洁古云∶治胎产之病,从厥阴经论之,是祖气生化之源也(厥阴肝木乃风化之始,故曰
化之源。
而祖气乃天真之气,非谷气东方生风,风生虫,人亦 虫也,故从厥阴风木论之)。厥阴与
少阳相为表里,故治法无犯胃气及上中二焦。有三禁,不可汗、不可下、不可利小便。发汗
则伤上焦之阳,通大便则脉数而动脾,利小便则内亡津液,胃中枯燥。制药之法,能不犯此
三禁则荣卫自和而寒热自止矣。如发渴需白虎(产后发渴恐属血虚,用白虎宜慎。东垣云∶
血虚忌白虎),气弱用黄 ,血刺痛而和以当归,腹中疼而加之芍药。大抵产病天行从增损
柴胡,杂症从增损四物,宜详察脉症而用之。
肝藏血兮肺主气,血为荣兮气为卫。阴阳配偶不参差,两脏通和皆类例。血衰气旺定无
孕,
血旺气衰应有体。寸微关滑尺带数,流利往来并雀啄。小儿之脉已现形,数月怀耽犹未觉。
左疾为男右疾女,流利相通速来去。两手关脉大相应,已形亦在前通语。左手带纵两个男,
右手带横一双女。左手脉逆生三男,右手脉顺生三女。寸关尺部皆相应,一男一女分形症。
有时子死母生存,或即母亡存子命。往来三部通流利,滑数相参皆替替。阳实阴虚脉得明,
遍满胸膛皆逆气。左脉太阳浮大男,右脉太阴沉细女。诸阳为男诸阴女,指下分明当计取。
三部沉正等无疑,尺内不止真胎妇。夫弃妻兮纵气雾,妻弃夫兮横气肋。子乘母兮逆气参,
母乘子兮顺气护。小儿日足胎成聚,身热脉乱无所苦。汗出不食吐逆时,精神结备其中住。
滑疾不散胎三月,但疾不散五月母。弦紧牢强滑者安,沉细而微归泉路。
洁古说:治疗胎产方面的疾病,应当从厥阴经进行辨证论治,这是因为厥阴肝木是生命化生的源头(厥阴肝木属于风化的起始阶段,所以被称为化生的源头。而祖气指的是先天赋予的真气,并非后天水谷之气所生;东方产生风,风孕育虫类,人类也是虫类的一种,因此要从厥阴风木的角度来论述)。厥阴经与少阳经互为表里关系,所以在治疗方法上,不能损伤胃气以及上、中二焦的功能。这里有三种禁忌,即不可使用发汗法、不可使用泻下法、不可使用利尿法。如果发汗,就会损伤上焦的阳气;如果通大便(使用泻下药),会导致脉象数急并扰动脾脏;如果利小便,就会导致体内津液枯竭,使胃中变得干燥。制药的原则是,只要不触犯这三种禁忌,营气和卫气自然调和,寒热症状自然停止。例如,如果出现口渴,需用白虎汤(产后出现口渴恐怕属于血虚,使用白虎汤应当谨慎。东垣曾说:血虚者忌用白虎汤);如果气弱,用人参(原文“黄”后缺字,结合语境及常见配伍,此处指人参或黄芪,但根据下文“气弱”,通常指补气药,古籍中常与人参并列或单用,此处依原文保留“黄”字,推测为黄芪或人参之误,但在翻译中忠实于原文“黄”字,暂译为黄[芪/参],鉴于WHO术语标准,若指代不明,需注明。注:原文“黄”后似有脱文,通常指人参或黄芪。此处按原文直译);如果血液刺痛,配合当归;如果腹中疼痛,加上芍药。大抵而言,产后患病如果是外感时行邪气,应从增损柴胡汤加减治疗;如果是杂病,应从增损四物汤加减治疗,应当详细诊察脉象和症状后再使用。
肝脏贮藏血液,肺脏主管气机,血成为荣气,气成为卫气。阴阳配偶协调没有差错,这两脏通畅调和都有类似的规律。如果血衰气旺,一定无法受孕;如果血旺气衰,应该会有身孕。寸脉微弱、关脉滑利、尺脉带数,脉象流利往来,如同雀啄一般。胎儿的脉象已经显现形态,但怀孕数月尚未被察觉。左手脉跳动急促提示怀男胎,右手脉跳动急促提示怀女胎,脉象流利相通且来去迅速。两手关脉大而相应,说明已经成形,这也是前人的经验之谈。左手脉呈现纵势,预示生两个男孩;右手脉呈现横势,预示生一双女孩。左手脉呈现逆势,预示生三个男孩;右手脉呈现顺势,预示生三个女孩。寸、关、尺三部脉象都相应协调,预示一男一女,性别特征分明。有时会出现子死母存的情况,或者母亡子存的情况。三部脉往来流利,滑数相间,皆显得有力。阳实阴虚的脉象可以明确判断,如果满布胸膛都是逆气。左脉表现为太阳浮大,主生男胎;右脉表现为太阴沉细,主生女胎。诸阳脉主男,诸阴脉主女,手指下的脉象分明,应当仔细计数选取。如果三部脉沉取端正相等,没有疑虑,尺脉内不止息,是真妊娠妇女的脉象。丈夫抛弃妻子,称为纵气如雾;妻子抛弃丈夫,称为横气如肋。儿子欺凌母亲,称为逆气相参;母亲庇护儿子,称为顺气相护。小儿足月,胎成聚集,身体发热,脉象紊乱,但母子无痛苦。出汗、不进食、呕吐的时候,精神凝聚储备在体内。脉象滑疾而不散,是怀孕三个月的特征;仅见疾脉而不散,是怀孕五个月且母体安好的特征。脉象弦紧牢强且滑,表示平安;脉象沉细而微,则指向死亡之路。
Jieguo stated: When treating diseases related to pregnancy and childbirth, one should reason from the Jueyin (Jueyin) meridian, as this is the source of the generation and transformation of ancestral Qi (Ancestral Qi refers to the innate true Qi, not the Qi derived from grain and water; the East generates Wind, Wind generates insects, and humans are also insects, hence the discussion proceeds from the perspective of Jueyin Wind-Wood). Jueyin and Shaoyang (Shaoyang) have a interior-exterior relationship. Therefore, in treatment methods, one must not damage Stomach Qi (Stomach Qi) or the functions of the Upper and Middle Jiao (Upper and Middle Jiao). There are three prohibitions: one must not induce sweating, one must not purge (purging), and one must not promote urination (promoting urination). Inducing sweating damages the Yang Qi (Yang Qi) of the Upper Jiao; purging stool causes the pulse to become rapid and disturbs the Spleen (Spleen); promoting urination leads to the internal loss of Body Fluids (Body Fluids), resulting in dryness in the Stomach (Stomach). The principle of preparing medicine is that if these three prohibitions are not violated, Ying (Ying) and Wei (Wei) will naturally harmonize, and cold and heat symptoms will cease. For example, if thirst occurs, Baihu Tang (White Tiger Decoction) should be used (thirst after childbirth may belong to Blood Deficiency (Blood Deficiency); using Baihu Tang requires caution. Dongyuan said: Baihu Tang is contraindicated for Blood Deficiency); if Qi is weak, Huang [missing character, likely Huangqi or Renshen] should be used; if there is stabbing pain in the blood, Danggui (Angelica Sinensis) should be added; if there is abdominal pain, Shaoyao (Peony Root) should be added. Generally speaking, if postpartum illness is due to epidemic pathogens, Zengsun Chaihu Tang (Modified Bupleurum Decoction) should be used with modifications; if it is miscellaneous disease, Zengsiwu Tang (Modified Four Substance Decoction) should be used with modifications. One should carefully observe the pulse and symptoms before applying them.
The Liver stores Blood (Blood), and the Lung governs Qi (Qi). Blood becomes Ying (Ying), and Qi becomes Wei (Wei). Yin and Yang are paired without discrepancy; the harmonious communication between these two organs follows similar patterns. If Blood is deficient and Qi is prosperous, conception is impossible; if Blood is prosperous and Qi is deficient, pregnancy should occur. A faint pulse at the Cun (Cun) position, a slippery pulse at the Guan (Guan) position, and a rapid pulse at the Chi (Chi) position, flowing smoothly and coming and going like a sparrow pecking, indicate that the fetal pulse has already manifested its form, yet months of gestation remain undetected. A rapid pulse on the left indicates a male fetus; a rapid pulse on the right indicates a female fetus. Smooth and connected pulses that come and go quickly suggest pregnancy. Enlarged and corresponding pulses at both Guan positions indicate that the fetus has taken shape, which is also prior knowledge. A longitudinal pulse pattern on the left suggests bearing two boys; a transverse pulse pattern on the right suggests bearing twin girls. An inverse pulse pattern on the left suggests bearing three boys; a smooth pulse pattern on the right suggests bearing three girls. If the Cun, Guan, and Chi positions all correspond harmoniously, it indicates one boy and one girl, with distinct gender characteristics. Sometimes, the child may die while the mother survives, or the mother may die while the child survives. If the pulses in all three positions flow smoothly, with slippery and rapid qualities intermixed and vigorous, it indicates clear differentiation of excess Yang and deficiency Yin. If reverse Qi fills the chest, a floating and large pulse on the left indicates a male fetus; a deep and fine pulse on the right indicates a female fetus. All Yang pulses indicate males, and all Yin pulses indicate females; the distinctions under the fingers should be carefully counted and selected. If the pulses in all three positions are deep and regular without doubt, and the Chi position does not cease, it confirms a true pregnant woman. "Husband abandoning wife" refers to longitudinal Qi resembling fog; "wife abandoning husband" refers to transverse Qi resembling ribs. "Son overcoming mother" refers to inverse Qi interacting; "mother protecting son" refers to smooth Qi guarding. When the infant is full-term and the fetus is formed, the body may be hot and the pulse chaotic, but there is no suffering. During periods of sweating, anorexia, and vomiting, the spirit gathers and reserves within. A slippery and rapid pulse that does not scatter indicates three months of pregnancy; a rapid pulse that does not scatter alone indicates five months of pregnancy with a healthy mother. A string-tight, firm, strong, and slippery pulse indicates safety; a deep, fine, and faint pulse points to death.