诸本无篇字。马云。人有忧与怒以无言。盖有其由。故名篇。
何气出行 甲乙。出、作不。是。
咽喉 喉咙。 张云。人有二喉。一软一硬。软者居后。是谓咽喉。乃水谷之道。通于六腑者也。
硬者居前。是谓喉咙。为宗气出入之道。所以行呼吸。通于五脏者也。其在太阴阳明论。则单以软者为咽。硬
者为喉。故曰喉主天气。咽主地气。
会厌 张云。会厌者。喉间之薄膜也。周遭会合。上连悬雍。咽喉食息之道。得以不乱者。赖其遮
厌。故谓之会厌。能开能阖。声由以出。故谓之户。汪云。气喉之蔽。以掩饮食。使不错入气喉。
音声之扇也。 志云。如户扉之开合。故曰扇。简案、说文。扇、扉也。
音声之机也。 马云。犹弩之有机。
悬壅垂 张云。悬而下垂。俗谓之小舌。当气道之冲。为喉间要会。故谓之关。
颃颡 张云。颃、颈也。颃颡、即颈中之喉颡。当咽喉之上。悬雍之后。张口可见者也。颡前有窍。
息通于鼻。故为分气之所泄。志云。颃颡者。 之上窍。口鼻之气及涕唾。从此相通。故为分气之所泄。谓气
之从此而分出于口鼻者也。简案、根结篇。张玉师注云。颃颡者。鼻之内窍。通
于喉咙。故颃颡不开。则洞涕不收。盖颃颡诸注未详。唯志所释为明备。但考字书无其义。疑是吭嗓。吭嗓即
咽喉之谓。活人书释颃颡者。悬壅两旁肉也。未知何据。
横骨 张云。即喉上之软骨也。下连心肺。故为神气所使。上连舌本。故主举发舌机也。
鼻洞 张云。涕液流泄于鼻也。颃颡之窍不开。则清气不行。清气不行。则浊液聚而下出。由于分气
之失职也。简案、鼻洞、即鼻渊。千金方引气厥论。鼻渊、作鼻洞、
颃颡不开 甲乙。开、作闭。张云。颃颡之窍不开。则清气不行。清气不行。则浊液聚而下出。由于分
气之失职也。
疾薄 甲乙无疾字。是。
重言也 甲乙也下有所谓吃者。其言逆故重之十字。张云。重言。言语蹇涩之谓。志云。口吃而期期也。
开阖不致 张云。不致、不能也。寒气客于会厌。则气道不利。既不能发扬而高。又不能低抑而下。
开阖俱有不便。故卒然失音。志云。厌不能发。谓不能开也。发不能下。谓不能阖也。
两泻其血脉 浊气乃辟 马云。必两次泻其血脉。则浊气乃 除矣。张云。两泻者。两足俱刺也。足
少阴之血脉。当是所注之 穴。即太溪也。然人有虚劳失音者。观此节之义。则亦无非属乎肾经。但其所致有
渐。与此卒然者不同。其治当分补泻耳。辟、开也。志云。浊气者。寒水之浊气。辟、除也。两泻其血脉者。
谓脉道有两歧。一通气于舌本。一通精液于廉泉玉英。盖足少阴主藏先天之精气。而上通于空窍者也。简案、
两泻、谓两次泻天突之穴。经文义自分明。马注为是。
天突 张云。天突为阴维任脉之会。取之能治暴喑。
All versions lack the character "Pian" (Chapter). Ma Yun states: People lose their voice due to sorrow and anger; there is presumably a reason for this, hence the chapter title.
What Qi causes aphonia? In *Jia Yi Jing* (Systematic Classic of Acupuncture and Moxibustion), the character "Chu" (out) is written as "Zuo" (make/do). This is correct.
Yan Hou (Pharynx and Larynx). Hou Long (Throat). Zhang Yun states: Humans have two throat structures, one soft and one hard. The soft part is posterior, called Yan Hou, which is the pathway for food and drink, connecting to the Six Fu Organs. The hard part is anterior, called Hou Long, which is the pathway for Zong Qi (Gathering Qi) to enter and exit, facilitating respiration, and connecting to the Five Zang Organs. In the *Tai Yang Yang Ming Lun* (Treatise on Taiyang and Yangming), only the soft part is referred to as Yan (Pharynx) and the hard part as Hou (Larynx). Thus, it is said that Hou governs Heavenly Qi, and Yan governs Earthly Qi.
Hui Yan (Epiglottis). Zhang Yun states: Hui Yan is a thin membrane in the larynx. It joins around, connecting superiorly to the uvula. The pathways for eating, drinking, and breathing in the pharynx and larynx remain orderly thanks to its covering and blocking function, hence named Hui Yan. It can open and close, allowing sound to emerge, thus called a "door" (Hu). Wang Yun states: It acts as a cover for the airway, preventing food from entering incorrectly. It is the fan of sound. Zhi Yun states: Like the opening and closing of a door leaf, hence called a fan. Jian An notes: *Shuo Wen Jie Zi* defines "Fan" as a door leaf. It is the mechanism of sound. Ma Yun states: Just as a crossbow has a trigger mechanism.
Xuan Yong Chui (Uvula). Zhang Yun states: It hangs down, commonly known as the little tongue. It is located at the critical junction of the airway, serving as an important convergence point in the larynx, hence called Guan (Pass/Barrier).
Hang Sang (Nasopharynx). Zhang Yun states: Hang refers to the neck. Hang Sang is the throat-pharynx within the neck. It is located above the pharynx and larynx, posterior to the uvula, visible when the mouth is opened. There are orifices anterior to Hang Sang where breath connects to the nose, making it the site where Qi diverges. Zhi Yun states: Hang Sang is the upper orifice. Breath from the mouth and nose, along with mucus and saliva, communicates through here, hence called the site of diverging Qi, meaning Qi exits separately through the mouth and nose. Jian An notes: In the *Gen Jie Pian*, Master Zhang Yu's commentary states: Hang Sang is the internal orifice of the nose, connecting to the larynx. Therefore, if Hang Sang does not open, clear rhinorrhea cannot be controlled. Generally, various annotations on Hang Sang are not detailed; only Zhi's explanation is clear and complete. However, checking dictionaries reveals no such definition, leading to suspicion that it might be "Keng Sang". Keng Sang means pharynx and larynx. *Huo Ren Shu* explains Hang Sang as the flesh on both sides of the uvula. The basis for this is unknown.
Heng Gu (Hyoid Bone/Cartilage). Zhang Yun states: It is the cartilage above the larynx. It connects inferiorly to the Heart and Lung, thus being directed by Shen Qi (Spiritual Qi). It connects superiorly to the root of the tongue, thus governing the movement of the tongue.
Bi Dong (Nasal Discharge/Rhinorrhea). Zhang Yun states: Mucus flows out from the nose. If the orifice of Hang Sang does not open, Clear Qi does not circulate. If Clear Qi does not circulate, turbid fluids accumulate and flow downward. This is due to the failure of the diverging Qi function. Jian An notes: Bi Dong is synonymous with Bi Yuan (Nasal Sinusitis/Ozena). *Qian Jin Fang* cites the *Qi Jue Lun*, writing Bi Yuan as Bi Dong.
Hang Sang Bu Kai (Failure of Hang Sang to Open). In *Jia Yi Jing*, the character "Kai" (open) is written as "Bi" (close). Zhang Yun states: If the orifice of Hang Sang does not open, Clear Qi does not circulate. If Clear Qi does not circulate, turbid fluids accumulate and flow downward. This is due to the failure of the diverging Qi function.
Ji Bo (Rapid/Close). *Jia Yi Jing* lacks the character "Ji". This is correct.
Zhong Yan Ye (Repetitive Speech/Stuttering). *Jia Yi Jing* adds ten characters after "Ye": "Suo Wei Chi Zhe, Qi Yan Ni Gu Zhong Zhi" (So-called stuttering, because the speech is obstructed, hence repeated). Zhang Yun states: Zhong Yan refers to hesitant and slurred speech. Zhi Yun states: Stuttering, saying "qi qi" (onomatopoeia for stuttering).
Kai He Bu Zhi (Inability to Open and Close Properly). Zhang Yun states: Bu Zhi means inability. When Cold Qi lodges in the Hui Yan, the airway becomes obstructed. It cannot rise and expand, nor can it lower and close. Both opening and closing become inconvenient, resulting in sudden aphonia. Zhi Yun states: "Yan Bu Neng Fa" means inability to open; "Fa Bu Neng Xia" means inability to close.
Liang Xie Qi Xue Mai, Zhuo Qi Nai Pi (Bleeding/Venesection twice from the blood vessels, then turbid Qi is expelled). Ma Yun states: One must bleed the blood vessels twice, then the turbid Qi will be eliminated. Zhang Yun states: Liang Xie means needling both feet. The blood vessel of Foot Shaoyin should be the Ying-Spring point, which is Taixi (KI3). However, some people suffer from aphonia due to deficiency and exhaustion. Observing the meaning of this section, it also belongs to the Kidney Meridian. But the onset is gradual, unlike the sudden onset described here. Treatment should distinguish between tonification and sedation. Pi means open. Zhi Yun states: Zhuo Qi refers to the turbid Qi of Cold Water. Pi means eliminate. Liang Xie Qi Xue Mai refers to the fact that the meridian has two branches: one connects to the root of the tongue, and the other conveys essence fluid to Lianquan and Yuying. Foot Shaoyin governs the storage of congenital essence and Qi, connecting superiorly to the orifices. Jian An notes: Liang Xie refers to sedating the Tiantu (CV22) acupoint twice. The meaning of the classic text is clear. Ma's annotation is correct.
Tian Tu (Tiantu CV22). Zhang Yun states: Tian Tu is the meeting point of the Yinwei Mai (Conception Vessel branch) and Ren Mai (Conception Vessel). Needling it can treat sudden aphonia.