淋沥不断名为漏，忽然大下谓之崩。紫黑块痛多属热，日久行多损任冲。脾虚不摄中气陷。暴怒伤肝
血妄行。临证察因须细辨，虚补瘀消热用清。
【注】妇人经行之后，淋沥不止，名曰经漏。经血忽然大下不止，名为经崩。若其色
紫黑成块，腹胁胀痛者，属热瘀；若日久不止，及去血过多而无块痛者，多系损伤任、冲
二经所致。更有忧思伤脾，脾虚不能摄血者；有中气下陷不能固血者；有暴怒伤肝，肝不
藏血而血妄行者。临证之时，须详审其因，而细细辨之。虚者补之，瘀者消之，热者清之。
治之得法，自无不愈。
荆芩四物汤
崩漏血多物胶艾，热多知柏少芩荆。漏涩香附桃红破，崩初胀痛琥珀攻。日久气血冲任损，
八珍大补养荣宁。思虑伤脾归脾治，伤肝逍遥香附青。
【注】崩血、漏血去血过多者，宜用胶艾四物汤补之，如属热多者，宜用知柏四物汤
清之；热少者，宜用荆芩四物汤和之。若漏血涩少，此属血滞，宜用四物汤加香附、桃
仁、红花破之。若崩血初起胀痛，此属瘀凝，宜用琥珀散攻之，崩漏日久，气血已亏，冲
伍伤损者，宜用八珍汤、十全大补汤、人参养荣汤，量补其损伤。若因思虑伤脾者，宜
用归脾汤补之；恚怒伤肝者，宜用逍遥散加炒香附、青皮平之。
胶艾四物汤 四物汤 琥珀散 八珍汤 十全大补汤 人参养荣汤 归脾汤 逍遥散（方俱见前调经汇方内）
补中益气汤 益胃升阳汤
气陷补中益气举，保元升柴归术陈，益胃升阳加芩曲，腹痛加芍嗽减参。
【注】崩漏日久，脾伤食少，中气下陷，不能载血者，宜用补中益气汤、益胃升阳汤
升举之。补中益气汤即人参、黄 、甘草（保元汤）加升麻、柴胡、当归、白术、陈皮
也。益胃升阳汤即补中益气汤加黄芩，神曲也。若腹痛者，宜加白芍药，有热者用黄芩，
无热者用肉桂调之；咳嗽者，肺热也，减人参。
调经升阳除湿汤
夹水水泻不甚弱，调经升阳除湿汤∶ 草升柴归苍术，羌独 本蔓荆防。
【注】崩漏下血夹水，或日水泻一二次，形气不甚弱者，宜用调经升阳除湿汤。其方
即黄 、甘草、升麻、柴胡、当归、苍术、羌活、独活、 本、蔓荆子、防风也，以风药
先胜其湿。若形气虚弱者，则当加人参、陈皮，合补中益气汤，补中胜湿可也。
失笑散 地榆苦酒煎
杀血心痛失笑散，蒲黄五灵脂定疼。崩血不已防滑脱，地榆苦酒煎止崩。
【注】崩血心腹痛甚者，名曰杀血。心痛乃血滞不散，宜用失笑散，其方即蒲黄、五
灵脂也。先定其痛，痛止然后随证治之。若崩血，补之仍然不止者，当防其滑脱，宜用
地榆一两，醋煎，露一宿，次早温服立止，止后随证治之，名地榆苦酒煎。
Dripping continuously is called "Lou" (Leukorrhea/Metrorrhagia), while sudden heavy flow is called "Beng" (Metrorrhagia/Menorrhagia). Purple-black clots with pain mostly belong to Heat; long-standing excessive bleeding damages the Ren and Chong vessels. Spleen deficiency fails to control blood, leading to sinking of Middle Qi; violent anger injures the Liver, causing blood to move recklessly. In clinical practice, one must carefully distinguish the etiology: tonify deficiency, resolve stasis, and clear heat.
[Note] After menstruation, if dripping continues without stopping, it is named "Jing Lou" (Menstrual Leukorrhea/Metrorrhagia). If menstrual blood suddenly flows heavily without stopping, it is named "Jing Beng" (Menstrual Metrorrhagia/Menorrhagia). If the color is purple-black with clots and accompanied by abdominal and hypochondriac distending pain, it belongs to Heat-Stasis; if it lasts for a long time or involves excessive blood loss without clots or pain, it is mostly due to damage to the Ren and Chong vessels. Furthermore, there are cases where worry and overthinking injure the Spleen, and Spleen deficiency fails to control blood; cases where Middle Qi sinks and fails to secure blood; and cases where violent anger injures the Liver, causing the Liver to fail to store blood, resulting in reckless movement of blood. During clinical examination, one must meticulously investigate the cause and differentiate carefully. Tonify those who are deficient, resolve those with stasis, and clear those with heat. With proper treatment, recovery is inevitable.
Jingqin Siwu Decoction (Scutellaria and Schizonepeta Four Substances Decoction)
For heavy bleeding in Beng and Lou, use Jiaoai Siwu Tang (Cinnamon Twig and Osmunda Decoction); for significant Heat, use Zhibai Siwu Tang (Anemarrhena and Phellodendron Four Substances Decoction) or a small amount of Jingjie (Schizonepeta Herba) and Huangqin (Scutellariae Radix). For scanty, obstructed Lou, use Xiangfu (Cyperi Rhizoma), Taoren (Persicae Semen), and Honghua (Carthami Flos) to break stasis; for initial Beng with distending pain, use Hupo (Succinum) to attack stasis. For long-standing depletion of Qi and Blood and damage to Chong and Ren, use Bazhen Tang (Eight Treasures Decoction) to greatly tonify and nourish Ying and calm the Spirit. For Spleen injury due to overthinking, use Guipi Tang (Restore the Spleen Decoction); for Liver injury, use Xiaoyao San (Free Wanderer Powder) with added Xiangfu and Qingpi (Aurantii Fructus Pericarpium).
[Note] For excessive blood loss in Beng and Lou, Jiaoai Siwu Tang should be used for tonification; if Heat is predominant, Zhibai Siwu Tang should be used for clearing; if Heat is slight, Jingqin Siwu Tang should be used for harmonizing. If Lou is scanty and obstructed, this indicates Blood stasis, and Siwu Tang (Four Substances Decoction) with added Xiangfu, Taoren, and Honghua should be used to break stasis. If initial Beng presents with distending pain, this indicates Stasis coagulation, and Hupo San (Amber Powder) should be used to attack stasis. For long-standing Beng and Lou with depleted Qi and Blood and damaged Chong and Ren vessels, Bazhen Tang, Shiquan Dabu Tang (Ten Significant Great Tonifying Decoction), and Renshen Yangrong Tang (Ginseng Nourishing the Spirit Decoction) should be used to tonify the damage according to severity. For Spleen injury due to overthinking, Guipi Tang should be used for tonification; for Liver injury due to rage, Xiaoyao San with fried Xiangfu and Qingpi should be used to soothe the Liver.
(All formulas are listed in the preceding section on Menstrual Regulation Formulas)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) & Yiwei Shengyang Tang (Benefit the Stomach and Raise the Yang Decoction)
For sinking Qi, use Buzhong Yiqi Tang to raise it; Baoyuan Tang contains Renshen (Ginseng Radix), Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium); Yiwei Shengyang Tang adds Huangqin and Shenqu (Massae Fermentatae Medicinalis) to Buzhong Yiqi Tang; add Shaoyao (Paeoniae Radix Alba) for abdominal pain, reduce Renshen for cough.
[Note] For long-standing Beng and Lou with Spleen injury, poor appetite, sinking of Middle Qi, and inability to carry blood, Buzhong Yiqi Tang and Yiwei Shengyang Tang should be used to raise and lift. Buzhong Yiqi Tang consists of Renshen, Huangqi, Gancao (Baoyuan Tang) plus Shengma, Chaihu, Danggui, Baizhu, and Chenpi. Yiwei Shengyang Tang is Buzhong Yiqi Tang plus Huangqin and Shenqu. If there is abdominal pain, add Shaoyao; if there is Heat, use Huangqin; if there is no Heat, use Rougui (Cinnamomi Cortex) for regulation; if there is cough, it indicates Lung Heat, so reduce the dosage of Renshen.
Tiaojing Shengyang Chushi Tang (Regulate Menstruation, Raise Yang, and Expel Dampness Decoction)
For bleeding mixed with water or watery diarrhea without severe weakness, use Tiaojing Shengyang Chushi Tang: Gancao, Shengma, Chaihu, Danggui, Cangzhu (Atractylodis Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Gaoben (Ligustici Rhizoma), Manjingzi (Viticis Semen), and Fangfeng (Saposhnikoviae Radix).
[Note] For metrorrhagia with water-mixed discharge, or one to two episodes of watery diarrhea daily, in patients whose physical constitution and Qi are not severely weak, Tiaojing Shengyang Chushi Tang should be used. This formula consists of Huangqi, Gancao, Shengma, Chaihu, Danggui, Cangzhu, Qianghuo, Duhuo, Gaoben, Manjingzi, and Fangfeng, using wind-dispersing herbs to overcome dampness first. If the physical constitution and Qi are weak, add Renshen and Chenpi, combining with Buzhong Yiqi Tang to strengthen the Middle and overcome dampness.
Shixiao San (Pain-Dismissing Powder) & Diyukujiu Jian (Diyu Vinegar Decoction)
For heart pain caused by massive blood loss, use Shixiao San; Puhuang (Typhae Pollen) and Wulingzhi (Trogopterori Faeces) relieve pain. To prevent collapse from unceasing metrorrhagia, use Diyukujiu Jian to stop bleeding.
[Note] Severe heart and abdominal pain during metrorrhagia is named "Shaxue" (Killing Blood). Heart pain results from stagnant blood that does not disperse; Shixiao San should be used, which consists of Puhuang and Wulingzhi. First settle the pain, and after the pain ceases, treat according to the syndrome. If metrorrhagia persists despite tonification, preventing collapse is necessary; use one liang of Diyuyu (Sanguisorbae Radix), decocted in vinegar, exposed overnight, and taken warm early the next morning to stop bleeding immediately. After cessation, treat according to the syndrome; this is named Diyukujiu Jian.