During pregnancy, the occurrence of hoarseness or even the inability to speak is referred to as pregnancy aphonia.

This condition is called "aphonia" in Suwen; in Nyuke Jinglun, it is referred to as "pregnancy muteness", "pregnancy aphonia during pregnancy", and "pregnancy tongue aphonia"; in Leizheng Zhicai, Jiyin Gangmu, and Yixue Xinwu, it is uniformly called "aphonia during pregnancy"; modern Chinese medicine gynecological works mostly refer to it as "aphonia during pregnancy" and "aphonia during pregnancy".

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1. External Contractionwind-cold︰Sudden hoarseness of voice, or even aphonia, accompanied by cough, nasal congestion, runny nose, aversion to cold with fever, thin white tongue coating, and floating slippery pulse. This is caused by wind-cold attacking the lung, leading to lung qi failing to disperse, and cold qi lodging in the epiglottis, resulting in impaired opening and closing, thus preventing sound production: sudden hoarseness of voice, or even aphonia, cough with thin clear sputum, along with nasal congestion, runny nose, aversion to cold with fever, and other exterior patterns. Treatment should focus on dispersing wind and dissipating cold, ventilating the lung and benefiting the throat. The formulas used are Inula Herb Powder or Three-Unconventional Decoction with the addition of Platycodon Root, cicada slough, Peucedanum, and Fritillaria Bulb.
2. Hot Phlegm︰The voice is heavy and unclear, or unable to produce sound, with phlegm in the throat, expectoration of thick yellow phlegm, dry or sore throat, constipation, dark urine, yellow and greasy tongue coating, and slippery, rapid pulse. This is mostly caused by external contraction of wind-heat pathogens invading the lungs, scorching fluids into phlegm, or unresolved wind-cold stagnating and transforming into heat, with body fluids scorched into phlegm, leading to phlegm-heat obstruction congesting the lungs and resulting in pregnancy-induced hoarseness. The diagnostic features are: heavy and unclear voice, expectoration of thick yellow phlegm, accompanied by dry and sore throat, yellow and greasy tongue coating, slippery and rapid pulse, and other signs of internal exuberance of phlegm-heat. Treatment should focus on clearing heat and resolving phlegm, ventilating the lungs and benefiting the throat, using Qingyan Ningfei Decoction with Bitter Apricot Seed, cicada slough, and Tabasheer. If wind-cold externally binds with pathogenic heat internally stagnating, symptoms include sudden hoarseness, dry mouth, sore throat, aversion to cold, and nasal congestion—this is the so-called "cold wrapping heat." Treatment should focus on ventilating the lungs and dispersing cold, while clearing interior heat, using Ma Xing Shi Gan Decoction with Platycodon Root, Anemarrhena, cicada slough, and Indian Trumpetflower Seed. If in the ninth month of pregnancy, the voice is heavy, low, or unable to produce sound, with normal complexion, robust body, phlegm in the throat, difficulty expectorating, chest tightness, constipation, yellow and greasy tongue coating, slippery and rapid pulse, and the syndrome belongs to fetal qi disease with excess, then Shoutai Taqi Powder is primarily used.
3. Lung Yin Deficiency︰During pregnancy, the voice gradually becomes hoarse, with dry mouth and throat, or cough and shortness of breath, a red tongue with scant fluid, and a thready rapid pulse. This is often due to preexisting lung dryness-heat, which consumes yin fluids. After conception, blood nourishes the fetus, leading to further depletion of yin-blood. The lungs lose their nourishment, causing dryness and roughness in the vocal tract, resulting in difficulty in sound production and gradually leading to pregnancy aphonia. Accompanied by persistent chronic cough, tidal fever, night sweats, and flushed cheeks in the afternoon, the treatment should focus on enriching and tonifying lung yin. The recommended formula is Yangjin Decoction with modifications.
4. Kidney Yin Deficiency︰The voice gradually becomes hoarse, sometimes even unable to produce sound, worsening by evening. There may be flushed cheeks, dizziness, dizzy vision, tinnitus, dry throat, soreness and weakness in the lower back and knees, a red tongue with possible cracks, patchy tongue coating, and a thin, rapid pulse. This is often due to constitutional weakness, post-illness deficiency of essence, or excessive strain, leading to the depletion of kidney essence. The voice originates from the lungs, is rooted in the kidneys, and is expressed through the tongue base. When kidney yin is increasingly deficient, it fails to nourish the tongue base, resulting in pregnancy aphonia. The distinguishing features of this syndrome include accompanying symptoms such as dry throat, tinnitus, dizzy vision, soreness in the lower back and weakness in the knees, and feverish feeling in the palms and soles. The treatment principle is to nourish kidney yin, using modified Duqi Pills.

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1. Zhangshi Yitong．Prenatal．Speechlessness: "Speechlessness is mostly due to phlegm blocking the heart orifice, and there are also cases of mute fetuses, which do not require medication. Qibo said, some people become mute in the ninth month of pregnancy, which is due to the severance of the collateral channels of the uterus. The uterine collaterals are connected to the kidneys, and the Shaoyin meridian runs through the kidneys and connects to the base of the tongue, hence the inability to speak. There is no cure, and it will recover by the tenth month. For those suffering from this condition, a strong decoction of Pulse-Reinforcing Powder should be taken on an empty stomach, along with Rehmannia pills, to support the qi of the lungs and kidneys to nourish the fetus. It is a mistake to use medicines that promote speech and expel pathogens from the exterior."