《难经》云∶会厌为吸门，胃为贲门，病痘之人，毒火上熏于肺，灼于胃，肺与胃
之上口，皆有疮而伤矣，水入则呛者，贲门伤则水不得入嗌，入会厌、会厌掩而
不内，故气逆喷出而呛也。食入则吐者，贲门伤则门户隘塞，食物不能直奔于胃，缓则汨汨而下，急则阻而吐
出矣，此其恶候，鲜有生者。其或舌上有疮烂破如蜂窠之状，舌痛强硬，不能为用延纳水谷，亦使水入则呛，食入则
吐，待舌疮平，则安矣。咽以咽物，喉以候气，咽居后而通于胃，喉居前而通于肺，肺无下窍，加橐
然，能受清虚之气，而不受有形之物，喉上有物若悬乳，名曰会厌，凡物入口，则舌抵上 ，舌抵上 则会厌必掩其喉，
故水谷但入咽，而不入喉，若痘生会厌，则木强不利开阖矣，干物间可入咽，而水饮或漏入喉，所以呛也，呛者、
犹云错喉，气须药补，汤药不入，则无补法，故不可治。〔翁〕七日以前痘色红紫而兼此证者，乃火气炎上，热毒壅
塞故也。痘色灰白不起而兼此证者，乃气血虚弱，肺胃受伤故也。二者俱是逆证。七日以后，外痘蒸长光润而有此证者，
是内证亦长，故致如此，外痘结痂，则内证亦靥矣，不治自愈。善治者，当察毒盛之痘于其咽喉干燥之先，而用甘桔汤、
解毒汤加麦冬、栝蒌皮穣、牛蒡子、玄参、荆芥之类，以清气道，不使热毒有犯，则自能免此患矣。袁氏治呛逆歌曰∶
痘中呛逆最凶危，沉香浓汁杏仁推，远把蜂糖多和水，按经煎透滤渣随，欲服晨时加好乳，汤中温热渐调之。余每
详察，痘呛者，乃元气耗铄，枭炎上升，故致呛逆，准恪后方。
人乳一钟，人参一钱，桔梗一钱，枇杷叶三片，共煎，滤渣，服乳。或用沉香磨人乳服者，虽效，总
不若此方之屡见捷也。
《难经》中说：会厌是吸门，胃的上口是贲门。患痘疮的人，毒火向上熏蒸肺部，灼烧胃部，肺和胃的上口都有疮疡而受损。水进入时发生呛咳，是因为贲门受伤，水无法顺利进入咽喉；水流到会厌处，会厌覆盖喉口阻止其进入，导致气逆上冲喷出而发生呛咳。食物进入时发生呕吐，是因为贲门受伤导致门户狭窄堵塞，食物不能直接迅速进入胃中，缓慢则汨汨而下，急迫则受阻而吐出。这是恶候，很少有存活者。如果舌头上有疮疡溃烂，形状像蜂巢一样，舌头疼痛僵硬，不能正常使用以接纳水谷，也会导致水入则呛、食入则吐，等到舌疮平复，病情就会安定。咽部用来吞咽食物，喉部用来呼吸气息，咽位于后方连通胃，喉位于前方连通肺。肺没有向下的窍道，依靠如风箱般的结构（橐龠），只能接受清虚之气，而不能接受有形之物。喉上方有一个像悬挂乳头一样的组织，名叫会厌。凡是食物入口，舌头抵住上颚，舌头抵住上颚则会厌必然覆盖喉口，所以水谷只进入咽部，而不进入喉部。如果痘疮生在会厌处，就会导致木性强硬不利开阖，干物间或可进入咽部，而饮水可能漏入喉部，所以发生呛咳。呛咳，也就是错入喉部的意思。气需要药物补益，汤药无法进入，就没有补益的方法，所以不可治。〔翁氏〕七日以前，痘色红紫并兼有此证的，是火气炎上，热毒壅塞的缘故。痘色灰白不起发并兼有此证的，是气血虚弱，肺胃受伤的缘故。这两种情况都是逆证。七日以后，外部痘疹蒸腾生长、光泽润泽并兼有此证的，是内部证候也在生长，所以导致如此，外部痘疹结痂，内部证候也会消退，不治自愈。善于治疗的人，应当在察知毒盛之痘在咽喉干燥之前，使用甘桔汤、解毒汤加入麦冬、栝蒌皮瓤、牛蒡子、玄参、荆芥之类，来清气道，不让热毒侵犯，自然能免除这个祸患。袁氏治疗呛逆的歌诀说：痘中呛逆最凶险危急，沉香浓汁配合杏仁推荐，远志用蜂糖多和水调和，按照经络煎透滤去药渣跟随，想要服用时在早晨加入好乳汁，汤药温热逐渐调服。我每次详细考察，痘疮引起的呛逆，是元气耗损削弱，邪火上升，所以导致呛逆，遵循恪定的后方。人乳一杯，人参一钱，桔梗一钱，枇杷叶三片，共同煎煮，滤去药渣，服用乳汁。或者用沉香磨入人乳服用，虽然有效，但总不如这个方剂屡见奇效。
The *Nan Jing* (Classic of Difficult Issues) states: The epiglottis is the "Xi Men" (Inlet Gate), and the upper opening of the stomach is the "Ben Men" (Receiving Gate). In patients suffering from smallpox, toxic fire steams upward to affect the Lung and scorches the Stomach. Both the Lung and the upper opening of the Stomach suffer from sores and damage. When water enters, choking occurs because the Ben Men is damaged, preventing water from entering the pharynx; when water reaches the epiglottis, the epiglottis covers the glottis to prevent entry, causing Qi to reverse and rush out, resulting in choking. When food enters, vomiting occurs because the damaged Ben Men causes a narrow and blocked passage; food cannot go directly into the Stomach quickly. If slow, it trickles down; if rapid, it is obstructed and vomited out. This is a malignant sign, with few survivors. If there are sores on the tongue that ulcerate like a honeycomb, accompanied by tongue pain and stiffness, rendering it unable to accept food and fluids, this also causes choking upon drinking and vomiting upon eating. The condition will stabilize once the tongue sores heal. The pharynx is used for swallowing, while the larynx is used for breathing. The pharynx is located posteriorly and connects to the Stomach; the larynx is located anteriorly and connects to the Lung. The Lung has no lower orifice and relies on the bellows-like mechanism (*Tuoyue*) to receive pure and empty Qi, but not tangible substances. Above the larynx lies an organ resembling a hanging nipple, called the epiglottis. Whenever food enters the mouth, the tongue presses against the hard palate; pressing the tongue against the hard palate causes the epiglottis to cover the larynx. Thus, food and drink enter the pharynx but not the larynx. If smallpox lesions occur on the epiglottis, the wood element becomes rigid, impairing opening and closing functions. Dry food may occasionally enter the pharynx, but liquids may leak into the larynx, causing choking. Choking implies misdirection into the larynx. Qi requires medicinal tonification; if decoctions cannot be taken, there is no method for tonification, making the condition untreatable. [Weng] If, before the seventh day, the smallpox rash is red-purple and accompanied by this syndrome, it is due to flaming fire rising and heat-toxin obstruction. If the rash is grayish-white, flat, and accompanied by this syndrome, it is due to deficiency of Qi and Blood and injury to the Lung and Stomach. Both are adverse syndromes. After the seventh day, if the external rash is steaming, growing, smooth, and glossy, accompanied by this syndrome, it indicates that internal pathology is also resolving; thus, when the external rash scabs, the internal pathology will resolve as well, and the disease will heal spontaneously without treatment. A skilled practitioner should observe toxic-rash cases before the onset of dryness and soreness in the throat and use Gan Jie Tang (Licorice and Platycodon Decoction) or Jie Du Tang (Detoxification Decoction) added with Maidong (Ophiopogon Tuber), Gualou Pi Rang (Trichosanthes Peel Pith), Niubangzi (Arctium Fruit), Xuanshen (Scrophularia Root), and Jingjie (Schizonepeta Spike), to clear the airway and prevent heat-toxin invasion, thereby avoiding this complication naturally. Yuan’s song on treating choking and reversal states: "Choking and reversal in smallpox are most fierce and critical; thick decoction of Chenxiang (Aquilaria Wood) and Xingren (Apricot Seed) are recommended; mix far with much bee honey and water; decoct thoroughly according to meridians, filter dregs, and follow; for morning administration, add good breast milk; warm the decoction gradually." Upon my detailed examination, choking in smallpox is caused by depletion of Yuan Qi (Original Qi) and rising of evil fire. Therefore, I follow the later prescription: One cup of human milk, one qian of Renshen (Ginseng Radix), one qian of Jiegeng (Platycodon Root), and three leaves of Pipaye (Loquat Leaf), decocted together, filtered, and taken with milk. Alternatively, grinding Chenxiang into human milk for consumption is effective, but never as frequently successful as this formula.