Library

In cases of fetal unrest during pregnancy, the syndromes are not uniform, and therefore the treatments differ. Fetal unrest must have a cause; it may be due to deficiency or excess, cold or heat. All these can become diseases affecting the fetus. Removing the pathological factor is the method for calming the fetus. Thus, prescriptions for calming the fetus should not be rigid, nor should they be strictly bound by the number of months of gestation. One must follow the syndrome and the meridians, treating according to the disease, which is the best approach. If one insists that Baizhu (Atractylodis Macrocephalae Rhizoma) and Huangqin (Scutellariae Radix) are the holy medicines for calming the fetus, sticking to their use will rarely avoid errors.

1. When fetal unrest is caused by cold, symptoms may include acid regurgitation, nausea, bloating, preference for warmth and aversion to cold, lower abdominal coldness with diarrhea, a deep and fine pulse, or the absence of fire signs despite fetal unrest. These all belong to Yang deficiency and cold syndromes. Warming the middle jiao will naturally calm the fetus. Suitable prescriptions include Wenwei Yin (Stomach-Warming Decoction) or Liyin Jian (Yin-Nourishing Decoction), modified as needed. One should also observe the patient's constitutional organ qi and prescribe accordingly.

2. When fetal unrest is caused by heat, symptoms typically include irritability and fever, thirst, restlessness, turbidity in the upper and lower body, threatened miscarriage (bleeding), dark urine, or slippery and rapid pulses throughout the six positions. Suitable prescriptions include Liangtai Yin (Fetus-Cooling Decoction) or Baoyin Jian (Yin-Preserving Decoction). If there is heat without deficiency, such as in Zhike Tang (Citrus Aurantium Decoction), Yi Mu Wan (Motherwort Pill), or Huangqin San (Scutellaria Powder), any of these can be selected to clear the fire and naturally calm the fetus.

3. When fetal unrest is caused by deficiency, careful regulation is most required. There is congenital deficiency and acquired deficiency; the preservation of the fetal origin depends entirely on this. Congenital deficiency stems from endowment; one should gradually tonify according to the imbalance of Yin and Yang, never seeking quick results, aiming for preservation. Acquired deficiency stems from lifestyle factors such as excessive sexual activity, fatigue, improper diet, and emotional disturbances, all of which can damage fetal qi. Treating this requires investigating the cause and regulating based on the illness, while maintaining caution. Ultimately, this revolves around Qi and Blood deficiency, so Taiyuan Yin (Fetal-Origin Decoction) should be the primary prescription. For Heart and Spleen Qi deficiency in the upper body, Xiaoyao Yin (Free and Easy Wanderer Decoction), Guipi Tang (Restore the Spleen Decoction), or Shoupi Jian (Spleen-Longevity Decoction) are suitable. For Liver and Kidney insufficiency in the lower body, Zuogui Yin (Left Restoring Decoction), Yougui Jian (Right Restoring Decoction), or Guyin Jian (Yin-Securing Decoction) are appropriate. For combined Qi and Blood deficiency, Wufu Yin (Five Blessings Decoction), Bazhen Tang (Eight-Treasure Decoction), or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) are suitable. For Spleen and Kidney Qi deficiency accompanied by turbid leukorrhea, Miyuan Jian (Secret Origin Decoction) or Tusi Jian (Dodder Seed Decoction) are used. For frequent nausea and vomiting, add Erchen Tang (Two-Aged Decoction) to previous prescriptions to harmonize. In treating deficiency syndromes, flexibility is key; rigidity is inadvisable.

4. Regarding excess stagnation of Qi: Conditions such as morning sickness (Ezu) and bloating causing unrest occur only when the constitution is not deficient but has much stagnation. By identifying the cause and promoting circulation, treating excess is not difficult. For persistent vomiting, Erchen Tang added with Zhike (Aurantii Fructus) and Sharen (Amomi Fructus Rotundus) is used, or Ren Shen Jupi Tang (Ginseng and Tangerina Peel Decoction) is also excellent. For food stagnation with bloating and unrest, Xiaohe Zhong Yin (Harmonizing the Middle Decoction) is modified. For Liver Qi stagnation and rebellion causing bloating and unrest, Jiegan Jian (Liver-Unblocking Decoction) is used. For anger stirring Liver Qi with accompanying fire, Huagan Jian (Fire-Transforming Decoction) is used. For Spleen and Lung Qi stagnation attacking upward causing pain, Zisu Yin (Perilla Leaf Decoction) is used. For Qi stagnation with Phlegm, Siqi Tang (Four-Sevenths Decoction) or Erchen Tang added with Danggui (Angelicae Sinensis Radix) is used. For Qi stagnation with fire causing bloating and irritability, Zhike Tang or Shutai Wan (Fetus-Restraining Pill) are used.

5. Wang Jiezhai stated: Regulating pregnant women lies in clearing heat and nourishing blood. Baizhu tonifies the Spleen and serves as the sovereign herb for calming the fetus; Tiaoshi Huangqin (Scutellaria Root) is the holy medicine for calming the fetus because it clears heat, making it suitable for addition in summer months. This view, though seemingly reasonable, has significant flaws that must be辨析 (analyzed). Fetal qi follows the mother's organ qi. Generally, those with Yin deficiency have more heat, and those with Yang deficiency have more cold. Using cold for cold and heat for heat restores balance. Considering ten people, three have cold, three have heat, and four are balanced. If one claims that conception inevitably increases internal heat, differing from normal people, why is it that treating Ezu requires Erchen Tang, Liujunzi Tang, Shengjiang (Zingiberis Rhizoma Recens), and Banxia (Pinelliae Rhizoma) to be effective? Does this truly indicate increased heat? Therefore, Huangqin is suitable for heat but not for cold. It is unsuitable not only for cold but also for balanced constitutions. Most pregnant women today have Qi deficiency rather than excess. Qi deficiency implies Yang deficiency; using Huangqin further may cause immediate harm or secretly damage the fetal origin and maternal Qi, leading to maternal debility or infant spleen disorders. Yet, people cannot discern the principle, regarding "holy medicine" as mandatory for all pregnancies regardless of Yin-Yang strength, causing considerable harm. As for Baizhu, although good for calming the fetus, if used improperly, its dry nature and closing Qi property make it unsuitable for Yin deficiency alone, and it requires discretion for Qi stagnation. Thus, prescribing is like beads on a plate—flexible, not rigid like a fixed peg on a zither.

Lizhai stated: If pregnancy involves insufficient Yuan Qi, fever, fatigue, or fetal unrest, use Danggui San (Angelica Powder). Due to emotional distress, add Zhike; for chest oppression, add Sugeng (Perillae Caulis); for pain, add Chaihu (Bupleuri Radix). For poor appetite or nausea, use Liujunzi Tang (Six-Gentlemen Decoction) with Zisu (Perillae Folium) and Zhike. For Ezu with vomiting, dizziness, and fatigue, use Shenju San (Ginseng and Tangerina Powder); if ineffective, use Liujunzi Tang. For Ezu with vomiting, anorexia, and irritability, use Shenju San. After a fall causing fetal movement, abdominal pain, and bleeding, use Jiao'ai Tang (Colla Corii Asini and Artemisia Decoction); if ineffective, use Bazhen Tang added with Ejiao (Colla Corii Asini) and Aiyi (Artemisiae Argyi Folium). After trauma or toxic injury causing lower back pain and shortness of breath, use Ejiao San; if ineffective, take Zhimu Wan (Anemarrhenae Pill) with decoction. After trauma causing fetal injury, bleeding, and abdominal pain, use Foshou San (Buddha's Hand Powder); if ineffective, take Zhimu Wan with Bazhen Tang. For palpitations, fear, irritability, and unrest named Zifan (Fetal Irritability), use Zhuye Tang (Bamboo Leaf Decoction). If ineffective, supplement Sini San (Four Substances Decoction) for Blood deficiency or Sijunzi Tang (Four Gentlemen Decoction) for Qi deficiency. For continuous bleeding named Tailou (Fetal Leakage), use Erhuang San (Two Yellows Powder) for Blood deficiency, or Bazhen Tang for heavy blood loss. If ineffective, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For bleeding after physical exertion, use Zhike Tang added with Shengdihuang (Rehmanniae Radix) and Shudihuang (Rehmanniae Radix Preparata); if ineffective or painful, add Danggui. For persistent bleeding, use Bazhen Tang with Ejiao and Aiyi. For intermittent pain or lower abdominal heaviness named Taotong (Fetal Pain), use Dihuang Danggui Tang (Rehmannia and Angelica Decoction); if ineffective, add Renshen (Ginseng), Baizhu, and Chenpi (Tangerina Peel). For Spleen Qi deficiency, use Sijunzi Tang with Danggui and Dihuang; for Middle Qi deficiency, use Buzhong Yiqi Tang. For puffy face and limbs resembling edema named Zizhong (Fetal Edema), use Baizhu San from Quansheng Ji; if ineffective, use Liujunzi Tang. For severe lower body swelling, use Buzhong Yiqi Tang with extra Fuling (Poria). For vomiting and diarrhea due to improper diet indicating Spleen-Stomach damage, use Liujunzi Tang. For toe swelling spreading to legs/knees with panting and unrest, or fluid between toes named Shuiqi (Water Qi), use Tianxian Teng San (Akebia Vine Powder); for weak Spleen-Stomach, combine with Sijunzi Tang; if ineffective, use Buzhong Yiqi Tang combined with Xiaoyao San. For fetal Qi attacking upward causing chest/abdominal fullness and pain named Zixuan (Fetal Suspension), use Zisu Yin. For poor appetite, combine with Sijunzi Tang; for afternoon heat, combine with Xiaoyao San. For scanty, difficult urination or stranguria named Zilin (Fetal Stranguria), use Anying San; if ineffective, combine with Bazhen Tang. For leg cramps with oliguria, urgently use Bawei Wan (Eight-Ingredient Pill); delay leads to untreatable conditions. For neck stiffness, muscle spasms, slurred speech, and profuse phlegm named Zixian (Fetal Epilepsy), use Lingyangjiao San (Antelope Horn Powder). For food stagnation with bloating/vomiting due to weak Spleen-Stomach digestion, use Liujunzi Tang; if ineffective, use Pingwei San added with Renshen and Fuling. For fetal distension or pain due to Spleen-Stomach Qi deficiency failing to support, use Antai Yin (Fetus-Calming Decoction) with Shengma (Cimicifugae Rhizoma) and Baizhu; if ineffective, use Buzhong Yiqi Tang. For umbilical/abdominal distension or urinary retention due to Spleen-Stomach Qi deficiency and fetal pressure on the bladder, use Siwu Tang added with Erchen Tang, Renshen, and Baizhu. Take on an empty stomach, then induce vomiting. After Qi settles, repeat until stable. For hematuria after overwork or fried foods due to Heat driving blood into the uterus, clear the Bladder with Xiaoyao San. For enuresis or frequency due to Liver Fire and Blood Heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). For chest/abdominal fullness, urinary obstruction, and generalized edema named Taishui Buli (Fetal Water Obstruction), use Liyu Tang (Carp Decoction); for weak Spleen-Stomach, supplement with Sijunzi Tang. Diseases share names but present differently, and vice versa; refer to the original formulas. If symptomatic treatment fails, treat according to the menstrual cycle stages.

Xu Donggao stated: Fetal unrest with lower back/abdominal pain and even bearing-down sensation is often due to Qi and Blood deficiency failing to nourish. The fetus in the womb is like fruit on a branch; if the branch withers, the fruit falls—this is natural. Women indulging in desires may stir internal Fire, causing fetal unrest and miscarriage. Generally, this falls under deficiency or Fire syndromes, addressed by clearing heat and nourishing blood. Two other causes of fetal disturbance must be known: Fetal disturbance due to maternal illness stabilizes once the maternal illness is treated; fetal disturbance due to physical trauma stabilizes after two to three doses of fetal-calming herbs.