薛立斋曰∶前证若外邪所伤，用独活寄生汤。劳伤血气，八珍汤加杜仲、砂仁、胶、艾。脾肾不足，前药
内加白术、骨脂。气血郁滞，紫苏饮加枳、桔。肝火动，小柴胡汤加白术、枳壳、山栀。肝脾郁结，归脾汤加
柴胡、枳壳。
慎斋按∶以上四条，序胎前有腰痛之证也。妊娠腰痛，有外感有内伤。《大全》主于风冷，石山主于血
滞，此客邪有余病也。
正宗以劳力房事论妊娠腰痛，则又悉病机之要矣。
《大全》曰∶妊娠小腹痛，由胞络虚，风寒相抟，痛甚亦令胎动。
慎斋按∶以上一条，序胎前有小腹痛之证也。小腹为足厥阴肝经部分，是经或阴血不足，或郁怒气滞，皆
足致小腹痛之证。况胎系于肾，肾肝同病。《大全》论风寒相抟，止就外邪一端言之耳。
王叔和曰∶妇人月经下，但为微少，师脉之，反言有躯，其后审然，其脉何类？师曰∶寸口脉，阴阳俱平，
荣卫调和，按之则滑，浮之则轻，阳明少阴，各如经法，身反洒淅，不欲食，头痛心乱，呕吐，呼则微数，
吸则不惊，阳多气溢，阴滑气盛，滑则多实，六经养成，所以月见。阴见阳精，汁凝胞散。散者损堕。设复阳
盛，双妊二胎。今阳不足，故令激经也。
娄全善曰∶妊娠经来不多，饮食精神如故，六脉和缓，滑大无病者，血盛有余也。儿大能饮，自不来矣。
慎斋按∶以上二条，序胎前经来，有有余不足之分也。胎前下血，则名漏胎。妊娠经来，则名激经。漏胎
则无时而下，激经则有时而至。叔和主于阳微不足，全善主于血盛有余，当以人禀之强弱参之。
薛立斋说：上述证候如果是外邪侵袭所致，使用独活寄生汤。如果是劳力损伤气血，用八珍汤加杜仲、砂仁、阿胶、艾叶。如果是脾肾不足，在前药基础上加白术、骨碎补。如果是气血郁滞，用紫苏饮加枳实、桔梗。如果是肝火妄动，用小柴胡汤加白术、枳壳、山栀。如果是肝脾郁结，用归脾汤加柴胡、枳壳。
慎斋按语：以上四条，叙述的是妊娠前出现腰痛的证候。妊娠腰痛，有外感和内伤之分。《妇人大全良方》主张是风冷所致，石山主张是血滞所致，这属于客邪有余的病证。
《妇人大全良方》说：妊娠期间小腹痛，是由于胞络虚弱，风寒相互搏结，疼痛剧烈也会导致胎动不安。
慎斋按语：以上一条，叙述的是妊娠前出现小腹痛的证候。小腹是足厥阴肝经所主的部位，这条经脉如果阴血不足，或者因郁怒导致气机阻滞，都足以引起小腹痛的证候。况且胎儿系于肾，肾与肝同病。《妇人大全良方》论述风寒相互搏结，只是从外邪这一方面来说罢了。
王叔和说：妇女月经下行，但量微少，医生诊脉，反而说有身孕，后来证实确实如此，这是什么脉象呢？医生说：寸口脉，阴阳两部都平和，营卫调和，重按则感觉滑利，轻取则感觉轻浮，阳明经和少阴经的脉象都符合常法，身体反而感到恶寒战栗，不想吃东西，头痛心烦，呕吐，呼气轻微急促，吸气不惊恐，阳气多而气溢，阴气滑利而气盛，滑脉主多实，六经养成，所以月经来潮。阴见阳精，汁液凝结胞宫散开。散开则会导致损伤堕胎。如果再次阳气旺盛，就会怀双胎。现在阳气不足，所以导致激经（妊娠期间按月仍有少量阴道出血）。
娄全善说：妊娠期间月经来潮但不多，饮食和精神状态如常，六脉和缓，滑大而无病态，这是血盛有余的表现。胎儿长大需要消耗血液，自然就不会再来月经了。
慎斋按语：以上两条，叙述的是妊娠前月经来潮，有血盛有余和血虚不足的区分。妊娠期间下血，称为漏胎。妊娠期间月经来潮，称为激经。漏胎是无时无刻不在出血，激经则是按时而至。王叔和主张是阳气不足，娄全善主张是血盛有余，应当根据人的体质强弱来综合参详。
Xue Lizhai stated: If the aforementioned syndrome is caused by external pathogens, use Duhuo Jisheng Tang (Notopterygium and Dangshen Decoction for Expelling Wind-Dampness and Nourishing Qi and Blood). If it is due to labor injury damaging Qi and Blood, use Bazhen Tang (Eight Treasure Decoction) with added Du Zhong (Eucommia Bark), Sha Ren (Amomum Fruit), E Jiao (Donkey-Hide Gelatin), and Ai Ye (Mugwort Leaf). If there is Spleen and Kidney deficiency, add Bai Zhu (Atractylodes Rhizome) and Gu Zhi (Bone Fragment) to the previous prescription. If there is Qi and Blood stagnation, use Zisu Yin (Perilla Infusion) with added Zhi Shi (Immature Bitter Orange) and Jie Geng (Platycodon Root). If Liver Fire is agitated, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Bai Zhu, Zhi Ke (Bitter Orange Peel), and Shan Zhi (Gardenia Fruit). If there is Liver and Spleen constraint, use Guipi Tang (Restore the Spleen Decoction) with added Chai Hu (Bupleurum Root) and Zhi Ke.
Shen Zhai commented: The above four points describe syndromes of lower back pain occurring before pregnancy. Lower back pain during pregnancy can be caused by external contraction or internal injury. *Da Quan* attributes it to wind-cold, while Shi Shan attributes it to blood stasis; these are conditions of excess pathogenic factors.
Zheng Zong discusses lower back pain during pregnancy in relation to overexertion and sexual intercourse, thereby grasping the essence of the pathogenesis.
*Da Quan* states: Lower abdominal pain during pregnancy is caused by deficiency of the uterine collaterals, where wind and cold contend with each other; severe pain may also disturb the fetus.
Shen Zhai commented: The above point describes syndromes of lower abdominal pain occurring before pregnancy. The lower abdomen is the area governed by the Foot-Jueyin Liver Meridian. If this meridian suffers from insufficient Yin-Blood or Qi stagnation due to suppressed anger, it can lead to lower abdominal pain. Furthermore, the fetus is anchored by the Kidneys, and the Kidneys and Liver often suffer together. *Da Quan*’s discussion on wind and cold contending only addresses the aspect of external pathogens.
Wang Shuhe said: When a woman’s menstruation flows but is scanty, and the physician palpates the pulse, stating contrary that she is pregnant, which proves true later, what kind of pulse is this? The physician said: At the Cun Kou (radial artery) position, both Yin and Yang pulses are balanced, Ying and Wei (Nutritive and Defensive Qi) are harmonious. Pressing reveals a slippery quality, while light palpation feels floating. The Yangming and Shaoyin meridians follow their respective normal methods. The body feels chills, there is loss of appetite, headache, mental restlessness, vomiting, rapid shallow breathing upon exhalation, and no alarm upon inhalation. Yang is abundant with Qi overflowing, Yin is slippery with Qi flourishing. Slippery indicates excess. The six meridians nurture life, hence menstruation occurs. Yin encounters Yang essence, fluids coagulate and the uterus disperses. Dispersal leads to damage and abortion. If Yang becomes excessive again, twins may result. Now, since Yang is insufficient, it causes "Ji Jing" (intermenstrual bleeding or continued spotting during early pregnancy).
Lou Quanshan said: During pregnancy, if menstruation comes but is not heavy, and diet and spirit remain normal, with the six pulses being harmonious, slippery, and large without pathological signs, this indicates abundant Blood and excess. Once the fetus grows large enough to consume nutrients, menstruation will cease naturally.
Shen Zhai commented: The above two points discuss menstruation before/during pregnancy, distinguishing between excess and deficiency. Bleeding during pregnancy is named "Lou Tai" (Leaking Fetus). Menstruation during pregnancy is named "Ji Jing". Lou Tai involves continuous bleeding, whereas Ji Jing occurs at regular intervals. Wang Shuhe attributes it to insufficient Yang, while Lou Quanshan attributes it to abundant Blood and excess. One must consider the individual’s constitutional strength when judging.