Hoarse After a Cold, or Suddenly Can’t Speak? Doctor Wu Jutong’s Cases of Sudden Loss of Voice (Ma Xing Shi Gan Tang)
What the patient was searching for: hoarse voice / can’t speak / raspy voice / hoarse after a cold / suddenly lost my voice Medical terms: loss of voice (shi yin, yin ya) · loss of voice after an external contraction · jin shi wu sheng (a full metal bell cannot ring) · acute laryngitis
Opening: the voice suddenly gone — enough to drive anyone frantic
Today we continue with the medical cases of Doctor Wu Jutong (吴鞠通) (1758–1836), one of the great Qing-dynasty physicians. His given name was Tang, his courtesy name Jutong, and he came from Huai’an, Jiangsu Province. He is counted among the founding figures of Warm Disease medicine (wen bing xue), and his Wen Bing Tiao Bian (Systematized Identification of Warm Diseases) made his name known across the whole empire.
The illness in today’s case is called shi yin — loss of voice — in plain words, you cannot speak. Doctor Luo Dalun says that when he was a child, after a cold with fever, he would lose his voice, and sometimes no sound at all would come out — the frustration of it is enough to drive anyone frantic. How are you supposed to answer in class when the teacher calls on you? So today, let’s see how Doctor Wu Jutong treated this kind of urgent voice loss brought on by an external contraction.
💬 Note from Doctor Luo: Every physician has his own fixed way of thinking when he treats disease. Learn his approach, and the more cases you have seen, the more complete your own repertoire becomes — and the more confidence you have inside yourself. A doctor like Wu Jutong is worth studying carefully. This case is recorded as happening on the second day of the second lunar month in the yi chou year — 1805.
The first patient: the right pulse drumming like thunder, yet the voice gone
The second day of the second month — still winter. In came a patient surnamed Zhu. Doctor Wu felt his pulse: the right pulse was surging, rapid and forceful (hong shu you li) — fast and fierce, pounding “bang, bang” against the fingers.
💬 Note from Doctor Luo: A surging, rapid, forceful pulse tells you that the external pathogen is still present — and that it is heat evil, because the pulse is fast and strong. In classical terms this is called jin shi wu sheng — “a full metal bell cannot ring.” What does that mean? The lung belongs to Metal. Think of the lung as a drum: a drum that is hollow inside gives a great “boom” when you strike it; but if you pack it full of stuff, it can’t ring at all. The lung is a hollow cavity, and the voice depends on that hollowness. When the lung is stuffed full of pathogenic heat, the voice is blocked — and you cannot speak.
What is the connection between the lung and the throat? Every breath passes through the throat. When the lung harbors pathogenic heat and the blood-heat engorges it, the voice is affected — that is why the four characters “jin shi wu sheng” describe the whole condition so exactly.
Doctor Wu took one look and said: this is a Ma Xing Shi Gan Tang pattern.
Ma Xing Shi Gan Tang: the “treat cold and heat together” method opened up by Doctor Zhang Zhongjing
Ma Xing Shi Gan Tang is a formula of Doctor Zhang Zhongjing.
💬 Note from Doctor Luo: Notice something — all along, many of the formulas Doctor Wu Jutong uses come from the Shang Han Lun (Treatise on Cold Damage). Don’t imagine that the Warm Disease school refuses to touch the cold-damage formulas, or that the classical-formula school refuses warm-disease formulas — there is no such thing! Patients do not fall ill according to your school of thought. You have to master every approach. Ma Xing Shi Gan Tang is a truly remarkable formula because it opened up an entire method of treatment — how to handle “external cold with internal heat” (han bao huo, literally “cold wrapping fire”): cold on the outside, heat on the inside. You use cooling herbs to clear the internal heat — but what about the cold outside? You use warming herbs to scatter it. Isn’t that contradictory?
Doctor Zhang Zhongjing opened a door — treating cold and heat together: ma huang (ephedra) is warm in nature; it induces sweat, releases the exterior and spreads the lung to scatter cold. Sheng shi gao (raw gypsum) clears internal heat. Xing ren (apricot kernel) opens the lung qi and stops cough and wheezing. Gan cao (licorice) harmonizes the middle. One herb scatters the external cold, one clears the internal heat — the two fit together like pieces of a lock. Countless later formulas grew out of this same idea: for scattering cold, su ye, jing jie, fang feng; for clearing heat, jin yin hua, pu gong ying, huang qin.
But Doctor Wu Jutong said: the thinking is right, yet ma huang cannot be used here! Why? The doctor before had already induced sweating — the external cold may already have been released, or is in the middle of being released. Sweating again would be too much — the patient could not bear being sweated over and over. So he changed to Qing Yin Tang plus gypsum and apricot kernel.
Changing the formula: jie geng moves upward, ban xia moves downward
What is Qing Yin Tang (Clear the Voice Decoction)? Its core is jie geng (Platycodon root) and gan cao (raw licorice); in ancient times he zi (chebulic myrobalan) was also added. Doctor Wu liked to add ban xia (Pinellia) as well.
💬 Note from Doctor Luo: What is ban xia for? To send qi downward — to lower the qi of the lung and stomach. The lung qi descends in step with the stomach qi’s descent: when the stomach qi goes down, only then can the lung qi come down. In this kind of patient, where pathogenic qi is congesting the qi mechanism above, the voice won’t come out — so you have to draw the qi downward. Jie geng is exactly the opposite — it moves upward: it opens the chest, frees the qi, benefits the throat, and resolves the toxins of the throat. Even in Doctor Zhang Zhongjing’s time, jie geng was used for throat illnesses. One goes up, one goes down — that is the pairing of ascent and descent. Remember this pair: after an external contraction, when you cannot speak, jie geng paired with ban xia is worth trying.
The first prescription: jie geng six qian (18 g), raw gypsum six qian (18 g), apricot kernel powder five qian (15 g), plus lu gen (fresh reed root) — lu gen (also called wei gen) clears heat, generates fluids, clears heat from the lung and stomach, cools the blood and vents the heat outward — plus gan cao to harmonize the middle. For throat problems gan cao is often used, as it has a detoxifying action. Sometimes fu ling (Poria) was added to drain dampness and shen qu (medicated leaven) to help digestion. Five cups of water boiled down to two cups; the dregs were boiled again for one more cup — three doses in total.
The follow-up visit: still the Ma Xing Shi Gan Tang approach, with more gypsum
The next day (the third of the month), Doctor Wu noted: “The lung itself harbors heat, and is struck by external wind” (fei zang ben re, wei wai feng suo bo) — the lung already had heat inside; then the wind outside blew on it; cold and heat interlocked, the lung qi got blocked, and the voice came and went.
💬 Note from Doctor Luo: See how clear Doctor Wu Jutong is — at every follow-up visit he writes down the cause of the illness so that everyone understands how he is treating it. He said: in the end it is still the Ma Xing Shi Gan Tang method that governs — so we stay with the Ma Xing Shi Gan Tang thinking. So he adjusted the previous formula: raw gypsum increased to one liang (30 g), ma huang three qian (9 g), apricot kernel paste six qian (18 g), honey-fried licorice three qian (9 g), ban xia five qian (15 g). The illness had not changed much, so he only adjusted the doses — the doses have to be adjusted, otherwise it seems as if the illness will never get better.
The fourth of the month: the pulse half as fierce, and sound returning
One more day passed (the fourth of the month): the surging, rapid, forceful right pulse had already halved in intensity — the force against the fingers was much less, a great improvement. The voice was gradually opening (yu yin jian kai) — he could make sounds again.
So Doctor Wu adjusted again, still using Ma Xing Shi Gan Tang plus ban xia: raw ma huang three qian (9 g), raw gypsum ground to powder one liang (30 g), apricot kernel cream seven qian (21 g), ginger-processed ban xia seven qian (21 g), honey-fried licorice three qian (9 g). Cooked in eight bowls of gan lan shui (sprinkled water) down to three bowls, in three doses. As the illness lessened, the doses came down step by step.
💬 Note from Doctor Luo: Here is a tip about raw gypsum — raw gypsum does not need to be decocted first! Many experts say it is a mineral and must be decocted first, but in Doctor Zhang Zhongjing’s day no one decocted it first. The active components of raw gypsum dissolve very quickly — it can be cooked right along with the other herbs, and it even does well added later. Once it is ground into powder, the surface area exposed to the water is large, and it dissolves out almost immediately.
The second patient: a 45-year-old wine drinker, and gypsum at four liang
That first case ends there — in Doctor Wu Jutong’s eyes it was a trifling little illness. To be honest, even without any medicine, after a few days the external contraction passes, the body’s upright qi (zheng qi) recovers, pushes the pathogen out, and the voice naturally returns. A hoarse voice is just one of the body’s reactions as it pushes the evil qi outward. But while you are actually sick, it is truly worrying — so a quick adjustment puts things right, and fast.
Then comes another patient surnamed Zhu, 45 years old, a wine drinker — a man who drank regularly. He suddenly lost his voice. Doctor Wu again prescribed Ma Xing Shi Gan Tang: raw gypsum four liang — 120 grams! — ma huang five qian, apricot kernel four qian, honey-fried licorice three qian.
💬 Note from Doctor Luo: Folks, that is a big dose — 120 grams of raw gypsum! This is how bold Doctor Wu Jutong’s dosages were.
And the result? After one day of taking it, no sweat, and the voice still would not come out. With the second dose, a light sweat broke, and the voice came out (wei han, yin chu) — sound was back, though not yet loud. He stayed on the same method: honey-fried ma huang three qian, raw gypsum three qian, honey-fried licorice three qian, apricot kernel four qian — taken for five days in a row, and the voice came out big and clear (yin da chu) — he could speak, and clearly.
Then Doctor Wu felt the pulse: it was slippery (mai hua). He used Qing Yin Tang to finish the job — jie geng, ban xia, honey-fried licorice.
The phlegm was not rooted out: “when the nine orifices are blocked, the cause comes from the stomach and intestines”
The voice was clear now, but the pulse was still slippery — phlegm-fluid (tan yin) had not been fully cleared. This phlegm-fluid lodged in the body, especially in the spleen and stomach, and it had to be removed.
💬 Note from Doctor Luo: The Nei Jing (Inner Canon) says — “when the nine orifices are blocked, the cause arises from the stomach and intestines” (jiu qiao bu li, jie wei chang zhi suo sheng). What are the nine orifices? Two eyes, two nostrils, one mouth, one throat, two ears — nine openings in all. The root of problems in the nine orifices is often the spleen and stomach — when the spleen and stomach lose regulation, their ability to send the clear upward and the turbid downward declines, and illness follows. So Doctor Wu prescribed the Fu Ling Yin (Poria Drink) from the Wai Tai Mi Yao (Arcane Essentials from the Imperial Library), dropping the newer herbs and focusing on regulating the spleen and stomach. After seven doses, he was well — cured in seven days.
Two singing children: American ginseng with abalone, and Qing Yin Tang with additions
Doctor Wu Jutong also treated loss of voice with food therapy.
The first: a singer, 15 years old, who sang every day — in those days people made their living singing at the wine houses — overworking the lung (lao shang fei), and the voice went hoarse. What to do? Xi yang shen (American ginseng), cut into thin slices, one liang (30 g); abalone, cut into thin slices, four liang (120 g); cook them into a soup and drink it. And when singing, take one slice of abalone and one slice of American ginseng and press them beside the cheek, letting the fluids moisten the throat little by little; sing gently, and the voice recovers — and afterward it never went hoarse again.
💬 Note from Doctor Luo: This is Doctor Wu Jutong’s food therapy method — using food therapy to treat loss of voice, moistening the lung and nourishing yin. Look how ingenious the thinking is.
The second: a singer, 16 years old, who had drunk wine to excess and then greedily eaten fruit afterward — the result was cold and heat wrestling together, damp-heat brewing internally, and he could not speak. This time Doctor Wu used Qing Yin Tang (jie geng, ban xia, gan cao) plus su geng and su ye (perilla stem and leaf) — the stem moves upward; shen qu (medicated leaven) — moves downward and helps digestion; lu gen (reed root) — clears heat; fu ling (Poria) — strengthens the spleen and sends the clear up and the turbid down.
💬 Note from Doctor Luo: This formula is remarkably complete — its main work is regulating the ascent and descent of qi and harmonizing the spleen, stomach, lung and stomach, with phlegm and dampness cleared as well. Every method is represented; the core is harmonizing the qi mechanism of the spleen and stomach. For this 16-year-old singer he used a small formula — a few doses, and after a few rounds of drinking it, he was cured. When it came to loss of voice, Doctor Wu Jutong truly had it “at his fingertips.”
Loss of voice can be cold or hot — don’t only clear heat
Taken together, these cases give a fairly complete picture of how to handle loss of voice.
💬 Note from Doctor Luo: Loss of voice can be hot or cold — if there is heat, use raw gypsum and other heat-clearing herbs; but there are also cold patterns — the voice lost from catching cold, which calls for warming the yang: some people really do use Si Ni Tang (Frigid Extremities Decoction) — fu zi (aconite) and gan jiang (dried ginger) come up and work well. Or simply: switch on the seat heater in the car, warm the back, drink some hot soup and let the body warm up — all helpful. A hair dryer blowing warm air works too, letting the body warm through gradually. So loss of voice can be a cold pattern; you cannot assume every case is heat.
As for the cases Doctor Wu Jutong treated here, every one was external cold with internal heat — and external cold with internal heat is the single most common stage of an external contraction illness.
💬 Note from Doctor Luo: Regular listeners of my lectures on externally contracted illness know this pattern well: often you catch cold outside and don’t pay attention, the pathogen moves inward, and the body starts to fight back; if you already harbor internal heat, the internal heat is stirred up even more easily — the struggle generates heat. So external cold with internal heat is a very common, long-lasting stage of external contraction illness. If the purely external-cold stage at the beginning was not controlled, what follows is a long, mixed cold-and-heat stage. A hoarse voice usually appears right in this stage — out of ten cases, a purely cold one that loses the voice right from the start is rare. So the treatment goes just the way Doctor Wu did it: scatter the external cold and clear the internal heat, the Ma Xing Shi Gan Tang approach used all together — that is the true way to treat it.
Bonus: what to do when your voice goes hoarse
At the end, Doctor Luo Dalun has a few words of advice:
💬 Note from Doctor Luo: For voice loss caused by an external contraction, as long as you use the proper method of expulsion and the external pathogen is cleared, the voice recovers. The worst thing is: treatment done wrong, and on top of that, gritting your teeth and forcing yourself to talk — pushing on with work, refusing proper treatment. That drags the problem out for a long time, and can even really damage the throat. So at this time don’t panic: the voice is hoarse, a fresh fire flares up, the fire grows stronger and the voice grows hoarser. Rest for a few days and it will pass — you don’t have to go on talking.
💬 Note from Doctor Luo: For truly urgent situations there is a formula too — in the old days, when a Peking opera singer had a performance the next day and the voice went hoarse today, the veteran physicians did have an emergency prescription, along the same lines of clearing internal heat and scattering external cold, only with additions such as feng huang yi (the inner membrane of an eggshell) and chan tui (cicada slough) — quite effective. But in ordinary cases, rest a few days; don’t be in such a hurry. In these cases of Doctor Wu Jutong, the only time he used huge doses was in the urgent situation — we don’t need doses that big. Generally speaking, raw gypsum in the range of 15 to 30 grams is plenty to settle the problem.
Learn Doctor Wu Jutong’s approach to loss of voice, and this kind of problem is basically solvable — it is not that complicated.
The original case records come from the Wu Jutong Yi An (Wu Jutong’s Case Records), shi yin (loss of voice) section; the commentary is organized from the public lectures of Doctor Luo Dalun (Ph.D. in diagnostics of Chinese medicine, Beijing University of Chinese Medicine).