脾胃愈虚而愈不安矣。
漏胎下血 妊娠经水。壅之以养胎。蓄之以为乳。若经水时下。此冲任气虚。不能约制而然。
千金云。妊娠血下不止。名曰漏胞。血尽则死。宜服干姜地黄散。气虚乏力少食者。宜益气固胎。
切勿泛用养血之剂。四君子去茯苓加胶、
艾、芎、归、黄 、砂仁。若漏血腹痛者。芎、归、人参、阿胶、大枣煎服。若因郁怒发热内热。
加味逍遥散。若血虚至夜发热。当归补血汤。劳动脾火。加味归脾汤。若因房事下血过多作痛。
八珍汤加胶、艾。脾胃虚陷。补中益气倍升、柴。风热。加防风、黄芩。月数将满而漏血者。此
必不守禁忌所致。亦有瘀血凝滞。不能转运而下者。气血先伤。后必难产。宜服紫苏饮。或用益
母草熬膏。肥人。砂仁汤调下。虚人。人参汤调下。妊娠三月。其经月来三五次。但不多。饮食
精神如故。此血气有余。儿大自不来矣。若作漏胎治之。其胎必堕。胎漏黄浆。或如豆汁。若肝
脾湿热。用升阳除湿汤。肝脾风热加味逍遥散。肝脾郁结。加味归脾汤。脾胃气虚。七味白术散。
脾气下陷。补中益气汤。肝经风热。防风、黄芩作丸服。风入肠胃。胃风汤。大全方治妊娠忽然
下黄汁如膏。或如豆汁。胎动腹痛。用黄 一两。川芎一钱。糯米一合煎服。暴下水者。其胎必
下。若徐徐而下者。可用补气安胎药主之。
惊胎僵仆 妊娠负重跌扑。凝血作痛。欲服活血药则恐伤胎。不服则伤血不去。治之当辨胎
之死生。如无别证。只用黑糖熬枯。入红酒童便调服。细嚼连皮胡桃肉过口。死者当下。生者其
痛即止。如余伤未尽。痛未止。四乌汤加延胡、木香。伤去而胎气未安。紫苏饮加童便、砂仁。
伤重者。香壳散加熟地、当归以护胎。势剧者。下瘀血汤加芎、归酒煎以去血。血去则胎自安。
然须详慎。若昏睡语言如狂。此血迫心包。当归活血汤。如腹中重坠。按之冰冷。此胎气已伤。急
用香桂散加酒大黄、生附子下之。若口中觉秽气者。急用平胃散加芒硝。下逐之。若因怒跌仆。
或手足抽搐者。紫苏饮加钩藤钩子。去血过多。八珍汤去茯苓加胶、艾、黄 。
胎上逼 妊娠胎动气逆。皆由调养失宜。致胎逆上。紫苏饮为必用之药。饮食不甘。兼四君
子。有热。加芩、栀、归、芍。
若恼怒伤肝。致胎逆上。加味逍遥散。因郁结伤脾。胎气不安。加味归脾汤。大抵胎气逆上。皆
属火旺。急用芩、术、香附之类。不可服大寒之药。反致他变。妊娠遍身痛。或冲心欲死。不能
饮食。缘胎有水致痛也。千金鲤鱼汤。或用白术五钱。黄芩二钱。白芍四钱。入活鲤鱼约重半斤
外一尾。煮汤代水煎服。妊娠胎动。昼夜呼叫。口噤唇搴。及下重痢不息者。用艾叶五两。以好
酒五升。同煮三升。去滓更煎。取一升服。口闭者。开口灌之。药下即瘥。临月胎上逼心。呕
哕欲死。急用童子小便灌之即下。或乌梅肉十枚。研烂入生姜三片。煎汤灌之亦下。取酸以降敛
之。兼辛以散火气之逆也。
陈良甫治一妇。孕七月。忽然胎上冲心而痛。坐卧不安。医治不效。又作死胎治。而用蓖麻、
麝香研贴脐中。命在垂亡。陈诊之。两尺脉皆绝。他脉和平。曰。此子悬也。若是胎死。必面赤
舌青。今面不赤。舌不青。其子未死。是胎上逼心。以紫苏饮治之。十服而胎安矣。
安胎 妇人半产。多在三个月及五月七月。除跌扑损伤外。因内热而虚者为多。曰热曰虚。
当分轻重。若前次三个月而堕。则下次必如期复然。盖先于此时受伤。故复至期必应。乘其虚也。
遇有半产者。须多服养气血固胎息之药。以补其虚损。下次有胎。先于两个月后。即用固胎药十
数服。以防三月之堕。其有连堕数次。胎滑甚者。服药须多。久则可留。八珍加陈皮、胶、艾、
条芩。多气。加香附、砂仁。肥盛有痰。加半夏。若瘦而多渴者禁用。怀妊三四月。肥盛色白气
虚者。用白术一倍。人参、续断、山药、香附各半倍。枳实汤泛为丸。朝暮砂仁汤下三钱。肥盛
色苍气实者。不须服药。至七八个月。但服砂仁汤或紫苏汤足矣。瘦而色白虚弱者。白术二倍。
人参一倍。山药、续断、芎、归各半倍。陈米饮
和丸。朝暮沸汤下三钱。瘦而色苍血热者。酒煮条芩。四制香附各一倍。四物各半倍。蜜丸。朝
暮沸汤下四钱。至八九月。肥盛色苍者。必用枳壳、苏梗以顺其气。慎不可用补气之药。非但参、
术当禁。浓味亦宜节省。肥白气虚者。则人参、白术必当加用。但补气药中。必兼香附、砂仁以
流动其气。若色白怯弱者。全以补养气血为主。非但枳壳、苏梗辈不可用。即砂仁亦不宜也。误
耗其气。必致难产。若色苍形瘦者。此气血流薄。当无难产之患。或久抱郁结之气。间或有之。
多服逍遥散可也。有误服行胎毒药胎动不安者。古法用生甘草、黑豆、淡竹叶煎服。若发热。用
香豉。然不若频与热童便尤良。以其能解药毒也。血下不止。或上溢而为吐衄者。四物换生地加
阿胶、山栀、炒黑蒲黄。若胎伤不安者。消息缓急虚实治之。凡妊娠脉宜滑利数实。大忌迟涩浮缓。
半产 半产俗名小产。盖由冲任气虚。不能摄养。或 扑闪坠。致气血损动。或因热病温疟
之类。薛立斋云。半产重于大产。盖大产如果熟自脱。小产如生采。破其皮壳。断其根蒂。岂不
重于大产。但人轻忽致死者多。治法。宜补形气。生新血。去瘀血。若未足月。痛而欲产。八珍
去茯苓、熟地。加胶、艾、 、草。若胎下而血不止。参、 、术、草、胶、艾、归、芍之类。
有热。加炮姜、茯苓。半产而心腹痛。或发寒热。以手按之愈痛者。宜散瘀血。芎、归、延胡、
桃仁、香附、丹皮、泽兰、童便之属。若按之则痛缓。是血虚。八珍去芍加炮姜。若痛而呕吐作
泻。是胃虚。六君子加炮姜。凡胎气弱欲小产者。八珍汤固之。若出血过多而发热。圣愈汤。汗
不止。急用保元汤。发热烦躁肉 筋惕。十全大补汤。大渴面赤。脉洪而虚。当归补血汤。身热
面赤。脉沉而微。四君子加姜、附。
东垣云。妇人分娩。及半产漏下。昏冒不省。瞑目无所知觉。盖因血暴亡。则心神无所养。
心包络火上炽。故令昏冒火。
胜其肺。故令瞑目不省人事。慎不可用寒凉泻火之药。盖瞑目之病。悉属于阴。即如伤寒郁冒。
得汗而解。必当补而升举之。古法用全生活血汤。其间风药庞杂。而无阳生阴长之功。宜补中益
气加门冬、五味。或大剂独参汤尤妥。血若暴下。是秋冬之令太旺。今举而升之。助其阳则目张
而神不昏矣。
石顽治一妇。怀孕六月。因丧子悲哭动胎。医用黄芩、白术辈安胎药二服不应。改用枳壳、
香附、紫苏、砂仁理气。一服胎遂上逼心下。胀闷喘急。口鼻出血。第三日午后来请石顽。薄暮
往诊。其脉急疾如狂风骤雨。十余至则不至。顷之复至如前。因谕之曰。此孕本非好胎。安之无
益。不若去之。以存母命。因思此胎。必感震气所结。震属木。惟金可制。令以铁斧烈火烧红。
醋淬。乘热调芒硝末一两灌之。明日复来请云。夜半果下异胎。下后脉息微和。神思恍惚。所去
恶露甚多。又与安神调血之剂。数服而安。
胎不长养 石顽曰。胎之长养。皆赖母之脾土输气于其子也。脾为一身之津梁。主周身之运
化。在脏为土。长养万物。莫不由此。故胎之生发。虽主肾肝。而长养实关乎脾。所以治胎气不
长。必用八珍、十全、归脾、补中之类。助其母气。其胎自长。多有延至十二三月而产者。观瘠
薄之土。虽艺不获。得沃泽灌溉。便能成实。义可见矣。亦有妊母气血自旺而胎不长者。此必父
气之孱弱。又当大剂保元专补其气。不得杂一味血药助母。则子气方得受益。复有胎气因妊母举
动失措。致儿内失荣养。不能长发。仍不陨坠者。此与果实干萎在枝无异。以妊娠气血无恙。但
子不得禀母气耳。非若妊娠有疾。枝伤果坠之比也。
过期不产 月数过期而不产者属气虚。亦有因胎漏而产迟者。尝见妊娠下血。胎虽不坠其气
血亦亏。多致逾
年不产。或十四五月而产者。俱是气血不足。胚胎难长故耳。凡十月之后不生者。当大补气血。
庶分娩无忧。又过期不产而脉沉细。但当脐下悸动。此为瘀积化水。当作鬼胎治之。
许裕卿治邵涵贞内子。孕十七月不产。不敢执意凭脉。问诸情况。果孕非病。但云孕五月以
后不动。心窃讶之。为主丹参一味。令日服七钱。两旬余胎下。已死而枯。其胎之死。料在五月
不动时。经十三月在腹。不腐而枯。如果实在树。败者必腐。然亦有不腐者。则枯胎之理可推也。
石顽曰。余昔治马云生妇。孕十三月不产。脉来微结。为处十全大补汤。服至二十余剂而下。胎
枯色白。所治虽异。而胎枯则一也。
咳嗽 娠妇咳嗽。悉以安胎为主。风邪伤肺。香苏散。寒邪伤肺。小建中汤。若肺胃气虚。
异功散。脾肺气虚。六君子加当归。久嗽不愈者。多因脾肺气虚。腠理不密。复感外邪。或因肺
虚阴火上炎所致。有外邪者。内补当归建中汤加细辛。阴火炎者。六味丸加麦冬、五味。
子烦 妊娠苦烦闷。头目昏重。是心肺虚热。或痰积于胸。吐涎恶食。千金竹沥汤。若吐甚
则胎动不安。烦闷口干。不得眠者。加味竹叶汤。气虚者。倍人参。气滞。紫苏饮。痰滞。二陈
加白术、黄芩、枳壳。胁满寒热。小柴胡。脾胃虚弱。六君子加紫苏、山栀。
类中风 此证若不早治。必致堕胎。宜服紫苏饮。若口噤不能言。用白术三钱。荆芥穗二钱。
黑豆三合。炒淋酒煎服。得汗即愈。口噤者。拗口灌之。可服三四剂。至有目昏黑而厥者。胎前
绝少。但一有此证。即是儿晕。属气与痰。故目昏黑发厥。只服紫苏饮。慎不可服苏合香丸。及
乌药顺气散等。
伤风 妊娠伤风。香苏散去香附加葱、豉。咳嗽多痰。加桔梗。或紫苏饮加葱、豉。安胎
为妙。嗽兼泻。气口脉滑实有力。中有宿食者。胃苓汤去苍术。俟脾胃实而治嗽。总不如浓煎葱
头汤为上。盖风药皆能堕胎。故嗽喘胎寒。多用连须葱汤。大能安胎散气。胎始无虞。或加香豉
尤妙。若不喘者。紫苏饮加砂仁。童便。
伤寒 冬时为寒所伤。轻者淅淅恶寒。翕翕发热。微嗽鼻塞。数日乃止。重者头疼作痛。
先寒后热。久则伤胎。药多避忌。不与常妇概治。但服葱白香豉汤。汗出则愈。千金治妊娠伤寒。
用葱白十茎。生姜二两。水煎热服。取汗即安。治妊娠热病。用葱白五茎。香豉一升。如前服法
取汗。若胎伤未死。但用葱一把。水煮食之。汗出即安。若胎已死。须臾自出。不应。加生姜、
苏叶。不可轻用发表药。若用发表。岂但堕胎。母命难保。惟葱白香豉汤、香苏散。可解邪气。
又可安胎。妊娠温热时行及伤寒邪气内犯。热毒迫胎。并宜千金石膏大青汤急救。庶可保全。迟
则不救。凡胎前疫证。与伤寒阳明府证。内实便秘。须急通大便。方不损胎。若大便自利者。真
气下泄。胎必难保。惟大小便如常。知里无热。则不伤胎气。
疟 妊娠 疟。无论胎息月数多少。总以安胎为主。而举世安胎。无过黄芩、白术。原夫胎
息之安与不安。全在母气之调与不调。故安胎先安母气。安有母气乖戾。胎气独安之理。当知黄
芩之安胎。惟治热盛胎动不宁。白术惟主脾虚不能保胎。设气虚胎气下坠。误用黄芩。气滞胎不
转运。误用白术。滋害何可胜言。所谓先安母气者。随其形体之肥瘦。气血之偏胜也。若妊娠形
盛色苍。肌肉 坚者。必多湿多痰。无论何疾。必显湿热本病。脉多滑实有力。绝无虚寒脉弱之
候。可峻用豁痰理气药治其本质。然后兼客邪见证而为制剂。治宜二陈汤随经加透表药。或合小柴
胡用之。盖柴胡为疟证之向导。故多用之。然有自汗过多。尺中微弱。或热盛手足清者。始终不
用柴胡。而用建中、桂、芍收功者。或见烦渴脉实。大便六七日不通。阳明府实。又宜凉膈去硝
黄加鲜首乌调之。须知禀质坚固者。其气多滞。内外壅遏。但有湿热。绝无虚寒之患。如元气本
弱。或病后得之。必需理脾行气。惟六君子汤为合剂。有痰食结滞。则加枳实、草果。内有寒。
则加炮姜。外有风。即加桂枝。胎动上逆不安。则加子芩。胎下坠。则加柴胡倍人参。以人参为
举胎圣药也。间有不应者。又需补中益气。大剂人参以升举之。中有留滞。则枳实理中加柴胡、
桂枝。合表里而治之。若夫日作间作。日晏日早。昼发夜发。寒多热多。及审饮食便溺动静安危
之法。则与常疟无异也。大抵病邪初发。元气未耗。疏风涤痰。消导饮食。在所必用。然须大剂
白术培护中土。以脾胃为一身之津粱。土浓自能载物也。其最可虑处。尤在三四发至六七发。其
势最剧。若过半月。虽淹缠不止。邪热渐衰。可无胎陨之虞矣。或有疟久气血虚败而小产者。此
The more deficient the Spleen and Stomach are, the more unsettled the fetus becomes.
Leaking Fetus with Bleeding: During pregnancy, menstruation should cease; Qi and Blood gather to nourish the fetus and accumulate to form milk. If menstruation still occurs on time, it is due to deficiency of Qi in the Chong and Ren vessels, failing to consolidate and restrain.
*Qianjin Fang* states: Unceasing bleeding during pregnancy is called "Leaking Womb." If the blood is exhausted, death ensues. It is appropriate to take Ganjiang Dihuang San (Dried Ginger and Rehmannia Powder). For those with Qi deficiency, fatigue, and poor appetite, it is appropriate to employ methods to tonify Qi and secure the fetus.
One must not indiscriminately use blood-nourishing formulas. One may use Sijunzi Tang (Four Gentlemen Decoction) removing Fuling (Poria), adding Ejiao (Donkey-hide Gelatin), Aye (Mugwort Leaf), Xiong (Szechuan Lovage Rhizome), Gui (Chinese Angelica Root), Huangqi (Astragalus Root), and Sharen (Amomum Fruit). If there is leaking blood accompanied by abdominal pain, one may decoct and take Xiong, Gui, Renshen (Ginseng Root), Ejiao, and Dazao (Jujube Fruit). If fever and internal heat arise from depression and anger, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If night fever arises from Blood deficiency, use Danggui Buxue Tang (Angelica Tonifying the Qi Decoction). If Spleen Fire is damaged by labor, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). If excessive bleeding and pain result from sexual intercourse, use Bazhen Tang (Eight Treasures Decoction) adding Ejiao and Aye. If Spleen and Stomach Qi sinks and collapses, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) increasing the dosage of Shengma (Cimicifuga Rhizome) and Chaihu (Bupleurum Root). If Wind-Heat is present, add Fangfeng (Saposhnikovia Root) and Huangqin (Scutellaria Root). If bleeding occurs as the months of pregnancy near completion, this is surely caused by disregarding taboos. There may also be stagnant Blood coagulating, unable to transform and move downward. In such cases, Qi and Blood are injured first, making difficult labor inevitable later. It is appropriate to take Zisu Yin (Perilla Infusion) or prepare a paste from Yimucao (Motherwort Herb). For obese individuals, administer with Sharen Tang (Amomum Decoction); for deficient individuals, administer with Renshen Tang (Ginseng Decoction). At three months of pregnancy, if menstruation comes three to five times a month but in small amounts, with diet and spirit remaining normal, this indicates surplus of Qi and Blood; once the fetus grows large, menstruation will naturally cease. If treated as Leaking Fetus, the fetus will surely abort. The discharge from fetal leakage may be yellow fluid or resemble bean juice. If Liver and Spleen Damp-Heat are present, use Shengyang Chushi Tang (Raise Yang and Drain Dampness Decoction). For Liver and Spleen Wind-Heat, use Jiawei Xiaoyao San. For Liver and Spleen Depression-Stagnation, use Jiawei Guipi Tang. For Spleen and Stomach Qi deficiency, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder). For sinking of Spleen Qi, use Buzhong Yiqi Tang. For Liver Channel Wind-Heat, make pills with Fangfeng and Huangqin. If Wind enters the Intestines and Stomach, use Weifeng Tang (Wind Protecting Decoction). *Daquan Fang* treats sudden discharge of yellow fluid like paste or bean juice during pregnancy, accompanied by fetal movement and abdominal pain, using Huangqin (Scutellaria Root) 1 liang, Chuanxiong (Sichuan Lovage Rhizome) 1 qian, and Nuomi (Glutinous Rice) 1 he, decocted and taken. If water flows down suddenly, the fetus will surely be expelled. If it flows down slowly, one may primarily use Qi-tonifying and fetus-securing medicines.
Startled Fetus and Falling: Carrying heavy loads and falling during pregnancy causes Blood stasis and pain. One fears that taking Blood-invigorating medicines will injure the fetus, yet not taking them leaves the Blood injury unresolved. Treatment must distinguish between the life and death of the fetus. If there are no other symptoms, simply boil Heitang (Black Sugar) until charred, mix with Hongjiu (Red Wine) and Tongbian (Child's Urine), and take. Chew Huetaorou (Walnut Kernel with Skin) thoroughly and swallow. If the fetus is dead, the stasis will descend; if alive, the pain will stop immediately. If residual injury remains and pain persists, use Siwu Tang (Four Substances Decoction) adding Yanhu (Corydalis Tuber) and Muxiang (Aucklandia Root). If the injury is cleared but Fetal Qi is still unsettled, use Zisu Yin adding Tongbian and Sharen. For severe injuries, use Xiangke San (Fragrant Shell Powder) adding Shudi (Prepared Rehmannia Root) and Danggui (Chinese Angelica Root) to protect the fetus. For critical conditions, use Xiayuxue Tang (Drain Stasis Blood Decoction) adding Chuanxiong and Danggui, decocted with wine to remove Blood stasis. Once the stasis is removed, the fetus naturally settles. However, caution is required. If coma, sleepiness, and delirious speech occur, this is Blood forcing its way into the Pericardium; use Danggui Huoxue Tang (Angelica Invigorating Blood Decoction). If there is a heavy bearing-down sensation in the abdomen, cold to the touch, this indicates injured Fetal Qi; urgently use Xianggui San (Fragrant Cinnamon Powder) adding Jiudahuang (Wine-processed Rhubarb) and Shengfuzi (Raw Aconite Child Lateral Root) to purge. If a foul odor is perceived in the mouth, urgently use Pingwei San (Calm the Stomach Powder) adding Mangxiao (Mirabilite) to purge. If falling results from anger, or if there are convulsions of the limbs, use Zisu Yin adding Gouteng (Uncaria Ramulus cum Uncis). If excessive blood loss occurs, use Bazhen Tang removing Fuling, adding Ejiao, Aye, and Huangqi.
Fetal Qi Rushing Upward: Fetal movement and rebellious Qi are all caused by improper care, leading to upward rebellion of Fetal Qi. Zisu Yin is an essential medicine. If appetite is poor, combine with Sijunzi Tang. If Heat is present, add Huangqin, Zhizi (Gardenia Fruit), Danggui, and Shaoyao (Peony Root).
If anger injures the Liver causing upward rebellion of Fetal Qi, use Jiawei Xiaoyao San. If depression injures the Spleen causing unsettled Fetal Qi, use Jiawei Guipi Tang. Generally, upward rebellion of Fetal Qi belongs to Excess Fire; urgently use Huangqin, Baizhu (Atractylodes Macrocephala Rhizome), Xiangfu (Cyperus Rhizome), etc. Do not take Great Cold medicines, as this may cause other complications. Generalized body pain during pregnancy, or Qi rushing to the heart causing near-death sensations and inability to eat, is due to Water affecting the fetus causing pain. *Qianjin Fang* Liyu Tang (Carp Decoction). Alternatively, use Baizhu 5 qian, Huangqin 2 qian, Shaoyao 4 qian, with one live carp weighing about half a jin, boiled in water as a decoction. For fetal movement with day-and-night crying, locked jaw, retracted lips, and incessant tenesmus/dysentery, use Aiye (Mugwort Leaf) 5 liang, boiled with 5 sheng of good wine to reduce to 3 sheng, strain, further concentrate to 1 sheng, and take. If the mouth is closed, pry it open and pour the medicine in. Recovery follows administration. Near term, if Fetal Qi rushes to the heart causing vomiting and retching, urgently pour Tongbian to relieve. Alternatively, grind 10 Wuumei (Mume Fruit) kernels, add 3 slices of Shengjiang (Fresh Ginger), decoct in water, and pour in. This uses Sour to descend and consolidate, combined with Pungent to dissipate rebellious Fire Qi.
Chen Liangfu treated a woman who, at seven months pregnant, suddenly experienced Fetal Qi rushing to the heart with pain, restlessness, and ineffective treatment. She was mistakenly treated for a dead fetus using Bipan (Castor Bean) and Shexiang (Musk) applied to the umbilicus, bringing her to the brink of death. Chen diagnosed absent pulses at both Chi positions, while other pulses were peaceful. He said, "This is Zixuan (Fetal Suspension). If the fetus were dead, the face would be red and tongue blue. Now the face is not red and the tongue is not blue; the fetus is alive. This is Fetal Qi rushing to the heart." He treated her with Zisu Yin. After ten doses, the fetus settled.
Securing the Fetus: Spontaneous abortion often occurs at three, five, and seven months. Aside from trauma, it is mostly due to Internal Heat combined with Deficiency. Regarding Heat and Deficiency, severity must be distinguished. If a previous abortion occurred at three months, the next will likely happen at the same time. This is because injury occurred at that time, so it recurs when the period arrives. Taking advantage of the deficiency, those with a history of spontaneous abortion must frequently take medicines to nourish Qi and Blood and secure the fetus to replenish deficits. Upon subsequent pregnancy, starting two months after conception, take dozens of doses of fetus-securing medicines to prevent abortion at three months. For those who have aborted several times consecutively with severe laxity, medication must be prolonged to retain the fetus. Use Bazhen Tang adding Chenpi (Tangerine Peel), Ejiao, Aye, and Huangqin. For Qi stagnation, add Xiangfu and Sharen. For obesity with Phlegm, add Banxia (Pinellia Tuber). Contraindicated for thin individuals with excessive thirst. At three to four months, for obese, fair-complexioned, Qi-deficient individuals, use double the amount of Baizhu, and half the amount of Renshen, Xuanduan (Dipsacus Root), Shanyao (Yam Rhizome), and Xiangfu. Make pills with Zhishi (Immature Bitter Orange Soup). Take 3 qian morning and evening with Sharen Tang. For obese, dark-complexioned, robust individuals, no medication is needed; by seven to eight months, Sharen Tang or Zisu Tang suffices. For thin, fair-complexioned, weak individuals, use double Baizhu, single Renshen, and half amounts of Shanyao, Xuanduan, Chuanxiong, and Danggui. Make pills with Chenmi Yin (Rice Decoction). Take 3 qian morning and evening with boiling water. For thin, dark-complexioned, Blood-Heat individuals, use Jiu Zhu Tiaoqin (Wine-processed Scutellaria) and Sizhi Xiangfu (Four-Processed Cyperus), each single dose, and half doses of Siwu Tang ingredients. Make honey pills. Take 4 qian morning and evening with boiling water. By eight to nine months, for obese, dark-complexioned individuals, Zhike (Aurantii Fructus) and Sugeng (Perilla Stem) must be used to smooth Qi. Strictly avoid Qi-tonifying medicines; not only Renshen and Baizhu are forbidden, but rich foods should also be restricted. For obese, fair-complexioned, Qi-deficient individuals, Renshen and Baizhu must be added. However, Qi-tonifying medicines must be combined with Xiangfu and Sharen to keep Qi moving. For fair-complexioned, timid/weak individuals, focus entirely on nourishing Qi and Blood; neither Zhike nor Sugeng should be used, nor even Sharen. Misusing these and depleting Qi will inevitably lead to difficult labor. For dark-complexioned, thin individuals, Qi and Blood flow freely, so difficult labor is unlikely. Occasionally, long-standing depression may cause issues; frequent use of Xiaoyao San is suitable. For those who accidentally took abortifacient medicines causing fetal unrest, ancient methods use Shenggancao (Raw Licorice Root), Heidou (Black Soybean), and Danzhuye (Bamboo Leaf) decocted. If fever is present, use Jiangchi (Fermented Soybean). However, frequently giving hot Tongbian is superior as it resolves drug toxicity. For unceasing bleeding or upper overflow causing hematemesis/epistaxis, modify Siwu Tang by replacing Shudi with Shengdi (Rehmannia Root), adding Ejiao, Shanzhi (Gardenia Fruit), and Chaohei Puhuang (Charred Pollen Typhae). For injured/unsettled fetus, treat according to urgency and deficiency/excess. Pregnancy pulses should be slippery, rapid, and full; sluggish, choppy, floating, or slow pulses are strictly contraindicated.
Spontaneous Abortion: Spontaneous abortion is commonly called Xiao Chan. It is generally due to deficiency of Qi in the Chong and Ren vessels, failing to support and nourish, or caused by trauma/falls damaging Qi and Blood. It may also result from febrile diseases or warm malaria. Xue Lizhai stated: Xiao Chan is heavier than Da Chan (Term Delivery). Da Chan is like a ripe fruit falling naturally; Xiao Chan is like picking unripe fruit, breaking the skin and severing the stem. Is it not heavier? Yet many die due to negligence. Treatment should tonify Form and Qi, generate new Blood, and remove Stasis. If pre-term with pain and urge to deliver, use Bazhen Tang removing Fuling and Shudi, adding Ejiao, Aye, Paogjiang (Fried Ginger), and Gancao (Licorice Root). If the fetus is expelled but bleeding continues, use Renshen, Paogjiang, Baizhu, Gancao, Ejiao, Aye, Danggui, and Shaoyao. If Heat is present, add Paogjiang and Fuling. For post-abortal epigastric/abdominal pain, chills/fever, and pain worsening upon pressure, resolve Blood stasis using Chuanxiong, Danggui, Yanhu, Taoren (Peach Kernel), Xiangfu, Danpi (Moutan Cortex), Zelan (Lycopus Herb), and Tongbian. If pain relieves upon pressure, it is Blood deficiency; use Bazhen Tang removing Shaoyao, adding Paogjiang. If pain with vomiting and diarrhea indicates Stomach deficiency, use Liujunzi Tang (Six Gentlemen Decoction) adding Paogjiang. For weak Fetal Qi threatening abortion, use Bazhen Tang to secure it. For excessive bleeding with fever, use Shengyu Tang (Holy Salvation Decoction). For unceasing sweating, urgently use Baoyuan Tang (Preserve the Origin Decoction). For fever, irritability, muscle twitching, and tendon tremors, use Shiquan Dabu Tang (Ten Great Tonifying Decoction). For extreme thirst, red face, and surging empty pulse, use Danggui Buxue Tang. For body heat, red face, and deep faint pulse, use Sijunzi Tang adding Jiang and Fuzi.
Li Dongyuan stated: Women experiencing delivery or spontaneous abortion with profuse bleeding, coma, and unconsciousness, eyes closed and unaware, suffer from sudden Blood loss leaving the Heart Spirit unsupported. Fire flares in the Pericardium, causing coma. Fire overcomes Lung Metal, causing closed eyes and unconsciousness. Cold/Cooling fire-draining medicines must never be used. Coma belongs to Yin. Similar to Shaoyang syndrome with oppression, resolution comes through sweating; one must tonify and lift. Ancient method uses Quan Shen Huoxue Tang (Whole Body Invigorating Blood Decoction), but the Wind-dispersing herbs are杂乱 (mixed/chaotic) lacking the function of Yang generating Yin. It is appropriate to use Buzhong Yiqi Tang adding Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry). Or a large dose of Dushen Tang (Single Ginseng Decoction) is better. If Blood flows violently, it is due to excessive Autumn/Winter Yin energy. Lifting and ascending now assists Yang, opening the eyes and clearing the spirit.
Shi Wan treated a woman pregnant six months who, grieving the death of a child, cried excessively disturbing the fetus. Doctors used Huangqin and Baizhu for two doses without effect, then switched to Zhike, Xiangfu, Zisu, and Sharen to regulate Qi. After one dose, Fetal Qi rushed to the chest and hypochondrium, causing distension, stifling breath, and nose/mouth bleeding. On the third day afternoon, they summoned Shi Wan. Evening pulse was rapid like a storm, stopping every ten beats then resuming. He advised, "This fetus is not viable; securing it is useless. Better to remove it to save the mother." He reasoned the fetus was bound by Zhen Qi (Thunder/Qi of Movement), associated with Wood, which Metal controls. He ordered an iron axe heated red, quenched in vinegar, and while hot, mixed with 1 liang Mangxiao powder and poured in. The next day, she reported passing an abnormal fetus at midnight. Pulse became mild, spirit confused, lochia profuse. Given calming and Blood-regulating herbs, she recovered.
Fetal Failure to Grow: Shi Wan stated: Fetal growth relies on the Mother's Spleen Earth transmitting Qi to the fetus. The Spleen is the pivot of the body, governing transformation and transportation. In the Zang organs, it is Earth, nurturing all things. Thus, while fetal generation is governed by Kidney and Liver, nourishment truly concerns the Spleen. Therefore, treating poor fetal growth requires Bazhen Tang, Shiquan Dabu Tang, Guipi Tang, Buzhong Yiqi Tang, etc., to assist the Mother's Qi, allowing the fetus to grow. Some carry to twelve or thirteen months. Just as barren soil yields nothing until irrigated by fertile waters, the principle is clear. There are cases where the mother's Qi and Blood are robust but the fetus does not grow; this is due to the Father's weak Jing (Essence). One should use large doses of Baoyuan Tang to tonify Qi exclusively, without mixing Blood medicines to aid the mother, so the Son's Qi can benefit. There are also cases where fetal movement disrupts maternal Qi transmission, causing lack of nourishment without expulsion. This is like a dried fruit hanging on a branch; maternal Qi and Blood are intact, but the fetus cannot receive Qi. This differs from branches breaking and fruits falling due to disease.
Post-term Pregnancy: Post-term non-delivery belongs to Qi deficiency. Some delay due to fetal leakage. I have seen pregnancy bleeding where the fetus did not drop, but Qi and Blood were depleted, leading to non-delivery for over a year or until fourteen/fifteen months. These are all due to insufficient Qi and Blood, making embryo growth difficult. For those not delivering after ten months, greatly tonify Qi and Blood to ensure safe delivery. For post-term non-delivery with deep fine pulses and palpitations below the navel, this is Stasis transforming into Water; treat as Guitai (Ghost Fetus).
Xu Yuqing treated Shao Hanzhen's wife, pregnant seventeen months without delivery. Not relying solely on pulse diagnosis, he asked details. Confirmed pregnancy, not illness. She reported no fetal movement after five months. Suspicious, he prescribed Danshen (Salvia Root) alone, 7 qian daily. After twenty days, the fetus was delivered, dead and shriveled. Death likely occurred at five months. Remaining in the womb for thirteen months, it dried without rotting. Like fruit on a tree, rotten ones decay, but some dry out; thus, the logic of a shriveled fetus can be inferred.
Shi Wan stated: I previously treated Mrs. Yun Maisheng, pregnant thirteen months without delivery. Pulse was slightly knotted. Prescribed Shiquan Dabu Tang. After twenty-plus doses, she delivered. The fetus was shriveled and white. Though treatments differed, the shriveled fetus was the same.
Cough: Pregnant women's cough should primarily focus on securing the fetus. Wind pathogen injuring Lung: use Xiangsu San (Perilla and Liquorice Powder). Cold pathogen injuring Lung: use Xiao Jianzhong Tang (Minor Construct the Middle Decoction). If Lung/Stomach Qi deficiency: use Yigong San (Extraordinary Gentlemen Powder). If Spleen/Lung Qi deficiency: use Liujunzi Tang adding Danggui. Chronic cough often stems from Spleen/Lung Qi deficiency, loose interstices, secondary external pathogens, or Lung deficiency with Yin Fire flaming upward. With external pathogen: use Neibu Danggui Jianzhong Tang (Internal Nourishing Angelica Construct Middle Decoction) adding Xixin (Asarum Root). With Yin Fire: use Liuwei Wan (Six-Ingredient Pill) adding Maidong and Wuweizi.
Zi Fan (Fetal Irritability): Pregnancy distress, stuffiness, heavy head/eyes indicates Heart/Lung Empty Heat or Phlegm accumulation in the chest, salivation, aversion to food. Use *Qianjin Fang* Zhuli Tang (Bamboo Juice Decoction). If severe vomiting disturbs the fetus, with irritability, dry mouth, insomnia: use Jiawei Zhuye Tang (Modified Bamboo Leaf Decoction). For Qi deficiency, double Renshen. For Qi stagnation: use Zisu Yin. For Phlegm stagnation: use Erchen Tang adding Baizhu, Huangqin, Zhike. For hypochondriac fullness with chills/fever: use Xiao Chaihu Tang (Minor Bupleurum Decoction). For Spleen/Stomach weakness: use Liujunzi Tang adding Zisu and Shanzhi.
Lei Zhong Feng (Stroke-like Syndrome): If not treated early, this leads to abortion. Take Zisu Yin. If locked jaw prevents speech: use Baizhu 3 qian, Jingjie Sui (Schizonepeta Flower Spike) 2 qian, Heidou 3 he. Stir-fry, pour wine over, decoct, and take. Sweating brings cure. For locked jaw, pry open and pour. May take 3-4 doses. Blindness/black vision with syncope is rare in pregnancy. If it occurs, it is "Fetal Faintness," belonging to Qi and Phlegm. Only take Zisu Yin. Strictly avoid Suhexiang Wan (Styrax Pill) and Wuyao Shunqi San (Illicium Regulating Qi Powder).
Wind-Cold: For pregnancy wind-cold, use Xiangsu San removing Xiangfu, adding Congbai (Scallion White) and Chidouchi (Red Fermented Soybean). For cough with phlegm, add Jiegeng (Platycodon Root). Or Zisu Yin adding Congbai and Chidouchi, prioritizing fetus security. Cough with diarrhea, slippery solid forceful Qi Kou pulse, indicating retained food: use Weiling Tang removing Cangzhu (Atractylodes Lancea Rhizome). Wait for Spleen/Stomach solidity before treating cough. Boiled Scallion Head Soup is best. Wind medicines can cause abortion; thus, for cough/wheezing/cold fetus, continuous scallion soup soothes Qi and secures the fetus. Adding Chidouchi is excellent. If no wheezing, use Zisu Yin adding Sharen and Tongbian.
Sha Han (Cold Damage): Winter cold injury. Mild cases: chilliness, slight fever, mild cough, nasal congestion, resolving in days. Severe cases: headache, alternating chills/fever, eventually injuring fetus. Medications require caution, not treating like ordinary women. Only use Congbai Chidouchi Tang (Scallion and Fermented Soybean Decoction); sweating cures. *Qianjin Fang* for pregnancy cold damage: Congbai 10 stalks, Shengjiang 2 liang, decoct hot, sweat to settle. For pregnancy febrile disease: Congbai 5 stalks, Chidouchi 1 sheng, same method. If fetus injured but alive: boil a handful of scallion, eat/drink, sweat to settle. If fetus dead: it will pass spontaneously. If not, add Shengjiang and Ziye (Perilla Leaf). Do not lightly use Exterior-Releasing medicines. Using them risks abortion and maternal death. Only Congbai Chidouchi Tang and Xiangsu San can resolve pathogens and secure the fetus. For pregnancy warm epidemic or internal invasion of cold pathogen with Heat toxin pressing the fetus, urgently use *Qianjin Fang* Shigao Daqing Tang (Gypsum and Indigo Decoction) to save. Delay means no rescue. For pre-partum epidemics and Yangming Fu syndrome with constipation, urgently purge bowels to spare the fetus. If spontaneous diarrhea occurs, True Qi leaks, fetus is hard to save. Only with normal urination/bowel movements and no interior Heat is fetal Qi spared.
Malaria in Pregnancy: Regardless of gestational age, prioritize securing the fetus. Worldly practice uses Huangqin and Baizhu. Fetal security depends on maternal Qi harmony. Secure maternal Qi first. Huangqin secures fetus only for Heat agitation; Baizhu secures only for Spleen deficiency. If Qi deficiency causes sinking, Huangqin misuse harms; if Qi stagnation prevents transport, Baizhu misuse harms. "Securing maternal Qi" means adjusting based on body type (fat/thin) and Qi/Blood excess/deficiency. Obese, dark-complexioned, firm-muscled women have much Damp/Phlegm and Heat-Damp patterns. Pulses are slippery/solid, never deficient/cold. Use strong Phlegm-resolving and Qi-regulating medicines for the root, then address exterior pathogens. Use Erchen Tang with exterior-releasing herbs, or combine with Xiao Chaihu Tang. Chaihu guides malaria treatment. However, for excessive sweating, weak Chi pulse, or Heat with cold limbs, avoid Chaihu; use Jianzhong Tang, Guizhi (Cinnamon Twig), Shaoyao to conclude. For thirst, solid pulse, constipation (Yangming Fu excess), use Liangge San removing Mangxiao/Dahuang, adding fresh Shouwu (Polygonum Multiflorum). Robust constitutions have Qi stagnation and Heat-Damp, no deficiency-cold. Weak constitution or post-illness requires Spleen-regulating and Qi-moving; Liujunzi Tang is suitable. Add Zhishi and Cao Guo (Nutmeg) for Phlegm/Food stagnation; add Paogjiang for interior Cold; add Guizhi for exterior Wind. For upward rebellious fetal movement, add Ziqin (Young Scutellaria); for sinking fetus, add Chaihu with doubled Renshen (the sage herb for lifting fetus). If ineffective, use Buzhong Yiqi Tang with large-dose Renshen. For internal stagnation, use Zhishi Lizhong Tang adding Chaihu/Guizhi to treat interior/exterior. Daily/intermittent timing, day/night onset, chills/heat ratio, and dietary/urinary assessment are same as ordinary malaria. Initially, when Yuan Qi is unspent, disperse Wind, drain Phlegm, digest Food is necessary. However, large-dose Baizhu must protect the Middle Jiao, as Spleen/Stomach is the pivot; thick Earth carries all. The most concerning phase is the 3rd to 6th attack, when pathology is fiercest. After half a month, although lingering, Pathogenic Heat declines, sparing the fetus. Malaria lasting long with Qi/Blood exhaustion may cause spontaneous abortion.