（附乳蛾、悬痈、杨梅疮）
丹溪先生云∶咽痛属血虚，用四物加竹沥。阴虚火上炎者，必用玄参；气虚加人参、竹
又云∶咽喉肿痛有阴虚阳气飞越，痰结在上者，脉必浮大，重取必涩，去死为近。宜人参一
味，浓煎，细细饮之，如作实症治之，祸在反掌。此发前人未发，救无穷之夭枉。余更以上
焦风热积热，及膀胱阴虚等症，一二于后云云。
治验
通府李朝用，咽喉肿痛，口舌生疮。此上焦风热，先用荆防败毒散二剂，喉痛渐愈。又
地官黄北盘喉痛，作渴饮冷，大便不通，此上下表里实热。用防风通圣散，治之顿愈。
地官胡诚甫，咽喉燥痛，此肾经膀胱虚热。用四物，加黄柏、知母、玄参，四剂少愈。更以人参固本丸，一剂不复
发。
职方卢抑斋，咽喉肿痛，两目蒙昧，小便赤涩，此膀胱湿热。用四苓散加黄柏、黄连、
知母、茵 、防己，治之而顿愈。又用六味地黄丸而痊。
儒者王文远，咽喉肿痛，口舌生疮，劳则愈甚，余谓脾肺气虚，膀胱有热。以补中益气
加玄参、酒炒黑黄柏、知母稍愈，乃去黄柏、知母，加山茱萸、山药乃瘥。
一儒者年逾五十，咽喉痛服凉药，或过劳痛愈甚，此中气虚热。以补中益气，加炒黑芩
、连，四剂而愈，乃去芩、连，又数剂痊愈。
一儒者脚发热，则咽喉作痛，内热口干，痰涎上涌。此肾经亏损，火不归经。用补中益
气加麦门、五味，及加减八味丸而痊愈。
一老人咽喉痛，小便数而赤，日晡尤甚，此膀胱阴虚，当滋化源。以补中益气加酒炒黑
黄柏、知母二味，四剂咽痛稍可，乃去二味加以山茱、山药、麦门、五味，顿愈。
一男子咽喉肿痛，药不能下，针患处出紫血少愈，以破棺丹噙化，更用清咽利膈散而愈
一男子素善饮，咽喉作痛，内热作渴，小便不利，饮食如常。此膀胱积热，用四苓散，
加茵 、大黄，四剂诸症渐退。又用清心莲子饮而安。
一星士，劳而入房，喉痛渐闭，痰涎上涌，四肢乍热。此阴虚阳气飞扬。用补中益气加
宪副姜时川，癸卯冬就诊于予，右寸浮数有力，口中有疮。余曰∶此胃火传于肺也，
滋味慎起居。甲辰秋复就诊，尺脉洪数而无力。余曰∶此肺金不能生肾水，宜静养以滋化源
。彼云∶今喉间及耳内，不时燥痛，肢体不时发热，若无根之火殒无疑矣。后谓刘古峡云∶
立斋谓我之病可疑。至乙巳孟春。古峡谓余曰∶姜公之病已如尊料。遂同余往视，喉果肿溃
脉愈洪大，或用泻火之药反速其殁。
云间吴上舍年逾五十，咽喉肿痛，或针出血，神思虽清，尺脉洪数，而无伦次，按之细
微如无。余曰∶有形而无痛，阳之类也，当峻补其阴，今反伤其阴血必死，已而果殁。盖此症乃
肾气亏损，无根之火炎上为患，惟加减八味丸料煎服，使火归源，庶几可救。
府庠归云桥之内，产后患喉痛，服清热等剂益甚。余诊之，属膀胱经血虚也，盖膀胱之
内脉上行，至颈而还，用八珍汤加牡丹皮、柴胡、酒炒黑黄柏，二剂而愈。
嘉靖辛丑仲秋，大方凭几执笔就书，咽喉间偶有痰涎，遂左顾吐之，以未及合而颈骨如
摧，莫能转视，至夜增剧，潜发盗汗，手足麻冷，卧起必藉人扶持，稍动则痛连心腹，苦楚万状
，不可胜数，如是者三四日。得立斋先生视之曰∶此怒动肝火，胆得火而筋挛缩。以六味地
黄丸料加山栀、柴胡，以清肝火生胆血。一剂未竟日，而谈笑举动，一一如常矣。接见宾从
，俱以为前日之病者罔也，先生之神妙，类多如此。惜乎，不肖疏怠蹇拙，不能尽述。姑以
其亲视者，笔之以为明验耳。吴门晚学生沈大方履文再顿首谨书。
一妇人喉间作痛，两月后而溃，遍身筋骨作痛，余以为杨梅疮毒，先以萆 汤，数剂而
平，更以四物加萆 、黄 二十剂，诸症悉退。
一弥月小儿，口内患之，后延遍身，年余不愈。以萆 为末，乳汁调服，母以白汤调服
，月余而愈。余见《保婴粹要》。
一男子先患喉痛，复发杨梅疮。用轻粉等剂，愈而复发，仍服前药，后又大发，上 溃
烂，与鼻相通，臂腕数颗，其状如桃，大溃，年余不敛，虚症悉见。余以萆 汤为主，兼以健脾
之剂，月余而安。余见《外科枢要》。
(Attached: Mutton-bean-shaped Swelling [Ru E], Suspended Abscess [Xuan Yong], Syphilis [Yang Mei Chu])
Mr. Danxi stated: Sore throat belongs to Blood deficiency; use Siwu Tang (Four Substances Decoction) with Bamboo Sap (Zhuli). For patients where Yin deficiency causes Fire to flare upward, Xuan Shen (Scrophulariae Radix) must be used; for Qi deficiency, add Ren Shen (Ginseng Radix et Rhizoma) and Zhuli (Bamboo Sap).
He also said: In cases of sore throat and swelling due to Yin deficiency causing the departure of Yang Qi, with Phlegm knotting in the upper jiao, the pulse will necessarily be floating and large; upon heavy pressure, it will be choppy, indicating proximity to death. It is appropriate to use a single ingredient, Ren Shen (Ginseng Radix et Rhizoma), decocted strongly, and drunk slowly. If treated as an Excess syndrome, disaster will follow in the turning of a hand. This elucidates theories not previously discovered by predecessors, saving countless lives from premature death. I further discuss symptoms such as Wind-Heat accumulation in the Upper Jiao, and Bladder Yin deficiency, as follows.
Clinical Cases
Li Chaoyong of Tongfu suffered from sore throat and swelling, with sores on the mouth and tongue. This was Wind-Heat in the Upper Jiao. Initially, Jingfang Baidu San (Atractylodes and Saposhnikovia Powder to Expel Toxins) was administered for two doses, after which the throat pain gradually healed.
Huang Beipan, a Di Guan (official title), suffered from sore throat, thirst with a desire for cold drinks, and constipation. This was an Excess Heat syndrome affecting both interior and exterior, upper and lower. Fangfeng Tongsheng San (Saposhnikovia Powder to Unblock the Intestines) was used, resulting in immediate recovery.
Hu Chengfu, a Di Guan, suffered from dry and painful throat. This was Deficient Heat in the Kidney and Bladder meridians. Siwu Tang (Four Substances Decoction) was used, added with Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), and Xuan Shen (Scrophulariae Radix). After four doses, there was slight improvement. Subsequently, Renshen Guben Wan (Ginseng Root-Nourishing Pill) was taken for one dose, preventing recurrence.
Lu Yizhai, a Zhifang (official title), suffered from sore throat and swelling, blurred vision, and red, difficult urination. This was Damp-Heat in the Bladder. Siling San (Four Poria Powder) was used, added with Huang Bo (Phellodendri Cortex), Huang Lian (Coptidis Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Yin Chen (Artemisiae Scopariae Herba), and Fang Ji (Stephaniae Tetrandrae Radix), resulting in immediate recovery. He was then cured completely by taking Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).
Wang Wenyuan, a Confucian scholar, suffered from sore throat and swelling, with sores on the mouth and tongue, worsening with fatigue. I diagnosed Spleen and Lung Qi deficiency with Heat in the Bladder. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with Xuan Shen (Scrophulariae Radix), Jiu Chao Hei Huang Bo (Wine-fried Blackened Phellodendri Cortex), and Zhi Mu (Anemarrhenae Rhizoma), leading to slight improvement. Then, Huang Bo and Zhi Mu were removed, and Shanzhuyu (Corni Fructus) and Shanyao (Dioscoreae Rhizoma) were added, leading to recovery.
A Confucian scholar over fifty years old experienced worsening throat pain when taking cooling medicines or overexerting himself. This was Deficient Heat in the Middle Qi. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with fried black Huang Qin (Scutellariae Radix) and Lian Zi (Nelumbinis Semen), curing him in four doses. Then, Huang Qin and Lian Zi were removed, and several more doses led to complete recovery.
A Confucian scholar experienced throat pain when his feet felt hot, accompanied by internal heat, dry mouth, and surging saliva. This was Kidney Meridian depletion with Fire failing to return to its source. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with Mai Men Dong (Asparagi Radix) and Wu Wei Zi (Schisandrae Chinensis Fructus), along with Jiawei Bawei Wan (Modified Eight-Ingredient Pill), resulting in recovery.
An elderly man suffered from sore throat, frequent and red urination, worsening in the late afternoon. This was Bladder Yin deficiency, requiring nourishment of the generating source. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, added with Jiu Chao Hei Huang Bo (Wine-fried Blackened Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma). After four doses, the throat pain subsided slightly. Then, these two herbs were removed, and Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Mai Men Dong (Asparagi Radix), and Wu Wei Zi (Schisandrae Chinensis Fructus) were added, leading to immediate recovery.
A male patient suffered from sore throat and swelling, unable to swallow medicine. Acupuncture at the affected site released a small amount of purple blood, providing slight relief. Po Guan Dan (Resurrection Coffin Pill) was held in the mouth to dissolve, followed by Qingyan Ligai San (Throat-Clearing and Diaphragm-Unblocking Powder), leading to recovery.
A male patient who habitually drank alcohol suffered from sore throat, internal heat, thirst, and difficult urination, while his appetite remained normal. This was accumulated Heat in the Bladder. Siling San (Four Poria Powder) was used, added with Yin Chen (Artemisiae Scopariae Herba) and Da Huang (Rhei Radix et Rhizoma). After four doses, all symptoms gradually receded. He was then stabilized by Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Drink).
An astrologer, after exertion and sexual intercourse, suffered from progressively closing throat pain, surging saliva, and alternating hot limbs. This was Yin deficiency with flying Yang Qi. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used...
Jiang Shichuan, Vice Commissioner, consulted me in winter of the Gui-Mao year. His Right Cun pulse was floating, rapid, and forceful, with sores in the mouth. I said: This is Stomach Fire transmitting to the Lung. He should be cautious with flavors and daily routine. In autumn of the Jia-Chen year, he consulted again; his Chi pulse was flooding, rapid, and powerless. I said: This is Lung Metal failing to generate Kidney Water. He should rest quietly to nourish the generating source. He said: Now my throat and ears are frequently dry and painful, and my limbs frequently feel hot; this is undoubtedly death caused by rootless Fire. Later, he told Liu Guxia: Lizai considers my condition suspicious. In early spring of the Yi-Si year, Guxia told me: Lord Jiang's condition has become exactly as you predicted. We went together to examine him; his throat was indeed swollen and ulcerated, and his pulse became even more flooding. Using Fire-draining medicines would have only accelerated his death.
Wu Shangshe from Yunjian, over fifty years old, suffered from sore throat and swelling. Sometimes bleeding was induced by acupuncture. Although his spirit was clear, his Chi pulse was flooding and rapid without order, and fine/deep upon pressure, feeling almost non-existent. I said: Form present but no pain indicates a Yang category. One should vigorously tonify Yin. However, injuring Yin Blood now leads to certain death. He subsequently died. This condition was Kidney Qi depletion with rootless Fire flaring upward. Only Jiawei Bawei Wan (Modified Eight-Ingredient Pill) decocted and taken could potentially save him by returning Fire to its source.
The wife of Gui Yunqiao, a government school student, suffered from postpartum sore throat, which worsened with cooling agents. My diagnosis indicated Bladder Meridian Blood deficiency. Since the Bladder meridian ascends to the neck and returns, Bazhen Tang (Eight-Treasure Decoction) was used, added with Mudan Pi (Moutan Cortex), Chai Hu (Bupleuri Radix), and Jiu Chao Hei Huang Bo (Wine-fried Blackened Phellodendri Cortex). She recovered in two doses.
In mid-autumn of the Xin-Chou year during the Jiajing reign, Dafang was writing a letter at his desk. Occasional phlegm in his throat prompted him to look left and spit. Because he did not close his mouth in time, his cervical bone felt as if crushed, rendering him unable to turn his head. The condition worsened at night, with nocturnal sweating, numbness and coldness in hands and feet, requiring support to rise and lie down. Any slight movement caused pain radiating to the heart and abdomen, unbearable suffering lasting three or four days. Mr. Lizai examined him and said: This is Liver Fire stirred by anger, causing Gallbladder sinews to spasm and contract due to Fire. Liuhuang Dihuang Wan (Six-Ingredient Pill with Rehmannia) material was used, added with Shan Zhi (Gardeniae Fructus) and Chai Hu (Bupleuri Radix), to clear Liver Fire and generate Gallbladder Blood. Before one dose was finished within a day, his conversation and movements returned to normal. Guests and followers were amazed, thinking the sick person from the previous day was someone else. The master's miraculous efficacy was often like this. Alas, I am unworthy, negligent, and clumsy, unable to record everything fully. I merely record what I witnessed personally as clear evidence. Shen Dafang, junior student of Wumen, bows twice and respectfully writes.
A female patient suffered from throat pain, which ulcerated after two months, accompanied by pain throughout the bones and sinews. I considered it Syphilis toxin. First, Bibi Tang (Smilacis Glabrae Decoction) was administered for several doses to calm the condition. Then, Siwu Tang (Four Substances Decoction) was used, added with Bi Xi (Smilacis Glabrae Rhizoma) and Huang Qi (Astragali Radix) for twenty doses, resolving all symptoms.
A one-month-old infant suffered from oral lesions that later spread to the whole body, persisting for over a year without healing. Bi Xi (Smilacis Glabrae Rhizoma) was powdered and taken with breast milk. The mother took it mixed with plain water. Recovery occurred within a month. I recorded this in *Baoying Cuiyao*.
A male patient first suffered from sore throat, then developed Syphilis. He used Calomel (Qing Fen) and other agents; the condition improved but relapsed. Taking the previous medicines again caused a severe outbreak, with upper ulcers communicating with the nose, and several nodules on arms and wrists resembling peaches, severely ulcerated and unhealed for over a year, presenting full deficiency symptoms. I primarily used Bibi Tang (Smilacis Glabrae Decoction), combined with Spleen-strengthening agents, achieving stability within a month. I recorded this in *Waike Shuyao*.