妊娠因甘肥过度腐积成痰,或七情郁结气盛为火,停蓄胃中,乍因寒热之感,邪正交争,阴阳相混,
故令心腹绞痛,吐利并作,挥霍变乱,谓之霍乱。如邪在上,则当心痛而吐多;邪在下,则当脐痛而利多;
邪在中脘,则腹中痛,吐利俱多。吐多伤气,利多伤血,血气受伤不能护养其胎,邪气鼓击胎元,子母未
有不殒者。此危证,不可不亟治也,宜香苏散加藿香叶,或先服后探吐之。又加味四味紫苏和胎饮,治心
腹绞痛,上吐下泻,亦效。予治孕妇霍乱,用六和汤累效。又有回生散、七味白术散,录后以备临证择用。
再考方书,单泻用胃苓汤,饮食停滞用平胃散,内伤饮食、外感风寒用藿香正气散,皆治霍乱之剂也。
香苏散 此方治霍乱,平正之至。
香附(炒) 紫苏(各二钱) 陈皮(一钱) 藿香叶 缩砂 炙草(各五分)
水煎服。如转筋,加木瓜一钱。胎动不安,加土炒白术一钱五分。如夏月得之,
加黄芩一钱五分,炒黄连一钱,香薷二钱。如冬月得之,加人参、土炒白术各一
钱,炮姜五分。
加味四味紫苏和胎饮 治心腹绞痛,上吐下泻。
紫苏 黄芩 白术(土炒。各一钱五分) 炙草(以上四味和胎饮本方) 藿香叶 陈皮(各一
钱) 砂仁(五分,炒)
姜枣引,水煎服。
六和汤 治霍乱吐泻,心烦腹胀。
陈皮(四分) 制半夏(七分) 杏仁(十粒,去皮尖) 竹茹 木瓜(各一钱) 扁豆(二钱
)茯苓(八分) 藿香 砂仁(研) 甘草(各五分)
姜一片,枣二枚,水煎服。如不愈,再服四味紫苏和胎饮。
回生散 治中气不和,霍乱吐泻,但一点胃气存者,服之回生。
陈皮(去白) 藿香(各五分)
上锉,水煎温服。
七味白术散 治脾胃虚弱,吐泻作渴不食。
人参 白术(土炒) 茯苓 木香 藿香 炙草(各五钱) 干葛(一两)
上为末,沸汤调服二钱。吐甚者,加生姜汁频服。
胃苓汤(见本卷泄泻门。) 平胃散 藿香正气散(俱见本卷诸痛门。)
妊娠期间,如果因过食甘甜肥腻之物,导致食物积滞化生痰浊;或者因七情郁结,气机旺盛化为火邪,停滞蓄积在胃中。此时若突然感受寒热之邪,邪气与正气相互交争,阴阳之气混淆紊乱,从而导致心腹部剧烈绞痛,呕吐与腹泻同时发作,病情变化迅速且混乱,这种病症称为霍乱。
如果病邪位于上部(上焦/胃之上部),则会出现心痛且呕吐症状较重;如果病邪位于下部(下焦/肠),则会出现肚脐周围疼痛且腹泻症状较重;如果病邪位于中部(中脘),则会出现腹部疼痛,呕吐和腹泻都严重。
呕吐过多会损伤气,腹泻过多会损伤血。气血受损后,无法保护和滋养胎儿,邪气鼓动冲击胎元,母子没有不堕胎或死亡的。这是危急重症,不可不紧急治疗。适宜使用香苏散加入藿香叶,或者先服用药物后再探吐以排出邪气。另外,加味四味紫苏和胎饮,也能治疗心腹绞痛、上吐下泻,同样有效。我治疗孕妇霍乱,使用六和汤屡获良效。还有回生散、七味白术散,记录在后面以备临证时选择使用。
再考证方书,单纯腹泻用胃苓汤,饮食停滞用平胃散,内伤饮食兼外感风寒用藿香正气散,这些都是治疗霍乱的方剂。
香苏散:此方治疗霍乱,平和端正到了极点。
香附(炒制)二钱,紫苏二钱,陈皮一钱,藿香叶五分,缩砂仁五分,炙甘草五分。
用水煎服。如果出现转筋(肌肉痉挛),加木瓜一钱。胎动不安,加土炒白术一钱五分。如果是夏季得的病,加黄芩一钱五分,炒黄连一钱,香薷二钱。如果是冬季得的病,加人参、土炒白术各一钱,炮姜五分。
加味四味紫苏和胎饮:治疗心腹绞痛,上吐下泻。
紫苏一钱五分,黄芩一钱五分,白术(土炒)一钱五分,炙甘草一钱五分(以上四味为和胎饮本方),藿香叶一钱,陈皮一钱,砂仁五分(炒制)。
用生姜、大枣做引子,水煎服。
六和汤:治疗霍乱引起的呕吐腹泻,心烦腹胀。
陈皮四分,制半夏七分,杏仁十粒(去皮尖),竹茹一钱,木瓜一钱,扁豆二钱,茯苓八分,藿香五分,砂仁(研碎)五分,甘草五分。
生姜一片,大枣两枚,水煎服。如果未痊愈,再服用四味紫苏和胎饮。
回生散:治疗中气不和,霍乱吐泻,只要还存有一点胃气,服用此药就能起死回生。
陈皮(去白)五分,藿香五分。
切碎,用水煎煮后温服。
七味白术散:治疗脾胃虚弱,呕吐腹泻引起口渴、不想进食。
人参五钱,白术(土炒)五钱,茯苓五钱,木香五钱,藿香五钱,炙甘草五钱,干葛一两。
研成细末,用沸水冲调服用二钱。呕吐严重的,加生姜汁频繁服用。
During pregnancy, if there is excessive consumption of sweet and fatty foods leading to food stagnation transforming into phlegm, or if emotional depression causes qi stagnation transforming into fire, which accumulates in the stomach. If suddenly exposed to cold or heat pathogens, the pathogenic factor and healthy qi contend with each other, causing yin and yang to mix chaotically, resulting in severe colic pain in the heart and abdomen, simultaneous vomiting and diarrhea, rapid and chaotic changes in condition. This disease is called Cholera (Huoluan).
If the pathogen is located in the upper part, it will cause heart pain with predominant vomiting; if the pathogen is in the lower part, it will cause periumbilical pain with predominant diarrhea; if the pathogen is in the middle Jiao (Zhongwan), it will cause abdominal pain with both severe vomiting and diarrhea.
Excessive vomiting damages Qi, while excessive diarrhea damages Blood. When Qi and Blood are injured, they cannot protect and nourish the fetus. The pathogenic factor agitates and strikes the fetal origin, so neither mother nor child can avoid miscarriage or death. This is a critical syndrome that must be treated urgently. It is suitable to use Xiangsu San (Fragrant Perilla Powder) added with Huoxiang Ye (Agastache Leaf), or to take the medicine first and then induce vomiting to expel the pathogen. Additionally, Jiawei Siwei Zisu Hetai Yin (Modified Four-Ingredient Perilla Fetal-Harmonizing Decoction) treats heart and abdominal colic with upper vomiting and lower diarrhea, and is also effective. I have treated pregnant women with Cholera using Liuhe Tang (Six Harmonies Decoction) with repeated success. There are also Huisheng San (Life-Returning Powder) and Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder), recorded below for selection during clinical practice.
Further consulting medical formularies, Wei Ling Tang (Stomach-Cinnamon Decoction) is used for pure diarrhea, Pingwei San (Peace the Stomach Powder) is used for food stagnation, and Huoxiang Zhengqi San (Agastache Regulating Qi Powder) is used for internal injury from diet combined with external contraction of wind-cold; all are formulas for treating Cholera.
Xiangsu San: This formula treats Cholera, being extremely balanced and orthodox.
Xiangfu (Cyperi Rhizoma, stir-fried) 2 qian, Zisu (Perillae Folium) 2 qian, Chenpi (Citri Reticulatae Pericarpium) 1 qian, Huoxiang Ye (Agastaches Herba) 5 fen, Suosha (Amomi Fructus Rotundus) 5 fen, Zhigancao (Glycyrrhizae Radicae et Rhizoma Praeparatum cum Melle) 5 fen.
Decoct in water and take orally. If muscle cramps occur, add Mugua (Chaenomelis Fructus) 1 qian. For restless fetus, add Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 1.5 qian. If contracted in summer, add Huangqin (Scutellariae Radix) 1.5 qian, Chao Huanglian (Coptidis Rhizoma stir-fried) 1 qian, Xiangru (Moslae Herba) 2 qian. If contracted in winter, add Renshen (Ginseng Radix et Rhizoma) and Baizhu (stir-fried with soil) 1 qian each, Paojiang (Zingiberis Rhizoma Praeparatum) 5 fen.
Jiawei Siwei Zisu Hetai Yin: Treats heart and abdominal colic with upper vomiting and lower diarrhea.
Zisu (Perillae Folium) 1.5 qian, Huangqin (Scutellariae Radix) 1.5 qian, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 1.5 qian, Zhigancao (Glycyrrhizae Radicae et Rhizoma Praeparatum cum Melle) 1.5 qian (these four constitute the original Hetai Yin), Huoxiang Ye (Agastaches Herba) 1 qian, Chenpi (Citri Reticulatae Pericarpium) 1 qian, Sharen (Amomi Fructus, stir-fried) 5 fen.
Use Shengjiang (Zingiberis Rhizoma Recens) and Zao (Jujubae Fructus) as guides, decoct in water and take orally.
Liuhe Tang (Six Harmonies Decoction): Treats Cholera with vomiting and diarrhea, restlessness, and abdominal distension.
Chenpi (Citri Reticulatae Pericarpium) 4 fen, Zhibanxia (Pinelliae Rhizoma Praeparatum) 7 fen, Xingren (Armeniacae Semen Amarum, 10 grains, skin and tip removed) 10 grains, Zhuru (Bambusae Caulis in Taeniam) 1 qian, Mugua (Chaenomelis Fructus) 1 qian, Biandou (Dolichoris Semen) 2 qian, Fuling (Poria) 8 fen, Huoxiang (Agastaches Herba) 5 fen, Sharen (Amomi Fructus, crushed) 5 fen, Gancao (Glycyrrhizae Radicae et Rhizoma) 5 fen.
Shengjiang (Zingiberis Rhizoma Recens) 1 slice, Zao (Jujubae Fructus) 2 pieces, decoct in water and take orally. If not cured, take Siwei Zisu Hetai Yin again.
Huisheng San (Life-Returning Powder): Treats disharmony of Middle Qi, Cholera with vomiting and diarrhea. If even a trace of Stomach Qi remains, taking this powder restores life.
Chenpi (Citri Reticulatae Pericarpium, white pith removed) 5 fen, Huoxiang (Agastaches Herba) 5 fen.
Crush, decoct in water, and take warm.
Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder): Treats Spleen and Stomach deficiency, vomiting and diarrhea causing thirst and anorexia.
Renshen (Ginseng Radix et Rhizoma) 5 qian, Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil) 5 qian, Fuling (Poria) 5 qian, Muxiang (Aucklandiae Radix) 5 qian, Huoxiang (Agastaches Herba) 5 qian, Zhigancao (Glycyrrhizae Radicae et Rhizoma Praeparatum cum Melle) 5 qian, Gange (Puerariae Lobatae Radix) 1 liang.
Grind into fine powder, mix with boiling water, and take 2 qian. For severe vomiting, add Shengjiangzhi (Zingiberis Rhizoma Recens Juice) and take frequently.
Weiling Tang (Wei Ling Tang, see Diarrhea section in this volume), Pingwei San (Pingwei San), Huoxiang Zhengqi San (Huoxiang Zhengqi San) (all see Pain section in this volume).