即子悬
〔薛〕胎上逼心之证，若气逆胎上，用紫苏饮。饮食不甘，兼以四君子。若内热晡
热，兼以逍遥散。若胃火所致，用四君、黄芩、枳壳、柴、栀。若脾郁所致，用归脾汤
加柴、栀、枳壳。一妊妇每因恚怒，其胎上逼，左关脉弦洪，乃肝火内动。用小柴胡
加茯苓、枳壳、山栀而愈。但体倦不食，用六君子调养脾土，加柴胡、枳壳，调和肝气
乃瘥。一妊妇胎上逼，胸满嗳气，饮食少思，此脾气郁滞，用紫苏饮顿安。又用四君
子加枳壳、柴胡、山栀而瘥。程文彬治孕妇七个月，胸膈饱闷，气喘，忽吐出一物如
小肠寸许，举家惊疑其胎烂。程至，诊得寸口脉洪滑，知其气盛血少，胎气凑上，中焦
蓄有湿热，湿生痰，知所吐之物，乃痰结聚，病名子悬。以紫苏饮加芩、连、贝母，十剂获痊。
本事方紫苏饮 治妊娠胎气不和，怀胎近上，胀满疼痛，谓之子悬。兼治临产惊恐，
气结连日不下。（一方无芎，名七宝散。）
紫苏茎叶（一两） 大腹皮 人参 川芎 陈皮 白芍药（各半两） 当归（七钱半）
甘草（二钱半）
上细锉，分作三服，每服用水一盏半，生姜四片，葱白七寸，煎至七分，去渣空心服。
曾有一妇，累日产不下，服遍催生药不验。予曰∶此必坐草太早，心怀一点惧气
结而不行，然非不顺也。《素问》云∶恐则气下。盖恐则精神怯，怯则上焦闭，闭则气还，
还则下焦胀，气乃不行矣。得此药一服便产。及妇人六七月子悬者，予用此数数有验，不
十服胎便近下。
陈良甫治一妇有孕七个月，远归，忽然胎上冲心而痛，坐卧不安，两医治之无效，遂
说胎已死矣，用蓖麻子研烂加麝香调，贴脐中以下之，命在垂亡。召陈诊视，两尺脉绝，
他脉平和。陈问二医，作何证治之？答曰∶死胎也。陈曰∶何以知之？曰∶两尺脉沉绝，以
此知之。陈曰∶此说出何经？二医无答。陈曰，此子悬也。若是胎死，却有辨处，面赤
舌青，子死母活。面青舌赤，吐沫，母死子活。唇口俱青，母子俱死。今面不赤，口不
青，其子未死，是胎上逼心，宜以紫苏饮子治之。至十服，而胎近下矣。
当归汤 治妊娠胎动，荡心闷绝，烦躁口干，横生倒产，上冲下筑，迷闷，唇口青
黑，手足厥冷。产科名保安散。一方无甘草，有川芎。浓朴。《产宝方》有川芎。
当归 阿胶（炒） 甘草（各一两） 人参（一两半） 连根葱白（一根）
上细锉，水二升，煎四味至升半，去滓下葱再煎，减三合，温服。一剂分为二三服。
大圣散 治妊娠忪悸，睡梦多惊，心腹胀满，连脐急痛，胎上逼。（见惊悸）
治胎上逼心烦闷方。又治妊娠六七月以后，胎动困笃。用葱白二七茎，浓煮汁饮之。
若胎未死即安，已死即出，未效再服。（娄全善云∶此方神妙，脉浮滑者宜之。《本草》云∶葱白通
阳气安胎。）
《秘录》治胎动上逼心痛。取艾叶如鸡子大，以头醋四升，煎取二升，分温服。又
治胎上逼心，热痛下血。神曲半斤，捣碎和熟水绞取汁三盅，无进温服，止。
治妊娠遍身痛，或冲心欲死，不能饮食。
白术（五两） 黄芩（二两） 芍药（四两）
上水六升，煮取二升半，分作三服。缘胎有水致痛，兼易产。
文仲、葛氏疗妊娠卒胎上迫心痛方 取弩弦急带之，立愈。
胶艾汤（见血崩。）保生丸（大法。）
这就是“子悬”病。
薛己认为：治疗胎上逼心之证，如果是气逆导致胎气上冲，使用紫苏饮。如果伴有饮食无味，兼用四君子汤。如果有内热及傍晚发热（晡热），兼用逍遥散。如果是胃火所致，使用四君子汤加黄芩、枳壳、柴胡、栀子。如果是脾郁所致，使用归脾汤加柴胡、栀子、枳壳。有一位孕妇每次因为愤怒，导致胎气上逼，左关脉弦洪，这是肝火内动。用小柴胡汤加茯苓、枳壳、山栀而痊愈。但身体疲倦不想吃东西，用六君子汤调养脾土，加柴胡、枳壳，调和肝气才好转。另一位孕妇胎上逼，胸满嗳气，饮食减少思食，这是脾气郁滞，用紫苏饮立刻安宁。又用四君子汤加枳壳、柴胡、山栀而痊愈。程文彬治疗一位怀孕七个月的孕妇，胸膈饱闷，气喘，忽然吐出一物如小肠寸许长，全家惊恐怀疑胎儿腐烂。程文彬到达后，诊得寸口脉洪滑，知道她气盛血少，胎气凑上，中焦蓄有湿热，湿生痰，所吐之物乃是痰结聚，病名子悬。用紫苏饮加黄芩、黄连、贝母，十剂后痊愈。
《本事方》中的紫苏饮：治疗妊娠胎气不和，怀胎位置偏上，胀满疼痛，称为子悬。兼治临产时惊恐，气结连日不下。（有一方没有川芎，名叫七宝散。）
紫苏茎叶（一两） 大腹皮 人参 川芎 陈皮 白芍药（各半两） 当归（七钱半） 甘草（二钱半）
以上药材细锉，分作三服，每服用一盏半水，生姜四片，葱白七寸，煎至七分，去渣空腹服用。
曾有一位妇女，多次难产，服遍催生药无效。我说：这一定是坐草太早，心怀一点惧气结而不行，但这并非不顺产。《素问》说：恐则气下。大概是因为恐惧则精神怯弱，怯弱则上焦闭塞，闭塞则气还，气还则下焦胀，气乃不行。得到此药一服便生产。至于妇人怀孕六七个月出现子悬者，我用此方数次都有验效，不到十服胎位便近下。
陈良甫治疗一位怀孕七个月的妇女，远途归来，忽然胎上冲心而痛，坐卧不安，两位医生医治无效，于是说胎儿已死，用蓖麻子研烂加麝香调匀，贴脐中以使其下行，命在垂危。召请陈良甫诊治，两尺脉绝，其他脉平和。陈良甫问两位医生，按什么证候治疗？回答说：是死胎。陈良甫说：怎么知道的？回答说：两尺脉沉绝，以此知道。陈良甫说：此说法出自哪部经典？两位医生无言以对。陈良甫说：这是子悬病。如果是胎死，却有辨别之处，面赤舌青，子死母活。面青舌赤，吐沫，母死子活。唇口俱青，母子俱死。现在面色不赤，口唇不青，其子未死，是胎上逼心，宜以紫苏饮子治疗。到十服，胎位便近下了。
当归汤：治疗妊娠胎动，荡心闷绝，烦躁口干，横生倒产，上冲下筑，迷闷，唇口青黑，手足厥冷。产科名为保安散。一方无甘草，有川芎、浓朴。《产宝方》有川芎。
当归 阿胶（炒） 甘草（各一两） 人参（一两半） 连根葱白（一根）
以上细锉，水二升，煎四味至升半，去滓下葱再煎，减三合，温服。一剂分为二三服。
大圣散：治疗妊娠惊悸，睡梦多惊，心腹胀满，连脐急痛，胎上逼。（见惊悸章节）
治疗胎上逼心烦闷方。又治妊娠六七月以后，胎动困笃。用葱白二七茎，浓煮汁饮之。若胎未死即安，已死即出，未效再服。（娄全善说：此方神妙，脉浮滑者适宜。《本草》说：葱白通阳气安胎。）
《秘录》治疗胎动上逼心痛。取艾叶如鸡子大，以头醋四升，煎取二升，分温服。又治胎上逼心，热痛下血。神曲半斤，捣碎和熟水绞取汁三盅，无进温服，止。
治疗妊娠遍身痛，或冲心欲死，不能饮食。
白术（五两） 黄芩（二两） 芍药（四两）
以上用水六升，煮取二升半，分作三服。因为胎有水致痛，兼易产。
This is the condition known as "Zi Xuan" (Fetal Distension).
Xue Ji stated: For the syndrome of fetal pressure on the heart, if it is caused by rebellious Qi causing the fetus to move upward, use Zisu Yin. If accompanied by poor appetite, combine with Sijunzi Tang. If there is internal heat and afternoon fever (Bu Re), combine with Xiaoyao San. If caused by Stomach Fire, use Sijunzi Tang added with Huangqin, Zhike, Chaihu, and Zhizi. If caused by Spleen Depression, use Guipi Tang added with Chaihu, Zhizi, and Zhike. One pregnant woman experienced fetal pressure every time she was angry; her left Guan pulse was wiry and surging, indicating Liver Fire stirring internally. She was cured using Xiao Chai Hu Tang added with Fuling, Zhike, and Shanzhi. However, due to fatigue and anorexia, Liu Junzi Tang was used to nourish the Spleen Earth, added with Chaihu and Zhike to harmonize Liver Qi, leading to recovery. Another pregnant woman suffered from fetal pressure, chest fullness, belching, and reduced desire for food; this was due to stagnant Spleen Qi. She was instantly relieved using Zisu Yin, and subsequently recovered using Sijunzi Tang added with Zhike, Chaihu, and Shanzhi. Cheng Wenbin treated a pregnant woman at seven months gestation who suffered from chest and diaphragm fullness and distension, and panting. She suddenly vomited an object resembling a segment of small intestine about one cun long. The whole family was terrified, suspecting the fetus had rotted. Upon arrival, Cheng Wenbin palpated a surging and slippery Cun Kou pulse, determining that she had abundant Qi but deficient Blood, causing the fetal Qi to rush upward. Damp-heat was accumulated in the Middle Jiao, generating Phlegm. The vomited object was actually congealed Phlegm. The disease name was Zi Xuan. He prescribed Zisu Yin added with Huangqin, Lian, and Beimu. After ten doses, she recovered completely.
The Zisu Yin from *Ben Shi Fang* treats disharmony of fetal Qi during pregnancy, where the fetus moves upward, causing distension and pain, termed Zi Xuan. It also treats fright during labor, where Qi stagnates preventing delivery for days. (One formula without Chuanxiong is called Qibao San.)
Zisu Jingye (Perilla Stem and Leaf) (1 liang), Dafupi, Renshen, Chuanxiong, Chenpi, Baishaoyao (each 0.5 liang), Danggui (7.5 qian), Gancao (2.5 qian).
Grind finely, divide into three doses. For each dose, use 1.5 sheng of water, 4 slices of Shengjiang, and 7 cun of Congbai. Decoct until 0.7 remains, strain, and take on an empty stomach.
Once, a woman suffered repeated difficult labors; all parturition-inducing medicines failed. I said: This must be due to sitting on the birth mat too early, with fear causing Qi to knot and not move. However, it is not obstructed delivery. *Su Wen* states: Fear causes Qi to descend. Generally, fear makes the spirit timid; timidity closes the Upper Jiao; closure causes Qi to return; returning Qi causes Lower Jiao distension, and Qi fails to move. With one dose of this medicine, she delivered. For women experiencing Zi Xuan at six or seven months, I have frequently used this formula with success; within ten doses, the fetus descends.
Chen Liangfu treated a pregnant woman at seven months who, after a long journey, suddenly experienced fetal Qi rushing to the heart with pain, unable to sit or lie comfortably. Two doctors failed to treat her and claimed the fetus was dead. They applied a paste of crushed Castor seeds and Musk to the umbilicus to induce expulsion, leaving her life in peril. Chen was summoned. Her Chi pulses were absent, while other pulses were peaceful. Chen asked the two doctors how they diagnosed it. They replied: Dead fetus. Chen asked: How do you know? They said: The Chi pulses are deep and absent. Chen asked: Which classic does this theory come from? The doctors had no answer. Chen said: This is Zi Xuan. If the fetus were dead, there would be distinguishing signs: red face and blue tongue indicate dead fetus and living mother; blue face and red tongue with foaming indicate dead mother and living fetus; blue lips and mouth indicate both die. Now, her face is not red, and lips are not blue; the fetus is alive. This is fetal pressure on the heart. Treat with Zisu Yin. After ten doses, the fetus descended.
Danggui Tang treats fetal movement during pregnancy, overwhelming chest distress and fainting, irritability, dry mouth, transverse presentation, breech presentation, upward rushing and downward pounding, confusion, cyanotic lips and mouth, and cold extremities. In obstetrics, it is named Bao'an San. One formula lacks Gancao but includes Chuanxiong and Houpo. *Chanbao Fang* includes Chuanxiong.
Danggui, Ejiao (stir-fried), Gancao (each 1 liang), Renshen (1.5 liang), Lian gen Congbai (1 root).
Grind finely. Use 2 sheng of water. Decoct the four ingredients until 1.5 sheng remains. Strain, add Congbai, decoct again until 3 he less remains. Take warm. Divide one dose into two or three servings.
Dasheng San treats pregnancy-related palpitations, frequent nightmares, abdominal distension and fullness, urgent pain extending to the navel, and fetal pressure. (See Palpitations section.)
Formula for treating fetal pressure with vexation and chest stuffiness. Also treats fetal restlessness and severe distress after the sixth or seventh month of pregnancy. Use fourteen stalks of Congbai, decoct strongly, and drink the juice. If the fetus is alive, it will settle; if dead, it will be expelled. Repeat if ineffective. (Lou Quanshan said: This formula is miraculous, suitable for those with floating and slippery pulses. *Bencao* states: Congbai unblocks Yang Qi and calms the fetus.)
*Milu Lu* treats fetal movement with upward pressure and heart pain. Take Aiye the size of a chicken egg, decoct in 4 sheng of first vinegar until 2 sheng remains. Take warm in divided doses. Also treats fetal pressure on the heart with hot pain and bleeding. Take Ban Shenqu (half a jin), crush, mix with cooked water, squeeze out three zhong of juice. Take warm when unable to eat, stop when effective.
Treats generalized body pain during pregnancy, or sensation of Qi rushing to the heart causing near-death feeling, and inability to eat.
Baizhu (5 liang), Huangqin (2 liang), Shaoyao (4 liang).
Use 6 sheng of water. Decoct until 2.5 sheng remains. Divide into three doses. Because the pain is caused by fluid retention affecting the fetus, this also facilitates easy delivery.
Wenzhong and Ge's formulas for sudden fetal pressure causing heart pain during pregnancy. Tie a tight crossbow string around the abdomen; immediate relief occurs.
Jiao'ai Tang (See Metrorrhagia section). Baosheng Wan (General Principles section).