夫烂喉丹痧之证，方书未载其名。上稽往古，《金匮》有阳毒之文，叔和着温毒之说，
其证形与今之名丹痧烂喉者极合。本论以升麻鳖甲汤、黄连解毒汤主治。是论邪入阴阳二经
。治法大例，原未教人穿凿执方，学人以意会之可也。今考斯证，每发于杂气邪阳之令，来
势卒暴莫制，如迅雷风烈，令人色沮，见者莫不萎 咋舌，却走不遑。与费氏所论痘证
中，邪火毒伏之例，如脉伏厥冷、汗淋便泄、哕逆躁烦诸恶款相同。甚有一门传染，不数日
间相继云亡者。呜呼！其惨酷何至今为烈耶。程郊倩云∶古人出痘少，温毒始盛；今人出痘
多，温毒亦少。时下种痘之术盛行，或邪毒未泄所致欤，抑亦气运自然之会欤。《吴医汇讲
》中，李祖二君，论证论治甚详。所谓骤寒则火郁而内溃，过散则火焰而腐增，洵属至理名
言，确乎不拔。然亦不外缪氏笔记中，肺胃为本，先散后清之旨云尔。推此论治，邪气在卫
，麻杏甘膏，势所必投；毒火侵营，犀角地黄，亦所当取；即如眉寿叶氏，宗喻老芳香宣窍
解毒之议，治用紫雪丹，其法亦不可缺。顾临证权宜，要在生心化裁之妙耳。然欤否欤，自
有能辨之者，管见一斑，俟高明教政。倘更示以指南，不致苍生贻误，幸甚幸甚。
夫耳者，肾所开窍，又属少阳胆三焦经脉所会之处。为痈为疡，不外乎诸经火逆所致。
然有虚火，有实火，不可不辨也。如风温袭阻，初起必寒热往来，头痛，耳中肿胀，脉弦硬
数，似乎疟状，用牛蒡、荆芥、薄荷、夏枯草、丹皮、山栀，或小柴胡汤，如得汗邪彻，则
肿胀自平；或至三、五日后，胀痛更甚，身热不和，风温化火，必挟肝邪上升，胀痛时如针
刺，内成脓矣，用羚羊角、丹皮、山栀、钩钩、夏枯草，或龙胆泻肝汤，俟脓泄邪彻，自热
退痛止。但其脓不能即干，必须十日半月收功；以少阳三焦多气少血，血少则肌肉难长，故
疮口难合耳，此实火之证也。须知耳内有脓时，不可用末药掺之，盖耳窍止有开而无合，将
药纳入，塞阻孔窍，脓不外泄，热毒即循络外达，绕耳红肿，则发外耳痈矣。必欲开刀脓泄
方愈。所谓虚火耳痈者，或因肝胆怒火遏郁，或因肾经真阴亏损，相火亢盛而发。初起亦必
寒热，胀而不肿，头顶连项掣痛，脉细数，神形静。此肝阳挟虚火上逆，不能消散，久则成
脓，此疡最难速愈。初时用羚羊角散，冀其镇肝清热，久宜用大补阴丸，或金匮肾气丸滋阴
补虚，庶可取效。又幼孩三、四岁时，亦有此证，经年脓水不干。此系先天不足，水不养木
，肝阳上逆而结。不痛不肿，不必治之；俟阴分足，肝阳平，则愈矣。又小儿因胎风胎热，
或洗浴灌水，耳内亦致作痛生脓。初时不可搽药，候毒尽自愈；如月外不瘥，以红绵散治之
。
耳菌，耳口中发一小粒，形红无皮，宛如菌状，不作脓，亦不作寒热，但耳塞不通，缠
绵不已，令人耳聋。先用针刺破，以玉红膏涂之，耳胀痛，用虎耳草汁滴入耳内，痛即止；
内服药同虚耳痈。
附∶耳漏生于耳根翎上，女孩穿耳穿伤者多此证，溃脓最难收口，必升药条提之，历久
方愈。
烂喉丹痧这一病证，在以往的医书中没有记载它的名称。向上追溯古代文献，《金匮要略》中有“阳毒”的论述，王叔和提出了“温毒”的说法，这些病症的表现形式与现在所说的丹痧、烂喉非常吻合。本论主张用升麻鳖甲汤、黄连解毒汤来主治。这是论述邪气侵入阴经和阳经的情况。治疗的大致原则，原本并没有教导人们要生搬硬套、拘泥于固定方剂，学习者应当用心领会其精神实质即可。
如今考察这种病症，往往在杂气（多种致病邪气）和邪阳盛行的时令发作，发病势头突然猛烈，无法控制，就像迅雷烈风一样，让人神色沮丧，见到的人无不惊讶咋舌，惊慌逃跑都来不及。这与费伯雄所论述的痘证中，邪火毒邪潜伏体内的情况相似，比如脉象伏匿、四肢厥冷、大汗淋漓、腹泻、呃逆、烦躁等种种危重症状相同。甚至有一家之内互相传染，在几天内相继死亡的情况。唉！其惨酷程度为何到了今天如此剧烈呢？程郊倩说：古人出痘少，温毒就盛行；今人出痘多，温毒就少。时下种痘技术盛行，或许是邪毒未能宣泄所致呢，还是运气自然变化的结果呢？《吴医汇讲》中，李祖二君对论证和治疗论述得非常详细。所谓“骤然受寒则火郁结而内部溃败，过度发散则如火焰般加剧并导致腐烂增加”，这确实是至理名言，确凿不可动摇。但这也不外乎缪氏笔记中提到的“以肺胃为本，先疏散后清解”的宗旨罢了。
推演这种论治方法，如果邪气在卫分，麻杏甘膏汤是必然要用的；如果毒火侵犯营分，犀角地黄汤也是应当选取的；就像叶天士先生，遵循喻嘉言关于芳香宣窍解毒的建议，治疗使用紫雪丹，这种方法也是不可缺少的。然而临证时的灵活变通，关键在于医生用心化裁的妙处罢了。是这样吗？自有能辨别的人，这只是我管见之一斑，等待高明之士指教纠正。如果能再给予指导，不致使百姓被延误误治，那就太幸运了。
耳朵，是肾开窍之处，又属于少阳胆经和三焦经脉交会的地方。发生痈疡，不外乎是各条经络的火气上逆所致。但是有虚火和实火之分，不能不加以辨别。如果是风温邪气侵袭阻滞，初起必定会有寒热往来、头痛、耳中肿胀，脉象弦硬而数，看起来像疟疾的样子，可以用牛蒡子、荆芥、薄荷、夏枯草、牡丹皮、山栀，或者小柴胡汤，如果出汗后邪气彻底清除，那么肿胀自然会平息；或者到了三、五天后，胀痛更加严重，身体发热不适，风温化为火邪，必定挟带肝经邪气上升，胀痛时如针刺一般，内部形成脓液了，可以用羚羊角、牡丹皮、山栀、钩藤、夏枯草，或者龙胆泻肝汤，等到脓液排出、邪气清除后，自然热退痛止。但是脓液不能立即干燥，必须经过十天半个月才能痊愈；因为少阳三焦多气少血，血少则肌肉难以生长，所以疮口难愈合，这是实火的证候。需要注意耳内有脓时，不可将药末掺入，因为耳窍只有开口而没有闭合功能，将药物纳入会堵塞孔窍，脓液无法向外排泄，热毒就会顺着经络向外扩散，导致耳朵周围红肿，这就引发了外耳痈。一定要切开排脓才能痊愈。
所谓的虚火耳痈，可能是因为肝胆怒火郁遏，或者因为肾经真阴亏损，相火亢盛而引发。初起也必定有寒热，胀但不肿，头顶连及颈部牵引疼痛，脉象细数，精神和形体表现安静。这是肝阳挟带虚火上逆，不能消散，时间久了就会成脓，这种溃疡最难快速痊愈。初起时用羚羊角散，希望它能镇肝清热，久病则宜用大补阴丸，或者金匮肾气丸滋阴补虚，才可能取得疗效。另外幼童在三、四岁时，也有这种病症，常年脓水不干。这是由于先天不足，水不养木，肝阳上逆而凝结。不痛不肿，不必治疗；等到阴分充足，肝阳平和，就会痊愈。还有小儿因为胎风胎热，或者洗浴时灌水进入耳内，也会导致耳内疼痛生脓。初时不可搽药，等待毒气排尽自愈；如果一个月后不好转，用红绵散治疗。
耳菌，是在耳道口中长出一个小颗粒，形状发红没有皮肤，宛如菌状，不化脓，也没有寒热症状，只是耳塞不通，缠绵不已，令人耳聋。先用针刺破，涂抹玉红膏；如果耳胀痛，用虎耳草汁滴入耳内，疼痛即止；内服药同虚耳痈的治疗方法。
The condition known as "Lanhou Dansha" (Rotting Throat with Red Rash) is not named in previous medical texts. Looking back to ancient records, the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) contains references to "Yang Du" (Yang Toxin), and Wang Shuhe proposed the concept of "Wen Du" (Warm Toxin). The clinical manifestations of these are extremely consistent with what is currently termed Dansha and Rotting Throat. This treatise advocates using Shengma Biejia Tang (Cinnamon Twig and Turtle Shell Decoction) and Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) as primary treatments. This discusses pathogens invading the Yin and Yang meridians. The general principles of treatment do not originally instruct practitioners to rigidly adhere to fixed formulas; learners should comprehend the underlying logic through careful study.
Upon investigation, this condition often erupts during seasons characterized by miscellaneous pathogens (*Za Qi*) and excessive Yang pathogens. Its onset is sudden and violent, uncontrollable like thunderstorms and fierce winds, causing pallor and dismay. Witnesses are often stunned, tongue-tied, and flee in panic. This resembles the cases of latent pathogenic fire and toxicity described by Fei Boqiong in his discussion on smallpox, such as hidden pulses, cold extremities, profuse sweating, diarrhea, hiccups, and restlessness—all severe symptoms. In some instances, it spreads within a family, leading to death within days. Alas, how has its cruelty become so intense today? Cheng Jiaoqian stated: "In ancient times, smallpox was rare, and Warm Toxins were prevalent; nowadays, smallpox is common, and Warm Toxins are rare." Perhaps the widespread practice of inoculation prevents toxin release, or is it merely a natural convergence of cosmic influences? In *Wu Yi Hui Jiang* (Compilation of Wu Medical Discussions), Li Zu and others discussed the pathology and treatment in detail. They noted that "sudden cold causes fire to stagnate and internally ulcerate, while excessive dispersal intensifies the flame and increases rotting." These are indeed profound truths, unshakable and certain. However, this does not exceed the principle outlined in Miao's notes: "Treating the Lung and Stomach as the root, first dispersing then clearing."
Applying this therapeutic logic: if the pathogen is at the Wei (Defensive) level, Maxing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is inevitably indicated; if toxic fire invades the Ying (Nutritive) level, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be selected. Just as Ye Tianshi followed Yu Jiayan’s proposal for aromatic orifice-opening and detoxification, using Zixue Dan (Purple Snow Pill), this method is indispensable. Yet, clinical flexibility lies in the masterful adaptation by the practitioner. Whether correct or not, those capable will discern. This is but a fragment of my limited insight, awaiting correction from experts. If further guidance can be provided to prevent harm to the people, I would be most grateful.
The ear is the opening of the Kidney and the convergence point of the Shaoyang Gallbladder and Sanjiao (Triple Burner) meridians. Abscesses and ulcers here are caused by the rebellion of Fire from various meridians. However, one must distinguish between Deficient Fire and Excess Fire. If Wind-Warmth attacks and obstructs, initial symptoms include alternating chills and fever, headache, ear swelling, and a wiry, hard, rapid pulse, resembling malaria. One may use Niubangzi (Arctii Fructus), Jingjie (Schizonepetae Herba), Bohe (Menthae Haplocalycis Herba), Xiakucao (Prunellae Spica), Mudanpi (Moutan Cortex), Zhizi (Gardeniae Fructus), or Xiaochaihu Tang (Minor Bupleurum Decoction). If sweating occurs and the pathogen is thoroughly expelled, the swelling will subside naturally. If, after three to five days, distending pain worsens, accompanied by fever and discomfort, the Wind-Warmth transforms into Fire, likely carrying Liver pathogenic factors upward. The pain becomes stabbing, and pus forms internally. At this stage, Lingyangjiao (Capricornis Cornu), Mudanpi, Zhizi, Gouteng (Uncariae Ramulus cum Uncis), and Xiakucao may be used, or Longdan Xiegan Tang (Gentiana Liver-Draining Decoction). Once pus drains and the pathogen is cleared, fever subsides and pain stops. However, the pus will not dry immediately; healing takes ten to fifteen days because the Shaoyang Sanjiao is abundant in Qi but deficient in Blood; insufficient Blood makes muscle regeneration difficult, hence slow wound closure. This is an Excess Fire syndrome. Note that when pus is present in the ear, powdered medicines should not be applied directly. The ear canal has openings but no closing mechanism; inserting powder blocks the orifice, preventing pus drainage. Heat and toxicity then spread along the collaterals externally, causing redness and swelling around the ear, leading to an external ear abscess. Surgical incision for drainage is necessary for cure.
The so-called Deficient Fire Ear Abscess arises from suppressed anger-fire of the Liver and Gallbladder, or from depletion of True Yin in the Kidney meridian, leading to hyperactive Minister Fire. Initial symptoms include chills and fever, distension without swelling, pulling pain from the vertex to the neck, a fine and rapid pulse, and quiet mental/physical state. This is Liver Yang carrying Deficient Fire upward, which cannot dissipate and eventually forms pus. Such ulcers are difficult to heal quickly. Initially, Lingyangjiao San (Antelope Horn Powder) is used to settle the Liver and clear heat; for chronic cases, Dabu Yin Wan (Major Nourishing Yin Pill) or Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet) are used to nourish Yin and tonify deficiency. Additionally, children aged three or four may suffer from this condition with persistent pus for years. This is due to congenital insufficiency, where Water fails to nourish Wood, causing Liver Yang to rebel and knot. There is no pain or swelling, and no treatment is needed; it resolves when Yin is sufficient and Liver Yang stabilizes. Furthermore, infants may experience ear pain and pus due to fetal wind-heat or water entering the ear during bathing. Do not apply medication initially; wait for the toxin to resolve spontaneously. If unresolved after a month, treat with Hongmian San (Red Cotton Powder).
Ear Polyp (Er Jun): A small, skinless, red nodule resembling a mushroom grows in the ear canal. It does not suppurate nor cause chills/fever, but causes persistent ear blockage and deafness. First, puncture with a needle and apply Yuhong Gao (Jade Red Ointment). For ear distending pain, drip Hu'ercao (Dorstenia Genus Juice) into the ear to stop pain. Internal medication follows the same protocol as for Deficient Fire Ear Abscess.
Appendix: Ear Fistula (Er Lou) occurs above the ear root. It is common in girls who have pierced their ears and suffered injury. Suppurating wounds are difficult to close; one must use Sheng Yao Tiao (Arsenic-containing Paste Stick) to promote pus discharge and remove necrotic tissue over a long period for cure.