咽（在喉之前，所以咽物。杨上善谓∶喉咙之后属咽者非）。属手太阳小肠，少阴心，足太
阴脾，厥阴肝经之会。（《素问》曰∶咽主地气，地气通于隘，足太阴脉布胃中，络于嗌，故病则腹满
而嗌干。《灵枢》曰∶足太阴之正，上结于咽）。又属足少阴肾经。（《灵枢》曰∶足少阴所生病者，
口热舌干，咽肿上气，嗌干及痛。《素问》曰∶邪客于足少阴之络，令人嗌痛，不可内食，无故善怒，
气上走贲上。注∶贲，鬲也。贲上，贲门也。《难经》胃为贲门。旧注∶气奔而上者非。朱丹溪曰∶
手足阴阳合生见证曰，咽肿，足少阴厥阴）。又属足阳明胃经。（《灵枢》曰∶阳明之脉上通于心，
上循咽，出于口）。又属足厥阴肝，少阳胆经。（《素问》曰∶肝者中之将也，取决于胆，咽为之使。
《灵枢》曰∶足少阳之正，上挟咽，出颐颔。《素问》又曰∶一阴，一阳代绝，此阴气至心，上下无常，
出入不知，喉
咽干燥，病在脾土。注∶一阴厥阴脉，一阳少阳脉，并木之气也。木克土，故咽喉病虽在脾上，实
由肝胆之所为也）。侠咽属手少阴心，足太阴脾经之会。喉（在咽之后，所以候气）。属手
太阴肺，足阳明胃，少阴肾，厥阴肝经，任脉之会。（《灵枢》曰∶手太阴之正，出缺盆，循喉咙。
《素问》曰∶喉主天气，天气通于肺，谓之肺系）。又属手少阴心，少阳三焦经。（《灵枢》曰∶手
少阴之正，上走喉咙，出于面。《素问》曰∶心咳之状，咳则心痛，喉仲介介如哽状，甚则咽肿喉痹。
张洁古曰∶三焦通喉，喉和则声鸣利，不和则暴喑热闭。《素问》又曰∶邪客于手少阳之络，令人喉
痹舌卷，口干心烦。又曰∶运气少阳所至为喉痹，耳鸣，呕涌。又曰∶一阴一阳结，谓之喉痹。注∶
一阴手少阴心也，一阳手少阳三焦也，二脉并络于喉，气热内结，故为喉痹）。又属手足阳明大肠胃，
手少阳三焦经之合。（《灵枢》曰∶手阳明之正，上循喉咙，出缺盆。又曰∶喉痹不能言，取足阳明，
能言取手阳明。《素问》曰∶手阳明、少阳厥逆，发喉痹嗌肿， 。注∶ 谓骨强而不随也。朱丹溪
曰∶手足阴阳经合生见证曰，喉痹，手足阳明、手少阳）。又属足太阴脾经。（《千金方》曰∶喉咙者，
脾胃之候也）。喉咙后属手厥阴心包经。结喉两旁应手大动脉（名人迎脉，一名五会）。属
足阳明胃经。（《内经》曰∶颈侧侠喉之动脉人迎，人迎足阳明胃脉也。阳明者常动。注∶动谓动于
结喉旁也。《素问》曰∶其脉之动，常左小而右大，左小常以候脏，右大常以候腑。按∶此动字与上
文不同，谓左右手二脉之动也）。人迎后属手阳明大肠经。经云∶咽喉者，
水谷之道也。喉咙者，气之所以上下者也。会厌者，音声之户也。悬雍者，音声之关也。咽与喉，会
厌与舌，此四者同在一门，而其用各异。喉以纳气，故喉气通于天。咽以纳食，故咽气通于地。会厌
管乎其上，以司开阖，掩其厌则食下，不掩其喉必错。必舌抵上 ，则会厌能闭其喉矣。四者交相为
用，缺一则饮食废而死矣。或问咽喉有痹有肿，二者之外，又有缠喉风、乳鹅生疮诸病，何邪致之，
何经病之，与治法大略，愿闻其说。曰∶十二经脉皆上循咽喉，尽得以病之，然统其所属者，乃在君
相二火。何则？经曰∶喉主天气，咽主地气。又曰∶诸逆冲上，皆属于火是也。盖肺主气天也，脾主
食地也，于是喉纳气，咽纳食。纳气者从金化，纳食者从土化。金性燥，土性湿。至于病也，金化变
动为燥，燥则涩，涩则闭塞而不仁，故在喉谓之痹。土化变动为湿，湿则泥，泥则壅胀而不通，故在
咽谓之肿。痹肿之病虽少异，然一时火郁于上焦，致痰涎气血聚结于咽喉也。自其咽肿形状分之，则
有缠喉风、乳蛾之名。缠喉风者，其肿透达于外，且麻且痒且痛。乳蛾者，肿于咽两傍，名双乳蛾；
一边肿者，名单乳蛾。喉痹之暴发暴死者，名走马喉痹。《内经》又有嗌塞咽喉干者，亦皆因诸经所
致，中间虽有经气之寒热不等，其为火证一也。大
抵治法，视火微甚，微则正治，甚则反治，撩痰出血，三者随宜而施，或更于手大指少商出血行气。
若肿达于外者，又必外敷以药。予尝治是证，每用鹅翎蘸米醋缴喉中，摘去其痰。盖醋味酸能收，其
痰随翎而出，又能消积血。若乳蛾甚而不散，上以小刀就蛾上刺血，用马牙硝吹点咽喉，以退火邪。
服射干、青黛、甘、桔、栀、芩、矾石、恶实、大黄之类，随其攸利为方，以散上焦之热。外所敷药，
如生地龙、韭根、伏龙肝之类皆可用。若夫生疮，或白或赤，其白者多涎，赤者多血，大率与口疮同
例，如蔷薇根皮、黄柏、青黛煎噙细咽亦佳。凡经云喉痹者，谓喉中呼吸不通，言语不出，而天气闭
塞也。云咽痛、云嗌痛者，谓咽喉不能纳唾与食，而地气闭塞也。云喉痹咽嗌痛者，谓咽喉俱病，天
地之气并闭塞也。盖病喉痹者，必兼咽嗌痛，病咽嗌痛者，未必兼喉痹也。
咽（位于喉的前方，因此用于吞咽食物。杨上善认为：喉咙之后属于咽的说法是不对的）。咽是手太阳小肠经、足少阴心经、足太阴脾经、足厥阴肝经的交会之处。（《素问》说：咽主接地气，地气通过咽喉通道与人体相通，足太阴脾经散布于胃中，联络于咽部，所以生病时会出现腹部胀满和咽干的症状。《灵枢》说：足太阴脾经的正经，向上结聚于咽部）。又属于足少阴肾经。（《灵枢》说：足少阴肾经所生的疾病，包括口热舌干、咽喉肿痛、气逆上冲、咽干及疼痛。《素问》说：邪气侵犯足少阴肾经的络脉，使人咽喉疼痛，无法进食，无故容易发怒，气向上冲击贲门。注：贲，即膈肌。贲上，即贲门。《难经》称胃的上口为贲门。旧注认为“气奔而上”的说法不对。朱丹溪说：手足阴阳经合生见证曰，咽喉肿痛，涉及足少阴和足厥阴经）。又属于足阳明胃经。（《灵枢》说：阳明经的经脉向上通达于心，沿咽部上行，出于口部）。又属于足厥阴肝经、足少阳胆经。（《素问》说：肝是将帅之官，取决于胆，咽喉作为其使者发挥作用。《灵枢》说：足少阳胆经的正经，向上夹持咽部，出于下颌。《素问》又说：一阴（厥阴）和一阳（少阳）交替断绝，这是阴气上达于心，上下无常，出入不知，导致咽喉干燥，病在脾土。注：一阴指厥阴脉，一阳指少阳脉，都含有木之气。木克土，所以咽喉病虽然表现在脾，实际上是由肝胆引起的）。侠咽处是手少阴心经、足太阴脾经的交会之处。
喉（位于咽的后方，因此用于候察气息）。喉是手太阴肺经、足阳明胃经、足少阴肾经、足厥阴肝经、任脉的交会之处。（《灵枢》说：手太阴肺经的正经，出于缺盆，沿喉咙上行。《素问》说：喉主接天气，天气通过肺与人体相通，这称为肺系）。又属于手少阴心经、手少阳三焦经。（《灵枢》说：手少阴心经的正经，向上走至喉咙，出于面部。《素问》说：心咳的症状，咳嗽时心痛，喉咙感觉像有异物梗塞，严重时咽喉肿痛、喉痹。张洁古说：三焦通连咽喉，喉气和顺则声音洪亮通畅，不和顺则突然失音、热闭。《素问》又说：邪气侵犯手少阳三焦经的络脉，使人患喉痹、舌卷、口干、心烦。又说：运气学说中，少阳之气所致病症表现为喉痹、耳鸣、呕吐涌逆。又说：一阴一阳结滞，称为喉痹。注：一阴指手少阴心经，一阳指手少阳三焦经，这两条经脉都络属咽喉，气热内结，所以形成喉痹）。又属于手足阳明大肠经、胃经，以及手少阳三焦经的合会之处。（《灵枢》说：手阳明大肠经的正经，向上沿喉咙，出于缺盆。又说：患喉痹不能说话的，取足阳明经穴位；能说话的，取手阳明经穴位。《素问》说：手阳明、少阳经气厥逆，引发喉痹、咽肿。注：此处指骨强直而不随动。朱丹溪说：手足阴阳经合生见证曰，喉痹，涉及手足阳明经、手少阳经）。又属于足太阴脾经。（《千金方》说：喉咙是脾胃功能的征候）。喉咙后方属于手厥阴心包经。结喉两旁可触及的大动脉（名为人迎脉，又名五会）。属于足阳明胃经。（《内经》说：颈部侧面挟持喉咙的动脉是人迎穴，人迎穴属于足阳明胃经。阳明经常跳动。注：动是指跳动在结喉旁边。《素问》说：其脉搏跳动，通常左侧小右侧大，左侧小常用来诊察脏病，右侧大常用来诊察腑病。按：此处的“动”字与上文不同，指的是左右手两条脉搏的跳动）。人迎穴后方属于手阳明大肠经。医经说：咽喉是水谷通行的道路。喉咙是气息上下通行的地方。会厌是声音发出的门户。悬雍垂是声音发出的关卡。咽与喉、会厌与舌，这四者同在一处，但功能各异。喉用来接纳气息，所以喉气通天。咽用来接纳食物，所以咽气通地。会厌管理上方，主管开合，掩蔽会厌则食物下行，不掩蔽则会误入喉中。必须舌尖抵住上腭，会厌才能关闭喉口。四者相互为用，缺少任何一个都会导致饮食废绝而死亡。
有人问：咽喉有痹症和肿症，在这两种之外，又有缠喉风、乳蛾生疮等各种疾病，是什么邪气导致的？属于哪条经络病变？治疗方法的概要，希望听听您的见解。回答说：十二经脉都向上循行经过咽喉，都能导致这些疾病，然而统摄所属的，主要在于君火和相火。为什么呢？医经说：喉主天气，咽主地气。又说：各种气逆冲上的症状，都属于火。肺主气，对应天；脾主食，对应地。于是喉纳气，咽纳食。纳气的过程从金化，纳食的过程从土化。金的性质燥，土的性质湿。至于发病时，金的变化转为燥，燥则涩滞，涩滞则闭塞且麻木不仁，所以在喉称为痹。土的变化转为湿，湿则黏腻，黏腻则壅胀且不通畅，所以在咽称为肿。痹和肿的病证虽然略有不同，但都是因为一时火郁结在上焦，导致痰涎气血聚结于咽喉。从咽肿的形状来区分，就有缠喉风、乳蛾的名称。缠喉风，其肿胀透达外部，并且伴有麻木、瘙痒和疼痛。乳蛾，肿胀在咽部两侧，名为双乳蛾；一边肿胀的，名为单乳蛾。喉痹突然发作并迅速死亡的，名为走马喉痹。《内经》中还有提到嗌塞、咽喉干的，也都是因为各条经脉所致，中间虽然有经气寒热的不同，但本质上都是火证。
大致治疗方法，视火的轻重而定，火轻则用正治法，火重则用反治法，撩除痰液、放血，这三种方法根据情况施用，或者在大拇指少商穴放血以行气。如果肿胀透达外部，还必须外敷药物。我曾治疗这类病症，常用鹅毛蘸米醋伸入喉中，挑出痰液。因为醋味酸能收敛，痰液随鹅毛而出，又能消散积血。如果乳蛾严重且不消散，用小刀在蛾上刺血，用马牙硝吹点咽喉，以退火邪。服用射干、青黛、甘草、桔梗、栀子、黄芩、矾石、牛蒡子、大黄等药物，根据其适宜性组方，以疏散上焦的热邪。外敷的药物，如生地龙、韭菜根、伏龙肝等都可用。如果是生疮，或白或红，白色的多伴有多涎，红色的多伴有多血，大体与口疮相同，用蔷薇根皮、黄柏、青黛煎煮含漱细细咽下也很好。凡是医经所说的喉痹，是指喉中呼吸不通，言语不出，天气闭塞。说的咽痛、嗌痛，是指咽喉不能吞咽唾液和食物，地气闭塞。说的喉痹咽嗌痛，是指咽喉都患病，天地之气都闭塞。患喉痹的人，一定兼有咽嗌痛；患咽嗌痛的人，未必兼有喉痹。
The pharynx (located anterior to the larynx, thus used for swallowing food. Yang Shangshan stated that the area posterior to the glottis belongs to the pharynx is incorrect). It is the convergence point of the Hand-Taiyang Small Intestine Meridian, Foot-Shaoyin Heart Meridian, Foot-Taiyin Spleen Meridian, and Foot-Jueyin Liver Meridian. (*Suwen* states: The pharynx governs Earth Qi; Earth Qi connects through the orifice. The Foot-Taiyin Meridian spreads in the stomach and connects with the epiglottis/pharynx, so disease manifests as abdominal fullness and dry throat. *Ling Shu* states: The regular branch of the Foot-Taiyin ascends and knots at the pharynx). It also belongs to the Foot-Shaoyin Kidney Meridian. (*Ling Shu* states: Diseases generated by the Foot-Shaoyin include heat in the mouth and tongue, dry tongue, swelling of the throat, ascending Qi, dry and painful throat. *Suwen* states: When pathogenic factors invade the collateral of the Foot-Shaoyin, it causes throat pain, inability to ingest food, spontaneous anger, and Qi moving upward to the cardia. Note: "Ben" refers to the diaphragm. "Ben shang" refers to the cardia. *Nanjing* calls the upper opening of the stomach the cardia. Old annotations claiming "Qi rushing upward" is incorrect. Zhu Danxi stated: Manifestations from the combination of Hand and Foot Yin-Yang meridians include throat swelling, involving the Foot-Shaoyin and Foot-Jueyin meridians). It also belongs to the Foot-Yangming Stomach Meridian. (*Ling Shu* states: The Yangming Meridian ascends to connect with the heart, follows the pharynx, and emerges from the mouth). It also belongs to the Foot-Jueyin Liver Meridian and Foot-Shaoyang Gallbladder Meridian. (*Suwen* states: The Liver is the general, decisions are made by the Gallbladder, and the throat serves as its envoy. *Ling Shu* states: The regular branch of the Foot-Shaoyang ascends flanking the pharynx and emerges from the jaw. *Suwen* further states: When one Yin (Jueyin) and one Yang (Shaoyang) alternate and cease, this Yin Qi reaches the heart, moving up and down without constancy, entering and exiting unknowingly, causing dry throat and pharynx, with the pathology in Spleen-Earth. Note: One Yin refers to the Jueyin meridian, One Yang refers to the Shaoyang meridian, both possessing Wood Qi. Wood overcomes Earth, therefore although throat diseases manifest on the Spleen, they are actually caused by the Liver and Gallbladder). The area flanking the pharynx is the convergence of the Hand-Shaoyin Heart Meridian and Foot-Taiyin Spleen Meridian.
The larynx (located posterior to the pharynx, thus used for monitoring Qi). It is the convergence point of the Hand-Taiyin Lung Meridian, Foot-Yangming Stomach Meridian, Foot-Shaoyin Kidney Meridian, Foot-Jueyin Liver Meridian, and Ren Mai (Conception Vessel). (*Ling Shu* states: The regular branch of the Hand-Taiyin emerges from the supraclavicular fossa and follows the larynx. *Suwen* states: The larynx governs Heaven Qi; Heaven Qi connects through the Lung, termed the Lung System). It also belongs to the Hand-Shaoyin Heart Meridian and Hand-Shaoyang Sanjiao Meridian. (*Ling Shu* states: The regular branch of the Hand-Shaoyin ascends to the larynx and emerges on the face. *Suwen* states: In Heart Cough, coughing causes heart pain, a sensation of something stuck in the throat like a fishbone, and severely, throat swelling and Bi syndrome. Zhang Jiegu stated: The Sanjiao connects to the larynx; when Laryngeal Qi is harmonious, voice is clear and smooth; when disharmonious, sudden aphonia and heat obstruction occur. *Suwen* further states: Pathogenic factors invading the collateral of the Hand-Shaoyang cause throat Bi, curled tongue, dry mouth, and vexation. It also states: In Six Qi transformations, the arrival of Shaoyang results in throat Bi, tinnitus, and vomiting/urge. It also states: When one Yin and one Yang knot together, it is called throat Bi. Note: One Yin refers to the Hand-Shaoyin Heart Meridian, One Yang refers to the Hand-Shaoyang Sanjiao Meridian; these two meridians both network the larynx, and internal knotting of Qi-Heat causes throat Bi). It also converges with the Hand-Yangming Large Intestine Meridian, Foot-Yangming Stomach Meridian, and Hand-Shaoyang Sanjiao Meridian. (*Ling Shu* states: The regular branch of the Hand-Yangming ascends along the larynx and emerges from the supraclavicular fossa. It also states: For throat Bi with inability to speak, select Foot-Yangming points; if able to speak, select Hand-Yangming points. *Suwen* states: Reversal of Qi in the Hand-Yangming and Shaoyang meridians triggers throat Bi and pharyngeal swelling. Note: This refers to rigidity of bones and lack of mobility. Zhu Danxi stated: Manifestations from the combination of Hand and Foot Yin-Yang meridians include throat Bi, involving the Hand and Foot Yangming meridians and Hand-Shaoyang meridian). It also belongs to the Foot-Taiyin Spleen Meridian. (*Qianjin Fang* states: The larynx is the indicator of Spleen and Stomach function). The posterior aspect of the larynx belongs to the Hand-Jueyin Pericardium Meridian. The large artery palpable on both sides of the thyroid cartilage (known as the Renying pulse, or Wuhui) belongs to the Foot-Yangming Stomach Meridian. (*Neijing* states: The artery on the side of the neck flanking the larynx is Renying, which belongs to the Foot-Yangming Stomach Meridian. The Yangming Meridian constantly moves. Note: "Move" refers to pulsation beside the thyroid cartilage. *Suwen* states: Its pulse movement is usually smaller on the left and larger on the right; the smaller left pulse often diagnoses Zang diseases, and the larger right pulse often diagnoses Fu diseases. Commentary: This "movement" differs from the previous text, referring to the pulsation of the arteries in both left and right wrists). Posterior to Renying belongs the Hand-Yangming Large Intestine Meridian. Medical classics state: The throat and pharynx are the pathways for water and grain. The larynx is where Qi ascends and descends. The epiglottis is the gate of sound. The uvula is the hinge of sound. The pharynx and larynx, epiglottis and tongue, these four exist in the same chamber but have different functions. The larynx accepts Qi, thus Laryngeal Qi connects to Heaven. The pharynx accepts food, thus Pharyngeal Qi connects to Earth. The epiglottis manages the upper part, controlling opening and closing; covering the epiglottis allows food to descend, while failing to cover it leads to aspiration. If the tongue presses against the hard palate, the epiglottis can close the larynx. These four interact mutually; lacking any one leads to the cessation of diet and death.
A question was posed: Besides Bi syndrome and swelling in the throat and pharynx, there are other diseases such as Chan Hou Feng (Throat-Wrapping Wind) and Ru E (Mamillary Pappus/Tonsillitis) with ulcers. What pathogenic factors cause them? Which meridians are involved? What are the general treatment methods? Please explain. The answer is: All twelve meridians ascend along the throat and pharynx and can cause disease, but generally, they are governed by Ministerial Fire and Sovereign Fire. Why? Classics state: The larynx governs Heaven Qi, the pharynx governs Earth Qi. It also states: All rebellious Qi rushing upward belongs to Fire. The Lung governs Qi (Heaven), the Spleen governs Food (Earth). Thus, the larynx accepts Qi, and the pharynx accepts food. Accepting Qi transforms via Metal; accepting food transforms via Earth. Metal's nature is Dryness; Earth's nature is Dampness. Upon disease, Metal transformation changes to Dryness; Dryness causes astringency, astringency causes blockage and numbness, hence in the larynx it is called Bi. Earth transformation changes to Dampness; Dampness causes stickiness, stickiness causes congestion and distension without unblocking, hence in the pharynx it is called swelling. Although Bi and swelling differ slightly, they are both caused by temporary Fire stagnation in the Upper Jiao, leading to the accumulation of Phlegm-Saliva, Qi, and Blood in the throat and pharynx. Differentiating by the shape of pharyngeal swelling yields the names Chan Hou Feng and Ru E. Chan Hou Feng involves swelling penetrating outward, accompanied by numbness, itching, and pain. Ru E involves swelling on both sides of the pharynx, named Double Ru E; swelling on one side is Single Ru E. Throat Bi that strikes suddenly and causes rapid death is called Zou Ma Hou Bi (Running-Horse Throat Bi). *Neijing* also mentions obstruction in the epiglottis and dry throat/pharynx, all caused by various meridians; although there may be differences in Cold or Heat of Meridian Qi, they are essentially Fire syndromes.
Generally, treatment depends on the severity of Fire: mild cases use direct treatment, severe cases use reverse treatment. Methods include removing phlegm, bleeding, and others applied as appropriate, or bleeding the Shaoshang point on the thumb to move Qi. If swelling penetrates outward, external application of medicine is necessary. I have treated this condition using a goose feather dipped in rice vinegar to swab the throat and remove phlegm. Vinegar is sour and astringent; phlegm exits with the feather, and it also resolves blood stasis. If Ru E is severe and does not resolve, prick the tonsil with a small knife to bleed, apply Natrii Sulfas (Maxiya Xiao) to the throat to reduce Fire. Decoctions containing Belamcandae Rhizoma (Shegan), Indigo Naturalis (Qingdai), Glycyrrhizae Radix et Rhizoma (Gancao), Platycodonis Radix (Jiegeng), Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin), Alumen (Fanshi), Arctii Fructus (Efang), and Rhei Radix et Rhizoma (Dahuang) are prescribed according to suitability to disperse Upper Jiao Heat. External applications include Lumbricus (Sheng Dilong), Allii Tuberosi Bulbus (Jiu Gen), and Longan Earth (Fulong Gan). If ulcers form, appearing white or red, white ones often involve excess saliva, red ones excess blood; generally similar to oral ulcers. Decocting Rosae Rugosae Cortex (Qiangweigenpi), Phellodendri Cortex (Huangbai), and Indigo Naturalis (Qingdai) for holding in the mouth and swallowing slowly is also effective. Whenever classics mention "Hou Bi," they refer to blocked breathing in the larynx, inability to speak, and closure of Heaven Qi. "Yan Tong" or "Ai Tong" refers to the inability to swallow saliva and food due to closure of Earth Qi. "Hou Bi Yan Ai Tong" refers to disease in both larynx and pharynx, with closure of both Heaven and Earth Qi. Those with Hou Bi must have Yan Ai Tong, but those with Yan Ai Tong do not necessarily have Hou Bi.