齐仲甫曰∶血寒则凝,血温则散。若堕胎损经,其血不止,或不出。一则因热而行,一则气虚不敛。泻血
多者,必烦闷而死。或因风冷堕胎,血冷相搏,气虚血逆上,则血结不出,抢上攻心,则烦闷而死,当温经逐
寒,其血自行。若血淋沥不止,是冲任气虚,不能约制故也,宜胶艾汤,加伏龙肝散。
陈良甫曰∶堕胎后复损经脉,下血不止,甚则烦闷至死,皆以调补胃气为主。
慎斋按∶以上二条,序堕胎之后,有下血不止,有血凝不出二证也。堕胎而血出过多不止者,经脉损而冲任
之气虚而不摄,是不足病也,法当大补气血以固其脱。堕胎而血凝不行作痛者,外邪乘而败浊之血闭而不流,是
有余病也,法当导瘀消蓄,以温其经。
不特堕胎为然也,即产后见是证,亦宜以此治之。
武叔卿曰∶妊娠日月未足,胎气未全而产者,谓之半产。盖由妊妇冲任气虚,不能滋养胎元,胎气不固。
或颠扑闪坠,致气血损动,或因热病温疟之类。仲景谓虚寒相抟,此名为革,妇人则半产漏下是也。
《产宝百问》曰∶驴马有孕,牡者近身则蹄之,名为护胎,所以绝无小产。人之胎系胞中,气血养之。静则
神藏,欲火一动,则精神走泄,火扰于中,则胎堕矣。种玉者,知欲而不知忌,可不慎哉。
戴景元曰∶妇人觉有娠,男即不宜与接。若不忌,主半产。盖女与男接,欲动情胜,亦必有所输泄,而子
宫不闭,固多致半产。女科书俱无此论,可谓发前人未发。
齐仲甫说:血遇寒则凝结,遇温则消散。如果堕胎损伤经脉,导致出血不止或血液凝滞不出。其中一种情况是因热邪推动血液运行(导致妄行),另一种情况是气虚不能收敛固摄。如果泻血过多,必然会导致烦闷而死。如果是因风冷导致堕胎,血与冷邪相互搏结,加上气虚导致血气上逆,就会造成血液凝结无法排出;若瘀血上冲攻心,也会引起烦闷而死。这种情况应当采用温经散寒的方法,血液自然流通。如果血液淋漓不尽,这是冲任二脉气虚,不能约束控制血液的缘故,适宜使用胶艾汤,并加入伏龙肝研末调服。
陈良甫说:堕胎后再次损伤经脉,导致下血不止,甚至严重到烦闷致死,治疗都应以调理补益胃气为主。
慎斋按语:以上两条论述了堕胎之后出现的两种证候:一种是下血不止,一种是血液凝滞不出。堕胎后出血过多且不止的,是因为经脉受损,冲任之气虚弱而不能统摄血液,这属于虚损类疾病,治法应当大补气血以固脱救急。堕胎后血液凝滞不行并伴有疼痛的,是因为外邪侵袭,败浊之血闭阻而不流动,这属于实证,治法应当引导瘀血消散蓄积,以温通经脉。
不仅堕胎如此,即使是产后出现这些证候,也适宜用这种方法治疗。
武叔卿说:妊娠月份未满,胎气尚未完全形成就分娩的,称为半产(小产)。这通常是由于孕妇冲任气虚,不能滋养胎元,导致胎气不稳固。或者是由于跌打闪挫坠落,导致气血受损扰动,或者是由于热病、温疟等疾病所致。张仲景曾说“虚寒相抟,此名为革”,在妇人身上表现为半产漏下。
《产宝百问》说:驴马怀孕时,公畜靠近母畜,母畜会用蹄子踢它,这叫做护胎,所以它们极少发生小产。人类的胎儿系于胞宫之中,依靠气血来滋养。如果保持安静,神志内守;如果情欲之火一动,精神就会耗散泄漏,火热扰动于体内,就会导致胎堕。那些想要生育子女的人,如果只知道追求欲望而不知道禁忌,能不谨慎吗?
戴景元说:妇人察觉自己怀孕后,就不宜与男子交接。如果不加禁忌,主要会导致半产。因为女子与男子交接,情欲发动、情意浓烈,必然会有精气输泄,导致子宫口不闭合,因此多会导致半产。女科书籍中都没有这种论述,可以说是揭示了前人未曾发现的问题。
Qi Zhongfu stated: Blood coagulates when cold and disperses when warm. If abortion damages the meridians, resulting in either unceasing bleeding or blood stagnation that fails to discharge, there are two main causes: one is due to heat forcing blood to move recklessly, and the other is due to Qi deficiency failing to consolidate and retain blood. Excessive hemorrhage will inevitably lead to death from restlessness and oppression. If abortion is caused by wind-cold, the cold blood struggles against each other; combined with Qi deficiency causing rebellious upward movement of blood, it results in blood coagulation and failure to discharge. If the blood rushes upward to attack the heart, it causes restlessness and oppression leading to death. In such cases, warming the meridians and expelling cold should be employed, allowing the blood to flow naturally. If blood drips incessantly, this is due to Qi deficiency in the Chong and Ren vessels, which fail to constrain and control the blood. The appropriate treatment is Jiao Ai Tang (Collagen and Mugwort Decoction), added with Fulonggan San (Dragon Well Earth Powder).
Chen Liangfu stated: After abortion, if the meridians are further damaged leading to unceasing lower bleeding, or even severe restlessness leading to death, the primary treatment principle is to regulate and tonify Stomach Qi.
Shenzhen commented: The above two passages describe two syndromes following abortion: unceasing lower bleeding and blood stagnation with failure to discharge. When abortion leads to excessive and unceasing bleeding, it is because the meridians are damaged and the Qi of the Chong and Ren vessels is deficient, failing to hold the blood. This is a deficiency syndrome; the method should be to greatly tonify Qi and Blood to secure the collapse. When abortion leads to blood stagnation, obstruction, and pain, it is because external pathogens invade, causing turbid and敗 (defeated) blood to close off and cease flowing. This is an excess syndrome; the method should be to guide out stasis and dissipate accumulation, thereby warming the meridians.
This applies not only to abortion but also to postpartum conditions presenting with these syndromes, which should also be treated accordingly.
Wu Shuqing stated: Delivery occurring before the full term of pregnancy, when fetal Qi is not yet fully formed, is called Ban Chan (semi-abortion or miscarriage). This is generally due to Qi deficiency in the pregnant woman's Chong and Ren vessels, failing to nourish the fetal root, resulting in unstable fetal Qi. It may also result from physical trauma, falls, or shocks that damage and disturb Qi and Blood, or from febrile diseases such as warm malaria. Zhang Zhongjing stated, "When deficiency and cold combine, this is named Ge (Leather Pulse); in women, it manifests as semi-abortion and dripping bleeding."
The Ba Wen (Hundred Questions on Childbirth) states: When donkeys or mares are pregnant, if the male approaches, the female kicks him with her hooves; this is called protecting the fetus, which is why they rarely experience miscarriage. Human fetuses are suspended in the Baozhong (uterus), nourished by Qi and Blood. If one remains quiet, the Spirit is stored within; if desire-fire moves, the Spirit leaks away. Fire disturbing internally leads to fetal expulsion. Those seeking to conceive who know desire but do not know restraint—can they not be cautious?
Dai Jingyuan stated: Once a woman perceives she is pregnant, sexual intercourse with men should be avoided. If one does not observe this taboo, it primarily leads to semi-abortion. Because when a woman engages with a man, desire moves and passion prevails, inevitably leading to the loss of essence. Consequently, the uterus does not close tightly, often resulting in semi-abortion. Such discussions are absent in gynecological texts, representing insights that reveal what predecessors had not previously articulated.