花粉、牛蒡煎服，即痰涌声鼾。询知骤起，因服凉药增剧，此阴寒无疑也。但痰塞满口，难以进药，即取鹅翎
蘸桐油厘许，入喉一卷，随出痰升许，以肉桂、炮姜、生甘草各五分入碗内，以滚水冲浸，仍顿汤中，以匙
抄咽一口，病者即云好了。连呷三四口，即起说饥。问饭可吃否？曰∶食粥最宜。（同上。）
蒋仲芳治一友，始而牙痛，既而咽肿。医投凉药痛转甚。诊其脉沉细，大便一日二三次，曰∶浮火上升也，
其足必冷。察之果然。以《金匮》肾气料，作汤与之，服完即睡，觉来病如失。
刘云密治一女子，年五旬，素因血虚生热，血化风，患遍身疙瘩，经年未痊，久之，少阳相火并于阳明，
而患喉痹。其势暴盛，喉中陡似瘙痒作嗽，气上而呛，血泡累累，上 一泡大如鸡卵，口塞不能合，气壅上更
急。少顷，泡尽破，血射如注，其口皮尽脱，喉皆溃烂，红肿异常，痛不可忍，且满口痰涎，如羹如糊。盖热
壅于上，而大伤寒气也。用养阴退阳，活血祛风，兼以止痛之剂。缘汤难吞，为末，或吹或点，诸症渐退。然
溃处肌未生，痛未止，因皮破致时时作嗽，而血随出，乃于吹口药中，入白芨磨浆，合丸如芡实，日夜噙化遂愈。
叶天士治杨某之病。阴气走泄为虚，秽浊上受则实。咽喉肿痹，上窍蒙闭，日暮昏烦，阴伤火炽，肌肤
柔白，气分不足，医治虽宜凉解清上，但不可犯及中下。连翘、郁金、马勃、牛蒡、竹叶心、黑山栀、杏仁、橘红。
艾某上焦之病，都是气分，气窒则上下不通，而中宫遂胀，热气蒸灼，喉舌疳蚀。清气之中，必佐解毒。
银花二钱，川贝三钱，马兜铃五分，连翘心一钱半，川通草一钱，白金汁一杯，活水芦根汁半杯。
王某咽喉痛痹，发时如有物阻隔，甚至痛连心下，每晚加剧，是阴液日枯，肝脏厥阳化火风上灼。法以柔
剂，用甘以缓其急耳。细生地、天冬、阿胶、生鸡子黄、元参心、糯稻根须。
徐灵胎曰∶此症喉中，必有细瘰生成，不但气分窒痹也，非糁药无功。又曰∶凡病属于经络脏腑者，皆
煎丸之所能治。一属形体及九窍，则属有形之病。实有邪气凝结之处，药入胃中，不过气到耳，安能去凝
结之邪？故煎丸之功，不过居其半耳。若欲速效，必用外治之法，可以应手而愈。博考方书，广求秘法，
自能得之。外治之法，上古所鲜闻，因其用针灸之术，通神入妙，何必外治？此则外治之最者也。后世针
法不传，于是乎以药代针，而多外治之法。若针灸既废，而外治之法亦不讲，则天下之病，即使用药的当，只
能愈其半耳。其外症之必须外治者，竟无愈理，此亦医道之一大关也，后之学人须知之。
裴兆期治一人，咽喉痛，不能饮食，时作时止者半岁，吹喉消痰降火药咸罔效。裴诊之，两寸洪大而虚，
尺部虚而无力，两足喜暖畏寒，口喜冷冻饮料，甫下咽旋越去，此下真寒上假热也。治当从其性而伏之，用八味丸
料加炒黑干姜，水煎，入青盐少许为向导，冷而与之，三剂而愈。锡类散，治烂喉疹。象牙屑焙、廉珠各三分，
飞，青黛六分，梅花冰片三厘，壁钱二十个，（勿用木板上者。）西牛黄、人手指甲（男病用女，女病用男。）
各五厘。共研极细末，吹患处。兼治乳蛾、牙疳、舌腐等症。
莱菔菜于初冬摊瓦屋上，或挂树上，任其风吹日晒雨洗霜凌，直至立春前一日收下。悬挂檐下有风无日处，
久久愈佳。一切喉症，煎浓汤服立愈。兼治痢疾。
《广笔记》治火上升，有痰留滞喉间，如有核，且法宜降气清火。用苏子研二钱，橘红三钱，贝母三钱，天
花粉三钱，茯苓三钱，麦冬五钱，白芍酒炒三钱，黑连翘一钱五分，黄柏蜜炙一钱五分，五味子一钱，打碎水
煎，加竹沥服之。
服用天花粉、牛蒡子煎剂后，患者立即出现痰液涌出、呼吸有声如打鼾的症状。询问得知病情突然加重，是因为服用了寒凉药物所致，这显然是阴寒证无疑。但此时痰涎堵塞满口，难以服药，于是取鹅毛管蘸取少许桐油，伸入喉中卷动，随即吐出约一升痰液。随后取肉桂、炮姜、生甘草各五分放入碗中，用滚水冲泡浸泡，再将碗置于热水中保温，用勺子舀起少量让患者咽下，患者当即表示病愈。连续喝三四口后，患者起身表示饥饿。问是否可以吃饭？回答说：吃粥最合适。（同上。）
蒋仲芳治疗一位朋友，起初牙痛，随后咽喉肿胀。医生投用寒凉药物后疼痛反而加剧。诊察其脉象沉细，大便每日二三次，说：这是虚火上浮，其双脚必定发冷。观察果然如此。使用《金匮要略》中的肾气丸方料，煎汤给患者服用，服完即入睡，醒来时病已消失。
刘云密治疗一名女子，五十岁，素来因血虚而生热，血虚化风，患遍身疙瘩，经年未愈。久而久之，少阳相火并入阳明，导致患喉痹（咽喉肿痛闭塞之症）。病情暴发猛烈，喉中突然似瘙痒引发咳嗽，气逆呛咳，血泡累累，上方一个泡大如鸡蛋，口塞不能闭合，气壅于上更加急促。片刻后，血泡全部破裂，血液喷射如注，嘴唇皮肤全部脱落，咽喉皆溃烂，红肿异常，疼痛难忍，且满口痰涎，如羹如糊。这是因为热邪壅滞于上，而大伤寒气所致。采用养阴退阳、活血祛风，兼以止痛的药剂。因为汤药难以吞咽，改为研末，或吹入咽喉或点涂患处，诸症逐渐消退。然而溃烂处肌肉未生，疼痛未止，因皮肤破损导致时时咳嗽，且随咳出血，于是在吹喉药中加入白芨磨成的浆液，合制成如芡实大小的药丸，日夜含化，遂痊愈。
叶天士治疗杨某的病。阴气外泄为虚证，秽浊之气上受为实证。咽喉肿痹，上窍蒙闭，傍晚时分昏乱烦躁，阴伤火炽，肌肤柔白，气分不足。医治虽然适宜凉解清上，但不可侵犯中焦和下焦。用药：连翘、郁金、马勃、牛蒡子、竹叶心、黑山栀、杏仁、橘红。
艾某的上焦疾病，都属于气分病变，气机窒塞则上下不通，中焦脾胃遂致胀满，热气蒸灼，导致喉舌疳蚀（口腔黏膜溃疡腐烂）。在清气之中，必须佐以解毒之品。用药：银花二钱，川贝三钱，马兜铃五分，连翘心一钱半，川通草一钱，白金汁一杯，活水芦根汁半杯。
王某咽喉痛痹，发作时如有物阻隔，甚至痛连心下（胃脘部），每晚加剧，这是阴液日渐枯竭，肝脏厥阳化火生风上灼所致。治法应以柔剂为主，用甘味药以缓解急迫。用药：细生地、天冬、阿胶、生鸡子黄、元参心、糯稻根须。
徐灵胎说：此症喉中，必有细小的瘰疬生成，不仅仅是气分窒痹，非外用撒药无效。又说：凡是属于经络脏腑的疾病，都是煎剂和丸剂所能治疗的。一旦属于形体及九窍的疾病，则属于有形之病。实有邪气凝结之处，药物进入胃中，药效不过到达气分层面，怎能去除凝结之邪？所以煎剂和丸剂的功效，只能占一半。若想速效，必须使用外治之法，可以应手而愈。广泛考证方书，广求秘法，自然能得到这些方法。外治之法，上古时期很少听闻，因为那时主要使用针灸之术，通神入妙，何必需要外治？这则是外治法中最上乘的。后世针法失传，于是以药代针，从而产生了多种外治之法。如果针灸既已废弃，而外治之法也不讲究，那么天下的疾病，即使用药得当，也只能治愈一半。那些必须通过外治的外症，竟然没有治愈的道理，这也是医道的一大关键所在，后来的学医者须知晓这一点。
裴兆期治疗一人，咽喉痛，不能饮食，时好时坏半年了，吹喉消痰降火药均无效。裴诊察发现，两寸脉洪大而虚，尺部脉虚而无力，双足喜暖畏寒，口中喜欢冷冻饮料，但刚下咽旋即吐出，这是下真寒上假热之证。治当顺从其本性而伏制它，使用八味丸方料加炒黑干姜，水煎，加入少许青盐作为引经药，冷服，三剂而愈。锡类散，治疗烂喉疹。象牙屑焙干、珍珠各三分，飞研，青黛六分，梅花冰片三厘，壁钱二十个（不要用木板上的），西牛黄、人手指甲（男病用女指甲，女病用男指甲）各五厘。共研极细末，吹敷患处。兼治乳蛾、牙疳、舌腐等症。
莱菔菜（萝卜叶）在初冬摊在瓦屋上，或挂在树上，任凭风吹日晒雨淋霜冻，直到立春前一天收下。悬挂在有风无日处的屋檐下，存放越久越好。一切喉症，煎浓汤服用立愈。兼治痢疾。
《广笔记》治疗火气上升，有痰留滞喉间，如有核状，且治法宜降气清火。用药：苏子研碎二钱，橘红三钱，贝母三钱，天花粉三钱，茯苓三钱，麦冬五钱，白芍酒炒三钱，黑连翘一钱五分，黄柏蜜炙一钱五分，五味子一钱，打碎水煎，加竹沥服用。
After decocting and taking *Tianhuafen* (Trichosanthis Radix) and *Niubangzi* (Arctii Fructus), the patient immediately experienced surging phlegm and snoring-like breathing sounds. Upon inquiry, it was learned that the condition suddenly worsened due to the intake of cold-natured medicines; this is undoubtedly a Yin-cold syndrome. However, with phlegm obstructing the mouth, it was difficult to administer oral medication. Therefore, an goose feather tube dipped in a small amount of Tung oil (*Tungtongyou*) was inserted into the throat and rolled around, expelling approximately one sheng of phlegm. Subsequently, *Rougui* (Cinnamomi Cortex), *Paojiang* (Prepared Zingiberis Rhizoma), and *Sheng Gancao* (Raw Glycyrrhizae Radix et Rhizoma), each 5 fen, were placed in a bowl, steeped in boiling water, and kept warm by placing the bowl in hot water. A spoonful was scooped up for the patient to swallow, whereupon the patient immediately declared recovery. After swallowing three or four spoonfuls, the patient rose and expressed hunger. When asked if food could be eaten, the reply was: "Eating congee is most suitable." (Ibid.)
Jiang Zhongfang treated a friend who initially suffered from toothache, followed by swelling of the throat. The physician administered cold-natured medicines, which exacerbated the pain. Pulse diagnosis revealed a deep and fine pulse, with bowel movements occurring two to three times daily. It was diagnosed as floating fire ascending, with cold feet confirmed upon observation. The formula from *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet), Shengqi Wan (Kidney Qi Pill), was decocted and administered. After finishing the dose, the patient slept and woke up with the illness gone.
Liu Yunmi treated a fifty-year-old woman who had long suffered from heat generated by blood deficiency and wind transformed from blood deficiency, presenting as generalized nodules that had not healed for years. Over time, Shaoyang Ministerial Fire merged with Yangming, leading to Hou Bi (throat obstruction). The condition erupted violently; sudden itching in the throat triggered coughing, with rebellious Qi causing choking. Numerous blood blisters formed, one on top being as large as a chicken egg, blocking the mouth so it could not close, with Qi stagnating upward becoming more urgent. Shortly after, all blisters ruptured, shooting blood like a stream. The lip skin sloughed off completely, and the throat became ulcerated with extreme redness and swelling, unbearable pain, and a mouth full of phlegm and saliva resembling gruel. This resulted from heat stagnating above and severe damage to cold Qi. Treatment employed formulas to nourish Yin, retreat Yang, invigorate blood, dispel wind, and relieve pain. Since decoctions were hard to swallow, the medicine was ground into powder and either insufflated or applied locally. Symptoms gradually subsided. However, since the ulcerated tissue had not regenerated and pain persisted, causing frequent coughing and bleeding due to broken skin, Baiji paste (from *Baiji*, Bletillae Rhizoma) was added to the insufflation powder, formed into pills the size of Euryale seeds, and held in the mouth day and night until cured.
Ye Tianshi treated a patient named Yang. Leakage of Yin Qi constitutes deficiency; reception of turbid pathogens constitutes excess. Swollen and obstructed throat, upper orifices blocked, evening confusion and irritability, Yin injury with blazing fire, soft and white skin, insufficient Qi in the Qi level. Although treatment should involve cooling and clearing the upper jiao, the Middle and Lower Jiao must not be violated. Herbs: Qiaoliang (Forsythiae Fructus), Yujin (Curcumae Radix), Mabo (Belamcandae Flos), Niubangzi (Arctii Fructus), Zhuyexin (Centenii Caulis), Hei Shanzhi (Charred Gardeniae Fructus), Xingren (Armeniacae Semen Amarum), Juhong (Citri Reticulatae Pericarpium Rubrum).
Patient Ai's upper jiao diseases all belonged to the Qi level. Qi stagnation caused blockage between upper and lower parts, leading to distension in the Middle Palace (Spleen/Stomach). Steaming heat scorched the throat and tongue, causing gan erosion (ulceration). In clearing Qi, detoxifying agents must be assisted. Herbs: Yinhua (Lonicerae Japonicae Flos) 2 qian, Chuanbei (Fritillariae Cirrhosae Bulbus) 3 qian, Madoulings (Aristolochiae Radix) 5 fen, Liaoqiaoxin (Forsythiae Caulis) 1.5 qian, Chuantongcao (Tetrapanacis Medulla) 1 qian, Baijinzhi (Platinum Juice) 1 cup, Huoshui Lugenzhi (Fresh Phragmitis Rhizoma Juice) half cup.
Patient Wang suffered from painful throat obstruction. At onset, it felt like something was blocking the passage, even radiating pain to the Xin Xia (epigastrium), worsening every night. This indicated daily depletion of Yin fluids, with Liver Jue-Yang transforming into fire and wind scorching upwards. The method should use soft agents, employing sweet flavors to relieve urgency. Herbs: Xi Shengdi (Rehmanniae Radix Preparata), Tiandong (Asparagi Radix), Ejiao (Colla Corii Asini), Sheng Jizihuang (Raw Chicken Egg Yolk), Yuanxuanxin (Scrophulariae Radix Stamen), Nuodaogenxu (Oryzae Sativa Radix Fibra).
Xu Lingtai stated: In this condition, there must be small lumps (luoli) forming in the throat; it is not merely Qi-level obstruction. External insufflation is ineffective without specific powders. He also said: Diseases belonging to meridians and zang-fu organs can be treated by decoctions and pills. Once the disease belongs to the body form and nine orifices, it becomes a tangible disease. Where pathogenic factors actually condense, drugs entering the stomach only reach the Qi level; how can they remove condensed pathogens? Thus, the efficacy of decoctions and pills accounts for only half. To achieve rapid results, external treatment methods must be used, which can cure promptly. Extensively consulting medical texts and seeking secret methods will naturally yield these approaches. External treatments were rarely heard of in ancient times because acupuncture and moxibustion were used, achieving miraculous results, making external topical treatments unnecessary. This represents the highest form of external treatment. Later generations lost the transmission of needle techniques, substituting drugs for needles, thereby developing many external treatment methods. If both acupuncture and external treatments are neglected, even with appropriate internal medication, only half the diseases can be cured. External symptoms requiring external treatment would have no chance of cure. This is a major critical point in medical practice, which future students must understand.
Pei Zhaoqi treated a person with sore throat unable to eat, intermittent for half a year, where throat insufflations for resolving phlegm and descending fire were ineffective. Pei's diagnosis showed surging yet empty pulses at both Cun positions, empty and weak pulses at Chi positions, preference for warmth and aversion to cold in both feet, and desire for cold drinks that were spat out immediately upon swallowing. This was true cold below and false heat above. Treatment should follow its nature to subdue it. Formula: Bajie Wan (Eight-Ingredient Pill) base plus stir-fried black Ganjiang (Zingiberis Rhizoma), decocted in water, with a little Qingyan (Natrii Chloridum) added as a guiding drug, served cold. Three doses resulted in cure. Xile San (Golden Powder for Throat) treats rotten throat and rashes. Ivory chips calcined, Pearl (Zhenzhu) each 3 fen, processed; Qingdai (Indigo Naturalis) 6 fen; Meihua Bingpian (Borneolum Syntheticum) 3 li; Biqian (Cellar Spider Web) 20 pieces (not those from wooden boards); Xiniu Huang (Bovis Calculus) and human fingernails (female nails for male patients, male nails for female patients) each 5 li. Grind into extremely fine powder and insufflate onto the affected area. Also treats Ru'e (tonsillitis), Ya'gan (gum erosion), and Shefu (tongue decay).
Laifan Cai (Radish leaves) spread on tiled roofs in early winter, or hung on trees, exposed to wind, sun, rain, and frost until the day before Li Chun (Start of Spring). Hang them in eaves where there is wind but no sun; the longer stored, the better. For all throat conditions, decoct into a strong soup and drink for immediate cure. Also treats dysentery.
*Guang Biji* treats rising fire with phlegm滞留 (retained) in the throat, feeling like a nodule. The method should descend Qi and clear fire. Herbs: Suzi (Perillae Fructus) crushed 2 qian, Juhong (Citri Reticulatae Pericarpium Rubrum) 3 qian, Beimu (Fritillariae Bulbus) 3 qian, Tianhuafen (Trichosanthis Radix) 3 qian, Fuling (Poria) 3 qian, Maidong (Ophiopogonis Radix) 5 qian, Baishao (Paeoniae Radix Alba) wine-fried 3 qian, Hei Liaoqiao (Charred Forsythiae Fructus) 1.5 qian, Huangbai (Phellodendri Cortex) honey-fried 1.5 qian, Wuweizi (Schisandrae Fructus) 1 qian, crushed and decocted in water, taken with Zhuli (Bambusa Textilis Sap).