李东垣曰∶经水漏不住有二。妇人脾胃虚损，致命门脉沉细而数疾，或沉弦而洪大有力，寸关脉亦然。
皆由脾胃有亏，下陷于肾，与相火相合，湿热下迫，经漏不止，其色紫黑，如夏月腐肉之臭。中有白带者，脉
必弦细，寒作于中；有赤带者，其脉洪数，病热明矣，必腰痛成脐下痛。临经欲行，而先发寒热往来，两胁急
缩，兼脾胃证出见，或四肢困倦，心烦闷不得眠卧，心下急，宜大补脾胃而升降气血，可一服而愈。或贵而后
贱，富而后贫，病名脱营者，心气不足，其火大炽，旺于血脉之中，又或脾胃饮食失节，火乘其中，形质肌肉
颜色似不病者，此心病也，下形于脉，故脾胃饮食不调，其证显矣而经水不时而下，或适来适断，暴下不止。
治当以大补气血之剂，补养脾胃，微加镇坠心火之药治其心，补阴
泻阳，经自止矣，《痿论》云∶悲哀太甚则胞络绝，胞络绝则阳气内动，发则心下满，数溲血也。故经曰∶
大经空虚，发则肌痹，传为脉痿，此之谓也。治宜升阳益胃汤。血脱益气，古人之法也。先补胃气以助生长，
故曰阳生阴长，诸甘药为之先务。
薛立斋曰∶血崩，经云∶阴虚阳搏，谓之崩。又云∶阳络伤则血外溢，阴络伤则血内溢。又云∶脾统血，
肝藏血。其为患因脾胃虚损，不能摄血归源；或因肝经有火，血得热而下行；或因肝经有风，血得风而妄行；
或因怒动肝火，血热而沸腾；或因肝经郁结，血伤而不归经；或因怒动肝火悲哀太过，胞络伤而下崩。治疗之
法∶脾胃虚弱者；六君子汤加芎、归、柴胡；脾胃虚陷者，补中益气加白芍、山栀；肝经血热，四物加柴、
栀、苓、术；肝经风热，加味逍遥，或小柴胡加山栀、白芍、丹皮；若怒动肝火，亦用前药；脾经郁火，归脾加
山栀、柴胡、丹皮；哀伤胞络，四君加升、柴、山栀。故东垣、丹溪诸先生云∶凡下血证，须用四君子以
收功。斯言厥有旨哉。若大去血后，毋以脉诊，当急用独参汤救之。其发热、咳嗽脉数，乃是元气虚弱，假热
之脉也，尤当用人参之类。此等证候，无不由脾胃先损，故脉洪大，察其有胃气受补可救。误用寒凉之药，复
伤脾胃生气，反不能摄血归元，是速其危也。
薛立斋医案
一妇人，内热作渴，饮食少思，腹内近左初如鸡卵，渐大四寸许，经水三月一至，肢体消瘦，齿颊似疮，
脉洪数而虚，左关尤甚，此肝脾郁结之证。外贴阿魏膏，午前用补中益气汤，午后以加味归脾汤。两月许，
肝火少退，脾胃尚健，仍与前汤送六味丸，午后又用逍遥散送归脾丸。又月余，日用芦荟丸二服，空心以逍
遥散下，晡时以归脾汤下，喜其调理谨慎，年余而愈。
一妇人，发热口干，月经不调，两腿无力，服祛风渗湿之剂，腿痛体倦，二膝浮肿，经事不通。余作脾、
肝、肾三经血虚火燥，证名鹤膝风，用六味丸、八味丸，兼服两月，形体渐健，饮食渐进，膝肿渐消，不半载而痊。
前证若脾肾虚寒，腿足软痛，或足膝枯细，用八味丸。若饮食过多，腿足或臀后酸痛，或浮肿作胀，用补中益气加茯苓、半夏主之。
一妇人，性沉静，勤于女工，善怒，小腹内结一块，或作痛，或痞满，月经不调，恪服伐肝之剂，内热寒热，胸膈
不利，饮食不甘，形体日瘦，牙龈蚀烂。此脾土不能生肺金，肺金不能生肾水，肾水不能生肝木，当滋化源，用补中益气、六味地黄，至仲春而愈。
松江太守何恭人，性善怒，腹聚一块年余，形体骨立，倏然往来， 蚀透腮，或泥春木旺克土，仍行伐肝。时季冬，
肝脉洪数，按之弦紧，余脉微弱。余曰∶洪数弦紧，肝经真气发见而邪气实也，自保不及，何能克土？况面色青中隐白，
乃肾水不足，肝木亏损，肺金克制，惟虑至春木不能发生耳。勉用壮脾胃、滋肾水，二剂，肝脉悉退。后大怒，耳内出血，肝脉仍大，按之如无，烦躁作渴。此无根之火，以前药加肉桂，二剂，肝脉仍敛，热渴顿退。复因大怒，
以致饮食不进，果卒于季冬辛巳日。此木衰弱而金刑克，信矣。
一妇人，经候过期，发热倦怠，或用四物、黄连之类，反两月一度，且少血而成块。又用峻药通之，两目如帛
所蔽。余曰∶脾为诸阴之首，目为血脉之宗，此脾伤，五脏皆为失所，不能归于目矣。遂用补中益气、济生归脾二汤，专主脾胃，年余而愈。
一妇人，年四十，索性急，先因饮食难化，月经不调，服理气化痰药，反肚腹膨胀，大便泄泻；又加乌
药、蓬术，肚腹肿胀，小便不利；加猪苓、泽泻，痰喘气急；手足厥冷，头面肢体肿胀，指按成窟，脉沉细，
右寸为甚。余曰∶此脾肺之气虚寒，不能通调水道，下输膀胱，渗泄之令不行，生化之气不运。即东垣所云∶
水饮留积，若土之在雨中，则为泥矣。得和风暖日，水湿去而阳化，自然万物生长。喜其脉相应，遂与金匮
加减肾气丸料服之，小便即通。数剂肿胀消半，四肢渐温，自能转侧。又与六君子加木香、肉桂、炮姜治之，
全愈。后不戒七情饮食，即为泄泻，仍用前药加附子五分而安。
一妇人，素有头晕，不时而作，月经迟而少。余以为中气虚，不能上升而头晕，不能下化而经少，用补
中益气汤而愈。后因劳而作，月经如涌，此劳伤火动，用前汤加五味子一剂、服之即愈。前证虽云亡血过多，
气无所附，实因肺气亏损。
西宾钱思曾云∶室年三十，尚无嗣，月经淋漓无期，夫妇异处者几年矣，思曾欲为娶外家，以谋诸余。余
曰∶此郁怒伤肝，脾虚火动，而血不归经，乃肝不能藏，脾不能摄也。当清肝火，补脾气，遂与加味归脾、逍
遥二药。送至其家，仍告其姑曰∶服此病自愈，而当受胎，外家可无娶也。果病愈，次年生子。
一妇人，多怒，经行或数日或半月后止，三年后淋漓无期，肌体倦瘦，口渴内热，盗汗如洗，日晡热甚。
余用参、术、 、归、茯神、远志、枣仁、麦冬、五味、丹皮、龙眼肉、炙草、柴胡、升麻，治之获痊。
此证先有怒动肝火，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。
一妇人，性善怒，产后唇肿内热，月水不调，食少作呕，大便不实，唇出血水。用理气消导，胸膈痞
满，头目不清，唇肿经闭；用清胃行血，肢体倦怠，发热烦躁，涎水涌出。欲用通经之剂。余曰∶病本七情，
肝脾虚损，数行攻伐，元气益虚者耳。法当补阴益阳，遂以加味归脾汤、加味逍遥散、补中益气汤，如法调
治，元气渐复，唇疮亦愈。后因怒，寒热耳痛，胸胁胀闷，唇 肿甚，此是怒动肝火而血伤，遂用四物合小柴
胡加山栀，顿愈。后又怒，胁乳作胀，肚腹作痛，呕吐酸涎，饮食不入，小水不利，此是怒动肝木克脾土，乃
用补脾气、养脾血而愈。又因劳役怒气，饮食失节，发热喘渴，体倦不食，去血如崩，唇肿炽甚，肝经有火。
脾经气虚，遂用补中益气加黑栀、丹皮、芍药而愈。此证每见，但治其疮，不固其本，而死者多矣。
一妇人，年六十有四，久郁怒，头痛寒热，春间乳内时痛，服流气饮之类益甚，不时有血如经行。又大
惊恐，饮食不进，夜寐不宁，乳肿及两胁， 痛如炙，午前后色赤。余以为肝脾郁火血燥，先以逍遥散加酒炒
黑龙胆一钱，山栀半钱，两剂顿退，又二剂而全消。再用归脾加炒栀、贝母，诸证悉退。
一妇人，因怒血崩，久不已，面青黄而或赤。此肝木制脾土而血虚也，用小柴胡合四物，以清肝火、生
肝血；又用归脾、补中二汤，益脾气以生肝血而痊。若因肝经有风热而血不宁者，用防风一味为丸，以兼证
之药煎送。或肝经火动而不宁者，用条芩炒为丸，以兼证之药煎送，无有不效。
一妇人，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，土受克则内症作。若自病见，用
四物加白术、茯苓、炒山栀、炒龙胆；若内症作，用四君加柴胡、白芍、神曲、吴萸炒连，诸症渐愈。惟月
经不止，是血分有热，脾气尚虚，以逍遥散倍用白术、茯苓、陈皮，又以补中益气加酒炒芍药，兼服而调。
归大化内人，患月事不期，崩血昏愦，发热不寐。或谓血热妄行，投以寒剂益甚；或以胎成受伤，投以
止血，亦不效。余曰∶此脾气虚弱，无以统摄故耳。法当补脾而血自止，用补中益气汤加炮姜，不数剂而效。
惟终夜少睡惊悸，其家另服八珍汤，更不效。余曰∶杂矣！乃与归脾汤加炮姜，以补心肾，遂如初。
一妇人，素有胃火，服清胃散而安，后因劳役，燥渴内热，肌肉消瘦，月经不行。此胃火消烁阴血，用逍
遥散加丹皮、炒山栀以清胃热，用八珍汤加茯苓、远志以养脾血，而经自行。
一妇，因劳耳鸣头痛体倦，此元气不足，用补中益气加麦冬、五味而痊。三年后，因饮食劳倦，前症
益甚，月经不行，晡热内热，自汗盗汗，用六味地黄丸、补中益气汤，顿愈。前症若因血虚有火，用四物加山
栀、柴胡；不应，八珍加前药。若气虚弱，用四君子。若怒便耳聋或鸣者，实也，小柴胡加芎、归、山栀；
虚用补中益气加山栀。若午前甚作火治，用小柴胡加炒连、炒栀，气虚用补中益气。午后作血虚，用四物加白
术、茯苓。若阴虚火动，或兼痰甚作渴，必用地黄丸以壮水之主。经云∶头痛耳鸣，九窍不利，肠胃之所生
也。脾胃一虚，耳目九窍皆为之病。
《治法纲》曰∶《内经》方，血枯一证，与血膈相似，皆
经闭不通之候。然而枯与膈则相反，有如冰炭。夫枯者，枯竭之谓；膈者，阻隔之谓。血本不虚，而或气或
寒或积，有所逆，病发于暂，其症则或痛或实，必通之，以血行而愈，此可攻者。枯者，其来有渐，脾胃气
乏，冲任内竭，其症无形，此必不可通者也。夫血既枯矣，只当补养阴气，使其血充。若勉强通之，则枯愈
枯，不危何待耶。
Li Dongyuan said: There are two types of menorrhagia (prolonged menstrual bleeding) that do not stop. In women, deficiency and damage to the Spleen and Stomach lead to a Mingmen pulse that is deep, fine, rapid, or deep, wiry, surging, large, and forceful; the Cunkou and Guankou pulses are similar. This is entirely due to Spleen and Stomach deficiency, with Qi sinking into the Kidney, combining with Ministerial Fire, causing Damp-Heat to press downward, resulting in continuous uterine bleeding. The blood color is purple-black, smelling like rotting meat in summer. If accompanied by leukorrhea (white vaginal discharge), the pulse must be wiry and fine, indicating cold within; if accompanied by bloody leukorrhea, the pulse is surging and rapid, clearly indicating heat, and there will inevitably be lower back pain extending to hypogastric pain. Before menstruation begins, chills and fever alternate, the bilateral flanks feel tight and contracted, and Spleen-Stomach symptoms appear, such as limb fatigue, mental restlessness, inability to sleep, and epigastric urgency. One should greatly tonify the Spleen and Stomach to regulate the ascending and descending of Qi and Blood, often achieving cure with a single dose. Alternatively, this condition, known as "Tuoying" (Depletion of Vitality), occurs when one's status changes from noble to base or rich to poor. Due to insufficient Heart Qi, Heart Fire blazes intensely within the blood vessels. Or, due to irregular diet damaging the Spleen and Stomach, Fire invades the Middle Jiao. Although the physical form, muscles, and complexion may appear healthy, this is actually a Heart disease manifesting in the pulse, making Spleen-Stomach dietary dysfunction obvious, leading to irregular menstruation, sudden cessation, or acute profuse bleeding. Treatment requires strong Qi and Blood tonification formulas to nourish the Spleen and Stomach, slightly adding herbs to suppress Heart Fire to treat the Heart. By nourishing Yin and draining Yang, menstruation will naturally cease. The *Treatise on Flaccidity* states: "Excessive grief severs the Bao Luo (uterine collaterals); when severed, Yang Qi moves internally, causing epigastric fullness and frequent hematuria." Thus it is said: "When the great vessels are empty, myofascial bi syndrome develops, transmitting to Mai Wei (pulse flaccidity)." This refers to such cases. The appropriate treatment is Shengyang Yiwetang (Ascending Yang and Benefit Stomach Decoction). Using Qi tonification for blood loss is an ancient method. First, tonify Stomach Qi to aid growth, hence "Yang generates Yin"; sweet-flavored herbs are the primary task.
Xue Lizhai said: Regarding metrorrhagia (sudden heavy uterine bleeding), the *Classic* states: "Yin deficiency with Yang pounding is called Beng." It also says: "Injury to Yang collaterals causes external blood overflow; injury to Yin collaterals causes internal blood overflow." Furthermore: "The Spleen controls blood, the Liver stores blood." Causes include: Spleen-Stomach deficiency failing to control blood return to its source; Liver channel fire causing blood to flow downward due to heat; Liver channel wind causing blood to act recklessly due to wind; anger stirring Liver fire causing blood to boil due to heat; Liver channel stagnation injuring blood preventing it from returning to its vessels; or anger stirring Liver fire/excessive grief injuring Bao Luo causing severe lower bleeding. Treatment methods: For Spleen-Stomach weakness, use Liujunzi Tang (Six Gentlemen Decoction) plus Chuanxiong, Danggui, Chaihu; for Spleen-Stomach sinking, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Baishao, Zhizi; for Liver channel blood heat, use Siwu Tang (Four Substances Decoction) plus Chaihu, Zhizi, Fuling, Baizhu; for Liver channel wind-heat, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) or Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Zhizi, Baishao, Danpi; for anger-stirred Liver fire, use the previous prescriptions; for Spleen channel stagnant fire, use Guipi Tang (Restore the Spleen Decoction) plus Zhizi, Chaihu, Danpi; for grief-injured Bao Luo, use Sijunzi Tang (Four Gentlemen Decoction) plus Shengma, Chaihu, Zhizi. Thus, masters Dongyuan and Danxi stated: "For all lower bleeding syndromes, one must conclude treatment with Sijunzi Tang." This statement is profound. After massive blood loss, do not rely on pulse diagnosis; urgently use Dushen Tang (Single Ginseng Decoction) for rescue. Fever, cough, and rapid pulse indicate false heat due to deficient Yuan Qi; especially use Renshen (Ginseng Radix et Rhizoma). These syndromes invariably stem from prior Spleen-Stomach damage, presenting with surging pulses; if stomach Qi is present and can tolerate tonification, rescue is possible. Misusing cold-cooling drugs further damages Spleen-Stomach vital Qi, preventing blood control, accelerating danger.
Xue Lizhai Medical Cases:
A woman suffered from internal heat and thirst, reduced appetite, and a mass in the left abdomen growing from egg-sized to four cun. Menstruation occurred every three months. She was emaciated, with ulcer-like lesions on teeth and cheeks. Pulse was surging, rapid, and deficient, especially at Zuoguan. This was Liver-Spleen stagnation. Applied Awei Gao externally; took Buzhong Yiqi Tang in the morning and Jiawei Guipi Tang in the afternoon. After two months, Liver fire subsided, Spleen-Stomach remained robust. Continued previous decoctions with Liuwei Wan (Six Flavor Pill) in the morning, and Xiaoyao San with Guipi Wan in the afternoon. After another month, took Lulu Wan twice daily, with Xiaoyao San on an empty stomach and Guipi Tang in the evening. Due to careful regulation, she recovered after over a year.
Another woman had fever, dry mouth, irregular menstruation, and weak legs. After taking wind-dispelling and damp-draining drugs, she developed leg pain, fatigue, knee swelling, and amenorrhea. I diagnosed Spleen-Liver-Kidney blood deficiency with fire dryness, named Hexikfeng (Crane Knee Wind). Used Liuwei Wan and Bawei Wan concurrently for two months. Physical strength improved, appetite increased, knee swelling subsided, cured in less than half a year. If Spleen-Kidney deficiency-cold caused soft/painful legs or thin knees, use Bawei Wan. If overeating caused leg/buttock soreness or swelling, use Buzhong Yiqi Tang plus Fuling, Banxia.
A third woman was quiet, diligent in needlework, prone to anger, with a hypogastric mass causing pain or fullness and irregular menstruation. Strict use of Liver-suppressing drugs led to internal heat/chills, chest oppression, poor appetite, emaciation, and gum erosion. This indicated Spleen Earth failing to generate Lung Metal, Lung Metal failing to generate Kidney Water, and Kidney Water failing to generate Liver Wood. Nourish the source using Buzhong Yiqi Tang and Liuwei Dihuang Wan, curing by mid-spring.
He Gongren, Prefect of Songjiang, was irritable, with an abdominal mass for over a year, severely emaciated, mobile mass eroding the cheek. Some attributed it to Spring Wood overacting on Earth, advocating Liver suppression. In late winter, Liver pulse was surging-rapid, wiry-tight upon pressure, others weak. I said: "Surging-rapid-wiry-tight indicates true Liver Qi emerging while pathogenic Qi is excess; self-preservation is difficult, how can it suppress Earth? Green complexion hiding white indicates Kidney Water insufficiency, Liver Wood depletion, Lung Metal suppression; fear Wood cannot generate in Spring." Prescribed Spleen-strengthening and Kidney-nourishing herbs; after two doses, Liver pulse receded. Later, anger caused ear bleeding, pulse remained large but empty upon pressure, with irritability/thirst. This was rootless fire; added Rougui (Cinnamon Bark) to previous formula. After two doses, pulse敛 (contracted), heat/thirst retreated. Further anger caused anorexia; she died on Xin-Si day in late winter. Wood weakness facing Metal suppression proved true.
A fourth woman had delayed menstruation, fever, and fatigue. Use of Siwu Tang and Huanglian made menstruation occur only once every two months with scanty, clotted blood. Harsh purgatives blurred vision. I said: "Spleen is head of Yin, eyes are congregation of blood vessels. Spleen injury causes five Zang organs to lose support, failing to nourish eyes." Used Buzhong Yiqi Tang and Jisheng Guipi Tang, focusing on Spleen-Stomach, cured after over a year.
A fifth woman, aged 40, impatient, had indigestion and irregular menstruation. Qi-regulating/phlegm-resolving drugs caused abdominal distension and diarrhea. Adding Wuyao, Pengzhi worsened swelling and oliguria. Adding Zhuling, Zexie caused phlegm-wheezing and dyspnea. Cold limbs, facial/limb edema leaving pits on pressure, deep-fine pulse, prominent Youcun. I diagnosed Spleen-Lung Qi deficiency-cold failing to regulate water passages, leading to fluid retention ("mud in rain"). Prescribed Jin Gui Ji Jian Shenqi Wan material. Urination resumed, swelling halved, limbs warmed. Followed with Liujunzi Tang plus Muxiang, Rougui, Paojiang for full recovery. Relapse due to emotional/dietary indiscretion treated with previous formula plus Fuzi (Aconite Lateralis Radix Preparata).
A sixth woman had chronic dizziness and scanty/delayed menstruation. Diagnosed as Middle Qi deficiency failing to ascend (dizziness) and descend (scant menses). Cured with Buzhong Yiqi Tang. Later, exertion triggered flooding menses (Lao Shang Huo Dong). Previous formula plus Wuweizi cured immediately. Though described as blood loss causing Qi detachment, it was actually Lung Qi deficiency.
Qian Sizeng (Guest Teacher) stated: At 30, childless, with prolonged irregular bleeding, separated from wife for years, he sought to take a concubine. I said: "Depressive anger injured Liver, Spleen deficiency stirred fire, blood failed to return to vessels; Liver fails to store, Spleen fails to control. Clear Liver fire, tonify Spleen Qi." Prescribed Jiawei Guipi Tang and Xiaoyao San. Told his mother-in-law: "Medicine will cure her and enable conception; no concubine needed." She conceived and gave birth the next year.
A seventh woman, prone to anger, had menses stopping after days or half a month, progressing to prolonged spotting over three years. Emaciated, thirsty, internal heat, night sweats, worse afternoon fever. Used Renshen, Baizhu, Danggui, Fushen, Yuanzhi, Zaoren, Maidong, Wuweizi, Danpi, Longyanrou, Zhigancao, Chaihu, Shengma. Cured. Initial anger-stirred Liver fire caused reckless blood flow; later Spleen Qi sinking failed to control blood. If stomach heat consumed fluids causing amenorrhea, clear Stomach. If Heart fire excessive, clear Heart. If excessive dry herbs used, nourish Blood. If long-term Qi/Blood decline, strengthen Spleen-Stomach.
An eighth woman, irritable, postpartum lip swelling/internal heat, irregular menses, anorexia/vomiting, loose stools, lip bleeding. Qi-regulating/digestive aids caused chest fullness, unclear head/eyes, lip swelling/amenorrhea. Stomach-clearing/blood-invigorating aids caused fatigue, fever/irritability, salivation. Considering emmenagogues, I said: "Root is seven emotions, Liver-Spleen deficiency, repeated attacking weakened Yuan Qi. Tonify Yin/Yang." Used Jiawei Guipi Tang, Jiawei Xiaoyao San, Buzhong Yiqi Tang. Yuan Qi recovered, lip sores healed. Anger caused chills/ear pain/flank fullness/lip swelling; Liver fire injuring blood. Used Siwu Tang combined with Xiao Chaihu Tang plus Zhizi, cured instantly. Further anger caused flank/breast distension, abdominal pain, sour vomiting, anorexia, oliguria; Liver Wood suppressing Spleen Earth. Tonified Spleen Qi/Blood, cured. Exertion/anger/diet irregularity caused fever/wheezing/thirst/fatigue/anorexia, flooding hemorrhage, severe lip swelling; Liver fire, Spleen Qi deficiency. Used Buzhong Yiqi Tang plus Hei Zhizi, Danpi, Shaoyao, cured. Often, treating only sores without securing the root leads to death.
A ninth woman, 64, chronic anger, headache/chills-fever, spring breast pain. Liufei Yin worsened it, with intermittent bleeding. Great fright caused anorexia, insomnia, breast/flank swelling, burning pain, redness midday/afternoon. Diagnosed Liver-Spleen stagnant fire/blood dryness. Used Xiaoyao San plus Jiu Chao Hei Longdan (1 qian), Zhizi (0.5 qian). Two doses cleared it, two more eliminated it. Then Guipi Tang plus Chao Zhizi, Beimu, all symptoms retreated.
A tenth woman had anger-induced metrorrhagia, persistent, yellow-green complexion sometimes red. Liver Wood suppressing Spleen Earth causing blood deficiency. Used Xiao Chaihu Tang combined with Siwu Tang to clear Liver fire/generate Liver blood; then Guipi Tang and Buzhong Yiqi Tang to benefit Spleen Qi/generate Liver blood, cured. If Liver wind-heat caused restless blood, use Fangfeng pills with decoction for concurrent symptoms. If Liver fire movement caused restlessness, use Tiao Qin pills with decoction, always effective.
An eleventh woman, impatient, anger caused pain in ears/neck/throat/teeth/chest/breasts (if not Taiyang), chest fullness, acid regurgitation, vomiting/diarrhea, scanty food intake, continuous menstruation. All Liver fire syndromes. Liver self-disease shows exterior signs; Earth suppression shows interior signs. Liver self-disease: Siwu Tang plus Baizhu, Fuling, Chao Zhizi, Chao Longdan. Interior signs: Sijunzi Tang plus Chaihu, Baishao, Shenqu, Chao Lian (with Evodia). Symptoms gradually improved. Continuous menstruation indicated blood heat with Spleen deficiency. Used Xiaoyao San with doubled Baizhu, Fuling, Chenpi, plus Buzhong Yiqi Tang with Jiu Chao Shaoyao concurrently.
Gu Dahua's inner lady had irregular menstruation, metrorrhagia with fainting, fever, insomnia. Cold drugs worsened it; hemostatics for suspected pregnancy trauma failed. I said: "Spleen Qi deficiency failing to control blood. Tonify Spleen, blood stops." Used Buzhong Yiqi Tang plus Paojiang, effective quickly. Insomnia/panic persisted; family used Bazhen Tang, ineffective. I said: "Too mixed." Prescribed Guipi Tang plus Paojiang to tonify Heart/Kidney, restored health.
A twelfth woman had stomach fire, calmed by Qingwei San. Exertion caused dryness/thirst/internal heat, emaciation, amenorrhea. Stomach fire consumed Yin blood. Used Xiaoyao San plus Danpi, Chao Zhizi to clear Stomach heat; Bazhen Tang plus Fuling, Yuanzhi to nourish Spleen blood, menstruation resumed.
A thirteenth woman had exertion-induced tinnitus/headache/fatigue, Yuan Qi deficiency. Cured with Buzhong Yiqi Tang plus Maidong, Wuweizi. Three years later, diet/exertion worsened symptoms, amenorrhea, afternoon/internal heat, spontaneous/night sweats. Cured instantly with Liuwei Dihuang Wan and Buzhong Yiqi Tang. If blood deficiency with fire, use Siwu Tang plus Zhizi, Chaihu; if ineffective, Bazhen Tang plus previous herbs. If Qi deficiency, use Sijunzi Tang. If anger-induced deafness/tinnitus is excess, use Xiao Chaihu Tang plus Chuanxiong, Danggui, Zhizi; if deficiency, Buzhong Yiqi Tang plus Zhizi. If worse in morning (fire), use Xiao Chaihu Tang plus Chao Lian, Chao Zhizi; if Qi deficiency, Buzhong Yiqi Tang. If worse in afternoon (blood deficiency), use Siwu Tang plus Baizhu, Fuling. If Yin deficiency with fire movement or phlegm-thirst, use Dihuang Wan to strengthen Water master. *Classic* states: "Headache, tinnitus, nine orifices dysfunction arise from intestines/stomach." Spleen-Stomach deficiency affects ears, eyes, nine orifices.
*Treatment Outline* states: *Neijing* mentions Xueku (Blood Depletion) similar to Xuege (Blood Obstruction), both amenorrhea. However, Ku (depletion) and Ge (obstruction) are opposite, like ice and charcoal. Ku means exhaustion; Ge means blockage. Blood is not deficient, but Qi/Cold/Stagnation cause reversal, acute onset, painful/excess symptoms, requiring unblocking for blood flow and cure; this is attackable. Ku develops gradually, Spleen-Stomach Qi乏, Chong-Ren internal exhaustion, formless symptoms, absolutely not unblockable. Since blood is depleted, only nourish Yin to fill blood. Forced unblocking makes depletion worse, leading to danger.