妊娠胎逆上逼,重则胀满疼痛,谓之子悬,紫苏饮为必用之药。盖因紫苏饮为治妊娠胎气不和,
浊气举胎上凑,胎热气逆,心胃胀满之症,且此症挟气者居多,宜疏气舒郁,非紫苏、腹皮、川芎、
陈皮无以流气,非归、芍无以养血,气血既利而胎自降。然邪之所凑,其气必虚,故以人参、甘草
补之。大抵胎气上逆,皆属火旺,急用芩、术、香附之类,不可服大寒之药,反致他变。予每治孕
妇心胃胀满。用尊生和气饮甚效。子悬,症有两尺脉绝,余脉平和,不可错认死胎,且死胎有面青、
舌青可辨,宜紫苏饮治之,则胎归原位,胀消脉起矣。如月胎上逼心,呕哕欲死,急用童便灌之即
下,或乌梅肉十枚研烂,入生姜三片,煎汤灌之亦下,取酸以降敛之,兼辛以散火气之逆也。又有因
坐草太早,心怀恐惧,气结不行,紫苏饮一服便产。
尊生和气饮 治孕妇心胃胀满。
人参 苏梗 白芍(酒炒) 川芎(各六分) 当归(一钱或六分酒洗) 腹皮(五分制净)
木香(二分磨冲) 炙草(三分)
妊娠吐血,凡七情内伤,六淫外感,皆足致失血之患。一主火热者,以气血壅养胎元,或有所感,
则气逆而火上乘,心烦满闷,血随而溢,甚者或致坠胎。但火有虚实之分,实火,清热养血;虚火,
滋阴补水,则血安胎固。若泛用行血、清血之剂,胎必坠而祸不旋踵矣。
鼻衄不止,东垣凉膈散,加当归、生地各一钱,茅花一大团,生姜(引)。
咳嗽咳血,宜凉血地黄汤。《医通》云∶咳嗽咯衄,胎前皆不宜见,如面赤声哑,不治。又云∶
凡咯吐血,多致坠胎,胎赖血养,不宜漏溢,宜紫苏饮加条芩。
尿血乃热乘血分,流渗于脬,故令尿血自尿门而下,若胎漏则自人门下血可辨。宜四物加山栀、
发灰,或阿胶、熟地、麦冬、五味之类。如怒动肝火,小柴胡加山栀;脾气下陷及劳动脾火,补中益
气加茯苓、车前;若浓味积热,加味清胃散;若肝脾血流,加味逍遥散。
肠风脏毒下血者,平胃散去苍术,加槐角、防风、当归、乌梅治之。
凉血地黄汤 治妊娠咳嗽、吐血、咳血。
生地(三钱) 麦冬(去心) 当归(各二钱酒洗) 黄芩(一钱半) 紫菀 知母(盐水炒)
白术(土炒) 天冬(去心各一钱) 犀角(八分) 陈皮 甘草(各四分)
水煎。有喘加栝蒌仁一钱。
加味清胃散 治胃中蕴热,斑疹,口舌生疮,齿龈腐烂出血。
生地(四钱) 丹皮(五钱) 当归 川连(酒蒸) 连翘(去心各三钱) 升麻 生草(各一钱五分)
妊娠期间胎气上逆逼迫,严重时出现腹部胀满疼痛,这种病症称为“子悬”,紫苏饮是治疗此症的必用方药。这是因为紫苏饮专门用于治疗妊娠期胎气不和,导致浊气上举、胎气受热上逆,从而引起心胃部位胀满的症状。而且这类病症多伴有气机郁滞,适宜采用疏理气机、舒展郁结的方法;如果不使用紫苏、大腹皮、川芎、陈皮就无法流通气机,不使用当归、白芍就无法滋养血液,气血通畅后胎气自然下降。然而邪气聚集之处,正气必然虚弱,所以用人参、甘草来补益正气。大致来说,胎气上逆多属于火旺所致,应紧急使用黄芩、白术、香附之类的药物,不可服用过于寒凉的药物,否则反而会导致其他变证。我每次治疗孕妇心胃胀满,使用尊生和气饮效果显著。
子悬症表现为两尺脉象消失(绝),其余脉象平和,不可误认为是死胎。且死胎可以通过面色发青、舌质发青来辨别,适宜用紫苏饮治疗,这样胎气回归原位,胀满消除,脉象也会恢复。如果胎儿上逼心脏,呕吐剧烈欲死,紧急灌服童便即可缓解,或者取十枚乌梅肉研烂,加入生姜三片,煎汤灌服也能缓解,这是利用酸味来降敛气逆,兼用辛味来散除火气之逆。又有因坐草(临产准备)太早,心中恐惧,导致气机郁结不行,服用一剂紫苏饮即可分娩。
尊生和气饮:治疗孕妇心胃胀满。
人参、苏梗、白芍(酒炒)、川芎(各六分)、当归(一钱或六分,酒洗)、大腹皮(五分,制净)、木香(二分,磨汁冲服)、炙甘草(三分)。
妊娠期间吐血,凡是七情内伤或六淫外感,都足以导致失血的祸患。主要病机在于火热,因为气血壅盛以供养胎元,若有所感触,则气机上逆而火邪上乘,导致心烦闷乱,血液随之溢出,严重时甚至导致堕胎。但火邪有虚实之分,实火需清热养血;虚火需滋阴补水,这样血液才能安宁,胎元得以稳固。如果泛用行血、清血的药剂,胎元必定坠落,灾祸随即而至。
鼻衄不止,可用东垣的凉膈散,加入当归、生地各一钱,茅花一大团,生姜作为引经药。
咳嗽咳血,适宜使用凉血地黄汤。《医通》记载:咳嗽咯血,在妊娠期间都不宜出现,如果出现面赤声哑,属于不治之症。又说:凡是咯吐鲜血,多会导致堕胎,因为胎赖血养,不宜漏溢,适宜用紫苏饮加条芩(黄芩)。
尿血是由于热邪侵入血分,流渗于膀胱,所以尿液从尿道排出带血,若为胎漏(先兆流产出血),则血液从阴道排出,二者可以辨别。适宜用四物汤加山栀、发灰,或者阿胶、熟地、麦冬、五味子之类的药物。如果是怒动肝火,用小柴胡汤加山栀;脾气下陷及劳动导致的脾火,用补中益气汤加茯苓、车前子;若是浓味积热,用加味清胃散;若是肝脾血流不畅,用加味逍遥散。
肠风脏毒下血者,用平胃散去苍术,加槐角、防风、当归、乌梅治疗。
凉血地黄汤:治疗妊娠咳嗽、吐血、咳血。
生地(三钱)、麦冬(去心)、当归(各二钱,酒洗)、黄芩(一钱半)、紫菀、知母(盐水炒)、白术(土炒)、天冬(去心,各一钱)、犀角(八分)、陈皮、甘草(各四分)。水煎服。若有气喘,加栝蒌仁一钱。
加味清胃散:治疗胃中蕴热,斑疹,口舌生疮,齿龈腐烂出血。
生地(四钱)、丹皮(五钱)、当归、川连(酒蒸)、连翘(去心,各三钱)、升麻、生甘草(各一钱五分)。
During pregnancy, if the fetal qi rebels and presses upward, causing severe abdominal distension and pain, this condition is termed "Zixuan" (Fetal Suspension). Zisu Yin (Perilla Decoction) is an essential prescription for treating it. This is because Zisu Yin specifically treats disharmony of fetal qi during pregnancy, where turbid qi rises and pushes the fetus upward, causing fetal heat and rebellious qi, leading to fullness and distension in the heart and stomach. Moreover, such conditions are mostly accompanied by Qi stagnation; it is appropriate to regulate Qi and relieve depression. Without Perillae Folium (Zisu), Tugong Fructus (Fupi), Chuanxiong Rhizome (Chuanxiong), and Tangerine Peel (Chenpi), Qi cannot flow freely; without Angelicae Sinensis Radix (Danggui) and Paeoniae Radix Alba (Baishao), Blood cannot be nourished. Once Qi and Blood are unobstructed, the fetal qi naturally descends. However, where pathogenic factors gather, Zheng Qi (Upright Qi) must be deficient; therefore, Ginseng Radix et Rhizoma (Renshen) and Glycyrrhizae Radix et Rhizoma Preparata (Zhigancao) are used to tonify deficiency. Generally, rebellious fetal qi belongs to excessive Fire; one should urgently use Scutellariae Radix (Huangqin), Atractylodis Macrocephalae Rhizoma (Baizhu), and Cyperi Rhizoma (Xiangfu), and must not administer overly cold medicines, lest they cause other complications. Whenever I treat pregnant women with heart and stomach distension, Zunsheng Heqi Yin (Harmonizing Qi Decoction for Respectful Life) yields excellent results.
The symptom of Zixuan presents with the absence of pulse at both Chi positions (Kidney pulses), while other pulses remain peaceful; it must not be mistaken for a dead fetus. A dead fetus can be distinguished by a bluish complexion and bluish tongue color. It is appropriate to treat it with Zisu Yin, after which the fetal qi returns to its original position, distension subsides, and the pulse reappears. If the fetus presses against the heart causing severe vomiting and retching, urgently administering child's urine (Tongbian) will provide relief. Alternatively, ten pieces of Mume Fructus flesh (Wumei Rou) can be mashed, mixed with three slices of Zingiberis Rhizoma Recens (Shengjiang), decocted in water, and administered orally. This utilizes the sour flavor to descend and astringe rebellious Qi, combined with the pungent flavor to disperse rebellious Fire Qi. In cases where labor preparation begins too early, causing fear and anxiety that leads to Qi knotting and stagnation, a single dose of Zisu Yin may induce delivery.
Zunsheng Heqi Yin: Treats heart and stomach distension in pregnant women.
Ren Shen (Ginseng Radix et Rhizoma), Su Geng (Perillae Caulis), Bai Shao (Paeoniae Radix Alba, stir-fried with wine), Chuan Xiong (Chuanxiong Rhizoma) — each 6 fen; Dang Gui (Angelicae Sinensis Radix) — 1 qian or 6 fen (washed with wine); Fu Pi (Tugong Fructus, processed and cleaned) — 5 fen; Mu Xiang (Aucklandiae Radix, ground and taken as juice) — 2 fen; Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) — 3 fen.
Hematemesis during pregnancy, whether caused by internal injury from the Seven Emotions or external invasion by the Six Excesses, is sufficient to cause hemorrhage. The primary pathogenesis involves Heat-Fire. Since Qi and Blood are abundant to nourish the fetal origin, any disturbance causes Qi to rebel and Fire to ascend, resulting in mental restlessness and chest oppression, with blood overflowing accordingly. In severe cases, this may lead to abortion. However, Fire has deficiency and excess types: Excess Fire requires clearing Heat and nourishing Blood; Deficient Fire requires nourishing Yin and supplementing Water, thereby stabilizing the blood and securing the fetus. If hemostatic or blood-cooling agents are indiscriminately used, the fetus will inevitably abort, and disaster will follow immediately.
Epistaxis that does not stop: Use Dongyuan's Liangge San (Cooling the Diaphragm Powder), adding Dang Gui (Angelicae Sinensis Radix) and Shu Di Huang (Rehmanniae Radix Preparata) each 1 qian, a large bunch of Mao Hua (Euphrasiae Herba or similar herb associated with stopping bleeding), and Sheng Jiang (Zingiberis Rhizoma Recens) as a guiding drug.
Cough with hemoptysis: Liangxue Dihuang Tang (Blood-Cooling Rehmannia Decoction) is appropriate. *Yitong* states: Cough with hemoptysis should not appear during pregnancy; if accompanied by red face and hoarse voice, it is incurable. It also states: Hemoptysis often leads to abortion, as the fetus relies on Blood for nourishment and leakage is unfavorable. It is appropriate to use Zisu Yin plus Tiao Qin (Scutellariae Radix/Huangqin).
Hematuria occurs when Heat invades the Blood level and seeps into the Bladder, causing blood to exit via the urethra. This can be distinguished from Taileu (threatened miscarriage bleeding), where blood exits via the vagina. Treatment is appropriate with Siwu Tang (Four Substances Decoction) added with Zhizi (Gardeniae Fructus) and Fa Hui (Hair Ash), or Ejiao (Colla Corii Asini), Shu Di Huang (Rehmanniae Radix Preparata), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). If anger stirs Liver Fire, use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhizi; if Spleen Qi sinks or Labor-induced Spleen Fire arises, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Cheqianzi (Plantaginis Semen); if accumulated heat from rich flavors occurs, use Jiawei Qingwei San (Modified Clear Stomach Powder); if Liver and Spleen Blood flow is obstructed, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).
For lower gastrointestinal bleeding due to Changfeng (Intestinal Wind) or Zhangdu (Visceral Toxin), use Pingwei San (Calm the Stomach Powder) minus Cangzhu (Atractylodis Rhizoma), added with Huaijiao (Gleditsiae Sinensis Fructus), Fangfeng (Saposhnikoviae Radix), Dang Gui (Angelicae Sinensis Radix), and Wumei (Mume Fructus).
Liangxue Dihuang Tang: Treats cough, hematemesis, and hemoptysis during pregnancy.
Sheng Di Huang (Rehmanniae Radix) — 3 qian; Maidong (Ophiopogonis Radix, heart removed); Dang Gui (Angelicae Sinensis Radix) — each 2 qian (washed with wine); Huang Qin (Scutellariae Radix) — 1.5 qian; Zi Wan (Asteris Radix); Zhi Mu (Anemarrhenae Rhizoma, stir-fried with salt water); Bai Zhu (Atractylodis Macrocephalae Rhizoma, earth-stir-fried); Tian Dong (Asparagi Radix, heart removed) — each 1 qian; Xi Jiao (Rhino Ceratops Horn) — 8 fen; Chen Pi (Citri Reticulatae Pericarpium); Gan Cao (Glycyrrhizae Radix et Rhizoma) — each 4 fen. Decoct in water. If wheezing is present, add Gualou Ren (Trichosanthis Semen) 1 qian.
Jiawei Qingwei San (Modified Clear Stomach Powder): Treats heat accumulation in the Stomach, macules and rashes, mouth and tongue sores, and gingival rotting with bleeding.
Sheng Di Huang (Rehmanniae Radix) — 4 qian; Dan Pi (Moutan Cortex) — 5 qian; Dang Gui (Angelicae Sinensis Radix); Chuan Lian (Coptidis Rhizoma, steamed with wine); Lian Qiao (Forsythiae Fructus, heart removed) — each 3 qian; Sheng Ma (Cimicifugae Rhizoma); Sheng Gan Cao (Raw Licorice Root) — each 1.5 qian.