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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: If a pregnant woman becomes aphonic at the ninth month of gestation, it is due to the obstruction of the collateral vessels of the uterus. No treatment is required; speech will recover naturally after delivery in the tenth month. This refers to the traditional view 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 prioritizes Yin meridians over Yang meridians, starting with Wood and ending with Water, illustrating the principle of mutual generation among the Five Elements.

However, from a theoretical perspective, the Qi and Blood of the Twelve Primary Meridians circulate continuously day and night without interruption, nourishing the fetal Qi at all times. Therefore, there is no rationale for each meridian exclusively nourishing the fetus at specific stages. The statement that aphonia occurs in the ninth month arises because by this time, the fetus has grown significantly, causing the collateral vessels connecting the uterus to the Kidney Meridian to become obstructed. Consequently, aphonia may occasionally occur. Since the Kidney Meridian ascends to connect with the root of the tongue, obstruction of this pathway leads to an inability to speak. Thus, speech recovers after delivery in the tenth month, and specific treatment is unnecessary. If treatment were applied, it should focus on tonifying the Heart and Kidney. "Aphonia" (Yin) here refers to having the capacity for voice but being unable to produce clear sound or speaking with a hoarse/whispering quality. Hence, the text says "unable to speak," which does not imply a complete loss of consciousness or muteness.

Voice originates from the throat and is articulated at the root of the tongue. Due to the enlarged fetus, the upward flow of the Kidney Meridian is blocked. The Kidney Meridian enters the Lungs, follows the throat, and connects to the root of the tongue. The throat is the domain of the Lungs, and the Lungs govern voice. Patients may whisper quietly; although they wish to speak, others cannot hear them clearly, hence the term "aphonia." The Lungs and Kidneys are mother-son organs in the Zang-Fu relationship, justifying the assertion that no treatment is needed. Interpreting "aphonia" as muteness would attribute the condition to Heart pathology, as the Heart governs vocalization, which is entirely unrelated to gestational aphonia. Zhang Hezi proposed descending Heart Fire, while Ma Xuantai advocated tonifying the Heart and Kidney. If the renal collaterals were truly severed, the condition would be incurable, contradicting the notion of spontaneous recovery postpartum. Therefore, the phrase "obstruction of the uterine collaterals" implies that the character "jue" (severance) should be interpreted as "zu" (obstruction).

If a pregnant woman suffers from excessive phlegm-saliva accumulation, suddenly collapses into rigidity, experiences intermittent convulsions, and loses consciousness, this is termed "Zixian" (Eclampsia of Pregnancy). It results from Blood deficiency leading to the flaming up of Deficient Fire, which agitates Phlegm upwards. The pulse is typically slightly rapid on the left and slippery and large on the right. Treatment should employ Siwu Tang (Four Substances Decoction) to nourish Blood, Jiuhuangqin (Wine-fried Scutellariae Radix) to clear Heat, and Erchen Tang (Two Aged Ingredients Decoction) to resolve Phlegm and regulate Qi. As stated in *Jiyao* (Essentials of Mechanisms): "Wind-Wood transforms into Heat; when Heat is extreme, Wind moves." One should use calming agents to overcome dryness, which corresponds to nourishing Blood. 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 Heat excess generating internal Wind. These are internally generated Wind and Fire, which extinguish themselves through Blood nourishment. For Heart and Liver Wind-Heat, Gouteng Tang (Uncaria Decoction) is indicated; for Liver and Spleen Blood deficiency, Jiawei Xiaoyao San (Modified Free Wanderer Powder) is used; for Liver and Spleen Depression and Anger, Jiaweigui Pi Tang (Modified Return the Spleen Decoction) is prescribed; for rebellious Qi and Phlegm stagnation, Zisu Yin (Perilla Infusion) is employed; and for Spleen depression with Phlegm stagnation, Erchen Tang plus Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis Rhizoma Recens Juice) is administered.