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The pharynx (Yan) is the organ where the Stomach receives food, while the larynx (Hou) is governed by the Lung and is responsible for respiration. Since the Lung has no lower orifice, it can only accept clear and empty Qi, but cannot accommodate tangible objects. Above the pharynx lies an organ resembling a hanging papilla, known as the epiglottis (Huiyan). When food enters the mouth, the tongue presses against the upper palate, causing the epiglottis to fold over the larynx, thereby allowing water and grain to enter the pharynx. If smallpox lesions develop on the epiglottis, the passage for liquids becomes obstructed. Consequently, solid food with residue can naturally enter the pharynx, whereas drinking water leaks into the larynx, causing choking. There are also cases of vomiting food. As stated in the *Classic* (*Jing*), the upper opening of the stomach is called the cardia (Benmen). If toxic fire scorches the stomach, ulcers form on the cardia, damaging it. Once the cardia is injured, the gateway becomes narrow and blocked; thus, food cannot rush directly into the stomach. If the process is slow, food flows back down; if rapid, it is chewed and vomited out. Since neither water nor grain can pass through, and medicinal stones cannot treat this condition, it becomes a malignant prognosis. However, the Qi of the Ministerial Fire of the Hand-Shaoyang Sanjiao Meridian and the Sovereign Fire of the Hand-Shaoyin Heart Meridian both connect to the throat and larynx. The onset of smallpox toxicity is governed by these two fires. As their heat steams upward, the throat and larynx are the first to be affected. Therefore, at the initial stage of fever and rash appearance, regardless of whether there is throat pain, dispersing and resolving methods should be employed first. If treatment is delayed even slightly, toxic pathogens will remain, causing swelling and blockage, preventing food intake and breathing, leading to critical danger. Thus, if external smallpox lesions are dense but the interior of the throat is notably free of pain, it indicates that the toxins have been fully expelled externally, and there is no need for excessive worry. Conversely, if internal lesions are numerous and painful, one must guard against complications such as choking on water, vomiting food, and loss of voice during the phase of full eruption. Therefore, preemptive treatment is necessary to ensure that external lesions mature and fill with pus first. This allows heat and toxins to dissipate externally, lightening internal symptoms and eliminating worries about throat ulcers. However, after the scabbing stage, if throat sounds improve day by day, it is auspicious; if the disease worsens and gas sounds in the throat resemble water, death ensues. If throat ulcers break open, accompanied by hoarseness and inability to eat, death ensues.

Sound originates from the Qi of the Lung passing through the airway; when the Lung is clear, sound is clear, but when the Lung is hot, sound becomes hoarse. The Lung belongs to Metal; metal resonates when hollow. During the eruption of smallpox, heat and toxins move upward. Heat generates phlegm, or wind-cold blocks the interstices (Couli), resulting in sticky saliva that obstructs the airway, causing hoarseness. Additionally, toxic pathogens counterflow into the throat forming smallpox lesions; since the lung orifices are narrow, hoarseness also occurs, representing the Metal element being overcome by Fire pathogens. In cases where smallpox lesions are red-purple with choking and hoarseness, it indicates flaming Fire moving upward and congested heat toxins. If lesions are grayish-white and non-elevated with choking and hoarseness, it signifies deficiency of Blood and Qi and injury to the Spleen and Stomach. In summary, choking and aphonia occurring within seven days of onset result from toxic vapors steaming upward due to lack of regulation, blocking the lung orifices and sealing the airways. Severe cases may see toxins unable to excrete, leading to erosion of internal ulcers, craters on the tongue root, corruption of the pharyngeal gate, cessation of breathing, and becoming incurable; in such cases, external lesions are invariably not lustrous. However, if this occurs after six or seven days, when external lesions are mature and lustrous, it is because internal lesions are also maturing; once external lesions crust, internal symptoms heal spontaneously, requiring no concern. Therefore, skilled practitioners, upon observing symptoms of heat congestion and abundant toxins, use herbs like Licorice Root and Platycodon Decoction (Ganjie Tang), Akebia Fruit (Niubangzi), Scrophularia Root (Xuanshen), and Schizonepeta (Jingjie) to clear the airway, preventing toxin invasion and avoiding such complications. Otherwise, heat toxins attacking the Defensive level may cause sudden swelling and pain, difficulty swallowing fluids, inability to speak, with life and death decided in an instant. Generally, throat diseases benefit most from purgation, which is among the most critical external conditions. However, if there are no internal ulcers initially, caused merely by heat toxin steaming or ingestion of spicy-hot foods, urgently use Licorice Root, Platycodon, Scrophularia, and Akebia Fruit. If speech is possible but unclear, it indicates Fire invading the Lung; use Licorice Root, Platycodon, Trichosanthes Root (Huafen), Scrophularia, and Ophiopogon Root (Maidong). If hoarseness is due to wind-cold obstruction, use modified Ginseng and Perilla Decoction (Rensu Yin); efficacy indicates good prognosis, while ineffectiveness indicates poor prognosis. Although sound emerges from the Lung, its root lies in the Yuan Qi of the Dantian. Thus, in various diseases, clear voice despite illness is termed "Form ill, Qi healthy"; aphonia before illness onset is "Form healthy, Qi ill"; and aphonia after illness onset is "Both Form and Qi ill." (Zhang) Commentary: Disorders of the throat are invariably caused by Fire. Fire is formless and burns rapidly; how can medication errors be tolerated! Therefore, a pulse that is excess, large, flooding, and rapid indicates Excess Heat, treated with cooling methods (Orthodox Treatment); a pulse that is deficient, fine, and rapid indicates Yin Deficiency, treated with supportive methods (Following Treatment). A deviation of even a hair's breadth leads to cessation of breath; caution is paramount!