胎妊者，两精相搏，二气妙凝，清升浊降，阴阳肇基，血以濡之，化其神魂，气以煦之，化其精
魄。气统于肺，血藏于肝，而气血之根，总原于土。土者，所以滋生气血，培养胎妊之本也。木火以
生养之，金水以收成之，土气充用，四维寄旺，涵养而变化之。五气皆足，十月而生矣。养胎之要，首在
培土。土运则清其火金，而上不病热；暖其水木，而下不病寒。木温而火清，则血流而不凝也。金凉而水
暖，则气行而不滞也。气血环抱，而煦濡之形神巩固，永无半产之忧矣。如胎之初结，中气凝蹇，升降之
机，乍而湮郁，冲和之气，渐而壅阻，其始胃气初郁，滋味厌常而喜新。及其两月胎成，则胃气阻逆，恶
心呕吐，食不能下等证作矣。且胎气在中，升降不利，水偏于下润，火偏于上炎，是以胎妊之证，往往下
寒而上热也。阴阳郁格为病，法宜行郁理气为主。以豆蔻苓砂汤主之。如堕胎之证，缘胎之结也。一月二
月，木气生之。三月四月，火气生之。五月六月，土气化之。七月八月，金气收之。九月十月，水气成之。
五气皆足，胎完而生矣。若生长之气衰，则胎堕于初结。收成之力弱，则胎殒于将完。其实皆土气之虚也
。土气困败，胎妊失养，是以善堕。胎妊欲堕，腰腹必痛，痛者，木陷而克土也。《难经》云∶“命门者
，诸精神之所舍，原气之所系，男子以藏精，女子以系胞。”命门阳败，肾水澌寒，侮土灭火，不生肝木
，木气郁陷，而贼脾土，此胎孕堕伤之原也。以胶艾苓参汤主之。如胎漏之证，缘胎成经断，血室盈满，
不复流溢，肝脾阳弱，莫能行血，养胎之余，易致堙瘀，瘀血蓄积，阻碍经络，胎妊渐长，隧
道壅塞，此后之血不得上济。月满阴盈，是以下漏。按其胎之左右，必有 块。或其平日原有宿 ，亦能
致此。若内无瘀血，则是肝脾下陷，经血亡脱，其胎必堕矣。如下血而腹痛者，则是胞气壅碍，土郁木陷
，肝气贼脾也。如妊娠血下腹痛者，以艾叶地黄阿胶汤主之。如妊娠下血 块连胎者，以桂枝茯苓汤主
之。如临产交骨不开者，以加味芎归汤主之。当归补血汤亦主之。
豆蔻苓砂汤
白蔻（一钱生研） 杏仁（二钱） 甘草（一钱） 砂仁（一钱炒研） 芍药（二钱） 竹
茹（三钱） 茯苓（三钱） 橘皮（二钱） 水煎大半杯，温服。治胎孕初结，恶心呕吐，昏晕燥渴之证，缘
中气郁阻，胃土不降，以此开郁降浊，清胆火而行肝血。内热加清凉之味，内寒加温暖之品，酌其脏腑阴阳而调之。
胶艾苓参汤
甘草（二钱） 人参（三钱） 茯苓（三钱） 当归（三钱） 艾叶（三钱） 阿胶（三钱） 芍药
（三钱） 水煎大半杯，温服。治胎孕欲堕者，腹痛加砂仁。
艾叶地黄阿胶汤
甘草（二钱） 地黄（三钱） 阿胶（三钱） 当归（三钱） 艾叶（三钱） 芍药（三钱）
茯苓（三钱） 丹皮（三钱） 水煎大半杯，温服。治妊娠血下腹痛者。
桂枝茯苓汤
桂枝（三钱） 茯苓（三钱） 甘草（二钱） 丹皮（三钱） 芍药（三钱） 桃仁（三钱）
水煎大半杯，温服。治妊娠下血， 块连胎者。轻者作丸，缓以消之。
加味芎归汤
当归（五钱） 龟板（童便炙酥） 川芎（各三钱） 血余炭（二钱） 水煎大半杯，温服。
治产妇交骨不开，属血虚者，约人行五里许即生。设是死胎亦下。
当归补血汤
（方见头痛） 水煎服。治交骨不开，属气虚者。
The formation of pregnancy (Tai Ren) results from the mutual interaction of the two essences (Jing) of parents, where the subtle condensation of Yin and Qi occurs. Clear Qi ascends, turbid Qi descends, establishing the foundation of Yin and Yang. Blood nourishes the fetus, transforming its Hun and Shen (Spirit); Qi warms the fetus, transforming its Jing and Po (Corporeal Soul). Qi is governed by the Lung, while Blood is stored in the Liver; however, the root of both Qi and Blood originates in the Spleen/Stomach (Earth element). The function of Earth is to generate and nourish Qi and Blood, which constitutes the foundation for cultivating the pregnancy. Wood and Fire energies nurture and grow it, while Metal and Water energies gather and mature it. When Earth Qi is abundant and functional, the four dimensions flourish, thereby nurturing and facilitating transformation. When the Qi of the Five Zang organs is sufficient, birth occurs after ten months.
The key to nurturing the fetus lies primarily in strengthening the Spleen/Stomach (Earth). If the Spleen/Stomach transport and transformation functions are normal, it clears Heat from Fire and Metal, preventing pathology in the upper body; it warms Water and Wood, preventing pathology in the lower body. With mild Wood and clear Fire, blood flows without stagnation; with cool Metal and warm Water, Qi moves without obstruction. Surrounded and embraced by Qi and Blood, the form and spirit of the fetus are consolidated, eliminating the worry of spontaneous abortion (Ban Chan).
If, at the initial stage of conception, the Middle Jiao Qi becomes stagnant and obstructed, the mechanism of ascending and descending is temporarily suppressed, and the harmonious Qi gradually becomes blocked. Initially, this manifests as slight Stomach Qi depression, where taste preferences shift from ordinary foods to novel ones. By the second month, when the fetus is formed, Stomach Qi becomes rebellious, leading to symptoms such as nausea, vomiting, and inability to retain food. Furthermore, since fetal Qi resides in the middle, if ascending and descending are impaired, Water dampness tends to sink downward, while Fire heat flares upward. Consequently, pregnancy pathologies often present with cold below and heat above. This disease arises from the constraint and rejection of Yin and Yang; the treatment principle should focus on promoting Qi movement and resolving stagnation. Doukou Ling Sha Tang (Cardamom and Poria Decoction) is indicated.
Regarding miscarriage (Tuo Tai), the cause lies in the process of fetal formation. In the first and second months, Wood Qi generates it. In the third and fourth months, Fire Qi generates it. In the fifth and sixth months, Earth Qi transforms it. In the seventh and eighth months, Metal Qi gathers it. In the ninth and tenth months, Water Qi completes it. When the Qi of the five elements is sufficient, the fetus matures and is born. If the generating force is weak, the fetus falls during the initial stage of formation. If the gathering force is weak, the fetus perishes just before completion. Ultimately, these are due to deficiency of Earth Qi. When Earth Qi is exhausted and defeated, the pregnancy loses nourishment, leading to a tendency toward miscarriage.
When a pregnancy is threatened with miscarriage, there is invariably pain in the waist and abdomen. The cause of pain is the sinking of Wood Qi which overacts upon Earth. The *Nan Jing* states: "The Ming Men (Gate of Life) is the residence of the spirit and essence, the connection of Yuan Qi; in men it stores Essence, and in women it connects to the Bao Luo (Uterus)." If Ming Men Yang fails and Kidney Water becomes cold, it insults Earth and extinguishes Fire, failing to generate Liver Wood. Consequently, Liver Qi sinks and depresses, further injuring Spleen Earth. This is the root cause of fetal loss. Jiao Ai Ling Shen Tang (Donkey-hide Gelatin and Mugwort Decoction) is indicated.
Regarding fetal leakage (Tai Lou), the cause is that after conception, menstruation ceases, and the Blood Chamber becomes full without external flow. If Liver and Spleen Yang are weak and unable to move blood, surplus blood intended to nourish the fetus may easily become stagnant. Accumulated blood stasis obstructs the meridians. As the fetus grows, the channels become blocked, preventing subsequent blood from ascending to nourish. When the lunar month is complete and Yin blood is full, leakage occurs downward. Palpation of the areas left and right of the uterus will reveal masses (Zheng Kuai). Alternatively, pre-existing blood stasis can also cause this. If there is no internal blood stasis, it indicates sinking of Liver and Spleen Qi with depletion of menstrual blood, leading inevitably to miscarriage. If bleeding is accompanied by abdominal pain, it signifies obstruction of Uterine Qi, depression of Earth causing Wood to sink, and Liver Qi injuring Spleen. For pregnancy with bleeding and abdominal pain, Aye Dihuang Ejiao Tang (Mugwort, Rehmannia, and Donkey-hide Gelatin Decoction) is indicated. For pregnancy with bleeding and masses involving the fetus, Guizhi Fuling Tang (Cinnamon Twig and Poria Decoction) is indicated. For difficult labor due to non-opening of the pubic symphysis (Jiao Gu), Jiawei Xiong Gui Tang (Modified Chuanxiong and Angelica Decoction) is indicated. Danggui Buxue Tang (Angelica Tonifying Blood Decoction) is also applicable.
[Formulas Section]
Doukou Ling Sha Tang (Cardamom and Poria Decoction):
Bai Kou Ren (White Cardamom Seed, 1 qian, raw and ground), Xing Ren (Apricot Kernel, 2 qian), Gan Cao (Licorice Root, 1 qian), Sha Ren (Amomum Fruit, 1 qian, stir-fried and ground), Shao Yao (Peony Root, 2 qian), Zhu Ru (Bamboo Shavings, 3 qian), Fu Ling (Poria, 3 qian), Ju Pi (Citrus Peel, 2 qian). Decoct in water to obtain half a cup, take warm. Indicated for early pregnancy with nausea, vomiting, dizziness, dry mouth, and thirst, caused by Middle Jiao Qi stagnation and failure of Stomach Earth to descend. This formula resolves stagnation, directs turbidity downward, clears Gallbladder Fire, and promotes Liver Blood circulation. Add cooling herbs for internal heat, warming herbs for internal cold, adjusting according to the Yin-Yang status of the Zang-Fu organs.
Jiao Ai Ling Shen Tang (Donkey-hide Gelatin and Mugwort Decoction):
Gan Cao (Licorice Root, 2 qian), Ren Shen (Ginseng Root, 3 qian), Fu Ling (Poria, 3 qian), Dang Gui (Angelica Sinensis Root, 3 qian), Ai Ye (Mugwort Leaf, 3 qian), E Jiao (Donkey-hide Gelatin, 3 qian), Shao Yao (Peony Root, 3 qian). Decoct in water to obtain half a cup, take warm. Indicated for threatened miscarriage. Add Sha Ren (Amomum Fruit) if abdominal pain is present.
Aye Dihuang Ejiao Tang (Mugwort, Rehmannia, and Donkey-hide Gelatin Decoction):
Gan Cao (Licorice Root, 2 qian), Di Huang (Rehmannia Root, 3 qian), E Jiao (Donkey-hide Gelatin, 3 qian), Dang Gui (Angelica Sinensis Root, 3 qian), Ai Ye (Mugwort Leaf, 3 qian), Shao Yao (Peony Root, 3 qian), Fu Ling (Poria, 3 qian), Dan Pi (Moutan Bark, 3 qian). Decoct in water to obtain half a cup, take warm. Indicated for pregnancy with bleeding and abdominal pain.
Guizhi Fuling Tang (Cinnamon Twig and Poria Decoction):
Gui Zhi (Cinnamon Twig, 3 qian), Fu Ling (Poria, 3 qian), Gan Cao (Licorice Root, 2 qian), Dan Pi (Moutan Bark, 3 qian), Shao Yao (Peony Root, 3 qian), Tao Ren (Peach Kernel, 3 qian). Decoct in water to obtain half a cup, take warm. Indicated for pregnancy with bleeding and masses involving the fetus. For mild cases, prepare as pills for slow resolution.
Jiawei Xiong Gui Tang (Modified Chuanxiong and Angelica Decoction):
Dang Gui (Angelica Sinensis Root, 5 qian), Gui Ban (Tortoise Shell, prepared with child's urine until crisp), Chuan Xiong (Ligusticum Rhizome, each 3 qian), Xue Yu Tan (Charred Hair, 2 qian). Decoct in water to obtain half a cup, take warm. Indicated for difficult labor due to non-opening of the pubic symphysis in cases of Blood deficiency; delivery typically occurs within the time it takes a person to walk about five li. It also expels dead fetuses.
Danggui Buxue Tang (Angelica Tonifying Blood Decoction):
(See formula under Headache section). Decoct in water and take. Indicated for non-opening of the pubic symphysis in cases of Qi deficiency.