太阳烦躁(无汗者用)大青龙,麻杏石甘(汤)温病宗,九味(羌活汤)冲和(又名冲和汤)易老制,能
令表热自肌松。
汗渴心烦白虎汤,阳明经热救中方,三黄(解毒汤)犀角(地黄汤)热归里,结实未成此法良。
晡潮便结语言狂,热结阳明承气汤,无汗不便表里实,防风通圣有兼长。
口糜龈烂出血,心、肺、胃之火盛也,宜甘露(饮)主之。俗名双、单蛾,即方书所谓喉痹
也。双蛾易治,单蛾难治,由心肾之火乘肺也,宜刺手大拇指出血。又以导赤散加桔梗、贝
母、射干治之,是为反治法。二证若服凉药不愈,宜用附子片以白蜜蒸熟,含咽其汁;又以
通脉四逆汤加猪胆汁、人尿与服;又以桂附八味汤,加黄连少许,水浸冷服,是为从治法。
此证不可纯用凉药,恐上热未除,中寒复起,毒瓦斯乘虚入腹,上喘下泄,手足厥冷,爪甲青
,口如鱼口者死。
(经义)《内经》云∶“一阴一阳结,谓之喉痹。”一阴谓心主,一阳谓三焦,二脉并结于
喉,气热内结,故为喉痹。
咽者、咽也,喉者、候也。咽接三脘以通胃,故以之咽物;喉通五脏以系肺,故以之候
气。气喉,谷咽,皎然明白。《千金》谓∶喉咙主通利水谷之道,咽门主通脏腑津液神气,
误也。
喉以纳气,故曰喉主天气,咽以纳食,故曰咽主地气。
喉风喉痹,皆由膈间素有痰涎,或因七情不节而作,火动痰上,壅塞咽喉,所以内外肿
痛,水浆不入,言语不出,可谓危且急矣。
太阳病出现烦躁症状(针对无汗者)应使用大青龙汤;麻杏石甘汤是治疗温病的宗法方剂;九味羌活汤由张元素(易老)创制,又名冲和汤,能使肌表的发热自然缓解。
若出现汗出、口渴、心烦的症状,白虎汤是救治阳明经热的中正良方;三黄解毒汤和犀角地黄汤适用于热邪归入里证的情况,此时若实结尚未形成,此法疗效良好。
若出现下午定时潮热、大便干结、胡言乱语的症状,这是热结于阳明的表现,应使用承气汤;若无汗且大便不通,属于表里俱实,防风通圣散具有兼治的优势。
口腔糜烂、牙龈腐烂出血,是由于心、肺、胃的火气旺盛所致,适宜用甘露饮为主进行治疗。俗称的双蛾、单蛾,即医书中所说的喉痹。双蛾容易治疗,单蛾难以治疗,这是由于心肾之火上乘侵犯肺脏所致,适宜针刺手大拇指出血治疗。另外可用导赤散加入桔梗、贝母、射干来治疗,这属于反治法。如果这两种证候服用凉药无效,适宜用附子片以白蜜蒸熟后,含在口中咽下其汁液;或者服用通脉四逆汤加入猪胆汁、人尿;或者服用桂附八味汤,加入少许黄连,用水浸泡后冷服,这属于从治法。此证不可单纯使用凉药,恐怕上部的热邪未除,中焦的寒邪又起,毒气乘虚进入腹部,导致上部气喘下部泄泻,手足厥冷,指甲发青,口开如鱼口状者死亡。
(经文义理)《内经》说:“一阴一阳结聚,称为喉痹。”一阴指的是心包络,一阳指的是三焦,这两条经脉并结于咽喉,气热内结,所以称为喉痹。
咽的功能是吞咽,喉的功能是候气。咽连接三脘以通达胃腑,所以用来吞咽食物;喉连通五脏以系联肺脏,所以用来候察气息。气通过喉,食物通过咽,界限分明明白。《千金方》说:喉咙主司水谷通利之道,咽门主司脏腑津液神气之通,这种说法是错误的。
喉用来接纳清气,所以说喉主天气;咽用来接纳食物,所以说咽主地气。
喉风和喉痹,都是因为膈间素有痰涎,或者因为七情失调而发作,火动痰升,壅塞咽喉,所以内外肿痛,水浆不能入口,言语不能发出,可以说是危险且急迫了。
For Taiyang disease presenting with irritability (specifically for cases without sweating), Da Qing Long Tang (Great Blue Dragon Decoction) should be used; Ma Xing Shi Gan Tang (Ephedra, Apricot Seed, Gypsum and Licorice Decoction) is the foundational formula for treating Warm Diseases (Wen Bing); Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction), created by Zhang Yuansu (Yi Lao) and also known as Chong He Tang (Harmonizing Decoction), can naturally relax the muscle layer to relieve exterior heat.
If symptoms of sweating, thirst, and mental restlessness appear, Bai Hu Tang (White Tiger Decoction) is the orthodox method for saving Yangming Channel Heat; San Huang Jie Du Tang (Three-Yellow Detoxification Decoction) and Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) are suitable when heat returns to the interior; if solid accumulation has not yet formed, this method is excellent.
If there is afternoon tidal fever, constipation, and delirious speech, this indicates heat binding in the Yangming stage, and Cheng Qi Tang (Purgative Decoction) should be used; if there is no sweating and bowel obstruction, indicating both exterior and interior excess, Fang Feng Tong Sheng San (Saposhnikovia Universal Benefit Powder) offers comprehensive advantages.
Mouth ulcers, rotten gums, and bleeding indicate excessive fire in the Heart, Lung, and Stomach; Gan Lu Yin (Sweet Dew Drink) is indicated as the primary treatment. Commonly known as Double E (Shuang E) and Single E (Dan E), these correspond to Hou Bi (Throat Bi Syndrome) in medical texts. Double E is easy to treat, while Single E is difficult, caused by Heart and Kidney fire attacking the Lungs; pricking the thumb to bleed is indicated. Additionally, Dao Chi San (Guide Out Redness Powder) added with Jie Geng (Platycodon Root), Bei Mu (Fritillaria Bulb), and She Ye (Belamcanda Rhizome) can be used for treatment, which constitutes a contrary treatment method (Fan Zhi Fa). If these two conditions do not improve with cooling medicines, it is appropriate to use Fu Zi Pian (Aconite Slices) steamed with honey, held in the mouth to swallow the juice; or administer Tong Mai Si Ni Tang (Unblock Pulse Four Inverted Decoction) added with pig bile and human urine; or take Gui Fu Ba Wei Tang (Cinnamon and Aconite Eight-Ingredient Decoction) with a small amount of Huang Lian (Coptis Rhizome), soaked in water and taken cold, which constitutes a following treatment method (Cong Zhi Fa). This condition must not be treated purely with cooling medicines, lest the upper heat remains unresolved while middle cold arises anew, allowing toxic qi to enter the abdomen through deficiency, leading to upper asthma and lower diarrhea, cold extremities, cyanotic nails, and a mouth open like a fish’s gills, which indicates death.
(Interpretation of Classic Meaning) The *Nei Jing* states: "When one Yin and one Yang knot together, it is called Hou Bi." One Yin refers to the Pericardium (Xin Zhu), and one Yang refers to the San Jiao (Triple Burner); these two meridians knot together at the throat, and internal heat knots within, thus forming Hou Bi.
"Yan" (Pharynx) means swallowing, and "Hou" (Larynx/Trachea) means monitoring. The pharynx connects to the three epigastria to communicate with the Stomach, hence it is used for swallowing food; the larynx communicates with the five zang organs to connect to the Lungs, hence it is used to monitor qi. Qi passes through the larynx, food passes through the pharynx, clearly distinct. The *Qian Jin* states that the larynx governs the unobstructed passage of water and grain, and the pharyngeal gate governs the passage of fluid, qi, and spirit of the zang-fu organs; this is incorrect.
The larynx receives clear qi, therefore it is said that the larynx governs Heavenly Qi; the pharynx receives food, therefore it is said that the pharynx governs Earthly Qi.
Hou Feng (Wind in the Throat) and Hou Bi both arise from phlegm-saliva previously existing in the diaphragm region, or due to irregularity of the seven emotions causing fire to move and phlegm to rise, obstructing the throat and pharynx, resulting in internal and external swelling and pain, inability to ingest fluids, and inability to speak, which can be considered critical and urgent.