经义
喉主天气，咽主地气。○肝者，中之将也，取决于胆。咽为之使。○一阴一阳结，谓之喉痹。○邪客于足
少阴之络，令人嗌干，不可内食。（《素问》）
咽喉者，水谷之道也；喉咙者，气之所以上下者也。○足少阴所生病者，口热、舌干、咽肿、上气、嗌
干及痛。○喉痹，不能言取足阳明，能言取手阳明。（《灵枢》）
哲言
凡《经》言喉痹者，谓喉中呼吸不通、言语不出，天气闭塞也；云咽痛、嗌痛者，谓咽喉不能纳唾与食，
地气闭塞也；云喉痹、咽嗌痛者，谓咽喉俱病，天地之气并闭塞也。（孙一奎）
喉有二管∶一为气管，一为食管。食管在前，气管在后。人有自刃而不死者，伤食管而未伤气管也，故
食管在前。气管上通于鼻，人方食时，气无不通，非食急未有呛入气管者。以鼻吸之，食急呛入者，仍归食管，
故气管在后。（《医参》）
喉者，候也；咽者， 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。（《得效方》）
咽与喉，会厌与舌，四者同在一门，其用各异。喉以纳气，故喉气通于天；咽以纳食，故咽气通于地。会
厌管乎其上，以司开阖，食下则吸而掩，气上则呼而出。是以舌抵上 ，则会厌能闭其喉。四者更相为用，缺
一则饮食废而死矣。○热气上行，结薄于喉之两旁，近外肿作，以其形似蛾，是谓乳蛾，有双、单之分。其比
乳蛾差小者，名曰闭喉。热结于舌下，复生小舌者，名曰子舌胀。热结于舌中，舌为之肿者，名曰木舌胀。热
结咽喉，肿绕于外，且麻且痒，肿而大者，名曰缠喉风痹。暴发暴死者，名曰走马喉痹。八种之名虽详，一言
可了，曰火。微者以咸软之，甚者以辛散之，其最无如砭针出血，血出则病已。（张子和）
咽喉之病，有单乳蛾、双乳蛾、单喉痹、双喉痹、缠喉风、急喉痹、悬雍垂、梅核气、尸咽、谷贼、骨鲠、
咽痛、咽疮。○悬雍生于上 ，虽无关于咽喉，所以暴肿者，亦热使然也。○尸咽者，阴阳不和，脾肺风热，
毒瓦斯壅盛不通，致令尸虫发动，上蚀于喉，或痒、或痛，与伤寒狐惑同，当参考。○谷贼者，谷芒强涩，人误食
之，滞于咽门，遂令刺肺。若不急治，亦能杀人。（《仁斋直指》）
补编
喉证∶治实之法，先宜发散，次宜清凉，或涌导痰涎，或针刺出血；治虚之法，须遵《内经》从治之旨，
徐徐频与。（《医学正传》）
喉痛治法，视火之微甚∶微则正治，甚则反治。撩痰、出血，随宜而施，或针手大指少商出血。若肿达于
外，必外敷药。有表证者，宜甘、桔、荆、防、羌活，表而出之。不恶寒者，可用酸味吹喉取痰，常以鹅翎蘸
米醋搅咽中，摘出其痰。若乳蛾肿甚者，先以小刀就蛾上刺出其血，再用牙硝吹点，以退火邪。内服如射
干、青黛、甘、桔、栀、芩、恶实、大黄之类，以散上焦之热。外敷如生卜、韭根、伏龙肝之类。若咽疮白者
多涎、赤者多血，大率与口疮同例。用蔷薇根皮、黄柏、青黛煎含细 亦妙。（《推求师意》）
《经》云∶一阴一阳结，谓之喉痹。一阴者，手少阴君火，心之脉也；一阳者，手少阳相火，三焦之脉
也。夫二经之脉，并络于喉，故气热则内结，结甚则肿胀，胀甚则痹，痹甚则不通而死。即所谓喉癣、喉风、
喉蛾等类是也。推原十二经，惟足太阳别下项，其余皆凑咽喉。然《内经》独言一阴一阳结为喉痹者，盖以君、
相二火独胜，则热且痛也。历考咽喉汤方，皆用辛散、咸软，去风痰、解热毒为主。如元参升麻汤、圣济透关
散，及玉钥匙、如圣散、普济消毒饮，皆急于治标而缓于治本耳。又考仲景《伤寒论》咽喉生疮等证，每用甘
草、桔梗，半夏散及汤。一为少阴水亏，不能上济君火，以致咽喉生疮，不能出声，故以半夏之辛滑，佐鸡子
清利窍通声，使以苦酒入阴，劫涎敛疮。桂枝解肌，由经脉而出肌表，悉从太阳开发。而半夏治咽痛，可无燥
津、涸液之患也。一为阴火上结而为咽痛，故用甘草甘凉泄热，功在缓肾急而救阴液，佐以桔梗，开提足少阴
之热邪也。若肾液下泄，不能上蒸于肺，致络燥而为咽痛者，又有猪肤一法，润燥、解热、缓中，使其阴阳协
和而后愈，是固本而兼治标者也。他如风火上郁，阴亏脉数而痛者，又有辛凉清上诸法。咽喉紧痹，气热而痛
者，则清肺泻热。情志郁勃，相火上炎而痛者，则降气开郁。肾液下亏，肝阳上越而痛者，宗钱氏六味汤。阴
阳交虚，龙相上灼而痛者，宗仲景猪肤法。（《临证指南》）
凡单、双乳蛾，若毒未甚、脓未成者，治之自可消散。若势甚者，必须砭出其血，此因其急，不得已而
用之也。○治喉痹之火，与救火同，不容少待。《内经》火郁发之。发谓发汗，然咽喉中岂能发汗？故出血者，
乃发汗之一端也。○阴虚喉痹，其证
内热、口渴、喉干，或唇红颊赤，痰涎壅盛，然必尺脉无神，或六脉虽数而浮软无力。是皆肾阴亏损，水不制
火而然。火甚者，宜滋阴八味煎、加减一阴煎；火微者，宜六味地黄汤、一阴煎。若因思虑焦劳，兼动心火者，
宜二阴煎。○格阳喉痹，由于无根之火，客于咽喉而然，察其证，则上热下寒，全非火象。诊其六脉微弱，全
无滑大之意，速用镇阴煎为上，八味地黄汤次之。○喉癣者，凡阴虚劳损之人，多有此病。其证满喉生疮，红
痛，久不能愈。此水亏虚火证也，宜用前阴虚喉痹之法治之。○瘟毒喉痹，乃天行之气。其证咽痛、项肿，此湿
热壅盛，最凶之候。宜清诸经之火，或泻阳明之热，当察缓急而治之。东垣普济消毒饮最妙。○凡火壅于上，
食物之类，最宜悉尼浆、绿豆饮，或萝卜汁和以清泉，少加元明粉，搅匀徐饮，既可消痰，亦可清火。（张景岳）
喉痛皆少阴病，但有寒、热、虚、实之分。少阴之火，直如奔马，逆冲咽喉，郁结不舒，或肿、或痛，证
必内热、口干、面赤，痰涎涌上，脉数无力。盖缘肾水亏损，相火无制而然。须用六味地黄汤，加门冬、五味
大剂服之。又有元阳亏损，无根之火，游行无制，客于咽喉者，须用八味丸煎汤冷冻饮料，引火归元。此正褚氏所
谓上病疗下也。人之咽喉如曲突，曲突火炎，若以水自上灌下，突曝烈矣。惟灶床下以盆水映之，上炎即熄。
此上病疗下之一验也。○又有急喉痹，其声如 ，痰如曳锯，为肺绝之候，速煎独参汤救之，迟则不及。（《赵氏医贯》）
喉痛之证，挟风火者十居八、九。若骤以滋腻酸敛之剂投之，百不一生。如辛酉壬戌患喉痛者，十人有五，
不但服温燥之药者立毙，即用清凉药中少加重浊者，尚且不救。余治愈百人，皆辛寒清淡疏散之品。若根据此法，
无一活矣。（《医贯砭》）
凡治喉痹，非吐不可。如胆矾、石绿之类为末，薄荷汁入醋调，以鸡翎蘸药，送入喉内，徐徐引痰吐出
为佳。（《东医宝鉴》）
痹者，闭也。咽喉闭结，汤药不通。有形之物，已难下咽，必
取无形之气，从鼻而入。用巴豆压油纸上，取油纸捻成条子，点灯吹灭，以烟熏鼻，使口鼻流涎，牙关自开。
（《名医类案》）
悬雍谓之帝钟。肿而下垂，有长数寸者，名帝钟风。宜用吹药，不可针，针破杀人。（《得效方》）
咽痛，诸药不效，乃鼻中生一红丝，悬一黑泡如樱，垂至咽门用杜牛膝根，入醋同捣汁，滴鼻内，丝断珠
破，其痛立已。（罗谦甫）
凡治鲠法，皆以类推。如鸬 治鱼鲠，磁石治针鲠，发灰治发鲠，虎骨治骨鲠，各从其类也。（《三因方》）
兽骨鲠，将狗倒吊，取涎咽下，骨化如神。狗善食骨也。（《万病回春》）
误吞稻、麦芒在咽，取鹅涎咽之即下。鹅能食谷也。（《医学纲目》）
选案
王子周岁，其母以一铁钉与之玩弄，吞入喉间。其父号呼求救，余闻啼声，曰∶钉下咽矣。索方无计，
乃阅本草，见所载曰∶铁畏朴峭。遂用磁石一钱，朴硝二钱，研末，以猪油加蜜，调与服之。解物如芋，润滑
无棱，药护其外，钉在其中。盖硝非磁石，不能使药附钉∶磁石非硝，不能逐钉速出。非油无以润，非蜜未必
服。合是四者，则着者着，逐者逐，润者润，同功合力，裹护而出矣。○王蓬雀患喉痹，头面浮大，喉颈粗极，
气急声哑，咽肿，口疮痛甚，坐而不卧者累日矣。脉则细数微弱，言则声微不振，所服芩、连、栀、柏。此盖
以伤阴而起，复为寒凉所逼，以致寒盛于下，格阳于上。水饮难入，尤畏烦热。余曰∶危哉！与镇阴煎，井水
浸冷，徐徐咽之。过宿，头项肿痛，尽消如失。（张景岳）
附方
缠喉风救急方 咽喉两旁，块肿如卵，气塞痰鸣，证在危急。用杜牛膝粗根两许，勿经水，捣汁和醋，
鸡毛蘸搅喉中，涎出自
消。后吹人中白、冰片。如牙关紧闭，和人乳捣汁，滴入鼻内。有用石 蓄根，和乳捣汁滴鼻，效同。
又方 京师一医，持秘方治喉痹，获利甚广。偶为翁曙公识破。其方惟用拭面肥皂，金箔为衣，灌吐稠痰，
危证立苏。
又方 治喉痹乳蛾。用壁钱窝一个，拔病者发一根缠定，灯上以银簪挑烧，存性为末，吹患处，立消。
【背景信息】
书名：医述 作者：程杏轩 朝代：元 章节：咽喉 类别：医论
【原文翻译】
经义
喉主管天气（呼吸之气），咽主管地气（饮食之水谷）。○肝是体内的将领，其决策取决于胆。咽是肝气运行的通道。○一阴（手少阴心经）与一阳（手少阳三焦经）之气郁结，称为喉痹（咽喉肿痛闭塞之病）。○邪气侵犯足少阴肾经的络脉，使人咽干，无法进食。（出自《素问》）
咽喉是水谷通行的道路；喉咙是气体上下出入的器官。○足少阴肾经所发生的疾病，包括口热、舌干、咽肿、气逆上冲、咽干及疼痛。○治疗喉痹不能言语者，取足阳明胃经穴位；能言语者，取手阳明大肠经穴位。（出自《灵枢》）
哲言
凡是《内经》所说的喉痹，是指喉中呼吸不通畅、不能说话，这是天气闭塞的表现；所说的咽痛、嗌痛，是指咽喉不能吞咽唾液和食物，这是地气闭塞的表现；所说的喉痹兼咽嗌痛，是指咽喉都患病，天地之气同时闭塞。（孙一奎）
喉有两个管道：一个是气管，一个是食管。食管在前，气管在后。有人被刀刺伤而未死，是因为伤了食管而未伤气管，所以食管在前。气管向上通于鼻，人在进食时，气息通畅无阻，如果不是进食过急，很少有食物呛入气管的情况。通过鼻子吸气，即使进食过急呛入的食物，仍会归回食管，所以气管在后。（《医参》）
喉，意为“候”（侦察、观察）；咽，意为“咽下”。咽连接三脘以通向胃，所以用来吞咽食物；喉连通五脏以系联肺，所以用来候察气息。气由喉入，谷由咽下，道理十分明白。（《得效方》）
咽与喉，会厌与舌，这四者同处一个门户，但功能各异。喉用来接纳空气，所以喉气通于天；咽用来接纳食物，所以咽气通于地。会厌位于上方，负责开关的开合，食物下行时会厌吸入并覆盖喉口，气体上行时会厌呼出而开放。因此，当舌尖抵住上颚时，会厌就能关闭喉口。这四者相互为用，缺了任何一个，就会因无法饮食而死亡。○热气上行，凝结在喉的两侧，靠近外部肿胀发作，因其形状似蚕蛾，称为乳蛾，有单发和双发之分。比乳蛾稍小的，名叫闭喉。热结在舌下，生出小舌头的，名叫子舌胀。热结在舌中，舌头肿胀的，名叫木舌胀。热结在咽喉，肿胀环绕外部，且麻且痒，肿大严重的，名叫缠喉风痹。突然发病迅速死亡的，名叫走马喉痹。这八种名称虽然详细，但一言可概括，即“火”。轻微的用咸味药软化它，严重的用辛味药发散它，最无效果的莫过于砭针刺血，出血则病愈。（张子和）
咽喉的疾病，有单乳蛾、双乳蛾、单喉痹、双喉痹、缠喉风、急喉痹、悬雍垂病变、梅核气、尸咽、谷贼、骨鲠、咽痛、咽疮。○悬雍垂生于上颚后方，虽然不直接关乎咽喉本体，但其突然肿胀，也是热邪所致。○尸咽，是由于阴阳不和，脾肺风热，毒瓦斯壅盛不通，导致尸虫发动，向上侵蚀咽喉，或痒或痛，与伤寒狐惑病相同，应当参考辨析。○谷贼，是指谷物的芒刺坚硬涩利，人误食后，滞留在咽门，进而刺伤肺部。如果不紧急治疗，也能致死。（《仁斋直指》）
补编
喉证的治疗：治疗实证的方法，先宜发散表邪，次宜清凉清热，或者涌吐导引痰涎，或者针刺出血；治疗虚证的方法，必须遵循《内经》从治的原则，慢慢频繁给药。（《医学正传》）
喉痛的治法，视火邪的轻重而定：轻微的正治，严重的反治。撩除痰液、放血，根据情况施用，或者针刺手大指少商穴出血。如果肿胀波及外部，必须外敷药物。有表证的，宜用甘草、桔梗、荆芥、防风、羌活等，解表透邪。不恶寒的，可用酸味药吹喉取痰，常用鹅翎蘸米醋搅动咽部，摘出其痰。如果乳蛾肿胀严重，先用小刀在蛾上刺出其血，再用牙硝吹点，以退火邪。内服如射干、青黛、甘草、桔梗、栀子、黄芩、牛蒡子、大黄之类，以疏散上焦的热邪。外敷如生萝卜、韭菜根、伏龙肝之类。如果咽疮白色多涎、红色多血，大体与口疮同类。用蔷薇根皮、黄柏、青黛煎汤含漱，细细品味也很妙。（《推求师意》）
《内经》说：一阴一阳结，谓之喉痹。一阴，指手少阴君火，是心的经脉；一阳，指手少阳相火，是三焦的经脉。这两条经脉的脉气，都联络于喉，所以气热则内部郁结，结甚则肿胀，胀甚则闭塞，闭塞甚则不通而死。这就是所谓的喉癣、喉风、喉蛾等类疾病。推究十二经脉，只有足太阳膀胱经别行向下项部，其余经脉都凑集于咽喉。然而《内经》唯独说一阴一阳结为喉痹，大概是因为君火、相火独盛，则热且痛。历考治疗咽喉的汤方，都用辛散、咸软的药物，以祛风痰、解热毒为主。如元参升麻汤、圣济透关散，以及玉钥匙、如圣散、普济消毒饮，都是急于治标而缓于治本。又考察仲景《伤寒论》中咽喉生疮等证，每用甘草、桔梗，半夏散及汤。一是由于少阴肾水亏虚，不能上济君火，以致咽喉生疮，不能出声，故用半夏的辛滑，佐以鸡蛋清利窍通声，使以苦酒（醋）入阴，劫夺涎液收敛疮口。桂枝解肌，由经脉而出肌表，全部从太阳经开发。而半夏治咽痛，没有燥伤津液、枯竭阴液的隐患。二是由于阴火上结而为咽痛，故用甘草甘凉泄热，功效在于缓解肾急而救阴液，佐以桔梗，开提足少阴经的热邪。如果肾液下泄，不能上蒸于肺，导致脉络干燥而为咽痛者，又有猪肤汤一法，润燥、解热、缓中，使其阴阳调和而后痊愈，这是固本而兼治标的方法。其他如风火上郁，阴亏脉数而痛者，又有辛凉清上的诸法。咽喉紧痹，气热而痛者，则清肺泻热。情志郁勃，相火上炎而痛者，则降气开郁。肾液下亏，肝阳上越而痛者，遵循钱乙六味地黄汤。阴阳交虚，龙雷之火上灼而痛者，遵循仲景猪肤汤法。（《临证指南》）
凡是单发、双发乳蛾，如果毒邪不重、脓未形成者，治疗自然可以消散。如果势态严重，必须砭刺出血，这是因其病情紧急，不得已而用的方法。○治疗喉痹的火邪，与救火相同，不容片刻等待。《内经》说火郁发之。发谓发汗，然而咽喉中怎么能发汗呢？所以出血，就是发汗的一种手段。○阴虚喉痹，其症状表现为内热、口渴、喉干，或者唇红颊赤，痰涎壅盛，但必然尺脉无神，或者六脉虽数但浮软无力。这都是肾阴亏损，水不制火所致。火邪重的，宜用滋阴八味煎、加减一阴煎；火邪轻的，宜用六味地黄汤、一阴煎。如果因思虑焦劳，兼动心火者，宜用二阴煎。○格阳喉痹，由于无根之火，客居咽喉所致，观察其症状，则上热下寒，完全不是火象。诊其六脉微弱，全无滑大之意，速用镇阴煎为上策，八味地黄汤次之。○喉癣，凡是阴虚劳损之人，多有此病。其症状满喉生疮，红痛，久不愈合。这是水亏虚火证，宜用前文阴虚喉痹的方法治疗。○瘟毒喉痹，是天行之气（传染病邪气）。其症状咽痛、项肿，这是湿热壅盛，是最凶险的证候。宜清诸经之火，或泻阳明之热，应当观察缓急而治疗。东垣的普济消毒饮最妙。○凡是火邪壅于上部，食物方面，最宜饮用悉尼浆（注：疑为某种浆液或笔误，此处保留原意）、绿豆饮，或者萝卜汁加清泉，少加元明粉，搅匀慢慢饮用，既可消痰，亦可清火。（张景岳）
喉痛都属于少阴病，但有寒、热、虚、实的区别。少阴之火，直如奔马，逆冲咽喉，郁结不舒，或肿、或痛，证候必有内热、口干、面赤，痰涎涌上，脉数无力。这是因为肾水亏损，相火无制所致。须用六味地黄汤，加麦冬、五味子大剂服用。又有元阳亏损，无根之火，游行无制，客居咽喉者，须用八味丸煎汤冷冻饮料，引火归元。这正是褚氏所说的上病疗下。人的咽喉如弯曲的烟突，烟突起火，如果用水从上往下灌，烟突会爆裂。只有在灶床下用盆水映照，上炎的火即熄灭。这是上病疗下的一个验证。○又有急喉痹，声音如拉锯，痰声如曳锯，是肺气将绝的征候，速煎独参汤急救，迟则来不及。（《赵氏医贯》）
喉痛之证，挟带风火的占十之八九。如果骤然投以滋腻酸敛的药物，百无一活。如在辛酉、壬戌年患喉痛的人，十人有五，不但服用温燥药物的人会立即死亡，即使在清凉药中稍微加重浊药物的，也救不活。我治愈上百人，都是用辛寒清淡疏散的药物。如果依据这种方法，没有不活的。（《医贯砭》）
凡是治疗喉痹，非吐不可。如用胆矾、石绿等研末，用薄荷汁调醋，以鸡毛蘸药，送入喉内，徐徐引出痰液吐出为佳。（《东医宝鉴》）
痹，就是闭塞。咽喉闭结，汤药不通。有形之物，已经难以下咽，必须取无形之气，从鼻而入。用巴豆压榨油涂在纸上，取油纸捻成条状，点灯吹灭，用烟熏鼻，使口鼻流涎，牙关自然张开。（《名医类案》）
悬雍垂称为帝钟。肿胀而下垂，有长数寸的，名叫帝钟风。宜用吹药，不可针刺，针刺破会杀人。（《得效方》）
咽痛，诸药无效，发现鼻中生一根红丝，悬挂一个黑泡如樱桃，垂至咽门，用杜牛膝根，入醋同捣汁，滴入鼻内，丝断珠破，其痛立止。（罗谦甫）
凡是治疗骨鲠的方法，都可以类推。如鸬鹚治鱼鲠，磁石治针鲠，发灰治发鲠，虎骨治骨鲠，各从其类也。（《三因方》）
兽骨鲠，将狗倒吊，取其涎液咽下，骨头化如神助。狗善于吃骨头。（《万病回春》）
误吞稻、麦芒在咽，取鹅涎咽下即下。鹅能吃谷物。（《医学纲目》）
选案
王子周岁，他的母亲给他一个铁钉玩耍，吞入喉间。他的父亲号呼求救，我听到啼哭声，说：“钉子已经咽下去了。”寻找方计无策，于是查阅本草，见记载说：“铁畏朴硝。”遂用磁石一钱，朴硝二钱，研末，以猪油加蜜，调匀给患儿服用。解物如芋头般润滑无棱，药物保护在外面，钉子在里面。大概硝石非磁石，不能使药附着在钉子上；磁石非硝石，不能快速驱逐钉子排出。非油无以润滑，非蜜未必肯服。合是四者，则着者着，逐者逐，润者润，同功合力，裹护而出。○王蓬雀患喉痹，头面浮肿大，喉颈粗极，气急声哑，咽肿，口疮痛甚，坐卧不安数日。脉象细数微弱，说话声音微弱不振，所服用的药物是黄芩、黄连、栀子、黄柏。这大概是因伤阴而起，又被寒凉药物逼迫，以致寒盛于下，格阳于上。饮水困难，尤其畏惧烦热。我说：“危险啊！”给予镇阴煎，井水浸冷，慢慢咽下。过了一夜，头项肿痛，尽消如失。（张景岳）
附方
缠喉风救急方 咽喉两旁，块肿如卵，气塞痰鸣，证在危急。用杜牛膝粗根约一两，不要经过水洗，捣汁和醋，用鸡毛蘸搅喉中，涎自出而消肿。之后吹人中白、冰片。如果牙关紧闭，和人乳捣汁，滴入鼻内。有用石蓄根，和人乳捣汁滴鼻，效果相同。
[Background Information]
Book: Yi Shu (Record of Medicine)
Author: Cheng Xingxuan
Dynasty: Yuan
Chapter: Throat and Pharynx
Category: Medical Discourse
Original Text Translation
Scriptural Principles
The throat (Hou) governs the Qi of Heaven (respiratory air), and the pharynx (Yan) governs the Qi of Earth (food and drink). ○ The Liver is the general within, and its decisions depend on the Gallbladder. The pharynx serves as its envoy. ○ When one Yin (Hand-Shaoyin Heart Meridian) and one Yang (Hand-Shaoyang Sanjiao Meridian) become knotted, it is called Hou Bi (throat obstruction with swelling and pain). ○ When pathogenic factors invade the collateral vessels of the Foot-Shaoyin Kidney Meridian, it causes dryness in the pharynx, making it impossible to ingest food. (From *Su Wen*)
The throat and pharynx are the pathways for water and grain; the laryngeal inlet is where Qi moves up and down. ○ Diseases occurring in the Foot-Shaoyin Kidney Meridian include heat in the mouth, dry tongue, swollen pharynx, upward rushing of Qi, dryness and pain in the pharynx. ○ For treating Hou Bi where speech is lost, select points from the Foot-Yangming Stomach Meridian; where speech is retained, select points from the Hand-Yangming Large Intestine Meridian. (From *Ling Shu*)
Philosophical Insights
Whenever the Classics mention "Hou Bi," they refer to blocked respiration in the throat and inability to speak, indicating the obstruction of Heavenly Qi; when mentioning Yan Tong or Ai Tong, they refer to the inability to swallow saliva and food in the throat and pharynx, indicating the obstruction of Earthly Qi; when mentioning both Hou Bi and Yan-Ai Pain, it indicates disease in both the throat and pharynx, with simultaneous obstruction of both Heavenly and Earthly Qi. (Sun Yikui)
The throat has two tubes: one is the trachea, and the other is the esophagus. The esophagus is anterior, and the trachea is posterior. People who survive knife wounds often do so because the esophagus was injured but not the trachea, hence the esophagus is anterior. The trachea connects upwards to the nose. During eating, Qi flows freely; unless eating is rushed, food rarely enters the trachea. By inhaling through the nose, even if food is rushed into the trachea, it still returns to the esophagus; thus, the trachea is posterior. (*Yi Can*)
The Hou (Throat/Larynx) means "to inspect" or "observe"; the Yan (Pharynx) means "to swallow." The pharynx connects to the three epigastria to communicate with the Stomach, thus used for swallowing objects; the larynx communicates with the Five Zang Organs to connect to the Lung, thus used to observe Qi. Qi enters via the larynx, grain descends via the pharynx; this is clear and evident. (*De Xiao Fang*)
The pharynx and larynx, epiglottis and tongue, these four reside in one gate but have different functions. The larynx accepts Qi, so Laryngeal Qi connects to Heaven; the pharynx accepts food, so Pharyngeal Qi connects to Earth. The epiglottis manages the opening and closing above; when food goes down, it inhales and covers; when Qi goes up, it exhales and opens. Therefore, when the tongue presses against the upper palate, the epiglottis can close the larynx. These four function mutually; lacking any one leads to death due to inability to eat and drink. ○ Upward-rising Heat condenses on both sides of the throat, causing external swelling resembling a silkworm moth, called Ru E (Tonsillar Hypertrophy/Tonsillitis), which can be unilateral or bilateral. Smaller than Ru E is called Bi Hou (Closed Throat). Heat knotting under the tongue generating a small tongue is called Zi She Zhang (Sublingual Swelling). Heat knotting in the middle of the tongue causing tongue swelling is called Mu She Zhang (Wooden Tongue). Heat knotting in the throat/pharynx, swelling around the exterior, with numbness and itching, severe swelling is called Chan Hou Feng Bi (Peritonsillar Abscess/Severe Throat Wind). Sudden onset and rapid death is called Zou Ma Hou Bi (Rapid-Onset Throat Obstruction). Although eight names are detailed, they can be summarized in one word: Fire. Mild cases are softened with salty substances; severe cases are dispersed with pungent substances. The least effective is no better than bloodletting with bi needles; once blood is out, the disease resolves. (Zhang Hezi)
Diseases of the throat and pharynx include unilateral Ru E, bilateral Ru E, unilateral Hou Bi, bilateral Hou Bi, Chan Hou Feng, Ji Hou Bi (Acute Throat Obstruction), Xuan Yong Chui (Uvula) lesions, Mei He Qi (Plum-pit Qi), Shi Yan (Corpse Throat), Gu Zei (Grain Thorn), Gu Geng (Bone Splinter), Yan Tong (Sore Throat), and Yan Chuang (Throat Ulcer). ○ The uvula arises at the upper rear; although not directly part of the throat proper, sudden swelling there is also caused by Heat. ○ Shi Yan results from disharmony of Yin and Yang, Wind-Heat in the Spleen and Lung, and accumulation of toxic vapors blocking flow, causing corpse-worms to activate and erode the throat upwards, causing itching or pain, similar to Huo Huo disease in Cold Damage; reference should be made. ○ Gu Zei refers to sharp, astringent awns of grains; if mistakenly ingested, they lodge in the pharyngeal gate, piercing the Lung. If not treated urgently, it can be fatal. (*Ren Zhi Zhi Zhi*)
Supplementary Compilation
Treatment of Throat Conditions: For Excess patterns, first disperse, then cool; or induce vomiting to guide out phlegm, or prick to bleed; for Deficiency patterns, one must follow the principle of contrary treatment from *Nei Jing*, administering medication slowly and frequently. (*Yi Xue Zheng Zhuan*)
Treatment of Sore Throat depends on the severity of Fire: mild cases use direct treatment, severe cases use contrary treatment. Removing phlegm and bleeding are applied as appropriate, such as pricking Shaoshang (LU11) on the thumb to bleed. If swelling extends externally, external application is necessary. With exterior signs, use Licorice, Platycodon, Schizonepeta, Saposhnikovia, Notopterygium to release the exterior. Without aversion to cold, sour substances can be blown into the throat to extract phlegm; commonly using a goose feather dipped in rice vinegar to stir the pharynx and remove phlegm. If Ru E swelling is severe, first prick the tonsil with a small knife to bleed, then apply Sal Nitre powder to reduce Fire. Internal administration includes Belamcanda, Indigo Naturalis, Licorice, Platycodon, Gardenia, Scutellaria, Arctium, Rhubarb, etc., to disperse Upper Jiao Heat. External application includes raw radish, Chinese chive root, Longtan soil, etc. If throat ulcers are white with much phlegm or red with much blood, they generally follow the same pattern as mouth ulcers. Decocting Rose Root Bark, Phellodendron, and Indigo Naturalis for gargling and savoring is excellent. (*Tui Qiu Shi Yi*)
*Nei Jing* states: One Yin and one Yang knot, called Hou Bi. One Yin refers to Hand-Shaoyin Ministerial Fire, the Heart meridian; One Yang refers to Hand-Shaoyang Ministerial Fire, the Sanjiao meridian. The meridians of these two organs all connect to the throat, so Heat Qi knots internally; severe knotting causes swelling, severe swelling causes obstruction, severe obstruction leads to death. This refers to conditions like Hou Xuan (Throat Herpes), Hou Feng (Throat Wind), Hou E (Throat Moth). Examining the twelve meridians, only the Foot-Taiyang Bladder Meridian branches down the neck; all others converge at the throat. However, *Nei Jing* specifically mentions One Yin and One Yang knotting as Hou Bi, likely because Ministerial Fire and Sovereign Fire alone prevail, causing Heat and Pain. Reviewing historical decoctions for throat diseases, they mainly use Pungent dispersants and Salty softeners to dispel Wind-Phlegm and resolve Heat-Toxicity. Such as Yuan Shen Sheng Ma Tang, Sheng Ji Tou Guan San, Yu Yao Chi, Ru Sheng San, Pu Ji Xiao Du Yin, all prioritize treating the branch (symptoms) over the root (cause). Also examining Zhang Zhongjing's *Shang Han Lun* regarding throat ulcers, Licorice and Platycodon are often used, along with Ban Xia San Ji Tang. One case is due to Foot-Shaoyin Water deficiency failing to ascend to nourish Sovereign Fire, causing throat ulcers and voice loss; thus Ban Xia's pungency and slipperiness, assisted by egg white to open orifices and restore voice, with bitter wine entering Yin to seize phlegm and astringe ulcers. Gui Zhi releases the muscle layer, exiting from meridians to the surface, entirely opening via Taiyang. Ban Xia treats sore throat without drying fluids or depleting Yin. Another case is Yin Fire knotting causing sore throat; thus Licorice's sweet-cool nature clears Heat, easing Kidney urgency and saving Yin fluids, assisted by Platycodon to lift Heat from Foot-Shaoyin. If Kidney fluids drain downward and fail to vaporize to the Lung, causing dry collaterals and sore throat, Zhu Fu Tang moistens dryness, clears Heat, and moderates the middle, harmonizing Yin and Yang to heal; this is strengthening the root while treating the branch. Others include Wind-Fire stagnation with Yin deficiency and rapid pulse pain, treated with Pungent-Cool clearing methods. Tight obstruction with Heat Qi and pain requires clearing Lung and purging Heat. Emotional depression with Ministerial Fire flaring up requires descending Qi and opening depression. Kidney fluid deficiency with Liver Yang rising requires Qian's Liu Wei Tang. Yin-Yang mutual deficiency with Dragon/Fire flaring up requires Zhongjing's Zhu Fu method. (*Lin Zheng Zhi Nan*)
For unilateral or bilateral Ru E, if toxicity is mild and pus not formed, treatment naturally dissipates it. If severe, bloodletting via bi needle is necessary due to urgency. ○ Treating Fire in Hou Bi is like fighting fire; delay is unacceptable. *Nei Jing* says "Disperse Fire Stagnation." Dispersal usually means sweating, but how can one sweat in the throat? Thus, bleeding is a form of dispersal. ○ Yin Deficiency Hou Bi presents with internal heat, thirst, dry throat, red lips and cheeks, abundant phlegm, but the Chi pulse lacks spirit, or all six pulses are rapid yet floating, soft, and weak. This is due to Kidney Yin deficiency failing to control Fire. Severe Fire uses Zi Yin Ba Wei Jian or Jia Jian Yi Yin Jian; mild Fire uses Liu Wei Di Huang Tang or Yi Yin Jian. If caused by excessive thinking and anxiety stirring Heart Fire, use Er Yin Jian. ○ Ge Yang Hou Bi results from Rootless Fire lodging in the throat; symptoms show Upper Heat and Lower Cold, completely unlike typical Fire signs. Six pulses are weak and faint, lacking slippery or large qualities. Use Zhen Yin Jian immediately as the best choice, followed by Ba Wei Di Huang Tang. ○ Hou Xuan (Throat Herpes) occurs frequently in those with Yin Deficiency and consumptive disease. Symptoms include ulcers throughout the throat, redness and pain, chronic non-healing. This is Water deficiency with Empty Fire; treat using the Yin Deficiency Hou Bi method. ○ Wen Du Hou Bi (Plague-Toxin Throat Obstruction) is caused by epidemic Qi. Symptoms include sore throat and neck swelling; this is severe Damp-Heat accumulation, the most ominous presentation. Clear Fire from all meridians or purge Yangming Heat, treating according to urgency. Dong Yuan's Pu Ji Xiao Du Yin is excellent. ○ Whenever Fire accumulates in the upper body, dietary choices should favor Sydney浆 (likely a specific local remedy or typo, kept as is), Mung Bean Drink, or Radish Juice mixed with spring water, adding a little Yuan Ming Fen (Mirabilite), stirred well and drunk slowly; this reduces phlegm and clears Fire. (Zhang Jingyue)
Sore throat belongs to Shaoyin disease, but differs in Cold, Heat, Deficiency, and Excess. Shaoyin Fire rushes like a galloping horse, counter-flowing to the throat, stagnating and uncomfortable, causing swelling or pain. Symptoms must include internal heat, dry mouth, red face, surging phlegm, rapid and weak pulse. This is due to Kidney Water deficiency failing to control Ministerial Fire. Use Liu Wei Di Huang Tang with Ophiopogon and Schisandra in large doses. Another case is Yuan Yang (Primordial Yang) deficiency with Rootless Fire roaming uncontrollably and lodging in the throat; use Ba Wei Wan decoction chilled and drunk cold to guide Fire back to its source. This is what Chu Shi called "treating the lower for disease in the upper." The human throat is like a curved chimney; if fire burns in the chimney, pouring water from top to bottom causes explosion. Only by placing a basin of water below the stove bed does the upward flame extinguish. This verifies treating the lower for upper disease. ○ Another case is Ji Hou Bi (Acute Throat Obstruction); sound like sawing wood, phlegm like dragging a saw, indicating Lung Qi exhaustion. Quickly decoct Du Shen Tang (Ginseng Decoction) to save; delay is too late. (*Zhao Shi Yi Guan*)
Sore throat cases involve Wind-Fire in 80-90%. Suddenly administering cloying, acidic, or astringent agents ensures almost certain death. In Xin You and Ren Xu years, half of those with sore throat died immediately from warm-drying drugs; even those given cooling drugs with slightly heavy/turbid ingredients could not be saved. I cured hundreds using only Pungent-Cool, light, clear, and dispersing agents. Following this method, none failed. (*Yi Guan Bian*)
All treatments for Hou Bi require inducing vomiting. Use Alum or Malachite ground to powder, mixed with Mint juice and Vinegar, dip a chicken feather in the medicine, insert into the throat, and slowly draw out phlegm for expectoration. (*Dong Yi Bao Jian*)
Bi means blockage. Throat and pharynx are closed, preventing ingestion of liquids and medicines. Since solid objects are hard to swallow, one must take intangible Qi via the nose. Press Castor Bean oil onto paper, roll the oiled paper into a strip, light it, blow it out, and smoke the nose to induce salivation in mouth and nose, naturally opening the jaw. (*Ming Yi Lei An*)
The uvula is called Di Zhong (Imperial Bell). When swollen and hanging down, several inches long, it is called Di Zhong Feng. Use blowing powders; do not needle, as needling causes death. (*De Xiao Fang*)
For sore throat unresponsive to various medicines, if a red thread appears in the nose suspending a black blister like a cherry, hanging to the pharyngeal gate, use Achyranthes root, crush with vinegar to juice, drip into the nose; when the thread breaks and blister pops, pain stops immediately. (Luo Qianfu)
Methods for treating foreign bodies can be analogized. Cormorant treats fish bones, Magnetite treats needle splinters, Ash of Hair treats hair splinters, Tiger Bone treats bone splinters; each follows its category. (*San Yin Fang*)
For animal bone splinters, hang a dog upside down, collect its saliva, and have the patient swallow it; the bone dissolves miraculously. Dogs love eating bones. (*Wan Bing Hui Chun*)
If rice or wheat awns are swallowed into the throat, swallow Goose saliva; they pass immediately. Geese can eat grain. (*Yi Xue Gang Mu*)
Selected Cases
Prince Wang, one year old, played with an iron nail given by his mother and swallowed it into the throat. His father cried for help. Hearing the crying, I said, "The nail has been swallowed." Searching for a remedy proved futile, so I consulted Materia Medica, finding the record: "Iron fears Mirabilite." Thus, I used 1 qian of Magnetite and 2 qian of Mirabilite, ground to powder, mixed with Pig Fat and Honey, and administered. The substance becomes smooth like taro without edges; the medicine protects the outside, the nail inside. Mirabilite without Magnetite cannot make the medicine adhere to the nail; Magnetite without Mirabilite cannot drive the nail out quickly. Oil provides lubrication; Honey ensures ingestion. Combining these four, the adhering adheres, the driving drives, the lubricating lubricates; working together, they wrap and expel the object. ○ Wang Pengque suffered from Hou Bi, with swollen head and face, extremely thick throat and neck, rapid breathing, hoarse voice, swollen pharynx, severe mouth ulcer pain, sitting restlessly for days. Pulse was fine, rapid, weak, and faint; speech was weak and unmoving. Previous medications included Scutellaria, Coptis, Gardenia, Phellodendron. This arose from Yin injury, further forced by Cold-Cool drugs, causing Cold excess below and Ge Yang (Rejecting Yang) above. Difficulty drinking, especially fearing irritability and heat. I said, "Dangerous!" Prescribed Zhen Yin Jian, cooled in well water, to be swallowed slowly. Overnight, head and neck swelling and pain disappeared completely. (Zhang Jingyue)
Attached Formulas
Chan Hou Feng Emergency Formula: Swelling on both sides of the throat like eggs, airway blocked, phlegm rattling, critical condition. Use coarse roots of Achyranthes Bidentata, approx. 1 liang, do not wash with water, crush to juice, mix with vinegar, dip chicken feather to stir throat; phlegm discharge reduces swelling. Afterwards blow Ren Zhong Bai (Human Tooth Fossil) and Bing Pian (Borneol). If jaw is locked tight, mix with Human Milk, crush to juice, drip into nose. Using Stone Succisa Root mixed with Human Milk, crushed to juice and dripped into nose, yields same effect.
Another Formula: A doctor in the capital held a secret formula for treating Hou Bi, gaining great profit. It was accidentally exposed by Weng Shugong. The formula used only facial cleansing soap, coated with Gold Leaf, to induce vomiting of thick phlegm; critical conditions revived immediately.
Another Formula: Treats Hou Bi and Ru E. Use one Spider Web nest, tie a hair plucked from the patient around it, burn on lamp with silver hairpin until carbonized, grind to powder, blow onto affected area; eliminates immediately.