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Qian Yi stated: The voice of the Heart manifests as speech. If a child cannot speak at four or five years of age, it is due to sudden fright experienced by the mother during pregnancy, allowing pathogenic factors to invade the child's Heart, resulting in deficiency of Heart Qi (vital energy of the Heart), thus causing inability to speak. Some cases are due to insufficiency of Kidney Qi (vital energy of the Kidneys) inherited from the father; some are caused by residual heat from the "Five Fires" in the wet nurse blocking the airway; some result from internal depletion of Body Fluids after illness, leading to dryness of the epiglottis; others are due to Spleen and Stomach weakness with failure of Clear Yang to ascend. For deficiency of Heart Qi, use Changpu Wan (Acorus Pill). For insufficiency of Kidney Qi, use Lingyangjiao Wan (Antelope Horn Pill). For blocked airway, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). For internal depletion of Body Fluids, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). For Spleen and Stomach weakness, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

Clinical Cases
One child presented with delayed speech and diarrhea, with a hoarse voice. After indiscriminate use of diuretic and heat-clearing agents, the throat sound became mute-like, and appetite decreased. In the morning, Dihuang Wan (Rehmannia Pill) added with Wuweizi (Schisandra Fruit) was administered; in the evening, Buzhong Yiqi Tang was given. The diarrhea gradually ceased. Subsequently, only the former pill was taken, and within two months, the throat sound gradually became clear.

Another child had prominent whites of the eyes, followed by loss of voice after diarrhea, accompanied by thirst and vomiting, with loose stools. Both morning and evening administration of Dihuang Wan led to recovery. Later, upon recurrence of diarrhea and subsequent loss of voice, the same pill cured the condition. These cases were all due to congenital insufficiency of Kidney Qi, hence the use of these medicines.

One child could not speak at five years of age, and was considered incurable by many. However, his physical appearance indicated deficiency of Lung and Kidney. Thus, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Wuweizi and Lurong (Deer Antler Velvet), along with Buzhong Yiqi Tang added with Wuweizi, was prescribed. After more than two months, his physique and Qi gradually strengthened. By nearly half a year, he could utter one or two words. By about one year of age, his voice returned to normal.

Changpu Wan (Acorus Pill): Treats delayed speech due to Heart deficiency.
Shichangpu (Rhizoma Acori Tatarinowii), Danshen (Radix Salviae Miltiorrhizae) (each 1 qian); Chishizhi (Halloysitum Rubrum) (3 qian); Renshen (Radix Ginseng) (0.5 liang); Tianmendong (Herba Asparagi) (decocted heart removed, dried, 1 qian).
Grind into powder, mix with refined honey to form pills the size of hemp seeds. Take 20–30 pills with warm water after meals.

Lingyangjiao Wan (Antelope Horn Pill): Treats delayed walking.
Lingyangjiao (Cornu Saigae Tataricae) sliced; Hu Jing Gu (Os Tigrinum) (vinegar-fried until yellow); Sheng Dihuang (Radix Rehmanniae Preparata) (dried); Suanzaoren (Semen Ziziphi Spinosae); Baifuling (Poria) (each 5 qian); Rougui (Cortex Cinnamomi); Fangfeng (Radix Saposhnikoviae); Danggui (Radix Angelicae Sinensis); Huangqi (Radix Astragali) (each 2.5 qian).
Grind into powder, mix with refined honey to form pills. Take an amount the size of a soap pod, dissolved in plain boiled water.

Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) (See formula under Abdominal Pain).
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See formula under Emaciation).
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (See formula under Kidney Disorders).
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) (See formula under Internal Hook).