愚弱冠时已为人疏方治病，然因年少，人多不相信。值里中有病喉者，延医治疗，烦愚作陪，病者
喉肿甚，呼吸颇难，医者犹重用发表之剂，而所用发表之药又非辛凉解肌，愚甚不以为然，出言驳之。医者谓
系缠喉风证，非发透其汗不能消肿。病家信其说，误服其药，竟至不救。后至津门应试，值《白喉忌表抉微》
书新出，阅之。见其立论以润燥滋阴清热为主，惟少加薄荷、连翘以散郁热，正与从前医者所用之药相反。
因喜而试用其方，屡奏功效。后值邑中患喉证者颇多，用《白喉忌表抉微》治法，有效有不效。观喉中，不必
发白，恒红肿异常。有言此系烂喉痧者，又或言系截喉痈者，大抵系一时之疠气流行而互相传染也。其病初
得脉多浮而微数，或浮而有力，久则兼有洪象，此喉证兼瘟病也。
此时愚年近三旬，临证恒自有见解，遇脉之初得浮数有力者，重
用玄参、花粉以清其热，牛蒡、连翘以利其喉，再加薄荷叶二钱以透其表，类能奏效。其为日既深，脉象
洪而有力者，又恒用白虎汤加银花、连翘、乳香、没药治愈。为其有截喉痈之名，间有加炙山甲，以消其
痈肿者。其肿处甚剧，呼吸有窒碍者，恒先用铍针刺出恶血，俾肿消然后服药，针药并施，其奏功亦愈速。
然彼时虽治愈多人，而烂喉痧、截喉痈之名究未见诸书也。后读《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。”经既明言痈发嗌中，此后世截喉痈之名所由来也。至谓不
泻其脓则危在目前，是针刺泻脓原为正治之法，即不待其化脓，针刺以出其恶血亦可为正治之法矣。又阅《伤
寒论》，“阳毒之为病面赤斑斑如锦纹，咽喉痛，唾脓血，五日可治，七日不可治。”王孟英解曰∶“阳毒
即后世之烂喉痧耳。”是烂喉痧衍之伤寒，而相传已久，截喉痈即烂喉痧之重者也。盖白喉与烂喉痧证均有
外感，特白喉证内伤重而外感甚轻，其外来之邪惟袭入三焦，三焦色白，是以喉现白色，故方中宣散之品但
少用薄荷、连翘已能逐邪外出。至烂喉痧原即《伤寒论》之阳毒，其中挟有瘟毒之气，初得之时，原宜重用宣
散之品，然宜散以辛凉，而断不可散以温热，且又宜重用凉药以佐之。此为喉证之大略也。
而愚临证数十年，知喉证中原有诸多变证，今详录二则以备参观。
愚在籍时，有刘姓童子，年逾十龄，咽喉肿疼，心中满闷杜塞，剧时呼吸顿停，两目上翻，身躯后挺。
然其所以呼吸顿停者，非咽喉杜塞，实觉胸膈杜塞也。诊其脉微细而迟，其胸膈常觉发凉，有时其凉上冲，
即不能息而现目翻身挺之象。即脉审证，知系寒痰结胸无疑。其咽喉肿疼者，寒痰充溢于上焦，迫其心肺
之阳上浮也。为拟方∶生赭石细末一两，干姜、乌附子各三钱，浓朴、陈皮各钱半。
煎服一剂，胸次顿觉开通，咽喉肿疼亦愈强半。又服两剂全愈。
奉天孙××，年二十，得喉证。屡经医治，不外《白喉忌表
抉微》诸方加减，病日增重，医者诿谓不治。后愚为诊视，其脉细弱而数，粘涎甚多，须臾满口，即得吐出。
知系脾肾两虚，肾虚则气化不摄，阴火上逆，痰水上泛，而脾土虚损又不能制之（若脾土不虚不但能制痰水上
泛并能制阴火上逆），故其咽喉肿疼，粘涎若斯之多也。投以六味地黄汤加于术，又少加苏子。连服十剂全愈。
我在二十岁左右时就已经为人开方治病，但因为年纪轻，人们大多不相信。当时乡里有人患喉病，请医生治疗，烦劳我作陪。患者咽喉肿胀严重，呼吸相当困难，而医生仍然重用发散表邪的药剂，且所用的发散药物并非辛凉解肌之品，我非常不以为然，便出言驳斥他。医生说这是缠喉风证，必须发透汗才能消肿。病人家属相信了他的说法，误服了那些药，最终导致病情恶化无法救治。
后来我到天津应试，正值《白喉忌表抉微》一书新出版，我便阅读了它。看到书中立论以润燥、滋阴、清热为主，只少量加入薄荷、连翘来疏散郁热，这正与之前那位医生所用的药物相反。我因此高兴地尝试使用书中的方剂，屡次取得显著疗效。
后来家乡患喉病的人很多，我用《白喉忌表抉微》的方法治疗，有的有效，有的无效。观察患者的喉咙，不一定发白，常常红肿异常。有人说这是烂喉痧，又有人说这是截喉痈，大抵是一时的疠气流行并互相传染所致。这种病初起时脉象多浮而微数，或浮而有力，久了则兼有洪大的脉象，这是喉病兼有瘟病（瘟疫性质的疾病）。
此时我年近三十，临证时往往有自己的见解。遇到脉象初起浮数有力的，我重用玄参、天花粉来清热，牛蒡子、连翘来利咽，再加二钱薄荷叶来透达表邪，通常都能奏效。如果病程日久，脉象洪大而有力，我又常用白虎汤加金银花、连翘、乳香、没药治愈。因为病名中有“截喉痈”，间或加入炙穿山甲，以消散痈肿。如果肿胀非常剧烈，呼吸有窒碍感的，我常先用铍针刺破放出恶血，待肿胀消退后再服药，针药并用，见效更快。
然而那时虽然治愈了很多人，但“烂喉痧”、“截喉痈”的名字终究没有见于医书。后来读《灵枢·痈疽篇》，其中说：“痈发于咽喉中间，名叫猛疽，猛疽如果不治疗，化脓后脓液不排出，堵塞咽喉，半天就会死亡。”经文既然明确说痈发于咽喉中，这就是后世“截喉痈”名称的来源。至于说不排出脓液就危险在眼前，说明针刺排脓原本是正确治法，即使不等到化脓，针刺放出恶血也可以作为正确治法。
我又阅读《伤寒论》：“阳毒这个病，面部红赤，斑纹如锦缎花纹，咽喉痛，吐脓血，五天可治，七天不可治。”王孟英解释说：“阳毒就是后世的烂喉痧。”这说明烂喉痧源自《伤寒论》中的阳毒，且流传已久；截喉痈则是烂喉痧的重症。
大概白喉与烂喉痧都有外感因素，只是白喉内伤重而外感轻，外来邪气只侵入三焦，三焦色白，所以喉咙呈现白色，因此方中宣散的药物只需少量使用薄荷、连翘就能将邪气驱逐外出。至于烂喉痧原本就是《伤寒论》中的阳毒，其中夹杂有瘟毒之气，初起时，原本应当重用宣散的药物，但宜用辛凉发散，绝不可用温热发散，而且宜重用凉药辅助。这是关于喉病治疗的概要。
而我临证数十年，知道喉病中原本有许多变证，现在详细记录两例以供参考。
我在家乡时，有个姓刘的童子，年龄超过十岁，咽喉肿痛，心中满闷堵塞，严重时呼吸突然停止，两眼上翻，身体向后挺硬。但他之所以呼吸突然停止，并不是咽喉堵塞，而是觉得胸膈堵塞。诊察他的脉象微细而迟，他胸膈常感觉发凉，有时寒气上冲，就不能呼吸而出现眼翻身挺的症状。根据脉象审察证候，知道这是寒痰结胸无疑。他咽喉肿痛的原因，是寒痰充溢于上焦，逼迫心肺的阳气上浮。于是我为他拟定方剂：生赭石细末一两，干姜、乌附子各三钱，厚朴、陈皮各一钱半。
煎服一剂后，胸中顿时感觉开通，咽喉肿痛也减轻了一半以上。又服两剂后完全痊愈。
奉天的孙某某，二十岁，得了喉病。多次医治，不外乎对《白喉忌表抉微》中的方剂进行加减，病情日益加重，医生推脱说无法治疗。后来我诊治，发现他脉象细弱而数，粘涎非常多，一会儿就满口都是，随即吐出。我知道这是脾肾两虚，肾虚则气化功能不能固摄，阴火上逆，痰水上泛，而脾土虚弱又不能制约它（如果脾土不虚，不仅能制约痰水上泛，也能制约阴火上逆），所以他的咽喉肿痛，粘涎如此之多。我投以六味地黄汤加白术，又少加苏子。连续服用十剂后完全痊愈。
When I was in my early twenties, I had already been prescribing formulas to treat diseases for others. However, due to my young age, people generally did not trust me. At that time, there was a case of throat disease in my village. A doctor was invited for treatment, and I was asked to accompany him. The patient's throat was severely swollen, making breathing quite difficult. Yet, the physician still heavily prescribed diaphoretic agents (formulas to induce sweating), and the specific herbs used were not acrid-cool muscle-relaxing agents. I strongly disagreed with this approach and voiced my objections. The doctor claimed it was *Chan Hou Feng* (Coiling Throat Wind, a severe throat condition) and insisted that sweating must be induced thoroughly to reduce the swelling. The family believed his assertion, administered the medication erroneously, and the patient ultimately died from the mismanagement.
Later, when I went to Tianjin for the imperial examinations, the book *Bai Hou Ji Biao Jue Wei* (Clarifying the Subtleties of Avoiding Diaphoresis in White Throat) had just been published. I read it and found its theoretical basis centered on moistening dryness, nourishing yin, and clearing heat, with only small amounts of Bohe (Menthae Haplocalycis Herba, 薄荷) and Lianqiao (Forsythiae Fructus, 连翘) added to dissipate constrained heat. This was exactly opposite to the medications used by the previous doctor. Delighted, I tried using its formulas and achieved frequent success.
Subsequently, many people in my county suffered from throat disorders. Using the methods from *Bai Hou Ji Biao Jue Wei*, some cases responded well while others did not. Observing the throats, they did not necessarily appear white but were often abnormally red and swollen. Some said this was *Lan Hou Sha* (Rotting Throat Rash), while others called it *Jie Hou Yong* (Throat-Blocking Carbuncle). Generally, these were caused by the spread of pestilential qi (pathogenic factors causing epidemics) through mutual infection. In the initial stage of the disease, the pulse was mostly floating and slightly rapid, or floating and forceful; after a long duration, it would acquire a surging quality. This indicates that the throat disorder is accompanied by a pestilential disease.
At this time, I was nearing thirty years old and often had my own insights during clinical practice. When encountering a pulse that was initially floating, rapid, and forceful, I would heavily use Xuanshen (Scrophulariae Radix, 玄参) and Huafen (Trichosanthis Radix, 天花粉) to clear heat, Niubangzi (Arctii Fructus, 牛蒡子) and Lianqiao (Forsythiae Fructus, 连翘) to benefit the throat, and add two qian of Bohe Ye (Menthae Haplocalycis Folium, 薄荷叶) to vent the exterior. These measures usually proved effective. If the illness had persisted for a long time and the pulse became surging and forceful, I would frequently use Baihu Tang (White Tiger Decoction) supplemented with Yinhua (Lonicerae Japonicae Flos, 金银花), Lianqiao (Forsythiae Fructus, 连翘), Ruxiang (Boswelliae Resina, 乳香), and Moyao (Commiphorae Myrrha, 没药) to achieve cures. Given the name "Jie Hou Yong," I occasionally added Zhi Shan Jia (Pangolin Scale, processed) to dissipate the carbuncle swelling. If the swelling was extremely severe and breathing was obstructed, I would first use a Pi Zhen (a flat needle for draining pus) to puncture and release evil blood, allowing the swelling to subside before administering herbal medicine. The combination of acupuncture and herbal therapy yielded faster results.
Although I cured many people at that time, the terms "Lan Hou Sha" and "Jie Hou Yong" had not yet appeared in medical texts. Later, reading the *Yong Ju Pian* (Chapter on Carbuncles and Ulcers) in the *Ling Shu* (Spiritual Pivot), I encountered the statement: "A carbuncle arising in the pharynx is called Meng Ju (Fierce Carbuncle). If Meng Ju is not treated, it turns into pus. If the pus is not drained, it blocks the throat, leading to death within half a day." Since the classic explicitly states that carbuncles arise in the pharynx, this explains the origin of the later term "Jie Hou Yong." Furthermore, since failing to drain the pus leads to imminent danger, needle drainage of pus is originally a correct therapeutic method. Even without waiting for suppuration, using needles to release evil blood can also serve as a correct treatment.
I also consulted the *Shang Han Lun* (Treatise on Cold Damage Disorders): "The disease of Yang Du (Yang Toxin) presents with a red face and mottled rash like brocade patterns, sore throat, and expectoration of pus and blood. It is treatable within five days but untreatable after seven days." Wang Mengying explained: "Yang Du is what later generations call Lan Hou Sha." This shows that Lan Hou Sha derives from Yang Du in the *Shang Han Lun* and has been transmitted for a long time; Jie Hou Yong is simply the severe form of Lan Hou Sha.
Generally speaking, both Bai Hou (White Throat) and Lan Hou Sha involve external contraction. However, in Bai Hou, internal injury is heavy while external contraction is light; the exogenous pathogen only invades the San Jiao (Triple Burner). Since the color associated with the San Jiao is white, the throat appears white. Therefore, in the formula, dispersing agents are used sparingly; even small amounts of Bohe (Menthae Haplocalycis Herba, 薄荷) and Lianqiao (Forsythiae Fructus, 连翘) are sufficient to expel the pathogen. In contrast, Lan Hou Sha is originally Yang Du from the *Shang Han Lun*, containing pestilential toxic qi. In the initial stage, heavy use of dispersing agents is appropriate, but they must be acrid-cool dispersants, never acrid-warm ones. Moreover, heavy use of cooling medicines should be employed as adjuvants. This summarizes the general principles for treating throat disorders.
Having practiced clinically for decades, I know that throat disorders often present with many variations. Here, I record two cases in detail for reference.
While residing in my hometown, a boy surnamed Liu, over ten years old, suffered from swollen and painful throat, chest fullness and obstruction. During severe episodes, breathing would suddenly cease, eyes would roll upward, and the body would arch backward. However, the reason for the sudden cessation of breathing was not blockage of the throat itself, but rather a sensation of blockage in the chest and diaphragm. His pulse was fine, thin, and slow. He often felt coldness in his chest and diaphragm; sometimes this coldness would rush upward, causing inability to breathe and manifesting as eye-rolling and body-arching. Based on the pulse and symptoms, I determined this was undoubtedly Cold Phlegm Binding in the Chest (Han Tan Jie Xiong). The swelling and pain in his throat were caused by cold phlegm overflowing in the Upper Jiao, forcing the Yang Qi of the Heart and Lungs to float upward. I prescribed a formula consisting of 1 liang of finely powdered Sheng Zhe Shi (Hematitum, 生赭石), 3 qian each of Gan Jiang (Zingiberis Rhizoma, 干姜) and Wu Fu Zi (Aconiti Lateralis Radix Praeparata, 乌附子), and 1.5 qian each of Hou Po (Magnoliae Officinalis Cortex, 厚朴) and Chen Pi (Citri Reticulatae Pericarpium, 陈皮).
After one dose decocted and taken, the chest felt immediately open, and the throat swelling and pain decreased significantly. After two more doses, he was completely cured.
Sun XX from Fengtian, aged twenty, contracted a throat disorder. Multiple treatments involved modifications of formulas from *Bai Hou Ji Biao Jue Wei*, yet the condition worsened daily. Physicians declared it incurable. Upon my examination, his pulse was fine, weak, and rapid, with excessive sticky saliva filling his mouth within moments, which he then spat out. I diagnosed this as deficiency of both Spleen and Kidney. Kidney deficiency leads to failure of Qi transformation to control fluids, causing Yin Fire to rebel and Phlegm-Fluids to flood upward. Meanwhile, Spleen Earth deficiency fails to control these fluids (if Spleen Earth were not deficient, it would not only control the flooding of Phlegm-Fluids but also restrain the rebellion of Yin Fire). Consequently, his throat swelled and pained, accompanied by such excessive sticky saliva. I administered Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) modified with Yu Zhu (Atractylodis Macrocephalae Rhizoma, 于术) and a small amount of Su Zi (Perillae Fructus, 苏子). After ten consecutive doses, he was fully recovered.