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Throat and pharynx disorders may arise from internal injury or external contraction, presenting with cold or heat, deficiency or excess, and varying in transmissibility. The following is a detailed discussion item by item.

Shanghan (Cold Damage) disease often involves throat symptoms. Section 20 of the Yangming Chapter in *Shanghan Lun* states: "In Yangming disease, if there is only dizziness, aversion to cold is absent, thus the patient can eat and cough; such a person must have a sore throat. If there is no cough, there will be no sore throat." This section mentions only sore throat without prescribing treatment. Upon careful examination of the text's meaning, this condition arises when the pathogen initially transmits from the Taiyang channel to the Yangming channel. The heat in the Stomach Fu organ is not yet fully consolidated (hence the ability to eat), while the heat simultaneously diffuses into the chest (the chest belongs to the Taiyang domain; here it implies Yangming disease involving Taiyang). This heat steams upward to the Lungs, causing coughing. Furthermore, due to the coughing, the heat rushes upward, resulting in sore throat. It is proposed to treat this with Baihu Tang (White Tiger Decoction), removing Gancao (Licorice Root) and adding Lianqiao (Forsythia Fruit) and Chuanbeimu (Fritillaria Bulb).

Section 3 of the Shaoyin Chapter states: "If a patient's pulse is tight at all three positions (Yin and Yang), yet sweat occurs spontaneously, this indicates loss of Yang Qi. This belongs to Shaoyin disease, and according to the method, sore throat should occur." This section also lacks a treatment prescription. Examining the Shaoyin pulse, it is typically fine and weak; here, however, it is tight at all positions, representing a variant pulse of Shaoyin disease. A tight pulse normally does not cause sweating; since spontaneous sweating occurs where it should not, we know this indicates loss of Yang Qi. The sore throat results from rootless Yang Qi rushing upward. It is proposed to use a large dose of Bawei Dihuang Tang (Eight-Ingredient Rehmannia Decoction), replacing Danpi (Moutan Bark) with Shaoyao (Peony Root), and adding Suzi (Perilla Seed) and Niuxi (Achyranthes Root) to converge the Yuan Yang (Original Qi) back to its root to stop sweating, thereby curing the sore throat naturally.

[Modified Bawei Dihuang Tang]
Da Huai Shudi (Prepared Rehmannia Root, 1 liang)
Jing Yurou (Cornus Fruit, 1 liang)
Sheng Huai Shanyao (Chinese Yam, 8 qian)
Sheng Hangshaoyao (White Peony Root, 3 qian)
Da Yunling Pian (Poria Cocos, 2 qian)
Zexie (Alisma Rhizome, 1.5 qian)
Wu Fuzi (Prepared Aconite Root, 2 qian)
Rougui (Cinnamon Bark, 2 qian, add after removing rough bark)
Huai Niuxi (Achyranthes Root, 3 qian)
Suzi (Perilla Seed, 2 qian, stir-fried and crushed)
Decoct in water to yield half a bowl of decoction, divide into two doses, take warm.

Section 30 of the Shaoyin Chapter states: "In Shaoyin disease, if there is diarrhea, sore throat, chest fullness, and irritability, Zhufu Tang (Swine Skin Decoction) is the primary treatment." This condition involves Shaoyin heat diffusing through the Triple Burner. In the upper and middle jiao, it manifests as sore throat and irritability/fullness because the True Yin of the Kidneys cannot ascend to harmonize with Yang, leading to dryness and heat. In the lower jiao, it manifests as diarrhea because the Zang organ pathology transfers heat to the Fu organs; bladder stasis causes water to flow into the Large Intestine, resulting in diarrhea. Zhufu Tang is used because pigs are water animals; their skin can be boiled into gelatin, possessing rich fluids that help Kidney Yin ascend and harmonize with Heart Yang to resolve dryness and heat. Combined with the cooling and moistening properties of Bami (White Honey) and the mild nature of Xiaofen (Starch/Rice Flour), cooked like porridge, the decoction lingers in the intestines and stomach, preventing expulsion via diarrhea. It slowly distributes its transformative qi to clear the heat diffusing through the Triple Burner.

Section 31 of the Shaoyin Chapter states: "In Shaoyin disease, on the second or third day, if there is sore throat, Gancao Tang (Licorice Decoction) may be given. If it does not improve, Jiegeng Tang (Platycodon Decoction) is given." This is also a heat pattern of Shaoyin disease. Gancao Tang is used for its ability to moisten the Lungs and benefit the throat; its sweet and緩 (moderating) nature also moderates the flaming up of Heart Fire, eliminating dryness and heat in the lower jiao. Jiegeng Tang is used because Jiegeng (Platycodon Root) can elevate the True Yin of the Kidneys, allowing Yin and Yang Qi to connect continuously. This prevents Upper Jiao Yang from floating upward and scorching the Lungs and throat, and its ascending power helps disperse stagnant heat in the throat. Later generations generally avoid using Jiegeng for throat diseases, but if the pulse is confirmed as the fine and weak pulse of Shaoyin disease, its use is acceptable. Moreover, ancient texts refer to Ku Jiegeng (Bitter Platycodon), which has both ascending and descending properties and possesses opening capabilities.

Section 32 of the Shaoyin Chapter states: "In Shaoyin disease, if the throat is injured and sores form, preventing speech and voice production, Kujiu Tang (Bitter Wine Decoction) is the primary treatment." The Shaoyin meridian connects with the Lungs and ascends along the throat, hence Shaoyin disease often involves throat conditions. Regarding Kujiu Tang, Dr. Tang believed that combining Kujiu (Vinegar) with Banxia (Pinellia Tuber) could rapidly rupture the throat sores. Kujiu is vinegar; applying raw Banxia powder mixed with vinegar externally can resolve sores, so aggressive rupture is not always necessary.

Section 9 of the Jueyin Chapter states: "In Shanghan, if there is initial cold extremities followed by fever, diarrhea will stop spontaneously. However, if sweating occurs, sore throat in the throat, and bi obstruction (blockage) of the throat result..." The sore throat here is primarily due to loss of Yin, contrasting with the loss of Yang sweating in Shaoyin disease. The Liver harbors excess heat; excessive sweating consumes Yin fluids, causing heat to rush upward and stagnate in the throat, creating pain ("bi"). Bi refers to the stagnation of heat, Qi, and Blood. Zhang Zhongjing did not specify treatment; I propose using sour and astringent herbs to stop sweating, cooling and moistening herbs to restore fluids, and dispersing and unblocking herbs to benefit the throat, combined into a formula.

[Lianyin Xiegan Tang (Astringe Yin and Drain Liver Decoction)]
Sheng Hangshaoyao (White Peony Root, 1.5 liang)
Tianhuafen (Trichosanthes Root, 1 liang)
Shegan (Belamcanda Rhizome, 4 qian)
Zhe Beimu (Fritillaria Thunbergii Bulb, 4 qian, crushed)
Suan Shiliu (Acid Pomegranate, 1 whole, crushed with peel)
Decoct together to yield half a bowl of decoction, divide into two doses, take warm.

The six sections recorded above cover most Shanghan-related throat disorders. However, based on years of clinical experience, I know there are cases outside these sections. I present one verified case for illustration.

I treated a student surnamed Zhu in Fengtian (Shenyang) who had suffered from Shanghan for three to four days. He lay curled up, drowsy and semi-conscious, occasionally speaking deliriously. When called, his eyes opened slightly. His tongue appeared coating-less but very dry with black spots. He had a sore throat, red and hot urine, and constipation for several days. His pulse was fine, weak, and deep. He felt internal heat, though his skin temperature was normal. This is a heat pattern of Shaoyin Shanghan, caused by latent pathogenic transformation into heat, entering the Shaoyin channel due to Kidney deficiency, suppressing Kidney Qi from ascending. This led to Upper Jiao dryness, tongue spots, and sore throat. The black spots indicate Kidney deficiency. Although the disease is heat-based, the pulse is fine and weak because the pulse originates from the Heart; suppressed Kidney Qi fails to assist the Heart, weakening cardiac pulsation. Thus, Shaoyin Shanghan pulses are consistently fine and weak regardless of cold or heat patterns.

Prescription: Shigao (Gypsum Fibrosum, finely powdered, 2 liang), Sheng Huai Shanyao (Chinese Yam, 1 liang), Dalushen (Codonopsis Root, 6 qian), Zhimu (Anemarrhena Rhizome, 6 qian), Gancao (Licorice Root, 2 qian). First, boil fresh Maogen (Imperata Rhizome, 2 liang) in water, then use this water to decoct the herbs. Yield three bowls of clear decoction. Take one bowl warm each time, mixing in one raw Chicken Egg Yolk (Jizi Huang). After one dose, the six pulses rose. After two doses, the pulse became surging and large. After three doses, the pulse normalized, spirit recovered, and dry tongue/sore throat improved. The next day, a modified version of the original formula was taken for one more dose, resulting in complete recovery. This formula is Kanli Hugen Tang (Kan and Li Mutually Rooted Decoction); details are provided elsewhere.

Warm diseases (Wenbing), especially those complicated by rashes, frequently involve throat symptoms. Formulary books call this Lanhou Sha (Rotting Throat Sand Rash), often caused by contagious pathogens. Treatment should focus on clearing warmth/heat and resolving rash toxins, making throat symptoms easier to cure.

Case: In Wuchen year in Tianjin, Song XX's eldest son suffered from Warm Rash with throat involvement. Physicians avoided heavy cooling herbs; after several doses, the condition worsened. I diagnosed a surging, long, and forceful pulse, indicating excess heat in the Yangming Stomach Fu. The rash was unresolved. Throat sides were red with slight ulceration. He felt intense internal heat, had scanty red urine, and constipation for three days. I prescribed a large dose of Baihu Tang (White Tiger Decoction) with Lianqiao (Forsythia Fruit, 4 qian) and Boheye (Mint Leaf, 1.5 qian) to vent the rash. Shigao (Gypsum Fibrosum) was used heavily (raw, 4 liang). Decocted in three bowls, taken warm in three doses. Condition improved significantly, but pulse remained forceful, and swallowing still painful. I repeated the formula, first boiling fresh Maogen (Imperata Rhizome, 2 liang) to decoct the herbs. Taken in three doses, he recovered completely, and bowels moved.

His second son later developed similar symptoms, more severe. Treated with the same formula, starting with Maogen decoction. Shigao started at 3 liang, increased to 5 liang until cured. His youngest daughter (7 years old) developed even more severe symptoms, with confluent red rash (considered incurable traditionally). Treated with the same formula. Shigao started at 2 liang, increased to 6 liang. Heat subsided slightly, but throat pain persisted. Constipation for six days. I administered pure Mangxiao (Natrii Sulfas/Mirabilite) dissolved in water. Bowels moved, heat decreased significantly, throat pain halved. Pulse remained forceful but showed superficial returning characteristics. I administered Aspirin (1 wa/approx. 0.6g) to induce sweating, aiding the pathogen's exit. Sweating occurred, and he recovered instantly.

Western medicine calls this Scarlet Fever (Erythema Infectiosum), caused by contagious bacteria, difficult to treat, especially with throat involvement. Zhang Zhongjing described "Yang Du" (Yang Toxin): "Red face with mottled rash like brocade, sore throat, spitting pus and blood," likely referring to this condition. Modern formulary books call it Lanhou Sha and suggest Maxing Ganshi Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction). However, in that formula, Shigao is double the amount of Mahuang. If borrowed, Shigao should be ten times Mahuang (1 liang Shigao : 1 qian Mahuang); in severe heat, twenty times (2 liang Shigao : 1 qian Mahuang) to avoid adverse effects.

Case: Friend Dong XX from Cangzhou, over 30, initially had parotitis from wind-cold, progressing to swelling extending to the chest. Medications failed. Post-Mid-Autumn Festival, he rode in rain due to critical condition. Upon arrival, submandibular and neck swelling was extreme, hard, hot, and red, resembling a mass of fire-toxin, reaching the heart region. Trismus (lockjaw), swollen/painful throat. Could only swallow half a mouthful of water with great effort, covering mouth. Chest filled with phlegm-saliva rising to throat; drinking small amounts triggered vomiting of phlegm. Sensation of Qi rushing upward, frequent hiccups. Pulse surging, slippery, long, forceful upon pressure, ~90 beats/min. Constipation for days. I diagnosed "Hamster Plague" (Mumps-like epidemic). Toxic heat was fierce, occupying Yangming Fu, like a prairie fire. Heavy Shigao was needed. Previous doctors used 1 liang Shigao with no effect. I stated Shigao is mildly cold per *Shennong Ben Cao Jing*; 1 liang is insufficient for such fierce toxin. Prescribed: Shigao (4 liang), Qing Banxia (Pinellia, 4 qian), Jinzhonglou (Paris Polyphylla, 3 qian), Lianqiao (2 qian), Shegan (2 qian). After taking, medicine felt stuck in chest, heat/swelling seemed to increase. Diagnosed concurrent Jie Xiong (Chest Binding) syndrome; fire had no downward outlet, causing upward rush. Urgently added Shigao (4 liang) and Zheshi (Hematitum/Ochre, 3 liang). Still stuck. Added Zheshi (3 liang), Gualouren (Trichosanthes Seed, 2 liang), Mangxiao (8 qian). Chest still blocked. Throat swelling worsened, unable to drink. Family panicked. I reassured them: "I urge medication because swelling progresses; delay means inability to ingest. Now that the chest holds much medicine, it must descend. Once descended, binding opens, bowels move, toxin/fire descends, and Upper Jiao swelling/heat resolves." At 10 PM, by midnight, medicine acted downward. By dawn, passed dry stool, Upper Jiao swelling/heat lightened, could drink water/gruel. Jaw opened slightly at breakfast. Afternoon: swelling/heat returned, chest hot to touch, pulse surging/solid. Suspected incomplete evacuation. Administered Dahuang (Rhubarb Root, 4 qian), Mangxiao (5 qian). Passed dry and loose stools. Condition greatly improved. Hard swelling persisted, chest hot, residual heat in pulse. Prescribed Shigao (4 liang), Jinyinhua (Honeysuckle Flower, 5 qian), Lianqiao (5 qian). Decocted in one large bowl, taken warm in divided doses, once daily. Cured in three days. This is Wen Yi (Warm Epidemic), highly contagious and virulent, hence difficult. Had I added Mangxiao/Dahuang earlier during the second dosage to open bowels promptly, the danger might have been avoided. My experience was limited then, unable to perfectly align with the disease mechanism at every moment.

Diphtheria (Baihou) presents with white patches or ulcers, a contagious disease. Typically preceded by internal heat accumulation, facilitating infection. Since internal injury is predominant, cooling, moistening, Yin-nourishing, and fire-clearing herbs are indicated; exterior-releasing agents are contraindicated. However, acrid-cooling herbs to disperse fire-stagnation, such as Bohe (Mint) and Lianqiao, are not forbidden. Yangyin Qingfei Tang (Nourish Yin and Clear Lung Decoction) and Shenxian Huoming Tang (Immortal Life-Saving Decoction) from *Baihou Jibiao Juwei* are excellent for Diphtheria. Add Lianqiao (3 qian) to Shenxian Huoming Tang; double or triple Shigao for severe heat; add Dahuang or Mangxiao for constipation. Diphtheria often co-occurs with Lanhou Sha.

*Ling Shu* Chapter on Carbuncles and Ulcers states: "Carbuncle arising in the throat is named Mengju (Fierce Abscess). If untreated, it turns to pus. If pus is not drained, blocking the throat, death occurs within half a day." This corresponds to Houjie Yong (Throat-Severing Carbuncle). Initially, severe redness and swelling occur in the throat. Use anti-ulcer herbs to dissipate it, and prick with flat needles to bleed profusely. Waiting for pus formation before draining is dangerous.

[Xiaozhong Liyan Tang (Reduce Swelling and Benefit Throat Decoction)]
Tianhuafen (Trichosanthes Root, 1 liang)
Lianqiao (Forsythia Fruit, 4 qian)
Jinyinhua (Honeysuckle Flower, 4 qian)
Danshen (Salvia Miltiorrhiza Root, 3 qian)
Shegan (Belamcanda Rhizome, 3 qian)
Xuanshen (Scrophularia Root, 3 qian)
Ruxiang (Frankincense, 2 qian)
Moyao (Myrrh, 2 qian)
Zhi Shan Jia (Processed Pangolin Scale, 1.5 qian)
Boheye (Mint Leaf, 1.5 qian)
Add Shigao (1 liang) for surging/solid pulse; add Huashi (Talcum, 6 qian) for difficult urination; add Dahuang (3 qian) for constipation.

Most throat disorders are heat-based, but some are cold (see case of Liu boy). The slightly elevated areas on both sides of the throat are tonsils (Biántáo Xiàn). Redness/swelling is tonsillitis. Recurrent swelling/nodules that reduce slightly with cooling herbs but recur with minor colds/internal heat indicate rooted tonsillitis. Medication alone is insufficient; surgical removal is required, followed by cooling/dispersing herbs to eradicate the root. Failure to remove may impair physical development in children.

*Jingui Yaolue* states: "Women feel as if there is roasted meat stuck in the throat (cannot spit out, cannot swallow down), commonly known as Meiheqi (Plum-pit Qi)." This is also a throat disorder. Commentators attribute it to Phlegm-Qi obstruction, but it actually involves Chong Qi (Penetrating Qi) rebellion. The original formula is Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction): Banxia descends Chong Qi, Houpo moves Qi, Fuling drains Phlegm, Shengjiang (Fresh Ginger) and Ziye (Perilla Leaf) diffuse Qi transformation. I often add Zheshi (Ochre, several qian) and needle Hegu (LI4) for faster results. This condition also affects men occasionally.