胎前之病,如恶阻、胞阻、胎漏、堕胎等证是也,产后之病,
如血块、血晕等证是也,妇科书中已详,可毋备述。而其最要
述者,惟胎前产后用药宜慎。凡治胎前之病,必须保护其胎,古人虽有“有故无殒,亦无殒也,大积大聚,
其可犯也,衰其大半而止”之训,奈今人胶执“有故无殒”之句,一遇里积之证,恣意用攻,往往非伤其子,
即伤其母,盖缘忽略衰其大半之文耳。窃揣胎在腹中,一旦被邪盘踞,攻其邪则胎必损,安其胎必碍
乎邪,静而筹之,莫若攻下方中,兼以护胎为妥,此非违悖《内经》,实今人之气体,不及古人万一也。且
不但重病宜慎其药,即寻常小恙,亦要留心。如化痰之半夏,消食之神曲,宽胀之浓朴,清肠之槐花,凉血
之丹皮、茅根,去寒之干姜、桂、附,利湿之米仁、通、滑,截疟之草果、常山,皆为犯胎之品,最易误
投,医者可不儆惧乎!至于产后之病,尝见医家不分虚实,必用生化成方,感时邪者,重投古拜,体实者未
尝不可,虚者攻之而里益虚,散之而表益虚,虚虚之祸,即旋踵矣!又有一等病患信虚,医人信补,不分
虚实,开口便说丹溪治产后之法,每每大补气血,体虚者未尝不可,倘外有时邪者,得补益剧,内有恶露
者,得补弥留,双证迭加,不自知其用补之咎耳。要之胎前必须步步护胎,产后当分虚实而治,毫厘差谬,
性命攸关。惟望同志者,凡遇胎前产后之 ,用药勿宜孟浪,慎之慎之!
Diseases during pregnancy, such as *Ezu* (pregnancy-induced nausea and vomiting), *Baozu* (abdominal pain during pregnancy), *Tailou* (spotting during pregnancy), and *Tuotai* (miscarriage), are detailed in gynecological texts and need not be repeated here. However, the most critical point is that medication must be used with extreme caution during both pregnancy and the postpartum period.
When treating diseases during pregnancy, one must protect the fetus. Although ancient texts state, "If there is a cause (pathogen), there will be no destruction to the mother or the fetus; large accumulations and masses may be attacked, but stop when half of the pathogen has been eliminated," modern practitioners often rigidly adhere to the phrase "if there is a cause, there will be no destruction." Upon encountering internal accumulation, they recklessly use purgative methods, often injuring either the fetus or the mother. This is likely due to neglecting the instruction to "stop when half of the pathogen has been eliminated."
I speculate that once pathogens occupy the space within the womb, attacking the pathogens damages the fetus, while protecting the fetus hinders the elimination of pathogens. After careful consideration, it is advisable to combine fetal protection measures within the formula used for attacking pathogens. This does not contradict the *Huangdi Neijing* (Yellow Emperor's Inner Canon); rather, it reflects that contemporary constitutions are far inferior to those of the ancients.
Moreover, caution is required not only for severe illnesses but also for minor ailments. For instance, *Banxia* (Pinelliae Rhizoma) for resolving phlegm, *Shenqu* (Massa Medicata Fermentata) for digesting food, *Houpo* (Magnoliae Officinalis Cortex) for relieving distension, *Huaihua* (Flos Sophorae) for clearing the intestines, *Danpi* (Moutan Cortex) and *Maogen* (Imperatae Rhizoma) for cooling blood, *Ganjiang* (Zingiberis Rhizoma), *Guizhi* (Cinnamomi Ramulus), and *Fuzi* (Aconiti Lateralis Radix Praeparata) for dispelling cold, *Yiyiren* (Coicis Semen), *Tongcao* (Tetrapanacis Medulla), and *Huashi* (Talcum) for promoting diuresis, and *Caoguo* (Tsao-ko Fructus) and *Changshan* (Dichroae Radix) for arresting malaria, are all substances that can harm the fetus. They are easily misused; should physicians not be vigilant and fearful?
Regarding postpartum diseases, I have observed physicians failing to distinguish between deficiency and excess syndromes, invariably prescribing *Shenghua Tang* (Decoction for Generating Blood). If the patient suffers from exogenous pathogens, heavy reliance on ancient formulas (such as *Baibai*, potentially referring to specific strong formulations or a textual error for a specific herb/formula contextually implying harsh treatment) may be acceptable for robust individuals, but for deficient patients, using attack methods further depletes the interior, and using dispersal methods further weakens the exterior. The disaster of "depleting the deficient" occurs immediately!
Furthermore, there are cases where patients believe themselves to be deficient, and doctors blindly prescribe tonics, ignoring the distinction between deficiency and excess. They cite Zhu Danxi’s methods for postpartum care, frequently using heavy tonification of Qi and Blood. While this might suit truly deficient bodies, if exogenous pathogens are present, tonification exacerbates the condition; if lochia (postpartum discharge) remains internally, tonification causes the pathogen to linger. With dual complications arising, the physician fails to recognize the fault of using tonics.
In summary, during pregnancy, one must step-by-step protect the fetus; during the postpartum period, treatment must differentiate between deficiency and excess. A discrepancy of a hair's breadth concerns life and death. I hope colleagues, when encountering conditions during pregnancy or the postpartum period, will avoid rash medication practices. Exercise utmost caution!