（崩漏 失血心痛 经闭不行 带下 淫浊 淋沥 淋辨 泄泻 小便血 师尼寡妇寒热 子嗣 胎教）
经曰。女子手少阴脉动甚者妊子。
妇人以血为主。故手少阴动甚为怀身之象。胎禀在下。反以上部动甚为胎脉之验者。盖阳神
气旺。与尺内阴搏阳别。同一胎脉。而有左右上下阴阳男女之辨。是以内经特为昭揭。
二阳之病发心脾。有不得隐曲。女子不月。其传为风消。其传为息贲者。死不治。
手足阳明。皆曰二阳。不得隐曲。言情欲不遂。而病发心脾也。风消者。发热消瘦。胃主肌
肉也。贲黄者。喘息上奔。胃气上逆也。此节虽言病发心脾。而实重在胃气。心为胃之母。胃为
脾之府。且与大肠一气贯通。焉有母伤而子独安。脏病而腑不病之理。
有病胸胁支满者。妨于食。病至则先闻腥臊臭。出清液。先唾血。四肢清。目眩。时时前后
血。病名血枯。此得之年少时。有所大脱血。若醉入房中。气竭肝伤。故月事衰少不来也。治之
以四乌 骨。一 茹。二物并合之。丸以雀卵。大如小豆。以五丸为后饭。饮以鲍鱼汁。利肠中。及伤肝也
此段经文。全重在气竭肝伤四字。为通节之纲旨。胸胁。肝部也。支满。肝病也。妨于食。木邪
凌土也。病则先闻腥臊臭。脾喜芳香。今脾土为木邪凌虐。病则先闻腥臊。臊乃肝之旺气也。出
清液。脾虚不能敷化水精也。先唾血。脾伤不能统运营血也。四肢清。阳衰不能傍达四末也。目
眩。阳不充而水上溢于经也。前后血。阴受伤而血内溢于络也。血枯。内有干血。血不归经而结
胞门也。良由年少不禁。气竭肝伤。而致月事衰少。或不来也。治以乌 骨四分。取其味咸走肾。
性温达肝。配以 茹一分。取其辛散内风。温去恶血。二物并合。功专破宿生新。丸以雀卵。取
其温补助阳。能调子脏精血。以五丸为后饭者。先药后饭。使药徐行下焦。力贵专攻。五丸不为
少也。饮以鲍鱼汁。利肠垢。和肝伤。取其臭秽之味。佐乌 骨而辟宿积之血也。乌 血黑如墨。
用之书契。则有贼人之害。故又名乌贼。入肾走血。而不伤伐真元。功在虻、蛭之上。考诸本草。
茹即是茜根。功专散血。不可误认 茹。 茹辛寒有毒。功专外科。观本经主治可知。
金匮云。妇人之病。因虚积冷结气。为诸经水断绝。至有历年血寒。积结胞门。寒伤经络凝
坚在上。呕吐涎唾。久成肺痈。形体损分。在中盘结。绕脐寒疝。或两胁疼痛。与脏相连。或结
热中。痛在关元。脉数无疮。肌若鱼鳞。时着男子。非止女身。在下未多。经候不匀。令阴掣痛。
少腹恶寒。或引腰脊。下根气街。气冲急痛。膝胫疼烦。奄忽眩冒。状如厥癫。或有忧惨。悲伤
多嗔。此皆带下。非有鬼神。久则羸瘦。脉虚多寒。审脉阴阳。虚实紧弦。行其针药。治危得安。
其虽同病。脉各异源。
妇人经闭诸病。无不由虚寒而成。经闭虽属虚寒。则崩漏之属虚热。从可识矣。夫经水历年断绝。则瘀积结于胞
门。寒气凝于经络。盖下焦寒积结聚。则中上二焦。皆不得通畅。所以在上则寒沫结聚而为咳。
咳久热结而为肺痈。在中则寒饮结聚而为疝。疝久热结。亦为内痈。大抵内痈皆起于结血。故申
之以脉数无疮。肌若鱼鳞。昭揭病形。然此不但妇人也。男子亦有是证。总由经络郁闭。寒从火
化所致。至于在下。则经候虽不调。而不至断绝。所瘀亦为不多。其证虽久。但少腹气街。引急
寒痛也。其或膝胫疼烦者。以四肢为诸阳之本。寒结于内。则在下之阳。不能上入。故膝胫反热
而痛也。至如奄忽状如厥癫。或时忧惨悲嗔。有若鬼神所凭。此皆阳神虚寒。不能统摄浊阴。发
为带下之候。故以久则羸瘦。脉虚多寒证之。然多寒。言属寒者多。非绝无属热者。假如羸瘦而
脉数。又为阴虚多热矣。设形盛而脉虚。岂不为气虚多寒乎。形盛而脉濡。宁不为湿热固结乎。
斯其所以为同脉异源也。
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。此名为革。妇人则
半产漏下。旋复花汤主之。
脉弦而大。按之减小而芤者。为表里失血之候。以其脉弦大无力而少徐缓冲和之气。故谓之
革。言胃气近于革除也。盖弦为阳气少。芤为阴血虚。妇人得之。主半产漏下。以旋复花汤主之。
本草谓旋复花主结气。葱白主寒热。新绛乃丝帛之染绯者。主活血。三味入肝理血。除邪散结。
岂非以气少无阳则寒。血虚无阴则热。两虚相搏。以害其肝之生化欤。若不明其相搏。止谓之虚。
何以用旋复花、葱白皆解客热之邪者。而不用温补其虚乎。
妇人陷经漏下。黑不解。胶姜汤主之。
气畅而血从。则百脉流动。以候天癸。苟有邪以阻之。则血不从其气。而自陷于血海。血海
者。肾主之。肾者。寒水也。其色黑。是以漏下黑矣。犹内经所谓结阴下血也。林亿云。臣亿等。
较诸本无胶姜汤方。当是妊娠中胶艾汤。
妇人少腹满如敦状。小便微难而不渴。生后者。此为水与血俱结在血室也。大黄甘遂汤主之。
其血当下。水有清浊。清则入经化血。浊则为溺为唾。苟因气化之乱。浊者入之。则不能化血。
而为血害也。水性惟能润下。下流不通。入与血居。必停于脉。随其所止。止于肌表者。作身肿。
止于筋骨者。作肢节肿。此止于血室。故作少腹如敦状。然血室虽与膀胱异道。膀胱是行水之府。
水蓄血室。气有相感。故膀胱之气亦不化。而小便微难。水与血皆阴类。虽有留积。不能发热。
故不渴。若渴则为膀胱结热而非水血矣。若小便自如。而少腹之如敦者。亦不谓之水并。当是他
邪血积可知矣。生后者。言曾生育过之妇。则有此患。非指产后而言。若室女则无是疾也。用甘
遂取其直达水停之处。大黄荡涤瘀血。阿胶为血室之向导也。
妇人经水不利下。抵当汤主之。亦治男子膀胱满急。有瘀血者。
伤寒阳明证。其人喜忘者。必有瘀血。大便色黑。抵当汤主之。发热下之不解。六七日不大
便者。有瘀血。亦抵当汤主之。伤寒有热。少腹满。应小便不利。今反利者。为有血也。宜抵当
丸。三者有病证。而后立方。今止云经水不利。然经水不利。岂尽血蓄不通。而无虚损者哉。此
必有蓄血形状。而出是方也。
妇人经水闭不利。脏坚癖不止。中有干血。下白物。矾石丸主之。
子宫血积。不与气和。故新血不至。遂成干血坚癖。外连子户。津液不行。化为白物。是用
绿矾消坚癖。破干血。杏仁利气开闭。润脏之燥。蜜以佐之。纳子户而药气可直达于子宫矣。设
干血在冲任之海者。必服药下之。纳之不能去也。
妇人腹中诸疾痛。当归芍药散主之。
此腹痛者。由中气虚。脾土不能升运阴阳。致二气乖离。肝木乘克而作痛。故用是汤。补中
伐木。通行阴阳也。妇人腹中痛。小建中汤主之。
小建中专主风木胜脾之腹痛。而妇人善怒。易动肝火。木邪乘土。多有腹痛经水妄行之疾。
故以此汤主之。带下经水不利。少腹满痛。经一月再见者。土瓜根散主之。阴 肿亦主之。
此亦因瘀血而病者。经水虽不利。但一月再见之不同。皆冲任脉瘀血之病。土瓜根消水饮。
芍药开血痹。桂枝通血脉。 虫破血积。更需以酒行之。至于 肿。非惟男子之睾丸。妇人之阴
户亦有之。多在产时。瘀血流入作痛。下坠出户也。
问曰。妇人年五十。所病下利数十日不止。暮即发热。少腹里急。腹满。手掌烦热。唇口干
燥。何也。师曰。此病属带下。何以故。曾经半产。瘀血在少腹不去。何以知之。其证唇口干燥。
故知之。当以温经汤主之。亦主妇人少腹寒。久不受胎。兼治崩中去血。或月水来过多。及至期不来。
问下利不止。答属带下。何也。妇人年已五十。经绝胞门闭塞。冲任不复输泻之时。所积血
自胞门化为带下。无所从出。大便属阴。故就大便为下利。是即以带下例治之。
王节斋曰。妇人女子。经脉不行。有脾胃损伤而致者。不可便认作经闭血死。轻用通经破血
之药。遇有此证。便须审其脾胃何如。若因饮食劳倦损伤脾胃。少食恶食。泄泻疼痛。或因误服
汗下攻伐药。伤其中气。以致血少而不行者。
只宜补养脾胃。用白术为君。茯苓、芍药为臣。佐以黄 、甘草、陈皮、肉桂、川芎、归身、柴
胡等药。脾旺则能生血。而经自行矣。又有饮食积滞。致损脾胃者。亦宜消积补脾。若脾胃无病。
按其少腹。果有血块凝结。方宜香附、蕲艾、桂心、桃仁行血通经等剂。
经云。饮食入胃。游溢精气。上输于脾。脾气散精。上归于肺。通调水道。下输膀胱。水精
四布。五经并行。故心脾和平。则经候如常。苟或七情内伤。六淫外侵。饮食失节。起居失宜。
脾胃虚损。则月经不调矣。若先期而至者。有因肝脾血燥。有因脾经郁滞。有因肝经怒火。有因
血分有热。有因劳役火动。其过期而至者。有因脾经血虚。有因肝经血少。有因气虚血弱。治法。
因肝脾血燥者。加味逍遥散。脾经郁滞者。归脾汤。肝经怒火者。小柴胡加生地。血分有热者。
四物汤加白术、茯苓、柴胡、丹皮。劳役火动者。补中益气汤。脾经血虚者。十全大补汤。肝经
血少者。六味丸。气虚血弱者。八珍汤。经候不调。无他证而不受胎。六味丸全料减泽泻一两。
加童便制香附四两。醋煮蕲艾一两。调理最妙。若有别证兼见。随证制汤送下。妇人劳伤气血。
冲任虚损。月水过多。淋漓不断。或过期不来。崩中下血。或白带白淋。四物汤加丁香、胶、艾。
若曾伤胎。瘀血停留。小腹急痛。五心烦热者。大温经汤。月水不调。阴虚潮热。或寒热如疟。
盗汗痰嗽。渐成骨蒸者。血热相搏也。加味逍遥散。月水准信不受孕者。其故有三。肥白腹不痛
者。闭子宫也。因痰。导痰汤。甚则间一二日。送滚痰丸二三服。腹多痛者。必食生冷过多。且
又多气。宜温热药。七气汤。如咳嗽形瘦。色赤多火阴血虚者不宜服。只以四物加陈皮、香附、
肉桂作丸。亦有血少不能摄精者。十全大补汤。兼寒。金匮温经汤。或曰。经正而子宫寒者非也。
若子宫寒。其经必过期矣。岂有准信而曰寒乎。黑瘦多火人。经少。色深紫而不受孕者。为胞血
枯而精被烁也。四物换生地加芩、连。瘦弱而不能受孕。子宫无血。精气不聚故也。十全大补之
类。经水不准。必不受胎。然参前受胎者有之。此是血热。抑有参前落后互兼者。将为寒热并乎。
大抵妇人受气则气乱。经期亦乱。故调经以理气为先。归附丸。气盛者。宜抑气以行血。血盛则
气行矣。经不调而血淡如水。宜补气血。保元汤加芎、归、肉桂、香附。腹痛。加胶、艾、延胡。
虚。加姜、附。经水有先期而来者。多属热。其证有二。血热者腹多不痛。身多热。此火也。其
色必紫。脉必洪数。四物汤中川芎减半。易生地加条芩、丹皮、香附。虚热者。四物合保丸。不
应。加炮姜、宣连炒黑、香附。干嗽者。逍遥散。气多血虚者。腹必疼。藿香正气散加芎、归、
香附。慎用凉药。若妇人年四十余。经水每月二三至者。此少年恣意太过。后必崩淋。经水后期
来者。多属寒。其证有三。血虚腹多不痛。微微身热。间亦有痛者。乃空痛也。脉必大而无力。
或浮涩濡细。宜调气生血。八物加香附。虚则四物加参、术、黄 、升麻、陈皮。气滞血虚者。
四物加丹皮、香附。肥盛多痰。去地黄再加橘、半、茯苓。血寒脉必沉迟弦紧。归附丸。过期色
淡者。痰多也。二陈加柴胡、香附、肉桂。若过期兼白带者。艾煎丸加香附。若咳。忌香附。逍
遥散加丹皮。嗽而泻者。养胃汤。血涩滞者。胸饱腰腹痛。醋煎散。或七气汤加减。冲任虚损。
少腹有寒。月水过期不能受孕者。温经汤。年老无病。而月水如期不断者。气血有余也。若反多。
或一月两至者。气虚不能统血。欲成崩淋也。既绝复来者。气病也。或伤损。或瘀血。皆以胁腹
急痛为辨。并宜四乌汤用赤芍。若其势可止。宜大剂八物汤。能食者。加芩、连。不能食者。加
炮姜止之。服药得效者。十有二三。虚甚者。多不能效。经水将来。腰疼腹痛。乃郁滞有瘀血。
四物加红花、丹皮、蓬术、延胡索、香附、木香。实热。加黄连。发热。加柴、芩。将来小腹先
痛。气血涩滞也。四乌汤加莪术、桃仁。经前先腹痛。脉浮弦者。小建中加丹皮、桃仁。经候欲行。身体先
痛。气血不足也。桂枝汤加芎、归。稍用熟附二三分。经后痛者。虽曰虚寒当补。然气散亦能作
痛。须视其受补否。不受补。四物加炮姜、艾、附。受补者。八物加炮姜、艾、附。泻者先治泻。
久有经行四五日腹中绵绵作痛者。此经行时因气滞而止。未尽故也。四乌汤加木香、蓬术、砂仁。
每遇经行。辄头疼气满。心下怔忡。饮食减少。肌肤不泽。此痰湿为患也。二陈加当归、炮姜、
[Beng Lou (Metrorrhagia and Metrostaxis), Bleeding with Heartache, Amenorrhea, Leukorrhea, Profuse Vaginal Discharge, Dysuria, Differentiation of Dysuria, Diarrhea, Hematuria, Alternating Fevers in Nuns, Widows, and Concubines, Fertility, Prenatal Education]
The *Neijing* states: When the pulse of the Hand-Shaoyin (Heart) meridian in women is markedly active, it indicates pregnancy.
Women are fundamentally based on blood; therefore, a marked activity in the Hand-Shaoyin pulse is a sign of conception. Although the fetus resides in the lower jiao, the verification of a fetal pulse relies on the marked activity in the upper part. This is because the Yang spirit and Qi are vigorous, interacting with the Yin pulsation at the Chi position while distinguishing Yang, which shares the same principle as typical fetal pulses but differentiates by left/right, upper/lower, Yin/Yang, and male/female characteristics. Thus, the *Neijing* specifically highlights this theory.
"Pathologies of the Two Yangs originate in the Heart and Spleen; there is an inability to express hidden desires, leading to amenorrhea in women. If it transmits to become 'Feng Xiao' (Wind Emaciation), or transmits to become 'Xi Ben' (Pulmonary Accumulation), it is a death syndrome and untreatable."
The Hand and Foot Yangming meridians are both called "Two Yangs." "Inability to express hidden desires" refers to unfulfilled emotional or sexual desires, causing pathology in the Heart and Spleen. "Feng Xiao" refers to fever and emaciation, as the Stomach governs muscles. "Xi Ben" (referred to as Ben Huang in the text, interpreted here as pulmonary accumulation with panting) refers to panting and qi rushing upward, indicating rebellious Stomach Qi. Although this section discusses pathology originating in the Heart and Spleen, the emphasis is actually on Stomach Qi. The Heart is the mother of the Stomach, and the Stomach is the residence of the Spleen, and they are connected via continuous Qi with the Large Intestine. How can the mother be injured while the son remains safe? How can Zang organs be diseased while Fu organs remain unaffected?
There is a disease characterized by fullness and distension supporting the chest and hypochondrium, interfering with food intake. Upon onset, the patient first perceives a fishy or foul odor, secretes clear fluid, expectorates blood, experiences cold limbs, dizziness, and frequent bleeding from both anterior and posterior orifices. This disease is named "Xue Ku" (Blood Depletion). It results from significant blood loss in youth, or sexual intercourse while intoxicated, leading to exhaustion of Qi and injury to the Liver. Consequently, menstruation becomes scanty or ceases. Treatment involves combining four parts of Cuttlefish Bone (Wu Zei Gu) and one part of Madder Root (Lu Ru). These two substances are mixed and formed into pills using quail eggs, sized like small beans. Take five pills after meals, administered with cuttlefish juice to promote intestinal lubrication and heal liver injury.
This passage emphasizes the four characters "Qi Exhaustion and Liver Injury" as the core theme. The chest and hypochondrium are the regions of the Liver; support and fullness indicate Liver pathology. Interference with eating represents Wood evil overacting on Earth. Perceiving a fishy odor upon onset occurs because the Spleen prefers aromatic scents; now that Spleen Earth is oppressed by Wood evil, the fishy odor (the prosperous Qi of the Liver) is perceived first. Secretion of clear fluid indicates Spleen deficiency failing to distribute fluids. Expectorating blood indicates Spleen injury failing to control circulating blood. Cold limbs indicate Yang decline failing to reach the extremities. Dizziness indicates insufficient Yang allowing Water Qi to overflow into the meridians. Anterior and posterior bleeding indicates Yin injury causing blood to overflow into the collaterals. Blood Depletion implies dry blood internally, with blood not returning to its vessels and accumulating in the uterine gate. This is largely due to lack of restraint in youth, causing Qi exhaustion and Liver injury, leading to scanty or absent menstruation. Treatment uses four parts Cuttlefish Bone for its salty taste entering the Kidney and warm nature reaching the Liver, combined with one part Madder Root for its pungent dispersion of internal wind and warming removal of evil blood. Together, they specialize in breaking old blood and generating new blood. Quail egg pills provide warmth and assist Yang, regulating the essence and blood of the uterus. Taking five pills as a post-meal dose ensures the medicine slowly descends to the lower jiao, focusing its force; five pills are not few. Cuttlefish juice promotes intestinal cleansing and harmonizes liver injury; its foul odor assists Cuttlefish Bone in dispelling accumulated blood. Cuttlefish blood is black as ink; historically used in contracts, it was feared to harm people, hence the name "Wu Zei" (Cuttlefish). It enters the Kidney and moves blood without damaging true Yuan Qi, surpassing the efficacy of leeches and horseflies. According to materia medica, Lu Ru is Qian Cao Gen (Madder Root), specializing in dispersing blood, and should not be confused with Mi Ru. Mi Ru is pungent, cold, toxic, and specialized for external surgery, as seen in the *Shennong Classic*.
The *Jingui Yaolue* states: Women's diseases arise from deficiency, accumulated cold, and constrained Qi, leading to the cessation of all menstrual flows. Some suffer from blood cold for years, accumulating in the uterine gate. Cold injuring the meridians congeals firmly above, causing vomiting of saliva and phlegm, which over time becomes Lung Abscess, damaging the body. In the middle, it knots around the umbilicus causing Cold Hernia, or pain in the hypochondrium connecting to the Zang organs. Or heat knots in the center, causing pain at the Guan Yuan point, with a rapid pulse but no ulcer, and skin resembling fish scales. This condition affects men as well as women. Below, menstrual flow is scanty and irregular, causing pulling pain in the yin, cold in the lower abdomen, or牵引 to the waist and spine, extending to the Qi Chuan area, with urgent pain in the Qi Chong vessel and painful knees and shins. Suddenly experiencing dizziness and vertigo, resembling syncope or epilepsy; or feeling sorrowful, sad, and irritable. These are all leukorrhea, not caused by ghosts or spirits. Over time, the body becomes emaciated, the pulse is deficient and cold. Examining the pulse for Yin/Yang, excess/deficiency, tight/string-like, and applying acupuncture and herbs can cure critical conditions. Although the diseases appear similar, their pulse origins differ.
Various cases of amenorrhea in women are invariably caused by deficiency and cold. Although amenorrhea belongs to deficiency-cold, metrorrhagia belonging to deficiency-heat can be inferred from this. When menstrual flow ceases for years, stasis accumulates in the uterine gate, and cold condenses in the meridians. Generally, if cold stagnation accumulates in the lower jiao, the middle and upper jiao cannot circulate freely. Thus, above, cold foam accumulates causing cough; prolonged cough leads to heat knotting forming Lung Abscess. In the middle, cold fluid accumulates forming hernia; prolonged hernia leads to heat knotting forming internal abscess. Generally, internal abscesses arise from blood stasis knotting, hence emphasizing "rapid pulse without ulcer, skin like fish scales" to reveal the disease form. However, this is not limited to women; men also have these symptoms, generally caused by meridian closure and cold transforming into fire. Below, although menstruation is irregular, it does not cease completely, and the stasis is minimal. The symptom is long-standing pulling cold pain in the Qi Chuan area of the lower abdomen. If there is painful and annoying knees and shins, it is because the four limbs are the root of all Yang; cold knotted internally prevents the Yang below from ascending, so the knees and shins become hot and painful. Regarding sudden episodes resembling syncope or epilepsy, or periods of sorrow and anger as if possessed by spirits, these are due to deficient and cold Yang Spirit failing to control turbid Yin, manifesting as leukorrhea. Thus, emaciation and a deficient, cold pulse confirm this. However, "many cold" means mostly cold, not absolutely excluding heat. For instance, emaciation with a rapid pulse indicates Yin deficiency with much heat. If the physique is robust but the pulse is deficient, is it not Qi deficiency with much cold? If the physique is robust and the pulse is soggy, is it not damp-heat consolidation? This explains why pulses may be identical yet originate from different sources.
At the Cun Kou position, the pulse is wiry and large. Wiry indicates reduction; large indicates hollow. Reduction indicates cold; hollow indicates deficiency. Cold and deficiency clashing together is named "Ge" (Leather) pulse. In women, this indicates spontaneous abortion and dripping vaginal bleeding, treated with Xuan Fu Hua Tang (Inula Flower Decoction).
A wiry and large pulse, which decreases and becomes hollow upon pressure, indicates bleeding from the interior and exterior. Because the wiry-large pulse lacks strength and the gentle, buffering Qi of the Stomach, it is called Ge pulse, meaning Stomach Qi is near elimination. Wiry indicates little Yang Qi; hollow indicates deficient Yin blood. Women with this pulse primarily suffer from spontaneous abortion and dripping bleeding, treated with Xuan Fu Hua Tang. Materia medica states Inula Flower treats constrained Qi, Scallion White treats alternating cold and heat, and Xin Jiang (new crimson silk) treats blood activation. These three enter the Liver to regulate blood, eliminate evil, and dissipate knots. Is it not because little Qi and no Yang cause cold, and deficient blood and no Yin cause heat, with the two deficiencies clashing and harming the Liver's generation function? If one does not understand this clash and simply calls it deficiency, why use Inula Flower and Scallion White, which resolve guest heat evils, instead of warming and tonifying the deficiency?
For women with sinking meridians, dripping vaginal bleeding where the color remains black and does not resolve, Jiao Jiang Tang (Gelatin and Ginger Decoction) is indicated.
When Qi flows smoothly, blood follows Qi, and the hundred vessels flow to await Tian Gui (menstrual essence). If evil obstructs, blood does not follow Qi but sinks into the Sea of Blood. The Sea of Blood is governed by the Kidney. The Kidney is Cold Water, and its color is black; thus, the dripping bleeding is black. This is similar to the *Neijing*'s description of Jie Yin (Knotted Yin) lower bleeding. Lin Yi stated: We compared various editions and found no formula for Jiao Jiang Tang; it should be Jiao Ai Tang (Gelatin and Mugwort Decoction) for pregnancy.
If a woman's lower abdomen is full like a Dun (ancient vessel), with slight difficulty in urination but no thirst, in a woman who has given birth, this is water and blood jointly knotted in the Blood Chamber, treated with Da Huang Gan Sui Tang (Rhubarb and Kansui Decoction).
The blood should descend. Water has clear and turbid aspects; the clear enters the meridians to transform into blood, while the turbid becomes urine or saliva. If chaotic Qi transformation causes the turbid to enter the vessels, it cannot transform into blood and becomes a harm to the blood. Water nature is to moisten and flow downward. If downward flow is blocked, water enters and resides with blood, stopping in the vessels wherever it stops. Stopping in the muscle surface causes body edema; stopping in sinews and bones causes limb joint edema. Now stopping in the Blood Chamber causes the lower abdomen to feel full like a Dun. Although the Blood Chamber and Bladder have different pathways, the Bladder is the residence of water transport. Water accumulating in the Blood Chamber creates mutual Qi influence, so Bladder Qi also fails to transform, causing slight urinary difficulty. Water and blood are both Yin categories; although stagnant, they do not generate heat, hence no thirst. If thirsty, it is Bladder heat knotting, not water-blood combination. If urination is normal but the lower abdomen feels full like a Dun, it is not water accumulation, but likely other evil blood stasis. "Post-partum" (Sheng Hou) refers to women who have given birth having this ailment, not specifically the postpartum period. Virgins do not have this disease. Kansui reaches the site of water stagnation directly; Rhubarb sweeps away blood stasis; Donkey-hide Gelatin acts as a guide for the Blood Chamber.
For women with difficult menstrual flow descending, Di Dang Tang (Di Dang Decoction) is indicated. It also treats men with fullness and urgency in the Bladder due to blood stasis.
In Shaoyang-Yangming syndrome, if the person suffers from forgetfulness, there must be blood stasis, and the stool will be black, treated with Di Dang Tang. If fever persists after purgation, and there is no bowel movement for six or seven days, there is blood stasis, also treated with Di Dang Tang. In Shaoyang disease with heat and fullness in the lower abdomen, urination should be difficult; if it is actually free, there is blood, suitable for Di Dang Wan (Di Dang Pill). These three cases present symptoms before prescribing formulas. Now it only says "difficult menstrual flow," but difficult menstruation is not entirely due to blood accumulation without deficiency. There must be signs of blood accumulation to justify this formula.
For women with closed and difficult menstrual flow, persistent hard masses in the viscera, dry blood inside, and white discharge, Fan Shi Wan (Alum Stone Pill) is indicated.
Uterine blood stasis does not harmonize with Qi, so new blood cannot arrive, forming dry blood and hard masses, extending externally to the vaginal opening. Fluids fail to circulate and transform into white discharge. Therefore, Green Alum (Lv Fan) is used to dissolve hard masses and break dry blood; Apricot Kernel promotes Qi, opens closure, and moistens visceral dryness; Honey assists. Inserted into the vagina, the medicinal Qi reaches the uterus directly. If dry blood is in the Chong and Ren seas, oral medication must induce descent; local insertion cannot remove it.
For various abdominal pains in women, Dang Gui Shao Yao San (Angelica and Peony Powder) is indicated.
This abdominal pain arises from deficiency of Middle Qi, where Spleen Earth cannot ascend and descend Yin and Yang, causing the two energies to diverge, and Liver Wood overacting to cause pain. Thus, this decoction tonifies the Center, subdues Wood, and circulates Yin and Yang. For women with abdominal pain, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is indicated.
Xiao Jian Zhong Tang specifically treats abdominal pain caused by Wind Wood overacting on Spleen. Women are prone to anger and moving Liver Fire; Wood evil overacting on Earth often causes abdominal pain and abnormal menstrual bleeding, hence this decoction is used. For leukorrhea with difficult menstruation, lower abdominal fullness and pain, and menstruation occurring twice in one month, Tu Gua Gen San (Trichosanthes Root Powder) is indicated. It also treats Yin swelling.
This is also caused by blood stasis. Although menstruation is difficult, the difference is occurring twice a month; both are Chong and Ren meridian blood stasis diseases. Trichosanthes Root dissipates fluid retention; Peony opens blood obstruction; Cinnamon Twig unites blood vessels; Ground Beetle breaks blood accumulation. Alcohol is needed to promote circulation. Regarding Yin swelling, it is not only the male testicle but also the female vulva; it often occurs during childbirth when blood stasis flows in, causing pain and prolapse.
Question: A fifty-year-old woman suffers from diarrhea for dozens of days without stopping, evening fever, urgency and fullness in the lower abdomen, palmar heat, and dry lips and mouth. What is this? Teacher said: This disease belongs to leukorrhea. Why? She previously had a spontaneous abortion, and blood stasis remains in the lower abdomen. How do we know? Her symptom of dry lips and mouth confirms it. Treat with Wen Jing Tang (Warm the Mersidian Decoction). It also treats cold in the lower abdomen of women, infertility due to long-term failure to conceive, metrorrhagia, excessive menstrual flow, or delayed menstruation.
Why is diarrhea attributed to leukorrhea? At age fifty, menstruation ceases, the uterine gate closes, and Chong and Ren no longer discharge. Accumulated blood transforms into leukorrhea from the uterine gate with nowhere to exit. The large intestine belongs to Yin, so it manifests as diarrhea through the stool. Thus, leukorrhea is treated as diarrhea.
Wang Jiezhai said: In women, amenorrhea can be caused by Spleen and Stomach damage. Do not immediately assume it is amenorrhea due to dead blood; lightly using blood-breaking medicines is dangerous. In such cases, examine the Spleen and Stomach. If dietary or fatigue injuries damage the Spleen and Stomach, causing poor appetite, aversion to food, diarrhea, and pain, or if mistaken sweating/purgation damages Middle Qi, leading to blood deficiency and amenorrhea, only tonify and nourish the Spleen and Stomach. Use Bai Zhu (Atractylodes Macrocephala Rhizome) as the sovereign herb, Fu Ling (Poria) and Shao Yao (Peony) as ministers, assisted by Huang Qi (Astragalus), Gan Cao (Licorice), Chen Pi (Tangerine Peel), Rou Gui (Cinnamon Bark), Chuan Xiong (Szechwan Lovage Rhizome), Dang Gui Shen (Angelica Sinensis Root Body), and Chai Hu (Bupleurum). When the Spleen is strong, it generates blood, and menstruation resumes. If food stagnation damages the Spleen and Stomach, resolve stagnation and tonify the Spleen. Only if the Spleen and Stomach are healthy and palpable blood masses exist in the lower abdomen should one use Xiang Fu (Cyperus), Qi Ai (Artemisia Argyi), Gui Xin (Cinnamon Heart), and Tao Ren (Apricot Seed) to move blood and unblock menstruation.
The Classic states: Food enters the Stomach, floating and overflowing with essence, transported up to the Spleen. Spleen Qi scatters essence, sending it up to the Lung. The Lung regulates water passages, transporting down to the Bladder. Water essence distributes four ways, and the five meridians run together. Thus, Heart and Spleen harmony ensures regular menstruation. If internal injury from Seven Emotions, external invasion of Six Evils, improper diet, or irregular lifestyle damages the Spleen and Stomach, menstruation becomes irregular. Early menstruation may be due to Liver-Spleen blood dryness, Spleen meridian stagnation, Liver meridian angry fire, blood-level heat, or labor-induced fire. Late menstruation may be due to Spleen meridian blood deficiency, Liver meridian blood scarcity, or Qi deficiency and blood weakness. Treatment: Liver-Spleen blood dryness uses Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder); Spleen stagnation uses Gui Pi Tang (Restore the Spleen Decoction); Liver angry fire uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Sheng Di Huang (Rehmannia); blood-level heat uses Si Wu Tang (Four Substances Decoction) plus Bai Zhu, Fu Ling, Chai Hu, and Dan Pi (Moutan); labor fire uses Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); Spleen blood deficiency uses Shi Quan Da Bu Tang (Great Tonification Ten Ingredients Decoction); Liver blood scarcity uses Liu Wei Wan (Six Ingredient Pill); Qi and blood weakness uses Ba Zhen Tang (Eight Treasures Decoction). For irregular menstruation without other symptoms preventing conception, use Liu Wei Wan reducing Ze Xie by one liang, adding Tong Bian Zhi Xiang Fu (Child Urine Processed Cyperus) four liang, and Cu Zhu Qi Ai (Vinegar-Boiled Artemisia Argyi) one liang for best regulation. If other symptoms coexist, prescribe decoctions accordingly. For women with Qi and blood injury, Chong and Ren deficiency, excessive menstruation, dripping continuously, or delayed menstruation, metrorrhagia, or white leukorrhea, use Si Wu Tang plus Ding Xiang (Clove), E Jiao (Donkey-hide Gelatin), and Ai Ye (Mugwort Leaf). If previous pregnancy injury leaves blood stasis, lower abdominal urgent pain, and five-center heat, use Da Wen Jing Tang (Major Warm the Meridian Decoction). For irregular menstruation with Yin deficiency tidal fever, alternating chills and fever like malaria, night sweats, phlegm cough, gradually becoming bone-steaming fever, caused by blood-heat interaction, use Jia Wei Xiao Yao San. For regular menstruation failing to conceive, there are three causes: Fat and white with no abdominal pain indicates closed uterus due to phlegm; use Dao Tan Tang (Guide Out Phlegm Decoction), or every one or two days send Gun Tan Wan (Rolling Phlegm Pill) two or three doses. Abdominal pain suggests excessive raw/cold food consumption and Qi excess; use warm herbs, Qi Qi Tang (Seven Qi Decoction). Avoid if coughing, emaciated, red-faced, with much fire and Yin deficiency; instead use Si Wu Tang plus Chen Pi, Xiang Fu, and Rou Gui made into pills. Some have insufficient blood to grasp sperm; use Shi Quan Da Bu Tang, or Jin Gui Wen Jing Tang if cold coexists. Some say regular menstruation with cold uterus is incorrect; if the uterus were cold, menstruation would be late, not regular. For dark-skinned, fiery individuals with scanty, deep purple menstruation failing to conceive, it is uterine blood depletion and essence burning; use Si Wu Tang replacing Sheng Di Huang with Huang Qin (Scutellaria) and Lian Zi (Lotus Plumule). For weak individuals failing to conceive due to uterine bloodlessness and scattered essence, use Shi Quan Da Bu Tang. Irregular menstruation prevents conception, though some conceive early. This is blood heat, or possibly mixed early/late patterns, suggesting simultaneous cold and heat. Generally, conception disrupts Qi, disturbing the cycle; thus, regulating Qi is primary in treating menstruation, using Gui Fu Wan. For excess Qi, suppress Qi to move blood; when blood is abundant, Qi flows. For irregular menstruation with pale, watery blood, tonify Qi and blood with Bao Yuan Tang plus Chuan Xiong, Dang Gui, Rou Gui, and Xiang Fu. For abdominal pain, add E Jiao, Ai Ye, and Yan Hu Suo. For deficiency, add Sheng Jiang (Fresh Ginger) and Fu Zi (Aconite). Early menstruation is mostly heat: Blood heat presents with little abdominal pain, body heat, purple color, and rapid/huge pulse; use Si Wu Tang halving Chuan Xiong, replacing with Sheng Di Huang, Tiao Qin (Scutellaria), Dan Pi, and Xiang Fu. Deficient heat uses Si Wu He Bao Yuan Wan; if ineffective, add Pao Jiang (Roasted Ginger) and Xuan Lian (Scutellaria) charred. Dry cough uses Xiao Yao San. Qi excess and blood deficiency causes abdominal pain; use Huo Xiang Zheng Qi San plus Chuan Xiong, Dang Gui, and Xiang Fu, avoiding cold herbs. For women over forty with menstruation two to three times a month, caused by youthful excess, metrorrhagia will follow. Late menstruation is mostly cold: Three presentations: Blood deficiency with little pain, slight body heat, or empty pain, with large/weak or floating/choppy/soggy/thin pulse; regulate Qi and generate blood with Ba Wu Tang plus Xiang Fu. For deficiency, Si Wu Tang plus Ren Shen, Bai Zhu, Huang Qi, Sheng Ma, and Chen Pi. Qi stagnation and blood deficiency uses Si Wu Tang plus Dan Pi and Xiang Fu. For obese individuals with much phlegm, remove Di Huang and add Ju Hong (Tangerine Peel) and Ban Xia (Pinellia) plus Fu Ling. Blood cold presents with deep-slow-wiry-tight pulse; use Gui Fu Wan. Late menstruation with pale color indicates much phlegm; use Er Chen Tang plus Chai Hu, Xiang Fu, and Rou Gui. If late with leukorrhea, use Ai Jian Wan plus Xiang Fu. If coughing, avoid Xiang Fu; use Xiao Yao San plus Dan Pi. Cough with diarrhea uses Yang Wei Tang. Blood stagnation with chest fullness, waist/abdominal pain uses Cu Jian San or Qi Qi Tang modifications. Chong-Ren deficiency with lower abdominal cold and delayed menstruation preventing conception uses Wen Jing Tang. Elderly women with regular, uninterrupted menstruation have excess Qi and blood. If excessive or twice a month, Qi deficiency fails to control blood, risking metrorrhagia. Menstruation resuming after cessation is a Qi disorder, or injury/stasis, distinguished by hypochondriac/abdominal urgent pain; treat with Si Wu Tang using Chi Shao (Red Peony). If the condition can be stopped, use large doses of Ba Wu Tang. If able to eat, add Huang Qin and Huang Lian; if unable, add Pao Jiang to stop it. Medication succeeds in two or three out of ten cases; severe deficiency rarely responds. Approaching menstruation with back/abdominal pain indicates stagnation and stasis; use Si Wu Tang plus Hong Hua (Safflower), Dan Pi, E Zhu (Curcuma), Yan Hu Suo, Xiang Fu, and Mu Xiang. Excess heat adds Huang Lian; fever adds Chai Hu and Huang Qin. Lower abdominal pain before onset indicates Qi-blood stagnation; use Si Wu Tang plus E Zhu and Tao Ren. Premenstrual abdominal pain with floating-wiry pulse uses Xiao Jian Zhong Tang plus Dan Pi and Tao Ren. Body pain before menstruation indicates Qi-blood insufficiency; use Gui Zhi Tang plus Chuan Xiong and Dang Gui, with a small amount of Shu Fu Zi (Processed Aconite). Post-menstrual pain, though considered deficiency-cold requiring tonification, can also result from Qi dispersion; assess tolerance. If intolerant, use Si Wu Tang plus Pao Jiang, Ai Ye, and Fu Zi; if tolerant, use Ba Wu Tang plus Pao Jiang, Ai Ye, and Fu Zi. Treat diarrhea first. Long-standing dull abdominal pain during menstruation for four to five days is due to Qi stagnation stopping flow prematurely; use Si Wu Tang plus Mu Xiang, E Zhu, and Sha Ren. Headache, chest fullness, palpitations, reduced appetite, and dull skin during menstruation indicate Phlegm-Dampness; use Er Chen Tang plus Dang Gui and Pao Jiang.