喑者，邪入阴部也。经云∶邪搏阴则为喑。又云∶邪入于阴，搏则为喑。然有二症∶一曰舌喑，乃中风舌
不转运之类是也；一曰喉喑，乃劳嗽失音之类是也。盖舌喑但舌本不能转运言语，而喉咽音声则如故也；喉喑
但喉中声嘶，而舌本则能转运言语也。
〔丹〕一男子年三十五岁，因连日劳倦，发啖，发为疟疾，医与疟药，三发后变为发热，舌短，言语不辨，
喉间痰吼有声，诊其脉洪数似滑，遂以独参汤加竹沥两蚶壳许，两服后吐膏痰三块，舌本正而言可辨，余证未
退，遂煎人参黄 汤服，半月而诸证皆退，粥食调补两月，方能起立。
人舌短言语不辨，乃痰涎闭塞舌本之脉而然。尝治一中年男子伤寒身热，师与伤寒药五帖，日后变神昏而
喑，遂作体虚有痰治之。人参五钱，黄 、白术、当归、陈皮各一钱，煎汤入竹沥、姜汁饮之。十二日，其舌
始能语得一字。又服之半月，舌渐能转运言语，热除而痊。盖足少阴脉挟舌本，脾足太阴之脉连舌本，手少阴
别系舌本，故此三脉虚则痰涎乘虚闭塞其脉道，而舌不能转运言语也。若此三脉亡血，则舌无血营养而喑。经
云∶刺足少阴脉，重虚出血，为舌难以言。又云∶刺舌下中脉太过血出不止为喑。治当以前方加补血药也。又
尝治一男子五十余岁，嗜酒吐血桶许，后不食，舌不能语，但渴饮水。脉略数，与归、芎、芍、地各一两，术、
参各二两，陈皮一两半，甘草二钱，入竹沥、童便、姜汁，至二十余帖能言。若此三脉，风热中之，则其脉弛
纵，故舌亦弛纵，不能转运而喑。风寒客之，则其脉缩急，故舌强舌卷而喑，治在中风半身不收求之也。
针灸 喑有二治∶
其一取脾。经云∶脾足太阴之脉，是动，则病舌本强，视盛虚热寒陷下取之也。
其二取心。经云∶手太阴之别，名曰通里，去腕一寸五分，别而上行，入于心中，系舌本，虚则不能言，
取之掌后一寸是也。
心脉涩甚为喑。（全文见虚实法。）
〔《素》〕心脉搏坚而长，当病舌卷不能言。（脉要精微论）
喑（失音），是邪气侵入阴分所致。《内经》说：邪气搏结于阴分就会引起失音。又说：邪气进入阴分，搏结就会导致失音。然而有两种症状：一种是舌喑，属于中风导致舌体僵硬、不能灵活转动言语的类型；另一种是喉喑，属于劳嗽导致声音嘶哑或失音的类型。大概舌喑只是舌根不能灵活转动以进行言语，但咽喉发出的声音依然正常；喉喑只是喉咙声音嘶哑，但舌根仍能灵活转动以进行言语。
〔丹溪〕有一个三十五岁的男子，因为连日劳累疲倦，引发寒热往来，发作成疟疾。医生给予治疟的药物，经过三次发作后，病情转变为发热、舌体短缩、言语不清，喉间有痰鸣声。诊察其脉象洪大、数且似乎滑利，于是用独参汤加入约两个蚶壳量的竹沥，服用两次后，吐出三块膏状痰液，舌根恢复灵活，言语能够分辨，其余症状尚未消退，于是煎服人参黄芪汤，半个月后所有症状都退去，再用粥食调养补益两个月，才能起身站立。
人出现舌短缩、言语不清，是由于痰涎闭塞了舌根的经脉所致。我曾治疗一位中年男子，患伤寒身体发热，医生给予伤寒药五帖，日后变为神志昏迷且失音，于是按体质虚弱兼有痰湿来治疗。用人参五钱，黄芪、白术、当归、陈皮各一钱，煎汤加入竹沥、姜汁饮用。十二天后，他的舌头才开始能说出一个字。又继续服用半个月，舌根逐渐能灵活转动言语，热邪去除而痊愈。因为足少阴肾经挟持舌根，足太阴脾经连接舌根，手少阴心经的别络系于舌根，所以这三条经脉虚弱时，痰涎乘虚闭塞脉道，导致舌根不能灵活转动言语。如果这三条经脉亡血，则舌部缺乏血液营养而失音。《内经》说：针刺足少阴脉，若造成严重的虚损并出血，会导致舌头难以言语。又说：针刺舌下中脉太过，导致出血不止，会引起失音。治疗应当用前方加上补血药物。我又曾治疗一位五十多岁的男子，嗜好饮酒导致吐血满桶，后来不吃东西，舌头不能说话，只口渴想喝水。脉象略微数，给予当归、川芎、白芍、熟地黄各一两，白术、人参各二两，陈皮一两半，甘草二钱，加入竹沥、童便、姜汁，服用二十多帖后能够说话。如果这三条经脉受到风热侵袭，则经脉弛缓纵缓，所以舌体也弛缓纵缓，不能灵活转动而失音。风寒客居于经脉，则经脉收缩拘急，所以舌体强硬、卷缩而失音，治疗应参照中风半身不遂的方法来寻求对策。
针灸治疗失音有两种方法：
其一取脾经穴位。《内经》说：足太阴脾经发生病变，会出现舌根强硬的病症，需视其盛虚、热寒、陷下的情况来选取穴位治疗。
其二取心经穴位。《内经》说：手少阴心经的别络，名叫通里穴，位于腕横纹上一寸五分处，分支向上行走，进入心中，系于舌根，经脉虚弱则不能言语，取穴在掌后一寸处（即通里穴）。
心脉涩滞严重会导致失音。（全文见虚实法章节。）
〔《素问》〕心脉搏动坚实而长，应当病发为舌卷缩不能言语。（出自《脉要精微论》）
Yin (aphonia) refers to the condition where pathogenic factors invade the Yin aspect. The Classics state: "When pathogens contend with the Yin, aphonia occurs." It is also stated: "When pathogens enter the Yin and contend, aphonia results." However, there are two types of symptoms: one is She Yin (tongue aphonia), which belongs to the category of wind-stroke causing tongue stiffness and inability to articulate; the other is Hou Yin (throat aphonia), which belongs to the category of chronic cough leading to hoarseness or loss of voice. Generally, She Yin involves only the inability of the root of the tongue to move flexibly for speech, while the sound produced by the throat remains normal; Hou Yin involves only hoarseness of the throat, while the root of the tongue can still move flexibly for speech.
[Danxi] A thirty-five-year-old man, due to continuous days of labor and fatigue, developed alternating chills and fever, manifesting as malaria. The physician administered antimalarial drugs. After three paroxysms, the condition transformed into fever, a short tongue, and indistinct speech, with phlegm-rattling sounds in the throat. His pulse was examined as surging, rapid, and seemingly slippery. Consequently, Dushen Tang (Ginseng Decoction) was prescribed with approximately the amount of Zhu Li (Bamboo Sap) contained in two clam shells. After two doses, three pieces of paste-like phlegm were vomited up. The root of the tongue became flexible, and speech could be distinguished, though other symptoms remained unresolved. Subsequently, Renshen Huangqi Tang (Ginseng and Astragalus Decoction) was decocted and taken. Half a month later, all symptoms subsided. He required two months of dietary supplementation with congee to regain his ability to stand.
A short tongue and indistinct speech result from phlegm-fluids obstructing the meridians at the root of the tongue. I once treated a middle-aged man suffering from Shanghan (Cold Damage) with body heat. After taking five doses of Shanghan medicine provided by another doctor, he developed delirium and aphonia. I treated him based on constitutional deficiency with phlegm. Ren Shen (Ginseng Root) 5 qian, Huang Qi (Astragalus Root), Bai Zhu (Atractylodes Rhizome), Dang Gui (Angelica Sinensis Root), and Chen Pi (Tangerine Peel) each 1 qian were decocted in water, mixed with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice), and drunk. After twelve days, his tongue could finally utter one character. After continuing this for half a month, the root of the tongue gradually regained flexibility for speech, the heat was eliminated, and he recovered. This is because the Foot-Shaoyin Kidney Meridian flanks the root of the tongue, the Foot-Taiyin Spleen Meridian connects to the root of the tongue, and the Branch of the Hand-Shaoyin Heart Meridian ties to the root of the tongue. When these three meridians are deficient, phlegm-fluids take advantage of the deficiency to obstruct the meridian pathways, causing the tongue to lose its flexibility for speech. If blood is lost in these three meridians, the tongue lacks blood nourishment and becomes aphonic. The Classics state: "Needling the Foot-Shaoyin meridian, if it causes severe deficiency and bleeding, leads to difficulty in speaking." It also states: "Excessive needling of the mid-meridian under the tongue, resulting in uncontrolled bleeding, causes aphonia." Treatment should involve adding blood-nourishing herbs to the aforementioned formula. I also treated a man over fifty who, addicted to alcohol, vomited blood filling a bucket. Later, he ceased eating, could not speak with his tongue, and felt only thirst for water. His pulse was slightly rapid. I prescribed Dang Gui (Angelica Sinensis Root), Chuan Xiong (Ligusticum Rhizome), Bai Shao (White Peony Root), and Shu Di Huang (Prepared Rehmannia Root) each 1 liang, Bai Zhu (Atractylodes Rhizome) and Ren Shen (Ginseng Root) each 2 liang, Chen Pi (Tangerine Peel) 1.5 liang, and Gan Cao (Licorice Root) 2 qian, mixed with Zhu Li (Bamboo Sap), Tong Bian (Child's Urine), and Jiang Zhi (Ginger Juice). After more than twenty doses, he could speak. If these three meridians are struck by Wind-Heat, the meridians become flaccid and lax, so the tongue also becomes flaccid and lax, unable to move flexibly, resulting in aphonia. If Wind-Cold invades, the meridians contract and tighten, so the tongue becomes stiff and curled, resulting in aphonia. Treatment should seek methods used for Wind-stroke with hemiplegia.
Acupuncture and Moxibustion treatment for aphonia has two approaches:
First, select Spleen meridian points. The Classics state: "The Foot-Taiyin Spleen Meridian, when disturbed, causes disease manifested as stiffness of the root of the tongue. Select points based on fullness/deficiency, heat/cold, and sinking/depression."
Second, select Heart meridian points. The Classics state: "The Branch of the Hand-Shaoyin Heart Meridian is named Tongli (HT5), located 1.5 cun above the wrist crease. It branches upward, enters the heart, and ties to the root of the tongue. Deficiency results in inability to speak. Select the point 1 cun behind the palm (i.e., Tongli)."
A very choppy Heart merpulse indicates aphonia. (See the chapter on Fullness and Emptiness for the full text.)
[Suwen] A firm and long Heart pulse indicates disease of tongue curling and inability to speak. (From *Essential Instructions for the Pulse Essentials*)