妇人怀胎，一月之时，足厥阴脉养。二月，足少阳脉养。三月，手心主脉养。四月，手少阳脉养。五月，足太阴脉
养。六月，足阳明脉养。七月，手太阴脉养。八月，手阳明脉养。九月，足少阴脉养。十月，足太阳脉养。诸阴阳各养
三十日活儿。手太阳、少阴不养者，下主月水，上为乳汁，活儿养母。怀娠者不可灸刺其经，必堕胎。
妇人怀娠三月而渴，其脉反迟者，欲为水分。复腹痛者，必堕胎。
脉浮汗出者，必闭。其脉数者，必发痈脓。五月、六月脉数者，必向坏。脉紧者，必胞漏。
脉迟者，必腹满而喘。脉浮者，必水坏为肿。
问曰∶有一妇人，年二十所，其脉浮数，发热呕咳，时下利，不欲食。脉复浮，经水绝，何也？师曰∶法当有娠，
何以故？此虚家法当微弱，而反浮数，此为戴阳。阴阳和合，法当有娠。到立秋，热当自去。何以知然？数则为热，热
者是火，火是木之子，死于未。未为六月位，土王，火休废，阴气生，秋节气至，火气当罢，热自除去，其病即愈。
师曰∶乳后三月有所见，后三月来，脉无所见，此便是躯。有儿者护之，恐病利也，何以故？怀妊阳气内养，乳中
虚冷。故令儿利。
妇人怀娠，六月、七月，脉弦发热，其胎逾腹，腹痛恶寒，寒者小腹如扇之状。所以然者，子脏开故也，当以附子
汤温其脏。
妇人妊娠七月，脉实大牢强者生，沉细者死。
妇人妊娠八月，脉实大牢强弦紧者生，沉细者死。
妇人怀躯六月、七月，暴下斗余水，其胎必倚而堕。此非时，孤浆预下故也。
师曰∶寸口脉洪而涩，洪则为气，涩则为血。气动丹田，其形即温。涩在于下，胎冷若冰。阳气胎活，阴气必终。
欲别阴阳，其下必僵。假令阳终，畜然若杯。
问曰∶妇人妊娠病，师脉之，何以知此妇人双胎，其一独死，其一独生？而为下其死者，其病即愈，然后竟免躯，
其脉何类？何以别之？
师曰∶寸口脉，卫气平调，荣气缓舒。阳施阴化，精盛有余，阴阳俱盛，故成双躯。今少阴微紧，血即浊凝，经养
不周，胎则偏夭。少腹冷满，膝膑疼痛，腰重起难，此为血理。若不早去，害母失胎。
师曰∶妇人有胎腹痛，其人不安，若胎病不长，欲知生死，令人摸之，如覆杯者则男，如肘头参差起者女也。冷在
何面？冷者为死，温者为生。
师曰∶妇人有漏下者，有中生后，因续下血，都不绝者，有妊娠下血者。假令妊娠腹中痛，为胞漏（一云阻），胶艾
汤主之。
妇人妊娠，经断三月，而得漏下，下血四十日不止，胎欲动，在于脐上，此为。妊娠六月动者，前三月经水利时胎
也。下血者，后断三月， 也，所以下血不止者，其 不去故也。当下其 ，宜桂枝茯苓丸。
问曰∶妇人病，经水断一、二月，而反经来，今脉反微涩，何也？师曰∶此前月中，若当下利，故令妨经。利止，
月经当自下，此非躯也。
妇人经自断而有躯，其脉反弦，恐其后必大下，不成躯也。
妇人怀躯，七月而不可知，时时衄血而转筋者，此为躯也。衄时嚏而动者，非躯也。脉来近去远，故曰反，以为有
躯，而反断，此为有阳无阴故也。
妇人经月下，但为微少。师脉之，反言有躯，其后审然，其脉何类？何以别之？
师曰∶寸口脉阴阳俱平，荣卫调和，按之滑，浮之则轻，阳明、少阴，各如经法，身反洒淅，不欲食饮，头痛心乱，
呕哕欲吐，呼则微数，吸则不惊，阳多气溢，阴滑气盛，滑则多实，六经养成，所以月见，阴见阳精，汁凝胞散，散者
损堕。设复阳盛，双妊二胎。今阳不足，故令激经也。
妇人妊娠，小便难，饮如故，当归贝母苦参丸主之。
妇人妊娠有水气，身重，小便不利，洒洒恶寒，起即头眩，葵子茯苓散主之。
妇人妊娠，宜服当归散，即易产无疾苦。
师曰∶有一妇人来诊（一作脉），自道经断不来。师言∶一月为 ，二月为血，三月为居经。是定作躯也，或为血积，
譬如鸡乳子，热者为禄，寒者多浊，且当须后月复来，经当入月几日来。假令以七日所来，因言且须后月十日所来相间。
设其主复来者，因脉之，脉反沉而涩，因问曾经半生，若漏下亡血者，定为有躯。其人言实有是，宜当护之。今经微弱，
恐复不安。设言当奈何？当为合药治之。
师曰∶有一妇人来诊，自道经断，即去，师曰∶一月血为闭，二月若有若无，三月为血积，譬如鸡伏子，中寒即浊，
中热即禄，欲令胎寿，当治其母，挟寒怀子，命则不寿也。譬如鸡伏子，试取鸡一毛拔去，覆子不遍，中寒者浊。今夫
人有躯，少腹寒，手掌反逆，奈何得有躯？妇人因言，当奈何？师曰∶当与温经汤。设与夫家俱来者，有躯。与父母家
俱来者，当言寒多，久不作躯。
师曰∶有一妇人来诊，因言阴阳俱和调，阳气长，阴气短，但出不入，去近来远，故曰反。以为有躯，偏反血断，
断来几日，假令审实者，因言急当治，恐经复下。设令宫中人，若寡妇无夫，曾夜梦寐交通，邪气或怀久作 瘕，急当
治，下服二汤。设复不愈，因言发汤，当中。下胎而反不下，此何等意邪？可使且将视赤乌（一作赤马）。
师曰∶若宫里张氏不瘥，复来相问。（臣亿等详此文理脱误不属无本可校以示阙疑余皆效此。）
师曰∶脉妇人得平脉，阴脉小弱，其人渴，不能食，无寒热，名为躯，桂枝主之，法六十日当有娠。设有医治逆者，
却一月加吐下者，则绝之。方在《伤寒》中。
妇人脉平而虚者，乳子法也。平而微者实，奄续法也。而反微涩，其人不亡血、下利，而反甚，其脉虚，但坐乳大
儿及乳小儿，此自其常，不能令甚虚竭，病与亡血虚等，必眩冒而短气也。
师曰∶有一妇人好装衣来诊，而得脉涩，因问曾乳子下利，乃当得此脉耳，曾半生漏下者，可。设不者，经断三月、
六月。设乳子漏下，可为奄续，断小儿勿乳，须利止复来相问，脉之。
师曰∶寸口脉微迟，尺微于寸，寸迟为寒，在上焦，但当吐耳。今尺反虚，复为强下之，如此，发胸满而痛者，必
吐血，少腹痛、腰脊痛者，必下血。师曰∶寸口脉微而弱，气血俱虚，若下血、呕吐、汗出者可；不者，趺阳脉微而弱。
春以胃气为本，吐利者可；不者，此为水气，其腹必满，小便则难。
妇人常呕吐而胃反，若常喘（一作多唾），其经又断，设来者，必少。
师曰∶有一妇人，年六十所，经水常自下，设久得病利，少腹坚满者为难治。
师曰∶有一妇人来诊，言经水少，不如前者，何也？师曰∶曾更下利，若汗出、小便利者可。何以故？师曰∶亡其
津液，故令经水少。设经下反多于前者，当所苦困。当言恐大便难，身无复汗也。
师曰∶寸口脉沉而迟，沉则为水，迟则为寒，寒水相抟，趺阳脉伏，水谷不化，脾气衰则 溏，胃气衰则身体肿。
少阳脉畀，少阴脉细，男子则小便不利，妇人则经水不通，经为血，血不利则为水，名曰血分。（一作水分）师曰∶寸口
脉沉而数，数则为出，沉则为入，出则为阳实，入则为阴结。趺阳脉微而弦，微则无胃气，弦则不得息。少阴脉沉而滑，
沉则为在里，滑则为实，沉滑相抟，血结胞门，其藏不泻，经络不通，名曰血分。
问曰∶病有血分。何谓也？师曰∶经水前断，后病水，名曰血分。此病为难治。
问曰∶病有水分，何谓也？师曰∶先病水，后经水断，名曰水分，此病易治。何以故？去水，其经自当下。脉濡而
弱，弱反在关，濡反在巅。迟在上，紧在下。迟则为寒，名曰浑。阳浊则湿，名曰雾。紧则阴气栗，脉反濡弱，濡则中
湿，弱则中寒，寒湿相搏，名曰痹。腰脊骨节苦烦，肌为不仁，此当为痹。而反怀躯，迟归经，体重，以下脚为 肿，
按之没指，腰冷不仁，此为水怀。喘则倚息，小便不通，紧脉为呕，血气无余，此为水分。荣卫乖亡，此为非躯。
Background Information:
Book: Mai Jing (Pulse Classic)
Author: Wang Shuhe
Dynasty: Western Jin
Chapter: Ping Ren Shen Tai Dong Xue Fen Shui Fen Tu Xia Fu Tong Zheng Di Er (Chapter 2: On Pregnancy, Fetal Movement, Blood and Water Divisions, Vomiting, Diarrhea, Abdominal Pain, etc.)
Category: Pulse Diagnosis
Translation:
When a woman is one month pregnant, the Qi and Blood of the Foot Jueyin Liver Meridian (which stores blood and regulates volume) nourish the fetus. At two months, they are nourished by the Foot Shaoyang Gallbladder Meridian (paired with the Liver, governing decision-making). At three months, by the Hand Jueyin Pericardium Meridian (the outer network protecting the Heart). At four months, by the Hand Shaoyang Sanjiao Meridian (transporting Yuan Qi and fluids). At five months, by the Foot Taiyin Spleen Meridian (governing the transformation and transportation of food essence). At six months, by the Foot Yangming Stomach Meridian (abundant in Qi and Blood). At seven months, by the Hand Taiyin Lung Meridian (governing Qi and respiration). At eight months, by the Hand Yangming Large Intestine Meridian (conveying waste). At nine months, by the Foot Shaoyin Kidney Meridian (storing Essence, the root of congenital constitution). At ten months, by the Foot Taiyang Bladder Meridian (governing the exterior of the body). Each Yin and Yang meridian nourishes for thirty days in its respective month, allowing the fetus to mature and be born. The Hand Taiyang Small Intestine and Hand Shaoyin Heart meridians do not directly participate in nourishing the fetus; their functions below maintain menstruation, and above transform into milk to nourish the infant and support the mother. During pregnancy, moxibustion or acupuncture should not be performed on these meridians, as it will inevitably cause miscarriage.
If a woman experiences thirst three months into pregnancy and her pulse is surprisingly slow, this may indicate "Water Division" pathology (disease caused by fluid retention). If accompanied by abdominal pain, miscarriage is inevitable.
If the pulse is floating and there is sweating, urinary obstruction will certainly occur. If the pulse is rapid, carbuncles and pus will certainly develop. If the pulse is rapid at five or six months of pregnancy, the condition will surely deteriorate. If the pulse is tight, uterine bleeding (leaking fetus) will occur.
If the pulse is slow, abdominal fullness and wheezing will certainly occur. If the pulse is floating, edema due to water flooding will certainly occur.
Question: A woman of about twenty years old has a floating and rapid pulse, fever, vomiting, cough, occasional diarrhea, and loss of appetite. Her pulse becomes floating again, and her menses have ceased. What is the cause? The Master said: According to the law, she should be pregnant. Why? Normally, those with deficiency have a weak pulse, but hers is surprisingly floating and rapid, indicating "Floating Yang" syndrome (deficient Yang floating upward). When Yin and Yang harmonize, pregnancy is expected. By the time of the Start of Autumn, the heat will naturally subside. How do we know this? Rapid pulse indicates heat; heat belongs to Fire. Fire is the son of Wood. In the Wei month (lunar June), Fire rests and Earth prospers, while Yin Qi begins to grow. With the arrival of Autumn solar terms, Fire Qi should recede, and heat will naturally disappear, curing the disease.
The Master said: If there is vaginal discharge three months after childbirth, followed by menstruation three months later, but the pulse shows no abnormalities, this indicates pregnancy. One must protect the fetus, fearing diarrhea. Why? Because during pregnancy, Yang Qi nourishes the fetus internally, leaving the breast area relatively cold and deficient. This causes the infant to suffer from diarrhea.
When a woman is six or seven months pregnant, if the pulse is wiry and she has fever, the fetus may protrude beyond the abdomen, accompanied by abdominal pain and aversion to cold, feeling as if the lower abdomen is being fanned by wind. This occurs because the uterus opens. It should be treated with Fuzi Tang to warm the uterus.
At seven months of pregnancy, a solid, large, firm, and strong pulse indicates survival, while a deep and fine pulse indicates death.
At eight months of pregnancy, a solid, large, firm, strong, wiry, and tight pulse indicates survival, while a deep and fine pulse indicates death.
If a woman at six or seven months of pregnancy suddenly expels more than a dou of watery fluid, the fetus will inevitably fall. This is not the time for delivery, but rather the premature leakage of amniotic fluid.
The Master said: If the Cunkou pulse is洪 (Hong/Surging) and 涩 (Se/Choppy), Hong indicates Qi excess, and Se indicates Blood deficiency. If Qi disturbs the Dantian, the body shape becomes warm. If Se appears in the lower part, the fetus is cold as ice. If Yang Qi prevails, the fetus lives; if Yin Qi is excessive, the fetus dies. To distinguish between Yin and Yang (life and death), the lower part of the fetus will become stiff. If Yang finally perishes, the accumulation in the abdomen will be hard like a cup.
Question: In cases of pregnancy disease, how does the physician determine via pulse diagnosis that a woman carries twins, one dead and one alive? After administering medicine to expel the dead fetus, the illness resolves, and eventually the living fetus is preserved. What does such a pulse resemble? How is it distinguished?
The Master said: At the Cunkou position, the Wei Qi (Defensive Qi) is balanced and smooth, and the Ying Qi (Nutritive Qi) is relaxed. Yang distributes, Yin transforms, Essence is abundant, and both Yin and Yang are prosperous, resulting in twins. Now, if the Shaoyin pulse is slightly tight, the blood becomes turbid and coagulated, nutrition is insufficient, causing one fetus to wither prematurely. There is coldness and fullness in the lower abdomen, knee pain, heavy waist making it difficult to rise; this is a disorder of the blood collaterals. If not removed early, it harms the mother and results in loss of the fetus.
The Master said: For pregnant women with abdominal pain and restlessness, if the fetus fails to grow, one can determine life or death by palpation. If the abdomen feels like an inverted cup, it is a male; if it feels uneven like an elbow joint, it is a female. Where is the cold? Cold indicates death; warmth indicates life.
The Master said: Women may experience metrorrhagia (bleeding outside of menstruation). Some occur before conception, some after, continuing without cessation. Some are gestational bleeding. If there is abdominal pain during pregnancy, it is called Baolou (Uterine Leakage, also known as Zu), treated with Jiao Ai Tang.
If a woman’s menses stop for three months during pregnancy but she experiences vaginal bleeding lasting forty days without stopping, and fetal movement is felt above the navel, this is called "Jijing" (stimulated menstruation, where light bleeding occurs monthly during early pregnancy without harming the fetus). If fetal movement is felt at six months, it is because conception occurred when the previous three months' menses were normal. The bleeding occurs because conception happened three months after the last period stopped; thus, bleeding persists because the stasis remains. One should purge the stasis using Guizhi Fuling Wan.
Question: A woman’s menses stop for one or two months, yet she bleeds again. Her pulse is now faint and choppy. Why? The Master said: This is because she had diarrhea in the first half of the month, which interfered with menstruation. Once diarrhea stops, menstruation should resume naturally; this is not pregnancy.
If a woman’s menses stop naturally due to pregnancy, but the pulse is wiry, she fears massive hemorrhage later, preventing successful gestation.
If a woman is pregnant, and at seven months it is uncertain, frequent epistaxis (nosebleed) and muscle cramps indicate pregnancy. However, if nosebleeds are accompanied by sneezing and tremors, it is not pregnancy. A pulse that comes near and goes far is called "Fan" (Reverse). Believing there is pregnancy but menses cease, this is due to having Yang without Yin.
If a woman’s menses are merely slightly scanty, but the physician says she is pregnant, and it proves true, what is the pulse like? How is it distinguished?
The Master said: The Cunkou pulse is balanced in Yin and Yang, Ying and Wei are harmonious. Pressing reveals slipperiness; lifting reveals lightness. The Hand Yangming and Foot Shaoyin pulses follow standard laws. The body feels chilly (Saxi), appetite is lost, headache and mental confusion occur, nausea and retching arise. Exhalation is slightly rapid, inhalation is calm. Yang is abundant with Qi overflow; Yin is slippery with Qi prosperity. Slippery indicates excess. The Six Channels nourish the fetus, so slight menstrual flow continues. Yin blood meets Yang essence, fluids coagulate, the uterus disperses; dispersion leads to damage and abortion. If Yang becomes excessive, twins result. Now, Yang is insufficient, hence the phenomenon of stimulated menstruation.
For pregnant women with difficult urination but normal appetite, Danggui Beimu Kushen Wan is indicated.
For pregnant women with water qi (fluid retention), heaviness, difficulty urinating, chills, and dizziness upon rising, Kuizi Fuling San is indicated.
Pregnant women are suitable for taking Danggui San, facilitating easy labor without pain.
The Master said: A woman came for consultation, stating her menses had stopped. The doctor said: One month of cessation is "Gou" (Dirt/Residue); two months is "Xue" (Blood); three months is "Ju Jing" (Resident Menses). This confirms pregnancy, or it could be blood accumulation. Like a hen incubating eggs, heat leads to hatching, cold leads to turbidity. Wait until next month to see when the menses return. If she says they come on the seventh day, tell her to return around the tenth day of the next month. If the menses do return, check the pulse. If it is deep and choppy, ask if she had a prior miscarriage or blood loss. If so, it is definitely pregnancy. She confirms this history; protection is advised. The pulse is weak, suggesting instability. If asked what to do, prescribe medicine.
The Master said: A woman came stating her menses stopped, then left. The doctor said: One month cessation is "Bi" (Closure); two months, presence or absence; three months, "Xue Ji" (Blood Accumulation). Like a hen incubating eggs, cold inside causes turbidity, heat inside causes hatching. To ensure fetal longevity, treat the mother. Carrying a child with cold pathogens shortens life. Like a hen incubating eggs, if a feather is plucked and coverage is incomplete, the cold part becomes turbid. Now the woman is pregnant, but her lower abdomen is cold and palms are reversed (cold). How can she be pregnant? She asks what to do. The doctor said: Use Wenjing Tang. If she came with her husband, she is pregnant. If she came with her parents, say there is much cold, and long-term infertility exists.
The Master said: A woman came stating Yin and Yang are harmonized, Yang grows, Yin shrinks, only exiting not entering, going near coming far, hence "Reverse." Suspecting pregnancy, yet menses cease. How many days since cessation? If confirmed, urgent treatment is needed, fearing menses might return. If she is a palace maid, widow, or had nocturnal emissions, evil qi may have formed a mass (Jia) over time. Urgent treatment is needed, starting with two decoctions. If unhealed, use a sweating decoction, aiming for middle efficacy. If the fetus is expelled but not delivered, what is the meaning? Observe the "Chi Wu" (Red Crow/Mare, referring to blood signs).
The Master said: If Zhang from the palace does not recover, inquire again. (Note: Chen Yi et al. detailed that this text has errors and lacks sources, showing doubt; others follow this example.)
The Master said: If a woman has a level pulse, with the Yin pulse slightly weak, thirst, inability to eat, no chills or fever, this is named Pregnancy. Treat with Guizhi Tang. According to the method, pregnancy should be confirmed within sixty days. If misdiagnosed and treated incorrectly, leading to vomiting and diarrhea after one month, stop treatment. The formula is in Shanghan Lun.
A woman with a level and empty pulse is nursing. Level and slightly weak indicates recent conception. Level but surprisingly faint and choppy, without blood loss or diarrhea, yet symptoms worsen, with a void pulse, is due to nursing a large infant and a small child. This is normal and does not lead to extreme depletion. Illness resembling blood loss or deficiency causes dizziness and shortness of breath.
The Master said: A woman who dresses elaborately comes for consultation with a choppy pulse. Ask if she had diarrhea after nursing. This pulse results from such history. Prior partial miscarriage with leakage can be cured. If not, and menses stop for three or six months. If nursing with leakage, consider early conception. Stop nursing the infant, wait for diarrhea to stop, then reconsult and check pulse.
The Master said: Cunkou pulse is faint and slow. Chi pulse is fainter than Cun. Slow at Cun indicates cold in the Upper Jiao, only vomiting will occur. Now Chi is deficient, compounded by harsh purgation. This leads to chest fullness and pain, likely hematemesis. Lower abdominal pain and lumbar spine pain indicate hematochezia. The Master said: Cunkou pulse faint and weak indicates Qi and Blood deficiency. Hemorrhage, vomiting, or sweating are acceptable outcomes. If not, Duyang pulse is faint and weak. Spring relies on Stomach Qi. Vomiting and diarrhea are acceptable; otherwise, it is Water Qi, abdominal fullness, and difficult urination.
Women who frequently vomit and have stomach reversal, or frequent wheezing (or excessive saliva), with ceased menses, if menses return, the volume will be scant.
The Master said: A sixty-year-old woman whose menses continue spontaneously, if she suffers from chronic diarrhea and lower abdominal hardness/fullness, is difficult to treat.
The Master said: A woman complains of scant menses compared to before. Why? The doctor said: Prior diarrhea, sweating, or frequent urination are acceptable. Why? Loss of body fluids causes scant menses. If menses become heavier than before, worry about exhaustion. Expect constipation and lack of sweating.
The Master said: Cunkou pulse deep and slow. Deep indicates Water, Slow indicates Cold. Cold and Water contend. Duyang pulse is hidden, digestion fails. Spleen Qi decline causes loose stools; Stomach Qi decline causes body edema.
Shaoyang pulse [text unclear], Shaoyin pulse fine. Men have difficult urination; women have amenorrhea. Menses are Blood. Blood stagnation becomes Water, named Blood Division (or Water Division). The Master said: Cunkou pulse deep and rapid. Rapid indicates Out, Deep indicates In. Out is Yang Excess, In is Yin Knot. Duyang pulse faint and wiry. Faint means no Stomach Qi; Wiry means inability to breathe. Shaoyin pulse deep and slippery. Deep is Interior, Slippery is Excess. Deep and Slippery contend, Blood knots at the Uterus Gate. The organ does not drain, collaterals are blocked, named Blood Division.
Question: What is Blood Division? The Master said: Menses cease first, then water disease (edema) develops, named Blood Division. This disease is difficult to treat.
Question: What is Water Division? The Master said: Water disease develops first, then menses cease, named Water Division. This disease is easy to treat. Why? Removing Water allows menses to resume naturally. Pulse is Ru (Soft) and Ruo (Weak). Weak is at Guan, Ru is at Dian (superficial). Slow is above, Tight is below. Slow is Cold, named Hun. Yang turbidity is Damp, named Wu (Mist). Tight indicates Yin Qi trembling. Pulse is surprisingly Ru and Ruo. Ru indicates internal Dampness, Ruo indicates internal Cold. Cold and Damp contend, named Bi (Obstruction). Waist, spine, and joints suffer annoyance; muscles are numb. This is Bi syndrome. But if pregnant, menses delay, weight increases, edema starts from legs, pressing leaves indentations, waist is cold and numb, this is Water Pregnancy. Wheezing requires leaning to breathe, urination blocked, Tight pulse causes vomiting, Blood and Qi exhausted, this is Water Division. Ying and Wei are disrupted, this is not pregnancy.