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When the Wei Qi (Defensive Qi) is awake, it circulates in the Yang meridians; when asleep, it circulates in the Yin meridians. The process of falling asleep must begin from the Foot-Shaoyin Kidney Meridian; therefore, the characteristics of Shaoyin disease are a faint and thin pulse and a desire to sleep. If ten days have passed since the onset of Taiyang disease, and the pulse has changed from floating to fine with drowsiness, it indicates that the exterior pathogenic factors have been resolved. If there is chest fullness and hypochondriac pain, it is a Xiao Chai Hu Tang (Minor Bupleurum Decoction) pattern. If the pulse is merely floating, Ma Huang Tang (Ephedra Decoction) should be used (This clause likely refers to a combined disease of the Taiyang and Shaoyang meridians. Although chest fullness is the same as before, the floating and fine pulse with drowsiness indicates that the exterior pathogen has resolved, while hypochondriac pain indicates pathogen in the Shaoyang, hence Xiao Chai Hu Tang is used. If the pulse is merely floating, one should first treat the Taiyang meridian. This is a hypothetical statement of flexibility, not implying that the pulse becomes floating after taking Xiao Chai Hu Tang. Cheng Wuji's annotation is not worthy of following). Dry mouth and throat with a desire to sleep (see "Bitter Taste in Mouth" section); desire to vomit but unable to do so, with a desire to sleep (see "Vomiting" section); vomiting and diarrhea with a desire to sleep (see "Vomiting and Diarrhea" section); diarrhea with a desire to sleep (see "Diarrhea" section); floating pulse, excessive sweating, and somnolence, if accompanied by heavy body and snoring, belong to Feng Wen (Wind-Warmth) (see "Feng Wen" section); if盗汗 (night sweats) occur upon closing the eyes, this is a combined disease of the Three Yang meridians (see "Night Sweats" section). Huo Huo disease presents with silence and desire to sleep, inability to close eyes, anorexia, aversion to food odor, complexion alternating between red, black, and white, and hoarseness; treat with Gan Cao Xie Xin Tang (Licorice Decoction for Draining the Epigastrium). For dry throat, use Ku Shen Tang (Sophora Root Decoction) for washing. For anal erosion by worms, use Xiong Huang fumigation. For rapid pulse, no fever, red eyes, and dark canthi, use Dang Gui Chi Xiao Dou San (Cowherb and Adzuki Bean Powder) (see "Huo Huo" section).

(The above content is already included in the "Bitter Taste in Mouth and Dry Throat" section.)

Sore throat caused by Taiyang disease and Yangming disease each has one pattern, both belonging to Heat patterns. Taiyang disease is treated with Ban Xia San (Pinellia Powder), and Yangming disease is treated with Si Ni San (Frigid Extremities Powder) plus Jie Geng (Platycodon). Sore throat in Shaoyin disease has six patterns: four Heat patterns and two Cold patterns. Heat patterns are treated with Zhu Fu Tang (Pig Skin Decoction), Gan Cao Tang (Licorice Decoction), Jie Geng Tang (Platycodon Decoction), and Ku Jiu Tang (Bitter Wine Decoction). Cold patterns are treated with Gui Zhi Gan Jiang Tang (Cinnamon Twig and Dried Ginger Decoction), Zhen Wu Tang (True Warrior Decoction), and Si Ni Tang (Frigid Extremities Decoction). Sore throat in Jueyin disease is also a Heat pattern, treated with Jie Geng Tang. Why are sore throats generally Heat patterns, yet Shaoyin disease has two Cold patterns? One is due to excessive sweating leading to collapse of Yang, so Gan Jiang (Dried Ginger) and Fu Zi (Aconite) are used to restore Yang and warm the meridians. The other is due to Yin excess repelling Yang, so Tong Mai Si Ni Tang (Pulse-Returning Frigid Extremities Decoction) is used to disperse Yin and unblock Yang.

If Taiyang disease is treated with purgation and the pulse becomes tight, sore throat will inevitably occur; treat with Ban Xia Tang (Pinellia Decoction).

Ban Xia San Ji Tang Formula: Ban Xia (Processed), Gui Zhi, Gan Cao (Roasted), in equal parts. Crush the herbs, decoct in water, and take small amounts frequently. Alternatively, make into powder, mix with plain water, and take one cubic inch spoonful; also effective. Take three times daily. (Zhang Zhongjing's method is to make powder and mix with water, without coarse crushing.)

Cheng Wuji notes: Gan Cao Tang mainly treats sore throat caused by guest heat in Shaoyin. Jie Geng Tang mainly treats sore throat caused by cold-heat conflict in Shaoyin. Ban Xia San Ji Tang mainly treats sore throat caused by guest cold in Shaoyin.

In Yangming disease, if there is only dizziness, no aversion to cold, ability to eat, and cough, the person will inevitably have a sore throat. If there is no cough, there is no sore throat (see "Dizziness" section).

Shaoyin and Jueyin: In Shaoyin disease, if sore throat occurs on the second or third day, give Gan Cao Tang. If not improved, give Jie Geng Tang. (When Yang pathogen transmits to Shaoyin causing sore throat, taking Gan Cao Tang resolves it. If cold and heat conflict causes sore throat, taking Gan Cao Tang does not resolve it; then give Jie Geng Tang to harmonize Shaoyin Qi.)

Gan Cao Tang Formula: Gan Cao (2 liang). One herb, decoct in 3 sheng of water to obtain 1.5 sheng, remove dregs, warm and take 0.7 sheng, three times daily.

Jie Geng Tang Formula: Jie Geng (1 liang), Gan Cao (2 liang). Two herbs, decoct in 3 sheng of water to obtain 1 sheng, remove dregs, divide into two doses and take warm. (Jie Geng is acrid and warm to disperse cold; Gan Cao is sweet and neutral to clear heat. Together they harmonize cold and heat.)

For sore throat in the throat center in Shaoyin disease, Ban Xia San Ji Tang is the main treatment. For injury and ulceration in the throat center in Shaoyin disease, resulting in inability to speak or produce sound, Ku Jiu Tang is the main treatment.

Ku Jiu Tang Formula: Ban Xia (14 pieces, washed and broken like a date pit), Ji Zi (one egg, remove yolk, place Ban Xia inside shell, add Ku Jiu to the shell). Mix the two ingredients, place Ban Xia in Ku Jiu, put the eggshell on a knife ring, and heat over fire until boiling three times. Remove dregs, hold in mouth and swallow slowly. If not improved, prepare three more doses. (According to Ben Cao annotations, Ku Jiu is white vinegar. Cheng Shi mentions the acidity of Ku Jiu; I believe the name and nature fit. How do we know that bitter-tasting wine cannot cure throat ulcers? If one dislikes the heat of wine, Ban Xia Tang is even more acrid and hot, let alone this bitter taste. The characters "fa" (emit) and "lian" (astringe) mentioned below contradict each other.)

If the pulse is tight at both Yin and Yang positions but there is sweating, it indicates collapse of Yang. This belongs to Shaoyin disease. According to the law, sore throat should occur, accompanied by vomiting and diarrhea. In Shang Han, if there is initial cold extremities followed by fever, diarrhea will stop spontaneously. If sweating occurs after stopping, bi obstruction in the throat will result (Cold extremities with diarrhea; fever stops diarrhea. Sweating indicates collapse of Yang. Sore throat indicates rising heat. Collapse of Yang leaves Yin alone, which reunites with heat, causing Yin-Yang knotting resulting in throat bi. Nei Jing states: Knotting of one Yin and one Yang results in throat bi. See "Diarrhea" section). For sore throat with diarrhea and chest pain, use Zhu Fu Tang. For cold extremities, faint pulse about to cease, no aversion to cold, and red face, use Tong Mai Si Ni Tang. After purgation, recurrence of cold extremities and absence of pulse in the lower part, use Ma Huang Sheng Ma Tang (all see "Diarrhea" section).

Yang Du (Poison) sore throat with red face and rash like brocade, expectoration of pus and blood: treatable within five days, untreatable after seven days. Use Sheng Ma Bie Jia Tang (Cimicifuga and Turtle Shell Decoction). (Huo Ren Shu says Yang Du is treated with Sheng Ma Tang; see "Yang Du" section.) Yin Du (Poison) sore throat with blue-green face and body pain like being beaten: treatable within five days, untreatable after seven days. Use Sheng Ma Bie Jia Tang minus Xiong Huang and Shu Jiao. (Huo Ren Shu says Yin Du is treated with Gan Cao Tang; see "Yin Du" section.)

Contraindications: Do not induce sweating if there is blockage in the throat; inducing sweating leads to hematemesis, qi exhaustion, cold extremities, desire to curl up in bed, and inability to self-warm. Do not purge if there is blockage in the throat; purging leads to lightness above and heaviness below, inability to take fluids, desire to curl up in bed when lying down, urgent dizziness, and frequent diarrhea (dozens of times a day).

Zhang Jiebin said: Some say that the Six Meridians Shang Han do not mention sore throat, only Shaoyin chapter mentions sore throat and throat injury. Why? Because Shaoyin sore throat is related to the meridians. The Shaoyin meridian passes through the liver and diaphragm, enters the lung, follows the throat, and connects to the root of the tongue, thus prone to sore throat and injury. Nei Jing states: Diseases produced include throat swelling, upward rushing Qi, dry throat, and pain. This is caused by pathogens traveling along the meridians.

Appendix:

Hua Shou said: Ban Xia Gui Zhi Gan Cao Tang treats Fu Qi (latent pathogen) disease. It is said that sudden cold strikes people out of season, latent in the Shaoyin meridian. Initially unnoticed, it manifests after a month with a weaker pulse, starting with sore throat, resembling Shang Han but not Hou Bi (throat obstruction) disease, and must be accompanied by diarrhea before using Ban Xia Gui Zhi Gan Cao Tang. This disease heals in two days, anciently called Kidney Shang Han. Subsequently, use Si Ni Tang.

Ban Xia Gui Zhi Gan Cao Tang Formula: Ban Xia (washed with boiling water), Gan Cao (roasted), Gui Xin (Cinnamon Heart), in equal parts. Crush, take 4 qian per dose, decoct in water, wait for cooling, and sip slowly.

Zhao Xianke said: Recent editions of Huo Ren Shu all print Si Ni San, but Si Ni San does not treat sore throat. I suspect a printing error. Zhang Zhongjing states: Si Ni San treats Shaoyin disease where transmitted pathogen generates heat, causing cold extremities. This case seems to be latent cold in Shaoyin meridian with weak pulse, requiring warming and dispersing. Since Ban Xia Gui Gan Tang (a warming agent) was used first, why use Chai Hu (a cooling agent) subsequently? It must be Si Ni Tang. Moreover, Tong Mai Si Ni Tang formula has an example of adding Jie Geng for sore throat; using this leaves no doubt.

Wu Qian said: Sore throat involves Yin and Yang Du (Poisons). Yang Du sore throat and swelling is extreme heat; Yin Du throat discomfort is extreme cold. Yang Du pulse is floating, rapid, and large, with sore throat and expectoration of pus and blood. Qian Jin and Wai Tai use Wu Shan Gao (Black Iris Ointment). Huo Ren uses Hei Nu Wan (Black Slave Pill). Another case of excessive Yang Qi, mania, sore throat, and large, solid, slippery, rapid pulse is treated by Huo Ren with Ting Li Ku Jiu Tang (Descurainia and Bitter Wine Decoction). For Shang Han sore throat, decoct raw Gan Cao strongly and drink it, or soak Shan Dou Gen (Sophora Tonkinensis Root) in water, hold the bitter liquid in the mouth, or crush He Shi Cao (Nemesis Herb) juice with rice vinegar to gargle, which is also excellent.

Liu Wansu said: For sore throat with ulcers, blow powder of Huang Bo (Phellodendron Bark) and Xi Xin (Asarum). For Shang Han with swollen cheeks and sore throat, bleed Shao Shang and Wei Zhong points. Shao Shang point is on the medial side of the thumb tip, near the nail corner like a leek leaf; prick with a three-edged needle until bleeding cures it.

Dai Tianzhang said: There are cases of initial headache and fever without Yang Du or Shaoyin symptoms, yet spontaneous sore throat. This is due to wearing thick clothes/blankets immediately after catching a cold, or drinking ginger hot wine and lying down, causing upper congestion. Or having internal heat seeking coolness, leading to external pathogen invasion, combining wind-cold with heat congestion. Use Shen Su Yin doubled Jie Geng plus half qian Mu Xiang, or Xiao Feng Bai Jie San, or Bai Du San, or Wu Ji San. Half dose of Bai Du San mixed with another half dose is called Jiao Jia San.