张仲景曰∶妇人脏躁,悲伤欲哭,象如神灵所作,数欠伸,甘草小麦大枣汤主之。
许学士曰∶有一妇人,数次无故悲泣不止,或谓有祟,祈禳请祷备至,终不应,予忆《金匮》有此证,急
治药,尽剂而愈。古人识病制方,种种妙绝如此。
陈良甫曰∶记管先生治一妊娠四五月,脏燥悲伤,遇昼则惨戚泪下,如有所凭,与仲景大枣汤而愈。
薛立斋曰∶有一妊妇,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。
但前证或因寒水攻心,或肺有风邪者,宜审察治之。
慎斋按∶以上四条,序脏燥悲伤证。仲景、学士二条,是概病机也。良甫、立斋二条,方主妊娠见证。无故
悲伤属肺病。脏燥者,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,故甘草、大枣以补脾。若立斋用八珍汤,补养气血,真佐前人未尽。
《大全》曰∶孕妇腹内盅鸣,用鼠窟前后土为细末,研麝香,酒调下立愈。
《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,仍入儿口即止。又云,孕妇腹中儿哭,治法亦用空房中鼠穴土,同川黄连浓煎汁饮之,即止。
慎斋按∶孕妇腹内盅鸣,即是儿哭证同类,故《大全》治法亦无异。立斋云∶黄连性寒,麝香开窍。当酌
用,究竟此作何证。凡病能有《灵》、《素》不载,而后人以意治之,不可深解者,此类是也。
张仲景说:妇女患脏躁病,出现悲伤想哭的症状,表现如同被神灵附体一般,频繁打哈欠和伸懒腰,应用甘草小麦大枣汤主治。
许学士说:曾有一位妇人,多次无缘无故地悲伤哭泣不止,有人说是中了邪祟,于是各种祈祷祭祀的方法都用尽了,但始终没有效果。我回忆起《金匮要略》中有此证候的记载,急忙用药治疗,服完一剂药后痊愈。古人认识疾病、制定方剂的精妙之处,竟达到如此地步。
陈良甫说:记得管先生治疗一位怀孕四五个月的孕妇,患有脏躁悲伤之症,白天则神情凄惨、泪流满面,好像有所依托一样,给予张仲景的大枣汤(即甘草小麦大枣汤)而治愈。
薛立斋说:有一位孕妇,感到悲哀且烦躁,她的丈夫询问原因,她说自己并无缘由,只是想要独自悲伤罢了。使用张仲景的方剂,又配合淡竹茹汤,并辅以八珍汤。但是前面的证候,有的可能是因为寒水之气攻心,有的是因为肺中有风邪,应当仔细审察后进行治疗。
慎斋按语:以上四条,叙述了脏躁悲伤的证候。张仲景和许学士的两条,是概括论述病机。陈良甫和薛立斋的两条,主要是针对妊娠期间出现的证候。无缘无故的悲伤属于肺病。所谓脏躁,就是肺脏干燥。在怀孕期间,气血壅盛以滋养胎元,导致津液不能充分滋润,从而使肺部干燥。肺燥时应当补益其母脏(脾),所以用甘草、大枣来补脾。如果像薛立斋那样使用八珍汤来补养气血,确实补充了前人未尽之处。
《妇人大全良方》说:孕妇腹中发出如虫鸣般的响声,可用老鼠洞前后的泥土研成细末,加入麝香,用酒调服,立即痊愈。
《产宝》说:胎儿脐带上的疙瘩滑入胎儿口中,是因为孕妇登高举臂,导致脐带脱出胎儿口腔,因此发出声音。让孕妇弯腰贴近地面,就像捡拾东西的样子,使脐带重新回到胎儿口中,声音就会停止。又说,孕妇腹中胎儿啼哭的治疗方法,也使用空房中的鼠穴土,同川黄连一起浓煎汁液服用,啼哭即可停止。
慎斋按语:孕妇腹中发出的虫鸣声,与胎儿啼哭的证候同类,所以《妇人大全良方》的治疗法也没有不同。薛立斋说:黄连性寒,麝香开窍。应当酌情使用,但这究竟属于什么证候呢?凡是疾病有《黄帝内经·灵枢》、《素问》未记载,而后人凭主观意图治疗的,无法深入理解的,这类情况就是如此。
Zhang Zhongjing stated: In women suffering from Zang Zao (Visceral Dryness), there are symptoms of sorrow and a desire to cry, presenting as if possessed by spiritual entities, accompanied by frequent yawning and stretching. It should be treated with Gancao Xiaomai Dazao Tang (Licorice, Wheat, and Jujube Decoction).
Xu Xueshi said: There was a woman who repeatedly wept uncontrollably without any apparent cause. Some suggested she was afflicted by malevolent spirits, so various prayers and exorcisms were performed extensively, but to no avail. I recalled that this syndrome was recorded in the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet), so I urgently prescribed medicine. After completing one dose, she recovered. The ingenuity of ancient physicians in recognizing diseases and formulating prescriptions is truly remarkable.
Chen Liangfu said: I recall Mr. Guan treating a pregnant woman at four or five months gestation who suffered from Zang Zao with sorrowful crying. During the day, she appeared desolate and shed tears as if supported by something unseen. She was cured after being administered Zhang Zhongjing's Dazao Tang (Jujube Decoction, referring to Gancao Xiaomai Dazao Tang).
Xue Lizhai said: There was a pregnant woman who felt sorrowful and irritable. When her husband asked about it, she replied that she had no specific reason but simply wished to grieve alone. He used Zhang Zhongjing's formula, combined with Danzhuru Tang (Bamboo Shave Decoction), assisted by Bazhen Tang (Eight Treasures Decoction). However, regarding the aforementioned syndromes, some may be caused by Cold Water attacking the Heart, or Wind-Evil residing in the Lungs; these must be carefully examined before treatment.
Shenzhai commented: The above four cases describe the syndrome of Zang Zao with sorrowful crying. The entries by Zhang Zhongjing and Xu Xueshi generally discuss the pathogenesis. The entries by Liangfu and Lizhai focus on manifestations during pregnancy. Unprovoked sorrow belongs to Lung disease. "Zang Zao" refers to the dryness of the Lung organ. During pregnancy, Qi and Blood are abundant to nourish the fetal origin, which prevents body fluids from adequately moistening, causing the Lungs to become dry. When the Lungs are dry, one should tonify their mother organ (the Spleen); therefore, Gancao (Licorice) and Dazao (Jujube) are used to tonify the Spleen. If one uses Bazhen Tang (Eight Treasures Decoction) to tonify Qi and Blood as Lizhai did, it indeed supplements what previous scholars left incomplete.
The *Daquan* (Complete Works) states: For pregnant women whose abdomens emit rumbling sounds like insects, use soil from the front and back of mouse burrows, grind it into fine powder, mix with Moschus (Musk), and take with wine for immediate relief.
The *Chanbao* (Treasure of Obstetrics) states: Sometimes a knot on the umbilical cord slips into the fetus's mouth. This occurs because the pregnant woman climbs high and raises her arms, causing the cord to slip out of the fetus's mouth, creating noise. To resolve this, have the pregnant woman bend her waist to the ground, as if picking up an object, allowing the cord to re-enter the fetus's mouth, at which point the sound stops. It also states that for fetal crying within the womb, the same method using soil from mouse holes in empty houses, decocted thickly with Chuan Huanglian (Coptis Chinensis), can stop the crying.
Shenzhai commented: The rumbling sound in the pregnant woman's abdomen is of the same category as fetal crying; thus, the treatment in the *Daquan* is no different. Lizhai noted: Huanglian (Coptis Rhizome) is cold in nature, and Moschus (Musk) opens orifices. These should be used with discretion. Ultimately, what kind of syndrome is this? Diseases that are not recorded in the *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions) of the *Huangdi Neijing* (Yellow Emperor's Inner Canon), yet are treated based on later physicians' subjective interpretations, cannot be deeply understood. Such cases are examples of this.