后重不可降气,便脓不得行血,惟顺气和血,佐以导滞消积之味,此治妊娠痢疾之要法也。
腹胀而痛,里急后重。三黄解毒汤加木香、当归。(寒二十。)
血痢不止。热乘大肠也,黄芩、芍药、甘草。
腹重坠下,元气虚也;胎动不安,内热甚也。补中益气汤加黄芩、白芍。(补六。)
痢下黄水,脾气下陷也。补中益气汤。(补六。)
黄而兼青,肝木克土也。宜平肝补土,补中益气汤加白芍、青皮。(补六。)
黄而兼黑,水反侮土也。宜补脾肾。七味丸。(补三十一。)肉桂有碍于胎,可易肉果、菟丝子。然火盛者亦兼黑色,
宜投寒凉之剂。
肠胃虚弱,风邪客之。胃风汤。(散十五。)
赤白脓血不止。黄连汤。(寒二十八。)
赤白灰色泄痢痛欲死。大宁散。(涩一。)
腹痛胸满。当归芍药汤。(补十一。)
肠鸣后重,谷道疼痛。蒙姜黄连丸。(和十六。)
胎气不和,相火上炎,郁而为热,亦致下利不止,似痢而实非痢也。四物汤加黄芩、白术、生地。(补七。)
血壅胎元则脾阴虚,不能运化水谷,而为泄泻;又胎系于肾,胎窃肾中之气,则肾阳不克,上蒸脾土,亦致脾虚泄
泻。即或间有风、寒、暑、湿之所感者,亦半属于脾肾之亏。
大便虚急。此脾土燥、大肠涩也。宜理脾胃与大肠,川连、干姜、木香、甘草。
呕吐腹痛,手足逆冷。寒水侮土也。六君子汤,(补一,)去半夏,加补骨脂、益智仁、煨鲜姜。
寒热作呕,肝木侮土也。异功散加柴胡、白芍、生姜。有火,加味逍遥散。(补二十二、补二十一。)
百节酸疼。因纵意口腹也,归凉节命散。(和十七。)
脐下阴冷。理中异功散加肉果、木香。(热二、补二十二。)
协热作泻。三黄熟艾汤。(寒三十三。)
伏暑不消,烦渴泻水。四苓散。(泻二。)
伤湿泄泻,小便自利。胃苓汤。(泻四。)
脾肾虚弱。白术散。(和十八。)
久泻不已。安胎和气饮,加减八珍汤。(和十一、补三十二。)
气急筋挛骨节痛。平安散、紫苏饮。(和十九、散三。)
Post-tenesmus should not be treated solely by descending Qi; passage of pus and blood should not be treated solely by promoting blood circulation. The key method for treating dysentery during pregnancy lies in harmonizing Qi, nourishing blood, and assisting with herbs that guide out stagnation and resolve accumulation.
Abdominal distension with pain, tenesmus (a feeling of incomplete defecation accompanied by straining). Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction) plus Muxiang (Aucklandiae Radix), Danggui (Angelicae Sinensis Radix). (Cold category, No. 20)
Incessant bloody dysentery. This is due to heat invading the Large Intestine. Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
Heaviness and bearing-down sensation in the abdomen indicate deficiency of Yuan Qi (Original Qi); restlessness of the fetus indicates intense internal heat. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Huangqin (Scutellariae Radix), Baishao (Paeoniae Radix Alba). (Tonify category, No. 6)
Passage of yellow watery stool indicates sinking of Spleen Qi. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). (Tonify category, No. 6)
Stool that is yellow mixed with green indicates Liver Wood overacting on Spleen Earth. It is appropriate to soothe the Liver and tonify the Spleen. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Baishao (Paeoniae Radix Alba), Qingpi (Citri Reticulatae Pericarpium Viride). (Tonify category, No. 6)
Stool that is yellow mixed with black indicates Water counter-rebelling against Spleen Earth. It is appropriate to tonify the Spleen and Kidney. Qiwei Wan (Seven-Ingredient Pill). (Tonify category, No. 31) If Rougui (Cinnamomi Cortex) is considered detrimental to the fetus, it can be replaced with Roudoukou (Myristicae Semen) and Tusizi (Cuscutae Semen). However, cases of excessive fire may also present with black coloration; in such instances, cold-natured formulas are appropriate.
Weakness of the Stomach and Intestines with wind pathogens lodging within. Weifeng Tang (Stomach-Wind Decoction). (Disperse category, No. 15)
Incessant passage of red and white pus and blood. Huanglian Tang (Coptis Decoction). (Cold category, No. 28)
Passage of red, white, and gray purulent stool with excruciating abdominal pain. Daning San (Great Peace Powder). (Astringe category, No. 1)
Abdominal pain with chest fullness. Danggui Shaoyao Tang (Angelica and Peony Decoction). (Tonify category, No. 11)
Borborygmus, tenesmus, and anal pain. Mengjiang Huanglian Wan (Mengjiang Coptis Pill). (Harmonize category, No. 16)
Disorder of fetal Qi, with Ministerial Fire flaming upward, stagnating and transforming into heat, can also cause incessant diarrhea. This resembles dysentery but is not truly dysentery. Siwu Tang (Four-Substance Decoction) plus Huangqin (Scutellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shengdihuang (Rehmanniae Radix Recens). (Tonify category, No. 7)
Blood stasis affecting the fetal root leads to Yin deficiency of the Spleen, resulting in the inability to transform and transport water and grain, causing diarrhea. Furthermore, the fetus is anchored to the Kidney; if the fetus steals Qi from the Kidney, Kidney Yang becomes insufficient, allowing cold to steam upward into Spleen Earth, also leading to Spleen-deficiency diarrhea. Even if there are occasional invasions by wind, cold, summerheat, or dampness, these are mostly attributable to deficiencies of the Spleen and Kidney.
Deficient urgency in defecation. This is due to dryness of Spleen Earth and涩 (obstruction/stagnation) of the Large Intestine. It is appropriate to regulate the Spleen and Stomach and the Large Intestine. Chuanlian (Coptidis Rhizoma), Ganjiang (Zingiberis Rhizoma), Muxiang (Aucklandiae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
Vomiting, abdominal pain, and cold extremities. This is Cold Water counter-rebelling against Spleen Earth. Liujunzi Tang (Six-Gentlemen Decoction) (Tonify category, No. 1), remove Banxia (Pinelliae Rhizoma), add Buguzhi (Psoraleae Fructus), Yizhiren (Euryales Semen), and Wei Jiang (Prepared Fresh Ginger).
Alternating chills and fever with vomiting indicates Liver Wood counter-rebelling against Spleen Earth. Yigong San (Extraordinary Power Powder) plus Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens). If there is fire, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) is used. (Tonify category, No. 22, No. 21)
Soreness and pain in all joints. Caused by indulgence in food and drink. Guiliang Jieming San (Return-Cool Joint-Life Powder). (Harmonize category, No. 17)
Coldness below the umbilicus. Lizhong Yigong San (Regulate the Middle and Extraordinary Power Powder) plus Roudoukou (Myristicae Semen), Muxiang (Aucklandiae Radix). (Heat category, No. 2, Tonify category, No. 22)
Diarrhea associated with heat (Xie Re Zuo Xie). Sanhuang Shuai Ai Tang (Three-Yellow Cooked Mugwort Decoction). (Cold category, No. 33)
Unresolved summerheat, irritability, thirst, and watery diarrhea. Siling San (Four-Poria Powder). (Diarrhea category, No. 2)
Dampness-injury diarrhea with free urination. Weiping Tang (Stomach-Poria Decoction). (Diarrhea category, No. 4)
Spleen and Kidney weakness. Baizhu San (Atractylodes Powder). (Harmonize category, No. 18)
Chronic diarrhea that does not cease. Antai Heqi Yin (Fetus-Soothing and Qi-Harmonizing Decoction), Jiaban Bazhen Tang (Modified Eight-Treasure Decoction). (Harmonize category, No. 11, Tonify category, No. 32)
Shortness of breath, tendon spasms, and bone/joint pain. Ping'an San (Peaceful Safety Powder), Zisu Yin (Perilla Leaf Decoction). (Harmonize category, No. 19, Disperse category, No. 3)