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(Three syndromes, nine prescriptions)

The Master said: When a woman presents with a peaceful pulse (Ping Mai, a normal pulse), but the Yin pulse (referring to the Chi position at the wrist, corresponding to the lower jiao/kidneys) is slightly weak. The patient experiences thirst and inability to eat, without aversion to cold or fever. This is named pregnancy. Gui Zhi Tang (Cinnamon Twig Decoction) should be used to treat it. According to the method, these symptoms should appear around the sixtieth day of pregnancy. If medical treatment is performed incorrectly, causing a reversal of conditions, and after one month vomiting or diarrhea occurs, the source of the disease should be cut off (stop the erroneous treatment and address the current symptoms).

[Commentary by Yan Yi] "Peaceful pulse" in women refers to the absence of pathological pulses. A slight weakness in the Yin pulse indicates insufficiency of Ying Qi (Nutritive Qi). Generally, when external pathogens invade and Ying Qi is insufficient, there must be aversion to cold and fever, but eating is not affected. Now, there is no aversion to cold or fever, yet eating is impaired; thus, we know it is pregnancy. During pregnancy, blood gathers and Qi contends, menstruation stops, and the fetus begins to coalesce after sixty days. At this time, Qi and Blood transform in the lower jiao. Ying Qi is insufficient, and Wei Qi (Defensive Qi) cannot function independently. Stagnation in the middle jiao prevents eating; fluid distribution is reduced, causing thirst. Gui Zhi Tang is used to benefit Ying Qi and harmonize Wei Qi. If a doctor treats it erroneously with other methods, changes may occur after another month. If vomiting and diarrhea are added, further damaging Ying Qi, the Spleen also loses its nourishing function. Huang Qin (Scutellaria Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Xiong (Chuanxiong Rhizome), Gui (Dang Gui Root), Shen (Ren Shen Ginseng Radix et Rhizoma) can be used. The key is to benefit Ying Qi, generate fluids, and harmonize the middle and lower jiao.

If a woman has a pre-existing Zheng disease (masses/lumps in the abdomen), and menstruation has stopped for less than three months, yet she suffers from continuous dripping vaginal bleeding. If fetal movement is felt above the umbilicus, this is due to the Zheng disease being harmful.

[Commentary by Yan Yi] Pre-existing Zheng masses are internally knotted. When blood gathers to form the fetus, the Zheng disease activates. Qi overflows into the Chong and Ren meridians. Consequently, the blood that nourishes the embryo cannot stay, leading to continuous dripping bleeding. The Zheng disease presses downward, causing fetal movement above the umbilicus; hence, it is called "Zheng harming." Generally, in conception: in the first month, blood begins to gather; in the second month, the embryo forms; in the third month, the fetus forms. Fetal movement only occurs after the fetus is formed. Now, if movement is felt at six months, it is because during the first three months when menstruation was regular, the fetus had not fully formed and bleeding occurred. After stopping menstruation for three months, the embryo finally forms and moves. If bleeding continues incessantly, it is because the Zheng pathogen remains. The *Nei Jing* states: "If there is a cause (pathogen), there will be no destruction [to the mother or fetus]." Removing the Zheng ensures fetal safety. Gui Zhi (Cinnamon Twig), Tao Ren (Peach Kernel), Mu Dan Pi (Moutan Cortex), and Shao Yao (Peony Root) can remove bad blood (stasis). Fu Ling (Poria) also benefits blood in the waist and umbilical region; this constitutes breaking blood stasis. However, treatments have dispersing, relaxing, astringing, and leaching properties. For knotting, use the acridity of Gui Zhi to disperse. The Liver stores blood; blood accumulation causes Liver tension, so use the sweetness of Tao Ren and Mu Dan Pi to relax. When Yin Qi activates, use the sourness of Shao Yao to astringe. Once bad blood is broken, assist with the bland leaching property of Fu Ling to promote flow.

Fetal movement at six months of pregnancy occurs because conception happened during the first three months when menstruation was regular. If bleeding occurred in the first three months, the fetus was not yet formed. After three months of amenorrhea, the fetus forms and moves. If bleeding continues, it is because the Zheng pathogen has not been removed. One should purge the Zheng pathogen. Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) is the main prescription.

Gui Zhi Fu Ling Wan Prescription
Gui Zhi (Cinnamon Twig), Fu Ling (Poria), Mu Dan Pi (Moutan Cortex), Tao Ren (Peach Kernel - peel and tips removed, stir-fried), Shao Yao (Peony Root) (equal parts).
Grind the above five herbs into powder. Mix with refined honey to make pills the size of rabbit droppings. Take one pill before meals daily. If ineffective, increase to three pills.

[Commentary by Yan Yi] This reiterates that fetal movement occurs only after three months of fetal formation. The previous chapter discussed continuous dripping bleeding after three months of amenorrhea; since the fetus was already formed, although bleeding occurred, fetal movement was felt above. This chapter discusses movement at six months, implying conception occurred when menstruation was regular in the first three months. Although the fetus formed, blood continued to flow down until the last three months when bleeding stopped. Thus, fetal movement begins at six months. Roughly, in the first three months, the fetus lost nourishment due to bleeding. The reason bleeding continues in both the first and last three months is that the Zheng pathogen remains. One must purge the Zheng pathogen; this pill is the main treatment.

When a woman is pregnant for six or seven months, the pulse is wiry (Xian), accompanied by fever, increased abdominal distension, abdominal pain, aversion to cold, and a sensation of cold in the lower abdomen as if fanned by a breeze. The reason for this is that the Zi Zang (Uterus) is open. It should be treated with Fu Zi Tang (Aconite Decoction) to warm the uterus.

[Commentary by Yan Yi] At six or seven months of pregnancy, when bones and sinews are strong, a wiry pulse indicates deficiency and cold. Yang Qi is constrained externally causing fever, while Yin Cold reverses internally causing distension. Abdominal pain and aversion to cold indicate internal Yang deficiency, leading to an open Zi Zang and the sensation of cold in the lower abdomen like being fanned. Fu Zi Tang is used to restore Yang and warm the uterus.

The Master said: Women may suffer from continuous dripping bleeding, persistent bleeding after miscarriage, or bleeding during pregnancy. If abdominal pain occurs during pregnancy, it is called Bao Zu (Placental Obstruction). Jiao Ai Tang (Donkey-hide Gelatin and Mugwort Decoction) should be used.

Jiao Ai Tang Prescription
E Jiao (Donkey-hide Gelatin - 2 liang), Ai Ye (Mugwort Leaf - 3 liang), Gan Cao (Licorice Root - 2 liang), Dang Gui (Angelica Sinensis Root - 3 liang), Chuan Xiong (Ligusticum Chuanxiong Rhizome - 2 liang), Shao Yao (Peony Root - 4 liang), Shu Di Huang (Prepared Rehmannia Root - 6 liang).
Boil the above seven herbs in 5 sheng of water and 3 sheng of clear wine. Reduce to 3 sheng, strain, add E Jiao and dissolve completely. Take 1 sheng warm, three times daily. If not cured, prepare again.

[Commentary by Yan Yi] Menstruation and conception both relate to the Chong and Ren meridians, which are governed by the Kidney. The Kidney belongs to Kan (Water). When Kan meets Li (Fire), blood fills and menstruation flows, similar to the moon's phases driven by sunlight. Essence is applied, the Heart Spirit responds internally, and blood follows. Thus, Ding-Ren combine and Kan-Li intersect; the two Qi condense and transform into a fetus. However, maintaining the intersection of Yin and Yang to nurture the fetus relies on Kun Earth (Spleen). When Yin and Yang embrace, Kun Earth acts as a dike, preventing leakage. If pre-existing turbid stasis lodges in the Chong and Ren, Yin knots and cannot intersect with Yang, causing persistent bleeding after miscarriage. In Bao Zu (Placental Obstruction) during pregnancy, Yang essence forms the fetus internally, while Yin blood nourishes the placenta externally. Kun Earth loses its dike function. This formula treats all such cases. Chuan Xiong and Dang Gui are acrid-warm, promoting Yang blood; Shao Yao is sour-cold, promoting Yin blood. E Jiao is sweet-warm. The *Nei Jing* states the Lung governs skin and hair, which originate from Kidney Water. Li Dongyuan stated it enters the Taiyin, Foot Shaoyin, and Jueyin meridians. I often think that among minerals, stones, grasses, and trees, none nourish better than animal products that resemble human tissue. E Jiao stabilizes the fetus and tonifies blood, effectively stopping leakage. Gan Cao harmonizes Yin and Yang, unifies vessels, relieves spasms, enters internally, opens Yin knots, and connects to Yang. Shu Di Huang is the sovereign herb for tonifying Kidney blood. Adjusting menstruation, stopping metrorrhagia, stabilizing the fetus, and nourishing blood—no formula surpasses this. However, modifications must be appropriate. If the pulse is slow and deep, indicating Yin excess over Yang, add Gan Jiang (Dried Ginger) and Guan Gui (Cinnamon Bark). If rapid and large, add Huang Qin (Scutellaria Root).

During pregnancy, if there is cramping abdominal pain, Dang Gui Shao Yao San (Angelica and Peony Powder) should be used.

Dang Gui Shao Yao San Prescription
Dang Gui (Angelica Sinensis Root - 3 liang), Shao Yao (Peony Root - 1 jin), Fu Ling (Poria - 4 liang), Bai Zhu (Atractylodes Macrocephala Rhizome - 4 liang), Ze Xie (Alisma Rhizome - 0.5 jin), Chuan Xiong (Ligusticum Chuanxiong Rhizome - 3 liang).
Grind the above six herbs into powder. Take one cun bi (measure), mix with wine, take three times daily.

[Commentary by Yan Yi] This differs from Bao Zu pain. It arises because Spleen Earth is overcome by Wood evil. Grain Qi does not rise, turbid Qi floods downward, blocking and contending with Yin blood, causing pain. Use multiple times more Shao Yao than other herbs to drain Liver Wood and relieve Yin obstruction, combined with Chuan Xiong and Dang Gui to tonify blood and stop pain. Assist with Fu Ling to leach dampness via urination. Bai Zhu strengthens the Spleen and dries dampness; Fu Ling and Ze Xiong move accumulated fluids out through urine. External and internal Six Evils can all injure the fetus and cause pain, not just dampness.

If pregnancy vomiting persists, Gan Jiang Ren Shen Ban Xia Wan (Dried Ginger, Ginseng, and Pinellia Pill) should be used.

Gan Jiang Ren Shen Ban Xia Wan Prescription
Gan Jiang (Dried Ginger), Ren Shen (Ginseng Radix et Rhizoma) (1 liang each), Ban Xia (Pinellia Tuber - 2 liang).
Grind the above three herbs into powder. Mix with fresh ginger juice to make pills the size of wutong seeds. Take 13 pills with warm water, three times daily.

[Commentary by Yan Yi] This is what later generations call "E Zu" (Morning Sickness/Emetic Disorder). Initially, Spleen and Stomach are weak, fluids stagnate, accumulating as phlegm-fluids. After the second month of pregnancy, the embryo transforms into a fetus. Turbid Qi rushes upward, overwhelming the Middle Jiao, causing phlegm-fluids to surge and vomit. Internal cold arises, so Gan Jiang stops cold, Ren Shen tonifies deficiency, and Ban Xia with Sheng Jiang (Fresh Ginger) resolves phlegm and directs rebellious Qi downward.

If pregnancy involves difficult urination but normal diet, Dang Gui Bei Mu Ku Shen Wan (Angelica, Coptis, and Sophora Pill) should be used.

Dang Gui Bei Mu Ku Shen Wan Prescription
Dang Gui (Angelica Sinensis Root), Bei Mu (Fritillaria Bulb), Ku Shen (Sophora Root) (4 liang each).
Grind the above three herbs into powder. Mix with refined honey to make pills the size of small beans. Take 3 pills with water, increasing to 10 pills.

[Commentary by Yan Yi] Difficult urination results from Heat stagnation in the Bladder, Qi condensing into dryness. The disease is in the Lower Jiao, not the Middle Jiao, hence diet is normal. Dang Gui harmonizes blood and moistens dryness. Materia Medica records Bei Mu treats hot strangury. Observing Zhang Zhongjing's Xian Xiong Tang, it is a formula for Lung Metal dryness stagnation. The Lung is the mother of Kidney Water. Dryness in Water stems from the mother Qi failing to transform. Bei Mu does not directly treat heat; resolving stagnation dissipates heat. It is not a bland diuretic. When stagnation clears, water flows. Ku Shen excels at clearing heat, opening orifices, and driving out water, assisting Bei Mu to enter the Bladder and remove heat knots.

If pregnancy involves water qi (fluid retention), heaviness of the body, difficult urination, chills, and dizziness upon rising, Kui Zi Fu Ling San (Abelmoschus Seed and Poria Powder) should be used.

Kui Zi Fu Ling San Prescription
Kui Zi (Abelmoschus Seed - 1 jin), Fu Ling (Poria - 3 liang).
Grind the above two herbs into powder. Take one cun bi with water, three times daily. Recovery occurs when urination becomes free.

For pregnant women, Dang Gui San (Angelica Powder) should be taken regularly.

Dang Gui San Prescription
Dang Gui (Angelica Sinensis Root), Huang Qin (Scutellaria Root), Shao Yao (Peony Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome) (1 jin each), Bai Zhu (Atractylodes Macrocephala Rhizome - 0.5 jin).
Grind the above five herbs into powder. Take one cun bi with wine, twice daily. Regular use during pregnancy facilitates easy delivery, keeps the fetus healthy, and treats various postpartum diseases.

[Commentary by Yan Yi] The *Nei Jing* states: "Yin pulsation distinct from Yang indicates pregnancy." The Chi pulse beats because Qi and Blood contend in the uterus, manifesting in the pulse. Essence remains, blood wraps, Yin and Yang intertwine. Contention leads to transformation, and transformation arises from motion. Stillness produces no life or transformation. Therefore, blood in pregnancy must not be still; stillness leads to coagulation, coagulation to stagnation, stagnation to deficiency and emptiness, all failing to combine with the fire that transforms the fetus. To ensure fetal development, the pulse must beat. Thus, regulation first harmonizes Yin and Yang and promotes Qi and Blood. Regularly taking fetal-nourishing herbs not only stabilizes the fetus and eases delivery but also prevents postpartum diseases. Chuan Xiong, Dang Gui, and Shao Yao stabilize the fetus and tonify blood. Bai Zhu has three uses: 1) Benefits the Stomach, generating calm Qi to nourish the fetus; 2) The fetus is tied to the Kidney, which dislikes dryness; Bai Zhu dries dampness and generates fluids; 3) It brings new blood transformed in the Middle Jiao and removes old stasis in the waist and umbilical region. For extra-uterine blood stagnated by cold-damp, it resolves them. Huang Qin reduces excessive fire back to mild fire, generating Qi, addressing Spleen-Stomach damp-heat, and opening blood stasis, making it suitable for regular use. However, modify based on pulse slowness/rapidness and deficiency. Take only if diseased; otherwise, unnecessary. Herbs attack evil and support righteousness; unlike grain, their flavors are biased, not balanced, and should not be taken long-term. The *Nei Jing* says: "Flavors enter and target their preferred organs. Increasing Qi for too long is the cause of premature death."

To nourish the fetus during pregnancy, Bai Zhu San (Atractylodes Powder) should be used.

Bai Zhu San Prescription
Bai Zhu (Atractylodes Macrocephala Rhizome), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Shu Jiao (Sichuan Pepper - 3 fen, sweat out), Mu Li (Oyster Shell - 4 fen).
Grind the above four herbs into powder. Take one qian bi with wine, three times daily, once at night. If painful, add Shao Yao. If epigastric pain, double Chuan Xiong. If irritability, vomiting, pain, and inability to eat, add Xi Xin (Asarum) 1 liang and large Ban Xia 20 pieces. After taking, drink vinegar-water. If vomiting, drink vinegar-water. If unresolved, drink wheat juice. If thirsty later, drink barley porridge. Even if cured, do not stop taking it.

[Commentary by Yan Yi] These four herbs are said in the Materia Medica to remove blood and nourish the fetus. Why? Because blood gathers to form the fetus. If exposed to evil, the gathered blood stagnates and resembles bad stasis. One must generate the new and remove the old to nourish the fetus. Nourishing the fetus depends not only on blood but also on the Kidney (where the fetus is anchored) and the Stomach (which nourishes it). Tonifying the Kidney secures essence; regulating the Stomach harmonizes the center. Bai Zhu regulates the Stomach; Shu Jiao opens obstruction; once opened, Yang essence arrives. Mu Li treats metrorrhagia; once stopped, Yin essence is secured. Chuan Xiong descends to the Sea of Blood, moves fetal Qi, breaks old stasis, and generates new. If Yin blood is unfavorable and Liver Wood harms, causing internal constraint and pain, use Shao Yao's sourness to unblock Yin. If rebellious Qi causes pain, use Chuan Xiong's acrid-warmth to promote Yang. If turbid bad Qi rebels to the Stomach causing vomiting, irritability, and anorexia, use Xi Xin to warm the center, resolve phlegm, and direct Qi downward. Ban Xia treats epigastric urgency/pain, harmonizes the Stomach, aids eating, and stops vomiting. If vomiting persists due to Liver Wood failing to show virtue, forget itself, use wheat drink to nourish original Qi and calm it, while also calming the Stomach, directing Qi downward, and stopping irritability—one stroke, two gains. Barley eliminates thirst, benefits Qi, and harmonizes the center; thus, it is used for thirst due to Middle Qi deficiency.

If a woman injures the fetus, experiencing abdominal fullness, inability to urinate, heaviness from the waist down resembling water qi, at seven months of pregnancy: The Taiyin should nourish but fails to do so. This is due to excess Heart Qi. One should needle Laogong (PC 8) and Guanyuan (CV 4) to drain. Slight improvement in urination indicates recovery.

[Commentary by Yan Yi] The *Nei Jing* states: All abdominal distensions belong to Heat; all damp swelling/fullness belongs to the Spleen. In Sanjiao disease, abdominal fullness and inability to pass stool lead to water overflow. The Heart is Upper Jiao but does not descend to the Kidney; the Kidney is Lower Jiao but cannot ascend to harmonize with the Heart; the Spleen is Middle Jiao. Heart Heat flares upward alone, the Kidney cannot harmonize, so Taiyin upper and lower do not connect. Grain Qi has no transport, failing to nourish the fetus, causing blockage. Upper blockage leads to Heat-Damp combining into abdominal fullness; Lower gate obstruction leads to heaviness below the waist like water. Needling Laogong allows Heart Qi to move; needling Guanyuan allows Kidney Qi to transform. Hand and Foot Shaoyin intersect, allowing free urination. Free urination cures Middle Jiao fullness and Lower Jiao heaviness.