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(Attached: Nostrils resembling soot, nostrils flaring)

Taiyang wind-stroke syndrome. Symptoms include nasal congestion with roaring sounds (Bi Ming) and dry retching. The cause of Bi Ming is wind pathogen interfering with the Lung. The Lung governs the skin and hair; when wind pathogen invades between the skin and hair without penetrating deeply, only light and ascending agents are needed to dissipate the pathogen from the skin and hair, after which Bi Ming will resolve spontaneously. If accompanied by heat, presenting as Bi Ming with nasal dryness, one should simultaneously clear heat from the Lung and Stomach. This remains a superficial condition. However, if pathogenic heat scorches the Lung, causing the nostrils to appear black like soot, this indicates impending exhaustion of Lung Qi. Urgent administration of large doses of sweet-cold herbs to generate fluids and purge heat is required, yet even then, recovery may be unlikely. In cases of nostril flaring, it may result from phlegm stagnation or heat stagnation; these conditions are still superficial and treatable. Conversely, if due to deficiency and exhaustion, where breath entering and exiting is faint, or exhalation exceeds inhalation, this constitutes a collapse syndrome, with less than one in a hundred recoveries.

Deafness belongs to Shaoyang syndrome. Shaoyang resides at the half-exterior and half-interior level. When pathogen enters Shaoyang, carrying phlegm upward, it obscures the clear orifices of the ear. Treatment should focus on clearing and resolving Shaoyang, after which deafness will cease. Another cause of deafness is excessive sweating leading to deficiency. The Classic states: "When taking the pulse, if the patient crosses their hands over the heart, and upon instruction to cough, fails to do so, this indicates bilateral deafness." This occurs because heavy sweating has caused deficiency. It also states: "Patients who cannot hear in both ears suffer from deficiency." Since this is attributed to deficiency, not only should sweating not be repeated, but purging should also be avoided. Only light and clear agents should be used to regulate the exterior and interior, allowing pathogen to recede gradually, diet to increase, and healthy Qi to recover, leading to natural healing. Forced treatment is ineffective.

Sore throat varies in etiology between yin-yang and cold-heat, making it difficult to distinguish. Generally, yang-heat syndromes often originate in Taiyang, while Yangming and Shaoyang may also present. Yin-cold diseases often strike Shaoyin, involving Taiyin and Jueyin. Treatments differ significantly between warm and cool methods. If differentiation is erroneous and prescriptions are administered arbitrarily, complications arise rapidly; caution is essential.

Wind pathogen enters via the skin and hair, first attacking Taiyang, where the Lung suffers first. If combined with phlegm-saliva, it causes sore throat with a sensation of obstruction. Prescribing wind-dispelling and throat-relieving herbs treats this shallow pathogen easily. Severe accumulation presents with redness and swelling, requiring herbs that break stagnation and reduce swelling. More severely, floating heat fills the three yang channels, binding with toxic saliva and evil blood. Within moments, throat distension and blockage prevent breathing, leading to death. Emetic methods may be used to disperse phlegm-saliva, or pricking methods to remove evil blood; rescue must not be delayed.

Yang-heat syndromes, even when extremely dangerous, are relatively easy to identify. However, Shaoyin sore throat is often unrecognized. Even when recognized, physicians fear using warming interior agents. Yet, extreme yin-cold repels yang upward, causing sore throat—a true cold, false heat syndrome—requiring warming methods. Warming methods vary and cannot be applied uniformly. As stated in the Classic: "In Shaoyin disease, if sore throat appears within two to three days, Gancao Tang (Licorice Decoction) may be given; if ineffective, Jiegeng Tang (Platycodon Decoction) is indicated." Also: "For Shaoyin disease with pain in the throat, Banxia San Ji Tang (Pinellia Powder and Decoction) is the primary treatment." And: "For Shaoyin disease with injury to the throat, ulceration, inability to speak, or loss of voice, Kujiu Tang (Bitter Wine Decoction) is indicated." Although these are Shaoyin diseases, lacking symptoms like diarrhea or cold limbs, they vary in severity and urgency. They avoid direct suppression with cold-cool herbs for one reason. If sore throat accompanies diarrhea, as stated: "In Shaoyin disease with diarrhea of undigested food, interior cold with exterior heat, cold limbs, faint pulse nearly imperceptible, body seemingly not afraid of cold, and sore throat, Tongmai Sini Jia Jiegeng Tang (Pulse-Restoring Four Reversals Plus Platycodon Decoction) is indicated." This is due to overwhelming yin-cold and impending depletion of primal yang, requiring urgent restoration of yang to its root, necessitating potent warming herbs.

Zhang Zhongjing established the use of warming medicines for sore throat specifically for true cold, false heat syndromes. Incorrect differentiation leads to rapid disaster. Without signs of yin excess and yang decline, methods to restore yang and overcome yin must not be used. Thus, Zhang Zhongjing also stated: "For Shaoyin disease with diarrhea, sore throat, chest fullness, and irritability, Zhufu Tang (Pig Skin Decoction) is indicated." Here, diarrhea caused yang depletion, whereas in the previous case, it caused yin exhaustion; treatments differ. Furthermore, in cases of intense yang-heat with surging phlegm-saliva, where the pulse is paradoxically slow and accompanied by heat-collapsing diarrhea, this represents a yang syndrome mimicking yin. Emesis is the best method here. The Classic states: "For various excess pathogens in the chest, with depression and pain in the chest, inability to eat, desire for pressure, presence of saliva/phlegm, frequent diarrhea (over ten times daily), slow pulse, and faint slippery cun position, emesis is indicated. Emesis stops the diarrhea." Because chest blockage contraindicates sweating and purging, Zhang Zhongjing warned against them. Emesis, containing dispersing properties, opens blockages and stops diarrhea.