妊娠伤寒,专以清热安胎为主,外用涂脐护胎之法,其或汗、或下,各随表里所见脉证主治。有表
证宜汗者,羌活冲和汤加柴胡、当归、芍药、苏叶、葱白之类。若里热实症,便秘、躁渴者,
亦用大黄转药,须酒制用。有病病当之,设患真寒脉伏厥冷者,则用姜、桂、附子。姜、桂虽热,用黄连、
甘草制之则无害矣。况应犯而犯似乎无犯,若不急为调治,以去极寒极热之病,则胎为
病所困而难于保全矣。奈何去病寒热之药,人多畏之,伤生寒热之病,人反安之何也?
妊娠寒热皆因气血虚损,风寒乘之。风为阳邪,化气而为热;寒为阴邪,化气而为寒;阴阳并挟,
寒热互见。经曰∶阳微恶寒,阴弱发热。此皆虚之所致,不因暑气所作,宜清解表邪,兼大补气血以主之,勿泥
寒热假象也。若寒热不已,熏蒸其胎,胎必伤矣。更有患胎疟者,一遇有胎,疟病即发。此人素有肝火,遇孕
则水养胎元,肝虚血燥,寒热往来,似疟非疟也,以逍遥散清肝火、养肝血,兼六味丸以滋化源。
妊娠饮食生冷,脾胃不能克化,致令心腹疼痛。伤血则赤,伤气则白,血气俱伤,则赤白相杂。至若腹
内重坠,胎气不安者,此腹重坠下,元气虚而不能升举,真气下陷也,大用补中汤而自安,
切勿顺气、行气,益增坠下之患。胎系于肾,如钟系于梁,栋柱不固,栋梁必挠,而钟岂能独全哉。况似痢
非痢者,多中气虚则不能上升,脾气虚则不能渗湿,肾气虚则不能闭藏。慎勿以有形
之假滞,而伤无形之元气,至元气一伤,变症百出矣。胎能保乎?
妊娠期间患伤寒,治疗应以清热安胎为主要原则,并可配合外用涂脐以保护胎儿的方法。至于发汗或攻下等治法,则需根据表证或里证的脉象和症状灵活施治。若有表证且适宜发汗者,可使用羌活冲和汤,并加入柴胡、当归、芍药、紫苏叶、葱白等药物。若为里热实证,出现便秘、烦躁口渴等症状,也可使用大黄制成的泻下药,但必须经过酒制处理。疾病有其特定的病机,如果患者表现为真寒证,如脉象沉伏、四肢厥冷,则应使用干姜、肉桂、附子。虽然干姜、肉桂性热,但若用黄连、甘草来制约其燥烈之性,便不会产生危害。况且,该用药而不用似乎是不当的;如果不及时调治,去除极寒或极热的病邪,胎儿就会被病邪所困,难以保全。为何人们害怕使用祛除寒热病邪的药物,反而对导致生命受损的寒热病邪习以为常呢?
妊娠期间的寒热症状,多因气血虚损,风寒之邪乘虚而入所致。风属于阳邪,转化为气后表现为热;寒属于阴邪,转化为气后表现为寒;阴阳二邪夹杂,导致寒热症状交替出现。医经中说:“阳气微弱则恶寒,阴气虚弱则发热。”这些症状皆由虚损引起,并非暑气所致,治疗宜清解表邪,同时大补气血为主,不要拘泥于寒热的假象。如果寒热症状持续不愈,熏蒸灼伤胎儿,胎儿必然受损。另有患妊娠疟疾者,一旦怀孕,疟疾即发作。这类人平素肝火旺盛,怀孕后阴血滋养胎元,导致肝血亏虚、血液干燥,出现寒热往来,症状似疟非疟。治疗应以逍遥散清肝火、养肝血,兼用六味丸以滋补肾阴化源。
妊娠期间饮食生冷,脾胃无法运化消化,导致心腹疼痛。损伤血分则见赤色(痢下赤冻),损伤气分则见白色(痢下白冻),气血俱伤,则赤白相杂。至于腹部有沉重下坠感,胎气不安者,这是因为腹部重坠下陷,元气虚弱不能升举,真气下陷所致,应大量使用补中益气汤,胎儿自然安定,切勿使用顺气、行气的药物,以免增加下坠的危害。胎儿系于肾,如同钟悬挂在梁上,如果栋梁不坚固,必然弯曲折断,钟岂能独自保全呢?况且那些似痢非痢的症状,多因中气虚不能上升,脾气虚不能渗湿,肾气虚不能闭藏所致。千万不要因为有形之物的假性停滞,而伤害无形的元气,一旦元气受损,各种变症就会层出不穷,胎儿还能保得住吗?
In cases of cold damage (Shanghan, a disease caused by external pathogenic factors) during pregnancy, treatment should primarily focus on clearing heat and calming the fetus. External methods such as applying medicaments to the navel can be used to protect the fetus. Regarding sweating or purging therapies, they should be administered according to the pulse and symptoms indicating exterior or interior patterns. If there are exterior signs suitable for sweating, Qianghuo Chonghe Tang (Qianghuo Harmonizing Decoction) can be used with added Chai Hu (Bupleuri Radix), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix), Zi Su Ye (Perillae Folium), and Cong Bai (Allii Fistulosi Bulbus). If there is an interior excess-heat pattern manifesting as constipation, restlessness, and thirst, Da Huang (Rhei Radix et Rhizoma) prepared as a purgative may be used, but it must be processed with wine. Diseases have their specific pathologies; if the patient presents with true cold patterns, such as a deep, hidden pulse and cold extremities, then Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex), and Fu Zi (Aconiti Lateralis Radix Praeparata) should be used. Although Gan Jiang and Rou Gui are hot in nature, their harshness can be neutralized by using Huang Lian (Coptidis Rhizoma) and Gan Cao (Glycyrrhizae Radix et Rhizoma), thus causing no harm. Moreover, failing to use necessary treatments when indicated is inappropriate; if extreme cold or heat pathogens are not promptly removed through regulation, the fetus will be trapped by the disease and difficult to preserve. Why do people fear medicines that eliminate pathogenic cold and heat, yet remain complacent about diseases that cause harm to life?
Chills and fever during pregnancy are generally due to deficiency and damage of Qi and Blood, allowing Wind-Cold pathogens to invade. Wind is a Yang pathogen that transforms into Qi and manifests as heat; Cold is a Yin pathogen that transforms into Qi and manifests as cold. When Yin and Yang pathogens combine, chills and fever appear alternately. The classics state: "When Yang is weak, there is aversion to cold; when Yin is weak, there is fever." These conditions result from deficiency, not from summer-heat. Treatment should involve resolving exterior pathogens while simultaneously greatly tonifying Qi and Blood, without being constrained by the false appearances of cold or heat. If chills and fever persist, steaming and damaging the fetus, the fetus will surely be injured. Furthermore, some women suffer from pregnancy malaria; once pregnant, the malarial disease immediately manifests. These individuals typically have Liver Fire. During pregnancy, Yin blood nourishes the fetal origin, leading to Liver deficiency and dry Blood, resulting in alternating chills and fever, resembling malaria but not being true malaria. Treatment should employ Xiaoyao San (Free and Easy Wanderer Powder) to clear Liver Fire and nourish Liver Blood, combined with Liuwei Wan (Six-Ingredient Pill with Rehmannia) to nourish the source of transformation (Kidney Yin).
Consumption of raw and cold foods during pregnancy impairs the Spleen and Stomach's ability to transform and transport, leading to pain in the heart and abdomen. Injury to Blood results in red dysentery; injury to Qi results in white dysentery; injury to both Qi and Blood results in mixed red and white discharge. In cases where there is a sensation of heaviness and bearing down in the abdomen with unstable fetal Qi, this is due to the downward sinking of Yuan Qi (Original Qi) because of its deficiency and inability to ascend, causing Zhen Qi (True Qi) to sink. Large doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to stabilize the fetus. One must strictly avoid using Qi-regulating or Qi-moving herbs, as this would exacerbate the bearing-down condition. The fetus is anchored by the Kidneys, like a bell suspended from a beam; if the beams and pillars are not solid, they will bend and break, and how could the bell remain intact alone? Moreover, symptoms resembling dysentery but not being true dysentery are often caused by deficiency of Middle Qi preventing ascent, deficiency of Spleen Qi preventing the seepage of dampness, and deficiency of Kidney Qi preventing closure. Do not injure the formless Yuan Qi due to the apparent stagnation of formed substances. Once Yuan Qi is damaged, myriad complications will arise, and how can the fetus be preserved?