妇人肠覃似孕,乃寒气客于肠外,与卫气相搏,气不得荣,因有所系,瘕而内着,恶气乃起,
肉乃生。其始生大如鸡卵,稍以益大,状如怀子,按之则坚,推之则移,月事以时下,此结气大肠,
为气病而血不病,故月事不断。当用散气之剂治之。其蓄血似孕,因多郁怒,经闭不月,腹渐大,初
时人以为孕,至过月不产,诸症渐见,此蓄血子门,为血病,当破血药下之。
凡孕妇出痘,热能动胎,胎落则气血衰败,而不能起发灌浆矣。故始终以安胎为主,外用细软之
帛,紧兜肚上,切不可用丁、桂燥热之品,及食牛虱毒物之类,以致触犯。其条芩、白术、艾叶、砂
仁之类,与痘相宜者,采而用之。其初发热,则以参苏饮发之,痘既出后,则多服安胎饮保之。渴
者,则用人参白术散加减;泻者,则用黄芩汤,合四君子
汤,内加诃子。血虚者,则以四物汤加托药;色灰白而起发较迟者,则用十全大补汤,去桂,服之。
总之,不问轻重,悉以清热安娠为主。更有孕妇出痘,正当盛时,忽临正产者,势必气血俱虚,亦只
以十全大补汤大补气血为主。虚寒者,少加熟附。若腹中微痛者,此恶露未尽也,宜四物汤,加干姜、
桂心、木香、黑豆,用熟地黄而去芍药。盖恐寒凉,有伤生气。然有当用者,酒炒用之。若寒战咬
牙,腹胀不渴,而足冷身热者,此乃脾胃内虚,外作假热也,宜参、 、归、附、木香之类,一、二
剂而愈者吉,不愈者凶。若孕妇肥胖者,则气居于表而慊于内也,人参可多,黄 宜少,多加带壳
缩砂,切忌脱蒂果子之类。至有痘将收靥,忽作泄泻,口渴饮水,小便短少,其痘胖壮红润者,此内热
也,宜五苓散,内加黄芩、芍药之类。若至滑泻不止,食少腹胀而足冷,痘色灰白,脉细无力者,
此犯五虚必死之症也。凡妇人方产之后,或半月左右,适逢出痘者,此无胎孕系累,惟气血尚虚。治
宜大补荣卫为主。若痘出多者,则加连翘、粘子之类。大便自利者,则用肉果、炮姜之类,余即照常
一例而治。至于孕妇出痘,在于初出之时胎落者,则血气虽为大虚,然热毒亦因走泄,兼之未经起胀
灌浆,则血气未曾外耗,倘非险逆,加以大补托里,每多得生。至于收靥之时胎落者,则毒已出表
消散,亦多无事,但重虚而元气易脱,倍宜补益耳。若正当起胀灌浆而胎落者,则气血衰败,内外
两虚,既不能逐毒以外出,则毒必乘虚而内攻,其为不救者多矣。
参苏饮
人参 紫苏 干葛 前胡 制夏 茯苓 陈皮(各等分) 枳壳(麦炒) 桔梗
木香 甘草(各减半)
黄芩汤 治热利。
黄芩 炙草 芍药(各等分) 大枣(五、七枚)
水煎服。
妇女患肠覃(肠道外的肿块)症状类似怀孕,这是因为寒气侵入肠道外部,与卫气相互搏结,导致气机运行受阻,无法濡养组织,从而在某处固定附着,形成瘕块并逐渐生长,恶邪之气由此产生,肉质增生。肿块初生时如鸡蛋大小,随后逐渐增大,形状如同怀胎,按压时感觉坚硬,推动时可以移动,月经仍能按时来潮。这是气机郁结于大肠,属于气分病变而血分未病,所以月经不断。治疗应当使用行气散结的方剂。
那种蓄血(瘀血积聚)症状类似怀孕的情况,多因长期抑郁或愤怒所致,导致闭经不来,腹部逐渐变大,起初人们误以为是怀孕,直到过了预产期仍未分娩,各种症状逐渐显现。这是瘀血积聚在子宫口,属于血分病变,应当使用破血逐瘀的药物将其攻下。
凡是孕妇出痘疹,热邪容易扰动胎元,若胎元坠落,则气血衰败,痘疹便不能正常起发和灌浆。因此,治疗始终以安胎为主。外用柔软的帛带紧紧兜住腹部,切不可使用丁香、肉桂等燥热性质的药物,以及食用牛虱等有毒食物,以免触犯禁忌。对于黄芩、白术、艾叶、砂仁等与痘疹病情相适应的药物,可以选用服用。在初期发热时,使用参苏饮来发散表邪;痘疹发出后,则多服用安胎饮以保护胎元。口渴者,用人参白术散加减治疗;腹泻者,用黄芩汤合四君子汤,内部加入诃子。血虚者,用四物汤加入托毒透疹的药物;痘色灰白且起发较迟者,用十全大补汤,去掉肉桂后服用。总之,无论病情轻重,都以清热安胎为主要原则。
另有孕妇出痘,正值痘疹旺盛之时,忽然临盆生产,势必导致气血俱虚,此时也只应以十全大补汤大补气血为主。若属虚寒证,可少量加入熟附子。如果腹中微痛,这是恶露未尽的表现,宜用四物汤,加入干姜、桂心、木香、黑豆,使用熟地黄但去掉芍药。这是担心寒凉药物损伤生机。然而若有必须使用的情况,需用酒炒制后使用。如果出现寒战咬牙、腹胀但不口渴、脚冷身热的症状,这是脾胃内部虚弱,外表出现假热的表现,宜用人参、[缺字]、当归、附子、木香等药物,服用一两剂痊愈为吉,不愈则为凶兆。若孕妇体型肥胖,则是气行于体表而内部亏虚,人参用量可稍多,黄芪用量宜少,多加带壳的缩砂仁,切忌食用脱蒂的果子之类。等到痘疹即将收靥(结痂脱落)时,忽然发生泄泻,口渴想喝水,小便短少,而痘疹饱满壮实、红润,这是内热所致,宜用五苓散,内部加入黄芩、芍药等药物。如果发展到滑泻不止,饮食减少、腹胀且脚冷,痘色灰白,脉象细弱无力,这是犯了“五虚”的死症。
凡是妇女刚生产完,或者半个月左右,恰好遇到出痘疹的,因为没有胎元的牵累,只是气血尚且虚弱。治疗宜以大补营卫为主。如果痘疹出得较多,则加入连翘、粘子等药物。大便自利(自然通畅)的,则用肉果、炮姜等药物,其余照常一例治疗。至于孕妇出痘,在初出之时胎落(流产)的,虽然气血大为虚弱,但热毒也因流产而随之走泄,加之痘疹未经过起胀灌浆阶段,气血未曾大量外耗,如果不是险逆之症,加以大补托里的治疗,往往能够保全母子性命。至于在收靥之时胎落的,则毒邪已出表消散,也大多无事,只是身体极度虚弱,元气容易脱失,更应加倍进行补益。如果在正当起胀灌浆之时胎落,则气血衰败,内外两虚,既然不能驱逐毒邪向外排出,毒邪必定乘虚内攻,这种情况大多无法救治。
Intestinal polyps (a type of abdominal mass) in women may resemble pregnancy. This condition arises when cold pathogenic factors invade the exterior of the intestines and contend with Wei Qi (Defensive Qi), obstructing Qi circulation and preventing proper nourishment. Consequently, a mass forms and adheres internally, generating malignant Qi and causing tissue proliferation. Initially, the mass is the size of a chicken egg, gradually enlarging until it resembles a pregnant abdomen. It feels firm upon palpation but can be moved upon pushing. Menstruation continues to occur on schedule. This indicates Qi stagnation in the Large Intestine; it is a disorder of Qi rather than Blood, hence menstruation remains uninterrupted. Treatment should employ formulas that dissipate Qi and resolve masses.
Conversely, accumulated Blood (Blood stasis) resembling pregnancy often results from chronic depression or anger, leading to amenorrhea and gradual abdominal distension. Initially mistaken for pregnancy, symptoms become apparent when delivery does not occur past the expected date. This represents Blood accumulation at the uterine os; it is a disorder of Blood and should be treated with blood-breaking purgatives.
In cases where pregnant women develop smallpox (or similar exanthematous diseases), heat pathogens may disturb the fetus. If the fetus is expelled, Qi and Blood decline, preventing the rash from erupting and suppurating properly. Therefore, the primary treatment principle throughout is to calm the fetus. Externally, soft silk bands should be used to tightly support the abdomen. One must strictly avoid drying and heating herbs such as Dingxiang (Caryophylli Flos) and Rongui (Cinnamomi Cortex), as well as toxic foods like cow lice. Herbs compatible with the disease state, such as Huangqin (Scutellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Aiyè (Artemisiae Argyi Folium), and Sharen (Amomi Fructus), should be selected for use. During the initial fever stage, Shen Su Yin (Ginseng and Perilla Decoction) is used to release the exterior. After the eruption, An Tai Yin (Fetus-Calming Decoction) is administered frequently to protect the fetus. For thirst, Ren Shen Bai Zhu San (Ginseng and Atractylodes Macrocephala Powder) is modified. For diarrhea, Huang Qin Tang (Scutellaria Decoction) combined with Si Jun Zi Tang (Four Gentlemen Decoction) is used, with Hezi (Chebulae Fructus) added internally. For Blood deficiency, Si Wu Tang (Four Substances Decoction) is used with herbs that support toxin expulsion. For rashes that are grayish-white and erupt slowly, Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) is used with Rongui (Cinnamon Twig) removed. In summary, regardless of severity, clearing heat and calming the fetus are the main principles.
If a pregnant woman delivers during the peak of the eruption, Qi and Blood will inevitably be deficient. The primary treatment remains Shi Quan Da Bu Tang to greatly tonify Qi and Blood. For deficiency-cold patterns, a small amount of Shu Fuzi (Prepared Aconite Lateralis Radix) may be added. Mild abdominal pain indicates incomplete lochia discharge; Si Wu Tang is prescribed with Gan Jiang (Zingiberis Rhizoma), Guixin (Cinnamomi Ramulus), Muxiang (Aucklandiae Radix), and Heidou (Sojae Semen Nigrum), using Shu Dihuang (Rehmanniae Radix Preparata) but removing Shaoyao (Paeoniae Radix). This avoids cold-natured herbs that might damage vital energy. However, if necessary, these herbs should be processed with wine. Symptoms such as chills, teeth grinding, abdominal distension without thirst, cold feet, and body heat indicate internal Spleen-Stomach deficiency manifesting as external false heat. Formulas containing Renshen (Ginseng), [missing character], Danggui (Angelicae Sinensis Radix), Fuzi (Aconiti Lateralis Radix Preparata), and Muxiang are indicated. Recovery within one or two doses is auspicious; otherwise, the prognosis is ominous. Obese pregnant women have Qi circulating superficially while being deficient internally; thus, Renshen dosage may be increased, while Huangqi (Astragali Radix) should be decreased. More Keduo Suansha (Cardamomi Fructus cum Calice) should be added. Dried fruits detached from the stem should be strictly avoided. When the rash is about to crust over, sudden diarrhea, thirst, scanty urine, yet plump, robust, and red rashes indicate internal heat. Wuling San (Five-Ingredient Powder with Poria) is prescribed with Huangqin and Shaoyao added. If this progresses to incontinence, poor appetite, abdominal distension, cold feet, grayish-white rashes, and a fine, weak pulse, it constitutes the "Five Deficiencies" syndrome, which is fatal.
For women who develop eruptions immediately postpartum or around half a month after delivery, there is no fetal burden, only Qi and Blood deficiency. Treatment focuses on greatly tonifying Ying (Nutritive) and Wei (Defensive) Qi. If many eruptions appear, add Lianqiao (Forsythiae Fructus) and Zhizi (Gardeniae Fructus). If bowel movements are normal, use Rouguo (Myristicae Semen) and Paojiang (Zingiberis Rhizoma Preparata); other treatments follow standard protocols. If a pregnant woman miscarries during the early eruption stage, although Qi and Blood are severely depleted, the heat-toxin is also expelled along with the fetus. Since the rash has not yet progressed to swelling and suppuration, external consumption of Qi and Blood is limited. With major tonifying and supporting therapies, survival is often possible. If miscarriage occurs during the crusting stage, the toxin has already exited the surface and dissipated; usually, there are no complications, though extreme deficiency requires doubled tonification to prevent Yuan Qi collapse. If miscarriage occurs during the swelling and suppuration stage, Qi and Blood are exhausted, resulting in both internal and external deficiency. Unable to expel toxins outward, the toxins attack inward, making recovery unlikely.
Shen Su Yin: Renshen (Ginseng), Zisu (Perillae Folium), Gange (Puerariae Radix), Qianhu (Peucedani Radix), Zhi Banxia (Pinelliae Rhizoma Preparatum), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium) in equal parts; Zhike (Aurantii Fructus Immaturus, wheat-bran fried), Jiegeng (Platycodonis Radix), Muxiang (Aucklandiae Radix), Gancao (Glycyrrhizae Radix et Rhizoma) in half portions.
Huang Qin Tang: Treats heat-type dysentery. Huangqin (Scutellariae Radix), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Shaoyao (Paeoniae Radix) in equal parts; Dazao (Ziziphi Jujubae Fructus) 5-7 pieces. Decoct in water and take orally.