喉与咽不同。喉者肺脘。呼吸之门户。主出而不纳。咽者胃脘。水谷之道路。主纳而不出。盖喉咽司呼
吸。主升降。此一身之紧关橐龠也。经曰。足少阴所生病者。口渴舌干咽肿。上气嗌干及痛。素问云。邪客于
足少阴之络。令人咽痛。不可纳食。又曰。足少阴之络。循喉咙。通舌本。凡喉痛者。皆少阴之病。但有
寒热虚实之分。少阴之火。直如奔马。逆冲于上。到此咽喉紧锁处。气郁结而不得舒。故或肿或痛也。其证必
内热口干面赤。痰涎涌上。其尺脉必数而无力。盖缘肾水亏损。相火无制而然。须用六味地黄门冬五味大剂作
汤服之。又有色欲过度。元阳亏损。无根之火。游行无制。客于咽喉者。须八味肾气丸大剂煎成。冰冷与饮。
使引火归原。庶几可救。此论阴虚咽痛者。如此治法。正褚氏所谓上病疗下也。人之喉咽如曲突。曲突火炎。
若以水自上灌下。曲突立爆烈矣。惟灶床下以盆水煦之。上炎即熄。此上病燎下之一验也。其间有乳鹅缠喉二
名不同。肿于咽两旁者。为双鹅。肿于一边者为单鹅。治法用鹅翎蘸米醋搅喉中。去尽痰涎。复以鹅翎探吐
之。令着实一咯。咯破鹅中紫血即溃。或紫金锭磨下即愈。甚而不散者。上以小刀刺出紫血即愈。
古方有刺少商穴法甚好。刀针刺血。急则用之。然亦有不宜用者。薛案云。一人年五十。咽喉肿痛。或针去
血。神思虽清。尺脉洪数而无伦。次按之微细如无。余曰。有形而无痛。戴阳之类也。当峻补其阴。今反伤阴
血必死。已而果殁。引此一案。以为粗工轻用刀针之戒。
缠喉风者。肿透达于外。且麻且痒且痛。可用谦甫解毒雄黄丸。
解毒雄黄丸
雄黄（一钱） 郁金（一分） 巴豆（十四粒去油皮） 醋糊丸。绿豆大。热茶送下。吐顽痰立苏。未吐再服。
古方有用巴豆油。摊纸作燃子。点火吹灭。以烟熏鼻中。实时口鼻流涎。牙关自开。即用此搐患处愈。有
一等阳虚咽痛者。口舌生疮。遇劳益甚。其脉必浮大。此脾肺气虚。膀胱虚热。须以理中汤加山药山茱萸服乃
痊。有上焦风热者。用荆防败毒散效。有咽喉肿痛。作渴饮冷。大便秘结。六脉俱实。必下之乃愈。
可用防风通圣散。今人虚热者多。实热者少。如此证不多得。此法不可轻用。又有急喉痹者。其声如鼾。痰如
拽锯。此为肺绝之候。速熬人参膏。用竹沥姜汁同调服。如未即得膏。速煎独参汤
服。早者十全七八。次则十救四五。迟则不救。
丹溪云。咽喉肿痛。有阴虚阳气飞越。痰结在上者。脉必浮大。重取必涩。其去死不远。宜独参汤浓煎细
细饮之。如作实证治。祸在反掌矣。仲景云。少阴客热咽痛。用甘草汤。少阴寒热相搏。用桔梗汤。少阴客寒
咽痛。用半夏散及汤。少阴病咽中伤生疮。不能语言。声不出者。苦酒汤。少阴阴虚客热不利。咽痛
胸满心烦者。猪肤汤。世人但知热咽痛。而不知有寒咽痛。经曰。太阳在泉。寒淫所胜。民病咽肿颔肿。陈
藏器用附子去皮脐。炮裂切片。以蜜涂炙。令蜜入内。噙咽其津。甘味尽。再换一
片噙之。
仲景云。下利清谷。里寒外热。脉微欲绝。面赤咽痛。用通脉四逆汤。盖以冬月伏寒在于肾经。发则咽
痛下利。附子汤温其经则愈。又有司天运气。其年乡村相染。若恶寒者。多是暴寒折热。寒闭于外。热郁于内。
切忌胆矾酸寒之剂点喉。反使阳郁结不伸。又忌硝黄等寒剂下之。反使阳下陷入里。则祸不旋踵矣。须用表
散之剂。若仲景甘桔汤之类。又有阳毒咽痛。用升麻汤。阴毒咽痛。用甘草汤。方见金匮要略及千金方中。
咽痛用诸药不效者。此非咽痛。乃是鼻中生一条红丝如发。悬一黑泡。大如樱珠。垂挂到咽门。而口中饮
食不入。须用牛膝根直而独条者。洗净入米醋四五滴。同研细。就鼻孔滴二三点入内去。则红丝断而珠破。
其病立安。又有喉间作痛。溃烂日久不愈。此必杨梅疮毒。须以萆 （即土茯苓）汤为主。
喉与咽是不同的。喉是肺的门户，是呼吸出入的关口，主要功能是呼气而不纳气。咽是胃的门户，是水谷饮食的道路，主要功能是纳物而不排出。可以说，喉和咽主管呼吸，主持气的升降，这是人体一身的关键枢纽（如风箱般的气机通道）。《内经》说：足少阴肾经所生的病证，包括口渴、舌干、咽喉肿痛、气逆、咽喉干燥及疼痛。《素问》说：邪气侵犯足少阴肾经的络脉，会导致人咽喉疼痛，无法进食。又说：足少阴肾经的络脉，循行经过喉咙，连通舌根。凡是咽喉疼痛的病症，都属于少阴肾经的病证，但其中有寒证、热证、虚证、实证的区别。
少阴相火（命门之火）迅猛如奔马，逆冲向上，到达咽喉这一狭窄紧锁之处，导致气机郁结而不能舒展，所以出现肿胀或疼痛。其症状必定伴有内热、口干、面红、痰涎涌上，尺脉（肾脉）必然数而无力。这是因为肾水亏损，相火失去制约所致。必须使用六味地黄丸加麦冬、五味子，大剂量煎汤服用。
另外，有因房事过度，导致元阳亏损，无根之火游行失控，客居于咽喉的情况，必须使用八味肾气丸（金匮肾气丸），大剂量煎成后，放冷让患者饮用，以引导火气回归本源，这样或许可以挽救。这是论述阴虚导致的咽痛，治疗方法正如褚氏所说的“上病疗下”（上部疾病从下部治疗）。人的喉咽就像烟囱的弯曲处，如果火焰在烟囱中燃烧，用水从上往下灌，烟囱会立刻爆裂。只有在灶台下面用盆水熏蒸加热，上面的火势就会熄灭。这是“上病疗下”的一个验证。
其中还有“乳鹅”和“缠喉”两个名称不同。肿胀在咽部两侧的叫“双鹅”，肿胀在一边的叫“单鹅”。治疗方法是用鹅毛蘸米醋搅动喉中，去除所有痰涎，再用鹅毛探吐，令患者用力咯出，咯破鹅状肿块中的紫血即溃烂愈合。或者用紫金锭磨汁服用即可痊愈。病情严重且不消散的，用小刀刺出紫血即可痊愈。
古方中有针刺少商穴的方法很好，用刀针放血，急症时使用。但也有不宜使用的情况。薛己医案记载：有一人五十岁，咽喉肿痛，有人给他针刺放血，虽然神志清醒了，但尺脉洪大无序，重按则微细若无。我说：这是有形之症却无痛感，属于戴阳证（虚阳上浮）。应当峻补其阴，现在反而损伤阴血，必死无疑。后来果然去世。引用这个案例，作为对庸医轻率使用刀针的警戒。
缠喉风，肿胀透达外部，且麻木、瘙痒、疼痛，可以使用谦甫解毒雄黄丸。
解毒雄黄丸
雄黄（一钱） 郁金（一分） 巴豆（十四粒，去油去皮） 用醋糊制成丸药，大小如绿豆。用热茶送服，吐出顽痰后立即苏醒。未吐可再服。
古方有用巴豆油，涂在纸上做成燃子，点火吹灭后，用烟熏鼻子，实时口鼻流涎，牙关自然张开，就用此法搐鼻治疗患处可愈。
有一类阳虚导致的咽痛，口舌生疮，劳累后加重，其脉象必然浮大。这是脾肺气虚，膀胱虚热。必须用理中汤加山药、山茱萸服用才能痊愈。有上焦风热的，用荆防败毒散有效。有咽喉肿痛，口渴想喝冷水，大便秘结，六脉都实，必须攻下才能痊愈。可用防风通圣散。如今人多是虚热，实热很少。像这样的证候不多见，这种方法不可轻率使用。
又有急喉痹，声音像打鼾，痰声像拉锯，这是肺气将绝的征候。速熬人参膏，用竹沥和姜汁调匀服用。如果来不及得到人参膏，速煎独参汤服用。早治的话十能救七八，稍晚则十能救四五，迟则无法救治。
朱丹溪说：咽喉肿痛，有阴虚阳气飞越，痰结在上部的，脉象必然浮大，重取必涩，离死亡不远。宜用独参汤浓煎细细饮服。如果当作实证治疗，祸患就在反掌之间。
张仲景说：少阴客热咽痛，用甘草汤。少阴寒热相搏，用桔梗汤。少阴客寒咽痛，用半夏散及汤。少阴病咽中受伤生疮，不能说话，声音出不来的，用苦酒汤。少阴阴虚客热不利，咽痛胸满心烦的，用猪肤汤。世人只知道热证咽痛，而不知道有寒证咽痛。《内经》说：太阳在泉之时，寒气盛行，百姓易患咽喉肿、下巴肿。陈藏器用附子去皮脐，炮裂切片，涂蜂蜜炙烤，让蜂蜜渗入，含咽其津液，甘味尽后再换一片含咽。
张仲景说：下利清谷（腹泻完谷不化），里寒外热，脉微欲绝，面赤咽痛，用通脉四逆汤。大概是因为冬季伏寒在于肾经，发作时出现咽痛下利。附子汤温通经脉则痊愈。
又有司天运气的影响，某年乡村相互传染，如果恶寒，多是暴寒折损热气，寒闭于外，热郁于内。切忌用胆矾等酸寒之剂点喉，反而使阳气郁结不能伸展。又忌用硝石、大黄等寒凉药剂攻下，反而使阳气下陷进入体内，那么灾祸转瞬即到。必须用发散表邪的药剂，如张仲景的甘桔汤之类。又有阳毒咽痛，用升麻汤。阴毒咽痛，用甘草汤。方剂见于《金匮要略》及《千金方》中。
咽痛用各种药物无效者，这不是普通的咽痛，而是鼻中生出一条红丝如头发，悬挂一个黑泡，大如樱桃，垂挂到咽门，口中饮食无法进入。须用牛膝根中直而独条者，洗净加入米醋四五滴，一同研细，就鼻孔滴入二三点在内，则红丝断而珠破，其病立即安宁。
The throat (Hou) and the pharynx (Yan) are different. The throat is the gate of the Lung, the portal for respiration, primarily responsible for expelling air but not receiving it. The pharynx is the gate of the Stomach, the pathway for water and food, primarily responsible for receiving but not expelling. Thus, the throat and pharynx govern respiration and regulate the ascending and descending of Qi; they serve as the critical pivot of the body's Qi mechanism, akin to a bellows. The Classics state: Diseases generated by the Foot-Shaoyin Kidney Meridian include thirst, dry tongue, swelling and pain in the throat, upward rushing of Qi, dryness and pain in the throat. The *Suwen* states: When pathogenic factors invade the collaterals of the Foot-Shaoyin Kidney Meridian, it causes throat pain and inability to eat. It also states: The collateral of the Foot-Shaoyin Kidney Meridian runs along the throat and connects to the root of the tongue. Therefore, all cases of throat pain belong to Shaoyin disease, though they may be differentiated into Cold, Heat, Deficiency, or Excess patterns.
The Ministerial Fire of Shaoyin surges like a galloping horse, counterflowing upwards. Upon reaching the narrow and tight junction of the throat, Qi becomes stagnant and unable to disperse, resulting in swelling or pain. Symptoms must include internal heat, dry mouth, flushed face, and surging phlegm-saliva. The Chi pulse (Kidney pulse) will be rapid and forceless at the surface but weak upon pressure. This is due to the depletion of Kidney Water, allowing Ministerial Fire to become uncontrolled. One must administer Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with added Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit) in large doses as a decoction.
Furthermore, in cases of excessive sexual activity leading to the depletion of Primordial Yang, the Rootless Fire wanders uncontrollably and lodges in the throat. One must administer Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill), prepared in large quantities, cooled before drinking, to guide the Fire back to its source. This may offer salvation. This discusses throat pain caused by Yin Deficiency; this treatment method aligns with Chu Shi’s principle of "treating upper diseases from the lower." The human throat and pharynx are like the curved flue of a chimney. If fire burns within the flue and water is poured from above, the flue will burst instantly. However, if water is heated from below at the stove base, the rising fire will extinguish. This is a verification of "treating upper diseases from the lower."
Among these, there are two distinct conditions named "Ruan E" (Goose-like swelling) and "Chan Hou" (Wrapping Throat). Swelling on both sides of the pharynx is called "Double Goose"; swelling on one side is called "Single Goose." The treatment involves dipping a goose feather in rice vinegar to stir the throat, removing all phlegm-saliva, then using the feather to induce vomiting, forcing a strong cough. Breaking the purple blood within the goose-like swelling leads to resolution. Alternatively, grinding Zijin Ding (Purple Gold Tablet) and taking it orally can cure it. For severe cases that do not dissipate, pricking the swelling to release purple blood cures it.
Ancient formulas recommend pricking the Shaoshang acupoint, which is excellent. Pricking with a needle or knife to bleed is used in emergencies. However, there are contraindications. Xue Ji’s medical case records: A fifty-year-old man suffered from swollen and painful throat. After someone pricked him to bleed, his mental clarity improved, but his Chi pulse was flooding and chaotic, yet faint and nearly imperceptible upon deep pressure. I said: This is a condition with physical signs but no pain, resembling Daiyang Syndrome (Floating Yang). It requires vigorous tonification of Yin. By injuring the Yin-Blood now, death is inevitable. He subsequently died. This case serves as a warning against crude practitioners rashly using needles and knives.
Chan Hou Feng (Wrapping Throat Wind) presents with swelling extending externally, accompanied by numbness, itching, and pain. Qianfu Jiedu Xionghuang Wan (Qianfu Antidote Realgar Pill) can be used.
**Jiedu Xionghuang Wan (Antidote Realgar Pill)**
Xionghuang (Realgar, 1 qian), Yujin (Curcuma Tuber, 1 fen), Badou (Croton Seed, 14 grains, oil and skin removed). Made into pills with vinegar paste, size of mung beans. Take with hot tea; stubborn phlegm will be vomited up, and consciousness restored immediately. If not vomited, take again.
Ancient formulas used Croton Oil spread on paper to make a burning roll. Ignite it, blow it out, and use the smoke to fumigate the nose. Saliva will flow from the mouth and nose, and the jaw will open naturally. This method can be used to insufflate the affected area for cure.
There is a type of throat pain caused by Yang Deficiency, characterized by sores in the mouth and tongue, worsening with fatigue. The pulse is necessarily floating and large. This indicates Spleen and Lung Qi Deficiency and Empty Heat in the Bladder. Lizhong Tang (Regulate the Middle Decoction) with added Shanyao (Chinese Yam) and Shanzhuyu (Cornus Fruit) should be taken to recover. For Upper Jiao Wind-Heat, Jingfang Baidu San (Atractylodes and Saposhnikovia Powder to Rescue from Misfortune) is effective. For throat swelling and pain, thirst for cold drinks, constipation, and solid pulses throughout, purgation is required for recovery. Fangfeng Tongsheng San (Saposhnikovia Powder to Unblock and Generate Health) can be used. Nowadays, most people have Empty Heat rather than Excess Heat. Such cases are rare; this method should not be used lightly.
In acute Hou Bi (Throat Obstruction), the voice sounds like snoring, and the phlegm sound resembles sawing wood. This is a sign of Lung Qi Exhaustion. Quickly prepare Renshen Gao (Ginseng Paste) and mix with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice) for administration. If paste is unavailable, quickly decoct Dushen Tang (Single Ginseng Decoction) and take it. Early treatment saves seven or eight out of ten; later treatment saves four or five; delayed treatment is incurable.
Zhu Danxi stated: Throat swelling and pain caused by Yin Deficiency with Flying Away of Yang Qi and Phlegm knotting in the upper part present with a floating and large pulse, becoming choppy upon heavy pressure. Death is near. One should administer Nongjian Dushen Tang (Strongly Decocted Single Ginseng Decoction) and sip it slowly. Treating this as an Excess pattern brings disaster instantly.
Zhang Zhongjing stated: For Shaoyin External Heat causing throat pain, use Gancao Tang (Licorice Decoction). For Shaoyin Cold-Heat struggle, use Jiegeng Tang (Platycodon Decoction). For Shaoyin External Cold causing throat pain, use Banxia San Ji Tang (Pinellia Powder and Decoction). For Shaoyin disease where the throat is injured and sores form, preventing speech and voice production, use Kujiu Tang (Bitter Wine Decoction). For Shaoyin Yin Deficiency with External Heat causing obstruction, throat pain, chest fullness, and irritability, use Zhufu Tang (Pig Skin Decoction). People only know about Heat-type throat pain and ignore Cold-type throat pain. The Classics state: When Taiyang is in the Earthly Branch position, excess Cold causes the people to suffer from throat and chin swelling. Chen Cangqi recommended using Fuzi (Aconite Lateral Root) peeled and de-navelled, roasted until cracked and sliced, coated with honey, roasted again until honey penetrates, then held in the mouth to swallow the saliva. Replace slices as the sweet taste fades.
Zhang Zhongjing stated: For diarrhea with undigested food, Interior Cold with Exterior Heat, faint pulse nearing extinction, flushed face, and throat pain, use Tongmai Sini Tang (Pulse-Unblocking Four-Reverse Decoction). This is because latent Cold from winter resides in the Kidney Meridian; upon manifestation, it causes throat pain and diarrhea. Fuzi Tang warms the meridians to cure it.
Regarding Si Tian Yun Qi (Heavenly Stem and Earthly Branch Influence), if a village suffers epidemic infection in a certain year, and chills are present, it is often sudden Cold suppressing Heat. Cold closes the exterior, Heat stagnates inside. One must strictly avoid using Danshan (Chalcanthite) or other sour-cold agents to drop into the throat, as this further traps Yang Qi. Avoid purging with Xiaokui (Mirabilite) or Huanglian (Coptis Rhizome) etc., as this drives Yang downward into the interior, bringing immediate disaster. One must use dispersing agents, such as Zhang Zhongjing’s Ganjie Tang (Licorice and Platycodon Decoction). For Yang Du (Yang Toxin) throat pain, use Shengma Tang (Cimicifuga Decoction). For Yin Du (Yin Toxin) throat pain, use Gancao Tang. These formulas are found in *Jinkui Yaolue* and *Qianjin Fang*.
If throat pain does not respond to various medicines, it is not ordinary throat pain. It is a red thread like hair growing in the nose, suspending a black blister the size of a cherry, hanging down to the throat gate, preventing food and drink from entering the mouth. Use a straight, single-stemmed Niuxi (Achyranthes Root), wash it clean, add 4-5 drops of rice vinegar, grind finely, and drip 2-3 drops into the nostril. The red thread breaks and the blister bursts, and the illness resolves immediately.
For throat pain with ulceration persisting for a long time without healing, this is likely due to Syphilis toxin (Meiyang Chuang Du). The primary treatment must be Bibi Tang (Dioscorea Hypoglauca Decoction), specifically Tubervine Root (Tufuling).