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Lu Yuanying treated a monk who was ill. Upon examining his pulse, he found only the right Guan position floating and slippery, while the pulses in other positions were normal. He said, "The right Guan position corresponds to the Spleen and connects with the Stomach; its meridian accompanies the root of the tongue. This is Wind striking the Lianquan point (Ren-23), caused by lying drunk in the draft, resulting in aphonia." After questioning the patient, it was confirmed. He then administered Zhibao Dan (Precious Treasure Pill) dissolved in Jingli (Ampelopsis Japonica Juice). The next day, the patient could speak.

Yu Zhen commented: A floating and slippery pulse at the right Guan position—could there not be symptoms such as vomiting and irritability caused by Wind and Phlegm? Yet, he exclusively diagnosed it as aphonia due to lying drunk in the wind. This must have been deduced by integrating observation, listening/smelling, and inquiry. However, the judgment was also quite skillful.

Zhu Danxi treated a middle-aged man suffering from Shanghan (Cold Damage) with fever. The physician administered Shanghan medicines for five to seven days, after which the patient developed coma and aphonia. Zhu treated this as underlying deficiency with Phlegm accumulation. He prescribed Renshen (Ginseng Radix et Rhizoma) 5 qian, Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Chenpi (Citri Reticulatae Pericarpium) each 1 qian, decocted in water. Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis Recens Juice) were added to the decoction for drinking. After twelve days, the tongue could articulate only one character. After another half month of administration, the tongue gradually regained mobility for speech, the heat subsided, and the patient recovered. This is because the Foot-Shaoyin Kidney Meridian accompanies the root of the tongue, the Foot-Taiyin Spleen Meridian connects with the root of the tongue, and the Branch Meridian of Hand-Shaoyin Heart ties to the root of the tongue. When these three meridians are deficient, Phlegm-Saliva takes advantage of the deficiency to block the meridians, rendering the tongue unable to move and speak. If these three meridians lack Blood nourishment, the tongue will also suffer from aphonia due to lack of nourishment. The Classic states: "Puncturing the Foot-Shaoyin meridian, if excessive bleeding causes double deficiency, results in difficulty speaking." It also says: "Excessive puncture of the vessel under the tongue causing continuous bleeding leads to aphonia." Treatment should involve adding Blood-nourishing herbs to the aforementioned formula.

Another man, over fifty years old, addicted to alcohol, experienced hematemesis (vomiting blood), followed by anorexia and inability to speak. He was thirsty and desired water, with a slightly rapid pulse. He was given Guishen (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), and Dihuang (Rehmanniae Radix) each 1 liang, Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) 2 liang, Chenpi (Citri Reticulatae Pericarpium) 1.5 liang, and Gancao (Glycyrrhizae Radix et Rhizoma) 2 qian. A small amount of Zhuli (Bambusae Caulis in Taenia), Tongbian (Infant Urine), and Jiangzhi (Zingiberis Recens Juice) was added. After more than twenty doses, he could speak. Regarding these three meridians, if attacked by Wind-Heat, the meridians become flaccid and lax, causing the tongue to become lax and unable to move, resulting in aphonia. If attacked by Wind-Cold, the meridians contract and tighten, causing the tongue to curl and resulting in aphonia. This parallels the mechanism of hemiplegia in Zhongfeng (Wind Stroke).

Yu Zhen commented: These three cases all treat Sheyin (tongue stiffness/aphonia involving the tongue body), not Houyin (hoarseness/laryngeal aphonia). The first case involves resolving Phlegm and unblocking orifices, indicating an Excess pattern. In the second case, Shanghan leading to coma and aphonia after five to seven days—surely there were signs of Excess Heat? Why were not Dahuang (Rhei Radix et Rhizoma), Huanglian (Coptidis Rhizoma), and Shigao (Gypsum Fibrosum) used? Instead, it was rashly attributed to deficiency with Phlegm. Wei's annotation states, "One might fear the heat transmitted to the Heart Meridian of Foot-Shaoyin." This view is correct and cannot serve as a model. However, careful reading of the case reveals no records of dry tongue, black coating, constipation, or irritability. Thus, the so-called "coma" was merely quietness amidst fever, accompanied by the desire to speak but inability to do so. The pulse must have been soggy, slippery, and weak. The fact that the condition did not advance or retreat after several days of administering Renshen, Huangqi, and Baizhu indicates the prescription was appropriate. Observing that it took twelve days to utter one character and another half month to regain speech before the heat subsided fully paints a picture of a Deficiency pattern. For any case of Shanghan-induced Sheyin, one should analyze it according to this case, rather than vaguely treating it based on Tao's statement about "heat transmitting to the Hand-Shaoyin Heart Meridian." The third case, post-hematemesis anorexia and aphonia, is undoubtedly a Deficiency pattern. Thirst and a rapid pulse suggest Yin deficiency, yet instead of Yin-nourishing herbs, Renshen and Baizhu were used. Mr. Weng's insight is truly profound.

Sun Zhao treated Cao Dushi, who had just moved into a newly built house. Half a month after moving, he drank heavily until drunk, and upon waking, lost his voice and could not speak. Sun Zhao examined him and said, "This illness is due to the new house. It should heal in half a month. First, administer Buxinqi Shuyu Wan (Shuyu Pill to Tonify Heart Qi), followed by Xixin (Asari Radix et Rhizoma) and Chuanxiong (Ligustici Chuanxiong Rhizoma)." After ten days, the illness gradually diminished; after twenty days, it completely resolved. After recovering, Cao appeared before the Emperor and asked who had treated him. He replied, "Sun Zhao." The Emperor summoned Sun Zhao and asked, "What illness did Cao have?" Sun Zhao answered, "Walls in new houses are damp, and the ground retains much Yin-dampness. When people first arrive, the Yin-dampness has not dissipated. Cao's Heart Qi was inherently deficient. Drinking to intoxication opened the pores, allowing Yin-dampness to invade the Heart Meridian, causing aphonia. I first used Shuyu Wan to strengthen Heart Qi, then used Chuanxiong and Xixin to dispel dampness, hence the return of speech."

[Appendix] One person suffered from Jingqi (Shock Qi) entering the Heart collaterals, resulting in aphonia. Mituo seng (Arsenic Sulfide Ore powder) was finely ground, approximately one spoonful, mixed with tea and taken orally, resulting in immediate recovery. Another person contracted this disease while being chased by a wild wolf in the mountains while logging. Someone taught them this formula, and they also recovered. Since the Heart opens into the tongue, both Dampness invading the Heart and Shock Qi entering the Heart can cause Sheyin.

Zhu Danxi treated a man with nocturnal emission who mistakenly consumed Renshen (Ginseng) and ascending/floating herbs, causing Qi stagnation in the Upper Jiao and resulting in aphonia with loss of voice. He used Tongbian (Infant Urine) soaked Xiangfu (Cyperi Rhizoma) powdered and taken with water to unblock the Upper Jiao to treat aphonia. He also prepared pills using Hafen (Arini Calcitum), Qingdai (Indigo Naturalis) as the sovereign herbs, and Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), and Xiangfu (Cyperi Rhizoma) as assistant herbs to tonify the Lower Jiao and treat nocturnal emission. The patient recovered well within ten days.

Jiang Yun stated: The Materia Medica says urine treats chronic cough and aphonia; therefore, treating aphonia often uses Renzhongbai (Calculus Humanus) because it can descend Fire.

A man nearing fifty years old, suffering from chronic Phlegm-cough, suddenly caught Wind-Cold and consumed alcohol and meat. Consequently, Juqi (Rebellious Qi) rushed to the throat, causing sudden severe aphonia. Moxibustion was applied to Fenglong (ST-40) of the Foot-Yangming Stomach Meridian, two points, three moxa cones each; and Zhaohai (KI-6) of the Foot-Shaoyin Kidney Meridian, one point, three moxa cones. The voice immediately returned. Truly, the words of the Classics are reliable. Huangqin (Scutellariae Radix) was used as the sovereign herb to descend Fire; Xingren (Armeniacae Semen Amarum), Chenpi (Citri Reticulatae Pericarpium), and Jiegeng (Platycodonis Radix) were used as minister herbs to drain Rebellious Qi; Hezi (Terminalia Chebulae Fructus) drained counterflow; and Gancao (Glycyrrhizae Radix et Rhizoma) harmonized Yuanqi (Primal Qi). The patient recovered well after taking the prescription.

A rural laborer worked hard in the fields and was extremely hungry. He ate a large meal suddenly, then lay down tiredly for a short while. Upon waking, he suddenly became aphonic and silent. This persisted for more than twenty days. Gao Gufeng examined him and said, "Fatigue injured the Spleen Qi; hunger and fullness injured the Stomach Qi. Yangming Qi was obstructed and failed to ascend; fluids did not circulate; the cardia was congested and stiff, thus preventing speech." He prescribed Budu Yiqi Tang (Decoction to Supplement Middle and Augment Qi) in ten large doses. After a nap, the patient sweated profusely all over, and his speech returned to normal.

Wang Weiyi had a history of blood disorders several years prior but was young and strong. In April, he suddenly developed cough. After taking dispersing herbs, he expectorated blood-streaked sputum a few times. Subsequently, he took too many Yin-nourishing herbs, resulting in a hoarse and raspy voice, with frequent sensations of chest congestion. The condition dragged on for over a month, and he invited Zhang Luyu to diagnose him. The pulse was deep and choppy, but firm upon heavy pressure and responsive upon light lifting. His physique was robust and complexion good, definitely not a sign of Yin deficiency. Zhang Luyu said, "Your Hoarseness, Sir, is 'Metal Solid Does Not Ring' (Excess pattern), not 'Metal Broken Does Not Ring' (Deficiency pattern)." Therefore, he used Shedou Tan Tang (Decoction to Guide Out Phlegm), adding Renzhonghuang (Human Feces Charcoal) and Zexie (Alismatis Rhizoma), focusing solely on draining Phlegm. After four doses, dark purple-black blood clots appeared in the sputum. The voice gradually returned, though the raspiness remained. He then took pills made of Qiushi (Calculation Humanum), Renzhonghuang (Human Feces Charcoal), and Jujube flesh. After a month, his voice became clear. Throughout the treatment, no Lung-clearing or Ying-Blood-nourishing herbs were ever used.

Yu Zhen commented: These four cases all involve Houyin (laryngeal aphonia), but the treatments differ. Their differences still align with ancient teachings and fit the pathology closely, hence their efficacy. If modern physicians use items like Jiaozi (likely referring to specific herbal preparations or folk remedies) or Luyi (reed clothing), although seemingly novel, they are irrelevant to the pathology. How could efficacy be achieved?