孟城按：先生曰：“孕妇补腰最为重要，补腰即所以安胎保胎，故安胎方用川断、狗脊、菟丝子以补肾壮腰。安胎须兼清热，故加钩藤清肝热，不仅安胎，还防子痫。”“若妊娠五月后，胎全不动者，可于上述安胎药中加入川芎9g，可以动胎气，且使生产时顺利。”
胎动不安除外界客观环境、生活起居及诸病理因素造成之外，孕妇妊娠期内服药不当，亦是重要原因。故孕妇有病，服药宜慎。师屡曰：“胎前破气之药不能用，祛风活血之品如桂枝、羌独活、牛膝、木瓜、络石藤等均不能用。如有痹症疼痛，可用丝瓜络、桑枝、秦艽之属。师且一再叮咛：“孕妇不妨用行气之品，然不可用香附，用之不慎易致堕胎。”
七、妊娠恶阻方
药物组成：姜半夏9g陈皮6g木香3g焦六曲9g藿香9g苏梗9g佛手4．5g
加减法：吐重者加吴萸、川连。
以上七方为先生临证习用之方，诸方用药看似平淡无奇，苟能辨证正确、化裁得宜，可收立竿见影之效。孟城用之近三十年，获益良多，正有不及以言语表达者。上述各方及先生经验之谈，乃从余早年随师侍诊时所记之《随师笔记》中录出，一仍原貌，皆用当日先生口语，不作文字修饰渲染，更不加分析以参己见，盖存其朴而葆其真也。其中奥义，读者触类旁通自能明了，毋须赘言也。
妊娠早期脉解
本文所云妊娠早期，乃受孕后从末次经净起算两月之间．此时胎气初结，诸征未显，为痫勾孕尚难分辨，以脉象为主，结合症状体征加以推断，有较重要之临床意义。然结胎伊始，气血方凝，形质未成，虽“脉为血派，气血之先。”可随时显示机体五脏六腑、阴阳气血运行之内在规律及发展变化之情况，迅速、传递机体内部之各种生理病理信息，然在停经后一月内，胎气甚弱，脉上尚难测知，往往须足一月后脉象始显，故早期孕脉之诊察时期，实为经停后第二个月内，仅一个月时间。因妊娠三月以后，孕脉渐渐明显，恶阻、腹征等亦渐出现，诊断已不为难。故本篇仅就早期孕脉稍加辨析。
先哲对于早期孕脉之论述虽多，大要不越二条，均为《黄帝内经》之经文。
其一，《素问·阴阳别论》曰：“阴搏阳别，谓之有子。”
何谓“阴搏阳别”?王冰注曰：“阴，谓尺中也。搏谓搏触于手也。尺脉搏击，与寸脉殊别，阳气挺然，则为有妊之兆。”王注中明谓“尺脉搏击”，而与寸脉作何殊别，尚未有说。
而王宏翰之注则更为详尽：“细释《内经》，并诸家之论，谓阴搏阳别，则尺脉搏击于手者，乃滑数有力。而寸脉来微，有别异于尺。则是寸脉来微，殊别于尺脉之滑数，是有子之象也。”又曰：“但孕子之脉，原有寸关尺俱数之脉，而此节之经文，乃寸微尺数之旨也。”王氏之注为多数医家所采纳，如戴同父《脉诀刊误》亦主寸微尺数之说。陈自明《校注妇人良方》亦曰：“寸微关滑尺带数，流利往来并雀啄，小儿之脉已见形，数月怀耽犹未觉。”
虽王氏之论为较多医家所赞同，然“寸脉来微”一语，尚欠理论及实践依据。盖脉以尺寸分阴阳，阳寸阴尺之说见于《难经》而《内经》则无也。故张介宾曰：“阴，如前手少阴也，或足少阴而言亦可。盖心主血，肾主子宫，皆胎孕之所主也。搏，搏击于手也。阳别者，言阴脉搏手，似乎阳邪，然其鼓动滑利，本非邪脉，盖以阴中见阳而别有和调之象，是谓阴搏阳别也。”初观文义，张注自较王注为优，将“阳别”之“阳”释为“阴脉搏手”，“别有和调之象”，确有见地。
通观“阴阳别论”原文，篇中“阴阳”两字之含义非一，皆具相对性，此处阴阳两字，当指阴经阳经而言。人身十二经脉，手足各三阴三阳，六阴经中，惟心肝肾三经为阴血之经，而三经中仅足少阴肾与胎孕最为相关，故约而言之。“阴搏”之“阴”，当指肾经，其相应之脉位在于两手尺部。此则景岳之注甚是。妇人怀妊之后，六脉皆现缓滑流利，不惟尺脉为然。而阴脉(当以尺部足少阴肾经脉为主体)之搏动，与三阳经脉象之搏动同中有别，尚须区分，足为“阳别”。
关于此点，余早岁侍诊于业师吴竺天先生，曾请师示妊娠脉法。师诲余曰：“三部脉缓滑冲和，转展流利，寸关浮沉正等，尺部稍俯，即是妊娠早期之脉。若尺脉不俯，即有疑问，当须仔细辨察，以免鱼目混珠。尺脉何以稍俯?盖受孕之初，男精女血凝于胞宫，肾气引全身之气血精华，集注至阴之地沉潜于里，以发育胎儿，是以尺脉当稍稍见沉。俯者略低之谓，亦即稍沉之意焉。”仲景《金匮要略》“妇人妊娠病脉证并治”篇指出妊娠之诊断：“妇人得平脉，阴脉小弱，其人渴，不能食，无寒热，名妊娠。”“渴，不能食，无寒热”为妊妇之症状，姑置不论。而其脉象“得平脉，阴脉小弱”，余之理解为：此处所说之“平脉”，并非常人脉法中之“平脉”，而是妊娠妇女之“平脉”。亦即缓滑冲和，转展流利之脉象。于此脉象基础之上，复见少阴肾脉较寸关略见“小弱”，弱脉之体状为沉而细，故“阴脉小弱”并非尺部见小脉与弱脉，当是滑利之孕脉至尺部略小而略俯，正与吴师数十年之经验相同。
其二，《素问·平人气象论》曰：“妇人手少阴脉动甚者，妊子也。”此句经文，为诊断妊娠之另一脉法。惟“手少阴脉”究属何处，诸家见解不尽相同，可概括为二三种意见：一指神门穴处之动脉。如王冰注曰：“手少阴脉，谓掌后陷中者，当小指动而应手者也。”二指左寸脉。如马莳注曰：“左寸部属手少阴心经，而手太阳小肠经之脉，为之表里。”《脉赋》云：“太阳大是男妊．故知手少阴之脉动甚者，为妊男子也。”三指两手寸口脉之尺部。如高世轼注曰：“少阴，尺脉也。”“两手少阴脉动甚者，则知肾气有余，感天一所生之气，故妊子也。”对于上述三种不同见解，余赞成启玄之注。经文明谓“手少阴脉”词义清晰，历历分明，故当依文解义，直指手少阴心经之脉，毋庸迂回曲折，舍近就远。
至于少阴脉之部位，在于左寸心部抑或神门穴处?两者均为手少阴之动脉，而左寸心部为寸口脉三部之一，妊娠脉滑数流利，三部统一，两手皆然，决无仅见于左寸，而余处不见之理。亦无论经文或千百年来之前人经验，均无独以左寸脉“动甚”以决妊娠之理．是故左寸之说不足为据。
手少阴脉当指小指内侧手少阴心经神门穴处之动脉，十二经皆有动脉。《内经》原有明文。神门穴处之动脉即是手少阴心经之动脉。此处之动脉，平素很难测知，即或指下有应，亦极微弱，每在似有似无之间。有两种情况，神门穴处可见明显之脉搏跳动：一是患有严重神经衰弱者，心血虚耗，心阳亢盛，可见神门脉动，然终不见妊娠脉缓滑冲和，转展流利之象，所显者无非病脉。二是妇人怀妊后经停匝月，神门穴处即现妊娠独有之滑利脉象，指下分明，清晰可辨，直至分娩后，始渐消失。此一脉象用以解释“手少阴脉动甚者，妊子也。”一句经文．最为恰当。余昔年曾与妇科医师合作，以神门脉诊断未婚先孕者，然后作放射免疫测定加以证实。几乎箭无虚发，历验不爽，正可为此作一反证。
至于王叔和《脉经》曰：妇人“三部阴脉沉浮正等，按之无绝者，有娠也。”何谓“沉浮正等”?王宏翰释曰：“按之浮沉正等者，即仲景所谓寸关尺三部之脉，大小浮沉迟数同等也。”又曰：“叔和谓妇人之脉，三部浮沉正等，又按之无绝者，谓阴阳和洽，有妊之兆也。”
叔和《脉经》之说乃妊娠妇人早期过后之常见脉象，因胎气渐盛，阴血渐充，尺脉盈满，故见三部浮沉正等而滑利不绝。
综上所述，如何能早期从脉诊测知妊娠?育龄妇女正常之月经规律突然改变，经汛过时不来，而又身无他病，寸口脉见缓滑流利，两尺较寸关稍沉而按之滑甚者，是为胎孕早期正常之脉。或按神门穴处，有明显脉动而又滑利不绝者，亦为早期妊娠之脉象依据。
脏躁一症，首见于《金匮要略》，皆由忧思日久，子脏枯燥，心火炎上，神明不宁而成。与癫狂之气郁痰凝，心肝火炽者迥异，因而治疗之法，亦当有别于癫狂。仲景之甘麦大枣汤，实为治疗脏躁千古不易之良方，据患者所现之脉症，增益药味，投剂得当，如响斯应。爰录二：例于下：
例一某局女会计宋某，年三十许，于1970年初，忽病哭笑无常，每日必发多次。发作之时，时而悲泣，伤感不已；时而喜笑怒骂，亲疏不避；时而欠伸频作，有若神灵所附。约一小时后，或作喜笑，或不笑，继则谴然自释，重归平静。清醒后与常人无少异，亦能治理账务。曾屡往某精神病院就诊，诊断为“精神分裂症”，已治数月不应．．余往诊时，病正发作，所见一如上述。病止后诊其脉弦而绌，舌质干红，苔薄白。此症显然是《金匮》之脏躁，仲景曰：“妇人脏躁，喜悲伤欲哭，象如神灵所作，数欠伸。”正与此例病情相符．．即以甘麦大枣汤加入养血柔肝、宁心安神之品：
淮小麦30g甘草4．5g大枣7枚当归9g炒白芍9g柏子仁9g太子参9g炒竹茹4．5g炒枣仁9g茯神9g合欢皮15g
服五帖，病由日发数次，减为五日内仅发两次，服至十帖，诸症悉蠲。数年后，邂逅其全家于中山公园，云愈后一切安然。
例二某局严科长之妻，年近半百，素患冠心病，失眠经久，睡去则恶梦频仍。1975年初春，与澡堂服务员发生口角，有理而受屈，遂精神失常。语多而无伦次，见人辄讲述其事，终日喋喋不休，夜眠则惊惕常作，此外别无他症。已服精神专科镇静药，半月不应，邀余治之。余诊其脉细软带滑，视其舌质淡，苔则薄白。余推究病情：据其年龄已在更年之期，经汛濒临断绝，阴阳本易错乱，加之脉细舌淡，气血亏乏。口角斗气，致使肝失条畅、心神受激而病发矣。论其见症，虽与上例迥然不同。而其病机实相类似。所不同者，前例兼见阴伤血燥，此则伴有心肝阳亢。爰疏一方：
淮小麦30g炙甘草9g大枣30g石菖蒲6g炙远志6g珍珠母30g龙齿12g丹参9g竹茹4．5g
上方服二十余帖即释然病解，至今已二十余年，乍见之下。俨然一龙踵老妇矣。虽仍体弱多病，而此症终未复发。
上述两例病案中，第一例之症状与《金匮要略》所述较相类似，对余之诊断与用药必无异议，而第二例则不然，其见症仅见多语及夜寐不安，而仲景原文中并无此症状，如何可作脏躁论治?关于脏躁之症状，余公侠医师在“从临床体会谈谈甘麦大枣汤的应用标准”一文中，作如下五点归纳：(刊于《江苏中医》1958年第8期)
1．患者言行失常，或无故悲伤，或喜怒不节者。
4．怕一切声光，怕与人交言，喜独居暗室者。
以上症状，不必悉具。本方加当归、白芍、茯神、枣仁、龙齿、牡蛎、柏子仁等，则效果更佳。
盖脏躁之病因，无非五脏阴液之不足，“喜悲伤欲哭”乃肺金津虚而然。“数欠伸”是肝肾之虚而见周身疲惫。心肝血虚则神乱“如有神灵所作”。今患者因兼肝阳微亢、心气激越而致多语，梦扰，正在本证范围之内，尚未越出雷池也。故以甘麦大枣汤加味治之竟收药到病除之效。
崩漏治验两则
一、“不补补之”治血崩
妇人崩中漏下之症，有因于血热者，有因于血瘀者，亦有因于脾肾虚损者，依法治之，必有良效。而余曾见年龄五十左右之妇女，正处更年期中，或老年妇人，有一种血崩，往往诸药罔效。据其见症，知为肾虚，而投以左右归及二至、六味、八味等方，皆难必效。自得魏之绣“不补补之”之法，投剂辄应，随手取效。始知此等血崩不仅肝肾亏损，且病及奇经以致冲任摇乱、封藏不固，当另求治法方可。
魏之琇于《续名医类案》中自出一案，载其治刘媪七十崩血，淋漓两月，遍服归脾、六味、四物、八珍、十全等方皆不能合者，为制“不补补之”之法：用熟地二两(半炒炭)、枸杞子五钱、枣仁五钱、白芍三钱、黄连三分，水煎服，复杯即应。
Mengcheng's commentary: The master once said, "Supplementing the lower back is of utmost importance for pregnant women; supplementing the lower back is the method to calm and protect the fetus. Therefore, in fetal-calming formulas, we use Duanmu (Dipsaci Radix), Gouji (Acanthopanacis Senticosi Caulis), and Tusizi (Cuscutae Semen) to tonify the kidney and strengthen the waist. Fetal calming must also clear internal heat, so we add Gouteng (Uncariae Ramulus cum Uncis) to clear liver heat, which not only calms the fetus but also prevents eclampsia." "If after five months of pregnancy the fetus shows no movement at all, one can add 9g of Chuanxiong (Ligustici Chuanxiong Rhizoma) to the aforementioned fetal-calming herbs. This can mobilize fetal qi and ensure a smooth delivery."
Fetal restlessness (Tai Dong Bu An) is caused not only by external objective environments, daily life routines, and various pathological factors, but also by improper medication during pregnancy. Therefore, when pregnant women are ill, medication should be administered with caution. The teacher often stated, "Qi-breaking drugs cannot be used before childbirth. Wind-dispelling and blood-invigorating substances such as Guizhi (Cinnamomi Ramulus), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Niuxi (Achyranthis Bidentatae Radix), Mugua (Chaenomelis Fructus), and Luoshiteng (Trachelospermi Caulis) must not be used. If there is bi-syndrome pain, one may use Silkgourd Vines (Sigualuo), Mulberry Twig (Sangzhi), and Qinjiao (Gentianae Macrophyllae Radix). The teacher repeatedly emphasized: 'Pregnant women may use Qi-moving substances, but Xiangfu (Cyperi Rhizoma) must not be used; careless use may easily lead to abortion.'"
Seven. Formulas for Pregnancy Morning Sickness
Function: Aromatic transformation of turbidity, harmonizing the stomach and stopping vomiting.
Indications: Pregnancy reactions, nausea, retching, vomiting, and loss of appetite.
Composition: Jiang Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine) 9g, Chenpi (Citri Reticulatae Pericarpium) 6g, Muxiang (Aucklandiae Radix) 3g, Jiao Liuqu (Zeiae Fructus Fermentatus) 9g, Huoxiang (Agastachis Herba) 9g, Sugeng (Perillae Caulis) 9g, Foshou (Citrus medica L.) 4.5g.
Modifications: For severe vomiting, add Wuzhuyu (Evodiae Fructus) and Chuanlian (Coptidis Rhizoma).
The above seven formulas are those commonly used by the master in clinical practice. Although the medications appear ordinary, if syndrome differentiation is correct and modifications are appropriate, immediate effects can be achieved. Mengcheng has used these formulas for nearly thirty years and benefited greatly from them; their subtleties are beyond words. The above formulas and the master's experiential discussions were recorded from my "Notes on Attending the Master" taken during my early years of accompanying him in consultations. They remain in their original form, using the master's spoken language of that day, without literary embellishment or personal analysis, aiming to preserve simplicity and authenticity. Readers who can apply these principles to other situations will understand the profound meanings without need for further explanation.
Analysis of Early Pregnancy Pulse
The "early pregnancy" mentioned here refers to the two-month period starting from the end of the last menstrual period. At this stage, fetal qi has just formed, and signs are not yet obvious. Differentiating between disease and pregnancy is difficult; thus, relying primarily on pulse diagnosis combined with symptoms and signs has significant clinical value. However, at the beginning of conception, although "the pulse is the pathway of blood and the precursor of qi and blood," reflecting the internal laws and changes of the five zang organs, six fu organs, yin-yang, qi, and blood, within the first month after amenorrhea, fetal qi is very weak, and the pulse is difficult to detect. It usually takes a full month for the pulse to become apparent. Therefore, the period for examining early pregnancy pulses is actually the second month after amenorrhea, lasting only one month. After three months of pregnancy, pregnancy pulses become more distinct, and morning sickness and abdominal signs gradually appear, making diagnosis easier. Hence, this section focuses only on analyzing early pregnancy pulses.
Although ancient scholars have discussed early pregnancy pulses extensively, the main points do not exceed two passages from the *Huangdi Neijing* (Yellow Emperor's Inner Canon).
First, the *Suwen: Yin Yang Bie Lun* states: "Yin pulsation with yang distinction indicates pregnancy."
What does "Yin pulsation with yang distinction" mean? Wang Bing annotated: "Yin refers to the chi position. Pulsation means striking the fingers. When the chi pulse strikes strongly, differing from the cun pulse, with yang qi standing out, it is a sign of pregnancy." Wang's note clearly mentions "chi pulse striking," but does not explain how it differs from the cun pulse.
Wang Honghan's annotation is more detailed: "Interpreting the *Neijing* and various schools' theories, 'yin pulsation with yang distinction' means the chi pulse striking the hand is slippery, rapid, and forceful. The cun pulse comes slightly weak, distinguishing itself from the chi. Thus, the slight weakness of the cun pulse distinguishes it from the slippery and rapid chi pulse, indicating pregnancy." He further stated: "Pregnancy pulses generally show rapidity in cun, guan, and chi positions, but this passage emphasizes the principle of a slight cun and rapid chi." Wang's annotation was adopted by many physicians, such as Dai Tongfu in *Maijue Kanwu*, who supported the view of slight cun and rapid chi. Chen Ziming in *Jiaozhu Funren Liangfang* also said: "Slight cun, slippery guan, and rapid chi, flowing smoothly like a sparrow pecking; the child's pulse shape is visible, yet months of pregnancy remain unnoticed."
Although Wang's theory was widely agreed upon, the phrase "cun pulse comes slightly weak" lacks theoretical and practical basis. The division of pulse into cun and chi for yin and yang is found in the *Nanjing* (Classic of Difficult Issues), not the *Neijing*. Therefore, Zhang Jiebin said: "Yin, as mentioned before, could refer to the Hand Shaoyin or Foot Shaoyin. The heart governs blood, and the kidney governs the uterus, both being central to pregnancy. Pulsation means striking the hand. 'Yang distinction' means the yin pulse strikes the hand, appearing like yang pathogenic factors, but its beating is slippery and smooth, not a pathogenic pulse. It shows yang within yin with a harmonious image, which is called 'yin pulsation with yang distinction.'" Initially, Zhang's annotation seems superior to Wang's, interpreting "yang" as "yin pulse striking the hand" and "distinct" as "having a harmonious image," which is insightful.
Reviewing the original text of "Yin Yang Bie Lun," the terms "yin" and "yang" have relative meanings throughout the chapter. Here, they likely refer to yin and yang meridians. Among the twelve meridians, only the Heart, Liver, and Kidney meridians are yin-blood meridians, and among these, the Foot Shaoyin Kidney meridian is most related to pregnancy. Therefore, approximately speaking, the "yin" in "yin pulsation" refers to the Kidney meridian, corresponding to the chi position on both wrists. Zhang Jiebin's annotation is correct. After pregnancy, all six pulses become slow, slippery, and smooth, not just the chi pulse. The pulsation of the yin pulse (primarily the Foot Shaoyin Kidney meridian at the chi position) differs subtly from the pulsation of the three yang meridians, requiring distinction, sufficient to be called "yang distinction."
Regarding this point, in my youth, while attending my master Mr. Wu Zhutian, I asked him to demonstrate pregnancy pulse methods. The master taught me: "When the three positions (cun, guan, chi) are slow, slippery, harmonious, and flowing smoothly, with cun and guan floating and sinking equally, and the chi position slightly sunken, this is the pulse of early pregnancy. If the chi pulse is not sunken, there is doubt, requiring careful differentiation to avoid confusion. Why is the chi pulse slightly sunken? Because at conception, male essence and female blood condense in the uterus. Kidney qi draws the essence of qi and blood from the whole body, concentrating in the lowest yin region, sinking internally to develop the fetus. Thus, the chi pulse should appear slightly deep. 'Sunken' means slightly low, i.e., slightly deep." In the *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet), Chapter on Pregnancy Diseases, Zhang Zhongjing states the diagnosis of pregnancy: "Women obtain a normal pulse, the yin pulse is small and weak; if they are thirsty, cannot eat, and have no chills or fever, it is named pregnancy." "Thirst, inability to eat, no chills or fever" are symptoms of pregnancy, which we set aside. Regarding the pulse "obtaining a normal pulse, yin pulse small and weak," I interpret "normal pulse" here not as the standard healthy pulse, but as the "normal pulse" of pregnant women, i.e., slow, slippery, harmonious, and flowing. On this basis, seeing the Shaoyin Kidney pulse slightly "small and weak" compared to cun and guan. Since a weak pulse is deep and thin, "yin pulse small and weak" does not mean seeing small and weak pulses at the chi position, but rather the slippery pregnancy pulse becoming slightly smaller and slightly sunken at the chi position, consistent with Master Wu's decades of experience.
Second, the *Suwen: Ping Ren Qi Xiang Lun* states: "When the Hand Shaoyin pulse moves vigorously in women, she is pregnant." This verse provides another pulse method for diagnosing pregnancy. However, where exactly the "Hand Shaoyin pulse" is located varies among scholars, summarized in two or three opinions: One refers to the artery at Shenmen acupoint. Wang Bing noted: "Hand Shaoyin pulse refers to the depression behind the palm, where movement under the little finger responds to the touch." Another refers to the left cun pulse. Ma Shi noted: "The left cun position belongs to the Hand Shaoyin Heart meridian, whose exterior-interior pair is the Hand Taiyang Small Intestine meridian." The *Mai Fu* says: "If Taiyang is large, it indicates a male fetus; thus, knowing the Hand Shaoyin pulse moves vigorously indicates a male fetus." A third opinion refers to the chi position of the cunkou pulse on both hands. Gao Shishi noted: "Shaoyin is the chi pulse." "When the Shaoyin pulses on both hands move vigorously, it indicates abundant kidney qi, sensing the qi generated by Heaven One, hence pregnancy." Among these three views, I agree with Qixuan's (Wang Bing's) annotation. The scripture clearly states "Hand Shaoyin pulse," with clear meaning, so we should interpret it literally, pointing directly to the pulse of the Hand Shaoyin Heart meridian, without detours.
As for the location of the Shaoyin pulse, is it the left cun heart position or Shenmen acupoint? Both are arteries of the Hand Shaoyin. The left cun is one of the three positions of the cunkou pulse. Pregnancy pulses are slippery, rapid, and smooth, unified across all three positions in both hands; it is impossible for it to appear only in the left cun and nowhere else. Neither the scripture nor centuries of experience supports deciding pregnancy solely by the "vigorous movement" of the left cun pulse. Thus, the left cun theory is insufficient.
The Hand Shaoyin pulse should refer to the artery at Shenmen acupoint on the medial side of the little finger, belonging to the Hand Shaoyin Heart meridian. All twelve meridians have arteries, as explicitly stated in the *Neijing*. The artery at Shenmen is the artery of the Hand Shaoyin Heart meridian. This artery is usually hard to detect; even if felt, it is extremely weak, often seeming present or absent. There are two situations where a noticeable pulse beats at Shenmen: First, in patients with severe neurasthenia, due to heart blood deficiency and hyperactive heart yang, Shenmen pulse may beat, but it never shows the slow, slippery, harmonious, and flowing image of a pregnancy pulse; it is merely a pathological pulse. Second, in pregnant women after missing periods for a month, the Shenmen area presents the unique slippery pulse of pregnancy, distinct and clear under the fingers, disappearing gradually only after delivery. This pulse image best explains the scripture "When the Hand Shaoyin pulse moves vigorously, she is pregnant." In past years, I collaborated with gynecologists to diagnose unmarried pregnancies using Shenmen pulse, confirmed by radioimmunoassay. It was almost infallible, proving this point.
Wang Shuhe's *Mai Jing* (Pulse Classic) states: "In women, if the three yin pulses float and sink equally, and pressing reveals no interruption, there is pregnancy." What does "float and sink equally" mean? Wang Honghan explained: "Pressing and finding float and sink equal means what Zhongjing called the cun, guan, and chi three positions having equal size, float/sink, and slow/rapid qualities." He further said: "Shuhe saying women's pulses float and sink equally in three positions, and pressing reveals no interruption, means yin and yang are harmonious, a sign of pregnancy."
Shuhe's description in *Mai Jing* is a common pulse image after the early stage of pregnancy. As fetal qi grows and yin blood fills, the chi pulse becomes full, resulting in three positions floating and sinking equally and slipping continuously without interruption.
In summary, how can pregnancy be detected early via pulse diagnosis? If a woman of childbearing age experiences a sudden change in her normal menstrual rhythm, with missed periods and no other illness, and the cunkou pulse appears slow, slippery, and smooth, with both chi positions slightly deeper than cun and guan and slippery upon pressure, this is the normal pulse of early pregnancy. Alternatively, if pressing the Shenmen acupoint reveals a distinct, continuous slippery pulse, this is also evidence of early pregnancy.
Healing Hysteria with Ganmai Dazao Decoction
Hysteria (Zang Zao) first appeared in the *Jinkui Yaolue*, caused by long-term worry and thought, leading to dryness of the uterine organ, flaming up of heart fire, and disturbance of the spirit. It is distinctly different from mania and madness caused by qi stagnation, phlegm coagulation, and blazing heart-liver fire; thus, treatment methods must differ. Zhang Zhongjing's Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) is an eternal excellent formula for treating hysteria. Based on the patient's pulse and symptoms, adding herbs and administering correctly yields immediate results. Two cases are recorded below:
Case 1: Ms. Song, a female accountant in her thirties, suddenly developed unpredictable crying and laughing in early 1970, occurring multiple times daily. During episodes, she would sometimes cry sadly; sometimes laugh, scold, and ignore social boundaries; sometimes yawn frequently, as if possessed. After about an hour, she might laugh or not, then suddenly relax and return to calmness. After waking, she was indistinguishable from others and could manage accounts. She visited a psychiatric hospital multiple times and was diagnosed with "Schizophrenia," treated for months without effect. When I examined her, the illness was active, showing the same symptoms. After the episode stopped, her pulse was wiry and constrained, tongue body dry red, coating thin white. This case clearly matches Zang Zao in the *Jinkui*: "Women with Zang Zao like to feel sad and want to cry, acting as if possessed by spirits, yawning frequently." Matching this case perfectly, I prescribed Ganmai Dazao Tang plus herbs to nourish blood, soften the liver, and calm the spirit:
Huaimai (Tritici Coenolepis) 30g, Gancao (Glycyrrhizae Radix et Rhizoma) 4.5g, Dazao (Jujubae Fructus) 7 pieces, Danggui (Angelicae Sinensis Radix) 9g, Chao Baishao (Paeoniae Radix Alba Preparata) 9g, Baiziren (Biota Semen) 9g, Taizishen (Pseudostellariae Radix) 9g, Chao Zhuru (Bambusae Caulis in Taenia Preparata) 4.5g, Chao Zaoren (Ziziphi Spinosae Semen Preparatum) 9g, Fushen (Poria cum Pinodia) 9g, Hehuanpi (Albiziae Cortex) 15g.
After five doses, frequency reduced from several times daily to twice in five days. After ten doses, all symptoms disappeared. Years later, I met her family in Zhongshan Park; she reported everything was peaceful after recovery.
Case 2: Wife of Section Chief Yan, nearly fifty, suffering from coronary heart disease and chronic insomnia with frequent nightmares. In early spring 1975, she had an argument with a bathhouse attendant, feeling wronged despite being right, leading to mental derangement. She spoke excessively and incoherently, recounting the incident to everyone all day, and startedle easily at night. No other symptoms. Sedatives from psychiatry failed for half a month. I examined her: pulse fine, soft, and slippery; tongue pale, coating thin white. Analyzing the condition: At menopausal age, menstruation nearing cessation, yin and yang are prone to disorder. Combined with fine pulse and pale tongue indicating qi and blood deficiency, the argument caused liver qi stagnation and heart spirit agitation. Although symptoms differed from Case 1, the pathology was similar. The difference was that Case 1 involved yin injury and blood dryness, while this case accompanied heart-liver yang hyperactivity. I prescribed:
Huaimai (Tritici Coenolepis) 30g, Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparated with Honey) 9g, Dazao (Jujubae Fructus) 30g, Shichangpu (Acori Tatarinowii Rhizoma) 6g, Zhi Yuanzhi (Polygalae Radix Preparated with Honey) 6g, Zhenzhumu (Margarita) 30g, Longchi (Draconis Os) 12g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 9g, Zhuru (Bambusae Caulis in Taenia) 4.5g.
After twenty-plus doses, she recovered completely. It has been over twenty years since then; she looks like a vigorous old woman. Though frail and sickly, this symptom never recurred.
In the above two cases, Case 1's symptoms resemble the *Jinkui Yaolue* description closely, leaving no doubt about diagnosis and prescription. Case 2 is different; symptoms were only excessive speech and sleep disturbance, not mentioned in Zhongjing's original text. How can it be treated as Zang Zao? Physician Yu Gongxia summarized five application standards for Ganmai Dazao Tang in "Clinical Experience with Ganmai Dazao Tang" (*Jiangsu Journal of Traditional Chinese Medicine*, 1958, Issue 8):
1. Patient's words and deeds are abnormal, or无故 sadness, or uncontrolled joy and anger.
2. Restlessness, inability to sleep, or vague dreams, or restlessness sitting or lying, or sensation of ants crawling on body.
3. Excessive sweating, dry mouth, poor appetite, constipation, not defecating for several days.
4. Fear of all sounds and light, fear of talking to people, preferring to live alone in dark rooms.
5. Abdominal palpation shows spasm of right abdominal muscles, or tension under right hypochondrium near navel, with masses.
These symptoms need not all be present. Adding Danggui, Baishao, Fushen, Zaoren, Longchi, Muli, and Baiziren to this formula improves efficacy.
The cause of Zang Zao is essentially deficiency of yin fluids in the five zang organs. "Like to feel sad and want to cry" is due to lung metal fluid deficiency. "Frequent yawning" is due to liver-kidney deficiency causing general fatigue. Heart-liver blood deficiency leads to spirit chaos "as if possessed." Now, the patient has excessive speech and dream disturbance due to slight liver yang hyperactivity and激越 heart qi, which falls within this syndrome scope. Thus, treating with modified Ganmai Dazao Tang achieved complete cure.
Two Verified Cases of Treating Metrorrhagia and Metrostaxis
I. "Non-tonifying Tonification" for Treating Blood Collapse
Metrorrhagia and metrostaxis in women can be caused by blood heat, blood stasis, or spleen-kidney deficiency. Following proper treatment yields good results. However, I have seen women around fifty, in menopause, or elderly women, with a type of blood collapse where various medicines fail. Based on symptoms, knowing it is kidney deficiency, prescribing Zuogui Wan, Yougui Wan, Erzhi Wan, Liuwei Dihuang Wan, or Bawei Dihuang Wan rarely works. After learning Wei Zhixiu's method of "Non-tonifying Tonification," prescriptions worked immediately. I realized this type of blood collapse involves not only liver-kidney depletion but also affecting the extraordinary vessels, causing Chong and Ren instability and failure to secure. A different treatment approach is needed.
Wei Zhixiu recorded a case in *Xu Mingyi Leian* treating Widow Liu, seventy years old, with bleeding for two months. Having tried Guipi Wan, Liuwei, Siwu, Bazhen, and Shiquan Dabu Tangs without success, he devised the "Non-tonifying Tonification" method: Using Shudi (Rehmanniae Radix Preparata) 2 liang (half charred), Gouqizi (Lycii Fructus) 5 qian, Zaoren (Ziziphi Spinosae Semen) 5 qian, Baishao (Paeoniae Radix Alba) 3 qian, Huanglian (Coptidis Rhizoma) 3 fen, decocted in water. The effect was immediate upon drinking.