妇人怀娠之后，恶心呕吐，思酸解渴，见食憎恶，困倦欲卧，人皆曰妊娠恶阻也，谁知是肝血太燥乎！夫妇人受
妊，本于肾气之旺也，肾旺是以摄精，然肾一受精而完娠，则肾水生胎，不暇化润于五脏；而肝为肾之子，日食母气
以舒，一日无津液之养，则肝气迫索，而肾水不能应，则肝益急，肝急则火动而逆也；肝气既逆，是以呕吐恶心之
症生焉。呕吐纵不至太甚，而其伤气则一也。气既受伤，则肝血愈耗，世人用四物汤治胎前诸症者，正以其能生肝
之血也。然补肝以生血，未为不佳，但生血而不知生气，则脾胃衰微，不胜频呕，犹恐气虚则血不易生也。故于平
肝补血之中，加以健脾开胃之品，以生阳气，则气能生血，尤益胎气耳。或疑气逆而用补气之药，不益助其逆乎！不
知妊娠恶阻，其逆不甚，且逆是因虚而逆，非因邪而逆也。因邪而逆者，助其气则逆增；因虚而逆者，补其气则逆转。
况补气于补血之中，则阴足以制阳，又何虑其增逆乎！
宜用顺肝益气汤。
人参（一两） 当归（一两，酒洗） 苏子（一两，炒，研） 白术（三钱，土炒） 茯苓（二钱） 熟地（五钱，
九蒸） 白芍（三钱，酒炒） 麦冬（三钱，去心） 熟陈皮（三分） 砂仁（一粒，炒，研） 神曲（一钱，炒）
水煎。服一剂轻，二剂平，三剂全愈。此方平肝则肝逆除，补肾则肝燥息，补气则血易生。凡胎病而少带恶阻
者，俱以此方投之无不安，最有益于胎妇，其功更胜于四物焉。
眉批∶方极效，但苏子一两。疑是一钱之误。然国初上元生人，禀赋最壮，或非用一两不效。今当下元，用
一钱可也，万不可用一两。
亦有肝郁气滞，胸膈膨闷，见食不恶，不能多食，虽系妊娠，而非恶阻。宜分别治之，后另有方。
疏肝化滞汤
全当归（酒洗，六钱） 杭芍（酒炒，三钱） 党参（去芦，三钱） 白扁豆（去皮，四钱） 云苓（二钱） 香
附（炒焦，二钱） 砂仁（炒研，钱半） 条芩（炒焦，八分） 神曲（炒焦，钱半） 广皮（八分） 薄荷（六分）
甘草（五分）
水煎服。
歌括∶怀孕之后恶阻现，恶心呕吐渴思酸。
见食憎恶常欲卧，血分太燥病属肝。
顺肝益气参归尝，苏子术苓熟地黄。
芍麦陈砂神曲炒，连服三剂逆气降。
After a woman becomes pregnant, she experiences nausea and vomiting, a craving for sour foods to quench thirst, aversion to food, fatigue, and a desire to lie down. People generally call this condition "pregnancy malaise" (Qiren Ezu). Little do they know that it is actually caused by excessive dryness of Liver Blood! The conception of a woman originates from the prosperity of Kidney Qi. Because Kidney Qi is prosperous, it can grasp essence. However, once the Kidney receives essence and forms an embryo, Kidney Water is used to nourish the fetus and has no spare capacity to moisten the five Zang organs. Since the Liver is the "child" organ of the Kidney (Water generates Wood), it relies daily on the maternal organ's (Kidney) Qi to expand and relax. If it lacks fluid nourishment for even one day, Liver Qi becomes urgent and contracted, while Kidney Water fails to respond in time, causing Liver Qi to become increasingly irritable. When Liver Qi is irritable, internal fire arises and rebels upward. Once Liver Qi rebels, symptoms such as vomiting and nausea arise. Even if vomiting is not severe, the damage to Qi is the same. Once Qi is damaged, Liver Blood is further depleted. The reason why people use Siwu Tang (Four Substance Decoction) to treat various conditions during pregnancy is precisely because it can generate Liver Blood. However, merely nourishing the Liver through blood generation, although not bad, is insufficient if one does not understand how to generate Qi; otherwise, the Spleen and Stomach will weaken and fail to withstand frequent vomiting. Moreover, it is feared that if Qi is deficient, Blood will be difficult to generate. Therefore, within the framework of soothing the Liver and nourishing Blood, herbs that strengthen the Spleen and stimulate appetite are added to generate Yang Qi. In this way, Qi can generate Blood, which is particularly beneficial to fetal Qi. Some may doubt: "If Qi is rebelling, using Qi-tonifying herbs will only exacerbate the rebellion!" They do not realize that in pregnancy malaise, the rebellion is not severe, and the rebellion is due to deficiency rather than pathogenic factors. For rebellions caused by pathogens, tonifying Qi increases rebellion; for rebellions caused by deficiency, tonifying Qi reverses the trend towards normalcy. Furthermore, when Qi is tonified amidst Blood-nourishing herbs, Yin is sufficient to control Yang, so there is no need to worry about increasing rebellion!
The appropriate prescription is Shun Gan Yi Qi Tang (Liver-Soothing and Qi-Boosting Decoction).
Ren Shen (Ginseng Radix et Rhizoma, 1 liang), Dang Gui (Angelicae Sinensis Radix, 1 liang, washed with wine), Su Zi (Perilla Fructus, 1 liang, stir-fried and crushed), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 qian, stir-fried with soil), Fu Ling (Poria, 2 qian), Shu Di Huang (Rehmanniae Radix Praeparata, 5 qian, steamed nine times), Bai Shao (Paeoniae Radix Alba, 3 qian, stir-fried with wine), Mai Dong (Ophiopogonis Radix, 3 qian, heart removed), Shu Chen Pi (Citri Reticulatae Pericarpium Praeparatum, 3 fen), Sha Ren (Amomi Fructus Rotundus, 1 grain, stir-fried and crushed), Shen Qu (Massa Medicata Fermentata, 1 qian, stir-fried).
Decoct in water and take orally. After one dose, symptoms lighten; after two doses, stability is achieved; after three doses, complete recovery occurs. This formula soothes the Liver to eliminate rebellion, tonifies the Kidney to extinguish Liver dryness, and tonifies Qi to facilitate Blood generation. For any fetal disorders accompanied by mild pregnancy malaise, administering this formula ensures safety and peace. It is most beneficial to pregnant women, surpassing the efficacy of Siwu Tang (Four Substance Decoction).
Marginal Note: The formula is extremely effective, but the use of 1 liang of Su Zi (Perilla Fructus) seems like a typo for 1 qian. However, individuals born in the early Qing Dynasty had robust constitutions, so perhaps 1 liang was necessary for efficacy. Now, in the late Qing period, constitutions are weaker, so 1 qian is sufficient. One must absolutely avoid using 1 liang.
There are also cases of Liver Qi stagnation and Qi mechanism obstruction, leading to chest and diaphragm distension and fullness, without aversion to food, but with an inability to eat large amounts. Although this occurs during pregnancy, it is not pregnancy malaise. These conditions should be treated differently; see the subsequent formula.
Shu Gan Hua Zhi Tang (Liver-Soothing and Stasis-Resolving Decoction)
Quan Dang Gui (Angelicae Sinensis Radix, washed with wine, 6 qian), Hang Shao Yao (Paeoniae Radix Alba, stir-fried with wine, 3 qian), Dang Shen (Codonopsis Radix, radix removed, 3 qian), Bai Bian Dou (Dolichos Lablab Semen Album, peel removed, 4 qian), Yun Ling Shen (Poria, 2 qian), Xiang Fu (Cyperi Rhizoma, stir-fried until scorched, 2 qian), Sha Ren (Amomi Fructus Rotundus, stir-fried and crushed, 1.5 qian), Tiao Qin (Scutellariae Radix, stir-fried until scorched, 8 fen), Shen Qu (Massa Medicata Fermentata, stir-fried until scorched, 1.5 qian), Guang Pi (Citri Reticulatae Pericarpium, 8 fen), Bo He (Menthae Haplocalycis Herba, 6 fen), Gan Cao (Glycyrrhizae Radix et Rhizoma, 5 fen).
Decoct in water and take orally.
Rhyme Formula:
After pregnancy begins, malaise appears,
Nausea, vomiting, thirst, craving sour flavors.
Aversion to food, often desiring rest,
Blood deficiency and dryness, the disease belongs to the Liver.
Use Shun Gan Yi Qi Tang with Ginseng and Angelica,
Perilla, Atractylodes, Poria, and Prepared Rehmannia.
Stir-fried Peony, Ophiopogon, Tangerine Peel, Amomum, and Fermented Dough,
Three consecutive doses lower the rebellious Qi.