《巢氏病源》小儿四、五岁不能语候∶人之五脏有五声，心之声为言。小儿四、五岁不能言者，由在胎时其
母卒有惊怖，内动于儿脏，邪气乘其心，令心气不和，至四、五岁不能言语也。
《千金》∶论小儿初出腹有连舌，舌下有膜如石榴子，中隔连其舌下后喜，令儿言语不发不转也。可以爪摘
断之，微有血出无害。若出血不止，可烧发作灰末敷之，血便止也。（姚和众云∶若不摘去，儿哑。）
张涣论∶心之声为言。若儿稍长，合语而迟语，由妊娠时其母因有惊怖，内动于儿脏，邪气乘于心，使心
气不足，舌本无力，故语迟也。
《千金》治小儿四、五岁不语方。
赤小豆酒和敷舌下。
《本草》日华子云∶社坛余胙酒，孩儿语迟，以少许令吃。
《圣惠》治小儿心气不足，舌本无力，令儿语迟。芍药散方
赤芍药（一两） 黄 （三分，锉） 犀角（屑） 槟榔 甘草（炙微赤，锉。以上各半两）
上件药捣，粗罗为末。每服一钱，以水一小盏，煎至五分去滓。量儿大小，不计时候，分减温服。
《圣惠》治小儿五、六岁不语者，为心气不足，舌本无力，发转不得。亦云风冷伤于少阴之经，是以舌难发于五
音，故至时不语。菖蒲丸方
菖蒲 人参（去芦头） 黄连（去须。以上各半两） 麦门冬（去心，焙） 天门冬（去心焙。各
一两） 赤石脂 丹参（各三分）
上件药捣，罗为末，炼蜜和丸如绿豆大。每服以温水研下五丸。量儿大小，不计时候，加减服之。
钱乙治小儿心气不足，五、六岁不能言。菖蒲丸
石菖蒲 丹参（各二钱） 天门冬（去心，焙秤） 麦门冬（去心，焙秤。各一两） 赤石脂（三
分） 人参（半两，切去须焙）
上同为细末，炼蜜丸绿豆大或麻子大。温水下五、七丸至一、二十丸。不计时候，日三、四服，久服取效。
又有病后肾虚不语者。宜兼服钱氏地黄丸（方在虚寒门中。）
张涣菖蒲汤丹方 治数岁不能语。
菖蒲（一寸，九节者） 远志（去心） 桂心（以上各一两） 酸枣仁 黄 人参（去芦） 黄
连（去须。以上各半两）
上件捣，罗为细末，炼蜜和如鸡头大。每服一粒至二粒，煎生姜汤下，不拘时候。
《张氏家传》治小儿不语方。
酸枣仁 柏子仁（各半两） 郁李仁 人参（各一两）
上为细末，蜜煮糊为丸如梧桐子大。小儿每服十丸。若是气虚之人，只使郁李仁、人参二件。
《庄氏集》 穴灸法∶四、五岁不语，灸两足踝上各三壮。
《庄氏集》 穴灸法∶小儿至五、六岁不语，是心气不足，舌无力，发转难故也。灸心 三壮，在第五椎下
两旁各一寸五分。
《巢氏病源》中关于小儿四、五岁还不能说话的病症候：人的五脏对应五种声音，心的声音表现为言语。小儿到了四、五岁还不会说话，是因为在胎儿时期，母亲突然受到惊吓恐惧，这种情绪内动影响了胎儿的脏腑，邪气乘虚侵袭心脏，导致心气不和，直到四、五岁时仍不能言语。
《千金方》论述：小儿刚出生时如果有“连舌”（舌系带过短），舌头下面有像石榴籽一样的薄膜，中间隔开连接着舌头下方后部，这会导致孩子说话不清晰、不流畅。可以用指甲掐断它，微微出血没有关系。如果出血不止，可以将其烧成灰末敷在伤口上，血就会停止。（姚和众说：如果不摘除切断，孩子会变成哑巴。）
张涣论述：心的声音表现为言语。如果孩子稍大一些，该说话的时候却说话迟缓，这是因为怀孕期间母亲曾受惊吓恐惧，内动影响了胎儿脏腑，邪气乘袭心脏，使心气不足，舌根无力，所以说话迟缓。
《千金方》治疗小儿四、五岁不说话的方法。
用赤小豆酒调和敷在舌头下面。
《本草拾遗》日华子说：社坛祭祀剩下的祭肉酒，对于孩子说话迟缓，给孩子吃少许即可。
《太平圣惠方》治疗小儿心气不足，舌根无力，导致孩子说话迟缓。芍药散方
赤芍药（一两） 黄芪（三分，锉碎） 犀角（锉屑） 槟榔 甘草（炙至微红，锉碎。以上各半两）
将上述药物捣碎，粗筛为粉末。每次服用一钱，用水一小盏，煎煮至五分，去渣。根据孩子的大小，不限时间，分次温服。
《太平圣惠方》治疗小儿五、六岁不说话，是因为心气不足，舌根无力，转动困难。也有说法认为是风冷损伤了少阴经，因此舌头难以发出五音，所以到了时候还不说话。菖蒲丸方
石菖蒲 人参（去芦头） 黄连（去须。以上各半两） 麦门冬（去心，焙干） 天门冬（去心焙干。各一两） 赤石脂 丹参（各三分）
将上述药物捣碎，筛为粉末，用炼蜜调和制成如绿豆大小的丸剂。每次用温水送服五丸。根据孩子的大小，不限时间，酌情加减服用。
钱乙治疗小儿心气不足，五、六岁不能说话。菖蒲丸
石菖蒲 丹参（各二钱） 天门冬（去心，焙干称量） 麦门冬（去心，焙干称量。各一两） 赤石脂（三分） 人参（半两，切去须并焙干）
将上述药物共同研为细末，用炼蜜制成如绿豆或麻子大小的丸剂。用温水送服五到七丸，最多一至二十丸。不限时间，每日三到四次服用，久服见效。
又有因病后肾虚导致不说话的情况。应当兼服钱乙的地黄丸（方剂见虚寒门中）。
张涣菖蒲汤丹方 治疗数岁还不能说话。
石菖蒲（一寸，九节者） 远志（去心） 桂心（以上各一两） 酸枣仁 黄芪 人参（去芦） 黄连（去须。以上各半两）
将上述药物捣碎，筛为细末，用炼蜜调和如鸡头大小。每次服用一粒至二粒，煎生姜汤送下，不限时间。
《张氏家传》治疗小儿不说话的方法。
酸枣仁 柏子仁（各半两） 郁李仁 人参（各一两）
将上述药物研为细末，用蜜煮糊制成如梧桐子大小的丸剂。小儿每次服用十丸。如果是气虚的人，只使用郁李仁、人参这两味药。
《庄氏集》穴位灸法：小儿到了五、六岁不说话，是心气不足，舌根无力，转动困难所致。灸心俞穴三壮，位于第五椎下两旁各一寸五分处。
*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.