《金匮》妊娠篇第一条，乃言妊娠之脉证，因其脉证，而藉以断其妊娠，并及治法及救误。其原文曰："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。于法六十日当有此证。设有医治逆者，却一月加吐下者，则绝之。"按此条文义，有许多不可通处，按之事实，亦无大用，只能阙疑，存而不论可也。如妊娠本非病，何必主桂枝汤？即用桂枝，何以无寒热？六十日当有此证者何证？岂即阴脉小弱，其人渴，不能食之证耶？此证二月之间，殊不多见，不知何所见而云然。况即有之，亦非要病，何以无病而医，竟至医治而逆耶。加吐下则绝之之"绝"字尤为费解。或谓绝其病根，或谓绝其医治，或又谓绝其妊娠。聚讼纷纷，莫衷一是。实则《金匮》为医家之书，非训病家者。绝其医治，乃告病家之言，非以训医者，意不相合也。若谓药苦，当勿药有喜，于妊娠本可通，何以又用桂枝汤，又何以云医治逆者。有逆必有顺，必非勿药之证矣。若云绝其病根，则语太浑融，何病不当去其病根？何治不当去其病根？而必谆谆于致误之后乎，意亦不当。惟绝其妊娠之一解，尚无破弊，但亦无益于事理，故吾谓可存而不论。揣其大意，则其中恐有缺义，而辞意可分两段：首一段，乃以脉证断妊娠之是否，次一段，则言妊娠恶阻之治法也。何以言之？妇人得平脉，是脉不病也，月事不见，虚者当见虚脉，瘀者当见涩脉，今脉无病象，而月事不来，即其停也非病可知，当属妊娠无疑矣。此即《素问·腹中论》"身有病而无邪脉"之义。断孕论脉，以此最确。余若寸口脉动，阴搏阳别诸法，虽出经文，却难必其有验，只以月事不至，脉无病象，断之最效而最易行，故仲景取之也。此第一段，以脉证断妊娠是否之义也。二段则言恶阻，原文"于法六十日当有此证"，而不明言其何证，惟推其语意，则此证为妊娠二月所必见者，故曰"于法六十日当有此证"，可知其证必普通常有，而非奇异之证矣。妊娠二月最常见者，莫如恶阻，则呕吐喜酸恶食是也。原文又谓："医治逆者，却一月加吐下"，吐而曰加，可知原来本吐，特因其医治不合，故加重耳。吐则恶阻也，六十日当有此证，而证中有吐象者，即不明言，无论何人，亦知其恶阻矣。女子以肝为先天，受胎之后，血养胎而不涵木，肝体亏则肝用强，犯胃则呕，胃受剋则恶食，肝体虚，求助于食则喜酸，孕则经停，经停之后，精华则养胎元，其中浊气无从发泄，乘肝之逆而犯胃，胃虚正不胜邪，则呕吐作矣。其必发于六十日者，以六十日为肝胆养胎之时也。由此言之，恶阻之因，虽由于经阻，而恶浊之气上逆，血不养肝，木来乘土，胆胃不降，尤为恶阻之主要病因也。桂枝汤方中，桂枝辛通，初受胎时，凝结未牢，不可轻用。甘、枣味甘，呕家所忌，唯生姜和胃降逆，去秽恶，芍药和肝，为必用正药。全方却不足取，不能盲从。恶阻轻证，不治自愈，二月一过，其证自平。重者日夜呕恶不绝，上逆甚则下必脱，恐致殒胎，非药不可。其治亦不出柔肝和胃，芳香鬯中数法。惟一切行气破气滑利之品，当忌用耳。半夏为止呕主药，后人以动胎忌之，甚可惜。或谓姜制则不碍胎，亦理想之谈，惟众俗所趋，不得不随波逐流，实则不必忌也。妊娠篇第二条："妇人宿有癥病，经断未及三月，而得漏下不止，胎动在脐上者，为癥痼害。妊娠六月动者，前三月经水利时，胎也。下血者，后断三月，衃也。所以血不止者，其癥不去故也。当下其癥。桂枝茯苓丸主之。"此条则言妊娠之变证，而非谓寻常之病矣。古文太简，又多脱落，后来解者，无一人能明白通畅，反致惑人，不如不释。今特为解释如下。知仲景之文深有至理，固非模棱之语、敷衍之词也。未释此条之先，当知妇人受胎之种别，平时经事调匀，停后毫无病脉，经停而受孕者，常也，然有居经者，三月一至，有避年者，一年一至。当详问平素，不能以其经停即谓之孕也。又有垢胎者，受孕之后，经行如常，经并不停，胎已渐长，不能以其经行而断其无孕也。此条所言之妇人，则垢胎之体耳。其曰："前三月经水利时胎也"，明谓其经行之时，即以受胎矣。垢胎之体，孕后仍当经行，今行而又停二月余，是与素体不合，可知其停，并非因孕而停，乃凝瘀而蓄耳。平常之人，经停受孕之后，而得漏下，则为半产，急宜固胎为主。今体与平人不同，停不因孕，而为瘀凝，即见漏下，亦宿瘀泄，非殒胎也。故申之曰："下血者，后断三月衃也。"明言其所下之血，乃停三月之瘀蓄，是衃而非胎矣。按之常理，胎动当在六月，动时当在脐下，今经断未及三月而动，动又不在脐下，而在脐上，其故何哉？盖其中有二因存焉。胎动应在六月，今未及三月而动，在常人本为不合，若在垢胎之体，则知其受胎之日远在前三月经行之时，益以经断之二月余，是亦六月矣。从其经断三月之不当动，而推得其受孕不在经断之时，非妙法欤。胎无三月能动之理，今虽未及三月而动，实则仍六月也。此理历来注释者均无人知，犹谓三月而动，为胎之变，或谓三月而动，乃衃非孕，最为无稽之谈。仲景妙文，精华内蕴，为后人所湮没丧失者，众矣。此其胎动在未及三月之理也。至其动在脐上者，则另有因。原文不谓其人宿有癥乎？癥者真也，瘀血所结之痞块也。胎动本在脐下，今反在脐上，又询知其人素有癥结，则知其动在脐上者，乃癥痼在下逼其胎向上而动耳。癥碍血行，故经断三月。经断三月，衃留益多，满而外泄，故得漏下不止。是既经之停、经之漏、胎之不安，均属癥痼为害。庆父不去，鲁难未已，不去其癥，病无已时也，故曰当下其癥。下癥当用去瘀之品，有胎之体亦无碍。《内经》曰："有故无殒，亦无殒也。大积大聚，其可犯也，衰其大半而止。"所主桂枝茯苓丸，方中祛瘀之品，不过桂、芍、丹、桃。其所以不取用大黄、、芒硝等猛剂，殆亦衰其大半之意耳。其言甚可思，凡有孕而当行攻下者，盖当以此为法乎。
其第三条曰："妇人怀妊六七月，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。"此条文字，本极明显，无须注释，意谓怀妊腹痛，证有由于子脏开而得者。其症状原因治法，均详列无遗，照病断证，照法施治，固甚易也，乃为后人一注，便生错误。其胎愈胀，非病象也，乃以为病象，少腹如扇，解作阵阵作冷，如扇扇之，尤误。乃千篇一律，更无独出手眼者。仲景有知，亦当呼冤于地下，今特为正之。怀妊至六七月，其胎已渐长大，非复从前之渺小，故曰其胎愈胀，并非谓其病胎愈作胀也。胎长大则胀，胀则子脏开，不观妇人临产之日，先有白汁淋漓不绝之象乎。则胎胀子脏开，液不藏之原因也。因胎胀而子脏开，因子脏开而受寒，述其因也。恶寒发热，有似表证，脉不浮而弦，弦者寒也。更见腹痛，知其寒在里也。少腹如扇，乃言少腹一起一落，高低急促，与呼吸相应也。如扇乃象形，与鼻扇之扇同一解释。里寒腹痛，脉弦，而见少腹高低，起落如扇，则知寒入子脏，挟冲而动，肝木横逆，胎儿不安，势非轻浅，盖妊娠腹痛之重证，急宜温其子脏之寒。即见寒热，但里重于表，仍从里治。况其寒热，无头痛骨楚之象，非必表证，仍因腹痛脏寒而起者耶。故曰："当以附子汤温其脏"。附子汤方缺而未见，或谓即伤寒附子汤。以药证之，附子温脏寒，为君；白芍和肝止腹痛，为臣；参术温脾固胎，为佐，固极相合，其信然欤。此条本明显无奇，惟历来注释者，均以少腹阵阵作冷，如被扇之状释子脏如扇之证，穿凿附会，点金成铁，为可异耳。
第四条曰："师曰：妇人有漏下者，有半产后因续下血都不绝者，有妊娠下血者，假令妊娠腹中痛，为胞阻，胶艾汤主之。"此言妊娠腹痛，有胞阻之证也。《医宗金鉴》妇科谓"妊娠腹痛曰胞阻"，大误。要知胞阻乃妊娠腹痛之一证，非尽腹痛均可谓之胞阻。古人解经，可笑如此。本条主要论述妊娠腹痛下血之证治，余俱陪衬文字。胞阻二字，照字面解之，乃阻胞中之气血，似乎当用通利，但以见证及所用胶艾汤方合之，又似不协。愚意当以方证相合为主，不必定从名称上着想，若但以胞阻病名论治，必不能见下血之证，即见下血之证，亦当如前一条因癥下血之论治，和能主胶艾汤。今以方证合之，当是血虚气滞。其下血乃冲任不摄，血不归经。血若不止，必有殒胎之险。方中重用地黄补虚恋胎为君，归、芍、胶、艾养营和肝为臣，佐川芎以行滞气，艾叶以温子脏，且炮黑姜又能引血归经，乃一补多行少之方也。此放即胶艾四物汤，女科以之统治调经、胎、产一切虚寒腹痛下血之证，无不效如桴鼓。本条胞阻既用此方，其证又相同，则其病因，断无纯属气血阻于胞中之理，当舍名取实可也。
又有土湿木菀，木陷土中之痛，脾主湿，脾虚则湿聚，肝主血，木郁则土菀。如第五条所谓"妇人怀娠，腹中痛，当归芍药散主之。"者是也。痛者，绵绵而痛，痛无休时也。方用归、芍养血和肝，川芎以行血中之滞气，苓、术健脾，泽泻以泻土湿之有余，亦肝脾并治之法也。方中分量，芍药最重，和肝脾为君也。泽泻次之，渗土湿为次也。其意岂不昭昭若揭乎。从第三条起至第五条，均言妊娠腹痛之证，而各各有别：有子脏开而受寒者，宜附子汤温子脏；有下血腹痛者，为胞阻，宜胶艾汤调冲任；有土湿木郁者，宜当归芍药散和肝脾。推而广之，其变化无涯举矣。
本文："妊娠呕吐不止，干姜人参半夏丸主之。"半夏降逆和胃，干姜温中祛寒，人参补中益气，方只三味，以其功能推之，则知此条，所谓呕吐不止者，证系脾胃虚寒之呕吐，故以扶正祛寒、和中降逆之方法治之。又可知此条所指之呕吐，必见呕吐清水，苔白脉迟诸虚寒证，方可用此法也。
本文："妊娠，小便难，饮食如故，当归贝母苦参丸主之。"此条眼目在"饮食如故"四字。盖小便难为脾肾阳虚，膀胱宣化失司，则必见食少纳减之证，今饮食如故，肾阳能蒸动可知。肾阳自足，则不当见小便难，可知其并非肾阳不足、膀胱不能宣化。又无身重腹满之证，则更非水气不行。以其所用方剂证之，当归行血疏肝，贝母解郁化痰，苦参清火泄热，是一疏肝解郁泄热之方。乃知其小便难者，为郁结伤肝，肝失疏泄，五志化火，火郁不申之证矣。推其证侯，小便难之外，必兼烙热黄赤之象，脉必弦数，苔必黄，舌必绛，方合肝郁化火、郁结不舒之证，方可用当归贝母苦参丸之法，后人柴胡清肝、龙胆泻肝等方，均从此脱胎者也。
本文："妊娠有水气，身重，小便不利，洒淅恶寒，起即头眩，葵子茯苓散主之。"此论胎前有水气之证，即后世所谓子肿、子满、子气各证也。小便不利而见身重，水湿不能宣化而溢于腠理也。水湿内蕴，阳气痹塞不通，则洒淅恶寒，水湿伤阳，清气不得上升，则生眩晕。但用葵子茯苓散淡渗水湿，水湿去则诸病悉愈。惟葵子滑利，胎前所忌，后人每不敢用，且胎前肿满，每起于七八月间，太阴司胎之时。脾肺气虚，亦生肿满，便不能再行渗利。后贤薛立斋谓：胎前作肿，纵生水湿，终属脾虚。所定全生白术散（白术、茯苓、大腹皮、橘皮、姜皮），四君子、六君子等汤，均为健脾之剂，颇能高出一筹。实则肺气虚不能行其津液，水精不布者，尤居多数。前人有以春泽汤去桂枝治子肿，寓有深意，可以取法。胎前作肿，不外健脾渗湿、顺气安胎八字。如《济阴纲目》所言：但一泻气利水，则愈。此谬论也。
本文："妇人伤胎，怀身腹满，不得小便，从腰以下重，如有水气状，怀身七月，太阴当养不养，此心气实，当刺泻劳宫及关元，小便微利则愈。"此条亦属胎前子满、子肿之类，惟与用葵子茯苓条有虚实之辨矣。此言伤胎，非胎伤之后始见各证，乃先有腹满等证，然后伤胎，乃倒装文法。能通其文理，则意义自明。人身之水，化而下行为溺，水中之阳，化而上升为气。气为水所化，故仍化为津液，气结子胎，亦结为水衣，实积气以举胎也。故将产先破水衣，护胎亦赖水衣，水衣护胎而不坠者，气统血故也。若有形之水不行，则逼胎下坠，气陷而不升，则胎不举，故曰伤胎。推原水之不化，由于肺不通调，而肺不通调，又由于心火剋金，故刺泻劳宫、关元，以泻火行水。劳宫心穴，关元肾穴也。刺法不传，代以汤剂，则养肺清心、导心府、宣膀胱，在所必用。昔人谓胎前宜凉，实本此义。惟数典忘祖，不知所自出耳。文中身重，或谓"重"即"肿"字，古文通用，且"重"即有水湿之象，义本通也。
Article 1 of the Pregnancy Chapter in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) discusses the pulse and symptoms of pregnancy. Based on these pulse and symptom patterns, it explains how to diagnose pregnancy, as well as treatment methods and correcting misdiagnoses. The original text states: "A woman presents with a calm pulse, while the Yin pulse (referring to the radial pulse at the cun position, often associated with the lower body/kidneys) is small and weak. She feels thirsty, cannot eat, and has no aversion to cold or fever. This is called pregnancy. It should be treated with Guizhi Tang (Cinnamon Twig Decoction). According to the rules, by the sixtieth day, this syndrome should appear. If there are medical interventions that go against the natural course, and after one month vomiting or diarrhea worsens, then stop such treatment."
Analyzing the meaning of this article, there are many inconsistencies, and it has little practical application when checked against facts. It is best to leave it as a doubt and not discuss it further. For instance, pregnancy itself is not a disease; why must Guizhi Tang be used? Even if Cinnamon Twig (Guizhi) is used, why does the patient lack aversion to cold and fever? What exactly is the "syndrome" expected at sixty days? Is it merely the syndrome of a small and weak Yin pulse, thirst, and inability to eat? Such a syndrome is rarely seen during the second month of pregnancy; it is unclear what observation led to this conclusion. Moreover, even if it exists, it is not a critical condition. Why treat a non-disease, leading to medical error and reversal? The character "Jue" (terminate/stop) in "worsening vomiting and diarrhea requires Jue" is particularly confusing. Some say it means cutting off the root of the disease, others say stopping the treatment, and still others say terminating the pregnancy. Opinions vary widely without consensus. In reality, *Jin Gui Yao Lue* is a book for physicians, not a manual for patients. "Stopping treatment" is advice given to patients, not instruction for doctors, so the intent does not align. If it meant avoiding bitter medicine and waiting for a happy outcome, this could make sense in pregnancy, but why use Guizhi Tang then? And why call it a medical error? An error implies a deviation from the correct path, meaning it is certainly not a case for simply withholding medication. If it means eliminating the root cause, the language is too vague. Shouldn't every disease have its root eliminated? Shouldn't every treatment aim to remove the root? Why emphasize this only after an error has occurred? The intent seems inappropriate here. Only the interpretation of "terminating the pregnancy" has no obvious flaws, yet it adds little to the logic. Therefore, I believe it can be left aside for discussion. Speculating on the general intent, there may be missing text, and the meaning can be divided into two parts: the first part uses pulse and symptoms to determine if pregnancy exists; the second part discusses the treatment for E Zu (morning sickness/pregnancy nausea).
Why do I say this? "The woman gets a calm pulse" means the pulse shows no signs of disease. Menstruation has stopped. A deficiency pattern would show a deficient pulse, and a blood stasis pattern would show a choppy pulse. Now, the pulse lacks pathological signs, yet menstruation has ceased. It is clear that the cessation is not due to illness but is undoubtedly pregnancy. This aligns with the meaning in *Su Wen · Fu Zhong Lun*: "The body has disease [symptoms], but the pulse is free of evil [pathological signs]." When diagnosing pregnancy via pulse, this method is the most accurate. Other methods like movement in the Cun Kou pulse or Yin pulsation distinguishing Yang, although found in classic texts, are hard to guarantee as effective. Relying solely on the absence of menstruation and the lack of pathological pulse signs is the most effective and easiest method, which is why Zhang Zhongjing adopted it. This constitutes the first part: determining pregnancy through pulse and symptoms.
The second part discusses E Zu. The original text says, "According to the rules, by sixty days this syndrome should appear," but does not specify what syndrome. Inferring from the context, this syndrome is inevitable at two months of pregnancy, hence "by sixty days." This implies the syndrome is common and ordinary, not rare. The most common occurrence at two months of pregnancy is E Zu, characterized by vomiting, craving sour foods, and food aversion. The text also says, "If medical intervention goes against the norm, and after one month vomiting increases," the word "increase" implies vomiting was already present but worsened due to improper treatment. Vomiting indicates E Zu. At sixty days, this syndrome appears, and since vomiting is present, even without explicit mention, anyone would recognize it as E Zu. Women consider the Liver their先天 (primary foundation). After conception, blood nourishes the fetus but fails to nourish Liver Wood. When the Liver substance is deficient, Liver function becomes hyperactive, invading the Stomach causing vomiting. The Stomach, being constrained, leads to food aversion. Due to Liver deficiency, seeking relief through food results in craving sour tastes. Pregnancy stops menstruation; after cessation, essence nourishes the fetal origin, leaving turbid Qi nowhere to vent. This turbid Qi, riding on Liver rebellion, invades the Stomach. With Stomach deficiency and righteous Qi unable to overcome evil, vomiting occurs. It manifests at sixty days because this is the time when Liver and Gallbladder nourish the fetus. Thus, while E Zu stems from menstrual obstruction, the primary causes are the upward rebellion of turbid Qi, blood failing to nourish the Liver, Liver Wood overacting on Spleen Earth, and failure of Gallbladder and Stomach Qi to descend.
In Guizhi Tang, Cinnamon Twig (Guizhi) is acrid and warm, promoting circulation. Early in pregnancy, the conception is not firmly established, so it should not be used lightly. Licorice (Gancao) and Jujube (Dazao) are sweet, which is contraindicated for those vomiting. Only Ginger (Shengjiang) harmonizes the Stomach, directs rebellious Qi downward, and removes filth; White Peony Root (Shaoyao) harmonizes the Liver. These are the essential herbs. The formula as a whole is not advisable and should not be followed blindly. Mild cases of E Zu resolve spontaneously; after two months, symptoms naturally subside. Severe cases involve continuous day-and-night vomiting. If upper rebellion is severe, lower collapse may follow, risking miscarriage, necessitating medication. Treatment involves softening the Liver, harmonizing the Stomach, and using aromatic herbs to unblock the middle. However, all Qi-moving, Qi-breaking, and slippery/diuretic agents must be avoided. Pinellia Banxia is the main herb for stopping vomiting. Later generations avoided it fearing it might disturb the fetus, which is a pity. Some claim processed ginger neutralizes this risk, but this is idealistic. Despite popular trend forcing compliance, there is actually no need to avoid it.
Article 2 of the Pregnancy Chapter: "A woman who has had a fixed mass (Zheng disease) for some time, whose menstruation has stopped for less than three months, yet experiences continuous spotting, and feels fetal movement above the umbilicus, this is harm caused by the fixed mass. If fetal movement occurs at six months, and menstruation was normal during the first three months after cessation, it is a true fetus. If bleeding occurs, and menstruation stopped three months prior, it is clotted blood (Pei). The reason the bleeding continues is that the Zheng mass remains. One must purge the Zheng mass. Treat with Guizhi Fuling Wan (Cinnamon Twig and Poria Pill)."
This article discusses complications of pregnancy, not ordinary diseases. Classical Chinese is too concise and often has missing characters. Later commentators failed to explain it clearly, causing confusion rather than clarity; it is better not to interpret it. I will explain it below to show that Zhongjing's writing contains profound logic, not ambiguous or perfunctory words. Before interpreting this, one must know different types of conception. Normally, if menstruation is regular and stops without pathological pulses, conception follows cessation. This is common. However, some have Ju Jing (menstruation once every three months) or Bi Nian (once a year). One must inquire about usual patterns; one cannot assume pregnancy just because menstruation stopped. There is also Gou Tai (conception occurring while menstruation continues normally). In such cases, menstruation continues despite gradual fetal growth; one cannot rule out pregnancy based on continued bleeding. The woman described here has the constitution of Gou Tai. "Menstruation was smooth during the first three months after cessation, indicating conception" explicitly states she conceived during her period. A woman with Gou Tai constitution should continue menstruating after pregnancy. Now, she bled and then stopped for over two months, inconsistent with her usual pattern. This cessation is not due to pregnancy but due to blood stasis accumulation. In normal women, spotting after conception cessation indicates threatened miscarriage, requiring immediate fetal stabilization. Here, the constitution differs; cessation is due to stasis, not pregnancy. Spotting is the discharge of old stasis, not miscarriage. Hence, "Bleeding... stopped three months ago... is Pei (clotted blood)." It clarifies the discharged blood is three-month-old accumulated stasis, not a fetus.
Normally, fetal movement occurs at six months, below the umbilicus. Here, movement occurs before three months and above the umbilicus. Why? Two reasons exist. Movement should be at six months; moving before three months is abnormal for normal women. But for Gou Tai, conception happened during the third previous menstruation. Adding the two months of cessation equals six months. Inferring conception did not happen at cessation from the fact that movement shouldn't occur at three months is a clever deduction. Fetuses cannot move at three months; though it seems less than three months, it is effectively six months. Commentators never understood this, absurdly claiming movement at three months indicates fetal anomaly or that it is stasis, not pregnancy. Zhongjing's profound wisdom has been lost to later generations. This explains early movement.
As for movement above the umbilicus, there is another reason. The text mentions a pre-existing Zheng mass. Zheng refers to true, solid masses formed by blood stasis. Fetal movement is normally below the umbilicus; now it is above. Knowing she has a Zheng mass, the movement above is caused by the lower Zheng mass pushing the fetus upward. The Zheng obstructs blood flow, causing three months of amenorrhea. Three months of amenorrhea leads to more retained stasis, which overflows, causing continuous spotting. Thus, amenorrhea, spotting, and fetal instability are all caused by the Zheng mass. As the saying goes, if Qingfu is not removed, Lu will not be at peace. Without removing the Zheng, the disease will not cease. Hence, "purge the Zheng." Purging Zheng requires blood-invigorating herbs, which do not harm the fetus. *Nei Jing* states: "If there is a cause, there is no injury; if there is a cause, there is no injury to the fetus. Large accumulations can be attacked, but stop when half is reduced." Guizhi Fuling Wan contains only Cinnamon Twig, White Peony Root, Moutan Cortex, and Peach Kernel for invigorating blood. It avoids harsh purgatives like Rhubarb or Mirabilite, adhering to the principle of reducing gradually. This is worth pondering; any pregnant woman needing purgative therapy should follow this method.
Article 3: "A woman pregnant for six or seven months presents with a wiry pulse, fever, increased abdominal distension, abdominal pain, aversion to cold, and a sensation of wind blowing in the lower abdomen. The reason is that the Zi Zang (uterus) is open. Treat with Fuzi Tang to warm the uterus."
This text is clear and needs no commentary. It means pregnancy abdominal pain can result from an open uterus. Symptoms, causes, and treatments are listed completely. Diagnosing and treating according to the law is easy, but later commentaries introduced errors. They mistook "increased fetal distension" as a pathological sign and interpreted "lower abdomen like a fan" as intermittent coldness like wind blowing, which is wrong. Lacking unique insight, they copied each other. If Zhongjing knew, he would cry injustice underground. I correct this now. At six or seven months, the fetus grows significantly, hence "increased distension," referring to physical expansion, not pathological swelling. Growth causes distension, which opens the Zi Zang. Have you not seen white fluid dripping continuously before labor? Distension opening the uterus causes fluid leakage. Because the uterus opens, cold enters. This explains the cause. Aversion to cold and fever resemble exterior syndromes, but the pulse is wiry, not floating. Wiry indicates cold. Plus abdominal pain confirms interior cold. "Lower abdomen like a fan" describes the lower abdomen rising and falling rapidly, corresponding to breathing. "Fan" is a simile, similar to nasal flaring. Interior cold abdominal pain, wiry pulse, and rhythmic lower abdominal movement indicate cold entering the uterus, disturbing Chong Mai, with Liver Wood rebelling. The fetus is unstable; this is a severe case of pregnancy abdominal pain. Urgently warm the uterine cold. Even with chills and fever, interior pathology outweighs exterior; treat the interior. Furthermore, without headache or body ache, it is not necessarily an exterior syndrome but arises from abdominal pain and organ cold. Hence, "Treat with Fuzi Tang to warm the uterus." The Fuzi Tang formula is missing, but some say it is the same as in *Shang Han Lun*. Matching herbs to symptoms: Aconite (Fuzi) warms organ cold as Sovereign; White Peony Root (Baishao) harmonizes Liver and stops pain as Minister; Ginseng (Renshen) and Atractylodes (Baizhu) warm Spleen and secure the fetus as Assistant. This fits perfectly. This article is straightforward, yet commentators bizarrely interpreted "lower abdomen like a fan" as intermittent coldness, twisting gold into iron.
Article 4: "The Master said: Women may have spotting, continuous bleeding after spontaneous abortion, or bleeding during pregnancy. If pregnancy is accompanied by abdominal pain, it is called Bao Zu (Womb Obstruction), treated with Jiao Ai Tang (Collagen and Mugwort Decoction)."
This discusses pregnancy abdominal pain with Bao Zu. *Yi Zong Jin Jian* Gynecology claims "pregnancy abdominal pain is called Bao Zu," which is a major error. Bao Zu is one type of pregnancy abdominal pain, not all abdominal pain. Ancient interpretations are laughable. This article mainly discusses treatment for pregnancy abdominal pain with bleeding; other parts are supplementary. Literally, Bao Zu means obstruction of Qi and Blood in the womb, suggesting unblocking methods. However, matching symptoms and Jiao Ai Tang suggests otherwise. My view prioritizes matching formula to syndrome rather than name. Treating solely by the name "Bao Zu" would miss the bleeding aspect. Even if bleeding is present, one might treat it like the previous Zheng-mass bleeding, which wouldn't suit Jiao Ai Tang. Matching formula to syndrome, this is Blood Deficiency with Qi Stagnation. Bleeding results from Chong and Ren vessels failing to control blood, causing blood to leave its channels. Unchecked bleeding risks miscarriage. The formula uses heavy Rehmannia (Dihuang) to tonify deficiency and secure the fetus as Sovereign; Angelica Sinensis (Danggui), White Peony Root (Baishao), Donkey-hide Gelatin (Ejiao), and Mugwort (Aiye) nourish Ying and harmonize Liver as Ministers; Ligusticum Chuanxiong (Chuanxiong) moves stagnant Qi as Assistant; Mugwort warms the uterus; Charred Ginger (Pao Jiang) guides blood back to channels. It is a formula with much tonification and little movement. This is essentially Jiao Ai Si Wu Tang. Gynecology uses it universally for deficiency-cold abdominal pain and bleeding in menstruation, pregnancy, and postpartum, with great efficacy. Since this Bao Zu uses this formula and shares symptoms, the cause cannot be purely Qi/Blood obstruction in the womb. Discard the name, focus on the reality.
There is also Dampness in Earth and Depression of Wood, pain from Wood sinking into Earth. Spleen governs Dampness; Spleen deficiency gathers Dampness. Liver governs Blood; Wood depression causes Earth stagnation. Article 5: "A pregnant woman with abdominal pain is treated with Danggui Shaoyao San (Angelica and White Peony Powder)." Pain is lingering and constant. Formula uses Danggui and Baishao to nourish Blood and harmonize Liver; Chuanxiong moves blood stagnation; Poria (Fuling) and Atractylodes (Baizhu) strengthen Spleen; Alisma (Zexie) drains excess Earth Dampness. This treats both Liver and Spleen. Baishao is heaviest, harmonizing Liver/Spleen as Sovereign. Zexie is next, draining Dampness as Secondary. The intent is clear. Articles 3 to 5 discuss pregnancy abdominal pain with distinctions: Cold from open Zi Zang treated with Fuzi Tang; Bleeding/Pain (Bao Zu) treated with Jiao Ai Tang; Dampness/Wood Depression treated with Danggui Shaoyao San. Extending this, variations are infinite.
Text: "Persistent vomiting in pregnancy is treated with Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill)." Banxia directs rebellious Qi down and harmonizes Stomach; Ganjiang warms Middle and dispels Cold; Renshen tonifies Middle and boosts Qi. Only three herbs. Inferring function, persistent vomiting here is Spleen-Stomach Deficiency-Cold. Thus, tonify Righteous Qi, dispel Cold, harmonize Middle, and direct Qi down. This vomiting must present with clear vomitus, white coating, and slow pulse (deficiency-cold signs) to use this method.
Text: "Pregnancy with difficult urination, but normal appetite, is treated with Danggui Beimu Kushen Wan (Angelica, Coix Seed, and Sophora Pill)." The key is "normal appetite." Difficult urination due to Spleen-Kidney Yang Deficiency and Bladder dysfunction would cause poor appetite. Normal appetite proves Kidney Yang steaming is intact. Sufficient Kidney Yang should not cause difficult urination; thus, it is not Kidney Yang Deficiency or Bladder failure. No heaviness or abdominal fullness rules out Water Qi stagnation. Analyzing the formula: Danggui moves Blood and soothes Liver; Beimu resolves phlegm and relieves depression; Kushen clears Fire and drains Heat. It soothes Liver, resolves depression, and drains Heat. Thus, difficult urination is due to depression injuring Liver, Liver failing to disperse, Five Emotions transforming into Fire, and Fire depression not venting. Inferentially, besides difficult urination, there must be burning yellow urine, wiry-rapid pulse, yellow coating, and crimson tongue, fitting Liver Depression transforming into Fire. This method spawned later formulas like Chaihu Qinggan Tang and Longdan Xiegan Tang.
Text: "Pregnancy with Water Qi, heaviness, difficult urination, shivering aversion to cold, and dizziness upon rising is treated with Kuizi Fuling San (Abelmosk and Poria Powder)." This discusses prenatal Water Qi, known later as Zi Zhong, Zi Man, Zi Qi. Difficult urination with heaviness indicates Water-Dampness failing to diffuse and overflowing into skin pores. Internal Water-Dampness blocks Yang Qi, causing shivering. Water-Dampness injures Yang, preventing Clear Qi from ascending, causing dizziness. Kuizi Fuling San gently leaches Water-Dampness; removing Dampness cures all diseases. Kuizi is slippery, contraindicated in pregnancy, so later doctors fear it. Prenatal edema often starts at 7-8 months, when Taiyin governs the fetus. Spleen-Lung Qi deficiency also causes edema, making leaching unsuitable. Xue Lizhai said prenatal edema, even with Water-Dampness, ultimately belongs to Spleen Deficiency. His Quansheng Baizhu San (Baizhu, Fuling, Dadoupi, Chenpi, Jiangpi) and Sizijunzi/Liujunzi Decoctions strengthen Spleen and are superior. Actually, Lung Qi deficiency failing to distribute fluids is more common. Using Chunze Tang minus Guizhi for Zi Zhong has deep meaning and can be modeled. Prenatal edema boils down to eight characters: Strengthen Spleen, Leach Dampness, Smooth Qi, Secure Fetus. The claim in *Ji Yin Gang Mu* that "only leaching Qi and Water cures it" is fallacious.
Text: "Women injuring the fetus: pregnant with abdominal fullness, inability to urinate, heaviness from waist down, resembling Water Qi. At seven months, Taiyin should nourish but fails. This is Excess Heart Qi. Prick and drain Laogong and Guanyuan points. Slight improvement in urination indicates cure." This belongs to Zi Man/Zi Zhong, differing from Kuizi Fuling San in Deficiency/Excess. "Injuring fetus" doesn't mean symptoms appear after injury; rather, symptoms like fullness precede fetal injury (inverted syntax). Understanding the grammar clarifies meaning. Body water transforms downward into urine; Yang within water transforms upward into Qi. Qi transforms into fluids. Qi condensing around the fetus forms the amniotic sac ("water coat"), accumulating Qi to lift the fetus. Labor breaks the sac first; the sac protects the fetus. The sac prevents dropping because Qi commands Blood. If有形 (solid) Water fails to move, it pushes the fetus down; sinking Qi fails to lift, injuring the fetus. Root cause: Water fails to transform due to Lung failing to regulate. Lung regulation fails due to Heart Fire overcoming Metal. Pricking/draining Laogong (Heart point) and Guanyuan (Kidney point) drains Fire and promotes Water flow. Laogong is Heart; Guanyuan is Kidney. Acupuncture methods are lost; decoctions replace them. Nourishing Lung, clearing Heart, guiding Heart House, and diffusing Bladder are essential. Ancients said prenatal stage favors cooling, based on this. Later generations forgot the source. "Heaviness" in text may mean "swelling"; ancient texts use them interchangeably, and "heaviness" implies Water-Dampness, so meanings align.