此病由肺肾气虚,风寒客之,令人颐颔粗肿,咽喉闭塞,汤药不下,死在须臾者,急灌黄药子散,吐出恶
涎而愈。此病轻者治肺,服姜附汤,灸天突穴五十壮亦好;重者服钟乳粉,灸关元穴,亦服姜附汤。
治验
一人患喉痹,痰气上攻,咽喉闭塞,灸天突穴五十壮,即可进粥,服姜附汤,一剂即愈,此治肺也。
一人患喉痹,颐颔粗肿,粥药不下,四肢逆冷,六脉沉细。急灸关元穴二百壮,四肢方暖,六脉渐生,
但咽喉尚肿,仍令服黄药子散,吐出稠痰一合乃愈,此治肾也。
一人患喉痹,六脉细,余为灸关元二百壮,六脉渐生。一医曰∶此乃热证,复以火攻,是抱薪救火也。遂
进凉药一剂,六脉复沉,咽中更肿。医计穷,用尖刀于肿处刺之,出血一升而愈。盖此证忌用凉药,痰见寒则
凝,故用刀出其肺血,而肿亦随消也。
(先生治肺治肾之法,千古卓见。况咽喉之证,风火为患,十有二三,肺肾虚寒,十有八九。喉科不明此
理,一味寒凉,即有外邪,亦致冰伏,若元本亏损,未有不闭闷致死者。所以咽喉妙法,第一开豁痰涎,痰涎
既涌,自然通快,然后审轻重以施治,姜附、灼艾,诚为治本之法,但人多畏之,而不肯用耳。然当危急时,
亦不可避忌,强为救治,亦可得生也。至于刺法,亦须知之。雍正四年,咽喉证甚行。友人之子沈礼庭亦患喉
痹,次日即烂。予诊其两寸无力,两尺空散,乃阴虚火动,以七味丸作汤与服一剂,证虽未减而痛势少缓。邻
家强其延喉科视之,彼医笑予动辄用热药,不知此乃阳明热甚证,火性急速,故一日而喉即腐溃,岂可用温补
剂耶!乃投白虎二剂,服未半,而神气改常,语言错乱,甚至颠倒不眠,其家惶急,复延予。予诊其脉乱而八
九至,予曰∶果病阳明燥火,石膏实为良剂。今系无根之焰,而妄用白虎,使胃络陷下,而不能上通,故心神
失守。以归脾汤加桂饮之,甫一剂而神恬脉静矣。噫!彼喉科一无学之人,妄为评品大方,乱投汤药,几至杀
人,亦愚矣。)
这种病是由于肺和肾的气虚,风寒之邪侵袭所致,导致下巴和颔部粗肿,咽喉闭塞,连汤药都无法咽下,随时可能死亡。此时应紧急灌服黄药子散,吐出恶臭的涎液后即可痊愈。病情较轻者,治疗肺部,服用姜附汤,并灸天突穴五十壮也有效;病情较重者,服用钟乳粉,灸关元穴,同时也可服用姜附汤。
治验记录:
有一人患喉痹,痰气上攻,咽喉闭塞,灸天突穴五十壮后,即可进食粥食,再服用姜附汤,一剂即愈,这是治疗肺部的案例。
有一人患喉痹,下巴和颔部粗肿,粥药无法咽下,四肢逆冷,六脉沉细。紧急灸关元穴二百壮,四肢才回暖,六脉逐渐恢复,但咽喉仍然肿胀,仍令其服用黄药子散,吐出一合稠痰后才痊愈,这是治疗肾脏的案例。
有一人患喉痹,六脉细弱,我为他灸关元穴二百壮,六脉逐渐恢复。一位医生说:“这是热证,再用火攻,是抱薪救火。”于是给予凉药一剂,六脉再次沉伏,咽喉更加肿胀。医生无计可施,用尖刀在肿胀处刺破,出血一升后痊愈。因为此证忌用凉药,痰遇寒则凝结,所以用刀刺出肺血,肿胀也随之消退。
(先生治疗肺部和肾脏的方法,是千古以来的卓越见解。况且咽喉疾病,由风火引起的占十之二三,由肺肾虚寒引起的占十之八九。喉科医生如果不明白这个道理,一味使用寒凉药物,即使有外邪,也会导致冰伏(邪气被寒凉遏制而深伏体内),如果元气根本亏损,没有不闭闷致死的。所以治疗咽喉病的妙法,首先是开豁痰涎,痰涎涌出后,自然通畅舒适,然后审察病情轻重来施治,姜附汤、艾灸确实是治本的方法,只是人们大多畏惧它,不肯使用罢了。然而在危急时刻,也不可不避忌讳,强行救治,也可以求得生存。至于刺血疗法,也需要了解。雍正四年,咽喉病症盛行。朋友的孩子沈礼庭也患喉痹,第二天就溃烂了。我诊察他的两寸脉无力,两尺脉空散,认为是阴虚火动,用七味丸改作汤剂给他服用一剂,症状虽未减轻,但疼痛稍缓。邻居家强迫他请喉科医生诊治,那位医生嘲笑我总是用热药,不知道这是阳明热盛的证候,火性急速,所以一天内喉咙就腐溃,怎么能用温补剂呢!于是投予白虎汤两剂,服用不到一半,神气改变常态,言语错乱,甚至颠倒不眠,家属惊慌焦急,又请我去诊治。我诊察他的脉象混乱且每息八九至,我说:“如果是阳明燥火证,石膏确实是良药。现在是无根之火,却妄用白虎汤,使胃络陷下,不能上通,所以心神失守。”用归脾汤加桂枝饮用之,刚服一剂,神志安宁,脉象平静了。唉!那些喉科医生是无学识的人,妄加评论大方,乱投汤药,几乎杀人,也是愚蠢啊。)
This disease is caused by deficiency of Qi in the Lung and Kidney, with pathogenic Wind-Cold invading. It leads to swelling of the chin and jaw, obstruction of the throat, inability to swallow liquids or medicines, and death may occur within moments. In such emergencies, urgently administer Huangyaozi San (Yellow Medicament Powder) to induce vomiting of foul phlegm, after which the patient will recover. For mild cases, treat the Lung by administering Jiangfu Tang (Ginger and Aconite Decoction); moxibustion on Tiantu (CV-22) for fifty moxa cones is also effective. For severe cases, administer Zhongru Fen (Stalactite Powder), moxa Guanyuan (CV-4), and also administer Jiangfu Tang.
Clinical Records:
One patient suffered from Hou Bi (Sore Throat/Obstruction), with Phlegm-Qi attacking upward, causing throat obstruction. After moxibustion on Tiantu (CV-22) for fifty cones, he was able to consume porridge. Subsequently, taking one dose of Jiangfu Tang (Ginger and Aconite Decoction) led to complete recovery. This illustrates treatment targeting the Lung.
Another patient suffered from Hou Bi (Sore Throat/Obstruction), with coarse swelling of the chin and jaw, inability to swallow porridge or medicine, cold limbs, and deep, fine pulses in all six positions. Emergency moxibustion on Guanyuan (CV-4) for two hundred cones warmed the limbs, and the pulses gradually returned. However, the throat remained swollen. He was instructed to take Huangyaozi San (Yellow Medicament Powder), and after vomiting one he of thick phlegm, he recovered. This illustrates treatment targeting the Kidney.
Another patient suffered from Hou Bi (Sore Throat/Obstruction) with fine pulses. I moxaed Guanyuan (CV-4) for two hundred cones, and his pulses gradually returned. A physician stated, "This is a Heat syndrome; using fire therapy is like carrying firewood to save a fire." He then administered a dose of cooling herbs. Consequently, the pulses became deep again, and the throat swelling worsened. The physician, having exhausted his methods, used a sharp knife to puncture the swollen area, releasing one sheng of blood, after which the patient recovered. This condition contraindicates cooling herbs because Phlegm coagulates upon encountering Cold. Therefore, puncturing to release Lung blood caused the swelling to subside.
(The Master's methods for treating the Lung and Kidney are outstanding insights of the ages. Moreover, among throat diseases, those caused by Wind-Fire account for only 20-30%, while those caused by Lung-Kidney Deficiency-Cold account for 80-90%. If throat specialists do not understand this principle and indiscriminately use cold-cooling herbs, even if external pathogens exist, they will become frozen and trapped. If the root Yuan Qi is depleted, closure and suffocation leading to death are inevitable. Thus, the best method for treating throat conditions is first to open and expel Phlegm-Saliva. Once the Phlegm-Saliva surges out, natural unblocking and comfort follow. Then, treatment should be applied based on severity. Jiangfu Tang (Ginger and Aconite Decoction) and burning moxa are indeed fundamental treatments, but people often fear them and refuse to use them. However, in critical situations, one must not avoid taboos; forced rescue can still lead to survival. Puncture therapy should also be understood. In the fourth year of Yongzheng, throat diseases were prevalent. A friend's son, Shen Liting, also suffered from Hou Bi (Sore Throat/Obstruction), which ulcerated the next day. I palpated his Cun positions (both left and right) as powerless and Chi positions (both left and right) as empty and scattered, diagnosing Yin Deficiency with Fire Hyperactivity. I prescribed Qiwai Wan (Seven-Ingredient Pill) prepared as a decoction. After one dose, symptoms did not diminish, but pain eased slightly. Neighbors insisted on consulting a throat specialist. That physician laughed at my frequent use of hot herbs, claiming this was a Yangming Excess-Heat syndrome where Fire nature is rapid, causing daily ulceration, and thus warm-tonifying agents should not be used. He administered Baihu Tang (White Tiger Decoction) for two doses. Before half was consumed, the patient's spirit changed abnormally, speech became confused, and he experienced insomnia and agitation. The family panicked and summoned me again. I palpated his pulse as chaotic, beating 8-9 times per breath. I said, "If it were truly Yangming Dryness-Fire, Shigao (Gypsum) would be an excellent agent. Now it is a Rootless Flame; recklessly using Baihu Tang has caused the Stomach collaterals to sink and fail to ascend, resulting in loss of Heart Spirit control." I administered Guipi Tang (Restore the Spleen Decoction) with added Guizhi (Cinnamon Twig). After just one dose, the spirit calmed and the pulse stabilized. Alas! Those throat specialists are unlearned individuals who rashly critique major prescriptions and indiscriminately administer herbal formulas, nearly killing patients through ignorance.)