用它固然不妨碍。况且古代所用的桔梗都是苦桔梗，其性能既能升又能降，实在具有开通的作用。
少阴篇第三十二节说：“少阴病，咽部受伤生疮，不能说话，声音发不出来的，用苦酒汤主治。”考察少阴经脉原本联络肺脏并上行经过喉咙，所以少阴篇多兼有咽喉的疾病。至于用苦酒汤治疗，唐代医家唐氏认为苦酒（醋）与半夏同用可以使咽部的疮疡迅速破溃。苦酒就是现在的醋，醋调拌生半夏末外敷原本就可以消除疮疡，不必一定要攻伐使其破溃。
厥阴篇第九节说：“伤寒先出现四肢厥冷，后来发热，下利必定自行停止，却反而出汗，咽中痛，喉部发生痹阻。”考察这一节的咽痛，主要是因为多亡阴，与少阴篇中汗出亡阳的情况原相对照。大概是因为患者的肝脏蕴有实热，因为出汗过多耗伤了阴液，热邪于是上窜郁结于咽中而作痛，所以说“其咽为痹”。痹的意思是热邪与气血凝滞不散。张仲景当日没有说明治疗方法，而我思考此证应当使用酸敛的药物以止汗，凉润的药物以恢复津液，宣通的药物以利咽，汇集这些药物组成方剂，或许可以奏效。现将所拟定的方剂详细记录如下。
【敛阴泻肝汤】
生杭芍（一两半） 天花粉（一两） 射干（四钱） 浙贝母（四钱，捣碎） 酸石榴（一个，连皮捣烂）
共同煎取汤盅一半，分两次温服。
上面记录的伤寒兼有咽喉病的六节内容，伤寒中的咽喉证大致已经完备。然而我临证多年，知道伤寒兼患咽喉病又有超出这六节之外的情况，试举一个治疗的验案来说明。
我在奉天（今沈阳）时治疗一名朱姓学生，患伤寒三四天，蜷缩卧倒，昏昏沉沉似睡非睡，偶尔说胡话，呼唤时眼睛微微睁开，舌上似乎没有苔，但舌皮非常干燥，且有黑斑，咽喉疼痛，小便赤红且热，大便几天未行，脉象微细兼沉，心中时常觉得发热，但肌肤的温度却正常。这是少阴伤寒的热证，因为先前有伏气化热，趁着肾脏虚损窜入少阴，遏制肾气不能上达，所以上焦燥热而出现舌斑和咽痛。舌上有黑斑，也是肾虚的现象。至于病既属于热证而脉象微细，诚然因为脉发于心，肾气因病不能上达与心相济，心脏跳动即无力，这就是为什么少阴伤寒无论或凉或热，脉象皆微细的原因。于是为他开方：生石膏细末二两，生怀山药一两，大潞参六钱，知母六钱，甘草二钱，先用鲜茅根二两煮水，用它来煎药，取清汤三盅，每次温服一盅，调入生鸡蛋黄一枚。服药一次后，六脉即起。服至第二次，脉象转为洪大。服至第三次，脉象又逐渐平和，精神也恢复了，舌干咽痛也见好转。第二天就在原方基础上稍作加减，再服一剂，所有疾病全部痊愈。考察上面使用的方剂，就是坎离互根汤。对该方的详细解释详见本方之后，此处不再赘述。
至于温病，或者温病兼有疹子，其中兼有咽喉证的尤其多。方书将这种病症称为烂喉痧，其证候多系由具有传染性的毒菌引起。治疗者，宜注意清除温热，解其疹毒，咽喉的病症也容易治愈。试举一个治疗的验案来说明。
戊辰年在天津，有宋某某的长子某某患温疹兼喉证。医生们都忌讳重用凉药，服用他的药数剂后，病情反而加重。随后请我去诊治，其脉象洪长有力，完全是阳明胃腑蕴有实热；其疹子似结痂而未结痂；看其咽喉两旁发红，略有溃烂处；心中自觉很热；小便短赤；大便三天未行。为他开具大剂量白虎汤，加连翘四钱，薄荷叶一钱半以托举疹毒外出。方中生石膏重用生者四两，将药煎成汤三盅，分三次温饮下，病情大见好转，但脉仍有力，咽喉进食仍然疼痛。接着又用原方，先取鲜白茅根二两煮水来煎药，仍分三次服下，服完一剂而痊愈，大便也通畅了。后来他的次子也患温疹喉证，比其兄长更为严重。仍然用前方治疗，初次即用茅根汤煎药，方中生石膏起初用三两，逐渐加至五两才痊愈。接着他的小女儿七岁时也患温疹喉证，比两个哥哥更重，其疹子周身连成一片，肉皮皆红（俗话称这类疹子都不能治愈）。也用前方治疗，因为她年幼，方中生石膏起初用二两，后加至六两，其热稍微减退但喉痛不减，其大便六日未行，于是单用净芒硝化水让她服下，大便即通，其热大减，喉痛也减轻了一半。再诊其脉虽然仍有力，实则已有浮而还表之象，于是用西药阿斯匹林一瓦（约0.6克），因病机向外越而助其出汗。果然服药后周身得汗，霍然全愈。
温疹之证，西方人名为猩红热，有毒菌传染，原本不易治疗，而兼有咽喉证的治疗尤其困难。张仲景所说的“阳毒为病，面赤斑斑如锦纹，咽喉痛，唾脓血”的，当即此证。近世方书中又名为烂喉痧，谓可用《伤寒论》麻杏甘石汤治疗。然而麻杏甘石汤中石膏的分量原为麻黄的两倍。如果借用其方，则石膏的分量当十倍于麻黄（石膏一两，麻黄一钱）；其热甚者，石膏的分量又当二十倍于麻黄（石膏二两，麻黄一钱），然后使用才没有弊端。
沧州友人董某某，年过三十岁，起初感冒发颐（腮腺炎），继则逐渐肿胀向下延伸至胸膺，服药无效。当时正值中秋节后，淋雨不止，因病势危急，冒雨驱车迎接我。到达后，见其下巴连颈部，壅肿异常，抚摸起来硬而且热，颜色很红，纯粹是一团火毒之气，下部肿胀已至心口；其牙关不开，咽喉肿疼，从牙缝进水半口，必须用手掩住口，十分用力才能咽下；且痰涎填满胸中，上至咽喉，并无容纳水的地方，进水少许，必吐出痰涎一口；且感觉有气自下向上冲，常作呃逆；其脉象洪滑而长，重按有力，一分钟约近九十次；大便几天未行。我说：“这就是俗称的虾蟆瘟。其毒热炽盛，盘踞在阳明之府，像烈火燎原一样，必须重用生石膏来清解，才能缓和其毒热之势。”从前在场的医生说曾用生石膏一两，毫无功效。我说：“石膏乃微寒之药，《神农本草经》原有明文记载，仅用一两许怎么能清除此炽盛的毒热。”于是为他开方，用生石膏四两，清半夏四钱，金线重楼三钱，连翘二钱，射干二钱。煎服后，感觉药停在胸间不下，其热与肿似乎有益增之势。知道此证兼有结胸，火热无下行之路，所以更加上冲。又急忙取生石膏四两，赭石三两，又煎汤服下，仍感觉停于胸间。又急忙取赭石三两，瓜蒌仁二两，芒硝八钱，又煎汤饮下，胸中仍不开通。此时咽喉更加肿胀，再饮水也不能咽下，病家惶恐无措。我安慰他们说：“我之所以连续急切用药，正是因为此病肿势浸长，恐怕稍缓则药不能进。现在其胸中既然贮积了如此多的药，断无不往下行的道理。药下行则结开便通，毒火随之下降，而上焦的肿热必消矣。”当时是晚上十点，到半夜感觉药力下行，黎明时下出若干燥粪，上焦肿热觉轻，水浆可进，晨饭时牙关也微开，服茶汤一碗。午后肿热又渐增，抚摸其胸，热又烙手，脉仍洪实。心想其燥粪必未尽下，于是投以大黄四钱，芒硝五钱，又下出燥粪，兼有溏粪，病遂大愈。而肿胀处硬的仍不甚消，胸间抚摸犹热，脉象亦仍有残余热象。又用生石膏四两，金银花、连翘各五钱，煎汤一大碗，分数次温饮下，日服一剂，三日全愈。考察此病实为温疫（疫病有寒温两种而寒者很少），确有传染至猛至烈的毒菌，是以难治。又考察此证在第二次用药时，若加硝、黄于药中，早通其大便，或许不至于以后如此危险，而当时阅历未深，还不能时刻与病机相应。
有白喉证，其发白或至腐烂，实为传染病之一端。其证大体先有蕴热，则易受传染。因为其证内伤为重，宜用凉润滋阴清火之品，而忌用表散之剂。然而使用辛凉之药以散其火郁，如薄荷、连翘诸药固在所不忌。《白喉忌表抉微》中的养阴清肺汤、神仙活命汤二方，原本为治疗白喉良方。而神仙活命汤中宜加连翘三钱；热甚者可将方中生石膏加倍，或加两倍；若大便不通者，大黄、芒硝皆可酌加。白喉之病，又常有与烂喉痧相并发的（参见医案中温疹兼喉痧治沈姓学生病案）。
又《灵枢》痈疽篇说：“痈发于嗌中，名曰猛疽，猛疽不治，化为脓，脓不泻，塞咽，半日死。”考察此证即后世所谓截喉痈。初起时，咽喉之间红肿甚剧，宜用消疮之药散之，兼用扁针刺之使多出血。若待其脓成而后泻之，恐怕不容待其成脓即有危险也。
【消肿利咽汤】
天花粉（一两） 连翘（四钱） 金银花（四钱） 丹参（三钱）
射干（三钱） 玄参（三钱） 乳香（二钱） 没药（二钱）
炙山甲（一钱半） 薄荷叶（一钱半）
脉象洪实者加生石膏一两，小便不利者加滑石六钱，大便不通者加大黄三钱。
咽喉之证热者居多，然亦间有寒者（参见“论喉证治法”内治刘姓童子一案）。又咽喉两旁微高处，西方人谓之扁桃腺，若红肿西方人谓之扁桃腺炎。若其处屡次红肿，渐起疙瘩，服清火药则微消，或略有感冒，或稍有内热复起者，此是扁桃腺炎已有根蒂，非但服药所能愈，必用手术割去之，再投以清火消肿之药，始能除根。若不割去，在幼童可累及其身体的发育。
《金匮》谓妇人咽中如有炙脔（吐之不出吞之不下，俗谓之梅核气病），此亦咽喉证之一也。考察：此证注疏家谓系痰气阻塞咽喉之中，然此证实兼有冲气之冲也。原方半夏厚朴汤主之，是以半夏降冲，厚朴开气，茯苓利痰，生姜、苏叶以宣通其气化。我用此方时，恒加赭石数钱，兼针其合谷穴，奏效更速（此证不但妇人男子亦间有之）。
Throat and pharynx disorders may arise from internal injury or external contraction, presenting with cold or heat, deficiency or excess, and varying in transmissibility. The following is a detailed discussion item by item.
Shanghan (Cold Damage) disease often involves throat symptoms. Section 20 of the Yangming Chapter in *Shanghan Lun* states: "In Yangming disease, if there is only dizziness, aversion to cold is absent, thus the patient can eat and cough; such a person must have a sore throat. If there is no cough, there will be no sore throat." This section mentions only sore throat without prescribing treatment. Upon careful examination of the text's meaning, this condition arises when the pathogen initially transmits from the Taiyang channel to the Yangming channel. The heat in the Stomach Fu organ is not yet fully consolidated (hence the ability to eat), while the heat simultaneously diffuses into the chest (the chest belongs to the Taiyang domain; here it implies Yangming disease involving Taiyang). This heat steams upward to the Lungs, causing coughing. Furthermore, due to the coughing, the heat rushes upward, resulting in sore throat. It is proposed to treat this with Baihu Tang (White Tiger Decoction), removing Gancao (Licorice Root) and adding Lianqiao (Forsythia Fruit) and Chuanbeimu (Fritillaria Bulb).
Section 3 of the Shaoyin Chapter states: "If a patient's pulse is tight at all three positions (Yin and Yang), yet sweat occurs spontaneously, this indicates loss of Yang Qi. This belongs to Shaoyin disease, and according to the method, sore throat should occur." This section also lacks a treatment prescription. Examining the Shaoyin pulse, it is typically fine and weak; here, however, it is tight at all positions, representing a variant pulse of Shaoyin disease. A tight pulse normally does not cause sweating; since spontaneous sweating occurs where it should not, we know this indicates loss of Yang Qi. The sore throat results from rootless Yang Qi rushing upward. It is proposed to use a large dose of Bawei Dihuang Tang (Eight-Ingredient Rehmannia Decoction), replacing Danpi (Moutan Bark) with Shaoyao (Peony Root), and adding Suzi (Perilla Seed) and Niuxi (Achyranthes Root) to converge the Yuan Yang (Original Qi) back to its root to stop sweating, thereby curing the sore throat naturally.
[Modified Bawei Dihuang Tang]
Da Huai Shudi (Prepared Rehmannia Root, 1 liang)
Jing Yurou (Cornus Fruit, 1 liang)
Sheng Huai Shanyao (Chinese Yam, 8 qian)
Sheng Hangshaoyao (White Peony Root, 3 qian)
Da Yunling Pian (Poria Cocos, 2 qian)
Zexie (Alisma Rhizome, 1.5 qian)
Wu Fuzi (Prepared Aconite Root, 2 qian)
Rougui (Cinnamon Bark, 2 qian, add after removing rough bark)
Huai Niuxi (Achyranthes Root, 3 qian)
Suzi (Perilla Seed, 2 qian, stir-fried and crushed)
Decoct in water to yield half a bowl of decoction, divide into two doses, take warm.
Section 30 of the Shaoyin Chapter states: "In Shaoyin disease, if there is diarrhea, sore throat, chest fullness, and irritability, Zhufu Tang (Swine Skin Decoction) is the primary treatment." This condition involves Shaoyin heat diffusing through the Triple Burner. In the upper and middle jiao, it manifests as sore throat and irritability/fullness because the True Yin of the Kidneys cannot ascend to harmonize with Yang, leading to dryness and heat. In the lower jiao, it manifests as diarrhea because the Zang organ pathology transfers heat to the Fu organs; bladder stasis causes water to flow into the Large Intestine, resulting in diarrhea. Zhufu Tang is used because pigs are water animals; their skin can be boiled into gelatin, possessing rich fluids that help Kidney Yin ascend and harmonize with Heart Yang to resolve dryness and heat. Combined with the cooling and moistening properties of Bami (White Honey) and the mild nature of Xiaofen (Starch/Rice Flour), cooked like porridge, the decoction lingers in the intestines and stomach, preventing expulsion via diarrhea. It slowly distributes its transformative qi to clear the heat diffusing through the Triple Burner.
Section 31 of the Shaoyin Chapter states: "In Shaoyin disease, on the second or third day, if there is sore throat, Gancao Tang (Licorice Decoction) may be given. If it does not improve, Jiegeng Tang (Platycodon Decoction) is given." This is also a heat pattern of Shaoyin disease. Gancao Tang is used for its ability to moisten the Lungs and benefit the throat; its sweet and緩 (moderating) nature also moderates the flaming up of Heart Fire, eliminating dryness and heat in the lower jiao. Jiegeng Tang is used because Jiegeng (Platycodon Root) can elevate the True Yin of the Kidneys, allowing Yin and Yang Qi to connect continuously. This prevents Upper Jiao Yang from floating upward and scorching the Lungs and throat, and its ascending power helps disperse stagnant heat in the throat. Later generations generally avoid using Jiegeng for throat diseases, but if the pulse is confirmed as the fine and weak pulse of Shaoyin disease, its use is acceptable. Moreover, ancient texts refer to Ku Jiegeng (Bitter Platycodon), which has both ascending and descending properties and possesses opening capabilities.
Section 32 of the Shaoyin Chapter states: "In Shaoyin disease, if the throat is injured and sores form, preventing speech and voice production, Kujiu Tang (Bitter Wine Decoction) is the primary treatment." The Shaoyin meridian connects with the Lungs and ascends along the throat, hence Shaoyin disease often involves throat conditions. Regarding Kujiu Tang, Dr. Tang believed that combining Kujiu (Vinegar) with Banxia (Pinellia Tuber) could rapidly rupture the throat sores. Kujiu is vinegar; applying raw Banxia powder mixed with vinegar externally can resolve sores, so aggressive rupture is not always necessary.
Section 9 of the Jueyin Chapter states: "In Shanghan, if there is initial cold extremities followed by fever, diarrhea will stop spontaneously. However, if sweating occurs, sore throat in the throat, and bi obstruction (blockage) of the throat result..." The sore throat here is primarily due to loss of Yin, contrasting with the loss of Yang sweating in Shaoyin disease. The Liver harbors excess heat; excessive sweating consumes Yin fluids, causing heat to rush upward and stagnate in the throat, creating pain ("bi"). Bi refers to the stagnation of heat, Qi, and Blood. Zhang Zhongjing did not specify treatment; I propose using sour and astringent herbs to stop sweating, cooling and moistening herbs to restore fluids, and dispersing and unblocking herbs to benefit the throat, combined into a formula.
[Lianyin Xiegan Tang (Astringe Yin and Drain Liver Decoction)]
Sheng Hangshaoyao (White Peony Root, 1.5 liang)
Tianhuafen (Trichosanthes Root, 1 liang)
Shegan (Belamcanda Rhizome, 4 qian)
Zhe Beimu (Fritillaria Thunbergii Bulb, 4 qian, crushed)
Suan Shiliu (Acid Pomegranate, 1 whole, crushed with peel)
Decoct together to yield half a bowl of decoction, divide into two doses, take warm.
The six sections recorded above cover most Shanghan-related throat disorders. However, based on years of clinical experience, I know there are cases outside these sections. I present one verified case for illustration.
I treated a student surnamed Zhu in Fengtian (Shenyang) who had suffered from Shanghan for three to four days. He lay curled up, drowsy and semi-conscious, occasionally speaking deliriously. When called, his eyes opened slightly. His tongue appeared coating-less but very dry with black spots. He had a sore throat, red and hot urine, and constipation for several days. His pulse was fine, weak, and deep. He felt internal heat, though his skin temperature was normal. This is a heat pattern of Shaoyin Shanghan, caused by latent pathogenic transformation into heat, entering the Shaoyin channel due to Kidney deficiency, suppressing Kidney Qi from ascending. This led to Upper Jiao dryness, tongue spots, and sore throat. The black spots indicate Kidney deficiency. Although the disease is heat-based, the pulse is fine and weak because the pulse originates from the Heart; suppressed Kidney Qi fails to assist the Heart, weakening cardiac pulsation. Thus, Shaoyin Shanghan pulses are consistently fine and weak regardless of cold or heat patterns.
Prescription: Shigao (Gypsum Fibrosum, finely powdered, 2 liang), Sheng Huai Shanyao (Chinese Yam, 1 liang), Dalushen (Codonopsis Root, 6 qian), Zhimu (Anemarrhena Rhizome, 6 qian), Gancao (Licorice Root, 2 qian). First, boil fresh Maogen (Imperata Rhizome, 2 liang) in water, then use this water to decoct the herbs. Yield three bowls of clear decoction. Take one bowl warm each time, mixing in one raw Chicken Egg Yolk (Jizi Huang). After one dose, the six pulses rose. After two doses, the pulse became surging and large. After three doses, the pulse normalized, spirit recovered, and dry tongue/sore throat improved. The next day, a modified version of the original formula was taken for one more dose, resulting in complete recovery. This formula is Kanli Hugen Tang (Kan and Li Mutually Rooted Decoction); details are provided elsewhere.
Warm diseases (Wenbing), especially those complicated by rashes, frequently involve throat symptoms. Formulary books call this Lanhou Sha (Rotting Throat Sand Rash), often caused by contagious pathogens. Treatment should focus on clearing warmth/heat and resolving rash toxins, making throat symptoms easier to cure.
Case: In Wuchen year in Tianjin, Song XX's eldest son suffered from Warm Rash with throat involvement. Physicians avoided heavy cooling herbs; after several doses, the condition worsened. I diagnosed a surging, long, and forceful pulse, indicating excess heat in the Yangming Stomach Fu. The rash was unresolved. Throat sides were red with slight ulceration. He felt intense internal heat, had scanty red urine, and constipation for three days. I prescribed a large dose of Baihu Tang (White Tiger Decoction) with Lianqiao (Forsythia Fruit, 4 qian) and Boheye (Mint Leaf, 1.5 qian) to vent the rash. Shigao (Gypsum Fibrosum) was used heavily (raw, 4 liang). Decocted in three bowls, taken warm in three doses. Condition improved significantly, but pulse remained forceful, and swallowing still painful. I repeated the formula, first boiling fresh Maogen (Imperata Rhizome, 2 liang) to decoct the herbs. Taken in three doses, he recovered completely, and bowels moved.
His second son later developed similar symptoms, more severe. Treated with the same formula, starting with Maogen decoction. Shigao started at 3 liang, increased to 5 liang until cured. His youngest daughter (7 years old) developed even more severe symptoms, with confluent red rash (considered incurable traditionally). Treated with the same formula. Shigao started at 2 liang, increased to 6 liang. Heat subsided slightly, but throat pain persisted. Constipation for six days. I administered pure Mangxiao (Natrii Sulfas/Mirabilite) dissolved in water. Bowels moved, heat decreased significantly, throat pain halved. Pulse remained forceful but showed superficial returning characteristics. I administered Aspirin (1 wa/approx. 0.6g) to induce sweating, aiding the pathogen's exit. Sweating occurred, and he recovered instantly.
Western medicine calls this Scarlet Fever (Erythema Infectiosum), caused by contagious bacteria, difficult to treat, especially with throat involvement. Zhang Zhongjing described "Yang Du" (Yang Toxin): "Red face with mottled rash like brocade, sore throat, spitting pus and blood," likely referring to this condition. Modern formulary books call it Lanhou Sha and suggest Maxing Ganshi Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction). However, in that formula, Shigao is double the amount of Mahuang. If borrowed, Shigao should be ten times Mahuang (1 liang Shigao : 1 qian Mahuang); in severe heat, twenty times (2 liang Shigao : 1 qian Mahuang) to avoid adverse effects.
Case: Friend Dong XX from Cangzhou, over 30, initially had parotitis from wind-cold, progressing to swelling extending to the chest. Medications failed. Post-Mid-Autumn Festival, he rode in rain due to critical condition. Upon arrival, submandibular and neck swelling was extreme, hard, hot, and red, resembling a mass of fire-toxin, reaching the heart region. Trismus (lockjaw), swollen/painful throat. Could only swallow half a mouthful of water with great effort, covering mouth. Chest filled with phlegm-saliva rising to throat; drinking small amounts triggered vomiting of phlegm. Sensation of Qi rushing upward, frequent hiccups. Pulse surging, slippery, long, forceful upon pressure, ~90 beats/min. Constipation for days. I diagnosed "Hamster Plague" (Mumps-like epidemic). Toxic heat was fierce, occupying Yangming Fu, like a prairie fire. Heavy Shigao was needed. Previous doctors used 1 liang Shigao with no effect. I stated Shigao is mildly cold per *Shennong Ben Cao Jing*; 1 liang is insufficient for such fierce toxin. Prescribed: Shigao (4 liang), Qing Banxia (Pinellia, 4 qian), Jinzhonglou (Paris Polyphylla, 3 qian), Lianqiao (2 qian), Shegan (2 qian). After taking, medicine felt stuck in chest, heat/swelling seemed to increase. Diagnosed concurrent Jie Xiong (Chest Binding) syndrome; fire had no downward outlet, causing upward rush. Urgently added Shigao (4 liang) and Zheshi (Hematitum/Ochre, 3 liang). Still stuck. Added Zheshi (3 liang), Gualouren (Trichosanthes Seed, 2 liang), Mangxiao (8 qian). Chest still blocked. Throat swelling worsened, unable to drink. Family panicked. I reassured them: "I urge medication because swelling progresses; delay means inability to ingest. Now that the chest holds much medicine, it must descend. Once descended, binding opens, bowels move, toxin/fire descends, and Upper Jiao swelling/heat resolves." At 10 PM, by midnight, medicine acted downward. By dawn, passed dry stool, Upper Jiao swelling/heat lightened, could drink water/gruel. Jaw opened slightly at breakfast. Afternoon: swelling/heat returned, chest hot to touch, pulse surging/solid. Suspected incomplete evacuation. Administered Dahuang (Rhubarb Root, 4 qian), Mangxiao (5 qian). Passed dry and loose stools. Condition greatly improved. Hard swelling persisted, chest hot, residual heat in pulse. Prescribed Shigao (4 liang), Jinyinhua (Honeysuckle Flower, 5 qian), Lianqiao (5 qian). Decocted in one large bowl, taken warm in divided doses, once daily. Cured in three days. This is Wen Yi (Warm Epidemic), highly contagious and virulent, hence difficult. Had I added Mangxiao/Dahuang earlier during the second dosage to open bowels promptly, the danger might have been avoided. My experience was limited then, unable to perfectly align with the disease mechanism at every moment.
Diphtheria (Baihou) presents with white patches or ulcers, a contagious disease. Typically preceded by internal heat accumulation, facilitating infection. Since internal injury is predominant, cooling, moistening, Yin-nourishing, and fire-clearing herbs are indicated; exterior-releasing agents are contraindicated. However, acrid-cooling herbs to disperse fire-stagnation, such as Bohe (Mint) and Lianqiao, are not forbidden. Yangyin Qingfei Tang (Nourish Yin and Clear Lung Decoction) and Shenxian Huoming Tang (Immortal Life-Saving Decoction) from *Baihou Jibiao Juwei* are excellent for Diphtheria. Add Lianqiao (3 qian) to Shenxian Huoming Tang; double or triple Shigao for severe heat; add Dahuang or Mangxiao for constipation. Diphtheria often co-occurs with Lanhou Sha.
*Ling Shu* Chapter on Carbuncles and Ulcers states: "Carbuncle arising in the throat is named Mengju (Fierce Abscess). If untreated, it turns to pus. If pus is not drained, blocking the throat, death occurs within half a day." This corresponds to Houjie Yong (Throat-Severing Carbuncle). Initially, severe redness and swelling occur in the throat. Use anti-ulcer herbs to dissipate it, and prick with flat needles to bleed profusely. Waiting for pus formation before draining is dangerous.
[Xiaozhong Liyan Tang (Reduce Swelling and Benefit Throat Decoction)]
Tianhuafen (Trichosanthes Root, 1 liang)
Lianqiao (Forsythia Fruit, 4 qian)
Jinyinhua (Honeysuckle Flower, 4 qian)
Danshen (Salvia Miltiorrhiza Root, 3 qian)
Shegan (Belamcanda Rhizome, 3 qian)
Xuanshen (Scrophularia Root, 3 qian)
Ruxiang (Frankincense, 2 qian)
Moyao (Myrrh, 2 qian)
Zhi Shan Jia (Processed Pangolin Scale, 1.5 qian)
Boheye (Mint Leaf, 1.5 qian)
Add Shigao (1 liang) for surging/solid pulse; add Huashi (Talcum, 6 qian) for difficult urination; add Dahuang (3 qian) for constipation.
Most throat disorders are heat-based, but some are cold (see case of Liu boy). The slightly elevated areas on both sides of the throat are tonsils (Biántáo Xiàn). Redness/swelling is tonsillitis. Recurrent swelling/nodules that reduce slightly with cooling herbs but recur with minor colds/internal heat indicate rooted tonsillitis. Medication alone is insufficient; surgical removal is required, followed by cooling/dispersing herbs to eradicate the root. Failure to remove may impair physical development in children.
*Jingui Yaolue* states: "Women feel as if there is roasted meat stuck in the throat (cannot spit out, cannot swallow down), commonly known as Meiheqi (Plum-pit Qi)." This is also a throat disorder. Commentators attribute it to Phlegm-Qi obstruction, but it actually involves Chong Qi (Penetrating Qi) rebellion. The original formula is Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction): Banxia descends Chong Qi, Houpo moves Qi, Fuling drains Phlegm, Shengjiang (Fresh Ginger) and Ziye (Perilla Leaf) diffuse Qi transformation. I often add Zheshi (Ochre, several qian) and needle Hegu (LI4) for faster results. This condition also affects men occasionally.