张子和曰∶有妇人年三十四，梦与鬼交，及见神堂阴司，舟楫桥梁，如此一十五年，竟无妊娠。此阳火盛
于上，阴水盛于下。见鬼神者，阴之灵。神堂者，阴之所。舟楫桥梁，水之用。两手寸脉皆沉而伏，知胸中有实
痰也。凡三涌、三泄、三汗，不旬日而无梦，一月而有娠。
朱丹溪曰∶妇人肥盛者，多不能孕育。以身中有脂膜闭塞子宫，致经事不行。瘦弱妇人不能孕育，以子宫无
血，精气不聚故也。肥人无子，宜先服二陈汤，四物去生地，加香附，久服之。丸更妙。
朱丹溪曰∶肥盛妇人，禀受甚浓，恣于酒食，经水不调，不能成孕。以躯脂满溢，湿痰闭塞子宫故也。宜燥
湿、去痰、行气、二陈加木香、二术、香附、芎、归，或导痰汤。
陈良甫曰∶妇人有全不产育，及二三十年断绝者，荡胞汤主之，日三服，夜一服，温覆汗，必下积血及冷赤
脓如豆汁，力弱大困者，一二服止。
何松庵曰∶有肥白妇人不能成胎者，或痰滞血海，子宫虚冷，不能摄精，尺脉沉滑而迟者，当温其子宫，
补中气，消痰为主。有瘦弱妇人不能成胎者，或内热多火，子宫血枯，不能凝精，尺脉洪数而浮者，当滋阴降
火，顺气养血为主。
慎斋按∶以上五条，序妇人不孕，有痰饮、积血、脂膜，为实邪有余之病也。
薛立斋曰∶妇人不孕，亦有六淫七情之邪伤冲任。或宿疾淹留，传遗脏腑，或子宫虚冷，或气旺血衰，或
血中伏热。又有脾胃虚损，不能荣养冲任。更当审男子形质何如。有肾虚精弱，不能融育成胎。有禀赋原弱，气
血虚损。有嗜欲无度，阴精衰惫。各当求原而治。至大要，则当审男女尺脉。若右尺脉细，或虚大无力，用八味
丸。左尺洪大，按之无力，用六味丸。两尺俱微细，或浮大，用十补丸。若误用辛热燥血，不唯无益，反受其害矣。
慎斋按∶以上一条，序不孕之理，兼男女病情而论之也。
Zi Hezi said: There was a thirty-four-year-old woman who dreamed of copulating with ghosts, or seeing divine halls and underworld offices, boats, and bridges. This condition persisted for fifteen years, yet she failed to conceive. This is due to excessive Yang fire in the upper jiao and excessive Yin water in the lower jiao. Seeing ghosts and deities is a manifestation of Yin spirits; divine halls are places where Yin qi gathers; boats and bridges are functions of water. Palpation revealed that both cun positions of the two wrists were deep and hidden (chen fu), indicating the presence of excess phlegm in the chest. After three treatments of emesis (yong), purgation (xie), and diaphoresis (han), the nightmares ceased within ten days, and she conceived within one month.
Zhu Danxi said: Women who are obese often cannot conceive. This is because fatty membranes block the uterus, causing amenorrhea. Thin and weak women cannot conceive because the uterus lacks blood, preventing the gathering of essence and qi. For obese women infertile, it is appropriate to first administer Er Chen Tang (Two-Cured Decoction). In Si Wu Tang (Four-Substance Decoction), remove Sheng Di Huang (Rehmanniae Radix) and add Xiang Fu (Cyperi Rhizoma); long-term administration is recommended. Forming pills is even better.
Zhu Danxi said: Obese women, possessing strong constitutions, indulge in alcohol and food, leading to irregular menstruation and inability to conceive. This is due to fullness of adipose tissue overflowing and damp-phlegm blocking the uterus. The treatment should involve drying dampness, resolving phlegm, and moving qi. One may use Er Chen Tang (Two-Cured Decoction) added with Mu Xiang (Aucklandiae Radix), Cang Zhu (Atractylodis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Xiang Fu (Cyperi Rhizoma), Chuan Xiong (Chuanxiong Rhizoma), and Dang Gui (Angelicae Sinensis Radix), or use Dao Tan Tang (Phlegm-Guiding Decoction).
Chen Liangfu said: For women who have never given birth or whose menstruation has ceased for twenty to thirty years, Dang Bao Tang (Uterus-Sweeping Decoction) is the primary prescription. It should be taken three times daily and once at night. After taking the medicine, cover warmly to induce sweating. Accumulated blood and cold red pus resembling bean juice will inevitably be discharged. If the patient is physically weak and severely debilitated, stop after one or two doses.
He Song'an said: Some fat and fair-skinned women cannot conceive due to phlegm stagnating in the Sea of Blood (Xue Hai) and uterine deficiency-cold, which prevents the reception of sperm. If the chi position pulse is deep, slippery, and slow, the treatment should focus on warming the uterus, tonifying middle qi, and eliminating phlegm. Some thin and weak women cannot conceive due to internal heat and excessive fire, resulting in uterine blood dryness, which prevents the condensation of sperm. If the chi position pulse is surging, rapid, and floating, the treatment should focus on nourishing yin, descending fire, regulating qi, and nourishing blood.
Shen Zhai commented: The above five cases describe infertility caused by phlegm-fluids, accumulated blood, and fatty membranes, which belong to diseases of excess pathogens and surplus conditions.
Xue Lizhai said: Female infertility can also result from pathogenic factors of the Six Excesses (Liu Yin) and Seven Emotions (Qi Qing) damaging the Chong and Ren vessels. Or, old diseases linger and transmit to the zang-fu organs. Or, there is uterine deficiency-cold, or abundant qi but deficient blood, or latent heat in the blood. Additionally, spleen-stomach deficiency fails to nourish the Chong and Ren vessels. One must also examine the male partner's constitution. There are cases of kidney deficiency and weak essence unable to fuse and form the fetus; cases of innate weakness with deficient qi and blood; and cases of excessive desires leading to exhaustion of yin essence. Each case requires identifying the root cause for treatment. The key point lies in examining the chi pulses of both men and women. If the right chi pulse is fine, or deficient and large without strength, use Ba Wei Wan (Eight-Ingredient Pill). If the left chi pulse is surging and large but weak upon pressure, use Liu Wei Wan (Six-Ingredient Pill). If both chi pulses are micro and fine, or floating and large, use Shi Bu Wan (Ten-Nourishing Pill). Misusing acrid-hot and blood-drying herbs will not only be ineffective but also harmful.
Shen Zhai commented: The above case discusses the principles of infertility, analyzing the conditions of both men and women.