罗谦甫治征南元帅不邻吉歹。年七旬。春间东征。南回至楚邱。因过饮。腹痛肠鸣自利
日夜约五十余行。咽嗌疼痛。耳前后赤肿。舌本强。涎唾稠粘。欲吐不能出。以手曳之方
出。言语艰难。反侧闷乱。夜不能卧。罗诊得脉浮数。按之沉细而弦。即谓中丞粘公曰。仲
景云。下利清谷。身体疼痛。急当救里。后清便自调。急当救表。救里四逆汤。救表桂枝汤
总帅今胃气不守。下利清谷。腹中疼痛。虽宜急治之。比之嗌咽。犹可少缓。公曰。何谓
也。答曰。内经云。疮发于咽嗌。名曰猛疽。此病治迟则塞咽。咽塞则气不通。气不通则半
日死。故宜急治。于是遂砭刺肿上。紫黑血出。顷时肿势大消。遂用桔梗、甘草、连翘、鼠
粘子、酒黄芩、升麻、防风等分。每服约五钱。水煎清。令热漱之。冷吐出之。咽下恐伤脾
胃。自利转甚。再服涎清肿散。声出。后以神应丸辛热之剂以散中寒。解化宿食而燥脾湿。
丸者。取其不即施行。则不犯其上焦。至其病所而后化。乃治主以缓也。不数服。利止痛定
后胸中闭塞。作阵而痛。复思灵枢有云。上焦如雾。宣五谷味。熏肤充身泽毛。若雾露之
溉。是为气也。今公年高气弱。自利无度。致胃中生发之气。不能滋养于心胃。故闭塞而痛
经云。上气不足。推之扬之。脾不足者。以甘补之。用异功散甘辛微温之剂温养脾胃。加
升麻、人参。上升以顺正气。不数服而胸快。利痛止。内经云。调气之方。必别阴阳。内者
内治。外者外治。微者调之。其次平之。胜者夺之。随其攸利。万举万全。又曰。病有远近
治有缓急。毋越其制度。又曰。急则治其标。缓则治其本。此之谓也。
震按一人之病而有寒热两岐者。当分缓急后先施治。此案即是成例。断勿学混沌汤作一
纲兜之计也。但凉解药漱而弗咽。恐亦无益。其涎清肿散者。想得力于砭刺耳。然今之喉证
用刀者往往受害。此又气运及风土俱有不同所致。
〔附〕杨立之自广府通判归楚州。喉间生痈。既肿溃而脓血流注。日夕不止。寝食俱废
医生束手。适杨吉老赴郡。二子邀之至。熟视良久曰。不须看脉。已知之。然此疾甚异。
须
先啖生姜片一斤。乃可投药。否则无法也。语毕即出。其子有难色。曰。喉中溃脓痛楚。岂
能食生姜。立之曰。吉老医术通神。其言不妄。试取一二片啖我。如不能进。屏去无害。遂
食之。初时殊为甘香。稍复加至半斤许。痛处已宽。满一斤。始觉味辛辣。脓血顿尽。粥食
入口。了无滞碍。明日。招吉老谢而问之。曰。君官南方。多食鹧鸪。此禽好啖半夏。久而
毒发。故以姜制之。今病源已清。无服他药。
一人咽喉间生肉。层层相叠。渐渐肿起。有窍出臭气。用臭橘叶煎服而愈。
一人但饮食。若别有一咽喉。斜过膈下。径达左胁。而作痞闷。以手按之。则沥沥有声
以控涎丹十粒服之。少时痞处热。作一声。转泻下痰饮二升。再食正下而达胃矣。
江应宿治一人。悬中下而赤。皆以为热。遍施凉药不效。此中气虚。用补中益气而愈。
马铭鞠治倪仲昭。患喉癣。邑中治喉者遍矣。喉渐渐腐去。饮食用粉面之烂者。必仰口
而咽。每咽。泣数行下。马曰。此非风火毒也。若少年曾患霉疮乎。曰未也。父母曾患霉疮
乎。曰。然。愈三年而得我。马以为此。必误服升药之故。凡患此疮者。中寒凉轻粉之毒。
毒发于身。升药之毒。毒发于愈后所生子女。毒深者且延及于孙若甥。倘不以治结毒之法治
之。必死。以甘桔汤为君。少入山豆根、龙胆草、射干。每剂用土茯苓半斤浓煎。送下牛黄
二分。半月而痊。竟不用吹药。后询知伊芳父母。果服升药愈。愈后曾口碎。故遗毒如此之烈
也。
景岳治一来宅女人。年近三旬。患虚损。更兼喉癣疼痛。多医罔效。张诊其脉。则数而
无力。察其证。则大便溏泄。问其治。则皆退热清火之剂。然愈清火而喉愈痛。因知其本非
实火。而且多用寒凉。以致肚腹不实。总亦格阳之类也。遂专用理阴煎及大补元煎之类。出
入间用。不半月而喉痛减。不半年而病全愈。
又治王蓬雀。年出三旬。患喉痹。十余日。头面浮大。喉颈粗极。气急声哑。咽肿口疮
痛楚之甚。一婢倚背。坐而不卧者累日矣。及察其脉。则细数微弱之甚。问其言。则声微
似不能振者。询其所服之药。则无非芩、连、知、柏之属。此盖以伤阴而起。而复为寒凉所
逼。以致寒盛于下。而格阳于上。即水饮之类俱已难入。而尤畏烦热。张曰危哉。再迟半日
必不救矣。遂与镇阴煎。以冷水顿冷。徐徐使咽之。用毕一煎。过宿而头项肿痛尽消如失
继进五福饮。数剂而起。
震按古人喉证案无甚佳者。以上数条。亦取其不同者而选之。王蓬雀案治法最佳。然此
人能受温补。故一剂即效。亦有投以温补而不效者。即阳证阴脉之死候也。未可谓景岳之法
概能活人。余乡有戚许君。初起外感发热。继则左耳门生小疖。溃腐。认为 耳。敷以药。
溃腐不退。通耳肿赤。延及头面皆肿赤。痛极汗大出。身热反得凉。颇能进食。似觉稍安。
越
三日。忽又发热。左耳前后连头面肿痛更甚。渐神昏谵语。盖因连日出门登厕。复受风邪所
致。内外科皆以脉小而数。按之无力。虑其虚陷。余友李昆阳兄至。曰。是为耳游风。非致
命之疮。重复冒风。故现险象。外敷以药。内用大剂风药散之。而肿痛与身热俱退。惟神昏
谵语不减。两日后。昏谵更甚。汤粥入口即吐。手足厥冷。呃逆不止。势又危极。李以箸抉
其
口视之。则咽喉腐烂。悬雍赤紫肿大。如茄子下坠。脉仍细数。右手尤软。乃曰。连日不食
胃气大虚。故呕且呃。命以白米三升。大锅煮粥。取锅面团结之粥油与食。遂纳而不吐。
复用药搅洗喉间之腐秽。随以石膏四五两。竹叶一大把。煎汤与漱。且服。服竟夜。神昏稍
醒。呃止厥回。又进大剂芩、莲、白虎、栀、翘等药。数日得愈。此与景岳之案冰炭相反。
因思凡为医者。读古人书。断不可执其一说。自以为是也。
罗谦甫治疗征南元帅不邻吉歹。患者七十岁。春季随军东征，从南方返回至楚邱时，因饮酒过量，出现腹痛、肠鸣、自发性腹泻，日夜约五十余次。咽喉疼痛，耳前耳后红肿，舌根僵硬，唾液稠粘，想吐却吐不出来，用手拉扯才吐出，言语困难，身体翻侧不安、烦闷混乱，夜间无法入睡。罗谦甫诊察发现脉象浮数，重按则沉细而弦。随即对中丞粘公说：“张仲景说过：‘下利清谷（腹泻排出未消化的食物），身体疼痛，应当紧急救治里证；待大小便恢复正常后，再紧急救治表证。’救治里证用四逆汤，救治表证用桂枝汤。现在总帅胃气不能固守，下利清谷，腹中疼痛，虽然应该紧急治疗，但比起咽喉的病症，还可以稍微延缓。”粘公问：“这是什么意思？”罗谦甫回答说：“《内经》说：‘疮疡发于咽喉，名叫猛疽。’这个病如果治疗迟缓，就会堵塞咽喉，咽喉堵塞则气机不通，气机不通半天内就会死亡。所以应该紧急治疗。”于是用砭石刺破肿胀处，流出紫黑色的血，片刻之间肿势大大消退。随后使用桔梗、甘草、连翘、鼠粘子（牛蒡子）、酒黄芩、升麻、防风等量，每服约五钱，水煎取清液，令患者热漱，冷却后吐出，咽下恐怕损伤脾胃，导致腹泻更加严重。再次服用后，唾液变清，肿势消散，声音发出。后来用神应丸这种辛热的药物来散除中焦寒邪，化解宿食并燥化脾湿。制成丸剂，是取其作用缓慢，不立即作用于上焦，到达病灶部位后再发挥作用，这是以缓治主症的方法。服药不多几次，腹泻停止，疼痛安定。之后胸中闭塞，阵发性疼痛。又想到《灵枢》说：“上焦如雾，宣发五谷的精微气味，熏蒸皮肤，充实身体，润泽毛发，像雾露灌溉一样，这就是气。”现在这位先生年高气弱，无节制地腹泻，导致胃中生发之气，不能滋养心胃，所以闭塞而痛。《内经》说：“上气不足，推引它，扬举它。”“脾不足的，用甘味补益它。”于是使用异功散这种甘辛微温的药物温养脾胃，加入升麻、人参，提升上升以顺应正气。服药不多几次，胸部畅快，腹泻和疼痛停止。《内经》说：“调理气机的方剂，必须辨别阴阳。在内者用内治法，在外者用外治法。病轻的调理它，其次平复它，邪盛的攻夺它。顺着其有利的方向，万举万全。”又说：“病有远近之分，治疗有缓急之别，不要超越常规制度。”又说：“急则治其标，缓则治其本。”说的就是这种情况。
俞震按语：一个人的病却有寒热两种分歧的情况，应当分清缓急先后进行治疗。这个医案就是成功的先例。千万不要学那碗混沌汤那样，用一个纲领包揽所有情况。但是，用凉性解表药漱口而不吞咽，恐怕也没有益处。他的唾液变清、肿势消散，想来得力于砭刺疗法。然而现在治疗喉证用刀的人往往受害，这又是运气及风土气候不同所致。
〔附〕杨立之从广府通判职位回到楚州，喉咙间生痈，已经肿胀溃烂，脓血流注，日夜不停，寝食俱废。医生束手无策。恰逢杨吉老赴郡城，杨立之的两个儿子邀请他到家中。杨吉老仔细看了很久，说：“不需要把脉，我已经知道了。但这病非常奇异，必须先吃一斤生姜片，然后才可以给药。否则没有办法。”说完就出去了。杨立之的儿子面露难色，说：“喉咙中溃烂流脓疼痛，怎么能吃生姜呢？”杨立之说：“吉老医术通神，他的话不会虚假。试着拿一两片给我吃。如果不能进食，扔掉也没关系。”于是吃了下去。起初觉得特别香甜，稍后又加到半斤左右，痛处已经宽松，吃完一斤，才开始觉得味道辛辣，脓血顿时干净，粥食入口，毫无阻碍。第二天，请杨吉老道谢并询问原因，杨吉老说：“您在南方做官，多吃鹧鸪。这种鸟喜欢吃半夏，久而久之毒性发作，所以用姜来制约它。现在病源已清除，无需服用其他药物。”
另一人咽喉间长肉，层层相叠，渐渐肿起，有孔窍散发臭气，用臭橘叶煎服而痊愈。
另一人只感觉饮食时，好像另有一个咽喉，斜着穿过膈下，直达左胁，感到痞闷。用手按压，则有沥沥的水声。服用控涎丹十粒，不久痞闷处发热，发出一声响动，转而下泻痰饮二升，再进食则正常下行到达胃部了。
江应宿治疗一人，悬雍垂（小舌头）下部发红，大家都认为是热证，遍用凉药无效。这是中气虚，用补中益气汤治愈。
马铭鞠治疗倪仲昭，患喉癣，县里治疗喉科的医生都看遍了，喉咙渐渐腐烂脱落，饮食只能用烂的面粉，必须仰头吞咽，每次吞咽，眼泪直流。马铭鞠说：“这不是风火毒。您年轻时曾患过霉疮（梅毒）吗？”回答说：“没有。”“父母曾患过霉疮吗？”回答说：“是的。”“痊愈三年后得了这个病。”马铭鞠认为，这一定是误服升药（含汞药物）的缘故。凡是患这种疮的人，体内中了寒凉轻粉的毒，毒发于身上；升药的毒，毒发于痊愈后所生的子女。毒深的甚至延及孙辈和外甥。如果不按照治疗结毒的方法来治疗，必死无疑。以甘桔汤为主药，少量加入山豆根、龙胆草、射干，每剂用土茯苓半斤浓煎，送服牛黄二分。半个月痊愈，竟然不用吹药。后来询问得知他的父母，果然服用升药治愈，痊愈后曾口碎（口腔溃疡），所以遗毒如此猛烈。
张景岳治疗一来宅的一位女性，年纪近三十，患虚损，兼有喉癣疼痛，多位医生无效。张景岳诊察她的脉象，则数而无力，观察症状，则大便溏泄，询问治疗方法，都是退热清火的药剂。然而越清火喉咙越痛，因此知道她本来就不是实火，而且多用寒凉，导致腹部不实，总体也是格阳（真寒假热）之类的病症。于是专门使用理阴煎及大补元煎之类，交替使用，不到半个月喉咙痛减轻，不到半年病完全痊愈。
又治疗王蓬雀，年龄三十多岁，患喉痹，十多天，头面浮肿变大，喉颈极粗，气急声哑，咽喉肿痛口疮，痛苦至极。一个婢女靠在背上，坐着不能躺卧好几天了。等到诊察脉象，则细数微弱到了极点，询问说话，则声音微弱似乎不能振作，询问所服用的药物，无非是黄芩、黄连、知母、黄柏之类。这大概是因伤阴而起，又受到寒凉药物的逼迫，导致寒盛于下，而格阳于上。即喝水一类都已经难以进入，尤其畏惧烦热。张景岳说：“危险啊！再迟半天一定救不回来了。”于是给予镇阴煎，用冷水彻底冷却，慢慢让患者吞咽。用完一剂，过夜后头项肿痛全部消失如同失去。接着进服五福饮，几剂后起身。
俞震按语：古人治疗喉证的医案没有什么特别好的。以上几条，也是选取其中不同的案例。王蓬雀一案的治疗方法最佳，然而这个人能承受温补，所以一剂就见效。也有投以温补而无效的，那就是阳证阴脉的死候。不能说张景岳的方法都能救人。我家乡有个亲戚许君，初起外感发热，接着左耳门生小疖，溃烂，被认为是耳疔，敷以药物，溃烂不退，整个耳朵红肿，蔓延到头面皆红肿，痛极大汗出，身体发热反而得到凉爽，颇能进食，似乎觉得稍安。过了三天，忽然又发热，左耳前后连同头面肿痛更甚，逐渐神志昏迷胡言乱语。大概因为连续出门上厕所，再次受风邪所致。内科外科都认为脉小而数，按之无力，担心其虚陷。我的朋友李昆阳兄来到，说：“这是耳游风，不是致命的疮。重复冒受风邪，所以现出险象。”外用药物敷贴，内用大剂量风药发散，肿痛与身体发热都退了。只有神志昏迷胡言乱语不减。两天后，昏谵更甚，汤粥入口即吐，手足冰冷，呃逆不止，形势又危急至极。李昆阳用筷子撬开他的口查看，则咽喉腐烂，悬雍垂赤紫肿大，像茄子下垂。脉仍细数，右手尤其软弱。于是说：“连续几天不进食，胃气大虚，所以呕吐且呃逆。”命令用白米三升，大锅煮粥，取锅面凝结的粥油给他吃，于是纳入而不吐。再用药物搅洗喉间的腐秽，随即用石膏四五两，竹叶一大把，煎汤漱口，并且服用。服了一整夜，神志稍醒，呃逆停止，四肢回暖。又进服大剂量黄芩、黄连、白虎汤、栀子、连翘等药，数日得愈。这与张景岳的案例冰炭相反。由此思考，凡是作为医生，读古人的书，绝对不可固执于一种说法，自以为是。
Luo Qianfu treated Bulin Jidai, the Marshal of the Southern Expedition. The patient was seventy years old. In spring, during the eastern campaign, upon returning south to Chuqiu, he had consumed excessive alcohol, resulting in abdominal pain, borborygmus (intestinal rumbling), and spontaneous diarrhea, occurring approximately fifty times a day and night. He suffered from throat pain, redness and swelling in front of and behind the ears, stiffness of the tongue base, thick and sticky saliva, an urge to vomit but inability to do so unless manually pulled out by hand, difficulty speaking, restlessness with turning over, mental confusion, and inability to sleep at night. Luo Qianfu diagnosed the pulse as floating and rapid, but deep, fine, and wiry upon heavy pressure. He then said to Vice-Intendant Zhan: "Zhang Zhongjing stated: 'In cases of diarrhea with undigested food and body pain, one should urgently treat the Interior; once bowel movements normalize, one should urgently treat the Exterior.' To treat the Interior, use Sini Tang (Four Reversal Decoction); to treat the Exterior, use Guizhi Tang (Cinnamon Twig Decoction). Currently, the Commander's Stomach Qi is failing to secure itself, presenting with diarrhea of undigested food and abdominal pain. Although urgent treatment is indicated, compared to the throat condition, it can be slightly delayed." Zhan asked, "What do you mean?" Luo replied, "The Neijing states: 'A carbuncle arising in the throat is called Mengju (Fierce Carbuncle). If this disease is treated late, it will block the throat. Throat blockage leads to obstruction of Qi flow. Obstruction of Qi flow results in death within half a day.' Therefore, urgent treatment is required." Consequently, he used bian stone (stone lancet) to prick the swollen area, releasing dark purple-black blood. Within moments, the swelling significantly subsided. Subsequently, he prescribed equal parts of Jiegeng (Platycodon Root), Gancao (Licorice Root), Lianqiao (Forsythia Fruit), Niubangzi (Burdock Fruit), Jiu Huangqin (Wine-processed Scutellaria Root), Shengma (Cimicifuga Rhizome), and Fangfeng (Saposhnikovia Root). Each dose was approximately five qian, decocted in water to obtain a clear liquid. The patient was instructed to gargle while hot and spit it out when cool; swallowing was avoided to prevent damaging the Spleen and Stomach, which could worsen the diarrhea. After another dose, the saliva cleared, the swelling dissipated, and voice returned. Later, Shenying Wan (Miraculous Response Pill), a pungent-hot preparation, was used to disperse Cold in the Middle Jiao, resolve retained food, and dry Spleen Dampness. It was formulated into pills because their slow action avoids immediate impact on the Upper Jiao, allowing them to reach the lesion site before taking effect, thus treating the main condition with a缓 (slow/gentle) approach. After a few doses, the diarrhea stopped, and pain subsided. However, chest oppression followed by paroxysmal pain occurred. Recalling the Ling Shu: "The Upper Jiao is like mist, disseminating the essence of grains, steaming the skin, filling the body, and moistening hair and bristles, like fog and dew irrigation; this is Qi." Now, due to the patient's advanced age and weak Qi, coupled with uncontrolled diarrhea, the generating Qi of the Stomach fails to nourish the Heart and Stomach, causing obstruction and pain. The Neijing states: "When Upper Qi is insufficient, push and lift it." "For Spleen deficiency, tonify with sweet flavors." Thus, Yigong San (Extraordinary Power Powder), a sweet-pungent and slightly warm formula, was used to warm and nourish the Spleen and Stomach, augmented with Shengma and Renshen (Ginseng Root) to ascend and follow the righteous Qi. After a few doses, the chest felt comfortable, and diarrhea and pain ceased. The Neijing states: "Formulas for regulating Qi must distinguish Yin and Yang. Internal diseases are treated internally, external diseases externally. Mild cases are regulated, moderate cases balanced, severe cases subdued. Following what is beneficial ensures success in every attempt." It also says: "Diseases have distant and near origins; treatments have slow and urgent aspects. Do not exceed established protocols." It further states: "In emergencies, treat the Branch (symptoms); in stability, treat the Root (cause)." This refers to such situations.
Yu Zhen's commentary: When a single disease presents with both Cold and Heat divergences, one must distinguish urgency and sequence in treatment. This case serves as a precedent. One must never adopt a "one-size-fits-all" approach like Hun Tun Tang (Chaotic Soup). However, using cooling resolving herbs for gargling without swallowing may be ineffective. The clearing of saliva and reduction of swelling likely resulted from the bian stone therapy. Yet, modern practitioners using knives for throat conditions often suffer harm, attributed to differences in climate cycles and local geography.
[Appendix] Yang Lizhi, returning from his post as Vice-Prefect of Guangfu to Chuzhou, developed a carbuncle in the throat. It swelled, ulcerated, and discharged pus and blood continuously day and night, disrupting sleep and appetite. Physicians were helpless. Fortunately, Yang Jilao arrived in the commandery. Yang Lizhi's two sons invited him. After careful observation, Yang Jilao said, "No need to check the pulse; I already know. However, this disease is very unusual. You must first consume one jin (approx. 500g) of sliced ginger before administering medicine. Otherwise, there is no method." He then left. The sons looked troubled, saying, "With pus and blood discharging from the ulcerated throat and severe pain, how can he eat ginger?" Yang Lizhi said, "Jilao's medical skill is divine; his words are not false. Try giving me one or two slices. If I cannot swallow, discard them safely." He ate them. Initially, they tasted sweet and fragrant. As he consumed about half a jin, the pain eased. Upon finishing one jin, the taste became pungent and spicy, and the pus and blood cleared instantly. Porridge entered the mouth without obstruction. The next day, he thanked Yang Jilao and asked for the reason. Yang Jilao said, "While serving in the South, you ate much Partridge. This bird likes to eat Banxia (Pinellia Tuber). Over time, toxicity accumulates and manifests. Hence, Ginger is used to counteract it. The source of the disease is now cleared; no other medicine is needed."
Another patient had flesh growing in the throat, layer upon layer, gradually swelling, with orifices emitting foul odor. He was cured by decocting and drinking leaves of Chouju (Stink Orange Leaf).
Another patient felt that during swallowing, as if there were an additional throat slanting under the diaphragm to the left hypochondrium, causing distension and stuffiness. Pressing the area produced gurgling sounds. He took ten pills of Kongxian Dan (Phlegm-Draining Pill). Soon, heat arose in the distended area, followed by a sound, and he passed two sheng (approx. 1 liter) of phlegm-fluid stool. Subsequent food intake descended normally to the Stomach.
Jiang Yingsu treated a patient with redness below the uvula. All considered it Heat, and cooling medicines were applied ineffectively. This was Deficiency of Middle Qi, cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Ma Mingju treated Ni Zhongzhao, who suffered from Hou Xuan (Throat Herpes/Lichen). Local throat specialists had all been consulted. The throat gradually necrotized. Food had to be soft flour-based, swallowed only with the head tilted back. Each swallow brought tears. Ma said, "This is not Wind-Fire Toxicity. Did you suffer from Meichuang (Syphilis) in your youth?" The patient replied, "No." "Did your parents suffer from it?" "Yes." "You contracted it three years after their recovery." Ma believed this was due to accidental ingestion of Sheng Yao (Calomel/Corrosive Mercury Compound). Those suffering from this sore ingest Cold-cooling Calomel toxicity, manifesting on the body; Sheng Yao toxicity manifests in offspring born after recovery. Severe toxicity extends to grandchildren and nephews. Without treating it as a Condensed Toxicity case, death is certain. Ganjie Tang (Licorice and Platycodon Decoction) was used as the sovereign herb, with small amounts of Shandougen (Sophora Tonkinensis Root), Longdancao (Gentian Root), and Shegan (Belamcanda Rhizome). Each dose included Banxia Fuling (Polyporus with Earth Solanum, here referring to Tu Fuling/Smilax Glabra Rhizome) half a jin, decocted strongly, taken with Niu Huang (Calculus Bovis/Bovine Calculus) two fen. Recovery occurred in half a month without using throat powders. Inquiry revealed his parents indeed recovered from Syphilis using Sheng Yao, suffering oral ulcers post-recovery, hence the severe residual toxicity.
Zhang Jingyue treated a woman in the Lai residence, nearly thirty years old, suffering from Xu Sun (Deficiency Consumption) accompanied by Hou Xuan pain. Many physicians failed. Zhang diagnosed her pulse as rapid but forceless, observed loose stools, and noted previous treatments involved clearing Heat and Fire. The more Fire was cleared, the worse the throat pain became. He deduced it was not Excess Fire, but rather excessive Cold-Cooling herbs leading to abdominal laxity, resembling Ge Yang (Gridlock Yang/True Cold False Heat). He exclusively used Liyin Jian (Regulate Yin Decoction) and Dabu Yuansheng Tang (Great Tonification of the Source Decoction), alternating them. Within half a month, throat pain decreased; within half a year, full recovery.
He also treated Wang Pengque, aged over thirty, suffering from Hou Bi (Throat Bi/Obsstruction). For over ten days, the head and face swelled massively, the throat and neck became extremely thick, breathing was急促 (rapid/difficult), voice hoarse, and throat swelling with oral ulcers caused extreme pain. A maid supported her back; she sat upright for days without lying down. Pulse was extremely fine, rapid, and weak. Speech was faint. Medications taken were mainly Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Zhimu (Anemarrhena Rhizome), and Huangbai (Phellodendron Bark). This originated from Yin injury, exacerbated by Cold-Cooling herbs, causing Cold to prevail in the Lower Jiao and Gridlock Yang in the Upper Jiao. Even water was difficult to swallow, and she feared irritability and heat. Zhang said, "Dangerous! Delay by half a day, and rescue will be impossible." He prescribed Zhenyin Jian (Settle Yin Decoction), cooled thoroughly with cold water, and administered slowly. After one decoction, overnight, head and neck swelling vanished. Subsequently, Wufu Yin (Five Blessings Drink) was given for several doses, leading to recovery.
Yu Zhen's commentary: Ancient cases of throat diseases are not particularly excellent. The above cases were selected for their diversity. The Wang Pengque case has the best treatment method, but this patient could tolerate Warm-Tonification, hence the immediate effect. There are cases where Warm-Tonification fails, indicating a fatal prognosis of Yang Syndrome with Yin Pulse. One cannot claim Zhang Jingyue's methods always save lives. My hometown relative, Mr. Xu, initially had exterior contraction fever, followed by a small boil behind the left ear. Ulcerated and deemed Er Ding (Ear Carbuncle), it was dressed with medicine. Ulceration persisted, spreading redness and swelling to the entire ear and face. Extreme pain caused profuse sweating, body heat felt cool, appetite improved, and he seemed slightly better. Three days later, fever recurred, swelling and pain behind the left ear and face intensified, progressing to delirium and coma. Likely due to exposure to Wind pathogen after going out and using the toilet. Both internal and external specialists saw a small, rapid, forceless pulse, fearing deficiency collapse. My friend Brother Li Kunyang arrived, stating, "This is Er You Feng (Roaming Wind of the Ear), not a lethal sore. Repeated wind exposure caused these critical signs." External dressing and internal large-dose Wind-dispelling herbs reduced swelling, pain, and fever. Delirium persisted. Two days later, delirium worsened, vomiting all food/water, cold limbs, continuous hiccups, critical condition. Li pried open the mouth with chopsticks: throat necrosis, uvula red-purple and swollen like a hanging eggplant. Pulse still fine-rapid, right hand especially soft. He said, "Days of no food led to great Stomach Qi deficiency, causing vomiting and hiccups." He ordered three sheng of white rice cooked in a large pot, taking the congee oil (rice gruel surface film) to feed. Vomiting stopped. Throat necrosis was cleaned with medicated wash. Then, Shi Gao (Gypsum Fibrosum) four to five liang and Zhu Ye (Bambusa Leaves) a large handful were decocted for gargling and drinking. After a night, consciousness partially returned, hiccups stopped, limbs warmed. Large doses of Huangqin, Huanglian, Baihu Tang (White Tiger Decoction), Zhizi (Gardenia Fruit), and Lianqiao were administered. Recovery in several days. This contrasts sharply with Zhang Jingyue's case. It reminds us that physicians must not rigidly adhere to ancient texts or assume their own views are correct.