俱死。（《济阴纲目》）
凡脉三阳俱盛，名曰双躯。若少阴微紧者，血即凝浊，经养不周，胎即偏夭，其一独死，其一独生。不去
其死，害母殃生。《千金》神造散，专治双胎一生一死者，用蟹爪以去其死，阿胶以安其生，甘草以和药性，
立方之意深远矣。（《冯氏锦囊》）
选案
顾季掖乃室，孕五月下血。医以人参、阿胶固胎，身肿气胀，血逆上奔，结聚于会厌胸膈间，食入触之痛
楚，旋即呕出。更医，咸以为胎气上逼，脾虚作肿，而成隔噎，用人参之补、五味之收，延至八月，呼吸将绝。
诊脉，尺部微涩难推，肺部洪大无伦，其喘声如曳锯，手臂青紫肿亮。余曰∶此证吾视若悬鉴，不必明言，以
滋惊恐。姑以善药通其下闭上壅可也。季掖必求病名。余曰∶上壅者，以肺脉之洪大，合于会厌之结塞，知其
肺当生痈也；下闭者，以尺脉之微涩，合于肉色之青肿，知其胎已久坏也。善药者，泻白散加芩、桔之苦以开
之，不用硝、黄等厉药也。服一大剂，腹即努痛。季掖曰∶产乎？余曰∶肺气开而下行，数时闭拒，恶秽得出
可也，奚产之云？再进一剂，身肿稍退，上气稍平，下白污如脓数斗，裹朽胎而出。旬余，尚去白污，并无点
血。可知胎朽腹中，已近百日，荫胎之血，和胎俱化为脓也。病者胸开进粥，神思清爽。然朽胎虽去，而秽气
充斥，周身为青肿者未去也；胸厌虽宽，而肺气壅遏，为寒热、咳嗽者未除也。余认真一，以清肺为主，果获
全瘳。（喻嘉言）
许裕卿治邵涵贞内子，孕十七月不产，不敢凭脉，问诸情况，果孕非病。但云孕五月以后不动，心窃讶之。
为主丹参一味，令日服七钱。两旬余，胎下，已死而枯。其胎之死，料在五月不动时。经十三月，在腹不腐，
如果实在树，败者必腐，然亦有不腐者，则枯胎之理可推也。（《张氏医通》）
鬼胎
妇人有鬼胎之说，岂虚无之鬼气，果能袭入胞宫，而遂得成形者乎？此不过由本妇之气质，或以邪思蓄注，
血随气结而不散；或以冲任滞逆，脉道壅瘀而不行。是皆内因之病，必非外来之邪，即血症、气瘕之类耳。当
以瘕之法治也。（张景岳）
或问∶妇人怀鬼胎者，何也？曰∶昼之所思，为夜之所梦。凡男女之性淫而虚者，肝肾相火，无时不起，
故患劳怯之人，多梦与鬼交。所谓鬼胎者，伪胎也。非实有鬼神交接成胎也。古云∶思想无穷，所愿不遂，为
白淫、白浊，流于子宫，结为鬼胎。乃本妇自己之血液淫精，结聚成块，胸腹胀满，俨若胎孕耳。（虞天民）
选案
杨氏女，薄暮游庙，见一黄衣，神觉心动，是夕遂梦与交，腹大如孕。伯仁诊之，曰∶此鬼胎也。女道其
故，乃与破血坠胎之药，下如蝌蚪鱼目者二升许，遂安。此非遇神交乎？曰∶有是事，无是理。岂有土木为形，
能与人交，而有精成胎耶？此非神之感于女，乃女之感于神耳。（《冯氏锦囊》）
受胎分男女
男女之合，二情交畅，阴血先至，阳精后冲，血开裹精，精人为骨，而男形成；阳精先入，阴血后参，精
开裹血，血入为本，而女形成。（《褚氏遗书》）
天之德，地之气，阴阳至和，流薄一体。因气而左动则属阳，阳资之则成男；因气而右动则属阴，阴资之
则成女。（《圣济经》）
经后一、二日，血海始净，精胜其血，感者成男；四、五日后，血脉已旺，精不胜血，感者成女；六、七
日后，虽交感亦不成胎。（李东垣）
《易》云∶干道成男，坤道成女。夫乾坤者，阴阳之性情也。左右者，阴阳之道路也。男女者，阴阳之仪
象也。父精母血，因感而会，精之泄，阳之施也。血能摄精，精成其骨，此万物之资
始于干元也。血之行也，精不能摄血成其胞，此万物之资生于坤元也。阴阳交媾，胚胎始凝，胎之所居，名曰
子宫。一系在下，上有两岐，一达于左，一达于右。精胜其血，则阳为之主，受气于左子宫，而男形成；精不
胜血，则阴为之主，受气于右子宫，而女形成。孕成而始化胞也。（朱丹溪）
信褚氏之言，则人有精先泄而生男，精后泄而生女者。信东垣之言，则有经始断交合生女，经久断交合生
男。亦有四、五日以前交合无孕，八、九日以后交合有孕者。俞子本又谓∶微阳不能射阴，弱阴不能摄阳，信
斯言也。世有 羸之夫，怯弱之妇，屡屡受胎；而血气方刚，精力过人者，往往不育。丹溪专以妇人经水为主，
然富贵之家，侍外家亦多，其中岂无月水如期者？大抵父母生子，如天地生物。易曰∶坤道其顺乎承天而时行。
知地之生物，不过顺承乎天，则知母之生子，亦不过顺承乎父。知母之顺承乎父，则种子者，果以妇人为主乎？
以男子为主乎？若主男子，则不拘老少强弱，康健病患，精之易泄难泄，只以交感之时，百脉齐到为善耳。若
男女之辨，不以精血先后为拘，不以经净几日为拘，不以夜半前后交感为拘，不以父母强弱为拘，只以精血
百脉齐到者别胜负耳。故精之百脉齐到，胜乎血则成男；血之百脉齐到，胜乎精则成女矣。（程鸣谦）
《经》云∶左右者，阴阳之道路也。男女者，阴阳之仪象也。故阴阳和而万物生，夫妇合而男女形。可
见男女之生，未有不本于阴阳之理者也。褚澄以精血先后分男女，东垣以日数奇偶分男女，鸣谦以百脉齐到分
男女，皆为理之未确。丹溪议褚、李之论为末融，而以易道之干元资始、坤元资生为证。娄全善叹为造极精微，
发前人之所未发。若以子宫分左右，而以两歧辨男女之说，夫子宫为命门，女子系胞，形如合钵，何尝两岐而
分左右？则是有两子宫矣。此说为凿空无据。《圣济》以左右阴阳分男女，未尝以子宫有左右之分也。况男女
交媾时，均有其精，何尝
有血？褚氏、东垣、丹溪俱以精血混言，几见男女媾精，妇人以血施也。前贤之论多谬，故僭辨之。（萧慎斋）
脉候
妇人手少阴脉动甚者，妊子也。○阴搏阳别，谓之有子。○何以知怀子之且生也？身有病而无邪脉也。（《素问》）
《内经》言手少阴脉动甚者谓之有子，阴搏阳别谓之有子。曰动、曰搏，皆有力之象也。而《金匮》复以
阴脉小弱，其人渴不能食，无寒热者为妊娠。二说何其相反耶？盖《内经》所云，一谓手中之少阴肾脉血聚气
盛，故脉动；一谓阴得胎气而强，故阴脉搏指，而阳脉反与之有别。此皆于三月之胎，诊之始验。其（《金匮》）
所云者，谓下焦之气血骤为胎蚀，暂似有亏，故脉小弱。此惟于两月左右验之，过此则不然矣。是以下文有于
法六十日当有此证句。由是观之，二书似反而实同也。然更以《千金》所云初时尺脉微小，呼吸五至，三月数
之语，合而参之，斯得圆通之妙焉。（《吴医汇讲》）
孕之脉数，损脉亦数，大略相似。然损脉之数，多兼弦涩；孕脉之数，必兼和滑。当于几微中辨其邪气胃
气之异也。○妇人怀孕，血留气聚，胞宫内实，故脉必滑数倍常，此当然也。然有中年受胎，及血气羸弱之妇，
则脉细小不数者亦有之。但于微弱中，亦必有隐隐滑动之象，此正阴搏阳别之谓也。○辨男女之法，自古至今，
言多矛盾。余以坎离之象定之，庶得其要。盖坎为天一之卦，坎中满，阳在内也；离为地二之卦，离中虚，阴
在内也。得坎象者为男，得离象者为女。所以男脉多沉实，沉实者，中满之象；女脉多浮虚，浮虚者，中虚之
象。无论人之老少、强弱，脉之部位、大小，但因象察象，无不附应。然尤于两尺为最也。○以左右分阴阳，则
左为阳，右为阴；以尺寸分阴阳，则寸为阳，尺为阴；以脉体分阴阳，则鼓搏沉实为阳，虚弱浮涩为阴。诸阳
实者为男，诸阴虚者为女，庶为定论。（张景岳）
妇人经水二、三月不来，诊其脉，微滑而数，略无间断，虽身有病，而无邪脉，即胎脉也。辨男女法，古
人咸以左大为男，右大为女。然多有素禀偏大、偏小者。惟寸口滑实为男，尺中滑实为女，最为要诀。如两寸
俱滑实为双男，两尺俱滑实为二女，右尺左寸俱滑实，为一男一女，此屡验也。（《张氏医通》）
选案
一妇年逾四旬，形色颇实，经水不调。诊两手脉皆不应，惟右关隐隐微动，复细按经渠、列缺穴分，亦不
应。心甚怪之。叩其夫，曰∶前有胎时，医诊亦言无脉，后服八物汤，幸产一子。予曰∶此由禀赋，无足怪焉。
可见天下之事，变幻无穷，难以理测。《脉经》但道其常，今两手无脉，不伤其生，又不妨胎，岂《脉经》所
能论及耶？此理之所无，事之所有也。（汪石山）
都死亡。（《济阴纲目》）
凡是寸、关、尺三部脉象都盛大，称为双胎。如果少阴脉微紧，血液就会凝滞浑浊，经血滋养不足，胎儿就会偏枯夭折，其中一个独自死亡，另一个独自存活。如果不除去那个死胎，会危害母亲并殃及活胎。《千金方》的神造散，专门治疗双胎中一死一生的情况，用蟹爪来去除死胎，阿胶来安固活胎，甘草来调和药性，立方的用意深远啊。（《冯氏锦囊》）
选案
顾季掖的妻子，怀孕五个月时阴道出血。医生用人参、阿胶来固护胎元，结果身体浮肿、气机胀满，逆血上冲，结聚在会厌和胸膈之间，食物进入触碰那里就疼痛，随即呕吐出来。换医生诊治，都认为这是胎气上逼，脾虚导致肿胀，形成了噎膈（吞咽困难），使用人参的补益、五味子的收敛，拖延到八个月，呼吸即将断绝。诊脉，尺部脉微涩难以推究，肺部脉洪大无比，喘息声像拉锯一样，手臂青紫肿胀发亮。我说：这个病症我看清楚得像照镜子一样，不必明说，以免增加惊恐。暂且用良药疏通下部的闭塞和上部的壅塞即可。季掖一定要知道病名。我说：上部的壅塞，是因为肺脉洪大，结合会厌处的结塞，知道肺将要生痈脓；下部的闭塞，是因为尺脉微涩，结合肌肉颜色青肿，知道胎儿已经久坏。所谓善药，是用泻白散加上黄芩、桔梗的苦味药物来开泄，不用硝石、大黄等猛烈药物。服用一大剂后，腹部立即阵痛。季掖问：是要生产了吗？我说：肺气开通而下行，之前数小时闭拒不通，恶露秽物排出就可以了，哪里谈得上是分娩？再进一剂，身体肿胀稍退，上逆之气稍平，排出白色污浊如脓液几斗，包裹着腐烂的胎儿排出。十几天后，还在排白色污浊，没有一点血迹。可知胎儿在腹中腐烂，已经接近一百天，荫养胎儿的血液，随着胎儿一起化为了脓液。病人胸部开阔能喝粥，神志清爽。然而腐烂的胎儿虽然去除了，但秽气充斥全身的青肿还未消退；胸膈虽然宽畅，但肺气壅遏导致的寒热、咳嗽还未清除。我认真辨证，以清肺为主，果然获得痊愈。（喻嘉言）
许裕卿治疗邵涵贞的妻子，怀孕十七个月不生产，不敢凭脉诊断，询问具体情况，确认是怀孕而非疾病。只说怀孕五个月后不动了，心里暗自惊讶。主用丹参一味药，令其每天服用七钱。二十多天后，胎儿产出，已经死亡且干枯。推测胎儿死亡的时间，就在五个月不动的时候。经过十三个月，在腹中不腐烂，就像果实实在挂在树上，败坏的必然腐烂，但也有不腐烂的，那么枯胎的道理可以推知了。（《张氏医通》）
鬼胎
妇女有鬼胎的说法，难道是虚无的鬼气，真的能侵入胞宫，从而形成形体吗？这不过是该女子的体质，或者因为邪思蓄积灌注，血液随气结聚而不散；或者因为冲任二脉滞逆，脉道壅塞瘀阻而不行。这些都是内因的疾病，必定不是外来的邪气，就是血症、气瘕之类的病罢了。应当用治疗瘕块的方法来治疗。（张景岳）
有人问：妇女怀鬼胎的原因是什么？回答说：白天所想的，成为夜晚所做的梦。凡是男女性情淫乱且虚弱的人，肝肾相火，无时无刻不起动，所以患劳损怯弱病的人，多梦与鬼交合。所谓的鬼胎，是伪胎。并非真有鬼神交接而成胎。古话说：思想无穷，愿望不能实现，导致白淫、白浊，流注于子宫，结聚成鬼胎。乃是本妇自己的血液淫精，结聚成块，胸腹胀满，俨然像怀孕一样。（虞天民）
选案
杨姓女子，傍晚游览庙宇，看见一个穿黄衣的人，心神感觉心动，当晚就梦见与之交合，腹部大得像怀孕。伯仁诊察后说：这是鬼胎。女子讲述原委，于是给予破血坠胎的药物，排出像蝌蚪鱼目一样的东西两升左右，于是平安。这不是遇到神灵交合吗？回答说：有这样的事，没有这样的理。难道有土木构成的形体，能与人交合而有精液成胎吗？这不是神灵感应女子，而是女子感应神灵罢了。（《冯氏锦囊》）
受胎分男女
男女交合，两情舒畅，阴血先到，阳精后冲，血打开包裹精，精入为骨，男性形成；阳精先入，阴血后参，精打开包裹血，血入为本，女性形成。（《褚氏遗书》）
天的德性，地的气机，阴阳达到至和，流动融合为一体。因气向左动则属阳，阳资助它则成男；因气向右动则属阴，阴资助它则成女。（《圣济经》）
月经结束后一、两天，血海刚干净，精胜过了血，感应的成男；四、五日后，血脉已旺盛，精不胜血，感应的成女；六、七日后，即使交感也不能成胎。（李东垣）
《易经》说：乾道成男，坤道成女。乾坤，是阴阳的性情。左右，是阴阳的道路。男女，是阴阳的仪象。父精母血，因感应而会合，精的排泄，是阳的施予。血能摄精，精成其骨，这是万物资始于乾元。血的运行，精不能摄血成其胞，这是万物资生于坤元。阴阳交媾，胚胎开始凝结，胎儿居住的地方，名叫子宫。有一根系带在下，上面有两个分支，一个通达左边，一个通达右边。精胜过血，则阳为主，受气于左子宫，男性形成；精不胜血，则阴为主，受气于右子宫，女性形成。怀孕形成后才分化出胞宫。（朱丹溪）
相信褚氏的话，就有精先泄而生男，精后泄而生女的。相信东垣的话，就有经刚断交合生女，经久断交合生男。也有四、五日以前交合无孕，八、九日以后交合有孕的。俞子本又说：微阳不能射阴，弱阴不能摄阳，相信这些话。世上有羸弱的丈夫、怯弱的妇女，屡屡受孕；而血气方刚、精力过人者，往往不育。丹溪专以妇人经水为主，然而富贵人家，侍奉外家也多，其中难道没有月水如期而至的吗？大抵父母生子，如同天地生物。《易经》说：坤道其顺乎承天而时行。知道大地生物，不过是顺承天道，就知道母亲生子，也不过是顺承父亲。知道母亲顺承父亲，那么种子一事，究竟是以妇人为主呢？还是以男子为主呢？如果以男子为主，就不拘泥于老少强弱、康健病患，精液易泄难泄，只在交感之时，百脉齐到就好。如果男女的区别，不拘泥于精血先后，不拘泥于经净几日，不拘泥于夜半前后交感，不拘泥于父母强弱，只以精血百脉齐到者辨别胜负罢了。所以精的百脉齐到，胜过血则成男；血的百脉齐到，胜过精则成女了。（程鸣谦）
《内经》说：左右，是阴阳的道路。男女，是阴阳的仪象。所以阴阳和谐而万物生，夫妇合而男女形。可见男女的出生，无不基于阴阳之理。褚澄以精血先后分男女，东垣以日数奇偶分男女，鸣谦以百脉齐到分男女，都是理论未确切。丹评议论褚、李的理论未融通，而以《易经》乾元资始、坤元资生为证。娄全善赞叹其造极精微，发挥前人所未发。如果说子宫分左右，以两歧辨男女之说，子宫即命门，女子系胞，形状如合钵，何曾有两歧而分左右？那就是有两个子宫了。这种说法是凭空捏造无依据的。《圣济经》以左右阴阳分男女，未曾说子宫有左右之分。况且男女交媾时，均有其精，何曾有血？褚氏、东垣、丹溪都以精血混言，哪里有男女媾精，妇人以血施予的情况？前贤的论述多有谬误，所以我冒昧辨析。（萧慎斋）
脉候
妇女手少阴脉跳动明显的，是怀孕了。○阴脉搏指有力，与阳脉有别，叫做有子。○怎么知道快要生产了呢？身体有病象但没有邪脉。（《素问》）
《内经》说手少阴脉跳动明显叫有子，阴脉搏指有力与阳脉有别叫有子。说“动”、说“搏”，都是有力度之象。而《金匮要略》又以阴脉小弱，其人口渴不能食，无寒热者为妊娠。这两种说法为何相反呢？大概《内经》所说，一是谓手中的少阴肾脉血聚气盛，所以脉动；一是谓阴得胎气而强，所以阴脉搏指，而阳脉反而与之有别。这些都在怀孕三个月时诊察才验证。《金匮》所说的，是指下焦气血骤然被胎元消耗，暂时似有亏损，所以脉小弱。这只有在怀孕两个月左右验证，过了这个时候就不是这样了。所以下文有依法六十日应当有此证的说法。由此看来，两本书看似相反实则相同。然而再以《千金方》所说初时尺脉微小，呼吸五至，三个月数之语，综合参详，就能得到圆通之妙了。（《吴医汇讲》）
怀孕的脉数，损脉也数，大致相似。但是损脉之数，多兼弦涩；孕脉之数，必兼和滑。应当在细微中辨别邪气与胃气的不同。○妇人怀孕，血留气聚，胞宫内实，所以脉必滑数倍于平常，这是当然的。但有中年受孕，以及血气羸弱的妇女，脉细小不数的也有。但在微弱中，也必有隐隐滑动之象，这正是阴搏阳别的含义。○辨别男女的方法，从古至今，说法多矛盾。我以坎离卦象来定，大概得其要领。盖坎为天一之卦，坎中满，阳在内；离为地二之卦，离中虚，阴在内。得坎象的为男，得离象的为女。所以男脉多沉实，沉实是中满之象；女脉多浮虚，浮虚是中虚之象。无论人的老少、强弱，脉的部位、大小，只要因象察象，无不相应。尤其在两尺脉最为明显。○以左右分阴阳，则左为阳，右为阴；以尺寸分阴阳，则寸为阳，尺为阴；以脉体分阴阳，则鼓搏沉实为阳，虚弱浮涩为阴。诸阳实者为男，诸阴虚者为女，这才是定论。（张景岳）
妇人经水二、三个月不来，诊其脉，微滑而数，略微无间断，虽身体有病，但没有邪脉，就是胎脉。辨别男女法，古人皆以左大为男，右大为女。但多有素禀偏大、偏小的。只有寸口滑实为男，尺中滑实为女，是最关键的诀窍。如两寸俱滑实为双男，两尺俱滑实为二女，右尺左寸俱滑实，为一男一女，这是屡经验证的。（《张氏医通》）
选案
一位四十多岁妇女，形色颇充实，经水不调。诊两手脉都不应指，只有右关隐隐微动，再细按经渠、列缺穴分部，也不应指。心里很奇怪。询问其丈夫，说：以前怀孕时，医生诊也说无脉，后来服用八物汤，幸好产下一子。我说：这是由于禀赋所致，不足为怪。可见天下之事，变幻无穷，难以用常理推测。《脉经》只说道其常理，如今两手无脉，不伤生命，又不妨碍胎儿，难道是《脉经》所能论及的吗？这是理论上没有的，现实中却有的事。（汪石山）
All died. (*Ji Yin Gang Mu*)
When the pulse at the cun, guan, and chi positions are all vigorous, it is called twin pregnancy (Shuang Qu). If the Shaoyin pulse is slightly tight, the blood will coagulate and become turbid, leading to insufficient nourishment from the menses, causing one fetus to wither and die while the other survives. If the dead fetus is not expelled, it will harm the mother and endanger the living fetus. The Shenzao San (Divine Creation Powder) from *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) is specifically used to treat cases of twins where one dies and one lives. It uses crab claws (Xie Zhua) to expel the dead fetus, Donkey-hide gelatin (Ejiao, Asini Corii Colla) to secure the living fetus, and Licorice root (Gancao, Glycyrrhizae Radix) to harmonize the properties of the herbs. The intention behind this prescription is profound. (*Feng Shi Jin Nang*)
Selected Case
The wife of Gu Jiye bled vaginally at five months of gestation. Physicians used Ginseng root (Renshen, Panacis Ginseng Radix) and Donkey-hide gelatin (Ejiao, Asini Corii Colla) to stabilize the fetus, resulting in generalized edema and abdominal distension. Counterflowing blood rushed upward, accumulating between the epiglottis and the chest/diaphragm. Food intake caused pain upon contact, followed immediately by vomiting. A subsequent physician diagnosed this as fetal qi pressing upward, spleen deficiency causing swelling, and formation of Ge Ye (Dysphagia/Esophageal Obstruction). They used the tonifying effects of Ginseng root (Renshen, Panacis Ginseng Radix) and the astringent properties of Schisandra fruit (Wuweizi, Schisandrae Chinensis Fructus). By the eighth month, her breathing was nearly exhausted. Pulse diagnosis revealed a faint and choppy chi pulse that was difficult to palpate, and an excessively flooding lung pulse. Her wheezing sounded like sawing wood, and her arms were cyanotic, swollen, and shiny. I said: "I see this condition clearly, like looking into a mirror. There is no need to state it explicitly to avoid causing panic. We should temporarily use effective herbs to unblock the lower obstruction and upper congestion." Jiye insisted on knowing the disease name. I said: "The upper congestion is indicated by the flooding lung pulse combined with the blockage at the epiglottis, suggesting lung abscess (Fei Yong); the lower obstruction is indicated by the faint and choppy chi pulse combined with the cyanotic and swollen flesh, indicating the fetus has been dead for a long time. The 'effective herbs' refer to Xie Bai San (White-Draining Powder) added with bitter herbs like Scutellaria root (Huangqin, Scutellariae Radix) and Platycodon root (Jiegeng, Platycodi Radix) to open the blockage, avoiding harsh drugs like Mirabilite (Xiaoshi, Natrii Sulfas) or Rhubarb (Dahuang, Rheomi Radix et Rhizoma). After one large dose, she experienced immediate abdominal labor pains. Jiye asked: 'Is she giving birth?' I said: 'The lung qi has opened and descended. After hours of closure and rejection, the foul matter can now be expelled. This is not delivery.' After another dose, the body swelling subsided slightly, and the upward rushing qi calmed. She discharged several dou of white, pus-like discharge containing the putrid fetus. For over ten days, she continued to discharge white turbidity without any blood. This indicates the fetus had been rotting in the abdomen for nearly 100 days; the blood nourishing the fetus had turned to pus along with the fetus. The patient's chest felt open, she could eat porridge, and her spirit was clear. However, although the putrid fetus was gone, the foul qi still filled her body, and the generalized cyanotic swelling remained; although the chest/pharynx was relaxed, the lung qi congestion causing chills, fever, and coughing persisted. I focused on clearing the lung, and she was completely cured. (Yu Jiayan)
Xu Yuqing treated the wife of Shao Hanzhen, who was seventeen months pregnant and had not delivered. He did not rely solely on pulse diagnosis but asked about her condition, confirming it was pregnancy, not illness. She reported that since the fifth month, the fetus had not moved, which surprised him internally. He prescribed a single herb, Salvia miltiorrhiza root (Danshen, Salviae Miltiorrhizae Radix), seven qian daily. After more than twenty days, the fetus was delivered, already dead and dried up. The death of the fetus likely occurred when movement stopped at five months. After thirteen months, the fetus did not rot in the uterus. Just as a fruit hanging on a tree rots if decayed, there are exceptions where it does not rot, allowing us to infer the principle of a dried fetus. (*Zhang Shi Yi Tong*)
Ghost Fetus (Gui Tai)
There is a concept of "ghost fetus" in women. Could it be that formless ghostly qi truly invades the uterus and takes shape? This is merely due to the woman's constitution, or perhaps obsessive thoughts accumulate, causing blood to knot with qi and not disperse; or because the Chong and Ren meridians are stagnant and reversed, causing the pulse channels to be congested and blocked. These are internal diseases, definitely not external pathogens, but rather belong to blood stasis or qi masses. They should be treated using methods for treating masses. (Zhang Jingyue)
Someone asked: Why do women conceive "ghost fetuses"? The answer is: Thoughts during the day become dreams at night. Those with licentious natures and deficiency often experience constant stirring of the ministerial fire in the liver and kidney. Thus, patients with consumption and weakness often dream of intercourse with ghosts. The so-called "ghost fetus" is a pseudo-fetus. It is not formed by actual intercourse with deities. Ancient texts say: Endless thoughts and unfulfilled desires lead to leukorrhea (Bai Yin/Bai Zhuo) flowing into the uterus, knotting into a ghost fetus. It is actually the woman's own blood and essence condensing into a mass, causing abdominal distension, resembling pregnancy. (Yu Tianmin)
Selected Case
A young woman named Yang visited a temple at dusk, saw a figure in yellow robes, and felt her heart move. That night she dreamed of intercourse, and her abdomen swelled as if pregnant. Boren diagnosed it as a "ghost fetus." After she explained the cause, he gave her blood-breaking and abortifacient herbs. She passed about two sheng of material resembling tadpoles or fish eyes, and then recovered safely. Was this not intercourse with a deity? The response was: The event happened, but the logic does not exist. How could a wooden or earthen form have intercourse with humans and produce semen to form a fetus? This was not the deity influencing the woman, but the woman's mind being influenced by the deity. (*Feng Shi Jin Nang*)
Conception and Sex Determination
When man and woman unite, their emotions flow smoothly. If yin blood arrives first and yang essence follows later, the blood opens to wrap the essence. The essence enters to form bone, resulting in a male. If yang essence enters first and yin blood follows, the essence opens to wrap the blood. The blood enters to form the root, resulting in a female. (*Chu Shi Yi Shu*)
The virtue of Heaven and the qi of Earth achieve perfect harmony, flowing and merging as one. Movement driven by qi to the left belongs to Yang; supported by Yang, it becomes male. Movement driven by qi to the right belongs to Yin; supported by Yin, it becomes female. (*Sheng Ji Jing*)
One or two days after menstruation ends, the Blood Sea is just cleared. Essence surpasses blood; conception results in a male. Four or five days later, blood vessels are vigorous; essence cannot surpass blood; conception results in a female. Six or seven days later, even if intercourse occurs, conception will not happen. (Li Dongyuan)
The *I Ching* states: The Way of Qian creates males, the Way of Kun creates females. Qian and Kun represent the nature of Yin and Yang. Left and Right represent the pathways of Yin and Yang. Male and Female represent the manifestations of Yin and Yang. Father's essence and Mother's blood meet through mutual influence. The emission of essence is the action of Yang. Blood captures essence; essence forms bone. This is how all things begin from Qianyuan (Primordial Yang). The movement of blood; essence cannot capture blood to form the womb. This is how all things are nurtured from Kunyuan (Primordial Yin). When Yin and Yang intertwine, the embryo begins to congeal. The place where the fetus resides is called the Uterus (Zi Gong). It has a cord below and bifurcates above, one reaching the left and one to the right. If essence surpasses blood, Yang dominates, receiving qi in the left uterus, forming a male. If essence does not surpass blood, Yin dominates, receiving qi in the right uterus, forming a female. Only after pregnancy is established does the placenta differentiate. (Zhu Danxi)
If we believe Chu Shi, then men emitting essence first bear sons, and those emitting last bear daughters. If we believe Li Dongyuan, then intercourse immediately after menstruation ends bears daughters, and intercourse after menstruation has ended for some time bears sons. There are also cases where intercourse before the fourth or fifth day results in no pregnancy, while intercourse after the eighth or ninth day results in pregnancy. Yu Ziben also stated: Weak Yang cannot penetrate Yin, and weak Yin cannot capture Yang. Believing this, we see that frail husbands and timid wives often conceive repeatedly, while those with robust blood/qi and abundant energy often suffer infertility. Danxi focused primarily on the woman's menstrual cycle. However, in wealthy households, many serve outside families; surely some have regular cycles? Generally, parents having children is like Heaven and Earth producing life. The *I Ching* says: "The Way of Kun is to follow and carry out the movements of Heaven according to time." Knowing that Earth produces life by following Heaven, we know that mothers bearing children also follow fathers. Knowing that mothers follow fathers, is seed-conception primarily dependent on the woman or the man? If dependent on the man, age, strength, health, or illness do not matter; whether essence emits easily or with difficulty, the key is that all pulses arrive simultaneously at the time of intercourse. If sex determination is not constrained by the order of essence/blood, days since menstruation, time of night, or parental strength, but only by which essence/blood and all pulses arrive with greater force: then if essence/pulses prevail over blood, it is male; if blood/pulses prevail over essence, it is female. (Cheng Mingqian)
The *Classic* states: Left and Right are the pathways of Yin and Yang. Male and Female are the manifestations of Yin and Yang. Thus, when Yin and Yang harmonize, all things are born; when husband and wife unite, male and female forms appear. It is evident that the birth of males and females is fundamentally based on the principles of Yin and Yang. Chu Cheng distinguished sexes by the order of essence and blood; Li Dongyuan by odd/even days; Mingqian by the simultaneous arrival of all pulses. All these theories are imprecise. Danxi criticized Chu and Li's theories as incomplete, citing the *I Ching*'s Qianyuan initiating creation and Kunyuan nurturing life. Lou Quanshan praised this as extremely subtle, revealing what predecessors had not. Regarding the theory that the uterus has left and right branches distinguishing sexes: The uterus is the Gate of Life (Ming Men). In women, the uterus holds the fetus, shaped like a closed bowl. How can it have left/right branches? This implies two uteri, which is baseless speculation. *Sheng Ji Jing* distinguishes sexes by left/right Yin/Yang without dividing the uterus. Moreover, during intercourse, both parties have essence; where is the blood? Chu, Li, and Danxi mixed essence and blood, rarely noting that in conception, the woman provides blood. Predecessors' discussions contain many errors, so I venture to clarify. (Xiao Shenzhai)
Pulse Signs
If the Hand-Shaoyin pulse beats vigorously in a woman, she is pregnant. ○ If the Yin pulse beats forcefully and differs from the Yang pulse, it is called pregnancy. ○ How do we know pregnancy is near term? The body shows signs of illness, but the pulse lacks pathogenic characteristics. (*Su Wen*)
The *Nei Jing* states that a vigorous Hand-Shaoyin pulse indicates pregnancy, and a strong Yin pulse differing from Yang indicates pregnancy. "Vigorous" and "Strong" both indicate forcefulness. However, *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) describes pregnancy as having a small and weak Yin pulse, thirst, inability to eat, and no chills/fever. Why are these contradictory? The *Nei Jing* refers to: 1) Blood accumulation and Qi abundance in the Kidney pulse (Hand-Shaoyin), causing pulsation; 2) Yin gaining fetal Qi and becoming strong, causing the Yin pulse to beat against the finger, while the Yang pulse differs. These are verified at three months. The *Jin Gui* description refers to: Lower Jiao Qi and Blood being temporarily depleted by the fetus, causing a small/weak pulse. This is verified around two months; later, it changes. Hence, the text mentions symptoms appearing around sixty days. Thus, the two books seem opposite but are actually consistent. Combining this with *Qian Jin* (Thousand Gold Formulas) stating early chi pulse is minute/small with five breaths per respiration, verified at three months, yields a comprehensive understanding. (*Wu Yi Hui Jiang*)
Pregnancy pulses are rapid, similar to exhaustion (Sun) pulses. However, exhaustion pulses are often wiry and choppy; pregnancy pulses are smooth and rapid. One must distinguish pathogenic Qi from Stomach Qi in subtle details. ○ In pregnancy, blood gathers and Qi accumulates, making the uterus full; thus, the pulse is smooth and rapid, exceeding normal levels. This is natural. However, in middle-aged conception or women with weak blood/qi, small and non-rapid pulses may occur. Yet, within the weakness, there is always a hidden smooth/sliding quality, which is the meaning of "Yin beating strongly while Yang differs." ○ Methods for determining sex are contradictory throughout history. I determine them using Kan and Li trigrams. Kan represents Heaven-One; Kan is full inside, representing Yang within. Li represents Earth-Two; Li is empty inside, representing Yin within. Obtaining Kan imagery indicates male; Li imagery indicates female. Thus, male pulses are often deep and solid (image of fullness); female pulses are often floating and deficient (image of emptiness). Regardless of age, strength, or pulse position, observing the imagery aligns perfectly, especially at the chi positions. ○ Dividing Yin/Yang by Left/Right: Left is Yang, Right is Yin. By Cun/Chi: Cun is Yang, Chi is Yin. By pulse body: Forceful/deep/solid is Yang; Weak/floating/choppy is Yin. Predominantly Yang/Solid indicates male; Predominantly Yin/Deficient indicates female. This is the definitive conclusion. (Zhang Jingyue)
If a woman's menses stop for two or three months, and the pulse is slightly smooth and rapid without interruption, though the body feels ill, the lack of pathogenic pulse confirms pregnancy. To determine sex: Ancients said larger left pulse is male, larger right is female. But constitutions vary. The most crucial rule is: Smooth and solid Cun pulse indicates male; smooth and solid Chi pulse indicates female. Both Cun smooth/solid = twin boys; Both Chi smooth/solid = twin girls; Right Chi and Left Cun smooth/solid = one boy, one girl. This is frequently verified. (*Zhang Shi Yi Tong*)
Selected Case
A woman over forty, with a robust appearance, had irregular menses. Both hands' pulses were imperceptible, except for a faint movement at the Right Guan position. Fine palpation at Jingqu (LU7) and Lieque (LU7) points also yielded no pulse. I was puzzled. Asking her husband, he said: "During a previous pregnancy, doctors also found no pulse. She took Ba Wu Tang (Eight Substances Decoction) and fortunately delivered a son." I said: "This is due to congenital constitution, nothing strange. Worldly affairs are infinitely variable and hard to predict by standard logic. *Mai Jing* (Pulse Classic) only describes norms. Here, no pulse in both hands does not harm life or the fetus. Can *Mai Jing* explain this? This is theoretically absent but factually present." (Wang Shishan)