心腹急痛面目青。冷汗气绝命必倾。
巢元方曰。妊娠心腹痛者。或腹内宿有冷痰。或新触风寒。皆因脏腑虚
而致发动。邪正相击。而并于气。随气下上。上冲于心则心痛。下冲于腹
则腹痛。故令心腹痛也。妊娠而痛之者。正邪二气。交击于内。若不时瘥
者。其痛冲胞络。必致动胎。甚则伤堕。池氏曰。妊娠心腹。忽然急痛。乃血
干胎损。动之所致。面目青。出冷汗者。乃心与脾无血以养。而气欲绝也。
愚按薛立斋妇人良方。有钩藤汤。专治妊娠胎动腹痛。面青冷汗气欲绝者。即此是也。
血下不止胎冲上心腹冷闷定伤身。
若血下不止。则胎随气上而冲心腹。心腹暖则子犹未死。或有可救。若
以手按之。其胎不动。更加心腹冷而且闷。则胎已死矣。何用安胎为哉。
按巢氏病源曰。妊娠胎死腹中候。此或因惊动倒朴。或染温疫伤寒邪
毒入于胞藏。致令胎死。其候当胎处冷。为胎已死也。
堕胎倒仆举重轻。致胎死在腹中居。已损未出血不止。冲心闷痛母魂孤。
或因跌仆。或举重轻。以致胎损腹中。血下过多而不止。则血干胎死。胎
愈枯燥。不能得出。则冲心闷痛。其母命亦难存矣。
按巢氏病源曰。妊娠僵仆。胎上抢心下血候。此谓行动倒仆。或从高堕
下。伤损胞络。致血下动胎。而血伤逆气者。胎随气上抢心。其死生之候。
其母舌青者。儿死母活。唇口无沫。儿生。唇青沫出者。母子俱死。唇口赤
舌青者。母死儿活。若血下不住。胞燥胎枯。则令胎死。
心腹突然剧烈疼痛，面色发青，出冷汗，气息微弱近乎断绝，生命必然危殆。
巢元方说：妊娠期间出现心腹疼痛，有的是因为腹内原本就有寒痰停滞，有的是因为新近感受风寒邪气，都是因为脏腑虚弱而导致发作。邪气与正气相互搏击，并合于气机之中，随着气机的升降而上下运行。向上冲逆至心脏则引起心痛，向下冲逆至腹部则引起腹痛，因此导致心腹疼痛。妊娠期间发生疼痛，是正邪二气在体内交相搏击。如果不能及时痊愈，疼痛就会冲击胞络，必然导致动胎，严重时会造成流产或堕胎。池氏说：妊娠期间心腹突然剧烈疼痛，是由于血液枯竭、胎元受损，从而引发胎动所致。面色发青、出冷汗，是因为心和脾缺乏血液的滋养，导致气机即将衰竭。
我按：薛立斋《妇人良方》中有钩藤汤，专门治疗妊娠胎动腹痛，面色发青、出冷汗且气息将绝的症状，指的就是这种情况。
如果阴道出血不止，胎气随血气上冲至心胸，若心腹部感觉温暖，则胎儿尚未死亡，或许还有救治的希望；如果用手指按压腹部，感觉胎动停止，并且心腹部感到寒冷且闷胀，那么胎儿已经死亡，哪里还需要安胎呢？
按巢氏《诸病源候论》记载：妊娠胎死腹中的征候，这可能是因为受惊跌倒，或者感染了温疫伤寒的邪毒进入胞宫，导致胎儿死亡。其征候表现为胎儿所在部位发冷，说明胎儿已经死亡。
因跌倒仆倒、提举重物等轻微外力，导致胎儿死于腹中。如果已经损伤但阴道出血不止，气血上冲心胸，导致胸闷疼痛，母亲的生命也将孤立无援（难以保全）。
有的因为跌仆，有的因为提举重物，导致胎儿在腹中受损。如果阴道出血过多且不止，导致血液枯竭、胎儿死亡。胎儿更加干枯燥涩，无法排出体外，从而冲逆心胸导致闷痛，此时母亲的生命也难以存活了。
按巢氏《诸病源候论》记载：妊娠僵仆、胎气上抢心胸并伴有下血的征候，这是指行走时跌倒，或者从高处坠落，损伤了胞络，导致出血并扰动胎元，而血液受伤后气机逆乱，胎气随着逆气上冲至心胸。关于母子生死的征候：如果母亲舌头发青，则是胎儿死亡而母亲存活；如果唇口没有泡沫，则是胎儿存活；如果唇色发青且有泡沫吐出，则是母子双亡；如果唇口颜色红润而舌头发青，则是母亲死亡而胎儿存活。如果阴道出血不止，胞宫干燥、胎元枯槁，就会导致胎儿死亡。
Sudden severe pain in the heart and abdomen, cyanosis of the face, cold sweating, and faintness of breath indicate a critical condition with imminent death.
Chao Yuanfang stated: Pregnancy-related epigastric and abdominal pain may be caused by pre-existing cold-phlegm (Cold Phlegm) retention within the abdomen or by recent exposure to wind-cold pathogens. These conditions arise due to deficiency of the Zang-Fu organs. The pathogenic factor and healthy Qi clash and merge with the Qi mechanism, moving up and down along with it. When rushing upward to the Heart, it causes Heart pain; when rushing downward to the abdomen, it causes abdominal pain, thus resulting in heart and abdominal pain. During pregnancy, pain occurs due to the internal clash between healthy Qi and pathogenic factors. If not resolved promptly, the pain will strike the Bao Luo (Uterine Collaterals), inevitably disturbing the fetus, and in severe cases, causing miscarriage or abortion. Chi Shi said: Sudden severe pain in the heart and abdomen during pregnancy is caused by blood depletion and fetal damage, leading to fetal movement. Cyanosis of the face and cold sweating indicate that the Heart and Spleen lack blood nourishment, leading to impending exhaustion of Qi.
I note: Xue Lizhai's *Furen Liang Fang* (Excellent Prescriptions for Women) contains Gouteng Tang (Uncaria Decoction), specifically treating pregnancy-related fetal disturbance and abdominal pain with cyanosis, cold sweating, and impending Qi exhaustion, which refers to this condition.
If vaginal bleeding persists, the fetal Qi rushes upward to the chest and abdomen along with the blood. If the heart and abdomen feel warm, the fetus has not yet died, and there may be hope for rescue. However, if palpation reveals no fetal movement, accompanied by coldness and stifling sensation in the heart and abdomen, the fetus has already died. Why would fetal stabilization be necessary?
According to Chao's *Bingyuan* (Source of Diseases): The sign of a dead fetus in the uterus during pregnancy may result from fright and falling, or from infection with epidemic toxins entering the Bao Zang (Uterus), causing fetal death. The sign is coldness at the site of the fetus, indicating fetal death.
Falling, stumbling, or lifting heavy objects can cause fetal death within the abdomen. If injury occurs but vaginal bleeding persists excessively, blood depletion leads to fetal death. As the fetus becomes increasingly dry and withered, it cannot be expelled, striking the heart and causing stifling pain, making the mother's life difficult to save.
According to Chao's *Bingyuan*: The sign of pregnancy collapse, fetal Qi rushing to the heart, and lower bleeding refers to falling while walking or falling from a height, damaging the Bao Luo (Uterine Collaterals). This causes bleeding that disturbs the fetus, and as blood is injured, Qi rebels. The fetal Qi follows the rebellious Qi upward to rush to the heart. Regarding signs of life and death for mother and child: If the mother's tongue is cyanotic, the fetus is dead and the mother lives. If the lips and mouth have no foam, the fetus lives. If the lips are cyanotic and foam is expelled, both mother and fetus die. If the lips and mouth are red and the tongue is cyanotic, the mother dies and the fetus lives. If vaginal bleeding does not stop, the Bao Gong (Uterus) becomes dry and the fetus withers, leading to fetal death.