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Wei Qi (Defensive Qi) protects the skin and hair, secures body fluids, and prevents their reckless discharge. When pathogenic factors interfere, Wei Qi fails to secure the exterior, causing body fluids to leak recklessly, resulting in spontaneous sweating. Spontaneous sweating caused by plague differs from other conditions; it often occurs immediately upon infection, making it a common occurrence in plague cases, which is actually milder compared to head sweating or night sweats. Treatment should focus exclusively on eliminating the plague pathogen; once the pathogen recedes, sweating will stop naturally. However, there are differences regarding exterior/interior and deficiency/excess. In some cases, the pathogen is in the meridians while sweating occurs at the skin level, which is not true sweating. In other cases, although the pathogen decreases slightly after sweating, recovery is incomplete; one must not assume that no exterior pathogen remains simply because sweating has occurred. One must carefully observe the pulse and symptoms. If the pathogen is in the exterior, add exterior-releasing herbs of the Three Yang meridians to Da Yuan Yin (Reach the Original Decoction) to promote dispersion and harmonization. If the pathogen is in the interior, use purgative, draining, or clearing methods. As for spontaneous sweating in miscellaneous diseases, it is also common, with dedicated sections for each, so I will not elaborate here. Only when extreme deficiency follows sweating or purgation, and all exterior pathogens have been eliminated, can tonification be used. If even slight exterior pathogens remain, erroneous tonification will cause great harm.

Medical texts often combine aphonia (loss of voice) and mutism (inability to speak) into a single syndrome. How could they know that those with aphonia can still move their tongues freely but produce no sound from the throat? Whereas those who cannot speak may have stiff tongues unable to move, or voices stuck in the throat, yet their vocal mechanism itself functions. By interpreting "silent" separately, I avoid confusing it with mutism. Silent speech due to plague is fatal in nine out of ten cases, as stated: "In heat diseases causing aphonia and inability to speak, if sweating does not occur within three to four days, death ensues." This condition generally results from plague pathogens entering the zang organs, where heat qi blocks, obstructs, and blazes. However, analyzing it further reveals several subtypes. Some result from pathogenic heat rushing to the Heart, depleting Heart Qi; these require clearing the Heart and descending fire, using herbs such as Sheng Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Tuber), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Hua Fen (Trichosanthis Radix), Lian Qiao (Forsythiae Fructus), Zhu Li (Bambusae Succus), Tian Zhu Huang (Bambusae Malleus), Zhu Ye (Bambusae Folium), Huang Lian (Coptidis Rhizoma), and Xi Jiao (Rhinocerotis Cornu). Others result from fire scorching Lung Metal, preventing its dissemination; these require clearing the Lung and descending fire, using herbs such as Huang Qin (Scutellariae Radix), Chuan Bei Mu, Niu Bang Zi (Arctii Fructus), Zhi Zi (Gardeniae Fructus), and Shi Shuang (Diospyros Frost). Still others result from heat-phlegm obstruction blocking Qi; these require clearing phlegm and descending fire. To clear phlegm, use Chuan Bei Mu, Gua Lou Ren (Trichosanthis Semen), and Dan Xing (Arisaematis Cum Bile); to descend fire, diagnose which meridian the fire resides in, select cooling herbs of that meridian, add phlegm-resolving herbs of that meridian, and simultaneously use Qi-regulating agents such as Zhi Ke (Aurantii Fructus), Chen Pi (Citri Reticulatae Pericarpium), Ju Hong (Citri Reticulatae Pericarpium Rubrum), and Fo Shou (Citri Sarcodactylis Fructus). ... Some result from failure to resolve pathogens early, allowing them to lurk in the Lung; these require resolving the pathogens. The Lung resembles a bell; suspended and struck, it rings. But if an inverted bell is filled with mud, it will never ring; similarly, lung obstruction prevents sound. Once pathogenic obstruction disperses, the Lung regains its emptiness and resonance. Use herbs such as Qian Hu (Peucedani Radix), Fang Feng (Saposhnikoviae Radix), Shui Ping (Urticae Herba), Su Ye (Perillae Folium), Sang Bai Pi (Mori Cortex), Chen Pi, Dan Chi (Sojae Preparata), Sheng Jiang (Zingiberis Rhizoma Recens), and Cong Bai (Allii Fistulosi Bulbus). (This subtype is mild among aphonia cases.) These all belong to the category of aphonia. As for mutism, there are also several types. Some result from severe Wind-Heat congestion causing cough and hoarseness; treat with Wind-dispersing and phlegm-resolving formulas using Qian Hu, Fang Feng, Chen Pi, Dou Ling (Stemonae Radix), Ginger, and Scallion. This is the mildest type. Another case involves Taiyang disease where, after sweating, the body remains burning hot, named Feng Wen (Wind-Warmth). With floating pulses at both Cun and Chi positions, spontaneous sweating, heavy body, excessive sleepiness, nasal congestion, and difficulty speaking, use Wei Rui Tang (Asparagi Decoction). There is also Hu Huo Syndrome (Chancroid/Trypanosomiasis-like condition), characterized by sores on the lips, dry throat, and hoarse voice. There is Shaoyin Syndrome with sores in the throat. There is Jing Syndrome (Tetanus/Convulsion) with locked jaw and inability to speak. These should be sought in the Treatise on Cold Damage and Miscellaneous Diseases sections, representing categories of mutism. Furthermore, the Classics state: "Why do people suddenly lose their voice due to sudden grief or anger?" The answer is: "The epiglottis is the gate of voice." (The epiglottis covers the glottis to prevent food/drink from entering the airway.) When cold pathogens lodge in the epiglottis, it cannot open or close properly, leading to loss of voice. This describes mutism caused by cold lodging in the meridians. Heat pathogens flowing into the meridians might theoretically cause this too, though it is rare; I record it here for experts to evaluate.

Er Li Tang (Two Pours Decoction)
Zhu Li (Bambusae Succus), Jing Li (Schizonepetae Succus), Li Zhi (Pirae Juice).
If Pirae juice is unavailable, substitute with Watermelon juice; if Schizonepetae succus is unavailable, using only Bamboo sap is acceptable. Mix equal parts evenly. For urgent conditions, take at any time. This treats aphonia following recovery; taking it before full recovery is also generally effective.