原病式曰喉痹痹不仁也俗作闭犹闭塞也火主肿胀故热客上焦而咽嗌肿胀也
子和曰内经云一阴一阳结谓之喉痹王太仆曰一阴者手少阴君火心主之脉气也一阳者手少
阳相
火三焦之脉气也二脉并络于喉气热则内结结甚则肿胀肿胀甚则痹痹甚而不通则死矣夫推原十
二经惟足太阳别下项其余皆凑于喉咙然内经何为独言一阴一阳结为喉痹盖君相二火独胜则热
结正络故痛且速也予谓一言可了者火是也故十二经中言嗌干嗌痛咽肿颔肿舌本强皆君火为之
也惟喉痹急速相火所为也夫君火者犹人火也相火者犹龙火也人火焚木其势缓龙火焚木其势速
内经之言喉痹则咽与舌其两间耳然其病同于火故不分也后之医者各详其状强立八名曰单乳蛾
双乳蛾单闭喉双闭喉子舌胀木舌胀缠喉风走马喉闭热气上行故传于喉之两旁近外肿作以其形
似是谓乳蛾一为单一为双也其比乳蛾差小者名闭喉热结于舌下复生一小舌子名曰子舌胀热结
于舌中舌为之肿名曰木舌胀木者强而不柔和也热结于咽喉肿绕于外且麻且痒肿而大者名曰缠
喉风喉痹暴发暴死者名曰走马喉痹此八种之名虽详若不归之火则相去远矣其微者可以咸
之
而大者以辛散之今之医者皆有其药也如薄荷乌头僵蚕白矾朴硝铜绿之类也至于走马喉痹何待
此乎其生死人反掌之间耳其最不误人者无如砭针出血血出则病已易曰血去惕出良以此夫昔予
治一妇人木舌胀其舌满口诸医不愈令以 针小而锐者砭之五七度肿减三日方平计所出血几至
盈斗又治一男子缠喉风肿表里皆作药不能下予以凉药灌于鼻中下十余行外以拔毒散敷之阳起
石烧赤与伏龙肝各等分细末之日以新水扫百遍三日热始退肿始消又尝治一贵妇喉痹盖龙火也
虽用凉剂而不可使冷服为龙火宣以火逐之火者烹饪之火是也乃使爆于烈日之中登于高堂之上
令侍婢携火炉坐药铫于上使药常极热不至大沸通口时时呷之百余次龙火自散此法以热行寒不
为热病 扦格故也大抵治喉痹用针出血最为上策但人畏针委曲旁求瞬息丧命凡用针而有针创者
宜捣
生姜一块调以热白汤时时呷之则创口易合铜人中亦有灸法然痛微者可用病速者恐迟则杀人故
治喉痹之火与救火同不容少待内经火郁发之发谓发汗然咽喉中岂能发汗故出血者乃发汗之一
端也后之君子母执小方而曰吾药不动脏腑又妙于出血若幸遇小疾而获效不幸遇大病而死矣母
遗后悔可也
《原病式》说：喉痹，痹是指麻木不仁；世俗写作“闭”，意思还是闭塞。火性主肿胀，所以热气客居上焦，导致咽喉部肿胀。
张子和说：《内经》讲：“一阴一阳结，谓之喉痹。”王太仆解释说：一阴，指的是手少阴君火（心包经）的脉气；一阳，指的是手少阳相火（三焦经）的脉气。这两条经脉都联络于喉咙。气热则内部郁结，郁结严重则肿胀，肿胀严重则痹阻，痹阻严重则不通，不通就会死亡。推究十二经脉，只有足太阳膀胱经别行向下至项部，其余各经都汇聚于喉咙。然而《内经》为何独独说一阴一阳结会导致喉痹呢？大概是因为君火和相火单独亢盛，导致热邪郁结在正络，所以疼痛发生得迅速。我认为可以用一个字来概括，就是“火”。所以在十二经中，凡是提到咽干、咽痛、咽肿、下颌肿、舌根强硬的，都是君火引起的。只有喉痹发病急速，是相火造成的。君火就像人间的火，相火就像龙火。人间的火烧木头，火势缓慢；龙火烧木头，火势迅猛。《内经》所说的喉痹，病变部位在咽与舌之间，但因为病因同属火，所以不加区分。后来的医生各自详细描述症状，强行设立八个名称：单乳蛾、双乳蛾、单闭喉、双闭喉、子舌胀、木舌胀、缠喉风、走马喉闭。热气上行，传布到喉咙两旁靠近外侧的地方，肿胀发作，因为形状相似，称为乳蛾，有单发和双发之分。比乳蛾稍小的，称为闭喉。热邪郁结在舌下，又生出一个小舌头，称为子舌胀。热邪郁结在舌中，舌头因此肿胀，称为木舌胀，“木”的意思是僵硬而不柔和。热邪郁结在咽喉，肿胀环绕外部，且麻且痒，肿胀较大的，称为缠喉风。喉痹突然发作、突然死亡的，称为走马喉痹。这八种名称虽然详细，但如果不能归结于火，就相差太远了。轻微的可以用咸味药软坚散结，严重的用辛味药发散。现在的医生都有这些药物，如薄荷、乌头、僵蚕、白矾、朴硝、铜绿之类。至于走马喉痹，哪里还用得着这些药呢？它在生死反掌之间。其中最不害人的方法，没有比砭针刺血更好的了，血出来病就好了。《易经》说“血去惕出”，就是这个道理。从前我治疗一个妇人患木舌胀，她的舌头充满口腔，各位医生治不好，我命令用小而锐利的针进行砭刺，五到七次后肿胀减轻，三天后才完全平复，估计流出的血几乎有一斗多。又治疗一个男子患缠喉风，表里都肿胀，药无法服下，我用凉药灌入鼻中，让他腹泻十多次，外面用拔毒散敷贴，将阳起石烧红与伏龙肝各等分研成细末，每天用新水调涂一百遍，三天后热才退，肿才消。曾经治疗一位贵妇人的喉痹，这是龙火之证。虽然使用凉剂，但不能让药冷服，要用火法驱逐龙火。所谓火，就是烹饪用的火。于是让患者在烈日下登上高堂，让侍女带着火炉坐在上面，把药铫放在火上，使药液保持极热但不大沸的状态，让患者不停地小口饮用一百多次，龙火自然消散。这种方法以热行寒，不会因热病而产生抵触。大抵治疗喉痹，用针刺出血是最上等的策略，但人们害怕针刺，曲折地寻求其他方法，转瞬之间丧命。凡是用针造成创口的，应该捣碎生姜一块，用热开水调和，时时小口饮用，这样创口容易愈合。铜人针灸图中也有灸法，但疼痛轻微者可用，病情急骤者恐怕延误会杀人。所以治疗喉痹的火，与救火相同，不容许丝毫等待。《内经》讲“火郁发之”，“发”指发汗，但在咽喉中怎么能发汗呢？所以出血其实是发汗的一种形式。后来的君子不要拘泥于小方，说我的药不动脏腑，又擅长出血。如果侥幸遇到小病而见效，不幸遇到大病而死，不要留下后悔就可以了。
*Yuan Bing Shi* states: "Hou Bi" (throat obstruction) refers to numbness and insensitivity; it is commonly written as "Bi" (closure), retaining the meaning of blockage. Fire governs swelling, so when heat lodges in the Upper Jiao (Triple Burner), it causes swelling of the pharynx and larynx.
Zhang Hezi says: *Nei Jing* (The Inner Canon) states: "When one Yin and one Yang knot, it is called Hou Bi." Wang Taipu explains: One Yin refers to the meridian qi of the Hand Shaoyin Ju Huo (Ministerial Fire/Heart Pericardium); One Yang refers to the meridian qi of the Hand Shaoyang Xiang Huo (Ministerial Fire/Triple Burner). These two meridians both connect to the throat. When qi becomes hot, internal knotting occurs; severe knotting leads to swelling; severe swelling leads to obstruction; severe obstruction leads to blockage, and blockage results in death. Investigating the twelve meridians, only the Foot Taiyang Bladder Meridian has a branch descending to the nape, while all others converge at the throat. Why does *Nei Jing* specifically state that the knotting of one Yin and one Yang causes Hou Bi? It is likely because the independent excess of Ju Huo and Xiang Huo causes heat to knot in the regular collaterals, resulting in rapid pain. I believe this can be summarized in one word: Fire. Therefore, in the twelve meridians, symptoms such as dry throat, sore throat, swollen throat, swollen mandible, and stiff tongue base are all caused by Ju Huo. Only Hou Bi, which develops rapidly, is caused by Xiang Huo. Ju Huo is like human fire, while Xiang Huo is like dragon fire. Human fire burning wood proceeds slowly; dragon fire burning wood proceeds rapidly. The Hou Bi mentioned in *Nei Jing* involves the area between the pharynx and the tongue, but since the pathology is identical regarding fire, no distinction is made. Later physicians described various conditions in detail and arbitrarily established eight names: Dan Ru E (Unilateral Tonsillar Abscess), Shuang Ru E (Bilateral Tonsillar Abscess), Dan Bi Hou (Unilateral Throat Closure), Shuang Bi Hou (Bilateral Throat Closure), Zi She Zhang (Sublingual Swelling), Mu She Zhang (Wooden Tongue Swelling), Chan Hou Feng (Throat-Encircling Wind), and Zou Ma Hou Bi (Galloping Horse Throat Obstruction). Heat rises and transmits to both sides of the throat near the exterior, causing swelling. Due to its shape resembling a moth's breast, it is called Ru E, occurring singly or doubly. Those slightly smaller than Ru E are called Bi Hou. Heat knotting under the tongue generates a small secondary tongue, called Zi She Zhang. Heat knotting in the middle of the tongue causes it to swell, called Mu She Zhang ("Mu" means stiff and unyielding). Heat knotting in the throat causes swelling surrounding the exterior, accompanied by numbness and itching; if large, it is called Chan Hou Feng. Sudden onset and sudden death in Hou Bi is called Zou Ma Hou Bi. Although these eight names are detailed, if they are not attributed to fire, they deviate significantly from the root cause. Mild cases can be treated with salty substances to soften hardness, and severe cases with pungent substances to disperse. Current physicians possess such herbs as Bohe (Mint), Wutou (Aconite Root), Jiangcan (Bombyx Batryticatus), Baifan (Alumen), Puxiao (Natrii Sulfas), and Tonglv (Chalcanthum). As for Zou Ma Hou Bi, why rely on these? Life and death hang in the balance. The method least likely to harm patients is bloodletting with Bian needles (stone needles); once blood flows, the disease resolves. The *I Ching* states "when blood leaves, fear departs," which is precisely this principle. Formerly, I treated a woman with Mu She Zhang whose tongue filled her mouth; other physicians failed to cure her. I ordered the use of small, sharp Bian needles to puncture the area five to seven times. After the swelling subsided, it took three days to fully resolve, and the estimated blood loss was nearly a dou (a unit of volume). I also treated a man with Chan Hou Feng, where swelling affected both interior and exterior, preventing oral medication. I administered cooling decoctions nasally, inducing more than ten bowel movements, and applied Baidu San (Detoxification Powder) externally. I roasted Yangqishi (Crocoitum) until red, mixed it with an equal amount of Fulonggan (Uterus of Hearth Earth), ground them into fine powder, and applied the mixture with fresh water one hundred times daily. After three days, the heat receded and swelling subsided. I once treated a noblewoman with Hou Bi, which was Dragon Fire. Although cooling formulas were used, they must not be taken cold; instead, the Dragon Fire should be driven out by fire. This "fire" refers to cooking fire. Thus, I had the patient ascend to a high hall under the scorching sun, with attendants carrying a stove and placing the medicine pot upon it, keeping the decoction extremely hot without boiling vigorously. The patient sipped the hot medicine continuously over one hundred times, causing the Dragon Fire to dissipate naturally. This method uses heat to administer cold properties, avoiding conflict with heat pathologies. Generally, bloodletting with needles is the supreme strategy for treating Hou Bi, yet people fear needles and seek alternative methods, leading to death in moments. For any needle-induced wounds, crushed ginger mixed with hot water should be sipped frequently to promote healing. Acupuncture charts also mention moxibustion, but it is suitable only for mild pain; for acute conditions, delay may be fatal. Treating the fire in Hou Bi is akin to fighting a fire; there is no room for delay. *Nei Jing* states "disperse fire stagnation," where "disperse" implies sweating. However, how can one induce sweating through the throat? Thus, bloodletting is essentially a form of dispersing sweat. Gentlemen of later generations should not cling to minor prescriptions claiming they do not affect the zang-fu organs and excel in bloodletting. If fortunate enough to succeed in minor illnesses but unfortunate to die from major ones, do not leave regrets.