妇人之经血,一有孕时,即蓄之以养胎。至产后,则变乳以养子,此天地生人自然之妙。倘孕妇忽然见红,
名曰漏胎,急宜服药保之,毋致血沥多而胎不保也。
若因风热动血者,即用四物汤,送下防风黄芩丸(二钱),一日两三服。若因怒动肝火者,用逍遥散加黑
山栀(一钱),条芩(五分)。若血虚妄走者,用四物汤加茯苓神、阿胶(各一钱),艾叶(五分),莲子(十
粒)。若脾虚不能摄血者,用归脾汤加胶、艾、莲子。若气虚下陷者,亦用补中益气汤。若去血大多,即用八
珍汤大补之,然必要人参,即同血脱益气一体耳。百问曰∶胎息未实,劳力触犯,或食毒物,或房劳惊恐,令
子宫虚滑,经血淋沥,败血凑心,子母难保,此急症也,速大补之。
败血凑心,多是气逆之故,宜急顺其气,速降其瘀,所谓急则治其标也。乃云速大补之。若补气乎,则气
愈壅逆。补血乎,则败血。将何以处治?斯诚乱道之语,误人之言,不待辨而自明矣。(徐评)
《产集》曰∶肝经有风,下非胎血,宜服防风黄芩丸。此实症也。
《千金方》曰∶娠妊下血不止,名曰漏胞。胞干便死,急用生地八两,以清酒三升,煮减半,绞去滓服,
此亦急症也。
有等妊娠,红漏不多,精神如故,六脉和平,此儿小血盛有余症也,医者望而知之。
四物汤
大生地(三钱) 当归(一钱) 白芍(一钱二分) 川芎(三分)
加丝绵烧灰(五分),水煎服。
防风黄芩丸
青条芩(一两,醋炒黑色) 防风(一两,炒)
共二味为末,酒糊为丸,米汤下。
逍遥散
当归身(一钱) 白芍(一钱) 白术(一钱五分) 柴胡(三分) 炙甘草(五分) 茯神(一钱五分)
水煎服。
归脾汤
人参(一钱) 白术(一钱五分,土炒) 黄 (二钱,蜜炙) 归身(一钱五分) 炙草(五分)
茯神(二钱) 枣仁(一钱五分,炒) 远志(五分) 广木香(五分) 桂元肉(五枚)
加姜枣,水煎。
八珍汤
人参(二钱) 白术(三钱) 茯苓(二钱) 甘草(五分) 熟地(五钱) 归身(一钱五分) 白芍(一钱)
川芎(五分)
加姜枣煎服。
补中益气汤(见前胎动)。
妇女的经血,一旦怀孕,就会蓄积起来以滋养胎儿。到了产后,则转化为乳汁以哺育婴儿,这是天地化生人类自然的奥妙。如果孕妇突然见红,称为“漏胎”,应当立即服药保胎,以免出血过多导致胎元不保。
如果是因风热扰动血液所致,就使用四物汤,送服防风黄芩丸(二钱),每日服用两三次。如果是因愤怒引发肝火所致,使用逍遥散加入黑山栀(一钱)、条芩(五分)。如果是血虚导致血液妄行,使用四物汤加入茯苓神、阿胶(各一钱)、艾叶(五分)、莲子(十粒)。如果是脾虚不能统摄血液,使用归脾汤加入阿胶、艾叶、莲子。如果是气虚下陷,也使用补中益气汤。如果失血量很大,就使用八珍汤进行大补,但必须用人参,这与治疗血脱证时益气的方法原理一致。《百问》中说:胎息尚未稳固,因劳累用力触犯,或食用有毒食物,或房事劳损惊恐,导致子宫虚滑,经血淋漓不尽,败血上凑于心,母子都难以保全,这是急症,应立即大补。
败血上凑于心,多是气机逆乱的原因,应当急于顺气,迅速降下瘀血,这就是所谓“急则治其标”的道理。文中却说“速大补之”。如果补气,则气会更加壅滞逆乱;如果补血,则会助长败血。这该如何处置?这确实是荒谬混乱的话语,误导人的言论,不用辩解也就显而易见了。(徐评)
《产集》说:肝经有风邪,下行非胎血,宜服用防风黄芩丸。这是实证。
《千金方》说:妊娠期间下血不止,称为“漏胞”。胞宫干燥则胎儿死亡,紧急时使用生地八两,用清酒三升,煮至减半,滤去药渣服用,这也是急症。
有一类妊娠者,红漏不多,精神如常,六脉平和,这是胎儿小、血盛有余的症状,医生一望便知。
四物汤
大生地(三钱) 当归(一钱) 白芍(一钱二分) 川芎(三分)
加丝绵烧成的灰(五分),水煎服。
防风黄芩丸
青条芩(一两,醋炒至黑色) 防风(一两,炒)
共两味研为末,用酒糊做成丸剂,米汤送服。
逍遥散
当归身(一钱) 白芍(一钱) 白术(一钱五分) 柴胡(三分) 炙甘草(五分) 茯神(一钱五分)
水煎服。
归脾汤
人参(一钱) 白术(一钱五分,土炒) 黄芪(二钱,蜜炙) 归身(一钱五分) 炙草(五分)
茯神(二钱) 枣仁(一钱五分,炒) 远志(五分) 广木香(五分) 桂元肉(五枚)
加生姜、大枣,水煎。
八珍汤
人参(二钱) 白术(三钱) 茯苓(二钱) 甘草(五分) 熟地(五钱) 归身(一钱五分) 白芍(一钱)
川芎(五分)
加生姜、大枣煎服。
The menstrual blood of women, once pregnancy occurs, is retained to nourish the fetus. After childbirth, it transforms into milk to nourish the infant; this is the natural wonder of Heaven and Earth in generating human life. If a pregnant woman suddenly experiences vaginal bleeding, it is called "Lou Tai" (Leaking Fetus). Medication should be taken immediately to preserve the fetus, lest excessive blood loss leads to miscarriage.
If caused by wind-heat disturbing the blood, use Siwu Tang (Four Substance Decoction) to administer Fangfeng Huangqin Wan (Saposhnikovia and Scutellaria Pill) (2 qian), taken two or three times a day. If caused by anger stirring up Liver Fire, use Xiaoyao San (Free and Easy Wanderer Powder) with added Hei Shanzhi (Black Gardenia Fruit) (1 qian) and Tiao Qin (Scutellariae Radix) (0.5 qian). If caused by Blood Deficiency leading to reckless blood movement, use Siwu Tang (Four Substance Decoction) with added Fushen (Poria with Hostwood) and Ejiao (Donkey-hide Gelatin) (each 1 qian), Aye (Mugwort Leaf) (0.5 qian), and Lianzi (Lotus Seed) (10 grains). If caused by Spleen Deficiency failing to control the blood, use Guipi Tang (Restore the Spleen Decoction) with added Ejiao (Donkey-hide Gelatin), Aye (Mugwort Leaf), and Lianzi (Lotus Seed). If caused by Qi Deficiency sinking downward, also use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If blood loss is substantial, use Bazhen Tang (Eight Treasure Decoction) for major tonification, but Ginseng must be included, which aligns with the principle of tonifying Qi in cases of Blood Collapse. *Baiwen* states: When fetal vitality is not yet solid, labor or physical exertion, ingestion of toxic substances, sexual excess, or fright due to fatigue can cause uterine deficiency and slipperiness, resulting in dripping menstrual blood. If foul blood rises to the Heart, both mother and child are at risk; this is an emergency requiring immediate strong tonification.
Foul blood rising to the Heart is mostly due to rebellious Qi. One should urgently smooth the Qi and rapidly descend the stasis, which is known as "treating the branch in acute conditions." The text suggests "immediate strong tonification." If one tonifies Qi, the Qi will become more obstructed and rebellious; if one tonifies Blood, it will aid the foul blood. How should this be managed? This is indeed nonsensical and misleading advice, self-evident without need for debate. (Commentary by Xu)
*Chanji* states: Wind pathogen in the Liver Channel causing downward flow that is not fetal blood; one should take Fangfeng Huangqin Wan (Saposhnikovia and Scutellaria Pill). This is an Excess pattern.
*Qianjin Fang* states: Continuous bleeding during pregnancy is called "Lou Bao" (Leaking Womb). If the womb dries out, the fetus dies. Urgently use Dihuang (Rehmanniae Radix) 8 liang, boiled in 3 sheng of clear wine until reduced by half, strained and administered. This is also an emergency.
In some pregnancies, there is slight bleeding, but the spirit remains normal and the six pulses are harmonious. This indicates the fetus is small and there is an abundance of blood; physicians can recognize this by observation alone.
Siwu Tang (Four Substance Decoction)
Dadihuang (Rehmanniae Radix Preparata) (3 qian) Danggui (Angelicae Sinensis Radix) (1 qian) Baishao (Paeoniae Radix Alba) (1.2 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma) (0.3 qian)
Add silk cotton ash (0.5 qian), decoct in water and take.
Fangfeng Huangqin Wan (Saposhnikovia and Scutellaria Pill)
Qing Tiaoqin (Scutellariae Radix) (1 liang, stir-fried with vinegar until black) Fangfeng (Saposhnikoviae Radix) (1 liang, stir-fried)
Grind these two ingredients into powder, form pills with wine paste, and take with rice soup.
Xiaoyao San (Free and Easy Wanderer Powder)
Dangguishen (Angelicae Sinensis Radix) (1 qian) Baishao (Paeoniae Radix Alba) (1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) (1.5 qian) Chaihu (Bupleuri Radix) (0.3 qian) Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) (0.5 qian) Fushen (Poria with Hostwood) (1.5 qian)
Decoct in water and take.
Guipi Tang (Restore the Spleen Decoction)
Renshen (Panacis Ginseng Radix) (1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) (1.5 qian, stir-fried with soil) Huangqi (Astragali Membranacei Radix) (2 qian, honey-fried) Guishen (Angelicae Sinensis Radix) (1.5 qian) Zhicao (Glycyrrhizae Radix et Rhizoma Preparata) (0.5 qian)
Fushen (Poria with Hostwood) (2 qian) Zaoren (Ziziphi Spinosae Semen) (1.5 qian, stir-fried) Yuanzhi (Polygalae Radix) (0.5 qian) Guangmuxiang (Costi Rhizoma) (0.5 qian) Guiyuanrou (Longan Aril) (5 pieces)
Add Jiang (Zingiberis Rhizoma) and Zao (Jujubae Fructus), decoct in water.
Bazhen Tang (Eight Treasure Decoction)
Renshen (Panacis Ginseng Radix) (2 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) (3 qian) Fuling (Poria) (2 qian) Gancao (Glycyrrhizae Radix et Rhizoma) (0.5 qian) Shudi (Rehmanniae Radix Preparata) (5 qian) Guishen (Angelicae Sinensis Radix) (1.5 qian) Baishao (Paeoniae Radix Alba) (1 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma) (0.5 qian)
Add Jiang (Zingiberis Rhizoma) and Zao (Jujubae Fructus), decoct and take.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See previous section on Fetal Restlessness).