疼痛或寒热者。邪在表也。宜发散。
肿痛痰涎壅盛者。邪在上也。宜降之。
痛而脉数无力者属阴虚。宜滋阴降火。
肿痛发热便秘者。表里俱实也。宜解表攻里。如症紧急。便刺患处。或刺少商穴。
一人咽痛脉数。以荆防败毒散加黄连二剂少愈。乃去芩、连。又六剂而愈。（此凭脉症
一人乳蛾肿痛。脉浮数。尚未成脓。针去恶血。饮荆防败毒散二剂而消。（此凭症也。）
一人咽喉作痛。痰涎上壅。予欲治以荆防败毒散加连翘、山栀、玄参、牛蒡子。彼自服
降火之药。反加发热。咽愈肿痛。急刺少商二穴。仍以前药加麻黄汗之。诸症并退。惟咽间
一紫泡仍痛。此欲作脓。以前药去麻黄一剂。脓溃而愈。（此凭症也。）
凡咽痛之疾。治之早或势轻者。宜荆防败毒散以散之。治之迟或势重者。须刺少商穴。
已结。必刺患处。亦有刺少商。咽虽利而未痊消者。必成脓也。然脓去则安。若有大便秘结
者。虽经针刺去血。必以防风通圣散（六）攻之。然甘寒之剂。非虚火不宜用。
一妇咽喉肿痛。大小便秘。以防风通圣散（六）一剂。诸症悉退。又荆防败毒散（七）三剂
而安。（此凭症也。）
治此。轻则荆防败毒散、吹喉散、重则用密钥匙。及刺患处出血最效。否则不救。针
少商二穴亦可。但不若刺患处之神速耳。
一人咽喉肿痛。脉数而实。以凉膈散一剂而痛止。再以荆防败毒散加牛蒡子二剂而肿退
。以荆防败毒散二剂。又以甘桔、荆防、玄参、牛蒡子四剂而平。
一人嗌痈肿痛。脉浮数。更沉实。饮防风通圣散（六）一剂。泻一次。势顿退。又荆防败
毒散二剂而消。（此凭症脉也。）
一人咽喉肿秘。牙关紧急。针不能入。先刺少商二穴出黑血。口即开。更针患处。饮清
咽利膈散一剂而愈。（此凭症也。）
大抵吐痰针刺。皆有发散之意。故多效。不用针刺。多致不救。
一人咽喉肿闭。痰涎壅甚。以胆矾吹咽中。吐痰碗许。更以清咽利膈汤四剂而安。（此
凭症也。）
一人咽喉肿痛。药不能下。针患处出紫血少愈。以破棺丹噙之。更以清咽消毒散（六五）
而愈。（此凭症也。）
一人咽喉干燥而痛。以四物汤（九）加黄柏、知母、玄参四剂少愈。再用人参固本丸（二
百四一）一剂。不复发。
一人口舌生疮。服凉药愈甚。治以理中汤（二七）而愈。（此因治误而变。）
一人咽痛。午后益甚。脉数无力。以四物汤（九）加黄柏、知母、荆、防四剂而愈。仍以
前药去荆防。加玄参、甘、桔数剂。后不再发。
一人口舌糜烂。服凉药愈甚。脉数无力。以四物加酒炒黄柏、知母、玄参一剂顿退。四
剂而痊。（此凭脉症也。）
一人口舌生疮。饮食不甘。劳而愈甚。以理中汤顿愈。（此凭症也。）
一人口舌生疮。脉浮而缓。用补中益气汤（十六）加炮干姜。更以桂末含之。即愈。
一人患之。劳而愈甚。以前药加附子三片。二剂即愈。
丹溪曰。口疮服凉药不愈者。此中气不足。虚火从上无制。用理中汤。甚则加附子。
一弱人咽痛。服凉药或遇劳愈甚。以补中益气汤（十六）加芩、连四剂而愈。乃去芩、连
又数剂不再发。（此凭症也。）
常治午后痛。去芩、连加黄柏、知母、玄参。亦效。
一老咽痛。日晡甚。以补中益气汤（十六）加酒炒黄柏、知母。数剂而愈。（此凭症也。）
一人乳蛾肿痛。饮食不入。疮色白。其脓已成。针之脓出。即安。（此凭症也。）
一人咽喉肿痛。予欲针之。以泄其毒。彼畏针。只服药。然药既熟。已不能下矣。始急
针患处。出毒血。更以清咽消毒药而愈。
一患者其气已绝。心头尚温。急针患处。出黑血即苏。如鲍符卿、乔侍郎素有此症。每
患。针去血即愈。
大抵咽喉之症。皆因火为患。其害甚速。须分缓急。及脓成否。若肿闭及壅塞者。死如
。宜用密钥匙吹患处。吐出痰涎。气得流通则苏。若吐后仍闭。乃是恶血或脓毒。须急针患
处。否则不治。前人云。喉闭之火与救火同不容少待。治喉之方固多。惟用针有回生之功。
学人不可不察。
一妇咽间作痛。两月后。始溃。突而不敛。遍身筋骨作痛。诸药不应。先以萆 汤数剂
而敛。更以四物汤（九）倍用萆 、黄 二十余剂。诸症悉退。（此凭症也。）
一弥月小儿。先于口内患之。后延于身。年余不愈。以萆 为末。乳汁调服。母以白汤调
服。月余而愈。（此凭症也。）
一人咽间先患。及于身。服轻粉之剂稍愈。已而复发。仍服之。亦稍愈。后大发。上
。与鼻相通。臂腿数枚。其状如桃。大溃。年余不敛。神思倦怠。饮食少思。虚症悉具。投
以萆汤为主。以健脾胃之剂兼服之。月余而安。（此凭症也。）
一妇患之。脸鼻俱蚀。筋骨作痛。脚面与膝各肿一块。三月而溃。脓水淋漓。半载不敛
。治以前药。亦愈。（此凭症也。）
一人咽喉肿痛。口舌生疮。先以清咽消毒散（六五）二服。更以玄参升麻汤而愈。（此凭
一人咽喉作痛。午后尤甚。以四物加酒炒知母、黄柏、桔梗治之而愈。（此凭症也。）
一人喉闭。服防风通圣散。肿不能咽。此症惟针乃可。牙关已闭。刺少商出血。口即开
。以胆矾吹患处。吐痰二碗许。仍投前药而愈。尝见此疾畏针不刺。多毙。（此凭症也。）
一人喉闭。肿痛寒热。脉洪数。此少阴心火。少阳相火。二脏为病。其症最恶。惟刺患
血为上。彼畏针。以凉膈散（二六）服之。药从鼻出。急乃愿针。则牙关已紧。遂刺少商二穴
。以手勒出黑血。口即开。仍刺喉间。治以前药。及密钥匙（四八）吹之顿退。又以人参败毒
散（六四）加芩、连、玄参、牛蒡子四剂而平。
经曰。火郁发之出血。亦发汗之一端。河间曰。治喉闭之火。与救火同。不容少怠。尝
闭不去血。喉风不去痰。以致不救者多矣每治喉咽肿痛。或生疮毒。以荆防败毒加芩连。重
者用防风通圣散。并效。
一人患此。劳则愈盛。以补中益气加玄参、酒炒黄柏、知母而愈。（此凭症也。）
一人口舌常破。如无皮状。或咽喉作痛。服清咽利膈散愈盛。治以理中汤而愈。（此因
治不应而更方也。）
精要曰。凡痈疽失于治疗。致令热毒冲心。咽咙口舌生疮。甚至生红黑菌。难于治疗。
宜琥珀犀角膏。
生犀角屑 真琥珀（研） 辰砂（研） 茯神（去皮木） 酸枣仁（去壳研） 人参 各一钱
（研一字）
上为细末。入乳钵研匀。炼蜜搜为膏。瓷器盛贮。疾作。每服一弹子大。浓煎麦
门冬汤化下。一日连进五服。或先服犀角散以解之。生犀角屑、玄参、（去芦）升麻、生黄
、赤芍药、麦门冬、生甘草、当归（各一两）、大黄（微炒二两）为粗末。每服三钱。水盏半煎
至七分。去滓温服。
Throat pain, or accompanied by aversion to cold and fever, indicates pathogenic factors in the exterior. It is appropriate to use dispersing methods.
Throat swelling and pain, with excessive phlegm-fluids, indicates pathogenic factors in the upper part. It is appropriate to use descending methods.
Pain with a rapid and forceless pulse belongs to Yin deficiency. It is appropriate to nourish Yin and descend fire.
Throat swelling and pain, with fever and constipation, indicates excess in both the interior and exterior. It is appropriate to release the exterior and purge the interior. If the condition is urgent, needle the affected area, or needle Shaoshang (LU-11).
A patient had throat pain and a rapid pulse. I prescribed Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction) plus Huanglian (Coptidis Rhizoma). After two doses, there was slight improvement. Then, Huangqin (Scutellariae Radix) and Huanglian were removed, and after another six doses, he recovered. (This diagnosis relied on pulse and symptoms.)
A patient had swollen and painful tonsils (Ru'e), with a floating and rapid pulse. The pus had not yet formed. Needling released the bad blood. He drank Jingfang Baidu San for two doses, and the swelling subsided. (This diagnosis relied on symptoms.)
A patient had throat pain with phlegm-fluids obstructing upwards. I intended to treat him with Jingfang Baidu San plus Lianqiao (Forsythiae Fructus), Shanzhi (Gardeniae Fructus), Xuanshen (Scrophulariae Radix), and Niubangzi (Arctii Fructus). However, he self-medicated with fire-descending drugs, which aggravated his fever and made the throat more swollen and painful. Urgently, Shaoshang (LU-11) bilaterally was needled. The previous prescription was used again with Mahuang (Ephedrae Herba) added to induce sweating. All symptoms receded, except for one purple blister in the throat which still hurt; this indicated impending suppuration. The previous prescription was used without Mahuang for one dose. The pus ruptured, and he recovered. (This diagnosis relied on symptoms.)
Generally, for throat pain diseases, if treated early or when the condition is mild, Jingfang Baidu San is appropriate for dispersal. If treated late or when the condition is severe, Shaoshang (LU-11) must be needled. If induration has occurred, the affected area must be needled. There are cases where Shaoshang is needled, the throat becomes patent but does not fully resolve, indicating that suppuration will occur. However, once the pus is discharged, peace returns. If there is constipation, even after needling to release blood, Fangfeng Tongsheng San (Saposhnikovia and Peony Decoction) must be used to purge. However, sweet-cold agents are not suitable for deficient fire.
A woman had swollen and painful throat, with obstruction of urination and defecation. She took one dose of Fangfeng Tongsheng San, and all symptoms receded. Then, she took three doses of Jingfang Baidu San, and stabilized. (This diagnosis relied on symptoms.)
For treating this, mild cases use Jingfang Baidu San or Chuihou San (Blowing Throat Powder); severe cases use Miyaoshi (Secret Key Powder), and needling the affected area to bleed is most effective. Otherwise, rescue is impossible. Needling Shaoshang (LU-11) bilaterally is also possible, but not as swift as needling the affected area.
A patient had swollen and painful throat, with a rapid and solid pulse. One dose of Liangge San (Cooling the Chest Powder) stopped the pain. Then, two doses of Jingfang Baidu San plus Niubangzi caused the swelling to subside. Two doses of Jingfang Baidu San, followed by four doses of Gancao (Licorice Root), Jiegeng (Platycodon Root), Jingjie (Schizonepeta Spike), Fangfeng (Saposhnikovia Root), Xuanshen, and Niubangzi brought equilibrium.
A patient had an abscess in the throat (Yi Yong), with swelling, pain, floating and rapid pulse, progressing to deep and solid. He drank one dose of Fangfeng Tongsheng San, resulting in one bowel movement, and the severity instantly retreated. Then, two doses of Jingfang Baidu San resolved it. (This diagnosis relied on symptoms and pulse.)
A patient had swollen and closed throat, with locked jaw, preventing needle insertion. First, Shaoshang (LU-11) bilaterally were needled to release black blood, and the mouth opened immediately. Then, the affected area was needled. He drank one dose of Qingyan Lige San (Clear Throat and Descend Diaphragm Powder) and recovered. (This diagnosis relied on symptoms.)
Generally, inducing expectoration and needling both have the intent of dispersal, hence they are often effective. Without needling, many cases become incurable.
A patient had swollen and closed throat with excessive phlegm-fluids. Danfan (Alumen) was blown into the throat, inducing expectoration of about one bowl of phlegm. Then, Qingyan Lige Tang was taken for four doses, and he stabilized. (This diagnosis relied on symptoms.)
A patient had swollen and painful throat, unable to swallow medicine. Needling the affected area released a little purple blood, leading to slight improvement. Po Guan Dan (Breaking Coffin Pill) was held in the mouth, and then Qingyan Xiaodu San cleared the infection, leading to recovery. (This diagnosis relied on symptoms.)
A patient had dry and painful throat. Siwu Tang (Four Substances Decoction) plus Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), and Xuanshen was taken for four doses, showing slight improvement. Then, Renshen Guben Wan (Ginseng Root-Knitting Pill) was taken for one dose, and it did not recur.
A patient had sores on the mouth and tongue. Taking cooling medicines worsened the condition. It was treated with Lizhong Tang (Regulate the Middle Decoction) and recovered. (This was a change due to mis-treatment.)
A patient had throat pain, worse in the afternoon, with a rapid and forceless pulse. Siwu Tang plus Huangbai, Zhimu, Jingjie, and Fangfeng was taken for four doses, and he recovered. The previous prescription was continued without Jingjie and Fangfeng, adding Xuanshen, Gancao, and Jiegeng for several doses, and it did not recur later.
A patient had erosion of the mouth and tongue. Taking cooling medicines worsened the condition, with a rapid and forceless pulse. Siwu Tang plus wine-fried Huangbai, Zhimu, and Xuanshen was taken for one dose, causing instant retreat, and four doses led to cure. (This diagnosis relied on pulse and symptoms.)
A patient had sores on the mouth and tongue, loss of taste for food, worsening with fatigue. Lizhong Tang cured him instantly. (This diagnosis relied on symptoms.)
A patient had sores on the mouth and tongue, with a floating and slow pulse. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Pao Ganjiang (Prepared Zingiberis Rhizoma) was used. Cinnamon powder was held in the mouth, leading to immediate recovery.
A patient suffered from this, worsening with fatigue. The previous prescription plus three slices of Fuzi (Aconiti Lateralis Radix Praeparata) was taken for two doses, leading to recovery.
Danyu said: For mouth ulcers not cured by cooling medicines, this is due to insufficient middle Qi, with deficient fire rising unchecked. Use Lizhong Tang; in severe cases, add Fuzi.
A weak person had throat pain, worsening with cooling medicines or fatigue. Buzhong Yiqi Tang plus Huangqin and Huanglian was taken for four doses, leading to recovery. Then, Huangqin and Huanglian were removed, and after several more doses, it did not recur. (This diagnosis relied on symptoms.)
For chronic afternoon pain, removing Huangqin and Huanglian and adding Huangbai, Zhimu, and Xuanshen is also effective.
An elderly person had throat pain, worse at dusk. Buzhong Yiqi Tang plus wine-fried Huangbai and Zhimu was taken for several doses, leading to recovery. (This diagnosis relied on symptoms.)
A patient had swollen and painful tonsils, unable to eat. The sore was white, indicating pus formation. Needling released the pus, and he stabilized immediately. (This diagnosis relied on symptoms.)
A patient had swollen and painful throat. I intended to needle to drain toxicity. He feared needling and only took medicine. However, by the time the medicine was ready, he could no longer swallow. Urgently, the affected area was needled to release toxic blood, and then Qingyan Xiaodu Yao cleared the infection, leading to recovery.
A patient's breath had ceased, but the heart remained warm. Urgently, the affected area was needled, releasing black blood, and he revived. Such as Bao Fuqing and Qiao Shilang, who had this condition habitually, recovered immediately upon needling and bleeding each time they suffered.
Generally, throat conditions are caused by fire, with rapid harm. One must distinguish urgency and whether pus has formed. If swollen, closed, and obstructed, death comes quickly. Use Miyaoshi to blow into the affected area to expel phlegm-fluids; if Qi flows freely, the patient revives. If obstruction persists after expectoration, it is bad blood or pus-toxicity, requiring urgent needling of the affected area; otherwise, it is incurable. Ancients said: Fire in throat closure is like fighting a fire, allowing no delay. Although there are many formulas for throat treatment, only needling has the power to revive the dead. Students must investigate this carefully.
A woman had pain in the throat. After two months, it ulcerated, protruding and not healing. Pain throughout bones and sinews occurred. Various medicines failed. First, Biba Tang was taken for several doses until healed. Then, Siwu Tang with doubled Biba (Dioscoreae Hypoglaucae Rhizoma) and Huangqi (Astragali Radix) was taken for over twenty doses, and all symptoms receded. (This diagnosis relied on symptoms.)
A one-month-old infant first developed the disease inside the mouth, then spread to the body, lasting over a year without cure. Biba powder was mixed with milk juice for oral administration. The mother took it mixed with plain water. Recovery occurred within a month. (This diagnosis relied on symptoms.)
A patient first developed the disease in the throat, spreading to the body. Taking mercury-containing preparations gave slight improvement. Recurrence followed, taking them again gave slight improvement. Later, a severe outbreak occurred, extending upwards to connect with the nose, with several lesions on arms and legs, resembling peaches, large and ulcerating, not healing for over a year. Mental fatigue and poor appetite appeared, with full deficiency symptoms. Main treatment was Biba Tang, combined with spleen-strengthening agents. Stability was achieved within a month. (This diagnosis relied on symptoms.)
A woman suffered from this, with facial and nasal erosion, bone and sinus pain, and swelling on the instep and knees. Ulceration occurred after three months, with dripping pus, not healing for half a year. Treatment with the previous medicine also led to recovery. (This diagnosis relied on symptoms.)
A patient had swollen and painful throat and sores on the mouth and tongue. First, two doses of Qingyan Xiaodu San were taken. Then, Xuanshen Shengma Tang (Scrophularia and Cimicifuga Decoction) led to recovery. (This diagnosis relied on symptoms.)
A patient had throat pain, especially severe in the afternoon. Treated with Siwu Tang plus wine-fried Zhimu, Huangbai, and Jiegeng, leading to recovery. (This diagnosis relied on symptoms.)
A patient had throat closure. Taking Fangfeng Tongsheng San resulted in swelling preventing swallowing. This condition requires needling. With locked jaw, Shaoshang was needled to release blood, opening the mouth. Danfan was blown into the affected area, expelling about two bowls of phlegm. The previous medicine was administered, leading to recovery. I have seen many die from fear of needling and refusal to undergo it. (This diagnosis relied on symptoms.)
A patient had throat closure with swelling, pain, aversion to cold, and fever, with a flooding and rapid pulse. This is a disease of the Shaoyin Heart Fire and Shaoyang Ministerial Fire, the worst type of symptom. Only needling the affected area to bleed is superior. He feared needling and took Liangge San. The medicine came out through the nose. Urgently, he agreed to needling, but the jaw was tight. Shaoshang (LU-11) bilaterally were needled, and black blood was squeezed out by hand, opening the mouth. The throat interior was still needled. Treated with the previous medicine and Miyaoshi blown in, symptoms instantly retreated. Then, Renshen Baidu San plus Huangqin, Huanglian, Xuanshen, and Niubangzi was taken for four doses, bringing equilibrium.
The Classic says: When fire is constrained, disperse it. Bleeding is also a form of sweating. Hejian said: Treating fire in throat closure is like fighting a fire, allowing no negligence. Many have died because closure was not bled, and wind-phlegm was not expelled. Whenever I treat throat swelling, pain, or sores/toxins, Jingfang Baidu San plus Huangqin and Huanglian is used; for severe cases, Fangfeng Tongsheng San is used, both being effective.
A patient suffered from this, worsening with fatigue. Buzhong Yiqi Tang plus Xuanshen, wine-fried Huangbai, and Zhimu led to recovery. (This diagnosis relied on symptoms.)
A patient had frequent rupture of mouth and tongue, appearing skinless, or throat pain. Taking Qingyan Lige San worsened the condition. Treated with Lizhong Tang, leading to recovery. (This was changing the formula due to ineffective treatment.)
Jingyao says: Generally, if carbuncles and sores are neglected, heat-toxin rushes to the heart, causing sores in the throat, mouth, and tongue, even forming red-black fungi, which are difficult to treat. Hupo Xijiao Gao (Amber and Rhinoceros Horn Ointment) is appropriate.
Raw Rhinoceros Horn shavings, True Amber (ground), Chen Sha (Cinnabar, ground), Fushen (Poria with Hostwood, skin and wood removed), Suanzaoren (Ziziphi Spinosae Semen, shell removed and ground), Renshen (Ginseng Radix et Rhizoma): each 1 qian (processed to 1 zi).
Grind into fine powder, mix evenly in a mortar, knead with refined honey into an ointment. Store in porcelain vessels. When the disease strikes, take a dose the size of a bullet, dissolve in strong decoction of Ophiopogonis Radix (Maidong). Take five doses continuously in one day. Alternatively, first take Xijiao San (Rhinoceros Horn Powder) to resolve it. Raw Rhinoceros Horn shavings, Xuanshen (rhizome removed), Shengma (Cimicifugae Rhizoma), Sheng Huangqi (Astragali Radix), Chi Shaoyao (Red Peony Root), Maidong (Ophiopogonis Radix), Sheng Gancao (Raw Licorice Root), Danggui (Angelicae Sinensis Radix): each 1 liang; Dahuang (Rhei Radix et Rhizoma, slightly fried): 2 liang. Grind into coarse powder. Take 3 qian per dose, decoct in 1.5 bowls of water until reduced to 0.7 bowls, remove dregs, and take warm.