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Any throat disease without phlegm is incurable. Phlegm sounds like thunder indicate a critical condition. A voice resembling the sound of dragging a saw indicates death. Hoarseness is incurable. A complexion resembling cooked blood/flesh indicates death. A black face with a miserable spirit indicates death. Trismus (lockjaw) indicates a critical condition. Gums swollen over the teeth indicate death. Staring with angry eyes indicates death. Abdominal pain indicates death. Unstopping bleeding from the nose indicates death. Black stool indicates death. Persistent tidal fever indicates a critical condition. Mouth movements and confused speech indicate death. Meat buds (polyps) growing inside the throat that do not hurt when pricked indicate death. Pus and blood that are neither fishy nor foul-smelling indicate death. Breath that exits but cannot be retained indicates death. Inability to lift hands or walk indicates death. The entire throat covered by membranes is incurable. Foul breath indicates death. White membrane covering the tip of the tongue indicates death. Loose teeth are incurable. Loss of the tongue indicates death. Throat pain caused by rising phlegm-fire is incurable. Throat pain caused by rising fire from scrofula (tuberculous lymphadenitis) is incurable. All of the above are fatal conditions; only one or two out of a hundred can be saved.

Throat diseases all originate from the five zang and six fu organs. When these organs are diseased, their manifestations appear in the throat. That which is located inside the pharyngeal gate is called "Yan" (pharynx), and that which is outside is called "Hou" (larynx). The color and shape of the Yan and Hou have distinct yin-yang and deficiency-excess toxicities. When they arise suddenly, accompanied by tightness of the jaw, abundant saliva and phlegm, and uncontrolled exhalation, leading to death from morning to evening, this constitutes an acute syndrome. Physicians who do not understand this often attribute it to phlegm-heat, failing to recognize the distinction between yin-yang and deficiency-excess. External syndromes belong to Yang, internal syndromes to Yin. Deficiency requires warming, excess requires purging. Heat is cleared, wind is dispersed, toxicity is resolved, membranes are removed, phlegm is transformed, saliva is eliminated, obstruction is opened with opening agents. For red, yellow, white, and ulcerated spots internally, medicament powders should be blown into the throat. For external swelling, redness, and nodules, medicament powders should be applied topically. Nodules that suppurate should be punctured with needles. Examine the syndrome and administer medication without panic. This is truly a mantra.

─ For Fire Syndrome Obstruction of the Throat (Huo Zheng Hou Bi), Chou Xin Yin (Draw Out the Fire Decoction) is indicated as the principal formula.
─ If the fire is intense and uncontrollable, Xi Xin Yin (Remove the Firewood Decoction) is indicated.
─ For excessive fire in the Gallbladder and Liver, Peony Root (Radix Paeoniae Alba), Gardenia Fruit (Fructus Gardeniae), and Gentian Root (Radix Gentianae) are the main herbs.
─ For excessive fire in the Stomach (Yangming channel), Raw Gypsum (Gypsum Fibrosum) is the main herb. If constipation occurs, Rhubarb Root (Radix Rhei Palmati) and Mirabilite (Natrii Sulfas) should be added to unblock the bowels, causing the fire to subside naturally.
─ When fire floats upward and heat knots in the head, face, and throat, clearing and descending is most appropriate. One must absolutely avoid mistakenly using formulas that raise Yang and disperse wind, because this fire originates from the interior; raising it will intensify the fire. The Classics state: "For those high up, suppress them." This is precisely what is meant. It does not refer to the principle of venting trapped fire or raising Yang to scatter fire. Students must carefully contemplate this and not claim ignorance due to misidentification.
─ For external treatment of swelling and pain in Fire Syndromes, grind Chinese Manchineel Fruit (Fructus Hippomane Mancinellae) in vinegar, dip a goose feather in it, and wipe the throat to draw out phlegm. Alternatively, dilute with a little clear water to avoid excessive acidity. Swish frequently in the throat without swallowing; inducing vomiting of phlegm is preferable. After swishing, blow Dai Chi San (Spoon-Replacement Powder) into the throat, and continue internal decoction therapy. Recovery is assured.
─ For fire stagnating upward, dietary management should favor Pear Juice and Mung Bean Soup. In southern regions where pears are scarce, juice from good radishes can be used, mixed with spring water and a small amount of Mirabilite. Drink slowly; this eliminates phlegm and clears fire.
─ For unilateral or bilateral tonsillar hypertrophy (Ru E), if the toxin is not severe and pus has not formed, treatment will lead to resolution. If the condition is critical, bloodletting via scarification is necessary for rapid relief. This is a desperate measure for emergencies. Ancient methods for treating Obstruction of the Throat involved pricking the Shaoshang point (LU11) three times; healing occurs upon bleeding.
─ Yin Deficiency Obstruction of the Throat. Symptoms include internal heat, thirst, dry throat, red lips and cheeks, and abundant saliva/phlegm. However, the six pulses are spiritless, or although rapid, they are floating, soft, and weak. Observation reveals excessive sexual activity or innate yin deficiency, manifesting as fatigue and weakness. This results from Kidney Yin depletion, where water fails to control fire. For severe fire, Zi Yin Ba Wei Jian (Eight-Ingredient Decoction for Nourishing Yin) or Jia Jian Yi Yin Jian (Modified One-Yin Decoction) are indicated. For mild fire, where there is no preference for cold substances, hard stools, or hot urine, Liu Wei Di Huang Tang (Six-Ingredient Pill with Rehmannia) or Yi Yin Jian (One-Yin Decoction) are indicated. For mental anxiety and agitation stirring Heart Fire, Er Yin Jian (Two-Yin Decoction) is indicated.
─ Ge Yang Obstruction of the Throat (Floating Yang Obstruction). This arises because fire fails to return to its source, with rootless fire lodging in the throat. Symptoms present as upper heat and lower cold, distinctly different from typical Fire Syndromes. Differentiation relies on detecting weak, thready pulses without slippery or large qualities, indicating no fire in the lower body and abdominal aversion to cold. This condition is caused by seminal injury from sexual excess, diarrhea damaging the Kidneys, or excessive use of cold/cooling herbs damaging Yang Qi in the absence of excess fire. Zhen Yin Jian (Settling Yin Decoction) is the superior treatment, followed by Ba Wei Di Huang Tang (Eight-Ingredient Pill with Rehmannia), or holding Honeyed Prepared Aconite Root (Radix Aconiti Lateralis Preparata) in the mouth to swallow. Further use of cold/cooling agents will likely prove fatal.
─ Yang Deficiency Obstruction of the Throat. This does not mean the throat obstruction is caused by Yang deficiency, but rather that Yang deficiency is caused by the throat obstruction (mismanagement). Cases include excessive use of attacking/purging agents damaging Stomach Qi, difficulty eating leading to empty reserves and damaged Stomach Qi, or inherent physical weakness unable to withstand labor, damaging Stomach Qi. Generally, internal deficiency of Middle Qi combined with external pain forces Yuan Yang to flee. Pulses are floating and scattered, or weak and choppy, with snoring-like voices and sawing-like phlegm sounds. These are signs of impending failure of the Stomach and Lung. Rapidly restore Yuan Qi by decocting Ginseng Root (Radix Ginseng) alone strongly and swallowing slowly. If phlegm is abundant, add Bamboo Sap (Succus Bambusae) or Ginger Juice (Succus Zingiberis Recens). Delay leads to fatality; treating as excess fire brings immediate disaster.
─ Ge Yang Obstruction of the Throat. Manifests as floating fire on the head and face, extremely coarse larynx,急促 breathing, hoarseness, swollen throat, oral ulcers, and severe pain. Pulses are fine and rapid. Speech is faint and weak. History reveals consumption of Coptis Rhizome (Rhizoma Coptidis), Gardenia, and Phellodendron Bark (Cortex Phellodendri). This resulted from Yang damage compounded by cold/cooling agents, causing cold to dominate below and repel Yang to above. Even tea and water are difficult to swallow, with aversion to irritability and heat. I stated: "Critical! Delay further and rescue will be impossible." I prepared Zhen Yin Jian, cooled it with cold water, and administered it slowly. After one dose, headache and neck swelling subsided by morning. Subsequent treatment with Wu Fu Yin (Five-Fortune Infusion) cured the patient within several doses. Skeptics were amazed and convinced.
─ Throat Bi Pain. Generally caused by phlegm-fire. Acute cases require expectoration followed by purgation to resolve via upper and lower dispersion. Severe cases require bloodletting via needle puncture, followed by emetics. This is the supreme strategy. Fearfulness and seeking alternative remedies lead to sudden death. Treating Throat Bi is like fighting fire; delay is unacceptable. The *Neijing* states: "Vent it." Venting implies dispersal. Emesis contains the meaning of dispersal. Bleeding is also a form of dispersal. Do not adhere to slow or mild formulas for such phlegm. Claiming "King's Way" medicines do not disturb the viscera may cure mild cases but leads to death in severe ones through procrastination. Is this not mistaken killing?
─ Throat Xuan Syndrome. Common in individuals with Yin Deficiency and consumptive disease. Symptoms include ulcers throughout the throat, redness, swelling, pain, and chronic non-healing. This is essentially Water Deficiency with Empty Fire. Treat according to the Yin Deficiency Obstruction of the Throat protocol. If accompanied by cough and Lung Heat, Si Yin Jian (Four-Yin Decoction) is indicated. For painful, broken ulcers throughout the throat, blow Niu Huang Yi Jin San (Calculus Bovis Powder to Benefit Metal) locally, while internally administering tonics for True Yin. Recovery is expected.
─ Wen Du Obstruction of the Throat (Plague-Toxin Throat Disease). Caused by epidemic qi. Symptoms include swelling of the throat and neck, sometimes extending to the head and face. Prevalent in the North, commonly known as Toad Plague, Cormorant Plague, or Big Head Plague. This is a fierce manifestation of damp-heat stagnation. Clear fire from all meridians or purge Yangming heat, adjusting based on urgency. Dong Yuan's Pu Ji Xiao Du Yin (Universal Rescue Detoxification Decoction) specifically treats this and is highly effective.
─ Fu Qi Syndrome (Latent Qi Syndrome). Known in ancient texts as Kidney Cold Damage. It refers to atypical violent cold invading the body, with toxins lying latent in the Shaoyin Kidney Meridian. No initial illness occurs; symptoms emerge after ten days to a month. Pulses are weak. Treatment follows Cold Damage protocols. This is not Throat Bi. Secondary symptoms may include diarrhea. This syndrome often involves Shaoyin/Shaoyang fire interacting with Taiyang cold, Taiyin dampness, and wind-cold pathogens. Treatment should focus on external pathogens rather than the throat itself; the throat will heal spontaneously. New formulas like Chai Hu Yin (Bupleurum Infusion) and various powder prescriptions can be adapted as needed.
─ Yangmei Toxic Sores (Syphilitic Chancre). Chronic ulceration and pain in the throat not healing. This is not Throat Bi but Syphilitic toxin. Xian Yi Liang Tang (Immortal Grain Decoction) is indicated. For severe cases, decoct Smilax Glabra Rhizome (Rhizoma Smilacis Glabrae) and swallow Wu Bao Dan (Five-Treasure Pills).
─ Deficiency Consumptive Throat Bi. Difficult to differentiate. A patient with deficiency consumptive disease presents with Throat Xuan swelling and pain, unresponsive to multiple physicians. Pulse is rapid but weak. Symptoms include loose stools. Previous treatments were cooling/clearing agents, yet throat pain worsened with cooling. Confirmed as non-excess fire; prior excessive cold/cooling herbs caused abdominal discomfort. This resembles Ge Yang syndrome. Treated successfully with Li Yin Jian (Regulate Yin Decoction) and Da Bu Yuan Qi Jian (Great Tonify Yuan Qi Decoction).
─ Suo Hou Feng Syndrome (Lock-Throat Wind). Contemporary people label any severe throat swelling, dysphagia, or phlegm obstruction as Lock-Throat Wind, unaware of the true, rare, and acute form. In Xiangyang, I observed a girl of marriageable age in mid-autumn. Suddenly, her throat became increasingly obstructed without apparent cause. Pulse showed no fire. Throat was not swollen or painful. Face was blue, eyes staring, unable to speak. Sound was thin as a needle, breathing labored as a thread, stretching neck in desperation. I suspected wind-pathogen blocking the throat, requiring acrid-warm dispersants. Administered Er Chen Tang (Two-Cured Decoction) with Ginger, with no effect. Considered Du Shen Tang (Single-Ginseng Decoction) to save the Lung, but feared blame due to critical condition. Other physicians did nothing. She died within a day and night. Another case followed similarly. I remain puzzled by these deaths to this day, feeling ashamed. I suspect lung Qi exhaustion. If encountered, only Single-Ginseng Decoction might save. I record this for future scholars to consider.
─ Foreign bodies stuck in the throat, such as splinters or bones, have sharp edges preventing downward passage. Pushing down against resistance is counterproductive. Advancing upward with food momentum induces vomiting, extracting the object easily like pulling a splinter. Deep splinters are hard to push down; delay allows digestion of the food vehicle, leading to swelling and greater harm. For bone impaction, swallow a large piece of Malt Sugar (Saccharum Japonicum) whole, or swallow a bundle of roasted chives (not cut) to wrap the sharp object and guide it down. Both methods are effective.
─ A child accidentally swallowed an iron nail, causing severe pain. I used Magnetitum (Magnetic Ore, 7 qian), Mirabilite (2 qian), and cooked lard (2 liang), mixed with honey powder, and fed it to the child. The next day, the iron passed in the stool. This is indeed an excellent prescription.