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The first type is *She Yin* (tongue aphonia), characterized by the inability of the tongue to move and articulate speech, while the voice from the throat remains normal. Lou Quanshan stated: When a person speaks briefly and unclearly, it is caused by phlegm-fluid obstructing the meridians at the root of the tongue. This is because the Kidney Meridian flanks the root of the tongue, the Spleen Meridian connects to the root of the tongue, and the Heart Meridian branches to tie the root of the tongue. If these three meridians are deficient, phlegm-fluid enters, blocking the vessel pathways and preventing the tongue from moving. It can be treated with Dangshen (Codonopsis Root), Huangqi (Astragalus Root), Baizhu (Atractylodes Rhizome), Danggui (Angelica Sinensis Root), Chenpi (Tangerine Peel), Zhuli (Bamboo Sap), and Jiangzhi (Ginger Juice), resulting in recovery within half a month. If blood loss leads to dryness and atrophy of the sinews in these three meridians, aphonia also occurs. The *Classic* states: "Needling below the tongue; if the vessel is pierced too deeply and bleeding does not stop, aphonia results." It also states: "Severely choppy pulse indicates aphonia," which refers to this condition. Adding blood-nourishing herbs to the aforementioned formula is appropriate. Furthermore, invasion by Wind-Cold causes the tongue to contract urgently. The *Classic* states: "A firm and long pulse (meaning wiry and tense) indicates disease where the tongue curls and cannot speak," referring to this scenario. Da Qin Jiao Tang (Great Notopterygia Decoction). (See Stroke chapter.) If Heat causes the vessels to become flaccid and slow, the tongue also cannot move; clearing Heat is suitable. The *Classic* states: "When the Spleen Meridian is diseased, the root of the tongue becomes stiff; observe its excess or deficiency, heat or cold, and apply the 'sunken point' needling method." It also states: "The divergent branch of the Hand-Taiyin [Lung] Meridian is called Tongli; located 1.5 cun above the wrist crease, it branches upward, enters the heart, and ties the root of the tongue. Deficiency leads to inability to speak; needle the point one cun behind the palm." In postpartum cases, residual blood confuses the orifices of the Heart, Heart Qi fails to flow, and the vessels do not circulate, leading to a stiff tongue; Qizhen San (Seven Treasures Powder) is used. For aphonia during pregnancy, the voice is hoarse, thin, and soundless because the Kidney Meridian is blocked by the fullness of the fetus, preventing connection to the root of the tongue; no treatment is necessary.

The second type is *Hou Yin* (laryngeal aphonia), characterized solely by a hoarse voice from the throat, while the tongue moves freely. This arises from prolonged labor-induced coughing. Sound originates from the Lung (generally, hollow objects with orifices produce sound; the Lung has orifices and is void). The throat is the pathway for breath. In chronic labor diseases, Fire insults Lung Metal; when Metal is damaged and broken, it cannot resonate. Additionally, excessive Fire causes Phlegm congestion; Phlegm blocks the Lung orifices, constituting "Metal being solid and thus not resonating" (*Jin Shi Bu Ming*). If Heat congestion forms sores, such as Lung Abscess and throat ulceration, the condition is even more severe. Mild cases present only with hoarseness and cracking of the voice; severe cases result in complete loss of voice, belonging to internal injury. Another cause is external Wind-Cold invading the Lung, generating constrained Heat and Phlegm; Phlegm-Fire obstructs and Lung orifices are unsmooth, causing hoarse and heavy voice. Also, loud shouting or singing leading to aphonia falls under the principle of "broken Metal." For common Phlegm-Fire congestion ascending, Xiangfu (Cyperi Rhizoma), soaked thoroughly in Tongbian (Child's Urine), ground into powder, and taken with water, is used to unblock the Upper Jiao. Hezi (Chebula Fruit), prepared and pitted, eliminates Phlegm, descends Fire, and opens the voice; Mutong (Akebia Caulis) descends Fire and clears the Lung, guiding Heat out via the Small Intestine; Jiegeng (Platycodon Root) benefits Lung Qi; Tongbian descends Fire and moistens the Lung; thus, these are commonly used in various formulas. Fasheng San (Voice-Generating Powder) resolves knotted Phlegm. Ju Hong (Exocarpium Citri Reticulatae) decocted in water resolves Phlegm very swiftly. For Cold enveloping Heat, release the exterior using Yujin (Curcuma Radix), Shengdi (Rehmannia Root), Ejiao (Donkey-Hide Gelatin), Zhimu (Anemarrhena Rhizome), Xingren (Apricot Seed), Jiegeng, Shashen (Glehnia Root), Chantui (Cicada Slough), Niubangzi (Arctii Fructus), and Tongbian. For Cold-Phlegm stagnation, Wufen Wan (Five Powders Pill) is used. For pain and aphonia due to accumulated Blood, Gejie Wan (Gecko Pill) is indicated (Blood congested by Heat, stagnating in Lung orifices). For consumptive disease with Blood depletion and excessive Fire, Qingdai (Indigo Naturalis) and Gefen (Concha Meretricis) mixed with Honey are taken. For Huhe Disease (aphthous stomatitis/genital ulcers) with hoarse voice, see the Shanghan chapter. For Qi deficiency with Dampness invasion and Phlegm-fluid coagulating in the Lung, tonify deficiency and eliminate Dampness. For Wind-Cold with constrained Heat and sudden cough with aphonia, Xingren Jian (Apricot Decoction) is used. Alternatively, moxa on Fenglong (ST40) twice, three moxibustions each, and Zhaohai (KI6) twice, one moxibustion each, yields immediate effect, accompanied by herbal medicine.

There is also sudden aphonia and difficulty in swallowing and breathing due to Cold pathogen lodging in the Huiyan (epiglottis); raw Fuzi (Aconite Lateralis Radix Preparata - note: text says raw, implying processed carefully or specific context, but standard is prepared), peeled of skin and umbilicus, cut into large slices, honey-roasted, held in the mouth without swallowing (another version says swallow saliva). Bitter-Cold herbs are contraindicated, fearing the formation of sores that are difficult to dissipate or suppurate.