师曰。妇人得平脉。阴脉小弱。其人渴不能食。无寒热。名妊娠。桂枝汤主之。（〔原注〕方见利中。）
于法六十日。当有此证。设有医治逆者。却一月加吐下者。则绝之。（妊娠脉经作躯。此证。作
娠。绝之下。有方在伤寒中五字。）
〔尤〕平脉。脉无病也。即内经。身有病而无邪脉之意。阴脉小弱者。初时胎气未盛而阴方受蚀。故
阴脉比阳脉小弱。至三四月。经血久蓄。阴脉始强。内经。所谓手少阴脉动者妊子。千金。所谓三月尺脉数。
是也。其人渴。妊子者。内多热也。一作呕。亦通。今妊妇二三月。往往恶阻不能食是已。无寒热者。无邪气
也。夫脉无故。而身有病。而又非寒热邪气。则无可施治。惟宜桂枝汤。和调阴阳而已。徐氏云。桂枝汤。外
证得之。为解肌和营卫。内证得之。为化气调阴阳也。六十日。当有此证者。谓妊娠两月。正当恶阻之时。
设不知而妄治。则病气反增。正气反损。而呕泻有加矣。绝之。谓禁绝其医药也。娄全善云。尝治一二妇恶阻
病吐。前医愈治愈吐。因思仲景绝之之旨。以炒糯米汤。代茶止药。月余渐安。
〔程〕此证有缺文。
〔鉴〕脉平无寒热。用桂枝汤。与妊娠渴不能食者不合。且文义断续不纯。其中必有脱简。
案楼氏纲目云。绝之者。谓绝止医治。候其自安也。予常治一二妇阻病吐。愈治愈逆。因思此仲景绝之
旨。遂停药月余自安。真大哉圣贤之言也。楼所载如此。以炒糯米代茶
汤。见于魏注。必有所据。桂枝汤可疑。程注金鉴似是。
妇人宿有症病。经断未及三月。而得漏下不止胎动。在脐上者为症痼。害妊娠。六月动者前三月经水利时
胎也。下血者。后断三月 也。所以血不止者。其症不去故也。当下其症。桂枝茯苓丸主之。（脉经。无宿
有症病四字。有妊娠二字。赵本害下。有一圈。 。作不血二字。非。三因方。作妇人宿有症病。妊娠经断
未及三月。即动。此症也。经断三月。而得漏下不止。胎动在脐上者。为症痼害。当去其症。案是以意改者不
必有所本也。诸注害下为句。魏以害妊娠为一句。似是。）
〔魏〕妇人宿有症病。旧血积聚之邪也。忽而经断。未及三月。即上条六十日以下。见渴不能食证之候
也。又忽尔经血至。且得漏下不止之证。以为胎堕乎。胎固在腹中。但动而不安。有欲堕之机矣。是症之为
病。而累及于胎者。如症在脐下。邪居于下。可以随血漏而症散。止漏安胎。病去胎全矣。如症在脐上。邪居
于上。虽血漏不止。而症自沉痼。名为症痼。势必令胎中之气血。先随血漏而堕。所以可决其
害将及于妊娠也。此就宿血积聚。居于胎之上下。以卜血漏不止。有无干碍妊娠之义也。再或妊娠六月矣。胎
忽动者。此亦宿血痼症所致。又当明辨其孰为正胎。孰为症邪而治之。前三月之间。经水顺利。得其正道。无
胎应行则行。有胎应止即止。此胎之正也。至三月以后。邪症为患。忽而漏血不止。此血非关胎血。乃断
经之后。三月之血闭而未行。于邪症之所在。必加添积聚。成为血 。所以漏下不止。而自与
胎不相涉也。惟久久不止。方害及于胎耳。血不止而痼症不去。必累害于胎。当下其症。症自下而胎自存。
所谓有物无殒者。亦此义也。（胎与 之辨。当于血未断之前三月求之。前三月经水顺利。则
经断必是胎。前三月有冒经下血者。则经断必成 。此说较前注之说。明畅易晓。附载于
此。以质高明。）
〔鉴〕此示人妊娠有病当攻病之义也。此条文义不纯。
其中必有缺文。姑存其理可也。方氏曰。胎动胎漏皆下血。而胎动有腹痛。胎漏无腹痛。故胎动
宜行气。胎漏宜清热。
楼氏纲目云。凡胎动多在当脐。今动在脐上。故知是症也。
桂枝茯苓丸方
桂枝 茯苓 牡丹（去心） 桃仁（去皮尖熬） 芍药（各等分）
上五味。末之。炼蜜和丸。如兔屎大。每日食前服一丸。不知。加至三丸。
〔程〕牡丹桃仁。以攻症痼。桂枝以和卫。芍药以和荣。茯苓以和中。五物相需。为治妊娠有症痼之小剂。
〔徐〕此方去症之力。不独桃仁。症者阴气也。遇阳则消。故以桂枝扶阳。而桃仁愈有力矣。其余皆养血之药也。
案桂枝。取之于通血脉消瘀血。犹桃核承气中所用。张氏医通。改作桂心。非也。千金。恶阻篇茯苓丸
注肘后云。妊娠忌桂。故熬。庞安时云。桂炒过。则不损胎也。此等之说。不必执拘。陈氏伤寒五法云。桂
枝不伤胎。盖桂枝轻而薄。但能解发邪气。而不伤血。故不堕胎。○案炮炙论序曰。大豆许。取重十两鲤
目比之。如兔屎。十二两鲤目。梧桐子。十四两鲤目。如兔屎。小于梧桐子。
妇人良方。夺命丸。专治妇人小产。下血至多。子死腹中。其人憎寒。手指唇口。爪甲青白。面色黄
黑。或胎上抢心。则闷绝欲死。冷汗自出。喘满不食。或食毒物。或误服草药。伤动胎气。下血不止。胎尚
未损。服之可安。已死服之可下。此方的系异人传授。至妙。（准绳云。此即仲景桂枝茯苓丸。）
即本方。以蜜丸如弹子大。每服一丸。细嚼淡醋汤送下。速进两丸。至胎腐烂腹中。危甚者。立可取出。
济阴纲目。催生汤。候产母腹痛腰痛。见胞浆下方服。
即本方。水煎热服。
妇人怀娠六七月。脉弦发热。其胎愈胀。腹痛恶寒者。少腹如扇。所以然者。子脏开故也。当以附子
汤温其脏。（〔原注〕方未见○愈胀。脉经。作逾腹。扇下。有之状二字。）
〔尤〕脉弦发热。有似表邪。而乃身不痛。而腹反痛。背不恶寒。而腹反恶寒。甚至少腹阵阵作冷。若
或扇之者然。所以然者。子脏开不能合。而风冷之气乘也。夫脏开风入。其阴内胜。则其脉弦为阴气。而发
热。且为格阳矣。胎胀者。内热则消。寒则胀也。
〔徐〕子脏者。子宫也。开者不敛也。
宜以附子汤温其脏。原方失注。想不过伤寒论中附子。合参苓术芍之附子汤耳。
案金鉴云。方缺。文亦不纯。必有残缺。然尤注义通。今从之。张氏医通云。妊娠脉弦为虚寒。虚阳
散外。故发热。阴寒内逆。故胎胀。腹痛恶寒者。其内无阳。子脏不能司闭藏之令。故阴中觉寒气。习习如
扇也。用附子汤。以温其脏。则胎自安。世人皆以附子为堕胎百药长。仲景独用以为安胎
圣药。非神而明之。莫敢轻试也。
师曰。妇人有漏下者。有半产后。因续下血都不绝者。
有妊娠下血者。假令妊娠腹中痛。为胞阻。胶艾汤主之。（阻。脉经。作漏。半产。脉经。作中生。）
〔鉴〕五六月堕胎者。谓之半产。妇人有漏下下血之疾。至五六月堕胎。而下血不绝者。此症痼之害
也。若无症痼。下血惟腹中痛者。为胞阻。胞阻者。胞中气血不和。而阻其化育也。故用芎归胶艾汤。温
和其血。血和而胎育也。
〔程〕漏下者。妊娠经来。脉经。以阳不足。谓之激经也。半产者。
以四五月堕胎。堕胎必伤其血海。血因续下不绝也。若妊娠下血腹中痛。为胞阻。则用胶艾汤以治。
巢源云。漏胞者。谓妊娠数月而经水时下。此由冲脉任脉虚。不能约制太阳少阴之经血故也。冲任之脉。
为经脉之海。皆起于胞内。手太阳。小肠脉也。手少阴。心脉也。是二经为表里。上为乳汁。下为月水。有
娠之人。经水所以断者。壅之以养胎。而蓄之为乳汁。冲在气虚。则胞内泄漏。
不能制其经血。故月水时下。亦名胞阻。漏血尽则人毙也。
芎归胶艾汤方（〔原注〕一方加干姜一两。胡洽治妇人胞动。无干姜。）
芎 阿胶 甘草（各二两） 艾叶 当归（各三两） 芍药（四两） 干
地黄（案原本缺两数唯徐沈尤用六两千金干地黄四两艾叶三两余各二两外台引集验同）
上七味。以水五升。清酒三升。合煮取三升。去滓。内胶令消尽。温服一升。日三服。不瘥更作。
〔程〕胶艾主乎安胎。四物主乎养血。和以甘草。行以酒势。血能循经养胎。则无漏下之患。
〔魏〕用芎 。行血中之凝。阿胶甘草当归地黄芍药五味。全补胞血之虚。艾叶。温子脏之血。寒证见。加干姜。
热证见者。干姜烧灰存性。温经散寒。开凝通阻。而血反止矣。干姜之加。乃注中所增。
实不易之药。余治妇人经血。屡试屡效者也。故竟僭而添入方中。高明鉴焉。
千金。胶艾汤。治妊娠二三月。上至七八月。其人顿仆
失据。胎动不安。伤损腰腹痛欲死。若有所见。及胎奔上抢心短气方。（外台。引集验同。即本方。）
又损伤门大胶艾汤。治男子伤绝。或从高堕下。伤五脏。微者唾血。及金疮伤经方。即本方。加干姜。
煮法后云。此汤治妇人产后。崩伤下血过多。虚喘欲死。腹中激痛。下血不止者。神良。
又治妊娠二三月。上至八九月。胎动不安。腰痛已有所见方。
即本方。去芍药地黄。不用清酒。
又治产后下赤白。腹中绞痛方。
即本方。无芎 。
和剂局方。胶艾汤。治劳伤血气。冲任虚损。月水过多。淋沥漏下。连日不断。脐腹疼痛。及妊娠将摄
失宜。胎动不安。腹痛下堕。或劳伤胞络。胞阻漏血。腰痛闷乱。或因损动胎上抢心。奔冲短气。及因产乳
冲任气虚。不能约制。经血淋沥不断。延引日月。渐成羸瘦。即本方。
妇人良方。陈氏六物汤。治血痢不止。腹痛难忍。
即本方。去甘草。
又四物汤。治妇人经病或先或后。或多或少。疼痛不一。腰足腹中痛。或崩中漏下。或半产恶露多。或
停留不出。妊娠腹痛。下血胎不安。产后块不散。或亡血过多。或恶露下。服之如神。
即本方。去阿胶艾叶甘草。
此药不知起于何代。或云始自魏华佗。今产宝方。乃朱梁时节度巡官昝殷所撰。其中有四物散。国朝太平
兴国中。修入圣惠方者数方。自后医者易散为汤。自皇朝以来。名医于此四物中。增损品味随意。虚实寒热。
无不得其效者。然非止妇人之疾可用而已。施氏医方祖剂云。仲景芎归胶艾汤。
乃四物汤之祖剂也。中间已具四物。后人裁而用之。
妇人怀娠。腹中 痛。当归芍药散主之。（娠。赵本。作妊。徐沈尤同。）
〔尤〕按说文。 。音绞。腹中急也。乃血不足。而水反侵之也。血不足而水侵。则胎失其所养。而
反得其所害矣。腹中能无 痛乎。芎归芍药。益血之虚。苓术泽泻。除水之
气。赵氏曰。此因脾土为木邪所客。谷气不举。湿气下流。
搏于阴血而痛。故用芍药多他药数倍。以泻肝木。亦通。
当归芍药散方
当归（三两） 芍药（一斤） 茯苓（四两） 白术（四两） 泽泻（半斤） 芎 （半斤乙作三两）
上六味。杵为散。取方寸匕。酒和日三服。
〔程〕腹中无因而作痛。或邪热所干。或胎气壅盛。用茯苓之淡以渗之。泽泻之咸以泄之。白术之甘以
补之。和以酒服者。藉其势以行药力。日三服。则药力相续。而腹痛自
止。案金鉴云。妊娠腹中急痛。用此方。未详其义。必是脱简。不释。此说却可疑。
三因方。本方煎法后云。元和纪用经曰。本六气经纬丸。能祛风补劳。养真阳退邪热。缓中安和神志。
润泽容色。散邪寒温瘴时疫。安期先生。赐李少君久饵之药。后仲景增减。为妇人怀妊腹痛方。本方用芍药四
两。泽泻茯苓川芎各一两。当归白术各二两。亦可以蜜丸服。（案此说涉荒诞。不可信据。）
和剂局方。当归芍药散。治妊娠腹中绞痛。心下急满。
及产后血晕。内虚气乏。崩中久痢。常服通畅血脉。不生痈疡。消痰养胃。明目益津。（即本方。妇人良方同。）
妊娠。呕吐不止。干姜人参半夏丸主之。
〔魏〕妊娠呕吐不止者。下实上必虚。上虚胸胃必痰饮凝滞。而作呕吐。且下实气必逆而上冲。亦能动痰
饮而为呕吐。方用干姜。温益脾胃。半夏开降逆气。人参补中益气。为丸缓以收补益之功。用治虚寒之妊
娠家。至善之法也。
张氏医通云。此即所谓恶阻病也。先因脾胃虚弱。津液留停。蓄为痰饮。至妊二月之后。浊阴上冲。
中焦不胜其逆。痰饮遂涌。中寒乃起。故用干姜止寒。人参补虚。半夏生姜治痰散逆也。
干姜人参半夏丸方
干姜 人参（各一两） 半夏（二两）
上三味。末之。以生姜汁糊为丸。如梧子大。饮服十丸。日三服。
〔程〕寒在胃脘。则令呕吐不止。故用干姜散寒。半夏生姜止呕。人参和胃。半夏干姜。能下胎。娄
全善曰。余治妊阻病。累用半夏。未尝动胎。亦有故无殒之义。临病之工。何必拘泥。
〔尤〕此益虚温胃
之法。为妊娠中虚。而有寒饮者设也。夫阳明之脉。顺而下行者也。有寒则逆。有热亦逆。逆则饮必从之。
而妊娠之体。精凝血聚。每多蕴而成热者矣。按外台方。青竹茹橘皮半夏。各五两。生姜茯苓。各四两。
麦冬人参。各三两。为治胃热气逆呕吐之法。可补仲景之未备也。
圣惠半夏丸。治妊娠恶阻病。醋心胸中冷。腹痛不能饮食。辄吐青黄汁方。
The Master said: In women, if the pulse is peaceful (Ping Mai), but the Yin pulse (Chai Mai/Radial artery at the cun position reflecting kidney yin) is slightly weak, and the patient experiences thirst and inability to eat, without aversion to cold or fever, this is diagnosed as pregnancy. (Original Note: The formula is found in the section on "Diarrhea".)
According to standard practice, around sixty days of gestation, these symptoms should appear. If improper treatment causes a reversal of the condition, and vomiting or diarrhea develops after another month, treatment should be ceased. (In *Mai Jing*, "this syndrome" is written as "body", and "pregnancy" as "shen". Below the characters "cease treatment", there are five additional characters: "there is a formula in Shang Han Zhong".)
[You Zaijing]: A peaceful pulse means the absence of pathological pulses, consistent with the meaning in *Nei Jing*: "the body has disease signs, but the pulse shows no pathogenic factors." The slight weakness of the Yin pulse occurs because initially, the fetal qi is not yet vigorous, while the yin blood is being consumed to nourish the fetus; thus, the Yin pulse appears weaker than the Yang pulse. By the third or fourth month, when menstrual blood has been retained for a long time, the Yin pulse begins to strengthen. As stated in *Nei Jing*: "If the Heart channel pulse moves, it indicates pregnancy." And in *Qian Jin Fang*: "At three months, the Chi pulse is rapid." These are consistent. Thirst in pregnancy is due to internal heat. Some versions read "vomiting," which is also acceptable. It is common for pregnant women in their second or third month to suffer from morning sickness and inability to eat. "No aversion to cold or fever" indicates the absence of external pathogens. Since the pulse is normal despite physical symptoms, and there are no exterior pathogenic factors like cold or heat, specific treatment is not applicable. Only Guizhi Tang (Cinnamon Twig Decoction) should be used to harmonize Ying and Wei and regulate Yin and Yang. Mr. Xu stated: When used for exterior syndromes, Guizhi Tang resolves the muscle layer and harmonizes Ying and Wei; when used for interior syndromes, it transforms Qi and regulates Yin and Yang. Around two months of pregnancy, during the peak of morning sickness, if one fails to recognize this and treats it aggressively, pathogenic qi will increase and healthy qi will be damaged, worsening vomiting and diarrhea. "Cease treatment" means to stop medical interventions. Lou Quanshan said: I once treated one or two women with morning sickness and vomiting who were getting worse with previous treatments. Recalling Zhang Zhongjing's principle of "ceasing treatment," I prescribed decocted sticky rice water as tea and stopped all medicines. After more than a month, they gradually recovered.
[Cheng Lin]: This text has missing passages.
[Wu Qian]: Using Guizhi Tang for a pulse that is peaceful and without cold/heat does not align with the syndrome of pregnancy accompanied by thirst and inability to eat. Furthermore, the text is disjointed, suggesting there must be missing bamboo slips.
According to Lou Zu's *Ji Yin Gang Mu*, "ceasing treatment" means stopping medical intervention and waiting for spontaneous recovery. I have treated one or two women with morning sickness and vomiting who worsened with treatment. Recalling Zhang Zhongjing's intent behind "ceasing treatment," I stopped medication for over a month, and they recovered spontaneously. Truly, the words of the sages are great! Lou's record mentions using fried glutinous rice as tea, a reference found in Wei Litong's commentary, which must have some basis. The use of Guizhi Tang is questionable; the annotations by Cheng Lin and Wu Qian seem more reasonable.
If a woman has an existing mass disease (Zheng Bing - abdominal masses), and her menstruation stops for less than three months, yet she experiences continuous spotting and fetal movement above the navel, this is a stubborn mass (Zheng Gu) harming the pregnancy. If fetal movement occurs at six months, it corresponds to the normal fetal movement following unobstructed menstruation in the first three months. The bleeding here is due to the cessation of menstruation for three months. The reason the bleeding continues is that the mass remains. One should attack the mass using Guizhi Fuling Wan (Cinnamon Twig and Poria Pill). (*Mai Jing* omits "existing mass disease" and adds "pregnancy". Zhao Kaimei's edition marks "harm" with a circle. *San Yin Fang* reads: "A woman with an existing mass, pregnant, menstruation stopped for less than three months, immediately moves; this is the mass. After three months of stopped menstruation, if spotting continues and fetal movement is above the navel, it is a mass harming pregnancy; one should remove the mass." These are later modifications without authoritative basis. Most commentators break the sentence after "harm," while Wei Litong connects "harming pregnancy," which seems more logical.)
[Wei Litong]: An existing mass in a woman refers to accumulated old blood and pathogenic factors. Suddenly, menstruation stops for less than three months, presenting symptoms similar to those described below the sixty-day mark (thirst, inability to eat). Then, unexpectedly, menstruation resumes with continuous spotting. Is this a miscarriage? No, the fetus remains in the uterus, but it is moving restlessly, showing signs of impending miscarriage. This is because the mass affects the fetus. If the mass is below the navel, the pathogen resides lower and can dissipate with the leaking blood, stopping the bleeding and protecting the fetus. If the mass is above the navel, the pathogen resides higher; even with continuous bleeding, the mass remains stubborn, termed a "stubborn mass." This will inevitably cause the fetus's Qi and blood to leak away, endangering the pregnancy. This analysis determines whether the bleeding affects the pregnancy based on the location of the accumulated blood relative to the fetus. Alternatively, if pregnancy reaches six months and the fetus suddenly moves, this is also caused by old blood and stubborn masses. One must distinguish between the true fetus and the pathogenic mass to treat accordingly. During the first three months, if menstruation was smooth, it followed the correct path; no fetus means flow, presence of a fetus means cessation. This is the normal state. After three months, if pathogenic masses cause sudden continuous bleeding, this blood is unrelated to fetal blood but rather the menstrual blood closed for three months accumulating in the site of the mass, forming stasis. Thus, bleeding continues independently of the fetus. Only prolonged bleeding harms the fetus. If bleeding persists and the mass is not removed, it will harm the fetus. One must attack the mass; once the mass is gone, the fetus survives. This illustrates the principle: "When there is a cause, there is no destruction." (To distinguish between fetus and mass, look back to three months before the bleeding started. If menstruation was smooth then, the cessation was likely pregnancy; if there was abnormal bleeding then, the cessation likely formed a mass. This explanation is clearer and is attached here for expert review.)
[Wu Qian]: This passage teaches that when a pregnant woman has a disease, one should treat the disease. The text is incomplete and likely has missing parts; we preserve its logic for now. Fang Shi noted: Both fetal movement and fetal leakage involve bleeding, but fetal movement includes abdominal pain, whereas fetal leakage does not. Therefore, fetal movement requires Qi-moving herbs, and fetal leakage requires heat-clearing herbs.
Lou Zu's *Ji Yin Gang Mu* states: Fetal movement usually occurs at the umbilicus; since it is above the navel here, it indicates a mass.
Guizhi Fuling Wan Formula
Guizhi (Cinnamon Twig), Fuling (Poria), Mudan Pi (Tree Peony Bark, remove heart), Taoren (Peach Kernel, remove skin and tip, roasted), 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.
[Cheng Lin]: Mudan Pi and Taoren attack the stubborn mass; Guizhi harmonizes Wei Qi; Shaoyao harmonizes Ying Blood; Fuling harmonizes the Middle Jiao. These five ingredients work together as a small formula for treating pregnancy complicated by stubborn masses.
[Xu Lingtai]: The power to resolve masses in this formula lies not only in Taoren. Masses are Yin pathogens; they dissolve when encountering Yang. Thus, Guizhi supports Yang, enhancing the efficacy of Taoren. The remaining herbs nourish blood.
Note: Guizhi is used here to promote blood circulation and resolve stasis, similar to its use in Taohe Chengqi Tang. Zhang Lu's *Zhang Shi Yi Tong* changes it to Guixin (Cinnamon Heart), which is incorrect. *Qian Jin Fang* notes under the Fuling Pill for Morning Sickness citing *Zhou Hou Fang*: Cinnamon is contraindicated in pregnancy, so it should be roasted. Pang Anshi said: Roasted cinnamon does not harm the fetus. Such views need not be rigidly adhered to. Chen Shi's *Shang Han Wu Fa* states: Cinnamon twig does not harm the fetus because it is light and thin, dispersing pathogenic Qi without damaging blood, thus not causing abortion. ○ According to the *Pao Zhi Lun Preface*: A bean-sized piece weighs ten times that of a carp eye; a pill the size of a rabbit dropping weighs twelve times a carp eye; a pill the size of a parasol tree seed weighs fourteen times a carp eye; a rabbit-dropping-sized pill is smaller than a parasol tree seed.
*Fu Ren Liang Fang*'s Deming Wan specializes in treating minor miscarriages with excessive bleeding and dead fetus retention. Symptoms include chills, cyanosis of fingers/lips/nails, yellow-black complexion, or fetal Qi rushing to the heart causing suffocation, cold sweats, panting, anorexia, or bleeding after ingesting toxins/herbs damaging the fetus. If the fetus is alive, it stabilizes; if dead, it expels it. This formula is attributed to a mysterious source and is highly effective. (*Zhun Sheng* states: This is Zhongjing's Guizhi Fuling Wan.)
Prepare as honey pills the size of a bullet. Chew one pill slowly and swallow with light vinegar water. Quickly take two pills until the dead fetus rots and can be expelled. In critical cases, immediate extraction is possible.
*Ji Yin Gang Mu*'s Cu Sheng Tang (Labor-Inducing Decoction) is taken when the mother experiences abdominal/lumbar pain and membrane rupture.
This is the same formula, decocted in water and taken hot.
In the sixth or seventh month of pregnancy, if the pulse is wiry, there is fever, the abdomen distends further, and there is abdominal pain with aversion to cold, feeling as if the lower abdomen is being fanned by wind. This occurs because the Zi Zang (uterus) is open. One should use Fuzi Tang (Aconite Decoction) to warm the uterus. (Original Note: Formula not seen. "Yu Zhang" in *Mai Jing* is "Yu Fu". Two characters "zhuang zhi" follow "shan".)
[You Zaijing]: A wiry pulse with fever resembles an exterior pathogen, but the body is not painful, only the abdomen; the back is not cold, only the abdomen, even feeling cold in the lower abdomen as if fanned. This is because the uterus is open and cannot close, allowing wind-cold to enter. With the opening and wind entry, Yin prevails internally, causing a wiry pulse (Yin pathology) and fever (floating Yang). Distension of the fetus occurs because heat causes contraction/shrinking, while cold causes distension.
[Xu Lingtai]: Zi Zang refers to the uterus. "Open" means failing to contract.
One should use Fuzi Tang to warm the uterus. The original formula is lost; it is likely the Fuzi Tang from *Shang Han Lun* combined with Renshen, Fuling, Baizhu, and Shaoyao.
Note: Wu Qian's *Jin Jian* says the formula is missing and the text is flawed, likely incomplete. However, You Zaijing's interpretation is coherent, so we follow it. Zhang Lu's *Zhang Shi Yi Tong* states: A wiry pulse in pregnancy indicates deficiency-cold; deficient Yang scatters outward causing fever; Yin-cold rebels inward causing fetal distension. Abdominal pain and aversion to cold indicate a lack of internal Yang, preventing the uterus from fulfilling its storing function, resulting in a sensation of cold wind. Using Fuzi Tang warms the uterus, securing the fetus. While most consider Fuzi a leading abortifacient, Zhongjing uniquely uses it as a sage herb for securing the fetus. Only those with divine insight dare to use it lightly.
The Master said: Women may experience continuous spotting (Lou Xia), continuous bleeding after a half-miscarriage,
or bleeding during pregnancy. If pregnancy is accompanied by abdominal pain, it is called Bao Zu (Uterine Obstruction), treated with Jiao Ai Tang. ("Zu" in *Mai Jing* is "Lou". "Ban Chan" in *Mai Jing* is "Zhong Sheng".)
[Wu Qian]: Miscarriage at five or six months is called Ban Chan (half-birth). Women with spotting diseases who miscarry at five or six months and continue bleeding are suffering from the harm of masses. Without masses, if bleeding is accompanied only by abdominal pain, it is called Bao Zu. Bao Zu means disharmony of Qi and Blood in the uterus, obstructing gestation. Thus, Xiong Gui Jiao Ai Tang is used to warm and harmonize the blood, allowing normal fetal development.
[Cheng Lin]: Lou Xia refers to menstruation during pregnancy, called "Ji Jing" (stimulated menstruation) in *Mai Jing* due to insufficient Yang. Ban Chan refers to miscarriage at four or five months, damaging the Blood Sea, leading to continuous bleeding. If pregnancy involves bleeding and abdominal pain, it is Bao Zu, treated with Jiao Ai Tang.
*Zhu Bing Yuan Hou Lun* states: Lou Bao refers to monthly bleeding during pregnancy. This is due to deficiency of Chong and Ren meridians, failing to control the blood of Taiyang and Shaoyin channels. Chong and Ren are the seas of meridians, originating in the uterus. Hand Taiyang (Small Intestine) and Hand Shaoyin (Heart) are exterior-interior pairs, transforming into milk above and menses below. During pregnancy, menses cease to nourish the fetus and transform into milk. If Chong Qi is deficient, leakage occurs, failing to control menses, causing monthly bleeding, also called Bao Zu. Exhaustion of bleeding leads to death.
Xiong Gui Jiao Ai Tang Formula (Original Note: One version adds Ganjiang 1 liang. Hu Qia's formula for uterine agitation excludes Ganjiang.)
Xiong (Chuanxiong), Ejiao (Donkey-hide Gel), Gancao (Licorice) — each 2 liang; Aiye (Mugwort Leaf), Danggui (Angelica Sinensis) — each 3 liang; Shaoyao (Peony Root) — 4 liang; Dihuang (Rehmannia Root) — (Note: Original lacks dosage; Xu, Shen, and You used 6 liang; *Qian Jin Fang* used 4 liang Dihuang, 3 liang Aiye, others 2 liang; *Wai Tai Mi Yao* cites *Ji Yan Fang* similarly).
Decoct the seven herbs in 5 sheng of water and 3 sheng of clear wine to obtain 3 sheng. Strain, add Ejiao, and melt completely. Take 1 sheng warm, three times daily. Repeat if ineffective.
[Cheng Lin]: Jiao Ai Tang primarily secures the fetus; Si Wu Tang primarily nourishes blood. Combined with Gancao and aided by wine, the blood circulates properly to nourish the fetus, preventing spotting.
[Wei Litong]: Xiong and Danggui move stagnation in the blood; Ejiao, Gancao, Danggui, Dihuang, and Shaoyao tonify deficiency in the uterine blood; Aiye warms the blood in the uterus. For cold syndromes, add Ganjiang; for heat syndromes, use charred Ganjiang. This warms meridians, dispels cold, resolves stagnation, and stops bleeding. Ganjiang was added by annotators and is an irreplaceable herb. I have successfully treated menstrual disorders with it. Thus, I presumptuously added it to the formula for experts to review.
*Qian Jin Fang* Jiao Ai Tang treats fetal restlessness, injury, lumbar/abdominal pain, fear of miscarriage, or fetal Qi rushing to the heart causing shortness of breath, from the second to eighth month. (*Wai Tai Mi Yao* cites *Ji Yan Fang*, same formula.)
Large Jiao Ai Tang in the Trauma Section treats men with severe injuries, falls, or internal organ damage, mild hemoptysis, or surgical wounds affecting meridians. This is the base formula plus Ganjiang.
Post-decoction note: This decoction is excellent for postpartum hemorrhage,虚喘 (deficiency panting), severe abdominal pain, and continuous bleeding.
It also treats fetal restlessness, lumbar pain, and spotting from the second to ninth month.
Remove Shaoyao and Dihuang; do not use clear wine.
It also treats postpartum discharge of red and white matter with colic.
Remove Xiong.
*He Ji Ju Fang* Jiao Ai Tang treats Qi and Blood damage, deficiency of Chong and Ren, heavy/prolonged menstruation, umbilical/abdominal pain, fetal restlessness due to poor care, threatened miscarriage, or trauma to the uterine collaterals causing obstruction and bleeding, lumbar pain, or fetal Qi rushing to the heart causing shortness of breath. It also treats postpartum deficiency leading to continuous spotting and emaciation. Same formula.
*Fu Ren Liang Fang* Chen Shi Liu Wu Tang treats persistent bloody dysentery with unbearable abdominal pain.
Same formula, remove Gancao.
Si Wu Tang treats irregular menstruation (early/late, heavy/light), various pains, lumbar/abdominal pain, metrorrhagia, excessive lochia after miscarriage, retained lochia, pregnancy abdominal pain with bleeding, postpartum masses, blood loss, or difficult labor. It is miraculous.
Same formula, remove Ejiao, Aiye, and Gancao.
The origin of this medicine is unknown; some say it started with Hua Tuo. *Chan Bao Fang*, compiled by Zan Yin of the Later Liang dynasty, contains Si Wu San. Several formulas were included in *Sheng Hui Fang* during the Taiping Xingguo era of our dynasty. Later, physicians changed the powder to decoction. Since the Song Dynasty, famous doctors have modified this Si Wu formula freely for excess/deficiency and cold/heat syndromes with great efficacy. It is not limited to women's diseases. Shi Shi's *Yi Fang Zu Ji* states: Zhongjing's Xiong Gui Jiao Ai Tang is the ancestral formula of Si Wu Tang. It already contains the four ingredients, which later generations extracted and used separately.
For abdominal cramping pain during pregnancy, use Dang Gui Shao Yao San. ("Shen" in Zhao's edition is "Ren"; Xu, Shen, and You agree.)
[You Zaijing]: According to *Shuo Wen*, [Jiao] (cramping pain) sounds like "jiao," indicating acute abdominal tension. This is due to blood deficiency allowing water-dampness to invade. When blood is deficient and dampness invades, the fetus loses nourishment and suffers harm, causing abdominal pain. Xiong, Gui, and Shaoyao tonify blood deficiency; Fuling, Baizhu, and Zexie drain dampness. Zhao stated: This is because Spleen Earth is invaded by Liver Wood, grain Qi fails to rise, dampness flows downward, and clashes with Yin blood causing pain. Hence, Shaoyao is used in much larger quantities to drain Liver Wood. This interpretation is also valid.
Dang Gui Shao Yao San Formula
Danggui (3 liang), Shaoyao (1 jin), Fuling (4 liang), Baizhu (4 liang), Zexie (0.5 jin), Xiong (0.5 jin, Yi version 3 liang).
Grind the six herbs into powder. Take one square-inch scoop, mixed with wine, three times daily.
[Cheng Lin]: Spontaneous abdominal pain may be due to pathogenic heat or excessive fetal Qi. Use Fuling to leach out dampness, Zexie to drain turbidity, and Baizhu to tonify Spleen. Wine aids the movement of medicinal power. Three doses daily ensure continuous effect, stopping pain. Note: Wu Qian's *Jin Jian* says the rationale for using this formula for pregnancy cramping is unclear and likely has missing text. This doubt is valid.
*San Yin Fang* post-decoction note cites *Yuan He Ji Yong Jing*: Ben Liu Qi Jing Wei Wan dispels wind, tonifies fatigue, nourishes True Yang, clears evil heat, calms the spirit, beautifies the complexion, and prevents epidemics. Given by Anqi Xiansheng to Li Shaojun, later modified by Zhongjing for pregnancy abdominal pain. The formula uses 4 liang Shaoyao, 1 liang each of Zexie, Fuling, Xiong, and 2 liang each of Danggui and Baizhu. It can also be made into honey pills. (Note: This claim is absurd and unreliable.)
*He Ji Ju Fang* Dang Gui Shao Yao San treats pregnancy colic, epigastric fullness, postpartum blood fainting, internal deficiency, chronic dysentery, and metrorrhagia. Regular use promotes blood circulation, prevents abscesses, resolves phlegm, nourishes the Stomach, brightens the eyes, and benefits fluids. (Same formula, *Fu Ren Liang Fang* agrees.)
For persistent vomiting during pregnancy, use Ganjiang Renshen Banxia Wan.
[Wei Litong]: Persistent vomiting in pregnancy implies upper deficiency and lower excess. Upper deficiency leads to phlegm-fluid retention in the chest/stomach, causing vomiting. Lower excess causes rebellious Qi to rush upward, disturbing phlegm-fluids. Ganjiang warms and tonifies Spleen/Stomach; Banxia descends rebellious Qi; Renshen tonifies Middle Qi. Forming pills allows slow absorption for tonification. This is an excellent method for deficiency-cold pregnancy.
Zhang Lu's *Zhang Shi Yi Tong* states: This is E Zu (morning sickness). Initially, Spleen/Stomach deficiency causes fluid retention and phlegm accumulation. After the second month of pregnancy, turbid Yin rushes upward, overwhelming the Middle Jiao, causing phlegm surge and middle-cold. Thus, Ganjiang stops cold, Renshen tonifies deficiency, and Banxia/Shengjiang resolves phlegm and directs Qi downward.
Ganjiang Renshen Banxia Wan Formula
Ganjiang (1 liang), Renshen (1 liang), Banxia (2 liang).
Grind the three herbs into powder. Use fresh ginger juice to make pills the size of parasol tree seeds. Take ten pills with water, three times daily.
[Cheng Lin]: Cold in the Epigastrium causes persistent vomiting. Ganjiang disperses cold; Banxia/Shengjiang stops vomiting; Renshen harmonizes the Stomach. Although Banxia and Ganjiang can induce abortion, Lou Quanshan said: I frequently used Banxia for morning sickness without harming the fetus. This follows the principle: "When there is a cause, there is no destruction." Physicians should not be rigid.
[You Zaijing]: This is a method to tonify deficiency and warm the Stomach, designed for pregnancy with Middle Jiao deficiency and cold-fluid retention. The Yangming channel normally flows downward. Cold or heat causes rebellion, carrying fluids with it. Pregnancy bodies often accumulate heat due to condensed essence and blood. According to *Wai Tai Mi Yao*, Qing Zhuru, Jupi, Banxia (5 liang each), Shengjiang, Fuling (4 liang each), Maidong, Renshen (3 liang each) treat stomach-heat rebellious vomiting. This supplements Zhongjing's incompleteness.
*Sheng Hui Fang* Banxia Wan treats pregnancy morning sickness, cold in the chest/heart, abdominal pain, anorexia, and vomiting of green/yellow fluid.