肺虚不任风寒，肾虚腰酸足软，猝然气喘不足以息者，此脾肺素亏，母虚子亦虚，肾气不归原，而上乘于肺也。
治宜生脉散、补中益气汤去升、柴加沉香、补骨脂主之。（萧慎斋）
妊妇因火动胎，气逆作喘者，用条芩、香附为末，水调服。（朱丹溪）
吐血
凡吐血证，或七情内伤，或六淫外感。而妊娠吐血，一主火热者，正以气血护养胎元，或有所感，则气
逆而火上乘也。但火有虚实之分，实火当清热养血，虚火当滋阴补水。（萧慎斋）
子嗽
妊娠咳嗽，名曰子嗽。其证若风邪伤肺者，用金沸草散；火邪克金者，用人参平肺散；寒邪伤肺者，用人
参败毒散；脾肺气虚者，用六君子汤加桔梗；血虚者，用四物汤加桔梗；肾火上炎者，用六味汤加五味子；脾
肺气虚，为风寒所伤者，用补中益气汤加桔梗。盖肺属辛金，生于己土，嗽久不已，多因脾虚不能生肺金，致
腠理不密，复感外邪；或因肺虚不能生肾水，以致阴火上炎。治当壮土金，生肾水，以安胎为要。（薛立斋）
子痫
妇人有孕之后，冲任血养胎元，以致肝脏少血，而木火内动，摇摇靡定，风象生焉。其证目吊口噤，角弓
反张，流涎昏迷，时作时止，与内伤之痫象相类。俗医以为外入之风，真属聋 。试问风入皮毛，则当恶寒发
热，何表证未见，而厥、少之证叠出？且无孕安然，有胎反病，风果如是耶？审其病情，无非肝肾阴虚，阴虚
则血燥，血燥则筋失所滋，强直反张，有似于风，而实非风也。即风亦属内动之风，而非外入之风也。良由胎
在母腹，阴血愈耗，虚火愈炽，经脉空而为火所灼，以故精不能养神，柔不能养筋，而如厥如癫，神魂失守。
治法有在阴、在阳之别∶阴虚者养阴，阳虚者养阳。庶阴液足而真气回，木火藏而虚风定，子安母亦安矣。考
古治子痫羚羊角散，方内惟羚角入肝舒筋，枣仁、当归补肝益血，与证相投。其防、独则耗真元，薏仁则下生
胎，多不合辙，未可轻用。（《会心录》）
子满
妊娠有水气，身重，小便不利，洒淅恶寒，起则头眩，葵子茯苓散主之。（《金匮》）
头面遍身浮肿，小水短少者，属水气为病，名曰子肿。自膝至足浮肿，小水清长者，属湿气为病，名曰子
气。遍身俱肿，腹胀而喘，在六、七个月时者，名曰子带。但两脚肿而肤浓者属湿，名曰皱脚。皮薄者属水，
名曰脆脚。大凡水之为病多喘促，气之为病多胀满，喘促属肺，胀满属脾。以其人素有水气湿邪，故受孕有肿
满之证。儿未成形，被水渍其胎，每致损坏。成形尚可调治。若在五、六月后，有是证者，多有生育顺利。（《医宗金鉴》）
妊娠胸满腹胀，小便不通，遍身浮肿者，用千金鲤鱼汤。脾胃虚弱者，佐以四君汤。若面目虚浮，肢体
如水气者，用全生白术散。若脾虚湿热，下部作肿者，用补中益气汤加茯苓。若饮食失节，呕吐泄泻者，用六
君子汤。若腿足发肿，喘闷不安，或指缝出水者，用天仙藤散。（薛立斋）
子满有水血相搏者，有停水受湿者，有经血壅闭者，有清浊不分者，总因脾虚不能制水所致。立斋治法，
不外健脾渗湿、顺气安胎为主。若《济阴》云∶但泻气利水则愈。此谬论也。（萧慎斋）
子悬
《本事方》云∶紫苏饮治妊娠子悬。子悬者，浊气举胎上凑也。胎热气逆，胸膈胀满，非苏叶、陈皮、
腹皮、川芎无以流气，非归、芍无以养血。气血既利，其人必虚，故以人参、甘草补之。（何松庵）
子悬之证，胎气上逼心胸是也。正以气血壅郁胎元，郁久则热，故良甫主于胎热气逆，松庵主于浊气举
胎，是以火热立论为当。若《大全》以为寒气冷冻饮料，养葵以为命门火衰，然必以人之壮弱，脉之迟数为凭。如
禀浓质壮，脉来洪数，此属火热；如脾
胃素虚，脉来迟细，此属虚寒。（萧慎斋）
子喑
帝曰∶人有重身九月而喑，此何为也？岐伯曰∶胞之络脉绝也。帝曰∶何以言之？岐伯曰∶胞络者，系于
肾，少阴之脉，贯肾系舌本，故不能言。帝曰∶治之奈何？岐伯曰∶无治也，当十月复。（《素问》）
按喑者，谓有言而无声。故《经》曰∶不能言。此"不能"二字，非绝不语之谓。凡人之音，出于喉咙，
发于舌本，因胎气肥大，阻肾上行之经，肾脉入肺中，循喉咙，系舌本，喉者肺之部，肺主出声，故其人切切
私语，有言而人不能听闻，故曰喑。如果肾之脉络绝，则其病不治，岂有产后自复之理乎？《经》云∶胞之络
脉绝。此"绝"字当作"阻"字解。（张 璜）
妊娠不语，经旨固无治法，后人不敢强立方论，独子和以降心火为治，元台以补心肾立法。则以胞之络脉
属于手、足少阴二经故也。但产后不语，属败血之入心。中风舌喑，属痰涎之滞络。则胎前子喑，亦必有所感，
更当详证参治，以补张、马二公之未尽。（萧慎斋）
子烦
烦者，心中烦乱不安也。由于受胎之后，血热干心，故令人郁闷撩乱不安。因在妊娠，故曰子烦。非子在
腹中而烦也。古云∶四月受少阴君火以养精，六月受少阳相火以养气，故烦。夫烦固多属火，今胎既受君相之
火以养，岂有反令母烦之理？若曰母虚而烦，则当每月皆然，何独拘于四月、六月？此说似属不通。（李太素）
妊娠烦闷有四证∶有虚烦，有心中烦，有胸中烦，有子烦，俱属于热。脏虚而热气乘心，令人烦者名虚烦，
亦即心中烦；痰饮凝积，呕吐痰沫者，名胸中烦；血积饮停，寒热相搏，致胎不安者，名子烦。（齐仲甫）
火入于肺则烦，入于肾则躁。胎系于肾，肾水养胎，则不足以滋肾中之火，火上烁肺，则为烦躁。此金水
亏涸之候，法当滋其化源，清金壮水为主。（萧慎斋）
子鸣
妊妇腹中脐带上疙瘩，儿含口中，因登高举臂，脱出儿口，以此作声。令妊妇曲腰就地，如拾物状，疙瘩
仍入儿口，即止。又腹中儿哭，用鼠窟土同黄连汁饮之即止。（《产宝百问》）
腹内钟鸣，与儿哭同类。故治法无异。立斋云∶黄连性寒，麝香开窍，当酌用。（萧慎斋）
腹痛
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。○妊娠腹中痛，为胞阻，胶艾汤主之。○妇人怀胎，腹中 痛，当归芍药散主之。（《金匮》）
胎前腹痛，有风寒客邪，痰饮七情，为有余之病也；有气阻、气虚、血虚，为不足之病也。脾胃气虚而
腹痛者，用补气调气之法。阴亏血虚而腹痛者，用补血温经之法。临证审之。（萧慎斋）
腰痛
妊娠腰痛，最为紧要。盖以胞胎系于腰，故腰疼酸急，胞系欲脱，必将产也。即不然，或因劳伤，损动
其经；或因冷气乘袭，腹痛引于腰背；或因挫闪气滞，或因肾元虚损；或因怒动肝火；或因肝脾气郁；或因膀
胱风邪乘袭；或因血热血滞。虽由来不同，若其痛不止，多动胎气。大抵治法总以固胎为主。（沈金鳌）
胁痛
妊妇胁痛有三∶哭泣也，内伤也，恼怒也。不可服行血破气药，宜用童便，或紫苏饮去人参加当归、白
芍为稳。（《见闻录》）
尿血
胎漏之血，自人门而下；尿血之血，自尿门而下。妊娠尿血，
属胞热者居多，治宜四物汤加发灰、山栀、阿胶。（李 ）
尿血易混于胎漏，得李氏一辨，已见多晰。但胎漏是无时频出；尿血是心火移于小肠，渗入膀胱，溺则下，
不溺则不下。（萧慎斋）
转胞
妇人病，饮食如故，烦热不得卧，而反倚息者，何也？师曰∶此名转胞，不得溺也。以胞系了戾，故致
此病，但利小便则愈，宜肾气丸主之。（《金匮》）
《素问》云女子胞，又云胞移热于膀胱。《灵枢》云冲脉、任脉皆起于胞中。此“胞”字皆音“包”，以
子宫为言也。《灵枢》又云膀胱之胞薄以懦。此“胞”字音“抛”，以溲脬为言也。盖音有二，而字则相同。
后人不解其意，或认膀胱与尿胞为二物。又因《类纂》则曰∶膀胱者，胞之室。反以子胞与膀胱为一物，其误
甚矣。夫膀胱即脬，脬即膀胱也。焉得复有一物居于膀胱之内者乎？其以子胞与膀胱为一物者，试思转胞下压
膀胱，则小便不通，其胞在上，而膀胱在下，部位各别，而非一物更明矣。（《冯氏锦囊》）
妊妇转胞，不得小便，由于中气虚怯，不能举胎，胎压其胞，胞系了戾，以补中益气汤升举之。（《赵氏医贯》）
转胞之病，孕妇禀受弱者，忧闷多者，性躁急者，食浓味者，大率有之。古方皆用滑利疏导药，鲜效。
因思胞为胎所压，展在一边，以致胞系了戾，水道不通也。胎若举起，悬在中央，胞系得疏，则水道自行矣。
治用参术饮，服后，随以指探吐，俟其气定，又饮又吐，小便立通。（《丹溪心法》）
胎前转胞，多因气虚血少。血少则胎无以养，气弱则胎不能举。下坠压于膀胱，胞为之转，而溺不出。丹
溪虽有忧闷、性躁、浓味诸因，其立方处治，自探吐推托之外，惟以补气血为主。然有脾肺气虚，不能下输膀
胱者；有气热郁结，膀胱津液不利者；
有金为火烁，肺燥热甚而不利者。当详审施治也。（萧慎斋）
子淋
子淋与转胞相类。小便频数，点滴而痛者为子淋；频数出少不痛者为转胞。（《证治要诀》）
子淋须分二证∶一则妊母自病；一则子为母病。妊母自病，又分二证∶或服食辛热，因生内热者，或自汗
自利，津液枯燥者。子为母病，亦分二证∶或胎气热壅者；或胎形迫塞者。证既不同，治亦有别。热则清之，
燥则润之，壅则通之，塞则行之。（万密斋）
孕妇小便涩少，由于气血聚养胎元，不及敷荣渗道，遂使膀胱郁热。当用养血药以荣渗道，加麦冬以滋水
源，滑石以清郁滞，名安荣散。若月分未多，减滑石，加石斛、山栀。然欲清膀胱之热，必疏厥阴之气，盖溺
窍乃厥阴之部分耳。（陈良甫）
妊娠小便涩少淋沥，用安荣散。若肝经虚热，用加味逍遥散；若服燥剂而小便频数或不利，用生地、茯苓、
知、柏、芎、归、甘草；频数而色黄赤，用四物汤加知母、黄柏；肺气虚而小便短少，用补中益气汤加麦冬、
五味子；热结膀胱而小便不利，用五淋散；脾肺燥热，不能生化，用黄芩清肺饮；膀胱阴虚，阳无所生，用滋
肾丸；膀胱阳虚，阴无所化，用肾气丸。（薛立斋）
胎不长养
人受气于有生，十二经脉迭相滋养。胎处胞中，或有枯萎者，由孕妇禀弱，阴阳血气偏胜，胞胎失于滋养，
所以枯萎不长也。惟宜资母血气，则胎从而有养矣。○妊娠将理无方，脾胃失调，饮食减少，不能行营卫、化精
微、养冲任，故令胎弱，子气不足。巢元方谓∶母病疗母则胎安是也。能使脾胃调和，水谷运化，而生气血，
何虑胎不长乎？（《圣济总录》）
胎元本乎血气。胎不长者，血气之不足耳。故于受胎之后，而漏血不止者有之，血不归胎也；妇人中年，
血气衰败者有之，
泉源日涸也；妇人多脾胃病者有之，仓禀薄则化源亏而冲任穷也；妇人多郁怒者有之，肝气逆则血不调而胎失
所养也。或血气寒而不长者，阳气衰则生气少也；或血气热而不长者，火邪盛则真阴损也。凡诸病此者，宜补、
宜固、宜温、宜清，但因其病而随机应之。或及期，或过月，胎气渐充，自无不长。惟是年迈体衰，数在天矣，
非可以人力为也。（张景岳）
过期不产
问∶娠妇有按月行经而胎自长者，有三、五个月间，其血大下，而胎不坠，或及期而分娩，或逾月而始生
者，其理何与？曰∶按月行经，而胎自长者，名曰盛胎。其妇血气充盛，养胎之外，其血有余故也。有数月之
胎，而血大下者，谓之漏胎。因事触胎，动其任脉，故血下而不伤子宫也。然孕中失血，胎虽不坠，气血亦亏，
多致逾月不产。曾见有十二三月，或二十余月而生者，俱是血气不足，胚胎难长故耳。凡十月之后未产者，当
服补气血药以培养之。（虞天民）
子死腹中
胞衣未下，急于胎之未生。子死腹中，危于胎之未下。盖胞衣未下，子与母气通其呼吸。若子死腹中，胞
脏气寒，胎血凝冱，气不升降。古方多用用行血顺气，及硝石、水银、 砂之类。但其胎已死，躯形已冷，血
凝气聚，复以寒药下之，不惟无益，反害母命者多矣。不知古人立方，深于用意。盖子死之故，因有二端，用
药寒温，各从其宜。有因孕妇胎漏，血尽子死者；有因坠堕颠仆，内伤子死者；有因久病，胎萎子死者。以附
子汤，进三服，使胞脏温暖，凝血流动。盖附子能破寒气堕胎故也。有因伤寒、热病、温疟，胎受邪热毒瓦斯，
内外交攻，因致胎死，留于胞脏，深虑胎受毒瓦斯，必然胀大，故用朴、硝等使胎化烂，副以行血顺气之药，死
胎即下，此立方之至意也。（《圣济总录》）
或因热病，或因颠仆，或因惊恐，或产时未到，惊动太早，
恶露已尽，致胎干身冷，不能自出。但视产妇，面赤舌青，子死母活；面青舌赤，母死子活；面舌俱青，母子
肺虚不能耐受风寒，肾虚导致腰酸腿软，突然气喘、呼吸短促的，这是脾肺素来亏虚，母脏虚弱则子脏亦弱，肾气不能归元，反而上冲于肺所致。
治疗宜用生脉散、补中益气汤去掉升麻、柴胡，加入沉香、补骨脂为主方。（萧慎斋）
孕妇因火邪扰动胎元，气逆作喘的，用黄芩、香附研为末，用水调服。（朱丹溪）
吐血
凡是吐血证，或是七情内伤，或是六淫外感。而妊娠期间吐血，主要病机在于火热，这是因为气血用来护养胎元，若有所感受，则气逆而火邪上乘。但火有虚实之分，实火应当清热养血，虚火应当滋阴补水。（萧慎斋）
子嗽（妊娠咳嗽）
妊娠期间咳嗽，名叫子嗽。其证候若因风邪伤肺的，用金沸草散；火邪克伐肺金的，用人参平肺散；寒邪伤肺的，用人参败毒散；脾肺气虚的，用六君子汤加桔梗；血虚的，用四物汤加桔梗；肾火上炎的，用六味地黄丸加五味子；脾肺气虚，被风寒所伤的，用补中益气汤加桔梗。大概肺属辛金，生于己土，咳嗽日久不愈，多因脾虚不能生肺金，导致腠理不紧密，又感受外邪；或因肺虚不能生肾水，以致阴火上炎。治疗应当壮土金，生肾水，以安胎为要务。（薛立斋）
子痫（妊娠痫证）
妇女怀孕之后，冲任二脉之血用来养胎元，导致肝脏血液减少，而木火在内妄动，身体动摇不定，产生风象。其证候表现为眼睛上吊、口噤不开、角弓反张、流涎昏迷，时发时止，与内伤引起的痫证相似。庸医认为是外入之风，真是荒谬。试问风邪侵入皮毛，应当恶寒发热，为何没有表证，而厥阴、少阴的证候接连出现？况且无孕时安然无恙，有了胎反而生病，风邪果真是这样吗？审察病情，无非是肝肾阴虚，阴虚则血燥，血燥则筋脉失去滋养，强直反张，看似风邪，实则不是风邪。即使是风，也属于内动之风，而非外入之风。良由胎儿在母腹中，阴血日益耗损，虚火日益炽盛，经脉空虚而被火邪灼烧，因此精不能养神，柔不能养筋，而出现如厥逆如癫狂的症状，神魂失守。
治疗方法有在阴、在阳的区别：阴虚者养阴，阳虚者养阳。这样阴液充足而真气回复，木火潜藏而虚风平息，胎儿安顿母亲也就安定了。考证古代治疗子痫的羚羊角散，方中只有羚羊角入肝舒筋，酸枣仁、当归补肝益血，与证候相符。其中的防风、独活则耗损真元，薏苡仁则下利滑胎，大多不合规矩，不可轻用。（《会心录》）
子满（妊娠水肿/羊水过多）
妊娠有水气，身体沉重，小便不利，洒淅恶寒，起身时头晕目眩，用葵子茯苓散主治。（《金匮要略》）
头面遍身浮肿，小便短少的，属于水气为病，名叫子肿。自膝盖至足部浮肿，小便清长的，属于湿气为病，名叫子气。遍身俱肿，腹胀且喘，发生在六、七个月时的，名叫子带。只是两脚肿而皮肤厚的属于湿，名叫皱脚。皮肤薄的属于水，名叫脆脚。大凡水气为病多伴有喘促，气滞为病多伴有胀满，喘促属于肺，胀满属于脾。因为患者素来有水气湿邪，所以受孕后有肿满之证。胎儿未成形时，被水浸渍其胎，往往导致损坏。若已成形尚可调治。若在五、六月后出现这些证候的，多有生育顺利的情况。（《医宗金鉴》）
妊娠胸满腹胀，小便不通，遍身浮肿的，用千金鲤鱼汤。脾胃虚弱者，佐以四君子汤。若面目虚浮，肢体如水气状的，用全生白术散。若脾虚湿热，下部作肿的，用补中益气汤加茯苓。若饮食失节，呕吐泄泻的，用六君子汤。若腿足发肿，喘闷不安，或指缝出水流的，用天仙藤散。（薛立斋）
子满有水血相搏的，有停水受湿的，有经血壅闭的，有清浊不分的，总因脾虚不能制水所致。薛立斋的治疗方法，不外乎健脾渗湿、顺气安胎为主。若《济阴纲目》说：只要泻气利水就好了。这是谬论。（萧慎斋）
子悬（胎气上逼）
《本事方》说：紫苏饮治疗妊娠子悬。子悬，是指浊气举胎向上冲凑。胎热气逆，胸膈胀满，不用苏叶、陈皮、腹皮、川芎无法行气，不用当归、白芍无法养血。气血既已通畅，人必然体虚，所以用人参、甘草补益。（何松庵）
子悬的证候，是胎气上逼心胸。正因为气血壅郁胎元，郁久则热，所以良甫主张胎热气逆，松庵主张浊气举胎，以此火热立论是恰当的。若《大全》认为是寒气冷冻饮料所致，养葵认为是命门火衰，然而必须以人的体质强弱、脉象迟数为依据。如禀赋浓厚体质强壮，脉来洪数，这属于火热；如脾胃素虚，脉来迟细，这属于虚寒。（萧慎斋）
子喑（妊娠失音）
黄帝问：人有怀孕九月而失音的，这是为什么呢？岐伯答：胞宫的络脉阻滞了。黄帝问：为什么这样说？岐伯答：胞络系于肾，少阴之脉，贯肾系舌本，所以不能言。黄帝问：怎么治疗？岐伯答：不需要治疗，等到十月分娩后自然恢复。（《素问》）
按：喑，是指有言而无声。所以《内经》说：不能言。这个“不能”二字，并非完全不说话的意思。凡人的声音，出于喉咙，发于舌本，因为胎气肥大，阻断了肾上行至舌本的经脉，肾脉入肺中，循喉咙，系舌本，喉是肺的部位，肺主出声，所以其人切切私语，有言而别人听不见，所以叫喑。如果肾的脉络真的断绝，那病就治不好了，哪有产后自然恢复的道理呢？《内经》说：胞之络脉绝。这个“绝”字应当解释为“阻”。（张璜）
妊娠不语，《内经》宗旨固然没有治法，后人不敢强行立方论治，只有张子和以降心火为治，元台以补心肾立法。这是因为胞之络脉属于手、足少阴二经的缘故。但是产后不语，属于败血入心；中风舌喑，属于痰涎阻滞络脉。那么胎前子喑，也必定有所感受，更应当详查证候参合治疗，以补充张、马二位公未尽之处。（萧慎斋）
子烦（妊娠心烦）
烦，是指心中烦乱不安。由于受胎之后，血热干扰心神，所以令人郁闷撩乱不安。因为在妊娠期间，所以叫子烦。不是在腹中的胎儿感到烦闷。古话说：四月受少阴君火以养精，六月受少阳相火以养气，所以烦。烦固多属于火，现在胎儿既然受君相之火以养育，难道反而会令母亲烦闷吗？如果说母亲虚而烦，则应当每月都如此，为何唯独拘泥于四月、六月？这种说法似乎讲不通。（李太素）
妊娠烦闷有四证：有虚烦，有心中烦，有胸中烦，有子烦，都属于热。脏虚而热气乘心，令人烦的叫做虚烦，也就是心中烦；痰饮凝积，呕吐痰沫的，叫做胸中烦；血积饮停，寒热相搏，导致胎不安的，叫做子烦。（齐仲甫）
火入于肺则烦，入于肾则躁。胎系于肾，肾水养胎，则不足以滋肾中之火，火上烁肺，则为烦躁。这是金水亏涸的征候，治法应当滋其化源，以清金壮水为主。（萧慎斋）
子鸣（胎儿啼哭）
孕妇腹中脐带上长疙瘩，胎儿含在口中，因登高举臂，疙瘩脱出胎儿口中，因此发出声响。让孕妇曲腰就地，像拾物状，疙瘩仍进入胎儿口中，声音即止。又有腹中儿哭，用鼠窟土同黄连汁饮用即止。（《产宝百问》）
腹内钟鸣，与儿哭同类。所以治法无异。薛立斋说：黄连性寒，麝香开窍，应当酌情使用。（萧慎斋）
腹痛
妇人怀孕六、七月，脉弦，发热，其胎愈胀，腹痛恶寒，少腹如扇风样冷。之所以这样，是因为子脏开敞的缘故。应当用附子汤温其脏。○妊娠腹中痛，为胞阻，胶艾汤主治。○妇人怀胎，腹中痛，当归芍药散主治。（《金匮要略》）
胎前腹痛，有风寒客邪，痰饮七情，属于有余的病；有气阻、气虚、血虚，属于不足的病。脾胃气虚而腹痛的，用补气调气之法。阴亏血虚而腹痛的，用补血温经之法。临证审察施行。（萧慎斋）
腰痛
妊娠腰痛，最为紧要。因为胞胎系于腰，所以腰疼酸急，胞系欲脱，必将生产。即使不是这样，或因劳伤，损动其经；或因冷气乘袭，腹痛引及腰背；或因挫闪气滞，或因肾元虚损；或因怒动肝火；或因肝脾气郁；或因膀胱风邪乘袭；或因血热血滞。虽然由来不同，若疼痛不止，多会动胎气。大抵治法总以固胎为主。（沈金鳌）
胁痛
孕妇胁痛有三：哭泣所致，内伤所致，恼怒所致。不可服用行血破气药，宜用童便，或紫苏饮去掉人参加当归、白芍为稳妥。（《见闻录》）
尿血
胎漏之血，从阴道而下；尿血之血，从尿道而下。妊娠尿血，属胞热的居多，治疗宜用四物汤加发灰、山栀、阿胶。（李）
尿血易混于胎漏，得李氏一辨，已经见得多清晰。但胎漏是无时频繁出血；尿血是心火移于小肠，渗入膀胱，排尿时下，不排尿时不下。（萧慎斋）
转胞（妊娠小便不通）
妇人患病，饮食如故，烦热不得卧，而反倚息（依靠物体呼吸），为什么呢？医生说：这叫转胞，不能小便。因为胞系扭转，所以导致此病，只要利小便就好了，宜肾气丸主治。（《金匮要略》）
《素问》说女子胞，又说胞移热于膀胱。《灵枢》说冲脉、任脉皆起于胞中。这里的“胞”字都音“包”，指子宫而言。《灵枢》又说膀胱之胞薄以懦。这里的“胞”字音“抛”，指尿脬而言。大概音有二，而字则相同。后人不懂其意，有的认为膀胱与尿胞是两个东西。又因《类纂》说：膀胱者，胞之室。反而把子胞与膀胱当作一个东西，错误很大。夫膀胱即脬，脬即膀胱也。哪里还能再有一个东西居于膀胱之内呢？那些把子胞与膀胱当作一个东西的人，试想转胞下压膀胱，则小便不通，其胞在上，而膀胱在下，部位各别，而不是一个东西更加明显了。（《冯氏锦囊》）
孕妇转胞，不能小便，由于中气虚怯，不能举胎，胎压其胞，胞系扭转，用补中益气汤升举之。（《赵氏医贯》）
转胞之病，孕妇禀受弱的，忧闷多的，性情急躁的，饮食浓味的，大率都有此病。古方都用滑利疏导药，鲜有效果。想到胞为胎所压，偏在一边，以致胞系扭转，水道不通。胎若举起，悬在中央，胞系得疏，则水道自行矣。治疗用参术饮，服后，随即用手指探吐，等其气定，又饮又吐，小便立即通利。（《丹溪心法》）
胎前转胞，多因气虚血少。血少则胎无以养，气弱则胎不能举。下坠压于膀胱，胞为之转，而溺不出。丹溪虽有忧闷、性躁、浓味诸因，其立方处治，自探吐推托之外，惟以补气血为主。然而有脾肺气虚，不能下输膀胱的；有气热郁结，膀胱津液不利的；有金为火烁，肺燥热甚而不利者。应当详审施治。（萧慎斋）
子淋（妊娠小便淋痛）
子淋与转胞相类。小便频数，点滴而痛的为子淋；频数出少不痛的为转胞。（《证治要诀》）
子淋须分二证：一则妊母自病；一则子为母病。妊母自病，又分二证：或服食辛热，因而生内热的，或自汗自利，津液枯燥的。子为母病，亦分二证：或胎气热壅的；或胎形迫塞的。证既不同，治亦有别。热则清之，燥则润之，壅则通之，塞则行之。（万密斋）
孕妇小便涩少，由于气血聚养胎元，不及敷荣渗道，遂使膀胱郁热。当用养血药以荣渗道，加麦冬以滋水源，滑石以清郁滞，名安荣散。若月分未多，减滑石，加石斛、山栀。然而想清膀胱之热，必疏厥阴之气，盖溺窍乃厥阴之部分耳。（陈良甫）
妊娠小便涩少淋沥，用安荣散。若肝经虚热，用加味逍遥散；若服燥剂而小便频数或不利，用地黄、茯苓、知母、黄柏、川芎、当归、甘草；频数而色黄赤，用四物汤加知母、黄柏；肺气虚而小便短少，用补中益气汤加麦冬、五味子；热结膀胱而小便不利，用五淋散；脾肺燥热，不能生化，用黄芩清肺饮；膀胱阴虚，阳无所生，用滋肾丸；膀胱阳虚，阴无所化，用肾气丸。（薛立斋）
胎不长养（胎儿发育迟缓）
人受气于有生，十二经脉迭相滋养。胎处胞中，或有枯萎的，由孕妇禀赋弱，阴阳血气偏胜，胞胎失于滋养，所以枯萎不长。只宜资助母体血气，则胎从而有养了。○妊娠将理无方，脾胃失调，饮食减少，不能行营卫、化精微、养冲任，故令胎弱，子气不足。巢元方说：母病疗母则胎安是也。能使脾胃调和，水谷运化，而生气血，何虑胎不长乎？（《圣济总录》）
胎元本乎血气。胎不长者，血气之不足耳。所以在受胎之后，而漏血不止的有之，血不归胎也；妇人中年，血气衰败的有之，泉源日涸也；妇人多脾胃病的有之，仓禀薄则化源亏而冲任穷也；妇人多郁怒的有之，肝气逆则血不调而胎失所养也。或血气寒而不长的，阳气衰则生气少也；或血气热而不长的，火邪盛则真阴损也。凡诸病此者，宜补、宜固、宜温、宜清，但因其病而随机应之。或及期，或过月，胎气渐充，自无不长。惟是年迈体衰，数在天矣，非可以人力为也。（张景岳）
过期不产（过期妊娠）
问：孕妇有按月行经而胎自长的，有三、五个月间，其血大下，而胎不坠，或及期而分娩，或逾月而始生的，其理何在？答：按月行经，而胎自长的，名叫盛胎。其妇血气充盛，养胎之外，其血有余故也。有数月之胎，而血大下的，谓之漏胎。因事触胎，动其任脉，故血下而不伤子宫也。然孕中失血，胎虽不坠，气血亦亏，多致逾月不产。曾见有十二三月，或二十余月而生者，俱是血气不足，胚胎难长故耳。凡十月之后未产的，当服补气血药以培养之。（虞天民）
子死腹中（胎死不下）
胞衣未下，急于胎之未生。子死腹中，危于胎之未下。盖胞衣未下，子与母气通其呼吸。若子死腹中，胞脏气寒，胎血凝冱，气不升降。古方多用行血顺气，及硝石、水银、硇砂之类。但其胎已死，躯形已冷，血凝气聚，复以寒药下之，不惟无益，反害母命者多矣。不知古人立方，深于用意。盖子死之故，因有二端，用药寒温，各从其宜。有因孕妇胎漏，血尽子死的；有因坠堕颠仆，内伤子死的；有因久病，胎萎子死的。用附子汤，进三服，使胞脏温暖，凝血流动。盖附子能破寒气堕胎故也。有因伤寒、热病、温疟，胎受邪热毒瓦斯，内外交攻，因致胎死，留于胞脏，深虑胎受毒瓦斯，必然胀大，故用朴、硝等使胎化烂，副以行血顺气之药，死胎即下，此立方之至意也。（《圣济总录》）
或因热病，或因颠仆，或因惊恐，或产时未到，惊动太早，恶露已尽，致胎干身冷，不能自出。但视产妇，面赤舌青，子死母活；面青舌赤，母死子活；面舌俱青，母子
**Lung Deficiency and Kidney Deficiency with Asthma**
When Lung Qi is deficient and unable to withstand wind-cold, and Kidney deficiency causes soreness of the lower back and weakness of the legs, sudden asthma with insufficient breath occurs. This is due to a prior deficiency of Spleen and Lung; when the "mother" organ (Kidney) is deficient, the "child" organ (Lung) is also deficient. The Kidney Qi fails to return to its root and instead ascends to attack the Lung.
Treatment should employ Shengmai San (Generate Pulse Powder) or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), and adding Chenxiang (Aquilariae Lignum Resinatum) and Buguzhi (Psoraleae Fructus) as the main formula. (Xiao Shenzhai)
**Pregnancy-related Asthma due to Fire**
For pregnant women whose fetus is disturbed by Fire, causing rebellious Qi and asthma, use Huangqin (Scutellariae Radix) and Xiangfu (Cyperi Rhizoma) ground into powder, taken with water. (Zhu Danxi)
**Hematemesis (Vomiting Blood)**
Generally, hematemesis is caused either by internal injury from the Seven Emotions or external contraction of the Six Excesses. However, hematemesis during pregnancy is primarily governed by Heat-Fire. This is because Qi and Blood are utilized to nourish the Fetal Origin; if pathogenic factors intervene, Qi rebels and Fire attacks upward. Fire can be excess or deficiency. For Excess Fire, clear Heat and nourish Blood; for Deficiency Fire, nourish Yin and augment Water. (Xiao Shenzhai)
**Zisu (Fetal Cough / Pregnancy Cough)**
Cough occurring during pregnancy is called Zisu.
- If caused by Wind-Evil attacking the Lung: use Jinfeicao San (Boilweed Powder).
- If caused by Fire-Evil overcoming Metal (Lung): use Renshen Pingfei San (Ginseng Lung-Pacifying Powder).
- If caused by Cold-Evil attacking the Lung: use Renshen Baidu San (Ginseng Detoxification Powder).
- If due to Spleen and Lung Qi Deficiency: use Liujunzi Tang (Six Gentlemen Decoction) plus Jiegeng (Platycodonis Radix).
- If due to Blood Deficiency: use Siwu Tang (Four Substances Decoction) plus Jiegeng.
- If due to Kidney Fire flaming upward: use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Wuweizi (Schisandrae Fructus).
- If due to Spleen and Lung Qi Deficiency compounded by Wind-Cold: use Buzhong Yiqi Tang plus Jiegeng.
The Lung belongs to Xin Metal, born from Ji Earth (Spleen). Chronic cough often results from Spleen deficiency failing to generate Lung Metal, leading to insecure interstices and susceptibility to external pathogens; or from Lung deficiency failing to generate Kidney Water, causing Yin Fire to flare up. Treatment should strengthen Earth and Metal, generate Kidney Water, with stabilizing the fetus as the priority. (Xue Lizhai)
**Zixian (Eclampsia / Pregnancy Convulsions)**
After conception, the blood of the Chong and Ren meridians nourishes the fetus, leading to Liver Blood deficiency. Wood and Fire move internally, causing instability and generating Wind symptoms. Signs include eyes rolling back, jaw locking, opisthotonos (arching of the back), salivation, coma, and intermittent发作, resembling internal injury epilepsy. Quack doctors attribute this to external Wind, which is absurd. If Wind entered the skin and hair, there would be aversion to cold and fever. Why are there no exterior signs, but rather repeated Jueyin and Shaoyin symptoms? Moreover, why is the woman healthy before pregnancy but ill after? Examining the condition reveals it is essentially Liver and Kidney Yin Deficiency. Yin deficiency leads to Blood dryness; Blood dryness causes tendons to lose nourishment, resulting in stiffness and arching, mimicking Wind but not being Wind. Even if considered Wind, it is internal Wind, not external. Because the fetus consumes Yin Blood, Deficiency Fire flares up, burning empty meridians. Essence fails to nourish the Spirit, and softness fails to nourish the tendons, leading to convulsions and madness, with the Soul and Spirit losing their residence.
Treatment differs based on Yin or Yang deficiency: nourish Yin if Yin is deficient, nourish Yang if Yang is deficient. Thus, Yin fluids become sufficient, True Qi returns, Wood and Fire are contained, and false Wind settles, ensuring safety for both mother and child. Ancient formulas like Lingyangjiao San (Antelope Horn Decoction) use Antelope Horn to enter the Liver and relax tendons, Zaoren (Ziziphi Spinosomi Semen) and Danggui (Angelicae Sinensis Radix) to tonify Liver and benefit Blood, matching the syndrome. Fangfeng (Saposhnikoviae Radix) and Duhuo (Angelicae Pubescentis Radix) deplete True Yuan, and Yiren (Coicis Semen) promotes urination and may abort; thus, they are inappropriate and should not be used lightly. (Huixin Lu)
**Ziman (Hydrops of Pregnancy / Polyhydramnios)**
Pregnancy with fluid retention, heavy body, difficult urination, chills, and dizziness upon rising is treated with Kuizi Fuling San (Abelmoschus Seed and Poria Powder). (Jinkui Yaolue)
Edema of the head, face, and whole body with scanty urine is Water-Qi disease, called Zizhong (Fetal Swelling). Edema from knees to feet with clear, long urine is Dampness disease, called Ziqi (Fetal Qi). Whole-body edema with abdominal distension and asthma at six or seven months is called Zidai (Fetal Belt). Edema only in both feet with thick skin is Dampness, called Zhoujiao (Wrinkled Feet). Edema with thin skin is Water, called Cuijiao (Brittle Feet). Generally, Water diseases cause asthma (associated with Lung), while Qi diseases cause distension (associated with Spleen). Since the patient has pre-existing Water-Qi and Dampness, pregnancy triggers swelling. Before fetal formation, water immersion damages the fetus; after formation, it can be treated. Symptoms appearing after five or six months often result in smooth delivery. (Yizong Jinjian)
**Pregnancy Edema Treatments**
- Chest fullness, abdominal distension, urinary retention, and whole-body edema: Qianjin Liyu Tang (Thousand Gold Carp Decoction).
- Spleen-Stomach weakness: supplement with Sijunzi Tang (Four Gentlemen Decoction).
- Puffy face/eyes and limb edema resembling water: Quansheng Baizhu San (Complete Life Atractylodes Macrocephala Powder).
- Spleen deficiency with Damp-Heat causing lower body edema: Buzhong Yiqi Tang plus Fuling (Poria).
- Irregular diet causing vomiting and diarrhea: Liujunzi Tang (Six Gentlemen Decoction).
- Leg/foot edema, asthma, restlessness, or oozing between fingers: Tianxianteng San (Akebia Vine Powder). (Xue Lizhai)
**Etiology of Ziman**
Ziman involves Water-Blood conflict, retained Water-Dampness, obstructed menses, or confusion of Clear/Turbid substances, all caused by Spleen deficiency failing to control Water. Xue Lizhai’s method focuses on strengthening Spleen, leaching Dampness, regulating Qi, and calming the fetus. The claim in Jiyin Gangmu that "only draining Qi and promoting urination cures it" is erroneous. (Xiao Shenzhai)
**Zixuan (Fetal Distension / Rising Fetal Qi)**
Ben Shi Fang states: Zisu Yin (Perilla Decoction) treats Zixuan. Zixuan refers to Turbid Qi pushing the fetus upward. Fetal Heat and rebellious Qi cause chest/diaphragm fullness. Perilla Leaf, Tangerine Peel, Melon Rind, and Chuanxiong are needed to circulate Qi; Danggui and Baishao are needed to nourish Blood. Once Qi and Blood flow freely, the body becomes deficient, so Renshen (Ginseng) and Gancao (Licorice) are added to tonify. (He Song'an)
Zixuan is fetal Qi pressing on the heart and chest. Qi and Blood stagnation around the fetus generates Heat. Liangfu emphasized Fetal Heat and Rebellious Qi; Song'an emphasized Turbid Qi lifting the fetus. Both views on Heat-Fire are appropriate. Some attribute it to Cold from frozen drinks or Mingmen Fire decline, but one must judge by constitution and pulse. Robust constitution with surging-rapid pulse indicates Heat-Fire; weak Spleen-Stomach with slow-thin pulse indicates Deficiency-Cold. (Xiao Shenzhai)
**Ziyin (Pregnancy Aphonia)**
Huangdi asked: Why does a woman lose her voice in the ninth month of pregnancy? Qibo answered: The collaterals of the uterus are blocked. Huangdi asked: Why? Qibo answered: The uterine collaterals connect to the Kidney. the Shaoyin Meridian passes through the Kidney and ties to the root of the tongue, hence the inability to speak. Huangdi asked: How to treat? Qibo answered: No treatment is needed; speech will return in the tenth month. (Suwen)
Note: "Aphonia" means having words but no sound. "Cannot speak" does not mean total silence. Sound comes from the throat and originates at the tongue root. Due to fetal enlargement, the ascending pathway of the Kidney meridian is blocked. The Kidney meridian enters the Lung, follows the throat, and ties to the tongue root. The throat is the domain of the Lung, which governs sound. Thus, the woman whispers, but others cannot hear. If Kidney collaterals were truly severed, the disease would be incurable, and postpartum recovery would be impossible. Therefore, "severed" (Jue) in "Uterine collaterals are severed" should be interpreted as "blocked." (Zhang Huang)
While the Classic provides no treatment for pregnancy aphonia, later physicians hesitated to prescribe formulas. Zhang Zihe treated it by descending Heart Fire; Yuan Tai treated it by tonifying Heart and Kidney, because the uterine collaterals belong to the Hand and Foot Shaoyin meridians. Postpartum aphonia is due to stagnant blood entering the Heart; stroke-induced aphonia is due to phlegm-damp blocking collaterals. Pregnancy aphonia must also have a specific cause; symptoms should be analyzed carefully to supplement the incomplete theories of Zhang and Ma. (Xiao Shenzhai)
**Zifen (Pregnancy Irritability)**
"Irritability" refers to mental restlessness and anxiety. After conception, Blood-Heat disturbs the Heart, causing depression and agitation. It is called Zifen because it occurs during pregnancy, not because the fetus is irritable. Ancients said: In the fourth month, Shaoyin Jun-Hour nourishes essence; in the sixth month, Shaoyang Xiang-Hour nourishes Qi, hence irritability. While irritability is often Fire-related, since the fetus receives Jun-Xiang Fire for nourishment, why would it make the mother irritable? If it were maternal deficiency causing irritability, it would occur every month, not just the fourth and sixth. This theory seems flawed. (Li Taisu)
There are four types of pregnancy irritability: Empty Irritability, Heart Irritability, Chest Irritability, and Zifen, all related to Heat.
- Empty Irritability: Organ deficiency allows Heat to invade the Heart.
- Chest Irritability: Phlegm-fluid accumulation causing vomiting of frothy sputum.
- Zifen: Blood stasis and fluid retention, Cold-Heat conflict, disturbing the fetus. (Qi Zhongfu)
Fire entering the Lung causes irritability; entering the Kidney causes restlessness. The fetus is tied to the Kidney. Kidney Water nourishes the fetus, leaving insufficient Water to control Kidney Fire. Fire scorches the Lung, causing irritability and restlessness. This indicates deficiency of Metal and Water. Treatment should nourish the source of transformation, clearing Metal and strengthening Water. (Xiao Shenzhai)
**Ziming (Fetal Crying / Fetal Movements)**
If a nodule forms on the umbilical cord inside the pregnant woman's abdomen and the fetus holds it in its mouth, climbing high or raising arms may dislodge it, causing noise. Having the pregnant woman bend over as if picking something up allows the nodule to re-enter the fetus's mouth, stopping the sound. For fetal crying in the abdomen, drinking rhizome earth mixed with Coptis juice stops it. (Chanbao Baiwen)
Abdominal bell-like ringing is similar to fetal crying, so treatments are the same. Xue Lizhai noted: Coptis is cold, and Musk opens orifices; use them with discretion. (Xiao Shenzhai)
**Abdominal Pain**
In the sixth or seventh month of pregnancy, if the pulse is wiry, there is fever, increased fetal distension, abdominal pain, aversion to cold, and a sensation of cold wind in the lower abdomen. This is because the Zi Zang (Uterus) is open. Treat with Fuzi Tang (Aconite Decoction) to warm the uterus.
- Abdominal pain during pregnancy due to Bao Zu (Obstruction of the Womb): Jiao'ai Tang (Donkey-Hide Gelatin Decoction).
- Abdominal pain during pregnancy: Danggui Shaoyao San (Angelica and Peony Powder). (Jinkui Yaolue)
Pre-natal abdominal pain can be Excess (Wind-Cold, Phlegm-Fluid, Seven Emotions) or Deficiency (Qi Stagnation, Qi Deficiency, Blood Deficiency).
- Spleen-Stomach Qi Deficiency: Tonify Qi and regulate Qi.
- Yin Deficiency and Blood Deficiency: Nourish Blood and warm the channels. Apply according to clinical examination. (Xiao Shenzhai)
**Lower Back Pain**
Pregnancy lower back pain is critical. The fetus is tied to the waist; soreness and urgency indicate the tie is loosening, signaling imminent labor. Alternatively, it may be due to labor injury damaging meridians, Cold invading causing pain radiating to the back, sprain/Qi stagnation, Kidney Essence deficiency, Liver Fire from anger, Liver-Spleen Qi stagnation, Bladder Wind invasion, or Blood Heat/Stasis. Regardless of cause, persistent pain disturbs the fetus. Treatment generally focuses on securing the fetus. (Shen Jin'ao)
**Hypochondriac Pain**
Pregnancy hypochondriac pain has three causes: weeping, internal injury, and anger. Do not use Blood-moving or Qi-breaking herbs. Use fresh human urine, or Zisu Yin (Perilla Decoction) without Renshen, adding Danggui and Baishao, for stability. (Jianwen Lu)
**Hematuria**
Blood from Taileu (Fetal Leakage) exits the vagina; blood from Hematuria exits the urethra. Pregnancy hematuria is mostly due to Uterine Heat. Treat with Siwu Tang plus Fahui (Burnt Hair), Shanzhi (Gardeniae Fructus), and Ejiao (Donkey-Hide Gelatin). (Li)
Hematuria is easily confused with Taileu. Li's differentiation clarifies this: Taileu is frequent and continuous; Hematuria results from Heart Fire transferring to the Small Intestine, seeping into the Bladder, and exiting only during urination. (Xiao Shenzhai)
**Zhuanbao (Malposition of the Urinary Bladder / Urinary Retention)**
A woman suffers from normal diet, heat, inability to lie flat, and orthopnea. Why? The Master says: This is Zhuanbao, inability to urinate. The bladder ligament is twisted. Promoting urination cures it; use Shenqi Wan (Kidney Qi Pill). (Jinkui Yaolue)
The term "Bao" (Womb/Bladder) has two pronunciations. In Suwen and Lingshu, "Bao" (pronounced 'bao') refers to the Uterus. In Lingshu, "Bao" (pronounced 'pao') refers to the Urinary Bladder. Later authors confused these, sometimes treating the Uterus and Bladder as separate entities, or conversely, merging them. The Bladder IS the Pao. There is nothing else inside the Bladder. Those who merge them fail to realize that in Zhuanbao, the fetus presses down on the Bladder, blocking urine. The Uterus is above, the Bladder below; they are distinct locations. (Fengshi Jinnang)
Pregnancy Zhuanbao, inability to urinate, is due to Middle Qi deficiency failing to lift the fetus. The fetus presses on the bladder, twisting the ligament. Use Buzhong Yiqi Tang to lift. (Zhao Shi Yi Guan)
Zhuanbao is common in women with weak constitutions, excessive worry, irritability, or rich diets. Ancient slippery/purgative formulas rarely work. The fetus presses the bladder to one side, twisting the ligament and blocking water passages. If the fetus is lifted to the center, the ligament untwists, and urination resumes. Treatment: Canzhu Yin, followed by induced vomiting to raise Qi. Repeat until urination flows. (Danxi Xinfa)
Pre-natal Zhuanbao is mostly due to Qi and Blood deficiency. Low Blood fails to nourish the fetus; weak Qi fails to lift it. The fetus descends and presses the Bladder, twisting it and blocking urine. Besides Danxi's causes (worry, irritability, rich diet), treatment focuses on tonifying Qi and Blood. However, consider: Spleen-Lung Qi deficiency failing to transport to the Bladder; Heat-Stagnation blocking Bladder fluids; or Lung Dryness/Heat from Fire scorching Metal. Diagnose carefully. (Xiao Shenzhai)
**Zilin (Pregnancy Dysuria)**
Zilin resembles Zhuanbao. Frequent, painful, drop-by-drop urination is Zilin; frequent, scanty, painless urination is Zhuanbao. (Zhengzhi Yaojue)
Zilin has two categories: Mother's own illness or Fetal issue affecting the mother.
Mother's illness: Internal Heat from spicy food, or Dryness from sweating/diarrhea.
Fetal issue: Fetal Heat obstruction, or Fetal shape compression.
Treat Heat by clearing, Dryness by moistening, Obstruction by unblocking, Compression by moving. (Wan Mizhai)
Scanty,涩 (astringent/scanty) urination is due to Qi/Blood gathering to nourish the fetus, leaving the Bladder with stagnant Heat. Use Blood-nourishing herbs, Maidong (Ophiopogonis Radix) to nourish Water source, and Huashi (Talcum) to clear stagnation. Formula: Anrong San. If early pregnancy, reduce Huashi, add Shihu (Dendrobii Caulis) and Shanzhi. To clear Bladder Heat, soothe Jueyin Qi, as the urethra belongs to Jueyin. (Chen Liangfu)
Scanty, dripping urination: Anrong San.
Liver Channel Deficiency Heat: Jiawei Xiaoyao San.
Dry herbs causing frequency/obstruction: Shengdi, Fuling, Zhimu, Huangbai, Chuanxiong, Danggui, Gancao.
Frequency with yellow/red urine: Siwu Tang plus Zhimu, Huangbai.
Lung Qi Deficiency with short urine: Buzhong Yiqi Tang plus Maidong, Wuweizi.
Heat binding the Bladder: Wulin San.
Spleen-Lung Dry-Heat: Huangqin Qingfei Yin.
Bladder Yin Deficiency (Yang has no source): Zishen Wan.
Bladder Yang Deficiency (Yin has no transformation): Shenqi Wan. (Xue Lizhai)
**Tai Bu Chang Yang (Failure of Fetal Growth)**
Qi nourishes the twelve meridians cyclically. The fetus resides in the womb. If it withers, it is due to maternal weak constitution, imbalance of Yin/Yang/Qi/Blood, and lack of nourishment. Tonify maternal Qi and Blood to nourish the fetus.
Poor prenatal care, Spleen-Stomach dysfunction, poor appetite, failure to circulate Ying/Wei, transform essences, and nourish Chong/Ren leads to weak fetus. As Chaoyuanfang said: Treating the mother's illness calms the fetus. Harmonize Spleen-Stomach, promote digestion, generate Qi/Blood, and the fetus will grow. (Shengji Zonglu)
Fetal origin depends on Qi and Blood. Failure to grow is due to insufficiency.
- Post-conception bleeding: Blood fails to return to the fetus.
- Middle-aged women with declining Qi/Blood: Source dries up.
- Women with Spleen-Stomach issues: Granary is thin, source is depleted, Chong/Ren exhausted.
- Women prone to anger: Liver Qi rebels, Blood is unregulated, fetus loses nourishment.
- Cold Qi/Blood: Yang deficiency reduces generating Qi.
- Hot Qi/Blood: Fire excess damages True Yin.
Treat with tonification, consolidation, warming, or clearing as indicated. If term is reached or passed, Qi/Blood gradually fills, and growth resumes. Only extreme old age/weakness is beyond human effort. (Zhang Jingyue)
**Guoqi Bu Chan (Post-term Pregnancy)**
Q: Some women menstruate monthly while the fetus grows; some bleed heavily at 3-5 months without miscarriage; some deliver on time or late. What is the reason?
A: Monthly bleeding with fetal growth is called Shengtai (Prosperous Fetus). Strong Qi/Blood leaves surplus blood for menstruation. Heavy bleeding with a viable fetus is Lou Tai (Leaking Fetus). Trauma moves the Ren Mai, causing bleeding without harming the uterus. However, blood loss depletes Qi/Blood, often delaying delivery. Cases of 12-13 months or even 20+ months exist due to insufficient Qi/Blood to sustain the embryo. After ten months, administer Qi/Blood tonics. (Yu Tianmin)
**Zi Si Fu Zhong (Dead Fetus in Utero)**
Retained placenta is urgent before birth. Dead fetus is more dangerous than retained placenta. Before birth, mother and fetus share respiration. If the fetus dies, the uterine cavity becomes cold, fetal blood coagulates, and Qi fails to ascend/descend. Ancient formulas used Blood-movers, Qi-regulators, and harsh purgatives like Nixiao (Niter), Shuiyin (Mercury), and Naosha (Sal Ammoniac). But if the fetus is dead and cold, using cold purgatives harms the mother. Ancient prescriptions were nuanced.
Two causes of fetal death:
1. Maternal bleeding, exhaustion of blood, or trauma/internal injury. Use Fuzi Tang (three doses) to warm the uterus and melt coagulated blood. Aconite breaks Cold and expels the fetus.
2. External pathogens (Cold Damage, Fever Disease, Warm Malaria) transmitting toxic Heat to the fetus. The fetus dies and rots, potentially swelling. Use Puxiao (Mirabilite/Niter) to rot the fetus, assisted by Blood/Qi movers, to expel the dead fetus. This is the intent of the formula. (Shengji Zonglu)
Causes: Heat disease, trauma, fright, premature labor stimulation, exhaustion of Lochia, leading to dried/cold fetus unable to exit.
Diagnosis:
- Red face, blue tongue: Fetus dead, Mother alive.
- Blue face, red tongue: Mother dead, Fetus alive.
- Blue face and tongue: Both dead.