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When the Wei Qi (Defensive Qi) is awake, it circulates in the Yang meridians; when asleep, it circulates in the Yin meridians. Sleep must begin from the Foot-Shaoyin Kidney Meridian; therefore, Shaoyin disease manifests as a faint and thin pulse with a desire to sleep. In Taiyang disease, if ten days have passed and the pulse is floating and fine with a desire to sleep, the exterior pathogen has been resolved. If there is chest fullness and hypochondriac pain, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. If the pulse is merely floating, Ma Huang Tang (Ephedra Decoction) is indicated. (This clause likely refers to a combined disease of the Taiyang and Shaoyang meridians. Although chest fullness is similar to previous descriptions, the floating, fine pulse and somnolence indicate that the exterior pathogen has resolved, while hypochondriac pain indicates Shaoyang pathogen, hence the use of Bupleurum formulas. If the pulse is merely floating, one should first treat Taiyang. This is a hypothetical discussion of flexible treatment, not implying that the pulse becomes floating after taking Bupleurum. Cheng Wuji's commentary is not worthy of adherence.) Dry mouth and throat with a desire to sleep (see "Bitter taste in mouth" section); desire to vomit but unable to do so, with a desire to sleep (see "Vomiting" section); vomiting and diarrhea with a desire to sleep (see "Vomiting and Diarrhea" section); diarrhea with a desire to sleep (see "Diarrhea" section); floating pulse, excessive sweating, and somnolence, if accompanied by heavy body and snoring, this is Feng Wen (Wind-Warmth disease) (see "Feng Wen" section); if dream sweat occurs upon closing the eyes, this is a combined disease of the Three Yang meridians (see "Dream Sweat" section). Huo Huo disease presents with silence and desire to sleep, inability to close eyes, anorexia, aversion to food odor, fluctuating facial color (red, black, or white), and hoarseness; Gan Cao Xie Xin Tang (Licorice Decoction for Draining the Epigastrium) is indicated. For dry throat, Ku Shen Tang (Sophora Root Decoction) is used for washing. For anal erosion by worms, Xiong Huang fumigation is used. For rapid pulse, no fever, red eyes, and dark canthi, Dang Gui Chi Xiao Dou San (Angelica Sinensis and Adzuki Bean Powder) is indicated (see "Huo Huo" section).

(The above content is included in the "Bitter taste in mouth and dry throat" section.)

Pharyngolaryngeal pain in Taiyang and Yangming diseases each has one syndrome, both belonging to Heat syndromes. Taiyang pharyngolaryngeal pain is treated with Ban Xia San (Pinellia Powder), and Yangming pharyngolaryngeal pain is treated with Si Ni San (Frigid Extremities Powder) plus Jie Geng (Platycodon). Shaoyin pharyngolaryngeal pain has six syndromes: four Heat syndromes and two Cold syndromes. Heat syndromes are treated with Zhu Fu Tang (Pig Skin Decoction), Gan Cao Tang (Licorice Decoction), Jie Geng Tang (Platycodon Decoction), and Ku Jiu Tang (Bitter Wine Decoction). Cold syndromes are treated with Gui Zhi Gan Jiang Tang (Cinnamon Twig and Ginger Decoction), Zhen Wu Tang (True Warrior Decoction), and Si Ni Tang (Frigid Extremities Decoction). Juemin pharyngolaryngeal pain has only one method, which is also a Heat syndrome, treated with Jie Geng Tang (Platycodon Decoction). Pharyngolaryngeal pain is generally a Heat syndrome; why are there two Cold syndromes specifically in Shaoyin? One is due to excessive sweating leading to collapse of Yang, so Gan Jiang (Dried Ginger) and Fu Zi (Aconite) are used to restore Yang and warm the meridians. The other is due to Yin excess repelling Yang, so Tong Mai Si Ni Tang (Pulse-Restoring Frigid Extremities Decoction) is used to disperse Yin and unblock Yang.

If Taiyang disease is treated with purgation and the pulse becomes tight, pharyngolaryngeal pain will definitely occur; Ban Xia Tang (Pinellia Decoction) is indicated.

Ban Xia San Ji Tang Formula: Ban Xia (Processed), Gui Zhi (Cinnamon Twig), Gan Cao (Roasted Licorice Root), equal parts. Crush the herbs, decoct in water, and take small sips frequently. Alternatively, make into a powder, mix with plain water, and take one cubic inch spoonful; also effective. Take three times daily. (Zhongjing's original method was to administer as a powder mixed with water, not crushed for decoction.)

Cheng Wuji notes: Gan Cao Tang (Licorice Decoction) treats pharyngolaryngeal pain caused by exogenous Heat in Shaoyin. Jie Geng Tang (Platycodon Decoction) treats pharyngolaryngeal pain caused by cold-heat conflict in Shaoyin. Ban Xia San Ji Tang treats pharyngolaryngeal pain caused by exogenous Cold in Shaoyin.

In Yangming disease, if there is only dizziness, no aversion to cold, ability to eat, and cough, pharyngolaryngeal pain will definitely occur; if there is no cough, there is no pharyngolaryngeal pain (see "Dizziness" section).

Shaoyin and Juemin diseases: In Shaoyin disease, if pharyngolaryngeal pain occurs within two to three days, Gan Cao Tang (Licorice Decoction) may be given. If ineffective, give Jie Geng Tang (Platycodon Decoction). (Yang pathogen transmitting to Shaoyin causes pharyngolaryngeal pain; taking Gan Cao Tang resolves it. If cold-heat conflict causes pharyngolaryngeal pain and Gan Cao Tang is ineffective, Jie Geng Tang harmonizes Shaoyin Qi.)

Gan Cao Tang Formula: Gan Cao (2 liang). One herb, decoct in 3 sheng of water to obtain 1.5 sheng, remove dregs, warm and take 0.7 sheng, three times daily.

Jie Geng Tang Formula: Jie Geng (1 liang), Gan Cao (2 liang). Two herbs, decoct in 3 sheng of water to obtain 1 sheng, remove dregs, divide into two doses and take warm. (Jie Geng is acrid and warm to disperse cold; Gan Cao is sweet and neutral to clear heat. Together they harmonize cold and heat.)

For Shaoyin disease with pain in the throat, Ban Xia San Ji Tang is indicated. For Shaoyin disease with injury to the throat causing ulcers, inability to speak, and loss of voice, Ku Jiu Tang (Bitter Wine Decoction) is indicated.

Ku Jiu Tang Formula: Ban Xia (14 pieces, washed and broken like a jujube pit), Ji Zi (one egg, remove yolk, place Ban Xia in shell, add Ku Jiu to shell). Mix these two ingredients, place Ban Xia in Ku Jiu, put the eggshell on a knife ring, and heat over fire until boiling three times. Remove dregs, hold in mouth and swallow slowly. If not cured, prepare three more doses. (Note: Bencao annotates "Ku Jiu" as vinegar. Cheng Shi says "acidity of Ku Jiu." I believe both names carry "bitter," so how can we know that bitter-tasting substances cannot cure throat ulcers? If one dislikes the heat nature of wine, Ban Xia Tang is even more pungent, let alone this bitter substance. The characters "fa" (disperse) and "lian" (astringe) in the following text seem contradictory.)

If the pulse at cun, guan, and chi positions is tight but there is sweating, this is collapse of Yang, belonging to Shaoyin disease. The law dictates pharyngolaryngeal pain accompanied by vomiting and diarrhea. In Shang Han, if there is initial cold extremities followed by fever, diarrhea will stop spontaneously. If sweating occurs after stopping, bi obstruction in the throat will develop (Cold extremities with diarrhea; fever stops diarrhea. Sweating indicates collapse of Yang. Pain in throat indicates rising heat. Collapse of Yang leaves Yin alone, which reunites with heat, causing Yin-Yang knotting resulting in Hou Bi [throat bi]. Nei Jing states: Knotting of one Yin and one Yang results in Hou Bi. See "Diarrhea" section.) For pharyngolaryngeal pain with diarrhea and chest pain, Zhu Fu Tang (Pig Skin Decoction) is indicated. For cold extremities, faint pulse nearing imperceptibility, no aversion to cold, and flushed face, Tong Mai Si Ni Tang (Pulse-Restoring Frigid Extremities Decoction) is indicated. For post-purgation recurrence of cold extremities and absent lower pulses, Ma Huang Sheng Ma Tang (Ephedra and Cyathula Decoction) is indicated (all see "Diarrhea" section).

Yang Du (Yang Toxin) pharyngolaryngeal pain with flushed face, rash like brocade, and expectoration of pus and blood is treatable within five days but not seven. Sheng Ma Die Jia Tang (Cimicifuga and Turtle Shell Decoction) is indicated. (Huoren Shu states Yang Du is treated with Sheng Ma Tang; see "Yang Du" section.) Yin Du (Yin Toxin) pharyngolaryngeal pain with cyanotic face and eyes, body pain like being beaten, is treatable within five days but not seven. Sheng Ma Die Jia Tang minus Xiong Huang (Realgar) and Shu Jiao (Sichuan Pepper) is indicated. (Huoren Shu states Yin Du is treated with Gan Cao Tang; see "Yin Du" section.)

Contraindications: Do not induce sweating if there is closure in the throat; sweating will cause hematemesis, qi exhaustion, cold extremities, desire to curl up, and inability to self-warm. Do not purge if there is closure in the throat; purging will cause upper lightness and lower heaviness, inability to take fluids, desire to curl up when lying down, dizziness, and frequent diarrhea (dozens of times daily).

Zhang Yuansu said: Some say the Six Meridians Shang Han do not mention pharyngolaryngeal pain, except in the Shaoyin chapter. Why? Because Shaoyin pharyngolaryngeal pain is related to the meridians. The Shaoyin meridian passes through the liver and diaphragm, enters the lung, follows the throat, and connects to the root of the tongue, hence the risk of pharyngolaryngeal pain. Nei Jing states: Diseases of the meridian include throat swelling, upward rushing of Qi, dry throat, and pain. This is due to pathogenic factors following the meridian course.

Appendix:

Hua Shou said: Ban Xia Gui Zhi Gan Cao Tang treats Fu Qi (latent pathogen) disease, where sudden cold strikes unexpectedly, latent in the Shaoyin meridian. Initially asymptomatic, it manifests after ten days with a weaker pulse, starting with pharyngolaryngeal pain resembling Shang Han but not Hou Bi, followed by diarrhea. Only then is Ban Xia Gui Zhi Gan Cao Tang indicated. This disease resolves in two days and is called Shen Shang Han (Kidney Cold Damage) in ancient texts. Subsequently, Si Ni Tang (Frigid Extremities Decoction) is used.

Ban Xia Gui Zhi Gan Cao Tang Formula: Ban Xia (washed in decoction), Gan Cao (roasted), Gui Xin (Cinnamon Heart), equal parts. Crush, take 4 qian per dose, decoct in water, cool, and sip slowly.

Zhao Sizhen said: Recent editions of Huoren Shu all print Si Ni San (Frigid Extremities Powder), but Si Ni San does not treat pharyngolaryngeal pain, suggesting a printing error. Zhongjing states Si Ni San treats Shaoyin disease with transmitted heat causing cold extremities. This case involves latent cold in Shaoyin with a weak pulse, requiring warming and dispersing. Since Ban Xia Gui Gan Tang (a warming formula) was used first, why follow with Chai Hu (a cooling formula)? It must be Si Ni Tang. Moreover, Tong Mai Si Ni Tang formula note mentions adding Jie Geng for pharyngolaryngeal pain, confirming this doubtlessly.

Wu Qian said: Pharyngolaryngeal pain involves Yin and Yang Du toxins. Yang Du throat swelling and pain is extreme heat; Yin Du throat dysfunction is extreme cold. Yang Du pulse is floating, rapid, and large, with pharyngolaryngeal pain and expectoration of pus and blood. Qianjin and Waitai use Wu Shan Gao (Black Bird Fan Ointment); Huoren uses Hei Nu Wan (Black Slave Pill). Also, excessive Yang leads to mania, pharyngolaryngeal pain, and surging, solid, slippery, rapid pulse; Huoren uses Ting Li Ku Jiu Tang (Descurainia Bitter Wine Decoction). For Shang Han pharyngolaryngeal pain, decoct raw Gan Cao thickly and drink, or soak Shan Dou Gen (Sophora Tonkinensis Root) in water and gargle with bitter liquid; or crush He Shi Cao (Nemesis Herb) juice with rice vinegar and gargle, which is also excellent.

Liu Wansu said: For pharyngolaryngeal pain with ulcers, blow Huang Bo (Phellodendron Bark) and Xi Xin (Asarum) powder. For Shang Han with swollen cheeks and pharyngolaryngeal pain, bleed Shao Shang (Lesser Shang) and Wei Zhong (Mid-Crotch) points. Shao Shang is located on the medial side of the thumb tip, near the nail corner like a leek leaf; prick with a three-edged needle until blood flows for cure.

Dai Yuanli said: There are cases of initial headache and fever without Yang Du or Shaoyin symptoms, yet spontaneous pharyngolaryngeal pain occurs. This is due to wearing thick clothes/blankets immediately after catching a cold, or using barbaric methods like drinking hot ginger wine and sleeping, leading to upper congestion. Or pre-existing internal heat seeking coolness attracts external pathogens, combining wind-cold with heat congestion. Use Shen Su Yin (Ginseng and Perilla Decoction) with doubled Jie Geng and added Mu Xiang (Aucklandia) half qian, or Xiao Feng Bai Jie San (Wind-Dispersing Hundred-Resolution Powder), or Bai Du San (Detoxification Powder), or Wu Ji San (Five Accumulations Powder). Half dose of Bai Du San combined with another formula is called Jiao Jia San (Intersecting Resolution Powder).