卫气护卫皮毛，禁固津液，不得妄泄。邪气干之，则不能固卫于外，由是津液妄泄，而自汗
出焉。瘟疫之自汗，与他症异，多有感而即患自汗者，则自汗竟属瘟疫中常事，较之头汗、盗汗等反
轻矣。当专治瘟邪，邪退而汗自止。但亦有表里虚实之异。有邪在经而汗在皮毛者，非真汗也。有
汗后邪虽稍减，犹未尽痊者，又未可因汗而谓其必无表邪也。须因脉症而详察之。其在表者，当于
达原饮中，加三阳经表药以疏利、和解之。在里者，下之、泻之、清之。至于杂症，亦多有自汗者，
各有本门，兹不赘。汗下后虚极，表邪尽去而自汗者，方可用补，稍有表邪，辄误补，则大害。
方书多将失音与不能言，合为一症。岂知失音者，舌仍能转运，而喉中则寂然无声也。不能
言者，或舌强不能转运，或喉中格格难出，而其声自在也。余以无声
解之，自难与不能言者混呼矣。瘟病无声，十不救一，所谓热病喑哑不言，三四日
不得汗出者死也。此症总由瘟邪入脏，热气冲塞燔灼所致。然析之，仍有数条。有因邪热冲心，
心气耗损而然者，宜清心降火，用生地、麦冬、川贝、花粉、连翘、竹沥、天竹黄、竹叶、黄连、
犀角之属。有因火烁肺金，不能宣布者，宜清肺降火，用黄芩、川贝、牛子、栀子、柿霜之属。
有因热痰壅塞而气闭者，宜清痰降火，清痰则川贝、蒌仁、胆星之属，降火则诊视其火在何经，
择用本经凉药，并加入本经化痰之品，而兼用枳壳、陈皮、橘红、佛手等理气之剂。□□□□□
□□□□□□□□□□□□□□□□□□□□□□□□□□□有因失于解散，邪伏肺中者，当解
散之。盖肺形如钟，悬而叩之则鸣，倘卧钟而实以泥土，断无鸣理，肺之窒塞亦犹是也。邪窒既
散，则空灵而响发矣。宜前胡、防风、水萍、苏叶、桑白皮、陈皮、淡豉、生姜、葱白之属，（此
症系失音之轻者。）此皆失音之类也。至于不能言，亦有数条。有因风热壅盛，咳嗽声哑者，以
消风降痰之剂治之，用前胡、防风、陈皮、兜铃、姜、葱之属，此症之最轻者。又有太阳发汗已，
身犹灼热，名风温。脉寸尺俱浮，自汗身重，多眠鼻塞，语言难出，宜葳蕤汤。又有狐惑症，唇
上生疮，咽干声哑者。
又有少阴症，咽中生疮者。又痉症口噤不能言者。当于伤寒与杂症门中求之，是皆不能言之类也。
又经曰∶人之猝有忧恚而言无音者，何道之故？曰会厌者，音声之户也。（会厌乃气喉之蔽，
以掩饮食，使不错入气喉。）寒气客于厌，则厌不能发，发不能下，至其开阖不致，故无音云云。
此又以寒客经络而致不语者。热邪流入经络，亦或有此理，然不经见，姑笔之以俟高明者。
二沥汤
竹沥 荆沥 梨汁
如无梨汁，即以西瓜汁代之；如无荆沥，止用竹沥亦可。等分和匀，病急不拘时服。此治瘥
后失音者，未瘥前服之总效。
卫气具有护卫皮毛、固摄津液的作用，防止其无故流失。若邪气侵犯，卫气便无法在体表固护，导致津液妄行外泄，从而出现自汗的症状。瘟疫引起的自汗与其他病症不同，多数是感邪后立即出现自汗，因此自汗在瘟疫中属于常见现象，相比于头汗、盗汗等反而较轻。治疗时应专门针对瘟邪，待邪气退去，汗自然停止。但其中也有表里、虚实的区别。有的邪气在经络而汗出在皮毛，这并不是真正的汗。有的出汗后邪气虽稍减，但并未完全痊愈，此时不可因为出汗就认为一定没有表邪。必须根据脉象和症状详细诊察。如果病邪在表，应当在达原饮中加入三阳经的解表药，以疏利和解。如果病邪在里，则采用攻下、泻下或清热的治疗方法。至于杂病中的自汗，也多有发生，各有专门的门类论述，此处不再赘述。如果在发汗或攻下之后，正气极度虚弱，且表邪已完全去除而出现自汗，这时才可以考虑使用补法；如果还有少许表邪，就错误地使用补法，会造成严重的危害。
医书中大多将失音（声音嘶哑或不能发声）与不能言（无法说话）合并为一类病症。哪里知道失音的人，舌头仍能灵活转动，只是喉咙中寂静无声；而不能言的人，或者是舌体僵硬无法转动，或者是喉咙中格格难出声音，但其声音本身是存在的。我将“无声”单独解释，自然难以与不能言混淆了。瘟疫病中出现无声，十个人中救不活一个，这就是所说的热病导致喑哑不言，如果三四天不出汗就会死亡。这种症状总归是由瘟邪侵入脏腑，热气冲塞、燔灼所致。然而细分起来，仍有几种情况。有的是因邪热冲犯心脏，导致心气耗损而引起的，适宜清心降火，使用生地、麦冬、川贝母、天花粉、连翘、竹沥、天竺黄、竹叶、黄连、犀角这类药物。有的是因火热灼伤肺金，导致肺气不能宣发的，适宜清肺降火，使用黄芩、川贝母、牛蒡子、栀子、柿霜这类药物。有的是因热痰壅塞导致气机闭塞的，适宜清化痰热并降火；清痰则用川贝母、瓜蒌仁、胆南星这类药物；降火则需诊视火势在哪条经络，选择该经络的凉性药物，并加入该经络化痰的药物，同时兼用枳壳、陈皮、橘红、佛手等理气的药剂。……有的是因未能及时解散邪气，导致邪气潜伏在肺中的，应当解散邪气。因为肺的形状像钟，悬挂着敲击就会鸣响，如果倒扣钟并填满泥土，绝对不会有响声，肺的窒塞也是这个道理。邪气窒塞一旦散开，肺恢复空灵，声音就能发出了。适宜使用前胡、防风、浮萍、苏叶、桑白皮、陈皮、淡豆豉、生姜、葱白这类药物。（此症属于失音中较轻的。）这些都属于失音的范畴。至于不能言，也有几种情况。有的是因风热壅盛，咳嗽导致声音嘶哑的，用消风降痰的方剂治疗，使用前胡、防风、陈皮、紫菀、姜、葱这类药物，这是最轻的病症。又有太阳病发汗后，身体仍然灼热，称为风温。脉象寸尺俱浮，自汗身重，嗜睡鼻塞，语言困难，适宜用葳蕤汤。又有狐惑症，嘴唇上生疮，咽干声哑的。又有少阴症，咽喉中生疮的。又有痉症，口噤不能说话的。这些应当在伤寒与杂病门类中寻求治法，都是不能言的类别。又经书说：人突然因忧愤而说不出话，是什么道理呢？回答说：会厌是声音的门户。（会厌是气喉的遮蔽物，用来掩盖饮食，防止误入气喉。）寒气客居在会厌，就会导致会厌不能开启，开启后也不能闭合，以至于开阖失调，所以就没有声音等等。这也是因寒邪客居经络而导致不语的情况。热邪流入经络，或许也有这种情况，但不常见，暂且记录下来以等待高明之人指正。
二沥汤
竹沥 荆沥 梨汁
如果没有梨汁，就用西瓜汁代替；如果没有荆沥，只用竹沥也可以。等量混合均匀，病情紧急时不拘时间服用。这是治愈后失音的治疗方，在未痊愈前服用总体有效。
Wei Qi (Defensive Qi) protects the skin and hair, secures body fluids, and prevents their reckless discharge. When pathogenic factors interfere, Wei Qi fails to secure the exterior, causing body fluids to leak recklessly, resulting in spontaneous sweating. Spontaneous sweating caused by plague differs from other conditions; it often occurs immediately upon infection, making it a common occurrence in plague cases, which is actually milder compared to head sweating or night sweats. Treatment should focus exclusively on eliminating the plague pathogen; once the pathogen recedes, sweating will stop naturally. However, there are differences regarding exterior/interior and deficiency/excess. In some cases, the pathogen is in the meridians while sweating occurs at the skin level, which is not true sweating. In other cases, although the pathogen decreases slightly after sweating, recovery is incomplete; one must not assume that no exterior pathogen remains simply because sweating has occurred. One must carefully observe the pulse and symptoms. If the pathogen is in the exterior, add exterior-releasing herbs of the Three Yang meridians to Da Yuan Yin (Reach the Original Decoction) to promote dispersion and harmonization. If the pathogen is in the interior, use purgative, draining, or clearing methods. As for spontaneous sweating in miscellaneous diseases, it is also common, with dedicated sections for each, so I will not elaborate here. Only when extreme deficiency follows sweating or purgation, and all exterior pathogens have been eliminated, can tonification be used. If even slight exterior pathogens remain, erroneous tonification will cause great harm.
Medical texts often combine aphonia (loss of voice) and mutism (inability to speak) into a single syndrome. How could they know that those with aphonia can still move their tongues freely but produce no sound from the throat? Whereas those who cannot speak may have stiff tongues unable to move, or voices stuck in the throat, yet their vocal mechanism itself functions. By interpreting "silent" separately, I avoid confusing it with mutism. Silent speech due to plague is fatal in nine out of ten cases, as stated: "In heat diseases causing aphonia and inability to speak, if sweating does not occur within three to four days, death ensues." This condition generally results from plague pathogens entering the zang organs, where heat qi blocks, obstructs, and blazes. However, analyzing it further reveals several subtypes. Some result from pathogenic heat rushing to the Heart, depleting Heart Qi; these require clearing the Heart and descending fire, using herbs such as Sheng Di Huang (Rehmanniae Radix), Mai Dong (Ophiopogonis Tuber), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Hua Fen (Trichosanthis Radix), Lian Qiao (Forsythiae Fructus), Zhu Li (Bambusae Succus), Tian Zhu Huang (Bambusae Malleus), Zhu Ye (Bambusae Folium), Huang Lian (Coptidis Rhizoma), and Xi Jiao (Rhinocerotis Cornu). Others result from fire scorching Lung Metal, preventing its dissemination; these require clearing the Lung and descending fire, using herbs such as Huang Qin (Scutellariae Radix), Chuan Bei Mu, Niu Bang Zi (Arctii Fructus), Zhi Zi (Gardeniae Fructus), and Shi Shuang (Diospyros Frost). Still others result from heat-phlegm obstruction blocking Qi; these require clearing phlegm and descending fire. To clear phlegm, use Chuan Bei Mu, Gua Lou Ren (Trichosanthis Semen), and Dan Xing (Arisaematis Cum Bile); to descend fire, diagnose which meridian the fire resides in, select cooling herbs of that meridian, add phlegm-resolving herbs of that meridian, and simultaneously use Qi-regulating agents such as Zhi Ke (Aurantii Fructus), Chen Pi (Citri Reticulatae Pericarpium), Ju Hong (Citri Reticulatae Pericarpium Rubrum), and Fo Shou (Citri Sarcodactylis Fructus). ... Some result from failure to resolve pathogens early, allowing them to lurk in the Lung; these require resolving the pathogens. The Lung resembles a bell; suspended and struck, it rings. But if an inverted bell is filled with mud, it will never ring; similarly, lung obstruction prevents sound. Once pathogenic obstruction disperses, the Lung regains its emptiness and resonance. Use herbs such as Qian Hu (Peucedani Radix), Fang Feng (Saposhnikoviae Radix), Shui Ping (Urticae Herba), Su Ye (Perillae Folium), Sang Bai Pi (Mori Cortex), Chen Pi, Dan Chi (Sojae Preparata), Sheng Jiang (Zingiberis Rhizoma Recens), and Cong Bai (Allii Fistulosi Bulbus). (This subtype is mild among aphonia cases.) These all belong to the category of aphonia. As for mutism, there are also several types. Some result from severe Wind-Heat congestion causing cough and hoarseness; treat with Wind-dispersing and phlegm-resolving formulas using Qian Hu, Fang Feng, Chen Pi, Dou Ling (Stemonae Radix), Ginger, and Scallion. This is the mildest type. Another case involves Taiyang disease where, after sweating, the body remains burning hot, named Feng Wen (Wind-Warmth). With floating pulses at both Cun and Chi positions, spontaneous sweating, heavy body, excessive sleepiness, nasal congestion, and difficulty speaking, use Wei Rui Tang (Asparagi Decoction). There is also Hu Huo Syndrome (Chancroid/Trypanosomiasis-like condition), characterized by sores on the lips, dry throat, and hoarse voice. There is Shaoyin Syndrome with sores in the throat. There is Jing Syndrome (Tetanus/Convulsion) with locked jaw and inability to speak. These should be sought in the Treatise on Cold Damage and Miscellaneous Diseases sections, representing categories of mutism. Furthermore, the Classics state: "Why do people suddenly lose their voice due to sudden grief or anger?" The answer is: "The epiglottis is the gate of voice." (The epiglottis covers the glottis to prevent food/drink from entering the airway.) When cold pathogens lodge in the epiglottis, it cannot open or close properly, leading to loss of voice. This describes mutism caused by cold lodging in the meridians. Heat pathogens flowing into the meridians might theoretically cause this too, though it is rare; I record it here for experts to evaluate.
Er Li Tang (Two Pours Decoction)
Zhu Li (Bambusae Succus), Jing Li (Schizonepetae Succus), Li Zhi (Pirae Juice).
If Pirae juice is unavailable, substitute with Watermelon juice; if Schizonepetae succus is unavailable, using only Bamboo sap is acceptable. Mix equal parts evenly. For urgent conditions, take at any time. This treats aphonia following recovery; taking it before full recovery is also generally effective.