（妊妇烦名子烦）
丹溪曰∶因胎元壅郁热气所致。
沈尧封曰∶子烦病因∶曰痰、曰火、曰阴亏。因痰者，胸中必满。仲景云，心中满而烦，宜瓜蒂散，此
是吐痰法。妊妇禁吐，宜二陈汤加黄芩、竹茹、旋复花。阴亏火甚者，仲景黄连阿胶汤最妙。
汪 庵《医方集解》有竹叶汤一方，治妊娠心惊胆怯，终日烦闷，名子烦。因受胎四五月，相火用事；或
盛夏君火大行，俱能乘肺以致烦闷。胎动不安，亦有停痰积饮，滞于胸膈，以致烦闷者。
麦冬（钱半） 茯苓 黄芩（一钱） 人参（五分） 淡竹叶（十片）
竹叶清烦，黄芩消热，麦冬凉肺。心火乘肺，故烦出于肺。茯苓安心，人参补虚，妊娠心烦，固多虚
也。如相火盛者，单知母丸；君火盛者，单黄连丸；心神不安者，朱砂安神丸。切不可作虚烦，用栀豉等药
治之。一方茯苓为君，无人参，有防风、知母，有痰者加竹沥。
严氏紫苏散 许叔微曰∶治怀胎近上，胀满痰痛，谓之子悬。陈良甫曰∶妊至四五月，君相二火养胎，
热气逆上，胎凑心胸，腹满痞闷，名曰子悬。用此加黄芩、山栀之类。一方无川芎，名七宝散。许叔微云∶
六七月子悬者用之，数数有验，不十服，胎便近下。
紫苏（一钱） 腹皮 人参 川芎 橘皮 白芍 当归（各三分） 甘草（一分）
锉分三服，水一盏，生姜四片，葱白煎，去渣服。
徐蔼辉曰∶去川芎，因避升提之故。
汪 庵曰∶治胎气不和，凑上胸腹，腹满，头疼，心腹腰胁皆痛，名子悬。因下焦气实，相火旺盛，举
胎而上，上逼心胸也。每服止用苏叶一钱，当归七分，腹皮以下皆五分，甘草二分，无葱白；心腹痛者，加
木香、延胡。
陈来章曰∶芎、归、芍药以和其血；苏、橘、大腹以顺其气。气顺血和，则胎安矣。既利其气，复以
人参、甘草养其气者。顺则顺其邪逆之气，养则养其冲和之气也。
徐蔼辉曰∶延胡动血，恐未可用。
赵养葵有命门虚寒，胎上凑心就暖一说。
沈尧封曰∶此是百中仅一，非实是虚寒脉证，热药不可尝试。
沈尧封曰∶郁姓妇怀妊九月，偶因劳动，遂觉腹痛，胎渐升至胸中，气塞不通，忽然狂叫咬人，数人
扶持不住，病名子上撞心，即子悬之最重者。用旋复代赭汤去参、枣，连灌两剂，胎堕得生。又一妇，证
亦如之，服前药，胎堕而死。
尧封又曰∶陆检修正室，子上撞心。江稳婆教磨代赭汁服，遂产两子。一子在上，横于心下，一子撞
着上子，故经一昼夜不至撞心，得不死，产下遂安。
葱白汤 治胎上逼心烦闷，又治胎动困笃。本草云∶葱白通阳安胎。楼全善曰∶此方神效，脉浮滑者
宜之。葱白二七茎，浓煮汁饮之，胎未死即安，已死即出。未效再服。
陈良甫曰∶一妇孕七个月远归，忽然胎上冲作痛，坐卧不安。两医治之无效，遂云胎已死。用蓖麻子研
烂，和麝香贴脐中以下之，命在呼吸。余诊视∶两尺脉绝，他脉和平。余问二医作何证治之？答云∶死胎。
问何以知之？曰∶两尺沉绝，以此知之。余曰∶此说出何书？二医无答。余曰∶此子悬也。若是死胎，却
有辨处∶面赤舌青，子死母活；面青舌赤吐沫，母死子活；唇舌俱青，子母俱死。今面不赤，舌不青，其
子未死，是胎上逼心，宜以紫苏饮。连进至十服，而胎近下矣。
李氏曰∶子悬证，火盛极，一时心气闷绝而死，紫苏饮连进可救。若两尺脉绝者，有误服动胎药，子死
腹中，则憎寒，手指唇爪俱青，全以舌为证验，芎归汤救之。
王孟英按∶戊申秋，荆人妊八月，而患咳嗽碍
眠，鼻衄如射，面浮肢肿，诸药不应。谛思其故，素属阴虚，内火自盛，胎因火动，上凑心胸，肺受其冲，
咳逆乃作，是不必治嗽，仍当以子悬治之。因以七宝散去参、芍、生姜，为其胸满而内热也；加生石膏以
清阳明之火；熟地黄以摄根蒂之阴。投匕即安。今年冬仲，亦以八月之娠，而悲哀劳瘁之余，胎气冲逆，眩
晕嗽痰，脘胀便溏，苔黄口渴。予蠲饮六神汤去胆星、茯苓，加枳实、苏叶、大腹皮以理气开郁；黄芩、栀
子、竹茹以清热安胎。一剂知，二剂已。凡子悬因于痰滞者，余每用此法，无不应如桴鼓。
沈尧封说：子烦的病因，归结为痰、火、阴亏三种。因痰引起的，胸中必然感到胀满。张仲景说：“心中胀满而心烦，适宜用瓜蒂散”，这是涌吐痰涎的方法。但孕妇禁止使用吐法，适宜用二陈汤加入黄芩、竹茹、旋覆花。若是阴液亏损且火势旺盛的，张仲景的黄连阿胶汤最为巧妙。
汪昂在《医方集解》中记载有一方叫竹叶汤，治疗妊娠期间心惊胆怯、终日烦闷，名为子烦。这是因为受孕四五月时，相火当令；或者是盛夏时节君火盛行，都能乘袭肺脏导致烦闷。胎动不安，也有因为停痰积饮停滞于胸膈，而导致烦闷的情况。
麦冬（半钱） 茯苓 黄芩（一钱） 人参（五分） 淡竹叶（十片）
竹叶清除烦热，黄芩消除热邪，麦冬清凉肺金。心火乘袭肺脏，所以烦闷出于肺。茯苓安心神，人参补虚损，妊娠心烦，大多属于虚证。如果相火旺盛，单用知母丸；君火旺盛，单用黄连丸；心神不安，用朱砂安神丸。切不可当作虚烦，用栀子豉汤等药物治疗。另一方案以茯苓为君药，无人参，有防风、知母，有痰者加竹沥。
严氏紫苏散 许叔微说：治疗怀孕后期，胀满痰痛，称为子悬。陈良甫说：怀孕到四五月，君火和相火共同滋养胎元，热气逆上，胎儿凑近心胸，腹部胀满痞闷，名叫子悬。使用此方加入黄芩、山栀之类。另一方没有川芎，名叫七宝散。许叔微说：怀孕六七个月出现子悬的用此方，屡次有效，不超过十服，胎儿就会下降。
紫苏（一钱） 大腹皮 人参 川芎 橘皮 白芍 当归（各三分） 甘草（一分）
汪昂说：治疗胎气不和，冲凑胸腹，腹部胀满，头痛，心腹腰胁都疼痛，名叫子悬。因为下焦气实，相火旺盛，托举胎儿而上，向上逼压心胸。每服只需用苏叶一钱，当归七分，大腹皮以下药物皆用五分，甘草二分，不加葱白；心腹痛者，加木香、延胡索。
陈来章说：川芎、当归、芍药用来调和血液；紫苏、橘皮、大腹皮用来顺理气机。气顺血和，则胎儿安定了。既然顺理了气机，又用人参、甘草来养护正气。所谓“顺”，是顺应其邪气逆乱之气；所谓“养”，是养护其冲和之气。
赵养葵有一种说法，认为命门虚寒，会导致胎气上凑心脏，需要温暖。
沈尧封说：这种情况百中仅见一例，如果不是确凿的虚寒脉证，热性药物不可尝试。
沈尧封说：有一位郁姓妇人怀孕九月，偶然因为劳累，便觉得腹痛，胎儿逐渐升至胸中，气塞不通，忽然狂叫咬人，几个人扶持不住，病名叫做“子上撞心”，这就是子悬中最严重的情况。用旋复代赭汤去掉人参、大枣，连续灌服两剂，胎儿堕下得以保全性命。又有一位妇人，症状也是如此，服用前面的药物，胎儿堕下而死。
尧封又说：陆检修正室，出现子上撞心。江稳婆教她磨代赭石汁服用，于是产下两个儿子。一个儿子在上面，横在心下，另一个儿子撞击上面的儿子，所以经过一昼夜不至于撞到心脏，得以不死，产后便平安无事。
葱白汤 治疗胎气上逼导致的心烦闷，又治疗胎动危急。本草书说：葱白通阳安胎。楼全善说：此方神效，脉象浮滑的适宜使用。葱白十四茎，浓煮汁饮用，胎儿未死即安，已死即排出。无效再服。
陈良甫说：一位妇人怀孕七个月远行归来，忽然胎气上冲作痛，坐卧不安。两位医生治疗无效，便说胎儿已经死了。用蓖麻子研烂，和麝香贴在脐中以下使其下降，性命危在旦夕。我诊视：两尺脉绝，其他脉象平和。我问两位医生诊断为何证？回答说：死胎。问怎么知道的？说：两尺脉沉绝，以此知道。我说：这个说法出自哪本书？两位医生无言以对。我说：这是子悬。如果是死胎，却有辨别之处：面赤舌青，子死母活；面青舌赤吐沫，母死子活；唇舌俱青，子母俱死。现在面色不赤，舌色不青，胎儿未死，这是胎气上逼心脏，适宜用紫苏饮。连续服用至十服，胎儿就下降了。
李氏说：子悬证，火盛极，一时心气闷绝而死，紫苏饮连续服用可以救治。如果两尺脉绝的，有误服动胎药，子死腹中，则憎恶寒冷，手指嘴唇指甲都发青，完全以舌象作为验证，用芎归汤救治。
王孟英按语：戊申年秋天，我的妻子怀孕八月，却患咳嗽影响睡眠，鼻出血如喷射状，面部浮肿肢体肿胀，各种药物无效。仔细思考其原因，素体阴虚，内火自然旺盛，胎气因火而动，上凑心胸，肺受其冲撞，咳逆于是发作，这不必治咳嗽，仍应当按子悬治疗。因此用七宝散去掉人参、芍药、生姜，因为她胸满且内热；加生石膏以清阳明之火；熟地黄以固摄根本之阴。投药即刻安宁。今年冬季中旬，也是八月妊娠，而在悲哀劳瘁之后，胎气冲逆，眩晕咳嗽有痰，胃脘胀满大便溏薄，苔黄口渴。我用蠲饮六神汤去掉胆南星、茯苓，加枳实、苏叶、大腹皮来理气开郁；黄芩、栀子、竹茹来清热安胎。一剂见效，二剂痊愈。凡是子悬因痰滞引起的，我每次都用这个方法，没有不灵验如响应的。
(Fetal restlessness in pregnant women is called "Zi Fan")
Zhu Danxi stated: This is caused by the stagnation and郁 (depression/stagnation) of heat qi due to the fetal origin.
Shen Yaofeng stated: The etiology of Zi Fan can be summarized into three categories: phlegm, fire, and yin deficiency. When caused by phlegm, there must be a sensation of fullness in the chest. Zhang Zhongjing said, "Fullness in the heart with restlessness is suitable for Gouti San," which is a method of inducing vomiting to expel phlegm. However, vomiting is contraindicated in pregnant women; it is suitable to use Erchen Tang added with Huangqin (Scutellariae Radix), Zhuru (Bambusae Caulis in Taenia), and Xuanfuhua (Inulae Flos). In cases of severe yin deficiency with hyperactive fire, Zhang Zhongjing's Huanglian Ejiao Tang is most excellent.
Wang Ang, in *Yifang Jijie*, recorded a formula called Zhuye Tang, used to treat pregnancy-induced palpitations, timidity, and daily restlessness, named Zi Fan. This occurs because during the fourth or fifth month of conception, Ministerial Fire is dominant; or during midsummer when Sovereign Fire prevails excessively, both can invade the Lung causing restlessness. Restless fetus may also result from retained phlegm and accumulated fluid stagnating in the chest and diaphragm, leading to restlessness.
*Ophiopogonis Radix* (Ban Qian / Half a Qian), *Poria*, *Scutellariae Radix* (Yi Qian / One Qian), *Ginseng Radix et Rhizoma* (Wu Fen / Five Fen), *Lophatheri Herba* (Ten slices).
Zhuye clears restlessness, Huangqin eliminates heat, and Maidong cools the Lung. Since Heart Fire invades the Lung, restlessness originates from the Lung. Fuling calms the mind, Renshen tonifies deficiency; pregnancy-related restlessness is mostly due to deficiency. If Ministerial Fire is excessive, use Zhimu Wan alone; if Sovereign Fire is excessive, use Huanglian Wan alone; if the spirit is unsettled, use Zhusha Anshen Wan. Do not mistake this for deficiency-heat and treat it with Zhizi Chi Tang or similar medications. Another prescription uses Fuling as the sovereign herb, without Renshen, but includes Fangfeng and Zhimu; add Zhuli (Bamboo Sap) if phlegm is present.
Yan Shi Zisu San. Xu Shuwei stated: It treats distension, fullness, and phlegmatic pain near the end of pregnancy, termed "Zi Xuan" (Fetal Suspension). Chen Liangfu stated: At four or five months of pregnancy, Sovereign and Ministerial Fires nourish the fetus. Heat qi reverses upward, the fetus crowds the heart and chest, causing abdominal fullness and stifling oppression, named Zi Xuan. Use this formula added with Huangqin and Shanzhi. Another variant without Chuanxiong is named Qibao San. Xu Shuwei said: For Zi Xuan occurring at six or seven months, this formula is effective; within ten doses, the fetus descends.
*Perillae Folium* (Yi Qian), *Aurantii Fructus* (Dafupi), *Ginseng Radix et Rhizoma*, *Chuanxiong Rhizoma*, *Citri Reticulatae Pericarpium*, *Paeoniae Radix Alba*, *Angelicae Sinensis Radix* (each San Fen / Three Fen), *Glycyrrhizae Radix et Rhizoma* (Yi Fen / One Fen).
Crude drugs are divided into three doses. Decoct with one cup of water, four slices of fresh ginger, and white parts of scallion. Strain and take.
Xu Aihui stated: Chuanxiong is removed to avoid its ascending and lifting properties.
Wang Ang stated: It treats disharmony of fetal qi rushing to the chest and abdomen, causing abdominal fullness, headache, and pain in the heart, abdomen, lower back, and hypochondrium, named Zi Xuan. This is due to excess qi in the lower jiao and hyperactive Ministerial Fire, lifting the fetus upward and pressing against the heart and chest. Each dose should only use Su Ye (Perilla Leaf) Yi Qian, Danggui (Angelicae Sinensis Radix) Qi Fen, and Dafupi and other herbs Wu Fen, Gancao (Glycyrrhizae Radix et Rhizoma) Er Fen, without scallion white; for heart and abdominal pain, add Muxiang (Aucklandiae Radix) and Yanhusuo (Corydalis Rhizoma).
Chen Laizhang stated: Chuanxiong, Danggui, and Shaoyao harmonize the blood; Zisu (Perilla Leaf), Ju Pi (Citri Reticulatae Pericarpium), and Dafupi (Arecae Pericarpium) regulate the qi. When qi flows smoothly and blood is harmonized, the fetus is secured. Having regulated the qi, Renshen and Gancao are used to nourish the qi. "Regulating" means smoothing the rebellious qi of pathogenic factors; "nourishing" means maintaining the harmonious qi of the Middle Jiao.
Xu Aihui stated: Yanhusuo moves blood and might be contraindicated.
Zhao Yangkui proposed that Mingmen (Gate of Life) deficiency-cold causes fetal qi to rush to the heart, requiring warming.
Shen Yaofeng stated: This scenario occurs in only one out of a hundred cases. Unless there are definitive deficiency-cold pulse and syndrome manifestations, hot-natured medicines should not be attempted.
Shen Yaofeng stated: A surnamed Yu woman, nine months pregnant, felt abdominal pain after accidental exertion. The fetus gradually rose to the chest, blocking qi flow. She suddenly screamed and bit people, unable to be restrained by several attendants. This condition is called "Shangzi Zhuangxin" (Upper Child Hitting the Heart), the most severe form of Zi Xuan. Using Xuanfu Daizhe Tang without Renshen and Dazao, administered continuously for two doses, the fetus was expelled, saving her life. Another woman had identical symptoms; taking the previous medication resulted in fetal expulsion and her death.
Yaofeng further stated: The principal wife of Lu Jianxiu suffered from Shangzi Zhuangxin. Midwife Jiang advised grinding Daizhe Shi (Magnetitum) juice for ingestion, resulting in the birth of two sons. One son was positioned above, lying across below the heart; the second son collided with the first, preventing him from hitting the heart for twenty-four hours, thus avoiding death. After delivery, she recovered safely.
Congbai Tang treats fetal qi pressing upward causing heart restlessness and oppression, and also treats critical fetal movement. Materia Medica states: Congbai (Allii Fistulosi Bulbus) unblocks yang and secures the fetus. Lou Quanshan stated: This formula is miraculous; it is suitable for floating and slippery pulses. Boil fourteen stalks of Congbai in thick decoction and drink. If the fetus is alive, it will settle; if dead, it will be expelled. Repeat if ineffective.
Chen Liangfu stated: A woman returned from a long journey at seven months of pregnancy and suddenly experienced fetal qi rushing upward with pain, unable to sit or lie comfortably. Two physicians failed to treat her and declared the fetus dead. They applied mashed castor beans mixed with musk below the navel to induce descent, leaving her life hanging by a thread. I examined her: the radial pulses at both chi positions were absent, while other pulses were peaceful. I asked the two physicians for their diagnosis. They replied: Dead fetus. I asked how they knew. They said: Because the chi pulses were deep and absent. I asked: Which book does this theory come from? The physicians had no answer. I said: This is Zi Xuan. If it were a dead fetus, there would be distinguishing signs: red face and blue tongue indicate fetal death with maternal survival; blue face, red tongue, and foaming indicate maternal death with fetal survival; blue lips and tongue indicate death of both mother and fetus. Currently, her face is not red, and her tongue is not blue, indicating the fetus is alive. This is fetal qi pressing on the heart; Zisu Yin is appropriate. After ten doses, the fetus descended.
Li Shi stated: In Zi Xuan syndrome, extreme fire excess can cause sudden cardiac qi obstruction and death; continuous administration of Zisu Yin can save the patient. If the chi pulses are absent, it may be due to mistakenly administering abortifacients, resulting in fetal death in utero. Symptoms include aversion to cold, and cyanosis of fingers, lips, and nails. Diagnosis relies entirely on the tongue; Xiong Gui Tang is used for rescue.
Wang Mengying’s commentary: In autumn of the Wushen year, my wife, eight months pregnant, suffered from coughing disturbing sleep, projectile epistaxis, facial edema, and limb swelling. Various medications were ineffective. Upon careful consideration, her constitution was inherently yin-deficient with internal fire hyperactivity. The fetus moved due to fire, rushing to the heart and chest, impacting the lungs, causing cough and reverse qi. Thus, treating the cough directly is unnecessary; instead, treat as Zi Xuan. Therefore, I used Qibao San removing Renshen, Shaoyao, and Shengjiang, due to her chest fullness and internal heat; added Shigypsum (Gypsum Fibrosum) to clear Yangming fire; and Shudihuang (Rehmanniae Radix Preparata) to secure the root yin. One dose brought immediate relief. In mid-winter of this year, again at eight months of pregnancy, following grief and exhaustion, fetal qi rebelled upward, causing dizziness, cough with phlegm, epigastric distension, loose stools, yellow coating, and thirst. I used Juan Yin Liu Shen Tang removing Dansheng (Arisaematis Cum Bile) and Fuling, adding Zhishi (Aurantii Fructus Immaturus), Zisu Ye (Perillae Folium), and Dafupi (Arecae Pericarpium) to regulate qi and open depression; Huangqin, Zhizi (Gardeniae Fructus), and Zhuru to clear heat and calm the fetus. One dose showed improvement, two doses cured. For all cases of Zi Xuan caused by phlegm stagnation, I employ this method, achieving results as promptly as a drumstick striking a drum.