梅核气者,乃痰气结于喉中如块,咽之不下,吐之不出。《金匮》云∶妇人咽中有如炙
脔,半夏浓朴汤主之。炙脔者,干肉也。此病不因肠胃,故不碍饮食、二便,不因表邪,故
无骨疼、寒热,乃为积寒所伤,不与血和,血中之气溢而浮于咽中,得水湿之气凝结难移。
男子亦间有之。药用半夏浓朴汤,乃二陈汤去陈皮、甘草,加浓朴、紫苏、生姜也。专治妇
人七情之气,郁滞不散,结成痰涎;或如梅核在咽,咯咽不下;或中脘痞满,气不舒畅;或
痰饮中滞,呕逆恶心,并可取效。盖半夏消痰降逆,浓朴散结,生姜、茯苓宣至高之滞而下
其湿,苏叶味辛气香、色紫性温,能入阴和血,则气与血和,不复上浮也。
喉喑者,谓有言而无声。由风火侵肺,误服寒凉生冷。音雌者轻,虚痨肺损音哑者难治
。又病患瘥后,气短及声不出者,皆肺气不行,宜服降气汤,多加前胡,临服加姜汁以佐之
。又妇人有子喑病,经云∶妇人重身九月而喑者,胞之络脉绝也,无治,当十月复。谓胎至
九月,儿体已长,胞宫之络脉,系于肾经者,阻绝不通,故间有是证。盖肾经之脉,上系舌
本,脉道阻绝,则不能言,至十月分娩后,而自能言,不必加治,治之当补心肾。
夫烂喉丹痧者,系天行疫疠之毒,故长幼传染者多,外从口鼻而入,内从肺胃而发。其
始起也,脉紧弦数,恶寒头胀,肤红肌热,咽喉结痹肿腐,遍体斑疹隐隐,斯时即宜疏表,
如牛蒡解肌汤、升麻葛根汤,内加消食等药;喉内用珠黄散吹之。至三、四日,温邪化火,
热盛痧透者,解肌汤内加犀角、羚羊、石斛、花粉;若大便干结燥实者,凉膈散亦可;如协
热便泄,舌苔白腻者,葛根芩连汤。至五、六日,热甚,神识时迷,咽喉腐烂,鼻塞不通,
时流浊涕,此以火盛上逆,循经入络,内逼心胞,用犀角地黄汤,或玉女煎内加胆星、石菖
、西黄、药珠,或紫雪丹。至七日后热退,遍体焦紫,痧 如麸壳,脱皮而愈。
如起时一、二日后,脉细弦劲,身虽红赤,痧不外透,神识昏蒙,语言错乱,气逆喘
急者,此疫毒内闭,即为险逆证。可用鲜生地四两捣汁,和金汁、梨汁、蔗浆;再用鲜芦
根煎汤,磨犀角汁冲和,送化紫雪丹或珠黄散。惟芳香开逐,庶可冀其侥幸于万一耳。
梅核气,是指痰气结聚在咽喉中,感觉像有一块东西,吞咽不下去,吐也吐不出来。《金匮要略》中说:妇女咽喉中有如烤肉块的感觉,用半夏厚朴汤主治。炙脔,就是干肉的意思。这种病不关乎肠胃,所以不影响饮食和二便;不关乎表邪,所以没有骨节疼痛、恶寒发热等症状,这是由于积寒损伤人体,导致气血不和,血中的气溢出并浮越于咽喉部位,遇到水湿之气凝结而难以消散。男子偶尔也会有此病。药用半夏厚朴汤,这是由二陈汤去掉陈皮、甘草,加入厚朴、紫苏、生姜组成。专门治疗妇女因七情(喜、怒、忧、思、悲、恐、惊)之气郁滞不散,结成痰涎;或者感觉像梅核卡在咽喉,咳不出又咽不下;或者中脘部痞塞胀满,气机不畅;或者痰饮停滞在中焦,呕吐恶心,都可以取得疗效。因为半夏能消痰降逆,厚朴能散结,生姜和茯苓能宣通上焦的滞气并下行湿气,紫苏叶味辛气香、色紫性温,能入阴分调和血液,使气与血调和,不再上浮。
喉喑,是指有声音但发不出声。多由风火侵犯肺脏,或误服寒凉生冷食物所致。音雌(声音嘶哑轻微)者较轻,虚劳肺损导致的音哑者难治。另外,病人病愈后,出现气短及声音出不来的情况,都是肺气运行不畅,适宜服用降气汤,多加前胡,服药时加入姜汁辅助。还有妇女有一种子喑病,《内经》说:妇女怀孕九月出现失音的,是因为胞宫的络脉暂时阻绝,不需要治疗,等到十月分娩后会自然恢复。意思是胎儿到九月时,身体已长大,连接肾经的胞宫络脉被阻碍不通,所以偶尔会出现这种情况。因为肾经的经脉上行系连舌根,脉道阻绝,所以不能说话,到十月分娩后,就能自然说话,不必特别治疗,若要治疗应当补益心肾。
至于烂喉丹痧,属于天行疫疠之毒,所以老少传染者很多,病邪从口鼻侵入,从肺胃内部发作。刚开始起病时,脉象紧弦数,恶寒头胀,皮肤发红肌肉发热,咽喉痹阻肿痛腐烂,全身斑疹隐约可见,此时就应当疏解表邪,如使用牛蒡解肌汤、升麻葛根汤,内部加入消食等药物;咽喉内部用珠黄散吹敷。到了三、四天,温邪化为火邪,热盛且痧毒透发,可在解肌汤中加入犀角、羚羊角、石斛、天花粉;如果大便干结燥实,也可用凉膈散;如果伴有热利泄泻,舌苔白腻,可用葛根芩连汤。到了五、六天,热势更甚,神志时而昏迷,咽喉腐烂,鼻塞不通,时常流出浊涕,这是因为火邪亢盛上逆,沿经络入络,内逼心包,可用犀角地黄汤,或在玉女煎中加入胆南星、石菖蒲、西黄(牛黄)、药珠(珍珠),或者紫雪丹。到了七日后热退,全身皮肤焦紫,痧疹脱皮如麸壳般脱落而痊愈。
如果在起病一、二日后,脉象细弦劲急,身体虽然红赤,但痧毒不外透,神志昏蒙,语言错乱,气逆喘急的,这是疫毒内闭,属于险逆证。可用鲜生地四两捣汁,混合金汁、梨汁、蔗浆;再用鲜芦根煎汤,磨犀角汁冲和,送服化开的紫雪丹或珠黄散。只有用芳香开窍逐邪的方法,或许还能侥幸挽回万一。
Meiheqi (Plum-pit Qi) refers to a sensation of a lump in the throat caused by the accumulation of phlegm and qi, which cannot be swallowed down nor spat out. The *Jin Gui Yao Lue* states: "When a woman feels as if there is a piece of roasted meat in her throat, Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction) should be used." Zhi luan (roasted meat) refers to dried meat. This condition does not involve the intestines or stomach, so it does not hinder eating or bowel/bladder functions; it is not caused by exterior pathogens, so there are no bone pains, aversion to cold, or fever. It results from accumulated cold injuring the body, causing disharmony between blood and qi. The qi within the blood overflows and floats upward into the throat, where it condenses with dampness and becomes difficult to move. Men may occasionally suffer from this as well. The prescription Banxia Houpo Tang consists of Erchen Tang (Two-Cured Decoction) with Chenpi (Tangerine Peel) and Gancao (Licorice Root) removed, and Houpo (Magnolia Bark), Zisu (Perilla Leaf), and Shengjiang (Fresh Ginger) added. It specifically treats qi stagnation due to the seven emotions (joy, anger, worry, thought, sadness, fear, fright) in women, leading to the formation of phlegm-saliva; or the sensation of a plum pit stuck in the throat, unable to be coughed up or swallowed; or fullness and distension in the epigastrium with unsmooth qi flow; or retention of phlegm-fluids in the middle jiao causing vomiting and nausea. All these can be effectively treated. Banxia (Pinellia Rhizome) resolves phlegm and directs rebellious qi downward; Houpo (Magnolia Bark) dissipates nodules; Shengjiang (Fresh Ginger) and Fuling (Poria) diffuse stagnation in the upper jiao and drain dampness downward; Zisu Ye (Perilla Leaf) is pungent, aromatic, purple, and warm in nature, entering the yin to harmonize blood, thus harmonizing qi and blood and preventing them from floating upward.
Houyin (Laryngeal Aphonia) refers to having a voice but being unable to produce sound. It is caused by wind-fire invading the lungs or the mistaken ingestion of cold and raw foods. Mild hoarseness (Yinci) is light in severity, while aphonia due to consumptive lung damage (Xulao Feisun) is difficult to treat. Additionally, after a patient recovers from an illness, shortness of breath and inability to speak indicate poor functioning of Lung Qi; Jiangqi Tang (Qi-Descending Decoction) with added Qianhu (Peucedani Radix) is appropriate, with Jiangzhi (Ginger Juice) added before administration. Furthermore, some women experience Zi Yin (Aphonia during Pregnancy). The *Neijing* states: "When a pregnant woman loses her voice at nine months, it is because the collateral vessels of the uterus are obstructed." No treatment is needed; speech will return after ten months. This occurs because when the fetus reaches nine months, its body has grown large, obstructing the collateral vessels of the uterus connected to the Kidney meridian. Since the Kidney meridian ascends to connect with the root of the tongue, obstruction prevents speech. After delivery at ten months, speech returns naturally. If treatment is necessary, it should focus on tonifying the Heart and Kidneys.
Lanhou Dansha (Rotten Throat Erythema/Scarlet Fever) is caused by epidemic pestilence toxins transmitted through the air, affecting people of all ages. The pathogen enters via the mouth and nose and manifests internally from the Lungs and Stomach. Initially, the pulse is tight, wiry, and rapid, accompanied by aversion to cold, head distension, red skin, hot muscles, and swollen, ulcerated, and obstructed throat. Generalized macules and papules are faintly visible. At this stage, exterior release is indicated, using formulas such as Niubang Jieji Tang (Arctium Muscle-Releasing Decoction) or Shengma Gegen Tang (Cimicifuga and Kudzu Decoction), with digestive aids added internally. Zhuhuang San (Pearl and Realgar Powder) should be insufflated into the throat. By the third or fourth day, if warm pathogens transform into fire and heat is intense with rash eruption, Xijiao (Rhinoceros Horn - now substituted with Water Buffalo Horn), Lingyangjiao (Antelope Horn), Shihu (Dendrobium), and Huafen (Trichosanthes Root) should be added to the muscle-releasing decoction. If stool is dry and constipated, Liangge San (Cool the Diaphragm Powder) may be used. If accompanied by heat-induced diarrhea and a white, greasy tongue coating, Gegen Qinlian Tang (Kudzu and Coptis Decoction) is suitable. By the fifth or sixth day, if heat is severe, consciousness is intermittently clouded, the throat is ulcerated, nasal congestion persists, and turbid discharge flows, this indicates excessive fire rebelling upward, entering collaterals along meridians, and pressing inward on the Pericardium. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), or Yunnv Jian (Lady's Mansion Decoction) supplemented with Danning (Arisaema cum Bile), Shichangpu (Acorus Rhizome), Xi Huang (Calculus Bovis), and Yao Zhu (Pearl), or Zixue Dan (Purple Snow Pill) may be used. After the seventh day, as heat subsides, the body turns dark purple, the rash sheds like bran, and recovery follows.
If, within one or two days of onset, the pulse is fine, wiry, and tense, the body is red but the rash fails to erupt, consciousness is confused, speech is disordered, and there is rebellious qi with wheezing and urgency, this indicates internal closure by epidemic toxins, representing a critical and adverse condition. Fresh Dihuang (Rehmannia Root) four liang, crushed for juice, mixed with Jinzhi (Gold Juice), Lizhi (Pear Juice), and Zhe Jiang (Sugarcane Juice); fresh Luzhen (Reed Rhizome) decocted for soup, mixed with ground Xijiao (Rhinoceros Horn) juice, can be used to administer Zixue Dan (Purple Snow Pill) or Zhuhuang San (Pearl and Realgar Powder). Only with aromatic methods to open orifices and expel pathogens is there a slight hope of survival.