妇人伤寒六经传变治例皆与男子同法惟经水适来适断热入血室与夫胎前产后崩漏带下则治有殊别也
热入血室
妇人中风发热恶寒经水适来得之七八日热除而脉迟身凉胸胁下满如结胸状谵语者此为热入血室也当刺
期门随其实而泻之(东垣云妄见妄闻夜梦亡人皆肝木太盛而为邪也刺期门与此义同)
许学士治一妇人患热入血室证医者不识用补血调气药延养数日遂成血结胸或劝用前药予曰小柴胡已迟不可行也无
己则有一焉刺期门穴斯可矣予不能针请善针者治之如言而愈或问曰热入血室何谓而成结胸也予曰邪气传入经络与正气
相搏上下流行或遇经水适来适断邪气乘虚而入血室血入邪迫上入肝经肝受邪则谵语而见鬼复入膻中则血结于胸也何以
言之妇人平居水当养于木血当养于肝方未受孕则下行之以为月水既妊则中蓄之以养胎及已产则上壅之以为乳皆此血也
今邪气蓄血并归肝经聚于膻中结于乳下故手触之则痛非汤剂可及故当刺期门也
妇人伤寒发热经水适来昼日明了夜则谵语如见鬼状者此为热入血室无犯胃气及上二焦必自愈(活人云小柴胡汤和之
○犯胃气谓下之犯上二焦谓发汗也)
衍义云一妇人温病已十二日诊其脉六七至而涩寸稍大尺稍小发寒热颊赤口干不了了耳聋问之病数日经水乃行此属
少阳热入血室也若治不对病则必死乃按其证与小柴胡汤服之二日又与小柴胡汤加桂干姜一日寒热遂止又云我脐下急痛
又与抵当丸微利脐下痛痊身渐凉脉渐匀尚不了了仍复与小柴胡次日又云我但胸中热燥口鼻干又少与调胃承气汤不得利
次日又云心下痛又与大陷胸丸半服利三行次日虚烦不乐时亦有所见时复狂言虽知其尚有燥屎以其极虚不敢攻之遂与竹
叶汤去其烦热其夜大便自通至晓两次中有燥屎数枚而狂言虚烦尽解但咳嗽唾此肺虚也恐乘虚而成肺痿遂与小柴胡去人
参大枣生姜加干姜五味子汤一日咳减二日而病悉愈以上皆用张仲景方
妇人中风七八日续得寒热发作有时经水适断者此为热入血室其血必结故如疟状发作有时小柴胡汤主之
附
云 妇人伤寒中风治法与男子无异惟热入血室妊娠伤寒则不同也宜以四物安养胎血佐以汗下之药治之妇人伤寒中
风自汗头痛项背强发热恶寒脉浮而缓恐热入血室故倍加芍药
桂枝加芍药汤
桂枝(一两半) 赤芍药(三两半)生姜(切一两半) 甘草(炙一两) 大枣(六枚擘)上锉细每服五钱水(煎
服)
妇人伤寒脉浮而紧头痛身热恶寒无汗发汗后恐热入血室宜麻黄加生地黄汤
麻黄(二两半) 桂枝(一两半) 甘草(半两炙) 生地黄(二两) 杏仁(二十五枚去皮尖)上 咀每服五钱
水煎服
活 妇人伤寒经脉方来初断寒热如疟狂言见鬼宜用干姜柴胡汤
柴胡(四两) 栝蒌根 桂枝(各一两半) 牡蛎( ) 干姜 甘草(炙各一两)上 咀每服五钱水一盏半煎至
七分去滓温服初服微烦再服汗出而愈
罗 小柴胡加地黄汤 治妇人室女伤寒发热经水适来适断昼日明了夜则谵语如见鬼神亦治产后恶露方来忽间断欲死
柴胡(一两二钱半) 人参 黄芩 甘草(炙) 半夏(汤洗七次) 生地黄(各七钱)上为粗末每服五钱生姜三
片枣二枚水煎服
云 妇人伤寒身热脉长而弦属阳明少阳往来寒热夜躁昼宁如见鬼状经水适断热入血室不实满者小柴胡加牡丹皮汤
主之大实满者桃仁承气汤下之
小柴胡加牡丹皮汤方
柴胡 人参 牡丹皮(各二两)甘草(炙) 生姜(各七钱半) 半夏(汤洗六钱) 大枣(三枚擘) 黄芩(七
钱半)上锉细每服一两水煎服
妇人伤寒头痛脉浮医反下之邪气乘虚而传于里经水闭不行心下结硬口燥舌干寒热往来狂言如见鬼状脉沉而数者当
下之宜小柴胡加芒硝大黄汤主之
柴胡(二两) 半夏(制一两半) 黄芩 生姜(各七钱半) 大黄 芒硝(各七钱) 甘草(炙五钱半) 大枣
(三枚擘) 上锉每服一两水煎去滓下芒硝再沸温服若脉不沉数则不可下
许 辛亥中寓居毗陵学官王仲礼其妹病伤寒发寒热遇夜则如鬼物所凭六七日忽昏塞涎响如引锯牙关紧急瞑目不知
人疾势极危召予视之予曰得病之初曾值月经来否其家曰月经方来病作而经遂止一二日发寒热昼虽静夜则有鬼祟从昨日
涎生不省人事予曰此热入血室之证也仲景云妇人中风发热恶寒经水适来昼则明了夜则谵语如见鬼状发作有时此名热入
血室医者不晓以刚剂与之遂致胸膈不利涎潮上脘喘急息高昏冒不知人事当先化其痰后除其热予急以一呷散投之两时顷
涎下得睡省人事次授以小柴胡加地黄汤三服而热除不汗而自解矣
云 妇人伤寒表虚自汗身凉四肢拘急脉沉而迟太阳标病少阳本病经水适断桂枝加附子红花汤
桂枝(二两半) 芍药 生姜(各一两半) 甘草(炙一两) 附子(炮) 红花(各五钱)上锉细每服一两水三
盏煎服
妇人伤寒太阳标病汗解表除邪热内攻热入血室经水过多无满实者甘草芍药汤
甘草 芍药 生地黄 川芎(各一两)上 咀每服一两水三盏煎至一盏半去滓入发灰五钱调匀温服不止者刺隐白
妊娠伤寒
吴 凡妊娠伤寒六经治例皆同但要安胎为主凡药中有犯胎者则不可用也如藿香正气散十味芎苏散参苏
饮小柴胡汤之类有半夏能犯胎如用须去之若痰多呕逆必用之以半夏曲则可如无沸汤泡七次去皮脐生姜自然汁拌晒干乃
可用也凡川乌附子天雄侧子肉桂干姜大黄芒硝芫花甘遂大戟蜀漆水蛭虻虫桃仁牡丹皮干漆代赭石瞿麦牛膝等类之物皆
动胎之药凡用必须斟酌仔细而详之也其余详见各条治例兹不录凡护胎之法伤寒热病热甚者宜用井底泥涂脐二寸干即又
涂之一方以白药子为末水调涂之一方以伏龙肝末水调涂之可护胎也大抵妊娠伤寒合用汤剂必加黄芩白术二味能安胎也
或以此二味煎汤与之或为细末白汤调下二三钱亦佳如妊妇素禀弱者药中四物汤佐之不可缺也且如用小柴胡汤去半夏加
白术合四物汤用之可以保胎除热也其效如神余皆仿此用之则妙矣
洁 黄 解肌汤治妇人妊娠伤风自汗
人参 黄 当归 川芎 甘草(炙各五钱) 芍药(六钱)加苍术生地黄亦可上为粗末每服五钱水煎温服无时
海 若妊娠伤寒中风表虚自汗头痛项强身热恶寒脉浮而弱太阳经病宜表虚六合汤
四物汤(四两) 桂枝 地骨皮(各七钱)
若妊娠伤寒头痛身热无汗脉紧太阳经病宜表实六合汤
四物汤(四两) 麻黄 细辛(各半两)
若妊娠伤寒中风湿之气肢节烦疼脉浮而热头痛者太阳标病也宜风湿六合汤
四物汤(四两) 防风 苍术(制各七钱)
若妊娠伤寒下后过经不愈湿毒发斑如锦纹宜升麻六合汤
四物汤(四两) 升麻 连翘(各七钱)
若妊娠伤寒胸胁满痛而脉弦少阳证宜柴胡六合汤
四物汤(四两) 柴胡 黄芩(各七钱)
若妊娠伤寒大便硬小便赤气满而脉沉数阳明太阳本病也急下之宜大黄六合汤
四物汤(四两) 大黄 桃仁(去皮尖麸炒十枚)
若妊娠伤寒汗下后咳嗽不止者宜人参六合汤
四物汤(四两) 人参 五味子(各五钱)
若妊娠伤寒后虚痞胀满者阳明本虚宜浓朴六合汤
四物汤(四两) 浓朴 枳实(麸炒各五钱)
若妊娠伤寒汗下后不得眠者宜栀子六合汤
四物汤(四两) 栀子 黄芩(各五钱)
若妊娠伤寒大渴蒸蒸而烦脉长而大者宜石膏六合汤
四物汤(四两) 石膏 知母(各五钱)
若妊娠伤寒小便不利太阳本病宜茯苓六合汤
四物汤(四两) 茯苓 泽泻(各五钱)
若妊娠伤寒太阳本病小便赤如血者宜琥珀六合汤
四物汤(四两) 琥珀 茯苓(各五钱)
若妊娠伤寒汗下后血漏不止胎气损动者宜胶艾六合汤
四物汤(四两) 阿胶 艾(各五钱一方加甘草同上一方加甘草干姜黄 )
若妊娠伤寒四肢拘急身凉微汗腹中痛脉沉而迟少阴病也宜附子六合汤
四物汤(四两) 附子(炮去皮剂) 桂(各五钱)
若妊娠伤寒蓄血证不宜堕胎药下之宜四物大黄汤下之
四物汤(四两) 生地黄 大黄(酒浸各五钱)
妇人妊娠或蓄血抵当桃仁勿妄施要教子母俱无损大黄四物对分之
丹 施孺人伤风未解两足下胫冷嗽多不吐痰头眩盖其性急又当临月
黄芩(半钱) 陈皮 白术(各一钱) 苏桔(三分) 木通 枳壳(炒各五分) 麻黄(三分) 甘草(炙二分)
桔梗 苍术(各半钱)上水煎服无时
云 妇人有孕伤寒脉浮头重腹中切痛宜桂枝芍药当归汤
桂枝 芍药 当归(各一两)上锉细每服一两水煎
妇人妊娠伤寒自利腹中痛食饮不下脉沉者太阴病也宜芍药汤
芍药 白术 甘草 茯苓(各一两)上如前修服
活 治妊娠伤寒安胎宜阿胶散
人参 白茯苓 阿胶(炒) 桑寄生 白术(各等分)上捣罗为细末糯米饮调下二钱日二服
治妊娠伤寒安胎宜白术散
白术 黄芩(新瓦上炒香各等分)上为末每服三钱水一钟生姜三片大枣一枚擘破同煎至七分去滓温服但觉头疼发热
便可服二三服即瘥惟四肢厥冷阴证见者未可服
治妊娠伤寒憎寒发热当发其汗宜葱白汤
葱白(十茎) 生姜(二两切)上锉水二盏煎至一盏连服取汗
海 葱白一物汤用葱白二把以水一升熟煮取汁令食尽亦生安胎若胎损须臾即出
紫苏散 治胎气不和揍上心腹胀满疼痛谓之子悬能安活胎亦下损胎又治伤寒头疼发热遍身疼痛
紫苏叶 当归(各一两) 人参 甘草(炙各半两) 大腹皮 川芎 白芍药 陈皮(去白各一两)每服八钱水一钟半生姜五片葱白三茎连须煎至一钟去滓食前热服若心腹甚痛者加木香元胡索研同煎服
芎苏散 治妊妇伤寒头痛增寒壮热身痛项强
紫苏叶 川芎 白芍药 白术 陈皮 干葛 甘草 麦门冬(各等分)锉散每服四钱姜四片葱白三茎煎热服
治妇人伤寒妊娠服药例
若发热恶寒不离桂枝芍药若往来寒热不离柴胡前胡若大渴者不离知母石膏五味子麦门冬若
大便泄者不离桂附干姜白术若大便燥结者不离大黄黄芩若月经适来适断者不离小柴胡若胎不安者不离人参阿胶白术黄
芩若发汗者不离煎豉生姜麻黄旋复若头痛者不离石膏山栀前胡若伤暑头痛者不离柴胡甘草石膏若满闷者不离枳实陈皮
若胎气不安者不离黄芩麦门冬人参若斑发黑者不离黄芩栀子升麻
大 治妊娠时气身大热令子不落护胎方
伏龙肝研为极细末调涂脐下三寸干即易瘥即止
又方 井水泥涂干即易之(二方出本事有效)
又方 浮萍 蓝根 朴硝 蛤粉 大黄(微炒)上为末水调傅脐上安胎解热极妙
又方 白药子为末水调傅腹上
治妊娠霍乱二方(附少阴吐利门)
治妊娠发斑变为黑色宜栀子大青汤
黄芩 升麻 栀子仁(各二两) 大青 杏仁(各半两) 上 咀每服五钱水一盏半细切葱白三寸煎至一盏去滓温
服
产后伤寒
吴 新产后患伤寒不可轻易发汗盖有产时伤力发热去血过多发热恶露不去发热三日蒸乳发热或有早起
动劳饮食停滞一皆发热状类伤寒要在仔细详辨切不可辄便发汗大抵产后大血空虚若汗之则变筋惕肉 或郁冒昏迷而不
省或风搐搦而不定或大便秘涩而难去其害非轻切宜精审凡有发热且与四物汤以川芎当归为君最多白芍药须炒过酒蒸熟
地黄佐之如发热加软苗柴胡人参干姜主之最效盖干姜之辛热能引血药入血分气药入气分也且能去恶养新有阳生阴长之
道以热治热深合内经之旨予尝用之取效如神故录以劝之如有恶露未尽者益母丸黑神散必兼用之若胃虚食少者必加白术
茯苓有痰呕逆者必加陈皮半夏其余六经各条治例皆同但药中必加四物汤为主乃养血务本之要也
产后中风数十日不解头微痛恶寒时时有热心下闷干呕汗出虽多阳旦证可与阳旦汤(即桂枝汤方见太阳病)
产后中风发热面赤喘而头痛竹叶汤主之
竹叶(一把) 葛根(三两) 防风 桔梗 桂枝 人参 甘草(炙各一两)上 咀每服五钱枣一枚姜五片水一盏
半煎一盏去滓服温覆使汗出若头项强用大附子半钱煎药扬去沫呕者加半夏一钱
丹 产后发热恶寒皆属血气虚左手脉不足补血右手脉不足补气凡恶寒发热又腹痛当去恶血恶寒发热乳汁不通及膨
者无子当消用麦芽二两炒研细清汤作四服调下有子当下用木通通草猪蹄汁调煎服
产后才见身热不可发表并一切苦寒药必用干姜治之大发其热轻则用茯苓淡渗其热
大 凡产后发热头痛身疼不可便作感冒治之此等多是血虚或败血作梗宜以平和之剂与服必效如玉露散或四物加北
柴胡等分煎服若便以小柴胡汤及竹叶石膏汤之类竟不救者多矣
玉露散 治产后乳脉不行身体壮热疼痛头目昏痛大便涩滞悉治之凉膈压热下乳
人参 茯苓 甘草(各半两) 苦梗(炒) 川芎 白芷(各一两) 当归(二钱半) 芍药(七钱半)上 咀每
服五钱水一盏煎至七分温服如烦热甚大便秘者加大黄二钱半
有汗出的称为柔痉,无汗出的称为刚痉。其证治详情详见《杂病五册》,此处不再赘述。
妇人患伤寒,六经传变的治法与男子相同。唯独遇到月经适来或适断时热入血室,以及胎前产后出现的崩漏、带下等情况,治疗方法则有特殊区别。
热入血室:
妇人患中风,出现发热、恶寒,恰逢月经来潮,病程经过七八天,热势已退而脉象迟缓,身体转凉,但胸胁部胀满,症状类似结胸,并伴有胡言乱语(谵语),这是热邪陷入血室的表现。应当针刺期门穴,根据实证情况采用泻法。(李东垣说:幻视幻听、夜间梦见亡人,都是肝木过盛受邪所致,针刺期门与此道理相同。)
许学士治疗一位患有热入血室证的妇人,医生不认识此证,使用补血调气的药物调养数日,结果导致血结胸。有人建议使用前药(指小柴胡汤类),我说:“用小柴胡汤已经太迟,不可行。”如果没有其他办法,只有一个选择:针刺期门穴即可治愈。我不会针灸,请擅长针灸的人治疗,按此方法果然痊愈。有人问:“热入血室为何会形成结胸?”我说:“邪气传入经络,与正气相搏,上下流行。如果遇到月经适来或适断,邪气乘虚而入血室,血液被邪气逼迫,向上进入肝经。肝受邪则出现谵语、见鬼;若再进入膻中,则血液结于胸部。为什么这样说呢?妇女平时,水滋养木,血滋养肝。在未受孕时,下行成为月经;怀孕后,蓄积在中焦以养胎;分娩后,上壅成为乳汁,都是这血的作用。现在邪气与蓄血并归肝经,聚于膻中,结于乳下,所以手触之则痛,非汤剂所能到达,因此应当针刺期门。”
妇人患伤寒,发热,恰逢月经来潮,白天神志清醒,夜晚则胡言乱语,如同看见鬼神一般,这是热入血室。不要侵犯胃气及上二焦,病必自愈。(《活人书》说:用小柴胡汤和解。○所谓“犯胃气”是指用攻下法,“犯上二焦”是指用发汗法。)
《衍义》记载:一位妇女患温病已十二天,诊察其脉搏一息六七至且涩,寸脉稍大,尺脉稍小,发冷发热,脸颊红赤,口干不适,耳聋。询问得知,患病数日后月经才来,这属于少阳热入血室。如果治疗不对症,必然死亡。于是按其证候给予小柴胡汤,服用两天后,又给予小柴胡汤加桂枝、干姜,一天后寒热停止。病人又说脐下急痛,又给予抵当丸,轻微通利大便后脐下痛痊愈,身体逐渐凉爽,脉搏逐渐均匀,但仍感不适。再次给予小柴胡汤。第二天病人又说心中烦热干燥,口鼻干,又少量给予调胃承气汤,未能通便。第二天病人又说心下疼痛,又给予大陷胸丸,半服后通利三次。第二天出现虚烦不乐,时而有所幻觉,时而胡言乱语。虽然知道体内还有燥屎,但因病人极度虚弱,不敢攻下。于是给予竹叶汤去除其烦热。当晚大便自然通畅,直到早晨两次排便中有几枚燥屎,胡言乱语和虚烦完全解除,只留下咳嗽吐痰的症状,这是肺虚。恐怕趁虚发展成肺痿,于是给予小柴胡汤去人参、大枣、生姜,加干姜、五味子。一天后咳嗽减轻,两天后病全愈。以上均使用张仲景的方剂。
妇人患中风,七八天后,持续出现寒热往来,发作有时,恰逢月经中断,这是热入血室。其血必结,所以症状像疟疾一样发作有时,主方用小柴胡汤。
附注:
云岐子说:妇人患伤寒、中风的治法与男子无异,唯独热入血室和妊娠伤寒不同。宜用四物汤安养胎血,佐以汗下之法治疗。妇人患伤寒、中风,自汗、头痛、项背强直、发热、恶寒、脉浮而缓,恐热入血室,故倍加芍药。
桂枝加芍药汤:
桂枝(一两半)、赤芍药(三两半)、生姜(切,一两半)、甘草(炙,一两)、大枣(六枚,掰开)。以上锉细,每次服用五钱,加水煎服。
妇人患伤寒,脉浮紧,头痛,身热,恶寒,无汗,发汗后恐热入血室,宜用麻黄加生地黄汤。
麻黄(二两半)、桂枝(一两半)、甘草(炙,半两)、生地黄(二两)、杏仁(二十五枚,去皮尖)。以上捣碎,每次服用五钱,加水煎服。
《活人书》:妇人患伤寒,经脉方来初断,寒热如疟,胡言乱语,见鬼,宜用干姜柴胡汤。
柴胡(四两)、栝蒌根、桂枝(各一两半)、牡蛎(缺字,疑为量词或炮制法)、干姜、甘草(炙,各一两)。以上捣碎,每次服用五钱,加水一盏半,煎至七分,去渣,温服。初服微烦,再服汗出而愈。
罗知悌:小柴胡加地黄汤。治疗妇人、少女患伤寒发热,月经适来或适断,白天神志清醒,夜晚胡言乱语,如同见鬼神。也治疗产后恶露方来忽间断,欲死之证。
柴胡(一两二钱半)、人参、黄芩、甘草(炙)、半夏(汤洗七次)、生地黄(各七钱)。以上为粗末,每次服用五钱,加生姜三片、枣二枚,水煎服。
云岐子:妇人患伤寒,身热,脉长而弦,属阳明、少阳往来寒热,夜躁昼宁,如见鬼状,月经适断,热入血室,不实满者,主方用小柴胡加牡丹皮汤。大实满者,用桃仁承气汤攻下。
小柴胡加牡丹皮汤方:
柴胡、人参、牡丹皮(各二两)、甘草(炙)、生姜(各七钱半)、半夏(汤洗,六钱)、大枣(三枚,掰开)、黄芩(七钱半)。以上锉细,每次服用一两,水煎服。
妇人患伤寒,头痛,脉浮,医生反而用攻下法,邪气乘虚传入里,月经闭止不行,心下痞结硬满,口燥舌干,寒热往来,胡言乱语,如同见鬼状,脉沉而数,应当攻下,宜用小柴胡加芒硝大黄汤主之。
柴胡(二两)、半夏(制,一两半)、黄芩、生姜(各七钱半)、大黄、芒硝(各七钱)、甘草(炙,五钱半)、大枣(三枚,掰开)。以上锉,每次服用一两,水煎,去渣,下芒硝,再煮沸,温服。若脉不沉数,则不可攻下。
许叔微:辛亥年间,寓居毗陵,学官王仲礼的妹妹患伤寒,发冷发热,遇夜则如被鬼物附身,六七天忽然昏塞,喉间痰声如拉锯,牙关紧急,闭目不知人事,病情极危。召我去诊治。我说:“得病之初,是否正值月经来潮?”家属说:“月经方来,病作而经遂止。”一二日后发冷发热,白天虽静,夜晚则有鬼祟。从昨日开始涎多,不省人事。我说:“这是热入血室的证候。张仲景说:妇人中风,发热恶寒,经水适来,昼则明了,夜则谵语,如见鬼状,发作有时,此名热入血室。医生不懂,用刚燥之剂与之,遂致胸膈不利,涎潮上脘,喘急息高,昏冒不知人事。应当先化痰,后除热。”我急忙给了一呷散,两个时辰左右,涎下,得睡,苏醒人事。接着给予小柴胡加地黄汤,三服后热除,未出汗而病自解。
云岐子:妇人患伤寒,表虚自汗,身凉,四肢拘急,脉沉而迟,太阳标病,少阳本病,经水适断,宜用桂枝加附子红花汤。
桂枝(二两半)、芍药、生姜(各一两半)、甘草(炙,一两)、附子(炮)、红花(各五钱)。以上锉细,每次服用一两,水三盏,煎服。
妇人患伤寒,太阳标病,汗解表除,邪热内攻,热入血室,经水过多,无满实者,宜用甘草芍药汤。
甘草、芍药、生地黄、川芎(各一两)。以上捣碎,每次服用一两,水三盏,煎至一盏半,去渣,入发灰五钱,调匀,温服。不止者,针刺隐白穴。
妊娠伤寒:
吴崑:凡妊娠伤寒,六经治例皆同,但要安胎为主。凡药中有犯胎者则不可用。如藿香正气散、十味芎苏散、参苏饮、小柴胡汤之类,有半夏能犯胎,如用须去之。若痰多呕逆,必用之以半夏曲则可。如无沸汤泡七次,去皮脐,生姜自然汁拌晒干,乃可用也。凡川乌、附子、天雄、侧子、肉桂、干姜、大黄、芒硝、芫花、甘遂、大戟、蜀漆、水蛭、虻虫、桃仁、牡丹皮、干漆、代赭石、瞿麦、牛膝等类药物,皆动胎之药。凡用必须斟酌仔细而详之也。其余详见各条治例,兹不录。凡护胎之法,伤寒热病热甚者,宜用井底泥涂脐二寸,干即又涂之。一方以白药子为末,水调涂之。一方以伏龙肝末,水调涂之,可护胎也。大抵妊娠伤寒合用汤剂,必加黄芩、白术二味,能安胎也。或以此二味煎汤与之,或为细末,白汤调下二三钱,亦佳。如妊妇素禀弱者,药中四物汤佐之,不可缺也。且如用小柴胡汤去半夏,加白术,合四物汤用之,可以保胎除热也,其效如神。余皆仿此用之,则妙矣。
李杲、朱震亨:解肌汤。治疗妇人妊娠伤风自汗。
人参、黄芪、当归、川芎、甘草(炙,各五钱)、芍药(六钱)。加苍术、生地黄亦可。以上为粗末,每次服用五钱,水煎,温服,不拘时候。
海藏:若妊娠伤寒、中风,表虚自汗,头痛,项强,身热,恶寒,脉浮而弱,太阳经病,宜用表虚六合汤。
四物汤(四两)、桂枝、地骨皮(各七钱)。
若妊娠伤寒,头痛,身热,无汗,脉紧,太阳经病,宜用表实六合汤。
四物汤(四两)、麻黄、细辛(各半两)。
若妊娠伤寒中风湿之气,肢节烦疼,脉浮而热,头痛者,太阳标病也,宜用风湿六合汤。
四物汤(四两)、防风、苍术(制,各七钱)。
若妊娠伤寒下后,过经不愈,湿毒发斑,如锦纹,宜用升麻六合汤。
四物汤(四两)、升麻、连翘(各七钱)。
若妊娠伤寒,胸胁满痛而脉弦,少阳证,宜用柴胡六合汤。
四物汤(四两)、柴胡、黄芩(各七钱)。
若妊娠伤寒,大便硬,小便赤,气满而脉沉数,阳明、太阳本病也,急下之,宜用大黄六合汤。
四物汤(四两)、大黄、桃仁(去皮尖,麸炒,十枚)。
若妊娠伤寒,汗下后,咳嗽不止者,宜用人参六合汤。
四物汤(四两)、人参、五味子(各五钱)。
若妊娠伤寒后,虚痞胀满者,阳明本虚,宜用浓朴六合汤。
四物汤(四两)、浓朴、枳实(麸炒,各五钱)。
若妊娠伤寒,汗下后,不得眠者,宜用栀子六合汤。
四物汤(四两)、栀子、黄芩(各五钱)。
若妊娠伤寒,大渴,蒸蒸而烦,脉长而大者,宜用石膏六合汤。
四物汤(四两)、石膏、知母(各五钱)。
若妊娠伤寒,小便不利,太阳本病,宜用茯苓六合汤。
四物汤(四两)、茯苓、泽泻(各五钱)。
若妊娠伤寒,太阳本病,小便赤如血者,宜用琥珀六合汤。
四物汤(四两)、琥珀、茯苓(各五钱)。
若妊娠伤寒,汗下后,血漏不止,胎气损动者,宜用胶艾六合汤。
四物汤(四两)、阿胶、艾(各五钱)。一方加甘草。同上一方加甘草、干姜、黄芪。
若妊娠伤寒,四肢拘急,身凉,微汗,腹中痛,脉沉而迟,少阴病也,宜用附子六合汤。
四物汤(四两)、附子(炮,去皮,切片)、桂(各五钱)。
若妊娠伤寒,蓄血证,不宜堕胎药下之,宜用四物大黄汤下之。
四物汤(四两)、生地黄、大黄(酒浸,各五钱)。
丹溪:妇人妊娠,或蓄血,抵当、桃仁勿妄施,要教子母俱无损。大黄四物对分之。
丹溪:施孺人伤风未解,两足下胫冷,嗽多不吐痰,头眩。盖其性急,又当临月。
黄芩(半钱)、陈皮、白术(各一钱)、苏桔(三分)、木通、枳壳(炒,各五分)、麻黄(三分)、甘草(炙,二分)、桔梗、苍术(各半钱)。以上水煎服,不拘时候。
云岐子:妇人有孕伤寒,脉浮,头重,腹中切痛,宜用桂枝芍药当归汤。
桂枝、芍药、当归(各一两)。以上锉细,每次服用一两,水煎。
妇人妊娠伤寒,自利,腹中痛,食饮不下,脉沉者,太阴病也,宜用芍药汤。
芍药、白术、甘草、茯苓(各一两)。以上如前修服。
《活人书》:治妊娠伤寒安胎,宜用阿胶散。
人参、白茯苓、阿胶(炒)、桑寄生、白术(各等分)。以上捣罗为细末,糯米饮调下二钱,日二服。
治妊娠伤寒安胎,宜用白术散。
白术、黄芩(新瓦上炒香,各等分)。以上为末,每次服用三钱,水一钟,生姜三片,大枣一枚,掰破,同煎至七分,去渣,温服。但觉头疼发热,便可服二三服即瘥。惟四肢厥冷,阴证见者,未可服。
治妊娠伤寒,憎寒发热,当发其汗,宜用葱白汤。
葱白(十茎)、生姜(二两,切)。以上锉,水二盏,煎至一盏,连服取汗。
海藏:葱白一物汤。用葱白二把,以水一升,熟煮取汁,令食尽,亦生安胎。若胎损,须臾即出。
紫苏散:治胎气不和,凑上心腹胀满疼痛,谓之子悬。能安活胎,亦下损胎。又治伤寒头疼发热,遍身疼痛。
紫苏叶、当归(各一两)、人参、甘草(炙,各半两)、大腹皮、川芎、白芍药、陈皮(去白,各一两)。每服八钱,水一钟半,生姜五片,葱白三茎,连须煎至一钟,去渣,食前热服。若心腹甚痛者,加木香、元胡索研同煎服。
芎苏散:治妊妇伤寒,头痛,增寒壮热,身痛,项强。
紫苏叶、川芎、白芍药、白术、陈皮、干葛、甘草、麦门冬(各等分)。锉散,每服四钱,姜四片,葱白三茎,煎热服。
治妇人伤寒妊娠服药例:
若发热恶寒,不离桂枝、芍药;若往来寒热,不离柴胡、前胡;若大渴者,不离知母、石膏、五味子、麦门冬;若大便泄者,不离桂、附、干姜、白术;若大便燥结者,不离大黄、黄芩;若月经适来适断者,不离小柴胡;若胎不安者,不离人参、阿胶、白术、黄芩;若发汗者,不离煎豉、生姜、麻黄、旋复;若头痛者,不离石膏、山栀、前胡;若伤暑头痛者,不离柴胡、甘草、石膏;若满闷者,不离枳实、陈皮;若胎气不安者,不离黄芩、麦门冬、人参;若斑发黑者,不离黄芩、栀子、升麻。
戴原礼:治妊娠时气,身大热,令子不落,护胎方。
伏龙肝研为极细末,调涂脐下三寸,干即易,瘥即止。
又方:井水泥涂,干即易之。(二方出《本事方》,有效)
又方:浮萍、蓝根、朴硝、蛤粉、大黄(微炒)。以上为末,水调傅脐上,安胎解热,极妙。
又方:白药子为末,水调傅腹上。
治妊娠霍乱二方(附少阴吐利门):
治妊娠发斑变为黑色,宜用栀子大青汤。
黄芩、升麻、栀子仁(各二两)、大青、杏仁(各半两)。以上捣碎,每次服用五钱,水一盏半,细切葱白三寸,煎至一盏,去渣,温服。
产后伤寒:
吴崑:新产后患伤寒,不可轻易发汗。盖有产时伤力发热、去血过多发热、恶露不去发热、三日蒸乳发热,或有早起动劳、饮食停滞,一皆发热,状类伤寒。要在仔细详辨,切不可辄便发汗。大抵产后大血空虚,若汗之,则变筋惕肉瞤,或郁冒昏迷而不省,或风搐搦而不定,或大便秘涩而难去,其害非轻。切宜精审。凡有发热,且与四物汤,以川芎、当归为君,最多白芍药,须炒过,酒蒸熟地黄佐之。如发热,加软苗柴胡、人参、干姜主之,最效。盖干姜之辛热能引血药入血分,气药入气分也,且能去恶养新,有阳生阴长之道,以热治热,深合《内经》之旨。予尝用之,取效如神,故录以劝之。如有恶露未尽者,益母丸、黑神散必兼用之。若胃虚食少者,必加白术、茯苓。有痰呕逆者,必加陈皮、半夏。其余六经各条治例皆同,但药中必加四物汤为主,乃养血务本之要也。
产后中风数十日不解,头微痛,恶寒,时时有热,心下闷,干呕,汗出,虽多,阳旦证,可与阳旦汤(即桂枝汤,方见太阳病)。
产后中风,发热,面赤,喘而头痛,竹叶汤主之。
竹叶(一把)、葛根(三两)、防风、桔梗、桂枝、人参、甘草(炙,各一两)。以上捣碎,每次服用五钱,枣一枚,姜五片,水一盏半,煎一盏,去渣,服,温覆使汗出。若头项强,用大附子半钱,煎药扬去沫。呕者,加半夏一钱。
丹溪:产后发热恶寒,皆属血气虚。左手脉不足,补血;右手脉不足,补气。凡恶寒发热,又腹痛,当去恶血。恶寒发热,乳汁不通,及膨者无子,当消,用麦芽二两,炒研细,清汤作四服,调下。有子当下,用木通、通草、猪蹄汁调煎服。
产后才见身热,不可发表,并一切苦寒药,必用干姜治之,大发其热。轻则用茯苓淡渗其热。
戴原礼:凡产后发热,头痛,身疼,不可便作感冒治之。此等多是血虚,或败血作梗,宜以平和之剂与服,必效。如玉露散,或四物加北柴胡等分煎服。若便以小柴胡汤及竹叶石膏汤之类,竟不救者多矣。
玉露散:治产后乳脉不行,身体壮热,疼痛,头目昏痛,大便涩滞,悉治之。凉膈压热,下乳。
人参、茯苓、甘草(各半两)、苦梗(炒)、川芎、白芷(各一两)、当归(二钱半)、芍药(七钱半)。以上捣碎,每次服用五钱,水一盏,煎至七分,温服。如烦热甚,大便秘者,加大黄二钱半。
Sweating indicates *Rou Jing* (Soft Spasm); no sweating indicates *Gang Jing* (Stiff Spasm). The syndrome differentiation and treatment are detailed in Volume 5 of *Miscellaneous Diseases*, so they are not repeated here.
For women suffering from *Shanghan* (Cold Damage), the transmission through the Six Channels and its treatment principles are the same as for men. However, when heat enters the Blood Chamber due to menstruation just starting or stopping, or in cases of metrorrhagia and leukorrhea before or after childbirth, the treatment methods differ specifically.
Heat Entering the Blood Chamber:
When a woman suffers from *Fengzhong* (Wind Strike) with fever and aversion to cold, coinciding with the onset of menstruation, and after seven or eight days the fever subsides but the pulse is slow, the body is cool, yet there is fullness and distension in the chest and hypochondrium resembling *Jie Xiong* (Chest Binding), accompanied by delirium, this is Heat Entering the Blood Chamber. One should puncture the *Qimen* (Liv 14) acupoint and apply the reducing method according to the excess condition. (Li Dongyuan stated: hallucinations, hearing voices at night, and dreaming of deceased persons are all caused by excessive Liver Wood affected by pathogenic factors; puncturing *Qimen* shares the same principle.)
Xu Xueshi treated a woman with Heat Entering the Blood Chamber. The physician failed to recognize the syndrome and used blood-nourishing and qi-regulating herbs, leading to Blood Binding in the Chest after several days. Someone suggested using the previous prescription (referring to Xiao Chai Hu Tang). I said, "Using Xiao Chai Hu Tang is now too late and ineffective." If no other option exists, there is one alternative: puncturing the *Qimen* acupoint will suffice. As I am not skilled in acupuncture, I requested a proficient practitioner to treat her, who cured her as advised. Someone asked, "Why does Heat Entering the Blood Chamber lead to Chest Binding?" I replied, "Pathogenic factors enter the meridians and contend with healthy Qi, circulating up and down. If coinciding with menstruation starting or stopping, pathogens enter the Blood Chamber vacuously. The blood is forced by pathogens upward into the Liver Meridian. The Liver receiving pathogens causes delirium and seeing ghosts; if it further enters the *Dan Zhong* (Conception Vessel area), blood binds in the chest. Why? Normally, water nourishes Wood, and blood nourishes the Liver. Before pregnancy, blood descends as menses; during pregnancy, it accumulates in the middle jiao to nourish the fetus; after birth, it rises to become milk. All are this blood. Now, pathogens and stagnant blood converge in the Liver Meridian, gathering at *Dan Zhong* and binding below the breasts, causing pain upon touch. This is beyond the reach of decoctions, hence puncturing *Qimen* is required."
When a woman suffers from *Shanghan* with fever coinciding with menstruation, being lucid during the day but delirious at night as if seeing ghosts, this is Heat Entering the Blood Chamber. Do not violate the Stomach Qi or the Upper Two Jiaos; the disease will heal itself. (*Huo Ren Shu* states: Use Xiao Chai Hu Tang to harmonize. ○ 'Violating Stomach Qi' refers to purgation; 'violating Upper Two Jiaos' refers to diaphoresis.)
*Yan Yi* records: A woman suffered from Warm Disease for twelve days. Her pulse was rapid (6-7 beats per respiration) and choppy, with the Cun position slightly large and Chi position slightly small. She had alternating chills and fever, flushed cheeks, dry mouth, discomfort, and deafness. It was learned that menstruation started only after several days of illness. This belongs to Shaoyang Heat Entering the Blood Chamber. Incorrect treatment would be fatal. Based on the syndrome, Xiao Chai Hu Tang was administered for two days, followed by Xiao Chai Hu Tang plus Guizhi and Ganjiang. After one day, chills and fever ceased. The patient reported urgency and pain below the umbilicus, so Didang Wan was given, resulting in mild bowel movement and relief of pain. The body cooled, and the pulse became regular, though she remained uncomfortable. Xiao Chai Hu Tang was given again. The next day, she complained of internal heat and dryness in the chest, mouth, and nose. A small dose of Tiaowei Chengqi Tang was given but failed to induce bowel movement. The next day, epigastric pain occurred, so Daxiexiong Wan was given. Half a dose resulted in three bowel movements. The next day, she exhibited empty irritability, occasional hallucinations, and delirium. Although dry feces were suspected, her extreme deficiency precluded aggressive purgation. Zhuye Tang was given to relieve irritability and heat. That night, spontaneous bowel movement occurred. By morning, two bowel movements contained several pieces of dry feces, and delirium and irritability resolved. Only coughing with sputum remained, indicating Lung deficiency. Fearful of developing Lung Abscess due to deficiency, Xiao Chai Hu Tang was modified by removing Renshen, Dazao, and Shengjiang, adding Ganjiang and Wuweizi. Cough decreased after one day, and the disease resolved after two days. All above prescriptions are from Zhang Zhongjing.
When a woman suffers from *Fengzhong* for seven or eight days, subsequently experiencing alternating chills and fever at specific times, coinciding with the cessation of menstruation, this is Heat Entering the Blood Chamber. The blood must be bound, hence symptoms resemble malaria with periodic occurrence. Xiao Chai Hu Tang is the primary formula.
Appendix:
Yun Qizi stated: The treatment of *Shanghan* and *Fengzhong* in women is identical to men, except for Heat Entering the Blood Chamber and *Shanghan* during pregnancy. One should use Siwu Tang to nourish fetal blood, assisted by diaphoretic or purgative herbs. For women with *Shanghan* or *Fengzhong* presenting with spontaneous sweating, headache, stiffness of the neck and back, fever, aversion to cold, and floating-slow pulse, suspecting Heat Entering the Blood Chamber, Shaoyao should be doubled.
Guizhi Jia Shaoyao Tang:
Guizhi (1.5 liang), Chi Shaoyao (3.5 liang), Shengjiang (sliced, 1.5 liang), Zhi Gancao (1 liang), Dazao (6 pieces, split). Coarsely crush, take 5 qian per dose, decoct in water.
For women with *Shanghan* presenting with floating-tight pulse, headache, fever, aversion to cold, and anhidrosis, after diaphoresis, to prevent Heat Entering the Blood Chamber, use Mahuang Jia Shengdihuang Tang.
Mahuang (2.5 liang), Guizhi (1.5 liang), Zhi Gancao (0.5 liang), Shengdihuang (2 liang), Xingren (25 pieces, peeled and de-seeded). Crush, take 5 qian per dose, decoct in water.
*Huo Ren Shu*: For women with *Shanghan* where menstruation has just stopped, presenting with alternating chills and fever like malaria, delirium, and hallucinations, use Ganjiang Chaihu Tang.
Chaihu (4 liang), Gualougen, Guizhi (each 1.5 liang), Muli, Ganjiang, Zhi Gancao (each 1 liang). Crush, take 5 qian per dose, decoct in 1.5 sheng water until 0.7 sheng remains, strain, and take warm. Mild irritability may occur after the first dose; sweating and recovery follow the second dose.
Luo Zhiti: Xiao Chai Hu Jia Dihuang Tang. Treats women and young girls with *Shanghan* fever, menstruation starting or stopping, lucid by day, delirious by night as if seeing ghosts/spirits. Also treats postpartum lochia that starts and suddenly stops, causing near-death state.
Chaihu (1.25 liang), Renshen, Huangqin, Zhi Gancao, Banxia (washed in hot water 7 times), Shengdihuang (each 7 qian). Make coarse powder, take 5 qian per dose with 3 slices of Shengjiang and 2 dates, decoct in water.
Yun Qizi: For women with *Shanghan* presenting with fever, long-string-like pulse, belonging to Yangming/Shaoyang alternating chills and fever, nighttime restlessness with daytime calm, hallucinations, and stopped menstruation, indicating Heat Entering the Blood Chamber without fullness/excess, use Xiao Chai Hu Jia Mudanpi Tang. For severe fullness/excess, use Taoren Chengqi Tang to purge.
Xiao Chai Hu Jia Mudanpi Tang Formula:
Chaihu, Renshen, Mudanpi (each 2 liang), Zhi Gancao, Shengjiang (each 0.75 liang), Banxia (washed in hot water, 0.6 liang), Dazao (3 pieces, split), Huangqin (0.75 liang). Coarsely crush, take 1 liang per dose, decoct in water.
For women with *Shanghan* presenting with headache and floating pulse, if the physician erroneously uses purgation, pathogens enter the interior vacuously, menstruation stops, epigastric hardness/fullness occurs, mouth and tongue become dry, with alternating chills/fever and delirium/hallucinations, and deep-rapid pulse, purgation is indicated. Use Xiao Chai Hu Jia Mangxiao Dahuang Tang.
Chaihu (2 liang), Zhi Banxia (1.5 liang), Huangqin, Shengjiang (each 0.75 liang), Dahuang, Mangxiao (each 0.7 liang), Zhi Gancao (0.55 liang), Dazao (3 pieces, split). Coarsely crush, take 1 liang per dose, decoct in water, strain, add Mangxiao, boil again, and take warm. Do not purge if the pulse is not deep-rapid.
Xu Shimicro: In the Xinhai year, residing in Piling, the sister of Wang Zhongli, an educational official, suffered from *Shanghan* with alternating chills and fever. At night, she seemed possessed by spirits. After six or seven days, she suddenly became comatose with rattling phlegm, locked jaw, closed eyes, and unconsciousness, in critical condition. Upon examination, I asked if menstruation had occurred at onset. Family replied menstruation started then stopped with illness. Chills/fever started after 1-2 days; quiet by day, haunted by spirits by night. Phlegm increased yesterday, leading to unconsciousness. I diagnosed Heat Entering the Blood Chamber. Citing Zhang Zhongjing: "Women with Fengzhong, fever/aversion to cold, menstruation starting, lucid by day, delirious by night... named Heat Entering Blood Chamber." Physicians wrongly used harsh/dry herbs, causing chest/pharynx obstruction, phlegm flooding upper jiao, panting, high breathing, coma. Treatment should first resolve phlegm, then clear heat. I urgently administered Yi Xi San. After two hours, phlegm drained, she slept and regained consciousness. Then, Xiaochaihu Jia Dihuang Tang was given for three doses, resolving fever without sweating.
Yun Qizi: For women with *Shanghan*, exterior deficiency with spontaneous sweating, cool body, limb stiffness, deep-slow pulse, Taiyang marked disease, Shaoyang root disease, and stopped menstruation, use Guizhi Jia Fuzi Honghua Tang.
Guizhi (2.5 liang), Shaoyao, Shengjiang (each 1.5 liang), Zhi Gancao (1 liang), Pao Fuzi, Honghua (each 0.5 liang). Coarsely crush, take 1 liang per dose, decoct in 3 sheng water.
For women with *Shanghan*, Taiyang marked disease, after sweating resolves exterior, internal pathogenic heat enters Blood Chamber, excessive menstruation without fullness/excess, use Gancao Shaoyao Tang.
Gancao, Shaoyao, Shengdihuang, Chuanxiong (each 1 liang). Crush, take 1 liang per dose, decoct in 3 sheng water until 1.5 sheng remains, strain, add 5 qian of hair ash, mix well, take warm. If bleeding persists, puncture Yinbai (SP 1).
Pregnancy Shanghan:
Wu Kun: All Six Channel treatments for *Shanghan* during pregnancy are the same, but fetal protection is paramount. Herbs damaging the fetus must be avoided. Examples include Huoxiang Zhengqi San, Shiwei Xiongsu San, Shen Su Yin, Xiao Chai Hu Tang, which contain Banxia that can harm the fetus. If Banxia is necessary, remove it. For excessive phlegm/vomiting, use Banxia Qu (fermented Banxia). Alternatively, soak Banxia in boiling water 7 times, peel, remove navel, and dry with fresh Shengjiang juice. Herbs like Chuanwu, Fuzi, Tianxiong, Cezi, Rougui, Ganjiang, Dahuang, Mangxiao, Yuanhua, Gansui, Daji, Shuqi, Shuizhi, Mengchong, Taoren, Mudanpi, Ganqi, Daizheshi, Qumai, Niuxi, etc., are uterine-moving drugs and require careful consideration. See individual sections for details. To protect the fetus in severe *Shanghan* heat, apply mud from the bottom of a well to the umbilicus (2 cun), reapplying when dry. Alternatively, use Baizaizi powder mixed with water, or Fulonggan powder mixed with water, applied to the umbilicus. Generally, add Huangqin and Baizhu to decoctions for pregnant women to secure the fetus. These can be decocted separately or taken as powder with warm water (2-3 qian). For weak constitutions, add Siwu Tang. Using Xiao Chai Hu Tang minus Banxia, plus Baizhu and Siwu Tang, effectively protects the fetus and clears heat. Other formulas should follow this principle.
Li Gao, Zhu Zhenheng: Jiemi Tang. Treats pregnant women with Wind Strike and spontaneous sweating.
Renshen, Huangqi, Danggui, Chuanxiong, Zhi Gancao (each 5 qian), Shaoyao (6 qian). Cangzhu and Shengdihuang may be added. Make coarse powder, take 5 qian per dose, decoct in water, take warm anytime.
Haizang: For pregnant women with *Shanghan/Fengzhong*, exterior deficiency, spontaneous sweating, headache, neck stiffness, fever, aversion to cold, floating-weak pulse (Taiyang meridian disease), use Biaoxu Liuhe Tang.
Siwu Tang (4 liang), Guizhi, Digupi (each 7 qian).
For pregnant women with *Shanghan*, headache, fever, anhidrosis, tight pulse (Taiyang meridian disease), use Biaoshi Liuhe Tang.
Siwu Tang (4 liang), Mahuang, Xixin (each 0.5 liang).
For pregnant women with *Shanghan* complicated by Wind-Dampness, joint pain, floating-hot pulse, headache (Taiyang marked disease), use Fengshi Liuhe Tang.
Siwu Tang (4 liang), Fangfeng, Zhi Cangzhu (each 7 qian).
For pregnant women with *Shanghan* after purgation, prolonged illness, damp-toxin rash like brocade patterns, use Shengma Liuhe Tang.
Siwu Tang (4 liang), Shengma, Lianqiao (each 7 qian).
For pregnant women with *Shanghan*, chest/hypochondriac fullness/pain, wiry pulse (Shaoyang syndrome), use Chaihu Liuhe Tang.
Siwu Tang (4 liang), Chaihu, Huangqin (each 7 qian).
For pregnant women with *Shanghan*, hard stool, red urine, abdominal fullness, deep-rapid pulse (Yangming/Taiyang root disease), urgent purgation is needed. Use Dahuang Liuhe Tang.
Siwu Tang (4 liang), Dahuang, Taoren (peeled, de-seeded, bran-fried, 10 pieces).
For pregnant women with *Shanghan* after sweating/purgation, persistent cough, use Renshen Liuhe Tang.
Siwu Tang (4 liang), Renshen, Wuweizi (each 5 qian).
For pregnant women with *Shanghan* resulting in empty bloating/fullness (Yangming root deficiency), use Nongpo Liuhe Tang.
Siwu Tang (4 liang), Houpo, Zhishi (bran-fried, each 5 qian).
For pregnant women with *Shanghan* after sweating/purgation, insomnia, use Zhizi Liuhe Tang.
Siwu Tang (4 liang), Zhizi, Huangqin (each 5 qian).
For pregnant women with *Shanghan*, intense thirst, steaming heat, irritability, long-large pulse, use Shigao Liuhe Tang.
Siwu Tang (4 liang), Shigao, Zhimu (each 5 qian).
For pregnant women with *Shanghan*, difficult urination (Taiyang root disease), use Fuling Liuhe Tang.
Siwu Tang (4 liang), Fuling, Zexie (each 5 qian).
For pregnant women with *Shanghan*, Taiyang root disease, urine red as blood, use Hupo Liuhe Tang.
Siwu Tang (4 liang), Hupo, Fuling (each 5 qian).
For pregnant women with *Shanghan* after sweating/purgation, continuous bleeding, fetal disturbance, use Jiaoai Liuhe Tang.
Siwu Tang (4 liang), Ejiao, Aiye (each 5 qian). Another version adds Gancao. Yet another adds Gancao, Ganjiang, Huangqi.
For pregnant women with *Shanghan*, limb stiffness, cool body, slight sweat, abdominal pain, deep-slow pulse (Shaoyin disease), use Fuzi Liuhe Tang.
Siwu Tang (4 liang), Pao Fuzi (peeled, sliced), Rougui (each 5 qian).
For pregnant women with *Shanghan* and Blood Stasis, do not use abortifacients. Use Siwu Dahuang Tang to purge.
Siwu Tang (4 liang), Shengdihuang, Dahuang (wine-soaked, each 5 qian).
Danxi: For pregnant women with Blood Stasis, do not recklessly use Didang or Taoren formulas; ensure mother and child remain unharmed. Divide Dahuang and Siwu Tang equally.
Danxi: Lady Shi suffered from unresolved Wind Strike, cold lower calves, cough with little sputum, dizziness. Her temperament was irritable, and she was near term.
Huangqin (0.5 qian), Chenpi, Baizhu (each 1 qian), Sujie (0.3 qian), Mutong, Chike (fried, each 0.5 qian), Mahuang (0.3 qian), Zhi Gancao (0.2 qian), Jiegeng, Cangzhu (each 0.5 qian). Decoct in water, take anytime.
Yun Qizi: Pregnant women with *Shanghan*, floating pulse, heavy head, cutting abdominal pain, use Guizhi Shaoyao Danggui Tang.
Guizhi, Shaoyao, Danggui (each 1 liang). Coarsely crush, take 1 liang per dose, decoct in water.
Pregnant women with *Shanghan*, spontaneous diarrhea, abdominal pain, inability to eat/drink, deep pulse (Taiyin disease), use Shaoyao Tang.
Shaoyao, Baizhu, Gancao, Fuling (each 1 liang). Prepare and take as previously described.
*Huo Ren Shu*: To protect the fetus in pregnant women with *Shanghan*, use Ejiao San.
Renshen, Baifuling, Chao Ejiao, Sangjisheng, Baizhu (equal parts). Grind to fine powder, take 2 qian with glutinous rice water, twice daily.
To protect the fetus in pregnant women with *Shanghan*, use Baizhu San.
Baizhu, Huangqin (stir-fried on new tile until fragrant, equal parts). Make powder, take 3 qian per dose with 1 zhong water, 3 slices Shengjiang, 1 split Dazao. Decoct until 0.7 remains, strain, take warm. Take 2-3 doses at first sign of headache/fever for quick recovery. Do not use if limbs are cold or Yin syndrome signs appear.
To induce sweating for pregnant women with *Shanghan* presenting with aversion to cold and fever, use Congbai Tang.
Congbai (10 stems), Shengjiang (sliced, 2 liang). Coarsely crush, decoct in 2 sheng water until 1 sheng remains. Take continuously to induce sweating.
Haizang: Congbai Yiwu Tang. Boil 2 bunches of Congbai in 1 sheng water until reduced to juice. Drink completely to safely deliver the fetus. If the fetus is damaged, it will be expelled quickly.
Zisu San: Treats disharmonious fetal Qi causing upper heart/abdominal fullness/pain (Zixuan). Calms and saves the fetus, also expels damaged fetus. Treats *Shanghan* headache, fever, body pain.
Zisuye, Danggui (each 1 liang), Renshen, Zhi Gancao (each 0.5 liang), Dafupi, Chuanxiong, Baishaoyao, Chenpi (de-white, each 1 liang). Take 8 qian per dose with 1.5 zhong water, 5 slices Shengjiang, 3 Congbai stems with roots. Decoct until 1 zhong remains, strain, take warm before meals. Add Muxiang and Yuanhusuo (ground) if severe pain.
Xiongsu San: Treats pregnant women with *Shanghan*, headache, worsening chills/fever, body pain, neck stiffness.
Zisuye, Chuanxiong, Baishaoyao, Baizhu, Chenpi, Jiangge, Gancao, Maidong (equal parts). Coarsely crush, take 4 qian per dose with 4 slices Shengjiang, 3 Congbai stems. Decoct and take warm.
Guidelines for Medication in Pregnant Women with *Shanghan*:
For fever/aversion to cold, use Guizhi/Shaoyao; for alternating chills/fever, use Chaihu/Qianhu; for intense thirst, use Zhimu/Shigao/Wuweizi/Maidong; for diarrhea, use Guizhi/Fuzi/Ganjiang/Baizhu; for constipation, use Dahuang/Huangqin; for menstruation starting/stopping, use Xiao Chai Hu Tang; for fetal insecurity, use Renshen/Ejiao/Baizhu/Huangqin; for diaphoresis, use Chao Doujiang/Shengjiang/Mahuang/Xuanfu; for headache, use Shigao/Zhizi/Qianhu; for summerheat headache, use Chaihu/Gancao/Shigao; for fullness/stuffiness, use Zhishi/Chenpi; for fetal insecurity, use Huangqin/Maidong/Renshen; for black spots/rash, use Huangqin/Zhizi/Shengma.
Dai Yuanli: To protect the fetus in pregnant women with seasonal diseases and high fever, preventing miscarriage:
Grind Fulonggan to fine powder, mix with water, apply to 3 cun below umbilicus. Change when dry, stop when healed.
Another formula: Apply well-bottom mud, change when dry. (From *Ben Shi Fang*, effective).
Another formula: Pingtong, Lan Gen, Poxiao, Ge Fen, Wei Chao Dahuang. Make powder, mix with water, apply to umbilicus. Excellent for protecting fetus and clearing heat.
Another formula: Baizaizi powder, mix with water, apply to abdomen.
Two formulas for Pregnancy Huoluan (attached to Shaoyin Vomiting/Diarrhea section):
For pregnant women with rash turning black, use Zhizi Daqing Tang.
Huangqin, Shengma, Zhiren (each 2 liang), Daqing, Xingren (each 0.5 liang). Crush, take 5 qian per dose with 1.5 sheng water, 3 cun sliced Congbai. Decoct until 1 sheng remains, strain, take warm.
Postpartum Shanghan:
Wu Kun: New mothers with *Shanghan* should not be lightly induced to sweat. Fever may arise from labor injury, excessive blood loss, retained lochia, lactation fever (day 3), early exertion, or food stagnation—all mimicking *Shanghan*. Careful differentiation is crucial; do not rush diaphoresis. Postpartum blood deficiency makes sweating dangerous, potentially causing muscle twitching, depression/coma, convulsions, or constipation. Be precise. For any fever, start with Siwu Tang, using Chuanxiong and Danggui as chief herbs, abundant Shaoyao, and wine-steamed Shudihuang as assistant. For fever, add soft-stemmed Chaihu, Renshen, Ganjiang. Ganjiang's pungent-warm nature guides blood/qi herbs to their respective domains, removes stasis, nourishes new blood, follows the principle of Yang generating Yin, and treats heat with heat, aligning with *Neijing*. I have used this successfully. If lochia is incomplete, combine with Yimu Wan or Heishen San. For weak stomach/poor appetite, add Baizhu/Fuling. For phlegm/vomiting, add Chenpi/Banxia. Other Six Channel treatments are similar, but always base them on Siwu Tang to nourish blood as the root.
Postpartum *Fengzhong* lasting dozens of days, mild headache, aversion to cold, intermittent heat, epigastric stuffiness, dry vomiting, profuse sweating, Yang Dan syndrome: Administer Yang Dan Tang (i.e., Guizhi Tang, see Taiyang Disease).
Postpartum *Fengzhong* with fever, red face, panting, headache: Zhuye Tang is primary.
Zhuye (1 bundle), Gegen (3 liang), Fangfeng, Jiegeng, Guizhi, Renshen, Zhi Gancao (each 1 liang). Crush, take 5 qian per dose with 1 date, 5 slices Shengjiang, 1.5 sheng water. Decoct until 1 sheng remains, strain, take warm, cover to induce sweat. For neck stiffness, add 0.5 qian Da Fuzi, boil medicine, skim foam. For vomiting, add 1 qian Banxia.
Danxi: Postpartum fever/aversion to cold belong to Qi/Blood deficiency. Deficient left pulse requires blood tonification; deficient right pulse requires Qi tonification. For chills/fever with abdominal pain, remove blood stasis. For chills/fever with blocked lactation or abdominal distension without conception, use Maiya (2 liang, fried, ground, taken in 4 doses with clear soup). For those with conception needing expulsion, use Mutong, Tongcao, pig trotter juice.
For postpartum fever, do not use diaphoretics or bitter-cold herbs. Must use Ganjiang to vigorously clear heat. For mild heat, use Fuling to leach out heat via urination.
Dai Yuanli: Postpartum fever, headache, body pain should not be treated as common cold. Often due to blood deficiency or blood stasis obstruction. Use mild formulas like Yulu San or Siwu Tang plus Bei Chaihu in equal parts. Many fail when treated solely with Xiao Chai Hu Tang or Zhuye Shigao Tang.
Yulu San: Treats postpartum blocked lactation, high fever, pain, dizziness, constipation. Clears heat, promotes lactation.
Renshen, Fuling, Gancao (each 0.5 liang), Chao Kugeng, Chuanxiong, Baizhi (each 1 liang), Danggui (2.5 qian), Shaoyao (7.5 qian). Crush, take 5 qian per dose, decoct in 1 sheng water until 0.7 remains, take warm. For severe irritability/constipation, add 2.5 qian Dahuang.