世传佛手散一方,即当归、川芎二味,谓专治胎动不安,生胎能安,死胎能下,将产又
能催
生,妊妇常服,可免半产。余十年前,即疑其理,无如世医莫不信用,即名医如陈修园书中
,亦盛称之,且间有用之得效者。然余究只敢用以催生,屡施有验,未尝肯用以安胎也。嗣
读某名家书,极论世以调经之药安胎之谬,为祸甚烈,乃私幸先得我心矣。近日目睹其祸,
爰取而论之。夫安胎本无定药,亦视其妇之体质而已。既孕之后,体质无非血气之寒热虚实
两途,故丹溪谓∶白术、黄芩为安胎之圣药者,亦举此以明虚寒、实热之两大端耳!然寒亦
有实,热亦有虚,总须辨明气血为要。若气寒血实,附子、桂枝可并用,以温气而行血气;
气寒血虚,当归、川芎可并用,以行气而补血也。若气热血实,则不免有胀满冲激之虞矣,
而可复以芎、归助热而增实乎?气虚血热,更不免腾沸躁扰,缓纵不任而下堕矣,而可复以
芎、归耗气而温血乎?故气虚血热胎动下漏者,急用甘寒、苦寒,助以补气生津,使血定而
筋坚,力能兜举,其势渐缓;再看有无凝血,于补气清热剂中,略佐行瘀,便万全矣。盖人
之子宫,万筋所细结也;筋热则纵弛,寒则坚强。太寒则筋急,而兜裹不密,气散血漏;太
热则筋弛而兜裹无力,亦气散血漏。今人之体,虚热居多,故孕后脉多洪滑数疾;若太滑或
按之即芤者,多堕,以其气热而血虚也。余于妇科经产,深佩孙真人之训,颇切讲求,用药
不拘成例,总从气血、寒热、虚实六字上着想,而于脉象上定其真假,故病无遁情,治未或
误也。古人以桂枝汤为妊娠主方,今人以四物汤为妊娠主方,真古今人识力不相及也。至谓
胎产百病,均以四物加味,极谬之谈,而百口称述,殊不可解。余见妊妇、产妇外感,致成
劳损者,皆此方加味之所致也。
世人相传的佛手散一方,仅由当归、川芎两味药组成,声称专门治疗胎动不安,能使活胎安稳,死胎排出,临产时又能催产,孕妇常服可避免流产。我十年前就怀疑其中的道理,无奈当时的医生无不信赖使用,就连名医如陈修园在书中也极力称赞它,而且偶尔也有使用见效的情况。然而我只敢用它来催产,多次使用都有验证,从未肯用它来安胎。后来读到某位名家的著作,极力论述世人用调经药来安胎的错误,认为其危害非常严重,于是暗自庆幸自己先于他人领悟了这一点。近日亲眼目睹了其造成的祸患,因此选取出来加以讨论。
大凡安胎本来没有固定的药物,也要看孕妇的体质而已。怀孕之后,体质无非分为血气的寒热虚实两个途径,所以朱丹溪说:白术、黄芩是安胎的圣药,也是列举这两者来说明虚寒和实热这两个主要方面罢了!然而寒证中也有实证,热证中也有虚证,总之必须辨明气血状况才是关键。如果是气寒血实,附子、桂枝可以并用,以温煦气机而运行血气;如果是气寒血虚,当归、川芎可以并用,以行气而补血。如果是气热血实,则不免有胀满冲激的担忧,又怎能再用川芎、当归助热而增加实邪呢?如果是气虚血热,更不免出现沸腾躁扰,松弛无法承受而下堕的情况,又怎能再用川芎、当归耗气而温血呢?所以气虚血热导致胎动下漏的,急用甘寒、苦寒的药物,辅助补气生津,使血液安定而筋脉坚固,有力兜举,其势逐渐缓解;再看是否有瘀血凝结,在补气清热的方剂中,稍微佐以活血化瘀的药,便万无一失了。
大概人的子宫,是由无数筋脉细密结聚而成的;筋脉受热则松弛,受寒则坚强。过于寒冷则筋脉拘急,而兜裹不紧密,导致气散血漏;过于炎热则筋脉弛缓而兜裹无力,也是气散血漏。现在人的体质,虚热居多,所以怀孕后脉象多表现为洪滑数疾;如果脉太滑或者按之即空(芤脉),大多会流产,这是因为气热而血虚的缘故。我在妇科经产方面,非常佩服孙思邈真人的教诲,颇加切切实实地研究探讨,用药不拘泥于成例,总是从气血、寒热、虚实这六个字上去思考,而在脉象上确定病情的真假,所以病情没有隐瞒,治疗很少出错。古人把桂枝汤作为妊娠的主方,今人把四物汤作为妊娠的主方,真是古今人的见识能力不相及啊。至于说胎产百病,都用四物汤加减,这是极其荒谬的言论,却有一百张嘴都在称述,实在不可理解。我见到孕妇、产妇因外感而致成劳损的,都是这个方子加减所致。
The formula "Foshou San" (Buddha's Hand Powder) passed down by the world consists of only two herbs: Danggui Radix Angelicae Sinensis (Dong Quai) and Chuanxiong Rhizoma Ligustici Chuanxiong. It is claimed to specifically treat restless fetus, capable of stabilizing a living fetus, expelling a dead fetus, and inducing labor at term; regular use by pregnant women can prevent miscarriage. Ten years ago, I suspected its rationale, but unfortunately, physicians at that time all believed in and used it. Even famous physicians like Chen Xiuyuan praised it highly in his writings, and occasionally there were cases where it proved effective. However, I only dared to use it for inducing labor, having applied it repeatedly with verified results, and never dared to use it for stabilizing the fetus. Later, I read a work by a certain renowned expert who strongly criticized the fallacy of using menstruation-regulating herbs for fetal stabilization, stating that the harm caused was severe. I privately felt fortunate to have realized this before others. Recently, witnessing the disasters caused by this practice, I have selected this topic for discussion.
Stabilizing the fetus inherently has no fixed formula; it depends entirely on the constitution of the woman. After conception, constitutions generally fall into two categories regarding blood and qi: cold/heat and deficiency/excess. Therefore, Zhu Danxi stated that Baizhu Rhizoma Atractylodis Macrocephalae (Atractylodes Macrocephala Rhizome) and Huangqin Cortex Scutellariae (Scutellaria Root) are the holy medicines for stabilizing the fetus; he cited these to illustrate the two major aspects of deficiency-cold and excess-heat! However, cold patterns can also be excess, and heat patterns can be deficiency. The key is always to distinguish the status of qi and blood. If there is qi-cold and blood-excess, Fuzii Radix et Lateralis Preparata (Prepared Aconite Lateral Root) and Guizhi Ramulus Cinnamomi (Cinnamon Twig) can be used together to warm qi and promote the circulation of blood and qi. If there is qi-cold and blood-deficiency, Danggui and Chuanxiong can be used together to move qi and nourish blood. If there is qi-heat and blood-excess, one cannot help but worry about distension and rushing sensations; how could one further use Chuanxiong and Danggui to assist heat and increase excess? If there is qi-deficiency and blood-heat, one cannot help but experience boiling restlessness and laxity unable to sustain support, leading to falling; how could one further use Chuanxiong and Danggui to consume qi and warm blood? Therefore, for restless fetus and leakage due to qi-deficiency and blood-heat, urgently use sweet-cold and bitter-cold herbs, assisted by those that tonify qi and generate fluids, so that blood settles and sinews become firm, possessing the strength to hold up, gradually easing the condition. Then check if there is stagnant blood; slightly adding blood-invigorating herbs to the qi-tonifying and heat-clearing formula ensures perfection.
Generally, the human uterus is densely knitted by myriad sinews. When sinews are hot, they become lax; when cold, they become firm. If too cold, sinews contract tightly, failing to hold securely, leading to scattering of qi and leakage of blood; if too hot, sinews relax and lack the strength to hold, also resulting in scattering of qi and leakage of blood. In modern people, deficiency-heat is predominant, so after pregnancy, pulses are often surging, slippery, rapid, and frequent. If the pulse is excessively slippery or feels hollow upon pressure (Kou Mai), miscarriage is likely, because of heat in qi and deficiency in blood. Regarding gynecological menstrual and obstetric conditions, I deeply admire the teachings of Sun Simiao (Zhenren), and have studied them earnestly. My prescription usage does not stick to rigid examples but always considers the six characters: qi/blood, cold/heat, and deficiency/excess. I determine the truth or falsity of the condition through pulse diagnosis, so that the disease reveals no hidden aspects, and treatment rarely errs. Ancients regarded Guizhi Tang (Cinnamon Twig Decoction) as the main formula for pregnancy; modern people regard Siwu Tang (Four Substances Decoction) as the main formula for pregnancy. This truly shows that the insight and capability of ancient and modern people are incomparable. To claim that all hundred diseases of pregnancy and childbirth are treated by modifying Siwu Tang is an extremely absurd statement, yet it is recited by countless mouths, which is truly incomprehensible. I have seen pregnant women and postpartum women suffering from exhaustion due to external pathogenic factors, all caused by the modification of this formula.