（咽喉十八证 附）
【歌】喉痹皆因二火攻，风痰壅热在喉咙。因生血泡咽关闭，性命危于旦夕中。砭血搅痰为上策，寒凉直
治定收功。咽喉亦有阴经证，误服寒凉立见凶。
【论】《内经》云∶一阴一阳结，谓之喉痹。王太仆云∶一阴者，手少阴君火心主之脉气也，一阳者，
手少阳相火三焦之脉气也，二脉正络于喉。然气热则内结，甚则肿胀，肿甚则痹，痹甚则不通而死。《原病式》
云∶痹者，不仁也，俗作闭，由闭塞也。火主肿胀，故热客上焦而咽嗌肿胀也。咽喉之疾，死生反掌，肿胀甚
者，急宜砭出血为尚，然后用寒凉药随证调之。子和云∶喉痹不归之火，相去远矣。以上之说，属火热明矣。
亦有伏气病，名肾伤寒，谓非时暴寒，伏毒于少阴，始衰不病，旬日乃发，脉微弱，法当咽痛，次必下痢。
当以辛热药攻其本病，顺其阴阳，则水升火降，而咽痛自已。又有少阴伤寒，不传太阳，寒邪抑郁，内格阳气
为热，上行于咽门经会之处，寒热相搏，而成咽痹。当以辛温甘苦治其标病，以通咽嗌。二者若误用寒凉，卒
致不救，呜呼，冤哉！学人可不深究之？其咽喉十八证，人多未明，开于后，括成歌，以便后学之记诵也。
【歌】十八咽喉君要通，双单乳蛾生喉中。牙蜞风毒牙龈肿，蝉舌之风舌必重。鱼口风如鱼吸水，舌黄舌
肿色黄浓。牙根作舋切牙噤，木舌肿如猪舌同。聚毒塞喉风热壅，缠喉风证绕喉攻。连珠五七相连起，更有悬
蜞蛊毒风。抢食口中多发泡，崩砂甘口齿断崩。毒名蜂子腮洋烂，松子风令满口红。走注瘰 风连颈，腮肿连
牙猎颊风。
【论】古有咽喉十八证，后学多不能记，故括成歌。夫单蛾风者，其形圆如小筋头，生于咽喉关上，或左
或右，可治；生于关下不见者，难治。双蛾风，两个生于喉间关下是也，难治。蝉舌风者，一名子舌，舌下再
生一舌是也。牙蜞风者，牙龈上肿甚，聚毒成疮是也。木舌风者，其舌肿大如煮猪舌，不能转动是也。舌黄风
者，自舌上肿痛，黄色是也。鱼口风者，如鱼吸水是也，不治。聚毒塞喉风，喉痹聚毒，涎垂稠实而发寒热是
也，关上可治，关下难治。悬蜞蛊毒风者，上眶肿，水食不下，形肿如鸡卵是也。抢食风者，亦名飞丝毒，生
口中，或食鲤 恶物，发泡是也。猎颊风者，腮颊结肿，牙尽处肿破是也。缠喉风者，风自颐缠绕，赤色，寒
热者是也。松子风者，口内满喉赤如猪肝，张口吐物则气逆关闭，饮食不能是也。崩砂甘口风，自舌下牙龈上
肿赤，口内作 如汤热，牙龈渐烂者，亦能脱齿是也。连珠风者，自舌下起，初起一个，又起一个，而甚者，
三、五、七、九个，连珠生起是也。蜂子毒者，或在脸腮洋烂，或在喉关舌下作 ，其色黄如蜂是也。走注瘰
风者，颈项结核五、七个，皮肤赤肿作寒热是也。
【脉】咽喉之脉，两寸洪溢，上盛下虚，脉忌微伏。
咽喉热证
咽喉热肿，吞水妨碍，语塞，桔梗汤。喉痹及时疫毒，牛蒡子散。风热肿痛，射干汤。缠喉风卒然失音，
不省人事，痰壅口噤，解毒雄黄丸。腮肿、单、双乳蛾、木舌、重舌，如圣金锭。咽喉肿闭，舌根肿痛，麝香
朱砂丸。喉闭不通，二圣散吹之，或吹喉散、密钥匙。喉痹痛，水谷不下者，通关散，或用射干逆流水吐之，
或服千两金丸。喉痹、乳蛾诸证在关上者，必有血泡，用喉针点破即宽。在关下不见者难治，用芦管削尖快，
令病患含水一口，从鼻孔中放芦管进击一下，出血妙。
桔梗汤
治热肿喉痹，饮水妨碍，言语不出。
桔梗（一钱，去芦） 甘草（一钱，生用） 连翘仁（一钱） 山栀子仁（炒黑，一钱） 薄荷叶（一钱） 生黄
芩（一钱）
水二钟，竹叶十片，煎服。
牛蒡子散
治风热上壅，咽喉肿痛，时疫毒瓦斯所致。
玄参（一钱） 升麻（一钱） 桔梗（去芦，一钱） 牛蒡子（研，一钱） 犀角（镑碎，一钱） 黄芩（生
用，一钱） 木通（一钱） 生甘草（一钱）
上锉，一剂，水二盏，生姜三片，煎八分，徐徐细咽下。
射干汤
治咽喉因风热壅盛疼痛难进水饮。
射干（五钱） 升麻（五钱） 牙硝（三钱五分） 马勃（三钱五分）
煎服。
解毒雄黄丸
治缠喉风急证，双蛾肿痛，汤药不下。
雄黄（一两） 巴豆（十四粒。去壳，去油） 郁金（一钱）
末之，醋糊丸绿豆大，热茶汤送下七丸，吐出顽涎即苏，大效。如牙关紧闭，以物斡开灌之，起死回生。
如圣金锭
咽喉急闭，腮颔肿痛，双、单乳蛾，重舌、木舌。
硫黄（研，三钱） 川芎（三钱） 腊茶（三钱） 薄荷叶（三钱） 川乌（泡，三钱） 硝石（五钱） 生地
黄（五钱）
末之，用生葱汁拌匀为锭如指大，每用一锭，先以凉水灌漱，次嚼薄荷叶五、七片，却用药同嚼极烂，以
井花水下。甚者连进三锭，并口内噙化之。
麝香朱砂丸
治咽喉肿闭，舌根肿痛，勺饮难进。
马蹄硝（七钱） 铅白霜（三钱） 龙脑（三钱） 寒水石（烧，一斤） 硼砂（三两） 麝香（二钱） 朱
砂（一两五钱） 甘草（十两，另自熬膏）
研细，甘草膏丸梧子大，朱砂为衣，每噙化一、二丸。
二圣散
治缠喉风、急喉痹，牙关紧急，痰涎壅盛。
胆矾（二钱五分） 白僵蚕（炒去丝，五钱）
末之，少许吹入喉中。
吹喉散
治三焦火热，口舌生疮，咽喉肿痛，汤水不入。
蒲黄（一两） 青黛（一两） 盆硝（二两） 薄荷汁（一钟，和匀前药。）
用瓷罐盛，慢火熬干，研细，每半钱，吹喉内，涎出妙。
密钥匙
治一切风热咽喉闭塞，口噤不开，牙关紧急。
朴硝（一两） 大黄（一钱） 雄黄（五钱）
末之，吹入喉内。
通关散（方见中风条下。）
千两金丸
大治喉风，不问阴阳、内外危急恶证。
蚵 草（半两） 铜青（半两） 大黄（半两） 牙硝（半两）
末之，以白梅肉捣烂和匀，作二十丸，丝绵裹噙化。
咽喉阴证
疫疠病，夏寒变及非时暴寒少阴证，脉微细而沉，自汗咽痛不利，名肾伤寒，半夏桂甘汤或苦酒汤。脏寒
咽闭吞吐不利，蜜附子。
半夏桂甘汤
治疫疠夏为寒变，及感非时暴寒之证。
半夏（二钱） 桂枝（二钱） 甘草（二钱） 姜（三片）
水煎服。
黄 芍药桂枝苦酒汤
治肾伤寒脉沉咽痛自汗。
黄 （五钱） 芍药（三钱） 桂枝（三钱）
水煎，苦酒和服。
三因蜜附子
治脏寒喉闭吞吐不利。
大附子（一个，去皮脐，切作大片，蜜炙令黄）
每含一片，味尽再易。
咽喉痰证
一切缠喉风证，牙关紧急，痰涎壅盛者，必用吐法搅去痰即宽。用珠子草，（俗名五爪龙草）取根捣入
陈米醋调灌下，用牙皂、桐油、鹅翎探吐，或千两金丸、二圣散、白矾散、一字散选而用之。吐痰后服甘桔汤
甚妙。
千两金丸
二圣散（俱见前咽喉热证条内。）
白矾散
吹急喉痹、缠喉风人事不省，牙关紧闭。
白矾（三钱） 巴豆（二粒，去壳，研）
将矾于铫内慢火熬化为水，置巴豆于内，候干去巴豆，取矾研末，每用少许，吹入喉中，顽痰出立愈。
一字散
治时气缠喉风，牙关紧急，水谷不下，人事不省。
白矾（飞过，一钱） 藜芦（一钱五分） 雄黄（一钱五分） 全蝎梢（一钱五分） 猪牙皂荚（去皮、弦，一钱
半）
末之，每用一豆大，鼻内搐之。
甘桔汤（方见咳嗽条下。）
[Eighteen Throat Syndromes - Appendix]
[Verse]
Pharyngitis (Hou Bi) is caused by the attack of wind and fire, with wind pathogen, phlegm turbidity, stagnation, and heat accumulating in the throat. Consequently, blood blisters form causing throat closure, endangering life within a day or night. Using Bian stones for bloodletting and stirring to expel phlegm is the superior strategy; using cold-cooling herbs directly will surely achieve success. However, there are also Yin meridian syndromes in the throat; misusing cold-cooling medicines will immediately lead to ominous consequences.
[Dissertation]
The *Neijing* states: The binding of one Yin and one Yang is called Pharyngitis (Hou Bi). Wang Bing (styled Taipu) stated: "One Yin" refers to the meridian qi of the Hand-Shaoyin Pericardium; "One Yang" refers to the meridian qi of the Hand-Shaoyang Sanjiao. These two meridians' direct collaterals connect to the throat. However, when Qi is heated, it binds internally; severely, it causes swelling. When swelling is severe, it becomes obstructed (Bi); when obstruction is severe, it leads to death due to blockage. The *Yuanbing Shi* states: Bi means numbness and insensibility, commonly written as "Bi" (closure), due to blockage. Fire nature governs swelling, so when heat pathogen lodges in the Upper Jiao, it causes throat swelling. Diseases of the throat change between life and death rapidly; for severe swelling, urgent Bian stone bloodletting should be employed, followed by adjusting with cold-cooling medicines according to the syndrome. Zhang Hezi said: Pharyngitis does not belong to the fire of returning meridians, which is far removed. The above explanations all belong to Heat-Fire syndromes, which is clear. However, there are also Fuqi diseases named Kidney Cold Damage (Shen Shanghan), referring to sudden cold from non-seasonal times, where toxic pathogens lie dormant in the Shaoyin meridian. Initially, when declining, no disease occurs; after ten days or half a month, it manifests with a faint pulse. According to method, it should present with sore throat, followed inevitably by dysentery. At this time, acrid-hot medicines should be used to attack the root disease, following Yin-Yang laws, so that Water ascends and Fire descends, and the sore throat heals itself. There is also Shaoyin Cold Damage that does not transmit to the Taiyang meridian; cold pathogen depresses, internally blocking Yang Qi transforming into heat, ascending to the throat gate and meridian intersection points. Cold and heat contend, forming throat obstruction. Here, acrid-warm and sweet-bitter medicines should be used to treat the branch disease to unblock the throat. If these two situations mistakenly use cold-cooling medicines, it ultimately leads to untreatable conditions. Alas, how unjust! Can students of medicine not investigate deeply? People generally do not understand the eighteen throat syndromes; they are listed below and compiled into verses for easier memorization by later learners.
[Verse]
You must understand the eighteen throat syndromes; unilateral or bilateral tonsillar hypertrophy (Ru E) grows in the throat. Ya Qi Wind toxin causes gum swelling; Chan She Wind causes tongue heaviness. Yu Kou Wind resembles a fish sucking water; yellow tongue and swollen tongue appear thick yellow. Root teeth itch, grinding teeth, and lockjaw occur; Mu Tong (Wood Tongue) swells like a pig's tongue. Accumulated toxins block the throat with wind-heat stagnation; Chan Hou Feng (Coiling Throat Wind) attacks around the throat. Lian Zhu (String of Pearls) Wind rises five to seven connected; there is also Xuan Qi Gu Du Wind. Qiang Shi Wind frequently produces blisters in the mouth; Beng Sha Gan Kou Wind causes teeth loosening and falling out. Du Ming Feng Zi Sai causes facial ulceration; Song Zi Wind makes the whole mouth red and swollen. Zou Zhu Lu Li Wind connects to the neck; Sai Zhong Lian Ya is Lie Jia Wind.
[Dissertation]
Anciently, there were eighteen throat syndromes, which later learners often could not remember, hence they were compiled into verses. Single Ru E Wind has a shape round like a small tendon head, growing at the upper gate of the throat, either left or right; it is treatable. Growing at the lower gate where it is not visible is difficult to treat. Double Ru E Wind consists of two growing at the lower gate of the throat; it is difficult to treat. Chan She Wind, also known as Zi Tongue, involves a second tongue growing under the main tongue. Ya Qi Wind involves severe swelling on the gums, with accumulated toxins forming ulcers. Mu Tong Wind involves the tongue swelling large like a boiled pig's tongue, unable to move. She Huang Wind involves pain and swelling on the tongue appearing yellow. Yu Kou Wind resembles a fish sucking water; it is untreatable. Ju Du Sai Hou Feng involves throat obstruction with accumulated toxins, dripping thick saliva accompanied by chills and fever; treatable at the upper gate, difficult at the lower gate. Xuan Qi Gu Du Wind involves swelling above the eye socket, inability to take food or water, and body swelling like a chicken egg. Qiang Shi Wind, also named Fei Si Du, grows in the mouth, producing blisters after eating carp or other bad substances. Lie Jia Wind involves swelling and nodules in the cheeks and jaw, breaking out at the end of the teeth. Chan Hou Feng involves wind coiling from the cheek, appearing red, with chills and fever. Song Zi Wind involves the inside of the mouth and throat being red like pig liver; opening the mouth to spit causes reverse Qi flow and closure, preventing eating. Beng Sha Gan Kou Wind involves swelling and redness on the gums under the tongue, feeling hot like boiling water in the mouth, with gums gradually rotting, also leading to tooth loss. Lian Zhu Wind starts under the tongue, initially one, then another; severely, three, five, seven, or nine grow up like a string of pearls. Feng Zi Du appears as ulceration on the face or cheeks, or pus formation at the throat gate or under the tongue, yellow like bees. Zou Zhu Lu Li Wind presents as five to seven tubercles in the neck, with red and swollen skin accompanied by chills and fever.
[Pulse Diagnosis]
Pulses for throat diseases show both Cun positions as surging and overflowing, indicating excess above and deficiency below. Pulses should avoid being faint and sunken.
Throat Heat Syndromes
Throat heat swelling, difficulty swallowing water, speech impediment: Jiegeng Tang. Pharyngitis and epidemic toxicity: Niubangzi San. Wind-heat swelling and pain: Shexiang Tang. Chan Hou Feng sudden loss of voice, unconsciousness, phlegm obstruction, lockjaw: Jiedu Xionghuang Wan. Cheek swelling, single/double Ru E, Mu Tong, Chong She: Rusheng Jinding. Throat swelling and closure, root of tongue pain: Shexiang Zhusha Wan. Throat closure with blockage: Ersheng San blown in, or Chuihou San, Mi Yanshi. Pharyngitis pain, inability to ingest food/water: Tongguan San, or induce vomiting with Shexiang and inverted water, or take Qianliangjin Wan. For Pharyngitis and Ru E syndromes at the upper gate, blood blisters must be present; puncture with a throat needle to relieve. Difficult to treat if at the lower gate and invisible; use a sharpened reed tube, have the patient hold water in the mouth, insert the tube through the nose and strike once to bleed; this is excellent.
Jiegeng Tang
Treats heat-swollen Pharyngitis, difficulty drinking, inability to speak.
Jie Geng (1 qian, remove rhizome node) Gan Cao (1 qian, raw) Lian Qiao Ren (1 qian) Shan Zhi Zi Ren (stir-fried black, 1 qian) Bo He Ye (1 qian) Sheng Huang Qin (1 qian)
With 2 zhong of water and 10 leaves of Zhu Ye, decoct and take.
Niubangzi San
Treats wind-heat congestion upward, throat swelling and pain, caused by epidemic toxic vapors.
Xuan Shen (1 qian) Sheng Ma (1 qian) Jie Geng (remove rhizome node, 1 qian) Niu Bang Zi (crushed, 1 qian) Xi Jiao (shaved thin, 1 qian) Huang Qin (raw, 1 qian) Mu Tong (1 qian) Sheng Gan Cao (1 qian)
Chop finely, one dose, with 2 zhan of water and 3 slices of Sheng Jiang, decoct to 8 fen, swallow slowly and finely.
Shexiang Tang
Treats throat pain and inability to drink water due to excessive wind-heat stagnation.
She Gan (5 qian) Sheng Ma (5 qian) Ya Xiao (3 qian 5 fen) Ma Bo (3 qian 5 fen)
Decoct and take.
Jiedu Xionghuang Wan
Treats acute Chan Hou Feng, double Ru E swelling and pain, inability to take soup/medicine.
Xiong Huang (1 liang) Ba Dou (14 grains, shell removed, oil removed) Yu Jin (1 qian)
Grind to powder, make pills with vinegar paste the size of mung beans. Take 7 pills sent down with hot tea broth. Vomiting stubborn phlegm leads to recovery; highly effective. If lockjaw occurs, pry open with an object and administer; brings back the dead to life.
Rusheng Jinding
Treats acute throat closure, cheek/jaw swelling, double/single Ru E, Chong She, Mu Tong.
Liu Huang (ground, 3 qian) Chuan Xiong (3 qian) La Cha (3 qian) Bo He Ye (3 qian) Chuan Wu (processed, 3 qian) Xiao Shi (5 qian) Sheng Di Huang (5 qian)
Grind to powder, mix with juice of raw Cong Bai to form ingots finger-sized. Use one ingot each time, first rinse mouth with cool water, then chew 5-7 leaves of Bo He, chew the medicine thoroughly with it, and swallow with well water. Severe cases take three ingots consecutively, holding them in the mouth to dissolve.
Shexiang Zhusha Wan
Treats throat swelling/closure, root of tongue pain/swelling, difficulty taking even spoonfuls of liquid.
Ma Ti Xiao (7 qian) Qian Bai Shuang (3 qian) Long Nao (3 qian) Han Shui Shi (calcined, 1 jin) Peng Sha (3 liang) She Xiang (2 qian) Zhu Sha (1 liang 5 qian) Gan Cao (10 liang, separately decocted into paste)
Grind finely, make pills with Gan Cao paste the size of wu tong seeds, coat with Zhu Sha. Hold 1-2 pills in the mouth to dissolve each time.
Ersheng San
Treats Chan Hou Feng, acute Pharyngitis, lockjaw, excessive phlegm/saliva.
Dan Fan (2 qian 5 fen) Bai Jiang Can (stir-fried, silk removed, 5 qian)
Grind to powder, blow a small amount into the throat.
Chuihou San
Treats Sanjiao Fire-Heat, oral/tongue ulcers, throat swelling/pain, inability to take liquids.
Pu Huang (1 liang) Qing Dai (1 liang) Pen Xiao (2 liang) Bo He Zhi (1 zhong, mixed evenly with previous herbs)
Store in a porcelain jar, dry over slow fire, grind fine. Blow half a qian into the throat; expulsion of phlegm is good.
Mi Yanshi
Treats all wind-heat throat closures, lockjaw, tight jaw.
Pu Xiao (1 liang) Da Huang (1 qian) Xiong Huang (5 qian)
Grind to powder, blow into the throat.
Tongguan San (Formula seen under Stroke section.)
Qianliangjin Wan
Greatly treats Hou Feng, regardless of Yin/Yang, internal/external critical malignant syndromes.
E Cao (half liang) Tong Qing (half liang) Da Huang (half liang) Ya Xiao (half liang)
Grind to powder, mash white plum flesh and mix evenly, make 20 pills, wrap in silk floss, hold in mouth to dissolve.
Throat Yin Syndromes
Epidemic pestilence disease, summer cold transformation, and non-seasonal sudden cold affecting Shaoyin syndrome: pulse faint, fine, and sunken, spontaneous sweating, sore throat, difficulty swallowing, named Kidney Cold Damage (Shen Shanghan): Banxia Gui Gan Tang or Kujiu Tang. Visceral cold causing throat closure, difficulty swallowing/spitting: Mi Fu Zi.
Banxia Gui Gan Tang
Treats epidemic pestilence summer cold transformation, and contracting non-seasonal sudden cold.
Ban Xia (2 qian) Gui Zhi (2 qian) Gan Cao (2 qian) Jiang (3 slices)
Decoct in water and take.
Huang Shao Yao Gui Zhi Kujiu Tang
Treats Kidney Cold Damage with sunken pulse, sore throat, spontaneous sweating.
Huang Qi (5 qian) Shao Yao (3 qian) Gui Zhi (3 qian)
Decoct in water, take mixed with Ku Jiu (bitter wine/vinegar).
Sanyin Mi Fu Zi
Treats visceral cold throat closure, difficulty swallowing/spitting.
Da Fu Zi (one piece, peel navel, slice thick, honey-roast until yellow)
Hold one slice each time; replace when taste is gone.
Throat Phlegm Syndromes
All Chan Hou Feng syndromes with lockjaw and excessive phlegm/saliva must use emesis methods to stir out phlegm for relief. Use Zhu Zi Cao (commonly named Wu Zhao Long Cao), take roots, crush, mix with aged rice vinegar, and administer. Induce vomiting with Ya Zao, Tong You, and goose feather, or select Qianliangjin Wan, Ersheng San, Bai Fan San, or Yi Zi San. After vomiting phlegm, taking Ganjie Tang is very effective.
Qianliangjin Wan
Ersheng San (Both seen in previous Throat Heat Syndromes section.)
Bai Fan San
Blow for acute Pharyngitis, Chan Hou Feng unconsciousness, lockjaw.
Bai Fan (3 qian) Ba Dou (2 grains, shell removed, crushed)
Slowly melt Bai Fan in a pot over low fire until liquid, place Ba Dou inside, wait until dry, remove Ba Dou, grind Bai Fan to powder. Blow a small amount into the throat; stubborn phlegm exits and cures immediately.
Yizi San
Treats seasonal Qi Chan Hou Feng, lockjaw, inability to eat/drink, unconsciousness.
Bai Fan (filtered, 1 qian) Li Lu (1 qian 5 fen) Xiong Huang (1 qian 5 fen) Quan Xie Shao (1 qian 5 fen) Zhu Ya Zao Jia (skin and strings removed, 1 qian 5 fen)
Grind to powder. Each time use size of a bean, insufflate into the nose.
Ganjie Tang (Formula seen under Cough section.)