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He Song'an said: In pregnancy complicated by malaria, chills and fever occur simultaneously. Qi belongs to Yang; deficiency of Yang leads to aversion to cold. Blood belongs to Yin; deficiency of Yin leads to fever. Generally, during pregnancy, one is most afraid of shivering chills, where the sinews and bones tremble, which easily disturbs the fetus (Tai Yuan). When prescribing herbs, securing the fetus must be the primary task. This is because Spleen and Stomach are weak, with food stagnation. Or if affected by Summer-heat pathogen, use Liu Jun Zi Tang (Six Gentlemen Decoction) with Jie Geng (Platycodon Root), Cang Zhu (Atractylodis Rhizoma), and Huo Xiang (Pogostemonis Herba). If external pathogens are predominant and food intake is low, use Huo Xiang Zheng Qi San (Agaricus Powder for Regulating Qi). If external pathogens are few and food intake is high, use Ren Shen Yang Wei Tang (Ginseng Decoction for Nourishing the Stomach) without Ban Xia (Pinelliae Rhizoma). For cases with more heat than cold, use Qing Pi Yin (Clearing Spleen Drink) without Ban Xia. For deficiency patterns, use Si Shou Yin (Four Beasts Drink) or Si Jun Zi Tang (Four Gentlemen Decoction) plus Chen Pi (Citri Reticulatae Pericarpium), Ban Xia, Cao Guo (Tsaoko Fructus), and Da Zao (Jujubae Fructus). If it persists for a long time, base the prescription on Liu Jun Zi Tang, assisted by fetal-securing herbs.

Zhao Yangkui said: There are cases of "Fetal Malaria," where the malaria symptoms appear as soon as pregnancy occurs. This person has inherent Liver Fire. Upon pregnancy, the Water nourishes the Fetus, leading to Liver deficiency and dryness of Blood, resulting in alternating chills and fever, resembling malaria but not being true malaria. Use Xiao Yao San (Free and Easy Wanderer Powder) to clear Liver Fire and nourish Liver Blood, combined with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to nourish the source of transformation and generation.

Shen Zhai's Note: The above three passages describe the syndrome of malaria before/during pregnancy. Pregnancy malaria may involve Wind-Cold, Summer-heat, or Heat pathogens, or signs of Qi and Blood deficiency, with alternating chills and fever, trembling of the jaw, shaking of the thighs, and trembling of all joints, making abortion very likely. Therefore, ancient physicians prioritized securing the fetus in their prescriptions. However, if the pathogenic factor is not expelled, the fetus may not necessarily be secured. Thus, nothing is more urgent for securing the fetus than expelling the pathogen. Yet, herbs that expel pathogens such as Chang Shan (Dichroae Radix), Cao Guo, Bing Lang (Arecae Semen), Hou Po (Magnoliae Officinalis Cortex), Ma Huang (Ephedrae Herba), Gui Zhi (Cinnamomi Ramulus), and Da Huang (Rhei Radix et Rhizoma) should not be used indiscriminately. It is appropriate to tonify Qi while releasing the exterior, and nourish Blood while clearing Heat.

Chen Liangfu said: During pregnancy, consumption of raw and cold foods impairs the Spleen and Stomach's ability to digest and transform, causing pain in the heart and abdomen. If the disease involves the Blood aspect, the stool will be red; if it involves the Qi aspect, it will be white. If both Qi and Blood are diseased, red and white will be mixed. If Heat invades the Large Intestine and Blood deficiency is present, bloody dysentery (Xue Li) results.

Hu Xianweng said: A pregnant woman suffered from persistent dysentery. Her pulse was deficient and slippery, with a choppy quality at both Guan positions. This was due to disharmony of the Fetal Qi, with Ministerial Fire flaming upward causing Heat. It resembled dysentery but was not true dysentery. Use Huang Qin (Scutellariae Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to secure the fetus, and Si Wu Tang (Four Substances Decoction) with Sheng Di Huang (Rehmanniae Radix) to regulate Blood. After several doses, she became stable.