妇人有身体肥胖，痰涎甚多，不能受孕者，人以为气虚之故，谁知是湿盛之故乎！夫湿从下受，乃言外邪之湿
也。而肥胖之湿，实非外邪，乃脾土之内病也。然脾土既病，不能分化水谷以养四肢，宜其身体瘦弱，何以能肥
胖乎？不知湿盛者，多肥胖；肥胖者，多气虚；气虚者，多痰涎，外似健壮而内实虚损也。内虚则气必衰，气衰则
不能行水，而湿停于肠胃之间，不能化精而化涎矣。夫脾本湿土，又因痰多愈加其湿，脾不能受热，必津润于胞胎，
日积月累，则胞胎竟变为汪洋之水窟矣。且肥胖之妇，内肉必满，遮隔子宫，不能受精，此必然之势也。况又加以
水湿之盛，即男子甚健，阳精直达子宫，而其水势滔滔，泛滥可畏，亦遂化精成水矣，又何能成妊哉？治法必须以
水化痰为主。然徒泄水化痰，而不急补脾胃之气，则阳气不旺，湿痰不去，人先病矣，乌望其茹而不吐乎？
方用加味补中益气汤。
人参（三钱） 黄 （三钱，生用） 柴胡（一钱） 甘草（一钱） 当归（三钱，酒洗） 白术（一两，
土炒） 升麻（四分） 陈皮（五分） 茯苓（五钱） 半夏（三钱，制）
水煎服。八剂痰涎尽消，再十剂水湿利，子宫涸出，易于受精而成孕矣。其在于昔，则如望洋观海，而至于今，
则是马到成功也。快哉！此方之妙，妙在提脾气而升于上，作云作雨，则水湿反利于下行；助胃气而消于下，为津为
液，则痰涎转易于上化。不必用消化之品以损其肥，而肥自无碍；不必用浚决之味以开其窍，而窍自能通。阳气充
足，自能摄精，湿邪散除，自可受种，何肥胖不孕之足虑乎？
眉批∶再十剂后方加杜仲一钱半，炒断丝、续断钱半，炒，必受孕矣。
歌括∶妇人肥胖痰涎多，胞胎湿盛奈若何。
泄水化痰非正治，急补脾胃莫蹉跎。
加味补中益气汤，参 柴草术苓当。
升麻陈皮制半夏，痰涎尽消脾气旺。
In women who are obese with excessive phlegm and saliva, rendering them unable to conceive, people attribute it to Qi deficiency. Little do they know that it is actually due to an excess of Dampness! The phrase "Dampness enters from below" refers to external pathogenic Dampness. However, the Dampness associated with obesity is not an external pathogen, but an internal disorder of the Spleen Earth. Since the Spleen Earth is diseased and cannot separate and transform food and fluids to nourish the four limbs, one would expect the body to be emaciated. Why then can it be obese? It is unknown that those with excess Dampness are often obese; those who are obese often have Qi deficiency; and those with Qi deficiency often have excessive phlegm and saliva. They appear robust on the outside but are truly deficient and damaged on the inside. Internal deficiency leads to weak Qi; weak Qi fails to move water, causing Dampness to stagnate between the stomach and intestines. Instead of transforming into essence, it transforms into phlegm and saliva. The Spleen is inherently damp earth, and due to excessive phlegm, its dampness increases further. The Spleen cannot tolerate heat, so fluids inevitably moisten the uterus (Bao Gong). Day by day and month by month, the uterus eventually becomes a pool of vast water. Moreover, in obese women, internal flesh is necessarily full, blocking and isolating the uterus, preventing fertilization. This is an inevitable trend. Furthermore, compounded by excessive water-dampness, even if the man is very vigorous and his Yang essence reaches the uterus directly, the torrential flood of water is terrifying and will transform the essence into water. How can pregnancy occur then? The treatment method must focus primarily on resolving water and transforming phlegm. However, merely draining water and transforming phlegm without urgently tonifying the Qi of the Spleen and Stomach means that Yang Qi will not flourish, damp-phlegm will not be eliminated, and the person will fall ill first. How can one hope to conceive and give birth? Use the Modified Bu Zhong Yi Qi Tang (Modified Tonify the Middle and Augment the Qi Decoction).
Ren Shen (Ginseng Radix) (3 qian), Huang Qi (Astragali Radix) (3 qian, raw), Chai Hu (Bupleuri Radix) (1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (1 qian), Dang Gui (Angelicae Sinensis Radix) (3 qian, wine-washed), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1 liang, soil-fried), Sheng Ma (Cimicifugae Rhizoma) (4 fen), Chen Pi (Citri Reticulatae Pericarpium) (5 fen), Fu Ling (Poria) (5 qian), Ban Xia (Pinelliae Rhizoma) (3 qian, processed).
Decoct in water and take orally. After eight doses, phlegm and saliva will completely disappear. After another ten doses, water-dampness will be drained, the uterus will dry out, and it will be easy to conceive and become pregnant. In the past, this condition was like gazing at the ocean—helpless—but now, success comes swiftly. How delightful! The brilliance of this formula lies in lifting Spleen Qi upwards to form clouds and rain, thereby facilitating the downward discharge of water-dampness; and assisting Stomach Qi to dissipate downwards, transforming into fluids, thereby making phlegm and saliva easier to resolve upwards. There is no need to use digestive agents to damage fat, as obesity will naturally cease to be an obstacle; there is no need to use dredging agents to open orifices, as they will naturally become patent. With sufficient Yang Qi, essence can be retained; with dispelled dampness, conception can occur. What is there to worry about infertility due to obesity?
Commentary: Add Du Zhong (Eucommiae Cortex) (1.5 qian), Chao Duan Si Teng (Cuscutae Semen, fried) and Xu Duan (Dipsaci Radix) (1.5 qian each, fried) after ten more doses, and pregnancy will surely occur.
Verse:
Women obese with much phlegm and saliva,
How to handle the excessive dampness in the womb?
Draining water and transforming phlegm is not the correct treatment;
Hurry to tonify the Spleen and Stomach, do not delay.
Modified Bu Zhong Yi Qi Tang contains Ginseng, Bupleurum, Licorice, Atractylodes, Poria, and Angelica.
Cimicifuga, Citrus peel, and processed Pinellia,
When phlegm and saliva vanish, Spleen Qi flourishes.