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(This condition is also known as the fetus pressing upward. Note by Fu Ziman.)

Yan's Schizonepeta Decoction (Zisu San): Xu Shuwei stated that it treats distension and pain in the upper abdomen near term during pregnancy, a condition termed "Zixuan" (Fetal Distension). Chen Liangfu stated: When pregnancy reaches four or five months, the Ministerial Fire nourishes the fetus. If heat qi rebels upward, the fetus crowds into the chest and heart region, causing abdominal fullness and stifling sensation. This formula is used with added Huangqin (Scutellariae Radix) and Zhizi (Gardeniae Fructus). Another version without Chuanxiong (Cyperi Rhizoma) is named Qibao San (Seven-Treasure Powder). The prescription consists of Zisu (Perillae Folium) 1 liang, Fupi (Tangeris Pericarpium Viride), Renshen (Ginseng Radix et Rhizoma), Chuanxiong, Ju Pi (Citri Reticulatae Pericarpium), Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix) each 3 fen, Gancao (Glycyrrhizae Radix et Rhizoma) 1 fen. It is cut into pieces and divided into three doses. Boil with 1 sheng of water, 4 slices of Shengjiang (Zingiberis Rhizoma Recens), and Congbai (Allii Fistulosi Bulbus), strain, and take the decoction. (Wang Ang noted: For this formula, only 1 qian of Zisu Ye (Perillae Folium) and 7 fen of Danggui are used per dose; all herbs below Fupi are 5 fen, and Gancao is 2 fen; Congbai is omitted.)

Shen Yaofeng treated a surnamed Yu woman who was nine months pregnant. Accidentally due to labor, she felt abdominal pain, and the fetus gradually rose to the chest. Qi obstruction caused sudden screaming and biting, unable to be restrained by several people holding her. This was the most severe case of Zixuan. He used Xuanfu Daizhe Tang (Inula and Hematite Decoction), removing Renshen and Dazao (Jujubae Fructus), and administered two consecutive doses. The fetus was expelled, and the mother survived. Another woman had similar symptoms but died after the fetus was expelled following the same medication.

Additionally, the wife of Lu Jianxiu experienced the fetus striking the heart. Midwife Jiang taught her to consume juice made from grinding Daizhishi (Hematitum), after which she delivered two sons. One fetus lay horizontally below the heart, and the other struck the upper fetus, causing continuous distress for a day and night. Although the heart was struck, she did not die, and was safe after delivery.

Chen Liangfu stated: A woman returned from a long journey at seven months of pregnancy and suddenly experienced fetal uprising with pain, restlessness in sitting and lying down. Two physicians failed to treat her effectively and claimed the fetus was dead. They applied a paste of crushed Bimazi (Ricini Semen) mixed with Shexiang (Moschus) below the umbilicus to induce expulsion, leaving her life hanging by a thread. Chen examined her and found the Chi pulse (Kidney pulse) absent on both sides, while other pulses were peaceful. Chen asked how they diagnosed it. They replied: Dead fetus. Chen asked how they knew. They said: Because the Chi pulses were deep and absent. Chen asked which book this theory came from. The physicians could not answer. Chen said: This is Zixuan. If the fetus were dead, there would be specific signs: red face and blue tongue indicate dead fetus and living mother; blue face, red tongue, and foaming indicate dead mother and living fetus; blue lips and tongue indicate death of both. Currently, her face is not red, and her tongue is not blue, so the fetus is alive. This is fetal uprising. She should continuously administer Zisu Yin (Schizonepeta Infusion), up to ten doses, until the fetus descends.

Note by You Zaijing: In the autumn of Wushen year, my wife, eight months pregnant, suffered from cough affecting sleep, spurting epistaxis (nosebleed), facial edema, and finger swelling. Various medicines were ineffective. I reasoned that she constitutionally has Yin deficiency, leading to abundant internal fire. The fetus, agitated by fire, crowds the chest and heart, impacting the lungs and causing rebellious cough. Thus, treating the cough directly is unnecessary; instead, one should treat Zixuan. I used Qibao San, removing Renshen, Baishao, and Shengjiang, because of her chest fullness and internal heat; added Sheng Shigao (Gypsum Fibrosum) to clear Yangming fire, and Shudi (Rehmanniae Radix Preparata) to secure the root Yin. Relief was immediate. This winter, again at eight months of pregnancy, after grief and exhaustion, fetal qi rebelled, causing dizziness, cough with phlegm, epigastric distension, loose stools, yellow coating, thirst, and dry mouth. I used Juan Yin Liu Shen Tang (Six-God Decoction to Remove Fluid Retention), removing Danxing (Arisaematis Cum Bile) and Fuling (Poria), adding Zhishi (Aurantii Fructus Immaturus), Zisu Ye, and Dafupi (Tangeris Pericarpium Viride) to regulate qi and relieve depression, and Huangqin, Zhizi, and Zhuru (Bambusae Caulis in Taenia) to clear heat and calm the fetus. Improvement after one dose, cure after two. For all Zixuan cases caused by phlegm stagnation, I use this method, and results are invariably prompt.

Xue Lizhai treated a pregnant woman whose fetal uprising occurred whenever she was angry. Her Left Guan pulse was wiry and surging, indicating internal stirring of Liver Fire. She was cured using Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Fuling, Zhike (Aurantii Fructus), and Zhizi. However, she remained fatigued and anorexic, and was cured using Liujunzi Tang (Six-Gentlemen Decoction) plus Zhike, Chaihu (Bupleuri Radix), and Zhizi.

Sun Wen Yuan treated the wife of Fei Shaoyuan, who was nine months pregnant, suffering from excessive phlegm, wheezing, and cough, with rebellious fetal qi. Her eyes were swollen shut and unable to open, with slight pain in the temporal regions. This was Zixuan complicated by Phlegm-Fire. Using Da Zisu Yin (Major Schizonepeta Infusion) as the main formula, after just one dose, the rebellious qi ceased, and the chest and diaphragm felt relaxed. Only the wheezing and cough persisted, which were settled with Qizhi Huatan Wan (Seven-Processed Phlegm-Resolving Pill). Zisu Yin composition: Zisu, Fupi, Chuanxiong, Baishao, Chenpi, Danggui, Shengjiang, Renshen, Gancao, Congbai.

Lu Zuyu treated the daughter-in-law of Mei Yangzhong, who was seven months pregnant. Her husband was away trading. She suffered from fetal qi rushing to the heart and frequent syncope. Zisu Antai Yin (Schizonepeta Fetus-Calming Infusion) given for several doses was ineffective. Pulse diagnosis showed Cun (Inch) greater than Guan (Bar), and Guan greater than Chi, all wiry and rapid. This indicated extreme Blood deficiency with flaming Fire. He used Qingqi Yangrong Tang (Clear Qi and Nourish Ying Decoction), grinding Chenxiang (Aquilariae Lignum Resinatum) 4 fen and Niuhuang (Calculus Bovis) 2 fen, and slowly administered the decoction. She revived before finishing one dose.

Wan Mizhai treated the wife of Xu Taihe, who was eight months pregnant and suffered from Ziman (Fetal Hydrops). Treatment as Zixuan was ineffective. Abdominal distension worsened, the fetus descended and pressed down, the vulva opened widely, and the amniotic sac shape was exposed externally. She could only lie supine and could not sit. Both hands' pulses were firm, large, and bounding. He said: The disease is harmless; it is twins. The fetuses are plump and weak in qi, unable to restrain themselves, hence the descent. He used Shutai Liqi Zhu (Fetus-Binding and Qi-Regulating Formula) as the main treatment, adding Renshen 1 qian and fried Shengma (Cimicifugae Rhizoma) 3 fen. After three doses, the fetus ascended and stabilized. She later gave birth to a boy and a girl.

Yang Chengliu treated my niece's wife, who was eight months pregnant. One day, fetal qi suddenly rushed upward, blocking the heart region, causing wheezing, fullness, anorexia, spontaneous sweating, suffocation, rigid recumbency, locked jaw, fixed gaze, non-red face, and non-blue tongue. Pressing the pulses on both hands, they were still present. I urgently took about two qian of pills, dissolved them in boiling water, and administered them. After administering the amount equivalent to two wine cups, the chest loosened, the mouth opened, eyes turned, limbs moved, and she revived. Asked what medicine was so effective? It was Bawei Wan (Eight-Ingredient Pill). Asked what disease required this pill? I said: Zixuan. Due to deficiency-cold of the Lower Yuan, lacking Fire to nourish the infant, the fetus moves upward to seek the warmth of Heart Fire, like shrinking feet upward when cold under blankets. Later, using Baizhu (Atractylodis Macrocephalae Rhizoma), Chuanxiong, and Danggui decoction to send down the previous pills, she took them for two months until delivery. (Shen Yaofeng commented: This is a rare case occurring once in a hundred. Unless there is definite evidence of deficiency-cold pulses and symptoms, hot medicines should not be attempted.)