仲景半夏汤治伤寒寒相搏咽痛或声不出者
半夏 桂枝 甘草(炙等分)
上 咀每七八钱或半两水煎放冷细细咽之
按本论咽中伤生疮不能言声不出者少阴证用苦酒汤或桔梗等方皆可选用
三因蜜附子治腑寒咽闭吞吐不利
大附子(一个去皮脐切作大片蜜涂炙令黄)
上每含咽津甘味尽更以附片涂蜜炙用
王隐君礞石滚痰丸治痰热咽嗌肿痛不利
桔梗半夏汤治痰气不降咽肿欲成喉痹者
(方并见痰饮门)
三因玉粉丸治寒痰壅结咽喉不利语声不出者
半夏(洗五钱) 草乌(一字炒) 桂(一字)
上末生姜自然汁浸蒸饼丸如鸡头大每大人一丸至夜含化多年不愈亦有效针经中说寒气客
于会厌卒然如哑此药主之
脉经曰少阴脉数妇人则阴中生疮男子则气淋 热结下焦则令人淋 不通淋之为病小便数
如粟状小腹弦急痛引脐中
原病式曰淋小便涩痛也热客膀胱郁不能渗泄故也或曰小便涩而不通者为热遗尿不禁者为
冷岂
知热甚客于肾部干于足厥阴之经廷孔郁结极甚而气血不能宣通则痿痹而神无所用故液渗入膀
胱而旋溺遗失不能收禁也经云目得血而能视脏得血而能液腑得血而能气夫血随气运气血宣
行则其中神自清利而应机能为用矣又灵枢经曰肾主二阴然水衰虚而怫热客其部分二阴郁结则
痿痹而神无所用故溲便遗失而不能禁止然则热证明矣是故世传方论虽曰冷淋复用榆皮黄芩瞿
麦茯苓通草鸡苏郁李仁栀子之类寒药治之而已其说虽妄其方乃是由不明气运变化之机宜乎认
是而为非也或谓患淋而服茴香益智滑石醇酒温药而愈者然则非冷欤不知此皆利小便之要药也
盖醇酒益智之性虽热而茴香之性温滑石之性寒所以能开发郁结使气液宣通热散而愈也
按此只是论热因处治然宝鉴曰小便不利其治有三不可概论津液偏渗于肠胃大便泄泻而小
便涩
少者宜分利而已热传下焦津液则热热而不行者必渗泄则愈脾胃气涩不能通调水道下输膀胱而
化者故可顺气令施化而出矣可见非止于热因也况有标本不同有论见后大抵三因谓大率有五者
总病机言也以气为本者气行而水自化也亦气血之谓然有得之于胎气者丹溪云郑宪使子年十六
生七个月后得淋病五七日必一作其发则大痛水道下如漆和粟者一盏方定脉之轻则涩重则弦视
其形瘦而长色青如苍意其必因其父服下部药遗热在胎留于子之命门而然遂以紫雪和黄柏末丸
梧子大晒及干热汤下百丸半日又上二百丸食物厌之又半日痛大作连腰腹水道乃行下漆和粟者
碗许痛减十之八后张子中与陈皮一两桔梗木通各半两又下一合许而安父得燥热尚能病子况母
得之者乎书此以证东垣红丝瘤之事(云云见妇人门)
张仲景的半夏汤用于治疗伤寒寒邪相搏结导致的咽痛，或者声音不能发出的情况。
[药物组成] 半夏、桂枝、甘草（炙），三味药等分。
[煎服法] 将上述药物捣碎成粗末，每次取七八钱或半两，用水煎煮，待药液放凉后，细细咽下。
[按语] 根据本论记载，咽喉受伤生疮导致不能说话、声音不能发出的，属于少阴证，可使用苦酒汤或桔梗汤等方剂，均可选用。
《三因极一病证方论》中的蜜附子用于治疗腑脏虚寒导致的咽喉闭塞、吞咽和呕吐不利的症状。
[药物组成] 大附子一个（去皮去脐，切成大片，涂蜂蜜炙烤至黄色）。
[用法] 每次含服，待津液咽下，甘甜味尽后，再用附片涂蜜炙烤使用。
王隐君的礞石滚痰丸用于治疗痰热导致的咽喉肿痛不利。
桔梗半夏汤用于治疗痰气不降导致的咽喉肿胀，欲形成喉痹的情况。
（这两个方剂均见“痰饮门”章节）
《三因极一病证方论》中的玉粉丸用于治疗寒痰壅结导致的咽喉不利、声音不能发出的情况。
[药物组成] 半夏（洗，五钱）、草乌（一字，炒制）、桂枝（一字）。
[制法与用法] 将上述药物研为细末，用生姜自然汁浸泡蒸饼制成丸药，大小如鸡头实。每成人每次服用一丸，夜间含化。多年不愈者亦有效。
《针经》中说：寒气客居于会厌穴，突然像哑巴一样失音，此药主治这种情况。
《脉经》说：少阴脉数，妇人则阴中生出疮疡，男子则患气淋。热邪结聚于下焦，就会使人患淋证。淋证这种病，小便频数，排出物状如粟米，小腹部拘急疼痛，牵引脐中。
《原病式》说：淋证是小便涩滞疼痛。热邪客居膀胱，郁结而不能渗泄，所以如此。有人说：小便涩滞不通的是热证，遗尿不禁的是冷证。哪里知道热邪甚盛客居于肾部，侵犯足厥阴肝经，导致廷孔（尿道口）郁结极甚，气血不能宣通，从而痿痹而神机无所作用，因此津液渗入膀胱，随即溺遗失禁，不能收摄控制。经文说：眼睛得到血的濡养就能视物，脏腑得到血的濡养就能化生津液，六腑得到血的濡养就能运行气机。血随着气运行，气血宣畅通行，那么其中的神机自然清利而应机发挥作用。另外，《灵枢经》说：肾主管二阴。然而水液衰少虚损，怫热客居其部位，二阴郁结则痿痹而神机无所作用，因此小便遗失而不能禁止。这样看来，这是热证明显了。所以世间流传的方论虽然说是冷淋，却复用榆皮、黄芩、瞿麦、茯苓、通草、鸡苏、郁李仁等寒凉药物治疗。这种说法虽然是荒谬的，但那些方子却是由于不明白气运变化的机理，认是而为非吧？或者说患淋证而服用茴香、益智仁、滑石、醇酒等温热药物而痊愈的，这难道不是冷证吗？不知道这些全都是利小便的要药。大概醇酒、益智仁的性质虽热，但茴香的性质温，滑石的性质寒，所以能开发郁结，使气液宣通，热散而痊愈。
[按语] 这里只是论述热证的原因及处理。但是《卫生宝鉴》说：小便不利的治疗有三种，不可一概而论。津液偏渗于肠胃，大便泄泻而小便涩少者，适宜采用分利的方法即可；热邪传变至下焦，津液受热煎熬而不行者，必须通过渗泄才能痊愈；脾胃气机涩滞，不能通调水道，下输膀胱而化生尿液，故可顺气令施化而出。由此可见，并不止于热证原因。况且有标本的不同，有关论述见后文。大体上《三因方》认为大率有五种，是从总病机而言的。以气为本的，气行而水自化，这也是指气血而言。也有得之于胎气的，丹溪说：郑宪使的儿子十六岁，出生七个月后患上淋病，每隔五七日必发作一次。发作时剧痛，尿道下行流出如漆混合粟米样的物质，约一盏的量才停止。脉象轻取则涩，重取则弦。观察其形体瘦长，面色青如苍色。推测必定是因为其父亲服用下部药物，遗留热邪在胎中，留于儿子的命门所致。于是用紫雪和黄柏末制成梧桐子大小的丸药，晒干，用热汤送服一百丸。半天后又服二百丸，食物厌恶。又过了半天，疼痛大作，牵连腰腹，水道乃行，排出如漆混合粟米样的物质约一碗许，疼痛减轻十分之八。后来张子中用陈皮一两、桔梗、木通各半两，又排出一合许而安。父亲得燥热尚且能病及儿子，何况母亲得病的呢？记录此事以证明东垣红丝瘤的事情。（详见妇人门）
Zhang Zhongjing's Banxia Tang (Pinellia Decoction) is used to treat sore throat or inability to speak caused by the binding of cold pathogens in Shanghan (Cold Damage diseases).
[Ingredients] Banxia (Pinelliae Rhizoma), Guizhi (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma, roasted), in equal parts.
[Preparation and Administration] Coarsely crush the above herbs. Take approximately 7-8 qian or half a liang per dose, decoct with water, allow to cool, and swallow slowly.
[Commentary] According to this treatise, when the throat is injured and sores form leading to inability to speak or loss of voice, it belongs to Shaoyin syndrome (Syndrome of the Lesser Yin). Kuchiu Tang (Bitter Wine Decoction) or Jiegeng Tang (Platycodon Decoction) can be selected for use.
The Mi Fuzi (Honey-fried Aconite) from San Yin Fang (Three Causes Formula) treats throat obstruction and difficulty in swallowing or vomiting due to fu-organ cold deficiency.
[Ingredients] One large Fuzi (Aconiti Lateralis Radix Praeparata), peeled, navel removed, sliced into large pieces, coated with honey, and roasted until yellow.
[Usage] Hold in the mouth each time, swallow saliva, and when the sweet taste is exhausted, apply another honey-roasted slice of Fuzi.
Wang Yinjun's Mengshi Guntan Wan (Lapis Volcanus Rolling Phlegm Pill) treats swelling, pain, and obstruction of the throat caused by phlegm-heat.
Jiegeng Banxia Tang (Platycodon and Pinellia Decoction) treats throat swelling that may develop into Hou Bi (Suffocating Throat/Epiglottitis) due to descending failure of phlegm and qi.
(Both formulas are found in the "Phlegm-Fluids" section.)
Yufen Wan (Jade Powder Pill) from San Yin Fang treats inability to speak and throat obstruction caused by the accumulation and knotting of cold-phlegm.
[Ingredients] Banxia (Pinelliae Rhizoma, washed, 5 qian), Caowu (Aconiti Kusnezoffii Radix, one zi, stir-fried), Gui (Cinnamomi Ramulus, one zi).
[Preparation and Usage] Grind the above into powder. Soak steamed wheat dough in fresh ginger juice to make pills the size of a chestnut. One pill per adult dose, dissolved in the mouth at night. Effective even for chronic cases lasting many years. The Zhen Jing (Needle Classic) states: When cold qi lodges in the Huiyan (epiglottis), sudden muteness occurs; this medicine treats it.
Mai Jing (Pulse Classic) states: If the Shaoyin pulse is rapid, women will develop sores in the yin region, while men will suffer from Qi Lin (Qi Strangury). Heat knotting in the lower jiao causes Lin syndrome. In Lin disease, urination is frequent, the discharge resembles millet grains, the lower abdomen is tense and urgent with pain radiating to the umbilicus.
Yuan Bing Shi (Treatise on Original Causes of Disease) states: Lin syndrome involves painful and difficult urination. This is because heat pathogens lodge in the bladder, stagnate, and fail to permeate and excrete. Some say: Painful and obstructed urination indicates heat; involuntary urine leakage indicates cold. How could they know that excessive heat lodging in the kidney region invades the Foot Jueyin Liver Meridian, causing extreme stagnation in the Ting Kong (urethral meatus), blocking the circulation of qi and blood, leading to flaccidity and paralysis where the spirit has no function? Consequently, fluids seep into the bladder, and urine is lost involuntarily without control. The Classics state: The eyes see when nourished by blood; organs generate fluids when nourished by blood; six fu-organs move qi when nourished by blood. Blood follows qi; when qi and blood circulate freely, the spirit within becomes clear and responsive. Furthermore, the Ling Shu (Spiritual Pivot) states: The Kidney governs the two yin openings. However, when water essence is deficient and vacuous, and lingering heat lodges in its sector, the two yin openings stagnate, leading to flaccidity and paralysis where the spirit has no function, thus causing urinary incontinence. Thus, the heat pattern is evident. Therefore, although worldly formulas claim it is Cold Lin and use cold medicines like Yu Pi (Ulmus Cortex), Huang Qin (Scutellariae Radix), Qu Mai (Polygoni Avicularis Herba), Fu Ling (Poria), Tong Cao (Tetrapanacis Medulla), Ji Su (Perillae Fructus), Yu Li Ren (Pruni Semen), and Zhi Zi (Gardeniae Fructus), their theory is absurd, yet their prescriptions work because they fail to understand the mechanism of qi transformation. They mistake truth for falsehood. Or, some say patients cured by Huixiang (Foeniculi Fructus), Yizhi Ren (Alpiniae Oxyphyllae Fructus), Huashi (Talcum), and warm wine must have had Cold Lin. Do not know that these are all essential drugs for promoting urination. Although Chunjiu (wine) and Yizhi Ren are hot, Huixiang is warm, and Huashi is cold; thus they can open stagnation, promote qi and fluid circulation, dissipate heat, and cure the disease.
[Commentary] This only discusses the heat cause and treatment. However, Bao Jian (Precious Mirror) states there are three treatments for difficult urination, which cannot be generalized. If body fluids leak into the intestines and stomach causing diarrhea and scanty, astringent urination, separation and promotion is suitable. If heat transmits to the lower jiao, scorching fluids so they do not flow, permeation and drainage must be used to cure. If spleen and stomach qi is stagnant, failing to regulate water passages and transport to the bladder for transformation, smoothing qi to facilitate transformation is appropriate. Thus, it is not solely due to heat. Moreover, there are differences between root and branch, discussed later. Generally, San Yin Fang mentions five types, speaking of the general pathogenesis. Those rooted in qi: when qi moves, water transforms; this refers to qi and blood. There are also congenital cases. Danxi stated: Zheng Xianshi's son, aged sixteen, developed Lin disease seven months after birth, recurring every five to seven days. Onset involved severe pain, with urine flowing down like lac mixed with millet grains, about one cup before subsiding. Pulse was choppy on light pressure and wiry on heavy pressure. His physique was thin and tall, complexion greenish like dark grass. It was surmised that his father had taken drugs for the lower body, leaving residual heat in the fetus, which lodged in the son's Mingmen (Gate of Vitality). Thus, Zixue (Purple Snow) and Huangbai (Phellodendri Cortex) powder were made into pills the size of wuizi (wutree seeds), dried, and administered with hot water, 100 pills initially. Half a day later, another 200 pills were given. Food intake was poor. Half a day later, pain intensified, radiating to waist and abdomen, allowing the water passage to open. About a bowl of substance like lac mixed with millet grains was discharged, reducing pain by 80%. Later, Zhang Zizhong used Chenpi (Citri Reticulatae Pericarpium, 1 liang), Jiegeng (Platycodonis Radix), and Mutong (Akebiae Caulis, each half liang), resulting in the discharge of another he and peace. The father's dry heat affected the son; how much more so if the mother is affected? This record proves Dong Yuan's case of red silk tumor (see Women's Section).