书云∶咽喉十八症，皆属于火，此言其大略也。然火有虚实之分，证有寒热之别，尤有内因、外因之殊，及
看舌胎苍老娇嫩之辨，临证审明，复切脉之虚实，有力，无力脉与症合，然后立方施治，未可概执为风热实症
也。今时之人，本质肾阴不足居多，而喉症属实者少。或虚中兼实，实中兼虚，或下焦阴火发为咽痛口疮者，亦
复不少。然六气之中，感发喉患，不独风寒与火，而暑湿燥亦然。唯暑湿成咽痛者
特稀，每感燥而发者多，盖因肾水不足故也。若临证不辨明，一见发热，便施表散，凡属风者，虽得其宜，或由
寒者，则非辛温不可。其属火者，固宜清降，亦当辨其虚实与郁，唯实火宜清降，虚火则当壮水，郁火则宜升发，
至湿与燥，又岂可表散耶！在他症虚实或难辨，而喉症最最易明，可一望而虚实立判，盖有形可据，有色可参，
有舌胎可辨。且痰涎有清浊之分，必须临证者，潜心参究，乃得其窍。至于机巧权变，虽存乎其人，亦要从方脉
中理会得来，庶无贻误耳。
一家传喉科，虽有三十六证之名，而治法不外紫地汤一方，何也？缘三十六症，皆由风热壅塞于上焦，触感
而发，骤起疼痛，形症各别，所属则同，故以一方统治之。如果系风热实症，根据法疗之，无不应手而愈。若属虚
症，及感燥而致者，必不见效。倘执呆方，定多贻误也。
一实症起，初发热恶寒，头疼，喉内红肿有形，而痛不能饮水，痰涎多稠，按脉浮数有力，舌色苍老坚敛而
黄，咽间闭塞，大小便或亦闭结，乃极重之症。可用风路针针少商、少冲、合谷及风池、囟会数处，其余诸穴，
不可妄针。原用针者，急泻其内蕴之热，即发汗之义，故不宜多针。其次用辛乌散，取吐痰涎，使蕴热之邪从涎
而出，吹回生丹以散其热结之痹，服紫地汤宣通肺胃风热之壅实。若大便闭者，加玄明粉降火祛热，消痰涎，去
脏腑宿滞，皆从大便而出。汗吐下三法合治，乃分三路以泻之，盖因咽喉为关要，失治则闭。又恐风热毒邪内攻，
缓则不及。凡实症必须根据法而治之，如属虚证，则断乎不可。
一初起似疟，怯寒发热者，乃喉患之本象也，并非外感风寒，切勿妄用羌独活、秦艽、苏叶、桂枝等味，盖
喉患本发于脏腑，非太阳膀胱表症也。若谓开首必须表散，以为层次治
法，此依稀影响之医从事俗见，究无根柢之学，殊不知火被升散而愈炽热，得辛温更致阳盛则闭，必轻则致重，
重则致危，莫可挽救。且《沈氏尊生集》亦言，喉症最忌发表。无论初起恶寒发热与否，只须辛凉而散兼养阴以
制之，不必祛热而热自除，喉患亦渐松减。乃阅历已久，验效且多，故敢语此。
一初发热不恶寒，咽间微痛，或红肿而色淡，或肿处皮色带亮，或肿而色赤不润，痰涎清薄且少，皆属虚候，
及下焦阴火，或由感燥而发，乃本于水亏，不能制火故也。经云∶骤起非火，缓起非寒而实热虚寒务须审，确有
似实而非实者，必须证之以脉。惟浮数有力者，方为实症。若细数无力，或右部大于左，更属虚症矣。而紫地汤、
辛乌散，皆不可用，即回生丹，亦不宜吹。只用青雪丹治以辛凉而散，兼采养阴法，自更获效矣。
一辛乌散。惟实症之必需其取痰涎最速，能提拔风热外出，即《内经》高者因而越之之义，一兼虚候，切勿
用之，反伤津液而症反加重，犹如伤寒治法，须存津液为要。辛乌散乃劫夺救急之法，果系实症，立刻取痰涎，
开关利喉，故应效最快，惟虚证乃属内因焉，可耗及津液，是以不宜用。且近来遇用辛乌散之症实少，百中不过
二三，大与曩昔有异，岂可执诸呆方而不知权变乎！
一是症不得以痰涎多寡论虚实。有虚候而涎多者，亦有实症而涎多者，有实症涎少者，亦有虚候涎少者。但
看涎之稠浊与清薄之别，凡临症于吹药时，可审其虚实。如果实症，其涎流出必稠浊而长，不断其气秽。若属虚
症，其涎吐出清薄而短。又有吹药后而无涎者，此津液为火所灼。更有感燥气而致喉患者，痰涎愈少，而治法尤
须养阴为要。若执定风热闭塞，妄用升散解毒，则大谬矣。
一喉患大小便闭结，最为重候，必须审明虚实，不可妄用攻下。有因表散过剂伤及津液，以致大便艰者；有
风热壅闭于上而不大便者；有值燥金之令，伤于燥而不便者；惟是实
症可下。若初起或大便闭结，亦不宜即下，须过二三日，看病患形色与夫喉间松减，而大便仍未解，可用玄明粉
下之，导热毒下行，即釜底抽薪之法也。本科只用玄明粉而不用大黄者，因其性峻烈威猛，恐伤真气，惟玄明粉
味辛微甘，能降心火，祛胃热，消痰涎，去胸膈脏腑宿滞，且消痈肿。若兼虚症者，即不宜用，必须润下法，或
于养阴中加火麻仁及芝麻之类。经云∶阴血下润则便通。又云∶肾主二便，肾开窍于二阴，须知重用，大熟地而
便自解。
一针刀更不可妄用其所用者，原因叉喉锁喉闭塞而施乃救急之法，并非诸喉症必需之具。至于针法，又须平
日将《针灸大成》考究及参玩铜人图，熟悉穴道，领会补泻之法，方可以言针。可笑近来治喉诸辈，动辄用针，
罔顾病患痛楚，其实可针之穴只少商、少冲、合谷、风池及囟会数处，其余诸穴，切不可妄针。尤有火窝坑一穴
与哑门相连，更不可妄针，一经失手误针，必立变音哑，为终身之患。至于用刀之处，亦因不得已而施及焉，尤
宜慎用为要。如双单蛾、重舌、木舌、呛食风可用刀，略破其皮，使出血以泻其势之肿盛者。若初起亦不宜轻用，
其坐舌莲花症却少，间或有之，亦不必用。犹有喉瘤一症，属七情抑郁及肝肾不足者，每患此，乃内因之症，更
不可用刀。倘误犯之，致害不浅。
一牙龈肿疼及牙痈之类，皆不宜刀破。若妄用之，反致延烂，或成牙漏骨槽之虞。虽古人谓喉痹不刺血，喉
风不倒痰，喉痈不放脓，乳蛾不针烙，皆非其治也。以及《内经》血实宜决之语，皆指症实而势肿盛者而施之也，
并非教人一遇喉患，不分虚实，即动手以刀切之，是诚何心哉！
一咽口症。近来患单者多而患双者少，但单者重而双者轻，且实症少而属虚者多。是症初起，微肿于会厌之
旁，一二日犹能吞饮，至三四日必肿满不能饮水。凡患左者必肿至右，然后渐消，方能进饮。患右者必肿至左，
情势虽重，却无大碍，七日必松减而愈，是以单咽
口之重者，在此肿也。而双咽口反轻者，因其肿分于左右而会厌之下有空缝可以入饮，不过三五日即愈。至于治
法，总不宜用刀。属实症者，照本科方疗之。若兼虚者，必须养阴中加辛凉而散治之为妙，并以赤麟散和青雪丹
吹之，自然获效。若咽口肿至上 ，情势极重者，可用刀于近上 边，略为点破，使其血出，以泻其势。但不可
切深，倘深切之，其肿虽平而刀痕反烂开，须用珍珠散及万一丹始能收敛。与其用刀非宜，不若勿用为妙，且愈
后无刀痕之伤，而病时亦少痛苦，岂不快哉！乃有以恃刀为能事者，毋论症之虚实，一遇喉肿，或双单蛾、咽口
喉瘤、牙痈、龈肿、舌肿等症，即以刀用力切之，血流盈地，今日未平，次日又切之，执定《内经》血实宜决之
旨，自信不移，孟浪施治，及至连切五六次而不愈，有因此而成牙漏者，有因刀痕延烂经年久不瘥者，甚有因刀
误而致殒命者矣。然用刀之治，未尝不愈数人，但是少耳。每有为刀伤而病患畏惧不复来，另往他医求诊者，并
非用刀之妙而愈也，何其不知悔悟如是耶！
一唇疮、口糜、舌疮，为最易治之症，近来竟遭此夭柱者不少，盖因误治而致也。凡舌疮诸症，必须分辨寒
热虚实，未可专执为胃热心火。若妄任清凉，或导赤散及泻心等法，其初白疮必反转为红，渐有延蔓之势，医者
不察，犹谓清之未透，复进寒凉而遏之，遂至水极似火，舌紫唇赤或燥裂而疮蔓满舌，及延烂至咽喉如白腐，以
致音哑，打呛气喘，变为败症而不救，是谁之过欤？凡小儿口疮，有脾虚不能统涎，以致口涎流多，及嘴角湿烂
而患者，有脾阴不足，过食甜味而致者；有由病后发热不退而生舌疮者；有属上焦实热，中焦虚寒，下焦阴火而
致者；有因麻痘后服清凉解毒药过多，致生舌疮者，虽曰口疮一症，而所因不同，故当审辨明，岂可以舌属心，
遂指定心火，而执治乎！且有伤燥而发口疮者，更须审辨明确，毋论发热与否，切忌表散，寒凉之剂一经妄投，
立变音哑而不救，尤须养阴清润为主，
其热却不疗而退，燥气就平疮亦自除矣。
一舌底青筋上生疮，如半粒白饭，此症惟小儿最多，或由疟后而生者，有久病后内热不退而致者，有因积滞
泄泻之后而患者，有病假热误服清凉而生此疮者，统是症各因诸医不识治者甚多，每为认作心热误治者，亦复不
少。盖因舌底筋纹即名舌本故也，虽曰属心，其责在脾。经云∶五脏皆系于舌，不独心也。舌疮则每由脾虚而致
焉。有发热，与不发热有早晨不热而午后热者，有头维潮热及手足心热者，总不宜疏散及清热之药，尤忌寒凉攻
下，但治法专主理脾，切勿认作为火，若妄用芩、连、连翘、木通、灯心、犀角、山栀之类，其白疮反转红色，
即延烂渐大，甚至舌尖与舌傍亦发疮，连及下唇口角皆有矣。犹复认为火盛，益进寒凉，或另遇他医，亦复如是，
不至危殆不休，深可叹也！其尤可恨者，既不审病源，不知治法，犹悍然诽谤理脾之非，何其冥顽之极，残忍之
深，一至于此耶！是皆未究医道之原本不学无术耳。按∶是症俗名对心疮，以起初色白而论，即知属虚无疑，显
然非实火也。虽经云∶诸痛疮痒皆属于火，是概乎言之，非指舌疮之谓也。平日不于薛氏《口齿类要》集中，详
究原理，及参考各家方论，徒从事于时俗之所，尚恃为专科，可以惑人赚利，吁！是乃仁术也，执是业者，安可
偏执而不博约乎？
凡是疮潮热未退者，六君加归芍麦门冬主之。若兼便泄者，七味白术散主之。或病后脾虚者，四君加归芍。
寒热往来者，补中益气主之。若疟后兼腹膨者，异功散加归芍主之。或咳嗽无痰间有内热者，金水六君煎主之。
若中焦虚寒，手指尖冷，面色青白者，理中汤主之。凡下焦阴火，或因寒凉过甚，而唇舌反现紫赤色渴不喜饮，
以及感燥气而致者，必须养阴清润，非重用熟地黄不效。方法见白腐论中。吹药用口疳散，或圣功丹，若神功丹
亦可。若属上焦实热，舌胎焦黄，口渴，宜导赤散加麦门冬、丹皮、贝母、黑山栀之类，吹药则用青雪丹，或圣
功丹。舌疮虽曰小疾，亦须证之以
脉。若症与脉合，治得其宜，则易愈，断无症实而脉虚之理，盖是疾脉虚者，症亦虚，脉实者，症亦实，乃最易
明晓之处，非比伤寒杂症之难辨也。
一舌疮最忌栗蒲刺壳煎洗，其性苦寒而味涩，未用此者，犹易治。倘误用洗过其疮，即反延蔓，一时难敛，
诚不易疗，尤忌以青苔煎洗。苔本阴湿而生性大寒凉兼有小毒，若误用致害不浅。惟桑树汁取以涂敷口疮甚妙，
其性味甘和，涂之不见辣痛，且并治口糜等症。
一舌疳及舌傍两边肿疼，或舌底生烂宕疮，中间黄白周遭一线红者，皆不易治。而诸医亦不识，治无不认为
心火，每用泻心导赤，如不应，便投犀角、黄连、黄柏、知母之类，愈凉而愈遏，以致舌烂弥漫，或高肿而不能
消，经年累月，变为败症者比比，良可悲夫。盖是症由于七情忧郁，肝木不舒，思虑烦闷而致者多。经云∶肝脉
系舌傍，五脏皆系于舌，非专属心也，故从肝治，乃得其旨。凡起初未服清凉者，犹易疗。一经寒凉杂进，便难
施治。若论延医之法，起初则以黑逍遥散加丹皮，其次归芍地黄汤。其忧思郁久者，黑归脾汤去远志加丹皮，或
因肝血不足而火旺者，滋肾生肝饮；木郁不条达者，滋肾疏肝饮，或逍遥散更妙。清凉降火，日久不愈，即成牙痈，转为骨槽风等候。及至延烂穿腮，诚难治者，恒多
也。惟是虚实之辨，升清之法，须遵薛氏。若成骨槽风者，则根据《证治全生集》法为宜。
一 腮，初则宜散宜清，久则宜补，当于《外科大成》及参薛氏书与《证治准绳》详究治之。其外宜用雷豉、
红豆研细末，以鸡蛋清调敷之。
一口内与舌，或因饮食嚼起小泡，不必以针挑破，只用两手齐缩，入衣内将裤带打一疙瘩，任其垂下，自然
立消。必须心静下降，其效
更速，诚奇事也。此乃理之所无而事之竟有者，曾经屡验。若性躁不宁者，则少效。如眼患偷针，以针穿红线刺
于衣角，则其患速愈，与此同一理也。
一走马牙疳须辨其寒热虚实，未可执定为阳明实火。凡小儿麻痘后，患此者多，每因寒凉之剂误服过分而成
者亦不少。又有因牙床肿痛，妄投清凉，变为牙疳腐烂涎流更剧，以致破唇穿腮而难治者，更属非鲜有，因嗜食
辛辣炙 之味，或服温热峻烈丸散者，亦足致此。
古籍记载：咽喉部的十八种病症，都属于火邪所致，这说的是大概情况。然而火邪有虚火和实火的区分，病症有寒证和热证的差异，更有内因和外因的不同，以及观察舌苔苍老或娇嫩的辨别方法。临证时必须审察清楚，再切按脉象的虚实，判断脉搏有力还是无力，且脉象与症状相符，然后才能确立方剂进行治疗，不可以一概认定为风热实证。当今之人，大多本质上是肾阴不足，而喉部病症属于实证的较少。或者是虚中夹实，实中夹虚，或者是因为下焦阴火上炎导致咽痛、口疮的，也不在少数。然而六气之中，引发喉部疾患的，不仅仅是风寒和火邪，暑湿燥邪也是如此。只是暑湿导致咽痛的特别稀少，每次感受燥邪而发病的较多，这是因为肾水不足的缘故。如果临证时不辨明虚实，一见发热就使用解表发散的方法，凡是属于风邪的，虽然治疗方法适宜，但如果是属于寒邪的，则非用辛温药物不可。那些属于火邪的，固然应该清热降火，但也应当辨别是实火还是虚火，以及是否有郁结，只有实火才适合清热降火，虚火则应当壮水制火（滋阴降火），郁火则应当升发透散，至于湿邪和燥邪，又怎么可以用解表发散的方法呢！在其他病症中虚实或许难以辨别，而喉部病症最容易明确，可以一望而知虚实立判，因为喉部有形态可依据，有颜色可参考，有舌苔可辨别。而且痰涎有清稀和稠浊的区别，必须由临证者潜心研究探讨，才能掌握其中的窍门。至于机变权谋，虽然取决于医生个人，但也必须从方药和脉理中领悟得来，这样才能避免延误病情。
一家传喉科，虽然有三十六种病症的名称，但治疗方法不外乎紫地汤这一首方剂，为什么呢？因为三十六种病症，都是由风热壅塞在上焦，感触外邪而发作，突然起病疼痛，形态症状各不相同，但所属病因相同，所以用一方统管治疗。如果确实是风热实证，按照这种方法治疗，没有不立刻痊愈的。如果属于虚证，以及感受燥邪导致的，一定不见效。倘若拘泥于死板的方子，定会造成很多延误。
一种实证发作，起初发热恶寒，头痛，喉内红肿有形，疼痛到不能饮水，痰涎多且稠厚，切脉浮数有力，舌色苍老坚敛而黄，咽喉间闭塞，大小便也可能闭结，这是极重的病症。可以使用风路针刺少商、少冲、合谷及风池、囟会等几处穴位，其余诸穴，不可乱刺。原来使用针刺的目的，是急于泻去体内蕴积的热邪，这也就是发汗的道理，所以不宜多针。其次使用辛乌散，通过催吐排出痰涎，使蕴积的热邪随痰涎而出，吹入回生丹以消散其热结造成的痹阻，服用紫地汤宣通肺胃风热的壅实。如果大便闭结，加入玄明粉以降火祛热，消化痰涎，去除脏腑宿滞，都从大便排出。汗法、吐法、下法三法合治，是分三路来泻除病邪，这是因为咽喉是关要之处，失治就会闭塞。又担心风热毒邪内攻，迟缓就来不及了。凡实证必须根据法则治疗，如果属虚证，则绝对不可以这样治。
一种初起像疟疾，怕冷发热的，这是喉患的本来的现象，并不是外感风寒，千万不要乱用羌活、独活、秦艽、苏叶、桂枝等药物，因为喉患本来发于脏腑，不是太阳膀胱经的表证。如果说开头必须解表发散，认为是层次分明的治法，这是些依样画葫芦、从事世俗见解、究无根基学问的医生，殊不知火邪被升散后会更炽热，得到辛温药更会导致阳盛而闭塞，必定轻症变重，重症变危，无法挽救。而且《沈氏尊生集》也说，喉症最忌讳发表。无论初起是否恶寒发热，只需用辛凉而散的药物兼养阴来制约它，不必刻意祛热而热自除，喉患也会逐渐松减。这是我阅历已久，验证有效且多的经验，所以敢这样说。
一种初起发热但不恶寒，咽喉间微痛，或者红肿但颜色淡，或者肿处皮色发亮，或者肿而颜色红但不润泽，痰涎清稀薄且少，这些都属虚候，以及下焦阴火，或由感受燥邪而发，都是根本在于水亏，不能制约火邪的缘故。医经说：骤起的多非火，缓起的多非寒，而实热虚寒务必审察，确有似实而非实的，必须用脉象来印证。只有脉浮数有力的，才是实证。如果脉细数无力，或者右部脉大于左部，更属于虚证了。此时紫地汤、辛乌散，都不可用，就是回生丹，也不宜吹入。只用青雪丹治疗，用辛凉而散的方法，兼采养阴法，自然能获得疗效。
一、辛乌散。只有实证必需，它取痰涎最快，能提拔风热外出，也就是《内经》“高者因而越之”的意思，一旦兼有虚候，切勿使用，反而伤津液而使症状加重，犹如伤寒治法，必须以保存津液为要。辛乌散是劫夺救急的方法，果真是实证，立刻取出痰涎，开通喉咙，所以见效最快，惟独虚证属于内因，会耗损津液，所以不宜用。而且近来遇到用辛乌散的病症实在很少，百人中不过二三，大与过去不同，怎么能拘守死板方子而不知权变呢！
一是这个病症不能以痰涎多少来论虚实。有虚候而涎多的，也有实证而涎多的，有实证涎少的，也有虚候涎少的。只看涎的稠浊与清薄的区别，凡临证在吹药时，可以审察虚实。如果属实证，其涎流出必稠浊而长，不断且气味秽臭。若属虚证，其涎吐出清薄而短。又有吹药后而无涎的，这是津液被火邪灼烧。还有感受燥气而导致喉患的，痰涎愈少，而治疗方法尤其必须以养阴为要。如果拘泥于风热闭塞，妄用升散解毒，那就大错特错了。
一、喉患出现大小便闭结，是最为严重的候象，必须审明虚实，不可乱用攻下。有的因为解表发散过剂伤及津液，以致大便艰难；有的因为风热壅闭于上而不大便；有的正值燥金当令，伤于燥而不便；只有实证才可以攻下。如果初起即使大便闭结，也不宜立即攻下，须过两三天，看病患形色以及喉间松减，而大便仍未解，可用玄明粉攻下，导热毒下行，这就是釜底抽薪的方法。本专科只用玄明粉而不用大黄，是因为大黄性峻烈威猛，恐伤真气，惟玄明粉味辛微甘，能降心火，祛胃热，消痰涎，去胸膈脏腑宿滞，且消痈肿。若兼虚证者，就不宜用，必须用润下法，或在养阴中加入火麻仁及芝麻之类。医经说：阴血下润则便通。又说：肾主二便，肾开窍于二阴，须知重用熟地黄而便自解。
一针刀更不可乱用。其所用的原因，是因为叉喉锁喉闭塞而施行的，乃是救急之法，并非所有喉症必需的器具。至于针法，又须平日将《针灸大成》考究及参玩铜人图，熟悉穴道，领会补泻之法，才可以言针。可笑近来治喉的诸辈，动辄用针，不顾病患痛楚，其实可针的穴只少商、少冲、合谷、风池及囟会几处，其余诸穴，切不可乱针。尤有火窝坑一穴与哑门相连，更不可乱针，一经失手误针，必立刻变音哑，成为终身之患。至于用刀之处，也是因为不得已而施行，尤其宜慎用为要。如双单蛾、重舌、木舌、呛食风可用刀，略破其皮，使出血以泻其势之肿盛者。如果初起也不宜轻用，其坐舌莲花症却少见，间或有之，也不必用。犹有喉瘤一症，属七情抑郁及肝肾不足者，每患此，乃内因之症，更不可用刀。倘误犯之，致害不浅。
一、牙龈肿疼及牙痈之类，都不宜刀破。如果乱用之，反而导致延烂，或成牙漏骨槽之虞。虽然古人说喉痹不刺血，喉风不倒痰，喉痈不放脓，乳蛾不针烙，都不是正确的治法。以及《内经》“血实宜决之”的话，都是指症实而势肿盛者而施行的，并非教人一遇喉患，不分虚实，就动手以刀切之，这是什么用心呢！
一、咽口症。近来患单侧的多而患双侧的少，但单侧重而双侧轻，且实证少而属虚的多。此症初起，微肿于会厌之旁，一二日还能吞饮，至三四日必肿满不能饮水。凡患左侧的必肿至右侧，然后渐消，方能进饮。患右侧的必肿至左侧，情势虽重，却无大碍，七日必松减而愈，是以单侧咽口的重症，在此肿胀也。而双侧咽口反轻者，因其肿分于左右而会厌之下有空缝可以入饮，不过三五日即愈。至于治疗方法，总不宜用刀。属实证者，照本科方疗之。若兼虚者，必须养阴中加辛凉而散治之为妙，并以赤麟散和青雪丹吹之，自然获效。若咽口肿至上颚，情势极重者，可用刀于近上颚边，略为点破，使其血出，以泻其势。但不可切深，倘深切之，其肿虽平而刀痕反烂开，须用珍珠散及万一丹始能收敛。与其用刀非宜，不若勿用为妙，且愈后无刀痕之伤，而病时亦少痛苦，岂不快哉！乃有以恃刀为能事者，毋论症之虚实，一遇喉肿，或双单蛾、咽口喉瘤、牙痈、龈肿、舌肿等症，即以刀用力切之，血流盈地，今日未平，次日又切之，执定《内经》“血实宜决之”旨，自信不移，孟浪施治，及至连切五六次而不愈，有因此而成牙漏者，有因刀痕延烂经年久不瘥者，甚有因刀误而致殒命者矣。然用刀之治，未尝不愈数人，但是少耳。每有为刀伤而病患畏惧不复来，另往他医求诊者，并非用刀之妙而愈也，何其不知悔悟如是耶！
一、唇疮、口糜、舌疮，是最易治的病症，近来竟遭此夭折者不少，盖因误治而致也。凡舌疮诸症，必须分辨寒热虚实，不可专执为胃热心火。如果妄任清凉，或导赤散及泻心等法，其初白疮必反转为红，渐有延蔓之势，医者不察，犹谓清之未透，复进寒凉而遏之，遂至水极似火，舌紫唇赤或燥裂而疮蔓满舌，及延烂至咽喉如白腐，以致音哑，打呛气喘，变为败症而不救，是谁之过欤？凡小儿口疮，有脾虚不能统涎，以致口涎流多，及嘴角湿烂而患者，有脾阴不足，过食甜味而致者；有由病后发热不退而生舌疮者；有属上焦实热，中焦虚寒，下焦阴火而致者；有因麻痘后服清凉解毒药过多，致生舌疮者，虽曰口疮一症，而所因不同，故当审辨明，岂可以舌属心，遂指定心火，而执治乎！且有伤燥而发口疮者，更须审辨明确，毋论发热与否，切忌表散，寒凉之剂一经妄投，立变音哑而不救，尤须养阴清润为主，其热却不疗而退，燥气就平疮亦自除矣。
一、舌底青筋上生疮，如半粒白饭，此症惟小儿最多，或由疟后而生者，有久病后内热不退而致者，有因积滞泄泻之后而患者，有病假热误服清凉而生此疮者，统是症各因诸医不识治者甚多，每为认作心热误治者，亦复不少。盖因舌底筋纹即名舌本故也，虽曰属心，其责在脾。医经说：五脏皆系于舌，不独心也。舌疮则每由脾虚而致焉。有发热，与不发热有早晨不热而午后热者，有头维潮热及手足心热者，总不宜疏散及清热之药，尤忌寒凉攻下，但治法专主理脾，切勿认作为火，若妄用芩、连、连翘、木通、灯心、犀角、山栀之类，其白疮反转红色，即延烂渐大，甚至舌尖与舌傍亦发疮，连及下唇口角皆有矣。犹复认为火盛，益进寒凉，或另遇他医，亦复如是，不至危殆不休，深可叹也！其尤可恨者，既不审病源，不知治法，犹悍然诽谤理脾之非，何其冥顽之极，残忍之深，一至于此耶！是皆未究医道之原本不学无术耳。按：是症俗名对心疮，以起初色白而论，即知属虚无疑，显然非实火也。虽医经说：诸痛疮痒皆属于火，是概乎言之，非指舌疮之谓也。平日不于薛氏《口齿类要》集中，详究原理，及参考各家方论，徒从事于时俗之所，尚恃为专科，可以惑人赚利，吁！是乃仁术也，执是业者，安可偏执而不博约乎？
凡是疮潮热未退者，六君加归芍麦门冬主之。若兼便泄者，七味白术散主之。或病后脾虚者，四君加归芍。寒热往来者，补中益气主之。若疟后兼腹膨者，异功散加归芍主之。或咳嗽无痰间有内热者，金水六君煎主之。若中焦虚寒，手指尖冷，面色青白者，理中汤主之。凡下焦阴火，或因寒凉过甚，而唇舌反现紫赤色渴不喜饮，以及感燥气而致者，必须养阴清润，非重用熟地黄不效。方法见白腐论中。吹药用口疳散，或圣功丹，若神功丹亦可。若属上焦实热，舌胎焦黄，口渴，宜导赤散加麦门冬、丹皮、贝母、黑山栀之类，吹药则用青雪丹，或圣功丹。舌疮虽曰小疾，亦须证之以脉。若症与脉合，治得其宜，则易愈，断无症实而脉虚之理，盖是疾脉虚者，症亦虚，脉实者，症亦实，乃最易明晓之处，非比伤寒杂症之难辨也。
一、舌疮最忌栗蒲刺壳煎洗，其性苦寒而味涩，未用此者，犹易治。倘误用洗过其疮，即反延蔓，一时难敛，诚不易疗，尤忌以青苔煎洗。苔本阴湿而生性大寒凉兼有小毒，若误用致害不浅。惟桑树汁取以涂敷口疮甚妙，其性味甘和，涂之不见辣痛，且并治口糜等症。
一、舌疳及舌傍两边肿疼，或舌底生烂宕疮，中间黄白周遭一线红者，皆不易治。而诸医亦不识，治无不认为心火，每用泻心导赤，如不应，便投犀角、黄连、黄柏、知母之类，愈凉而愈遏，以致舌烂弥漫，或高肿而不能消，经年累月，变为败症者比比，良可悲夫。盖是症由于七情忧郁，肝木不舒，思虑烦闷而致者多。医经说：肝脉系舌傍，五脏皆系于舌，非专属心也，故从肝治，乃得其旨。凡起初未服清凉者，犹易疗。一经寒凉杂进，便难施治。若论延医之法，起初则以黑逍遥散加丹皮，其次归芍地黄汤。其忧思郁久者，黑归脾汤去远志加丹皮，或因肝血不足而火旺者，滋肾生肝饮；木郁不条达者，滋肾疏肝饮，或逍遥散更妙。清凉降火，日久不愈，即成牙痈，转为骨槽风等候。及至延烂穿腮，诚难治者，恒多也。惟是虚实之辨，升清之法，须遵薛氏。若成骨槽风者，则根据《证治全生集》法为宜。
一、颊腮肿痛，初则宜散宜清，久则宜补，当于《外科大成》及参薛氏书与《证治准绳》详究治之。其外宜用雷豉、红豆研细末，以鸡蛋清调敷之。
一口内与舌，或因饮食嚼起小泡，不必以针挑破，只用两手齐缩，入衣内将裤带打一疙瘩，任其垂下，自然立消。必须心静下降，其效更速，诚奇事也。此乃理之所无而事之竟有者，曾经屡验。若性躁不宁者，则少效。如眼患偷针，以针穿红线刺于衣角，则其患速愈，与此同一理也。
一走马牙疳须辨其寒热虚实，不可执定为阳明实火。凡小儿麻痘后，患此者多，每因寒凉之剂误服过分而成者亦不少。又有因牙床肿痛，妄投清凉，变为牙疳腐烂涎流更剧，以致破唇穿腮而难治者，更属非鲜有，因嗜食辛辣炙烤之味，或服温热峻烈丸散者，亦足致此。
The ancient text states: "The eighteen syndromes of the throat and pharynx all belong to Fire," which refers to the general situation. However, Fire is divided into Deficiency Fire and Excess Fire; syndromes are distinguished by Cold and Heat; there are differences between internal causes and external causes; and differentiation is required based on whether the tongue coating is rough and aged or tender and delicate. When treating clinically, one must examine clearly, then palpate the pulse for deficiency or excess, determining whether it is forceful or feeble, ensuring the pulse matches the symptoms, before prescribing a formula for treatment. One cannot generally assume it to be an Excess Wind-Heat syndrome. Most people nowadays have a constitutional deficiency of Kidney Yin, so throat conditions belonging to Excess are rare. There may be Excess complicated by Deficiency, or Deficiency complicated by Excess; cases where Yin Fire from the Lower Jiao rises causing sore throat and mouth ulcers are also not uncommon. Among the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), pathogens causing throat diseases are not limited to Wind-Cold and Fire; Summer-heat, Dampness, and Dryness are also involved. However, throat pain caused specifically by Summer-heat and Dampness is very rare; cases triggered by Dryness are more common, due to insufficient Kidney Water. If clinical differentiation is not clear, and dispersing methods are applied immediately upon seeing fever, although this may be appropriate for Wind pathogens, for Cold pathogens, acrid-warm herbs are indispensable. For Fire pathogens, clearing and descending are indeed suitable, but one must distinguish between Excess Fire and Deficiency Fire, as well as consider stagnation. Excess Fire should be cleared and descended; Deficiency Fire requires strengthening Water (nourishing Yin to subdue Fire); Stagnant Fire should be lifted and dispersed. How can Dampness and Dryness be treated with dispersing methods! In other diseases, distinguishing Excess and Deficiency may be difficult, but throat conditions are the easiest to clarify; Excess and Deficiency can be judged at a glance because there are forms to observe, colors to reference, and tongue coatings to differentiate. Moreover, saliva and phlegm can be clear or turbid; only by profound study during clinical practice can one grasp the essence. Although ingenuity and flexibility depend on the individual, they must be understood through formulas and pulse diagnosis to avoid errors.
A hereditary throat specialty clinic has thirty-six named syndromes, yet its treatment methods revolve around a single formula, Zidi Tang (Purple Ground Decoction). Why? Because all thirty-six syndromes arise from Wind-Heat obstructing the Upper Jiao, triggered by pathogenic contact, causing sudden pain. Although the manifestations differ, the underlying cause is the same, so one formula governs them all. If it is truly an Excess Wind-Heat syndrome, following this method will invariably lead to immediate recovery. If it belongs to Deficiency or is caused by Dryness, it will certainly be ineffective. Clinging to rigid formulas will inevitably cause delays.
In an Excess syndrome onset, initial symptoms include fever, aversion to cold, headache, redness and swelling in the throat with visible form, severe pain preventing drinking, abundant thick phlegm, a floating, rapid, and forceful pulse, a rough, firm, and yellow tongue coating, throat obstruction, and possibly constipation of both bowels and bladder. This is a critical condition. One may use acupuncture at Shaoshang (LU11), Shaochong (HT9), Hegu (LI4), Fengchi (GB20), and Xinhui (EX-HN6) using the "Wind Path" needle technique; other points should not be needled indiscriminately. The purpose of this needling is to urgently drain internal heat, which is equivalent to inducing sweating, so excessive needling is inappropriate. Next, Xinwu San (Acrid Aconite Powder) is used to induce vomiting and expel phlegm, allowing trapped heat to exit via the phlegm. Huisheng Dan (Revival Pill) is blown into the throat to dissipate heat-induced obstruction. Zidi Tang is administered to unblock Excess Wind-Heat in the Lung and Stomach. If constipation exists, Xuanming Fen (Mirabilite) is added to descend fire, dispel heat, resolve phlegm, and eliminate stagnant waste from the organs, evacuating through the bowels. The combination of sweating, vomiting, and purging methods treats the disease from three routes, draining the pathogens. Since the throat is a critical passageway, failure to treat promptly leads to closure. There is also fear that Wind-Heat toxic pathogens will attack internally, making delay dangerous. Excess syndromes must be treated according to these principles; Deficiency syndromes absolutely contraindicate this approach.
Some cases initially resemble malaria, with chills and fever. This is the inherent presentation of throat pathology, not an external Wind-Cold invasion. Do not recklessly use Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Qinjiao (Gentianae Macrophyllae Radix), Ziye (Perillae Folium), or Guizhi (Cinnamomi Ramulus). Throat pathology originates from the Zang-Fu organs, not the Taiyang Bladder exterior syndrome. Those who insist on initial dispersing as a hierarchical treatment method are practicing superficial medicine without foundational knowledge. Unknowingly, lifting and dispersing causes Fire to burn fiercer; acrid-warm herbs exacerbate Yang excess and closure, turning mild cases severe and severe cases critical, beyond rescue. *Shen Shi Zun Sheng Ji* also states that throat syndromes most strictly forbid exterior-releasing methods. Regardless of initial chills or fever, only acrid-cool dispersants combined with Yin-nourishing agents are needed. Heat will remove itself without direct clearing, and throat symptoms will gradually ease. This is based on long experience and verified efficacy.
Initial fever without aversion to cold, slight throat pain, or redness/swelling with pale color, shiny skin over swelling, or red but dry swelling, along with scanty thin saliva/phlegm, all indicate Deficiency patterns. These stem from Yin Fire of the Lower Jiao or Dryness invasion, fundamentally due to Water deficiency failing to control Fire. The Classics state: "Sudden onset is rarely Fire; slow onset is rarely Cold; Excess Heat and Deficiency Cold must be carefully examined." Cases appearing Excess but actually Deficient require pulse confirmation. Only a floating, rapid, and forceful pulse indicates Excess. A fine, rapid, and feeble pulse, or a Right pulse larger than the Left, indicates Deficiency. In such cases, Zidi Tang and Xinwu San are contraindicated, and even blowing Huisheng Dan is unsuitable. Use Qingxue Dan (Green Snow Powder) with acrid-cool dispersants and Yin-nourishing methods for effectiveness.
Xinwu San is necessary only for Excess syndromes because it rapidly extracts phlegm, lifting Wind-Heat outward, aligning with the *Neijing* principle: "Those high up should be evacuated upward." If Deficiency signs are present, do not use it, as it damages Body Fluids and worsens symptoms. Like in Shaoyin disease treatment, preserving Body Fluids is paramount. Xinwu San is a drastic emergency method; for true Excess, it quickly opens the throat. However, Deficiency syndromes are internal causes; using it consumes fluids, so it is unsuitable. Recently, cases requiring Xinwu San are rare (2-3 per 100), differing greatly from the past. One must not cling to rigid formulas without flexibility.
Throat conditions cannot be judged by the quantity of phlegm alone. Deficiency may have abundant phlegm; Excess may have abundant phlegm; Excess may have little phlegm; Deficiency may have little phlegm. Observe whether phlegm is thick/turbid or thin/clear. During topical application, assess Excess vs. Deficiency. In Excess, phlegm flows out thick, turbid, long, continuous, and foul-smelling. In Deficiency, phlegm is thin, clear, short, and discontinuous. No phlegm after application indicates Body Fluids burned by Fire. Dryness-induced throat issues yield less phlegm, requiring nourishing Yin as the priority. Assuming Wind-Heat obstruction and using lifting/dispersing/antidotal herbs is a major error.
Throat conditions with constipation of bowels and bladder are critical. Differentiate Excess and Deficiency; do not blindly purge. Causes include: excessive exterior-releasing damaging fluids; Wind-Heat obstructing the Upper Jiao; or Dryness season injury. Purging is only for Excess. Even if constipated initially, wait 2-3 days. If throat swelling subsides but bowels remain blocked, use Xuanming Fen to guide heat/toxins downward (pulling firewood from under the cauldron). This specialty uses Xuanming Fen instead of Dahuang (Rhei Radix et Rhizoma) because Dahuang is too harsh and may damage True Qi. Xuanming Fen is acrid-slightly sweet, descends Heart Fire, clears Stomach Heat, resolves phlegm, removes stagnation, and reduces abscesses. For Deficiency, use moistening purgatives or add Huomaren (Cannabis Seed) and Sesame to Yin-nourishing formulas. The Classics say: "Yin blood moistens below, facilitating bowel movement." Also: "Kidney governs the two lower orifices." Heavy doses of Shudihuang (Rehmanniae Radix Praeparata) facilitate bowel movement.
Needles and knives must not be used recklessly. Knives are only for emergency relief of locked throat obstruction. Acupuncture requires thorough study of *Zhenjiu Dacheng* (Great Compendium of Acupuncture and Moxibustion) and bronze mannequins, mastering point locations and tonification/reduction techniques. It is laughable that modern practitioners needle indiscriminately, ignoring patient pain. Valid points are only Shaoshang, Shaochong, Hegu, Fengchi, and Xinhui. Other points, especially Huowokeng (connected to Yamen GV15), must not be needled; accidental needling causes permanent aphonia. Knife use is also for emergencies only. Indications include Double/Single Swallow's Tongue (Erythema tonsillaris), Chong She (Double Tongue), Mu She (Wooden Tongue), and Qiangshi Feng (Choking Wind). Briefly puncture skin to bleed and reduce swelling. Do not use lightly in early stages. Zuo She Lianhua (Lotus Syndrome) is rare and doesn't require knives. Throat tumors due to emotional depression and Liver/Kidney deficiency are internal causes; knives are strictly forbidden. Mistakes cause severe harm.
Gum swelling/pain and dental abscesses should not be incised. Reckless cutting causes ulceration or alveolar osteomyelitis. Ancient texts stating "throat bi no pricking blood, throat wind no expectoration, throat abscess no drainage, swallow's tongue no moxa" are incorrect interpretations. *Neijing*'s "Excess blood should be drained" applies only to Excess syndromes with severe swelling, not indiscriminate cutting regardless of Excess/Deficiency. What is the intent behind this?
Yankou (Palatine Tonsil) syndrome: Unilateral cases are now more common than bilateral. Unilateral is heavier, Bilateral lighter. Excess is rare; Deficiency is common. Initially, slight swelling near the epiglottis allows swallowing for 1-2 days. By day 3-4, swelling prevents drinking. Left-side swelling spreads to right, then subsides. Right-side spreads to left, resolves in 7 days. Unilateral severity lies in this spread. Bilateral is lighter because swelling divides, leaving space under epiglottis for drinking; resolves in 3-5 days. Treatment generally forbids knives. For Excess, use standard formulas. For Deficiency, combine Yin-nourishing with acrid-cool dispersants. Blow Chilin San (Red Scale Powder) and Qingxue Dan. If swelling reaches the soft palate with extreme severity, briefly puncture near the top to bleed and reduce pressure. Do not cut deep; deep cuts cause ulceration requiring Zhenzhu San (Pearl Powder) and Wan Yi Dan for healing. Avoiding knives prevents scarring and pain. Some rely on knives regardless of syndrome, cutting repeatedly until bleeding fills the floor, citing *Neijing*. After 5-6 cuts without cure, complications like alveolar osteomyelitis or chronic non-healing wounds occur, sometimes death. Few heal by knife; many fear treatment and seek others. This lack of repentance is lamentable.
Lip sores, oral candidiasis (Kou Mi), and tongue sores are easily treated, yet recent deaths occur due to misdiagnosis. Tongue sores must differentiate Cold/Heat/Excess/Deficiency; do not assume Stomach Heat/Heart Fire. Blind use of cooling herbs, Daochi San (Guide Out Redness Decoction), or Xiexin Tang (Drain Heart Decoction) turns white sores red, spreading蔓延. Physicians, thinking clearing is incomplete, add more cold herbs, leading to "Water extreme resembling Fire": purple tongue, red lips, cracking, spreading sores, white rot in throat, aphonia, choking, asthma, becoming untreatable敗症. Who is at fault? Pediatric mouth sores vary: Spleen deficiency failing to control saliva (drooling, wet corners); Spleen Yin deficiency from sweets; post-fever lingering heat; Upper Jiao Excess Heat, Middle Jiao Deficiency Cold, Lower Jiao Yin Fire; or excessive cooling/antidotal herbs after smallpox/measles. Causes differ; do not fixate on Heart Fire just because the tongue relates to the Heart. Dryness-induced sores require careful differentiation; avoid dispersing. Misuse of cold herbs causes immediate aphonia. Nourish Yin and clear dryness; heat retreats, dryness calms, sores heal.
Sores on blue veins under the tongue, like half a grain of white rice, occur mostly in children, post-malaria, post-prolonged illness with internal heat, or after stagnation diarrhea. Often misdiagnosed as Heart Heat. The root of the tongue (She Ben) relates to the Spleen, though associated with Heart. Classics: "All five Zang connect to the tongue, not just Heart." Tongue sores often stem from Spleen Deficiency. Fever patterns vary (morning vs. afternoon, tidal fever, palm/sole heat). Avoid dispersing/clearing; strictly avoid cold/purging. Treat by regulating Spleen. Do not mistake for Fire. Using Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Lianqiao (Forsythiae Fructus), Mutong (Akebiae Caulis), Dengxincao (Junci Medulla), Xijiao (Rhinocerotis Cornu - substitute available), Zhizi (Gardeniae Fructus) turns white sores red, spreading to tongue tip/sides/lips. Adding more cold herbs worsens it. Physicians blaming Spleen-regulation are ignorant and cruel. This stems from lacking fundamental medical knowledge. Commonly called "Dui Xin Chuang" (Opposite Heart Sore); initial whiteness indicates Deficiency, not Excess Fire. "All pain/sores/itching belong to Fire" is a generalization, not specific to tongue sores. One must study Xue’s *Kouchi Lei Yao* and various formulas, not follow popular trends for profit. Medicine is a benevolent art; practitioners must be broad and precise, not biased.
For sores with tidal fever unresolved: Liu Jun Zi Tang (Six Gentlemen Decoction) plus Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), and Maidong (Ophiopogonis Radix). With diarrhea: Qi Wei Bai Zhu San (Seven-Ingredient White Atractylodes Powder). Post-illness Spleen Deficiency: Si Jun Zi Tang (Four Gentlemen Decoction) plus Danggui, Baishao. Alternating chills/fever: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Post-malaria with abdominal distension: Yi Gong San (Extraordinary Ability Powder) plus Danggui, Baishao. Cough without phlegm, occasional internal heat: Jin Shui Liu Jun Jian (Metal-Water Six Gentlemen Decoction). Middle Jiao Deficiency Cold, cold fingertips, pale face: Li Zhong Tang (Regulate the Middle Decoction). Lower Jiao Yin Fire, or excessive cold herbs causing purple-red lips/tongue, thirst without desire to drink, or Dryness invasion: Nourish Yin and clear dryness with heavy Shudihuang. Method in *Bai Fu Lun*. Topical: Kou Gan San (Mouth Ulcer Powder), Sheng Gong Dan, or Shen Gong Dan. Upper Jiao Excess Heat, scorched yellow coating, thirst: Daochi San plus Maidong, Danpi (Moutan Cortex), Beimu (Fritillariae Bulbus), Hei Zhizi (Black Gardeniae Fructus). Topical: Qingxue Dan or Sheng Gong Dan. Tongue sores, though minor, require pulse verification. Symptom-pulse match ensures easy cure. Excess symptoms never have Deficient pulses; Deficient symptoms never have Excess pulses. This is easier to diagnose than Shaoyin disease or miscellaneous disorders.
Tongue sores strictly forbid washing with Lipu Ci Ke (Prickly Ash Shell) decoction. Its bitter-cold/astringent nature makes it hard to treat if used mistakenly, causing spreading and delayed healing. Green moss (Qing Tai) decoction is also forbidden; it is damp, cold, slightly toxic, and harmful. Mulberry sap (Sangshu Zhi) applied to mouth sores is excellent: sweet/mild, no burning pain, treats candidiasis too.
She Gan (Tongue Ulcer) and swelling/pain on tongue sides, or rotten sores under tongue with yellow-white center and red rim, are difficult to treat. Physicians misdiagnose as Heart Fire, using Xiexin/Daochi. If ineffective, they add Xijiao, Huanglian, Huangbai, Zhimu. Cooling increases obstruction, leading to widespread tongue rot or persistent swelling, becoming untreatable败症 over years. This stems from emotional depression, Liver Qi stagnation, and worry. Classics: "Liver meridian connects to tongue sides; all Zang connect to tongue, not just Heart." Treat from Liver. Early stage (before cold herbs) is treatable. Once cold herbs are mixed, treatment is hard. Initial treatment: Hei Xiaoyao San (Black Free and Easy Wanderer Powder) plus Danpi. Next: Gui Shao Di Huang Tang (Rehmannia and Peony Rehmannia Decoction). For prolonged worry/depression: Hei Guipi Tang (Black Restore the Spleen Decoction) minus Yuanzhi, plus Danpi. For Liver Blood Deficiency with Fire: Zishen Shenggan Yin (Nourish Kidney Generate Liver Infusion). For Liver Stagnation: Zishen Shugan Yin (Nourish Kidney Soothe Liver Infusion) or Xiaoyao San. Prolonged cooling fails, leading to dental abscess or Gu Cao Feng (Bone Channel Wind). Cheek perforation is hard to treat. Follow Xue’s differentiation and ascending Clear Qi methods. For Gu Cao Feng, follow *Zhengzhi Quansheng Ji*.
Cheek swelling: Initially disperse/clear; later tonify. Study *Waike Dacheng*, Xue’s works, and *Zhengzhi Zhunsheng*. External application: Leichi (Fermented Soybean) and Hongdou (Red Bean) powder mixed with egg white.
Small blisters in mouth/tongue from chewing food need not be pricked. Pinch hands together, insert inside clothes, tie belt knot, let hang down; blisters disappear naturally. Calm mind accelerates effect. Strange but verified. Restless patients get less effect. Similar to treating Hordeolum (Stye) by piercing red thread into clothing corner.
Zouma Ya Gan (Running Horse Dental Gangrene) must differentiate Cold/Heat/Excess/Deficiency; do not assume Yangming Excess Fire. Common post-measles/smallpox in children, often from excessive cold herbs. Gum swelling/pain treated with cold herbs turns into gangrene with profuse saliva, lip/ch cheek perforation. Spicy/fried foods or hot/warming pills also cause it.