古人治病,先论其所主,男子调其气,妇人调其血。血室不蓄,则二气谐和;血室凝结,
则水火相刑。妇人左关浮紧不可下,当发其汗以救血室。荣卫得和,津液自通,浃然汗出而解。
仲景云∶妇人伤寒,经水适断,
昼日明了,暮则谵语,如见鬼状,此为热入血室。无犯胃气及上二焦。无犯胃气者,言不可下
也,小柴胡汤主之。若行汤迟则热入胃,今津燥中焦,上焦不荣,成血结胸状,须当刺期门也。
世有《妇人伤寒》书,称仲景所撰,与男子治法不同,此大谬也。予尝改之。不过云男子先调其
气,妇人先调其血,此大略之异耳。要知脉紧无汗名伤寒,脉缓有汗为伤风。热病脉洪大,
中暑沉细,其证一也。假如中 用白虎汤,胃实用承气汤,岂必调血而后行汤耶?仲景《伤寒论》
所以不分妇人者,良亦无以甚异也。
若妊妇伤寒,药性须凉,慎不可行桂枝、半夏、桃仁等药。小柴胡去半夏名黄龙汤,特为妊
妇而去也。大抵产前先安胎,产后先补益,次服伤寒药。若病稍退即止药,不可尽剂,此为
大法。故黄帝问∶妇人重身,毒之奈何?岐伯曰∶有故无陨,亦无殒也。大积大聚,其可犯者,
衰其大半而已。
桂枝红花汤 治妇人伤寒,发热恶寒,四肢拘急,口干舌燥,经肺凝滞,不得往来,宜服。
桂枝 芍药 甘草(各一钱) 红花(八分)
上咀,水盏半,姜二片、枣二枚,煎七分,温服。良久,汗出解。
黄芩芍药汤 治妇人伤寒,口燥咽干,腹满不思饮食。
黄芩 白芍药 白术 生干地黄(各一钱)
上咀,水盏半,煎七分,温服。寒加生姜。
尝归汤 治妇人伤寒,喘急烦躁,或战而作寒,阴阳俱虚,不可下,宜服此药。
柴胡 白术(各一钱) 人参 甘草 赤芍药 当归(各七分) 五味子 木通(各半分)
上咀,水盏半,姜三片、枣二枚,煎八分,稍热服。
干地黄汤 治妇人伤寒疾后犹有余气不去,谓之遗热。
干地黄(一钱) 大黄 黄连 黄芩 柴胡 白芍药 甘草(各七分)
上咀,水一盏,煎七分。温服,取溏利,汗出解。
烧 散男子病新瘥,妇人与之交合得病名曰阳易。其证里急,腰胯及腹内痛,身重,
宜服此。
男子 裆(烧灰为末,以水调方寸匕,服之即愈。)
青竹茹汤 治妇人病未平复,因有所动,致热气上冲胸膈,手足拘急搐搦如中风状。
栝蒌根(二两) 淡竹茹叶(半斤)
上水二升半,煮一半作三服。
古人治疗疾病,首先论述其主治原则,男子调理气机,女子调理血液。血室(子宫及冲任脉)不瘀滞,则阴阳二气和谐;血室凝结,则水火相克。女子左关脉浮紧者不可攻下,应当发汗以救治血室。营卫调和,津液自然通畅,周身微微出汗而病解。
张仲景说:女子患伤寒,月经刚断,白天神志清醒,傍晚则胡言乱语,如见鬼魅之状,这是热邪陷入血室。不要损伤胃气及上、中二焦。所谓“不要损伤胃气”,是指不可使用攻下法,以小柴胡汤为主治方。如果服用汤药过迟,则热邪会传入胃中,导致如今津液干燥于中焦,上焦失于濡养,形成类似血结胸的证候,此时必须针刺期门穴。
世间有《妇人伤寒》一书,声称是张仲景所著,认为与男子的治疗方法不同,这是极大的谬误。我曾对此加以改正。不过只是说男子先调气,女子先调血,这只是大略上的差异罢了。要知道,脉紧无汗称为伤寒,脉缓有汗称为伤风。热病脉象洪大,中暑脉象沉细,其证候表现是一致的。假如中暑用白虎汤,胃实热用承气汤,难道一定要先调血然后再服药吗?张仲景的《伤寒论》之所以不分男女,确实是因为没有太大的差异。
如果是孕妇患伤寒,药性须用凉性,千万不可使用桂枝、半夏、桃仁等药物。小柴胡汤去掉半夏名为黄龙汤,特意为了孕妇而去掉半夏。大致而言,产前先安胎,产后先补益,然后再服用治疗伤寒的药物。如果病情稍退就停药,不可服完整个疗程,这是大法。所以黄帝问:妇女怀孕,有毒性的药物该如何使用?岐伯说:有病则病受之,不会造成伤害。对于大的积聚病证,可以攻伐,但只需削弱大半即可。
桂枝红花汤:治疗女子伤寒,发热恶寒,四肢拘挛急迫,口干舌燥,经血凝滞不通,适宜服用。
桂枝、芍药、甘草(各一钱),红花(八分)。
以上药材切碎,用水一盏半,生姜两片、大枣两枚,煎至七分,温服。过一段时间,出汗即解。
黄芩芍药汤:治疗女子伤寒,口燥咽干,腹部胀满不想饮食。
黄芩、白芍药、白术、生干地黄(各一钱)。
以上药材切碎,用水一盏半,煎至七分,温服。若寒重加生姜。
尝归汤:治疗女子伤寒,喘急烦躁,或战栗发冷,阴阳俱虚,不可攻下,适宜服用此药。
柴胡、白术(各一钱),人参、甘草、赤芍药、当归(各七分),五味子、木通(各半分)。
以上药材切碎,用水一盏半,生姜三片、大枣两枚,煎至八分,稍热时服用。
干地黄汤:治疗女子伤寒病后仍有残余邪气不去,称为遗热。
干地黄(一钱),大黄、黄连、黄芩、柴胡、白芍药、甘草(各七分)。
以上药材切碎,用水一盏,煎至七分。温服,取大便溏利,出汗即解。
烧裆散:男子病初愈,女子与其性交而得的病名曰阳易。其证候为里急,腰胯及腹内疼痛,身体沉重,适宜服用此药。
男子内裤裆部(烧成灰研末,用水调服一方寸匕,服后即愈。)
青竹茹汤:治疗女子病未痊愈,因有所活动,导致热气上冲胸膈,手足拘挛抽搐如中风状。
栝蒌根(二两),淡竹茹叶(半斤)。
以上用水二升半,煮至一半量,分三次服用。
In ancient times, when treating diseases, one first discusses the main principle: for men, regulate Qi; for women, regulate Blood. If the Blood Chamber (uterus and Chong-Ren vessels) is not stagnant, Yin and Yang Qi harmonize; if the Blood Chamber is coagulated, Water and Fire clash. For women with a floating and tight pulse at the left Guan position, purgation is contraindicated; instead, sweating should be induced to rescue the Blood Chamber. When Ying and Wei harmonize, body fluids flow naturally, and the disease resolves with slight perspiration throughout the body.
Zhang Zhongjing stated: "When a woman suffers from Shanghan (Cold Damage), and her menstruation has just ceased, she is clear-minded during the day but delirious in the evening, seeing things as if ghosts were present. This is Heat entering the Blood Chamber. Do not damage the Stomach Qi or the Upper and Middle Jiao." To say "do not damage the Stomach Qi" means that purgation is forbidden; Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary formula. If the administration of the decoction is delayed, Heat will enter the Stomach, causing dryness of fluids in the Middle Jiao and lack of nourishment in the Upper Jiao, resulting in a condition resembling Xue Jie Xiong (Blood Binding in the Chest). In such cases, Qimen (LR14) must be needled.
There exists a book titled *Furen Shanghan* (Shanghan in Women), claiming it was written by Zhang Zhongjing and asserting that treatment methods differ from those for men. This is a great error. I have corrected this. It merely states that men first regulate Qi and women first regulate Blood, which is only a general difference. One must know that a tight pulse without sweat is named Shanghan, while a slow pulse with sweat is named Shangfeng (Wind Strike). In Re Bing (Heat Disease), the pulse is large and flooding; in Zhongshu (Summerheat Stroke), the pulse is deep and fine; their manifestations are essentially the same. For example, if using Baihu Tang (White Tiger Decoction) for summerheat, or Chengqi Tang (Order the Qi Decoction) for Stomach excess heat, why must Blood regulation precede medication? The reason Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) does not distinguish between men and women is indeed because there is no significant difference.
If a pregnant woman suffers from Shanghan, the medicinal properties must be cooling. One must strictly avoid herbs like Guizhi (Cinnamon Twig), Banxia (Pinellia Rhizome), and Taoren (Peach Seed). Xiao Chai Hu Tang minus Banxia is named Huanglong Tang (Yellow Dragon Decoction), specifically formulated for pregnant women by removing Banxia. Generally, before childbirth, one first calms the fetus; after childbirth, one first tonifies and supplements, then treats the Shanghan. If the illness subsides slightly, stop the medication; do not complete the full dosage. This is the major principle. Thus, the Yellow Emperor asked: "How should toxic medicines be used for a heavily pregnant woman?" Qibo replied: "If there is an existing pathogen, there will be no harm to the mother or fetus." For massive accumulations and聚 (masses), they may be attacked, but only until more than half is reduced.
Guizhi Honghua Tang (Cinnamon Twig and Safflower Decoction): Treats Shanghan in women, characterized by fever and aversion to cold, stiffness and spasm of the four limbs, dry mouth and tongue, stagnation of menstrual blood, and inability to flow freely.
Ingredients: Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Gancao (Licorice Root) (each 1 qian); Honghua (Safflower) (0.8 fen).
Preparation: Coarsely crush the herbs. Add 1.5 cups of water, 2 slices of Shengjiang (Fresh Ginger), and 2 dates. Decoct to 0.7 parts. Take warm. After some time, perspiration occurs and the disease resolves.
Huangqin Shaoyao Tang (Scutellaria and Peony Decoction): Treats Shanghan in women, characterized by dry mouth and throat, abdominal fullness, and loss of appetite.
Ingredients: Huangqin (Scutellaria Root), Baishao (White Peony Root), Baizhu (Atractylodes Macrocephala Rhizome), Shenggandi Huang (Rehmannia Root prepared fresh) (each 1 qian).
Preparation: Coarsely crush the herbs. Add 1.5 cups of water. Decoct to 0.7 parts. Take warm. Add Shengjiang if cold predominates.
Changgui Tang (Return-to-Home Decoction): Treats Shanghan in women, characterized by panting, irritability, or shivering with chills, deficiency of both Yin and Yang, where purgation is contraindicated.
Ingredients: Chaihu (Bupleurum Root), Baizhu (Atractylodes Macrocephala Rhizome) (each 1 qian); Renshen (Ginseng Root), Gancao (Licorice Root), Chi Shaoyao (Red Peony Root), Danggui (Angelica Sinensis Root) (each 0.7 fen); Wuweizi (Schisandra Fruit), Mutong (Akebia Stem) (each 0.5 fen).
Preparation: Coarsely crush the herbs. Add 1.5 cups of water, 3 slices of Shengjiang, and 2 dates. Decoct to 0.8 parts. Take slightly warm.
Gan Dihuang Tang (Dry Rehmannia Decoction): Treats residual pathogenic Qi remaining after Shanghan in women, known as Yi Re (Lingering Heat).
Ingredients: Ganhui Di Huang (Dried Rehmannia Root) (1 qian); Dahuang (Rhubarb Root), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Chaihu (Bupleurum Root), Baishao (White Peony Root), Gancao (Licorice Root) (each 0.7 fen).
Preparation: Coarsely crush the herbs. Add 1 cup of water. Decoct to 0.7 parts. Take warm. Aim for loose stools; the disease resolves with perspiration.
Shao Dang San (Burned Crotch Powder): A disease contracted by a woman having intercourse with a man who has recently recovered from an illness is called Yang Yi (Yang Transmission). Symptoms include internal urgency, pain in the loins, hips, and abdomen, and heaviness of the body.
Ingredients: The crotch part of a man's underwear (burned to ash, powdered, mixed with water, and taken as one cun bi dose). Recovery follows immediately.
Qingzhuru Tang (Green Bamboo Sheath Decoction): Treats a woman whose illness has not fully resolved, and due to exertion, Heat rises to rush against the chest and diaphragm, causing stiffness and spasms of the hands and feet resembling Zhongfeng (Wind Stroke).
Ingredients: Gualou Gen (Trichosanthes Root) (2 liang); Danzhuru Ye (Light Bamboo Leaf Sheath) (0.5 jin).
Preparation: Add 2.5 sheng of water. Boil down to half volume. Divide into three doses.