凡孕妇脾胃健旺,气血充足,则胎安产顺,毋庸用药调理。惟禀不足而气血衰,脾胃弱而劳役过,以致诸症
百出,不得不资药力矣。昔丹溪定补母安胎之方,以补气血为主,以顺气清凉为佐。参、术、黄芩,为安胎之圣
药;芎、归、熟地,为补血之妙剂。加以苏、陈等味,定为常服主方。至胎成六月,茯苓性降,不宜多用。黄
肥胎,不可常加。香附虽快气疏肝,过则耗气无补。砂仁能止呕定痛,多亦动血行胎。此诚先贤之法戒,后学之
准绳也。而犹以为未备,因分析胎前诸症,拟成数十余方,以便临期酌用。
凡妊娠一二月,恶阻呕逆,烦闷嗜卧,即俗所谓病儿也。此由妇人本元虚弱,平时喜怒不节,寒暑不调,中
脘宿有停痰积饮,受孕经闭,饮食相搏,气不宣通。以致心下烦闷,头眩眼花,四肢倦怠,闻食即呕,喜酸嗜鲜,
多卧少起,甚至呕逆不食。法当顺气理血,豁痰导水,而诸症自除。以加味参橘饮治之。
加味参橘饮
人参(一钱) 白术(二钱) 砂仁(三分) 浓朴(一钱) 橘红(四分) 当归(一钱) 香附(五分)
甘草(三分) 姜(三片) 竹茹(一丸)
若无力,服参,去之亦可,或方内加半夏曲八分。
凡妊娠二三月,胎动不安者,盖因子宫久虚,气血两弱,不能摄元养胎,致令不安欲堕。急服安胎饮以保
之。若先经堕过者,可先服大造丸,继服杜仲丸,庶无半产之患。
汤氏云∶半产多在三五七个月,如前次在几个月堕者,后必如期复然。故当追算,前在三个月堕者,即于
未堕半月前,先服清热养血固胎之药数帖,以补其虚。五月、七月堕者,亦于未堕半月前,预先服药,方保平安。
此据受孕后夹热者而言。盖三五七系阳月,缘火能销铄故也。
安胎饮
人参(一钱,虚者倍用) 当归(二钱) 熟地(三钱) 条芩(一钱) 川芎(七分) 白术(二钱)
陈皮(四分) 紫苏(四分) 甘草(四分) 元枣(二枚)
如虚肥人,陈皮去白,加川连五分。如脾胃溏泻,加莲子十粒,砂仁五分,川连五分炒,去熟地、黄芩。
怒而多泻,加木香三分。渴加麦冬二钱。怔忡、惊悸,加枣仁二钱,益智仁一钱,龙眼肉十个。
大造丸
紫河车(一具,泔水洗净,炙酥) 杞子(一两) 人参(一两五钱) 当归(二两) 麦冬(一两三钱)
天冬(一两) 益智(一两) 茯苓(二两) 五味(五钱) 熟地(姜炒,二两) 川膝(五钱) 山药
(八钱) 菟丝子(盐水炒,四两) 川柏(盐水炒,一两)
共为末,蜜炼丸如桐子大,白滚汤送下五十丸。
杜仲丸
杜仲(姜汁炒) 川断(酒浸)
各等分为末,炼蜜为丸如桐子大,米饮汤送下五六十丸。
又方
杜仲(三钱) 川断(三钱)
水煎服。名为泰山盘石饮。
凡是孕妇脾胃功能强健,气血充足,那么胎儿安稳、分娩顺利,就不需要用药调理。只有那些先天禀赋不足导致气血衰弱,或者脾胃虚弱又过度劳累,从而引发各种病症的,才不得不借助药力来治疗。过去朱丹溪制定了补母安胎的方剂,以补益气血为主,以顺气清凉为辅。人参、白术、黄芩,是安胎的圣药;川芎、当归、熟地黄,是补血的神奇药剂。再加上紫苏、陈皮等药物,定为常服的主方。到了胎儿长成六个月时,茯苓性味沉降,不宜多用。黄芩能肥胎,但不可经常添加。香附虽然能快气疏肝,但过量则会耗气而无补益作用。砂仁能止呕定痛,但过多也会动血伤胎。这确实是先贤的法度戒律,后学者的准则标准。但我仍认为这些内容不够完备,因此分析妊娠前的各种病症,拟定了几十个方剂,以便在临产时酌情使用。
凡是怀孕一到两个月,出现恶阻(妊娠呕吐)、恶心呕吐、心烦胸闷、嗜睡倦怠,就是俗话所说的“病儿”。这是由于妇人原本元气虚弱,平时喜怒没有节制,寒暑调节不当,中脘部位素有停痰积饮,受孕后经血闭止,饮食与痰饮相互搏结,气机不能宣通。从而导致心下烦闷,头晕眼花,四肢倦怠,闻到食物气味就呕吐,喜欢酸味和新鲜食物,多卧少起,甚至呕吐严重无法进食。治法应当顺气理血,豁痰导水,这样各种症状自然消除。用加味参橘饮来治疗。
加味参橘饮
人参(一钱) 白术(二钱) 砂仁(三分) 厚朴(一钱) 橘红(四分) 当归(一钱) 香附(五分)
甘草(三分) 生姜(三片) 竹茹(一丸)
如果患者体弱无力,服用人参,去掉也可以,或者在方中加入半夏曲八分。
凡是怀孕两三个月,出现胎动不安的情况,大概是因为子宫长久虚弱,气血两亏,不能固摄元气滋养胎儿,导致胎儿不安欲堕。急需服用安胎饮来保胎。如果之前曾经流产过的,可以先服用大造丸,接着服用杜仲丸,这样就可以避免半产(中期流产)的祸患。
汤氏说:半产多发生在第三、五、七个月,如果前次是在几个月时流产的,后来必定会如期再次发生。所以应当推算,前次在三个月流产的,就在未流产半个月前,先服用清热养血固胎的药物几帖,以补其虚。第五个月、第七个月流产的,也在未流产半个月前预先服药,才能保障平安。这是根据受孕后夹杂热邪的情况而言的。因为三、五、七属于阳月,由于火能销铄(消耗)的缘故。
安胎饮
人参(一钱,体虚者加倍使用) 当归(二钱) 熟地黄(三钱) 黄芩(一钱) 川芎(七分) 白术(二钱)
陈皮(四分) 紫苏(四分) 甘草(四分) 大枣(二枚)
如果是虚胖的人,陈皮去白,加入黄连五分。如果脾胃溏泻,加入莲子十粒,砂仁五分,黄连五分炒过,去掉熟地黄、黄芩。
发怒且多腹泻,加入木香三分。口渴加入麦冬二钱。心悸怔忡、惊悸,加入酸枣仁二钱,益智仁一钱,龙眼肉十个。
大造丸
紫河车(一具,用淘米水洗净,炙至酥脆) 枸杞子(一两) 人参(一两五钱) 当归(二两) 麦冬(一两三钱)
天冬(一两) 益智仁(一两) 茯苓(二两) 五味子(五钱) 熟地黄(姜炒,二两) 川牛膝(五钱) 山药
(八钱) 菟丝子(盐水炒,四两) 黄柏(盐水炒,一两)
共研为末,炼蜜制成如梧桐子大小的丸药,用白开水送服五十丸。
Whenever a pregnant woman's Spleen and Stomach functions are robust, and Qi and Blood are sufficient, the fetus will be secure and delivery smooth, requiring no medicinal regulation. Only when innate constitution is deficient leading to weak Qi and Blood, or when the Spleen and Stomach are weak combined with overexertion, resulting in various symptoms, is it necessary to rely on medicinal power for treatment. In the past, Zhu Danxi established prescriptions for nourishing the mother to secure the fetus, focusing primarily on tonifying Qi and Blood, with regulating Qi and clearing heat as auxiliaries. Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), and Huangqin (Scutellaria Root) are considered holy medicines for securing the fetus; Chuanxiong (Szechwan Lovage Rhizome), Danggui (Angelica Sinensis Radix), and Shudihuang (Prepared Rehmannia Root) are miraculous agents for nourishing Blood. Combined with Zisu (Perilla Leaf), Chenpi (Tangerine Peel), and other ingredients, this was set as the main prescription for regular use. When the fetus reaches six months of development, Fuling (Poria) has a descending nature and should not be used excessively. Huangqin (Scutellaria Root) can fatten the fetus but should not be added frequently. Xiangfu (Cyperus Rhizome) although capable of promoting Qi flow and soothing the Liver, if taken in excess consumes Qi without providing benefit. Sharen (Amomum Fruit) can stop vomiting and relieve pain, but excessive use may disturb Blood and move the fetus. These are indeed the laws and warnings of former sages, and the standards for later learners. However, I still consider this insufficient, so I have analyzed various conditions during pregnancy and drafted dozens of prescriptions for reference during clinical practice.
When pregnancy is one to two months old, nausea and vomiting due to Morning Sickness (Ezu), irritability, chest oppression, and lethargy occur, which is commonly known as "sickening of the child." This arises because the woman's original Qi is inherently weak, her emotions of joy and anger are unregulated, she fails to adapt to cold and heat changes, and there is retained phlegm and accumulated fluid in the Zhongwan region. After conception, menstruation ceases, food intake struggles with the retained fluids, and Qi mechanism fails to circulate freely. This leads to epigastric irritability, dizziness, blurred vision, limb fatigue, vomiting upon smelling food, craving sour and fresh foods, lying down more than rising, and even severe vomiting preventing food intake. The method should be to regulate Qi and harmonize Blood, resolve phlegm and guide out water, such that all symptoms will naturally disappear. Treat with Jiawei Shanju Yin (Modified Ginseng and Citrus Decoction).
Jiawei Shanju Yin (Modified Ginseng and Citrus Decoction)
Renshen (Ginseng) (1 qian) Baizhu (Atractylodes Macrocephala Rhizome) (2 qian) Sharen (Amomum Fruit) (3 fen) Houpo (Magnolia Bark) (1 qian) Juhong (Citrus Reticulata Pericarpium Rubrum) (4 fen) Danggui (Angelica Sinensis Radix) (1 qian) Xiangfu (Cyperus Rhizome) (5 fen)
Gancao (Licorice Root) (3 fen) Jiang (Fresh Ginger) (3 slices) Zhuru (Bamboo Shavings) (1 pill)
If the patient lacks strength, Renshen (Ginseng) may be omitted, or Banxiaqu (Pinellia Fermented Pill) 8 fen may be added to the formula.
When pregnancy is two to three months old, fetal movement insecurity occurs, likely due to long-standing uterine deficiency, where both Qi and Blood are weak, failing to grasp Yuan Qi and nourish the fetus, causing the fetus to become insecure and prone to miscarriage. Urgently administer Antai Yin (Fetus-Securing Decoction) to protect it. If there was a previous miscarriage, Dazao Wan (Great Creation Pill) may be taken first, followed by Duzhong Wan (Eucommia Pill), thereby avoiding the risk of mid-term miscarriage.
Mr. Tang stated: Mid-term miscarriages often occur in the third, fifth, or seventh month. If a previous miscarriage occurred in a specific month, it is likely to recur at the same time subsequently. Therefore, calculation is necessary. If a previous miscarriage occurred in the third month, take several doses of herbs that clear heat, nourish Blood, and secure the fetus half a month before the expected date to tonify deficiency. For those who miscarry in the fifth or seventh month, similarly take medication half a month in advance to ensure safety. This discussion pertains to cases involving internal heat after conception. The third, fifth, and seventh months are Yang months; since Fire can consume and melt, these times are critical.
Antai Yin (Fetus-Securing Decoction)
Renshen (Ginseng) (1 qian, double dose for deficiency) Danggui (Angelica Sinensis Radix) (2 qian) Shudihuang (Prepared Rehmannia Root) (3 qian) Tiaoqin (Scutellaria Root) (1 qian) Chuanxiong (Szechwan Lovage Rhizome) (7 fen) Baizhu (Atractylodes Macrocephala Rhizome) (2 qian)
Chenpi (Tangerine Peel) (4 fen) Zisu (Perilla Leaf) (4 fen) Gancao (Licorice Root) (4 fen) Yuanzao (Chinese Jujube) (2 pieces)
For patients who are deficient and obese, remove the white part of Chenpi (Tangerine Peel) and add Huanglian (Coptis Rhizome) 5 fen. If there is loose stool due to Spleen-Stomach weakness, add Lianzi (Lotus Seed) 10 grains, Sharen (Amomum Fruit) 5 fen, and Huanglian (Coptis Rhizome) 5 fen stir-fried; remove Shudihuang (Prepared Rehmannia Root) and Huangqin (Scutellaria Root).
If anger causes diarrhea, add Muxiang (Aucklandia Root) 3 fen. If thirsty, add Maidong (Ophiopogon Tuber) 2 qian. For palpitations and fright, add Zaoren (Ziziphus Seed) 2 qian, Yizhiren (Alpinia Oxyphylla Fruit) 1 qian, and Longyanrou (Longan Aril) 10 pieces.
Dazao Wan (Great Creation Pill)
Ziheche (Human Placenta) (1 whole unit, washed with rice water, roasted until crisp) Gouqi (Lycium Fruit) (1 liang) Renshen (Ginseng) (1.5 liang) Danggui (Angelica Sinensis Radix) (2 liang) Maidong (Ophiopogon Tuber) (1.3 liang)
Tiantong (Asparagus Tuber) (1 liang) Yizhi (Alpinia Oxyphylla Fruit) (1 liang) Fuling (Poria) (2 liang) Wuwei (Schisandra Fruit) (5 qian) Shudihuang (Prepared Rehmannia Root) (roasted with ginger, 2 liang) Chuanxi (Cyathula Root or Achyranthes Root - here likely Cyathula based on context of strengthening bones/muscles, often translated as Cyathulae Radix) (5 qian) Shanyao (Dioscorea Rhizome)
(8 qian) Tusizi (Cuscuta Seed) (stir-fried with salt water, 4 liang) Chuanbai (Phellodendron Bark) (stir-fried with salt water, 1 liang)
Grind all into powder, refine honey, and make pills the size of tung tree seeds. Take 50 pills with plain boiled water.
Duzhong Wan (Eucommia Pill)
Duzhong (Eucommia Bark) (stir-fried with ginger juice) Chuanduan (Drynaria Rhizome) (soaked in wine)
Grind equal parts into powder, refine honey, and make pills the size of tung tree seeds. Take 50-60 pills with rice decoction.
Another Prescription
Duzhong (Eucommia Bark) (3 qian) Chuanduan (Drynaria Rhizome) (3 qian)
Decoct in water and take. Named Taishan Panshi Yin (Mount Tai Rock-Solid Decoction).