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Capítulo 69 de 81
黄帝内经·灵枢
The Yellow Emperor asked Shaoshi: Some people suddenly lose their voice due to worry and fear (sudden suffering from grief and fright), as if a riverbed were blocked. Which kind of Qi (💨 the subtle substances that circulate within the human body) has its movement obstructed, causing the voice to fail to be produced normally? I wish to hear the reasoning behind this.
Shaoshi replied: The throat (pharynx) is the passage through which water and grain enter the body; the larynx is the pathway through which breath moves up and down; the epiglottis (the laryngeal cartilage that acts as a "curtain" covering the tracheal opening when swallowing) is the gate from which sound emerges; the lips are the "fan blades" that project sound outward; the tongue is the "mechanism" that forms sound; the uvula (commonly known as the "little tongue") is the "pass" through which sound travels; the hanghang (nasopharynx) is the channel through which airflow is distributed; the hyoid bone is governed by spirit-qi (qi directed by consciousness and intention) and is primarily responsible for driving the movement of the tongue.
Therefore, if a person has clear nasal discharge that does not stop, it is because the hanghang (nasopharynx) fails to open and close properly, and its function of distributing airflow has become disordered.
If the epiglottis is thin and agile, then the emission of qi is rapid, opening and closing are smooth, and both exhalation and sound production are easy. If the epiglottis is thick and sluggish, opening and closing become difficult, and the emission of qi is delayed. Hence, speech appears heavy (slow and labored).
When a person suddenly loses the ability to speak, it is because cold qi (❄️ yin-cold pathogenic qi) has invaded the epiglottis. The epiglottis cannot start properly, and even when it does start, it cannot close fully downward, so its opening and closing become clumsy. Thus, there is no voice.
The Yellow Emperor asked: How should acupuncture treat this?
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. Take two points on this meridian (such as Zhaohai, etc.) and bleed its blood vessels to drain them; then turbid qi (metabolic stasis pathogenic qi) can be eliminated. The vessels of the epiglottis connect upward with the Conception Vessel. Needling Tiantu point (CV-22), the epiglottis can restore its voice-producing function.
The core idea of this chapter lies in constructing a systemic functional model of the vocal organs. The ancients broke down the process of phonation into a complete chain of "qi-form" coordination:
| Anatomical Site | Functional Role | Plain-Language Understanding |
|---|---|---|
| Pharynx (throat) | Passage of water and grain | Food pathway |
| Larynx | Passage for qi to move upward/downward | Airway for breathing and voice |
| Epiglottis | Gate of sound | The "door" of the voice |
| Lips | Fan of sound | Regulate the outward projection of sound |
| Tongue | Mechanism of sound | Core organ for articulation |
| Uvula | Pass of sound | Checkpoint for opening/closing the vocal tract |
| Nasopharynx | Where qi is distributed | Channel for allocating airflow |
| Hyoid bone | Driven by spirit-qi | "Lever" for tongue movement |
This model embodies the book Lingshu's consistent functional anatomy approach—it does not aim for precise anatomical dissection, but rather uses function as the guiding principle, incorporating all structures related to phonation into an integrated cooperative system. The ancients believed that "sound" is not produced by a single organ in isolation, but rather, qi exits and enters through the epiglottis gate, the tongue acts as the articulatory mechanism, the lips and uvula regulate opening and closing, and the nasopharynx distributes airflow—all ultimately coordinated under the command of spirit-qi as a holistic movement.
Regarding pathogenesis, this chapter summarizes the core mechanism of sudden aphonia as "cold qi lodging at the epiglottis." This is fully consistent with the Neijing's pathological concept of "cold governs contraction": cold is stagnant and constricting by nature, and when it lodges at the epiglottis, it cripples its opening and closing. The gate fails to open, qi cannot move in and out properly, and thus there is no voice. This recognition that "when the form is chilled, the qi is blocked" is a typical example in the Neijing's etiology and pathogenesis of "external pathogens attacking a specific orifice."
Regarding treatment, Qibo chose 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 course is directly related to the epiglottis. This is a classic application of the principle "where the meridian passes, there the treatment extends." At the same time, the fundamental driving force behind voice production lies in kidney qi (the kidney governs qi reception and is the root of qi), so starting from the Kidney Meridian addresses both the local meridian obstruction and the root source of qi. Tiantu point (CV-22), located on the Conception Vessel just below the laryngeal prominence, is a key point for treating throat and airway disorders, reflecting the approach of "selecting points locally." The two places where blood is bled to "dispel turbid qi" illustrate the acupuncture drainage principle used for excess pathogenic obstruction.
The greatest value of this chapter lies in its earliest systematic description of vocal function. Modern voice medicine divides phonation into three subsystems: the power system (lungs and respiratory airflow—hence "the larynx is where qi moves up and down"), the vibratory system (vocal folds; the ancients regarded the "epiglottis" as the gate—although its anatomical location does not exactly correspond to the modern vocal folds, its functional description closely parallels: opening and closing determine voicing), and the resonance-articulation system (pharyngeal, oral, and nasal cavities; tongue, lips, soft palate, etc.—hence "lips as the fan," "tongue as the mechanism," "uvula as the pass," and "nasopharynx distributing qi"). That such a complete framework existed over two thousand years ago is indeed remarkable.
Regarding "sudden aphonia due to cold qi lodging at the epiglottis," conditions such as acute laryngitis, acute vocal fold edema, and even functional aphonia (hysterical voice loss) due to psychological stress may present with sudden voice loss in modern medicine. The TCM concept of "cold pathogen" has some correspondence with "mucosal congestion and edema of the supraglottic region after exposure to cold," but "cold qi" belongs to an etiology derived through categorical analogical reasoning, not a directly measurable physical cold. This is a theoretical model based on phenomenological correlation, not a precise microbiological or pathological diagnosis.
Regarding "a thin and agile epiglottis produces rapid qi emission; a thick and large epiglottis results in delayed qi output, " this can be understood as an ancient observation of individual morphological differences in the larynx—those with thin and nimble laryngeal structures speak quickly and easily, while those with thick and heavy structures speak slowly. This resonates with the modern anatomical concept of individual variation, though the ancients attributed it to the epiglottis (rather than the vocal folds), an anatomical inaccuracy.
Acupuncture on the Foot-Shaoyin Meridian and Tiantu point for aphonia does have application in modern clinical practice, particularly as adjunctive treatment for voice disorders such as chronic laryngitis, vocal nodules, and functional aphonia. Some studies suggest that acupuncture may improve vocal function by regulating local laryngeal blood circulation, reducing edema, and relieving laryngeal muscle tension. However, from an evidence-based medicine perspective, high-quality randomized controlled trials remain limited, and the exact efficacy and mechanism require further verification. It must be clearly stated that for aphonia caused by acute airway obstruction, tumors, or other organic lesions, acupuncture cannot replace standard modern medical diagnosis and treatment.
Cautiously avoid wind-cold and protect the throat: The text notes that sudden aphonia is related to cold pathogens. In daily life, one should keep the neck and throat warm, avoid sudden chilling or direct cold wind on the throat, especially during seasonal transitions and marked temperature differences. This is non-therapeutic everyday protective care.
Regulate emotions; avoid sudden grief or fear: The Yellow Emperor's question concerned "sudden grief and harm" leading to loss of voice, indicating that violent emotional swings can affect the normal movement of qi. Maintaining emotional stability in daily life and avoiding excessive fright or worry is conducive to the free flow of qi.
Use the voice correctly; avoid overexertion: Vocalization is a fine motor function involving coordinated action across multiple organs. Chronic yelling and excessive voice use can deplete vocal function. In daily life, speak at a measured pace and moderate volume, giving the throat adequate "rest."
Nourish with fluids: The pharynx is the meeting point of the food pathway and the airway. Maintaining proper hydration habits and avoiding chronic dryness of the throat helps sustain a moist and lubricated vocal tract. This is universal daily care and does not target any specific illness.
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This content is based on ancient Chinese medical classics and is intended solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication advice, or treatment recommendation. If you are unwell, please seek medical attention promptly.