【歌】妊娠伤寒先保胎,六经表里次安排,若然不解生传变,自有专科莫乱猜。
【论】妊娠伤寒专以散风清热安胎为主,如发表香苏饮,半表半里黄龙汤,清火黄连解毒汤,余详伤寒本科。
【方】
香苏饮
香附 苏叶 陈皮 甘草 砂仁
姜水煎服。如太阳经加羌活、防风,阳明经加葛根、知母,少阳加柴胡。
黄连解毒汤
黄连 黄芩 山栀 黄柏
水煎。
黄龙汤
柴胡 黄芩 人参 甘草
实热去参加砂、桔。
【歌】乍寒乍热名为疟,荣卫阴阳气不和,汗少汗多行补散,若然和解用柴胡。
【论】疟者,寒热交争,皆因于风寒也。风为阳邪,化气而为热,寒为阴邪,化气而为寒。阴阳交争,寒
热更作,或阴并于阳,则阴实阳虚而恶寒。若阳并于阴,则阳实阴虚而发热。先伤于寒后伤于风,则先寒后热。先
伤于风后伤于寒,则先热后寒。初疟无汗者,散之。久疟多汗者,补之。
【方】
小柴胡汤
柴胡 黄芩 人参 甘草
加茯苓、知母、陈皮、生姜。
【歌】水谷不化属脾虚,臭秽稠粘作热医,清热浓肠兼理气,和中理气更扶脾。
【论】泄泻者,痛腹肠鸣水谷不化,或喜欢呕逆,协热下利,并宜四苓散、黄芩白芍汤。若里急后重,下
痢赤白,稠粘臭秽,谓
之滞下,宜香连丸。能食者轻,绝不食者死。壶公曰∶有妊娠病痢不止,脉虚而滑,两关脉涩。此胎气不和,相
火上炎,似痢非痢也,用安胎药而愈。
【方】
香连丸
川连(五钱,吴茱萸同炒,拣去吴茱萸不用) 木香(一钱)
神曲糊丸,米饮服一钱。
【歌诀】妊娠期间患伤寒,首要任务是保护胎儿,其次根据六经表里辨证进行安排。如果病情未能解除并发生传变,自有专科医生处理,切勿胡乱猜测。
【论述】妊娠期间患伤寒,治疗以疏散风邪、清热安胎为主。例如用于发表(解表)的香苏饮,用于半表半里证的黄龙汤,以及用于清火的黄连解毒汤,其余详细内容参见《伤寒论》相关章节。
【方剂】
香苏饮
组成:香附、紫苏叶、陈皮、甘草、砂仁。
用法:用生姜水煎服。若病在太阳经,加羌活、防风;若病在阳明经,加葛根、知母;若病在少阳经,加柴胡。
黄连解毒汤
组成:黄连、黄芩、山栀(栀子)、黄柏。
用法:水煎服。
黄龙汤
组成:柴胡、黄芩、人参、甘草。
加减:若实热较重,加入砂仁、桔梗。
【歌诀】忽冷忽热称为疟疾,这是由于营卫阴阳之气不和所致。汗少者行发散法,汗多者行补益法,若需和解则使用柴胡剂。
【论述】疟疾,表现为寒热交替发作,皆因风寒之邪引起。风为阳邪,化气而表现为热;寒为阴邪,化气而表现为寒。阴阳相互交争,寒热交替出现。若阴气并入阳气,则阴实阳虚而恶寒;若阳气并入阴气,则阳实阴虚而发热。先受寒邪后受风邪,则先恶寒后发热;先受风邪后受寒邪,则先发热后恶寒。初起疟疾无汗的,用发散法;久疟多汗的,用补益法。
【方剂】
小柴胡汤
组成:柴胡、黄芩、人参、甘草。
加减:加入茯苓、知母、陈皮、生姜。
【歌诀】水谷不消化属于脾虚,气味臭秽且质地稠粘属热证治疗范畴。治宜清热厚肠兼理气,调和脾胃理气更扶持脾气。
【论述】泄泻,症状包括腹痛、肠鸣、水谷不化,或伴有呕吐逆气,协热下利等,均适宜使用四苓散、黄芩白芍汤。若有里急后重,下痢赤白,质地稠粘臭秽,称为“滞下”,适宜使用香连丸。能进食者病轻,完全不能进食者预后不良(死证)。壶公说:有妊娠期患痢疾不止,脉象虚而滑,两关脉涩。这是胎气不和,相火上炎,看似痢疾实则非痢疾,使用安胎药而痊愈。
[Verse] In cases of cold damage (Shanghan) during pregnancy, the primary goal is to protect the fetus, followed by arranging treatment according to the six meridians' exterior and interior patterns. If the condition fails to resolve and undergoes transmission, there are specialized departments to handle it; do not guess rashly.
[Discussion] The treatment of cold damage during pregnancy focuses mainly on dispersing wind, clearing heat, and calming the fetus. For example, use Xiangsu Yin for releasing the exterior, Huanglong Tang for half-exterior half-interior conditions, and Huanglian Jiedu Tang for clearing fire. Details are provided in the relevant chapters of Shanghan Lun.
[Formulas]
Xiangsu Yin (Fragrant Perilla Decoction)
Ingredients: Cyperi Rhizoma (Xiangfu), Perillae Folium (Suye), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao), Amomi Fructus (Sharen).
Usage: Decoct with ginger water. If the disease is in the Taiyang meridian, add Notopterygii Rhizoma et Radix (Qianghuo) and Saposhnikoviae Radix (Fangfeng); if in the Yangming meridian, add Puerariae Radix (Gegen) and Anemarrhenae Rhizoma (Zhimu); if in the Shaoyang meridian, add Bupleuri Radix (Chaihu).
Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity)
Ingredients: Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Gardeniae Fructus (Shanzhi), Phellodendri Cortex (Huangbai).
Usage: Decoct with water.
Huanglong Tang (Yellow Dragon Decoction)
Ingredients: Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Ginseng Radix (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao).
Modification: If excess heat is severe, add Amomi Fructus (Sharen) and Platycodonis Radix (Jiegeng).
[Verse] Alternating chills and fever are termed malaria (Nue), caused by disharmony of Ying and Wei Qi and Yin and Yang. For scant sweating, employ dispersing methods; for profuse sweating, employ tonifying methods. For harmonizing, use formulas containing Chaihu.
[Discussion] Malaria is characterized by alternating chills and fever, all resulting from Wind-Cold pathogens. Wind is a Yang pathogen that transforms into Qi manifesting as Heat; Cold is a Yin pathogen that transforms into Qi manifesting as Cold. When Yin and Yang contend, chills and fever alternate. If Yin merges into Yang, Yin becomes excess and Yang becomes deficient, leading to aversion to cold. If Yang merges into Yin, Yang becomes excess and Yin becomes deficient, leading to fever. If injured by Cold first and then by Wind, chills precede fever. If injured by Wind first and then by Cold, fever precedes chills. For initial malaria without sweating, use dispersing methods. For chronic malaria with profuse sweating, use tonifying methods.
[Formulas]
Xiao Chaihu Tang (Minor Bupleurum Decoction)
Ingredients: Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Ginseng Radix (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao).
Modification: Add Alisma Rhizoma (Fuling), Anemarrhenae Rhizoma (Zhimu), Citri Reticulatae Pericarpium (Chenpi), and Zingiberis Rhizoma Recens (Shengjiang).
[Verse] Undigested food and water belong to Spleen deficiency; foul odor and thick, sticky consistency indicate Heat treatment categories. Treatment should clear heat, thicken the intestines, and regulate Qi; harmonizing the middle and regulating Qi further supports the Spleen.
[Discussion] Diarrhea involves abdominal pain, borborygmus, and undigested food and water, or may be accompanied by vomiting and regurgitation, or diarrhea with heat. All these are suitable for treating with Siling San and Huangqin Baishao Tang. If there is tenesmus (liji houzhang), dysentery with red and white stool, thick, sticky, and foul-smelling discharge, it is called "stagnant down" (Zhixia), suitable for treating with Xianglian Wan. Those who can eat have mild disease; those who cannot eat at all have a fatal prognosis. Hu Gong said: There are cases of pregnant women suffering from continuous dysentery, with a pulse that is deficient and slippery, and the pulses at both Guan positions are choppy. This is due to disharmony of fetal Qi and ministerial fire flaring upward; it resembles dysentery but is not true dysentery. It was cured using fetal-calming medicines.
[Formulas]
Xianglian Wan (Fragrant Coptis Pill)
Ingredients: Coptidis Rhizoma (Chuanlian) (5 qian, stir-fried with Evodiae Fructus, then discard the Evodiae Fructus), Aucklandiae Radix (Muxiang) (1 qian).
Usage: Make pills with fermented dough (Shenqu paste), take 1 qian with rice drink.