《产宝》论曰∶夫妊娠肿满，由脏气本弱，因产重虚，土不克水，血散入四肢，遂致腹
胀，手足面目皆浮肿，小便秘涩。陈无择云∶凡妇人宿有风寒冷湿，妊娠喜脚肿，俗呼为
皱脚。亦有通身肿满，心腹急胀，名曰胎水。
论曰∶凡妊娠之人，无使气极。若心静气和，则胎气安稳。若中风寒邪气及有所触
犯，则随邪而生病也。凡妊娠经血壅闭以养胎，若忽然虚肿，乃胎中挟水，水血相搏，脾
胃恶湿，主身之肌肉，湿渍气弱，则肌肉虚，水气流溢，故令身肿满也。然其由有自，或
因泄泻下痢，脏腑虚滑，耗损脾胃；或因寒热疟疾烦渴，引饮太过，湿渍脾胃，皆能使
头面或手足浮肿也。然水渍于胞，儿未成形而胎多损坏，及其临产日脚微肿，乃胞脏水
少血多，水出于外，故现微肿，则易生也。宿有寒气，因寒冷所触，故能令腹胀肿满也。
《产乳集》论妊娠自三月成胎之后，两足自脚面渐肿腿膝以来，行步艰辛，以至喘闷，
饮食不美，似水气状。至于脚指间有黄水出者，谓之子气，直至分娩方消。此由妇人素
有风气，或冲任经有血风，未可妄投汤药，亦恐大段甚者，虑将产之际费力，有不测之忧，
故不可不治于未产之前也。古方论中少有言者，按《名医录》宋少主元徽中，与徐文伯
微行学针法，文伯见一妊妇足肿不能行，少主脉之，此女形也。文伯诊之曰∶此男胎也，
在左则胎黑色。少主怒欲破之。文伯恻然曰∶臣请针之，胎遂堕，男形而色黑。此妊娠足
肿之说，见于古者。今巢氏《病源》中但有子烦之论，《千金》并《产宝》方亦略言之，
刘禹锡《续传广信方》以为妊妇有水气而成胎，《太平圣惠》亦言之，皆非也。元丰中，
淮南陈景初，名医也，独有方论治此病，方名初谓之香附散，李伯时易名曰天仙藤散也。
〔薛〕前证若胸满腹胀，小便不通，遍身浮肿，用鲤鱼汤。脾胃虚弱，佐以四君子。
若面目虚浮，肢体如水气，用全生白术散；如未应，用六君子汤。脾虚湿热，下部作肿，用
补中益气加茯苓。若饮食失宜，呕吐泄泻，用六君子汤。若腿足发肿，喘闷不安，或指缝
出水，用天仙藤散。脾胃虚弱，兼四君子汤；如未应，用补中益气汤。若脾肺气滞，用加
味归脾汤佐以加味逍遥散。一妊妇每胎至五月，肢体倦怠，饮食无味，先两足肿，渐
至遍身，后及头面，此是脾肺气虚，朝用补中益气，夕用六君子加苏梗而愈。凡治妊娠，
毋泥月数，但见某经证，即用本药为善。
一妊妇年三十八，妊娠水肿，以鲤鱼汤加五苓散、人参。湿加苍术一钱，浓朴、陈皮五
分，萝卜子炒、车前子、滑石各一钱，作一帖。若喘急加苦葶苈，小便不利加木通、灯草，甚者车前
子、浚川散，其湿毒自消。防己治腰以下湿热肿，如内伤胃弱者，不可用也。
天仙藤散
天仙藤（洗，略炒） 香附子（炒） 陈皮 甘草 乌药（不必天台者，但得软白辛而香者良）
上等分，净秤为细末，每服三钱，水一大盏，姜三片，木瓜三片，紫苏三叶，同煎
至七分，放温澄清，空心食前服，日三服。小便利，气脉通，体轻肿渐消，更不须多服。（元
丰末，王荆公居金陵，举家病，以诗赠景初曰∶举族贫兼病，烦君药石功，到家何所寄，一一问征鸿。因
此见方得于李伯时家传方，录于临川张右丞宅。）
《产宝》疗妊娠身肿有水气，心腹胀满，小便少。
茯苓（四两） 杏仁 槟榔（各三两） 旋复花 郁李仁（各一两）
上为粗末，以水六升，煮取二升，去滓分温三服。小便通即瘥。
崔氏疗妊娠体肿有水气，心腹急满。
茯苓 白术（四两） 旋复花（二两） 杏仁 黄芩（各三两）
上细切，以水七升，煮取二升半，分温三服。忌桃、李、雀肉。酢物。
疗妊娠遍身洪肿，葶苈子散二方。
葶苈子（一两） 白术（五两） 茯苓 桑白皮 郁李仁（各二两）
上为粗末，水六升，煮取二升，分三服，小便利即瘥。
又方
泽泻 葶苈（各二两） 茯苓 枳壳 白术（各六两）
上细切，以水六升，煮取二升，分温两服，小便利即瘥。
泽泻散 治妊娠气壅，身体腹胁浮肿，喘急，大便不通，小便赤涩，宜服。
泽泻 木通 桑白皮 赤茯苓 枳壳 槟榔（各一钱半）
上作一服，水二盅，生姜五片，煎至一盅，食前服。
防己汤 治妊娠脾虚，通身浮肿，心腹胀满，喘促，小便不利。
防己（一钱半） 桑白皮 赤茯苓 紫苏茎叶（各二钱） 木香（半钱）
作一服，煎服法同前。
千金鲤鱼汤 治妊娠腹大，胎间有水气。
白术（五两） 茯苓（四两） 当归 芍药（各三两）
上细锉片，以鲤鱼一尾，修事如食法，煮取汁，去鱼不用，每服四钱，入鱼汁一盏半，
生姜七片，橘皮少许，煎至七分，去滓空心服。《集验》同。
肾着汤 治妊娠腰脚肿。
茯苓 白术（各四两） 干姜 甘草（各二两） 杏仁（三两）
上 咀，每服四钱，水一盏半，煎至七分，食前服。
指迷五皮散 治胎水。寻常脾虚肿满亦治。
大腹皮 桑白皮 生姜皮 茯苓皮 橘皮（各等分）
上 咀，每服半两，水二盏，浓磨木香水一呷，同煎至八分，去滓空心温服。亦治
男子脾虚肿满。
治妊娠两脚浮肿，名曰脆脚。因脾衰不能制水，血化成水所致。用生料平胃散，姜、
枣水煎服。或为末，紫苏叶煎汤调下。
全生白术散 治妊娠面目虚浮，如水肿状。
白术（一两） 生姜皮 大腹皮 茯苓皮 陈皮（各半两）
上为细末，每服二钱，米饮调下，不拘时。
子和治妊娠从脚上至腹肿，小便不利，微渴。猪苓五两为末，以熟水服方寸匕，日三
服。
〔丹〕子肿多湿，用山栀一撮，米饮吞下。
Chen Bao discusses: Pregnancy edema and distension arise from the inherent weakness of the zang-fu qi, exacerbated by the extreme deficiency following childbirth. Earth fails to control Water, blood scatters into the four limbs, leading to abdominal distension, generalized edema of the hands, feet, face, and eyes, along with scanty and difficult urination. Chen Wuyue states: Women who have a history of wind, cold, chill, and dampness often experience foot swelling during pregnancy, commonly known as "wrinkled feet" (Zhou Jiao). There are also cases of generalized edema and distension with urgent fullness in the heart and abdomen, termed "fetal water" (Tai Shui).
It is discussed that pregnant women should avoid excessive emotional agitation. If the mind is calm and qi is harmonious, fetal qi remains stable. If exposed to wind-cold pathogenic factors or other physical/emotional trauma, illness will ensue according to the pathogen. During pregnancy, menstrual blood is retained to nourish the fetus. Sudden generalized edema indicates water-dampness retained within the fetus, where water and blood contend. The Spleen and Stomach dislike dampness; they govern the muscles of the body. Dampness infiltration weakens qi, causing muscle flaccidity, allowing water fluids to overflow, resulting in generalized edema. However, causes vary: some result from diarrhea or dysentery causing visceral laxity and damaging the Spleen and Stomach; others stem from excessive fluid intake due to thirst from alternating chills and fever or malaria, where dampness infiltrates the Spleen and Stomach, causing edema of the head, face, hands, or feet. If water dampness infiltrates the uterus, the fetus may be damaged before formation. Near term, slight foot swelling occurs because the uterine viscera have less water and more blood, with water exiting externally; this slight swelling facilitates delivery. A pre-existing cold condition triggered by cold exposure can cause abdominal distension and swelling.
Chan Ru Ji discusses that after three months of gestation, both feet gradually swell from the dorsum to the knees and shins, making walking difficult, accompanied by panting, chest oppression, and poor appetite, resembling water-qi disease. If yellow fluid oozes from between the toes, it is called "child qi" (Zi Qi), which resolves only after delivery. This is due to the woman's prior constitution of wind pathogens or blood-wind in the Chong and Ren meridians. Decoctions should not be administered recklessly. If the condition is severe, one must worry about exhaustion during labor and unforeseen dangers; thus, treatment before delivery is necessary. Ancient formulas rarely mention this. According to Ming Yi Lu, during the reign of Emperor Yuanhui of Song, the young emperor and Xu Wenbo studied acupuncture incognito. Xu Wenbo saw a pregnant woman with swollen feet unable to walk. The emperor palpated her pulse and diagnosed a female fetus. Xu Wenbo diagnosed: "This is a male fetus; if on the left, the fetus will be black." The emperor, angry, wanted to abort it surgically. Xu Wenbo compassionately said: "Your subject requests to use acupuncture." The fetus was expelled, confirmed as male and black. This case illustrates ancient knowledge of pregnancy-induced foot swelling. Currently, Chao Yuanfang's *Zhu Bing Yuan Hou Lun* only discusses "fetal irritability" (Zi Fan); *Qian Jin Fang* and *Chan Bao* mention it briefly. Liu Yuxi's *Xu Zhuan Xin Fang* attributes fetal formation to water-qi in pregnancy, and *Taiping Sheng Hui Fang* also mentions it, but these are considered incorrect. In the Yuanfeng era, Chen Jingchu of Huainan, a famous physician, had specific formulas for this disease. Initially named Xiang Fu San, Li Boshi renamed it Tian Xian Teng San.
Xue Ji comments: For the aforementioned symptoms, if there is chest fullness, abdominal distension, urinary retention, and generalized edema, use Li Yu Tang (Carp Decoction). For Spleen-Stomach deficiency, combine with Si Jun Zi Tang (Four Gentlemen Decoction). If the face and eyes are puffy and limbs resemble water-qi disease, use Quan Sheng Bai Zhu San (Complete Life Atractylodes Powder); if ineffective, use Liu Jun Zi Tang (Six Gentlemen Decoction). For Spleen deficiency with damp-heat causing lower body edema, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fu Ling (Poria). For improper diet causing vomiting and diarrhea, use Liu Jun Zi Tang. For leg and foot swelling, panting, restlessness, or oozing between fingers, use Tian Xian Teng San. For Spleen-Stomach deficiency, combine with Si Jun Zi Tang; if ineffective, use Bu Zhong Yi Qi Tang. For Spleen-Lung qi stagnation, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) combined with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). One patient experienced limb fatigue and loss of taste at five months gestation, starting with bilateral foot swelling spreading to the whole body and face. This was Spleen-Lung qi deficiency; morning administration of Bu Zhong Yi Qi Tang and evening administration of Liu Jun Zi Tang plus Su Geng (Perilla Stem) led to recovery. When treating pregnancy conditions, do not rigidly adhere to gestational months; treat based on the meridian pattern observed.
A thirty-eight-year-old pregnant woman with edema was treated with Li Yu Tang plus Wu Ling San (Five-Ingredient Powder with Poria), Ren Shen (Ginseng). For heavy dampness, Cang Zhu (Atractylodis Rhizoma) 1 qian, Hou Po (Magnoliae Officinalis Cortex) and Chen Pi (Citri Reticulatae Pericarpium) 0.5 qian were added, along with fried Luo Bo Zi (Raphani Semen), Che Qian Zi (Plantaginis Semen), and Hua Shi (Talcum) each 1 qian, as one dose. For panting, add Ku Ting Li (Semen Lepidii et Descurainiae); for difficult urination, add Mu Tong (Akebiae Caulis) and Deng Cao (Junci Medulla); for severe cases, use Che Qian Zi and Jun Chuan San (Jun Chuan Powder), resolving damp-toxins naturally. Fang Ji (Stephaniae Tetrandrae Radix) treats damp-heat edema below the waist but is contraindicated in internal injury with stomach weakness.
Tian Xian Teng San (Aristolochiae Vitis Decoction)
Tian Xian Teng (Vitis Aristolochiae Caulis, washed and lightly stir-fried), Xiang Fu Zi (Cyperi Rhizoma, stir-fried), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Wu Yao (Linderae Radix - preferably soft, white, and aromatic). Equal parts, finely powdered. Take 3 qian per dose, decoct with 1 large cup of water, 3 slices of Sheng Jiang (Zingiberis Rhizoma), 3 slices of Mu Gua (Chaenomelis Fructus), and 3 leaves of Zi Su (Perillae Folium) until reduced to 70%. Strain, warm, and take on an empty stomach before meals, three times daily. Once urination is clear, qi and pulses are unobstructed, and the body feels light with reduced edema, further doses are unnecessary. (Recorded by Wang Anshi in Jinling during the late Yuanfeng era, derived from Li Boshi's family recipe.)
Chan Bao treats pregnancy body swelling with water-qi, heart/abdominal fullness, and scanty urination.
Fu Ling (Poria) 4 liang, Xing Ren (Armeniacae Semen Amarum), Bin Lang (Arecae Semen) each 3 liang, Xuan Fu Hua (Inulae Flos), Yu Li Ren (Prunus Semen) each 1 liang. Coarsely powdered. Decoct in 6 sheng of water to obtain 2 sheng. Strain and take warm in three doses. Cures when urination flows freely.
Cui Shi treats pregnancy body swelling with water-qi, urgent heart/abdominal fullness.
Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 4 liang, Xuan Fu Hua (Inulae Flos) 2 liang, Xing Ren (Armeniacae Semen Amarum), Huang Qin (Scutellariae Radix) each 3 liang. Finely cut. Decoct in 7 sheng of water to obtain 2.5 sheng. Take warm in three doses. Avoid peaches, plums, sparrow meat, and vinegar foods.
For generalized severe pregnancy edema, Ting Li Zi San (Descurainiae/Semen Lepidii Decoction) two formulas.
Ting Li Zi (Semen Lepidii et Descurainiae) 1 liang, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5 liang, Fu Ling (Poria), Sang Bai Pi (Mori Cortex), Yu Li Ren (Prunus Semen) each 2 liang. Coarsely powdered. Decoct in 6 sheng of water to obtain 2 sheng. Take in three doses. Cures when urination flows freely.
Another Formula
Ze Xie (Alismatis Rhizoma), Ting Li (Semen Lepidii et Descurainiae) each 2 liang, Fu Ling (Poria), Zhi Ke (Aurantii Fructus Immaturus), Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 6 liang. Finely cut. Decoct in 6 sheng of water to obtain 2 sheng. Take warm in two doses. Cures when urination flows freely.
Ze Xie San (Alismatis Powder) treats pregnancy qi congestion, body/abdomen/flank edema, panting, constipation, and dark/scanty urination.
Ze Xie (Alismatis Rhizoma), Mu Tong (Akebiae Caulis), Sang Bai Pi (Mori Cortex), Chi Fu Ling (Poria cum Mycelio et Lignum), Zhi Ke (Aurantii Fructus Immaturus), Bin Lang (Arecae Semen) each 1.5 qian. As one dose, decoct in 2 zhong of water with 5 slices of Sheng Jiang (Zingiberis Rhizoma) to 1 zhong. Take before meals.
Fang Ji Tang (Stephaniae Tetrandrae Decoction) treats pregnancy Spleen deficiency, generalized edema, heart/abdominal fullness, panting, and difficult urination.
Fang Ji (Stephaniae Tetrandrae Radix) 1.5 qian, Sang Bai Pi (Mori Cortex), Chi Fu Ling (Poria cum Mycelio et Lignum), Zi Su Jing Ye (Perillae Caulis et Folium) each 2 qian, Mu Xiang (Aucklandiae Radix) 0.5 qian. As one dose, decoct as above.
Qian Jin Li Yu Tang (Carp Decoction from Qian Jin Fang) treats pregnancy abdominal enlargement due to water-qi between the fetus and mother.
Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5 liang, Fu Ling (Poria) 4 liang, Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba) each 3 liang. Finely sliced. Prepare one carp as food, decoct to extract juice, discard fish. Take 4 qian of powder mixed with 1.5 cups of fish juice, 7 slices of Sheng Jiang (Zingiberis Rhizoma), and a little Ju Pi (Citri Reticulatae Pericarpium). Decoct to 70%, strain, and take on an empty stomach. Same as Ji Yan Fang.
Shen Zhuo Tang (Kidney Attaching Decoction) treats pregnancy waist and foot swelling.
Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 4 liang, Gan Jiang (Zingiberis Rhizoma Recens), Gan Cao (Glycyrrhizae Radix et Rhizoma) each 2 liang, Xing Ren (Armeniacae Semen Amarum) 3 liang. Cut into pieces. Take 4 qian per dose, decoct in 1.5 cups of water to 70%. Take before meals.
Zhi Mi Wu Pi San (Five Barks Powder Directing Wonder) treats fetal water. Also treats ordinary Spleen deficiency edema/distension.
Da Fu Pi (Arecae Pericarpium), Sang Bai Pi (Mori Cortex), Sheng Jiang Pi (Zingiberis Rhizoma Exocarpium), Fu Ling Pi (Poria Exocarpium), Ju Pi (Citri Reticulatae Pericarpium) equal parts. Cut into pieces. Take 0.5 liang per dose, decoct in 2 cups of water with a sip of strong Mu Shan Shui (Liquidambar Resin Water) to 80%. Strain and take warm on an empty stomach. Also treats male Spleen deficiency edema/distension.
Treatment for pregnancy bilateral foot edema, named "Cui Jiao" (Brittle Feet - likely a typo for Zhou Jiao/Wrinkled Feet in original text). Caused by Spleen failure to control water, transforming blood into water. Use Sheng Liao Ping Wei San (Raw Material Calm the Stomach Powder) decocted with Ginger and Jujube. Or powder form, taken with Perilla leaf decoction.
Quan Sheng Bai Zhu San (Complete Life Atractylodes Powder) treats pregnancy facial puffiness resembling edema.
Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 liang, Sheng Jiang Pi (Zingiberis Rhizoma Exocarpium), Da Fu Pi (Arecae Pericarpium), Fu Ling Pi (Poria Exocarpium), Chen Pi (Citri Reticulatae Pericarpium) each 0.5 liang. Finely powdered. Take 2 qian per dose, mixed with rice drink, anytime.
Zi He He treats pregnancy edema from feet to abdomen, difficult urination, slight thirst. Zhu Ling (Polyporus) 5 liang powdered. Take 1 cun bi (square inch measure) with cooked water, three times daily.
Dan Xi comments: Zi Zhong (fetal edema) is mostly due to dampness. Use Zhi Zi (Gardeniae Fructus) one handful, swallowed with rice drink.