（附乳蛾、悬痈、杨梅疮）
丹溪先生云∶咽痛属血虚，用四物加竹沥。阴虚火上炎者，必用玄参；气虚加人参、竹
又云∶咽喉肿痛有阴虚阳气飞越，痰结在上者，脉必浮大，重取必涩，去死为近。宜人参一
味，浓煎，细细饮之，如作实症治之，祸在反掌。此发前人未发，救无穷之夭枉。余更以上
焦风热积热，及膀胱阴虚等症，一二于后云云。
治验
通府李朝用，咽喉肿痛，口舌生疮。此上焦风热，先用荆防败毒散二剂，喉痛渐愈。又
地官黄北盘喉痛，作渴饮冷，大便不通，此上下表里实热。用防风通圣散，治之顿愈。
地官胡诚甫，咽喉燥痛，此肾经膀胱虚热。用四物，加黄柏、知母、玄参，四剂少愈。更以人参固本丸，一剂不复
发。
职方卢抑斋，咽喉肿痛，两目蒙昧，小便赤涩，此膀胱湿热。用四苓散加黄柏、黄连、
知母、茵 、防己，治之而顿愈。又用六味地黄丸而痊。
儒者王文远，咽喉肿痛，口舌生疮，劳则愈甚，余谓脾肺气虚，膀胱有热。以补中益气
加玄参、酒炒黑黄柏、知母稍愈，乃去黄柏、知母，加山茱萸、山药乃瘥。
一儒者年逾五十，咽喉痛服凉药，或过劳痛愈甚，此中气虚热。以补中益气，加炒黑芩
、连，四剂而愈，乃去芩、连，又数剂痊愈。
一儒者脚发热，则咽喉作痛，内热口干，痰涎上涌。此肾经亏损，火不归经。用补中益
气加麦门、五味，及加减八味丸而痊愈。
一老人咽喉痛，小便数而赤，日晡尤甚，此膀胱阴虚，当滋化源。以补中益气加酒炒黑
黄柏、知母二味，四剂咽痛稍可，乃去二味加以山茱、山药、麦门、五味，顿愈。
一男子咽喉肿痛，药不能下，针患处出紫血少愈，以破棺丹噙化，更用清咽利膈散而愈
一男子素善饮，咽喉作痛，内热作渴，小便不利，饮食如常。此膀胱积热，用四苓散，
加茵 、大黄，四剂诸症渐退。又用清心莲子饮而安。
一星士，劳而入房，喉痛渐闭，痰涎上涌，四肢乍热。此阴虚阳气飞扬。用补中益气加
宪副姜时川，癸卯冬就诊于予，右寸浮数有力，口中有疮。余曰∶此胃火传于肺也，
滋味慎起居。甲辰秋复就诊，尺脉洪数而无力。余曰∶此肺金不能生肾水，宜静养以滋化源
。彼云∶今喉间及耳内，不时燥痛，肢体不时发热，若无根之火殒无疑矣。后谓刘古峡云∶
立斋谓我之病可疑。至乙巳孟春。古峡谓余曰∶姜公之病已如尊料。遂同余往视，喉果肿溃
脉愈洪大，或用泻火之药反速其殁。
云间吴上舍年逾五十，咽喉肿痛，或针出血，神思虽清，尺脉洪数，而无伦次，按之细
微如无。余曰∶有形而无痛，阳之类也，当峻补其阴，今反伤其阴血必死，已而果殁。盖此症乃
肾气亏损，无根之火炎上为患，惟加减八味丸料煎服，使火归源，庶几可救。
府庠归云桥之内，产后患喉痛，服清热等剂益甚。余诊之，属膀胱经血虚也，盖膀胱之
内脉上行，至颈而还，用八珍汤加牡丹皮、柴胡、酒炒黑黄柏，二剂而愈。
嘉靖辛丑仲秋，大方凭几执笔就书，咽喉间偶有痰涎，遂左顾吐之，以未及合而颈骨如
摧，莫能转视，至夜增剧，潜发盗汗，手足麻冷，卧起必藉人扶持，稍动则痛连心腹，苦楚万状
，不可胜数，如是者三四日。得立斋先生视之曰∶此怒动肝火，胆得火而筋挛缩。以六味地
黄丸料加山栀、柴胡，以清肝火生胆血。一剂未竟日，而谈笑举动，一一如常矣。接见宾从
，俱以为前日之病者罔也，先生之神妙，类多如此。惜乎，不肖疏怠蹇拙，不能尽述。姑以
其亲视者，笔之以为明验耳。吴门晚学生沈大方履文再顿首谨书。
一妇人喉间作痛，两月后而溃，遍身筋骨作痛，余以为杨梅疮毒，先以萆 汤，数剂而
平，更以四物加萆 、黄 二十剂，诸症悉退。
一弥月小儿，口内患之，后延遍身，年余不愈。以萆 为末，乳汁调服，母以白汤调服
，月余而愈。余见《保婴粹要》。
一男子先患喉痛，复发杨梅疮。用轻粉等剂，愈而复发，仍服前药，后又大发，上 溃
烂，与鼻相通，臂腕数颗，其状如桃，大溃，年余不敛，虚症悉见。余以萆 汤为主，兼以健脾
之剂，月余而安。余见《外科枢要》。
丹溪先生说：咽痛属于血虚，使用四物汤加竹沥。阴虚导致火气上炎的患者，必须用玄参；气虚则加入人参、竹沥。
他又说：咽喉肿痛若因阴虚导致阳气飞越，且痰结于上部，脉象必然浮大，重按则涩，这是接近死亡的征兆。适宜用人参一味药，浓煎后细细饮用。如果当作实证来治疗，灾祸就在反掌之间。这是阐发了前人未曾发现的理论，能拯救无数无谓的死亡。我在此基础上，进一步论述上焦风热积热，以及膀胱阴虚等病症，如下所述。
医案记录
通府李朝用，咽喉肿痛，口舌生疮。这是上焦风热，先用荆防败毒散两剂，喉痛逐渐痊愈。
地官黄北盘，咽喉痛，口渴想喝冷水，大便不通，这是上下表里实热证。用防风通圣散治疗，顿时痊愈。
地官胡诚甫，咽喉干燥疼痛，这是肾经和膀胱的虚热。用四物汤，加黄柏、知母、玄参，四剂后稍见好转。接着服用人参固本丸，一剂后不再复发。
职方卢抑斋，咽喉肿痛，两眼昏蒙，小便赤涩，这是膀胱湿热证。用四苓散加黄柏、黄连、知母、茵陈、防己，治疗而顿时痊愈。后又服用六味地黄丸而完全康复。
儒者王文远，咽喉肿痛，口舌生疮，劳累后加重。我认为这是脾肺气虚，膀胱有热。用补中益气汤加玄参、酒炒黑黄柏、知母，稍见好转，于是去掉黄柏、知母，加入山茱萸、山药，病才痊愈。
一位年过五十的儒者，咽喉痛时服用凉药，或过度劳累后疼痛加剧，这是中气虚热。用补中益气汤，加炒黑的黄芩、黄连，四剂后痊愈，于是去掉黄芩、黄连，又服数剂彻底痊愈。
一位儒者脚发热时，咽喉就作痛，伴有内热口干，痰涎上涌。这是肾经亏损，火不归经。用补中益气汤加麦门冬、五味子，以及加减八味丸，从而痊愈。
一位老人咽喉痛，小便频数且色赤，傍晚时分尤其严重，这是膀胱阴虚，应当滋生化之源。用补中益气汤加酒炒黑黄柏、知母两味药，四剂后咽痛稍减，于是去掉这两味药，加上山茱萸、山药、麦门冬、五味子，顿时痊愈。
一名男子咽喉肿痛，药物无法咽下，针刺患处流出少量紫血后稍有好转，用破棺丹含化，再用清咽利膈散治疗而痊愈。
一名男子平时喜欢饮酒，咽喉作痛，内热口渴，小便不利，但饮食如常。这是膀胱积热，用四苓散，加茵陈、大黄，四剂后诸症逐渐消退。又用清心莲子饮而安定。
一位星士，劳累后行房事，喉痛逐渐闭塞，痰涎上涌，四肢忽冷忽热。这是阴虚阳气飞扬。用补中益气汤加……
宪副姜时川，癸卯年冬天在我这里就诊，右寸脉浮数有力，口中有疮。我说：这是胃火传于肺，要注意节制滋味和起居。甲辰年秋天再次就诊，尺脉洪数而无力。我说：这是肺金不能生肾水，宜静养以滋生化之源。他说：现在喉间及耳内不时燥痛，肢体不时发热，这肯定是无根之火导致的死亡无疑了。后来他对刘古峡说：立斋认为我的病情可疑。到了乙巳年初春，古峡对我说：姜公的病已经像您预料的那样了。于是同我去诊视，喉部果然肿胀溃烂，脉象更加洪大，如果用泻火的药反而会加速他的死亡。
云间吴上舍年过五十，咽喉肿痛，有时针刺出血，神思虽然清醒，但尺脉洪数而无伦次，按之细微如无。我说：有形而无痛，属于阳证的类别，应当峻补其阴，如今反而损伤其阴血必死无疑，后来果然死亡。这个病症乃是肾气亏损，无根之火炎上为患，只有用加减八味丸料煎服，使火归源，或许可以挽救。
府庠归云桥的妻子，产后患喉痛，服用清热等药剂反而加重。我诊察她，属于膀胱经血虚证，因为膀胱经脉上行至颈部而回还，用八珍汤加牡丹皮、柴胡、酒炒黑黄柏，两剂后痊愈。
嘉靖辛丑年仲秋，大方凭几执笔写信时，咽喉间偶有痰涎，于是向左看并吐痰，因来不及合拢嘴巴而导致颈骨如摧折般疼痛，不能转头视物，到夜晚病情加重，暗中盗汗，手足麻木冰冷，卧起必须依靠人扶持，稍微活动则痛连心腹，痛苦万状，不可胜数，如此持续了三四天。得到立斋先生诊视说：这是怒动肝火，胆得火而筋挛缩。用六味地黄丸料加山栀、柴胡，以清肝火生胆血。一剂药还没吃完一天，谈笑举动就一切如常了。接待宾客随从，大家都以为前一天生病的人不是他一样，先生的神妙，大多如此。可惜我不肖疏怠笨拙，不能完全记述。姑且将亲自目睹的情况记录下来，作为明证罢了。吴门晚学生沈大方履文再顿首谨书。
一名妇人喉间作痛，两个月后溃烂，遍身筋骨作痛，我认为是杨梅疮毒，先用萆薢汤，数剂后平复，再用四物汤加萆薢、黄芪二十剂，诸症全部消退。
一名满月的婴儿，口腔内患病，后来蔓延至全身，一年多不愈。用萆薢研末，乳汁调服，母亲用白开水调服，月余而愈。我见于《保婴粹要》。
一名男子先患喉痛，又发杨梅疮。用轻粉等药剂，好了又复发，仍服前药，后来又大发，上面溃烂，与鼻子相通，手臂手腕处有几颗，形状如桃，大溃烂，一年多不愈合，虚症全现。我以萆薢汤为主，兼用健脾的药剂，月余而安。我见于《外科枢要》。
(Attached: Mutton-bean-shaped Swelling [Ru E], Suspended Abscess [Xuan Yong], Syphilis [Yang Mei Chu])
Mr. Danxi stated: Sore throat belongs to Blood deficiency; use Siwu Tang (Four Substances Decoction) with Bamboo Sap (Zhuli). For patients where Yin deficiency causes Fire to flare upward, Xuan Shen (Scrophulariae Radix) must be used; for Qi deficiency, add Ren Shen (Ginseng Radix et Rhizoma) and Zhuli (Bamboo Sap).
He also said: In cases of sore throat and swelling due to Yin deficiency causing the departure of Yang Qi, with Phlegm knotting in the upper jiao, the pulse will necessarily be floating and large; upon heavy pressure, it will be choppy, indicating proximity to death. It is appropriate to use a single ingredient, Ren Shen (Ginseng Radix et Rhizoma), decocted strongly, and drunk slowly. If treated as an Excess syndrome, disaster will follow in the turning of a hand. This elucidates theories not previously discovered by predecessors, saving countless lives from premature death. I further discuss symptoms such as Wind-Heat accumulation in the Upper Jiao, and Bladder Yin deficiency, as follows.
Clinical Cases
Li Chaoyong of Tongfu suffered from sore throat and swelling, with sores on the mouth and tongue. This was Wind-Heat in the Upper Jiao. Initially, Jingfang Baidu San (Atractylodes and Saposhnikovia Powder to Expel Toxins) was administered for two doses, after which the throat pain gradually healed.
Huang Beipan, a Di Guan (official title), suffered from sore throat, thirst with a desire for cold drinks, and constipation. This was an Excess Heat syndrome affecting both interior and exterior, upper and lower. Fangfeng Tongsheng San (Saposhnikovia Powder to Unblock the Intestines) was used, resulting in immediate recovery.
Hu Chengfu, a Di Guan, suffered from dry and painful throat. This was Deficient Heat in the Kidney and Bladder meridians. Siwu Tang (Four Substances Decoction) was used, added with Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), and Xuan Shen (Scrophulariae Radix). After four doses, there was slight improvement. Subsequently, Renshen Guben Wan (Ginseng Root-Nourishing Pill) was taken for one dose, preventing recurrence.
Lu Yizhai, a Zhifang (official title), suffered from sore throat and swelling, blurred vision, and red, difficult urination. This was Damp-Heat in the Bladder. Siling San (Four Poria Powder) was used, added with Huang Bo (Phellodendri Cortex), Huang Lian (Coptidis Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Yin Chen (Artemisiae Scopariae Herba), and Fang Ji (Stephaniae Tetrandrae Radix), resulting in immediate recovery. He was then cured completely by taking Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).
Wang Wenyuan, a Confucian scholar, suffered from sore throat and swelling, with sores on the mouth and tongue, worsening with fatigue. I diagnosed Spleen and Lung Qi deficiency with Heat in the Bladder. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with Xuan Shen (Scrophulariae Radix), Jiu Chao Hei Huang Bo (Wine-fried Blackened Phellodendri Cortex), and Zhi Mu (Anemarrhenae Rhizoma), leading to slight improvement. Then, Huang Bo and Zhi Mu were removed, and Shanzhuyu (Corni Fructus) and Shanyao (Dioscoreae Rhizoma) were added, leading to recovery.
A Confucian scholar over fifty years old experienced worsening throat pain when taking cooling medicines or overexerting himself. This was Deficient Heat in the Middle Qi. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with fried black Huang Qin (Scutellariae Radix) and Lian Zi (Nelumbinis Semen), curing him in four doses. Then, Huang Qin and Lian Zi were removed, and several more doses led to complete recovery.
A Confucian scholar experienced throat pain when his feet felt hot, accompanied by internal heat, dry mouth, and surging saliva. This was Kidney Meridian depletion with Fire failing to return to its source. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with Mai Men Dong (Asparagi Radix) and Wu Wei Zi (Schisandrae Chinensis Fructus), along with Jiawei Bawei Wan (Modified Eight-Ingredient Pill), resulting in recovery.
An elderly man suffered from sore throat, frequent and red urination, worsening in the late afternoon. This was Bladder Yin deficiency, requiring nourishment of the generating source. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with Jiu Chao Hei Huang Bo (Wine-fried Blackened Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma). After four doses, the throat pain subsided slightly. Then, these two herbs were removed, and Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Mai Men Dong (Asparagi Radix), and Wu Wei Zi (Schisandrae Chinensis Fructus) were added, leading to immediate recovery.
A male patient suffered from sore throat and swelling, unable to swallow medicine. Acupuncture at the affected site released a small amount of purple blood, providing slight relief. Po Guan Dan (Resurrection Coffin Pill) was held in the mouth to dissolve, followed by Qingyan Ligai San (Throat-Clearing and Diaphragm-Unblocking Powder), leading to recovery.
A male patient who habitually drank alcohol suffered from sore throat, internal heat, thirst, and difficult urination, while his appetite remained normal. This was accumulated Heat in the Bladder. Siling San (Four Poria Powder) was used, added with Yin Chen (Artemisiae Scopariae Herba) and Da Huang (Rhei Radix et Rhizoma). After four doses, all symptoms gradually receded. He was then stabilized by Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Drink).
An astrologer, after exertion and sexual intercourse, suffered from progressively closing throat pain, surging saliva, and alternating hot limbs. This was Yin deficiency with flying Yang Qi. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used...
Jiang Shichuan, Vice Commissioner, consulted me in winter of the Gui-Mao year. His Right Cun pulse was floating, rapid, and forceful, with sores in the mouth. I said: This is Stomach Fire transmitting to the Lung. He should be cautious with flavors and daily routine. In autumn of the Jia-Chen year, he consulted again; his Chi pulse was flooding, rapid, and powerless. I said: This is Lung Metal failing to generate Kidney Water. He should rest quietly to nourish the generating source. He said: Now my throat and ears are frequently dry and painful, and my limbs frequently feel hot; this is undoubtedly death caused by rootless Fire. Later, he told Liu Guxia: Lizai considers my condition suspicious. In early spring of the Yi-Si year, Guxia told me: Lord Jiang's condition has become exactly as you predicted. We went together to examine him; his throat was indeed swollen and ulcerated, and his pulse became even more flooding. Using Fire-draining medicines would have only accelerated his death.
Wu Shangshe from Yunjian, over fifty years old, suffered from sore throat and swelling. Sometimes bleeding was induced by acupuncture. Although his spirit was clear, his Chi pulse was flooding and rapid without order, and fine/deep upon pressure, feeling almost non-existent. I said: Form present but no pain indicates a Yang category. One should vigorously tonify Yin. However, injuring Yin Blood now leads to certain death. He subsequently died. This condition was Kidney Qi depletion with rootless Fire flaring upward. Only Jiawei Bawei Wan (Modified Eight-Ingredient Pill) decocted and taken could potentially save him by returning Fire to its source.
The wife of Gui Yunqiao, a government school student, suffered from postpartum sore throat, which worsened with cooling agents. My diagnosis indicated Bladder Meridian Blood deficiency. Since the Bladder meridian ascends to the neck and returns, Bazhen Tang (Eight-Treasure Decoction) was used, added with Mudan Pi (Moutan Cortex), Chai Hu (Bupleuri Radix), and Jiu Chao Hei Huang Bo (Wine-fried Blackened Phellodendri Cortex). She recovered in two doses.
In mid-autumn of the Xin-Chou year during the Jiajing reign, Dafang was writing a letter at his desk. Occasional phlegm in his throat prompted him to look left and spit. Because he did not close his mouth in time, his cervical bone felt as if crushed, rendering him unable to turn his head. The condition worsened at night, with nocturnal sweating, numbness and coldness in hands and feet, requiring support to rise and lie down. Any slight movement caused pain radiating to the heart and abdomen, unbearable suffering lasting three or four days. Mr. Lizai examined him and said: This is Liver Fire stirred by anger, causing Gallbladder sinews to spasm and contract due to Fire. Liuhuang Dihuang Wan (Six-Ingredient Pill with Rehmannia) material was used, added with Shan Zhi (Gardeniae Fructus) and Chai Hu (Bupleuri Radix), to clear Liver Fire and generate Gallbladder Blood. Before one dose was finished within a day, his conversation and movements returned to normal. Guests and followers were amazed, thinking the sick person from the previous day was someone else. The master's miraculous efficacy was often like this. Alas, I am unworthy, negligent, and clumsy, unable to record everything fully. I merely record what I witnessed personally as clear evidence. Shen Dafang, junior student of Wumen, bows twice and respectfully writes.
A female patient suffered from throat pain, which ulcerated after two months, accompanied by pain throughout the bones and sinews. I considered it Syphilis toxin. First, Bibi Tang (Smilacis Glabrae Decoction) was administered for several doses to calm the condition. Then, Siwu Tang (Four Substances Decoction) was used, added with Bi Xi (Smilacis Glabrae Rhizoma) and Huang Qi (Astragali Radix) for twenty doses, resolving all symptoms.
A one-month-old infant suffered from oral lesions that later spread to the whole body, persisting for over a year without healing. Bi Xi (Smilacis Glabrae Rhizoma) was powdered and taken with breast milk. The mother took it mixed with plain water. Recovery occurred within a month. I recorded this in *Baoying Cuiyao*.
A male patient first suffered from sore throat, then developed Syphilis. He used Calomel (Qing Fen) and other agents; the condition improved but relapsed. Taking the previous medicines again caused a severe outbreak, with upper ulcers communicating with the nose, and several nodules on arms and wrists resembling peaches, severely ulcerated and unhealed for over a year, presenting full deficiency symptoms. I primarily used Bibi Tang (Smilacis Glabrae Decoction), combined with Spleen-strengthening agents, achieving stability within a month. I recorded this in *Waike Shuyao*.