Fetal Qi (1)

Women nourish the fetus with blood, but sometimes the blood is insufficient or imbalanced, leading to various fetal qi syndromes. Although this is not directly related to the blood syndromes discussed in this book, it is still a matter of blood, similar yet different, so it is discussed together to enlighten readers.

During pregnancy, the fetus only has two components: water and blood. Water is essentially qi, so during childbirth, the water membrane comes first, followed by the blood membrane; similarly, during menstruation, the watery fluid comes first, followed by the fresh blood. Water is transformed from qi, which belongs to yang, while blood belongs to yin. Since water precedes blood, it means yang precedes yin. Therefore, during menstruation, the Tian Gui water must first reach the uterus before the Chong and Ren blood follows suit and also reaches the uterus, thus initiating the monthly flow. Similarly, during conception, the Tian Gui must first make contact, and then the blood gathers, so it is not called "male-female intercourse," but rather "male-female fertilization" (2). Fertilization refers to the mixture of water and blood. After the fetus is formed, the yang qi in the kidneys transforms the water to nourish the fetus, while the water and grains in the stomach are processed into blood, which is then delivered to the uterus via the Chong and Ren meridians to nourish the fetus. When the fetus has enough water, the blood does not dry up; when the fetus has enough blood, the qi is not overly active. When water and blood are balanced, the pregnancy proceeds without problems, so any illness is usually due to disharmony between water and blood. There are many aspects of fetal disease, but I will cut through the tangled threads and focus on just two factors—water and blood—and establish a law that can solve ten thousand problems.

What is morning sickness (3)? It occurs because the water and fire in the fetus rise up and enter the stomach. The Chong and Ren meridians are uterine vessels that all ascend to the Yangming channel. Normally, the qi of the Yangming channel flows downward, but now, due to the presence of the fetus, the uterus closes, preventing the rebellious qi from descending and forcing it to rise instead, carrying the water in the uterus with it, drying up the stomach soil and causing phlegm and water to overflow, resulting in vomiting. The treatment should focus on regulating the stomach and eliminating phlegm. Er Chen Tang with Zhi Ke, Sha Ren, ginger, and Huo Xiang can be used for this purpose, as can Xiang Sha Liu Jun Zi Tang. When the water descends, the qi descends, and the stomach becomes calm without vomiting. Alternatively, if the uterine qi rises and combines with the dry qi of the Yangming channel to create fire, it can also cause vomiting, bitter and sour regurgitation, hiccups, refusal to eat, blockage of the fetus below and rebellion of the qi above, leading to many fire-related symptoms. Therefore, it is commonly believed that hot medicines should not be used before pregnancy, and for this reason, the treatment should focus on clearing the stomach and reducing fire, with Xiao Chai Hu Tang and Mai Men Dong Tang being suitable options.

What is fetal choking (4)? It occurs because the water and fire in the fetus rise up and affect the lungs. Nourishing the fetus relies entirely on water and blood. If the water is insufficient to moisten the blood, the blood will dry up; if the blood is insufficient to nourish the water, the qi will become hot. When dryness and heat combine, it creates fetal fire. Fetal fire travels upward along the Chong meridian and attacks the lung metal, causing coughing and wheezing, red cheeks, throat discomfort, and choking coughs. Hence the name "fetal choking," and Zhang Zhongjing's Mai Men Dong Tang is the main prescription, with Yunv Jian plus Wu Wei Zi also being excellent. In this formula, Niu Xi is specifically used to suppress rebellious qi, Ban Xia also suppresses rebellious qi and reduces water; Niu Xi suppresses rebellious qi and reduces fire, both of which are used to stabilize the fetus with drugs that might otherwise induce abortion, so they can be used without hesitation. Additionally, if the water in the fetus rises and forms phlegm, irritating the lungs and causing fetal choking, then it is also advisable to remove the water, using Su Zi Jiang Qi Tang and Liu Jun Zi Tang with Wu Wei, Pao Jiang, and Xi Xin for treatment. If both water and fire are active and cause coughing, then Xie Bai San with apricot kernels, melon seed frost, Bai Qian, Huang Qin, Zhi Ke, and Gan Cao can be used, or Ting Li Da Zao Xie Fei Tang can be used, but Ting Li is quite strong and should not be used too much.

Pregnant women often experience lower abdominal pain, which can be divided into two categories: water-related and blood-related. In the water-related category, if the bladder qi cannot transform the water, the uterus will become swollen. If the water cannot be discharged, there will be short,涩 urine, swelling, and other symptoms. If it is determined that the problem is due to heat stagnation, use Dao Chi San with Shan Zhi and Fang Ji to clear it. If it is determined that the problem is due to cold stagnation and the yang qi cannot transform, use Wu Ling San, which utilizes the water's power to relieve the lower abdominal pain, and Ju He Wan with Fu Ling can also be used. In the blood-related category, the uterus is governed by the liver and kidneys. If the liver yang cannot reach the uterus, the uterine blood will stagnate and cause pain, so Si Wu Tang with Ai Ye, Xiang Fu, A Jiao, and Hu Yi can be used. If the kidney yang cannot reach the uterine chamber, the fetus will feel cold and painful, extending up to the lower back, so Si Wu Tang with Du Zhong, Gu Zhi, Tai Wu, and Ai Ye can be used. This is called "uterine blockage" (5), meaning that the yin blood and yang qi in the uterus are blocked from interacting. In severe cases, use Shen Qi Wan; in mild cases, use Jiao Ai Si Wu Tang.

Both blood and water are yin, with water being the yin liquid transformed from innate yang qi, and blood being the yin juice transformed from acquired stomach qi. Kidney yin, in turn, depends on the water and fluids of the stomach to be produced, while stomach qi relies on the yang produced by the kidneys to thrive. Now, if the yang in the kidneys is insufficient, the pulse becomes tense and feverish, the abdomen swells and drops, there is lower abdominal pain and coldness, and the uterus wants to open, Zhang Zhongjing uses Fu Zi Tang to treat this, protecting the kidney yang and supporting the stomach qi. This is a method of tonifying yang. Additionally, if the stomach lacks water and fluids, the uterus becomes dry and sad, almost as if possessed by a spirit, constantly stretching and yawning. The reason for this is that the kidneys lack water and the blood lacks strength, leaving nothing to nourish. The water in the kidneys is the Tian Gui in the uterus, while the fluids in the mouth are the fluids in the stomach. When the organs are dry, the lung metal cannot be adequately moisturized, so the lung takes on the role of sadness. Those who stretch and yawn clearly have kidney problems. As for those possessed by spirits, if the blood is dry, the heart cannot transform the liquid, and the spirit has no guardian. Gan Mai Da Zao Tang nourishes the kidney yin, sending water from the Chong and Ren meridians to the kidneys, allowing the kidney yin to be produced, which is a method of tonifying yin. Looking at these two points, all methods of nourishing yin and tonifying yang can be interconnected.

Fetal leakage (6) is also divided into two types: water and blood. The blood-related type is due to excessive fire, which forces the blood to flow recklessly, so Si Wu Tang with A Jiao, fried Shan Zhi, side柏 leaves, and Huang Qin is recommended. The water-related type, on the other hand, is like bean juice, flowing up to a certain level, known as "solitary fluid" (7). If too much water is lost, the fetus will dry up and inevitably collapse. Water is qi, and it only leaks when the qi escapes, so Huang Qi and glutinous rice concentrated decoction can be used to replenish and nourish it; Mao Gen, Bai Shu, Ren Shen, Lu Jiao Shuang, Sang Piao Xiao, and silver, all can be used in alcohol decoctions as well.

Furthermore, blood originates in the kidneys and is regulated by the lungs. Since the lung qi cannot accept it, water leaks out, and now, seeing that the lungs are cold and weak and cannot regulate the flow, there is urinary incontinence, indicating that the lung qi cannot accept it, and therefore water leaks out. It is advisable to use Bai Shu, Ren Shen, Hai Piao Xiao, Long Gu, Mu Li, Bai He, He Zi, Zhu Gen, and silver for treatment.

Child urination (8) is characterized by dribbling urination. It is also divided into two types: water-related and blood-related. Water-related issues occur in the bladder, causing congestion and stagnation, so Wu Lin San with Mu Tong and Ze Xie is recommended. Blood-related issues occur in the blood chamber, causing pain in the yin area, with blood dripping down, so Si Wu Tang with Cong Rong, Mao Gen, Ou Jie, Tiao Qin, Chi Ling, and Cao Shao is recommended.

Child suspension (9) refers to fetal qi pressing upward and blocking the chest and heart. It is also divided into two types: water-related and blood-related. Water-related issues arise from qi deficiency, causing water to form phlegm and accumulate around the fetus, with turbid qi rising upward, making the pulse slow and sluggish. Liu Jun Zi Tang with Zhi Ke, Zi Su, Fu Pi, Chuan Xiong, and Xiang Fu can be used for treatment. Blood-related issues arise from blood deficiency, causing the fetal yin liver qi to rebel and push the fetus upward, so Xiao Chai Hu Tang combined with Si Wu Tang, plus Yun Ling, Huang Lian, and Huang Bai, can be used. Six Wei Wan with Niu Xi and Mai Dong can also be used to guide the qi downward, which is also a way of suppressing the qi, so there is no need to fear that Niu Xi will cause abortion.

Regarding child suspension, if the mother is seven or eight months pregnant and the blood is deficient, the fetus has no nourishment, and even downward medications cannot cure it, then it is necessary to greatly nourish the blood. Zhi Gan Cao Tang with Gui Zhi removed and added Huai Yao and Zao Ren can be used for treatment, as can Sheng Yu Tang with Bai Shu, Yun Ling, and Gan Cao, and Gan Mai Da Zao Tang is also suitable. Additionally, it is important to improve the diet, using Huang Qi, Ren Shen, Shan Yao, Bai Zhi, Qian Shi, and stewed pig's trotters for the best results.

Child qi (10) refers to edema. The uterus and bladder share the same space, with the uterus being the place where the fetus resides, encroaching on the bladder and preventing the bladder's water from being properly transformed. Also, since the bladder's qi transformation is initially insufficient, it can serve as a place for the fetus, so Wu Ling San is the main prescription. If the fetal fire affects the lungs and the source of transformation is unclear, leading to short and edematous urine, then Gui Zhi removed and added Zhi Mu, Mai Dong, Huang Qin, apricot kernels, and Fang Ji can be used for treatment.

Child vexation (11) refers to blood deficiency. Blood is controlled by the heart, so when the blood is sufficient, the heart is not vexed. However, since the fetus consumes blood, and the fetal fire also interacts with the heart fire, the fire disturbs the heart, leading to vexation and insomnia. Zao Ren Tang is the main prescription, and Zhu Sha An Shen Wan can also be used for treatment.

Child dizziness (12) refers to phlegm in the qi, with symptoms such as dizziness and vertigo, all caused by fetal water rising and turning into phlegm. Er Chen Tang with Zi Su, Zhi Ke, apricot kernels, ginger juice, and bamboo sap can be used for treatment.

Child epilepsy (13) refers to blood-related wind, with symptoms such as sudden fainting, falling unconscious, limb convulsions, and later recovery, with the mouth clenched and eyes staring straight ahead, sometimes even arching the back. This is caused by blood deficiency in pregnant women and wind evil invading the liver. The treatment should focus on nourishing the blood and dispelling the wind, using Si Wu Tang with Gou Teng, Fang Feng, Fu Shen, Sang Ji Sheng, Du Huo, and Ling Yang Jiao, as well as Xiao Chai Hu Tang and Xiao Chai Hu Tang can also be used for treatment.

Difficulty in urination is due to qi deficiency. When qi is transformed, water can come out, but now, urine drips out drop by drop, because the uterus presses down on the urethra. Investigating the reason for this pressure, it turns out that the kidney qi is insufficient, unable to lift the fetus upward, which is called "uterine reversal" (14), and Shen Qi Wan is the main prescription. Alternatively, if the stomach qi is insufficient, unable to lift the fetus upward, then Bu Zhong Yi Qi Tang is the main prescription.

Difficulty in defecation is due to blood deficiency. When pregnant women have sufficient blood, they are healthy; but when the blood is insufficient, they cannot even provide nourishment to the fetus, let alone distribute it to other organs, resulting in symptoms such as thirst, coughing, fever, and constipation. The treatment should focus on increasing the blood supply; when the blood is sufficient, defecation will naturally occur. Si Wu Tang with apricot kernels, sesame seeds, Cong Rong, and Tu Si Zi can be used for treatment, as can Xiao Chai Hu Tang with sesame seeds, Zhi Ke, and Hou Pu for treatment.

In summary, if the fetal qi is disharmonious, it is all a water-related issue, and regulating the water will naturally harmonize the qi. If the fetal fire is too strong, it is all a blood-related issue, and regulating the blood will naturally extinguish the fire. If one understands the relationship between water, fire, and blood qi, treating fetal diseases will not be difficult, nor will treating blood-related conditions, and even treating miscellaneous ailments will be effortless.

This book focuses on blood loss, and all its discussions are related to this topic. However, fetal diseases are especially evident in the interplay of water, fire, and blood qi, so if one can clearly understand this relationship (15), then there will be no hidden motives (16) regarding the four elements of water, fire, blood, and qi. Other fetal diseases that have not been recorded can be found in other books on pregnancy and childbirth.

[Notes] (1) Fetal qi: Refers to all accompanying syndromes that occur during pregnancy. (2) Fertilization: Refers to the act of male and female intercourse. (3) Morning sickness: Also known as pregnancy-induced nausea and vomiting. It typically occurs around the second month of pregnancy and is characterized by nausea, vomiting, heaviness in the head, and dizziness. It is often caused by the upward rebellion of fetal qi, disrupting the normal descent of stomach qi. (4) Fetal choking: Refers to coughing and respiratory distress during pregnancy. Often accompanied by yin deficiency and water deficiency, leading to five-heart vexation and heat. It is usually caused by pre-existing yin deficiency, combined with the fact that during pregnancy, most qi and blood concentrate in the lower body, leaving the yin region unable to support the upper body, resulting in lung yin deficiency. (5) Uterine blockage: Refers to abdominal pain and vaginal bleeding during pregnancy. Often caused by disharmony between qi and blood, obstructing the fetus. (6) Fetal leakage: Also known as uterine leakage. Refers to painless vaginal bleeding during pregnancy. It can be caused by qi deficiency, blood heat, weak fetal foundation, or frequent sexual activity. (7) Solitary fluid: Refers to amniotic fluid. (8) Child urination: Refers to frequent and painful urination during pregnancy. Often caused by lower-jiao heat or damp-heat. (9) Child suspension: Refers to feeling fetal movement is restless and chest is congested after the fourth or fifth month of pregnancy, or feeling fetal qi is rebellious and pressing on the chest. Often caused by qi deficiency and rebellious qi in the Chong and Ren meridians. (10) Child qi: Refers to swelling below the knees and long, clear urine during the sixth or seventh month of pregnancy. (11) Child vexation: Refers to restlessness, palpitations, and timidity during pregnancy. Often caused by yin deficiency, phlegm-fire, and liver depression. (12) Child dizziness: Refers to dizziness and vertigo during pregnancy. (13) Child epilepsy: Refers to pregnancy-induced seizures, also known as "child fainting." It occurs after the sixth or seventh month of pregnancy, or near delivery, with symptoms such as sudden dizziness, falling unconscious, limb convulsions, clenched teeth, staring eyes, foaming at the mouth, and even arching the back. (14) Uterine reversal: Refers to difficulty in urination during pregnancy. Often caused by the fetus pressing on the bladder, resulting in lower abdominal distension and mild pain, and difficulty in urination. (15) To participate: Same as "to take part." (16) Hidden motives: Refers to concealing the truth or falsifying facts.

[Commentary] This chapter explains all accompanying syndromes during pregnancy based on the mechanism of water and blood circulation, collectively referred to as fetal qi.

Morning sickness is often caused by the presence of the fetus in the uterus, preventing the water and blood of the Chong and Ren meridians from descending and forcing them to rise instead, interfering with the Yangming channel and causing morning sickness. The treatment should focus on harmonizing the stomach and reducing rebellious qi, using Xiang Sha Liu Jun Zi Tang. For cases where the Yangming channel's dry qi is stimulated, the treatment should focus on clearing the stomach and reducing fire, using Xiao Chai Hu Tang and Mai Men Dong Tang.

Fetal choking is often caused by the water and blood of the Chong and Ren meridians rising upward. If the water cannot nourish the blood, the blood will dry up; if the blood cannot nourish the water, the qi will become hot. When dryness and heat combine, they attack the lung metal, causing red cheeks, throat obstruction, and choking coughs. Mai Men Dong Tang and Yunv Jian are recommended for treatment. If the water in the fetus rises and forms phlegm, irritating the lungs and causing fetal choking, then Su Zi Jiang Qi Tang and Liu Jun Zi Tang with Pao Jiang, Xi Xin, and Wu Wei Zi can be used for treatment. For cases where phlegm and fire coexist, Xie Bai San and Ting Li Da Zao Xie Fei Tang can be used.

Pregnant women often experience lower abdominal pain, which can be divided into water-related and blood-related categories. In the water-related category, if the bladder qi cannot transform the water, the urine will be red and涩, and Dao Chi San and Wu Ling San can be used for treatment. In the blood-related category, if the uterine blood stagnates, Si Wu Tang with glue and herbs can be used for treatment. If there is lower back pain, Si Wu Tang with Du Zhong and Gu Zhi, or Shen Qi Wan can be used.

Fetal leakage also has water-related and blood-related distinctions. For the water-related type, if the water flows like bean juice, use Huang Qi and glutinous rice concentrated decoction. If the lung qi cannot accept it, resulting in urinary incontinence, use Bai Shu, Ren Shen, Hai Piao Xiao, Long Gu, Mu Li, Bai He, He Zi, Ju Gen, and silver decoctions. For the blood-related type, if the blood flows recklessly, use Si Wu Tang with glue, Shan Zhi, side柏, and Huang Qin. If the spleen does not manage the blood, use Gui Pi Tang with modifications.

Child urination is a case of urinary stagnation, with water-related issues addressed by Wu Lin San and blood-related issues addressed by Si Wu Tang.

Child suspension is a case of fetal qi pressing upward, with water-related issues involving phlegm accumulation around the fetus and blood-related issues involving the fetal fire pushing the fetus upward. The former is treated with Liu Jun Zi Tang with modifications, while the latter is treated with Xiao Chai Hu Tang combined with Si Wu Tang with modifications. Additionally, if both water and blood are deficient and the fetus has no nourishment, seeking food upward, then use Gan Mai Da Zao Tang to replenish water and Zhi Gan Cao Tang to replenish blood.

Child qi refers to pregnancy edema, with the bladder and uterus sharing the same space, the uterus being occupied by the fetus and encroaching on the bladder, preventing the bladder's water from being properly transformed. Thus, edema occurs, and the root cause is still disharmony between water and blood, so Wu Ling San with modifications is recommended for treatment.

Child vexation is due to the blood not nourishing the heart, while child dizziness is due to phlegm in the qi. The former is treated with Zao Ren Tang with modifications, while the latter is treated with Er Chen Tang with modifications.

Child epilepsy is due to blood-related wind, with sudden fainting and limb convulsions. Uterine reversal is due to spleen and kidney qi deficiency, unable to lift the fetus, pressing down on the urethra and causing difficulty in urination. The former is treated with Si Wu Tang with Gou Teng and Fang Feng, while the latter is treated with Bu Zhong Yi Qi Tang combined with Shen Qi Wan.

---

Volume Six