不语之症，内伤外感皆有。外感不语，即噤口伤寒也，世有其症，无其书，故补注之。内伤
不语，有舌强不语者，神志仍清，口亦能开，但舌本强硬，不能言语也。有口噤不语者，舌
本无病，但牙关紧咬，口不能开而不能言语也。有神昏不语者，呼之不应，问之不答，如醉如
睡，而不得言语也。外感不语之症有五条，初起恶寒发热，失于发散表汗，不得发越，遂发
烦热喘渴，误认里热，误投凉剂。有口噤不语之症，此寒凉抑遏表邪之一条也。又有发热日
久，热邪不解，应清火而不清，有下症而失下，诸窍热壅，语言不出，此里热昏沉之一条
也。倘因恼怒停食，又兼外冒风邪，发热谵语渴不消水，人见其谵语，误认里热，苦寒冷冻饮料
凝结中焦，今有谵语之后，即变不语，此寒凉抑遏食气之一条也。又有内积痰饮，外冒风
寒，又误食生冷，与夹食伤寒不相上下，此寒凉抑遏痰迷不语之一条也。以上诸条，即大便
秘结有下症者，止用芒硝、玄明粉、硝以消坚，不用大黄重浊泥滞。又有时行异气，沿门传
染，温毒湿毒，暴热暴寒，袭人毛窍，或发疫症， 痧毒瓦斯不得外泄，内扰神明，志识昏
迷，叉手捻空，口噤不语，此时疫不语之一条也。治表邪不语，若身表尚热，两足无汗六脉
浮滑数动，或脉沉伏模糊，治宜辛温发汗，冬三月北方口不干者，可用麻黄汤；若口干者，
用羌活败毒散。余三月，不用麻黄，竟用羌活败毒散，佐以石菖蒲、半夏开窍豁痰，禁用寒凉攻下。
治里热不语，若身表不热，手足时常有汗，口干唇焦，六脉沉数，宜清其里热，则诸窍通
达，导赤各半汤、凉膈散；有下症者，承气汤下之。
治食气不语，若发热胸满，手足或冷或热，唇不焦，口不渴，右脉滑大不数，或反沉伏，先
用吐法，随用理气稍滞，如保和散、枳桔平胃散加石菖蒲、白豆蔻。无汗者加干葛、防风；
太阳见症，加羌活；少阳见症，加柴胡；若表邪已散，时时手足有汗，便结不通，有下症者下之。
治痰迷不语，若胸膈满闷，恶心呕吐，口不干渴，右关脉滑，按之沉弦不数，治宜二陈导痰
汤合平胃散，加枳、桔。亦有用吐法，上涌其痰。若有表邪，加各经散表之药。若表邪已
散，手足时时有汗，栀连二陈汤冲竹沥热服。若便结不通，有下症者，竹沥导痰汤加玄明粉下之。
治疫毒不语，先用败毒散散表。若胸前满闷，可用吐法，吐中有发散之义。若肠胃有积热，
脉见沉数，当清凉解毒，然亦不可骤用寒凉。古人用败毒散治疫毒，以天地邪气从外而入，
仍要从毛窍而出，发散则毒得外出，苦寒则毒抑遏。
羌独败毒散 见发热。
导赤各半汤 见腹痛。
凉膈散 见发狂。
承气汤 见便结。
枳桔平胃散 即平胃散加枳壳、桔梗。
栀连二陈汤 即二陈汤加山栀、黄连。
竹沥导痰汤 即导痰汤冲竹沥。
痰结不语，即令有火，亦防寒凉抑遏。此方清火而无凝滞，化痰而不推荡。
清胃汤
升麻 生地 山栀 黄连 甘草
膏粱积热，壅结中焦，则诸窍闭塞而言语不出，故以此方清胃热，治其本也。
不语的症状，内伤和外感都会导致。外感引起的不语，就是噤口伤寒，世间有这种病症，却没有专门的医书论述，所以我补充注释它。内伤引起的不语，有舌体僵硬导致不能说话的情况，神志仍然清醒，嘴巴也能张开，只是舌根强硬，无法言语。有牙关紧闭导致不能说话的情况，舌根本身没有病变，只是牙齿紧咬，嘴巴张不开而不能说话。有神志昏迷导致不能说话的情况，呼唤他不回应，询问他不回答，像喝醉了一样或像在睡觉，因而不能说话。
外感不语的病症有五种情况：初起时恶寒发热，如果未能及时发散表邪出汗，导致邪气不得发越，于是出现烦躁、发热、气喘、口渴，误认为是里热，错误地投用寒凉药剂。这是其中一条，即因寒凉抑制遏阻表邪导致的口噤不语。又有发热日久，热邪未解，应当清火却不清火，有可下之症却失于攻下，导致各种孔窍被热邪壅塞，语言不出，这是里热昏沉的一条。倘若因为恼怒和停食，又兼受风邪侵袭，发热、谵语、口渴但不欲饮水，人们看到他的谵语，误认为是里热，苦寒冰冷的饮料凝结在中焦，于是在谵语之后，转变为不语，这是寒凉抑制遏阻食气的一条。又有体内积聚痰饮，外部感受风寒，又误食生冷食物，这与夹食伤寒不相上下，这是寒凉抑制遏阻痰迷导致不语的一条。以上这些情况，即使大便秘结且有可下之症，也只使用芒硝、玄明粉等药物来消除坚积，不使用大黄这样重浊黏滞的药物。还有时行异气，沿门传染，温毒湿毒，暴热暴寒，侵袭人的毛孔，或者引发疫病，痧毒瓦斯不得向外宣泄，向内扰乱神明，意识昏迷，两手交叉捻弄空物，牙关紧闭不语，这是时疫不语的一条。
治疗表邪引起的不语，如果身体表面尚热，两脚无汗，六脉浮滑数动，或者脉象沉伏模糊，治疗宜用辛温发汗法。冬季三个月北方地区口不干的人，可以使用麻黄汤；如果口干，使用羌活败毒散。其余三个月，不用麻黄，直接用羌活败毒散，佐以石菖蒲、半夏开窍豁痰，禁用寒凉攻下。
治疗里热引起的不语，如果身体表面不热，手足时常有汗，口干唇焦，六脉沉数，宜清其里热，则诸窍通达，可用导赤各半汤、凉膈散；有可下之症的，用承气汤攻下。
治疗食气引起的不语，如果发热胸满，手足或冷或热，嘴唇不焦，口不渴，右脉滑大不数，或者反而沉伏，先用吐法，随后调理气机稍显阻滞的情况，如保和散、枳桔平胃散加石菖蒲、白豆蔻。无汗者加干葛、防风；出现太阳经症状者，加羌活；出现少阳经症状者，加柴胡；如果表邪已散，时时手足有汗，大便结不通，有可下之症的则攻下。
治疗痰迷引起的不语，如果胸膈满闷，恶心呕吐，口不干渴，右关脉滑，按之沉弦不数，治疗宜用二陈导痰汤合平胃散，加枳壳、桔梗。也有使用吐法的，向上涌出痰涎。如果有表邪，加入各经疏散表邪的药物。如果表邪已散，手足时时有汗，用栀连二陈汤冲竹沥热服。如果大便结不通，有可下之症的，用竹沥导痰汤加玄明粉攻下。
治疗疫毒引起的不语，先用败毒散疏散表邪。如果胸前满闷，可用吐法，吐法中蕴含发散的意义。如果肠胃有积热，脉象见沉数，应当清凉解毒，然而也不可骤然使用寒凉。古人用败毒散治疗疫毒，是因为天地邪气从外而入，仍要从毛孔而出，发散则毒邪得以外出，苦寒则毒邪被抑制遏阻。
羌独败毒散 见发热条。
导赤各半汤 见腹痛条。
凉膈散 见发狂条。
承气汤 见便结条。
枳桔平胃散 即平胃散加枳壳、桔梗。
栀连二陈汤 即二陈汤加山栀、黄连。
竹沥导痰汤 即导痰汤冲竹沥。
痰结不语，即使有火，也要防止寒凉抑遏。此方清火而无凝滞，化痰而不推荡。
The symptom of mutism (aphasia) can be caused by both internal injury and external contraction. Mutism due to external contraction is known as Jin Kou Shang Han (Cold Damage with Clenched Jaw), a condition that exists in the world but lacks dedicated medical texts, hence this supplementary annotation. Mutism due to internal injury includes cases where the tongue is stiff; in these cases, consciousness remains clear, the mouth can open, but the root of the tongue is rigid, preventing speech. It also includes cases where the jaw is clenched; here, the tongue itself is not diseased, but the teeth are tightly locked, the mouth cannot open, and speech is impossible. Furthermore, there are cases of mutism due to clouded consciousness; the patient does not respond to calls or questions, appearing intoxicated or asleep, thus unable to speak.
There are five types of mutism due to external contraction:
1. At the onset, with aversion to cold and fever, if the exterior pathogen is not released through sweating, the pathogen fails to vent outward, leading to irritability, fever, panting, and thirst. Misidentifying this as interior heat and incorrectly administering cooling agents constitutes one type: mutism with clenched jaw caused by cold-natured herbs suppressing and obstructing the exterior pathogen.
2. Prolonged fever where the heat pathogen is not resolved; if fire-clearing measures are neglected and purgatives are missed when indicated, heat congestion blocks various orifices, preventing speech. This is one type of mutism due to interior heat and cloudiness.
3. If anger and food stagnation occur alongside an external wind-cold invasion, resulting in fever, delirious speech, and thirst without desire to drink water, observers may mistake delirium for interior heat. Consuming bitter, cold drinks causes congealing in the Middle Jiao. Consequently, mutism follows delirium. This is one type of mutism caused by cold-natured substances suppressing and obstructing food qi.
4. Internal accumulation of phlegm-fluids combined with external wind-cold invasion and mistaken consumption of raw/cold foods resembles Shang Han with Food Stagnation. This is one type of mutism caused by cold-natured substances suppressing and obstructing phlegm confusion. In all the above cases, even if constipation presents with indications for purgation, only Mang Xiao (Natrii Sulfas) and Xuan Ming Fen (Mirabilite) should be used to dissolve hardness, avoiding Da Huang (Rhei Radix et Rhizoma) which is heavy, turbid, and cloying.
5. Epidemic alien qi spreads door-to-door; warm toxins and damp toxins, sudden heat and cold, invade the hair follicles, potentially causing epidemic diseases. Sha toxins fail to vent outward, disturbing the Spirit internally, causing confusion of mind and consciousness, patients crossing hands and picking at empty air, with clenched jaws and mutism. This is one type of mutism due to epidemic toxins.
Treatment for mutism due to exterior pathogens: If the body surface is still hot, feet have no sweat, and the six pulses are floating, slippery, rapid, and active, or if pulses are deep, hidden, and indistinct, treatment should employ acrid-warm diaphoresis. During the three winter months in northern regions where the mouth is not dry, Ma Huang Tang (Ephedra Decoction) may be used; if the mouth is dry, Qiang Huo Bai Du San (Notopterygium Decoction for Resolving Toxins) is used. For the other three months, Ma Huang is omitted, and Qiang Huo Bai Du San is used directly, assisted by Shi Chang Pu (Acori Tatarinowii Rhizoma) and Ban Xia (Pinelliae Rhizoma) to open orifices and resolve phlegm. Cold-natured purgatives are strictly prohibited.
Treatment for mutism due to interior heat: If the body surface is not hot, hands and feet often have sweat, the mouth is dry, lips are scorched, and the six pulses are deep and rapid, interior heat should be cleared so that orifices become unobstructed. Dao Chi Ge Ban Tang (Half-Dao Chi Decoction) or Liang Ge San (Cooling the Diaphragm Powder) may be used. If there are indications for purgation, Cheng Qi Tang (Descending the Qi Decoction) should be administered.
Treatment for mutism due to food/qi stagnation: If there is fever and chest fullness, hands and feet may be cold or hot, lips are not scorched, the mouth is not thirsty, and the right pulse is slippery, large, and not rapid, or conversely deep and hidden, first employ emesis. Subsequently, regulate qi stagnation using formulas such as Bao He San (Preserve Harmony Powder) or Zhi Jie Ping Wei San (Bitter Orange and Platycodon Pingwei Powder) added with Shi Chang Pu and Bai Dou Kou (Amomi Fructus Rotundus). Add Gan Ge (Puerariae Radix) and Fang Feng (Saposhnikoviae Radix) if there is no sweat; add Qiang Huo (Notopterygii Rhizoma et Radix) if Tai Yang symptoms appear; add Chai Hu (Bupleuri Radix) if Shao Yang symptoms appear. If exterior pathogens are dispersed, and hands/feet occasionally sweat with constipation and indications for purgation, administer purgatives.
Treatment for mutism due to phlegm confusion: If there is chest/diaphragm fullness, nausea, vomiting, no mouth dryness/thirst, and the right Guan pulse is slippery, deep, wiry, and not rapid upon pressure, treat with Er Chen Dao Tan Tang (Two-Aged Phlegm-Resolving Decoction) combined with Ping Wei San (Calm the Stomach Powder), adding Zhi Ke (Aurantii Fructus Pericarpium) and Jie Geng (Platycodi Radix). Emesis may also be used to induce upward expulsion of phlegm. If exterior pathogens exist, add herbs for dispersing exterior pathogens from respective meridians. If exterior pathogens are dispersed and hands/feet occasionally sweat, take Zhi Lian Er Chen Tang (Gardenia and Coptis Two-Aged Decoction) mixed with Zhu Li (Bambusa Textilis Sap) while hot. If constipation persists with indications for purgation, use Zhu Li Dao Tan Tang (Phlegm-Resolving Decoction with Bamboo Sap) added with Xuan Ming Fen to purge.
Treatment for mutism due to epidemic toxins: First use Bai Du San (Toxin-Resolving Powder) to disperse the exterior. If there is chest fullness, emesis may be used, as emesis contains the principle of dispersion. If there is accumulated heat in the intestines/stomach with deep, rapid pulses, cool and clear toxicity, but do not abruptly use cold-natured herbs. Ancients used Bai Du San for epidemic toxins because heaven-and-earth pathogenic qi enters from outside and must exit via hair follicles; dispersion allows toxin to exit outward, whereas bitter-cold herbs suppress and obstruct the toxin.
Qiang Du Bai Du San (See Fever)
Dao Chi Ge Ban Tang (See Abdominal Pain)
Liang Ge San (See Mania)
Cheng Qi Tang (See Constipation)
Zhi Jie Ping Wei San: Ping Wei San plus Zhi Ke and Jie Geng.
Zhi Lian Er Chen Tang: Er Chen Tang plus Shan Zhi (Gardeniae Fructus) and Huang Lian (Coptidis Rhizoma).
Zhu Li Dao Tan Tang: Dao Tan Tang mixed with Zhu Li.
For mutism due to phlegm knotting, even if fire is present, one must guard against suppression by cold-natured herbs. This formula clears fire without stagnation and resolves phlegm without violent purging.
Qing Wei Tang (Stomach-Clearing Decoction)
Sheng Ma (Cimicifugae Rhizoma), Sheng Di (Rehmanniae Radix), Shan Zhi (Gardeniae Fructus), Huang Lian (Coptidis Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma)
Accumulated heat from rich/greasy foods congests the Middle Jiao, blocking orifices and preventing speech. Thus, this formula clears stomach heat to treat the root cause.