妊娠小便难。其因有三。血短于养胎。而诸腑以及经脉。各借滋于水饮。而渗泄之气化自缓和。一也。胞胎具
一团阳气。热逼小肠膀胱之界。使气壅所出之窍者。二也。又胞胎之生气。浮纵而鼓塞于少腹。以挨挤膀胱。
俾膀胱逼窄而尝扁。不能容十分之二三。故水饮少入。即急满而欲尿。既短而数。且挤其溺管狭小。而出又
艰难者。三也。今妊娠小便难。又不渴悸而饮如故。不呕满而食如故。是小便之难。不当责上中二焦。而为胎
热胎胀无疑。故用贝母、苦参之苦寒者。殆寒以清火。苦以束胎也。然后合补血之当归以润血。而借滋之水
饮。将得路而下渗矣。盖贝母体轻色白。能开郁滞之气。苦参味苦性沉。能坚散漫之气。故疡家为散火消肿
之专药。夫母气之郁滞疏通。子气之散漫摄伏。又血液自裕。而替下借滋之水。则小便复何留连阻滞。而尚
有艰涩之苦乎。真神明之制也。尝读仲景妊娠诸条。并细按其病脉症治。而知妇人怀身十月。俱恩中生
害。而前后方药。却又害中生恩者也。盖母身之气血自虚。则以不能荫胎。而胎弱者。将为子病。幸而子胞之
气血自壮。则又以善能养胎。而胎盛者。复为母灾。甚至子胎病虚。更加伤母。母灾太甚。又复伤胎。非恩中之
害而何。至其治法。于干姜、人参、半夏丸。则纯用西金辛辣之气。以克制其生机之上冲。于当归、贝母、苦参丸。
又纯用苦寒收束之味。以坚拢其形质之放荡。盖权衡于母子之间。而以益母损子者为正治。则正保母以
养子之意。故曰。害中之恩者此也。
妊娠有水气。身重。小便不利。洒淅恶寒。起即头眩。葵子茯苓散主之。
葵子茯苓散方 葵子（一斤） 茯苓（三两）
上二味。杵为散。饮服方寸匕。日三服。小便利则愈。
妊娠有水气。见上条小便难注。水性下沉。而滞其经络之气。故身重。然必以小便不利为确诊者。因水气不
行而旁溢。且身重。尚有脾阳不运之别症故也。洒淅恶寒。言恶寒之状。如以冷水洒身上。而有淅栗之象。盖
因水气在经络。而卫阳阻抑失守也。妊娠胎气下实。原多眩症。况小便不利。而复积水气以上冲乎。故头眩
也。是则利其小便。使水气去。而诸症俱愈矣。葵子甘寒滑利。盖甘以走气。寒以清热。滑以行津。利以通窍。合
茯苓、以渗泄之。则小盒饭渐利矣。
妇人妊娠宜常服。当归散主之。
当归散方 当归 芍药 芎 黄芩（各一斤） 白术（半斤）
上五味。杵为散。酒饮服方寸匕。日再服。妊娠常服即易产。胎无疾苦。产后百日悉主之。
妇人妊娠。就未怀身。及怀身者。而两言之也。妇人妊娠之血。总贵充足而营运。故以补血行血之归、芎、为主。
而以行阴之芍药。引入肝脏。则血无枯槁及留滞之患矣。但血盛则气亦盛。而多生热。热则恐其耗血。故以
黄芩、清之。又血足则阴亦足。而或聚湿。湿则恐其滞血。故以白术燥之。此在妇人。则行经畅快。而无 瘕漏
下诸虞。在妊娠。则荫子裕如。而无半产腹痛等弊。故俱可以为常服之主药也。至于妊娠、产前、产后。更以血
为根本。尤所宜服。故悉主之。酒饮和服。见前当归芍药散注。
妊娠养胎。白术散主之。
白术散方 白术 芎 蜀椒（三分去汗） 牡蛎（失分两）
上四味。杵为散。酒服一钱匕、日三服。夜一服。但苦痛加芍药。心下毒痛。倍加川芎。一心烦吐痛。不能饮食。
加细辛一两。半夏大者二十枚。服之后。更以醋浆水服之。若呕以醋浆水服之。复不解者。小麦汁服之。已后
渴者。大麦汁服之。病虽愈。服之不置。（不置即常服）
白术去湿气。芎 补血气。蜀椒束胎气。牡蛎安逆气。妊娠不足者之病。不过此四者。故可为常服之主药。苦
痛者。以胎痛为苦之谓。胎痛。由于血短而气张。芍药敛气养血。故加之。心下毒痛。因膻中之阴阳。以养胎而
自虚。阴虚则拘痛。阳虚则窒痛。芎 为血中之气药。其性高而上浮。能两补心下之阴阳。故加之。心液短而
龙雷之虚火乘之。故烦。膈气虚寒。失照临化被之妙。故吐痛而不能饮食。细辛辛温。盖温以祛寒。辛以伏火
也。又半夏辛燥而降逆。能助细辛以伏电光之火。故并加之。服后、服醋浆水者。以酸敛降虚热。恐乍温之而
不受。反助其上冲之虚热而作呕也。若服此而呕不解。是心气虚。而不能下御冲气之所致。与其下敛之而
不服。毋宁填上而为自备之计乎。小麦为心之谷。煮汁服之。则补上以御下。故其呕自已也。已而作渴者。阳
气初复。而津液不足以副之。正心烦之余症也。大麦汁能润肺而生津液。故继小麦而为服耳。病指苦痛及
心烦吐呕等而言。诸病虽愈。药犹勿置。防其复也。但服药用酒。是其定引。其醋浆大小麦汁。俱是服药后另
服者。玩本文服药后。更以醋浆水云云。则可见矣。醋浆非苦酒。即米饮所作之酸水也。与下文大小麦汁
同用五谷。以各治其脏之义。妊娠阳气各有盛衰。故胞胎因之而各分寒热。阳气盛而胎热者。譬之三月
春晴。天气下育地中。尝天虚而地实。于是为生机过锐以凌太虚。（此指妊娠之热晕热呕而言）为燠热。
（此指因胎而发表热）为雨露不敷而干旱。（此言血不足以养胎而作心烦热渴之恶阻）为水泉下
涸等害。（指小水因热而不利者）此有故而病。则宜甘凉苦寒。如七条之归母苦参丸。八条之葵子茯苓
散。五条之当归芍药散等剂。即或无病。亦宜常服九条之当归散。其覆之以春云。润之以凉雨。节天地姑恤
之过爱。所以留长养万物之序也。阳气衰而胎寒者。譬之三春阴冷。阳光薄于下交。则地中之阴翳。冒春而
上占阳位。于是为生气不抱根株。（指漏下）为冰判欲。冻（指子藏如扇）为崩芽重萎。（指半产）为岚雾
上塞清虚。（指吐痛不欲食）此有故而病。则宜甘温辛温。如二条之桂苓丸。三条之附子汤。四条之胶艾
汤。六条之干姜人参半夏丸等剂。即或无病。亦宜服本条之白术散勿置。其被之以阳和。滋之以热雨。转天
地离火之明夷。只在此呵嘘胎息之微也。然妇人妊娠。得坤地之化。尝阴多而阳少。故本篇诸条。用温者。十
居其七。而用清者。十居其三。如来言浩劫不杀生。其仲景之谓乎。
妇人伤胎。怀身腹满。不得小便。从腰以下重。如有水气状。怀身七月。太阴当养不养。此心气实。当刺泻劳宫及
关
元。小便微利。则愈。
伤胎。妇人受伤于胎也。即下文腹满等之义。肺气自缩。不能展舒。而下逼胎气。则胎气上肆。故腹满。又肺气
自缩。而不管呵嘘传送。故不得小便。且肺气自缩。而失上提下挚之用。故腰以下重也。然三者。大似水病。以
不得小便。似有水之根。而腹满腰重。似有水之症。故曰如有水状。而实非水者。盖怀身至七月。胎中外长皮
毛。内鼓呼吸之候。正母以太阴肺经之气血。与胞中之肺脏感通相养者也。今其所以失下逼传送。及提挈
之用。而不养胎者。以心火气实。上克肺金。俾肺金清肃之气。畏缩而不布之道也。夫心为脏。脏不可泻。手厥
阴心包为之腑。掌心劳宫。是其经之井穴。刺以泻之。则泻经以及腑。泻腑以及脏。而心气上平矣。又心之经
脉。与小肠为表里。任脉部中。脐下、同身寸之三寸。为关元穴。为小肠之募也。关元与水分逼近。而司分理水
道者。刺以泻之。则小便微利。此又泻表以及里。而心气平于下矣。心火克金之气平。令肺气下展。故以上三
症自愈。以其原非有水。注意在泻火。而不在泻水。故但曰小便微利耳。此亦阳气盛而胎热者之治例也。
关元穴。千金言妇人刺之。主无子。又云妊娠刺之。则落胎。此就阳虚者而言也。盖关元又与气海逼近。阳气
虚。而又刺泻之。则关元气海益寒。而成地寒不谷。花寒不果之祸。其无子落胎。宜矣。若阳实而刺泻之。则适
得其平。而复何患哉。此医贵智能圆通之士也。
妊娠期间小便困难，其原因有三点。一是血液亏短以滋养胎儿，导致各脏腑及经脉都依赖水饮来滋润，从而使得渗泄的气化功能自然变得缓和，这是第一点。二是胞胎具有一团阳气，热气逼迫小肠与膀胱的交界，使气机壅塞在排泄的窍道中，这是第二点。三是胞胎的生发之气浮散放纵，鼓动并堵塞于少腹部，挤压膀胱，致使膀胱受逼而狭窄，常常处于扁平状态，不能容纳十分之二三的水量，因此水饮稍一进入，就感到急满想排尿；既短少又频数，且挤压尿道使其狭小，导致排出又艰难，这是第三点。如今妊娠小便困难，患者又不口渴、无心悸，饮水如常，不呕吐、无胀满，饮食如故，这说明小便的困难，不应归咎于上焦和中焦，而是胎热和胎胀无疑。所以使用贝母、苦参这类苦寒的药物，大概是利用寒性来清火，利用苦味来收敛固摄胎儿。然后再配合补血润血的当归，借助滋润之水饮，使其得以通路而下渗。因为贝母质地轻、颜色白，能开通郁滞的气机；苦参味道苦、性质沉，能坚固散漫的气机。所以外科医生将其作为散火消肿的专用药物。母体气机的郁滞得到疏通，子体（胎儿）气机的散漫得到摄伏，再加上血液自然充裕，替代下焦借滋的水饮，那么小便还有什么留连阻滞、尚且艰涩的痛苦呢？这真是神妙巧妙的方制啊。
我曾经研读仲景关于妊娠的各条论述，并仔细辨析其病脉症治，从而知道妇人怀胎十月，都是在恩惠中藏着危害，而前后的方药，却又是从危害中生出恩惠的。因为母体的气血如果虚弱，就不能荫蔽胎儿，导致胎儿衰弱，进而成为子病；幸好如果子胞的气血强壮，又能善于养胎，导致胎盛，反而成为母的灾祸。甚至子胎病虚，更加损伤母亲；母体灾祸太甚，又反过来损伤胎儿，这难道不是恩中之害吗？至于治疗方法，对于干姜、人参、半夏丸，则纯用西金（肺金）辛辣之气，来克制生机向上冲逆；对于当归、贝母、苦参丸，又纯用苦寒收束的药味，来坚固拢束形质的放荡。这是在权衡母子之间关系，以益母损子为正治法，这正是保全母亲以养育儿子的意思。所以说，这就是害中之恩。
妊娠有水气，身体沉重，小便不利，洒淅恶寒，起身即头眩，用葵子茯苓散主治。
葵子茯苓散方：葵子（一斤），茯苓（三两）。
以上两味药，捣碎过筛为散，用米汤送服一方寸匕，每日三次。小便通利就好了。
妊娠有水气，见上一条的小便难注。水性下沉，停滞阻碍经络之气，所以身体沉重。然而必须以小便不利作为确诊依据，是因为水气不行而旁溢，且身体沉重，还有脾阳不运的其他症状区别。洒淅恶寒，是说恶寒的样子，像冷水洒在身上，而有战栗的现象。这是因为水气在经络，卫阳被阻抑失守所致。妊娠胎气下实，原本多眩晕症状，何况小便不利，又积水气向上冲呢？所以出现头眩。这样只要利其小便，使水气去除，各种症状就会痊愈。葵子甘寒滑利，甘能走气，寒能清热，滑能行津，利能通窍，配合茯苓以渗泄之，那么小便就会逐渐通利了。
妇人妊娠宜常服当归散主治。
当归散方：当归、芍药、川芎、黄芩（各一斤），白术（半斤）。
以上五味药，捣碎过筛为散，用酒送服一方寸匕，每日两次。妊娠常服就容易生产，胎儿没有疾苦，产后百日也适用此方。
妇人妊娠，无论是未怀孕时，还是已怀孕时，都提到这一点。妇人妊娠的血，总以充足且营运通畅为贵，所以以补血行血的当归、川芎为主药，而以行阴的芍药引入肝脏，这样血就没有枯槁及留滞的患害了。但是血盛则气亦盛，而多生热，热则恐怕耗血，所以用黄芩来清之。又血足则阴亦足，而或聚湿，湿则恐怕滞血，所以用白术来燥之。这在妇人来说，则行经畅快，而没有瘕积、漏下等忧虑；在妊娠来说，则荫蔽胎儿裕如，而没有半产、腹痛等弊病。所以都可以作为常服的主药。至于妊娠、产前、产后，更以血为根本，尤其适宜服用，所以都适用此方。用酒调和服用，见前当归芍药散的注释。
妊娠养胎，用白术散主治。
白术散方：白术、川芎、蜀椒（三分，去汗）、牡蛎（失分两，疑为“四分”或特定剂量，原文如此）。
以上四味药，捣碎过筛为散，用酒送服一钱匕，每日三次，夜间一次。如果痛苦疼痛加芍药；心下剧烈疼痛，加倍加川芎；如果心烦、吐、痛，不能饮食，加细辛一两，大半夏二十枚。服药后，再用醋浆水送服。如果呕吐，用醋浆水送服；如果仍不解，用小麦汁送服。此后口渴者，用大麦汁送服。病虽愈，服药不要停止。（不置即常服之意）。
白术去湿气，川芎补血气，蜀椒束胎气，牡蛎安逆气。妊娠不足的病，不过这四方面，所以可作为常服的主药。苦痛，是指以胎痛为苦。胎痛，由于血短而气张，芍药敛气养血，所以加入。心下剧烈疼痛，因膻中的阴阳，因养胎而自虚，阴虚则拘挛作痛，阳虚则窒闷作痛。川芎是血中之气药，其性高而上浮，能两补心下的阴阳，所以加入。心液短而龙雷之虚火乘之，所以烦；膈气虚寒，失去照临化被的妙用，所以吐痛而不能饮食。细辛辛温，温能祛寒，辛能伏火。又半夏辛燥而降逆，能助细辛以伏电光之火（指虚火），所以一并加入。服药后，服醋浆水，是因为酸能收敛降虚热，恐怕刚温补而不受，反而助其上冲的虚热而作呕。如果服此药而呕不解，是心气虚，不能下御冲气所致。与其下敛而不受，不如填上而为自备之计。小麦为心之谷，煮汁服用，则补上以御下，所以呕吐自止。随后作渴者，是阳气初复，而津液不足以副之，正是心烦之余症。大麦汁能润肺而生津液，所以继小麦之后服用。病指苦痛及心烦吐呕等而言。诸病虽愈，药犹勿停，以防复发。但服药用酒，是其定引。其醋浆大小麦汁，都是服药后另服的。玩味本文服药后，更以醋浆水云云，就可以看出来了。醋浆非苦酒，即是米饮所制作的酸水。与下文大小麦汁同用五谷，以各治其脏的意思。妊娠阳气各有盛衰，所以胞胎因而各自分寒热。阳气盛而胎热者，譬如三月春晴，天气下育地中，尝天虚而地实，于是为生机过锐以凌太虚。（此指妊娠之热晕热呕而言），为燠热（此指因胎而发表热），为雨露不敷而干旱（此言血不足以养胎而作心烦热渴之恶阻），为水泉下涸等害（指小水因热而不利者）。此有故而病，则宜甘凉苦寒，如七条之归母苦参丸，八条之葵子茯苓散，五条之当归芍药散等剂。即或无病，亦宜常服九条之当归散。其覆之以春云，润之以凉雨，节天地姑恤之过爱，所以留长养万物之序也。阳气衰而胎寒者，譬如三春阴冷，阳光薄于下交，则地中之阴翳，冒春而上占阳位，于是为生气不抱根株（指漏下），为冰判欲冻（指子藏如扇），为崩芽重萎（指半产），为岚雾上塞清虚（指吐痛不欲食）。此有故而病，则宜甘温辛温，如二条之桂苓丸，三条之附子汤，四条之胶艾汤，六条之干姜人参半夏丸等剂。即或无病，亦宜服本条之白术散勿置。其被之以阳和，滋之以热雨，转天地离火之明夷，只在此呵嘘胎息之微也。然妇人妊娠，得坤地之化，尝阴多而阳少，故本篇诸条，用温者，十居其七，而用清者，十居其三。如来言浩劫不杀生，其仲景之谓乎。
妇人伤胎，怀身腹满，不得小便，从腰以下重，如有水气状。怀身七月，太阴当养不养，此心气实，当刺泻劳宫及关元，小便微利，则愈。
伤胎，是妇人受伤于胎。即下文腹满等之义。肺气自缩，不能展舒，而下逼胎气，则胎气上肆，所以腹满。又肺气自缩，而不管呵嘘传送，所以不得小便。且肺气自缩，而失上提下挚之用，所以腰以下重也。然而这三者，大似水病，以不得小便，似有水之根，而腹满腰重，似有水之症，所以说如有水状，而实非水者。盖怀身至七月，胎中外长皮毛，内鼓呼吸之候，正母以太阴肺经之气血，与胞中之肺脏感通相养者也。今其所以失下逼传送，及提挈之用，而不养胎者，以心火气实，上克肺金，俾肺金清肃之气，畏缩而不布之道也。夫心为脏，脏不可泻，手厥阴心包为之腑，掌心劳宫，是其经之井穴，刺以泻之，则泻经以及腑，泻腑以及脏，而心气上平矣。又心之经脉，与小肠为表里，任脉部中，脐下、同身寸之三寸，为关元穴，为小肠之募也。关元与水分逼近，而司分理水道者，刺以泻之，则小便微利。此又泻表以及里，而心气平于下矣。心火克金之气平，令肺气下展，所以上三症自愈。以其原非有水，注意在泻火，而不在泻水，故但曰小便微利耳。此亦阳气盛而胎热者之治例也。
关元穴，《千金》言妇人刺之，主无子。又云妊娠刺之，则落胎。此就阳虚者而言也。盖关元又与气海逼近，阳气虚，而又刺泻之，则关元气海益寒，而成地寒不谷，花寒不果之祸。其无子落胎，宜矣。若阳实而刺泻之，则适得其平，而复何患哉。此医贵智能圆通之士也。
Dysuria during pregnancy has three causes. First, blood is insufficient to nourish the fetus, causing all zang-fu organs and meridians to rely on fluids for moistening, which naturally slows down the qi transformation of seepage and excretion; this is the first cause. Second, the gestational sac possesses a cluster of yang qi; heat forces the boundary between the Small Intestine and Bladder, causing qi stagnation in the orifices of excretion; this is the second cause. Third, the vital qi of the gestational sac floats and spreads,鼓动 (stirring) and blocking the lower abdomen, squeezing the bladder, making it narrow and often flat, unable to hold even two or three tenths of its capacity. Thus, when a small amount of fluid enters, there is an urgent fullness and desire to urinate; the stream is short and frequent, and the urethra is squeezed narrow, making urination difficult; this is the third cause. Now, regarding dysuria in pregnancy, if the patient is not thirsty, has no palpitations, drinks normally, does not vomit, has no distension, and eats normally, it indicates that the difficulty in urination should not be blamed on the Upper and Middle Jiao, but is undoubtedly due to fetal heat and fetal distension. Therefore, Bitter and Cold herbs like Beimu (Fritillariae Bulbus) and Kushen (Sophorae Flavescentis Radix) are used, likely employing coldness to clear fire and bitterness to consolidate and secure the fetus. Then, Danggui (Angelicae Sinensis Radix), which tonifies blood and moistens, is combined to borrow the moistening power of fluids, allowing them to find a path and seep downward. Since Beimu is light in texture and white in color, it can open stagnant qi; Kushen is bitter in taste and heavy in nature, it can firm scattered qi. Thus, surgeons use it as a specific herb to dissipate fire and reduce swelling. When the mother's qi stagnation is unblocked, and the fetus's scattered qi is controlled, and blood becomes abundant, replacing the fluids needed below, what lingering obstruction or painful difficulty in urination would remain? This is truly a divine prescription.
I have studied Zhang Zhongjing's clauses on pregnancy and carefully analyzed their diseases, pulses, symptoms, and treatments, realizing that women carrying a child for ten months face harm within grace, while the preceding and subsequent prescriptions derive grace from harm. If the mother's qi and blood are deficient, she cannot shade the fetus, leading to a weak fetus and subsequently fetal disease. Fortunately, if the fetal sac's qi and blood are strong, it nourishes the fetus well, leading to a robust fetus, which becomes a disaster for the mother. Even worse, if the fetal disease is deficiency, it further injures the mother; if the maternal disaster is severe, it again injures the fetus. Is this not harm within grace? As for treatment methods: for Ganjiang, Renshen, Banxia Wan (Dry Ginger, Ginseng, and Pinellia Pill), purely using the pungent and warm qi of Metal (Lung) to restrain the upward rushing of vital energy; for Danggui, Beimu, Kushen Wan (Angelica, Fritillaria, and Sophora Pill), purely using bitter and cold astringent flavors to firm and gather the dissipated physical form. This balances the relationship between mother and fetus, treating by benefiting the mother and slightly harming the fetus as the correct approach, thereby preserving the mother to nourish the fetus. Thus it is said, this is grace within harm.
Pregnancy with water qi, heaviness of the body, dysuria, aversion to cold with shivering, dizziness upon rising, treated with Kuizi Fuling San (Abelmoschus Seed and Poria Powder).
Kuizi Fuling San Formula: Kuizi (Hibisci Abelmoschi Semen, 1 jin), Fuling (Poria, 3 liang).
Crush the above two ingredients into a powder. Take one cunbi (a measure equivalent to a spoonful) with water, three times daily. Recovery occurs when urination becomes free.
Pregnancy with water qi, referring to the previous clause on dysuria. Water nature sinks, stagnating and obstructing qi in the meridians, hence heaviness of the body. However, dysuria must be taken as the definitive diagnosis because water qi fails to move and overflows laterally; also, heaviness of the body distinguishes it from other symptoms of Spleen Yang failure. "Shaxi awan han" describes aversion to cold as if cold water were sprinkled on the body, causing shivering. This is because water qi is in the meridians, obstructing and destabilizing Wei Yang. Pregnancy with solid fetal qi below often involves dizziness; how much more so with dysuria and accumulated water qi rushing upward? Hence dizziness. Thus, promoting urination removes water qi, and all symptoms resolve. Kuizi is sweet, cold, slippery, and draining; sweet moves qi, cold clears heat, slippery promotes fluid movement, and draining opens orifices. Combined with Fuling for seepage and excretion, urination will gradually become free.
Women in pregnancy should regularly take Danggui San (Angelica Powder) as the main formula.
Danggui San Formula: Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Xiong (Chuanxiong Rhizoma), Huangqin (Scutellariae Radix) (each 1 jin), Baizhu (Atractylodis Macrocephalae Rhizoma) (0.5 jin).
Crush the above five ingredients into a powder. Take one cunbi with wine, twice daily. Regular intake during pregnancy facilitates easy delivery and keeps the fetus free from distress; it is also applicable for one hundred days postpartum.
This refers to women both before conception and during pregnancy. Blood in pregnant women should be abundant and circulating smoothly. Thus, Danggui and Xiong, which tonify and move blood, are primary, while Shaoyao, which acts on Yin, guides blood into the Liver, preventing dryness and stagnation. However, abundant blood leads to abundant qi and excessive heat, which may consume blood; thus Huangqin is used to clear heat. Sufficient blood means sufficient Yin, which may accumulate dampness, potentially stagnating blood; thus Baizhu is used to dry dampness. For non-pregnant women, this ensures smooth menstruation without masses or metrorrhagia; for pregnant women, it adequately nourishes the fetus without risks of miscarriage or abdominal pain. Hence, they serve as main herbs for regular use. Since blood is fundamental in pregnancy, pre-delivery, and post-delivery, this formula is suitable for all these stages. Taking it with wine follows the note on Danggui Shaoyao San.
For nurturing the fetus during pregnancy, Baizhu San (Atractylodes Powder) is the main formula.
Baizhu San Formula: Baizhu (Atractylodis Macrocephalae Rhizoma), Xiong (Chuanxiong Rhizoma), Shujiao (Sichuan Pepper Fruit, 3 fen, processed to remove moisture), Muli (Ostreae Concha, dosage unclear in text, possibly 4 fen).
Crush the above four ingredients into a powder. Take one qianbi with wine, three times daily, and once at night. If suffering from pain, add Shaoyao. If experiencing severe pain in the epigastrium, double the amount of Chuanxiong. If suffering from irritability, vomiting, pain, and inability to eat, add Yixin (Asari Radix et Rhizoma) 1 liang and large Banxia (Pinelliae Tuber) 20 pieces. After taking the medicine, follow up with Cu Jiangshui (Vinegar Grain Water). If vomiting persists, take with Cu Jiangshui; if still unresolved, take Xiaomai Zhi (Wheat Juice); if thirst develops later, take Damai Zhi (Barley Juice). Even after recovery, do not stop taking the medicine (Bu Zhi means continuous use).
Baizhu removes dampness, Xiong tonifies blood and qi, Shujiao consolidates fetal qi, and Muli calms rebellious qi. Deficiencies in pregnancy generally involve these four aspects, making it a main formula for regular use. "Ku tong" refers to fetal pain caused by blood deficiency and qi expansion; Shaoyao astringes qi and nourishes blood, hence added. Severe epigastric pain occurs because the Yin and Yang of the Danzhong (Conception Vessel area) become deficient from nourishing the fetus; Yin deficiency causes cramping pain, Yang deficiency causes stifling pain. Chuanxiong is a Qi herb within Blood, with a high and floating nature, capable of tonifying both Yin and Yang in the epigastrium, hence added. Shortage of Heart fluid allows deficient Fire of Dragon and Thunder to attack, causing irritability; deficiency-cold of the Diaphragm loses its transformative function, causing vomiting, pain, and anorexia. Yixin is acrid and warm, warming to dispel cold and acrid to subdue fire. Banxia is acrid, drying, and descending, assisting Yixin to subdue deficient fire, hence added. Taking Cu Jiangshui afterward uses sourness to astringe and descend deficient heat, fearing that sudden warmth might be rejected and aggravate rebellious deficient heat causing vomiting. If vomiting persists despite this, it indicates Heart Qi deficiency failing to control rebellious Qi. Rather than forcing descent, it is better to fill the upper Jiao as preparation. Wheat is the grain of the Heart; drinking its juice tonifies the upper to resist the lower, stopping vomiting. Thirst developing later indicates initial recovery of Yang Qi but insufficient fluids; it is a residual symptom of irritability. Barley juice moistens the Lungs and generates fluids, hence taken after wheat juice. The disease refers to pain, irritability, vomiting, etc. Even if cured, continue medication to prevent recurrence. Wine serves as a guiding agent. Vinegar grain water and wheat/barley juices are taken separately after the main medicine. Vinegar grain water is acidic rice drink, similar to grains used to treat specific organs. Pregnancy Yang Qi varies in abundance and deficiency, leading to fetal heat or cold. Excess Yang and fetal heat are likened to spring sunshine nurturing the earth; excessive vitality overwhelms emptiness, causing dizziness/vomiting, surface heat, dryness/thirst (malnutrition of fetus), and scanty dark urine. Such pathological conditions require sweet-cool and bitter-cold formulas like Danggui Kushen Wan, Kuizi Fuling San, or Danggui Shaoyao San. Even without disease, regular use of Danggui San is advised to cool and moisten like spring clouds and rain, balancing heaven and earth's excessive love to maintain the order of growth. Deficient Yang and fetal cold are likened to cold spring where sunlight is weak; Yin shadows occupy Yang positions, causing leakage (failure to root), uterine cold (like a fan), miscarriage (withered buds), and vomiting/anorexia (fog blocking clarity). Such conditions require sweet-warm and acrid-warm formulas like Guiling Wan, Fuzi Tang, Jiao'ai Tang, or Ganjiang Renshen Banxia Wan. Even without disease, regular use of Baizhu San is advised to warm and nourish like gentle sun and hot rain, transforming the darkness of Li Fire through subtle fetal breathing. Women in pregnancy inherit Kun Earth's transformation, tending to have more Yin and less Yang. Thus, in this chapter, seven-tenths of formulas are warming, and three-tenths are cooling. This aligns with the principle of not killing unnecessarily, reflecting Zhang Zhongjing's benevolence.
Traumatized fetus: Pregnant woman with abdominal fullness, inability to urinate, heaviness from waist down, resembling water retention. At seven months of pregnancy, the Taiyin (Lung) should nourish but fails to do so. This is due to excess Heart Qi. One should puncture and drain Laogong (PC 8) and Guanyuan (CV 4). If urination becomes slightly free, recovery ensues.
Traumatized fetus refers to injury affecting the fetus, implying the abdominal fullness mentioned below. Lung Qi contracts and cannot expand, pressing down on fetal Qi, causing fetal Qi to surge upward, resulting in abdominal fullness. Lung Qi contraction also fails to manage respiration and transmission, causing inability to urinate. Loss of Lung Qi's lifting and anchoring function causes heaviness below the waist. These three symptoms resemble water disease: inability to urinate suggests water roots, and abdominal/waist heaviness suggests water symptoms, hence "resembling water," though it is not actually water. At seven months, the fetus develops hair/skin externally and breathes internally; the mother's Taiyin Lung Meridian Qi and Blood should nourish the fetal Lung organ. Failure to transmit and lift, and failure to nourish the fetus, is due to excess Heart Fire overcoming Lung Metal, causing Lung's clearing and descending Qi to shrink and fail to distribute. The Heart is a Zang organ and cannot be drained directly; the Pericardium (Hand Jueyin) is its Fu organ. Laogong (PC 8), the Jing-Well point of the Pericardium meridian on the palm, is punctured to drain. Draining the meridian drains the Fu, and draining the Fu drains the Zang, calming Heart Qi upwards. The Heart meridian is exterior-interior with the Small Intestine. Guanyuan (CV 4), three cun below the umbilicus on the Ren Meridian, is the Front-Mu point of the Small Intestine. Close to Shuifen (CV 9), Guanyuan manages water pathways. Puncturing and draining it makes urination slightly free, draining the interior via the exterior and calming Heart Qi downwards. With Heart Fire overcoming Metal balanced, Lung Qi expands downward, resolving the three symptoms. Since there is no actual water, the focus is draining Fire, not water, hence only slight urination is noted. This is a treatment example for excess Yang and fetal heat.
Guanyuan: *Qianjin Yaofang* states puncturing it in women treats infertility. It also states puncturing it during pregnancy causes abortion. This applies to Yang deficiency. Guanyuan is close to Qihai (CV 6); if Yang is deficient and drained, Guanyuan and Qihai become excessively cold, leading to barren land and sterile flowers, causing infertility or abortion. This is expected. If Yang is excess and drained, balance is achieved, and there is no worry. This highlights the need for physicians to be intelligent and flexible.