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(Mouth dryness, tongue dryness, throat discomfort, oral ulceration)

Cheng Wuji's Commentary: Throat dryness, mouth dryness, and tongue astringency all belong to heat syndromes, differing only in severity. The exception is the Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) syndrome of Taiyang Cold Damage with internal cold, where throat dryness results from erroneous sweating. In this case, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be used to restore Yang Qi. This is a treatment for "Huai Bing" (ruined disease caused by mismanagement) following an error, addressing the complication rather than the original cold pathogen. However, the causes of throat dryness vary: some occur after sweating or purging, while others do not. Treatments may include harmonization, mild sweating, urgent purging, or mild purging. One must examine accompanying symptoms to apply appropriate light or heavy treatments. Ultimately, they are all heat syndromes. As the classics state: "Those with dry throat and mouth cannot be treated with sweating," because such cases often involve interior syndromes. For those without true cold patterns, skilled physicians should cross-reference the section on thirst to achieve comprehensive success.

Taiyang Syndrome: Those with dry throat cannot be treated with sweating (due to insufficient body fluids). In Cold Damage with floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to wind, and cramping in the legs, the pattern is originally suitable for Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite). If erroneously treated with Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior, it may result in cold limbs, throat dryness, vexation, vomiting, and regurgitation; treat with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction). After emesis or purging in Cold Damage, if the condition remains unresolved after seven to eight days, with exterior and interior heat, occasional aversion to wind, severe thirst, dry tongue, and vexation, use Baitu Jia Renshen Tang (Gypsum and Ginseng Decoction). If epigastric fullness persists despite using Xixin Tang (Heart-Draining Decoctions), accompanied by thirst, dry mouth, vexation, and urinary difficulty, use Wuling San (Five-Ingredient Powder with Poria). In Taiyang syndrome, after excessive sweating and purging, leading to constipation for five to six days, dry tongue with thirst, slight afternoon tidal fever, and hardness/fullness/pain from the epigastrium to the lower abdomen, use Daxiexiong Tang (Major Downward Draining Granule).

Yangming Syndrome: Abdominal fullness, floating-tight pulse, bitter taste, dry throat, and wheezing. If the patient has fever and aversion to wind, erroneous purging leads to abdominal fullness and difficult urination. If the patient has fever without aversion to wind but aversion to heat, erroneous purging leaves the stomach empty, causing mental anguish (Ao Nao). Erroneous purging leading to delirium, followed by erroneous moxibustion (burning needle), causes insomnia (Xu Xueshi suggests Xiaochaihu Tang [Minor Bupleurum Decoction] is appropriate). In Yangming syndrome, mouth dryness with rinsing water but no desire to swallow indicates impending epistaxis; use Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) or Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). After sweating or purging in Yangming syndrome, if there is thirst, desire to drink water, dry mouth, and dry tongue, use Baitu Jia Renshen Tang (Gypsum and Ginseng Decoction). Floating pulse, fever, dry mouth, dry nose, and ability to eat indicate impending epistaxis; use Huangqin Tang (Scutellaria Decoction). Yangming Wind Strike with bitter taste, dry throat, abdominal fullness, slight wheezing, fever, aversion to wind, floating-tight pulse may use Mahuang Tang (Ephedra Decoction) or Xiaochaihu Tang (Minor Bupleurum Decoction).

Shaoyang Syndrome: Bitter taste, dry throat, and vertigo/dizziness are suitable for Xiaochaihu Tang (Minor Bupleurum Decoction).

Shaoyin Syndrome: Spontaneous diarrhea of clear pure green fluid, pain in the epigastrium, and dry mouth/throat require urgent purging with Dachengqi Tang (Major Order the Qi Decoction). In Shaoyin syndrome, if dry mouth and throat appear within two to three days of onset, urgent purging with Dachengqi Tang (Major Order the Qi Decoction) is required. (Cheng Wuji notes: When Cold Damage transmits channels over five to six days and enters Shaoyin, dry mouth/tongue/thirst indicates deepening pathogen. Here, dry mouth/throat appearing early (2-3 days) when the pathogen has not yet deeply penetrated indicates intense heat depleting Kidney Water. Urgent purging with Dachengqi Tang preserves Kidney Water. In primary illness with deep penetration, urgent purging is indicated. Restlessness implies death due to dried Kidney Water. Zhang Yuansu comments: Some argue Dachengqi Tang is for Yangming downward indications. Why use it in Shaoyin? The Stomach is the sea of water and grain, nourishing the four peripheries. Pathogens from peripheries transmit to the Stomach. If Stomach Earth becomes dry/hot, Kidney Water dries. Early dry mouth/throat indicates rapid transmission of deep heat. Thus, urgent purging preserves Kidney Water. "When Earth is solid, Water is clear," meaning water and grain do not mix, leading to clear diarrhea and dry mouth/throat due to Stomach Earth excess-heat. Green stool belongs to Liver; Liver pathogen transmits to Kidney. Since Kidney meridian emerges from Lung, connects to Heart, and enters chest, epigastric pain occurs. Urgent purging removes excess heat and expels Kidney pathogen. If abdominal distension and constipation occur at 6-7 days, interior pathogens are obstructed severely; Stomach Earth dominance depletes Kidney. Urgent purging expels Stomach heat to nourish Kidney Water. Both Yangming and Shaoyin have urgent purging clauses. Though syndromes differ, the principle of interior transmission is the same, hence both use Dachengqi Tang. Note: Tongue dryness is milder; throat dryness is heavier. Although both throat and tongue connect to Shaoyin meridians, the tongue is the sprout of the Heart. Cold Damage favors Yang and dislikes Yin, so tongue dryness is considered milder.)

Jueyin Syndrome: In Cold Damage after seven days, following drastic purging, if the Cun pulse is deep and slow, hands and feet are cold, lower pulses are absent, throat is uncomfortable, expectoration of pus and blood occurs, and diarrhea is unceasing, the prognosis is poor; use Mahuang Shengma Tang (Ephedra and Ascending Dragon Decoction). In Cold Damage from day one to four/five, if cold limbs appear, fever will likely follow. It should be treated with purging, but if erroneously sweated, it will cause oral injury and red ulceration.

Wu Qian's Commentary: In Shaoyin syndrome, a rapid pulse indicates purging is possible; a deep pulse requires Fuzi Tang (Aconite Decoction) added with Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Maimendong (Ophiopogon Tuber), Wuweizi (Schisandra Fruit), and Tianhuafen (Trichosanthes Root). For post-illness deficiency heat with persistent vexation/fever, use Zhuyeshigu Tang (Bamboo Leaf and Gypsum Decoction), removing Banxia (Pinellia Tuber) and adding Tianhuafen (Trichosanthes Root) for moistening. After sweating, emesis, or purging, dry mouth and throat indicate depleted fluids, failing ascent of Kidney Water, and defluxion of deficient fire upward; use Shengjin Yiqi Tang (Generate Fluids and Boost Qi Decoction) or Zhuyeshigu Tang (Bamboo Leaf and Gypsum Decoction). If the pulse is deep and faint, feet are cold, and tongue is dry, the prognosis is difficult. Shaoyin syndrome has examples of urgent purging to save Kidney Water. For deficient patients with water exhaustion and fire dryness who cannot be purged, use Buzhong Yiqi Tang (Center-Supplementing and Qi-Boosting Decoction) with doubled Renshen (Ginseng), plus Wuweizi (Schisandra Fruit), Maimendong (Ophiopogon Tuber), Tianhuafen (Trichosanthes Root), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome) to nourish water. Huhe Disease (Fulminant Disease) also presents with dry throat, silence, desire to sleep but inability to close eyes, and hoarseness. Dry throat characterizes Huhe; parasitic erosion of the lower part defines "Hu." For dry throat with ulcers on the lower lip, use Huanglian Xijiao Tang (Coptis and Rhinoceros Horn Decoction).

Zhao Xianke's Commentary: *Huo Ren Shu* states that heat in the Spleen organ depletes fluids, causing dry mouth and throat. While fluid depletion is correct, it is not solely due to Spleen heat. The Spleen governs Taiyin; Taiyin syndrome features abdominal fullness and dry throat, which can be termed Spleen heat as a specific manifestation, but other cases are different. For example, Baitu Jia Renshen Tang (Gypsum and Ginseng Decoction) with dry mouth/tongue indicates exterior-interior heat. Bitter taste and dry throat indicate Shaoyang channel heat or Yangming wind strike. Urgent purging for dry mouth/throat with clear green diarrhea, epigastric pain, and dry mouth indicates Shaoyin channel heat. Dry throat, vexation, and vomiting after erroneous sweating indicate depleted fluids leading to potential Yangming interior heat. Are these numerous syndromes all due to Spleen heat?