张仲景曰∶怀孕腹痛，当归芍药散治之。此益气血也。然或有宿痰，或风冷触犯，或气或食，统以香附、
砂仁、苏梗、生姜四味极稳。
当归芍药散
当归 白芍 茯苓 白术 泽泻 川芎
水煎服。或为末，每服二钱。
大凡腰痛皆属肾虚，在妊中最宜急治。盖胞胎系于带脉，带脱则胞下坠矣。古方用青娥散治之，予常以熟地、
杜仲合保胎丸多效。
青娥丸
杜仲（四两，姜炒） 补骨脂（一两，盐炒） 核桃肉（二两）
为末蜜丸，酒下。
昔于庚辰岁，海宁万家渡金姓，娶妻十载未孕，忽月事过期，长安医者谓之孕，遂以熟地阿胶苓术之类补安。
延至十月，尚不见产。腹日大，妇日病，及至十五月，人不起床，食不过喉，腹大异常。偶一腹痛，即肠鸣如
踏水车之响，门外俱闻其声。危急之甚，斯时 因朱敷文、吴大成兄相请在彼，邀往诊之。其人已奄奄一息，
诸医袖手待毙。有曰鬼胎，曰经阻。予诊之，六脉滑大无伦，按之坚实，乃曰非孕也，此痰臌也。由思多伤脾，
脾不为胃行其津液而化痰。初误为孕，服滋腻寒凉之药，致痰不行，积久而成斯症。若不攻之，必无生理。随
用二陈汤加南星、浓朴、槟榔、三棱、莪术、桂、姜，二三剂即下行，病家恐致痢，急复请。视脉稍和，所下者
赭色成块，挑开内白色。予曰∶此血裹痰也。即于前方加大黄、礞石。又数剂，日下二三十行，腹渐消而进糜
粥矣。十日后，转用姜桂六君子汤、枳实理中丸、煎丸并进，而病患起矣。众皆敬服。彼时若再姑息不攻，安得
不胀死？所以药贵得当，何妨破格用之？以救此垂危之人，因存是案以备后人之用。
读吴菱山先生辨疑书中治一妇，乃痰
饮血 症，为前医作胎之误，与此症相似。
滑本胎脉，若至滑大无伦，按之坚实，非胎之脉明矣。奈何诸医之不悟也。见所下赭色，而痰裹于内，即
于前方又加大黄攻瘀，礞石攻痰，此所谓随机应变不泥于方也。
张仲景说：怀孕后出现腹痛，用当归芍药散治疗。这是为了补益气血。然而，如果有宿存的痰饮，或者受到风冷侵袭，或者是气滞或食积引起的，统统一律使用香附、砂仁、苏梗、生姜这四味药，非常稳妥。
当归芍药散
当归 白芍 茯苓 白术 泽泻 川芎
用水煎服。或者制成粉末，每次服用二钱。
大凡腰痛都属于肾虚，在怀孕期间尤其应当紧急治疗。因为胞胎系于带脉，如果带脉松弛，胞胎就会下坠。古方使用青娥散来治疗，我常用熟地黄、杜仲配合保胎丸，效果显著。
青娥丸
杜仲（四两，姜炒） 补骨脂（一两，盐炒） 核桃肉（二两）
研成粉末，用蜂蜜做成丸剂，酒送服。
过去在庚辰年，海宁万家渡有一位金姓人家，娶妻十年未孕，忽然月经过期，长安的医生说是怀孕了，于是用熟地黄、阿胶、茯苓、白术之类的药物进行滋补安胎。拖延到十个月，仍然没有分娩。肚子一天天变大，妇人一天天病重，等到十五个月时，人无法起床进食，食物甚至咽不下去，腹部异常肿大。偶尔一次腹痛，就肠鸣如踩水车般的响声，门外都能听到声音。情况危急到了极点，当时因为朱敷文、吴大成兄弟相请，邀请我去诊治。病人已经奄奄一息，其他医生袖手旁观等待死亡。有人说这是鬼胎，有人说这是经血阻滞。我诊察后，发现六脉滑大无比，按压坚实，便说这不是怀孕，而是痰臌（因痰湿积聚导致的腹部胀大病症）。这是由于思虑过度损伤了脾脏，脾不能为胃传输津液而生成痰饮。起初误认为是怀孕，服用了滋腻寒凉的药物，导致痰饮停滞，积累日久形成了这个病症。如果不攻逐痰邪，必定没有生机。随即使用二陈汤加入南星、厚朴、槟榔、三棱、莪术、桂枝、生姜，两三剂后痰浊下行，病人家属担心会导致痢疾，急忙再次请我复诊。查看脉搏稍微平和，排出的物质呈赭红色成块状，挑开后内部是白色的。我说：这是血液包裹着痰饮。于是在前方基础上加大黄、礞石。又经过几剂，每天排泄二三十次，腹部逐渐消退，开始能吃稀粥了。十天后，改用姜桂六君子汤、枳实理中丸，汤剂和丸剂同时服用，病患便康复了。众人都敬佩信服。那时如果再姑息不攻逐，难道不会胀死吗？所以用药贵在恰当，不妨破格使用，以挽救这个垂危的人，因此保存这个医案以备后人参考。
读吴菱山先生《辨疑书》中治疗一位妇女，也是痰饮血瘀症，被前医误认为是胎证，与此症相似。
滑脉本是胎脉，但如果滑大无比，按压坚实，显然不是胎脉。为什么那些医生不明白呢？看到排出的赭红色物质，而痰饮包裹在内部，就在前方基础上加大黄攻逐瘀血，礞石攻逐痰饮，这就是所谓的随机应变，不拘泥于固定方剂。
Zhang Zhongjing stated: For abdominal pain during pregnancy, Danggui Shaoyao San (Angelica and Peony Powder) is used for treatment. This aims to tonify Qi and Blood. However, if there is retained phlegm, or invasion by wind-cold, or it is caused by Qi stagnation or food retention, using the four herbs Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus), Suggeng (Perillae Caulis), and Shengjiang (Zingiberis Rhizoma Recens) uniformly is extremely stable and effective.
Danggui Shaoyao San (Angelica and Peony Powder)
Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alismatis Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma).
Decoct in water and take orally. Alternatively, grind into powder, taking two qian per dose.
Generally speaking, lower back pain belongs to Kidney deficiency, which requires urgent treatment during pregnancy. This is because the fetus is tied to the Dai Mai (Girdle Vessel); if the Dai Mai becomes lax, the uterus will prolapse. Ancient formulas use Qing'e San (Blue Young Man Powder) for treatment; I often use Shudi (Rehmanniae Radix Praeparata) and Duzhong (Eucommiae Cortex) combined with Baotai Wan (Fetus-Securing Pill) with good results.
Qing'e Wan (Blue Young Man Pill)
Duzhong (Eucommiae Cortex, 4 liang, stir-fried with ginger juice), Buguzhi (Psoraleae Fructus, 1 liang, fried with salt), Hetaorou (Semen Juglandis).
Grind into powder, make pills with honey, and swallow with wine.
In the past, during the Gengchen year, in Wanjia Du, Haining, a man surnamed Jin had been married for ten years without conceiving. Suddenly, his wife's menstruation was overdue. A physician from Chang'an diagnosed it as pregnancy and prescribed tonifying and calming herbs such as Shudi (Rehmanniae Radix Praeparata), Ejiao (Asini Corii Colla), Fuling (Poria), and Baizhu (Atractylodis Macrocephalae Rhizoma). The condition dragged on until the tenth month, yet no delivery occurred. Her abdomen enlarged daily, and she became increasingly ill. By the fifteenth month, she could not get out of bed or eat; food barely passed her throat, and her abdomen was abnormally distended. Occasionally, when abdominal pain occurred, bowel sounds were heard like the noise of treading a water wheel, audible even outside the door. The situation was critically dangerous. At that time, due to the invitation of brothers Zhu Fuwen and Wu Dacheng, I was invited to diagnose. The patient was on her deathbed, and other physicians stood by waiting for her to die. Some suggested "Ghost Fetus," others suggested "Obstructed Menses." Upon diagnosis, I found the six pulses slippery and excessively large, firm upon pressure. I said, "This is not pregnancy; this is Tan Gu (Phlegm Distension)." It resulted from excessive worry damaging the Spleen, causing the Spleen to fail to transport fluids for the Stomach, thereby generating phlegm. Initially misdiagnosed as pregnancy, the administration of cloying and cold-cooling medicines caused the phlegm to stagnate, accumulating over time to form this syndrome. If the pathogenic factor is not attacked, there is no hope for survival. I immediately used Erchen Tang (Two-Cured Decoction) added with Nanxing (Arisaematis Rhizoma Preparatum), Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Guizhi (Cinnamomi Ramulus), and Shengjiang (Zingiberis Rhizoma Recens). After two or three doses, the turbid matter moved downward. The family feared it would cause dysentery and urgently requested a follow-up. Checking the pulse, it had slightly harmonized. The discharged material was dark red and clotted; upon picking it open, the interior was white. I said, "This is blood wrapping phlegm." I then added Dahuang (Rhei Radix et Rhizoma) and Mengshi (Melanitis Leucopsis Squama) to the previous formula. After several more doses, she defecated twenty to thirty times daily. Her abdomen gradually subsided, and she began consuming congee. Ten days later, we switched to Jianggui Liujunzi Tang (Six-Gentlemen Decoction with Ginger and Cinnamon) and Zhishi Lizhong Wan (Immature Bitter Orange and Middle-Warming Pills), administering both decoctions and pills simultaneously, and the patient recovered. Everyone respected and accepted this. If we had hesitated and failed to attack at that time, would she not have died from distension? Therefore, medication must be appropriate; one should not hesitate to use unconventional methods to save a critical patient. Thus, I preserved this case for future reference.
Reading Mr. Wu Lingshan's book *Bianyi Shu* (Book of Clarifying Doubts), he treated a woman with Phlegm-Fluid and Blood stasis syndrome, misdiagnosed by previous physicians as a fetal condition, which is similar to this case.
Slippery pulses are indeed typical of pregnancy; however, if they are excessively slippery and large, and firm upon pressure, it is clearly not a fetal pulse. Why did the physicians fail to realize this? Seeing the discharged dark-red material, and recognizing the phlegm wrapped inside, adding Dahuang (Rhei Radix et Rhizoma) to attack blood stasis and Mengshi (Melanitis Leucopsis Squama) to attack phlegm in the previous formula exemplifies adapting to circumstances without being rigidly bound to fixed formulas.