*Chao Shi Bing Yuan* (Source of Pathogenesis by Chao Yuanfang) on the syndrome of infants aged four or five years unable to speak: The five internal organs correspond to five vocalizations; the vocalization of the Heart is speech. If an infant aged four or five cannot speak, it is because during gestation, the mother suddenly experienced fright and terror, which internally agitated the fetus's organs. Evil qi took advantage of this to invade the Heart, causing disharmony of Heart Qi, resulting in the inability to speak until the age of four or five.

*Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) discusses: When an infant is first born, if there is "tongue-tie" (ankyloglossia), with a membrane under the tongue resembling a pomegranate seed, separating and connecting the posterior part of the tongue, this causes the child's speech to be undeveloped and unarticulated. It can be severed with fingernails; slight bleeding is harmless. If bleeding does not stop, burning it to ash and applying the powder will stop the bleeding. (Yao Hezhong stated: If not removed, the child will become mute.)

Zhang Huan discussed: The vocalization of the Heart is speech. If a slightly older child speaks late when they should speak, it is due to the mother experiencing fright and terror during pregnancy, which internally agitated the fetus's organs. Evil qi invaded the Heart, causing deficiency of Heart Qi and weakness of the tongue root, hence delayed speech.

*Qian Jin Fang* prescription for treating infants aged four or five who do not speak.
Apply red adzuki bean wine mixed and applied under the tongue.

Ri Hua Zi in *Ben Cao* (Materia Medica) stated: Wine from the leftover sacrificial meat of the earth altar ritual; for children with delayed speech, give them a small amount to consume.

*Tai Ping Sheng Hui Fang* (Holy惠民 Formulas of the Taiping Era) for treating pediatric Heart Qi deficiency, weakness of the tongue root, leading to delayed speech. Shaoyao San (Peony Powder) formula:
Chi Shaoyao (Radix Paeoniae Rubra, 1 liang) Huangqi (Herba Astragali, 3 fen, sliced) Xijiao (Cornu Rhinocerotis, crushed) Binglang (Semen Arecae) Gancao (Radix Glycyrrhizae, roasted until slightly red, sliced. All above 0.5 liang)
Crush the above ingredients and sieve into coarse powder. Take 1 qian per dose, add one small cup of water, decoct until reduced to 0.5 cup, remove dregs. Adjust dosage according to the child's size, at any time, take warm in divided doses.

*Tai Ping Sheng Hui Fang* for treating infants aged five or six who do not speak, due to Heart Qi deficiency and weakness of the tongue root making movement difficult. It is also said that wind-cold injured the Shaoyin meridian, thus the tongue finds it difficult to produce the five tones, resulting in silence at the appropriate time. Changpu Wan (Acorus Pill) formula:
Shichangpu (Rhizoma Acori Tatarinowii) Renshen (Radix Ginseng, remove rhizome) Huanglian (Rhizoma Coptidis, remove roots. All above 0.5 liang) Maimendong (Tuber Ophiopogonis, remove heart, baked) Tianmendong (Tuber Asparagi, remove heart, baked. Each 1 liang) Chishizhi (Lapis Kaolinii) Danshen (Radix Salviae Miltiorrhizae. Each 3 fen)
Crush the above ingredients and sieve into powder, mix with refined honey to form pills the size of mung beans. Take 5 pills per dose dissolved in warm water. Adjust dosage according to the child's size, at any time.

Qian Yi treated pediatric Heart Qi deficiency, inability to speak at five or six years old. Changpu Wan (Acorus Pill):
Shichangpu (Rhizoma Acori Tatarinowii) Danshen (Radix Salviae Miltiorrhizae. Each 2 qian) Tianmendong (Tuber Asparagi, remove heart, bake and weigh) Maimendong (Tuber Ophiopogonis, remove heart, bake and weigh. Each 1 liang) Chishizhi (Lapis Kaolinii, 3 fen) Renshen (Radix Ginseng, 0.5 liang, slice, remove roots, bake)
Grind all together into fine powder, mix with refined honey to form pills the size of mung beans or sesame seeds. Take 5-7 pills up to 10-20 pills with warm water. At any time, take 3-4 times daily, long-term use yields results.

There are also cases of mutism due to Kidney Yin/Yang deficiency after illness. One should concurrently administer Qian's Dihuang Wan (Rehmannia Pill) (formula found in the Deficiency-Cold section).

Zhang Huan's Changpu Tang Dan (Acorus Decoction Pill) formula treats mutism in children of several years old.
Shichangpu (Rhizoma Acori Tatarinowii, 1 cun, nine-jointed type) Yuanzhi (Radix Polygalae, remove heart) Guixin (Cortex Cinnamomi, all above 1 liang) Suanzaoren (Semen Ziziphi Spinosae) Huangqi (Herba Astragali) Renshen (Radix Ginseng, remove rhizome) Huanglian (Rhizoma Coptidis, remove roots. All above 0.5 liang)
Crush and sieve the above into fine powder, mix with refined honey to form pills the size of a corn kernel. Take 1-2 pills per dose, swallow with decocted ginger soup, at any time.

*Zhang Shi Jia Chuan* (Zhang Family Transmission) prescription for treating pediatric mutism.
Suanzaoren (Semen Ziziphi Spinosae) Baiziren (Semen Platycladi, each 0.5 liang) Yuliren (Semen Pruni Armeniacae) Renshen (Radix Ginseng, each 1 liang)
Grind into fine powder, make pills the size of sophora seeds using honey paste. Children take 10 pills per dose. For those with Qi deficiency, only use Yuliren and Renshen.

*Zhuang Shi Ji* (Collected Works of Zhuang) Acupuncture and Moxibustion Method: For mutism at four or five years old, moxa three burns (zhuang) on both ankles above.

*Zhuang Shi Ji* (Collected Works of Zhuang) Acupuncture and Moxibustion Method: Mutism in infants aged five or six is due to Heart Qi deficiency, weakness of the tongue root, and difficulty in articulation. Moxa Xinshu (BL-15) three burns, located 1.5 cun lateral to the lower border of the fifth thoracic vertebra.