安胎、固胎、养胎必当察其由来之邪,分其胎之所损在气在血,何者之虚?其胎与母受病孰先孰后?
方
制君臣佐使各适其宜,岂可守已定之方执而不通耶!
恶阻与胎化不成何如?曰∶一月始形,二月始膏,三月精血始化为胎,男女分矣。所谓恶阻与
胎之成否,皆在三月相火化胎之时。恶阻者,由相火化精血为胎,而子宫秽腐因火冲逆,上攻于胃,有
伤其味,故食不得入,津液亦不化,停积为痰为饮为呕吐,此以子宫秽气所阻其食,故名恶阻。前人
未明相火之道,故止言由中气壅实,故恶闻食气。
若夫不成胎者有二焉,一为母身之天真不足以化其胎,一为父精不足,皆致子宫与天赋凝结之真
不全。故在三月则化不成形也。有当时即漏下者,有待十月如产者。
一妇年三十余,或经住,或成形未具,其胎必堕。察其性急多怒,色黑气实。此相火火盛,不
能生气化胎,反食气伤精故也。因今住经第二月,用黄芩、白术、当归、甘草,服至三月尽止药,后得一
子。
一妇经住三月后,尺脉或涩,或微弱,其妇却无病,知是子宫真气不全,故阳不施阴,不化精血,虽
凝终不成形,至产血块,或产血胞。
一妇腹渐大如怀子,至十月,求易产药。察其神色甚困难。与之药,不数日,产白虫半桶。盖由妇之
元气大虚,精血虽凝不能成胎,而为秽腐蕴积之久,湿化为热,湿热生虫,理之所有。亦须周十月之气
发动而产,终是不祥,其妇不及月死。湿热生虫,譬之沟渠污浊积久不流,则诸虫生于其中矣!
安胎、固护胎儿、滋养胎儿,必须考察导致疾病的邪气来源,分辨胎儿受损是在气分还是在血分,以及哪一方虚弱。胎儿与母亲患病,究竟是谁先谁后?
处方时,君臣佐使的配伍应当各得其所,怎么可以死守既定的方剂而不知变通呢!
关于恶阻(妊娠早期恶心呕吐等反应)与胎儿发育不全的情况是怎样的呢?回答说:怀孕一个月开始成形,两个月形成膏脂状,三个月精血开始转化为胎儿,男女性别也就区分开了。所谓恶阻以及胎儿能否成型,都发生在第三个月相火(指命门之火,推动生长发育的动力)化生胎儿的时候。恶阻的原因,是由于相火将精血化为胎儿,子宫内的秽浊腐败之气因火势冲逆而上攻于胃,损伤了胃的功能,所以食物无法进入,津液也无法运化,停滞积聚成为痰饮或引起呕吐,这是因为子宫秽气阻碍了饮食,所以命名为恶阻。前人没有明白相火的道理,所以只说是由于中气壅滞实热,因此厌恶食物的气味。
至于胎儿不能成型的,有两种情况:一是母亲身体的先天真气不足以化生胎儿,二是父亲精气不足,这都会导致子宫与天赋凝结的真气不完整。所以在第三个月时,化生过程无法完成形态。有的当时就出现阴道流血,有的要等到十个月分娩时才排出。
有一位三十多岁的妇女,有时月经停止,有时胎儿成形但未具备完整形态,其胎儿必然流产。观察她性格急躁易怒,面色发黑,气息充实有力。这是相火过盛,不能生气以化生胎儿,反而消耗气并损伤精气的缘故。恰逢这次停经第二个月,使用黄芩、白术、当归、甘草,服用到第三个月结束停药,后来生下一个孩子。
有一位妇女停经三个月后,尺脉(诊察肾气及下焦状况的脉位)时而涩滞,时而微弱,但她本人并没有其他病症,知道这是子宫真气不完整,所以阳气不能施布于阴,不能化生精血,虽然受精卵凝结但最终不能成形,到了分娩时排出血块,或者排出血胞(胎盘组织)。
有一位妇女腹部逐渐增大像怀孕一样,到了十个月,寻求催生药物。观察她的神色非常困顿艰难。给她用药,没过几天,产出了半桶白色虫子。这是由于妇人元气极度虚弱,精血虽然凝结但不能成胎,而是作为秽浊腐败之物蕴积日久,湿气转化为热,湿热滋生虫体,这是情理之中的事。这也需要等到满十月气机发动才产出,终究是不祥之兆,这位妇女不到一个月就死了。湿热生虫,就像沟渠污浊积聚久了不流动,各种虫子就会在其中产生一样!
To secure the fetus (An Tai), consolidate the fetus (Gu Tai), and nourish the fetus (Yang Tai), one must investigate the origin of the pathogenic factors, distinguish whether the fetal damage lies in Qi or Blood, and identify which aspect is deficient. One must also determine whether the disease originated in the mother or the fetus first.
When prescribing, the roles of Sovereign, Minister, Assistant, and Envoy (Jun Chen Zuo Shi) in the formula should be appropriately matched. How can one rigidly adhere to a fixed prescription without flexibility!
Regarding E Zu (Morning Sickness/Nausea of Pregnancy) and incomplete fetal development: In the first month, the form begins to appear; in the second month, it becomes like paste; in the third month, Essence and Blood begin to transform into the fetus, and male and female distinctions are established. Whether E Zu occurs and whether the fetus forms properly both depend on the phase when Xiang Huo (Ministerial Fire, the fire of the Mingmen that drives growth and transformation) transforms the fetus during the third month. E Zu arises because, as Xiang Huo transforms Essence and Blood into the fetus, turbid and foul qi within the Uterus rushes upward due to the force of the fire, attacking the Stomach. This damages the Stomach's function, preventing food intake and hindering the transformation of Body Fluids. These fluids stagnate and accumulate to form Phlegm and Yin (fluid retention), leading to vomiting. It is named E Zu because the turbid qi of the Uterus obstructs the intake of food. Previous scholars did not understand the principle of Xiang Huo, so they merely stated that it was caused by excess and stagnation of Middle Qi, leading to an aversion to food odors.
As for cases where the fetus fails to develop, there are two causes: one is that the mother's innate True Qi is insufficient to transform the fetus; the other is that the father's Essence is insufficient. Both result in an incompleteness of the true essence condensed in the Uterus and endowed by Heaven. Consequently, the transformation cannot achieve form by the third month. Some experience vaginal bleeding immediately, while others do not deliver until the tenth month, expelling blood clots or placental tissue.
A woman in her thirties experienced amenorrhea at times, or formed a fetus that lacked complete structure, resulting in inevitable miscarriage. Upon examination, she had an irritable and angry temperament, dark complexion, and robust Qi. This indicated excessive Xiang Huo, which failed to generate Qi to nourish the fetus, but instead consumed Qi and damaged Essence. During the second month of this particular amenorrhea, Huang Qin (Scutellariae Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) were administered. Medication was stopped after the end of the third month, and she subsequently gave birth to a healthy child.
Another woman, three months post-amenorrhea, presented with a Chi pulse (pulse position used to diagnose Kidney Qi and lower jiao conditions) that was either choppy or weak and faint, yet she exhibited no other symptoms. This indicated incomplete True Qi in the Uterus. Thus, Yang could not act upon Yin, and Essence and Blood were not transformed. Although conception occurred, it failed to develop into a proper form. At delivery, she expelled blood clots or placental membranes.
A woman’s abdomen gradually enlarged as if pregnant. By the tenth month, she sought medication for easier delivery. Her expression and spirit appeared extremely distressed. After administering medicine, she delivered half a bucket of white worms within a few days. This was due to severe deficiency of the woman's Yuan Qi (Primary Qi). Although Essence and Blood had condensed, they could not form a fetus; instead, they accumulated as turbid and foul matter for a long time. Dampness transformed into Heat, and Damp-Heat generated worms, which is logically consistent. The expulsion required the full ten months for Qi to activate, but it remained an ominous sign; the woman died less than a month later. The generation of worms from Damp-Heat is analogous to stagnant, filthy water in a ditch that does not flow for a long time, causing various insects to breed within it.