娠妇六七个月,暴下黄汁水,或如胶或如豆汁,多者升许,名曰孤浆,并非产也。然每每胎动腹痛,皆气
血元虚,若认为产,心慌神张,则胎必根据而坠矣。急服黄 糯米汤可保胎,服。人参者更妙。方用黄 六两,
糯米半升,水七升,煮汁三升,分作四服,日三夜一,尽服完为妙。
薛立斋曰∶妊妇误服毒药胎动不安者,急
服甘草、黑豆、淡竹叶,浓煎以解之。予谓毒药者,即《内经》妇人身重,毒之如何。此必有他病,而用胎中
所忌之药,致胎动也,非真有信砒毒耳。
《素·六元正纪大论》曰∶妇人重身,毒之何如?曰∶有故无殒,亦无殒也。盖药所以去其病,病去则胎
自安。虽大毒之药,何伤胎之有哉!苟药不中病,虽通草、滑石等平淡之药,亦足以伤其胎。是医者之过,非
药之过也。若汪氏之说,全失经文之旨矣。(徐评)
淡竹叶欠妥。若误服热药致胎动者,绿豆汁饮之最妙。(徐评)
《大全》曰∶娠妊心痛,乃风邪痰饮交结。予谓肝气不畅者多。若伤于络,则乍作乍安,名曰厥痛。若胎
动下血,乃伤触子脏也,用安胎饮或火龙散、手拈散。轻者一味砂仁汤,使气调自安。若果真心痛,指甲青,
朝发暮死,夕发旦死,无能为力。然此症怀孕者少,盖心真痛为寒冷入心,水克心,火灭也。而怀妊者必有胎
热,当之不致寒水上凌于心。
心者君主之官,端拱无为,岂能为痛,痛者,乃肝胃之气不畅,或风邪痰饮交结之故也。(徐评)
火龙散
川楝子 茴香(各一钱) 艾叶(一钱五分,盐水炒)
煎服。
手拈散
延胡索(五分) 五灵脂 草果 乳香 没药(各一钱)
共为末,每服一钱。
妊娠妇女在怀孕六七个月时,突然大量排出黄色汁液,有的像胶状,有的像豆汁样,多者可达一升左右,这称为“孤浆”,并不是临产征兆。然而这种情况常伴有胎动和腹痛,其根本原因是气血元气虚弱。如果误认为是临产,导致心慌神乱,胎儿必然随之坠落。此时应立即服用黄耆糯米汤以保胎,若加入人参效果更佳。方剂组成:黄耆六两,糯米半升,加水七升,煎煮至取汁三升,分四次服用,白天服三次,夜间服一次,全部服完为宜。
薛立斋说:孕妇误服毒药导致胎动不安的,应立即服用甘草、黑豆、淡竹叶,浓煎后服用以解毒。我认为所谓的“毒药”,即《内经》中所说的“妇人身重,毒之如何”。这里一定是有其他疾病,而使用了孕期禁忌的药物,导致胎动,并非真的误服了砒霜等剧毒之物。
《素问·六元正纪大论》说:妇人怀孕身重,可以用毒药治疗吗?回答说:有病则病受之,不会伤及母体,也不会伤及胎儿。因为药物是用来祛除疾病的,病邪去除后,胎儿自然安固。即使是毒性很大的药物,又怎么会伤害胎儿呢!如果药不对症,即使是通草、滑石等平淡的药物,也足以伤害胎儿。这是医者的过错,不是药物的过错。至于汪氏的说法,完全违背了经文的旨意。(徐灵胎评注)
徐灵胎认为:淡竹叶不太妥当。如果是误服热性药物导致胎动的,饮用绿豆汁最为奇妙。
《妇人大全良方》说:妊娠期心痛,是风邪与痰饮相互交结所致。我认为多因肝气不畅引起。如果损伤了络脉,则疼痛时作时止,称为“厥痛”。如果胎动并伴有阴道出血,则是伤触了子宫(子脏),应使用安胎饮或火龙散、手拈散。病情轻者,单用一味砂仁汤,使气机调畅即可安宁。如果真的是真心痛,指甲发青,早晨发作晚上死亡,晚上发作早晨死亡,则无能为力。然而这种症状在孕妇中很少见,因为真正的真心痛是由于寒冷侵入心脏,水克火,心火熄灭所致。而孕妇体内必有胎热,因此不会受到寒水上凌于心。
心是君主之官,端坐无为,怎么会产生疼痛呢?疼痛的原因,乃是肝胃之气不畅,或者风邪痰饮相互交结的缘故。(徐灵胎评注)
During the sixth or seventh month of pregnancy, a woman may suddenly discharge a large amount of yellow fluid, which may resemble glue or bean curd dregs, with quantities reaching up to one sheng (approx. 1 liter). This condition is termed "Gu Jiang" (Lonely Amniotic Fluid) and is not a sign of labor. However, it is often accompanied by fetal movement and abdominal pain, caused fundamentally by deficiency in Qi and Blood Yuan Qi. If mistaken for labor, causing panic and mental agitation, the fetus will inevitably be expelled. One should immediately administer Huangqi Nuomi Tang (Astragalus and Glutinous Rice Decoction) to secure the fetus; adding Renshen (Ginseng) yields even better results. The prescription consists of Huangqi (Astragali Radix) 6 liang, Nuomi (Glutinous Rice) half a sheng, added with 7 sheng of water, boiled down to obtain 3 sheng of decoction. It should be divided into four doses: three during the day and one at night, until fully consumed.
Xue Lizhai stated: For pregnant women whose fetal movement and insecurity are caused by accidentally ingesting toxic drugs, one should immediately administer Gancao (Licorice Root), Heidou (Black Soybean), and Danzhuye (Lophatherum Herb), decocted strongly to detoxify. I believe that the term "toxic drugs" refers to what is mentioned in *Neijing* regarding "a woman's heavy body, how to treat with poison?" There must be another disease present, and contraindicated medications during pregnancy were used, causing fetal movement, rather than actual ingestion of arsenic or similar potent poisons.
*Suzhen Liu Yuan Zheng Ji Da Lun* states: When a woman is heavily pregnant, can toxic drugs be used? It answers: If there is a pathology, the pathology receives the effect, and neither the mother nor the fetus is harmed. Medicines are used to eliminate disease; once the disease is gone, the fetus becomes naturally secure. Even highly toxic medicines, how could they harm the fetus? Conversely, if the medicine does not address the pathology, even mild and bland medicines such as Tongcao (Tetrapanacis Medulla) and Huashi (Talcum) are sufficient to harm the fetus. This is the fault of the physician, not the medicine. Therefore, Wang's interpretation completely misses the purport of the classic text. (Commentary by Xu Lingtai)
Xu Lingtai commented: Danzuye (Lophatherum Herb) is not entirely appropriate. If fetal movement is caused by accidentally ingesting hot-natured drugs, drinking Moutouji (Mung Bean Juice) is most excellent.
*Daquan* states: Heart pain during pregnancy is due to the intermingling of Wind pathogen and Phlegm-fluid retention. I believe it is mostly caused by stagnant Liver Qi. If the collaterals are injured, the pain comes and goes intermittently, termed "Jue Tong" (Rebellious Pain). If fetal movement occurs with vaginal bleeding, it indicates injury to the Zi Zang (Uterus); An Tai Yin (Fetus-Securing Decoction), Huolong San (Fire Dragon Powder), or Shounian San (Hand-Picking Powder) should be used. For mild cases, a single herb decoction of Sharen (Amomum Fruit) allows Qi regulation and natural relief. If it is truly Zhen Xin Tong (True Heart Pain), characterized by cyanosis of the fingernails, where morning onset leads to evening death and evening onset leads to morning death, no treatment is effective. However, this condition is rare in pregnancy because true heart pain results from Cold invading the Heart, where Water overcomes Fire, extinguishing the Heart Fire. Pregnant women necessarily possess Fetal Heat, so they would not suffer from Cold Water overwhelming the Heart.
The Heart is the Sovereign Official, sitting upright and acting without exertion; how can it feel pain? Pain arises from the stagnation of Liver and Stomach Qi, or the intermingling of Wind pathogen and Phlegm-fluid retention. (Commentary by Xu Lingtai)
Huolong San (Fire Dragon Powder)
Chuanlianzi (Toosendan Fructus) and Huixiang (Foeniculi Fructus) (each 1 qian), Aiye (Artemisiae Argyi Folium) (1.5 qian, stir-fried with salt water).
Decoct and take orally.
Shounian San (Hand-Picking Powder)
Yanhusuo (Corydalis Rhizoma) (0.5 qian), Wulingzhi (Trogopterori Faeces), Caoguo (Tsaoko Fructus), Rushen (Boswelliae Resina), Moyao (Myrrhae Resina) (each 1 qian).
Grind into fine powder, take 1 qian per dose.