陈良甫曰∶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,荣卫不和,
致阴阳隔绝,热乘心脾,津液枯燥,故心烦口燥。与子烦大同小异,宜知母丸。
薛立斋曰∶前证若胃经实火,用竹叶石膏汤;若胃经虚热,用人参黄 散;若胃经气虚,用补中汤;若肺经
虚热,用紫苏饮;若肝经火动,用加味逍遥散;若脾气郁结,用加味归脾汤;若肾经火动,用加味地黄丸。
《大全》曰∶有孕妇暴渴,唯饮五味汁。名医耿隅诊其脉曰∶此血欲凝,非疾也。已而果孕。然古方有血
欲凝而渴饮五味之证,不可不知。
慎斋按∶以上九条,序胎前有子烦、烦躁、口干、血渴之证也。妊娠烦躁,本属肺肾二经有火。仲景云∶
火入于肺则烦,入于肾则躁。胎系于肾,肾水养其胎元。则元气弱,不足以滋肾中之火,火上烁肺,肺受火
刑,变为烦躁,此金亏水涸之候。法当滋其化源,清金保肺,壮水滋肾为主。良甫以君相二火论子烦,《产宝》
以停痰积饮论子烦,未悉病机之要。若丹溪,以子烦为气血壅聚胎元,热气上冲为病,亦是大概言之耳。
陈良甫曰∶妊娠至四五月来,君相二火养胎。平素有热,故胎热气逆,上凑心胸,胀满痞闷,名曰子悬。法
当补气血,疏壅滞,用严氏紫苏饮,加山栀、条芩之类。紫苏、陈皮和气,大腹敛气宽中,芎、归、参、芍养
血补气,甘草缓急,加生姜、葱白,名产宝方。
陈良甫说:妊娠期间出现烦躁、口干的症状,是因为足太阴脾经的气脉通于口,手少阴心经的气脉通于舌。如果脏腑之气虚弱,营卫不和,导致阴阳隔绝,热邪侵犯心脾,津液干枯枯燥,所以出现心烦、口燥。这与“子烦”(妊娠心烦)大同小异,适宜使用知母丸。
薛立斋说:上述病症,如果是胃经实火,使用竹叶石膏汤;如果是胃经虚热,使用人参黄芪散;如果是胃经气虚,使用补中益气汤;如果是肺经虚热,使用紫苏饮;如果是肝经火动,使用加味逍遥散;如果是脾气郁结,使用加味归脾汤;如果是肾经火动,使用加味地黄丸。
《妇人大全良方》说:有孕妇突然极度口渴,只喝五味汁。名医耿隅诊察其脉搏说:这是血欲凝滞之象,并非疾病。后来果然怀孕。然而古方中有因血欲凝滞而渴饮五味汁的证候,不可不知道。
慎斋按语:以上九条,叙述了胎前有子烦、烦躁、口干、血渴等证候。妊娠烦躁,本属于肺、肾二经有火。张仲景说:火入于肺则烦,入于肾则躁。胎元系于肾,肾水滋养胎元。因此元气虚弱,不足以滋润肾中之火,火上灼烁肺金,肺受火刑,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,以壮水滋肾为主。陈良甫用君相二火来论述子烦,《产宝》用停痰积饮来论述子烦,都没有完全洞察病机的关键。至于朱丹溪,认为子烦是气血壅聚于胎元,热气上冲所致,这也是大概而言罢了。
陈良甫说:妊娠到了四五月时,君相二火用来养胎。平素体内有热,所以胎热气逆,向上凑集心胸,导致胀满痞闷,名叫“子悬”。治法应当补益气血,疏通壅滞,使用严氏紫苏饮,加入山栀、黄芩之类。紫苏、陈皮调和气机,大腹皮收敛气机并宽中,川芎、当归、人参、白芍养血补气,甘草缓解急迫,加入生姜、葱白,名为《产宝》方。
Chen Liangfu stated: In cases of pregnancy complicated by irritability and dry mouth, the Qi of the Foot-Taiyin Splein Meridian connects to the mouth, and the Qi of the Hand-Shaoyin Heart Meridian connects to the tongue. If the Qi of the Zang-Fu organs is deficient, and Ying (Nutritive) and Wei (Defensive) are disharmonious, leading to a separation of Yin and Yang, heat invades the Heart and Spleen, causing the body fluids to become dry and withered. Consequently, mental restlessness and dry mouth occur. This condition is largely similar to "Zi Fan" (pregnancy-related irritability), and Zhimu Wan (Anemarrhena Pill) is appropriate for treatment.
Xue Lizhai stated: For the aforementioned conditions, if there is Excess Fire in the Stomach Meridian, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction); if there is Deficient Heat in the Stomach Meridian, use Renshen Huangqi San (Ginseng and Astragalus Powder); if there is Qi deficiency in the Stomach Meridian, use Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi); if there is Deficient Heat in the Lung Meridian, use Zisu Yin (Perilla Infusion); if there is Fire stirring in the Liver Meridian, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); if there is Qi stagnation and knotting in the Spleen, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction); if there is Fire stirring in the Kidney Meridian, use Jiawei Dihuang Wan (Modified Rehmannia Pill).
The *Daquan* (Great Compendium) states: There are pregnant women who experience sudden extreme thirst, drinking only juice made from five flavors. The renowned physician Geng Yu diagnosed their pulse and said: "This indicates blood attempting to coagulate; it is not a disease." Subsequently, pregnancy was confirmed. However, one must be aware of ancient formulas describing this syndrome of thirst due to blood coagulation where patients drink five-flavor juice.
Shenzhai commented: The above nine sections describe syndromes occurring before delivery, such as Zi Fan, irritability, dry mouth, and blood-thirst. Pregnancy irritability fundamentally belongs to Fire in the Lung and Kidney meridians. Zhang Zhongjing stated: "Fire entering the Lung causes Fan (restlessness); Fire entering the Kidney causes Zao (irritability)." The fetus is anchored in the Kidney, and Kidney Water nourishes the fetal origin. Thus, Yuan Qi (Primal Qi) becomes weak, insufficient to moisten the Fire within the Kidney. This Fire scorches Lung Metal, and the Lung suffers from Fire punishment, transforming into irritability. This is a sign of Metal deficiency and Water exhaustion. The treatment method should focus on nourishing the source of transformation, clearing Metal and protecting the Lung, primarily by strengthening Water and nourishing the Kidney. Chen Liangfu discussed Zi Fan using the theory of Ministerial and Sovereign Fire; *Chanbao* discussed Zi Fan using the theory of retained phlegm and accumulated fluid. Neither fully grasped the essence of the pathogenesis. As for Zhu Danxi, he considered Zi Fan to be caused by the accumulation of Qi and Blood around the fetal origin, with hot Qi rushing upward; this is also a general statement.
Chen Liangfu stated: When pregnancy reaches four or five months, the Sovereign and Ministerial Fires nourish the fetus. If one habitually has internal heat, the fetal heat becomes rebellious, rushing upward to congest the chest and heart, causing distension, fullness, and stifling sensation, named "Zi Xuan" (fetal suspension). The treatment method should tonify Qi and Blood, and unblock stagnation, using Yan's Zisu Yin (Perilla Infusion), added with Zhizi (Gardenia) and Huangqin (Scutellaria). Zisu (Perilla Leaf) and Chenpi (Aged Tangerine Peel) harmonize Qi; Dafupi (Areca Peel) gathers Qi and expands the middle; Xiong (Ligusticum Rhizome), Danggui (Angelica Sinensis), Renshen (Ginseng), and Shaoyao (Peony Root) nourish Blood and tonify Qi; Gancao (Licorice) relieves urgency; adding Shengjiang (Fresh Ginger) and Congbai (Green Onion White) constitutes the formula from *Chanbao*.