门人问曰∶《金匮》妊娠一门，夫子之注甚详，恐难为浅学道也。此外，还有简易之法，贤愚可共晓否？
曰∶夫道一而已矣，浅者自见其浅，深者自见其深也。《金匮》本于《灵》、《素》，后之高明者，得《金匮》之一知
半解，敷衍成篇。如今之举业家，取五经四书题目，作臭腐时文，文无定体，惟不失立言之语气，而合时文之法度，斯
得矣！兹且从俗而言时法。王海藏云∶胎前气血和平，则百病不生。若气旺而热，热则耗气血而胎不安，当清热养血为
主。若起居饮食调摄得宜，绝嗜欲，安养胎气，虽感别症，总以安胎为主。又云∶安胎之法有二∶如母病以致动胎者，
但疗母则胎自安；或胎气不固，或有触动以致母病者，宜安胎则母自愈。汪石山云∶凡胎前总以养血健脾、清热疏气为
主，吾乡称为女科之最上者，父子相传，不外此说。而更深一步者，赵养葵云∶胎茎之系于脾，犹钟之系于梁也。若栋
柱不固，栋梁亦挠；必使肾中和暖，然后胎有生气，日长而无陨坠之虞；何必定以黄芩、白术哉！乃此四节，平易近人，
行道人不可不俯而相就，毋取惊俗为也。
门人问曰∶夫子引王海藏云∶热则耗气血而胎不安。而朱丹溪谓胎前当清热养血为主，以白术、黄芩为安胎之圣药。
立论相同，而《金匮》治妊娠，开章即以桂枝汤为首方，且有大热之附子汤，温补之胶艾汤，不啻南辕北辙之异！究竟
从仲景乎？从海藏、丹溪乎？
曰∶海藏、丹溪之论，原从《金匮》常服之当归散得来。《金匮》之附子汤、胶艾汤，又与其本篇养胎之白术散同义，
须审妇人平日之体气偏阴偏阳，丰浓羸瘦；致病之因寒因热；病形之多寒多热；病情之喜寒喜热；又合之于脉而治之，
不可执一也。
门人问曰∶《金匮》论妊娠，开章以桂枝汤居其首，其原文云∶“妇人得平脉，阴脉小弱，其人渴，不能食，无寒热，
名妊娠，桂枝汤主之”。“于法六十日当有此症，设有医治逆者，却一月加吐下者，则绝之”。各家所注，非失之浅则失之
凿，请一一明之，以为一隅之举。
曰∶《金匮》云“妇人得平脉”者，言经水不行，不可为无病之人，而平脉乃为无病之脉，诊见此脉有喜出望外之意，
故曰“得”也。其云“阴脉小弱”者，以阴脉属下焦尺部，视上、中二部之脉，不过小弱；小弱则非等于涩，为血滞之
病脉，此即《内经》所谓妇人有孕，身有病而无邪脉之旨也。其云“渴，不能食”者，以妇人所食谷味，化为血气，下
为月水；今月水乍聚而欲成胎，则中焦之气壅塞。中焦者胃也，胃病则懒于纳谷，故不能食；胃病则燥气偏胜，故口干
而渴也。其云“无寒热”者，症自内起，不关外邪，安有恶寒发热之象哉？！故以“渴，不能食，无寒热”七字，为妊
娠之确切真语也。且云“于法六十日当有此症”者，特为“阴脉小弱”一句，自明其师古而不泥古之意。《内经》云∶阴
搏阳别，谓之有子。言阴尺脉旺与阳寸迥别。《难经》云∶按之不绝者，有孕也。亦言按阴尺而不绝也。今云阴脉小弱，
何以与前圣后贤相反至此？而不知妊娠之初，月水乍聚，一月为 ，二月为胚，三月为胎。今在六十日之内，其胎尚在
将成未成之间，下焦之血运于中焦，而护 胚，则下焦转虚，所以见小弱之脉；过此胎成，则渐见阴搏与按之不绝之脉
矣。其云“医治逆者”四句。言妊娠只有六十日，以三月成胎之数计之，却少了一个月，其形不过为一团结聚之血，岂
容药之稍误？若误药而加吐下，则祸不旋踵矣！“绝之”者，明告其故，更以《周易》勿药之说导之也。其用桂枝汤奈何？
盖以身有病而脉无故，又非寒热邪气。凡一切温凉补泻之剂，皆未尽善；惟有桂枝汤一方，调和阴阳之为得也。
门人问曰∶巢元方谓妊娠一月名始形，足厥阴脉养之。二月名始膏，足少阳脉养之。三月始胎，手心主脉以养之；
当此时，血不流行，形象始化。四月始受水精以成血脉，手少阳脉养之。五月始受火精以成气，足太阴脉养之。六月始
受金精以成筋，足阳明脉养之。七月始受木精以成骨，手太阴脉养之。八月始受土精以成肤革，手阳明脉养之。九月始
受
石精以成毛发，足少阴脉养之。十月五脏六腑，关节人形皆备。陈良甫宗其说，以五行分发四时。徐之才以十月分发某
月见某症则用某药。各家之说，当从否乎？
曰∶十月分经养胎之说，创自隋之巢氏，张子和既斥其谬矣。须知妇人自受胎以后，十二经气血俱翕聚以养胎元，
岂有某经养某月胎之理？又岂有限于某月必见某症、必用某方施治之理？齐东野人之语，吾辈切勿述之以污口。
门人问曰∶时医相传口诀，谓胎前无寒，吾乡女科俱宗此说，然其说与丹溪辈吻合者多，而求之《金匮》则大不然
矣。《金匮》云∶妇人怀孕六七月，脉弦发热，其胎愈胀，腹痛恶寒者，少腹如扇，所以然者，子脏开故也。当以附子汤
温其脏。仲景安胎用附子汤，大有取义。今人置而勿用，岂古法不堪为今用欤？
曰∶医之所贵者，力学之外，得明师益友。日举其所治之症与圣经之异同，合而讲论，始知其妙。其云妇人怀孕六
七月，其六七月之前，身无大病可知也。今诊其脉弦，弦为阴象；其身发热，热为阳浮；其胎愈胀，胀为虚寒。何以谓
之曰“愈”？“愈”者，“更加”之意也。吾于此一字，而知此妇人本脏素属虚寒者，常有微胀，今因病而增胀，故曰“愈”
也。且可因此一字而定其脉。弦为阴盛于内，发热为阳格于外也。且人之一身，以背与腹分其阴阳也。背为阳，而头项
该括其中；腹为阴，而大小腹该括其中。今痛而恶寒，不在阳部之背与头项，而在阴部之腹大腹，在脐上之中脘、下脘，
乃太阴坤土、阳明中土所属也。小腹在于脐下，乃少阴水脏、膀胱水腑之所属也。小腹两旁名为少腹，乃厥阴肝脏、
胞中血海之所居也。今云小腹如扇者，实指子脏虚寒，不能司闭藏
之令，故阴中寒气，习习如扇也。附子汤方，《金匮》阙之，其为《伤寒论·少阴篇》之附子汤无疑。《张氏医通》云∶
世人皆以附子为堕胎百药长，仲景独以为安胎之圣药，若非神而明之，莫敢轻试也。
门人问曰∶妊娠二三月，心烦、恶食、呕吐等症，医名“恶阻”；得胎后，腹常痛，医名“胞阻”。但“恶阻”症《金
匮》无其名，而“胞阻”则有之。但“阻”者，阻隔之义，隔者宜通，保胎岂得用通之法乎？不然何以谓之“阻”乎？
曰∶《金匮》虽无恶阻之名，而第一节云“其人渴，不能食，无寒热，名妊娠，桂枝汤主之”。一本“渴”字作“呕”
字，注家谓为“恶阻”，《产宝》谓为“子病”是也。呕吐不止者，《金匮》用半夏人参丸，主胃有寒饮。若胃热上行而呕
吐，《千金》于此方，以生姜易干姜，加茯苓、麦冬，重加鲜竹茹，作汤甚效。方中取半夏味辛降逆，辛则性烈，以直通
其阻隔。楼全善、薛立斋皆谓为治恶阻之良方。高鼓峰谓与参、术同用，不独于胎无碍，而且大有健脾、安胎之功。余
每用六君子汤辄效。至于胞阻，《金匮》则与漏下、（俗名漱经。）半产、（四五月堕胎，谓之半产。）半产后下血不绝、（伤
其血海。）妊娠因症而下血（《金匮》用桂枝茯苓丸下其症而安其胎。）合而并论。盖以胞阻与各症，皆为冲任二脉之所司，
病异而源同也。且夫妊娠之胎气，原由阳精内成与阴血外养之者也。今阴血之自结，与胎阻隔而不相和，阴结阴位，所
以腹中作痛。书云∶“通则不痛”。通之即所以安之，惟胶艾汤丝丝入扣。且胞阻所云与漏下等症，皆阴阳失于抱负、坤
土失于 防所致。《金匮》制此方以统治各病，微乎！微乎！方中芎、归宜通其阳血，芍、地宜通其阴血，又得阿胶血肉
之品，同类相从以养之，皆令阴阳之抱负也。甘草缓中解急，又得艾叶温暖子宫，补火而生土者以助之，皆令坤土之
防也。故为调经、止漏、安胎、养血之良方。
又问∶《金匮》云∶妇人“腹中 痛，当归芍药散主之”，亦是胞阻与否？
曰∶ 痛者，微痛而绵绵也。乃脾虚反受水凌，郁欲求伸而不得，故绵绵作痛，宜当归芍药散兼渗其湿，与胞阻之
治
不同。
门人问曰∶《金匮》云∶妇人妊娠，宜当归散主之，此以凉补为安胎法也。又云∶“妊娠养胎，白术散主之”，此以温
补为安胎法也。今皆宗丹溪“黄芩、白术为安胎之圣药”之说，是白术散用蜀椒之法可以永废矣。夫子以为何如？
曰∶二方皆主白术，谓白术为安胎之圣药则可；又合黄芩以并言，则未免为一偏之言耳。凡瘦人多火，火盛则耗血
而伤胎，宜用当归散。肥白人外盛内虚，虚则生寒，而胎不长，宜用白术散。余内子每得胎三月必坠，遵丹溪法，用药
连坠五次。后余赴省应试，内子胎适三个月，漏红欲坠，先慈延族伯字延义，以四物汤加鹿角胶、补骨脂、杜仲、续断
各二钱，一服而安。令每旬一次。余归已六个月矣，阅其方大为一骇！叹曰∶补骨脂《本草》载其坠胎，又合鹿角胶、
杜仲之温，芎 之行以助之，竟能如此之效！设余在家，势必力争，又以黄芩、白术坠之矣！此后凡遇胎漏欲坠之症，
不敢专主凉血；而半产应期而坠者，专主大衰论治。扁鹊谓∶命门为男子藏精、女子系胞之所，胎孕系于命门，命门之
火，即是元气，以此养胎，故有日长之势。譬如果实，生于春而结于夏；若春夏忽作非时之寒气凉风，则果实亦因之以
黄陨矣。惟用大补大温之剂，令子宫常得暖气，则胎自日长而有成。若非惯患半产，不必小题大做。凡得胎后，预服扶
胎之药，以防漏坠，只用平补之法，余新定所以载丸，最验。
门人问曰∶夫子前刻《三字经》，引徐忠可谓∶《金匮》妊娠篇凡十方，而丸散居七，汤居三，盖以汤者荡也，妊娠
当以安胎为主，则攻补皆宜缓，不宜峻故也。但十方间有未录音，未知其故？
曰∶古人识见百倍于今人，凡未悉其所以然之妙者，恐针锋不能相对，贻误后人，故姑阙之。且当归散、白术散二
方，余亦罕用也。
门人问曰∶海藏以四物等分，随所患之症，加入二味，名六合汤，驱病而无损于胎，且亦简便可从，夫子何不全录
之以为法乎？
曰∶四物汤为妇科之总方，海藏取之以护胎，胎得所护，则寒、热、攻、补之峻剂，俱在胎外，以除病而胎元则晏
然，不知此法甚巧而可从。但伤寒宜按六经而加之，杂病宜取按各病之主药而加之，难以预定为何药。且海藏表实方加
麻黄、细辛，尚无大误；而表虚方加防风、苍术，则失之远矣！何不云一合麻黄汤，一合桂枝汤之为得乎！吾更推其意
而论正之∶子满者，孕妇忽见通身肿满，是胎中挟水，水与血相搏，前方加白术、陈皮、茯苓、泽泻。子气者，病在气
而不在水，气滞而足面肿、喘闷烦食，甚则脚指出黄水，前方去地黄，加香附、紫苏、陈皮、天仙藤、炙甘草，《金匮》
葵子茯苓散慎勿轻用。子悬者，何柏斋谓为浊气举胎上凑也；胎热气逆、心胃胀满，前方去地黄，加紫苏、陈皮、大腹
皮、人参、甘草、生姜。子烦者，心中懊 、口燥心烦，前方加麦冬、知母、竹叶、人参、甘草。子淋者，孕妇小便涩
少，乃肺燥而天气不降，前方加天门冬以清之；肾燥而地气不升，前方加细辛以润之；佐木通、茯苓以通其便，人参、
甘草以补其虚，即《本草》安荣散之义。而《金匮》云∶妊娠，小便难，饮食如故，以当归贝母苦参丸主之。大意以肺
之治节，行于膀胱，则热邪之气除，而淋沥自止。而转胞症，又与子淋便难二症分别，或因禀受弱者，或因忧郁伤脾者，
或因性急伤肝者，或因忍小便所致者。大抵胎下而压胞，胞系了戾不通，其状小腹急痛、不得小便、甚者至死，必令胎
能举起，悬在中央，胞系得疏，水道自行。前方加参、术、陈、半、升麻、生姜，空心服之，或服药后以手探吐，吐后
又服之。又《金匮》云∶“但利小便则愈，宜肾气丸主之”。意者，胞之所以正者。胞之前后左右，皆大气充满，扶之使
正，此方大补肾中之气，所以神效。子嗽者，怀孕咳嗽，由于火盛克金，前方加桑白皮、天门冬、紫苑、竹茹、甘草。
子痫者，怀孕卒倒无知、目吊口噤、角弓反张，系肝风内动，火势乘风而迅发，前方加羚羊角、钩藤、竹沥、贝母、僵
蚕；甚者间服风引汤，继以竹叶石膏汤、鸡子黄连汤以急救之。子鸣者，妊娠腹内儿有哭声，乃脐下疙瘩，儿含口中，
因孕妇登高举臂，脱出儿口，以作此声，前方加茯苓、白术，仍散钱于地，令其由腰拾之，一二刻间疙瘩入儿口，其鸣
即止。子喑者，妊娠八九月间，忽然不语。盖胎系于肾，肾脉荣舌本，今因胎气壅闭，肾脉阻塞，应静候其分娩后，则
自愈；或用前方加茯苓、远志，一二服亦可。凡此之类，言之不尽，学人以意通之可也。
门人问曰∶妇人妊娠之脉何如？
The student asked, "Master's annotations on the chapter of pregnancy in *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) are very detailed, which might be difficult for those with shallow learning to understand. Are there any simpler methods that both the wise and the foolish can comprehend?"
The Master replied, "The Dao (Way/Principle) is one. Those with shallow insight see its shallowness, while those with deep insight see its profundity. *Jingui Yaolue* originates from *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions). Later scholars of high acumen, grasping only a fragmentary understanding of *Jingui Yaolue*, expanded upon it to form chapters. It is like today's candidates for the imperial examinations who take topics from the Five Classics and Four Books to write stale eight-legged essays. These essays have no fixed structure; as long as they do not violate the tone of establishing speech and conform to the rules of the eight-legged essay, they are acceptable! For now, let us speak according to popular custom regarding simple methods. Wang Haicang said: 'If qi and blood are harmonious before pregnancy, hundred diseases will not arise. If qi is vigorous and hot, heat consumes qi and blood, causing fetal instability; the treatment should primarily focus on clearing heat and nourishing blood.' If daily life and diet are regulated properly, desires are cut off, and fetal qi is nurtured peacefully, even if other symptoms occur, the primary goal should always be to calm the fetus. He further stated: 'There are two methods for calming the fetus: If the mother's illness causes fetal movement, treating the mother's illness alone will naturally stabilize the fetus; or if fetal qi is insecure, or if disturbances cause maternal illness, calming the fetus will naturally heal the mother.' Wang Shishan said: 'Generally, before pregnancy, the primary approach is to nourish blood, strengthen the spleen, clear heat, and soothe qi. This is regarded in our hometown as the highest theory in gynecology, passed down from father to son, without deviating from this saying.' However, taking it a step further, Zhao Yangkui said: 'The connection between the fetus and the spleen is like a bell hanging from a beam. If the pillar is not solid, the beam will bend; only by ensuring warmth in the kidney can the fetus gain vital energy, growing daily without fear of miscarriage. Why must one insist on using Huangqin (Scutellariae Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma)?' These four perspectives are approachable and accessible. Practitioners should accommodate them rather than seeking to shock the vulgar with unconventional practices.
The student asked, "You cited Wang Haicang saying, 'Heat consumes qi and blood, causing fetal instability.' Meanwhile, Zhu Danxi argued that before pregnancy, one should primarily clear heat and nourish blood, regarding Baizhu and Huangqin as the holy medicines for calming the fetus. Their arguments seem identical, yet *Jingui Yaolue* treats pregnancy by opening with Guizhi Tang (Cinnamon Twig Decoction), and includes Fuzi Tang (Aconite Root Decoction), which is greatly hot, and Jiao'ai Tang (Donkey-Hide Gelatin and Mugwort Decoction), which is warming and tonifying. Is this not as contradictory as driving south while intending to go north? Should we follow Zhang Zhongjing, or follow Haicang and Danxi?"
The Master replied, "The theories of Haicang and Danxi originally stem from Danggui San (Angelica Powder), a regular preventive prescription in *Jingui Yaolue*. The Fuzi Tang and Jiao'ai Tang in *Jingui Yaolue* share the same meaning as Baizhu San (Atractylodes Powder) for nurturing the fetus in the same chapter. One must examine the woman's constitution—whether it leans yin or yang, whether she is robust or emaciated; the cause of illness—whether cold or heat; the manifestation of symptoms—whether predominantly cold or heat; and her preference—whether she prefers cold or heat. Treatment must then be combined with pulse diagnosis. One cannot adhere rigidly to a single method.
The student asked, "*Jingui Yaolue* discusses pregnancy, placing Guizhi Tang at the beginning. The original text states: 'When a woman has a normal pulse, but the yin pulse (at the cun position relative to yin, often referring to chi/radial depth or specifically the chi pulse being weak compared to others) is slightly weak, and she experiences thirst, inability to eat, and no chills or fever, this is named pregnancy, treated with Guizhi Tang.' It also says, 'According to the method, these symptoms should appear around sixty days. If a physician treats incorrectly, reversing the condition, and after one month vomiting and diarrhea occur, stop medication.' Various commentaries are either too superficial or too pedantic. Please explain them one by one as an example.
The Master replied, "When *Jingui Yaolue* says 'a woman obtains a normal pulse,' it means that although menstruation has ceased, she cannot be considered disease-free; however, a 'normal pulse' indicates a healthy state. Discovering such a pulse brings unexpected joy, hence the word 'obtains.' Regarding 'yin pulse slightly weak,' the yin pulse belongs to the lower jiao chi position. Compared to the upper and middle positions, it is merely slightly weak. 'Slightly weak' does not equate to 'choppy' (se), which is a pathological pulse for blood stagnation. This aligns with the principle in *Neijing*: 'A pregnant woman may have bodily symptoms but lacks pathological pulses.' Regarding 'thirst and inability to eat': food consumed by women transforms into qi and blood, which descends as menstrual flow. Now that menstrual blood has just gathered to form a fetus, the qi of the middle jiao becomes congested. The middle jiao is the stomach; when the stomach is affected, appetite declines, leading to inability to eat; stomach pathology leads to excess dryness-qi, causing dry mouth and thirst. Regarding 'no chills or fever': the symptoms originate internally, unrelated to external pathogens, so why would there be signs of aversion to cold or fever?! Thus, the seven characters 'thirst, inability to eat, no chills or fever' constitute the precise description of pregnancy. Furthermore, stating 'according to the method, these symptoms should appear around sixty days' specifically clarifies the phrase 'yin pulse slightly weak,' demonstrating adherence to ancient wisdom without being bound by it. *Neijing* states: 'Yin pulsation distinct from yang indicates pregnancy,' meaning the chi pulse is vigorous and distinctly different from the cun pulse. *Nanjing* states: 'Pulse that does not cease upon pressure indicates pregnancy,' also referring to the chi pulse. So why does *Jingui* say 'yin pulse slightly weak,' seemingly contradicting past sages? One must realize that at the beginning of pregnancy, when menstrual blood first gathers, the first month is called 'beginning of form,' the second 'beginning of paste,' and the third 'fetus.' Within sixty days, the fetus is in a state of forming but not yet formed. Blood from the lower jiao moves to the middle jiao to protect the embryo, causing the lower jiao to become deficient, hence the slight weakness of the pulse. After this stage, when the fetus is formed, the 'yin pulsation' and 'pulse not ceasing upon pressure' will gradually appear. Regarding the four sentences on 'incorrect medical treatment': Pregnancy reaches sixty days, which is one month short of the three-month mark for fetal formation. At this stage, the shape is merely a clump of coagulated blood; how can medication tolerate even slight error? If mistaken medication causes vomiting and diarrhea, disaster will follow immediately. 'Stop medication' (Jue zhi) clearly explains the reason and guides the patient using the concept of 'medication abstinence' from the *I Ching*. Why use Guizhi Tang? Because the body has symptoms but the pulse is normal, and there are no external cold-heat pathogens. All warming, cooling, tonifying, and draining agents are imperfect; only Guizhi Tang, which harmonizes yin and yang, is appropriate.
The student asked, "Chao Yuanfang stated: In the first month of pregnancy, named 'beginning of form,' the Foot Jueyin Liver Meridian nourishes it. In the second month, named 'beginning of paste,' the Foot Shaoyang Gallbladder Meridian nourishes it. In the third month, 'fetus' begins, and the Hand Jueyin Pericardium Meridian nourishes it; at this time, blood circulation slows, and the image begins to transform. In the fourth month, it receives water essence to form blood vessels, nourished by the Hand Shaoyang Triple Burner Meridian. In the fifth month, it receives fire essence to form qi, nourished by the Foot Taiyin Spleen Meridian. In the sixth month, it receives metal essence to form sinews, nourished by the Foot Yangming Stomach Meridian. In the seventh month, it receives wood essence to form bones, nourished by the Hand Taiyin Lung Meridian. In the eighth month, it receives earth essence to form skin and flesh, nourished by the Hand Yangming Large Intestine Meridian. In the ninth month, it receives stone essence to form hair and nails, nourished by the Foot Shaoyin Kidney Meridian. In the tenth month, the five zang organs, six fu organs, joints, and human form are all complete. Chen Liangfu followed this theory, distributing the Five Elements across the four seasons. Xu Zhicai distributed specific months to predict symptoms and prescribe herbs. Should we adopt these various theories?"
The Master replied, "The theory of monthly meridian nourishment of the fetus was created by the Chao family in the Sui Dynasty, and Zhang Zihe already refuted its fallacy. One must know that after conception, the qi and blood of all twelve meridians gather together to nourish the fetal origin. How could one meridian nourish the fetus in a specific month? And how could there be a rule that a specific month must present specific symptoms requiring specific prescriptions? This is mere talk from the outskirts of Qi; we must not repeat it to defile our mouths.
The student asked, "Contemporary doctors pass down a mantra stating 'there is no cold before pregnancy.' Our local gynecology schools all follow this view. However, this view aligns much with Zhu Danxi's school, yet contradicts *Jingui Yaolue* significantly. *Jingui Yaolue* states: 'In the sixth or seventh month of pregnancy, if the pulse is wiry, there is fever, the fetus feels more distended, abdominal pain with aversion to cold, and the lower abdomen feels like it is being fanned by the wind. The reason is that the Zi Zang (uterus) is open. It should be treated with Fuzi Tang to warm the organ.' Zhang Zhongjing's use of Fuzi Tang for calming the fetus has profound significance. Today, people discard it and do not use it. Is it that ancient methods are unsuitable for modern use?"
The Doctor replied, "What is precious in medicine, besides diligent study, is having enlightened teachers and helpful friends. By daily comparing the symptoms treated with those in the classics and discussing them together, one discovers the subtleties. When he says 'sixth or seventh month,' it implies that before this period, the body had no major illness. Now, the pulse is wiry; wiry is a yin image. The body has fever; fever is floating yang. The fetus feels more distended; distension indicates deficiency-cold. Why use the character 'yu' (more/increase)? 'Yu' means 'increased.' From this single character, I know this woman's internal organs were originally deficient and cold, with frequent mild distension. Now, due to illness, the distension increases, hence 'yu.' This character also helps determine the pulse. Wiry indicates yin abundance internally; fever indicates yang repelled externally. Furthermore, the human body divides yin and yang by back and abdomen. The back is yang, including the head and neck; the abdomen is yin, including the large and small abdomen. Now, pain and aversion to cold are not in the yang parts (back and head/neck) but in the yin part (abdomen). Specifically, above the navel at Zhongwan and Xiawan belong to Taiyin Kun Earth and Yangming Middle Earth. Below the navel is the small abdomen, belonging to Shaoyin Water Organ and Bladder Water Fu. The sides of the small abdomen are called Shaofu, where the Jueyin Liver and the Sea of Blood (Zigong/Uterus) reside. Saying 'lower abdomen feels like fanning' actually refers to uterine deficiency-cold failing to perform its closing and storing functions, so cold qi in the yin region blows gently like a fan. The formula Fuzi Tang is missing in *Jingui Yaolue*, but it is undoubtedly the Fuzi Tang from the Shaoyin Chapter of *Shanghan Lun*. *Zhangshi Yitong* states: 'People generally consider Fuzi the chief among drugs causing abortion, yet Zhang Zhongjing uniquely regards it as a holy medicine for calming the fetus. Unless one understands it divinely, one dares not try it lightly.'
The student asked, "In the second or third month of pregnancy, symptoms like irritability, aversion to food, and vomiting are medically termed 'E Zu' (Bad Obstruction). After conceiving, if the abdomen often hurts, it is medically termed 'Bao Zu' (Womb Obstruction). But 'E Zu' has no name in *Jingui Yaolue*, whereas 'Bao Zu' does. 'Zu' means obstruction/blockage. Blocked things should be unblocked. How can preservation of the fetus use unblocking methods? Otherwise, why call it 'obstruction'?"
The Master replied, "Although *Jingui Yaolue* lacks the name 'E Zu,' Section 1 states: 'Thirst, inability to eat, no chills or fever, named pregnancy, treated with Guizhi Tang.' Some versions read 'thirst' as 'vomiting.' Commentators call this 'E Zu,' and *Chanbao* calls it 'Zi Bing' (Fetal Disease). For incessant vomiting, *Jingui Yaolue* uses Banxia Renshen Wan (Pinellia and Ginseng Pill), indicating cold-fluid retention in the stomach. If vomiting is due to stomach heat rising, *Qianjin Fang* modifies this formula by replacing Ganjiang (Dried Ginger) with Shengjiang (Fresh Ginger), adding Fuling (Poria), Maidong (Ophiopogon), and heavy doses of Xian Zhuru (Fresh Bamboo Shavings), prepared as a decoction, which is very effective. The formula uses Banxia (Pinelliae Rhizoma) for its pungent flavor to descend rebellious qi; pungency is fierce, directly unblocking the obstruction. Lou Quanshan and Xue Lizhai both regard this as an excellent formula for E Zu. Gao Gugeng stated that used with Renshen (Ginseng) and Baizhu, it not only harms the fetus not at all but greatly strengthens the spleen and calms the fetus. I find Liu Junzi Tang (Six Gentlemen Decoction) highly effective. As for Bao Zu, *Jingui Yaolue* discusses it together with Lou Xia (Leaking Bleeding, colloquially 'washing the经期'), Ban Chan (Miscarriage at 4-5 months), post-miscarriage continuous bleeding (damaging the Sea of Blood), and pregnancy bleeding due to pathogenic factors (*Jingui* uses Guizhi Fuling Wan to drain the pathogen and calm the fetus). This is because Bao Zu and these conditions are all governed by the Chong and Ren meridians; though the diseases differ, their source is the same. Moreover, fetal qi originates from the internal formation of yang essence and external nourishment by yin blood. Now, yin blood coagulates and obstructs the fetus, lacking harmony. Yin congeals in the yin position, causing abdominal pain. The book says: 'Unblocking relieves pain.' Unblocking is thus calming; only Jiao'ai Tang fits perfectly. Also, Bao Zu and leaking bleeding result from yin-yang failing to embrace each other and Kun Earth failing to defend. *Jingui Yaolue* created this formula to govern all these diseases. Subtle! Subtle! In the formula, Xiong (Chuanxiong) and Gui (Danggui) unblock yang-blood; Shao (Baishao) and Di (Shudihuang) unblock yin-blood. Coupled with Ejiao (Donkey-hide Gelatin), a substance of flesh and blood, similar follows similar to nourish, allowing yin-yang to embrace. Gancao (Licorice) moderates the center and resolves urgency. Aiye (Mugwort Leaf) warms the uterus, assisting Fire to generate Earth, allowing Kun Earth to defend. Thus, it is an excellent formula for regulating menstruation, stopping leakage, calming the fetus, and nourishing blood.
Further question: "*Jingui Yaolue* states: 'For abdominal [pain] in women, Danggui Shaoyao San (Angelica and Peony Powder) is the main treatment.' Is this also Bao Zu?"
The Master replied: "[Pain] here refers to a slight, lingering pain. It arises because Spleen deficiency allows Water to overwhelm, stagnating and seeking extension but unable to achieve it, resulting in lingering pain. Danggui Shaoyao San should be used to leach out dampness. This differs from the treatment of Bao Zu.
The student asked, "*Jingui Yaolue* states: 'For pregnancy in women, Danggui San should be used'; this is a method of calming the fetus via cooling tonification. It also states: 'For nurturing the fetus in pregnancy, Baizhu San should be used'; this is a method of calming the fetus via warming tonification. Now, everyone follows Danxi's saying that 'Huangqin and Baizhu are the holy medicines for calming the fetus.' Can the method of using Shujiao (Sichuan Pepper) in Baizhu San be permanently abolished? What does the Master think?"
The Master replied: "Both formulas feature Baizhu as the principal herb; calling Baizhu the holy medicine for calming the fetus is acceptable. However, pairing it with Huangqin creates a biased statement. Generally, thin people have much fire; excessive fire consumes blood and damages the fetus, so Danggui San is suitable. Fat and white people have exterior excess and interior deficiency; deficiency generates cold, and the fetus fails to grow, so Baizhu San is suitable. My wife used to miscarry every time she reached three months of pregnancy. Following Danxi's method, I administered medication five times, resulting in five miscarriages. Later, when I went to the provincial capital for exams, my wife's pregnancy reached three months, with red spotting threatening miscarriage. My late mother invited a clan uncle, Dr. Yan Yi, who prescribed Siwu Tang (Four Substance Decoction) plus Lujiaojiao (Donkey-hide Gelatin), Buguzhi (Psoraleae Fructus), Duzhong (Eucommiae Cortex), and Xuduan (Dipsaci Radix), each 2 qian. One dose stabilized her. She was instructed to take it once every ten days. When I returned home six months later, I saw the prescription and was greatly shocked! I sighed: 'Buguzhi is recorded in Bencao as causing abortion. Combined with the warmth of Lujiaojiao and Duzhong, and the moving action of Xiong and Gui, how could it be so effective! If I had been home, I would surely have argued against it, and we would have used Huangqin and Baizhu, causing another miscarriage!' Since then, whenever encountering threatened miscarriage with spotting, I dare not exclusively use blood-cooling methods. For habitual miscarriages occurring at term, I exclusively treat based on severe deficiency. Bian Que said: 'The Mingmen (Gate of Life) is where men store essence and women attach the womb. Pregnancy attaches to the Mingmen. The fire of the Mingmen is Yuan Qi (Original Qi). Nourishing the fetus with this gives it the momentum of daily growth.' It is like fruit born in spring and formed in summer; if sudden abnormal cold air and cool winds occur in spring or summer, the fruit will wither and fall. Only by using strongly tonifying and warming agents to keep the uterus constantly warm will the fetus grow daily to term. For those not habitually prone to miscarriage, there is no need to make a mountain out of a molehill. After conceiving, to prevent spotting and miscarriage, one should only use mild tonification. My newly formulated Suoyi Zai Wan is most effective.
The student asked, "In your previous commentary on the *Three Character Classic*, you quoted Xu Zhongke: 'In the pregnancy chapter of *Jingui Yaolue*, there are ten formulas in total, seven pills/powders and three decoctions. This is likely because decoctions are sweeping/aggressive; since pregnancy requires calming the fetus, both attacking and tonifying methods should be slow, not drastic.' But among the ten formulas, some are not recorded. Do you know why?"
The Master replied: "The insights of the ancients were a hundredfold greater than ours. For those whose profound mechanisms were not fully understood, fearing that needle-points could not meet (i.e., treatments might clash or fail), and to avoid misleading future generations, they temporarily omitted them. Moreover, I rarely use Danggui San and Baizhu San myself.
The student asked, "Wang Haicang takes Siwu Tang in equal proportions, adds two herbs according to the specific disease, naming it Liuhe Tang (Six Harmonies Decoction). It drives away disease without harming the fetus, and is simple and convenient. Why doesn't the Master record all of them as a method?"
The Master replied: "Siwu Tang is the master formula for gynecology. Wang Haicang took it to protect the fetus. Once the fetus is protected, harsh agents for cold, heat, attack, and tonification act outside the fetus to remove disease, leaving the fetal origin safe. This method is clever and applicable. However, for Shanghan (Cold Damage), additions should follow the Six Channels; for miscellaneous diseases, additions should follow the principal herbs for each disease. It is difficult to predetermine exactly which herbs to add. Furthermore, Wang Haicang's addition of Mahuang (Ephedrae Herba) and Xixin (Asari Radix) to the exterior-excess formula is not a major error; but adding Fangfeng (Saposhnikoviae Radix) and Cangzhu (Atractylodis Rhizoma) to the exterior-deficiency formula is far off! Why not simply say 'combine with Mahuang Tang' or 'combine with Guizhi Tang'? Let me deduce his intent and correct it:
* **Zi Man** (Fetal Distension): The pregnant woman suddenly presents with whole-body swelling. This is water retained in the fetus, water fighting with blood. Add Baizhu, Chenpi (Citri Reticulatae Pericarpium), Fuling, and Zexie (Alismatis Rhizoma) to the front formula.
* **Zi Qi** (Fetal Qi Stagnation): The disease is in qi, not water. Qi stagnation causes swelling of the instep, panting, chest oppression, irritability, and poor appetite. Severe cases exude yellow fluid from toes. Remove Dihuang from the front formula, add Xiangfu (Cyperi Rhizoma), Zisu (Perillae Folium), Chenpi, Tianxianteng (Akebiae Caulis), and Zhi Gancao (Prepared Licorice). Do not lightly use Kuizi Fuling San from *Jingui Yaolue*.
* **Zi Xuan** (Fetal Suspension): He Bozhai considers this turbid qi lifting the fetus upward. Fetal heat and rebellious qi cause heart and stomach fullness. Remove Dihuang, add Zisu, Chenpi, Dafupi (Arecae Pericarpium), Renshen, Gancao, and Shengjiang.
* **Zi Fan** (Fetal Irritability): Mental restlessness, dry mouth, and irritability. Add Maidong, Zhimu (Anemarrhenae Rhizoma), Zhuye (Bamboo Leaf), Renshen, and Gancao.
* **Zi Lin** (Fetal Strangury): Pregnant woman has scanty, difficult urination. This is Lung dryness preventing Heaven Qi from descending; add Tiandongdong (Asparagi Radix) to clear. Kidney dryness prevents Earth Qi from ascending; add Xixin to moisten. Assist with Mutong (Akebiae Caulis) and Fuling to promote urination, and Renshen and Gancao to tonify deficiency. This embodies the meaning of Anrong San from Bencao. *Jingui Yaolue* states: 'Pregnancy with difficult urination but normal diet is treated with Danggui Beimu Kushen Wan.' The gist is that Lung regulation acts on the Bladder, removing heat pathogens and stopping dribbling.
* **Zhuan Bao** (Reversed Uterus/Cystoptosis): Different from Zi Lin and difficult urination. Caused by weak constitution, depression injuring Spleen, impatience injuring Liver, or holding urine. Generally, the fetus presses down on the bladder, twisting the bladder ligaments and blocking flow. Symptoms include acute lower abdominal pain, inability to urinate, and potentially death. The fetus must be lifted to the center, relaxing the ligaments so water pathways open. Add Renshen, Baizhu, Chenpi, Banxia, Shengma (Cimicifugae Rhizoma), and Shengjiang to the front formula, taken on an empty stomach. Or, induce vomiting after taking medicine, then take medicine again. *Jingui Yaolue* also says: 'Promoting urination alone cures it; use Shenqi Wan (Kidney Qi Pill).' The idea is that Shenqi Wan replenishes Qi in the Kidney center, supporting the bladder to return to its proper position, surrounded by abundant Great Qi, thus achieving miraculous effects.
* **Zi Sou** (Fetal Cough): Pregnancy cough due to excessive Fire overcoming Metal. Add Sangbaipi (Morus Alba Bark), Tiandongdong, Ziwan (Asteris Radix), Zhuru, and Gancao.
* **Zi Xian** (Fetal Convulsion): Sudden fainting, loss of consciousness, eyes rolled back, jaw clenched, opisthotonos during pregnancy. Due to internal stirring of Liver Wind, with Fire riding the Wind to erupt rapidly. Add Lingyangjiao (Saiga Antelope Horn), Gouteng (Uncariae Ramulus cum Uncis), Zhuli (Bamboo Sap), Beimu (Fritillariae Bulbus), and Jiangcan (Bombyx Batryticatus). For severe cases, intermittently use Fengyin Tang, followed by Zhuyeshigu Tang and Jizidan Huanglian Tang for emergency rescue.
* **Zi Ming** (Fetal Crying): Sound of crying heard inside the pregnant abdomen. This is a lump under the umbilicus held in the baby's mouth. When the pregnant woman climbs high and raises her arms, the lump falls out of the baby's mouth, making this sound. Add Fuling and Baizhu to the front formula. Scatter coins on the ground and instruct her to pick them up from a bending position. Within 1-2 ke (time units), the lump re-enters the baby's mouth, and the crying stops.
* **Zi Yin** (Fetal Aphonia): Sudden loss of voice in the 8th or 9th month of pregnancy. The fetus attaches to the Kidney; the Kidney meridian nourishes the root of the tongue. Now, fetal qi congestion blocks the Kidney meridian. One should wait quietly for delivery, after which it heals itself. Alternatively, add Fuling and Yuanzhi (Polygalae Radix) to the front formula; one or two doses suffice.
All such cases are endless. Students should understand them through conceptual application.
The student asked, "What is the pulse of a pregnant woman?"