舌者音声之机也。喉者音声之关也。小儿卒然无音者。乃寒气客于会厌。则厌不能发。发不
能下。开阖不致。故无音也。若咽喉声音如故。而舌不能转运言语。则为舌喑。此乃风冷之邪客
于脾络。或中舌下廉泉穴所致。若舌本不能转运言语而喉中声嘶者。则为喉喑。此亦风痰阻塞。
使气道不通。故声不得发。而喉无音也。大抵此证多有禀赋不足。不能言者。有乳母五志之火遗
儿。熏闭清道。不能言者。有惊风中风不能言者。若遗热与津液耗者。七味白术散。清气不升者。
补中益气汤。禀赋不足与虚火伤肺者。地黄丸。若仰首咳嗽。肢体羸瘦。目白睛多。或兼解囟呵
欠切牙等证。悉属肾虚。非地黄丸加鹿茸、远志不能治也。若吐泻后。或大病后。虽有声而不能
言。又能咽物者。非失音。乃胃气不能上升。地黄丸与补中益气汤兼服。
小儿寤寐。不时切牙及啮乳者。虽多属惊。然所致各有不同。惟啮乳惊搐者。抱龙丸。若发
热饮水。叫哭而搐者。心经实热也。泻心汤。睡困惊悸。合目而卧者。心经虚热也。导赤散。面
青目札。呵欠项强烦闷者。肝经实热也。柴胡清肝散。手循衣领。及乱捻物者。肝经虚热也。发
搐目青面赤。肝经风热也。并宜六味丸。
夜啼有二。曰脾寒。曰心热。夜属阴。阴胜则脾脏之寒愈盛。脾为至阴。喜温而恶寒。寒则
腹中作痛。故曲腰而啼。得灯火。其啼便止。其候面青白。手腹俱冷。不思乳食。亦曰胎寒。益
黄散加钩藤。若见灯愈啼者。心热也。心属火。见灯则烦热内生。两阳相搏。故仰身而啼。其候
面赤。手腹俱暖。口中气热。导赤散加黄连、麦冬。若面色白而黑睛少。属肾气不足。至夜阴虚
而啼也。宜用六味丸。因惊者。参客忤惊啼治之。惊啼者。邪气乘心也。哭而多泪。是惊也。啼
而无泪。是痛也。若因心火不足而惊啼者。秘旨安神丸。心火炽盛。导赤散。木火相搏。加柴胡、
栀子。肝血不足。六味丸。
The tongue is the mechanism of speech. The throat is the gate of voice. Sudden loss of voice in infants is caused by cold pathogen invading the epiglottis, rendering it unable to open or close properly, leading to disordered opening and closing, thus resulting in aphonia. If the voice in the throat remains normal but the tongue cannot move flexibly for speech, this is termed "tongue aphonia" (She Yin). This is caused by wind-cold pathogen invading the spleen collaterals or affecting the Lianquan acupoint under the tongue. If the root of the tongue cannot move flexibly for speech while the throat sounds hoarse, this is termed "throat aphonia" (Hou Yin). This is also due to wind-phlegm obstruction blocking the airway, preventing sound emission. Generally, such conditions often stem from congenital deficiency causing inability to speak; some result from maternal emotional fire transmitted to the infant, steaming and blocking the clear orifices; others result from convulsive disorders or wind-stroke causing inability to speak. For cases with residual heat and consumption of body fluids, use Qiwei Baizhu San (Seven-Ingredient White Atractylodes Decoction). For cases where clear qi fails to ascend, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For cases of congenital deficiency and deficient fire injuring the lung, use Dihuang Wan (Rehmannia Pill). If symptoms include coughing with head extended, emaciation of limbs, prominent whites of the eyes, or accompanying signs like fontanelle depression, yawning, and teeth grinding, these all belong to kidney deficiency and cannot be cured without Dihuang Wan added with Lu Rong (Deer Antler) and Yuan Zhi (Polygala Root). After vomiting and diarrhea, or following a severe illness, if there is voice but inability to speak, yet swallowing ability remains, this is not aphonia but rather stomach qi failing to ascend; Dihuang Wan and Buzhong Yiqi Tang should be taken together.
Infants may grind their teeth or suck/bite nipples during sleep or wakefulness. Although this mostly belongs to fright, the causes vary. Only cases involving biting nipples accompanied by convulsions are treated with Baolong Wan (Embracing Dragon Pill). Cases with fever, thirst, crying, and convulsions indicate excess heat in the heart meridian, treated with Xiexin Tang (Drain the Heart Decoction). Cases with drowsiness, palpitations, and lying with closed eyes indicate deficient heat in the heart meridian, treated with Daochi San (Guide Red Powder). Cases with greenish complexion, blinking eyes, yawning, neck stiffness, and irritability indicate excess heat in the liver meridian, treated with Chaihu Qinggan San (Bupleurum Clearing Liver Heat Powder). Cases with hands grasping clothes and aimlessly fidgeting indicate deficient heat in the liver meridian, treated with Liuwei Wan (Six-Ingredient Rehmannia Pill). Cases with convulsions, blue-green eyes, and red face indicate wind-heat in the liver meridian, also suitable for Liuwei Wan.
Night crying has two types: spleen cold and heart heat. Night belongs to yin; when yin prevails, spleen cold intensifies. The spleen is the organ of extreme yin, preferring warmth and detesting cold. Cold causes abdominal pain, leading to crying with a curved waist, which stops upon exposure to lamp light. Signs include greenish-white complexion, cold hands and abdomen, and refusal to feed; this is also called fetal cold, treated with Yihuang San adding Gouteng (Uncaria Ramulus). If crying worsens with lamp light, it indicates heart heat. The heart belongs to fire; lamp light generates internal烦热 (irritating heat), and the interaction of two yangs causes the infant to cry with an arched back. Signs include red face, warm hands and abdomen, and hot breath, treated with Daochi San adding Huanglian (Coptis Rhizome) and Maidong (Ophiopogon Tuber). If the complexion is white with small black pupils, it indicates insufficient kidney qi, with night crying due to yin deficiency at night, treated with Liuwei Wan. Crying due to fright should be treated according to methods for Ke Wu Jing Ti (Fright due to Guest Malevolence). Fright crying involves pathogenic factors attacking the heart. Crying with many tears indicates fright; crying without tears indicates pain. If fright crying is due to insufficient heart fire, use Mizhi Anshen Wan (Secret Instruction Calming Spirit Pill). If heart fire is blazing, use Daochi San. If wood and fire interact, add Chaihu (Bupleurum Root) and Zhizi (Gardenia Fruit). If liver blood is insufficient, use Liuwei Wan.