诸本无篇字。马云。人有忧与怒以无言。盖有其由。故名篇。
何气出行 甲乙。出、作不。是。
咽喉 喉咙。 张云。人有二喉。一软一硬。软者居后。是谓咽喉。乃水谷之道。通于六腑者也。
硬者居前。是谓喉咙。为宗气出入之道。所以行呼吸。通于五脏者也。其在太阴阳明论。则单以软者为咽。硬
者为喉。故曰喉主天气。咽主地气。
会厌 张云。会厌者。喉间之薄膜也。周遭会合。上连悬雍。咽喉食息之道。得以不乱者。赖其遮
厌。故谓之会厌。能开能阖。声由以出。故谓之户。汪云。气喉之蔽。以掩饮食。使不错入气喉。
音声之扇也。 志云。如户扉之开合。故曰扇。简案、说文。扇、扉也。
音声之机也。 马云。犹弩之有机。
悬壅垂 张云。悬而下垂。俗谓之小舌。当气道之冲。为喉间要会。故谓之关。
颃颡 张云。颃、颈也。颃颡、即颈中之喉颡。当咽喉之上。悬雍之后。张口可见者也。颡前有窍。
息通于鼻。故为分气之所泄。志云。颃颡者。 之上窍。口鼻之气及涕唾。从此相通。故为分气之所泄。谓气
之从此而分出于口鼻者也。简案、根结篇。张玉师注云。颃颡者。鼻之内窍。通
于喉咙。故颃颡不开。则洞涕不收。盖颃颡诸注未详。唯志所释为明备。但考字书无其义。疑是吭嗓。吭嗓即
咽喉之谓。活人书释颃颡者。悬壅两旁肉也。未知何据。
横骨 张云。即喉上之软骨也。下连心肺。故为神气所使。上连舌本。故主举发舌机也。
鼻洞 张云。涕液流泄于鼻也。颃颡之窍不开。则清气不行。清气不行。则浊液聚而下出。由于分气
之失职也。简案、鼻洞、即鼻渊。千金方引气厥论。鼻渊、作鼻洞、
颃颡不开 甲乙。开、作闭。张云。颃颡之窍不开。则清气不行。清气不行。则浊液聚而下出。由于分
气之失职也。
疾薄 甲乙无疾字。是。
重言也 甲乙也下有所谓吃者。其言逆故重之十字。张云。重言。言语蹇涩之谓。志云。口吃而期期也。
开阖不致 张云。不致、不能也。寒气客于会厌。则气道不利。既不能发扬而高。又不能低抑而下。
开阖俱有不便。故卒然失音。志云。厌不能发。谓不能开也。发不能下。谓不能阖也。
两泻其血脉 浊气乃辟 马云。必两次泻其血脉。则浊气乃 除矣。张云。两泻者。两足俱刺也。足
少阴之血脉。当是所注之 穴。即太溪也。然人有虚劳失音者。观此节之义。则亦无非属乎肾经。但其所致有
渐。与此卒然者不同。其治当分补泻耳。辟、开也。志云。浊气者。寒水之浊气。辟、除也。两泻其血脉者。
谓脉道有两歧。一通气于舌本。一通精液于廉泉玉英。盖足少阴主藏先天之精气。而上通于空窍者也。简案、
两泻、谓两次泻天突之穴。经文义自分明。马注为是。
天突 张云。天突为阴维任脉之会。取之能治暴喑。
各版本中无“篇”字。马云认为：人因忧愁和愤怒而失语，大概是有原因的，所以命名为此篇。
什么气导致失音？《甲乙经》中，“出”字作“作”字。这是正确的。
咽喉。喉咙。张云认为：人有两个喉部结构，一个软一个硬。软的在后，称为咽喉，是水谷通行的道路，与六腑相通。硬的在前，称为喉咙，是宗气出入的道路，用于行呼吸，与五脏相通。在《太阴阳明论》中，则单独以软的为咽，硬的为喉。所以说喉主天气，咽主地气。
会厌。张云认为：会厌是喉间的薄膜。周围聚合，上连悬雍垂。咽喉饮食和呼吸之道得以不乱，依靠它的遮盖和厌恶（阻挡），所以叫会厌。它能开能合，声音由此发出，所以叫它做门户。汪云认为：它是气道的遮蔽物，用来掩盖饮食，使食物不错入气道。是声音的扇叶。志云认为：像门扉的开合，所以叫扇。简案：《说文解字》说，扇就是门扉。是声音发出的机关。马云认为：就像弩弓有机关一样。
悬壅垂。张云认为：悬挂而下垂，俗称小舌。位于气道的冲要之处，是喉间的重要交会点，所以叫关。
颃颡（háng sǎng）。张云认为：颃即颈。颃颡就是颈中的喉颡。位于咽喉之上，悬雍垂之后，张口可见。颃颡前有窍，气息通于鼻，所以是分气之所泄。志云认为：颃颡是上窍。口鼻之气及涕唾，从此相通，所以叫分气之所泄，意思是气从此分别出于口鼻。简案：《根结篇》张玉师注云：颃颡是鼻内的窍，通于喉咙。所以颃颡不开，则洞涕不收。大概关于颃颡的各种注解都不详尽，只有志的解释最为明白完备。但考证字书没有这个义项，怀疑是吭嗓。吭嗓即咽喉的意思。《活人书》解释颃颡是悬雍垂两边的肉。不知依据是什么。
横骨。张云认为：即喉上的软骨。下连心肺，所以受神气的驱使。上连舌本，所以主管舌机的举发。
鼻洞。张云认为：涕液流泄于鼻。颃颡的窍不开，则清气不行。清气不行，则浊液聚积而下出。这是由于分气失职所致。简案：鼻洞，即鼻渊。《千金方》引用《气厥论》，将鼻渊写作鼻洞。
颃颡不开。《甲乙经》中，“开”字作“闭”字。张云认为：颃颡的窍不开，则清气不行。清气不行，则浊液聚积而下出。这是由于分气失职所致。
疾薄。《甲乙经》无“疾”字。这是正确的。
重言也。《甲乙经》在“也”字下有“所谓吃者，其言逆故重之”十字。张云认为：重言，指言语蹇涩。志云认为：口吃而期期（形容口吃的声音）。
开阖不致。张云认为：不致，即不能。寒气客居于会厌，则气道不利。既不能发扬向上，又不能低抑向下。开和阖都有不便，所以突然失音。志云认为：厌不能发，指不能开；发不能下，指不能阖。
两泻其血脉，浊气乃辟。马云认为：必须两次泻其血脉，则浊气才能清除。张云认为：两泻，指双脚都刺。足少阴的血脉，应当是所注的穴，即太溪穴。然而人有虚劳导致的失音，看这一节的意义，也无非属于肾经。只是其致病过程是渐进的，与此处突然发生的不同。治疗应当区分补泻。辟，开也。志云认为：浊气，是寒水的浊气。辟，除也。两泻其血脉，指脉道有两歧，一通向舌本，一通向精液至廉泉玉英。盖足少阴主藏先天精气，而上通于空窍。简案：两泻，指两次泻天突穴。经文意义自然分明。马注是正确的。
All versions lack the character "Pian" (Chapter). Ma Yun states: People lose their voice due to sorrow and anger; there is presumably a reason for this, hence the chapter title.
What Qi causes aphonia? In *Jia Yi Jing* (Systematic Classic of Acupuncture and Moxibustion), the character "Chu" (out) is written as "Zuo" (make/do). This is correct.
Yan Hou (Pharynx and Larynx). Hou Long (Throat). Zhang Yun states: Humans have two throat structures, one soft and one hard. The soft part is posterior, called Yan Hou, which is the pathway for food and drink, connecting to the Six Fu Organs. The hard part is anterior, called Hou Long, which is the pathway for Zong Qi (Gathering Qi) to enter and exit, facilitating respiration, and connecting to the Five Zang Organs. In the *Tai Yang Yang Ming Lun* (Treatise on Taiyang and Yangming), only the soft part is referred to as Yan (Pharynx) and the hard part as Hou (Larynx). Thus, it is said that Hou governs Heavenly Qi, and Yan governs Earthly Qi.
Hui Yan (Epiglottis). Zhang Yun states: Hui Yan is a thin membrane in the larynx. It joins around, connecting superiorly to the uvula. The pathways for eating, drinking, and breathing in the pharynx and larynx remain orderly thanks to its covering and blocking function, hence named Hui Yan. It can open and close, allowing sound to emerge, thus called a "door" (Hu). Wang Yun states: It acts as a cover for the airway, preventing food from entering incorrectly. It is the fan of sound. Zhi Yun states: Like the opening and closing of a door leaf, hence called a fan. Jian An notes: *Shuo Wen Jie Zi* defines "Fan" as a door leaf. It is the mechanism of sound. Ma Yun states: Just as a crossbow has a trigger mechanism.
Xuan Yong Chui (Uvula). Zhang Yun states: It hangs down, commonly known as the little tongue. It is located at the critical junction of the airway, serving as an important convergence point in the larynx, hence called Guan (Pass/Barrier).
Hang Sang (Nasopharynx). Zhang Yun states: Hang refers to the neck. Hang Sang is the throat-pharynx within the neck. It is located above the pharynx and larynx, posterior to the uvula, visible when the mouth is opened. There are orifices anterior to Hang Sang where breath connects to the nose, making it the site where Qi diverges. Zhi Yun states: Hang Sang is the upper orifice. Breath from the mouth and nose, along with mucus and saliva, communicates through here, hence called the site of diverging Qi, meaning Qi exits separately through the mouth and nose. Jian An notes: In the *Gen Jie Pian*, Master Zhang Yu's commentary states: Hang Sang is the internal orifice of the nose, connecting to the larynx. Therefore, if Hang Sang does not open, clear rhinorrhea cannot be controlled. Generally, various annotations on Hang Sang are not detailed; only Zhi's explanation is clear and complete. However, checking dictionaries reveals no such definition, leading to suspicion that it might be "Keng Sang". Keng Sang means pharynx and larynx. *Huo Ren Shu* explains Hang Sang as the flesh on both sides of the uvula. The basis for this is unknown.
Heng Gu (Hyoid Bone/Cartilage). Zhang Yun states: It is the cartilage above the larynx. It connects inferiorly to the Heart and Lung, thus being directed by Shen Qi (Spiritual Qi). It connects superiorly to the root of the tongue, thus governing the movement of the tongue.
Bi Dong (Nasal Discharge/Rhinorrhea). Zhang Yun states: Mucus flows out from the nose. If the orifice of Hang Sang does not open, Clear Qi does not circulate. If Clear Qi does not circulate, turbid fluids accumulate and flow downward. This is due to the failure of the diverging Qi function. Jian An notes: Bi Dong is synonymous with Bi Yuan (Nasal Sinusitis/Ozena). *Qian Jin Fang* cites the *Qi Jue Lun*, writing Bi Yuan as Bi Dong.
Hang Sang Bu Kai (Failure of Hang Sang to Open). In *Jia Yi Jing*, the character "Kai" (open) is written as "Bi" (close). Zhang Yun states: If the orifice of Hang Sang does not open, Clear Qi does not circulate. If Clear Qi does not circulate, turbid fluids accumulate and flow downward. This is due to the failure of the diverging Qi function.
Ji Bo (Rapid/Close). *Jia Yi Jing* lacks the character "Ji". This is correct.
Zhong Yan Ye (Repetitive Speech/Stuttering). *Jia Yi Jing* adds ten characters after "Ye": "Suo Wei Chi Zhe, Qi Yan Ni Gu Zhong Zhi" (So-called stuttering, because the speech is obstructed, hence repeated). Zhang Yun states: Zhong Yan refers to hesitant and slurred speech. Zhi Yun states: Stuttering, saying "qi qi" (onomatopoeia for stuttering).
Kai He Bu Zhi (Inability to Open and Close Properly). Zhang Yun states: Bu Zhi means inability. When Cold Qi lodges in the Hui Yan, the airway becomes obstructed. It cannot rise and expand, nor can it lower and close. Both opening and closing become inconvenient, resulting in sudden aphonia. Zhi Yun states: "Yan Bu Neng Fa" means inability to open; "Fa Bu Neng Xia" means inability to close.
Liang Xie Qi Xue Mai, Zhuo Qi Nai Pi (Bleeding/Venesection twice from the blood vessels, then turbid Qi is expelled). Ma Yun states: One must bleed the blood vessels twice, then the turbid Qi will be eliminated. Zhang Yun states: Liang Xie means needling both feet. The blood vessel of Foot Shaoyin should be the Ying-Spring point, which is Taixi (KI3). However, some people suffer from aphonia due to deficiency and exhaustion. Observing the meaning of this section, it also belongs to the Kidney Meridian. But the onset is gradual, unlike the sudden onset described here. Treatment should distinguish between tonification and sedation. Pi means open. Zhi Yun states: Zhuo Qi refers to the turbid Qi of Cold Water. Pi means eliminate. Liang Xie Qi Xue Mai refers to the fact that the meridian has two branches: one connects to the root of the tongue, and the other conveys essence fluid to Lianquan and Yuying. Foot Shaoyin governs the storage of congenital essence and Qi, connecting superiorly to the orifices. Jian An notes: Liang Xie refers to sedating the Tiantu (CV22) acupoint twice. The meaning of the classic text is clear. Ma's annotation is correct.
Tian Tu (Tiantu CV22). Zhang Yun states: Tian Tu is the meeting point of the Yinwei Mai (Conception Vessel branch) and Ren Mai (Conception Vessel). Needling it can treat sudden aphonia.