吕元膺治一僧病。诊其脉。独右关浮滑。余部无恙。曰。右关属脾络胃。挟舌本。盖风
中廉泉。得之醉卧当风而成喑。问之而信。乃取荆沥化至宝丹饮之。翌日遂解语。
震按右关浮滑。岂无风与痰为呕吐烦懑等证。而独决其醉卧当风以成喑耶。此必于望闻
问之间参合得之。然亦巧矣。
丹溪治一中年男子。伤寒身热。医与伤寒药。五七日。变神昏而喑。遂作本体虚有痰治
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
能语一字。又服之半月。舌渐能转运言语。热除而痊。盖足少阴脉挟舌本。脾足太阴之脉连
舌本。手少阴别脉系舌本。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
此三脉无血。则舌无血营养亦喑。经曰。刺足少阴脉。重虚出血。为舌难以言。又言刺舌下
中脉太过。血出不止为喑。治当以前方加补血药也。
一男子五十余岁。嗜酒。吐血后。不食。舌不能言。但渴饮水。脉略数。与归身、芍、地各
一两。参、术二两。陈皮一两五钱。甘草二钱。入竹沥、童便、姜汁少许。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
故舌卷而喑。在中风半身不收求之也。
震按此三条皆治舌喑。非喉喑也。首条化痰通窍。是实证。次条伤寒五七日神昏而喑。
岂无实热证。用大黄、黄连、石膏者耶。而猥云作体虚有痰治也。魏注云。恐热传少阴心经
此案不可为训。极是。但细读之。案中不载舌干胎黑便秘烦躁等证。则所谓神昏者。身热
人静而嘿嘿耳。且必有欲言不能言之状也。其脉亦必濡滑无力也。参、 、术服之数日病无
进退。即可知其对证。观于十二日舌始语得一字。又半月而舌能言。热乃退。全绘一虚证情
形矣。凡遇伤寒舌喑者。宜以此条寻绎之。勿竟以陶氏热传手少阴心经句笼统为治。第三条
吐血后不食。舌不能言。是虚证无疑矣。渴饮水。脉带数。不与滋阴而与参、术。翁之见识
高哉。
孙兆治曹都使。新造一宅落成。迁入经半月。饮酒大醉。卧起失音。喑不能言。召孙视
之。曰。因新宅故得此疾耳。半月当愈。先服补心气薯蓣丸。继用细辛、川芎。十日其疾渐
减。二十日全愈。曹既安。见上。问谁医。曰孙兆。上乃召问曰。曹何疾也。对曰。凡新宅
壁皆湿。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
而乘心经。故不能语。臣先用薯蓣丸。使心气壮。然后以川芎、细辛去湿气。所以能语也。
〔附〕一人惊气入心络。喑不能言。以密陀僧研细一匙许。茶调服。遂愈。有人因伐木
山中。为野狼所逐而得是疾。或授以此方。亦愈。盖心开窍于舌。故湿气入心。惊气入心。皆
使舌喑也。
丹溪治一人遗精。误服参 及升浮剂。遂气壅于上焦而喑。声不出。乃用童便浸香附为
末。调服。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。填补下焦
以治遗。十余日良愈。
江云。本草言尿主久嗽失音。故治喑多用尿白。能降火故也。
一男子年近五十。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
明别之丰隆二穴。各三壮。足少阴照海穴。各一壮。其声立出。信哉圣经之言也。仍以黄芩
降火为君。杏仁、陈皮、桔梗泻厥气为臣。诃子泻逆。甘草和元气为佐。服之良愈。
一乡人力田辛苦。复饥甚。饮食骤饱。倦卧半响。醒后忽喑哑不言。如是者二十余日矣
高鼓峰诊之曰。劳倦伤脾。饥饱伤胃。阳明之气遏而不升。津液不行。贲门拥涩。故语言
不能出耳。以补中益气汤十大剂与之。偶午睡觉。通身汗下。言语如常。
王唯一数年前虽有血证。而年壮力强。四月间。忽患咳嗽。服发散药后。痰中见血数口
继服滋阴药过多。遂声飒而哑。时觉胸中气塞。迁延月余。邀张路玉诊之。脉虽沉涩。而
按之益力。举之应指。且体丰色泽。绝非阴虚之候。张曰。台翁之声哑。是金实不鸣。非金
破不鸣之比。因疏导痰汤。加人中黄、泽泻。专一涤痰为务。四剂后。痰中见紫黑血数块。
其声渐出而飒未除。更以秋石兼人中黄、枣肉丸服。经月而声音清朗。始终未尝用清理肺气
调养营血药也。
震按四条皆是喉喑。而治法各异。其异处仍合于古训。切于病情。故能取效。若今人之
用叫子、芦衣等物。虽若新奇而与病无涉。效何由得。
吕元膺治疗一位僧人患病。诊察他的脉象，只有右关脉浮滑，其余部位的脉象正常。他说：“右关脉对应脾脏并联络胃腑，其经脉挟持舌根。这是风邪中伤了廉泉穴，因醉酒卧睡时受风而导致的失音。”询问病情后证实确实如此，于是取荆沥化开至宝丹让他服用。第二天就能说话了。
俞震按语：右关脉浮滑，难道没有风痰引起的呕吐、烦闷等症状吗？却唯独断定是因醉卧当风导致失音呢？这一定是通过望、闻、问三诊综合参详得出的结论。但这判断也很巧妙。
朱丹溪治疗一位中年男子，患伤寒身体发热，医生给予伤寒药物治疗，五七天后，出现神志昏迷且失音的症状。于是将其作为本身体虚兼有痰浊来治疗。用人参五钱，黄耆、白术、当归、陈皮各一钱，煎汤，加入竹沥和姜汁饮用。十二天后，舌头才能说出一个字。又继续服用半个月，舌头逐渐能转动言语，热退病愈。因为足少阴肾经挟持舌根，足太阴脾经连接舌根，手少阴心经的别脉系连舌根，所以这三条经脉虚弱，则痰涎乘虚闭塞脉道，导致舌头不能转动言语。如果这三条经脉没有血液滋养，那么舌头缺乏血液营养也会失音。《内经》说：“刺足少阴脉，若重虚导致出血，会造成舌头难以说话。”又说：“刺舌下中脉太过，血出不止会导致失音。”治疗应当用前方加上补血药。
另一位五十多岁的男子，嗜好饮酒，吐血之后，不吃东西，舌头不能说话，只是口渴想喝水，脉象略微数急。给予当归身、芍药、地黄各一两，人参、白术二两，陈皮一两五钱，甘草二钱，加入少许竹沥、童便、姜汁。服用二十多剂后，能够说话。像这三条经脉，若被风热侵袭，则经脉弛缓纵缓，所以舌头也弛缓纵缓，不能转动而失音。若被风寒客袭，则经脉收缩紧急，所以舌头卷缩而失音。这与中风半身不遂的道理相似。
俞震按语：这三条案例都是治疗舌喑（舌体僵硬不能言语），而非喉喑（咽喉肿痛声音嘶哑）。第一条是化痰通窍，属于实证。第二条伤寒五七天神志昏迷且失音，难道没有实热证候吗？为何不用大黄、黄连、石膏等药？却轻率地说是体虚有痰。魏注说：“恐怕热邪传入少阴心经。”这个观点不可作为典范，非常正确。但仔细研读此案，案中未记载舌干苔黑、便秘、烦躁等症状，那么所谓的神昏，不过是身体发热时安静沉默而已，且一定伴有想说话却说不出来的状态。其脉象也必然是濡滑无力的。服用人参、黄耆、白术数日后病情无进退变化，就可以知道其对证。看十二天舌头才说出一个字，又半个月舌头能言语，热才退，完全描绘出一副虚证的图景。凡是遇到伤寒舌喑者，应该以此条为例细细推求，不要笼统地以陶氏所说的“热传手少阴心经”来治疗。第三条吐血后不进食，舌头不能说话，无疑是虚证。口渴饮水，脉带数象，却不使用滋阴药，反而使用人参、白术，翁之见的识见真高明啊。
孙兆治疗曹都使，新宅落成，迁入半月，饮酒大醉，起床后失音，不能说话。请孙兆诊治。孙兆说：“这是因为新宅的缘故得此病。半个月应当痊愈。先服用补心气薯蓣丸，继用细辛、川芎。十天疾病逐渐减轻，二十天完全痊愈。”曹都使安好后，进见皇帝，问是谁医治的。回答说：“是孙兆。”皇上于是召见询问：“曹都使患什么病？”孙兆回答说：“凡是新宅墙壁皆潮湿，地面也多阴湿之气。人刚来，阴气未散。曹都使心气素来虚弱，饮酒至醉，毛孔张开，阴湿之气趁机侵犯心经，所以不能说话。臣先用薯蓣丸使心气壮盛，然后用川芎、细辛去除湿气，所以能说话。”
〔附〕有一人惊气入于心络，失音不能说话。用密陀僧研成细末约一匙，茶调服，随即痊愈。有人因在山中伐木，被野狼追逐而得此病，有人传授此方，也痊愈了。因为心开窍于舌，所以湿气入心、惊气入心，都会导致舌喑。
朱丹溪治疗一人遗精，误服人参及升浮类药物，导致气壅滞于上焦而失音，发不出声音。于是用童便浸泡香附为末，调服，疏通上焦以治疗失音。又用蛤粉、青黛为君药，黄柏、知母、香附为佐药制成丸剂，填补下焦以治疗遗精。十余日良愈。
江云说：本草书说尿主治久咳失音，所以治失音多用尿白（人中白），能降火的原因。
一位近五十岁的男子，久患痰嗽，忽然一日感受风寒，又吃了酒肉，于是厥气走喉，突发暴喑。给予灸足阳明胃经的丰隆穴两个，各三壮；足少阴肾经的照海穴，各一壮。声音立刻发出。诚如经典所言。仍以黄芩降火为君药，杏仁、陈皮、桔梗泻厥气为臣药，诃子泻逆气，甘草调和元气为佐药。服用后良愈。
一位乡间农民耕田辛苦，又极度饥饿，饮食突然过饱，疲倦躺卧半晌，醒来后忽然失音不语。这样已经二十多天了。高鼓峰诊察后说：“劳倦损伤脾气，饥饱损伤胃气。阳明之气遏阻不能上升，津液不行，贲门拥塞涩滞，所以语言不能出。给予补中益气汤十大剂给他。偶然午睡醒来，全身出汗，言语恢复正常。”
王唯一数年前虽有血证，但年壮力强。四月间，忽然患咳嗽，服用发散药后，痰中带血几口。接着服用滋阴药过多，导致声音飒然而哑，时常觉得胸中气塞，拖延月余，邀请张路玉诊治。脉象虽沉涩，但重按有力，轻举应指，且身体丰满色泽好，绝非阴虚之候。张路玉说：“台翁的声音嘶哑，是金实不鸣，不是金破不鸣的情况。”于是用疏导痰汤，加人中黄、泽泻，专门以涤痰为务。四剂后，痰中带紫黑色血块几块，声音逐渐发出但飒声未除。更用秋石兼人中黄、枣肉丸服用，经过一个月声音清朗。始终未曾使用清理肺气、调养营血的药物。
俞震按语：这四条案例都是喉喑，但治疗方法各异。其不同之处仍符合古训，切合病情，所以能取得疗效。若今人使用叫子、芦衣等物，虽然看似新奇但与病情无关，疗效从何而来？
Lu Yuanying treated a monk who was ill. Upon examining his pulse, he found only the right Guan position floating and slippery, while the pulses in other positions were normal. He said, "The right Guan position corresponds to the Spleen and connects with the Stomach; its meridian accompanies the root of the tongue. This is Wind striking the Lianquan point (Ren-23), caused by lying drunk in the draft, resulting in aphonia." After questioning the patient, it was confirmed. He then administered Zhibao Dan (Precious Treasure Pill) dissolved in Jingli (Ampelopsis Japonica Juice). The next day, the patient could speak.
Yu Zhen commented: A floating and slippery pulse at the right Guan position—could there not be symptoms such as vomiting and irritability caused by Wind and Phlegm? Yet, he exclusively diagnosed it as aphonia due to lying drunk in the wind. This must have been deduced by integrating observation, listening/smelling, and inquiry. However, the judgment was also quite skillful.
Zhu Danxi treated a middle-aged man suffering from Shanghan (Cold Damage) with fever. The physician administered Shanghan medicines for five to seven days, after which the patient developed coma and aphonia. Zhu treated this as underlying deficiency with Phlegm accumulation. He prescribed Renshen (Ginseng Radix et Rhizoma) 5 qian, Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Chenpi (Citri Reticulatae Pericarpium) each 1 qian, decocted in water. Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis Recens Juice) were added to the decoction for drinking. After twelve days, the tongue could articulate only one character. After another half month of administration, the tongue gradually regained mobility for speech, the heat subsided, and the patient recovered. This is because the Foot-Shaoyin Kidney Meridian accompanies the root of the tongue, the Foot-Taiyin Spleen Meridian connects with the root of the tongue, and the Branch Meridian of Hand-Shaoyin Heart ties to the root of the tongue. When these three meridians are deficient, Phlegm-Saliva takes advantage of the deficiency to block the meridians, rendering the tongue unable to move and speak. If these three meridians lack Blood nourishment, the tongue will also suffer from aphonia due to lack of nourishment. The Classic states: "Puncturing the Foot-Shaoyin meridian, if excessive bleeding causes double deficiency, results in difficulty speaking." It also says: "Excessive puncture of the vessel under the tongue causing continuous bleeding leads to aphonia." Treatment should involve adding Blood-nourishing herbs to the aforementioned formula.
Another man, over fifty years old, addicted to alcohol, experienced hematemesis (vomiting blood), followed by anorexia and inability to speak. He was thirsty and desired water, with a slightly rapid pulse. He was given Guishen (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), and Dihuang (Rehmanniae Radix) each 1 liang, Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) 2 liang, Chenpi (Citri Reticulatae Pericarpium) 1.5 liang, and Gancao (Glycyrrhizae Radix et Rhizoma) 2 qian. A small amount of Zhuli (Bambusae Caulis in Taenia), Tongbian (Infant Urine), and Jiangzhi (Zingiberis Recens Juice) was added. After more than twenty doses, he could speak. Regarding these three meridians, if attacked by Wind-Heat, the meridians become flaccid and lax, causing the tongue to become lax and unable to move, resulting in aphonia. If attacked by Wind-Cold, the meridians contract and tighten, causing the tongue to curl and resulting in aphonia. This parallels the mechanism of hemiplegia in Zhongfeng (Wind Stroke).
Yu Zhen commented: These three cases all treat Sheyin (tongue stiffness/aphonia involving the tongue body), not Houyin (hoarseness/laryngeal aphonia). The first case involves resolving Phlegm and unblocking orifices, indicating an Excess pattern. In the second case, Shanghan leading to coma and aphonia after five to seven days—surely there were signs of Excess Heat? Why were not Dahuang (Rhei Radix et Rhizoma), Huanglian (Coptidis Rhizoma), and Shigao (Gypsum Fibrosum) used? Instead, it was rashly attributed to deficiency with Phlegm. Wei's annotation states, "One might fear the heat transmitted to the Heart Meridian of Foot-Shaoyin." This view is correct and cannot serve as a model. However, careful reading of the case reveals no records of dry tongue, black coating, constipation, or irritability. Thus, the so-called "coma" was merely quietness amidst fever, accompanied by the desire to speak but inability to do so. The pulse must have been soggy, slippery, and weak. The fact that the condition did not advance or retreat after several days of administering Renshen, Huangqi, and Baizhu indicates the prescription was appropriate. Observing that it took twelve days to utter one character and another half month to regain speech before the heat subsided fully paints a picture of a Deficiency pattern. For any case of Shanghan-induced Sheyin, one should analyze it according to this case, rather than vaguely treating it based on Tao's statement about "heat transmitting to the Hand-Shaoyin Heart Meridian." The third case, post-hematemesis anorexia and aphonia, is undoubtedly a Deficiency pattern. Thirst and a rapid pulse suggest Yin deficiency, yet instead of Yin-nourishing herbs, Renshen and Baizhu were used. Mr. Weng's insight is truly profound.
Sun Zhao treated Cao Dushi, who had just moved into a newly built house. Half a month after moving, he drank heavily until drunk, and upon waking, lost his voice and could not speak. Sun Zhao examined him and said, "This illness is due to the new house. It should heal in half a month. First, administer Buxinqi Shuyu Wan (Shuyu Pill to Tonify Heart Qi), followed by Xixin (Asari Radix et Rhizoma) and Chuanxiong (Ligustici Chuanxiong Rhizoma)." After ten days, the illness gradually diminished; after twenty days, it completely resolved. After recovering, Cao appeared before the Emperor and asked who had treated him. He replied, "Sun Zhao." The Emperor summoned Sun Zhao and asked, "What illness did Cao have?" Sun Zhao answered, "Walls in new houses are damp, and the ground retains much Yin-dampness. When people first arrive, the Yin-dampness has not dissipated. Cao's Heart Qi was inherently deficient. Drinking to intoxication opened the pores, allowing Yin-dampness to invade the Heart Meridian, causing aphonia. I first used Shuyu Wan to strengthen Heart Qi, then used Chuanxiong and Xixin to dispel dampness, hence the return of speech."
[Appendix] One person suffered from Jingqi (Shock Qi) entering the Heart collaterals, resulting in aphonia. Mituo seng (Arsenic Sulfide Ore powder) was finely ground, approximately one spoonful, mixed with tea and taken orally, resulting in immediate recovery. Another person contracted this disease while being chased by a wild wolf in the mountains while logging. Someone taught them this formula, and they also recovered. Since the Heart opens into the tongue, both Dampness invading the Heart and Shock Qi entering the Heart can cause Sheyin.
Zhu Danxi treated a man with nocturnal emission who mistakenly consumed Renshen (Ginseng) and ascending/floating herbs, causing Qi stagnation in the Upper Jiao and resulting in aphonia with loss of voice. He used Tongbian (Infant Urine) soaked Xiangfu (Cyperi Rhizoma) powdered and taken with water to unblock the Upper Jiao to treat aphonia. He also prepared pills using Hafen (Arini Calcitum), Qingdai (Indigo Naturalis) as the sovereign herbs, and Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), and Xiangfu (Cyperi Rhizoma) as assistant herbs to tonify the Lower Jiao and treat nocturnal emission. The patient recovered well within ten days.
Jiang Yun stated: The Materia Medica says urine treats chronic cough and aphonia; therefore, treating aphonia often uses Renzhongbai (Calculus Humanus) because it can descend Fire.
A man nearing fifty years old, suffering from chronic Phlegm-cough, suddenly caught Wind-Cold and consumed alcohol and meat. Consequently, Juqi (Rebellious Qi) rushed to the throat, causing sudden severe aphonia. Moxibustion was applied to Fenglong (ST-40) of the Foot-Yangming Stomach Meridian, two points, three moxa cones each; and Zhaohai (KI-6) of the Foot-Shaoyin Kidney Meridian, one point, three moxa cones. The voice immediately returned. Truly, the words of the Classics are reliable. Huangqin (Scutellariae Radix) was used as the sovereign herb to descend Fire; Xingren (Armeniacae Semen Amarum), Chenpi (Citri Reticulatae Pericarpium), and Jiegeng (Platycodonis Radix) were used as minister herbs to drain Rebellious Qi; Hezi (Terminalia Chebulae Fructus) drained counterflow; and Gancao (Glycyrrhizae Radix et Rhizoma) harmonized Yuanqi (Primal Qi). The patient recovered well after taking the prescription.
A rural laborer worked hard in the fields and was extremely hungry. He ate a large meal suddenly, then lay down tiredly for a short while. Upon waking, he suddenly became aphonic and silent. This persisted for more than twenty days. Gao Gufeng examined him and said, "Fatigue injured the Spleen Qi; hunger and fullness injured the Stomach Qi. Yangming Qi was obstructed and failed to ascend; fluids did not circulate; the cardia was congested and stiff, thus preventing speech." He prescribed Budu Yiqi Tang (Decoction to Supplement Middle and Augment Qi) in ten large doses. After a nap, the patient sweated profusely all over, and his speech returned to normal.
Wang Weiyi had a history of blood disorders several years prior but was young and strong. In April, he suddenly developed cough. After taking dispersing herbs, he expectorated blood-streaked sputum a few times. Subsequently, he took too many Yin-nourishing herbs, resulting in a hoarse and raspy voice, with frequent sensations of chest congestion. The condition dragged on for over a month, and he invited Zhang Luyu to diagnose him. The pulse was deep and choppy, but firm upon heavy pressure and responsive upon light lifting. His physique was robust and complexion good, definitely not a sign of Yin deficiency. Zhang Luyu said, "Your Hoarseness, Sir, is 'Metal Solid Does Not Ring' (Excess pattern), not 'Metal Broken Does Not Ring' (Deficiency pattern)." Therefore, he used Shedou Tan Tang (Decoction to Guide Out Phlegm), adding Renzhonghuang (Human Feces Charcoal) and Zexie (Alismatis Rhizoma), focusing solely on draining Phlegm. After four doses, dark purple-black blood clots appeared in the sputum. The voice gradually returned, though the raspiness remained. He then took pills made of Qiushi (Calculation Humanum), Renzhonghuang (Human Feces Charcoal), and Jujube flesh. After a month, his voice became clear. Throughout the treatment, no Lung-clearing or Ying-Blood-nourishing herbs were ever used.
Yu Zhen commented: These four cases all involve Houyin (laryngeal aphonia), but the treatments differ. Their differences still align with ancient teachings and fit the pathology closely, hence their efficacy. If modern physicians use items like Jiaozi (likely referring to specific herbal preparations or folk remedies) or Luyi (reed clothing), although seemingly novel, they are irrelevant to the pathology. How could efficacy be achieved?