陈良甫曰∶凡妊娠患热病,脏腑熏灼,其胎致死,身冷而胎不自出,服黑神散暖其胎,气温即自下。药用
附子、桂心、干姜、当归、生地、白芍、黑豆。
《大全》曰∶妊娠羸瘦,或挟疾病,脏腑虚损,气血枯竭,既不能养胎,致伤胎气不固,终不能安者,可
下之,免害妊妇。
慎斋按∶既云脏腑虚损,气血枯竭,而遽云下之,以免害妊妇,独罔顾披枝伤根之患乎?
《大全》曰∶妊娠五七日,因事筑磕着胎,或子死腹中,恶露以下,疼痛不止,口噤欲绝,用神妙佛手散
探之。若不损则痛止,子母俱安。若损胎,立便逐下。又名芎 汤。又
云此药治伤胎去血,多神效。
《快捷方式方》曰∶治毒药攻胎,药毒冲上,外证牙关紧急,口不能言,两手强直握拳,自汗,身微热,与胎前
中风相似。但其脉浮而软,十死一生,医多不识。若作中风治之,必死。用白扁豆二两,生,去皮为末,汲新
水调下即效。
《快捷方式方》曰∶妊妇或食毒物,或误服草药,伤动胎气,下血不止,胎尚未损,服之可安,已死,服之可
下。用桂、桃仁、丹皮、赤芍、茯苓,名夺命丸,淡醋汤下,丹溪亦称其妙。
慎斋按∶以上七条,序胎前有伤胎证也。妊娠怀胎。或饮食不慎,起居不时,则有伤胎之患。而胎之伤也
不一,有惊恐坠仆,有热病诸疾,有筑磕、毒药、毒食种种,均足致胎之伤。此非脉之可凭,必须医者数问。以
悉其情,而后可以审证施治也。
陈良甫说:凡是孕妇患上热病,脏腑受到火热熏蒸灼烧,会导致胎儿死亡。此时身体发冷但胎儿不会自然排出,服用黑神散以温暖胎元,待胎气回暖后胎儿自然会娩出。药物包括附子、桂心、干姜、当归、生地、白芍、黑豆。
《妇人大全良方》说:孕妇身体消瘦羸弱,或者兼夹疾病,导致脏腑虚损,气血枯竭,既然不能滋养胎儿,致使胎气受损不稳固,最终无法安胎的,可以采用下法(攻下),以免危害孕妇生命。
慎斋按语:既然说是脏腑虚损,气血枯竭,却立刻说要使用下法来避免危害孕妇,难道不顾及砍断树枝而伤害树根的祸患吗?
《妇人大全良方》说:怀孕五到七天时,因为事情撞击腹部伤及胎儿,或者胎儿死于腹中,恶露已经排出,疼痛不止,牙关紧闭几乎昏厥,使用神妙佛手散试探治疗。如果胎儿未受损,则疼痛停止,母子平安。如果胎儿已受损,则会立即逐出排出。此方又名芎䓖汤。又说此药治疗伤胎去血,多有神奇疗效。
《快捷方式方》说:治疗毒药攻伐胎儿,药毒上冲,外在症状表现为牙关紧急,口不能言,两手强直握拳,自汗,身体微热,这与产前中风相似。但其脉象浮而软,十死一生,医生大多不认识。如果当作中风治疗,必然致死。使用白扁豆二两,生用,去皮研为末,汲取新水调服即见效。
《快捷方式方》说:孕妇如果食用毒物,或误服草药,伤动胎气,下血不止,若胎儿尚未损坏,服用此药可安胎;若胎儿已死,服用此药可使死胎排出。药物组成是桂枝、桃仁、丹皮、赤芍、茯苓,名为夺命丸,用淡醋汤送服,朱丹溪也称赞其奇妙。
慎斋按语:以上七条,叙述了胎前损伤胎儿的证候。妊娠期间怀胎,如果饮食不慎,起居没有规律,就会有损伤胎儿的祸患。而胎儿受伤的原因不一,有惊恐、坠跌仆倒,有热病等各种疾病,有撞击、毒药、毒食种种情况,都足以导致胎儿受伤。这不仅仅依靠脉诊就能确定,必须让医生多次询问,以了解详细情况,然后才能审察证候施以治疗。
Chen Liangfu stated: Whenever a pregnant woman suffers from a febrile disease, the internal organs are scorched by heat, which can cause fetal death. At this time, the body becomes cold, and the fetus does not expel naturally. Administering Heishen San (Black Spirit Decoction) to warm the fetus will allow it to be expelled naturally once the uterine temperature recovers. The medicinal ingredients include Fuzi (Aconiti Lateralis Radix Praeparata), Guixin (Cinnamomi Cortex), Ganjiang (Zingiberis Rhizoma), Danggui (Angelicae Sinensis Radix), Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), and Heidou (Sojae Semen Nigrum).
The *Daquan* (Great Compendium) states: If a pregnant woman is emaciated or complicated by other diseases, leading to deficiency and damage of the internal organs, and exhaustion of Qi and Blood, such that she cannot nourish the fetus, causing the fetal Qi to become unstable and ultimately unable to maintain the pregnancy, purgative methods may be employed to prevent harm to the mother.
Shenzhai commented: It has been stated that the internal organs are deficient and damaged, and Qi and Blood are exhausted, yet it is immediately suggested to use purgatives to avoid harming the mother. Does this not disregard the danger of cutting off the branches and damaging the roots?
The *Daquan* states: During the fifth to seventh week of pregnancy, if the abdomen is struck or bumped due to certain events, injuring the fetus, or if the fetus dies in the uterus with lochia already discharged, accompanied by unceasing pain and lockjaw nearly causing collapse, Shenmiao Foshou San (Miraculous Buddha's Hand Decoction) should be used for exploration/treatment. If the fetus is not injured, the pain will cease, and both mother and child will be safe. If the fetus is injured, it will be expelled immediately. This formula is also known as Xiong Tang (Ligusticum Decoction). It is further stated that this medicine treats blood loss due to fetal injury with miraculous efficacy.
The *Kuaijie Fangji* (Quick-Reference Prescriptions) states: To treat poison attacking the fetus, where toxic fumes rise upward, presenting external symptoms of tight jaw, inability to speak, rigid hands clenched in fists, spontaneous sweating, and slight fever—symptoms resembling wind-stroke before delivery. However, the pulse is floating and soft; the prognosis is ten deaths to one survival, and many physicians fail to recognize it. If treated as wind-stroke, death is inevitable. Use Bai Biandou (Dolichos Lablab Seed), two liang, raw, peeled and powdered, mixed with fresh water and taken orally for immediate effect.
The *Kuaijie Fangji* states: If a pregnant woman consumes poisonous substances or mistakenly takes herbal medicines, injuring the fetal Qi and causing continuous vaginal bleeding, if the fetus is not yet damaged, taking this medicine can stabilize the pregnancy; if the fetus is already dead, taking it will induce expulsion. The ingredients are Guizhi (Cinnamomi Ramulus), Taoren (Persicae Semen), Danpi (Moutan Cortex), Chishao (Paeoniae Radix Rubra), and Fuling (Poria), named Duoming Wan (Life-Seizing Pill), taken with light vinegar decoction. Zhu Danxi also praised its efficacy.
Shenzhai commented: The above seven items describe conditions of fetal injury prior to delivery. During pregnancy, improper diet or irregular daily routine can lead to fetal injury. The causes of fetal injury vary: there are fright, falls, and trauma; febrile diseases and various illnesses; impacts, poisons, and toxic foods—all of which can cause fetal injury. Diagnosis cannot rely solely on pulse reading; the physician must inquire repeatedly to ascertain the circumstances thoroughly, thereby enabling accurate syndrome differentiation and appropriate treatment.