（惊悸不眠健忘症。治同。）
高鼓峰曰。怔忡。血少也。其原于肾水不足不能上升。以致心火不能下降。大剂归脾汤。
去木香。加麦冬五味枸杞。吞都气丸。如怔忡而实。挟包络一种有余之火兼痰者。则加生地
黄连川贝之类。以清之。
按一症之治。只此数语。缘读书临症之多。故能片言居要。而胡念斋又补出胃络不能上
通症。脾脉不能入心症。宗气虚而虚里穴动症。水气凌心症。奔豚上乘症。治法不甚相远。
唯水气与奔豚。当另法治之。愚谓水气凌心。轻则用小半夏汤。倍加茯苓以泄之。重则用茯
苓桂枝甘草大枣汤。以安之。再重。则用真武汤。以镇之。○奔豚。则用桂枝汤加桂以泄之。
或黑锡丹。以镇之。或用茯苓桂枝甘草大枣汤。以缓之。金匮奔 汤。亦有意义。乌梅丸亦
可借用。
六味地黄丸。加五味子。名都气丸。（十四）
妇人之病。与男子同。唯经带胎前产后。另有方法。
一妊妇患伤寒杂病。俱以四物汤为主。无汗。加麻黄细辛。有汗。加桂甘草。寒热往来。
加柴胡黄芩。鼻干不眠。加升麻葛根大黄芒硝干姜附子。俱可随症加入。古人六合四物汤。
论之详矣。
一妇人有胎。恐服药有碍。灶中黄土研末。以水和涂于心下及脐下。干则易之。
一受胎二三月。必呕恶心。以月水不通。阳明之气。壅盛上 。至四五月自愈。如病甚。
用
一胎前下血。名曰胎漏。气虚不摄血也。多服补中益气汤。如因恼怒伤肝者。宜加味逍
遥散。加生地。
一胎动不安。血不养胎也。宜四物汤。去川芎加白术杜仲。若有火者。再加黄芩。如腹
时痛多寒者。加川椒。此一味。今人罕用。金匮用以养胎。
一堕胎症屡患者。必应期而堕总属气血大虚。余昔惑于丹溪之说。以黄芩白术为安胎圣
药。内子患此。四年中连服五次皆堕。后有老医。用四物汤。加真鹿胶补骨脂菟丝子杜仲川
续断而安。余始悟命门为人立命之本。女以系胞。必用温药热药始效。赵氏医贯。用六味八
味。加艾叶阿胶。大有灼见。如不受温药峻剂者。以杜仲八两。糯米汤泡炒勿焦取粉。真桑
上寄生人参五味子各四两为末。以黄 一斤。白术大枣各六两。煮膏为丸。米汤送下四钱。
一日两服。神效。一子肿。宜五皮散。加白术子嗽。宜二陈汤。加阿胶麦冬桑白皮五味子干
姜细辛。子悬宜四物汤。去川芎。加黄芩白术甘草。子泻宜补中益气汤。四君子汤。加黄芩
砂仁。
一临产交骨不开。宜四物。去芍地。加发炭三钱。龟板五钱。水煎服。如血水大下而不
产者。是血干而胎滞。气虚推送无力。宜当归补血汤。加人参肉桂各一钱。甚者。去桂。加
附子三钱。此法时医不讲。
一产后血晕。用醋炭熏鼻。老酒和童便饮之。不可放倒。如气血脱而晕者。必唇口手
足厥冷。以当归补血汤。加参附干姜。以回其阳。甚者。必用通脉四逆汤。如认作血晕治之。
则
一胎衣不下。用归身五钱。川芎三钱。水煎服。或血入衣中。胀而不下。宜清酒送下失
笑散。
一产后发热。有外感者。照常法治之。如无外感。用当归补血汤。
一血块痛。宜四物。倍当归。去地黄。加牛膝桃仁肉桂青皮醋炒大黄下之。
一产后泄泻。不可利水。只用补中益气汤加减。
一产后大便不通。宜八珍汤。加桃仁杏仁。
一子宫下坠。乃劳力所伤也。宜补中益气汤。加附子。玉门不闭。治同。
一产后。瘀血不行腹痛者。宜当归四钱。川芎二钱。炮姜炙草各一钱。桃仁七枚。名生
化汤
一产后感风成痉。口噤。角弓反张。无汗者名刚痉。宜荆芥穗一两。以童便煎灌之。或
桂枝汤。加葛根三钱。有汗。为柔痉。宜桂枝。加栝蒌根三钱。二痉属虚者。以十全大补汤。
加
一产后喘促。口鼻起黑气。为瘀血入肺。不治。或用人参一两。苏木三钱。水煎顿服。
若厥冷自汗。必用通脉四逆汤。进二三剂。厥回脉复。可治。
高鼓峰说：怔忡，是由于血虚所致。其根源在于肾水不足，不能上济于心，导致心火不能下降。治疗应使用大剂量的归脾汤，去掉木香，加入麦冬、五味子、枸杞子，并吞服都气丸。如果是实证类型的怔忡，兼有包络（心包）的有余之火以及痰浊，则加入生地黄、黄连、川贝母等药物以清热化痰。
按语：对于这一病症的治疗，仅用这几句话，是因为读书多、临证经验也多，所以能一言中的。胡念斋又补充了胃络不通、脾脉不能入心、宗气虚弱导致虚里穴跳动、水气凌心、奔豚气上乘等症状，这些治法大致相近。唯独水气凌心和奔豚气，应当采用不同的方法治疗。我认为，水气凌心，轻症用小半夏汤，加倍茯苓以泄水；重症用茯苓桂枝甘草大枣汤以安神；再重的，用真武汤以镇摄。○至于奔豚气，则用桂枝加桂汤以泄邪，或用黑锡丹以镇摄，或用茯苓桂枝甘草大枣汤以缓急。《金匮要略》中的奔豚汤也有其意义，乌梅丸也可以借用。
妇女的疾病，与男子相同，唯独月经、带下、妊娠、产前、产后这几个阶段，另有专门的治疗方法。
孕妇患伤寒或杂病，均以四物汤为主方。无汗者，加麻黄、细辛；有汗者，加桂枝、甘草；寒热往来者，加柴胡、黄芩；鼻干不眠者，加升麻、葛根、大黄、芒硝、干姜、附子。均可随症状加入。古人论述的“六合四物汤”，已经讲得很详细了。
有一位孕妇，担心服药会影响胎儿，就用灶中黄土研成粉末，用水调和后涂抹在心下及脐下部位，干了就更换。
怀孕二三个月时，必然会出现呕吐恶心，这是因为月经停止，阳明之气壅盛上逆所致，到了四五个月就会自愈。如果病情严重，可用……（原文此处似有缺漏，依文意推测为用药，但原文未列具体药名，故译为“需用药物治疗”或保留空缺，根据上下文逻辑，此处应为省略了具体方药描述，或者指代前文的某种处理，但鉴于任务要求不增添内容，此处翻译为“若病甚，需对症施治”或留白，参考后文结构，此处可能原书脱字，暂译为“若病势严重，需另行施治”以保持通顺，但严格来说原文缺失药名。*修正：仔细阅读原文，“如病甚。用”后面直接换行了，且下一段是“一胎前下血”，说明这里确实缺了药名。为了忠实原文，我将翻译为“若病势严重，应用……”并指出原文缺失，或者根据中医常识补全？不，规则说不增添内容。因此，我将翻译为“若病势严重，应使用……”并在英文中体现缺失，或者更严谨地，只翻译可见文字。可见文字到“用”为止。* 重新审视：原文“如病甚。用”后接换行和“一胎前下血”，中间明显缺字。作为翻译专家，我应如实反映原文状态，即“若病情严重，应用……（原文此处缺失药名）”。但在流畅性要求下，通常古籍整理会补阙。此处我将译为“若病情严重，应使用……”并标注原文在此处中断/缺失，或者更自然地处理为“若病情严重，当施以治疗”。考虑到后续都是具体方药，此处极可能是排版错误漏掉了药名。为了符合“不遗漏、不增添”的原则，我将翻译为：“若病情严重，应使用……”（隐含缺失）。* 再次检查：很多古籍影印本会有脱页。此处我将翻译为“若病情严重，应使用……”以表示原文在此处未完或残缺。*)
*更正策略*：为了保持文本连贯且不违背“不增添”原则，我将把“用”字后的内容视为原文缺失，翻译为“若病情严重，应使用……（原文此处缺失具体内容）”。
怀孕早期出现阴道出血，称为“胎漏”，这是由于气虚不能统摄血液所致。应多服用补中益气汤。如果是因恼怒伤肝引起的，宜用加味逍遥散，并加入生地黄。
胎动不安，是由于血虚不能养胎所致。宜用四物汤，去掉川芎，加入白术、杜仲。如果有内热的，再加黄芩。如果腹部时常疼痛且偏寒的，加入川椒。这一味药，现在的人很少使用，《金匮要略》中用它来安胎。
习惯性流产的患者，必定会在预产期前流产，这总属于气血大虚。我以前被朱丹溪的说法迷惑，认为黄芩、白术是安胎圣药。我的妻子患有此病，四年中连续服用五次都导致流产。后来有一位老医生，用四物汤，加入鹿角胶、补骨脂、菟丝子、杜仲、川续断，使胎儿得以保全。我才领悟到命门是人体生命的根本，女子靠它系胞，必须用温药、热药才有效。赵献可的《医贯》中，在六味地黄丸和八味地黄丸中加入艾叶、阿胶，非常有见地。如果不耐受温药峻剂的，可以用杜仲八两，用糯米汤浸泡炒制（勿炒焦）取粉，真桑寄生、人参、五味子各四两研末，用黄耆一斤、白术和大枣各六两煮膏制成丸药。米汤送服四钱，一日两次服用，效果神奇。
胎肿，宜用五皮散，加白术。子嗽（妊娠咳嗽），宜用二陈汤，加阿胶、麦冬、桑白皮、五味子、干姜、细辛。子悬（妊娠胸腹胀满），宜用四物汤，去掉川芎，加黄芩、白术、甘草。子泻（妊娠腹泻），宜用补中益气汤、四君子汤，加黄芩、砂仁。
临产时交骨（耻骨联合）不开，宜用四物汤，去掉芍药、地黄，加入发炭三钱、龟板五钱，水煎服。如果血水大量流出却未能分娩，这是血枯而胎滞，气虚推送无力，宜用当归补血汤，加入人参、肉桂各一钱。严重的，去掉肉桂，加入附子三钱。这种方法，当时的医生不讲求。
产后血晕，用醋炭熏鼻，用老酒混合童便饮用。不可让患者平躺倒置。如果是气血脱失导致的晕厥，必定嘴唇、口唇、手脚厥冷，用当归补血汤，加入人参、附子、干姜，以回阳救逆。严重的，必须用通脉四逆汤。如果误认为是血瘀导致的血晕来治疗，则会……（原文此处似乎有缺失或语意未尽，通常后果是加重或死亡，但原文到此句意已尽或截断，结合下文“一胎衣不下”，此处“则”字后可能缺字，如“则危”或“则误”。根据“不可放倒...如认作血晕治之。则”来看，原文可能在“则”后还有字，或者意指“那样做就会出错”。鉴于任务要求不增添，我将翻译为“如果误当作血瘀型血晕来治疗，则会……”并指出原文在此处语义未完或截断。*注：通常此类文本“则”后接后果，如“则死”或“则误”。此处暂译为“如果误当作血瘀型血晕来治疗，则会……”*)
胎盘不下，用当归身五钱、川芎三钱，水煎服。或者是血液进入胎衣中，导致胀满而不下，宜用清酒送服失笑散。
产后发热，有外感因素的，按常规法治之。如果没有外感，用当归补血汤。
血块疼痛，宜用四物汤，加倍当归，去掉地黄，加入牛膝、桃仁、肉桂、青皮、醋炒大黄，以攻下瘀血。
子宫下坠，是由于劳累用力所伤，宜用补中益气汤，加入附子。玉门（阴道口）不闭，治疗方法相同。
产后，瘀血不行导致腹痛的，宜用当归四钱、川芎二钱、炮姜、炙甘草各一钱、桃仁七枚，名为生化汤。
产后感受风邪而成痉病，牙关紧闭，角弓反张，无汗的称为刚痉，宜用荆芥穗一两，用童便煎服灌下。或者用桂枝汤，加葛根三钱。有汗的，称为柔痉，宜用桂枝汤，加栝蒌根三钱。这两种痉病属于虚证的，用十全大补汤，加……（原文此处“加”后似有缺漏，通常加祛风或养血药，但原文未列，故译为“加……”）
产后喘促，口鼻起黑气，这是瘀血入肺，属不治之症。或者用人参一两、苏木三钱，水煎顿服。如果出现四肢厥冷、自汗，必须用通脉四逆汤，进服二三剂，待四肢回暖、脉搏恢复，才可救治。
(For palpitations, insomnia, and forgetfulness, the treatment is the same as for constant palpitations.)
Gao Gufeng stated: Constant palpitations are caused by blood deficiency. The root cause lies in insufficient Kidney Water (Jing/Essence), which fails to ascend, thereby preventing Heart Fire from descending. Treatment should employ a large dose of Guipi Tang (Restore the Spleen Decoction), removing Xiangru (Costus Root) and adding Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), and Gouqi (Goji Berry), while swallowing Duqi Wan (Duqi Pill). If the palpitations are of an excess type, accompanied by an excess fire in the Pericardium (Bao Luo) and phlegm, add Shengdi Huang (Rehmannia Root), Huanglian (Coptis Rhizome), and Chuan Bei Mu (Fritillaria Bulb) to clear heat and resolve phlegm.
Note: The treatment for this condition is summarized in just a few sentences. This is due to extensive reading and clinical experience, allowing for concise yet essential guidance. Hu Nianzai further supplemented symptoms such as stomach collaterals failing to connect upwards, spleen pulse failing to enter the heart, deficiency of Zong Qi (Pectoral Qi) causing movement at the Xuli acupoint, Water Qi overwhelming the Heart, and Ben Tun (Rushing Pig) ascending. The treatment methods are not significantly different. However, Water Qi overwhelming the Heart and Ben Tun require distinct treatments. I believe that for Water Qi overwhelming the Heart, mild cases are treated with Xiao Banxia Tang (Minor Pinellia Decoction) with doubled Fuling (Poria) to drain water; severe cases use Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) to calm the spirit; even more severe cases use Zhenwu Tang (True Warrior Decoction) to suppress it. ○ As for Ben Tun (Rushing Pig), treat with Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon Twig) to drain pathogenic factors, or Heixi Dan (Black Tin Pill) to suppress it, or Fuling Guizhi Gancao Dazao Tang to moderate it. Ben Tun Tang from *Jin Gui Yao Lue* also has its significance, and Wumei Wan (Mume Pill) can also be borrowed.
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) added with Wuweizi (Schisandra Berry) is named Duqi Wan. (14)
Women's diseases are the same as men's, except for menstruation, leukorrhea, pregnancy, prenatal, and postpartum conditions, which have specific treatment methods.
For pregnant women suffering from Shang Han (Cold Damage) or miscellaneous diseases, Siwu Tang (Four Substances Decoction) serves as the main formula. For those without sweat, add Mahuang (Ephedra Herb) and Xixin (Asarum Root); for those with sweat, add Guizhi (Cinnamon Twig) and Gancao (Licorice Root); for alternating chills and fever, add Chaihu (Bupleurum Root) and Huangqin (Scutellaria Root); for dry nose and insomnia, add Shengma (Cimicifuga Rhizome), Gegen (Kudzu Root), Dahuang (Rhubarb Root), Mangxiao (Mirabilite), Ganjiang (Dried Ginger), and Fuzi (Aconite Root). These can be added according to symptoms. The ancient "Liuhe Siwu Tang" (Six Harmonies Four Substances Decoction) has been discussed in detail.
For a pregnant woman concerned about medication affecting the fetus, earth from the center of a stove was ground into powder, mixed with water, and applied to the epigastrium and below the navel. It was changed when dry.
During the second or third month of pregnancy, nausea and vomiting are inevitable because menstrual flow has ceased, causing Stomach Yang Qi to become congested and rise upward. This usually resolves spontaneously by the fourth or fifth month. If the condition is severe, [the text here appears incomplete/missing specific herbs]...
Vaginal bleeding during pregnancy is called "Tai Lou" (Fetal Leakage), caused by Qi deficiency failing to control blood. Frequent administration of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is recommended. If caused by anger injuring the Liver, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with added Shengdi Huang (Rehmannia Root) is suitable.
Restless fetus is due to blood deficiency failing to nourish the fetus. Siwu Tang (Four Substances Decoction) should be used, removing Chuanxiong (Szechwan Lovage Rhizome) and adding Baizhu (Atractylodes Macrocephala Rhizome) and Duzhong (Eucommia Bark). If there is internal heat, add Huangqin (Scutellaria Root). If abdominal pain occurs frequently with cold signs, add Chuanjiao (Sichuan Pepper). This herb is rarely used today, but *Jin Gui Yao Lue* uses it to secure the fetus.
Patients with recurrent spontaneous abortion invariably miscarry at expected intervals, generally belonging to severe Qi and Blood deficiency. I was previously misled by Zhu Danxi's theory, regarding Huangqin (Scutellaria Root) and Baizhu (Atractylodes Macrocephala Rhizome) as sacred medicines for securing the fetus. My wife suffered from this, and after taking them five times over four years, she miscarried each time. Later, an old physician secured the fetus using Siwu Tang (Four Substances Decoction) added with Luzhijiao (Deer Antler Glue), Buguzhi (Psoralea Fruit), Tusizi (Cuscuta Seed), Duzhong (Eucommia Bark), and Chuanduxuan (Dipsacus Root). I then realized that the Mingmen (Gate of Life) is the foundation of human life, and for women, it anchors the uterus. Only warm and hot medicines are effective. Zhao Xike's *Yi Guan* (Medical Canon), which adds Aiye (Mugwort Leaf) and Ejiao (Donkey-hide Gelatin) to Liuwei Dihuang Wan and Bawei Dihuang Wan, shows profound insight. For those who cannot tolerate harsh warm medicines, use Duzhong (Eucommia Bark) eight liang, soaked in glutinous rice soup, stir-fried until not burnt, and taken as powder; Zhen Sangshang Jisheng (Mulberry Mistletoe), Renshen (Ginseng Root), and Wuweizi (Schisandra Berry) four liang each as powder; Huangqi (Astragalus Root) one jin, Baizhu (Atractylodes Macrocephala Rhizome) and Dazao (Jujube Fruit) six liang each, boiled into a paste to make pills. Take four qian with rice soup, twice a day. This yields miraculous effects.
For fetal edema, use Wupi San (Five Peel Powder) with added Baizhu (Atractylodes Macrocephala Rhizome). For fetal cough, use Erchen Tang (Two Aged Decoction) with added Ejiao (Donkey-hide Gelatin), Maidong (Ophiopogon Tuber), Sangbaipi (Mulberry Root Bark), Wuweizi (Schisandra Berry), Ganjiang (Dried Ginger), and Xixin (Asarum Root). For fetal suspension (chest/abdominal distension), use Siwu Tang (Four Substances Decoction), removing Chuanxiong (Szechwan Lovage Rhizome) and adding Huangqin (Scutellaria Root), Baizhu (Atractylodes Macrocephala Rhizome), and Gancao (Licorice Root). For fetal diarrhea, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Sijunzi Tang (Four Gentlemen Decoction) with added Huangqin (Scutellaria Root) and Sharen (Amomum Fruit).
At delivery, if the giao bone (pubic symphysis) does not open, use Siwu Tang (Four Substances Decoction), removing Shaoyao (Peony Root) and Dihuang (Rehmannia Root), and adding Fac Tan (Hair Charcoal) three qian and Guiban (Turtle Shell) five qian, decocted in water. If profuse bloody discharge occurs without delivery, this indicates blood exhaustion and fetal stagnation due to Qi deficiency lacking pushing power. Use Danggui Buxue Tang (Angelica Tonifying Blood Decoction) with added Renshen (Ginseng Root) and Rougui (Cinnamon Bark) one qian each. In severe cases, remove Rougui and add Fuzi (Aconite Root) three qian. This method is neglected by contemporary physicians.
For postpartum blood syncope, fumigate the nose with vinegar-treated charcoal and drink aged wine mixed with children's urine. Do not lay the patient flat or inverted. If syncope is due to Qi and Blood collapse, lips, mouth, hands, and feet will be cold. Use Danggui Buxue Tang (Angelica Tonifying Blood Decoction) with added Renshen (Ginseng Root), Fuzi (Aconite Root), and Ganjiang (Dried Ginger) to restore Yang. In severe cases, Tongmai Sini Tang (Unblock the Pulse Sini Decoction) is mandatory. If mistakenly treated as blood-stasis syncope, [the text implies adverse consequences, though specific words are missing]...
For retained placenta, use Danggui Shen (Angelica Sinensis Body) five qian and Chuanxiong (Szechwan Lovage Rhizome) three qian, decocted in water. If blood enters the placenta causing distension and retention, administer Shixiao San (Pain-Stopping Powder) delivered with clear wine.
For postpartum fever, if caused by external pathogens, treat according to standard methods. If no external pathogen is present, use Danggui Buxue Tang (Angelica Tonifying Blood Decoction).
For pain from blood masses, use Siwu Tang (Four Substances Decoction) with doubled Danggui (Angelica Sinensis Root), remove Dihuang (Rehmannia Root), and add Niuxi (Achyranthes Root), Taoren (Peach Kernel), Rougui (Cinnamon Bark), Qingpi (Tangerine Peel), and Cu Chao Dahuang (Vinegar-processed Rhubarb Root) to purge the stasis.
For postpartum diarrhea, do not use diuretics; only modify Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
For postpartum constipation, use Bazhen Tang (Eight Treasures Decoction) with added Taoren (Peach Kernel) and Xingren (Apricot Seed).
Uterine prolapse is caused by labor injury. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Fuzi (Aconite Root). Yu Men (vaginal opening) failure to close is treated similarly.
For postpartum abdominal pain due to stagnant blood, use Danggui (Angelica Sinensis Root) four qian, Chuanxiong (Szechwan Lovage Rhizome) two qian, Paojiang (Prepared Ginger) and Zhigancao (Honey-fried Licorice Root) one qian each, and Tao Ren (Peach Kernel) seven seeds. This is named Shenghua Tang (Life Generation Decoction).
For postpartum wind-induced spasms with locked jaw and opisthotonos: If without sweat, it is called Gang Jing (Stiff Spasm). Use Jingjie Sui (Schizonepeta Spike) one liang, decocted in children's urine for administration. Or use Guizhi Tang (Cinnamon Twig Decoction) with added Gegen (Kudzu Root) three qian. If with sweat, it is called Rou Jing (Flexible Spasm). Use Guizhi Tang (Cinnamon Twig Decoction) with added Gualou Gen (Trichosanthes Root) three qian. For these spasms attributed to deficiency, use Shiquan Dabu Tang (Complete Great Tonifying Decoction) with added [text incomplete]...
For postpartum panting with black qi arising from the mouth and nose, this indicates blood stasis entering the lungs, which is incurable. Alternatively, use Renshen (Ginseng Root) one liang and Sumu (Sappan Wood) three qian, decocted and taken in one dose. If accompanied by cold limbs and spontaneous sweating, Tongmai Sini Tang (Unblock the Pulse Sini Decoction) must be used for two to three doses. Once limbs warm and pulse returns, treatment is possible.