《素问》曰∶运气，少阳所至为喉痹，耳鸣呕涌。又曰∶少阳司天之政三之气炎暑至，民病喉痹，此乃属
火者也，宜仲景桔梗汤；或面赤斑者属阳毒，宜阳毒诸方汗之。又曰∶太阴之胜，火气内郁，喉痹。又云∶太
阴在泉，湿淫所胜，病嗌肿，喉痹，此属湿者也宜活人半夏桂枝甘草汤。又云∶太阳在泉，寒淫所胜民病咽痛
颔肿，此属寒者也。轻者表散，重者理中，四逆酌用。或面青黑者属阴毒，宜阴毒诸方汗之。按∶运气虽有火
湿寒之不同，然湿则热生乎中寒则火郁于内，同归于火，故治法大要以发之为主。如针刺刀砭药，则赤麟散、
金碧二丹，皆是大苦大寒辛热之剂，间亦有时需用，断不可轻易浪投，慎之。（岫云）
内因 因胸膈素有痰涎，或纵酒过度，或忿怒失常，或房事不节，火动其痰，涌塞于咽喉之间，以致内外
肿痛水浆不入。（《医鉴》）有属运气天行者，有因七情郁结者，有寒客会厌者，有寒伤肾而帝中肿者。
外候 外候最多，已载前编，兹不复赘。（岫云）其毒聚于内，涎唾稠粘，但发寒热者，塞喉风也。暴发
暴死者，名走马喉风。（子和）走马喉风，卒然失音，不省人事，痰壅口噤闭塞而死，与诸卒中相似，必先有
喉痛为辨耳。（李惺庵）
论喉与咽之异 喉痹者，谓喉中呼吸不通，言语不出，乃天气闭塞也。咽痛谓咽嗌不能纳唾，饮食不入，
乃地气闭塞也。（《类要》）
病喉痹者，必兼咽痛，咽嗌痛者，不必尽兼喉痹。（王宇泰）
论表与里之分 属表者必兼恶寒，且寸脉弱小于关尺，此寒闭于外，热郁内，宜辛凉
发散，切忌酸寒。属里者，身无热而寸脉滑，石于关尺，乃积热于内，壅滞生痰，宜苦寒折伏及涌吐之法。
（李惺庵）亦有表证轻而无寒热者宜细辨之。（岫云）恶寒而寸脉小，乡里所患相同，此属天行时气，宜先表
散。大忌酸寒吹点，苦寒下之。（景嵩崖）
辨虚与实之异 实火因过失煎炒炙 醇酒，热毒蕴积，胸膈不利，烦渴便闭。虚火因七情劳欲，气虚虚火
上炎，咽膈干燥，二便如常。（《入门》）
辨阴阳之分 阳虚者，两寸浮大，遇劳益甚，此肺脾气怯，不能堤防下焦，须培补中宫。阴虚者，两尺洪
数，日晡转甚，此肝肾阴虚，不能制御龙雷，必滋养癸水，脉法两寸浮洪而溢者，喉痹也。两尺细微无力者，
虚炎也。若微甚而伏者，死。浮大而涩者，亦死。沉细者，不治。洪大有力者，易治。弦数有力为实火，左寸
虚数尺微为虚火，宜滋养金水。两脉若浮大，重取而涩者，此阴气大虚，阳气浮越也，宜补阴敛阳，人参一味
浓煎汤饮之，用喉科法治之必死。
治法 喉症不一，不可概以实热为治。大率热则通之，寒则补之，不寒不热，根据经调之。汤剂荡涤，而外
复有针刺等法，要皆急治时不可缓，非若脏腑积久之病，磨化调养之可比。（《圣济录》）
治实之法，轻者先宜发散，次用清凉。重者先涌导痰涎，针砭出血，再用煎剂。治虚之法，须遵《内经》
从治之旨，徐徐与之。（《正传》）凡喉症，过四五日为重，三日前可消，若非是急证。一二日不发寒热，第
三日始发寒热。若头痛则兼伤于寒，须疏风散寒。问二便如何？便利者，乃浮游之火上攻，宜消风祛热，降气
解毒之剂。妇人喉痛，必先问其经水通闭，若经闭者，用通经药愈矣。喉疼连胸，红肿而痛，右寸浮洪而数甚，
系肺痈，须用蜜调药，加百草霜、桔梗为妥。凡喉中无形而红肿者，宜多用灯心灰。喉碎者，先吹长肉药，后
用碧丹。痰不出，用金丹加制皂角少许，倘至穿烂，
多用口疳药加龙骨、珍珠。喉症，无痰不治，有痰声如解锯者危，用金丹吹之。初发寒战，后即身凉，口不碎，
无重舌，二便利，即非热症，盖虚寒亦能发痰，此痰不可去尽，乃身内精液与乳蛾 舌之痰，吐尽而肿消者不
同，当先用吹药，喉一通即，服煎药第一剂发散，和解第二剂，即温补导火纳气。设三四日后再发寒战，或见
心肋痛等症者，难治。发时牙关紧，喉舌肿口碎腥臭，重舌，或舌胎黄而有刺，便闭者，此是热症，赤麟散角
药紫地汤、金丹、碧丹、开风路针皆神效。若根据法治之症不减，牙关反闭，唇不肿纹，如无病患者，不治。
（《尊生书》）
论忌用寒凉针砭之证 专用芩连栀柏之类正治之，则上热未除，中寒复起，毒瓦斯乘虚入腹，变为败症。
（《正传》）虚火上炎者，纯用寒凉，必致上喘下泻。亦最忌发汗，针砭出血，内伤虚损，咽痛失音者，误针
之，必不救。（《嵩崖》）寒伤肾而致帝中肿者，此证人皆不知，宜以八味丸加减。切禁用针帝中，号喉花，
关乎性命其慎之。（岫云）
死症 胸前高起，上喘下泄，手足指甲青紫，七日以后，全不入食，口如鱼口者，死。又急喉痹症，声如
鼾睡，此为肺绝，必死。用人参、竹沥、姜汁或可救其万一。（丹溪）舌肿满口，色如胡桃、茄子、朱砂纸，
不治。口渴气喘，痰如桃胶，一颈皆肿，面带红紫，或青，或纯白，无神，皆不治。喉风过一日夜，牙噤喉响
如雷，灯火近口即灭，此气已离根，有升无降，不治。喘急额汗者，不治。（景日胗）
用药加减法 主以甘桔汤，加薄荷、荆芥、防风、黄芩、玄参、牛蒡子、竹茹等。咳嗽加贝母、陈皮。渴
加花粉、麦冬。唾血加紫菀。呕恶加半夏。胸满加枳壳。便闭加大黄。痰甚加石膏。火甚加川黄连。卒闭暴死
用解毒雄黄丸。此皆治实火之法也。凡属虚者，当从权为主，古人有用肉桂、人参、附子、炮姜者，但理其下
而上自安，此乃求本之治也。大抵血虚用四物汤，气虚用补中益气汤，肝火用逍遥
散，肾虚用地黄汤，佐以治标之品。又有命门火衰，龙浮咽嗌痛者，唯八味丸最效。而寒凉之剂，则一毫不可浪
用也。（《汇补》）咽痛必用荆芥，阴虚火炎必用玄参，气虚加人参、竹沥，血虚四物加竹沥。（丹溪）凡喉症
最忌半夏、生姜，最喜梨汁、柿子。（《嵩崖》）一切咽喉痛紫雪为要药。（程云来）紫雪纯寒，重症不可用，
或合赤麟散用之始佳。（岫云）
《素问》说：在运气学说中，少阳相火主令之时，容易出现喉痹，症状包括耳鸣、呕吐涌逆。又说：当少阳司天，在三之气阶段，炎暑降临，民众易患喉痹，这属于火邪致病，适宜使用张仲景的桔梗汤；或者如果患者面色赤红且有斑疹，属于阳毒证，适宜用治疗阳毒的方剂通过发汗来解除病邪。又说：太阴湿土胜复之时，火气内郁，会导致喉痹。又说：太阴在泉之时，湿气过盛，会出现咽喉肿痛、喉痹，这属于湿邪致病，适宜使用朱肱《活人书》中的半夏桂枝甘草汤。又说：太阳寒水在泉之时，寒气过盛，民众会出现咽痛、下颌肿胀，这属于寒邪致病。病情轻的采用解表发散法，病情重的采用温中散寒法，四逆汤酌情选用。或者如果患者面色青黑，属于阴毒证，适宜用治疗阴毒的方剂通过发汗来解除病邪。按语：虽然运气学说中有火、湿、寒的不同，但湿气则热生于其中，寒气则火郁结于内，最终都归结为火邪，所以治疗的大要以发散为主。如针刺、刀砭（古代一种割治疮疡的工具）以及药物，像赤麟散、金碧二丹，都是大苦大寒或辛热的药剂，偶尔也有时候需要用到，但绝不可轻易随意投药，务必谨慎。（岫云注）
内因：由于胸膈原本就有痰涎，或者纵酒过度，或者愤怒失常，或者房事不节制，导致火动而挟痰，涌塞于咽喉之间，致使内外肿痛，连水浆都无法吞咽。（《医鉴》）有的属于运气天时流行病，有的因七情郁结所致，有的因寒气客居会厌，有的因寒气伤肾导致喉中肿胀。
外候：外部征象最多，已记载在前编中，这里不再赘述。（岫云注）如果毒邪聚积于内，涎唾稠粘，只出现寒热症状的，称为塞喉风。突然发作并迅速死亡的，称为走马喉风。（子和注）走马喉风，突然失音，不省人事，痰壅口噤闭塞而死，与各种卒中相似，但必须先有喉痛作为鉴别依据。（李惺庵注）
论喉与咽的区别：喉痹，是指喉中呼吸不通畅，言语不能发出，这是天气闭塞的表现。咽痛，是指咽嗌不能吞咽唾液和饮食，这是地气闭塞的表现。（《类要》）
患喉痹的人，必定兼有咽痛；患咽痛的人，不一定都兼有喉痹。（王宇泰注）
论表证与里证的区分：属于表证的，必定兼有恶寒，且寸脉弱小于关尺脉，这是寒邪闭阻于外，热邪郁结于内，适宜用辛凉发散法，切忌使用酸寒收敛之品。属于里证的，身体无发热而寸脉滑利大于关尺脉，这是积热于内，壅滞生痰，适宜用苦寒折伏及涌吐的方法。（李惺庵注）也有表证轻微而没有寒热症状的，应当仔细辨别。（岫云注）恶寒且寸脉小，如果乡里患有相同病症，这属于天时流行的时气病，适宜先进行解表发散。最忌讳使用酸寒吹点药，以及苦寒攻下之法。（景嵩崖注）
辨虚证与实证的差异：实火是因为过失食用煎炒炙烤食物及醇酒，导致热毒蕴积，胸膈不利，烦渴便秘。虚火是因为七情劳欲，气虚导致虚火上炎，咽膈干燥，大小便正常。（《入门》）
辨阴阳的区分：阳虚者，两寸脉浮大，遇劳累加重，这是肺脾气怯，不能堤防下焦，必须培补中宫（脾胃）。阴虚者，两尺脉洪数，傍晚时分加重，这是肝肾阴虚，不能制约龙雷之火，必须滋养癸水（肾水）。脉法上，两寸脉浮洪而溢出的，是喉痹。两尺脉细微无力的，是虚炎。如果脉微甚而伏匿的，预后不良致死。脉浮大而涩的，也预后不良致死。脉沉细的，难以治愈。脉洪大有力的，容易治愈。脉弦数有力的是实火，左寸脉虚数、尺脉微弱的是虚火，适宜滋养金水（肺肾）。如果两脉若浮大，重取而涩的，这是阴气大虚，阳气浮越，适宜补阴敛阳，单用人参一味浓煎汤饮服，如果用喉科常规清热法治必死无疑。
治法：喉症种类繁多，不可一概以实热论治。大抵热证则通泄，寒证则温补，不寒不热者，根据经络调理。汤剂荡涤邪气，外加针刺等方法，都要急治，时机不可延误，不像脏腑积久之病，可以慢慢调养化解。（《圣济录》）
治疗实证的方法，轻的先宜发散，次用清凉。重的先涌吐导引痰涎，针刺砭石出血，再用煎剂。治疗虚证的方法，须遵循《内经》从治的宗旨，徐徐图之。（《正传》）凡是喉症，过了四五天为重证，三天前可消除，如果不是急证。一两天不发寒热，到第三天开始发寒热。如果头痛则兼感寒邪，须疏风散寒。询问二便情况如何？便利者，是浮游之火上攻，适宜用消风祛热、降气解毒的方剂。妇人喉痛，必先问其月经通闭情况，如果经闭者，用通经药即可痊愈。喉疼连胸，红肿而痛，右寸脉浮洪而数甚，系肺痈，须用蜜调药，加百草霜、桔梗为宜。凡是喉中无形而红肿的，宜多用灯心灰。喉部溃烂碎破的，先吹长肉药，后用碧丹。痰不出，用金丹加少许制皂角，倘若至穿烂，多用口疳药加龙骨、珍珠。喉症，无痰不治，有痰声如解锯（拉锯声）者危重，用金丹吹之。初发寒战，后即身凉，口不碎，无重舌，二便通畅，即非热症，盖虚寒也能发痰，此痰不可去尽，这与体内精液与乳蛾舌之痰，吐尽而肿消的情况不同，当先用吹药，喉一通即服煎药，第一剂发散，第二剂和解，即温补导火纳气。设三四日后再发寒战，或见心肋痛等症者，难治。发作时牙关紧闭，喉舌肿口碎腥臭，重舌，或舌苔黄而有刺，便秘者，这是热症，赤麟散、角药、紫地汤、金丹、碧丹、开风路针皆神效。如果依法治之症不减，牙关反闭，唇不肿纹，如无病患者，不治。（《尊生书》）
论忌用寒凉针砭的证候：专用黄芩、黄连、栀子、黄柏之类正治之，则上热未除，中寒复起，毒瓦斯乘虚入腹，变为败症。（《正传》）虚火上炎者，纯用寒凉，必致上喘下泻。也最忌发汗，针砭出血，内伤虚损，咽痛失音者，误针之，必不救。（《嵩崖》）寒气伤肾而导致喉中肿胀者，此证人都不知道，适宜用八味丸加减。切禁用针刺激喉中，号喉花，关乎性命，务必谨慎。（岫云注）
死症：胸前高起，上喘下泄，手足指甲青紫，七日以后，全不入食，口如鱼口者，死。又急喉痹症，声如鼾睡，此为肺绝，必死。用人参、竹沥、姜汁或可救其万一。（丹溪注）舌肿满口，色如胡桃、茄子、朱砂纸，不治。口渴气喘，痰如桃胶，一颈皆肿，面带红紫，或青，或纯白，无神，皆不治。喉风过一日夜，牙噤喉响如雷，灯火近口即灭，此气已离根，有升无降，不治。喘急额汗者，不治。（景日胗注）
用药加减法：主以甘桔汤，加薄荷、荆芥、防风、黄芩、玄参、牛蒡子、竹茹等。咳嗽加贝母、陈皮。渴加花粉、麦冬。唾血加紫菀。呕恶加半夏。胸满加枳壳。便闭加大黄。痰甚加石膏。火甚加川黄连。卒闭暴死用解毒雄黄丸。此皆治实火之法也。凡属虚者，当从权为主，古人有用肉桂、人参、附子、炮姜者，但理其下而上自安，此乃求本之治也。大抵血虚用四物汤，气虚用补中益气汤，肝火用逍遥散，肾虚用地黄汤，佐以治标之品。又有命门火衰，龙浮咽嗌痛者，唯八味丸最效。而寒凉之剂，则一毫不可浪用也。（《汇补》）咽痛必用荆芥，阴虚火炎必用玄参，气虚加人参、竹沥，血虚四物加竹沥。（丹溪注）凡是喉症最忌半夏、生姜，最喜梨汁、柿子。（《嵩崖》）一切咽喉痛紫雪为要药。（程云来注）紫雪纯寒，重症不可用，或合赤麟散用之始佳。（岫云注）
The *Suwen* (Basic Questions) states: In the theory of Six Qi and Five Movements, when Shaoyang (Lesser Yang) prevails, it leads to throat obstruction (Hou Bi), tinnitus, and vomiting with regurgitation. It further states: When Shaoyang governs the Heavenly Qi, during the third phase of the year, intense heat and summer warmth arrive, causing the people to suffer from throat obstruction; this belongs to Fire pathogenic factors, and Zhang Zhongjing's Jiegeng Tang (Platycodon Decoction) is appropriate. Or, if the face is red with macules, it belongs to Yang Toxin (Yang Du), and various formulas for Yang Toxin should be used to induce sweating. It also states: When Taiyin (Greater Yin) wins over, internal stagnation of Fire occurs, leading to throat obstruction. Furthermore: When Taiyin governs the Earthly Qi, excessive Dampness causes swelling of the pharynx and throat obstruction; this belongs to Dampness pathogenic factors, and Banxia Guizhi Gancao Tang (Pinellia, Cinnamon Twig, and Licorice Decoction) from Zhu Gong's *Huoren Shu* is appropriate. Additionally: When Taiyang (Greater Yang) governs the Earthly Qi, excessive Cold causes the people to suffer from sore throat and submandibular swelling; this belongs to Cold pathogenic factors. For mild cases, exterior-dispersing methods are used; for severe cases, middle-warming methods are employed, and Sini Tang (Frigid Extremities Decoction) is used as appropriate. Or, if the face is blue-black, it belongs to Yin Toxin (Yin Du), and various formulas for Yin Toxin should be used to induce sweating. Commentary: Although the theories of Six Qi and Five Movements differ in terms of Fire, Dampness, and Cold, Dampness generates Heat within, and Cold causes Fire to stagnate internally; ultimately, they all converge on Fire. Therefore, the general principle of treatment is dispersal. Techniques such as acupuncture, knife-lancing (Bian stone therapy), and medications like Chilín San (Red Lin Powder), Jinbi Er Dan (Golden and Green Elixirs), which are extremely bitter-cold or acrid-hot, are occasionally necessary but must never be administered lightly or indiscriminately. Caution is essential. (Commentary by Xiu Yun)
Internal Causes: Due to phlegm-fluid retention originally present in the chest and diaphragm, or excessive indulgence in alcohol, or abnormal anger, or irregular sexual activity, Fire stirs up Phlegm, surging and blocking between the throat and pharynx, resulting in internal and external swelling and pain, making it impossible to swallow even water or gruel. (*Yi Jian*) Some cases belong to epidemic diseases caused by heavenly timing, some are due to emotional depression and knotting, some result from Cold invading the hyoid bone area (huiyan), and some arise from Cold injuring the Kidney causing swelling in the throat.
External Manifestations: External signs are numerous and have been recorded in the previous section, so they are not repeated here. (Commentary by Xiu Yun) If toxic pathogens accumulate internally, with thick and sticky saliva, presenting only with chills and fever, it is called Sai Hou Feng (Blocked Throat Wind). Sudden onset and rapid death is named Zouma Hou Feng (Running Horse Throat Wind). (Commentary by He Hanzhang) Zouma Hou Feng involves sudden loss of voice, unconsciousness, phlegm congestion, locked jaw, and death by blockage, resembling various types of stroke, but must be distinguished by the prior presence of sore throat. (Commentary by Li Xing'an)
On the Difference Between Throat (Hou) and Pharynx (Yan): Throat obstruction refers to blocked breathing in the throat and inability to speak, representing the blockage of Heavenly Qi. Sore throat refers to the inability to swallow saliva and food in the pharynx, representing the blockage of Earthly Qi. (*Lei Yao*)
Patients with throat obstruction must have concomitant sore throat, but those with sore throat do not necessarily have throat obstruction. (Commentary by Wang Yutai)
On the Distinction Between Exterior and Interior Syndromes: Syndromes belonging to the Exterior must include aversion to cold, and the Cun pulse at the wrist is weaker and smaller than the Guan and Chi pulses; this indicates Cold closing the exterior and Heat stagnating internally, requiring acrid-cool dispersing methods, and strictly avoiding sour-cold astringents. Syndromes belonging to the Interior present with no body heat but a slippery Cun pulse larger than the Guan and Chi pulses; this indicates accumulated Heat internally causing stagnation and Phlegm formation, requiring bitter-cold suppression and emetic methods. (Commentary by Li Xing'an) There are also mild exterior syndromes without chills or fever that require careful differentiation. (Commentary by Xiu Yun) Aversion to cold with a small Cun pulse, especially when similar illnesses occur in the same locality, belongs to epidemic seasonal Qi, requiring initial exterior dispersal. The use of sour-cold topical powders and bitter-cold purgatives is strictly forbidden. (Commentary by Jing Songya)
Differentiating Deficiency and Excess Syndromes: Excess Fire results from improper consumption of fried, roasted, and grilled foods and strong wine, leading to heat-toxin accumulation, chest discomfort, irritability, thirst, and constipation. Deficiency Fire results from emotional stress and fatigue/sexual excess, where Qi deficiency causes deficient Fire to flare upward, leading to dryness of the throat and epigastrium, with normal bowel and bladder movements. (*Ru Men*)
Differentiating Yin and Yang: In Yang Deficiency, both Cun pulses are floating and large, worsening with exertion; this indicates Lung and Spleen Qi weakness failing to control the Lower Jiao, requiring tonification of the Middle Jiao (Spleen/Stomach). In Yin Deficiency, both Chi pulses are flooding and rapid, worsening in the late afternoon; this indicates Liver and Kidney Yin deficiency failing to control Dragon-Liver Fire, requiring nourishment of Gui Water (Kidney Water). Regarding pulse diagnosis: Floating, flooding, and overflowing Cun pulses indicate throat obstruction. Fine and weak Chi pulses indicate deficient inflammation. If pulses are extremely faint and hidden, death ensues. If floating and large yet choppy, death ensues. If deep and fine, it is untreatable. If flooding and forceful, it is easily treatable. Wiry, rapid, and forceful pulses indicate Excess Fire; empty, rapid left Cun and weak Chi pulses indicate Deficient Fire, requiring nourishment of Metal and Water (Lung and Kidney). If both pulses are floating and large but become choppy upon heavy pressure, this indicates severe Yin deficiency with floating Yang; treating with pure Yin-tonifying and Yang-astringing methods, specifically decocting a single dose of Ren Shen (Ginseng Radix et Rhizoma) for drinking, is required. Treating with standard throat-specialist cooling methods will certainly lead to death.
Treatment Methods: Throat conditions vary and cannot generally be treated solely as Excess Heat. Generally, Heat is treated by draining, Cold by tonifying, and neither extreme by regulating according to the meridians. Decoctions cleanse, supplemented by external methods like acupuncture; these require urgent treatment without delay, unlike chronic organ diseases that allow for slow conditioning. (*Shengji Lu*)
For treating Excess syndromes, mild cases first require dispersal, followed by cooling. Severe cases first require inducing vomiting to expel phlegm, bloodletting via acupuncture/lancing, followed by decoctions. For treating Deficiency syndromes, one must follow the principle of "treating contrary to appearance" from the *Neijing*, proceeding slowly. (*Zheng Chuan*) Generally, throat conditions worsen after four to five days; before three days, they can be resolved. If not an acute condition, chills and fever may not appear until the third day. If accompanied by headache, it indicates concurrent Cold invasion, requiring wind-dispelling and cold-expelling methods. Ask about bowel and bladder movements: if unobstructed, it is floating wandering Fire attacking upward, requiring wind-eliminating, heat-clearing, qi-descending, and toxin-resolving formulas. For women with sore throat, ask about menstruation first; if amenorrheic, using menstruation-promoting herbs will cure it. Throat pain radiating to the chest with redness, swelling, and pain, accompanied by a floating, flooding, and rapid Right Cun pulse, indicates Lung Abscess (Fei Yong); honey-modified medicine with Baicao Shuang (Cinnabar Dust) and Jie Geng (Platycodon Root) is appropriate. For diffuse redness and swelling without visible lesions in the throat, Deng Xin Hui (Juncus Ash) should be used frequently. For ulcerated/throat tissue breakdown, apply flesh-generating powder first, then Bi Dan (Green Elixir). If phlegm cannot be expectorated, use Jin Dan (Golden Elixir) with a little processed Zao Jiao (Gleditsia Sinensis Fruit); if perforation occurs, use mouth ulcer medicines with Long Gu (Fossilized Bones) and Zhen Zhu (Pearl). Throat conditions without phlegm are not difficult to treat; those with phlegm producing sounds like sawing wood are critical, treated with Jin Dan insufflation. Initial chills followed by cooling of the body, no oral ulcers, no double tongue, and clear bowels/bladder indicate it is not a Heat syndrome; indeed, Deficiency-Cold can generate phlegm. This phlegm should not be completely expelled, differing from the phlegm of Ru E (Tonsils) and She (Tongue) where expulsion resolves swelling. Initially use insufflation powder; once the throat opens, take the first decoction for dispersal, the second for harmonizing, then warming tonification to guide fire and integrate Qi. If chills recur after three to four days, or chest/hypochondriac pain appears, it is difficult to treat. During attacks, if the jaw is tight, throat/tongue swollen, mouth ulcerated with foul odor, double tongue present, or tongue coating yellow with prickles, and constipation exists, this is a Heat syndrome; Chilín San, Jiao Yao, Zi Di Tang, Jin Dan, Bi Dan, and Kai Feng Lu Zhen (Wind-Opening Road Acupuncture) are all highly effective. If symptoms persist despite correct treatment, jaw locks further, lips are not swollen, and the patient appears healthy otherwise, it is untreatable. (*Zun Sheng Shu*)
On Contraindications for Cold/Cooling and Lancing: Using purely bitter-cold herbs like Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Zhi Zi (Gardenia Fruit), and Huang Bai (Phellodendron Bark) as direct treatment leaves upper Heat unresolved while triggering Middle Jiao Cold; toxins enter the abdomen through deficiency, becoming fatal. (*Zheng Chuan*) For Deficient Fire flaring upward, using purely cold/cooling herbs inevitably causes upper wheezing and lower diarrhea. Sweating induction and bloodletting are also strictly contraindicated. For internal injury with deficiency damage, sore throat, and loss of voice, mistaken lancing is incurable. (*Song Ya*) For throat swelling caused by Cold injuring the Kidney, few recognize this pattern; Bajie Wan (Eight-Ingredient Pill) modified is appropriate. Lancing the throat (Hou Hua) is strictly forbidden as it concerns life and death; caution is essential. (Commentary by Xiu Yun)
Fatal Signs: Swelling rising high on the chest, upper wheezing and lower diarrhea, cyanosis of fingernails/toes, total refusal of food after seven days, and a mouth opening like a fish's gill indicate death. In acute throat obstruction, snoring-like sounds indicate Lung Exhaustion and certain death. Ren Shen (Ginseng), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice) might save one in ten thousand. Tongue swelling filling the mouth, colored like walnut, eggplant, or cinnabar paper, is untreatable. Thirst, wheezing, phlegm like peach gum, neck-wide swelling, and facial coloration of red-purple, blue, or pure white without spirit are all untreatable. Throat wind lasting more than a day and night, with locked jaw and thunderous throat sounds extinguishing nearby lamps, indicates Qi has separated from its root, ascending without descending; this is untreatable. Wheezing with forehead sweating is untreatable. (Commentary by Jing Rizhen)
Medication Modification Methods: The main formula is Ganjie Tang (Licorice and Platycodon Decoction), modified with Bo He (Mint), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Huang Qin (Scutellaria), Xuan Shen (Scrophularia), Niu Bang Zi (Arctium Seed), and Zhu Ru (Bamboo Shavings). Add Bei Mu (Fritillaria) and Chen Pi (Citrus Peel) for cough. Add Hua Fen (Trichosanthes Root) and Mai Dong (Ophiopogon) for thirst. Add Zi Wan (Aster) for hemoptysis. Add Ban Xia (Pinellia) for nausea/vomiting. Add Zhi Ke (Aurantium) for chest fullness. Add Da Huang (Rhubarb) for constipation. Add Shi Gao (Gypsum) for severe phlegm. Add Chuan Huang Lian (Coptis) for severe Fire. For sudden closure and collapse, use Jiedu Xionghuang Wan (Detoxifying Realgar Pill). These are methods for treating Excess Fire. For Deficiency patterns, flexibility is key; ancients used Rou Gui (Cinnamon Bark), Ren Shen (Ginseng), Fu Zi (Aconite), and Pao Jiang (Prepared Ginger), regulating the lower body so the upper settles naturally; this is treating the root. Generally, Blood Deficiency uses Siwu Tang (Four Substance Decoction), Qi Deficiency uses Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Liver Fire uses Xiaoyao San (Free and Easy Wanderer Powder), and Kidney Deficiency uses Dihuang Tang (Rehmannia Decoction), supplemented by symptomatic treatments. For Mingmen Fire decline with Dragon Fire floating causing throat pain, Bajie Wan (Eight-Ingredient Pill) is most effective. Cold/cooling agents must never be used recklessly. (*Hui Bu*) Sore throat requires Jing Jie (Schizonepeta); Yin Deficiency with Fire Flare requires Xuan Shen (Scrophularia); Qi Deficiency adds Ren Shen (Ginseng) and Zhu Li (Bamboo Sap); Blood Deficiency adds Zhu Li (Bamboo Sap) to Siwu Tang (Four Substance Decoction). (Commentary by Danxi) All throat conditions strictly forbid Ban Xia (Pinellia) and Sheng Jiang (Fresh Ginger), favoring Li Zhi (Pear Juice) and Shi Zi (Persimmon). (Commentary by Song Ya) Zi Xue (Purple Snow) is the essential medicine for all throat pains. (Commentary by Cheng Yunlai) Zi Xue is purely cold; it should not be used for severe cases alone, but combined with Chilín San (Red Lin Powder) for best results. (Commentary by Xiu Yun)