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Shuang'e (Bilateral Tonsillitis) is a condition caused by the Fire of the Shaoyin channel rushing upward to the throat. Its onset is extremely rapid and urgent. In severe cases, patients cannot even swallow drops of water; there are instances where death occurs due to the inability to eat or drink for several consecutive days. Although this condition arises from Fire, the nature of the Fire differs, being categorized as either Yin Fire or Yang Fire. If not clearly distinguished and treated with indiscriminate medication, death may occur in an instant—either perishing from taking hot-natured drugs or turning blue-green in complexion.

How do Yang syndrome symptoms present? The throat must first feel dry, and the mouth will be extremely thirsty with a strong desire to drink. Phlegm may accumulate between the chest and diaphragm, creating a sensation of wanting to vomit but unable to do so, or wanting to swallow but unable to. The throat swells like an ulcer, the uvula becomes very red, the inner sides of both throat walls swell like rooster combs, and the exterior also swells. Pain is unbearable during the day but slightly relieved at night, allowing for sleep. The tongue becomes stiff and protruding, and the eyes become red. Warm-natured medicines must absolutely not be used; if mistakenly administered, the patient will go mad immediately. This condition can be completely cured simply by using emetic therapy. Ancient practitioners sometimes used raw Camellia oleifera oil applied with a goose feather to sweep the throat, expelling about a bowlful of stubborn phlegm, achieving immediate results. However, in cases of extreme Fire hyperactivity, a single emetic may not suffice. What should be done? One must inquire about the patient's diet, lifestyle, and previous medications. If the condition was induced by prior intake of hot-natured drugs, which is common, the patient's stool will likely be dry and constipated for three to four days, or urination will be painful and difficult. In such cases, boldly use my decoction for treatment. The formula is named "Dougen Shensan" (Wonderful Bean Root Powder). One dose brings relief, and the Shuang'e symptoms vanish.

The efficacy of this formula lies in the heavy use of Sophorae Tonkinensis Radix et Cortex (Shandougen). This herb is most effective at clearing Excess Fire of the Shaoyin channel. However, without Licorice Root (Gancao) and Platycodon Root (Jiegeng) to assist, the medicinal action would descend rather than ascend to the throat. Therefore, these two are used as Minister herbs. Qingdai (Indigo Naturalis) is also a miraculous drug for relieving pain and reducing swelling, used here as an Assistant herb. Banxia (Pinellia Rhizome) and Huafen (Trichosanthes Root) serve merely to eliminate stubborn phlegm, thereby facilitating the dissipation of Fire.

In contrast, Yin syndrome Shuang'e presents with visible swelling but little pain, or intermittent pain that is heavier at night and lighter during the day. The mouth is not dry, only slightly parched. Cold water feels refreshing upon swallowing, though discomfort returns shortly after. There is chest distension, normal bowel movements, and clear, copious urine; even if yellow, it is not difficult or painful to pass. These are all signs of Yin deficiency leading to Fire hyperactivity. Nothing is more wonderful than administering large doses of Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish Yin. Naturally, the phlegm sounds cease, and swelling and pain disappear. This is because Liuwei Dihuang Wan specifically tonifies the Fire of the Gate of Vitality (Mingmen); once the lower heat is resolved, the upper heat naturally dissipates. Longlei Fire (Ministerial Fire) cannot be guided back to its source unless led by true Fire-tonifying agents.

However, in both syndromes, patients often cannot swallow medicine or food. Even with such excellent formulas, how can they be administered? For Yang syndrome, sweeping the throat with a goose feather induces slight vomiting, opening the esophagus enough to administer medicine. For Yin syndrome, emetic therapy must not be used, as excessive vomiting causes Fire to boil further. Another ingenious method involves pricking the Shaoshang point (LU11), located beside the nail of the thumb on the hand, to release a few drops of blood. The blood will be purple-black; once released, the throat relaxes slightly, allowing for the administration of Dihuang Tang (Rehmannia Decoction). If the patient refuses acupuncture, one may alternatively apply Aconite Lateralis Radix Praeparata (Fuzi) powder mixed with vinegar to the soles of the feet. After one double-hour period (two hours), the esophagus opens, and medication can be given. This is indeed a superb method.

Dougen Shensan (Wonderful Bean Root Powder)
Sophorae Tonkinensis Radix et Cortex (Shandougen) - 3 qian
Licorice Root (Gancao) - 3 qian
Ephedrae Herba (Mahuang) - 5 fen
Platycodonis Radix (Jiegeng) - 3 qian
Pinelliae Rhizoma (Banxia) - 2 qian
Indigo Naturalis (Qingdai) - 3 qian
Trichosanthis Radix (Huafen) - 3 qian
Decoct in water and take orally.