妊娠胎动不安由冲任经虚胎气不固,或过饮房劳致损,或举重跌躅致伤,或喜怒过伤血脉,或热药损动胎元,
然母病而致胎动者,俱治其母而胎自安,胎有病而致动母疾者,只安其胎而母病无不愈。又当以形色验之,面赤舌
青为子死母活,面青舌赤为母死子活,舌面俱青子母皆死,面舌俱赤母子皆活。
主以安胎散加生地、白芍、麦冬、牡蛎,气逆加枳壳,气陷加柴胡,气满加腹皮,气虚加人参,烦渴加知母,
潮热加山栀,肝脾两虚而挟热者,加味逍遥散,冲任两虚而微热者,生熟地黄丸,冲任两虚而热甚者,知柏四物汤,
冲任两虚而挟寒者,胶艾四物汤。
安胎散
治胎动脉微数者。
条芩(一两半) 白术(一两半,炒) 当归(二两) 甘草(八钱)
制为散,水煎五钱,去渣早暮兼进以胎安为度。
妊娠冲任脉虚,虚火迫动胎元,故胎动不安,是胎动因于虚热焉。白术健脾生血,当归养血荣胎,甘草泻火
缓急,条芩清热安胎也。为散水煮,俾热化血荣则冲任完固而胎得所养,胎无不安,何胎动之有哉。
生熟地黄丸
治胎动脉虚数者。
生地(五两) 熟地(五两) 天冬(三两,去心) 麦冬(三两,去心) 当归(三两) 白芍(一两半,
炒) 茯神(一两半,去木) 白术(一两半,炒) 知母(一两半,炒) 牡蛎(三两,生)
制为末,炼蜜糊丸,米饮下五钱。
妊娠肝肾两虚,阴血不足,冲任为虚热内迫而胎失所养,故胎动不安,是胎动因于血虚有热焉。生地滋阴壮水,
熟地补血滋阴,天冬清心润肺以益肾水,麦冬润肺清心以生津液,当归养血荣冲脉,白芍敛阴固任脉,茯神渗湿安
神,白术健脾生血,知母清热润燥以安胎,牡蛎潜热益阴以固胎也。炼蜜以丸之,米饮以下之,俾阴血内充则虚热
潜藏而冲任完固,何胎动之有哉。
十圣散
治胎动脉虚软者。
熟地(五两) 人参(一两半) 黄 (三两,蜜炙) 白术(一两半,炒) 当归(三两) 白芍(一两半,
酒炒) 川芎(一两) 续断(三两) 甘草(五钱,炙) 砂仁(一两,炒)
制为散,水煎五钱,去渣服。
妊娠气血大亏,不能滋荣胎息,故胎动不安,是胎动因于气血大亏焉。人参扶元补气,黄 补气固中,熟地
补血以滋冲任,白术健脾以生血气,当归养血荣经脉,白芍敛阴安胎息,川芎调血海,续断续经筋脉,炙草缓中
益胃,砂仁开胃醒脾也。为散水煎,使脾胃调和则气血内充而胎得所养,胎无不宁,何胎动之足虑哉。
妊娠期间胎动不安,是由于冲任二脉虚弱、胎气不固,或因房事过度、劳累损伤,或举重、跌扑导致受伤,或喜怒情绪过极损伤血脉,或服用热性药物损伤胎元所致。
然而,如果是母亲患病而导致胎动,应当治疗母亲的疾病,胎儿自然就会安定;如果是胎儿有病而引发母体不适,只需安胎,母亲的病症没有不痊愈的。此外,还应当通过观察面色和舌色来验证:面赤舌青表示胎儿已死而母亲存活,面青舌赤表示母亲已死而胎儿存活,舌面俱青表示母子皆死,面舌俱赤表示母子皆活。
胎动不安时脉象必定急疾,肝脾血虚时脉象必定弦而虚,胎损时脉象涩滞,受触击时脉象紧束。
治疗应以清热、养血、顺气、安胎为主,宜以静制动,总体要使脾肾功能完善坚固,则胎儿自然安宁。
主方使用安胎散加生地、白芍、麦冬、牡蛎,气逆加枳壳,气陷加柴胡,气满加厚朴(腹皮),气虚加人参,烦渴加知母,潮热加山栀。若肝脾两虚兼有热者,用加味逍遥散;冲任两虚兼有微热者,用生熟地黄丸;冲任两虚兼有热甚者,用知柏四物汤;冲任两虚兼有寒者,用胶艾四物汤。
安胎散
治疗胎动脉象微数者。
条芩(一两半) 白术(一两半,炒) 当归(二两) 甘草(八钱)
制成散剂,水煎五钱,去渣滓,早晚服用,以胎安为度。
妊娠期间冲任脉虚,虚火迫动胎元,所以胎动不安,这是胎动因于虚热所致。白术健脾生血,当归养血荣养胎儿,甘草泻火缓急,条芩清热安胎。制成散剂用水煎煮,使热化血荣,则冲任完固而胎儿得到滋养,胎儿没有不安定的,哪里会有胎动呢?
生熟地黄丸
治疗胎动脉象虚数者。
生地(五两) 熟地(五两) 天冬(三两,去心) 麦冬(三两,去心) 当归(三两) 白芍(一两半,炒) 茯神(一两半,去木) 白术(一两半,炒) 知母(一两半,炒) 牡蛎(三两,生)
制成粉末,炼蜜为丸,米饮送服五钱。
妊娠期间肝肾两虚,阴血不足,冲任被虚热内迫而胎儿失去滋养,所以胎动不安,这是胎动因于血虚有热所致。生地滋阴壮水,熟地补血滋阴,天冬清心润肺以益肾水,麦冬润肺清心以生津液,当归养血荣养冲脉,白芍敛阴固守任脉,茯神渗湿安神,白术健脾生血,知母清热润燥以安胎,牡蛎潜降虚热益阴以固胎。炼蜜为丸,米饮送下,使阴血内充则虚热潜藏而冲任完固,哪里会有胎动呢?
十圣散
治疗胎动脉象虚软者。
熟地(五两) 人参(一两半) 黄芪(三两,蜜炙) 白术(一两半,炒) 当归(三两) 白芍(一两半,酒炒) 川芎(一两) 续断(三两) 甘草(五钱,炙) 砂仁(一两,炒)
制成散剂,水煎五钱,去渣服用。
妊娠期间气血大亏,不能滋荣胎息,所以胎动不安,这是胎动因于气血大亏所致。人参扶元补气,黄芪补气固中,熟地补血以滋冲任,白术健脾以生血气,当归养血荣养经脉,白芍敛阴安胎息,川芎调血海,续断续经筋脉,炙甘草缓中益胃,砂仁开胃醒脾。制成散剂水煎,使脾胃调和则气血内充而胎儿得到滋养,胎儿没有不宁静的,有什么值得忧虑的呢?
Fetal restlessness and insecurity during pregnancy arise from deficiency of the Chong and Ren meridians with insecure fetal qi, or damage due to excessive sexual activity and fatigue, or injury from lifting heavy objects and falling. It may also result from extreme emotions damaging blood vessels, or from taking hot-natured medicines that harm the fetal origin.
However, if the mother's illness causes fetal restlessness, treating the mother's disease will naturally stabilize the fetus; if a fetal pathology causes maternal discomfort, stabilizing the fetus will invariably cure the mother's condition. Furthermore, one should verify the prognosis by observing facial color and tongue appearance: red face and blue tongue indicate fetal death with maternal survival; blue face and red tongue indicate maternal death with fetal survival; both tongue and face being blue indicate death of both mother and fetus; both tongue and face being red indicate survival of both mother and fetus.
In cases of fetal restlessness, the pulse is necessarily rapid. In liver and spleen blood deficiency, the pulse is wiry and deficient. In fetal damage, the pulse is choppy. Upon trauma/blow, the pulse is tight.
Treatment should focus on clearing heat, nourishing blood, regulating qi, and calming the fetus. One should employ stillness to overcome movement, ensuring the spleen and kidney functions are complete and solid, so that the fetus naturally becomes tranquil.
The main prescription is An Tai San (Stabilize Fetus Powder) supplemented with Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Radix), and Mu Li (Ostreae Concha). For rebellious qi, add Zhi Ke (Aurantii Fructus); for sinking qi, add Chai Hu (Bupleuri Radix); for abdominal fullness, add Fu Pi (Moutan Cortex or Magnolia Bark); for qi deficiency, add Ren Shen (Ginseng Radix); for irritability and thirst, add Zhi Mu (Anemarrhenae Rhizoma); for tidal fever, add Shan Zhi Zi (Gardeniae Fructus). If there is dual deficiency of liver and spleen with accompanying heat, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). If there is dual deficiency of Chong and Ren meridians with slight heat, use Sheng Shu Di Huang Wan (Raw and Prepared Rehmannia Pill). If there is dual deficiency of Chong and Ren meridians with severe heat, use Zhi Bai Si Wu Tang (Anemarrhena and Phellodendron Four Substances Decoction). If there is dual deficiency of Chong and Ren meridians with accompanying cold, use Jiao Ai Si Wu Tang (Donkey-hide Gelatin and Mugwort Four Substances Decoction).
An Tai San (Stabilize Fetus Powder)
Indicated for fetal restlessness with a slightly rapid pulse.
Tiao Qin (Scutellariae Radix) (1 liang 5 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1 liang 5 qian, stir-fried), Dang Gui (Angelicae Sinensis Radix) (2 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma) (8 qian).
Processed into powder, decocted in water (5 qian dose), dregs removed, taken morning and evening until the fetus is stabilized.
During pregnancy, deficiency of the Chong and Ren meridians allows deficient fire to agitate the fetal origin, causing fetal restlessness; thus, this type of restlessness stems from deficient heat. Bai Zhu strengthens the spleen and generates blood; Dang Gui nourishes blood and enriches the fetus; Gan Cao clears fire and relieves urgency; Tiao Qin clears heat and calms the fetus. Taken as a powder decocted in water, this transforms heat and enriches blood, making the Chong and Ren meridians solid so the fetus receives nourishment. If the fetus is not insecure, how could there be fetal restlessness?
Sheng Shu Di Huang Wan (Raw and Prepared Rehmannia Pill)
Indicated for fetal restlessness with a deficient and rapid pulse.
Sheng Di Huang (Rehmanniae Radix) (5 liang), Shu Di Huang (Rehmanniae Radix Praeparata) (5 liang), Tian Dong (Asparagi Radix) (3 liang, heart removed), Mai Dong (Ophiopogonis Radix) (3 liang, heart removed), Dang Gui (Angelicae Sinensis Radix) (3 liang), Bai Shao (Paeoniae Radix Alba) (1 liang 5 qian, stir-fried), Fu Shen (Poria Cum Radix) (1 liang 5 qian, wood removed), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1 liang 5 qian, stir-fried), Zhi Mu (Anemarrhenae Rhizoma) (1 liang 5 qian, stir-fried), Mu Li (Ostreae Concha) (3 liang, raw).
Processed into powder, bound with refined honey into pills, taken with rice drink (5 qian dose).
During pregnancy, dual deficiency of liver and kidney leads to insufficient yin blood. The Chong and Ren meridians are pressured internally by deficient heat, causing the fetus to lose nourishment, resulting in fetal restlessness; thus, this type of restlessness stems from blood deficiency with heat. Sheng Di Huang nourishes yin and strengthens water; Shu Di Huang tonifies blood and nourishes yin; Tian Dong clears the heart and moistens the lungs to benefit kidney water; Mai Dong moistens the lungs and clears the heart to generate fluids; Dang Gui nourishes blood and enriches the Chong vessel; Bai Shao astringes yin and secures the Ren vessel; Fu Shen leaches out dampness and calms the spirit; Bai Zhu strengthens the spleen and generates blood; Zhi Mu clears heat and moistens dryness to calm the fetus; Mu Li subdues heat and benefits yin to secure the fetus. Bound with honey and taken with rice drink, this fills the interior with yin blood so that deficient heat hides itself, making the Chong and Ren meridians solid. How could there be fetal restlessness?
Shi Sheng San (Ten Sages Powder)
Indicated for fetal restlessness with a deficient and soft pulse.
Shu Di Huang (Rehmanniae Radix Praeparata) (5 liang), Ren Shen (Ginseng Radix) (1 liang 5 qian), Huang Qi (Astragali Radix) (3 liang, honey-fried), Bai Zhu (Atractylodis Macrocephalae Rhizoma) (1 liang 5 qian, stir-fried), Dang Gui (Angelicae Sinensis Radix) (3 liang), Bai Shao (Paeoniae Radix Alba) (1 liang 5 qian, wine-fried), Chuan Xiong (Ligustici Chuanxiong Rhizoma) (1 liang), Xu Duan (Dipsaci Radix) (3 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma) (5 qian, roasted), Sha Ren (Amomi Fructus Rotundus) (1 liang, stir-fried).
Processed into powder, decocted in water (5 qian dose), dregs removed, taken orally.
During pregnancy, severe deficiency of qi and blood fails to nourish and enrich the fetal breath, causing fetal restlessness; thus, this type of restlessness stems from severe qi and blood deficiency. Ren Shen supports the primal qi and tonifies qi; Huang Qi tonifies qi and consolidates the middle; Shu Di Huang tonifies blood to nourish the Chong and Ren meridians; Bai Zhu strengthens the spleen to generate qi and blood; Dang Gui nourishes blood and enriches the meridians; Bai Shao astringes yin and calms the fetal breath; Chuan Xiong regulates the Blood Sea; Xu Duan connects sinews and meridians; Roasted Gan Cao moderates the middle and benefits the stomach; Sha Ren awakens the spleen and opens the appetite. Taken as a powder decocted in water, this harmonizes the spleen and stomach so that qi and blood fill the interior and the fetus receives nourishment. If the fetus is not tranquil, what is there to worry about?