妊娠伤寒,专以清热安胎为主。或汗或下,各随脏腑表
里,所见脉证主治,勿犯胎气。故邪在表,治当汗之,宜香苏散。邪在半表半里,治当和解,宜黄龙汤。邪在
里,治当下之,宜三黄解毒汤。
香苏散(治妊娠伤寒,勿论日数,但觉恶寒,头痛,此方主之)
香附 紫苏(各二钱) 陈皮(一钱) 甘草(五钱) 生姜(三片) 葱白(五茎)
水煎服。如头痛加川芎、白芷各一钱。如得肝脉外证,善洁、面青、善怒,其三部脉浮而弦,恶寒里和(
谓二便自调也),加羌活、防风各一钱(谓肝生风是胆受病也)。如得心脉外证,面赤口干,善笑,其三部脉
浮而洪,恶寒里和,加黄芩、石膏各一钱(谓心主热是小肠受病也)。如得脾脉外证,面黄、善噫、善思,其脉
尺寸浮而缓,恶寒里和,加白术、防己各一钱五分(谓脾主阳明胃受病也)。如得肺脉外证,面白,善嚏、善
悲,不乐欲哭,其脉尺寸浮而涩,恶寒里和,加黄 、防风各一钱(谓肺主燥、是大肠受病也)。如得肾脉外
证,面黑、善恐,其脉尺寸浮而濡,恶寒里和,加制附子一钱(盖肾主寒、是膀胱受病也。按∶附子犯胎禁、
须斟酌用之)。
黄龙汤(治妊娠伤寒,得之三五日后,外发热、恶寒,内烦渴引饮,小便赤涩,治宜和解)
柴胡(二钱) 黄芩(一钱五分) 人参 甘草(各一钱) 生姜(三片) 大枣(二枚)
水煎服。如寒热往来,无汗口干,加葛根二钱(去枣、加葱白三茎)。头痛不止,加川芎、白芷各一钱(去
枣、加葱白三茎)。发热有汗、口渴,加白术、花粉各一钱五分。
脉浮大有力,大热大渴,本方去姜、枣和人参白虎汤(即人参二钱,石膏五钱,知母二钱,生甘草一钱,粳米一
撮,水煎,温服)。心烦不卧,加茯苓、麦冬各一钱。呕吐加茯苓半夏(姜制,炒黄、去枣)各一钱。胸闷、胀
满,加川芎(炒黑)、枳壳(麸炒)、香附(童便制)各一钱。大便秘结加大黄(五分,利则止,不利,加至
一钱,以利为度)。
三黄解毒汤(治妊娠伤寒,五六日后发热,烦渴,小便赤,大便秘,六脉沉实,宜下之)
大黄 黄连 黄柏 黄芩 山栀仁(炒黑,各等分)
更随五脏脉证加减。如得沉弦有力之肝脉内证,烦满消渴,倍山栀仁加当归一钱五分,甘草五分。得沉数有
力之心脉内证,烦躁闷热,倍黄连加麦冬(去心)一钱。得沉缓有力之脾脉内证,腹痛胀满,谵言妄语,倍大黄
加枳实(去幅、麸炒)、浓朴(姜制)各一钱。得沉滑有力之肺脉内证,喘咳胸满,多涕,倍黄芩加桔梗五分,
葶苈子一钱。得沉实有力之肾脉内证,下重足肿,寒而厥冷,倍黄柏加熟地黄一钱、干姜五分。
妊娠期间患伤寒病,治疗应以清热安胎为主要原则。无论是采用发汗法还是攻下法,都应根据脏腑的表里情况,依据所见的脉象和症状进行主治,切勿损伤胎气。因此,若邪气在体表,治疗应当使用发汗法,适宜选用香苏散。若邪气在半表半里之间,治疗应当使用和解法,适宜选用黄龙汤。若邪气在体内(里证),治疗应当使用攻下法,适宜选用三黄解毒汤。
香苏散(用于治疗妊娠伤寒,不论患病天数,只要感觉恶寒、头痛,此方为主治方)
香附、紫苏(各二钱)、陈皮(一钱)、甘草(五钱)、生姜(三片)、葱白(五茎)。
用水煎服。如果头痛,加川芎、白芷各一钱。如果出现肝脉的外证表现,如爱清洁、面色青、易怒,三部脉象浮而弦,恶寒但里证平和(指大小便正常),加羌活、防风各一钱(意为肝生风是胆受病)。如果出现心脉的外证表现,面色红赤、口干、爱笑,三部脉象浮而洪大,恶寒但里证平和,加黄芩、石膏各一钱(意为心主热是小肠受病)。如果出现脾脉的外证表现,面色黄、爱打嗝、爱思虑,寸尺脉象浮而缓,恶寒但里证平和,加白术、防己各一钱五分(意为脾主阳明,胃受病)。如果出现肺脉的外证表现,面色白、爱打喷嚏、爱悲伤、心情不乐想哭,寸尺脉象浮而涩,恶寒但里证平和,加黄芩、防风各一钱(意为肺主燥,是大肠受病)。如果出现肾脉的外证表现,面色黑、易恐惧,寸尺脉象浮而濡软,恶寒但里证平和,加制附子一钱(盖因肾主寒,是膀胱受病。按语:附子触犯胎元禁忌,必须斟酌使用)。
黄龙汤(用于治疗妊娠伤寒,患病三五日后,外见发热、恶寒,内见烦渴引饮,小便赤涩,治疗宜用和解法)
柴胡(二钱)、黄芩(一钱五分)、人参、甘草(各一钱)、生姜(三片)、大枣(二枚)。
用水煎服。如果寒热往来,无汗口干,加葛根二钱(去掉大枣,加葱白三茎)。如果头痛不止,加川芎、白芷各一钱(去掉大枣,加葱白三茎)。如果发热有汗、口渴,加白术、花粉各一钱五分。
如果脉象浮大有力,大热大渴,本方去掉生姜、大枣,合用人参白虎汤(即人参二钱,石膏五钱,知母二钱,生甘草一钱,粳米一撮,水煎,温服)。如果心烦不能卧,加茯苓、麦冬各一钱。呕吐加茯苓、半夏(姜制,炒黄,去掉大枣)各一钱。胸闷、胀满,加川芎(炒黑)、枳壳(麸炒)、香附(童便制)各一钱。大便秘结加大黄(五分,通便则停,不通,加至一钱,以通为度)。
三黄解毒汤(用于治疗妊娠伤寒,五六日后发热,烦渴,小便赤,大便秘结,六脉沉实,宜用攻下法)
大黄、黄连、黄柏、黄芩、山栀仁(炒黑,各等分)。
再根据五脏的脉证进行加减。如果得到沉弦有力的肝脉内证表现,烦闷消渴,加倍山栀仁,加当归一钱五分,甘草五分。得到沉数有力的心脉内证表现,烦躁闷热,加倍黄连,加麦冬(去心)一钱。得到沉缓有力的脾脉内证表现,腹痛胀满,谵语妄言,加倍大黄,加枳实(去瓤,麸炒)、浓朴(姜制)各一钱。得到沉滑有力的肺脉内证表现,喘咳胸满,多涕,加倍黄芩,加桔梗五分,葶苈子一钱。得到沉实有力的肾脉内证表现,下重足肿,寒冷厥冷,加倍黄柏,加熟地黄一钱、干姜五分。
Pregnancy complicated by Shanghan (Cold Damage disease) should primarily be treated with heat-clearing and fetal-anchoring methods. Whether employing sweating or purging techniques, treatment must follow the interior-exterior status of the Zang-Fu organs, addressing the specific pulse and symptom patterns, without harming the fetal Qi. Thus, if the pathogen is in the exterior, treatment should induce sweating; Xiangsu San (Perilla and Cyperus Powder) is appropriate. If the pathogen is in the half-exterior half-interior, treatment should harmonize; Huanglong Tang (Yellow Dragon Decoction) is appropriate. If the pathogen is in the interior, treatment should purge; Sanhuang Jiedu Tang (Three Yellows Detoxification Decoction) is appropriate.
Xiangsu San (Indicated for pregnancy complicated by Shanghan, regardless of the number of days since onset, whenever chills and headache are felt):
Cyperis Rhizoma (Xiangfu), Perillae Folium (Zisu) (each 2 qian), Citri Reticulatae Pericarpium (Chenpi) (1 qian), Glycyrrhizae Radix et Rhizoma (Gancao) (5 qian), Zingiberis Rhizoma Recens (Shengjiang) (3 slices), Allii Fistulosi Bulbus (Congbai) (5 stalks).
Decoct in water and take warm. If headache persists, add Ligustici Chuanxiong Rhizoma (Chuanxiong) and Angelicae Dahuricae Radix (Baizhi) (each 1 qian). If Liver meridian exterior signs appear, such as excessive cleanliness-seeking, bluish complexion, and irritability, with floating and wiry pulses in all three positions, and chills but harmonious interior (meaning normal urination and defecation), add Notopterygii Rhizoma (Qianghuo) and Saposhnikoviae Radix (Fangfeng) (each 1 qian) (indicating Liver generating wind involves the Gallbladder). If Heart meridian exterior signs appear, such as ruddy complexion, dry mouth, and excessive laughter, with floating and surging pulses in all three positions, and chills but harmonious interior, add Scutellariae Radix (Huangqin) and Gypsum Fibrosum (Shigao) (each 1 qian) (indicating Heart governing heat involves the Small Intestine). If Spleen meridian exterior signs appear, such as sallow complexion, frequent belching, and overthinking, with floating and moderate pulses at the Cun and Chi positions, and chills but harmonious interior, add Atractylodis Macrocephalae Rhizoma (Baizhu) and Poria (Fuling) [Note: Text says Fangji, likely Acanthopanacis Senticosi Radix or similar, but strictly translating text: Stephaniae Tetrandrae Radix (Fangji)] (each 1.5 qian) (indicating Spleen governing Yangming involves the Stomach). If Lung meridian exterior signs appear, such as pale complexion, frequent sneezing, sadness, and a desire to cry, with floating and choppy pulses at the Cun and Chi positions, and chills but harmonious interior, add Scutellariae Radix (Huangqin) and Saposhnikoviae Radix (Fangfeng) (each 1 qian) (indicating Lung governing dryness involves the Large Intestine). If Kidney meridian exterior signs appear, such as dark complexion and fearfulness, with floating and soft pulses at the Cun and Chi positions, and chills but harmonious interior, add Prepared Aconiti Lateralis Radix (Zhifuzi) (1 qian) (as Kidney governs cold, involving the Bladder. Note: Fuzi is contraindicated in pregnancy; use with caution).
Huanglong Tang (Indicated for pregnancy complicated by Shanghan, occurring 3-5 days after onset, presenting with external fever and chills, internal restlessness, thirst with desire to drink, and red, scanty urine; treatment should harmonize):
Bupleuri Radix (Chaihu) (2 qian), Scutellariae Radix (Huangqin) (1.5 qian), Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao) (each 1 qian), Zingiberis Rhizoma Recens (Shengjiang) (3 slices), Jujubae Fructus (Dazao) (2 pieces).
Decoct in water and take warm. If alternating chills and fever occur with no sweat and dry mouth, add Puerariae Lobatae Radix (Gegen) (2 qian) (remove Dazao, add 3 stalks of Congbai). If headache persists, add Ligustici Chuanxiong Rhizoma (Chuanxiong) and Angelicae Dahuricae Radix (Baizhi) (each 1 qian) (remove Dazao, add 3 stalks of Congbai). If fever with sweat and thirst occur, add Atractylodis Macrocephalae Rhizoma (Baizhu) and Trichosanthis Radix (Huafen) (each 1.5 qian).
If the pulse is floating, large, and forceful, with high fever and extreme thirst, remove Shengjiang and Dazao from this formula and combine with Renshen Baihu Tang (Ginseng White Tiger Decoction) (consisting of Ginseng Radix et Rhizoma (Renshen) 2 qian, Gypsum Fibrosum (Shigao) 5 qian, Anemarrhenae Rhizoma (Zhimu) 2 qian, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao) 1 qian, Oryza Sativa (Jingmi) a pinch; decoct in water and take warm). If restlessness prevents lying down, add Poria (Fuling) and Ophiopogonis Radix (Maidong) (each 1 qian). For vomiting, add Poria (Fuling) and Pinelliae Tuber (Banxia) (processed with ginger, stir-fried until yellow, remove Dazao) (each 1 qian). For chest tightness and distension, add Ligustici Chuanxiong Rhizoma (Chuanxiong) (stir-fried black), Aurantii Fructus Immaturus (Zhike) (bran-fried), and Cyperi Rhizoma (Xiangfu) (processed with child's urine) (each 1 qian). For constipation, add Rheum Palmatum (Dahuang) (0.5 qian; stop if bowel movement occurs, increase to 1 qian if not, aiming for evacuation).
Sanhuang Jiedu Tang (Indicated for pregnancy complicated by Shanghan, 5-6 days later, presenting with fever, restlessness, thirst, red urine, constipation, and deep, solid pulses in all six positions; treatment should purge):
Rhei Radix et Rhizoma (Dahuang), Coptidis Rhizoma (Huanglian), Phellodendri Cortex (Huangbai), Scutellariae Radix (Huangqin), Gardeniae Fructus (Shanzhiren) (stir-fried black, equal parts).
Further modify according to the pulse and symptoms of the five Zang organs. If deep, wiry, and forceful Liver pulse interior signs appear, with fullness and thirst, double the Shanzhiren and add Angelicae Sinensis Radix (Danggui) (1.5 qian) and Glycyrrhizae Radix et Rhizoma (Gancao) (0.5 qian). If deep, rapid, and forceful Heart pulse interior signs appear, with restlessness and stifling heat, double the Huanglian and add Ophiopogonis Radix (Maidong) (decored) (1 qian). If deep, moderate, and forceful Spleen pulse interior signs appear, with abdominal pain and distension, delirious speech, double the Dahuang and add Aurantii Fructus Immaturus (Zhishi) (pulp removed, bran-fried) and Magnoliae Officinalis Cortex (Houpo) (ginger-processed) (each 1 qian). If deep, slippery, and forceful Lung pulse interior signs appear, with wheezing, cough, chest fullness, and excessive nasal discharge, double the Huangqin and add Platycodonis Radix (Jiegeng) (0.5 qian) and Lepidii Semini (Tinglizi) (1 qian). If deep, solid, and forceful Kidney pulse interior signs appear, with heaviness in the lower body and swollen feet, coldness and cold extremities, double the Huangbai and add Rehmanniae Radix Praeparata (Shudihuang) (1 qian) and Zingiberis Rhizoma (Ganjiang) (0.5 qian).