一曰舌喑，乃舌不能转运言语，而喉咙声音如故也。娄全善云∶人舌短语不清，
乃痰涎闭塞舌本之脉而然。盖肾脉挟舌本，脾脉连舌本，心脉别系舌本，三脉有虚
则痰涎入之，脉道闭塞不能运舌矣。以参、蓍、术、归、陈皮、竹沥、姜汁治之，
半月愈。若三脉亡血筋枯缩，亦喑。《经》云∶刺舌下，中脉太过，血出不止，为
喑。又云∶脉涩甚为喑，是也。前方加补血药。又风寒客之则急缩。《经》云∶脉搏
坚而长，（即弦劲意。）病舌卷不能言，是也。大秦艽汤。（见中风。）又热则脉弛
缓，亦不能
运，宜清热。《经》云∶脾脉病，舌本强，视盛虚热寒，陷下取之。又云∶手太阴之
别曰通里，去腕下一寸五分，别而上行，入于心中，系舌本，虚则不能言，取之掌
后一寸。产后败血迷心窍，心气不通，脉亦不行，舌强者，七珍散。妊娠喑者，其
言哑细无音，由肾脉为胎盛阻绝，不能上通舌本也，不必治。
一曰喉喑，但喉中声哑而舌则能转运也。由劳嗽久而然，盖声出于肺，（凡物中空
有窍者能鸣，肺有窍而虚者也。）喉为道路，劳病日久，火刑肺金，金伤，破则不鸣。又火盛
则痰壅，痰塞肺窍，是为金实亦不鸣也。若热壅成疮，肺痈喉烂，则更甚矣。不甚
者声止嘶破，甚则竟不出声也，此属内伤。又有外感风寒入肺，郁热成痰，痰火窒
塞，肺窍不利，声亦嘶哑重浊。又有大声疾呼、讴歌失音者，亦金破之义也。平常
痰火上壅，香附，童便浸透，为末，调服，以疏通上焦。诃子，泡，去核，以消痰、
降火、开音；木通以降火清肺，导热由小肠出；桔梗以利肺气；童便以降火润肺，
故诸方通用之。发声散，开结痰。橘红煎汤，化痰甚捷。寒包热者，解表，郁金、
生地、阿胶、知母、杏仁、桔梗、沙参、蝉蜕、牛蒡子、童便。寒痰结滞，五粉丸。
积血作痛失音，蛤蚧丸。（血为热壅，结滞肺窍。）劳证血枯火盛，青黛、蛤粉，蜜调服。狐
惑声哑，详伤寒。气虚感湿，痰涎凝肺，补虚去湿。风寒郁热，暴咳失音，杏仁煎。
或灸丰隆二穴各三壮、照海二穴各一壮，立效，仍药之。
又有寒客会厌而卒喑，吞吐不利者，生附子去皮、脐，切大片，蜜炙，噙之勿
咽，一云咽津。忌苦寒药，恐成疮，难消难溃。
第一种是舌喑，表现为舌头不能灵活转动以言语，但喉咙发出的声音依然正常。娄全善说：人说话简短且不清楚，是由于痰涎阻塞了舌本的脉络所致。因为肾脉夹持舌本，脾脉连接舌本，心脉分支系于舌本，这三条经脉如果虚弱，痰涎就会侵入，导致脉道闭塞，舌头无法运转。用党参、黄芪、白术、当归、陈皮、竹沥、姜汁来治疗，半个月可痊愈。如果这三条经脉因失血导致筋脉干枯萎缩，也会引起喑哑。《黄帝内经》说：针刺舌下穴位，如果刺中血脉过深，出血不止，会导致喑哑。又说：脉象涩滞严重也会导致喑哑，说的就是这种情况。前面的方剂中加入补血药物即可。另外，风寒邪气侵袭则导致舌头紧急收缩。《黄帝内经》说：脉搏坚硬而长（即弦劲之意），病证为舌卷缩不能言语，说的就是这种情况。大秦艽汤。（见中风章节。）如果是热邪导致脉弛缓，也不能运舌，适宜清热。《黄帝内经》说：脾脉有病，舌本僵硬，观察其盛虚寒热的情况，采用陷下取穴法治疗。又说：手太阴肺经的别络叫做通里，位于腕横纹上一寸五分处，分支向上行走，进入心中，系连舌本，如果该经虚弱则不能言语，应取掌后一寸处的穴位。产后败血迷蒙心窍，心气不通，脉道也不行，导致舌头僵硬的，用七珍散。妊娠期间出现喑哑的人，说话声音细弱无声，是因为肾脉被胎气盛满阻绝，不能上通至舌本，不需要治疗。
第二种是喉喑，仅表现为喉咙声音嘶哑，而舌头能够灵活转动。这是由于长期劳嗽所致，声音出于肺脏（大凡物体中空有孔窍的就能发声，肺脏是有孔窍且虚空的器官）。喉咙是气息通行的道路，劳损性疾病日久，火邪刑克肺金，肺金受伤，破损则不能发声。另外，火邪旺盛则痰液壅塞，痰堵塞肺窍，这也是“金实不鸣”的情况。如果热邪壅盛形成疮疡，肺痈喉烂，情况就更严重了。不严重的只是声音嘶哑破裂，严重的竟然发不出声音，这属于内伤。又有外感风寒入肺，郁热生痰，痰火窒塞，肺窍不利，声音也嘶哑重浊。又有大声呼喊、歌唱导致失音的，也属于“金破”的道理。平常痰火上壅，可用香附，用童便浸透，研为末，调服，以疏通上焦。诃子，泡制，去核，用以消痰、降火、开音；木通用以降火清肺，引导热邪从小肠排出；桔梗用以利肺气；童便用以降火润肺，所以各方通用这些药物。发声散，用于开通结聚之痰。橘红煎汤，化痰非常快捷。寒包热者，解表，用郁金、生地、阿胶、知母、杏仁、桔梗、沙参、蝉蜕、牛蒡子、童便。寒痰结滞，用五粉丸。积血作痛导致失音，用蛤蚧丸。（血为热邪壅遏，结滞于肺窍。）劳损证血枯火盛，用青黛、蛤粉，蜂蜜调服。狐惑病声音嘶哑，详见伤寒章节。气虚感受湿邪，痰涎凝滞于肺，补虚祛湿。风寒郁热，暴咳失音，用杏仁煎。或者灸丰隆二穴各三壮、照海二穴各一壮，立即见效，同时配合药物治疗。
又有寒邪客居会厌导致突然喑哑，吞咽吐纳不利的，用生附子去皮和脐，切成大片，用蜜炙烤，含在口中不要咽下，另一种说法是咽下津液。忌用苦寒药物，恐怕形成疮疡，难以消散溃破。
The first type is *She Yin* (tongue aphonia), characterized by the inability of the tongue to move and articulate speech, while the voice from the throat remains normal. Lou Quanshan stated: When a person speaks briefly and unclearly, it is caused by phlegm-fluid obstructing the meridians at the root of the tongue. This is because the Kidney Meridian flanks the root of the tongue, the Spleen Meridian connects to the root of the tongue, and the Heart Meridian branches to tie the root of the tongue. If these three meridians are deficient, phlegm-fluid enters, blocking the vessel pathways and preventing the tongue from moving. It can be treated with Dangshen (Codonopsis Root), Huangqi (Astragalus Root), Baizhu (Atractylodes Rhizome), Danggui (Angelica Sinensis Root), Chenpi (Tangerine Peel), Zhuli (Bamboo Sap), and Jiangzhi (Ginger Juice), resulting in recovery within half a month. If blood loss leads to dryness and atrophy of the sinews in these three meridians, aphonia also occurs. The *Classic* states: "Needling below the tongue; if the vessel is pierced too deeply and bleeding does not stop, aphonia results." It also states: "Severely choppy pulse indicates aphonia," which refers to this condition. Adding blood-nourishing herbs to the aforementioned formula is appropriate. Furthermore, invasion by Wind-Cold causes the tongue to contract urgently. The *Classic* states: "A firm and long pulse (meaning wiry and tense) indicates disease where the tongue curls and cannot speak," referring to this scenario. Da Qin Jiao Tang (Great Notopterygia Decoction). (See Stroke chapter.) If Heat causes the vessels to become flaccid and slow, the tongue also cannot move; clearing Heat is suitable. The *Classic* states: "When the Spleen Meridian is diseased, the root of the tongue becomes stiff; observe its excess or deficiency, heat or cold, and apply the 'sunken point' needling method." It also states: "The divergent branch of the Hand-Taiyin [Lung] Meridian is called Tongli; located 1.5 cun above the wrist crease, it branches upward, enters the heart, and ties the root of the tongue. Deficiency leads to inability to speak; needle the point one cun behind the palm." In postpartum cases, residual blood confuses the orifices of the Heart, Heart Qi fails to flow, and the vessels do not circulate, leading to a stiff tongue; Qizhen San (Seven Treasures Powder) is used. For aphonia during pregnancy, the voice is hoarse, thin, and soundless because the Kidney Meridian is blocked by the fullness of the fetus, preventing connection to the root of the tongue; no treatment is necessary.
The second type is *Hou Yin* (laryngeal aphonia), characterized solely by a hoarse voice from the throat, while the tongue moves freely. This arises from prolonged labor-induced coughing. Sound originates from the Lung (generally, hollow objects with orifices produce sound; the Lung has orifices and is void). The throat is the pathway for breath. In chronic labor diseases, Fire insults Lung Metal; when Metal is damaged and broken, it cannot resonate. Additionally, excessive Fire causes Phlegm congestion; Phlegm blocks the Lung orifices, constituting "Metal being solid and thus not resonating" (*Jin Shi Bu Ming*). If Heat congestion forms sores, such as Lung Abscess and throat ulceration, the condition is even more severe. Mild cases present only with hoarseness and cracking of the voice; severe cases result in complete loss of voice, belonging to internal injury. Another cause is external Wind-Cold invading the Lung, generating constrained Heat and Phlegm; Phlegm-Fire obstructs and Lung orifices are unsmooth, causing hoarse and heavy voice. Also, loud shouting or singing leading to aphonia falls under the principle of "broken Metal." For common Phlegm-Fire congestion ascending, Xiangfu (Cyperi Rhizoma), soaked thoroughly in Tongbian (Child's Urine), ground into powder, and taken with water, is used to unblock the Upper Jiao. Hezi (Chebula Fruit), prepared and pitted, eliminates Phlegm, descends Fire, and opens the voice; Mutong (Akebia Caulis) descends Fire and clears the Lung, guiding Heat out via the Small Intestine; Jiegeng (Platycodon Root) benefits Lung Qi; Tongbian descends Fire and moistens the Lung; thus, these are commonly used in various formulas. Fasheng San (Voice-Generating Powder) resolves knotted Phlegm. Ju Hong (Exocarpium Citri Reticulatae) decocted in water resolves Phlegm very swiftly. For Cold enveloping Heat, release the exterior using Yujin (Curcuma Radix), Shengdi (Rehmannia Root), Ejiao (Donkey-Hide Gelatin), Zhimu (Anemarrhena Rhizome), Xingren (Apricot Seed), Jiegeng, Shashen (Glehnia Root), Chantui (Cicada Slough), Niubangzi (Arctii Fructus), and Tongbian. For Cold-Phlegm stagnation, Wufen Wan (Five Powders Pill) is used. For pain and aphonia due to accumulated Blood, Gejie Wan (Gecko Pill) is indicated (Blood congested by Heat, stagnating in Lung orifices). For consumptive disease with Blood depletion and excessive Fire, Qingdai (Indigo Naturalis) and Gefen (Concha Meretricis) mixed with Honey are taken. For Huhe Disease (aphthous stomatitis/genital ulcers) with hoarse voice, see the Shanghan chapter. For Qi deficiency with Dampness invasion and Phlegm-fluid coagulating in the Lung, tonify deficiency and eliminate Dampness. For Wind-Cold with constrained Heat and sudden cough with aphonia, Xingren Jian (Apricot Decoction) is used. Alternatively, moxa on Fenglong (ST40) twice, three moxibustions each, and Zhaohai (KI6) twice, one moxibustion each, yields immediate effect, accompanied by herbal medicine.
There is also sudden aphonia and difficulty in swallowing and breathing due to Cold pathogen lodging in the Huiyan (epiglottis); raw Fuzi (Aconite Lateralis Radix Preparata - note: text says raw, implying processed carefully or specific context, but standard is prepared), peeled of skin and umbilicus, cut into large slices, honey-roasted, held in the mouth without swallowing (another version says swallow saliva). Bitter-Cold herbs are contraindicated, fearing the formation of sores that are difficult to dissipate or suppurate.