Synopsium of the Golden Chamber, Volume 2, Chapter 20: Pulse Manifestations and Treatment of Women’s Pregnancy Disorders
Overall Paraphrase
The Synopsis of the Golden Chamber, Chapter 20: Pulse Manifestations and Treatment of Women’s Pregnancy Disorders primarily discusses the patterns and principles governing pregnancy-related pulses and common disorders. All formulas, dosages, and acupuncture methods recorded in this chapter are from ancient texts and are provided solely for academic study; they do not constitute modern medication or treatment recommendations.
- The Master said: When a woman’s pulse is calm, the yin pulse (the chi/cubit position) is slightly small and weak, accompanied by thirst and inability to eat, without aversion to cold or fever, this is called pregnancy. The ancients used Guizhi Tang (Cinnamon Twig Decoction) as the main treatment (the formula appears in the chapter on diarrhea). Generally, these reactions appear around sixty days of pregnancy; if mistakenly treated, and after another month vomiting and diarrhea increase, this indicates injury to fetal qi, and the mistaken treatment should be stopped, with careful nurturing and rest.
- When a woman normally suffers from zheng disease (abdominal mass-type disorders), and menstruation has stopped for less than three months but uterine bleeding (non-menstrual vaginal bleeding) continues without stopping, and she feels fetal movement above the navel, this is harm caused by the accumulation of a mass (zheng block).
- When fetal movement occurs in the sixth month of pregnancy, if menstrual flow remained open during the first three months with fetal movement accompanied by bleeding, and after the last three months menstruation ceased but bleeding continues, the cause of the unceasing bleeding lies in the mass not being removed. The mass should be eliminated, and Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) is the main treatment.
- 🌿 Guizhi Fuling Wan Formula: Guizhi (cinnamon twig), Fuling (poria), Mudanpi (tree peony bark, core removed), Taoren (peach kernel, skin and tip removed, parched), Shaoyao (peony root), equal amounts of each. The ancient method was to grind into powder, mix with honey into pills the size of rabbit droppings, take one pill before meals daily; if no effect, increase up to three pills.
- When a woman is six or seven months pregnant, with wiry pulse and fever, worsening abdominal distension, abdominal pain with aversion to cold, and the lower abdomen feels cold as if fanned (shao fu ru shan, “lower abdomen like a fan”), this is the zi zang (uterus) opening and not secure; Fuzi Tang (Aconite Decoction) should be used to warm and nourish the uterus (original formula not extant).
- The Master said: When a woman has vaginal bleeding—whether non-menstrual uterine bleeding, continuous bleeding after a miscarriage/abortion, or bleeding during pregnancy—if there is abdominal pain during pregnancy, this is called bao zu (threatened miscarriage with abdominal pain and bleeding), and Jiao Ai Tang is the main treatment.
- 🌿 Xiong Gui Jiao Ai Tang Formula: Chuanxiong (Sichuan lovage) two liang, Ejiao (ass-hide gelatin) two liang, Gancao (licorice) two liang, Aiye (mugwort leaf) three liang, Danggui (Chinese angelica) three liang, Shaoyao (peony) four liang, dried Rehmannia (original formula does not specify the amount). The ancient method was to decoct with five sheng of water and three sheng of clear wine, taking three sheng; after straining, add Ejiao and melt it, take one sheng warm, three times daily; if no effect, a new batch may be made.
- When a woman is pregnant and has persistent mild abdominal pain (mianmian zuo tong), Danggui Shaoyao San (Chinese Angelica and Peony Powder) is the main treatment. 🌿 Formula: Danggui three liang, Shaoyao one jin, Fuling four liang, Baizhu (white atractylodes) four liang, Zexie (alisma) half jin, Chuanxiong half jin (some versions say three liang). The ancient method was to grind into powder, take one fangcun spoon with wine, three times daily.
- When vomiting during pregnancy is unceasing, Ganjiang Renshen Banxia Wan (Dried Ginger, Ginseng, and Pinellia Pill) is the main treatment. 🌿 Formula: Ganjiang (dried ginger) one liang, Renshen (ginseng) one liang, Banxia (pinellia) two liang. The ancient method was to mix with ginger juice into pills the size of wu seeds (Job’s tears), take ten pills with water (the original text says “nineteen,” likely a scribal error for “ten”), three times daily.
- When urination is difficult during pregnancy yet eating and drinking are normal, Danggui Beimu Kushen Wan (Chinese Angelica, Fritillaria, and Sophora Root Pill) is the main treatment (for men, add Huashi / talcum powder half liang). 🌿 Formula: Danggui, Beimu (fritillaria), Kushen (sophora root), four liang each. The ancient method was to mix with honey into pills the size of small beans, take three pills with water, gradually increasing to ten pills.
- When there is water qi (edema) during pregnancy—the body feeling heavy, urination unfavorable, chills with a shivering sensation, and dizziness upon standing—Kuizi Fuling San (Malva Seed and Poria Powder) is the main treatment. 🌿 Formula: Dongkuizi (mallow seed) one jin, Fuling three liang. The ancient method was to grind into powder, take one fangcun spoon with water, three times daily; once urination is free, recovery follows.
- For women during pregnancy, the ancients advocated regular intake of Danggui San (Chinese Angelica Powder). 🌿 Formula: Danggui, Huangqin (baical skullcap root), Shaoyao, Chuanxiong, one jin each, Baizhu half jin. The ancient method was to grind into powder, take one fangcun spoon with wine, twice daily. The ancients believed regular use during pregnancy facilitated childbirth, kept the fetus free from illness, and that all postpartum diseases were managed by it—this is an archaic, generalized statement and should not be applied literally in modern contexts.
- For nurturing the fetus during pregnancy, Baizhu San (Atractylodes Powder) is the main treatment. 🌿 Formula: Baizhu, Chuanxiong, Shujiao (Sichuan pepper) three fen (sweated/processed), Muli (oyster shell). The ancient method was to grind into powder, take one qian spoon with wine, three times daily, plus once at night. If there is severe pain, add Shaoyao; if there is intense cardiac pain, double the Chuanxiong; if there is heart vexation, vomiting, pain, and inability to eat or drink, add Xixin (Asarum) one liang and large Banxia twenty pieces. After taking, regulate with vinegar-water (cu jiang shui); if vomiting occurs, take the medicine with vinegar-water; if still not resolved, take wheat juice; thereafter if thirsty, take barley porridge. The ancients held that even after recovery, one may continue taking it and should not stop prematurely.
- 🩺 When a woman harms the fetus—pregnancy with abdominal distension, inability to urinate, heaviness from the waist downward, resembling water qi—in the seventh month of pregnancy, the Taiyin (Spleen) should be nourishing but is not nourishing; this is heart qi excess. The ancients recorded treatment by needling to drain Laogong (PC 8) and Guanyuan (CV 4). When urination becomes slightly free, recovery follows (see the Yu Han text). These acupuncture methods must never be self-administered in modern times.
🧠 Deep Understanding
Core Principles 💡
- Pregnancy disorders are governed by qi and blood, cold and heat, water-dampness, and zheng-accumulation. This chapter covers both physiological pregnancy reactions and pathological states such as zheng disease, bao zu, and water qi, embodying the integration of “disease differentiation and pattern differentiation.”
- “You gu wu yun” (if there is a condition, there is no harm in attacking)—dispelling pathogens to secure the fetus: When pre-existing zheng masses coexist with pregnancy, if the mass is not removed, bleeding will not stop. Zhongjing used Guizhi Fuling Wan to gradually disperse the mass. In the formula, Guizhi warms and unblocks the blood vessels, Fuling promotes moisture drainage downward, Mudanpi and Taoren activate blood and transform stasis, and Shaoyao harmonizes the nutritive qi; the honey pill ensures gradual action, reflecting the academic idea of “attacking hardness without injuring fetal qi.” It must be clearly stated: this is by no means a routine tocolytic (fetus-securing) formula, and any modern application requires strict evaluation by a specialist physician.
- Bleeding during pregnancy must be differentiated as deficiency or excess: Uterine bleeding, post-miscarriage bleeding, and bao zu all involve bleeding, but the mechanisms differ. Jiao Ai Tang uses Ejiao, Aiye, Dihuang, Danggui, and Shaoyao to nourish blood and stop bleeding, with Chuanxiong to regulate blood and Gancao to harmonize the middle, reflecting the approach of “stopping bleeding without leaving stasis, nourishing blood to secure the fetus.”
- Abdominal pain during pregnancy must distinguish cold, heat, deficiency, and excess: Deficiency-cold presents as a cold lower abdomen “as if fanned,” treated with Fuzi Tang to warm the viscera; blood deficiency with dampness stasis presents as persistent mild abdominal pain, treated with Danggui Shaoyao San to nourish blood, soothe the liver, strengthen the spleen, and drain dampness. This shows that the ancients already emphasized “treating the same disease with different methods.”
- Pregnancy complications: Unceasing vomiting is treated by descending rebellious stomach qi; difficult urination is treated from the perspective of blood deficiency, dryness-heat, and impaired bladder qi transformation; water qi with heavy body is treated from the perspective of unfavorable urination and stagnant water-dampness—leading respectively to Ganjiang Renshen Banxia Wan, Danggui Beimu Kushen Wan, and Kuizi Fuling San.
- Acupuncture principles: Laogong is the Ying-spring point of the Pericardium channel, and Guanyuan is a Ren channel point. The ancients held that “heart qi excess” could be drained by needling Laogong and Guanyuan to promote urination; however, Guanyuan is close to the uterus, and needling near it during pregnancy carries extremely high risk—modern practice absolutely forbids non-professional manipulation.
Modern Understanding 🌟
- This chapter represents an early systematic document of traditional Chinese gynecology and obstetrics, recording common issues such as pregnancy vomiting, bleeding, abdominal pain, edema, and difficult urination, holding significant value in the history of medicine.
- “Zheng gu hai” (zheng causing harm) can be understood as an ancient description of uterine fibroids, ovarian masses, or other organic diseases coexisting with pregnancy; “bao zu” resembles threatened miscarriage or ectopic pregnancy, but ancient and modern concepts cannot be simply equated.
- Modern obstetrics, through ultrasound, hormonal assays, genetic screening, and other tools, can more accurately assess embryonic development and maternal status. Statements in the text such as “regular use of Danggui San makes childbirth easy” or “manages all postpartum diseases” belong to the limitations of their era and must not be adopted verbatim.
- Some modern studies of certain formulas suggest anti-inflammatory, blood-activating, and smooth-muscle-regulating effects, but evidence on medication safety during pregnancy remains limited; any use must be evaluated under a physician’s guidance and must not be self-administered according to ancient formulas.
Wellness Insights ⚡
- During pregnancy, one should maintain emotional calm, avoid overexertion and fright, consistent with the ancient concept of “nurturing the fetus.”
- The diet should be light and moderate; when vomiting is pronounced, eating small frequent meals may help—but do not self-administer anti-emetic formulas.
- Keep the lower abdomen warm and avoid cold stimulation; if abnormal bleeding, abdominal pain, edema, or difficulty urinating occurs, seek timely care at a正规 medical facility.
- The ancients emphasized “you gu wu yun,” but modern people must not use this as justification for self-directed aggressive treatment; any ancient method of “nurturing the fetus” or “easing childbirth” must be verified through modern medical examination.
📚 Related Knowledge
- Related concepts: Chong and Ren channels, uterus (bao gong), zheng-jia (abdominal masses), uterine bleeding (lou xia), bao zu, zi zang, Taiyin nourishing the fetus, you gu wu yun.
- Further reading: Synopsis of the Golden Chamber, Chapter 21: Pulse Manifestations and Treatment of Postpartum Disorders; Synopsis of the Golden Chamber, Chapter 22: Pulse Manifestations and Treatment of Miscellaneous Women’s Disorders; Huangdi Neijing·Suwen·Shanggu Tianzhen Lun; Lingshu·Wuyin Wuwei; Zhubing Yuanhou Lun·Zhenyun Bing Zhuhou; Chen Ziming, Furen Daquan Liangfang·Renshen Men.
Buua Note: This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research; it does not constitute any medical diagnosis, medication, or treatment advice. If you feel unwell, please seek medical attention promptly.
