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Chapter 69 of 81
黄帝内经·灵枢
The Yellow Emperor consulted Shaoshi, saying: When a person suddenly loses their voice due to worry and fear (sudden affliction from distress and fright), as if a river channel has been blocked, which kind of Qi (💨 the subtle substance circulating within the human body) has encountered an obstruction in its movement, causing the voice to fail in normal production? I wish to hear the reasoning behind this.
Shaoshi replied: The pharynx (throat) is the passage through which food and drink enter the human body; the larynx (throat proper) is the pathway through which breath moves upward and downward; the epiglottis (laryngeal cartilage, the "curtain" that covers the tracheal opening when swallowing) is the doorway from which sound is produced; the lips are the "fan blades" through which sound is transmitted outward; the tongue is the "mechanism" through which sound is formed; the uvula (commonly known as the "little tongue") is the "checkpoint" through which sound passes; the nasopharynx (posterior nasal cavity) is the channel through which airflow is distributed; and the hyoid bone (os hyoideum) is governed by spirit-qi (qi presided over by mental awareness) and is primarily responsible for driving the movement of the tongue.
Therefore, if a person's nasal passages discharge clear nasal discharge without stopping, it is because the nasopharynx fails to open and close properly, and its function of distributing airflow has become abnormal.
If the epiglottis is thin and flexible, then qi issuance is rapid, opening and closing are smooth, and both exhaling and producing sound are easy; if the epiglottis is thick and sluggish, then opening and closing become difficult, and qi exits slowly, which is why speech becomes heavy speech (slow, labored articulation).
When a person suddenly loses their voice, it is because cold qi (❄️ a yin-natured pathogenic qi) has invaded the epiglottis. The epiglottis cannot initiate properly, and even if it does initiate, it cannot fully descend and close into position. With opening and closing impaired, there is consequently no sound.
The Yellow Emperor asked: How does one treat this with acupuncture?
Qibo said: The Foot-Shaoyin Kidney Meridian connects upward to the root of the tongue, links with the hyoid bone, and terminates at the epiglottis. On this meridian, select two points (such as Zhaohai and other points) to drain the blood vessels, and the turbid qi (metabolically stagnant pathogenic qi) can be eliminated. The meridian of the epiglottis connects upward with the Conception Vessel. Needling the Tiantu point, the epiglottis can restore its voice-producing function.
The central idea of this section lies in establishing a systematic functional model of the vocal organs. The ancients decomposed the voice-production process into a complete chain of "qi-form" coordination:
| Anatomical Site | Functional Role | Vernacular Understanding |
|---|---|---|
| Pharynx (Throat) | Passage of water and grain | Food passage |
| Larynx (Throat proper) | Upper passage of qi | Airway for breathing and voice |
| Epiglottis | Gate of voice and sound | The "door" of sound |
| Lips | Fan of voice and sound | Regulates the outward transmission of sound |
| Tongue | Mechanism of voice and sound | Core organ for articulation |
| Uvula | Checkpoint of voice and sound | Barrier for opening and closing the vocal tract |
| Nasopharynx | Outlet of qi distribution | Channel for airflow distribution |
| Hyoid Bone | Governed by spirit-qi | "Lever" for tongue movement |
This model embodies the functional anatomical approach consistent throughout the Lingshu—not deliberately pursuing precise dissection of anatomical entities, but rather using function as the guiding principle, incorporating voice-related structures into an integrated collaborative system. The ancients believed that "voice and sound" are not accomplished by any single organ in isolation, but rather constitute a holistic movement in which qi passes in and out through the epiglottic gate, the tongue serves as the articulatory mechanism, the lips and uvula regulate opening and closing, the nasopharynx distributes airflow, and ultimately all is governed under the coordination of spirit-qi.
Regarding pathogenesis, this chapter summarizes the core mechanism of sudden voice loss as "cold qi lodging at the epiglottis." This is entirely consistent with the pathological concept in the Neijing that "cold dominates contraction and constriction": cold is characterized by congealing, stagnating, and contracting. When it lodges at the epiglottis, it causes dysfunction in opening and closing; the gate fails to open, qi cannot pass normally, and thus there is no sound. This understanding of "when the form is cold, qi is closed" is a typical example in Neijing etiology and pathogenesis of "external pathogens attacking localized orifices and portals."
Regarding treatment, Qibo selected points on the Foot-Shaoyin Kidney Meridian and the Conception Vessel. The kidney meridian "ascends to connect with the tongue, links with the hyoid bone, and terminates at the epiglottis"—its pathway directly relates to the epiglottis. This exemplifies the classic point-selection principle of "where the meridian passes, there treatment can reach." Furthermore, the fundamental driving force of voice production lies in kidney qi (the kidney governs qi reception and serves as the root of qi), so treating from the kidney meridian not only resolves the local meridian obstruction but also addresses the root source of qi. The Tiantu point (CV-22) is located on the Conception Vessel, directly below the laryngeal prominence, and is a key point for treating disorders of the throat and respiratory tract, reflecting the principle of "local point selection." Draining blood at the two points to "dispel turbid qi" embodies the acupuncture draining method principle for addressing stagnant pathogenic excess.
The greatest value of this section lies in its earliest systematic description of vocal function. Modern voice medicine divides voice production into three subsystems: the power system (lungs and respiratory airflow, corresponding to "the throat is where qi moves up and down"), the vibratory system (vocal folds—the ancients used "epiglottis" as the gate, and although the anatomical identification does not correspond exactly to the modern vocal folds, the functional description is highly matching—opening and closing determines sound production), and the resonance and articulation system (pharyngeal cavity, oral cavity, nasal cavity, tongue, lips, soft palate, etc., corresponding to "lips as the fan blade," "tongue as the mechanism," "uvula as the checkpoint," and "nasopharynx distributing qi"). That such a complete framework-level understanding existed over two thousand years ago is genuinely remarkable.
Regarding "cold qi lodging at the epiglottis causing sudden voicelessness," conditions in modern medicine such as acute laryngitis, acute vocal fold edema, and even functional voice loss due to psychological stress (hysterical aphonia) may all present with sudden loss of voice. The "cold pathogen" described in Chinese medicine has some correspondence with "mucosal congestion and edema of the supraglottic area after exposure to cold," but "cold qi" belongs to categorical analogy-based etiological inference, not directly measurable physical coldness. It represents a theoretical model based on phenomenological associations, rather than a precise diagnosis from microbiology or pathology.
Regarding "when the epiglottis is thin and quick, qi issues rapidly; when the epiglottis is large and thick, qi exits slowly," this can be understood as the ancients' observation of individual differences in laryngeal morphology—those with thin and flexible laryngeal structures produce sound with ease and briskness, while those with thick and heavy structures speak slowly. This resonates with the concept of individual anatomical variation in modern anatomy, though the ancients attributed it to the epiglottis (rather than the vocal folds), representing an anatomical layer of imprecision.
Acupuncture at the Foot-Shaoyin meridian and Tiantu point for treating voice loss does have clinical application in modern acupuncture practice, particularly as adjunctive therapy for voice disorders such as chronic laryngitis, vocal fold nodules, and functional aphonia. Some studies suggest that acupuncture may improve vocal function by regulating local blood circulation in the throat, reducing edema, and alleviating laryngeal muscle tension; however, from an evidence-based medicine perspective, high-quality randomized controlled trials remain limited, and the precise efficacy and mechanisms of action await further verification. It must be clearly stated that for voice loss caused by acute laryngeal obstruction, tumors, or other organic pathology, acupuncture cannot replace standard modern medical diagnosis and treatment.
Guard against wind-cold, protect the throat: This chapter indicates that sudden voice loss is related to cold pathogens. In daily life, attention should be paid to keeping the neck and throat warm, avoiding sudden chilling or direct cold wind on the throat, especially during seasonal transitions and periods of large temperature fluctuations. This is a non-therapeutic daily living preventive measure.
Regulate emotions, avoid sudden anxiety or fright: The Yellow Emperor's question concerned "sudden affliction leading to voicelessness," suggesting that intense emotional fluctuations may affect the normal movement of qi. Maintaining emotional stability in daily life and avoiding excessive fright or excessive worry contributes positively to the smooth flow of breath and qi.
Use the voice properly, avoid overexertion: Voice production is a fine motor process involving the coordinated action of multiple organs. Prolonged loud shouting or excessive voice use can deplete vocal function. In daily life, one should maintain a composed speaking pace, moderate volume, and give the throat adequate time to "rest."
Nourish with fluids: The pharynx is the convergence point of the food-and-water passage and the airway. Maintaining appropriate hydration habits and avoiding prolonged dryness of the throat helps preserve the moisture of the vocal tract. This is a general daily care practice, not targeted at any specific disease.
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This content is based on classical Chinese medicine texts and is provided solely for traditional cultural study and reading purposes. It does not constitute any medical diagnosis, medication, or treatment advice. If you experience discomfort, please seek medical attention promptly.