妊娠腹痛名胞阻，须审心腹少腹间，伤食心胃胎腰腹，少腹胞寒水尿难。
【注】孕妇腹痛，名为胞阻。须审其痛，或上在心腹之间者，多属食滞作痛；或下在腰腹
之间者，多属胎气不安作痛；若在少腹之间者，则必因胞血受寒，或停水尿难作痛也。
加味平胃散 延胡四物汤
心胃痛多伤食滞，苍朴陈甘果枳曲，便秘加军倍甘草，胎动延胡四物宜。
【注】孕妇心胃作痛者，多因伤食停滞。宜平胃散，即陈皮、浓朴、苍术、甘草也，加
草果、枳壳、神曲以消之。若更大便秘结，日久则加硝、黄以攻之，然必倍甘草以缓其峻
性，庶不伤胎。若腰腹作痛，胎动下血，则当用四物汤，君以延胡，以定痛而保胎也。
四物汤（方见首卷）
加味胶艾四物汤 蜜硝汤
腹腰痛甚防胎堕，胶艾四物杜酒葱，外邪宜加羌独活，内热便秘蜜硝攻。
【注】胞蒂系于腰。凡腹腰痛者，须防胎堕。宜用胶艾四物汤，加杜仲、大豆淋酒、葱
白以定痛而保胎。若因外感风寒之邪，则加羌活、独活以散之；若内热、大小便闭者，则
用蜂蜜、芒硝煎汤以攻之。经曰“有故无陨”是也。
胶艾四物汤（方见首卷）
加味芎归饮 导赤散 五苓散
胞血受寒少腹疼，参吴胶艾草归芎。尿涩热甚导赤散，木通生地甘草灵。水盛阳虚五苓效，术
泽肉桂茯猪苓。
【注】少腹作痛者，乃胞中之血受寒也。宜加味芎归饮温之，其方即人参、吴茱萸、阿
胶、蕲艾、炙甘草、当归、川芎也。若因尿涩而痛，则是膀胱水病热甚，则以导赤散清
利之，其方即生地、木通、甘草也。若水盛相虚不化，则以五苓散渗利之，其方即茯苓、
白术、泽泻、猪苓、肉桂也。
Abdominal pain during pregnancy is termed "Bao Zu" (Placental Obstruction), and it is necessary to carefully distinguish whether the pain is located in the epigastrium/abdomen or the hypogastrium. Pain in the heart and stomach region is mostly due to food stagnation; pain involving the lower back and abdomen is mostly due to fetal unrest; pain confined to the hypogastrium is necessarily caused by cold invading the blood of the uterus, or by fluid retention leading to difficult urination.
[Note] Abdominal pain in pregnant women is named Bao Zu. One must examine the location of the pain: if the pain is in the upper area between the heart and abdomen, it mostly belongs to pain caused by food stagnation; if the pain is in the lower area between the waist and abdomen, it mostly belongs to pain caused by fetal unrest; if the pain is in the hypogastrium, it is definitely due to cold affecting the uterine blood, or pain caused by fluid accumulation and difficult urination.
Jiawei Pingwei San (Modified Pingwei Powder) and Yanhu Siwu Tang (Yanhusuo Four Substances Decoction)
Pain in the heart and stomach region is mostly caused by food stagnation; use Cangzhu, Houpo, Chenpi, Gancao, Zhike, Shenqu (i.e., Jiawei Pingwei San); if accompanied by constipation, add Jun (Dahuang/Rhubarb) and double the dosage of Gancao; if there is fetal movement, Yanhu Siwu Tang is suitable.
[Note] Heart and stomach pain in pregnant women is mostly due to food stagnation. It is appropriate to use Pingwei San, which consists of Chenpi, Houpo, Cangzhu, and Gancao, plus Caoguo, Zhike, and Shenqu to resolve stagnation. If stool is severely constipated for a long time, Mangxiao (Natrii Sulfas) and Huanglian (actually Huangqin/Huangbo? Context implies Dahuang/Mangxiao for purging, text says Xiao, Huang - likely Mangxiao and Dahuang) can be added to purge, but Gancao must be doubled to moderate its harsh nature, thereby not harming the fetus. If there is pain in the waist and abdomen with fetal movement and bleeding, Siwu Tang (Four Substances Decoction) should be used, with Yanhusuo as the sovereign herb, to relieve pain and secure the fetus.
Siwu Tang (Formula seen in Volume 1)
Jiawei Jiao'ai Siwu Tang (Modified Jiao'ai Four Substances Decoction) and Mixiao Tang (Honey and Mangxiao Decoction)
Severe abdominal and lumbar pain requires prevention of miscarriage; use Jiao'ai Siwu Tang plus Duzhong, Daoudou Linjiu (Soybean soaked wine), and Congbai (Scallion white); if due to external pathogenic factors, add Qianghuo and Duhuo; if due to internal heat and constipation, use Honey and Mangxiao to purge.
[Note] The placenta is attached to the waist. Whenever there is abdominal and lumbar pain, one must guard against miscarriage. It is appropriate to use Jiao'ai Siwu Tang, adding Duzhong, Daoudou Linjiu, and Congbai to stabilize pain and secure the fetus. If it is due to external invasion of Wind-Cold pathogens, then add Qianghuo and Duhuo to disperse them; if there is internal heat and closure of both large and small bowels, then use Honey and Mangxiao decocted in water to purge. As the classics say: "Yougu Wuyun" (When there is an existing pathology, the medicine will target the pathology without injuring the mother).
Jiao'ai Siwu Tang (Formula seen in Volume 1)
Jiawei Xionggui Yin (Modified Xiongui Drink), Daochi San (Guide Out Red Powder), and Wuling San (Five-Ingredient Powder with Poria)
Cold invading the uterine blood causes hypogastric pain; use Renshen, Wuzhuyu, Ejiao, Aye, Zhigancao, Danggui, Chuanxiong (i.e., Jiawei Xionggui Yin); if urine is涩 (astringent/difficult) and pain is severe with heat, use Daochi San (Mutong, Shengdi, Gancao); if water abundance and Yang deficiency prevail, Wuling San is effective (Baizhu, Zexie, Rougui, Fuling, Zhuling).
[Note] Pain in the hypogastrium indicates that the blood in the uterus has been affected by cold. It is appropriate to use Jiawei Xionggui Yin to warm it; this formula consists of Renshen, Wuzhuyu, Ejiao, Qi Ai, Zhigancao, Danggui, and Chuanxiong. If the pain is due to difficult urination, this is a disorder of bladder water metabolism with severe heat, so use Daochi San to clear heat and promote diuresis; this formula consists of Shengdi, Mutong, and Gancao. If water abundance and Kidney Yang deficiency prevent transformation, use Wuling San to leach out dampness; this formula consists of Fuling, Baizhu, Zexie, Zhuling, and Rougui.