〔丹〕俞继道遗精，误服参、 及升浮剂，遂气壅于上焦而喑，声不出。用童便浸香附，为末调服，而
疏通上焦以治喑。又用蛤粉、青黛为君，黄柏、知母、香附佐之为丸，而填补下焦以治遗，十余日良愈。（本草言
童便主久嗽失音，故治喑多用童便，由童便能降火故也。）出声音方。
诃子炮去核，木通各一两，甘草半两，用水三升，煎至升半，入生姜、地黄汁一合，再煎数沸，放温，分
六服，食后，日作半料。（诃子治逆气，破结气。木通通利九窍，治肺痈甚当。）
〔河〕诃子汤 治失音不能言语。
诃子（四个，半生半炮） 桔梗（一两，半生半炙） 甘草（二寸，半炙半生）
上为细末，每服二钱，童便一盏，水一盏，煎五七沸，温服。甚者不过三服愈。（桔梗通利肺气，诃子
泄肺导气，童便降火甚速。）
一方 桔梗三两，大诃子四个，甘草二两，炮制皆同。每服一钱匕，入砂糖一小块，不入童便，独用水五盏，
煎至三盏，时时细呷，一日服尽，其效甚速。
〔海〕发声散 治咽喉语声不出。
栝蒌皮（锉） 白僵蚕（去头） 甘草（各等分。俱各炒黄）
上细末，每三钱，温酒调下，或生姜自然汁调下。用五分，绵裹噙化。咽津亦得，不拘时候，日两三服。
〔《肘》〕治卒失音咽不出。陈皮五两，水三升，煮取一升，去渣，顿服。
〔罗〕玉粉丸 治冬月寒痰结，咽喉不利，语声不出。
半夏（洗，五次） 草乌（一字炒） 桂（一字）
上为细末，生姜汁浸饼为丸，如鸡豆大，每服一丸，至夜含化。多年不愈，亦有效。《黄帝针经》中说，寒
气客于会厌，卒然而哑，此药主之。
〔丹〕蛤蚧丸 治肺间邪气，胸中积血作痛，失音，并治久咳失音。
蛤蚧（一对，去嘴足，温水浸去膜，刮了血脉，用好醋炙） 诃子（煨，去核） 阿胶（炒） 生地
麦门冬（去心） 北细辛（去苗） 甘草（炙。各半两）
上为末，炼蜜丸，如枣大。每服一丸，含化，食后。
〔《千》〕治暴嗽失音，语不出方。
杏仁（研如泥） 姜汁 砂糖 白蜜（各一升） 五味 紫菀（各三两） 通草 贝母（各四两）
桑白皮（五两）
上 咀，以水九升，煮五味、紫菀、通草、贝母、桑白皮，取三升，去渣，纳杏仁泥，姜汁、蜜糖和搅，
微火煎取四升，初服三合，日再夜一，后稍加。
通声膏方
五味 款冬花 通草（各三两） 人参 细辛 桂心 青竹皮 菖蒲（各二两） 杏仁（一升）
白蜜（二斤） 枣膏 姜汁（一升） 酥（五升）
上 咀，以水五升，微火煎三上三下，去渣，纳姜汁、枣膏、酥、蜜煎令调和，酒服如枣大二丸。
〔丹〕咳嗽声嘶者，此血虚受热也。用青黛、蛤粉，蜜调服之。
〔世〕失音。槐花，瓦上炒令香熟，于地上出火毒，三更后，床上仰卧，随意服，亦治咯血。
〔《千》〕风寒之气客于中，滞而不发，故喑不能言。
〔盂〕人患卒哑。杏仁三分，去皮尖熬，另研桂一分如泥，和取杏核大，绵裹含，细细咽之，日五夜三。
〔丹〕治失音。以桂末着舌下咽津妙。（《千金》、《斗门》、《食忌》、《圣惠方》同。）治风冷失音，
以紫梗荆芥根一两，研汁入酒相和，温饮半盏，服无时。（《圣惠方》）
〔《圣》〕治风冷失音，咽喉不利。以 荷根二两绞汁，酒一大盏，相和令匀，不计时候，温服半钟。
〔孙〕内侍曹都使，新造一宅落成，迁入经半月，饮酒大醉，卧起失音不能语。召孙至，诊曰∶因新宅
故得此疾耳，半月当愈。但服补心气薯蓣丸，治湿用细辛、川芎，又十日其病渐减，二十日全愈。曹既安，见
上问谁医。曰∶孙兆郎中。上乃召问曰∶曹，何疾也？对曰∶凡新宅，壁土皆湿，地亦阴多，人乍来阴气未散，
曹心气素虚，饮酒至醉，毛窍皆开，阴湿之气从而入乘心经，心经既虚，而湿气又乘之，所以不能语，臣先用
薯蓣丸使心气壮，然后以川芎、细辛，又去湿气，所以能语也。
运气 喑有二∶
一曰热助心实。经云∶少阴之复，暴喑，治以苦寒是也。
二曰寒攻心虚。经云∶岁火不及，寒乃大行，民病暴喑，治以咸温是也。
狐惑声哑，其证默默欲眠，目不能闭，起居不安是也。（治法见伤寒。）
〔《灵》〕黄帝问于少师曰∶人之卒然忧恚，而言无音者，何道之塞，何气出行，使音不彰？愿闻其方。
少师答曰∶咽喉者，水谷之道也。喉咙者，气之所以上下者也。会厌者，声音之户也。口唇者，音声之扇也。
舌者，音声之机也。悬雍垂者，音声之关也。颃颡者，分气之所泄也。横骨者，神气所使主发舌者也。故人之
鼻洞涕出不收者，颃颡不开，分气失也。是故厌小而疾薄，则发气疾，其开阖利，其出气易，其厌大而浓，则
开阖难，其气出迟，故重言也。人卒然无音者，寒气客于厌，则厌不能发，发不能下至，其开阖不致，故无音。
黄帝曰∶刺之奈何？岐伯曰∶足之少阴，上系于舌，络于横骨，终于会厌，两泻其血脉，浊气乃辟。会厌之脉，
上络任脉，取之天突，其厌乃发也。（夏恚无言篇）
厥气走喉而不能言，手足清，大便不利，取足少阴。（杂病篇 厥气者，逆气也，足少阴脉循喉咙，
又挟舌本，故取之。）
针灸 喑有三法∶
其一取足少阴。上二段经文是也。
其二取足阳明。经云∶足阳明之别，名曰丰隆，去踝八寸，别走太阴，下络喉嗌，其病气逆，则喉痹卒喑，
取之所别是也。予治一男子四十九岁，久病痰嗽，忽一日感风寒，食酒肉，遂厥气走喉，病暴喑，与灸足阳明
丰隆二穴各三壮，足少阴照海穴各一壮，其声立出，信哉圣经之言也。仍用黄芩降火为君，杏仁、陈皮、桔梗
泻厥气为臣，诃子泄逆，甘草和元气为佐，服之良愈。
其三取手阳明。经云∶暴喑气哽，取扶突与舌本出血。舌本，廉泉穴也。
〔《甲》〕喑不能言，合谷及涌泉、阳交主之。
〔桑〕卒暴失音∶神门、涌泉。
〔《甲》〕食饮善呕，不能言，通谷主之。暴喑气哽，喉痹咽痛不得息，饮食不下，天鼎主之。喑不能言，
期门主之。暴喑不能言，支沟主之。
[Zhu Danxi] Yu Jidao suffered from spermatorrhea and mistakenly took ginseng, Atractylodes macrocephala Rhizome (Baizhu), and ascending-floating agents, leading to qi stagnation in the upper jiao resulting in aphonia (loss of voice) with inability to speak. He used water human urine (Tongbian) to soak Cyperi Rhizoma (Xiangfu), ground into powder, and taken with water to unblock the upper jiao to treat aphonia. He also used Trichosanthes Powder (Ge Fen) and Indigo Naturalis (Qingdai) as principal herbs, with Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), and Cyperi Rhizoma (Xiangfu) as adjuvant herbs, made into pills to tonify the lower jiao to treat spermatorrhea. After more than ten days, he recovered well. (*Bencao* states that water human urine mainly treats chronic cough with loss of voice, so it is often used to treat aphonia because it can descend fire.) From *Shengyin Fang*.
Hezi (processed, pitted), Tongcao (Mutong) each 1 liang, Gancao half liang. Use 3 sheng of water, decoct until 1.5 sheng remains. Add 1 he of fresh ginger juice and Rehmanniae Radix (Dihuang) juice. Decoct for a few more boils. Let cool to warm temperature. Divide into six doses. Take after meals. Prepare half the dosage daily. (Hezi treats rebellious qi and breaks stagnant qi. Mutong unblocks the nine orifices and is very suitable for treating lung abscess.)
[Li Dongyuan] Hezi Tang: Treats aphonia with inability to speak.
Hezi (4 fruits, half raw, half processed) Jiegeng (1 liang, half raw, half honey-fried) Gancao (2 cun, half honey-fried, half raw)
Grind all into fine powder. Each dose: 2 qian. Add 1 zhan of water human urine and 1 zhan of water. Decoct for 5-7 boils. Take warm. For severe cases, recovery occurs within no more than three doses. (Jiegeng unblocks and benefits lung qi; Hezi drains lung qi and guides qi downward; water human urine descends fire very rapidly.)
Another prescription: Jiegeng 3 liang, Da Hezi 4 fruits, Gancao 2 liang. Processing methods are the same as above. Each dose: 1 qian bi (a small spoonful). Add a small piece of brown sugar. Do not use water human urine. Use only 5 sheng of water. Decoct until 3 sheng remain. Sip slowly from time to time. Finish within one day. The effect is very rapid.
[Wang Haizang] Fasheng San: Treats inability to speak due to throat obstruction.
Gualou Pi (scraped/cut) Baijiangcan (remove head) Gancao (equal parts. All stir-fried until yellow)
Grind into fine powder. Each dose: 3 qian. Mix with warm wine to take, or mix with fresh ginger juice. Take 5 fen, wrap in cotton, hold in mouth to dissolve. Swallow saliva. No specific timing required. Take 2-3 times daily.
*[Zhou Hou Bei Ji Fang]* Treats sudden aphonia with throat discomfort. Chenpi 5 liang. Water 3 sheng. Boil until 1 sheng remains. Remove dregs. Take in one dose.
[Luo Tianyi] Yufen Wan: Treats cold-phlegm accumulation in winter causing throat obstruction and aphonia.
Banxia (washed 5 times) Caowu (stir-fried, amount: 1 zi) Guizhi (amount: 1 zi)
Grind into fine powder. Soak rice cake in fresh ginger juice to form pills, size of chicken beans. Each dose: 1 pill. Hold in mouth to dissolve at night. Effective even for chronic cases lasting years. *Huangdi Zhenjing* states: "When cold pathogen lodges in the epiglottis, sudden aphonia occurs; this medicine treats it."
[Zhu Danxi] Gejie Wan: Treats evil qi in the lungs, blood stasis in the chest causing pain, aphonia, and also chronic cough with aphonia.
Gejie (1 pair, remove beak and feet, soak in warm water to remove membrane, scrape off blood vessels, roast with good vinegar) Hezi (roasted, pitted) Ejiao (fried) Shengdi
Maimendong (remove heart) Beixixin (remove seedlings) Gancao (honey-fried. Each 0.5 liang)
Grind into powder. Make pills with refined honey, size of dates. Each dose: 1 pill. Hold in mouth to dissolve. Take after meals.
*[Qianjin Fang]* Prescription for sudden cough with aphonia and inability to speak.
Xingren (ground into paste) Jiangzhi (ginger juice) Shatang (brown sugar) Baimi (white honey) (each 1 sheng) Wuweizi Ziwan Tongcao Beimu (each 3 liang)
Sangbaipi (5 liang)
Cut into pieces. Use 9 sheng of water. Decoct Wuweizi, Ziwan, Tongcao, Beimu, Sangbaipi until 3 sheng remain. Remove dregs. Add Xingren paste, ginger juice, honey. Stir and mix. Simmer over low heat until 4 sheng remain. Initial dose: 3 he. Daytime twice, nighttime once. Gradually increase dose later.
Tongsheng Gao Formula
Wuweizi Kuandonghua Tongcao (each 3 liang) Renshen Xixin Guixin Qingzhupi Changpu (each 2 liang) Xingren (1 sheng)
Baimi (2 jin) Zaogao Jiangzhi (1 sheng) Su (5 sheng)
Cut into pieces. Use 5 sheng of water. Simmer over low heat with three boilings and three restings (three up, three down). Remove dregs. Add ginger juice, date paste, su, and honey. Decoct until mixed. Take with wine, two pills size of dates.
[Zhu Danxi] Cough with hoarse voice is caused by blood deficiency and heat. Use Qingdai and Ge Fen, mixed with honey and taken.
[Popular Prescription] Aphonia. Huaihua (Sophora flower), stir-fry on tile until fragrant and cooked. Place on ground to eliminate fire toxicity. After midnight (3rd watch), lie supine on bed. Take as desired. Also treats hemoptysis.
*[Qianjin Fang]* Wind-cold pathogen lodges in the middle, stagnates and fails to disperse, thus causing aphonia and inability to speak.
[Meng Shi] Sudden aphonia. Xingren 3 fen, remove skin and tips, roast. Grind Guizhi separately into paste, amount: 1 fen. Mix to form pill size of apricot pit. Wrap in cotton, hold in mouth, swallow saliva slowly. Daytime 5 times, nighttime 3 times.
[Zhu Danxi] Treatment for aphonia. Place Guimo (cinnamon powder) under the tongue and swallow saliva. Excellent. (*Qianjin*, *Doumen*, *Shiji*, *Shenghui Fang* agree.) Treatment for wind-cold aphonia: Use Zijie Jingjie Gen (root of Schizonepeta) 1 liang, grind to juice, mix with wine. Warm drink half zhan. Take anytime. (*Shenghui Fang*)
*[Shengji Zonglu]* Treatment for wind-cold aphonia and throat obstruction. Loto Root (Ou Gen) 2 liang, squeeze to get juice. Mix with 1 large zhan of wine until uniform. Take anytime. Warm drink half zhong.
[Sun Simiao] Imperial Attendant Cao Dushi had a new house completed. After moving in for half a month, he drank heavily to intoxication. Upon waking, he lost his voice and could not speak. Sun Simiao was summoned. Diagnosis: This illness is due to the new house. It will heal in half a month. Only take Bushenqi Shuyu Wan. To treat dampness, use Xixin and Chuanxiong. After another ten days, symptoms gradually decreased. After twenty days, full recovery. When Cao was safe, he asked the Emperor who treated him. Said: Physician Sun Zhao. The Emperor summoned and asked: What disease did Cao have? Answer: Generally, walls in new houses are wet, and the ground has much yin energy. When people first arrive, yin qi has not dispersed. Cao's heart qi was originally deficient. Drinking to intoxication opens all hair pores. Yin-damp qi enters and attacks the Heart Meridian. Since Heart Meridian is deficient, and dampness attacks it, he cannot speak. I first used Shuyu Wan to strengthen heart qi, then used Chuanxiong and Xixin to remove dampness, thus enabling speech.
In the theory of Six Qi (Yunqi), there are two types of aphonia:
First, heat assists heart excess. The Classic says: "Rebound of Shaoyin causes sudden aphonia; treat with bitter-cold."
Second, cold attacks heart deficiency. The Classic says: "If year fire is insufficient, cold dominates greatly. People suffer sudden aphonia; treat with salty-warm."
Huoxuan disease with hoarse voice: Symptoms include silent desire to sleep, eyes unable to close, restlessness in daily life. (Treatment method see Shanghan section.)
*[Ling Shu]* Yellow Emperor asked Shaoshi: "When people suddenly become distressed and angry, losing their voice, which pathway is blocked? Which qi moves out, causing voice to fail to manifest? I wish to hear the method."
Shaoshi answered: "The pharynx is the pathway for water and food. The larynx is where qi ascends and descends. The epiglottis is the door of voice. The lips are the fan of voice. The tongue is the mechanism of voice. The uvula is the gate of voice. The Hongsang (nasopharynx) is where divided qi exits. The Henggu controls the tongue movement via spirit qi. Therefore, when nose leaks mucus uncontrollably, it is because Hongsang does not open, and divided qi is lost. Thus, if the epiglottis is small and thin, qi emission is fast, opening/closing is smooth, air exit is easy. If the epiglottis is large and thick, opening/closing is difficult, air exit is slow, hence double speech. When people suddenly lose voice, cold pathogen lodges in the epiglottis. The epiglottis cannot move up or down, opening/closing is inconsistent, thus no voice."
Yellow Emperor said: "How to needle?" Qibo said: "Foot Shaoyin connects to the tongue, networks to Henggu, ends at the epiglottis. Drain both sides of the blood vessels, turbid qi will depart. The vessel of the epiglottis networks upward to the Ren Mai. Select Tiantu point, then the epiglottis can function." (From Xia Hui Wu Yan Pian)
"Rebellious qi travels to the throat causing inability to speak, cold hands and feet, constipation. Select Foot Shaoyin." (Zabing Pian: Rebellious qi means counterflow qi. Foot Shaoyin meridian follows the throat and flanks the root of the tongue, thus select it.)
Acupuncture and Moxibustion: Three methods for aphonia:
First, select Foot Shaoyin. The above two classic passages refer to this.
Second, select Foot Yangming. The Classic says: "The Luo-connecting vessel of Foot Yangming is named Fenglong, 8 cun above the ankle, diverges to Taiyin, descends to network the throat/pharynx. Its disease is rebellious qi, causing throat obstruction and sudden aphonia. Select the divergence point." I treated a 49-year-old man with chronic phlegm-cough. Suddenly catching wind-cold and eating meat/alcohol, rebellious qi traveled to the throat, causing sudden aphonia. I moxa'd Fenglong (ST40) on Foot Yangming, 3 moxa cones each side, and Zhaohai (KI6) on Foot Shaoyin, 1 moxa cone each side. His voice immediately returned. Truly, the words of the Classics are trustworthy. I also used Huangqin to descend fire as principal, Xingren, Chenpi, Jiegeng to drain rebellious qi as minister, Hezi to drain rebellion, Gancao to harmonize primal qi as assistant. He recovered well after taking it.
Third, select Hand Yangming. The Classic says: "Sudden aphonia with qi choking, select Futu (LI18) and bleed the root of the tongue." The root of the tongue is Lianquan (CV23).
*[Jia Yi Jing]* Aphonia with inability to speak: Hegu (LI4), Yongquan (KI1), Yangjiao (GB35) are indicated.
[Sang] Sudden aphonia: Shenmen (HT7), Yongquan (KI1).
*[Jia Yi Jing]* Vomiting easily after eating/drinking, inability to speak: Tonggu (ST44) is indicated. Sudden aphonia with qi choking, throat obstruction, sore throat, difficulty breathing, inability to swallow food/water: Tianding (SI14) is indicated. Aphonia with inability to speak: Qimen (LR14) is indicated. Sudden aphonia with inability to speak: Zhigou (SJ6) is indicated.