一妇人多怒。经行或数日。或半月方止。三年后。淋沥无期。肌体倦瘦。口干内热。盗
汗如洗。日晡热甚。用参、 、归、术、茯神、远志、枣仁、麦冬、五味、丹皮、龙眼、炙
草、柴胡、升麻。治之获愈。此证先因怒动肝火。血热妄行。后乃脾气下陷。不能摄血归源
故用前药。若胃热亡津液而经不行。宜清胃。若心火亢甚者。宜清心。若服燥药过多者。
宜养血。若病久气血衰。宜健脾胃。
震按前案治血热生风。此案治脾虚下陷。迥然不同。但前案易认。此案内热倦瘦。盗汗
口干。日晡热甚。已近痨怯病形。幸未咳嗽经停耳。若认为痨怯而用清火。则必死。
立斋曰。一妇性急。每怒非太阳耳项喉齿胸乳作痛。则胸满吞酸。吐泻少食。经行不止
此皆肝火之证。肝自病则外证见。土受克则内证作。余先以四物加白术、茯苓、柴胡、炒
栀、炒龙胆。清肝养血。次用四君子加柴胡、芍药、神曲。合左金以培土制肝。渐愈。惟月
A woman was prone to anger. Her menstruation would last for several days or half a month before stopping. After three years, the bleeding became incessant and prolonged. Her body became weak and emaciated, with dry mouth and internal heat, profuse night sweats like washing, and severe fever in the afternoon (Shen hour). She was treated with Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Rhizoma), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Fu Shen (Poria with Hostwood), Yuan Zhi (Polygalae Radix), Suan Zao Ren (Ziziphi Spinosomi Semen), Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Mu Dan Pi (Moutan Cortex), Long Yan Rou (Longan Arillus), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Chai Hu (Bupleuri Radix), and Sheng Ma (Cimicifugae Rhizoma), resulting in recovery. This condition initially arose from anger stirring up Liver Fire, causing blood heat to move recklessly; subsequently, it involved Spleen Qi sinking, failing to control blood and return it to its source. Hence, the aforementioned herbs were used. If menstruation is absent due to Stomach Heat consuming body fluids, the Stomach should be cleared. If Heart Fire is excessively hyperactive, the Heart should be cleared. If excessive intake of drying/hot herbs has occurred, blood should be nourished. If the disease has been long-standing leading to Qi and Blood deficiency, the Spleen and Stomach should be strengthened.
Yu Zhen’s commentary: The previous case treated Wind generated by Blood Heat, whereas this case treats Sinking of Spleen Qi due to Deficiency; they are completely different. However, the previous case was easy to recognize. In this case, the patient presented with internal heat, weakness and emaciation, night sweats, dry mouth, and severe afternoon fever, resembling the pattern of Lao Que (Consumptive Disease/Tuberculosis-like syndrome). Fortunately, there was no cough or amenorrhea. If misdiagnosed as Consumptive Disease and treated with clearing heat and purging fire, death would inevitably result.
Xue Lizhai stated: A woman had an impatient temperament. Whenever she became angry, she suffered either from pain in the Taiyang channel regions (ears, neck, throat, teeth, chest, breasts) or from chest fullness, acid regurgitation, vomiting, diarrhea, poor appetite, and incessant menstruation. These are all manifestations of Liver Fire. When the Liver itself is diseased, external symptoms appear; when Earth (Spleen/Stomach) is overcome by Wood (Liver), internal symptoms arise. I first used Si Wu Tang (Four Substances Decoction) added with Bai Zhu (Atractylodis Rhizoma), Fu Ling (Poria), Chai Hu (Bupleuri Radix), Chao Zhi Zi (Fried Gardenia Fruit), and Chao Long Dan Cao (Fried Gentian Root) to clear Liver Fire and nourish Blood. Subsequently, I used Si Jun Zi Tang (Four Gentlemen Decoction) added with Chai Hu (Bupleuri Radix), Shao Yao (Paeoniae Radix), Shen Qu (Massa Medicata Fermentata), combined with Zuo Jin Wan (Left Metal Pill) to tonify Earth and restrain Liver. The condition gradually improved. Only every month...