徐文伯从宋后废帝出乐游苑门。逢一妇人。有娠。帝以善诊。诊之曰。此腹有女也。问
文伯。曰。腹有两子。一男一女。男左边青黑。形小于女。帝性急。便欲剖视。文伯恻然曰
若刀斧。恐其变异。请针之立堕。便泻足太阴隐白穴。补手阳明合谷穴。胎便应针而落。
两儿相续出。果如其言。
魏曰。可见堕胎之证。以脾为主。则知安胎之法。亦以脾为主。
震按徐公之术精矣。而奏对尤善。盖宋废帝荒淫无道。若以验胎致杀孕妇为谏。帝必不
从。乃云。若用刀斧恐其变异。则帝方欲其说之不验而无所文饰也。斯听其用针矣。仁人之
言。其利溥哉。
陈斗岩治叶南洲妻。经闭五月。下白或赤。午后发热。咳嗽呕吐。医以为痨瘵。陈视之
曰。两尺脉皆实。此必有孕。外受风邪。搏激故耳。饮清和之剂而安。未半年。生一子。
薛立斋治妊娠三月。其经月来三五次。但不多。饮食精神如故。此血盛有余。儿大能饮
自不来矣。果然。
震按此二条似孕似病。近亦最多。必须善诊。方能不惑。
一妊娠每至五月。肢体倦怠。饮食无味。先两足肿。渐至遍身。后及头面。此是脾肺气
虚。朝用朝中益气。夕用六君子加苏梗。而愈。
程文彬治孕妇七个月。胸膈饱闷。气喘。忽吐出一物。如小肠寸许。举家惊疑其胎烂。
程至。诊得寸口脉洪滑。知其气盛血少。胎气凑上。中焦蓄有湿热。湿生痰。知所吐之物。
乃痰结聚。病名子悬。以紫苏饮加芩、连、贝母。十剂获全。
震按此二案。乃子肿子悬治法之大略也。
孙东宿治一匠妇。怀妊五月而患心痛。究其所由起。谓由失足坠楼也。始教饮韭菜汁一
盏。痛止。其夫又从邻医取药煎服。服后心复痛。吐鲜血盈益。胸间冲冲上抵。疼不可言。
孙诊之。六脉洪大。汗出如雨。喘息不休。其妇楼居低小。令亟移居楼下。随与益元散五钱
用紫苏汤调服。即熟睡至晓。汗敛喘定。痛亦止。再与固胎饮一帖全安。邻医私询曰。吐
血脉忌洪大。加以喘汗。危益甚矣。且妊妇禁汗。禁下。禁利小便。先生之药悉犯之。而反
获效。何哉。孙曰。医贵审证。此妇之汗。以楼居低小。当酷暑而热逼故也。汗多血去而胎
失养。故忡忡上抵。喘息不续。移楼下以避暑气。益元散为解暑圣药。而紫苏又安胎下气之
妙品。气下则血归原而病痊矣。此对证之药。法出五海藏医垒元戎四血饮是也。特诸君检阅
不遍。即检阅亦不知为胎产之治。余不过融会前人之法。用而不谬耳。
震按胎前而用滑石。汗多而用紫苏。所谓有故无殒亦无殒也。乃引四血歙以证之。实系
附会。因此方惟紫苏、丹参、蒲黄、滑石四味。遂可假托耳。
一妇妊已七月。梦见亡故祖母。挥拳打背一下。惊醒。即觉胎动不安。血已下。大小便
皆急。腰与小腹胀疼者五日。此亦事之奇也。孙诊其脉。两寸俱短弱。此上焦元气太虚。当
骤补之。人参、 、术、阿胶各二钱。归、芍、条芩、杜仲各一钱。砂仁、香附各五分。苎
根嫩皮三钱。葱白六钱。一剂而血止。两剂诸证悉除。四剂后。减去苎根、葱白。调理旬日
足月而产一女。
东宿曰。张氏妇年二十一。其夫延予诊。左寸关短弱。尺滑。右寸亦滑。关濡弱。尺沉
微。诊毕。问予曰。脉何如。予曰。心神脾志。皆大不足。肺经有痰。夫曰不然。乃有身也
予曰。左寸短弱如此。安得有孕。夫曰。已七十日矣。予俯思久之。问曰。曾经孕育否。
夫曰。已经二次。今乃三也。予问二产皆足月否。男耶女耶。夫曰。实不敢讳。始产近九个
月。手足面目完全。而水火不分。 肉一片。生下即死。次亦九个月。产下亦无啼声。看时
口中无舌。亦旋死。二胎之异。不知何故。望先生细心察之。予方悟二胎之不完者。由心脾
二经不足所致也。今左寸右关之脉可见矣。乃为筹思一方。专以补心血为主。令其多服。以
百帖为率。枣仁、远志、茯神各一钱。白术二钱。归、芍、枸杞各一钱五分。甘草五分。生
地八分。艾絮二分。龙眼肉五枚。水煎服。足月而产一子。次年又有身。不以前事为意。至
九个月产下。形体俱具。外有脂膜一片包其面。耳目口鼻皆见。但不能去此脂膜。因思上年
之子。为药之力也。
震按两寸短弱为上焦元气大虚。左寸短弱为无孕。皆阅历老到之言。又可见察脉者。必
须逐部细诊。但此案既云心脾二经不足。何但补心而不补脾耶。
徐文伯跟随宋后废帝走出乐游苑门。遇到一位怀孕的妇人。皇帝因为擅长诊断，诊察后说：“这个腹中怀的是女孩。”又问徐文伯。徐文伯说：“腹中有两个胎儿，一男一女。男孩在左边，颜色青黑，体型比女孩小。”皇帝性情急躁，立刻想要剖开查看。徐文伯怜悯地说：“如果用刀斧，恐怕会有变异。请让我用针刺，胎儿便会立即落下。”于是泻足太阴脾经的隐白穴，补手阳明大肠经的合谷穴。胎儿便随着针刺而脱落。两个婴儿相继出生，果然像他说的那样。
魏氏评论说：由此可见，堕胎之证，以脾脏为主。那么知道安胎的方法，也以脾脏为主。
俞震按语：徐公的技术精湛，而且应对尤为巧妙。大概宋废帝荒淫无道，如果以验明胎象导致杀害孕妇来进谏，皇帝一定不会听从。却说“如果用刀斧恐怕会有变异”，这正是皇帝正希望他的说法不灵验从而没有借口掩饰的时候。于是听任他使用针刺。仁人的话语，其利益真是广大啊。
陈斗岩治疗叶南洲的妻子。月经闭止五个月，阴道流出白色或赤色分泌物，午后发热，咳嗽呕吐。医生认为是痨瘵（肺结核）。陈斗岩诊察后说：“两尺脉都实，这必定是有孕。外感风邪，搏击激荡所致。”服用清和之剂而安定。不到半年，生下一个儿子。
薛立斋治疗妊娠三个月，每月月经来潮三到五次，但量不多，饮食精神如常。这是血盛有余，胎儿大了自然能吸收而不来了。果然如此。
俞震按语：这两条案例似孕似病，近来也最多见。必须善于诊断，才能不被迷惑。
有一位孕妇每到五月，肢体倦怠，饮食无味，先两脚肿胀，逐渐蔓延至全身，后来波及头面。这是脾肺气虚。早晨服用补中益气汤，晚上服用六君子汤加紫苏梗，而痊愈。
程文彬治疗怀孕七个月的孕妇，胸膈饱闷，气喘，忽然吐出一个物体，像小肠一寸多长。全家惊恐怀疑是胎烂。程文彬到达，诊得寸口脉洪滑，知道她气盛血少，胎气上凑，中焦蓄积有湿热，湿生痰。知道所吐之物，乃是痰结聚，病名子悬（妊娠期胸胁胀满）。用紫苏饮加黄芩、黄连、贝母，十剂获得全愈。
孙东宿治疗一个工匠的妻子，怀孕五月却患心痛。探究其起因，说是因失足从楼上摔下。起初教她喝一盏韭菜汁，疼痛停止。她的丈夫又从邻居医生那里取药煎服。服药后心再次疼痛，吐出鲜血盈盆，胸口冲撞向上抵住，疼痛不可言状。孙东宿诊察，六脉洪大，汗出如雨，喘息不停。那妇人居住在低矮的小楼里，命令赶快搬到楼下居住。随即给予益元散五钱，用紫苏汤调服，便熟睡到天亮，汗收敛喘平息，疼痛也停止。再给固胎饮一帖完全安康。邻居医生私下询问说：“吐血脉象忌洪大，加上喘汗，危险更加严重了。而且孕妇禁用发汗、禁攻下、禁利小便。先生的药全都犯了这些禁忌，反而获效，为什么呢？”孙东宿说：“医术贵在审证。这位妇女的出汗，是因为居住房屋低矮，正值酷暑热气逼迫所致。汗多血去而胎儿失去滋养，所以心慌上抵，喘息不继。搬到低楼避暑气，益元散是解暑圣药，而紫苏又是安胎下气的妙品。气降则血归原处而病痊愈。这是对证的药物，法出自《海藏医垒元戎》四物汤加减。只是各位检阅不遍，即使检阅也不知道这是胎产的治疗。我不过是融会前人的方法，运用而不谬误罢了。”
俞震按语：胎前而用滑石，汗多而用紫苏，所谓“有故无殒亦无殒”（有病则病受之，不会伤害胎儿）。于是引用四物汤来证明，实在属于附会。因为这个方子只有紫苏、丹参、蒲黄、滑石四味药，于是可以假托罢了。
有一位妇人怀孕已七月，梦见去世的祖母，挥拳打背一下，惊醒。即觉得胎动不安，阴道流血，大小便皆急迫，腰与小腹胀痛五天。这也是奇怪的事。孙东宿诊其脉，两寸俱短弱，这是上焦元气太虚，应当骤补。用人参、白术、阿胶各二钱，当归、芍药、黄芩、杜仲各一钱，砂仁、香附各五分，苎麻根嫩皮三钱，葱白六钱。一剂而血止，两剂诸证悉除。四剂后，减去苎麻根、葱白，调理旬日足月而生下一女。
孙东宿说：张姓妇人二十一岁，她的丈夫请我诊治。左寸关短弱，尺脉滑；右寸也滑，关脉濡弱，尺脉沉微。诊毕，我问助手说：“脉象如何？”助手说：“心神脾志，都大不足。肺经有痰。”丈夫说：“不是这样，是有身孕了。”助手说：“左寸短弱如此，怎么会有孕？”丈夫说：“已经七十天了。”助手俯思良久，问道：“曾经孕育过吗？”丈夫说：“已经两次，现在是第三次。”助手问第二次生产都是足月吗？是男是女？丈夫说：“实在不敢隐瞒，第一次产近九个月，手足面目完全，但水火不分，有一片肉包裹，生下即死。第二次也是九个月，产下也没有啼声，看时口中没有舌头，也随即死亡。二胎的异常，不知道什么原因。希望先生细心察之。”助手这才明白二胎的不完整，是由心脾二经不足所致。现在左寸右关的脉象可见了。于是为她筹划一方，专门以补心血为主，令其多服，以一百帖为限度。用枣仁、远志、茯神各一钱，白术二钱，当归、芍药、枸杞各一钱五分，甘草五分，生地八分，艾绒二分，龙眼肉五枚，水煎服。足月而生下一子。次年又有身，不以前事为意，到九个月产下，形体俱备，外面有一层脂膜包着面部，耳目口鼻都看得见，但不能去掉此脂膜。因此想到去年的孩子，是药物的力量啊。
俞震按语：两寸短弱为上焦元气大虚，左寸短弱为无孕，都是阅历老到的言论。又可见诊脉者，必须逐部细诊。但这个案例既然说是心脾二经不足，为什么只补心而不补脾呢？
Xu Wenbo accompanied Emperor Houfei of Song out of the gate of Leyou Garden. They encountered a pregnant woman. The emperor, skilled in diagnosis, examined her and said, "There is a female fetus in the abdomen." He then asked Xu Wenbo. Xu Wenbo replied, "There are two fetuses in the abdomen, one male and one female. The male is on the left, with a bluish-black complexion, and smaller in size than the female. The emperor had an impatient temperament and immediately wanted to剖视 (surgically inspect). Xu Wenbo, feeling pity, said, "If using knives or axes, there may be complications. Please allow me to use acupuncture, and the fetuses will fall immediately." Thus, he reduced (Xie) the Yinbai acupoint (SP-1, White Pearl) of the Foot-Taiyin Spleen Meridian and supplemented (Bu) the Hegu acupoint (LI-4, Union Valley) of the Hand-Yangming Large Intestine Meridian. The fetuses fell as expected by the needle. The two infants were born successively, exactly as he predicted.
Wei commented: This shows that for conditions of abortion, the Spleen is primary. Therefore, it can be known that methods for securing pregnancy also prioritize the Spleen.
Yu Zhen's note: Master Xu's skills were exquisite, and his responses were particularly clever. It seems Emperor Houfei was decadent and tyrannical. If he advised against killing the pregnant woman by verifying the fetal gender, the emperor would certainly not have listened. By saying, "If using knives or axes, there may be complications," he provided an excuse the emperor hoped would prove false, thus avoiding any cover-up. Consequently, the emperor allowed the use of acupuncture. The words of a benevolent person bring immense benefit.
Chen Douyan treated the wife of Ye Nanzhou. Her menstruation had ceased for five months, with white or red vaginal discharge, afternoon fever, cough, and vomiting. Physicians considered it Laozhai (Consumption/Tuberculosis). Chen examined her and said, "Both Chi pulses are excess; this must be pregnancy. It is caused by external Wind pathogen agitating the interior." She took a Qinghe (Clearing and Harmonizing) formula and stabilized. Within half a year, she gave birth to a son.
Xue Lizhai treated a patient at three months of pregnancy who experienced menstrual-like bleeding three to five times a month, but in small amounts. Her diet and spirit remained normal. This was due to Excess Blood, which the growing fetus could absorb, hence no further bleeding occurred. This proved correct.
Yu Zhen's note: These two cases resemble pregnancy yet appear pathological, which is common nowadays. One must be skilled in diagnosis to avoid confusion.
A certain pregnant woman, upon reaching five months, suffered from limb fatigue and loss of taste. Swelling began in both feet, gradually spreading to the whole body, and later involving the head and face. This was Qi and Yang deficiency of the Spleen and Lung. In the morning, she took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); in the evening, Liujunzi Tang (Six Gentlemen Decoction) with Zi Su Geng (Perilla Stem), and she recovered.
Cheng Wenbin treated a pregnant woman at seven months who complained of chest fullness and distension, and shortness of breath. Suddenly, she expectorated an object resembling a segment of small intestine, about one cun long. The family was terrified, suspecting uterine rot. Cheng arrived, palpated the Cun Kou pulse as Hong Hua (Surging and Slippery), determined that Qi was excessive while Blood was deficient, causing Fetal Qi to rush upward. Damp-Heat accumulated in the Middle Jiao generated Phlegm. The expectorated object was congealed Phlegm. The disease name was Zi Xuan (Fetal Distension). He used Zi Su Yin (Perilla Decoction) added with Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), and Bei Mu (Fritillaria Bulb). After ten doses, she fully recovered.
Yu Zhen's note: These two medical records outline the general treatment principles for Zi Zhong (Fetal Edema) and Zi Xuan.
Sun Dongsu treated a craftsman's wife who suffered from Heart pain at five months of pregnancy. Investigating the cause, he learned it resulted from falling from a building. Initially, he taught her to drink a cup of Le Jiu Zhi (Leek Juice), after which the pain stopped. Her husband then obtained medicine from a neighbor physician to decoct and administer. After taking it, the Heart pain returned, accompanied by vomiting copious fresh blood, a sensation of rushing upward in the chest, and unbearable pain. Sun diagnosed six pulses as Hong Da (Surging and Large), with profuse sweating like rain and continuous panting. Since the woman lived in a low, small upper-story room, he ordered her to move downstairs immediately. He then prescribed Yi Yuan San (Benefit the Origin Powder), five qian, mixed and taken with Zi Su Tang (Perilla Decoction). She slept soundly until dawn, the sweat ceased, breathing stabilized, and pain stopped. Another dose of Gu Tai Yin (Secure the Fetus Decoction) ensured complete safety. A neighbor physician privately asked, "The pulse for hematemesis should not be Hong Da. Combined with panting and sweating, the condition is critically dangerous. Moreover, pregnant women are contraindicated for diaphoresis, purgation, and promoting urination. Your prescriptions violate all these prohibitions, yet you achieved efficacy. Why?" Sun replied, "Medicine values syndrome differentiation. This woman's sweating was due to living in a low, small room during intense summer heat. Profuse sweating depleted Blood, causing the Fetus to lose nourishment, leading to palpitations and upward rushing, and interrupted breathing. Moving to the lower floor avoided the summer heat. Yi Yuan San is a sacred remedy for clearing summerheat, and Zi Su is an excellent product for calming the Fetus and directing Qi downward. When Qi descends, Blood returns to its origin, and the illness resolves. This is a syndrome-specific prescription. The method derives from modifications of Si Wu Tang in *Hai Zang Yi Lei Yuan Rong*. It is merely that you have not reviewed extensively, or even if you did, you would not recognize it as a treatment for pregnancy and childbirth. I merely integrated previous masters' methods and applied them without error."
Yu Zhen's note: Using Shi Huak (Talcum) before delivery and Zi Su (Perilla Leaf) when sweating excessively exemplifies "You Gu Wu Yun, Yi Wu Yun" (When there is a pathogenic factor, there is no injury; thus no injury occurs). Citing Si Wu Tang to prove this is actually forced association. This formula contains only Zi Su, Dan Shen (Salvia Root), Pu Huang (Typha Pollen), and Shi Huak. Thus, it can be falsely attributed.
A woman, seven months pregnant, dreamed of her deceased grandmother striking her back once. Upon waking, she felt fetal restlessness, vaginal bleeding, urgency in urination and defecation, and lower abdominal and lumbar distending pain for five days. This was also a strange event. Sun palpated her pulses; both Cun pulses were Duan Ruo (Short and Weak), indicating severe deficiency of Upper Jiao Yuan Qi. Immediate tonification was required. He used Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Rhizome), and E Jiao (Donkey-Hide Gelatin) each 2 qian; Dang Gui (Angelica Root), Shao Yao (Peony Root), Huang Qin (Scutellaria Root), and Du Zhong (Eucommia Bark) each 1 qian; Sha Ren (Amomum Fruit) and Xiang Fu (Cyperus Rhizome) each 0.5 qian; Zhu Gen N Pi (Bamboo Shoot Skin/Phragmites Root Bark) 3 qian; and Cong Bai (Scallion White) 6 qian. After one dose, bleeding stopped; after two doses, all symptoms resolved. After four doses, Zhu Gen and Cong Bai were removed. After ten days of regulation, she delivered a healthy daughter at term.
Dongsu said: Mrs. Zhang, aged twenty-one, had her husband invite me to diagnose. The Left Cun and Guan were Duan Ruo (Short and Weak), Chi was Hua (Slippery); Right Cun was also Hua, Guan was Ru Ruo (Soft and Weak), Chi was Chen Wei (Deep and Minute). After diagnosis, I asked my assistant, "How is the pulse?" The assistant said, "Heart Spirit and Spleen Will are significantly deficient. There is Phlegm in the Lung Meridian." The husband said, "No, she is pregnant." The assistant said, "With such Short and Weak Left Cun, how can there be pregnancy?" The husband said, "It has been seventy days." The assistant pondered deeply, then asked, "Have you been pregnant before?" The husband said, "Twice already; this is the third time." The assistant asked if both previous births were at term, and whether they were male or female. The husband said, "I dare not hide it. The first was nearly nine months; limbs, face, and eyes were complete, but water and fire were indistinguishable, covered by a piece of flesh; died immediately after birth. The second was also nine months; no cry upon birth; mouth lacked a tongue; died shortly after. I do not know the cause of the abnormalities in the second and third pregnancies. I hope you examine carefully." The assistant then realized that the incompleteness of the previous two fetuses was caused by deficiency in the Heart and Spleen meridians, evident in the Left Cun and Right Guan pulses. He formulated a prescription focusing primarily on tonifying Heart Blood, advising frequent intake, up to one hundred doses. He used Suan Zao Ren (Zizyphus Seed), Yuan Zhi (Polygala Root), Fu Shen (Poria with Hostwood) each 1 qian; Bai Zhu 2 qian; Dang Gui, Bai Shao (White Peony Root), Gou Qi Zi (Goji Berry) each 1.5 qian; Gan Cao (Licorice Root) 0.5 qian; Sheng Di Huang (Rehmannia Root) 0.8 fen; Ai Xu (Mugwort Floss) 0.2 fen; and Long Yan Rou (Longan Aril) five pieces. Decocted in water. At term, she delivered a son. The following year, she became pregnant again, disregarding past events. At nine months, she delivered; the infant was fully formed, with a layer of fatty membrane covering the face, though eyes, ears, nose, and mouth were visible, but the membrane could not be removed. Reflecting on the previous child, he concluded it was due to the power of the medication.
Yu Zhen's note: Short and Weak pulses in both Cun indicate severe deficiency of Upper Jiao Yuan Qi; Short and Weak Left Cun indicates absence of pregnancy. These are insights from experienced practice. It is also evident that pulse diagnosis requires careful examination of each position. However, in this case, since it stated deficiency in both Heart and Spleen meridians, why only tonify the Heart and not the Spleen?