张景岳曰∶声音出于脏气，脏实则声宏，脏虚则声怯。然舌为心苗，心病则舌不能转，此心在声音之主
也。声由气而发，肺病则气夺，此肺为声音之户也。肾藏精，精化气，阴虚则无气，此肾为声音之根也。病
虽由五脏，而三者实为之主。
然人以肾为根，元气所由生，使肾一衰，则元阳寝弱。声音之标在心肺，声音之本则在肾。经云∶内夺
而厥，则为喑痱。此肾虚也。肾为声音之根，信非谬矣。
喑病分虚实∶实者病在标，风寒火邪，气逆之闭，易治
之；若其色欲伤肾，忧思伤心，惊恐伤胆，饥馁疲劳伤脾，非各求其属，而大补元气，安望其嘶败者复
完，而残损者复振乎？此虚为难治矣。
然犹有难易者，暂而近者易，渐久者难；脉缓滑者易，细数者难；素无损伤者易，积有劳怯者难。以
及病患久嗽声哑，肺肾俱败，但宜补肺气，滋肾水，养金润燥，其声自出。或略加诃子、百药煎之类，
兼收敛以治其标。若见假热痰盛，再用寒凉消耗，鲜不危矣。
癫、痫，狂三者，虽有轻重之分，实因痰火郁悒，心神耗散，气虚不能胜敌，痰火猖狂犯上之所致也。
正《内经》所谓主不明则十二官危，使道闭塞不通，形乃大伤是也。
夫人事混浊，神识不清，语言颠倒，曰癫。一云失心风。有狂之意，不如狂之甚。属心血不足。乃求望
高远，所愿不遂者有之。心脉及两寸必虚数，或洪大无力。当从心清，治心舒郁养神，石菖蒲、香附子、
川芎、当归、茯神、栀子、贝母、麦冬、橘红、柏仁之类。痰多者先以涌剂，去其痰后，服安神药。若心
经蓄热，发作不常，或时烦躁，鼻眼觉有热气，不能自由，有类心风，稍定复作，清心汤加石菖蒲。思虑
伤心而得者，酒调天门冬、地黄膏，多服乃效。
妄歌妄笑，登高逾垣，骂詈不避亲疏，曰狂，俗谓之风子是也。与伤寒热极发狂，同属痰火内盛。
有乐极而成，有怒极而成。寻火寻痰，分多少而治。牛黄泻心汤、滚痰丸，极对症方。须断浓味、酒肉、面
食、姜蒜、煎炒。《内经》所谓夺其食乃已，即此义也。此心火独盛，阳气有余，神不守舍，
痰火壅盛而然耳。
亦有水涸相火独旺而致者，忽然僵仆作兽声，手足劲强，厥不知人，曰痫，俗名羊头风是也。方
书以五畜分五脏。丹溪断其为痰，千古灼见。大法行痰为主，用黄连、胆星、栝蒌仁。如内有热者，用凉
药以清其心。有痰气实者，可用吐法。虚实在脉上辨，不可以肥瘦取。若虚而不能吐下者，用人参、菖蒲、
茯苓、麦冬、全蝎、竹沥之类。
大抵癫为心血不足，狂为痰火实盛，痫病独生乎痰，因火动之所作也。治法∶痫宜乎吐，狂宜乎下，
癫则安神养血，兼清痰火。虽然，此病神脱目瞪，如愚如痴者，纵仓扁复生，亦末如之何也。
又有小儿胎痫，胎元之始，当母受惊之邪，出腹后一二岁始发，或八九岁发之，必待复感之邪，与
所感母腹之邪相搏而后作。然小儿质弱，目瞪不过岁月，难出成人之年。盖肾间生命之气虚而不复，故不复
寿也。
张景岳说：声音源于脏腑之气，脏腑充实则声音洪亮，脏腑虚弱则声音怯弱。然而舌是心的外候，心患病则舌体转动不灵，这说明心在声音的产生中起主导作用。声音由气发动，肺患病则气受损，这说明肺是声音发出的门户。肾藏精，精能化气，阴虚则无气可生，这说明肾是声音的根本。疾病虽然涉及五脏，但心、肺、肾三者实际上是主导者。
然而人以肾为根本，元气由此而生，如果肾气一旦衰弱，元阳就会逐渐减弱。声音的表象（标）在心肺，声音的根本（本）则在肾。医经说：“内里精气亏损而厥逆，就会导致失音和肢体瘫痪。”这是肾虚的表现。肾作为声音的根本，确实不是谬论。
失音病分为虚证和实证：实证病位在标，由风寒或火邪导致气机逆乱闭塞所致，容易治疗；如果是因房事过度损伤肾脏，忧愁思虑损伤心脏，惊恐损伤胆腑，饥饿疲劳损伤脾脏，如果不分别求其病因所属，而大补元气，怎能使嘶哑败坏的声音恢复完整，使残损的身体重新振作呢？这就是虚证难以治疗的原因。
然而其中还有难易之分：发病时间短且病情近的容易治疗，病程缓慢且久远的难治；脉象缓滑的容易治疗，脉象细数的难治；素来没有损伤的容易治疗，长期患有劳损虚怯病的难治。至于病人长期咳嗽导致声音嘶哑，肺肾俱败的情况，只宜补益肺气，滋补肾水，养肺金以润燥，声音自然能发出。或者稍微加用诃子、百药煎之类的药物，兼用收敛之法以治其标。如果见到假热且痰多旺盛，再用寒凉药物消耗正气，很少有不陷入危境的。
癫、痫、狂三种病，虽然有轻重之分，实际上都是因为痰火郁结，心神耗散，气虚不能抵御邪气，导致痰火猖狂上犯所致。这正是《内经》所说的“君主之官不明则十二官危，使道闭塞不通，形体受到严重损害”的道理。
人神志昏乱，神识不清，言语颠倒错乱，称为癫。另一种说法叫失心风。有狂的意思，但不如狂病严重。属于心血不足。多见于追求高远目标而愿望未能实现的人。其心脉及两手寸脉必然虚数，或洪大无力。应当从清心入手，治疗以舒心解郁、养神为主，可用石菖蒲、香附子、川芎、当归、茯神、栀子、贝母、麦冬、橘红、柏子仁等药物。痰多的先用涌吐剂，去除痰涎后，再服用安神药物。如果是心经蓄积热邪，发作不定时，有时烦躁，鼻眼感觉有热气，无法自控，类似心风，稍安定后又发作，可用清心汤加石菖蒲。因思虑伤心而得的，用酒调服天门冬膏、地黄膏，多服才见效。
胡乱唱歌大笑，登高爬墙，骂人不避亲疏，称为狂，俗称风子。与伤寒热极导致的发狂相同，都属于痰火内盛。有的因乐极生悲而成，有的因怒极而成。寻找火邪和痰邪，根据多少分别治疗。牛黄泻心汤、滚痰丸是非常对症的方剂。必须断绝浓味、酒肉、面食、姜蒜、煎炒食物。《内经》所说的“剥夺其饮食病就好了”，就是这个意思。这是心火独盛，阳气有余，神不守舍，痰火壅盛所致。
也有因肾水枯竭、相火独旺而导致的，突然僵倒仆地发出兽叫声，手足强直，厥冷不知人事，称为痫，俗名羊头风。医书以五种动物对应五脏。朱丹溪断定其为痰证，是千古确切的见解。大法以祛痰为主，使用黄连、胆南星、瓜蒌仁。如果体内有热，用凉药清心。如果有痰气实盛的，可以用吐法。虚实要在脉象上辨别，不能以胖瘦来判断。如果是虚证而不能使用吐下法的，用人参、石菖蒲、茯苓、麦冬、全蝎、竹沥等药物。
大体上，癫是心血不足，狂是痰火实盛，痫病独生于痰，是因火动而引发的。治疗方法：痫病适宜用吐法，狂病适宜用下法，癫病则应安神养血，兼清痰火。虽然如此，这类病人如果神气脱失、两眼直视，像傻子一样痴呆，即使仓公、扁鹊再生，也没有办法了。
又有小儿胎痫，在胎儿时期，母亲受惊邪侵袭，出生后一两年才开始发作，或者八九岁发作，必定要等到再次感受外邪，与母腹中所感之邪相互搏结而后发作。然而小儿体质虚弱，两眼直视的症状不过一年左右，很难活到成年。这是因为肾间生命之气虚弱而无法恢复，所以寿命不长。
Zhang Jingyue stated: Voice originates from the qi of the zang organs. When the zang organs are full, the voice is loud; when they are deficient, the voice is weak. However, the tongue is the sprout of the Heart (Xin). When the Heart is diseased, the tongue cannot move freely, indicating that the Heart is the master of voice production. Voice is emitted by qi. When the Lung (Fei) is diseased, qi is depleted, indicating that the Lung is the gateway for voice. The Kidney (Shen) stores essence (Jing), and essence transforms into qi. Yin deficiency leads to a lack of qi, indicating that the Kidney is the root of voice. Although disease involves all five zang organs, the Heart, Lung, and Kidney are actually the masters.
However, humans regard the Kidney as the root, from which Yuan Qi (Original Qi) arises. If the Kidney declines, Yuan Yang (Original Yang) gradually weakens. The superficial aspect (Biao) of voice lies in the Heart and Lung, while its root (Ben) lies in the Kidney. The Classics state: "Internal depletion leading to Jue (reversal) results in aphonia and apoplexy." This indicates Kidney deficiency. That the Kidney is the root of voice is indeed not a fallacy.
Aphonia is divided into excess and deficiency patterns. Excess patterns involve the Biao (superficial level), caused by Wind-Cold or Fire pathogens leading to qi rebellion and obstruction; these are easy to treat. If it is due to sexual indiscretion injuring the Kidney, worry and overthinking injuring the Heart, fright injuring the Gallbladder, or hunger and fatigue injuring the Spleen, one must seek the specific cause and greatly tonify Yuan Qi. Otherwise, how can hoarse and damaged voices recover, and broken bodies be revitalized? Thus, deficiency patterns are difficult to treat.
Among these, there are still distinctions of difficulty: acute and recent cases are easy to treat, while chronic and long-standing ones are difficult; slow and slippery pulses indicate ease of treatment, while thin and rapid pulses indicate difficulty; those without prior injury are easy to treat, while those with accumulated劳 (labor/overwork) and consumptive diseases are difficult. Regarding patients with chronic cough leading to hoarseness, where both Lung and Kidney are failing, one should only tonify Lung qi and nourish Kidney water, nourishing Metal to moisten dryness, so that voice will naturally emerge. One may slightly add herbs like Hezi (Chebulae Fructus) and Baiyaojian (Fermented Tea Brick) to converge and treat the Biao. If false heat and abundant phlegm are seen, using cold and cooling herbs to consume further will rarely fail to lead to danger.
Dian (Manic-Depressive Psychosis), Xian (Epilepsy), and Kuang (Mania) have differences in severity, but essentially arise from Phlegm-Fire stagnation, dispersion of Shen (Spirit), and qi deficiency unable to resist pathogens, causing Phlegm-Fire to recklessly attack upwards. This corresponds to what the Neijing says: "If the Ruler is unclear, the twelve officials are in danger; if the pathways are blocked, the form suffers greatly."
When a person's spirit is confused, consciousness is unclear, and speech is inverted and disordered, it is called Dian. It is also known as Shi Xin Feng (Loss of Heart Wind). It has elements of Kuang but is less severe than Kuang. It belongs to Blood deficiency of the Heart. It often occurs in those who pursue high goals but fail to achieve them. The Heart pulse and both Cun (inch) positions will be deficient and rapid, or large and forceless. Treatment should focus on clearing the Heart, soothing Liver depression, and nourishing Shen, using herbs such as Shichangpu (Acori Tatarinowii Rhizoma), Xiangfu (Cyperi Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Fushen (Poria with Hostwood), Zhizi (Gardeniae Fructus), Beimu (Fritillariae Thunbergii Bulbus), Maidong (Ophiopogonis Radix), Juhong (Citri Reticulatae Pericarpium Rubrum), and Bairen (Platycladi Semen). For abundant phlegm, first use emetics to remove phlegm, then administer calming medicines. If Heat accumulates in the Heart channel, with irregular attacks, occasional irritability, and sensations of heat in the nose and eyes with loss of control, resembling Heart Wind, which subsides slightly then recurs, use Qingxin Tang (Clear the Heart Decoction) plus Shichangpu. For cases caused by overthinking injuring the Heart, mix Tiandongtian (Asparagi Radix) paste and Dihuang (Rehmanniae Radix) paste with wine and take frequently for effect.
Singing and laughing wildly, climbing high walls, cursing without avoiding relatives or strangers, is called Kuang, commonly known as Feng Zi (Wind Child). It shares the same etiology as mania caused by extreme heat in Shanghan (Cold Damage), belonging to excessive internal Phlegm-Fire. It can result from extreme joy or extreme anger. Treat by seeking Fire and Phlegm, addressing their quantity. Niuhuang Xiexin Tang (Calculus Bovis Draining the Heart Decoction) and Guntan Wan (Rolling Phlegm Pill) are highly appropriate formulas. One must avoid rich flavors, meat, alcohol, wheat products, ginger, garlic, and fried foods. As the Neijing states, "depriving food cures it," which implies this meaning. This is due to exclusive flourishing of Heart Fire, excess Yang qi, Shen failing to reside within, and accumulation of Phlegm-Fire.
There are also cases caused by exhaustion of Water (Kidney Yin) leading to independent flourishing of Ministerial Fire (Xiang Huo). Suddenly collapsing with animal-like sounds, stiff limbs, Jue (cold reversal) and unconsciousness, is called Xian, commonly known as Yang Tou Feng (Sheep Head Wind). Medical texts associate five animals with five zang organs. Zhu Danxi determined it to be Phlegm, a profound insight through ages. The general principle is to resolve Phlegm primarily, using Huanglian (Coptidis Rhizoma), Danning (Arisaematis Cum Bile), and Gualouren (Trichosanthis Semen). If internal heat exists, use cooling herbs to clear the Heart. If Phlegm-Qi is excess, vomiting methods may be used. Differentiate deficiency and excess via pulse, not by body fatness or thinness. For deficiency unable to tolerate vomiting or purging, use Renshen (Ginseng Radix), Changpu (Acori Tatarinowii Rhizoma), Fuling (Poria), Maidong (Ophiopogonis Radix), Quanxie (Scorpio), and Zhuli (Bambusa Textilis Caulis in Succus).
Generally, Dian is due to Heart Blood deficiency, Kuang is due to excess Phlegm-Fire, and Xian arises solely from Phlegm, triggered by Fire movement. Treatment methods: Xian suits vomiting, Kuang suits purging, Dian requires calming Shen and nourishing Blood, combined with clearing Phlegm-Fire. Nevertheless, if patients have lost their Shen, stare fixedly, and appear foolish or痴 (idiotic), even if Cang Gong or Bian Que were reborn, nothing could be done.
There is also infantile Tai Xian (Congenital Epilepsy). At the fetal stage, if the mother was affected by fright pathogens, it may manifest one or two years after birth, or at eight or nine years old. It must await secondary pathogenic invasion to clash with the pathogen acquired in the womb before manifesting. However, children have weak constitutions; if they stare fixedly for more than a year, it is difficult for them to survive to adulthood. This is because the vital Qi in the Kidneys is deficient and cannot recover, thus limiting lifespan.