咳而失音，有新久虚实之异。新者多实，痰火闭郁，所谓金实不鸣也。久者多虚，肺损
气脱，
所谓金破亦不鸣也。实者逐邪蠲饮易治。虚者补肺养气难治。亦有肺已虚损而风寒未尽，或
痰火闭塞者，则攻补俱碍，其治尤难也。
诃子饮 治久嗽语声不出。
诃子肉 杏仁（各一钱，炒） 通草（一钱半）
分二服，每服水二盅，姜三片，煎一盅，食远温服。
一方 诃子四个，有桔梗一两半，甘草二寸。
杏仁煎 治嗽失音不出。
杏仁（三两，研泥） 生姜汁 蜜（各一两） 木通 桑白皮 贝母（各一两二钱） 紫菀
五味（各一两）
水三升，煎半升，去滓，入杏仁、蜜、姜汁，再熬成稀膏，食后卧噙化一匙。
又方 皂角一握，去皮弦子，萝卜三个，切片，水一碗，煎至半碗服之。不过三
服，能使语出声。
治盛寒失音不语，咽喉痒痛。
桂心 杏仁（各一两）
为末，蜜丸樱桃大，绵裹咽津。
戴云∶有嗽而咽痛失音，多进冷剂而声愈不出者，宜生姜汁调消风散，少少进之。或只
一味
姜汁亦得。又云∶声哑声，寒包其热也，宜细辛、半夏、生姜之属，辛以散之。若痰热壅于
肺者，金空则鸣，必清肺中邪滞，用清咽宁肺汤主之。
清咽宁肺汤
桔梗（二钱） 炒山栀 黄芩 桑皮 甘草 前胡 知母 贝母（各一钱）
水二盅，煎八分，食后服。
《和剂》款冬花散 治肺已虚而风寒未尽，喘满烦闷，痰涎壅盛，鼻塞流涕，咽
喉不利。
杏仁 阿胶（炒） 麻黄（去根节） 半夏（汤洗，姜制） 款冬花 桑叶 知母 贝母（各
一两）
上 咀，每服二钱，水一盅，姜三片，水煎，食前温服。《准绳》用炙甘草和半夏加一
倍。
咳嗽并伴有声音嘶哑或失音，有新病与久病、实证与虚证的区别。新发的病症多属实证，由痰火闭阻郁结所致，这就是所说的“金实不鸣”（肺金被邪气充实而声音不出）。久病的病症多属虚证，因肺气亏损、元气耗脱所致，这就是所说的“金破亦不鸣”（肺金破损而声音不出）。实证通过祛除邪气、消除痰饮容易治疗；虚证需要补益肺气、滋养正气则难以治疗。也有肺部已经虚损但风寒之邪尚未清除，或者痰火闭塞的情况，此时攻邪与补虚都受到阻碍，治疗尤其困难。
诃子饮：治疗长期咳嗽导致声音无法发出。
药材：诃子肉、杏仁（各一钱，炒制）、通草（一钱半）。
用法：分为两次服用，每次用水两盅，生姜三片，煎煮至一盅，饭后稍远时温服。
杏仁煎：治疗咳嗽导致失音无法发声。
药材：杏仁（三两，研成泥状）、生姜汁、蜂蜜（各一两）、木通、桑白皮、贝母（各一两二钱）、紫菀、五味子（各一两）。
用法：用水三升，煎煮至半升，去除药渣，加入杏仁泥、蜂蜜、姜汁，再次熬制成稀膏状，饭后卧床时含化一匙。
又一方：皂角一握，去掉皮和籽，萝卜三个，切片，用水一碗，煎煮至半碗后服用。不超过三次服用，能使声音恢复。
治疗感受极寒导致的失音不语，咽喉痒痛。
药材：桂心、杏仁（各一两）。
用法：研为细末，用蜂蜜制成如樱桃大小的丸剂，用绵布包裹，让津液慢慢咽下。
戴云说：有咳嗽且咽喉疼痛导致失音，如果过多服用寒凉药物反而声音更出不来者，适宜用生姜汁调匀消风散，少量多次服用。或者只用一味生姜汁也可以。又说：声音嘶哑，是寒气包裹住内热的表现，适宜使用细辛、半夏、生姜这类药物，利用辛味来发散邪气。如果是痰热壅塞在肺部，肺部空虚则能鸣响，必须清除肺中的邪气滞浊，主要使用清咽宁肺汤。
清咽宁肺汤：
药材：桔梗（二钱）、炒山栀、黄芩、桑白皮、甘草、前胡、知母、贝母（各一钱）。
用法：用水两盅，煎煮至八分，饭后服用。
《太平惠民和剂局方》款冬花散：治疗肺部已经虚损但风寒之邪未尽，出现气喘胸闷烦闷，痰涎壅盛，鼻塞流涕，咽喉不利。
药材：杏仁、阿胶（炒制）、麻黄（去掉根和节）、半夏（热水洗，姜汁制）、款冬花、桑叶、知母、贝母（各一两）。
用法：将药材切碎，每次取二钱，用水一盅，生姜三片，水煎，饭前温服。《医学准绳六要》中使用炙甘草配合半夏，用量加倍。
Cough accompanied by loss of voice presents differences between recent and chronic onset, as well as excess and deficiency patterns. Recent onset is mostly excess type, caused by the obstruction and stagnation of phlegm-fire, which is referred to as "Metal being solid does not sound" (the Lung Metal is obstructed by pathogenic factors, preventing vocalization). Chronic onset is mostly deficiency type, resulting from damage to the Lung and depletion of Qi, which is referred to as "Metal being broken also does not sound" (the Lung Metal is damaged, leading to loss of voice). Excess patterns are easier to treat by expelling pathogens and eliminating fluid retention. Deficiency patterns are difficult to treat as they require tonifying the Lung and nourishing Qi. There are also cases where the Lung is already deficient but Wind-Cold has not fully resolved, or where Phlegm-Fire is blocking; in such instances, both attacking pathogens and tonifying deficiencies are hindered, making treatment particularly difficult.
Hezi Yin (Persimmon Sepal Decoction): Treats chronic cough with inability to speak.
Ingredients: Hezi Rou (Pericarpium Diospyros Kaki), Xingren (Semen Armeniacae Amarum) (each 1 qian, stir-fried), Tongcao (Medulla Tetrapanacis) (1.5 qian).
Administration: Divide into two doses. For each dose, use two zhong of water and three slices of fresh ginger, decoct until one zhong remains. Take warm after meals.
Another prescription: Hezi (Persimmon Sepal) four pieces, Jiegeng (Radix Platycodonis) 1.5 liang, Gancao (Radix Glycyrrhizae) two cun.
Xingren Jian (Apricot Kernel Decoction): Treats cough with loss of voice.
Ingredients: Xingren (Semen Armeniacae Amarum) (3 liang, ground into paste), Shengjiang Zhi (Jucius Zingiberis Recens), Fengmi (Melle) (each 1 liang), Mutong (Caulis Akebiae), Sangbaipi (Cortex Mori Radicis), Beimu (Bulbus Fritillariae Cirrhosae) (each 1.2 liang), Ziwan (Herba Asteris Tatarici), Wuwei (Fructus Schisandrae Chinensis) (each 1 liang).
Administration: Use three sheng of water, decoct until half a sheng remains. Remove dregs, add Xingren paste, Fengmi, and Shengjiang Zhi, and boil again into a thin paste. After meals, while lying down, hold one spoonful in the mouth to dissolve slowly.
Another prescription: Zaojiao (Fructus Gleditsiae Sinensis) one handful, remove skin and seeds; Luobo (Radix Raphani Sativi) three pieces, sliced. Use one bowl of water, decoct until half a bowl remains, then take. Within three doses, voice can be restored.
Treats loss of voice and muteness due to severe Cold, with itchy and painful throat.
Ingredients: Guixin (Cortex Cinnamomi Cassiae), Xingren (Semen Armeniacae Amarum) (each 1 liang).
Administration: Grind into powder, form pills the size of cherry pits using Melle. Wrap in cotton wool and swallow with saliva.
Dai Yun stated: In cases of cough with sore throat and loss of voice, if excessive intake of cold agents causes further loss of voice, it is appropriate to mix Xiaofeng San (Wind-Expelling Powder) with Shengjiang Zhi (Jucius Zingiberis Recens) and administer in small amounts frequently. Alternatively, using only Shengjiang Zhi alone is also effective. Furthermore, hoarseness is caused by Cold enveloping Heat; it is appropriate to use herbs such as Xixin (Radix Asari), Banxia (Rhizoma Pinelliae), and Shengjiang (Rhizoma Zingiberis Recens), utilizing their acrid nature to disperse the pathogen. If Phlegm-Heat is congested in the Lung, causing the Lung to be empty and thus able to sound, one must clear the pathogenic stagnation from the Lung, primarily using Qingyan Ningfei Tang (Throat-Clearing Lung-Calming Decoction).
Qingyan Ningfei Tang (Throat-Clearing Lung-Calming Decoction):
Ingredients: Jiegeng (Radix Platycodonis) (2 qian), Chao Shanzhi (Fructus Gardeniae Jasminoidis, stir-fried), Huangqin (Radix Scutellariae), Sangpi (Cortex Mori Radicis), Gancao (Radix Glycyrrhizae), Qianhu (Radix Peucedani), Zhimu (Rhizoma Anemarrhenae), Beimu (Bulbus Fritillariae Cirrhosae) (each 1 qian).
Administration: Use two zhong of water, decoct until eight fen remain. Take after meals.
Kundonghua San (Coltsfoot Flower Powder) from *Heji Ju Fang* (Formulas of the Bureau for the Care of the People): Treats Lung deficiency with unresolved Wind-Cold, presenting with wheezing, chest fullness, irritability, profuse phlegm-saliva, nasal congestion with runny nose, and throat discomfort.
Ingredients: Xingren (Semen Armeniacae Amarum), Ejiao (Colla Corii Asini, stir-fried), Mahuang (Herba Ephedrae, roots and nodes removed), Banxia (Rhizoma Pinelliae, washed in hot water, processed with ginger juice), Kundonghua (Flos Farfarae), Sangye (Folium Mori), Zhimu (Rhizoma Anemarrhenae), Beimu (Bulbus Fritillariae Cirrhosae) (each 1 liang).
Administration: Cut the herbs into small pieces. Take 2 qian per dose, with one zhong of water and three slices of ginger. Decoct in water and take warm before meals. *Zhunsheng* uses Zhi Gancao (Radix Glycyrrhizae Preparata) combined with Banxia, doubling the dosage.