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The ancient text states: "The eighteen syndromes of the throat and pharynx all belong to Fire," which refers to the general situation. However, Fire is divided into Deficiency Fire and Excess Fire; syndromes are distinguished by Cold and Heat; there are differences between internal causes and external causes; and differentiation is required based on whether the tongue coating is rough and aged or tender and delicate. When treating clinically, one must examine clearly, then palpate the pulse for deficiency or excess, determining whether it is forceful or feeble, ensuring the pulse matches the symptoms, before prescribing a formula for treatment. One cannot generally assume it to be an Excess Wind-Heat syndrome. Most people nowadays have a constitutional deficiency of Kidney Yin, so throat conditions belonging to Excess are rare. There may be Excess complicated by Deficiency, or Deficiency complicated by Excess; cases where Yin Fire from the Lower Jiao rises causing sore throat and mouth ulcers are also not uncommon. Among the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), pathogens causing throat diseases are not limited to Wind-Cold and Fire; Summer-heat, Dampness, and Dryness are also involved. However, throat pain caused specifically by Summer-heat and Dampness is very rare; cases triggered by Dryness are more common, due to insufficient Kidney Water. If clinical differentiation is not clear, and dispersing methods are applied immediately upon seeing fever, although this may be appropriate for Wind pathogens, for Cold pathogens, acrid-warm herbs are indispensable. For Fire pathogens, clearing and descending are indeed suitable, but one must distinguish between Excess Fire and Deficiency Fire, as well as consider stagnation. Excess Fire should be cleared and descended; Deficiency Fire requires strengthening Water (nourishing Yin to subdue Fire); Stagnant Fire should be lifted and dispersed. How can Dampness and Dryness be treated with dispersing methods! In other diseases, distinguishing Excess and Deficiency may be difficult, but throat conditions are the easiest to clarify; Excess and Deficiency can be judged at a glance because there are forms to observe, colors to reference, and tongue coatings to differentiate. Moreover, saliva and phlegm can be clear or turbid; only by profound study during clinical practice can one grasp the essence. Although ingenuity and flexibility depend on the individual, they must be understood through formulas and pulse diagnosis to avoid errors.

A hereditary throat specialty clinic has thirty-six named syndromes, yet its treatment methods revolve around a single formula, Zidi Tang (Purple Ground Decoction). Why? Because all thirty-six syndromes arise from Wind-Heat obstructing the Upper Jiao, triggered by pathogenic contact, causing sudden pain. Although the manifestations differ, the underlying cause is the same, so one formula governs them all. If it is truly an Excess Wind-Heat syndrome, following this method will invariably lead to immediate recovery. If it belongs to Deficiency or is caused by Dryness, it will certainly be ineffective. Clinging to rigid formulas will inevitably cause delays.

In an Excess syndrome onset, initial symptoms include fever, aversion to cold, headache, redness and swelling in the throat with visible form, severe pain preventing drinking, abundant thick phlegm, a floating, rapid, and forceful pulse, a rough, firm, and yellow tongue coating, throat obstruction, and possibly constipation of both bowels and bladder. This is a critical condition. One may use acupuncture at Shaoshang (LU11), Shaochong (HT9), Hegu (LI4), Fengchi (GB20), and Xinhui (EX-HN6) using the "Wind Path" needle technique; other points should not be needled indiscriminately. The purpose of this needling is to urgently drain internal heat, which is equivalent to inducing sweating, so excessive needling is inappropriate. Next, Xinwu San (Acrid Aconite Powder) is used to induce vomiting and expel phlegm, allowing trapped heat to exit via the phlegm. Huisheng Dan (Revival Pill) is blown into the throat to dissipate heat-induced obstruction. Zidi Tang is administered to unblock Excess Wind-Heat in the Lung and Stomach. If constipation exists, Xuanming Fen (Mirabilite) is added to descend fire, dispel heat, resolve phlegm, and eliminate stagnant waste from the organs, evacuating through the bowels. The combination of sweating, vomiting, and purging methods treats the disease from three routes, draining the pathogens. Since the throat is a critical passageway, failure to treat promptly leads to closure. There is also fear that Wind-Heat toxic pathogens will attack internally, making delay dangerous. Excess syndromes must be treated according to these principles; Deficiency syndromes absolutely contraindicate this approach.

Some cases initially resemble malaria, with chills and fever. This is the inherent presentation of throat pathology, not an external Wind-Cold invasion. Do not recklessly use Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Qinjiao (Gentianae Macrophyllae Radix), Ziye (Perillae Folium), or Guizhi (Cinnamomi Ramulus). Throat pathology originates from the Zang-Fu organs, not the Taiyang Bladder exterior syndrome. Those who insist on initial dispersing as a hierarchical treatment method are practicing superficial medicine without foundational knowledge. Unknowingly, lifting and dispersing causes Fire to burn fiercer; acrid-warm herbs exacerbate Yang excess and closure, turning mild cases severe and severe cases critical, beyond rescue. *Shen Shi Zun Sheng Ji* also states that throat syndromes most strictly forbid exterior-releasing methods. Regardless of initial chills or fever, only acrid-cool dispersants combined with Yin-nourishing agents are needed. Heat will remove itself without direct clearing, and throat symptoms will gradually ease. This is based on long experience and verified efficacy.

Initial fever without aversion to cold, slight throat pain, or redness/swelling with pale color, shiny skin over swelling, or red but dry swelling, along with scanty thin saliva/phlegm, all indicate Deficiency patterns. These stem from Yin Fire of the Lower Jiao or Dryness invasion, fundamentally due to Water deficiency failing to control Fire. The Classics state: "Sudden onset is rarely Fire; slow onset is rarely Cold; Excess Heat and Deficiency Cold must be carefully examined." Cases appearing Excess but actually Deficient require pulse confirmation. Only a floating, rapid, and forceful pulse indicates Excess. A fine, rapid, and feeble pulse, or a Right pulse larger than the Left, indicates Deficiency. In such cases, Zidi Tang and Xinwu San are contraindicated, and even blowing Huisheng Dan is unsuitable. Use Qingxue Dan (Green Snow Powder) with acrid-cool dispersants and Yin-nourishing methods for effectiveness.

Xinwu San is necessary only for Excess syndromes because it rapidly extracts phlegm, lifting Wind-Heat outward, aligning with the *Neijing* principle: "Those high up should be evacuated upward." If Deficiency signs are present, do not use it, as it damages Body Fluids and worsens symptoms. Like in Shaoyin disease treatment, preserving Body Fluids is paramount. Xinwu San is a drastic emergency method; for true Excess, it quickly opens the throat. However, Deficiency syndromes are internal causes; using it consumes fluids, so it is unsuitable. Recently, cases requiring Xinwu San are rare (2-3 per 100), differing greatly from the past. One must not cling to rigid formulas without flexibility.

Throat conditions cannot be judged by the quantity of phlegm alone. Deficiency may have abundant phlegm; Excess may have abundant phlegm; Excess may have little phlegm; Deficiency may have little phlegm. Observe whether phlegm is thick/turbid or thin/clear. During topical application, assess Excess vs. Deficiency. In Excess, phlegm flows out thick, turbid, long, continuous, and foul-smelling. In Deficiency, phlegm is thin, clear, short, and discontinuous. No phlegm after application indicates Body Fluids burned by Fire. Dryness-induced throat issues yield less phlegm, requiring nourishing Yin as the priority. Assuming Wind-Heat obstruction and using lifting/dispersing/antidotal herbs is a major error.

Throat conditions with constipation of bowels and bladder are critical. Differentiate Excess and Deficiency; do not blindly purge. Causes include: excessive exterior-releasing damaging fluids; Wind-Heat obstructing the Upper Jiao; or Dryness season injury. Purging is only for Excess. Even if constipated initially, wait 2-3 days. If throat swelling subsides but bowels remain blocked, use Xuanming Fen to guide heat/toxins downward (pulling firewood from under the cauldron). This specialty uses Xuanming Fen instead of Dahuang (Rhei Radix et Rhizoma) because Dahuang is too harsh and may damage True Qi. Xuanming Fen is acrid-slightly sweet, descends Heart Fire, clears Stomach Heat, resolves phlegm, removes stagnation, and reduces abscesses. For Deficiency, use moistening purgatives or add Huomaren (Cannabis Seed) and Sesame to Yin-nourishing formulas. The Classics say: "Yin blood moistens below, facilitating bowel movement." Also: "Kidney governs the two lower orifices." Heavy doses of Shudihuang (Rehmanniae Radix Praeparata) facilitate bowel movement.

Needles and knives must not be used recklessly. Knives are only for emergency relief of locked throat obstruction. Acupuncture requires thorough study of *Zhenjiu Dacheng* (Great Compendium of Acupuncture and Moxibustion) and bronze mannequins, mastering point locations and tonification/reduction techniques. It is laughable that modern practitioners needle indiscriminately, ignoring patient pain. Valid points are only Shaoshang, Shaochong, Hegu, Fengchi, and Xinhui. Other points, especially Huowokeng (connected to Yamen GV15), must not be needled; accidental needling causes permanent aphonia. Knife use is also for emergencies only. Indications include Double/Single Swallow's Tongue (Erythema tonsillaris), Chong She (Double Tongue), Mu She (Wooden Tongue), and Qiangshi Feng (Choking Wind). Briefly puncture skin to bleed and reduce swelling. Do not use lightly in early stages. Zuo She Lianhua (Lotus Syndrome) is rare and doesn't require knives. Throat tumors due to emotional depression and Liver/Kidney deficiency are internal causes; knives are strictly forbidden. Mistakes cause severe harm.

Gum swelling/pain and dental abscesses should not be incised. Reckless cutting causes ulceration or alveolar osteomyelitis. Ancient texts stating "throat bi no pricking blood, throat wind no expectoration, throat abscess no drainage, swallow's tongue no moxa" are incorrect interpretations. *Neijing*'s "Excess blood should be drained" applies only to Excess syndromes with severe swelling, not indiscriminate cutting regardless of Excess/Deficiency. What is the intent behind this?

Yankou (Palatine Tonsil) syndrome: Unilateral cases are now more common than bilateral. Unilateral is heavier, Bilateral lighter. Excess is rare; Deficiency is common. Initially, slight swelling near the epiglottis allows swallowing for 1-2 days. By day 3-4, swelling prevents drinking. Left-side swelling spreads to right, then subsides. Right-side spreads to left, resolves in 7 days. Unilateral severity lies in this spread. Bilateral is lighter because swelling divides, leaving space under epiglottis for drinking; resolves in 3-5 days. Treatment generally forbids knives. For Excess, use standard formulas. For Deficiency, combine Yin-nourishing with acrid-cool dispersants. Blow Chilin San (Red Scale Powder) and Qingxue Dan. If swelling reaches the soft palate with extreme severity, briefly puncture near the top to bleed and reduce pressure. Do not cut deep; deep cuts cause ulceration requiring Zhenzhu San (Pearl Powder) and Wan Yi Dan for healing. Avoiding knives prevents scarring and pain. Some rely on knives regardless of syndrome, cutting repeatedly until bleeding fills the floor, citing *Neijing*. After 5-6 cuts without cure, complications like alveolar osteomyelitis or chronic non-healing wounds occur, sometimes death. Few heal by knife; many fear treatment and seek others. This lack of repentance is lamentable.

Lip sores, oral candidiasis (Kou Mi), and tongue sores are easily treated, yet recent deaths occur due to misdiagnosis. Tongue sores must differentiate Cold/Heat/Excess/Deficiency; do not assume Stomach Heat/Heart Fire. Blind use of cooling herbs, Daochi San (Guide Out Redness Decoction), or Xiexin Tang (Drain Heart Decoction) turns white sores red, spreading蔓延. Physicians, thinking clearing is incomplete, add more cold herbs, leading to "Water extreme resembling Fire": purple tongue, red lips, cracking, spreading sores, white rot in throat, aphonia, choking, asthma, becoming untreatable敗症. Who is at fault? Pediatric mouth sores vary: Spleen deficiency failing to control saliva (drooling, wet corners); Spleen Yin deficiency from sweets; post-fever lingering heat; Upper Jiao Excess Heat, Middle Jiao Deficiency Cold, Lower Jiao Yin Fire; or excessive cooling/antidotal herbs after smallpox/measles. Causes differ; do not fixate on Heart Fire just because the tongue relates to the Heart. Dryness-induced sores require careful differentiation; avoid dispersing. Misuse of cold herbs causes immediate aphonia. Nourish Yin and clear dryness; heat retreats, dryness calms, sores heal.

Sores on blue veins under the tongue, like half a grain of white rice, occur mostly in children, post-malaria, post-prolonged illness with internal heat, or after stagnation diarrhea. Often misdiagnosed as Heart Heat. The root of the tongue (She Ben) relates to the Spleen, though associated with Heart. Classics: "All five Zang connect to the tongue, not just Heart." Tongue sores often stem from Spleen Deficiency. Fever patterns vary (morning vs. afternoon, tidal fever, palm/sole heat). Avoid dispersing/clearing; strictly avoid cold/purging. Treat by regulating Spleen. Do not mistake for Fire. Using Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Lianqiao (Forsythiae Fructus), Mutong (Akebiae Caulis), Dengxincao (Junci Medulla), Xijiao (Rhinocerotis Cornu - substitute available), Zhizi (Gardeniae Fructus) turns white sores red, spreading to tongue tip/sides/lips. Adding more cold herbs worsens it. Physicians blaming Spleen-regulation are ignorant and cruel. This stems from lacking fundamental medical knowledge. Commonly called "Dui Xin Chuang" (Opposite Heart Sore); initial whiteness indicates Deficiency, not Excess Fire. "All pain/sores/itching belong to Fire" is a generalization, not specific to tongue sores. One must study Xue’s *Kouchi Lei Yao* and various formulas, not follow popular trends for profit. Medicine is a benevolent art; practitioners must be broad and precise, not biased.

For sores with tidal fever unresolved: Liu Jun Zi Tang (Six Gentlemen Decoction) plus Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), and Maidong (Ophiopogonis Radix). With diarrhea: Qi Wei Bai Zhu San (Seven-Ingredient White Atractylodes Powder). Post-illness Spleen Deficiency: Si Jun Zi Tang (Four Gentlemen Decoction) plus Danggui, Baishao. Alternating chills/fever: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Post-malaria with abdominal distension: Yi Gong San (Extraordinary Ability Powder) plus Danggui, Baishao. Cough without phlegm, occasional internal heat: Jin Shui Liu Jun Jian (Metal-Water Six Gentlemen Decoction). Middle Jiao Deficiency Cold, cold fingertips, pale face: Li Zhong Tang (Regulate the Middle Decoction). Lower Jiao Yin Fire, or excessive cold herbs causing purple-red lips/tongue, thirst without desire to drink, or Dryness invasion: Nourish Yin and clear dryness with heavy Shudihuang. Method in *Bai Fu Lun*. Topical: Kou Gan San (Mouth Ulcer Powder), Sheng Gong Dan, or Shen Gong Dan. Upper Jiao Excess Heat, scorched yellow coating, thirst: Daochi San plus Maidong, Danpi (Moutan Cortex), Beimu (Fritillariae Bulbus), Hei Zhizi (Black Gardeniae Fructus). Topical: Qingxue Dan or Sheng Gong Dan. Tongue sores, though minor, require pulse verification. Symptom-pulse match ensures easy cure. Excess symptoms never have Deficient pulses; Deficient symptoms never have Excess pulses. This is easier to diagnose than Shaoyin disease or miscellaneous disorders.

Tongue sores strictly forbid washing with Lipu Ci Ke (Prickly Ash Shell) decoction. Its bitter-cold/astringent nature makes it hard to treat if used mistakenly, causing spreading and delayed healing. Green moss (Qing Tai) decoction is also forbidden; it is damp, cold, slightly toxic, and harmful. Mulberry sap (Sangshu Zhi) applied to mouth sores is excellent: sweet/mild, no burning pain, treats candidiasis too.

She Gan (Tongue Ulcer) and swelling/pain on tongue sides, or rotten sores under tongue with yellow-white center and red rim, are difficult to treat. Physicians misdiagnose as Heart Fire, using Xiexin/Daochi. If ineffective, they add Xijiao, Huanglian, Huangbai, Zhimu. Cooling increases obstruction, leading to widespread tongue rot or persistent swelling, becoming untreatable败症 over years. This stems from emotional depression, Liver Qi stagnation, and worry. Classics: "Liver meridian connects to tongue sides; all Zang connect to tongue, not just Heart." Treat from Liver. Early stage (before cold herbs) is treatable. Once cold herbs are mixed, treatment is hard. Initial treatment: Hei Xiaoyao San (Black Free and Easy Wanderer Powder) plus Danpi. Next: Gui Shao Di Huang Tang (Rehmannia and Peony Rehmannia Decoction). For prolonged worry/depression: Hei Guipi Tang (Black Restore the Spleen Decoction) minus Yuanzhi, plus Danpi. For Liver Blood Deficiency with Fire: Zishen Shenggan Yin (Nourish Kidney Generate Liver Infusion). For Liver Stagnation: Zishen Shugan Yin (Nourish Kidney Soothe Liver Infusion) or Xiaoyao San. Prolonged cooling fails, leading to dental abscess or Gu Cao Feng (Bone Channel Wind). Cheek perforation is hard to treat. Follow Xue’s differentiation and ascending Clear Qi methods. For Gu Cao Feng, follow *Zhengzhi Quansheng Ji*.

Cheek swelling: Initially disperse/clear; later tonify. Study *Waike Dacheng*, Xue’s works, and *Zhengzhi Zhunsheng*. External application: Leichi (Fermented Soybean) and Hongdou (Red Bean) powder mixed with egg white.

Small blisters in mouth/tongue from chewing food need not be pricked. Pinch hands together, insert inside clothes, tie belt knot, let hang down; blisters disappear naturally. Calm mind accelerates effect. Strange but verified. Restless patients get less effect. Similar to treating Hordeolum (Stye) by piercing red thread into clothing corner.

Zouma Ya Gan (Running Horse Dental Gangrene) must differentiate Cold/Heat/Excess/Deficiency; do not assume Yangming Excess Fire. Common post-measles/smallpox in children, often from excessive cold herbs. Gum swelling/pain treated with cold herbs turns into gangrene with profuse saliva, lip/ch cheek perforation. Spicy/fried foods or hot/warming pills also cause it.