【歌】脏气相乘并肺中，气争肺溢不宣通，治宜顺气兼清肺，
脉涩肢寒必见凶。
【论】《产宝》曰∶胎前喘息皆由荣卫之气流行失度。气经于脏，脏不能受，诸气上并于肺，肺隘而气争，
故喘息也。其始得之，或因恚怒，则精却，上焦闭而气不行，则留于肝，肝乘于肺，则喘出于肝也。或因惊恐，
则心无所根据，神无所根据，气乱于中，心乘于肺，此喘出于心也。或因跌仆，肾气暴动，伤而不通，肾气上乘于肺，
此喘出于肾也。或饱食过度，动作用力，谷气逆肺，此喘出于脾也。
【脉】吕沧州治经历哈散，侍人病喘不得卧，众作肺受风邪，治勿效，吕诊之，气口盛于人迎一倍，厥阴
弦动而疾，两尺俱短而离经，因告之曰∶病得之毒药动血以致胎死不下，奔迫上冲，故喘也。用催生汤加芎归服
之，果下一死胎而喘止。
【方】
马兜玲散
马兜玲 苏子 枳壳 桔梗 甘草 桑白皮 陈皮 砂仁
（附胎压膀胱）
【歌】小便淋漓号子淋，胸烦闷乱热乘心，津虚食热娘为病，气滞胎壅子见侵，泽泻茯苓甘竹叶，木通栀子
麦冬芩，膀胱胎压宜升起，日久须当议补阴。
【论】肾开窍于二阴，与膀胱为表里，妊娠胞系于肾，肾虚热不能利水而小便淋漓，甚者心烦闷乱，名曰
子淋，子淋散主之。肾虚不能司化，六味丸去丹皮加车前子。
万密斋曰∶子淋须分二症，一则妊母自病，一则子为母病。然妊妇自病又分二症，有食辛辣咸物因生内热者，
有自汗自利津液不足者。子为母病亦有二症，有胎气壅热，有胎形迫塞，症既不同，治亦各别。
景曰∶妊娠小便难，饮食如故，当归贝母苦参丸，蜜丸豆大，每服三丸。
【方】
子淋散
茯苓 麦冬 木通 甘草 大腹皮 淡竹叶
水煎服。
附∶胎压膀胱，六脉细弱，气血俱虚，不能承载其胎，坠下压住膀胱下口，因此溺不得出，令稳婆以香油涂手，
自产门托起其胎，溺出如注，却以补中益气汤升提之。或使一人对患者，皆仰卧以足抵其足，徐徐摇动其腿腹，
而胎自上。
[Song] Visceral Qi invades and converges in the Lungs, causing Qi contention and overflow with failure of diffusion and descent. Treatment should regulate Qi and clear Lung heat; if a choppy pulse and cold limbs are present, the prognosis is ominous.
[Discussion] The *Chanbao* states: Dyspnea during pregnancy is caused by the loss of regulation in the circulation of Ying (Nutritive) and Wei (Defensive) Qi. When Qi passes through the viscera, the viscera cannot accommodate it, causing various Qi to rush upward and converge in the Lungs. The Lung orifice becomes narrow, leading to Qi contention, thus resulting in dyspnea. Initially, it may arise from anger, which causes Jing (Essence) to retreat, closing the Upper Jiao and obstructing Qi flow, causing stagnation in the Liver. Liver Qi then overacts on the Lungs, so the dyspnea originates from the Liver. It may also arise from fright, causing the Heart Spirit to lack foundation and Qi to become chaotic in the Middle Jiao. Heart Qi then overacts on the Lungs, so the dyspnea originates from the Heart. It may arise from falls or trauma, causing sudden disturbance of Kidney Qi, injury, and obstruction, allowing Kidney Qi to ascend to the Lungs, so the dyspnea originates from the Kidney. It may arise from overeating combined with physical exertion, causing Grain Qi to rebel against the Lungs, so the dyspnea originates from the Spleen.
[Pulse Case] Lü Canghai treated a servant of Jingli Hasan who suffered from dyspnea preventing him from lying down. Others attributed this to Wind-Evil invading the Lungs, but treatment was ineffective. Lü diagnosed that the Renying Pulse was one-fold stronger than the Qikou Pulse, the Jueyin Pulse was wiry, rapid, and agitated, and both Chchi Pulses were short and deviated from the normal meridian pattern (Lijing Mai). He informed them: "The illness resulted from toxic drugs disturbing Blood, causing fetal death without expulsion. The rushing pressure ascends, causing dyspnea." He administered Cuisheng Tang (Labor-Delivery Decoction) added with Chuanxiong Rhizoma (Chuanxiong) and Angelicae Sinensis Radix (Danggui). Indeed, a dead fetus was expelled, and the dyspnea ceased.
[Formula]
Madouling San (Aristolochia Powder)
Aristolochiae Fructus (Madou Ling), Perillae Fructus (Suzi), Aurantii Fructus Immaturus (Zhiqiao), Platycodonis Radix (Jiegeng), Glycyrrhizae Radix et Rhizoma (Gancao), Morus Albae Cortex (Sangbaipi), Citri Reticulatae Pericarpium (Chenpi), Amomi Fructus (Sharen).
(Attachment: Fetal Pressure on Bladder)
[Song] Dribbling and difficult urination is called Zilin (Fetal Strangury); chest irritability and mental confusion result from Heat attacking the Heart. Fluid deficiency and dietary Heat cause maternal disease; Qi stagnation and fetal congestion invade the fetus. Use Ze Xie, Fu Ling, Gancao, and Dan Zhuye; Mutong, Zhizi, Maidong, and Huangqin. If bladder pressure requires lifting, use ascending methods; if prolonged, consider nourishing Yin.
[Discussion] The Kidneys open into the two yin passages and are exterior-interior related to the Bladder. During pregnancy, the Bao (Uterus) is connected to the Kidneys. Kidney Deficiency with Heat fails to transform fluids, causing dribbling urination; severe cases involve heart irritability and confusion, named Zilin (Fetal Strangury), treated primarily with Zilin San. For Kidney Deficiency failing to govern transformation, use Liuwei Wan (Six-Ingredient Pill with Rehmannia) removing Moutan Cortex and adding Plantaginis Seed.
Wan Mizhai stated: Zilin must be differentiated into two syndromes: one where the pregnant woman herself is ill, and one where the fetus is affected by the mother. However, maternal illness divides into two: one caused by internal Heat from consuming spicy and salty foods, and one caused by fluid deficiency from spontaneous sweating and diarrhea. Fetal involvement due to the mother also has two types: one where fetal Qi is congested with Heat, and one where fetal shape causes physical compression. Since symptoms differ, treatments vary.
Jing Yue stated: For difficulty in urination during pregnancy with normal diet, use Danggui Beimu Kushen Wan (Angelica, Fritillaria, and Sophora Pill), honey-pilled to bean size, taken three pills per dose.
[Formula]
Zilin San (Fetal Strangury Powder)
Poria (Fuling), Ophiopogonis Radix (Maidong), Akebia Caulis (Mutong), Glycyrrhizae Radix et Rhizoma (Gancao), Arecae Pericarpium (Dafupi), Lophatheri Herba (Dan Zhuye).
Decoct in water and take.
Attachment: Fetal pressure on the Bladder, with six pulses fine and weak, indicating Qi and Blood deficiency unable to support the fetus. The fetus descends and presses the lower outlet of the Bladder, preventing urination. Have the midwife apply sesame oil to her hands and lift the fetus from the birth canal; urine will flow like a stream. Subsequently, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to lift. Alternatively, have one person face the patient, both supine with feet pressing against each other, slowly shaking the legs and abdomen until the fetus rises naturally.