吴（三六）外冷内热。久逼失音。用两解法。（寒热客邪迫肺）麻杏甘膏汤
宋（三十）先失音。继喉痹。是气分窒塞。微寒而热。水饮呛出。咯痰随出随阻。此仍在上痹。舌黄口渴。
议与苦辛寒方。
射干 麻黄 杏仁 生甘草 石膏 苡仁
陆（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。仿金实无声议治。
麻黄 杏仁 生甘草 石膏 射干 苡仁
又 芦根汁 杏仁汁 莱菔汁 鲜竹沥 熬膏。
范（三一）气燥。喉痹失音。少阳木火犯上。（胆火烁喉）
生鸡子白 冬桑叶 丹皮 麦冬 生白扁豆壳
某 喉干失音。一月未复。津液不上供。肺失清肃。右寸脉浮大。（气分燥津液亏）
枇杷叶（一钱半） 马兜铃（八分） 地骨皮（一钱） 桑皮（八分） 麦冬（一钱） 生甘草（三分） 桔梗（六
分） 白粳米（二钱）
某 血后音哑。便溏。（失血津液亏）
生扁豆 炒白芍 炙草 川斛 山药 米糖 大枣
何 劳损。气喘失音。全属下元无力。真气不得上注。纷纷清热治肺。致食减便溏。改投热药。又
是劫液。宜乎喉痛神疲矣。用补足三阴方法。（阴虚）
熟地 五味 炒山药 茯苓 芡实 建莲肉
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）
夫宫商角征羽。歌哭呼笑呻。此五脏所属之音声也。原其发声之本在于肾。其标则在乎
肺。病有虚实。由咳嗽而起者居多。或肺有燥火。外感寒邪。火气郁遏而喑者。有肺金燥甚。
木火上炎。咽干喉痹而喑者。有风热痰涎。壅遏肺窍而喑者。有嗔怒叫号。致伤会厌者。亦
有龙相之火上炎。凌烁肺金。久咳不已而喑者。有内夺而厥。则为喑俳。此肾虚也。是即暴
中之不能言者也。先生有金空则鸣。金实则无声。金破碎亦无声。此三言足以该之矣。有
邪者。是肺家实也。无邪者。是久咳损肺。破碎无声也。其治法有寒者散寒。有火者清火。有
风痰则祛风豁痰。若龙相上炎烁肺者。宜金水同治。若暴中之喑。全属少阴之虚。宜峻补
肝肾。或稍兼痰火而治之。其用药总宜甘润。而不宜苦燥。斯得之矣。（华岫云）
徐评 久嗽失音。必由药误。麦冬五味。此失音之灵丹也。服之久。无不失音者。若全失。即使其
人力如虎。而走如马。半年之后。无有不死。若风寒痰火偶尔失音者。即不治亦愈。但更加以麦
冬五味。则弄假成真矣。此老竟茫然也。
吴（三十六岁）外感寒邪而内有郁热。因久病逼迫导致失音。采用表里双解法。（寒热客邪迫肺）麻杏甘膏汤
宋（三十岁）先出现失音，随后发展为喉痹。这是气分窒塞所致。症状表现为微恶寒且发热，饮水时呛咳，咯出的痰液随即造成阻塞。这仍然属于上焦的痹证。舌苔黄，口渴。
建议给予苦辛寒性质的方剂。
射干 麻黄 杏仁 生甘草 石膏 苡仁
陆（二十二岁）秋季凉燥之气引发咳嗽。初起时皮毛凛凛怕冷，冬季出现失音，直到夏季仍未痊愈，但饮食尚可。推测是屡次遭受暴冷暴暖的伤害。
未必是正气虚弱导致的失音，仿照“金实无声”的理论进行议治。
麻黄 杏仁 生甘草 石膏 射干 苡仁
又方：芦根汁、杏仁汁、莱菔汁、鲜竹沥，熬制成膏。
范（三十一岁）气机燥涩。喉痹失音。少阳胆火犯上。（胆火烁喉）
生鸡子白 冬桑叶 丹皮 麦冬 生白扁豆壳
某患者 喉咙干燥失音。一个月未恢复。津液不能上承滋润，肺脏失去清肃功能。右寸脉浮大。（气分燥津液亏）
枇杷叶（一钱半） 马兜铃（八分） 地骨皮（一钱） 桑皮（八分） 麦冬（一钱） 生甘草（三分） 桔梗（六分） 白粳米（二钱）
某患者 失血后声音嘶哑。大便溏薄。（失血津液亏）
生扁豆 炒白芍 炙草 川斛 山药 米糖 大枣
何患者 劳损。气喘失音。完全属于下元无力。真气不能上注于咽喉。此前纷纷使用清热药物治疗肺部，导致食欲减退、大便溏薄。改为投用热性药物，又是劫伤津液。难怪出现喉痛、精神疲乏。宜用补足三阴的方法。（阴虚）
熟地 五味 炒山药 茯苓 芡实 建莲肉
孙（二十一岁）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）
宫、商、角、徵、羽五音，歌、哭、呼、笑、呻五种声音，分别归属于五脏。推究发声的根本在于肾，其标则在肺。疾病有虚有实，由咳嗽引起的居多。有的是肺有燥火，外感寒邪，火气郁遏而导致失音；有的是肺金燥甚，木火上炎，咽干喉痹而导致失音；有的是风热痰涎，壅遏肺窍而导致失音；有的是嗔怒叫号，致伤会厌；也有的是龙雷相火上炎，凌烁肺金，久咳不已而导致失音；有的是内夺而厥，则为喑俳，这是肾虚的表现，也就是暴中之后不能说话的情况。先生有言：“金空则鸣，金实则无声，金破碎亦无声。”这三句话足以概括了。有邪气的，是肺家实证；无邪气的，是久咳损肺，破碎无声。其治疗方法，有寒者散寒，有火者清火，有风痰则祛风豁痰。若龙相火上炎烁肺者，宜金水同治。若暴中之喑，全属少阴之虚，宜峻补肝肾，或稍兼痰火而治之。其用药总宜甘润，而不宜苦燥，如此便能得当了。（华岫云评）
徐评 久嗽失音，必定是由用药错误所致。麦冬、五味子，这是治疗失音的灵丹。服用久了，没有不失音的。如果完全失音，即使其人精力如虎，行动如马，半年之后，无不死亡。若是风寒痰火偶尔导致的失音，即使不治疗也会痊愈。但如果加上麦冬、五味子，就会弄假成真（导致病情加重）。这位老先生竟然茫然无知。
Wu (36 years old) presented with external cold and internal heat. Due to prolonged illness forcing the condition, hoarseness occurred. A simultaneous resolution method was used (Cold-heat pathogenic factors forcing the Lung). Ma Xing Gan Shi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction)
Song (30 years old) first experienced hoarseness, followed by throat obstruction (Hou Bi). This is due to Qi stagnation in the Qi level. Symptoms included slight aversion to cold and fever, choking on water intake, and sputum that caused immediate obstruction upon expectoration. This still belongs to upper jiao obstruction. The tongue coating was yellow, and there was thirst.
It is proposed to use a bitter, acrid, and cold formula.
Shéyè (Belamcanda Rhizome), Máhuáng (Ephedra Herba), Xìngrén (Prunus Armeniaca Seed), Shēng Gāncǎo (Raw Glycyrrhizae Radix et Rhizoma), Shí Gāo (Gypsum Fibrosum), Yǐ Rén (Coicis Semen)
Lu (22 years old) suffered from cough due to autumn coolness and dryness. Initially, the skin and hair felt chilly. Hoarseness occurred in winter and persisted until summer without recovery, although appetite remained good. It is speculated that this resulted from repeated injuries of sudden cold and sudden warmth.
This may not be due to deficiency of the two Qi (Yin and Yang). Treatment is modeled after the principle of "Metal being solid produces no sound" (Jin Shi Wu Sheng).
Máhuáng (Ephedra Herba), Xìngrén (Prunus Armeniaca Seed), Shēng Gāncǎo (Raw Glycyrrhizae Radix et Rhizoma), Shí Gāo (Gypsum Fibrosum), Shéyè (Belamcanda Rhizome), Yǐ Rén (Coicis Semen)
Another prescription: Lúgēn Zhī (Reed Rhizome Juice), Xìngrén Zhī (Apricot Seed Juice), Láifú Zhī (Radish Juice), Xiān Zhúlí (Fresh Bamboo Sap), boiled into an electuary.
Fan (31 years old) Qi dryness. Throat obstruction and hoarseness. Shaoyang Wood-Fire attacking upwards (Gallbladder Fire scorching the throat).
Shēng Jīzǐ Bái (Raw Egg White), Dōng Sāngyè (Mulberry Leaf), Dānpí (Moutan Cortex), Màidōng (Ophiopogonis Radix), Shēng Bái Biǎndòu Ké (Raw White Lablab Bean Shell)
A certain patient: Dry throat and hoarseness. No recovery for one month. Body fluids fail to ascend and nourish. The Lung loses its clear and descending function. The right Cun pulse is floating and large (Dryness in the Qi level and deficiency of body fluids).
Pípá Yè (Loquat Leaf, 1.5 qian), Mādōulíng (Aristolochia Root, 8 fen), Dìgǔpí (Cortex Lycii, 1 qian), Sāngpí (Morus Bark, 8 fen), Màidōng (Ophiopogonis Radix, 1 qian), Shēng Gāncǎo (Raw Licorice, 3 fen), Jiégěng (Platycodon Root, 6 fen), Bái Jīngmǐ (White Rice, 2 qian)
A certain patient: Hoarseness after blood loss. Loose stools (Deficiency of body fluids due to blood loss).
Shēng Biǎndòu (Raw Lablab Bean), Chǎo Báisháo (Stir-fried White Peony Root), Zhì Cǎo (Honey-fried Licorice), Chuān Hú (Dendrobium), Shānyào (Dioscorea Rhizome), Mǐ Táng (Rice Sugar), Dàzǎo (Jujube Fruit)
He: Consumptive disease. Panting and hoarseness. Entirely due to weakness of the Lower Yuan. True Qi fails to ascend and pour downwards. Previous treatments frequently used cooling herbs to clear the Lung, resulting in reduced appetite and loose stools. Switching to hot herbs further depleted fluids. Hence, sore throat and mental fatigue ensued. It is appropriate to use methods to tonify the Three Yin meridians (Yin Deficiency).
Shúdì (Prepared Rehmannia Root), Wǔwèi (Schisandra Berry), Chǎo Shānyào (Stir-fried Dioscorea Rhizome), Fúlíng (Poria), Qiànshí (Euryale Seed), Jiàn Liánròu (Lotus Seed Flesh)
Sun (21 years old): Chronic cough. Hoarseness and throat obstruction.
Chén Ējiāo (Donkey-hide Gelatin, decocted together, 2 qian), Shēng Jīzǐ Huáng (Raw Egg Yolk, decocted together, 1 unit), Chǎo Màidōng (Stir-fried Ophiopogonis Radix, 1.5 qian), Chuān Hú (Dendrobium, 3 qian), Tián Běi Shāshēn (Sweet Glehnia Root, 1.5 qian), Chǎo Shēngdì (Stir-fried Prepared Rehmannia Root, 2 qian), Shēng Gāncǎo (Raw Licorice, 3 fen), Fúshén (Poria with Hostwood, 1.5 qian)
The five tones Gong, Shang, Jue, Zhi, Yu, and the five vocalizations Song, Ku, Hu, Xiao, Shen belong to the Five Zang organs. The root of voice production lies in the Kidney, while its branch lies in the Lung. Diseases presenting with hoarseness can be excess or deficiency, mostly arising from cough. Some cases involve Lung dryness-fire combined with external cold pathogens, where fire is constrained leading to aphonia. Some involve excessive dryness of Lung Metal with Liver Wood fire flaming upward, causing dry throat and aphonia. Some involve wind-heat and phlegm-saliva obstructing the Lung orifices. Some result from anger and shouting injuring the epiglottis. Some involve Dragon Fire and Ministerial Fire flaming upward, scorching Lung Metal, leading to chronic cough and aphonia. Some involve internal depletion and厥 (Jue/counterflow qi), resulting in aphonia and paralysis, which is Kidney deficiency, also known as sudden stroke-induced aphonia. Mr. Ye stated: "Empty metal rings; solid metal does not ring; broken metal also does not ring." These three statements cover the essence. Cases with pathogenic factors represent Lung excess; cases without pathogenic factors represent Lung damage from chronic cough, where the metal is broken and silent. Treatment methods include dispersing cold for cold patterns, clearing fire for fire patterns, expelling wind and resolving phlegm for wind-phlegm patterns. For Ministerial Fire scorching the Lung, treat both Metal and Water simultaneously. For sudden stroke aphonia, which is entirely Shaoyin deficiency, vigorously tonify the Liver and Kidney, possibly addressing concurrent phlegm-fire. Medications should generally be sweet and moistening, avoiding bitter and drying herbs. Thus, the treatment will be appropriate. (Commentary by Hua Xiuyun)
Xu's Commentary: Chronic cough with hoarseness is often caused by medication errors. Maidong (Ophiopogonis Radix) and Wuwei (Schisandra Berry) are the miraculous pills for hoarseness. If taken for a long time, they invariably cause hoarseness. If total aphonia occurs, even if the person has strength like a tiger and speed like a horse, death is inevitable within half a year. If hoarseness is occasional due to wind-cold, phlegm, or fire, it may resolve spontaneously without treatment. However, adding Maidong and Wuwei will make the fake real (aggravate the condition). This old doctor was completely ignorant.