黄健玲基于孕前预培其损与孕后辨证安胎治疗滑胎经验

HUANG Jian-Ling’s Experience in Treating Habitual Abortion by Preventive Treatment of Insufficiency before Pregnancy and Preventing Miscarriage Based on Syndrome Differentiation after Pregnancy

黄健玲教授认为,滑胎的产生有胎元和母体两方面原因,根本病机为肾虚冲任不固,胎失所系。滑胎的防治需分“孕前预培其损”和“孕后辨证安胎”两个阶段,孕前预培阶段按脾肾气虚证、肝肾阴虚证、肾虚肝郁证3型进行辨证施治;孕后安胎阶段按脾肾两虚证、肝肾阴虚证、肾虚血瘀证3型进行辨证施治。无论孕前调理还是孕后辨证治疗,均需补肾滋肾、健脾益气养血以固胎元,方药以寿胎丸合四君子汤加减;若见肝肾阴虚者,加用二至丸;出现肝郁脾虚者,可加用逍遥丸等;活血化瘀药物宜选用平和之品如当归、川芎、丹参、鸡血藤,不宜使用峻猛破血的药物如三棱、莪术等,以防伤及胎元。

Professor HUANG Jian-Ling believes that the development of habitual abortion is associated with the embryo and the maternal body,and the basic pathogenesis of habitual abortion is due to kidney deficiency and insecurity of thoroughfare vessel and conception vessel which causes fetal displacement.The prevention and treatment of habitual abortion can be divided into two stages,i.e.,preventive treatment of insufficiency before pregnancy and preventing miscarriage based on syndrome differentiation after pregnancy.Preventive treatment of insufficiency before pregnancy can be achieved by syndrome differentiation and treatment following the three types of spleen-kidney qi deficiency syndrome,liver-kidney yin deficiency syndrome,kidney deficiency and liverstagnation syndrome.And miscarriage prevention after pregnancy can be achieved by syndrome differentiation and treatment following the three types of spleen-kidney deficiency syndrome,liver-kidney yin deficiency syndrome,and kidney deficiency and blood stasis syndrome.Both pre-pregnancy and post-pregnancy treatment should be based on tonifying and nourishing the kidney,strengthening the spleen,replenishing qi and nourishing blood to strengthen the fetus,and the basic formula of modified Shoutai Pill plus Sijunzi Decoction can be utilized.For the patients with the syndrome of liver-kidney yin deficiency,Er Zhi Pills can be added to the basic formula;for the patients with the syndrome of liver-depression and spleen deficiency,modified Xiaoyao Pills can be added to the basic formula.For activating blood and removing stasis,mild-nature herbs such as Radix Angelicae Sinensis,Rhizoma Chuanxiong,Radix Salviae Miltiorrhizae,and Caulis Spatholobi are recommended,and the drastic herbs for activating blood such as Rhizoma Sparganii and Rhizoma Curcumae are not recommended,thus to avoid the damage of the fetus.