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(Fetal restlessness in pregnant women is called "Zi Fan")

Zhu Danxi stated: This is caused by the stagnation and郁 (depression/stagnation) of heat qi due to the fetal origin.

Shen Yaofeng stated: The etiology of Zi Fan can be summarized into three categories: phlegm, fire, and yin deficiency. When caused by phlegm, there must be a sensation of fullness in the chest. Zhang Zhongjing said, "Fullness in the heart with restlessness is suitable for Gouti San," which is a method of inducing vomiting to expel phlegm. However, vomiting is contraindicated in pregnant women; it is suitable to use Erchen Tang added with Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taenia), and Xuanfuhua (Inulae Flos). In cases of severe yin deficiency with hyperactive fire, Zhang Zhongjing's Huanglian Ejiao Tang is most excellent.

Wang Ang, in *Yifang Jijie*, recorded a formula called Zhuye Tang, used to treat pregnancy-induced palpitations, timidity, and daily restlessness, named Zi Fan. This occurs because during the fourth or fifth month of conception, Ministerial Fire is dominant; or during midsummer when Sovereign Fire prevails excessively, both can invade the Lung causing restlessness. Restless fetus may also result from retained phlegm and accumulated fluid stagnating in the chest and diaphragm, leading to restlessness.

*Ophiopogonis Radix* (Ban Qian / Half a Qian), *Poria*, *Scutellariae Radix* (Yi Qian / One Qian), *Ginseng Radix et Rhizoma* (Wu Fen / Five Fen), *Lophatheri Herba* (Ten slices).

Zhuye clears restlessness, Huangqin eliminates heat, and Maidong cools the Lung. Since Heart Fire invades the Lung, restlessness originates from the Lung. Fuling calms the mind, Renshen tonifies deficiency; pregnancy-related restlessness is mostly due to deficiency. If Ministerial Fire is excessive, use Zhimu Wan alone; if Sovereign Fire is excessive, use Huanglian Wan alone; if the spirit is unsettled, use Zhusha Anshen Wan. Do not mistake this for deficiency-heat and treat it with Zhizi Chi Tang or similar medications. Another prescription uses Fuling as the sovereign herb, without Renshen, but includes Fangfeng and Zhimu; add Zhuli (Bamboo Sap) if phlegm is present.

Yan Shi Zisu San. Xu Shuwei stated: It treats distension, fullness, and phlegmatic pain near the end of pregnancy, termed "Zi Xuan" (Fetal Suspension). Chen Liangfu stated: At four or five months of pregnancy, Sovereign and Ministerial Fires nourish the fetus. Heat qi reverses upward, the fetus crowds the heart and chest, causing abdominal fullness and stifling oppression, named Zi Xuan. Use this formula added with Huangqin and Shanzhi. Another variant without Chuanxiong is named Qibao San. Xu Shuwei said: For Zi Xuan occurring at six or seven months, this formula is effective; within ten doses, the fetus descends.

*Perillae Folium* (Yi Qian), *Aurantii Fructus* (Dafupi), *Ginseng Radix et Rhizoma*, *Chuanxiong Rhizoma*, *Citri Reticulatae Pericarpium*, *Paeoniae Radix Alba*, *Angelicae Sinensis Radix* (each San Fen / Three Fen), *Glycyrrhizae Radix et Rhizoma* (Yi Fen / One Fen).

Crude drugs are divided into three doses. Decoct with one cup of water, four slices of fresh ginger, and white parts of scallion. Strain and take.

Xu Aihui stated: Chuanxiong is removed to avoid its ascending and lifting properties.

Wang Ang stated: It treats disharmony of fetal qi rushing to the chest and abdomen, causing abdominal fullness, headache, and pain in the heart, abdomen, lower back, and hypochondrium, named Zi Xuan. This is due to excess qi in the lower jiao and hyperactive Ministerial Fire, lifting the fetus upward and pressing against the heart and chest. Each dose should only use Su Ye (Perilla Leaf) Yi Qian, Danggui (Angelicae Sinensis Radix) Qi Fen, and Dafupi and other herbs Wu Fen, Gancao (Glycyrrhizae Radix et Rhizoma) Er Fen, without scallion white; for heart and abdominal pain, add Muxiang (Aucklandiae Radix) and Yanhusuo (Corydalis Rhizoma).

Chen Laizhang stated: Chuanxiong, Danggui, and Shaoyao harmonize the blood; Zisu (Perilla Leaf), Ju Pi (Citri Reticulatae Pericarpium), and Dafupi (Arecae Pericarpium) regulate the qi. When qi flows smoothly and blood is harmonized, the fetus is secured. Having regulated the qi, Renshen and Gancao are used to nourish the qi. "Regulating" means smoothing the rebellious qi of pathogenic factors; "nourishing" means maintaining the harmonious qi of the Middle Jiao.

Xu Aihui stated: Yanhusuo moves blood and might be contraindicated.

Zhao Yangkui proposed that Mingmen (Gate of Life) deficiency-cold causes fetal qi to rush to the heart, requiring warming.

Shen Yaofeng stated: This scenario occurs in only one out of a hundred cases. Unless there are definitive deficiency-cold pulse and syndrome manifestations, hot-natured medicines should not be attempted.

Shen Yaofeng stated: A surnamed Yu woman, nine months pregnant, felt abdominal pain after accidental exertion. The fetus gradually rose to the chest, blocking qi flow. She suddenly screamed and bit people, unable to be restrained by several attendants. This condition is called "Shangzi Zhuangxin" (Upper Child Hitting the Heart), the most severe form of Zi Xuan. Using Xuanfu Daizhe Tang without Renshen and Dazao, administered continuously for two doses, the fetus was expelled, saving her life. Another woman had identical symptoms; taking the previous medication resulted in fetal expulsion and her death.

Yaofeng further stated: The principal wife of Lu Jianxiu suffered from Shangzi Zhuangxin. Midwife Jiang advised grinding Daizhe Shi (Magnetitum) juice for ingestion, resulting in the birth of two sons. One son was positioned above, lying across below the heart; the second son collided with the first, preventing him from hitting the heart for twenty-four hours, thus avoiding death. After delivery, she recovered safely.

Congbai Tang treats fetal qi pressing upward causing heart restlessness and oppression, and also treats critical fetal movement. Materia Medica states: Congbai (Allii Fistulosi Bulbus) unblocks yang and secures the fetus. Lou Quanshan stated: This formula is miraculous; it is suitable for floating and slippery pulses. Boil fourteen stalks of Congbai in thick decoction and drink. If the fetus is alive, it will settle; if dead, it will be expelled. Repeat if ineffective.

Chen Liangfu stated: A woman returned from a long journey at seven months of pregnancy and suddenly experienced fetal qi rushing upward with pain, unable to sit or lie comfortably. Two physicians failed to treat her and declared the fetus dead. They applied mashed castor beans mixed with musk below the navel to induce descent, leaving her life hanging by a thread. I examined her: the radial pulses at both chi positions were absent, while other pulses were peaceful. I asked the two physicians for their diagnosis. They replied: Dead fetus. I asked how they knew. They said: Because the chi pulses were deep and absent. I asked: Which book does this theory come from? The physicians had no answer. I said: This is Zi Xuan. If it were a dead fetus, there would be distinguishing signs: red face and blue tongue indicate fetal death with maternal survival; blue face, red tongue, and foaming indicate maternal death with fetal survival; blue lips and tongue indicate death of both mother and fetus. Currently, her face is not red, and her tongue is not blue, indicating the fetus is alive. This is fetal qi pressing on the heart; Zisu Yin is appropriate. After ten doses, the fetus descended.

Li Shi stated: In Zi Xuan syndrome, extreme fire excess can cause sudden cardiac qi obstruction and death; continuous administration of Zisu Yin can save the patient. If the chi pulses are absent, it may be due to mistakenly administering abortifacients, resulting in fetal death in utero. Symptoms include aversion to cold, and cyanosis of fingers, lips, and nails. Diagnosis relies entirely on the tongue; Xiong Gui Tang is used for rescue.

Wang Mengying’s commentary: In autumn of the Wushen year, my wife, eight months pregnant, suffered from coughing disturbing sleep, projectile epistaxis, facial edema, and limb swelling. Various medications were ineffective. Upon careful consideration, her constitution was inherently yin-deficient with internal fire hyperactivity. The fetus moved due to fire, rushing to the heart and chest, impacting the lungs, causing cough and reverse qi. Thus, treating the cough directly is unnecessary; instead, treat as Zi Xuan. Therefore, I used Qibao San removing Renshen, Shaoyao, and Shengjiang, due to her chest fullness and internal heat; added Shigypsum (Gypsum Fibrosum) to clear Yangming fire; and Shudihuang (Rehmanniae Radix Preparata) to secure the root yin. One dose brought immediate relief. In mid-winter of this year, again at eight months of pregnancy, following grief and exhaustion, fetal qi rebelled upward, causing dizziness, cough with phlegm, epigastric distension, loose stools, yellow coating, and thirst. I used Juan Yin Liu Shen Tang removing Dansheng (Arisaematis Cum Bile) and Fuling, adding Zhishi (Aurantii Fructus Immaturus), Zisu Ye (Perillae Folium), and Dafupi (Arecae Pericarpium) to regulate qi and open depression; Huangqin, Zhizi (Gardeniae Fructus), and Zhuru to clear heat and calm the fetus. One dose showed improvement, two doses cured. For all cases of Zi Xuan caused by phlegm stagnation, I employ this method, achieving results as promptly as a drumstick striking a drum.