大全云∶妊娠心腹痛者,或由宿有冷疼,或新触风寒,皆由脏虚而致动也。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,故令心腹痛也。妊娠而痛者,邪正二气交攻于内,若不时瘥者,其痛冲击胞
络,必致动胎,甚则伤堕矣。又云,妊娠心腹疼痛,多是风寒湿冷痰饮,与脏气相击,故令腹
痛攻冲不已,则致胎动也。
薛氏曰∶前证若风寒痰饮,用金沸草散,杂病咳嗽,胎气郁结,加香附、川芎;若饮食停
滞,用六君加紫苏、枳壳;若怒动肝火,前药更加柴胡、山栀;若郁结伤脾,用归脾汤加枳壳、山栀。
一妊妇心腹作痛,吐痰恶心,胎气上攻,饮食少思,此脾虚气滞而为痰,用六君子加柴
胡、枳壳,诸证渐退,饮食渐进,又用四君子加枳壳、山栀、桔梗而安。后因怒,两胁气胀,中
脘作痛,恶寒呕吐,用六君加柴胡、升麻、木香一剂而愈。
川芎散 治妊娠素有冷气,忽心腹痛如刀刺。
川芎 当归(各一钱) 人参 吴茱萸 浓朴(姜制,各五分) 茯苓 桔梗(各四分) 芍药(七分半)
枳壳 甘草(各二分)
上剂水煎,稍热服。
当归芍药散 治妊娠腹中绞痛,心下急痛,及疗产后崩中,去血过多,眩晕虚乏。
白芍药(炒四两)(产后忌芍药,而此方兼治,且以为君,愚谓产后惟去血过多者可用,若恶
露不行作痛者,不可用也) 当归 茯苓 白术(各二两) 泽泻 川芎(各一两)
上为细末,每服二钱,食前温调服。
阿胶散 治妊娠胎动,腹中绞痛,不思饮食。
当归(炒) 陈皮(各一两) 白术 白茯苓 阿胶(炒) 川芎(各七钱半) 甘草(二钱半)
上 咀,每服三钱,水一盏,姜三片,枣一枚,煎七分服。(胎动方中多用艾叶,而此则用
白术者,盖不治痛,而治不思饮食也,妙在当归、陈皮为君)
一方 治妊娠患腹痛,并胎动不安。
当归(三两) 川芎 阿胶 人参 浓朴(各二两) 葱白(切,一升)
上 咀,以水七升煎至三升,分三服。一方有甘草,无浓朴、川芎。
香莪散 治妊娠五个月以后,常胸膈间气刺痛满,或肠鸣,以至呕逆减食,此由喜怒
忧虑过度,饮食失节之所致也。蔡元度宠人有子,夫人怒欲逐之,遂病,医官王师复处此方,
三服而愈。
广中莪术(炒,一两) 丁香(半两) 粉草(二钱半)
上为细末,空心盐汤点服一大钱,觉胸中如物按下之状。
古今录验方 疗妊娠腹内冷痛,忽胎动。
薤白(一升) 当归(切,四两)
上以水五升煮取四升,作三服。
一方 治妊娠胎动欲落,腹中痛不可忍。(镇坠解热护胎,方法俱妙,于体强暴病者可用)
上等银(一斤) 茅根(二斤,去黑皮)
上以水九升煮银,取五升,入清酒一升同煎茅根取三升,分三服,立安。
一方 治妊娠腹痛。(血热血虚腹痛,若此方甚妙)
用生地黄三斤捣,酒一升合煎减半,顿服愈。
一方 治妊娠四五个月,忽然腹绞痛。
大枣(十四枚,炒令黑) 盐(一钱,炒令赤)
上为末,取一撮许,酒调服即愈。一方单用枣十四枚,烧存性为末,童子小便调下。
一方单用盐一斤,烧令赤,以两指取一撮,酒调服。
《大全》记载:妊娠期间出现心腹疼痛,可能是因为原本就有冷痛宿疾,或者是新近感受风寒,这都是因为脏腑虚弱导致邪气扰动所致。邪气与正气相互搏击,并汇聚于气分,随着气的运行上下流动,向上冲逆至心脏则引起心痛,向下攻冲至腹部则引起腹痛,因此导致心腹疼痛。妊娠期间发生疼痛,是邪气与正气在体内交相攻伐,如果不时常痊愈,这种疼痛冲击胞络(子宫及其脉络),必然会导致胎动不安,严重时甚至会造成流产或堕胎。又说,妊娠期间心腹疼痛,大多是风寒湿冷、痰饮等邪气,与脏腑之气相互搏击,从而导致腹部疼痛攻冲不止,进而引发胎动。
薛己认为:上述病症如果是由于风寒、痰饮引起的,使用金沸草散;如果是杂病咳嗽且胎气郁结,加入香附、川芎;如果是饮食停滞,使用六君子汤加紫苏、枳壳;如果是愤怒引动肝火,在前药基础上再加柴胡、山栀;如果是郁结损伤脾气,使用归脾汤加枳壳、山栀。
有一位孕妇心腹作痛,吐痰恶心,胎气上攻,食欲减退,这是脾虚气滞而生痰,使用六君子汤加柴胡、枳壳,各种症状逐渐消退,饮食逐渐恢复,后来又用四君子汤加枳壳、山栀、桔梗而安胎成功。后来因为发怒,两胁气胀,中脘穴处疼痛,恶寒呕吐,使用六君子汤加柴胡、升麻、木香,一剂药后痊愈。
川芎散:治疗妊娠期间素来有冷气,突然心腹疼痛如刀刺一般。
药材:川芎、当归(各一钱)、人参、吴茱萸、浓朴(姜制,各五分)、茯苓、桔梗(各四分)、芍药(七分半)、枳壳、甘草(各二分)。
用法:以上药物加水煎煮,稍热时服用。
当归芍药散:治疗妊娠期间腹中绞痛,心下急痛,以及治疗产后崩中(大量出血),因失血过多导致的眩晕、虚弱乏力。
药材:白芍药(炒四两)(注:产后通常忌用芍药,但此方兼治产后病,且作为主药,我认为只有产后失血过多者可用,若恶露不行导致疼痛者,不可使用)、当归、茯苓、白术(各二两)、泽泻、川芎(各一两)。
用法:以上药物研为细末,每次服用二钱,饭前温开水调服。
阿胶散:治疗妊娠胎动,腹中绞痛,不思饮食。
药材:当归(炒)、陈皮(各一两)、白术、白茯苓、阿胶(炒)、川芎(各七钱半)、甘草(二钱半)。
用法:以上药物切碎,每次服用三钱,加水一盏,生姜三片,大枣一枚,煎至七分,服用。(治疗胎动的方剂中多用艾叶,而此方用白术,是因为不仅治疗疼痛,更主要治疗不思饮食,妙在以当归、陈皮为主药。)
另一首方子:治疗妊娠患腹痛,并胎动不安。
药材:当归(三两)、川芎、阿胶、人参、浓朴(各二两)、葱白(切,一升)。
用法:以上药物切碎,用水七升煎至三升,分三次服用。另一版本有甘草,无浓朴、川芎。
香莪散:治疗妊娠五个月以后,经常胸膈间气刺痛满闷,或者肠鸣,以至于呕吐逆气、减少进食,这是由于喜怒忧虑过度,饮食失节所导致的。蔡元度宠妾生子,夫人愤怒想要驱逐她,宠妾因此生病,医官王师复开具此方,服用三剂后痊愈。
药材:广中莪术(炒,一两)、丁香(半两)、粉草(二钱半)。
用法:以上药物研为细末,空腹时用盐汤送服一大钱,感觉胸中有物按下般轻松。
古今录验方:治疗妊娠腹内冷痛,突然胎动。
药材:薤白(一升)、当归(切,四两)。
用法:以上药物用水五升煮取四升,分三次服用。
另一首方子:治疗妊娠胎动欲落,腹中痛不可忍。(具有镇坠解热护胎的功效,方法精妙,适用于体质强壮暴病者)
药材:上等银(一斤)、茅根(二斤,去黑皮)。
用法:以上药物用水九升煮银,取五升水,加入清酒一升同煎茅根,取三升药液,分三次服用,立即安定。
另一首方子:治疗妊娠腹痛。(对于血热、血虚引起的腹痛,此方非常巧妙)
用法:用生地黄三斤捣碎,与酒一升合煎减半,一次性服用即愈。
另一首方子:治疗妊娠四五个月,忽然腹绞痛。
药材:大枣(十四枚,炒至黑色)、盐(一钱,炒至红色)。
用法:以上药物研为末,取一小撮,用酒调服即愈。另一版本单用枣十四枚,烧存性研为末,用童子小便调下。
另一首方子:单用盐一斤,烧令赤红,用手指捏取一小撮,用酒调服。
The *Daquan* records: Heart and abdominal pain during pregnancy may arise from pre-existing cold pain conditions or recent exposure to wind-cold. These are all caused by the deficiency of the zang-fu organs leading to the disturbance of pathogens. When pathogenic factors and healthy qi strike each other and converge in the qi level, they move up and down with the qi. If they rush upward to the heart, it causes heart pain; if they attack downward to the abdomen, it causes abdominal pain. Thus, heart and abdominal pain occur. During pregnancy, pain results from the mutual attack of pathogenic and healthy qi within the body. If not cured promptly, this pain impacts the Bao Luo (uterine collaterals), inevitably causing fetal movement, and in severe cases, may lead to miscarriage or abortion. It is also stated that heart and abdominal pain during pregnancy are mostly due to wind-cold-dampness, cold, phlegm-fluids, etc., clashing with the qi of the zang-fu organs, causing relentless abdominal pain and attacking sensations, which then leads to fetal movement.
Xue Ji stated: For the aforementioned symptoms, if caused by wind-cold or phlegm-fluids, use Jinfei Cao San (Jinfei Grass Powder). If complicated by cough and constrained fetal qi, add Xiangfu (Cyperi Rhizoma) and Chuanxiong (Ligustici Chuanxiong Rhizoma). If caused by food stagnation, use Liujunzi Tang (Six Gentlemen Decoction) with Zisu (Perillae Folium) and Zhike (Aurantii Fructus). If triggered by anger moving liver-fire, add Chaihu (Bupleuri Radix) and Shanzhi (Gardeniae Fructus) to the previous prescriptions. If constriction injures spleen-qi, use Guipi Tang (Restore the Spleen Decoction) with Zhike (Aurantii Fructus) and Shanzhi (Gardeniae Fructus).
A pregnant woman suffered from heart and abdominal pain, expectorated phlegm, felt nauseous, had fetal qi rushing upward, and poor appetite. This was due to spleen deficiency and qi stagnation generating phlegm. She was treated with Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleuri Radix) and Zhike (Aurantii Fructus). Her symptoms gradually subsided, and her appetite improved. Subsequently, she was given Sijunzi Tang (Four Gentlemen Decoction) with Zhike (Aurantii Fructus), Shanzhi (Gardeniae Fructus), and Jiegeng (Platycodonis Radix), which stabilized the fetus. Later, due to anger, she experienced distension and qi stagnation in both hypochondria, pain at the Zhongwan (CV12) point, aversion to cold, and vomiting. She was cured after one dose of Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma), and Muxiang (Aucklandiae Radix).
Chuanxiong San (Ligusticum Powder): Treats pre-existing cold qi in pregnancy, suddenly causing heart and abdominal pain like knife stabs.
Ingredients: Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix) (each 1 qian); Renshen (Ginseng Radix et Rhizoma), Wuzhuyu (Evodiae Fructus), Nongpu (Magnoliae Officinalis Cortex) (prepared with ginger, each 5 fen); Fuling (Poria), Jiegeng (Platycodonis Radix) (each 4 fen); Shaoyao (Paeoniae Radix) (7.5 fen); Zhike (Aurantii Fructus), Gancao (Glycyrrhizae Radix et Rhizoma) (each 2 fen).
Preparation: Decoct these ingredients in water and take warm.
Danggui Shaoyao San (Angelica and Paeony Powder): Treats colicky abdominal pain and urgent epigastric pain during pregnancy, as well as postpartum metrorrhagia (heavy bleeding), dizziness, weakness, and fatigue due to excessive blood loss.
Ingredients: Baishaoyao (Paeoniae Radix Alba) (stir-fried, 4 liang) [Note: Shaoyao is usually contraindicated postpartum, but this formula treats postpartum conditions and uses it as the sovereign herb. I believe it is only suitable for postpartum women with excessive blood loss; it should not be used for pain caused by lochia retention]; Danggui (Angelicae Sinensis Radix), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 2 liang); Zexie (Alismatis Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 1 liang).
Preparation: Grind into fine powder. Take 2 qian before meals, mixed with warm water.
Ejiao San (Donkey-hide Gelatin Powder): Treats fetal movement, colicky abdominal pain, and loss of appetite during pregnancy.
Ingredients: Danggui (Angelicae Sinensis Radix) (stir-fried), Chenpi (Citri Reticulatae Pericarpium) (each 1 liang); Baizhu (Atractylodis Macrocephalae Rhizoma), Bai Fuling (Poria), Ejiao (Colla Corii Asini) (stir-fried), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 7.5 qian); Gancao (Glycyrrhizae Radix et Rhizoma) (2.5 qian).
Preparation: Cut into pieces. Take 3 qian per dose, decocted with 1 cup of water, 3 slices of ginger, and 1 jujube, until reduced to 0.7 parts. [Formulas for fetal movement often use Aiyi (Artemisiae Argyi Folium), but this formula uses Baizhu because it treats loss of appetite rather than just pain. The brilliance lies in using Danggui and Chenpi as sovereign herbs.]
Another Formula: Treats abdominal pain and unstable fetal movement during pregnancy.
Ingredients: Danggui (Angelicae Sinensis Radix) (3 liang); Chuanxiong (Ligustici Chuanxiong Rhizoma), Ejiao (Colla Corii Asini), Renshen (Ginseng Radix et Rhizoma), Nongpu (Magnoliae Officinalis Cortex) (each 2 liang); Congbai (Allii Fistulosi Bulbus) (cut, 1 sheng).
Preparation: Cut into pieces. Decoct in 7 sheng of water until reduced to 3 sheng. Divide into three doses. Another version contains Gancao (Glycyrrhizae Radix et Rhizoma) but lacks Nongpu (Magnoliae Officinalis Cortex) and Chuanxiong (Ligustici Chuanxiong Rhizoma).
Xiang'e San (Curcuma and Cyperus Powder): Treats chest and diaphragm qi stabbing pain and fullness, borborygmus, vomiting, and reduced food intake occurring frequently after five months of pregnancy. This is caused by excessive joy, anger, worry, and irregular diet. Cai Yuandu’s favored concubine gave birth to a son; the madam was angry and wanted to expel her, causing the concubine to fall ill. Physician Wang Shifu prescribed this formula, and she recovered after three doses.
Ingredients: Guangzhong E Zhu (Curcumae Zedoariae Rhizoma) (stir-fried, 1 liang); Dingxiang (Caryophylli Flos) (0.5 liang); Fencao (Glycyrrhizae Radix et Rhizoma) (2.5 qian).
Preparation: Grind into fine powder. Take 1 qian on an empty stomach with salt water. One will feel a sensation of pressure being lifted from the chest.
Gu Jin Lu Yan Fang (Ancient and Modern Verified Formulas): Treats cold pain inside the abdomen and sudden fetal movement during pregnancy.
Ingredients: Xiebai (Allii Macrostemonis Bulbus) (1 sheng); Danggui (Angelicae Sinensis Radix) (cut, 4 liang).
Preparation: Decoct in 5 sheng of water until 4 sheng remain. Divide into three doses.
Another Formula: Treats threatened abortion with unbearable abdominal pain. [It has the effect of settling, clearing heat, and protecting the fetus. The method is exquisite and suitable for patients with strong constitutions suffering from acute illness.]
Ingredients: Shangdeng Yin (Silver) (1 jin); Maogen (Imperatae Rhizoma) (2 jin, remove black skin).
Preparation: Boil the silver in 9 sheng of water to obtain 5 sheng of liquid. Add 1 sheng of clear wine and decoct the Maogen (Imperatae Rhizoma) together until 3 sheng remain. Divide into three doses. The condition stabilizes immediately.
Another Formula: Treats abdominal pain during pregnancy. [Very effective for abdominal pain due to blood-heat or blood-deficiency.]
Preparation: Crush 3 jin of Shengdihuang (Rehmanniae Radix), combine with 1 sheng of wine, decoct until reduced by half, and take in one dose. Cure.
Another Formula: Treats sudden colicky abdominal pain in the fourth or fifth month of pregnancy.
Ingredients: Dazao (Ziziphi Jujubae Fructus) (14 pieces, stir-fried until black); Yan (Salt) (1 qian, stir-fried until red).
Preparation: Grind into powder. Take a pinch, mix with wine, and take. Cure. Another version uses only 14 jujubes, burned to retain their nature, ground into powder, and taken with urine from an uncircumcised boy.
Another Formula: Uses only 1 jin of salt, heated until red-hot. Take a pinch with two fingers, mix with wine, and take.