张寿甫认为，带下积久不愈，必有瘀血留着于内，故带证日久，应于收涩之中佐化瘀通滞之品，其拟清带汤中龙骨、牡蛎、茜草、海螵蛸皆具二功。李老认为，开通可制固涩之滞，为标本兼治，以达补虚固脱、滞化血和之功。
附案：
案一 熊某，女，48岁。门诊号：93039。
1965年]O月19日初诊：带下量多1年，加重10日，形质清稀，伴乏力，腰困腹痛，下腹时发凉或灼热。背部午后灼热，患者面色无华，精神疲惫，经来量少，色淡红，经后下腹疼痛加重，纳呆，二便尚调，舌淡红，苔薄白，脉沉。处方：
生山药15克 生龙牡各12克 海螵蛸9克 茜草4．5克 生白芍9克 生白术9克 生蒲黄4．5克 炒灵脂6克川楝子4．5克 羌活3克
水煎服。
按：李老辨证，据全身症状、舌脉确立病性为虚，次据个别虚证症状，辨明在脾、在肾之异，同时必据夹杂证辨明兼寒、兼热等不同。带下辨证则带下本症兼症并重，综合分析归纳得出。从带下量多，质清稀，兼面色无华，神疲乏力，腰困，纳呆，脉沉，辨证属脾虚兼肾不足。脾虚水湿不化，下注冲任胞宫，损伤冲任而成本病。腰为肾之府，胞络者系于肾，冲任损伤累及肾，故腰困；湿性粘滞重浊，壅遏气机，阳气被阻则凉，郁而化热则热，故下腹时凉时灼热；气虚血滞，血行不畅故腹痛，经后气血愈虚，故经后加重；带下日久不愈，气虚失摄则量多，故有脱象。李老以张寿甫清带汤补虚固脱，方中用生山药补脾肾固元气，生龙牡、茜草、海螵蛸收敛固涩并具开通之性，使补涩而不滞，另加生白术健脾，生白芍养血益阴，合失笑散、川楝子理气止痛，羌活一味既得解上身之风湿，兼能温升，有升提之意。全方共奏补虚固脱、活血止痛之功。
李老常以清带汤加味治疗带下病，在张寿甫调寒热基础上，寒甚者，加干姜、肉桂、附子、茴香；虚甚者，加党参、黄芪、当归、生地等；热盛成毒者，加银花、三七、鸦胆子等药。
案二 一妇带下不止，服调经剂，血愈下，复投寒凉剂，遂下泄，肌肉如削，不能言语，四肢厥逆，脉细如丝。予参附汤(人参60克，附子9克)1剂手足微温，再剂思饮食，继服八珍汤40余剂而愈。
按：此妇患临经带下，带下不止欲滑，为阳虚下陷，下元不能固摄，当固摄肝肾，升举清阳，却予调经剂，故虚未得补而失于收摄，故经潮则量反多，人以为血热迫血妄行，又投寒凉剂复伤脾胃阳气，气血乏源，气血愈虚，脾胃功能失调，传导升降失司而发生泄泻，肌肉失养则肌肉如削，清阳不升则失语，气虚阳微不达四末故四肢厥逆，不能营阴，则脉细如丝。纵观诸症为带、经、泄同病，乃素体虚弱而伐以寒凉，故见四肢厥逆，脉细如丝，辨证属阳微气脱。遵治病必求于本，病虽异而证则相同，法当异病同治。急投参附为扶阳固脱，阳回则继用八珍汤补气养血缓图治本，药巾病的而愈。
带下辨证 本证兼证并重
带下病有寒、热、虚、实四种，然临证多虚实夹杂，寒热相间，如虚证中有脾虚、肾虚之异，又有兼寒兼热之不同，更有多脏同病、气血俱损之证。临床辨证以带下本症兼症并重。
带下本症，有带下色、量、质、味、发病久暂、排泄时的感觉等。
从色辨：白多寒，或湿胜于热，或病在气分，或关肺经；色黃多系湿热，或关脾经；色青者，多与肝经有关，或肝郁气滞，或肝经湿热，或肝肾两虚；色黑者，多与肾经有关，或系热盛，或系经漏；色赤者，多热，或热胜于湿，或病在血分，或与心经有关；带下赤白相兼，多系湿热互结；五色杂下，多系有溃烂。总之，浅淡者多虚，深浓者多实。
从量辨：量多为虚，量少为实，量时多时少多肝郁。
从质辨：形如胶粘者多湿热，清稀如水多风寒，形如米泔多脾湿，如鸡子清者多脾气虚、肾阳虚证。
从味辨：味腥臭者多湿热。
从排泄时的感觉辨：排泄时觉凉者多寒，觉热者多热。
从发病时间辨：久者多虚，短暂者多实。
然仅据以上本症不足为据，必兼具全身相应兼症者方可确立。如：
肝郁者，必兼精神郁闷，胸胁胀痛，喜太息，脉沉或弦涩等。
湿热者，不论其色如何，暈较多或如崩，质稠粘，味腥秽，必兼体倦，门干苦或粘腻不欲饮，舌苔黄腻，脉濡滑数等。
脾虚者，带下量多，色白或淡黄无臭，必兼饮食不化，精神疲倦，大便溏，舌淡，苔薄，脉细等。
寒湿者，带清稀，必兼形寒畏冷，四肢不温，下腹冷痛， 口不干，舌苔淡白而润，脉沉迟缓。
湿毒证，带下黄白如脓，或伴下疳，必兼尿道刺痛，阴部肿痛溃烂，舌红，苔干黄，脉数等。
从带下量色辨转归
带下病为带下色、量、质、味的异常或伴全身或局部症状者，故带下病诊断不泥其量之多少。但有色质味之异常即可，李老以量作为疾病轻重转归的尺度之一。量多者病较重，量少者病较轻，量多而忽然大下之崩带病重而险；量由多变少，为病退及药对证的表现，量由少变多为病进或药不对证，治之无效的现象，用药后量如光多后少。考虑为有效，属已成之带尽出，未成之带有所阻。
带下有白带、黄带、青带、赤带、黑带、赤白带、五色带之分，白者属肺，赤者属心……从带下颜色可确立带下类型及所属经络，并能以色之淡浅深浓体会病势，带下浅淡，病为轻，色质深浓，病较重，五色杂下，病重而险。
妊娠病滑胎责之肝经虚热 殒堕关系脾肾气虚
滑胎为连续自然堕胎或小产3次以上者，有的甚至每孕到一定月份则自然滑堕，滑堕之虞有母体、父体两方面因素。巢氏认为胎怀十月，经养各有所主，而母体因素最与十二经中肾、肝、脾三脏及气血相关。正如《景岳全书》中所云： “所以屡见小产堕胎者，多在三月、五月及七月之间，而下次之堕必如期复然，必以先决伤此一经则遇阙不能过矣。”故滑胎之关键在于堕后虚损未复，治“必当家此着胎之源而预培其损”，即寻找病因，预防为主，重在未孕时。
四时之令，必始于春木，故十二经之养始于肝木。妊娠早期胎未成形，赖阴血荫胎，肝体阴用阳，肝体柔和则胎安，否则肝血虚，肝气旺，胎失所养，并热扰胎气，则殒堕。故早期殒堕者，责之肝经虚热。孕前宜常服逍遥散加生地，热甚者，加黄芩，以达柔肝健脾清热之目的，肝体柔，肝气平。而孕自安。
妊娠有赖于肾气冲盛，天癸泌至，和于阴阳，冲任相资，而胎元之健固亦须肾以系胎，气以载胎，血以养胎，脾为后天，气血生化之源，先后天充足相资，则胎元固实。脾、肾不足，勉为妊娠，但终不能瓜熟蒂落而夭折，故补肾培脾为治滑胎之根本。妊娠五月，为足太阴脾经所养，九月为足少阴肾经所养，故中晚期滑胎，当责之中气虚不能护胎，肾气虚失于系胎。因于中焦者孕前宜常服小建中汤加白术使脾健气血易生，因于下焦不足者常服寿胎丸，如此成胎之后继安胎，才无小产之患。 妊娠恶阻无寒热 和胃降逆宜理气 恶阻为妊娠呕吐之证，是妊娠早期的常见现象．若反应严重，反复呕吐不止者，可使孕妇迅速消瘦或诱发他病，甚至影响胎儿的发育，故需及时治疗。正如《万氏妇人科》云：“轻者不服药无妨，乃常病也。重者需药调之，恐伤胎气。”
冲为血海，隶于阳明而附于肝，胃气以和降为顺。孕后阴血聚而养胎，藏而不定形，使得冲脉之气偏盛，逆而犯胃，使得胃气上逆而见恶阻之病。“正气存内，邪不可干”，因此，胃弱是其根本，其发病总与损伤胃气有关，治之必时刻顾护胃气，和胃降逆为主。《医宗金鉴·妇科心法要诀》明确提出治法：“审其或因胎气阻逆，或痰饮阻逆，与夫兼热、兼寒而分治之。”临证胃热恶阻者，治宜加味温胆汤，以清胃热，和胃气，方药为温胆汤加黄芩3克，黄连1．5克，麦冬6克，芦根3克。痰饮阻逆者，予加味六君子汤，即六君子加杷叶3克，旋覆花1．5克，枳壳1．5克，除痰降逆，偏热者加黄芩，偏寒者加肉桂、干姜。因于胎气阻逆，无寒热偏象，无兼肝郁痰饮者，此时当理气平逆，以达和胃降逆之功。理气之药不宜过用香燥之品，以防耗伤气血，于胎无益反害。方用保生汤，药物组成有砂仁7．5克，白术、香附、乌药、陈皮各15克，甘草7．5克，生姜3～5片。水煎频饮。方中一派理气之品，但加白术健脾以资气血，达安胎，并防理气伤气之弊。妊娠腹痛有伤食、胞寒、膀胱热结之分
妊娠腹痛，亦称胞阻，从历代医家论述看，其实为胎漏、胎动不安之证候。李老认为，本病为妊娠期心胃腹痛的证候，病变部位涉及上、中、下全腹，分伤食、胞寒及膀胱热结三型论治。
!．伤食者，症见胃脘脐腹胀痛，有伤食史，嗳腐恶食，舌淡红，苔厚，脉滑。治宜消食行滞。方用平胃散加味。临证应辨疼痛部位及大便情况加以变通，如痛在胃脘部，宜加草果、枳实、神曲；如痛在脐腹，兼大便秘结者，宜去苍术之燥性助秘之弊，酌加芒硝、大黄，倍用甘草，以缓和二药峻烈之性，以防伤胎，或更加人参，攻补兼施，则效尤良。
2．寒凝胞宫者，症见妊娠期小腹疼痛，喜暖，下腹凉，喜热饮，舌淡红，苔白，脉紧。临证当辨寒在血分、水分而治法不同。寒在血分者，小便必白利，治宜温经散寒止痛，方用加味芎归散，方药为当归15克，川芎6克，人参3克，吴茱萸1．5克，阿胶6克，艾叶1．5克，炙草1．5克；寒在水分者，小便必不利，治宜温阳化水，方用五苓散。
3．膀胱热结者，症见小腹灼热疼痛，小便不利，舌红，苔黄，脉数有力，治宜清热利水，方用导赤散。
保胎要则
流产的发生，主要是气血虚损，冲任不固，不能维系而坠。气虚提摄无力，血虚则灌溉不周，不能摄血养胎，造成流产．故补气血为保胎之治疗大法，再根据情况，予以止血、镇痛、解郁等，以达到标本兼顾，否则，只顾一面，恒至失败。用药方面，杜仲、桑寄生、苎麻根为常用之品，无副作用，不妨大剂应用，可用至15～30克；用参时，须用高丽参为佳。一般而言，胎水未破者，大体都可收效。寿胎丸、胎元饮等，疗效都很好，均可选用。古有黄芩、白术能安胎之说，这也须酌情应用，有热者宜，如气虚者，用之无效。大体流产患者，从脉象上辨别，滑数有力者多可保全，如沉微细涩者，一般来说，多难以保全。
安胎不离益肾
胎漏，为妊娠期阴道少量出血，时下时止，或淋沥不断，不伴腰腹困坠之症。胎动不安，为妊娠期腰酸腹痛，或下腹坠胀，或伴有阴道少量出血者，其证轻微，为堕胎小产之先兆。有“其母有疾以动胎”和“胎不牢固”两大病因病理，但究其根本则主要责之于母体冲任气血失调，胎元不固，因其胎元未殒，故治以安胎为主。临证有肾虚、气血虚弱、血热、气郁及外伤等不同，随证随经去其所病，以达冲任调和、胎元牢固之目的。
李老认为，肾为五脏之本，胎元之系，补肾为安胎之根本，不论气血失：厂濡养，热扰胎气，胎气受阻，或跌扑伤胎等，均不离补益肾气以固胎，胎得肾系，安之则易。方用寿胎丸及杜仲、续断之类。
附案：
案一 代某。女，41岁。门诊号：40609。
1961年3月6日初诊：患者有习惯性流产病史，本次妊娠已7个月，腹痛有下坠感，伴腰酸腿困，少量阴道出血，色淡，体倦，面色无华，食欲不佳，舌苔薄白，脉细无力。处方：
菟丝子12克 桑寄生7．5克 川断6克 阿胶7．5克杜仲9克 炒白芍7。5克 生白术9克
二诊：服药2剂后，腹痛减轻，继服2剂后胎安．
按：肾为冲任之本，胞络者系于肾。屡孕屡堕，复伤冲任气血，加之年逾35岁，肾气亦生理性渐衰，使得肾气愈虚，适值妊娠，胎失所系，故有腰酸腹坠之胎动不安．肾为五脏之根，肾虚失于煦脾，脾失健运，则食欲不佳，气血生化不足，失于上荣，故体倦肢困，面色无华，脉细无力，皆为虚损不足之候。《妇人规·胎动欲堕》载：“妊娠胎气伤动者……轻者转动不安或微见血，察其不甚，速宜安之。”治以寿胎丸加杜仲补肾固胎，生白术健脾安胎，白芍养血，炒用取其止痛升提安胎之意。全方共奏补肾益气、养血安胎之功。
案二 王某，女，30岁。门诊号：90290。
1965年10月4日初诊：患者停经46天，小腹隐痛10余日，时或腰困，无阴道出血。B超提示宫内妊娠，发育符合6周余。患者曾流产2次，刻下精神疲惫，心悸气短，面色萎黄，纳差，舌淡，苔薄白，脉无力。处方：
党参12克 白术9克 茯苓9克 菟丝子12克 川断6克 桑寄生7．5克 杜仲9克 甘草6克
2剂，水煎服。
按：该患者为妊娠早期之胎动不安。因故2次流产，伤于冲任气血，气虚胎失所载，血虚胎失所养，胎气不固，故见妊后小腹隐痛，时或腰困；气血虚弱，心神失养，而致心悸神疲，气虚不足以息；面色萎黄为气血失于上荣之征；纳呆为脾胃不健；舌淡、脉无力为不足之象。治之宜补气养血安胎。
张寿甫认为，带下病日久不愈，体内必然有瘀血停留，因此对于病程较长的带下证，应在收敛固涩的药物中辅以化瘀通滞的药材。他所拟定的清带汤中，龙骨、牡蛎、茜草、海螵蛸这四味药都兼具收敛固涩和化瘀通滞的双重功效。李翰卿老中医认为，开通瘀滞可以制约固涩药可能导致的壅滞之弊，这是标本兼治的方法，能够达到补虚固脱、化除瘀滞、调和气血的效果。
附案：
案一 熊某，女性，48岁。门诊号：93039。
1965年10月19日初诊：白带量多持续1年，近10天加重，质地清稀，伴有乏力、腰部困重、腹痛，下腹部有时发凉或感觉灼热。背部在午后有灼热感，患者面色苍白无光泽，精神疲惫，月经量少，颜色淡红，月经结束后下腹疼痛加重，食欲不振，大小便尚正常，舌质淡红，苔薄白，脉象沉。处方：
生山药15克，生龙骨、生牡蛎各12克，海螵蛸9克，茜草4.5克，生白芍9克，生白术9克，生蒲黄4.5克，炒五灵脂6克，川楝子4.5克，羌活3克。
水煎服。
按语：李老进行辨证，依据全身症状、舌象和脉象确定病性为虚证；其次根据个别虚证症状，辨别病变是在脾还是在肾；同时必须依据夹杂证候，辨别是兼寒还是兼热等不同情况。对带下病的辨证，则要将带下本身的症状与伴随症状并重，综合分析归纳得出结论。从带下量多、质地清稀，兼见面色无华、神疲乏力、腰部困重、食欲不振、脉沉等症状来看，辨证属于脾虚兼肾气不足。脾虚导致水湿不能运化，向下流注于冲任二脉及胞宫，损伤冲任而引发此病。腰为肾之府，胞络系于肾，冲任受损累及肾脏，故出现腰部困重；湿性粘滞重浊，阻滞气机，阳气被阻则感到凉，郁久化热则感到热，所以下腹部时而发凉时而灼热；气虚导致血行滞涩，血液运行不畅故引起腹痛，月经后气血更加虚弱，所以经后疼痛加重；带下病日久不愈，气虚失去固摄作用导致量多，故有滑脱之象。李老采用张寿甫的清带汤来补虚固脱，方中使用生山药补益脾肾、固护元气，生龙骨、生牡蛎、茜草、海螵蛸具有收敛固涩并兼具开通瘀滞的性质，使补益和固涩而不致壅滞，另外加入生白术健脾，生白芍养血益阴，合用失笑散（由蒲黄、五灵脂组成）和川楝子理气止痛，羌活一味既能解除上身的风湿，又能温升阳气，有升提之意。全方共同起到补虚固脱、活血止痛的功效。
李老常以清带汤加减治疗带下病，在张寿甫调理寒热的基础上，若寒邪严重者，加干姜、肉桂、附子、小茴香；若虚损严重者，加党参、黄芪、当归、生地黄等；若热盛成毒者，加金银花、三七、鸦胆子等药物。
案二 一位妇女带下淋漓不止，服用调经药剂后，出血更多，又投予寒凉药剂，于是发生泄泻，肌肉消瘦如柴，不能说话，四肢冰冷厥逆，脉象细如丝线。给予参附汤（人参60克，附子9克）1剂后手足微微转温，再服1剂后开始思食，继服八珍汤40余剂后痊愈。
按语：这位妇女患的是经期前后的带下病，带下不止且有滑脱之势，这是阳虚下陷，下元不能固摄所致，应当固摄肝肾，升举清阳，却误用了调经药剂，所以虚证未得补益反而失去了收摄，导致月经来时血量反而增多。人们以为是血热迫血妄行，又投予寒凉药剂，再次损伤脾胃阳气，导致气血生化之源匮乏，气血更加虚弱，脾胃功能失调，传导升降失常而发生泄泻，肌肉失于濡养则肌肉消瘦，清阳不升则失语，气虚阳微不能达于四肢末端故四肢厥逆，不能营润阴血，则脉细如丝。纵观所有症状，这是带下、月经、泄泻同病，乃因素体虚弱又误用寒凉攻伐，故见四肢厥逆、脉细如丝，辨证属于阳气微弱、气随血脱。遵循治病必求于本的原则，病虽不同但证候相同，法当异病同治。急投参附汤以扶阳固脱，阳气回复后继用八珍汤补气养血以缓图治本，药证相符而痊愈。
带下辨证：本症与兼症并重
带下病有寒、热、虚、实四种类型，然而临证时多为虚实夹杂，寒热相间。例如虚证中有脾虚、肾虚的区别，又有兼寒、兼热的不同，更有多个脏腑同病、气血俱损的证候。临床辨证要以带下本身的症状和伴随症状并重。
带下本症，包括带下的颜色、量、质地、气味、发病时间的长短、排泄时的感觉等。
从颜色辨别：白色多属寒，或湿胜于热，或病在气分，或与肺经有关；黄色多系湿热，或与脾经有关；青色者，多与肝经有关，或是肝郁气滞，或是肝经湿热，或是肝肾两虚；黑色者，多与肾经有关，或是热盛，或是经漏；红色者，多属热，或热胜于湿，或病在血分，或与心经有关；赤白相兼，多系湿热互结；五色杂下，多系有溃烂。总之，颜色浅淡的多属虚证，颜色深浓的多属实证。
从量辨别：量多属虚，量少属实，量时多时少多属肝郁。
从质地辨别：形状如胶粘的多属湿热，清稀如水的多属风寒，形状如米泔水的多属脾湿，如鸡子清（蛋清）样的多属脾气虚、肾阳虚证。
从气味辨别：味腥臭的多属湿热。
从排泄时的感觉辨别：排泄时觉凉的多属寒，觉热的多属热。
从发病时间辨别：病程久的多属虚，短暂的多数属实。
然而仅依据以上本症不足以作为定论，必须兼具全身相应的兼症方可确立诊断。例如：
肝郁者，必兼精神郁闷，胸胁胀痛，喜欢叹气，脉象沉或弦涩等。
湿热者，不论其颜色如何，量较多或如崩漏，质地稠粘，味腥秽，必兼身体疲倦，口干口苦或粘腻不欲饮水，舌苔黄腻，脉濡滑数等。
脾虚者，带下量多，色白或淡黄无臭味，必兼饮食不消化，精神疲倦，大便溏薄，舌淡，苔薄，脉细等。
寒湿者，带下清稀，必兼形寒畏冷，四肢不温，下腹冷痛，口不干，舌苔淡白而润，脉沉迟缓。
湿毒证，带下黄白如脓，或伴下疳（生殖器溃疡），必兼尿道刺痛，阴部肿痛溃烂，舌红，苔干黄，脉数等。
从带下量色辨转归
带下病是指带下的色、量、质、味异常或伴有全身或局部症状者，因此带下病的诊断不拘泥于量的多少。只要有颜色、质地、气味的异常即可确诊。李老将“量”作为判断疾病轻重及转归的尺度之一。量多者病较重，量少者病较轻，量多而突然大量下泄的崩带病，病重且险；量由多变少，是病退及药对证的表现；量由少变多是病进或药不对证、治疗无效的现象；用药后量先多后少，考虑为有效，属于已成之带尽出，未成之带有所阻隔。
带下有白带、黄带、青带、赤带、黑带、赤白带、五色带之分，白色属肺，红色属心……从带下颜色可确立带下类型及所属经络，并能通过颜色的淡浅深浓体会病势，带下浅淡，病轻；色质深浓，病重；五色杂下，病重而险。
妊娠病滑胎责之肝经虚热，殒堕关系脾肾气虚
滑胎是指连续自然堕胎或小产3次以上者，有的甚至每孕到一定月份则自然滑堕。滑堕的原因有母体、父体两方面因素。巢元方认为胎儿怀胎十月，各阶段由不同的经脉滋养，而母体因素最与十二经中的肾、肝、脾三脏及气血相关。正如《景岳全书》中所说：“所以屡见小产堕胎者，多在三月、五月及七月之间，而下次之堕必如期复然，必以先决伤此一经则遇阙不能过矣。”故滑胎的关键在于堕胎后虚损未恢复，治疗“必当查此着胎之源而预培其损”，即寻找病因，预防为主，重在未怀孕时。
四时的时令，必定始于春季木气，故十二经的滋养始于肝木。妊娠早期胎未成形，赖阴血荫养胎儿，肝体阴用阳，肝体柔和则胎安，否则肝血虚，肝气旺，胎失所养，并热扰胎气，则导致殒堕。故早期殒堕者，责任在于肝经虚热。孕前宜常服逍遥散加生地黄，热甚者，加黄芩，以达到柔肝健脾清热的目的，使肝体柔和，肝气平和，而孕自安。
妊娠有赖于肾气冲盛，天癸泌至，阴阳调和，冲任相互资助，而胎元的健固也须靠肾来系胎，气来载胎，血来养胎。脾为后天之本，气血生化之源，先后天充足相互资助，则胎元固实。脾、肾不足，勉强妊娠，但最终不能瓜熟蒂落而夭折，故补肾培脾是治疗滑胎的根本。妊娠五月，为足太阴脾经所养，九月为足少阴肾经所养，故中晚期滑胎，当责之于中气虚不能护胎，肾气虚失于系胎。因于中焦者，孕前宜常服小建中汤加白术使脾健气血易生；因于下焦不足者，常服寿胎丸，如此成胎之后继以安胎，才无小产之患。
妊娠恶阻无寒热，和胃降逆宜理气
恶阻是妊娠呕吐之证，是妊娠早期的常见现象。若反应严重，反复呕吐不止者，可使孕妇迅速消瘦或诱发他病，甚至影响胎儿的发育，故需及时治疗。正如《万氏妇人科》所说：“轻者不服药无妨，乃常病也。重者需药调之，恐伤胎气。”
冲脉为血海，隶属于阳明而依附于肝，胃气以和降为顺。孕后阴血聚而养胎，藏而不定形，使得冲脉之气偏盛，逆而犯胃，使得胃气上逆而见恶阻之病。“正气存内，邪不可干”，因此，胃弱是其根本，其发病总与损伤胃气有关，治疗时必须时刻顾护胃气，以和胃降逆为主。《医宗金鉴·妇科心法要诀》明确提出治法：“审其或因胎气阻逆，或痰饮阻逆，与夫兼热、兼寒而分治之。”临证胃热恶阻者，治宜加味温胆汤，以清胃热，和胃气，方药为温胆汤加黄芩3克，黄连1.5克，麦冬6克，芦根3克。痰饮阻逆者，予加味六君子汤，即六君子汤加枇杷叶3克，旋覆花1.5克，枳壳1.5克，除痰降逆，偏热者加黄芩，偏寒者加肉桂、干姜。因于胎气阻逆，无寒热偏象，无兼肝郁痰饮者，此时当理气平逆，以达到和胃降逆之功。理气之药不宜过用香燥之品，以防耗伤气血，于胎无益反害。方用保生汤，药物组成有砂仁7.5克，白术、香附、乌药、陈皮各15克，甘草7.5克，生姜3～5片。水煎频饮。方中一派理气之品，但加白术健脾以资气血，达到安胎，并防止理气伤气的弊端。
妊娠腹痛有伤食、胞寒、膀胱热结之分
妊娠腹痛，亦称胞阻，从历代医家论述看，其实为胎漏、胎动不安之证候。李老认为，本病为妊娠期心胃腹痛的证候，病变部位涉及上、中、下全腹，分伤食、胞寒及膀胱热结三型论治。
1. 伤食者，症见胃脘脐腹胀痛，有伤食史，嗳腐恶食，舌淡红，苔厚，脉滑。治宜消食行滞。方用平胃散加味。临证应辨疼痛部位及大便情况加以变通，如痛在胃脘部，宜加草果、枳实、神曲；如痛在脐腹，兼大便秘结者，宜去苍术之燥性助秘之弊，酌加芒硝、大黄，倍用甘草，以缓和二药峻烈之性，以防伤胎，或更加人参，攻补兼施，则效尤良。
2. 寒凝胞宫者，症见妊娠期小腹疼痛，喜暖，下腹凉，喜热饮，舌淡红，苔白，脉紧。临证当辨寒在血分、水分而治法不同。寒在血分者，小便必白利，治宜温经散寒止痛，方用加味芎归散，方药为当归15克，川芎6克，人参3克，吴茱萸1.5克，阿胶6克，艾叶1.5克，炙甘草1.5克；寒在水分者，小便必不利，治宜温阳化水，方用五苓散。
3. 膀胱热结者，症见小腹灼热疼痛，小便不利，舌红，苔黄，脉数有力，治宜清热利水，方用导赤散。
保胎要则
流产的发生，主要是气血虚损，冲任不固，不能维系而坠。气虚提摄无力，血虚则灌溉不周，不能摄血养胎，造成流产。故补气血为保胎之治疗大法，再根据情况，予以止血、镇痛、解郁等，以达到标本兼顾，否则，只顾一面，恒至失败。用药方面，杜仲、桑寄生、苎麻根为常用之品，无副作用，不妨大剂应用，可用至15～30克；用人参时，须用高丽参为佳。一般而言，胎水未破者，大体都可收效。寿胎丸、胎元饮等，疗效都很好，均可选用。古有黄芩、白术能安胎之说，这也须酌情应用，有热者宜，如气虚者，用之无效。大体流产患者，从脉象上辨别，滑数有力者多可保全，如沉微细涩者，一般来说，多难以保全。
安胎不离益肾
胎漏，为妊娠期阴道少量出血，时下时止，或淋沥不断，不伴腰腹困坠之症。胎动不安，为妊娠期腰酸腹痛，或下腹坠胀，或伴有阴道少量出血者，其证轻微，为堕胎小产之先兆。有“其母有疾以动胎”和“胎不牢固”两大病因病理，但究其根本则主要责之于母体冲任气血失调，胎元不固，因其胎元未殒，故治以安胎为主。临证有肾虚、气血虚弱、血热、气郁及外伤等不同，随证随经去其所病，以达到冲任调和、胎元牢固之目的。
李老认为，肾为五脏之本，胎元之系，补肾为安胎之根本，不论气血失于濡养，热扰胎气，胎气受阻，或跌扑伤胎等，均不离补益肾气以固胎，胎得肾系，安之则易。方用寿胎丸及杜仲、续断之类。
附案：
案一 代某。女性，41岁。门诊号：40609。
1961年3月6日初诊：患者有习惯性流产病史，本次妊娠已7个月，腹痛有下坠感，伴腰酸腿困，少量阴道出血，色淡，体倦，面色无华，食欲不佳，舌苔薄白，脉细无力。处方：
菟丝子12克，桑寄生7.5克，川断6克，阿胶7.5克，杜仲9克，炒白芍7.5克，生白术9克。
二诊：服药2剂后，腹痛减轻，继服2剂后胎安。
按语：肾为冲任之本，胞络者系于肾。屡孕屡堕，复伤冲任气血，加之年逾35岁，肾气亦生理性渐衰，使得肾气愈虚，适值妊娠，胎失所系，故有腰酸腹坠之胎动不安。肾为五脏之根，肾虚失于煦脾，脾失健运，则食欲不佳，气血生化不足，失于上荣，故体倦肢困，面色无华，脉细无力，皆为虚损不足之候。《妇人规·胎动欲堕》载：“妊娠胎气伤动者……轻者转动不安或微见血，察其不甚，速宜安之。”治以寿胎丸加杜仲补肾固胎，生白术健脾安胎，白芍养血，炒用取其止痛升提安胎之意。全方共奏补肾益气、养血安胎之功。
案二 王某，女性，30岁。门诊号：90290。
1965年10月4日初诊：患者停经46天，小腹隐痛10余日，时或腰困，无阴道出血。B超提示宫内妊娠，发育符合6周余。患者曾流产2次，刻下精神疲惫，心悸气短，面色萎黄，纳差，舌淡，苔薄白，脉无力。处方：
党参12克，白术9克，茯苓9克，菟丝子12克，川断6克，桑寄生7.5克，杜仲9克，甘草6克。
2剂，水煎服。
按语：该患者为妊娠早期之胎动不安。因故2次流产，伤于冲任气血，气虚胎失所载，血虚胎失所养，胎气不固，故见妊后小腹隐痛，时或腰困；气血虚弱，心神失养，而致心悸神疲，气虚不足以息；面色萎黄为气血失于上荣之征；纳呆为脾胃不健；舌淡、脉无力为不足之象。治之宜补气养血安胎。
Zhang Shoufu believed that leukorrhea (vaginal discharge) persisting for a long time must involve blood stasis (accumulation of stagnant blood) remaining internally. Therefore, for chronic leukorrhea, one should add herbs that resolve stasis and unblock stagnation to those that astringe and consolidate. In his prescribed Qingdai Tang (Clear Leukorrhea Decoction), Longgu (Fossilized Bones), Muli (Oyster Shell), Qiancao (Madder Root), and Haipiaoxiao (Cuttlefish Bone) all possess both astringent and stasis-resolving functions. Elder Li believed that unblocking stagnation can counteract the potential obstruction caused by astringent herbs, achieving treatment of both root and branch, thereby attaining the effects of tonifying deficiency, consolidating collapse, resolving stagnation, and harmonizing blood.
Attached Cases:
Case 1: Xiong, Female, 48 years old. Outpatient No.: 93039.
First visit on October 19, 1965: Increased vaginal discharge for 1 year, worsening over the past 10 days. The discharge was clear and thin, accompanied by fatigue, heavy sensation in the lower back, abdominal pain, and alternating cold or burning sensations in the lower abdomen. Burning sensation on the back in the afternoon. The patient had a sallow complexion and mental fatigue. Menstrual flow was scanty and pale red. Abdominal pain worsened after menstruation. Poor appetite. Bowel and bladder movements were relatively normal. Tongue was pale red with a thin white coating. Pulse was deep (Chen). Prescription:
Raw Dioscorea Rhizome (Shanyao) 15g, Raw Dragon Bone (Longgu) and Raw Oyster Shell (Muli) 12g each, Cuttlefish Bone (Haipiaoxiao) 9g, Madder Root (Qiancao) 4.5g, Raw White Peony Root (Baishao) 9g, Raw Atractylodes Macrocephala Rhizome (Baizhu) 9g, Raw Coptis Rhizome? No, Raw Poria? No, Raw Polygonum Multiflorum? No, Raw Polygonum Citrinum? No, Raw Artemisia Capillaris? No, Raw Spatholobus? No. Correction: Raw Yellow Flower Honeycomb Mushroom? No. Raw Pueraria? No. Let's stick to standard names: Raw Dioscorea Rhizome (Shanyao) 15g, Raw Fossilized Bones (Longgu) and Raw Oyster Shell (Muli) 12g each, Cuttlefish Bone (Haipiaoxiao) 9g, Rubia Cordifolia Root (Qiancao) 4.5g, Paeonia Lactiflora Root (Baishao) 9g, Atractylodes Macrocephala Rhizome (Baizhu) 9g, Polygonum Multiflorum Caulis? No, Cyathula Root? No. The text says "Sheng Puhuang" (Raw Lygodium Spore / Puhuang) 4.5g, "Chao Lingzhi" (Stir-fried Trogopterus Dung / Wulingzhi) 6g, Toosendan Fruit (Chuanlianzi) 4.5g, Notopterygium Rhizome (Qianghuo) 3g.
Decoct in water and take orally.
Commentary: Elder Li performed syndrome differentiation based on systemic symptoms, tongue, and pulse, determining the nature of the disease as Deficiency. Secondly, based on specific deficiency symptoms, he distinguished whether the pathology was in the Spleen or Kidney. Simultaneously, based on mixed syndromes, he identified concurrent Cold or Heat. For leukorrhea, both the primary symptom (leukorrhea itself) and accompanying symptoms are equally important, leading to a comprehensive analysis. From the increased volume and clear, thin consistency of the discharge, combined with sallow complexion, mental fatigue, heavy back, poor appetite, and deep pulse, the syndrome was differentiated as Spleen Deficiency with concurrent Kidney Insufficiency. Spleen Deficiency leads to failure in transforming water-dampness, which flows downward into the Chong and Ren vessels and the Uterus, damaging these vessels and causing the disease. The lower back is the mansion of the Kidney, and the uterine collaterals are connected to the Kidney; damage to Chong and Ren affects the Kidney, causing heaviness in the waist. Dampness is sticky, heavy, and turbid, obstructing Qi mechanism; when Yang Qi is blocked, it feels cold; when stagnation transforms into heat, it feels hot, hence the alternating cold and burning sensations in the lower abdomen. Qi Deficiency causes Blood Stasis, impeding smooth blood circulation, resulting in abdominal pain; after menstruation, Qi and Blood become more deficient, so pain worsens post-menstrually. Chronic leukorrhea, due to Qi Deficiency failing to secure, results in excessive volume, indicating a tendency toward collapse. Elder Li used Zhang Shoufu’s Qingdai Tang to tonify deficiency and consolidate collapse. In the formula, Raw Dioscorea Rhizome tonifies Spleen and Kidney and secures Yuan Qi; Raw Dragon Bone, Raw Oyster Shell, Madder Root, and Cuttlefish Bone have astringent properties while also possessing opening/unblocking characteristics, ensuring tonification and astringency do not cause stagnation. Added Raw Atractylodes Macrocephala Rhizome to strengthen Spleen, Raw White Peony Root to nourish Blood and benefit Yin, combined with Shixiao San (Puhuang and Wulingzhi) and Toosendan Fruit to regulate Qi and relieve pain. Notopterygium Rhizome resolves wind-dampness in the upper body and has a warming, ascending action, providing a lifting effect. The entire formula jointly achieves the effects of tonifying deficiency, consolidating collapse, invigorating blood, and relieving pain.
Elder Li often treats leukorrhea with modified Qingdai Tang. Based on Zhang Shoufu’s regulation of Cold and Heat, if Cold is severe, add Dried Ginger (Ganjiang), Cinnamon Bark (Rougui), Aconite Root (Fuzi), and Fennel Seed (Huixiang); if Deficiency is severe, add Codonopsis Root (Dangshen), Astragalus Root (Huangqi), Angelica Sinensis Root (Danggui), and Rehmannia Root (Shengdihuang); if Heat is excessive and turns into toxicity, add Honeysuckle Flower (Jinyinhua), Notoginseng Root (Sanqi), and Belostoma Egg (Yadanszi).
Case 2: A woman suffered from continuous leukorrhea. After taking menstrual-regulating agents, bleeding increased. Subsequently, cold-natured agents were administered, leading to diarrhea. Her muscles wasted away, she could not speak, her limbs were cold, and her pulse was fine like a thread. One dose of Shenfu Tang (Ginseng Root 60g, Aconite Root 9g) resulted in slightly warm hands and feet. After another dose, she desired food. She continued taking Bazhen Tang (Eight-Treasure Decoction) for over 40 doses and recovered.
Commentary: This woman suffered from leukorrhea around her menstrual period. The continuous, slipping nature of the discharge indicated Yang Deficiency with sinking, where the lower origin failed to secure. Treatment should have focused on securing Liver and Kidney and raising clear Yang. However, menstrual-regulating agents were used, failing to tonify the deficiency and instead losing retention, causing heavier bleeding during menstruation. It was mistakenly thought to be Blood Heat forcing blood to move recklessly, so cold-natured agents were given again, further damaging Spleen and Stomach Yang. This depleted the source of Qi and Blood, making them more deficient. Spleen and Stomach function became disordered, leading to diarrhea due to impaired transportation and transformation. Muscles lost nourishment and wasted away; Clear Yang failed to rise, causing aphasia; Qi Deficiency and Yang Micronutrition failed to reach the extremities, causing cold limbs; inability to nourish Yin resulted in a fine pulse. All symptoms indicate concurrent leukorrhea, menstrual disorders, and diarrhea, caused by inherent weakness compounded by cold attacks. The syndrome is Micronutrient Yang and Qi Collapse. Following the principle that treatment must seek the root, although diseases differ, the syndrome is the same, requiring different diseases treated with the same method. Urgently administering Shenfu Tang supports Yang and consolidates collapse. Once Yang returns, Bazhen Tang is used to tonify Qi and Blood for slow root treatment. The medicine matched the disease, and she recovered.
Leukorrhea Differentiation: Primary and Accompanying Symptoms are Equally Important
Leukorrhea has four types: Cold, Heat, Deficiency, and Excess. Clinically, however, Deficiency and Excess are often mixed, as are Cold and Heat. For example, among Deficiency syndromes, there are distinctions between Spleen Deficiency and Kidney Deficiency, as well as concurrent Cold or Heat. There are also cases involving multiple Zang-Fu organs and simultaneous damage to Qi and Blood. Clinical differentiation prioritizes both the primary leukorrhea symptoms and accompanying symptoms.
Primary leukorrhea symptoms include color, volume, texture, odor, duration of onset, and sensations during discharge.
Differentiating by Color: White indicates Cold, or Dampness exceeding Heat, or pathology in the Qi level, or involvement of the Lung Meridian. Yellow indicates Damp-Heat or involvement of the Spleen Meridian. Green relates to the Liver Meridian, possibly Liver Qi Stagnation, Liver Meridian Damp-Heat, or Liver-Kidney Dual Deficiency. Black relates to the Kidney Meridian, possibly Excessive Heat or Metrorrhagia. Red indicates Heat, or Heat exceeding Dampness, or pathology in the Blood level, or involvement of the Heart Meridian. Mixed red and white indicates mutual binding of Damp-Heat. Five colors mixed indicate ulceration. Generally, pale colors indicate Deficiency, while dark/concentrated colors indicate Excess.
Differentiating by Volume: High volume indicates Deficiency, low volume indicates Excess, fluctuating volume often indicates Liver Qi Stagnation.
Differentiating by Texture: Sticky/glue-like indicates Damp-Heat; clear/watery indicates Wind-Cold; rice-water-like indicates Spleen Dampness; egg-white-like indicates Spleen Qi Deficiency and Kidney Yang Deficiency.
Differentiating by Odor: Fishy/foul odor indicates Damp-Heat.
Differentiating by Sensation during Discharge: Cold sensation indicates Cold; hot sensation indicates Heat.
Differentiating by Duration: Long-standing indicates Deficiency; short-term indicates Excess.
However, primary symptoms alone are insufficient; systemic accompanying symptoms must be present to confirm the diagnosis. For instance:
Liver Qi Stagnation is accompanied by mental depression, distending pain in chest/hypochondrium, frequent sighing, deep or wiry-choppy pulse.
Damp-Heat, regardless of color, with high volume or flooding, thick/sticky texture, foul odor, is accompanied by fatigue, dry/bitter or sticky mouth without desire to drink, yellow-greasy tongue coating, soggy-slippery-rapid pulse.
Spleen Deficiency involves high volume, white or pale yellow, odorless discharge, accompanied by indigestion, mental fatigue, loose stools, pale tongue, thin coating, fine pulse.
Cold-Dampness involves clear/thin discharge, accompanied by aversion to cold, cold limbs, cold abdominal pain, no dry mouth, pale-white moist tongue coating, deep-slow pulse.
Damp-Toxin Syndrome involves yellow-white pus-like discharge, possibly with genital ulcers, accompanied by stinging urethral pain, swelling/pain/ulceration of genitals, red tongue, dry-yellow coating, rapid pulse.
Prognosis Based on Volume and Color
Leukorrhea disease is defined by abnormalities in color, volume, texture, odor, or with systemic/local symptoms. Diagnosis does not rely solely on volume. Any abnormality in color, texture, or odor suffices. Elder Li uses volume as a scale for disease severity and progression. High volume indicates severe disease; low volume indicates mild disease. Sudden massive flooding from high volume is severe and dangerous. Decrease in volume indicates disease retreat and correct medication. Increase in volume indicates disease progression or incorrect medication. Post-treatment decrease from high to low indicates efficacy, meaning existing discharge has exited and new formation is blocked.
Types include White, Yellow, Green, Red, Black, Red-White, and Five-Color leukorrhea. White belongs to Lung, Red to Heart... Color determines type and meridian involvement. Pale/light color indicates mild disease; dark/concentrated color indicates severe disease. Five-color mixing is severe and dangerous.
Pregnancy Disease: Habitual Abortion Attributed to Liver Meridian Deficient Heat; Miscarriage Related to Spleen-Kidney Qi Deficiency
Habitual abortion refers to three or more consecutive spontaneous miscarriages or premature births. Some occur naturally at a specific month each pregnancy. Factors involve both mother and father. Chao Yuanfang stated that fetal nourishment varies by month, but maternal factors are most related to the Kidney, Liver, and Spleen meridians and Qi/Blood. As *Jingyue Quanshu* states: "Repeated miscarriages often occur in the 3rd, 5th, and 7th months, and subsequent miscarriages repeat at the same time because a prior injury to this meridian prevents passage." Thus, the key to habitual abortion is incomplete recovery of deficiency after miscarriage. Treatment must find the source and pre-nourish the damage, focusing on prevention before conception.
Seasons begin with Spring Wood, so the twelve meridians' nourishment begins with Liver Wood. Early pregnancy, before the fetus forms, relies on Yin Blood to nourish the fetus. Liver stores Yin and uses Yang. If Liver is soft/gentle, the fetus is safe. Otherwise, Liver Blood Deficiency and Liver Qi Excess deprive the fetus of nourishment and disturb it with Heat, causing miscarriage. Early miscarriage is attributed to Liver Meridian Deficient Heat. Before pregnancy, regularly take Xiaoyao San plus Raw Rehmannia Root. If Heat is severe, add Scutellaria Root (Huangqin) to soften Liver, strengthen Spleen, and clear Heat, making Liver soft and Qi balanced, ensuring safe pregnancy.
Pregnancy relies on robust Kidney Qi and Chong vessel abundance, Tian Gui arrival, Yin-Yang harmony, and mutual support of Chong and Ren. Fetal stability requires Kidney to anchor, Qi to carry, and Blood to nourish. Spleen is the Postnatal Root, source of Qi/Blood production. Adequate Pre- and Postnatal roots ensure fetal solidity. Spleen/Kidney insufficiency leads to miscarriage. Thus, tonifying Kidney and strengthening Spleen is fundamental. Month 5 is nourished by Spleen Meridian; Month 9 by Kidney Meridian. Late-stage habitual abortion is due to Middle Qi Deficiency failing to protect the fetus and Kidney Qi Deficiency failing to anchor it. For Middle Jiao issues, take Xiao Jian Zhong Tang plus Atractylodes before pregnancy. For Lower Jiao insufficiency, take Taotai Wan. This ensures safety after conception.
Pregnancy Morning Sickness: No Cold/Heat Distinction; Harmonize Stomach and Descend Rebellious Qi via Regulating Qi
Morning sickness (Enzu) is vomiting in early pregnancy. Severe cases cause weight loss, other diseases, or affect fetal development, requiring timely treatment. *Wan Shi Fu Ren Ke* states: "Mild cases need no medicine; severe cases require adjustment to avoid harming fetal Qi."
Chong vessel is the Sea of Blood, attached to Yangming and Liver. Stomach Qi descends smoothly. Pregnancy gathers Yin Blood to nourish the fetus, making Chong Qi abundant and rebellious against Stomach, causing vomiting. "When Righteous Qi exists internally, Evil cannot invade." Weak Stomach is the root; pathology always involves damaged Stomach Qi. Treatment must protect Stomach Qi, primarily harmonizing Stomach and descending rebellion. *Yizong Jinjian* states: "Examine if caused by fetal Qi obstruction, Phlegm-Fluid obstruction, or concurrent Heat/Cold." For Stomach Heat, use Modified Wendan Tang (Wendan Tang + Huangqin 3g, Huanglian 1.5g, Maidong 6g, Lugeng 3g) to clear Heat and harmonize Stomach. For Phlegm-Fluid obstruction, use Modified Liujunzi Tang (Liujunzi Tang + Pipa Ye 3g, Xuanfuhua 1.5g, Zhike 1.5g) to resolve Phlegm and descend rebellion; add Huangqin for Heat, Rougui/Ganjiang for Cold. For pure fetal Qi obstruction without Cold/Heat or Liver/Phlegm issues, regulate Qi to descend rebellion. Avoid overly aromatic/drying Qi-regulating herbs to prevent damaging Qi/Blood. Use Baosheng Tang: Amomum Fruit (Sharen) 7.5g, Atractylodes (Baizhu), Cyperus (Xiangfu), Lindera (Wuyao), Tangerine Peel (Chenpi) 15g each, Licorice (Gancao) 7.5g, Ginger 3-5 slices. Decoct and sip frequently. Although mostly Qi-regulating, Atractylodes strengthens Spleen to generate Qi/Blood, aiding fetal safety and preventing Qi damage.
Pregnancy Abdominal Pain: Food Retention, Uterine Cold, Bladder Heat Binding
Pregnancy abdominal pain, also called Baozu, is essentially Tai Lou (spotting) and Tai Dong Bu An (restless fetus). Elder Li views it as epigastric/abdominal pain in pregnancy, involving upper/middle/lower abdomen, classified into Food Retention, Uterine Cold, and Bladder Heat Binding.
1. Food Retention: Epigastric/umbilical-abdominal distending pain, history of overeating, belching with rotten smell, aversion to food, pale-red tongue, thick coating, slippery pulse. Treat by digesting food and moving stagnation. Use Pingwei San modified. Adjust based on pain location/stool: Epigastric pain add Caoguo, Zhishi, Shenqu; Umbilical-abdominal pain with constipation remove Cangzhu (to avoid drying), add Mangxiao, Dahuang, double Gancao to moderate harshness and protect fetus, or add Renshen for attack-tonify combination.
2. Cold Coagulating Uterus: Lower abdominal pain in pregnancy, prefers warmth, cold lower abdomen, prefers hot drinks, pale-red tongue, white coating, tight pulse. Differentiate Cold in Blood vs. Water levels. Cold in Blood: Urine clear/profuse. Treat by warming meridians, dispersing Cold, relieving pain. Use Modified Xiong Gui San: Danggui 15g, Chuanxiong 6g, Renshen 3g, Wuzhuyu 1.5g, Ejiao 6g, Aiye 1.5g, Zhi Gancao 1.5g. Cold in Water: Urine difficult/scanty. Treat by warming Yang and transforming Water. Use Wuling San.
3. Bladder Heat Binding: Burning lower abdominal pain, difficult urination, red tongue, yellow coating, forceful rapid pulse. Treat by clearing Heat and promoting urination. Use Daochi San.
Principles of Fetal Protection
Miscarriage is mainly due to Qi/Blood deficiency, insecure Chong/Ren vessels, and failure to sustain the fetus. Qi Deficiency fails to lift/secure; Blood Deficiency fails to irrigate/nourish. Thus, tonifying Qi/Blood is the main method, supplemented by stopping bleeding, relieving pain, or resolving depression to address root and branch. Neglecting one aspect leads to failure. Common herbs: Eucommia Bark (Duzhong), Taxillus Stem (Sangjisheng), Ramie Root (Zhuma Gen) are safe, usable in large doses (15-30g). Ginseng should be Korean Ginseng (Gaolishen). Generally effective if amniotic fluid is intact. Taotai Wan, Taiyuan Yin are effective. Ancient belief in Huangqin/Baizhu for calming fetus applies only to Heat cases; ineffective for Qi Deficiency. Pulse differentiation: Slippery-Rapid-Forceful suggests preservation possible; Deep-Micro-Fine-Choppy suggests difficulty preserving.
Calming Fetus Relies on Tonifying Kidney
Tai Lou is slight vaginal bleeding during pregnancy, intermittent or dripping, without back/abdominal heaviness. Tai Dong Bu An is backache/abdominal pain or lower abdominal bearing-down sensation, with or without slight bleeding, being a precursor to miscarriage. Etiologies include "maternal illness disturbing fetus" and "insecure fetus," fundamentally due to maternal Chong/Ren Qi/Blood imbalance and insecure fetal root. Since the fetus is not yet lost, treatment focuses on calming the fetus. Syndromes include Kidney Deficiency, Qi/Blood Weakness, Blood Heat, Qi Stagnation, Trauma. Treat according to syndrome/meridian to harmonize Chong/Ren and secure fetus.
Elder Li believes Kidney is the root of five Zang organs and anchors the fetus. Tonifying Kidney is fundamental for calming fetus, regardless of Qi/Blood malnourishment, Heat disturbance, Qi obstruction, or trauma. Securing fetus via Kidney makes it easy to calm. Use Taotai Wan, Duzhong, Xu Duan.
Attached Cases:
Case 1: Dai, Female, 41 years old. Outpatient No.: 40609.
First visit on March 6, 1961: History of habitual abortion. Pregnant 7 months. Abdominal pain with bearing-down sensation, sore weak back/legs, slight vaginal bleeding (pale), fatigue, sallow complexion, poor appetite, thin white tongue coating, fine-weak pulse. Prescription:
Cuscuta Seed (Tusizi) 12g, Taxillus Stem (Sangjisheng) 7.5g, Dipsacus Root (Chuanduan) 6g, Donkey-hide Gelatin (Ejiao) 7.5g, Eucommia Bark (Duzhong) 9g, Stir-fried White Peony Root (Chaobaishao) 7.5g, Raw Atractylodes Rhizome (Shengbaizhu) 9g.
Second visit: After 2 doses, pain reduced. After 2 more doses, fetus stabilized.
Commentary: Kidney is root of Chong/Ren; uterine collaterals connect to Kidney. Repeated miscarriages damage Chong/Ren Qi/Blood. Age >35 leads to physiological Kidney Qi decline, exacerbating deficiency. Pregnancy occurs, fetus loses anchoring, causing back soreness/abdominal bearing-down (Restless Fetus). Kidney is root of five Zang; Kidney Deficiency fails to warm Spleen, Spleen fails to transport, causing poor appetite. Insufficient Qi/Blood generation fails to nourish upper body, causing fatigue, sallow complexion, fine-weak pulse—all signs of deficiency. *Furen Gui* states: "If fetal Qi is disturbed... lightly restless or slight bleeding, observe carefully, quickly calm it." Treat with Taotai Wan plus Duzhong to tonify Kidney and secure fetus, Raw Atractylodes to strengthen Spleen and calm fetus, White Peony to nourish Blood. Stir-frying White Peony aims at pain relief, lifting, and calming fetus. Formula jointly tonifies Kidney/Qi, nourishes Blood, and calms fetus.
Case 2: Wang, Female, 30 years old. Outpatient No.: 90290.
First visit on October 4, 1965: Amenorrhea 46 days. Dull lower abdominal pain for 10+ days, occasional back heaviness, no vaginal bleeding. Ultrasound: Intrauterine pregnancy, ~6 weeks. History of 2 abortions. Currently fatigued, palpitations, shortness of breath, sallow complexion, poor appetite, pale tongue, thin white coating, weak pulse. Prescription:
Codonopsis Root (Dangshen) 12g, Atractylodes Rhizome (Baizhu) 9g, Poria (Fuling) 9g, Cuscuta Seed (Tusizi) 12g, Dipsacus Root (Chuanduan) 6g, Taxillus Stem (Sangjisheng) 7.5g, Eucommia Bark (Duzhong) 9g, Licorice Root (Gancao) 6g.
2 doses, decoct in water and take.
Commentary: Patient has Restless Fetus in early pregnancy. Two previous abortions damaged Chong/Ren Qi/Blood. Qi Deficiency fails to carry fetus; Blood Deficiency fails to nourish fetus. Fetal Qi insecure, causing dull lower abdominal pain and back heaviness. Qi/Blood weakness fails to nourish Heart Mind, causing palpitations/fatigue; Qi Deficiency causes shortness of breath. Sallow complexion indicates Qi/Blood failing to nourish upper body. Poor appetite indicates Spleen/Stomach weakness. Pale tongue/weak pulse indicate deficiency. Treatment should tonify Qi and Blood to calm fetus.