薛立斋曰∶东垣云∶脾胃之气壮，则过时而不饥，多食而不伤。盖胃主司纳，脾主消化，五脏之本也。食倍
而伤者，脾气虚而不化也。若投以峻剂，则脾胃复伤，而胎亦损。当审所因调治。若饮食停滞，或腹痛，平胃散。
呕吐恶心，加枳壳、砂仁。吞酸嗳腐，加黄连、吴茱。腹满泄泻，六君子汤。停肉食，加山楂；面食，加麦芽、
卜子；糯食，加白酒曲；米食，加谷芽；鱼腥伤，倍陈皮；伤辛热之物，加黄连；伤生冷之物，加砂仁、木
香。大凡脾胃虚弱，饮食难化，以白术、陈皮为末，神曲丸最稳，枳壳丸可暂用，枳实峻厉，能耗真气，治者慎之。
慎斋按∶以上二条，序胎前有伤食证也。妊娠伤食，多由脾胃虚弱，不能运化。况胎以脾胃为主，脾胃强，
则胎系如悬盅而不坠。若伤食不化，则脾困而胎不能固。故凡消食导滞，先以补脾健胃为主，则饮食自化。一
切峻厉克伐之药，未可浪投，以伤胎气。观立斋一条，得其本矣。
《大全》曰∶妊娠吐血者，皆由脏腑有伤。凡忧思惊怒，皆伤脏腑，气逆于上，血随而溢，心闷满烦，久而
不已，多致堕胎。
薛立斋曰∶妊娠吐血，若肝经怒火，先用小柴胡、山栀、生地，次用四物、加味逍
遥散；若肝经风热者，防风子芩丸；心经有热者，朱砂安神丸；心气不足者，补心汤；思虑伤心者，妙香散；胃
经有火者，犀角地黄汤；膏粱积热者，加味清胃散；肺经有火者，黄芩清肺饮；气不摄血，用补中汤；肾经虚
火者，加味六味丸。
慎斋按∶以上二条，序胎前有吐血证也。吐血证，或七情内伤，或六淫外感，皆足致失血之患。而妊娠吐血，
一主火热者，正以气血壅养胎元，或有所感，则气逆而火上乘，此立斋分证，独主火论也。但火有虚实之分，
实火当清热以养血，虚火当滋阴以补水，则胎安而可固。若执以寻常治血之法，用行血消血之剂，胎必堕，而祸
不旋踵矣。
薛立斋说：李东垣认为，脾胃之气强健，就会过了饭点也不觉得饿，吃得多也不会受伤。这是因为胃负责受纳食物，脾负责消化食物，它们是五脏的根本。饮食过量而受伤的，是因为脾气虚弱不能运化。如果此时使用药性猛烈的药物，会再次损伤脾胃，进而损害胎儿。应当审察病因进行调治。如果是饮食停滞，或者伴有腹痛，用平胃散。出现呕吐恶心症状的，加入枳壳、砂仁。出现吞酸、嗳气且有腐臭味道的，加入黄连、吴茱萸。出现腹部胀满、泄泻的，用六君子汤。因食用肉类停滞不化的，加入山楂；面食停滞的，加入麦芽、莱菔子；糯米类食物停滞的，加入白酒曲；米饭停滞的，加入谷芽；因鱼腥之物受伤的，加倍使用陈皮；因辛辣温热之物受伤的，加入黄连；因生冷之物受伤的，加入砂仁、木香。大凡脾胃虚弱，饮食难以消化的，将白术、陈皮研成粉末，制成神曲丸最为稳妥，枳壳丸可以暂时使用，枳实药性峻烈，会耗损真气，治疗者务必谨慎。
慎斋按语：以上两条，叙述了胎前伤食的证候。妊娠期间伤食，多由脾胃虚弱，不能运化所致。况且胎儿以脾胃为主，脾胃强健，则胎儿像悬挂的钟一样稳固而不坠落。如果伤食不化，则脾脏困顿而胎儿不能固摄。所以凡是消食导滞，都应以补脾健胃为主，这样饮食自然能消化。一切药性峻烈克伐的药物，不可随意投用，以免损伤胎气。看薛立斋的一条论述，就抓住了根本。
《妇人大全良方》说：妊娠吐血，都是由脏腑受损引起的。凡是忧愁、思虑、惊恐、愤怒，都会损伤脏腑，导致气逆于上，血液随之溢出，心中闷胀烦乱，如果长久不止，多会导致堕胎。
薛立斋说：妊娠吐血，如果是肝经怒火，先用小柴胡汤、山栀、生地，再用四物汤、加味逍遥散；如果是肝经风热的，用防风子芩丸；心经有热的，用朱砂安神丸；心气不足的，用补心汤；思虑损伤心脏的，用妙香散；胃经有火的，用犀角地黄汤；膏粱厚味积热的，用加味清胃散；肺经有火的，用黄芩清肺饮；气不摄血的，用补中益气汤；肾经虚火的，用加味六味丸。
慎斋按语：以上两条，叙述了胎前吐血的证候。吐血证，或是七情内伤，或是六淫外感，都足以导致失血的祸患。而妊娠吐血，主要归结为火热，正因为气血壅盛以滋养胎元，如果有所感触，则气逆而火气上乘，这是薛立斋分证时，唯独主论火邪的原因。但是火有虚实之分，实火应当清热以养血，虚火应当滋阴以补水，这样胎儿安稳且可固摄。如果拘泥于寻常治血的方法，使用行血消血的药剂，胎儿必定流产，灾祸立刻就会降临。
Xue Lizhai stated: Li Dongyuan said, "When the Qi of the Spleen and Stomach is robust, one will not feel hungry past mealtime, and excessive eating will not cause injury." This is because the Stomach governs reception (accepting food), and the Spleen governs digestion; they are the root of the Five Zang organs. Injury from excessive food intake occurs due to deficiency of Spleen Qi and failure of transformation. If harsh medicines are administered, it will further injure the Spleen and Stomach, thereby damaging the fetus. One must examine the etiology for treatment. For food stagnation or abdominal pain, use Pingwei San (Pingwei Powder). For vomiting and nausea, add Zhike (Aurantii Fructus) and Sharen (Amomi Fructus). For acid regurgitation and belching with a putrid odor, add Huanglian (Coptidis Rhizoma) and Wuzhuyu (Evodiae Fructus). For abdominal distension and diarrhea, use Liujunzi Tang (Six Gentlemen Decoction). For meat stagnation, add Shanzha (Crataegi Fructus); for flour-based food stagnation, add Maiya (Hordei Fructus Germinatus) and Boluozhi (Raphani Semen); for glutinous rice stagnation, add Baijiuqu (Levisticum Officinale Fermented Dough); for rice stagnation, add Guya (Oryzae Fructus Germinatus); for injury caused by fishy odors, double the dosage of Chenpi (Citri Reticulatae Pericarpium); for injury from spicy and hot substances, add Huanglian (Coptidis Rhizoma); for injury from cold and raw substances, add Sharen (Amomi Fructus) and Muxiang (Aucklandiae Radix). Generally, for weak Spleen and Stomach where food is difficult to digest, grinding Baizhu (Atractylodis Macrocephalae Rhizoma) and Chenpi (Citri Reticulatae Pericarpium) into powder and forming Shenqu Wan (Shenqi Pill) is the most stable method. Zhike Wan (Zhike Pill) can be used temporarily. Zhishi (Aurantii Fructus Immaturus) is harsh and consumes true Qi; practitioners must exercise caution.
Shenzhen commented: The above two sections describe the syndrome of food injury during pregnancy. Food injury in pregnancy is mostly due to weakness of the Spleen and Stomach and inability to transport and transform. Moreover, the fetus relies on the Spleen and Stomach; when the Spleen and Stomach are strong, the fetus hangs securely like a suspended bell without falling. If food injury leads to indigestion, the Spleen becomes encumbered, and the fetus cannot be secured. Therefore, for resolving food stagnation, one should primarily tonify the Spleen and strengthen the Stomach, so that food digests naturally. All harsh and attacking medicines should not be recklessly administered to avoid damaging fetal Qi. Reviewing Xue Lizhai's statement reveals the fundamental principle.
The *Daquan* (Great Compendium) stated: Hematemesis during pregnancy is always caused by injury to the Zang organs. Worry, overthinking, fright, and anger all injure the Zang organs, causing Qi to rebel upward, with blood following and overflowing. This results in chest oppression, fullness, and irritability. If prolonged and unceasing, it often leads to miscarriage.
Xue Lizhai stated: For hematemesis during pregnancy, if it is due to Fire-Flare from the Liver Channel, first use Xiaochaihu Tang (Minor Bupleurum Decoction), Zhizi (Gardeniae Fructus), and Shengdi (Rehmanniae Radix), followed by Siwu Tang (Four Substances Decoction) and Jiawei Xiaoyao San (Modified Free Wanderer Powder); if due to Wind-Heat in the Liver Channel, use Fangfeng Ziqin Wan (Saposhnikoviae and Scutellaria Pill); if there is Heat in the Heart Channel, use Zhusha Anshen Wan (Cinnabar Calming Spirit Pill); if Heart Qi is deficient, use Buxin Tang (Tonify Heart Decoction); if overthinking injures the Heart, use Miaoxiang San (Wonderful Fragrance Powder); if there is Fire in the Stomach Channel, use Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction); if there is accumulated heat from rich and greasy foods, use Jiawei Qingwei San (Modified Clear Stomach Powder); if there is Fire in the Lung Channel, use Huangqin Qingfei Yin (Scutellaria Lung-Clearing Infusion); if Qi fails to control blood, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if there is Deficiency-Fire in the Kidney Channel, use Jiawei Liuwei Wan (Modified Six-Ingredient Pill with Rehmannia).
Shenzhen commented: The above two sections describe the syndrome of hematemesis during pregnancy. Hematemesis may result from internal injury by the Seven Emotions or external contraction of the Six Excesses, both sufficient to cause hemorrhage. However, hematemesis in pregnancy is primarily attributed to Fire-Heat, precisely because Qi and Blood are abundant to nourish the Fetal Origin; if disturbed, Qi rebels and Fire ascends. This is why Xue Lizhai’s differentiation focuses solely on Fire. Nevertheless, Fire has Deficiency and Excess distinctions. Excess Fire should be cleared to nourish Blood, while Deficiency Fire should be treated by yin-nourishing to replenish Water, thereby stabilizing and securing the fetus. If one adheres to ordinary methods for treating blood disorders using blood-invigorating and blood-resolving agents, the fetus will inevitably miscarry, and disaster will follow immediately.