失音者，语无声音，盖即喑也。夫喉咙者，气之所上下也；会厌者，声音之门户也。其
气宣
能言语也。《外台》云∶肝风其口不能言，脾风声不出，或上下手。又云∶脾之脉，挟喉连
舌本，心之别脉系舌本。今心脾脏受风邪，故舌强不得语也。河间云∶内夺而厥，谓肾脉虚
弱，其气厥不至舌下，则舌喑不能言，足废不能用，经名喑痱，地黄饮子主之。比而论之，
失音者，语言如故，而声音不出，为脏之虚也。舌强不能语，虽语而謇涩不清，痰涎风气之
所为也。不语者，绝无语言，非神昏不知人，即脏气厥，不至舌下，要须分别治之。
河间地黄饮子
熟地黄 巴戟（去心） 石斛 山茱萸 苁蓉（酒浸，焙） 附子（泡） 五味子
肉桂 麦冬 白茯苓 石菖蒲 远志（去心，各等分）
上为末，每服三钱，水一盏半，生姜五片，枣一枚，薄荷七叶，同煎至八分，服无时。
涤痰汤
清心散（二方并见前逐痰涎门。）
《宝鉴》茯神散
茯神心（一两，炒） 薄荷（二两，焙） 蝎梢（去毒，五钱）
上为末，每服一二钱，温酒调下，此治风气挟痰不语之剂。
足阳明脉，循颊车；手太阳脉，循颈上颊。二经俱受风寒，筋骨引颊，令人口 僻。目
不能
《外台》治中风，面目相引，口 ，牙车急及舌不得转方
独活（三两） 竹沥 生地黄汁（各一升）
三味合煎，取一升顿服之，即愈。
又方
牡蛎（熬） 矾石（烧） 附子（泡去皮） 灶下黄土
上各等分为末，取三年雄鸡冠血，和药敷其上，候复故，便洗去之。《千金翼》云∶左
戴元礼云∶有无故口眼 斜，投以中风药不效，盖缘骨虚中受风邪所致。当于此求之，
不可例作寻常中风治之。
又方
蓖麻子去壳烂捣，右 涂左，左 涂右。或以鳝血入麝香少许涂之。
失音，是指说话没有声音，也就是所谓的“喑”。喉咙是气息上下通行的通道；会厌是声音发出的门户。如果气机宣通，就能正常言语。《外台秘要》中说：肝受风邪则口不能言，脾受风邪则声音发不出，或者出现手足运动障碍。又说：脾的经脉，挟持喉咙连接舌根；心的别行经脉系连舌根。现在心、脾两脏受到风邪侵袭，所以舌头僵硬而不能言语。刘河间说：内里精气亏虚而厥逆，是指肾脉虚弱，其气厥逆不至舌下，就会导致舌喑不能言语，足部废用不能行走，这种病在经络中称为“喑痱”，用地黄饮子主治。比较而言，失音的人，语言内容如常，只是声音发不出来，这是脏气虚弱的表现。舌强不能言语，虽然能说话但言语蹇涩不清，这是痰涎和风邪所致。不语的人，完全没有语言，如果不是神志昏迷不知人事，就是脏气厥逆，不至舌下，必须分别进行治疗。
河间地黄饮子
熟地黄、巴戟天（去心）、石斛、山茱萸、肉苁蓉（酒浸，焙干）、附子（炮制）、五味子、肉桂、麦冬、白茯苓、石菖蒲、远志（去心），以上各等分。
将上述药物研为细末，每次服用三钱，用水一盏半，生姜五片，大枣一枚，薄荷七片，共同煎煮至八分满，不拘时候服用。
《宝鉴》茯神散
茯神心（一两，炒）、薄荷（二两，焙干）、蝎梢（去毒，五钱）。
将上述药物研为细末，每次服用一二钱，用温酒调服，这是治疗风气挟带痰浊导致不语的方剂。
足阳明胃经，循行经过颊车穴；手太阳小肠经，循行经过颈部上行至面颊。这两条经脉都受到风寒侵袭，筋骨牵引面颊，导致人口眼歪斜。眼睛不能正常转动。
《外台秘要》治疗中风，面目相互牵引，口眼歪斜，牙关紧急及舌头不能转动的方剂：
独活（三两）、竹沥、生地黄汁（各一升）。
将这三味药合煎，取药液一升，一次性顿服，即可痊愈。
又一方：
牡蛎（熬制）、矾石（烧制）、附子（炮制去皮）、灶下黄土。
将上述药物各等分为细末，取三年雄鸡冠血，调和药物敷于患处，等到恢复常态后，便洗去药物。《千金翼方》说：左侧歪斜涂右侧，右侧歪斜涂左侧。或者用鳝鱼血加入少许麝香涂抹。
戴元礼说：有无故出现口眼歪斜的情况，投以治疗中风的药物无效，这大概是因为骨骼空虚，中间受到风邪所致。应当从这个角度寻求病因，不可一概当作寻常中风来治疗。
又一方：
蓖麻子去壳捣烂，右侧歪斜涂左侧，左侧歪斜涂右侧。或者用鳝鱼血加入少许麝香涂抹。
Yin (aphonia) refers to the inability to produce sound when speaking, which is also known as "yin". The throat is the passage through which qi ascends and descends; the epiglottis is the gateway for voice production. If qi flows freely, speech can be produced normally. *Waitai Mi Yao* states: When liver wind strikes, the mouth cannot speak; when spleen wind strikes, sound cannot emerge, or there may be impairment of hand and foot movement. It further states: The spleen meridian runs along the throat and connects to the root of the tongue; the divergent meridian of the heart ties to the root of the tongue. Now, if the heart and spleen organs are invaded by wind pathogen, the tongue becomes stiff and speech is impaired. Liu Hejian stated: Internal depletion leading to jue (reversal cold/impairment) refers to a deficiency and weakness of the kidney meridian, where its qi fails to reach below the tongue due to jue reversal, resulting in aphonia (tongue stiffness preventing speech) and leg paralysis (inability to use the feet). This condition is named "Yin Fei" in the classics and is treated with Dihuang Yinzi (Rehmannia Decoction). Comparatively, those with yin (loss of voice) retain normal language content but cannot produce sound, indicating a deficiency of the zang organs. Those with a stiff tongue unable to speak may attempt to talk but with slurred and unclear articulation, caused by phlegm-dampness and wind pathogen. Those who do not speak at all have no language output; this is either due to clouded spirit and unconsciousness, or due to zang qi jue reversal failing to reach below the tongue. These conditions must be differentiated and treated separately.
Hejian Dihuang Yinzi (Rehmannia Decoction of Liu Hejian)
Shu Dihuang (Prepared Rehmannia Root), Bajitian (Morinda Officinalis Root, heart removed), Shihu (Dendrobium Stem), Shanzhuyu (Cornus Fruit), Congrong (Cistanche Stem, soaked in wine, baked), Fuzi (Aconite Lateral Root, processed), Wuweizi (Schisandra Fruit), Rougui (Cinnamon Bark), Maidong (Ophiopogon Tuber), Baifuling (Poria with Hostwood), Shichangpu (Acorus Rhizome), Yuanzhi (Polygala Root, heart removed). All ingredients in equal proportions.
Grind the above herbs into powder. Take 3 qian per dose, decoct with 1.5 cups of water, 5 slices of fresh ginger, one jujube, and seven leaves of bohe (Mint) until reduced to 0.8 cup. Take at any time.
Ditan Tang (Phlegm-Expelling Decoction)
Qingxin San (Clear Heart Powder) (Both formulas are described in the preceding section on "Expelling Phlegm-Dampness".)
*Baojian* Fushen San (Poria Spirit Powder from Baojian)
Fushen Xin (Poria Spirit with Hostwood, 1 liang, stir-fried), Bohe (Mint, 2 liang, baked), Xie Shao (Scorpion Tail, detoxified, 5 qian).
Grind the above herbs into powder. Take 1–2 qian per dose, mixed with warm wine. This is a formula treating aphonia caused by wind pathogen combined with phlegm.
The Foot-Yangming Stomach Meridian follows the Jiache point; the Hand-Taiyang Small Intestine Meridian follows the neck up to the cheek. When both meridians are affected by wind-cold, the sinews and bones pull the cheek, causing deviation of the mouth and eyes (facial paralysis). The eyes cannot move properly.
*Waitai Mi Yao* treats stroke with facial pulling, deviation of the mouth and eyes, tightness of the jaw, and immobility of the tongue with the following formula:
Duhuo (Angelica Pubescens Root, 3 liang), Zhuli (Bamboo Sap), Sheng Dihuang Zhi (Fresh Rehmannia Juice, each 1 sheng).
Decoct these three ingredients together, obtain 1 sheng of liquid, and take it in one dose. Recovery will follow.
Another prescription:
Muli (Oyster Shell, calcined), Fanshi (Alum, burnt), Fuzi (Aconite Lateral Root, processed and peeled), Zaohuangtu (Yellow Earth from the Hearth, 1 liang).
Grind each ingredient into powder in equal proportions. Mix with the blood of the comb of a three-year-old rooster and apply to the affected area. Wash off once normal appearance returns. *Qianjin Yi Fang* states: Apply to the left side if the right is deviated, and to the right side if the left is deviated. Alternatively, use eel blood mixed with a small amount of Shexiang (Musk) for application.
Dai Yuanli stated: There are cases of sudden deviation of the mouth and eyes without apparent cause where treatments for stroke are ineffective. This is likely due to bone deficiency allowing wind pathogen to invade internally. One should seek the cause from this perspective and not treat it routinely as ordinary stroke.
Another prescription:
Remove the shell of Bimazi (Castor Seed) and pound it into a paste. Apply to the left side if the right is deviated, and to the right side if the left is deviated. Alternatively, use eel blood mixed with a small amount of Shexiang (Musk) for application.