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The Master said: "When a woman has a normal pulse, with the Yin pulse (pulse at the cun position reflecting internal/visceral status) being slightly weak, and presents with thirst and inability to eat, without chills or fever, this is named pregnancy. Guizhi Tang (Cinnamon Twig Decoction) should be administered. According to the method, these symptoms should appear around the sixtieth day of pregnancy; if medical treatment is incorrectly applied, it may delay the appearance of these symptoms by one month. If vomiting or diarrhea ensues, medication should be discontinued, allowing for self-recovery."

[Annotation] When menstruation ceases and a normal pulse is found, without chills or fever, it indicates no disease inside or outside. Thirst and inability to eat are early signs of Ezu (morning sickness/pregnancy nausea). Thus, even if the Yin pulse is small and weak, pregnancy can be diagnosed. However, Ezu typically manifests around sixty days of gestation. If a physician fails to recognize pregnancy and applies incorrect treatment, symptoms may be delayed by a month. If vomiting and diarrhea occur subsequently, medication should be stopped to allow natural recovery. Nevertheless, using Guizhi Tang for a patient with a normal pulse, no chills/fever, yet suffering from thirst and anorexia, does not align well with the syndrome, and the textual coherence is broken, suggesting missing text.

[Collected Annotations] Xu Bin stated: A "normal pulse" means no pathological pulse signs, resembling that of a healthy person. The Yin pulse being small and weak refers to a pulse that is neither large nor forceful, but soft and weak, distinct from a fine pulse. Since other pulses are normal, only the lower Jiao's Yin pulse shows slight abnormality, indicating no disease in the Middle and Upper Jiao. The occurrence of thirst and anorexia implies that thirst is not due to Upper Jiao heat, nor anorexia due to Stomach pathology. Shaoyang disease presents with anorexia, but here there are no chills or fever, ruling out Shaoyang exterior syndrome. Therefore, thirst is caused by flaming Yin fire, anorexia by nausea obstructing food intake, and the small Yin pulse reflects the fetus consuming Qi. Hence, it is named pregnancy.

Li [Name omitted] stated: This section describes pregnancy Ezu. The Cun position (Yang pulse) governs Qi, while the Chi position (Yin pulse) governs Blood. A small and weak Yin pulse indicates Blood deficiency. Blood nourishes the fetus; thus, fluid depletion causes thirst. Spleen belongs to Kun Earth, bearing all things; fetal stability relies on Spleen Qi. Anorexia results from weak Spleen Qi. In other diseases causing thirst and anorexia, the pulse is usually irregular with chills/fever. Here, despite anorexia, the pulse is normal and free of chills/fever, confirming pregnancy.

Guizhi Tang (See under Diarrhea section)

"If a woman has a pre-existing Zheng mass (abdominal mass), and menstruation has ceased for less than three months, yet she experiences continuous spotting and fetal movement above the umbilicus, this is harm caused by the Zheng mass. If fetal movement occurs at six months of pregnancy, and menstruation was regular during the first three months, it is a true fetus. If bleeding occurs after three months of amenorrhea, it is a Zheng mass. The reason for insufficient blood is that the Zheng mass remains. It should be purged, and Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) should be used."

[Annotation] Cessation of menstruation with pregnancy is named Gestation. Bleeding during gestation is called Lou Xia (spotting). If a woman with a pre-existing Zheng mass conceives and experiences spotting before three months, with continuous bleeding and restless fetus, this is harm from the Zheng mass. Similarly, if this occurs at six months, it is also Zheng harm. However, if blood stasis has formed clots, because blood volume was low and fetal Qi weak in the first three months, purging the Zheng mass is contraindicated. By the later three months, blood stasis is established and fetal Qi is strong, so Guizhi Fuling Wan is indicated to purge the Zheng mass. This illustrates the principle that when a pregnant woman has disease, the disease should be treated. The text is incomplete, likely containing missing passages; retain the principle.

[Collected Annotations] Lou Quanshan stated: Fetal movement usually occurs at the umbilicus; movement above suggests a Zheng mass.

Cheng Lin stated: In women with Zheng masses who conceive, continuous bleeding is caused by the Zheng mass, not typical fetal restlessness or leakage. Purging the Zheng mass ensures fetal safety. This aligns with the *Neijing* principle: "If there is a cause, there will be no destruction," meaning treating the pathogen will not harm the mother.

Fang Shi stated: Both fetal restlessness and leakage involve bleeding, but restlessness includes abdominal pain, while leakage does not. Restlessness requires Qi-moving methods; leakage requires heat-clearing methods.

Wei Litong stated: Distinguishing between fetus and Zheng mass depends on the three months prior to amenorrhea. Regular menstruation beforehand confirms pregnancy; prior bleeding suggests Zheng mass formation.

Guizhi Fuling Wan Formula
Guizhi (Cinnamon Twig), Fuling (Poria), Mudanpi (Moutan Cortex, remove heart), Taoren (Peach Kernel, remove skin and tip), Shaoyao (White Peony Root) - equal parts.
Grind the five herbs into powder, mix with refined honey to form pills the size of rabbit droppings. Take one pill before meals daily. If ineffective, increase to three pills.

"If a woman is pregnant for six or seven months, presenting with a wiry pulse, fever, increased abdominal distension, abdominal pain, aversion to cold, and a sensation of cold in the lower abdomen as if fanned, this is due to the opening of the Zi Zang (uterus). Attizizi Tang (Aconite Decoction) should be used to warm the uterus. (Formula not found)"

[Annotation] At six or seven months of pregnancy, a wiry pulse and fever may resemble an exterior syndrome. However, if accompanied by increased fetal distension, abdominal pain, and aversion to cold without headache or body ache, it is not an exterior syndrome. The "fanning" sensation in the lower abdomen indicates cold invasion due to Yang deficiency and uterine opening. Attizizi Tang warms the uterus and dispels cold. The formula is missing, and the text is incomplete.

[Collected Annotations] Cheng Lin stated: Fetal distension and pain can cause fever and aversion to cold. The "fanning" sensation indicates severe Yin cold. Pregnancy requires Yin-Yang harmony for fetal stability; Yang deficiency and Yin excess lead to uterine opening. Attizizi Tang warms the meridians.

Li [Name omitted] stated: Zi Zang refers to the uterus. Guan Yuan is three inches below the umbilicus; Bao Men is two inches left of Guan Yuan, Zi Hu is two inches right. Ming Men is where the uterus is tied, located between the kidneys behind the spine at the level of the 14th thoracic vertebra. It is not the same as Zi Zang. Current interpretations place Zi Zang in the lower abdomen, contradicting the location of Ming Men. This is an error.

You Yi stated: Wiry pulse and fever mimic exterior syndrome, but absence of body pain and presence of abdominal pain/cold indicate interior cold. Wind and cold enter the open uterus. Interior Yin excess causes wiry pulse and false heat (Ge Yang). Heat causes contraction, cold causes distension. Although the formula is missing, the intent to warm the interior and dispel cold is clear.

"The Master said: 'Women may experience spotting, continuous bleeding after spontaneous abortion (half-birth), or bleeding during pregnancy. If pregnancy is accompanied by abdominal pain, it is called Bao Zu (womb obstruction). Jiao Ai Tang (Colla Corii Asini and Moxa Decoction) should be administered.'"

[Annotation] Abortion at five or six months is called Ban Chan (half-birth). Continuous bleeding after abortion is due to Zheng mass harm. If there is no Zheng mass, but only abdominal pain, it is Bao Zu. Bao Zu means disharmony of Qi and Blood in the womb, hindering development. Jiao Ai Tang harmonizes the blood to support fetal development.

[Collected Annotations] Cheng Lin stated: Spotting during pregnancy is called Ji Jing (stimulated menstruation) due to Yang insufficiency. Half-birth damages the Sea of Blood, causing continuous bleeding. For Bao Zu with abdominal pain, use Jiao Ai Tang.

You Yi stated: Scanty menstruation and post-partum/post-abortion bleeding result from deficiency of Chong and Ren meridians and failure of Yin Qi to hold. Jiao Ai Tonk tonifies and secures.

Jiao Ai Tang Formula
Xiong (Ligusticum Chuanxiong Rhizome), Ejiao (Colla Corii Asini), Gancao (Licorice Root) - 2 liang each; Aiye (Artemisia Argyi Leaf), Danggui (Angelica Sinensis Radix) - 3 liang each; Shaoyao (White Peony Root) - 4 liang; Shengdi Huang (Rehmannia Glutinosa Radix Preparata).
Boil the seven ingredients in 5 sheng of water and 3 sheng of clear wine to obtain 3 sheng. Strain, dissolve Ejiao, and take 1 sheng warm, three times daily. Repeat if necessary.

"For pregnancy with cramping abdominal pain, Danggui Shaoyao San (Angelica Sinensis and White Peony Powder) should be used."

[Note] The rationale for using this formula for acute pregnancy pain is unclear; likely missing text. Not explained.

Danggui Shaoyao San Formula
Danggui (Angelica Sinensis Radix) - 3 liang; Shaoyao (White Peony Root) - 1 jin; Fuling (Poria); Baizhu (Atractylodes Macrocephala Rhizome) - 4 liang each; Zexie (Alisma Orientale Rhizome), Xiong (Ligusticum Chuanxiong Rhizome) - 0.5 jin each.
Grind the six herbs into powder. Take one cun bi (measure) mixed with wine, twice daily.

"For persistent vomiting during pregnancy, Jiangren Banxia Wan (Ginger, Ginseng, and Pinellia Pill) should be used."

[Annotation] Pregnancy vomiting is Ezu. It arises from cold-fluid retention in the Stomach obstructing the fetus and appetite. Ganjiang (Dried Ginger) warms the Stomach cold; Banxia (Pinellia Tuber) stops vomiting. Since persistent vomiting damages Stomach Qi, Renshen (Ginseng Radix) is added to support it.

[Collected Annotations] Cheng Lin stated: Cold in the Epigastrium causes persistent vomiting. Ganjiang dispels cold; Banxia and Shengjiang (Fresh Ginger) stop vomiting; Renshen harmonizes the Stomach. Although Banxia and Ganjiang are considered potentially abortifacient, Lou Quanshan reported successful use of Banxia for Ezu without harming the fetus, citing the "treating the cause" principle. One should not be dogmatic.

You Yi stated: This method tonifies deficiency and warms the Stomach, suitable for pregnancy with middle-jiao deficiency and cold. The Yangming meridian flows downward. Cold or heat causes rebellion, leading to fluid retention. Pregnancy involves condensation of essence and blood, often generating heat. The *Waitai Mi Yao* formula with Qingzhuru (Bamboo Shavings), Chenpi (Citrus Peel), Banxia, Shengjiang, Fuling, Maidong (Ophiopogon Tuber), and Renshen treats stomach-heat rebellious vomiting, supplementing Zhang Zhongjing's work.

Jiangren Banxia Wan Formula
Ganjiang (Dried Ginger), Renshen (Ginseng Radix) - 1 liang each; Banxia (Pinellia Tuber) - 2 liang.
Grind the three herbs into powder. Form pills with fresh ginger juice, sized like wisteria seeds. Take ten pills with warm water, three times daily.

"For pregnancy with difficult urination but normal diet, Danggui Beimu Kushen Wan (Angelica, Fritillaria, and Sophora Pill) should be used."

[Note] Formula and syndrome do not match; likely missing text. Not explained.

Danggui Beimu Kushen Wan Formula
Danggui (Angelica Sinensis Radix), Beimu (Fritillaria Cirrhosa Bulb), Kushen (Sophora Flavescens Root) - 4 liang each.
Grind the three herbs into powder. Form pills with refined honey, sized like adzuki beans. Take three pills with warm water, increasing to ten pills if necessary.

"For pregnancy with water retention, heaviness, dysuria, aversion to cold, and dizziness upon rising, Kuizi Fuling San (Abelmoschus Seed and Poria Powder) should be used."

[Annotation] Exterior water retention causes edema and aversion to cold; water accumulating in muscles causes heaviness. Interior water retention causes dysuria; water blocking ascending Yang Qi causes dizziness upon rising. Kuizi (Abelmoschus Seed) and Fuling (Poria) promote diuresis and unblock orifices.

Kuizi Fuling San Formula
Kuizi (Abelmoschus Esculentus Fruit Seed) - 1 sheng; Fuling (Poria) - 3 liang.
Grind the two herbs into powder. Take one cun bi with warm water, three times daily. Recovery occurs when urination improves.

"For pregnant women, Danggui San (Angelica Powder) is recommended for regular consumption."

[Annotation] Medication is unnecessary if asymptomatic. However, for thin women with heat, which may consume blood and harm the fetus, regular use stabilizes the condition.

[Collected Annotations] You Yi stated: Pregnancy is vulnerable to heat damage. Danggui San uses Huangqin (Scutellaria Baicalensis Root) to clear heat within the blood-nourishing base of Xiong, Danggui, and Shaoyao, assisted by Baizhu to harmonize the Stomach. Zhenheng praised Huangqin and Baizhu as sacred fetal-calming herbs, but they calm the fetus by removing damp-heat, not directly.

Danggui San Formula
Danggui (Angelica Sinensis Radix), Huangqin (Scutellaria Baicalensis Root), Shaoyao (White Peony Root), Xiong (Ligusticum Chuanxiong Rhizome) - 1 jin each; Baizhu (Atractylodes Macrocephala Rhizome) - 0.5 jin.
Grind the five herbs into powder. Take one cun bi with wine, twice daily. Regular consumption facilitates delivery, prevents fetal distress, and treats various postpartum conditions.

"For nurturing the fetus during pregnancy, Baizhu San (Atractylodes Powder) should be used."

[Annotation] For obese pregnant women with cold constitution, which may harm the fetus, regular use is recommended.

[Collected Annotations] You Yi stated: Fetal damage can result from heat or cold, depending on organ Yin-Yang balance. Danggui San treats heat; Baizhu San treats cold. Baizhu harmonizes the Stomach, Xiong regulates blood, Shujiao (Sichuan Pepper) dispels cold, and Muli (Oyster Shell) calms the fetus. Zhang Zhongjing placed them together to deeply instruct future generations.

Baizhu San Formula
Baizhu (Atractylodes Macrocephala Rhizome), Xiong (Ligusticum Chuanxiong Rhizome), Shujiao (Sichuan Pepper, remove sweat/surface moisture) - 3 fen each; Muli (Oyster Shell).
Grind the four herbs into powder. Take one qian bi with wine, three times daily, plus once at night. If pain persists, add Shaoyao. If epigastric severe pain occurs, double Xiong. If irritability, vomiting, pain, and anorexia occur, add Yixin (Asarum Root) 1 liang and large Banxia 20 pieces. Follow with vinegar-water. If vomiting persists, use wheat juice. If thirsty afterward, use barley porridge. Continue even after recovery.

"If a woman suffers fetal injury, presenting with abdominal fullness, inability to urinate, heaviness from the waist down resembling water retention, at seven months of pregnancy, when the Taiyin stage should nurture but fails to do so, due to excess Heart Qi, Laogong (PC 8) and Guan Yuan (CV 4) should be punctured and drained. Mild improvement in urination indicates recovery."

[Note] Textual meaning is unclear. Puncturing these points may induce abortion; likely a misplaced passage. Not explained.