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Xia Ziyi recorded in *Qiji Fang* (Strange Disease Prescriptions): A person had a piece of flesh growing in the throat, layered and stacked, gradually swelling without pain. After a long time, orifices appeared emitting foul odor, rendering them unable to eat or drink. Using leaves of *Citrus aurantium* L. (Chouju Ye) decocted in water, taken continuously, resulted in recovery.

[Commentary by Shen Yuan] Patients with swelling but no pain, or pain without ulceration, are all caused by Phlegm-Dampness (Tan Shi). This condition involves flesh growing in the throat, layered and stacked, gradually swelling without pain, which is also caused by Phlegm-Dampness. Over time, only orifices emit foul odor, which is the excretion of Phlegm-Toxin outward. If it were not Phlegm-Dampness, there would inevitably be pain and ulceration. Leaves of *Citrus aurantium* L. disperse Qi and resolve Phlegm; when Qi disperses, Phlegm transforms, hence recovery upon ingestion.

Hua Tuo said: A person felt as if there were an object in the throat; moving while expectorating sputum caused unbearable pain. The skin on the body cracked with fluid oozing out; eyes were red and swollen but painless; feet swelled like a measuring cup yet could walk. This is truly a rare and unseen disease. It arises from eating raw vegetables containing centipede eggs unknowingly, leading to the growth of centipedes above the stomach entrance. Entering the stomach causes stomach pain; ascending to the throat causes throat pain; hunger exacerbates the pain. The prescription uses one chicken, boiled and seasoned with five spices, emitting a strong fragrance. While the patient sleeps soundly, place the chicken near their mouth; the centipedes will naturally crawl out. When they emerge, capture them immediately—there may be one or several. Once all have exited, the patient will recover spontaneously. Generally, if nothing moves in the throat, there are no centipedes. At this point, administer Quanfu Tang (Whole Skin Decoction) for ten doses; skin cracks will heal naturally, and foot swelling resembling a cup will subside. Since the centipedes are in the Upper Jiao (Upper Burner), mere drug ingestion cannot save them, as the medicine descends to the stomach while the centipedes remain above the stomach entrance, thus unable to kill them. Therefore, guide them out first, then treat with herbs to restore Qi and Blood. Skin cracking occurs because centipede toxic fumes reside beside the Lung, which governs skin and hair, hence skin cracking. Feet swelling like cups relates to the Kidney, as the foot is the domain of the Kidney. The Lung resides above and is the Mother of the Kidney; when the Mother is ill, the Child suffers. However, Kidney Water is not deficient, but toxin remains in the Kidney region, causing large, floating edema of the foot skin, not a bone disease. Hence, walking is still possible. Eyes belong to the Liver; the Liver is steamed by toxic Qi from the Lung, causing redness and swelling.

Zhu Danxi said: For cases of sore throat unresponsive to various medicines, this is not merely a sore throat. Instead, a red line like a hair grows in the nose, suspending a black blister the size of a cherry pit, hanging down to the pharyngeal gate. Food and drink cannot enter the mouth. Use deep-dug roots of *Achyranthes bidentata* (Tuniuxi), selecting single, thick ones, crush them, add three to five drops of good vinegar, grind finely, and drip two or three drops into the nose. The blister breaks, blood stasis is vomited out, and relief follows immediately.

*Bencao Gangmu* records: A person suffered such that after swallowing food, it seemed to go down a separate throat, slanting under the diaphragm, passing through the hypochondrium, causing distension and stuffiness. Pressing with hand produced gurgling sounds. Administering Kongyan Dan (Controlling Phlegm-Fluid Pill) ten pills; after a short while, heat arose in the stifled area, followed by a loud sound and evacuation of several sheng of phlegm-fluid. The food then reached the stomach normally.

The Dou family case: A twenty-three-year-old woman, nine months pregnant. One day, a fishbone lodged in the throat. Half a day later, she vomited, followed by vomiting about a bowl of blood, yet the fishbone remained in the throat. Suddenly, she vomited a tube-like object over three chi long, shaped like small intestine, moist and half a cun thick. Inside were undigested fish, vegetables, vermicelli, and rice. Family members pushed it back into her mouth, leaving five cun remaining, which her husband re-inserted. She became comatose and weak, vomiting incessantly, unable to even take liquids. I was called to treat her. I placed a basin of burning charcoal before the bed and poured a bowl of good vinegar onto it, filling the room with vinegar vapor to clear the spirit. Administered Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill); abdomen felt slight pain. Then administered Ren Shen (Ginseng Root) one fen, Hong Hua (Safflower), Mu Dan Pi (Moutan Cortex), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Sheng Di Huang (Rehmanniae Radix), and E Jiao (Colla Corii Asini) decocted together. After five or six doses, the illness resolved.

Sun Dongsu treated Zang Shaogeng, aged fifty. Every time he ate or drank, his chest and diaphragm felt unsmooth, sensing obstruction in the throat tube, difficult to swallow. Stool was dry and constipated, internal heat present, muscles gradually wasting away. Physicians prescribed Wuxiang Lianqiao Tang (Five-Spice Forsythia Decoction) and Wuge Dingxiang San (Five-Fold Cardamom Powder), various formulas for dysphagia/obstruction, but none were effective. Sun arrived, observed his dark complexion, bright eyes without depletion, but rapid breathing and emaciation. Sun knew he was a man of complex schemes and indecision. His pulse was wiry and large on the left, slippery and large on the right. Sun said to him: "Based on the pulse, you are overly scheming yet indecisive, Qi stagnation transforms into Fire, Spleen emotion is not smooth, leading to formation of Phlegm-Saliva. Consequently, Blood deficiency, dry stool, internal heat, and muscle wasting. Zhang Jifeng stated that dysphagia is a disorder of the Spirit/Mind. Inferring from this, you must reduce thinking, restrain sexual desires, eat bland food, and abandon delusions, keeping the Spirit pure. Only then will medication be effective. Otherwise, even if great elixirs existed, how could herbs and minerals suffice? Since you traveled far, how dare I not speak my mind frankly! I have devised a suitable formula; take it immediately. The formula uses Liushi (Calcitrum) six liang, Zhi Gancao (Honey-fried Licorice Root) and Baijiezi (White Mustard Seed) one liang each, Luobozi (Radish Seed), Yexia (Belamcanda Rhizome), and Lianqiao (Forsythia Fruit) one and a half liang each, Zhensha (Cinnabar) five qian. Decoct Zhuru (Bamboo Shavings) four liang in water, make dough with mantou flour, form pills the size of mung beans. Take one qian five fen with Dengxin Cao Tang (Juncus Effusus Decoction) after meals and at night, three times daily. Upon completing the course, the illness vanished."

Quanfu Tang (Whole Skin Decoction)
Gancao (Licorice Root), Yiren (Coix Seed), Danggui (Angelicae Sinensis Radix) (each one liang); Baishao (White Peony Root) (five qian); Huangqi (Astragali Radix), Fangfeng (Saposhnikoviae Radix) (each five fen); Jingjie (Schizonepetae Spica), Chenpi (Citri Reticulatae Pericarpium) (each one qian).
Decoct in water and take orally.

Kongyan Dan (Controlling Phlegm-Fluid Pill)
Gansui (Kansui Radix) (remove heart), Daji (Euphorbiae Pekinensis Radix) (remove skin), Baijiezi (White Mustard Seed).
Grind into powder in equal parts, make pills with paste, take with Ginger Decoction before sleep.

Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) (See Eye Section)