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Treating hyperemesis gravidarum (nausea and vomiting during early pregnancy).

Qing Banxia (Pinelliae Rhizoma Praeparatum, 1 liang [approx. 37.5g], rinsed twice with warm water until no alum taste remains, then decocted) Jing Qingdai (Indigo Naturalis, 3 qian [approx. 11.25g]) Chishizhi (Halloysit Rubra, 1 liang [approx. 37.5g])

Decoct in a small pot used for cooking rice to obtain one large bowl of clear liquid. Mix in 2 liang [approx. 75g] of honey. Drink slowly while warm. Take only one mouthful at a time, finishing the dose within half a day. If vomiting persists after taking the medicine, or if there is dry fecal impaction, remove Chishizhi and add Sheng Zheishi (Raw Haematitum, finely crushed) 1 liang [approx. 37.5g]. If one dislikes the slight medicinal taste of Qingdai, it may be omitted, using only Banxia and Zheishi.

One might ask: The *Shennong Bencao Jing* (Divine Farmer's Materia Medica) states that Zheishi can cause abortion. This formula treats hyperemesis gravidarum, and sometimes substitutes Zheishi for Chishizhi; are you not concerned about the risk of abortion? I reply: In severe cases of hyperemesis gravidarum, even a sip of water is vomited out. The body's qi transformation and fluid metabolism fail to descend. This often leads to dry fecal impaction, remaining unpassed for more than ten days. In extreme cases, obstruction may occur at the Youmen (pylorus, the lower opening of the stomach) or Lanmen (the junction of the large and small intestines), causing blockage of upper and lower qi mechanisms, resulting in full abdominal pain. This is a critical condition endangering life. Since the illness is critical, only potent medicines can reverse it. Moreover, the nature of Zheishi is inherently not dispersing or breaking. Its heavy-settling power serves only to direct downward有形 (有形 - tangible/solid) stagnations. If the fetus is six or seven months old, its use might be contraindicated; however, during the time of hyperemesis gravidarum, the fetus is only two or three months old, and the fetal form has not yet fully developed. At this stage, it is merely a stagnation of menstrual blood. Zheishi has no property of breaking blood stasis, therefore its use causes no harm. Furthermore, in patients who vomit, both the Chong Mai (Penetrating Vessel) qi and Stomach qi rebel upward. Borrowing the settling power of Zheishi to counteract this rebellious upward movement allows qi transformation to return to balance. As stated in the *Neijing* (Inner Canon): "When there is a disease, there is no injury [to the healthy qi]" (You gu wu yun, yi wu yun ye). In my treatment of hyperemesis gravidarum, when encountering solidification in the Shangwan (upper epigastrium), where not even a spoonful of liquid can pass down for ten days, and whatever is ingested—water or medicine—is vomited up shortly after entering the mouth, other physicians have been helpless, declaring it incurable. However, I boldly and heavily prescribe several liang of Raw Zheishi, decocted into one large bowl of soup, which is drunk slowly while warm. Once vomiting stops, the obstruction resolves, and bowel movements resume, the fetus remains uninjured (Detailed case records can be found in my proposed Shen Zhen Zhen Qi Tang [Ginseng and Hematite Decoction to Suppress Rebellious Qi] and the discussion on Zheishi below).