舌胎生刺，咽干如炙，伤寒难症见之，阳盛阴消之象，然扶
阴益阳其危可解，痘疹若见，总以烈毒肆虐，非仅爆炙已也。甚则干焦日黑，总以咽喉壅毒，所以咽哑水呛
无言。若 ，舌刺如煤者，不治欲解其危，非寒凉荡涤不可，即使攻解须在回时早图可也，用大黄、栝蒌仁、
石膏、枳壳为主。音哑是肺热，有肺痿，有风毒入肺，哑有火郁，舌有痰迷。
心者，声音之主；丹田者，声音之府；喉者，声音之门也。被热毒煎熬，热甚生痰，津液胶锢，痰毒
填实，肺窍有碍气道，其毒不能尽行于肌表，故音哑。然热毒既已不行，以致肺窍填实，虽有根有主，声音
亦不能发越也。且肺金以空而鸣，不空则不鸣，宜用力子（二钱）、桔梗（一钱）、花粉（二钱）、甘草（一钱）、菖蒲（八
分）、黄芩（八钱）、麦冬（二钱）、知母（二钱）、钩丁（二钱）、川贝（一钱）、天麻（二钱）、前胡（二钱）、芍药（二
钱），以清其火，顺其痰，则肺开而声音出矣。如久泻后音哑汗出者，元气脱也，不治痰，疹始中声哑者，以人
事安静，饮食如常者佳。若起发之时，即音哑失声音，切牙者，寒战者，烦躁昏迷者，干呕水呛锁喉者，痰
壅喘急者，泄泻不止者，腹胀闷乱者，皆凶。未出声变者，表郁病也。已出声变者，膈热病也。出后而声不出
者，表膈兼病也。又咳嗽出声者，不在此例，此时亦用北沙参清肺，肺敛则声开，惟疹回一月外，方可
用诃子、阿胶、糯米。
舌苔上生出芒刺，咽喉干燥如同被火烤灼，这是伤寒病中难以治疗的危重证候表现，属于阳气亢盛、阴液消损的征象。然而，若能扶助阴气、制约阳热，其危险即可解除；若见于痘疹（天花或麻疹类疾病），则总因烈性毒邪肆虐所致，不仅仅是单纯的燥热熏灼而已。严重时舌面干枯焦黑呈黑色，总因咽喉部壅塞毒邪，所以导致声音嘶哑、饮水呛咳、无法言语。如果舌刺如煤炭般漆黑，属于不治之症欲求缓解危机，非用寒凉药物荡涤攻下不可，即使需要攻下解表，也必须在病情回转之时及早谋划，方药以大黄、瓜蒌仁、石膏、枳壳为主。
声音嘶哑多因肺热引起，有的属于肺痿，有的属于风毒侵入肺部，嘶哑有因火郁所致，舌象有因痰迷心窍所致。
心是声音的主宰；丹田是声音的府库；喉是声音的门户。若被热毒煎熬，热势过盛而生痰，津液胶结固滞，痰毒填塞充实，阻碍肺窍和气道，致使毒邪不能完全发散于肌表，因此出现声音嘶哑。既然热毒不能外行，导致肺窍填实，虽然声音有根有主，但也不能发越出来。且肺属金，以中空而发声，若不空则不发声，宜用力子（二钱）、桔梗（一钱）、花粉（二钱）、甘草（一钱）、石菖蒲（八分）、黄芩（八钱）、麦冬（二钱）、知母（二钱）、钩藤（二钱）、川贝母（一钱）、天麻（二钱）、前胡（二钱）、芍药（二钱），以清泻火热，理顺痰浊，则肺气宣开而声音发出。如果是久泻之后出现声音嘶哑并出汗，属于元气脱失，不予治疗痰浊；若痘疹初起即出现声音嘶哑，而以人事安静、饮食正常者为佳。若在痘疹起发阶段，即出现声音嘶哑、失音、咬牙、寒战、烦躁昏迷、干呕饮水呛咳、锁喉（咽喉闭塞）、痰壅喘急、泄泻不止、腹胀闷乱者，均属凶险之证。尚未出声即发生变证的，属于表郁病；已经出声后发生变证的，属于膈热病；出疹之后声音仍不出者，属于表证与膈证兼病。另外咳嗽伴声音发出的，不在此例讨论范围内。此时也可使用北沙参清肺，肺气收敛则声音开启，只有等到痘疹消退一个月以后，方可使用诃子、阿胶、糯米。
Mangci (thorny projections) appear on the tongue coating, and the throat is dry as if roasted. This is a difficult syndrome seen in Shanghan (Cold Damage diseases), representing the image of Yang excess and Yin consumption. However, by supporting Yin and benefiting Yang, the danger can be resolved. If seen in Douzhen (smallpox or measles), it is generally due to the rampant action of fierce toxins, not merely simple scorching heat. In severe cases, the tongue becomes dry, scorched, and black daily, primarily due to toxic accumulation blocking the throat, resulting in hoarseness, choking on water, and inability to speak. If the thorns on the tongue are like coal, indicating an untreatable condition where one seeks to resolve the crisis, non-cold-cooling purgation is indispensable. Even if attack and resolution are required, plans must be made early during the time of recovery. The main herbs used are Dahuang (Rhei Radix et Rhizoma), Gualou Ren (Trichosanthis Semen), Shigao (Gypsum Fibrosum), and Zhike (Aurantii Fructus).
Hoarseness is caused by Lung Heat; there are cases of Fei Wei (Lung萎/Atrophy), and cases where Wind-Toxin enters the Lung. Hoarseness can be due to Fire Depression, and the tongue may show signs of Phlegm Confusion.
The Heart is the master of voice; the Dantian (Elixir Field) is the residence of voice; the Hou (Throat) is the gate of voice. When subjected to heat-toxin simmering, excessive heat generates phlegm, body fluids become sticky and bound, and phlegm-toxin fills and obstructs. This hinders the Lung Orifices and the airway, preventing the toxin from fully dispersing to the muscle surface, thus causing hoarseness. Since the heat-toxin no longer moves outward, leading to obstruction of the Lung Orifices, even though the voice has its root and master, it cannot resonate. Furthermore, Metal (Lung) sounds because it is hollow; if not hollow, it does not sound. It is appropriate to use Li Zi (Camelliae Seed), Jiegeng (Platycodonis Radix), Huafen (Trichosanthis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Changpu (Acori Tatarinowii Rhizoma), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), Zhimu (Anemarrhenae Rhizoma), Gouding (Uncariae Ramulus cum Uncis), Chuanbei (Fritillariae Cirrhosae Bulbus), Tianma (Gastrodiae Rhizoma), Qianhu (Peucedani Radix), and Shaoyao (Paeoniae Radix) to clear the fire and smooth the phlegm, so that the Lung opens and the voice emerges. If hoarseness and sweating occur after prolonged diarrhea, it indicates Yuanqi (Original Qi) collapse; do not treat the phlegm. If hoarseness occurs at the beginning of Douzhen, but the patient remains calm with normal diet and appetite, this is auspicious. If hoarseness and loss of voice occur during the eruption stage, accompanied by teeth grinding, chills, restlessness, coma, dry retching, choking on water, Suohou (Lock Throat/stridor), phlegm obstruction with rapid breathing, incessant diarrhea, abdominal distension with confusion, these are all ominous signs. Changes occurring before the voice appears indicate Bi Yu Bing (Exterior Stagnation Disease); changes occurring after the voice appears indicate Ge Re Bing (Diaphragmatic Heat Disease); voice failing to emerge after eruption indicates simultaneous Exterior and Diaphragm disease. Coughing with voice emission is not included in this category. At this time, Beishashen (Glehniae Radix) can also be used to clear the Lung; when the Lung consolidates, the voice opens. Only after the rash has receded for over a month should Hezi (Terminalia Chebulae Fructus), Ejiao (Colla Corii Asini), and Nuomi (Oryzae Glutinosis Semen) be used.