凡妊娠胎气不安者,证本非一,治亦不同。盖胎气不安,必有所因,或虚或实,或寒或
热,皆能为胎气之病,去其所病,便是安胎之法。故安胎之方不可执,亦不可泥其月数,但
当随证随经,因其病而药之,乃为至善。若谓白术、黄芩乃安胎之圣药,执而用之,鲜不误
矣。
一、胎气有寒而不安者,其证或吞酸吐酸,或呕恶胀满,或喜热畏凉,或下寒泄泻,或
脉多沉细,或绝无火证,而胎有不安者,皆属阳虚寒证,但温其中而胎自安矣。宜用温胃饮
、理阴煎之类加减主之。亦当以平素之脏气,察其何如,酌而用之。
一、胎气有热而不安者,其证必多烦热,或渴或躁,或上下不清,或漏血、溺赤,或六
脉滑数等证。宜凉胎饮、保阴煎之类主之。若但热无虚者,如枳壳汤、一母丸、黄芩散之类
,皆可择用,清其火而胎自安矣。
一、胎气有虚而不安者,最费调停。然有先天虚者,有后天虚者,胎元攸系,尽在于此
。先天虚者,由于禀赋,当随其阴阳之偏,渐加培补,万毋欲速,以期保全。后天虚者,由
于人事,凡色欲劳倦,饮食七情之类,皆能伤及胎气,治此者,当察其所致之由,因病而调
,仍加戒慎可也。然总之不离于血气之虚,皆当以胎元饮为主。若心脾气虚于上者,宜逍遥
饮、归脾汤、寿脾煎之类主之。若肝肾不足于下者,宜左归饮、右归饮、固阴煎主之。若气
血俱虚者,宜五福饮、八珍汤、十全大补汤之类主之。若脾肾气虚而兼带浊者,宜秘元煎、
菟丝煎之类主之。若多呕恶者,当随前证前方,各加二陈汤之类以和之。凡治虚证,贵在随
机应变,诚有不可以凿执言者。
一、胎气有实滞气滞,凡为恶阻,为胀满而不安者,惟其素本不虚,而或多郁滞者乃有
之,但察其所由而开之导之,诸治实者固无难也。呕吐不止者,二陈汤加枳壳、砂仁主之,
或用人参橘皮汤亦妙。食滞胀满不安者,小和中饮加减主之。肝气滞逆,胀满不安者,解肝
煎主之。怒动肝气兼火者,化肝煎主之。脾肺气滞,上攻作痛者,紫苏饮主之。气滞兼痰者
,四七汤、二陈汤加当归主之。气滞兼火,为胀为烦者,枳壳汤、束胎丸之类主之。
一、王节斋曰∶调理妊妇,在于清热养血,白术补脾为安胎君药,条实黄芩为安胎圣药
,清热故也,暑月宜加用之。此一说者,虽若有理,而实有大病,不可不辨也。夫孕之胎气
,必随母之脏气,大都阴虚者多热气,阳虚者多寒气,寒之则寒,热之则热者,是为平气。
今以十人言之,则寒者居其三,热者居其三,平者居其四,此大较也。若谓受胎之后,必增
内热,自与常人不同,则何以治恶阻者,必用二陈、六君、生姜、半夏之属而后效,其果增
热否乎?故治热宜黄芩,寒则不宜也。非惟寒者不宜,即平气者亦不宜。盖凡今之胎妇,气
实者少,气虚者多。气虚则阳虚,而再用黄芩,有即受其损而病者,有用时虽或未觉,而阴
损胎元,暗残母气,以致产妇羸困,或儿多脾病者,多由乎此。奈今人不能察理,但以圣药
二字,认为胎家必用之药,无论人之阴阳强弱,凡属安胎,无不用之,其害盖不少矣。至若
白术,虽善安胎,然或用不得善,则其性燥而气闭,故凡阴虚者非可独用,气滞者亦当权宜
。是以用药之难,当如盘珠,有不可胶柱而鼓瑟也。
立斋曰∶妊娠若元气不实,发热倦怠,或胎气不安,用当归散。因气恼,加枳壳;胸膈
痞闷,再加苏梗;或作痛,加柴胡。若饮食不甘,或欲呕吐,用六君加紫苏、枳壳。若恶阻
呕逆,头眩体倦,用参橘散;未应,用六君子汤。若恶阻呕吐,不食烦闷,亦用参橘散之类
。若顿仆胎动,腹痛下血,用胶艾汤;未应,用八珍加胶、艾。若顿仆、毒药,腰痛短气,
用阿胶散;未应,煎送知母丸。若顿仆胎伤,下血腹痛,用佛手散;未应,用八珍送知母丸
。若心惊胆怯,烦闷不安,名子烦,用竹叶汤。未应,血虚佐以四物,气虚佐以四君。若下
血不止,名胎漏,血虚用二黄散,血去多用八珍汤。未应,用补中益气汤。若因事而动,下
血,用枳壳汤加生、熟地黄;未应,或作痛,更加当归。血不止,八珍加胶艾。若不时作痛
,或小腹重坠,名胎痛,用地黄当归汤;未应,加参、术、陈皮。或因脾气虚,用四君加归
、地;中气虚,用补中益气汤。若面目虚浮,肢体如水气,名子肿,用《全生》白术散;未
应,用六君子汤。下部肿甚,用补中益气倍加茯苓。或因饮食失宜,呕吐泄泻,此是脾胃亏
损,用六君子汤。若足指发肿,渐至腿膝,喘闷不安,或足指缝出水,名水气,用天仙藤散
;脾胃虚弱,兼以四君子;未应,用补中益气,兼以逍遥散。若胎气上攻,心腹胀满作痛,
名子悬,用紫苏饮。饮食不甘,兼四君子;内热晡热,兼逍遥散。若小便涩少,或成淋沥,
名子淋,用安营散;不应,兼八珍汤。腿足转筋,而小便不利,急用八味丸,缓则不救。若
项强筋挛,语涩痰盛,名子痫,用羚羊角散。或饮食停滞,腹胀呕吐,此是脾胃虚弱,而不
能消化,用六君子汤;不应,用平胃散加参、苓。或胎作胀,或胀作痛,此是脾胃气虚,不
能承载,用安胎饮加升麻、白术;不应,用补中益气汤。或脐腹作胀,或小便淋闭,此是脾
胃气虚,胎压尿胞,用四物加二陈、参、术,空心服后探吐,药出气定,又服又吐,数次必
安。或因劳役所伤,或食煎妙,小便带血,此是血得热而流于胞中,宜清膀胱,用逍遥散。
或遗尿不禁,或为频数,此是肝火血热,用加味逍遥散。若胸满腹胀,小便不通,遍身浮肿
,名胎水不利,用鲤鱼汤;脾胃虚,佐以四君子。病名同而形证异,形证异而病名同,聊见
本方。凡用见证之药不应,当分月经治之。
徐东皋曰∶胎有不安而腰疼腹痛,甚则至于下坠者,未必不由气血虚,无所营养而使之
然也。夫胎之在腹,如果之在枝,枝枯则果落,固理之自然。妇人性偏恣欲,火动于中,亦
能致胎不安而有堕者,大抵不外乎属虚属火二者之间,清热养血之治尽之矣。此外有二因动
胎者,又不可不知也。有因母病动胎者,但疗母病则胎自稳;有因触伤动胎者,当以安胎药
二三剂而胎自安。
凡妊娠期间胎气不安的,证候本就不止一种,治疗方法也各不相同。大概胎气不安,必定有其原因,或是虚证或是实证,或是寒证或是热证,都能导致胎气病变,去除其致病原因,就是安胎的方法。所以安胎的方剂不可拘执,也不可死板地依据怀孕月数,只应当根据证候和经络,针对病因用药,这才是最好的方法。如果说白术、黄芩是安胎的圣药,固执地使用它们,很少有不误事的。
一、胎气因寒而不安的,症状有的反酸吐酸水,有的恶心胀满,有的喜欢热而畏惧凉,有的下部寒冷泄泻,有的脉象多沉细,或者完全没有火证,但胎气不安的,都属于阳虚寒证,只要温补中焦,胎气自然安定。适宜使用温胃饮、理阴煎等方剂加减主治。也应当根据平素脏腑之气,观察具体情况,斟酌后使用。
一、胎气因热而不安的,症状必然多有烦热,或者口渴或者烦躁,或者上下部不清爽,或者漏血、小便赤红,或者六脉滑数等症状。适宜使用凉胎饮、保阴煎等方剂主治。如果只有热证没有虚证,如枳壳汤、一母丸、黄芩散等方剂,都可以选择使用,清除火热,胎气自然安定。
一、胎气因虚而不安的,最费调治周旋。然而有先天不足的,有后天亏损的,胎元的维系,全在于此。先天不足者,由于禀赋原因,应当随着阴阳偏颇的情况,逐渐加以培补,千万不要求快,以期望保全胎儿。后天亏损者,由于人事因素,凡是房事过度、劳累倦怠、饮食失调、七情内伤之类,都能损伤胎气,治疗这类情况,应当考察其致病原因,因病调理,同时加以戒慎小心即可。总之不离于气血虚弱,都应当以胎元饮为主方。如果心脾气虚在上部的,适宜使用逍遥饮、归脾汤、寿脾煎等方剂主治。如果肝肾不足在下部的,适宜使用左归饮、右归饮、固阴煎主治。如果气血俱虚的,适宜使用五福饮、八珍汤、十全大补汤等方剂主治。如果脾肾气虚兼带下浑浊的,适宜使用秘元煎、菟丝煎等方剂主治。如果呕吐恶心的,应当根据前述证候和前文方剂,各加二陈汤等方剂来调和。凡是治疗虚证,贵在随机应变,确实有不可以僵化固执来说明的。
一、胎气有实滞气滞,凡是恶阻(妊娠呕吐),胀满而不安的,只有那些平素体质不虚,而多有郁滞的人才会出现,只要考察其缘由而开导疏通,治疗实证本来就没有困难。呕吐不止的,用二陈汤加枳壳、砂仁主治,或者用人参橘皮汤也很好。食积胀满不安的,用小和中饮加减主治。肝气滞逆,胀满不安的,用解肝煎主治。愤怒动肝气兼有火的,用化肝煎主治。脾肺气滞,上攻作痛的,用紫苏饮主治。气滞兼痰的,用四七汤、二陈汤加当归主治。气滞兼火,表现为胀满烦闷的,用枳壳汤、束胎丸等方剂主治。
一、王节斋说:调理孕妇,在于清热养血,白术补脾作为安胎的主药,条实黄芩作为安胎的圣药,是因为能清热,暑天适宜加用。这一种说法,虽然似乎有理,但实际上有大毛病,不可不辨明。怀孕的胎气,必定随母亲的脏腑之气,大多阴虚者多热气,阳虚者多寒气,寒的就用寒药,热的就用热药,这是平和之气。现在拿十个人来说,寒证占三个,热证占三个,平和的占四个,这是大概情况。如果说受孕之后,必定增加内热,自然与常人不同,那么为什么治疗恶阻的,必须用二陈汤、六君子汤、生姜、半夏之类的药物才有效,那果真是增加热了吗?所以治疗热证适宜用黄芩,寒证则不适宜。不仅寒证不适宜,就是平和之气也不适宜。大概现在的孕妇,气实的少,气虚的多。气虚则阳虚,如果再使用黄芩,有的立即受到损害而生病,有的使用时虽然还没感觉,但暗中损伤胎元,暗残母气,以致产妇瘦弱困倦,或者孩子多患脾病,大多由此引起。无奈今人不能察理,只把“圣药”二字,认为胎家必用的药,无论人的阴阳强弱,凡是属于安胎,无不用它,其害处大概不少了。至于白术,虽然善于安胎,但如果使用不得法,则其性燥而气闭,所以凡是阴虚者不可以单独使用,气滞者也应当权宜变通。因此用药之难,应当像盘中的珠子一样灵活,不可胶柱鼓瑟(比喻拘泥成法,不知变通)。
立斋说:妊娠如果元气不实,发热倦怠,或者胎气不安,使用当归散。因为气恼,加枳壳;胸膈痞闷,再加苏梗;或者作痛,加柴胡。如果饮食不甘,或者想呕吐,用六君子汤加紫苏、枳壳。如果恶阻呕逆,头眩体倦,用参橘散;无效,用六君子汤。如果恶阻呕吐,不食烦闷,也用参橘散之类。如果跌倒胎动,腹痛下血,用胶艾汤;无效,用八珍汤加阿胶、艾叶。如果跌倒、毒药伤害,腰痛短气,用阿胶散;无效,煎服送下知母丸。如果跌倒胎伤,下血腹痛,用佛手散;无效,用八珍汤送服知母丸。如果心惊胆怯,烦闷不安,名叫子烦,用竹叶汤。无效,血虚佐以四物汤,气虚佐以四君子汤。如果下血不止,名叫胎漏,血虚用二黄散,失血多用八珍汤。无效,用补中益气汤。如果因事而动,下血,用枳壳汤加生地黄、熟地黄;无效,或者作痛,更加当归。血不止,用八珍汤加阿胶、艾叶。如果不时作痛,或小腹重坠,名叫胎痛,用地黄当归汤;无效,加人参、白术、陈皮。或者因脾气虚,用四君子汤加当归、地黄;中气虚,用补中益气汤。如果面目虚浮,肢体像有水气,名叫子肿,用《全生集》白术散;无效,用六君子汤。下部肿甚,用补中益气汤倍加茯苓。或者因饮食失宜,呕吐泄泻,这是脾胃亏损,用六君子汤。如果足指发肿,渐至腿膝,喘闷不安,或者足指缝出水,名叫水气,用天仙藤散;脾胃虚弱,兼用四君子汤;无效,用补中益气汤,兼用逍遥散。如果胎气上攻,心腹胀满作痛,名叫子悬,用紫苏饮。饮食不甘,兼用四君子汤;内热午后热,兼用逍遥散。如果小便涩少,或成淋沥,名叫子淋,用安营散;无效,兼用八珍汤。腿足转筋,而小便不利,急用八味丸,缓则无法救治。如果项强筋挛,语涩痰盛,名叫子痫,用羚羊角散。或者饮食停滞,腹胀呕吐,这是脾胃虚弱,而不能消化,用六君子汤;无效,用平胃散加人参、茯苓。或者胎作胀,或胀作痛,这是脾胃气虚,不能承载,用安胎饮加升麻、白术;无效,用补中益气汤。或者脐腹作胀,或小便淋闭,这是脾胃气虚,胎压尿胞,用四物汤加二陈汤、人参、白术,空腹服用后探吐,药出气定,又服又吐,数次必安。或者因劳役所伤,或吃煎炒食物,小便带血,这是血得热而流于胞中,宜清膀胱,用逍遥散。或者遗尿不禁,或为频数,这是肝火血热,用加味逍遥散。如果胸满腹胀,小便不通,遍身浮肿,名叫胎水不利,用鲤鱼汤;脾胃虚,佐以四君子汤。病名同而形证异,形证异而病名同,略见于本方。凡是使用见证的药物无效,应当分月经治之。
徐东皋说:胎有不安而腰疼腹痛,甚至至于下坠的,未必不是由气血虚,无所营养而使之这样。胎儿在腹中,就像果实挂在树枝上,树枝枯槁则果实落下,这确实是理所当然的。妇人如果性情放纵欲望,火动于中,也能导致胎不安而有堕胎的,大致不外乎属于虚证和火证二者之间,清热养血的治法就能涵盖。此外有两个原因动胎的,又不可不知道。有因母亲生病动胎的,只要治疗母亲疾病则胎自然稳定;有因触伤动胎的,应当用安胎药二三剂则胎自然安定。
In cases of fetal unrest during pregnancy, the syndromes are not uniform, and therefore the treatments differ. Fetal unrest must have a cause; it may be due to deficiency or excess, cold or heat. All these can become diseases affecting the fetus. Removing the pathological factor is the method for calming the fetus. Thus, prescriptions for calming the fetus should not be rigid, nor should they be strictly bound by the number of months of gestation. One must follow the syndrome and the meridians, treating according to the disease, which is the best approach. If one insists that Baizhu (Atractylodis Macrocephalae Rhizoma) and Huangqin (Scutellariae Radix) are the holy medicines for calming the fetus, sticking to their use will rarely avoid errors.
1. When fetal unrest is caused by cold, symptoms may include acid regurgitation, nausea, bloating, preference for warmth and aversion to cold, lower abdominal coldness with diarrhea, a deep and fine pulse, or the absence of fire signs despite fetal unrest. These all belong to Yang deficiency and cold syndromes. Warming the middle jiao will naturally calm the fetus. Suitable prescriptions include Wenwei Yin (Stomach-Warming Decoction) or Liyin Jian (Yin-Nourishing Decoction), modified as needed. One should also observe the patient's constitutional organ qi and prescribe accordingly.
2. When fetal unrest is caused by heat, symptoms typically include irritability and fever, thirst, restlessness, turbidity in the upper and lower body, threatened miscarriage (bleeding), dark urine, or slippery and rapid pulses throughout the six positions. Suitable prescriptions include Liangtai Yin (Fetus-Cooling Decoction) or Baoyin Jian (Yin-Preserving Decoction). If there is heat without deficiency, such as in Zhike Tang (Citrus Aurantium Decoction), Yi Mu Wan (Motherwort Pill), or Huangqin San (Scutellaria Powder), any of these can be selected to clear the fire and naturally calm the fetus.
3. When fetal unrest is caused by deficiency, careful regulation is most required. There is congenital deficiency and acquired deficiency; the preservation of the fetal origin depends entirely on this. Congenital deficiency stems from endowment; one should gradually tonify according to the imbalance of Yin and Yang, never seeking quick results, aiming for preservation. Acquired deficiency stems from lifestyle factors such as excessive sexual activity, fatigue, improper diet, and emotional disturbances, all of which can damage fetal qi. Treating this requires investigating the cause and regulating based on the illness, while maintaining caution. Ultimately, this revolves around Qi and Blood deficiency, so Taiyuan Yin (Fetal-Origin Decoction) should be the primary prescription. For Heart and Spleen Qi deficiency in the upper body, Xiaoyao Yin (Free and Easy Wanderer Decoction), Guipi Tang (Restore the Spleen Decoction), or Shoupi Jian (Spleen-Longevity Decoction) are suitable. For Liver and Kidney insufficiency in the lower body, Zuogui Yin (Left Restoring Decoction), Yougui Jian (Right Restoring Decoction), or Guyin Jian (Yin-Securing Decoction) are appropriate. For combined Qi and Blood deficiency, Wufu Yin (Five Blessings Decoction), Bazhen Tang (Eight-Treasure Decoction), or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) are suitable. For Spleen and Kidney Qi deficiency accompanied by turbid leukorrhea, Miyuan Jian (Secret Origin Decoction) or Tusi Jian (Dodder Seed Decoction) are used. For frequent nausea and vomiting, add Erchen Tang (Two-Aged Decoction) to previous prescriptions to harmonize. In treating deficiency syndromes, flexibility is key; rigidity is inadvisable.
4. Regarding excess stagnation of Qi: Conditions such as morning sickness (Ezu) and bloating causing unrest occur only when the constitution is not deficient but has much stagnation. By identifying the cause and promoting circulation, treating excess is not difficult. For persistent vomiting, Erchen Tang added with Zhike (Aurantii Fructus) and Sharen (Amomi Fructus Rotundus) is used, or Ren Shen Jupi Tang (Ginseng and Tangerina Peel Decoction) is also excellent. For food stagnation with bloating and unrest, Xiaohe Zhong Yin (Harmonizing the Middle Decoction) is modified. For Liver Qi stagnation and rebellion causing bloating and unrest, Jiegan Jian (Liver-Unblocking Decoction) is used. For anger stirring Liver Qi with accompanying fire, Huagan Jian (Fire-Transforming Decoction) is used. For Spleen and Lung Qi stagnation attacking upward causing pain, Zisu Yin (Perilla Leaf Decoction) is used. For Qi stagnation with Phlegm, Siqi Tang (Four-Sevenths Decoction) or Erchen Tang added with Danggui (Angelicae Sinensis Radix) is used. For Qi stagnation with fire causing bloating and irritability, Zhike Tang or Shutai Wan (Fetus-Restraining Pill) are used.
5. Wang Jiezhai stated: Regulating pregnant women lies in clearing heat and nourishing blood. Baizhu tonifies the Spleen and serves as the sovereign herb for calming the fetus; Tiaoshi Huangqin (Scutellaria Root) is the holy medicine for calming the fetus because it clears heat, making it suitable for addition in summer months. This view, though seemingly reasonable, has significant flaws that must be辨析 (analyzed). Fetal qi follows the mother's organ qi. Generally, those with Yin deficiency have more heat, and those with Yang deficiency have more cold. Using cold for cold and heat for heat restores balance. Considering ten people, three have cold, three have heat, and four are balanced. If one claims that conception inevitably increases internal heat, differing from normal people, why is it that treating Ezu requires Erchen Tang, Liujunzi Tang, Shengjiang (Zingiberis Rhizoma Recens), and Banxia (Pinelliae Rhizoma) to be effective? Does this truly indicate increased heat? Therefore, Huangqin is suitable for heat but not for cold. It is unsuitable not only for cold but also for balanced constitutions. Most pregnant women today have Qi deficiency rather than excess. Qi deficiency implies Yang deficiency; using Huangqin further may cause immediate harm or secretly damage the fetal origin and maternal Qi, leading to maternal debility or infant spleen disorders. Yet, people cannot discern the principle, regarding "holy medicine" as mandatory for all pregnancies regardless of Yin-Yang strength, causing considerable harm. As for Baizhu, although good for calming the fetus, if used improperly, its dry nature and closing Qi property make it unsuitable for Yin deficiency alone, and it requires discretion for Qi stagnation. Thus, prescribing is like beads on a plate—flexible, not rigid like a fixed peg on a zither.
Lizhai stated: If pregnancy involves insufficient Yuan Qi, fever, fatigue, or fetal unrest, use Danggui San (Angelica Powder). Due to emotional distress, add Zhike; for chest oppression, add Sugeng (Perillae Caulis); for pain, add Chaihu (Bupleuri Radix). For poor appetite or nausea, use Liujunzi Tang (Six-Gentlemen Decoction) with Zisu (Perillae Folium) and Zhike. For Ezu with vomiting, dizziness, and fatigue, use Shenju San (Ginseng and Tangerina Powder); if ineffective, use Liujunzi Tang. For Ezu with vomiting, anorexia, and irritability, use Shenju San. After a fall causing fetal movement, abdominal pain, and bleeding, use Jiao'ai Tang (Colla Corii Asini and Artemisia Decoction); if ineffective, use Bazhen Tang added with Ejiao (Colla Corii Asini) and Aiyi (Artemisiae Argyi Folium). After trauma or toxic injury causing lower back pain and shortness of breath, use Ejiao San; if ineffective, take Zhimu Wan (Anemarrhenae Pill) with decoction. After trauma causing fetal injury, bleeding, and abdominal pain, use Foshou San (Buddha's Hand Powder); if ineffective, take Zhimu Wan with Bazhen Tang. For palpitations, fear, irritability, and unrest named Zifan (Fetal Irritability), use Zhuye Tang (Bamboo Leaf Decoction). If ineffective, supplement Sini San (Four Substances Decoction) for Blood deficiency or Sijunzi Tang (Four Gentlemen Decoction) for Qi deficiency. For continuous bleeding named Tailou (Fetal Leakage), use Erhuang San (Two Yellows Powder) for Blood deficiency, or Bazhen Tang for heavy blood loss. If ineffective, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For bleeding after physical exertion, use Zhike Tang added with Shengdihuang (Rehmanniae Radix) and Shudihuang (Rehmanniae Radix Preparata); if ineffective or painful, add Danggui. For persistent bleeding, use Bazhen Tang with Ejiao and Aiyi. For intermittent pain or lower abdominal heaviness named Taotong (Fetal Pain), use Dihuang Danggui Tang (Rehmannia and Angelica Decoction); if ineffective, add Renshen (Ginseng), Baizhu, and Chenpi (Tangerina Peel). For Spleen Qi deficiency, use Sijunzi Tang with Danggui and Dihuang; for Middle Qi deficiency, use Buzhong Yiqi Tang. For puffy face and limbs resembling edema named Zizhong (Fetal Edema), use Baizhu San from Quansheng Ji; if ineffective, use Liujunzi Tang. For severe lower body swelling, use Buzhong Yiqi Tang with extra Fuling (Poria). For vomiting and diarrhea due to improper diet indicating Spleen-Stomach damage, use Liujunzi Tang. For toe swelling spreading to legs/knees with panting and unrest, or fluid between toes named Shuiqi (Water Qi), use Tianxian Teng San (Akebia Vine Powder); for weak Spleen-Stomach, combine with Sijunzi Tang; if ineffective, use Buzhong Yiqi Tang combined with Xiaoyao San. For fetal Qi attacking upward causing chest/abdominal fullness and pain named Zixuan (Fetal Suspension), use Zisu Yin. For poor appetite, combine with Sijunzi Tang; for afternoon heat, combine with Xiaoyao San. For scanty, difficult urination or stranguria named Zilin (Fetal Stranguria), use Anying San; if ineffective, combine with Bazhen Tang. For leg cramps with oliguria, urgently use Bawei Wan (Eight-Ingredient Pill); delay leads to untreatable conditions. For neck stiffness, muscle spasms, slurred speech, and profuse phlegm named Zixian (Fetal Epilepsy), use Lingyangjiao San (Antelope Horn Powder). For food stagnation with bloating/vomiting due to weak Spleen-Stomach digestion, use Liujunzi Tang; if ineffective, use Pingwei San added with Renshen and Fuling. For fetal distension or pain due to Spleen-Stomach Qi deficiency failing to support, use Antai Yin (Fetus-Calming Decoction) with Shengma (Cimicifugae Rhizoma) and Baizhu; if ineffective, use Buzhong Yiqi Tang. For umbilical/abdominal distension or urinary retention due to Spleen-Stomach Qi deficiency and fetal pressure on the bladder, use Siwu Tang added with Erchen Tang, Renshen, and Baizhu. Take on an empty stomach, then induce vomiting. After Qi settles, repeat until stable. For hematuria after overwork or fried foods due to Heat driving blood into the uterus, clear the Bladder with Xiaoyao San. For enuresis or frequency due to Liver Fire and Blood Heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). For chest/abdominal fullness, urinary obstruction, and generalized edema named Taishui Buli (Fetal Water Obstruction), use Liyu Tang (Carp Decoction); for weak Spleen-Stomach, supplement with Sijunzi Tang. Diseases share names but present differently, and vice versa; refer to the original formulas. If symptomatic treatment fails, treat according to the menstrual cycle stages.
Xu Donggao stated: Fetal unrest with lower back/abdominal pain and even bearing-down sensation is often due to Qi and Blood deficiency failing to nourish. The fetus in the womb is like fruit on a branch; if the branch withers, the fruit falls—this is natural. Women indulging in desires may stir internal Fire, causing fetal unrest and miscarriage. Generally, this falls under deficiency or Fire syndromes, addressed by clearing heat and nourishing blood. Two other causes of fetal disturbance must be known: Fetal disturbance due to maternal illness stabilizes once the maternal illness is treated; fetal disturbance due to physical trauma stabilizes after two to three doses of fetal-calming herbs.