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。
【舌喑】经云∶心脉涩甚为喑。又云∶心脉搏坚而长，当病舌卷不能言。娄全善云∶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，热除而瘥。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。丹溪治一男子三十五岁，因连日劳倦发喊，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，吐胶痰三块，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。针灸喑有二法∶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∶手少阴之别，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。
【喉喑】《灵枢经》忧恚无言篇，黄帝问于少师曰∶人之卒然忧恚而言无音者，何道之塞？何气
出行，使音不彰？愿闻其方。少师答曰∶咽喉者，水谷之道也。喉咙者，气之所以上下者也。会厌者，
声音之户也。口唇者，音声之扇也。舌者，音声之机也。悬雍垂者，音声之关也。颃颡者，分气之所
泄也。横骨者，神气所使，主发舌者也。故人鼻洞涕出不收者，颃颡不开，分气失也。是故厌小而疾
薄，则发
气疾，其开阖利，其出气易；其厌大而浓，则开阖难，其气出迟，故重言也。人卒然无音者，寒气客
于厌，则厌不能发，发不能下，至其开阖不致，故无音。黄帝曰∶刺之奈何？岐伯曰∶足之少阴上系
于舌，络于横骨，终于会厌。两泻其血脉，浊气乃辟，会厌之脉，上络任脉，取之天突，其厌乃发也。
杂病篇，厥气走喉而不能言，手足清，大便不利，取足少阴。丹溪治俞继道遗精，误服参 及升浮剂，
遂气壅于上焦而喑，声不出，用香附、童便浸透为末调服，而疏通上焦以治喑。又用蛤粉、青黛为君，
黄柏、知母、香附佐之为丸，而填补下焦以治遗，十余日良愈。出声音方，诃子炮去核，木通各一两，
甘草半两，用水三升，煎至升半，入生姜、地黄汁一合，再煎数沸，放温，分六服，食后，日作半料。
河间诃子汤，诃子折逆气，破结气，木通通利机窍，桔梗通利肺气，童便降火润肺，故诸方通用之。
发声散，开结痰。《肘后方》陈皮五两，水三升，煮取一升，去渣顿服，泄滞气下痰。《千金》云∶
风寒之气客于中，滞而不发，故喑不能言，宜服发表之药，不必治喑。以紫梗荆芥根一两，研汁，入
酒相和，温服半盏，服无时。又方，用 荷根二两绞汁，
酒一大盏和匀，温服半盏，无时，此皆治风冷失音。冬月寒痰结咽喉不利，语声不出。经云∶寒气客
于会厌，卒然而哑是也。玉粉丸主之。肺间邪气，胸中积血作痛，失音，蛤蚧丸。暴嗽失音，宜润燥
通声膏。咳嗽声嘶者，此血虚受热也。用青黛、蛤粉，蜜调服之。槐花，瓦上炒令香熟，于地上出火
毒，三更后，床上仰卧随意服，治热而失音。杏仁三分去皮尖炒，另研如泥，桂一分和，取杏核大，
绵裹含，细细咽之，日五夜三。又方，以桂末着舌下，咽津妙，此治寒而失音。孙兆口诀云∶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。孙用补心气薯蓣丸，以细辛、川
芎治湿，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，燃后以川芎、细辛，
又去湿气，所以能语也。运气喑有二法∶一日热助心实。经云∶少阴之复，暴喑，治以苦寒是也。二
曰寒攻心虚。经云∶岁火不及，寒乃大行，民病暴喑，治以咸温是也。
狐惑声哑，其证默默欲眠，目不能闭，起居不安是也。针灸喑有三法∶其一取足少阴篇首所引二段经
文是也。其二取足阳明。经云∶足阳明之别，名曰丰隆，去踝八寸，别走太阴，下络喉嗌，其病气逆
则喉痹卒喑，取之所别是也。娄全善治一男子四十九岁，久病痰嗽，忽一日感风寒，食酒肉，遂厥气
走喉病暴喑。与灸足阳明丰隆二穴各三壮，足少阴照海穴各一壮，其声立出，信哉，圣经之言也。仍用
黄芩降火为君，杏仁、陈皮、桔梗泻厥气为臣，诃子泄逆，甘草和元气为佐，服之良愈。其三取手阳
明。经云∶暴喑气哽，取扶突与舌本出血。舌本，廉泉穴也。
【妊娠喑】《素问》黄帝曰∶人之重身，九月而喑，此为何也？岐伯曰∶胞之络脉绝也。帝曰∶
何以言之？岐伯曰∶胞络者，系于肾，少阴之脉贯肾、系舌本，故不能言。帝曰∶治之奈何？岐伯曰∶
无治也。当十月复。（王注云∶少阴，肾脉也，气不荣养，故不能言。）
【产后喑】陈氏云∶产后不语，因心气虚而不能通于舌，则舌强不能言语者，宜服七珍散。余当
推其所因而治之。薛新甫曰∶经云大肠之脉散舌下。又云脾之脉，是动则病舌本强，不能言。又云肾
之别脉，上入于心系舌本，虚则不能言。窃谓前
证，若心肾气虚，用七珍散。肾虚风热，地黄饮。大肠风热，加味逍遥散加防风、白芷。脾经风热，
秦艽升麻汤。肝经风热，柴胡清肝散加防风、白芷。脾气郁结，加味归脾汤加升麻。肝木太过，小柴
胡加钓藤钩。脾受土侮，六君加升麻、白芷、钓藤钩。肝脾血虚，用佛手散。脾气虚，用四君子。气
血俱虚，八珍汤；如不应，用独参汤；更不应，急加附子补其气而生其血。若径用血药则误矣。郭氏
论人心有七孔三毛，产后虚弱，多致停积败血闭于心窍，神志不能明了。心气通于舌，心气闭塞则舌
亦强矣，故令不语，但服七珍散。胡氏孤凤丹散，治产后闭目不语，用白矾细研，每服一钱，热水调
下。
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。”然而主要有两种证型：一是舌喑，属于中风导致舌体运动障碍的类型；二是喉喑，属于劳损咳嗽导致声音嘶哑或失音的类型。大概来说，舌喑只是舌根不能灵活转动以辅助言语，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辅助言语。
【舌喑】《内经》说：“心脉涩滞严重会导致失音。”又说：“心脉搏动坚实而长，应当病发为舌卷缩不能言语。”娄全善说：“人舌体短缩、言语不清，是由于痰涎闭塞了舌本的经脉所致。”我曾治疗一名中年男子，患伤寒身体发热，医生给予伤寒药五帖，后来病情变化出现神志昏迷且失音，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、姜汁服用。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，舌头逐渐能灵活转动言语，热退后痊愈。因为足少阴肾经夹行于舌本，足太阴脾经连系于舌本，手少阴心经的别络系于舌本，所以这三条经脉虚弱时，痰涎乘虚闭塞脉道，导致舌头不能灵活转动言语。如果这三条经脉亡血，则舌头缺乏血液滋养而失音。《内经》说：“针刺足少阴脉若造成重虚并出血，会导致舌头难以言语。”又说：“针刺舌下中脉太过，出血不止会导致失音。”治疗应当用前方加入补血药物。我又曾治疗一名五十多岁的男子，因嗜酒吐血约一桶后不再进食，舌头不能言语，只口渴想喝水，脉象略数。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，服至二十多帖后能说话。如果这三条经脉受风热侵袭，则经脉弛缓纵缓，所以舌头也弛缓纵缓不能转动而失音。若风寒客袭，则经脉收缩拘急，所以舌体强硬、舌卷缩而失音。治疗应参照中风半身不遂的方法来求治。丹溪治疗一名三十五岁男子，因连日劳累呼喊，引发疟疾，医生给予疟疾药，发作三次后变为发热、舌体短缩、言语不清，喉间痰鸣有声，诊其脉洪数似滑，于是用独参汤加竹沥两蚶壳量，服两次后，吐出胶状痰块三块，舌根恢复正常，言语清晰，其余症状未退，于是煎服人参黄芪汤，服用半个月后所有症状皆退，再用粥食调养补益两个月，才能起身站立。
针灸治疗失音有两种方法：其一取脾经。《内经》说：“足太阴脾经发生病变会病发为舌根强硬，需视其盛、虚、热、寒、陷下等情况进行取穴治疗。”其二取心经。《内经》说：“手少阴心经的别络，名叫通里，位于腕横纹上一寸五分处，别行向上进入心中，系于舌本，虚证则不能言语，取穴在掌后一寸处。”
【喉喑】《灵枢经·忧恚无言篇》记载，黄帝问少师说：“人突然因忧愤而不能说话的原因是什么？哪条道路阻塞？什么气运行异常，导致声音不显？希望听听其中的道理。”少师回答说：“咽喉是水谷通行的道路。喉咙是气体上下出入的部位。会厌是声音的门户。口唇是声音的扇子。舌是声音的机关。悬雍垂是声音的关卡。颃颡（鼻咽部）是分泄气的地方。横骨受神气支配，主要控制舌的运动。所以，人鼻孔流涕不收者，是因为颃颡不开，分气功能失常。因此，会厌小而薄的人，发声快，开阖通畅，出气容易；会厌大而厚的人，开阖困难，出气迟缓，所以说话重浊。人突然失音，是因为寒气客居于会厌，导致会厌不能张开，张开也不能闭合，直到开阖失调，所以失音。”黄帝说：“如何针刺治疗？”岐伯说：“足少阴肾经上行系于舌，联络于横骨，终于会厌。泻其血脉中的浊气，浊气排除后，会厌的脉络上络任脉，取天突穴，会厌就能张开发挥作用。”
《灵枢·杂病篇》记载，厥气走窜至喉部而不能言语，手足寒冷，大便不通，取足少阴经治疗。丹溪治疗俞继道遗精，误服人参及升浮类药物，导致气壅塞于上焦而失音，声音不出，用香附、童便浸透研末调服，以疏通上焦治疗失音。又用蛤粉、青黛为君药，黄柏、知母、香附为佐药制成丸剂，以填补下焦治疗遗精，十余日后痊愈。
出自《声音方》，诃子炮制去核，木通各一两，甘草半两，用水三升，煎至一升半，加入生姜、地黄汁一合，再煎几沸，放温，分六次服用，饭后服，每天用一半药料。河间先生的诃子汤，诃子能降逆气、破结气，木通通利机窍，桔梗通利肺气，童便降火润肺，所以各方通用。
发声散，用于开通结聚之痰。《肘后方》记载，陈皮五两，水三升，煮取一升，去渣顿服，可泄滞气、下痰。《千金方》说：“风寒之气客居体内，停滞而不发散，所以失音不能言语，适宜服用发表的药物，不必专门治疗失音。”用紫梗荆芥根一两，研汁，与酒混合，温服半盏，随时可服。另一法，用藕根二两绞汁，与一大盏酒混合均匀，温服半盏，随时可服，这都是治疗风冷导致的失音。冬季寒痰凝结于咽喉不利，语声不出，《内经》说：“寒气客居于会厌，突然失音”，用玉粉丸主治。肺间有邪气，胸中积血作痛，失音，用蛤蚧丸。暴咳失音，宜用润燥通声膏。咳嗽声音嘶哑，这是血虚受热所致。用青黛、蛤粉，蜂蜜调服。槐花，在瓦上炒至香熟，在地上去除火毒，三更后仰卧床上随意服用，治疗热性失音。杏仁三分去皮尖炒，另研如泥，桂一分混合，取杏核大，用棉包裹含在口中，细细咽下，白天五次夜间三次。另一法，将桂末置于舌下，咽津液甚妙，这是治疗寒性失音。孙兆口诀云：“内侍曹都使，新建宅邸落成迁入，经过半个月，饮酒大醉，起床后失音不能言语。孙兆用补心气薯蓣丸，以细辛、川芎祛湿，十日病情渐减，二十日全愈。曹都使病愈后见皇上问是谁医治，说是孙兆郎中，皇上召来询问说：‘曹都使患的是什么病？’孙兆回答说：‘凡是新宅墙壁泥土皆湿，地面也多阴气，人刚来阴气未散，曹都使心气素来虚弱，饮酒至醉，毛孔皆开，阴湿之气从外侵入乘袭心经，心经既虚，湿气又乘虚而入，所以不能言语。臣先用薯蓣丸使心气壮实，然后用川芎、细辛去除湿气，所以能言语。’”
运气致喑有两种方法：一是热助心实。《内经》说：“少阴之复，突发失音，用苦寒药物治疗。”二是寒攻心虚。《内经》说：“岁火不及，寒气大行，百姓病发突发失音，用咸温药物治疗。”
狐惑病声音嘶哑，其症状表现为沉默欲睡，眼睛不能闭合，起居不安。
针灸治疗失音有三种方法：其一是取足少阴经，即篇首引用的两段经文所述内容。其二是取足阳明经。《内经》说：“足阳明胃经的别络，名叫丰隆，位于外踝上八寸处，别行走向太阴经，向下联络喉嗌，其病气逆则喉痹突发失音，取该别络所在穴位即可。”娄全善治疗一名四十九岁男子，久患痰嗽，忽然一日感受风寒，食用酒肉，导致厥气走窜至喉部病发突发失音。给予灸足阳明丰隆穴各三壮，足少阴照海穴各一壮，声音立刻发出，确实验证了圣经之言。仍用黄芩降火为君药，杏仁、陈皮、桔梗泻厥气为臣药，诃子泄逆气，甘草和元气为佐药，服用后痊愈。其三是取手阳明经。《内经》说：“突发失音气哽，取扶突穴与舌本穴出血。舌本穴，即廉泉穴。”
【妊娠喑】《素问》记载，黄帝说：“妇人怀孕，到第九个月失音，这是什么原因？”岐伯说：“胞宫的络脉阻滞不通。”帝曰：“为什么这么说？”岐伯说：“胞络系于肾，足少阴肾经贯穿肾脏、系于舌本，所以不能言语。”帝曰：“如何治疗？”岐伯说：“不需要治疗。等到第十个月自然会恢复。（王冰注解说：少阴指肾脉，气不能荣养舌本，所以不能言语。）”
【产后喑】陈氏说：“产后不语，是因为心气虚不能通达于舌，导致舌强不能言语，适宜服用七珍散。我应当推究其原因进行治疗。”薛新甫说：“《内经》说大肠的经脉散布于舌下。又说脾的经脉，发生病变会病发为舌根强硬，不能言语。又说肾的别脉，上行进入心系舌本，虚证则不能言语。我认为前述证候，若心肾气虚，用七珍散。肾虚风热，用地黄饮。大肠风热，用加味逍遥散加防风、白芷。脾经风热，用秦艽升麻汤。肝经风热，用柴胡清肝散加防风、白芷。脾气郁结，用加味归脾汤加升麻。肝木太过，用小柴胡汤加钩藤。脾受土侮（肝木克脾土之反侮），用六君子汤加升麻、白芷、钩藤。肝脾血虚，用佛手散。脾气虚，用四君子汤。气血俱虚，用八珍汤；如果无效，用独参汤；更无效，急加附子补气以生血。如果直接用补血药就错了。”郭氏论述人心有七孔三毛，产后虚弱，多导致败血停积闭于心窍，神志不能明了。心气通于舌，心气闭塞则舌也强硬，所以令人不语，只需服用七珍散。胡氏孤凤丹散，治疗产后闭目不语，用白矾细研，每次服一钱，热水调下。
Yin (loss of voice) is caused by pathogenic factors invading the Yin aspect. The Classics state: "When pathogenic factors contend with the Yin, loss of voice occurs." It also states: "When pathogenic factors enter the Yin and contend, it results in loss of voice." However, there are two main syndromes: one is She Yin (tongue-related loss of voice), which belongs to the type where stroke causes impairment of tongue movement; the other is Hou Yin (throat-related loss of voice), which belongs to the type where chronic coughing leads to hoarseness or aphonia. Generally speaking, She Yin involves only the inability of the root of the tongue to move flexibly to assist 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 to assist speech.
[She Yin] The Classics state: "Severe stagnation of the Heart pulse leads to loss of voice." It also states: "A firm and long Heart pulse indicates a disease of tongue retraction and inability to speak." Lou Quanshan stated: "When a person's tongue is short and speech is indistinct, it is due to phlegm-fluid obstructing the meridians connected to the root of the tongue." I once treated a middle-aged man suffering from Shanghan (cold damage) with fever. After taking five doses of Shanghan medicine prescribed by another doctor, his condition worsened to stupor and aphasia. I then treated him for constitutional deficiency with phlegm-dampness, using Ren Shen (Ginseng Radix et Rhizoma) 5 qian, Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Chen Pi (Citri Reticulatae Pericarpium) each 1 qian, decocted in water, with Zhu Li (Bambusae Caulis in Taenia) and Jiang Zhi (Zingiberis Recens Juice) added. After twelve days, he could utter only one word. After another half-month of treatment, his tongue gradually regained flexibility for speech, the heat subsided, 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 Hand-Shaoyin Heart meridian's branch ties to the root of the tongue. When these three meridians are deficient, phlegm-fluid takes advantage of the deficiency to obstruct the meridians, causing the tongue to lose its ability to move and articulate. If blood is lost in these three meridians, the tongue lacks blood nourishment and becomes aphonic. The Classics state: "If the Foot-Shaoyin meridian is punctured causing severe deficiency and bleeding, the tongue will be difficult to move for speech." It also states: "Excessive puncture of the vessels under the tongue leading to continuous bleeding causes loss of voice." Treatment should involve adding blood-nourishing herbs to the previous formula. I also treated a man over fifty who, after vomiting approximately one bucket of blood due to alcohol abuse and ceasing food intake, could not speak but felt thirsty and drank water; his pulse was slightly rapid. I prescribed Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Shao (Paeoniae Radix Alba), and Shu Di Huang (Rehmanniae Radix Praeparata) each 1 liang, Bai Zhu (Atractylodis Rhizoma) and Ren Shen (Ginseng Radix et Rhizoma) each 2 liang, Chen Pi (Citri Reticulatae Pericarpium) 1.5 liang, and Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 qian, with Zhu Li (Bambusae Caulis in Taenia), Tong Bian (Infant Urine), and Jiang Zhi (Zingiberis Recens Juice) added. After more than twenty doses, he could speak. If wind-heat invades these three meridians, the meridians become flaccid and lax, causing the tongue to be lax and unable to move, resulting in aphonia. If wind-cold invades, the meridians contract and spasm, causing the tongue to be stiff and retracted, resulting in aphonia. Treatment should follow the methods for treating stroke with hemiplegia. Danxi treated a thirty-five-year-old man who, after shouting continuously due to fatigue, developed malaria. After three attacks following treatment with malaria medicines, he developed fever, tongue retraction, indistinct speech, and rattling phlegm in the throat. His pulse was surging, rapid, and seemingly slippery. I administered Du Shen Tang (Single Ginseng Decoction) with Zhu Li (Bambusae Caulis in Taenia) equivalent to two clam shells. After two doses, he expectorated three pieces of gelatinous phlegm, his tongue root returned to normal, and speech became clear. As other symptoms persisted, I decocted and administered Ren Shen Huang Qi Tang (Ginseng and Astragalus Decoction). After half a month of this, all symptoms receded. He then recovered his ability to stand after two months of dietary supplementation with congee.
There are two acupuncture methods for treating aphonia: First, select the Spleen meridian. The Classics state: "Pathological changes in the Foot-Taiyin Spleen meridian cause stiffness of the tongue root; treat according to excess, deficiency, heat, cold, or sinking conditions." Second, select the Heart meridian. The Classics state: "The branch of the Hand-Shaoyin Heart meridian is named Tongli (HT5), located 1.5 cun above the wrist crease, ascending into the heart and tying to the root of the tongue. In deficiency cases where speech is impaired, select the point 1 cun behind the palm."
[Hou Yin] The *Lingshu Jing* (Spiritual Pivot), chapter "Worry and Anger Without Speech," records: The Yellow Emperor asked Shaoshi: "What causes sudden loss of voice due to worry and anger? Which pathway is blocked? What abnormal qi movement prevents sound projection? I wish to hear the explanation." Shaoshi replied: "The pharynx is the pathway for water and grain. The larynx is the passage for qi ascent and descent. The epiglottis is the door of sound. The lips are the fan of sound. The tongue is the mechanism of sound. The uvula is the gate of sound. The Hangsang (nasopharynx) is where divided qi escapes. The Henggu (hyoid bone) is directed by spirit qi and primarily controls tongue movement. Therefore, if nasal discharge cannot be contained, it is because the Hangsang is not opening, and the function of dividing qi is lost. Thus, those with small and thin epiglottides emit sound quickly, open and close easily, and exhale air readily; those with large and thick epiglottides have difficulty opening and closing, exhale air slowly, and thus speak with a heavy voice. Sudden aphonia occurs when cold pathogen lodges in the epiglottis, preventing it from opening or closing properly, leading to dysfunction of opening and closing, hence no sound." The Yellow Emperor asked: "How to treat with needling?" Qibo replied: "The Foot-Shaoyin Kidney meridian ascends to tie to the tongue, connects to the Henggu, and terminates at the epiglottis. By draining the blood vessels twice, turbid qi is expelled. The epiglottis meridian connects upward to the Ren Mai (Conception Vessel); selecting Tian Tu (CV22) allows the epiglottis to function."
The *Zabing Pian* (Miscellaneous Diseases Chapter) of the *Lingshu* states: When jue qi (rebellious qi) travels to the throat causing aphonia, accompanied by cold extremities and constipation, select the Foot-Shaoyin meridian. Danxi treated Yu Jidao for seminal emission. Due to mistakenly consuming Ren Shen (Ginseng Radix et Rhizoma) and ascending-floating agents, qi became congested in the upper jiao, causing aphonia and inability to vocalize. He used Xiang Fu (Cyperi Rhizoma) soaked in Tong Bian (Infant Urine), ground into powder and taken with liquid, to unblock the upper jiao and treat aphonia. He also prepared pills using Ha Fen (Concha Meretricis) and Qing Dai (Indigo Naturalis) as the sovereign herbs, with Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), and Xiang Fu (Cyperi Rhizoma) as minister herbs, to tonify the lower jiao and treat seminal emission. He recovered well after ten days.
From *Shengyin Fang* (Formula for Voice): He Zi (Terminalia Chebulae Fructus) processed and pitted, Mu Tong (Akebiae Caulis) each 1 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 0.5 liang. Decoct in 3 sheng of water until 1.5 sheng remains. Add 1 he of Sheng Jiang (Zingiberis Rhizoma Recens) and Di Huang Zhi (Rehmanniae Juice). Boil briefly. Warm and divide into six doses. Take after meals, using half the material daily. Hejian's He Zi Tang (Chebula Decoction): He Zi (Terminalia Chebulae Fructus) descends rebellious qi and breaks stagnation; Mu Tong (Akebiae Caulis) unblocks orifices; Jie Geng (Platycodonis Radix) unblocks Lung qi; Tong Bian (Infant Urine) clears fire and moistens lungs. Hence, these formulas are commonly used together.
Fasheng San (Voice-Unblocking Powder) opens knotted phlegm. *Zhouhou Fang* (Handbook of Prescriptions for Emergencies): Chen Pi (Citri Reticulatae Pericarpium) 5 liang, water 3 sheng. Boil to obtain 1 sheng. Strain and take in one dose to drain stagnant qi and descend phlegm. *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) states: "When wind-cold pathogen lodges internally, stagnating and failing to disperse, aphonia results. It is appropriate to use exterior-releasing drugs; there is no need to specifically treat aphonia." Use Zijie Jingjie Gen (Radix Schizonepetae cum Radice) 1 liang, crush and extract juice, mix with wine, warm and take half a zhan at any time. Another prescription: Ou Gen (Nelumbinis Rhizomatis Rhizoma) 2 liang, extract juice, mix with one large zhan of wine, warm and take half a zhan at any time. These all treat wind-cold induced aphonia. In winter, cold-phlegm knots in the throat causing obstruction and aphonia. The Classics state: "Cold pathogen lodging in the Huian (epiglottis) causes sudden muteness." Treat with Yufen Wan (Jade Powder Pill). For evil qi in the lungs, accumulated blood in the chest causing pain and aphonia, use Gejie Wan (Gecko Pill). For sudden cough with aphonia, use Rundao Tongsheng Gao (Moistening Dryness and Unblocking Voice Ointment). Cough with hoarseness is due to blood deficiency with heat. Use Qing Dai (Indigo Naturalis) and Ha Fen (Concha Meretricis), mixed with honey and taken. Huai Hua (Sophorae Flos), roasted on a tile until fragrant, cooled on the ground to remove fire toxicity, taken freely after midnight while lying supine, treats heat-induced aphonia. Xing Ren (Armeniacae Semen Amarum) 3 fen, peeled and tip removed, stir-fried, ground separately into paste, mixed with Gui (Cinnamomi Ramulus) 1 fen. Form a pill size of an apricot pit, wrap in cotton, hold in mouth, swallow saliva slowly. Take 5 times day and 3 times night. Another method: Place Gui Mo (Cinnamomi Ramulus Powder) under the tongue, swallowing saliva is excellent; this treats cold-induced aphonia. Sun Zhao's Koujue says: "Eunuch Cao Dushi built a new house and moved in. Half a month later, after getting heavily drunk, he woke up with aphonia and could not speak. Sun Zhao used Buxin Qi Shuyu Wan (Ginseng and Dioscorea Pill to Tonify Heart Qi), using Xi Xin (Asari Radix et Rhizoma) and Chuan Xiong (Ligustici Chuanxiong Rhizoma) to treat dampness. After ten days, the illness gradually decreased; after twenty days, full recovery. When Cao recovered and saw the Emperor asking who treated him, saying it was Physician Sun Zhao, the Emperor summoned Sun Zhao and asked: 'What disease did Cao suffer?' Sun Zhao answered: 'All wall mud in new houses is damp, and the ground is yin-heavy. When people first arrive, the yin qi has not dispersed. Cao's Heart qi was originally deficient. Getting drunk opened all hair pores, allowing yin-damp qi to enter and attack the Heart meridian. Since the Heart meridian was deficient, dampness took advantage. Thus, he could not speak. I first used Shuyu Wan to strengthen Heart qi, then used Chuan Xiong and Xi Xin to remove dampness, so he could speak.'"
There are two types of Yunqi (Five Movements and Six Qi) induced aphonia: One is heat assisting Heart excess. The Classics state: "In the recurrence of Shaoyin, sudden aphonia occurs; treat with bitter-cold drugs." Two is cold attacking Heart deficiency. The Classics state: "When Year Fire is insufficient, cold dominates greatly, and people suffer sudden aphonia; treat with salty-warm drugs."
Huo Huo (Huohuo disease) with hoarse voice presents with silence, desire to sleep, inability to close eyes, and restlessness.
There are three acupuncture methods for treating aphonia: First, select the Foot-Shaoyin meridian, referring to the two Classic passages cited at the beginning of the chapter. Second, select the Foot-Yangming meridian. The Classics state: "The branch of the Foot-Yangming Stomach meridian is named Fenglong (ST40), located 8 cun above the malleolus, diverging to connect with the Taiyin, descending to link the throat. Its pathology involves rebellious qi causing throat bi and sudden aphonia; select the divergence point." Lou Quanshan treated a forty-nine-year-old man with chronic phlegm-cough. Suddenly, after contracting wind-cold and consuming alcohol and meat, he suffered from jue qi traveling to the throat causing sudden aphonia. He moxa'd Fenglong (ST40) on the Foot-Yangming meridian with three moxa cones on each side, and Zhaohai (KI6) on the Foot-Shaoyin meridian with one cone on each side. His voice immediately returned, confirming the truth of the Sacred Classics. He then used Huang Qin (Scutellariae Radix) as sovereign herb to clear fire, Xing Ren (Armeniacae Semen Amarum), Chen Pi (Citri Reticulatae Pericarpium), and Jie Geng (Platycodonis Radix) as minister herbs to drain jue qi, He Zi (Terminalia Chebulae Fructus) to drain rebellious qi, and Gan Cao (Glycyrrhizae Radix et Rhizoma) as assistant herb to harmonize yuan qi. He recovered well. Third, select the Hand-Yangming meridian. The Classics state: "For sudden aphonia and qi choking, select Futu (LI18) and Sheben (Lianquan/CV23) to induce bleeding. Sheben refers to the Lianquan acupoint."
[Pregnancy Aphonia] The *Suwen* records: The Yellow Emperor said: "Why does a pregnant woman lose her voice in the ninth month?" Qibo replied: "Because the collateral vessels of the uterus are obstructed." The Emperor asked: "Why do you say so?" Qibo replied: "The uterine collaterals are tied to the Kidney. The Shaoyin meridian passes through the Kidney and ties to the root of the tongue, hence the inability to speak." The Emperor asked: "How to treat?" Qibo replied: "No treatment is needed. It will recover in the tenth month. (Wang Bing's commentary: Shaoyin refers to the Kidney meridian. Qi fails to nourish, hence the inability to speak.)"
[Postpartum Aphonia] Chen Shi stated: "Postpartum muteness is due to Heart qi deficiency failing to communicate with the tongue, causing tongue stiffness and inability to speak. It is appropriate to consume Zhenzhen San (Seven Treasures Powder). I should deduce the cause and treat accordingly." Xue Xinpu stated: "The Classics state the Large Intestine meridian scatters below the tongue. It also states pathological changes in the Spleen meridian cause tongue stiffness and inability to speak. It also states the branch of the Kidney meridian enters the Heart system and ties to the root of the tongue; deficiency leads to inability to speak. I believe that for the aforementioned syndromes, if Heart and Kidney qi are deficient, use Zhenzhen San. If Kidney deficiency with wind-heat, use Dihuang Yin (Dihuang Decoction). If Large Intestine wind-heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Fang Feng (Saposhnikoviae Radix) and Bai Zhi (Angelicae Dahuricae Radix). If Spleen meridian wind-heat, use Qin Jiao Sheng Ma Tang (Belamcanda and Ligusticum Decoction). If Liver meridian wind-heat, use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) plus Fang Feng (Saposhnikoviae Radix) and Bai Zhi (Angelicae Dahuricae Radix). If Spleen qi stagnation, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction) plus Sheng Ma (Cimicifugae Rhizoma). If Liver wood is excessive, use Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Gou Teng (Uncariae Ramulus Cum Uncis). If Spleen suffers from Earth counter-restriction (Wood insulting Earth), use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Sheng Ma (Cimicifugae Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), and Gou Teng (Uncariae Ramulus Cum Uncis). If Liver and Spleen blood are deficient, use Foshou San (Buddha's Hand Powder). If Spleen qi is deficient, use Sijun Zi Tang (Four Gentlemen Decoction). If both qi and blood are deficient, use Bazhen Tang (Eight Treasures Decoction); if ineffective, use Dushen Tang (Single Ginseng Decoction); if still ineffective, urgently add Fu Zi (Aconiti Lateralis Radix Praeparata) to tonify qi and generate blood. Using blood-tonifying drugs directly would be a mistake." Guo Shi discussed that the human Heart has seven apertures and three hairs. Postpartum weakness often leads to retained bloody stasis blocking the Heart apertures, causing unclear spirit and consciousness. Heart qi communicates with the tongue; if Heart qi is blocked, the tongue becomes stiff, causing muteness. Simply consume Zhenzhen San. Hu Shi's Gufeng Dan San (Lone Phoenix Pill Powder) treats postpartum closed-eye muteness. Use Bai Fan (Alumen) finely ground, take 1 qian per dose, mixed with hot water.