若阴虚血热妄行者，宜保阴煎、加减一阴煎。
保阴煎（见血热经早）
加减一阴煎（见血热经迟）
若火盛迫血妄行而无虚证者，宜徙薪饮、黄芩散加续断、丹参。
徙薪饮（见《新方八阵·寒阵》）治三焦凡火，一切内热，渐觉而未甚者，先宜清以此剂，其甚
者，宜抽薪饮。
陈皮（八分） 黄芩（二钱） 麦冬 芍药 黄柏 茯苓 牡丹皮（各一钱半）
水一钟半，煎七分，食远温服。如多郁气逆伤肝，胁肋疼痛，或致动血者，加青皮、栀子。
黄芩散即子芩散（见血热论外方）
若血热兼滑者，宜保阴煎、槐榆散、生地黄汤。
保阴煎（见血热经早）
槐榆散（见《妇人规古方》）治血崩及肠风下血。
槐花 地榆（等分炒焦）
上二味，用酒煎饮之。
生地黄汤（见《古方八阵·固阵》）治热痢便血，崩淋不止。
生地黄（五钱） 地榆（七钱半） 炙甘草（二钱半）
上 咀，用水二钟，煎一钟，分空心日晚二服。
若肝经怒火动血者，加味四物汤。
加味四物汤（见经不调）
若肝经怒火动血，逆气未散者，化肝煎或保阴煎加减主之。
化肝煎（见《新方八阵·寒阵》）治怒气伤肝，因而气逆动血，致为烦热，胁痛胀满动血等证。
青皮 陈皮（各二钱） 芍药（二钱） 丹皮 栀子（炒） 泽泻（各钱半如血见下部者以甘草代之）
土贝母（二、三钱）
水一钟半，煎七、八分，食远温服。如大便下血者，加地榆；小便下血者，加木通各一钱五分。如兼寒
热，加柴胡一钱。如火盛，加黄芩一、二钱。如胁腹胀痛，加白芥子一钱。胀滞多者，勿用芍药。
保阴煎（见血热经早）
若血有滞逆而妄行者，四物汤、丹参散。
四物汤（见经不调）
丹参散（见调经论外备用方）
若营气不足，血不能调而妄行者，五福饮、四物
汤、四君子汤、八珍汤，择宜用之。
五福饮（见血热经早）
四物汤（见经不调）
四君子汤（见血虚经乱）
八珍汤（见经不调）
若脾气虚陷不能收摄而脱血者，寿脾煎、归脾汤、四君子汤加芎、归。再甚者，举元煎。
寿脾煎（见血虚经乱）
归脾汤（见经不调）
四君子汤（见血虚经乱）
举元煎（见《新方八阵·补阵》）治气虚下陷，血崩血脱，亡阳垂危等证。有不利于归、熟
（地）等剂而
但宜补气者，以此主之。
人参 黄 （炙各三五钱） 炙甘草（一、二钱） 升麻（五、七分炒用） 白术（炒一、二钱）
水一钟半，煎七、八分，温服。如兼阳气虚寒者，桂、附、干姜随宜佐用。如兼滑脱者，加乌梅二个，
或文蛤七、八分。
若脾肾虚寒，兼呕兼溏泄而畏寒者，理阴煎、五君子煎、理中汤。
理阴煎（见血寒经迟）
五君子煎（见《新方八阵·热阵》）治脾胃虚寒，呕吐泄泻而兼湿者。
人参（二、三钱） 白术 茯苓（各二钱） 炙甘草（一钱） 干姜（炒黄一、二钱）
水一钟半煎服。
理中汤（见血虚经乱）
若阳气大虚脱陷者，四维散。
四维散（见《新方八阵·热阵》）治脾肾虚寒滑脱之甚，或泄利不能止，或气虚下陷，二阴血
脱不能禁者，无出此方之右。
人参（一两） 制附子（二钱） 干姜（炒黄二钱） 炙甘草（一、二钱） 乌梅肉（五分或一钱）
（酌其味之微甚，随病患之意而用之），
或不用乌梅，此即四味回阳饮也。
上为末，和匀，用水拌湿蒸一饭顷，取起烘干，再为末，每服一、二钱，温汤调下。
若脾肾阴气不固者，固阴煎、五阴煎、秘元煎。
固阴煎（见肾虚经乱）
五阴煎（见血虚经乱）
秘元煎（见血虚经乱）
若肝胆气虚不能藏血者，必多惊恐畏怯，宜五福饮、七福饮、八珍汤。兼阳虚者，仍加姜桂。
五福饮（见血热经早）
七福饮（见血虚经乱）
八珍汤（见经不调）
若去血过多，血脱气竭者，当速用独参汤提握其气，以防脱绝。或用当归补血汤。
独参汤（见《古方八阵·补阵》）治诸气虚气脱，及反胃呕吐，喘促，粥粉入胃即吐。凡诸虚证垂
危者。
人参（二两）
水一升，煮取四合，乘热顿服，日再进之，兼以人
参煮粥食之，尤妙。
《宝鉴》当归补血汤（见《古方八阵·补阵》）治血气损伤，或因误攻致虚，肌热口渴，目赤面红，
脉大而虚，重按全无。及病因饥饱劳役者。
黄 （炙一两） 当归（三钱）
水一钟半，煎八分，食远服。
若崩淋既久，血滑不禁，宜涩宜固者，龙骨散、如圣散、七灰散之类，同人参兼用之。
龙骨散（见《妇人规古方》）治血崩不止。
龙骨（ ） 当归 香附（炒各一两） 棕毛炭（五钱）
上为细末，每服四钱，空心米汤调下。忌油腻鸡鱼炙 物。
如圣散（见《妇人规古方》）治血崩，三服全愈。
棕榈子 乌梅肉 干姜（俱烧存性为末，各等分）
上每服二钱，空心乌梅汤调服。一方单用棕皮，半烧半生，为末，每空心服二钱，亦妙。
七灰散（见《妇人规古方》）治血崩，神效。
莲蓬壳 罂粟壳 腌蟹壳 益母草 旱莲草 棕毛叶 藕节（各等分俱烧存性，为末）
空心醋点汤调下三钱。一秘方用棉花子以铜锅炒黑为末，黄酒调下二、三钱，三两次即止。并治崩漏、小
产血不止。
凡血淋治法，大约如前。但其秽臭脉滑者，多火，宜从清凉；若腥臭清寒脉细者，多寒，必须温补。其
或久病，则精去无穷，尾闾易竭，非大加培补不可。惟固阴煎及十全大
补汤之类为宜。
固阴煎（见肾虚经乱）
十全大补汤（见调经论外备用方）
崩淋之病，有暴崩者，有久崩者。暴崩者其来骤，其治亦易。久崩者其患深，其治亦难。且凡血因崩去，
势必渐少，少而不止，病则为淋。此等证候，未有不由忧思郁怒，先损脾胃，次及冲任而然者。崩淋既久，真
阴日亏，多致寒热咳嗽，脉见弦数或豁大等证。此乃元气亏损，阴虚假热之脉。尤当用参、地、归、术甘温之
属，以峻培本源，庶可望生。但得胃气未败，受补可救。若不能受补，而日事清凉，以苟延目前，则终非吉
兆也。
崩淋病，治有五脏之分。然有可分者，有不可分者。可分者，如心肺居于膈上，二阳脏也；肝脾肾居
于膈下，三阴脏也。治阳者宜治其气，治阴者宜治其精，此可分之谓也。然五脏相移，精气相错，此又其
不可分者也。即如病本于心，君火受伤，必移困于脾土，故治脾即所以治心也。病本于肺，治节失职，
必残及于肾水，故治肾即所以治肺也。脾为中州之官，水谷所司，饷道不资，必五路俱病，不究其母，
则必非治脾良策。肝为将军之官，郁怒是病，胜则伐脾，败则自困，不知强弱，则攻
补不无倒施。不独此也，且五脏五气，无不相涉，故五脏中皆有神气，皆有肺气，皆有胃气，皆有肝气，皆有
肾气。而其中之或此或彼，为利为害，各有互相倚伏之妙。故必悟脏气之大本，其强弱何在？死生之权，其缓
急何在？精气之大要，其消长何在？攻补之大法，其先后何在？斯足称慧然之明哲。若谓心以枣仁、远志；
肺以桔梗、麦冬；脾以白术、甘草；肝以青皮、芍药；肾以独活、玄参之类，是不过肤毛之见，又安知性命之
道也！诸证皆然，不止崩淋者若此。
妇人于四旬外经期将断之年，多有渐见阻隔，经期不至者。当此之际，最宜防察。若果气血和平，素无他
疾，此固渐止而然，无足虑也。若素多忧郁不调之患，而见此过期阻隔，便有崩决之兆。若隔之浅者，其崩尚
轻，隔之久者，其崩必甚，此因隔而崩者也。当预服四物、八珍之类以调之。否则恐其郁久而决，则为患滋大也。
若其既崩之后，则当辨其有火、无火。有火者因火逼血，宜保阴煎主之；无火者因隔而决，或其有滞，当
去其故而养其新，宜调经饮先以理之，然后各因其宜，可养则养，用小营煎；可固则固，用固阴煎之类主之。
保阴煎（见血热经早）
调经饮（见经期腹痛）
小营煎（见血虚经乱）
固阴煎（见肾虚经乱）
王叔和曰∶五崩何等？曰∶白崩者形如涕，赤崩者形如绛津，黄崩者形如烂瓜，青崩者形如
蓝色，黑崩者形如 血也。
立斋曰∶前证治法，因脾胃亏损，不能摄血归源
者，用六君加芎、归、柴胡。
六君子汤（见经期腹痛）
若因肝经之火而血下行，用奇效四物汤，或四物加柴、栀、芩、术。
奇效四物汤（见血热论外方）
四物汤（见经不调）
若肝经风热而血妄行，用加味逍遥散，或小柴胡加栀、芍、丹皮。若怒动肝火而血沸腾，亦用前药。
加味逍遥散（见经不调）
小柴胡汤（见《古方八阵·散阵》）治邪在肝胆半表半里之间，寒热往来，喜呕，或日晡发热，
胁痛耳聋，郁怒 疟等证。
柴胡（半斤） 半夏（半斤） 人参 甘草 黄芩 生姜（各三两） 大枣（十二枚劈）
上七味，以水一斗二升，煮取六升，去滓，再煎取三升，温服一升，日三服。若胸中烦而不呕，去半夏、
人参，加栝蒌实一枚；若渴者，去半夏加人参，合前成四两半，栝蒌根四两；若腹中痛者，去黄芩加芍药三
两；若胁下痞硬，去大枣加牡蛎四两；若心下悸，小便不利者，去黄芩加茯苓四两；若不渴，外有微热者，去
人参加桂三两，温覆取微汗，愈。若咳者，去人参、大枣、生姜，加五味子半升，干姜二两。
按右方乃汉时古数也，今方改用∶
柴胡（二、三钱） 半夏 黄芩（各一、二钱） 人参（二、三钱） 甘草（五、七分）
上加姜、枣，水煎服。
若脾经郁结而血不归经，用归脾加柴、栀、丹皮。
归脾汤（见经不调）
若悲伤胞络而血下崩，用四君加柴、栀、升麻。
四君子汤（见血虚经乱）
附案 大尹王天成之内，久患崩，自服四物凉血之剂，或作或彻。因怒发热，
其血不止，服前药不应，乃主降火，更加胁腹大痛，手足俱冷。余曰∶此脾胃虚寒所致。先用附子理中汤，
热退痛止。又用济生归脾汤、补中益气汤，崩血顿愈。若泥
“痛无补法”，则误矣。
血崩简易方
一方∶治风热血崩。用荆芥穗，灯火烧焦，为末，每服一、二钱，童便调服。
一方∶治血崩。用陈槐花一两，百草霜半两，为末，每服一、二钱，烧红秤锤，淬酒服。
If the condition is caused by Yin deficiency and blood heat leading to reckless bleeding, Baoyin Decoction (Preserve Yin Decoction) and Jiajian Yiyin Decoction (Modified One-Yin Decoction) are appropriate.
Baoyin Decoction (See "Early Menstruation due to Blood Heat")
Jiajian Yiyin Decoction (See "Late Menstruation due to Blood Heat")
If the condition is caused by excessive fire forcing blood to bleed recklessly without signs of deficiency, Xixin Yin (Fire-Extinguishing Drink), Huangqin San (Scutellaria Powder) added with Xu Duan (Dipsacus Root) and Dan Shen (Salvia Miltiorrhiza) are appropriate.
Xixin Yin (See *New Formulas Eight Arrays · Cold Array*) treats various fires in the Triple Burner and all internal heat; when symptoms are just beginning and mild, clear heat with this formula first. For severe cases, Chou Xin Yin (Fire-Pulling Decoction) is appropriate.
Chen Pi (Tangerine Peel, 8 fen), Huang Qin (Scutellaria Root, 2 qian), Mai Dong (Ophiopogon Tuber), Shao Yao (Peony Root), Huang Bo (Phellodendron Bark), Fu Ling (Poria), Mu Dan Pi (Moutan Cortex, each 1.5 qian).
Add 1.5 zhong of water, decoct to 0.7 zhong, take warm after meals. If liver qi stagnation causes rebellion and injury to the Liver, resulting in hypochondriac pain or triggering bleeding, add Qing Pi (Green Tangerine Peel) and Zhi Zi (Gardenia Fruit).
Huangqin San is the same as Ziqin San (See external formulas for "Blood Heat Theory").
If blood heat is accompanied by slippery discharge, Baoyin Decoction, Huaiyu San (Sophora and Ulmus Powder), and Sheng Dihuang Tang (Rehmannia Decoction) are appropriate.
Baoyin Decoction (See "Early Menstruation due to Blood Heat")
Huaiyu San (See *Ancient Formulas of Furen Gui*) treats metrorrhagia and intestinal wind bleeding.
Huai Hua (Sophora Flower), Di Yu (Sanguisorba Root) (equal parts, stir-fried until charred).
Decoct the above two herbs in wine and drink.
Sheng Dihuang Tang (See *Ancient Formulas Eight Arrays · Consolidate Array*) treats dysentery with bloody stool and continuous metrorrhagia and leukorrhea.
Sheng Di Huang (Rehmanniae Radix, 5 qian), Di Yu (Sanguisorbae Radix, 7.5 qian), Zhi Gan Cao (Prepared Licorice Root, 2.5 qian).
Cut into pieces, add 2 zhong of water, decoct to 1 zhong, divide into two doses taken on an empty stomach and in the evening.
If Liver Fire disturbs the blood, Jiawei Siwu Tang (Modified Four Substances Decoction) is appropriate.
Jiawei Siwu Tang (See "Irregular Menstruation")
If Liver Fire disturbs the blood and rebellious Qi has not yet dispersed, Huagans Tang (Liver-Calming Decoction) or modified Baoyin Decoction should be used.
Huagans Tang (See *New Formulas Eight Arrays · Cold Array*) treats anger injuring the Liver, causing Qi rebellion and blood disturbance, leading to irritability, heat, hypochondriac pain, distension, fullness, and bleeding.
Qing Pi (Green Tangerine Peel), Chen Pi (Tangerine Peel) (each 2 qian), Shao Yao (Peony Root, 2 qian), Dan Pi (Moutan Cortex), Zhi Zi (Gardenia Fruit, stir-fried), Ze Xie (Alisma Rhizome) (each 1.5 qian; if bleeding occurs from the lower orifices, replace with Gan Cao). Tu Bei Mu (Fritillaria Thunbergii Bulb, 2–3 qian).
Add 1.5 zhong of water, decoct to 0.7–0.8 zhong, take warm after meals. If there is bloody stool, add Di Yu (Sanguisorba Root); if there is hematuria, add Mu Tong (Akebia Caulis) each 1.5 qian. If accompanied by chills and fever, add Chai Hu (Bupleurum Root) 1 qian. If fire is excessive, add Huang Qin (Scutellaria Root) 1–2 qian. If there is hypochondriac and abdominal pain, add Bai Jie Zi (Mustard Seed) 1 qian. In cases of significant distension and stagnation, do not use Shao Yao (Peony Root).
Baoyin Decoction (See "Early Menstruation due to Blood Heat")
If blood has stasis and rebellion causing reckless bleeding, Siwu Tang (Four Substances Decoction) and Danshen San (Salvia Powder) are appropriate.
Siwu Tang (See "Irregular Menstruation")
Danshen San (See external backup formulas for "Menstrual Regulation Theory")
If Ying Qi (Nutritive Qi) is insufficient and blood cannot be regulated, leading to reckless bleeding, Wufu Yin (Five Blessings Drink), Siwu Tang (Four Substances Decoction), Sijunzi Tang (Four Gentlemen Decoction), and Bazhen Tang (Eight Treasures Decoction) may be selected according to the situation.
Wufu Yin (See "Early Menstruation due to Blood Heat")
Siwu Tang (See "Irregular Menstruation")
Sijunzi Tang (See "Menstrual Disorder due to Blood Deficiency")
Bazhen Tang (See "Irregular Menstruation")
If Spleen Qi is deficient and sinking, failing to contain blood leading to hemorrhage, Shoupi Jian (Longevity Spleen Decoction), Guipi Tang (Restore the Spleen Decoction), or Sijunzi Tang (Four Gentlemen Decoction) added with Xiong (Ligusticum Rhizome) and Gui (Cinnamon Twig/Cassia Twig) are appropriate. For more severe cases, Juyuan Jian (Raise Source Decoction) is used.
Shoupi Jian (See "Menstrual Disorder due to Blood Deficiency")
Guipi Tang (See "Irregular Menstruation")
Sijunzi Tang (See "Menstrual Disorder due to Blood Deficiency")
Juyuan Jian (See *New Formulas Eight Arrays · Tonify Array*) treats Qi deficiency with sinking, metrorrhagia, blood collapse, Yang collapse, and critical conditions. It is indicated for those unsuitable for tonics like Dang Gui (Angelica Sinensis) and Shu Di (Prepared Rehmannia Root) who only require Qi tonification.
Ren Shen (Ginseng Root), Huang Qi (Astragalus Root, prepared, each 3–5 qian), Zhi Gan Cao (Prepared Licorice Root, 1–2 qian), Sheng Ma (Cimicifuga Rhizome, 5–7 fen, stir-fried), Bai Zhu (Atractylodes Macrocephala Rhizome, stir-fried, 1–2 qian).
Add 1.5 zhong of water, decoct to 0.7–0.8 zhong, take warm. If accompanied by Yang deficiency and cold, Gui (Cinnamon Twig) and Fu Zi (Aconite Lateral Root Preparata) and Gan Jiang (Dried Ginger) may be added as needed. If accompanied by slipping and loss of control, add Wu Mei (Mume Fruit) two pieces, or Wen Ge (Clam Shell) 7–8 fen.
If Spleen and Kidney are deficient and cold, accompanied by vomiting, loose stools, and aversion to cold, Liyin Jian (Nourish Yin Decoction), Wujunzi Jian (Five Gentlemen Decoction), and Lizhong Tang (Regulate the Middle Decoction) are appropriate.
Liyin Jian (See "Cold Menstruation due to Blood Cold")
Wujunzi Jian (See *New Formulas Eight Arrays · Heat Array*) treats Spleen and Stomach deficiency-cold with vomiting, diarrhea, and dampness.
Ren Shen (Ginseng Root, 2–3 qian), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria, each 2 qian), Zhi Gan Cao (Prepared Licorice Root, 1 qian), Gan Jiang (Dried Ginger, stir-fried yellow, 1–2 qian).
Add 1.5 zhong of water and decoct.
Lizhong Tang (See "Menstrual Disorder due to Blood Deficiency")
If Yang Qi is severely deficient and sinking, Siwei San (Four Dimensions Powder) is appropriate.
Siwei San (See *New Formulas Eight Arrays · Heat Array*) treats severe Spleen and Kidney deficiency-cold with slipping and loss of control, unceasing diarrhea, Qi deficiency with sinking, or inability to control bleeding from the anterior and posterior orifices. Nothing surpasses this formula.
Ren Shen (Ginseng Root, 1 liang), Zhi Fu Zi (Prepared Aconite Lateral Root, 2 qian), Gan Jiang (Dried Ginger, stir-fried yellow, 2 qian), Zhi Gan Cao (Prepared Licorice Root, 1–2 qian), Wu Mei Rou (Mume Fruit Flesh, 5 fen or 1 qian, adjust based on taste preference and patient's will),
Alternatively, do not use Wu Mei; this becomes Siwei Huiyang Yin (Four Elements Return Yang Drink).
Grind the above into powder, mix evenly, moisten with water, steam for the time it takes to cook a meal, take out, dry, grind again. Take 1–2 qian per dose, mixed with warm water.
If Spleen and Kidney Yin Qi are insecure, Guyin Jian (Consolidate Yin Decoction), Wuyin Jian (Five Yins Decoction), and Miyuan Jian (Secret Origin Decoction) are appropriate.
Guyin Jian (See "Kidney Deficiency Menstrual Disorder")
Wuyin Jian (See "Menstrual Disorder due to Blood Deficiency")
Miyuan Jian (See "Menstrual Disorder due to Blood Deficiency")
If Liver and Gallbladder Qi is deficient and unable to store blood, there will likely be much fear and timidity. Wufu Yin (Five Blessings Drink), Qifu Yin (Seven Blessings Drink), and Bazhen Tang (Eight Treasures Decoction) are appropriate. If accompanied by Yang deficiency, add Sheng Jiang (Fresh Ginger) and Gui Zhi (Cinnamon Twig).
Wufu Yin (See "Early Menstruation due to Blood Heat")
Qifu Yin (See "Menstrual Disorder due to Blood Deficiency")
Bazhen Tang (See "Irregular Menstruation")
If excessive blood loss leads to blood collapse and Qi exhaustion, Dushen Tang (Single Ginseng Decoction) should be used immediately to lift and grasp the Qi to prevent collapse. Alternatively, Danggui Buxue Tang (Angelica Tonify Blood Decoction) may be used.
Dushen Tang (See *Ancient Formulas Eight Arrays · Tonify Array*) treats various Qi deficiency and Qi collapse, regurgitation, vomiting, panting, and immediate vomiting of food and drink. It is for any critical deficiency condition.
Ren Shen (Ginseng Root, 2 liang).
Add 1 sheng of water, boil to obtain 4 he, take in one hot dose. Administer twice daily. Also, cook congee with Ren Shen (Ginseng Root); this is especially excellent.
*Baojian* Danggui Buxue Tang (See *Ancient Formulas Eight Arrays · Tonify Array*) treats Qi and Blood damage, or deficiency caused by mistaken purgation, skin heat, thirst, red eyes, red face, large and empty pulse, completely absent upon heavy pressure. It is also for conditions caused by hunger, fullness, or overwork.
Huang Qi (Astragali Radix, prepared, 1 liang), Dang Gui (Angelicae Sinensis Radix, 3 qian).
Add 1.5 zhong of water, decoct to 0.8 zhong, take after meals.
If metrorrhagia and leukorrhea have persisted for a long time, with slippery blood that cannot be controlled, astringent and consolidating methods are needed. Longgu San (Dragon Bone Powder), Rusheng San (Like Sage Powder), Qihui San (Seven Ashes Powder) etc., should be used together with Ren Shen (Ginseng Root).
Longgu San (See *Ancient Formulas of Furen Gui*) treats unceasing metrorrhagia.
Long Gu (Dragon Bone), Dang Gui (Angelicae Sinensis Radix), Xiang Fu (Cyperus Rhizome, stir-fried, each 1 liang), Zong Mao Tan (Date Palm Fiber Charcoal, 5 qian).
Grind into fine powder. Take 4 qian per dose, mixed with rice soup on an empty stomach. Avoid greasy foods, chicken, fish, and roasted items.
Rusheng San (See *Ancient Formulas of Furen Gui*) treats metrorrhagia; complete cure after three doses.
Zong Lu Zi (Palmae Fructus), Wu Mei Rou (Mume Fruit Flesh), Gan Jiang (Dried Ginger) (all burned to retain nature, ground into powder, equal parts).
Take 2 qian per dose, mixed with Wu Mei (Mume Fruit) soup on an empty stomach. Another single formula uses only Zong Pi (Date Palm Stem Bark), half burned half raw, ground into powder. Take 2 qian on an empty stomach; this is also excellent.
Qihui San (See *Ancient Formulas of Furen Gui*) treats metrorrhagia with miraculous effect.
Lian Peng Ke (Nelumbinis Nucifera Calyx Shell), Ying Su Ke (Papaveris Capsicum), Yan Xie Ke (Pickled Crab Shell), Yi Mu Cao (Leonuri Herba), Han Lian Cao (Ecliptae Herba), Zong Mao Ye (Date Palm Leaf), Ou Jie (Nelumbinis Rhizomatis Node) (all equal parts, burned to retain nature, ground into powder).
Take 3 qian on an empty stomach, mixed with vinegar-water. A secret formula uses Cotton Seeds (Mian Hua Zi) fried black in a copper pot, ground into powder, taken with yellow wine, 2–3 qian, stopping bleeding in two or three doses. It also treats metrorrhagia, leukorrhea, and post-abortion bleeding.
The treatment principles for blood strangury are generally as described above. However, if the discharge is foul-smelling and the pulse is slippery, it indicates Fire, and cooling methods are appropriate. If the smell is fishy, clear/cold, and the pulse is fine, it indicates Cold, and warming tonification is necessary. In chronic cases, essence is lost endlessly, and the Wei Li (tailgate/kidney gate) is easily exhausted; powerful tonification is required. Guyin Jian (Consolidate Yin Decoction) and Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) are suitable.
Guyin Jian (See "Kidney Deficiency Menstrual Disorder")
Shiquan Dabu Tang (See external backup formulas for "Menstrual Regulation Theory")
Metrorrhagia includes sudden metrorrhagia and chronic metrorrhagia. Sudden metrorrhagia comes rapidly and is easier to treat. Chronic metrorrhagia involves deep pathology and is difficult to treat. Furthermore, as blood is lost through metrorrhagia, volume gradually decreases. If this continues, the condition transforms into strangury/leukorrhea. These syndromes invariably originate from worry, thought, depression, and anger, first damaging the Spleen and Stomach, then affecting the Chong and Ren vessels. Prolonged metrorrhagia depletes True Yin day by day, often leading to alternating chills and fever, cough, and pulses that are wiry-rapid or wide-empty. This represents Yuan Qi deficiency and false heat due to Yin deficiency. It is crucial to use sweet-warm herbs like Ren Shen (Ginseng Root), Di Huang (Rehmannia Root), Dang Gui (Angelica Sinensis), and Bai Zhu (Atractylodes Macrocephala Rhizome) to vigorously tonify the root source, offering hope for recovery. As long as Stomach Qi remains intact and can accept tonification, rescue is possible. If the patient cannot accept tonification and daily cooling measures are used merely to prolong life temporarily, it is ultimately an ill omen.
Treatment of metrorrhagia distinguishes among the Five Zang organs. However, some aspects are distinguishable, while others are not. The distinguishable aspects: Heart and Lung reside above the diaphragm and belong to the Two Yang organs; Liver, Spleen, and Kidney reside below the diaphragm and belong to the Three Yin organs. Treating Yang organs focuses on Qi; treating Yin organs focuses on Essence/Jing. This is what is meant by distinguishable. However, the Five Zang organs transfer disease to one another, and Essence/Qi intermixes; this is the indistinguishable aspect. For example, if the disease originates in the Heart, damaging the Ministerial Fire, it inevitably burdens the Spleen Earth; thus, treating the Spleen is treating the Heart. If the disease originates in the Lung, failing its regulating function, it inevitably damages Kidney Water; thus, treating the Kidney is treating the Lung. The Spleen is the official of the Central Region, managing water and grain. If the supply route fails, all five pathways become diseased. Without investigating the mother organ, treating the Spleen alone is not a good strategy. The Liver is the General official; depression and anger cause disease. If strong, it attacks the Spleen; if weak, it traps itself. Without knowing strength and weakness, attack and tonification may be reversed. Moreover, the Five Zang organs and their Qi are interconnected. Each Zang contains Spirit Qi, Lung Qi, Stomach Qi, Liver Qi, and Kidney Qi. Their interactions, benefits, and harms have subtle mutual dependencies. Therefore, one must understand the root of Zang Qi: where lies its strength? Where lies the key to life and death? What are the essentials of Essence/Qi: where lies its waxing and waning? What are the great laws of attack and tonification: where lies the sequence? Only then can one be called wise and philosophical. To say that the Heart uses Suan Zao Ren (Ziziphus Seed) and Yuan Zhi (Polygala Root); the Lung uses Jie Geng (Platycodon Root) and Mai Dong (Ophiopogon Tuber); the Spleen uses Bai Zhu (Atractylodes Macrocephala Rhizome) and Gan Cao (Licorice Root); the Liver uses Qing Pi (Green Tangerine Peel) and Shao Yao (Peony Root); the Kidney uses Du Huo (Angelica Pubescens Root) and Xuan Shen (Scrophularia Root)—these are superficial views. How could they know the Way of Life and Nature? All syndromes are like this, not just metrorrhagia.
Women in their forties, approaching menopause, often experience gradual obstruction and missed periods. At this time, prevention and observation are most important. If Qi and Blood are harmonious and there are no other diseases, this is simply a natural cessation and need not be worried about. However, if the woman usually suffers from depression and irregular menstruation, and now experiences delayed periods and obstruction, this signals impending metrorrhagia. If the obstruction is shallow, the metrorrhagia will be mild; if the obstruction is long-standing, the metrorrhagia will be severe. This is metrorrhagia caused by obstruction. One should preemptively use Siwu Tang (Four Substances Decoction) or Bazhen Tang (Eight Treasures Decoction) to regulate. Otherwise, fearing prolonged stagnation leading to rupture, the harm will be greater.
After metrorrhagia has occurred, one must distinguish between presence or absence of Fire. If Fire is present, it forces blood; Baoyin Decoction (Preserve Yin Decoction) is indicated. If Fire is absent, it is rupture due to obstruction or stasis. One should remove the old and nourish the new. Use Tiaojing Yin (Regulate Menstruation Drink) first to regulate, then tailor the treatment: if nourishment is needed, use Xiaoying Jian (Small Nourishing Decoction); if consolidation is needed, use Guyin Jian (Consolidate Yin Decoction).
Baoyin Decoction (See "Early Menstruation due to Blood Heat")
Tiaojing Yin (See "Abdominal Pain during Menstruation")
Xiaoying Jian (See "Menstrual Disorder due to Blood Deficiency")
Guyin Jian (See "Kidney Deficiency Menstrual Disorder")
Wang Shuhe said: What are the Five Metrorrhagias? Answer: White metrorrhagia resembles mucus; Red metrorrhagia resembles dark crimson fluid; Yellow metrorrhagia resembles rotten melon; Blue metrorrhagia resembles blue color; Black metrorrhagia resembles clotted blood.
Li Jingyue (Lizhai) said: For the aforementioned syndromes, if treatment is needed because Spleen and Stomach deficiency fails to guide blood back to its source, use Liujunzi Tang (Six Gentlemen Decoction) added with Xiong (Ligusticum Rhizome), Gui (Cinnamon Twig/Cassia Twig), and Chai Hu (Bupleurum Root).
Liujunzi Tang (See "Abdominal Pain during Menstruation")
If blood flows downward due to Liver Fire, use Qixiao Siwu Tang (Miraculous Efficacy Four Substances Decoction) or Siwu Tang (Four Substances Decoction) added with Chai Hu (Bupleurum Root), Zhi Zi (Gardenia Fruit), Huang Qin (Scutellaria Root), and Bai Zhu (Atractylodes Macrocephala Rhizome).
Qixiao Siwu Tang (See external formulas for "Blood Heat Theory")
Siwu Tang (See "Irregular Menstruation")
If blood rebels due to Liver Wind-Heat, use Jiawei Xiaoyao San (Modified Free Wanderer Powder) or Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhi Zi (Gardenia Fruit), Shao Yao (Peony Root), and Dan Pi (Moutan Cortex). If Liver Fire moves due to anger and blood boils, the previous medicines are also used.
Jiawei Xiaoyao San (See "Irregular Menstruation")
Xiao Chaihu Tang (See *Ancient Formulas Eight Arrays · Disperse Array*) treats pathogens in the Shaoyang (half-exterior, half-interior) of the Liver and Gallbladder, alternating chills and fever, frequent vomiting, afternoon fever, hypochondriac pain, deafness, and malaria due to depression/anger.
Chai Hu (Bupleuri Radix, 0.5 jin), Ban Xia (Pinelliae Rhizoma, 0.5 jin), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Huang Qin (Scutellariae Radix), Sheng Jiang (Zingiberis Rhizoma Recens, each 3 liang), Da Zao (Jujubae Fructus, 12 pieces, split).
Boil the above seven ingredients in 12 sheng of water to obtain 6 sheng, strain, decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily. If there is chest irritability but no vomiting, remove Ban Xia (Pinelliae Rhizoma) and Ren Shen (Ginseng Radix et Rhizoma), add Gua Lou Shi (Trichosanthis Fructus) one piece. If thirsty, remove Ban Xia (Pinelliae Rhizoma), add Ren Shen (Ginseng Radix et Rhizoma) to total 4.5 liang, add Gua Lou Gen (Trichosanthis Radix) 4 liang. If abdominal pain, remove Huang Qin (Scutellariae Radix), add Shao Yao (Paeoniae Radix Alba) 3 liang. If hypochondriac fullness/hardness, remove Da Zao (Jujubae Fructus), add Mu Li (Ostrea Concha) 4 liang. If palpitations and difficulty urinating, remove Huang Qin (Scutellariae Radix), add Fu Ling (Poria) 4 liang. If not thirsty but with slight exterior heat, remove Ren Shen (Ginseng Radix et Rhizoma), add Gui Zhi (Cinnamomi Ramulus) 3 liang, cover warmly to induce slight sweating for cure. If coughing, remove Ren Shen (Ginseng Radix et Rhizoma), Da Zao (Jujubae Fructus), Sheng Jiang (Zingiberis Rhizoma Recens), add Wu Wei Zi (Schisandrae Fructus) 0.5 sheng, Gan Jiang (Zingiberis Rhizoma) 2 liang.
Note: The right formula uses Han dynasty measurements. Modern usage converts to:
Chai Hu (Bupleuri Radix, 2–3 qian), Ban Xia (Pinelliae Rhizoma), Huang Qin (Scutellariae Radix) (each 1–2 qian), Ren Shen (Ginseng Radix et Rhizoma, 2–3 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 5–7 fen).
Add Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus), decoct in water and take.
If Spleen depression causes blood to leave its vessels, use Guipi Tang (Restore the Spleen Decoction) added with Chai Hu (Bupleurum Root), Zhi Zi (Gardenia Fruit), and Dan Pi (Moutan Cortex).
Guipi Tang (See "Irregular Menstruation")
If grief injures the Pericardium Collateral causing blood to gush downward, use Sijunzi Tang (Four Gentlemen Decoction) added with Chai Hu (Bupleurum Root), Zhi Zi (Gardenia Fruit), and Sheng Ma (Cimicifugae Rhizoma).
Sijunzi Tang (See "Menstrual Disorder due to Blood Deficiency")
Case Record: The wife of Dayin Wang Tiancheng suffered from chronic metrorrhagia. She self-administered Siwu Tang (Four Substances Decoction) and cooling-blood agents, with intermittent relief. Due to anger and fever, her bleeding continued. Previous medicines failed. The physician advocated clearing fire, which worsened hypochondriac/abdominal pain and caused cold extremities. I stated: This is due to Spleen and Stomach deficiency-cold. First use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction); fever subsided, pain stopped. Then use Jisheng Guipi Tang (Jisheng Restore the Spleen Decoction) and Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction); metrorrhagia ceased instantly. Clinging to "pain has no tonification method" would have been a mistake.
Simple Formula for Metrorrhagia
Formula 1: Treats Wind-Blood Heat Metrorrhagia. Use Jingjie Sui (Schizonepeta Spike), burn scorched with lamp fire, grind into powder. Take 1–2 qian per dose, mixed with child's urine.
Formula 2: Treats Metrorrhagia. Use Chen Huai Hua (Old Sophora Flower) 1 liang, Baicao Shuang (Soot from Hundred Herbs) 0.5 liang, grind into powder. Take 1–2 qian per dose, quench a red-hot steelyard weight in wine and take.