妇人怀胎，一月之时，足厥阴脉养。二月，足少阳脉养。三月，手心主脉养。四月，手少阳脉养。五月，足太阴脉
养。六月，足阳明脉养。七月，手太阴脉养。八月，手阳明脉养。九月，足少阴脉养。十月，足太阳脉养。诸阴阳各养
三十日活儿。手太阳、少阴不养者，下主月水，上为乳汁，活儿养母。怀娠者不可灸刺其经，必堕胎。
妇人怀娠三月而渴，其脉反迟者，欲为水分。复腹痛者，必堕胎。
脉浮汗出者，必闭。其脉数者，必发痈脓。五月、六月脉数者，必向坏。脉紧者，必胞漏。
脉迟者，必腹满而喘。脉浮者，必水坏为肿。
问曰∶有一妇人，年二十所，其脉浮数，发热呕咳，时下利，不欲食。脉复浮，经水绝，何也？师曰∶法当有娠，
何以故？此虚家法当微弱，而反浮数，此为戴阳。阴阳和合，法当有娠。到立秋，热当自去。何以知然？数则为热，热
者是火，火是木之子，死于未。未为六月位，土王，火休废，阴气生，秋节气至，火气当罢，热自除去，其病即愈。
师曰∶乳后三月有所见，后三月来，脉无所见，此便是躯。有儿者护之，恐病利也，何以故？怀妊阳气内养，乳中
虚冷。故令儿利。
妇人怀娠，六月、七月，脉弦发热，其胎逾腹，腹痛恶寒，寒者小腹如扇之状。所以然者，子脏开故也，当以附子
汤温其脏。
妇人妊娠七月，脉实大牢强者生，沉细者死。
妇人妊娠八月，脉实大牢强弦紧者生，沉细者死。
妇人怀躯六月、七月，暴下斗余水，其胎必倚而堕。此非时，孤浆预下故也。
师曰∶寸口脉洪而涩，洪则为气，涩则为血。气动丹田，其形即温。涩在于下，胎冷若冰。阳气胎活，阴气必终。
欲别阴阳，其下必僵。假令阳终，畜然若杯。
问曰∶妇人妊娠病，师脉之，何以知此妇人双胎，其一独死，其一独生？而为下其死者，其病即愈，然后竟免躯，
其脉何类？何以别之？
师曰∶寸口脉，卫气平调，荣气缓舒。阳施阴化，精盛有余，阴阳俱盛，故成双躯。今少阴微紧，血即浊凝，经养
不周，胎则偏夭。少腹冷满，膝膑疼痛，腰重起难，此为血理。若不早去，害母失胎。
师曰∶妇人有胎腹痛，其人不安，若胎病不长，欲知生死，令人摸之，如覆杯者则男，如肘头参差起者女也。冷在
何面？冷者为死，温者为生。
师曰∶妇人有漏下者，有中生后，因续下血，都不绝者，有妊娠下血者。假令妊娠腹中痛，为胞漏（一云阻），胶艾
汤主之。
妇人妊娠，经断三月，而得漏下，下血四十日不止，胎欲动，在于脐上，此为。妊娠六月动者，前三月经水利时胎
也。下血者，后断三月， 也，所以下血不止者，其 不去故也。当下其 ，宜桂枝茯苓丸。
问曰∶妇人病，经水断一、二月，而反经来，今脉反微涩，何也？师曰∶此前月中，若当下利，故令妨经。利止，
月经当自下，此非躯也。
妇人经自断而有躯，其脉反弦，恐其后必大下，不成躯也。
妇人怀躯，七月而不可知，时时衄血而转筋者，此为躯也。衄时嚏而动者，非躯也。脉来近去远，故曰反，以为有
躯，而反断，此为有阳无阴故也。
妇人经月下，但为微少。师脉之，反言有躯，其后审然，其脉何类？何以别之？
师曰∶寸口脉阴阳俱平，荣卫调和，按之滑，浮之则轻，阳明、少阴，各如经法，身反洒淅，不欲食饮，头痛心乱，
呕哕欲吐，呼则微数，吸则不惊，阳多气溢，阴滑气盛，滑则多实，六经养成，所以月见，阴见阳精，汁凝胞散，散者
损堕。设复阳盛，双妊二胎。今阳不足，故令激经也。
妇人妊娠，小便难，饮如故，当归贝母苦参丸主之。
妇人妊娠有水气，身重，小便不利，洒洒恶寒，起即头眩，葵子茯苓散主之。
妇人妊娠，宜服当归散，即易产无疾苦。
师曰∶有一妇人来诊（一作脉），自道经断不来。师言∶一月为 ，二月为血，三月为居经。是定作躯也，或为血积，
譬如鸡乳子，热者为禄，寒者多浊，且当须后月复来，经当入月几日来。假令以七日所来，因言且须后月十日所来相间。
设其主复来者，因脉之，脉反沉而涩，因问曾经半生，若漏下亡血者，定为有躯。其人言实有是，宜当护之。今经微弱，
恐复不安。设言当奈何？当为合药治之。
师曰∶有一妇人来诊，自道经断，即去，师曰∶一月血为闭，二月若有若无，三月为血积，譬如鸡伏子，中寒即浊，
中热即禄，欲令胎寿，当治其母，挟寒怀子，命则不寿也。譬如鸡伏子，试取鸡一毛拔去，覆子不遍，中寒者浊。今夫
人有躯，少腹寒，手掌反逆，奈何得有躯？妇人因言，当奈何？师曰∶当与温经汤。设与夫家俱来者，有躯。与父母家
俱来者，当言寒多，久不作躯。
师曰∶有一妇人来诊，因言阴阳俱和调，阳气长，阴气短，但出不入，去近来远，故曰反。以为有躯，偏反血断，
断来几日，假令审实者，因言急当治，恐经复下。设令宫中人，若寡妇无夫，曾夜梦寐交通，邪气或怀久作 瘕，急当
治，下服二汤。设复不愈，因言发汤，当中。下胎而反不下，此何等意邪？可使且将视赤乌（一作赤马）。
师曰∶若宫里张氏不瘥，复来相问。（臣亿等详此文理脱误不属无本可校以示阙疑余皆效此。）
师曰∶脉妇人得平脉，阴脉小弱，其人渴，不能食，无寒热，名为躯，桂枝主之，法六十日当有娠。设有医治逆者，
却一月加吐下者，则绝之。方在《伤寒》中。
妇人脉平而虚者，乳子法也。平而微者实，奄续法也。而反微涩，其人不亡血、下利，而反甚，其脉虚，但坐乳大
儿及乳小儿，此自其常，不能令甚虚竭，病与亡血虚等，必眩冒而短气也。
师曰∶有一妇人好装衣来诊，而得脉涩，因问曾乳子下利，乃当得此脉耳，曾半生漏下者，可。设不者，经断三月、
六月。设乳子漏下，可为奄续，断小儿勿乳，须利止复来相问，脉之。
师曰∶寸口脉微迟，尺微于寸，寸迟为寒，在上焦，但当吐耳。今尺反虚，复为强下之，如此，发胸满而痛者，必
吐血，少腹痛、腰脊痛者，必下血。师曰∶寸口脉微而弱，气血俱虚，若下血、呕吐、汗出者可；不者，趺阳脉微而弱。
春以胃气为本，吐利者可；不者，此为水气，其腹必满，小便则难。
妇人常呕吐而胃反，若常喘（一作多唾），其经又断，设来者，必少。
师曰∶有一妇人，年六十所，经水常自下，设久得病利，少腹坚满者为难治。
师曰∶有一妇人来诊，言经水少，不如前者，何也？师曰∶曾更下利，若汗出、小便利者可。何以故？师曰∶亡其
津液，故令经水少。设经下反多于前者，当所苦困。当言恐大便难，身无复汗也。
师曰∶寸口脉沉而迟，沉则为水，迟则为寒，寒水相抟，趺阳脉伏，水谷不化，脾气衰则 溏，胃气衰则身体肿。
少阳脉畀，少阴脉细，男子则小便不利，妇人则经水不通，经为血，血不利则为水，名曰血分。（一作水分）师曰∶寸口
脉沉而数，数则为出，沉则为入，出则为阳实，入则为阴结。趺阳脉微而弦，微则无胃气，弦则不得息。少阴脉沉而滑，
沉则为在里，滑则为实，沉滑相抟，血结胞门，其藏不泻，经络不通，名曰血分。
问曰∶病有血分。何谓也？师曰∶经水前断，后病水，名曰血分。此病为难治。
问曰∶病有水分，何谓也？师曰∶先病水，后经水断，名曰水分，此病易治。何以故？去水，其经自当下。脉濡而
弱，弱反在关，濡反在巅。迟在上，紧在下。迟则为寒，名曰浑。阳浊则湿，名曰雾。紧则阴气栗，脉反濡弱，濡则中
湿，弱则中寒，寒湿相搏，名曰痹。腰脊骨节苦烦，肌为不仁，此当为痹。而反怀躯，迟归经，体重，以下脚为 肿，
按之没指，腰冷不仁，此为水怀。喘则倚息，小便不通，紧脉为呕，血气无余，此为水分。荣卫乖亡，此为非躯。
【背景信息】
书名：脉经 作者：王叔和 朝代：西晋 章节：平妊娠胎动血分水分吐下腹痛证第二 类别：脉学
译文：
妇女怀孕一个月时，由足厥阴肝经（主管贮藏血液和调节血量）的气血来滋养胎儿。两个月时，由足少阳胆经（与肝相表里，主决断）的气血来滋养。三个月时，由手厥阴心包经（保护心脏的外围经络）的气血来滋养。四个月时，由手少阳三焦经（运行元气和水液）的气血来滋养。五个月时，由足太阴脾经（主管运化水谷精微）的气血来滋养。六个月时，由足阳明胃经（多气多血之经）的气血来滋养。七个月时，由手太阴肺经（主气，司呼吸）的气血来滋养。八个月时，由手阳明大肠经（传导糟粕）的气血来滋养。九个月时，由足少阴肾经（主藏精，为先天之本）的气血来滋养。十个月时，由足太阳膀胱经（主一身之表）的气血来滋养。所有阴阳经脉各自在相应的月份滋养三十天，使胎儿成熟出生。手太阳小肠经和手少阴心经不直接参与滋养胎儿，因为它们的功能在下主要维持月经，在上则转化为乳汁，以滋养婴儿并供养母亲。怀孕期间，不可对相关的经脉进行艾灸或针刺治疗，否则必然导致流产。
妇女怀孕三个月出现口渴，如果脉象反而迟缓，这可能是“水分”病（水饮停聚导致的病变）。如果再伴有腹痛，必然会导致流产。
脉象浮且出汗的，必然会出现小便闭塞不通。脉象数的，必然会发生痈肿化脓。怀孕五月、六月脉象数的，病情必然趋向恶化。脉象紧的，必然出现胞宫出血（漏胎）。
脉象迟缓的，必然腹部胀满且气喘。脉象浮的，必然因水湿泛滥而导致水肿。
问：有一位二十岁左右的妇女，脉象浮数，发热、呕吐、咳嗽，时常腹泻，不想吃东西。脉象再次变浮，月经停止，这是什么原因？老师说：按照常理应当是怀孕。为什么这样说？一般体虚的人脉象应当微弱，现在反而浮数，这是“戴阳”证（虚阳上浮）。阴阳和谐结合，按理应当怀孕。等到立秋时节，热症自然会消退。怎么知道会这样呢？脉数代表有热，热属于火，火是木之子，在未月（农历六月）火气休废，土气旺盛，阴气开始生长，随着秋季节气的到来，火气应当罢退，热症自然除去，疾病就会痊愈。
老师说：产后三个月内有阴道出血，再过三个月月经来潮，但脉象没有异常表现，这就是已经怀孕。如果有胎儿，要注意保护，恐怕发生腹泻。为什么？因为怀孕后阳气在内滋养胎儿，乳房部位相对虚冷。所以会导致婴儿腹泻。
妇女怀孕六个月、七个月，脉象弦且发热，胎儿过大超出腹部范围，腹痛且怕冷，感觉小腹像被扇子扇风一样冷。之所以这样，是因为子宫口张开所致，应当用附子汤来温煦子宫。
妇女怀孕七个月，脉象实大牢强表示胎儿能存活，脉象沉细表示胎儿难保。
妇女怀孕八个月，脉象实大牢强弦紧表示胎儿能存活，脉象沉细表示胎儿难保。
妇女怀孕六个月、七个月，突然大量排出斗余的水样液体，胎儿必然随之坠落。这不是正常的分娩时间，而是孤浆（羊水）提前流出所致。
老师说：寸口脉洪大而涩，洪大代表气盛，涩代表血少。气扰动丹田，身体形态就会温热。涩象出现在下部，胎儿寒冷如冰。阳气充足则胎儿存活，阴气极盛则胎儿必亡。想要辨别阴阳生死，胎儿下部必然僵硬。假如阳气终绝，腹部积聚物坚硬如杯状。
问：妇女患妊娠病，医生诊脉，如何知道这位妇女怀的是双胎，其中一个单独死亡，另一个单独存活？通过下药使死胎排出，病症即愈，然后最终保全活胎，这种脉象是什么样？如何辨别？
老师说：寸口脉显示卫气平和调畅，营气舒缓。阳气施布，阴气化生，精气旺盛有余，阴阳都旺盛，所以形成双胎。现在少阴脉微紧，血液浑浊凝滞，对胎儿的营养供给不周全，导致一个胎儿偏枯夭折。少腹冷痛胀满，膝盖疼痛，腰部沉重起身困难，这是血络瘀阻之象。如果不尽早去除病邪，会伤害母体并丧失胎儿。
老师说：妇女怀孕腹痛，心神不安，如果胎儿发育不良，想知道其生死，让人触摸腹部，形状像倒扣的杯子则是男孩，像肘头参差不齐突起则是女孩。寒冷在哪里？寒冷部位表示胎儿已死，温暖部位表示胎儿存活。
老师说：妇女有漏下（非经期阴道出血）症状，有的发生在受孕之前，有的发生在受孕之后，接着持续出血，都不停止的，有的是妊娠期出血。假如妊娠期腹部疼痛，这是胞漏（一说为阻），用胶艾汤主治。
妇女怀孕，月经停止三个月，却出现阴道出血，流血四十天不止，胎动明显，位置在脐上，这称为“激经”（妊娠早期仍按月行经而无损于胎儿者）。怀孕六个月胎动的，是因为前三个月月经正常时受孕的。出血的，是因为后来月经停止三个月才受孕的，所以下血不止的原因，是瘀血不去的缘故。应当攻下瘀血，宜用桂枝茯苓丸。
问：妇女患病，月经停止一两个月，反而又来月经，现在脉象反而微涩，为什么？老师说：这是因为前半个月，如果曾经腹泻，所以妨碍了月经。腹泻停止后，月经应当自行来潮，这并不是怀孕。
妇女月经自行停止而怀孕，脉象反而弦，恐怕其后必然发生大出血，无法成胎。
妇女怀孕，到了七月还无法确定是否怀孕，经常鼻出血且转筋的，这是怀孕的表现。鼻出血时打喷嚏且肢体抖动的，不是怀孕。脉象来近去远，所以叫反脉，认为有孕，反而断经，这是因为有阳无阴的缘故。
妇女月经量少，只是稍微减少。医生诊脉，反而说有孕，后来证实确实如此，这种脉象是什么样？如何辨别？
老师说：寸口脉阴阳俱平，营卫调和，重按感觉滑利，轻取感觉轻浮，手阳明大肠经和足少阴肾经的脉象都符合常规。身体反而感到洒淅恶寒，不想饮食，头痛心烦，恶心欲吐，呼气稍快，吸气不惊。阳气多而气溢，阴气滑利而气盛，滑脉代表实证，六经气血养成，所以仍有少量月经来潮。阴血见到阳精，汁液凝固，胞宫散开，散开的会导致损伤堕胎。假如阳气又盛，则会怀双胎。现在阳气不足，所以导致激经现象。
妇女怀孕，小便困难，饮食如常，用当归贝母苦参丸主治。
妇女怀孕有水气，身体沉重，小便不利，恶寒战栗，起身即头晕目眩，用葵子茯苓散主治。
妇女怀孕，适宜服用当归散，这样可以容易生产且无病痛。
老师说：有一位妇女来就诊（一作诊脉），自述月经停止不来。医生说：一个月停经称为“垢”，两个月称为“血”，三个月称为“居经”。这是确定怀孕的标志，或者是血积。譬如母鸡孵蛋，热的能孵化出小鸡，冷的则浑浊不成形。暂且等到下个月再来看，月经应该在几号来。假如说是初七来的，那么就说等到下个月初十左右再来，间隔几天。假如下次月经真的来了，再诊脉，脉象反而沉涩，于是询问是否曾经半产或小产失血，如果是，定为怀孕。那人说确实有过这种情况，应当注意保护。现在脉象微弱，恐怕又不安。假如问该怎么办？应当配药治疗。
老师说：有一位妇女来就诊，自述月经停止，随即离开。医生说：一个月停经称为“闭”，两个月若有若无，三个月称为“血积”。譬如母鸡孵蛋，中间受寒则浑浊，中间受热则孵化。想要让胎儿长寿，应当治疗母亲。挟带寒邪怀孕，生命就不长寿。譬如母鸡孵蛋，试着拔去母鸡一根羽毛，覆盖鸡蛋不全面，受寒的部分就会浑浊。现在妇女怀孕，少腹寒冷，手掌逆冷，怎么能怀孕？妇女于是问该怎么办？医生说：应当给予温经汤。假如是和丈夫一起来的，说明怀孕；如果是和父母一起来的，应当说寒气多，长期不能怀孕。
老师说：有一位妇女来就诊，自述阴阳俱和调，阳气长，阴气短，只有出不入，去近来远，所以叫反脉。认为有孕，偏偏反而断经，断经几天？假如审察属实，就说应当紧急治疗，恐怕月经再次来潮。假如是宫中女子，或者寡妇无夫，曾经夜间梦交，邪气或许久留形成瘕块，应当紧急治疗，先服两种汤药。假如还不愈，就说发汗汤，应当中病。假如下胎而不下来，这是什么意思？可以让且观察赤乌（一作赤马，指血色或征象）。
老师说：假如宫里张氏的病不好，再来询问。（臣亿等详细考证此文理脱误不属，无本可校，以示阙疑，其余皆效仿此例。）
老师说：妇女得平脉，阴脉小弱，其人口渴，不能进食，无寒热症状，名为妊娠，用桂枝汤主治，按法六十天左右应当确认怀孕。假设有医治不当的，过一个月出现呕吐腹泻的，则应停止治疗。方剂在《伤寒论》中。
妇女脉象平和而虚，是哺乳期的正常脉象。平和而微弱的，是受孕初期的脉象。平和而反见微涩，其人没有亡血、腹泻，反而症状严重，脉象虚，只因为哺乳大婴儿及哺乳小儿，这是其常态，不会导致极度虚竭。生病与亡血虚弱相同，必然眩晕冒昧且短气。
老师说：有一位妇女喜欢穿着华丽衣服来就诊，脉象涩，于是询问是否曾哺乳婴儿后腹泻，才会得到这种脉象。曾经半产漏下的，可以治愈。假如不愈，月经停止三个月、六个月。假如哺乳期漏下，可视为受孕初期，断绝小儿哺乳，须待腹泻停止后再来问诊，诊脉。
老师说：寸口脉微迟，尺脉比寸脉更微，寸脉迟代表寒，病在上焦，只会呕吐罢了。现在尺脉反而虚，又被强力攻下，如此，出现胸满而痛的，必然吐血；少腹痛、腰脊痛的，必然下血。老师说：寸口脉微而弱，气血俱虚，如果出现下血、呕吐、汗出还可以；假如不出现，趺阳脉微而弱。春季以胃气为本，出现吐利的还可以；假如不出现，这是水气病，腹部必然胀满，小便则困难。
妇女经常呕吐且胃反，如果经常气喘（一作多唾），月经又停止，假如来潮，量必然很少。
老师说：有一位六十岁的妇女，月经经常自行来潮，假如久病腹泻，少腹坚硬胀满的，为难治。
老师说：有一位妇女来就诊，说月经量少，不如以前，为什么？医生说：曾经腹泻，或者汗出、小便通利的还可以。为什么？医生说：津液亡失，所以导致月经量少。假如月经反而比以前多，应当担心痛苦困顿。应当说恐怕大便困难，身体不再出汗。
老师说：寸口脉沉而迟，沉代表水，迟代表寒，寒水相互搏结，趺阳脉伏，水谷不消化，脾气衰则便溏，胃气衰则身体浮肿。
少阳脉畀（此处疑为衍文或特定脉象描述，通常少阳脉弦），少阴脉细，男子则小便不利，妇女则月经不通。经血为血，血行不畅则为水，名叫血分。（一作水分）老师说：寸口脉沉而数，数代表出，沉代表入，出则为阳实，入则为阴结。趺阳脉微而弦，微则无胃气，弦则不得息。少阴脉沉而滑，沉则在里，滑则为实，沉滑相搏，血结胞门，其脏不泻，经络不通，名叫血分。
问：病有血分，是什么意思？老师说：月经先前停止，后来生病水肿，名叫血分。此病难治。
问：病有水分，是什么意思？老师说：先前生病水肿，后来月经停止，名叫水分，此病易治。为什么？去掉水邪，月经自然来潮。脉濡而弱，弱脉反在关部，濡脉反在巅部（浮取）。迟脉在上，紧脉在下。迟则为寒，名叫浑。阳浊则湿，名叫雾。紧则阴气战栗，脉反濡弱，濡则中湿，弱则中寒，寒湿相搏，名叫痹。腰脊骨节苦烦，肌肤麻木不仁，这应当诊断为痹证。而反而怀孕，月经推迟，体重增加，以下肢为甚的水肿，按之没指，腰部冷感麻木不仁，这是水气怀孕。气喘则倚息，小便不通，紧脉为呕，血气无余，这是水分。营卫乖亡，这不是怀孕。
Background Information:
Book: Mai Jing (Pulse Classic)
Author: Wang Shuhe
Dynasty: Western Jin
Chapter: Ping Ren Shen Tai Dong Xue Fen Shui Fen Tu Xia Fu Tong Zheng Di Er (Chapter 2: On Pregnancy, Fetal Movement, Blood and Water Divisions, Vomiting, Diarrhea, Abdominal Pain, etc.)
Category: Pulse Diagnosis
Translation:
When a woman is one month pregnant, the Qi and Blood of the Foot Jueyin Liver Meridian (which stores blood and regulates volume) nourish the fetus. At two months, they are nourished by the Foot Shaoyang Gallbladder Meridian (paired with the Liver, governing decision-making). At three months, by the Hand Jueyin Pericardium Meridian (the outer network protecting the Heart). At four months, by the Hand Shaoyang Sanjiao Meridian (transporting Yuan Qi and fluids). At five months, by the Foot Taiyin Spleen Meridian (governing the transformation and transportation of food essence). At six months, by the Foot Yangming Stomach Meridian (abundant in Qi and Blood). At seven months, by the Hand Taiyin Lung Meridian (governing Qi and respiration). At eight months, by the Hand Yangming Large Intestine Meridian (conveying waste). At nine months, by the Foot Shaoyin Kidney Meridian (storing Essence, the root of congenital constitution). At ten months, by the Foot Taiyang Bladder Meridian (governing the exterior of the body). Each Yin and Yang meridian nourishes for thirty days in its respective month, allowing the fetus to mature and be born. The Hand Taiyang Small Intestine and Hand Shaoyin Heart meridians do not directly participate in nourishing the fetus; their functions below maintain menstruation, and above transform into milk to nourish the infant and support the mother. During pregnancy, moxibustion or acupuncture should not be performed on these meridians, as it will inevitably cause miscarriage.
If a woman experiences thirst three months into pregnancy and her pulse is surprisingly slow, this may indicate "Water Division" pathology (disease caused by fluid retention). If accompanied by abdominal pain, miscarriage is inevitable.
If the pulse is floating and there is sweating, urinary obstruction will certainly occur. If the pulse is rapid, carbuncles and pus will certainly develop. If the pulse is rapid at five or six months of pregnancy, the condition will surely deteriorate. If the pulse is tight, uterine bleeding (leaking fetus) will occur.
If the pulse is slow, abdominal fullness and wheezing will certainly occur. If the pulse is floating, edema due to water flooding will certainly occur.
Question: A woman of about twenty years old has a floating and rapid pulse, fever, vomiting, cough, occasional diarrhea, and loss of appetite. Her pulse becomes floating again, and her menses have ceased. What is the cause? The Master said: According to the law, she should be pregnant. Why? Normally, those with deficiency have a weak pulse, but hers is surprisingly floating and rapid, indicating "Floating Yang" syndrome (deficient Yang floating upward). When Yin and Yang harmonize, pregnancy is expected. By the time of the Start of Autumn, the heat will naturally subside. How do we know this? Rapid pulse indicates heat; heat belongs to Fire. Fire is the son of Wood. In the Wei month (lunar June), Fire rests and Earth prospers, while Yin Qi begins to grow. With the arrival of Autumn solar terms, Fire Qi should recede, and heat will naturally disappear, curing the disease.
The Master said: If there is vaginal discharge three months after childbirth, followed by menstruation three months later, but the pulse shows no abnormalities, this indicates pregnancy. One must protect the fetus, fearing diarrhea. Why? Because during pregnancy, Yang Qi nourishes the fetus internally, leaving the breast area relatively cold and deficient. This causes the infant to suffer from diarrhea.
When a woman is six or seven months pregnant, if the pulse is wiry and she has fever, the fetus may protrude beyond the abdomen, accompanied by abdominal pain and aversion to cold, feeling as if the lower abdomen is being fanned by wind. This occurs because the uterus opens. It should be treated with Fuzi Tang to warm the uterus.
At seven months of pregnancy, a solid, large, firm, and strong pulse indicates survival, while a deep and fine pulse indicates death.
At eight months of pregnancy, a solid, large, firm, strong, wiry, and tight pulse indicates survival, while a deep and fine pulse indicates death.
If a woman at six or seven months of pregnancy suddenly expels more than a dou of watery fluid, the fetus will inevitably fall. This is not the time for delivery, but rather the premature leakage of amniotic fluid.
The Master said: If the Cunkou pulse is洪 (Hong/Surging) and 涩 (Se/Choppy), Hong indicates Qi excess, and Se indicates Blood deficiency. If Qi disturbs the Dantian, the body shape becomes warm. If Se appears in the lower part, the fetus is cold as ice. If Yang Qi prevails, the fetus lives; if Yin Qi is excessive, the fetus dies. To distinguish between Yin and Yang (life and death), the lower part of the fetus will become stiff. If Yang finally perishes, the accumulation in the abdomen will be hard like a cup.
Question: In cases of pregnancy disease, how does the physician determine via pulse diagnosis that a woman carries twins, one dead and one alive? After administering medicine to expel the dead fetus, the illness resolves, and eventually the living fetus is preserved. What does such a pulse resemble? How is it distinguished?
The Master said: At the Cunkou position, the Wei Qi (Defensive Qi) is balanced and smooth, and the Ying Qi (Nutritive Qi) is relaxed. Yang distributes, Yin transforms, Essence is abundant, and both Yin and Yang are prosperous, resulting in twins. Now, if the Shaoyin pulse is slightly tight, the blood becomes turbid and coagulated, nutrition is insufficient, causing one fetus to wither prematurely. There is coldness and fullness in the lower abdomen, knee pain, heavy waist making it difficult to rise; this is a disorder of the blood collaterals. If not removed early, it harms the mother and results in loss of the fetus.
The Master said: For pregnant women with abdominal pain and restlessness, if the fetus fails to grow, one can determine life or death by palpation. If the abdomen feels like an inverted cup, it is a male; if it feels uneven like an elbow joint, it is a female. Where is the cold? Cold indicates death; warmth indicates life.
The Master said: Women may experience metrorrhagia (bleeding outside of menstruation). Some occur before conception, some after, continuing without cessation. Some are gestational bleeding. If there is abdominal pain during pregnancy, it is called Baolou (Uterine Leakage, also known as Zu), treated with Jiao Ai Tang.
If a woman’s menses stop for three months during pregnancy but she experiences vaginal bleeding lasting forty days without stopping, and fetal movement is felt above the navel, this is called "Jijing" (stimulated menstruation, where light bleeding occurs monthly during early pregnancy without harming the fetus). If fetal movement is felt at six months, it is because conception occurred when the previous three months' menses were normal. The bleeding occurs because conception happened three months after the last period stopped; thus, bleeding persists because the stasis remains. One should purge the stasis using Guizhi Fuling Wan.
Question: A woman’s menses stop for one or two months, yet she bleeds again. Her pulse is now faint and choppy. Why? The Master said: This is because she had diarrhea in the first half of the month, which interfered with menstruation. Once diarrhea stops, menstruation should resume naturally; this is not pregnancy.
If a woman’s menses stop naturally due to pregnancy, but the pulse is wiry, she fears massive hemorrhage later, preventing successful gestation.
If a woman is pregnant, and at seven months it is uncertain, frequent epistaxis (nosebleed) and muscle cramps indicate pregnancy. However, if nosebleeds are accompanied by sneezing and tremors, it is not pregnancy. A pulse that comes near and goes far is called "Fan" (Reverse). Believing there is pregnancy but menses cease, this is due to having Yang without Yin.
If a woman’s menses are merely slightly scanty, but the physician says she is pregnant, and it proves true, what is the pulse like? How is it distinguished?
The Master said: The Cunkou pulse is balanced in Yin and Yang, Ying and Wei are harmonious. Pressing reveals slipperiness; lifting reveals lightness. The Hand Yangming and Foot Shaoyin pulses follow standard laws. The body feels chilly (Saxi), appetite is lost, headache and mental confusion occur, nausea and retching arise. Exhalation is slightly rapid, inhalation is calm. Yang is abundant with Qi overflow; Yin is slippery with Qi prosperity. Slippery indicates excess. The Six Channels nourish the fetus, so slight menstrual flow continues. Yin blood meets Yang essence, fluids coagulate, the uterus disperses; dispersion leads to damage and abortion. If Yang becomes excessive, twins result. Now, Yang is insufficient, hence the phenomenon of stimulated menstruation.
For pregnant women with difficult urination but normal appetite, Danggui Beimu Kushen Wan is indicated.
For pregnant women with water qi (fluid retention), heaviness, difficulty urinating, chills, and dizziness upon rising, Kuizi Fuling San is indicated.
Pregnant women are suitable for taking Danggui San, facilitating easy labor without pain.
The Master said: A woman came for consultation, stating her menses had stopped. The doctor said: One month of cessation is "Gou" (Dirt/Residue); two months is "Xue" (Blood); three months is "Ju Jing" (Resident Menses). This confirms pregnancy, or it could be blood accumulation. Like a hen incubating eggs, heat leads to hatching, cold leads to turbidity. Wait until next month to see when the menses return. If she says they come on the seventh day, tell her to return around the tenth day of the next month. If the menses do return, check the pulse. If it is deep and choppy, ask if she had a prior miscarriage or blood loss. If so, it is definitely pregnancy. She confirms this history; protection is advised. The pulse is weak, suggesting instability. If asked what to do, prescribe medicine.
The Master said: A woman came stating her menses stopped, then left. The doctor said: One month cessation is "Bi" (Closure); two months, presence or absence; three months, "Xue Ji" (Blood Accumulation). Like a hen incubating eggs, cold inside causes turbidity, heat inside causes hatching. To ensure fetal longevity, treat the mother. Carrying a child with cold pathogens shortens life. Like a hen incubating eggs, if a feather is plucked and coverage is incomplete, the cold part becomes turbid. Now the woman is pregnant, but her lower abdomen is cold and palms are reversed (cold). How can she be pregnant? She asks what to do. The doctor said: Use Wenjing Tang. If she came with her husband, she is pregnant. If she came with her parents, say there is much cold, and long-term infertility exists.
The Master said: A woman came stating Yin and Yang are harmonized, Yang grows, Yin shrinks, only exiting not entering, going near coming far, hence "Reverse." Suspecting pregnancy, yet menses cease. How many days since cessation? If confirmed, urgent treatment is needed, fearing menses might return. If she is a palace maid, widow, or had nocturnal emissions, evil qi may have formed a mass (Jia) over time. Urgent treatment is needed, starting with two decoctions. If unhealed, use a sweating decoction, aiming for middle efficacy. If the fetus is expelled but not delivered, what is the meaning? Observe the "Chi Wu" (Red Crow/Mare, referring to blood signs).
The Master said: If Zhang from the palace does not recover, inquire again. (Note: Chen Yi et al. detailed that this text has errors and lacks sources, showing doubt; others follow this example.)
The Master said: If a woman has a level pulse, with the Yin pulse slightly weak, thirst, inability to eat, no chills or fever, this is named Pregnancy. Treat with Guizhi Tang. According to the method, pregnancy should be confirmed within sixty days. If misdiagnosed and treated incorrectly, leading to vomiting and diarrhea after one month, stop treatment. The formula is in Shanghan Lun.
A woman with a level and empty pulse is nursing. Level and slightly weak indicates recent conception. Level but surprisingly faint and choppy, without blood loss or diarrhea, yet symptoms worsen, with a void pulse, is due to nursing a large infant and a small child. This is normal and does not lead to extreme depletion. Illness resembling blood loss or deficiency causes dizziness and shortness of breath.
The Master said: A woman who dresses elaborately comes for consultation with a choppy pulse. Ask if she had diarrhea after nursing. This pulse results from such history. Prior partial miscarriage with leakage can be cured. If not, and menses stop for three or six months. If nursing with leakage, consider early conception. Stop nursing the infant, wait for diarrhea to stop, then reconsult and check pulse.
The Master said: Cunkou pulse is faint and slow. Chi pulse is fainter than Cun. Slow at Cun indicates cold in the Upper Jiao, only vomiting will occur. Now Chi is deficient, compounded by harsh purgation. This leads to chest fullness and pain, likely hematemesis. Lower abdominal pain and lumbar spine pain indicate hematochezia. The Master said: Cunkou pulse faint and weak indicates Qi and Blood deficiency. Hemorrhage, vomiting, or sweating are acceptable outcomes. If not, Duyang pulse is faint and weak. Spring relies on Stomach Qi. Vomiting and diarrhea are acceptable; otherwise, it is Water Qi, abdominal fullness, and difficult urination.
Women who frequently vomit and have stomach reversal, or frequent wheezing (or excessive saliva), with ceased menses, if menses return, the volume will be scant.
The Master said: A sixty-year-old woman whose menses continue spontaneously, if she suffers from chronic diarrhea and lower abdominal hardness/fullness, is difficult to treat.
The Master said: A woman complains of scant menses compared to before. Why? The doctor said: Prior diarrhea, sweating, or frequent urination are acceptable. Why? Loss of body fluids causes scant menses. If menses become heavier than before, worry about exhaustion. Expect constipation and lack of sweating.
The Master said: Cunkou pulse deep and slow. Deep indicates Water, Slow indicates Cold. Cold and Water contend. Duyang pulse is hidden, digestion fails. Spleen Qi decline causes loose stools; Stomach Qi decline causes body edema.
Shaoyang pulse [text unclear], Shaoyin pulse fine. Men have difficult urination; women have amenorrhea. Menses are Blood. Blood stagnation becomes Water, named Blood Division (or Water Division). The Master said: Cunkou pulse deep and rapid. Rapid indicates Out, Deep indicates In. Out is Yang Excess, In is Yin Knot. Duyang pulse faint and wiry. Faint means no Stomach Qi; Wiry means inability to breathe. Shaoyin pulse deep and slippery. Deep is Interior, Slippery is Excess. Deep and Slippery contend, Blood knots at the Uterus Gate. The organ does not drain, collaterals are blocked, named Blood Division.
Question: What is Blood Division? The Master said: Menses cease first, then water disease (edema) develops, named Blood Division. This disease is difficult to treat.
Question: What is Water Division? The Master said: Water disease develops first, then menses cease, named Water Division. This disease is easy to treat. Why? Removing Water allows menses to resume naturally. Pulse is Ru (Soft) and Ruo (Weak). Weak is at Guan, Ru is at Dian (superficial). Slow is above, Tight is below. Slow is Cold, named Hun. Yang turbidity is Damp, named Wu (Mist). Tight indicates Yin Qi trembling. Pulse is surprisingly Ru and Ruo. Ru indicates internal Dampness, Ruo indicates internal Cold. Cold and Damp contend, named Bi (Obstruction). Waist, spine, and joints suffer annoyance; muscles are numb. This is Bi syndrome. But if pregnant, menses delay, weight increases, edema starts from legs, pressing leaves indentations, waist is cold and numb, this is Water Pregnancy. Wheezing requires leaning to breathe, urination blocked, Tight pulse causes vomiting, Blood and Qi exhausted, this is Water Division. Ying and Wei are disrupted, this is not pregnancy.