经云∶妇人重生九月而喑者,胞之络脉绝也,无治,当十月复。谓人之受孕,一月肝经养胎,二月
胆经养胎,三月心经养胎,四月小肠经养胎,五月脾经养胎,六月胃经养胎,七月肺经养胎,
八月大肠经养胎,九月肾经养胎,十月膀胱经养胎。先阴经而后阳经,始于木终于水,以五行之相生言也。
然以理推之,十二经之脉昼夜流行无间,无日、无时而不共养胎气也,必无分经养胎
之理。今曰九月而喑,时至九月,儿体已长,胞宫之络脉系于肾经者,阻绝不通,故间有之。盖肾经
之脉上系舌本,脉道阻绝,则不能言,故十月分娩后而能言,不必加治,治之当补心肾。喑谓
有言而无声,故经曰不能言,不能非绝然不语之谓。凡音出于喉咙,发于舌本,因胎气肥大,阻肾上行
之经。肾脉入肺,循喉咙,系舌本。喉者,肺之部,肺主声音。其人窃窃私语,心虽有言,而人不能听,故
曰喑。肺肾子母之脏,故云不必治。若大全解作不语,则为心病,以心主发声也,与子喑了不相干,若张子
和有降心火之说,马玄台有补心肾之言。如果肾之脉络绝,则其病不治,岂有产后自复之理乎。
故经云∶胞之络脉绝。此绝字当作阻字解也。
孕妇痰涎壅盛,忽然僵仆,或时发搐,不省人事,是血虚而阴火炎上,鼓动其痰,左脉微数,右脉滑
大者,名曰子痫,宜四物养血,酒芩清热,二陈化痰理气。故《机要》云∶风木为热,热
甚则风动,宜静胜其燥,是养血也。治法仍以安胎为主,勿过用中风之药。盖多由血虚则生热,热盛则生
风,皆内起之风火,养血而风火自灭也。若心肝风热,用钩藤汤;肝脾血虚,加味逍遥
散;肝脾郁怒,加味归脾汤;气逆痰滞,紫苏饮;脾郁痰滞,二陈加竹沥、姜汁。
《黄帝内经》记载:妇女怀孕九个月时出现失音症状,是因为胞宫的络脉阻滞不通,无需治疗,等到第十个月分娩后自然会恢复。这是说人受孕之后,第一个月由肝经滋养胎儿,第二个月胆经滋养胎儿,第三个月心经滋养胎儿,第四个月小肠经滋养胎儿,第五个月脾经滋养胎儿,第六个月胃经滋养胎儿,第七个月肺经滋养胎儿,第八个月大肠经滋养胎儿,第九个月肾经滋养胎儿,第十个月膀胱经滋养胎儿。按照顺序先阴经后阳经,始于木终于水,这是从五行相生的角度来解释的。
然而从道理上推断,十二经脉的气血昼夜循环流动没有间断,每一天、每一个时辰都在共同滋养胎气,必然不存在分经单独养胎的道理。现在说怀孕九月而失音,是因为到了第九个月,胎儿身体已经长大,连接胞宫与肾经的络脉受到阻碍而不通畅,所以偶尔会出现这种情况。因为肾经的脉络上行联系到舌根,脉道受阻,所以不能说话,因此十月分娩后就能说话,不需要特别治疗,如果要治疗应当补益心和肾。“喑”是指有声音但发不出声(或声音嘶哑),所以经文说“不能言”,这里的“不能”并非指完全不能说话的哑症。
凡是声音出于喉咙,发于舌根,因为胎体肥大,阻断了肾脏向上运行的经脉。肾脉进入肺部,沿着喉咙,联系舌根。喉咙是肺所主的部位,肺主管声音。患者只能小声私语,心里虽然有话想说,但别人听不清楚,所以称为“喑”。肺和肾是子母关系的脏腑,所以说不必治疗。如果把“喑”解释为完全不说话,那就是心病,因为心主发声,这与“子喑”毫无关系。如果像张子和那样主张降心火,或者马玄台主张补心肾,如果真的是肾的脉络彻底断绝,那么这种病就无法治愈,怎么会有产后自然恢复的道理呢?所以经文说“胞之络脉绝”,这个“绝”字应当解释为“阻”的意思。
孕妇痰涎壅盛,突然跌倒僵直,或者时而抽搐,不省人事,这是因为血虚导致阴火上炎,鼓动痰湿,左脉微数,右脉滑大,这叫做“子痫”。适宜用四物汤养血,酒制黄芩清热,二陈汤化痰理气。所以《兰室秘藏》中说:风木生热,热极则生风,宜用静(养血)来克制燥,这就是养血的方法。治疗方法仍以安胎为主,不要过度使用治疗中风的药物。大多是因为血虚产生内热,热盛则生风,这些都是内部产生的风火,养血则风火自然熄灭。如果是心肝风热,用钩藤汤;肝脾血虚,用加味逍遥散;肝脾郁怒,用加味归脾汤;气逆痰滞,用紫苏饮;脾郁痰滞,用二陈汤加竹沥、姜汁。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) records: "When a woman becomes aphonic in the ninth month of pregnancy, it is due to the obstruction of the collateral vessels of the uterus. No treatment is needed; speech will recover after the tenth month." This refers to the belief that after conception, the Liver Meridian nourishes the fetus in the first month, the Gallbladder Meridian in the second, the Heart Meridian in the third, the Small Intestine Meridian in the fourth, the Spleen Meridian in the fifth, the Stomach Meridian in the sixth, the Lung Meridian in the seventh, the Large Intestine Meridian in the eighth, the Kidney Meridian in the ninth, and the Bladder Meridian in the tenth. This sequence follows Yin meridians before Yang meridians, starting with Wood and ending with Water, explained through the theory of mutual generation among the Five Elements.
However, reasoning from principles, the Qi and Blood of the Twelve Meridians circulate day and night without interruption, nourishing the fetal Qi jointly at every hour and day; thus, there is no logical basis for each meridian exclusively nourishing the fetus at specific times. The statement that aphonia occurs in the ninth month arises because by this time, the fetus has grown large, causing the collateral vessels connecting the uterus to the Kidney Meridian to become obstructed, leading to occasional cases. Since the Kidney Meridian ascends to connect with the root of the tongue, obstruction of these vessels results in an inability to speak. Therefore, speech recovers after delivery in the tenth month, requiring no special treatment; if treatment were necessary, it should focus on tonifying the Heart and Kidney. "Aphonia" (Yin) here refers to having intent to speak but producing no sound or hoarse voice. Thus, the classic states "unable to speak," where "unable" does not mean complete muteness.
Sound originates from the throat and is articulated at the root of the tongue. Due to the enlarged fetus blocking the ascending pathways of the Kidney, and since the Kidney Meridian enters the Lungs, runs along the throat, and connects to the root of the tongue, while the throat is the domain of the Lungs which governs voice, the patient may whisper privately. Although the mind intends to speak, others cannot hear clearly, hence termed "aphonia." As the Lungs and Kidneys are mother-son organs, it is stated that no treatment is needed. If "aphonia" were interpreted as complete silence, it would indicate Heart pathology, as the Heart governs vocalization, which is unrelated to "fetal aphonia." Approaches such as Zhang Hehe’s suggestion to descend Heart Fire, or Ma Xuantai’s proposal to tonify Heart and Kidney, are flawed. If the renal collaterals were truly severed, the condition would be incurable, contradicting the notion of spontaneous recovery postpartum. Therefore, when the classic says "obstruction of the uterine collaterals," the character "severed/absolute" (Jue) should be interpreted as "blocked" (Zu).
If a pregnant woman experiences excessive phlegm-saliva accumulation, sudden collapse or stiffening, intermittent convulsions, and loss of consciousness, accompanied by a slightly rapid left pulse and a slippery-large right pulse, this is named "Eclampsia of Pregnancy" (Zi Xian). It is caused by Blood deficiency leading to deflection of Yin Fire upward, stirring phlegm. Treatment should involve Si Wu Tang (Four Substances Decoction) to nourish Blood, Wine-processed Huang Qin (Scutellariae Radix) to clear Heat, and Er Chen Tang (Two Aged Herbs Decoction) to resolve Phlegm and regulate Qi. As stated in *Lan Shi Mi Cang*: "Wind-Wood generates Heat; extreme Heat generates Wind. One should use stillness (nourishing Blood) to overcome dryness." The therapeutic principle remains primarily to calm the fetus, avoiding excessive use of medicines for treating Stroke. This condition usually arises from Blood deficiency generating internal Heat, and extreme Heat generating internal Wind-Fire; nourishing Blood extinguishes Wind-Fire naturally. For Heart-Lung Wind-Heat, use Gou Teng Tang (Uncaria Decoction); for Liver-Spleen Blood deficiency, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder); for Liver-Spleen Stagnation and Anger, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction); for rebellious Qi and Phlegm stagnation, use Zi Su Yin (Perilla Infusion); for Spleen stagnation and Phlegm retention, use Er Chen Tang with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice).