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Yin (aphonia) refers to the condition where pathogenic factors invade the Yin aspect. The Classics state: "When pathogens contend with the Yin, aphonia occurs." It is also stated: "When pathogens enter the Yin and contend, aphonia results." However, there are two types of symptoms: one is She Yin (tongue aphonia), which belongs to the category of wind-stroke causing tongue stiffness and inability to articulate; the other is Hou Yin (throat aphonia), which belongs to the category of chronic cough leading to hoarseness or loss of voice. Generally, She Yin involves only the inability of the root of the tongue to move flexibly for speech, while the sound produced by the throat remains normal; Hou Yin involves only hoarseness of the throat, while the root of the tongue can still move flexibly for speech.

[Danxi] A thirty-five-year-old man, due to continuous days of labor and fatigue, developed alternating chills and fever, manifesting as malaria. The physician administered antimalarial drugs. After three paroxysms, the condition transformed into fever, a short tongue, and indistinct speech, with phlegm-rattling sounds in the throat. His pulse was examined as surging, rapid, and seemingly slippery. Consequently, Dushen Tang (Ginseng Decoction) was prescribed with approximately the amount of Zhu Li (Bamboo Sap) contained in two clam shells. After two doses, three pieces of paste-like phlegm were vomited up. The root of the tongue became flexible, and speech could be distinguished, though other symptoms remained unresolved. Subsequently, Renshen Huangqi Tang (Ginseng and Astragalus Decoction) was decocted and taken. Half a month later, all symptoms subsided. He required two months of dietary supplementation with congee to regain his ability to stand.
A short tongue and indistinct speech result from phlegm-fluids obstructing the meridians at the root of the tongue. I once treated a middle-aged man suffering from Shanghan (Cold Damage) with body heat. After taking five doses of Shanghan medicine provided by another doctor, he developed delirium and aphonia. I treated him based on constitutional deficiency with phlegm. Ren Shen (Ginseng Root) 5 qian, Huang Qi (Astragalus Root), Bai Zhu (Atractylodes Rhizome), Dang Gui (Angelica Sinensis Root), and Chen Pi (Tangerine Peel) each 1 qian were decocted in water, mixed with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice), and drunk. After twelve days, his tongue could finally utter one character. After continuing this for half a month, the root of the tongue gradually regained flexibility for speech, the heat was eliminated, and he recovered. This is because the Foot-Shaoyin Kidney Meridian flanks the root of the tongue, the Foot-Taiyin Spleen Meridian connects to the root of the tongue, and the Branch of the Hand-Shaoyin Heart Meridian ties to the root of the tongue. When these three meridians are deficient, phlegm-fluids take advantage of the deficiency to obstruct the meridian pathways, causing the tongue to lose its flexibility for speech. If blood is lost in these three meridians, the tongue lacks blood nourishment and becomes aphonic. The Classics state: "Needling the Foot-Shaoyin meridian, if it causes severe deficiency and bleeding, leads to difficulty in speaking." It also states: "Excessive needling of the mid-meridian under the tongue, resulting in uncontrolled bleeding, causes aphonia." Treatment should involve adding blood-nourishing herbs to the aforementioned formula. I also treated a man over fifty who, addicted to alcohol, vomited blood filling a bucket. Later, he ceased eating, could not speak with his tongue, and felt only thirst for water. His pulse was slightly rapid. I prescribed Dang Gui (Angelica Sinensis Root), Chuan Xiong (Ligusticum Rhizome), Bai Shao (White Peony Root), and Shu Di Huang (Prepared Rehmannia Root) each 1 liang, Bai Zhu (Atractylodes Rhizome) and Ren Shen (Ginseng Root) each 2 liang, Chen Pi (Tangerine Peel) 1.5 liang, and Gan Cao (Licorice Root) 2 qian, mixed with Zhu Li (Bamboo Sap), Tong Bian (Child's Urine), and Jiang Zhi (Ginger Juice). After more than twenty doses, he could speak. If these three meridians are struck by Wind-Heat, the meridians become flaccid and lax, so the tongue also becomes flaccid and lax, unable to move flexibly, resulting in aphonia. If Wind-Cold invades, the meridians contract and tighten, so the tongue becomes stiff and curled, resulting in aphonia. Treatment should seek methods used for Wind-stroke with hemiplegia.

Acupuncture and Moxibustion treatment for aphonia has two approaches:
First, select Spleen meridian points. The Classics state: "The Foot-Taiyin Spleen Meridian, when disturbed, causes disease manifested as stiffness of the root of the tongue. Select points based on fullness/deficiency, heat/cold, and sinking/depression."
Second, select Heart meridian points. The Classics state: "The Branch of the Hand-Shaoyin Heart Meridian is named Tongli (HT5), located 1.5 cun above the wrist crease. It branches upward, enters the heart, and ties to the root of the tongue. Deficiency results in inability to speak. Select the point 1 cun behind the palm (i.e., Tongli)."
A very choppy Heart merpulse indicates aphonia. (See the chapter on Fullness and Emptiness for the full text.)
[Suwen] A firm and long Heart pulse indicates disease of tongue curling and inability to speak. (From *Essential Instructions for the Pulse Essentials*)