Sore Throat Every Month, Can’t Even Eat When It Flares Up?

Opening: this patient had stumped every famous physician in the capital

On the third day of the third lunar month of 1818 (Jiaqing year 23, wu yin), a strange patient walked into the consulting room of Doctor Wu Jutong (吴鞠通).

💬 Note from Doctor Luo: Throat trouble — every one of us runs into it in our lives. One external contraction, one bout of sore, swollen throat: that is normal. But the gentleman in today’s story was different. His throat pain would not stop, and it flared up every single month — for years on end. How could anyone live like that?

The patient, Mr. Sun, was 36 years old, in the prime of life, serving as an attendant in the Qing imperial court. But the moment he sat down and Doctor Wu Jutong took his pulse, the doctor’s heart sank — pressing down all the way to the bone, all six pulses were undetectable. The pulse simply could not be felt at all!

Who was the patient? He looked perfectly fine — yet his pulse had vanished

Stranger still: this man’s consciousness, appetite, movement, sitting and lying were all completely normal — he ate well, slept soundly, never complained of fatigue standing or sitting, and looked exactly like a healthy person.

💬 Note from Doctor Luo: This is what made the illness so hard — say he is sick, and the man is bouncing around as lively as can be; say he is well, and you cannot feel his pulse at all. What do you call this? "Strong outside, hollow within" — the person looks fine, but inside he has long since been drained dry.

It turned out that Mr. Sun had suffered from Hou Bi (喉痹) — throat pain and swelling, complicated by wind-phlegm (Doctor Luo explains: this wind-phlegm is Hou Feng, a throat emergency that attacks like a gust of wind wrapping the exterior pathogen around the throat) — for six or seven years. Cold weather, hot weather, hunger, a full stomach, fatigue — any trigger set it off. No month passed without a flare-up. When it struck, his throat swelled and hurt; sometimes he even ran a fever, as if he had caught a cold. Worst of all: the pain was so bad he could not even eat, and it took days to recover.

The previous doctors all treated it as a cold: releasing the exterior, dispelling wind, clearing heat — the more they treated, the more it flared

Over all those years, how had the earlier physicians treated him? When he flared up it looked like an external contraction or a seasonal throat complaint, so they gave him surface-releasing wind-dispelling formulas — releasing the exterior, dispersing wind, clearing heat and resolving toxin. Everything was treated as an external contraction.

💬 Note from Doctor Luo: Right here you can see a doctor’s real skill. And clearly it had not worked — if it had, he would not be sitting in front of Doctor Wu Jutong today. "Mei fa bu neng shi, shu ri fang yu" — every time it flared he could not eat, and it took days to recover. His body wasted away more and more, until he was thin enough to be blown over by a breeze and his pulse could not even be felt.

Doctor Wu Jutong asked one crucial question: do you like to sing opera?

Doctor Wu Jutong did not rush to write a prescription. He asked Mr. Sun: How did this illness begin?

Mr. Sun confessed honestly: he was an amateur opera singer — a piao you, like the people today who love karaoke — fond of singing and playing instruments. In those days the pleasure-seeking young men of the capital all played at this, and he met them every day to sing — singing until two or three in the morning, night after night of staying up late. On top of that, serving in the imperial court meant pressing official business and irregular meals.

💬 Note from Doctor Luo: The moment Doctor Wu Jutong heard this he understood — the pathogen sits in the collaterals, but the root is deficiency. This man did not have an external contraction; he had yin deficiency! Staying up late singing every day exhausted his throat and damaged his body fluids; pressing official business and irregular meals then injured his spleen-stomach qi and blood. Day after day his yin fluids were drained, and deficiency fire pushed upward — at the first gust of wind, the slightest trigger — cold, heat, exertion, anxiety — the fire rushed up and his throat swelled and hurt.

The diagnostic highlight: why does a man who "looks normal" turn out to be so badly depleted?

Doctor Wu Jutong’s diagnosis hung on one word — "deficiency": yin deficiency, with deficiency fire flaring upward. But Mr. Sun looked perfectly normal, didn’t he?

💬 Note from Doctor Luo: Everyone, take note — modern life is full of people exactly like this! Look around your workplace: people clock in on time in the morning, busy all day, looking perfectly normal. But how many people in the modern world are actually not depleted? For fame, for a living, people can be desperately depleted and still perform like a normal person — that is called overdrawing, spending your upright qi a little ahead of schedule. So you can never assume a person is truly fine just because they look fine on the surface.

So Doctor Wu Jutong set the treatment strategy: nourish yin and subdue yang — build up the yin, and draw the deficiency fire back down.

Taking the prescription apart: the Zhuanxi Dasheng Gao — a pot of "great nourishing paste" that nourishes yin and subdues yang

Doctor Wu Jutong prescribed his own famous formula — the Zhuanxi Dasheng Gao (专翕大生膏) — starting with half a jin (250 g).

💬 Note from Doctor Luo: This formula is the classic of nourishing yin and subduing yang in the Wen Bing Tiao Bian (Systematic Differentiation of Warm Diseases). Doctor Luo calls it "extraordinarily, extraordinarily classic" and says he has long wanted to brew a batch of these ancient pastes himself just to experience them. The composition is exquisite: ren shen (ginseng) and fu ling (poria) tonify qi and strengthen the spleen; gui ban (tortoise plastron), bie jia (freshwater turtle shell) and mu li (oyster shell) nourish yin, subdue yang and clear deficiency heat; bao yu (abalone), hai shen (sea cucumber), wu ji (black-bone chicken), zhu ji sui (pig spinal cord), ji zi huang (egg yolk) and e jiao (ass-hide gelatin) — the "flesh-and-blood sentient" products — generously tonify the yin of the liver and kidney; shu di huang (cooked rehmannia), gou qi zi (wolfberry) and sha yuan ji li (flatstem milkvetch seed) tonify the liver and kidney; mai dong (ophiopogon) and wu wei zi (schisandra) nourish and restrain the yin; lian zi (lotus seed) and qian shi (euryale seed) strengthen the spleen and secure astringency; and yang yao zi (lamb kidney) warms the yang — seeking yang within yin and yin within yang, not one-sided yin-nourishing alone. There are more than twenty ingredients in the whole formula. The sentient products (the meats) and the insentient herbs are decocted separately — slow fire, refined for three days and nights, the dregs strained off, then decocted again for six days and nights, gradually combined into one pot and simmered into a paste, then the gelatinous medicines and finely ground herb powders are added and stirred in to finish the paste. It is enormously labor-intensive. For families that cannot afford ginseng, zhi yang shen (prepared American ginseng) can be substituted.

The turn: after half the paste, appetite opened and spirit surged — with one order: "never sing again"

When the paste was half finished, the change in Mr. Sun delighted his whole family — his appetite opened wide, his eating improved, and his spirit turned vigorous. With spirit back, he looked alive again.

💬 Note from Doctor Luo: Doctor Wu Jutong also gave him one piece of advice: never sing again. Day after day he exhausted his throat — the yin-deficiency foundation had just been rebuilt, and singing would only drain it back down. Treat the root of the illness; if the root cause in your lifestyle is not removed, even the best medicine is wasted.

The result: by spring of the following year, four jin of paste — six years of suffering, never to return

Mr. Sun listened. He obediently took the whole batch of Zhuanxi Dasheng Gao — by the spring of the following year, one full batch totaling four jin (2 kg). What happened?

💬 Note from Doctor Luo: The throat pain never came back! The old complaint that had flared every month for six or seven years never flared again. When the pulse was checked again, all six positions had returned; looking at the man himself, his body was plump and well-nourished — formerly thin enough to be blown away, now filled out, clearly showing the tonics had taken hold. This paste matched his pattern perfectly.

Doctor Luo’s commentary: where does chronic pharyngitis actually come from?

With the case told, Doctor Luo took the opportunity to lay out the origins of chronic pharyngitis from start to finish — so many people in daily life have chronic pharyngitis that never heals, and the causes differ:

💬 Note from Doctor Luo: Let me walk through the causes of chronic pharyngitis: First, liver qi stagnation with stomach qi rebelling upward — when you get angry the stomach qi rises, stomach acid soaks the throat, and over the months and years the acid corrodes the throat into inflammation. This proportion is very high — many people have acid rising up at night and do not even know it. Second, kidney essence deficiency with deficiency fire flaring upward — this is the type in today’s case, and formulas like Yin Huo Tang (Guide Fire Decoction) or Shou Huo Tang (Restrain Fire Decoction) can be used. Third, kidney yin deficiency with deficiency fire flaring upward — slightly different from kidney essence deficiency. Fourth, residual pathogen lingering in the throat after an external contraction.

💬 Note from Doctor Luo: How do you tell whether your own case belongs to the yin-deficiency family? Look at your tongue — dark red, with a very thin coating or none at all, and cracks across the surface — that is most likely it. Doctor Wu Jutong’s case tells us: some throat pain cannot be cured by clearing fire alone; you must nourish yin and subdue yang at the root — this is exactly the principle behind "some sore throats only get better through nourishing yin and subduing yang."

Bonus: if your job wears out your voice, how should you protect your throat?

At the end, Doctor Luo shared some private words on voice care — because he himself is a "voice-wearing professional," lecturing and recording every day.

💬 Note from Doctor Luo: By my recording desk I keep a bottle of olive juice (made from green olives — it moistens the throat), and the moment my voice goes hoarse I take a sip. Remember this: when the weather is freezing, don’t shout; when you’re eating, don’t shout; when your voice is tired, don’t force it. Professor Wang Mianzhi (王绵之), the great master of formula studies at Beijing University of Chinese Medicine, always had a stick of ginseng steeping in his cup while he lectured — sipping water as he taught — tonifying qi and nourishing yin so his voice could hold out. There is an old saying: "duo yan shu qiong, bu ru shou zhong" — too much speech leads to exhaustion; better to guard the center — talking too much drains qi and yin, and when it is time to close your mouth and rest, close it.

💬 Note from Doctor Luo: This case is a classic application of the Zhuanxi Dasheng Gao and the nourish-yin-subdue-yang approach. From now on, whenever someone’s throat pain will not heal, don’t rush to call it heat and clear it — ask yourself whether it might be deficiency. Learning from the great physicians is precisely the meaning of studying case records.

What to take away

• A throat that flares up every month for years, with food impossible to swallow during attacks, is not an ordinary cold. When a patient looks perfectly normal yet the six pulses cannot be felt at all — "strong outside, hollow within" — the root is deep deficiency, not external contraction.
• Ask about lifestyle. Staying up late singing, pressing work, and irregular meals drain yin fluids; deficiency fire then flares upward at the slightest trigger. The root cause must be removed — Doctor Wu Jutong ordered Mr. Sun to give up singing forever.
• For yin deficiency with deficiency fire, clear-fire herbs are not the answer — nourish yin and subdue yang. The Zhuanxi Dasheng Gao does this with ginseng and poria to tonify qi, turtle shell, turtle plastron and oyster shell to subdue yang, and the flesh-and-blood sentient products (abalone, sea cucumber, black-bone chicken, pig spinal cord, egg yolk, ass-hide gelatin) to rebuild the liver and kidney yin — seeking yang within yin, not one-sided nourishment. Treatment took four jin (2 kg) of paste over many months — chronic deficiency needs patient, sustained rebuilding.
• Chronic pharyngitis has four main roots: liver qi stagnation with stomach acid rising; kidney essence deficiency; kidney yin deficiency; and residual pathogen after an external contraction. Check your tongue — dark red, thin or absent coating, with cracks — to identify the yin-deficiency type.
• Protect your voice: olive juice for hoarseness, don’t shout in freezing weather or while eating, and don’t force a tired voice. "Too much speech leads to exhaustion; better to guard the center."

Compiled from Doctor Luo Dalun’s commentary on the case records of Doctor Wu Jutong; the original case comes from Wu Jutong’s Case Records (section on Hou Bi / laryngeal bi syndrome).