(此证即胎上逼也。附子满。)
严氏紫苏散,许叔微云∶治怀胎近上胀满疼痛,谓之子悬。陈良甫曰∶妊至四五月,君相二火养胎,热气
逆上,胎凑心胸,腹满痞闷,用此加黄芩、山栀之类。一方无川芎,名七宝散。紫苏一两,腹皮、人参、川芎、
橘皮、白芍、当归各三分,甘草一分,锉分三服,水一盏,生姜四片,葱白煎,去渣服。(汪 庵曰∶此方每服止用苏
叶一钱,当归七分,腹皮以下皆五分,甘草二分,无葱白。)
沈尧封治郁姓妇,怀妊九月,偶因劳动,遂觉腹痛,胎渐升至胸中,气塞不通,忽然狂叫咬人,数人扶持
不住,即子悬之最重也。用旋复代赭汤去参、枣,连灌两剂,胎堕得生。又一妇证亦如之,服前药胎堕而死。
又陆检修正室,子上撞心,江稳婆教磨代赭汁服,遂产两子。一子在上横于心下,一子撞着上子,故经一
昼夜不止,撞心得不死,产下遂安。
陈良甫曰∶一妇孕七个月远归,忽然胎上冲作痛,坐卧不安。两医治之无效,遂云胎已死矣。用蓖麻子研
烂,和麝香贴脐中以下之,命在呼吸。陈诊之,两尺脉绝,他脉和平。陈问二医作何证治之,答云∶死胎。陈
问何以知之?曰∶两尺沉绝,以此知之。陈曰∶此说出何书?二医无以答。陈曰∶此子悬也。若是胎死,却有辨
处∶面赤舌青,子死母活;面青舌赤吐沫,母死子活;唇舌俱青,母子俱死。今面不赤,舌不青,其子未死,
是胎上逼。宜以紫苏饮连进,至十服,而胎近下矣。
雄按∶戊申秋,荆人妊八月而患咳嗽碍眠,鼻衄如射,面浮指肿,诸药不应。余思素属阴虚,内火自盛,
胎因火动,上凑心胸,肺受其冲,咳逆乃作。是不必治其嗽,仍当以子悬治之。用七宝散去参、芍、生姜,
为其胸满而内热也;加生石膏以清阳明之火,熟地以摄根蒂之阴。投匕即安。今年冬亦以八月之妊,而
悲哀劳瘁之余,胎气冲逆,眩晕嗽痰,脘胀便溏,舌黄口渴,予蠲饮六神汤去胆星、茯苓,加枳实、苏叶、
大腹皮以理气开郁,黄芩、栀子、竹茹以清热安胎,一剂知,二剂已。凡子悬证,因于痰滞者,余每用此
法,无不应如桴鼓。
薛立斋治一妊妇,每因恚怒,其胎上逼,左关脉弦洪,乃肝火内动。用小柴胡加茯苓、枳壳、山栀而愈。
但体倦不食,用六君子加枳壳、柴胡、山栀而瘥。
孙文垣治费少垣乃眷,妊已九月,痰多喘嗽,胎气上逆,眼撑不能起,两太阳微疼,此子悬症,兼痰火也。
以大紫苏饮为主,才服一帖,即不上逆,胸膈顿宽。惟喘咳不止,与七制化痰丸而安。紫苏饮∶紫苏、腹皮、
川芎、白芍、陈皮、当归、生姜、人参、甘草、葱白。
陆祖愚治梅养中子妇,孕七月,其夫出外经商,患胎上冲心,不时昏晕。或与紫苏安胎饮,数剂不效。脉
之,寸大于关,关大于尺,俱带弦数,此血虚极而火炎之故也。用清气养荣汤,磨沉香四分,牛黄二分,煎就
徐徐灌之,不终剂而苏矣。
万密斋治徐太和之妻,娠八月,得子满病。或作子悬治不效。腹满转甚,胎坠下迫,玉门大张,胞形外露,
但仰卧不能坐,其脉两手俱坚大搏指。谓曰∶病无害,乃双胎也。胎肥气弱,不能束约,故下坠耳。用束胎利
气主之,加人参一钱,升麻炒三分,服三剂,胎复上而安,后生一男一女。
杨乘六治我修侄妇,妊八月,一日胎忽上抢,塞至心口,喘满不思食,自汗,闷绝僵卧,口噤目直视,面
色不赤,舌色不青,按其两手脉息尚有,急取丸子两许,滚水研化灌之。灌至两酒杯,胸口松动,口开睛转,
手足运动而苏。问何药,乃尔神效?曰∶八味丸也。又问此何病而用此丸?曰∶此子悬也。由下元虚冷,中无
火以养婴儿,故上凑以就心火之温,如入睡被中,足冷则上缩也。后用 、术、芎、归煎送前丸,服至两月而
产。(沈尧封云∶此是百中仅一,非实见虚寒脉证,热药不可尝试。)
严氏紫苏散,许叔微说:治疗怀孕后期腹部胀满疼痛的病症,称为“子悬”。陈良甫说:妊娠到四、五个月时,君火与相二火滋养胎儿,热气逆乱上行,胎儿凑聚心胸部位,导致腹部胀满痞闷,使用此方并加入黄芩、山栀等药物。另一版本方剂中不含川芎,名为七宝散。配方为:紫苏一两,大腹皮、人参、川芎、橘皮、白芍、当归各三分,甘草一分,锉碎分为三次服用,用水一盏,生姜四片,葱白煎煮,去渣后服用。(汪昂说:此方每次仅用苏叶一钱,当归七分,大腹皮以下的药材各五分,甘草二分,不加葱白。)
沈尧封诊治一位郁姓妇女,怀孕九个月,偶然因劳累,随即感到腹痛,胎儿逐渐上升至胸中,气机堵塞不通,突然狂叫咬人,数人扶持不住,这是子悬证中最严重的情况。使用旋复代赭汤去掉人参、大枣,连续灌服两剂,胎儿堕下得以保全性命。又有一位妇女症状相同,服用前药后胎儿堕下而死亡。
还有陆检正的妻子,胎儿上撞心脏,江稳婆教她磨取代赭石汁服用,于是产下两个儿子。一个胎儿横在心下,另一个胎儿撞击上面的胎儿,所以经过一昼夜不停止,虽然撞击心脏但未致死,产下后便安然无恙。
陈良甫说:一位妇女怀孕七个月远行归来,忽然胎气上冲作痛,坐卧不安。两位医生治疗无效,便说胎儿已经死了。用蓖麻子研烂,混合麝香贴在脐中以下以引胎下行,性命危在旦夕。陈良甫诊察发现,两手尺脉绝迹,其他脉搏平和。陈良甫问两位医生将其作为什么证候治疗,回答说:死胎。陈良甫问怎么知道的?回答说:因为两尺脉沉伏绝迹,所以知道是死胎。陈良甫说:这种说法出自哪本书?两位医生无法回答。陈良甫说:这是子悬证。如果是胎死,却有辨别之处:面赤舌青,是子死母活;面青舌赤吐沫,是母死子活;唇舌俱青,是母子俱死。现在面色不赤,舌色不青,胎儿未死,这是胎气上逼。应当连续服用紫苏饮,直到十服,胎儿位置便下降安定了。
雄按(尤在泾按语):戊申年秋天,我的妻子怀孕八个月患咳嗽影响睡眠,鼻出血如喷射状,面部浮肿手指肿胀,各种药物无效。我思考她素来阴虚,内火自然旺盛,胎儿因火热扰动,上凑心胸,肺受其冲击,咳逆于是发作。这不必治疗咳嗽,仍应当按子悬证治疗。使用七宝散去掉人参、白芍、生姜,因为她胸满且内热;加生石膏以清阳明经之火,熟地黄以固摄根本之阴。投药即安。今年冬天也是怀孕八月,在悲哀劳瘁之后,胎气冲逆,出现眩晕、咳嗽痰多、胃脘胀满、大便溏薄、舌苔黄、口渴等症状,我用蠲饮六神汤去掉胆南星、茯苓,加枳实、苏叶、大腹皮以理气开郁,黄芩、栀子、竹茹以清热安胎,一剂见效,二剂痊愈。凡是子悬证,因痰滞引起的,我每用此法,没有不效如响应的。
薛立斋诊治一位孕妇,每次因愤怒,胎气上逼,左关脉弦洪,这是肝火内动。用小柴胡汤加茯苓、枳壳、山栀而愈。但身体疲倦不想进食,用六君子汤加枳壳、柴胡、山栀而病愈。
孙文垣诊治费少垣的妻子,怀孕已九个月,痰多喘嗽,胎气上逆,眼睛撑得不能抬起,两侧太阳穴轻微疼痛,这是子悬症,兼有痰火。以大紫苏饮为主方,才服一帖,胎气即不上逆,胸膈顿时宽舒。只是喘咳不止,给予七制化痰丸而安定。紫苏饮组成:紫苏、大腹皮、川芎、白芍、陈皮、当归、生姜、人参、甘草、葱白。
陆祖愚诊治梅养中的儿媳,怀孕七个月,丈夫外出经商,患胎气上冲心脏,不时昏晕。有人给予紫苏安胎饮,数剂无效。诊脉,寸脉大于关脉,关脉大于尺脉,都带有弦数之象,这是血虚极甚而火炎上的缘故。使用清气养荣汤,磨沉香四分,牛黄二分,煎好后徐徐灌服,不到一剂就苏醒过来了。
万密斋诊治徐太和的妻子,怀孕八个月,患上子满病。有人按子悬证治疗无效。腹部胀满更加严重,胎儿下坠压迫,阴道口大开,胞衣形状外露,只能仰卧不能坐,两手脉象都坚大搏指。万密斋说:病无大碍,是双胎。胎儿肥盛气弱,不能约束,所以下坠罢了。使用束胎利气方主治,加人参一钱,炒升麻三分,服用三剂,胎儿重新上升而安定,后来生下一男一女。
杨乘六诊治我的侄媳妇,怀孕八个月,一天胎气忽然上抢,塞至心口,喘满不想吃东西,自汗,闷绝僵卧,口噤目直视,面色不赤,舌色不青,按压两手脉息尚存,急忙取丸子约两许,滚水研化灌服。灌至两酒杯的量,胸口松动,口开眼转,手足运动而苏醒。问是什么药如此神效?说是八味丸。又问这是什么病用此丸?说是子悬证。由于下元虚冷,中间没有火来养育婴儿,所以上凑以寻求心火的温暖,就像睡觉盖被子,脚冷则向上缩一样。后来用白术、川芎、当归煎汤送服前面的丸子,服用两个月后生产。(沈尧封说:这是百中仅有一例的情况,如果不是确实见到虚寒脉证,热药不可尝试。)
(This condition is also known as the fetus pressing upward. Note by Fu Ziman.)
Yan's Schizonepeta Decoction (Zisu San): Xu Shuwei stated that it treats distension and pain in the upper abdomen near term during pregnancy, a condition termed "Zixuan" (Fetal Distension). Chen Liangfu stated: When pregnancy reaches four or five months, the Ministerial Fire nourishes the fetus. If heat qi rebels upward, the fetus crowds into the chest and heart region, causing abdominal fullness and stifling sensation. This formula is used with added Huangqin (Scutellariae Radix) and Zhizi (Gardeniae Fructus). Another version without Chuanxiong (Cyperi Rhizoma) is named Qibao San (Seven-Treasure Powder). The prescription consists of Zisu (Perillae Folium) 1 liang, Fupi (Tangeris Pericarpium Viride), Renshen (Ginseng Radix et Rhizoma), Chuanxiong, Ju Pi (Citri Reticulatae Pericarpium), Baishao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix) each 3 fen, Gancao (Glycyrrhizae Radix et Rhizoma) 1 fen. It is cut into pieces and divided into three doses. Boil with 1 sheng of water, 4 slices of Shengjiang (Zingiberis Rhizoma Recens), and Congbai (Allii Fistulosi Bulbus), strain, and take the decoction. (Wang Ang noted: For this formula, only 1 qian of Zisu Ye (Perillae Folium) and 7 fen of Danggui are used per dose; all herbs below Fupi are 5 fen, and Gancao is 2 fen; Congbai is omitted.)
Shen Yaofeng treated a surnamed Yu woman who was nine months pregnant. Accidentally due to labor, she felt abdominal pain, and the fetus gradually rose to the chest. Qi obstruction caused sudden screaming and biting, unable to be restrained by several people holding her. This was the most severe case of Zixuan. He used Xuanfu Daizhe Tang (Inula and Hematite Decoction), removing Renshen and Dazao (Jujubae Fructus), and administered two consecutive doses. The fetus was expelled, and the mother survived. Another woman had similar symptoms but died after the fetus was expelled following the same medication.
Additionally, the wife of Lu Jianxiu experienced the fetus striking the heart. Midwife Jiang taught her to consume juice made from grinding Daizhishi (Hematitum), after which she delivered two sons. One fetus lay horizontally below the heart, and the other struck the upper fetus, causing continuous distress for a day and night. Although the heart was struck, she did not die, and was safe after delivery.
Chen Liangfu stated: A woman returned from a long journey at seven months of pregnancy and suddenly experienced fetal uprising with pain, restlessness in sitting and lying down. Two physicians failed to treat her effectively and claimed the fetus was dead. They applied a paste of crushed Bimazi (Ricini Semen) mixed with Shexiang (Moschus) below the umbilicus to induce expulsion, leaving her life hanging by a thread. Chen examined her and found the Chi pulse (Kidney pulse) absent on both sides, while other pulses were peaceful. Chen asked how they diagnosed it. They replied: Dead fetus. Chen asked how they knew. They said: Because the Chi pulses were deep and absent. Chen asked which book this theory came from. The physicians could not answer. Chen said: This is Zixuan. If the fetus were dead, there would be specific signs: red face and blue tongue indicate dead fetus and living mother; blue face, red tongue, and foaming indicate dead mother and living fetus; blue lips and tongue indicate death of both. Currently, her face is not red, and her tongue is not blue, so the fetus is alive. This is fetal uprising. She should continuously administer Zisu Yin (Schizonepeta Infusion), up to ten doses, until the fetus descends.
Note by You Zaijing: In the autumn of Wushen year, my wife, eight months pregnant, suffered from cough affecting sleep, spurting epistaxis (nosebleed), facial edema, and finger swelling. Various medicines were ineffective. I reasoned that she constitutionally has Yin deficiency, leading to abundant internal fire. The fetus, agitated by fire, crowds the chest and heart, impacting the lungs and causing rebellious cough. Thus, treating the cough directly is unnecessary; instead, one should treat Zixuan. I used Qibao San, removing Renshen, Baishao, and Shengjiang, because of her chest fullness and internal heat; added Sheng Shigao (Gypsum Fibrosum) to clear Yangming fire, and Shudi (Rehmanniae Radix Preparata) to secure the root Yin. Relief was immediate. This winter, again at eight months of pregnancy, after grief and exhaustion, fetal qi rebelled, causing dizziness, cough with phlegm, epigastric distension, loose stools, yellow coating, thirst, and dry mouth. I used Juan Yin Liu Shen Tang (Six-God Decoction to Remove Fluid Retention), removing Danxing (Arisaematis Cum Bile) and Fuling (Poria), adding Zhishi (Aurantii Fructus Immaturus), Zisu Ye, and Dafupi (Tangeris Pericarpium Viride) to regulate qi and relieve depression, and Huangqin, Zhizi, and Zhuru (Bambusae Caulis in Taenia) to clear heat and calm the fetus. Improvement after one dose, cure after two. For all Zixuan cases caused by phlegm stagnation, I use this method, and results are invariably prompt.
Xue Lizhai treated a pregnant woman whose fetal uprising occurred whenever she was angry. Her Left Guan pulse was wiry and surging, indicating internal stirring of Liver Fire. She was cured using Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Fuling, Zhike (Aurantii Fructus), and Zhizi. However, she remained fatigued and anorexic, and was cured using Liujunzi Tang (Six-Gentlemen Decoction) plus Zhike, Chaihu (Bupleuri Radix), and Zhizi.
Sun Wen Yuan treated the wife of Fei Shaoyuan, who was nine months pregnant, suffering from excessive phlegm, wheezing, and cough, with rebellious fetal qi. Her eyes were swollen shut and unable to open, with slight pain in the temporal regions. This was Zixuan complicated by Phlegm-Fire. Using Da Zisu Yin (Major Schizonepeta Infusion) as the main formula, after just one dose, the rebellious qi ceased, and the chest and diaphragm felt relaxed. Only the wheezing and cough persisted, which were settled with Qizhi Huatan Wan (Seven-Processed Phlegm-Resolving Pill). Zisu Yin composition: Zisu, Fupi, Chuanxiong, Baishao, Chenpi, Danggui, Shengjiang, Renshen, Gancao, Congbai.
Lu Zuyu treated the daughter-in-law of Mei Yangzhong, who was seven months pregnant. Her husband was away trading. She suffered from fetal qi rushing to the heart and frequent syncope. Zisu Antai Yin (Schizonepeta Fetus-Calming Infusion) given for several doses was ineffective. Pulse diagnosis showed Cun (Inch) greater than Guan (Bar), and Guan greater than Chi, all wiry and rapid. This indicated extreme Blood deficiency with flaming Fire. He used Qingqi Yangrong Tang (Clear Qi and Nourish Ying Decoction), grinding Chenxiang (Aquilariae Lignum Resinatum) 4 fen and Niuhuang (Calculus Bovis) 2 fen, and slowly administered the decoction. She revived before finishing one dose.
Wan Mizhai treated the wife of Xu Taihe, who was eight months pregnant and suffered from Ziman (Fetal Hydrops). Treatment as Zixuan was ineffective. Abdominal distension worsened, the fetus descended and pressed down, the vulva opened widely, and the amniotic sac shape was exposed externally. She could only lie supine and could not sit. Both hands' pulses were firm, large, and bounding. He said: The disease is harmless; it is twins. The fetuses are plump and weak in qi, unable to restrain themselves, hence the descent. He used Shutai Liqi Zhu (Fetus-Binding and Qi-Regulating Formula) as the main treatment, adding Renshen 1 qian and fried Shengma (Cimicifugae Rhizoma) 3 fen. After three doses, the fetus ascended and stabilized. She later gave birth to a boy and a girl.
Yang Chengliu treated my niece's wife, who was eight months pregnant. One day, fetal qi suddenly rushed upward, blocking the heart region, causing wheezing, fullness, anorexia, spontaneous sweating, suffocation, rigid recumbency, locked jaw, fixed gaze, non-red face, and non-blue tongue. Pressing the pulses on both hands, they were still present. I urgently took about two qian of pills, dissolved them in boiling water, and administered them. After administering the amount equivalent to two wine cups, the chest loosened, the mouth opened, eyes turned, limbs moved, and she revived. Asked what medicine was so effective? It was Bawei Wan (Eight-Ingredient Pill). Asked what disease required this pill? I said: Zixuan. Due to deficiency-cold of the Lower Yuan, lacking Fire to nourish the infant, the fetus moves upward to seek the warmth of Heart Fire, like shrinking feet upward when cold under blankets. Later, using Baizhu (Atractylodis Macrocephalae Rhizoma), Chuanxiong, and Danggui decoction to send down the previous pills, she took them for two months until delivery. (Shen Yaofeng commented: This is a rare case occurring once in a hundred. Unless there is definite evidence of deficiency-cold pulses and symptoms, hot medicines should not be attempted.)