天津王氏妇,年二十六岁,受妊后,呕吐不止。
病因 素有肝气病,偶有拂意,激动肝气,恒作呕吐。至受妊后,则呕吐连连不止。
证候 受妊至四十日时,每日必吐,然犹可受饮食,后则吐浸加重,迨至两月以后勺水不存。
及愚诊视时,不能食者已数日矣。困顿已极,不能起床。诊其脉虽甚虚弱,仍现滑象,至
数未改,惟左关微浮,稍似有力。
诊断 恶阻呕吐,原妊妇之常,兹因左关独浮而有力,知系肝气胆火上冲,是以呕吐特甚。有谓
恶阻呕吐虽甚剧无碍者,此未有阅历之言。愚自行道以来,耳闻目睹,因此证偾事者已
有多人,甚勿忽视。此宜急治以镇肝降胃之品,不可因其受妊而不敢放胆用药也。
处方 生赭石(两半轧细) 党参(三钱) 生怀山药(一两) 生怀地黄(八钱)
生杭芍(六钱) 大甘枸杞(五钱) 净萸肉(四钱) 青黛(三钱) 清半夏(六钱)
药共九味,先将半夏用温水淘三次,将矾味淘净,用煮菜小锅煮取清汤一盅,调以面粉煮作茶汤,
和以白糖令其适口,服下其吐可止。再将余药八味煎汤一大盅,分三次温服。
复诊 将药连服两剂,呕吐即止。精神气力稍振,可以起坐,其脉左关之浮已去,六部皆近和平。惟
仍有恶心之时,懒于饮食,拟再治以开胃、理肝、滋阴、清热之剂。
处方 生怀山药(一两) 生杭芍(五钱) 冬瓜仁(四钱捣碎) 北沙参(四钱)
碎竹茹(三钱) 净青黛(二钱) 甘草(二钱)
共煎汤一大盅,分两次温服下。
效果 将药连服三剂,病遂全愈,体渐撤消,能起床矣。
天津一位姓王的妇女,年龄二十六岁,怀孕后呕吐不止。
病因:她平时就有肝气郁结的病症,偶尔遇到不顺心的事,就会激动肝气,常常引起呕吐。到了怀孕之后,呕吐就连续不断,无法停止。
证候:怀孕到四十天时,每天必定呕吐,但还能进食;后来呕吐逐渐加重,等到两个月以后,连一勺水都留不住。
当我诊视时,她已经几天不能吃东西了。身体极度困倦疲惫,无法起床。诊察她的脉象虽然非常虚弱,但仍显现出滑象,脉率没有改变,只是左关脉微微浮起,稍微有点力气。
诊断:恶阻(妊娠反应)引起的呕吐,原本是孕妇的常态,这次因为唯独左关脉浮而有力,知道是肝气和胆火上冲所致,所以呕吐特别严重。有人说恶阻呕吐即使很剧烈也无妨,这是没有临床经验的话。我自从行医以来,耳闻目睹,因此病导致严重后果的人已有不少,千万不要忽视。这应当紧急治疗,使用镇肝降胃的药物,不要因为患者怀孕就不敢大胆用药。
处方:生赭石(半两,轧细) 党参(三钱) 生怀山药(一两) 生怀地黄(八钱)
生杭芍(六钱) 大甘枸杞(五钱) 净萸肉(四钱) 青黛(三钱) 清半夏(六钱)
药共九味,先将半夏用温水淘洗三次,将矾味淘洗干净,用煮菜的小锅煮取清汤一盅,调入面粉煮成茶汤,加入白糖使其口感适宜,服用后呕吐可止。再将其余八味药煎取一大盅汤,分三次温服。
复诊:将药连续服用两剂,呕吐即止。精神气力稍见恢复,可以坐起,其脉象左关的浮象已去,六部脉皆接近平和。只是仍有恶心之时,懒得饮食,打算再用开胃、理肝、滋阴、清热的方剂治疗。
处方:生怀山药(一两) 生杭芍(五钱) 冬瓜仁(四钱,捣碎) 北沙参(四钱)
碎竹茹(三钱) 净青黛(二钱) 甘草(二钱)
共同煎取一大盅汤,分两次温服。
效果:将药连续服用三剂,病遂痊愈,身体逐渐消瘦恢复,能够起床了。
A twenty-six-year-old woman surnamed Wang in Tianjin suffered from incessant vomiting after conception.
Etiology: She had a pre-existing condition of Liver Qi stagnation; occasionally, when encountering unpleasant matters, her Liver Qi would be agitated, frequently causing vomiting. After conception, the vomiting became continuous and unceasing.
Symptoms: At forty days of pregnancy, she vomited daily but could still tolerate food intake. Later, the vomiting intensified gradually, and after two months, not even a spoonful of water could remain in her stomach.
When I examined her, she had been unable to eat for several days. She was extremely exhausted and unable to get out of bed. Her pulse was very weak yet exhibited a slippery quality (Hua Mai), with the rate unchanged. However, the Left Guan position was slightly floating and seemed somewhat forceful.
Diagnosis: Vomiting due to Morning Sickness (E Zu) is originally common among pregnant women. In this case, because only the Left Guan pulse was floating and forceful, it indicates that Liver Qi and Gallbladder Fire were rushing upward, causing particularly severe vomiting. Some claim that even severe morning sickness vomiting is harmless; this statement lacks clinical experience. Since I began practicing medicine, through what I have heard and seen, many people have suffered serious consequences from this condition. It must not be ignored. Urgent treatment with herbs that calm the Liver and direct Stomach Qi downward is required. One should not hesitate to use potent medications simply because the patient is pregnant.
Prescription: Sheng Zhe Shi (Ochre Stone, half tael, finely crushed), Dang Shen (Codonopsis Root, 3 qian), Sheng Huai Shan Yao (Dioscorea Hypoglauca Rhizome, 1 liang), Sheng Huai Di Huang (Rehmannia Root, 8 qian), Sheng Hang Shao (Paeonia Lactiflora Root, 6 qian), Da Gan Gou Qi Zi (Lycium Fruit, 5 qian), Jing Yu Rou (Cornus Fruit, 4 qian), Qing Dai (Indigo Naturalis, 3 qian), Qing Ban Xia (Pinellia Tuber, 6 qian).
There are nine ingredients in total. First, wash the Ban Xia three times with warm water until the alum taste is removed. Boil it in a small pot used for cooking vegetables to obtain one cup of clear decoction. Mix in flour and boil to make a paste-like tea, adding white sugar to make it palatable. Taking this will stop the vomiting. Then, decoct the remaining eight herbs in one large cup of water, and take warm in three divided doses.
Follow-up Visit: After taking the medicine for two doses, the vomiting stopped. Her spirit and strength slightly recovered, allowing her to sit up. The floating quality at the Left Guan position disappeared, and all six positions of the pulse approached harmony. However, she still experienced occasional nausea and lacked appetite. Therefore, a formula to open the stomach, regulate the Liver, nourish Yin, and clear heat was planned.
Prescription: Sheng Huai Shan Yao (Dioscorea Hypoglauca Rhizome, 1 liang), Sheng Hang Shao (Paeonia Lactiflora Root, 5 qian), Dong Gua Ren (Benincasa hispida Seed, 4 qian, crushed), Bei Sha Shen (Glehnia Root, 4 qian), Sui Zhu Ru (Bamboo Shavings, 3 qian), Jing Qing Dai (Indigo Naturalis, 2 qian), Gan Cao (Licorice Root, 2 qian).
Decoct together in one large cup of water, and take warm in two divided doses.
Outcome: After taking the medicine for three doses, the illness was completely cured. Her body gradually regained its normal state, and she was able to get out of bed.