bubble_chart Concept

This condition refers to symptoms of hoarseness or loss of voice during speech.

In the Neijing, terms such as "瘖", "acute hoarseness", and "無音" are mentioned. Later medical practitioners have also referred to it as "音瘖", "aphonia", "聲不出", "不能言", "聲啞", "喉中聲嘶", and "暴啞".

Additionally, "aphonia during pregnancy", "postpartum hoarseness", "痘瘖", and "measles 瘖" are not within the scope of discussion for this condition.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰Sudden hoarseness, throat itching, cough, accompanied by fever, aversion to cold, vocal cord swelling, congestion, thin white tongue coating, and floating tight pulse. It is caused by external invasion of wind-cold, lung qi failing to disperse, and cold pathogens stagnating in the throat. The distinguishing features are hoarseness and throat itching, accompanied by fever, aversion to cold, absence of sweating, floating tight pulse, and other exterior cold patterns. The treatment should focus on dispersing wind and dissipating cold, ventilating the lung to restore the voice. The recommended prescription is Three-Unconventional Decoction. For wind-cold, the main symptoms are hoarseness, throat itching, cough, and floating tight pulse.
2. Wind-heat External Contraction︰Hoarseness and sore throat with a burning sensation, accompanied by fever, aversion to wind, cough with yellow phlegm, vocal cord congestion and edema, thin yellow tongue coating, and floating rapid pulse. It is caused by external invasion of wind-heat or cold pathogen transforming into heat, lung qi failing in purification, and heat scorching the throat, leading to hoarseness along with wind-heat exterior syndrome. Treatment should focus on dispersing wind and clearing heat, ventilating the lung to restore voice. The recommended formula is Mulberry Leaf and Chrysanthemum Decoction with modifications. For severe heat, Qingyan Ningfei Decoction can be used. Although both belong to exterior syndromes, they are wind-heat patterns, characterized mainly by hoarseness, sore throat, yellow phlegm, and floating rapid pulse.
3. Pathogenic Heat Invading the Lung︰Hoarseness and sore throat with a sense of obstruction, sticky membrane redness and swelling, vocal cord congestion, sticky phlegm and chest tightness, dry stool and dark urine, red tongue texture with sticky yellow coating, slippery and rapid pulse. Due to the invasion of dryness-heat pathogens attacking the lung metal, scorching fluids to form phlegm, and the obstruction of phlegm-heat, symptoms manifest as hoarseness, dry throat, parched mouth, and shortness of breath with cough as the main features. Treatment should focus on clearing dryness and rescuing the lung, with the prescription selection being Dryness-Clearing Lung-Rescuing Decoction.
4. Lung-kidney Yin Deficiency︰Hoarseness lasting for a long time, dry and sore throat, itchy throat with sticky phlegm, slightly red vocal cords, dry sticky membrane, red tongue texture with little coating, thin and rapid pulse. Constitutional yin deficiency, overexertion injuring the lung and kidney, insufficient body fluids, deficiency fire flaming upward, leading to throat discomfort, hoarseness, and dry throat. Treatment should focus on enriching and tonifying the lung and kidney, clearing heat and restoring voice. Prescription options include Lily Bulb Metal-Securing Decoction or Six-Ingredient Rehmannia Pill. If there is deficiency of both qi and yin, treatment should aim at tonifying qi and nourishing yin, using Four Gentlemen Decoction combined with Lily Bulb Metal-Securing Decoction.
5. Phlegm and Blood Stasis Intermingling︰Hoarseness lasting for a long time, or gradually worsening, or dry and painful throat, thickened vocal cords, with nodules, polyps, or throat masses, tongue color {|###|}purplish-dark{|###|}, thin coating, wiry and thin pulse. Due to {|###|}qi stagnation and blood stasis{|###|}, or phlegm-turbidity accumulation, obstructing the throat collaterals, leading to thickened vocal cords or nodules. For cases dominated by {|###|}blood stasis{|###|}, treatment should focus on {|###|}invigorating blood and resolving stasis{|###|}, with the formula selection Orifice-Opening Blood-Activating Decoction. For cases dominated by phlegm-turbidity accumulation, presenting with vocal cord polyps, treatment should aim to eliminate phlegm and resolve stasis, {|###|}subduing swelling and dissipating bind{|###|}, with the formula selection Erzi Ershi Decoction plus Appendiculate Cremastra Pseudobulb, Paniculate Bolbostemma, Tangerine Seed, and lychee seed.

Hoarseness is a common symptom in throat diseases, with distinctions between cold, heat, deficiency, and excess. Jingyue Quanshu states: "The voice originates from the visceral qi; when the viscera are strong, the voice is robust, and when the viscera are weak, the voice is timid." Therefore, the differentiation and treatment of hoarseness revolve around deficiency and excess. Additionally, "In the case of hoarseness, one must understand deficiency and excess. In cases of excess, the symptoms are superficial, caused by obstruction leading to loss of voice; in cases of deficiency, the symptoms are fundamental, caused by internal depletion leading to loss of voice."