【歌】恶阻生于二月时，心烦闷乱食难施。胚胎经隧多壅塞，浊气攻冲运化迟，气郁停痰兼胃实，虚寒肝火
并忧思，大都止呕调脾胃，顺气和中最得宜。
【论】恶阻者，谓妊娠吐呕、恶心、头眩、恶食、择食是也。《产宝》谓之子病。巢氏谓之恶阻。陈良甫谓
胃气怯弱，中脘停痰，脉息和顺，但四肢沉重，头眩择食，惟嗜酸咸，甚者寒热呕吐，胸膈烦满，半夏茯苓丸。
张仲景曰∶妇人得平脉，阴脉小弱，其人渴不能食，无寒热，名妊娠，于法六十日当有此症，设有医者治逆却一月
加吐下者，则绝之。《金匮要略》曰∶妊娠呕吐不止，干姜人参半夏丸。
【脉】呕吐痰水寸必沉滑，涩郁迟寒微虚数热，怒气伤肝脉弦而弱，或虚或实有力无力。
痰水
恶阻多因胃有痰，饮随气上亦相参，二陈砂藿堪和胃，若喜酸尝主是男。戴复庵曰∶胎前恶阻见物呕吐，嗜
酸咸物，多卧少起，俗名病鬼。盖其人宿有痰饮，血壅遏而不行，饮随气上停滞肝经，故喜酸物，金能克木，以辛
胜之，小半夏茯苓汤主之，或二陈汤、砂仁、藿香。
虚寒
胃虚令人常吐食，胃冷无缘纳水浆，二者必然脉迟细，人参半夏与干姜。
肝火
小腹平明气上冲，因而郁塞满胸中，厥阴相火冲于胃，茹橘芦根用总同。罗大无曰∶妊娠三月呕吐恶阻，每
至寅卯时觉小腹有气上冲，然后膈满而吐，此肝火挟冲脉之火上冲也，用沉香磨水，化抱龙丸一服，胸膈气不升吐自止
也。
气郁
气郁中焦呕吐生，头眩胸满胀非轻，脉来左手弦而弱，苓半煎汤下抑青。朱丹溪曰∶呕吐晕眩，脉左弦而弱，
此恶气因怒气所激，肝气伤乃挟胎气上逆，参术补之非也，宜半夏茯苓汤下抑青丸，或砂仁炒为末，淡姜汤调
服二钱。
胃实
气血成胎二月间，中焦壅塞不能还，必然秽浊攻于胃，水谷如何得下关。芦根汤。丹溪曰∶妊娠呕逆不食，
心烦闷乱，乃是气血积聚以养胎元，精血内郁，秽浊之气上攻于胃，宜陈皮半夏汤。
用药大法
李茂翁曰∶左脉弱而呕，服诸药不止者，当服理血归原药则愈矣。经曰∶无阴则呕是也。归原散。薛立斋曰∶
中脘停痰，二陈汤加枳壳，若饮食停滞，六君子汤加枳壳，若脾胃虚弱，异功散。胃气不足，人参桔皮汤。气恼
加枳壳，胸胁痞闷加苏梗，胁痛加柴胡，饮食少思六君子加枳壳、苏梗，头晕体倦六君子，脾胃虚弱，呕吐不食，
半夏茯苓汤加白术。盖白术、茯苓、半夏、陈皮、砂仁善能安胎气，健脾胃，予常用验矣。故王子亨白术散、局
方人参丁香散、杨振人参桔皮汤、齐自明醒脾饮，不用半夏亦可。
【方】
半夏茯苓丸
茯苓 半夏 桔皮 枳壳 人参 甘草 干姜
蜜丸每服二十丸。《肘后方》无姜、半。只五品。
干姜人参半夏丸
干姜 人参（各一两） 半夏（二两） 生姜汁
糊丸，砂仁汤下。
橘皮竹茹汤
橘皮 竹茹 茯苓 半夏 生姜
水煎服忌羊、鸡、鱼、面。
芦根汤
生芦根 桔皮 生姜 大腹皮 枇杷叶
水煎。
归原散
人参 白术 茯苓 陈皮 半夏 桔梗 甘草 枳壳 川芎 当归 白芍 丁香
姜枣水煎。
半夏茯苓汤
半夏 茯苓 生姜 桔皮 人参 旋复花 白芍 甘草 川芎 桔梗 细辛 生地
如热去细辛加知母，泻去生地，二服后，服茯苓丸。
二香散
香附（一两） 藿香（五钱） 甘草（二钱）
为末砂仁汤调服二钱。
【歌诀】恶阻症多发生于妊娠第二个月，患者心中烦闷、神志紊乱、食欲减退。这是因为胚胎形成后，经络气血多有壅滞，导致浊气上逆攻冲，脾胃运化功能迟缓。此病常由气机郁结、痰饮停滞兼胃腑实热，或虚寒、肝火旺盛并伴有忧思过度所致。治疗大抵以止呕、调理脾胃为主，顺气和中最为适宜。
【论述】所谓恶阻，是指妊娠期间出现呕吐、恶心、头晕、厌恶食物、挑食等症状。《产宝》称之为“子病”。巢元方称之为“恶阻”。陈良甫认为，这是由于胃气虚弱，中脘部停聚痰饮，脉象和顺，仅表现为四肢沉重、头晕、挑食，特别嗜好酸咸食物；严重者会出现寒热交替、呕吐，胸膈部烦闷胀满，可用半夏茯苓丸治疗。张仲景说：妇女诊得平和之脉，尺部脉象细小微弱，患者口渴不能进食，无恶寒发热症状，诊断为妊娠，按病程推算六十天左右应当出现这些症状。如果有医生误治导致病情逆转，反而在一个月后加重了呕吐和下利，则应停止错误的治疗（或指断绝病源/调整治法）。《金匮要略》记载：妊娠呕吐不止，用干姜人参半夏丸治疗。
【脉诊】呕吐痰水者，寸口脉必见沉滑；涩脉主气郁，迟脉主寒，微脉主虚，数脉主热；因怒气伤肝者，脉象弦而弱；脉象或虚或实，有力无力需辨证。
痰饮型
恶阻多因胃中有痰饮，随气上逆亦与此相关，二陈汤加砂仁、藿香可调和胃气，若喜食酸味则主生男胎。戴复庵说：胎前恶阻见到见物即吐，嗜食酸咸，多卧少起，俗称“病鬼”。大概是因为其人素来有痰饮，血液壅遏不行，饮邪随气上逆停滞于肝经，所以喜食酸味，因为金能克木，以辛味胜之，用小半夏茯苓汤主治，或者用二陈汤、砂仁、藿香。
虚寒型
胃虚使人经常呕吐食物，胃冷无缘无故无法摄入水浆，这两种情况脉象必然迟细，用人参半夏汤配合干姜治疗。
肝火型
小腹平时感觉有气向上冲撞，因而郁塞充满胸中，厥阴相火上冲至胃，使用竹茹、橘皮、芦根等药总归相同。罗大无说：妊娠三个月呕吐恶阻，每到寅卯时（凌晨3-7点）觉得小腹有气上冲，然后胸膈满闷而呕吐，这是肝火挟带冲脉之火上冲所致，用沉香磨水，送服抱龙丸一剂，胸膈气不升，呕吐自然停止。
气郁型
气机郁结于中焦而生呕吐，头晕胸闷腹胀并不轻微，脉象左手弦而弱，用苓半煎汤送服抑青丸。朱丹溪说：呕吐晕眩，脉象左弦而弱，这是恶气因怒气激发，肝气受伤乃挟带胎气上逆，用参术补气是错误的，宜用半夏茯苓汤送服抑青丸，或者将砂仁炒为末，淡姜汤调服二钱。
胃实型
气血凝聚成胎在二月间，中焦壅塞不能回转，必然秽浊之气攻冲于胃，水谷如何能够进入关窍？用芦根汤。丹溪说：妊娠呕逆不食，心烦闷乱，乃是气血积聚以滋养胎元，精血内郁，秽浊之气上攻于胃，宜用陈皮半夏汤。
用药大法
李茂翁说：左脉弱且呕吐，服用各种药物不止的，应当服用理血归原的药物则会痊愈。经文说：“无阴则呕”就是这个道理。用归原散。薛立斋说：中脘停痰，用二陈汤加枳壳；若饮食停滞，用六君子汤加枳壳；若脾胃虚弱，用异功散。胃气不足，用人参桔皮汤。气恼加枳壳，胸胁痞闷加苏梗，胁痛加柴胡，饮食少思用六君子汤加枳壳、苏梗，头晕体倦用六君子汤。脾胃虚弱，呕吐不食用半夏茯苓汤加白术。大概白术、茯苓、半夏、陈皮、砂仁善于安胎气，健脾胃，这是我常用且验证有效的。所以王子亨的白术散、局方的人参丁香散、杨振的人参桔皮汤、齐自明的醒脾饮，不用半夏也可以。
【方剂】
半夏茯苓丸
茯苓、半夏、桔皮、枳壳、人参、甘草、干姜。
蜜丸，每服二十丸。《肘后方》无姜、半夏，只有五味药。
干姜人参半夏丸
干姜、人参（各一两），半夏（二两），生姜汁。
糊丸，砂仁汤送下。
橘皮竹茹汤
橘皮、竹茹、茯苓、半夏、生姜。
水煎服，忌食羊、鸡、鱼、面。
归原散
人参、白术、茯苓、陈皮、半夏、桔梗、甘草、枳壳、川芎、当归、白芍、丁香。
姜枣水煎。
半夏茯苓汤
半夏、茯苓、生姜、桔皮、人参、旋复花、白芍、甘草、川芎、桔梗、细辛、生地。
若有热去细辛加知母，若腹泻去生地，服两剂后，再服茯苓丸。
[Verse]
Ezu (Morning Sickness) often occurs in the second month of pregnancy, characterized by mental restlessness, confusion, and difficulty eating. This is because after conception, the meridians and collaterals are often congested, causing turbid qi to attack upward and slowing down digestion and transformation. The condition usually results from Qi stagnation, phlegm retention combined with stomach excess, or deficiency-cold, liver fire, and excessive worry. Generally, treatment focuses on stopping vomiting and regulating the spleen and stomach; smoothing Qi and harmonizing the middle jiao is most appropriate.
[Discussion]
Ezu refers to symptoms during pregnancy such as vomiting, nausea, dizziness, food aversion, and selective eating. *Chanbao* calls it "Zibing" (Fetal Disease). Chao Yuanfang calls it "Ezu". Chen Liangfu believes this is due to weak stomach qi and phlegm retention in the epigastrium. The pulse is harmonious, but the patient experiences heavy limbs, dizziness, selective eating, and a strong craving for sour and salty foods. In severe cases, there may be alternating chills and fever, vomiting, and fullness and irritability in the chest and diaphragm; Banxia Fuling Wan (Pinellia and Poria Pill) can be used. Zhang Zhongjing stated: When a woman has a normal pulse but the yin pulse (cun kou/radial artery deep position or chi pulse) is slightly weak, and she suffers from thirst and inability to eat without chills or fever, it is diagnosed as pregnancy. According to the method, these symptoms should appear around the sixtieth day. If a physician treats incorrectly and causes reversal, worsening vomiting and diarrhea within a month, the erroneous treatment should be stopped (or the disease source cut off). *Jinkui Yaolue* states: For persistent vomiting during pregnancy, Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill) is used.
[Pulse Diagnosis]
For vomiting of phlegm and water, the cun (inch) pulse must be deep and slippery. A choppy pulse indicates Qi stagnation, a slow pulse indicates cold, a faint pulse indicates deficiency, and a rapid pulse indicates heat. Injury to the liver from anger presents with a wiry and weak pulse; the pulse may be deficient or excess, with varying strength.
Phlegm-Type
Ezu is mostly caused by phlegm in the stomach, where fluids follow the rebellious qi. Erchen Tang (Two-Cured Decoction) added with Sharen (Amomum Fruit) and Huoxiang (Patchouli Herb) can harmonize the stomach. Craving sour foods suggests a male fetus. Dai Fu'an said: In pre-natal Ezu, seeing objects triggers vomiting, craving for sour and salty foods, lying down much and rising little, commonly known as "Binggui" (Sickness Ghost). This is likely because the person has chronic phlegm-fluids, blood is congested and does not flow, and fluids rise with qi and stagnate in the Liver Meridian, hence the craving for sour foods. Since Metal controls Wood, pungent flavors overcome it. Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) is the main treatment, or alternatively Erchen Tang, Sharen, or Huoxiang.
Deficiency-Cold Type
Stomach deficiency leads to frequent vomiting of food; stomach cold makes it impossible to take in water or broth. In both cases, the pulse is necessarily slow and fine. Renshen Banxia Tang (Ginseng and Pinellia Decoction) with Ganjiang (Dried Ginger) is used.
Liver-Fire Type
Qi rushes upward from the lower abdomen, causing stagnation and fullness in the chest. Jueyin (Liver) ministerial fire rushes to the stomach. Zhuyu (Bamboo Shavings), Ju Pi (Tangerine Peel), and Lugeng (Reed Rhizome) are generally effective. Luo Dawu said: In the third month of pregnancy, Ezu vomiting often occurs at Yin-Mao hours (3-7 AM), feeling qi rushing up from the lower abdomen, followed by chest fullness and vomiting. This is Liver Fire carrying Chong Mai (Penetrating Vessel) fire upward. Use Chenxiang (Aquilaria Wood) ground in water to dissolve Baolong Wan (Embrace Dragon Pill) once; when chest qi stops rising, vomiting ceases naturally.
Qi-Stagnation Type
Qi stagnation in the middle jiao generates vomiting, accompanied by dizziness, chest fullness, and distension. The left hand pulse is wiry and weak. Lingban (Poria and Pinellia) decoction is used to administer Yiqing Wan (Suppress Green Pill). Zhu Danxi said: Vomiting and dizziness with a wiry and weak left pulse indicate that evil qi, stimulated by anger, injures the Liver Qi, which then carries fetal qi upward. Using Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala) to tonify is incorrect. Instead, use Banxia Fuling Tang (Pinellia and Poria Decoction) to administer Yiqing Wan, or grind Sharen (Amomum Fruit) into powder and take 2 qian with light ginger soup.
Stomach-Excess Type
In the second month, Qi and Blood condense to form the fetus. The middle jiao becomes congested and cannot circulate properly. Turbid and foul qi inevitably attacks the stomach, making it difficult for food and drink to pass through the gates. Lugeng Tang (Reed Rhizome Decoction) is used. Danxi said: Pregnancy vomiting and refusal to eat, with mental restlessness, is due to Qi and Blood accumulating to nourish the fetal origin. Essence and Blood stagnate internally, and turbid qi attacks the stomach. Chenpi Banxia Tang (Tangerine Peel and Pinellia Decoction) is appropriate.
General Principles of Medication
Li Maoweng said: If the left pulse is weak and vomiting persists despite various medications, one should take Lixue Guiyuan Yao (Blood-Regulating and Origin-Returning Medicine) to recover. The classic says: "Without Yin, there is vomiting." Guiyuan San (Return to Origin Powder) is used. Xue Lizhai said: For phlegm retention in the epigastrium, use Erchen Tang (Two-Cured Decoction) with Zhike (Aurantii Fructus); for food stagnation, use Liujunzi Tang (Six-Gentlemen Decoction) with Zhike; for spleen and stomach weakness, use Yigong San (Extraordinary Skill Powder). For insufficient stomach qi, use Renshen Jiupi Tang (Ginseng and Tangerine Peel Decoction). Add Zhike for anger-induced Qi stagnation, Sugen (Perilla Stem) for chest and hypochondriac stuffiness, Chaihu (Bupleurum Root) for hypochondriac pain, and add Zhike and Sugen to Liujunzi Tang for poor appetite. For dizziness and fatigue, use Liujunzi Tang. For spleen and stomach weakness with vomiting and anorexia, use Banxia Fuling Tang (Pinellia and Poria Decoction) with Baizhu (Atractylodes Macrocephala). Baizhu, Fuling (Poria), Banxia (Pinellia), Chenpi (Tangerine Peel), and Sharen (Amomum Fruit) are good at calming the fetus and strengthening the spleen and stomach; I have verified their efficacy frequently. Therefore, Wang Ziheng's Baizhu San (Atractylodes Powder), Bureau Formula's Renshen Dingxiang San (Ginseng and Clove Powder), Yang Zhen's Renshen Jiupi Tang, and Qi Ziming's Xingpi Yin (Spleen-Awakening Drink) can be used without Banxia.
[Formulas]
Banxia Fuling Wan (Pinellia and Poria Pill)
Fuling (Poria), Banxia (Pinellia Tuber), Jiupi (Tangerine Peel), Zhike (Aurantii Fructus), Renshen (Ginseng Root), Gancao (Licorice Root), Ganjiang (Dried Ginger).
Honey pills, 20 pills per dose. *Zhouhou Fang* omits Jiang and Banxia, using only five ingredients.
Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill)
Ganjiang (Dried Ginger), Renshen (Ginseng Root) (1 liang each), Banxia (Pinellia Tuber) (2 liang), Shengjiang (Fresh Ginger Juice).
Paste pills, taken with Sharen (Amomum Fruit) decoction.
Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction)
Jupi (Tangerine Peel), Zhuru (Bamboo Shavings), Fuling (Poria), Banxia (Pinellia Tuber), Shengjiang (Fresh Ginger).
Decoct in water. Avoid mutton, chicken, fish, and wheat noodles.
Lugeng Tang (Reed Rhizome Decoction)
Sheng Lugeng (Fresh Reed Rhizome), Jiupi (Tangerine Peel), Shengjiang (Fresh Ginger), Dafupi (Areca Seed Husk), Pipaye (Loquat Leaf).
Decoct in water.
Guiyuan San (Return to Origin Powder)
Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Chenpi (Tangerine Peel), Banxia (Pinellia Tuber), Jiegeng (Platycodon Root), Gancao (Licorice Root), Zhike (Aurantii Fructus), Chuanxiong (Sichuan Lovage Rhizome), Danggui (Angelica Sinensis Root), Baishao (White Peony Root), Dingxiang (Clove).
Decoct with Fresh Ginger and Jujube.
Banxia Fuling Tang (Pinellia and Poria Decoction)
Banxia (Pinellia Tuber), Fuling (Poria), Shengjiang (Fresh Ginger), Jiupi (Tangerine Peel), Renshen (Ginseng Root), Xuanfuhua (Inula Flower), Baishao (White Peony Root), Gancao (Licorice Root), Chuanxiong (Sichuan Lovage Rhizome), Jiegeng (Platycodon Root), Xixin (Asarum Root), Shengdi (Rehmannia Root).
If heat is present, remove Xixin and add Zhimu (Anemarrhena Rhizome); if diarrhea is present, remove Shengdi. After two doses, take Fuling Wan (Poria Pill).
Erxiang San (Two Fragrances Powder)
Xiangfu (Cyperus Rhizome) (1 liang), Huoxiang (Patchouli Herb) (5 qian), Gancao (Licorice Root) (2 qian).
Grind into powder, take 2 qian mixed with Sharen (Amomum Fruit) decoction.