加味五淋散
17.子淋频浊窘涩疼, 五淋栀苓归芍芩, 甘草再加生地泽, 车前滑石
木通寻.
【注】孕妇小便频数窘涩, 点滴疼痛, 名曰子淋. 宜五淋散, 即黑栀
,赤茯苓, 当归, 白芍, 黄芩, 甘草, 加生地, 泽泻, 车前子, 滑石
,木通, 以清热而利水, 则小便自通矣.
18.妊娠经来名激经, 胎漏下血腹不疼, 若是伤胎腹必痛, 尿血漏血
要分明.
【注】妇人受孕之后, 仍复行经者, 名曰激经, 为血有余. 若孕妇无
故下血, 或下黄汁豆汁而腹不痛者, 谓之胎漏. 若其胎已伤而下血者
,其腹必疼. 孕妇又有尿血一证, 腹亦不痛, 然与胎漏之证又不同.
盖尿血出于溺孔, 漏血出自人门, 三者俱下血, 而各不同治者, 不可
不详辨也.
阿胶汤 黄耆汤 银苎酒 加味四物汤
19.激经无病不须治, 子大能食经自停, 胎漏下血多因热, 四物阿胶
栀侧芩. 或下黄汁豆汁样, 黄耆糯米苎根银, 若是尿血膀胱热, 四物
血余共茅根.
【注】激经无他证相兼者, 不须用药, 其胎壮子大能食其血, 而经自
停. 若胎漏下血, 多属血热, 宜阿胶汤清之. 其方即四物汤加阿胶,
黑栀, 侧柏叶, 黄芩也. 或漏下黄汁, 或如豆汁甚多者, 其胎干枯必
倚而堕, 宜用黄耆汤, 即黄耆二两, 糯米一合煎服. 或银苎酒, 即苎
麻根, 纹银煎酒服. 若尿血, 则是膀胱血热, 宜四物汤加血余, 白茅
根以凉之.
四物汤方见首卷
17. 妊娠期间小便频数、浑浊、窘迫涩痛，使用五淋散（由栀子、茯苓、当归、芍药、黄芩组成），再加生地黄、泽泻、车前子、滑石、木通来治疗。
【注】孕妇出现小便频数、窘迫涩滞、点滴排出时伴有疼痛，称为“子淋”（妊娠期淋证）。适宜使用五淋散，即黑栀子、赤茯苓、当归、白芍、黄芩、甘草，加上生地黄、泽泻、车前子、滑石、木通，以清热利水，则小便自然通畅。
18. 妊娠期间仍有月经来潮称为“激经”，胎漏下血但腹部不疼痛；若是伤胎则腹部必然疼痛，尿血与漏血需要仔细分辨。
【注】妇女受孕之后，仍然有月经来潮的，称为“激经”，这是因为体内气血有余。如果孕妇无故阴道出血，或者流出黄色汁液或豆汁样液体但腹部不疼痛的，称为“胎漏”。如果胎儿已经受损而下血，其腹部必然疼痛。孕妇还有一种病证叫“尿血”，腹部也不疼痛，但这与胎漏的病证又不同。因为尿血是从尿道口排出，而漏血是从阴道口排出，这三种情况虽然都涉及下血，但治疗方法各不相同，不可不详细辨别。
19. 激经若无其他病症兼夹则不需要治疗，待胎儿长大能吸收血液后，月经自然会停止；胎漏下血多因血热引起，可用四物汤加阿胶、栀子、侧柏叶、黄芩治疗。若流出黄色汁液或豆汁样液体，可用黄芪汤加糯米、苎麻根、银煎服。若是尿血且属膀胱热盛，可用四物汤加血余炭、白茅根治疗。
【注】激经如果没有其他症状兼夹的，不需要用药，因为胎儿强壮、发育良好时会吸收母体多余的血液，月经自然会停止。如果是胎漏下血，多属于血热证，适宜用阿胶汤来清热止血。该方剂即四物汤加入阿胶、黑栀子、侧柏叶、黄芩。或者漏下黄色汁液，或像豆汁一样量很多的，说明胎儿干枯必将会导致流产，适宜使用黄芪汤，即黄芪二两、糯米一合煎服。或者使用银苎酒，即苎麻根、纹银煎酒后服用。若是尿血，则是膀胱血热所致，适宜用四物汤加入血余炭、白茅根以凉血止血。
四物汤方剂见本书首卷
Jiawei Wulin San (Modified Five Strangury Decoction)
17. During pregnancy, frequent, turbid, distressing, and astringent urinary pain is treated with Wulin San (Five Strangury Decoction), composed of Gardeniae Fructus (Zhizi), Poria (Fuling), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), and Scutellariae Radix (Huangqin), added with Rehmanniae Radix (Shengdihuang), Alismatis Rhizoma (Zexie), Plantaginis Semen (Cheqianzi), Talcum (Huashi), and Akebiae Caulis (Mutong).
[Annotation] When pregnant women experience frequent urination, distress, astringency, and pain during the passage of small amounts of urine, it is named "Zilin" (Strangury of Pregnancy). It is suitable to use Wulin San, which consists of Gardeniae Fructus (Zhizi), Poria (Fuling), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Scutellariae Radix (Huangqin), Glycyrrhizae Radix et Rhizoma (Gancao), added with Rehmanniae Radix (Shengdihuang), Alismatis Rhizoma (Zexie), Plantaginis Semen (Cheqianzi), Talcum (Huashi), and Akebiae Caulis (Mutong), to clear heat and promote diuresis, thereby allowing normal urination.
18. Menstruation occurring during pregnancy is called "Jijing" (Agitated Menses); bleeding from the uterus without abdominal pain is called "Tailou" (Fetal Leakage); if the fetus is injured, abdominal pain will inevitably occur; hematuria and fetal leakage must be clearly distinguished.
[Annotation] When a woman continues to menstruate after conception, it is called "Jijing," indicating an excess of blood. If a pregnant woman bleeds from the vagina without cause, or discharges yellow fluid or bean-juice-like fluid without abdominal pain, it is termed "Tailou." If the fetus has been damaged and bleeding occurs, there will inevitably be abdominal pain. Pregnant women may also suffer from "hematuria," where there is no abdominal pain, but this condition differs from Tailou. Hematuria originates from the urethra, whereas bleeding from Tailou comes from the vagina. Although all three conditions involve bleeding, their treatments differ significantly and require careful differentiation.
Ejiao Tang (Donkey-Hide Gelatin Decoction) Huangqi Tang (Astragalus Decoction) Yinzhu Jiu (Silver and Ramie Wine) Jiawei Siwu Tang (Modified Four Substances Decoction)
19. Agitated menses without other symptoms require no treatment; once the fetus grows large enough to consume the excess blood, menstruation will naturally cease. Fetal leakage due to bleeding is often caused by blood heat, treatable with Siwu Tang (Four Substances Decoction) added with Colla Corii Asini (Ejiao), Gardeniae Fructus (Zhizi), Platycladi Cacumen (Cebaiye), and Scutellariae Radix (Huangqin). If yellow or bean-juice-like discharge occurs, use Huangqi Tang (Astragalus Decoction) with Glinis Semen (Nuomici), Boehmeriae Niveae Radix (Zhugen), and Silver (Yin). If hematuria is present due to bladder heat, use Siwu Tang (Four Substances Decoction) added with Capillis Carbonisatus (Xuyutan) and Imperatae Rhizoma (Baimaogen).
[Annotation] If agitated menses occur without accompanying symptoms, medication is unnecessary; as the fetus develops strongly and consumes the maternal blood, menstruation will stop spontaneously. If fetal leakage involves bleeding, it mostly belongs to blood heat syndrome, and Ejiao Tang (Donkey-Hide Gelatin Decoction) should be used to clear heat and stop bleeding. This formula consists of Siwu Tang (Four Substances Decoction) added with Colla Corii Asini (Ejiao), Gardeniae Fructus (Zhizi), Platycladi Cacumen (Cebaiye), and Scutellariae Radix (Huangqin). Alternatively, for profuse yellow or bean-juice-like discharge, indicating a withered fetus likely to abort, Huangqi Tang (Astragalus Decoction) is indicated, comprising Astragali Radix (Huangqi) two taels and Glinis Semen (Nuomici) one he measured unit, decocted and taken orally. Or use Yinzhu Jiu (Silver and Ramie Wine), made by decocting Boehmeriae Niveae Radix (Zhugen) and fine silver in wine. For hematuria resulting from bladder blood heat, Siwu Tang (Four Substances Decoction) added with Capillis Carbonisatus (Xuyutan) and Imperatae Rhizoma (Baimaogen) should be used to cool the blood.
The formula for Siwu Tang (Four Substances Decoction) can be found in the first volume of this book.