妇人以血养胎。血或不足。或不和。于是有胎气诸证。此与本书血证不涉。然亦血分中事。不类而类。因并
论以启人之悟。
孕妇胎中。止有水血二者而已。水即是气。故生产时。水衣先至。后下血衣。行经时亦先下浆水。后下鲜血。
水者气之所化。气属阳。血属阴。水先乎血。是为阳先乎阴也。故行经也。必天癸之水。至于胞中。而后冲任
之血应之。亦至胞中。于是月事乃下。其受胎也。亦必天癸先交。而冲血后聚。故不曰男女构血。而曰男女
构精。精者。水与血混合之名也。既成胎后。肾中之阳气。则化水以养胎。胃中之水谷。则取汁化血。从冲任
两脉。下注胞中以养胎。胎中水足。则血不燥。胎中血足。制气不亢。水血调和。则胎孕无病。所以有病者。皆
水与血不和之故。胎病多端。吾且斩断葛藤。但就水血二者立法。可以通一毕万矣。
恶阻者何也。胎中之水火。上逆入胃故也。冲任乃胞脉。皆上属于阳明。阳明之气。下行为顺。今因有胎。子
宫收闭。冲气不得下泄。转而上逆。挟胞中之水。以干胃土。则为痰水上溢。因而呕吐。治宜调胃利痰。二陈
汤。加枳壳砂仁生姜藿香治之。香砂六君子汤亦治之。水降则气降。胃得安而不呕吐矣。又或胞气上逆。
上合阳明燥气而为火。亦致吐逆。呕苦呕酸。哕气拒食。胎塞于下。气逆于上。多生火证。故世谓胎前不宜
热药。以此之故。法宜清胃降火。小柴胡汤主之。麦门冬汤亦治之。
子呛者何也。胎中之水火。上干于肺故也。养胎全赖水与血二者。若水不足以濡血。则血燥。血不足以济
水。则气热。燥热相合。是为胎火。胎火循冲脉而上。干犯肺金。则咳喘交作。两颊发赤。咽喉不利。气呛咳嗽。
故名子呛。仲景麦门冬汤治之。时方玉女煎。加五味子亦妙。方中牛膝。正取其降冲逆。半夏降冲逆。降水
也。牛膝降冲逆。降火也。皆以堕胎之药安胎。用之得宜。正无畏缩。又有胎中之水。上泛为痰。冲肺作咳。以
致子呛者。于法又宜去水。苏子降气汤。六君子汤。加五味炮姜细辛治之。若是水火兼动。而致咳嗽。宜泻
白散。加杏仁栝蒌霜白前黄芩枳壳甘草。或葶苈大枣泻肺汤治之。但葶苈猛。不可多用。
孕妇少腹痛。仍分水分血分两端。在水分者。膀胱之气不能化水。则子脏胀满。水不得泄。必见小便短涩。
胀喘诸证。审是热结不行者。导赤散。加山栀防己以清之。审系寒结而阳气不化者。五苓散治之。取其水
利。则少腹之痛自止。橘核丸。加茯苓亦治之。在血分者。胞为肝肾所司。肝阳不达于胞中。则胞血凝滞而
痛。四物汤。加艾叶香附阿胶茴香。肾阳不达于胞室。则胎冷痛。上连腰脊。四物汤。加杜仲故纸台乌艾叶。
此名胞阻。谓胞中阴血。与阳气阻隔也。重则用肾气丸。轻则用胶艾四物汤。
血与水皆阴也。水为先天阳气所化之阴液。血为后天胃气所化之阴汁。肾阴又转赖胃之水津而生。胃
气又实藉肾之生阳而旺。今有肾中之生阳不足者。脉弦发热。愈胀而下坠。腹痛恶寒。子宫欲开。仲景用
附子汤治之。保肾之阳。以扶胃气。此补阳法也。又有胃中之水津不足者。则子脏干燥。悲伤欲哭。象如神
灵所凭。数欠伸。所以然者。以肾水不足。冲血不足。无所润养。肾水在下。则为胞中之天癸。在上则为口中
之津液。脏燥。则肺金不得津液之润养。故肺主悲伤。欠伸者。明系肾病。如神所凭者。血燥则心不化液。而
神无守也。甘麦大枣汤。滋肾之阴。从冲任以输水于肾。而肾阴因籍以生。此补阴法也。视此二条。一切滋
阴补阳之法。可以贯通。
胎漏。亦分水与血二证。下血者属血热。因其火甚。故逼血妄行。宜四物汤。加阿胶炒栀子侧柏叶黄芩。下
水者。或如豆汁。下至升许。名曰孤浆。去水太多。则胎干枯。必倚而坠。水即气也。惟其气泄。是以水泄。黄
糯米浓煎。补而滋之。茅根白术人参鹿角霜桑螵蛸白银。酒水煎服。亦佳。
再按血统于脾。而藏于肝。肝主疏漏。故漏血。治以归脾汤。加柴胡山栀阿胶。于法尤合。水生于肾而制于
肺。肺气不纳。故漏水。今观肺中虚寒。不能制下。则小便遗溺。可知肺气不纳。所以漏水之理矣。宜用白术
人参海螵蛸龙骨牡蛎百合诃子苎根白银。
子淋者。小便淋沥。亦分水淋血淋二者。水淋病在膀胱。胀闭涩滞。宜五淋散。加木通泽泻。血淋者。病在血
室。阴中割痛。下滴血点。四物汤。加苁蓉茅根藕节条芩赤苓草梢。
子悬者。胎气上逼。悬塞心胸。亦分水分血分二者。水分之病。由于气虚。水泛为痰。壅凑其胎。浊气上逆。脉
必沉滑迟弱。六君子汤。加枳壳紫苏腹皮川芎香附治之。血分之病。由于血虚。胎中厥阴肝经相火上僭。
举胎上逼。宜小柴胡合四物汤。再加云苓黄连黄柏。六味丸。加牛膝麦冬以引之使下。亦高者抑之之义。
毋畏牛膝之堕胎也。
又按子悬之证。有孕七八月。产母血虚。胎无所养。上行求食者。但用下降之药。不能治也。宜大补其血。炙
甘草汤。去桂枝。加淮药枣仁治之。圣愈汤。加白术云苓甘草亦治之。甘麦大枣汤皆宜。又当美其饮食。用
黄人参山药白芷芡实猪蹄炖服。最佳。
子气者。水肿也。胞与膀胱。并域而居。胞宫为胎所占。侵逼膀胱。以致膀胱之水。不能化行。亦由膀胱之气
化。先有不足。故能为胎占。用五苓散主之。若是胎火乘肺。化源不清。以致便短水肿者。去桂枝。加知母麦
冬黄芩杏仁防己治之。
子烦者。血虚也。血者心之所主。血足则心不烦。胎既耗血。胎中之火。又上与心火相合。火扰其心。是以虚
烦不能眠。酸枣仁汤治之。朱砂安神丸。亦治之。
子眩者。气分之痰也。其证目眩头晕。皆由胎水上逆为痰之所致。二陈汤。加紫苏枳壳杏仁姜汁竹沥治之。
子痫者。血分之风也。其证忽然昏冒。卒倒无知。手足抽掣。过时则醒。口噤反张。乃孕妇血虚。风邪入肝之
所致。法宜补血祛风。四物汤。加钩藤防风茯神桑寄生独活羚羊角。逍遥散小柴胡。皆可借治。
小便不通者。气不足也。气化则水能出。今小便点滴不通。是胞系下压其溺窍故也。究其所以下压溺窍
之故。则因肾气不足。不能举胎而上。此名转胞。宜肾气丸主之。又或胃气不足。不能升提其胎。补中益气
汤主之。
大便不通者。血不足也。孕妇之血足则无病。血既不足。则供胎犹未能给。更何能分给诸脏。是以必现口
渴咳逆发热大便不通等证。治宜滋生其血。血足则大便自通。四物汤。加杏仁麻仁苁蓉菟丝子治之。逍
遥散。加麻仁枳壳浓朴亦治之。
总而论之。胎气不和者。皆是水分之病。调水则气自和。胎火太旺者。皆是血分之病。调血则火自熄。能知
水火血气之故。则治胎不难。治失血之证亦不难。即治杂证。更无所难。
此书为失血说法。其气一门。皆连类而及之者。然胎病之发。尤水火血气之显然者。能参透此条。则于水
火血气四字。自无隐匿之情。其他胎病。有未备录者。另有胎产之书可查。
妇女以血液来滋养胎儿。如果血液不足或不调和，就会出现胎气相关的各种证候。这些情况与本书主要论述的出血病症无关，但也属于血分范畴，虽不相似却又有联系，因此一并论述以启发读者的领悟。
孕妇体内，只有水和血两种物质。水即是气的体现，所以在分娩时，羊水（水衣）先破，随后才排出胎盘和血液（血衣）。在月经来潮时，也是先流出浆液状的水，后流出鲜红的血液。水是气所化生的，气属阳，血属阴，水先于血出现，这体现了阳先于阴的道理。所以行经时，必须是天癸之水到达胞宫，然后冲脉和任脉的血随之应和，也到达胞宫，于是月经才能下行。受孕也是如此，必须天癸先交汇，然后冲脉之血后汇聚。所以古人不说男女交合是“构血”，而说是“构精”。“精”就是水和血混合的名称。
胎儿形成之后，肾中的阳气会化生水液来滋养胎儿，胃中的水谷精微会提取汁液化为血液，通过冲脉和任脉两条经络，向下注入胞宫以滋养胎儿。胎中水充足，则血液不燥；胎中血充足，则制约气机使其不亢奋。水与血调和，胎儿就没有疾病。之所以生病，都是水和血不调和的缘故。胎病种类繁多，我暂且抛开繁杂的细节，仅从水和血两个方面确立治疗法则，就可以掌握根本，通晓万法了。
什么是恶阻（妊娠呕吐）？是因为胎中的水火之气上逆进入胃部。冲脉和任脉是胞宫的脉络，都向上归属于阳明胃经。阳明之气以下行为顺，现在因为有胎儿，子宫闭合，冲气不能向下宣泄，反而转而上逆，挟带胞宫中的水湿侵犯胃土，导致痰水上溢，从而引起呕吐。治疗应当调理胃气、利化痰湿，用二陈汤，加枳壳、砂仁、生姜、藿香治疗。香砂六君子汤也可以治疗。水降则气降，胃得到安宁就不会呕吐了。或者胞气上逆，与阳明的燥气结合化为火邪，也会导致吐逆，表现为呕吐苦水或酸水，呃逆拒食。胎儿堵塞在下，气逆在上，容易产生火证，所以世人说胎前不宜用热药，就是这个原因。治法应当清胃降火，以小柴胡汤为主方。麦门冬汤也可以治疗。
什么是子呛（妊娠咳嗽）？是因为胎中的水火之气上犯肺脏。养胎完全依赖水和血这两种物质。如果水不足以濡润血液，则血液干燥；如果血不足以济助水液，则气机生热。燥热相结合，就形成了胎火。胎火沿着冲脉上行，侵犯肺金，导致咳嗽气喘交替发作，两颊发红，咽喉不利，气逆呛咳，所以称为子呛。张仲景用麦门冬汤治疗。民间常用方玉女煎，加五味子也很有效。方中的牛膝，正是取其降低冲脉逆气的作用；半夏也能降低冲逆，这是针对水气的；牛膝降低冲逆，这是针对火气的。这些都是通常认为会导致堕胎的药物，但用得恰当，正无需畏惧退缩。还有胎中的水湿上泛成为痰饮，冲犯肺部引起咳嗽，从而导致子呛的情况，治法又应当去水湿，用苏子降气汤、六君子汤，加五味子、炮姜、细辛治疗。如果是水火之气同时扰动导致咳嗽，宜用泻白散，加杏仁、瓜蒌霜、白前、黄芩、枳壳、甘草治疗。或者用葶苈大枣泻肺汤治疗。但葶苈子药性猛烈，不可多用。
孕妇少腹疼痛，仍然要分为水分和血分两端。属于水分病的，膀胱的气化功能不能化水，导致子宫胀满，水液无法排泄，必然出现小便短少涩滞、腹胀气喘等症状。仔细辨证如果是热结不通的，用导赤散，加山栀、防己以清热。如果是寒结且阳气不能气化导致的，用五苓散治疗。取其利水功效，少腹疼痛自然停止。橘核丸加茯苓也可以治疗。属于血分病的，胞宫由肝和肾所主管。肝阳不能通达胞宫，则胞血凝滞而痛，用四物汤，加艾叶、香附、阿胶、小茴香治疗。肾阳不能通达胞室，则胎儿寒冷疼痛，疼痛向上牵连腰脊，用四物汤，加杜仲、补骨脂、台乌药、艾叶治疗。这名叫胞阻，意思是胞宫中的阴血与阳气阻隔不通。病情重的用肾气丸，病情轻的用胶艾四物汤。
血和水都属于阴。水是先天阳气所化生的阴液，血是后天胃气所化生的阴汁。肾阴又转而依赖胃中的水津来生成，胃气又确实借助肾的生发阳气而旺盛。现在有肾中生发阳气不足的，脉象弦而发热，腹部越来越胀且下坠感明显，腹痛恶寒，子宫欲开。张仲景用附子汤治疗。这是保护肾阳以扶持胃气的方法，属于补阳法。又有胃中的水津不足的，导致子宫干燥，悲伤想哭，症状像神灵附体一样，频繁打哈欠伸懒腰。之所以这样，是因为肾水不足，冲脉之血也不足，没有东西来滋润养育。肾水在下，就是胞宫中的天癸；在上，就是口中的津液。脏躁，使得肺金得不到津液的滋润，所以肺主悲伤。频繁打哈欠伸懒腰，明显是肾病。像被神灵附体一样的表现，是因为血燥导致心不能化生津液，神志无所守持。用甘麦大枣汤，滋补肾阴，通过冲任将水输送到肾，肾阴因此得以滋生，这是补阴法。看了这两条，一切滋阴补阳的方法都可以贯通理解。
胎漏（妊娠期阴道少量出血），也分为水和血两个证候。下血的属于血热，因为火热太盛，逼迫血液妄行，宜用四物汤，加阿胶、炒栀子、侧柏叶、黄芩。下水的，或者像豆汁一样，流出一升左右，名叫孤浆。如果流失的水太多，胎儿就会干枯，必然依靠重力坠落。水就是气，正因为气泄，所以水泄。用黄糯米浓煎，补益并滋润它。也可以用白茅根、白术、人参、鹿角霜、桑螵蛸、白银，酒水煎服，效果也很好。
再按：血统属于脾，而储藏于肝，肝主疏泄，所以漏血，治以归脾汤，加柴胡、山栀、阿胶，在治法上尤其合适。水生于肾而受肺制约，肺气不收敛，所以漏水。现在看到肺中虚寒，不能制约下部，导致小便失禁遗溺，就可以明白肺气不收敛，所以导致漏水的道理了。宜用白术、人参、海螵蛸、龙骨、牡蛎、百合、诃子、苎麻根、白银治疗。
子淋（妊娠小便淋沥），小便淋沥不尽，也分水淋和血淋二者。水淋的病在膀胱，表现为胀闭涩滞，宜用五淋散，加木通、泽泻。血淋的病在血室，表现为阴中刺痛，滴下血点，用四物汤，加肉苁蓉、白茅根、藕节、黄芩、赤茯苓、甘草梢治疗。
子悬（妊娠胸胁胀满），胎气上逼，悬塞心胸，也分为水分和血分二者。水分方面的病，由于气虚，水泛为痰，壅凑阻碍胎儿，浊气上逆，脉象必定沉滑迟弱，用六君子汤，加枳壳、紫苏、大腹皮、川芎、香附治疗。血分方面的病，由于血虚，胎中厥阴肝经的相火上僭越，举托胎儿上逼，宜用小柴胡汤合四物汤，再加云苓、黄连、黄柏。或者用六味丸，加牛膝、麦冬以引导其下行，这也是“高者抑之”的意思。不要畏惧牛膝会导致堕胎。
另外按语：子悬这个证候，有怀孕七八个月的，产母血虚，胎儿无人供养，向上寻求食物滋养的，只用下降的药物，不能治愈。应当大补其血，用炙甘草汤，去掉桂枝，加淮山药、枣仁治疗。圣愈汤，加白术、云苓、甘草也可以治疗。甘麦大枣汤也都适宜。还应当改善饮食，用黄芪、人参、山药、白芷、芡实、猪蹄炖服，效果最佳。
子气（妊娠水肿），就是水肿。胞宫与膀胱，处于同一区域。胞宫被胎儿占据，侵逼膀胱，导致膀胱的水液不能气化运行，也是因为膀胱的气化功能原本就有不足，所以能被胎儿占据。用五苓散为主方。如果是胎火乘袭肺脏，化源不清，导致小便短少、水肿的，去掉桂枝，加知母、麦冬、黄芩、杏仁、防己治疗。
子烦（妊娠心烦），是血虚所致。血由心所主，血足则心不烦。胎儿既已耗血，胎中的火气又上与心火相合，火邪扰乱心神，所以虚烦不能入睡。用酸枣仁汤治疗。朱砂安神丸也可以治疗。
子眩（妊娠眩晕），是气分中的痰证。其症状目眩头晕，都是由胎水上逆化为痰所致。用二陈汤，加紫苏、枳壳、杏仁、姜汁、竹沥治疗。
子痫（妊娠抽搐），是血分中的风证。其症状忽然昏倒无知，突然跌倒不知人事，手足抽搐，过一段时间醒来，牙关紧闭，身体反张，这是孕妇血虚，风邪侵入肝脏所致。治法宜补血祛风，用四物汤，加钩藤、防风、茯神、桑寄生、独活、羚羊角。逍遥散、小柴胡汤，都可以借用来治疗。
小便不通，是气不足。气化正常则水能排出。现在小便点滴不通，是胞系向下压迫尿道口所致。究其压迫尿道口的原因，是因为肾气不足，不能举托胎儿向上。这名叫转胞，宜用肾气丸为主方。或者又是胃气不足，不能升提胎儿，用补中益气汤为主方。
大便不通，是血不足。孕妇血足则无病。血既然不足，供应胎儿尚且不够，哪里还能分给其他脏腑？所以必然出现口渴、咳逆、发热、大便不通等症状。治宜滋生血液，血足则大便自然通畅。用四物汤，加杏仁、火麻仁、肉苁蓉、菟丝子治疗。逍遥散，加火麻仁、枳壳、厚朴也可以治疗。
总而言之，胎气不和的，都是水分方面的病，调好水则气自然调和。胎火太旺的，都是血分方面的病，调好血则火自然熄灭。能知晓水火血气的缘故，那么治疗胎病就不难，治疗失血证也不难，即使是治疗杂病，更没有什么难的。
这本书是为失血证立法的，其中关于气的一门，都是连类提及的。然而胎病的发作，尤其是水火血气方面表现得最为明显。能参透这一条，对于水火血气这四个字，自然就没有隐匿不明的地方了。其他胎病，有未详细收录的，另有专门论述胎产的书籍可以查阅。
Women nourish the fetus with blood. If blood is insufficient or unharmonious, various syndromes related to fetal qi arise. These are not directly related to the hemorrhagic syndromes discussed in this book, but they also belong to the realm of blood. Although dissimilar, they share connections; therefore, they are discussed together to inspire understanding.
In a pregnant woman, there are only two substances in the womb: water and blood. Water is the manifestation of qi. Thus, during childbirth, the amniotic sac (water coat) breaks first, followed by the expulsion of the placenta and blood (blood coat). During menstruation, watery fluid is discharged first, followed by fresh red blood. Water is transformed from qi; qi belongs to Yang, and blood belongs to Yin. Water appears before blood, illustrating that Yang precedes Yin. Therefore, for menstruation to occur, Tian Gui (menstrual essence) must reach the uterus, after which the blood of the Chong and Ren meridians responds and also reaches the uterus, allowing menstrual flow to descend. Conception follows the same principle: Tian Gui must intersect first, followed by the gathering of Chong blood. Hence, ancient texts describe sexual intercourse as "joining essence" rather than "joining blood." Essence refers to the mixture of water and blood.
After conception, the Yang qi within the Kidneys transforms into fluids to nourish the fetus, while the grain and water from the Stomach are extracted to transform into blood. Through the Chong and Ren meridians, these substances flow downward into the uterus to nourish the fetus. When the fetus has sufficient water, the blood remains moist; when it has sufficient blood, it restrains Qi from becoming hyperactive. With water and blood harmonized, the pregnancy proceeds without disease. Pathologies arise solely due to the disharmony between water and blood. Fetal diseases are numerous; I will set aside complex details and establish treatment principles based on water and blood, thereby grasping the root and comprehending myriad conditions.
What is E Zu (pregnancy nausea/vomiting)? It occurs because the water and fire of the fetus reverse upward into the Stomach. The Chong and Ren meridians are the collaterals of the uterus and connect upward to the Yangming Stomach meridian. Yangming Qi should descend smoothly. However, due to the presence of the fetus, the uterus closes, preventing Chong Qi from descending and causing it to reverse upward. Carrying dampness from the uterus, it invades the Spleen/Stomach earth, leading to phlegm-fluids surging upward and causing vomiting. Treatment should regulate the Stomach and drain phlegm-fluids using Er Chen Tang (Two-Cured Decoction), augmented with Zhi Ke (Aurantium Fructus), Sha Ren (Amomi Fructus Rotundus), Sheng Jiang (Zingiberis Rhizoma Recens), and Huo Xiang (Pogostemonis Herba). Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomi Six-Gentlemen Decoction) is also effective. When water descends, Qi descends, and the Stomach is pacified, stopping vomiting. Alternatively, uterine Qi may reverse upward, combining with Yangming dryness to generate Fire, also causing vomiting and regurgitation of bitter or sour fluids, hiccups, and food refusal. The fetus blocks below, while Qi reverses above, often generating Heat syndromes. This is why it is said that hot herbs should be avoided during pregnancy. The method should clear the Stomach and descend Fire, primarily using Xiao Chai Hu Tang (Minor Bupleurum Decoction). Mai Men Dong Tang (Ophiopogon Decoction) is also applicable.
What is Zi Qiang (pregnancy cough)? It results from the water and fire of the fetus invading the Lungs. Nourishing the fetus relies entirely on water and blood. If water is insufficient to moisten blood, blood becomes dry; if blood is insufficient to assist water, Qi generates heat. Dryness and heat combine to form Fetal Fire. This Fire travels up along the Chong Meridian and invades Lung Metal, causing alternating cough and asthma, flushed cheeks, throat obstruction, and airway irritation. Zhang Zhongjing treats this with Mai Men Dong Tang. The popular formula Yu Nu Jian (Jade Woman Decoction) augmented with Wu Wei Zi (Schisandrae Fructus) is also excellent. In these formulas, Niu Xi (Achyranthis Bidentatae Radix) is used specifically to descend Chong Qi reversal; Ban Xia (Pinelliae Rhizoma) descends Chong Qi regarding water; Niu Xi descends Chong Qi regarding Fire. Although these are typically considered abortifacient herbs, when used appropriately, there is no need for fear. Another cause of Zi Qiang is fetal water flooding upward to become phlegm, attacking the Lungs and causing cough. In such cases, the method should eliminate water using Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction) or Liu Jun Zi Tang (Six-Gentlemen Decoction), augmented with Wu Wei Zi, Pao Jiang (Prepared Ginger), and Xi Xin (Asari Radix et Rhizoma). If both water and fire are disturbed causing cough, Xie Bai San (Drain White Powder) augmented with Xing Ren (Armeniacae Semen Amarum), Gua Lou Shuang (Benincasae Pericarpium Depuratum), Bai Qian (Cynanchi Stauntonii Radix), Huang Qin (Scutellariae Radix), Zhi Ke, and Gan Cao (Glycyrrhizae Radix et Rhizoma) is suitable. Or Ting Li Da Zao Xie Fei Tang (Sedum and Jujube Decoction to Drain the Lungs) can be used. However, Ting Li (Sedimi Semen) is potent and should not be overused.
Lower abdominal pain in pregnancy is divided into water and blood categories. In water-related cases, Bladder Qi fails to transform water, causing uterine distension and inability to excrete water, manifesting as scanty/dysuric urination, abdominal distension, and panting. If determined to be Heat accumulation, Dao Chi San (Guide Out Red Powder) augmented with Shan Zhi (Gardeniae Fructus) and Fang Ji (Stephaniae Tetrandrae Radix) clears Heat. If determined to be Cold accumulation with Yang failure to transform, Wu Ling San (Five-Ingredient Powder with Poria) is used to promote diuresis, relieving lower abdominal pain. Ju He Wan (Tangerine Seed Pill) augmented with Fu Ling (Poria) is also effective. In blood-related cases, the uterus is governed by the Liver and Kidneys. If Liver Yang fails to reach the uterus, uterine blood stagnates causing pain, treated with Si Wu Tang (Four-Substance Decoction) augmented with Ai Ye (Artemisiae Argyi Folium), Xiang Fu (Cyperi Rhizoma), E Jiao (Colla Corii Asini), and Hui Xiang (Foeniculi Fructus). If Kidney Yang fails to reach the uterus, the fetus feels cold and painful, radiating to the lower back and spine, treated with Si Wu Tang augmented with Du Zhong (Eucommiae Cortex), Gu Zhi (Psoraleae Fructus), Tai Wu (Arecae Semen Preparatum), and Ai Ye. This is called Bao Zu (Uterine Obstruction), meaning Yin blood in the uterus is blocked from Yang Qi. Severe cases use Shen Qi Wan (Kidney Qi Pill); mild cases use Jiao Ai Si Wu Tang (Colla Corii Asini and Four-Substance Decoction).
Blood and water both belong to Yin. Water is the Yin fluid transformed by congenital Yang Qi; blood is the Yin juice transformed by acquired Stomach Qi. Kidney Yin relies on Stomach fluids for generation, while Stomach Qi relies on Kidney Yang for prosperity. If congenital Yang in the Kidneys is insufficient, symptoms include a wiry pulse, fever, increasing distension and bearing-down sensation, abdominal pain, aversion to cold, and impending labor. Zhang Zhongjing uses Fu Zi Tang (Aconite Decoction) to protect Kidney Yang and support Stomach Qi; this is a Yang-tonifying method. If Stomach fluids are insufficient, the uterus becomes dry, causing sadness, desire to cry, sensations resembling spirit possession, and frequent yawning/stretching. This occurs because Kidney water is insufficient, leading to insufficient Chong blood for nourishment. Kidney water resides below as Tian Gui in the uterus and above as saliva in the mouth. Zang Zao (Visceral Dryness) prevents Lung Metal from receiving moisture, so the Lung governs sadness. Yawning indicates Kidney pathology; spirit-like symptoms indicate Blood dryness preventing Heart from transforming fluids, leaving the Spirit unanchored. Gan Mai Da Zao Tang (Sweet Wheat, Licorice, and Jujube Decoction) nourishes Kidney Yin, transmitting water via Chong/Ren to the Kidneys to generate Yin; this is a Yin-tonifying method. Understanding these two approaches allows one to master all Yin-nourishing and Yang-tonifying methods.
Tai Lou (pregnancy spotting/leakage) is also divided into water and blood syndromes. Bleeding belongs to Blood Heat; excessive Fire forces blood to move recklessly. Treat with Si Wu Tang augmented with E Jiao, Chao Zhi Zi (Stir-fried Gardeniae Fructus), Ce Bai Ye (Platycladi Cacumen), and Huang Qin. Discharging water, appearing like bean curd dregs and amounting to about one sheng, is called Gu Jiang (Solitary Fluid). Excessive loss of water causes fetal desiccation and inevitable miscarriage. Since water is Qi, Qi leakage causes water leakage. Boiled yellow glutinous rice provides supplementation and nourishment. A decoction of Bai Mao Gen (Imperatae Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Lu Jiao Shuang (Cervi Cornu Degelatinatum), Sang Piao Xiao (Mantidis Oötheca), and Yin Bai (Argentum) brewed in wine and water is also beneficial.
Furthermore: Blood is controlled by the Spleen and stored in the Liver; the Liver governs dispersion, so for bleeding, Gui Pi Tang (Restore the Spleen Decoction) augmented with Chai Hu (Bupleuri Radix), Shan Zhi, and E Jiao is particularly appropriate. Water is generated by the Kidneys and regulated by the Lungs; if Lung Qi fails to grasp, water leaks. Observing that deficiency-cold in the Lungs fails to control the lower body, leading to urinary incontinence, explains why Lung Qi failing to grasp causes water leakage. Treat with Bai Zhu, Ren Shen, Hai Piao Xiao (Sepiae Endoconcha), Long Gu (Fossilia Ossis Mastodi), Mu Li (Concha Ostreae), Bai He (Lilii Bulbus), He Zi (Terminalia Chebulae Fructus), Zhu Gen (Imperatae Rhizoma), and Yin Bai.
Zi Lin (pregnancy strangury) involves dribbling urine and is divided into Water Strangury and Blood Strangury. Water Strangury affects the Bladder, presenting with distension, obstruction, and dysuria; treat with Wu Lin San (Five-Strangury Powder) augmented with Mu Tong (Akebiae Caulis) and Ze Xie (Alismatis Rhizoma). Blood Strangury affects the Blood Chamber, presenting with stabbing pain in the yin and droplets of blood; treat with Si Wu Tang augmented with Cong Rong (Cynomorii Herba), Bai Mao Gen, Ou Jie (Nymphaeae Rhizomatis Humulus), Tiao Qin (Scutellariae Radix), Chi Ling (Polyporus), and Cao Shao (Glycyrrhizae Radix et Rhizoma cum Glycyrrhizae Radix Rubra).
Zi Xuan (pregnancy suspension/distension) involves fetal Qi pressing upward, blocking the chest and heart, divided into water and blood aspects. Water aspect disease stems from Qi deficiency, with water flooding to become phlegm, obstructing the fetus, and turbid Qi reversing upward; the pulse is deep, slippery, slow, and weak. Treat with Liu Jun Zi Tang augmented with Zhi Ke, Zi Su (Perillae Folium), Fu Pi (Tangeris Pericarpium Viride), Chuan Xiong (Chuanxiong Rhizoma), and Xiang Fu. Blood aspect disease stems from Blood deficiency, with Minister Fire from the Jueyin Liver Meridian in the fetus flaring up, pushing the fetus upward. Treat with Xiao Chai Hu Tang combined with Si Wu Tang, further augmented with Fu Ling, Huang Lian (Coptidis Rhizoma), and Huang Bai (Phellodendri Cortex). Or use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) augmented with Niu Xi and Mai Dong (Ophiopogonis Radix) to guide downward, following the principle of "suppressing what is high." Do not fear Niu Xi's potential to induce abortion.
Note: For Zi Xuan in the 7th or 8th month, if maternal Blood deficiency leaves the fetus unsupported, seeking nourishment upward, descending drugs alone are ineffective. One must greatly tonify Blood using Zhi Gan Cao Tang (Honey-fried Licorice Decoction), removing Gui Zhi (Cinnamomi Ramulus), and adding Huai Yao (Dioscoreae Rhizoma) and Zao Ren (Ziziphi Spinosae Semen). Sheng Yu Tang (Sage Protects Life Decoction) augmented with Bai Zhu, Fu Ling, and Gan Cao is also effective. Gan Mai Da Zao Tang is suitable. Dietary improvement is essential: stew Huang Qi (Astragali Radix), Ren Shen, Shan Yao (Dioscoreae Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Qian Shi (Euryales Semen), and Zhu Ti (Suis Carnis) for best results.
Zi Qi (pregnancy edema) refers to edema. The uterus and Bladder share the same region. Occupied by the fetus, the uterus presses on the Bladder, preventing water transformation and movement, due to pre-existing insufficiency in Bladder Qi transformation. Treat primarily with Wu Ling San. If Fetal Fire attacks the Lungs, clouding the source of transformation and causing scanty urine and edema, remove Gui Zhi and add Zhi Mu (Anemarrhenae Rhizoma), Mai Dong, Huang Qin, Xing Ren, and Fang Ji.
Zi Fan (pregnancy irritability) is caused by Blood deficiency. Blood is governed by the Heart; sufficient Blood means the Heart is not irritable. The fetus consumes Blood, and Fetal Fire combines with Heart Fire, disturbing the Heart, causing restlessness and insomnia. Treat with Suan Zao Ren Tang (Sour Jujube Decoction). Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill) is also applicable.
Zi Xuan (pregnancy vertigo - *note: distinct from Zi Xuan above*) is Phlegm in the Qi level. Symptoms include dizzy vision and head spinning, caused by fetal water reversing upward to become phlegm. Treat with Er Chen Tang augmented with Zi Su, Zhi Ke, Xing Ren, Jiang Zhi (Zingiberis汁), and Zhu Li (Bambusae Sap).
Zi Xian (pregnancy eclampsia/seizures) is Wind in the Blood level. Symptoms include sudden fainting, collapse, unconsciousness, limb convulsions, recovery after some time, locked jaw, and opisthotonos. This results from maternal Blood deficiency allowing Wind pathogens to enter the Liver. The method should tonify Blood and dispel Wind using Si Wu Tang augmented with Gou Teng (Uncariae Ramulus cum Uncis), Fang Feng (Saposhnikoviae Radix), Fu Shen (Poria cum Radix), Sang Ji Sheng (Taxilli Herba), Du Huo (Angelicae Pubescentis Radix), and Ling Yang Jiao (Capricornus Saigae Tataricae Cornu). Xiao Yao San (Free and Easy Wanderer Powder) and Xiao Chai Hu Tang can also be borrowed for treatment.
Urinary retention is due to Qi insufficiency. Normal Qi transformation allows water excretion. Current点滴 (drop-by-drop) retention indicates the uterine ligaments pressing down on the urethral orifice. The cause of this pressure is Kidney Qi insufficiency failing to lift the fetus upward. This is called Zhuan Bao (Reversed Uterus). Treat primarily with Shen Qi Wan. Alternatively, Stomach Qi insufficiency failing to lift the fetus requires Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
Constipation is due to Blood insufficiency. Sufficient Blood in pregnancy ensures health. Insufficient Blood cannot even supply the fetus, let alone other organs, leading to thirst, cough, fever, and constipation. The method should generate Blood; once Blood is sufficient, bowels will naturally move. Treat with Si Wu Tang augmented with Xing Ren, Ma Ren (Cannabis Semen), Cong Rong, and Tu Si Zi (Cuscutae Semen). Xiao Yao Tang augmented with Ma Ren, Zhi Ke, and Hou Po (Magnoliae Officinalis Cortex) is also effective.
In summary, disharmonious fetal Qi is always a disorder of the Water component; regulating water harmonizes Qi. Excessive Fetal Fire is always a disorder of the Blood component; regulating Blood extinguishes Fire. Understanding the causes of water, fire, blood, and Qi makes treating fetal diseases easy, treating hemorrhagic syndromes easy, and even treating miscellaneous diseases effortless.
This book establishes laws for hemorrhagic syndromes; the Qi section mentions related topics by analogy. However, fetal diseases most clearly manifest through water, fire, blood, and Qi. Comprehending this section reveals no hidden aspects of these four concepts. Other fetal diseases not fully recorded here can be found in specialized obstetrics texts.