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Luo Qianfu treated Bulin Jidai, the Marshal of the Southern Expedition. The patient was seventy years old. In spring, during the eastern campaign, upon returning south to Chuqiu, he had consumed excessive alcohol, resulting in abdominal pain, borborygmus (intestinal rumbling), and spontaneous diarrhea, occurring approximately fifty times a day and night. He suffered from throat pain, redness and swelling in front of and behind the ears, stiffness of the tongue base, thick and sticky saliva, an urge to vomit but inability to do so unless manually pulled out by hand, difficulty speaking, restlessness with turning over, mental confusion, and inability to sleep at night. Luo Qianfu diagnosed the pulse as floating and rapid, but deep, fine, and wiry upon heavy pressure. He then said to Vice-Intendant Zhan: "Zhang Zhongjing stated: 'In cases of diarrhea with undigested food and body pain, one should urgently treat the Interior; once bowel movements normalize, one should urgently treat the Exterior.' To treat the Interior, use Sini Tang (Four Reversal Decoction); to treat the Exterior, use Guizhi Tang (Cinnamon Twig Decoction). Currently, the Commander's Stomach Qi is failing to secure itself, presenting with diarrhea of undigested food and abdominal pain. Although urgent treatment is indicated, compared to the throat condition, it can be slightly delayed." Zhan asked, "What do you mean?" Luo replied, "The Neijing states: 'A carbuncle arising in the throat is called Mengju (Fierce Carbuncle). If this disease is treated late, it will block the throat. Throat blockage leads to obstruction of Qi flow. Obstruction of Qi flow results in death within half a day.' Therefore, urgent treatment is required." Consequently, he used bian stone (stone lancet) to prick the swollen area, releasing dark purple-black blood. Within moments, the swelling significantly subsided. Subsequently, he prescribed equal parts of Jiegeng (Platycodon Root), Gancao (Licorice Root), Lianqiao (Forsythia Fruit), Niubangzi (Burdock Fruit), Jiu Huangqin (Wine-processed Scutellaria Root), Shengma (Cimicifuga Rhizome), and Fangfeng (Saposhnikovia Root). Each dose was approximately five qian, decocted in water to obtain a clear liquid. The patient was instructed to gargle while hot and spit it out when cool; swallowing was avoided to prevent damaging the Spleen and Stomach, which could worsen the diarrhea. After another dose, the saliva cleared, the swelling dissipated, and voice returned. Later, Shenying Wan (Miraculous Response Pill), a pungent-hot preparation, was used to disperse Cold in the Middle Jiao, resolve retained food, and dry Spleen Dampness. It was formulated into pills because their slow action avoids immediate impact on the Upper Jiao, allowing them to reach the lesion site before taking effect, thus treating the main condition with a缓 (slow/gentle) approach. After a few doses, the diarrhea stopped, and pain subsided. However, chest oppression followed by paroxysmal pain occurred. Recalling the Ling Shu: "The Upper Jiao is like mist, disseminating the essence of grains, steaming the skin, filling the body, and moistening hair and bristles, like fog and dew irrigation; this is Qi." Now, due to the patient's advanced age and weak Qi, coupled with uncontrolled diarrhea, the generating Qi of the Stomach fails to nourish the Heart and Stomach, causing obstruction and pain. The Neijing states: "When Upper Qi is insufficient, push and lift it." "For Spleen deficiency, tonify with sweet flavors." Thus, Yigong San (Extraordinary Power Powder), a sweet-pungent and slightly warm formula, was used to warm and nourish the Spleen and Stomach, augmented with Shengma and Renshen (Ginseng Root) to ascend and follow the righteous Qi. After a few doses, the chest felt comfortable, and diarrhea and pain ceased. The Neijing states: "Formulas for regulating Qi must distinguish Yin and Yang. Internal diseases are treated internally, external diseases externally. Mild cases are regulated, moderate cases balanced, severe cases subdued. Following what is beneficial ensures success in every attempt." It also says: "Diseases have distant and near origins; treatments have slow and urgent aspects. Do not exceed established protocols." It further states: "In emergencies, treat the Branch (symptoms); in stability, treat the Root (cause)." This refers to such situations.

Yu Zhen's commentary: When a single disease presents with both Cold and Heat divergences, one must distinguish urgency and sequence in treatment. This case serves as a precedent. One must never adopt a "one-size-fits-all" approach like Hun Tun Tang (Chaotic Soup). However, using cooling resolving herbs for gargling without swallowing may be ineffective. The clearing of saliva and reduction of swelling likely resulted from the bian stone therapy. Yet, modern practitioners using knives for throat conditions often suffer harm, attributed to differences in climate cycles and local geography.

[Appendix] Yang Lizhi, returning from his post as Vice-Prefect of Guangfu to Chuzhou, developed a carbuncle in the throat. It swelled, ulcerated, and discharged pus and blood continuously day and night, disrupting sleep and appetite. Physicians were helpless. Fortunately, Yang Jilao arrived in the commandery. Yang Lizhi's two sons invited him. After careful observation, Yang Jilao said, "No need to check the pulse; I already know. However, this disease is very unusual. You must first consume one jin (approx. 500g) of sliced ginger before administering medicine. Otherwise, there is no method." He then left. The sons looked troubled, saying, "With pus and blood discharging from the ulcerated throat and severe pain, how can he eat ginger?" Yang Lizhi said, "Jilao's medical skill is divine; his words are not false. Try giving me one or two slices. If I cannot swallow, discard them safely." He ate them. Initially, they tasted sweet and fragrant. As he consumed about half a jin, the pain eased. Upon finishing one jin, the taste became pungent and spicy, and the pus and blood cleared instantly. Porridge entered the mouth without obstruction. The next day, he thanked Yang Jilao and asked for the reason. Yang Jilao said, "While serving in the South, you ate much Partridge. This bird likes to eat Banxia (Pinellia Tuber). Over time, toxicity accumulates and manifests. Hence, Ginger is used to counteract it. The source of the disease is now cleared; no other medicine is needed."

Another patient had flesh growing in the throat, layer upon layer, gradually swelling, with orifices emitting foul odor. He was cured by decocting and drinking leaves of Chouju (Stink Orange Leaf).

Another patient felt that during swallowing, as if there were an additional throat slanting under the diaphragm to the left hypochondrium, causing distension and stuffiness. Pressing the area produced gurgling sounds. He took ten pills of Kongxian Dan (Phlegm-Draining Pill). Soon, heat arose in the distended area, followed by a sound, and he passed two sheng (approx. 1 liter) of phlegm-fluid stool. Subsequent food intake descended normally to the Stomach.

Jiang Yingsu treated a patient with redness below the uvula. All considered it Heat, and cooling medicines were applied ineffectively. This was Deficiency of Middle Qi, cured by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

Ma Mingju treated Ni Zhongzhao, who suffered from Hou Xuan (Throat Herpes/Lichen). Local throat specialists had all been consulted. The throat gradually necrotized. Food had to be soft flour-based, swallowed only with the head tilted back. Each swallow brought tears. Ma said, "This is not Wind-Fire Toxicity. Did you suffer from Meichuang (Syphilis) in your youth?" The patient replied, "No." "Did your parents suffer from it?" "Yes." "You contracted it three years after their recovery." Ma believed this was due to accidental ingestion of Sheng Yao (Calomel/Corrosive Mercury Compound). Those suffering from this sore ingest Cold-cooling Calomel toxicity, manifesting on the body; Sheng Yao toxicity manifests in offspring born after recovery. Severe toxicity extends to grandchildren and nephews. Without treating it as a Condensed Toxicity case, death is certain. Ganjie Tang (Licorice and Platycodon Decoction) was used as the sovereign herb, with small amounts of Shandougen (Sophora Tonkinensis Root), Longdancao (Gentian Root), and Shegan (Belamcanda Rhizome). Each dose included Banxia Fuling (Polyporus with Earth Solanum, here referring to Tu Fuling/Smilax Glabra Rhizome) half a jin, decocted strongly, taken with Niu Huang (Calculus Bovis/Bovine Calculus) two fen. Recovery occurred in half a month without using throat powders. Inquiry revealed his parents indeed recovered from Syphilis using Sheng Yao, suffering oral ulcers post-recovery, hence the severe residual toxicity.

Zhang Jingyue treated a woman in the Lai residence, nearly thirty years old, suffering from Xu Sun (Deficiency Consumption) accompanied by Hou Xuan pain. Many physicians failed. Zhang diagnosed her pulse as rapid but forceless, observed loose stools, and noted previous treatments involved clearing Heat and Fire. The more Fire was cleared, the worse the throat pain became. He deduced it was not Excess Fire, but rather excessive Cold-Cooling herbs leading to abdominal laxity, resembling Ge Yang (Gridlock Yang/True Cold False Heat). He exclusively used Liyin Jian (Regulate Yin Decoction) and Dabu Yuansheng Tang (Great Tonification of the Source Decoction), alternating them. Within half a month, throat pain decreased; within half a year, full recovery.

He also treated Wang Pengque, aged over thirty, suffering from Hou Bi (Throat Bi/Obsstruction). For over ten days, the head and face swelled massively, the throat and neck became extremely thick, breathing was急促 (rapid/difficult), voice hoarse, and throat swelling with oral ulcers caused extreme pain. A maid supported her back; she sat upright for days without lying down. Pulse was extremely fine, rapid, and weak. Speech was faint. Medications taken were mainly Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Zhimu (Anemarrhena Rhizome), and Huangbai (Phellodendron Bark). This originated from Yin injury, exacerbated by Cold-Cooling herbs, causing Cold to prevail in the Lower Jiao and Gridlock Yang in the Upper Jiao. Even water was difficult to swallow, and she feared irritability and heat. Zhang said, "Dangerous! Delay by half a day, and rescue will be impossible." He prescribed Zhenyin Jian (Settle Yin Decoction), cooled thoroughly with cold water, and administered slowly. After one decoction, overnight, head and neck swelling vanished. Subsequently, Wufu Yin (Five Blessings Drink) was given for several doses, leading to recovery.

Yu Zhen's commentary: Ancient cases of throat diseases are not particularly excellent. The above cases were selected for their diversity. The Wang Pengque case has the best treatment method, but this patient could tolerate Warm-Tonification, hence the immediate effect. There are cases where Warm-Tonification fails, indicating a fatal prognosis of Yang Syndrome with Yin Pulse. One cannot claim Zhang Jingyue's methods always save lives. My hometown relative, Mr. Xu, initially had exterior contraction fever, followed by a small boil behind the left ear. Ulcerated and deemed Er Ding (Ear Carbuncle), it was dressed with medicine. Ulceration persisted, spreading redness and swelling to the entire ear and face. Extreme pain caused profuse sweating, body heat felt cool, appetite improved, and he seemed slightly better. Three days later, fever recurred, swelling and pain behind the left ear and face intensified, progressing to delirium and coma. Likely due to exposure to Wind pathogen after going out and using the toilet. Both internal and external specialists saw a small, rapid, forceless pulse, fearing deficiency collapse. My friend Brother Li Kunyang arrived, stating, "This is Er You Feng (Roaming Wind of the Ear), not a lethal sore. Repeated wind exposure caused these critical signs." External dressing and internal large-dose Wind-dispelling herbs reduced swelling, pain, and fever. Delirium persisted. Two days later, delirium worsened, vomiting all food/water, cold limbs, continuous hiccups, critical condition. Li pried open the mouth with chopsticks: throat necrosis, uvula red-purple and swollen like a hanging eggplant. Pulse still fine-rapid, right hand especially soft. He said, "Days of no food led to great Stomach Qi deficiency, causing vomiting and hiccups." He ordered three sheng of white rice cooked in a large pot, taking the congee oil (rice gruel surface film) to feed. Vomiting stopped. Throat necrosis was cleaned with medicated wash. Then, Shi Gao (Gypsum Fibrosum) four to five liang and Zhu Ye (Bambusa Leaves) a large handful were decocted for gargling and drinking. After a night, consciousness partially returned, hiccups stopped, limbs warmed. Large doses of Huangqin, Huanglian, Baihu Tang (White Tiger Decoction), Zhizi (Gardenia Fruit), and Lianqiao were administered. Recovery in several days. This contrasts sharply with Zhang Jingyue's case. It reminds us that physicians must not rigidly adhere to ancient texts or assume their own views are correct.