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The *Suwen: Treatise on the Manifestation of the Five Qi* states: The five types of overexertion cause injury: prolonged gazing injures blood, prolonged lying down injures qi, prolonged sitting injures flesh, prolonged standing injures bones, and prolonged walking injures sinews. This is referred to as the injuries caused by the five types of overexertion.

The Liver stores blood and opens into the eyes; therefore, prolonged gazing fatigues the eyes and injures the blood. The Lung acts as the canopy (Huagai), governing the qi of the entire body, distributing it throughout, and circulating endlessly. Prolonged lying down causes Lung qi to become stagnant and thus injured. The Spleen governs transportation and transformation and controls the muscles; prolonged sitting impairs Spleen function and injures the muscles. Prolonged standing fatigues the bones, and prolonged walking fatigues the sinews, so both result in injury. Initially, the blood, qi, flesh, bones, and sinews are injured; over time, this extends to the Zang organs. This is what is meant by the injuries caused by the five types of overexertion. However, individuals who are physically idle often have stagnant blood and qi. If they only engage in mental exertion, it directly injures the internal organs (Wu Nei), and the resulting disease is particularly severe.

In the *Lingshu: Chapter on Speechlessness Due to Grief and Anger*, the Yellow Emperor asked: What causes sudden loss of voice due to grief and anger? Which pathway is blocked? Shaoshi replied: The pharynx (Yanhou) is the pathway for water and food; the larynx (Houlong) is where qi ascends and descends; the epiglottis (Huiyan) is the gate of sound; the lips are the fan of sound; the tongue is the mechanism of sound; the uvula (Xuan Yong Chui) is the lock of sound; the nasopharynx (Hangsang) is where qi is distributed; and the transverse bone (Heng Gu) is controlled by spirit and qi, primarily governing tongue movement. Therefore, if nasal discharge flows uncontrollably, it is because the nasopharynx fails to open, leading to a failure in distributing qi. Thus, if the epiglottis is small and thin, sound emission is rapid, opening and closing are smooth, and air exits easily; if the epiglottis is large and thick, opening and closing are difficult, air exit is slow, and speech becomes hoarse. Sudden aphonia occurs when cold pathogen lodges in the epiglottis, preventing it from moving up or down, causing dysfunction in opening and closing, resulting in no sound.

The pulmonary airway (Hou) is located anteriorly near the chest, while the esophageal throat (Yanhou) is posteriorly near the back. Between them lies a membrane called the epiglottis (Huiyan); "Yan" means to cover, serving to cover the glottis. When food enters the mouth, the epiglottis covers the airway and opens the esophagus; when speaking, it covers the esophagus and opens the airway. Therefore, if food reaches the throat or if the airway opens during speech, food may accidentally enter the airway, clashing with Lung qi and causing coughing and choking, because the airway is anterior. Thus, the epiglottis is the gate of sound; the lips are the fan of sound; the tongue moves to modulate sound into language, so the tongue is the mechanism. If the tongue is stiff or flaccid, speech cannot be formed despite vocal cord function. The soft tissue hanging from the upper laryngeal opening is called the uvula (Xuan Yong), serving as the lock of sound. The transverse bone (Heng Gu) is the tender bone at the root of the tongue, originally generated by the Heart, so it is governed by spirit and qi to move the tongue, as the tongue is the sprout of the Heart. The nasopharynx (Hangsang) is the area inside the forehead above the roof of the mouth; fluids and qi ascend through the throat to the nasopharynx, spreading like smoke. If nasopharyngeal qi fails to open, fluids and qi cannot distribute, flowing down from the nose as mucus; since qi cannot constrain it, it is called rhinorrhea (Bi Dong). This is due to insufficient clear yang failing to penetrate and open the nasopharynx, which is why infants and the elderly often suffer from this condition. Variations in speech fluency or difficulty arise from differences in the size and thickness of the epiglottis. Responsiveness in conversation depends on the clarity or dullness of the Heart, not external factors. If cold pathogen lodges in the epiglottis, preventing opening and closing, sudden aphonia occurs; if sudden grief and anger cause qi rebellion, injuring the epiglottis and impairing its mechanism, this can be inferred analogously.

The Yellow Emperor asked: How should acupuncture be applied? Qibo replied: The Foot-Shaoyin Kidney Meridian ascends to connect with the tongue root, links with the transverse bone, and terminates at the epigllottis. By draining the blood vessels in these two areas, turbid qi will be expelled. The meridian of the epiglottis connects upward to the Ren Mai (Conception Vessel). Select Tian Tu (CV22) to restore epiglottic function.

The Foot-Shaoyin Kidney Meridian ascends to tie the tongue root, links the transverse bone, and terminates at the epiglottis; the epiglottic meridian further connects upward to the Ren Mai (Conception Vessel). Therefore, using needle therapy to drain the blood vessels of the Foot-Shaoyin and Ren Mai clears turbid qi and allows clear yang to penetrate, restoring the voice via the epiglottis. Tian Tu (CV22) is the Luo-Connecting point of the Ren Mai, located below the Adam's apple.