夫胎以阳生阴长,气行血随,营卫调和,则及期而产。若或滋养一有不利,则枝枯而果落,藤萎而花坠。
故《五常政大论》曰∶“根于中者,命曰神机,神去则机息。根于外者,命曰气立,气止则化绝。”正此谓
也。凡妊娠之数见堕胎者,必以气脉亏损而然。而亏损之由,有禀质之素弱者,有年力之衰残者,有忧怒劳苦
而困其精力者,有色欲不慎而盗损其生气者,此外如跌
扑、饮食之类,皆能伤其气脉。气脉有伤而胎可无恙者,非先天之最完固者不能,而常人则未之有也。且胎
怀十月,经养各有所主,所以屡见小产、堕胎者,多在三个月及五月、七月之间,而下次之堕必如期复然。正
以伤此一经,而再值此经则遇阙不能过矣。况妇人肾以系胞,而腰为肾之府,故胎妊之妇,最虑腰痛,痛甚则
坠,不可不防。故凡畏堕胎者,必当察此所伤之由,而切为戒慎。凡治堕胎者,必当察此养胎之源,而预培其
损,保胎之法,无出于此。若待临期,恐无及也。凡胎孕不固,无非气血损伤之病,盖气虚则提摄不固,血虚
则灌溉不周,所以多致小产。故善保胎者,必当专顾血虚,宜以胎元饮为主而加减用之;其次则芍药芎归汤;
再次则泰山磐石散或千金保孕丸,皆有夺造化之功,所当酌用者也。
胎元饮(见安胎)
芍药芎归汤(见《妇人规古方》)即芎归补中汤。治气血虚半产。
川芎 当归 黄 (炙) 白术(炒) 人参 芍药(炒) 杜仲(炒) 艾叶 阿胶(炒)
五味子(杵炒各一钱) 甘草(炙五分)
上每服五钱,水煎服。若脾气虚弱,须用补中益气
汤。若气虚有火,宜用安胎饮。
泰山磐石散(见安胎论外方)
千金保孕丸(见安胎论外方)
又凡胎热者,血易动,血动者,胎不安,故堕于内热而虚者,亦常有之。若脾气虚而血热者,宜四圣散。
肝肾虚而血热者,宜凉胎饮。肝脾虚而血热者,宜固胎煎。
四圣散(见胎漏)
凉胎饮(见安胎)
固胎煎(见《新方八阵·因阵》)治肝脾多火多滞而屡堕胎者。
黄芩(二钱) 白术(一、二钱) 当归 芍药 阿胶(各钱半) 陈皮(一钱) 砂仁(五分)
水一钟半煎服。
又立斋法∶治血虚、血热数堕胎者,于调补之外,时值初夏,教以浓煎白术汤,下黄芩末二钱,与数十
帖,得保而生,亦可法也。
此外,凡有他证而胎不安者,当于“安胎”条中酌而治之。
胎儿的形成依赖于阳气的生发与阴血的滋养,气行则血随,营卫调和,便能足月分娩。如果滋养稍有不利,就会像树枝干枯果实坠落、藤蔓枯萎花朵凋谢一样导致流产。
所以《黄帝内经·素问·五常政大论》说:“根源于体内的,叫做神机,神气离去则机能停止;根源于体外的,叫做气立,气机停止则化生绝灭。”正是说的这个道理。凡是怀孕期间多次发生堕胎的,必定是因为气脉亏损所致。而气脉亏损的原因,有先天体质素来虚弱的,有年龄体力衰退残损的,有因忧愁愤怒劳累辛苦而困倦精力的,有因房事不慎而暗中损耗生气的,此外如跌打损伤、饮食不当等,都能伤害气脉。气脉受了伤而胎儿还能安然无恙的,除非是先天禀赋极其完固的人才能做到,普通人是没有这种情况的。况且怀孕十月,经络气血的养护各有侧重,所以屡次出现小产、堕胎的情况,多发生在怀孕三个月、五个月、七个月这几个阶段,而下一次的堕胎也必然会在相应的时间再次发生。正是因为损伤了某一经络的气血,当再次轮到该经气血旺盛时,遇到空缺就无法通过,从而导致流产。更何况妇人肾脏负责系连子宫(胞宫),腰部是肾脏的府邸,所以怀孕的妇女,最担心腰痛,疼痛严重就会导致坠胎,不可不加以防范。因此,凡是害怕堕胎的,必须考察造成损伤的原因,并切实地谨慎戒惧。凡是治疗堕胎的,必须考察养胎的根本源头,预先培补其亏损,保胎的方法,没有超出这一原则的。如果等到临产时才处理,恐怕就来不及了。凡是胎孕不稳固,无非是气血损伤的疾病,气虚则提摄固护无力,血虚则灌溉濡养不周,所以多导致小产。因此善于保胎的人,必须专门顾护血虚,适宜以胎元饮为主方进行加减使用;其次则是芍药芎归汤;再次则是泰山磐石散或千金保孕丸,这些都有夺造化之功,应当酌情使用。
芍药芎归汤(见《妇人规古方》),即芎归补中汤。治疗气血虚弱导致的小产。
药材:川芎、当归、黄(炙)、白术(炒)、人参、芍药(炒)、杜仲(炒)、艾叶、阿胶(炒)、五味子(杵炒,各一钱)、甘草(炙五分)。
用法:每次服用五钱,水煎服。如果脾气虚弱,须用补中益气汤。如果气虚伴有内热,宜用安胎饮。
另外,凡是胎热的情况,血液容易妄动,血液妄动则胎元不安,所以因内热兼虚而导致堕胎的情况,也常有发生。如果是脾气虚而血热者,适宜用四圣散。肝肾虚而血热者,适宜用凉胎饮。肝脾虚而血热者,适宜用固胎煎。
固胎煎(见《新方八阵·因阵》),治疗肝脾火旺气滞且屡发堕胎者。
药材:黄芩(二钱)、白术(一至二钱)、当归、芍药、阿胶(各钱半)、陈皮(一钱)、砂仁(五分)。
用法:水一钟半煎服。
另外,薛立斋的治疗方法:治疗血虚、血热导致多次堕胎者,在调补之外,正值初夏时节,教导患者浓煎白术汤,送服黄芩末二钱,连续服用数十帖,得以保全胎儿并顺利出生,这也是值得效法的方法。
The formation of the fetus relies on the generation of Yang Qi and the nourishment of Yin Blood. When Qi moves, Blood follows, and Ying (Nutritive) and Wei (Defensive) harmonize, delivery occurs at term. If nourishment is in any way inadequate, it will be like branches withering and fruit falling, or vines shrinking and flowers dropping, leading to miscarriage.
Therefore, *Suwen: Wuchang Zheng Da Lun* states: "Those rooted within are called Shen Ji (Spirit Mechanism); when Shen departs, the mechanism ceases. Those rooted outside are called Qi Li (Qi Establishment); when Qi stops, transformation ends." This precisely refers to this principle. In cases of recurrent spontaneous abortion during pregnancy, it must be due to the deficiency and damage of Qi and Mai (Vessels). The causes of this deficiency include: innate constitutional weakness; decline in age and physical strength; exhaustion of Jing (Essence) and vitality due to worry, anger, labor, and hardship; secret loss of Sheng Qi (Vital Qi) due to imprudent sexual activity; as well as external factors such as falls/trauma and improper diet, all of which can injure Qi and Mai. For Qi and Mai to be injured yet the fetus remain unharmed requires the most solid congenital endowment; for ordinary people, this does not happen. Moreover, throughout the ten months of gestation, the nurturing by different meridians has its specific dominance. Therefore, recurrent early miscarriages or abortions often occur between the third, fifth, and seventh months. Subsequent abortions tend to recur at these same stages. This is because once a specific meridian's Qi/Blood is damaged, when that meridian's time arrives again, the deficiency prevents passage, leading to abortion. Furthermore, the Kidney connects to the Bao Gong (Uterus), and the Waist is the Mansion of the Kidney. Thus, pregnant women should be most wary of lower back pain; severe pain leads to fetal descent, so prevention is essential. Therefore, those fearing abortion must investigate the cause of injury and exercise utmost caution. In treating abortion, one must examine the source of fetal nourishment and preemptively tonify the deficiency. The method of preserving the fetus lies herein. If treatment is delayed until term, it may be too late. Unstable pregnancy is invariably a disease of Qi and Blood injury. Qi deficiency leads to failure in lifting and securing; Blood deficiency leads to insufficient irrigation and moistening, thus often causing miscarriage. Hence, experts in preserving the fetus must focus on Blood deficiency, primarily using Tai Yuan Yin (Fetal Origin Decoction) with modifications; secondly, Shaoyao Xiong Gui Tang (Peony, Ligusticum, and Angelica Decoction); and thirdly, Taishan Panshi San (Mount Tai Porphyry Powder) or Qianjin Baoyun Wan (Thousand Gold Pregnancy Preservation Pill). These possess the merit of rivaling creation and should be used judiciously.
Tai Yuan Yin (See Section on An Tai / Preserving Fetus)
Shaoyao Xiong Gui Tang (See *Fu Ren Gui Ancient Formulas*), also known as Xiong Gui Bu Zhong Tang. Treats miscarriage due to Qi and Blood deficiency.
Ingredients: Chuanxiong Radix (Ligusticum Chuanxiong), Danggui Radix (Angelica Sinensis), Huangqi Radix (Astragalus Membranaceus, honey-fried), Baizhu Rhizoma (Atractylodes Macrocephala, stir-fried), Renshen Radix Ginseng (Panax Ginseng), Shaoyao Radix Alba (Paeonia Lactiflora, stir-fried), Duzhong Cortex Eucommiae (Eucommia Ulmoides, stir-fried), Yeye Folium Artemisiae Argyi (Mugwort Leaf), Ejiao Colla Asini (Donkey-hide Gelatin, stir-fried), Wuweizi Fructus Schisandrae (Schisandra Chinensis, pounded and stir-fried, 1 qian each), Gancao Radix Glycyrrhizae (Licorice Root, honey-fried, 0.5 qian).
Usage: Take 5 qian per dose, decoct in water and drink. If Spleen Qi is deficient, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If Qi deficiency is accompanied by Heat, use Antai Yin (Preserve Fetus Decoction).
Taishan Panshi San (See External Formulas in Section on An Tai / Preserving Fetus Theory)
Qianjin Baoyun Wan (See External Formulas in Section on An Tai / Preserving Fetus Theory)
Additionally, in cases of Fetal Heat, Blood is prone to agitation; agitated Blood makes the fetus unstable. Thus, abortion due to internal heat and deficiency is common. For Spleen Qi deficiency with Blood Heat, Six Holy Powder (Sisheng San) is suitable. For Liver-Kidney deficiency with Blood Heat, Cool Fetus Decoction (Liangtai Yin) is suitable. For Liver-Spleen deficiency with Blood Heat, Secure Fetus Decoction (Gutai Jian) is suitable.
Sisheng San (See Section on Tailou / Fetal Bleeding)
Liangtai Yin (Cool Fetus Decoction) (See Section on An Tai / Preserving Fetus)
Gutai Jian (Secure Fetus Decoction) (See *Xin Fang Ba Zhen · Yin Zhen*), treats recurrent abortion due to Liver-Spleen Fire excess and Qi stagnation.
Ingredients: Huangqin Cortex Scutellariae (Scutellaria Baicalensis, 2 qian), Baizhu Rhizoma Atractylodis Macrocephalae (Atractylodes Macrocephala, 1-2 qian), Danggui Radix Angelicae Sinensis (Angelica Sinensis), Shaoyao Radix Alba (Paeonia Lactiflora), Ejiao Colla Asini (Donkey-hide Gelatin, 1.5 qian each), Chenpi Pericarpium Citri Reticulatae (Citrus Reticulata, 1 qian), Sharen Fructus Amomi Rotundus (Amomum Villosum, 0.5 qian).
Usage: Decoct in 1.5 zhong of water and drink.
Furthermore, Master Lizhai's method: For treating recurrent abortion due to Blood deficiency and Blood Heat, in addition to regulating and tonifying, during early summer, instruct the patient to decoct Baizhu Tang (Atractylodes Decoction) strongly and administer 2 qian of Huangqin powder (Scutellaria Powder) with it. After taking dozens of doses, the pregnancy can be preserved and birth achieved. This is also a method worth emulating.
In other cases where other syndromes cause fetal instability, treatment should be judged according to the "An Tai" (Preserving Fetus) section.