（证三条方九首）
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。
〔衍义〕妇人平脉者。言其无病脉也。阴脉小弱。其荣气不足耳。凡感邪而荣气不
足者。则必恶寒发热。不妨于食。今无寒热。妨于食。是知妊娠矣。妊娠者。血聚气
搏。经水不行。至六十日始凝成胎。斯时也。气血化于下。荣气不足。卫不独行。壅
突中焦而不能食。津液少布。其人渴。用桂枝汤益荣和卫。设有医以他治。则更
一月当化。若加吐下。复损其荣。土亦失其养育。条芩、白术可也。芎、归可也。参、
可也。但要益荣生津。和中下二焦而已。
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。
〔衍义〕宿有 痼内结。及至血聚成胎。而 病发动。气淫于冲任。由是养胚之血。
不得停留。遂漏不止。 痼下迫其胎动于脐上。故曰 痼害也。凡成胎妊者。一
月血始聚。二月始胚。三月始胎。胎成始能动。今六月动者。前三月经水利时。胎
下血者。未成也。后断三月。始胚以成胎。方能动。若血下不止。而 乘故也。必当
去其 。内经曰。有故无殒。亦无殒也。 去则胎安也。桂枝、桃仁、丹皮、芍药。能去
恶血。茯苓亦利腰脐间血。即是破血。然有散有缓有收有渗。结者散以桂枝之
辛。肝藏血。血蓄者肝急。缓以桃仁、丹皮之甘。阴气之发动者。收以芍药之酸。恶
血既破。佐以茯苓之淡渗。利而行之。
妊娠六月动者。前三月经水利时。胎下血者。后断三月不血也。所以血不止者。其
不去故也。当下其 。桂枝茯苓丸主之。
桂枝茯苓丸方
桂枝 茯苓 牡丹 桃仁（去皮尖熬） 芍药（各等分）
上五味。末之。炼蜜丸如兔屎大。每日食前服一丸。不知。加至三丸。
〔衍义〕此复申明胎成三月而后动也。上章以经断三月而漏下不止。然胎已成。
故虽漏下。而胎动于上也。此章以六月动者。以前三月经水利时而成胎。胎虽
成而血时下。至后三月始断而不血。是以妊娠六月而胎始动。盖前三月因下
血而胎失养。前三月与后三月之血。下不止者。以其 不去故也。当下其 。此丸主之。
妇人怀妊六七月。脉弦发热。其胎愈胀。腹痛恶寒者。少腹如扇。其所以然者。子脏
开故也。当以附子汤温其脏。
〔衍义〕妊至六七月筋骨坚强之时。若其脉弦。弦为虚。为寒。内格其阳于外而发
热。阴寒内逆而作胀。腹痛恶寒者。其内无阳。故子脏开。少腹如扇也。用附子汤复返其阳。以温其脏。
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。
胶艾汤方
阿胶（二两） 艾叶（三两） 甘草（二两） 当归（三两）
芎（二两） 芍药（四两） 干地黄（六两）
上七味。以水五升。清酒三升合煮。取三升去滓。内胶消尽。温服一升。日三服。不瘥。更作。
〔衍义〕经水与结胎。皆冲任也。冲任乃肾用事者也。肾属坎。坎者时与离会。则血
满经水行。犹月之禀日光为盈亏也。精有所施。心神内应。血即是从。故丁壬合
而坎离交。二气凝结。变化 胎矣。然持守其阴阳交合。长养成胎者。皆坤土资
之也。阴阳抱负。则坤土堤防。故不漏。若宿有瘀浊客于冲任。则阴自结而不得
与阳交合。故有半产漏下不绝也。若妊娠胞阻者。为阳精内成胎。阴血外养胞。
负坤土失其堤防。用此方皆治之。芎、归辛温。宣通其阳血。芍药味酸寒。宣通其
阴血。阿胶之甘温。内经曰。肺合外皮毛。皮毛生于肾水。东垣谓其入于太阴足
少阴厥阴。尝思在身气化成形。金石草木之药。终不如血肉之资养同类者以
养之。此方用阿胶安胎补血。塞其漏泄宜矣。甘草和阴阳。通血脉。缓中解急。其
气内入。开利阴血之结。而通于阳。地黄犹是补肾血之君药也。调经止崩。安胎
养血。妙理无出此方。然加减又必从宜。若脉迟缓。阴胜于阳。则加干姜、官桂。若数大。则宜加黄芩。
妇人怀妊。腹中 痛。当归芍药散主之。
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 （三两）
上六味。杵为散。取方寸匕。酒和。日三服。
〔衍义〕此与胞阻痛者不同。因脾土为木邪所克。谷气不举。浊淫下流。以塞搏阴
血而痛也。用芍药多他药数倍以泻肝木。利阴塞。以与芎归补血止痛。又佐茯苓渗湿以降于小便
也。白术益脾燥湿。茯、泽行其所积。从小便出。盖内外六淫。皆能伤胎成痛。不但湿而已也。
妊娠呕吐不止。干姜人参半夏丸主之。
干姜人参半夏丸方
干姜 人参（各一两） 半夏（二两）
上三味。末之。以生姜汁和丸。如梧子大。饮服十三丸。日三服。
〔衍义〕此即后世所谓恶阻病也。先因脾胃虚弱。津液留滞。蓄为痰饮。至妊二月
之后。胚化成胎。浊气上冲。中焦不胜其逆。痰饮遂涌。呕吐而已。中寒乃起。故用
干姜止寒。人参补虚。半夏生姜治痰散逆也。
妊娠小便难。饮食如故。当归贝母苦参丸主之。
当归贝母苦参丸方
当归 贝母 苦参（各四两）
上三味。末之。炼蜜丸。如小豆大。饮服三丸。加至十丸。
〔衍义〕小便难者。膀胱热郁。气结成燥。病在下焦。不在中焦。所以饮食如故。用当
归和血润燥。本草贝母治热淋。以仲景陷胸汤观之。乃治肺金燥郁之剂肺是
肾水之母。水之燥郁。由母气不化也。贝母非治热。郁解则热散。非淡渗利水也。
其结通则水行。苦参长于治热。利窍逐水。佐贝母入行膀胱以除热结也。
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。
葵子茯苓散方
葵子（一斤） 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。
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。
〔衍义〕内经阴搏阳别。谓之有子。尺脉搏击者。由子宫之气血相搏。而形于脉也。
精留血裹。阴阳纽合也。动搏则变化。而变化生于动。若静而不动。则不生不化。
是以妊娠之血不可以静。静则凝。凝则泣。泣则亏少而虚。皆不得与化胎之火
相合。要其胎孕生化。必脉动搏。故调之者。先和阴阳。利其气血。常服养胎之药。
非惟安胎易产。且免产后诸病。芎、归、芍药之安胎补血。白术之用有三。一者益
胃。致安气以养胎。二者胎系于肾。肾恶燥。能燥湿而生津。三者皆致中焦所化
之新血。去腰脐间之陈瘀。至若胎外之血。因寒湿滞者。皆解之。黄芩减壮火而
反于少火。则可以生气。与脾土湿热来伤。及开血之瘀闭。故为常服之剂。然当
以脉之迟数虚弱加减之。有病可服。否则不必也。药者。但宜攻邪扶正。不比米
谷。性味偏而不正。不可久服。内经曰。味之所入。各归所喜攻。气增而久。夭之由也。
妊娠养胎。白术散主之。
白术散方
白术 芎 蜀椒（三分出汗） 牡蛎（四分）
上四味。杵为散。酒服一钱匕。日三服。夜一服。但苦痛。加芍药。心下痛。倍加川芎。
心烦吐痛。不能饮食。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。已后渴者。大麦粥服之。病虽愈。服之勿置。
〔衍义〕四味。本草皆谓能去血而养胎。何也。盖血聚而后成胎。少遇邪则所聚之
血。时宿而不运。反类瘀恶。必生新开陈。然后胎可养也。养胎不惟在血。而胎系
于肾。养之又在于胃。所以补其肾。调其胃。补肾、固其精也。调胃和其中也。用术
调胃。蜀椒开痹。痹开则阳精至。牡蛎治崩。崩止则阴精固。川芎下入血海。运动
胎气。破旧生新。或阴血不利。肝木为害。在内抑屈而痛者。泻以芍药之酸通其
阴。设冲逆而痛者。则欲以芎 之辛温。宣通其阳。或挟瘀恶之气。上逆于胃而
患吐。烦不能食者。用细辛温中。去痰下气。半夏治心下急痛。和胃进食。止吐逆。
若呕而不止者。由肝木不务德。舍己而忘。用小麦饮。养其本气以安之。又且平
胃下气止烦。一举两得。大麦主消渴益气调中。故中气不足而渴者用之。
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。
〔衍义〕内经诸腹胀大。皆属于热。诸湿肿满。皆属于脾。三焦病者。腹满不得便。溢
则为水。心、上焦也。而不下行于肾。肾下焦也。不得上和于心。脾、中焦也。心之热
独炎于上。肾不得和。则太阴上下不交。谷气无所输。不得养其胎而成闭塞。上
闭不通。则湿热并而为腹满。下关不利。则腰以下如水状。刺劳宫。心气行矣。刺
关元。肾气化矣。手足少阴交。则小便利矣。便利。则中焦之满。下焦之重。皆愈矣。
（共三条证候，九首方剂）
老师说道：妇人诊得平和之脉，但尺部脉象细小微弱。患者感到口渴且不能进食，没有恶寒发热的症状，这称为妊娠。治疗宜用桂枝汤。按照规律，怀孕六十天左右应当出现这些证候。如果医生误治，导致病情变化，再过一个月，出现呕吐或腹泻的症状，那么应当切断病源（停止错误的治疗并针对当前症状处理）。
〔衍义〕所谓妇人平脉，是指没有病邪的脉象。尺脉小弱，说明营气不足。凡是感受外邪而营气不足的，必然会出现恶寒发热，但不影响饮食。现在没有恶寒发热，却影响饮食，由此可知是妊娠。妊娠时，血液汇聚，气机搏结，月经停止，直到六十天胚胎才凝结成形。这个时候，气血在下焦化生，营气不足，卫气不能单独运行，壅滞于中焦导致不能进食；津液分布减少，所以患者口渴。使用桂枝汤来补益营气、调和卫气。假如医生用其他方法误治，再过一个月应当有所转化。如果加上呕吐和腹泻，进一步损伤营气，脾胃也失去养育功能。可以使用黄芩、白术，或者川芎、当归，或者人参等药物。关键在于补益营气、生津液，调和中和下二焦即可。
妇人素有癥病（腹内结块），月经停止不到三个月，却出现阴道淋漓出血不止。胎动感觉在脐上的，这是癥病为害。
〔衍义〕体内素有癥病结聚，等到血液汇聚成胎时，癥病发作，气机淫溢于冲任二脉。因此，滋养胚胎的血液无法停留，于是淋漓出血不止。癥病下迫导致胎动位于脐上，所以说这是癥病为害。凡形成妊娠者，第一个月血开始汇聚，第二个月始成胚，第三个月始成胎。胎成之后才会动。现在怀孕六个月才动，是因为前三个月月经通畅时，胚胎尚未完全形成而下血；断经三个月后，胚胎才形成，此时才会动。如果下血不止，那是因为有癥病作祟。《内经》说：“有故无殒，亦无殒也。”（如果有实邪存在，用药攻伐不会伤害母体，也不会伤害胎儿。）去除癥病，胎儿就能安宁。桂枝、桃仁、牡丹皮、芍药能去除瘀血。茯苓也能利导腰脐间的瘀血，这也属于破血范畴。然而，药物作用有散、缓、收、渗的不同。结聚者，用桂枝的辛味以散之；肝藏血，血蓄积则肝急，用桃仁、牡丹皮的甘味以缓之；阴气发动时，用芍药的酸味以收之。瘀血既已破除，佐以茯苓的淡渗之性，利导而行。
怀孕六个月胎动，是因为前三个月月经通畅时受孕。如果在前三个月下血，那时胚胎未成。断经三个月后，胚胎才形成，才会动。如果下血不止，是因为癥病未去。应当攻下癥病。用桂枝茯苓丸主治。
桂枝茯苓丸方
桂枝 茯苓 牡丹皮 桃仁（去皮尖，炒） 芍药（各等分）
以上五味药，研成细末，炼蜜制成如兔屎大小的丸药。每天饭前服一丸，无效的话，加至三丸。
〔衍义〕这里再次阐明胎成三个月后才动。上一章讲断经三个月而漏下不止，此时胎已成，所以虽然漏下，但胎动在上方。这一章讲怀孕六个月才动，是因为前三个月月经通畅时成胎。胎虽成但血时下，直到后三个月才断绝下血。因此妊娠六月胎始动。大概前三月因下血而胎失养。前三月与后三月下血不止的原因，是因为癥病未去。应当攻下癥病，此丸主治。
妇人怀孕六七月，脉弦，发热，胎胀更甚，腹痛恶寒，少腹部像被扇子扇风一样冷。之所以这样，是因为子宫开张的缘故。应当用附子汤温煦子宫。
〔衍义〕怀孕到六七月，筋骨坚强的时候，如果脉弦，弦主虚、主寒。阳气被格拒于外而发热，阴寒内逆导致腹胀。腹痛恶寒，是因为体内无阳，所以子宫开张，少腹感觉像被扇子扇风。用附子汤使阳气回复，以温煦子宫。
老师说道：妇人有阴道淋漓出血的，有半产后继续下血都不停的，有妊娠期下血的。假如妊娠期腹中疼痛，称为胞阻。用胶艾汤主治。
胶艾汤方
阿胶（二两） 艾叶（三两） 甘草（二两） 当归（三两）
川芎（二两） 芍药（四两） 干地黄（六两）
以上七味药，用水五升，清酒三升混合煮取三升，去渣，加入阿胶溶化尽。每次温服一升，每天三次。不好，再煎服。
〔衍义〕月经与结胎，都关乎冲任二脉。冲任由肾所主。肾属坎卦，坎卦与时令中的离卦相会，则血满而月经行，如同月亮受日光照射而有盈亏。精有所施，心神内应，血随之而来。所以丁壬合而坎离交，二气凝结，变化而成胎。然而，维持阴阳交合，长养成胎的，都是坤土（脾）资生的。阴阳怀抱，则坤土堤防稳固，所以不漏。如果素有瘀浊客居于冲任，则阴自结而不能与阳交合，所以有半产漏下不绝的情况。如果是妊娠胞阻，是因为阳精在内成胎，阴血在外养胞，坤土失去了堤防作用。用此方都能治疗。川芎、当归辛温，宣通阳血；芍药味酸寒，宣通阴血。阿胶甘温，《内经》说肺合皮毛，皮毛生于肾水。李东垣谓其入太阴、足少阴、厥阴。我常想，在身之气化成形，金石草木之药，终究不如血肉之品资助同类来养之。此方用阿胶安胎补血，堵塞漏泄是很适宜的。甘草调和阴阳，通血脉，缓中解急，其气内入，开利阴血之结而通于阳。地黄是补肾血的君药。调经止崩，安胎养血，妙理不出此方。然而加减又必须适宜。如果脉迟缓，阴胜于阳，则加干姜、官桂。如果脉数大，则宜加黄芩。
妇人怀孕，腹中拘急绵绵作痛，用当归芍药散主治。
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） 川芎（三两）
以上六味药，捣碎为散。取一方寸匕，用酒调和，每天服三次。
〔衍义〕这与胞阻痛不同。这是因为脾土被木邪克制，谷气不举，浊气淫溢下流，阻塞搏结阴血而致痛。用芍药比其他药多几倍以泻肝木，利阴塞，配合川芎、当归补血止痛。又佐以茯苓渗湿，通过小便排出。白术益脾燥湿，茯苓、泽泻行其所积之物，从小便出。大概内外六淫，都能伤胎成痛，不仅仅是湿邪而已。
干姜人参半夏丸方
干姜 人参（各一两） 半夏（二两）
以上三味药，研成细末，用生姜汁和丸，如梧桐子大小。温水送服十三丸，每天三次。
〔衍义〕这就是后世所说的恶阻病。先因脾胃虚弱，津液留滞，蓄积为痰饮。到了怀孕两个月之后，胚化成胎，浊气上冲，中焦不胜其逆，痰饮遂涌，导致呕吐。中寒乃起，所以用干姜止寒，人参补虚，半夏、生姜治痰散逆。
当归贝母苦参丸方
当归 贝母 苦参（各四两）
以上三味药，研成细末，炼蜜制成如小豆大小的丸药。温水送服三丸，加至十丸。
〔衍义〕小便难，是膀胱热郁，气结成燥，病在下焦，不在中焦，所以饮食正常。用当归和血润燥。本草记载贝母治热淋，从仲景陷胸汤来看，它是治疗肺金燥郁的药剂。肺是肾水之母，水的燥郁，是由母气不化引起的。贝母并非治热，郁解则热散，它不是淡渗利水的药。其结通则水行。苦参擅长治热，利窍逐水，佐贝母入膀胱以除热结。
妊娠有水气，身体沉重，小便不利，洒淅恶寒，起身即头眩，用葵子茯苓散主治。
葵子茯苓散方
葵子（一斤） 茯苓（三两）
以上两味药，捣碎为散。温水送服一方寸匕，每天三次。小便通利就好了。
当归散方
当归 黄芩 芍药 川芎（各一斤） 白术（半斤）
以上五味药，捣碎为散。酒送服一方寸匕，每天两次。妊娠常服，生产容易，胎儿无病痛，产后各种疾病也都主治。
〔衍义〕《内经》说阴搏阳别，谓之有子。尺脉搏击，是由于子宫气血相搏，反映在脉象上。精留血裹，阴阳纽合。动搏则变化，而变化生于动。如果静而不动，则不生不化。因此妊娠之血不可以静，静则凝，凝则泣（涩），泣则亏少而虚，都不能与化胎之火相合。要使其胎孕生化，必脉动搏。所以调理者，先和阴阳，利其气血。常服养胎之药，不仅安胎易产，而且免除产后诸病。川芎、当归、芍药安胎补血。白术的作用有三：一是益胃，致安气以养胎；二是胎系于肾，肾恶燥，白术能燥湿而生津；三是皆致中焦所化之新血，去腰脐间之陈瘀。至于胎外之血，因寒湿滞者，皆解之。黄芩减壮火而反于少火，则可以生气，与脾土湿热来伤，及开血之瘀闭，故为常服之剂。然而应当根据脉之迟数虚弱进行加减。有病可服，否则不必。药者，只宜攻邪扶正，不比米谷，性味偏而不正，不可久服。《内经》说：“味之所入，各归所喜攻。气增而久，夭之由也。”
白术散方
白术 川芎 蜀椒（三分，出汗） 牡蛎（四分）
以上四味药，捣碎为散。酒服一钱匕，每天三次，夜间一次。如果苦痛，加芍药。心下痛，加倍加川芎。心烦吐痛，不能饮食，加细辛一两，半夏大者二十枚。服用后，再用醋浆水服之。如果呕，用醋浆水服之。仍不解的，用小麦汁服之。以后渴的，用大麦粥服之。病虽愈，服药不要停止。
〔衍义〕这四味药，本草都说能去血而养胎。为什么呢？大概血聚而后成胎，稍遇邪气，则所聚之血，时常宿滞而不运，反而类似瘀恶。必须生新开陈，然后胎可养。养胎不仅在血，而胎系于肾，养之又在于胃。所以补其肾，调其胃。补肾，固其精也；调胃，和其中也。用白术调胃，蜀椒开痹，痹开则阳精至。牡蛎治崩，崩止则阴精固。川芎下入血海，运动胎气，破旧生新。如果阴血不利，肝木为害，在内抑屈而痛者，用芍药之酸通其阴。如果冲逆而痛者，则欲以川芎之辛温，宣通其阳。如果挟瘀恶之气，上逆于胃而患吐，烦不能食者，用细辛温中，去痰下气。半夏治心下急痛，和胃进食，止吐逆。如果呕而不止者，由肝木不务德，舍己而忘，用小麦饮，养其本气以安之，又且平胃下气止烦，一举两得。大麦主消渴益气调中，故中气不足而渴者用之。
妇人伤胎，怀身腹满，不得小便，从腰以下重，如有水气状。怀孕七月，太阴当养不养，此心气实，应当针刺泻劳宫穴及关元穴，小便微利则愈。
〔衍义〕《内经》说诸腹胀大，皆属于热；诸湿肿满，皆属于脾。三焦病者，腹满不得便，溢则为水。心，上焦也，而不下行于肾；肾，下焦也，不得上和于心；脾，中焦也。心之热独炎于上，肾不得和，则太阴上下不交，谷气无所输，不得养其胎而成闭塞。上闭不通，则湿热并而为腹满；下关不利，则腰以下如水状。刺劳宫，心气行矣；刺关元，肾气化矣。手足少阴交，则小便利矣。便利，则中焦之满，下焦之重，皆愈矣。
(Three syndromes, nine prescriptions)
The Master said: When a woman presents with a peaceful pulse (Ping Mai, a normal pulse), but the Yin pulse (referring to the Chi position at the wrist, corresponding to the lower jiao/kidneys) is slightly weak. The patient experiences thirst and inability to eat, without aversion to cold or fever. This is named pregnancy. Gui Zhi Tang (Cinnamon Twig Decoction) should be used to treat it. According to the method, these symptoms should appear around the sixtieth day of pregnancy. If medical treatment is performed incorrectly, causing a reversal of conditions, and after one month vomiting or diarrhea occurs, the source of the disease should be cut off (stop the erroneous treatment and address the current symptoms).
[Commentary by Yan Yi] "Peaceful pulse" in women refers to the absence of pathological pulses. A slight weakness in the Yin pulse indicates insufficiency of Ying Qi (Nutritive Qi). Generally, when external pathogens invade and Ying Qi is insufficient, there must be aversion to cold and fever, but eating is not affected. Now, there is no aversion to cold or fever, yet eating is impaired; thus, we know it is pregnancy. During pregnancy, blood gathers and Qi contends, menstruation stops, and the fetus begins to coalesce after sixty days. At this time, Qi and Blood transform in the lower jiao. Ying Qi is insufficient, and Wei Qi (Defensive Qi) cannot function independently. Stagnation in the middle jiao prevents eating; fluid distribution is reduced, causing thirst. Gui Zhi Tang is used to benefit Ying Qi and harmonize Wei Qi. If a doctor treats it erroneously with other methods, changes may occur after another month. If vomiting and diarrhea are added, further damaging Ying Qi, the Spleen also loses its nourishing function. Huang Qin (Scutellaria Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Xiong (Chuanxiong Rhizome), Gui (Dang Gui Root), Shen (Ren Shen Ginseng Radix et Rhizoma) can be used. The key is to benefit Ying Qi, generate fluids, and harmonize the middle and lower jiao.
If a woman has a pre-existing Zheng disease (masses/lumps in the abdomen), and menstruation has stopped for less than three months, yet she suffers from continuous dripping vaginal bleeding. If fetal movement is felt above the umbilicus, this is due to the Zheng disease being harmful.
[Commentary by Yan Yi] Pre-existing Zheng masses are internally knotted. When blood gathers to form the fetus, the Zheng disease activates. Qi overflows into the Chong and Ren meridians. Consequently, the blood that nourishes the embryo cannot stay, leading to continuous dripping bleeding. The Zheng disease presses downward, causing fetal movement above the umbilicus; hence, it is called "Zheng harming." Generally, in conception: in the first month, blood begins to gather; in the second month, the embryo forms; in the third month, the fetus forms. Fetal movement only occurs after the fetus is formed. Now, if movement is felt at six months, it is because during the first three months when menstruation was regular, the fetus had not fully formed and bleeding occurred. After stopping menstruation for three months, the embryo finally forms and moves. If bleeding continues incessantly, it is because the Zheng pathogen remains. The *Nei Jing* states: "If there is a cause (pathogen), there will be no destruction [to the mother or fetus]." Removing the Zheng ensures fetal safety. Gui Zhi (Cinnamon Twig), Tao Ren (Peach Kernel), Mu Dan Pi (Moutan Cortex), and Shao Yao (Peony Root) can remove bad blood (stasis). Fu Ling (Poria) also benefits blood in the waist and umbilical region; this constitutes breaking blood stasis. However, treatments have dispersing, relaxing, astringing, and leaching properties. For knotting, use the acridity of Gui Zhi to disperse. The Liver stores blood; blood accumulation causes Liver tension, so use the sweetness of Tao Ren and Mu Dan Pi to relax. When Yin Qi activates, use the sourness of Shao Yao to astringe. Once bad blood is broken, assist with the bland leaching property of Fu Ling to promote flow.
Fetal movement at six months of pregnancy occurs because conception happened during the first three months when menstruation was regular. If bleeding occurred in the first three months, the fetus was not yet formed. After three months of amenorrhea, the fetus forms and moves. If bleeding continues, it is because the Zheng pathogen has not been removed. One should purge the Zheng pathogen. Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) is the main prescription.
Gui Zhi Fu Ling Wan Prescription
Gui Zhi (Cinnamon Twig), Fu Ling (Poria), Mu Dan Pi (Moutan Cortex), Tao Ren (Peach Kernel - peel and tips removed, stir-fried), Shao Yao (Peony Root) (equal parts).
Grind the above five herbs into powder. Mix with refined honey to make pills the size of rabbit droppings. Take one pill before meals daily. If ineffective, increase to three pills.
[Commentary by Yan Yi] This reiterates that fetal movement occurs only after three months of fetal formation. The previous chapter discussed continuous dripping bleeding after three months of amenorrhea; since the fetus was already formed, although bleeding occurred, fetal movement was felt above. This chapter discusses movement at six months, implying conception occurred when menstruation was regular in the first three months. Although the fetus formed, blood continued to flow down until the last three months when bleeding stopped. Thus, fetal movement begins at six months. Roughly, in the first three months, the fetus lost nourishment due to bleeding. The reason bleeding continues in both the first and last three months is that the Zheng pathogen remains. One must purge the Zheng pathogen; this pill is the main treatment.
When a woman is pregnant for six or seven months, the pulse is wiry (Xian), accompanied by fever, increased abdominal distension, abdominal pain, aversion to cold, and a sensation of cold in the lower abdomen as if fanned by a breeze. The reason for this is that the Zi Zang (Uterus) is open. It should be treated with Fu Zi Tang (Aconite Decoction) to warm the uterus.
[Commentary by Yan Yi] At six or seven months of pregnancy, when bones and sinews are strong, a wiry pulse indicates deficiency and cold. Yang Qi is constrained externally causing fever, while Yin Cold reverses internally causing distension. Abdominal pain and aversion to cold indicate internal Yang deficiency, leading to an open Zi Zang and the sensation of cold in the lower abdomen like being fanned. Fu Zi Tang is used to restore Yang and warm the uterus.
The Master said: Women may suffer from continuous dripping bleeding, persistent bleeding after miscarriage, or bleeding during pregnancy. If abdominal pain occurs during pregnancy, it is called Bao Zu (Placental Obstruction). Jiao Ai Tang (Donkey-hide Gelatin and Mugwort Decoction) should be used.
Jiao Ai Tang Prescription
E Jiao (Donkey-hide Gelatin - 2 liang), Ai Ye (Mugwort Leaf - 3 liang), Gan Cao (Licorice Root - 2 liang), Dang Gui (Angelica Sinensis Root - 3 liang), Chuan Xiong (Ligusticum Chuanxiong Rhizome - 2 liang), Shao Yao (Peony Root - 4 liang), Shu Di Huang (Prepared Rehmannia Root - 6 liang).
Boil the above seven herbs in 5 sheng of water and 3 sheng of clear wine. Reduce to 3 sheng, strain, add E Jiao and dissolve completely. Take 1 sheng warm, three times daily. If not cured, prepare again.
[Commentary by Yan Yi] Menstruation and conception both relate to the Chong and Ren meridians, which are governed by the Kidney. The Kidney belongs to Kan (Water). When Kan meets Li (Fire), blood fills and menstruation flows, similar to the moon's phases driven by sunlight. Essence is applied, the Heart Spirit responds internally, and blood follows. Thus, Ding-Ren combine and Kan-Li intersect; the two Qi condense and transform into a fetus. However, maintaining the intersection of Yin and Yang to nurture the fetus relies on Kun Earth (Spleen). When Yin and Yang embrace, Kun Earth acts as a dike, preventing leakage. If pre-existing turbid stasis lodges in the Chong and Ren, Yin knots and cannot intersect with Yang, causing persistent bleeding after miscarriage. In Bao Zu (Placental Obstruction) during pregnancy, Yang essence forms the fetus internally, while Yin blood nourishes the placenta externally. Kun Earth loses its dike function. This formula treats all such cases. Chuan Xiong and Dang Gui are acrid-warm, promoting Yang blood; Shao Yao is sour-cold, promoting Yin blood. E Jiao is sweet-warm. The *Nei Jing* states the Lung governs skin and hair, which originate from Kidney Water. Li Dongyuan stated it enters the Taiyin, Foot Shaoyin, and Jueyin meridians. I often think that among minerals, stones, grasses, and trees, none nourish better than animal products that resemble human tissue. E Jiao stabilizes the fetus and tonifies blood, effectively stopping leakage. Gan Cao harmonizes Yin and Yang, unifies vessels, relieves spasms, enters internally, opens Yin knots, and connects to Yang. Shu Di Huang is the sovereign herb for tonifying Kidney blood. Adjusting menstruation, stopping metrorrhagia, stabilizing the fetus, and nourishing blood—no formula surpasses this. However, modifications must be appropriate. If the pulse is slow and deep, indicating Yin excess over Yang, add Gan Jiang (Dried Ginger) and Guan Gui (Cinnamon Bark). If rapid and large, add Huang Qin (Scutellaria Root).
During pregnancy, if there is cramping abdominal pain, Dang Gui Shao Yao San (Angelica and Peony Powder) should be used.
Dang Gui Shao Yao San Prescription
Dang Gui (Angelica Sinensis Root - 3 liang), Shao Yao (Peony Root - 1 jin), Fu Ling (Poria - 4 liang), Bai Zhu (Atractylodes Macrocephala Rhizome - 4 liang), Ze Xie (Alisma Rhizome - 0.5 jin), Chuan Xiong (Ligusticum Chuanxiong Rhizome - 3 liang).
Grind the above six herbs into powder. Take one cun bi (measure), mix with wine, take three times daily.
[Commentary by Yan Yi] This differs from Bao Zu pain. It arises because Spleen Earth is overcome by Wood evil. Grain Qi does not rise, turbid Qi floods downward, blocking and contending with Yin blood, causing pain. Use multiple times more Shao Yao than other herbs to drain Liver Wood and relieve Yin obstruction, combined with Chuan Xiong and Dang Gui to tonify blood and stop pain. Assist with Fu Ling to leach dampness via urination. Bai Zhu strengthens the Spleen and dries dampness; Fu Ling and Ze Xiong move accumulated fluids out through urine. External and internal Six Evils can all injure the fetus and cause pain, not just dampness.
If pregnancy vomiting persists, Gan Jiang Ren Shen Ban Xia Wan (Dried Ginger, Ginseng, and Pinellia Pill) should be used.
Gan Jiang Ren Shen Ban Xia Wan Prescription
Gan Jiang (Dried Ginger), Ren Shen (Ginseng Radix et Rhizoma) (1 liang each), Ban Xia (Pinellia Tuber - 2 liang).
Grind the above three herbs into powder. Mix with fresh ginger juice to make pills the size of wutong seeds. Take 13 pills with warm water, three times daily.
[Commentary by Yan Yi] This is what later generations call "E Zu" (Morning Sickness/Emetic Disorder). Initially, Spleen and Stomach are weak, fluids stagnate, accumulating as phlegm-fluids. After the second month of pregnancy, the embryo transforms into a fetus. Turbid Qi rushes upward, overwhelming the Middle Jiao, causing phlegm-fluids to surge and vomit. Internal cold arises, so Gan Jiang stops cold, Ren Shen tonifies deficiency, and Ban Xia with Sheng Jiang (Fresh Ginger) resolves phlegm and directs rebellious Qi downward.
If pregnancy involves difficult urination but normal diet, Dang Gui Bei Mu Ku Shen Wan (Angelica, Coptis, and Sophora Pill) should be used.
Dang Gui Bei Mu Ku Shen Wan Prescription
Dang Gui (Angelica Sinensis Root), Bei Mu (Fritillaria Bulb), Ku Shen (Sophora Root) (4 liang each).
Grind the above three herbs into powder. Mix with refined honey to make pills the size of small beans. Take 3 pills with water, increasing to 10 pills.
[Commentary by Yan Yi] Difficult urination results from Heat stagnation in the Bladder, Qi condensing into dryness. The disease is in the Lower Jiao, not the Middle Jiao, hence diet is normal. Dang Gui harmonizes blood and moistens dryness. Materia Medica records Bei Mu treats hot strangury. Observing Zhang Zhongjing's Xian Xiong Tang, it is a formula for Lung Metal dryness stagnation. The Lung is the mother of Kidney Water. Dryness in Water stems from the mother Qi failing to transform. Bei Mu does not directly treat heat; resolving stagnation dissipates heat. It is not a bland diuretic. When stagnation clears, water flows. Ku Shen excels at clearing heat, opening orifices, and driving out water, assisting Bei Mu to enter the Bladder and remove heat knots.
If pregnancy involves water qi (fluid retention), heaviness of the body, difficult urination, chills, and dizziness upon rising, Kui Zi Fu Ling San (Abelmoschus Seed and Poria Powder) should be used.
Kui Zi Fu Ling San Prescription
Kui Zi (Abelmoschus Seed - 1 jin), Fu Ling (Poria - 3 liang).
Grind the above two herbs into powder. Take one cun bi with water, three times daily. Recovery occurs when urination becomes free.
For pregnant women, Dang Gui San (Angelica Powder) should be taken regularly.
Dang Gui San Prescription
Dang Gui (Angelica Sinensis Root), Huang Qin (Scutellaria Root), Shao Yao (Peony Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome) (1 jin each), Bai Zhu (Atractylodes Macrocephala Rhizome - 0.5 jin).
Grind the above five herbs into powder. Take one cun bi with wine, twice daily. Regular use during pregnancy facilitates easy delivery, keeps the fetus healthy, and treats various postpartum diseases.
[Commentary by Yan Yi] The *Nei Jing* states: "Yin pulsation distinct from Yang indicates pregnancy." The Chi pulse beats because Qi and Blood contend in the uterus, manifesting in the pulse. Essence remains, blood wraps, Yin and Yang intertwine. Contention leads to transformation, and transformation arises from motion. Stillness produces no life or transformation. Therefore, blood in pregnancy must not be still; stillness leads to coagulation, coagulation to stagnation, stagnation to deficiency and emptiness, all failing to combine with the fire that transforms the fetus. To ensure fetal development, the pulse must beat. Thus, regulation first harmonizes Yin and Yang and promotes Qi and Blood. Regularly taking fetal-nourishing herbs not only stabilizes the fetus and eases delivery but also prevents postpartum diseases. Chuan Xiong, Dang Gui, and Shao Yao stabilize the fetus and tonify blood. Bai Zhu has three uses: 1) Benefits the Stomach, generating calm Qi to nourish the fetus; 2) The fetus is tied to the Kidney, which dislikes dryness; Bai Zhu dries dampness and generates fluids; 3) It brings new blood transformed in the Middle Jiao and removes old stasis in the waist and umbilical region. For extra-uterine blood stagnated by cold-damp, it resolves them. Huang Qin reduces excessive fire back to mild fire, generating Qi, addressing Spleen-Stomach damp-heat, and opening blood stasis, making it suitable for regular use. However, modify based on pulse slowness/rapidness and deficiency. Take only if diseased; otherwise, unnecessary. Herbs attack evil and support righteousness; unlike grain, their flavors are biased, not balanced, and should not be taken long-term. The *Nei Jing* says: "Flavors enter and target their preferred organs. Increasing Qi for too long is the cause of premature death."
To nourish the fetus during pregnancy, Bai Zhu San (Atractylodes Powder) should be used.
Bai Zhu San Prescription
Bai Zhu (Atractylodes Macrocephala Rhizome), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Shu Jiao (Sichuan Pepper - 3 fen, sweat out), Mu Li (Oyster Shell - 4 fen).
Grind the above four herbs into powder. Take one qian bi with wine, three times daily, once at night. If painful, add Shao Yao. If epigastric pain, double Chuan Xiong. If irritability, vomiting, pain, and inability to eat, add Xi Xin (Asarum) 1 liang and large Ban Xia 20 pieces. After taking, drink vinegar-water. If vomiting, drink vinegar-water. If unresolved, drink wheat juice. If thirsty later, drink barley porridge. Even if cured, do not stop taking it.
[Commentary by Yan Yi] These four herbs are said in the Materia Medica to remove blood and nourish the fetus. Why? Because blood gathers to form the fetus. If exposed to evil, the gathered blood stagnates and resembles bad stasis. One must generate the new and remove the old to nourish the fetus. Nourishing the fetus depends not only on blood but also on the Kidney (where the fetus is anchored) and the Stomach (which nourishes it). Tonifying the Kidney secures essence; regulating the Stomach harmonizes the center. Bai Zhu regulates the Stomach; Shu Jiao opens obstruction; once opened, Yang essence arrives. Mu Li treats metrorrhagia; once stopped, Yin essence is secured. Chuan Xiong descends to the Sea of Blood, moves fetal Qi, breaks old stasis, and generates new. If Yin blood is unfavorable and Liver Wood harms, causing internal constraint and pain, use Shao Yao's sourness to unblock Yin. If rebellious Qi causes pain, use Chuan Xiong's acrid-warmth to promote Yang. If turbid bad Qi rebels to the Stomach causing vomiting, irritability, and anorexia, use Xi Xin to warm the center, resolve phlegm, and direct Qi downward. Ban Xia treats epigastric urgency/pain, harmonizes the Stomach, aids eating, and stops vomiting. If vomiting persists due to Liver Wood failing to show virtue, forget itself, use wheat drink to nourish original Qi and calm it, while also calming the Stomach, directing Qi downward, and stopping irritability—one stroke, two gains. Barley eliminates thirst, benefits Qi, and harmonizes the center; thus, it is used for thirst due to Middle Qi deficiency.
If a woman injures the fetus, experiencing abdominal fullness, inability to urinate, heaviness from the waist down resembling water qi, at seven months of pregnancy: The Taiyin should nourish but fails to do so. This is due to excess Heart Qi. One should needle Laogong (PC 8) and Guanyuan (CV 4) to drain. Slight improvement in urination indicates recovery.
[Commentary by Yan Yi] The *Nei Jing* states: All abdominal distensions belong to Heat; all damp swelling/fullness belongs to the Spleen. In Sanjiao disease, abdominal fullness and inability to pass stool lead to water overflow. The Heart is Upper Jiao but does not descend to the Kidney; the Kidney is Lower Jiao but cannot ascend to harmonize with the Heart; the Spleen is Middle Jiao. Heart Heat flares upward alone, the Kidney cannot harmonize, so Taiyin upper and lower do not connect. Grain Qi has no transport, failing to nourish the fetus, causing blockage. Upper blockage leads to Heat-Damp combining into abdominal fullness; Lower gate obstruction leads to heaviness below the waist like water. Needling Laogong allows Heart Qi to move; needling Guanyuan allows Kidney Qi to transform. Hand and Foot Shaoyin intersect, allowing free urination. Free urination cures Middle Jiao fullness and Lower Jiao heaviness.