汪石山曰∶徐之才与巢元方,有十月养胎用药之法,当逐月详其所属之经,气血虚实,而用是经之药,虚则
补之,壅者疏之,热则凉之,寒者温之,不可汗下,及利小便。盖胎元必赖气血以养,若汗则亡阳伤气,下则
亡阴伤血,利小便则伤精液。是以三者,皆在所忌。凡胎前病,总以养血、健脾、清热、疏气为主。
慎斋按∶十月分经养胎之说,创自巢元方《病源论》。夫巢氏为隋代名医,张子和叹其谬立名色。故云支派
之分,自巢氏始。《病源》之失,亦自巢氏始。即如受胎,始于命门子户,人身十二经气血,俱翕聚以养胎元,
岂有某经养某月胎之理。而陈良甫附会其说,以五行分发四时,安养胎法,尤无理甚矣。若
徐之才,又因元方、良甫之谬,而以十月分发某月见某证,则用某药立方主治,分列条下。夫孕妇胎前,病邪
百出,岂有限于某月必见某证,执用某方以治之,不但胶柱鼓瑟,直是齐东之语,荒诞不稽者也。故存巢陈二
论,删去徐氏十条,以正《妇人良方》讹以传讹之失。汪石山见理甚明,亦从而称述之,何欤?
汪石山曰∶妊娠必须清热调血,使血循经,以养其胎。故丹溪用黄芩、白术,为安胎圣药。盖胎之成,由母
之气血蓄聚以养之,气血既聚则易郁。是以先哲多用黄芩清热,香附开郁也。
汪石山说:徐之才与巢元方,提出了怀孕十个月养胎用药的方法,应当逐月详细考察所属的经络,以及气血的虚实情况,然后使用对应经络的药物。虚证则补益它,气机壅滞则疏通它,热证则用凉性药,寒证则用温性药,不可使用发汗、攻下及通利小便的方法。因为胎元的形成必然依赖气血来滋养,如果发汗则会耗伤阳气损伤正气,攻下则会耗伤阴液损伤血液,通利小便则会损伤精液。因此这三种方法都在禁忌之列。大凡妊娠前的疾病,总以养血、健脾、清热、疏理气机为主。
慎斋按语:按照月份分经养胎的说法,创始于巢元方的《诸病源候论》。巢氏是隋代的著名医家,张子和感叹他谬误地创立了各种病名分类。所以说医学流派的分支,从巢氏开始;《诸病源候论》的失误,也从巢氏开始。就像受孕,起始于命门和子户(子宫),人身十二经络的气血,都汇聚在一起以滋养胎元,哪里有某条经络专门在某个月份养胎的道理。而陈良甫附和这种说法,用五行分配四季,制定安胎方法,更是荒谬至极。至于徐之才,又因为巢元方、陈良甫的错误,将十月分别对应某月出现某种证候,就使用某种药物组成方剂主治,分条列在下文。孕妇在妊娠期间,病邪变化多端,怎么会有限制在某月必定出现某种证候,执着地使用某个方剂来治疗的道理?这不仅是拘泥固执,简直是齐东野老之语,荒诞不经且无法考证的。所以保留巢元方和陈良甫的理论,删去徐之才的十条内容,以纠正《妇人良方》以讹传讹的错误。汪石山见解非常明确,也进而称述这一观点,这是为什么呢?
汪石山说:妊娠必须清热调血,使血液循行于经脉之中,以滋养胎儿。所以朱丹溪使用黄芩、白术,作为安胎的圣药。大概胎儿的形成,是由母亲的气血蓄积汇聚来滋养的,气血既然汇聚就容易郁结。因此先贤多用黄芩清热,香附开郁解结。
Wang Shishan stated: Xu Zhicai and Chao Yuanfang proposed methods for medicinally nourishing the fetus over ten months of pregnancy. One should examine month by month which meridians are involved, as well as the deficiency or excess of Qi and Blood, and then use herbs corresponding to those meridians. For deficiency, tonify it; for stagnation, unblock it; for heat, cool it; for cold, warm it. Sweating (diaphoresis), purgation, and promoting urination must not be used. This is because the fetal origin relies on Qi and Blood for nourishment. If sweating is induced, Yang Qi is lost and Zheng Qi (Upright Qi) is damaged; if purgation is used, Yin fluids are lost and Blood is damaged; if urination is promoted, Essence and Body Fluids are damaged. Therefore, these three methods are all contraindicated. Generally, diseases during pregnancy should primarily focus on nourishing Blood, strengthening the Spleen, clearing Heat, and regulating Qi.
Shenzhai commented: The theory of nourishing the fetus by meridians according to specific months originated from Chao Yuanfang's *Zhu Bing Yuan Hou Lun* (Treatise on the Pathogenesis and Symptoms of All Diseases). Chao was a famous physician of the Sui Dynasty; Zhang Zihe lamented his erroneous creation of disease categories. Thus, it is said that the branching of medical schools began with Chao, and the flaws in *Zhu Bing Yuan Hou Lun* also began with him. Regarding conception, it starts at the Mingmen (Gate of Life) and Zihu (Sub-house/Uterus). The Qi and Blood of the twelve meridians of the body gather together to nourish the fetal origin. How could there be a principle where one specific meridian nourishes the fetus in a specific month? Chen Liangfu later forced this theory upon the Five Elements distributed across four seasons, formulating methods for calming the fetus, which was extremely illogical. Furthermore, Xu Zhicai, following the errors of Chao Yuanfang and Chen Liangfu, assigned specific symptoms appearing in specific months over ten months, prescribing specific herbs and formulas for treatment, listed item by item. However, pathogenic factors in pregnant women during gestation are myriad and variable. How can it be limited to certain symptoms appearing only in certain months, rigidly using specific formulas for treatment? This is not only inflexible and dogmatic but also akin to the absurd tales of Qidong—wild, unreasonable, and unverifiable. Therefore, the theories of Chao and Chen were retained, while Xu’s ten points were deleted to correct the error of passing down mistakes found in *Fu Ren Liang Fang* (Good Prescriptions for Women). Wang Shishan saw the truth clearly and further expounded upon it. Why is this?
Wang Shishan stated: In pregnancy, one must clear Heat and regulate Blood, ensuring Blood circulates within the meridians to nourish the fetus. Therefore, Zhu Danxi used Huangqin (Scutellariae Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) as the sacred medicines for calming the fetus. The formation of the fetus depends on the accumulation and gathering of the mother's Qi and Blood for nourishment. Once Qi and Blood gather, they are prone to stagnation. Hence, ancient sages often used Huangqin to clear Heat and Xiangfu (Cyperi Rhizoma) to resolve stagnation.