(八）妊娠感冒王××，女，30岁。妊娠五月，营气不足，津液不充，胃肠虚燥，大使秘结。又复感外邪，以致发热微寒，腹胀痞满，咳嗽口干，脉左寸浮弦兼数，左关小数，舌尖赤，苔黄厚腻。外则风寒为患，内则热郁津亏。方药：葛根12克麻绒3克杏仁9克(捣）桂枝9克炒柴胡9克杭芍9克炒黄芩6克法半夏9克黄连3克(酒炒）郁李仁15克(捣）生姜2片炒谷芽9克神曲9克(烧）甘草3克火麻仁15克(捣）大枣3个1剂寒热全解，便通里和。《李继昌医案》
【评按】此案外有风寒见证，内现热郁津亏，当治以疏解合和中润便法。疏方兼顾中气，有利于妊娠期增强抗御外邪的能力。
(九）胎漏、胎动不安、滑胎
例一孙××，女，31岁，已婚。病历号129830。初诊(1976年2月18日）：结婚四年不孕。功能性子宫出血十年余，经治疗后，现已孕二月余，怀孕四十天时，曾见红七天，目前腹痛腰酸，胸闷心慌，带多色黄，有时泛恶，寐差便艰，舌苔白腻、尖有瘀点，脉象沉细。辨证：肝气逆，脾气弱，心肾又虚。治法：调肝脾，益心肾。方药：党参12克白术9克茯苓12克山药12克麦冬9克橘红6克苏梗6克川断12克桑寄生15克大枣4枚6剂。2月26日二诊：服上药六剂，诸恙均见减轻，劳则午后少腹隐痛，腰酸，胃纳正常，空腹仍欲泛恶，舌苔白腻、尖有瘀点，脉左软微数，右细软微数，病由脾胃不健，肝肾又虚，治以健脾胃，补肝肾。方药：党参12克白术9克茯苓12克山药12克玉竹12克橘皮6克木香6克川断12克桑寄生15克狗脊12克6剂。3月11日三诊：妊娠三月，服上药后，少腹痛止，有时腰酸，咽干，鼻干如塞，胃纳二便如常，舌苔薄白腻，尖有瘀点，脉左软滑，病由肺气弱，肾阴虚，治以补气养阴，以固胎元。方药：党参12克白术9克山药12克麦冬9克橘皮6克川断12克桑寄主15克玉竹12克6剂。
(《钱伯煊妇科医案》）
例二林调，女，20岁，已婚。妊娠已五个月，近二月来阴道又流血。色红质稠，心烦齿衄，口干腥臭，尿少而黄，舌质红，舌质薄黄，脉弦滑数。服西药，血未已。辨证：肝火内炽，热扰冲任。治法：清肝泻火安胎。方药：龙胆草9克枯黄芩9克生栀子6克软毛柴3克杭白芍9克生地黄15克大乌豆24克白苧根15克车前草15克干地榆15克服2剂。次诊：药后阴中流血已止，口干齿衄亦愈，继以清热凉血安胎之剂续进，以资巩固。枯黄芩9克杭白芍6克生甘草3克大乌豆30克生地黄15克川续断9克白苧根15克服3剂。
(《孙浩铭妇科临床经验》）
例三黄某，32岁。初诊日期：1978年10月8日。患者停经两个多月，月经过期20多天时，曾做小便青蛙试验为阳性。现阴道有少量流血已5天，色鲜红，腹隐痛及下坠感，腰微酸。一年前曾自然流产二次，也是早孕2个多月，未有小孩。患者形体稍瘦，常有头晕腰酸，本次孕后有轻度妊娠反应，且感疲倦，近日没有注意适当休息，数日前出现阴道流血。舌色梢淡，但尖边较红，脉细滑、略弦。辨证：胎动不安(肾阴不足兼有肝经虚热）。治法：滋肾健脾，益气安胎，佐以养肝清热止血。方药：菟丝子25克川断15克桑寄生15克阿胶12克
(烊化）旱莲草15克女贞子15克白芍10克生甘草5克荆芥炭6克4剂。每日1剂，留渣再煎，并嘱卧床休息。服药3剂后，阴道流血和腹痛已逐渐停止，但仍有腰酸和大便干结，后按上方去荆芥炭、白芍，改用桑椹15克，肉苁蓉15克，4剂。药后诸症已基本消失，舌脉亦正常，后接二诊方去旱莲草，改用淮山药15克，续服6剂，嗣后每周服药三剂，以资巩固。至妊娠5个月后停药，后足月顺产一男孩）
(《罗元恺医著选》）
例四姚某，女，35岁，已婚。初诊日期1958年5月30日。婚后十二年，先后流产或早产五次，其中一次是妊娠四个月时流产，余均为五个月和六个月，每于妊娠一个月后必漏血十余天，井同时出现血压降低，引起头晕，至三、四个月左腿及左腰疼痛，虽屡次积极进行保胎措施，仍不能避免妊娠之中断。在第四次妊娠时，曾服胎产金丹，亦未获效。现已怀孕两个多月，近二十天内恶心呕吐，择食，大便稍干，小便正常。精神较差，睡眠尚可。诊其脉左关沉弦短、右沉滑、舌正无苔。辨证：滑胎(西医诊断：习惯性流产）。治法：宜先调脾胃，次固肝肾。待脾胃健强，续予补肝肾以固胎本，并建中气以养胎元。方药：
(1)台党参6克白术6克茯苓6克炙甘草3克广陈皮4.5克砂仁3克霍香6克山药9克生姜3片大枣3枚此方缓服3剂，恶阻止后，继服下方。以泰山磐石饮与安胎银苧酒加减合方：
(2)熟地黄12克白术6克制黑川附子3克别直参3克杜仲9克当归3克桑寄生9克杭巴戟9克苁蓉9克川续断6克苧麻根9克此方每剂煎两次，每次煎一小时，共取400毫升，分两次温服。一周服1剂，并绝对控制性生活，以免扰动胎元。患者按法服之，直至足月顺利分娩。
(《蒲辅周医案》）
【评按】胎漏指妇女孕后阴道下血，时下时止或淋漓不断，通常无明显腰腹症状，胎动不安除有少量出血外，常先感胎动下坠，腹微胀：滑胎则指习惯性流产。这类病证多因气血虚，或肾虚、房室不节，或肝肾阴火扰动冲任，亦可因外伤所致。
例一胎漏，以脾虚为主，兼有肝气逆、心肾虚，故治以和肝脾、补心肾，固胎元，使肝气平、脾气旺而胎漏得止。此案在治法上数脏兼调，方药配伍精当。
例二胎漏案，辨证为肝火内炽，热扰冲任，治以龙胆草、黄芩、栀子等以泻肝清热；生地、乌豆、杭芍、地榆以凉血柔肝；苧根、川断以安胎固冲。可谓辨证精审，方义周全。《孙浩铭妇科临床经验》一书还记载了一例习惯性流产患者(因肾虚所致），于第三次妊娠停经不到40天，又现阴道流血，色淡红，腰酸，小腹坠感，恶心、纳少。脉细滑，舌苔薄白。孕妇而有肾虚的病本，自然导致冲任不固，胎失所养。故治以固肾扶脾，佐以收涩之品。疏方有川断、漂白术、地榆、杭芍、生黄芪、乌梅、盐砂仁、菟丝子等药;后又根据症状的变化随证加减，颇有效验。说明胎漏病证，尤当明辨虚、实、寒、热及其兼证，方能获得较好的疗效。例三胎动不安，病理属肝肾阴虚，罗氏治以滋肾养肝、清热止血法，使患者痛缓血止。
例四滑胎案，由于患者中虚，有恶阻之象，治宜先调脾胃，方用香砂六君子汤加减；次益肝肾，固胎本。蒲氏以泰山盘石饮与安胎银芋酒加减合方治之，既治本元，复顾胎漏，故有殊功。
(十）子肿刘××，女，35岁。因妊娠11月，全身浮肿，咳嗽气逼，入院治疗已七天，曾服双氢克尿塞、利尿素，以及中药五皮饮加白术、当归、黄芪等剂、全身浮肿加剧，腹水增加，病情严重，正考虑引产未决之际，经该院应邀会诊。诊得患者颜面及全身浮肿，恶风鼻衄，咳喘不止，呃逆不能食，大便尚通，小便短赤，舌粗白尖红，脉浮数有力，虽未见发热口渴等症，而肺经风水高冲、挟有胃热之候显然可见。遂从《金匮》凤水论治。方用越婢加半夏汤。净麻黄4．5克生石膏12克法半夏6克生甘草3克生姜4．5克红枣4枚加杏仁9克连服6剂，虽汗出不多，而尿量增加，输出量大于输入量，每天高达2900毫升，全身浮肿消失，腹水亦除，体重由122市斤减至92市斤。心肺正常，咳喘见平，饮食睡眠恢复正常。
(杨志一：医案札记，《江西医药》9：29，1963）
【评按】：患者已届妊娠后期，肿、喘并作，诊为妊娠风水兼有肺胀。此二证可互为因果。杨氏用越婢加半夏汤，既去肺经风水，又清阳明胃热。全方发挥了宣肺、清胃、利水的综合疗能，既不越前人成法，而方治亦颇精审合宜。
(十一）子哈柯××，女，38岁。1961年7月9日初诊。妊娠6个月时耳聋耳鸣，语音细哑、低微不清，卧则消失。现在妊娠7个月，上述症状更为明显，久坐久立愈甚。心烦少寐，气短，腰酸，大便不畅。脉细滑，舌淡，苔薄白。辨证：中气不足，胎盛阻碍经络，气血运行不畅。治法：益气升提，佐以安胎。方药：潞党参15克漂白术6克秦当归3克(后入）盐砂仁3克(后入）盐陈皮3克升麻2克软毛柴2克贡阿胶9克(另炖冲）旧艾叶3克川菖蒲2克
(后入）生黄芪9克枯黄芩6克2剂。次诊：药后耳聋耳鸣好转，语音稍亮，照前方续服十余剂收效。
(《孙浩铭妇科临床经验》）
【评按】子喑为孕期中声音低哑的病证。此案兼有耳聋、鸣，辨证属中虚、胎盛阻遏经络。故治以益气升提，佐黄芩、阿胶、艾叶以安胎，菖蒲以宣气开窍，方药照顾比较全面。
(十二）胎水肿满沈××，女，30岁，部队干部。初诊日期：1974年7月8日。患者妊娠六个半月，脚肿已一个月，腹部胀满特甚，胀满至剑突部，气喘促，坐卧不宁。已在某部队医院住院二十多天，诊为羊水过多，用救护车送来门诊中药治疗。查患者体格较肥胖，足部浮肿明显，腹部膨隆如妊娠九个月状,气喘多汗，尿少纳呆，舌质淡胖，苔白，脉沉滑。辨证：属脾虚湿重之胎水肿满。治法：健脾燥湿，行气利水，方用全生白术散加减。方药:白术25克苍术6克白茯苓30克茯苓皮30克陈皮6克姜皮9克大腹皮15克泽泻15克北杏仁12克生牡蛎25克4剂。7月12日再诊：眼药后腹胀明显减轻,水肿亦减退，尿量稍增，喘促已基本平复，坐卧已无不适感。仍守前法，按上方加减。白术25克白茯苓30克茯苓皮30克大腹皮15克芡实30克姜皮6克桑寄生15克苏叶9克7剂。服药后肿满已完全消除。后军医院为了巩固疗效，照上方减量再配服七剂，至足月时顺产一男孩，体重六斤半。
(《罗元恺医著选》）
【评按】胎水肿满即羊水过多。患者妊娠月余，腹胀满上至剑突部，气喘多汗、尿少纳呆。脾主湿，脾虚不运则水湿内留为患。治以全生白术散加减以健脾燥湿、行气利水。加杏仁者，降肺气以利水，给水邪以出路；加牡蛎以镇摄，使逆气趋于平复。就脏腑而言，其主治的重点在脾。
(十三）子痫前驱目血管××，女，30岁。孕近10月,忽发足甲剧痛,同时两目流血，头痛。医以外感施治，头痛更甚，目血更多，呕吐大汗，神迷肢掣，目吊口噤。脉虚弦劲急。舌淡，苔薄。辨证：阴虚火炽，肝风内动，属子痫前驱证。治法：养阴濡液，平肝熄风。方药：犀角尖O.9克(磨冲）细生地24克熟枣仁24克旱莲草24克、女贞子24克阿胶珠9克钩藤9克滁菊9克天冬9克沙参12克仙鹤草60克上方连服3剂后肢掣渐平，目血已止，神志渐清，仍感胃气上逆，咽干9头痛，失眠。大病后亏损未复，再予和胃养阴安神之剂。沙参9克茯神9克玉竹9克石斛9克麦芽9克生白芍9克于术6克霍香6克女贞子24克旱莲草24克、连服4剂，诸证获愈，逾周分娩，母子平安。
(《王渭川临床经验选》）
【评按】此案为子痫前驱期双目流血。按肝开窍于目，足甲属肾，患者已有子痫见症，此为阴虚火炽，肝风内动。王氏取犀角地黄汤中主药配合其它养阴平肝、熄风定神之品而获效，方治较有法度。
(十四）流产后出血耿某，女，27岁。初诊日期：1975年6月19日。患者于5月13日自然流产，7天后血止。5月30日又开始阴道出血，持续约30天之久，血量逐渐增多，最多时有半痰盂。伴有腹痛。过去曾有两次流产史。舌紫暗，脉沉涩。辨证：血虚血瘀，血不归经。治法：活血化瘀，养血温通。方药：当归9克川芎3克红花3克益母草3克桃仁4．5克炙甘草3克五灵脂6克蒲黄6克炮姜1．5克治疗经过：6月21日，服药：剂后，血量大减，服三剂后出血已止。
(《刘奉五妇科经验》
【评按】流产后本已阴血耗损，复有大量出血，腹痛瘀阻，血不归经。刘氏以活血化瘀、养血温通法治之，疏方为生化汤
(《景岳全书》引钱氏方）加益母草、红花、蒲黄、灵脂，加强了原方的祛瘀效能。此方虽不用大队补血之品，然瘀血化则新血生，此亦治病求本之法。
(8) Common Cold during Pregnancy
Patient Wang XX, female, 30 years old. At five months of pregnancy, due to deficiency of Ying-Qi (nutritive Qi) and insufficiency of Jin-Ye (body fluids), the stomach and intestines became dry and deficient, leading to constipation. Subsequently, an external pathogenic factor was contracted, resulting in fever with slight aversion to cold, abdominal distension and fullness, cough, and dry mouth. The pulse was floating and wiry with rapidity at the left Cun position, and fine and small at the left Guan position; the tongue tip was red, and the coating was yellow, thick, and greasy. The pathology involved external Wind-Cold invasion and internal heat stagnation with fluid depletion. Prescription: Ge Gen (Kudzu Root) 12g, Ma Rong (Hemp Seed Fiber) 3g, Xing Ren (Apricot Seed) 9g (crushed), Gui Zhi (Cinnamon Twig) 9g, Chao Chai Hu (Stir-fried Bupleurum) 9g, Hang Shao (Hangzhou White Peony Root) 9g, Chao Huang Qin (Stir-fried Scutellaria) 6g, Fa Ban Xia (Prepared Pinellia) 9g, Huang Lian (Coptis Rhizome) 3g (wine-fried), Yu Li Ren (Bush Cherry Pit) 15g (crushed), Sheng Jiang (Fresh Ginger) 2 slices, Chao Gu Ya (Stir-fried Sprouted Millet) 9g, Shen Qu (Medicated Leaven) 9g (burnt), Gan Cao (Licorice Root) 3g, Huo Ma Ren (Hemp Seed) 15g (crushed), Da Zao (Jujube) 3 pieces. After one dose, the chills and fever completely resolved, bowel movements normalized, and the interior harmonized. — From *Li Jichang's Medical Cases*
[Commentary] This case presents external Wind-Cold symptoms and internal heat stagnation with fluid depletion. Treatment should combine exterior-resolving methods with middle-jiao harmonizing and intestinal moistening. The formula considers the Middle Jiao Qi, thereby enhancing the body's resistance to external pathogens during pregnancy.
(9) Fetal Leakage, Restless Fetus, Habitual Abortion
Case 1
Sun XX, female, 31 years old, married. Medical Record No. 129830. First visit (February 18, 1976): Infertile for four years after marriage. History of dysfunctional uterine bleeding for over ten years; after treatment, currently pregnant for over two months. At forty days of gestation, vaginal bleeding lasted for seven days. Current symptoms include abdominal pain, sore back, chest tightness, palpitations, excessive yellow leukorrhea, occasional nausea, poor sleep, and difficult defecation. Tongue coating is white and greasy with blood stasis spots on the tip; pulse is deep and fine. Syndrome differentiation: Rebellious Liver Qi, weak Spleen Qi, and deficiency of Heart and Kidney. Treatment method: Regulate Liver and Spleen, tonify Heart and Kidney. Prescription: Dang Shen (Codonopsis) 12g, Bai Zhu (Atractylodes Macrocephala) 9g, Fu Ling (Poria) 12g, Shan Yao (Chinese Yam) 12g, Mai Dong (Ophiopogon Tuber) 9g, Ju Hong (Tangerine Red Peel) 6g, Su Geng (Perilla Stem) 6g, Chuan Duan (Dipsacus Root) 12g, Sang Ji Sheng (Mulberry Mistletoe) 15g, Da Zao (Jujube) 4 pieces. Total 6 doses.
Second visit (February 26): After taking six doses of the above prescription, all symptoms improved. However, there is dull pain in the lower abdomen and sore back after exertion, normal appetite, but desire to vomit when fasting. Tongue coating remains white and greasy with blood stasis spots on the tip; pulse is soft and slightly rapid on the left, and fine, soft, and slightly rapid on the right. Pathology shifts to unhealthiness of Spleen and Stomach, and deficiency of Liver and Kidney. Treatment method: Strengthen Spleen and Stomach, tonify Liver and Kidney. Prescription: Dang Shen (Codonopsis) 12g, Bai Zhu (Atractylodes Macrocephala) 9g, Fu Ling (Poria) 12g, Shan Yao (Chinese Yam) 12g, Yu Zhu (Polygonatum Odoratum Rhizome) 12g, Ju Pi (Tangerine Peel) 6g, Mu Xiang (Aucklandia Root) 6g, Chuan Duan (Dipsacus Root) 12g, Sang Ji Sheng (Mulberry Mistletoe) 15g, Gou Ji (Cyrtomium Rhizome) 12g. Total 6 doses.
Third visit (March 11): Three months of pregnancy. After taking the previous prescription, lower abdominal pain ceased, occasional sore back, dry throat, nasal congestion sensation, normal appetite and excretion. Tongue coating is thin, white, and greasy with blood stasis spots on the tip; left pulse is soft and slippery. Pathology involves weak Lung Qi and Yin deficiency of Kidney. Treatment method: Tonify Qi and nourish Yin to secure the fetus. Prescription: Dang Shen (Codonopsis) 12g, Bai Zhu (Atractylodes Macrocephala) 9g, Shan Yao (Chinese Yam) 12g, Mai Dong (Ophiopogon Tuber) 9g, Ju Pi (Tangerine Peel) 6g, Chuan Duan (Dipsacus Root) 12g, Sang Ji Sheng (Mulberry Mistletoe) 15g, Yu Zhu (Polygonatum Odoratum Rhizome) 12g. Total 6 doses.
— From *Qian Boxuan's Gynecological Medical Cases*
Case 2
Lin Diao, female, 20 years old, married. Five months pregnant. Vaginal bleeding recurred for the past two months. Blood is red and thick, accompanied by irritability, epistaxis, dry mouth with foul odor, scanty yellow urine. Tongue body is red with thin yellow coating; pulse is wiry, slippery, and rapid. Western medicine failed to stop the bleeding. Syndrome differentiation: Blazing Liver Fire disturbing the Chong and Ren vessels. Treatment method: Clear Liver and purge Fire to calm the fetus. Prescription: Long Dan Cao (Gentiana Root) 9g, Ku Huang Qin (Scutellaria Baicalensis) 9g, Sheng Zhi Zi (Gardenia Fruit) 6g, Ruan Mao Chai Hu (Bupleurum) 3g, Hang Bai Shao (White Peony Root) 9g, Sheng Di Huang (Rehmannia Root) 15g, Da Wu Dou (Black Soybean) 24g, Bai Zhu Gen (Artemisia Argyi Root) 15g, Che Qian Cao (Plantago Herb) 15g, Gan Di Yu (Sanguisorba Root) 15g. Take 2 doses.
Second visit: Vaginal bleeding stopped, dry mouth and epistaxis resolved. Continue with heat-clearing, blood-cooling, and fetus-calming agents to consolidate efficacy. Prescription: Ku Huang Qin (Scutellaria Baicalensis) 9g, Hang Bai Shao (White Peony Root) 6g, Sheng Gan Cao (Licorice Root) 3g, Da Wu Dou (Black Soybean) 30g, Sheng Di Huang (Rehmannia Root) 15g, Chuan Xu Duan (Dipsacus Root) 9g, Bai Zhu Gen (Artemisia Argyi Root) 15g. Take 3 doses.
— From *Sun Haoming's Gynecological Clinical Experience*
Case 3
Huang XX, 32 years old. First visit date: October 8, 1978. Amenorrhea for over two months; frog test positive when menstruation was overdue by 20+ days. Currently experiencing slight vaginal bleeding for 5 days, bright red blood, dull abdominal pain with bearing-down sensation, mild lower back soreness. Two spontaneous abortions occurred a year ago at over two months of gestation. Patient is slightly thin, often suffers from dizziness and back soreness. Mild pregnancy reaction this time, fatigue, lack of adequate rest recently, bleeding started a few days ago. Tongue color slightly pale, tip and edges redder; pulse fine, slippery, slightly wiry. Syndrome differentiation: Restless Fetus (Kidney Yin deficiency with deficient Heat in Liver channel). Treatment method: Nourish Kidney and strengthen Spleen, tonify Qi to calm fetus, assist with nourishing Liver, clearing Heat, and stopping bleeding. Prescription: Tu Si Zi (Cuscuta Seed) 25g, Chuan Duan (Dipsacus Root) 15g, Sang Ji Sheng (Mulberry Mistletoe) 15g, E Jiao (Donkey-Hide Gelatin) 12g (melted), Han Lian Cao (Eclipta Herb) 15g, Nu Zhen Zi (Ligustrum Fruit) 15g, Bai Shao (White Peony Root) 10g, Sheng Gan Cao (Licorice Root) 5g, Jing Jie Tan (Charred Schizonepeta) 6g. Total 4 doses. One dose daily, decoct residue again, and advise bed rest.
After 3 doses, vaginal bleeding and abdominal pain gradually stopped, but back soreness and dry stool persisted. Modified prescription: Remove Jing Jie Tan and Bai Shao; add Sang Shen (Mulberry Fruit) 15g, Rou Cong Rong (Cistanche Stem) 15g. Total 4 doses. Symptoms basically disappeared, tongue and pulse normalized. Continued with second-visit prescription, remove Han Lian Cao, replace with Huai Shan Yao (Chinese Yam) 15g, take for 6 doses. Thereafter, take 3 doses weekly to consolidate. Stop medication after 5 months of pregnancy; subsequently delivered a healthy boy at term.
— From *Luo Yuankai's Selected Medical Writings*
Case 4
Yao XX, female, 35 years old, married. First visit date: May 30, 1958. Married for twelve years, experienced five miscarriages or premature births previously (one at four months, others at five and six months). Bleeding occurs for over ten days after one month of pregnancy each time, accompanied by hypotension and dizziness. Left leg and waist pain occur at three to four months. Despite active fetal preservation measures, pregnancy interruption could not be avoided. Tai Chan Jin Dan was taken during the fourth pregnancy without effect. Currently pregnant for over two months, nausea and vomiting for twenty days, selective eating, slightly dry stool, normal urination. Poor spirit, fair sleep. Left Guan pulse deep, wiry, short; right pulse deep and slippery; tongue normal, no coating. Syndrome differentiation: Habitual Abortion (Western diagnosis: Habitual Miscarriage). Treatment method: First regulate Spleen and Stomach, then secure Liver and Kidney. Once Spleen and Stomach are strong, continue tonifying Liver and Kidney to secure the fetal root, and establish Middle Qi to nourish the fetus. Prescription:
(1) Tai Dang Shen (Codonopsis) 6g, Bai Zhu (Atractylodes Macrocephala) 6g, Fu Ling (Poria) 6g, Zhi Gan Cao (Honey-fried Licorice) 3g, Guang Chen Pi (Tangerine Peel) 4.5g, Sha Ren (Amomum Fruit) 3g, Huo Xiang (Patchouli) 6g, Shan Yao (Chinese Yam) 9g, Sheng Jiang (Fresh Ginger) 3 slices, Da Zao (Jujube) 3 pieces. Take slowly for 3 doses. After morning sickness stops, continue with the following formula.
Combined modification of Taishan Panshi Yin and Antai Yinzhu Jiu:
(2) Shu Di Huang (Prepared Rehmannia) 12g, Bai Zhu (Atractylodes Macrocephala) 6g, Zhi Hei Chuan Fu Zi (Processed Black Aconite) 3g, Bie Zhi Shen (American Ginseng) 3g, Du Zhong (Eucommia Bark) 9g, Dang Gui (Angelica Sinensis) 3g, Sang Ji Sheng (Mulberry Mistletoe) 9g, Hang Ba Ji Tian (Morinda Root) 9g, Rong Rong (Cistanche) 9g, Chuan Xu Duan (Dipsacus Root) 6g, Zhu Ma Gen (Ramie Root) 9g. Decoct each dose twice, one hour per decoction, collect 400ml total, divide into two warm doses. Take one dose per week. Strictly control sexual intercourse to avoid disturbing the fetus. Patient followed this regimen until full-term delivery.
— From *Pu Fuzhou's Medical Cases*
[Commentary] Fetal leakage refers to vaginal bleeding during pregnancy that comes and goes or persists continuously, usually without obvious lumbar or abdominal symptoms. Restless fetus involves slight bleeding preceded by sensations of fetal movement descending and mild abdominal distension. Habitual abortion refers to recurrent miscarriages. These conditions are often caused by Qi and Blood deficiency, Kidney deficiency, excessive sexual activity, disturbance of Chong and Ren vessels by Liver-Kidney Yin fire, or trauma.
Case 1 is fetal leakage, primarily due to Spleen deficiency with rebellious Liver Qi and Heart-Kidney deficiency. Treatment harmonizes Liver and Spleen, tonifies Heart and Kidney, and secures the fetus, calming Liver Qi and strengthening Spleen Qi to stop leakage. The multi-organ regulation and precise herb combination are notable.
Case 2 is fetal leakage due to blazing Liver Fire disturbing Chong and Ren. Treatment uses Long Dan Cao, Huang Qin, Zhi Zi to purge Liver Heat; Sheng Di, Wu Dou, Bai Shao, Di Yu to cool blood and soften Liver; Zhu Gen, Chuan Duan to calm fetus and secure Chong. The differentiation is precise and the formula comprehensive. Another habitual abortion case (due to Kidney deficiency) is recorded in Sun Haoming's book: third pregnancy, amenorrhea <40 days, light red bleeding, back soreness, bearing-down sensation, nausea, poor appetite. Fine slippery pulse, thin white coating. Kidney deficiency leads to insecure Chong and Ren, failing to nourish the fetus. Treatment secures Kidney, supports Spleen, and adds astringents like Chuan Duan, Bai Zhu, Di Yu, Bai Shao, Huang Qi, Wu Mei, Yan Sha Ren, Tu Si Zi. Symptom-based modifications were effective. This highlights the need to distinguish deficiency/excess and cold/heat in fetal leakage. Case 3 is restless fetus due to Liver-Kidney Yin deficiency; Luo treated with nourishing Kidney/Liver, clearing Heat, and stopping bleeding, relieving pain and stopping bleeding.
Case 4 is habitual abortion due to Middle Jiao deficiency with morning sickness. Treatment first regulates Spleen/Stomach using Xiang Sha Liu Jun Zi Tang modification; then tonifies Liver/Kidney. Pu used a combined modification of Taishan Panshi Yin and Antai Yinzhu Jiu, treating both root and branch, yielding excellent results.
(10) Edema during Pregnancy (Zi Zhong)
Liu XX, female, 35 years old. Admitted for eleven months of pregnancy with generalized edema, cough, and dyspnea for seven days. Previously treated with Hydrochlorothiazide, Urea, and Chinese medicine (Wu Pi Yin plus Bai Zhu, Dang Gui, Huang Qi), resulting in worsened edema and increased ascites. Condition severe, considering induction of labor. Consultation requested. Examination revealed facial and generalized edema, aversion to wind, epistaxis, incessant cough and wheezing, hiccups, inability to eat, though bowels moved. Urine was scanty and dark red. Tongue coarse white with red tip; pulse floating, rapid, and forceful. Although no fever or thirst, clear signs of Wind-Water attacking Lung channel with Stomach Heat were present. Treated according to "Wind-Water" theory in *Jin Gui Yao Lue*. Prescription: Yue Bi Jia Ban Xia Tang. Jing Ma Huang (Ephedra) 4.5g, Sheng Shi Gao (Gypsum Fibrosum) 12g, Fa Ban Xia (Prepared Pinellia) 6g, Sheng Gan Cao (Licorice Root) 3g, Sheng Jiang (Fresh Ginger) 4.5g, Hong Zao (Red Date) 4 pieces, plus Xing Ren (Apricot Seed) 9g. Taken for 6 doses consecutively. Although sweating was minimal, urine output increased significantly, exceeding intake, reaching up to 2900ml/day. Generalized edema resolved, ascites disappeared. Weight dropped from 61kg to 46kg. Cardiopulmonary functions normalized, cough/wheezing subsided, diet and sleep recovered.
— Yang Zhiyi: Medical Notes, *Jiangxi Medicine* 9:29, 1963
[Commentary] In late pregnancy, edema and wheezing co-occur, diagnosed as Pregnancy Wind-Water with Lung Distension. These two syndromes can cause each other. Yang used Yue Bi Jia Ban Xia Tang to resolve Wind-Water in Lung channel and clear Yangming Stomach Heat. The formula comprehensively diffuses Lung, clears Stomach, and promotes diuresis, adhering to classical methods while being precise.
(11) Hoarseness during Pregnancy (Zi Yin)
Ke XX, female, 38 years old. First visit July 9, 1961. Deafness and tinnitus began at six months of pregnancy, voice became thin, hoarse, and indistinct, resolving when lying down. At seven months, symptoms worsened, aggravated by prolonged sitting or standing. Irritability, poor sleep, shortness of breath, back soreness, incomplete defecation. Pulse fine and slippery, tongue pale, coating thin white. Syndrome differentiation: Insufficient Middle Qi, heavy fetus obstructing meridians, poor Qi and Blood circulation. Treatment method: Tonify Qi and raise Yang, assist with calming fetus. Prescription: Lu Dang Shen (Codonopsis) 15g, Bai Zhu (Atractylodes Macrocephala) 6g, Dang Gui (Angelica Sinensis) 3g (added later), Yan Sha Ren (Amomum Fruit) 3g (added later), Yan Chen Pi (Tangerine Peel) 3g, Sheng Ma (Cimicifuga Rhizome) 2g, Ruan Mao Chai Hu (Bupleurum) 2g, Gong E Jiao (Donkey-Hide Gelatin) 9g (separately stewed and mixed), Jiu Ai Ye (Mugwort Leaf) 3g, Chuan Chang Pu (Acorus Rhizome) 2g (added later), Sheng Huang Qi (Astragalus Root) 9g, Ku Huang Qin (Scutellaria Baicalensis) 6g. 2 doses.
Second visit: Deafness and tinnitus improved, voice slightly clearer. Continued previous prescription for over ten doses with good effect.
— From *Sun Haoming's Gynecological Clinical Experience*
[Commentary] Zi Yin refers to hoarseness during pregnancy. This case includes deafness and tinnitus, differentiated as Middle deficiency and fetus obstruction of meridians. Treatment raises Qi, assists with Huang Qin, E Jiao, Ai Ye to calm fetus, and Chang Pu to open orifices. The formula is comprehensive.
(12) Fetal Edema and Fullness (Tai Shui Zhong Man)
Shen XX, female, 30 years old, military cadre. First visit July 8, 1974. Six and a half months pregnant. Foot swelling for one month, severe abdominal distension extending to xiphoid process, dyspnea, restlessness. Hospitalized for over twenty days, diagnosed with polyhydramnios. Transported by ambulance for Chinese medicine treatment. Patient is obese, marked foot edema, abdomen distended like nine months pregnancy, dyspnea with sweating, scanty urine, poor appetite. Tongue pale and swollen, white coating, pulse deep and slippery. Syndrome differentiation: Spleen deficiency with heavy Dampness causing Fetal Edema. Treatment method: Strengthen Spleen, dry Dampness, move Qi, promote diuresis. Formula: Quan Sheng Bai Zhu San modified. Prescription: Bai Zhu (Atractylodes Macrocephala) 25g, Cang Zhu (Atractylodes Lancea) 6g, Bai Fu Ling (Poria) 30g, Fu Ling Pi (Poria Skin) 30g, Chen Pi (Tangerine Peel) 6g, Jiang Pi (Ginger Skin) 9g, Da Fu Pi (Areca Peel) 15g, Ze Xie (Alisma Rhizome) 15g, Bei Xing Ren (Apricot Seed) 12g, Sheng Mu Li (Oyster Shell) 25g. 4 doses.
Revisit July 12: Abdominal distension significantly reduced, edema subsided, urine slightly increased, dyspnea basically resolved, comfortable sitting/lying. Maintain previous method, modify prescription: Bai Zhu (Atractylodes Macrocephala) 25g, Bai Fu Ling (Poria) 30g, Fu Ling Pi (Poria Skin) 30g, Da Fu Pi (Areca Peel) 15g, Qian Shi (Chinese Chestnut) 30g, Jiang Pi (Ginger Skin) 6g, Sang Ji Sheng (Mulberry Mistletoe) 15g, Su Ye (Perilla Leaf) 9g. 7 doses. Swelling and fullness completely eliminated. Military hospital dispensed reduced dose for another 7 doses to consolidate. Delivered a healthy boy (3.25kg) at term.
— From *Luo Yuankai's Selected Medical Writings*
[Commentary] Tai Shui Zhong Man is polyhydramnios. Severe abdominal distension, dyspnea, sweating, scanty urine, poor appetite. Spleen governs Dampness; Spleen deficiency fails to transport, leading to internal water retention. Quan Sheng Bai Zhu San strengthens Spleen, dries Dampness, moves Qi, and promotes diuresis. Xing Ren descends Lung Qi to facilitate water passage; Mu Li anchors and calms rebellious Qi. The focus is on the Spleen.
(13) Pre-eclamptic Prodrome
Mu Xue Guan XX, female, 30 years old. Near ten months of pregnancy. Sudden severe pain in toenails, simultaneous bleeding from eyes, headache. Treated as external contraction, headache worsened, eye bleeding increased, vomiting, profuse sweating, confusion, limb convulsions, eyes rolled back, jaw locked. Pulse empty, wiry, tense, and urgent. Tongue pale, thin coating. Syndrome differentiation: Yin deficiency with blazing Fire, internal stirring of Liver Wind, belonging to pre-eclamptic prodrome. Treatment method: Nourish Yin and moisten fluids, calm Liver and extinguish Wind. Prescription: Xi Jiao Jian (Rhinoceros Horn Tip) 0.9g (ground and mixed), Xi Sheng Di Huang (Rehmannia Root) 24g, Shu Zao Ren (Ziziphus Seed) 24g, Han Lian Cao (Eclipta Herb) 24g, Nu Zhen Zi (Ligustrum Fruit) 24g, E Jiao Zhu (Gelatin Pellet) 9g, Gou Teng (Uncaria Ramulus) 9g, Chu Ju (Chrysanthemum) 9g, Tian Dong (Asparagus Tuber) 9g, Sha Shen (Glehnia Root) 12g, Xian He Cao (Agrimony Herb) 60g.
After 3 doses, limb convulsions subsided, eye bleeding stopped, consciousness cleared. Still felt rebellious Stomach Qi, dry throat, headache, insomnia. Post-illness deficiency not yet recovered. Prescribed harmonizing Stomach, nourishing Yin, and calming Spirit: Sha Shen (Glehnia Root) 9g, Fu Shen (Poria with Hostwood) 9g, Yu Zhu (Polygonatum Odoratum Rhizome) 9g, Shi Hu (Dendrobium Stem) 9g, Mai Ya (Sprouted Barley) 9g, Sheng Bai Shao (White Peony Root) 9g, Yu Zhu (Atractylodes) 6g, Huo Xiang (Patchouli) 6g, Nu Zhen Zi (Ligustrum Fruit) 24g, Han Lian Cao (Eclipta Herb) 24g. Taken for 4 doses, all symptoms resolved. Delivered one week later, mother and child safe.
— From *Wang Weichuan's Clinical Experience Selection*
[Commentary] This case shows eye bleeding in pre-eclamptic prodrome. Liver opens into eyes, toenails belong to Kidney. With eclampsia signs, this is Yin deficiency with blazing Fire and internal Liver Wind. Wang used main herbs from Xi Jiao Di Huang Tang combined with Yin-nourishing, Liver-calming, and Wind-extinguishing agents, demonstrating sound methodology.
(14) Post-abortion Hemorrhage
Geng XX, female, 27 years old. First visit June 19, 1975. Spontaneous abortion on May 13, bleeding stopped after 7 days. Vaginal bleeding resumed May 30, lasting about 30 days, volume increasing, up to half a痰盂 (sputum basin). Accompanied by abdominal pain. History of two previous abortions. Tongue purple-dark, pulse deep and choppy. Syndrome differentiation: Blood deficiency with Blood stasis, blood failing to return to its vessels. Treatment method: Invigorate Blood and resolve stasis, nourish Blood and warm unblock. Prescription: Dang Gui (Angelica Sinensis) 9g, Chuan Xiong (Ligusticum Rhizome) 3g, Hong Hua (Carthamus Flower) 3g, Yi Mu Cao (Motherwort Herb) 3g, Tao Ren (Peach Kernel) 4.5g, Zhi Gan Cao (Honey-fried Licorice) 3g, Wu Ling Zhi (Trogopterus Dung) 6g, Pu Huang (Typha Pollen) 6g, Pao Jiang (Roasted Ginger) 1.5g.
Treatment course: June 21, after one dose, bleeding volume decreased significantly; after three doses, bleeding stopped.
— From *Liu Fengwu's Gynecological Experience*
[Commentary] Post-abortion, Yin-Blood is already depleted; massive hemorrhage follows, with abdominal pain and stasis blocking, blood failing to stay in vessels. Liu used invigorating Blood, resolving stasis, nourishing Blood, and warming/unblocking methods. The prescription is Sheng Hua Tang (*Jing Yue Quan Shu* citing Qian's formula) added with Yi Mu Cao, Hong Hua, Pu Huang, Ling Zhi, enhancing the original formula's stasis-resolving power. Although lacking large amounts of blood-tonifying herbs, resolving stasis allows new blood generation, addressing the root cause.