《素问》曰∶人有重身，九月而喑，此何为也？曰∶胞之络脉绝也。曰∶何以言之？曰∶胞络者，系于肾，
少阴之脉贯肾，系舌本，故不能言。曰∶治之奈何？曰∶无治也，当十月复。
《大全》曰∶孕妇不语，非病也，间有如此者，不须服药，临产月，但服保生丸、四物汤之类，产下便语
得，亦自然之理，非药之功也。医者不说与人，临月以寻常药服之，产后能语，以为医之功，岂其功也哉。博陵
医之神者，曰郝翁士，有一妇人妊喑，嘿不能言。郝曰∶儿胎大经壅，儿生经行则言矣，不可毒以药。
薛立斋曰∶《内经》穷理之言，人有患此，当调摄以需之，不必惊畏而泛用药也。
张子和曰∶妇人重身，九月而喑者，是脬之络脉不相接也。经曰无治，虽有此论，可煎玉烛散二两，放冷，
入蜜少许，时呷之，则心火下降，而肺金自清，故能作声也。
马玄台曰∶经云，妇人重身，九月而喑
者，胞之络脉绝也，无治，当十月复。方论人之受孕，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，手足十二经之脉，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，胞络、宫之络脉，系于肾经者，
阻绝不通，故间有之。盖肾经之脉，下贯于肾，上系舌本，脉道阻绝，则不能言，故至十月分娩后自能言，不
必治，治之当补心肾为宜。《大奇论》以胞精不足者，善言为死，不言为生。此可验九月而喑，非胞精之不足，
故十月而复也。
张 璜按∶喑谓有言而无声，故经曰不能言。此不能二字，非绝然不语之谓。凡人之音，生于喉咙，发于舌
本。因胎气肥大，阻肾上行之经。以肾之脉，入肺中，循喉咙，系舌本。喉者，肺之部，肺主声音。其人切切
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。若夫全解作不语，则为心病，以心主发
声为言也，与子喑了不相干。若子和有降心火之说，玄台有补心肾之言。如果肾之脉络绝，而上干心，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。
慎斋按∶以上四条，序胎前有子喑之证也。妊娠不语，遵《内经》之旨，固无治法，故《大全》而下，后人
不敢强立方论。独子
和以降心火为治，玄台以补心肾立法，则以胞之络脉，属手足少阴二经故也。但产后不语，属败血之入心。中
风舌喑，属痰涎之滞络。则胎前子喑，亦必有所感。更当详证参治，以补张马二公之未尽。若子喑用玉烛散，
似属无理。
《素问》说：人有怀孕的情况，到了第九个月出现失音，这是为什么呢？回答说：这是因为胞宫的络脉阻滞不通。又问：为什么这样说？回答说：胞宫的络脉与肾相连，足少阴肾经贯穿肾脏，并系连于舌根，所以导致不能说话。又问：该如何治疗？回答说：不需要治疗，等到第十个月分娩后自然会恢复。
《妇人大全良方》说：孕妇不说话，并不是疾病，偶尔有这种情况的，不需要服药，在临产月份，只需服用保生丸、四物汤之类的药物，产后就能说话，这也是自然的道理，并非药物的功效。医生如果不向人说明这一点，在临月时给孕妇服用普通的药物，产后能说话，就认为是医生的功劳，这难道是医生的功劳吗？博陵的神医郝翁士，有一位妇人怀孕失音，沉默不能言语。郝翁说：胎儿长大导致经络壅滞，胎儿出生后经络通畅就能说话了，不能用毒药来治疗。
薛立斋说：《内经》中关于此理的说法是透彻的，有人患此病，应当通过调养护理来等待其自愈，不必惊慌畏惧而滥用药物。
张子和说：妇人怀孕，到第九个月失音，是因为膀胱的络脉不相连接。经文说“不需要治疗”，虽然有这种说法，但可以煎煮玉烛散二两，放凉后，加入少许蜂蜜，不时啜饮，这样心火下降，肺金自然清肃，所以能发出声音。
马玄台说：经文说，妇人怀孕，到第九个月失音，是因为胞宫的络脉阻滞不通，不需要治疗，等到第十个月会恢复。讨论人的受孕过程，第一个月肝经养胎，第二个月胆经养胎，第三个月心经养胎，第四个月小肠经养胎，第五个月脾经养胎，第六个月胃经养胎，第七个月肺经养胎，第八个月大肠经养胎，第九个月肾经养胎，第十个月膀胱经养胎。先阴经后阳经，始于木终于水，这是从五行相生的角度而言的。然而按道理推断，手足十二经脉的气血昼夜流行无间断，没有哪一天哪一个时刻不是共同滋养胎气的，必定没有分经养胎的道理。现在说第九个月失音，时间到了九月，胎儿身体已长，胞宫及子宫的络脉，系属于肾经的，被阻绝不通，所以偶尔会出现这种情况。大概肾经的脉络，下行贯入肾脏，上行系连舌根，脉道阻绝，就不能说话，所以到十月分娩后自然能说话，不需要治疗，如果要治疗，应当以补益心肾为宜。《大奇论》说胞精不足的，多言为死证，不言为生证。这可以验证第九个月失音，并非胞精不足，所以第十个月会恢复。
张璜按语：失音是指有言语能力但发不出声音，所以经文说“不能说话”。这个“不能”二字，并非绝对不说话的意思。凡人的声音，产生于喉咙，发源于舌根。因为胎气肥大，阻断了肾经上行的路径。由于肾经的脉络，进入肺部，沿着喉咙，系连舌根。喉咙，是肺所主的部位，肺主管声音。这个人虽然私下小声说话，心里虽有话语，但别人听不见，所以叫作失音。肺和肾，是子母关系的脏腑，所以说“不需要治疗”。如果把“喑”完全解释为不说话，那就是心病，因为心主发声为言，这与妊娠失音毫无关系。如果像张子和那样主张降心火，马玄台主张补心肾。如果确实是肾的脉络阻滞，并且上扰心神，那么病情就无法治愈，怎么会有产后自然恢复的道理呢？所以经文说“胞之络脉绝”，这里的“绝”字应当解释为“阻”字。
慎斋按语：以上四条，叙述了胎前妊娠失音的症状。妊娠不语，遵循《内经》的宗旨，本来就没有特定的治疗方法，所以从《大全良方》以下，后人不敢强行制定方论。只有张子和以降心火为治法，马玄台以补心肾为立法原则，这是因为胞宫的络脉属于手少阴心和足少阴肾两条经脉的缘故。但是产后不语，属于败血入心的病症；中风导致的舌强失音，属于痰涎阻滞经络的病症。那么胎前的妊娠失音，也必然有所感应。更应当详细辨证参合治疗，以补充张子和、马玄台两位先生未尽之处。如果用玉烛散治疗妊娠失音，似乎缺乏道理。
Suwen states: "When a person is pregnant, they may lose their voice in the ninth month. Why is this?" The answer is: "This is due to the obstruction of the collateral vessels of the uterus (Baogong)." One asks: "Why do you say so?" The answer is: "The collateral vessels of the uterus are connected to the Kidney. The Foot-Shaoyin Kidney Meridian passes through the Kidney and connects to the root of the tongue; therefore, speech becomes difficult." One asks: "How should it be treated?" The answer is: "No treatment is needed; it will recover naturally in the tenth month."
Daquan Liangfang states: "A pregnant woman's inability to speak is not a disease. In occasional cases like this, medication is unnecessary. During the month before delivery, one may simply take medicines such as Baosheng Wan or Siwu Tang. Speech will return after childbirth, which is a natural process, not a result of the medicine's efficacy. If physicians do not explain this to others and administer ordinary medicines during the final month, and speech returns postpartum, claiming credit for the cure, is this truly the physician's merit? Hao Wengshi, a divine physician from Boling, treated a woman with pregnancy-related aphonia who was mute and unable to speak. Hao said: 'As the fetus grows, the meridians become congested. Once the baby is born and the meridians flow freely, speech will return. Do not use toxic drugs.'"
Xue Lizhai stated: "The reasoning in Neijing is profound. For those suffering from this condition, one should adjust lifestyle and wait for recovery, without panic or indiscriminate use of medication."
Zi Hezi stated: "When a pregnant woman loses her voice in the ninth month, it is because the collateral vessels of the bladder (Paofu) are disconnected. Although the classic text says 'no treatment is needed,' one can decoct Yuzhu San (Jade Candle Powder), 2 liang, let it cool, add a little honey, and sip it occasionally. This causes Heart Fire to descend and Lung Metal to clear itself, thus enabling speech."
Ma Xuantai stated: "The classic text says that when a pregnant woman loses her voice in the ninth month, it is due to the obstruction of the uterine collateral vessels, requiring no treatment, with recovery expected in the tenth month. Regarding conception: in the first month, the Liver Meridian nourishes the fetus; second month, Gallbladder Meridian; third month, Heart Meridian; fourth month, Small Intestine Meridian; fifth month, Spleen Meridian; sixth month, Stomach Meridian; seventh month, Lung Meridian; eighth month, Large Intestine Meridian; ninth month, Kidney Meridian; tenth month, Bladder Meridian. This sequence starts with Yin meridians and ends with Yang, beginning with Wood and ending with Water, reflecting the generation cycle of the Five Elements. However, logically speaking, the Qi and Blood of the twelve meridians of the hands and feet circulate continuously day and night, nourishing the fetal Qi at all times; there is no principle of specific meridians nourishing the fetus at specific times. Now, regarding aphonia in the ninth month: by the ninth month, the fetus has grown large, obstructing the uterine collaterals connected to the Kidney Meridian, causing blockage. Thus, it occurs occasionally. The Kidney Meridian descends into the Kidney and ascends to connect to the root of the tongue. When the meridian pathway is blocked, speech is lost. Therefore, speech returns naturally after delivery in the tenth month without treatment. If treatment is required, tonifying the Heart and Kidney is appropriate. Daqi Lun states that insufficient Uterine Essence leads to excessive talking (a sign of death) or silence (a sign of life). This verifies that aphonia in the ninth month is not due to insufficient Uterine Essence, hence recovery in the tenth month.
Zhang Huang commented: "Aphonia refers to having the ability to speak but lacking voice, hence the text says 'unable to speak.' These two characters 'unable to' do not mean absolute muteness. Human sound originates in the throat and issues from the root of the tongue. Due to enlarged fetal Qi blocking the ascending path of the Kidney Meridian—which enters the Lung, follows the throat, and connects to the root of the tongue—the throat (the domain of the Lung, which governs sound) is affected. The patient may whisper privately; although the mind intends to speak, others cannot hear, hence termed 'aphonia.' The Lung and Kidney are mother-son organs; thus, it is said 'no treatment is needed.' If 'aphonia' were interpreted entirely as muteness, it would indicate a Heart disorder, as the Heart governs vocalization, which is unrelated to pregnancy aphonia. Zi Hezi advocated lowering Heart Fire, while Ma Xuantai advocated tonifying Heart and Kidney. If the Kidney's collaterals were truly severed and disturbed the Heart, the condition would be incurable, contradicting the possibility of spontaneous recovery postpartum. Therefore, in the phrase 'obstruction of the uterine collateral vessels,' the character 'severed' (Jue) should be interpreted as 'blocked' (Zu)."
Shenzhen commented: "The above four passages describe the symptom of pregnancy aphonia prior to delivery. Following the principles of Neijing, there is indeed no specific treatment for pregnancy muteness; thus, later authors following Daquan Liangfang dared not arbitrarily prescribe formulas. Only Zi Hezi proposed lowering Heart Fire, and Ma Xuantai proposed tonifying Heart and Kidney, based on the fact that the uterine collaterals belong to the Hand-Shaoyin Heart and Foot-Shaoyin Kidney meridians. However, postpartum muteness belongs to stagnant blood entering the Heart; stroke-induced tongue stiffness and aphonia belong to phlegm-fluid stagnation in the collaterals. Therefore, pregnancy aphonia must also have specific causes. One must carefully differentiate symptoms and treat accordingly to supplement the incomplete views of Masters Zhang and Ma. Using Yuzhu San for pregnancy aphonia seems unreasonable."