凡孕妇诸症别无他故,因受胎之后,气血有方,不能滋养其胎而母病至矣。气血既虚,使胎不
安于母腹,须大补气血,则胎自安。有胎动而母病者,安其胎,母病愈。盖胎前患病,以安胎办主。
若胎孕一动,病必难治,医须慎之。
夫产后之患多起于风寒、饮食之间,其余则血气为患。夏月之病多因于风,冬月之病多因于寒,
惟饮食之患无定时也。盖易产之后,其病易治;难产之后,其病难治。难产必深感风寒,兼气血极虚,
虽略进饮食,力不能胜,亦为之患也。产后诸症,多类伤寒,莫作伤寒治之,更莫作杂症治之。此
乃女科不传之诀,医者切莫狐疑。其治法前后不同,二十日前气血未定,恶露未尽,当破血为主;
二十日外气血已定,各归经络,虽有恶露,驱逐不行。凡有诸症要补气血,更兼活血,诸书以月外
作杂症治之,其言谬矣。
经水或一、二月一至,或期年一至,不甚瘦弱者,此气盛血衰也。慎勿作血隔治,当补血为主∶
当归(三钱) 川芎(二钱) 芍药 生地 丹参 玄胡 小茴 牛膝 苏梗 圆眼肉(各一钱)
妇人如同前病,身体瘦弱,或发寒热,此气血两虚,血
枯经闭。宜大补气血为主∶
人参(五分) 茯苓 白术 归身 芍药 圆眼肉(各二钱) 沙参 丹参 生地 木通(各一钱)
妇人败血不日而至,此非败血,气虚故也。宜补气为主∶
人参(五分) 甘草(五分) 白术 黄 茯苓 阿胶(各二钱) 木通(八分)
妇人月水先期而至,小腹作痛,气血两热故也。当理气清火为主∶
延胡索 甘草(各三钱) 黄 山楂 抚芎(各二钱) 芍药 苏梗 丹皮 木通 香附(各一钱)
妇人月水后期而至,此气血虚寒故也。
川芎 当归 艾叶 香附 红花(各二钱) 桂枝 黑姜(各五分) 玄胡索 木通(各一钱)
凡是孕妇出现各种病症,如果没有其他原因,是因为受孕之后,气血处于重新分配的状态,无法充分滋养胎儿,从而导致母亲生病。既然气血已经虚弱,使得胎儿在母腹中不安稳,就必须大补气血,那么胎儿自然就会安稳。如果有胎动且母亲患病的情况,先安胎,母亲的病就会痊愈。大概是因为胎前患病,应以安胎作为主要治疗原则。如果胎气一旦动摇,疾病就难以治愈,医生必须谨慎对待。
至于产后的病患,大多起因于风寒侵袭或饮食不当,其余则多由血气失调引起。夏季的疾病多因风邪所致,冬季的疾病多因寒邪所致,只有饮食引起的病患没有固定的时间规律。一般来说,顺产之后的疾病容易治疗;难产之后的疾病则难以治疗。难产必定导致身体深受风寒侵袭,加上气血极度虚弱,即使稍微进食一些食物,身体力量也无法承受消化负担,从而引发病患。产后出现的各种症状,大多类似于伤寒,但不能当作伤寒来治疗,更不能当作杂症来治疗。这是妇科不轻易外传的要诀,医生千万不要犹豫怀疑。其治疗方法前后有所不同:产后二十天内,气血尚未稳定,恶露未尽,治疗应当以破血(活血化瘀)为主;二十天以后,气血已经稳定,各归经络,虽然仍有恶露,但不再强行驱逐排出。凡是有各种症状,都要补益气血,同时兼顾活血。许多医书认为产后一个月后应按杂症治疗,这种说法是错误的。
月经或者一两个月来一次,或者一年才来一次,但身体不是很瘦弱的人,这是气盛血衰的表现。千万不要当作血隔(经血阻滞不通)来治疗,应当以补血为主:当归(三钱)、川芎(二钱)、芍药、生地、丹参、玄胡索、小茴香、牛膝、苏梗、桂圆肉(各一钱)。
如果是同样的病情,但身体瘦弱,或者出现发冷发热症状的妇女,这是气血两虚,血枯经闭。适宜以大补气血为主:人参(五分)、茯苓、白术、当归身、芍药、桂圆肉(各二钱)、沙参、丹参、生地、木通(各一钱)。
妇女出现败血(瘀血内阻)症状不久便到来,这并非真正的败血,而是气虚的缘故。适宜以补气为主:人参(五分)、甘草(五分)、白术、黄芪、茯苓、阿胶(各二钱)、木通(八分)。
妇女月经提前到来,小腹疼痛,这是因为气血两热。应当以理气清火为主:延胡索、甘草(各三钱)、黄芩、山楂、抚芎(即川芎,各二钱)、芍药、苏梗、牡丹皮、木通、香附(各一钱)。
妇女月经推后到来,这是因为气血虚寒。川芎、当归、艾叶、香附、红花(各二钱)、桂枝、炮姜(各五分)、玄胡索、木通(各一钱)。
Whenever a pregnant woman presents with various symptoms without other causes, it is because after conception, the Qi and Blood are redistributed and cannot sufficiently nourish the fetus, leading to illness in the mother. Since both Qi and Blood are deficient, causing fetal instability within the uterus, it is necessary to greatly tonify Qi and Blood, so that the fetus will naturally become stable. In cases where there is fetal movement accompanied by maternal illness, stabilizing the fetus will cure the maternal illness. Generally, for illnesses occurring during pregnancy, the primary principle should be to stabilize the fetus. If fetal Qi becomes unstable, the disease becomes difficult to treat, and physicians must exercise caution.
As for postpartum ailments, they mostly arise from wind-cold invasion or dietary indiscretion, while others are caused by disturbances in Qi and Blood. Diseases in summer are often due to wind, diseases in winter are often due to cold, whereas ailments caused by diet have no fixed timing. Generally speaking, diseases following an easy delivery are easy to treat; those following a difficult delivery are hard to treat. A difficult delivery inevitably leads to severe exposure to wind-cold, combined with extreme deficiency of Qi and Blood. Even if food intake is slightly increased, the body's strength cannot handle digestion, thereby causing illness. Various symptoms appearing after childbirth are mostly similar to Shanghan (Cold Damage Syndrome), but they should not be treated as Shanghan, nor as miscellaneous diseases. This is a secret technique of gynecology not easily transmitted; physicians must not hesitate or doubt. The treatment methods differ before and after: within twenty days postpartum, when Qi and Blood are unsettled and lochia has not yet cleared, treatment should focus on breaking blood stasis (invigorating blood and resolving stasis); after twenty days, when Qi and Blood have settled and returned to the meridians, even if some lochia remains, it should not be forcibly expelled. For any symptoms present, one must tonify Qi and Blood while simultaneously invigorating blood circulation. Many medical texts suggest treating conditions after one month postpartum as miscellaneous diseases, which is erroneous.
If menstruation occurs once every one or two months, or even once a year, but the person is not significantly emaciated, this indicates abundant Qi and deficient Blood. Do not mistakenly treat it as Blood obstruction (stagnation of menstrual blood); instead, prioritize tonifying Blood: Dang Gui (Radix Angelicae Sinensis) (3 qian), Chuan Xiong (Rhizoma Chuanxiong) (2 qian), Shao Yao (Paeoniae Radix Alba), Sheng Di Huang (Radix Rehmanniae Preparata), Dan Shen (Radix Salviae Miltiorrhizae), Yuan Hu (Rhizoma Corydalis), Xiao Hui Xiang (Fructus Foeniculi), Niu Xi (Radix Achyranthis Bidentata), Su Geng (Caulis Perillae), Yuan Yan Rou (Sarcotesta Longan) (each 1 qian).
For women presenting with similar conditions but who are physically weak or experience chills and fever, this indicates dual deficiency of Qi and Blood, resulting in dried-up blood and amenorrhea. It is appropriate to primarily greatly tonify Qi and Blood: Ren Shen (Radix Ginseng) (5 fen), Fu Ling (Poria), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Dang Gui Shen (Radix Angelicae Sinensis head), Shao Yao (Paeoniae Radix Alba), Yuan Yan Rou (Sarcotesta Longan) (each 2 qian), Sha Shen (Radix Glehniae seu Adenophorae), Dan Shen (Radix Salviae Miltiorrhizae), Sheng Di Huang (Radix Rehmanniae Preparata), Mu Tong (Caulis Akebiae seu Aristolochiae) (each 1 qian).
If a woman experiences "败血" (retained blood/stasis) symptoms shortly after delivery, this is not true retained blood but rather due to Qi deficiency. It is appropriate to primarily tonify Qi: Ren Shen (Radix Ginseng) (5 fen), Gan Cao (Radix Glycyrrhizae), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Huang Qi (Radix Astragali), Fu Ling (Poria), E Jiao (Colla Corii Asini) (each 2 qian), Mu Tong (Caulis Akebiae seu Aristolochiae) (8 fen).
If a woman’s menstruation arrives early and is accompanied by lower abdominal pain, this is due to heat in both Qi and Blood. Treatment should focus on regulating Qi and clearing fire: Yan Hu Suo (Rhizoma Corydalis), Gan Cao (Radix Glycyrrhizae) (each 3 qian), Huang Qin (Radix Scutellariae), Shan Zha (Fructus Crataegi), Fu Xiong (Rhizoma Chuanxiong, specifically from Fujian) (each 2 qian), Shao Yao (Paeoniae Radix Alba), Su Geng (Caulis Perillae), Mu Dan Pi (Cortex Moutan), Mu Tong (Caulis Akebiae seu Aristolochiae), Xiang Fu (Rhizoma Cyperi) (each 1 qian).
If a woman’s menstruation is delayed, this is due to deficiency and cold in both Qi and Blood. Chuan Xiong (Rhizoma Chuanxiong), Dang Gui (Radix Angelicae Sinensis), Ai Ye (Folium Artemisiae Argyi), Xiang Fu (Rhizoma Cyperi), Hong Hua (Flos Carthami) (each 2 qian), Gui Zhi (Ramulus Cinnamomi), Hei Jiang (Rhizoma Zingiberis Preparatum) (each 5 fen), Yuan Hu Suo (Rhizoma Corydalis), Mu Tong (Caulis Akebiae seu Aristolochiae) (each 1 qian).