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Dysuria during pregnancy has three causes. First, blood is insufficient to nourish the fetus, causing all zang-fu organs and meridians to rely on fluids for moistening, which naturally slows down the qi transformation of seepage and excretion; this is the first cause. Second, the gestational sac possesses a cluster of yang qi; heat forces the boundary between the Small Intestine and Bladder, causing qi stagnation in the orifices of excretion; this is the second cause. Third, the vital qi of the gestational sac floats and spreads,鼓动 (stirring) and blocking the lower abdomen, squeezing the bladder, making it narrow and often flat, unable to hold even two or three tenths of its capacity. Thus, when a small amount of fluid enters, there is an urgent fullness and desire to urinate; the stream is short and frequent, and the urethra is squeezed narrow, making urination difficult; this is the third cause. Now, regarding dysuria in pregnancy, if the patient is not thirsty, has no palpitations, drinks normally, does not vomit, has no distension, and eats normally, it indicates that the difficulty in urination should not be blamed on the Upper and Middle Jiao, but is undoubtedly due to fetal heat and fetal distension. Therefore, Bitter and Cold herbs like Beimu (Fritillariae Bulbus) and Kushen (Sophorae Flavescentis Radix) are used, likely employing coldness to clear fire and bitterness to consolidate and secure the fetus. Then, Danggui (Angelicae Sinensis Radix), which tonifies blood and moistens, is combined to borrow the moistening power of fluids, allowing them to find a path and seep downward. Since Beimu is light in texture and white in color, it can open stagnant qi; Kushen is bitter in taste and heavy in nature, it can firm scattered qi. Thus, surgeons use it as a specific herb to dissipate fire and reduce swelling. When the mother's qi stagnation is unblocked, and the fetus's scattered qi is controlled, and blood becomes abundant, replacing the fluids needed below, what lingering obstruction or painful difficulty in urination would remain? This is truly a divine prescription.

I have studied Zhang Zhongjing's clauses on pregnancy and carefully analyzed their diseases, pulses, symptoms, and treatments, realizing that women carrying a child for ten months face harm within grace, while the preceding and subsequent prescriptions derive grace from harm. If the mother's qi and blood are deficient, she cannot shade the fetus, leading to a weak fetus and subsequently fetal disease. Fortunately, if the fetal sac's qi and blood are strong, it nourishes the fetus well, leading to a robust fetus, which becomes a disaster for the mother. Even worse, if the fetal disease is deficiency, it further injures the mother; if the maternal disaster is severe, it again injures the fetus. Is this not harm within grace? As for treatment methods: for Ganjiang, Renshen, Banxia Wan (Dry Ginger, Ginseng, and Pinellia Pill), purely using the pungent and warm qi of Metal (Lung) to restrain the upward rushing of vital energy; for Danggui, Beimu, Kushen Wan (Angelica, Fritillaria, and Sophora Pill), purely using bitter and cold astringent flavors to firm and gather the dissipated physical form. This balances the relationship between mother and fetus, treating by benefiting the mother and slightly harming the fetus as the correct approach, thereby preserving the mother to nourish the fetus. Thus it is said, this is grace within harm.

Pregnancy with water qi, heaviness of the body, dysuria, aversion to cold with shivering, dizziness upon rising, treated with Kuizi Fuling San (Abelmoschus Seed and Poria Powder).

Kuizi Fuling San Formula: Kuizi (Hibisci Abelmoschi Semen, 1 jin), Fuling (Poria, 3 liang).
Crush the above two ingredients into a powder. Take one cunbi (a measure equivalent to a spoonful) with water, three times daily. Recovery occurs when urination becomes free.

Pregnancy with water qi, referring to the previous clause on dysuria. Water nature sinks, stagnating and obstructing qi in the meridians, hence heaviness of the body. However, dysuria must be taken as the definitive diagnosis because water qi fails to move and overflows laterally; also, heaviness of the body distinguishes it from other symptoms of Spleen Yang failure. "Shaxi awan han" describes aversion to cold as if cold water were sprinkled on the body, causing shivering. This is because water qi is in the meridians, obstructing and destabilizing Wei Yang. Pregnancy with solid fetal qi below often involves dizziness; how much more so with dysuria and accumulated water qi rushing upward? Hence dizziness. Thus, promoting urination removes water qi, and all symptoms resolve. Kuizi is sweet, cold, slippery, and draining; sweet moves qi, cold clears heat, slippery promotes fluid movement, and draining opens orifices. Combined with Fuling for seepage and excretion, urination will gradually become free.

Women in pregnancy should regularly take Danggui San (Angelica Powder) as the main formula.

Danggui San Formula: Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Xiong (Chuanxiong Rhizoma), Huangqin (Scutellariae Radix) (each 1 jin), Baizhu (Atractylodis Macrocephalae Rhizoma) (0.5 jin).
Crush the above five ingredients into a powder. Take one cunbi with wine, twice daily. Regular intake during pregnancy facilitates easy delivery and keeps the fetus free from distress; it is also applicable for one hundred days postpartum.

This refers to women both before conception and during pregnancy. Blood in pregnant women should be abundant and circulating smoothly. Thus, Danggui and Xiong, which tonify and move blood, are primary, while Shaoyao, which acts on Yin, guides blood into the Liver, preventing dryness and stagnation. However, abundant blood leads to abundant qi and excessive heat, which may consume blood; thus Huangqin is used to clear heat. Sufficient blood means sufficient Yin, which may accumulate dampness, potentially stagnating blood; thus Baizhu is used to dry dampness. For non-pregnant women, this ensures smooth menstruation without masses or metrorrhagia; for pregnant women, it adequately nourishes the fetus without risks of miscarriage or abdominal pain. Hence, they serve as main herbs for regular use. Since blood is fundamental in pregnancy, pre-delivery, and post-delivery, this formula is suitable for all these stages. Taking it with wine follows the note on Danggui Shaoyao San.

For nurturing the fetus during pregnancy, Baizhu San (Atractylodes Powder) is the main formula.

Baizhu San Formula: Baizhu (Atractylodis Macrocephalae Rhizoma), Xiong (Chuanxiong Rhizoma), Shujiao (Sichuan Pepper Fruit, 3 fen, processed to remove moisture), Muli (Ostreae Concha, dosage unclear in text, possibly 4 fen).
Crush the above four ingredients into a powder. Take one qianbi with wine, three times daily, and once at night. If suffering from pain, add Shaoyao. If experiencing severe pain in the epigastrium, double the amount of Chuanxiong. If suffering from irritability, vomiting, pain, and inability to eat, add Yixin (Asari Radix et Rhizoma) 1 liang and large Banxia (Pinelliae Tuber) 20 pieces. After taking the medicine, follow up with Cu Jiangshui (Vinegar Grain Water). If vomiting persists, take with Cu Jiangshui; if still unresolved, take Xiaomai Zhi (Wheat Juice); if thirst develops later, take Damai Zhi (Barley Juice). Even after recovery, do not stop taking the medicine (Bu Zhi means continuous use).

Baizhu removes dampness, Xiong tonifies blood and qi, Shujiao consolidates fetal qi, and Muli calms rebellious qi. Deficiencies in pregnancy generally involve these four aspects, making it a main formula for regular use. "Ku tong" refers to fetal pain caused by blood deficiency and qi expansion; Shaoyao astringes qi and nourishes blood, hence added. Severe epigastric pain occurs because the Yin and Yang of the Danzhong (Conception Vessel area) become deficient from nourishing the fetus; Yin deficiency causes cramping pain, Yang deficiency causes stifling pain. Chuanxiong is a Qi herb within Blood, with a high and floating nature, capable of tonifying both Yin and Yang in the epigastrium, hence added. Shortage of Heart fluid allows deficient Fire of Dragon and Thunder to attack, causing irritability; deficiency-cold of the Diaphragm loses its transformative function, causing vomiting, pain, and anorexia. Yixin is acrid and warm, warming to dispel cold and acrid to subdue fire. Banxia is acrid, drying, and descending, assisting Yixin to subdue deficient fire, hence added. Taking Cu Jiangshui afterward uses sourness to astringe and descend deficient heat, fearing that sudden warmth might be rejected and aggravate rebellious deficient heat causing vomiting. If vomiting persists despite this, it indicates Heart Qi deficiency failing to control rebellious Qi. Rather than forcing descent, it is better to fill the upper Jiao as preparation. Wheat is the grain of the Heart; drinking its juice tonifies the upper to resist the lower, stopping vomiting. Thirst developing later indicates initial recovery of Yang Qi but insufficient fluids; it is a residual symptom of irritability. Barley juice moistens the Lungs and generates fluids, hence taken after wheat juice. The disease refers to pain, irritability, vomiting, etc. Even if cured, continue medication to prevent recurrence. Wine serves as a guiding agent. Vinegar grain water and wheat/barley juices are taken separately after the main medicine. Vinegar grain water is acidic rice drink, similar to grains used to treat specific organs. Pregnancy Yang Qi varies in abundance and deficiency, leading to fetal heat or cold. Excess Yang and fetal heat are likened to spring sunshine nurturing the earth; excessive vitality overwhelms emptiness, causing dizziness/vomiting, surface heat, dryness/thirst (malnutrition of fetus), and scanty dark urine. Such pathological conditions require sweet-cool and bitter-cold formulas like Danggui Kushen Wan, Kuizi Fuling San, or Danggui Shaoyao San. Even without disease, regular use of Danggui San is advised to cool and moisten like spring clouds and rain, balancing heaven and earth's excessive love to maintain the order of growth. Deficient Yang and fetal cold are likened to cold spring where sunlight is weak; Yin shadows occupy Yang positions, causing leakage (failure to root), uterine cold (like a fan), miscarriage (withered buds), and vomiting/anorexia (fog blocking clarity). Such conditions require sweet-warm and acrid-warm formulas like Guiling Wan, Fuzi Tang, Jiao'ai Tang, or Ganjiang Renshen Banxia Wan. Even without disease, regular use of Baizhu San is advised to warm and nourish like gentle sun and hot rain, transforming the darkness of Li Fire through subtle fetal breathing. Women in pregnancy inherit Kun Earth's transformation, tending to have more Yin and less Yang. Thus, in this chapter, seven-tenths of formulas are warming, and three-tenths are cooling. This aligns with the principle of not killing unnecessarily, reflecting Zhang Zhongjing's benevolence.

Traumatized fetus: Pregnant woman with abdominal fullness, inability to urinate, heaviness from waist down, resembling water retention. At seven months of pregnancy, the Taiyin (Lung) should nourish but fails to do so. This is due to excess Heart Qi. One should puncture and drain Laogong (PC 8) and Guanyuan (CV 4). If urination becomes slightly free, recovery ensues.

Traumatized fetus refers to injury affecting the fetus, implying the abdominal fullness mentioned below. Lung Qi contracts and cannot expand, pressing down on fetal Qi, causing fetal Qi to surge upward, resulting in abdominal fullness. Lung Qi contraction also fails to manage respiration and transmission, causing inability to urinate. Loss of Lung Qi's lifting and anchoring function causes heaviness below the waist. These three symptoms resemble water disease: inability to urinate suggests water roots, and abdominal/waist heaviness suggests water symptoms, hence "resembling water," though it is not actually water. At seven months, the fetus develops hair/skin externally and breathes internally; the mother's Taiyin Lung Meridian Qi and Blood should nourish the fetal Lung organ. Failure to transmit and lift, and failure to nourish the fetus, is due to excess Heart Fire overcoming Lung Metal, causing Lung's clearing and descending Qi to shrink and fail to distribute. The Heart is a Zang organ and cannot be drained directly; the Pericardium (Hand Jueyin) is its Fu organ. Laogong (PC 8), the Jing-Well point of the Pericardium meridian on the palm, is punctured to drain. Draining the meridian drains the Fu, and draining the Fu drains the Zang, calming Heart Qi upwards. The Heart meridian is exterior-interior with the Small Intestine. Guanyuan (CV 4), three cun below the umbilicus on the Ren Meridian, is the Front-Mu point of the Small Intestine. Close to Shuifen (CV 9), Guanyuan manages water pathways. Puncturing and draining it makes urination slightly free, draining the interior via the exterior and calming Heart Qi downwards. With Heart Fire overcoming Metal balanced, Lung Qi expands downward, resolving the three symptoms. Since there is no actual water, the focus is draining Fire, not water, hence only slight urination is noted. This is a treatment example for excess Yang and fetal heat.

Guanyuan: *Qianjin Yaofang* states puncturing it in women treats infertility. It also states puncturing it during pregnancy causes abortion. This applies to Yang deficiency. Guanyuan is close to Qihai (CV 6); if Yang is deficient and drained, Guanyuan and Qihai become excessively cold, leading to barren land and sterile flowers, causing infertility or abortion. This is expected. If Yang is excess and drained, balance is achieved, and there is no worry. This highlights the need for physicians to be intelligent and flexible.