经义
妇人重身，毒之何如？有故无殒，亦无殒也。（《素问》）
总论
凡看病妇，当先问娠，不可仓卒。○凡治病妇，不可轻用破气行血之药，恐有娠在疑似间也。（张子和）
妊娠一月名胎胚，足厥阴脉养之；二月名始膏，足少阳脉养之；三月名始胎，手心主脉养之；四月始成血
脉，手少阳脉养之；五月始成其气，足太阴脉养之；六月始成其筋，足阳明脉养之；七月始成其骨，手太阴脉
养之；八月始成肤革，手阳明脉养之；九月始成毛发，足少阴脉养之；十月五脏六腑关节人形皆备。此其大略
也。（《巢氏病源》）
胎有男女，则成有迟速。体有阴阳，则怀有向背。故男动在三月，阳性早也；女动在五月，阴性迟也。女
胎背母而怀，故母之腹软；男胎面母而怀，故母之腹硬。（《景岳全书》）
《举要》云∶男腹如箕，女腹如釜。盖男女孕于胞中，男面母腹，则足膝抵腹，下大上小，故如箕；女
面背母，则背脊抵腹，其形正圆，故如釜也。（《冯氏锦囊》）
胎前为实，象乎坎卦；产后为虚，象乎离卦。胎前多热，坎中阳也；生后多寒，离中阴也。（方星岩）
恶阻
妇人得平脉，阴脉小弱，其人渴，不能食，无寒热，名妊娠，桂枝汤主之。○于法六十日，当有此证，设
有医治逆者，却一月加吐下者，则绝之。○妊娠吐呕不止，干姜人参半夏丸主之。（《金匮》）
恶阻者，谓呕吐、恶心、头眩、恶食、择食是也。绝之者，谓绝止医治，候其自安也。予尝治一、二妊妇
恶阻，病呕吐，愈治愈逆，因思仲景绝之之旨，以炒糯米汤代茶，止药月余，渐安。○《大全》谓半夏动胎。
观仲景用干姜人参半夏丸，罗谦甫用半夏茯苓汤，丹溪用二陈汤加减，并治胎前恶阻，痰逆呕吐等证，俱效。
予用治恶阻，未尝动胎，正《经》云有故无殒是也。（娄全善）
妊娠之初，经脉内闭，育养胎息，肠胃阻洳，散入焦膈。若素有痰饮，则饮与血搏，食饮辄吐，头目旋
晕，憎闻食气，喜啖
酸咸，肢倦困懒，多卧少起，名曰恶阻。已产之后，胞外余血，败瘀流利，名曰恶露。盖恶者，不善不净之义。
阻者，阻节之阻。血搏痰饮，当渐消之。露者，露水之露，当急逐之。由是而知胎前曰恶阻，产后曰恶露。古
人命名之意，良有以也。（《简易方》）
凡妊二、三月，呕逆不食，或心中烦闷，此乃气血积聚，以养胎元。精血内郁，秽腐之气上攻于胃，是以
呕逆不食；血既养胎，心失所荣，是以心中烦闷。法当调血散郁，用参、术、甘草补中气，橘红、紫苏、木香、
生姜散郁气，茯苓、麦冬、黄芩、竹茹清热解烦，名参橘饮。（朱丹溪）
恶阻多在三月，相火化胎之候。壮火食气，上冲胃口，食入即吐。少阴肾水养胎，少阳相火益炽，须用清
肝滋肾汤，即六味加柴胡、白芍。先用逍遥止呕，甚则加茱、连。（赵养葵）
恶阻一证，古人以形病而脉不病别之。余谓恶阻无不喜食酸物，不若以嗜酸别之，更为明切。亦有妊妇气
血调和，不患恶阻者，亦有虽患，轻而暂者，又不可不知。（沈金鳌）
妇人怀孕，其始证见恶阻，而恶阻自《金匮》有"绝之"之法，以下巢元方主于气凝血聚，陈良甫主于停
饮积痰，仲景作寒治，太无、养葵作火论，病机可谓详悉。但胎前无寒，产后无热，此常法也。故恶阻呕吐，
大抵寒少热多，总属血壅胎元，脏气不能宣通，停痰积饮，郁热壅滞，变而为火。故丹溪、立斋治以枳壳、紫
苏、香、砂，为降气顺气之法。所谓胎前须顺气者此也。（萧慎斋）
选案
汪姓妇，经阻数月，发热呕吐，水浆不入，卧床不起，大肉尽脱。凡古方治恶阻者，试之殆遍，而无一效，
转疑非孕。拟用真武重镇，药熟瓶破，因而中止。然气不相接，手足冷，形神败，冷汗出，已制木矣。诊尺中，
尚有滑意。余曰∶果真阳脱胃绝，讵有尺滑之理？《经》曰∶食不得入，是有火也。吐甚胃伤，四
肢主脾，故作厥耳。且呕吐一证，人惟责之胃，不知责之肾，而恶阻之病，多有冲阳上升而胃不安者，尤当求
之于肾。爰酌嘉禾饮，君以熟地，臣以人参，佐以粟米，使以甘蔗汁，缓令呷尽。一日而呕定，凡三月而康，
腹中生气跃动矣。是冬产一男。（汪广期）
胎动不安
妊娠胎动不安者，多由冲任血虚，受胎不实故也。然有饮酒、房室过度，损动不安者；有忤触伤仆，动而
不安者；有怒气伤肝，或郁结不舒，触动血脉不安者；有过服暖药，并犯禁之药，动而不安者。有因母病而胎
动者，但治母病，其胎自安；有因胎不坚固，动致母病者，但当安胎，其母自愈。（陈良甫）
妊娠胎气不安者，证本非一，治亦不同。盖胎气不安，必有所因∶或虚、或实、或寒、或热，皆能为病。
去其所病，便是安胎之法。故安胎之方，不可执，亦不可泥，但当随证随经，因其病而治之，乃为至善。若谓
白术、黄芩乃安胎之圣药，执而用之，鲜不误矣。（张景岳）
胎前大约以凉血顺气为主，而肝、脾、胃三经，尤为所重。因肝藏血，血以护胎，肝血失荣，胎无以荫矣；
肝主升，肝气横逆，胎亦上冲矣。胎气系于脾，如寄生之托于苞桑，女萝之施于松柏，脾虚胎无所附，滑堕难
免矣。胃为水谷之海，妊妇全赖水谷之精华以养胎，如兵家饷道，不容一刻缓也。其余有邪去邪，有火去火，
阴虚清滋，阳虚温补，随机应变，法尽善矣。（《临证指南》）
选案
闵介眉甥媳，素禀气虚多痰，怀妊三月，因腊月受寒，恶寒不食，呕逆清血，腹痛下坠，脉细如丝。与干
姜人参半夏丸，二服不应。更与附子理中汤，加苓、半、肉桂，调理而安。门人问曰∶尝闻桂、附、半夏，孕
妇禁服，而此并行无碍，何也？曰∶举世皆以黄芩、白术为安胎圣药，桂、附为陨胎峻剂，孰知反有
安胎妙用哉？盖子气之安危，系乎母气之偏胜。若母气多火，得芩、连则安，得桂、附则危；母气多痰，得苓、
半则安，得归、地则危；母气多寒，得桂、附则安，得芩、连则危。务在调其偏胜，适其寒温。世未有母气逆
而胎得安者，亦未有母气安而胎反堕者。所以《金匮》有怀妊六、七月，胎胀、腹痛、恶寒、少腹如扇，用附
子汤温其脏者。然认证不真，不得妄行是法。一有差误，祸不旋踵。（《张氏医通》）
胎漏
妇人宿有症病，经断未及三月，而得漏下不止，胎动在脐上者，为症痼害。妊娠六月动者，前三月经水利
时，胎也。下血者，后断三月 也。所以血不止者，其症不去故也，当下其症，桂枝茯苓丸主之。（《金匮》）
妊娠有漏胎、激经之分∶漏胎无时而下，激经有时而至。（萧慎斋）
胎动与胎漏皆下血。胎动则腹痛，胎漏无腹痛。胎动宜养血，胎漏宜清热。（《女科正宗》）
妊妇经血不固者，谓此胎漏。然胎漏之由，有因胎气者，有因病气者。而胎气之由，亦有二焉。余尝诊一
妇人，脉见滑数，别无他病，问其经事，则如常不断，但略少耳。余曰∶此必妊也。因胎小，血盛有余而然。
后三月外，经止，果产一男。妊妇多有此类。常见怀胎七、八个月而生子者，人但以血止为度，谓之不足月。
然其受胎于未止之前，至此而足，人所不知。（《景岳全书》）
妊娠体壮，脉息和平，饮食如故，他无所苦，而经时下者，乃血气充旺，养胎之余血也。然亦不可使之多，
宜和血凉血，佛手散加黄芩、白术。不已，加阿胶。若去血过多，八珍汤加胶、艾。如因怒伤肝而动血，佛手
散加山栀、白芍。（薛立斋）
胎漏有用糯米、苎根者，糯米谷味之阴，所以补地气之不足也。漏下黄赤为热，故用苎根以凉之。苎根补
阴，善能安胎，润
燥解热也。有用阿胶、艾叶者，阿胶益金固血，艾叶助阳上升，升则不堕，固则不流也。（《见闻录》）
伤风
妊娠伤风，宜用香苏饮加葱、豉，咳嗽多痰加桔梗，或紫苏饮加葱、豉。盖风药皆能伤胎，葱豉汤能安胎
气散邪气。（《张氏医通》）
伤寒
妊娠伤寒，专以清热安胎为主，或汗或下，各随表里所见脉证主治，勿犯胎气。（万密斋）
有胎而病外感，剂中必加四物。是治病保胎要法。（《临证指南》）
伤食
妊娠伤食，多由脾胃虚弱，不能运化所致。盖胎以脾胃为主，脾胃强则胎系如悬钟而不堕。若伤食不化，
则脾困而胎不能固矣。故凡消食导滞，先以补脾健胃为主，则饮食自化。一切峻厉克伐之药，未可浪投。（萧慎斋）
疟疾
妊娠疟疾，致病之原，虽因风寒暑热之感，亦因气血之虚。寒热鼓颔，战栗振摇，堕胎最易。古人用药，
先以安胎为急，但邪不去，则胎不安，故安胎莫先于去邪。然如常山、草果、槟、朴之属，未可浪投，惟发表
中兼补气，清热中兼养血为善。（萧慎斋）
痢疾
妊娠痢疾，有三禁、五审。一禁荡涤肠胃，二禁渗利膀胱，三禁兜涩气滞。盖荡涤则阳气下陷，胎气愈
堕；渗利则阴精脱亡，胎失荣养；兜涩则浊气壅滞，后重转加。故善治孕妇之痢者，宜以调气为先，如炉冶分
金，已败之血，则随之而下；未伤之血，则统之而安。所谓五审者∶一审饮食之进与不进。夫下痢乃肠胃受伤，
若痢虽甚，而饮食如常者易已，故痢以噤口为最重。在初胃气全盛之时，犹不足虑；但须理其滞气，则饮食自
进矣。或初时能食，旬候之外反不能食，脉息不振，此必荡涤太过，胃气受
伤所致。亦有过服苦寒破气之药，而致呃逆呕秽者，此为胃败危候。惟峻与温补，庶可挽回。二审溲之通与不
通。盖下痢清浊不分，痢频而小便通利者，胎必无虞。或胎压膀胱而小便不通者，名曰转胞。切忌利水，急与
升提，自效。三审腹之痛与不痛。盖痢证有寒、热、虚、实之分。痛有止歇，奔迫下坠，至圊不及者，火也；
痛自下而攻击于上者，火也；痛而胀满，不胜摩按，服热汤而愈痛者，火也；实也。痛无止歇，而无绞刺之状
者，寒也；痛自上而攻注于下者，寒也；痛而不满，时喜热手摩按者，寒也，虚也。大约初痢胀满为实热，久
痢痛为虚寒。即或初因火起切痛，久痢气伤，亦必变为虚寒也。急须温补，切勿利气。四审后之重与不重。
夫下痢后重，浊气壅滞故也。开通壅滞，必以调气为主，在妊娠尤为切要。调气则后重自除，而胎息自安矣。
初痢后重，治宜开其壅滞。久痢后重，又当升其阳气，阳气升则胃气运，胃气运则周身之气悉皆条达，而无壅
塞之患矣。五审身之热与不热。盖下痢为里气受病，若见身热，表里俱困，元神将何以恃而得振驱邪之力耶？
如人迎之脉浮数，可先用和营透表之药，分解其势，然后徐徐清理。若初痢不发热，至数日，半月后始发热，
脉来渐小，或虚大无力者，此真阴内亡，虚阳发越于外也。其在平人，可用辛温峻补；若在孕妇，桂、附又难
轻用，惟藉参、术、姜、萸、胶、艾之属。使非大补峻投，难望回天之 也。（《痢证汇参》）
妊娠饮食生冷，脾胃不能克化，致令心腹疼痛。伤血则赤，伤气则白，血气俱伤则赤白相杂，腹内重坠，
胎气不安，此由于脾胃气虚，不能升举而下陷也。治用补中益气汤，病退而胎自安。切勿浪投顺气行气，益增
坠下之患。盖胎系于肾，如钟系于梁，若柱不固，其梁必挠，而钟岂能独全乎？况似痢非痢者多，中气虚则不
能上升，脾气虚则不能渗湿，肾气虚则不能闭藏。慎勿以有形之假滞而伤无形之元气。元气一伤，变证百出，
胎能保乎！
（《冯氏锦囊》）
胎前痢疾，亦有暑邪、湿热外感致病，不可专主饮食生冷为患。但妊娠痢疾，本于脾胃不和，因而气血
受病。若守河间之法，降气后重自除，行血便脓自止，不知胎前之气果可降乎？气降则胎下坠。胎前之血果可
行乎？血行则胎必堕。莫若用木香以调气，当归以养血，此二药乃胎前痢疾妙品。再以四物汤加白术、黄芩为
治。丹溪所谓先托住正气以固其胎，而后调气和血。此治妊痢之要法也。（萧慎斋）
泄泻
妊娠泄泻，必原其由，大抵不外脾肾，二脏虚者居多。夫血统于脾，血护胎元则脾阴虚，食不运化而
作泻。胎系于肾，气弱则命门火衰，胎窃其气以拥护，肾阳不能上蒸脾土而为泻。虽其间未尝无风、寒、暑、
湿之外感，饮食生冷之内伤，而脾肾有亏者，其本也。（萧慎斋）
霍乱
霍乱者，阳明胃经病也。良由妊娠平日五味肥甘，腐积成痰，七情郁结，气盛为火，停胃中。乍因寒
热之感，阴阳相混，故令心腹绞痛，吐利并作，挥霍变乱。吐多伤气，利多伤血，气血受伤，不能养胎。邪气
鼓击，而母未有不殒者，不可不亟治也。香苏散加藿香主之。（万密斋）
妊娠霍乱，吐利绞痛，最易伤胎。宜辨其饮食生冷，暑、湿、风、寒四气之感，随其邪之所因而治之，
尤以保胎为主。（萧慎斋）
喘
妊娠气喘，有因乍感风寒，喘急而不得卧者，此客邪胜也。治宜疏散，参苏饮主之。若脾虚四肢无力，
[Scriptural Principles]
When a woman is pregnant and medicinal treatment involving toxic or harsh substances is necessary, what is the situation? (If) there is an existing pathogen, neither the mother nor the fetus will be harmed. (From *Suwen*)
[General Discussion]
Whenever treating a female patient, one must first inquire about pregnancy; do not act hastily. ○ When treating diseases in pregnant women, one should not lightly use herbs that break qi and move blood, for fear that the patient might be in the early stages of pregnancy. (Zhang Zihe)
The first month of pregnancy is called "Tai Pei" (Fetal Embryo), nourished by the Foot Jueyin Liver Meridian; the second month is called "Shi Gao" (Beginning of Fat/Grease), nourished by the Foot Shaoyang Gallbladder Meridian; the third month is called "Shi Tai" (Beginning of Fetus), nourished by the Hand Jueyin Pericardium Meridian; the fourth month begins to form blood vessels, nourished by the Hand Shaoyang Sanjiao Meridian; the fifth month begins to form its qi, nourished by the Foot Taiyin Spleen Meridian; the sixth month begins to form its tendons, nourished by the Foot Yangming Stomach Meridian; the seventh month begins to form its bones, nourished by the Hand Taiyin Lung Meridian; the eighth month begins to form skin and integument, nourished by the Hand Yangming Large Intestine Meridian; the ninth month begins to form hair, nourished by the Foot Shaoyin Kidney Meridian; the tenth month, the five zang organs, six fu organs, joints, and human form are all complete. This is the general outline. (*Chaoshi Bingyuan*)
Fetuses can be male or female, so their formation speed differs. Constitutions have yin and yang distinctions, so the direction of conception varies. Therefore, male fetuses move at three months because yang qi moves early; female fetuses move at five months because yin qi moves late. Female fetuses face away from the mother, so the mother's abdomen feels soft; male fetuses face the mother, so the mother's abdomen feels hard. (*Jingyue Quanshu*)
*Juyao* states: The abdomen carrying a male resembles a winnowing basket (narrow top, wide bottom); the abdomen carrying a female resembles a cauldron (perfectly round). Generally, when conceived in the uterus, if the male fetus faces the mother's abdomen, its feet and knees press against the abdominal wall, making it wider at the bottom and narrower at the top, thus resembling a basket; if the female fetus faces away from the mother, its spine presses against the abdominal wall, making the shape perfectly round, thus resembling a cauldron. (*Fengshi Jinnang*)
Pre-partum conditions resemble excess patterns, symbolizing the Kan trigram; post-partum conditions resemble deficiency patterns, symbolizing the Li trigram. Pre-partum conditions often involve heat, corresponding to the yang line in Kan; post-partum conditions often involve cold, corresponding to the yin line in Li. (Fang Xingyan)
[Nausea and Vomiting of Pregnancy]
A woman presents with a calm pulse, but the yin pulse (radial/ulnar aspect related to kidney/yin) is small and weak. She experiences thirst, inability to eat, and no aversion to cold or fever. This is named pregnancy, treated with Guizhi Tang (Cinnamon Twig Decoction). ○ According to standard practice, around sixty days into pregnancy, these symptoms should appear. If medical intervention causes adverse reactions, and after another month vomiting or diarrhea worsens, one should cease medication and wait for spontaneous recovery. ○ For persistent vomiting during pregnancy, Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill) is indicated. (*Jingui Yaolue*)
"Nausea and Vomiting of Pregnancy" (Ezu) refers to vomiting, nausea, dizziness, food aversion, and selective eating. "Ceasing treatment" (Juezhi) means stopping incorrect therapies and waiting for the body to stabilize on its own. I once treated one or two pregnant women with Ezu presenting as vomiting; the more they were treated, the worse they became. Reflecting on Zhongjing’s principle of "ceasing treatment," I used fried glutinous rice soup as tea, stopped other medications for over a month, and she gradually recovered. ○ *Daquan* states that Banxia (Pinellia Rhizome) disturbs the fetus. Observing Zhongjing’s use of Ganjiang Renshen Banxia Wan, Luo Qianfu’s use of Banxia Fuling Tang (Pinellia and Poria Decoction), and Danxi’s use of Erchen Tang (Two-Aged Decoction) modified for pre-partum Ezu, phlegm-reversal, and vomiting, all were effective. My use of these for Ezu never disturbed the fetus, confirming the scripture’s statement: "Where there is a cause/pathogen, there is no harm." (Lou Quanshan)
In early pregnancy, meridians close internally to nurture the fetus. The intestines and stomach are obstructed, and nutrients scatter to the chest and diaphragm. If phlegm-fluid retention exists historically, fluid binds with blood, causing immediate vomiting upon eating, dizziness, aversion to food odors, craving for sour/salty flavors, limb fatigue, preference for lying down, and infrequent rising. This is named Ezu. After delivery, residual blood outside the uterus flows out as敗瘀 (stasis), named Elu (Lochia). "E" (Evil/Bad) implies impurity; "Zu" (Obstruction) implies blockage. Blood binding with phlegm-fluid should be gradually resolved. "Lu" (Dew) implies moisture/drainage, which should be urgently purged. Thus, pre-partum obstruction is called Ezu, and post-partum discharge is called Elu. The ancients’ naming logic is sound. (*Ji Yi Fang*)
In the second or third month of pregnancy, vomiting and loss of appetite, or mental restlessness, occur due to qi and blood accumulating to nourish the fetal origin. Essence and blood stagnate internally, generating foul turbid qi that attacks the stomach, causing vomiting and anorexia; since blood nourishes the fetus, the Heart loses nourishment, causing mental restlessness. The method is to harmonize blood and dissipate stagnation: use Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), and Gancao (Licorice Root) to tonify middle qi; Juhong (Tangerine Peel), Zisu (Perilla Leaf), Muxiang (Aucklandia Root), and Shengjiang (Fresh Ginger) to disperse stagnant qi; Fuling (Poria), Maidong (Ophiopogon Tuber), Huangqin (Scutellaria Root), and Zhuru (Bamboo Shavings) to clear heat and relieve vexation. This is named Shenju Yin (Ginseng and Tangerine Drink). (Zhu Danxi)
Ezu often occurs at three months, during the phase where Ministerial Fire transforms the fetus. Vigorous fire consumes qi and rushes upward to the stomach, causing immediate vomiting after eating. Shaoyin Kidney Water nourishes the fetus, while Shaoyang Ministerial Fire becomes more intense. Qinggan Zishen Tang (Liver-Clearing and Kidney-Nourishing Decoction), i.e., Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Chaihu (Bupleurum Root) and Baishao (White Peony Root), is required. Use Xiaoyao San (Free and Easy Wanderer Powder) first to stop vomiting; if severe, add Wuzhuyu (Evodia Fruit) and Lianzi (Lotus Plumule). (Zhao Yangkui)
Regarding Ezu, ancients distinguished it by symptoms present while the pulse remained normal. I argue that Ezu patients invariably crave sour foods; distinguishing it by this craving is clearer. Some pregnant women have harmonious qi and blood and do not suffer from Ezu; some have mild, transient cases. This must be known. (Shen Jin'ao)
For pregnant women, initial symptoms show Ezu. Since *Jingui* introduced the "cease treatment" method, later authors like Chao Yuanfang attributed it to qi stagnation and blood accumulation, Chen Liangfu to retained fluids and accumulated phlegm, Zhongjing to cold patterns, and Taiwu/Yangkui to fire patterns. Pathogenesis descriptions are detailed. However, pre-partum generally lacks cold, and post-partum generally lacks heat. Thus, Ezu vomiting is mostly heat rather than cold, belonging to blood congestion around the fetus, failing to circulate organ qi, leading to retained phlegm/fluids, stagnant heat, and transformation into fire. Therefore, Danxi and Lizhai used Zhike (Bitter Orange), Zisu, Xiangfu (Cyperus Rhizome), and Sharen (Amomum Seed) to descend and smooth qi. This is why "pre-partum requires smoothing qi." (Xiao Shenzhai)
[Selected Case]
A surnamed Wang woman suffered from Ezu for months, with fever, vomiting, inability to retain fluids, bedridden status, and severe muscle wasting. Ancient formulas for Ezu were tried extensively without effect, leading to suspicion of non-pregnancy. I planned to use Zhenwu Tang (True Warrior Decoction) for heavy sedation, but the medicine pot broke before administration. Her qi was disconnected, hands and feet cold, spirit exhausted, sweating cold sweat—she appeared moribund. Palpating the Chi (cun) pulse, a slippery quality remained. I said: If true Yang collapse and Stomach qi extinction occurred, how could the Chi pulse be slippery? The Scripture says: "Inability to eat indicates Fire." Severe vomiting damages Stomach qi; limbs belong to the Spleen, hence the cold extremities. Regarding vomiting, people blame only the Stomach, ignoring the Kidney. Ezu often involves Chong Mai (Penetrating Vessel) Yang rising, disturbing the Stomach; thus, seek the root in the Kidney. I prepared Jiahe Yin (Harmonizing Grain Drink): Shudi (Rehmannia Root) as Sovereign, Renshen as Minister, Sumi (Millet) as Assistant, Sugarcane Juice as Envoy. Sip slowly. Vomiting stopped in one day; she recovered in three months, feeling fetal movement. That winter, she delivered a boy. (Wang Guangqi)
[Fetal Restlessness]
Fetal restlessness during pregnancy is mostly due to deficiency of blood in the Chong and Ren vessels, resulting in unstable conception. However, it can be caused by excessive alcohol consumption or sexual activity damaging the fetus; by physical trauma or falls disturbing the fetus; by anger injuring the Liver or emotional depression disturbing blood vessels; by overusing warming herbs or violating contraindicated drugs. If the mother’s illness causes fetal movement, treat the mother’s illness, and the fetus will settle. If the fetus’s instability causes maternal illness, secure the fetus, and the mother will heal. (Chen Liangfu)
Fetal restlessness has various presentations and treatments. It always has a cause: deficiency, excess, cold, or heat. Removing the pathology is the method of securing the fetus. Therefore, formulas for securing the fetus should not be rigid or dogmatic; one must follow the syndrome and meridian, treating according to the disease. Claiming Baizhu (Atractylodes Rhizome) and Huangqin (Scutellaria Root) are the "sacred medicines" for securing the fetus is rarely successful if applied blindly. (Zhang Jingyue)
Pre-partum treatment mainly focuses on cooling blood and smoothing qi, emphasizing the Liver, Spleen, and Stomach meridians. The Liver stores blood, which protects the fetus; if Liver blood fails to nourish, the fetus loses support. The Liver governs ascending; if Liver qi rebels upward, the fetus rises. The fetus relies on the Spleen like parasites on trees; if Spleen qi is deficient, the fetus has no attachment, risking miscarriage. The Stomach is the sea of water and grain; the pregnant woman relies entirely on its essence to nourish the fetus, like a military supply line that cannot be interrupted. Other pathogens should be removed, fire cleared, yin nourished, or yang warmed as needed. Methods are perfect when flexible. (*Linzheng Zhinan*)
[Selected Case]
The niece-in-law of Min Jiemei had constitutionally deficient qi and much phlegm. At three months pregnant, she caught cold in December, experiencing chills, anorexia, vomiting clear blood, abdominal pain with bearing-down sensation, and a thread-like pulse. Given Ganjiang Renshen Banxia Wan, two doses failed. Switched to Fuzi Lizhong Tang (Aconite and Licorice Middle-Warming Decoction) plus Fuling, Banxia, and Rougui (Cinnamon Bark), she stabilized. A student asked: I heard Guizhi, Fuzi, and Banxia are contraindicated in pregnancy, yet here they work well together. Why? I replied: The world regards Huangqin and Baizhu as sacred for securing the fetus, and Guizhi/Fuzi as harsh abortifacients. Who knows they can also secure the fetus? The fetus’s safety depends on the mother’s constitutional bias. If the mother has excess fire, Huangqin/Lianzi secure her, but Guizhi/Fuzi endanger her; if she has excess phlegm, Fuling/Banxia secure her, but Danggui/Dihuang endanger her; if she has excess cold, Guizhi/Fuzi secure her, but Huangqin/Lianzi endanger her. One must adjust the bias and balance cold/warmth. No mother with rebellious qi has a safe fetus, nor does a stable mother lose her fetus. Thus, *Jingui* mentions using Fuzi Tang to warm the viscera for fetal distension/pain/cold at 6-7 months. However, accurate diagnosis is crucial; errors bring immediate disaster. (*Zhangshi Yitong*)
[Fetal Bleeding]
If a woman has a historical mass (Zheng), stops menstruating for less than three months, yet suffers continuous bleeding, and feels fetal movement above the umbilicus, this is a Zheng lesion harming the pregnancy. If fetal movement occurs at six months, and menstruation was regular before stopping for three months, it is a normal pregnancy. If bleeding occurs after stopping for three months, it is pathological. The reason bleeding continues is that the Zheng remains; it must be expelled. Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) is indicated. (*Jingui Yaolue*)
Pregnancy bleeding distinguishes between Lou Tai (Leaking Fetus) and Ji Jing (Stimulated Menstruation): Lou Tai bleeds continuously without pattern; Ji Jing bleeds periodically. (Xiao Shenzhai)
Both Fetal Restlessness and Fetal Bleeding involve blood loss. Restlessness includes abdominal pain; bleeding does not. Restlessness requires nourishing blood; bleeding requires clearing heat. (*Nuke Zhengzong*)
Irregular bleeding in pregnancy is called Fetal Bleeding. Causes include fetal qi factors or pathological qi factors. Fetal qi causes have two types. I once diagnosed a woman with a slippery-rapid pulse and no other illness. Her menstruation continued but was lighter. I predicted pregnancy due to abundant blood supporting a small fetus. After three months, menstruation stopped, and she delivered a boy. Many pregnant women experience this. Some deliver at 7-8 months; people consider this premature because bleeding stopped earlier. But conception happened before bleeding stopped, so it is full-term, though unknown to laypeople. (*Jingyue Quanshu*)
If a pregnant woman is robust, pulses are calm, diet is normal, and no other discomfort exists, yet menstrual blood flows, this is surplus blood from vigorous qi and blood nourishing the fetus. However, it should not be excessive. Harmonize and cool blood using Foshou San (Buddha’s Hand Powder) plus Huangqin and Baizhu. If ineffective, add Ejiao (Donkey-hide Gelatin). If blood loss is heavy, use Bazhen Tang (Eight-Treasure Decoction) plus Ejiao and Aiyè (Mugwort Leaf). If anger injures the Liver causing bleeding, use Foshou San plus Zhizi (Gardenia Fruit) and Baishao. (Xue Lizhai)
For Fetal Bleeding, glutinous rice and Zhugen (Chinese Hemp Root) are used. Glutinous rice represents yin of grains, supplementing Earth qi. Yellow/red discharge indicates heat, so Zhugen cools. Zhugen nourishes yin, calms the fetus, moistens dryness, and clears heat. Ejiao and Aiyè are also used: Ejiao benefits Metal and consolidates blood; Aiyè assists Yang to ascend. Ascending prevents falling; consolidating prevents leaking. (*Jianwen Lu*)
[Wind-Cold Invasion]
For wind-cold invasion during pregnancy, use Xiangsu Yin (Fragrant Perilla Drink) plus Congbai (Green Onion White) and Douchi (Fermented Soybean). For cough with much phlegm, add Jiegeng (Platycodon Root); or use Zisu Yin (Perilla Drink) plus Congbai and Douchi. Wind-dispersing herbs generally harm the fetus, but Congchi Tang (Green Onion and Fermented Bean Decoction) secures fetal qi and disperses pathogens. (*Zhangshi Yitong*)
[Cold Damage]
For cold damage during pregnancy, focus primarily on clearing heat and securing the fetus. Induce sweating or purge bowels according to exterior/interior pulse-syndromes, avoiding harm to the fetus. (Wan Mizhai)
When treating external contraction with pregnancy present, always add Siwu Tang (Four Substances Decoction). This is a key method for treating disease while protecting the fetus. (*Linzheng Zhinan*)
[Food Injury]
Food injury during pregnancy is mostly due to Spleen/Stomach weakness failing to transform and transport. The fetus relies on the Spleen/Stomach; strong digestion keeps the fetus suspended like a bell from a beam. If food stagnates, the Spleen becomes trapped, and the fetus becomes insecure. Therefore, resolving food stagnation must prioritize tonifying the Spleen and strengthening the Stomach so digestion occurs naturally. Harsh purgatives should not be used recklessly. (Xiao Shenzhai)
[Malaria]
Malaria during pregnancy originates from wind-cold-summerheat-dampness invasion and qi-blood deficiency. Chills and shaking easily cause miscarriage. Ancients prioritized securing the fetus first. However, if pathogens remain, the fetus cannot be secure; thus, eliminating pathogens precedes securing the fetus. However, herbs like Changshan (Dogwood Bark), Caoguo (Black Cardamom), Binglang (Areca Seed), and Houpo (Magnolia Bark) should not be used lightly. It is best to release the exterior while tonifying qi, and clear heat while nourishing blood. (Xiao Shenzhai)
[Dysentery]
Dysentery during pregnancy has three prohibitions and five examinations. Prohibitions: 1. Purging the intestines/stomach; 2. Promoting urination; 3. Astringing qi stagnation. Purging sinks Yang qi, worsening miscarriage risk; promoting urination depletes Yin essence, starving the fetus; astringing traps turbid qi, worsening tenesmus. Good treatment prioritizes regulating qi. Like refining gold in a furnace, damaged blood passes down; undamaged blood is preserved. Five Examinations: 1. Appetite: Dysentery injures intestines/stomach. If appetite remains normal despite severe dysentery, prognosis is good. "Closed mouth" dysentery (inability to eat) is most serious. Early stage with strong Stomach qi is manageable; regulate stagnation to restore appetite. If appetite returns then vanishes with weak pulse, it indicates over-purging damaged Stomach qi. Bitter-cold qi-breaking herbs may cause hiccups/vomiting, indicating critical Stomach failure requiring urgent warm-tonification. 2. Urination: Dysentery mixes clear/turbid. Frequent dysentery with free urination suggests fetal safety. If fetal pressure blocks bladder causing urinary retention (Zhuanbao), avoid diuretics; use lifting methods immediately. 3. Abdominal Pain: Dysentery has cold/heat/deficiency/excess types. Pain with intervals, urgency, and inability to reach toilet indicates Fire/Excess. Pain radiating upward indicates Fire. Pain with distension, intolerance to pressure, worsening with hot drinks indicates Fire/Excess. Continuous pain without cramping indicates Cold. Pain radiating downward indicates Cold. Pain without distension, relieved by warmth/massage indicates Cold/Deficiency. Early dysentery with distension is Excess-Heat; chronic dysentery with pain is Deficiency-Cold. Even if starting with Fire pain, chronic Qi damage leads to Deficiency-Cold requiring warm-tonification, avoiding qi-draining herbs. 4. Tenesmus: Caused by turbid qi stagnation. Regulating qi is essential in pregnancy. Regulating qi resolves tenesmus and calms fetal breath. Early tenesmus requires opening stagnation; chronic tenesmus requires raising Yang qi. Rising Yang moves Stomach qi, ensuring smooth flow throughout the body. 5. Fever: Dysentery affects interior qi. Fever indicates exterior-interior distress, weakening Yuan Shen’s ability to expel pathogens. If Renying pulse is floating-rapid, use harmonizing-nourishing and exterior-releasing herbs first to resolve tension, then clear carefully. If no fever initially but fever develops days/weeks later with shrinking or empty-large pulse, this is True Yin exhaustion with floating Empty Yang. Healthy adults may use pungent-warm tonic explosions; pregnant women should avoid Guizhi/Fuzi lightly. Use Renshen, Baizhu, Shengjiang, Shanzhuyu (Cornus Fruit), Ejiao, Aiyè instead. Without major tonic explosion, recovery is unlikely. (*Lizheng Huican*)
Consuming raw/cold foods during pregnancy damages Spleen/Stomach transformation, causing heart/abdominal pain. Injury to blood causes red stool; injury to qi causes white stool; combined injury causes mixed red/white stool, abdominal heaviness, and fetal insecurity. This stems from Spleen/Stomach Qi deficiency failing to raise and sinking downward. Treat with Buzhong Yiqi Tang (Middle-Boosting and Qi-Supplementing Decoction); as illness recedes, the fetus settles. Do not recklessly use qi-moving herbs, increasing sinking risk. The fetus ties to the Kidney like a bell to a beam; if the pillar is weak, the beam bends, and the bell cannot survive. Many cases mimic dysentery. Middle Qi deficiency fails to rise; Spleen Qi deficiency fails to separate clear/turbid; Kidney Qi deficiency fails to secure. Do not let有形 (form-based) false stagnation injure无形 (formless) Yuan Qi. Once Yuan Qi is injured, myriad complications arise, and the fetus cannot be saved!
(*Fengshi Jinnang*)
Pre-partum dysentery can also stem from Summerheat-Dampness external pathogens, not just raw/cold food. However, pregnancy dysentery roots in Spleen/Stomach disharmony affecting qi/blood. Following Hejian’s method of descending qi to resolve tenesmus and moving blood to stop pus ignores whether pre-partum qi can be descended (descending qi drops the fetus) or blood moved (moving blood causes miscarriage). Better to use Muxiang to regulate qi and Danggui (Angelica Sinensis) to nourish blood—these are excellent for pregnancy dysentery. Combine with Siwu Tang plus Baizhu and Huangqin. As Danxi said: First support righteous qi to secure the fetus, then regulate qi and harmonize blood. This is the key method for pregnancy dysentery. (Xiao Shenzhai)
[Diarrhea]
Pregnancy diarrhea must trace its origin, mostly involving Spleen/Kidney deficiency. Blood derives from the Spleen; if Spleen Yin is deficient, food fails to transform, causing diarrhea. The fetus ties to the Kidney; if Qi is weak, Mingmen Fire declines, and the fetus steals Qi for support. Kidney Yang fails to steam Spleen Earth, causing diarrhea. Although external wind-cold-summerheat-dampness or internal raw/cold food injuries exist, Spleen/Kidney deficiency is the root. (Xiao Shenzhai)
[Colic and Vomiting]
Colic and vomiting (Huoluan) is a disease of the Yangming Stomach Meridian. Often caused by rich/fatty foods creating phlegm, emotional stagnation transforming qi into fire, stagnating in the Stomach. Sudden cold/heat mixing yin/yang causes heart/abdominal colic, simultaneous vomiting and diarrhea, chaotic disruption. Vomiting damages Qi; diarrhea damages Blood. Damaged qi/blood cannot nourish the fetus. Pathogenic agitation endangers the mother; urgent treatment is required. Xiangsu San (Fragrant Perilla Powder) plus Huoxiang (Patchouli Herb) is indicated. (Wan Mizhai)
Pregnancy Huoluan with vomiting/diarrhea/colic easily harms the fetus. Differentiate causes: raw/cold food, summerheat, dampness, wind, or cold. Treat according to the pathogen, prioritizing fetal protection. (Xiao Shenzhai)
[Asthma]
Pregnancy asthma caused by sudden wind-cold invasion, with急促 (rapid) breathing and inability to lie flat, indicates external pathogen excess. Treatment should disperse externally; Shen Su Yin (Ginseng and Perilla Drink) is indicated. If Spleen deficiency causes limb weakness,