Library

Zhu Danxi said: There are pregnant women suffering from this condition. Upon pulse diagnosis, the pulses in both hands appear choppy (Se), and upon heavy pressure, they become wiry (Xian). This is caused by worry and fright. A choppy pulse indicates blood deficiency with excess qi, while a wiry pulse indicates the presence of fluid retention (Yin). Blood deficiency leads to weakness of the uterus (Bao), which cannot lift itself; excess qi combined with fluid retention causes turbidity in the middle jiao, narrowing and compressing the uterus. The uterus, knowing it must avoid pressure, descends, resulting in a sensation of prolapse. Treatment involves Si Wu Tang (Four Substances Decoction) added with Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), Banxia (Pinellia Tuber), Chenpi (Tangerine Peel), and Shengjiang (Fresh Ginger), taken on an empty stomach. Immediately after, the patient's throat should be stimulated to induce vomiting of the medicine. After a short while, more is administered. Repeating this process for eight doses brings relief. Whether this method is truly effective or merely coincidental remains uncertain. However, subsequent cases treated sequentially showed efficacy, though the exact mechanism is unclear.

Zhu Danxi said: In pregnancies of seven or eight months, urinary retention occurs. Many physicians failed to promote urination, leading to urgent distension. Pulse diagnosis revealed fine and weak (Xi Ruo) pulses. This is due to deficiency of qi and blood, which fails to support the fetus upward. Consequently, the heavy fetus descends and compresses the lower opening of the bladder, preventing urine output. If tonifying herbs are administered to lift the fetus, patency may return naturally. However, before the medicinal effect takes hold, distension worsens. In one instance, an elderly woman applied sesame oil to her hand and manually lifted the fetus through the vagina, causing urine to flow freely and relieving the distension immediately. Large doses of Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome) were then administered. After three days, the fetus gradually rose, and urination normalized.

Zhao Yangkui said: Pregnant women suffering from Zhuan Bao (displaced bladder/uterus) experience urinary retention due to deficiency and timidity of Middle Qi (Spleen/Stomach Qi), which fails to support the fetus. The fetal weight compresses the uterus, twisting its connecting tissues, thus blocking urination. Treatment involves tonifying qi and using ascending herbs to open the lower orifice, such as modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).

*Zheng Zhi Yao Jue* states: The concept of Zhuan Bao is discussed in various texts. As the fetus grows and moves downward, it presses against the bladder (Pao), causing it to tilt, hence the name "Displaced Bladder." Note that Zi Lin (Fetal Strangury) resembles Zhuan Bao. However, frequent urination with scanty, painful drops is Zi Lin. Frequent urination with scanty output but no pain is Zhuan Bao. Occasionally, mild pain may occur, but it differs fundamentally from Zi Lin. Both conditions may be treated with Sheng Liao Wu Ji San (Five Accumulations Powder without processing) or Wu Ling San (Five-Ingredient Powder with Poria) added with Ejiao (Donkey-Hide Gelatin).

Shen Zhai commented: The above twelve items describe the syndrome of Zhuan Bao occurring before delivery. Regarding pregnancy-related Zhuan Bao, *Jia Yi Jing* and *Jin Gui Yao Lue* detail the symptoms. The pathogenesis can be divided into excess (Shi) and deficiency (Xu). The four points below Ren Zhai attribute the cause to holding urine, overeating, sexual intercourse, and heat in the bladder (Pao), representing disease caused by excess pathogens. The three points following Zhu Danxi attribute the cause to blood deficiency and qi deficiency, representing disease due to insufficiency. Generally, pre-delivery Zhuan Bao results from qi deficiency and blood deficiency. Blood deficiency means the fetus lacks nourishment; qi weakness means the fetus cannot be supported, leading to descent and compression of the bladder. The bladder tilts, and urine cannot exit. Reviewing Zhu Danxi’s discussion, although factors like emotional depression, irritability, and rich diet are mentioned, his prescriptions primarily focus on tonifying qi and blood, aside from methods like inducing vomiting and manual lifting. Therefore, Li Lizhai stated that treating this condition exactly according to Zhu Danxi’s methods is appropriate. Expanding on this, there are also cases of Spleen and Lung qi deficiency failing to transport fluids to the bladder; cases of qi-heat stagnation in the bladder obstructing fluid metabolism; and cases where Metal (Lung) is scorched by Fire (Heart), leading to severe damp-heat in Spleen Earth obstructing flow. These require careful differentiation and treatment.