瘴病初起发热头痛。或呕逆或不呕逆。兼症虽多。惟以其神昏不能言。但噫噫作声。或全不
作声。谓之 瘴。此热瘴之甚者。故谚云。 瘴无不死。为不治之症也。但不犯不可服之药。治得
其道。千百人亦可起一二人。其脉初起一二日。七八至而弦。热大至三四日。热微神清脉反和平。
如其症。精神清目开如常。能饮食能大小便。热微脉平常。只是全不作声者。此真 瘴极难救。
盖肺气入心则为声音。今瘴毒之热沸其血涌于上。塞于
心肺之窍。故不能言。七日后多死。治当散其血。用麦冬汤。调黑神散。亦有得生。如其症目上视。
口噤牙关紧闭昏不知人。遗尿遗屎不能言。以手重拿曲池虎口。颊车人中亦知畏疼。不能出声叫哭。
待热微时稍言一二句。此痰迷心窍也。为哑瘴用青州白丸子二陈合星附汤。或三生饮。元气虚者。
加人参十可活三四。如手足搐搦气逆者。附香散。及养正丹。如因食冷所致者。苏感丸。
如其症。精神不甚昏。能饮食。大小便亦通。热不甚。惟舌本强木不转而不能言者。亦非正 瘴。
乃瘴毒中于心脾二经所致。心之别脉系舌本。脾之别脉连舌下。邪气入其经络亦然。用正舌散。
及全蝎麝香南星茯苓之类治之。
如其症初起或者寒瘴。或者热瘴。能言语。因医者误用发汗。及升药降药而变 者。为不治之症。
虽神气清爽脉息和平。二三日决死。不可用药。
瘴病初起时出现发热、头痛。有的伴有呕吐逆气，有的则不呕吐。虽然兼症很多，但唯独以神志昏迷、不能说话，只是发出“噫噫”的声音，或者完全不出声为特征，这称为“哑瘴”。这是热性瘴病中极严重的类型，所以谚语说：“哑瘴没有能治好的”，属于不治之症。但是如果不服用禁忌的药物，治疗得当，千百人中也可以救活一两个人。
其脉象在初起的一两天内，脉搏跳动急促（七八至）且弦紧；到了热势最盛的三四天，如果热势稍减、神志清醒、脉象反而平和，如患者精神清爽、眼睛睁开如常、能进食、大小便正常、热势轻微、脉象平常，只是完全不能说话，这属于真正的哑瘴，极难救治。
大概因为肺气入心则产生声音。现在瘴毒的热邪沸腾血液，使血涌向上方，堵塞了心肺的窍道，所以不能说话。这种情况七日后大多死亡。治疗应当散瘀血，使用麦冬汤，并调服黑神散，也有能够存活的。
如果症状表现为眼球上视、牙关紧闭、口噤、神志昏迷不知人事、大小便失禁、不能说话，但用手用力按压曲池穴和虎口（合谷穴）、颊车穴、人中穴时，患者也知道因疼痛而畏惧躲避，不能出声叫哭，等到热势稍减时能说出一两句，这属于痰迷心窍。对于这种哑瘴，使用青州白丸子配合二陈汤加星附汤，或者使用三生饮。如果是元气虚弱者，加入人参，十人可活三四人。如果出现手足抽搐、气逆的症状，使用附香散及养正丹。如果是因食用生冷食物引起的，使用苏感丸。
如果症状表现为精神不是特别昏沉，能进食，大小便也通畅，热势不严重，只是舌根僵硬麻木、转动不灵而不能说话，这也不是真正的哑瘴。而是瘴毒侵袭心脾两经所致。心的别络联系舌根，脾的别络连接舌下，邪气侵入这些经络也会造成这种情况。使用正舌散，以及全蝎、麝香、南星、茯苓等药物治疗。
如果初起时或者是寒瘴，或者是热瘴，原本能言语，但因为医生误用发汗法，以及升提药或降泄药而导致病情变化的，属于不治之症。即使神气清爽、脉息平和，二三天内也必然死亡，不可再用药。
At the onset of miasma disease, fever and headache occur. Some patients experience vomiting or regurgitation, while others do not. Although there are many accompanying symptoms, the defining characteristic is mental confusion with an inability to speak, producing only "yi yi" sounds, or complete silence; this is termed "aphonic miasma" (Ya Zhang). This represents a severe form of heat-type miasma. Hence, the proverb states, "Aphonic miasma has no survivors," indicating it is an incurable condition. However, if forbidden medications are avoided and treatment follows the correct principles, one or two out of thousands might be saved.
In the first one or two days of onset, the pulse is rapid (seven to eight beats per breath) and wiry. By the third or fourth day, when heat is at its peak, if the heat subsides slightly, consciousness clears, and the pulse becomes peaceful, and if the patient's spirit is clear, eyes open normally, able to eat and excrete, with mild heat and a normal pulse, yet still completely unable to speak, this constitutes true aphonic miasma, which is extremely difficult to rescue.
Generally, voice is produced when Lung Qi enters the Heart. Now, the heat of miasma toxins boils the blood, causing it to surge upward and block the orifices of the Heart and Lungs, resulting in the inability to speak. Most patients die after seven days. Treatment should focus on dispersing stagnant blood using Maidong Tang (Ophiopogon Decoction) combined with Heishen San (Black Divine Powder); some may survive.
If symptoms include upward deviation of the eyes, locked jaw, coma, loss of bladder and bowel control, and inability to speak, but the patient shows pain avoidance when strong pressure is applied to Quchi (LI11), Hegu (LI4), Jiache (ST6), and Renzhong (GV26), and can utter a few words once the heat subsides, this indicates phlegm confusing the Heart orifice. For this type of aphonic miasma, use Qingzhou Bai Wan Zi (Qingzhou White Pills) combined with Erchen Tang (Two-Aged Decoction) plus Xingfu Tang (Arisaema and Aconite Decoction), or Sansheng Yin (Three-Life Decoction). In cases of deficient Yuan Qi, add Renshen (Ginseng Root); three or four out of ten may survive. If there are spasms of the limbs and rebellious Qi, use Fuxiang San (Aucklandia and Costus Powder) and Yangzheng Dan (Nourishing Righteousness Pill). If caused by consuming cold foods, use Sugan Wan (Su Gan Pill).
If the patient is not severely confused, can eat, has unobstructed urination and defecation, has mild heat, but suffers from a stiff and numb tongue root that cannot move, preventing speech, this is not true aphonic miasma. It results from miasma toxins affecting the Heart and Spleen meridians. The collateral vessels of the Heart connect to the tongue root, and those of the Spleen connect to under the tongue; pathogenic qi invading these collaterals causes similar effects. Treat with Zhengshe San (Tongue-Correcting Powder) along with Quanxie (Scorpion), Shexiang (Musk), Nanxing (Arisaema Rhizome), and Fuling (Poria).
If initially presenting as either cold-type or heat-type miasma, where the patient could originally speak, but the condition deteriorates due to the physician's erroneous use of diaphoretic methods, or ascending/descending herbs, it becomes an incurable condition. Even if the spirit is clear and the pulse is peaceful, death will occur within two or three days; medication should not be administered.