带下之因有四。一因气虚。脾精不能上升而下陷也。一因胃中湿热及痰。流注于带脉。溢于膀胱。故下浊液也。一
因伤于五脏。故下五色之带也。一因风寒入于胞门。或中经脉。流传脏腑而下也。然有赤白之分者何也。赤者属血属热。
热入小肠而成。若实热郁结。则为赤白兼下。白者属气属寒。寒入大肠而成。因血少复亡其阳。故白滑之物下流。亦有
湿痰流注下焦。或肝肾阴淫之湿。或缘惊恐而木乘土位。浊液下流。或色欲太甚。肾精亏损之故。或产多之妇。伤血伤
液。皆能成带下之疾。宜概用莲须、杜仲、续断之辈。大抵属痰与热者居多。以湿热下注而化痰也。宜投止涩升提之品。
寒者十无一二。宜投鹿角胶温涩之品。然总要健脾燥湿。升提胃气。佐以补涩。如茯苓、白术、柴胡、川芎之类。总之
妇人多郁。郁则伤肝。肝伤则脾受克。湿土下陷。脾精不守。不能输为营血。而白物下流。宜开郁补脾。若色如浓泔臭
秽者。湿热甚也。宜二术、芩、柏、半夏、车前。佐以升提。下如鸡子白状。脾肾虚也。腰腿酸疼。面目浮肿。必脾肾
双补。宜归脾丸、八味丸。妇人又多忧思恚怒。伤损心脾。肺脏之火时发。血走不归经。而患赤白带下。白是脾虚。盖
肝气郁则脾受伤。脾伤则湿胜。皆由风木郁于地中使然耳。宜开提肝气。助补脾元。宜补中益气汤加茯苓、枣仁、山药、
苍术、黄柏、麦冬。或六味丸加杜仲、牡蛎。牛膝、海螵蛸。若阴虚火盛。则以滋阴清火为要。宜六味丸加五味子、杞
子、黄柏、车前、菟丝子。昔人云。崩中日久。变为白带。漏下多时。骨水枯竭。何谓也。盖崩久气血虚脱。故白滑之
物。下流不止也。必大补之。赤带多因心火。时炽不已。久而阴血渐虚。中气渐损。而下赤矣。必养心和肝。缓中凉血
清气之品。若赤带久不止。必血虚矣。宜胶艾四物汤加麦冬、杏仁、牡蛎。带下之因。不外乎此。其详更有可述者。如
白带腥臭。多悲不乐。阳气虚衰者。大寒也。宜桂附汤。脉息沉微。赤白带下。腹中痛。阴中亦痛。经来愆期。子宫虚
冷。不能成孕者。寒甚也。宜元戎六合汤。白带久不止。脐腹冷痛。阴中亦痛。经水不止。或因崩后。脉弱无力而酸疼。
由于虚也。宜东垣固真丸。产后去血多。经水不调。白带如倾。淋沥臭秽。亦由虚也。宜卫生汤。内热脉数。赤白带下
不止。由于热也。宜杞子、生地。内火盛。阴虚烦热而赤白带下。或七情所伤。脉数而带下。亦由于热也。宜二黄三白
丸、白芷散。或益母草末酒服。肥人白带。阴户痛。身黄皮缓体重。阴中如水湿也。宜升麻燥湿汤。湿而挟热。大便或
泄或闭。小便塞。脉涩而气盛。湿热也。宜十枣汤。下体畏冷。带下如鸡子白。脾肾虚惫也。宜补骨脂丸加肉桂。漏血
久冷。赤白带下。月水不调。面黄肢弱。经水或多或少。如栀子汁。如屋漏水。血虚而寒也。宜血虚带下方。白带淫水
不绝。精神虚损也。宜八珍汤加升麻、南星、半夏、陈皮、香附。血气不调。湿热白带。四肢倦怠。五心烦热。痰郁嘈
杂也。宜解带散。脉数而白带不止。七情所伤也。宜侧柏樗皮丸。女人 瘕 癖。腹胀胸满。赤白带下。久患血气虚弱。
萎黄无力。乃由寒湿也。宜大圣万安散。赤白带下不止。燥热烦渴。由湿热郁于下焦之分也。宜宣明导水丸。劳役过度。
饮食不节。损伤脾胃。以致阳气下陷。白带久不止也。宜补中益气汤。时时带下。由胃虚有痰。饮食减少。中气不和也。
宜六君子汤。健忘怔忡。惊悸不寐。怠惰体困。不思饮食。时常白带不止。由思虑过伤心脾也。宜归脾汤。脐下冷。撮
痛。阴冷大寒。而白带时下也。宜延胡苦楝汤。劳伤血脉。胞络受寒。小便白浊。日夜无度。脐腹疼痛。腰膝无力也。
宜内金鹿茸丸。 疝。白带下注。香港脚。腰以下冷。尿数。与白带长流而不禁固。肌瘦身重。面白。目无见。行步欹侧。
腿膝枯细。大便闭。心下痞闷。懊 。饮食不下。背寒。此上中下三阳真气俱竭也。故哕呕不止。为胃寒已极。脉沉紧
而涩。按之空虚。为阴寒已竭。宜酒煮当归丸。老年白带白淫不止。日久淋沥。皆气多血少。虚寒力衰也。宜老年白带
方。十全大补汤加益智仁。室女带下纯白。冲任虚寒也。宜白蔹丸。寡妇师尼室女。郁火盛炽。阴户或痒或痛。而成赤
淋。乃血热也。宜泻膀胱之火。宜赤淋丸。其或白淋。则气虚也。宜乌金丸、乌艾丸。如是以治带病。宁有或遗哉。
脉法 脉经曰。诊妇人漏血。下赤白。日下血数升。脉急疾者死。迟者生。又曰。诊妇人漏下赤白不止。脉小
虚滑者生。大紧实数者死。又曰。妇人带下脉浮。恶寒者。不治。又曰。妇人带下。六极之病。脉浮则为肠鸣腹满。紧
则为腹中痛。数则为阴中痒痛生疮。弦则阴中掣痛。李 曰。肾脉浮迟。主患带浊。
带下原由症治 孙思邈曰。诸方说三十六疾者。十二症。九痛。七害。五伤。三痼不通。是也。何谓十二症。
是所下之物。一曰状如膏。二曰如黑血。三曰如紫汁。四曰如赤肉。五曰如脓痂。六曰如豆汁。七曰如葵羹。八曰如凝
血。九曰如清血。血似水。十曰如米泔。十一曰如月浣。乍前乍却。十二曰经度不应期也。何谓九痛。一曰阴中伤痛。
二曰阴中淋沥痛。三曰小便即痛。四曰寒冷痛。五曰经来腹中痛。六曰气满痛。七曰汁出阴中如有虫啮痛。八曰胁下分
痛。九曰腰胯痛。何谓七害。一曰窍孔痛不利。二曰中寒热痛。三曰小腹急坚痛。四曰脏不仁。五曰子门不端引背痛。
六曰月浣乍多乍少。七曰害吐。何谓五伤。一曰两腹支满痛。二曰心痛引胁。三曰气结不通。四曰邪思泄利。五曰前后
痼寒。何谓三痼。一曰羸瘦不生肌肤。二曰绝产乳。三曰经水闭塞。病有异同。方亦不一。又曰三十六种疾。皆由子脏
冷热。劳损而下起于阴内也。陈自明曰。带下有五因。经行产后。邪入胞门。传于脏腑而致之。若伤足厥阴肝经。色如
青泥。伤手少阴心经。色如红津。伤手太阴肺经。形如鼻涕。伤足太阴脾经。色如烂瓜。伤足少阴肾经。黑如 血。人
有带脉横于腰间。如束带之状。病生于此。故名为带。东垣云。血崩久则亡阳。故白滑之物下流。未必全拘于带脉。亦
有湿痰流注下焦。或肾肝阴淫之湿胜。或因惊恐而木乘土位。或思慕为筋痿。戴人以六脉滑大有力。用宣导之法。此泻
其实也。东垣以脉微细沉紧。或洪大而虚。用补阳调经。乃兼责其虚也。丹溪用海石、南星、椿根皮之类。乃治其湿痰
也。窃谓前症皆当壮脾胃升阳气为主。佐以各经见症之药。色青属肝。小柴胡加山栀、防风。湿热壅滞。小便赤涩。龙
胆泻肝汤。肝
血不足。或燥热风热。六味丸。色赤属心。小柴胡加山栀、当归。思虑过伤。妙香散。色白属肺。补中益气汤加山栀。
色黄属脾。六君子加山栀、柴胡。不应。归脾汤。色黑属肾。六味丸。气血俱虚。八珍汤。气血下陷。补中益气汤。湿
痰流注。前汤加茯苓、半夏、苍术、黄柏。气虚痰饮下注。四七汤送六味丸。不可拘肥多痰瘦多火。而以燥湿泻火药轻
治之。张从政曰。圣惠方以带下由风冷。巢氏内篇。又以为寒则多白。热则多赤。二家之说皆非也。盖以冲任督三脉。
皆统于篡户循阴气。行廷孔溺孔之端。以带脉束之。因诸经上下往来遗热于带脉之间。热者血也。血积多日不流。火则
从金之化而为白。乘少腹间冤热。白物滑溢。随溲而下。绵绵不绝。或有痛者。则因壅碍而成痛也。内经曰。少腹冤热。
溲出白液。冤者屈带也。病非本经。为他经冤抑而成此疾也。犹之赤白痢。赤者新积属心火。白者旧积从肺金。故赤白
痢不可曲分寒热。又如痈疖。始赤血。次溃白脓。又岂为寒哉。且赤白痢者。是邪热传于大肠。下广肠。出赤白也。带
下者。传于小肠。入脬经。下赤白也。据此二症。皆可同治湿法以治之。先以导水丸、禹功散泻讫。次以淡剂降心火。
益肾水。
下小溲。分水道。则自愈。然有此法。又不可偏执。更宜详其虚实而用之。内经惟肠 便血。血温身热者死。赤白带下。
白液白物。蛊病肾消。皆不能死。人有死者。药之过也。室女同。戴思恭曰。赤白带下。皆因七情内伤。或下元虚冷。
感非一端。大率下白带多。间有赤者。并宜顺气散吞震灵丹。仍佐艾附丸。或米饮调沙参末。带下不止成 羸者。四物
加牡蛎五分。吞固真丸。多服取效。有带疾愈后。一二月或再发。半年一发。先血而后下带。来不可遏。停蓄未几。
又复倾泻。此名漏带。最难治者也。下截之血。小腹主之。有因血虚而虚热陷下小肠。致小便涩痛。色白如泔。或成砂
粒。不可作淋治。用冷剂。宜四物五苓各半帖和煎。李 曰。瘦人多热。脉数。外症潮热。乃阴虚火盛也。芩柏樗皮丸
不止。用地骨皮一两、生地五两、酒十盏煎三盏。分三服。肥人多湿。身黄脉缓。阴户如冰或痛。白带。升阳燥湿汤。
湿痰流下。渗入膀胱。二陈加二术、升、柴。因日久淋沥不已。或崩中暴下。或产后去血过多。以致阴亏阳竭。荣气不
升。经脉凝注。卫气下陷。精气累滞于下焦。蕴积而成。白滑如涕。下流腥臭者。黄 建中汤。去桂加当归煎。吞苦楝
丸。始因亡血。复亡其阳。阳气虚极。带下腥臭。多悲不乐。附桂汤。常用酒煮当归丸。风邪入胞门。或中经脉。流传
脏腑。俱宜胃风汤。或单地榆散。平时阴阳过多。及产后亡血下虚。风邪乘虚入于胞络。暖宫丸加姜、附、吴萸。孕妇
带下。全是湿热。芩术樗皮丸。室女经水初下。一时惊悸。或浴以冷水。或当风取凉。故经水止而即患带下。琥珀朱砂
丸。又有白淫一症。如白精之状。不可误作白带。过服热药。王肯堂曰。有湿痰而弱不禁攻者。燥之。热湿宜凉燥。寒
湿宜温燥。带下久而枯涸者濡之。常以四物料蜜丸服。以此疗年高妇人白带良验。为润剂也。有脉微食少。及久病曾经
攻下者。俱非虚治。有热用凉补。无热用温补。有因肠间败脓。淋露不已。腥秽殊甚。遂至脐腹更增冷痛。卒无已期者。
治须排脓为先。白芷一两。单叶红蜀葵根二两。白芍、枯矾各五钱。蜡丸。空心及饭前。米汤下十丸或十五丸。候脓尽。
仍别以补药补之。吴昆曰。白芷性香而升举。黄荆实性辛而利气。瓦楞子性燥而胜湿。炒焦则火可生土。土可防水。
粉则燥可胜湿。湿胜则无以下注而白带止。此古人于此三物。有单用一物以止之也。又曰。葵花禀草木之阴。涵天地之
阳。故能润燥升阳。使营卫上行。不复陷于带脉之下而为带下。故以之治带病也。又曰。妇人无病容。单下白带者。责
之湿热下注。妇人久病赤白。并责之气血下陷。多成瘵也。又曰气陷下焦。则白带。血陷下焦。则赤带。必涩药止之。
将未尽之带留而不去。以利药下之。则既损其中。又伤其下。皆非治也。千金用白马毛散。以白马则得干之刚。可以利
气。毛得血余。可以固血。气利则白愈。血固则赤止。以此意也。龟鳖牡蛎。外刚内柔。离之象也。去其柔而用其刚。
故
可以化 。而赤白之成带者。无复中留。可使营卫之行不复陷下。营不陷则无赤。卫不陷则无白。武之望曰。白淫。谓
曰物淫如白精之状。又有日夜津流如清米泔。或如粘胶者。谓之白崩。与白淫大同。多忧思过度所致。用平补镇心丹。
思伤脾胃者。四七汤下白丸子。痞闷少食者。沉香降气汤。劳伤肾气。心肾不交者。金锁正元丹。
The causes of leukorrhea (dai xia) are fourfold. First, it is due to Qi deficiency, where Spleen essence fails to ascend and instead sinks downward. Second, it arises from damp-heat and phlegm in the Stomach, which flow into the Dai Mai (Girdle Vessel), overflow into the Bladder, and result in the discharge of turbid fluid. Third, it results from damage to the Five Zang organs, leading to the discharge of leukorrhea of five colors. Fourth, it occurs when wind-cold invades the Bao Men (uterine gate) or meridians, spreads to the Zang-Fu organs, and descends.
Regarding the distinction between red and white leukorrhea: Red leukorrhea belongs to Blood and Heat, caused by heat invading the Small Intestine; if excess heat stagnates, red and white discharges occur together. White leukorrhea belongs to Qi and Cold, caused by cold invading the Large Intestine; due to blood deficiency and loss of Yang, white slippery substances flow down. There are also cases where damp-phlegm flows into the Lower Jiao, or excessive Yin-dampness from the Liver and Kidneys, or fright causing Wood to overact on Earth, leading to turbid fluid discharge; or excessive sexual activity depleting Kidney essence; or multiparous women damaging Blood and fluids—all can cause leukorrhea. Generally, herbs such as Lotus Stamen (Lian Xu), Eucommia Bark (Du Zhong), and Teasel Root (Xu Duan) may be used broadly. Most cases belong to Phlegm and Heat; since damp-heat flows downward, resolving Phlegm is key, and astringent and ascending agents should be employed. Cold patterns account for one or two out of ten, treated with warming and astringent agents like Deer Antler Glue (Lu Jiao Jiao). However, the general principle is to strengthen the Spleen, dry dampness, and raise Stomach Qi, assisted by tonifying and astringing herbs such as Poria (Fu Ling), Atractylodes Macrocephala Rhizome (Bai Zhu), Bupleurum Root (Chai Hu), and Ligusticum Chuanxiong Rhizome (Chuan Xiong). In summary, women often suffer from depression/stagnation; stagnation injures the Liver, which then overacts on the Spleen, causing damp-Earth to sink. Spleen essence fails to guard itself and cannot transform into Ying-Blood, resulting in white discharge. Treatment should involve relieving stagnation and tonifying the Spleen. If the discharge resembles thick rice water and has a foul odor, damp-heat is severe; use Atractylodes Rhizomes (Er Zhu), Scutellaria Root (Huang Qin), Phellodendron Bark (Huang Bai), Pinellia Tuber (Ban Xia), and Plantago Seed (Che Qian Zi), assisted by ascending agents. If the discharge resembles egg white, it indicates Spleen-Kidney deficiency, accompanied by soreness/weakness of the waist and legs, and edema of the face and eyes; both Spleen and Kidney must be tonified simultaneously, using Guipi Wan (Restore the Spleen Pill) or Bawei Wan (Eight-Ingredient Pill). Women also often suffer from worry, thought, and anger, injuring the Heart and Spleen; Lung Fire flares intermittently, causing Blood to wander and not return to its vessels, leading to red and white leukorrhea. White discharge is due to Spleen deficiency; because Liver Qi stagnation injures the Spleen, and Spleen injury leads to excess dampness, all caused by Wind-Wood stagnating within. Treatment should soothe Liver Qi and assist Spleen Yuan, using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Poria (Fu Ling), Sour Jujube Kernel (Suan Zao Ren), Chinese Yam (Shan Yao), Atractylodes Rhizome (Cang Zhu), Phellodendron Bark (Huang Bai), and Ophiopogon Tuber (Mai Dong). Alternatively, Liuwei Wan (Six-Ingredient Pill) plus Eucommia Bark (Du Zhong), Oyster Shell (Mu Li), Achyranthes Root (Niu Xi), and Cuttlebone (Hai Piao Xiao). If Yin deficiency with vigorous Fire is present, nourishing Yin and clearing Fire is essential, using Liuwei Wan plus Schisandra Berry (Wu Wei Zi), Goji Berry (Gou Qi Zi), Phellodendron Bark (Huang Bai), Plantago Seed (Che Qian Zi), and Dodder Seed (Tu Si Zi).
Ancients said: "Prolonged metrorrhagia transforms into leukorrhea; prolonged leakage depletes bone marrow fluids." What does this mean? It implies that prolonged bleeding leads to Qi and Blood depletion, causing white slippery substances to flow continuously. Massive tonification is required. Red leukorrhea is often due to unceasing blazing of Heart Fire; over time, Yin Blood gradually depletes, and Middle Qi weakens, leading to red discharge. Treatment should nourish the Heart and Liver, using agents that moderate the middle, cool Blood, and clear Qi. If red leukorrhea persists, Blood deficiency is certain; use Jiao Ai Siwu Tang (Colla Corii Asini, Mugwort, and Four Substances Decoction) plus Ophiopogon Tuber (Mai Dong), Apricot Seed (Xing Ren), and Oyster Shell (Mu Li). The causes of leukorrhea do not exceed these points, though details can be elaborated.
For example, leukorrhea with a fishy odor, accompanied by sadness and lack of joy, indicates Yang Qi deficiency and severe Cold; use Guifu Tang (Cinnamon Twig and Aconite Decoction). Pulse deep and faint, with red and white leukorrhea, abdominal pain, vulvar pain, delayed menstruation, and uterine cold sterility indicates severe Cold; use Yuanrong Liuhe Tang. Persistent leukorrhea with cold pain in the umbilical/abdominal region, vulvar pain, continuous menstruation, or weakness/soreness after metrorrhagia with a weak pulse indicates Deficiency; use Dongyuan Guzhen Wan (Dongyuan's Pill to Secure Truth). Postpartum excessive blood loss, irregular menstruation, profuse leukorrhea with foul odor is also due to Deficiency; use Weisheng Tang. Internal heat with rapid pulse, persistent red and white leukorrhea indicates Heat; use Goji Berry (Gou Qi Zi) and Rehmannia Root (Sheng Di Huang). Excessive internal fire, Yin deficiency with vexatious heat, or emotional injury causing rapid pulse and leukorrhea indicates Heat; use Erhuang Sanbai Wan, Baizhi San, or Motherwort Powder taken with wine. Leukorrhea in obese individuals with vulvar pain, yellow skin, loose skin, heavy body, and wet sensation in the vagina indicates Dampness; use Shengma Zaoshi Tang (Cimicifuga Damp-Drying Decoction). Dampness combined with Heat, alternating diarrhea/constipation, urinary obstruction, choppy pulse with abundant Qi indicates Damp-Heat; use Shizao Tang (Ten Jujube Decoction). Cold lower body, leukorrhea resembling egg white indicates Spleen-Kidney exhaustion; use Buguzhi Wan plus Cinnamon Bark (Rou Gui). Prolonged cold bleeding, red and white leukorrhea, irregular menstruation, sallow complexion, weak limbs, variable menstrual flow resembling Gardenia juice or dripping roof water indicates Blood deficiency with Cold; use Xuxue Daixia Fang. Continuous leukorrhea-like fluid with mental depletion indicates Essence/Qi deficiency; use Bazhen Tang plus Cimicifuga Rhizome (Sheng Ma), Arisaema Rhizome (Nan Xing), Pinellia Tuber (Ban Xia), Tangerine Peel (Chen Pi), and Cyperus Rhizome (Xiang Fu). Disharmonious Qi/Blood, damp-heat leukorrhea, limb fatigue, five-palm heat, and phlegm-stagnation heartburn indicate Phlegm-Stagnation; use Jiedai San. Rapid pulse with persistent leukorrhea due to emotional injury indicates Emotional Injury; use Ceboi Chupi Wan (Biota Top and Malania Bark Pill). Uterine masses (Jia Pi) with abdominal distension, chest fullness, red and white leukorrhea, chronic Qi/Blood deficiency, sallow complexion, and weakness indicate Cold-Dampness; use Dasheng Wan'an San. Persistent red and white leukorrhea with dryness, heat, and thirst indicates Damp-Heat stagnating in the Lower Jiao; use Xuanming Dao Shui Wan. Overwork and irregular diet damaging the Spleen/Stomach, causing Yang Qi sinking and persistent leukorrhea, requires Buzhong Yiqi Tang. Frequent leukorrhea due to Stomach deficiency with Phlegm, reduced appetite, and disharmonious Middle Qi requires Liujunzi Tang. Forgetfulness, palpitations, insomnia, lethargy, poor appetite, and frequent leukorrhea due to excessive thinking injuring Heart/Spleen requires Guipi Tang. Cold below the umbilicus, cramping pain, severe vulvar cold, and intermittent leukorrhea require Yanhu Kulian Tang. Meridian injury with Cold in the Bao Luo, cloudy urine day and night, abdominal pain, and weak waist/knees require Neijin Lurong Wan. Hernia, leukorrhea, podagra, cold below the waist, frequent urination, uncontrollable leukorrhea, emaciation with heaviness, pale face, blurred vision, staggering gait, thin legs/knees, constipation, epigastric fullness, restlessness, anorexia, and back cold indicate exhaustion of True Qi in Upper, Middle, and Lower Shaoyang; incessant hiccups/vomiting indicate extreme Stomach Cold, deep-tight-choppy pulse with empty pressure indicates extreme Yin Cold; use Jiuzhu Danggui Wan (Wine-Boiled Angelica Decoction). Elderly leukorrhea and Baiyin (white seminal discharge) with prolonged leakage indicates Qi excess/Blood deficiency and deficient Cold; use Laonian Daixia Fang, Shiquan Dabu Tang plus Alpinia Oxyphylla Fruit (Yi Zhi Ren). Virgin leukorrhea purely white indicates Chong-Ren deficiency-Cold; use Bailian Wan. Widows, nuns, and virgins with vigorous depressive fire, vulvar itching/pain, and red strangury indicate Blood Heat; clear Bladder Fire using Chilin Wan. White strangury indicates Qi deficiency; use Wujin Wan or Wu'ai Wan. Treating leukorrhea thus leaves no omissions.
Pulse Diagnosis: *Mai Jing* states: Diagnosing women with metrorrhagia, discharging red and white, several sheng per day: rapid pulse indicates death, slow pulse indicates survival. Also: persistent red/white leakage with small-deficient-slippery pulse indicates survival; large-tight-solid-rapid pulse indicates death. Leukorrhea with floating pulse and aversion to cold is untreatable. Leukorrhea is one of the Six Extremes diseases: floating pulse indicates borborygmus and abdominal fullness; tight pulse indicates abdominal pain; rapid pulse indicates vulvar itching/pain and sores; wiry pulse indicates pulling pain in the vulva. Li says: Floating-slow Kidney pulse governs leukorrhea and turbidity.
Etiology and Treatment of Leukorrhea: Sun Simiao stated that the thirty-six diseases refer to twelve symptoms, nine pains, seven harms, five injuries, and three chronic obstructions. Twelve symptoms refer to the discharged material: 1. Like paste, 2. Like black blood, 3. Like purple juice, 4. Like red flesh, 5. Like pus crust, 6. Like bean curd dregs, 7. Like okra soup, 8. Like coagulated blood, 9. Like clear blood (water-like), 10. Like rice water, 11. Like menstruation (irregular flow), 12. Menstruation not on schedule. Nine pains: 1. Vulvar pain, 2. Dripping vulvar pain, 3. Pain upon urination, 4. Cold pain, 5. Abdominal pain during menstruation, 6. Qi-fullness pain, 7. Vulvar discharge pain like insect biting, 8. Hypochondriac pain, 9. Waist/hip pain. Seven harms: 1. Orifice pain/difficulty, 2. Internal cold-heat pain, 3. Lower abdominal urgent/firm pain, 4. Organ insensitivity, 5. Cervical deviation pulling back pain, 6. Menstrual volume fluctuation, 7. Vomiting harm. Five injuries: 1. Bilateral abdominal distension/pain, 2. Heart pain radiating to hypochondrium, 3. Qi knot obstruction, 4. Evil thoughts/loose stools, 5. Chronic cold anterior/posterior. Three chronic conditions: 1. Emaciation without flesh growth, 2. Infertility, 3. Amenorrhea. Diseases differ, formulas vary. Thirty-six diseases arise from uterine cold/heat and labor injury originating internally. Chen Ziming stated five causes of leukorrhea: post-menstrual/postpartum pathogen invasion into Bao Men spreading to Zang-Fu. Damage to Foot-Jueyin Liver meridian yields green mud color; Hand-Shaoyin Heart meridian yields red saliva; Hand-Taiyin Lung meridian yields mucus shape; Foot-Taiyin Spleen meridian yields rotten melon color; Foot-Shaoyin Kidney meridian yields dark blood color. The Dai Mai crosses the waist like a belt; disease here is named Dai. Dongyuan stated: Prolonged metrorrhagia loses Yang, causing white slippery discharge; not solely confined to Dai Mai, but also damp-phlegm in Lower Jiao, Liver/Kidney Yin-damp excess, fright causing Wood attacking Earth, or longing causing sinew atrophy. Dai Ren treated slippery-large-forceful six pulses with cathartic methods to drain excess. Dongyuan treated micro-fine-deep-tight or large-empty pulses with Yang-tonifying/menstruation-regulating methods addressing deficiency. Danxi used Hai Shi, Nan Xing, Chun Gen Pi to treat damp-phlegm. I believe all preceding symptoms should primarily strengthen Spleen/Stomach and raise Yang Qi, assisting with meridian-specific herbs. Green belongs to Liver: Xiaochaihu Tang plus Gardenia (Shanzhi), Saposhnikovia (Fangfeng). Damp-heat congestion with red/scanty urine: Longdan Xiegan Tang. Liver Blood deficiency or dry/wind-heat: Liuwei Wan. Red belongs to Heart: Xiaochaihu Tang plus Shanzhi, Dang Gui. Excessive thought injuring: Miaoxiang San. White belongs to Lung: Buzhong Yiqi Tang plus Shanzhi. Yellow belongs to Spleen: Liujunzi Tang plus Shanzhi, Chai Hu; if ineffective, Guipi Tang. Black belongs to Kidney: Liuwei Wan. Qi/Blood dual deficiency: Bazhen Tang. Qi/Blood sinking: Buzhong Yiqi Tang. Damp-phlegm flow: Former decoction plus Fu Ling, Ban Xia, Cang Zhu, Huang Bai. Qi deficiency with Phlegm-fluid sinking: Siqi Tang delivering Liuwei Wan. Do not rigidly apply drying-damp/draining-fire to fat (phlegm) vs thin (fire); Zhang Zhengcong stated *Shenghui Fang* attributes leukorrhea to wind-cold, while *Chaoshi Bingyuan* says cold yields white, heat yields red; both are incorrect. Chong, Ren, Du meridians converge at the perineum, circulate Yin Qi, pass through urethral/vaginal openings, bound by Dai Mai. Various meridians transmit heat to Dai Mai; heat involves Blood. Blood accumulating days without flowing transforms via Metal into White under Fire influence. Accompanying lower abdomen unjust heat, white slippery substance overflows with urine, continuous. Pain arises from obstruction. *Neijing*: "Lower abdomen unjust heat, urine excretes white fluid." Unjust means constrained. Disease is not from the primary meridian but suppressed by others. Like red/white dysentery: red is new accumulation Heart Fire, white is old accumulation Lung Metal; do not arbitrarily divide cold/heat. Like abscesses: start red blood, then suppurate white pus; how can this be cold? Dysentery transmits heat to Large Intestine/Great Intestine; leukorrhea transmits to Small Intestine/Pao Meridian. Both can be treated with damp-draining methods. First purge with Dao Shui Wan/Yugong San, then use bland agents to descend Heart Fire, benefit Kidney Water, reduce urine, separate water pathways. Do not adhere rigidly; verify deficiency/excess. *Neijing* states intestinal bleeding with warm body/heat dies; leukorrhea, white fluid, gu disease, kidney consumption do not kill; death is due to medication error. Same for virgins. Daigong stated: Red/white leukorrhea due to emotional injury or lower origin cold. Mostly white, occasionally red; use Shunqi San swallowing Zhenling Dan, assisted by Aifu Wan or Ginseng powder with rice drink. Leukorrhea causing emaciation: Siwu Tang plus Mu Li, swallow Guzhen Wan. Recurrent leukorrhea after cure, first blood then discharge, unstoppable, then pouring again, named Loudai, hardest to treat. Lower blood governed by lower abdomen. Blood deficiency with deficient heat sinking to Small Intestine causes painful white urine like rice water or sand grains; do not treat as strangury with cold agents; use half Siwu, half Wuling decoctions mixed. Li stated: Thin people have heat, rapid pulse, tidal fever, Yin deficiency Fire hyperactivity; if Qinbai Chupi Wan fails, use Gudupi and Shengdi with wine. Fat people have dampness, yellow skin, slow pulse, ice-cold/painful vulva, leukorrhea; use Shengyang Zaoshi Tang. Damp-phlegm sinking to Bladder: Erchen Tang plus Er Zhu, Sheng Ma, Chai Hu. Prolonged leakage, sudden metrorrhagia, or postpartum blood loss causing Yin deficiency/Yang exhaustion, Ying Qi not rising, meridians congealing, Wei Qi sinking, Essence stagnating in Lower Jiao forming white slippery smelly discharge: Huangqi Jianzhong Tang minus Guizhi plus Dang Gui, swallow Kulian Wan. Initial blood loss plus Yang loss, extreme Yang deficiency, smelly leukorrhea, sadness: Fugui Tang. Commonly use Jiuzhu Danggui Wan. Wind pathogen entering Bao Men/meridians spreading to Zang-Fu: Weifeng Tang or Duyu San alone. Excessive intercourse or postpartum blood loss/vacuity allowing wind into Bao Luo: Nuangong Wan plus Ginger, Fuzi, Wuyu. Pregnant leukorrhea is entirely Damp-Heat: Qinshu Chupi Wan. Virgin menstruation starting with fright/cold bath/wind exposure stopping menstruation and causing leukorrhea: Hupo Zhusha Wan. Baiyin (white seminal discharge) resembles white sperm, mistaken for leukorrhea; avoid hot drugs. Wang Kentang stated: Damp-phlegm with weak constitution intolerant to attack requires drying. Heat-damp needs cool-drying; cold-damp needs warm-drying. Long-term dry leukorrhea requires moistening; use Siwu pills with honey for elderly leukorrhea. Micro-pulse/low appetite/post-purgation cases are not simple deficiency. Heat uses cool-tonification; no heat uses warm-tonification. Intestinal pus leakage with severe odor/cold pain requires draining pus first: Baizhi, Hibiscus Root, Baishao, Kufan wax pills. Wu Kun stated: Baizhi is aromatic/ascending; Huangjingshi is pungent/qi-moving; Walrus Tooth (or similar hard shell) is drying/damp-resisting. Fried generates Earth to control Water; powder dries damp to stop leukorrhea. Sunflower seed embodies Yin of plants and Yang of heaven/earth, moistens/dries, raises Yang, ascends Ying/Wei, preventing sinking into Dai Mai. Women with normal appearance but isolated leukorrhea blame Damp-Heat sinking. Long-term red/white leukorrhea blames Qi/Blood sinking, often becoming consumptive. Qi sinking Lower Jiao = leukorrhea; Blood sinking Lower Jiao = red leukorrhea. Must use astringents to retain incomplete discharge; purgatives damage Middle/Lower. *Qianjin* uses Baimao San: Horse hair gains Yang strength to move Qi, retains Blood residue to solidify Blood; Qi moves white resolves, Blood solidifies red stops. Turtle/Turtle Shell/Oyster Shell are externally hard/internally soft, Li image. Remove softness, use hardness to resolve stasis, prevent Ying/Wei sinking; Ying not sinking = no red, Wei not sinking = no white. Wu Zhiwang stated: Baiyin resembles white sperm; daily flow like rice water or sticky glue is Baibeng, similar to Baiyin, caused by excessive worry/thought. Use Pingbu Zhenxin Dan. Thought injuring Spleen/Stomach: Siqi Tang with Baixian Wan. Epigastric fullness/poor appetite: Chenxiang Jiangqi Tang. Labor injuring Kidney Qi, Heart-Kidney non-interaction: Jin suo Zhengyuan Dan.