有妇人胎死于腹,病喘不得卧,诊其脉,气口盛人迎一倍,左关弦动而疾,两尺俱短而离经,因曰病
盖得之毒药动血,以致死胎不下,奔迫上冲,非风寒作喘也。大剂芎归汤加催生药服之,夜
半果下一死胎而喘止。其夫曰病外家诚有怀,以室人见嫉,故药去之,众所不知也。然妊娠气喘,有乍感风
寒而不得卧者,客邪盛也,发散自愈,参苏饮主之。若脾虚四肢无力,肺虚不任风寒,肾
虚腰 ,短气不能行步,猝然气喘不息,此脾肺素亏,母虚子亦虚,肾气不归元而上乘于肺也,生脉散、
补中汤去升柴主之。丹溪所谓火动作喘,此胎前最多。至于毒药伤胎病喘,世俗往往有之,病机之
不可不察者也。
仲景曰∶妇人脏躁,喜悲伤欲哭,象如神灵所凭,数欠伸,甘麦大枣汤主之。立斋治一妊妇,悲哀烦躁。其夫询之,
云∶我无故,但欲自悲耳。用仲景方,又用淡竹茹汤佐八珍汤而愈。故妊娠无故悲伤,属肺病脏躁者,肺之脏燥也,胎
前气血壅养胎元,则津液不能充润,而肺为之燥。肺燥当补母,故有甘草、大枣以补脾。若立斋用八珍汤补养气血,更
发前人之所未尽。
《产宝》曰∶腹中脐带上疙瘩,儿含口中,因妊妇登高举臂,脱出儿口,以此作声,令妊妇曲腰就地如拾物状,仍
入口中即止。又云∶孕妇腹中儿哭,治法用空房中鼠穴土同川黄连浓煎汁,饮之即止。
有一位妇人,胎儿死于腹中,出现气喘、无法平卧的症状。诊察其脉象,气口脉比人迎脉大一倍,左关脉弦动且急促,两尺脉均短促且呈现离经之象。因此判断:此病是由于服用毒药扰动血液,导致死胎未能排出,气血奔迫上冲所致,并非风寒引起的气喘。给予大剂量的芎归汤并加入催产药物服用,半夜果然排出一枚死胎,气喘随即停止。她的丈夫说:“我的岳母确实曾怀孕,因被妻子嫉妒,所以用药堕胎,这是众人都不知道的秘密。”
然而,妊娠期间出现气喘,有因突然感受风寒而无法平卧的,这是外邪盛实所致,通过发散治疗即可自愈,主方用参苏饮。如果是脾虚导致四肢无力,肺虚不能抵御风寒,肾虚导致腰痛、气短不能行走,突然发生气喘不止,这是由于脾肺素来亏虚,母体虚弱则子脏亦虚,肾气不能归元而上逆乘犯肺脏所致,主方用生脉散、补中益气汤(去掉升麻、柴胡)。朱丹溪所说的火热动作致喘,这在产前最为多见。至于因毒药损伤胎元而导致的气喘,世俗间往往存在,这是病情机理不可不仔细审察的地方。
张仲景说:妇人脏躁症,喜欢悲伤想哭,症状像被神灵附体一样,频繁打哈欠和伸懒腰,主方用甘麦大枣汤。薛立斋治疗一位孕妇,表现为悲哀烦躁。询问其丈夫后得知,患者说:“我无缘无故,只是想要自我悲伤罢了。”使用张仲景的方剂,又配合淡竹茹汤辅助八珍汤而痊愈。所以妊娠期间无缘无故悲伤,属于肺病脏躁的,是肺脏干燥所致。产前气血壅滞以滋养胎元,导致津液不能充分滋润,从而使肺脏干燥。肺燥应当补益母脏(脾),所以方中有甘草、大枣来补脾。如果像薛立斋那样用八珍汤补养气血,更是发挥了前人未曾详尽论述的作用。
《产宝》记载:胎儿在腹中脐带上含有疙瘩,含在口中,因为孕妇登高举臂,导致疙瘩脱出胎儿口中,因此发出声音。让孕妇弯腰贴近地面,做出捡拾物品的样子,疙瘩重新进入胎儿口中,声音即止。又说:孕妇腹中胎儿啼哭,治疗方法是用空房中的老鼠洞里的土与川黄连一起浓煎汁液,给孕妇饮用,啼哭即止。
A woman had a fetus that died in the uterus, presenting with wheezing (asthma) and an inability to lie flat. Upon pulse diagnosis, the Qi Kou pulse was one times larger than the Ren Ying pulse; the Left Guan pulse was wiry, moving, and rapid; both Chi pulses were short and deviated from the normal course (Li Jing). It was therefore concluded: This illness resulted from taking drugs that disturbed the blood, causing the dead fetus not to be expelled. The qi rushed upward violently, which is not wheezing caused by wind-cold. A large dose of Xiong Gui Tang (Angelica and Ligusticum Decoction) with added labor-inducing herbs was administered. By midnight, a dead fetus was indeed expelled, and the wheezing ceased. Her husband said, "My mother-in-law was indeed pregnant, but she took medicine to abort it because she was jealous of my wife. This was unknown to everyone."
However, during pregnancy, wheezing can occur due to sudden contraction of wind-cold, leading to an inability to lie flat; this is caused by excess external pathogens and will heal spontaneously through dispersing methods, primarily treated with Shen Su Yin (Ginseng and Perilla Drink). If there is spleen deficiency causing weakness in the four limbs, lung deficiency failing to withstand wind-cold, or kidney deficiency causing lower back pain, shortness of breath, and inability to walk, resulting in sudden incessant wheezing, this is due to inherent deficiency of the spleen and lungs. When the mother is deficient, the child is also deficient; the kidney qi fails to return to its origin and overcomes the lung. This is primarily treated with Sheng Mai San (Generate the Pulse Powder) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Sheng Ma and Chai Hu removed. Zhu Danxi stated that wheezing caused by fire movement is most common before childbirth. As for wheezing caused by drugs damaging the fetus, this often occurs in secular practice, and the pathology must be carefully examined.
Zhang Zhongjing said: In women suffering from Zang Zao (Visceral Agitation), there is a tendency toward sadness and weeping, resembling possession by spirits, accompanied by frequent yawning and stretching. This is primarily treated with Gan Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction). Xue Lizhai treated a pregnant woman who presented with sorrow and irritability. Upon inquiry with her husband, it was learned that she said, "I have no reason, I just want to feel sad." Using Zhang Zhongjing's formula, assisted by Dan Zhu Ru Tang (Bamboo Shavings Decoction) and Ba Zhen Tang (Eight Treasures Decoction), she recovered. Therefore, unprovoked sadness during pregnancy belonging to Lung disease and Zang Zao is due to dryness of the lung. During pregnancy, qi and blood are congested to nourish the fetal source, so body fluids cannot sufficiently moisten, causing the lung to become dry. Dryness of the lung should be treated by tonifying the mother organ (Spleen); hence, Licorice and Jujube are used to tonify the spleen. If, as Xue Lizhai did, Ba Zhen Tang is used to tonify qi and blood, it further elaborates on what previous authors had not fully expounded.
The *Chan Bao* records: A nodule on the umbilical cord may be held in the mouth of the fetus. If the pregnant woman climbs high and raises her arms, the nodule may slip out of the fetus's mouth, producing sounds. To stop this, the pregnant woman should bend her waist to the ground as if picking up an object; once the nodule re-enters the fetus's mouth, the sound stops. It also states: For a fetus crying in the womb of a pregnant woman, the treatment method is to decoct earth from rat holes in empty rooms with Chuan Huang Lian (Coptis Rhizome) into a thick liquid and administer it to the pregnant woman, which stops the crying.