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Zhu Danxi treated a woman, aged forty, who was nine months pregnant and suffering from *Zhuanbao* (a condition in pregnancy characterized by urinary retention due to fetal pressure). She had been unable to urinate for three days. Her feet were swollen, her physique emaciated, her left pulse slightly harmonious, and her right pulse choppy.
This must be caused by overeating damaging the Qi mechanism. The fetal ligament is weak and cannot support the fetus, causing it to descend and compress the bladder, shifting it to one side. The Qi mechanism becomes urgent and blocked, preventing the water passages from draining. Treatment should focus on nourishing blood and tonifying Qi. Once blood and Qi are regulated, the fetal ligament will naturally lift the fetus. A decoction was prepared with Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix Tail (Guangui), Paeoniae Radix (Shaoyao), Tangerine Peel with White Pith (Dairchenpi), Prepared Licorice Root (Zhigancao), Pinelliae Tuber (Banxia), and Fresh Ginger (Shengjiang), boiled strongly into four doses. The patient was allowed to cry out freely. The next morning, the dregs of these four doses were combined and decocted as a single serving to induce vomiting. Urination immediately flowed freely, discharging dark fluid. Subsequently, the original formula was modified by adding Areca Seed (Dafupi), Stir-fried Bitter Orange (Chao Zhiqiao), Green Onion Leaf (Qingcong Ye), and Amomum Fruit (Sharen), administered as twenty doses to prevent deficiency before and after delivery. She delivered safely and remained healthy postpartum.

Another pregnant woman at seven months experienced urinary retention. Numerous physicians failed to promote diuresis, and her abdominal distension and urgency worsened. Her pulse was fine and weak, indicating that deficiency of Qi and Blood could not support the fetus, causing the fetus to press upon the lower outlet of the bladder, thus preventing urine excretion. Using tonic herbs to lift the Qi might be too slow and exacerbate the fullness. Therefore, a midwife was instructed to apply sesame oil to her hands and manually lift the fetus through the vagina. Urine gushed forth, and the distension and urgency instantly resolved. Thereafter, large doses of Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], and Cimicifugae Rhizoma (Shengma) were administered orally. If slight fullness recurred, manual lifting was repeated as before.
Jiang Yun stated: It would be better to have the pregnant woman lie on a bed and tilt the bed vertically so that the fetus naturally shifts downward, allowing urine to spray out, which is far superior to manual lifting.

Yu Zhen commented: Both cases utilized tonic herbs, demonstrating the fallacy of using diuretic and Qi-breaking drugs. In the first case, the patient cried out for four days before inducing vomiting; students of medicine should draw courage from this and avoid arbitrary changes that lead to self-harm.

Zhu Danxi treated a woman who miscarried around the third month of pregnancy. Her pulse was large and powerless on the left, and choppy upon heavy pressure, indicating Blood deficiency. Since she was young, treatment focused solely on tonifying Middle Qi to allow Blood to flourish naturally. It was early summer, so a strong decoction of Atractylodis Macrocephalae Rhizoma (Baizhu) was prepared, mixed with one qian of Scutellariae Radix (Huangqin) powder. After consuming three to four liang, the pregnancy was preserved and she delivered successfully.

A woman in her thirties experienced amenorrhea or incomplete fetal development leading to inevitable miscarriage. Observing her irritable and angry temperament, dark complexion, and robust Qi, Zhu identified excessive Ministerial Fire failing to generate Yuan Qi for conception, instead consuming Qi and damaging Essence. He prescribed Scutellariae Radix (Huangqin), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), and Glycyrrhizae Radix et Rhizoma (Gancao) starting from the second month of missed menses, stopping at the end of the third month. She subsequently gave birth to a son.

Yu Zhen commented: The previous case generated Blood by tonifying Qi; this case nourished Qi by clearing Heat. Only two herbs, Huangqin and Baizhu, were used in small quantities, yet success was achieved. Such outcomes are rare today. However, daily decoctions of Ramie Root Decoction (Zhuma Tang), occasionally supplemented with ashes of silkworm cocoons, pumpkin peduncles, or Melia Toosendan seeds, have also proven effective.

In a woman whose menses had ceased for three months, the Chi pulse was either choppy or faint. Although she reported no illness, this indicated incomplete True Qi in the uterus, resulting in Yang failing to distribute and Yin failing to transform. Although Essence and Blood coagulated, they failed to form a viable fetus. At delivery, blood clots or placental membranes were expelled. Only when the pulse was vigorous did the placenta remain intact.

Yu Zhen commented: Distinguishing between a viable fetus and non-pregnancy relies on differentiating between a Choppy/Faint Chi pulse and a Fine-Slippery Chi pulse that does not vanish upon pressure. One must discern this clearly under the fingers to confirm the diagnosis. In the following case, the patient’s spirit was exhausted, making medication difficult. Her Chi pulse was certainly not slippery and lacked root upon pressure. Later, in Shi Shan’s case, both Chi pulses were floating and weak, barely tolerating palpation, similar to this case, yet a major tonic regimen saved the fetus, illustrating variability in clinical presentations.

A woman’s abdomen enlarged progressively like pregnancy. By the tenth month, she sought herbs for easy delivery. Her spirit was exhausted, making medication inadvisable. Shortly after, she delivered half a bucket of white worms. This occurred because extreme deficiency of Yuan Qi prevented the coagulated Essence and Blood from forming a fetus; instead, turbid decay accumulated over time, transforming dampness into Heat, which generated worms. This is consistent with natural principles. Delivery required the completion of the ten-month cycle but was an ominous sign. The woman died within a month. Worms generated by Damp-Heat are akin to insects breeding in stagnant, polluted ditches.

Shi Shan treated a tall, thin woman with a sallow-white complexion and irritable temperament, aged thirty-something, who suffered recurrent miscarriages (seven or eight times). Her pulses were soft and powerless throughout; the two Chi pulses were floating but weak and intolerant of deep palpation. He stated: Frequent miscarriages deplete Qi and Blood, leaving the fetus without nourishment, much like crops dying when water dries up or trees falling when soil erodes. Furthermore, the third and fifth months correspond to the activation of Shaoyang Fire; her irritability exacerbates this, explaining why miscarriages often occur in the third, fifth, and seventh months. He prescribed a Major Tonic Decoction minus Cinnamon Twig (Guizhi), added with Phellodendri Cortex (Huangbai) and Scutellariae Radix (Huangqin), taken as a decoction and later as honey pills. After six months of treatment, her pregnancy stabilized, and she bore two sons.

Chen Douyan treated a woman who miscarried at four months. More than ten days later, her abdomen swelled, accompanied by fever, asthma, a vigorous pulse, red face, foul breath, and a bluish-black tongue.
Chen diagnosed: A vigorous pulse indicates the fetus has not yet passed. Red face signifies Heart Fire excess and dry Blood. Bluish tongue and foul breath indicate Liver failure and fetal death.
Everyone claimed the fetus had passed long ago. Upon re-examination, the signs remained unchanged. Chen administered Pingwei San plus Magnesium Sulfate (Mangxiao) and double the dose of Angelicae Sinensis Radix Tail (Guangui), washed down with a decoction of Snake Slough (Shetui). Soon, borborygmus sounded like thunder, and waves of pain struck the waist and abdomen. A dead fetus was expelled, and the illness resolved.
Wei Yun noted: Postpartum asthma with a vigorous pulse is typically incurable. Survival here depended entirely on the "ten days" interval. Had the fetus not been retained, such delay would be impossible.

Chen Renfu treated a woman near forty, constitutionally weak, who induced abortion herself. Within five days, her abdomen distended like a drum up to the heart region, causing vomiting and inability to eat. Tonics failed. Her six pulses were faint; she complained only of fatal distension. This was Spleen Qi injury causing distension. Although acute symptoms require treating the branch, adhering strictly to Danxi’s methods might be too slow. Chen used Tao Ren Cheng Qi Tang plus Magnolia Bark (Houpo) and Immature Bitter Orange (Zhishi), doubling Magnesium Sulfate (Mangxiao) and Rhubarb (Dahuang). One-quarter of the dose was taken, resulting in vomiting one-third of the content. The next morning, bowel movement remained obstructed. Urgency prompted administration of 3 qian of Amber Pill (Hupo Wan). By Shen hour, significant defecation occurred, reducing distension but leaving fatigue, limb weakness, loss of taste, and fever. Subsequently, Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], Angelicae Sinensis Radix (Danggui), Paeoniae Radix (Shaoyao), Atractylodis Macrocephalae Rhizoma (Baizhu), Citrus Reticulatae Pericarpium (Chenpi), and Crataegi Fructus (Shanzha) were decocted. Eight doses brought stability.
Wei Yun noted: This case shows failure of tonics followed by worsening with blood-breaking herbs; readers should compare carefully.

Xue Lizhai treated a pregnant woman at five months who miscarried after taking Jianhong Pill. Abdominal distension and pain ensued, worsening with blood-breaking agents. Palpation increased pain.
Xue stated: Harsh medicines severely injured the Spleen and Stomach. He prescribed Bazhen Tang with doubled Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Pinelliae Tuber (Banxia), Frankincense (Ruxiang), and Myrrh (Moyao). Pain ceased after two doses; full recovery followed after several doses.
Wei Yun noted: Palpation distinguishes Deficiency from Excess in pain. Lizhai correctly treated severe pain on pressure as major Deficiency, requiring keen insight.
Yu Zhen commented: This case represents standard practice; the previous case was terminal. Treating the branch in emergencies is a last resort.

A constitutionally timid woman delivered a daughter at four months and breastfed. She suffered from scabies for over a year, becoming emaciated. In the fifth month, she endured her mother-in-law’s funeral rites for a month, frequently feeling dizzy and wanting to lie down. One day, catching a pathogen, she suddenly developed high swelling and pain in the Heart and Spleen regions, untouchable, with incessant vomiting. Her six pulses were extremely faint and fine. Physicians, seeing a deficient pulse but substantial pathology, mistakenly believed pain should not be treated with Qi tonics. They used Tangerine Peel (Qingpi), Cyperi Rhizoma (Xiangfu), and Evodiae Fructus (Wuzhuyu), achieving cure. Later, she contracted malaria and miscarried, receiving Qi-regulating agents. Although symptoms subsided, her Yuan Qi collapsed. Further tonics with Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], failed. Pulses became thread-like and nearly absent. Xue diagnosed: All prior Qi-regulating herbs damaged True Yuan. He consecutively administered Ginseng Radix et Rhizoma (Renshen), [Ginseng Radix et Rhizoma], Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), Aconiti Lateralis Radix Preparata (Fuzi), Ginger (Shengjiang), and Cinnamomi Cortex (Guizhi) for six doses, interspersed with Bawei Wan. Within five days, sleep and appetite improved, and pulses recovered. Xue remarked: These tonics should have been given during the initial pain; malaria would not have occurred.
Yu Zhen commented: The initial pain was cured, then malaria and miscarriage occurred, attributed to "symptom resolution." Blaming the earlier lack of warming tonics seems retrospective. Reflecting on my own experience with Heart/Spleen pain cases that recur frequently until critical, one wonders if they violated Xue’s principle. However, recurring cases typically show wiry, small, firm, or rapid pulses, not extremely faint ones. When pulses are thread-like, warming tonics are universally applicable.

Jiang Yingsu treated Wang Hao’s wife, thirty-five, who took abortifacients due to fear of childbirth, resulting in profuse bleeding lasting over ten days, with occasional epistaxis. Medications failed. Jiang found rapid and slightly wiry pulses in all six positions, diagnosing rebellious Jueyang Fire. He prescribed Siwu Tang substituting Rehmanniae Radix (Shengdi), adding Oviductus Bufonis (Ejiao), stir-fired Gardeniae Fructus (Chao Zhizi), and Mint (Bohe). One dose cured her.
Jiang Yun stated: Internal Heat with Deficiency causes most miscarriages. Around the third to fifth months, Shaoyang Ministerial Fire is active, increasing miscarriage risk. Hence, Scutellariae Radix (Huangqin), Atractylodis Macrocephalae Rhizoma (Baizhu), and Oviductus Bufonis (Ejiao) are sacred herbs for stabilizing pregnancy.

Sun Dongsu stated: His niece, Dai Shi, at five months pregnant, suffered sudden heavy bleeding and afternoon chills. All pulses were rapid; Left Cun was slippery and large, Right Guan beat against the finger, Left Guan was weak. He prescribed Paeoniae Radix Alba (Baishao) 2 qian, Rehmanniae Radix (Shengdi), Oviductus Bufonis (Ejiao), Ginseng Radix et Rhizoma (Renshen), and Polygoni Multiflori Caulis (Puhuang) 1 qian each, Bupleuri Radix (Chaihu), Cyperi Rhizoma (Xiangfu), Sanguisorbae Radix (Diyu), and Schizonepetae Spica (Jingjie) 0.7 fen each, Licorice Root (Gancao) 0.5 fen. Afternoon chills and fevers occurred three times nightly, with headache, nausea, abdominal hardness, and many blood clots. Mental fatigue confirmed Deficiency. He used Buzhong Yiqi Tang plus Ejiao, Prepared Ginger (Paojiang), Baishao, and Mume Fructus (Wumei). That afternoon, a white blister appeared on the sclera of the right eye, swelling and drooping, with facial edema, indicating uncontrolled wandering Deficient Fire. That night, severe chills/fever, black fingernails, pale lips, profuse sweating, abdominal pain radiating to breasts occurred. He continued Buzhong Yiqi Tang plus Ejiao, Baishao, Cinnamomi Ramulus (Guizhi), Schisandrae Fructus (Wuweizi), and Ophiopogonis Tuber (Maidong). Fever, sweat, and thirst ceased; spirit stabilized, indicating life returned. The next day, coughing led to fetal expulsion. Dushen Tang followed. That night, borborygmus and two diarrheal episodes occurred. He prescribed Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) 3 qian each, Prepared Licorice Root (Zhigancao) 1.5 qian, Prepared Ginger (Paojiang) 1 qian, Cinnamon Heart (Guixin) and Poria (Fuling) 0.5 fen each, Citrus Reticulatae Pericarpium (Chenpi) 0.7 fen, Lotus Seed (Lianzi), and Jujube (Dazao). Later, cough was treated with Six Gentlemen Decoction (Sijunzi Tang) plus Paojiang, Wuweizi, and Asteris Flos (Ziwan), leading to recovery.
Yu Zhen commented: Administering Dushen Tang immediately after miscarriage and heavy doses of Renshen/Baizhu upon diarrhea reflects pre-existing Deficiency. Acute tonification is justified. Quacks would withhold tonics and use blood-resolving herbs.

Zhang Luyu treated a woman at six months pregnant who miscarried due to grief-induced fetal agitation. Two doses of Huangqin and Baizhu failed. Switching to Zhiqiao, Xiangfu, Perillae Folium (Zisu), and Amomum Fruit (Sharen) to regulate Qi caused the fetus to press upward against the heart, causing distension, asthma, and epistaxis. On the third evening, the pulse was frantic like a storm, skipping beats. Zhang advised: This is not a viable fetus; preserving it is futile. Removing it saves the mother. Believing the fetus was affected by Wood energy (Zhen trigram), he used Metal to control it. A red-hot iron axe quenched in vinegar was used to mix 1 liang of Magnesium Sulfate (Mangxiao) powder, administered hot. At midnight, an abnormal fetus was passed. Pulse and spirit stabilized afterward, though lochia was heavy. Calming and blood-nourishing agents restored peace.

Xu Yuqing treated Shao Hanzhen’s wife, pregnant for seventeen months without delivery. Relying on history rather than pulse alone, he confirmed pregnancy but noted no fetal movement since five months. He prescribed solely Salviae Miltiorrhizae Radix (Danshen) 7 qian daily. Over two weeks, a dead, shriveled fetus was passed. Death likely occurred at five months. Thirteen months in utero, it dried without rotting, unlike fruit which rots. Zhang Shiwen recalled treating a woman pregnant thirteen months; Ten Great Tonics Decoction yielded a white, shriveled fetus. Though treatments differed, the result—shriveling—was the same.

Yu Zhen commented: Abnormal fetuses (like yak fetuses or tadpole/lizard forms) are recorded in ancient texts, but shriveled fetuses are rarely mentioned. The analogy of a shriveled fruit is apt. The Book of Later Han records Bao Wu’s mother delivering a snake alongside Wu, which later wept blood at her coffin. The nature of such anomalies defies standard diagnostic methods. Medical histories record Pan treating two women: one "pregnant" two years, the other fourteen months. Diagnosis revealed disease, not pregnancy. Administration of a decoction resulted in passing over a hundred flesh blocks and a large snake, respectively. Both survived, demonstrating excellent diagnostic skill.