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。于法六十日当有此症。设有医治
逆者却一月。加吐下者则绝之。
桂枝汤方（别见）
经言阳搏阴别。为有子。盖谓脉之外廓。沉柔而得阴脉之常。但中间一线阳脉。高起而搏指。特与平部之阴
脉各别。是阴中另具一阳也。非有子而何哉。又言左尺滑者妊也。夫滑为气血交聚之诊。左尺应胞门。胞门
之中。阳精如端居贵人。而妇人之气血。会聚而包裹之。其脉安得不以滑见耶。二说俱就左尺而言之也。又
曰。手少阴脉动甚者妊子也。盖谓心肾同主手足之少阴。而司精血相通之妙者也。夫两物相击。轻小者动。
亦受击者动。已见动脉下。今心主之脉。无端而动甚。岂非下焦肾中。得外阳以实之。而上击之所致乎。故知
妊子也。此从寸口而言之也。然三说虽各不同。而其理则一。以尺脉之两边。沉柔细滑而得阴体。故其中始
见弦长。而别为搏指。因之上冲寸口。而见动甚矣。此诸脉与外症之晕眩呕逆相符也。本经平脉。不特尺不
阳搏阴别。及不滑。并手少阴不动之类。凡不沉浮迟数者。皆在其中。此仲景于经旨之外。又言妊娠之变诊
也。阴脉、以下文小弱。及桂枝汤脉之阳浮阴弱推之。当指沉按而言。以阴脉小弱。言四脏之心肝脾肺。而不
言肾。肾中得别阳以实之。岂有小弱之理。惟是四脏之精气。趋固胎元。故见小弱。正与前人三说。相为表里。
盖惟肾脉搏别滑实。故致四脏之阴脉小弱。则仲景丢开尺脉。而言四脏之阴脉。与经文撇开足少阴。而言
手少阴者同义也。但凡渴而不能食者。多有寒热之外症。以少阳中风寒。则渴而默默不欲食。且寒热往来
耳。今既有此而无彼。合而断之。脉平、为人病脉不病。四脏之阴脉小弱。为脏真趋赴肾经以养胎。渴、为津液
下掣。不能食、为生气上冲。故知为妊娠矣。桂枝汤养阳以益阴。故主之。养阳、则实上以御下之冲气。故能食。
养阳以益阴。则阴脉不小弱。而渴亦可止也。六十日、胎气已成。阴血奔赴。故于法当有前此之脉症。以胎气
已成。则向长之机势上侵。而不能食。阴血奔赴。故阴脉小弱而渴也。设或医家以微渴而误清上焦之火。则
上虚而胎气益张。因少不能食而误伤中土之阴。则胃干而脏真失养。胎气下张而上冲。故不食既早。脏真
自虚而下顾。故干渴先形。前项脉症。遂减却一月。而于三十日见矣。若逆甚而因渴以吐之。因不能食而下
之。吐则上提。而阴血不下贯。故不渴。下则下泄。而生气不上冲。故反能食。遂绝然无前此之脉症矣。然至阴
血不下贯。生气不上冲。岂妊娠之佳兆乎哉。此处主桂枝汤。当但服药。而不啜热粥为合。盖啜粥是助桂
枝辛甘之性以祛邪。不啜粥则任芍药酸敛之性以养脏故也。绝之之义。钱塘娄氏。谓绝止医治。本经从
无此喷饭之文。 李徐氏。谓绝止吐下。仲景又无此不传之药。且于文于理。明明言常例该迟至六十日。治
逆则早见三十天。逆甚则母气不相顾。子气不日增。而无此矣。盖危词也。呜呼。吾安得知音者。而与之读金
匮之文耶。
妇人宿有 病。经断未及三月。而得漏下不止。胎动在脐上者。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。（ 音胚凝血也）
桂枝茯苓丸方 桂枝 茯苓 芍药 丹皮 桃仁（各等分去皮尖熬）
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。
本条十一句。凡两段。前五句为一段。辨似胎而非胎之病。后六句为一段。言虽病而暗妊之胎。总以本方为
主治。诸注混淆。不得经旨。 死血也。详 瘕注。痼者固也。 痼者。 病之坚固宿痰也。妇人之经血。其精悍
之源。起于阳明胃腑。然后由脏腑而充贯经络。与男子同。但男子藏而不泻。妇人则十二经各从内络。而渐
注于血室。血室者。胞门在其左。子户在其右。形气相隔。而以窈冥之细络相通者也。胞门中清虚无物。则血
室满而气盈血溢。从贴脊而下。却前行由少腹。而出从溺管之下。阴庭之上一窍。以为月水。若胞门贮有阳
精。则血室中之气血。如朝觐会同之象。而旁从窈冥之细络。趋赴胎元而辅翼滋养之。使血室虚而不满。且
吸取十二经之精汁以为供奉。故经断也。然妇人前阴。列有三窍。假令道路不明。则是动是漏。总不能辨。且
后文腹痛。小便不利等症。亦安能了然耶。故不惜饶舌。琐屑言之。膀胱、浮居少腹。（膀胱居肠之中。何谓浮
居少腹。盖对阴庭及血道而言也）。其窍原高。阴庭即交接处。上通胞门子户。其位次之。血室路经贴脊。其
位最下。但其道自腰俞之下。却从络脉而前行少腹。又缠中道而出向阴庭之上壁。故曰溺管之下。阴庭之
上者此也。是胎动之血。已于血室中通过胞胎。而为撒手失护之血。其道从胎中。直由阴庭正道而下。下多。
则胎落而不可安也。胎漏之血。因血络为 痼所阻。未及到胎。而为血室失守之血。其道由贴脊之腰俞。历
少腹而下者。较之胎动落胎。为可少耽时日。而安之十得其七也。诊法以腰俞 痛。少腹沉满者为漏。无此
而但腹痛。及垂垂气陷者。为动。又血多而骤者。为动。血少而谩者。为漏也。盖谓妇人宿有 病。如平时少
腹坚硬。按之有形。或临经腰腹胀痛。不可宁耐等症即是。夫经断似为有子。若未及三月。而漏下不止。便非
有胎欲堕之候。再验其如胎动之状。而在脐上。便不得认为胎动。而投以安胎等剂矣。盖未及三月。其胎尚
在少腹。安得动在脐上。其为 滞气鼓无疑。故知从前经断。为 痼之旧血不去、而害其新血渐生。现今漏
下。为 痼之死血阻塞。而害其生血归元之所致也。若前症后、漏止经断。又过三月。是六月矣。至六月而复
动下血者。是前三月漏下时。经水少利而受胎。故此三月中。仍然经断。而今复下血者。又后断三月中。不抱
胎之 血耳。其所以不抱胎而血不止者。以其 痼不去。而阻塞荫胎之路故也。则主化 之桂苓丸。 去
而血得抱胎之路。复何漏下不止之病乎。夫 痼俱起于气寒而经尾不运。故用生阳补气之桂枝以温之。
又痼俱成于气滞。而瘀血不散。故用升阳通气之丹皮以动之。然后以入血之芍药。引至 所。而以破瘀
之桃仁。逐之使下也。本经言血不行则为水。故又用渗泄之茯苓。仍从前阴而去耳。一丸至三丸。而不宜多
服者。盖取其渐磨。而不欲急攻以动胎血之义。
妇人怀妊六七月。脉弦。发热。其胎愈胀。腹痛恶寒者。少腹如扇。所以然者。子藏开故也。当以附子汤温其藏。
（方
缺）妇人怀妊。除少阴君主之官。其经气血。不堪供应胞胎。手太阳与心经为表里。随心为主。故俱不养胎
外。其余经脉。逐月抡滋。故一月始胚。足厥阴肝脉养之。二月始膏。足少阳胆脉养之。三月始胞。手厥阴心包
脉养之。四月形体成。手少阳三焦脉养之。五月能动。足太阴脾脉养之。六月筋骨立。足阳明胃脉养之。七月
毛发生。手太阴肺脉养之。八月脏腑具。手阳明大肠脉养之。九月谷气入胃。足少阴肾脉养之。十月诸神备。
足太阳膀胱脉养之。即产矣。妊娠六七月。是胃与肺养胎之候。胃为悍气之源。肺司诸气之总。二者化醇。则
阳气之柔者养筋。而脉不瘦削弦急。阳虚故脉弦也。又里寒、则逼微阳于外。故发热。里阳充满而包裹胎气。
则胎气受持而相安于不觉。阳虚而失包裹之用。故其胞纵放。而殊觉愈胀也。腹痛者。里寒之应。表虚、故恶
寒也。少腹如扇、言少腹中如以冷风扇入之状。正阳气失守。而不能温胎之应也。子藏开者。非子藏开解之
谓。盖阳主护卫周密之用。阳虚而不护不密。故曰开也。附子辛咸温热。辛以散寒。咸以润下。温热以补助阳
气。故可为下焦子藏之温药也。原方虽缺。以鄙意拟之。或以附子为君。而加肉桂、芍药。及当归、茯苓之类耶。
盖肉桂为皮。其性内裹。能伏表热以温里。芍药酸敛。其性内行下走。能引桂附直至子藏。且气因于血。气虚
者。血必虚。故加温经补血之当归。又内寒者。多聚水。故加茯苓以渗泄耳。并附于此。以正高明。或曰。六月
胃脉养胎。七月肺脉养胎。二经所喜。辛甘温畅。似于干姜、甘草无忤乎。
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。
胶艾汤方
阿胶（二两） 艾叶（三两） 当归（三两） 芎 （二两） 芍药（四两） 干地黄（三两） 甘草（二两）
上七味。以水五升。清酒三升合煮。取二升。去滓内胶。令消尽。温服一升。日三服不瘥。更作服。
此辨胞阻之症治也。言妇人血症。种种不同。即妊娠下血。尚有各别。必下血而腹痛。然后谓之胞阻。勿误认
误治也。漏下是临经不畅。经后陆续见红。如渗漏之状。故曰漏下。即二条所谓 痼害。而漏下不止是也。此
就未妊者而言。故曰妇人。半产后下血不绝。妇人杂症十一条曰。寸口脉弦而大。弦则为减。大则为芤。减则
为寒。芤则为虚。虚寒相抟。妇人则半产漏下。是半产之故。由于上焦气减。不能提挚。下焦血虚。不能固守之
所致。则产后之下血不绝。益可知矣。妊娠下血不止胞阻。其胎动胎漏。虽已详二条注。但胎动之故。除心肺
间之天气上空。不能下提。以致自陷自脱。如瓜果无力而萎黄落蒂之外。余皆登高临深。弯腰扭体。以内伤
其胎。如瓜果之突遭冰雹。风摇而落者。故其血由子藏而下。而其症重也。若胎漏之故。其因不外三者。气虚
失提。亦漏中之一。 痼、二也。胞阻、三也。夫气虚失提。犹为易辨。独 病胞阻。分别甚微。不可不察也。 病为
气血尚能养胎。特胎络为死血所逆。失其入胎之路而下。故桂苓丸。惟去 而不补血者此也。胞阻为胎络
并无郁瘀。特其血室中气血两虚。而自阻其养胎之妙。故名胞阻。血虚失养。故腹痛。气虚失守。故下血。此本
汤大补其血。而并温其气。且绝不用破 之药者。又可证也。汤意合胶归芎地而全用者。以阿胶之皮性。善
外走。芎 之撺性、善上走。所以滋十二经脉之血。而内注血室也。以当归之直根者。深入厥阴。以地黄之黑
色者。下入少阴。所以滋肝肾阴藏之血。而浮注血室也。然后重用行阴之芍药。以统御之。则由血室而渐可
灌溉胞胎矣。艾味辛苦。而气性温浮。盖辛能利入胞之络。苦能坚下脱之血。气温性浮。得甘浮之甘草。以为
副。则又能养气而上提其血矣。酒性温润浮行。温则为艾叶、甘草之使。润则为胶、归、芎、地、之臣。浮以固脱。行
以走滞。且醇酒味浓生热。清酒薄则生气。将并气虚失提之漏血者。亦可主治也。
妇人怀妊。腹中 痛。当归芍药散主之。（ 音鸠又音朽）
当归芍药散方 当归（三两） 芍药（一斤） 芎 （半斤一作三两） 白术（四两） 茯苓（四两） 泽泻
（半斤）
上六味。杵为末。取方寸匕。酒和日三服。
此胞胎吸血以自养。血不足而因燥留饮。且以水气应胞胎之候也。血不足则腹中之络脉急痛。因燥留饮。
而且以水气应胞胎。则胎中之络脉格痛。以下内联走。而善于养营之芍药为君。而以辛温补血之归、芎两
佐之。则血足。而已有替去其水之地。然后以滋阴而善于利水之泽泻。为臣。而以培土燥湿之苓、术两副之。
则腹中与胞中之水气俱去矣。其 痛宁有不愈者哉。
妊娠呕吐不止。干姜人参半夏丸主之。
干姜人参半夏丸方 干姜（一两） 人参（一两） 半夏（二两）
上三味。末之。以生姜汁糊为丸。如梧子大。饮服十二丸。日三服。
妊娠呕吐。其因有二。分母体之气血以养胎。于是母气自虚。虚则生寒。而饮食之机不下运。因而上出者一
也。又胞胎在下。其生气潜滋暗长。有日增之势。而上鼓上冲者。二也。妊娠呕吐不止。是二者兼而有之。故重
用降逆之半夏。以止呕吐之外。又佐干姜、人参以温补中气而安胃。则一举而两得矣。盖胎中之生气。于五
行为木。于四时为春。于方位为东。方中干姜、半夏及姜糊为丸。俱辛辣之味。夫辛辣者。秋金之象。此所以能
摄生气。而使之下缉之义也。胞胎三十日。如正月。六十日如二月。九十日如三月。其发生上鼓之气。犹之三
春之地气上冲太虚之象。故呕吐晕眩诸症。必见于六七十日者。此风筝之起于二三月之义也。若至四月。
地气平满。风筝不起。故妊娠于百日之外。子气平满。而呕吐、晕眩俱愈。我故曰。生气如日增之势。而上鼓上
冲者此也。
妊娠小便难。饮食如故。归母苦参丸主之。
归母苦参丸方 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。
The Master said: When a woman presents with a pulse that is generally peaceful (Ping Mai, indicating health or normalcy), but the Yin pulse (typically felt at the Chi position on the radial artery) is slightly weak, and she experiences thirst and an inability to eat, without chills or fever, this is named pregnancy. Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment. According to standard principles, these symptoms should appear around the sixtieth day of gestation. If prior medical intervention was incorrect, causing the condition to manifest one month earlier, or if vomiting and diarrhea have been added, the erroneous treatments must be discontinued (or the pathological root severed).
Guizhi Tang (Cinnamon Twig Decoction) formula (see elsewhere).
The classic states "Yang Bo Yin Bie" (Pulsation of Yang distinct from Yin) as a sign of conception. This implies that while the outer contour of the pulse is deep and soft, conforming to the normal characteristics of the Yin pulse, there is a thread-like Yang pulse in the center that rises high and beats against the fingers, distinctly different from the Yin pulse at the middle level. This indicates Yang within Yin. How could this not signify pregnancy? It is also stated that a slippery pulse (Hua Mai) at the left Chi position indicates pregnancy. The slippery pulse is a diagnosis of gathering Qi and Blood. The left Chi corresponds to the Bao Men (uterus). Within the Bao Men, the Yang essence resides like a dignitary, while the woman's Qi and Blood gather to surround it; thus, how can the pulse not appear slippery? Both of these explanations refer specifically to the left Chi pulse. It is further said that excessive movement of the Shao Yin pulse (Hand-Shaoyin) indicates pregnancy. This refers to the fact that the Heart and Kidney both govern the Hand and Foot Shao Yin meridians and oversee the subtle connection between Essence and Blood. When two objects strike each other, the lighter one moves, and the struck one also moves, as explained under the section on Moving Pulse (Dong Mai). Now, if the pulse of the Heart master moves excessively for no apparent reason, is it not caused by the lower Jiao Kidney receiving external Yang to become full, striking upwards? Thus, we know it is pregnancy. This explanation derives from the Cun Kou (radial artery) pulse. Although these three theories differ, their underlying principle is the same. Because the sides of the Chi pulse are deep, soft, fine, and slippery, possessing the Yin form, the center eventually appears string-like and long, beating against the fingers, and surging upward to the Cun Kou, appearing as excessive movement. This aligns with the various pulses and external symptoms such as dizziness and vomiting. The "peaceful pulse" mentioned in the classic not only excludes cases where the Chi pulse lacks "Yang Bo Yin Bie" or slipperiness, and where the Hand-Shaoyin does not move excessively, but also includes any pulse that is neither floating nor sinking, rapid nor slow. This is Zhong Jing adding descriptions of variant diagnoses for pregnancy beyond the original script. Regarding "Yin pulse small and weak," inferred from the subsequent text and the floating-Yang/weak-Yin nature of the Guizhi Tang pulse, it refers to deep palpation. By saying the Yin pulse is small and weak regarding the Heart, Liver, Spleen, and Lung (the four Zang organs) without mentioning the Kidney, it is because the Kidney receives distinct Yang to become full and would not be small and weak. Rather, the Essence and Qi of the four Zang organs rush to secure the fetal origin, hence appearing small and weak. This stands in correspondence with the previous three theories. Precisely because the Kidney pulse beats with distinct slipperiness and fullness, it causes the Yin pulses of the four Zang organs to appear small and weak. Therefore, Zhong Jing sets aside the Chi pulse to discuss the Yin pulses of the four Zang organs, which is equivalent to the scripture setting aside the Foot-Shaoyin to discuss the Hand-Shaoyin. Generally, those who are thirsty and cannot eat often have external symptoms of chills and fever. If it were Shaoyang wind-cold, there would be thirst, silence, desire not to eat, and alternating chills and fever. Since these are absent here, combining the findings: a peaceful pulse means the person is ill but the pulse is not; the small and weak Yin pulses of the four Zang organs indicate the Zhen Qi (True Qi) rushing to the Kidney meridian to nourish the fetus; thirst indicates fluids being pulled downward; inability to eat indicates Rising Qi surging upward. Thus, we know it is pregnancy. Guizhi Tang nourishes Yang to benefit Yin, so it is indicated. Nourishing Yang fills the upper body to resist the surging Qi from below, enabling eating; nourishing Yang to benefit Yin prevents the Yin pulse from being small and weak and stops thirst. At sixty days, fetal Qi is established, and Yin blood rushes downward, so according to method, the aforementioned pulse and symptoms should appear. With fetal Qi established, the trend of growth invades upward, causing inability to eat; Yin blood rushes downward, causing small and weak Yin pulses and thirst. If a physician mistakenly clears Fire in the Upper Jiao due to slight thirst, the upper becomes deficient, and fetal Qi expands further. If they mistakenly injure the Yin of the Middle Earth due to slight inability to eat, the Stomach dries, and Zhen Qi loses nourishment. Fetal Qi expands downward and surges upward, so inability to eat appears early; Zhen Qi becomes deficient and looks downward, so dryness and thirst manifest first. The aforementioned pulse and symptoms thus appear one month early, at thirty days. If the error is severe, inducing vomiting due to thirst or purgation due to inability to eat, vomiting lifts Qi upward, preventing Yin blood from descending, so thirst ceases; purgation drains Qi downward, preventing Rising Qi from surging upward, so eating ability returns. Consequently, the previous pulse and symptoms completely disappear. However, when Yin blood does not descend and Rising Qi does not surge, is this a good omen for pregnancy? Here, using Guizhi Tang, one should take the medicine without drinking hot porridge. Drinking porridge aids the acrid-sweet nature of Cinnamon Twig to dispel pathogens; not drinking porridge allows the sour-astringent nature of White Peony Root to nourish the Zang organs. Regarding the meaning of "Jue Zhi" (discontinue/sever): Lou Shi of Qiantang interpreted it as stopping medical treatment, which is absurd given the text. Li and Xu interpreted it as stopping vomiting and purgation methods, but Zhong Jing did not leave such untransmitted prescriptions. Moreover, logically, the norm delays symptoms to sixty days; mis-treatment brings them to thirty days; severe mis-treatment means maternal Qi fails to care for the child, and fetal Qi does not grow daily, ending the pregnancy. This is alarmist language. Alas, where can I find a kindred spirit to read the *Jinkui Yaolue* with me?
If a woman has a chronic Zheng (mass/stasis) disease, and her menses stop for less than three months, yet she suffers from continuous spotting (Lou Xia), and feels fetal movement above the umbilicus, this is called a Zheng Harm (Gue Hai). If fetal movement occurs at six months of pregnancy, it was conceived during the time the menses were regular in the preceding three months. Bleeding after stopping for three months indicates this scenario. The reason the bleeding does not stop is that the Zheng mass remains. One should purge the Zheng mass using Guizhi Fuling Wan (Cinnamon Twig and Poria Pill). (Zheng refers to coagulated blood.)
Guizhi Fuling Wan Formula: Guizhi (Cinnamon Twig), Fuling (Poria), Shaoyao (White Peony Root), Danpi (Moutan Cortex), Taoren (Peach Kernel) — equal parts, remove skins and tips, decocted.
Grind the five herbs into powder, mix with refined honey to make pills the size of a rabbit pellet. Take one pill before meals daily. If ineffective, increase to three pills.
This paragraph contains eleven sentences divided into two sections. The first five sentences distinguish diseases that resemble pregnancy but are not. The last six sentences describe pregnancy hidden by disease, always treating with this formula. Various commentaries are confused and miss the scriptural intent. Zheng refers to dead blood (see notes on Jia). Guo means solid. Zheng Guo refers to the firm, chronic phlegm/blood stasis of Zheng disease. Women's menstrual blood originates from the vigorous source in the Yangming Stomach, then fills the meridians via the Zang-Fu, similar to men. However, men store without releasing, while women's twelve meridians connect internally and gradually pour into the Blood Chamber (Xue Shi). The Blood Chamber consists of Bao Men on the left and Zi Hu on the right, separated in form and Qi but connected by subtle networks. If Bao Men is empty and clear, the Blood Chamber fills, Qi overflows, and blood exits through the opening below the urethra and above the Yinting point as menstruation. If Bao Men stores Yang Essence, the Qi and Blood in the Blood Chamber resemble a court assembly, diverting through subtle networks to support and nourish the fetal origin, leaving the Blood Chamber empty and drawing essence from the twelve meridians, thus stopping menstruation. However, the female external genitalia have three openings. If the pathways are unclear, distinguishing movement from leakage is impossible, and symptoms like abdominal pain and difficult urination cannot be understood. Hence, detailed explanation is necessary. The Bladder floats in the Lower Jiao (relative to Yinting and blood channels). Its orifice is high; Yinting connects to Bao Men and Zi Hu, ranking next. The Blood Chamber path runs along the spine, lowest in position, but its course goes from below Yaoshu, forward through collateral vessels to the Lower Abdomen, winding to the wall above Yinting. Thus, "below the urethra, above Yinting." Blood from fetal movement passes through the fetus in the Blood Chamber and becomes unprotected blood flowing directly down the proper path of Yinting; excessive flow leads to miscarriage. Blood from fetal leakage is blocked by Zheng stasis in the collaterals before reaching the fetus, becoming blood lost from the Blood Chamber's control, flowing from Yaoshu through the Lower Abdomen; this allows more time for stabilization than fetal movement, with seven out of ten recoverable. Diagnosis: Yaoshu pain and heavy/full Lower Abdomen indicate leakage; absence of these with only abdominal pain and sinking Qi indicates movement. Profuse sudden bleeding indicates movement; scant slow bleeding indicates leakage. Chronic Zheng disease manifests as hardness in the Lower Abdomen, palpable masses, or unbearable pain before menstruation. Although stopped menses suggest pregnancy, continuous spotting before three months suggests threatened miscarriage rather than viable pregnancy. If movement is felt above the umbilicus before three months, it is not fetal movement but Zheng stagnation and Qi distension. The fetus is still in the Lower Abdomen. Thus, the stopped menses were caused by old blood from Zheng failing to depart, harming new blood generation; current spotting is caused by dead blood blocking the return of generating blood. If spotting stops and menses resume, passing another three months to reach six months, and then bleeding and movement recur, it means conception occurred when menses were light in the first three months, so menses continued to stop. Current bleeding is Zheng blood not nurturing the fetus. The reason bleeding continues is that Zheng remains, blocking the path nourishing the fetus. Guizhi Fuling Wan transforms Zheng, clearing the path for blood to nurture the fetus, stopping leakage. Zheng arises from Cold Qi stagnating menstruation, so Guizhi warms and tonifies Yang Qi. Stasis forms from Qi stagnation and unresolved blood stasis, so Danpi moves Qi and raises Yang. Shaoyao enters the blood to guide treatment to the Zheng site, and Taoren breaks stasis to expel it. Since stagnant blood becomes water, Fuling drains dampness via the anterior orifice. Taking one to three pills avoids excessive dosage, favoring gradual resolution over aggressive attack to protect fetal blood.
When a pregnant woman at six or seven months presents with a String-like pulse (Xian Mai), fever, increased abdominal distension, abdominal pain, aversion to cold, and a sensation of cold wind blowing in the Lower Abdomen, it is because the Zi Zang (uterus) is open. Treat with Fuzi Tang (Aconite Decoction) to warm the Zang. (Formula missing.)
During pregnancy, excluding the Heart (Monarch organ) and its meridian, whose Qi and Blood are insufficient to nourish the fetus, the Hand-Taiyang and Heart meridians follow the Heart and do not nourish the fetus. Other meridians nourish the fetus monthly: Month 1, Embryo, nourished by Foot-Jueyin Liver; Month 2, Paste, nourished by Foot-Shaoyang Gallbladder; Month 3, Sac, nourished by Hand-Jueyin Pericardium; Month 4, Form formed, nourished by Hand-Shaoyang Sanjiao; Month 5, Movement begins, nourished by Foot-Taiyin Spleen; Month 6, Bones and sinews established, nourished by Foot-Yangming Stomach; Month 7, Hair grows, nourished by Hand-Taiyin Lung; Month 8, Viscera complete, nourished by Hand-Yangming Large Intestine; Month 9, Grain Qi enters stomach, nourished by Foot-Shaoyin Kidney; Month 10, Spirits prepared, nourished by Foot-Taiyang Bladder, then birth occurs. At six or seven months, the Stomach and Lung nourish the fetus. The Stomach is the source of fierce Qi; the Lung commands all Qi. Their transformation produces mild Yang to nourish sinews, keeping the pulse from becoming thin and stringy. Yang deficiency causes the stringy pulse. Interior Cold forces weak Yang outward, causing fever. Full interior Yang wraps the fetal Qi peacefully; Yang deficiency fails to wrap, causing the uterus to relax and feel distended. Abdominal pain reflects interior Cold; exterior deficiency causes aversion to cold. "Lower abdomen like a fan" describes cold wind blowing inside, reflecting loss of Yang Qi unable to warm the fetus. "Zi Zang open" does not mean anatomical opening, but lack of protective closure due to Yang deficiency. Fuzi is acrid, salty, and warm-hot; acrid disperses cold, salty moistens downward, warm-hot tonifies Yang, making it suitable for warming the lower Jiao uterus. Though the original formula is missing, I propose Fuzi as the sovereign herb, possibly adding Rougui (Cinnamon Bark), Shaoyao, Danggui (Angelica Sinensis), and Fuling. Rougui wraps heat inward to warm the interior; Shaoyao is sour and astringent, moving inward and downward to guide Cinnamon and Aconite to the uterus. Since Qi depends on Blood, Qi deficiency implies Blood deficiency, so add Danggui to warm meridians and tonify Blood. Interior Cold often gathers water, so add Fuling to drain dampness. Some argue that since Stomach and Lung meridians nourish the fetus at six and seven months, and prefer acrid-sweet-warm畅通, Ganjiang (Dried Ginger) and Gancao (Licorice) might be suitable.
The Master said: Women may suffer from spotting, continuous bleeding after spontaneous abortion, or bleeding during pregnancy. If pregnancy is accompanied by abdominal pain, it is called Bao Zu (Womb Obstruction). Jiao Ai Tang (Ejiao and Moxa Decoction) is the primary treatment.
Jiao Ai Tang Formula: Ejiao (Donkey-hide Gelatin, 2 liang), Aiye (Moxa Leaf, 3 liang), Danggui (3 liang), Chuanxiong (Ligusticum, 2 liang), Shaoyao (4 liang), Shengdi Huang (Rehmannia, 3 liang), Gancao (Licorice, 2 liang).
Decoct the seven herbs in 5 sheng of water and 3 sheng of clear wine to obtain 2 sheng. Remove dregs, dissolve Ejiao. Take 1 sheng warm, three times daily. If ineffective, prepare again.
This distinguishes the syndrome and treatment of Bao Zu. Women's blood disorders vary; even pregnancy bleeding differs. Only bleeding accompanied by abdominal pain is termed Bao Zu; do not misdiagnose or mistreat. Spotting (Lou Xia) is irregular menstruation with lingering red discharge after periods, like leakage. This refers to the Zheng Harm mentioned earlier. This applies to non-pregnant women. Continuous bleeding after miscarriage is due to Upper Jiao Qi failing to lift and Lower Jiao Blood failing to secure, as described in the Miscellaneous Diseases chapter ("Choppy and large pulse... choppy indicates deficiency, large indicates hollow... deficiency-cold combination causes miscarriage and spotting"). Pregnancy bleeding includes Bao Zu, Tai Dong (Fetal Movement), and Tai Lou (Fetal Leakage). Tai Dong results from falling from heights, bending, or twisting, injuring the fetus, causing blood to exit the uterus with severe symptoms. Tai Lou causes include Qi deficiency failing to lift, Zheng stasis, and Bao Zu. Qi deficiency is easy to identify. Distinguishing Zheng from Bao Zu is subtle. Zheng involves blood and Qi capable of nourishing the fetus, but collaterals are obstructed by dead blood, losing the path to the fetus; thus Guizhi Fuling Wan removes Zheng without tonifying blood. Bao Zu involves no stasis in collaterals, but dual deficiency of Qi and Blood in the Blood Chamber obstructs nourishment; hence the name. Blood deficiency causes pain; Qi deficiency causes bleeding. Jiao Ai Tang greatly tonifies Blood and warms Qi, avoiding Zheng-breaking herbs. Ejiao and Chuanxiong nourish the twelve meridians and fill the Blood Chamber; Danggui enters Jueyin; Shengdi Huang enters Shaoyin to nourish Liver-Kidney Yin and float into the Blood Chamber. Heavy Shaoyao controls Yin, allowing irrigation of the fetus. Aiye is acrid-bitter and warm-floating; acrid benefits uterine collaterals, bitter secures descending blood. Combined with sweet-floating Gancao, it tonifies Qi to lift blood. Wine is warm-moistening and floating-moving; it acts as an assistant for Aiye and Gancao, and a minister for Ejiao, Danggui, Chuanxiong, and Shengdi Huang. Floating secures descent, moving resolves stagnation. Strong wine generates heat, thin wine generates Qi, treating spotting from Qi deficiency.
For abdominal colic pain during pregnancy, Danggui Shaoyao San (Angelica and White Peony Powder) is indicated. (Colic pain, pronounced Jiu/Xiu.)
Danggui Shaoyao San Formula: Danggui (3 liang), Shaoyao (1 jin), Chuanxiong (0.5 jin or 3 liang), Baizhu (Atractylodes, 4 liang), Fuling (4 liang), Zexie (Alisma, 0.5 jin).
Grind six herbs into powder. Take one cun-bi measure mixed with wine, three times daily.
The fetus absorbs blood to self-nourish; blood insufficiency leads to dryness and retained fluids, responding to the fetal stage. Blood insufficiency causes urgent pain in abdominal collaterals; retained fluids cause grid-like pain in fetal collaterals. Shaoyao, excellent for nourishing Ying, is the sovereign herb. Danggui and Chuanxiong, acrid-warm and blood-tonifying, are assistants. Once blood is sufficient, there is space to replace fluids. Zexie, yin-nourishing and diuretic, is the minister. Baizhu and Fuling, earth-tonifying and damp-drying, are deputies. Fluids in the abdomen and uterus are eliminated, curing colic.
For persistent vomiting during pregnancy, Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill) is indicated.
Ganjiang Renshen Banxia Wan Formula: Ganjiang (Dried Ginger, 1 liang), Renshen (Ginseng, 1 liang), Banxia (Pinellia, 2 liang).
Grind three herbs into powder. Use fresh ginger juice to make pills the size of wutze (mustard seed). Take 12 pills with water, three times daily.
Pregnancy vomiting has two causes: Mother's Qi and Blood are divided to nourish the fetus, leading to maternal deficiency, cold, and failure of digestion to descend, causing upward emission (Cause 1). The fetus is in the lower Jiao, its generating Qi secretly growing with increasing momentum, surging upward (Cause 2). Persistent vomiting combines both. Thus, heavy Banxia descends rebellious Qi to stop vomiting, assisted by Ganjiang and Renshen to warm and tonify Middle Qi and calm the Stomach. The generating Qi of the fetus corresponds to Wood, Spring, and East. Ganjiang, Banxia, and ginger paste are acrid-spicy, corresponding to Autumn Metal. Acrid-spicy captures generating Qi and directs it downward. Thirty days of gestation resembles January; sixty days, February; ninety days, March. The surging Qi resembles spring earth Qi rising to the sky, hence vomiting and dizziness appear around sixty-seventy days, like kites flying in February-March. By four months, earth Qi is balanced, kites do not fly; thus, after one hundred days, fetal Qi is full, and vomiting/dizziness cease. This confirms the theory of increasing generating Qi surging upward.
For difficult urination during pregnancy with normal diet, Gui Mu Ku Shen Wan (Angelica, Coix Seed, and Sophora Pill) is indicated. (Note: Text says "Gui Mu Ku Shen Wan", ingredients listed as Danggui, Beimu, Kushen).
Gui Mu Ku Shen Wan Formula: Danggui (Angelica), Beimu (Fritillaria), Kushen (Sophora) — equal parts, 4 liang each.
Grind three herbs into powder. Mix with refined honey to make pills the size of small beans. Take 3 pills with water, increase to 10 pills.