《金匮要略》曰∶假令妊娠腹中痛，为胞阻，胶艾汤主之。
徐忠可按∶胞阻者，阻其欲行之血，而气不相顺也；四物汤养阴补血。血妄行，必挟风而为痰浊。胶以骡
皮为主，能去风。以济水煎成，能澄浊。艾性温而善行，能导血归经。甘草和之，使四物不偏于阴，此三味
之力也。
薛立斋曰∶胎或作胀，或腹作痛，此是脾胃气虚，不能承载，用安胎饮加升麻、白术，不应，用补中汤。
《金匮要略》曰∶妇人怀胎，腹中 痛，当归芍药散主之。又，妇人腹中痛，小建中汤主之。
刘宗浓曰∶洁古地黄当归汤，治妇人有孕胎痛。胎痛，丹溪以血虚治之，故四物去
川芎，倍加熟地，此心法也。
薛立斋按∶妊娠腹中不时作痛，或小腹重坠，名胎痛，用当归地黄汤，即内补丸，不应，加参、术、陈皮，
或因脾气虚，四君加归、地。
慎斋按∶以上四条，序胎前腹痛，有气阻、气虚、血虚，为不足病也。胎有脾胃气虚而腹痛者，用补气调气
之法。有阴亏血虚而腹痛者，用补血温经之法。与前条风寒痰饮之证迥别，临证审之。
薛立斋曰∶顿仆胎动，腹痛下血，用胶艾汤，未应，用八珍汤加胶、艾。若顿仆胎伤，下血腹痛，用佛手散。
未应，八珍汤下知母丸。
王叔和曰∶妇人有胎腹痛，其人不安。若胎病不动，欲知生死，令人摸之，如覆杯者男，如肘颈参差起者
女也。冷者为死，温者为生。
慎斋按∶以上二条，序胎前腹痛，有顿仆伤胎而胎动不安，致有腹痛之证，此非不内外因。一辨用药治法，
一辨生死之法也。
《金匮要略》说：如果妊娠期间腹中疼痛，这称为胞阻（妊娠腹痛），用胶艾汤主治。
徐忠可按语：所谓胞阻，是指阻碍了原本应当运行的血液，导致气血不相顺接；四物汤用于滋养阴血、补充血液。血液妄行，必定挟带风邪而化为痰浊。阿胶以驴皮为主料，能够祛风；用济水煎煮成药，能够澄清浊液；艾叶性温且善于通行，能引导血液回归经脉；甘草调和诸药，使四物汤不偏于滋阴，这是这三味药的作用力。
薛立斋说：胎气有时感到胀满，或者腹部疼痛，这是脾胃气虚，不能承载胎元所致，使用安胎饮加入升麻、白术；如果无效，使用补中益气汤。
《金匮要略》说：妇女怀孕后，腹中疼痛，用当归芍药散主治。另外，妇女腹中疼痛，用小建中汤主治。
刘宗浓说：洁古地黄当归汤，治疗妇女怀孕期间的胎痛。对于胎痛，朱丹溪认为应从血虚角度治疗，因此在使用四物汤时去掉川芎，加倍增加熟地黄，这是其诊疗心法。
薛立斋按语：妊娠期间腹中不时作痛，或小腹有重坠感，称为胎痛，使用当归地黄汤，即内补丸；如果无效，加入人参、白术、陈皮；如果是因脾气虚弱，可使用四君子汤加入当归、熟地黄。
慎斋按语：以上四条，论述了胎前腹痛，分为气阻、气虚、血虚，属于不足之证。胎元因脾胃气虚而腹痛的，采用补气调气的方法。因阴亏血虚而腹痛的，采用补血温经的方法。这与前文所述的风寒痰饮之证截然不同，临证时需仔细审察。
薛立斋说：因跌倒或撞击导致胎动不安，腹痛并伴有下血，使用胶艾汤；如果无效，使用八珍汤加入阿胶、艾叶。若是因跌倒撞击损伤胎元，出现下血和腹痛，使用佛手散；如果无效，在服用八珍汤的同时送服知母丸。
王叔和说：妇女怀孕腹中疼痛，其人胎元不安。如果判断胎元是否存活以辨别生死，让人触摸孕妇腹部，如果感觉像倒扣的杯子那样圆润光滑的是男孩，如果感觉像肘部或颈部那样高低不平的是女孩。腹部发冷的是死胎，温热的是活胎。
慎斋按语：以上两条，论述了胎前腹痛，有因跌倒撞击伤胎而导致胎动不安，进而引起腹痛的证候，这不属于外感或内伤之外的其他病因。一条是辨别用药治法，一条是辨别生死的方法。
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: If abdominal pain occurs during pregnancy, it is termed Bao Zu (Uterine Obstruction/Pregnancy Abdominal Pain), and Jiao Ai Tang (Donkey-hide Gelatin and Mugwort Decoction) should be primarily used.
Xu Zhongke’s commentary: "Bao Zu" refers to the obstruction of blood that ought to flow, resulting in a lack of smooth coordination between Qi and Blood; Si Wu Tang (Four Substances Decoction) nourishes Yin and tonifies Blood. When Blood flows recklessly, it inevitably carries Wind pathogen and transforms into turbid Phlegm. E jiao (Donkey-hide Gelatin), primarily made from donkey hide, can dispel Wind. Decocting with Ji Shui (Water of Ji River) can clarify turbidity. Ai Ye (Mugwort Leaf) is warm in nature and good at promoting circulation, guiding Blood back to its vessels. Gan Cao (Licorice Root) harmonizes the formula, preventing Si Wu Tang from being overly Yin-nourishing; this is the efficacy of these three ingredients.
Xue Lizhai states: If the fetus feels distended or the abdomen hurts, this is due to deficiency of Spleen and Stomach Qi, which fails to support the fetus. Use An Tai Yin (Fetus-Supporting Powder) added with Sheng Ma (Cimicifugae Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma). If ineffective, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
The *Jin Gui Yao Lue* states: For women pregnant who suffer abdominal pain, Dang Gui Shao Yao San (Angelica Sinensis and Paeonia Albiflora Powder) should be used. Additionally, for women suffering abdominal pain, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) should be used.
Liu Zongnong states: Jie Gu Di Huang Dang Gui Tang (Glehnia Rehmannia and Angelica Sinensis Decoction) treats fetal pain in pregnant women. Regarding fetal pain, Zhu Danxi treated it as Blood deficiency; thus, he removed Chuan Xiong (Ligusticum Chuanxiong Rhizome) from Si Wu Tang (Four Substances Decoction) and doubled the amount of Shu Di Huang (Prepared Rehmannia Root); this is his clinical insight.
Xue Lizhai’s commentary: During pregnancy, if the abdomen hurts intermittently, or there is a heavy bearing-down sensation in the lower abdomen, it is named Tai Tong (Fetal Pain). Use Dang Gui Di Huang Tang (Angelica Sinensis and Rehmannia Decoction), which is also Nei Bu Wan (Internal Nourishment Pill). If ineffective, add Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Chen Pi (Citri Reticulatae Pericarpium). If due to Spleen Qi deficiency, use Si Jun Zi Tang (Four Gentlemen Decoction) added with Dang Gui (Angelica Sinensis Radix) and Di Huang (Rehmannia Glutinosa Radix).
Shen Zhai’s commentary: The above four items discuss pre-delivery abdominal pain, categorizing them into Qi obstruction, Qi deficiency, and Blood deficiency, all belonging to deficiency syndromes. For abdominal pain caused by Spleen and Stomach Qi deficiency affecting the fetus, use methods to tonify Qi and regulate Qi. For abdominal pain caused by Yin deficiency and Blood deficiency, use methods to tonify Blood and warm the meridians. This is distinctly different from the syndromes of Wind-Cold, Phlegm, and Fluid retention mentioned earlier; careful examination is required during clinical practice.
Xue Lizhai states: If trauma such as falling causes fetal movement, abdominal pain, and bleeding, use Jiao Ai Tang (Donkey-hide Gelatin and Mugwort Decoction). If ineffective, use Ba Zhen Tang (Eight Treasures Decoction) added with E jiao (Donkey-hide Gelatin) and Ai Ye (Mugwort Leaf). If trauma damages the fetus, causing bleeding and abdominal pain, use Fo Shou San (Buddha's Hand Powder). If ineffective, administer Zhi Mu Wan (Anemarrhenae Pill) with Ba Zhen Tang (Eight Treasures Decoction).
Wang Shuhe states: When a pregnant woman suffers abdominal pain, her condition is unstable. To determine if the fetus is alive or dead, one may palpate the abdomen. If it feels like an inverted cup (smooth and round), it indicates a male fetus; if it feels uneven like an elbow or neck, it indicates a female fetus. A cold abdomen indicates a dead fetus; a warm abdomen indicates a living fetus.
Shen Zhai’s commentary: The above two items discuss pre-delivery abdominal pain, specifically cases where trauma leads to restless fetus and subsequent abdominal pain; this does not fall under external or internal etiologies alone. One item distinguishes treatment methods, and the other distinguishes methods for determining life and death.