经云∶舌者音声之机也。喉者音声之关也。小儿卒然无音者，乃寒气客于会厌，则厌不能发
，发不能下，致其门阖不致，故无音也。若咽喉音声如故，而舌不能转运言语，则为舌喑，
此乃风冷之邪，客于脾之络，或中于舌下廉泉穴所致也。盖舌乃心之苗，心发声为言，风邪
阻塞其经络，故舌不能转运也。若舌不能转运言语，而喉中声嘶者，则为喉喑。此亦为风冷
所客，使气道不通，故声不得发，而喉无音也。然或风痰阻塞，或因心惊气虚，或因脾之脉
络受风，或因风痰滞于脾之络，或因脾气不足，或胃中清气不升，皆足以致喑。大抵此症，
亦有禀父肾气不足不能言者；有乳母五志之火，遗儿熏闭清道不能言者；或儿病津液耗损会
厌干涸不能言者；或肾气不充，虚火上炎，伤肺不能言者；有惊风中风不能言者。若遗热与
津液耗损者，用七味白术散。清气不升者，用补中益气汤。禀肾不足与虚火伤肺者，用六味
地黄丸。若仰首咳嗽，肢体羸瘦，目白睛多，或兼解颅呵欠切牙等症，悉属肾虚，非用地黄
丸，不能救也。
治验
一小儿面色目睛多白，两足胫常热，所患之症，悉属肾虚。毕姻后，唾痰口干，头晕久泻，
忽然失音。先君云∶此亦肾虚也。用补中益气汤，八味、四神二丸，补之寻愈。
一小儿亦面色目睛多白，大便频泄，侵晨作泻，肌体骨立，食少唾痰。先君谓肾气不足之故
。不信，后加头晕声喑，足胫逆冷，复请治，仍欲祛痰。又云∶头晕声喑，中气不能上升也
，足胫逆冷，阳气不能充达也。遂用补中益气汤及四神、八味二丸，以补命门之火而愈。
一小儿患泄泻，声音不亮。杂用清热等剂，声音如哑，饮食少思，去后多在侵晨。朝用地黄
丸加五味子，夕用补中益气汤，其泻顿止，却专服前丸，不两月声亮而愈。
一小儿目睛白多黑少，吐泻后喉喑口渴，大便不实，朝夕悉服地黄丸而痊。后患泻，其喉复
喑，仍服前丸遂愈。
一小儿十一岁，形羸骨立，面皎口干，白睛多而黑睛少，不能顿言，用六味地黄丸、补中益
气汤，其形渐充，年余而能言。
一小儿解囟不言，其形属肾虚而兼疳症。先用六味地黄丸以补肾水；又用补中益气汤以补肺
金，半载渐愈，年余，疳病痊而能言。
一小儿喉音不亮，至十九岁，咽仍不响，面色赤白，睛多畏明。毕姻后，头觉胀，视物皆大
，作渴饮冷，亦用前二药，喜其远帏幕、戒浓味，二年诸症悉愈，其声响亮。
世传通关散 治惊风愈后，声哑不能言者。以大南星一个，炮为末，每服二分，猪胆汁调下
，便能言语。
治要茯苓补心汤 治心气不足，善悲愁怒，衄血面黄，五心烦热，或咽喉痛，舌本作强。
茯苓（四钱） 桂心 甘草（炒。各三分） 紫石英（ ） 人参（各一钱） 大枣（二枚） 麦门冬（去心，一
钱
上水煎服。
导痰汤
半夏 南星 茯苓 陈皮（炒） 枳实（炒） 甘草（炒）
上姜水煎服。
防风散 治脾脏中风，多汗恶风，身体怠惰，四肢不能动，色微黄，不嗜食，舌强语涩，口
眼斜，或肌肤不仁，腹膨心烦，翕翕发热，神思如醉，其脉浮缓，胸满痰涎，志意昏浊。
独活（一钱五分） 防风 茯神（去木） 人参 附子（炮，去皮脐） 前胡 沙参 半夏（汤洗七次） 黄
（炒） 旋复花 羚羊角（镑） 甘草
上水煎服。
半夏汤
半夏 桂枝 甘草（各等分）
上水煎，细细呷之。
鸡头丸 治小儿诸病后不能语。
雄鸡头（一个，炙） 鸣蝉（三个，炙焦） 大黄（锦纹者湿纸裹， ） 甘草（炙，一两） 木通 人参（各
半两） 当归 黄 川芎 远志（去心，姜汁制，略炒） 麦门冬（去心焙。各三分）
上为末，炼蜜丸，小豆大，平旦米饮下五丸，日三服，儿大者加之，久服取效。
射干汤 治夏秋暴寒喘咳，喉哑失声，喉中如梗。
半夏（五钱，汤泡） 生姜（四钱，泡） 杏仁（三钱，去双仁，皮尖） 射干 甘草（炙） 紫菀 肉桂
枳实（炒） 当归 橘皮 独活 麻黄（去节泡。各二钱）
上每二三钱，水煎服。
菖蒲丸（方见语迟）
钱氏全蝎散（方见偏风噤）
地黄丸（方见肾脏）
七味白术散（方见积痛）
补中益气汤（方见虚羸）
二陈汤（方见吐秽）
《黄帝内经》说：舌是发出声音的关键机关。喉是控制声音的门户。小儿突然失音，是因为寒气侵袭会厌（位于喉头上方的软骨瓣），导致会厌开合不利，启闭失灵，所以发不出声音。如果咽喉发声如常，但舌头不能灵活转动以言语，这称为“舌喑”，这是风冷邪气侵袭脾经的络脉，或者中于舌下的廉泉穴所致。因为舌是心的外候，心主发声为言，风邪阻塞经络，所以舌头不能灵活转动。如果舌头不能灵活转动言语，但喉咙声音嘶哑，这称为“喉喑”。这也是因为风冷邪气侵袭，使气道不通畅，所以声音发不出来，喉咙无声。然而，有时因风痰阻塞，或因受惊导致气虚，或因脾经络脉受风，或因风痰停滞在脾络，或因脾气不足，或胃中清气不升，都足以导致失音。大抵这类病症，也有禀受父亲肾气不足而不能说话的；有乳母五志之火，遗留给婴儿熏蒸闭塞清道而不能说话的；或婴儿患病津液耗损，会厌干涸而不能说话的；或肾气不充盛，虚火上炎，损伤肺脏而不能说话的；有因惊风、中风而不能说话的。如果是余热未清与津液耗损者，使用七味白术散。清气不升者，使用补中益气汤。禀赋肾不足与虚火伤肺者，使用六味地黄丸。如果出现仰头咳嗽，肢体消瘦，眼白多黑少，或兼有囟门迟闭、呵欠、咬牙等症状，都属于肾虚，非用地黄丸，不能治愈。
治验记录：
一个小孩面色和眼珠白多黑少，两小腿经常发热，所患症状都属于肾虚。结婚后，唾痰口干，头晕，长期腹泻，突然失音。家父说：这也是肾虚。使用补中益气汤，以及八味丸、四神丸，补益后很快痊愈。
另一个小孩也是面色和眼珠白多黑少，大便频繁泄泻，清晨作泻，身体瘦骨嶙峋，食少唾痰。家父说是肾气不足的缘故。家属不信，后来出现头晕、声音嘶哑，小腿逆冷，再次请求治疗，仍想祛痰。又说：头晕声哑，是中气不能上升；小腿逆冷，是阳气不能充达。于是使用补中益气汤及四神丸、八味丸，以补命门之火而痊愈。
一个小孩患泄泻，声音不响亮。杂用清热等药剂，声音变得像哑巴，饮食减少，多在清晨排便。早晨服用加五味子的地黄丸，晚上服用补中益气汤，腹泻立刻停止，之后专门服用前面的地黄丸，不到两个月声音变亮而痊愈。
一个小孩眼白多黑少，吐泻后喉咙失音口渴，大便不成形，早晚都服用地黄丸而痊愈。后来患腹泻，喉咙又失音，仍然服用前面的药丸便好了。
一个十一岁的小孩，形体消瘦，瘦骨嶙峋，面色皎洁口干，眼白多黑少，不能立即说话，使用六味地黄丸、补中益气汤，形体逐渐丰满，一年多后能说话。
一个小孩囟门未闭合且不言语，其形体属于肾虚兼疳症。先用六味地黄丸补肾水；又用补中益气汤补肺金，半年逐渐好转，一年多后，疳病痊愈并能说话。
一个小孩喉咙声音不亮，到十九岁，咽部仍不响，面色赤白，眼珠多且畏光。结婚后，头部觉得胀，视物皆大，口渴喜冷饮，也使用前两种药，庆幸他远离帷幔（指房事节制）、戒除浓味食物，两年后诸症悉愈，声音响亮。
世间流传的通关散，治疗惊风痊愈后，声音嘶哑不能说话者。用一个大南星，炮制为末，每次服用二分，猪胆汁调服下，便能说话。
治要方剂：
茯苓补心汤：治疗心气不足，容易悲伤愁怒，鼻出血面色黄，五心烦热，或咽喉痛，舌体僵硬。
茯苓（四钱） 桂心 甘草（炒。各三分） 紫石英（适量） 人参（各一钱） 大枣（二枚） 麦门冬（去心，一钱）
以上用水煎服。
导痰汤：
半夏 南星 茯苓 陈皮（炒） 枳实（炒） 甘草（炒）
以上用姜水煎服。
防风散：治疗脾脏中风，多汗恶风，身体怠惰，四肢不能动，颜色微黄，不爱吃东西，舌强语涩，口眼歪斜，或肌肤麻木不仁，腹部膨隆心烦，微微发热，神思昏沉如醉，脉象浮缓，胸满痰涎，意志昏浊。
独活（一钱五分） 防风 茯神（去木） 人参 附子（炮，去皮脐） 前胡 沙参 半夏（汤洗七次） 黄芪（炒） 旋复花 羚羊角（镑） 甘草
以上用水煎服。
鸡头丸：治疗小儿各种疾病后不能说话。
雄鸡头（一个，炙烤） 蝉蜕（三个，炙焦） 大黄（锦纹者湿纸包裹，煨） 甘草（炙，一两） 木通 人参（各半两） 当归 黄芪 川芎 远志（去心，姜汁制，略炒） 麦门冬（去心焙。各三分）
以上研为末，炼蜜为丸，如小豆大，清晨米饮送服五丸，每日三次，年龄大的儿童增加剂量，久服见效。
射干汤：治疗夏秋暴寒喘咳，喉咙哑失声，喉中如有梗塞感。
半夏（五钱，汤泡） 生姜（四钱，泡） 杏仁（三钱，去双仁，皮尖） 射干 甘草（炙） 紫菀 肉桂 枳实（炒） 当归 橘皮 独活 麻黄（去节泡。各二钱）
以上每次取二三钱，用水煎服。
菖蒲丸（方见语迟）
钱氏全蝎散（方见偏风噤）
地黄丸（方见肾脏）
七味白术散（方见积痛）
补中益气汤（方见虚羸）
二陈汤（方见吐秽）
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The tongue is the mechanism of voice production. The larynx is the gate of voice control. Sudden loss of voice in children occurs when cold pathogenic factors invade the epiglottis (a cartilaginous flap at the root of the tongue), causing dysfunction in its opening and closing, leading to failure of the glottic aperture to close properly, thus resulting in aphonia. If the voice from the throat remains normal but the tongue cannot move flexibly for speech, this is termed "tongue aphonia" (She Yin). This is caused by wind-cold pathogens invading the collateral vessels of the Spleen meridian or affecting the Lianquan acupoint under the tongue. Since the tongue is the sprout of the Heart, and the Heart governs vocalization into speech, wind pathogens blocking the meridians cause the tongue to lose flexibility. If the tongue cannot move flexibly for speech but the throat voice is hoarse, this is termed "laryngeal aphonia" (Hou Yin). This is also caused by wind-cold invasion obstructing the airway, preventing sound emission and resulting in a silent throat. However, aphonia can also result from wind-phlegm obstruction, qi deficiency due to fright, wind invasion of the Spleen collateral vessels, stagnation of wind-phlegm in the Spleen collaterals, Spleen qi deficiency, or failure of clear qi from the Stomach to ascend. Generally, this condition may stem from congenital insufficiency of Kidney qi inherited from the father; heat from the mother's five emotions passing to the infant and steaming/blocking the clear pathways; depletion of body fluids due to illness causing dryness of the epiglottis; insufficient Kidney qi with deficient fire flaming upward damaging the Lung; or aphonia following convulsions or stroke. For cases involving residual heat and fluid depletion, use Qiwei Baizhu San (Seven-Ingredient White Atractylodes Macrocephala Powder). For failure of clear qi to ascend, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For congenital Kidney insufficiency and deficient fire damaging the Lung, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If symptoms include coughing with the head tilted back, emaciation, eyes with excessive white sclera, or associated signs such as delayed fontanelle closure, yawning, and teeth grinding, these all indicate Kidney deficiency, which cannot be cured without Dihuang Wan (Rehmannia Pill).
Clinical Cases:
A child presented with a pale complexion and eyes with excessive white sclera, and frequent heat in the lower legs. All symptoms indicated Kidney deficiency. After marriage, the patient experienced sputum production, dry mouth, dizziness, chronic diarrhea, and sudden aphonia. My father stated: "This is also Kidney deficiency." Treatment with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), combined with Bawei Wan (Eight-Ingredient Pill) and Sishen Wan (Four-Spirit Pill), led to rapid recovery through tonification.
Another child presented with a pale complexion, excessive white sclera, frequent loose stools especially in the early morning, severe emaciation ("skin and bones"), poor appetite, and sputum production. My father attributed this to insufficient Kidney qi. The family did not believe this. Later, the patient developed dizziness, hoarseness, and cold extremities below the knees. Upon reconsultation, they still desired phlegm-resolving treatment. I explained: "Dizziness and hoarseness indicate that middle qi fails to ascend; cold extremities indicate yang qi fails to reach the periphery." Consequently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) along with Sishen Wan (Four-Spirit Pill) and Bawei Wan (Eight-Ingredient Pill) were used to tonify the Fire of the Gate of Vitality (Mingmen), resulting in cure.
A child suffered from diarrhea with a weak voice. Miscellaneous heat-clearing agents were used, rendering the voice aphonic, reducing appetite, with stools occurring mostly in the early morning. In the morning, Dihuang Wan (Rehmannia Pill) added with Wuweizi (Schisandra Fruit) was administered; in the evening, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was given. The diarrhea stopped immediately. Subsequently, only the former pill was taken, and within two months, the voice became clear and the patient recovered.
A child with excessive white sclera experienced laryngeal aphonia and thirst after vomiting and diarrhea, with unformed stools. Taking Dihuang Wan (Rehmannia Pill) both morning and night led to recovery. When diarrhea recurred later, causing recurrent laryngeal aphonia, taking the same pill again resulted in cure.
An eleven-year-old child was emaciated with visible ribs, had a bright complexion with dry mouth, excessive white sclera, and could not speak immediately. Treatment with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) gradually restored physical strength, and the child could speak after more than a year.
A child with an unclosed fontanelle and mutism presented with signs of Kidney deficiency complicated by malnutrition syndrome (Gan disease). Initially, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was used to tonify Kidney water; subsequently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used to tonify Lung metal. Gradual improvement occurred over half a year, and after more than a year, the malnutrition resolved and speech returned.
A child had a hoarse voice that persisted until age nineteen, with no resonance in the throat. The complexion was red and white, with excessive white sclera and photophobia. After marriage, the patient complained of head distension, macropsia (objects appearing larger), thirst, and preference for cold drinks. The previous two formulas were used. Fortunately, the patient abstained from sexual activity and rich flavors. After two years, all symptoms resolved, and the voice became clear.
The widely circulated Tongguan San (Pass-the-Gate Powder) treats aphonia following recovery from convulsions. One large Tiantan (Arisaema Cum Bile) is processed into powder. Each dose is 2 fen, mixed with pig bile and taken orally, restoring speech.
Essential Treatments:
Fuling Buxin Tang (Poria Tonifying the Heart Decoction): Treats Heart qi deficiency, prone to sadness and anger, epistaxis, yellow complexion, five-palm heat, or sore throat, and stiff tongue.
Fuling (Poria) (4 qian), Guixin (Cinnamon Bark), Gancao (Licorice Root, stir-fried) (each 3 fen), Zhi Shiyuan (Fluorite) (appropriate amount), Renshen (Ginseng Root) (each 1 qian), Dazao (Jujube Fruit) (2 pieces), Maidong (Ophiopogon Tuber, heart removed) (1 qian).
Decoct with water and take orally.
Daotan Tang (Phlegm-Resolving Decoction):
Banxia (Pinellia Tuber), Nanxing (Arisaema Rhizome), Fuling (Poria), Chenpi (Citrus Reticulata Peel, stir-fried), Zhishi (Immature Bitter Orange, stir-fried), Gancao (Licorice Root, stir-fried).
Decoct with ginger water and take orally.
Fangfeng San (Saposhnikovia Powder): Treats Wind-stroke of the Spleen organ, characterized by profuse sweating and aversion to wind, bodily lethargy, immobility of limbs, slightly yellow complexion, anorexia, stiff tongue with slurred speech, deviation of mouth and eyes, numbness of skin and muscles, abdominal distension with irritability, slight fever, mental confusion resembling intoxication, floating and moderate pulse, chest fullness with phlegm-saliva, and turbid will.
Duhuo (Angelica Pubescens Root) (1.5 qian), Fangfeng (Saposhnikovia Root), Fushen (Poria with Hostwood Removed), Renshen (Ginseng Root), Fuzi (Prepared Aconite Root, peeled and de-navelled), Qianhu (Peucedani Radix), Shashen (Glehniae Radix), Banxia (Pinellia Tuber, washed seven times in hot water), Huangqi (Astragalus Root, stir-fried), Xuanjinhua (Inula Flower), Lingyangjiao (Antelope Horn, shaved), Gancao (Licorice Root).
Decoct with water and take orally.
Banxia Tang (Pinellia Decoction):
Banxia (Pinellia Tuber), Guizhi (Cinnamon Twig), Gancao (Licorice Root) (equal parts).
Decoct with water and sip slowly.
Jitou Wan (Rooster Head Pill): Treats inability to speak after various pediatric illnesses.
Xiongjitou (Male Rooster Head, roasted), Mingchan (Cicada Slough, roasted until scorched), Dahuang (Rhubarb Root, wrapped in wet paper and baked), Gancao (Licorice Root, roasted, 1 liang), Mutong (Akebia Stem), Renshen (Ginseng Root) (each 0.5 liang), Danggui (Angelica Sinensis Root), Huangqi (Astragalus Root), Chuanxiong (Ligusticum Rhizome), Yuanzhi (Polygalae Radix, heart removed, processed with ginger juice and lightly roasted), Maidong (Ophiopogon Tuber, heart removed and dried) (each 3 fen).
Grind into powder, mix with refined honey to form pills the size of small beans. Take 5 pills with rice drink at dawn, three times daily. Increase dosage for older children. Long-term use yields results.
Shegan Tang (Belamcanda Decoction): Treats acute cold-induced wheezing and cough in summer and autumn, hoarse voice, aphonia, and sensation of obstruction in the throat.
Banxia (Pinellia Tuber, 5 qian, soaked in hot water), Shengjiang (Fresh Ginger, 4 qian, soaked), Xingren (Apricot Seed, 3 qian, remove double kernels and skins/spines), Shegan (Belamcanda Rhizome), Gancao (Licorice Root, roasted), Ziwan (Aster Root), Rougui (Cinnamon Bark), Zhishi (Immature Bitter Orange, stir-fried), Danggui (Angelica Sinensis Root), Jupi (Tangerine Peel), Duhuo (Angelica Pubescens Root), Mahuang (Ephedra Stem, nodes removed and soaked) (each 2 qian).
Take 2-3 qian each time, decoct with water and take orally.
Changpu Wan (Acorus Pill) (See formula for Delayed Speech)
Qianshi Quanxie San (Qian's Scorpion Powder) (See formula for Hemiplegia and Trismus)
Dihuang Wan (Rehmannia Pill) (See formula for Kidney Disease)
Qiwei Baizhu San (Seven-Ingredient White Atractylodes Macrocephala Powder) (See formula for Accumulation Pain)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See formula for Emaciation)
Erchen Tang (Two-Aged Decoction) (See formula for Vomiting Impurities)