妊娠烦闷有四证,有心中烦,胸中烦,有子烦,诸属于热。若脏虚而气乘心,令人烦者,名虚烦。若
积痰饮,呕吐痰沫者,名胸中烦。或血积停饮,寒热相搏,致胎气不安,谓子烦。大抵多
由阴既养胎,孤阳独旺,心肺虚热,是以撩乱不宁。更有时当盛夏,君火大行,俱能乘肺,以致
烦躁、胎动不安者,皆因时而致之者也,亦当因时治之,生脉散最佳。
妊娠烦躁口干者,足太阴脾经其气通于口,手少阴心经其气
通于舌,若脏腑气虚,热乘心脾,津液胎燥,故心烦口燥,与子
烦大同小异,宜知母丸。若肝经火动,加味逍遥散;若肾经火动,加味地黄丸。
古有妇人暴渴,惟饮五味汁,名医耿隅诊其脉曰∶此血欲凝,非疾也。已而果孕,故古方有血欲凝而渴饮五味之证,
本属肺肾二经有火,盖火入于肺则烦,入于肾则躁,胎系于肾,肾水养其胎元,则不足以滋肾中之火,火上烁肺,变为
烦躁,此金亏水涸之候。法当滋其化源,清金保肺,重浊壮水,滋肾为主。
《本事方》云∶紫苏饮治妊娠胎气不和,坏胎逆上,胀满疼痛,名子悬。子悬者,浊气举胎上凑也。
胎热气逆,心胃胀满,此证挟气者居多。疏气舒郁、非紫苏、腹皮、川芎、陈皮无以流气;非
归、芍无以养血,气血既利而胎治降。然邪之所凑,其正必虚,故以人参、甘草补之。又曰∶有妊娠
心腹胀满者,由腹内素有寒气,致令停饮;与气相争,故令心腹胀满也,须以脉之迟数辨之。
妊娠期间出现烦闷症状主要有四种证型,包括心中烦、胸中烦、子烦(妊娠期特有的烦躁),这些大多归属于热证。如果是因为脏腑虚弱,气机逆乱上乘于心,导致人感到烦躁的,称为虚烦。如果有痰饮积聚,伴有呕吐痰沫的,称为胸中烦。如果是血积与停饮相互搏结,寒热交争,导致胎气不安的,称为子烦。大抵上多是因为阴血用来滋养胎儿,导致孤阳独旺,心肺出现虚热,从而使人撩乱不宁。再加上正值盛夏时节,君火(心火)盛行,都能乘袭肺脏,以致引起烦躁、胎动不安,这些都是因时令气候而导致的疾病,也应当根据时令特点进行治疗,使用生脉散效果最佳。
妊娠期间出现烦躁且口干的症状,足太阴脾经的气脉通达于口,手少阴心经的气脉通达于舌。如果脏腑之气虚弱,热邪乘袭心脾,导致津液枯竭、胎儿燥热,所以出现心烦和口燥,这与子烦大同小异,适宜使用知母丸。如果是肝经火动引起的,使用加味逍遥散;如果是肾经火动引起的,使用加味地黄丸。古代记载有妇人突然极度口渴,只喝五味汁的情况,名医耿隅诊断其脉象说:“这是血液欲凝之兆,并非疾病。”后来果然怀孕,所以古方中有“血欲凝而渴饮五味”的证候,这原本属于肺肾二经有火。因为火入于肺则产生烦感,入于肾则产生躁感。胎元系于肾,肾水滋养胎元,就不足以制约肾中的火,火上灼烁肺金,转变为烦躁,这是金亏水涸的征候。治法应当滋生化之源,清金保肺,重用厚味药物壮水,以滋补肾阴为主。
《本事方》记载:紫苏饮治疗妊娠胎气不和,胎气逆上冲,导致胀满疼痛,称为子悬。子悬,是指浊气上举,胎气上凑心胸。胎热气逆,导致心胃胀满,这个证候多兼夹气滞。疏通气机、舒展郁结,非用紫苏、腹皮、川芎、陈皮不能流通气机;非用当归、白芍不能养血,气血通畅后胎气自然下降安定。然而邪气聚集之处,正气必然虚弱,所以用人参、甘草来补益正气。又说:有妊娠期间心腹胀满的,是由于腹内素有寒气,导致水饮停滞;水饮与气相争,所以导致心腹胀满,必须通过脉象的迟数来辨别。
There are four types of restlessness during pregnancy: restlessness in the heart, restlessness in the chest, and *Zi Fan* (pregnancy-related restlessness); these generally belong to heat syndromes. If the internal organs are deficient and Qi ascends to invade the Heart, causing restlessness, it is named *Xu Fan* (deficiency restlessness). If there is accumulation of phlegm-fluids accompanied by vomiting of phlegm foam, it is named *Xiong Zhong Fan* (chest restlessness). If blood stasis and retained fluids contend with cold and heat, leading to instability of fetal Qi, it is called *Zi Fan*. Generally, this arises because Yin blood is consumed to nourish the fetus, leaving Yang unopposed and flourishing alone, resulting in deficiency-heat in the Heart and Lungs, which causes agitation and unrest. Furthermore, if this occurs in midsummer when Ministerial Fire (Heart Fire) is prevalent, it can invade the Lungs, leading to restlessness and unstable fetal movement; these are caused by seasonal factors and should be treated according to the season, with Sheng Mai San (Pulse-Generating Powder) being the most effective.
Regarding restlessness and dry mouth during pregnancy, the Qi of the Foot-Taiyin Spleen Meridian connects to the mouth, and the Qi of the Hand-Shaoyin Heart Meridian connects to the tongue. If the Qi of the internal organs is deficient and heat invades the Heart and Spleen, depleting body fluids and causing fetal dryness, it results in heart restlessness and oral dryness. This is largely similar to *Zi Fan*, and Zhi Mu Wan (Anemarrhena Pill) is appropriate. If Liver Meridian fire is active, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) should be used; if Kidney Meridian fire is active, Jia Wei Di Huang Wan (Modified Rehmannia Pill) is indicated. Ancient texts record a case where a woman suffered sudden extreme thirst and only drank Wu Wei Zhi (Five-Flavor Juice). The renowned physician Geng Yu diagnosed her pulse and said, "This indicates blood is about to congeal; it is not a disease." She subsequently became pregnant. Thus, ancient formulas mention the syndrome of "thirst due to blood congealing, relieved by drinking five-flavor juice," which originally belongs to fire in the Lung and Kidney meridians. Fire entering the Lung causes *Fan* (restlessness/agitation), while fire entering the Kidney causes *Zao* (irritability). The fetus is rooted in the Kidney; as Kidney Water nourishes the fetal origin, it may be insufficient to control the fire within the Kidney. This fire scorches Lung Metal, transforming into restlessness and irritability, which is a sign of deficiency of Metal and depletion of Water. The treatment method should be to nourish the source of transformation, clear Metal and protect the Lung, and use heavy, rich substances to strengthen Water, focusing primarily on nourishing the Kidney.
The *Ben Shi Fang* states: Zi Su Yin (Perilla Decoction) treats disharmony of fetal Qi during pregnancy, where fetal Qi rebels and ascends, causing distension, fullness, and pain, known as *Zi Xuan* (fetal suspension). *Zi Xuan* refers to turbid Qi rising and pressing against the fetus upwards. Fetal heat and rebellious Qi cause distension and fullness in the Heart and Stomach; this condition mostly involves Qi stagnation. To diffuse Qi and relieve depression, one cannot circulate Qi without Zi Su (Perilla Leaf), Fu Pi (Areca Peel), Chuan Xiong (Sichuan Lovage Rhizome), and Chen Pi (Aged Tangerine Peel); one cannot nourish Blood without Gui (Angelica Sinensis) and Shao (White Peony Root). Once Qi and Blood flow freely, the fetal Qi descends and stabilizes. However, where pathogenic factors gather, healthy Qi must be deficient; therefore, Ren Shen (Ginseng) and Gan Cao (Licorice) are used to tonify. It also states: In cases of heart and abdominal distension and fullness during pregnancy, this is due to pre-existing cold in the abdomen causing retention of fluids; these fluids contend with Qi, causing distension and fullness. This must be differentiated by examining whether the pulse is slow or rapid.