HOARSENESS, DYSPHONIA, LOSS OF VOICE, APHONIA

GENERAL

Clinical Manifestations
Treatment Principle
Herb Formulas	Herb Combination: Sm. Oroxyli Mu Hu Die + Sm. Sterculiae Lychnophorae Pang Da Hai
Points	LI-4, LI-18, REN-22 LI-4, LI-18, PC-5 LI-4, LI-18, PC-5, REN-22 Sudden loss of voice: 1. HT-5, SJ-17 2. SJ-6, SJ-8, UB-66

WIND-COLD

Clinical Manifestations	Sudden weakness, hoarseness or loss of voice A mildly red, swollen throat Vocal cords are normal or pale Chills and fever with more chills than fever Slightly sore throat Congested throat Occipital headache Anhidrosis Sometimes a cough due to an itchy throat Muscle aches Neck stiffness Nasal obstruction or Runny nose with thin, watery mucus Sneezing T: Pink C: White P: Floating and tight
Treatment Principle	Disperse Wind-Cold Clear the Lungs Improve the voice
Herb Formulas	San Niu Tang modified Liu Wei Tang modified San Ao Tang With Internal Heat: Da Qing Long Tang With underlying Yang Deficiency: Ma Huang Fu Zi Xi Xin Tang Gargle: Acute Laryngitis Gargle Chinese patent medicines: Gan Mao Ling Chuan Xiong Cha Tiao Wan
Points	GB-20, Shijing (2 cun below the midpoint of the patella), SJ-17, UB-12 Bailao, GB-20, LI-4, LU-7, REN-22, UB-12, UB-13 For significant wheezing: + Dingchuan For nasal congestion or rhinitis: + DU-23

WIND-COLD WITH DRYNESS

Clinical Manifestations	Itching or tickling in the throat Blocked or stuffy nose Hoarseness Sneezing General body aches Cough with expectoration of thin, watery or frothy white sputum Dry nasal passages Headache Chills with low grade fever Slight headache Nasal obstruction Nausea Drooling Vomiting Dry throat No thirst Intolerance of Cold Anhidrosis Maybe asthma Nasal congestion Sticky nasal discharge Cough Sore throat T: Pink C: Thin, white and dry P: Superficial and wiry or Tight or Wiry
Treatment Principle	Mildly Disperse Cool Dryness Disperse the Lung Qi Resolve Phlegm Transform thin mucus Soothe the Lungs Stop cough
Herb Formulas	Xing Su San
Points

WIND-COLD WITH INTRNAL QI STAGNATION

Clinical Manifestations	Headache Stifling sensation in the chest Focal distention in the chest Anhidrosis Fever Severe chills Cough Nasal congestion Nasal obstruction Dyspnea Hypochondriac distention Aversion to Cold A low voice Hoarseness T: Normal C: Thin and white or White and slippery P: Superficial and tight
Treatment Principle	Release pathogens from the Exterior Regulate the Qi Disseminate Lung Qi Relieve coughing Smooth the channels
Herb Formulas	Shi Shen Tang
Points

WIND-COLD-DAMPNESS WITH QI DEFICIENCY

Clinical Manifestations	Hoarseness High fever accompanied by severe chills and shivering Aversion to Cold Pain worse at night Difficult movement Local inflammation Migratory pain Soreness and pain of the extremities Nasal congestion with sonorous breathing Anhidrosis Pain and stiffness of the head and neck Focal distention and fullness of the chest and diaphragm A productive cough May have numbness and heaviness in the limbs Body aches Nasal obstruction Cough with sputum Stuffy nose Joint pain Pain worse with Cold and better with warmth Pain aggravated by Wind Pain aggravated by Dampness Pain is stabbing Muscle weakness Pain alleviated by movement Slight muscle edema Heaviness of the joints Cold joints Headache Dizziness T: Pale or Slightly purple or Purple spots C: White or thin, white, greasy P: Slippery or Slightly superficial or Superficial and soft or Slightly rough or Slow and Soft or Wiry and tight or Superficial and rapid that is forceless under pressure
Treatment Principle	Release the Exterior Augment Qi Remove Wind-Cold-Damp Eliminate Painful Obstruction Circulate Qi and Blood
Herb Formulas	Ren Shen Bai Du San
Points

SHAO YANG JING

Clinical Manifestations	Alternating chills and fever Restlessness Irritability Anorexia Sometimes fatigue Nausea Occasional vomiting Headaches (side of head) Hypochondriac pain Rib pain Achiness Ear infection Hearing difficulty Red eyes Stiff shoulders Throat pain Hoarseness Hip pain T: Normal with bumps or dots on side C: Thin white P: Wiry
Treatment Principle	Harmonize the Liver and Gall Bladder
Herb Formulas	Xiao Chai Hu Tang
Points	GB-41, SJ-5 To harmonize the Liver and Gall Bladder: GB-34, LIV-3, LIV-14, SJ-5 To stop nausea and vomiting: PC-6, SP-4, ST-36 To treat headache: GB-1, GB-8, GB-14, Taiyang To treat constipation: SJ-6, ST-25 To treat fever: DU-13, DU-14 To support the San Jiao and Regulate Yin: PC-5, PC-6 To support Yin: KI-7 To support the Ying: SP-10 Head: GB-8, SJ-20, Yintang Eyes: GB-14, GB-20, ST-1, UB-1, UB-2 Ear: GB-2, SJ-5, SJ-17, SJ-21 Hypochondriac area: GB-34, GB-40 Ear: Shenmen, Gall Bladder, Point 0

WIND-HEAT

Clinical Manifestations	Sudden Weakness, hoarseness or loss of voice Red, swollen throat and vocal cords Maybe white or yellow exudate on the surface Severe cases: Difficulty swallowing Fever with slight chills Maybe a slight aversion to Cold Slight aversion to Wind Painful red, swollen throat Sweating Headache Stuffy, runny nose Dry mouth A sore throat with a burning sensation Chest congestion and distention Constipation Anxiety Fatigue Poor appetite Malaise Insistence on cold foods Productive cough Yellow, sticky mucus Foamy mouth T: Red tip C: Thin and yellow P: Floating and rapid
Treatment Principle	Expel Wind-Heat Purge Fire in the Lungs and Stomach Dispel Heat
Herb Formulas	Qing Yan Li Ge Tang Sang Ju Yin modified Shu Feng Qing Re Tang modified Qing Yan Li Ge Tang modified Gargles: Acute Laryngitis Gargle #1 Liu Shen Wan (dissolve in water and gargle) Chinese patent medicines: Yin Qiao Jie Du Pian Liu Shen Wan Qing Yin Wan
Points	GB-20, LI-4, LI-11, Shijing (2 cun below the midpoint of the patella), SJ-17, UB-12 Bailao, LI-4, LI-11, LI-18, LU-6, LU-10, REN-22, SJ-6 For a very, sore, swollen throat: + LU-11, SI-17

PERVERSE DRYNESS ATTACKS THE LUNGS

Clinical Manifestations	Hoarse, husky or raspy voice Dry, hacking cough or Cough with thick, sticky, hard to expectorate sputum Dry skin Dry mouth, nose and lips Dry, ticklish, painful throat Thirst Little or no sweat Fever and chills with more fever than chills Sputum is difficult to expectorate Maybe hemoptysis Cough may cause chest pain Epistaxis Headache Anhidrosis Dry skin and hair Constipation T: Dry with a red tip C: Thin, yellow and dry P: Superficial, maybe rapid
Treatment Principle	Clear the Lungs Disperse Wind Clear Heat Moisten Dryness
Herb Formulas	Sang Xing Tang Bai He Gu Jin Tang For severe Dryness damaging Lung Yin: Qing Zao Jiu Fei Tang If symptoms persist for a long time: Yang Yin Qing Fei Tang Chinese patent medicines: Ling Bei Qiu Li Gan Li Fei Yang Yin Qing Fei Tang Jiang
Points	Jinjin-Yuye, KI-3, LU-1, LU-6, SP-6, UB-13 KI-3, KI-6, LU-5, LU-7, LU-10, REN-22

QI STAGE: LUNG HEAT

Clinical Manifestations	Hoarseness with a sore throat High fever No chills Aversion to Heat Cough with yellow, sticky sputum Asthma Restlessness Thirst Irritated throat Loss of voice Dry mouth Dry throat Swelling of the vocal cords Inflammation of the oral cavity Dark yellow urine Dyspnea Chest congestion and pain Shortness of breath Thick yellow Phlegm Scanty urine Dry stools T: Red C: Thick and yellow, maybe dry and sticky P: Rapid, maybe slippery, maybe forceful
Treatment Principle	Clear Heat in Lungs Moisten Dryness
Herb Formulas	Xiang Sheng Po Di Wan Qing Zao Jiu Fei Tang With Dryness: Jin Sang Wu Generating Lung Yin Deficiency: Qing Fei Tang
Points	Dingchuan, DU-13, DU-14, LI-11, LU-5, LU-10, ST-44. UB-13

YING STAGE: HEAT ATTACKS THE PERICARDIUM

Clinical Manifestations	High fever worse at night Thirst Hoarseness with profuse Phlegm Insomnia Major mental problems Dramatic change of personality Delirium Speech difficulty Aphasia Poor memory Dizziness Maybe fainting Maybe coma Feverish extremities T: Deep red P: Thready and rapid
Treatment Principle	Clear Heat in Pericardium
Herb Formulas
Points	To Clear Heat from the Heart: HT-3, PC-8, Sifeng, bleed Shixuan For delirium: PC-7 To detoxify: LI-11 To Pacify Heart and calm the Shen: HT-5, HT-6, HT-7 To Nourish Yin: KI-3, SP-6

PHLEGM-HEAT CONGESTS THE LUNGS

Clinical Manifestations	Husky, raspy or hoarse voice Throat clearing Expectoration of thick, yellow mucus Maybe worse in the morning Worse with smoking Worse with prolonged use Dry throat Sore throat Throat congestion Dry mouth Bitter taste in the mouth Maybe low-grade fever Cough with yellow mucus T: Normal C: Greasy and yellow P: Slippery and maybe rapid
Treatment Principle	Clear the Lungs Resolve Phlegm Clear Heat Benefit the throat
Herb Formulas	Qing Yan Ning Fei Tang modified Run Hou Wan With Dryness: Bei Mu Gua Lou San Chinese Patent Medicines: Qing Qi Hua Tan Wan Qing Yin Wan Gargles: Acute Laryngitis Gargle #1 Liu Shen Wan (dissolve in water and gargle)
Points	LI-11, LI-18, LU-1, LU-5, LU-6, LU-7, LU-10, REN-17, REN-22, ST-40, UB-13 For wheezing: + Dingchuan For chest fullness: + PC-5

LUNG YIN DEFICIENCY

Clinical Manifestations	Severe, dry hacking cough No sputum expectorated Small amounts of difficult to expectorate sputum Blood tinged sputum (when Yin Deficiency Fire is present) Afternoon fever Night sweats Malar flush (especially in afternoon) Five Sole Heat Dry mouth and throat Itching in throat Hoarse voice, low voice or loss of voice Emaciation T: Red and dry C: None P: Thready and rapid
Treatment Principle	Nourish Yin Moisten the Lungs
Herb Formulas	Bai He Gu Jin Tang Yang Yin Qing Fei Tang Du Qi Wan Er Dong Er Mu Tang With Heat: Bu Fei E Jiao Tang Zi Yin Jiang Huo Tang
Points	KI-3, KI-6, LU-1, LU-5, LU-6, LU-7, LU-9, LU-10, ST-36, UB-13, UB-17, UB-23, UB-43 KI-6, LU-1, LU-7, LU-9, ST-36, UB-13, UB-17, UB-43 With Empty Fire Rising: + KI-3, LU-5, LU-6, LU-10, UB-23

LUNG AND STOMACH YIN DEFICIENCY

Clinical Manifestations	Cough with little yellow sputum Spitting saliva Wheezing Shortness of breath Dry, uncomfortable sensation in throat Hiccups Dry mouth Coughing up difficult-to-extectorate Phlegm Nausea Scanty urination Hoarseness Thirst Asthma Flushed face Five sole Heat Vomiting T: Red and dry C: Little or None P: Thready and rapid or Deficient and rapid
Treatment Principle	Nourish Yin Moisten the Lungs
Herb Formulas	Mai Men Dong Tang
Points

LUNG AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	A chronic or recurrent raspy or hoarse voice which is sometimes more mild then severe The voice is low and talking can be accomplished with great effort only It is difficult to speak for a long time The condition is aggravated with fatigue or excessive speaking gradually getting worse or recurs in the afternoon or evening After rest, the hoarse voice may improve Unproductive cough or Scanty, sticky phlegm or Sometimes blood-streaked sputum Dry mouth Dry throat Itchy throat with some sputum Dry throat mucosa Congestion of the vocal cords Low back and knees sore and weak "Steaming Bone" tidal fever Night sweats Malar flush Maybe hoarse voice Maybe pain in shin, foot, and heel Sterility Spermatorrhea T: Red and dry C: None P: Thready and rapid
Treatment Principle	Nourish Yin Moisten the Lungs Reinforce the Kidneys Improve the voice
Herb Formulas	Bai He Gu Jin Tang Ba Xian Chang Shou Wan Yang Yin Qing Fei Tang + Da Bu Yin Wan Liu Wei Di Huang Wan Qiong Yu Gao If Kidney Deficiency is prominent: Mai Wei Di Huang Wan Gargle: Chronic Laryngitis Gargle Chinese patent medicines: Mai Wei Di Huang Wan Li Fei Yang Yin Qing Fei Tang Jiang
Points	KI-3, LU-1, Shijing (2 cun below the midpoint of the patella), SJ-17, UB-13, UB-23 HT-6, KI-3, KI-6, LU-6, LU-9, UB-13, UB-23 KI-3, KI-6, LU-1, LU-5, LU-6, LU-7, LU-9, LU-10, ST-36, UB-13, UB-17, UB-23, UB-43 KI-3, KI-6, LU-7, LU-9, UB-13, UB-23 With Heat: LU-10

LUNG AND SPLEEN QI DEFICIENCY

Clinical Manifestations	Chronic hoarse voice which is worse with use, fatigue and in the morning A weak, low voice Pale vocal cords which are flaccid and without tone Protracted, incessant cough Expectoration of copious, clear, watery or white Phlegm Short, weak, breathing on exertion Spontaneous sweating A poor appetite A pale complexion Asthma Four limbs tired General lassitude Distention and pain of the epigastrium and abdomen Loose stools T: Pale and swollen C: White P: Thready and weak or Deficient and weak
Treatment Principle	Reinforce the Spleen Benefit the Lungs Warm and transform Phlegm-Dampness
Herb Formulas	Bu Zhong Yi Qi Tang Gargle: Decoct equal amounts (9-12g) Rx. Platycodi Jie Geng, Rx. Glycyrrhizae Gan Cao and Sm. Sterculiae Pang Da Hai and gargle several times daily. Chinese Patent Medicines: Bu Zhong Yi Qi Wan Ren Shen Yang Ying Wan
Points	DU-14, LI-4, LU-7, LU-9, SP-6, ST-36, UB-13 LU-9, REN-17, SP-3, ST-36, UB-13, UB-20, UB-43

HEART BLOOD DEFICIENCY WITH LIVER QI STAGNATION

Clinical Manifestations	Absent-mindedness Frequent feelings of extreme sadness with an urge to cry Hoarseness Inability to control one's emotions Depression Restless sleep May be night sweats Lack of mental focus Tight abdominal muscles Irritability Abnormal speech or behavior Disorientation Frequent yawning Sadness Overly sensitive or self-conscious Insomnia T: Red or pale red C: Scanty P: Thready and rapid
Treatment Principle	Nourish the Heart Calm the Shen Harmonize the Middle Jiao Relieve acute conditions Relax tension Tonify Spleen Qi
Herb Formulas	Gan Mai Da Zao Tang
Points

LIVER QI STAGNATION

Clinical Manifestations	Sudden loss of voice brought on by depression, anger worry, emotional turmoil or sudden upset Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses Premenstrual syndrome Chronic cases: Heat-flushing Red eyes Tidal fever Dry mouth Short temper T: Pink or Dark (Red edges with Heat) C: Thin and white P: Wiry or Choppy (Rapid with Heat)
Treatment Principle	Soothe the Liver Clear Stagnation Benefit the throat Clear Heat if necessary
Herb Formulas	Xiao Jiang Qi Tang modified With Heat: Chai Hu Qing Gan Tang Chinese patent medicines: Xiao Yao Wan Shu Gan Wan
Points	HT-5, LIV-3, PC-5, PC-6, SJ-6, Yintang

LIVER QI STAGNATION: PHLEGM AND QI STAGNANT AND BLOCKED

Clinical Manifestations	Feeling of obstruction in throat as if a slice of roast meat were stuck there which cannot be coughed up nor swallowed down. This sensation becomes more prominent during emotional upset and subsides when relaxed Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Slippery and wiry (slippery due to Phlegm)
Treatment Principle	Spread Qi Resolve Phlegm
Herb Formulas	Ban Xia Hou Po Tang
Points	LI-18, LIV-3, PC-5, SI-17, SJ-6

LIVER QI STAGNATION WITH SPLEEN DAMPNESS

Clinical Manifestations	Alternating chills and fever Dry throat Hoarseness Bitter or sour taste in the mouth Dizziness Sensation of fullness in the chest and hypochondrium Irritability Heartburn Chest distention Difficulty taking deep breaths Hardness beneath the Heart Hypochondriac pain with pressure Stress Being downcast with no desire to eat Anorexia Vertigo May be palpitations Dysphoria Retching Abdominal pain Stomach ache Reduced appetite Subcostal bloating Depression Amenorrhea Tendency to diarrhea Nervousness Nausea Vomiting May be urinary dysfunction Restlessness Sometimes fatigue Headaches (side of head) Rib pain Achiness Ear infection Hearing difficulty Red eyes Stiff shoulders Throat pain Hip pain T: Pink C: Thin and white P: Wiry
Treatment Principle	Relieve the Liver Harmonize the Liver and Spleen
Herb Formulas	Xiao Chai Hu Tang
Points

LIVER QI STAGNATION INVADES THE STOMACH

Clinical Manifestations	Epigastric pain (worse when emotionally upset) Belching with acid regurgitation Nausea Vomiting Hoarseness Anorexia Epigastric distention Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Harmonize the Stomach
Herb Formulas	Xiao Yao San
Points	LIV-3, LIV-14, PC-6, REN-12

LIVER QI STAGNATION TRANSFORMING INTO HEAT WITH QI AND BLOOD DEFICIENCY

Clinical Manifestations	Irritability Short temper Restlessness Fever or tidal fever Red eyes Dry mouth and throat Palpitations Lower abdominal pain Difficult urination Painful urination Increased menstrual flow Uterine bleeding Early menstruation Aching in limbs Dizziness Mental instability Red face Thirst Turbid urine Alternating chills and fever Red cheeks Wheezing Nervousness Headache Red eyes Dry mouth Hoarseness Anorexia Infertility Abdominal pain Spontaneous sweating or night sweats with fever Anxiety Dry eyes Hypochondriac pain Somnolence Insomnia Aching shoulders Five Sole Heat Earache Premenstrual tension Hot flashes Fatigue Lassitude Depression Restlessness Constipation with flushing up Pale complexion Bitter taste in mouth Vertigo Abdominal distention near the umbilicus Epistaxis Irregular menstruation Heaviness in the lower abdomen T:Red or Red edges C: Thin and yellow P: Thready, rapid and wiry or Wiry and tight and rapid
Treatment Principle	Pacify the Liver Spread Liver Qi Strengthen the Spleen Nourish the Blood and Yin Sedate the Heart Clear Heat
Herb Formulas	Jia Wei Xiao Yao San
Points

LIVER YIN DEFICIENCY

Clinical Manifestations	Dizziness Blurred vision Impaired vision Dry eyes Night blindness Tinnitus Headache Nervousness Insomnia with much dreaming Dry throat Hoarseness Thirst Five Sole Heat Night sweats Light menses or Late menses or Amenorrhea T: Red C: Little P: Thready, wiry and rapid
Treatment Principle	Nourish Yin Nourish the Liver
Herb Formulas	Qi Ju Di Huang Wan
Points	KI-3, LIV-3, UB-18, UB-23

KIDNEY YIN DEFICIENCY WITH FIRE FLARING

Clinical Manifestations	Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of the low back Spermatorrhea or Premature ejaculation Aching in the bones Aching in the leg and heel Dry mouth Hoarseness Thirst Night sweats Five Sole Heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and/or Constipation Urine short and red Heightened libido If Heart Fire also Flares: Insomnia Frequent dreams Palpitations If Liver Yang also Rises: Dizziness Blurred vision T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Subdue Fire
Herb Formulas	Zhi Bai Di Huang Wan
Points	KI-1, KI-2, KI-3, KI-6, KI-9, KI-10, REN-4, SP-6, UB-23 If Heart Fire also Flares: HT-7, PC-7, UB-15 If Liver Yang also Rises: LIV-3, UB-18

QI, BLOOD AND PHLEGM STAGNATION (NODES)

Clinical Manifestations	Relatively severe huskiness and hoarseness of voice A sensation of something stuck in the throat Frequent clearing of the throat Polyps on the vocal cords Thickening, lumpiness and darkening of the vocal cords T: Variable C: Variable P: Variable
Treatment Principle	Invigorate the Blood Remove Stagnation Circulate Qi Transform Phlegm
Herb Formulas	Qing Yan Ning Fei Tang modified Bai He Gu Jin Tang modified Mai Wei Di Huang Wan modified Bu Zhong Yi Qi Tang modified
Points	LI-18, LU-7, REN-22, SI-17

BLOOD AND PHLEGM STAGNATION (NODES)

Clinical Manifestations	Hoarseness - gradually gets worse Nodes - maybe cancerous Dry throat with pain T: Purple C: Thin and white P: Thready or Choppy
Treatment Principle	Invigorate the Blood Remove Stagnation
Herb Formulas	Tong Qiao Huo Xue Tang Fa Sheng San Hui Yan Zhu Yu Tang Xuan Bi Kai Yin Cha
Points	Shijing (2 cun below the midpoint of the patella), SJ-17, SP-10, UB-17 LI-4, LU-6, REN-16, REN-17, REN-21, REN-22, ST-6, ST-9, ST-36

HOARSENESS, DYSPHONIA, LOSS OF VOICE, APHONIA

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