《脉经》曰∶妇人怀躯七月而不可知,时时衄血而转筋者,此为躯也。
衄时噎而动者,非躯也。《素问》云∶妇人足少阴脉动甚者
,妊
子也(《素问》以足少阴脉动甚者为有妊,《脉经》以手少阴脉动甚为有子,岂心肾同一诊
耶)。又云∶阴搏阳别谓之有子(王注云∶阴谓尺中也,搏谓搏触于手也,尺脉搏击与寸脉殊
别,则为有孕之兆)。《脉经》云∶娠脉初时寸微小,呼吸五至,三月而尺数也,脉滑疾重
,
以脉滑疾重,以手按之散者,胎已三月也。脉重手按之不散,但疾不滑者,五月也。尺脉左
偏大者为男,右偏大者为女,左右俱大产二子。大者如实(实字妙)状,妇人娠孕四月。欲知
男女法∶左疾为男,右疾为女,左右俱疾为生二子(王子亨云∶娠孕三部俱滑而疾,在左为
男,在右为女)。遣娠孕面南行还复呼之,左回首者是男,右回首者是女。看上圊时夫从后
急呼之,左回首者是男,右回首者是女。
斑水蛭及虻虫,乌头附子配天雄,野葛水银并巴豆,牛膝薏苡与蜈蚣,三棱代赭芫花
射,
大戟蛇蜕黄雌雄,牙硝芒硝丹皮桂,槐花牵牛皂角同,半夏南星与通草,瞿麦干姜桃仁通,
砂干漆蟹脚爪,地蟾茅根莫用好。
(谓呕吐、恶心、头眩、恶食、择食是也)
《千金方》云∶凡妇人虚羸,血气不足,肾气又弱,或当风饮冷太过,心下有痰水者,
欲有
胎而喜病阻。所谓欲有胎者,其人月水尚来,颜色肌肤如常,但苦沉重愦闷,不欲饮食,又
不知其患所在,脉理顺时平和,则是欲有娠也。如此经二月日后便觉不通,则结胎也(仲圭
曰∶此说难于取信。受孕之预兆即是恶阻,但必发于经水已闭之后,断无见于月事通行之际
。藉曰有之亦病而非娠也)。阻病者,患心中愦愦,头重眼眩,四肢沉重懈惰,不欲执作,
恶闻食气,欲啖咸酸果实,多卧少起(恶阻俗谓病儿。然亦间有不病者,又不拘于强弱,此
何以故?即俗所谓胎气好恶。阻亦有寒热,不可不知)。世谓恶食至三四月日已上,皆大剧吐
逆不能自胜举也。此经血既闭,水渍于脏,脏气不宣通,故心烦愦闷,气逆而呕吐也。血脉
不通,经络否涩,则四肢沉重。挟风则头目眩也。甚者或作寒热,恍惚不能支持,第症有轻
重耳。轻者不必服药,重者须以药疗之,使痰水消除,便能食也。既得食力,体强气壮,力
足以养胎,母便健矣。盖半夏茯苓汤、茯苓丸,端治恶阻,然此二药比来少有服者,以半
夏有
动胎之性。盖胎初结,虑其易散,不可不谨也。张仲景《伤寒论》中黄龙汤正谓娠孕而设也
(即小柴胡大半夏)。《局方》则有人参丁香汤,杨振则有人参橘皮汤,王子亨立白术散,陈
士明用醒脾饮,皆不用半夏而服之多效。
按薛氏曰∶前症若中脘停痰,用二陈加枳壳。若脾胃虚弱,用异功散。若饮食停滞,用
六君
子加枳壳。若胃气不足,用人参橘皮汤。兼气恼加枳壳,胸胁否满更加苏梗,胁痛再加柴胡
。若饮食少思用六君子加苏梗、枳壳,头晕体倦用六君子汤。若脾胃虚弱,呕吐不食,用半
夏茯苓汤。盖半夏乃健脾气、化痰滞之主药也。脾胃虚弱而呕吐,或痰涎壅盛而饮食少思,
胎不安者,必用茯苓半夏汤,倍加白术。然半夏、茯苓、陈皮、砂仁善能安胎气、健脾胃也
。若左脉弱而呕,服诸药不止者,当用调理归原药则愈。经云无阴则呕是也。
《脉经》说:妇女怀孕七个月时若尚不能确诊,时常出现鼻出血并伴有筋脉抽搐的,这是妊娠的表现。
如果鼻出血时伴有咽喉噎塞感且身体颤动的,则不是妊娠。
《素问》说:妇女足少阴肾经脉动明显的,是怀孕了(《素问》认为足少阴脉动甚是有孕,《脉经》认为手少阴脉动甚是有子,难道心和肾的诊法是一样的吗?)。
又说:尺部脉搏搏动有力而与寸部明显不同的,称为有子(王冰注解说:阴指尺脉,搏指脉搏触于手指的感觉,尺脉搏击与寸脉不同,就是有孕的征兆)。
《脉经》说:妊娠初期寸脉微小,呼吸五次脉跳一次,到了三个月尺脉变数,脉象滑利疾速而重按不散,用手重按时脉象散开的,是怀孕三个月了。
脉象重按不散,只是疾速而不滑利的,是怀孕五个月了。
尺脉左侧偏大的生男孩,右侧偏大的生女孩,左右都大的生双胞胎。
脉象大而充实像实证的样子,是怀孕四个月。
想知道男女的方法:左脉疾速为男,右脉疾速为女,左右都疾速为生双胞胎(王子亨说:妊娠三部脉都滑利疾速,在左侧为男,在右侧为女)。
让孕妇面朝南行走,突然呼唤她,向左回首的是男孩,向右回首的是女孩。
看孕妇上厕所时,丈夫从后面急呼她,向左回首的是男孩,向右回首的是女孩。
斑蝥、水蛭及虻虫,乌头、附子配天雄,野葛、水银并巴豆,牛膝、薏苡仁与蜈蚣,三棱、代赭石、芫花、射干,大戟、蛇蜕、黄雌雄(指紫河车或特定药材,此处依原文保留),牙硝、芒硝、丹皮、桂枝,槐花、牵牛子、皂角同用,半夏、南星与通草,瞿麦、干姜、桃仁通草,砂仁、干漆、蟹脚爪,地蟾、茅根莫要好用。
(这里指的是呕吐、恶心、头晕、厌食、挑食等症状)
《千金方》说:凡是妇女身体虚弱瘦弱,血气不足,肾气又弱,或者当风饮冷太过,心下有痰水的,想要怀孕却容易患恶阻病。
所谓想要怀孕的人,她的月经还在来潮,脸色肌肤如常,只是苦于身体沉重烦闷,不想吃东西,又不知道病痛在哪里,脉象理顺平和,这就是将要怀孕。
像这样过了两个月后觉得月经不通,就是结胎了(仲圭说:这种说法难以取信。受孕的先兆即是恶阻,但必定发生在月经闭止之后,绝无见于月经通行之际的情况。假如真有这种情况,也是病而不是妊娠)。
恶阻病患者,患心中烦乱,头重眼眩,四肢沉重懈怠懒惰,不想劳作,厌恶闻食物气味,想吃咸酸果实,多卧少起(恶阻俗称病儿。但也有不患此病的,也不拘泥于体质强弱,这是什么原因呢?即俗话所说的胎气好恶。恶阻也有寒热之分,不可不知)。
世人说恶食到三四个月以上,都是剧烈呕吐逆气不能自持的情况。
这是因为经血既已闭止,水湿浸渍于脏腑,脏气不宣通,所以心烦烦闷,气逆而呕吐。
血脉不通,经络阻滞涩滞,所以四肢沉重。
挟带风邪则头目眩晕。
严重的甚至出现寒热,恍惚不能支持,只是症状有轻重罢了。
轻者不必服药,重者须以药治疗,使痰水消除,便能进食。
既然得到食物的滋养,身体强壮气力充足,力量足以养胎,母亲就健康了。
大概半夏茯苓汤、茯苓丸,是专门治疗恶阻的,然而这两种药近来少有服用的,因为半夏有动胎的性质。
大概胎儿初结,担心其容易消散,不可不谨慎。
张仲景《伤寒论》中的黄龙汤正是为妊娠所设的(即小柴胡汤合大半夏汤)。
《局方》中有人参丁香汤,杨振有人参橘皮汤,王子亨立白术散,陈士明用醒脾饮,都不用半夏而服用大多有效。
按薛氏说:前面的病症如果是中脘停痰,用二陈汤加枳壳。
如果是脾胃虚弱,用异功散。
如果是饮食停滞,用六君子汤加枳壳。
如果是胃气不足,用人参橘皮汤。
兼有气恼加枳壳,胸胁痞满再加苏梗,胁痛再加柴胡。
如果是饮食少思用六君子汤加苏梗、枳壳,头晕体倦用六君子汤。
如果是脾胃虚弱,呕吐不食,用半夏茯苓汤。
大概半夏是健脾气、化痰滞的主药。
脾胃虚弱而呕吐,或痰涎壅盛而饮食少思,胎不安者,必须用茯苓半夏汤,倍加白术。
然而半夏、茯苓、陈皮、砂仁善于安胎气、健脾胃。
如果左脉弱而呕吐,服用各种药不止者,应当用调理归原药则痊愈。
经书说无阴则呕就是这个道理。
The *Mai Jing* (Pulse Classic) states: If a woman is seven months pregnant and this cannot be determined, and she frequently experiences epistaxis (nosebleed) accompanied by muscle spasms, this indicates pregnancy.
If the nosebleed is accompanied by a sensation of choking in the throat and tremors, it is not pregnancy.
The *Su Wen* (Basic Questions) states: When the pulse of the Foot-Shaoyin (Kidney Meridian) moves vigorously, it indicates pregnancy (*Su Wen* considers vigorous movement of the Foot-Shaoyin pulse as a sign of pregnancy, while *Mai Jing* considers vigorous movement of the Hand-Shaoyin pulse as a sign of conception; are the diagnostic methods for Heart and Kidney identical?).
It also states: When the Yin pulse (referring to the Chi position at the wrist) beats strongly and is distinct from the Yang pulse (Cun position), it is called having a child (Wang Bing's commentary explains: 'Yin' refers to the Chi position; 'Bo' refers to the pulse striking the fingers; if the Chi pulse beats differently from the Cun pulse, it is an omen of pregnancy).
The *Mai Jing* states: At the beginning of pregnancy, the Cun pulse is minute and small, with five breaths per pulse beat; by the third month, the Chi pulse becomes rapid. A pulse that is slippery and rapid, heavy and unscattered when pressed firmly, indicates three months of pregnancy. If the pulse is unscattered when pressed heavily but is only rapid and not slippery, it indicates five months of pregnancy.
If the Chi pulse is larger on the left side, it indicates a male fetus; if larger on the right, a female fetus; if both are large, twins will be born. A pulse that is large and solid resembles an excess pattern, indicating four months of pregnancy.
To determine the sex of the fetus: A rapid pulse on the left indicates a male, on the right a female, and rapid on both sides indicates twins (Wang Ziheng states: If all three positions of the pregnancy pulse are slippery and rapid, left-sided predominance indicates a male, right-sided a female).
Have the pregnant woman face south and walk; suddenly call her name. If she turns her head to the left, it is a boy; if to the right, a girl.
When the pregnant woman is using the toilet, have her husband call out urgently from behind. Turning her head to the left indicates a boy; turning to the right indicates a girl.
Banmiao (Mylabris), Shuizhi (Hirudo), and Mengchong (Ophryogenia), Wutou (Aconitum carmichaelii root lateral prepared), Fuzi (Aconitum carmichaelii root lateral prepared) combined with Tianxiong (Aconitum kusnezoffii root), Yege (Gelsemium elegans stem), Shuiyin (Mercurius), and Badou (Crotonis Fructus), Niuxi (Achyranthis Bidentatae Radix), Yiyiren (Coicis Semen), and Wugong (Scolopendra), Sanleng (Sparganii Rhizoma), Daizhe (Haematitum), Yuanhua (Genkwa Flos), and Shegan (Belamcandae Rhizoma), Daji (Euphorbiae Pekinensis Radix), Shutie (Ophioglossi Cutis), Huang Cixiong (Placentae Hominis or specific herb), Yanxiao (Natrii Sulfas), Mangxiao (Natrii Sulfas), Danpi (Moutan Cortex), Guizhi (Cinnamomi Ramulus), Huaihua (Sophorae Flos), Qianniu (Pharbitidis Semen), and Zaojiao (Gleditsiae Sinensis Spina) should not be used together. Banxia (Pinelliae Rhizoma), Nanxing (Arisaematis Cum Bile), and Tongcao (Tetrapanacis Medulla), Qumai (Dianthi Herba), Ganjiang (Zingiberis Rhizoma), Taoren (Persicae Semen), Tongcao, Sharen (Amomi Fructus Rotundus), Gанqi (Drynariae Rhizoma - *Note: Text says Ganqi, likely referring to a drying agent or typo for another herb, kept as literal*), Xiejiaozhao (Scyllae Pedipalp), Dipchan (Bufo bufo gargarizans skin), and Maogen (Imperatae Rhizoma) should not be used well.
(This refers to symptoms such as vomiting, nausea, dizziness, food aversion, and selective eating.)
The *Qianjin Fang* states: Whenever a woman is emaciated and weak, deficient in blood and qi, with weak kidney qi, or has consumed too much cold drinks after exposure to wind, and has phlegm-fluid retention in the epigastrium, she may desire pregnancy but suffer from Ezu (morning sickness/obstruction disease).
Those who desire pregnancy still have their menstrual flow, with normal complexion and skin, but suffer from heaviness and mental restlessness, lack of appetite, and do not know where the illness lies; if the pulse is smooth and peaceful, this indicates impending pregnancy.
After two months, if menstruation ceases, then conception has occurred (Zhong Gui says: This statement is hard to believe. The precursor to conception is indeed Ezu, but it must occur after menstruation has stopped; it never appears during active menstruation. Even if it did, it would be a disease, not pregnancy).
Patients with Ezu suffer from mental restlessness, heavy head and dizzy eyes, heavy and lethargic limbs, unwillingness to work, aversion to the smell of food, desire for salty, sour fruits, sleeping more and rising less (Ezu is commonly called "disease of the fetus." However, some do not suffer from it, regardless of strength; why is this? It is what is commonly known as fetal temperament preferences. Ezu can also be cold or heat patterns, which must be known).
People say that food aversion lasting beyond three or four months involves severe vomiting and regurgitation that one cannot control.
This occurs because the menstrual blood has closed, water dampness infiltrates the zang organs, the zang qi is not free and unobstructed, causing mental restlessness and irritability, rebellious qi leading to vomiting.
Blood vessels are unobstructed, meridians are blocked and stagnant, causing heavy limbs.
Accompanied by wind, there is dizziness of the head and eyes.
Severe cases may present with chills and fever, confusion and inability to support oneself; it is merely a matter of severity.
Mild cases need not take medicine; severe cases require medicinal treatment to eliminate phlegm-fluid, allowing appetite to return.
Once nourishment is obtained, the body strengthens and qi becomes robust, providing sufficient power to nourish the fetus, and the mother becomes healthy.
Generally, Banxia Fuling Tang (Pinellia and Poria Decoction) and Fuling Wan (Poria Pill) are specifically for treating Ezu, yet these two prescriptions are rarely used recently because Banxia has properties that disturb the fetus.
Since the fetus is newly formed, there is concern it may easily scatter, so caution is necessary.
The Huanglong Tang (Yellow Dragon Decoction) in Zhang Zhongjing's *Shanghan Lun* was specifically set for pregnancy (which is Xiao Chaihu Tang combined with Ban Xia Hou Po Tang/Large Banxia Decoction).
The *Ju Fang* contains Ren Shen Ding Xiang Tang (Ginseng and Clove Decoction), Yang Zhen has Ren Shen Ju Pi Tang (Ginseng and Tangerine Peel Decoction), Wang Ziheng established Bai Zhu San (Atractylodes Macrocephala Powder), and Chen Shiming uses Xing Pi Yin (Spleen-Awakening Decoction); none use Banxia, yet they are mostly effective.
According to Dr. Xue: For the aforementioned symptoms, if there is phlegm retention in the middle jiao, use Er Chen Tang (Two-Cured Decoction) plus Zhike (Aurantii Fructus).
If spleen and stomach are weak, use Yi Gong San (Extraordinary Skill Powder).
If food stagnation exists, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Zhike.
If stomach qi is insufficient, use Ren Shen Ju Pi Tang.
If accompanied by emotional anger, add Zhike; if chest and hypochondriac fullness/stagnation exist, add Sugen (Perillae Caulis); if hypochondriac pain exists, add Chaihu (Bupleuri Radix).
If there is little desire for food, use Liu Jun Zi Tang plus Sugen and Zhike; if dizzy and fatigued, use Liu Jun Zi Tang.
If spleen and stomach are weak, with vomiting and no appetite, use Banxia Fuling Tang.
Generally, Banxia is the main herb for strengthening spleen qi and resolving phlegm stagnation.
For spleen and stomach weakness with vomiting, or excessive phlegm-saliva with little desire for food, and unsettled fetus, Fuling Banxia Tang (Poria and Pinellia Decoction) must be used, with doubled Baizhu (Atractylodis Macrocephalae Rhizoma).
However, Banxia, Fuling, Chenpi (Citri Reticulatae Pericarpium), and Sharen are good at calming the fetus qi and strengthening the spleen and stomach.
If the left pulse is weak and vomiting persists despite various medicines, one should use Tiao Li Gui Yuan Yao (Regulating and Returning to Origin Medicine) to cure it.
The Classics state: "Without yin, there is vomiting," which is the reason.