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Sheng Yongjing treated Daoist Gu Benchu, who suffered from aphonia. Other physicians had treated him for Jueyin Cold Damage (Jueyin Shanghan). Upon arrival, Sheng said: "This is a combination of internal injury and external contraction; the condition is incurable. He will sweat on a certain day and die on another." This proved to be true. When asked for the reason, he explained: "The Lung belongs to Metal and governs voice. When Lung Qi scatters, aphonia occurs. Moreover, his dark complexion indicates exhaustion of Kidney Qi. The specific day corresponds to Fire, which overcomes Metal (Fire attacking Metal position). With the True Yang seized, death is inevitable." (From *Wujiang County Annals*.)

Sun Wen Yuan treated Xu Jian'an, who, after eating new garlic stir-fried with meat in the first lunar month and being exposed to wind-cold, developed cough, sore throat, and hoarseness. This patient originally had phlegm-fire, which was constrained by external pathogens, preventing their dispersal. Treatment should moisten the Lung, resolve phlegm, and regulate Qi to address the root, while simultaneously releasing the exterior and dispersing pathogens to treat the branch. Only then can pain be removed and voice restored. Initially, he was given Trichosanthis Semen (Gualou Ren), Tangerine Peel (Juhong), Platycodon Root (Jiegeng), Licorice Root (Gancao), Mint (Bohe), Mulberry Bark (Sangbai Pi), Ground Tallow Tree Root Bark (Digupi), Kudzu Root (Gegen), and Peucedanum Root (Qianhu) for four doses. Subsequently, he took Phlegm-Expelling Pills (Guntan Wan) combined with Seven-Processed Phlegm-Resolving Pills (Qizhi Huatan Wan) for two doses at night. All symptoms resolved, and his voice became clear. This is the method of "removing firewood from under the cauldron" (treating the root cause).

Zhang Luyu treated a merchant from the west who, after catching cold upon arriving in Suzhou, suddenly developed wheezing, aphonia, and swollen, painful throat. His physique was robust, and his appetite was normal. His pulse was floating and soft but became firm upon deep pressure. This indicated cold enveloping heat pathogens, damaging the Lung collaterals. He prescribed Mahuang Xingren Gancao Shigao Decoction (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) added with Pinellia Rhizome (Banxia) and Asarum Root (Xixin), along with a large dose of Polygonatum Rhizome (Weirui/Yuzhu). After two doses, wheezing ceased and voice returned. However, slight aphonia remained during respiration. He then administered Erchen Tang (Two-Cured Decoction) added with Immature Bitter Orange (Zhishi), Platycodon Root (Jiegeng), and Polygonatum Rhizome (Weirui). After two doses of regulation, the patient recovered.

Wang Weiyi treated a patient who had experienced hemoptysis years prior but was young and strong. In April, he suddenly developed a cough. After taking diaphoretic herbs, blood appeared in his sputum. Subsequent excessive use of yin-nourishing herbs led to a raspy, hoarse voice and a sensation of chest oppression, persisting for over a month. His pulse was deep and choppy but forceful upon pressure, and responsive upon light touch. His body was fat and skin lustrous, clearly not a Yin deficiency pattern. This type of hoarseness is "Metal fullness causing silence" (Jin Shi Bu Ming), distinct from "Metal fracture causing silence" (Jin Po Bu Ming). Therefore, he prescribed Daotan Tang (Phlegm-Guiding Decoction) added with Human Manure Yellow (Renzhonghuang) and Alumen (Zexie), focusing solely on resolving phlegm. After four doses, purple blood clots appeared in the sputum, and the voice gradually returned, though still imperfect. He then used Stone Autumn (Qiushi) combined with Renzhonghuang and jujube flesh made into pills, taken for one month, resulting in a clear voice. Throughout, no Lung-clearing or Ying-blood-nourishing herbs were used.

Zhang Feichou treated Guo Daigong, who ate little on the Dragon Boat Festival, felt fatigued, and suffered diarrhea. Clearing and purging treatments had failed. After falling while defecating, he fell into a coma. Days later, when consulted, his six pulses were faint and nearly vanished, his right arm was immobile, and he was aphonic. Someone suggested using Rhubarb (Dahuang); Zhang urgently stopped this, saying: "This is extreme deficiency of Spleen and Lung Qi; how can it withstand such attack? Only rice gruel and Ginseng Soup are appropriate. As the saying goes, 'If gruel enters the stomach, the deficient will survive.'" Following this advice, diarrhea stopped, consciousness returned, and voice gradually recovered. After regaining ability to eat, only Dushen Tang (Single Ginseng Decoction) was used for regulation, leading to recovery without further medication.

Zi Tingsu treated a woman at eight months of pregnancy who lay mute. Physicians gave up. He stated: "This is what the *Neijing* calls 'Fetal Aphonia' (Tai Yin). She will recover without medicine by the tenth month." (From * Jiashan County Annals*.)

During the Wanli era, He Jichong, a renowned physician from Jingkou from a medical family, was still a student at home. The son of the Prefect of Zhenjiang suddenly lost his speech. The envoy sent for He's father, who was away, so He Jichong went instead. He diagnosed: "The young master has no disease; do not use medicine. Simply have women breathe air into his mouth repeatedly." They did so, and after half an hour, he could speak. Asked why, he replied: "There were many women in the yamen, and the young master was very handsome. The women, admiring him, likely sucked his mouth while holding him, temporarily seizing Shaoyang Qi. Breathing restores it." Such incidents were extraordinary. (From *Zhangshi Zhiyan*.)

Lu Xiaoyu treated Fan Lu's son, who indulged in rich foods and alcohol, and had a irritable temperament. Initially suffering hemoptysis, he took Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) for over a month without improvement, developing hematuria and cough. Suddenly, he became hoarse, yet his muscles and appetite remained normal. Others treated him as consumption (Lai Zhai) with no effect. His left Guan pulse was surging and wiry; right Guan was slippery, large, and rapid. This was an excess Fire pattern, not deficiency-based consumption. Rich food generated phlegm; alcohol aided fire. Fire flared, phlegm surged, and stasis obstructed the chest, causing hoarseness. Anger injured the Liver; Liver channel connects to the tongue base and genitalia. Dragon-Lei fire moving caused blood to rebel upward and leak downward. Treatment should clear heat, descend Qi, resolve phlegm, and guide blood back to its source. Recovery in ten days was expected. Using Rehmannia, Anemarrhena, and Asparagus would be wrong. He used Zhenxia Tianqu and Hawthorn Fruit (Shanzha) to resolve Stomach damp-phlegm as sovereign; Apricot Kernel (Xingren) and Tangerine Peel (Juhong) to benefit Lung orifices as minister; Peach Kernel (Taoren) and Turmeric Tuber (Yujin) to move Liver stagnation as assistant; Gardenia (Shanzhi) and Raw Licorice (Sheng Gancao) to clear Upper Jiao as envoy; Talcum (Huashi) and Plantago Seed (Cheqian) to clear Lower Jiao. Reed Rhizome (Maogen) decoction was used to boil the herbs. After several doses, bleeding stopped, voice cleared, and all symptoms vanished within ten days.

Xue Lizai treated a wealthy man who neglected his lifestyle, suddenly losing his voice and becoming confused with surging phlegm-saliva. This was Kidney Meridian deficiency-cold and Qi reversal, failing to connect with Clear Yang. He prescribed Dihuang Yinzi (Rehmannia Infusion). Otherwise, biting the tongue would follow. The Classics state: "When Shaoyin Qi arrives, the tongue is bitten; when Shaoyang Qi arrives, the cheek is bitten." The patient refused, using wind-dispelling herbs, and indeed bit his tongue. Emergency use of Dihuang Yinzi brought peace.

Xiong's Note: This winter, Jiang Jingtang's wife suffered left-sided headache, muscle spasms, and distress. Days later, she was mute, anorexic, and constipated, with urination every other day, cracked lips, and black tongue. Doctors used Niuhuang Wan (Calculus Bovis Pill), Zixue Dan (Purple Snow Elixir), Rhinoceros Horn, and Bamboo Sap, leading to confusion. Her brother Zhou Yuhe consulted me. Her face was greenish-yellow, tongue black and greasy, pulse slow and soft. I gave Dihuang Yinzi for five doses; she spoke and recognized people. Eight doses led to bowel movement; ten-plus doses led to recovery. She had two miscarriages in spring/summer and illness from worry/labor in autumn. Ying-Yin was greatly deficient, causing sudden internal wind.

A woman had been mute for half a year, unresponsive to various drugs. Her Chi pulses were floating and rapid. Initially, Liuwei Wan (Six-Ingredient Pill) material added with Cinnamon Bark (Rougui) was used for several doses, showing slight improvement. Then Dihuang Yinzi was used for thirty-plus doses, leading to cure. Men with this symptom also respond to this formula.

A woman fell due to anger, with surging phlegm and muteness. Niuhuang Qingxin Wan (Calculus Bovis Heart-Clearing Pill) revived her slightly. Shenxian Jieyu Dan (Immortal Speech-Unblocking Pill) added Gardenia (Shanzhi), Bupleurum Root (Chaihu), and Platycodon Root (Jiegeng) gradually improved her. Finally, Liujun Zi Tang (Six-Gentlemen Decoction) added with Aurantium (Zhike) cured her. Shenxian Jieyu Dan composition: Aconite Tuber (Baifuzi), Acorus Rhizome (Shichangpu), Polygala Root (Yuanzhi), Gastrodia Tuber (Tianma), Scorpion (Quanxie), Notopterygium Rhizome (Qianghuo), Pinellia Tuber (Nanxing), Costus Root (Muxiang). Muxiang is 0.5 liang; others are 1 liang, coated with Cinnabar (Chensha).

Xia Gongmingdao, governing Hushan and Guiqi, visited Yu Wanjingsheng Bosheng in the mountains and discussed Zhang Boming of Linchuan's medical skills. Zhang's son suddenly lost speech without other discomforts. Physicians were baffled. Zhang said: "This is a heat pattern." Slow resolution leads to self-healing. Also, his servant had chills and fever. One doctor used common herbs. Zhang said: "Heat is extreme; treatment is futile. Take him home." The servant bowed, left, and died that evening before reaching home. (From *Guidi Gao*.)

Wei Yuheng said: Yan Tieqiao was talented and bold in poetry and wine. Last summer, he suddenly lost his voice with intermittent cough, adhering to the rule of no medicine. In early August, I visited him. A maid brought medicine. I asked: "You said no medicine, now you take it? What treatment? What herbs?" The prescription contained Peucedanum Root (Qianhu), Platycodon Root (Jiegeng), Apricot Kernel (Xingren), Perilla Fruit (Suzi)—wind-cold formulas. I said: "Your condition does not suit this. Can wind-cold last a hundred days? Long-standing Liver-Kidney disease, Ministerial Fire punishing Metal requires Jiling Gao, Zuogui Wan, or Liuwei Dihuang Wan. Do not err." Another doctor also advised Liuwei Dihuang Wan. After 30-40 doses, hemorrhoids suddenly appeared, and voice returned. Lung disease transmitting to Large Intestine is a good sign. However, severe hemorrhoid pain lasted over a month due to late treatment and rigid adherence to ancient formulas for Liuwei Dihuang Wan. Years later, he drank heavily, passed the provincial exam, and went to Fujian as a tutor. He contracted malaria, returned months later with consumptive disease, and died. From aphonia to death was ten years; he was 37. Regrettable!

Old Man Song Huizhang, over sixty, habitual drinker, suffered cough and aphonia. Doctors treated as wind-cold, worsening condition. I used Raw and Prepared Rehmannia (Sheng/Di Huang), Ophiopogon Tuber (Maidong), Glehnia Root (Shashen), Trichosanthis Semen (Gualou Ren), and Goji Berry (Qizi). After twenty-plus doses, hemorrhoids appeared, and cough/aphonia healed. Years later, traveling to Beijing through floodwaters, hemorrhoids recurred with labor/pus. At this point, hemorrhoids suddenly healed, but cough/aphonia returned. Treatment in Beijing failed. Pulse was wiry, choppy, and rapid. I told him: "Initially, healing via hemorrhoids was organ-to-meridian transmission (Shun/Favorable). Now, healing of hemorrhoids with disease recurrence is meridian-to-organ transmission (Ni/Unfavorable)." He died months later.

Xu Lingtai said: Chronic cough leading to aphonia is always due to medicinal error. Ophiopogon Tuber (Maidong) and Schisandra Berry (Wuweizi) are the "miracle pills" for causing aphonia; long-term use invariably leads to loss of voice. If total aphonia occurs, even if the person is strong as a tiger and fast as a horse, they will die within six months. If aphonia is occasional due to wind-cold, phlegm, or fire, it may heal spontaneously. But adding Maidong and Wuweizi turns false illness into true disease.