许学士曰∶妇人妊娠,唯在抑阳助阴。然胎前药,最恶群队。若阴阳交错,别生他病。唯南山道士枳壳散,
所以抑阳。四物汤,所以助阴。但枳壳散少寒,单服之,恐有胎寒腹痛之患。以内补丸佐之,则阳不至强,阴
不至弱,阴阳调而胎孕安。此前人未尝论及也。
娄全善曰∶观许学士论枳壳、四物、内补三方,人皆用之,何如?大率妊妇唯在抑阳助阴。经云∶阴搏阳
别,谓之有子。盖关前为阳,关后为阴,尺中之脉,按之搏手不绝者,妊也。妇人平居,阳气微盛,无他病。
及妊子,则经闭以养胎。若阳气盛搏之,则经脉妄行,胎始不固,故贵抑阳助阴。但枳壳散少寒,内补丸佐之,
则阴阳调和,而胎气自安矣。
朱丹溪曰∶世之难产者,往往见于郁闷安佚之人,富贵豢养之家。若贫贱辛苦者,无有也。方书止有瘦胎
饮一论,其方为湖阳公主设也,实非极至之言。彼湖阳公主,奉养太过,其气必实,耗其气,使之和平,故易
产。此南山道士进瘦胎、枳壳散,抑阳降气,为众方之冠,温隐居加木香、当归佐之。若形肥人,知其气必虚,
久坐知其气不运,而气愈弱,儿在胞胎,因母气不能自运,故难
产。当补其母之气,则儿健易产矣。遂于《大全方》紫苏饮,加参、术补气药,随母形色禀性,参时加减,名曰
达生散,人参、白术、白芍、当归、腹皮、紫苏、陈皮、甘草,加枳壳、砂仁。
慎斋按∶以上五条,序胎前用方之大略也。胎前用药,清热养血为主。而清热养血之后,唯以补脾为要,
此培后天元气之本也。若养葵则不用芩、术,而以地黄饮加杜、续以补肾。夫胎系于肾,肾固则胎自安,此补
脾不如补肾之要妙也。许学士内补丸已启其端,赵氏从而发明之,可谓扶安胎之秘旨矣。
许学士说:妇女妊娠期间,关键在于抑制阳气、资助阴气。然而,妊娠期间的用药,最忌讳药物杂乱无章。如果阴阳之气交错混乱,就会引发其他疾病。只有南山道士的枳壳散,是用来抑制阳气的;四物汤,是用来资助阴气的。但是枳壳散药性偏寒,单独服用,恐怕会导致胎寒腹痛的隐患。如果用内补丸来辅助它,那么阳气就不会过盛,阴气也不会虚弱,阴阳调和,胎孕就能安稳。这是前人未曾论述过的观点。
娄全善说:看许学士关于枳壳散、四物汤、内补丸这三方的论述,大家都使用它们,怎么样?大体上孕妇的关键在于抑制阳气、资助阴气。医经中说:“阴脉搏动而区别于阳脉,称为怀孕。”大概关前部位属阳,关后部位属阴,尺部的脉象,按之搏指有力且不绝断的,就是怀孕。妇女平时生活,阳气略微旺盛,没有其它疾病。等到怀孕后,月经闭止以滋养胎儿。如果阳气盛实搏击经脉,就会导致经脉妄行,胎元始而不稳固,所以贵在抑制阳气、资助阴气。但是枳壳散药性偏寒,用内补丸来辅助它,那么阴阳调和,胎气自然安稳了。
朱丹溪说:世间的难产者,往往出现在郁闷安逸的人身上,也就是富贵人家豢养出来的人。如果是贫贱辛苦劳作的人,就没有这种情况。医书中只有瘦胎饮这一种论述,这个方子是为湖阳公主制定的,实际上并不是极致的言论。那位湖阳公主,奉养太过分,她的体质必然实盛,消耗她的气血,使身体恢复平和,所以容易生产。这是南山道士进献瘦胎饮、枳壳散,抑制阳气、降下气机,在众多方剂中居于首位,温隐居在此基础上加入木香、当归来辅助它。如果是形体肥胖的人,知道他的气必然虚弱,久坐不动知道他的气机不运行,因而气更加衰弱,胎儿在胞胎中,因为母亲的气不能自行运化,所以难产。应当补益母亲的气,那么胎儿健壮就容易生产了。于是我在《大全方》紫苏饮的基础上,加入人参、白术等补气药,根据母亲的形体特征和禀赋性格,随时进行加减,命名为达生散,药物包括人参、白术、白芍、当归、腹皮、紫苏、陈皮、甘草,再加入枳壳、砂仁。
慎斋按语:以上五条,叙述了胎前用药的大致原则。胎前用药,以清热养血为主。而在清热养血之后,唯有补脾是关键,这是培补后天元气根本的方法。如果是养葵(此处疑为特定病症或人名,依原文直译),则不用黄芩、白术,而是用地黄饮加杜仲、续断来补肾。胎儿系于肾,肾气坚固则胎元自然安稳,这是补脾不如补肾的要妙之处。许学士的内补丸已经开启了这一端绪,赵氏进而加以阐发,可以说是扶持安胎的秘旨了。
Xu Xueshi stated: In women during pregnancy, the key lies in suppressing Yang and assisting Yin. However, for medications used during pregnancy, it is most undesirable to have a chaotic mixture of herbs. If Yin and Yang energies become intermixed and disordered, other diseases may arise. The Zhiqiao San (Bitter Orange Powder) by the Daoist of Nanshan Mountain is used to suppress Yang; the Siwu Tang (Four Substances Decoction) is used to assist Yin. However, Zhiqiao San has a slightly cold nature, and taking it alone may cause the risk of fetal coldness and abdominal pain. By using Neibu Wan (Internal Supplement Pill) as an adjuvant, Yang will not become excessive, and Yin will not become deficient; when Yin and Yang are harmonized, the pregnancy will be secure. This is a point not previously discussed by earlier scholars.
Lou Quanshan said: Regarding Xu Xueshi’s discussion on the three formulas—Zhiqiao San, Siwu Tang, and Neibu Wan—and their widespread use, what is your opinion? Generally, for pregnant women, the principle is to suppress Yang and assist Yin. The Classics state: "When the Yin pulse beats distinctly separate from the Yang, it indicates pregnancy." Roughly speaking, the area before the cun position belongs to Yang, and the area after belongs to Yin. If the pulse at the chi position feels vigorous and unceasing upon pressure, it indicates pregnancy. When a woman is not pregnant, her Yang energy is slightly abundant, and she suffers no other illness. Once pregnant, menstruation ceases to nourish the fetus. If Yang energy becomes excessively strong and clashes with the meridians, it causes erratic flow in the vessels, making the fetus unstable. Therefore, it is crucial to suppress Yang and assist Yin. Since Zhiqiao San is slightly cold, using Neibu Wan as an adjuvant harmonizes Yin and Yang, thereby stabilizing the fetal qi naturally.
Zhu Danxi stated: Difficult labor often occurs in individuals who are prone to depression and live in ease, typically those raised in wealthy families. It rarely happens among the poor and hardworking. Medical texts only contain one discussion on Shoutai Yin (Fetus-Thinning Drink), which was formulated for Princess Huyang. It is not, however, the ultimate truth. Princess Huyang received excessive nourishment, so her constitution was likely excess and robust; consuming her Qi to restore balance made childbirth easier. The Daoist of Nanshan Mountain presented Shoutai Yin and Zhiqiao San to suppress Yang and descend Qi, ranking them among the best formulas. Wuyin Jushi added Muxiang (Aucklandiae Radix) and Danggui (Angelicae Sinensis Radix) to assist them. For obese individuals, we know their Qi is likely deficient; prolonged sitting indicates stagnant Qi movement, leading to further weakness. The fetus, residing in the womb, relies on the mother's Qi for movement; if the mother's Qi cannot function autonomously, difficult labor ensues. One should tonify the mother's Qi so that the fetus becomes strong and delivery is facilitated. Thus, I modified the Zisu Yin (Perilla Leaf Decoction) from *Daquan Fang* by adding Qibi (Qi-tonifying) herbs such as Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). Adjusted according to the mother's physique and constitutional type, it was named Dasheng San (Reaching Life Powder). Its ingredients include Renshen, Baizhu, Baishao (Paeoniae Radix Alba), Danggui, Fupi (Citri Reticulatae Pericarpium), Zisu (Perillae Folium), Chenpi (Tangerine Peel), Gancao (Licorice Root), along with Zhiqiao and Sharen (Amomi Fructus Rotundus).
Shenzhai commented: The above five points outline the general principles of prescribing during pregnancy. Medications for pregnancy primarily focus on clearing heat and nourishing blood. After clearing heat and nourishing blood, the most critical step is tonifying the Spleen, which is the foundation of cultivating postnatal Yuan Qi (Original Energy). In cases like Yangkui, Huangqin (Scutellariae Radix) and Baizhu are not used; instead, Dihuang Yin (Rehmannia Decoction) is combined with Duzhong (Eucommiae Cortex) and Xuduan (Dipsaci Radix) to tonify the Kidney. The fetus is anchored by the Kidney; if the Kidney is solid, the fetus remains secure. This reveals the subtle superiority of tonifying the Kidney over tonifying the Spleen in certain contexts. Xu Xueshi’s Neibu Wan initiated this line of thought, which Zhao Shi further elucidated, truly uncovering the secret principles of supporting fetal security.