本 老年嗜饮热火酒，致热毒熏肺，发疮主痈，咳吐秽脓，
胸右痛，不利转侧，脉左大。初用桔梗汤去 、姜，加连翘、山栀，四服咳稀痛止。仍宜排脓解毒，用桔梗、
银花（各一钱）、贝母（钱半）、生薏苡（五钱）、当归、甘草节、广皮（各一钱二分）、白芨、生 （各一钱）、
甜葶苈（炒七分）。数服脓稀疮痈皆平。
韦 嗽重痰腥，胸背隐痛，脉数有力，已成肺痈。此肺受风寒，蕴邪壅热，宜疏痰导热，则呼吸自利，
不至胀痛喘急，而腥痰渐少。桔梗汤三服，兼用陈腌芥卤汁一杯温服，愈。
戴氏 元气久削，痰嗽肺痿，寸脉虚数少神，难治之症。紫菀汤三服，阿胶水煨冲服。后去桔梗、
知母，加山药、莲子、黄 ，取补土以生金，嗽热渐减。
肺为音所自出，而肾为之根，以肺通会厌，而肾脉挟舌本也。夫金空则鸣，失音一症，亦如金实则喑，
金碎则哑，必辨其虚实，而后治法可详。其寒包内热，闭窒气分致失音者，以麻杏汤之属开其痹。其醉卧当风，
邪干肺窍猝失音者，以苏子汤之属降其痰。其木火犯肺，咽干喉痹致失音者，以麦冬汤之属润其燥。其痰热
客肺，喘急上气致失音者，以桔干汤之属疏其壅。其逆风叫号，致伤会厌者，以养金汤之属清其音。其暴嗽失
音者，杏仁桑皮汤。久咳失音者，蛤蚧散。若由阴虚劳嗽声嘎者，相火烁金也。百合固金汤去元参、桔梗，
加五味、诃子，或扶羸汤去秦艽、柴胡。其内夺而厥，为喑痱者，肾虚也。地黄饮子减桂、附、戟。其中风症，
舌喑不能言者，音如故而舌不掉也。虚者六君子汤加竹茹、姜汁，实者大秦艽汤，仍宜加减。其总治气血虚燥，
喉音不清者，清音汤、加减诃子汤、脂蜜膏方。此失音症治，大约润肺滋肾之品，为宜也。
《医通》曰∶失音大都不越于肺，须分暴喑久喑。暴喑多是寒包热邪，宜辛凉和解。消风散用姜汁冲
服。肺虚伤风，喘咳声嘶，千金酥蜜膏。火邪伤肺，咽痛声哑，生脉散合六味丸，或猪脂白蜜熬膏挑服。久病
失音，气虚挟痰，宜滋肺肾之化源。生脉散下都气丸。咽干声槁，润肺为主，生脉散加玉竹。若不应，生脉散噙
童真丸。
《景岳全书·因阵》载秘方竹衣麦冬汤。治劳瘵痰嗽声哑不出难治者，服此神效。竹衣鲜者，一钱、
竹茹三钱、麦冬二钱、竹叶十四片、甘草五分、橘红五分、茯苓、桔梗各一钱、杏仁七粒、竹沥一杯。煎七分，
竹沥和匀服。
徐灵胎《指南批本》曰∶诸症失音，皆有可愈之理，惟用麦冬、五味、熟地、桂枝等药，补住肺中痰
火以致失音，则百无一生。又云∶久嗽失音，必由药误。麦冬、五味是失音之灵药也，服之久，无不失音者。
倘风寒痰火，偶尔失音，即不治亦愈，但更加以麦冬、五味，则弄假成真矣。
【背景信息】
书名：类证治裁 作者：林佩琴 朝代：清 章节：肺痈肺痿脉案 / 失音论治 类别：综合
【待处理原文】
本（患者姓本）老年时嗜好饮用热性烈性白酒，导致热毒熏蒸肺部，引发疮疡痈肿，咳嗽并吐出腥臭脓液，右侧胸部疼痛，身体转动不便，左侧脉象宏大。初期使用桔梗汤（Platycodon Decoction），去除原方中的甘草、生姜，加入连翘（Forsythiae Fructus）、山栀（Gardeniae Fructus），服用四剂后，咳嗽减轻，疼痛停止。仍宜采用排脓解毒之法，处方用桔梗（一钱）、金银花（各一钱）、贝母（钱半）、生薏苡仁（五钱）、当归、甘草节、广皮（各一钱二分）、白芨、生黄芪（各一钱）、甜葶苈子（炒七分）。连续服用数剂后，脓液变稀，疮痈平复。
韦（患者姓韦）咳嗽严重，痰液有腥味，胸背部隐隐作痛，脉象数而有力，已成肺痈（Lung Abscess）。此因肺受风寒侵袭，邪气蕴结化热，宜疏化痰浊、导热下行，则呼吸自然通畅，不至于出现胀痛喘急，且腥痰逐渐减少。服用桔梗汤三剂，同时配合饮用一杯温热的陈年腌芥菜卤汁，痊愈。
戴氏（戴姓患者）元气长期亏损，患有痰嗽肺痿（Lung Flaccidity），寸口脉虚数且缺乏神气，属于难治之症。服用紫菀汤三剂，另用阿胶（Donkey-hide Gelatin）加水煨化后冲服。后来去掉桔梗、知母，加入山药、莲子、黄芪，取“补土以生金”之意，咳嗽和热象逐渐减轻。
肺是声音发出的源头，而肾是声音的根本，因为肺通过会厌与外界相通，而肾的经脉挟持舌根。五行中，金属中空则鸣响；失音这一病症，也如同金属实心则无声（喑），金属破碎则声哑，必须辨别其虚实，然后治疗方法才能详尽。若是寒邪包裹内热，闭塞气机导致失音者，用麻杏石甘汤之类开通痹阻。若是醉酒后卧于风中，邪气侵犯肺窍突然失音者，用苏子降气汤之类降泄痰浊。若是肝木心火犯肺，咽干喉痹导致失音者，用麦门冬汤之类滋润燥邪。若是痰热客居肺部，喘急上气导致失音者，用桔梗甘草汤之类疏通壅滞。若是迎风呼喊，损伤会厌导致失音者，用养金汤之类清利咽喉。若是突发咳嗽导致失音者，用杏仁桑皮汤。久咳导致失音者，用蛤蚧散。若是由阴虚劳嗽导致声音嘶哑者，此为相火灼伤肺金。可用百合固金汤去掉玄参、桔梗，加入五味子、诃子，或者用扶羸汤去掉秦艽、柴胡。若是精气内夺而厥逆，出现失音兼下肢痿废者，为肾虚所致。用地黄饮子减去肉桂、附子、远志。若是中风症，舌强不语者，声音如常但舌头僵硬不灵活。属虚者用六君子汤加竹茹、姜汁，属实者用大秦艽汤，仍宜根据情况加减。若是总治气血虚弱干燥，喉音不清者，可用清音汤、加减诃子汤、脂蜜膏方。这些治疗失音病症的方法，大抵以润肺滋肾的药物为宜。
《医通》说：失音大多不离肺脏，须分暴喑（突然失音）和久喑（长期失音）。暴喑多是寒邪包裹热邪，宜用辛凉和解之法。消风散用姜汁冲服。肺虚伤风，喘咳声嘶，用千金酥蜜膏。火邪伤肺，咽痛声哑，用生脉散合六味地黄丸，或者用猪脂和白蜜熬成膏挑服。久病失音，气虚夹杂痰湿，宜滋养肺肾的化源。用生脉散送服都气丸。咽干声音枯槁，以润肺为主，用生脉散加玉竹。如果无效，用生脉散含服童真丸。
《景岳全书·因阵》记载秘方竹衣麦冬汤。治疗劳瘵（肺结核）痰嗽声哑不出、难治的患者，服用此方神效。鲜竹衣一钱、竹茹三钱、麦冬二钱、竹叶十四片、甘草五分、橘红五分、茯苓、桔梗各一钱、杏仁七粒、竹沥一杯。煎至七分满，将竹沥混合均匀后服用。
徐灵胎在《指南批本》中说：各种病症导致的失音，都有可治愈的道理，唯独如果使用麦冬、五味子、熟地黄、桂枝等药物，补住肺中的痰火而导致失音，则百无一活。又说：久咳失音，必定是由于用药错误所致。麦冬、五味子是导致失音的“灵药”，服用久了，没有不失音的。倘若因风寒痰火偶尔失音，即使不治疗也会痊愈，但如果再加上麦冬、五味子，就会弄假成真（导致永久性失音）。
Background Information:
Book: *Lei Zheng Zhi Cai* (Compendium of Treatment Based on Syndrome Differentiation)
Author: Lin Peiqin
Dynasty: Qing
Chapter: Pulse Cases of Lung Abscess and Lung Flaccidity / Discussion on Diagnosis and Treatment of Aphonia
Category: Comprehensive
Original Text Translation:
Patient Ben, in his old age, had a habit of drinking hot, strong liquor. This led to heat-toxin steaming the lungs, causing sores and abscesses, with coughing up of foul-smelling pus. He experienced pain in the right chest and difficulty turning his body. The pulse on the left was large. Initially, he was treated with Jiegeng Tang (Platycodon Decoction), removing Licorice Root (*Gancao*) and Ginger (*Shengjiang*), adding Forsythia Fruit (*Lianqiao*) and Gardenia Fruit (*Shanzhi*). After four doses, the cough subsided and pain ceased. It was still appropriate to employ methods for draining pus and detoxifying. The prescription consisted of Platycodon Root (*Jiegeng*, 1 qian), Honeysuckle Flower (*Yinjinhua*, 1 qian each), Fritillaria Bulb (*Beimu*, 1.5 qian), Raw Coix Seed (*Sheng Yiyiren*, 5 qian), Angelica Sinensis (*Danggui*), Licorice Root tips (*Gancao Jie*), Tangerine Peel (*Guangpi*, 1.2 qian each), Bletilla Tuber (*Baiji*), Raw Astragalus Root (*Sheng Huangqi*, 1 qian each), and Sweet Descurainia Seed (*Tian Tingli*, stir-fried 0.7 fen). After several doses, the pus became thin, and the sores and abscesses resolved.
Patient Wei suffered from severe coughing with fishy-smelling sputum, dull pain in the chest and back, and a rapid, forceful pulse. This indicated the formation of Lung Abscess (*Fei Yong*). This condition arose because the lungs were invaded by wind-cold, causing pathogenic factors to accumulate and transform into heat. It was appropriate to disperse phlegm and guide heat downward, so that breathing would naturally become smooth, avoiding distending pain, wheezing, and urgency, while the fishy sputum gradually decreased. After three doses of Jiegeng Tang (Platycodon Decoction), combined with drinking one cup of warm brine from aged pickled mustard greens, he recovered.
The Dai family patient had long-term depletion of primordial qi, suffering from phlegm-cough and Lung Flaccidity (*Fei Fei*). The cun position of the pulse was deficient, rapid, and lacked spirit, indicating a difficult-to-treat syndrome. After three doses of Ziwan Tang (Aster Decoction), Donkey-hide Gelatin (*Ejiao*) was prepared by simmering with water and taken as a suspension. Later, Platycodon Root (*Jiegeng*) and Anemarrhena Rhizome (*Zhimu*) were removed, and Chinese Yam (*Shanyao*), Lotus Seed (*Lianzi*), and Astragalus Root (*Huangqi*) were added, following the principle of "tonifying Earth to generate Metal." The cough and heat symptoms gradually diminished.
The Lungs are the source of voice, while the Kidneys are its root, because the Lungs connect through the epiglottis, and the Kidney meridians flank the base of the tongue. In Five Element theory, metal rings when hollow; similarly, aphonia (loss of voice) is like solid metal being silent (*yin*) or broken metal sounding hoarse (*ya*). One must differentiate between deficiency and excess before detailing treatment methods. For cases where cold wraps internal heat, blocking the qi mechanism and causing aphonia, formulas such as Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) should be used to open the obstruction. For sudden aphonia due to pathogenic factors invading the lung orifices after sleeping in the wind while drunk, formulas such as Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) should be used to descend phlegm. For aphonia caused by Liver Wood and Heart Fire attacking the Lungs, leading to dry throat and throat bi-syndrome, formulas such as Maidong Tang (Ophiopogon Decoction) should be used to moisten dryness. For aphonia caused by phlegm-heat lodging in the Lungs, leading to wheezing and rebellious qi, formulas such as Jiegeng Gancao Tang (Platycodon and Licorice Decoction) should be used to dredge congestion. For aphonia resulting from injury to the epiglottis due to shouting against the wind, Yangjin Tang (Nourishing Metal Decoction) should be used to clear the voice. For sudden aphonia due to acute cough, Xingren Sangpi Tang (Apricot Kernel and Mulberry Bark Decoction) is indicated. For chronic cough-induced aphonia, Gejie San (Gecko Powder) is indicated. For hoarseness due to yin-deficiency labor-cough, this indicates ministerial fire scorching Lung Metal. Baihe Gujin Tang (Lily Preserving Metal Decoction) can be used by removing Scrophularia Root (*Yuanshen*) and Platycodon Root (*Jiegeng*), adding Schisandra Berry (*Wuweizi*) and Chebula Fruit (*Hezi*), or using Fului Tang (Supporting Emaciation Decoction) by removing Gentian Root (*Qinjiao*) and Bupleurum Root (*Chaihu*). For aphonia accompanied by lower limb flaccidity due to depletion of essence and reversal, this is due to Kidney deficiency. Dihuang Yinzi (Rehmannia Infusion) should be used, reducing Cinnamon Twig (*Rougui*) and Aconite Root (*Fuzi*), and Polygala Root (*Yuanzhi*). For stroke syndromes where the tongue is stiff and speechless (*yin*), the voice remains normal but the tongue does not move freely. For deficiency patterns, Liujunzi Tang (Six Gentlemen Decoction) with Bamboo Sap (*Zhuru*) and Ginger Juice (*Jiangzhi*) is used; for excess patterns, Da Qinjiao Tang (Great Gentian Decoction) is used, with modifications as needed. For general treatment of qi and blood deficiency with dryness causing unclear throat sounds, Qingyin Tang (Clear Voice Decoction), Jiajian Hezi Tang (Modified Chebula Decoction), or Zhimi Gao (Fat and Honey Paste) are suitable. Generally, treatments for aphonia favor herbs that moisten the Lungs and nourish the Kidneys.
*YiTong* states: Aphonia mostly involves the Lungs; one must distinguish between sudden aphonia (*bao yin*) and chronic aphonia (*jiu yin*). Sudden aphonia is often due to cold wrapping heat pathogens, suitable for acrid-cool harmonizing methods. Xiaofeng San (Eliminate Wind Powder) should be taken with Ginger Juice. For Lung deficiency with wind invasion, causing wheezing, cough, and hoarseness, Qianjin Sumi Gao (Thousand Gold Butter-Honey Paste) is used. For fire-pathogen injuring the Lungs, causing sore throat and hoarseness, Shengmai San (Generate the Pulse Powder) combined with Liuwei Wan (Six-Ingredient Pill with Rehmannia) or Pig Fat and White Honey Paste is used. For chronic illness-induced aphonia with qi deficiency and phlegm, it is appropriate to nourish the source of transformation of the Lungs and Kidneys. Shengmai San (Generate the Pulse Powder) administered with Duqi Wan (All-Qi Pill) is used. For dry throat and withered voice, moistening the Lungs is primary; Shengmai San (Generate the Pulse Powder) with Polygonatum Odoratum Rhizome (*Yuzhu*) is used. If ineffective, Shengmai San (Generate the Pulse Powder) is held in the mouth with Tongzhen Wan (Child's True Pill).
*Jingyue Quanshu · Yin Zhen* records the secret formula Zhuyi Maidong Tang (Bamboo Sheath and Ophiopogon Decoction). It treats difficult cases of consumption (*Lai Zhai*) with phlegm-cough and loss of voice, showing miraculous efficacy. Ingredients: Fresh Bamboo Sheath (*Zhuyi*, 1 qian), Pericarpium Arecae Semen Betel (Bamboo Floss) (*Zhuru*, 3 qian), Ophiopogon Tuber (*Maidong*, 2 qian), Bamboo Leaf (*Zhuye*, 14 pieces), Licorice Root (*Gancao*, 5 fen), Exocarpium Citri Reticulatae (*Juhong*, 5 fen), Poria (*Fuling*), Platycodon Root (*Jiegeng*, 1 qian each), Apricot Kernel (*Xingren*, 7 grains), Bamboo Sap (*Zhuli*, 1 cup). Decoct until reduced to 70%, mix evenly with Bamboo Sap (*Zhuli*) and take.
Xu Lingtai, in his commentary on *Zhinan*, stated: Various conditions causing aphonia have curable principles. However, if herbs such as Ophiopogon Tuber (*Maidong*), Schisandra Berry (*Wuweizi*), Prepared Rehmannia Root (*Shudi*), and Cinnamon Twig (*Guizhi*) are used incorrectly, trapping phlegm-fire in the Lungs and causing aphonia, then fewer than one in a hundred will survive. He also said: Chronic cough-induced aphonia is necessarily due to medication errors. Ophiopogon Tuber (*Maidong*) and Schisandra Berry (*Wuweizi*) are "miracle drugs" for causing aphonia; prolonged use inevitably leads to loss of voice. If aphonia occurs occasionally due to wind-cold, phlegm, or fire, it may resolve even without treatment. But adding Ophiopogon Tuber (*Maidong*) and Schisandra Berry (*Wuweizi*) will make the temporary condition permanent.