门人歙县吴子嘉茂才鸿勋，传治喉症方，名咽喉急症异功散，云得自苏州，灵验异常，
历试
元参六分，真麝香三分，共为细末，收藏瓷瓶封口，切勿走气，不论烂喉风、喉闭、双单喉
蛾，用寻常膏药一张，取此散如黄豆大，贴项间，患左贴左，患右贴右，患中贴中，贴三四
时即起泡，用银针挑破即愈，凡阴证起泡更速。（此方亦见《疫痧草》。）
《金匮翼》烂喉痧方，最为神妙。药用西牛黄五厘，冰片三厘，象牙屑三分焙，人指甲
五厘，（
砖上者可用，木板上者不可用），共为极细末，吹患处。凡属外淫喉患，无不应手而瘳，不
特烂喉痧奉为神丹也。惟药品修制不易，猝难即得，有力者宜预制备用。如一时不及修合，
别有简便之法∶用壁钱五六个，瓦焙为末，加人指甲末五厘，西牛黄三厘，亦效。又治喉蛾
方，断灯草数茎缠指甲，就火熏灼，俟黄燥，将二物研细，更用火逼壁虱（即臭虫）十个，共
捣为末，置银管，向患处吹之神效。见黄霁青（太守安涛贤已编）。
临症视舌。最为可凭，然亦未可执一。《正义》云∶凡见黑舌，问其曾食酸甜咸物，则能染
成黑色，非因病而生也。然梁成之黑，必润而不燥，刮之即退为异。又惟虚寒舌润能染，若实热
舌苔干燥，何能染及耶？凡临症欲视病患舌苔燥润，禁饮汤水，饮后则难辨矣。《重庆堂随
笔》云∶淡舌白苔，亦有热症，黄浓满苔，亦有寒症，舌绛无津，亦有痰症，当以脉症便溺
参勘。又白苔食橄榄即黑，（凡酸物皆然。）食枇杷即黄，又如灯下看黄苔，每成白色，然则
舌虽可凭，而亦未尽可凭，非细心审察，亦难免于误治矣。
黑舌苔有寒热之分，辨别不精，死生立判。汪苓友谓舌苔虽黑，必冷滑无芒刺，斯为阴
证无疑，诚扼要之言也。（舒驰远《伤寒集注》）谓黑苔干刺为二证，一为阳明热结，阴津立亡，
法主大黄、芒硝，急夺其阳，以救其阴，阴回则津回。一为少阴中寒，真阳霾没，不能熏蒸
津液，以致干燥起刺，法主附子、炮姜，急驱其阴，以回其阳，阳回则津回。据此则黑苔冷
滑者，必无阳证，而黑苔干刺者，有阳证复有阴证矣。临症者可不慎欤？
舌现人字纹，多因误投寒药所致，杨乘六治沈姓感症危甚，舌黑而枯，满舌遍裂人字纹
，曰∶脉不必诊也。此肾气凑心，八味证也，误用芩连，无救矣。逾日果殁。
程杏轩治农人患伤寒数日，寒热交作，自汗如雨，脉虚神倦，舌苔白滑，分开两歧，宛
如刀划，询知误服凉药，与六味回阳饮，服之有效，断进左右二归饮数剂，舌苔渐退而安。又《
伤寒金镜录》有裂纹如人字形者，因君火燔灼，热毒炎上而发裂，宜用凉膈散，此则舌见红
色，又当细辨脉症，分别治之。
缪氏子年十六，舌上重生小舌，肿不能食，医以刀割之，敷以药，阅时又生，屡治不痊
，精力日惫，向余求药，检方书用蛇蜕烧灰研末敷之，（不用刀割。）立愈，后不复发。
我的学生、歙县秀才吴鸿勋，传授了一个治疗咽喉急症的方子，名叫“咽喉急症异功散”，说是从苏州得来的，疗效极其显著。
玄参六分，真麝香三分，共同研磨成细末，收藏在瓷瓶中并封口，千万不要让药气散失。无论是烂喉风、喉闭还是双单侧的喉蛾（扁桃体炎），取一张普通的膏药，放上如黄豆大小的此药散，贴在颈部患处：左侧患病贴左侧，右侧患病贴右侧，中间患病贴中间。贴敷三四小时后就会起泡，用银针挑破即可痊愈，凡是阴证类型的，起泡速度更快。（这个方子也见于《疫痧草》一书。）
《金匮翼》中记载的治疗烂喉痧的方子，最为神妙。药用西牛黄五厘，冰片三厘，象牙屑三分（需焙干），人指甲五厘（砖上生长的可用，木板上生长的不可用），共同研磨成极细的粉末，吹入患处。凡是属于外感邪气引起的咽喉疾患，没有不立刻治愈的，不仅仅是烂喉痧将其奉为神丹。只是这些药材的炮制和采集不容易，突然之间难以得到，有钱有势的人应该预先制备以备不时之需。如果一时来不及炮制调配，另有简便的方法：取五六个壁钱（即灶马或类似昆虫），在瓦片上焙干研成末，加入人指甲末五厘，西牛黄三厘，也有效。又有一个治疗喉蛾的方子：剪断几根灯心草缠绕在人指甲上，就在火边熏烤，等到变黄干燥后，将这两样东西研细，再用火逼出十个壁虱（即臭虫），一起捣碎研成末，放入银管中，向患处吹送，效果神奇。这是见之于黄霁青（太守安涛贤已编纂）的记录。
临症时观察舌象，是最为可靠的依据，但也不可拘泥固执。《正义》中说：凡是见到黑舌，要询问患者是否吃过酸、甜、咸的食物，因为食物能染成黑色，并非因病而生。然而，梁成（一种食物）导致的黑舌，必然是湿润而不干燥的，刮之即退，这是异常的情况。另外，只有虚寒体质且舌面湿润时才容易被染色，如果是实热证，舌苔干燥，怎么能被染色呢？凡是在临症想要观察病患舌苔的燥润情况时，应禁止饮用汤水，因为饮水后就难以辨别了。《重庆堂随笔》中说：淡白舌伴白苔，也有热证；黄厚满布舌苔，也有寒证；舌色深红无津液，也有痰证，应当结合脉象、症状和二便情况进行综合判断。另外，吃橄榄会使白苔变黑（凡是酸性食物都是如此），吃枇杷会使舌苔变黄；又如灯光下看黄苔，往往看成白色。既然如此，舌象虽然可以作为参考，但也并非完全可信，如果不细心审察，也难免导致误治。
黑舌苔有寒证和热证的区别，辨别不精确，生死立判。汪苓友认为舌苔虽然发黑，但必定冷滑而无芒刺，这才是阴证无疑，这确实是扼要之言。（舒驰远在《伤寒集注》中）认为黑苔干而有芒刺分为两种证候：一种是阳明热结，阴津立刻亡失，治法主要用大黄、芒硝，急夺其阳热，以救其阴津，阴津恢复则病情好转；另一种是少阴中寒，真阳被阴霾遮蔽，不能熏蒸津液，以致干燥起刺，治法主要用附子、炮姜，急驱其阴寒，以回复阳气，阳气回复则津液自生。据此来看，黑苔冷滑的，必然没有阳证；而黑苔干而有芒刺的，既有阳证也有阴证。临症者能不谨慎吗？
舌面上出现“人”字形的裂纹，多是因为误用了寒凉药物所致。杨乘六治疗一位姓沈的患者，感受外邪病情危重，舌色黑而干枯，满舌遍裂成人字形裂纹，说：“脉象不必诊察了。这是肾气凑心，属于八味丸证，误用了黄芩、黄连，无法挽救了。”过了一天果然去世。
程杏轩治疗一位农民患伤寒几天，寒热交替发作，自汗如雨，脉象虚弱精神疲倦，舌苔白滑，分开两歧，宛如刀划的痕迹，询问得知是误服了凉药，给予六味回阳饮服用，见效后，断断续续进服左右二归饮几剂，舌苔逐渐消退而痊愈。另外，《伤寒金镜录》中有裂纹如人字形的，是因为君火燔灼，热毒炎上而引发裂纹，宜用凉膈散治疗，这种情况下舌色呈现红色，又应当仔细辨别脉症，分别进行治疗。
缪氏的儿子十六岁，舌头上重新长出一个小舌头，肿胀不能进食，医生用刀割除，敷上药物，过了一段时间又长出来，多次治疗都不痊愈，精力日渐疲惫，向我求药。我查阅医书，用蛇蜕烧成灰研末敷之（不用刀割），立刻痊愈，后来没有再复发。
My student, Wu Hongxun, a *Xiucai* (scholar) from Shexian, transmitted a prescription for treating acute throat conditions, named "Yan Hou Ji Zheng Yi Gong San" (Extraordinary Efficacy Powder for Acute Throat Emergencies). He stated it was obtained from Suzhou and possessed extraordinary efficacy.
*Xuanshen* (Radix Scrophulariae, 6 fen), *Zhen Shexiang* (Real Musk, 3 fen), were ground together into a fine powder, stored in a porcelain bottle with the seal tight to prevent the loss of medicinal qi. Regardless of whether it is *Lan Hou Feng* (Rotting Throat Wind), *Hou Bi* (Throat Closure), or *Shuang Dan Hou E* (Bilateral or Unilateral Tonsillitis), apply a piece of ordinary plaster, place a dose of this powder the size of a soybean on it, and adhere it to the neck: if the affliction is on the left, apply to the left; if on the right, apply to the right; if in the center, apply to the center. After three to four hours, a blister will form. Puncture it with a silver needle, and it will heal. For *Yin* syndrome types, the blister forms even faster. (This prescription is also recorded in *Yi Sha Cao*).
The prescription for *Lan Hou Sha* (Rotting Throat Plague) found in *Jin Kui Yi* is most miraculous. It uses *Xi Niu Huang* (Western Calculus Bovis, 5 li), *Bingpian* (Borneol, 3 li), *Xiangya Xie* (Ivory Chips, 3 li, roasted), and *Ren Zhijia* (Human Nail, 5 li—those grown on bricks are usable, those on woodboards are not). These are ground into an extremely fine powder and blown into the affected area. For any throat affliction caused by external pathogenic factors, there is no case that does not heal promptly. It is not only revered as a divine pill for *Lan Hou Sha*. However, the preparation and acquisition of these medicines are difficult and hard to obtain suddenly. Those with means should prepare them in advance for emergency use. If preparation is not possible in time, there is another simple method: take five or six *Bi Qian* (House Spider/Weaver's Tent insect), roast them on a tile until dry, grind into powder, add *Ren Zhijia* powder (5 li) and *Xi Niu Huang* (3 li); this is also effective. Another prescription for *Hou E* (Tonsillitis): cut several strands of *Dengcao* (Juncus Effusus Stamen), wrap them around a fingernail, and smoke/burn over fire until yellow and dry. Grind these two substances finely. Then, using fire, extract ten *Bishi* (Bedbugs), and crush them together with the previous mixture into a powder. Place in a silver tube and blow into the affected area; the effect is miraculous. This was recorded by Huang Jiqing (Prefect An Tao Xianyi compiled it).
Observing the tongue during clinical practice is the most reliable basis, yet one must not be dogmatic. *Zhengyi* states: Whenever a black tongue is seen, ask if the patient has consumed sour, sweet, or salty foods, as these can stain the tongue black, which is not due to disease. However, blackening from Liangcheng (a type of food) must be moist and not dry, and scrapes off easily, which is abnormal. Furthermore, only tongues with deficiency-cold and moisture can be stained; if it is excess-heat with dry tongue coating, how can it be stained? When observing the dryness or moisture of a patient's tongue coating, forbid drinking soup or water, as drinking makes differentiation difficult. *Chongqing Tang Suibi* states: A pale tongue with white coating may indicate heat syndrome; a thick, full yellow coating may indicate cold syndrome; a crimson tongue without fluids may indicate phlegm syndrome. One must cross-reference with pulse and symptoms, as well as urination and defecation. Additionally, eating olives turns white coating black (all acidic foods do this); eating loquats turns the coating yellow; looking at a yellow coating under lamplight often makes it appear white. Thus, while the tongue can be relied upon, it is not entirely reliable. Without careful examination, misdiagnosis and mistreatment are inevitable.
Black tongue coating is divided into cold and heat types. Imprecise differentiation leads to immediate determination of life or death. Wang Lingyou stated that although the tongue coating is black, if it is cold and slippery without prickles, it is undoubtedly a *Yin* syndrome. This is indeed a concise and essential statement. (Shu Chiyuan in *Shanghan Jinzhu*) stated that black coating with dryness and prickles represents two syndromes: one is Yangming heat accumulation where yin fluids perish instantly; the treatment focuses on *Dahuang* (Rhei Radix et Rhizoma) and *Mangxiao* (Natrii Sulfas) to urgently purge yang heat to save yin fluids; once yin returns, fluids return. The other is Shaoyin internal cold where true yang is obscured, unable to vaporize fluids, leading to dryness and prickles; the treatment focuses on *Fuzi* (Aconiti Lateralis Radix Praeparata) and *Paojiang* (Zingiberis Rhizoma Preparatum) to urgently dispel yin cold to restore yang; once yang returns, fluids return. Based on this, black coating that is cold and slippery definitely excludes yang syndrome, whereas black coating that is dry and pricky involves both yang and yin syndromes. Can clinicians afford to be careless?
A "Ren" (human character) shaped crack on the tongue is mostly caused by the erroneous administration of cold medicines. Yang Chengliu treated a Mr. Shen who suffered from a severe exogenous condition. His tongue was black and withered, covered with cracks forming the character "Ren". He said: "There is no need to diagnose the pulse. This is Kidney Qi rushing to the Heart, indicating the Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) syndrome. The erroneous use of Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma) makes it incurable." The patient died the next day.
Cheng Xingxuan treated a farmer who had suffered from Shanghan (Cold Damage) for several days, with alternating chills and fever, profuse spontaneous sweating like rain, weak pulse, and mental fatigue. The tongue coating was white and slippery, split into two branches, resembling a knife cut. Upon inquiry, it was learned that he had erroneously taken cooling medicines. He was given Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Restore Yang), which proved effective. Subsequently, he took Zuo You Er Gui Yin (Left and Right Two Guipi Decoctions) for several doses. The tongue coating gradually receded, and he recovered. Additionally, *Shanghan Jinjing Lu* records cracks like the character "Ren", caused by the blazing of Minister Fire and upward flare of heat toxins. In such cases, Liang Ge San (Cool the Chest Powder) should be used. Here, the tongue appears red, so one must carefully differentiate the pulse and symptoms and treat accordingly.
The son of the Miao family, aged sixteen, had a small tongue growing anew on his tongue, swollen and unable to eat. A doctor cut it with a knife and applied medicine, but it grew back after some time. Multiple treatments failed, and his vitality declined daily. He sought medicine from me. I consulted medical texts and used She Tui (Ophichthidae Exuvies) burned to ash and ground into powder for application (without cutting). He healed immediately, and it did not recur.