丹溪曰∶妇人无子者,多由血少不能摄精,俗医悉谓子宫虚冷,投以辛热之药,煎熬脏
腑,血气沸腾,祸不旋踵。或有服艾者,不知艾性至热(艾性虽热实暖,下焦寒者宜之),入火炙则下行,入药服则上
行,多
服则致毒,咎将谁挽?若是肥盛妇人,禀受甚浓,恣于酒食之人,经水不调,不能成胎,谓
之躯脂满溢,闭塞子宫,宜行湿燥痰,用星、半、苍术、台芎、防风、羌活、滑石,或导痰
汤之类。若是瘦怯性急之人,经水不调,不能成胎,谓之子宫干涩,无血不能摄受精气,宜
凉血降火,或四物汤加香附、黄芩、柴胡,养血养阴等药。东垣有六味地黄丸,以补妇人之
阴血不足(六味丸果验),无子服之者,能使胎孕。
薛氏曰∶妇人之不孕,亦有因六淫七情之邪,有伤冲任;或宿疾淹留,传遗脏腑;或子
宫虚冷,或气旺血衰,或血中伏热;又有脾胃虚损,不能营养冲任(求责极当,诚哉言也)。审此更当察其男子之形
质虚实何如,有肾虚精弱,不能融育成胎者;有禀赋元弱,气血虚损者;有嗜欲无度,阴精
衰惫者,各当求其原而治之。至于大要,则当审男女之尺脉。若左尺微细,或虚大无力者,
用八味丸;左尺洪大,按之无力者,用六味丸;两尺俱微细,或浮大者,用十补丸(岂此三方所能尽,宜扩充之)。若
误
用
辛热燥血,不惟无益,反受其害。
朱丹溪说:妇女不孕,大多是因为血少不能摄纳精子。世俗医生都说是子宫虚冷,便投用辛热性质的药物,煎熬脏腑,导致气血沸腾,灾祸立刻就会降临。有的人服用艾草,却不知道艾的性质极热(艾性虽然热,但其实是温暖的,下焦寒凉者适宜使用),如果入火灸治则药力下行,入药内服则药力上行,多服会导致中毒,这罪责由谁来承担呢?如果是体型肥胖的妇人,禀赋浓厚,又放纵于酒食的人,月经不调,不能受孕,这叫做“躯脂满溢”,脂肪充满溢出,闭塞了子宫,应当采用祛湿、燥痰的方法,使用半夏、天南星、苍术、台芎(川芎的一种)、防风、羌活、滑石等药,或者使用导痰汤之类的方剂。如果是身体瘦弱、性情急躁的人,月经不调,不能受孕,这叫做“子宫干涩”,因为无血而不能摄受精气,应当采用凉血降火的方法,或者使用四物汤加入香附、黄芩、柴胡,以及养血养阴等药物。李东垣有六味地黄丸,用来补充妇人阴血的不足(六味丸果然有效),不孕者服用它,能够促进胎孕。
薛己说:妇女不孕,也有因为六淫(风、寒、暑、湿、燥、火六种外感病邪)和七情(喜、怒、忧、思、悲、恐、惊七种情志变化)的邪气,损伤了冲脉和任脉;或者有旧疾滞留体内,传变遗留影响脏腑;或者子宫虚冷,或者气旺血衰,或者血中有伏热;又有脾胃虚弱受损,不能滋养冲任(追究根本非常恰当,这话确实正确)。审视这些情况时,更应当观察男子的体质虚实如何。有的男子肾虚精弱,不能融合育成胎;有的禀赋原本虚弱,气血亏损;有的嗜欲无度,阴精衰败疲惫,都应当探究其根源而治疗。至于关键要点,则应当审察男女双方的尺脉。如果左尺脉微细,或虚大无力,使用八味丸;左尺脉洪大,按之无力,使用六味丸;两尺脉都微细,或浮大,使用十补丸(难道这三个方剂就能穷尽所有情况吗?应该加以扩充运用)。如果误用辛热燥血的药物,不仅没有益处,反而会受到伤害。
Zhu Danxi stated: Infertility in women is often due to insufficient blood that fails to retain sperm. Quack doctors invariably attribute this to deficiency-cold of the uterus and administer acrid-warm herbs, which scald the zang-fu organs, causing qi and blood to boil, bringing disaster swiftly. Some take mugwort (Ai Ye), unaware that its nature is extremely hot (although mugwort is warm and suitable for coldness in the lower jiao), when moxibusted it acts downward, but when taken as a decoction it acts upward; excessive consumption leads to toxicity, whose responsibility can be blamed on whom? In cases of obese women with strong constitutions who indulge in alcohol and food, resulting in irregular menstruation and inability to conceive, this is termed "fullness of body fat overflowing," where adipose tissue obstructs the uterus. The treatment should involve resolving dampness and drying phlegm, using Pinelliae Rhizoma Preparatum (Banxia), Arisaematis Rhizoma (Tian Nan Xing), Atractodis Rhizoma (Cang Zhu), Ligustici Chuanxiong Rhizoma (Tai Xiong), Saposhnikoviae Radix (Fang Feng), Notopterygii Rhizoma et Radix (Qiang Huo), Talcum (Hua Shi), or formulas such as Dao Tan Tang. In cases of thin, irritable individuals with irregular menstruation and infertility, termed "dryness and astringency of the uterus" due to lack of blood to receive fertilizing qi, the treatment should cool blood and descend fire, using Si Wu Tang added with Cyperi Rhizoma (Xiang Fu), Scutellariae Radix (Huang Qin), Bupleuri Radix (Chai Hu), and other herbs that nourish blood and yin. Li Dongyuan’s Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) supplements deficiency of yin-blood in women; those taking it for infertility may achieve conception.
Xue Ji stated: Female infertility may also result from pathogenic factors of the six climatic influences (Liu Yin) and seven emotions (Qi Qing) damaging the Chong and Ren vessels; or from lingering old diseases transmitting to and affecting the zang-fu organs; or from deficiency-cold of the uterus; or from abundant qi and deficient blood; or from latent heat in the blood; or from deficiency and damage of the spleen and stomach failing to nourish the Chong and Ren vessels (seeking the root cause is highly appropriate, truly said). In examining these, one must further assess the male partner’s constitutional excess or deficiency. Some have kidney deficiency and weak essence, unable to fuse and form the fetus; some have innate weakness with qi and blood deficiency; some have immoderate desires leading to exhaustion of yin essence. Each case requires identifying the origin and treating accordingly. The general principle involves examining the chi pulse of both men and women. If the left chi pulse is faint and fine, or empty and large without strength, use Ba Wei Wan (Eight-Ingredient Pill); if the left chi pulse is surging and large but empty upon pressure, use Liu Wei Wan (Six-Ingredient Pill); if both chi pulses are faint and fine, or floating and large, use Shi Bu Wan (Ten-Supplement Pill) (surely these three formulas cannot cover all cases; they should be expanded upon). Misusing acrid-warm and blood-drying herbs will not only be ineffective but also harmful.