妊(ren)(ren)娠中(zhong)、晚(wan)期(qi),出(chu)現(xian)肢體面目(mu)腫(zhong)(zhong)(zhong)脹(zhang),稱(cheng)為(wei)子(zi)(zi)腫(zhong)(zhong)(zhong),也稱(cheng)“妊(ren)(ren)娠腫(zhong)(zhong)(zhong)脹(zhang)”,根據腫(zhong)(zhong)(zhong)脹(zhang)部(bu)位(wei)及程度不(bu)同(tong),古人又有“子(zi)(zi)氣”“子(zi)(zi)腫(zhong)(zhong)(zhong)”“子(zi)(zi)滿”“皺(zhou)腳”“脆(cui)(cui)腳”等(deng)名(ming)稱(cheng)。《醫(yi)宗金鑒》說:“頭面遍身浮腫(zhong)(zhong)(zhong),小(xiao)水(shui)短少者(zhe)(zhe)(zhe),屬水(shui)氣為(wei)病(bing)(bing),故名(ming)曰(yue)(yue)子(zi)(zi)腫(zhong)(zhong)(zhong)。自膝至足腫(zhong)(zhong)(zhong),小(xiao)水(shui)長(chang)者(zhe)(zhe)(zhe),屬濕氣為(wei)病(bing)(bing),故名(ming)曰(yue)(yue)子(zi)(zi)氣。遍身俱腫(zhong)(zhong)(zhong),腹脹(zhang)而喘(chuan),至六七個月時者(zhe)(zhe)(zhe),名(ming)曰(yue)(yue)子(zi)(zi)滿。但兩腳腫(zhong)(zhong)(zhong)而膚厚者(zhe)(zhe)(zhe)屬濕,故口(kou)皺(zhou)腳,皮薄者(zhe)(zhe)(zhe)屬水(shui),名(ming)曰(yue)(yue)脆(cui)(cui)腳。”本病(bing)(bing)發生的病(bing)(bing)因病(bing)(bing)機(ji)為(wei)孕婦(fu)素體脾(pi)腎虛(xu)弱,因孕重(zhong)虛(xu),致脾(pi)失運化,水(shui)濕停(ting)聚(ju),腎陽(yang)虛(xu)怯不(bu)能(neng)化氣行水(shui);或胎(tai)體漸長(chang),有礙氣機(ji)升降,濁陰留聚(ju),而致子(zi)(zi)腫(zhong)(zhong)(zhong)。子(zi)(zi)腫(zhong)(zhong)(zhong)若失治(zhi)誤治(zhi)可(ke)發展為(wei)子(zi)(zi)痛(tong),嚴重(zhong)影響(xiang)孕婦(fu)及胎(tai)兒的健康。本病(bing)(bing)的治(zhi)療因水(shui)濕停(ting)聚(ju)者(zhe)(zhe)(zhe)治(zhi)宜溫陽(yang)利水(shui),因氣滯(zhi)者(zhe)(zhe)(zhe)治(zhi)宜理氣行滯(zhi)消(xiao)腫(zhong)(zhong)(zhong)。
(一)問診要點
根據(ju)妊娠中、晚(wan)期出現肢體面目(mu)腫(zhong)脹,經休息不(bu)(bu)(bu)能自行消失者即可診(zhen)斷。還應(ying)詢(xun)問有無心腹(fu)脹滿(man),呼(hu)吸不(bu)(bu)(bu)暢,喘(chuan)促(cu)不(bu)(bu)(bu)得(de)臥(wo),煩躁不(bu)(bu)(bu)安等。了解腹(fu)部大(da)小是否(fou)與孕月相符,有無異(yi)常(chang)增大(da)現象,應(ying)與子懸、子滿(man)相鑒別。
本病以腫脹(zhang)(zhang)(zhang)為主癥(zheng),但應分清氣病與水病,因子水停者,皮(pi)薄(bo)(bo)而光亮,按之凹陷;因于氣滯(zhi)者,皮(pi)色不(bu)變(bian),隨按隨起。脾虛者,四肢(zhi)面(mian)目浮(fu)腫,皮(pi)薄(bo)(bo)光亮,氣短懶言,食少便溏;腎虛者,下肢(zhi)腫甚,腰酸肢(zhi)冷,氣滯(zhi)者,下肢(zhi)腫脹(zhang)(zhang)(zhang),皮(pi)色不(bu)變(bian),胸(xiong)脅脹(zhang)(zhang)(zhang)滿(man)。
(二)分型問診
1.脾虛
問(wen)診:妊娠中、晚期,面(mian)目肢體浮腫,甚(shen)至全(quan)身浮腫,皮薄光(guang)亮,按之凹陷,胸悶氣(qi)短,脘腹痔滿,口淡(dan)納(na)呆,體倦乏力,小便不利,大便溏(tang)薄。
治法:健脾行水(shui)。方用白(bai)術散(san)加味。
2.腎虛
問診:妊娠中、晚期,面目四(si)肢浮腫,下肢尤(you)甚(shen),桉(an)之(zhi)凹陷,頭暈耳鳴,心悸(ji)氣(qi)短(duan),腰(yao)酸(suan)肢冷,小便短(duan)少。
治法:溫(wen)腎助陽,化氣(qi)行水。方用真武(wu)湯加(jia)減。
3.氣滯
問診:妊娠中(zhong)晚期,足踝腫(zhong)脹(zhang),漸及于腿,皮(pi)色(se)不(bu)變,隨(sui)按隨(sui)起(qi),胸脅脹(zhang)滿(man),食(shi)少泛惡(e),頭暈脹(zhang)痛。
治法:理氣行(xing)滯,健脾消腫。方用天仙藤(teng)散(san)加減。
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