Library

The *Suwen* (Basic Questions) states: In the theory of Six Qi and Five Movements, when Shaoyang (Lesser Yang) prevails, it leads to throat obstruction (Hou Bi), tinnitus, and vomiting with regurgitation. It further states: When Shaoyang governs the Heavenly Qi, during the third phase of the year, intense heat and summer warmth arrive, causing the people to suffer from throat obstruction; this belongs to Fire pathogenic factors, and Zhang Zhongjing's Jiegeng Tang (Platycodon Decoction) is appropriate. Or, if the face is red with macules, it belongs to Yang Toxin (Yang Du), and various formulas for Yang Toxin should be used to induce sweating. It also states: When Taiyin (Greater Yin) wins over, internal stagnation of Fire occurs, leading to throat obstruction. Furthermore: When Taiyin governs the Earthly Qi, excessive Dampness causes swelling of the pharynx and throat obstruction; this belongs to Dampness pathogenic factors, and Banxia Guizhi Gancao Tang (Pinellia, Cinnamon Twig, and Licorice Decoction) from Zhu Gong's *Huoren Shu* is appropriate. Additionally: When Taiyang (Greater Yang) governs the Earthly Qi, excessive Cold causes the people to suffer from sore throat and submandibular swelling; this belongs to Cold pathogenic factors. For mild cases, exterior-dispersing methods are used; for severe cases, middle-warming methods are employed, and Sini Tang (Frigid Extremities Decoction) is used as appropriate. Or, if the face is blue-black, it belongs to Yin Toxin (Yin Du), and various formulas for Yin Toxin should be used to induce sweating. Commentary: Although the theories of Six Qi and Five Movements differ in terms of Fire, Dampness, and Cold, Dampness generates Heat within, and Cold causes Fire to stagnate internally; ultimately, they all converge on Fire. Therefore, the general principle of treatment is dispersal. Techniques such as acupuncture, knife-lancing (Bian stone therapy), and medications like Chilín San (Red Lin Powder), Jinbi Er Dan (Golden and Green Elixirs), which are extremely bitter-cold or acrid-hot, are occasionally necessary but must never be administered lightly or indiscriminately. Caution is essential. (Commentary by Xiu Yun)

Internal Causes: Due to phlegm-fluid retention originally present in the chest and diaphragm, or excessive indulgence in alcohol, or abnormal anger, or irregular sexual activity, Fire stirs up Phlegm, surging and blocking between the throat and pharynx, resulting in internal and external swelling and pain, making it impossible to swallow even water or gruel. (*Yi Jian*) Some cases belong to epidemic diseases caused by heavenly timing, some are due to emotional depression and knotting, some result from Cold invading the hyoid bone area (huiyan), and some arise from Cold injuring the Kidney causing swelling in the throat.

External Manifestations: External signs are numerous and have been recorded in the previous section, so they are not repeated here. (Commentary by Xiu Yun) If toxic pathogens accumulate internally, with thick and sticky saliva, presenting only with chills and fever, it is called Sai Hou Feng (Blocked Throat Wind). Sudden onset and rapid death is named Zouma Hou Feng (Running Horse Throat Wind). (Commentary by He Hanzhang) Zouma Hou Feng involves sudden loss of voice, unconsciousness, phlegm congestion, locked jaw, and death by blockage, resembling various types of stroke, but must be distinguished by the prior presence of sore throat. (Commentary by Li Xing'an)

On the Difference Between Throat (Hou) and Pharynx (Yan): Throat obstruction refers to blocked breathing in the throat and inability to speak, representing the blockage of Heavenly Qi. Sore throat refers to the inability to swallow saliva and food in the pharynx, representing the blockage of Earthly Qi. (*Lei Yao*)

Patients with throat obstruction must have concomitant sore throat, but those with sore throat do not necessarily have throat obstruction. (Commentary by Wang Yutai)

On the Distinction Between Exterior and Interior Syndromes: Syndromes belonging to the Exterior must include aversion to cold, and the Cun pulse at the wrist is weaker and smaller than the Guan and Chi pulses; this indicates Cold closing the exterior and Heat stagnating internally, requiring acrid-cool dispersing methods, and strictly avoiding sour-cold astringents. Syndromes belonging to the Interior present with no body heat but a slippery Cun pulse larger than the Guan and Chi pulses; this indicates accumulated Heat internally causing stagnation and Phlegm formation, requiring bitter-cold suppression and emetic methods. (Commentary by Li Xing'an) There are also mild exterior syndromes without chills or fever that require careful differentiation. (Commentary by Xiu Yun) Aversion to cold with a small Cun pulse, especially when similar illnesses occur in the same locality, belongs to epidemic seasonal Qi, requiring initial exterior dispersal. The use of sour-cold topical powders and bitter-cold purgatives is strictly forbidden. (Commentary by Jing Songya)

Differentiating Deficiency and Excess Syndromes: Excess Fire results from improper consumption of fried, roasted, and grilled foods and strong wine, leading to heat-toxin accumulation, chest discomfort, irritability, thirst, and constipation. Deficiency Fire results from emotional stress and fatigue/sexual excess, where Qi deficiency causes deficient Fire to flare upward, leading to dryness of the throat and epigastrium, with normal bowel and bladder movements. (*Ru Men*)

Differentiating Yin and Yang: In Yang Deficiency, both Cun pulses are floating and large, worsening with exertion; this indicates Lung and Spleen Qi weakness failing to control the Lower Jiao, requiring tonification of the Middle Jiao (Spleen/Stomach). In Yin Deficiency, both Chi pulses are flooding and rapid, worsening in the late afternoon; this indicates Liver and Kidney Yin deficiency failing to control Dragon-Liver Fire, requiring nourishment of Gui Water (Kidney Water). Regarding pulse diagnosis: Floating, flooding, and overflowing Cun pulses indicate throat obstruction. Fine and weak Chi pulses indicate deficient inflammation. If pulses are extremely faint and hidden, death ensues. If floating and large yet choppy, death ensues. If deep and fine, it is untreatable. If flooding and forceful, it is easily treatable. Wiry, rapid, and forceful pulses indicate Excess Fire; empty, rapid left Cun and weak Chi pulses indicate Deficient Fire, requiring nourishment of Metal and Water (Lung and Kidney). If both pulses are floating and large but become choppy upon heavy pressure, this indicates severe Yin deficiency with floating Yang; treating with pure Yin-tonifying and Yang-astringing methods, specifically decocting a single dose of Ren Shen (Ginseng Radix et Rhizoma) for drinking, is required. Treating with standard throat-specialist cooling methods will certainly lead to death.

Treatment Methods: Throat conditions vary and cannot generally be treated solely as Excess Heat. Generally, Heat is treated by draining, Cold by tonifying, and neither extreme by regulating according to the meridians. Decoctions cleanse, supplemented by external methods like acupuncture; these require urgent treatment without delay, unlike chronic organ diseases that allow for slow conditioning. (*Shengji Lu*)

For treating Excess syndromes, mild cases first require dispersal, followed by cooling. Severe cases first require inducing vomiting to expel phlegm, bloodletting via acupuncture/lancing, followed by decoctions. For treating Deficiency syndromes, one must follow the principle of "treating contrary to appearance" from the *Neijing*, proceeding slowly. (*Zheng Chuan*) Generally, throat conditions worsen after four to five days; before three days, they can be resolved. If not an acute condition, chills and fever may not appear until the third day. If accompanied by headache, it indicates concurrent Cold invasion, requiring wind-dispelling and cold-expelling methods. Ask about bowel and bladder movements: if unobstructed, it is floating wandering Fire attacking upward, requiring wind-eliminating, heat-clearing, qi-descending, and toxin-resolving formulas. For women with sore throat, ask about menstruation first; if amenorrheic, using menstruation-promoting herbs will cure it. Throat pain radiating to the chest with redness, swelling, and pain, accompanied by a floating, flooding, and rapid Right Cun pulse, indicates Lung Abscess (Fei Yong); honey-modified medicine with Baicao Shuang (Cinnabar Dust) and Jie Geng (Platycodon Root) is appropriate. For diffuse redness and swelling without visible lesions in the throat, Deng Xin Hui (Juncus Ash) should be used frequently. For ulcerated/throat tissue breakdown, apply flesh-generating powder first, then Bi Dan (Green Elixir). If phlegm cannot be expectorated, use Jin Dan (Golden Elixir) with a little processed Zao Jiao (Gleditsia Sinensis Fruit); if perforation occurs, use mouth ulcer medicines with Long Gu (Fossilized Bones) and Zhen Zhu (Pearl). Throat conditions without phlegm are not difficult to treat; those with phlegm producing sounds like sawing wood are critical, treated with Jin Dan insufflation. Initial chills followed by cooling of the body, no oral ulcers, no double tongue, and clear bowels/bladder indicate it is not a Heat syndrome; indeed, Deficiency-Cold can generate phlegm. This phlegm should not be completely expelled, differing from the phlegm of Ru E (Tonsils) and She (Tongue) where expulsion resolves swelling. Initially use insufflation powder; once the throat opens, take the first decoction for dispersal, the second for harmonizing, then warming tonification to guide fire and integrate Qi. If chills recur after three to four days, or chest/hypochondriac pain appears, it is difficult to treat. During attacks, if the jaw is tight, throat/tongue swollen, mouth ulcerated with foul odor, double tongue present, or tongue coating yellow with prickles, and constipation exists, this is a Heat syndrome; Chilín San, Jiao Yao, Zi Di Tang, Jin Dan, Bi Dan, and Kai Feng Lu Zhen (Wind-Opening Road Acupuncture) are all highly effective. If symptoms persist despite correct treatment, jaw locks further, lips are not swollen, and the patient appears healthy otherwise, it is untreatable. (*Zun Sheng Shu*)

On Contraindications for Cold/Cooling and Lancing: Using purely bitter-cold herbs like Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Zhi Zi (Gardenia Fruit), and Huang Bai (Phellodendron Bark) as direct treatment leaves upper Heat unresolved while triggering Middle Jiao Cold; toxins enter the abdomen through deficiency, becoming fatal. (*Zheng Chuan*) For Deficient Fire flaring upward, using purely cold/cooling herbs inevitably causes upper wheezing and lower diarrhea. Sweating induction and bloodletting are also strictly contraindicated. For internal injury with deficiency damage, sore throat, and loss of voice, mistaken lancing is incurable. (*Song Ya*) For throat swelling caused by Cold injuring the Kidney, few recognize this pattern; Bajie Wan (Eight-Ingredient Pill) modified is appropriate. Lancing the throat (Hou Hua) is strictly forbidden as it concerns life and death; caution is essential. (Commentary by Xiu Yun)

Fatal Signs: Swelling rising high on the chest, upper wheezing and lower diarrhea, cyanosis of fingernails/toes, total refusal of food after seven days, and a mouth opening like a fish's gill indicate death. In acute throat obstruction, snoring-like sounds indicate Lung Exhaustion and certain death. Ren Shen (Ginseng), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice) might save one in ten thousand. Tongue swelling filling the mouth, colored like walnut, eggplant, or cinnabar paper, is untreatable. Thirst, wheezing, phlegm like peach gum, neck-wide swelling, and facial coloration of red-purple, blue, or pure white without spirit are all untreatable. Throat wind lasting more than a day and night, with locked jaw and thunderous throat sounds extinguishing nearby lamps, indicates Qi has separated from its root, ascending without descending; this is untreatable. Wheezing with forehead sweating is untreatable. (Commentary by Jing Rizhen)

Medication Modification Methods: The main formula is Ganjie Tang (Licorice and Platycodon Decoction), modified with Bo He (Mint), Jing Jie (Schizonepeta), Fang Feng (Saposhnikovia), Huang Qin (Scutellaria), Xuan Shen (Scrophularia), Niu Bang Zi (Arctium Seed), and Zhu Ru (Bamboo Shavings). Add Bei Mu (Fritillaria) and Chen Pi (Citrus Peel) for cough. Add Hua Fen (Trichosanthes Root) and Mai Dong (Ophiopogon) for thirst. Add Zi Wan (Aster) for hemoptysis. Add Ban Xia (Pinellia) for nausea/vomiting. Add Zhi Ke (Aurantium) for chest fullness. Add Da Huang (Rhubarb) for constipation. Add Shi Gao (Gypsum) for severe phlegm. Add Chuan Huang Lian (Coptis) for severe Fire. For sudden closure and collapse, use Jiedu Xionghuang Wan (Detoxifying Realgar Pill). These are methods for treating Excess Fire. For Deficiency patterns, flexibility is key; ancients used Rou Gui (Cinnamon Bark), Ren Shen (Ginseng), Fu Zi (Aconite), and Pao Jiang (Prepared Ginger), regulating the lower body so the upper settles naturally; this is treating the root. Generally, Blood Deficiency uses Siwu Tang (Four Substance Decoction), Qi Deficiency uses Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Liver Fire uses Xiaoyao San (Free and Easy Wanderer Powder), and Kidney Deficiency uses Dihuang Tang (Rehmannia Decoction), supplemented by symptomatic treatments. For Mingmen Fire decline with Dragon Fire floating causing throat pain, Bajie Wan (Eight-Ingredient Pill) is most effective. Cold/cooling agents must never be used recklessly. (*Hui Bu*) Sore throat requires Jing Jie (Schizonepeta); Yin Deficiency with Fire Flare requires Xuan Shen (Scrophularia); Qi Deficiency adds Ren Shen (Ginseng) and Zhu Li (Bamboo Sap); Blood Deficiency adds Zhu Li (Bamboo Sap) to Siwu Tang (Four Substance Decoction). (Commentary by Danxi) All throat conditions strictly forbid Ban Xia (Pinellia) and Sheng Jiang (Fresh Ginger), favoring Li Zhi (Pear Juice) and Shi Zi (Persimmon). (Commentary by Song Ya) Zi Xue (Purple Snow) is the essential medicine for all throat pains. (Commentary by Cheng Yunlai) Zi Xue is purely cold; it should not be used for severe cases alone, but combined with Chilín San (Red Lin Powder) for best results. (Commentary by Xiu Yun)