妊妇有至五个月，肢体倦怠，饮食无味，先两足肿，渐至遍身头面俱肿，人以为湿气使然也，谁知是脾肺气虚
乎！夫妊娠虽有按月养胎之分，其实不可拘于月数，总以健脾补肺为大纲。盖脾统血，肺主气，胎非血不荫，非气
不生，脾健则血旺而荫胎，肺清则气旺而生子。苟肺衰则气馁，气馁则不能运气于皮肤矣；脾虚则血少，血少则不
能运血于肢体矣。气与血两虚，脾与肺失职，所以饮食难消，精微不化，势必至气血下陷，不能升举，而湿邪即乘
其所虚之处，积而成浮肿症，非由脾肺之气血虚而然耶。治法当补其脾之血与肺之气，不必祛湿，而湿自无不去之理。
方用加减补中益气汤。
人参（五钱） 黄 （三钱，生用） 柴胡（一钱） 甘草（一分） 当归（三钱，酒洗） 白术（五钱，土炒）
茯苓（一两） 升麻（三分） 陈皮（三分）
水煎服。四剂即愈，十剂不再犯。夫补中益气汤之立法也，原是升提脾肺之气，似乎益气而不补血，然而血非
气不生，是补气即所以生血。观当归补血汤用黄 为君，则较着彰明矣。况湿气乘脾肺之虚而相犯，未便大补其
血，恐阴太盛而招阴也。只补气而助以利湿之品，则气升而水尤易散，血亦随之而生矣。然则何以重用茯苓而至一
两，不几以利湿为君乎？嗟！嗟！湿症而不以此药为君，将以何者为君乎！况重用茯苓于补气之中，虽曰渗湿，而
仍是健脾清肺之意。且凡利水之品，多是耗气之药，而茯苓与参术合，实补多于利，所以重用之以分湿邪，即以补
气血耳。
眉批∶白术一味，今多以苍术充之，于白术伪者更多。白术补胎，苍术打胎，用者宜审。若恐其伪，以白扁
豆、山药代之较妥。
歌括∶妊娠五月足浮肿，渐及全身延面头。
脾肺气虚失运化，湿邪侵入皮下留。
加减补中益气汤，参归术 柴胡草。
升麻陈皮白茯苓；连服四剂浮肿消。
When a pregnant woman reaches five months, she experiences limb fatigue and loss of appetite. The swelling begins in both feet and gradually spreads to the entire body, including the head and face. People attribute this to dampness (Shi Qi), but little do they know it is due to Qi deficiency of the Spleen and Lung (Pi Fei Qi Xu)!
Although pregnancy involves nourishing the fetus month by month, one should not rigidly adhere to the monthly schedule; the general principle is always to invigorate the Spleen and tonify the Lung. The Spleen governs Blood, and the Lung governs Qi. The fetus cannot be nourished without Blood, nor can it grow without Qi. When the Spleen is healthy, Blood becomes abundant and nourishes the fetus; when the Lung is clear, Qi becomes vigorous and generates the child. If the Lung declines, Qi becomes deficient; if Qi is deficient, it cannot transport nutrients to the skin. If the Spleen is weak, Blood becomes scant; if Blood is scant, it cannot reach the limbs. With simultaneous deficiency of Qi and Blood, and dysfunction of the Spleen and Lung, digestion fails, and essence and grains are not transformed. Consequently, Qi and Blood sink and fail to ascend, allowing Dampness (Shi Xie) to invade the deficient areas, accumulating into edema. Is this not caused by the Qi and Blood deficiency of the Spleen and Lung?
The treatment method should focus on tonifying the Blood of the Spleen and the Qi of the Lung. There is no need to explicitly dispel Dampness, as it will naturally dissipate. The formula used is Modified Buzhong Yiqi Tang (Modified Tonify the Middle and Augment the Qi Decoction).
Ren Shen (Ginseng Radix) (5 qian), Huang Qi (Astragali Radix) (3 qian, raw), Chai Hu (Bupleuri Radix) (1 qian), Gan Cao (Licorice Root) (1 fen), Dang Gui (Angelicae Sinensis Radix) (3 qian, wine-washed), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (5 qian, soil-fried), Fu Ling (Poria) (1 liang), Sheng Ma (Cimicifugae Rhizoma) (3 fen), Chen Pi (Citri Reticulatae Pericarpium) (3 fen).
Decoct with water and take orally. Cure is expected after four doses, and recurrence is prevented after ten doses. The rationale of Buzhong Yiqi Tang is originally to lift the Qi of the Spleen and Lung. It appears to tonify Qi without nourishing Blood; however, since Blood cannot generate without Qi, tonifying Qi serves to generate Blood. This is clearly demonstrated by Dang Gui Bu Xue Tang (Dong Quai and Astragalus Decoction), which uses Huang Qi as the sovereign herb. Moreover, since Dampness invades due to Spleen and Lung deficiency, it is inadvisable to heavily tonify Blood, lest excessive Yin attract more Yin pathogenic factors. By tonifying Qi and assisting with herbs that promote diuresis, Qi ascends, water disperses easily, and Blood generates accordingly. Then why use such a heavy dose of Fu Ling (one liang)? Does this not make diuresis the primary action? Alas! If this herb were not the sovereign for dampness, what would be? Furthermore, using Fu Ling heavily within a Qi-tonifying formula, although it promotes dampness leaching, still embodies the intent of invigorating the Spleen and clearing the Lung. Most diuretic herbs consume Qi, but when Fu Ling is combined with Ren Shen and Bai Zhu, its tonifying effect outweighs its draining effect. Thus, Fu Ling is used heavily to disperse Dampness, thereby aiding in the tonification of Qi and Blood.
Marginal Note: Bai Zhu (Atractylodis Macrocephalae Rhizoma) is often substituted with Cang Zhu (Atractylodis Rhizoma) nowadays, and fake Bai Zhu is even more common. Bai Zhu nourishes the fetus, whereas Cang Zhu may abort it; users must distinguish carefully. If concerned about adulteration, substituting with Bai Bian Dou (Lablab Seed) or Shan Yao (Dioscoreae Rhizoma) is safer.
Verse:
At five months of pregnancy, foot swelling occurs,
Spreading to the whole body, reaching the head and face.
Spleen and Lung Qi deficiency fails to transform,
Dampness invades and stays beneath the skin.
Modified Buzhong Yiqi Tang, with Ginseng, Dong Quai, Atractylodes, Astragalus, Bupleurum, Licorice,
Cimicifuga, Citrus peel, and Poria;
Four consecutive doses eliminate the edema.