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。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。
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。楼全善云。
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。
妇人宿有 病。经断未及三月。而得漏下不止。胎动在脐上者。此为 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 不去故也。当下其 。桂枝茯苓丸主之。
、旧血所积。为宿病也。 痼害者。宿病之气。害其胎气也。于法妊娠六月。其胎当动。今未
三月。胎不当动而忽动者。特以 痼害之之故。是六月动者胎之常。三月动者胎之变也。夫 病之人。
其经月当不利。经不利。则不能受胎。兹前三月经水适利。胞宫净而胎可结矣。胎结故经断不复下。
乃未三月而 血仍下。亦以 痼害之之故。是血留养胎者其常。血下不止者其变也。要之。其 不去。
则血必不守。血不守。则胎终不安。故曰当下其 。桂枝茯苓丸。下 之力。颇轻且缓。盖恐峻厉之
药。将并伤其胎气也。
桂枝茯苓丸方
桂枝 茯苓 丹皮 桃仁（去皮尖熬） 芍药（各等分）
上五味。末之。炼蜜丸如兔屎大。每日食前服一丸。不知。加至三丸。
妇人怀妊六七月。脉弦发热。其胎愈胀。腹痛恶寒。少腹如扇。所以然者。子脏开故也。当以附
子汤温其脏。
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。而风冷之气乘之也。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。胎热则消。寒则胀也。附子汤方未见。然温里散寒之意。概可推矣。
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。
妇人经水淋沥。及胎产前后下血不止者。皆冲任脉虚。而阴气不能守也。是惟胶艾汤为能补而固之。
中有芎、归。能于血中行气。艾叶利阴气。止痛安胎。故亦治妊娠胞阻。胞阻者。胞脉阻滞。血少
而气不行也。
胶艾汤方
干地黄（六两） 川芎 阿胶 甘草（各二两） 艾叶 当归（各三两） 芍药（四两）
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。
妇人怀妊。腹中 痛。当归芍药散主之。
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 川芎（各三两） 芍药（一斤） 茯苓 白术（各四两） 泽泻（半斤）
上六味。杵为散。取方寸匕。酒和。日三服。
妊娠呕吐不止。干姜人参半夏丸主之。
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。
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。梧子大。饮服十丸。日三服。
妊娠小便难。饮食如故。当归贝母苦参丸主之。
小便难而饮食如故。则病不由中焦出。而又无腹满身重等证。则更非水气不行。知其血虚热郁。而
津液涩少也。本草当归补女子诸不足。苦参入阴利窍除伏热。贝母能疗郁结。兼清水液之源也。
当归贝母苦参丸方
当归 贝母 苦参（各四两）
上三味末之。炼蜜丸如小豆大。饮服三丸。加至十丸。
妊娠有水气。身重。小便不利。洒淅恶寒。起即头眩。葵子茯苓散主之。
妊娠小便不利。与上条同。而身重恶寒头眩。则全是水气为病。视虚热液少者。霄壤悬殊矣。葵
子、茯苓滑窍行水。水气既行。不淫肌体。身不重矣。不侵卫阳。不恶寒矣。不犯清道。不头眩矣。经
曰。有者求之。无
者求之。盛虚之变。不可不审也。
葵子茯苓散方
葵子（一升） 茯苓（三两）
上二味。杵为散。饮服方寸匕。日二服。小便利则愈。
妇人妊娠宜常服。当归散主之。
妊娠之后。最虑湿热伤动胎气。故于芎、归、芍药养血之中。用白术除湿。黄芩除热。丹溪称黄
芩、白术为安胎之圣药。夫芩、术非能安胎者。去其湿热而胎自安耳。
当归散方
当归 黄芩 芍药 川芎（各一斤） 白术（半斤）
上五味。杵为散。酒服方寸匕。日再服。妊娠常服即易产。胎无疾苦。产后百病悉主之。
妊娠养胎。白术散主之。
妊娠伤胎。有因湿热者。亦有因湿寒者。随人脏气之阴阳而各异也。当归散。正治湿热之剂。白
术散。白术、牡蛎燥湿。川芎温血。蜀椒去寒。则正治湿寒之剂也。仲景并列于此。其所以诏示后人
者深矣。
白术散方
白术 川芎 蜀椒（去汗） 牡蛎（各三分）
上四味。杵为散。酒服一钱匕。日三服。夜一服。但苦痛加芍药。心下毒痛。倍加芎 。心烦吐
痛。不能食饮。加细辛一两。半夏大者二十枚服之。后更以醋浆水服之。若呕。以醋浆水服之。复不
解者。小麦汁服之。已后渴者。大麦粥服之。病虽愈。服之勿置。
妇人伤胎怀身。腹满不得小便。从腰以下重。如有水状。怀身七月。太阴当养不养。此心气实。
当刺泻劳宫及关元。小便微利则愈。
伤胎。胎伤而病也。腹满不得小便。从腰以下重。如有水气。而实非水也。所以然者。心气实故
也。心、君火也。为肺所畏。而妊娠七月。肺当养胎。心气实则肺不敢降。而胎失其养。所谓太阴当
养不养也。夫肺主气化者也。肺不养胎。则胞中之气化阻。而水乃不行矣。腹满便难身重。职是故也。
是不可治其肺。当刺劳宫以泻心气。刺关元以行水气。使小便微利。则心气降。心降而肺自行矣。劳
宫、心之穴。关元、肾之穴。
The Master said: When a woman presents with a calm pulse, but the Yin pulse (pulse at the cun position on the left or radial artery pulse characteristics indicating Yin deficiency) is slightly weak, and she experiences 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 sixty days of gestation. If improper treatment is applied, causing vomiting or diarrhea to worsen after one month, medication should be discontinued.
A "calm pulse" means a pulse free from disease, consistent with the meaning in *Neijing* (Classic of Internal Canon) that although there are bodily symptoms, 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 smaller and weaker than the Yang pulse. By the third or fourth month, when menstrual blood has been retained for a long time, the Yin pulse becomes strong. This corresponds to the statement in *Neijing* that movement in the Hand-Shaoyin (Heart) meridian indicates pregnancy, and the statement in *Qianjin Fang* (Prescriptions Worth a Thousand Gold) that the chi pulse becomes rapid at three months of pregnancy. Thirst in the patient arises because pregnancy often involves internal heat. Some versions read "vomiting," which is also acceptable. It is common for pregnant women in their second or third month to experience nausea and food aversion (morning sickness), which is exactly this condition. The absence of chills and fever indicates no external pathogenic invasion. Since the pulse is normal despite bodily symptoms, and it is not caused by cold-heat pathogens, no specific treatment is needed other than using Guizhi Tang to harmonize Ying and Wei (Nutritive and Defensive levels) and regulate Yin and Yang. Mr. Xu stated: Guizhi Tang, when used for exterior syndromes, releases the muscle layer and harmonizes Ying and Wei; when used for interior disorders, it transforms Qi and regulates Yin and Yang. The phrase "symptoms should appear at sixty days" refers to the second month of pregnancy, when morning sickness is most prominent. If this physiological state is misunderstood and treated aggressively, pathogenic factors may increase and healthy Qi may be damaged, exacerbating vomiting and diarrhea. "Jue zhi" (cut off/discontinue) means to stop administering medicine. Lou Quanshan said: I once treated several women suffering from severe vomiting due to morning sickness, where previous treatments made the vomiting worse. Recalling Zhang Zhongjing's principle of "discontinuing treatment," I substituted roasted glutinous rice soup for tea and stopped all medications for over a month, after which the condition gradually stabilized.
If a woman previously had a zheng mass (abdominal mass formed by blood stasis), and her menstruation stops for less than three months, yet she suffers from continuous spotting and feels fetal movement above the umbilicus, this is called "gu hai" (chronic disease harming the fetus). If fetal movement occurs at six months of pregnancy, it indicates conception occurred during the period when menstruation was regular in the preceding three months, which is normal. If bleeding occurs, it indicates the presence of a zheng mass after three months of amenorrhea. The reason the bleeding does not stop is that the zheng mass remains. One must eliminate the zheng mass using Guizhi Fuling Wan (Cinnamon Twig and Poria Pill).
Zheng refers to accumulated old blood forming a chronic condition. Gu hai refers to the qi of this chronic condition harming the fetal qi. Normally, fetal movement occurs at six months of gestation. If movement occurs before three months, it is abnormal due to the interference of the zheng mass. Thus, movement at six months is the norm, while movement at three months is an anomaly. Women with zheng masses typically have irregular menstruation. Irregular menstruation prevents conception. However, if menstruation was regular in the first three months, the uterus became clean, allowing conception to occur. Once conceived, menstruation stops. Yet, if bleeding persists before three months, it is again due to the gu hai. Normally, blood stays to nourish the fetus; persistent bleeding is abnormal. In summary, as long as the zheng mass remains, blood cannot be contained; if blood is not contained, the fetus cannot be secure. Therefore, one must eliminate the zheng mass using Guizhi Fuling Wan. The purgative power of this pill is mild and slow, likely to avoid damaging the fetal qi with harsh medicines.
Guizhi Fuling Wan Formula:
Guizhi (Ramulus Cinnamomi), Fuling (Poria), Mudanpi (Cortex Moutan), Taoren (Semen Persicae, peeled and removed of tips, stewed), Shaoyao (Radix Paeoniae Rubra/Alba) — 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.
When a woman is six or seven months pregnant, presenting with a wiry pulse, fever, increased abdominal distension due to the fetus, abdominal pain, aversion to cold, and a sensation of cold in the lower abdomen as if fanned by wind, it is because the zi zang (uterus) is open. One should use Fuzi Tang (Aconite Decoction) to warm the uterus.
A wiry pulse with fever resembles an exterior pathogen, but the body is not painful while the abdomen is, and the back is not cold while the abdomen is. Even the lower abdomen feels intermittently cold, as if fanned. This happens because the uterus is open and unable to close, allowing wind-cold to invade. With the organ open and wind entering, Yin cold dominates internally. Hence, the wiry pulse indicates Yin qi, and the fever is false heat due to Yang being repelled outward (Ge Yang). Fetal distension occurs because the fetus shrinks with heat and expands with cold. Although the formula for Fuzi Tang is not recorded here, the intent to warm the interior and dispel cold can be inferred.
The Master said: Women may present with continuous spotting, post-abortion bleeding that continues, or bleeding during pregnancy. If pregnancy is accompanied by abdominal pain and bleeding, it is called Bao Zu (womb obstruction). Jiao Ai Tang (Donkey-Hide Gelatin and Mugwort Decoction) should be administered.
Continuous light menstrual flow, or bleeding before and after childbirth, results from deficiency in the Chong and Ren meridians, causing Yin qi to fail in its securing function. Only Jiao Ai Tang can tonify and consolidate. It contains Xiong (Chuanxiong Rhizome) and Gui (Danggui Radix Angelicae Sinensis), which move Qi within the blood. Ai Ye (Folium Artemisiae Argyi) benefits Yin qi, relieves pain, and calms the fetus. Thus, it also treats Bao Zu in pregnancy. Bao Zu refers to obstruction of the uterine vessels, where blood is scant and Qi fails to circulate.
Jiao Ai Tang Formula:
Gan Dihuang (Radix Rehmanniae Preparata, 6 liang), Chuanxiong (Rhizoma Chuanxiong), Ejiao (Colla Corii Asini), Gancao (Radix Glycyrrhizae Preparata, each 2 liang), Ai Ye (Folium Artemisiae Argyi), Danggui (Radix Angelicae Sinensis, each 3 liang), Shaoyao (Radix Paeoniae Alba, 4 liang).
Boil the seven ingredients in 5 sheng of water and 3 sheng of clear wine until 3 sheng remain. Strain, add Ejiao, and stir until dissolved. Take 1 sheng warm, three times daily. If not cured, prepare another dose.
When a pregnant woman suffers from abdominal cramping pain, Danggui Shaoyao San (Angelica and Peony Powder) should be administered.
According to Shuowen Jiezi, "Jiao" (described as 疒交) sounds like "jiao" and refers to acute abdominal pain. This is caused by blood deficiency allowing water-dampness to invade. When blood is deficient and dampness invades, the fetus loses its nourishment and suffers harm. Can the abdomen not feel cramping pain? Xiong, Gui, and Shaoyao tonify blood deficiency. Ling, Zhu, and Zexie drain dampness. Mr. Zhao stated: This is because Spleen Earth is invaded by Liver Wood, preventing the ascent of Grain Qi and causing dampness to flow downward, clashing with Yin blood to cause pain. Therefore, Shaoyao is used in quantities several times greater than other herbs to drain Liver Wood. This explanation is also valid.
Danggui Shaoyao San Formula:
Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong, each 3 liang), Shaoyao (Radix Paeoniae Alba, 1 jin), Fuling (Poria), Baizhu (Rhizoma Atractylodis Macrocephalae, each 4 liang), Zexiae (Rhizoma Alismatis, 0.5 jin).
Grind the six herbs into powder. Take one fangcun bi (measure) mixed with wine, three times daily.
For incessant vomiting during pregnancy, Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill) should be administered.
This is a method to tonify deficiency and warm the stomach, specifically for pregnancy complicated by middle-jiao deficiency and cold-fluid retention. The Yangming meridian normally flows downward. Cold causes rebellion; heat also causes rebellion. Rebellion leads fluid retention to rise. Pregnant women often accumulate heat due to condensed essence and blood. Note that the *Waitai Miyao* records a formula for treating vomiting due to stomach heat and rebellious Qi: Qingzhuru (Bambusa Textilis Caulis), Ju Pi (Pericarpium Citri Reticulatae), Banxia (Rhizoma Pinelliae) each 5 liang; Shengjiang (Rhizoma Zingiberis Recens), Fuling each 4 liang; Maidong (Radix Ophiopogonis), Renshen (Radix Ginseng) each 3 liang. This supplements Zhang Zhongjing’s unrecorded methods.
Ganjiang Renshen Banxia Wan Formula:
Ganjiang (Radix Zingiberis Preparata), Renshen (Radix Ginseng, each 1 liang), Banxia (Rhizoma Pinelliae, 2 liang).
Grind the three herbs into powder. Use fresh ginger juice to make paste and form pills the size of wutong seeds. Take ten pills with water, three times daily.
For difficult urination during pregnancy with normal diet, Danggui Beimu Kushen Wan (Angelica, Fritillaria, and Sophora Pill) should be administered.
Difficult urination with normal diet indicates the pathology is not in the middle jiao. Without symptoms like abdominal fullness or heaviness, it is not water-gas stagnation. It indicates blood deficiency with heat constraint and scanty body fluids. Materia Medica states Danggui tonifies various deficiencies in women; Kushen (Radix Sophorae Flavescentis) enters the Yin to benefit orifices and remove latent heat; Beimu (Bulbus Fritillariae Cirrhosae) treats depression and clears the source of fluids.
Danggui Beimu Kushen Wan Formula:
Danggui (Radix Angelicae Sinensis), Beimu (Bulbus Fritillariae Cirrhosae), Kushen (Radix Sophorae Flavescentis, each 4 liang).
Grind the three herbs into powder. Mix with refined honey to form pills the size of small beans. Take three pills with water, increasing to ten pills if necessary.
For pregnancy complicated by water-gas, presenting with heaviness, difficult urination, chills, and dizziness upon rising, Kuizi Fuling San (Abelmoschus and Poria Powder) should be administered.
Difficult urination in pregnancy is similar to the previous case, but heaviness, chills, and dizziness indicate pure water-gas pathology, vastly different from the previous case of blood deficiency and heat. Kuizi (Fructus Abelmoschi) and Fuling (Poria) lubricate orifices and promote diuresis. Once water-gas moves, it no longer floods the muscles, so heaviness ceases; it no longer attacks Wei Yang, so chills cease; it no longer obstructs clear orifices, so dizziness ceases. The Classics say: Seek the cause of what exists, and seek the cause of what does not exist. Changes between excess and deficiency must be carefully examined.
Kuizi Fuling San Formula:
Kuizi (Fructus Abelmoschi, 1 sheng), Fuling (Poria, 3 liang).
Grind the two herbs into powder. Take one fangcun bi with water, twice daily. Cure is achieved when urination becomes smooth.
Women in pregnancy should regularly take Danggui San (Angelica Powder).
After conception, the greatest concern is damp-heat damaging the fetal qi. Therefore, within the blood-nourishing formula of Xiong, Gui, and Shaoyao, Baizhu (Rhizoma Atractylodis Macrocephalae) is used to remove dampness, and Huangqin (Radix Scutellariae) to clear heat. Zhu Danxi called Huangqin and Baizhu the holy medicines for calming the fetus. Actually, Huangqin and Baizhu do not directly calm the fetus; rather, by removing damp-heat, the fetus naturally becomes secure.
Danggui San Formula:
Danggui (Radix Angelicae Sinensis), Huangqin (Radix Scutellariae), Shaoyao (Radix Paeoniae Alba), Chuanxiong (Rhizoma Chuanxiong, each 1 jin), Baizhu (Rhizoma Atractylodis Macrocephalae, 0.5 jin).
Grind the five herbs into powder. Take one fangcun bi with wine, twice daily. Regular consumption during pregnancy facilitates delivery and keeps the fetus free from distress. It also treats various postpartum diseases.
For nurturing the fetus during pregnancy, Baizhu San (Atractylodes Powder) should be administered.
Fetal damage can result from damp-heat or damp-cold, varying according to the Yin-Yang constitution of the individual organs. Danggui San treats damp-heat. Baizhu San uses Baizhu and Muli (Concha Ostreae) to dry dampness, Chuanxiong to warm blood, and Shujiao (Pericarpium Zanthoxyli) to dispel cold; thus, it treats damp-cold. Zhang Zhongjing listed them together, revealing profound guidance for future generations.
Baizhu San Formula:
Baizhu (Rhizoma Atractylodis Macrocephalae), Chuanxiong (Rhizoma Chuanxiong), Shujiao (Pericarpium Zanthoxyli, sweat removed), Muli (Concha Ostreae, each 3 fen).
Grind the four herbs into powder. Take one qianbi with wine, three times daily, and once at night. If only pain is present, add Shaoyao. If there is severe pain in the epigastrium, double the amount of Chuanxiong. If there is irritability, vomiting, pain, and inability to eat or drink, add 1 liang of Xixin (Herba Asari) and twenty large Banxia (Rhizoma Pinelliae). Afterwards, take with vinegar-water. If vomiting persists, take with vinegar-water. If still unresolved, take wheat juice. If thirsty afterwards, take barley porridge. Even after recovery, do not discontinue use.
When a woman injures the fetus during pregnancy, presenting with abdominal fullness, inability to urinate, heaviness from the waist down resembling water accumulation, at seven months of pregnancy, the Taiyin (Lung) fails to nourish the fetus due to excess Heart Qi. One should needle Laogong (PC 8) and Guanyuan (CV 4) to drain the excess. Mild diuresis will lead to recovery.
Injured fetus refers to fetal pathology. Abdominal fullness, urinary retention, and lower body heaviness resemble water accumulation but are not actually water. This is due to excess Heart Qi. The Heart is Ministerial Fire, feared by the Lung. At seven months of pregnancy, the Lung should nourish the fetus. Excess Heart Qi prevents the Lung from descending, causing the fetus to lose nourishment—this is "Taiyin failing to nourish." The Lung governs Qi transformation. If the Lung does not nourish the fetus, Qi transformation in the uterus is blocked, and water fails to move. Abdominal fullness, difficult defecation, and heaviness result from this. One should not treat the Lung directly. Instead, needle Laogong to drain Heart Qi and Guanyuan to promote water movement. Mild diuresis allows Heart Qi to descend; once Heart Qi descends, Lung Qi functions automatically. Laogong is an acupoint of the Heart; Guanyuan is an acupoint of the Kidney.