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[Verse] During pregnancy, a low voice or inability to speak is termed "Zi Yin" (Fetal Aphonia). This occurs due to the obstruction of the collaterals of the Shaoyin (Kidney) meridian, preventing vocalization. Treatment should focus on clearing Heart fire and descending heat, regulating the relationship between the Heart and Kidney. After delivery, when the meridians become unobstructed, speech will naturally clear.

[Discussion] In the *Huangdi Neijing* (Yellow Emperor's Inner Canon), the Yellow Emperor asked: Why does a pregnant woman lose her voice in the ninth month? Qibo replied: This is because the collateral vessels of the uterus are temporarily obstructed. The Emperor asked: Why is this so? Qibo said: The collateral vessels of the uterus connect to the Kidney and belong to the Foot-Shaoyin Kidney Meridian. This meridian passes through the Kidney and connects to the root of the tongue. Therefore, when the collaterals are obstructed, speech is impaired. The Emperor asked: How should it be treated? Qibo said: No specific treatment is needed; it will recover by the tenth month. Ma Xuantai explained: Although it is often stated that the ninth month is when the Kidney meridian nourishes the fetus, attributing aphonia solely to this is somewhat rigid. However, at nine months, as the fetus grows, the uterine collaterals connecting to the Kidney may be compressed and obstructed, occasionally causing this condition. Since the Kidney meridian descends into the Kidney and ascends to connect with the root of the tongue, obstruction prevents speech until delivery restores the flow. A physician from Boling, known for his divine skill, said: Mr. Hao had a pregnant patient who was mute. Mr. Hao said: This is due to congestion of the meridions caused by the large fetus; once the child is born and the meridians unblock, speech will return. Xiao Gengliu stated: The *Da Qi Lun* chapter of the *Neijing* mentions that if Uterine Essence is insufficient, being able to speak indicates death, while inability to speak indicates life. This validates that aphonia in the ninth month is not due to insufficiency of Uterine Essence, hence recovery occurs by the tenth month.

[Verse] Coughs manifest differently across the twelve meridians. Etiologies include Fire, Phlegm, Damp-Heat, Wind, and Cold. Differentiation must be made between Excess and Deficiency based on the Seven Emotions and Six Climatic Factors. Therapeutic methods must be flexible and adaptable.

[Discussion] The Lung governs Qi and corresponds externally to the skin and hair. Exposure to cold or consumption of cold drinks damages the Lung, resulting in cough. Cough with phlegm/saliva is called "Sou"; cough without phlegm is called "Ke". The Qi of the Zang and Fu organs relies on the Lung. Each organ may contract disease when exposed to pathogenic factors during its corresponding season: Autumn affects the Lung, Winter affects the Kidney, Spring affects the Liver, and Summer affects the Spleen. If diseases in these organs persist, they may transmit to their associated Fu organs in Winter. Cough during pregnancy is termed "Zi Sou" (Fetal Cough). For Excess patterns, use Shen Su Yin (Ginseng and Perilla Decoction) to disperse; for Deficiency patterns, use Tian Men Dong Tang (Asparagus Root Decoction) to tonify. Prolonged coughing may injure fetal Qi.

Xue Lizhai stated: For coughs, if caused by Wind-Evil damaging the Lung in Autumn, use Jin Fei Cao San (Boiling Water Grass Powder); if caused by Fire-Evil overcoming Metal in Summer, use Ping Fei San (Lung-Calming Powder); if caused by Cold-Evil damaging the Lung in Winter, use Ren Shen Bai Du San (Ginseng and Detoxification Powder); if caused by Wind-Evil damaging the Lung in Spring, use Shen Su Yin. However, the Lung belongs to Xin-Metal and is born from Ji-Earth (Spleen/Stomach). Prolonged cough often results from Spleen Deficiency failing to generate Lung Qi, leading to loose interstices and susceptibility to external Wind. Alternatively, Lung Deficiency may fail to generate Kidney Water, causing Ministerial Fire to flare upward. Treatment should prioritize tonifying Earth to generate Metal and nourishing the Kidney to calm the Fetus.

[Prescriptions]
Shen Su Yin (Ginseng and Perilla Decoction)
Perillae Folium (Zisu), Citri Reticulatae Pericarpium (Chenpi), Platycodonis Radix (Jiegeng), Peucedani Radix (Qianhu), Aurantii Fructus Immaturus (Zhike), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao).
Add Anemarrhenae Rhizoma (Zhimu) and Amomi Fructus Rotundus (Sharen).

Tian Men Dong Tang (Asparagus Root Decoction)
Asparagi Radix (Tiandong), Asteris Radix (Ziwan), Anemarrhenae Rhizoma (Zhimu), Morus Cortex (Sangbai Pi), Schisandrae Fructus (Beiwei).
Add additional Epimedii Folium (Yinyanghuo - *Note: Text says 'One plus Ejiao', likely meaning add 1 qian of Donkey-hide Gelatin*) -> Correction: Add Ejiao (Donkey-hide Gelatin) 1 qian.

Baihe San (Lily Bulb Powder)
Lilii Bulbus (Baihe), Asteris Radix (Ziwan), Ophiopogonis Radix (Maidong), Platycodonis Radix (Jiegeng), Morus Cortex (Sangbai Pi), Glycyrrhizae Radix et Rhizoma (Gancao), Bambusae Folium (Zhuru).
Decoct in water, add three spoons of honey.