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After decocting and taking *Tianhuafen* (Trichosanthis Radix) and *Niubangzi* (Arctii Fructus), the patient immediately experienced surging phlegm and snoring-like breathing sounds. Upon inquiry, it was learned that the condition suddenly worsened due to the intake of cold-natured medicines; this is undoubtedly a Yin-cold syndrome. However, with phlegm obstructing the mouth, it was difficult to administer oral medication. Therefore, an goose feather tube dipped in a small amount of Tung oil (*Tungtongyou*) was inserted into the throat and rolled around, expelling approximately one sheng of phlegm. Subsequently, *Rougui* (Cinnamomi Cortex), *Paojiang* (Prepared Zingiberis Rhizoma), and *Sheng Gancao* (Raw Glycyrrhizae Radix et Rhizoma), each 5 fen, were placed in a bowl, steeped in boiling water, and kept warm by placing the bowl in hot water. A spoonful was scooped up for the patient to swallow, whereupon the patient immediately declared recovery. After swallowing three or four spoonfuls, the patient rose and expressed hunger. When asked if food could be eaten, the reply was: "Eating congee is most suitable." (Ibid.)

Jiang Zhongfang treated a friend who initially suffered from toothache, followed by swelling of the throat. The physician administered cold-natured medicines, which exacerbated the pain. Pulse diagnosis revealed a deep and fine pulse, with bowel movements occurring two to three times daily. It was diagnosed as floating fire ascending, with cold feet confirmed upon observation. The formula from *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet), Shengqi Wan (Kidney Qi Pill), was decocted and administered. After finishing the dose, the patient slept and woke up with the illness gone.

Liu Yunmi treated a fifty-year-old woman who had long suffered from heat generated by blood deficiency and wind transformed from blood deficiency, presenting as generalized nodules that had not healed for years. Over time, Shaoyang Ministerial Fire merged with Yangming, leading to Hou Bi (throat obstruction). The condition erupted violently; sudden itching in the throat triggered coughing, with rebellious Qi causing choking. Numerous blood blisters formed, one on top being as large as a chicken egg, blocking the mouth so it could not close, with Qi stagnating upward becoming more urgent. Shortly after, all blisters ruptured, shooting blood like a stream. The lip skin sloughed off completely, and the throat became ulcerated with extreme redness and swelling, unbearable pain, and a mouth full of phlegm and saliva resembling gruel. This resulted from heat stagnating above and severe damage to cold Qi. Treatment employed formulas to nourish Yin, retreat Yang, invigorate blood, dispel wind, and relieve pain. Since decoctions were hard to swallow, the medicine was ground into powder and either insufflated or applied locally. Symptoms gradually subsided. However, since the ulcerated tissue had not regenerated and pain persisted, causing frequent coughing and bleeding due to broken skin, Baiji paste (from *Baiji*, Bletillae Rhizoma) was added to the insufflation powder, formed into pills the size of Euryale seeds, and held in the mouth day and night until cured.

Ye Tianshi treated a patient named Yang. Leakage of Yin Qi constitutes deficiency; reception of turbid pathogens constitutes excess. Swollen and obstructed throat, upper orifices blocked, evening confusion and irritability, Yin injury with blazing fire, soft and white skin, insufficient Qi in the Qi level. Although treatment should involve cooling and clearing the upper jiao, the Middle and Lower Jiao must not be violated. Herbs: Qiaoliang (Forsythiae Fructus), Yujin (Curcumae Radix), Mabo (Belamcandae Flos), Niubangzi (Arctii Fructus), Zhuyexin (Centenii Caulis), Hei Shanzhi (Charred Gardeniae Fructus), Xingren (Armeniacae Semen Amarum), Juhong (Citri Reticulatae Pericarpium Rubrum).

Patient Ai's upper jiao diseases all belonged to the Qi level. Qi stagnation caused blockage between upper and lower parts, leading to distension in the Middle Palace (Spleen/Stomach). Steaming heat scorched the throat and tongue, causing gan erosion (ulceration). In clearing Qi, detoxifying agents must be assisted. Herbs: Yinhua (Lonicerae Japonicae Flos) 2 qian, Chuanbei (Fritillariae Cirrhosae Bulbus) 3 qian, Madoulings (Aristolochiae Radix) 5 fen, Liaoqiaoxin (Forsythiae Caulis) 1.5 qian, Chuantongcao (Tetrapanacis Medulla) 1 qian, Baijinzhi (Platinum Juice) 1 cup, Huoshui Lugenzhi (Fresh Phragmitis Rhizoma Juice) half cup.

Patient Wang suffered from painful throat obstruction. At onset, it felt like something was blocking the passage, even radiating pain to the Xin Xia (epigastrium), worsening every night. This indicated daily depletion of Yin fluids, with Liver Jue-Yang transforming into fire and wind scorching upwards. The method should use soft agents, employing sweet flavors to relieve urgency. Herbs: Xi Shengdi (Rehmanniae Radix Preparata), Tiandong (Asparagi Radix), Ejiao (Colla Corii Asini), Sheng Jizihuang (Raw Chicken Egg Yolk), Yuanxuanxin (Scrophulariae Radix Stamen), Nuodaogenxu (Oryzae Sativa Radix Fibra).

Xu Lingtai stated: In this condition, there must be small lumps (luoli) forming in the throat; it is not merely Qi-level obstruction. External insufflation is ineffective without specific powders. He also said: Diseases belonging to meridians and zang-fu organs can be treated by decoctions and pills. Once the disease belongs to the body form and nine orifices, it becomes a tangible disease. Where pathogenic factors actually condense, drugs entering the stomach only reach the Qi level; how can they remove condensed pathogens? Thus, the efficacy of decoctions and pills accounts for only half. To achieve rapid results, external treatment methods must be used, which can cure promptly. Extensively consulting medical texts and seeking secret methods will naturally yield these approaches. External treatments were rarely heard of in ancient times because acupuncture and moxibustion were used, achieving miraculous results, making external topical treatments unnecessary. This represents the highest form of external treatment. Later generations lost the transmission of needle techniques, substituting drugs for needles, thereby developing many external treatment methods. If both acupuncture and external treatments are neglected, even with appropriate internal medication, only half the diseases can be cured. External symptoms requiring external treatment would have no chance of cure. This is a major critical point in medical practice, which future students must understand.

Pei Zhaoqi treated a person with sore throat unable to eat, intermittent for half a year, where throat insufflations for resolving phlegm and descending fire were ineffective. Pei's diagnosis showed surging yet empty pulses at both Cun positions, empty and weak pulses at Chi positions, preference for warmth and aversion to cold in both feet, and desire for cold drinks that were spat out immediately upon swallowing. This was true cold below and false heat above. Treatment should follow its nature to subdue it. Formula: Bajie Wan (Eight-Ingredient Pill) base plus stir-fried black Ganjiang (Zingiberis Rhizoma), decocted in water, with a little Qingyan (Natrii Chloridum) added as a guiding drug, served cold. Three doses resulted in cure. Xile San (Golden Powder for Throat) treats rotten throat and rashes. Ivory chips calcined, Pearl (Zhenzhu) each 3 fen, processed; Qingdai (Indigo Naturalis) 6 fen; Meihua Bingpian (Borneolum Syntheticum) 3 li; Biqian (Cellar Spider Web) 20 pieces (not those from wooden boards); Xiniu Huang (Bovis Calculus) and human fingernails (female nails for male patients, male nails for female patients) each 5 li. Grind into extremely fine powder and insufflate onto the affected area. Also treats Ru'e (tonsillitis), Ya'gan (gum erosion), and Shefu (tongue decay).

Laifan Cai (Radish leaves) spread on tiled roofs in early winter, or hung on trees, exposed to wind, sun, rain, and frost until the day before Li Chun (Start of Spring). Hang them in eaves where there is wind but no sun; the longer stored, the better. For all throat conditions, decoct into a strong soup and drink for immediate cure. Also treats dysentery.

*Guang Biji* treats rising fire with phlegm滞留 (retained) in the throat, feeling like a nodule. The method should descend Qi and clear fire. Herbs: Suzi (Perillae Fructus) crushed 2 qian, Juhong (Citri Reticulatae Pericarpium Rubrum) 3 qian, Beimu (Fritillariae Bulbus) 3 qian, Tianhuafen (Trichosanthis Radix) 3 qian, Fuling (Poria) 3 qian, Maidong (Ophiopogonis Radix) 5 qian, Baishao (Paeoniae Radix Alba) wine-fried 3 qian, Hei Liaoqiao (Charred Forsythiae Fructus) 1.5 qian, Huangbai (Phellodendri Cortex) honey-fried 1.5 qian, Wuweizi (Schisandrae Fructus) 1 qian, crushed and decocted in water, taken with Zhuli (Bambusa Textilis Sap).