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[General Principle]
The binding of one Yin meridian and one Yang meridian is called Hou Bi (Laryngeal Obstruction / Sore Throat). (*Neijing* states): The so-called "one Yin" refers to the Liver Meridian and Pericardium Meridian; the so-called "one Yang" refers to the Gallbladder Meridian and Sanjiao (Triple Burner) Meridian. These four meridians all contain Ministerial Fire (Xiang Huo) and connect to the throat region. (Wang Bing's commentary): When Qi becomes heated, it binds internally; severe binding leads to swelling; severe swelling leads to obstruction; severe obstruction leads to death due to phlegm blockage. (Zhang Zihe)

[Internal Causes]
Due to pre-existing phlegm-fluids in the chest and diaphragm, or excessive alcohol consumption, or abnormal anger, or immoderate sexual activity, fire stirs up phlegm, surging and blocking between the pharynx and larynx, causing internal and external swelling and pain, making it impossible to swallow even water. (*Yijian*)

[External Manifestations]
Heat Qi ascends and binds on both sides of the throat, swelling near the exterior with a shape resembling a sinew knot, known as Ru E (Tonsillitis), which can be unilateral or bilateral. Smaller than Ru E is called Bi Hou (Closed Throat). Heat binding under the tongue causes a small extra tongue to grow, called Zi She (Sublingual Tongue). Heat binding in the middle causes the tongue to swell, called Mu She (Wooden Tongue). Heat binding in the throat causes swelling around the exterior, accompanied by numbness and itching, with significant redness and enlargement, called Chan Hou Feng (Entangling Throat Wind). Toxicity gathering internally with thick, surging saliva and only chills and fever present is called Sai Hou Feng (Blocked Throat Wind). Sudden onset of Hou Bi leading to rapid death is called Zou Ma Hou Feng (Running Horse Throat Wind). (Zhang Zihe) This condition presents with sudden loss of voice, unconsciousness, phlegm congestion, clenched jaw, and death from suffocation, similar to various strokes, but distinguished by preceding sore throat.

[Distinction Between Larynx and Pharynx]
Hou Bi refers to blocked breathing in the larynx and inability to speak, caused by the obstruction of Heaven Qi (Lung Qi). Yan Tong (Pharyngeal Pain) refers to the inability to swallow saliva or food in the pharynx, caused by the obstruction of Earth Qi (Stomach Qi). (*Lei Yao*)

[Distinction Between Exterior and Interior Syndromes]
Exterior syndromes must be accompanied by aversion to cold, and the Cun (inch) pulse is weaker and smaller than the Guan (bar) and Chi (cubit) pulses. This indicates cold closing the exterior and heat郁 (stagnating) internally; appropriate treatment is acrid-cool dispersing, strictly avoiding sour-cold astringents. Interior syndromes present without chills or fever, but the Cun pulse is slippery and excess compared to the Guan and Chi pulses. This indicates heat accumulating internally and stagnating to generate phlegm; appropriate treatment is bitter-cold suppression and emesis methods. (*Huibu*)

[Distinction Between Deficiency and Excess Syndromes]
Excess Fire results from overeating fried foods, with heat-toxin accumulation, chest discomfort, irritability, thirst, and constipation. Deficiency Fire results from emotional strain and desire, with Qi deficiency causing false fire to flare, dryness in the throat and diaphragm, and normal urination and defecation. (*Rumen*)

[Distinction Between Yin and Yang Deficiency]
Yang deficiency presents with floating and large pulses at both Cun positions, worsening with exertion; this is Lung and Spleen Qi weakness failing to control the Lower Jiao, requiring tonification of the Middle Jiao (Spleen/Stomach). Yin deficiency presents with flooding and rapid pulses at both Chi positions, worsening in the afternoon; this is Liver and Kidney Yin deficiency failing to control Dragon-Liver Fire, requiring nourishment of Gui Water (Kidney Yin).

[Pulse Diagnosis]
Floating, flooding, and overflowing pulses at both Cun positions indicate Hou Bi. Microscopic, fine, and weak pulses at both Chi positions indicate Deficiency Fire. If the pulse is extremely micro or hidden (Fu), it indicates death. Floating, large, and choppy pulses also indicate death.

[Therapeutic Methods]
Treating Excess: First disperse, then use cooling agents, or induce vomiting to guide out phlegm, or prick to bleed. Treating Deficiency: Must follow the principle of contrary treatment from *Neijing*, administering medication slowly and frequently. (*Zhengchuan*)

[Contraindication of Cold-Cooling Herbs]
If solely using herbs like Huang Qin (Scutellaria Root), Lian Zi (Coptis Rhizome), Zhi Zi (Gardenia Fruit), and Huang Bai (Phellodendron Bark) for direct treatment, the upper heat will not be removed, while middle cold arises; toxins enter the abdomen through deficiency, turning into fatal conditions. (*Zhengchuan*)

[Fatal Signs]
Swelling high on the chest, upper asthma and lower diarrhea, cyanosis of fingernails and toenails, inability to eat after seven days, and mouth opening like a fish's mouth indicate death. Another acute Hou Bi presenting with snoring-like sounds indicates Lung Qi exhaustion and death. Ginseng, Bamboo Sap, and Ginger Juice may save one in ten thousand cases. (Zhu Danxi)

[Throat Blowing Method]
For dry and painful throat, swollen larynx, inability to swallow liquids or saliva, difficulty entering fluids (which may exit via nose), first use Bo He (Mint), Bing Pian (Borneol), Xuan Ming Fen (Mirabilite), Peng Sha (Borax), Qing Dai (Indigo Naturalis), Niu Huang (Calculus Bovis), Pu Xiao (Niter), Jiang Can (Bombyx Batryticatus), etc., ground into powder and blown into the throat to settle phlegm and clear fire.

[Emetic Method]
For throat wind with swelling/pain and abundant phlegm-fluids, whether due to wind-phlegm surging upward or phlegm-fire stirring internally (fire being the root of phlegm, phlegm the branch), first emeticize the phlegm, then clear the fire. Use Bai Fan (Alum) stir-fried with Ba Dou (Croton Seed) until dry, remove Ba Dou, grind Bai Fan into powder, mix with Zao Jiao (Gleditsia Sinensis) powder, blend with vinegar, and induce vomiting using a goose feather probe. After vomiting, regulate with Gan Jie Tang (Licorice and Platycodon Decoction). If the jaw is locked and the patient is unconscious/unable to take oral medicine, blow the powder into the nose.

[Nasal Fumigation Method]
Bi means obstruction. When the throat is closed and decoctions cannot pass, and solid food is hard to swallow, one must utilize invisible Qi entering from the nose. Press Ba Dou (Croton Seed) oil onto paper, roll the oiled paper into a strip, light it, blow it out, and fumigate the nose with smoke to induce salivation from mouth and nose, naturally relaxing the jaw. (*Lei An*)

[Throat Pricking Method]
For Ru E and similar conditions above the throat gate, blood blisters are usually present; pricking them with a throat needle or pen tube brings immediate relief. Conditions below the throat gate that are not visible are difficult to treat. Sharpen a reed tube, have the patient hold a mouthful of water, insert the tube from the nostril, and prick once; bleeding is highly effective.

[Shaoshang Acupoint Pricking Method]
Location: On the medial side of the thumb, about the width of a leek leaf from the nail corner. Male patients: left hand; Female patients: right hand. Insert approximately 0.3 cun. Press from the arm towards the puncture site to induce bleeding; cure follows.

[Fire Pricking Method]
Severe throat abscesses must be pricked. Apply Ba Dou (Croton Seed) oil to paper, roll into a strip, light it, and blow it out when smoke appears. Have the patient open their mouth and insert the smoldering strip into the throat; purple blood will be expelled shortly, bringing relief.

[Medication]
Primary formula: Gan Jie Tang (Licorice and Platycodon Decoction), added with Bo He (Mint), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Huang Qin (Scutellaria), Xuan Shen (Scrophularia), Niu Bang Zi (Arctium Fruit), Zhu Ru (Bamboo Shavings). For cough, add Bei Mu (Fritillaria) and Chen Pi (Citrus Peel). For thirst, add Hua Fen (Trichosanthes Root) and Mai Dong (Ophiopogon). For spitting blood, add Zi Wan (Aster). For nausea/vomiting, add Ban Xia (Pinellia). For chest fullness, add Zhi Ke (Aurantium). For constipation, add Da Huang (Rhubarb). For severe phlegm, add Shi Gao (Gypsum). For severe fire, add Huang Lian (Coptis). For sudden closure and collapse, use Jie Du Xiong Huang Wan (Detoxifying Realgar Pill). These are methods for treating Excess Fire. For Deficiency patterns, modify accordingly. Ancients used Ren Shen (Ginseng), Fu Zi (Aconite), Rou Gui (Cinnamon Bark), Jiang Can (Bombyx); regulating the lower part allows the upper to settle naturally, which is treating the root. Generally, for Blood Deficiency, use Si Wu Tang (Four Substances Decoction). For Qi Deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). For Liver Fire, use Xiao Yao San (Free and Easy Wanderer Powder). For Kidney Deficiency, use Di Huang Tang (Rehmannia Decoction). Add symptom-targeting herbs. For Ming Men (Gate of Life) Fire Decline with Dragon Fire floating to the throat, Ba Wei Wan (Eight-Ingredient Pill) is most potent; cold-cooling herbs must absolutely not be used.

[Appendix: Latent Pathogenic Qi]
Latent Pathogenic Qi, named Shen Shang Han (Kidney Cold Damage), refers to non-seasonal violent cold lying dormant in the Shaoyin (Kidney) meridian. Cold pathogen depression blocks Yang Qi. Initially asymptomatic, it manifests after ten days, ascending to the throat junction. Cold and heat struggle, causing sore throat. Pulse is weak and thin, followed by diarrhea. Treat the root with acrid-hot herbs to harmonize Yin and Yang, allowing Water to ascend and Fire to descend, stopping the sore throat. Gan Jie Gui Ban Tang (Licorice, Platycodon, Cinnamon, and Pinellia Decoction) is primary. (*Shanghan* theory)

[Appendix: Epidemic Qi]
In years of excessive Si Tian (Heavenly Stem) luck, villages suffer similar infections. Seasonal pathogens accumulate in the Upper Jiao due to deficiency, causing chills, fever, and throat pain, commonly known as Xia Ma Wen (Toad Plague) or Lu Wen (Cormorant Plague). This condition is severe; avoid Dan Fan (Chalcanthite) and other sour-cold herbs that suppress Yang Qi; avoid Xiao (Niter) and Huang (Rhubarb) purgatives that draw pathogens inward. Use acrid-cool, sweet-bitter, exterior-interior resolving agents. Pu Ji Xiao Du Yin (Universal Benefit Detoxification Decoction) is primary.

[Selected Formulas for Throat Disorders]
Jie Geng Tang (Platycodon Decoction): Governs all throat diseases.
Ingredients: Niu Bang Zi (Arctii Fructus), Xuan Shen (Scrophulariae Radix), Sheng Ma (Cimicifugae Rhizoma), Jie Geng (Platycodonis Radix), Xi Jiao (Rhinocerotis Cornu - note: substitute with Niuhuang or Shui Niu Jiao in modern practice), Huang Qin (Scutellariae Radix), Mu Tong (Akebiae Caulis), Gan Cao (Glycyrrhizae Radix et Rhizoma).

Qing Re Hua Tan Wan (Clear Heat and Resolve Phlegm Pill): Treats phlegm-fire sore throat.
Ingredients: Bei Mu (Fritillariae Bulbus), Hua Fen (Trichosanthis Radix), Zhi Ke (Aurantii Fructus), Jie Geng (Platycodonis Radix), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Xuan Shen (Scrophulariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).

Si Wu Tang (Four Substances Decoction): Treats sore throat due to Fire stirring from Blood Deficiency.

Si Jun Zi Tang (Four Gentlemen Decoction): Treats sore throat due to Fire stirring from Qi Deficiency.

Di Huang Tang (Rehmannia Decoction): Treats sore throat due to Ministerial Fire flaming upward.

Gui Fu Ba Wei Wan (Cinnamon and Aconite Eight-Ingredient Pill): Treats sore throat due to Dragon Fire surging upward. (See Stroke chapter for formulas above).

Xiao Yao San (Free and Easy Wanderer Powder): Treats sore throat due to Liver Fire flaming upward. (See Fire Syndromes chapter).

Pu Ji Xiao Du Yin (Universal Benefit Detoxification Decoction): (See Head Wind chapter).

Jie Du Xiong Huang Wan (Detoxifying Realgar Pill): Treats acute Hou Bi, salvageable even if seemingly dead.
Ingredients: Xiong Huang (Realgar), Yu Jin (Curcumae Radix) (1 liang each), Ba Dou (Crotonis Semen) (14 seeds).
Add Jiang Can (Bombyx Batryticatus) 2.5 qian, Mang Xiao (Natrii Sulfas) 5 qian. Pill with vinegar paste, take with clear tea.

Ban Xia Gui Gan Tang (Pinellia, Cinnamon, and Licorice Decoction): Treats Kidney Cold Damage.
Ingredients: Ban Xia (Pinelliae Rhizoma), Gui Zhi (Cinnamomi Ramulus), Jie Geng (Platycodonis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).

Fu Zi Jian (Aconite Decoction): Treats organ cold with throat closure and difficulty swallowing.
Usage: One slice of large Fu Zi (Aconiti Lateralis Radix Praeparata), coated with honey and roasted yellow. Hold one slice in the mouth to swallow juice; replace when flavor fades.

Quick Method Secret Formula: Treats Hou Bi and Ru E.
Usage: One handful of fresh Du Niu Xi (Achyranthis Bidentatae Radix), seven leaves of Ai Ye (Artemisiae Argyi Folium), pounded together, mixed with cow's milk, instilled into the nose. Phlegm-fluids exit from mouth and nose shortly after, providing immediate effect. This herb is named Tian Ming Jing (Euphorbiae Humifusae Herba), also known as He Sou Cao. It has stems flowering like wild chrysanthemums, seeds like mugwort, sticks to clothes, and has a strong fox-like odor, also called He Shi (Asari Radix et Rhizoma - *Note: Text describes a specific weed, likely Euphorbia or similar, despite naming confusion in classical texts*).

Secret Formula for Acute Throat Wind:
Usage: Seven spiders. Grind 5 qian of Ming Fan (Alumen) into powder, place on an iron knife blade, arrange spiders in the powder, melt powder with charcoal fire under the knife. When dry, grind together finely, store in a small porcelain jar. Use a "zi" amount (approx. 0.3-0.6g), blow into throat. Thick phlegm expulsion indicates cure.

Fish Bone Stuck in Throat: Chew olive flesh or pit, grind with water, and swallow. Alternative: Drink decoction of Pu Xiao (Natrii Sulfas) to expel bone. Wei Ling Xian (Synephylti Radix) is also effective.