Library

[Background Information]
Book: *Lenglu Yihua* (Medical Conversations from the Cold Cottage)
Author: Lu Yitian
Dynasty: Qing
Chapter: Obstetrics and Gynecology (Tai Chan)
Category: Medical Discourse

[English Translation]

A woman whose menstruation has ceased for three months may take two qian of Chuanxiong Rhizoma powder, mixed with water decocted from Artemisia argyi leaves. If she feels a slight movement inside her abdomen, it is pregnancy; if not, it is not. This method is recorded in various gynecological texts, yet it should not be tried lightly. My wife had always suffered from Liver Qi stagnation. In the year Jichou, when she was three months pregnant, she took a small amount of Chuanxiong Rhizoma powder and immediately experienced severe fetal movement and extreme restlessness. Thus, one knows that established prescriptions should not be rigidly adhered to. Another prescription found in medical books is Foshou San (Buddha's Hand Powder), which uses Angelicae Sinensis Radix and Chuanxiong Rhizoma, each five qian, decocted with water and wine, to treat restless fetus. Yan Jian-san (courtesy name Ren), a Confucian physician from Hangzhou, stated that while this formula can stabilize the fetus when taken temporarily, long-term use leads to repeated pregnancies that fail to survive to term, based on his personal experience.

The Chen family gynecology clinic in Xincheng Town, Xiushui County, prohibits the use of Chuanxiong Rhizoma in treating various antenatal conditions because its ascending nature easily disturbs the fetal qi. They also state that Longan Arillus should not be taken lightly postpartum, as its sweet taste may induce vomiting, potentially causing stagnant blood to ascend. I recalled that Zhang Jingyue treated retained placenta by stirring hair from the parturient into her throat to induce vomiting, thereby causing the qi to ascend and blood to disperse, softening the placenta so it would fall naturally. Although this method is clever, it might cause stagnant blood to rise due to vomiting, thereby increasing harm.

Xiao Shenzhai, in *Nuke Jinglun* (Classic Compendium of Gynecology), stated that giving birth after ten months of gestation is the norm. Cases extending beyond this period, such as those of Emperor Yao and Emperor Zhao of Han, are rare exceptions; claims of two or four years of gestation are absurd and baseless.

I have verified that the *History of Yuan* records Huang HT giving birth after twenty-four months of pregnancy, which must not be fabricated. Additionally, Wang Xuequan’s *Chongqing Tang Suibi* records the words of Wang Dachang: An old physician, Fu Peilin, treated the wife of a seamster named Zhou. She had amenorrhea, abdominal pain, and hardness, and medication was ineffective. After more than two years, she suddenly gave birth to a son, and her abdominal distension vanished instantly. The child was very small and named Guanbao; I often saw him. Therefore, gestation lasting several years is indeed possible and should not be dismissed as absurd.

Cai Songting’s prescription for difficult labor uses Astragali Radix and Rehmanniae Radix Preparata, each one liang; Dangshen Radix, Lycii Fructus, Tortoise Carapax and Plastrum (vinegar-processed), and Angelicae Sinensis Radix, each four qian; Poria, three qian; and Paeoniae Radix Alba and Chuanxiong Rhizoma, each one qian. Regardless of whether the membranes have ruptured, take four to five doses, using only the first decoction to ensure potent medicinal strength. This formula aims to tonify Qi and Blood, claiming it to be foolproof. Feng Chuzhan’s Wanchuan Tang (Ten Thousand Complete Decoction for Inducing Labor and Protecting Birth) uses Ginseng Radix three to five qian, Angelicae Sinensis Radix two qian, Achyranthis Bidentatae Caulis Apicem three qian, Chuanxiong Rhizoma and Zingiberis Rhizoma Praeparatum (charred), each one qian, Cinnamomi Cortex six fen, Persic Semen thirteen grains, and Carthami Flos (wine-fried) three fen. It tonifies while promoting circulation, claiming not only to induce labor effectively but also to prevent all postpartum diseases caused by stagnant blood. Proponents of Cai’s formula criticize Feng’s as too warming; proponents of Feng’s criticize Cai’s as cloying and obstructive. I believe Feng’s formula is suitable only for those with deficient-cold constitutions; otherwise, it may leave lingering hazards. Cai’s formula is superior. Pregnant women should avoid common herbs such as Moutan Cortex, Red Paeoniae Radix, Achyranthis Bidentatae Radix, Coicis Semen, Fritillariae Bulbus, Pinelliae Tuber, Arisaematis Rhizoma, Tetsu Herba, Plantaginis Semen, Alismatis Rhizoma, Talcum, Sophorae Flos, Hordei Fructus Germinatus, Shenqu, Longgu Fictilium (Dragon Bone), Angelicae Sinensis Radix Tail (when using the body, remove the tail), Trionycis Carapax et Plastrum, and Testudinis Carapax et Plastrum. Generally, herbs that move blood, promote Qi, unblock collaterals, or drain dampness are prohibited. Thus, Wang Mengying stated that there is no dampness during pregnancy, so even Poria should be avoided. Strong alcohol, Sichuan pepper, and garlic are also forbidden as they assist fire and consume Yin. To secure the fetus, decocted Pumpkin Stipe is best, surpassing other medicines; mixing it with ash from an ox’s nose is especially excellent.

*Bozhai Bian* records: A woman suffered sudden thirst and drank only Schisandrae Fructus juice. The renowned physician Geng Yu diagnosed her pulse and said, "This is due to blood attempting to coagulate; it is not a disease." She subsequently became pregnant. Since ancient formulas mention symptoms of thirst due to blood coagulation treated with Schisandrae Fructus, this cannot be ignored. Note: This theory is rare in obstetric texts; it is recorded here for reference. Ge Qingfeng Zishen, in *Yiyi Maibu* (Medical and Yi Pulse Section), regarding the "stomach pregnancy" pulse, stated that when Yang enters Yin, the pulse should be short and rapid. Luo Yangzai considered this an unprecedented discovery, though his book did not survive.

Bupao San (Bladder-Reinforcing Powder) treats postpartum enterovesical fistula (Jiaochang Bing). Due to damage to the bladder and intestines, filth accumulates and blocks, causing urine and feces to exit through the wrong orifices. Bupao San is very effective. The formula uses one chi of raw yellow silk, cut up; half a qian each of White Moutan Cortex and Bletillae Rhizoma; decocted in one bowl of water until thick like syrup; pounded with a wooden pestle until smooth; taken in one dose on an empty stomach. Silence must be maintained during ingestion, or it will be ineffective. Chen Bianmengqin mastered this method, using raw yellow silk, Bletillae Rhizoma, Yellow Beeswax, Alum, and Succinum, pounded with water into pills, taken with broth boiled from a pig bladder. This is particularly precise and worthy of emulation.

To distinguish pregnancy, ancients relied on the presence of symptoms despite a normal pulse. Shen Jin’ao further distinguished it by craving sour foods. He Xichi used the darkening of nipples and areolae, and breast elevation at five months, as evidence. To distinguish fetal gender, ancients believed a larger left pulse indicated a male, and a larger right pulse indicated a female. Zhang Luyu alone argued that a slippery and solid pulse at the Cun position indicates a male, and at the Chi position indicates a female; both Cun positions slippery and solid indicate twin males; both Chi positions slippery and solid indicate twin females; right Chi and left Cun slippery and solid indicate one male and one female. These are essential secrets.

Shi Jiajun from Yanghu recounted that his fellow townsman, the renowned physician Mr. Zhou Ba, examined a pregnant woman with swelling and pain in the left breast, stating that left breast swelling indicates a male, which proved correct. I verified that *Qianjin Fang* states: a nodule in the left breast indicates a male, and in the right breast indicates a female. *Kunyuan Shibao* also validates left-male/right-female based on early breast nodules, likely deriving from this meaning.

For a dead fetus in utero, ancient methods used purgatives. Verification signs include abdominal oppression, chest heaviness, coldness, absence of fetal movement, foul breath, earth-colored complexion, and blue tongue. [Text fragment missing/obscured]. Decoct half a cup of wine and half a cup of water, add five qian of Natrii Sulfas, simmer, and take warm. The fetus will dissolve and pass. Xue Lizhai noted: After taking Natrii Sulfas for a dead fetus, if the patient experiences limb fatigue and faint breathing, urgently use Sizijunzi Tang (Four Gentlemen Decoction) as the base, supplemented with Siwu Tang (Four Substances Decoction), added with Ginger and Cinnamon. Xiao Shenzhai stated: One must verify blue tongue, cold abdomen, and foul breath before using purgatives for a dead fetus. First, secure the original Qi of pregnancy by tonifying Qi and nourishing Blood, then purge. If uncertain, using harsh purgatives risks disaster. *Baochan Yaolu* states: Even without medicine, if the mother does not panic or rush, the fetus will eventually be born without harming the mother. The womb is extremely hot; if the mother remains calm and eats well, internal heat steams the fetus, softening and rotting it. Within one to four days, it passes naturally, though the odor is unpleasant. This shows...

For death of the fetus due to weak Blood (symptoms: abdominal distension and pain, failure to pass within a day, deep and hidden pulses at both Chi positions, faint and spiritless movement), boil Yimucao膏 (Motherwort Paste), and mix with a decoction of Chuanxiong Rhizoma, Angelicae Sinensis Radix, Cinnamomi Cortex, and Abutilonis Semen. Take two to three cups, and the fetus will pass. This treatment is optimal. Wu Jutong treated a woman with a dead fetus retained for two days. Her pulse was large, flooding, and hollow. She had continuous profuse sweating and mental confusion approaching collapse. Wu said: "Heart Qi is too deficient to hold the fetus. Regardless of whether the fetus is dead, first secure Heart Qi." He used Niujin Tang (Rescue the Reverted Decoction - Rehmanniae Radix, Ophiopogonis Tuber, Paeoniae Radix Alba, Ecliptae Herba, Glycyrrhizae Radix Preparata, Dragon Bone, Turtle Shell) plus Ginseng. Boiled into three cups. After one cup, sweating stopped; after two cups, spirit cleared and mind calmed. Before finishing the third cup, the dead fetus passed. Post-delivery, tonify Kidney and Liver Yin to harmonize with Heart Yang, leading to recovery. This opens a new path for treating dead fetuses.

*Chanbao* states: If a nodule on the umbilical cord slips into the infant's mouth, and the pregnant woman climbs high and raises her arms, the nodule may slip out of the infant's mouth, causing crying. Is this how to induce birth? However, I observed Cheng Guang treat intrauterine crying by pouring beans on the ground and having the woman bend down to pick them up, which stopped the crying. Wan Mizhai’s method involved having the woman perform a male bow, which also stopped it. Thus, the "holding in mouth" theory seems plausible, but only a mouth can hold something; how can it be compared to a time without a mouth? Moreover, "holding" occurs within the misty primordial Qi, not necessarily true sucking of blood for nourishment. Wang’s view seems rigid.

Ji Shouqiao Nan, a scholar from Xiushui, elegant and skilled in poetry, deeply understood medical principles, especially gynecology. He claimed over twenty years of experience diagnosing high-risk obstetric cases. Most gynecological cases involve abortion or difficult labor, which he discussed incisively. Recording his views: Treating spontaneous abortion often uses astringents; treating difficult labor often uses purgatives. Neither is correct. Half-births result from deficiency-slippage or internal heat. After conception, Chong and Ren vessel blood is absorbed by the fetus, leaving no surplus to flow downward. Insufficient blood causes the fetus to wither and fall. The root is internal heat and fire excess, Yang flourishing and Yin deficient, further reducing blood. Treatment should prioritize nourishing Blood, followed by clearing heat. Relying on cloying tonics causes obstruction. Regarding childbirth, it follows the natural generative principle of Heaven and Earth and is inherently safe; danger arises from human error. Pushing too early causes premature descent, inability to rotate, rupture of membranes, and dryness, risking transverse or breech presentation. Treatment again prioritizes nourishing Blood; as Blood generates, the fetus exits. Misusing purgatives damages Chong and Ren vessels, causing Qi rebellion and blood flooding, leading to imminent death. Beware! Beware!

Qi Yuzhong’s *Sanjin Jianwen Lu* states: Shanxi postpartum women fast and eat nothing, consuming only thin millet porridge several times a day for a month. If they eat rice, flour, chicken, or pork within ten days, the condition is incurable. Anyi region forbids sleep for ten days. Note: Many die postpartum from dietary injury. Drinking porridge is best, but do not let them starve; drink as soon as hungry, in large amounts. Forbidding sleep for ten days is excessive and exhausts Spirit and Qi. In my hometown, we advise sleeping propped on high pillows with someone watching, waking them if they sleep too long, allowing free sleep only after four or five days. This method is better.