夫咽为胃主纳，喉为肺主出，司呼吸，肺无下窍，故能受清虚之气，而不能受有形
之物，咽上有物如悬乳，其名会厌，凡物入口则舌抵上 ，会厌必折其喉，故水谷得
入咽耳。若痘生会厌，则水强不利开关，所以食有渣滓，自能入咽，水饮则漏入喉而呛
也。更有吐食者，《经》曰∶胃为贲门。若毒火熏灼于胃，则贲门有疮而伤矣。贲门伤
则门户隘塞，是以食物不能直奔于胃，缓则 而下，急则咀而吐出矣。水谷既不能
通，药石又不能治，故为恶候。然手少阴君火，心主之脉气，手少阳相火，三焦之脉
气，并络于咽喉，痘毒之起，君相二火主之，其火上蒸，故咽喉最为先受，是以发热
见点之初，不问咽喉痛与不痛，先为发散解利。如稍迟缓，则毒留肿塞，饮食不入，呼
吸不能而危矣。故如外痘稠密，而咽喉之内独少不痛者，是毒已尽出，不必过虑。如内
多而痛者，须防充贯之时，水呛吐食失声之变。故宜预治，务使外痘，先行蒸长，充托
成浆，则热毒分消于外，而内症自轻，咽疮之患可无虑也。然此而至收靥之后，咽音日
轻一日，吉；如病益甚，而喉中气响 如水声者，死。咽疮破烂，音哑断食者，死。
夫气出于肺之气喉而为声，肺清则声清，肺热则声哑，盖肺属金，金空则鸣，惟
痘疮之发，热毒上行，热能生痰，或因风寒阻塞腠理，是以痰唾粘稠，有碍气道，故乃音哑，兼
有其毒冲逆咽喉而成为痘，肺窍窄狭，故亦有音哑，是肺金受火邪之克也。凡痘色红紫呛而音
哑者，乃火气炎上，热毒壅塞也。如痘色灰白不起，呛而音哑者，乃血气虚弱，脾胃受伤也。总
之，七日前发呛失音者，此毒瓦斯熏蒸，失于调解，以致肺窍不通，闭塞管龠，甚或毒无从泄，乃
内疮糜烂舌根成坑，咽门腐坏，呼吸俱废，变为不治之症，其外痘必不光润也。惟六七日后，外
痘蒸长光润而有此者，是内痘亦长使之而然，外痘结痂，则内症自愈，不必虑也。故善治者，
若见热壅毒盛之症，则用甘桔、牛蒡、玄参、荆芥之类，以清气道，不致毒之有犯，则自能免此患
矣。否则，热毒攻卫，或有发为卒然肿痛，水浆难入，言语不通，死生顷刻者。大凡喉病最宜下
利，此外症之最危者也。然有内本无疮，因为热毒熏蒸，或误食辛热之物所致者，急用甘桔、玄参、
牛蒡之类。如能言而但声不清者，是火乘于肺也，宜用甘桔、花粉、玄参、麦冬之类。若感风寒闭
塞而声不清者，则宜参苏饮加减服之，治之而即效者吉，不效者凶。盖声虽出于肺，而其源实根
于丹田之元气，故诸病声音清者，谓之形病而气不病，未病而音哑者，形不病而气病也。既病而
晋哑者，形气俱病也。（张）按∶喉之为患，莫非火之为害。火，无形者也，焚灼迅速，岂容再误于
药！故脉实洪数者为实热，宜用清凉之法而正治；脉虚细数者为阴虚，宜用假令之法而从治；
少差毫厘，便致一息不运，慎哉！
咽喉是胃受纳食物的通道，喉部由肺所主，主管呼吸排出。肺没有向下的孔窍，因此只能接受清虚之气，而不能容纳有形的物体。咽喉上方有一块像悬垂乳头一样的组织，名叫会厌。凡是食物入口时，舌头抵住上颚，会厌就会弯曲遮盖喉部，所以水谷才能进入咽部。如果痘疹生在会厌处，那么水液就难以顺利通过开关（会厌），因此含有渣滓的食物能自然进入咽部，而饮水则会漏入喉中引起呛咳。还有呕吐饮食的情况，《黄帝内经》说：胃的上口称为贲门。如果毒火熏灼胃部，导致贲门生疮受损。贲门受伤则门户狭窄堵塞，因此食物不能直接奔入胃中，缓慢时则反流而下，急促时则咀嚼后吐出。水谷既不能通过，药物又无法治疗，所以成为恶候。然而手少阴心经的君火脉气与手少阳三焦经的相火脉气，都联络于咽喉。痘毒发作，由君火和相火主导，这两股火上蒸，所以咽喉最先受邪。因此在发热出痘初期，不论咽喉是否疼痛，都要先采用发散解表的方法。如果稍微迟缓，毒邪滞留导致肿胀堵塞，饮食无法进入，呼吸受阻，就会危及生命。所以如果体表痘疹稠密，而咽喉内部唯独不痛，说明毒邪已经全部外发，不必过分担忧。如果体内痘疹多且疼痛，必须防止在痘疹充盛贯顶之时，出现水呛、吐食、失声等变证。因此应当预先治疗，务必使体表痘疹先行蒸长，充实托毒成浆，这样热毒就能分散消解于体外，内部症状自然减轻，咽喉生疮的祸患就可以不用担心了。然而到了收靥结痂之后，咽喉声音一天天减轻，这是吉兆；如果病情加重，喉中有气响如水声者，主死。咽喉疮疡破烂，声音嘶哑且断绝饮食者，主死。
声音出于肺的气道，肺清则声音清脆，肺热则声音嘶哑。肺属金，中空则鸣响。只有痘疮发作时，热毒上行，热能生痰，或者因为风寒阻塞腠理，导致痰唾粘稠，阻碍气道，从而引起声音嘶哑。再加上痘毒冲逆咽喉形成痘疹，肺窍窄小，所以也有声音嘶哑，这是肺金受到火邪克制。凡是痘色红紫，伴有呛咳和声音嘶哑的，是火气炎上，热毒壅塞所致。如果痘色灰白不起发，伴有呛咳和声音嘶哑的，是血气虚弱，脾胃受伤所致。总之，发病七日前出现呛咳失音的，这是因为毒瓦斯熏蒸，失于调理，导致肺窍不通，闭塞管龠，甚至毒邪无处宣泄，导致内部疮疡糜烂、舌根成坑、咽门腐坏，呼吸停止，变为不治之症，其体表的痘疹必然不光泽润泽。只有在六七日后，体表痘疹蒸长光润而出现这种情况的，是因为内部痘疹也随之生长所致，待体表痘疹结痂，内部症状自然痊愈，不必担忧。所以善于治疗的人，如果见到热壅毒盛的病症，就使用甘草、桔梗、牛蒡子、玄参、荆芥之类的药物，以清气道，不让毒邪侵犯，自然能避免这种祸患。否则，热毒攻袭卫分，可能突然引发肿痛，水浆难入，言语不通，生死只在顷刻之间。大凡喉病最适宜通利大便，这是外症中最危险的。但是如果有内部原本没有疮疡，只是因为热毒熏蒸，或误食辛辣热物导致的，急用甘草、桔梗、玄参、牛蒡子之类的药物。如果能说话但声音不清脆的，是火邪乘袭肺脏，宜用甘草、桔梗、花粉、玄参、麦冬之类的药物。如果是感受风寒闭塞导致声音不清脆的，则宜用参苏饮加减服用，治疗见效的为吉，无效的为凶。盖因声音虽出于肺，但其根源实在丹田的元气。所以各种疾病中声音清亮的，叫做形病而气未病；未患病前声音嘶哑的，是形未病而气已病；患病后声音嘶哑的，是形和气都已病了。（张）按语：喉部的病患，无非是火的危害。火是无形的，焚烧灼烧迅速，岂容用药再延误！所以脉象实大洪数的是实热，宜用清凉之法正治；脉象虚细数的是阴虚，宜用假令之法从治；稍有毫厘之差，就会导致气息断绝，务必谨慎啊！
The pharynx (Yan) is the organ where the Stomach receives food, while the larynx (Hou) is governed by the Lung and is responsible for respiration. Since the Lung has no lower orifice, it can only accept clear and empty Qi, but cannot accommodate tangible objects. Above the pharynx lies an organ resembling a hanging papilla, known as the epiglottis (Huiyan). When food enters the mouth, the tongue presses against the upper palate, causing the epiglottis to fold over the larynx, thereby allowing water and grain to enter the pharynx. If smallpox lesions develop on the epiglottis, the passage for liquids becomes obstructed. Consequently, solid food with residue can naturally enter the pharynx, whereas drinking water leaks into the larynx, causing choking. There are also cases of vomiting food. As stated in the *Classic* (*Jing*), the upper opening of the stomach is called the cardia (Benmen). If toxic fire scorches the stomach, ulcers form on the cardia, damaging it. Once the cardia is injured, the gateway becomes narrow and blocked; thus, food cannot rush directly into the stomach. If the process is slow, food flows back down; if rapid, it is chewed and vomited out. Since neither water nor grain can pass through, and medicinal stones cannot treat this condition, it becomes a malignant prognosis. However, the Qi of the Ministerial Fire of the Hand-Shaoyang Sanjiao Meridian and the Sovereign Fire of the Hand-Shaoyin Heart Meridian both connect to the throat and larynx. The onset of smallpox toxicity is governed by these two fires. As their heat steams upward, the throat and larynx are the first to be affected. Therefore, at the initial stage of fever and rash appearance, regardless of whether there is throat pain, dispersing and resolving methods should be employed first. If treatment is delayed even slightly, toxic pathogens will remain, causing swelling and blockage, preventing food intake and breathing, leading to critical danger. Thus, if external smallpox lesions are dense but the interior of the throat is notably free of pain, it indicates that the toxins have been fully expelled externally, and there is no need for excessive worry. Conversely, if internal lesions are numerous and painful, one must guard against complications such as choking on water, vomiting food, and loss of voice during the phase of full eruption. Therefore, preemptive treatment is necessary to ensure that external lesions mature and fill with pus first. This allows heat and toxins to dissipate externally, lightening internal symptoms and eliminating worries about throat ulcers. However, after the scabbing stage, if throat sounds improve day by day, it is auspicious; if the disease worsens and gas sounds in the throat resemble water, death ensues. If throat ulcers break open, accompanied by hoarseness and inability to eat, death ensues.
Sound originates from the Qi of the Lung passing through the airway; when the Lung is clear, sound is clear, but when the Lung is hot, sound becomes hoarse. The Lung belongs to Metal; metal resonates when hollow. During the eruption of smallpox, heat and toxins move upward. Heat generates phlegm, or wind-cold blocks the interstices (Couli), resulting in sticky saliva that obstructs the airway, causing hoarseness. Additionally, toxic pathogens counterflow into the throat forming smallpox lesions; since the lung orifices are narrow, hoarseness also occurs, representing the Metal element being overcome by Fire pathogens. In cases where smallpox lesions are red-purple with choking and hoarseness, it indicates flaming Fire moving upward and congested heat toxins. If lesions are grayish-white and non-elevated with choking and hoarseness, it signifies deficiency of Blood and Qi and injury to the Spleen and Stomach. In summary, choking and aphonia occurring within seven days of onset result from toxic vapors steaming upward due to lack of regulation, blocking the lung orifices and sealing the airways. Severe cases may see toxins unable to excrete, leading to erosion of internal ulcers, craters on the tongue root, corruption of the pharyngeal gate, cessation of breathing, and becoming incurable; in such cases, external lesions are invariably not lustrous. However, if this occurs after six or seven days, when external lesions are mature and lustrous, it is because internal lesions are also maturing; once external lesions crust, internal symptoms heal spontaneously, requiring no concern. Therefore, skilled practitioners, upon observing symptoms of heat congestion and abundant toxins, use herbs like Licorice Root and Platycodon Decoction (Ganjie Tang), Akebia Fruit (Niubangzi), Scrophularia Root (Xuanshen), and Schizonepeta (Jingjie) to clear the airway, preventing toxin invasion and avoiding such complications. Otherwise, heat toxins attacking the Defensive level may cause sudden swelling and pain, difficulty swallowing fluids, inability to speak, with life and death decided in an instant. Generally, throat diseases benefit most from purgation, which is among the most critical external conditions. However, if there are no internal ulcers initially, caused merely by heat toxin steaming or ingestion of spicy-hot foods, urgently use Licorice Root, Platycodon, Scrophularia, and Akebia Fruit. If speech is possible but unclear, it indicates Fire invading the Lung; use Licorice Root, Platycodon, Trichosanthes Root (Huafen), Scrophularia, and Ophiopogon Root (Maidong). If hoarseness is due to wind-cold obstruction, use modified Ginseng and Perilla Decoction (Rensu Yin); efficacy indicates good prognosis, while ineffectiveness indicates poor prognosis. Although sound emerges from the Lung, its root lies in the Yuan Qi of the Dantian. Thus, in various diseases, clear voice despite illness is termed "Form ill, Qi healthy"; aphonia before illness onset is "Form healthy, Qi ill"; and aphonia after illness onset is "Both Form and Qi ill." (Zhang) Commentary: Disorders of the throat are invariably caused by Fire. Fire is formless and burns rapidly; how can medication errors be tolerated! Therefore, a pulse that is excess, large, flooding, and rapid indicates Excess Heat, treated with cooling methods (Orthodox Treatment); a pulse that is deficient, fine, and rapid indicates Yin Deficiency, treated with supportive methods (Following Treatment). A deviation of even a hair's breadth leads to cessation of breath; caution is paramount!