大凡女子自天癸既通而后。气血调和。则经水如期。不先不后。自无崩漏之患。若劳动过极。以致脏腑亏伤。而冲
任二脉。亦虚不能约束其经血。使之如期而下。故或积久或不须积久。忽然暴下。若山之崩。如器之漏。故曰崩漏。究
其原。则有六大端。一由火热。二由虚寒。三由劳伤。四由气陷。五由血瘀。六由虚弱。何以见火热之所由也。或脾胃
伤损。下陷于肾。与相火相合。湿热下迫。血色紫黑。臭如烂肉。中挟白带。则寒作于中。脉必弦细。中挟赤带。则全
由热作。脉必洪数。其症兼腰脐下痛。两胁急缩。心烦闷。心下急。不眠。欲崩。先发寒热。平时临行经。亦发寒热。
此必大补脾胃而升降气血。宜补中益气汤与凉血地黄汤相合加减用。或心气不足。心火大炽。旺于血脉之中。又脾胃失
调。而心火乘之。肌肉颜色如常。此为心病。经水不时下。亦暴下不止。治必大补气血。脾胃少加。镇坠心火。以治其
心。补阴泻阳。而崩自止矣。宜六味丸加黄连、麦冬。或肝经有热。血得热而下行。宜四物汤加柴胡、山栀、苍术。或
风热郁于肝经。血得风而妄行。宜加味逍遥散。或怒动肝火。肝家血热而沸腾。宜小柴胡汤加山栀、丹皮、龙胆。或脾
经郁热。血为热迫而不归经。宜归脾汤加柴胡、山栀、丹皮。或悲哀太过。损伤胞络。令血下注。宜四君子汤加柴胡、
丹皮、山栀。或血为热伤。脉象虚洪。所下皆紫黑色。宜河间生地黄散。或血室有热。崩下不止。服温药不效。宜金华
散。或天暑地热。阳来乘阴。经血沸溢。宜简易黄芩汤。以上皆火热所统之病也。何以见虚寒之所由也。或心气不足。
又劳役饮食不节。其脉两尺弦紧而洪。按之无力。其症脐下如冰。求浓衣被以御寒。白带白滑之物虽多。间下如屋漏水。
下时有鲜血。不多。右尺脉时微洪。屋漏水多。暴下者。是急弦脉为寒多。而洪脉时见乃热少。合而言之。急弦者。北
方寒水多也。洪脉时出者。命门包络之火也。黑物多。赤物少。合现房漏水之状。宜丁香胶艾汤。（此条脉症与方本东垣）
或经候过多。其色瘀黑。甚者崩下。呼吸少气。脐腹冷极。则汗出如雨。尺脉微小。由冲任虚衰。为风冷客乘胞中。气
不能固。宜鹿茸丸。或气血劳伤。冲任脉虚。如经来非时。忽然崩下。或如豆汁。或成血片。或五色相杂。或赤白相兼。
脐腹冷痛。经久未止。令人黄瘦口干。饮食减少。四肢无力。虚烦惊悸。宜伏龙肝散。或经血适下。过服寒凉之药等物。
因愈崩漏。肚腹痞闷。饮食不入。发热烦躁。脉洪大而虚。由脾经气血虚而发躁。缓治则不救。宜八珍汤加炮姜。以上
皆虚寒所统之病也。何以见劳伤之所由也。或因劳役。令脾胃虚弱。气短气逆。自汗不止。身热闷乱。恶见饮食。肢倦
便泄。漏下不止。其色鲜明。宜当归芍药汤。（此条亦本东垣）或思虑伤脾。不能摄血。致令妄行。并健忘怔忡。惊悸不
寐。且心脾伤痛。怠惰少食。宜归脾汤。或忧思郁结。劳伤心经。不能为血之主。遂令妄行。宜柏子仁汤。或缘卒然大
怒。有伤肝脏。而血暴下。宜养血平肝散。以上皆劳伤所统之病也。何以见气陷之所由也。或经漏不止。鲜血。项筋急。
脑痛。脊骨强痛。不思饮食。宜柴胡调经汤。或露下恶血。月水不调。或暴崩不止。多下水浆之物。皆由饮食不节。或
劳伤形体。或素有心气不足。因饮食劳倦。致令心火乘脾。必怠惰嗜卧。四肢不收。困倦乏力。无气以动。气短上气。
逆急上冲。其脉缓而弦急。按之洪大。得之脾土受邪也。脾主滋荣周身者也。心主血。血主脉。二者受邪。病皆在脉。
脉者血之府也。脉者人之神也。心不主令。胞络代之。故曰。心之脉主属心系。心系者。胞络命门之脉也。主月事。皆
由脾胃虚而心胞乘之。故漏下。血水不调也。况脾胃为血气阴阳之根蒂。当除湿去热益气。气上伸以胜其湿。又云。火
郁则发之。宜调经升阳除湿汤。（此条亦本东垣）或冲任气虚。经脉不调。崩中漏下。宜断下汤。以上皆气陷所统之病也。
何以见血瘀之所由也。或血大至。纯下瘀血成腐。势不可止。甚则头目昏晕。四肢厥冷腹痛。宜胶艾汤。或血崩不止。
昏迷不省。宜五灵脂散。或瘀积血崩。所下皆成五色。宜香附子散。或瘀积久而血崩。脐腹 痛。宜立效散。或室女二
七之期。天癸未至而后至。亦有卒然暴下。淋沥不止。有若崩漏者。其失血必多。宜加减四物汤。以上皆血瘀所统之病
也。何以见虚弱之所由也。或崩中不止。结作血片。如鸡肝色。碎烂。宜小蓟根汤。或崩血无度。虚损羸瘦。宜鹿茸散。
或诸虚不足。久不受孕。骨热形羸。而崩中带下。宜补宫丸。或带下漏血不止。及风寒冷热劳损冲任。崩中暴下。腰重
里急。淋沥不断。宜芎 汤。以上皆虚弱所统之病也。就此六者。而分类推之。以究其原。崩漏之病。宁有遗哉。然其
治之。亦必有道矣。方氏云。血属阴静。则循经荣内。动则错经妄行。凡人七情过极。则动五志之火。五志之火亢盛。
则经血暴下。久而不止。谓之崩中。如风动木摇。火燃水沸之类。治崩次第。初用止血以塞其流。中用清热凉血以澄其
源。末用补血以还其旧。若止塞流而不澄源。则滔天之热不可遏。若止澄源而不复旧。则孤孑之阳无以立。故本末不遗。
前后不紊。方可言治。方氏此论。乃治崩要法。医者深悉乎六者之由。而运之以塞流澄源复旧三法。则庶几其得之矣。
脉法 仲景曰。寸口脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。寒虚相搏。此名曰革。妇人则半
产漏下。旋复花汤主之。脉经曰。问曰。五崩何等类。师曰。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。又曰。诊妇人下赤白。日下血数升。脉急疾者死。迟者生。妇人带下。脉浮
恶寒漏下者不治。又曰。尺脉急而弦大。风邪入少阴之经。女子漏白下赤。又曰。漏血下赤白不止。脉小虚滑者生。大
紧实数者死。陈自明曰。寸脉微迟为寒在上焦。则吐血衄血。尺脉微迟。为寒在下焦。则崩血便血。大抵数小为顺。洪
大为逆。大法当调补脾胃为主。又曰。尺寸脉虚者。漏血脉浮者。俱不治。李 曰。脉微弱为少气。女子崩中漏下。致
面色焦枯。心脉独沉。主气郁下流。血崩去红。肾脉浮芤。肾虚也。女人则经漏。后部弹手、阴跷脉也。主里急。
崩漏原由症治 素问曰。阴虚阳搏谓之崩。又曰。少阳司天。初之气。风胜乃摇。候乃大温。其病血崩。陈自
明曰。妇人血崩而心痛甚。名曰杀血心痛。由心脾血虚也。若小产去血过多而心痛甚者亦然。用乌贼骨炒为末。醋汤调
下妙。失笑散亦妙。严用和曰。妇人平居。经脉调适。冲任二脉。互相涵养。阴阳二气不相偏胜。则月事时下。若将理
失宜。喜怒劳役。过度伤肝。肝为血库。伤之则不能藏血于宫。宫不能传血于海。所以崩漏。漏下者。淋沥不断。病之
轻者也。崩中者。忽然暴下。乃漏症之甚者也。倘久不止。面黄肌瘦。虚烦口干。脐腹冷痛。吐逆不食。四肢虚困。甚
则为胀为肿者不治。李杲曰。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。皆由脾胃亏。下
隔于肾。与相火收合。温热下迫。经漏不止。其色紫黑而臭。中有白带者。脉必弦细。寒作于中。中有赤带者。其脉洪
数疾。其热明矣。必腰痛。或脐下痛。临经欲行。先见寒热往来。两胁急缩。兼见脾胃症。如四肢困热。心烦不卧。心
下急。宜以大补气血之药。举养脾胃。微加镇坠心火之药治其心。补阴泻阳。经自止矣。又曰。妇人血崩。是肾水阴虚。
不能镇守包络相火。故血走而崩也。凉血地黄汤。朱震亨曰。东垣治法。洵不容易。但学人尤当寻思急则治标。用白芷
汤调百草霜末。甚者用棕灰。后用四物加炒干姜调理。因劳用参 带升补药。因寒用干姜。因热用黄芩。崩过多。先用
五灵脂末一服。当分寒热。盖五灵脂能行能止。紫色成块者热也。四物加黄连之类。李 曰。崩漏之由。虚与热而已。
治法多端。随症制宜。如经行犯房。劳役过度。气血俱虚。忽然暴下者。宜大补气血。气虚。四物加参、 。血虚。四
物加胶、艾、炒干姜。虚寒脐腹冷痛。伏龙肝散。膏粱浓味。致脾湿下流于胃。与相火合为湿热。迫经下漏者。解毒四
物汤、四物坎离丸。饮食失节。火乘脾胃下陷。容颜似无病。而外见脾气困倦。烦热不卧者。宜补阴泻阳。升阳调经汤、
升阳举经汤。子宫为四气相搏。血亦难停者。风搏。不换金正气散加川芎、官桂。四物加荆芥。寒搏。及年老久崩。伏
龙肝散加附子、鹿茸、阿胶蒲黄丸。暑搏。单芩心丸。或益元散加百草霜。湿搏。升阳除湿汤。悲哀甚而包络绝。包络
绝而阳气内陷。发则心下崩。数溲血者。备金散、四制香附丸。徐春甫曰。崩漏最为大病。年少之人。火炽血热。房事
过多。经行交感。俱致斯疾。大都凉血固涩。升气益荣。而可愈也。中年以上人。及高年寡妇。多是忧虑过度。气血俱
虚。此为难治。必须大补气血。养脾升胃固血。庶保十之二三。若不早治。正如圯厦之难支也。盖血崩症。有因虚。有
因热。虚则下陷。热则流溢。视其缓急标本治之。缓用四物加条芩、附子。急用神效丸。有因血脏虚冷。宜四物加黄芩、
阿胶、参、 。东垣谓崩带下久。有属于寒。不可一论。王肯堂曰。冷者。脉紧细。手足寒。红而淡黑。或五色。当归
建中汤加龙骨、血竭、附子。送下紫石英丸。热者脉洪。四肢温。心烦。口苦燥。血沸而成。黄芩汤、清心莲子饮。加
竹沥、生地。甚者生地汁、磨京墨、百草霜冷服。虚者胶艾汤加麦冬、鹿茸、龙骨、枣仁。实者腹中痛。四物加香附。
心虚者。恍惚多梦。健忘。舌强盗汗。小便多而红。柏子仁汤。酸枣仁汤加龙骨、京墨、百草霜。若崩中。作麝香、当
归、香者。（者疑为附之误）心气已散。急服灵砂、龙骨等。又曰。血者心之色也。血见黑即止。肾水制心火故也。又曰。
凡血崩。脉沉弦而洪。或沉细而数。或崩而又兼久泻者。皆胃气下陷也。故以升举为要。万全曰。崩中多因中气虚。不
能收敛其血。加以积热在里。迫血妄行。故令暴崩。崩久不止。遂成下漏。治法。初病宜止血。四物调十灰散。以血止
为度。次则清热。用凉血地黄汤。如血未尽。再吞十灰丸。血已尽止。里热尽除。然后补其虚。宜加味补中益气汤、地
黄丸、参术大补丸。以平为度。武之望曰。丹溪云。涎郁胸中。清气不升。故经脉壅遏而降下。非开涎不足以行气。非
气升则血不能归隧道。此论血泄之义甚明。盖开胸膈浊涎。则清气升。清气升则血归隧道。不崩矣。故其症或腹满如孕。
或脐腹 痛。或血结成片。或血出则快。止则闷。或脐上动。其治法。宜开结痰。行滞气。消瘀血。余尝谓丹溪先生善
治痰。观此另得一种见解。不益信哉。
鳌按。痰郁气遏。是崩漏中有此一症。非必定如是也。
Generally speaking, after a woman's menstruation begins (Tian Gui), if her Qi and Blood are harmonious, her menstrual period will arrive on schedule, neither early nor late, and naturally there will be no risk of metrorrhagia and metrostaxis (Beng Lou). However, if excessive labor leads to damage of the Zang-Fu organs, and the Chong and Ren meridians (the two main meridians regulating menstruation) become deficient and unable to constrain the menstrual blood to flow on time, then sometimes after accumulation for a long time, or sometimes without much accumulation, sudden profuse bleeding occurs. It is like a mountain collapsing or a vessel leaking, hence it is called Beng Lou. Investigating its root causes, there are six main categories: one is caused by Fire-Heat, two by Deficiency-Cold, three by Labor Injury, four by Qi Sinking, five by Blood Stasis, and six by Weakness.
How can one identify that it is caused by Fire-Heat? If the Spleen and Stomach are damaged, Qi sinks into the Kidney, combining with Ministerial Fire (Xiang Huo, fire residing in the Liver and Kidneys), causing Damp-Heat to press downward. The blood color is purple-black, smelling like rotting meat, mixed with white leukorrhea; this indicates Cold in the Middle Jiao, and the pulse must be wiry and fine. If mixed with red leukorrhea, it is entirely due to Heat, and the pulse must be surging and rapid. Symptoms include pain in the lower back and below the umbilicus, tightness and contraction of both hypochondria, mental restlessness and oppression, urgency in the epigastrium, insomnia, a sensation that metrorrhagia is about to occur, preceded by alternating chills and fever. Even normally, before the onset of menstruation, alternating chills and fever may occur. This condition requires greatly tonifying the Spleen and Stomach to regulate the ascending and descending of Qi and Blood. It is appropriate to combine Bu Zhong Yi Qi Tang (Supplement the Middle and Augment the Qi Decoction) with Liang Xue Di Huang Tang (Cool the Blood and Rehmannia Decoction) and modify accordingly. Or, if Heart Qi is insufficient and Heart Fire blazes, flourishing within the blood vessels, combined with Spleen-Stomach dysfunction where Heart Fire overacts on the Spleen, while muscle color remains normal, this is a Heart disease. Menstrual blood flows irregularly and stops not even with sudden profuse bleeding. Treatment must greatly tonify Qi and Blood, slightly regulate the Spleen-Stomach, suppress Heart Fire to treat the Heart, nourish Yin and purge Yang, so that metrorrhagia and metrostaxis will stop naturally. Liu Wei Wan (Six-Ingredient Pill with Rehmannia) added with Huang Lian (Coptis Rhizome) and Mai Dong (Ophiopogon Tuber) is suitable. Or, if there is Heat in the Liver Meridian, blood flows downward due to Heat, Si Wu Tang (Four Substances Decoction) added with Chai Hu (Bupleurum Root), Shan Zhi (Gardeniae Fructus), and Cang Zhu (Atractylodis Rhizoma) is suitable. Or, if Wind-Heat stagnates in the Liver Meridian, blood acts recklessly due to Wind, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) is suitable. Or, if anger stirs Liver Fire, causing Liver Blood Heat to boil, Xiao Chai Hu Tang (Minor Blue Green Dragon Decoction) added with Shan Zhi, Dan Pi (Moutan Cortex), and Long Dan (Gentianae Radix) is suitable. Or, if Heat stagnates in the Spleen Meridian, blood is forced by Heat not to return to its vessels, Gui Pi Tang (Restore the Spleen Decoction) added with Chai Hu, Shan Zhi, and Dan Pi is suitable. Or, if excessive grief damages the Bao Luo (Pericardium/uterine collaterals), causing blood to pour downward, Si Jun Zi Tang (Four Gentlemen Decoction) added with Chai Hu, Dan Pi, and Shan Zhi is suitable. Or, if blood is injured by Heat, the pulse is deficient and surging, and the discharged blood is all purple-black, He Jian Sheng Di Huang San (He Jian's Rehmannia Powder) is suitable. Or, if there is Heat in the Blood Chamber (Uterus), causing continuous metrorrhagia unresponsive to warm medicines, Jin Hua San (Golden Flower Powder) is suitable. Or, if summer heat and earth heat cause Yang to invade Yin, boiling and overflowing menstrual blood, Jian Yi Huang Qin Tang (Simple Scutellaria Decoction) is suitable. All the above are diseases governed by Fire-Heat.
How can one identify that it is caused by Deficiency-Cold? Perhaps Heart Qi is insufficient, compounded by labor and irregular diet. The pulse at both Chi positions is wiry, tight, and surging, but weak upon pressure. Symptoms include coldness below the umbilicus as if ice-cold, seeking thick clothes and quilts to ward off cold. Although there is much white leukorrhea and slippery discharge, occasionally "leaking roof" type discharge appears, with small amounts of fresh red blood. The Right Chi pulse is occasionally slightly surging. In cases of abundant "leaking roof" discharge and sudden profuse bleeding, the wiry-tight pulse indicates predominant Cold, while the occasional surging pulse indicates minor Heat. Synthesizing these, the wiry-tight pulse represents abundant Northern Cold Water, while the occasional surving pulse represents the Fire of the Ming Men (Gate of Life) and Pericardium. Abundance of black discharge and scarcity of red discharge present the appearance of leaking roof water. Ding Xiang Jiao Ai Tang (Clove and Moxa Gum Decoction) is suitable. (This section's pulse/symptoms and formula originate from Li Dongyuan). Or, if menstruation is excessively heavy, dark and瘀 (stagnant), severe cases involve profuse bleeding, shortness of breath, extreme cold in the umbilical and abdominal region, sweating like rain, and minute Chi pulses. This is due to deficiency and decline of the Chong and Ren meridians, where Wind-Cold invades the uterus, and Qi fails to consolidate. Lu Rong Wan (Deer Antler Pill) is suitable. Or, if Qi and Blood are injured by labor, and the Chong and Ren meridians are deficient, such that menstruation comes out of season with sudden profuse bleeding, resembling bean curd juice, forming blood clots, mixing five colors, or mixing red and white, with cold pain in the umbilical and abdominal region persisting for a long time, leading to sallow complexion, emaciation, dry mouth, reduced appetite, limb weakness, mental restlessness, palpitations, and fright, Fu Long Gan San (Warming Earth Powder) is suitable. Or, if during menstruation, excessive consumption of cold-cooling medicines worsens the metrorrhagia and metrostaxis, causing abdominal fullness and stuffiness, inability to eat, fever, irritability, and a surging yet deficient pulse, this is irritability caused by Qi and Blood deficiency in the Spleen Meridian. Slow treatment will fail to save the patient; Ba Zhen Tang (Eight Treasures Decoction) added with Pao Jiang (Prepared Ginger) is suitable. All the above are diseases governed by Deficiency-Cold.
How can one identify that it is caused by Labor Injury? Perhaps due to physical labor, the Spleen and Stomach become weak, with shortness of breath, rebellious Qi, incessant spontaneous sweating, body heat with mental confusion, aversion to food, limb fatigue with loose stools, and continuous dripping bleeding with bright color. Dang Gui Shao Yao Tang (Angelica and Peony Decoction) is suitable. (This section also originates from Li Dongyuan). Or, if overthinking injures the Spleen, failing to control blood, causing reckless movement, accompanied by forgetfulness, palpitations, fright, insomnia, heart and spleen pain, lethargy, and poor appetite, Gui Pi Tang is suitable. Or, if worry and thought lead to stagnation, injuring the Heart Meridian through labor, failing to act as the master of blood, causing reckless movement, Bai Zi Ren Tang (Biota Seed Decoction) is suitable. Or, if sudden great anger injures the Liver, causing sudden profuse bleeding, Yang Xue Ping Gan San (Nourish Blood and Calm Liver Powder) is suitable. All the above are diseases governed by Labor Injury.
How can one identify that it is caused by Qi Sinking? Perhaps menstrual leakage continues with fresh blood, tightness of neck tendons, headache, and stiffness/pain in the spine, with loss of appetite. Chai Hu Tiao Jing Tang (Bupleurum Regulating Menstruation Decoction) is suitable. Or, if foul blood leaks, menstruation is irregular, or sudden metrorrhagia occurs with discharge of watery fluids, all due to irregular diet, physical labor injury, or inherent Heart Qi insufficiency. Due to diet and labor fatigue, Heart Fire overacts on the Spleen,必然 leading to lethargy, desire to sleep, limbs not moving freely, fatigue and weakness, lack of energy to move, shortness of breath, upward rushing Qi, and urgent upward rebellion. The pulse is slow and wiry-tight, surging and large upon pressure, resulting from pathogenic invasion of Spleen Earth. The Spleen governs nourishing the whole body. The Heart governs Blood, and Blood governs the Vessels. When both are invaded, the disease manifests in the vessels. Vessels are the residence of Blood. Vessels are the Spirit of humans. When the Heart does not issue commands, the Bao Luo takes over. Thus it is said: The Heart's vessels belong to the Heart System. The Heart System refers to the vessels of the Bao Luo and Ming Men, which govern menstruation. All result from Spleen-Stomach deficiency allowing Heart-Bao to overact, causing leakage and irregular blood/water. Moreover, the Spleen and Stomach are the root of Qi, Blood, Yin, and Yang. One should eliminate Dampness, remove Heat, and tonify Qi, letting Qi rise to overcome Dampness. It is also said: When Fire is stagnant, it should be dispersed. Tiao Jing Sheng Yang Chu Shi Tang (Regulate Menstruation, Raise Yang, Eliminate Dampness Decoction) is suitable. (This section also originates from Li Dongyuan). Or, if Chong and Ren Qi is deficient, meridians are irregular, with metrorrhagia and metrostaxis, Duan Xia Tang (Stop Downward Flow Decoction) is suitable. All the above are diseases governed by Qi Sinking.
How can one identify that it is caused by Blood Stasis? Perhaps blood volume is huge, discharging only putrid blood clots, unstoppable, even leading to dizziness of head and eyes, cold extremities, and abdominal pain. Jiao Ai Tang (Donkey-Hide Gelatin and Mugwort Decoction) is suitable. Or, if blood metrorrhagia continues with coma and unconsciousness, Wu Ling Zhi San (Trogopterus Dung Powder) is suitable. Or, if stasis accumulation causes blood metrorrhagia, discharging five-colored substances, Xiang Fu Zi San (Cyperi Rhizoma Powder) is suitable. Or, if long-term stasis accumulation causes blood metrorrhagia with abdominal pain, Li Xiao San (Instant Efficacy Powder) is suitable. Or, for unmarried girls around age fourteen (Er Qi), when Tian Gui has not yet arrived but subsequently arrives, sudden profuse bleeding with continuous dripping, resembling metrorrhagia and metrostaxis, involves significant blood loss. Jia Jian Si Wu Tang (Modified Four Substances Decoction) is suitable. All the above are diseases governed by Blood Stasis.
How can one identify that it is caused by Weakness? Perhaps metrorrhagia continues, forming blood clots like chicken liver color, fragmented and rotten. Xiao Ji Gen Tang (Small Thistle Root Decoction) is suitable. Or, if blood metrorrhagia is boundless, leading to deficiency, emaciation, and weakness, Lu Rong San (Deer Antler Powder) is suitable. Or, if various deficiencies exist, infertility persists, with bone heat and emaciation, accompanied by metrorrhagia and leukorrhea, Bu Gong Wan (Tonify Uterus Pill) is suitable. Or, if leukorrhea and dripping blood continue, and Wind-Cold-Heat labor injures Chong and Ren, causing sudden metrorrhagia, heavy waist with internal tension, and continuous dripping, Xiong Tang (Peony and Ligusticum Decoction) is suitable. All the above are diseases governed by Weakness.
By classifying and deducing from these six aspects to investigate their origins, are there any omissions in the disease of metrorrhagia and metrostaxis? However, treating it must follow a method. Fang Shi said: Blood belongs to Yin and is quiet; it circulates within the vessels to nourish internally. When moved, it flows recklessly out of course. Extreme emotional fluctuations stir the Fire of the Five Wills. When this Fire is hyperactive, menstrual blood flows profusely and does not stop for a long time, called Metrorrhagia (Beng Zhong). It is like wind shaking trees or fire boiling water. The sequence for treating metrorrhagia is: first, use hemostatics to block the flow (Sa Liu); second, use clearing Heat and cooling Blood to clarify the source (Cheng Yuan); third, use blood-tonifying herbs to restore the original state (Fu Jiu). If one only blocks the flow without clarifying the source, the raging heat cannot be contained. If one only clarifies the source without restoring the original state, the isolated Yang has nothing to stand upon. Therefore, neither root nor branch should be neglected, and order should not be confused, before one can speak of treatment. Fang Shi's theory is the essential method for treating metrorrhagia. If physicians deeply understand the six causes and apply the three methods of blocking flow, clarifying source, and restoring original state, they will likely succeed.
Pulse Methods: Zhang Zhongjing said: The Cun Kou pulse is wiry and large. Wiry indicates reduction, Large indicates hollow. Reduction indicates Cold, Hollow indicates Deficiency. Cold and Deficiency interacting is named Ge (Leather) pulse. In women, this causes miscarriage and leakage. Xuan Fu Hua Tang (Inula Flower Decoction) governs it. Mai Jing said: Question: What are the categories of the Five Bengs? Master said: White Beng resembles mucus. Red Beng resembles crimson fluid. Yellow Beng resembles rotten melon. Green Beng resembles blue color. Black Beng resembles coagulated blood. It also says: Diagnosing women with red and white discharge, losing several sheng of blood daily, death if the pulse is rapid, life if slow. Women with leukorrhea, floating pulse, aversion to cold, and leakage are incurable. It also says: Chi pulse urgent, wiry, and large indicates Wind Pathogen entering the Shaoyin Meridian, causing women to leak white and red discharge. It also says: Continuous leakage of red and white blood, life if the pulse is small, deficient, and slippery; death if large, tight, solid, and rapid. Chen Ziming said: Cun pulse slightly slow indicates Cold in the Upper Jiao, causing hematemesis and epistaxis. Chi pulse slightly slow indicates Cold in the Lower Jiao, causing metrorrhagia and hematochezia. Generally, small and rapid pulses are favorable, surging and large pulses are unfavorable. The general principle is to primarily regulate and tonify the Spleen and Stomach. It also says: Deficient pulses at Cun and Chi positions, and floating pulses in leakage, are both incurable. Li [Missing Character] said: Weak and minute pulse indicates shortness of Qi. Women with metrorrhagia and leakage develop sallow and withered complexions. A solitary sinking Heart pulse indicates Qi depression flowing downward and blood loss. Floating and hollow Kidney pulse indicates Kidney Deficiency. In women, this causes menstrual leakage. The posterior part beating against the finger is the Yin Qiao Mai, governing internal tension.
Causes and Treatments of Metrorrhagia and Metrostaxis: Su Wen said: Yin Deficiency with Yang pounding is called Beng. It also said: When Shaoyang rules the year, in the first Qi phase, Wind dominance causes shaking, weather becomes very warm, and the disease is blood metrorrhagia. Chen Ziming said: Women with blood metrorrhagia and severe heart pain are named Sha Xue Xin Tong (Killing Blood Heart Pain), caused by Heart and Spleen Blood Deficiency. The same applies if heart pain is severe after miscarriage due to excessive blood loss. Using cuttlefish bone (Hai Piao Xiao) fried into powder, taken with vinegar soup is excellent. Shi Xiao San (Sorrow-Dispersing Powder) is also excellent. Yan Yonghe said: When women are at peace, meridians are regulated, Chong and Ren meridians nourish each other, and Yin and Yang Qi do not dominate, menstruation arrives monthly. If care is improper, anger, joy, labor, and strain excessively injure the Liver. The Liver is the repository of blood; if injured, it cannot store blood in the uterus, and the uterus cannot transmit blood to the Sea of Blood, hence metrorrhagia and metrostaxis. Leaking (Lou) is continuous dripping, a mild disease. Metrorrhagia (Beng) is sudden profuse bleeding, the severe form of leaking. If it does not stop for long, leading to sallow face, emaciated muscles, mental restlessness, dry mouth, cold pain in umbilicus and abdomen, vomiting, inability to eat, limb weakness, and eventually distension and edema, it is incurable. Li Gao said: Women with Spleen-Stomach deficiency manifest Ming Men pulse as deep, fine, and rapid, or deep, wiry, and strongly surging, with Cun and Guan pulses similar. All result from Spleen-Stomach deficiency, sinking past the Kidney, combining with Ministerial Fire, causing warm-heat pressing downward, continuous menstrual leakage, purple-black smelly blood, mixed with white leukorrhea, pulse wiry and fine, indicating Cold in the middle. Mixed with red leukorrhea, pulse is surging, rapid, and疾 (fast), clearly indicating Heat. Must have lower back pain or umbilical pain. Before menstruation, alternating chills and fever, tightness of hypochondria, combined with Spleen-Stomach symptoms like limb heat, mental restlessness, insomnia, and epigastric urgency. Use greatly tonifying Qi and Blood medicines to raise and nourish the Spleen-Stomach, slightly adding medicines to suppress Heart Fire to treat the Heart, nourish Yin and purge Yang, and menstruation will stop naturally. It also said: Women's blood metrorrhagia is due to Kidney Water Yin Deficiency, unable to suppress Pericardium Ministerial Fire, causing blood to flee and burst. Liang Xue Di Huang Tang governs it. Zhu Zhenheng said: Dongyuan's treatment methods are indeed not easy. But students must ponder "treat the acute aspect first." Use Bai Zhi Tang (Angelica Dahurica Decoction) to mix Bai Cao Shuang (Charred Grass Ash) powder; for severe cases, use palm ash. Later, regulate with Si Wu Tang added with fried Gan Jiang (Dried Ginger). For labor-induced cases, use Shen (Ginseng) [Missing Character] with ascending and tonifying medicines. For Cold, use Gan Jiang. For Heat, use Huang Qin (Scutellaria Root). For excessive bleeding, first take Wu Ling Zhi (Trogopterus Dung) powder once, distinguishing Cold and Heat. Wu Ling Zhi can promote circulation and stop bleeding. Purple clotted blood indicates Heat; Si Wu Tang added with Huang Lian is suitable. Li [Missing Character] said: The causes of metrorrhagia and metrostaxis are merely Deficiency and Heat. Treatment methods vary according to symptoms. For example, intercourse during menstruation or excessive labor causing Qi and Blood deficiency with sudden profuse bleeding requires greatly tonifying Qi and Blood. For Qi Deficiency, Si Wu Tang added with Shen [Missing Character]. For Blood Deficiency, Si Wu Tang added with E Jiao (Donkey-Hide Gelatin), Ai Ye (Mugwort Leaf), and fried Gan Jiang. For Deficiency-Cold with umbilical/abdominal cold pain, Fu Long Gan San. Rich foods causing Spleen Dampness flowing to Stomach, combining with Ministerial Fire to form Damp-Heat forcing menstruation downward, require Jie Du Si Wu Tang (Detoxify Four Substances Decoction) or Si Wu Kan Li Wan (Four Substances Kan-Li Pill). Irregular diet causing Fire to invade Sinking Spleen-Stomach, face appearing healthy but externally showing Spleen Qi fatigue, irritability, and insomnia, require nourishing Yin, purging Yang, and ascending Yang to regulate menstruation: Sheng Yang Tiao Jing Tang or Sheng Yang Ju Jing Tang. If the uterus is attacked by four pathogens, blood is hard to stop: Wind attack, Bu Huan Jin Zheng Qi San added with Chuan Xiong (Ligusticum Chuanxiong Rhizome) and Guan Gui (Cinnamon Bark); Si Wu Tang added with Jing Jie (Schizonepeta Spike). Cold attack, and old age with chronic metrorrhagia, Fu Long Gan San added with Fu Zi (Aconite Lateralis Radix Praeparata), Lu Rong (Deer Antler), E Jiao, and Pu Huang (Typha Pollen) Wan. Summer Heat attack, Dan Qin Xin Wan (Single Scutellaria Heart Pill) or Yi Yuan San (Benefit Origin Powder) added with Bai Cao Shuang. Dampness attack, Sheng Yang Chu Shi Tang. Severe grief severing the Bao Luo, causing Yang Qi to sink internally, manifesting as heart-bottom metrorrhagia and frequent urination of blood, Bei Jin San (Prepare Metal Powder) or Si Zhi Xiang Fu Wan (Four-Processed Cyperi Rhizoma Pill). Xu Chunfu said: Metrorrhagia and metrostaxis are major diseases. Young people with blazing Fire and hot Blood, excessive sexual activity, or intercourse during menstruation all contract this disease. Generally, cooling Blood, astringing, raising Qi, and benefiting Ying can cure it. People over middle age and elderly widows often suffer from excessive worry, Qi and Blood deficiency, making it difficult to treat. Must greatly tonify Qi and Blood, nourish Spleen, raise Stomach, and consolidate Blood, preserving two or three out of ten lives. If not treated early, it is like supporting a collapsing building. Blood metrorrhagia is caused by Deficiency or Heat. Deficiency causes sinking, Heat causes overflow. Treat based on urgency and root/branch. For chronic cases, Si Wu Tang added with Tiao Qin (Scutellaria) and Fu Zi. For acute cases, Shen Xiao Wan (Divine Efficacy Pill). For Blood Organ Deficiency-Cold, Si Wu Tang added with Huang Qin, E Jiao, Shen [Missing Character]. Dongyuan stated that chronic metrorrhagia and leukorrhea can belong to Cold, not solely one theory. Wang Kentang said: Cold type: pulse tight and fine, cold hands and feet, red but pale black or five-colored discharge. Dang Gui Jian Zhong Tang added with Long Gu (Fossilized Bones), Xue Jie (Dragon's Blood), and Fu Zi. Administer Zi Shi Ying Wan (Purple Quartz Pill). Heat type: surging pulse, warm limbs, mental restlessness, bitter and dry mouth, blood boiling. Huang Qin Tang or Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction) added with Zhu Li (Bamboo Sap) and Sheng Di (Rehmannia Root). For severe cases, Sheng Di juice, ground Jing Mo (Beijing Ink), and Bai Cao Shuang taken cold. Deficiency type: Jiao Ai Tang added with Mai Dong, Lu Rong, Long Gu, and Zao Ren (Ziziphus Seed). Excess type: abdominal pain, Si Wu Tang added with Xiang Fu (Cyperi Rhizoma). Heart Deficiency type: trance, many dreams, forgetfulness, stiff tongue, night sweats, frequent red urine. Bai Zi Ren Tang or Suan Zao Ren Tang added with Long Gu, Jing Mo, and Bai Cao Shuang. If metrorrhagia occurs, make Musk, Dang Gui, and Xiang [Missing Character] (Suspected error for Fu). If Heart Qi has scattered, urgently take Ling Sha (Spirit Mercury) and Long Gu. It also said: Blood is the color of the Heart; blood stops upon seeing black because Kidney Water controls Heart Fire. It also said: For all blood metrorrhagia, if pulse is deep, wiry, and surging, or deep, fine, and rapid, or metrorrhagia accompanied by chronic diarrhea, all indicate Stomach Qi sinking. Therefore, raising and lifting is essential. Wan Quan said: Metrorrhagia is mostly due to Middle Qi deficiency, unable to converge blood, compounded by accumulated Heat inside forcing blood to run recklessly, causing sudden metrorrhagia. Chronic metrorrhagia becomes leakage. Treatment: early stage should stop bleeding, Si Wu Tiao Shi Hui San (Four Substances Regulating Ten Ashes Powder), stopping when bleeding ceases. Next, clear Heat using Liang Xue Di Huang Tang. If blood is not exhausted, swallow Shi Hui Wan (Ten Ashes Pill). Once blood stops and internal Heat is cleared, then tonify deficiency with Jia Wei Bu Zhong Yi Qi Tang, Di Huang Wan (Rehmannia Pill), or Shen Zhu Da Bu Wan (Ginseng and Atractylodes Great Tonification Pill), aiming for balance. Wu Zhiwang said: Danxi said: Phlegm-Damp stagnates in the chest, Clear Qi does not ascend, thus meridians are blocked and descend. Without opening phlegm, Qi cannot move; without Qi rising, Blood cannot return to tunnels. This explains blood leakage clearly. Opening turbid phlegm in chest/diaphragm allows Clear Qi to ascend; when Clear Qi ascends, Blood returns to tunnels, and metrorrhagia stops. Thus symptoms may include abdominal fullness like pregnancy, umbilical pain, blood forming clots, relief upon bleeding but oppression when stopped, or movement above umbilicus. Treatment should resolve phlegm clots, move stagnant Qi, and dissipate blood stasis. I once said Mr. Danxi was good at treating phlegm; observing this reveals another perspective, confirming his wisdom.
Shen Jin'ao notes: Phlegm stagnation and Qi constraint is one symptom in metrorrhagia and metrostaxis, but not necessarily always so.