咳而失音，有新久虚实之异。新者多实，痰火闭郁，所谓金实不鸣也。久者多虚，肺损
气脱，
所谓金破亦不鸣也。实者逐邪蠲饮易治。虚者补肺养气难治。亦有肺已虚损而风寒未尽，或
痰火闭塞者，则攻补俱碍，其治尤难也。
诃子饮 治久嗽语声不出。
诃子肉 杏仁（各一钱，炒） 通草（一钱半）
分二服，每服水二盅，姜三片，煎一盅，食远温服。
一方 诃子四个，有桔梗一两半，甘草二寸。
杏仁煎 治嗽失音不出。
杏仁（三两，研泥） 生姜汁 蜜（各一两） 木通 桑白皮 贝母（各一两二钱） 紫菀
五味（各一两）
水三升，煎半升，去滓，入杏仁、蜜、姜汁，再熬成稀膏，食后卧噙化一匙。
又方 皂角一握，去皮弦子，萝卜三个，切片，水一碗，煎至半碗服之。不过三
服，能使语出声。
治盛寒失音不语，咽喉痒痛。
桂心 杏仁（各一两）
为末，蜜丸樱桃大，绵裹咽津。
戴云∶有嗽而咽痛失音，多进冷剂而声愈不出者，宜生姜汁调消风散，少少进之。或只
一味
姜汁亦得。又云∶声哑声，寒包其热也，宜细辛、半夏、生姜之属，辛以散之。若痰热壅于
肺者，金空则鸣，必清肺中邪滞，用清咽宁肺汤主之。
清咽宁肺汤
桔梗（二钱） 炒山栀 黄芩 桑皮 甘草 前胡 知母 贝母（各一钱）
水二盅，煎八分，食后服。
《和剂》款冬花散 治肺已虚而风寒未尽，喘满烦闷，痰涎壅盛，鼻塞流涕，咽
喉不利。
杏仁 阿胶（炒） 麻黄（去根节） 半夏（汤洗，姜制） 款冬花 桑叶 知母 贝母（各
一两）
上 咀，每服二钱，水一盅，姜三片，水煎，食前温服。《准绳》用炙甘草和半夏加一
倍。
Cough accompanied by loss of voice presents differences between recent and chronic onset, as well as excess and deficiency patterns. Recent onset is mostly excess type, caused by the obstruction and stagnation of phlegm-fire, which is referred to as "Metal being solid does not sound" (the Lung Metal is obstructed by pathogenic factors, preventing vocalization). Chronic onset is mostly deficiency type, resulting from damage to the Lung and depletion of Qi, which is referred to as "Metal being broken also does not sound" (the Lung Metal is damaged, leading to loss of voice). Excess patterns are easier to treat by expelling pathogens and eliminating fluid retention. Deficiency patterns are difficult to treat as they require tonifying the Lung and nourishing Qi. There are also cases where the Lung is already deficient but Wind-Cold has not fully resolved, or where Phlegm-Fire is blocking; in such instances, both attacking pathogens and tonifying deficiencies are hindered, making treatment particularly difficult.
Hezi Yin (Persimmon Sepal Decoction): Treats chronic cough with inability to speak.
Ingredients: Hezi Rou (Pericarpium Diospyros Kaki), Xingren (Semen Armeniacae Amarum) (each 1 qian, stir-fried), Tongcao (Medulla Tetrapanacis) (1.5 qian).
Administration: Divide into two doses. For each dose, use two zhong of water and three slices of fresh ginger, decoct until one zhong remains. Take warm after meals.
Another prescription: Hezi (Persimmon Sepal) four pieces, Jiegeng (Radix Platycodonis) 1.5 liang, Gancao (Radix Glycyrrhizae) two cun.
Xingren Jian (Apricot Kernel Decoction): Treats cough with loss of voice.
Ingredients: Xingren (Semen Armeniacae Amarum) (3 liang, ground into paste), Shengjiang Zhi (Jucius Zingiberis Recens), Fengmi (Melle) (each 1 liang), Mutong (Caulis Akebiae), Sangbaipi (Cortex Mori Radicis), Beimu (Bulbus Fritillariae Cirrhosae) (each 1.2 liang), Ziwan (Herba Asteris Tatarici), Wuwei (Fructus Schisandrae Chinensis) (each 1 liang).
Administration: Use three sheng of water, decoct until half a sheng remains. Remove dregs, add Xingren paste, Fengmi, and Shengjiang Zhi, and boil again into a thin paste. After meals, while lying down, hold one spoonful in the mouth to dissolve slowly.
Another prescription: Zaojiao (Fructus Gleditsiae Sinensis) one handful, remove skin and seeds; Luobo (Radix Raphani Sativi) three pieces, sliced. Use one bowl of water, decoct until half a bowl remains, then take. Within three doses, voice can be restored.
Treats loss of voice and muteness due to severe Cold, with itchy and painful throat.
Ingredients: Guixin (Cortex Cinnamomi Cassiae), Xingren (Semen Armeniacae Amarum) (each 1 liang).
Administration: Grind into powder, form pills the size of cherry pits using Melle. Wrap in cotton wool and swallow with saliva.
Dai Yun stated: In cases of cough with sore throat and loss of voice, if excessive intake of cold agents causes further loss of voice, it is appropriate to mix Xiaofeng San (Wind-Expelling Powder) with Shengjiang Zhi (Jucius Zingiberis Recens) and administer in small amounts frequently. Alternatively, using only Shengjiang Zhi alone is also effective. Furthermore, hoarseness is caused by Cold enveloping Heat; it is appropriate to use herbs such as Xixin (Radix Asari), Banxia (Rhizoma Pinelliae), and Shengjiang (Rhizoma Zingiberis Recens), utilizing their acrid nature to disperse the pathogen. If Phlegm-Heat is congested in the Lung, causing the Lung to be empty and thus able to sound, one must clear the pathogenic stagnation from the Lung, primarily using Qingyan Ningfei Tang (Throat-Clearing Lung-Calming Decoction).
Qingyan Ningfei Tang (Throat-Clearing Lung-Calming Decoction):
Ingredients: Jiegeng (Radix Platycodonis) (2 qian), Chao Shanzhi (Fructus Gardeniae Jasminoidis, stir-fried), Huangqin (Radix Scutellariae), Sangpi (Cortex Mori Radicis), Gancao (Radix Glycyrrhizae), Qianhu (Radix Peucedani), Zhimu (Rhizoma Anemarrhenae), Beimu (Bulbus Fritillariae Cirrhosae) (each 1 qian).
Administration: Use two zhong of water, decoct until eight fen remain. Take after meals.
Kundonghua San (Coltsfoot Flower Powder) from *Heji Ju Fang* (Formulas of the Bureau for the Care of the People): Treats Lung deficiency with unresolved Wind-Cold, presenting with wheezing, chest fullness, irritability, profuse phlegm-saliva, nasal congestion with runny nose, and throat discomfort.
Ingredients: Xingren (Semen Armeniacae Amarum), Ejiao (Colla Corii Asini, stir-fried), Mahuang (Herba Ephedrae, roots and nodes removed), Banxia (Rhizoma Pinelliae, washed in hot water, processed with ginger juice), Kundonghua (Flos Farfarae), Sangye (Folium Mori), Zhimu (Rhizoma Anemarrhenae), Beimu (Bulbus Fritillariae Cirrhosae) (each 1 liang).
Administration: Cut the herbs into small pieces. Take 2 qian per dose, with one zhong of water and three slices of ginger. Decoct in water and take warm before meals. *Zhunsheng* uses Zhi Gancao (Radix Glycyrrhizae Preparata) combined with Banxia, doubling the dosage.