庞氏曰经云伏气之病古方谓之肾伤寒谓非时有暴寒中人伏毒瓦斯于少阴经始衰不病旬月乃
发脉微弱法当咽痛以伤寒非喉痹之病次必下痢
谨按少阴伤寒一二日病乃不自太阳传也因是经不足而卒中寒寒邪抑郁内格阳气为热上行
于咽
门经会之处寒热相搏而痛或成喉痹为医不察脉证虚实即用寒凉之剂攻治卒致殒没而患者自谓
其分鸣呼冤哉殊不察少阴病咽痛及生疮不能言声不出者药用甘苦辛温制其标病以通咽嗌至若
伤寒伏气内发咽痛兼下利清谷里寒外热面赤胀微弱者用辛热之药攻其本病以顺阴阳利止则水
升火降而咽痛自无也此非杂病一阴一阳结为喉痹之比不可妄施针砭及寒凉之药且夫火热之动
为病急速子和论治已详然伤寒伏气为病咽痛或肿本阴寒厥甚逼热上行其喉为痹逼热下行必便
脓血此标热而本寒也仲景自有治例故子和略之不议若是则火热喉痹肿甚者急用药吹点或刺少
商合谷丰隆涌泉关冲等穴以解脉络之结经者内与甘辛凉剂降火制其标本亦不可便用苦寒之药
攻治倘有内寒格热为病吾恐反增其势矣
详见痰饮门
详见气门
陈无择云风燥皆使喉痹咽肿则不能吞干则不能咽多因饮啖辛热或复呕吐咯伤致咽系干枯
之所
为也与喉门自别又有悬门暴肿闭塞喉咙亦如喉闭但悬壅在上 俗谓莺翁又谓之鹅聚俗语声讹
不可不备识
庞氏说:《内经》记载:“伏气之病”,古方称之为“肾伤寒”。这是指非时节的暴寒侵袭人体,毒瓦斯潜伏于少阴经。等到正气开始衰弱而发病,通常在旬月之后才发作。脉象微弱,按照法度应当出现咽痛,这属于伤寒而非喉痹的病证;随后必然会出现下痢。
谨按:少阴伤寒在发病的一两天内,病邪并非从太阳经传变而来。这是因为经脉本身不足,突然遭受寒邪中伤。寒邪郁结在内,格拒阳气,使阳气化为热邪上行至咽喉门户,即经脉交汇之处。寒热相互搏结而导致疼痛,或者形成喉痹。由于医生不仔细诊察脉证虚实,就立即使用寒凉药物攻治,导致患者突然死亡,而患者自己却觉得冤枉,唉!实在是不明察少阴病导致的咽痛,以及生疮不能说话、声音发不出来的情况。用药应以甘苦辛温为主,来制约标病,以通畅咽喉。至于伤寒伏气在内发作,咽痛兼有下利清谷(大便中有未消化的食物)、里寒外热、面色赤红、脉搏微弱等情况,应用辛热的药物攻治本病,以顺应阴阳。腹泻停止则水升火降,咽痛自然消除。这与杂病中一阴一阳结聚导致的喉痹不同,不可妄施针砭及寒凉药物。况且火热引起的疾病变化迅速,子和(刘完素)论述治疗已经很详细了。然而伤寒伏气导致的疾病,咽痛或肿胀,本质是阴寒极甚,逼迫热邪上行,导致喉咙闭塞;逼迫热邪下行则必然导致便脓血。这是标热而本寒。张仲景自有治疗方法,所以子和简略而不议论。如果是这样,对于火热喉痹肿胀严重的,急需用药吹点或针刺少商、合谷、丰隆、涌泉、关冲等穴位,以解除脉络的结滞。经典记载内服甘辛凉剂以降火,制约标本,也不可以立即使用苦寒药物攻治。倘若是有内寒格拒热邪导致的疾病,我担心反而会增加病势。
详见痰饮门。
详见气门。
陈无择说:风燥都会导致喉痹、咽肿,从而不能吞咽;干燥则不能咽下。多因饮食辛辣温热之物,或反复呕吐咯血损伤,导致咽系干枯所致。这与喉门(喉部疾病)自相区别。又有悬雍垂突然肿胀闭塞喉咙的情况,也像喉闭,但悬雍垂在上部。俗称“莺翁”,又叫做“鹅聚”,俗语发音讹误,不可不详细辨识。
Pang stated: The *Classic of Internal Difficulty* (*Huangdi Neijing*) records: "The disease of latent qi," which ancient prescriptions call "Kidney Cold Damage" (Shen Shanghan). This refers to sudden cold from an improper season invading the human body, where toxic qi lies dormant in the Shaoyin meridian. When the healthy qi begins to weaken and the disease manifests, it usually occurs after a decade or month. The pulse is weak; according to the principles, throat pain should occur. This belongs to the category of Cold Damage (Shanghan) rather than the disease of sore throat (Houbi); subsequently, diarrhea must inevitably follow.
Respectfully note: In the first one or two days of Shaoyin Cold Damage, the pathogen does not transmit from the Taiyang meridian. This is because the meridian itself is insufficient, leading to a sudden strike by cold pathogens. The cold pathogens stagnate internally, obstructing the Yang qi, causing the Yang qi to transform into heat and ascend to the gateway of the throat, which is the convergence point of meridians. Cold and heat contend with each other, resulting in pain, or forming Houbi. Because physicians fail to carefully examine the pulse and symptoms for deficiency or excess, they immediately use cold and cool agents to attack and treat, causing the patient to die suddenly. The patient themselves feels wronged. Alas! They fail to observe that for Shaoyin disease causing throat pain, as well as sores preventing speech and voice production, the medication should be sweet, bitter, pungent, and warm to control the branch manifestation and unblock the pharynx. As for Cold Damage latent qi manifesting internally, accompanied by throat pain and diarrhea with undigested food (Qinggu), interior cold with exterior heat, red face, and weak pulse, pungent and hot medications should be used to attack the root disease to harmonize Yin and Yang. Once diarrhea stops, Water ascends and Fire descends, and throat pain naturally disappears. This is not comparable to miscellaneous diseases where one Yin and one Yang knot together to form Houbi. One must not recklessly apply acupuncture, moxibustion, or cold and cool drugs. Furthermore, diseases caused by fire and heat move rapidly; Zihe (Liu Wansu) has discussed treatment in detail. However, for diseases caused by Cold Damage latent qi, throat pain or swelling stems from extreme Yin cold forcing heat upward, causing the throat to become blocked; forcing heat downward inevitably leads to pus and blood in the stool. This is branch heat but root cold. Zhang Zhongjing has his own treatment examples, so Zihe omitted them without discussion. If this is the case, for severe swelling in fire-heat Houbi, one should urgently use medicated powder insufflation or prick acupoints such as Shaoshang (LU11), Hegu (LI4), Fenglong (ST40), Yongquan (KI1), and Guanchong (SJ1) to resolve the knots in the collaterals. Classics state that internally administering sweet, pungent, and cool agents lowers fire and controls both root and branch; one must not immediately use bitter-cold drugs to attack and treat. If there are diseases caused by internal cold repelling heat, I fear it would only increase the pathological momentum.
See detailedly in the Phlegm-Fluids section.
See detailedly in the Qi section.
Chen Wuze said: Wind and dryness both cause Houbi and throat swelling, making swallowing impossible; dryness makes swallowing difficult. This is often due to consuming spicy and hot foods or repeated vomiting and hemoptysis causing injury, leading to the drying up of the throat system. This differs from diseases originating in the throat gate. There is also sudden swelling of the uvula blocking the throat, similar to throat closure, but the uvula is located superiorly. It is commonly called "Yingweng" (Oriental Magpie-Robin's throat?), also known as "Eju" (Goose cluster), with vulgar pronunciation errors; this must be carefully recognized.