囟会(灸七壮 治鼻 鼻痔)、上星(三壮 七壮 治浊涕)、通天(灸七壮 灸后鼻
出鼻积方愈)、迎香(治鼻塞多涕)、人中、风府、百会、风池、大椎、曲差、合谷(并治鼻流
臭秽)。
川芎散(因六九) 雄黄散(因八四) 《宣明》防风汤(因七七) 凉膈散(攻十九,痘八
三) 硫黄散(因八九) 防风通圣散(攻十六) 苍耳散(因七三) 清化饮(新因十三) 补中
益气汤(补三十) 神愈散(因七四) 《正传》脑漏秘方(因七九) 十全大补汤(补二十) 黄
白散(因八十) 《千金》 肉方(因八五) 竹叶石膏汤(寒五、六) 白矾散(因八七) 《简
易》 肉方(因八六) 黄芩知母汤(寒五一)
川芎茶调散(散四六 伤风鼻塞) 羌活胜风汤(散六一 风热鼻塞) 面鼻诸方(详因阵
六九至一百止)
《脉解篇》曰∶所谓入中为喑者,阳盛已衰,故为喑也。内夺而厥,则为喑俳,此肾虚
也。少阴不至者,厥也。
《经脉篇》曰∶手少阴之别,名曰通里,循经入于心中,系舌本,属目系。其实则支膈
,虚则不能言,取之掌后一寸,别走太阳也。足阳明之别,名曰丰隆。其别者,循胫骨外廉
,上络头项,合诸经之气,下络喉嗌。其病气逆则喉痹瘁喑,实则狂巅,虚则足不收,胫枯
,取之所别也。
《奇病论》帝曰∶人有重身,九月而喑,此为何也?岐伯对曰∶胞之络脉绝也。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。帝曰∶有病膺肿颈痛,胸满腹胀,此为何病?何以得之?岐伯曰∶名厥逆。帝曰∶治之奈
何?岐伯曰∶灸之则喑,石之则狂,须其气并,乃可治也。帝曰∶何以然?岐伯曰∶阳气重上
,有余于上。灸之则阳气入阴,入则喑;石之则阳气虚,虚则狂。
《大奇论》曰∶胃脉沉鼓涩,胃外鼓大,心脉小急坚,皆膈偏枯,男子发左,女子发右
,不喑舌转,可治,三十日起;其从者喑,三岁起;年不满二十者,三岁死。肝脉骛暴,有
所惊骇,脉不至若喑,不治自已。
《忧恚无言篇》帝曰∶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。少师曰∶咽喉者,水谷之道也。喉咙者,气之所以上下者也。会厌者,音声之户
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。故人之鼻洞涕出不收者,颃颡不开,分气泄也。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。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。
《逆调论》曰∶不得卧而息有音者,是阳明之逆也。足三阳者下行,今逆而上行,故息
有音也。夫起居如故而息有音者,此肺之络脉逆也。络脉不得随经上下,故留经而不行,络
脉之病患也微,故起居如故而息有音也。
《宣明五气篇》曰∶五邪所乱,邪入于阳则狂,邪入于阴则痹。搏阳则为巅疾,搏阴则
为喑。阳入之阴则静,阴出之阳则怒,是谓五乱。
《脉要精微论》曰∶心脉搏坚而长,当病舌卷不能言;其 而散者,当消环自已。
《生气通天论》曰∶阳不胜其阴,则五脏气争,九窍不通。
《脉度篇》曰∶五脏常内阅于上七窍也。五脏不和,则七窍不通。
《邪气脏腑病形篇》曰∶心脉涩甚则为喑。
《寒热病篇》曰∶暴喑气硬,取扶突与舌本出血。
《宝命全角论》曰∶夫盐之味咸者,其气令器津泄;弦绝者,其音嘶败;木敷者,其叶
发;病深者,其声哕。人有此三者,是谓坏府,毒药无治,短针无取,此皆绝皮伤肉,血气
争黑。
《热病篇》曰∶痱之为病也,身无痛者,四肢不收,智乱不甚,其言微知,可治;甚则
不能言,不可治也。
《阴阳应象大论》曰∶东方生风,在地为木,在脏为肝,在音为角,在声为呼。南方生
热,在地为火,在脏为心,在音为征,在声为笑。中央生湿,在地为土,在脏为脾,在音为
宫,在声为歌。西方生燥,在地为金,在脏为肺,在音为商,在声为哭。北方生寒,在地为
水,在脏为肾,在音为羽,在声为呻。
囟会穴(艾灸七壮,治疗鼻部疾病、鼻痔)、上星穴(三壮或七壮,治疗浊涕)、通天穴(艾灸七壮,灸后鼻腔内的积滞物排出则痊愈)、迎香穴(治疗鼻塞、流多涕)、人中穴、风府穴、百会穴、风池穴、大椎穴、曲差穴、合谷穴(均用于治疗鼻涕流出且气味臭秽)。
川芎散(参考因证篇第六十九条)、雄黄散(参考因证篇第八十四条)、《宣明论方》防风汤(参考因证篇第七十七条)、凉膈散(参考攻邪篇第十九条、痘疹篇第八十三条)、硫黄散(参考因证篇第八十九条)、防风通圣散(参考攻邪篇第十六条)、苍耳散(参考因证篇第七十三条)、清化饮(参考新感因证篇第十三条)、补中益气汤(参考补益篇第三十条)、神愈散(参考因证篇第七十四条)、《正传》脑漏秘方(参考因证篇第七十九条)、十全大补汤(参考补益篇第二十条)、黄白散(参考因证篇第八十条)、《千金方》肉方(参考因证篇第八十五条)、竹叶石膏汤(参考寒热篇第五、六条)、白矾散(参考因证篇第八十七条)、《简易方》肉方(参考因证篇第八十六条)、黄芩知母汤(参考寒热篇第五十一条)。
川芎茶调散(参考散剂篇第四十六条,治疗伤风鼻塞)、羌活胜风汤(参考散剂篇第六十一条,治疗风热鼻塞)、面部及鼻部各类方剂(详见因证阵第六十九条至第一百条)。
《脉解篇》说:所谓病邪深入导致失音的,是因为阳气过盛而后衰退,所以出现失音。体内精气被夺而致厥逆,就会发生失音和瘫痪,这是肾虚的表现。少阴经气不能到达,就是厥逆。
《经脉篇》说:手少阴心经的别络,名叫通里,沿经脉进入心中,联系舌根,归属于目系。实证时会出现胸膈支撑胀满,虚证时则不能说话,治疗应取腕后一寸处的穴位,该络脉别走太阳经。足阳明胃经的别络,名叫丰隆。其分支,沿胫骨外侧上行,联络头项部,汇聚各经之气,向下联络咽喉。如果经气上逆,就会导致喉痹、声音嘶哑;实证表现为狂乱和巅顶疾病,虚证表现为足部无法收持、小腿干枯,治疗应取该络脉的别出之处。
《奇病论》黄帝问:有人怀孕到第九个月时失音,这是什么原因?岐伯回答说:胞宫的络脉阻滞不通。胞络连接于肾,少阴肾经贯穿肾脏并联系舌根,所以不能说话。黄帝问:如何治疗?岐伯说:不需要治疗,等到第十个月自然恢复。黄帝问:如果有人患有胸部肿胀、颈部疼痛、胸闷腹胀,这是什么病?是怎么得的?岐伯说:名叫厥逆。黄帝问:怎么治疗?岐伯说:如果用艾灸,会导致失音;如果用砭石泻法,会导致发狂,必须等待气血调和之后,才可以治疗。黄帝问:为什么这样?岐伯说:阳气重聚于上部,上部有余。艾灸会使阳气陷入阴分,陷入阴分就会失音;砭石泻法会使阳气虚弱,阳气虚弱就会发狂。
《大奇论》说:胃脉沉取搏动涩滞,胃脉浮取搏动盛大,心脉小急且坚硬,这些都会导致膈塞偏枯。男子发病在左侧,女子发病在右侧,如果不失音且舌头转动灵活,可以治愈,三十天起效;如果伴有失音,则需要三年才能起效;年龄不满二十岁的,三年内死亡。肝脉疾速暴急,如果有受惊骇的情况,脉象不至或出现失音,不需要治疗,自己会痊愈。
《忧恚无言篇》黄帝问:人突然因为忧愁愤怒而不能说话的,是什么通道阻塞,什么气运行异常,导致声音不显扬?希望听听其中的道理。少师说:咽喉是水谷通行的道路。喉咙是气体上下出入的地方。会厌是声音的门户。口唇是声音的扇叶。舌头是声音的机关。悬雍垂是声音的关卡。颃颡是分泄气息的地方。横骨受神气支配,主要控制舌头的运动。所以人的鼻孔流涕不止的,是因为颃颡不开,气息外泄。因此,会厌小而薄的人,发声迅速,开阖通畅,呼气容易;会厌大而厚的人,开阖困难,呼气缓慢,所以说话会有重音。人突然失音的,是因为寒气客居在会厌,导致会厌不能发动,发动了也不能下降,开阖不一致,所以没有声音。黄帝问:如何针刺治疗?岐伯说:足少阴肾经向上联系舌根,络于横骨,终于会厌。在两处泻其血脉,浊气就能排除。会厌的脉络,向上联络任脉,取天突穴,会厌就能发动了。
《逆调论》说:不能平卧且呼吸有声音的,这是阳明经气逆乱。足三阳经的气本应下行,现在逆而上行,所以呼吸有声音。如果起居如常但呼吸有声音,这是肺的络脉逆乱。络脉不能随经脉上下运行,所以留滞在经中而不行,络脉病变轻微,所以起居如常但呼吸有声音。
《宣明五气篇》说:五种邪气扰乱人体,邪气侵入阳分则发狂,侵入阴分则成痹。邪气搏结于阳则为巅顶疾病,搏结于阴则失音。阳气入于阴分则安静,阴气出于阳分则发怒,这叫做五乱。
《脉要精微论》说:心脉搏动坚实而长,应当患舌卷缩不能说话;如果脉象软弱而散的,应当消渴环自身体自愈。
《生气通天论》说:阳气不胜阴气,那么五脏之气争乱,九窍不通畅。
《脉度篇》说:五脏经常内察上部的七窍。五脏不和,则七窍不通畅。
《邪气脏腑病形篇》说:心脉涩甚则失音。
《宝命全角论》说:盐的味道咸,它的气味能使容器渗出津液;琴弦断了,它的声音就嘶哑败坏;树木腐烂,它的叶子就脱落;病情深重的,声音就哕逆。人有这三种表现,叫做坏府,毒药无法治疗,短针无法取用,这都是表皮受损伤及肌肉,血气争斗变黑。
《热病篇》说:痱病这种病,身体无痛,四肢不能收持,智力混乱不严重,说话能让人听懂一点,可以治疗;严重时不能说话,就无法治疗。
《阴阳应象大论》说:东方生风,在地为木,在脏为肝,在五音为角,在五声为呼。南方生热,在地为火,在脏为心,在五音为征,在五声为笑。中央生湿,在地为土,在脏为脾,在五音为宫,在五声为歌。西方生燥,在地为金,在脏为肺,在五音为商,在五声为哭。北方生寒,在地为水,在脏为肾,在五音为羽,在五声为呻。
Xinhui (GV22) (Moxibustion, 7 moxa cones; treats nasal diseases, nasal polyps), Shangxing (GV23) (3 or 7 moxa cones; treats turbid nasal discharge), Tongtian (GV6) (Moxibustion, 7 moxa cones; after moxibustion, accumulation in the nose is discharged and the condition cures), Yingxiang (LI20) (treats nasal congestion, excessive rhinorrhea), Renzhong (GV26), Fengfu (GV16), Baihui (GV20), Fengchi (GB20), Dazhui (GV14), Qucha (BL4), Hegu (LI4) (all treat foul-smelling nasal discharge).
Chuanxiong San (Corydalis Powder) (refer to Etiology Chapter, line 69), Xionghuang San (Realgar Powder) (refer to Etiology Chapter, line 84), Fangfeng Tang (Saposhnikovia Decoction) from *Xuanming Lun* (refer to Etiology Chapter, line 77), Liangge San (Cooling the Diaphragm Powder) (refer to Attack Pathogens Chapter, line 19; Vaccine Chapter, line 83), Liuhuang San (Sulfur Powder) (refer to Etiology Chapter, line 89), Fangfeng Tongsheng San (Saposhnikovia and Gardenia Powder) (refer to Attack Pathogens Chapter, line 16), Can'er San (Xanthium Powder) (refer to Etiology Chapter, line 73), Qinghua Yin (Clearing Transformation Drink) (refer to New Etiology Chapter, line 13), Buzhong Yiqi Tang (Decoction for Replenishing the Middle and Augmenting Qi) (refer to Tonification Chapter, line 30), Shenyu San (Divine Healing Powder) (refer to Etiology Chapter, line 74), Naolou Mifang (Secret Recipe for Brain Leakage) from *Zhengchuan* (refer to Etiology Chapter, line 79), Shiquan Dabu Tang (Decoction for Perfect Great Tonification) (refer to Tonification Chapter, line 20), Huangbai San (Yellow and White Powder) (refer to Etiology Chapter, line 80), Roufang from *Qianjin* (refer to Etiology Chapter, line 85), Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) (refer to Cold-Heat Chapter, lines 5-6), Baifan San (Alum Powder) (refer to Etiology Chapter, line 87), Roufang from *Jianyi* (refer to Etiology Chapter, line 86), Huangqin Zhimu Tang (Scutellaria and Anemarrhena Decoction) (refer to Cold-Heat Chapter, line 51).
Chuanxiong Chatiao San (Corydalis Tea-Flushed Powder) (refer to Powders Chapter, line 46; treats wind-cold nasal congestion), Qianghuo Shengfeng Tang (Notopterygium Decoction for Overcoming Wind) (refer to Powders Chapter, line 61; treats wind-heat nasal congestion), Various formulas for the face and nose (see detailed in Etiology Array, lines 69 to 100).
The *Maijie Pian* (Chapter on Pulse Resolution) states: "What is meant by pathogenic factors entering inward causing aphonia is that Yang qi becomes excessive and then declines, thus resulting in aphonia." Internal depletion leading to Jue (reversal cold/convulsion) results in aphonia and paralysis, which is due to Kidney deficiency. When Shaoyin (Lesser Yin) qi fails to arrive, it is Jue.
The *Jingmai Pian* (Chapter on Meridians) states: "The Luo-connecting vessel of the Hand-Shaoyin (Heart) meridian is named Tongli (HT5). It follows the meridian into the heart, connects with the root of the tongue, and belongs to the eye system. In excess conditions, it causes chest fullness and support; in deficiency conditions, speech is impaired. Treatment involves taking the point one cun behind the wrist, where it diverges to the Taiyang (Greater Yang) meridian." The Luo-connecting vessel of the Foot-Yangming (Stomach) meridian is named Fenglong (ST40). Its branch follows the lateral aspect of the tibia, ascends to connect with the head and neck, gathers the Qi of various meridians, and descends to connect with the throat. If Qi rebels upward, it causes throat obstruction and hoarseness; in excess, it manifests as mania and cephalalgia; in deficiency, the feet cannot be held and the shins become withered. Treatment involves taking the divergence point of this vessel.
In the *Qibing Lun* (Treatise on Strange Diseases), the Yellow Emperor asked: "Why does a pregnant woman lose her voice in the ninth month?" Qibo replied: "This is because the collateral vessels of the uterus are blocked. The uterine collaterals are connected to the Kidney. The Shaoyin (Kidney) meridian passes through the Kidney and connects to the root of the tongue, hence the inability to speak." The Yellow Emperor asked: "How should it be treated?" Qibo said: "No treatment is needed; it will recover naturally in the tenth month." The Yellow Emperor asked: "If someone suffers from swelling of the chest and neck, chest fullness, and abdominal distension, what disease is this? How did it arise?" Qibo said: "It is named Jue-ni (Reversal Counterflow)." The Yellow Emperor asked: "How should it be treated?" Qibo said: "Moxibustion will cause aphonia; stone therapy (Bianshi) will cause mania. One must wait until the Qi harmonizes before treating." The Yellow Emperor asked: "Why is this so?" Qibo said: "Yang Qi is heavy and rises upward, creating an excess above. Moxibustion causes Yang Qi to enter Yin; entering Yin leads to aphonia. Stone therapy depletes Yang Qi; depletion leads to mania."
The *Daqi Lun* (Treatise on the Great Paradox) states: "If the Stomach pulse is deep, forceful yet choppy, and superficially forceful and large, and the Heart pulse is small, urgent, and firm, these indicate Ge (diaphragmatic obstruction) and Pianku (hemiplegia). In men, it affects the left side; in women, the right side. If there is no aphonia and the tongue moves freely, it is treatable, recovering in thirty days. If accompanied by aphonia, recovery takes three years. For those under twenty years old, death occurs within three years." If the Liver pulse is rapid and violent, following fright, and the pulse is absent or aphonia occurs, no treatment is needed; it will heal spontaneously.
In the *Youhui Wu Yan Pian* (Treatise on Sudden Loss of Speech Due to Worry and Anger), the Yellow Emperor asked: "When a person suddenly loses their voice due to sudden worry and anger, which pathway is blocked? Which Qi flows abnormally, preventing the voice from resonating? I wish to hear the explanation." Master Shao said: "The pharynx is the pathway for water and food. The larynx is the passage for Qi ascending and descending. 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 the outlet for distributing Qi. The Henggu (hyoid bone) is directed by Shen (Spirit) and primarily controls the tongue. Therefore, when nasal discharge flows uncontrollably, it is because the Hangsang is not opening, allowing Qi to leak. Thus, if the epiglottis is small and thin, Qi emits quickly, opening and closing are smooth, and exhalation is easy. If the epiglottis is large and thick, opening and closing are difficult, exhalation is slow, hence double articulation (stuttering/heavy speech). Sudden aphonia occurs because Cold Qi lodges in the epiglottis, preventing it from moving; even if it moves, it cannot descend, causing inconsistent opening and closing, hence no sound." The Yellow Emperor asked: "How should acupuncture be applied?" Qibo said: "The Foot-Shaoyin (Kidney) meridian ascends to connect with the tongue, links to the Henggu, and terminates at the epiglottis. Bleeding from the blood vessels in two locations will expel turbid Qi. The vessels of the epiglottis ascend to link with the Ren (Conception) Vessel; treating Tianchu (RN22) allows the epiglottis to function."
The *Nidiao Lun* (Treatise on Counter-regulation) states: "Inability to lie flat accompanied by noisy breathing indicates rebellion of the Yangming (Stomach) meridian. The Foot-Taiyang, Foot-Taiyin, and Foot-Yangming meridians normally descend; now they rebel and ascend, causing noisy breathing. If daily activities remain normal but breathing is noisy, this is rebellion of the Lung's collateral vessels. Collateral vessels cannot follow the main meridians up and down, so they stagnate in the main channels without circulating. Since collateral vessel pathology is minor, daily activities remain normal despite noisy breathing."
The *Xuanming Wuqi Pian* (Treatise on the Manifestation of Five Qi) states: "When five types of pathogenic factors disrupt the body, pathogenic factors entering Yang cause mania; entering Yin cause Bi (obstruction) syndrome. Clashing with Yang causes cephalic disease; clashing with Yin causes aphonia. Yang entering Yin brings tranquility; Yin emerging from Yang brings anger. This is called the Five Disruptions."
The *Maiyao Jingwei Lun* (Treatise on the Essence and Subtlety of Pulse Diagnosis) states: "If the Heart pulse is firm and long, one should expect tongue retraction and inability to speak. If the pulse is weak and scattered, Xiao Huan (wasting-thirst ring) will resolve itself."
The *Shengqi Tongtian Lun* (Treatise on Vital Qi Connecting to Heaven) states: "If Yang cannot overcome Yin, the Qi of the Five Zang organs contends, and the Nine Orifices become obstructed."
The *Maidu Pian* (Treatise on Pulse Length) states: "The Five Zang organs constantly inspect the seven orifices above. If the Five Zang organs are disharmonious, the seven orifices are obstructed."
The *Xieqi Zangfu Bingxing Pian* (Treatise on Pathogenic Factors, Zang-Fu, and Disease Manifestations) states: "A very choppy Heart pulse indicates aphonia."
The *Hanre Bing Pian* (Treatise on Cold-Heat Diseases) states: "For sudden aphonia and hard Qi, bleed Futu (LI18) and the root of the tongue."
The *Baoming Quanjiao Lun* (Treatise on Preserving Life and Completing the Corner) states: "Salt tastes salty; its vapor causes moisture to seep from vessels. When a string breaks, its sound becomes hoarse and ruined. When wood rots, its leaves fall. When disease is deep, the voice becomes hiccups. A person exhibiting these three signs is said to have 'Ruined Fu' organs. Toxic drugs cannot treat it, and short needles cannot access it. This represents damage to the skin and flesh, with blood and Qi contending and turning black."
The *Rebing Pian* (Treatise on Heat Diseases) states: "Fei (Flaccidity) disease presents with no body pain and inability to control the limbs. If mental confusion is slight and speech is faint but understandable, it is treatable. If severe, with inability to speak, it is untreatable."
The *Yinyang Yingxiang Dalun* (Great Treatise on Yin-Yang Correspondences) states: "The East generates Wind; on earth it is Wood; in the Zang organs it is the Liver; in the five tones it is Jue; in the five sounds it is Hu (shouting). The South generates Heat; on earth it is Fire; in the Zang organs it is the Heart; in the five tones it is Zhi; in the five sounds it is Xiao (laughter). The Center generates Dampness; on earth it is Earth; in the Zang organs it is the Spleen; in the five tones it is Gong; in the five sounds it is Ge (singing). The West generates Dryness; on earth it is Metal; in the Zang organs it is the Lung; in the five tones it is Shang; in the five sounds it is Ku (crying). The North generates Cold; on earth it is Water; in the Zang organs it is the Kidney; in the five tones it is Yu; in the five sounds it is Shen (groaning)."