沈尧封曰∶子烦病因，曰痰、曰火、曰阴亏。因痰者，胸中必满，宜二陈加黄芩、竹茹、旋复花。阴亏火
盛，仲景地黄阿胶汤最妙。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，以致烦躁，胎动不安。亦有停痰积饮，滞于胸膈以致烦躁者。
麦冬钱半，茯苓、黄芩各一钱，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。神不安者，
朱砂安神丸。切不可作虚损，用栀豉等药治之。一方茯苓为主，无人参，有防风。一方有防风、知母，无人参，
有痰者加竹沥。
薛立斋治一妊妇，烦热吐痰，恶热，恶心头晕。此脾虚风痰为患，用半夏白术天麻汤，以补元气、祛风邪，
渐愈。惟头昏未痊，乃用补中益气汤加蔓荆子，以升补阳气而愈。
一妊妇烦热兼咽间作痛，用知母散（知母、麦冬、黄 、子芩、赤苓、甘草。）加山栀、竹沥，以清肺
金而愈。后内热咳嗽，小便自遗，用补中益气加麦冬、山栀，以补肺气，滋肾水而痊。（雄按∶后治未妥。）
薛立斋治一妊妇，停食腹满，呕吐吞酸，作泻不食。以为饮食停滞，兼肝木伤脾土，用六君子汤以健脾胃，
加苍术、浓朴以消饮食，吴茱萸、制黄连以清肝火，诸症悉愈。又以六君加砂仁调理，而脾土乃安。
一娠妇呕吐胁胀，或寒热往来，面色青黄，此木旺而克脾土。用六君子加柴胡、桔梗、枳壳而安。
一娠妇胸胁胀痛，吐痰不食，此脾胃虚而饮食为痰。用半夏茯苓汤渐愈，又用六君子加枳壳、苏梗、桔梗
而饮食如常。后因恚怒，胁胀不食，吐痰恶心，用半夏茯苓汤加柴胡、山栀而愈。（立斋治娠妇，亦时用半夏。）
一妊妇因怒，寒热，胸胁胀痛，呕吐不食，症如伤寒，此怒动肝火，脾气受伤也。用六君子加柴胡、山栀、
枳壳、丹皮而愈。但内热口干，用四君子加芎、归、升麻而安。（雄按∶丹皮忌用。）
一妊妇霍乱已止，但不进饮食，口内味酸，泛行消导宽中。薛曰∶此胃气伤而虚热也，当服四君子汤。彼
不信，乃服人参养荣汤，呕吐酸水，其胎不安，是药复伤也。仍与四君子汤，俾煎熟，令患者嗅药气，不作呕，
则呷少许。恐复呕，则胎为钓动也，如是旬余而愈。（胃虚固不待言，既作酸，则犹有湿热，专用四君犹未尽
合，否则人参养荣亦补剂，何以反加呕酸耶？）
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、川芎、白芍四味也。按呕吐不外肝、胃两经病，人身脏腑，本是接壤，怀妊则腹
中增了一物，脏腑机括为之不灵，水谷之精微不能上蒸为气血，遂凝聚而为痰饮，窒塞胃口，所以食入作呕，
此是胃病。又妇人既有妊，则精血养胎，无以摄纳肝阳，则肝阳易升，肝之经脉夹胃，肝阳过升，则饮食自不
能下胃，此是肝病。《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，补阴以抑
阳也；用人参，生津以养胃也。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，川芎亦能宣
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。
又蔡姓妇恶阻，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。按∶肝
阳上升，补阴吸阳，原属治本正理，至肝阳亢盛，滴水吐出，即有滋阴药亦无所用。不得不用黄连之苦寒，先
折其太甚，然后以滋阴药调之，以收全效。（雄按∶左金丸亦妙。）
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？不然何其言之验耶？
沈尧封治朱承宗室，甲戌秋，体倦吐食。诊之，略见动脉，询得停经两月，恶阻症也。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，复邀沈诊，前之动脉不见，
但觉细软，呕恶日夜不止，且吐蛔两条。沈曰∶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。（藜按∶仍是治肝之法。）
喻嘉言治李思萱室人有孕，冬月感寒，至春而发。因连食鸡子鸡面，遂成夹食伤寒。一月才愈，又伤食，
吐泻交作，前后七十日，共反五次，遂成膈证。诊时，其脉上涌而乱，重按全无，呕哕连绵不绝，声细如虫鸣，
久久方大呕一声。曰∶病患胃中全无水谷，已翻空向外，此不可救之证也。无已，必多用人参。但才入胃中，
即从肠出，奈何？李曰∶尽十两，余尚可勉备。喻曰∶足矣。乃煎人参汤，调赤石脂末，以坠安其翻出之胃，
气乃少回。少顷大便，气即脱去，凡三日，服过人参五两，赤石脂末一斤，俱从大肠泻出，得食仍呕，但不呕
药耳。因思必以药之渣滓，如粟粥之类与服，方可望其稍停胃中。顷之传下，又可望其少停肠中，遂以人参、
陈皮二味，剪如芥子大，和粟米同煎作粥，与半盏不呕，良久又与半盏。如是三日，始得胃舍稍安。但大肠之
空尚未填实，复以赤石脂为丸，每用人参汤，吞服两许。如是再三日，大便亦稀。此三日参橘粥内，己加入陈
仓米，每进一盏，日十余次，人事遂大安矣。仍用四君子汤调理，共享人参九两，全愈。然此亦因其胎尚未堕，
有一线生气可续。不然，用参虽多，安能回元气于无何有之乡哉？后生一子小甚，缘母病百余日，失荫故也。
黄咫旭乃室，病膈气二十余日，饮粒全不入口。诊之，尺脉已全不至矣。询其二便，自病起至今，从未一
行，止是痰沫上涌，厌厌待尽。或谓其脉已离根，顷刻当坏。喻曰∶不然。《脉经》上部有脉，下部无脉，其
人当吐，不吐者死，是吐则未必死也。但得天气下降，则地道自通。此证以气高不返，中无开阖，因成危候，
宜缓法以治其中，自然见效。遂变旋复代赭成法，用其意，不用其方。缘尺脉全无，莫可验其孕否。若有而不
求，以赭石、干姜辈伤之，呼吸立断矣。姑阙疑以赤石脂易赭石，煨姜易干姜，用六君子汤加旋复花，煎调服
下，呕即稍定。三日后渐渐不呕，又三日粥饮渐加。但不大便已月余矣，日以通利为嘱，曰∶脏气久结，饮食
入胃，每日止能透下一二节，积之既久，自然通透。盖以归、地润肠，恐滞膈而作呕，（喻君于肝肾病治法，
终身未晓。）硝、黄通肠，恐伤胎而殒命。姑拂其请，坚持三五日，果气下肠通，月余腹中之孕渐着，而病全
瘳矣。（雄按∶归、地滞膈之说，何可浓非？魏氏独擅此长，谓可概治一切，未免矫枉过正。如后列施笠泽一
案，断不可投以血药者，乌得专究肝肾，而不问其他耶？）
施笠泽治吴玄水妇妊病，呕吐四十日，不进糜饮，二十七日不溲溺，众以为必死矣。诊其脉俱沉滑而数，
曰∶此痰因火搏，凝结中脘，阴阳失次，气苞血聚，是谓关格，靡有攸处，治之则生，不治则死。吴曰∶虽九
仙之木精石髓，其如不内何？曰∶姑试之。乃用鸡 、沉丁香、海石等，末之若尘，用甘澜水浓煎枇杷叶，
取汤调服。始吐渐留，旋进香砂汤，一饮而溲通，再饮而糜进。然喉中有物，哽哽不能上下。曰∶此病根也。
仍用煎汤探吐，吐出结痰如麦冬、莲实者三四枚，其病遂瘳，妊亦无恙。
沈尧封说：子烦（妊娠心烦）的病因，有痰、火、阴亏三种。因痰引起的，胸中必然胀满，适宜用二陈汤加黄芩、竹茹、旋复花。阴亏而火盛者，张仲景的地黄阿胶汤最为精妙。汪昂《医方集解》中有一方叫竹叶汤，治疗妊娠期间心惊胆怯、整天烦闷，称为子烦。因为受孕四五月时，相火（命门之火）当令，或者盛夏时节君火（心火）盛行，都能乘袭肺金，导致烦躁、胎动不安。也有因停痰积饮，阻滞于胸膈而导致烦躁的。药用麦冬一钱半，茯苓、黄芩各一钱，人参五分，淡竹叶十片。竹叶清解烦热，黄芩消除热邪，麦冬凉润肺金，心火乘袭肺金，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。如果是相火旺盛者，单用知母丸。君火旺盛者，单用黄连丸。心神不安者，用朱砂安神丸。切不可当作虚损病，用栀子、豆豉等药物治疗。一方以茯苓为主药，无人参，有防风。一方有防风、知母，无人参，有痰者加竹沥。
薛立斋治疗一位孕妇，烦热吐痰，怕热，恶心头晕。这是脾虚风痰为患，用半夏白术天麻汤，来补元气、祛风邪，逐渐痊愈。只是头昏未完全好，于是用补中益气汤加蔓荆子，以升提补益阳气而痊愈。
另一位孕妇烦热兼咽喉间作痛，用知母散（知母、麦冬、黄芩、子芩、赤茯苓、甘草。）加山栀、竹沥，以清肺金而痊愈。后来出现内热咳嗽，小便失禁，用补中益气汤加麦冬、山栀，以补肺气、滋肾水而痊愈。（尤在泾按：后面的治疗不够妥当。）
薛立斋治疗一位孕妇，食滞腹满，呕吐吞酸，腹泻不能进食。认为是饮食停滞，兼肝木克伤脾土，用六君子汤来健脾胃，加苍术、厚朴来消饮食，吴茱萸、制黄连来清肝火，各种症状全部痊愈。又用六君子汤加砂仁调理，脾土才安定。
一位孕妇呕吐胁肋胀满，有时寒热往来，面色青黄，这是肝木旺盛而克制脾土。用六君子汤加柴胡、桔梗、枳壳而安顿。
一位孕妇胸胁胀痛，吐痰不食，这是脾胃虚弱而饮食化为痰。用半夏茯苓汤逐渐痊愈，又用六君子汤加枳壳、苏梗、桔梗而饮食恢复正常。后来因为愤怒，胁肋胀满不食，吐痰恶心，用半夏茯苓汤加柴胡、山栀而痊愈。（薛立斋治疗孕妇，也时常使用半夏。）
一位孕妇因为发怒，出现寒热，胸胁胀痛，呕吐不食，症状像伤寒，这是怒气触动肝火，脾气受伤所致。用六君子汤加柴胡、山栀、枳壳、丹皮而痊愈。但仍有内热口干，用四君子汤加川芎、当归、升麻而安顿。（尤在泾按：丹皮应当忌用。）
一位孕妇霍乱已经停止，但不进饮食，口内味酸，泛行消导宽中之法。薛立斋说：这是胃气受伤而虚热，应当服用四君子汤。患者不信，反而服用人参养荣汤，呕吐酸水，胎儿不安，是药物再次伤害了身体。仍然给予四君子汤，让煎熟后，让患者闻药气，如果不呕吐，就喝少许。担心再次呕吐，会导致胎元被扰动，如此十多天后痊愈。（尤在泾按：胃虚固然不用说，既然出现酸味，则还有湿热，专用四君子汤并不完全合适，否则人参养荣汤也是补剂，为什么反而加重呕吐酸水呢？）
沈尧封说：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，一剂呕吐停止，四剂全愈。一位医生嘲笑说：古方中生地、半夏同用的很少。不知道此方就是《千金方》中的半夏茯苓汤，去掉了细辛、桔梗、川芎、白芍四味药。按：呕吐不外乎肝、胃两经的病。人身脏腑，本是相邻接壤，怀孕则腹中增加了一物，脏腑机括变得不灵敏，水谷的精微不能上蒸化为气血，于是凝聚而为痰饮，阻塞胃口，所以食入即呕，这是胃病。另外妇人既有妊娠，则精血养胎，无以摄纳肝阳，则肝阳容易上升，肝的经脉夹胃而行，肝阳过升，则饮食自然不能下胃，这是肝病。《千金方》半夏茯苓汤中，用二陈汤化痰以通胃；用旋复花，取“高者抑之”之意；用地黄，补阴以抑制阳亢；用人参，生津以养胃。其治法可谓详细且完备。至于细辛也能散痰，桔梗也能理上焦之气，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，所以车氏都不用。斟酌得极其完善，四剂获安是有原因的。
又蔡姓妇女恶阻（妊娠呕吐），水药俱吐，松江医生用抑青丸立刻见效。黄连一味研为末，粥糊丸如麻子大，每次服用二三十丸。按：肝阳上升，补阴以吸阳，原本属于治本的正理，到了肝阳亢盛，滴水吐出，即使有滋阴药也无用处。不得不使用黄连的苦寒，先折服其太盛的火势，然后用滋阴药调理，以收全效。（尤在泾按：左金丸也很妙。）
沈姓妇女恶阻，水浆下咽即吐，医药杂投无效。身体骨瘦如柴，精神困倦，自料必死，医生也束手无策。一位老妇人说：急停药，八十日当自愈。后果然如其所言。停药者，就是《金匮要略》中“绝之”的含义。至于八十日当愈这一句话，难道是《金匮要略》中“六十日当有此证”的误写吗？不然为什么说得这么灵验呢？
沈尧封治疗朱承宗室的妻子，甲戌年秋天，体倦吐食。诊脉，略微见到动脉，询问得知停经两个月，是恶阻症。叙述之前的治疗方法，有效也有无效的。如果无效，就应当停药。记录半夏茯苓汤方给她，无效，接连换了几个医生。过了二十天，再次邀请沈尧封诊治，之前的动脉不见了，只觉得脉象细软，呕恶日夜不止，而且吐出蛔虫两条。沈尧封说：恶阻无碍，吐蛔是重症，姑且安蛔，以观察动静。用乌梅丸，早晚各二十丸，四天蛔虫停止，呕吐也不再发作。这是治疗恶阻的变局，所以记录下来。（藜按：这仍然是治肝的方法。）
喻嘉言治疗李思萱的妻子有孕，冬天感寒，到春天发作。因为连续吃鸡蛋鸡面，遂成夹食伤寒。一个月才痊愈，又伤食，吐泻交作，前后七十天，共反胃五次，遂成膈证。诊脉时，脉象上涌而乱，重按全无，呕哕连绵不绝，声音细如虫鸣，很久才大呕一声。喻嘉言说：病患胃中完全没有水谷，已经翻空向外，这是不可救的证候。不得已，必须多用用人参。但是刚进入胃中，就从肠道排出，怎么办？李思萱说：尽用十两，我还勉强备得起。喻嘉言说：足够了。于是煎人参汤，调赤石脂末，以镇坠安顿其翻出之胃，气才稍微回返。一会儿大便，气随即脱去，凡三天，服过人参与五两，赤石脂末一斤，都从大肠泻出，得到食物仍呕吐，只是不呕药罢了。于是想必须用药的渣滓，如粟粥之类给患者服用，方可希望其稍停于胃中。不久传至肠中，又希望其少停于肠中，遂用人参、陈皮二味，剪如芥子大，和粟米同煎作粥，给半盏不呕吐，良久再给半盏。如此三天，才使得胃舍稍微安顿。但大肠的空虚尚未填实，又以赤石脂为丸，每次用人参汤，吞服一两许。如此再三天，大便也稀了。这三日的参橘粥内，己加入陈仓米，每进一盏，日十余次，人事才大大安顿。仍用四君子汤调理，共用参九两，全愈。然而这也是因为其胎尚未堕，有一线生气可续。不然，用人参虽多，怎么能回元气于虚无之境呢？后来生了一个很小的儿子，因为母亲病百余日，失去荫蔽的缘故。
黄咫旭的妻子，病膈气二十余日，饮食粒粒不入口。诊脉，尺脉已完全不至。询问其二便，自发病至今，从未一行，只是痰沫上涌，奄奄一息等待死亡。有人说其脉已离根，顷刻当坏。喻嘉言说：不对。《脉经》说上部有脉，下部无脉，其人当吐，不吐者死，是吐则未必死。只要天气下降，地道自然通畅。此证以气高不返，中无开阖，因而成为危候，宜缓法以治其中，自然见效。于是变通旋复代赭汤成法，取其意，不用其方。因为尺脉全无，无法验证是否怀孕。如果有孕而不求，以赭石、干姜辈损伤它，呼吸立即断绝。姑且存疑，以赤石脂代替赭石，煨姜代替干姜，用六君子汤加旋复花，煎调服下，呕吐即稍定。三日后渐渐不呕，又三日粥饮渐加。但不大便已月余矣，日以通利为嘱，说：脏气久结，饮食入胃，每日只能透下一二节，积之既久，自然通透。大概因为归、地润肠，恐怕滞膈而作呕，（喻嘉言对于肝肾病治法，终身未晓。）硝、黄通肠，恐怕伤胎而殒命。姑且违背其请求，坚持三五日，果然气下肠通，月余腹中之孕渐着，而病全愈了。（尤在泾按：归、地滞膈之说，怎么可以如此非议？魏氏独擅此长，谓可概治一切，未免矫枉过正。如后列施笠泽一案，断不可投以血药者，怎么能专门追究肝肾，而不问其他耶？）
施笠泽治疗吴玄水的妻子怀孕患病，呕吐四十日，不进糜饮，二十七日不排尿，众人认为必死无疑。诊其脉俱沉滑而数，说：这是痰因火搏，凝结中脘，阴阳失次，气苞血聚，是谓关格，靡有攸处，治之则生，不治则死。吴玄水说：即使是九仙之木精石髓，又能如何，因为它不进去呢？施笠泽说：姑且试试。于是用鸡肉、沉香、丁香、海浮石等，研为尘末，用甘澜水浓煎枇杷叶，取汤调服。开始呕吐逐渐留住，随即进香砂汤，一饮而溲通，再饮而糜进。然而喉中有物，哽哽不能上下。说：这是病根。仍用煎汤探吐，吐出结痰如麦冬、莲实者三四枚，其病遂愈，妊娠也无恙。
Shen Yaofeng stated: The etiology of *Zi Fan* (pregnancy-related vexation and heat) includes phlegm, fire, and yin deficiency. When caused by phlegm, there is necessarily fullness in the chest, and Er Chen Tang (Two-Cured Decoction) added with Huang Qin (Scutellariae Radix), Zhu Ru (Bambusae Caulis in Taenia), and Xuan Fu Hua (Inulae Flos) is appropriate. For cases of yin deficiency with vigorous fire, Zhang Zhongjing's Di Huang E Jiao Tang (Rehmanniae and Donkey-Hide Gelatin Decoction) is most excellent. Wang Ang's *Yi Fang Ji Jie* (Collection of Explanations on Medical Formulas) contains a formula called Zhu Ye Tang (Bamboo Leaf Decoction), which treats pregnancy-induced palpitations, timidity, and constant vexation, termed *Zi Fan*. This occurs because during the fourth or fifth month of conception, Ministerial Fire (Mingmen Fire) is active, or during midsummer when Sovereign Fire (Heart Fire) prevails; both can invade Lung Metal, leading to restlessness and fetal agitation. There are also cases where retained phlegm and accumulated fluid obstruct the chest and diaphragm, causing vexation. The prescription consists of Mai Dong (Ophiopogonis Radix) 1.5 qian, Fu Ling (Poria) and Huang Qin (Scutellariae Radix) each 1 qian, Ren Shen (Ginseng Radix et Rhizoma) 0.5 qian, and Dan Zhu Ye (Lophatheri Herba) 10 slices. Zhu Ye clears vexation, Huang Qin eliminates heat, Mai Dong cools Lung Metal. Since Heart Fire invades Lung Metal, vexation arises from the Lung; Fu Ling calms the mind, and Ren Shen tonifies deficiency. Pregnancy-related vexation is mostly due to deficiency. If Ministerial Fire is vigorous, use Zhi Mu Wan (Anemarrhenae Pill) alone. If Sovereign Fire is vigorous, use Huang Lian Wan (Coptidis Pill) alone. If the spirit is unsettled, use Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill). One must not treat this as a consumptive disease using Zhi Zi Dou Chi Tang (Gardenia and Soybean Decoction). One variation uses Fu Ling as the chief ingredient, without Ren Shen, but with Fang Feng (Saposhnikoviae Radix). Another variation includes Fang Feng and Zhi Mu, without Ren Shen; add Zhu Li (Bambusae Succus) if there is phlegm.
Xue Lizhai treated a pregnant woman with vexatious heat, expectoration of phlegm, aversion to heat, nausea, and dizziness. This was caused by Spleen deficiency and wind-phlegm. He used Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) to tonify Yuan Qi and dispel wind pathogenic factors, resulting in gradual recovery. However, dizziness persisted, so he prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Man Jing Zi (Vittatenii Fructus) to raise and tonify Yang Qi, leading to complete cure.
Another pregnant woman suffered from vexatious heat accompanied by throat pain. She was treated with Zhi Mu San (Anemarrhenae Powder) [composed of Zhi Mu, Mai Dong, Huang Qin, Zi Qin, Chi Fu Ling, Gan Cao] added with Shan Zhi (Gardeniae Fructus) and Zhu Li (Bambusae Succus) to clear Lung Metal, resulting in cure. Later, she developed internal heat and coughing with urinary incontinence. She was treated with Bu Zhong Yi Qi Tang added with Mai Dong and Shan Zhi to tonify Lung Qi and nourish Kidney Water, leading to recovery. (You Zaijing noted: The subsequent treatment was inadequate.)
Xue Lizhai treated a pregnant woman with food stagnation, abdominal fullness, vomiting with acid regurgitation, diarrhea, and anorexia. He diagnosed it as food stagnation combined with Liver Wood injuring Spleen Earth. He used Liu Jun Zi Tang (Six-Gentlemen Decoction) to strengthen the Spleen and Stomach, added Cang Zhu (Atractylodis Rhizoma) and Hou Po (Magnoliae Officinalis Cortex) to digest food, and Wu Zhu Yu (Evodiae Fructus) with processed Huang Lian (Coptidis Rhizoma) to clear Liver Fire. All symptoms resolved. He then used Liu Jun Zi Tang added with Sha Ren (Amomi Fructus Rotundus) for regulation, stabilizing Spleen Earth.
A pregnant woman experienced vomiting and hypochondriac distension, with alternating chills and fever, and a greenish-yellow complexion. This indicated hyperactive Liver Wood suppressing Spleen Earth. She was treated with Liu Jun Zi Tang added with Chai Hu (Bupleuri Radix), Jie Geng (Platycodonis Radix), and Zhi Ke (Aurantii Fructus Immaturus), resulting in stabilization.
Another pregnant woman had chest and hypochondriac distending pain, expectoration of phlegm, and anorexia. This was due to Spleen and Stomach deficiency causing food to transform into phlegm. She was gradually cured with Ban Xia Fu Ling Tang (Pinellia and Poria Decoction), and then her diet normalized after taking Liu Jun Zi Tang added with Zhi Ke, Su Geng (Perillae Caulis), and Jie Geng. Later, due to anger, she experienced hypochondriac distension, anorexia, expectoration of phlegm, and nausea. She was cured with Ban Xia Fu Ling Tang added with Chai Hu and Shan Zhi. (Xue Lizhai frequently used Ban Xia when treating pregnant women.)
A pregnant woman, triggered by anger, presented with chills and fever, chest and hypochondriac distending pain, vomiting, and anorexia, resembling Taiyang disease. This was anger stirring Liver Fire and injuring Spleen Qi. She was cured with Liu Jun Zi Tang added with Chai Hu, Shan Zhi, Zhi Ke, and Dan Pi (Moutan Cortex). However, internal heat and dry mouth persisted, so Si Jun Zi Tang (Four-Gentlemen Decoction) added with Xiong (Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), and Sheng Ma (Cimicifugae Rhizoma) stabilized her condition. (You Zaijing noted: Dan Pi should be avoided.)
A pregnant woman’s Huoluan (cholera-like syndrome) had stopped, but she refused food and had an acidic taste in her mouth. Digestive-promoting methods were attempted. Xue Lizhai said: This is Stomach Qi injury with deficient heat; she should take Si Jun Zi Tang. She did not believe him and instead took Ren Shen Yang Rong Tang (Ginseng and Longan Decoction for Nourishing the Spirit), resulting in vomiting of acid water and fetal instability, indicating further drug injury. He again administered Si Jun Zi Tang, advising her to smell the decoction before drinking. If no vomiting occurred, she would sip a small amount. To prevent recurrent vomiting from disturbing the fetus, she recovered after more than ten days. (You Zaijing noted: While Stomach deficiency is evident, the presence of acidity suggests damp-heat; using only Si Jun Zi Tang is not entirely appropriate. Otherwise, since Ren Shen Yang Rong Tang is also a tonic, why did it exacerbate vomiting and acidity?)
Shen Yaofeng stated: A surnamed Fei woman, three months pregnant, vomited food and drink. Medications such as Ju Pi (Citri Reticulatae Pericarpium), Zhu Ru, and Huang Qin were ineffective. Che Weijin from Songjiang used Er Chen Tang added with Xuan Fu Hua and Jiang Pi (Zingiberis Pericarpium), decocted in water with one cup of Sheng Di Zhi (Rehmanniae Radix Praeparata) juice mixed in. Vomiting stopped after one dose and fully resolved after four doses. A physician mocked this, saying that combining Sheng Di and Ban Xia is rare in ancient formulas. He did not realize this formula is essentially Ban Xia Fu Ling Tang from *Qian Jin Fang*, minus Xi Xin (Asari Radix et Rhizoma), Jie Geng, Chuan Xiong, and Bai Shao (Paeoniae Radix Alba). Analysis: Vomiting primarily involves the Liver and Stomach meridians. Viscera are adjacent; pregnancy adds a mass to the abdomen, rendering visceral mechanisms less agile. Essence and qi from food and drink fail to vaporize upward into blood and qi, condensing into phlegm-fluids that block the stomach opening, causing vomiting upon eating—this is a Stomach disorder. Additionally, pregnancy consumes essence and blood to nourish the fetus, failing to anchor Liver Yang, causing Liver Yang to rise easily. Since the Liver meridian surrounds the Stomach, excessive rising of Liver Yang prevents food from entering the Stomach—this is a Liver disorder. In *Qian Jin Fang*’s Ban Xia Fu Ling Tang, Er Chen Tang transforms phlegm to unblock the Stomach; Xuan Fu Hua applies the principle of "suppressing what is high"; Sheng Di nourishes Yin to suppress Yang; Ren Shen generates fluids to nourish the Stomach. The method is detailed and comprehensive. Xi Xin disperses phlegm, Jie Geng regulates Upper Jiao Qi, Chuan Xiong circulates blood stasis, all having ascending properties. Bai Shao levels Liver and consolidates Yin, but Zhang Zhongjing’s protocol removes it for chest fullness; thus, Che omitted them. The careful deliberation explains the success in four doses.
Another case involved a surnamed Cai woman with severe morning sickness (*E Zu*), vomiting all liquids and medicines. A physician from Songjiang used Yi Qing Wan (Suppress Blue Pill) with immediate effect. It consisted of Huang Lian powder formed into pills the size of hemp seeds with congee paste, taken 20–30 pills per dose. Analysis: Rising Liver Yang requires nourishing Yin to absorb Yang, which is fundamentally correct. However, when Liver Yang is hyperactive to the point of rejecting even drops of liquid, yin-nourishing drugs are useless. One must use the bitter-cold nature of Huang Lian to first subdue the excessive fire, then regulate with yin-nourishing drugs for complete efficacy. (You Zaijing noted: Zuo Jin Wan is also excellent.)
A surnamed Shen woman suffered from severe morning sickness, vomiting immediately after swallowing liquids. Various medications failed. She became emaciated and exhausted, believing death was inevitable, and doctors were helpless. An old woman advised: Stop all medication immediately; you will recover in eighty days. This proved accurate. "Stopping medication" aligns with the concept of "Jue Zhi" (abandoning treatment) in *Jin Gui Yao Lue*. The prediction of recovery in eighty days might be a misinterpretation of the sixty-day mark in *Jin Gui Yao Lue*, or perhaps highly accurate.
Shen Yaofeng treated the wife of Zhu Chengzong in autumn of the Ji Xu year. She presented with fatigue and vomiting. Pulse showed slight arterial movement. Upon inquiry, amenorrhea for two months confirmed *E Zu*. Previous treatments had variable results. If ineffective, medication should stop. Shen provided Ban Xia Fu Ling Tang. It failed, and several other physicians were consulted. Twenty days later, Shen re-examined her. The arterial pulse was gone, replaced by a fine and soft pulse. Vomiting and nausea persisted day and night, and she vomited two roundworms. Shen said: *E Zu* itself is not dangerous, but vomiting roundworms is serious. Let us calm the worms and observe. He prescribed Wu Mei Wan (Mume Pill), twenty pills morning and evening. After four days, worm expulsion ceased, and vomiting stopped. This represents a variant approach to treating *E Zu*, hence recorded. (Li noted: This is still a method of treating the Liver.)
Yu Jiayan treated the wife of Li Sixuan who was pregnant. She contracted cold in winter, manifesting in spring. Due to consuming eggs and chicken noodles consecutively, she developed Cold Damage complicated by food stagnation. It took one month to resolve, but she suffered another food injury, resulting in alternating vomiting and diarrhea for seventy days. She regurgitated five times, developing Ge Zheng (Diaphragmatic Obstruction Syndrome). At diagnosis, the pulse surged chaotically at the superficial level but vanished upon deep pressure. Vomiting and hiccups were continuous, sounding like insect chirps, followed by occasional violent retching. Yu said: The patient’s Stomach is empty of food and fluid, everted outward. This is incurable. However, we must use large amounts of Ren Shen. But it passes through the intestines immediately. What to do? Li replied: Use ten liang; I can afford it. Yu said: That is sufficient. He decocted Ren Shen soup, mixed with Chi Shi Zhi (Halloysitum Rubrum) powder to settle the everted Stomach. Qi slightly returned. Shortly after defecation, Qi escaped again. Over three days, five liang of Ren Shen and one jin of Chi Shi Zhi powder were excreted via the large intestine. Food intake still caused vomiting, though medicine was retained. Yu reasoned that solid residue, like millet congee, might stay in the Stomach. He cut Ren Shen and Chen Pi (Citri Reticulatae Pericarpium) into mustard-seed-sized pieces, cooked with millet into congee. Half a bowl was given; no vomiting occurred. After a while, another half bowl was given. Over three days, the Stomach settled. The large intestine remained empty, so he made Chi Shi Zhi pills, taken with Ren Shen soup (one liang per dose). Over three more days, stool became loose. Chen Cang Mi (aged rice) was added to the congee; ten bowls daily brought significant stability. Finally, Si Jun Zi Tang regulated her health. Total Ren Shen consumption: nine liang. Full recovery. This succeeded because the fetus was intact, preserving a thread of vital energy. Otherwise, massive Ren Shen could not restore vitality from nothingness. She later gave birth to a very small son due to maternal illness lasting over a hundred days depriving the fetus of nourishment.
Huang Zhixu’s wife suffered from Ge Qi (Diaphragmatic Qi Stagnation) for over twenty days, unable to swallow any food. Pulse examination revealed absent Chi (Kidney) pulses. Bowel and bladder movements had ceased since onset. Only phlegm foam rose upward; she lay dying. Some said the pulse had detached from its root, implying imminent death. Yu Jiayan disagreed: *Mai Jing* states that if the upper pulse exists but the lower pulse is absent, the patient should vomit; if they do not vomit, they die. Thus, vomiting does not necessarily mean death. If Heaven Qi descends, Earthly pathways will open. This case features ascending Qi that fails to return, lacking opening and closing mechanisms in the middle, creating a critical state. Gentle methods should be used. He modified Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction), adopting its principle but not its formula. Since Chi pulse was absent, pregnancy status was unknown. Using Dai Zhe Shi (Hematitum) or Gan Jiang (Zingiberis Rhizoma) could harm a potential fetus, causing immediate death. Suspending judgment, he substituted Chi Shi Zhi for Dai Zhe Shi, and Wei Jiang (roasted Ginger) for Gan Jiang, prescribing Liu Jun Zi Tang added with Xuan Fu Hua. Vomiting subsided after decoction administration. After three days, vomiting ceased; after three more days, congee intake increased. Constipation had lasted over a month. Yu instructed daily bowel regulation, stating: Visceral Qi has been bound for long. Food enters the Stomach, but only one or two segments pass down daily. Accumulation eventually clears naturally. He avoided Dang Gui (Angelicae Sinensis Radix) and Di Huang (Rehmanniae Radix) for moistening intestines, fearing they would stagnate the diaphragm and cause vomiting (Yu Jiayan never mastered Liver-Kidney treatments). He avoided Xiao Shi (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) for purging, fearing fetal loss. Ignoring requests for these, he persisted for three to five days. Indeed, Qi descended, intestines cleared, pregnancy progressed, and the disease resolved. (You Zaijing noted: The claim that Dang Gui and Di Huang stagnate the diaphragm is questionable. Wei Zhixiu excels here, claiming universal application, which is an overcorrection. As seen in Shi Lizewen’s case below, blood-invigorating drugs are contraindicated; how can one focus solely on Liver-Kidney while ignoring other factors?)
Shi Lizewen treated the wife of Wu Xianshui, pregnant, vomiting for forty days, refusing congee or drinks, and not urinating for twenty-seven days. Everyone deemed it fatal. Pulse was deep, slippery, and rapid. Shi said: Phlegm binds with fire, coagulating in the Middle Jiao. Yin and Yang lose order; Qi envelops blood, forming Guan Ge (Obstruction and Reversal Syndrome), with nowhere to go. Treatment brings life; neglect brings death. Wu asked: Even if I provide immortal elixirs, how can they enter? Shi said: Let me try. He powdered Ji Rou (Chicken Flesh), Chen Xiang (Aquilariae Lignum Resinatum), Ding Xiang (Eugeniae Flos), and Hai Shi (Pumex). He decocted Pi Ye (Loquat Leaf) in Gan Lan Shui (water stirred vigorously) to make a thick soup, mixing the powder into it. Vomiting gradually decreased. Then, Xiang Sha Tang (Agastache and Amomum Decoction) was given. One dose restored urination; two doses allowed congee intake. However, a lump remained in the throat, obstructing swallowing. Shi said: This is the root cause. He induced vomiting with decoction, expelling three or four clumps of condensed phlegm resembling Mai Dong and lotus seeds. The disease cured, and the pregnancy remained safe.