师曰∶妇人得平脉，阴脉小弱，其人渴，不能食，无寒热，名妊娠，桂枝汤主之。于
法六十日，当有此证；设有医治逆者，却一月；加吐下者，则绝之。
【注】妇人经断得平脉，无寒热，则内外无病，其人渴不能食，乃妊娠恶阻之渐也。故
阴脉虽小弱，亦可断为有孕。但恶阻，于法六十日当有此证，设医不知是孕，而治逆其
法，却一月即有此证也。若更加吐下者，则宜绝止医药，听其自愈可也。然脉平无寒热，
用桂枝汤，与妊娠渴不能食者不合、且文义断续不纯，其中必有脱简。
【集注】徐彬曰∶平脉者，不见病脉，一如平人也。阴脉小弱者，脉形小不大，软弱
无力，非细也。诸脉既平，而独下焦阴脉，微见不同，是中、上二焦无病，乃反见渴不能
食之证，则渴非上焦之热，不能食亦非胃家之病矣。少阳有嘿嘿不欲食之证，今无寒热
亦无少阳表证可疑矣。是渴乃阴火上炽，不能食乃恶心阻食，阴脉小乃胎元蚀气，故曰∶
名妊娠也。
李 曰∶此节病证，即妊娠恶阻是也。寸为阳脉主气，尺为阴脉主血，阴脉小弱者，血
不足也，血以养胎，则液竭而渴。又脾为坤土，浓德载物，胎气赖以奠安，不能食者，脾
气弱也。凡有他病而渴不能食者，脉必不平而有寒热，今虽不能食，反得平脉，又无寒
热，故主妊娠。
桂枝汤方（见下利中）
妇人宿有 病，经断未及三月，而得漏下不止，胎动在脐上者，为 痼害。妊娠六
月动者，前三月经水利时，胎也。下血者，后断三月， 也，所以血不足者，其 不去故
也，当下其 ，桂枝茯苓丸主之。
【注】经断有孕，名曰妊娠。妊娠下血，则为漏下，妇人宿有 痼之疾而育胎者，未
及三月而得漏下，下血不止，胎动不安者，此为 痼害之也；已及六月而得漏下，下血胎
动不安者，此亦 痼害之也。然有血 成块者，以前三月经虽断，血未盛，胎尚弱，未
可下其 痼也。后三月血成 ，胎已强，故主之桂枝茯苓丸，当下其 痼也。此示人妊
娠有病当攻病之义也。此条文义不纯，其中必有阙文，姑存其理可也。
【集注】娄全善曰∶凡胎动，多当脐，今动在脐上者，故知是 也。
程林曰∶此有 病而怀胎者，虽有漏血不止，皆 痼之为害，非胎动胎漏之证，下
其痼，妊娠自安。此《内经》所谓有故无殒，亦无殒也。
方氏曰∶胎动胎漏皆下血，而胎动有腹痛，胎漏无腹痛。故胎动宜行气，胎漏宜清
热。
魏荔彤曰∶胎与 之辨，当于血未断之前三月求之。前三月之经水顺利，则经断必
是胎。前三月有曾经下血者，则经断必成 。
桂枝茯苓丸
桂枝 茯苓 牡丹（去心，） 桃仁（去皮尖，） 芍药（各等分）
上五味，末之，炼蜜和丸，如兔屎大，每日食前服一丸，不知，加至三丸。
妇人怀娠六七月，脉弦，发热，其胎愈胀，腹痛恶寒者，少腹如扇，所以然者，子
脏开故也，当以附子汤温其脏。（方未见）
【注】妇人怀娠六七月，脉弦发热，似表证也；若其胎愈胀，腹痛恶寒，而无头痛身
痛，则非表证也。少腹如扇状，其恶寒如扇风之侵袭也。所以然者，因其人阳虚子脏开，
寒邪侵入，故用附子汤温子脏而逐寒，但方缺，文亦不纯，必有残缺。
【集注】程林曰∶胎胀腹痛，亦令人发热恶寒。少腹如扇者，阴寒胜也。妊娠阴阳调
和，则胎气安，今阳虚阴盛，不能约束胞胎，故子脏为之开也。附子汤用以温经。
李 曰∶按子脏即子宫也。脐下三寸为关元，关元左二寸为胞门，右二寸为子户，命
门为女子系胞之处，非谓命门即子脏也。盖命门是穴名，在腰后两肾中，附脊骨之第十
四椎之两旁。今经衣冠文物说少腹如扇者，子脏开，则子脏在少腹明矣。岂有在少腹者，而
反谓其在脊后者乎？此误也。
尤怡曰∶脉弦发热，有似表证，而乃身不痛而腹反痛，背不恶寒而腹反恶寒，甚至
少腹阵阵作冷，若或扇之者，其所以然者，子脏开不能阖，而风冷之气乘之也。夫脏开风
入，其阴内胜，则其脉弦为阴气，而发热且为格阳矣。胎胀者，热则消，寒则胀也。附
子汤方未见，然温里散寒之意概可推矣。
师曰∶妇人有漏下者，有半产后，因续下血都不绝者。有妊娠下血者，假令妊娠腹
中痛，为胞阻，胶艾汤主之。
【注】五六月堕胎者，谓之半产。妇人有漏下、下血之疾，至五六月堕胎而下血不绝
者，此 痼之害也。若无 痼下血，惟腹中痛者，则为胞阻。胞阻者，胞中气血不和，而
阻其化育也，故用芎归胶艾汤温和其血，血和而胎育也。
【集注】程林曰∶漏下者，妊娠经来，脉经以阳不足谓之激经也。半产者，以四五月
堕胎，堕胎必伤其血海，血因续下不绝也，若妊娠下血腹中痛，为胞阻，则用胶艾汤以治。
尤怡曰∶妇人经水淋沥，及胎产前后下血不止者，皆冲任脉虚，而阴气不能守也，是
惟胶艾汤能补而固之。
芎归胶艾汤方
芎 阿胶 甘草（各二两） 艾叶 当归（各三两） 芍药（四两） 干地黄
上七味，以水五升，清酒三升，合煮取三升，去滓，内胶，令消尽，温服一升，日
三服，不瘥更作。
妇人怀娠，腹中 痛，当归芍药散主之。
【按】妊娠腹中急痛用此方，未详其义，必是脱简，不释。
当归芍药散方
当归（三两） 芍药（一斤） 茯苓（四两） 白术（四两） 泽泻（半斤） 芎 （半斤）
上六味，杵为散，取方寸匕，酒和，日二服。
妊娠，呕吐不止，干姜人参半夏丸主之。
【注】妊娠呕吐谓之恶阻。恶阻者，谓胃中素有寒饮，恶阻其胎而妨饮食也。主之以
干姜上寒，半夏止呕；恶阻之人，日日呕吐，必伤胃气，故又佐人参也。
【集注】程林曰∶寒在胃脘，则令呕吐不止，故用干姜散寒，半夏、生姜止呕，人参
和胃。半夏、干姜能下胎。娄全善云∶余治娠阻病，累用半夏，未尝动胎，亦有故无殒
之义，临病之工，何必拘泥。
尤怡曰∶此益虚温胃之法，为妊娠中虚而有寒者设也。夫阳明之脉，顺而下行者也。
有寒则逆，有热亦逆，逆则饮必从之，而妊娠之体，精凝血聚，每多蕴而成热者矣。按
《外台》方∶青竹茹、橘皮、半夏各五两，生姜、茯苓各四两，麦冬、人参各三两，为治
胃热气逆呕吐之法，可补仲景之未备也。
干姜人多半夏丸方
干姜 人参（各一两） 半夏（二两）
上三味，末之，以生姜汁糊为丸，如梧子大，饮服十丸，日三服。
妊娠，小便难，饮食如故，当归贝母苦参丸主之。
【按】方证不合，必有脱简，不释。
当归贝母苦参丸方
当归 贝母 苦参（各四两）
上三味，末之，炼蜜为丸，如小豆大，饮服三丸，加至十丸。
妊娠，有水气，身重，小便不利，洒淅恶寒，起即头眩，葵子茯苓散主之。
【注】妊娠外有水气则浮肿，洒淅恶寒，水盛贮于肌肤，故身重；内有水气，则小便
不利，水盛阻遏阳气上升，故起即头眩也。用葵子茯苓者，是专以通窍利水为主也。
葵子茯苓散方
葵子（一升） 茯苓（三两）
上二味，杵为散，饮服方寸匕，日三服，小便利则愈。
妇人妊娠宜常服，当归散主之。
【注】妊娠无病不须服药，若其人瘦而有热，恐耗血伤胎，宜常服此以安之。
【集注】尤怡曰∶妊娠最虑热伤，故于芎、归、芍药养血之中，用黄芩清热，佐白术和
胃也。震亨称黄芩、白术为安胎圣药，夫芩、术非能安胎者也，去其湿热，其胎自安耳！
当归散方
当归 黄芩 芍药 芎 （各一斤） 白术（半斤）
上五味，杵为散，酒饮服方寸匕，日再服，妊娠常服即易产，胎无苦疾，产后百病
悉主之。
妊娠养胎，白术散主之。
【注】妊娠妇人，肥白有寒，恐其伤胎，宜常服此。
【集注】尤怡曰∶妊娠伤胎，有因热者，亦有因寒者，随人脏气之阴阳而各异也。当
归散正治热之剂。白术散君白术和胃，臣川芎调血，使蜀椒去寒，佐牡蛎安胎也，则正
治寒之剂也。仲景并列于此，其所以昭示后人者深矣。
白术散方
白术 芎 蜀椒（去汗，三分） 牡蛎
上四味，杵为散，酒服一钱匕，日三服，夜一服。但苦痛，加芍药；心下毒痛，倍加
芎；心烦吐痛，不能食饮，加细辛一两，半夏大者二十枚，服之后，更以醋浆水服之。若
呕，以醋浆水服之复不解者，小麦汁服之。以后渴者，大麦粥服之，病虽愈，服之勿置。
妇人伤胎，怀身腹满，不得小便，从腰以下重，如有水气状，怀身七月，太阴当养
不养，此心气实，当刺泻劳宫及关元，小便微利则愈。
【按】文义未详，此穴刺之落胎，必是错简，不释。
老师说道：妇女脉象平和，尺部脉（阴脉）略显细弱，患者感到口渴、不能进食，没有恶寒发热的症状，这是妊娠的表现，用桂枝汤主治。按照规律，怀孕六十天左右会出现这些症状；如果医生误治，反而使病情推迟一个月出现；如果再出现呕吐或腹泻的症状，就应当停止用药，让身体自行恢复。
【注】妇女月经停止后出现平和的脉象，且无恶寒发热，说明体内体外都没有疾病。患者口渴、不能进食，是妊娠恶阻（妊娠早期恶心呕吐等反应）的初期表现。因此，虽然尺部脉象细小微弱，也可以判断为怀孕。但是，恶阻症状通常在怀孕六十天左右出现，如果医生不知道这是怀孕，而采用错误的治法，就会使症状推迟一个月才出现。如果再加上呕吐和腹泻，就应当停止药物治疗，听任其自愈即可。然而，脉象平和且无寒热，使用桂枝汤，与妊娠口渴不能食的症状不符，且文义不连贯，其中必定有脱漏的文字。
【集注】徐彬说：平脉是指没有病脉，就像正常人一样。阴脉小弱，是指脉形不大，软弱无力，而不是指脉细。既然其他脉象都平和，唯独下焦的阴脉微有不同，说明中、上二焦没有疾病。现在反而出现口渴、不能吃的症状，那么口渴就不是上焦的热证，不能吃也不是胃部的病变。少阳病有默默不想吃东西的症状，但现在没有恶寒发热，也没有少阳表证的嫌疑。所以口渴是阴火上炎，不能吃是恶心阻碍饮食，阴脉小是因为胎元消耗了气，所以说：这是妊娠。
李 说：这一节的病症，就是妊娠恶阻。寸口脉属阳主气，尺部脉属阴主血，阴脉小弱，说明血不足。血用来滋养胎儿，就会导致津液枯竭而口渴。另外，脾属坤土，厚德载物，胎气的安定依赖脾气，不能吃是因为脾气虚弱。凡是有其他疾病导致口渴不能吃的，脉象一定不平且有寒热，现在虽然不能吃，却得到平和的脉象，又没有寒热，所以判断为妊娠。
桂枝汤方（见下利篇中）
妇女素有癥病（腹内结块），月经停止不到三个月，却出现淋漓不止的下血，胎动在肚脐上方的，这是癥病为害。如果是怀孕六个月胎动的，前三个月月经正常时受孕的，是真正的胎孕。如果下血，且停经三个月的，是癥病。之所以血不足，是因为癥病不去除的缘故，应当攻下癥病，用桂枝茯苓丸主治。
【注】月经停止而有孕，称为妊娠。妊娠期间下血，称为漏下。妇女素有癥病而怀孕的，不到三个月就出现漏下，下血不止，胎动不安的，这是癥病为害；已经到六个月出现漏下，下血胎动不安的，这也是癥病为害。但是如果有瘀血成块的，因为前三个月月经虽断但血量未盛，胎气尚弱，不可以攻下癥病。后三个月血已成块，胎气已强，所以主张用桂枝茯苓丸，攻下癥病。这是告诉人们妊娠有病应当先治病的道理。此条文义不纯，其中必定有缺文，姑且保留其道理即可。
【集注】娄全善说：凡是胎动，多在肚脐处，现在动在肚脐上方，所以知道是癥病。
程林说：这是有癥病而怀胎的人，虽然有漏血不止，都是癥病为害，不是胎动胎漏的证候，攻下癥病，妊娠自然平安。这就是《内经》所说的“有故无殒”，也不会伤害母体。
方氏说：胎动和胎漏都会下血，但胎动有腹痛，胎漏无腹痛。所以胎动宜行气，胎漏宜清热。
魏荔彤说：区分胎和癥，应当在月经停止前三个月寻找线索。前三个月月经顺利，那么月经停止必定是怀孕。前三个月有过下血的，那么月经停止必定形成癥病。
以上五味药，研成末，炼蜜和丸，如兔屎大小，每天饭前服一丸，无效的话，加至三丸。
妇女怀孕六七月，脉弦，发热，胎胀更厉害，腹痛恶寒，小腹像被扇子扇风一样冷，之所以这样，是因为子宫开泄的缘故，应当用附子汤温暖子宫。（方剂未见）
【注】妇女怀孕六七月，脉弦发热，看似表证；但如果胎胀更厉害，腹痛恶寒，而没有头痛身痛，那就不是表证。小腹像扇子扇风一样，那种恶寒就像被风吹袭一样。之所以这样，是因为其人阳虚，子宫开泄，寒邪侵入，所以用附子汤温暖子宫并驱散寒气，但方剂缺失，文义也不纯粹，必定有残缺。
【集注】程林说：胎胀腹痛，也会让人发热恶寒。小腹像扇子扇风，是阴寒胜过的表现。妊娠时阴阳调和，则胎气安，现在阳虚阴盛，不能约束胞胎，所以子宫为之开泄。附子汤用来温经。
李 说：按子宫即子宫。脐下三寸为关元穴，关元左二寸为胞门穴，右二寸为子户穴，命门是女子系胞之处，并非谓命门就是子宫。盖命门是穴位名，在腰后两肾之间，附着于脊柱第十四椎两旁。现在根据经衣冠文物说法，小腹像扇子扇风，子宫开泄，那么子宫在少腹是明显的。难道在少腹的，反而说它在脊背后吗？这是错误的。
尤怡说：脉弦发热，有似表证，但身体不痛而腹部反痛，背部不恶寒而腹部反恶寒，甚至小腹阵阵发冷，好像有人扇风一样，之所以这样，是因为子宫开泄不能闭合，风寒之气乘虚而入。脏开风入，阴气内盛，所以脉弦为阴气，发热且为格阳（真寒假热）。胎胀，是因为热则消，寒则胀。附子汤方未见，但温里散寒的意思大概可以推测。
老师说：妇女有漏下的，有半产后，接着下血都不停止的。有妊娠下血的，假如妊娠腹中痛，称为胞阻，用胶艾汤主治。
【注】五六月堕胎的，称为半产。妇女有漏下、下血的病，到五六月堕胎而下血不绝的，这是癥病为害。如果没有癥病下血，只有腹中痛的，则为胞阻。胞阻，是胞中气血不和，阻碍化育，所以用芎归胶艾汤温和其血，血和则胎育正常。
【集注】程林说：漏下，是妊娠期间来月经，《脉经》称之为激经（因阳气不足所致）。半产，是四五月堕胎，堕胎必伤血海，血因此续下不绝。若妊娠下血腹中痛，为胞阻，则用胶艾汤治疗。
尤怡说：妇女经水淋沥，及胎产前后下血不止的，都是冲任脉虚，阴气不能守固，只有胶艾汤能补益而固摄。
川芎 阿胶 甘草（各二两） 艾叶 当归（各三两） 芍药（四两） 干地黄
以上七味药，用水五升，清酒三升，合煮取三升，去渣，加入阿胶，令其完全溶解，温服一升，每天三次服用，不好再煎服。
妇女怀孕，腹中绞痛，用当归芍药散主治。
【按】妊娠腹中急痛用此方，不详其义，必定是脱简，不解释。
当归（三两） 芍药（一斤） 茯苓（四两） 白术（四两） 泽泻（半斤） 川芎（半斤）
以上六味药，捣碎为散，取一方寸匕，用酒调服，每天两次。
【注】妊娠呕吐称为恶阻。恶阻，是说胃中素有寒饮，阻碍胎气并妨碍饮食。用干姜温胃寒，半夏止呕；恶阻之人，日日呕吐，必伤胃气，所以又佐以人参。
【集注】程林说：寒在胃脘，则令呕吐不止，所以用干姜散寒，半夏、生姜止呕，人参和胃。半夏、干姜能下胎。娄全善说：我治疗妊娠恶阻病，多次使用半夏，未曾动胎，也有“有故无殒”的道理，临病之工，何必拘泥。
尤怡说：这是益虚温胃的方法，为妊娠中虚而有寒的人设立的。阳明经脉是顺行下行的。有寒则逆，有热亦逆，逆则饮邪随之，而妊娠体质，精凝血聚，每多蕴而成热。按《外台秘要》方：青竹茹、橘皮、半夏各五两，生姜、茯苓各四两，麦冬、人参各三两，是治胃热气逆呕吐的方法，可补充仲景之未备。
以上三味药，研成末，用生姜汁糊为丸，如梧桐子大，温水送服十丸，每天三次。
【按】方证不合，必有脱简，不解释。
以上三味药，研成末，炼蜜为丸，如小豆大，温水送服三丸，加至十丸。
妊娠，有水气，身重，小便不利，洒淅恶寒，起即头眩，用葵子茯苓散主治。
【注】妊娠外有水气则浮肿，洒淅恶寒，水盛贮于肌肤，故身重；内有水气，则小便不利，水盛阻遏阳气上升，故起即头眩也。用葵子茯苓者，是专以通窍利水为主也。
以上两味药，捣碎为散，温水送服一方寸匕，每天三次，小便利则愈。
【注】妊娠无病不须服药，如果其人瘦而有热，恐耗血伤胎，宜常服此以安之。
【集注】尤怡说：妊娠最虑热伤，所以在芎、归、芍药养血之中，用黄芩清热，佐白术和胃。震亨称黄芩、白术为安胎圣药，夫芩、术非能安胎者也，去其湿热，其胎自安耳！
当归散方
以上五味药，捣碎为散，酒饮服一方寸匕，每天两次，妊娠常服即易产，胎无苦疾，产后百病悉主之。
【注】妊娠妇人，肥白有寒，恐其伤胎，宜常服此。
【集注】尤怡说：妊娠伤胎，有因热者，亦有因寒者，随人脏气之阴阳而各异也。当归散正治热之剂。白术散君白术和胃，臣川芎调血，使蜀椒去寒，佐牡蛎安胎也，则正治寒之剂也。仲景并列于此，其所以昭示后人者深矣。
白术散方
以上四味药，捣碎为散，酒服一钱匕，每天三次，夜间一次服用。如果痛苦，加芍药；心下剧痛，倍加川芎；心烦吐痛，不能食饮，加细辛一两，半夏大者二十枚，服之后，更以醋浆水服之。如果呕吐，以醋浆水服之复不解者，小麦汁服之。以后渴者，大麦粥服之，病虽愈，服之勿置。
妇女伤胎，怀身腹满，不得小便，从腰以下重，如有水气状，怀身七月，太阴当养不养，此心气实，当刺泻劳宫及关元，小便微利则愈。
【按】文义未详，此穴刺之落胎，必是错简，不解释。
The Master said: "When a woman has a normal pulse, with the Yin pulse (pulse at the cun position reflecting internal/visceral status) being slightly weak, and presents with thirst and inability to eat, without chills or fever, this is named pregnancy. Guizhi Tang (Cinnamon Twig Decoction) should be administered. According to the method, these symptoms should appear around the sixtieth day of pregnancy; if medical treatment is incorrectly applied, it may delay the appearance of these symptoms by one month. If vomiting or diarrhea ensues, medication should be discontinued, allowing for self-recovery."
[Annotation] When menstruation ceases and a normal pulse is found, without chills or fever, it indicates no disease inside or outside. Thirst and inability to eat are early signs of Ezu (morning sickness/pregnancy nausea). Thus, even if the Yin pulse is small and weak, pregnancy can be diagnosed. However, Ezu typically manifests around sixty days of gestation. If a physician fails to recognize pregnancy and applies incorrect treatment, symptoms may be delayed by a month. If vomiting and diarrhea occur subsequently, medication should be stopped to allow natural recovery. Nevertheless, using Guizhi Tang for a patient with a normal pulse, no chills/fever, yet suffering from thirst and anorexia, does not align well with the syndrome, and the textual coherence is broken, suggesting missing text.
[Collected Annotations] Xu Bin stated: A "normal pulse" means no pathological pulse signs, resembling that of a healthy person. The Yin pulse being small and weak refers to a pulse that is neither large nor forceful, but soft and weak, distinct from a fine pulse. Since other pulses are normal, only the lower Jiao's Yin pulse shows slight abnormality, indicating no disease in the Middle and Upper Jiao. The occurrence of thirst and anorexia implies that thirst is not due to Upper Jiao heat, nor anorexia due to Stomach pathology. Shaoyang disease presents with anorexia, but here there are no chills or fever, ruling out Shaoyang exterior syndrome. Therefore, thirst is caused by flaming Yin fire, anorexia by nausea obstructing food intake, and the small Yin pulse reflects the fetus consuming Qi. Hence, it is named pregnancy.
Li [Name omitted] stated: This section describes pregnancy Ezu. The Cun position (Yang pulse) governs Qi, while the Chi position (Yin pulse) governs Blood. A small and weak Yin pulse indicates Blood deficiency. Blood nourishes the fetus; thus, fluid depletion causes thirst. Spleen belongs to Kun Earth, bearing all things; fetal stability relies on Spleen Qi. Anorexia results from weak Spleen Qi. In other diseases causing thirst and anorexia, the pulse is usually irregular with chills/fever. Here, despite anorexia, the pulse is normal and free of chills/fever, confirming pregnancy.
Guizhi Tang (See under Diarrhea section)
"If a woman has a pre-existing Zheng mass (abdominal mass), and menstruation has ceased for less than three months, yet she experiences continuous spotting and fetal movement above the umbilicus, this is harm caused by the Zheng mass. If fetal movement occurs at six months of pregnancy, and menstruation was regular during the first three months, it is a true fetus. If bleeding occurs after three months of amenorrhea, it is a Zheng mass. The reason for insufficient blood is that the Zheng mass remains. It should be purged, and Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) should be used."
[Annotation] Cessation of menstruation with pregnancy is named Gestation. Bleeding during gestation is called Lou Xia (spotting). If a woman with a pre-existing Zheng mass conceives and experiences spotting before three months, with continuous bleeding and restless fetus, this is harm from the Zheng mass. Similarly, if this occurs at six months, it is also Zheng harm. However, if blood stasis has formed clots, because blood volume was low and fetal Qi weak in the first three months, purging the Zheng mass is contraindicated. By the later three months, blood stasis is established and fetal Qi is strong, so Guizhi Fuling Wan is indicated to purge the Zheng mass. This illustrates the principle that when a pregnant woman has disease, the disease should be treated. The text is incomplete, likely containing missing passages; retain the principle.
[Collected Annotations] Lou Quanshan stated: Fetal movement usually occurs at the umbilicus; movement above suggests a Zheng mass.
Cheng Lin stated: In women with Zheng masses who conceive, continuous bleeding is caused by the Zheng mass, not typical fetal restlessness or leakage. Purging the Zheng mass ensures fetal safety. This aligns with the *Neijing* principle: "If there is a cause, there will be no destruction," meaning treating the pathogen will not harm the mother.
Fang Shi stated: Both fetal restlessness and leakage involve bleeding, but restlessness includes abdominal pain, while leakage does not. Restlessness requires Qi-moving methods; leakage requires heat-clearing methods.
Wei Litong stated: Distinguishing between fetus and Zheng mass depends on the three months prior to amenorrhea. Regular menstruation beforehand confirms pregnancy; prior bleeding suggests Zheng mass formation.
Guizhi Fuling Wan Formula
Guizhi (Cinnamon Twig), Fuling (Poria), Mudanpi (Moutan Cortex, remove heart), Taoren (Peach Kernel, remove skin and tip), Shaoyao (White Peony Root) - equal parts.
Grind the five herbs into powder, mix with refined honey to form pills the size of rabbit droppings. Take one pill before meals daily. If ineffective, increase to three pills.
"If a woman is pregnant for six or seven months, presenting with a wiry pulse, fever, increased abdominal distension, abdominal pain, aversion to cold, and a sensation of cold in the lower abdomen as if fanned, this is due to the opening of the Zi Zang (uterus). Attizizi Tang (Aconite Decoction) should be used to warm the uterus. (Formula not found)"
[Annotation] At six or seven months of pregnancy, a wiry pulse and fever may resemble an exterior syndrome. However, if accompanied by increased fetal distension, abdominal pain, and aversion to cold without headache or body ache, it is not an exterior syndrome. The "fanning" sensation in the lower abdomen indicates cold invasion due to Yang deficiency and uterine opening. Attizizi Tang warms the uterus and dispels cold. The formula is missing, and the text is incomplete.
[Collected Annotations] Cheng Lin stated: Fetal distension and pain can cause fever and aversion to cold. The "fanning" sensation indicates severe Yin cold. Pregnancy requires Yin-Yang harmony for fetal stability; Yang deficiency and Yin excess lead to uterine opening. Attizizi Tang warms the meridians.
Li [Name omitted] stated: Zi Zang refers to the uterus. Guan Yuan is three inches below the umbilicus; Bao Men is two inches left of Guan Yuan, Zi Hu is two inches right. Ming Men is where the uterus is tied, located between the kidneys behind the spine at the level of the 14th thoracic vertebra. It is not the same as Zi Zang. Current interpretations place Zi Zang in the lower abdomen, contradicting the location of Ming Men. This is an error.
You Yi stated: Wiry pulse and fever mimic exterior syndrome, but absence of body pain and presence of abdominal pain/cold indicate interior cold. Wind and cold enter the open uterus. Interior Yin excess causes wiry pulse and false heat (Ge Yang). Heat causes contraction, cold causes distension. Although the formula is missing, the intent to warm the interior and dispel cold is clear.
"The Master said: 'Women may experience spotting, continuous bleeding after spontaneous abortion (half-birth), or bleeding during pregnancy. If pregnancy is accompanied by abdominal pain, it is called Bao Zu (womb obstruction). Jiao Ai Tang (Colla Corii Asini and Moxa Decoction) should be administered.'"
[Annotation] Abortion at five or six months is called Ban Chan (half-birth). Continuous bleeding after abortion is due to Zheng mass harm. If there is no Zheng mass, but only abdominal pain, it is Bao Zu. Bao Zu means disharmony of Qi and Blood in the womb, hindering development. Jiao Ai Tang harmonizes the blood to support fetal development.
[Collected Annotations] Cheng Lin stated: Spotting during pregnancy is called Ji Jing (stimulated menstruation) due to Yang insufficiency. Half-birth damages the Sea of Blood, causing continuous bleeding. For Bao Zu with abdominal pain, use Jiao Ai Tang.
You Yi stated: Scanty menstruation and post-partum/post-abortion bleeding result from deficiency of Chong and Ren meridians and failure of Yin Qi to hold. Jiao Ai Tonk tonifies and secures.
Jiao Ai Tang Formula
Xiong (Ligusticum Chuanxiong Rhizome), Ejiao (Colla Corii Asini), Gancao (Licorice Root) - 2 liang each; Aiye (Artemisia Argyi Leaf), Danggui (Angelica Sinensis Radix) - 3 liang each; Shaoyao (White Peony Root) - 4 liang; Shengdi Huang (Rehmannia Glutinosa Radix Preparata).
Boil the seven ingredients in 5 sheng of water and 3 sheng of clear wine to obtain 3 sheng. Strain, dissolve Ejiao, and take 1 sheng warm, three times daily. Repeat if necessary.
"For pregnancy with cramping abdominal pain, Danggui Shaoyao San (Angelica Sinensis and White Peony Powder) should be used."
[Note] The rationale for using this formula for acute pregnancy pain is unclear; likely missing text. Not explained.
Danggui Shaoyao San Formula
Danggui (Angelica Sinensis Radix) - 3 liang; Shaoyao (White Peony Root) - 1 jin; Fuling (Poria); Baizhu (Atractylodes Macrocephala Rhizome) - 4 liang each; Zexie (Alisma Orientale Rhizome), Xiong (Ligusticum Chuanxiong Rhizome) - 0.5 jin each.
Grind the six herbs into powder. Take one cun bi (measure) mixed with wine, twice daily.
"For persistent vomiting during pregnancy, Jiangren Banxia Wan (Ginger, Ginseng, and Pinellia Pill) should be used."
[Annotation] Pregnancy vomiting is Ezu. It arises from cold-fluid retention in the Stomach obstructing the fetus and appetite. Ganjiang (Dried Ginger) warms the Stomach cold; Banxia (Pinellia Tuber) stops vomiting. Since persistent vomiting damages Stomach Qi, Renshen (Ginseng Radix) is added to support it.
[Collected Annotations] Cheng Lin stated: Cold in the Epigastrium causes persistent vomiting. Ganjiang dispels cold; Banxia and Shengjiang (Fresh Ginger) stop vomiting; Renshen harmonizes the Stomach. Although Banxia and Ganjiang are considered potentially abortifacient, Lou Quanshan reported successful use of Banxia for Ezu without harming the fetus, citing the "treating the cause" principle. One should not be dogmatic.
You Yi stated: This method tonifies deficiency and warms the Stomach, suitable for pregnancy with middle-jiao deficiency and cold. The Yangming meridian flows downward. Cold or heat causes rebellion, leading to fluid retention. Pregnancy involves condensation of essence and blood, often generating heat. The *Waitai Mi Yao* formula with Qingzhuru (Bamboo Shavings), Chenpi (Citrus Peel), Banxia, Shengjiang, Fuling, Maidong (Ophiopogon Tuber), and Renshen treats stomach-heat rebellious vomiting, supplementing Zhang Zhongjing's work.
Jiangren Banxia Wan Formula
Ganjiang (Dried Ginger), Renshen (Ginseng Radix) - 1 liang each; Banxia (Pinellia Tuber) - 2 liang.
Grind the three herbs into powder. Form pills with fresh ginger juice, sized like wisteria seeds. Take ten pills with warm water, three times daily.
"For pregnancy with difficult urination but normal diet, Danggui Beimu Kushen Wan (Angelica, Fritillaria, and Sophora Pill) should be used."
[Note] Formula and syndrome do not match; likely missing text. Not explained.
Danggui Beimu Kushen Wan Formula
Danggui (Angelica Sinensis Radix), Beimu (Fritillaria Cirrhosa Bulb), Kushen (Sophora Flavescens Root) - 4 liang each.
Grind the three herbs into powder. Form pills with refined honey, sized like adzuki beans. Take three pills with warm water, increasing to ten pills if necessary.
"For pregnancy with water retention, heaviness, dysuria, aversion to cold, and dizziness upon rising, Kuizi Fuling San (Abelmoschus Seed and Poria Powder) should be used."
[Annotation] Exterior water retention causes edema and aversion to cold; water accumulating in muscles causes heaviness. Interior water retention causes dysuria; water blocking ascending Yang Qi causes dizziness upon rising. Kuizi (Abelmoschus Seed) and Fuling (Poria) promote diuresis and unblock orifices.
Kuizi Fuling San Formula
Kuizi (Abelmoschus Esculentus Fruit Seed) - 1 sheng; Fuling (Poria) - 3 liang.
Grind the two herbs into powder. Take one cun bi with warm water, three times daily. Recovery occurs when urination improves.
"For pregnant women, Danggui San (Angelica Powder) is recommended for regular consumption."
[Annotation] Medication is unnecessary if asymptomatic. However, for thin women with heat, which may consume blood and harm the fetus, regular use stabilizes the condition.
[Collected Annotations] You Yi stated: Pregnancy is vulnerable to heat damage. Danggui San uses Huangqin (Scutellaria Baicalensis Root) to clear heat within the blood-nourishing base of Xiong, Danggui, and Shaoyao, assisted by Baizhu to harmonize the Stomach. Zhenheng praised Huangqin and Baizhu as sacred fetal-calming herbs, but they calm the fetus by removing damp-heat, not directly.
Danggui San Formula
Danggui (Angelica Sinensis Radix), Huangqin (Scutellaria Baicalensis Root), Shaoyao (White Peony Root), Xiong (Ligusticum Chuanxiong Rhizome) - 1 jin each; Baizhu (Atractylodes Macrocephala Rhizome) - 0.5 jin.
Grind the five herbs into powder. Take one cun bi with wine, twice daily. Regular consumption facilitates delivery, prevents fetal distress, and treats various postpartum conditions.
"For nurturing the fetus during pregnancy, Baizhu San (Atractylodes Powder) should be used."
[Annotation] For obese pregnant women with cold constitution, which may harm the fetus, regular use is recommended.
[Collected Annotations] You Yi stated: Fetal damage can result from heat or cold, depending on organ Yin-Yang balance. Danggui San treats heat; Baizhu San treats cold. Baizhu harmonizes the Stomach, Xiong regulates blood, Shujiao (Sichuan Pepper) dispels cold, and Muli (Oyster Shell) calms the fetus. Zhang Zhongjing placed them together to deeply instruct future generations.
Baizhu San Formula
Baizhu (Atractylodes Macrocephala Rhizome), Xiong (Ligusticum Chuanxiong Rhizome), Shujiao (Sichuan Pepper, remove sweat/surface moisture) - 3 fen each; Muli (Oyster Shell).
Grind the four herbs into powder. Take one qian bi with wine, three times daily, plus once at night. If pain persists, add Shaoyao. If epigastric severe pain occurs, double Xiong. If irritability, vomiting, pain, and anorexia occur, add Yixin (Asarum Root) 1 liang and large Banxia 20 pieces. Follow with vinegar-water. If vomiting persists, use wheat juice. If thirsty afterward, use barley porridge. Continue even after recovery.
"If a woman suffers fetal injury, presenting with abdominal fullness, inability to urinate, heaviness from the waist down resembling water retention, at seven months of pregnancy, when the Taiyin stage should nurture but fails to do so, due to excess Heart Qi, Laogong (PC 8) and Guan Yuan (CV 4) should be punctured and drained. Mild improvement in urination indicates recovery."
[Note] Textual meaning is unclear. Puncturing these points may induce abortion; likely a misplaced passage. Not explained.