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Women nourish the fetus with blood. If blood is insufficient or unharmonious, various syndromes related to fetal qi arise. These are not directly related to the hemorrhagic syndromes discussed in this book, but they also belong to the realm of blood. Although dissimilar, they share connections; therefore, they are discussed together to inspire understanding.

In a pregnant woman, there are only two substances in the womb: water and blood. Water is the manifestation of qi. Thus, during childbirth, the amniotic sac (water coat) breaks first, followed by the expulsion of the placenta and blood (blood coat). During menstruation, watery fluid is discharged first, followed by fresh red blood. Water is transformed from qi; qi belongs to Yang, and blood belongs to Yin. Water appears before blood, illustrating that Yang precedes Yin. Therefore, for menstruation to occur, Tian Gui (menstrual essence) must reach the uterus, after which the blood of the Chong and Ren meridians responds and also reaches the uterus, allowing menstrual flow to descend. Conception follows the same principle: Tian Gui must intersect first, followed by the gathering of Chong blood. Hence, ancient texts describe sexual intercourse as "joining essence" rather than "joining blood." Essence refers to the mixture of water and blood.

After conception, the Yang qi within the Kidneys transforms into fluids to nourish the fetus, while the grain and water from the Stomach are extracted to transform into blood. Through the Chong and Ren meridians, these substances flow downward into the uterus to nourish the fetus. When the fetus has sufficient water, the blood remains moist; when it has sufficient blood, it restrains Qi from becoming hyperactive. With water and blood harmonized, the pregnancy proceeds without disease. Pathologies arise solely due to the disharmony between water and blood. Fetal diseases are numerous; I will set aside complex details and establish treatment principles based on water and blood, thereby grasping the root and comprehending myriad conditions.

What is E Zu (pregnancy nausea/vomiting)? It occurs because the water and fire of the fetus reverse upward into the Stomach. The Chong and Ren meridians are the collaterals of the uterus and connect upward to the Yangming Stomach meridian. Yangming Qi should descend smoothly. However, due to the presence of the fetus, the uterus closes, preventing Chong Qi from descending and causing it to reverse upward. Carrying dampness from the uterus, it invades the Spleen/Stomach earth, leading to phlegm-fluids surging upward and causing vomiting. Treatment should regulate the Stomach and drain phlegm-fluids using Er Chen Tang (Two-Cured Decoction), augmented with Zhi Ke (Aurantium Fructus), Sha Ren (Amomi Fructus Rotundus), Sheng Jiang (Zingiberis Rhizoma Recens), and Huo Xiang (Pogostemonis Herba). Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomi Six-Gentlemen Decoction) is also effective. When water descends, Qi descends, and the Stomach is pacified, stopping vomiting. Alternatively, uterine Qi may reverse upward, combining with Yangming dryness to generate Fire, also causing vomiting and regurgitation of bitter or sour fluids, hiccups, and food refusal. The fetus blocks below, while Qi reverses above, often generating Heat syndromes. This is why it is said that hot herbs should be avoided during pregnancy. The method should clear the Stomach and descend Fire, primarily using Xiao Chai Hu Tang (Minor Bupleurum Decoction). Mai Men Dong Tang (Ophiopogon Decoction) is also applicable.

What is Zi Qiang (pregnancy cough)? It results from the water and fire of the fetus invading the Lungs. Nourishing the fetus relies entirely on water and blood. If water is insufficient to moisten blood, blood becomes dry; if blood is insufficient to assist water, Qi generates heat. Dryness and heat combine to form Fetal Fire. This Fire travels up along the Chong Meridian and invades Lung Metal, causing alternating cough and asthma, flushed cheeks, throat obstruction, and airway irritation. Zhang Zhongjing treats this with Mai Men Dong Tang. The popular formula Yu Nu Jian (Jade Woman Decoction) augmented with Wu Wei Zi (Schisandrae Fructus) is also excellent. In these formulas, Niu Xi (Achyranthis Bidentatae Radix) is used specifically to descend Chong Qi reversal; Ban Xia (Pinelliae Rhizoma) descends Chong Qi regarding water; Niu Xi descends Chong Qi regarding Fire. Although these are typically considered abortifacient herbs, when used appropriately, there is no need for fear. Another cause of Zi Qiang is fetal water flooding upward to become phlegm, attacking the Lungs and causing cough. In such cases, the method should eliminate water using Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction) or Liu Jun Zi Tang (Six-Gentlemen Decoction), augmented with Wu Wei Zi, Pao Jiang (Prepared Ginger), and Xi Xin (Asari Radix et Rhizoma). If both water and fire are disturbed causing cough, Xie Bai San (Drain White Powder) augmented with Xing Ren (Armeniacae Semen Amarum), Gua Lou Shuang (Benincasae Pericarpium Depuratum), Bai Qian (Cynanchi Stauntonii Radix), Huang Qin (Scutellariae Radix), Zhi Ke, and Gan Cao (Glycyrrhizae Radix et Rhizoma) is suitable. Or Ting Li Da Zao Xie Fei Tang (Sedum and Jujube Decoction to Drain the Lungs) can be used. However, Ting Li (Sedimi Semen) is potent and should not be overused.

Lower abdominal pain in pregnancy is divided into water and blood categories. In water-related cases, Bladder Qi fails to transform water, causing uterine distension and inability to excrete water, manifesting as scanty/dysuric urination, abdominal distension, and panting. If determined to be Heat accumulation, Dao Chi San (Guide Out Red Powder) augmented with Shan Zhi (Gardeniae Fructus) and Fang Ji (Stephaniae Tetrandrae Radix) clears Heat. If determined to be Cold accumulation with Yang failure to transform, Wu Ling San (Five-Ingredient Powder with Poria) is used to promote diuresis, relieving lower abdominal pain. Ju He Wan (Tangerine Seed Pill) augmented with Fu Ling (Poria) is also effective. In blood-related cases, the uterus is governed by the Liver and Kidneys. If Liver Yang fails to reach the uterus, uterine blood stagnates causing pain, treated with Si Wu Tang (Four-Substance Decoction) augmented with Ai Ye (Artemisiae Argyi Folium), Xiang Fu (Cyperi Rhizoma), E Jiao (Colla Corii Asini), and Hui Xiang (Foeniculi Fructus). If Kidney Yang fails to reach the uterus, the fetus feels cold and painful, radiating to the lower back and spine, treated with Si Wu Tang augmented with Du Zhong (Eucommiae Cortex), Gu Zhi (Psoraleae Fructus), Tai Wu (Arecae Semen Preparatum), and Ai Ye. This is called Bao Zu (Uterine Obstruction), meaning Yin blood in the uterus is blocked from Yang Qi. Severe cases use Shen Qi Wan (Kidney Qi Pill); mild cases use Jiao Ai Si Wu Tang (Colla Corii Asini and Four-Substance Decoction).

Blood and water both belong to Yin. Water is the Yin fluid transformed by congenital Yang Qi; blood is the Yin juice transformed by acquired Stomach Qi. Kidney Yin relies on Stomach fluids for generation, while Stomach Qi relies on Kidney Yang for prosperity. If congenital Yang in the Kidneys is insufficient, symptoms include a wiry pulse, fever, increasing distension and bearing-down sensation, abdominal pain, aversion to cold, and impending labor. Zhang Zhongjing uses Fu Zi Tang (Aconite Decoction) to protect Kidney Yang and support Stomach Qi; this is a Yang-tonifying method. If Stomach fluids are insufficient, the uterus becomes dry, causing sadness, desire to cry, sensations resembling spirit possession, and frequent yawning/stretching. This occurs because Kidney water is insufficient, leading to insufficient Chong blood for nourishment. Kidney water resides below as Tian Gui in the uterus and above as saliva in the mouth. Zang Zao (Visceral Dryness) prevents Lung Metal from receiving moisture, so the Lung governs sadness. Yawning indicates Kidney pathology; spirit-like symptoms indicate Blood dryness preventing Heart from transforming fluids, leaving the Spirit unanchored. Gan Mai Da Zao Tang (Sweet Wheat, Licorice, and Jujube Decoction) nourishes Kidney Yin, transmitting water via Chong/Ren to the Kidneys to generate Yin; this is a Yin-tonifying method. Understanding these two approaches allows one to master all Yin-nourishing and Yang-tonifying methods.

Tai Lou (pregnancy spotting/leakage) is also divided into water and blood syndromes. Bleeding belongs to Blood Heat; excessive Fire forces blood to move recklessly. Treat with Si Wu Tang augmented with E Jiao, Chao Zhi Zi (Stir-fried Gardeniae Fructus), Ce Bai Ye (Platycladi Cacumen), and Huang Qin. Discharging water, appearing like bean curd dregs and amounting to about one sheng, is called Gu Jiang (Solitary Fluid). Excessive loss of water causes fetal desiccation and inevitable miscarriage. Since water is Qi, Qi leakage causes water leakage. Boiled yellow glutinous rice provides supplementation and nourishment. A decoction of Bai Mao Gen (Imperatae Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Lu Jiao Shuang (Cervi Cornu Degelatinatum), Sang Piao Xiao (Mantidis Oötheca), and Yin Bai (Argentum) brewed in wine and water is also beneficial.

Furthermore: Blood is controlled by the Spleen and stored in the Liver; the Liver governs dispersion, so for bleeding, Gui Pi Tang (Restore the Spleen Decoction) augmented with Chai Hu (Bupleuri Radix), Shan Zhi, and E Jiao is particularly appropriate. Water is generated by the Kidneys and regulated by the Lungs; if Lung Qi fails to grasp, water leaks. Observing that deficiency-cold in the Lungs fails to control the lower body, leading to urinary incontinence, explains why Lung Qi failing to grasp causes water leakage. Treat with Bai Zhu, Ren Shen, Hai Piao Xiao (Sepiae Endoconcha), Long Gu (Fossilia Ossis Mastodi), Mu Li (Concha Ostreae), Bai He (Lilii Bulbus), He Zi (Terminalia Chebulae Fructus), Zhu Gen (Imperatae Rhizoma), and Yin Bai.

Zi Lin (pregnancy strangury) involves dribbling urine and is divided into Water Strangury and Blood Strangury. Water Strangury affects the Bladder, presenting with distension, obstruction, and dysuria; treat with Wu Lin San (Five-Strangury Powder) augmented with Mu Tong (Akebiae Caulis) and Ze Xie (Alismatis Rhizoma). Blood Strangury affects the Blood Chamber, presenting with stabbing pain in the yin and droplets of blood; treat with Si Wu Tang augmented with Cong Rong (Cynomorii Herba), Bai Mao Gen, Ou Jie (Nymphaeae Rhizomatis Humulus), Tiao Qin (Scutellariae Radix), Chi Ling (Polyporus), and Cao Shao (Glycyrrhizae Radix et Rhizoma cum Glycyrrhizae Radix Rubra).

Zi Xuan (pregnancy suspension/distension) involves fetal Qi pressing upward, blocking the chest and heart, divided into water and blood aspects. Water aspect disease stems from Qi deficiency, with water flooding to become phlegm, obstructing the fetus, and turbid Qi reversing upward; the pulse is deep, slippery, slow, and weak. Treat with Liu Jun Zi Tang augmented with Zhi Ke, Zi Su (Perillae Folium), Fu Pi (Tangeris Pericarpium Viride), Chuan Xiong (Chuanxiong Rhizoma), and Xiang Fu. Blood aspect disease stems from Blood deficiency, with Minister Fire from the Jueyin Liver Meridian in the fetus flaring up, pushing the fetus upward. Treat with Xiao Chai Hu Tang combined with Si Wu Tang, further augmented with Fu Ling, Huang Lian (Coptidis Rhizoma), and Huang Bai (Phellodendri Cortex). Or use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) augmented with Niu Xi and Mai Dong (Ophiopogonis Radix) to guide downward, following the principle of "suppressing what is high." Do not fear Niu Xi's potential to induce abortion.

Note: For Zi Xuan in the 7th or 8th month, if maternal Blood deficiency leaves the fetus unsupported, seeking nourishment upward, descending drugs alone are ineffective. One must greatly tonify Blood using Zhi Gan Cao Tang (Honey-fried Licorice Decoction), removing Gui Zhi (Cinnamomi Ramulus), and adding Huai Yao (Dioscoreae Rhizoma) and Zao Ren (Ziziphi Spinosae Semen). Sheng Yu Tang (Sage Protects Life Decoction) augmented with Bai Zhu, Fu Ling, and Gan Cao is also effective. Gan Mai Da Zao Tang is suitable. Dietary improvement is essential: stew Huang Qi (Astragali Radix), Ren Shen, Shan Yao (Dioscoreae Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Qian Shi (Euryales Semen), and Zhu Ti (Suis Carnis) for best results.

Zi Qi (pregnancy edema) refers to edema. The uterus and Bladder share the same region. Occupied by the fetus, the uterus presses on the Bladder, preventing water transformation and movement, due to pre-existing insufficiency in Bladder Qi transformation. Treat primarily with Wu Ling San. If Fetal Fire attacks the Lungs, clouding the source of transformation and causing scanty urine and edema, remove Gui Zhi and add Zhi Mu (Anemarrhenae Rhizoma), Mai Dong, Huang Qin, Xing Ren, and Fang Ji.

Zi Fan (pregnancy irritability) is caused by Blood deficiency. Blood is governed by the Heart; sufficient Blood means the Heart is not irritable. The fetus consumes Blood, and Fetal Fire combines with Heart Fire, disturbing the Heart, causing restlessness and insomnia. Treat with Suan Zao Ren Tang (Sour Jujube Decoction). Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill) is also applicable.

Zi Xuan (pregnancy vertigo - *note: distinct from Zi Xuan above*) is Phlegm in the Qi level. Symptoms include dizzy vision and head spinning, caused by fetal water reversing upward to become phlegm. Treat with Er Chen Tang augmented with Zi Su, Zhi Ke, Xing Ren, Jiang Zhi (Zingiberis汁), and Zhu Li (Bambusae Sap).

Zi Xian (pregnancy eclampsia/seizures) is Wind in the Blood level. Symptoms include sudden fainting, collapse, unconsciousness, limb convulsions, recovery after some time, locked jaw, and opisthotonos. This results from maternal Blood deficiency allowing Wind pathogens to enter the Liver. The method should tonify Blood and dispel Wind using Si Wu Tang augmented with Gou Teng (Uncariae Ramulus cum Uncis), Fang Feng (Saposhnikoviae Radix), Fu Shen (Poria cum Radix), Sang Ji Sheng (Taxilli Herba), Du Huo (Angelicae Pubescentis Radix), and Ling Yang Jiao (Capricornus Saigae Tataricae Cornu). Xiao Yao San (Free and Easy Wanderer Powder) and Xiao Chai Hu Tang can also be borrowed for treatment.

Urinary retention is due to Qi insufficiency. Normal Qi transformation allows water excretion. Current点滴 (drop-by-drop) retention indicates the uterine ligaments pressing down on the urethral orifice. The cause of this pressure is Kidney Qi insufficiency failing to lift the fetus upward. This is called Zhuan Bao (Reversed Uterus). Treat primarily with Shen Qi Wan. Alternatively, Stomach Qi insufficiency failing to lift the fetus requires Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).

Constipation is due to Blood insufficiency. Sufficient Blood in pregnancy ensures health. Insufficient Blood cannot even supply the fetus, let alone other organs, leading to thirst, cough, fever, and constipation. The method should generate Blood; once Blood is sufficient, bowels will naturally move. Treat with Si Wu Tang augmented with Xing Ren, Ma Ren (Cannabis Semen), Cong Rong, and Tu Si Zi (Cuscutae Semen). Xiao Yao Tang augmented with Ma Ren, Zhi Ke, and Hou Po (Magnoliae Officinalis Cortex) is also effective.

In summary, disharmonious fetal Qi is always a disorder of the Water component; regulating water harmonizes Qi. Excessive Fetal Fire is always a disorder of the Blood component; regulating Blood extinguishes Fire. Understanding the causes of water, fire, blood, and Qi makes treating fetal diseases easy, treating hemorrhagic syndromes easy, and even treating miscellaneous diseases effortless.

This book establishes laws for hemorrhagic syndromes; the Qi section mentions related topics by analogy. However, fetal diseases most clearly manifest through water, fire, blood, and Qi. Comprehending this section reveals no hidden aspects of these four concepts. Other fetal diseases not fully recorded here can be found in specialized obstetrics texts.