妊娠伤寒,专以清热安胎为主,外用涂脐护胎之法,其或汗、或下,各随表里所见脉证主治。有表
证宜汗者,羌活冲和汤加柴胡、当归、芍药、苏叶、葱白之类。若里热实症,便秘、躁渴者,
亦用大黄转药,须酒制用。有病病当之,设患真寒脉伏厥冷者,则用姜、桂、附子。姜、桂虽热,用黄连、
甘草制之则无害矣。况应犯而犯似乎无犯,若不急为调治,以去极寒极热之病,则胎为
病所困而难于保全矣。奈何去病寒热之药,人多畏之,伤生寒热之病,人反安之何也?
妊娠寒热皆因气血虚损,风寒乘之。风为阳邪,化气而为热;寒为阴邪,化气而为寒;阴阳并挟,
寒热互见。经曰∶阳微恶寒,阴弱发热。此皆虚之所致,不因暑气所作,宜清解表邪,兼大补气血以主之,勿泥
寒热假象也。若寒热不已,熏蒸其胎,胎必伤矣。更有患胎疟者,一遇有胎,疟病即发。此人素有肝火,遇孕
则水养胎元,肝虚血燥,寒热往来,似疟非疟也,以逍遥散清肝火、养肝血,兼六味丸以滋化源。
妊娠饮食生冷,脾胃不能克化,致令心腹疼痛。伤血则赤,伤气则白,血气俱伤,则赤白相杂。至若腹
内重坠,胎气不安者,此腹重坠下,元气虚而不能升举,真气下陷也,大用补中汤而自安,
切勿顺气、行气,益增坠下之患。胎系于肾,如钟系于梁,栋柱不固,栋梁必挠,而钟岂能独全哉。况似痢
非痢者,多中气虚则不能上升,脾气虚则不能渗湿,肾气虚则不能闭藏。慎勿以有形
之假滞,而伤无形之元气,至元气一伤,变症百出矣。胎能保乎?
妊娠期间患伤寒,治疗应以清热安胎为主要原则。可配合外用涂脐以保护胎儿的方法。至于发汗或攻下等治法,则需根据表证或里证的脉象和症状来主治。若有表证适宜发汗的,可用羌活冲和汤加入柴胡、当归、芍药、紫苏叶、葱白等药物。若为里热实证,出现便秘、烦躁口渴等症状,也可使用大黄制成的转药(泻下药),但必须经过酒制后使用。疾病有其特定的病机对应,如果患者患有真寒证,表现为脉伏、四肢厥冷,则应使用干姜、肉桂、附子。干姜、肉桂虽然性热,但若用黄连、甘草加以制约,便不会产生危害。况且,该用药而用药看似违背常理,实则并未真正违逆医道;如果不及时调理治疗,去除极寒极热的病邪,那么胎儿就会被病邪所困,难以保全。为何人们往往畏惧那些能祛除病邪寒热属性的药物,反而对导致生命受损的寒热病邪习以为常呢?
妊娠期间的寒热症状,皆因气血虚损,风寒之邪乘虚而入所致。风属于阳邪,化气而生热;寒属于阴邪,化气而生寒;阴阳二邪夹杂,导致寒热症状交替出现。《内经》说:“阳气微弱则恶寒,阴气虚弱则发热。”这些都是由虚证引起的,并非暑气所致,治疗宜清解表邪,同时大补气血作为主法,不要拘泥于寒热的假象。如果寒热症状不止,熏蒸灼伤胎儿,胎儿必然受损。更有患“胎疟”者,一旦怀孕,疟疾样病症随即发作。这类人平素肝火旺盛,怀孕后阴血滋养胎元,导致肝血亏虚、血液燥热,出现寒热往来的症状,看似疟疾而非疟疾,可用逍遥散清肝火、养肝血,兼服六味地黄丸以滋生化之源。
妊娠期间饮食生冷,脾胃无法运化消化,导致心腹疼痛。损伤血分则大便带血(赤痢),损伤气分则下白冻(白痢),气血俱伤,则赤白相杂。至于腹部有沉重下坠感,胎气不安的情况,这是因为腹部重坠下行,元气虚弱不能升举,真气下陷所致,应大量使用补中益气汤,胎儿自然安定,切勿使用顺气、行气的药物,以免增加下坠的危害。胎儿系于肾,如同钟悬挂在梁上,栋梁不坚固,必然弯曲折断,钟岂能独自保全呢?况且那些似痢非痢的症状,多因中气虚不能上升,脾气虚不能渗湿,肾气虚不能闭藏所致。千万不要因为有形质的假性积滞,而伤害无形的元气,一旦元气受损,各种变症就会层出不穷,胎儿还能保得住吗?
In cases of cold damage (Shanghan, a disease caused by external pathogenic cold) during pregnancy, treatment should primarily focus on clearing heat and calming the fetus. External methods such as applying medicaments to the navel can be used to protect the fetus. Regarding diaphoresis (inducing sweating) or purgation (inducing bowel movement), treatment should be guided by the pulse and symptoms indicating exterior or interior patterns. If an exterior pattern is present requiring diaphoresis, Qianghuo Chonghe Tang (Notopterygium Decoction for Harmonizing the Middle) may be used with added Chai Hu (Bupleuri Radix), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba), Zi Su Ye (Perillae Folium), and Cong Bai (Allii Fistulosi Bulbus). If there is an interior excess-heat pattern manifesting as constipation, restlessness, and thirst, Da Huang (Rhei Radix et Rhizoma) prepared as a purgative may also be used, but it must be processed with wine. Diseases have specific pathological correspondences; if the patient presents with true cold patterns characterized by deep, imperceptible pulses and cold extremities, Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex), and Fu Zi (Aconiti Lateralis Radix Praeparata) should be employed. Although Gan Jiang and Rou Gui are hot in nature, their harmful effects are neutralized when constrained by Huang Lian (Coptidis Rhizoma) and Gan Cao (Glycyrrhizae Radix et Rhizoma). Moreover, using medication when indicated may seem like violating conventional caution, yet it does not truly go against medical principles; if one fails to promptly regulate and treat the condition to eliminate extreme cold and heat pathogens, the fetus will be besieged by the disease and difficult to preserve. Why do people fear medications that remove pathogenic cold and heat, while accepting the cold and heat diseases that harm life?
Cold and heat sensations during pregnancy are all due to deficiency and damage of Qi and Blood, allowing Wind-Cold pathogens to invade. Wind is a Yang pathogen that transforms into heat; Cold is a Yin pathogen that transforms into cold. When Yin and Yang pathogens combine, cold and heat symptoms appear alternately. The Classics state: "When Yang is weak, there is aversion to cold; when Yin is weak, there is fever." These are all caused by deficiency, not by summer-heat. Treatment should involve clearing and resolving exterior pathogens while simultaneously greatly tonifying Qi and Blood. One should not be confused by the false appearance of cold and heat. If the cold and heat persist, steaming and damaging the fetus, the fetus will surely be injured. Furthermore, some patients suffer from "Fetal Malaria" (Tai Nue), where malaria-like symptoms occur immediately upon conception. These individuals typically have pre-existing Liver Fire. During pregnancy, Yin blood nourishes the fetal origin, leading to Liver Blood deficiency and dryness, resulting in alternating chills and fever. This resembles malaria but is not malaria. It should be treated with Xiaoyao San (Free and Easy Wanderer Powder) to clear Liver Fire and nourish Liver Blood, combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish the source of transformation.
Consumption of raw and cold foods during pregnancy impairs the Spleen and Stomach's ability to transform and transport, causing pain in the heart and abdomen. Injury to the Blood aspect results in bloody stools (red dysentery); injury to the Qi aspect results in white mucus discharge (white dysentery); injury to both results in mixed red and white discharge. In cases of abdominal heaviness and downward bearing sensation with unstable fetal Qi, this is due to the downward sinking of Yuan Qi (Original Qi) which is too weak to ascend, causing Zhen Qi (True Qi) to sink. Large doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to stabilize the fetus. One must strictly avoid using Qi-regulating or Qi-moving herbs, as this will exacerbate the downward bearing pathology. The fetus is anchored by the Kidney, much like a bell hung from a beam. If the beam is not sturdy, it will bend and break, and how can the bell remain intact? Moreover, symptoms resembling dysentery but not being true dysentery are often due to Middle Qi deficiency failing to ascend, Spleen Qi deficiency failing to separate turbid fluids, and Kidney Qi deficiency failing to secure and store. Do not injure the formless Yuan Qi because of the apparent stagnation of formed substances. Once the Yuan Qi is damaged, myriad pathological changes will emerge, and how can the fetus be preserved?