论证
阳施阴化，胎孕乃成。血气虚损，不能养胎，则胎自堕。譬如枝枯则果落，藤萎则花坠。又或劳怒动火，
亦能堕胎。正如风撼其树，人折其枝也。（《沈氏尊生书》）
胎堕太多，气血耗甚，胎无滋养，故频堕也。譬之水涸而禾枯，土削而木倒。（汪石山）
妊娠少腹胀坠，须防小产之患，见红即难安矣。枝枯则果落，急宜补肾；架朽则钟堕，急宜补脾。（《见闻录》）
驴马有孕，牡者近身则蹄之，名为护胎，所以绝无小产。人之胎系胞中，气血养之，静则神藏。若欲火
一动，则精神走泄，火扰其中，则胎堕矣。可不慎哉！（《产宝百问》）
凡保胎，当养脾胃。脾胃为仓廪之官，脏腑之所禀受，胚胎由之以滋养也。胃属阳明，阳明者，冲任之长
也。（《薛氏医案》）
凡妊娠之数见堕胎者，必以气血亏损而然。而亏损之由，有禀质素弱者，有年力衰残者，有忧怒劳苦而困
其精力者，有色欲不慎而损其生气者。此外如跌扑、饮食之类，皆能伤其气血。气血有伤，而胎可无恙者，非
先天之完固者不能，而常人则未之有也。且胎怀十月，经养各有所主，所以屡见小产堕胎者，多在三、五、七
月之间。下次之堕，必如期而然。正以先次伤此一经，再值此经，则遇阙不能过矣。况肾以系胞，而腰为肾之
府，故妊妇最忌腰痛，痛甚则坠，不可不防。○凡小产有远近，其在二、三月为近，五、六月为远。新受而产者
其势轻，怀久而产者其势重，此皆人之所知也。至若尤有近者，则随孕随产矣。盖胎元始肇，一月如珠露，二
月如桃花，三、四月而后血脉形体具，五、六月而后筋骨毛发生。方其初受，不过一滴之元津耳。此其橐 正
无根据，根 尚无地，巩之则固，决之则流。故凡受胎之后，极宜节欲，以防泛溢。盖明产者，胎已成形，小产
必觉；暗产者，胎仍似水，直溜何知？（张景岳）
论治
妇人妊娠，宜常服当归散主之。○妊娠养胎，白术散主之。○妇人有漏下者，有半产后因续下血都不绝者，
有妊娠下血者，胶艾汤主之。（《金匮》）
半产重于大产。盖大产如果熟自脱；小产如生采，破其皮壳，断其根蒂，岂不重于大产？但人轻忽者多。
治法宜补形气，生新去瘀。若未足月，痛而欲产者，补中汤安之；若产而血不止者，人参黄 汤止之；若胎气
弱而小产者，八珍汤固之。（薛立斋）
堕胎与半产有别。如一、二、三、四月，胎未成形而下者，名曰堕胎；五、六、七、八月，胎已成形而
下者，名曰半产。总属妊妇气血弱，冲任虚，以致胎元不固。《千金》保胎丸一方最
妙。赵养葵以六味地黄汤加杜仲、续断、五味子、阿胶，为安胎之圣药，亦传心之秘典也。○堕胎血出过多者，
经脉损而冲任之气虚不摄，是不足也，当大补气血，以固其脱。堕胎血凝作痛者，外邪乘而败浊之血闭而不流，
是有余也，当导瘀消蓄，以温其经。不特堕胎为然，即产后见是证，亦宜以此法治之。（萧慎斋）
叶孕三月，兢兢自持，至期必动。医家非凉血则固气，非升举则利气，百药不效，其胎必堕，皆由易于受
而易于堕也。究堕之之故，果安在哉？盖胎系于脾，而根于肾。其屡孕者，相火之有余也；屡堕者，相火之过
旺也；屡堕而不先不后者，脾土主有信也。缪氏谓三月阳明脉养胎，其人脾土素弱，而相火摇摇，风木侮之，
无故自落，岂寻常意见所能补救者耶？必也戒怒以舒肝，却虑以安脾，节欲以养肾，然后用先君子猪肚丸药，
清相火以实脾土，土旺则四脏之气皆旺，精自生而气自固，不必虑难安易落之胎矣。虽然，药宜早服于未孕之
先，莫迟服于已孕之后，所谓未雨绸缪，不治已病治未病也。（《会心录》）
古人用黄芩安胎，是因子气过热，故用苦寒以安之。脾为一身之津梁，主内外诸气，而胎息运化之机全赖
脾土，故用白术以助之。然惟形瘦血热，营行过疾，胎动不安者，乃为相宜。若形弱气衰，胎常下坠者，非人
参举之不安；形实气盛，胎常不运者，非香、砂耗之不安；血虚火旺，腹常急痛者，非归、芍养之不安；体肥
痰盛，呕逆眩晕者，非苓、半豁之不安。凡此皆治母气之偏胜也。若因风寒所伤而胎不安者，则香苏散、葱豉
汤，量所宜用；伏邪时气，尤宜急下。凡此，俱安胎要诀。下药中独芒硝不可犯。（张飞畴）
安胎、固胎、养胎，必当察其由来，分其胎之所损，在气在血，何者之虚？胎与母病，孰先孰后？方制君、
臣、佐、使，各适其宜。岂可守一定之方，执而不通耶！（《推求师意》）
脉候
寸口脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚；虚寒相搏，此名曰革。妇人则半产漏下。（张仲景）
附方
猪肚丸 人参、苦参、丹参、元参、沙参、扁豆、石斛、白芍、芡实、莲肉、山药、茯苓、甘草、锅焦。
用雄猪肚一具，洗净，将药装入，蒸熟捣烂，焙干为末，蜜丸，每早滚汤下五钱。
【病因论述】
阳气施化，阴气转化，胎孕才能形成。如果血气虚损，不能滋养胎儿，胎儿就会自然流产。这就像树枝干枯果实就会掉落，藤蔓枯萎花朵就会坠落一样。又或者因为劳累和愤怒导致体内火气妄动，也能够导致堕胎。这正如风吹撼动树木，人折断树枝一样。（出自《沈氏尊生书》）
如果流产次数过多，气血消耗非常严重，胎儿缺乏滋养，所以会频繁流产。这就好比水源干涸禾苗枯死，土壤削薄树木倾倒。（汪石山观点）
妊娠期间如果出现少腹胀满下坠感，必须防备小产的危险，一旦出现见红（阴道出血）就很难安稳了。树枝干枯果实就会掉落，急需补肾；架子朽坏钟就会坠落，急需补脾。（出自《见闻录》）
驴马怀孕时，公畜靠近母畜，母畜会用蹄子踢它，这叫护胎，所以它们极少发生小产。人类的胎儿系在胞宫之中，依靠气血来滋养，保持安静则神气内藏。如果欲望之火一动，精神就会走泄，火热扰动胞宫内部，就会导致堕胎。能不谨慎吗！（出自《产宝百问》）
凡是保胎，应当调养脾胃。脾胃是掌管饮食仓廪的器官，脏腑所禀受的精微物质都源于此，胚胎也是由此得到滋养。胃属于阳明经，阳明经是冲脉和任脉的统领。（出自《薛氏医案》）
凡是妊娠期间多次出现堕胎的，必定是因为气血亏损所致。而亏损的原因，有先天体质素来虚弱的，有年龄精力衰退的，有因为忧愁、愤怒、劳累辛苦而困倦精力的，有因为房事不慎而损伤生机的。此外如跌打损伤、饮食不当等，都能伤害气血。气血受到损伤，而胎儿还能安然无恙的，如果不是先天根基完固的人是不能做到的，而普通人中是没有这种情况的。况且胎儿怀胎十月，每个月由不同的经脉负责养育，所以屡见小产或堕胎的，多发生在第三、五、七个月之间。下次流产，必然会在相同的时间发生。正是因为上一次损伤了这一条经脉，再次遇到这条经脉当令之时，就会出现空缺而无法通过的情况。何况肾主系胞，腰为肾之府，所以孕妇最忌讳腰痛，疼痛剧烈就会导致坠胎，不可不预防。○凡是小产有早晚之分，在第二、三个月发生的称为“近”，第五、六个月发生的称为“远”。刚受孕不久就生产的，其势较轻；怀孕很久才生产的，其势较重，这是人们都知道的。至于还有更早的，那就是随怀孕随生产了。大概胎儿元气刚开始萌发，一个月像露珠，两个月像桃花，三、四个月之后血脉形体具备，五、六个月之后筋骨毛发生长。在其初受胎时，不过是一滴元津而已。此时它的根基还没有根据，根蒂还没有着落之地，加固它就稳固，决口它就流散。所以凡是受孕之后，极宜节制性欲，以防精气泛溢。所谓明产，是指胎儿已经成形，小产时一定会有感觉；暗产，是指胎儿还像水一样无形，直接流掉哪里知道呢？（张景岳观点）
【治疗论述】
妇人妊娠，适宜常服用当归散为主方。○妊娠养胎，以白术散为主方。○妇女如果有漏下（非经期阴道出血），有小产后因续下血都不停的，有妊娠期下血的，都用胶艾汤主治。（出自《金匮要略》）
半产（小产）重于大产（足月分娩）。大概大产就像果实成熟自然脱落；小产就像生采，破坏了皮壳，切断了根蒂，难道不比大产更重吗？只是人们大多轻视忽略。治疗方法应当补益形气，生新去瘀。如果未满月，腹痛想要生产的，用补中益气汤使其安胎；如果生产后血不止的，用人参黄芪汤止血；如果胎气弱导致小产的，用八珍汤固摄。（薛立斋观点）
堕胎与半产是有区别的。如一、二、三、四月，胎儿尚未成形而下落的，名叫堕胎；五、六、七、八月，胎儿已经成形而下落的，名叫半产。总归属于孕妇气血虚弱，冲任二脉空虚，导致胎元不固。《千金方》中的保胎丸一方最为奇妙。赵养葵用六味地黄汤加上杜仲、续断、五味子、阿胶，作为安胎的圣药，这也是传心的秘典。○堕胎出血过多的，是经脉受损且冲任之气虚弱不能固摄，属于不足证，应当大补气血，以固脱止崩。堕胎后血液凝结作痛的，是外邪乘虚而入，败浊之血闭阻而不流通，属于有余证，应当疏导瘀血消除蓄积，以温通经脉。不仅堕胎如此，即使产后见到这些证候，也应当用这种方法治疗。（萧慎斋观点）
叶姓孕妇怀孕三个月，小心翼翼自我约束，到了时期必然发动。医生不是用凉血就是固气，不是用升举就是利气，百药无效，胎儿必然流产，这都是因为易于受孕也易于流产的缘故。探究流产的原因，究竟在哪里呢？大概胎儿系于脾，而根于肾。那些多次怀孕的，是相火有余；多次流产的，是相火过旺；多次流产且不先不后的，是脾土守信（按时令规律）。缪希雍说三月阳明脉养胎，其人脾土素来虚弱，而相火摇摇欲坠，风木克制脾土，无故自行堕落，难道是寻常意见所能补救的吗？必须戒怒以舒展肝气，消除忧虑以安宁脾气，节制欲望以滋养肾脏，然后使用先君子猪肚丸药，清泻相火以充实脾土，土旺则四脏之气皆旺，精自生而气自固，不必担忧难安易落的胎儿了。虽然如此，药物宜在未怀孕之前早服，不要迟服在已怀孕之后，这就是所谓的未雨绸缪，不治已病治未病。（出自《会心录》）
古人用黄芩安胎，是因为胎儿气过热，所以用苦寒药来安定它。脾是一身的津液枢纽，主管内外诸气，而胎儿呼吸运化的机制全赖脾土，所以用白术来辅助它。然而只有形体消瘦、血热、营血运行过快、胎动不安的，才适合使用。如果形体虚弱、气衰，胎儿经常下坠的，不用人参提升就不能安胎；如果形体结实、气盛，胎儿经常不动的，不用香附、砂仁耗散（行气）就不能安胎；如果血虚火旺，腹部经常急痛的，不用当归、白芍滋养就不能安胎；如果身体肥胖、痰湿盛，呕吐眩晕的，不用茯苓、半夏豁痰就不能安胎。凡此种种，都是治疗母体气机偏胜的方法。如果是因为风寒所伤导致胎不安的，则用香苏散、葱豉汤，根据适宜情况选用；伏邪时气，尤其应当急下。凡此，都是安胎的要诀。下药中唯独芒硝不可触犯。（张飞畴观点）
安胎、固胎、养胎，必须考察其由来，分辨胎儿所受损害，是在气还是在血，哪方面虚？是胎病还是母病，谁先谁后？然后制定君、臣、佐、使的药方，各适其宜。怎么能守着固定的方子，固执不通呢！（出自《推求师意》）
【脉候】
寸口脉弦而大，弦脉表示阳气衰减，大脉表示中空如芤，衰减则为寒，中空则为虚；虚与寒相互搏结，这名叫革脉。妇女出现这种脉象则会半产漏下。（张仲景观点）
【附方】
猪肚丸：人参、苦参、丹参、玄参、沙参、扁豆、石斛、白芍、芡实、莲肉、山药、茯苓、甘草、锅焦。
用法：用雄猪肚一个，洗净，将药物装入其中，蒸熟捣烂，焙干研为细末，用蜂蜜制成丸药，每天早晨用滚开水送服五钱。
[Discussion on Etiology]
When Yang energy is applied and Yin energy transforms, conception occurs. If Qi and Blood are deficient and damaged, failing to nourish the fetus, the fetus will naturally miscarry. This is like a branch withering causing fruit to fall, or a vine collapsing causing flowers to drop. Alternatively, labor and anger may stir up internal fire, which can also lead to abortion. Just as wind shakes a tree or a person breaks a branch. (From *Shen Shi Zun Sheng Shu*)
If miscarriages occur too frequently, Qi and Blood are severely depleted, and the fetus lacks nourishment, hence frequent miscarriages. It is like water drying up causing crops to wither, or soil eroding causing trees to fall. (Wang Shishan)
During pregnancy, if there is distension and bearing-down sensation in the lower abdomen, one must guard against the risk of spontaneous abortion (minor miscarriage). Once vaginal bleeding appears, stability is difficult to maintain. When branches wither, fruits fall; urgently tonify the Kidney. When frames rot, bells fall; urgently tonify the Spleen. (From *Jian Wen Lu*)
When donkeys or horses are pregnant, if a male approaches, the female kicks it with her hooves; this is called "protecting the fetus," so they rarely experience minor miscarriages. In humans, the fetus is suspended in the Uterus (Bao Gong), nourished by Qi and Blood. Stillness allows Spirit to be stored internally. If desire-fire moves, Spirit leaks out, fire disturbs the interior, and the fetus aborts. Can one not be cautious? (From *Chan Bao Bai Wen*)
To preserve the fetus, one should nourish the Spleen and Stomach. The Spleen and Stomach are the officials of granaries, from which Zang-Fu organs receive their endowment, and embryos are nourished thereby. The Stomach belongs to the Yangming channel, which is the head of the Chong and Ren vessels. (From *Xue Shi Yi An*)
Frequent abortions during pregnancy are invariably due to deficiency and damage of Qi and Blood. Causes of deficiency include: innate weak constitution, declining age and vitality, exhaustion of essence and vitality due to worry, anger, labor, and hardship, and damage to vital energy due to imprudent sexual activity. Additionally, falls, dietary issues, etc., can all injure Qi and Blood. If Qi and Blood are injured yet the fetus remains unharmed, this requires an intact congenital foundation; ordinary people do not have this. Moreover, throughout the ten months of gestation, different meridians govern nourishment each month. Thus, recurrent minor miscarriages often occur between the 3rd, 5th, and 7th months. Subsequent miscarriages tend to happen at the same time. This is because the previous injury affected a specific meridian, and when that meridian becomes active again, the defect prevents passage. Furthermore, the Kidney suspends the Uterus, and the waist is the mansion of the Kidney. Therefore, pregnant women most fear lower back pain; severe pain leads to bearing down, so prevention is essential. ○ Minor miscarriages vary in timing: those in the 2nd and 3rd months are considered "early" (near), while those in the 5th and 6th months are "late" (far). Abortion shortly after conception has a lighter course; abortion after long gestation has a heavier course, which is common knowledge. There are even earlier cases where abortion occurs immediately upon conception. Initially, fetal vitality begins: in the first month like dew, in the second like peach blossoms. By the 3rd-4th months, blood vessels and form are established; by the 5th-6th months, bones, sinews, hair, and teeth grow. At initial conception, it is merely a drop of primordial fluid. Its root has no basis, its foundation no ground; consolidation makes it firm, rupture makes it flow. Therefore, after conception, one must strictly abstain from sexual desire to prevent overflow. "Manifest abortion" implies the fetus has formed, and minor miscarriage is felt; "hidden abortion" implies the fetus is still like water, flowing away unnoticed. (Zhang Jingyue)
[Discussion on Treatment]
For pregnant women, Danggui San (Angelica Powder) should be taken regularly. ○ For nourishing the fetus during pregnancy, Baizhu San (Atractylodes Powder) is indicated. ○ For women with metrorrhagia (bleeding between periods), continuous bleeding after partial abortion, or bleeding during pregnancy, Jiao'ai Tang (Colla Corii Asini and Mugwort Decoction) is indicated. (From *Jin Gui Yao Lue*)
Partial abortion (minor miscarriage) is more severe than full-term delivery. Full-term delivery is like a ripe fruit falling naturally; partial abortion is like picking unripe fruit, breaking the shell and severing the root. Is it not more severe? Yet people often neglect it. Treatment should tonify Form and Qi, generate new tissue, and remove stasis. If preterm labor pains occur before term, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) calms it; if bleeding continues after delivery, Renshen Huangqi Tang (Ginseng and Astragalus Decoction) stops it; if weak fetal Qi causes minor miscarriage, Bazhen Tang (Eight Treasures Decoction) secures it. (Xue Lizhai)
Abortion (early loss) differs from partial abortion (later loss). Loss in the 1st-4th months before formation is called abortion; loss in the 5th-8th months after formation is called partial abortion. Both belong to deficiency of Qi and Blood in the pregnant woman and deficiency of the Chong and Ren vessels, leading to insecure fetal vitality. The Baotai Wan (Fetus-Preserving Pill) from *Qianjin Fang* is excellent. Zhao Yangkui uses Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) plus Duzhong, Xuduan, Wuweizi, and Ejiao as a sacred medicine for calming the fetus, a secret transmission. ○ For excessive bleeding after abortion, meridians are damaged and Qi of Chong/Ren is deficient and failing to control, representing Deficiency; urgently tonify Qi and Blood to secure collapse. For blood coagulation causing pain after abortion, external pathogens invade, turbid blood blocks and stagnates, representing Excess; guide out stasis, eliminate accumulation, and warm the meridians. This applies not only to abortion but also to postpartum presentations of these syndromes. (Xiao Shenzhai)
Patient Ye maintained strict caution during the first three months of pregnancy, but movement inevitably occurred at term. Physicians used either cooling-blood or Qi-stabilizing methods, or lifting or Qi-promoting methods, but hundred medicines failed, and the fetus aborted. This is due to being easy to conceive but easy to lose. Investigating the cause: the fetus is tied to the Spleen and rooted in the Kidney. Frequent pregnancies indicate excess of Ministerial Fire; frequent abortions indicate excessive Ministerial Fire; abortions occurring precisely on schedule indicate the Spleen Earth's reliability. Miu Xi Yong stated that in the 3rd month, the Yangming channel nourishes the fetus. If the patient has inherently weak Spleen Earth and shaking Ministerial Fire, Wind Wood attacks it, causing spontaneous loss without cause. How can ordinary opinions remedy this? One must avoid anger to soothe the Liver, eliminate worry to calm the Spleen, and restrain desire to nourish the Kidney. Then use the Pig Stomach Pill (Zhudu Wan) to clear Ministerial Fire and solidify Spleen Earth. When Earth is strong, Qi of the Four Zang organs strengthens, Essence generates, and Qi secures, eliminating worries about unstable fetuses. Although, medicine should be taken early before pregnancy, not late after conception—this is preparing for rain before it falls, treating disease before it arises. (From *Hui Xin Lu*)
Ancients used Huangqin (Scutellariae Radix) to calm the fetus because fetal Qi was too hot, using bitter-cold to calm it. The Spleen is the pivot of fluids in the body, governing internal and external Qi, and fetal respiration and transformation rely entirely on Spleen Earth, so Baizhu (Atractodis Rhizoma) is used to assist. However, this is suitable only for thin individuals with Heat in Blood, rapid Ying circulation, and restless fetus. For weak form and衰竭 Qi with frequent bearing down, Renshen (Ginseng Radix) is needed to lift; for robust form and abundant Qi with stagnant fetus, Xiangfu and Sharen are needed to move Qi; for Blood deficiency with Fire hyperactivity and abdominal cramping, Danggui and Shaoyao are needed to nourish; for obesity with Phlegm abundance, vomiting, and dizziness, Fuling and Banxia are needed to resolve Phlegm. These all treat maternal Qi imbalance. If fetal unrest is caused by Wind-Cold, Xiangsu San or Congchi Tang should be used appropriately; for latent pathogens or seasonal epidemics, purgatives are urgent. These are key principles of calming the fetus. Among purgatives, Mangxiao (Natrii Sulfas) must never be used. (Zhang Feichou)
Calming, securing, and nourishing the fetus requires investigating the origin, distinguishing the damage to the fetus, whether in Qi or Blood, and which aspect is deficient. Is it fetal disease or maternal disease, which came first? Then formulate Jun, Chen, Zuo, Shi roles appropriately. How can one stick rigidly to a fixed formula? (From *Tui Qiu Shi Yi*)
[Pulse Diagnosis]
The Cun Kou pulse is Wiry (Xian) and Large (Da). Wiry indicates reduction/deficiency; Large indicates Hollow (Kou). Reduction indicates Cold; Hollow indicates Deficiency. Deficiency and Cold clashing is named Ge (Leather) pulse. In women, this indicates partial abortion and metrorrhagia. (Zhang Zhongjing)
[Attached Formula]
Zhudu Wan (Pig Stomach Pill): Renshen (Ginseng Radix), Kushen (Sophorae Flavescentis Radix), Danshen (Salviae Miltiorrhizae Radix), Yuan Shen (Scrophulariae Radix), Shashen (Glehniae Radix), Bian Dou (Dolichoris Semen), Shihu (Dendrobii Caulis), Baishao (Paeoniae Radix Alba), Qianshi (Euryales Semen), Lian Rou (Nelumbinis Plumula), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Guojiao (Carbonized Rice).
Usage: Take one male pig stomach, clean it, insert the herbs inside, steam until cooked, mash, dry, and grind into powder. Make pills with honey. Take 5 qian with boiling water every morning.