妊娠霍乱,或邪在上胃脘,则当心痛而吐多;邪在下胃脘,则当脐痛而利多;邪在中胃脘,则腹中痛,而
吐利俱多。吐多伤气,利多伤血,邪击胎元,母命易殒。气血伤而无以养胎,子命易倾,此急证也,宜香苏散。
若吐泻频作,先服六和汤,次服丹溪安胎饮。
香苏散
香附 紫苏叶(各二钱) 陈皮(一钱) 甘草(五分) 姜(三片) 葱白(五茎)
水煎服。
如转筋加木瓜一钱,胎动加白术(蜜炙)一钱,夏加黄芩一钱,冬加人参、白术各一钱。
六和汤
扁豆(二钱) 人参 木香(各一钱) 半夏(姜制、炒黄,七分) 茯苓(八分) 砂仁(五分)
杏仁(去皮尖、捣,十粒) 陈皮 藿香 甘草(各四分) 姜(三片) 枣(二枚)
水煎服。
丹溪安胎饮
人参(一钱) 川芎 条芩(各八分) 白术(蜜炙) 当归 熟地黄(各二钱) 紫苏 陈皮 甘草(各四分)
砂仁(三分)
姜、枣为引,水煎服。
妊娠泄泻,不渴,小便清白者,宜加味三白散。若内热,烦渴,小便清赤涩者,宜加味黄芩汤。若呕逆,喜饮,
水谷不化,小便不利者,宜黄连阿胶丸。若或清或白,水谷不化,腹痛、肠鸣为洞泄者,先服五苓散,次服黄
连阿胶丸,若水谷不化,泻痛不止者,宜白术防风汤。若泻黄水有沫,肠鸣腹痛,脉沉紧,数者,宜戊己丸。
凡妊娠泄泻,通治以补脾、行滞、安胎为主,宜六君汤加减,未应,宜益黄散加减。若五更泄泻,乃脾肾虚弱,
宜五更时服四神丸,午间服白术散;未应,或应而复泄,饮食不思,急服八味丸,补命门真火,以生脾土。若元
气下陷,发热作渴,肢体倦怠,宜补中益气汤(方见前子气条中)。
加味三白散
白术(蜜炙) 茯苓(各三钱) 白芍 浓朴(姜制) 苍术(米泔浸、炒) 砂仁(炒、去壳,各一钱)
甘草(五分) 姜(三片)
水煎服。
加味黄芩汤
黄芩(二钱) 白芍(一钱) 甘草(五分) 白术(蜜炙,三钱) 茯苓(一钱二分) 通草(八分)
水煎服。如腹痛加砂仁、黄连(姜汁炒,各一钱)。
黄连阿胶丸
黄连 茯苓 阿胶(炒,各一两)
上为末,水熬阿胶为丸,空心,米饮下,(或加干姜五钱亦可)。
五苓散
猪苓 茯苓 白术(蜜炙,各一钱) 泽泻(八钱) 肉桂(五钱)
为末,每服三钱,米饮下。
白术防风汤
白术(蜜炙,三钱) 白芍(炒,二钱) 陈皮(炒,一钱五分) 防风(一钱)
水煎,食前服。如久泻加升麻三分。
戊己丸
黄连(姜汁炒) 吴茱萸(盐水泡) 白芍(各一两)
水丸,米饮下。
六君汤
人参 白术(蜜炙) 茯苓 半夏(姜制、炒黄) 陈皮(各一钱) 甘草(蜜炙,五分) 姜(三片)
枣(二枚)
水煎服。如米食伤加谷叶(炒)一钱。面食伤加萝卜子(炒)一钱。肉食伤加山楂肉一钱。寒热呕吐加柴
胡、生姜各八分。呕吐腹痛手足逆冷加干姜一钱、肉桂五分。
益黄散
陈皮(一钱) 青皮 诃子肉 甘草(炙,各五分) 丁香(一分)
水煎服。如泻黄色加木香、肉果(煨)各五分。若呕吐不食、腹痛、恶寒加木香、干姜、肉桂各五分。
四神丸
破故纸(四两,酒炒) 五味子(炒) 肉豆蔻(煨,各二两) 吴茱萸(一两,泡) 大枣百枚(生姜八两、
切片同煮枣烂、去姜勿用)
净取枣肉捣丸,每服二钱,五更时淡盐汤下。
白术散
白术(蜜炙,一钱) 人参(五分) 甘草(炙) 丁香(各二分) 姜(三片)
水煎服。
八味丸
熟地黄(八两) 淮山药(姜汁炒) 山萸肉(各四两) 牡丹皮 白茯苓 泽泻(各三两) 肉桂附子
(制极熟,各一两)
为末,蜜丸,淡盐汤下五十丸。(按丹皮、肉桂、附子、胎家禁忌,用须斟酌)
妊娠期间发生霍乱,如果病邪位于上胃脘,就会出现心口疼痛且呕吐严重;如果病邪位于下胃脘,就会出现肚脐周围疼痛且腹泻严重;如果病邪位于中胃脘,就会腹中疼痛,且呕吐和腹泻都严重。呕吐过多会损伤气,腹泻过多会损伤血,邪气冲击胎元,母亲的性命容易丧失。气血受损而无法滋养胎儿,胎儿的生命也容易倾覆,这是急症,适宜使用香苏散。如果呕吐和腹泻频繁发作,先服用六和汤,接着服用丹溪安胎饮。
香苏散
香附、紫苏叶(各二钱),陈皮(一钱),甘草(五分),生姜(三片),葱白(五茎)。
用水煎煮后服用。
如果出现转筋(肌肉痉挛),加木瓜一钱;如果胎动不安,加蜜炙白术一钱;夏季加黄芩一钱;冬季加人参、白术各一钱。
六和汤
扁豆(二钱),人参、木香(各一钱),半夏(姜制、炒至黄色,七分),茯苓(八分),砂仁(五分),杏仁(去皮尖、捣碎,十粒),陈皮、藿香、甘草(各四分),生姜(三片),大枣(两枚)。
用水煎煮后服用。
丹溪安胎饮
人参(一钱),川芎、条芩(各八分),白术(蜜炙)、当归、熟地黄(各二钱),紫苏、陈皮、甘草(各四分),砂仁(三分)。
以生姜、大枣为引,用水煎煮后服用。
妊娠期间出现泄泻,如果不口渴,小便颜色清白,适宜使用加味三白散。如果有内热,烦躁口渴,小便清赤且涩痛,适宜使用加味黄芩汤。如果有呕逆,喜欢饮水,但水谷不消化,小便不利,适宜使用黄连阿胶丸。如果大便或清或白,水谷不消化,伴有腹痛、肠鸣音亢进属于洞泄的,先服用五苓散,接着服用黄连阿胶丸;如果水谷不消化,腹泻疼痛不止,适宜使用白术防风汤。如果排泄黄水且有泡沫,肠鸣腹痛,脉象沉紧而数,适宜使用戊己丸。
凡是妊娠泄泻,通用治疗原则以补脾、行滞、安胎为主,适宜使用六君汤加减;如果无效,适宜使用益黄散加减。如果是五更泄泻,属于脾肾虚弱,适宜在五更时服用四神丸,午间服用白术散;如果无效,或者有效后又复发,饮食不思,紧急服用八味丸,以补命门真火,从而生发脾土。如果元气下陷,发热且口渴,肢体倦怠,适宜使用补中益气汤(方剂见前文子气条中)。
加味三白散
白术(蜜炙)、茯苓(各三钱),白芍、浓朴(姜制)、苍术(米泔水浸泡、炒制)、砂仁(炒、去壳,各一钱),甘草(五分),生姜(三片)。
用水煎煮后服用。
加味黄芩汤
黄芩(二钱),白芍(一钱),甘草(五分),白术(蜜炙,三钱),茯苓(一钱二分),通草(八分)。
用水煎煮后服用。如果腹痛,加砂仁、黄连(姜汁炒,各一钱)。
黄连阿胶丸
黄连、茯苓、阿胶(炒,各一两)。
以上药物研为细末,用水熬化阿胶制成丸药,空腹时,用米汤送服。(也可以加干姜五钱)。
五苓散
猪苓、茯苓、白术(蜜炙,各一钱),泽泻(八钱),肉桂(五钱)。
研为细末,每次服用三钱,用米汤送服。
白术防风汤
白术(蜜炙,三钱),白芍(炒,二钱),陈皮(炒,一钱五分),防风(一钱)。
用水煎煮,饭前服用。如果是久泻,加升麻三分。
戊己丸
黄连(姜汁炒)、吴茱萸(盐水泡)、白芍(各一两)。
制成水丸,用米汤送服。
六君汤
人参、白术(蜜炙)、茯苓、半夏(姜制、炒至黄色)、陈皮(各一钱),甘草(蜜炙,五分),生姜(三片),大枣(两枚)。
用水煎煮后服用。如果是米食积滞伤胃,加炒谷叶一钱;面食积滞伤胃,加炒萝卜子一钱;肉食积滞伤胃,加山楂肉一钱;寒热交替呕吐,加柴胡、生姜各八分;呕吐腹痛且手足逆冷,加干姜一钱、肉桂五分。
益黄散
陈皮(一钱),青皮、诃子肉、甘草(炙,各五分),丁香(一分)。
用水煎煮后服用。如果腹泻呈黄色,加木香、肉果(煨)各五分。如果呕吐不食、腹痛、恶寒,加木香、干姜、肉桂各五分。
四神丸
破故纸(四两,酒炒),五味子(炒),肉豆蔻(煨,各二两),吴茱萸(一两,泡),大枣一百枚(生姜八两、切片同煮至枣烂、去掉生姜不用)。
只取枣肉捣碎制成丸药,每次服用二钱,五更时用淡盐汤送服。
白术散
白术(蜜炙,一钱),人参(五分),甘草(炙)、丁香(各二分),生姜(三片)。
用水煎煮后服用。
八味丸
熟地黄(八两),淮山药(姜汁炒)、山萸肉(各四两),牡丹皮、白茯苓、泽泻(各三两),肉桂、附子(制极熟,各一两)。
研为细末,用蜂蜜制成丸药,每次服用五十丸,用淡盐汤送服。(按:牡丹皮、肉桂、附子为孕妇禁忌,使用时需斟酌)。
During pregnancy, if Huoluan (cholera-like syndrome with sudden vomiting and diarrhea) occurs:
If the pathogenic factor is located in the upper stomach region, heart pain and severe vomiting will occur; if it is in the lower stomach region, periumbilical pain and severe diarrhea will occur; if it is in the middle stomach region, abdominal pain will occur, accompanied by both severe vomiting and diarrhea. Excessive vomiting damages Qi (vital energy), while excessive diarrhea damages Blood. If the pathogen strikes the fetal origin, the mother's life is easily endangered. If Qi and Blood are damaged and unable to nourish the fetus, the fetus's life is also prone to collapse. This is an acute condition, and Xiangsu San (Fragrant Perilla Powder) is indicated.
If vomiting and diarrhea occur frequently, first administer Liuhe Tang (Six Harmonies Decoction), followed by Danxi Antai Yin (Danxi’s Fetus-Stabilizing Drink).
Xiangsu San (Fragrant Perilla Powder)
Xiangfu (Cyperi Rhizoma), Zi Su Ye (Perillae Folium) (each 2 qian); Chenpi (Citri Reticulatae Pericarpium) (1 qian); Gancao (Glycyrrhizae Radix et Rhizoma) (5 fen); Shengjiang (Zingiberis Rhizoma Recens) (3 slices); Congbai (Allii Fistulosi Bulbus) (5 stalks).
Decoct in water and take orally.
If muscle spasms (Zhuanjin) occur, add Mugua (Chaenomelis Fructus) 1 qian; if fetal movement is restless, add Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried 1 qian; in summer, add Huangqin (Scutellariae Radix) 1 qian; in winter, add Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) each 1 qian.
Liuhe Tang (Six Harmonies Decoction)
Baidou (Lablab Semen Album) (2 qian); Renshen (Ginseng Radix), Muxiang (Aucklandiae Radix) (each 1 qian); Banxia (Pinelliae Rhizoma) processed with ginger, stir-fried until yellow (7 fen); Fuling (Poria) (8 fen); Sharen (Amomi Fructus) (5 fen); Xingren (Armeniacae Semen Amarum) peeled, core removed, crushed (10 grains); Chenpi (Citri Reticulatae Pericarpium), Huoxiang (Agastaches Herba), Gancao (Glycyrrhizae Radix et Rhizoma) (each 4 fen); Shengjiang (Zingiberis Rhizoma Recens) (3 slices); Dazao (Jujubae Fructus) (2 pieces).
Decoct in water and take orally.
Danxi Antai Yin (Danxi’s Fetus-Stabilizing Drink)
Renshen (Ginseng Radix) (1 qian); Chuanxiong (Chuanxiong Rhizoma), Tiao Qin (Scutellariae Radix) (each 8 fen); Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried; Danggui (Angelicae Sinensis Radix); Shudihuang (Rehmanniae Radix Preparata) (each 2 qian); Zisu (Perillae Folium), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma) (each 4 fen); Sharen (Amomi Fructus) (3 fen).
Use Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) as guides, decoct in water and take orally.
In cases of pregnancy-associated diarrhea (Shexie):
If there is no thirst and urine is clear and white, Jiawei Sanbai San (Modified Three Whites Powder) is indicated.
If there is internal heat, irritability, thirst, and urine is clear-red and scanty/dysuric, Jiawei Huangqin Tang (Modified Scutellaria Decoction) is indicated.
If there is retching/vomiting, desire to drink, but food and fluids are not digested, and urination is difficult, Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill) is indicated.
If stool is either clear or white, food and fluids are not digested, accompanied by abdominal pain and borborygmus (characteristic of Dongxie/Cave Diarrhea), first administer Wuling San (Five-Ingredient Powder with Poria), then Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill).
If food and fluids are not digested, and diarrhea with pain persists, Baizhu Fangfeng Tang (Atractylodes and Saposhnikovia Decoction) is indicated.
If yellow watery stool with foam is passed, accompanied by borborygmus, abdominal pain, and a deep, tight, rapid pulse, Wuji Wan (Wu-Ji Pill) is indicated.
For all pregnancy-associated diarrhea, the general treatment principle focuses on tonifying Spleen, moving stagnation, and stabilizing the fetus. Liujun Tang (Six Gentlemen Decoction) with modifications is indicated; if ineffective, Yihuang San (Yellow-Enhancing Powder) with modifications is indicated.
If morning diarrhea (Wugeng Xiexie) occurs, indicating Spleen and Kidney deficiency, Sishen Wan (Four Spirits Pill) should be taken at dawn (Wugeng time), and Baizhu San (Atractylodes Powder) at noon. If ineffective, or if symptoms recur after initial improvement, with loss of appetite, Bawei Wan (Eight-Ingredient Pill) should be taken urgently to tonify the True Fire of Mingmen (Gate of Life) to generate Spleen Earth.
If Yuanqi (Original Qi) sinks, accompanied by fever, thirst, and limb fatigue, Buzhong Yiqi Tang (Middle-Warmer and Qi-Supplementing Decoction) is indicated (formula see previous section on Zi Qi).
Jiawei Sanbai San (Modified Three Whites Powder)
Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried, Fuling (Poria) (each 3 qian); Baishao (Paeoniae Radix Alba), Nongpo (Magnoliae Officinalis Cortex) processed with ginger; Cangzhu (Atractylodis Rhizoma) soaked in rice wash water, stir-fried; Sharen (Amomi Fructus) stir-fried, husk removed (each 1 qian); Gancao (Glycyrrhizae Radix et Rhizoma) (5 fen); Shengjiang (Zingiberis Rhizoma Recens) (3 slices).
Decoct in water and take orally.
Jiawei Huangqin Tang (Modified Scutellaria Decoction)
Huangqin (Scutellariae Radix) (2 qian); Baishao (Paeoniae Radix Alba) (1 qian); Gancao (Glycyrrhizae Radix et Rhizoma) (5 fen); Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried (3 qian); Fuling (Poria) (1.2 qian); Tongcao (Tetrapanacis Medulla) (8 fen).
Decoct in water and take orally. If abdominal pain occurs, add Sharen (Amomi Fructus) and Huanglian (Coptidis Rhizoma) processed with ginger juice (each 1 qian).
Huanglian Ejiao Wan (Coptis and Donkey-Hide Gelatin Pill)
Huanglian (Coptidis Rhizoma), Fuling (Poria), Ejiao (Colla Corii Asini) stir-fried (each 1 liang).
Grind into powder. Dissolve Ejiao in water to form pills. Take on an empty stomach with rice drink. (Alternatively, add Ganjiang (Zingiberis Rhizoma) 5 qian).
Wuling San (Five-Ingredient Powder with Poria)
Zhuling (Polypori), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried (each 1 qian); Zexie (Alismatis Rhizoma) (8 qian); Rougui (Cinnamomi Cortex) (5 qian).
Grind into powder. Take 3 qian per dose with rice drink.
Baizhu Fangfeng Tang (Atractylodes and Saposhnikovia Decoction)
Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried (3 qian); Baishao (Paeoniae Radix Alba) stir-fried (2 qian); Chenpi (Citri Reticulatae Pericarpium) stir-fried (1.5 qian); Fangfeng (Saposhnikoviae Radix) (1 qian).
Decoct in water, take before meals. For chronic diarrhea, add Shengma (Cimicifugae Rhizoma) 3 fen.
Wuji Wan (Wu-Ji Pill)
Huanglian (Coptidis Rhizoma) processed with ginger juice, Wuzhuyu (Evodiae Fructus) soaked in salt water, Baishao (Paeoniae Radix Alba) (each 1 liang).
Make water pills, take with rice drink.
Liujun Tang (Six Gentlemen Decoction)
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried, Fuling (Poria), Banxia (Pinelliae Rhizoma) processed with ginger, stir-fried until yellow, Chenpi (Citri Reticulatae Pericarpium) (each 1 qian); Gancao (Glycyrrhizae Radix et Rhizoma) honey-fried (5 fen); Shengjiang (Zingiberis Rhizoma Recens) (3 slices); Dazao (Jujubae Fructus) (2 pieces).
Decoct in water and take orally. For injury from rice food, add Gu Ye (Coeli Fructus) stir-fried 1 qian. For injury from wheat food, add Luobo Zi (Raphani Semen) stir-fried 1 qian. For injury from meat food, add Shanzha Rou (Crataegi Fructus) 1 qian. For alternating cold and heat with vomiting, add Chaihu (Bupleuri Radix) and Shengjiang (Zingiberis Rhizoma Recens) each 8 fen. For vomiting, abdominal pain, and cold extremities, add Ganjiang (Zingiberis Rhizoma) 1 qian and Rougui (Cinnamomi Cortex) 5 fen.
Yihuang San (Yellow-Enhancing Powder)
Chenpi (Citri Reticulatae Pericarpium) (1 qian); Qingpi (Citri Reticulatae Pericarpium Viride), Hezi Rou (Terminaliae Chebulae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma) roasted (each 5 fen); Dingxiang (Eugenii Flos) (1 fen).
Decoct in water and take orally. For yellow diarrhea, add Muxiang (Aucklandiae Radix) and Rouguo (Myristicae Semen) baked (each 5 fen). For vomiting, inability to eat, abdominal pain, and aversion to cold, add Muxiang (Aucklandiae Radix), Ganjiang (Zingiberis Rhizoma), and Rougui (Cinnamomi Cortex) each 5 fen.
Sishen Wan (Four Spirits Pill)
Poguzhi (Psoraleae Fructus) 4 liang, stir-fried with wine; Wuweizi (Schisandrae Chinensis Fructus) stir-fried; Roudoukou (Myristicae Semen) baked (each 2 liang); Wuzhuyu (Evodiae Fructus) 1 liang, soaked; Dazao (Jujubae Fructus) 100 pieces, boiled with 8 liang sliced Shengjiang (Zingiberis Rhizoma Recens) until soft, discard ginger, use only jujube flesh.
Mash jujube flesh to make pills. Take 2 qian per dose at dawn with light salt water.
Baizhu San (Atractylodes Powder)
Baizhu (Atractylodis Macrocephalae Rhizoma) honey-fried (1 qian); Renshen (Ginseng Radix) (5 fen); Gancao (Glycyrrhizae Radix et Rhizoma) roasted, Dingxiang (Eugenii Flos) (each 2 fen); Shengjiang (Zingiberis Rhizoma Recens) (3 slices).
Decoct in water and take orally.
Bawei Wan (Eight-Ingredient Pill)
Shudihuang (Rehmanniae Radix Preparata) 8 liang; Huaishanyao (Dioscoreae Hypoglaucae Rhizoma) stir-fried with ginger juice, Shanzhrou (Corni Fructus) (each 4 liang); Mudanpi (Moutan Cortex), Baifuling (Poria), Zexie (Alismatis Rhizoma) (each 3 liang); Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Preparata) processed thoroughly (each 1 liang).
Grind into powder, make honey pills. Take 50 pills per dose with light salt water. (Note: Mudanpi, Rougui, and Fuzi are contraindicated in pregnancy; use with caution).