咽喉司呼吸之升降，乃一身之橐 也。毒瓦斯不能舒散，则壅聚于此，肿痛闭塞，水浆难入，则
死生系之，深可畏也。首尾俱宜甘桔汤加麦门冬、牛蒡子、玄参、杏仁，或加味甘桔汤，及《拔萃
》甘桔汤俱可用。热甚痛甚者，宜东垣凉膈散加牛蒡子，或以甘桔汤合黄连解毒汤加石膏、木通、
牛蒡子、山豆根、射干，并外用玉钥匙点之。咽痛便秘者，宜四顺清凉饮下之。以上证治，必其能
食肉热者，方可用此寒凉之剂。若上焦虽热而下焦不热，或不喜饮食者，只用加味甘桔汤，徐徐咽
服，不必用牛蒡子，恐其性凉伤脾也。
一、咽喉肿痛，凡痘疮多有是证，但七日前见者为逆，七日后见者无虑。盖起发灌脓之时，内外
之痘俱大，以致气道壅肿而然，此痘也，非喉痹之毒也。待外痘既靥，则内证自除矣，不必治之。
徐氏曰∶凡咽喉肿痛不能饮食者，内服加味甘桔汤。外看身上有痘之最大者，此其毒瓦斯相连，
宜用香油灯草燃而淬之，一淬即愈。或用手捻破，以痘疔散涂之。
陈氏曰∶凡身壮热，大便坚实，或口舌生疮，咽喉肿痛，皆疮毒未尽，宜用四味射干鼠粘子汤
。如不应，宜七味白术散。
一、痘疮弄舌吐舌者，脾之热也，轻者导赤散，甚者泻黄散。
一、唇口与五内相通，故热毒内发，口舌必先受伤，毒甚则口舌或紫或白或黑，舌或肿大，此皆
实热之证，宜内服黄连解毒汤加石膏、牛蒡子、木通、生地，或东垣凉膈散。若大便干结者，宜《
局方》凉膈散，外用玉钥匙点之。若口舌生疳者，以吹口丹，或阴阳散敷之。
一、牙龈肿烂成疳者，此阳明热毒内攻也，杀人甚速，宜甘露饮主之，外用老茶叶、菲菜根煎浓汤
洗之，仍用翎毛刷去腐肉，洗见鲜血，乃以神授丹，或搽牙散敷之，日三次，或绵茧散亦可。若烂
至喉中者，用小竹管将绵茧散吹入，虽遍口牙齿烂落、口唇穿破者，皆可敷药而愈。然必有黄白脓
水者方可治，若色如干酱，其肉臭烂，日烂一分者俱不治。
一、牙疳臭烂，气粗热甚，舌白至唇，口臭如烂肉，大便泻脓血，肚腹胀痛，此胃虚毒瓦斯内攻
，胃烂之证。苦山根发红点者，此疳毒内攻，故见于山根，亦胃烂之证，俱不治。
一、痘疹退后，若有牙龈腐烂，鼻血横流者，并为失血之证，宜《局方》犀角地黄汤加山栀、
木通、玄参、黄芩之类以利小便，使热毒下行，外用神授丹治之，不可缓也。若疳疮色白者，为胃
烂，此不治之证。
咽喉主管呼吸之气的升降出入，是全身气机运行的关键枢纽。如果毒邪之气不能顺畅疏散，就会在此处壅集聚结，导致红肿疼痛、气道闭塞，连水和食物都难以咽下，此时生死悬于一线，后果极其严重，令人深感畏惧。治疗上，无论病程初期还是后期，都适宜使用甘桔汤（甘草与桔梗组成的基础方）加入麦门冬、牛蒡子、玄参、杏仁，或者加味甘桔汤，以及《拔萃方》中的甘桔汤均可应用。若热势极盛且疼痛剧烈者，适宜使用李东垣的凉膈散加入牛蒡子，或者将甘桔汤与黄连解毒汤合用，再加入石膏、木通、牛蒡子、山豆根、射干，并配合外用玉钥匙散点涂患处。若出现咽痛伴大便秘结者，适宜服用四顺清凉饮以通腑泄热。以上所述证候及治疗方法，必须适用于患者能够进食肉类等温热性质食物的情况，方可使用这些寒凉性质的药物。如果患者上焦虽有热象但下焦并不热，或者食欲不振、不喜欢饮食，则只宜使用加味甘桔汤，慢慢吞咽服用，不必使用牛蒡子，因为担心其性凉会损伤脾胃。
一、咽喉肿痛：凡是痘疮（天花或类似出疹性疾病）患者多有此证，但在发病七日前出现的属于逆证（预后不良），七日之后出现的则无需担忧。这是因为在痘疹起发、灌脓的阶段，体内外痘疹均处于肿胀状态，导致气道壅塞肿胀所致，这是痘疮本身的反应，并非喉痹（急性咽喉炎）的毒邪。待体表痘疹结痂脱落，内部症状自然消除，不必专门治疗。徐氏说：凡咽喉肿痛导致无法饮食者，内服加味甘桔汤。观察身上最大的痘疹，这是毒邪相连所致，适宜用香油灯草点燃后迅速接触（淬）患处，一次即可痊愈。或者用手捻破痘疹，涂抹痘疔散。
陈氏说：凡身体高热，大便干结坚硬，或者口舌生疮，咽喉肿痛，都是疮毒未尽的表现，适宜使用四味射干鼠粘子汤。如果无效，适宜使用七味白术散。
一、痘疮期间出现弄舌（舌头伸缩不定）或吐舌（舌头伸出难收）的现象，是脾经有热的表现。轻症用导赤散，重症用泻黄散。
一、唇口与五脏六腑相通，因此热毒从内发出时，口舌必然首先受伤。毒邪严重时，口舌颜色可能变为紫色、白色或黑色，舌头可能肿大，这些都是实热证的表現，适宜内服黄连解毒汤加入石膏、牛蒡子、木通、生地，或者李东垣的凉膈散。若大便干结者，适宜使用《太平惠民和剂局方》的凉膈散，外用玉钥匙散点涂。若口舌生疳（口腔黏膜溃烂），可用吹口丹或阴阳散敷贴。
一、牙龈肿胀腐烂形成疳疮者，这是阳明胃经热毒内攻所致，致死速度很快，适宜以甘露饮为主治疗。外用老茶叶、韭菜根煎煮浓汤清洗患处，仍需用羽毛刷去除腐肉，直到洗出鲜血为止，然后使用神授丹或搽牙散敷贴，每日三次，也可以使用绵茧散。若腐烂延伸至喉中，可用小竹管将绵茧散吹入，即使满口牙齿腐烂脱落、嘴唇穿孔破裂，都可以敷药治愈。但是，必须有黄白色的脓水才可治疗，若颜色像干酱一样，肉质臭烂，每天腐烂一分者，均属于不治之症。
一、牙疳（牙龈坏死腐烂）伴有恶臭腐烂，呼吸粗重，热势极盛，舌苔白厚直至嘴唇，口臭如烂肉味，大便排泄脓血，腹部胀满疼痛，这是胃气虚弱，毒邪内攻，导致胃壁腐烂的证候。若苦山根（鼻根部）出现红点，这是疳毒内攻，反映在苦山根，也属于胃烂的证候，均属于不治之症。
一、痘疹消退后，若出现牙龈腐烂、鼻血横流的情况，都属于失血证候，适宜使用《太平惠民和剂局方》的犀角地黄汤加入山栀、木通、玄参、黄芩等药物以利小便，使热毒随尿液下行排出，外用神授丹治疗，不可拖延。若疳疮颜色发白，属于胃烂，这是不治之症。
The throat and pharynx govern the ascending and descending of respiratory Qi, serving as the central pivot for the movement of Qi throughout the body. If toxic pathogens cannot disperse smoothly, they will accumulate here, causing swelling, pain, and obstruction, making it difficult to swallow water or food; life and death then hang in the balance, a situation that is deeply alarming. For treatment, whether at the beginning or end of the disease, Ganjie Tang (Licorice and Platycodon Decoction) added with Ophiopogonis Radix (Maidong), Arctii Fructus (Niubangzi), Scrophulariae Radix (Xuanshen), and Apricot Seed (Xingren) is suitable. Alternatively, Jiawei Ganjie Tang (Modified Licorice and Platycodon Decoction) or the Ganjie Tang from *Ba Cui Fang* can be used. If heat is severe and pain is intense, Li Dongyuan's Liangge San (Cool the Diaphragm Powder) added with Arctii Fructus (Niubangzi) is appropriate. One may also combine Ganjie Tang with Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity), adding Gypsum (Shigao), Akebia Caulis (Mutong), Arctii Fructus (Niubangzi), Sophorae Tonkinensis Radix et Cortex (Shandougen), and Belamcandae Rhizoma (Shegan), while externally applying Yuyaochi (Jade Key) powder. In cases of sore throat accompanied by constipation, Sishun Qingliang Yin (Four-Obedience Cooling Drink) should be administered to unblock the bowels. The above syndromes and treatments are applicable only if the patient can consume meat and other warm-natured foods; otherwise, these cold-natured formulas should not be used. If there is heat in the Upper Jiao but not in the Lower Jiao, or if the patient has poor appetite, only Jiawei Ganjie Tang should be used, taken slowly by swallowing, without Arctii Fructus (Niubangzi), lest its cold nature damage the Spleen.
1. Sore throat and swelling: This symptom often occurs in patients with smallpox (痘疮). However, appearance within seven days of onset is considered a adverse sign (Ni Zheng), whereas appearance after seven days is generally harmless. This occurs because during the stage of eruption and suppuration, both external and internal pustules swell, causing airway congestion and edema. This is a manifestation of the smallpox itself, not the toxicity of Hou Bi (acute pharyngitis). Once the external pustules crust over, the internal symptoms will naturally resolve, requiring no specific treatment. Xu stated: For sore throat and swelling preventing eating and drinking, internally administer Jiawei Ganjie Tang. Examine the largest pustules on the body; this indicates connected toxicity. It is suitable to ignite a rush wick dipped in sesame oil and quickly touch (cuì) the affected area; one application brings cure. Alternatively, puncture the pustule manually and apply Dou Ding San (Pustule Cancer Powder).
Chen stated: For high fever, hard stools, mouth and tongue ulcers, and sore throat and swelling, these indicate incomplete resolution of toxin from sores. Siwei Shegan Niuzi Tang (Four-Ingredient Belamcanda and Arctus Decoction) is suitable. If ineffective, Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) is appropriate.
1. Tongue protrusion and rolling in smallpox: This indicates Heat in the Spleen. Mild cases are treated with Daochi San (Guide Out Redness Powder); severe cases with Xiehuang San (Drain Yellow Powder).
1. The lips and mouth connect with the Zang-Fu organs. Therefore, when internal Heat-Toxin erupts, the mouth and tongue are injured first. With severe toxicity, the mouth and tongue may turn purple, white, or black, and the tongue may swell. These are all manifestations of Excess Heat. Internally, Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) added with Gypsum (Shigao), Arctii Fructus (Niubangzi), Akebia Caulis (Mutong), and Rehmanniae Radix Preparata (Shengdi) is suitable, or Li Dongyuan’s Liangge San (Cool the Diaphragm Powder). If stools are dry and bound, Liangge San from *Ju Fang* (Tai Ping Hui Min He Ji Ju Fang) is appropriate, with external application of Yuyaochi (Jade Key) powder. For mouth and tongue ulcers (Gan Chuang), Chui Kou Dan (Blow Mouth Pill) or Yinyang San (Yin-Yang Powder) can be applied.
1. Swollen and ulcerated gums forming Gan Chuang (mouth cancer/ulcers): This is caused by Heat-Toxin attacking inward from the Yangming Stomach channel. It is rapidly fatal. Ganlu Yin (Sweet Dew Drink) is the primary treatment. Externally, wash with a strong decoction of old tea leaves and Chinese chive root. Use a feather brush to remove necrotic tissue until fresh blood appears, then apply Shenshou Dan (Divine Grant Pill) or Cha Ya San (Teeth Rubbing Powder), three times daily. Mian Jian San (Silkworm Cocoon Powder) is also acceptable. If the ulceration extends into the throat, blow Mian Jian San into the throat using a small bamboo tube. Even if teeth fall out and lips perforate, medication can effect a cure. However, treatment is only viable if yellow-white pus is present. If the color resembles dried sauce, the flesh is foul and rotting, and the decay progresses by one fen daily, it is incurable.
1. Foul-smelling gum ulcers with rapid breathing and intense heat, white coating extending to the lips, fetid odor like rotting meat, purulent bloody diarrhea, abdominal distension and pain: This indicates Stomach Deficiency with internal attack of toxins, leading to gastric ulceration. Red spots appearing on the Shan Gen (root of the nose) indicate internal attack of Gan Toxin manifesting at the Shan Gen, which is also a sign of gastric ulceration. Both conditions are incurable.
1. After the subsidence of rash diseases, if gum ulceration and profuse epistaxis occur, these are signs of blood loss. Ju Fang’s Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Gardenia Fruit (Shanzhi), Akebia Caulis (Mutong), Scrophulariae Radix (Xuanshen), and Scutellariae Radix (Huangqin) is suitable to promote urination, directing Heat-Toxin downward. Externally, treat with Shenshou Dan (Divine Grant Pill). Do not delay. If the Gan Chuang is white, it indicates gastric ulceration, which is an incurable condition.