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For all throat disorders, if the onset is acute, fever may not occur within one or two days, and the condition is relatively mild. However, if fever appears on the third day, the disease must be severe. One must inquire whether urination and defecation are unobstructed. If both urine and stool flow freely, even if symptoms are severe, it is merely floating fire attacking upward; taking wind-dispelling and heat-clearing medicines such as Xiaofeng San (Wind-Dispersing Powder) will lead to recovery. If urine and stool are obstructed, there must be interior excess fire; heavy medications that descend fire, resolve toxicity, and promote the free flow of urine and stool are indispensable. Otherwise, how can the toxic fire exit? How can the disease be resolved? If headache accompanies symptoms of Shanghan (Cold Damage), treatment is difficult. For all throat disorders, recovery is only possible after bowel movements become regular. If constipation persists, a cure should not be lightly promised.

For patients suffering from Hou Bi (Throat Obstruction), first roll up both arms to the pulse gate area. Then observe the middle and distal phalanges of the middle finger until purple veins appear. Puncture these purple veins with a needle to bleed; the patient can eat and drink immediately thereafter. Also check for purple-red veins behind the ears on both sides; puncturing them to bleed is beneficial.

If Hou Bi (Throat Closure/Obstruction) is not treated by bloodletting, if Hou Feng (Throat Wind/Acute Laryngitis with Spasm) does not induce expectoration, if Hou Yong (Throat Abscess) is not drained, and if Hou Bi and Hou E (Tonsillar Swelling) are not cauterized, the treatment methods are illegal/inappropriate.

Dai Ren (Zhang Congzheng) stated: Throat obstruction is an emergency; puncturing various acupoints to bleed is the best strategy. The *Neijing* states, "When fire is constrained, it must be vented." "Vented" refers to one aspect of inducing sweating.

Dou Menglin said: Throat closure results from external cold pathogen invasion combined with internal injury from hot foods, or drinking hot liquids and bathing immediately after severe cold exposure. This forces cold qi into the Spleen meridian, blocking the Middle Jiao, while evil heat lodges in the Heart meridian, causing this disease. With excessive phlegm-saliva accumulation, sudden throat closure occurs, preventing Qi circulation, often leading to death. Emergency treatment involves puncturing purple veins on the wrist or Shaoshang (LU 11) to bleed, followed by administering four to five pills of Xionghuang Jiedu Wan (Realgar Antidote Pill) ground in cold tea. Blow Bingpian San (Borneol Powder) into the throat to expel wind-phlegm and thick saliva.

In Wind-Toxin Throat Obstruction, the exterior is red and swollen, while the interior is slightly red with white patches, resembling steamed cakes. Swelling extends to the cheeks. Exterior symptoms include aversion to cold without fever, swelling of the cheeks and jaw, and lockjaw. This is caused by wind-phlegm binding and blocking the throat. Treatment must focus on resolving phlegm using blowing powders. If the exterior is red and swollen, apply external compresses, leaving a small hole in the center, and keep it moist to enhance efficacy.

In Wind-Heat Throat Obstruction, swelling is red with slight purple discoloration, shaped like a fist. The face is blue-green, and eyes gaze upward. Exterior symptoms include high fever and aversion to cold, resembling Cold Damage. This disease arises from long-standing accumulated heat-toxin compounded by wind exposure. If the patient's voice is hoarse, use lung-moistening herbs.

In Yin-Toxin Throat Obstruction, swelling is closed and resembles a purple plum, showing slight black or grayish-white hues. Blood that is bright red indicates a treatable condition; black blood indicates untreatability. Exterior symptoms include aversion to cold, tremors, lower back pain, and cold feet. This results from contracting yin-dampness and fire pathogens in winter. Bright red blood and soft swelling with phlegm in the throat indicate treatability; black blood, severe swelling, hardness, and dry throat indicate difficulty. First administer Huadu Dan (Toxin-Resolving Pill), then Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction), followed by blowing powders. Abstain from alcohol for one month.

Shanghan Throat Obstruction is caused by lingering toxins from Cold Damage appearing after eight or nine days, where heat-toxin enters the Heart and Spleen meridians. Apply Bingpian San (Borneol Powder).

Throat closure typically presents two days prior with chest tightness, shortness of breath, sudden throat pain, cold extremities, and imminent death due to Qi blockage. Immediately use a chicken feather dipped in tung oil to stimulate vomiting in the throat to clear phlegm. Rapidly massage both arms dozens of times until reaching the thumb, then puncture Shaoshang (LU 11) to bleed. For men, puncture the left side; for women, the right. In severe cases, puncture both hands.

Throat obstruction belongs to Phlegm, Wind, or Heat, all resulting from constrained fire combined with heat-toxin. Severe swelling without redness or with slight whiteness indicates deficiency of the throat.

Throat obstruction and tonsillitis occurring after Cold Damage are difficult to treat because Qi is blocked without form or momentum. Symptoms include stiffness of the throat and neck, and upward-gazing eyes, making prognosis poor.

Blood stasis causing obstruction should be treated with Carthami Flos juice. If fresh flowers are unavailable, decoct and squeeze the juice. Alternatively, use one tael of Rubia cordifolia root decocted, or Achyranthes bidentata juice mixed with vinegar, or Patrinia juice, or Belamcanda chinensis decoction held in the mouth and swallowed.

For throat closure, first induce expectoration using Gengti San (Seedpod Powder) or Xionghuang Huadu Dan, or hold one tael of Natrii Sulfas finely in the mouth, or consume Radish juice.

Feng Shi said: Throat obstruction is similar to Chanhou Feng (Entangling Throat Wind). The throat surface is red, breathing is coarse, and the throat is red, swollen, and closed due to accumulated heat generating wind and gathering toxic phlegm. In severe cases, a fleshy tumor blocks the interior, preventing Qi flow. If the nose and face turn blue-black, accompanied by alternating chills and fever, head drooping, and phlegm retention, it is untreatable. Visceral cold can also cause throat closure and difficulty swallowing. When lower cold is extreme, upper heat becomes excessive. This pattern is close to Tonsillitis but requires different treatment. Generally, formless swelling and closure constitute Obstruction, while formed swelling and pain constitute Tonsillitis. Inducing wind-phlegm addresses the branch in emergencies; resolving toxicity addresses the root in chronic cases. For upper heat and lower cold, use warming medicines taken cold before meals; do not mistakenly use cooling medicines.

The Classics state: "The binding of one Yin and one Yang is called Throat Obstruction." One Yin refers to Shao-Yin Ministerial Fire; One Yang refers to Shao-Yang Ministerial Fire. The Hand-Shao-Yin Heart meridian flanks the pharynx; the Foot-Shao-Yin Kidney meridian follows the throat. Patients often have phlegm-saliva in the diaphragm due to excessive alcohol/diet, anger, or sexual indiscretion. Excessive drinking moves Stomach fire (common in the wealthy); anger moves Liver fire (common in women); sexual indiscretion moves Kidney fire (common in men). Fire moves phlegm upward, causing phlegm-heat to scorch and block the pharynx. Phlegm is the root of fire; fire is the branch of phlegm. Fire acts rapidly, causing rapid swelling and pain externally and internally, preventing water intake. This is the most urgent and critical external symptom. Treatment principle: address the branch urgently, the root slowly. Address the branch with pills/powders to vomit phlegm and dissipate heat; address the root with decoctions to descend fire and tonify deficiency. However, practitioners often only claim to treat Spleen-Lung fire without descending Liver-Kidney fire. One must follow the *Neijing* method of treating contrary indications. Do not abruptly use cold/cooling herbs, as this exacerbates danger. Excess fire requires direct treatment; deficiency fire requires contrary treatment. Distinguish clearly to avoid error.

Furthermore: The pharynx, larynx, epiglottis, and tongue share a common gateway but have distinct functions. The larynx receives Qi, connecting to Heaven; the pharynx receives food, connecting to Earth. The epiglottis controls opening and closing above, covering the airway to ensure food and water enter correctly. These four interact; if one is blocked, eating ceases and death ensues. "Throat Obstruction" means inability to breathe through the throat or speak, blocking Heavenly Qi. "Pharyngeal Pain" means inability to swallow saliva or food, blocking Earthly Qi. "Throat Obstruction with Pharyngeal Pain" means both Heavenly and Earthly Qi are blocked.

Furthermore: The pharynx is posterior, governing food; the larynx is anterior, governing Qi. Among the twelve meridians, only the Foot-Taiyang governs the exterior and descends below the nape; others circulate internally through the throat. All can be diseased, unified under Ministerial Fires. The larynx governs Heavenly Qi, affecting Lung Metal; change leads to Dryness, causing涩 (astringency/blockage). The pharynx governs Earthly Qi, belonging to Spleen Earth; change leads to Dampness, causing swelling. Both result from constrained fire in the Upper Jiao, causing phlegm-Qi-blood accumulation in the throat, swelling outward, itching, and pain, known as Entangling Throat Wind. Swelling on both sides is Throat Obstruction. Single/Double Tonsils, Wooden Tongue, Tongue Swelling, Running Horse Throat Wind, White Throat Wind, and Scarlet Fever are all related to Wind-Fire and are not distinguished here. Only Running Horse Throat Wind kills fastest.

Furthermore: Throat obstruction mostly belongs to Phlegm-Heat; severe cases require tung oil-induced vomiting. Entangling Throat Wind also belongs to Phlegm-Heat, characterized by swelling inside and out, also treated with tung oil. Lung Exhaustion with Throat Closure presents with floating, scattered, fine pulse and snoring sound with rattling phlegm. Use Danshen Tang (Ginseng Decoction) mixed with Bamboo Sap and Ginger Juice. Early treatment yields 70-80% success; delayed treatment yields 30-40%; very late treatment is fatal.

Medical Theory Selection states: Cold stagnation in organs causes Qi contraction and obstruction, leading to Throat Obstruction. Deficiency below causes Throat Obstruction; treating lower cold resolves the obstruction.

"Running Horse Obstruction" refers to extremely acute Throat Obstruction where death is rapid, and slow-acting medicines fail. Acupuncture at specific points is effective. Throat Wind is similar; both are emergencies.

Q: Why does Wind-Toxin Throat Obstruction cause internal and external swelling? A: Wind-toxin qi binds in the throat, causing blockage, interacting with phlegm. *Suwen* states: "Without wind, phlegm does not move; without phlegm, wind cannot attach." Wind-phlegm binding blocks the throat. External symptoms include throat swelling like an egg, pale color, cheek swelling resembling sores, chills/fever, lockjaw, and aphonia. First, puncture the swollen jaw joint with a small knife, then puncture Shaoshang (LU 11) and other points to induce vomiting. Q: Why does Wind-Heat Throat Closure cause internal and external swelling? A: Long-standing heat-toxin combined with wind exposure causes wind-heat binding. Symptoms include red face, swollen cheeks, chills/fever, fist-sized mass in throat, and bright red blood. Treatment is the same.

For lockjaw, caused by wind-phlegm binding, use vinegar-mixed Yuanmingfen (Natrii Sulfas) solution灌 (irrigate) into the throat and induce vomiting with a chicken feather. Externally, apply powdered Myrobalan mixed with vinegar.

Deficient Yang attacking upward results from prolonged illness weakening Yuan Qi, allowing evil fire to ascend. Throat swelling and pain prevent Qi descent/ascent, failing to balance Water and Fire. Heart fire rushes to the throat, causing swelling and closure. Symptoms include aphonia, lockjaw, full mouth of phlegm, cold extremities, dizziness. Treat with Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction).

Severe Throat Obstruction with coma, staring eyes, and fixed gaze: Apply Fructus Evodiae powder mixed with vinegar to the soles of both feet, then treat with Descending Qi Decoction. Add Pedicularis and Lindera for wheezing; add Agarwood and Ginseng for shortness of breath. Once extremities warm, drink thin porridge to consolidate Yuan Qi. Eating promotes life; fasting leads to death.

If cheeks are swollen and face red, it is Wind-Toxin infection. Wash with Perilla Leaf and Cypress Branch decoction. Use Schizonepeta, Saposhnikovia, and Notopterygium to dispel wind, or use Shixuan San (Ten-Acupoint Powder).

Alcohol-Toxin Throat Obstruction resembles an egg, with bright red, mirror-like swelling. Exterior symptoms include fever, aversion to cold, headache, and stiff neck. This is Upper Jiao heat affecting Heart and Spleen meridians, causing phlegm congestion in the throat. Take Arctii Fructus Decoction to induce vomiting. Acupuncture is the same; apply Borneol Powder.

Wind-Heat Throat Obstruction results from excessive worry/work or speaking in the wind, causing Wind to enter Lung Meridian and generate phlegm. Resolving phlegm is key. Fresh red color turning purple-red over time: puncture with a small knife to release slight blood, dispersing fire. Then take decoction and apply Borneol Powder. Transition from purple-red to pale red indicates gradual healing.

Qi-Abscess Throat Obstruction is caused by toxin accumulation in the throat with thick phlegm and chills/fever. Divide into Upper, Middle, and Lower gates. Toxin in the Lower Gate is difficult to treat. For Upper and Middle Gates, use blowing powders. Swallow five to six Xionghuang Huadu Pills with warm tea, adjusting dosage based on severity.