病由风冷 风冷失声者，由风冷之气，客于会厌，伤于悬壅之所为也。声气通发，事因关户，会厌是
音声之户，悬壅是音声之关，风冷客于关户之间，所以失声也。（《病源论》）
中冷声嘶者，风冷伤于肺之所为也。肺主气，五脏同受气于肺，而五脏有五声，皆禀气而通之。气为阳，
若温暖则阳气和宣，其声通畅。风冷为阴，阴邪搏于阳气，使气道不调流，所以声嘶也。（同上）
风寒之气客于中，滞而不能发，故喑不能言及喑哑失声，皆风邪所为也，入脏皆能杀人。（《千金》）
病由肾虚 心为声音之主，肺为声音之门，肾为声音之根。风寒暑湿，气血痰热，邪气有干于心肺者，
病在上脘，
随证解之，邪气散则天籁鸣矣。唯夫肾虚为病，不能纳诸气以归元，故气奔而上，咳嗽痰壅，或喘或胀，髓虚多
唾，骨冷足痿，胸腹百骸俱为之牵制，其嗽愈重，其气愈乏，其声愈干，君子当于受病之处图之可也。按钱氏
方小儿吐泻利，其小便过多，以致脾虚不食，钱用益黄散作效。数日以后，忽尔不语，钱知其脾气已复，肾气尚
虚，投以地黄丸益肾，相继数剂，于是能言。余益信声音之根出于肾也不诬矣。（《直指》）
病分三因 有内热痰郁，窒塞肺金，而声哑不出者，及有咳嗽久远，伤气而散者，此内因也。有外受风
寒，腠理闭塞，外束内郁，嗽而声哑，三拗之类，此外因也。又有忽暴吸风，卒然声不出者，亦外因也。有因争
竞，大声号呼，以致失声，或因歌唱伤气而声不出，此不内外因也，养息自愈。（《医统》）
脉候 脉沉涩声不出者为郁，脉浮紧为寒束声哑，洪大为火，脉滑为痰，脉沉伏久病声不出者难治。
（《医统》）
虚实证治 言者心之声，声者肺之韵，肺体清虚，以气之鼓迫则鸣。犹钟磬之悬架，其内空虚，击之
则鸣；内有污浊壅窒，击之则声哑而不明也。若有邪郁痰壅（按∶原此有“肺痿狐蜮”四字，今芟却）等因，
则其声哑嗄，惟去其痰邪等，即犹去钟磐之泥土浊垢，击之自鸣，复何哑乎。若夫水亏火炎，金伤声碎者，则犹
钟磐击损，欲其如故，须复铸之，所以痰火声嘶，其得全愈者鲜矣。即施益水清金之法，犹恐不迨，若更以苦
寒妄治，虚虚之祸，岂不旋踵而至哉。（《痰火点雪》）
喑哑之病，当知虚实。实者其病在标，因窍闭而喑也。虚者其病在本，因内夺而喑也。窍闭者，有风寒之闭，外感
证也，有火邪之闭，热乘肺也；有气逆之闭，肝滞强也。风闭者可散而愈，火闭者可清而愈，气闭者可顺而愈，
此皆实邪之易治者也。至若痰涎之闭，虽曰有虚有实，然非治节不行，何致痰邪若此，此其虚者多而实者少，当
察邪正、分缓急而治之可也。内夺者，有色欲之夺，伤其肾也；忧思之夺，伤其心也；大惊大恐之夺，伤其胆
也，饥馁疲劳之夺，伤其脾也。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，此皆虚邪之难治者
也。然难易之辨固若此，而犹有难易之辨者，则辨其久暂，辨其病因，乃可悉焉。盖暂而近者易，渐而久者难。
脉缓而滑者易，脉细而数者难。素无损伤者易，积有劳怯者难。数剂而开者易，久药罔效者难。此外复有号叫
歌唱悲哭，及因热极暴饮冷水，或暴吸风寒而致喑者，乃又其易者也。若此者，但知养息则弗药可愈，是皆所
当辨者。（《景岳》）
失音大都不越于肺，然须以暴病得之，为邪郁气逆；久病得之，为津枯血槁。盖暴喑总是寒包热邪，或本
内热而后受寒，或先外感而食寒物，并宜辛凉和解，稍兼辛温散之，消风散（见《头痛》）用姜汁调服，缓缓
进之，或只一味生姜汁亦可，冷热嗽后失音尤宜。若咽破声嘶而痛，是火邪遏闭伤肺，昔人所谓金实不鸣，金
破亦不鸣也，古法用清咽宁肺汤，今改用生脉散合六味丸作汤，所谓壮水之主，以制阳光也。肥人痰湿壅滞、
气道不通而声喑者，二陈、导痰开涤之，一切滋补皆为禁剂。至若久病失音，必是气虚挟痰之故，宜滋肺肾之
化源，非生脉散下都气丸不可。凡咽干声槁者，润肺为主，生脉散合异功散。若膈内作痛，破瘀为先，代抵当
丸最妥。又咽痛起于四、五日间，或因咳剧而得，或多稠痰结痰而咽喉上 肿痛，其声虽哑，而尚有音破浊，脉
大缓而右寸尤甚，此热结于肺也，宜用辛凉之剂，如桔梗汤加葱白、香豉、荆芥、薄荷，慎不可骤用敛降之药。
若暴哑声不出，咽痛异常，卒然而起，或欲咳而不能咳，或无痰，或清痰上溢，脉多弦紧，或数疾无伦，此大寒
犯肾也，麻黄附子细辛汤温之，并以蜜制附子含之，慎不可轻用寒凉之剂。二证寒热天渊，不可不辨也。亦有
叫骂声嘶而喉破失音者，十全大补汤。（《医通》）
声哑者，寒包其热也，宜细辛、半夏、生姜，辛以散之。亦有痰热壅于肺者，经云金空则鸣，必清金中邪
滞，用清热宁肺汤。（《统旨》）（按∶宁肺汤即咳嗽清金化痰汤之类。）
有声音不出之人，服冷剂愈失声，即是肾经虚寒，投附子之剂数枚方可，此不可不识。（《要诀》）
咳嗽声哑 咳嗽声嘶者，此血虚受热也，用青黛、蛤粉，蜜调服之。（丹溪）
凡病患久嗽声哑，乃是元气不足，肺气不滋，宜补气养金润燥，其声自 。若虚劳之人，则宜滋肾水、润
肺金为本，诃子百药煎收敛以治其标，标本兼治，此十全也。（《医统》）
若见其假热而过用寒凉，凡见其痰盛而妄行消耗，则未有一免者矣。（《景岳》）
若冬月咳嗽，寒痰结于咽喉，语声不出者，此寒气客于会厌，故卒然而喑也，麻杏甘石汤或《古今录验》
续命汤选用。（《医通》）
舌喑喉喑 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。然有二证∶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。（《纲目》）（按∶此
说宜置之篇首，然此门专以喉喑为主，故敢次于此，而以舌喑治验等，并列下方。）
内侍曹都使，新造一宅，落成迁入，经半月，饮酒大醉，卧起失音不能语。召孙至，诊曰∶因新宅，故得
此病耳，半月当愈，但服补心气薯蓣丸，治湿用细辛、川芎。又十日其病渐减，二十日全愈。曹既安，见上，问
谁医，曰孙兆郎中。上乃召问曰∶曹何疾也？对曰∶凡新宅壁土皆湿，地亦阴多，人乍来，阴气未散。曹心气
素虚，饮酒至醉，毛窍皆开，阴湿之气，从而入乘心经，心经既虚，而湿气又乘之，所以不能语。臣先用薯蓣丸，
使心气壮，然后以川芎、细辛，又去湿气，所以能语也。（同上）
更有舌喑不能言者，亦当分新久。新病舌喑不能言，必是风痰为患，类中风例治之。若肥人舌强不能言，或舌
根强硬，导痰汤为主。若久病后，或大失血后，舌萎不能言，大虚挟寒例治之。要在临证审察病因无误。然中风
暴病失音，多缘少阴真气久虚而得，更兼遗尿五绝证见，不可治矣。（《医通》）
悬壅损 凡患风毒或病喉痈，病既愈而声则喑者，此其悬壅已损，虽喑无害也，不必治之。（《景岳》）
死证 诸病不语，或声干沉，难以痊复。（《直指》）
久病患不语，为心气绝者死。（《医统》）
酒色过度，肾脏亏伤，不能纳气归元，气奔咽嗌，嗽痰喘胀，诸病杂揉，致气乏失音者，俗名哑劳是也，神
人莫疗。（《简明医彀》）
治方 若卒中冷，声嘶哑者，甘草一两，桂二两，五味子二两，杏仁三十枚，生姜八两切，以水七升，煮取二
升，为二服服之。（《肘后》）《圣惠》治风冷失声，语音不出，宜服杏仁煎，于本方加紫菀、贝母、细辛、饴糖、蜜。《直
指》杏仁煎，治咳嗽暴重，声音不出。于《圣惠》方中，去桂、甘草、细辛，加桑白皮、木通、石菖蒲。（用砂糖，不用
饴糖，生姜用汁。《朱氏》去石菖蒲，曰∶更加款冬花、知母各一两，尤好。）
桂汤，治卒失音方。
浓煮桂汁，服一升，覆取汗。亦可末桂着舌下，渐渐咽汁。（《千金》）（按∶末桂着舌下，本出《肘后》。）
治寒气拍着，语声不出，杏子膏。
官桂（去皮） 桔梗 杏仁（去皮尖）
上等分为细末，用杏仁研膏为丸，如梧桐子大，含化立效。（《选奇后集》）
治中冷声嘶，止喘咳，温肺气，温肺汤方。
杏仁（汤浸去皮尖双仁炒黄） 桂（去粗皮） 麻黄（去根节各半两） 糯米（三合） 甘草（炙锉一分）
上五味粗捣筛，分作五服，每服用水三盏，煎取一盏，滤去滓，用鸡子白一枚，和药温服。（《圣济》）
三拗汤，治风寒邪郁，咳嗽失音。（《医统》）（方见《伤寒》中。）
陵（二二），秋凉燥气咳嗽，初病皮毛凛凛，冬月失音，至夏未愈，而纳食颇安。想屡经暴冷暴暖之伤，未
必是二气之馁，仿金石无声议治。
麻黄 杏仁 生甘草 石膏 射干 苡仁（《临证指南》）
治失音，回声饮子。
皂角（一挺刮去黑皮并子） 萝卜（三个切作片）
上以水二碗，同煎至半碗以下服之，不过三服便语，吃萝卜更妙。（《养老书》）
诃子汤，治失音不能言语者。
诃子（四个半炮半生） 桔梗（一两半炙半生） 甘草（二寸半炙半生）
上为细末，每服二钱，用童子小便一盏，同水一盏，煎至五、七沸，温服。甚者不过三服即愈。（《宣明》）
（按∶《纲目》载丹溪用童便浸香附为末方，曰∶《本草》言童便主久嗽失音，故治喑多用童便，由童便能
降火故也。）《圣效方》去童便，加砂糖。
清音丸，嗽而失音。
桔梗 诃子（各一两） 甘草（五钱） 硼砂 青黛（各三钱） 冰片（三分）
上为细末，炼蜜丸如龙眼大，每服一丸含化。（《统旨》）
响胜（《回春》作响声）破笛丸，治歌讴失音不语者，宜服神效。
连翘 桔梗 甘草（各二两半） 薄荷（四两） 诃子肉（煨） 砂仁 大黄（酒蒸各一两） 川芎（一两半）
百药煎（二两）
上为细末，鸡子清和为丸，如弹子大，每用一丸，临卧噙化服。（《医林集要》）
通音煎，治音哑。
白蜜（一斤） 川贝母（一两去心为末） 款冬花（二两去梗为末） 胡桃肉（二十个去衣研烂）
上四味和均，饭上蒸熟，不拘时，开水煎服。（《心悟》）
孙（二一），久咳失音喉痹。
陈阿胶（同煎二钱） 生鸡子黄（同煎一枚） 炒麦冬（一钱半） 川斛（三钱） 甜北沙参（一钱半）
炒生地（二钱） 生甘草（三分） 茯神（一钱半，《临证指南》）
病由风冷：因风冷导致失声的，是由于风冷之气侵袭会厌（位于喉部，控制声音发出的瓣膜），损伤了悬雍垂（俗称小舌头）部位所致。声音的产生与气息通畅有关，关键在于“关户”（比喻发声的关键门户）。会厌是声音的门户，悬雍垂是声音的关卡，风冷邪气客居在关户之间，所以导致失声。（出自《诸病源候论》）
中焦受冷导致声音嘶哑的，是风冷损伤肺脏所致。肺主司气，五脏的气都来源于肺，而五脏对应五种声音，都依赖肺气贯通才能发出。气属阳，如果温暖则阳气调和宣通，声音就能通畅。风冷属阴，阴邪与阳气相搏结，使气道运行不畅，所以声音嘶哑。（同上）
风寒邪气侵入体内，阻滞气机而不能发越，因此出现失音不能说话及声音嘶哑失声，这都是风邪所为，若邪气深入脏腑都能危及生命。（出自《千金方》）
病由肾虚：心是声音的主宰，肺是声音的门户，肾是声音的根本。风寒暑湿、气血痰热等邪气干扰心肺，病位在上脘，随证治疗即可，邪气散去则声音自然恢复。唯有肾虚致病，不能收纳诸气归于元气之根，导致气机上奔，咳嗽痰多壅盛，或者气喘或者腹胀，髓海空虚多唾沫，骨骼寒冷足部痿软，胸腹全身筋骨都受到牵制影响，咳嗽越重，气越虚弱，声音越干枯。君子应当在发病的根本原因处寻求对策。据钱乙的医案记载，小儿吐泻痢疾后，小便过多，导致脾虚不想吃饭，钱乙用益黄散治疗见效。几天后，突然不说话，钱乙知道脾气已恢复，但肾气尚且虚弱，于是投用地黄丸补肾，连续服用几剂后，孩子就能说话了。我更加相信声音的根本出于肾，这是确凿无疑的。（出自《直指方》）
病分三因：有内热痰郁，阻塞肺金，导致声音嘶哑不出来的，以及有长期咳嗽，耗伤正气而致声音散失的，这属于内因。有外感风寒，腠理闭塞，外邪束缚内气郁滞，咳嗽而声音嘶哑的，如三拗汤之类，这属于外因。又有忽然暴吸风邪，突然声音出不来的，也属于外因。有因争吵，大声呼喊，导致失声的，或因唱歌伤气而声音出不来的，这属于不内外因，通过调养休息可自行痊愈。（出自《医统》）
脉候：脉象沉涩而声音不出的是气机郁滞；脉象浮紧的是寒邪束表导致声音嘶哑；脉象洪大的是火邪；脉象滑的是痰湿；脉象沉伏且久病声音不出的是难治之症。（出自《医统》）
虚实证治：说话是心的声音表现，声音是肺的韵律体现。肺体清虚，依靠气的鼓动冲击而发声。就像钟磬悬挂在那里，内部空虚，敲击就会鸣响；如果内部污浊壅塞，敲击就会声音嘶哑而不清晰。如果有邪气郁滞、痰湿壅盛等情况，那么声音就会嘶哑，只有去除痰邪等病因，就如同去掉钟磬上的泥土污垢，敲击自然会鸣响，怎么会嘶哑呢？如果是肾水亏虚、虚火上炎，损伤肺金导致声音破碎的，就如同钟磬被击损，想要恢复原状，必须重新铸造，所以痰火导致的声嘶，完全治愈的很少。即使采用滋水清金的治法，还恐怕来不及，如果再误用苦寒药物妄加治疗，造成虚上加虚的祸患，岂不是转眼就到吗？（出自《痰火点雪》）
喑哑的病，应当辨别虚实。实证病在标，因为窍道闭塞而失音。虚证病在本，因为内部精气夺失而失音。窍道闭塞的，有风寒闭塞，属于外感证；有火邪闭塞，属于热邪乘袭肺脏；有气逆闭塞，属于肝气郁滞强盛。风邪闭塞的可以发散而愈，火邪闭塞的可以清热而愈，气逆闭塞的可以顺气而愈，这些都是实邪容易治疗的。至于痰涎闭塞，虽然也有虚实之分，但如果不是治节功能不行，怎么会致使痰邪如此严重呢？这种情况虚证多而实证少，应当观察邪正盛衰，分清缓急来治疗。内部精气夺失的，有房劳过度损伤肾脏的；有忧思过度损伤心脏的；有大惊大恐损伤胆腑的；有饥饿疲劳损伤脾脏的。如果不分别求其所属脏腑而大补元气，怎能希望嘶败的声音恢复完整、残损的身体振作起来呢？这些都是虚邪难以治疗的。然而难易的辨别固然如此，还有更细微的难易辨别，就是辨别病程的长短，辨别病因，才能详尽了解。大概暂时和近期的容易治疗，逐渐和久远的难治。脉象缓而滑的容易治疗，脉象细而数的难治。素来没有损伤的容易治疗，积劳成疾虚损的难治。几剂药就见效的容易治疗，久服药物无效的难治。此外还有因叫骂、歌唱、悲哭，以及因极热时暴饮冷水，或暴吸风寒而导致失音的，这些又是容易治疗的。像这种情况，只要知道调养休息，不服药也可以痊愈，这些都是应当辨别的。（出自《景岳全书》）
失音大多不离肺病，但须区分是新病还是久病。新病得之，是因为邪气郁滞、气机逆乱；久病得之，是因为津液枯竭、血液干槁。大概暴发性失音总是寒包热邪，或者是本来内有热而后感受寒邪，或者是先外感寒邪又吃了寒凉食物，都适宜用辛凉和解的方法，稍加辛温发散，可用消风散（见《头痛》篇）用姜汁调服，缓缓进服，或者只用一味生姜汁也可以，冷热咳嗽后失音尤其适宜。如果咽喉破损、声音嘶哑且疼痛，这是火邪遏闭损伤肺脏，古人所谓“金实不鸣，金破亦不鸣”，古法用清咽宁肺汤，现在改用生脉散合六味地黄丸煎汤，这就是所谓的“壮水之主，以制阳光”。肥胖之人因痰湿壅滞、气道不通而声音嘶哑的，用二陈汤、导痰汤开涤痰湿，一切滋补药都是禁忌。至于久病失音，必定是气虚挟痰的缘故，宜滋养肺肾的化源，非生脉散下都气丸不可。凡是咽干声音枯槁的，以润肺为主，用生脉散合异功散。如果膈内疼痛，以破瘀为先，代抵当丸最妥当。另外咽喉痛起于四、五天间，或因剧烈咳嗽引起，或多稠痰结聚导致咽喉上下肿痛，声音虽然嘶哑，但还有破浊之音，脉象大缓且右寸脉尤为明显，这是热结于肺，宜用辛凉药剂，如桔梗汤加葱白、香豉、荆芥、薄荷，千万不要骤用收敛降逆的药物。如果是突然声音嘶哑说不出话，咽喉异常疼痛，突然发作，或者想咳却咳不出来，或者无痰，或者清稀痰液上溢，脉象多弦紧，或数疾无序，这是大寒侵犯肾脏，用麻黄附子细辛汤温散，并用蜜制附子含服，千万不要轻用寒凉药剂。这两种证候寒热天壤之别，不可不辨别。也有因叫骂导致声音嘶哑、咽喉破损失音的，用十全大补汤。（出自《医学入门》）
声音嘶哑的，是寒邪包裹热邪，宜用细辛、半夏、生姜，用辛味药发散它。也有痰热壅塞于肺的，经云“金空则鸣”，必须清除肺中金邪滞碍，用清热宁肺汤。（出自《证治准绳·杂病米聚·统旨》）（按：宁肺汤即咳嗽清金化痰汤之类。）
有声音出不来的人，服用冷性药剂后反而更加失声，这就是肾经虚寒，投用附子类药剂几枚才可以，这一点不可忽视。（出自《要诀》）
咳嗽声哑：咳嗽声音嘶哑的，这是血虚受热所致，用青黛、蛤粉，蜂蜜调服。（朱丹溪）
凡是病人长期咳嗽声音嘶哑，乃是元气不足，肺气不滋润，宜补气养肺润燥，声音自然恢复。如果是虚劳病人，则应以滋肾水、润肺金为本，用诃子、百药煎收敛以治其标，标本兼治，这才是十全之法。（出自《医统》）
如果见到假热而过用寒凉药，凡见到痰盛而妄用消耗药，就没有能避免伤害的了。（张景岳）
如果是冬季咳嗽，寒痰结于咽喉，说话声音出不来的，这是寒气客居会厌，所以突然失音，可选用麻杏甘石汤或《古今录验》续命汤。（出自《医学入门》）
舌喑与喉喑：喑，是邪气侵入阴分。经云：“邪搏阴则为喑。”又说：“邪入于阴，搏则为喑。”然而有两种证候：一是舌喑，乃中风导致舌体不能转动之类的病症。二是喉喑，乃劳嗽导致失音之类的病症。大概舌喑只是舌本不能转动言语，而喉咽发出的声音则如常。喉喑只是喉中声音嘶哑，而舌本能正常转动言语。（出自《本草纲目》）（按：此说应放在篇首，但此门专以喉喑为主，所以敢将其置于此处，而将舌喑的治疗验案等，并列在下方。）
内侍曹都使，新建了一所宅院，落成迁入，过了半个月，饮酒大醉，起床后失音不能说话。召孙兆前来诊治，孙兆说：“因为是新宅，所以得这个病，半个月应当痊愈，只需服用补心气薯蓣丸，治疗湿气用细辛、川芎。”又过了十天，病情逐渐减轻，二十天完全痊愈。曹都使安好后，拜见皇上，问是谁医治的，回答说：“是孙兆郎中。”皇上于是召来询问：“曹都使是什么病？”孙兆回答说：“凡是新宅墙壁泥土皆潮湿，地气也多阴湿，人刚来，阴气未散。曹都使心气素来虚弱，饮酒至醉，毛孔皆开，阴湿之气，趁机侵入心经，心经既虚，湿气又乘虚而入，所以不能说话。臣先用薯蓣丸，使心气强壮，然后用川芎、细辛，祛除湿气，所以能说话。”（同上）
更有舌喑不能说话的，也应当区分新病久病。新病舌喑不能说话，必定是风痰为患，按类中风例治疗。如果是肥胖之人舌强不能说话，或舌根强硬，以导痰汤为主。如果是久病后，或大失血后，舌萎不能说话，按大虚挟寒例治疗。关键在于临证审察病因无误。然而中风暴病失音，多缘于少阴真气久虚而得，再加上遗尿、五绝证出现，就无法治疗了。（出自《医学入门》）
悬雍垂损伤：凡是患有风毒或喉痈，病虽痊愈但声音嘶哑的，这是悬雍垂已经受损，虽然失音但无大害，不必治疗。（出自《景岳全书》）
死证：各种疾病导致不语，或声音干枯低沉，难以康复。（出自《直指方》）
久病病人不语，是心气绝的表现，预后不良致死。（出自《医统》）
酒色过度，肾脏亏伤，不能纳气归元，气奔咽喉，咳嗽痰喘腹胀，各种病症混杂，导致气乏失音的，俗名哑劳，神仙也无法治疗。（出自《简明医彀》）
治方：如果是卒中冷邪，声音嘶哑的，甘草一两，桂枝二两，五味子二两，杏仁三十枚，生姜八两切片，用水七升，煮取二升，分两次服用。（出自《肘后备急方》）《太平圣惠方》治风冷失声，语音不出，宜服杏仁煎，在本方基础上加紫菀、贝母、细辛、饴糖、蜂蜜。《直指方》杏仁煎，治咳嗽暴重，声音不出。在《圣惠方》中去掉桂枝、甘草、细辛，加桑白皮、木通、石菖蒲。（用砂糖，不用饴糖，生姜用汁。《朱氏集验方》去掉石菖蒲，曰：再加款冬花、知母各一两，更好。）
桂汤，治突然失音方。
浓煮桂汁，服一升，覆盖身体取汗。也可以将桂末放在舌下，渐渐咽下汁液。（出自《千金方》）（按：桂末放舌下，原本出自《肘后方》。）
治寒气拍着，语声不出，杏子膏。
上等分为细末，用杏仁研膏制成丸，如梧桐子大小，含化立效。（出自《选奇后集》）
杏仁（汤浸去皮尖双仁炒黄） 桂枝（去粗皮） 麻黄（去根节各半两） 糯米（三合） 甘草（炙锉一分）
以上五味药粗捣筛，分作五服，每服用水三盏，煎取一盏，滤去渣滓，用鸡蛋清一枚，和药温服。（出自《圣济总录》）
三拗汤，治风寒邪郁，咳嗽失音。（出自《医统》）（方见《伤寒》篇中。）
陵姓患者（第二十二例），秋凉燥气咳嗽，初病皮毛凛凛怕冷，冬季失音，到夏季未愈，但饮食颇安。想是屡经暴冷暴暖的伤害，未必是二气衰弱，仿照金石无声议治。
麻黄 杏仁 生甘草 石膏 射干 苡仁（出自《临证指南医案》）
以上用水二碗，同煎至半碗以下服用，不超过三服便能说话，吃萝卜更好。（出自《养老奉亲书》）
诃子（四个半炮半生） 桔梗（一两半炙半生） 甘草（二寸半炙半生）
以上为细末，每服二钱，用童子小便一盏，同水一盏，煎至五、七沸，温服。严重的不过三服即愈。（出自《宣明论方》）（按：《本草纲目》记载丹溪用童便浸香附为末方，曰：《本草》言童便主久嗽失音，故治喑多用童便，因为童便能降火缘故。）《圣效方》去掉童便，加砂糖。
桔梗 诃子（各一两） 甘草（五钱） 硼砂 青黛（各三钱） 冰片（三分）
以上为细末，炼蜜丸如龙眼大，每服一丸含化。（出自《证治准绳·杂病米聚·统旨》）
连翘 桔梗 甘草（各二两半） 薄荷（四两） 诃子肉（煨） 砂仁 大黄（酒蒸各一两） 川芎（一两半） 百药煎（二两）
以上为细末，鸡子清和为丸，如弹子大，每用一丸，临卧噙化服。（出自《医林集要》）
通音煎，治音哑。
白蜜（一斤） 川贝母（一两去心为末） 款冬花（二两去梗为末） 胡桃肉（二十个去衣研烂）
以上四味和均，饭上蒸熟，不拘时候，开水煎服。（出自《寓意草》）
陈阿胶（同煎二钱） 生鸡子黄（同煎一枚） 炒麦冬（一钱半） 川斛（三钱） 甜北沙参（一钱半） 炒生地（二钱） 生甘草（三分） 茯神（一钱半，《临证指南医案》）
Disease Caused by Wind-Cold: Loss of voice due to wind-cold occurs when the pathogenic factors of wind-cold invade the epiglottis (a flap-like structure in the larynx that controls sound production) and damage the uvula (commonly known as the little tongue). The generation of voice depends on the smooth flow of Qi, with key mechanisms referred to as "guanhu" (metaphorically describing the critical gateway for sound emission). The epiglottis serves as the gate of sound, and the uvula acts as the lock; when wind-cold pathogens lodge between these structures, loss of voice ensues. (From *Zhubing Yuanhou Lun*)
Hoarseness caused by cold in the middle jiao results from wind-cold damaging the Lungs. The Lungs govern Qi, and all five Zang organs derive their Qi from the Lungs. Each Zang organ corresponds to one of the five vocal tones, which rely on Lung Qi to resonate. Qi belongs to Yang; if warm, Yang Qi harmonizes and spreads, allowing clear voice. Wind-cold belongs to Yin; when Yin pathogens contend with Yang Qi, they disrupt the smooth flow of the airways, resulting in hoarseness. (Ibid.)
When wind-cold pathogens invade the interior, stagnating and preventing the expression of voice, symptoms such as aphonia (loss of voice), inability to speak, and hoarseness occur. These are all caused by wind pathogens. If the pathogens penetrate into the Zang organs, they can be fatal. (From *Qianjin Fang*)
Disease Caused by Kidney Deficiency: The Heart is the master of voice, the Lungs are the gate of voice, and the Kidneys are the root of voice. Pathogens such as wind, cold, summer-heat, dampness, blood stasis, phlegm, and heat may interfere with the Heart and Lungs, causing disease in the upper jiao. Treatment should follow the syndrome differentiation; once pathogens disperse, natural voice returns. However, when kidney deficiency causes disease, it fails to grasp and return all Qi to its source. This leads to upward rushing of Qi, coughing with copious phlegm, wheezing or distension, marrow emptiness with excessive salivation, cold bones with flaccid limbs, and牽制 (restriction) throughout the chest, abdomen, and bones. As cough worsens, Qi becomes more deficient, and voice becomes drier. One must address the root cause of the disease. According to Qian Yi’s medical records, a child suffering from vomiting, diarrhea, and dysentery had excessive urination, leading to Spleen deficiency and anorexia. Qian Yi used Yihuang San with success. Several days later, the child suddenly became mute. Qian Yi deduced that while Spleen Qi had recovered, Kidney Qi remained deficient, and administered Dihuang Wan to tonify the Kidneys. After several doses, the child could speak again. This confirms beyond doubt that the root of voice lies in the Kidneys. (From *Zhizhi Fang*)
Differentiation of Three Causes: Internal heat and phlegm stagnation obstructing the Metal (Lungs), causing hoarseness or aphonia, along with chronic cough depleting Qi and scattering voice, belong to internal causes. External contraction of wind-cold, closing the interstices, binding externally and郁 (stagnating) internally, causing cough and hoarseness, treated with formulas like San'ao Tang, belong to external causes. Sudden inhalation of wind causing abrupt aphonia also falls under external causes. Loss of voice due to shouting during arguments, or vocal strain from singing, belongs to neither-internal-nor-external causes; self-healing through rest and nourishment is expected. (From *Yitong*)
Pulse Diagnosis: A deep and choppy pulse with aphonia indicates Qi stagnation. A floating and tight pulse with hoarseness indicates cold binding the exterior. A surging and large pulse indicates fire. A slippery pulse indicates phlegm. A deep and hidden pulse with long-standing aphonia indicates a difficult-to-treat condition. (From *Yitong*)
Treatment of Excess and Deficiency Syndromes: Speech is the manifestation of the Heart's voice, and vocal tone is the resonance of the Lungs. The Lung tissue is pure and hollow, producing sound through the鼓动 (pulsation/driving force) of Qi. Like bells hung in suspension, their interiors are empty; striking them produces sound. If the interior is turbid and obstructed, striking them yields dull, unclear sounds. In cases of pathogenic stagnation and phlegm obstruction, voice becomes hoarse. Removing the phlegm and pathogens is akin to cleaning mud from a bell; once clean, it rings clearly. Conversely, if Kidney Water is deficient and Fire flares up, damaging Lung Metal and shattering the voice, it is like a cracked bell. To restore it, re-forging is required. Thus, hoarseness due to phlegm-fire rarely heals completely. Even with methods to nourish Water and clear Metal, recovery may be insufficient. Misusing bitter-cold herbs would exacerbate deficiency, leading to rapid deterioration. (From *Tanhuo Dianxue*)
Aphonia and hoarseness must be differentiated as excess or deficiency. Excess syndromes affect the branch (biao), caused by orifice closure. Deficiency syndromes affect the root (ben), caused by internal depletion. Orifice closure includes wind-cold closure (exterior contraction), fire-pathogen closure (heat invading Lungs), and Qi-reversal closure (Liver Qi stagnation). Wind closure resolves with dispersal; fire closure with clearing; Qi-reversal with smoothing. These are easy-to-treat excess conditions. Phlegm-saliva closure involves both deficiency and excess but often leans toward deficiency due to failed regulation. Differentiate pathogenic vs. healthy Qi and urgency to treat. Internal depletion includes sexual exhaustion damaging Kidneys, worry/thought damaging Heart, shock/fear damaging Gallbladder, and hunger/fatigue damaging Spleen. Without targeting the specific organ and greatly tonifying Yuan Qi, recovery is unlikely. These are difficult-to-treat deficiency conditions. Further differentiation based on duration (acute vs. chronic), etiology, and pulse (slow/slipping vs. fine/rapid) helps predict prognosis. Acute/recent cases are easier than chronic/accumulated ones. Patients without prior injury heal easier than those with chronic consumptive diseases. Quick response to medication indicates ease; resistance indicates difficulty. Cases due to shouting, singing, crying, drinking cold water when hot, or sudden wind-cold exposure are generally easy to treat and may resolve with rest alone. (From *Jingyue Quanshu*)
Aphonia generally relates to the Lungs. Acute onset suggests pathogenic stagnation and Qi reversal; chronic onset suggests fluid depletion and blood dryness. Sudden aphonia is usually cold enveloping heat, either pre-existing internal heat followed by cold invasion, or external cold combined with cold food intake. Treat with acrid-cool harmonizing methods, slightly adding acrid-warm dispersants. Xiao Feng San (see Headache section) mixed with ginger juice, taken slowly, or pure ginger juice, is suitable, especially after cold/heat coughs. Throat rupture with hoarseness and pain indicates fire-pathogen constriction damaging Lungs ("Metal full does not ring, Metal broken does not ring"). Ancient method uses Qingyan Ningfei Tang; modern approach combines Shengmai San with Liuwei Dihuang Wan decoction, embodying "strengthening the master of Water to control Yang." Obese patients with phlegm-dampness blocking airways require Erchen Tang or Daotan Tang to open and wash away phlegm; all tonics are contraindicated. Chronic aphonia is due to Qi deficiency with phlegm; nourish Lung-Kidney sources using Shengmai San plus Duqi Wan. Dry throat and withered voice require moistening Lungs, using Shengmai San combined with Yigong San. Diaphragmatic pain requires breaking stasis first, using Daidang Wan. Sore throat appearing within 4-5 days, possibly from severe cough or thick phlegm accumulation, with hoarse but distinct voice and large/slow pulse (especially right Cun), indicates heat knotting in Lungs. Use acrid-cool agents like Jiegeng Tang plus Congbai, Jiangchi, Jingjie, Bohe. Avoid astringent/descending drugs abruptly. Sudden aphonia with severe throat pain, possibly coughless or with clear sputum, and wiry/tight or rapid/pulseless pulses, indicates severe cold attacking Kidneys. Warm with Mahuang Fuzi Xixin Tang and hold honey-processed Fuzi in mouth. Do not use cold herbs lightly. These two conditions (cold vs. heat) are vastly different and must be distinguished. Hoarseness from shouting with throat rupture requires Shiquan Dabu Tang. (From *Yitong*)
Hoarseness due to cold enveloping heat requires Xixin, Banxia, and Shengjiang to disperse with acrid flavors. Phlegm-heat congesting Lungs requires clearing Metal of pathogenic stagnation using Qingre Ningfei Tang. (From *Tongzhi*) (Note: Ningfei Tang is similar to Kechou Qingjin Huatan Tang.)
Patients whose voice loss worsens with cold medicines have Kidney channel deficiency-cold. Administer Fuzi preparations. This must be recognized. (From *Yaojue*)
Cough with Hoarseness: Cough-induced hoarseness stems from Blood deficiency with heat. Use Qingdai and Gafen mixed with honey. (Danxi)
Chronic cough with hoarseness indicates insufficient Yuan Qi and unmoistened Lung Qi. Tonify Qi, nourish Metal, and moisten dryness to restore voice. For consumptive disease, nourish Kidney Water and moisten Lung Metal as root, using Hezi and Baiyaojian to secure the branch. Treating both root and branch is ideal. (From *Yitong*)
Overuse of cold herbs for false heat, or draining herbs for abundant phlegm, leads to harm. (Jingyue)
Winter cough with cold-phlegm knotting in throat causing aphonia is due to cold lodging in the epiglottis. Use Maxing Gan Shi Tang or Xuming Tang from *Gujin Luyan*. (From *Yitong*)
Tongue Aphonia vs. Throat Aphonia: Aphonia implies pathogenic invasion of Yin channels. Classics state: "Pathogens contending with Yin cause aphonia." There are two types: Tongue aphonia (e.g., stroke causing tongue immobility) and Throat aphonia (e.g., chronic cough causing voice loss). Tongue aphonia involves tongue immobility but normal throat sound. Throat aphonia involves hoarse throat sound but normal tongue movement. (From *Bencao Gangmu*)
Case: Cao Dusshi, newly moved into a damp house, got drunk, and lost his voice. Sun Zhao diagnosed it as dampness entering the Heart channel due to open pores from alcohol and Yin-dampness from the new house. Cao had pre-existing Heart Qi deficiency. Treated with Shuyu Wan to strengthen Heart Qi, then Chuanxiong and Xixin to remove dampness. Recovered in 20 days. (Ibid.)
Tongue aphonia differs by new vs. old disease. New cases involve wind-phlegm, treat as stroke. Obese patients with stiff tongue use Daotan Tang. Post-illness or post-hemorrhage tongue atrophy indicates severe deficiency-cold. Stroke-related aphonia with urinary incontinence and five terminal signs is incurable. (From *Yitong*)
Uvula Damage: After wind-toxin or throat abscess heals, persistent hoarseness indicates uvula damage. No treatment needed. (From *Jingyue Quanshu*)
Death Signs: Inability to speak or dry/deep voice in various diseases indicates poor prognosis. (From *Zhizhi Fang*)
Long-term muteness indicates Heart Qi exhaustion, leading to death. (From *Yitong*)
Excessive wine and sex damaging Kidneys, failing to grasp Qi, causing breathlessness, cough, and aphonia (colloquially "mute consumption") is incurable even by gods. (From *Jianming Yigou*)
Prescriptions: For sudden cold-induced hoarseness: Gancao 1 liang, Guizhi 2 liang, Wuweizi 2 liang, Xingren 30 pieces, Shengjiang 8 liang slices. Decoct in 7 sheng water to 2 sheng, divide into two doses. (From *Zhouhou Beiji Fang*) *Shenghui Fang* adds Ziwan, Beimu, Xixin, Yitang, Honey to make Xingren Jian. *Zhizhi Fang* version removes Guizhi, Gancao, Xixin, adds Sangbaipi, Mutong, Shichangpu, uses rock sugar instead of maltose, ginger juice. *Zhu Shi* further removes Shichangpu, adds Kuandonghua and Zhimu.
Guizhi Tang for sudden aphonia: Concentrated Guizhi juice, 1 sheng, induce sweating. Or place Guizhi powder under tongue to swallow slowly. (From *Qianjin Fang*)
Xingzi Gao for cold-induced aphonia: Guirou (cinnamon bark), Jiegeng, Xingren. Powdered, made into pills with Xingren paste, size of Sophora seeds, dissolve in mouth. (From *Xuanqi Houji*)
Wenfei Tang for cold-induced hoarseness/cough: Xingren, Guizhi, Mahuang, Nuomi, Gancao. Coarsely powdered, divided into 5 doses. Decoct each dose in 3 cups water to 1 cup, filter, mix with egg white, take warm. (From *Shengji Zonglu*)
San'ao Tang for wind-cold stagnation, cough, aphonia. (From *Yitong*) See *Shanghan* section.
Case: Ling patient, autumn dryness cough, winter aphonia, unresolved by summer. Treated with Mahuang, Xingren, Sheng Gancao, Shigao, Shegan, Yiyi Ren. (From *Linzheng Zhinan Yian*)
Huisheng Yinzi for aphonia: Zaojiao (scraped), Radish slices. Decoct in 2 bowls water to <0.5 bowl. Take within 3 doses. Eating radish is beneficial. (From *Yanglao Fengqin Shu*)
Hezi Tang for aphonia: Hezi (half roasted/half raw), Jiegeng (half roasted/half raw), Gancao (half roasted/half raw). Powdered. 2 qian per dose, decoct with boy's urine and water. Severe cases resolve in 3 doses. (From *Xuanming Lunfang*) Note: Danxi used boy's urine to soak Xiangfu for aphonia due to its fire-descending property. *Shengxiao Fang* replaces urine with rock sugar.
Qingyin Wan for cough with aphonia: Jiegeng, Hezi, Gancao, Pengsha, Qingdai, Bingpian. Honey pills, dissolve one pill per dose. (From *Tongzhi*)
Xiangsheng Podi Wan for singing-induced aphonia: Lianqiao, Jiegeng, Gancao, Bohe, Hewenzi Rou, Sharen, Dahuang, Chuanxiong, Baiyaojian. Egg white pills, dissolve one pill before sleep. (From *Yilin Ji Yao*)
Tongyin Jian for hoarseness: Baimi, Chuan Beimu, Kuandonghua, Hutao Rou. Steam over rice, take with boiled water. (From *Yuyi Cao*)
Case: Sun patient, chronic cough, aphonia, throat bi. Chen Ejiao, Sheng Jizihuang, Chao Maidong, Chuan Hu, Tian Baishashen, Chao Shengdi, Sheng Gancao, Fushen. (From *Linzheng Zhinan Yian*)