子满者,妇人孕至五、六个月,腹大异常,胸腹胀满,手、足、面目浮肿,气逆不安,小便不通,
此由胞中蓄水,名曰胎水。若不上治,生子手足软短有疾,或胎死腹中。用千金鲤鱼汤治其水。
若脾虚不运,清浊不分,佐以四君子;若面目虚浮,肢体如水气,全生白术散;若脾湿虚热,下部作肿,
补中汤加茯苓;若饮食失节,呕吐、泄泻,六君子汤;若腿足发肿,喘闷不宁,或指缝出
水,天仙藤散;若脾肺气滞,加味归脾汤,佐以加味逍遥散。然遍身浮肿,胀满之甚者,名为子满。若只脚
面浮肿,行走艰难,或脚趾内有黄水出者,谓之子气。直至分娩方消也。故妊娠脚肿,至
八、九月及胫腿俱肿,非水气比,不可以水病治之,反伤真气。凡有此者,必易产,因胞脏中水血俱
多,不致燥胎故也。若初孕即肿者,是水气过多,儿未成体,则胎必堕。
子肿与子气相类,但子气在下体,子肿在头面。若子满产五、
六月以后,比子气与子肿不同。盖胎大则腹满,满则甚气,遍身浮肿也。
《金匮》曰∶妇人怀娠六、七月,脉弦发热,其胎愈胀,腹痛恶寒,少腹如扇者,子脏开故也,当以附
子汤温其脏。徐忠可曰∶六、七月胃肺养胎,而气为寒所滞,故胎愈胀;寒在内,腹痛恶寒。然恶寒有
属表者,此连腹痛,乃知寒伤内矣。少腹如扇,阵阵作冷,若扇之状,恶寒之异也,且独在少腹,因子脏受
寒不能合,故少腹独开不饮也。子脏即子宫。附子能入肾温下焦,故宜附子汤温其经。妊妇偶有所伤,
胎动不安,痛不可忍,用带壳缩砂,不拘多少,和皮炒黑色,为末,热酒下二钱。不饮酒者,米饮下,腹中觉热,胎自
安矣。
妊娠心腹痛,或宿有冷疼,或新触风寒,皆因脏虚而发也。邪正相击而并于气,随气上下,上冲于心,则
心痛;下攻于腹,则腹痛。邪正二气交攻于内,久若不瘥,痛冲胞胎,必动胎。洁古
地黄当归汤治妇人有孕胎痛。丹溪以血虚治之,故四物汤去川芎,倍加熟地,此心法也。
妊娠不时腹痛,或小腹重坠,名胎痛。地黄三钱、当归一钱,二味煎汤主之,不应加参、术、陈皮。因
中气虚而下坠作痛者,补中益气汤。
子满,是指妇女怀孕到五、六个月时,腹部异常增大,胸部和腹部胀满,手、足及面目浮肿,气机上逆而心神不安,小便不通畅。这是由于胞宫(子宫)中蓄积了水液,称为胎水。如果不及时进行治疗,生下的孩子可能手足软弱短小且有疾病,或者胎儿死于腹中。使用千金鲤鱼汤来治疗这种水湿停滞。如果是脾虚导致运化功能失常,清浊不分,可配合使用四君子汤;如果面目虚浮,肢体像有水气一样,使用全生白术散;如果是脾虚伴有湿气且产生虚热,下部出现肿胀,使用补中汤并加入茯苓;如果饮食不节制,出现呕吐、腹泻,使用六君子汤;如果腿脚肿胀,气喘胸闷烦躁不安,或者手指缝间渗出液体,使用天仙藤散;如果是脾肺气机阻滞,使用加味归脾汤,并配合加味逍遥散。然而,全身浮肿且胀满严重的,才称为子满。如果只是脚面浮肿,行走困难,或者脚趾内有黄水流出,这称为子气,直到分娩才会消退。所以妊娠期间脚肿,到了八、九个月以及小腿和腿部都肿胀的,不是水气病,不能按照水病来治疗,否则会反而损伤真气。凡是这种情况的孕妇,生产通常容易,因为胞宫中水和血都比较多,不会导致胎儿干燥。如果在刚怀孕时就出现肿胀,这是水气过多,胎儿尚未成形,那么胎儿必然会流产。
子肿与子气相似,但子气发生在身体下部,子肿发生在头面部。如果子满出现在怀孕五、六个月以后,与子气和子肿不同。因为胎儿变大则腹部胀满,胀满严重则气机不畅,导致全身浮肿。
《金匮要略》说:妇女怀孕六、七个月,脉象弦紧且发热,胎儿胀感更明显,腹痛且怕冷,小腹部感觉像被扇子扇风一样凉,这是因为子脏(子宫)开张的缘故,应当用附子汤温暖子宫。徐忠可说:怀孕六、七个月时,胃和肺负责滋养胎儿,如果气机被寒气阻滞,所以胎儿胀感更重;寒气在体内,导致腹痛和怕冷。然而,怕冷有属于表证的,这里连着腹痛,就知道是寒气伤了内脏。小腹部感觉像被扇子扇风,阵阵发冷,像被扇子吹过一样,这是怕冷的特殊表现,而且只在小腹部,因为子脏受寒不能闭合,所以小腹部单独张开而不收敛。子脏就是子宫。附子能入肾经温暖下焦,所以适宜用附子汤温暖经脉。孕妇偶尔受到外伤,胎动不安,疼痛难以忍受,可以使用带壳的缩砂仁,数量不限,连同皮一起炒成黑色,研成粉末,用热酒送服二钱。不喝酒的人,用米汤送服,腹部感到温热,胎儿自然安定。
妊娠期间心腹疼痛,或者是以前就有冷痛,或者是新近触犯风寒,都是因为脏腑虚弱而引发的。邪气与正气相互搏击并汇聚于气分,随着气机上下运行,向上冲撞心脏,就会心痛;向下攻冲腹部,就会腹痛。邪气与正气在体内交争,时间久了如果不痊愈,疼痛冲击胞胎,必然会导致胎动不安。洁古的地黄当归汤治疗孕妇因胎引起的疼痛。丹溪认为这是由于血虚引起的,所以使用四物汤去掉川芎,加倍使用熟地黄,这是治疗的关键方法。
妊娠期间不时腹痛,或者小腹沉重下坠,称为胎痛。使用三钱地黄、一钱当归,两味药煎汤服用为主,如果无效,加入人参、白术、陈皮。因为中气虚弱而下坠引起疼痛的,使用补中益气汤。
Ziman (Excessive Abdominal Distension in Pregnancy) refers to the condition where a woman, at five or six months of pregnancy, experiences abnormal abdominal enlargement, distension and fullness in the chest and abdomen, edema of the hands, feet, face, and eyes, rebellious Qi causing mental restlessness, and difficulty in urination. This is caused by water accumulation in the Baozhong (uterus), named Taishui (Fetal Water). If not treated promptly, the newborn may suffer from weak and short limbs with deformities, or the fetus may die in utero. Qianjin Liyu Tang (Thousand Golden Carp Decoction) is used to treat this water retention. If spleen deficiency leads to impaired transportation and transformation, resulting in the failure to distinguish clear from turbid, it can be assisted with Sijunzi Tang (Four Gentlemen Decoction); if there is puffy swelling of the face and eyes, and limbs resembling water qi, Quansheng Baizhu San (Quansheng Atractylodes Macrocephala Powder) is used; if there is spleen dampness with deficient heat causing swelling in the lower body, Buzhong Tang (Middle-Boosting Decoction) with added Fuling (Poria) is prescribed; if irregular diet causes vomiting and diarrhea, Liujunzi Tang (Six Gentlemen Decoction) is used; if leg and foot swelling occur with panting, chest stuffiness, and restlessness, or fluid oozing from between fingers, Tianxianteng San (Akebia Vine Powder) is applied; if there is stagnation of Qi in the spleen and lungs, Jiawei Guipi Tang (Modified Restore the Spleen Decoction) is used, assisted by Jiawei Xiaoyao San (Modified Free Wanderer Powder). However, only when generalized edema and severe distension are present is it termed Ziman. If only the dorsum of the foot is swollen, making walking difficult, or yellow fluid exudes from between toes, it is called Zi Qi (Fetal Qi), which resolves only after delivery. Therefore, for ankle swelling in pregnancy, especially when extending to the calves and legs at eight or nine months, it is not comparable to water disease and should not be treated as such, lest it damage the True Qi. Such cases usually result in easier childbirth because the uterus contains abundant water and blood, preventing the fetus from drying out. However, if swelling occurs immediately upon conception, it indicates excessive water qi while the fetus is not yet formed, leading to inevitable miscarriage.
Zizhong (Fetal Edema) is similar to Zi Qi, but Zi Qi occurs in the lower body, whereas Zizhong affects the head and face. If Ziman appears after five or six months of pregnancy, it differs from Zi Qi and Zizhong. As the fetus grows, abdominal distension increases, leading to severe Qi stagnation and generalized edema.
The *Jinkui Yaolue* states: "In women pregnant for six or seven months, if the pulse is wiry and accompanied by fever, the fetal distension worsens, abdominal pain and aversion to cold occur, and the lower abdomen feels like being fanned, this is due to the opening of the Zizang (uterus). It should be treated with Fuzi Tang (Aconite Decoction) to warm the uterus." Xu Zhongke stated: "At six or seven months, the Stomach and Lung nourish the fetus. If Qi is stagnant due to cold, the fetal distension worsens; internal cold causes abdominal pain and aversion to cold. Although aversion to cold can be exterior-related, here it is accompanied by abdominal pain, indicating internal cold injury. The sensation of the lower abdomen being fanned implies paroxysmal coldness, distinct from general aversion to cold, occurring specifically in the lower abdomen because the Zizang, affected by cold, fails to close, leaving the lower abdomen open and unconsolidated. Zizang refers to the uterus. Fuzi enters the Kidney meridian to warm the Lower Jiao, hence Fuzi Tang is suitable to warm the meridians. If a pregnant woman suffers accidental trauma causing restless fetus and unbearable pain, use Suisha Ren (Amomi Fructus Rotundus) with shell, any amount, stir-fried with peel until black, powdered, and taken with hot wine (2 qian). Non-drinkers may take it with rice gruel. When warmth is felt in the abdomen, the fetus will settle naturally."
Abdominal and cardiac pain during pregnancy, whether pre-existing cold pain or newly contracted wind-cold, arises from visceral deficiency. Pathogenic and healthy Qi clash and converge in the Qi mechanism, moving up and down. Rising to the Heart causes cardiac pain; descending to the abdomen causes abdominal pain. Prolonged internal conflict without resolution may cause pain to impact the Chongbao (fetus), inevitably disturbing the fetus. Jiegu's Dihuang Danggui Tang (Rehmannia and Angelica Decoction) treats fetal pain in pregnancy. Danxi attributed this to Blood deficiency, thus prescribing Siwu Tang (Four Substances Decoction) minus Chuanxiong, with doubled Shudi (Prepared Rehmannia Root), which is the core method.
Intermittent abdominal pain or heavy bearing sensation in the lower abdomen during pregnancy is termed Taitong (Fetal Pain). It is primarily treated with a decoction of 3 qian Dihuang (Rehmannia Root) and 1 qian Danggui (Angelica Sinensis). If ineffective, add Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), and Chenpi (Tangerine Peel). For pain caused by sinking due to Middle Qi deficiency, Buzhong Yiqi Tang (Middle-Boosting and Qi-Invigorating Decoction) is used.