《金匮》曰∶妇人得平脉，阴脉小弱，其人渴，不能食，无寒热，名妊娠。于法六十日当有此证。设有
医治逆者，却一月加吐下者，则绝之。
沈尧封曰∶楼全善云∶恶阻谓呕吐恶心，头眩，恶食择食是也。绝之者，谓绝止医药，候其自安也。余
尝治一二妊妇呕吐，愈治愈逆，因思“绝之”之旨，停药月余自安。
朱丹溪曰∶有妊二月，呕吐，眩晕，脉之左弦而弱，此恶阻因怒气所激。肝气既伤，又挟胎气上逆，以
茯苓半夏汤下抑青丸。
《千金》半夏茯苓汤 治妊娠阻病，心中愦闷，空烦吐逆，恶闻食气，头眩，体重，四肢百节疼烦
沉重，多卧少起，恶寒，汗出，疲极，黄瘦。
半夏 生姜（各三十铢） 干地黄 茯苓（各十八铢） 橘皮 旋复花 细辛 人参 芍药 芎 桔梗
甘草（各十二铢）
右十二味 咀，以水一斗，煮取三升，分三服。若病阻，积月日不得治，及服药冷热失候，病变客热烦
渴，口生疮者，去橘皮、细辛，加前胡、知母各十二铢；若变冷下利者，去干地黄，入桂心十二铢；若食
少，胃中虚生热，大便闭塞，小便亦少者，宜加大黄十八铢，去地黄，加黄芩六铢，余根据方服一剂，得下
后消息。看气力冷热增损，更服一剂汤，便急使茯苓丸，令能食，便强健也。忌生冷醋滑油腻。
《千金》茯苓丸 服前汤两剂后，服此即效。
茯苓 人参 桂心（熬） 干姜 半夏 橘皮（各一两） 白术 葛根 甘草 枳实（各二两）
右十味，蜜丸梧子大，饮服二十丸，渐加至三十丸，日三次。
徐蔼辉曰∶《肘后》不用干姜、半夏、橘皮、白术、葛根，只用五物。妊娠忌桂，故熬。
王孟英按∶胎前、产后，非确有虚寒脉证者，皆勿妄投热剂，暑月尤宜慎之。
又治妊娠恶阻呕吐不下食方
青竹茹 橘皮（各十八铢） 茯苓 生姜（各一两） 半夏（三十铢）
右五味，水六升，煮取二升半，分三服。
《千金》橘皮汤 治妊娠呕吐，不下食。
橘皮 竹茹 人参 白术（各十八铢） 生姜（一两） 浓朴（十二铢）
右六味，水七升，煮取二升半，分三服。
沈尧封曰∶费姓妇怀妊三月，呕吐饮食，服橘皮、竹茹、黄芩等药不效。松郡车渭津用二陈汤加旋复花、
姜皮，水煎，冲生地汁一杯，一剂吐止，四剂全愈。一医笑曰∶古方生地、半夏同用甚少。不知此方即《千
金》半夏茯苓汤，除去细辛、桔梗、芎 、白芍四味。
尧封又曰∶呕吐不外肝、胃两经病。人身脏腑，本是接壤，怀妊则腹中增了一物，脏腑机栝，为之不灵，
水谷之精微，不能上蒸为气血，凝聚而为痰饮，窒塞胃口，所以食入作呕，此是胃病；又妇人既娠，则精血
养胎，无以摄纳肝阳，而肝阳易升，肝之经脉夹胃，肝阳过升，则饮食自不能下胃，此自肝病。《千金》半
夏茯苓汤中用二陈，化痰以通胃也；用旋复，高者抑之也；用地黄，补阴吸阳也；用人参，生津养胃也。其法
可谓详且尽矣。至若细辛亦能散痰，桔梗亦能理上焦之气，芎 亦能宣血中之滞，未免升提；白芍虽能平肝
敛阴，仲景法，胸满者去之，故车氏皆不用。斟酌尽善，四剂获安，有以也。
王孟英按∶发明尽致，精义入神。
沈尧封曰∶蔡姓妇恶阻，水药俱吐。松郡医用抑青丸，立效。黄连一味为末，粥糊丸麻子大，每服二
三十丸。
尧封又曰∶肝阳上升，补阴吸阳，原属治本正理。至肝阳亢甚，滴水吐出，即有滋阴汤药，亦无所用，不
得不用黄连之苦寒，先折其太甚，得水饮通，然后以滋阴药调之，以收全效。
王孟英按∶左金丸亦妙。
沈尧封曰∶沈姓妇恶阻，水浆下咽即吐，医药杂投不应。身体骨立，精神困倦，自料必死，医亦束手。一
老妇云∶急停药，八十日当愈。后果如其言。停药者，即《金匮》“绝之”之义也。至八十日当愈一语，岂《金
匮》“六十日当有此证”之误耶？不然，何此言之验也。
尧封又曰∶朱宗承正室，甲戌秋，体倦吐食，诊之略见动脉，询得停经两月，恶阻证也。述前治法，有
效有不效。如或不效，即当停药，录半夏茯苓汤方与之，不效，连更数医。越二旬，复邀余诊。前之动脉
不见，但觉细软，呕恶日夜不止，且吐蛔两条。余曰∶恶阻无碍，吐蛔是重候。姑安其蛔以观动静，用乌梅
丸，早晚各二十丸，四日蛔止，呕亦不作。此治恶阻之变局也，故志之。
《金匮要略》说：妇女脉象平和，但尺部（阴脉）脉象细小微弱，患者感到口渴，不能进食，没有恶寒发热的表证，这称为妊娠。按照规律，怀孕六十天左右应当出现这些症状。如果此时错误地用药治疗，反而导致病情加重，一个月后出现呕吐或腹泻加剧的情况，就应当停止药物治疗，等待其自行恢复。
沈尧封说：楼全善认为，恶阻是指呕吐恶心、头晕目眩、厌恶食物或挑食的症状。“绝之”的意思，是指停止使用药物，等待身体自然安宁。我曾经治疗过几位孕妇的呕吐症，越治越严重，因此思考“绝之”的含义，停药月余后她们自然痊愈了。
朱丹溪说：有一位怀孕两个月的妇女，出现呕吐、眩晕，诊察其左脉弦而弱，这是恶阻因愤怒情绪激发所致。肝气受损，又夹杂胎气上逆，用茯苓半夏汤配合抑青丸治疗。
《千金方》中的半夏茯苓汤，治疗妊娠恶阻病，心中烦闷不适，空虚烦躁伴呕吐逆气，厌恶食物气味，头晕目眩，身体沉重，四肢关节疼痛烦扰且沉重，嗜睡少起，怕冷，出汗，极度疲劳，面色黄瘦。
药材：半夏、生姜（各三十铢）、干地黄、茯苓（各十八铢）、橘皮、旋复花、细辛、人参、芍药、川芎、桔梗、甘草（各十二铢）。
以上十二味药，切碎，用水一斗，煮取三升，分三次服用。如果病症迁延数月未治，以及服药时冷热失当，导致病变为客热烦渴、口舌生疮者，去掉橘皮、细辛，加入前胡、知母各十二铢；如果变为寒冷下利者，去掉干地黄，加入桂心十二铢；如果饮食减少，胃中虚而生热，大便闭塞，小便也少者，宜加大黄十八铢，去掉地黄，加入黄芩六铢，其余按原方服用一剂，根据排便后的情况斟酌调整。观察体力强弱和寒热变化增减药量，再服一剂汤药，随后急使服用茯苓丸，以恢复食欲，增强体质。忌食生冷、醋、滑腻及油腻食物。
《千金方》中的茯苓丸：在服用前述汤药两剂后，服用此丸即见效。
药材：茯苓、人参、桂心（熬制）、干姜、半夏、橘皮（各一两）、白术、葛根、甘草、枳实（各二两）。
以上十味药，炼蜜为丸，如梧桐子大小，温水送服二十丸，逐渐增加至三十丸，每日三次。
徐蔼辉说：《肘后备急方》中不用干姜、半夏、橘皮、白术、葛根，只用五味药。因为妊娠忌用桂枝，所以这里用熬制的桂心。
王孟英按语：胎前、产后，如果没有确切的虚寒脉证，都不要妄投热性药物，夏季尤其应当谨慎。
又治疗妊娠恶阻呕吐不能进食的方子：
药材：青竹茹、橘皮（各十八铢）、茯苓、生姜（各一两）、半夏（三十铢）。
以上五味药，用水六升，煮取二升半，分三次服用。
《千金方》中的橘皮汤：治疗妊娠呕吐，不能进食。
药材：橘皮、竹茹、人参、白术（各十八铢）、生姜（一两）、厚朴（十二铢）。
以上六味药，用水七升，煮取二升半，分三次服用。
沈尧封说：一位费姓妇女怀孕三个月，呕吐饮食，服用橘皮、竹茹、黄芩等药无效。松江人车渭津用二陈汤加旋复花、姜皮，水煎，冲入生地汁一杯，一剂后呕吐停止，四剂后完全痊愈。有一位医生嘲笑说：古方中生地和半夏同用的情况很少。不知道这个方子就是《千金方》的半夏茯苓汤，去掉了细辛、桔梗、川芎、白芍四味药。
沈尧封又说：呕吐不外乎是肝、胃两经的疾病。人体的脏腑本是相邻接的，怀孕后腹中多了一个胎儿，脏腑的气机运转变得不灵活，水谷的精微物质不能向上蒸腾化为气血，凝聚而成痰饮，阻塞胃口，所以食物进入后作呕，这是胃病；另外妇人怀孕后，精血用来滋养胎儿，无法摄纳肝阳，导致肝阳容易上升，肝的经脉夹行于胃旁，肝阳过度上升，则饮食自然不能下行入胃，这是肝病。《千金方》半夏茯苓汤中使用二陈汤（陈皮、半夏等），是为了化痰以疏通胃气；使用旋复花，是遵循“高者抑之”的原则；使用地黄，是为了补阴以吸引潜藏阳气；使用人参，是为了生津养胃。这种方法可谓详尽完备。至于细辛也能散痰，桔梗也能调理上焦之气，川芎也能宣通血中之滞，未免有升提之弊；白芍虽然能平肝敛阴，但张仲景的法度中，胸满者要去掉它，所以车氏都没有使用。斟酌得十分完善，四剂便获安宁，是有原因的。
王孟英按语：分析透彻，精义入神。
沈尧封说：一位蔡姓妇女患恶阻，水和药都吐出来。松江医生用抑青丸，立即见效。黄连一味研成末，用米粥糊制成麻子大小的丸药，每次服用二三十丸。
沈尧封又说：肝阳上升，通过补阴来吸引潜藏阳气，原本属于治本的正理。但如果肝阳亢盛到极点，连滴水都吐出来，即使有滋阴的汤药，也没有用处，不得不使用黄连的苦寒之性，先折服其过于亢盛的势头，待水饮能够通行后，再用滋阴药调理，以收全效。
沈尧封说：一位沈姓妇女患恶阻，水浆咽下即吐，各种药物混合使用均无效。身体消瘦如柴，精神困倦，自料必死无疑，医生也束手无策。一位老妇人说：赶快停药，八十天就会痊愈。结果果然像她所说的那样。所谓“停药”，就是《金匮要略》中“绝之”的含义。至于“八十天当愈”这句话，难道是《金匮要略》中“六十日当有此证”的错误吗？不然的话，为什么这句话如此灵验呢？
沈尧封又说：朱宗承的正室夫人，甲戌年秋天，身体疲倦呕吐食物，诊察脉搏略微见到动脉，询问得知停经两个月，是恶阻证。叙述之前的治疗方法，有的有效有的无效。如果不效，就应当停药，抄录半夏茯苓汤方给她，仍无效，接连更换了几位医生。过了二十天，再次邀请我诊治。之前见到的动脉不见了，只觉得脉象细软，呕吐恶心日夜不止，并且吐出两条蛔虫。我说：恶阻本身无大碍，吐蛔虫是重症。姑且安定蛔虫以观察动静，用乌梅丸，早晚各服二十丸，四天蛔虫停止吐出，呕吐也不再发作。这是治疗恶阻的变局，所以记录下来。
Jingui Yaolue (Essential Prescriptions from the Golden Cabinet) states: In women, if the pulse is generally peaceful but the Yin pulse (pulse felt at the deep position on the cun guan chi positions, often corresponding to the kidney/essence level) is slightly small and weak, and the person experiences thirst, inability to eat, without aversion to cold or fever, this is named pregnancy. According to the method, these symptoms should appear around the sixtieth day. If medical treatment is applied incorrectly, causing the condition to worsen, and after one month vomiting or diarrhea intensifies, one should cease medication (stop using drugs) and wait for self-recovery.
Shen Yaofeng stated: Lou Quanshan said that "Ezu" (Morning Sickness/Pregnancy Nausea) refers to vomiting, nausea, dizziness, aversion to food, or picky eating. "Ceasing medication" means stopping the use of medicine and waiting for the body to settle naturally. I once treated a few pregnant women with vomiting; the more they were treated, the worse it became. Thus, I pondered the meaning of "ceasing medication," stopped prescribing for over a month, and they recovered spontaneously.
Zhu Danxi said: A woman two months pregnant experienced vomiting and dizziness. Her left pulse was wiry and weak. This Ezu was triggered by anger. Since the Liver Qi was injured and further carried upward by the fetal Qi, she was treated with Fuling Banxia Tang (Poria and Pinellia Decoction) followed by Yiqing Wan (Suppress Green Pill).
Qianjin Fang's Banxia Fuling Tang treats pregnancy obstruction disease, characterized by mental restlessness, empty irritability with vomiting and reflux, aversion to food odors, dizziness, heaviness of the body, pain and heaviness in all limbs and joints, excessive sleepiness with little rising, aversion to cold, sweating, extreme fatigue, and sallow emaciation.
Ingredients: Banxia (Pinelliae Rhizoma), Shengjiang (Zingiberis Rhizoma Recens) (each 30 zhu); Gan Dihuang (Rehmanniae Radix Preparata), Fuling (Poria) (each 18 zhu); Ju Pi (Citri Reticulatae Pericarpium), Xuanfu Hua (Inulae Flos), Xixin (Asari Radix et Rhizoma), Renshen (Ginseng Radix et Rhizoma), Shaoyao (Paeoniae Radix Rubra or Alba), Xiong (Ligustici Chuanxiong Rhizoma), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma) (each 12 zhu).
The above twelve ingredients are crushed, boiled in ten dou of water until three sheng remain, divided into three doses. If the obstruction persists for months without treatment, or if improper hot/cold medication leads to pathogenic heat causing irritability, thirst, and mouth sores, remove Ju Pi and Xixin, add Qian Hu (Peucedani Radix) and Zhi Mu (Anemarrhenae Rhizoma), each 12 zhu. If it transforms into cold-type diarrhea, remove Gan Dihuang and add Guixin (Cinnamomi Ramulus Cortex), 12 zhu. If food intake is low, stomach deficiency generates heat, stool is blocked, and urine is scant, add Dahuang (Rhei Radix et Rhizoma), 18 zhu, remove Dihuang, add Huangqin (Scutellariae Radix), 6 zhu. Take one dose according to the formula, then adjust based on bowel movement. Observe strength and cold/heat signs to modify dosage, take another dose of decoction, then urgently administer Fuling Wan (Poria Pill) to restore appetite and strengthen the body. Avoid raw, cold, vinegar, slippery, and greasy foods.
Qianjin Fang's Fuling Wan: After taking two doses of the aforementioned decoction, taking this pill yields efficacy.
Ingredients: Fuling (Poria), Renshen (Ginseng Radix et Rhizoma), Guixin (Cinnamomi Ramulus Cortex, processed), Ganjiang (Zingiberis Rhizoma), Banxia (Pinelliae Rhizoma), Ju Pi (Citri Reticulatae Pericarpium) (each 1 liang); Baizhu (Atractylodis Macrocephalae Rhizoma), Gegen (Puerariae Lobatae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Zhishi (Aurantii Fructus Immaturus) (each 2 liang).
The above ten ingredients are made into pills the size of wu zi (wu-tzu seeds) with honey. Take 20 pills with warm water, gradually increasing to 30 pills, three times daily.
Xuaihui noted: Zhouhou Fang does not use Ganjiang, Banxia, Ju Pi, Baizhu, or Gegen, using only five ingredients. Cinnamon is contraindicated in pregnancy, hence the use of processed Guixin.
Wang Mengying commented: For pre- and postpartum periods, unless there is definitive evidence of deficiency-cold pulse and symptoms, do not recklessly administer hot-natured agents, especially in summer.
Another prescription for treating pregnancy Ezu vomiting with inability to eat:
Ingredients: Qing Zhuru (Bambusae Caulis in Taenia), Ju Pi (Citri Reticulatae Pericarpium) (each 18 zhu); Fuling (Poria), Shengjiang (Zingiberis Rhizoma Recens) (each 1 liang); Banxia (Pinelliae Rhizoma) (30 zhu).
The above five ingredients are boiled in six sheng of water until two and a half sheng remain, divided into three doses.
Qianjin Fang's Jupi Tang treats pregnancy vomiting with inability to eat.
Ingredients: Ju Pi (Citri Reticulatae Pericarpium), Zhuru (Bambusae Caulis in Taenia), Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 18 zhu); Shengjiang (Zingiberis Rhizoma Recens) (1 liang); Houpo (Magnoliae Officinalis Cortex) (12 zhu).
The above six ingredients are boiled in seven sheng of water until two and a half sheng remain, divided into three doses.
Shen Yaofeng said: A Mrs. Fei, three months pregnant, vomited food and drink. Medications including Jupi, Zhuru, and Huangqin were ineffective. Che Weijin from Songjiang used Erchen Tang (Two-Aged Powder) plus Xuanfu Hua and Jiangpi (Zingiberis Pericarpium), decocted in water, mixed with one cup of Shengdi juice (Rehmanniae Radix Preparata Juice). One dose stopped vomiting, four doses resulted in full recovery. A physician laughed, saying: It is rare for Shengdi and Banxia to be used together in ancient formulas. He did not know this formula is essentially Qianjin Fang's Banxia Fuling Tang, minus Xixin, Jiegeng, Xiong, and Shaoyao.
Shen Yaofeng further stated: Vomiting primarily involves the Liver and Stomach meridians. The organs and viscera in the human body are adjacent. During pregnancy, an additional entity (the fetus) increases in the abdomen, making the mechanism of the viscera less agile. The essence and qi of food and grain cannot steam upward to transform into blood and qi, instead condensing into phlegm-fluids that obstruct the stomach gate, causing food to induce vomiting upon entry; this is a Stomach disease. Furthermore, upon pregnancy, essence and blood nourish the fetus, leaving insufficient resources to control Liver Yang, causing Liver Yang to rise easily. The Liver meridian runs alongside the Stomach; excessive rising of Liver Yang prevents food from descending into the Stomach; this is a Liver disease. In Qianjin Fang's Banxia Fuling Tang, Erchen Tang components are used to resolve phlegm and unblock the Stomach; Xuanfu Hua is used following the principle of "suppressing what is high"; Dihuang is used to nourish Yin and attract/subdue Yang; Renshen is used to generate fluids and nourish the Stomach. This method is indeed detailed and thorough. Although Xixin can scatter phlegm, Jiegeng can regulate Upper Jiao Qi, and Xiong can promote blood circulation, they may have ascending properties; although Shaoyao can calm the Liver and consolidate Yin, Zhang Zhongjing's method dictates removing it when chest fullness is present; thus, Mr. Che omitted them. The deliberation was perfect, resulting in peace after four doses, which is justified.
Wang Mengying commented: The analysis is exhaustive, and the profound meaning is divine.
Shen Yaofeng said: A Mrs. Cai suffered from Ezu, vomiting both water and medicine. A doctor from Songjiang used Yiqing Wan (Suppress Green Pill), which had immediate effect. Huanglian (Coptidis Rhizoma) alone was powdered, formed into pills the size of hemp seeds using rice paste, with a dose of 20-30 pills each time.
Shen Yaofeng further stated: Rising Liver Yang, treated by nourishing Yin to subdue Yang, is originally the correct principle for treating the root. However, if Liver Yang becomes excessively hyperactive to the point where even a drop of water is vomited, even Yin-nourishing decoctions are useless. One must use the bitter-cold nature of Huanglian to first suppress its excessive intensity. Once fluid metabolism resumes, then Yin-nourishing medicines are used to regulate, achieving complete efficacy.
Wang Mengying commented: Zuojin Wan (Left Metal Pill) is also excellent.
Shen Yaofeng said: A Mrs. Shen suffered from Ezu, vomiting immediately after swallowing any liquid. Various medications failed. She became emaciated as bone, mentally exhausted, believing death was inevitable; doctors were helpless. An old woman said: Stop medication immediately; you will recover in eighty days. The result matched her words. "Stopping medication" is the meaning of "Ceasing" (Jue) in Jingui Yaolue. Regarding the phrase "recover in eighty days," is it an error for "symptoms appear at sixty days" in Jingui Yaolue? Otherwise, why would this statement be so accurate?
Shen Yaofeng further stated: The principal wife of Zhu Zongcheng, in autumn of the Ji Xu year, experienced fatigue and vomiting. Her pulse showed slight arterial characteristics. Inquiry revealed amenorrhea for two months, confirming Ezu. Previous treatments had mixed results. When ineffective, medication should be stopped. I provided the Banxia Fuling Tang formula. It remained ineffective, and several other doctors were consulted. Twenty days later, I was invited again. The previous arterial pulse was gone, replaced by a fine and soft pulse. Vomiting and nausea persisted day and night, and two roundworms were vomited. I said: Ezu itself is not dangerous; vomiting roundworms is a severe symptom. Temporarily calm the roundworms to observe dynamics. Use Wumei Wan (Mume Pill), twenty pills morning and evening. After four days, roundworm vomiting ceased, and general vomiting stopped. This is a variant situation in treating Ezu, so it is recorded.