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**Lung Deficiency and Kidney Deficiency with Asthma**
When Lung Qi is deficient and unable to withstand wind-cold, and Kidney deficiency causes soreness of the lower back and weakness of the legs, sudden asthma with insufficient breath occurs. This is due to a prior deficiency of Spleen and Lung; when the "mother" organ (Kidney) is deficient, the "child" organ (Lung) is also deficient. The Kidney Qi fails to return to its root and instead ascends to attack the Lung.
Treatment should employ Shengmai San (Generate Pulse Powder) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), and adding Chenxiang (Aquilariae Lignum Resinatum) and Buguzhi (Psoraleae Fructus) as the main formula. (Xiao Shenzhai)

**Pregnancy-related Asthma due to Fire**
For pregnant women whose fetus is disturbed by Fire, causing rebellious Qi and asthma, use Huangqin (Scutellariae Radix) and Xiangfu (Cyperi Rhizoma) ground into powder, taken with water. (Zhu Danxi)

**Hematemesis (Vomiting Blood)**
Generally, hematemesis is caused either by internal injury from the Seven Emotions or external contraction of the Six Excesses. However, hematemesis during pregnancy is primarily governed by Heat-Fire. This is because Qi and Blood are utilized to nourish the Fetal Origin; if pathogenic factors intervene, Qi rebels and Fire attacks upward. Fire can be excess or deficiency. For Excess Fire, clear Heat and nourish Blood; for Deficiency Fire, nourish Yin and augment Water. (Xiao Shenzhai)

**Zisu (Fetal Cough / Pregnancy Cough)**
Cough occurring during pregnancy is called Zisu.
- If caused by Wind-Evil attacking the Lung: use Jinfeicao San (Boilweed Powder).
- If caused by Fire-Evil overcoming Metal (Lung): use Renshen Pingfei San (Ginseng Lung-Pacifying Powder).
- If caused by Cold-Evil attacking the Lung: use Renshen Baidu San (Ginseng Detoxification Powder).
- If due to Spleen and Lung Qi Deficiency: use Liujunzi Tang (Six Gentlemen Decoction) plus Jiegeng (Platycodonis Radix).
- If due to Blood Deficiency: use Siwu Tang (Four Substances Decoction) plus Jiegeng.
- If due to Kidney Fire flaming upward: use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Wuweizi (Schisandrae Fructus).
- If due to Spleen and Lung Qi Deficiency compounded by Wind-Cold: use Buzhong Yiqi Tang plus Jiegeng.
The Lung belongs to Xin Metal, born from Ji Earth (Spleen). Chronic cough often results from Spleen deficiency failing to generate Lung Metal, leading to insecure interstices and susceptibility to external pathogens; or from Lung deficiency failing to generate Kidney Water, causing Yin Fire to flare up. Treatment should strengthen Earth and Metal, generate Kidney Water, with stabilizing the fetus as the priority. (Xue Lizhai)

**Zixian (Eclampsia / Pregnancy Convulsions)**
After conception, the blood of the Chong and Ren meridians nourishes the fetus, leading to Liver Blood deficiency. Wood and Fire move internally, causing instability and generating Wind symptoms. Signs include eyes rolling back, jaw locking, opisthotonos (arching of the back), salivation, coma, and intermittent发作, resembling internal injury epilepsy. Quack doctors attribute this to external Wind, which is absurd. If Wind entered the skin and hair, there would be aversion to cold and fever. Why are there no exterior signs, but rather repeated Jueyin and Shaoyin symptoms? Moreover, why is the woman healthy before pregnancy but ill after? Examining the condition reveals it is essentially Liver and Kidney Yin Deficiency. Yin deficiency leads to Blood dryness; Blood dryness causes tendons to lose nourishment, resulting in stiffness and arching, mimicking Wind but not being Wind. Even if considered Wind, it is internal Wind, not external. Because the fetus consumes Yin Blood, Deficiency Fire flares up, burning empty meridians. Essence fails to nourish the Spirit, and softness fails to nourish the tendons, leading to convulsions and madness, with the Soul and Spirit losing their residence.
Treatment differs based on Yin or Yang deficiency: nourish Yin if Yin is deficient, nourish Yang if Yang is deficient. Thus, Yin fluids become sufficient, True Qi returns, Wood and Fire are contained, and false Wind settles, ensuring safety for both mother and child. Ancient formulas like Lingyangjiao San (Antelope Horn Decoction) use Antelope Horn to enter the Liver and relax tendons, Zaoren (Ziziphi Spinosomi Semen) and Danggui (Angelicae Sinensis Radix) to tonify Liver and benefit Blood, matching the syndrome. Fangfeng (Saposhnikoviae Radix) and Duhuo (Angelicae Pubescentis Radix) deplete True Yuan, and Yiren (Coicis Semen) promotes urination and may abort; thus, they are inappropriate and should not be used lightly. (Huixin Lu)

**Ziman (Hydrops of Pregnancy / Polyhydramnios)**
Pregnancy with fluid retention, heavy body, difficult urination, chills, and dizziness upon rising is treated with Kuizi Fuling San (Abelmoschus Seed and Poria Powder). (Jinkui Yaolue)
Edema of the head, face, and whole body with scanty urine is Water-Qi disease, called Zizhong (Fetal Swelling). Edema from knees to feet with clear, long urine is Dampness disease, called Ziqi (Fetal Qi). Whole-body edema with abdominal distension and asthma at six or seven months is called Zidai (Fetal Belt). Edema only in both feet with thick skin is Dampness, called Zhoujiao (Wrinkled Feet). Edema with thin skin is Water, called Cuijiao (Brittle Feet). Generally, Water diseases cause asthma (associated with Lung), while Qi diseases cause distension (associated with Spleen). Since the patient has pre-existing Water-Qi and Dampness, pregnancy triggers swelling. Before fetal formation, water immersion damages the fetus; after formation, it can be treated. Symptoms appearing after five or six months often result in smooth delivery. (Yizong Jinjian)

**Pregnancy Edema Treatments**
- Chest fullness, abdominal distension, urinary retention, and whole-body edema: Qianjin Liyu Tang (Thousand Gold Carp Decoction).
- Spleen-Stomach weakness: supplement with Sijunzi Tang (Four Gentlemen Decoction).
- Puffy face/eyes and limb edema resembling water: Quansheng Baizhu San (Complete Life Atractylodes Macrocephala Powder).
- Spleen deficiency with Damp-Heat causing lower body edema: Buzhong Yiqi Tang plus Fuling (Poria).
- Irregular diet causing vomiting and diarrhea: Liujunzi Tang (Six Gentlemen Decoction).
- Leg/foot edema, asthma, restlessness, or oozing between fingers: Tianxianteng San (Akebia Vine Powder). (Xue Lizhai)

**Etiology of Ziman**
Ziman involves Water-Blood conflict, retained Water-Dampness, obstructed menses, or confusion of Clear/Turbid substances, all caused by Spleen deficiency failing to control Water. Xue Lizhai’s method focuses on strengthening Spleen, leaching Dampness, regulating Qi, and calming the fetus. The claim in Jiyin Gangmu that "only draining Qi and promoting urination cures it" is erroneous. (Xiao Shenzhai)

**Zixuan (Fetal Distension / Rising Fetal Qi)**
Ben Shi Fang states: Zisu Yin (Perilla Decoction) treats Zixuan. Zixuan refers to Turbid Qi pushing the fetus upward. Fetal Heat and rebellious Qi cause chest/diaphragm fullness. Perilla Leaf, Tangerine Peel, Melon Rind, and Chuanxiong are needed to circulate Qi; Danggui and Baishao are needed to nourish Blood. Once Qi and Blood flow freely, the body becomes deficient, so Renshen (Ginseng) and Gancao (Licorice) are added to tonify. (He Song'an)

Zixuan is fetal Qi pressing on the heart and chest. Qi and Blood stagnation around the fetus generates Heat. Liangfu emphasized Fetal Heat and Rebellious Qi; Song'an emphasized Turbid Qi lifting the fetus. Both views on Heat-Fire are appropriate. Some attribute it to Cold from frozen drinks or Mingmen Fire decline, but one must judge by constitution and pulse. Robust constitution with surging-rapid pulse indicates Heat-Fire; weak Spleen-Stomach with slow-thin pulse indicates Deficiency-Cold. (Xiao Shenzhai)

**Ziyin (Pregnancy Aphonia)**
Huangdi asked: Why does a woman lose her voice in the ninth month of pregnancy? Qibo answered: The collaterals of the uterus are blocked. Huangdi asked: Why? Qibo answered: The uterine collaterals connect to the Kidney. the Shaoyin Meridian passes through the Kidney and ties to the root of the tongue, hence the inability to speak. Huangdi asked: How to treat? Qibo answered: No treatment is needed; speech will return in the tenth month. (Suwen)

Note: "Aphonia" means having words but no sound. "Cannot speak" does not mean total silence. Sound comes from the throat and originates at the tongue root. Due to fetal enlargement, the ascending pathway of the Kidney meridian is blocked. The Kidney meridian enters the Lung, follows the throat, and ties to the tongue root. The throat is the domain of the Lung, which governs sound. Thus, the woman whispers, but others cannot hear. If Kidney collaterals were truly severed, the disease would be incurable, and postpartum recovery would be impossible. Therefore, "severed" (Jue) in "Uterine collaterals are severed" should be interpreted as "blocked." (Zhang Huang)

While the Classic provides no treatment for pregnancy aphonia, later physicians hesitated to prescribe formulas. Zhang Zihe treated it by descending Heart Fire; Yuan Tai treated it by tonifying Heart and Kidney, because the uterine collaterals belong to the Hand and Foot Shaoyin meridians. Postpartum aphonia is due to stagnant blood entering the Heart; stroke-induced aphonia is due to phlegm-damp blocking collaterals. Pregnancy aphonia must also have a specific cause; symptoms should be analyzed carefully to supplement the incomplete theories of Zhang and Ma. (Xiao Shenzhai)

**Zifen (Pregnancy Irritability)**
"Irritability" refers to mental restlessness and anxiety. After conception, Blood-Heat disturbs the Heart, causing depression and agitation. It is called Zifen because it occurs during pregnancy, not because the fetus is irritable. Ancients said: In the fourth month, Shaoyin Jun-Hour nourishes essence; in the sixth month, Shaoyang Xiang-Hour nourishes Qi, hence irritability. While irritability is often Fire-related, since the fetus receives Jun-Xiang Fire for nourishment, why would it make the mother irritable? If it were maternal deficiency causing irritability, it would occur every month, not just the fourth and sixth. This theory seems flawed. (Li Taisu)

There are four types of pregnancy irritability: Empty Irritability, Heart Irritability, Chest Irritability, and Zifen, all related to Heat.
- Empty Irritability: Organ deficiency allows Heat to invade the Heart.
- Chest Irritability: Phlegm-fluid accumulation causing vomiting of frothy sputum.
- Zifen: Blood stasis and fluid retention, Cold-Heat conflict, disturbing the fetus. (Qi Zhongfu)

Fire entering the Lung causes irritability; entering the Kidney causes restlessness. The fetus is tied to the Kidney. Kidney Water nourishes the fetus, leaving insufficient Water to control Kidney Fire. Fire scorches the Lung, causing irritability and restlessness. This indicates deficiency of Metal and Water. Treatment should nourish the source of transformation, clearing Metal and strengthening Water. (Xiao Shenzhai)

**Ziming (Fetal Crying / Fetal Movements)**
If a nodule forms on the umbilical cord inside the pregnant woman's abdomen and the fetus holds it in its mouth, climbing high or raising arms may dislodge it, causing noise. Having the pregnant woman bend over as if picking something up allows the nodule to re-enter the fetus's mouth, stopping the sound. For fetal crying in the abdomen, drinking rhizome earth mixed with Coptis juice stops it. (Chanbao Baiwen)

Abdominal bell-like ringing is similar to fetal crying, so treatments are the same. Xue Lizhai noted: Coptis is cold, and Musk opens orifices; use them with discretion. (Xiao Shenzhai)

**Abdominal Pain**
In the sixth or seventh month of pregnancy, if the pulse is wiry, there is fever, increased fetal distension, abdominal pain, aversion to cold, and a sensation of cold wind in the lower abdomen. This is because the Zi Zang (Uterus) is open. Treat with Fuzi Tang (Aconite Decoction) to warm the uterus.
- Abdominal pain during pregnancy due to Bao Zu (Obstruction of the Womb): Jiao'ai Tang (Donkey-Hide Gelatin Decoction).
- Abdominal pain during pregnancy: Danggui Shaoyao San (Angelica and Peony Powder). (Jinkui Yaolue)

Pre-natal abdominal pain can be Excess (Wind-Cold, Phlegm-Fluid, Seven Emotions) or Deficiency (Qi Stagnation, Qi Deficiency, Blood Deficiency).
- Spleen-Stomach Qi Deficiency: Tonify Qi and regulate Qi.
- Yin Deficiency and Blood Deficiency: Nourish Blood and warm the channels. Apply according to clinical examination. (Xiao Shenzhai)

**Lower Back Pain**
Pregnancy lower back pain is critical. The fetus is tied to the waist; soreness and urgency indicate the tie is loosening, signaling imminent labor. Alternatively, it may be due to labor injury damaging meridians, Cold invading causing pain radiating to the back, sprain/Qi stagnation, Kidney Essence deficiency, Liver Fire from anger, Liver-Spleen Qi stagnation, Bladder Wind invasion, or Blood Heat/Stasis. Regardless of cause, persistent pain disturbs the fetus. Treatment generally focuses on securing the fetus. (Shen Jin'ao)

**Hypochondriac Pain**
Pregnancy hypochondriac pain has three causes: weeping, internal injury, and anger. Do not use Blood-moving or Qi-breaking herbs. Use fresh human urine, or Zisu Yin (Perilla Decoction) without Renshen, adding Danggui and Baishao, for stability. (Jianwen Lu)

**Hematuria**
Blood from Taileu (Fetal Leakage) exits the vagina; blood from Hematuria exits the urethra. Pregnancy hematuria is mostly due to Uterine Heat. Treat with Siwu Tang plus Fahui (Burnt Hair), Shanzhi (Gardeniae Fructus), and Ejiao (Donkey-Hide Gelatin). (Li)

Hematuria is easily confused with Taileu. Li's differentiation clarifies this: Taileu is frequent and continuous; Hematuria results from Heart Fire transferring to the Small Intestine, seeping into the Bladder, and exiting only during urination. (Xiao Shenzhai)

**Zhuanbao (Malposition of the Urinary Bladder / Urinary Retention)**
A woman suffers from normal diet, heat, inability to lie flat, and orthopnea. Why? The Master says: This is Zhuanbao, inability to urinate. The bladder ligament is twisted. Promoting urination cures it; use Shenqi Wan (Kidney Qi Pill). (Jinkui Yaolue)

The term "Bao" (Womb/Bladder) has two pronunciations. In Suwen and Lingshu, "Bao" (pronounced 'bao') refers to the Uterus. In Lingshu, "Bao" (pronounced 'pao') refers to the Urinary Bladder. Later authors confused these, sometimes treating the Uterus and Bladder as separate entities, or conversely, merging them. The Bladder IS the Pao. There is nothing else inside the Bladder. Those who merge them fail to realize that in Zhuanbao, the fetus presses down on the Bladder, blocking urine. The Uterus is above, the Bladder below; they are distinct locations. (Fengshi Jinnang)

Pregnancy Zhuanbao, inability to urinate, is due to Middle Qi deficiency failing to lift the fetus. The fetus presses on the bladder, twisting the ligament. Use Buzhong Yiqi Tang to lift. (Zhao Shi Yi Guan)

Zhuanbao is common in women with weak constitutions, excessive worry, irritability, or rich diets. Ancient slippery/purgative formulas rarely work. The fetus presses the bladder to one side, twisting the ligament and blocking water passages. If the fetus is lifted to the center, the ligament untwists, and urination resumes. Treatment: Canzhu Yin, followed by induced vomiting to raise Qi. Repeat until urination flows. (Danxi Xinfa)

Pre-natal Zhuanbao is mostly due to Qi and Blood deficiency. Low Blood fails to nourish the fetus; weak Qi fails to lift it. The fetus descends and presses the Bladder, twisting it and blocking urine. Besides Danxi's causes (worry, irritability, rich diet), treatment focuses on tonifying Qi and Blood. However, consider: Spleen-Lung Qi deficiency failing to transport to the Bladder; Heat-Stagnation blocking Bladder fluids; or Lung Dryness/Heat from Fire scorching Metal. Diagnose carefully. (Xiao Shenzhai)

**Zilin (Pregnancy Dysuria)**
Zilin resembles Zhuanbao. Frequent, painful, drop-by-drop urination is Zilin; frequent, scanty, painless urination is Zhuanbao. (Zhengzhi Yaojue)

Zilin has two categories: Mother's own illness or Fetal issue affecting the mother.
Mother's illness: Internal Heat from spicy food, or Dryness from sweating/diarrhea.
Fetal issue: Fetal Heat obstruction, or Fetal shape compression.
Treat Heat by clearing, Dryness by moistening, Obstruction by unblocking, Compression by moving. (Wan Mizhai)

Scanty,涩 (astringent/scanty) urination is due to Qi/Blood gathering to nourish the fetus, leaving the Bladder with stagnant Heat. Use Blood-nourishing herbs, Maidong (Ophiopogonis Radix) to nourish Water source, and Huashi (Talcum) to clear stagnation. Formula: Anrong San. If early pregnancy, reduce Huashi, add Shihu (Dendrobii Caulis) and Shanzhi. To clear Bladder Heat, soothe Jueyin Qi, as the urethra belongs to Jueyin. (Chen Liangfu)

Scanty, dripping urination: Anrong San.
Liver Channel Deficiency Heat: Jiawei Xiaoyao San.
Dry herbs causing frequency/obstruction: Shengdi, Fuling, Zhimu, Huangbai, Chuanxiong, Danggui, Gancao.
Frequency with yellow/red urine: Siwu Tang plus Zhimu, Huangbai.
Lung Qi Deficiency with short urine: Buzhong Yiqi Tang plus Maidong, Wuweizi.
Heat binding the Bladder: Wulin San.
Spleen-Lung Dry-Heat: Huangqin Qingfei Yin.
Bladder Yin Deficiency (Yang has no source): Zishen Wan.
Bladder Yang Deficiency (Yin has no transformation): Shenqi Wan. (Xue Lizhai)

**Tai Bu Chang Yang (Failure of Fetal Growth)**
Qi nourishes the twelve meridians cyclically. The fetus resides in the womb. If it withers, it is due to maternal weak constitution, imbalance of Yin/Yang/Qi/Blood, and lack of nourishment. Tonify maternal Qi and Blood to nourish the fetus.
Poor prenatal care, Spleen-Stomach dysfunction, poor appetite, failure to circulate Ying/Wei, transform essences, and nourish Chong/Ren leads to weak fetus. As Chaoyuanfang said: Treating the mother's illness calms the fetus. Harmonize Spleen-Stomach, promote digestion, generate Qi/Blood, and the fetus will grow. (Shengji Zonglu)

Fetal origin depends on Qi and Blood. Failure to grow is due to insufficiency.
- Post-conception bleeding: Blood fails to return to the fetus.
- Middle-aged women with declining Qi/Blood: Source dries up.
- Women with Spleen-Stomach issues: Granary is thin, source is depleted, Chong/Ren exhausted.
- Women prone to anger: Liver Qi rebels, Blood is unregulated, fetus loses nourishment.
- Cold Qi/Blood: Yang deficiency reduces generating Qi.
- Hot Qi/Blood: Fire excess damages True Yin.
Treat with tonification, consolidation, warming, or clearing as indicated. If term is reached or passed, Qi/Blood gradually fills, and growth resumes. Only extreme old age/weakness is beyond human effort. (Zhang Jingyue)

**Guoqi Bu Chan (Post-term Pregnancy)**
Q: Some women menstruate monthly while the fetus grows; some bleed heavily at 3-5 months without miscarriage; some deliver on time or late. What is the reason?
A: Monthly bleeding with fetal growth is called Shengtai (Prosperous Fetus). Strong Qi/Blood leaves surplus blood for menstruation. Heavy bleeding with a viable fetus is Lou Tai (Leaking Fetus). Trauma moves the Ren Mai, causing bleeding without harming the uterus. However, blood loss depletes Qi/Blood, often delaying delivery. Cases of 12-13 months or even 20+ months exist due to insufficient Qi/Blood to sustain the embryo. After ten months, administer Qi/Blood tonics. (Yu Tianmin)

**Zi Si Fu Zhong (Dead Fetus in Utero)**
Retained placenta is urgent before birth. Dead fetus is more dangerous than retained placenta. Before birth, mother and fetus share respiration. If the fetus dies, the uterine cavity becomes cold, fetal blood coagulates, and Qi fails to ascend/descend. Ancient formulas used Blood-movers, Qi-regulators, and harsh purgatives like Nixiao (Niter), Shuiyin (Mercury), and Naosha (Sal Ammoniac). But if the fetus is dead and cold, using cold purgatives harms the mother. Ancient prescriptions were nuanced.
Two causes of fetal death:
1. Maternal bleeding, exhaustion of blood, or trauma/internal injury. Use Fuzi Tang (three doses) to warm the uterus and melt coagulated blood. Aconite breaks Cold and expels the fetus.
2. External pathogens (Cold Damage, Fever Disease, Warm Malaria) transmitting toxic Heat to the fetus. The fetus dies and rots, potentially swelling. Use Puxiao (Mirabilite/Niter) to rot the fetus, assisted by Blood/Qi movers, to expel the dead fetus. This is the intent of the formula. (Shengji Zonglu)

Causes: Heat disease, trauma, fright, premature labor stimulation, exhaustion of Lochia, leading to dried/cold fetus unable to exit.
Diagnosis:
- Red face, blue tongue: Fetus dead, Mother alive.
- Blue face, red tongue: Mother dead, Fetus alive.
- Blue face and tongue: Both dead.