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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."