证三条（按当作二条。）方九首
妇人宿有 病（脉经。首五句。作妇人妊娠。经断三月。而得漏下。下血四十日不止。胎欲动。在于脐上。此而妊
娠三十字。血不止。作下血不止。）
按瘀血 痼。必在脐下。妊娠二三月堕者。多其所害。此云在脐上者。窃不无疑。或者讹字。敢俟有识论定。（脉
经胎在脐上。更疑。）
桂枝茯苓丸方
〔朱〕服法甚缓。以深固之邪。止堪渐以磨之也。
按此方茯苓。亦是引药下导者。（说见于虚劳肾气丸下。）芍药取之通壅。（宜参伤寒论述义太阴病下。）此五味之所
以相配也。
又按玄珠经。通真丸。妇人通经。男子破血。用大黄。桃仁。天水末。（一名益元散。）干漆。杜牛膝（医学纲目四
卷中引。）正得此方之意。
妇人怀娠六七月。脉弦发热。
按恶寒。尤氏为腹恶寒。然犹似身恶寒。存考。
师曰。妇人有漏下者。
〔朱〕妇人下血。大概由于冲任二经为病。或无端漏下。或半产后下血。或妊娠下血。下血虽异。而源头则一。
按此条漏下。与半产后下血。是客。妊娠下血腹中痛。是主。三证并列。以备参对也。鉴程剖析不了。朱氏为是。
但芎归胶艾汤。则足以兼三证而治之矣。（程氏引脉经。考原书。作今阳不足。故令激经也。）
又按魏氏曰。假令妊娠而下血腹中痛。此胞气阻滞之故也。胎气何以阻。以气虚寒也。气虚寒。则血必不足而凝。
凝则气愈阻而作痛。气阻血凝。则又内生虚热。血之凝者尚凝。而余血遂漏不止。甚则伤胎而动。动而竟坠。此胞中气
血。因虚而寒。因寒而阻。因阻而凝。因阻凝而热。因热而下血。因下血而伤胎坠孕。递及之道也。此说太巧。姑存之。
芎归胶艾汤方
医心方。产经云。治妊身七八月。腰腹痛。胎不安。汗出逆冷。饮食不下。气上烦满。四肢痹强。当归汤方。
于本方。去芎 。加生姜。橘皮。
千金翼。当归汤。治产后血留下焦不去。
于本方。去阿胶。艾叶。加桂枝。
圣惠。治产后下痢。腹中 痛。当归散方。
于本方。去阿胶。加干姜。
圣济。治妊娠因惊胎动不安。当归汤方。
于本方。加人参。不用清酒。
又治妊娠卒下血。致胎不安。少腹疼痛。人参汤方。
于本方。去芍药。加人参。黄芩。吴茱萸。生姜。不用清酒。
又治妊娠胎动有所下血。腹胁疼痛。宜服阿胶散方。
于本方。去芍药。加赤石脂。龙骨。黄 。干姜。不用酒。
卫生家宝。丁香胶艾汤。治崩漏走下不止。
于本方。加丁香末四分。
兰室秘藏。丁香胶艾汤。治崩漏不止。盖心气不足。劳役。及饮食不节。所谓经漏少时。其脉二尺俱弦紧洪。按之
无力。其证自觉脐下如冰。求浓衣被。以御其寒。白带白滑之物多。间有如屋漏水下。时有鲜血。右尺脉时微洪也。
于本方。去甘草。加丁香。
妇人怀娠。腹中 痛。
先兄曰。说文。有HT 无 。云。HT 。腹中急也。从 声。
当归芍药散方
〔朱〕芎归芍药。足以和血舒肝。苓术泽泻。足以运脾胜湿。此即后人逍遥散之蓝本也。
按妊娠之常。饮水动易停潴。是以内寒腹痛。此方利水散寒。以使胎气盛实。芎归二味。不特养血。亦能散寒止痛。
古方往往见之。此方所用。或此意也。（抱朴子至理篇曰。当归芍药之止绞痛。）先兄亦曰。此方芍药多用。取之缓其痛。
与小建中之芍药同趣。赵说似迂曲。
妊娠呕吐不止。
按张氏医通。全取赵氏。
干姜人参半夏丸方
医心方。僧深方。治妇人妊身。恶阻酢心。胸中冷腹痛。不能饮食。辄吐青黄汁方。用人参干姜半夏凡三物等。
分治下。以地黄汁和。丸如梧子。一服三丸。日三。今案极要方云。各分稍加至十丸。产经云。人参丸神良。
幼幼新书。婴孺。治小儿。调中止痢。去冷进食。人参丸方。
于本方。加茯苓。蜜丸。
当归贝母苦参丸方
按张氏医通。本于赵氏。
本草序例。雷公炮炙论。云如小豆许者。取重八两鲤鱼目比之。
葵子茯苓散方
〔朱〕葵子通利诸窍。称能滑胎。其疏泄血分可知。而得茯苓之淡渗。功专气分者。为之佐。使水从气分而去。则
胎自无虞。
按冬葵子。本草白字曰。主五癃。利小便。黑字曰。疗妇人乳难内闭。
白术散方
先兄曰。千金半夏汤。治香港脚上入腹。方中用细辛。与此治心烦吐痛者同趣。又范汪旋覆花汤。治胸膈痰结。亦用
细辛。俱取其辛温通气。散膈上寒饮也。
按千金。治咳嗽胸胁支满。多唾上气方。酒一升半。浸肥皂荚两挺。经宿。煮取半升。分三服。七日忌如药法。若
吐多。以酢饭三四口止之。此方。呕用醋浆。其义一也。
证候有三条（按：实际应作两条）。方剂有九首。
妇人平素有癥病（指腹内结块，固定不移，痛有定处的疾病），脉经中前五句写作：“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。”这三十个字是关于“血不止，作下血不止”的说明。
按：瘀血痼疾（指久治不愈、根深蒂固的瘀血阻滞），必定在脐下。妊娠二三个月发生堕胎者，多受其害。此处说在脐上，我私下对此表示怀疑。或许是文字讹误，暂且等待有识之士论定。（脉经中说胎在脐上，更令人怀疑。）
桂枝茯苓丸方
〔朱〕服药方法非常缓慢，因为这是深伏固着的邪气，只能逐渐消磨它。
按：此方中的茯苓，也是引导药力向下的药物。（这一观点见于对虚劳肾气丸的解说之下。）芍药取其疏通壅滞的作用。（宜参考伤寒论述义中太阴病部分的内容。）这就是五味药之所以这样配伍的原因。
又按：玄珠经中的通真丸，用于妇人通经，男子破血，使用大黄、桃仁、天水末（一名益元散）、干漆、杜牛膝（医学纲目第四卷中引用）。正符合本方的意旨。
妇人怀孕六七月，脉象弦，发热。
按：恶寒，尤氏解释为腹部恶寒，然而似乎还是身体恶寒，存疑以考察。
老师说：妇人有漏下（非经期阴道少量持续出血）的。
〔朱〕妇人下血，大概是由于冲任二经发病所致。有的无故漏下，有的半产后下血，有的妊娠下血。下血的表现虽然不同，但源头却是一样的。
按：此条中的漏下，与半产后下血，是客证；妊娠下血伴腹中痛，是主证。三证并列，以备对照参考。鉴程无法剖析清楚，朱氏的说法是正确的。但是芎归胶艾汤，就足以兼治这三证了。（程氏引用脉经，考证原书，写作“今阳不足，故令激经也”。）
又按：魏氏说：假如妊娠而下血且腹中痛，这是胞气阻滞的缘故。胎气为什么受阻？因为气虚寒。气虚寒，则血必然不足而凝滞。凝滞则气更加受阻而产生疼痛。气阻血凝，则又在体内产生虚热。已经凝滞的血仍然凝滞，而余血便漏下不止。严重时损伤胎气而致胎动，胎动最终导致堕胎。这是胞中气血，因虚而寒，因寒而阻滞，因阻滞而凝滞，因阻滞凝滞而生热，因热而下血，因下血而伤胎坠孕，层层递进的道理。这种说法太巧妙，姑且保留它。
芎归胶艾汤方
医心方、产经记载：治疗怀孕七八个月，腰腹痛，胎不安，汗出逆冷，饮食不下，气上烦满，四肢痹强。当归汤方。
在本方基础上，去掉川芎，加入生姜、橘皮。
千金翼方：当归汤，治疗产后瘀血留在下焦不去除。
在本方基础上，去掉阿胶、艾叶，加入桂枝。
圣惠方：治疗产后下痢，腹中痛。当归散方。
在本方基础上，去掉阿胶，加入干姜。
圣济总录：治疗妊娠因惊吓导致胎动不安。当归汤方。
在本方基础上，加入人参，不用清酒。
又治疗妊娠突然下血，导致胎不安，少腹疼痛。人参汤方。
在本方基础上，去掉芍药，加入人参、黄芩、吴茱萸、生姜，不用清酒。
又治疗妊娠胎动有所下血，腹胁疼痛。宜服阿胶散方。
在本方基础上，去掉芍药，加入赤石脂、龙骨、黄芩、干姜，不用酒。
卫生家宝：丁香胶艾汤，治疗崩漏（妇女非经期阴道大量出血或淋漓不断）走下不止。
在本方基础上，加入丁香末四分。
兰室秘藏：丁香胶艾汤，治疗崩漏不止。盖因心气不足，劳累役使，以及饮食不节制。所谓经漏持续时间短，其脉象两尺部都呈现弦紧洪大，按之无力。其症状自觉脐下如冰，寻求厚衣厚被以御寒，白带白滑之物多，间或有如屋漏水般滴下，时有鲜血，右尺脉时常微洪。
在本方基础上，去掉甘草，加入丁香。
妇人怀孕，腹中痛。
先兄说：说文解字中，有“𦙶”无“痛”字（注：原文此处可能有字形缺失或异体字，意指古文中特定表述）。云：“𦙶”，即腹中急迫感。从某声。
当归芍药散方
〔朱〕川芎、当归、芍药，足以调和血液、舒缓肝气；茯苓、白术、泽泻，足以运化脾土、胜除湿邪。这就是后人逍遥散的蓝本。
按：妊娠期间的常态，饮水容易停聚滞留，因此出现内寒腹痛。此方利水散寒，以使胎气盛实。川芎、当归两味药，不仅养血，也能散寒止痛。古方中往往能见到这种用法，此方所用，或许也是这个意思。（抱朴子至理篇说：“当归芍药可止绞痛。”）先兄也说：此方芍药用量较多，取其缓解疼痛之意。与小建中汤中芍药的用意相同。赵氏的说法似乎迂曲。
干姜人参半夏丸方
医心方、僧深方：治疗妇人怀孕，恶阻酢心（反酸烧心），胸中冷腹痛，不能饮食，经常吐出青黄色汁液。方用人参、干姜、半夏这三种药各等分。分别处理后，用地黄汁调和，制成梧桐子大小的丸药。每次服用三丸，每日三次。现今查看极要方记载：每种药稍加量至十丸。产经记载：人参丸神效。
幼幼新书：婴孺篇，治疗小儿，调理中焦止痢，去除寒冷增进食欲。人参丸方。
在本方基础上，加入茯苓，蜜丸。
本草序例、雷公炮炙论说：像小豆那样大小，取重八两鲤鱼目的重量来比较。
葵子茯苓散方
〔朱〕冬葵子通利各种窍道，号称能滑胎，其疏泄血分的作用可知。而得到茯苓淡渗利湿的功效，专门作用于气分，作为佐使，使水液从气分而去，那么胎气自然没有忧患。
按：冬葵子，本草白字条目说：主治五种淋证，利小便。黑字条目说：治疗妇人乳难内闭。
白术散方
先兄说：千金方中的半夏汤，治疗脚气上入腹，方中使用细辛，与此方治疗心烦吐痛，用意相同。另外范汪的旋覆花汤，治疗胸膈痰结，也使用细辛，都是取其辛温通气，消散膈上寒饮的作用。
按：千金方中，治疗咳嗽胸胁支满，多唾上气的方子，用酒一升半，浸泡肥皂荚两挺，过夜后，煮取半升，分三次服用。七天忌口如服药法。如果呕吐多，用醋饭三四口止住。此方用醋浆止呕，其中的道理是一样的。
Three patterns of symptoms (Note: Actually should be two). Nine prescriptions.
A woman who has long had a mass disease (referring to intra-abdominal masses that are fixed, immovable, and painful at specific locations), the Mai Jing (Pulse Classic) writes in the first five sentences: "A pregnant woman, having missed her period for three months, experiences metrorrhagia (irregular vaginal bleeding during pregnancy), bleeding continues for forty days without stopping, the fetus seems ready to move, located above the umbilicus." These thirty characters explain "bleeding does not stop, treated as continuous bleeding."
According to analysis: Blood stasis stubborn diseases (referring to blood stasis obstruction that is chronic, incurable, and deeply rooted) must be below the umbilicus. Those who suffer miscarriage in the second or third month of pregnancy are mostly harmed by this. The text here says it is above the umbilicus; I privately doubt this. It may be a textual error, awaiting determination by knowledgeable scholars. (The Mai Jing states the fetus is above the umbilicus, which causes further suspicion.)
Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) Prescription
[Zhu] The method of taking the medicine is very slow, because this is a deep-seated and stubborn pathogen, which can only be gradually ground away.
Analysis: Poria (Fuling) in this prescription also serves as a guiding drug directing downwards. (This view is seen in the commentary on Xulao Shenqi Wan below.) Peony (Shaoyao) is used for its ability to unblock stagnation. (Refer to the discussion on Taiyin Disease in Shanghan Lun Shuyi.) This is why the five flavors are matched together.
Furthermore, according to the Xuanzhu Jing, Tongzhen Wan is used to regulate menstruation in women and break blood stasis in men, using Rhubarb (Dahuang), Peach Kernel (Taoren), Tianshui Powder (Tianshui Mo, also known as Yiyuan San), Dried Lacquer (Ganqi), and Achyranthes Root (Niuxi) (cited in Volume 4 of Yixue Gangmu). This perfectly aligns with the intent of this prescription.
When a woman is six or seven months pregnant, the pulse is wiry (Xian) and there is fever.
Analysis: Aversion to cold, You Shi interpreted it as abdominal aversion to cold, but it seems more like general body aversion to cold. To be investigated.
The Master said: There are women who experience metrorrhagia (irregular vaginal bleeding).
[Zhu] Vaginal bleeding in women generally results from disorders of the Chong and Ren meridians. Some have spontaneous metrorrhagia, some have bleeding after a half-abortion, and some have bleeding during pregnancy. Although the manifestations of bleeding differ, the source is the same.
Analysis: In this clause, metrorrhagia and post-half-abortion bleeding are secondary patterns (ke); metrorrhagia accompanied by abdominal pain during pregnancy is the primary pattern (zhu). The three patterns are listed side by side for comparative reference. Jian Cheng could not analyze this clearly; Zhu's statement is correct. However, Xionggui Jiao'ai Tang is sufficient to treat all three patterns simultaneously. (Cheng Shi cited the Mai Jing, verifying the original text, which reads "Now Yang is insufficient, thus causing Ji Jing [stimulated menstruation].")
Furthermore, Wei Shi said: If a pregnant woman has bleeding and abdominal pain, this is due to the obstruction of the uterine Qi. Why is fetal Qi obstructed? Because of Qi deficiency and cold. Qi deficiency and cold cause blood insufficiency and coagulation. Coagulation leads to further Qi obstruction and pain. Qi obstruction and blood coagulation generate internal deficient heat. The coagulated blood remains coagulated, while residual blood leaks continuously. Severely, it damages the fetus causing movement, and movement eventually leads to abortion. This is the progressive mechanism: Uterine Qi and blood become cold due to deficiency, obstructed due to cold, coagulated due to obstruction, generating heat due to obstruction and coagulation, leading to bleeding due to heat, damaging the fetus and causing abortion due to bleeding. This explanation is too clever; let us preserve it for now.
Xionggui Jiao'ai Tang (Szechwan Lovage Root, Angelica Sinensis, Donkey-hide Gelatin, and Mugwort Decoction) Prescription
Yixin Fang and Chan Jing record: Treating pregnancy at seven or eight months, lower back and abdominal pain, fetal restlessness, sweating with cold limbs, inability to eat or drink, Qi rising causing vexation and fullness, numbness and stiffness in the four limbs. Danggui Tang (Angelica Decoction) formula.
Based on this prescription, remove Ligusticum (Xiong), add Fresh Ginger (Shengjiang) and Tangerine Peel (Jupi).
Qianjin Yi Fang: Danggui Tang, treating postpartum blood stasis remaining in the lower jiao and not dispersing.
Based on this prescription, remove Donkey-hide Gelatin (Ejiao) and Mugwort (Aiye), add Cinnamon Twig (Guizhi).
Shenghui Fang: Treating postpartum dysentery and abdominal pain. Danggui San (Angelica Powder) formula.
Based on this prescription, remove Donkey-hide Gelatin (Ejiao), add Dried Ginger (Ganjiang).
Shengji Zonglu: Treating fetal restlessness due to fright during pregnancy. Danggui Tang.
Based on this prescription, add Ginseng (Renshen), do not use clear wine.
Also treating sudden bleeding during pregnancy causing fetal restlessness and lower abdominal pain. Renshen Tang (Ginseng Decoction).
Based on this prescription, remove Peony (Shaoyao), add Ginseng (Renshen), Scutellaria (Huangqin), Evodia (Wuzhuyu), and Fresh Ginger (Shengjiang), do not use clear wine.
Also treating fetal movement with bleeding and abdominal/hypochondriac pain. Suitable to take Ejiao San (Donkey-hide Gelatin Powder).
Based on this prescription, remove Peony (Shaoyao), add Red Kaolin (Chishizhi), Dragon Bone (Longgu), Scutellaria (Huangqin), and Dried Ginger (Ganjiang), do not use wine.
Weisheng Jiabao: Dingxiang Jiao'ai Tang (Clove and Donkey-hide Gelatin Decoction), treating Binglou (metrorrhagia and metrostaxis) flowing down continuously.
Based on this prescription, add Clove powder (Dingxiang Mo), 4 fen.
Lanshi Micang: Dingxiang Jiao'ai Tang, treating persistent Binglou. Due to Heart Qi insufficiency, overwork, and irregular diet. So-called Jinglou lasting a short time, the pulse at both Chi positions is wiry, tight, and surging, but weak upon pressure. Symptoms include feeling as if the area below the navel is icy, seeking thick clothes and blankets to ward off cold, excessive white leukorrhea, occasional dripping like roof water leakage, sometimes fresh blood, and the right Chi pulse is occasionally slightly surging.
Based on this prescription, remove Licorice (Gancao), add Clove (Dingxiang).
A woman is pregnant, suffering from abdominal pain.
My elder brother said: In Shuowen Jiezi, there is the character '𦙶' but no 'Tong' (pain). It says: '𦙶' refers to a sense of urgency in the abdomen. Derived from a certain phonetic component.
Danggui Shaoyao San (Angelica and Peony Powder) Prescription
[Zhu] Ligusticum (Xiong), Angelica (Gui), and Peony (Shaoyao) are sufficient to harmonize blood and soothe the Liver. Poria (Fuling), Atractylodes (Baizhu), and Alisma (Zexie) are sufficient to transform Spleen function and overcome dampness. This is the prototype for the later Xiaoyao San.
Analysis: The normal state during pregnancy involves easy retention of fluids from drinking, leading to internal cold and abdominal pain. This prescription promotes urination and dispels cold, thereby strengthening fetal Qi. Ligusticum and Angelica not only nourish blood but also dispel cold and relieve pain. Such usage is often seen in ancient prescriptions; perhaps this is the intent here. (Baopuzi Zhili Pian states: "Angelica and Peony can stop severe colic.") My elder brother also said: This prescription uses a large amount of Peony to relieve pain. This shares the same intent as the Peony in Xiao Jianzhong Tang. Zhao's theory seems convoluted.
Persistent vomiting during pregnancy.
Analysis: Zhangshi Yitong completely adopts Zhao's view.
Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill) Prescription
Yixin Fang, Seng Shen Fang: Treating pregnant women with nausea and acid regurgitation, cold abdominal pain in the chest, inability to eat, frequently vomiting green and yellow juice. Use Ginseng, Dried Ginger, and Pinellia in equal parts. Process separately, mix with Rehmannia juice, make pills the size of a wisteria seed. Take three pills per dose, three times a day. According to the current examination of Ji Yao Fang: increase each ingredient slightly to ten pills. Chan Jing records: Renshen Wan is miraculous.
Youyou Xinshu: Yingru section, treating infants and children, regulating the middle jiao to stop dysentery, removing cold to promote appetite. Renshen Wan.
Based on this prescription, add Poria (Fuling), honey pills.
Danggui Beimu Kushen Wan (Angelica, Coptis, and Sophora Pill) Prescription
Analysis: Zhangshi Yitong is based on Zhao's work.
Bencao Xuli and Leigong Paozhi Lun state: Similar in size to a small bean, weighing eight taels compared to a carp eye.
Kuizi Fuling San (Okra Seed and Poria Powder) Prescription
[Zhu] Okra seeds (Kuizi) unblock various orifices and are known to facilitate childbirth (slippery womb); their ability to drain the blood level is evident. With the light and渗 (permeating) action of Poria (Fuling), which specializes in the Qi level, acting as an assistant, allowing water to exit via the Qi level, the fetal Qi will naturally be safe.
Analysis: Okra seeds (Dongkuizi): White entry in Bencao states: Mainly treats five types of strangury, promotes urination. Black entry states: Treats difficult labor and internal blockage in women.
Baizhu San (Atractylodes Macrocephala Powder) Prescription
My elder brother said: Banxia Tang in Qianjin treats foot qi ascending into the abdomen, using Asarum (Xixin) in the formula, which shares the same intent as this prescription for treating vexation, vomiting, and pain. Additionally, Fan Wang's Xuanfuhua Tang treats phlegm accumulation in the chest and diaphragm, also using Asarum (Xixin), all utilizing its acrid-warm property to circulate Qi and disperse cold-fluid in the diaphragm.
Analysis: In Qianjin, a prescription for cough with chest/flank distension and copid sputum uses one sheng and half of wine to soak two pods of Soapberry (Feizaojia) overnight, then boil to obtain half a sheng, divided into three doses. Avoidances for seven days follow the medication rules. If vomiting is excessive, stop it with three or four mouthfuls of vinegar rice. This prescription uses vinegar slurry to stop vomiting; the principle is the same.