妊娠出疹,当以四物加减,而加条芩、艾叶,以安胎清热为主,则胎不动而麻疹自出矣。然热毒蒸胎,
胎多受伤,但胎虽伤而母实无恙也。盖疹与痘不同,痘宜内实,以痘当从外解,故胎落毒瓦斯乘虚而内攻,
其母亡。疹宜内虚,以疹当从内解,
故胎落热毒随胎而下,其母存。虽然,与其胎去而母存,孰若子母两全之为愈也。且古人徒知清热以安胎,
不思疹未出而即以清热为事,则疹难出而内热愈深,是欲保胎,反足以伤胎也,宜轻扬表托,则疹出而热
自清,继以滋阴清解,则于疹于胎两不相碍,不安胎而胎自安矣。如疹出不快,宜白虎汤合用升麻葛根汤,
倍加元参、牛蒡治之。胎气上冲,急用苎根、艾叶煎汤,磨槟榔服之,再以四物汤进之。热甚胎不安,服固
胎饮数剂。如又不愈,腹疼腰酸,即知胎有必堕之机。如胎堕,即以产法论治矣。
升麻葛根汤
葛根 升麻 白芍 甘草(各等分)
水一盏,煎七分,温服。此解表发散之方也。表热壮盛,邪实于表。经曰∶轻可去实。故用升麻、葛根
以疏表。所以然者,升麻能解疫毒,升阳于至阴之下,以助发生之气。葛根能解热毒,兼疏营卫,以导起
发之机。二味之外,又加甘草佐之,以和在表之气;芍药佐之,以和在里之营。去其实邪,和其营卫,风寒自
解,麻疹自出。
固胎饮 止痛安胎。
地黄 川芎(各五分) 归身 人参 白芍 陈皮(各一钱) 白术(土炒) 黄芩(各一钱五分)
甘草(三分) 黄连 黄柏(各一分) 桑上羊儿藤(七叶,圆者)
上细切,每服二三钱,入糯米二十粒,水一钟,煎至七分,温服。痛加砂仁,血虚加阿胶。
白虎汤(见本卷疟门,附桂枝白虎汤下。) 四物汤(见本卷安胎门。)
妊娠期间出现麻疹,应当以四物汤为基础进行加减,并加入黄芩(条芩)和艾叶,以安胎和清热为主要治疗原则,这样胎儿就不会受到扰动,麻疹自然能够透发出来。然而,热毒熏蒸会影响胎儿,导致胎儿多受损伤,但即使胎儿受损,母亲通常安然无恙。这是因为麻疹与天花不同,天花宜使体内正气充实,因为天花邪气应从体表解除,如果胎元脱落,毒瓦斯就会趁虚内攻,导致母亲死亡;而麻疹宜使体内相对空虚,因为麻疹邪气应从内部解除,所以胎元脱落时,热毒会随胎元一同排出,母亲得以存活。虽然如此,与其失去胎儿而保全母亲,不如母子双全更为理想。况且古人只知道通过清热来安胎,却不思考在麻疹尚未发出时就急于清热,会导致麻疹难以透出且内热更加深重,这本想保护胎儿,反而足以伤害胎儿。因此,适宜使用轻扬升散的药物托举疹毒外出,这样麻疹透出后热邪自然清除,随后采用滋阴清解的方法,这样既有利于麻疹又有利于胎儿,两不相碍,不需要刻意安胎而胎儿自然安稳。如果麻疹出得不顺畅,适宜将白虎汤与升麻葛根汤合用,加倍使用玄参、牛蒡子进行治疗。如果胎气上冲,紧急使用苎麻根、艾叶煎汤,磨碎槟榔服用,然后再服用四物汤。如果热势严重导致胎动不安,服用固胎饮数剂。如果病情仍未好转,出现腹痛腰酸,就知道胎儿有必然堕落的征兆。如果胎儿已经堕落,就按照产后病的方法进行治疗。
升麻葛根汤
药材:葛根、升麻、白芍、甘草(各等分)。
用法:用水一盏,煎至七分,温服。这是解表发散的方剂。针对表热壮盛,邪气实于体表的证候。经书说:“轻可去实。”所以使用升麻、葛根来疏解表邪。之所以这样做,是因为升麻能解疫毒,提升阳气于至阴之下,以助发生之气;葛根能解热毒,兼疏营卫,以引导疹毒起发之机。在这两味药之外,又加入甘草辅助,以调和在表之气;加入白芍辅助,以调和在里之营血。去除实邪,调和营卫,风寒自然解除,麻疹自然透出。
固胎饮 功效:止痛安胎。
药材:地黄、川芎(各五分)、当归身、人参、白芍、陈皮(各一钱)、白术(土炒)、黄芩(各一钱五分)、甘草(三分)、黄连、黄柏(各一分)、桑上羊儿藤(七片叶子,圆形的)。
用法:以上药物细切,每次服用二三钱,加入糯米二十粒,水一钟,煎至七分,温服。疼痛剧烈加砂仁,血虚加阿胶。
During pregnancy, if macules (rash) appear, one should modify Siwu Tang (Four Substance Decoction) and add Huangqin (Scutellariae Radix, specifically the strip-shaped root) and Aye (Mugwort Leaf), focusing on stabilizing the fetus and clearing heat. In this way, the fetus will remain undisturbed, and the macules will naturally erupt. However, heat-toxin steaming the uterus often injures the fetus; although the fetus may be injured, the mother usually remains unharmed. This is because macules differ from smallpox. Smallpox treatment favors internal solidity because the pathogen should resolve from the exterior; if the fetus detaches, toxic vapors attack inward due to deficiency, leading to the mother's death. Macule treatment favors internal emptiness because the pathogen resolves from within; thus, if the fetus detaches, heat-toxin exits with the fetus, preserving the mother. Nevertheless, rather than losing the fetus while saving the mother, it is better for both mother and child to survive. Moreover, ancients only knew to clear heat to stabilize the fetus. They failed to consider that clearing heat before the macules have erupted makes eruption difficult and deepens internal heat. Thus, intending to protect the fetus, they inadvertently harm it. Therefore, it is appropriate to use light, ascending, and dispersing herbs to support the eruption of macules; once the macules emerge, heat clears naturally. Subsequently, using yin-nourishing and heat-clearing methods ensures neither the macules nor the fetus are hindered; without deliberate fetal stabilization, the fetus remains secure. If macules do not erupt smoothly, combine Baihu Tang (White Tiger Decoction) with Shengma Gegen Tang (Kudzu and Cimicifuga Decoction), doubling the dosage of Xuanshen (Scrophulariae Radix) and Niubangzi (Arctii Fructus). If fetal qi rushes upward, urgently decoct Zhumagen (Chinese Ramie Root) and Aye (Mugwort Leaf), grind Binglang (Areca Seed) into powder, mix and take orally, then administer Siwu Tang (Four Substance Decoction). If severe heat causes fetal restlessness, administer Gutai Yin (Fetus-Stabilizing Drink) for several doses. If there is no improvement and abdominal pain and lower back soreness occur, it indicates inevitable fetal abortion. If the fetus aborts, treat according to postpartum disease protocols.
Shengma Gegen Tang (Kudzu and Cimicifuga Decoction)
Ingredients: Gegen (Puerariae Lobatae Radix), Shengma (Cimicifugae Rhizoma), Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma) in equal parts.
Preparation: Decoct one cup of water until reduced to 70%, take warm. This is a formula for resolving the exterior and inducing sweating. It addresses vigorous exterior heat and excess pathogens at the surface. The Classics state: "Light substances can remove excess." Hence, Shengma and Gegen are used to vent the exterior. The reason is that Shengma resolves epidemic toxins and raises yang qi from beneath extreme yin, assisting the generative qi. Gegen resolves heat toxins, regulates Ying and Wei, and facilitates the eruption mechanism. Besides these two, Gancao is added to harmonize exterior qi, and Baishao is added to harmonize interior Ying blood. By removing excess pathogens and harmonizing Ying and Wei, wind-cold resolves spontaneously, and macules erupt naturally.
Gutai Yin (Fetus-Stabilizing Drink)
Efficacy: Relieves pain and stabilizes the fetus.
Ingredients: Dihuang (Rehmanniae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 5 fen); Danggui Shen (Angelicae Sinensis Radix), Renshen (Ginseng Radix), Baishao (Paeoniae Radix Alba), Chenpi (Citri Reticulatae Pericarpium) (each 1 qian); Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) (1.5 qian); Gancao (Glycyrrhizae Radix et Rhizoma) (3 fen); Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex) (each 1 fen); Sangshang Yangerteng (Celastrus Orbiculatus Stem growing on mulberry tree, seven round leaves).
Preparation: Finely cut the above ingredients. Take 2-3 qian per dose, add 20 grains of Nuomi (Oryza Sativa Glutinosa Semen), one cup of water, decoct until reduced to 70%, take warm. Add Renchen (Amomi Fructus) for pain; add Ejiao (Asini Corii Colla) for blood deficiency.
Baihu Tang (White Tiger Decoction) (See Malaria Section in this volume, under Guizhi Baihu Tang.)
Siwu Tang (Four Substance Decoction) (See Fetal Stabilization Section in this volume.)