《大全》曰∶妊娠心痛，乃风邪痰饮交结，伤心支络，乍安乍作。若伤子脏，则胎动而血下。
慎斋按∶以上一条，序胎前有心痛之证也。心痛不止，风邪痰饮，为外感有余病。妊娠心气虚而血少，亦
足致此。《大全》论，不过举其一端耳。
《大全》曰∶肾主腰足，因劳伤损动其经，虚则风冷乘之。腰痛不止，多动胎气。妇人肾以系胞，妊娠腰
痛，甚则胎堕。故妊娠腰
痛，最为紧要。若闪挫气不行腰痛者，通气散。肾虚者，青娥不老丸。总以固胎为主。
汪石山曰∶有妇人怀娠八月，尝病腰痛，不能转侧，大便燥结，医用人参等补剂，痛益加，用硝黄通利之
药，燥结虽行，而痛如故。诊之脉稍洪近快，曰∶此血热血滞也，宜四物加木香、乳、没、黄柏、火麻仁。五
帖痛减，燥结润，复加发热面赤，或时恶寒，前方去乳、没，加柴、芩。二帖寒热除，而腰痛复作，此血已利
矣，前方加人参，服之安。
何松庵曰∶腰者肾之府，足少阴之所留注。妊娠腰痛，多属劳力。盖胞系于肾，劳力任重，致伤胞系，则腰
必痛，甚则胞系欲脱，多致小产。宜安胎为主，胎安而痛自愈。若素享安逸而腰痛，必房事不节，致伤胞系
也。若脉缓，遇天阴，或久坐而痛者，湿热也。腰重如带物而冷者，寒湿也。脉大而痛不已者，肾虚也。脉涩
而日轻夜重者，气血凝滞也。脉浮者，为风邪所乘。脉实者，闪挫也。若临月腰痛，胞欲脱肾，将产之候也。
《女科大全》说：妊娠期间的心痛，是由于风邪与痰饮相互纠结，损伤了心部的支络，导致疼痛时好时坏。如果伤及子宫（子脏），就会导致胎动不安并伴有阴道出血。
慎斋按语：以上这一条，叙述了怀孕前有心痛这种病症的情况。心痛不止，是因为风邪和痰饮，属于外感引起的实证有余之病。但妊娠期心气虚弱且血液不足，也足以导致这种情况。《女科大全》的论述，只是举出了其中一方面罢了。
《女科大全》说：肾主管腰部和足部，因为劳累损伤使得经脉受损，正气虚弱时风寒湿邪就会趁虚侵袭。腰痛不止，容易扰动胎气。妇女的肾通过胞系连接子宫，妊娠期间腰痛，严重时会导致流产。所以妊娠期的腰痛，是最为紧要的问题。如果是因闪挫导致气机不畅引起的腰痛，使用通气散。如果是肾虚引起的，使用青娥不老丸。总的原则是以固护胎元为主。
汪石山说：有一位妇女怀孕八个月，曾经患有腰痛，不能翻身侧卧，大便干燥结滞。医生用人参等补益药剂，疼痛反而加重；又用芒硝、大黄等通利泻下的药物，虽然大便通畅了，但疼痛依旧。诊察其脉象稍洪大且接近快速，说：这是血热兼有血瘀阻滞，适宜用四物汤加入木香、乳香、没药、黄柏、火麻仁。服用五帖后疼痛减轻，大便变得润通，随后又出现发热面赤，有时恶寒的症状，前方去掉乳香、没药，加入柴胡、黄芩。服用两帖后寒热症状消除，但腰痛再次发作，这说明血液已经流通了，在前方中加入人参，服用后病情安定。
何松庵说：腰部是肾的外府，是足少阴肾经气血停留灌注的地方。妊娠期间的腰痛，多属于劳累所致。因为胞宫系于肾，劳累负重，导致胞系受伤，腰部必然疼痛，严重时胞系欲脱，多导致小产。适宜以安胎为主，胎元安稳而疼痛自然痊愈。如果平时享受安逸却出现腰痛，一定是房事不节制，导致胞系受伤。如果脉象缓弱，遇到阴天或久坐后疼痛加重的，是湿热证。腰部沉重如同带着重物且感觉寒冷的，是寒湿证。脉象大而疼痛不止的，是肾虚证。脉象涩且白天轻晚上重的，是气血凝滞证。脉象浮的，是被风邪所乘袭。脉象实的，是闪挫伤所致。如果临近预产期腰痛，是胞宫下坠、肾气松动，即将分娩的征候。
*Daquan* states: Heart pain during pregnancy is caused by the entanglement of wind pathogen and phlegm-fluid, damaging the collateral branches of the heart, resulting in pain that comes and goes. If the *Zizang* (uterus) is injured, it leads to fetal movement and vaginal bleeding.
Shenzhen's commentary: The above paragraph describes the syndrome of heart pain occurring before delivery. Persistent heart pain due to wind pathogen and phlegm-fluid belongs to excess syndromes caused by external contraction. However, deficiency of heart qi and blood insufficiency during pregnancy are also sufficient to cause this condition. The discussion in *Daquan* only mentions one aspect.
*Daquan* states: The Kidney governs the waist and feet. Due to strain and injury affecting the meridians, when deficiency occurs, wind-cold pathogens take advantage. Persistent lower back pain often disturbs the fetal qi. In women, the Kidney connects to the uterus via the uterine ligaments (*Baoxi*). Lower back pain during pregnancy, if severe, can lead to miscarriage. Therefore, lower back pain during pregnancy is of utmost importance. For lower back pain caused by sprain or strain with stagnant qi, use *Tongqi San*. For cases due to Kidney deficiency, use *Qing'e Bulao Wan*. The general principle is to prioritize securing the fetus.
Wang Shishan said: A woman at eight months of pregnancy suffered from lower back pain, unable to turn or lie on her side, accompanied by dry and constipated stool. The physician administered tonifying agents such as Ginseng, which exacerbated the pain. Then, purgatives containing Nitre (Xiaoshi) and Rhubarb (Dahuang) were used; although the constipation was relieved, the pain remained unchanged. Upon examination, the pulse was slightly surging and rapid. He stated: This is heat in the blood combined with blood stasis. It is appropriate to use *Siwu Tang* added with Costus Root (Muxiang), Frankincense (Ruxiang), Myrrh (Moyao), Phellodendron Bark (Huangbai), and Hemp Seed (Huomaren). After five doses, the pain decreased, and the stool became moist. Subsequently, fever, red face, and occasional aversion to cold appeared. The previous formula had Frankincense and Myrrh removed, and Bupleurum Root (Chaihu) and Scutellaria Root (Huangqin) were added. After two doses, the alternating chills and fever subsided, but the lower back pain recurred. This indicated that the blood circulation had been restored. Ginseng was added to the previous formula, after which the condition stabilized.
He Song'an said: The waist is the mansion of the Kidney, where the Qi and Blood of the Foot-Shaoyin Kidney Meridian accumulate and flow. Lower back pain during pregnancy mostly belongs to labor-induced causes. Since the uterus is connected to the Kidney, heavy lifting and overexertion injure the uterine ligaments, causing inevitable lower back pain. In severe cases, the uterine ligaments may detach, often leading to spontaneous abortion. Treatment should prioritize calming the fetus; once the fetus is secure, the pain will heal itself. If a woman who usually enjoys comfort suffers from lower back pain, it must be due to unregulated sexual intercourse injuring the uterine ligaments. If the pulse is slow, and pain worsens on cloudy days or after prolonged sitting, it is damp-heat. If the waist feels heavy as if bound by objects and cold, it is cold-dampness. If the pulse is large and pain persists, it is Kidney deficiency. If the pulse is choppy and pain is lighter during the day and heavier at night, it is stagnation of Qi and Blood. If the pulse is floating, it is invasion by wind pathogen. If the pulse is excess, it is due to sprain or trauma. If lower back pain occurs near term, it indicates the descent of the uterus and loosening of the Kidney Qi, signaling imminent childbirth.