治妇人病，必先明冲任之脉。冲脉起于气街，（在毛际两旁。）并少阴之经，挟脐上行至
胸中
而散。任脉起于中极之下，（脐下四寸）。以上毛际循腹里上关元。又云∶冲任脉皆起于胞中
，上循背里，为经脉之海，皆血之所从生，而胎之所有系。明于冲任之故，本原洞悉，不概
治以男子泛用之药，自能所治辄效矣。
肝气之病，近时甚多，妇女为尤甚。即十余岁之童女，往往左胁下痞积胀满呕逆，此先
天之
肝血不足也。治以疏伐则剧，治以滋养则平，比比而然。况乎天癸久转，生育频多之妇人，
其血愈亏，肝愈旺，上犯胃脘，下侵于足，甚至纳食即吐，两足挛痛，致发痉厥。此肝气久
痛，必入于络，因血少不能流通，其气必滞，非养血和络，补水滋木，焉能疗治。世人概以
谓东方常实，有泻无补，遂皆以肝无补法论治。殊不知肝气之痛，大半属于水亏木炽，所以
逍遥散为治肝之始方，并无泻伐之品，其中归、芍补肝，白术、甘草补中，加以柴胡、煨姜
为疏通之用。气平即继以八珍汤调养之，则自然所发渐轻。若随俗附和，任意用枳壳、香附
、青皮、郁金等破气之药，元气日益消耗，阳衰则阴竭，祸不旋踵矣。景岳《质疑难》云肝
无补法者，以肝气之不可补，非谓肝血之不可补。补肝血莫如滋肾水，肾者木之母也，母旺
则子强，是以当滋化源，此千古之良法也。夫将军之官，其性刚劲，木火同居，风乘火势，
火助风威，母赞其胜，此言其气实有余也。若求其本，则乙癸同源，滋阴养血，尤为急矣。
妇人血结胞门，则上焦之阳不得入于阴，在下则小腹里急，五液时下，在上则孤阳独浮
，为
嗔怒发热，口燥发厥。治法先宜开痹破阴结，不得一味滋腻，致成虫满。当看其虚实，用景
岳《新阵》柴胡饮六方，柴陈煎、归柴饮、解肝化肝煎等方，因病加减治之，较古方尤为灵
动。
妊娠伤寒及温热症，最难措手，须辨舌胎，张诞先舌鉴六条，实为名论，治宜宗之。其
一云
∶孕妇初伤于寒，见面赤舌上白滑，即当微汗之，以解其表。如面舌俱白，发热多饮冷水，
阳极变阴所致，当用温中之药。若见厥冷烦躁，误与凉剂，则厥逆吐利而死。其二云∶面赤
舌黄，五六日里症见，当微利之，庶免热邪伤胎之患。若面舌俱黄，此失于发汗，湿热入里
所致，当用清利水药。其三云∶面舌俱黑，水火相刑，不必问其月数，子母俱死，面赤舌微
黑者，还当保胎。如见灰色，乃邪入子宫，其胎必不能固。若面赤者，根本未伤，当急下以
救其母。其四云∶妊娠伤寒温热，见面舌俱赤，宜随症汗下，子母无虞，面色皎白而舌赤者
，母气素虚，当略用温散法。若面黑舌赤，亦非吉兆。若在临月，则子得生而母当殒。其五
云∶见面赤舌紫，其人必嗜饮，乃酒毒内传所致。如淡紫戴青，为阴症夹食，难治也，即用
枳实、理中、四逆辈，亦难为力。若面赤舌青，母虽无妨，子殒腹内，急宜用芎归汤合平胃
散，加朴硝下之，以救其母。其六云∶面黑而舌干卷短，或黄黑刺裂，乃里症至急，不下则
热邪伤胎，下之危在顷刻。如无循衣撮空直视等证，十中可挽回一二，妊娠伤寒伤风，首宜
固胎顺气，虽见脉紧无汗，不可用麻黄、青龙及一切解表猛剂，以风药性升，皆犯胎气也。
郑虚谷曰∶妊娠伤风，无论时月及月分多少，俱宜严氏紫苏饮加葱白为至稳。
古人用芩、术安胎，是因子气过热不宁，故用黄芩苦寒以安之。脾为一身之津梁，主内
外诸
气，而胎息运化之机，全赖脾土，故用白术以助之。然惟形瘦血热，营行过疾，而胎常上逼
者宜之。至若形盛气衰，胎常下坠者，非人参举之不安；形盛气实，胎常不运者，非香、砂
耗之不安；血虚火旺，腹常急痛者，非芎、归、地、芍养之不安；体肥痰盛呕逆眩晕，非芩
、半豁之不安。此皆治母之偏胜也，妇人
坠胎与难产病之最险者也。治坠胎往往用补涩，治难产往往用攻下，皆非正法。盖半产之故
，由于虚滑者半，由于内热者半，得胎之后，冲任之血，为胎所吸，无余血下行，血苟不足
，则胎必枯槁而坠。其本由于内热，火盛阳旺，而阴劫血益少矣。治宜养血为先，清热次之
，若泥于腻补，反生壅滞之害。至于产育，乃天地生生化育之理，本无危险，皆人之自作也
。用力不可太早，早则胎先坠下。舒转不及，胞浆先破，胎已枯涩，遂有横生倒产之虞。其
治亦不外乎养血为主，血生则胎自出，若误用攻下之药。则胎虽已产，冲任大伤，气冒血崩
，危在呼吸矣。慎之慎之。
治疗妇女疾病，必须先明确冲脉和任脉的情况。冲脉起始于气街（位于阴毛两侧），与足少阴肾经并行，挟持肚脐上行至胸中而散布。任脉起始于中极穴之下（脐下四寸），沿阴毛边缘循行于腹部内部，向上到达关元穴。又有说法称：冲脉和任脉都起始于胞宫（子宫），向上沿着脊柱内侧运行，是十二经脉的海，也是血液生成的源头，更是胎儿赖以系连的根本。明白了冲任二脉的道理，就能洞悉疾病的本源，不再像对待男子那样泛泛地使用药物，自然能够治疗有效。
肝气病变，近来非常多见，妇女尤为严重。即使是十几岁的少女，也往往出现左胁下有痞块、胀满、呕吐逆气等症状，这是先天性的肝血不足所致。如果用疏泄攻伐的方法治疗，病情就会加重；如果用滋养的方法治疗，病情就能平复，这种情况比比皆是。何况那些月经长期正常、生育频繁的妇女，她们的血液更加亏损，肝气更加旺盛，向上侵犯胃脘，向下侵扰下肢，甚至导致进食后立即呕吐，两脚痉挛疼痛，进而引发抽搐昏厥。这是因为肝气久痛，必然侵入络脉，因为血少不能流通，气机必然滞涩，如果不养血调和络脉，补水以滋助肝木，怎么能治愈呢？世人一概认为“东方（肝）常实”，只有泻法没有补法，于是都按照“肝无补法”的理论来治疗。殊不知肝气的疼痛，大半属于肾水亏虚、肝木炽盛，所以逍遥散是治疗肝病的基础方剂，其中并没有泻伐的药物，其中的当归、白芍补养肝脏，白术、甘草补益脾胃，加上柴胡、煨姜作为疏通之用。气机平和之后，接着用八珍汤调养，那么发作自然会逐渐减轻。如果随俗附和，任意使用枳壳、香附、青皮、郁金等破气耗气的药物，元气日益消耗，阳气衰微则阴血枯竭，灾祸立刻就会降临。张景岳在《质疑难》中说“肝无补法”，是指肝气不可补，并非指肝血不可补。补肝血不如滋补肾水，因为肾是肝之母，母旺则子强，所以应当滋生化之源，这是千古以来的良法。将军之官（肝），其性刚劲，木火同居，风借火势，火助风威，母子相赞其胜，这是说肝气实有余的情况。如果探求根本，则乙癸同源（肝肾同源），滋阴养血，尤为紧急。
妇人血结于胞门（子宫口），则上焦的阳气不能进入阴分，在下则小腹拘急紧迫，津液不时下泄；在上则孤阳独浮，表现为易怒发热、口干、四肢厥冷。治疗方法应先宜开通痹阻、破除阴结，不能用一味滋腻的药物，以免导致气机壅满。应当辨别虚实，使用张景岳《新阵》中的柴胡饮六方，如柴陈煎、归柴饮、解肝化肝煎等方剂，根据病情加减治疗，比古方更为灵活有效。
妊娠期间患伤寒及温热病，最难处理，必须辨别舌苔。张诞先的《舌鉴》中有六条论述，确实是著名的理论，治疗应当遵循这些原则。第一条说：孕妇初感寒邪，见面色红赤、舌苔白滑，就应当轻微发汗，以解除表邪。如果面色和舌苔都白，发热且想喝冷水，这是阳极变阴所致，应当使用温中的药物。如果出现四肢厥冷、烦躁不安，误用凉药，就会导致四肢厥逆、呕吐腹泻而死。第二条说：面色红赤、舌苔黄，五六天后出现里证，应当轻微通利大便，以免热邪伤害胎儿。如果面色和舌苔都黄，这是失于发汗，湿热入里所致，应当使用清利湿热的药物。第三条说：面色和舌苔都黑，这是水火相刑（阴阳离决），不必问怀孕几个月了，母子都会死亡；如果面色红赤、舌苔微黑，还应当保胎。如果见到灰色，说明邪气已进入子宫，胎儿必然不能稳固。如果面色红赤，说明根本未伤，应当急用下法以救母亲。第四条说：妊娠期间患伤寒温热病，见面色和舌苔都红赤，应当根据症状采用汗法或下法，母子都没有危险；如果面色皎白而舌红赤，说明母亲素体虚弱，应当略微使用温散法。如果面黑舌赤，也不是吉兆。如果在临产月份，则胎儿能生而母亲会死亡。第五条说：见面色红赤、舌质紫，这个人一定嗜好饮酒，是酒毒内传所致。如果淡紫色带青色，为阴症夹食积，难以治疗，即使使用枳实、理中汤、四逆汤之类的药物，也难以奏效。如果面赤舌青，母亲虽然无妨，但胎儿已死在腹内，应当急用芎归汤合平胃散，加入朴硝攻下，以救母亲。第六条说：面黑而舌干卷短，或者舌苔黄黑且有刺裂，这是里证危急，不通便则热邪伤害胎儿，通便则危险就在顷刻之间。如果没有循衣摸空、直视等危重证候，十个人中可以挽回一两个。妊娠期间患伤寒伤风，首先应当固护胎儿、顺调气机，即使见到脉紧无汗，也不可用麻黄汤、大青龙汤及一切解表的猛药，因为风药性质升散，都会触犯胎气。郑虚谷说：妊娠伤风，无论怀孕几个月，都适宜使用严氏紫苏饮加葱白，最为稳妥。
古人用黄芩、白术安胎，是因为胎儿之气过热不宁，所以用黄芩的苦寒之性来安定它。脾是一身津液运行的枢纽，主管内外各种气机，而胎儿呼吸运化的机能，全赖脾土，所以用白术来辅助它。然而，只有形体消瘦、血热、营血运行过快，而胎儿经常上逼者才适宜。至于形体肥胖、气机衰弱，胎儿经常下坠者，不用人参提升就不能安胎；形体肥胖、气机实盛，胎儿经常不运转者，不用香附、砂仁耗散就不能安胎；血虚火旺，腹部经常急痛者，不用川芎、当归、地黄、白芍滋养就不能安胎；身体肥胖、痰多、呕吐眩晕者，不用黄芩、半夏豁痰就不能安胎。这些都是治疗母亲的偏胜之弊，而妇人堕胎与难产是最危险的病症。治疗堕胎往往用补涩法，治疗难产往往用攻下法，都不是正法。大概半产的原因，由于虚滑的占一半，由于内热的占一半，得到胎儿之后，冲任之血被胎儿吸收，没有多余的血液下行，血液如果不足，则胎儿必然枯槁而坠落。其根本原因在于内热，火盛阳旺，阴血被劫夺而更少。治疗应当以养血为先，清热次之，如果拘泥于腻补，反而会产生壅滞的危害。至于分娩，本是天地生生不息的规律，本来没有危险，都是人自作自受。用力不可太早，早了则胎儿先坠下。舒展转动不及，羊水先破，胎儿已经枯涩，于是就有横生倒产的忧虑。治疗也不外乎以养血为主，血生则胎儿自然产出，如果误用攻下的药物，则胎儿虽然已产出，但冲任二脉大伤，气随血脱、血崩，危险就在呼吸之间了。谨慎啊，谨慎啊。
The treatment of women's diseases must first clarify the condition of the Chong (Penetrating) and Ren (Conception) vessels. The Chong vessel originates from the Qicheng (Qi Street) point (located on both sides of the pubic hairline), runs parallel with the Foot-Shaoyin Kidney meridian, flanks the navel, ascends to the chest, and disperses. The Ren vessel originates below the Zhongji point (four cun below the umbilicus), follows the pubic hairline along the interior of the abdomen, and ascends to the Guanyuan point. It is also said that both the Chong and Ren vessels originate from the Baozhong (uterus), ascend along the interior of the back, serve as the Sea of the Twelve Meridians, are the source from which blood is generated, and are the foundation upon which the fetus depends. Understanding the principles of the Chong and Ren vessels allows one to thoroughly comprehend the root cause of diseases, avoiding the indiscriminate use of medications typically applied to men, thereby ensuring effective treatment.
Liver Qi disorders are prevalent nowadays, especially among women. Even young girls in their teens often present with masses, distension, and vomiting in the left hypochondrium, which stems from congenital deficiency of Liver Blood. Treatment with draining and attacking methods exacerbates the condition, while nourishing treatments bring it under control, a phenomenon frequently observed. This is particularly true for women who have had regular menstruation for years and frequent pregnancies; their blood becomes increasingly deficient, leading to hyperactive Liver Qi that invades the stomach epigastrium upwards and affects the lower limbs downwards, potentially causing immediate vomiting after eating, spasmodic pain in both legs, and even convulsions and syncope. Since chronic Liver Qi pain inevitably enters the collaterals, and blood deficiency prevents smooth circulation, causing Qi stagnation, only by nourishing blood, harmonizing collaterals, and tonifying water to nourish wood can this be cured. People generally believe that the "East" (Liver) is constantly full, admitting only draining but no tonification, thus treating according to the theory that "the Liver has no tonification method." Little do they know that most Liver Qi pain belongs to Water deficiency and Wood hyperactivity. Therefore, Xiaoyao San (Free and Easy Wanderer Powder) is the primary formula for treating Liver disorders, containing no draining ingredients; instead, it uses Danggui (Angelica Sinensis Root) and Shaoyao (Peony Root) to tonify the Liver, Baizhu (Atractylodes Macrocephala Rhizome) and Gancao (Licorice Root) to tonify the Spleen/Stomach, supplemented by Chaihu (Bupleurum Root) and Wei Jiang (Roasted Ginger) for unblocking. Once the Qi is balanced, Bazhen Tang (Eight-Treasure Decoction) should follow for conditioning, gradually lightening the attacks. If one blindly follows custom and arbitrarily uses Qi-breaking drugs like Zhike (Aurantii Fructus), Xiangfu (Cyperus Rhizome), Qingpi (Citrus Reticulata Pericarpium Viride), and Yujin (Curcuma Longa Rhizome), Yuanqi (Original Qi) will be depleted day by day; Yang decline leads to Yin exhaustion, and disaster follows swiftly. Zhang Jingyue stated in *Zhiyi Nan* that "the Liver has no tonification method" referring to the fact that Liver Qi cannot be directly tonified, not that Liver Blood cannot be. To tonify Liver Blood, nothing surpasses nourishing Kidney Water, for the Kidney is the mother of the Liver; when the mother is strong, the child is robust. Thus, nourishing the source of transformation is an excellent method passed down through ages. The General Officer (Liver) has a rigid nature; Wood and Fire reside together, wind rides fire, and fire aids wind, with mother supporting child's excess—this describes an excess of Qi. However, seeking the root reveals that Yi-Gui share the same source (Liver and Kidney share essence/blood); thus, nourishing Yin and tonifying blood is urgent.
When women suffer from Blood stasis at the Baomen (uterine gate), Yang Qi from the Upper Jiao cannot enter Yin. Below, there is urgency and tightness in the lower abdomen and constant discharge of fluids; above, solitary Yang floats alone, causing irritability, fever, dry mouth, and cold extremities. The treatment should first open obstruction and break Yin knots, avoiding purely cloying/nourishing herbs that might cause Qi stagnation. One must assess deficiency or excess and use the six formulas of Chaihu Yin from Zhang Jingyue's *Xin Zhen*, such as Chaichen Jian, Guochai Yin, and Jiegan/Huagan Jian, modifying them according to the disease. These are more flexible than ancient formulas.
Pregnancy complicated by Shanghan (Cold Damage) or Wenre (Warm Heat) syndromes is difficult to manage. One must distinguish the tongue coating. Zhang Danxian’s *Shejian* (Tongue Diagnosis) outlines six principles, which are famous theories worthy of adoption. First: If a pregnant woman initially contracts cold, presenting with a red face and white slippery tongue coating, mild sweating should be induced to release the exterior. If both face and tongue are white, accompanied by fever and craving for cold water, this indicates extreme Yang transforming into Yin; warming middle-jiao herbs should be used. If cold extremities and restlessness appear, misusing cooling agents will lead to cold reversal, vomiting, diarrhea, and death. Second: A red face and yellow tongue coating appearing after five to six days indicate interior syndrome; mild purgation should be employed to prevent heat damaging the fetus. If both face and tongue are yellow, it results from neglected sweating allowing damp-heat to enter the interior; clearing and draining damp-heat herbs are indicated. Third: Black face and tongue indicate mutual punishment of Water and Fire (Yin-Yang separation); regardless of gestational age, both mother and fetus will die. If the face is red and tongue slightly black, the fetus should still be preserved. Gray color indicates pathogen entering the uterus, making fetal stability impossible. If the face is red, the root is undamaged, and urgent purgation may save the mother. Fourth: In pregnancy with Shanghan/Wenre, if face and tongue are red, sweating or purging based on symptoms ensures safety for both. If the face is pale/white and tongue red, indicating maternal constitutional deficiency, mild warming and dispersing methods should be used. Black face with red tongue is ominous; near term, the fetus may survive while the mother dies. Fifth: Red face with purple tongue suggests alcoholism and internal transmission of wine toxicity. Pale purple with cyan indicates Yin syndrome with food retention, which is hard to treat; even using Zhishi (Immature Bitter Orange), Lizhong Tang, or Sini Tang may fail. Red face with blue/green tongue indicates the mother is safe, but the fetus has died intrauterinely; urgently use Xionggui Tang combined with Pingwei San plus Mangxiao (Mirabilite) to purge and save the mother. Sixth: Black face with dry, curled, short tongue, or yellow-black prickly/cracked tongue, indicates critical interior syndrome. Without purging, heat damages the fetus; purging risks immediate danger. If signs like grasping at clothes or staring are absent, one or two out of ten might be saved. For pregnancy complicated by Wind-Cold, securing the fetus and smoothing Qi is paramount. Even with tight pulse and no sweat, Mahuang Tang (Ephedra Decoction), Daqinglong Tang (Major Green Dragon Decoction), or other strong diaphoretics must be avoided because wind-dispersing herbs rise upward and disturb the fetal Qi. Zheng Xugu stated: For pregnancy complicated by Wind-Cold, regardless of months, Yan Shi’s Zisu Yin (Perilla Leaf Decoction) added with Congbai (Scallion White) is safest.
Ancients used Huangqin (Scutellaria Root) and Baizhu (Atractylodes Macrocephala Rhizome) to calm the fetus because fetal Qi was too hot and restless; Huangqin’s bitter-cold nature calms it. The Spleen is the hub of body fluids and governs all Qi; fetal respiration and transformation rely entirely on Spleen Earth, so Baizhu assists it. However, this suits only thin individuals with blood heat and rapid Ying circulation where the fetus presses upward. For obese individuals with weak Qi and downward-falling fetus, Renshen (Ginseng Root) lifting is needed. For obese individuals with excess Qi and stagnant fetus, Xiangfu (Cyperus Rhizome) and Sharen (Amomum Fruit) dispersing is required. For blood deficiency with fire hyperactivity and abdominal pain, Xiong (Ligusticum Rhizome), Guibai (Angelica Sinensis Root), Dihuang (Rehmannia Root), and Shaoyao (Peony Root) nourishment is necessary. For obese individuals with phlegm-dampness, vomiting, and dizziness, Huangqin (Scutellaria Root) and Banxia (Pinellia Tuber) resolving phlegm is needed. These address maternal imbalances. Miscarriage and dystocia are the most dangerous conditions in women. Treating miscarriage often involves tonifying and astringing; treating dystocia often involves purging, neither being correct. Half of spontaneous abortions are due to deficiency and slipping; half due to internal heat. After conception, Chong-Ren blood is absorbed by the fetus, leaving none for menstrual flow. If blood is insufficient, the fetus withers and falls. The root is internal heat; excessive fire/Yang depletes Yin-blood. Treatment prioritizes nourishing blood, then clearing heat. Clinging to cloying tonics causes stagnation. Childbirth follows Heaven and Earth’s generative principle and is naturally safe; dangers arise from human error. Pushing too early causes premature descent. Delayed turning leads to premature rupture of membranes; the fetus becomes dry and stuck, risking transverse or breech presentation. Treatment focuses on nourishing blood; as blood generates, the fetus delivers naturally. Misusing purgatives, even after delivery, severely injures Chong-Ren vessels, causing Qi collapse and hemorrhage, endangering life instantly. Be cautious, be cautious.