皆失于调治也。若六七发后不止。即当和营健脾。若禀质柔脆者。虽有风邪。不得纯用表药。以
风药性升。能使胎气上逆。而为呕逆喘胀。膈塞痞满之患。虽有实滞。不得过用降泄之味。能引
邪气下陷。致胎坠不安。而为泄利不食。小腹疼重之患矣。若疫疟毒盛势剧。急与凉膈、承气、
黄连解毒救之。瘟疟 不爽。烦热大渴。或壮热无寒。或先热后寒者。当与桂枝白虎、人参白
虎撤其在里之热。不可与夏秋 疟比例而推也。盖有是证而用是药。有故无陨。亦无陨也。惟在
速祛邪气以救胎息之燔灼。若迟疑未决。下手稍软。救无及矣。
痢 妊娠痢下。有三禁五番。一禁荡涤肠胃。二禁渗利膀胱。三禁兜涩滞气。盖荡涤则阳气
下陷。胎气愈坠。渗利则阴津脱亡。胎失荣养。兜涩则浊气愈滞。后重转加。故善治妊娠之痢者。
惟以调气为先。盖调气之法。如炉冶分金。
已败之积沫。则随气而下。未伤之津液。则统之而安。不善治痢者。惟守通因通用。痛无补法之
说。峻用苦寒荡涤。使未伤之津液。溷厕败秽之中。建瓴而下。而胃气有权者。尚可胜其药力。
譬诸引汲灌渠。一决而荡无余滓。陈腐去而仓廪自修。津气自复也。若肾气不固之人。秘藏不密。
五液尽随转利药注下。使既病之津液。更加猛利峻攻。不致精神离散。血液告竭不已。况能保其
胎息乎。夫调气之药有三善。一使胃气有常。水谷输运。二使腹满腹痛后重渐除。三使浊气开发。
不致侵犯胎元。此治妊娠下痢之大端也。所谓五审者。一审饮食之进与不进。夫下痢乃肠胃受病。
若痢势虽甚。饮食无妨者易已。故痢以噤口为最剧。在初起浊邪全盛之时。不足为虑。但要清理
积滞。饮食自进矣。若七日以后。尚不能食。脉反数盛。此必初时失于清理之故。急需调气理中。
则积沫渐下。饮食渐进矣。或初时能食。至一旬一气后。反不能食。脉息不振。此必荡涤太过。
胃气受伤所致。亦有过用芩、连、槟、朴。苦寒破气。而致呃逆呕哕者。胃气大败。最危之兆。
惟峻与温补。庶可挽回。若脉见数疾无伦。或翕翕虚大。或歇止不前。或弦细搏指者。皆胃气告
匮。百不一生矣。二审溲之通与不通。下痢清浊不分。若痢虽频。而水道顺利者。胎必无虞。若
月数将满。胎压膀胱。每多溲便频数。转胞胀 之患。切禁利水伤津。急与开提自通。但须察其
脉无过旺过硬之形。便宜补中益气。稍加泽泻、车前以升清降浊。投之无不辄应。非特妊娠为然。
即平人久痢。津液大伤而溲涩不通者。亦宜上法也。三审腹之痛与不痛。下痢腹痛。必然之理。
然间有浊湿下趋。而无郁沸之火者。则不痛也。但此多见于肥白人之白痢。若血痢与瘦人多火者。
罕见也。治宜调气运积。不用清火明矣。原其腹痛有寒热之分。痛有止歇。痛则奔迫下坠。至圊
不及者。火也。痛自下而攻击于上者。火也。痛而胀满。不胜摩按。热饮愈甚者。火也。实也。
痛无止歇。常时痛而无绞刺者。
寒也。痛自上而奔注于下者。寒也。痛而不满。时喜温手摩按。饮热暂缓。欲至圊而可忍须臾者。
虚也。寒也。大约初痢胀痛。为热为实。久利 痛。为虚为寒。即初因火注切痛。痢久气伤。亦
必变为虚寒也。故久痢腹痛之脉。无论大小迟数。但以按之渐渐小者。并属虚寒。急须温补。慎
勿利气。惟急痛脉实。久按不衰者。可稍用炮黑姜、连和之。四审后之重与不重。下痢后重。浊
气壅滞也。夫开通壅滞。必以调气为本。在妊娠尤为切要。调气则后重自除。而胎息自安矣。但
初痢后重。首宜开发其滞。若久痢后重。又当升举其阳。阳气升则胃气运。胃气运则周身中外之
气皆调达。而无壅滞之患矣。故治孕妇之后重。无问胎之大小。但脉见有余。则宜调气。脉见不
足。便与升提。虽血痢亦宜阳药。一切滋腻血药。总无干预。以气有统血之功。则血无妄行之虑
也。五审身之热与不热。下痢为里气受病。若见身热。表里俱困。元神将何所恃而得振祛邪之力
哉。惟人迎之脉浮数。可先用和营透表之法分解其势。然后徐行清理。若初痢不发热。数日半月
后发热。脉来渐小。或虚大少力者。此真阴内亡。虚阳发露于外。在平人或可用辛温峻补。敛之
以归其源。若妊娠则桂、附又难轻用。惟藉参、术、姜、萸、胶、艾之属。非大剂浓煎峻投。难
望其转日回天之绩也。或痢久卫虚。起居不慎。而感冒虚风发热者。但当察其左手三部。必显浮
缓之象。又需理中汤加桂枝。合表里而治之。以内气久虚之邪。不得参、术助其中气。则客邪不
得解散也。五审既明。三禁勿犯。又当审察其积之稠与不稠。色之鲜与不鲜。则元气之浓薄。病
患之寒热。可晓然无惑矣。如赤白寒热之辨。昔人拟议纷纭。要非正论。以大略言。气分之病其
色白。血分之病其色赤。气血紊乱。则赤白兼并。盖气属阳。阳伤则受冷居多。即有火注下迫。
皆阳气郁遏。本寒标热之证。不可纯归于热。但当验其积之稠粘如糊。色白如脂。方可暂与清热
治标。若汁沫如水。色晦如尘。急须温理
其气。即有热证。皆假象无疑也。血属阴。阴伤则受热居多。然多有气伤阳不统阴之血。又不得
不从事于辛温也。故治血痢。尤当以色之显晦。验其虚实寒热。此义前人未发也。故凡积之瘀晦
不鲜。清稀不稠者。皆系虚寒之候。即前所云阳不统阴之血。急投人参、姜、艾。庶或保全。倘
不审而误饵芩、连。是速其毙也。惟积之稠粘紫赤而光泽者。合用苦燥以坚肠胃之滑脱。又必佐
以调气之药。则阴邪得以解释。非若白痢之不可杂以芩、连、芍药等味。引领滞秽。袭伤阴血也。
况有病后疟后。或本质虚羸之人。及秋冬天令寒冷时下痢。加以胎孕扼腕。可与平人夏秋之痢同
日而语哉。予尝用浓朴汤去干姜。治妊娠能食。腹胀后重。积秽稠粘之白痢。甘草干姜汤理中汤。
治妊娠腹痛少食。积沫清稀之白痢。浓朴生姜甘草半夏人参汤。治妊娠腹胀后重。赤白相兼之痢。
黄芩芍药汤送香连丸。治妊娠能食后重。积秽稠粘之血痛。连理汤合千金三物胶艾汤。治妊娠少
腹疼重。瘀晦不鲜。或间有鲜血之痢。驻车丸治妊娠发热后重。阴虚畏食之血痢。白头翁加甘草
阿胶汤。治妊娠热毒内攻。噤口不食。腹胀后重。脓血稠粘之痢。千金胶艾榴皮汤治妊娠脓血清
稀。胎动不安。久泄不止之痢。补中益气汤治妊娠先疟后痢。及疟痢齐作。元气下陷。胎气下坠。
小便频数。或转胞不得溺之痢。以上诸方。并加砂仁以调其气。乌梅以调其血。未常不随手辄效也。
石顽治郝（失记其字）。媳。怀孕九月。患疟三四发后。即呕恶畏食。诊其脉。气口涩数不
调。左关尺弦数微滑。此中脘有冷物阻滞之候。以小柴胡去黄芩加炮姜、山楂。四服稍安思食。
但性不嗜粥。连食肺鸭之类。遂疟痢兼并。胎气下坠不安。以补中益气去黄 加香、砂、乌梅。
五服而产。产后疟痢俱不复作矣。其仆妇产后数日。亦忽下痢脓血。至夜微发寒热。小腹胀痛。
与千金三物胶艾汤去榴皮加炮黑山楂。六服而瘳。
子淋 妊娠小便淋者。乃肾与膀胱虚热。不能制水。然妊娠胞系于肾。肾间虚热移于膀胱而
成斯证。若小便涩少淋涩。生料六味丸加麦冬、五味。肉桂、车前。若膀胱阳虚。阴无以化。肾
气丸。肺气虚而频数短少。生脉散加山药、泽泻。若小肠热。小便赤涩。导赤散。若肺虚膀胱热
而气化不行。生脉合导赤散。若因肺经蕴热。黄芩清肺饮。肝经湿热。加味逍遥散。膏粱浓味。
加味清胃散。苦因劳役所伤。或食煎爆。小便带血。此血得热而流于脬中。补中益气加丹皮、栀
子。若因脾胃气虚。胎压尿脬而胎胀腹痛。八珍汤倍茯苓加橘、半。空心服。服后探吐。药出气
定。又服又吐。数次必安。
遗尿 妊妇遗尿不觉。胎满故也。千金白薇散。薛氏云。若脬中有热。加味逍遥散。脾肺气
虚。补中益气汤加益智仁。肝肾阴虚。六味丸。孕后有水从阴户出不止者。千金鲤鱼汤加肉桂、人参。
诸血 妊妇尿血。热乘血分。以致流渗于脬。名子淋。导赤散。若因怒动肝火。小柴胡加山
栀。若脾气下陷。及劳动脾火。补中益气加茯苓、车前。若因浓味积热。加味清胃散。若因肝脾
血热。加味逍遥散。
妊娠吐衄 由七情脏腑所伤。气逆于上。致血上溢不止。心闷甚者多死。或堕胎也。若肝经
怒火。加味逍遥散。膏粱积热。加味消胃散。郁结伤脾。加味归脾汤。肺经有火。黄芩清肺饮。
因气郁滞。紫苏饮。气不摄血。补中益气去升麻加煨葛根。肾经虚火。六味丸加麦冬、五味。咳
嗽咯衄。胎前皆不宜见。面赤声哑。不治。咯血吐血。多致堕胎。胎赖血养。不宜漏溢。紫苏饮
加条芩。如产后吐衄咯血者。皆难治。漏极如同月水。胞干胎死。母亦难保。肠风藏毒。肠胃不
调。胀满下血者。平胃散去苍术加槐角、防风、当归、乌梅。
诸痛 宿有偏正头风。川芎茶调散。宿有冷痞痰饮结聚。或新触风寒。邪正相击。上冲于心
则心痛。下击于腹则腹痛。痛不已则胎动不安。此病多寒多食。间有属热者。并宜正气散。寒。
加木香、炮姜。食积发热。加芩、连、炮姜。气。加砂仁、香附。痰。加橘皮、生姜。若因错杂
之邪。当审其因而治。胎前产后心痛。用川楝、茴香炒各三钱。盐炒艾叶钱半。水煎服之。腹痛。
或发或止。名曰痛胎。属血少。四物加香附为末。紫苏汤送下。气滞者。紫苏饮。胃口痛。禁用
指迷。但宜养胃汤。妊娠腹中满痛叉心。不得饮食。千金芩术芍药汤。胁痛。其故有三。哭泣也。
内伤也。恼怒也。有胎不宜服行伤破气药。只宜童便和酒服之。或紫苏饮去参用白芍、当归。加
砂仁、童便。虽曰伤重。勿服伤药。且须安胎为要。背痛。气滞也。紫苏饮。腰腹背痛。是因劳
伤损动。痛不止。多动胎气。补中益气加续断、杜仲。有因淋证作痛者居多。当审治之。走注痛
者。败血入经之证。四乌汤加薄桂、杜仲、续断。肥盛人多湿热。腰痛重坠。或下白物者。二妙
散加柴胡、防风、茯苓、半夏。气血郁滞。遍身拘急不舒而痛。眼生黑花。夜不能卧。紫苏饮加
枳壳、桔梗。腰痛甚者。肾虚极也。其胎必堕。急服八珍汤加胶、艾、黄 。或紫苏饮加减。脐
下冷痛。腹胀虚疼。小便频数。大便虚滑。皆食生冷所致。小建中加炮姜、木香。不应。更加茴
香、良姜。小腹痛。由胞络虚热相搏所致。紫苏饮加生姜。虚寒。用胶艾汤。不应。寒甚也。加
桂、附温之内。伤甚者。胎下无疑。若服不效。须视小腹近下处。若肿胀浮薄发光者。孕痈也。
千金托里散。或薏苡仁煎汁饮。若心腹急痛。烦闷面青。冷汗气绝。血下不止。其胎上冲者。不治。
子肿 妊妇四肢浮肿。或腹大者。其证有二。有水肿。有胎气肿。然胎前水肿者少。只是胎
气。谓之子肿。乃气病也。盖因脏腑本虚。脾土不能制水。血散四肢。遂腹胀。手足面目皆浮。
甚则通身肿满。心腹急胀。悉宜紫苏饮。小便不利
者。其胎气兼水气也。紫苏饮加泽泻、白术、茯苓、木通。若发浮气喘腹胀。服药后肿退皮宽。
六君子调理。若面目虚浮。肢体如水气肿胀。全生白术散。不应。六君子加腹皮、车前。下部肿
甚。补中益气加茯苓。或因饮食失宜。呕吐泄泻。此是脾胃亏损。六君子加炮姜、木香、香附。
若足指发肿。渐至腿膝喘闷不安。或足指缝水出。名子气。乃妇人素有风气。或冲任有血挟风水。
不可妄投汤药。二陈加乌药、香附、木通。脾胃虚弱。更加参、术。兼进逍遥散。不应。紫苏饮。
凡妊娠经血壅闭。忽然虚肿。乃胞中挟水。水血相搏。脾胃主肌肉而恶湿。湿渍气弱。则肌肉虚。
水气流溢。则身肿满。或因泄泻下痢。脏腑虚滑。耗损脾胃。或因寒热烦渴。引饮太过。湿渍脾
胃。皆能使手足头面浮肿。然水渍于胞。儿未成形。则胎多损坏。及其临产。胫脚微肿。乃胞藏
血少水多。水出于外。故现微肿。则易生也。妊娠通身浮肿。胸胁不分。或心腹急胀。名曰胎水。
千金鲤鱼汤。有妊娠腹胀。服前汤三五剂。大小便皆下恶水。肿消胀去。遂下死胎。此证盖因怀
娠腹大。终不知胎水之患也。郑虚庵曰。身半以上肿者。发汗。身半以下肿者。利小便。上下俱
肿。汗利分消其湿。若唇黑。缺盆平。背平。脐突。足底平。皆不治。
不语 不语者。多为痰闭心窍。亦有哑胎。不须服药。岐伯曰。人有重身九月而喑。此胞络
之脉绝也。胞络者。系于肾。少阴之脉。贯肾系舌本。故不能言。无治也。当十月复。凡患此者。
浓煎生脉散空心服地黄丸。助肺肾之气以养胎。若与通声开发之药。误矣。
谵语 妊娠谵语。为脏腑热极之候。急宜童便时时灌之。不应。用生地黄黄连散清其血中之
都是因为失于调理治疗。如果疟疾发作六七次后仍不止，就应当调和营血、健脾益气。如果体质柔弱脆弱的人，即使有风邪，也不能单纯使用解表药，因为风药性主升散，会导致胎气上逆，从而引发呕吐、呃逆、气喘、腹胀、胸膈堵塞、痞满等祸患。即使体内有实邪积滞，也不能过度使用降泄的药物，因为这会引邪气下陷，导致胎元坠落不安，从而引发腹泻、痢疾、不能进食、小腹疼痛沉重等祸患。如果是疫疟毒盛且病势危急，急需用凉膈散、承气汤、黄连解毒汤来救治。如果是瘟疟，症状不爽快，烦热大渴，或者壮热无寒，或者先发热后发冷的，应当用桂枝白虎汤、人参白虎汤来清除体内的热邪，不可与夏秋季节的普通疟疾相提并论而简单推断。这是因为有这种证候就用这种药物，有病邪存在就不会造成真正的损伤，即使有损伤也是暂时的。关键在于迅速祛除邪气以拯救被火热燔灼的胎息。如果犹豫不决，下手力度稍轻，就来不及抢救了。
妊娠期间患痢疾，有三禁和五审。一禁荡涤肠胃；二禁渗利膀胱；三禁兜涩（收敛固涩）导致气机阻滞。因为荡涤会使阳气下陷，胎气更加下坠；渗利会使阴津脱失，胎元失去荣养；兜涩会使浊气更加停滞，里急后重症状加重。所以善于治疗妊娠痢疾的人，只以调气为先。调气的方法，就像冶炼炉中分离金银一样，已经败坏的积沫，就会随着气机下行排出；未受伤的津液，就能统摄而安宁。不善于治痢的人，只死守“通因通用”、“痛无补法”的说法，峻烈地使用苦寒药物荡涤，使未受伤的津液混入厕所的败秽之中，像从高屋建瓴一样泻下。胃气强盛的人，还可以承受药力，就像开渠引水，一旦决口就荡涤干净，陈腐去除了，仓廪自然修整，津气自然恢复。如果是肾气不固、秘藏不密的人，五种体液都会随着转利药注下，使已经生病的津液，再遭受猛利峻攻，不致使精神离散、血液枯竭不停止。何况还能保住胎息吗？调气的药有三善：一是使胃气正常，水谷得以输运；二是使腹满、腹痛、里急后重逐渐消除；三是使浊气开发，不致侵犯胎元。这是治疗妊娠下痢的大原则。所谓的五审：一审饮食的进与不进。下痢是肠胃受病，如果痢疾势头虽然很猛，但饮食不受妨碍的容易治愈，所以痢疾中以噤口痢最为严重。在初起浊邪全盛的时候，不值得忧虑，只要清理积滞，饮食自然会进。如果七天以后，还不能进食，脉象反而数而盛大，这一定是初起时失于清理的缘故，急需调气理中，那么积沫会逐渐下行，饮食也会逐渐进步。或者初起时能进食，到一个旬日或节气之后，反而不能进食，脉息不振，这一定是荡涤太过，胃气受伤所致。也有过用黄芩、黄连、槟榔、厚朴，苦寒破气，而导致呃逆、呕吐、哕逆的。胃气大败，是最危险的征兆，只有峻烈地给予温补，才可能挽回。如果脉象见数疾无比，或者浮虚宽大，或者歇止不前，或者弦细搏指，这些都是胃气告竭的表现，百无一生的。二审小便的通与不通。下痢清浊不分，如果痢疾虽然频繁，但水道顺利，胎元一定无忧。如果月份将满，胎压膀胱，常常出现小便频数，转为胞胀的祸患，切忌利水伤津，急用开提之法自通。但必须观察其脉象没有过旺过硬的形态，便适宜补中益气，稍加泽泻、车前子以升清降浊，投药没有不立即见效的。不仅是妊娠如此，就是普通人久痢，津液大伤而小便涩滞不通的，也适宜上述方法。三审腹部的痛与不痛。下痢腹痛，是必然的道理。然而间或有浊湿下趋，而没有郁沸之火的，就不痛。但这多见于肥白人的白痢。如果是血痢和瘦人多火的人，很少见。治疗适宜调气运积，不用清火，这是明显的。推究腹痛有寒热之分。疼痛有停止间歇的，痛则奔迫下坠，来不及上厕所的，是火证。疼痛从下向上攻击的，是火证。疼痛而胀满，不能忍受按摩，喝热水更严重的，是火证，属实证。疼痛没有停止间歇，常时痛而无绞刺感的，是寒证。疼痛从上向下奔注的，是寒证。疼痛而不胀满，时常喜欢温热的手按摩，喝热水暂缓，想要上厕所但可以忍耐片刻的，是虚证，也是寒证。大约初痢胀痛，为热为实；久利痛，为虚为寒。即使初起因火注切痛，痢久气伤，也必定变为虚寒。所以久痢腹痛的脉象，无论大小迟数，只要按之渐渐变小的，都属虚寒，急需温补，切勿利气。只有急痛脉实，久按不衰的，可以稍用炮黑姜、黄连调和它。四审后重的有与无。下痢后重，是浊气壅滞。开通壅滞，必须以调气为本，在妊娠尤为切要。调气则后重自除，而胎息自安。但初痢后重，首先宜开发其滞；若久痢后重，又当升举其阳。阳气升则胃气运，胃气运则周身中外之气皆调达，而无壅滞的祸患了。所以治疗孕妇的后重，不问胎的大小，只要脉见有余，则宜调气；脉见不足，便与升提。即使是血痢也宜用阳药，一切滋腻的血药，总无干预，因为气有统血之功，则血无妄行的顾虑。五审身体的热与不热。下痢是里气受病，如果见身热，表里俱困，元神靠什么来振作祛邪的力量呢？只有人迎脉浮数，可先用和营透表的方法分解其势，然后慢慢进行清理。如果初痢不发热，数日半月后发热，脉来渐小，或虚大少力的，这是真阴内亡，虚阳发露于外。在普通人或许可以用辛温峻补，敛之以归其源。如果是妊娠，桂枝、附子又难以轻用，只能借助人参、白术、干姜、山茱萸、阿胶、艾叶之类，非大剂浓煎峻投，难望其有转日回天的功效。或者痢久卫虚，起居不慎，而感冒虚风发热的，只当观察其左手三部脉，必显浮缓之象，又需理中汤加桂枝，合表里而治之。因为内气久虚之邪，不得人参、白术助其中气，则客邪不得解散。五审既明，三禁勿犯，又应当审察积滞的稠与不稠，颜色的鲜与不鲜，那么元气的浓薄，病患的寒热，就可以清楚无疑了。如赤白寒热的辨别，前人议论纷纭，都不是正论。大概说来，气分的病其色白，血分的病其色赤，气血紊乱，则赤白兼并。气属阳，阳伤则受冷居多，即使有火注下迫，都是阳气郁遏，本寒标热的证候，不可纯归于热。只当验其积滞稠粘如糊，色白如脂，方可暂与清热治标。如果汁沫如水，色晦如尘，急需温理其气，即使有热证，都是假象无疑。血属阴，阴伤则受热居多，然而多有气伤阳不统阴的血，又不得不从事于辛温。所以治血痢，尤当以颜色的显晦，验其虚实寒热，这个义理前人未曾发挥。所以凡是积滞瘀晦不鲜，清稀不稠的，都是虚寒的候象，就是前面所说的阳不统阴的血，急投人参、干姜、艾叶，或许可以保全。如果不审察而误服黄芩、黄连，是加速其死亡。只有积滞稠粘紫赤而光泽的，合用苦燥以坚肠胃之滑脱，又必佐以调气的药，则阴邪得以解释，不像白痢那样不可杂以黄芩、黄连、芍药等味，引领滞秽，袭伤阴血。况且有病后疟后，或者本质虚羸的人，以及秋冬天令寒冷时下痢，加上胎孕扼腕，可以与平人夏秋的痢疾同日而语吗？我曾经用浓朴汤去干姜，治妊娠能食，腹胀后重，积秽稠粘的白痢；甘草干姜汤、理中汤，治妊娠腹痛少食，积沫清稀的白痢；浓朴生姜甘草半夏人参汤，治妊娠腹胀后重，赤白相兼的痢；黄芩芍药汤送香连丸，治妊娠能食后重，积秽稠粘的血痢；连理汤合千金三物胶艾汤，治妊娠少腹疼重，瘀晦不鲜，或间有鲜血的痢；驻车丸治妊娠发热后重，阴虚畏食的血痢；白头翁加甘草阿胶汤，治妊娠热毒内攻，噤口不食，腹胀后重，脓血稠粘的痢；千金胶艾榴皮汤治妊娠脓血清稀，胎动不安，久泄不止的痢；补中益气汤治妊娠先疟后痢，及疟痢齐作，元气下陷，胎气下坠，小便频数，或转胞不得溺的痢。以上诸方，并加砂仁以调其气，乌梅以调其血，未尝不随手辄效。
石顽治疗郝某（失记其字）的儿媳，怀孕九月，患疟疾三四发后，即呕恶畏食。诊其脉，气口涩数不调，左关尺弦数微滑，这是中脘有冷物阻滞的候象。用小柴胡汤去黄芩加炮姜、山楂，四服稍安思食。但她性不嗜粥，连食肺鸭之类，遂疟痢兼并，胎气下坠不安。用补中益气汤去黄芩加香附、砂仁、乌梅，五服而产。产后疟痢俱不复作。他的仆妇产后数日，亦忽下痢脓血，至夜微发寒热，小腹胀痛。给千金三物胶艾汤去榴皮加炮黑山楂，六服而愈。
子淋 妊娠小便淋者，乃肾与膀胱虚热，不能制水。然而妊娠胞系于肾，肾间虚热移于膀胱而成此证。如果小便涩少淋涩，用生料六味丸加麦冬、五味子、肉桂、车前子。如果膀胱阳虚，阴无以化，用肾气丸。肺气虚而频数短少，用生脉散加山药、泽泻。如果小肠热，小便赤涩，用导赤散。如果肺虚膀胱热而气化不行，用生脉散合导赤散。如果因肺经蕴热，用黄芩清肺饮。肝经湿热，用加味逍遥散。膏粱浓味，用加味清胃散。苦因劳役所伤，或食煎爆，小便带血，这是血得热而流于脬中，用补中益气汤加丹皮、栀子。如果因脾胃气虚，胎压尿脬而胎胀腹痛，用八珍汤倍茯苓加橘红、半夏，空心服。服后探吐，药出气定，又服又吐，数次必安。
遗尿 妊妇遗尿不觉，是因为胎满的缘故。用千金白薇散。薛氏说，如果脬中有热，用加味逍遥散。脾肺气虚，用补中益气汤加益智仁。肝肾阴虚，用六味丸。孕后有水从阴户出不止者，用千金鲤鱼汤加肉桂、人参。
诸血 妊妇尿血，热乘血分，以致流渗于脬，名子淋，用导赤散。如果因怒动肝火，用小柴胡汤加山栀。如果脾气下陷，及劳动脾火，用补中益气汤加茯苓、车前。如果因浓味积热，用加味清胃散。如果因肝脾血热，用加味逍遥散。
妊娠吐衄 由七情脏腑所伤，气逆于上，致血上溢不止。心闷甚者多死，或堕胎。如果肝经怒火，用加味逍遥散。膏粱积热，用加味消胃散。郁结伤脾，用加味归脾汤。肺经有火，用黄芩清肺饮。因气郁滞，用紫苏饮。气不摄血，用补中益气汤去升麻加煨葛根。肾经虚火，用六味丸加麦冬、五味。咳嗽咯衄，胎前皆不宜见，面赤声哑，不治。咯血吐血，多致堕胎，胎赖血养，不宜漏溢，用紫苏饮加条芩。如产后吐衄咯血者，皆难治。漏极如同月水，胞干胎死，母亦难保。肠风藏毒，肠胃不调，胀满下血者，用平胃散去苍术加槐角、防风、当归、乌梅。
诸痛 宿有偏正头风，用川芎茶调散。宿有冷痞痰饮结聚，或新触风寒，邪正相击，上冲于心则心痛，下击于腹则腹痛。痛不已则胎动不安。此病多寒多食，间有属热者，并宜正气散。寒，加木香、炮姜。食积发热，加黄芩、黄连、炮姜。气，加砂仁、香附。痰，加橘皮、生姜。如果因错杂之邪，当审其因而治。胎前产后心痛，用川楝、茴香炒各三钱，盐炒艾叶钱半，水煎服之。腹痛，或发或止，名曰痛胎，属血少，用四物汤加香附为末，紫苏汤送下。气滞者，用紫苏饮。胃口痛，禁用指迷茯苓丸，但宜养胃汤。妊娠腹中满痛叉心，不得饮食，用千金芩术芍药汤。胁痛，其故有三：哭泣也，内伤也，恼怒也。有胎不宜服行伤破气药，只宜童便和酒服之。或者紫苏饮去参用白芍、当归，加砂仁、童便。虽曰伤重，勿服伤药，且须安胎为要。背痛，气滞也，用紫苏饮。腰腹背痛，是因劳伤损动，痛不止，多动胎气，用补中益气汤加续断、杜仲。有因淋证作痛者居多，当审治之。走注痛者，败血入经之证，用四乌汤加薄桂、杜仲、续断。肥盛人多湿热，腰痛重坠，或下白物者，用二妙散加柴胡、防风、茯苓、半夏。气血郁滞，遍身拘急不舒而痛，眼生黑花，夜不能卧，用紫苏饮加枳壳、桔梗。腰痛甚者，肾虚极也，其胎必堕，急服八珍汤加胶、艾、黄芪。或者紫苏饮加减。脐下冷痛，腹胀虚疼，小便频数，大便虚滑，皆食生冷所致，用小建中汤加炮姜、木香。不应，更加茴香、良姜。小腹痛，由胞络虚热相搏所致，用紫苏饮加生姜。虚寒，用胶艾汤。不应，寒甚也，加桂、附温之内。内伤甚者，胎下无疑。如果服不效，须视小腹近下处，若肿胀浮薄发光者，孕痈也，用千金托里散，或者薏苡仁煎汁饮。如果心腹急痛，烦闷面青，冷汗气绝，血下不止，其胎上冲者，不治。
子肿 妊妇四肢浮肿，或腹大者，其证有二：有水肿，有胎气肿。然胎前水肿者少，只是胎气，谓之子肿，乃气病也。盖因脏腑本虚，脾土不能制水，血散四肢，遂腹胀，手足面目皆浮，甚则通身肿满，心腹急胀，悉宜紫苏饮。小便不利者，其胎气兼水气也，紫苏饮加泽泻、白术、茯苓、木通。如果发浮气喘腹胀，服药后肿退皮宽，用六君子汤调理。如果面目虚浮，肢体如水气肿胀，用全生白术散。不应，六君子汤加腹皮、车前。下部肿甚，用补中益气汤加茯苓。或者因饮食失宜，呕吐泄泻，这是脾胃亏损，用六君子汤加炮姜、木香、香附。如果足指发肿，渐至腿膝喘闷不安，或足指缝水出，名子气，乃妇人素有风气，或冲任有血挟风水，不可妄投汤药，用二陈汤加乌药、香附、木通。脾胃虚弱，更加参、术。兼进逍遥散。不应，用紫苏饮。凡妊娠经血壅闭，忽然虚肿，乃胞中挟水，水血相搏。脾胃主肌肉而恶湿，湿渍气弱，则肌肉虚，水气流溢，则身肿满。或者因泄泻下痢，脏腑虚滑，耗损脾胃。或者因寒热烦渴，引饮太过，湿渍脾胃，皆能使手足头面浮肿。然水渍于胞，儿未成形，则胎多损坏。及其临产，胫脚微肿，乃胞藏血少水多，水出于外，故现微肿，则易生也。妊娠通身浮肿，胸胁不分，或心腹急胀，名曰胎水，用千金鲤鱼汤。有妊娠腹胀，服前汤三五剂，大小便皆下恶水，肿消胀去，遂下死胎。此证盖因妊娠腹大，终不知胎水之患也。郑虚庵说：身半以上肿者，发汗；身半以下肿者，利小便；上下俱肿，汗利分消其湿。如果唇黑，缺盆平，背平，脐突，足底平，皆不治。
不语 不语者，多为痰闭心窍，亦有哑胎，不须服药。岐伯说：人有重身九月而喑，此胞络之脉绝也。胞络者，系于肾，少阴之脉，贯肾系舌本，故不能言，无治也，当十月复。凡患此者，浓煎生脉散空心服地黄丸，助肺肾之气以养胎。如果与通声开发之药，误矣。
This is all due to a lack of proper regulation and treatment. If the malaria attacks continue for six or seven episodes without cessation, one should harmonize the Ying (Nutritive) level and strengthen the Spleen. For those with a delicate and fragile constitution, even if there is Wind pathogen, pure exterior-releasing herbs should not be used solely, because Wind herbs have an ascending nature, which can cause the Qi of the fetus to rebel upward, leading to complications such as vomiting, hiccups, asthma, abdominal distension, chest oppression, and fullness. Even if there are excess stagnations, overuse of descending and purgative flavors should be avoided, as this can draw the pathogen downward, causing the fetus to fall and become unstable, resulting in diarrhea, dysentery, loss of appetite, and heavy pain in the lower abdomen. If epidemic malaria is severe and virulent, urgently use Liangge San (Cooling the Chest Powder), Chengqi Tang (Order the Qi Decoction), or Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) to save the patient. For plague malaria presenting with discomfort, irritability, heat, and great thirst, or high fever without chills, or fever preceding chills, use Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction) or Renshen Baihu Tang (Ginseng and White Tiger Decoction) to withdraw the heat from the interior. This cannot be compared or deduced simply like ordinary malaria in summer and autumn. The principle is: when there is a specific syndrome, use specific medicine; when there is a pathogen, there will be no true damage, or any damage will be minimal. The key lies in rapidly expelling the pathogen to rescue the fetal breath from being scorched by fire. If one hesitates and is indecisive, or applies a gentle hand, it will be too late to save the situation.
Pregnant women suffering from dysentery have three prohibitions and five examinations. The first prohibition is against purging the intestines and stomach; the second is against diuresis affecting the bladder; the third is against astringents that stagnate Qi. Purging causes Yang Qi to sink, further dropping the fetal Qi; diuresis causes Yin fluids to escape, depriving the fetus of nourishment; astringents cause turbid Qi to stagnate further, worsening the tenesmus. Therefore, those skilled in treating pregnancy dysentery prioritize regulating Qi. Regulating Qi is like separating gold from silver in a furnace: the already corrupted phlegm-mucus follows the Qi downward and exits, while the unharmed fluids are preserved and stabilized. Those unskilled in treating dysentery rigidly adhere to the theories of "treating obstruction with draining" and "no tonification for pain," using harsh bitter-cold purgatives. This causes unharmed fluids to mix with fecal waste and pour down like water from a height. Only those with strong Stomach Qi can withstand the medicinal force, akin to opening a channel where water rushes out, clearing all dregs; once the old and rotten are removed, the granary repairs itself, and fluids and Qi recover naturally. However, for those with insecure Kidney Qi and loose closure, all five fluids may drain away with the purgative, subjecting already diseased fluids to fierce attack. Unless spirit scatters and blood exhausts, how can the fetal breath be protected? Regulating Qi has three benefits: first, it maintains normal Stomach Qi, allowing transport of water and grain; second, it gradually eliminates abdominal fullness, pain, and tenesmus; third, it opens turbid Qi, preventing it from invading the fetal origin. This is the main principle in treating pregnancy dysentery.
The so-called Five Examinations are as follows: First, examine food intake. Dysentery is a disease of the intestines and stomach. If the dysentery is severe but food intake is unaffected, it is easy to cure. Thus, anorexic dysentery (Jinkou Li) is the most severe. At the onset when turbid pathogens are abundant, there is little cause for worry; one only needs to clear stagnation, and appetite will return. If after seven days one still cannot eat, and the pulse is rapid and vigorous, it is likely due to failure to clear stagnation initially. Urgently regulate Qi and harmonize the Middle Jiao, so that accumulated mucus descends and diet gradually improves. Or, if one could eat initially but loses appetite after ten days or a solar term, and the pulse is weak, it is likely due to excessive purging injuring Stomach Qi. There are also cases of overusing Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Binglang (Areca Seed), and Houpo (Magnolia Bark), where bitter-cold herbs break Qi, leading to hiccups, vomiting, and retching. Great failure of Stomach Qi is a sign of extreme danger; only fierce warming and tonification can reverse it. If the pulse is extremely rapid, floating and empty-large, intermittent, or wiry-thin and beating forcefully against the finger, these indicate exhaustion of Stomach Qi, with less than one in a hundred chances of survival.
Second, examine urination. In dysentery, clear and turbid are mixed. If dysentery is frequent but urination is smooth, the fetus is safe. If near term, the fetus presses on the bladder, often causing frequent urination and turning into a condition of urinary retention and distension. Diuretics that injure fluids are strictly prohibited; urgently use lifting methods to restore free flow. Observe that the pulse does not show signs of excessive fullness or hardness; then it is appropriate to tonify the Middle and boost Qi, adding slightly Zexie (Alisma Rhizome) and Cheqiancao (Plantago Seed) to raise the clear and descend the turbid. Administration usually yields immediate results. This applies not only to pregnancy but also to ordinary people with chronic dysentery who have severely injured fluids and experience difficult, obstructed urination.
Third, examine abdominal pain. Abdominal pain in dysentery is inevitable. However, sometimes turbid dampness sinks downward without stagnant boiling fire, so there is no pain. This is mostly seen in white dysentery among fat, pale individuals. It is rare in bloody dysentery or among thin individuals prone to fire. Treatment should regulate Qi and move stagnation, not clear fire, which is obvious. Investigating abdominal pain, there is a distinction between cold and heat. Pain with intervals, characterized by urgent bearing-down sensation, inability to reach the toilet in time, indicates Fire. Pain attacking upward from below indicates Fire. Pain with fullness, intolerance to pressure, and worsening with hot drinks indicates Fire, which is Excess. Pain without intervals, constant dull pain without cramping, indicates Cold. Pain rushing downward from above indicates Cold. Pain without fullness, preference for warm massage, relief with hot drinks, ability to endure the urge to defecate for a moment, indicates Deficiency and Cold. Generally, initial dysentery with distension and pain is Heat and Excess; chronic dysentery pain is Deficiency and Cold. Even if initial sharp pain was due to Fire, prolonged dysentery injures Qi and inevitably transforms into Deficiency-Cold. Therefore, for chronic dysentery abdominal pain, regardless of pulse size or speed, if it becomes smaller upon pressing, it belongs to Deficiency-Cold, requiring urgent warming and tonification, avoiding Qi-draining methods. Only if the pain is acute, the pulse is full, and remains unchanged after long pressing, can one slightly use Paojiang (Prepared Ginger) and Lian (Coptis) to harmonize.
Fourth, examine tenesmus. Tenesmus in dysentery is caused by turbid Qi stagnation. To open stagnation, one must base treatment on regulating Qi, which is crucial in pregnancy. Regulating Qi removes tenesmus and stabilizes the fetal breath. For initial tenesmus, one should first develop and resolve stagnation; for chronic tenesmus, one should lift the Yang. When Yang rises, Stomach Qi moves; when Stomach Qi moves, Qi throughout the body regulates, eliminating stagnation. Thus, for pregnant women with tenesmus, regardless of fetal size, if the pulse shows excess, regulate Qi; if the pulse shows deficiency, lift and raise. Even in bloody dysentery, Yang-tonifying herbs are suitable; all cloying blood-nourishing herbs are generally ineffective because Qi has the function of controlling Blood, preventing reckless bleeding.
Fifth, examine body heat. Dysentery is a disease of the interior Qi. If body heat is present, both exterior and interior are distressed; how can the Yuan Shen (Original Spirit) rely on anything to振奋 (rally) and expel pathogens? If the Renying (Carotid) pulse is floating and rapid, first use methods to harmonize Ying and release the exterior to dissipate the pathogenic force, then slowly clear and resolve. If there is no fever initially but fever develops after several days or half a month, with a pulse becoming smaller or empty-large and weak, this indicates internal depletion of True Yin and exposure of deficient Yang. In ordinary people, pungent-warm fierce tonification might be used to gather Qi back to its source. However, in pregnancy, Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) are difficult to use lightly. One must rely on Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Ganjiang (Dried Ginger), Shanzhuyu (Cornus Fruit), Ejiao (Donkey-hide Gelatin), and Aijie (Mugwort Leaf). Without large doses decocted thickly and administered vigorously, it is hard to expect a miraculous recovery. Or, if dysentery has weakened Wei (Defensive) Qi, and careless living leads to contracting deficient Wind with fever, observe the left hand pulses; they must show a floating-slow image. Use Lizhong Tang (Regulate the Middle Decoction) plus Guizhi to treat both interior and exterior. Because pathogens in the context of long-term interior Qi deficiency require Renshen and Baizhu to assist Middle Qi, otherwise external pathogens cannot be resolved.
Once the Five Examinations are clear and the Three Prohibitions are observed, one must also examine whether the stool is sticky or watery, and whether the color is bright or dull, to understand the thickness of Yuan Qi and the cold-heat nature of the disease. Regarding the differentiation of red and white dysentery, past scholars debated extensively, but their views were not entirely correct. Generally, diseases of the Qi level manifest as white; diseases of the Blood level manifest as red. When Qi and Blood are disordered, red and white mix. Qi belongs to Yang; Yang injury often involves cold. Even if there is Fire forcing downward, it is often due to constrained Yang, representing a root-cold and branch-heat syndrome, not purely heat. One should check if the discharge is sticky like paste and white like fat; only then can one temporarily use heat-clearing herbs to treat the branch. If the discharge is watery and the color is dull like dust, urgently warm and regulate Qi. Even if heat symptoms exist, they are likely false appearances. Blood belongs to Yin; Yin injury often involves heat. However, there are many cases of Blood due to Qi injury and Yang failing to control Yin, requiring pungent-warm herbs. Therefore, in treating bloody dysentery, one must judge deficiency-excess and cold-heat by the brightness of the color, a insight not previously developed. Thus, dark, dull, thin, and non-sticky discharge indicates Deficiency-Cold, specifically Yang failing to control Yin. Urgently administer Renshen, Ganjiang, and Aijie to preserve life. Failure to examine and mistakenly administering Huangqin and Huanglian accelerates death. Only if the discharge is sticky, purple-red, and glossy should bitter-dry herbs be used to firm the slipping intestines, accompanied by Qi-regulating herbs to explain Yin pathogens. Unlike white dysentery, which should not be mixed with Huangqin, Huanglian, or Shaoyao (Peony Root) to avoid guiding turbidity to injure Yin Blood. Moreover, post-illness or post-malaria states, constitutions that are inherently weak, or dysentery occurring in the cold seasons of autumn and winter, combined with pregnancy, cannot be treated the same as ordinary summer-autumn dysentery in healthy people.
I once used Nonghou Tang (Thick Magnolia Decoction) minus Ganjiang to treat pregnancy with appetite, abdominal distension, tenesmus, and sticky white dysentery; Gancao Ganjiang Tang (Licorice and Ginger Decoction) and Lizhong Tang to treat pregnancy with abdominal pain, poor appetite, and thin white mucus dysentery; Nonghou Shengjiang Gancao Banxia Renshen Tang (Thick Magnolia, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction) to treat pregnancy with abdominal distension, tenesmus, and mixed red-white dysentery; Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) delivered with Xianglian Wan (Fragrant Coptis Pill) to treat pregnancy with appetite, tenesmus, and sticky bloody dysentery; Lianli Tang (Coptis and Gastrodia Decoction) combined with Qianjin Sanwu Jiao'ai Tang (Thousand Gold Three-Ingredient Gelatin and Mugwort Decoction) to treat pregnancy with lower abdominal pain and heaviness, dark-dull discharge, or occasional fresh blood dysentery; Zhuche Wan (Park Rest Pill) to treat pregnancy with fever, tenesmus, and Yin-deficient anorexic bloody dysentery; Baitouweng Jia Gancao Ejiao Tang (Bupleurum Plus Licorice and Gelatin Decoction) to treat pregnancy with internal heat-toxin, anorexia, abdominal distension, tenesmus, and thick pus-blood dysentery; Qianjin Jiaoai Liupi Tang (Thousand Gold Gelatin, Mugwort, and Pomegranate Peel Decoction) to treat pregnancy with thin pus-clear dysentery, restless fetus, and chronic diarrhea; Buzhong Yiqi Tang (Tonify the Middle and Boost Qi Decoction) to treat pregnancy with prior malaria followed by dysentery, simultaneous malaria and dysentery, sinking Yuan Qi, dropping fetal Qi, frequent urination, or urinary retention due to turned bladder. All the above formulas add Sharen (Amomum Fruit) to regulate Qi and Wumei (Mume Fruit) to regulate Blood, never failing to produce immediate effects.
Shiwan treated the daughter-in-law of Hao (name forgotten), who was nine months pregnant. After three or four episodes of malaria, she experienced vomiting, aversion to food. Her pulse was rough, rapid, and irregular at the Qi Kou (Radial Artery); the Left Guan and Chi positions were wiry, rapid, and slightly slippery. This indicated cold matter blocking the Zhongwan (Middle Epigastrium). I prescribed Xiaochaihu Tang (Minor Bupleurum Decoction) minus Huangqin, plus Paojiang and Shanzha (Hawthorn Fruit). After four doses, she felt better and desired food. However, she disliked porridge and ate lung and duck meat continuously, leading to combined malaria and dysentery with dropping fetal Qi. I prescribed Buzhong Yiqi Tang minus Huangqin, plus Xiangfu (Cyperus Rhizome), Sharen, and Wumei. After five doses, she gave birth. Postpartum, neither malaria nor dysentery recurred. His servant woman, a few days postpartum, suddenly had bloody-pus dysentery, slight chills and fever at night, and lower abdominal distension and pain. I prescribed Qianjin Sanwu Jiao'ai Tang minus Liupi (Pomegranate Peel), plus Paohei Shanzha (Charred Hawthorn Fruit). After six doses, she recovered.
Zilin (Strangury of Pregnancy) Strangury in pregnancy is due to deficient heat in the Kidney and Bladder, unable to control water. Since the uterus is connected to the Kidney, deficient heat in the Kidney transfers to the Bladder, causing this syndrome. If urine is scanty,涩 (astringent/difficult), and strangury occurs, use Shengliao Liuwei Wan (Raw Six-Ingredient Pill) plus Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), Rougui (Cinnamon Bark), and Cheqianzi (Plantago Seed). If Bladder Yang is deficient and Yin cannot transform, use Shenqi Wan (Kidney Qi Pill). If Lung Qi is deficient causing frequent, short urination, use Shengmai San (Generate the Pulse Powder) plus Shanyao (Dioscorea Rhizome) and Zexie. If Small Intestine is hot with red, astringent urine, use Daochi San (Direct Out the Red Powder). If Lung deficiency and Bladder heat cause failure of Qi transformation, use Shengmai San combined with Daochi San. If due to latent heat in the Lung Meridian, use Huangqin Qingfei Yin (Scutellaria Lung-Clearing Drink). If Liver Meridian damp-heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If due to rich foods, use Jiawei Qingwei San (Modified Stomach-Clearing Powder). If due to labor injury or eating fried/spicy foods, with blood in urine, this is blood flowing into the bladder due to heat; use Buzhong Yiqi Tang plus Danpi (Moutan Cortex) and Zhizi (Gardenia Fruit). If due to Spleen-Stomach Qi deficiency, with fetal pressure on the bladder causing fetal distension and abdominal pain, use Bazhen Tang (Eight-Treasure Decoction) doubling Fuling (Poria), plus Chenpi (Tangerine Peel) and Banxia (Pinellia Tuber), taken on an empty stomach. After taking, induce vomiting; when medicine comes out and Qi settles, take again and vomit again; after several times, it will surely settle.
Yiniao (Enuresis) Pregnant women experiencing involuntary urination do so because the fetus is full. Use Qianjin Baiwei San (Thousand Root White Anemone Powder). Xue Shi said, if there is heat in the bladder, use Jiawei Xiaoyao San. If Spleen-Lung Qi is deficient, use Buzhong Yiqi Tang plus Yizhiren (Bitter Almond). If Liver-Kidney Yin is deficient, use Liuwei Wan (Six-Ingredient Pill). If fluid leaks continuously from the vagina after pregnancy, use Qianjin Liyu Tang (Thousand Root Carp Decoction) plus Rougui and Renshen.
Zhuxue (Various Bleeding) Pregnant women with hematuria, where heat enters the Blood level, causing leakage into the bladder, is named Zilin; use Daochi San. If due to anger stirring Liver Fire, use Xiaochaihu Tang plus Zhizi. If Spleen Qi sinks or Labor stirs Spleen Fire, use Buzhong Yiqi Tang plus Fuling and Cheqian. If due to accumulation of heat from rich foods, use Jiawei Qingwei San. If due to Liver-Spleen Blood heat, use Jiawei Xiaoyao San.
Grenqing TuNV (Pregnancy Vomiting and Epistaxis) Caused by injury to organs and viscera from Seven Emotions, with Qi rebelling upward, causing continuous upper bleeding. Severe chest oppression often leads to death or miscarriage. If Liver Meridian Fire, use Jiawei Xiaoyao San. If rich food accumulation heat, use Jiawei Xiaowei San (Modified Stomach-Clearing Decoction). If constraint injures Spleen, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). If Lung Meridian has fire, use Huangqin Qingfei Yin. If due to Qi stagnation, use Zisu Yin (Perilla Decoction). If Qi fails to control Blood, use Buzhong Yiqi Tang minus Shengma (Cimicifuga Rhizome), added with Weigen (Prepared Kudzu Root). If Kidney Meridian deficient fire, use Liuwei Wan plus Maidong and Wuweizi. Coughing up blood or epistaxis should not appear during pregnancy; if face is red and voice hoarse, it is incurable. Hemoptysis and hematemesis often cause miscarriage, as the fetus relies on Blood for nourishment and leakage is undesirable. Use Zisu Yin plus Tianku Qin (Scutellaria Root). If postpartum vomiting/epistaxis/hemoptysis occurs, it is difficult to treat. Extreme leakage resembling menstruation dries the uterus, kills the fetus, and endangers the mother. Changfeng Cangdu (Intestinal Wind and Hidden Toxin), intestinal-stomach dysfunction, bloating with lower bleeding: use Pingwei San minus Cangzhu (Atractylodes Lancea Rhizome), added with Huaijiao (Sophora Fruit), Fangfeng (Saposhnikovia Root), Danggui (Angelica Sinensis), and Wumei.
Zhutong (Various Pains) Chronic lateral or frontal headache: use Chuanxiong Chatiao San (Ligusticum Tea-Adjusting Powder). Chronic cold痞 (fullness), phlegm-fluid accumulation, or new contraction of Wind-Cold, where pathogenic and righteous Qi clash: upward striking the Heart causes heart pain; downward striking the abdomen causes abdominal pain. Unrelenting pain disturbs the fetus. This disease is mostly Cold and Food-related, occasionally Heat; Zhengqi San (Righteous Qi Powder) is suitable for all. For Cold, add Muxiang (Aucklandia Root) and Paojiang. For Food stagnation with fever, add Huangqin, Huanglian, and Paojiang. For Qi, add Sharen and Xiangfu. For Phlegm, add Chenpi and Shengjiang (Fresh Ginger). If due to mixed pathogens, investigate the cause and treat accordingly. For pre- and post-partum heart pain, stir-fry Chuanlian (Toosendan Fruit) and Huixiang (Fennel Fruit) each 3 qian, salt-stir-fried Aiye (Mugwort Leaf) 1.5 qian, decoct in water and drink. For abdominal pain, intermittent, named Tongtai (Painful Fetus), due to Blood deficiency: use Siwu Tang (Four-Substance Decoction) plus Xiangfu powder, delivered with Zisu Tang. For Qi stagnation, use Zisu Yin. For stomach pain, prohibit Zhimi (Vermifuge Pill), use Yangwei Tang (Nourish Stomach Decoction). For pregnancy abdominal fullness/pain piercing the heart, inability to eat: use Qianjin Qinshu Shaoyao Tang (Thousand Root Scutellaria, Atractylodes, and Peony Decoction). For hypochondriac pain, causes are three: crying, internal injury, anger. With pregnancy, avoid Qi-breaking herbs; only use child’s urine mixed with wine. Or Zisu Yin minus Renshen, using Shaoyao and Danggui, adding Sharen and child’s urine. Even if injury is severe, do not use damaging herbs; securing the fetus is paramount. For back pain, due to Qi stagnation, use Zisu Yin. For waist-abdomen-back pain due to labor injury, unrelenting pain disturbing the fetus: use Buzhong Yiqi Tang plus Xuduan (Dipsacus Root) and Duzhong (Eucommia Bark). Many pains are due to strangury; investigate and treat. Migratory pain is a sign of敗血 (stagnant blood) entering meridians: use Siwu Tang (Four Black Decoction) plus Bo Gui (Thin Cinnamon Bark), Duzhong, and Xuduan. Fat people often have damp-heat, heavy waist pain, or leukorrhea: use Ermiao San (Two Marvels Powder) plus Chaihu (Bupleurum Root), Fangfeng, Fuling, and Banxia. Qi-Blood stagnation causing whole-body stiffness and pain, black spots in eyes, insomnia: use Zisu Yin plus Zhike (Bitter Orange) and Jiegeng (Platycodon Root). Severe waist pain indicates extreme Kidney deficiency; the fetus will likely abort. Urgently服用 Bazhen Tang plus Ejiao, Aijie, and Huangqi (Astragalus Root). Or modify Zisu Yin. Cold pain below the navel, abdominal distension/virtual pain, frequent urination, loose stools, all caused by eating raw/cold foods: use Xiao Jianzhong Tang (Minor Construct the Middle Decoction) plus Paojiang and Muxiang. If ineffective, add Huixiang and Liangjiang (Galangal). Lower abdominal pain caused by deficiency-heat in the uterine collaterals clashing: use Zisu Yin plus Shengjiang. For Deficiency-Cold, use Jiaoai Tang. If ineffective, Cold is severe; add Guizhi and Fuzi to warm internally. Severe internal injury ensures fetal expulsion. If medication fails, inspect the lower abdomen; if swollen, thin, and shiny, it is a pregnancy abscess: use Qianjin Tuoli San (Thousand Root Supporting Interior Powder) or drink Coix Seed juice. If sudden severe heart-abdominal pain, irritability, blue face, cold sweat, collapse, continuous bleeding, and fetus rushing upward: incurable.
Zizhong (Fetal Edema) Pregnant women with limb edema or large abdomen have two syndromes: Water Edema and Fetal Qi Edema. However, Water Edema is rare in pregnancy; it is usually just Fetal Qi, called Zizhong, which is a Qi disease. Due to visceral deficiency, Spleen Earth cannot control Water, Blood scatters to limbs, causing abdominal distension, swelling of hands, feet, face, and even whole-body edema with urgent chest-abdominal distension. All should use Zisu Yin. If urination is difficult, Fetal Qi combines with Water Qi: Zisu Yin plus Zexie, Baizhu, Fuling, and Mutong. If floating, asthma, and abdominal distension occur, and swelling subsides with loose skin after medication: use Liujunzi Tang (Six-Gentlemen Decoction) for regulation. If face/eyes are puffy and limbs swell like water: use Quansheng Baizhu San (Complete Life Atractylodes Powder). If ineffective, Liujunzi Tang plus Fupi (Melon Rind) and Cheqian. If lower body swelling is severe: use Buzhong Yiqi Tang plus Fuling. Or due to improper diet, vomiting, and diarrhea, indicating Spleen-Stomach damage: use Liujunzi Tang plus Paojiang, Muxiang, and Xiangfu. If toe swelling spreads to knees with asthma/discomfort, or water oozes from toe webs, named Zi Qi (Fetal Qi), due to inherent Wind or Chong-Ren Blood carrying Wind-Water: do not blindly prescribe decoctions. Use Erchen Tang (Two-Aged Decoction) plus Wuyao (Lindera Root), Xiangfu, and Mutong. If Spleen-Stomach is weak, add Renshen and Baizhu. Also advance Xiaoyao San. If ineffective, use Zisu Yin. Whenever pregnancy menstrual blood is blocked, sudden virtual swelling indicates Water holding in the uterus, Water-Blood clashing. Spleen-Stomach governs muscles and dislikes dampness; dampness impairs Qi, making muscles virtual; water flows溢出, causing whole-body swelling. Or due to diarrhea/dysentery damaging Spleen-Stomach; or due to cold/heat/thirst leading to excessive drinking, dampening Spleen-Stomach, all causing extremity/facial swelling. However, if water infiltrates the uterus before the fetus forms, the fetus is often damaged. Near delivery, slight leg/foot swelling indicates the uterus has little Blood and much Water; water exits externally, showing slight swelling, indicating easy birth. Whole-body pregnancy edema, indistinguishable chest-hypochondrium, or urgent chest-abdominal distension, named Taishui (Fetal Water): use Qianjin Liyu Tang. Some pregnancy abdominal distension, after 3-5 doses of the previous decoction, excretes foul water via bowels/bladder, swelling subsides, distension goes, then dead fetus is expelled. This condition arises because one knows the large abdomen of pregnancy but ignores the hazard of Fetal Water. Zheng Xu'an said: Swelling above the middle body requires sweating; swelling below requires diuresis; swelling everywhere requires sweating and diuresis to dissipate dampness. If lips are black, clavicles flat, back flat, umbilicus protruding, soles flat: incurable.
Buyu (Mutism) Mutism is mostly due to Phlegm closing the Heart orifice; there is also哑胎 (mute fetus), requiring no medication. Qibo said: A person heavily pregnant for nine months becomes mute because the Bao Luo (Uterine Collateral) vessels cease. The Bao Luo connects to the Kidney; the Shaoyin Meridian passes through the Kidney and ties to the tongue root, hence inability to speak. No treatment needed; speech returns at ten months. For those suffering this, decoct Shengmai San thickly and take on an empty stomach with Dihuang Wan (Rehmannia Pill) to assist Lung-Kidney Qi to nourish the fetus. Using voice-opening medications would be a mistake.
Chanyu (Delirious Speech) Delirious speech in pregnancy indicates extreme heat in the viscera. Urgently administer child’s urine frequently. If ineffective, use Shengdi Huang Huanglian San (Rehmannia and Coptis Powder) to clear the heat in the Blood.