经义
任脉为病，男子外结七疝，女子带下瘕聚。（《难经》）
论证
妇人年五十，所病下利，数十日不止，幕即发热，少腹里急，腹满，手掌烦热，唇口干燥，何也？师曰∶
此病属带下。何以
故？曾经半产，瘀血在少腹不去。何以知之？其证唇口干燥，故知之。当以温经汤主之。（《金匮》）
按∶所病下利之"利"字，当是"血"字，文义始属，当改之。（《医宗金鉴》）
带下有五，多因经行产后，风入胞门，传于脏腑所致。伤厥阴肝经，色如青泥；伤少阴心经，色如红津；
伤太阴肺经，形如白涕；伤太阴脾经，黄如烂瓜；伤少阴肾经，黑如 血。（《妇人良方》）
冲、任、督三脉，同起而异行，一源而三歧，皆络于带脉，统于纂户，循阴器，行廷孔、溺孔上端。因他
经遗热于带脉之间，客热抑郁，血积不流，从金之化而为白，随溲而下，是为白带。多不痛，或有痛者。《经》
曰∶少腹冤热而痛，溲出白液，冤者，屈滞也。病非本经，为他经冤郁而成。若赤白痢，不可曲分寒热，止可
分新旧而治之。譬如痈疖，始见赤血，次溃白脓，又岂为寒者哉？痢是热传大肠下广肠，带是热传小肠入脬经。
二证皆可同湿热治法。（张子和）
带下由于任脉湿热郁甚，津液溢而为病。如以火炼金，热甚反兼水化，又如六月热极，物反出液而湿润，
林木流津。故肝热则出泪，心热则出汗，脾热则出涎，肺热则出涕，肾热则出唾，犹煎汤热甚则沸溢。俗医治
带，用辛热药，微者或令郁结暂开，重者反加病剧，莫若以辛苦寒药按法治之。（刘河间）
带下者，营卫滞气所成也。皆因喜怒忧思，产育房劳，伤其营卫，或挟有湿热，使浊气渗入膀胱，故秽白
之物，如涕下流，面色无光，腰腿酸痛，精神短少。世俗徒知虚寒，不知湿热，反用温补，偏助心火，心火既
盛，阴血渐烁。譬之猪膏，烹之则融，冷之则凝。湿淫不清，则为白带。若热气熏蒸，则为腥腐之气。法当清
上实下，理脾养血，而湿热自解。（罗赤诚）
带下者，由湿痰流注于带脉而下浊液，故曰带下。妇女多有
之。赤者属热，兼虚兼火治之；白者属湿，兼虚兼痰治之。年久不止，补脾肾兼升提治之。大抵瘦人多火，肥
人多痰，最要分辨。白带、白浊、白淫三种，三者相似，而迥然各别。白带者，时常流出清冷稠粘，此下元虚
损也；白浊者，随小便而来，混浊如泔，此胃中浊气渗入膀胱也；白淫者，常在小便之后，来亦不多，此男精
不摄，滑而自出也。（《临证指南》）
带由精窍而出，如男子梦遗之相同。而淫浊则在溺窍，乃湿热由膀胱而下，不可不辨。○淫浊与带下之不
同者，盖白带出于胞宫，精之余也；淫浊出于膀胱，水之浊也。虽膀胱与肾为表里，故带浊之源，无非皆出于
阴分。然带由脾肾之虚滑者多，淫浊由膀胱之湿热者多。此其所以有辨也。（张景岳）
论治
女子下赤白而不甚稠，曰白淫，与男子白浊同系于相火，如龙雷之扰，而不澄清也。属足少阴、太阴，治
当清补。如有滑白稠粘者，谓之带下，属手厥阴、少阳。如男子自遗之精，原乎心包，系乎脊膂，络淫带脉，
通于任脉，下抵涌泉，上至泥丸，治宜血肉之剂以培之。时人泥于常套，作流痰治，以牡蛎、龙骨、地榆之类
涩之，和以四物，加以升提。殊不知根本损伤，以致腐败而下。彼塞滞不清之物，则益加其滞，升提不正之气，
则愈增加其郁。惟以六龙固本丸、十六味保元汤主之。证属于虚，则当补养。其他称湿、称痰，俗谓脏冷。又
云白属气，赤属血。皆泛而不切之言。（吴梅坡）
妇人忧思郁怒，损伤心脾，肝火时发，血不归经，所以多患带疾。盖肝郁则脾伤，脾伤则气陷，是脾精不
守，不能输为营血，而下白滑之物，皆由肝木郁于土中使然。法当开提肝气，补助脾元。盖以白带多属气虚，
故补气健脾，为治法之要领也。若下如米泔而臭秽者，此湿热胜也。亦有脾胃气虚，不能制水，而湿痰下坠者，
宜二术、黄柏、茯苓、车前为主，佐以升提。若下如鸡
子清者，此脾胃虚极也。色必不华，足胫必浮，腰腿必酸，宜五味子、八味丸，间用调脾养心，如归脾之类。
若阴虚有火者，宜六味丸加五味、菟丝、车前、黄柏。叔和云∶崩中日久为白带，漏下多时骨髓枯。盖言崩久
气血虚脱耳。此证虽有气、血、寒、热之分，总属气虚下陷之故。（缪仲淳）
人身带脉，统摄一身无形之水。下焦肾气虚损，带脉漏下，白为气虚，赤为有火，治当补肾为主。脾虚者，
六君子汤加升麻；气虚者，补中益气汤；肝虚者，逍遥散兼六味丸。（赵养葵）
带脉总束诸脉，如人束带而前垂也。妇人多郁怒伤肝，肝乘脾，土伤生湿，湿生热，热则流通，故滑浊之
物渗入膀胱，从小便而出也。古人作湿寒治，用辛温药。丹溪作湿热治，用苦寒药。夫苦寒正治也，辛温从治
也。如湿热怫郁于内，腹痛带下，非辛温从治，能开散之乎？若少腹不痛，止下带者，虽有湿热，而气不郁结，
则用苦寒治之为当也。（方约之）
带证，由外邪风冷湿热、内伤瘀血湿痰，皆有余之病。若东垣以血海将枯，津液复亡，是原其病在血虚
也。仲淳以脾精不守，元气下陷，是原其病在气虚也。养葵更推原带脉为病，下焦肾气虚损所致，尤为探本之
要。此吴梅坡以十六味保元汤、六龙固本丸治带证，盖有自来矣。（萧慎斋）
妇人浊带，其因有六∶一心旌动摇，心火不静而带下者，当清火，宜朱砂安神丸、清心莲子饮。若无邪
火，但心虚而带下者，宜秘元煎、人参丸、茯菟丸。一欲事过度，滑泄不固而带下者，宜秘元煎、苓术菟丝丸、
济生固精丸。一人事不畅，精道逆而为浊为带者，初宜威喜丸，久宜固阴煎。一湿热下流，而为浊带，脉数，
色赤，烦渴多热者，宜保阴煎、加味逍遥散。若热甚兼淋而赤者，宜龙胆泻肝汤。一元气虚而带下者，宜寿脾
煎、七福饮、十全大补汤。若阳气虚寒，脉微涩，腹痛多寒者，宜加姜、附。一脾肾气虚下陷而带下者，宜归
脾汤、补中益气汤。（张景岳）
选案
一妇经多带下者，日轻夜重，泄泻无时，拟属下多亡阴，治用血药，益甚，始悟此病，合阳生阴长之治。
夫经多带下，又兼泄泻，皆由阳虚下陷。盖日则阳旺，而得健运之职，故轻；夜则阴旺，而阳不得其职，故重。
易以参、术助阳，服之而效。（缪仲淳）
一女七岁下白，其母疑焉。夜卧因以帛垫身，始知其故。予曰∶女子二七任脉通。今任脉未通，带脉未
成，何以得此？是必脾虚有湿而然。方用白术、茯苓、山药、苡仁、扁豆、芡实、白芍、甘草、陈皮为末，服
之而止。嫁后一产而脱，体气早亏之过也。（许宣治）
[Scriptural Interpretation]
When the Ren Mai (Conception Vessel) is diseased, men present with seven types of hernias in the external genitalia, while women present with leukorrhea and zhajù (abdominal masses)。(From *Nan Jing*)
[Pathogenesis Analysis]
A woman around fifty years old suffers from lower bleeding (Note: *Yi Zong Jin Jian* corrects "li" [diarrhea] to "xue" [blood]), which has persisted for dozens of days without stopping. She experiences fever in the evening, urgency and tightness in the lower abdomen, abdominal fullness, vexatious heat in the palms, and dryness of the lips and mouth. What is the cause? The Master said: This disease belongs to the category of leukorrhea. Why? Because she previously suffered a miscarriage, leaving blood stasis in the lower abdomen that has not dissipated. How do we know this? Her symptoms of dry lips and mouth indicate the presence of blood stasis. It should be treated with Wen Jing Tang (Warming the Menses Decoction). (From *Jin Gui Yao Lue*)
Commentary: The character "li" (benefit/diarrhea) in "the disease presents as lower li" should be "xue" (blood) for the meaning to make sense; it should be corrected. (From *Yi Zong Jin Jian*)
Leukorrhea has five main types, mostly caused by wind pathogens invading the uterus gate during menstruation or postpartum, transmitting to the zang-fu organs. Injury to the Jueyin Liver Meridian results in discharge like green mud; injury to the Shaoyin Heart Meridian results in discharge like red fluid; injury to the Taiyin Lung Meridian results in discharge resembling white mucus; injury to the Taiyin Spleen Meridian results in discharge like rotten melon flesh; injury to the Shaoyin Kidney Meridian results in discharge like black blood. (From *Fu Ren Da Quan Liang Fang*)
The Chong, Ren, and Du vessels originate from the same source but travel different paths, branching into three, all connecting to the Dai Mai (Girdle Vessel), governed by the vaginal opening, circulating through the external genitalia, and ascending to the upper ends of the urethral and vaginal orifices. When heat from other meridians lingers in the Dai Mai, pathogenic heat stagnates, causing blood accumulation and stagnation. Through the transformation associated with Metal, it turns white and discharges with urine, forming white leukorrhea. It usually does not hurt, though sometimes it does. The Classics state: "Heat and pain in the lower abdomen, with white fluid discharging from the urine." "Yuan" refers to stagnation and obstruction. This disease is not inherent to the primary meridian but arises from the stagnation of other meridians. If it were dysentery with red and white discharge, one cannot forcibly distinguish cold from heat, but must treat based on whether it is new or chronic. Just as sores and boils first show red blood and then ulcerate with white pus, how can this be considered a cold syndrome? Dysentery involves heat transmitting to the Large Intestine and lower bowel, while leukorrhea involves heat transmitting to the Small Intestine and entering the Bladder Meridian. Both conditions can be treated with methods for clearing heat and draining dampness. (Zi He Zi)
Leukorrhea occurs when damp-heat in the Ren Mai becomes severely stagnant, causing body fluids to overflow. Like using fire to smelt metal, extreme heat paradoxically generates water-like phenomena; similarly, in the extreme heat of June, objects exude moisture, and trees flow sap. Thus, Liver heat causes tears, Heart heat causes sweat, Spleen heat causes saliva, Lung heat causes nasal mucus, and Kidney heat causes spit, just as boiling soup overflows when too hot. Lay physicians treating leukorrhea use acrid-warm herbs; mild cases may see temporary relief of stagnation, but severe cases worsen. It is better to follow the method using bitter-cold herbs. (Liu He Jian)
Leukorrhea is formed by the stagnation of Ying (Nutritive) and Wei (Defensive) Qi. It is caused by anger, worry, sorrow, thought, childbirth, or sexual fatigue damaging Ying and Wei Qi, or by accompanying damp-heat allowing turbid Qi to seep into the Bladder. Consequently, foul white substances flow down like mucus, accompanied by a dull complexion, soreness and pain in the waist and legs, and diminished spirit. Laypeople only recognize deficiency-cold, ignoring damp-heat, and wrongly use warming tonics, which exacerbate Heart Fire. Once Heart Fire is excessive, Yin Blood is gradually scorched. Like lard, it melts when heated and solidifies when cooled. Unresolved dampness forms white leukorrhea; if steamed by heat, it produces a fishy, putrid odor. The treatment should clear the Upper Jiao, secure the Lower Jiao, regulate the Spleen, nourish Blood, thereby resolving the damp-heat. (Luo Chi Cheng)
Leukorrhea is caused by damp-phlegm flowing into the Dai Mai and discharging turbid fluids. Women often suffer from it. Red discharge indicates Heat, treated by addressing deficiency and fire; white discharge indicates Dampness, treated by addressing deficiency and phlegm. For chronic cases, tonify the Spleen and Kidney and use lifting methods. Generally, thin people have more Fire, while fat people have more Phlegm; this distinction is crucial. White leukorrhea, white turbidity, and white spermatorrhea are similar yet distinct. White leukorrhea flows constantly, clear, cold, thick, and sticky, indicating deficiency of the Lower Yuan. White turbidity comes with urine, cloudy like rice washings, indicating turbid Qi from the Stomach seeping into the Bladder. White spermatorrhea occurs after urination, in small amounts, indicating failure to control essence in men. (From *Lin Zheng Zhi Nan*)
Leukorrhea exits via the essence orifice, similar to nocturnal emission in men. Turbidity exits via the urine orifice, where damp-heat descends from the Bladder; this must be distinguished. The difference between turbidity and leukorrhea is that white leukorrhea originates from the Uterus, being the residue of essence; turbidity originates from the Bladder, being the turbidity of water. Although the Bladder and Kidney are exterior-interior pairs, both sources stem from the Yin aspect. However, leukorrhea is mostly due to Spleen-Kidney deficiency and slipping, while turbidity is mostly due to Bladder damp-heat. This is why they must be distinguished. (Zhang Jing Yue)
[Treatment Principles]
Women with red and white discharge that is not very thick are called "Bai Yin" (White Spermatorrhea/Leukorrhea), related to Ministerial Fire disturbing clarity, similar to Dragon-Lei fire. It belongs to the Foot Shaoyin and Foot Taiyin meridians; treatment should be clearing and tonifying. If there are slippery, thick, sticky white secretions, it is called leukorrhea, belonging to the Hand Jueyin and Hand Shaoyang meridians. Similar to spontaneous seminal emission in men, its root is in the Pericardium, linked to the spine, connecting to the Dai Mai, communicating with the Ren Mai, descending to Yongquan, and ascending to Niwan. Treatment should use animal-derived tonics. Contemporary physicians mistakenly treat it as flowing phlegm, using astringents like Mu Li (Oyster Shell), Long Gu (Dragon Bone), Di Yu (Sanguisorba), combined with Si Wu Tang and lifting agents. They fail to realize this is fundamental damage leading to decay and discharge. Astringents increase stagnation; lifting agents increase depression. One should use Liu Long Gu Ben Wan and Shi Liu Wei Bao Yuan Tang. For deficiency patterns, tonification is required. Claims of dampness, phlegm, or cold viscera, or that white relates to Qi and red to Blood, are vague and inaccurate. (Wu Mei Po)
Women suffering from worry, thoughts, depression, and anger damage the Heart and Spleen. Liver Fire flares intermittently, causing blood to leave its vessels, leading to frequent leukorrhea. Liver stagnation injures the Spleen; Spleen injury causes Qi sinking; thus, Spleen Essence fails to guard itself and cannot transform into Nutritive Blood, resulting in downward discharge of white, slippery substances. This is caused by Liver Wood stagnating in Earth. The method should open and lift Liver Qi and assist Spleen Yuan. Since white leukorrhea is mostly Qi deficiency, tonifying Qi and strengthening the Spleen is key. If discharge resembles rice water and is foul-smelling, it indicates excess damp-heat. If Spleen-Stomach Qi deficiency fails to control water, leading to damp-phlegm sinking, use Bai Zhu, Cang Zhu, Huang Bo, Fu Ling, Che Qian Zi, assisted by lifting agents. If discharge resembles egg white, it indicates extreme Spleen-Stomach deficiency. The complexion will be dull, calves swollen, waist and legs sore. Use Wu Wei Zi and Ba Wei Wan, alternating with Spleen-regulating and Heart-nourishing formulas like Gui Pi Tang. For Yin deficiency with fire, use Liu Wei Wan plus Wu Wei Zi, Tu Si Zi, Che Qian Zi, Huang Bo. Shu He said: "Prolonged metrorrhagia leads to leukorrhea; prolonged leakage dries up the bone marrow." This refers to Qi and Blood depletion from long-term bleeding. Although this condition varies by Qi, Blood, Cold, and Heat, it fundamentally stems from Qi deficiency and sinking. (Miao Zhong Chun)
The Dai Mai governs the invisible fluids of the body. Deficiency of Lower Jiao Kidney Qi causes the Dai Mai to leak; white indicates Qi deficiency, red indicates Fire. Treatment should primarily tonify the Kidney. For Spleen deficiency, use Liu Jun Zi Tang plus Sheng Ma; for Qi deficiency, use Bu Zhong Yi Qi Tang; for Liver deficiency, use Xiao Yao San combined with Liu Wei Wan. (Zhao Yang Kui)
The Dai Mai binds all meridians, like a belt hanging forward. Women often suffer Liver injury from depression and anger; Liver attacks Spleen, Earth is injured and generates Dampness, Dampness generates Heat, Heat causes flow, so slippery turbid substances seep into the Bladder and exit via urine. Ancients treated this as damp-cold with acrid-warm herbs. Dan Xi treated it as damp-heat with bitter-cold herbs. Bitter-cold is direct treatment; acrid-warm is indirect treatment. If damp-heat is constrained internally with abdominal pain and leukorrhea, can acrid-warm indirect treatment not disperse it? If the lower abdomen is not painful and only leukorrhea occurs, even with damp-heat, if Qi is not constrained, bitter-cold direct treatment is appropriate. (Fang Yue Zhi)
Leukorrhea syndromes, caused by external Wind-Cold-Damp-Heat or internal Blood Stasis-Damp-Phlegm, are excess diseases. Dong Yuan traced the origin to drying of the Blood Sea and loss of fluids, attributing it to Blood deficiency. Zhong Chun traced it to Spleen Essence failing to guard and Yuan Qi sinking, attributing it to Qi deficiency. Yang Kui further traced it to Dai Mai disease caused by Lower Jiao Kidney Qi deficiency, which is particularly fundamental. This explains why Wu Mei Po uses Shi Liu Wei Bao Yuan Tang and Liu Long Gu Ben Wan for leukorrhea, having historical precedent. (Xiao Shen Zhai)
Causes of turbid leukorrhea in women include six types: 1. Heart agitation and unstable Heart Fire causing leukorrhea: Clear Fire, use Zhu Sha An Shen Wan or Qing Xin Lian Zi Yin. If no evil fire, but Heart deficiency causing leukorrhea: use Mi Yuan Jian, Ren Shen Wan, or Fu Tu Wan. 2. Excessive sexual activity causing sliding and insecurity: use Mi Yuan Jian, Ling Zhu Tu Si Wan, or Ji Sheng Gu Jing Wan. 3. Sexual dissatisfaction causing reverse flow of essence into turbidity/leukorrhea: initially use Wei Xi Wan, long-term use Gu Yin Jian. 4. Damp-Heat flowing downward causing turbid leukorrhea with rapid pulse, red color, thirst, and heat: use Bao Yin Jian or Jia Wei Xiao Yao San. If heat is severe with strangury and redness: use Long Dan Xie Gan Tang. 5. Yuan Qi deficiency causing leukorrhea: use Shou Pi Jian, Qi Fu Yin, or Shi Quan Da Bu Tang. If Yang Qi deficiency with cold, faint/choppy pulse, and cold abdominal pain: add Sheng Jiang and Fu Zi. 6. Spleen-Kidney Qi deficiency with sinking causing leukorrhea: use Gui Pi Tang or Bu Zhong Yi Qi Tang. (Zhang Jing Yue)
[Selected Cases]
A woman with heavy menstruation and leukorrhea had symptoms lighter during the day and heavier at night, with constant diarrhea. Initially diagnosed as Yin loss from excessive lower discharge, treated with blood tonics, which worsened the condition. Realization came that this case requires the principle of "Yang generating Yin." Heavy menstruation, leukorrhea, and diarrhea are all due to Yang deficiency and sinking. Daytime Yang is strong, performing its transport function, so symptoms are light; nighttime Yin is strong, Yang loses its function, so symptoms are heavy. Switching to Shen (Ginseng) and Zhu (Atractylodes) to assist Yang resulted in efficacy. (Miao Zhong Chun)
A seven-year-old girl presented with white leukorrhea; her mother was suspicious. Using cloth pads at night revealed the issue. I stated: Girls' Ren Mai opens at age fourteen. Here, the Ren Mai is not open, and the Dai Mai is not formed; how could this occur? It must be due to Spleen deficiency with Dampness. Formula: Bai Zhu, Fu Ling, Shan Yao, Yi Yi Ren, Bian Dou, Qian Shi, Bai Shao, Gan Cao, Chen Pi powdered and taken. Discharge stopped. After marriage, one childbirth led to collapse; this was due to early constitutional deficiency. (Xu Xuan Zhi)