师曰。妇人（经断后。而）得平（和之）脉。（关后为阴。其）阴脉（视关前稍见
）小弱。（是胎元蚀气也。）其人渴。（非上焦有热。乃阴火上壅也。）不能食。（非
胃家有病。乃恶心阻食也。）无寒热。（外无表邪也。）名（曰）妊娠。（凡一切温凉
补泻之剂。皆未尽善。惟以）桂枝汤主之。于法六十日。（胎已成而气干上。）当有此
证。设有医（者。不知为孕。而误药之为施）治（之）逆者。却一月。（先见此证。若）
加吐下者。（当明告其一误不可再误。前为药苦。兹）则绝之。（易所谓勿药有喜是也。
）
尤在泾云、平脉。脉无病也。即内经身有病而无邪脉之意。阴脉小弱者。初时胎气
未盛。而阴方受蚀。故阴脉比阳脉小弱。至三四月经血久蓄。阴脉始强。内经所谓手少
阴脉动者妊子。千金所谓三月尺脉数是也。其人渴。妊子者。内多热也。一作呕。亦通。
今妊妇二三月。往往恶阻不能食是已。无寒热者。无邪气也。夫脉无故而身有病。而
又非寒热邪气。则无可施治。惟宜桂枝汤和调阴阳而已。徐氏云、桂枝汤。外证得之为
解肌和营卫。内证得之。为化气调阴阳也。今妊娠初得。上下本无病。因子室有凝。气
溢上下。故但以芍药一味固其阴气。使不得上溢。以桂甘姜枣。扶上焦之阳。而和其胃
气。但令上之阳气充。能御相侵之阴气足矣。未尝治病。正所以治病也。否则以渴为热
邪而解之。以不能食为脾不健而燥之。岂不谬哉。六十日当有此证者。谓妊娠两月。正
当恶阻之时。设不知而妄治。则病气反增。正气反损。而呕泻有加矣。绝之。谓禁绝其
医药也。楼全善云、尝治一妇人恶阻病吐。前医愈治愈吐。因思仲景绝
之之旨。以炒糯米汤代茶。止药月余。渐安。又一本。绝之。谓当断绝其病根。不必泥于
安胎之说。而狐疑致误也。亦通。
妇人（行经时经未净。或遇冷气房事。六淫邪气。冲断其经。则余血停留。凝聚成
块。结于胞中。名为 病。如）宿有 病。（或不在子宫。则仍行经而受孕。经断即是孕
矣。乃）经断未及三月。而得漏下不止。胎（无血以养则辄）动（若动）在（脐下。则
胎真欲落矣。今动）脐上者。此为（每月凑集之新血。因） （气）痼（坚。阻其不入
于胞之为）害。（其血无所入而下漏。其实非胎病也。虽然。经断原有胎与 之异。欲
知其的证。必由今之三月。上溯前之三月。统共以六月为准。若）妊娠六月动者。（问而
知其）前三月经水（顺）利（应）时。（而无前后参差。其经断。即可必其为）胎也。
（若前之三月。其期经水迟早不定。便知今之）下血者。（乃）后断三月（所积之）
（而非胎）也。（然既有胎。何以又为漏下。而不知旧血未去。则新血不能入胞养胎。而
下走不止。）所以血不止者。其 不去故也。（ 不去。则胎终不安。必）当下其 。
（以）桂枝茯苓丸主之。
此为妊娠宿有 病。而出其方治也。
桂枝茯苓丸方
桂枝 茯苓 丹皮 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。
妇人怀妊六七月。脉弦发热。（有似表证。）其胎愈胀。（乃头与身不痛。而）腹
痛（背不恶寒。而腹）恶寒。（甚至）少腹（阵阵作冷状）如（被）扇。所以然者。子
脏开（而不能阖。而风冷之气乘之之）故也。（夫脏开风入。其阴内胜。则其弦为阴气。
而发热且为格阳矣。胎胀者。热则消。寒则开也。）当以附子汤温其脏。
此为胎胀少腹如扇者。出其方治也。
李氏云、子脏。即子宫也。脐下三寸为关元。左二寸为胞门。右二寸为子户。昔人
谓命门为女子系胞之
处。非谓命门即子脏也。金匮明明指出少腹。何荒经者之聚讼纷纷也。
师曰。妇人有漏下者。（妊娠经来。俗谓之激经也。）有（四五月坠胎。谓之半产。
）半产后。（伤其血海。）因续下血。都不绝者。有妊娠下血者。（如前之因 者。
固有之。）假令妊娠（无 而下血。惟见）腹中痛（者。则）为胞阻。（胞阻者。
胞中之气血不和。而阻其化育也。以）胶艾汤主之。（推而言之。凡妇人经水淋沥。及
胎阻前后下血不止者。皆冲任脉虚。阴气不守也。此方皆可补而固之。）
此为胞阻者而出其方治也。然此方为经水不调。胎产前后之总方。
胶艾汤方
干地黄（六两） 川芎 阿胶 甘草（各二两） 艾叶 当归（各三两） 芍药（四
两）
上七味。以水五升。清酒三升。合煎取三升。去滓。内胶。令消尽。温服一升。日
三服。不瘥。更作。
妇人怀孕。腹中 痛。当归芍药散主之。
此为怀妊腹中 痛者。出其方治也。
徐忠可云、 痛者。绵绵而痛。不若寒疝之绞痛。血气之刺痛也。乃正气不足。使
阴得乘阳。而水气胜土。脾郁不伸。郁而求伸。土气不调。则痛绵绵矣。故以归芍养血。
苓术扶脾。泽泻泻其有余之旧水。芎 畅其欲遂之血气。不用黄芩。 痛因虚。则稍挟
寒也。然不用热药。原非大寒。正气充则微寒自去耳。
当归芍药散方
当归 芎 （各三两） 芍药（一斤） 茯苓 白术（各四两） 泽泻（半斤）
上六味。杵为散。取方寸匕。酒和。日二服。
妊娠（胃中有寒饮。则呕吐。）呕吐不止。（则寒而且虚矣。以）干姜人参半夏
丸主之。
此为妊娠之呕吐不止。而出其方也。半夏得人参。不惟不碍胎。且能固胎。
干姜人参半夏丸方
干姜 人参（各一两） 半夏（二两）
上三味末之。以生姜汁糊为丸。梧子大。饮服十丸。日三服。
妊娠小便难。饮食如故。（以）当归贝母苦参丸主之。
尤在泾云、小便难而饮食如故。则病不由中焦出。而又无腹满身重等证。则更非水
气不行。知其血虚热郁。而津液涩少也。当归补血。苦参除热。贝母主淋沥邪气。以肺
之治节。行于膀胱。则邪热之气除。而淋沥愈矣。此兼清水液之源也。
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。
妊娠有水气。（谓未有肿胀。无其形。但有其气也。水气在内。则）身重小便不利。
（水气在外。则）洒淅恶寒。（水能阻遏阳气上升。故）起即头眩。（以）葵子茯苓
散主之。（是专以通窍利水为主也。葵能滑胎而不忌。有病则病当之也。）
此为妊娠有水气者。而出其方治也。
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。日二服。小便利则愈。
妇人妊娠。（无病不须服药。若其人瘦而有热。恐热气耗血伤胎。）宜常服当归散
主之。
徐忠可云、生物者。土也。而土之所以生物者。湿也。血为湿化。胎尤赖之。故以
当归养血。芍药敛阴。肝主血。而以芎 通肝气。脾统血。而以白术健脾土。其用黄芩
者。安胎之法。惟以凉血利气为主。白术佐之。则湿无热而不滞。故白术佐黄芩。有安
胎之能。是立方之意。以黄芩为主也。胎产之难。皆由热郁而燥。机关不利。养血健脾。
君以黄芩。自无燥热之患。故曰常服易产。胎无疾苦。并主产后百病也。
当归散方
当归 黄芩 芍药 芎 （各一斤） 白术（半斤）
上五味。杵为散。酒服方寸匕。日再服。妊娠常服。即易产。胎无疾苦。产后百病。
悉主之。
妊娠（肥白有寒。当以温药） 养胎。白术散主之。
尤在泾云、妊娠伤胎。有因湿热者。亦有因湿寒者。随人脏气之阴阳而各异也。当
归散。正治湿热之剂。
白术散。白术牡蛎燥湿。川芎温血。蜀椒去寒。则正治湿寒之剂也。仲景并列于此。其
所以诏示后人者深矣。
白术散方
白术 川芎 蜀椒（三分去汗） 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。已后渴者。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。
尤在泾云、伤胎。胎伤而病也。腹满不得小便。从腰以下重。如有水气。而实非水
也。所以然者。心气实故也。心。君火也。为肺所畏。而妊娠七月。肺当养胎。心气实。
则肺不敢降。而胎失其养。所谓太阴当养不养也。夫肺主气化者也。肺不养胎。则胞
中之气化阻。而水仍不行矣。腹满便难身重。职是故也。是不可治其肺。当刺劳宫以泻
心气。刺关元以行肾气。使小便微利。则心气降。心降而肺自行矣。劳宫。心之穴。关
元。肾之穴。
徐忠可云、按仲景妊娠篇凡十方。而丸散居七。汤居三。盖汤者。荡也。妊娠当以
安胎为主。则攻补皆不
宜骤。故缓以图之耳。若药品无大寒热。亦不取泥膈之药。盖安胎以养阴调气为急也。
老师说：妇女在停经后，出现平和的脉象。阴脉（指尺部脉）比关前（寸部）稍显小弱，这是胎元消耗母体之气的表现。病人感到口渴，这不是上焦有热，而是阴火上冲所致；不能进食，这并非胃中有病，而是妊娠恶阻引起的恶心厌食；没有寒热症状，说明体表没有外邪。这种情况称为妊娠。凡是温、凉、补、泻的药物都不完全适宜，应当用桂枝汤来主治。按照规律，怀孕六十天左右（此时胎儿已成形，胎气上干），应当出现这些症状。如果有医生不知道是怀孕而误施治疗，导致逆治，再过一个月，如果之前已有这些症状，又增加了呕吐或腹泻的情况，就应当明白告知患者：一次错误不可再犯，之前的药物已经造成了痛苦，现在应当停止用药（正如《易经》所说“勿药有喜”，即不吃药反而会有喜事/好转）。
尤在泾说：平脉，是指脉象没有病态。也就是《内经》中“身有病而无邪脉”的意思。阴脉小弱，是因为初期胎气不盛，而阴血正在被消耗，所以阴脉比阳脉小弱。到了三四个月，经血久蓄，阴脉才会强盛。《内经》所谓手少阴脉动者是怀孕，《千金方》所谓三月时尺脉搏数是这个意思。病人感到口渴，怀孕的人体内多有热。一作“作呕”，也通顺。现在孕妇两三个月，往往因为恶阻而不能进食，就是这种情况。没有寒热，说明没有邪气。既然脉象无故而有身体病症，又不是寒热邪气，那么就无可施治，只宜用桂枝汤调和阴阳罢了。徐氏说：桂枝汤，用于外证是为了解散肌表、调和营卫；用于内证，是为了化气、调理阴阳。现在妊娠初期，上下本无病，但因为子宫有凝滞之气，气溢于上下，所以只用芍药一味来固护阴气，使其不得上溢，再用桂枝、甘草、生姜、大枣扶助上焦阳气，调和胃气。只要上焦阳气充足，能抵御相侵的阴气就够了。这并没有直接治病，这正是治病的方法。否则，把口渴当作热邪而解表，把不能进食当作脾虚不健而燥湿，难道不是谬误吗？六十天应当有此证，是说妊娠两个月，正当恶阻的时候。如果不知道而妄加治疗，那么病气反而增加，正气反而受损，呕吐腹泻会更加严重。“绝之”，意思是禁绝医药。楼全善说：曾经治疗一个妇人患恶阻病呕吐，前面的医生越治越吐，于是想到张仲景“绝之”的宗旨，用炒糯米汤代替茶水，停药一个多月，逐渐安定。另一版本认为，“绝之”是指应当断绝病根，不必拘泥于安胎的说法，以免犹豫不决导致误诊，这也讲得通。
妇女在行经时经血未净，或者遇到冷气房事，六淫邪气冲击中断了月经，导致余血停留，凝聚成块，结在胞宫中，名为癥病。如素有癥病，或者癥病不在子宫，则仍然行经而受孕，经血停止即是怀孕。但是经血停止不到三个月，却出现漏下不止，胎动（若胎动在脐下，则胎真欲坠落；现在胎动在脐上），这是因为每月汇聚的新血，因癥气坚固，阻碍其进入胞宫造成的危害。血液无处可入而向下漏下，其实并不是胎有病。虽然如此，经血停止原本就有怀孕和癥病的区别，想要知道确切的证候，必须从现在的三个月，向上追溯前三个月，总共以六个月为准。如果妊娠六个月出现胎动，询问得知前三个月月经顺利按时来潮，且没有前后参差，那么经血停止就可以确定是怀孕。如果前三个月经期迟早不定，就知道现在的下血，是后断经三个月所积存的瘀血（而非胎）。然而既有胎，为什么又有漏下？是因为不知道旧血未去，新血就不能进入胞宫养胎，从而向下走漏不止。所以血不止的原因，是瘀血不去的缘故。瘀血不去，则胎终不安，必须攻下其瘀血，以桂枝茯苓丸主治。
桂枝茯苓丸方
桂枝、茯苓、丹皮、桃仁（去皮尖，熬）、芍药（各等分）
以上五味药研末，炼蜜制成如兔屎大小的丸药。每天饭前服一丸，效果不明显，加至三丸。
妇女怀孕六七个月，脉弦，发热（看似表证），胎胀（头身不痛，而腹痛，背部不恶寒，而腹部恶寒，甚至少腹阵阵发冷像被扇子扇风一样）。之所以这样，是因为子脏开泄（不能闭合，风冷之气乘虚而入）的缘故。脏腑开泄，风邪侵入，阴气内胜，所以脉弦为阴气盛，发热则是格阳（真寒假热）。胎胀，是因为热则消减，寒则开泄。应当用附子汤温暖子宫。
这是针对胎胀、少腹如扇的症状，给出其方治方法。
李氏说：子脏，就是子宫。脐下三寸是关元穴，左边二寸是胞门穴，右边二寸是子户穴。古人说命门是女子系胞之处，并不是说命门就是子脏。《金匮要略》明明指出是少腹，那些荒谬的经典注家为何聚讼纷纷呢？
老师说：妇女有漏下的情况（妊娠期间阴道出血，俗称激经）。有四五月坠胎的，称为半产。半产后，损伤了血海，因此继续下血，淋漓不绝的。还有妊娠期间下血的（如前面因癥病导致的，固然有这种情况）。假如妊娠期间没有癥病而下血，只见腹中痛的，称为胞阻（胞阻，是指胞宫中的气血不和，阻碍了化育功能）。以胶艾汤主治。（推而言之，凡是妇女经水淋漓，以及胎产前后下血不止的，都是冲任脉虚，阴气不守。此方都可以用来补益和固摄。）
这是针对胞阻的情况，给出其方治方法。然而此方是治疗经水不调、胎产前后疾病的总方。
胶艾汤方
干地黄（六两）、川芎、阿胶、甘草（各二两）、艾叶、当归（各三两）、芍药（四两）
以上七味药，用水五升，清酒三升，合煎取三升，去渣，加入阿胶，令其溶化尽。温服一升，每日三次。不好，再制作服用。
妇女怀孕，腹中绞痛，用当归芍药散主治。
这是针对怀孕腹中绞痛的情况，给出其方治方法。
徐忠可说：绞痛，是绵绵而痛，不像寒疝的绞痛，也不像血气阻滞的刺痛。这是正气不足，使阴气得乘阳位，水气胜土，脾郁不伸，郁而求伸，土气不调，所以疼痛绵绵。因此用归、芍养血，苓、术扶脾，泽泻泻其有余的旧水，川芎畅达其欲遂的血气。不用黄芩，是因为绞痛因虚，稍微挟带寒气。然而不用热药，原非大寒，正气充盛则微寒自去。
当归芍药散方
当归、川芎（各三两）、芍药（一斤）、茯苓、白术（各四两）、泽泻（半斤）
以上六味药，捣碎为散。取一方寸匕的药量，用酒调和，每日服两次。
妊娠期间胃中有寒饮，导致呕吐不止（则寒而且虚矣），用干姜人参半夏丸主治。
这是针对妊娠呕吐不止的情况，给出其方治方法。半夏得人参配合，不仅不碍胎，而且能固胎。
干姜人参半夏丸方
干姜、人参（各一两）、半夏（二两）
以上三味药研末，用生姜汁糊制成梧桐子大小的丸药。温水送服十丸，每日三次。
尤在泾说：小便难而饮食正常，说明病不由中焦引起，又没有腹满身重等证，那就更不是水气不行。可知是血虚热郁，津液涩少。当归补血，苦参除热，贝母主淋沥邪气。通过肺的治节功能，作用于膀胱，则邪热之气除去，淋沥自愈。这是兼清水源的方法。
当归贝母苦参丸方
当归、贝母、苦参（各四两）
以上三味药研末，炼蜜制成如小豆大小的丸药。温水送服三丸，加至十丸。
妊娠有水气（谓尚未出现肿胀，无形态可见，只有水气之感）。水气在内，则身重、小便不利；水气在外，则洒淅恶寒（水能阻遏阳气上升，所以起身即头眩）。用葵子茯苓散主治（这是专门以通窍利水为主的方法。葵子能滑胎但不忌，因为有病则病当之）。
这是针对妊娠有水气的情况，给出其方治方法。
葵子茯苓散方
葵子（一升）、茯苓（三两）
以上两味药，捣碎为散。温水送服一方寸匕，每日两次。小便通利则愈。
妇女妊娠，若无病不需服药。如果其人瘦而有热，恐热气耗血伤胎，宜常服当归散主治。
徐忠可说：生物者，土也。而土之所以生物者，湿也。血由湿化，胎尤其依赖它。所以用当归养血，芍药敛阴。肝主血，用川芎通达肝气；脾统血，用白术健脾土。使用黄芩的原因，安胎之法，唯以凉血利气为主。白术佐助黄芩，则湿无热而不滞。所以白术佐黄芩，有安胎之能。这是立方的用意，以黄芩为主。胎产之难，皆由热郁而燥，机关不利。养血健脾，君药以黄芩，自然无燥热之患。所以说常服易产，胎无疾苦，并主治产后百病。
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。酒服一方寸匕，每日两次。妊娠常服，即易产，胎无疾苦，产后百病，都主治。
尤在泾说：妊娠伤胎，有因湿热者，也有因湿寒者，随人脏气的阴阳而各异。当归散，正是治疗湿热的剂型。白术散，白术、牡蛎燥湿，川芎温血，蜀椒去寒，则是正治湿寒的剂型。仲景并列于此，其所以昭示后人的道理很深了。
白术散方
白术、川芎、蜀椒（三分，去汗）、牡蛎
以上四味药，捣碎为散。酒服一钱匕，每日三次，夜间一次。如果苦痛，加芍药。心下剧痛，加倍加川芎。心烦吐痛，不能食饮，加细辛一两，半夏大者二十枚。服药之后，再用醋浆水服用。如果呕吐，用醋浆水服用。仍不解的，用小麦汁服用。以后口渴的，用大麦粥服用。病虽愈，服药不要停止。
妇女伤胎，怀身腹满，不得小便，从腰以下重，如有水状。怀身七月，太阴当养不养，此心气实，应当针刺泻劳宫及关元穴，小便微利则愈。
尤在泾说：伤胎，是胎受伤而生病。腹满不得小便，从腰以下重，如有水气，而实非水气。之所以这样，是因为心气实的缘故。心，是君火，为肺所畏。而妊娠七月，肺当养胎。心气实，则肺不敢降，而胎失其养。所谓太阴当养不养。肺主气化，肺不养胎，则胞中的气化受阻，而水仍不行。腹满、便难、身重，职此之故。不可治其肺，应当刺劳宫以泻心气，刺关元以行肾气，使小便微利，则心气降。心降而肺自行矣。劳宫，是心的穴位；关元，是肾的穴位。
徐忠可说：按张仲景妊娠篇凡十方，而丸散居七，汤居三。大概汤者，荡也。妊娠当以安胎为主，则攻补皆不宜骤进，故缓以图之耳。若药品无大寒热，亦不取泥膈之药。盖安胎以养阴调气为急也。
The Master said: When a woman has ceased menstruation and presents with a harmonious pulse, if the Yin pulse (the Chi position) is slightly smaller and weaker than the Yang pulse (the Cun position), this indicates that the fetal origin is consuming maternal Qi. The patient feels thirsty; this is not due to heat in the Upper Jiao, but rather Yin fire rushing upward. She cannot eat; this is not a disease of the Stomach, but nausea and food aversion caused by pregnancy obstruction (Morning Sickness). There are no chills or fever, indicating no exterior pathogenic factor. This condition is named Pregnancy. For all warming, cooling, tonifying, and purging agents, none are entirely suitable; one should primarily use Guizhi Tang (Cinnamon Twig Decoction). According to the method, around sixty days after conception (when the fetus is formed and its Qi affects the upper body), these symptoms should appear. If a physician, unaware of the pregnancy, mistakenly applies treatment causing adverse effects, and after another month, if the initial symptoms persist and vomiting or diarrhea are added, one must clearly inform the patient: do not repeat the error. The previous medication has caused suffering; now, stop all medication (as stated in the *I Ching*, "Do not use medicine, and there will be joy/improvement").
You Zaijing commented: A "Ping Mai" (Harmonious Pulse) means the pulse shows no signs of disease, consistent with the meaning in *Nei Jing* of "having bodily symptoms but no pathogenic pulse." The small and weak Yin pulse occurs because initially, fetal Qi is not yet vigorous, while Yin blood is being consumed; thus, the Yin pulse is smaller and weaker than the Yang pulse. By the third or fourth month, as menstrual blood accumulates for a long time, the Yin pulse becomes strong. As *Nei Jing* states, movement in the Hand-Shaoyin pulse indicates pregnancy; *Qian Jin Fang* mentions the rapid pulse at the Chi position in the third month, which refers to this. Thirst in pregnancy indicates internal heat. Some versions read "vomiting," which is also acceptable. Pregnant women in their second or third months often suffer from obstruction and inability to eat, which is exactly this situation. No chills or fever indicate no pathogenic factor. Since the pulse is normal yet there are bodily symptoms, and it is not due to cold-heat pathogens, no specific treatment is needed; only Guizhi Tang (Cinnamon Twig Decoction) should be used to harmonize Ying and Wei and regulate Yin and Yang. Xu Shi stated: Guizhi Tang (Cinnamon Twig Decoction), when used for exterior syndromes, releases the muscle layer and harmonizes Ying and Wei; when used for interior syndromes, it transforms Qi and regulates Yin and Yang. In early pregnancy, the upper and lower bodies are fundamentally healthy, but due to stagnation in the uterus, Qi overflows up and down. Therefore, using only Shaoyao (White Peony Root) to secure Yin Qi and prevent it from overflowing, combined with Guizhi (Cinnamon Twig), Gancao (Licorice), Shengjiang (Fresh Ginger), and Dazao (Jujube) to support Upper Jiao Yang and harmonize Stomach Qi, ensures that sufficient Yang Qi can resist invading Yin Qi. This does not directly treat a disease, but precisely treats the disease. Otherwise, treating thirst as Heat Evil and resolving it, or treating inability to eat as Spleen deficiency and drying it, would indeed be erroneous. The appearance of these symptoms at sixty days refers to the period of two months' gestation, which is the time of morning sickness. If treated blindly without knowing it is pregnancy, pathogenic Qi increases, Healthy Qi decreases, and vomiting and diarrhea worsen. "Jue Zhi" (Cut off/Stop) means to prohibit medical intervention. Lou Quanshan stated: I once treated a woman with morning sickness vomiting; previous doctors made her vomit more by treating her. Thinking of Zhang Zhongjing's principle of "Jue Zhi," I replaced tea with fried glutinous rice soup and stopped medication for over a month, after which she gradually stabilized. Another interpretation is that "Jue Zhi" means cutting off the root of the disease, not sticking to the theory of "An Tai" (Calming the Fetus), to avoid hesitation leading to error; this is also plausible.
When a woman's menstruation is incomplete during her period, or encounters cold air during intercourse, or is affected by the Six Evils (Pathogenic Factors) that interrupt the flow, residual blood remains, condenses into masses, and knots in the Bao Zhong (Uterus), named Zheng Bing (Mass Disease). If one already has Zheng Bing, or if the mass is not in the uterus, menstruation may continue until conception occurs; cessation of menstruation then indicates pregnancy. However, if less than three months have passed since cessation, yet continuous spotting occurs, and the fetus moves (if movement is below the umbilicus, the fetus is truly about to fall; if above the umbilicus), this is because the new blood gathering monthly is blocked from entering the uterus by the firmness of the Zheng Qi. The blood has nowhere to enter and leaks downward; this is actually not a problem with the fetus itself. Although there is a difference between pregnancy and Zheng Bing upon cessation of menstruation, to know the exact syndrome, one must look back from the current third month to the previous three months, totaling six months. If at six months of pregnancy there is fetal movement, and inquiry reveals that menstruation was regular and smooth for the previous three months without irregularity, then the cessation of menstruation can be confirmed as pregnancy. If the previous three months had irregular timing, then the current bleeding is due to accumulated blood from the last three months of amenorrhea (not the fetus). However, if there is a fetus, why is there still spotting? It is because the old blood has not been expelled, so new blood cannot enter the uterus to nourish the fetus and instead flows downward continuously. Therefore, the reason blood does not stop is that the Blood Stasis (Yu Xue) has not been removed. As long as the stasis remains, the fetus cannot be stable; one must purge the stasis, using Guizhi Fuling Wan (Cinnamon Twig and Poria Pill).
This section provides the formula and treatment for pregnancy complicated by pre-existing Zheng Bing.
Guizhi Fuling Wan Formula
Guizhi (Cinnamon Twig), Fuling (Poria), Danpi (Moutan Cortex), Taoren (Peach Seed, peeled and toasted), Shaoyao (White Peony Root) — equal parts.
Grind the five herbs into powder. Mix with refined honey to form pills the size of a rabbit pellet. Take one pill before meals daily. If ineffective, increase to three pills.
In women pregnant for six or seven months, the pulse is wiry (Xian) and there is fever (resembling an exterior syndrome), the abdomen distends further (without headache or body pain, but abdominal pain occurs; the back is not sensitive to cold, but the abdomen is, even feeling cold in the lower abdomen as if fanned by wind). The reason for this is that the Zi Zang (Substrate Organ/Uterus) is open (unable to close), allowing wind-cold Qi to invade. When the organ is open and wind enters, Yin prevails internally; thus, the wiry pulse indicates excess Yin, and the fever is due to Yang repulsion (False Heat). The abdominal distension is due to heat causing consumption and cold causing opening. One should use Fuzi Tang (Aconite Decoction) to warm the Zi Zang.
This section provides the formula and treatment for abdominal distension and lower abdomen feeling cold like being fanned.
Li Shi stated: Zi Zang refers to the Uterus. Guan Yuan (CV4) is three cun below the umbilicus; Bao Men (extra point) is two cun to the left; Zi Hu (extra point) is two cun to the right. Ancients said the Ming Men (Gate of Life) is where the woman's uterus is tied, but this does not mean Ming Men is the Zi Zang. *Jin Gui Yao Lue* clearly points to the lower abdomen; why do absurd commentators argue endlessly?
The Master said: Women may experience spotting (vaginal bleeding during pregnancy, commonly called Ji Jing). Or they may have a miscarriage (Ban Chan) at four or five months. After a miscarriage, damaging the Blood Sea, continuous bleeding persists without stopping. Also, there is bleeding during pregnancy (such as that caused by Zheng Bing mentioned earlier). Suppose a pregnant woman bleeds without Zheng Bing and only experiences abdominal pain; this is called Bao Zu (Womb Obstruction). Bao Zu means the Qi and Blood in the womb are disharmonious, obstructing gestation. Use Jiao Ai Tang (Collagen and Mugwort Decoction) as the primary treatment. (Extending this logic, for any woman with dripping menstruation or continuous bleeding before or after childbirth, it is due to deficiency of the Chong and Ren meridians and failure of Yin Qi to hold. This formula can tonify and secure them.)
This section provides the formula and treatment for Bao Zu. However, this formula is a general prescription for irregular menstruation and bleeding before and after childbirth/delivery.
Jiao Ai Tang Formula
Gan Dihuang (Prepared Rehmannia Root, 6 liang), Chuanxiong (Szechwan Lovage Rhizome), Ejiao (Donkey-hide Gelatin), Gancao (Licorice Root, each 2 liang), Aiye (Mugwort Leaf), Danggui (Angelica Sinensis, each 3 liang), Shaoyao (White Peony Root, 4 liang).
Decoct the seven herbs in 5 sheng of water and 3 sheng of clear wine to obtain 3 sheng of liquid. Strain. Add Ejiao and melt completely. Take 1 sheng warm, three times daily. If not improved, prepare again.
During pregnancy, if there is colicky abdominal pain, use Danggui Shaoyao San (Angelica and White Peony Powder) as the primary treatment.
This section provides the formula and treatment for colicky abdominal pain during pregnancy.
Xu Zhongke stated: Colicky pain here is a lingering, dull pain, unlike the cramping pain of Cold Hernia or the stabbing pain of Qi and Blood stagnation. It is due to insufficiency of Healthy Qi, allowing Yin to overcome Yang, Water Qi to overcome Earth, causing Spleen depression and frustration. The Earth Qi fails to regulate, resulting in lingering pain. Thus, Danggui and Shaoyao nourish Blood; Fuling and Baizhu support the Spleen; Zexie drains excess old water; Chuanxiong promotes the free flow of desired Qi and Blood. Huangqin (Scutellaria Root) is not used because the pain is due to deficiency and slight cold. However, hot herbs are not used either, as it is not severe cold; when Healthy Qi is sufficient, mild cold disappears naturally.
Danggui Shaoyao San Formula
Danggui (Angelica Sinensis), Chuanxiong (Szechwan Lovage Rhizome, each 3 liang), Shaoyao (White Peony Root, 1 jin), Fuling (Poria), Baizhu (Atractylodes Macrocephala Rhizome, each 4 liang), Zexiale (Alisma Rhizome, 0.5 jin).
Grind the six herbs into powder. Take one cun-bi (square-inch measure) mixed with wine, twice daily.
If there is incessant vomiting during pregnancy due to cold-fluid retention in the Stomach (indicating both cold and deficiency), use Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill) as the primary treatment.
This section provides the formula for incessant vomiting during pregnancy. Banxia (Pinellia Tuber) paired with Renshen (Ginseng) does not harm the fetus and can actually stabilize it.
Ganjiang Renshen Banxia Wan Formula
Ganjiang (Dried Ginger), Renshen (Ginseng, each 1 liang), Banxia (Pinellia Tuber, 2 liang).
Grind the three herbs into powder. Make pills using fresh ginger juice paste, sized like wu zi (walnut seeds). Take ten pills with warm water, three times daily.
If there is difficulty urinating during pregnancy, but diet remains normal, use Danggui Beimu Kushen Wan (Angelica, Fritillaria, and Sophora Pill) as the primary treatment.
You Zaijing commented: Difficulty urinating with normal diet indicates the disease does not originate from the Middle Jiao, and without symptoms like abdominal fullness or heaviness, it is certainly not fluid retention. It indicates Blood deficiency with Heat stagnation and scanty fluids. Danggui nourishes Blood; Kushen (Sophora Root) clears Heat; Beimu (Fritillaria Bulb) treats strangury and pathogenic Qi. Through the Lung's regulatory function acting on the Bladder, pathogenic Heat is cleared, and strangury resolves. This also clears the source of fluids.
Danggui Beimu Kushen Wan Formula
Danggui (Angelica Sinensis), Beimu (Fritillaria Bulb), Kushen (Sophora Root, each 4 liang).
Grind the three herbs into powder. Mix with refined honey to form pills the size of a mung bean. Take three pills with water, increasing to ten pills.
If there is "Water Qi" during pregnancy (meaning no visible swelling, only a sensation of water Qi): Internal Water Qi causes heaviness and difficult urination; External Water Qi causes aversion to cold (Shaxi). Water blocks the ascent of Yang Qi, causing dizziness upon rising. Use Kuizi Fuling San (Abelmosk Seed and Poria Powder) as the primary treatment (This focuses on unblocking orifices and promoting diuresis. Kuizi (Abelmosk Seed) can slip the fetus but is not contraindicated here because "where there is disease, the disease bears the burden").
This section provides the formula and treatment for Water Qi during pregnancy.
Kuizi Fuling San Formula
Kuizi (Abelmosk Seed, 1 sheng), Fuling (Poria, 3 liang).
Grind the two herbs into powder. Take one cun-bi with water, twice daily. Recovery occurs when urination becomes free.
For pregnant women without illness, medication is unnecessary. If the woman is thin and has heat, fearing that heat consumes Blood and harms the fetus, she should regularly take Danggui San (Angelica Powder) as the primary treatment.
Xu Zhongke stated: The element that generates life is Earth. What allows Earth to generate life is Dampness. Blood is transformed by Dampness, and the fetus relies on it especially. Thus, Danggui nourishes Blood; Shaoyao astringes Yin. The Liver governs Blood, so Chuanxiong is used to circulate Liver Qi. The Spleen governs Blood, so Baizhu strengthens Spleen Earth. Huangqin (Scutellaria Root) is used because the method for calming the fetus relies mainly on cooling Blood and promoting Qi flow. With Baizhu assisting Huangqin, Dampness does not stagnate due to Heat. Therefore, Baizhu assisting Huangqin has the ability to calm the fetus. The intent of this formula is to make Huangqin the sovereign herb. Difficulties in pregnancy and childbirth arise from Heat stagnation and dryness, causing mechanical dysfunction. Nourishing Blood and strengthening the Spleen, with Huangqin as the sovereign, prevents dryness and Heat. Hence, it is said that regular use facilitates easy delivery, keeps the fetus free from distress, and treats hundred diseases postpartum.
Danggui San Formula
Danggui (Angelica Sinensis), Huangqin (Scutellaria Root), Shaoyao (White Peony Root), Chuanxiong (Szechwan Lovage Rhizome, each 1 jin), Baizhu (Atractylodes Macrocephala Rhizome, 0.5 jin).
Grind the five herbs into powder. Take one cun-bi with wine, twice daily. Regular use during pregnancy facilitates easy delivery, keeps the fetus free from distress, and treats all postpartum diseases.
For obese, white-complexioned pregnant women with cold, warm herbs should be used to nourish the fetus; Baizhu San (Atractylodes Powder) is the primary treatment.
You Zaijing commented: Damage to the fetus in pregnancy can be due to Damp-Heat or Damp-Cold, varying according to the Yin-Yang of the person's Zang organs. Danggui San is the correct treatment for Damp-Heat. Baizhu San uses Baizhu and Muli (Oyster Shell) to dry Dampness, Chuanxiong to warm Blood, and Shuzhao (Sichuan Pepper) to remove Cold; thus, it is the correct treatment for Damp-Cold. Zhang Zhongjing listed them together to deeply instruct later generations.
Baizhu San Formula
Baizhu (Atractylodes Macrocephala Rhizome), Chuanxiong (Szechwan Lovage Rhizome), Shuzhao (Sichuan Pepper, processed to remove sweat), Muli (Oyster Shell).
Grind the four herbs into powder. Take one qian-bi with wine, three times daily, and once at night. If suffering from pain, add Shaoyao. If there is severe pain in the epigastrium, double the amount of Chuanxiong. If there is irritability, vomiting, pain, and inability to eat or drink, add Yixin (Asarum) 1 liang and large Banxia (Pinellia Tuber) 20 pieces. After taking the medicine, follow with vinegar-water. If vomiting occurs, take vinegar-water. If still unresolved, take wheat juice. If thirsty afterward, take barley porridge. Even if the disease is cured, do not discontinue the medicine.
If a woman injures the fetus, presenting with abdominal fullness during pregnancy, inability to urinate, heaviness from the waist down resembling water accumulation, at seven months of pregnancy, when the Taiyin (Lung) should nourish the fetus but fails to do so, this is due to Excess Heart Qi. One should needle and drain Laogong (PC8) and Guan Yuan (CV4). Recovery occurs when urination becomes slightly free.
You Zaijing commented: "Shang Tai" means the fetus is injured and diseased. Abdominal fullness, inability to urinate, and heaviness from the waist down resemble water accumulation but are not actually water. The reason is Excess Heart Qi. The Heart is Ministerial Fire, feared by the Lung. At seven months of pregnancy, the Lung should nourish the fetus. If Heart Qi is excessive, the Lung dares not descend, and the fetus loses its nourishment. This is what is meant by "Taiyin should nourish but does not." The Lung governs Qi transformation. If the Lung does not nourish the fetus, Qi transformation in the Bao Zhong is blocked, and water does not move. Abdominal fullness, difficult urination, and heaviness are due to this. One should not treat the Lung directly; instead, needle Laogong to drain Heart Qi and needle Guan Yuan to promote Kidney Qi, making urination slightly free. Then Heart Qi descends; once the Heart descends, the Lung functions automatically. Laogong is the Xi-Cleft point of the Heart meridian; Guan Yuan is the Front-Mu point of the Conception Vessel (associated with Kidney/Juan Yuan).
Xu Zhongke stated: In Zhang Zhongjing's chapter on pregnancy, there are ten formulas in total, seven being pills/powders and three being decoctions. Decoctions (Tang) are sweeping/cleansing. Since pregnancy requires calming the fetus, aggressive tonification or purgation is not suitable for sudden application; thus, slow action is taken. If the herbs are not extremely cold or hot, nor cloying/sticking to the chest, it is because urgent matters in calming the fetus involve nourishing Yin and regulating Qi.