肉桂。经水愆期。胸胁腰腹刺痛。虚浮寒战。此冲任衰弱。脏气虚冷故也。温经汤加减。一切气
上凑心。心腹攻筑。胁肋刺痛。月水不调者。用香附三钱。乌药一钱。陈皮、苏叶各六分。干姜
四五分煎服。经水有紫黑色。腹痛者。乃气血相并也。腹不痛者。血热也。淡红色者。血虚也。
其来必皆不准。腹痛者。四乌汤加蓬术、川连。不痛者。但加川连。色淡者。增损四物汤。色如
黄浆水。心胸嘈杂汪洋。乃胃中有湿痰也。六君子加肉桂、木香、苍术。曾经下利。若汗出小便
利者。为亡津液。故经水反少。补脾和胃。血自生矣。经行之际。禁用苦寒辛散之药。饮食亦然。
经水不止。如左尺按之空虚。是气血俱脱。轻手其脉数疾。举之弦紧或涩。此是阳脱阴亡。或见
热证于口眼鼻。或渴。是名阴躁。阳欲先去也。急用大建中汤。或十全大补送肾气丸以补命门之
下脱。痰多占住血海。因而下多者。目必渐昏。肥人多此。南星、苍术、川芎、香附作丸服。肥
人不及日数而多者。痰多血虚有热。亦用前丸更加黄连、白术。肥盛饮食过度而经水不调者。乃
是湿痰。宜苍术、半夏、茯苓、白术、香附、泽泻、芎、归。躯脂满而经闭者。以导痰汤加川连、
川芎。不可服四物。以地黄泥膈故也。血枯经闭。四物加参、 、肉桂。切禁桃仁、红花。因郁火
者。逍遥、归脾间服。阴虚经脉不通。小便涩。身体疼痛。以四物倍芍药。加肉桂、丹皮、香附、
甘草。经行之际。与产后一般。将理失宜。为病不浅。若被惊则血气错乱。渐止不行。或逆于上
而从口鼻中出。或逆于身而为血分劳瘵。若其时劳力太过。则生
虚热。亦为疼痛之根。若郁怒则气逆。气逆则血滞于腰腿心腹背肋之间。遇经行时则痛而重。
经过则安。若怒极而伤于肝。则又有目晕呕吐之证。加以血不循经。遂成淋漓不止。凡此之类。
感风则病风。感冷则病冷。久而不治。崩漏带下。七 八瘕。皆从此而成矣。
薛立斋治一妇。腹内一块不时上攻。或痛作声。吞酸痞闷。月经不调。小便不利。面色青黄
相兼。已二年余。此肝脾气滞。以六君子加芎、归、柴胡、炒川连、木香、吴茱萸二剂。次与归
脾汤下芦荟丸。月余肝脾和而诸证退。又与补中益气加茯苓、丹皮。中气健而经自调。
又治一中年妇。素性急。先因饮食难化。月经不调。服理气化痰药。反肚膨胀。大便泄泻。
又加乌药、蓬术。肚腹愈胀。小便不利。加猪苓、泽泻。痰喘气急。手足厥冷。头面肢体肿胀。
指按沉而屈。脉沉细。右寸为甚。此脾肺之气虚寒。不能通调水道下输膀胱。渗泄之令不行。生
化之气不运。东垣所云。水饮留积。若土之在雨中。则为泥矣。得和风暖日。水湿去而阳化。自
然万物生长。喜其证脉相应。遂与加减肾气丸。小便即通。数剂肿满消半。四肢渐温。自能转
侧。又与六君子加木香、肉桂、炮姜而愈。
崩漏 经云。阴虚阳搏谓之崩。又云。阴络伤则血内溢。又云。脾统血。肝藏血。崩之为患。
或脾胃虚损。不能摄血。或肝经有火。血热妄行。或怒动肝火。血热沸腾。或脾经郁结。血不归
经。或悲伤胞络。血崩下脱。治疗之法。脾胃虚弱者。六君子加芎、归、柴胡。脾胃虚陷者。补
中益气加酒炒白芍。肝经血热者。四物汤加柴胡、山栀、丹皮。肝经怒火。小柴胡加山栀、芍药、
丹皮。脾经郁火。归脾汤加山栀。故先哲云。凡下血证。须用四君子收功。斯言厥有旨哉。若大脱血后。毋
以脉诊。急用独参汤加当归救之。其发热潮热。咳嗽脉数。乃是元气虚弱。假热之脉也。尤当加
用人参。此等证候。无不由脾胃先损而患。故脉洪大。察其中有胃气。受补可救。误投寒凉之药。
复伤脾胃生气。使血反不归源也。暴崩下血不止者。乃血不归经。阴血随阳盛之势。妄行下漏也。
身热不痛者。逍遥散加熟地、川芎。不应。此血热沸腾也。四物加芩、连、肉桂。按东垣云。经
漏不止有二。皆由脾胃有亏。下陷于肾。与相火相合。湿热下迫。经漏不止。其色紫黑。如夏月
腐肉之臭。中有白带者。脉必弦细。寒伏于中也。有赤带者。其脉洪数。病热明矣。必腰痛。或
脐下痛。临经欲行。先寒热往来。两胁急缩。兼脾胃证见。或四肢困热。烦不得眠。心中急。补
中益气加茯苓、芍药。大补脾胃而升降气血。可一服而愈。或先贵后贱。先富后贫。心气不足。
其火大炽。旺于血脉之中。形质肌肉颜色似不病者。此心病也。经水不时而下。或适来适断。暴
下不止。治当先说恶死之言劝论。令惧死而心不动。以补中益气下安神丸。补养脾胃。镇坠心火。
更以人参养荣。补阴制阳。经自止矣。暴崩下血腹痛有二。有瘀血有空痛。瘀血者。体必作寒。
脉必弦。如空痛者。不寒。少腹上喜热按。脉微弱。但瘀血当去。空痛当补。有因内伤。若少腹
不痛。八物汤加芩、连。如痛者。四乌汤加莪术。年高而崩者。法在不治。治亦无功。经候不调。
血气成块。崩中下漏者。此是血海虚寒。外乘风冷。搏结不散。醋煎散加麝香。血虚气损。或凝
积块。七 八瘕。上则气逆呕吐。下则泄下五色。金匮温经汤加姜、桂。以艾煎酒温服。血崩之
人。有服前药不效者。火也。三补丸。即三黄丸去大黄用黄柏。风入胞门。忽时崩下鲜血者。一
味防风丸。金匮旋复花汤送下。风热入肝经。崩下发热。手心灼热者。一味子芩丸。小建中汤送
下。崩漏淋沥。冲任衰弱。脏腑虚冷故也。千金茯苓补心汤。如小腹急痛。兼下赤白带者。艾煎
丸。若下血过多。血气不足。四肢倦怠乏力。增损四物汤。有
去血虽多。间有崩漏水下。时有鲜血者。四物加丁香、胶、艾、香附、丹皮。失血血崩白淋及经
事来多者。四物加参、 、胶、艾、椿根皮。去血过多。虚劳发热有痰者。补中益气加苓、半。
有热。少加芩、连。（原缺）加乌药、桂心。口干。去升麻加煨葛根。
东垣论崩漏并不言热。其主在寒。即使有热证。亦是虚热。若以寒药治之。即瘀血愈凝结。
经血愈不止矣。四物加炮姜调理。因劳者。用参、 带升补药。血崩甚而腹痛。人多疑恶血未尽。
及见血色瘀晦。愈信恶血之说。不敢便止。大凡血之为患。欲出未出之际。停在腹中。即成瘀色。
未必尽为瘀热。又曷知瘀之不为虚冷乎。若必待瘀血净后止之。恐并其人而不存矣。且腹痛更有
说。积而腹痛。血通则痛止。崩而腹痛。血住则痛止。千金治崩淋带下。五崩热病下血。寒热下
血。经行犯房室下血。经来举重伤任脉下血。产后脏开经利下血。外实内虚之病。用小牛角 散。
若崩中去血不断。本方去禹余粮、干姜、乌 骨、龙骨、赤小豆。加甘草、地榆、小蓟根、丹参、
干地黄、芎 、赤石脂、龟甲、柏子仁。名角 鹿茸散。积冷崩中去血不止。腰背痛。四肢沉重
虚极。小牛角 散去鹿茸、阿胶、乌 骨、赤小豆。加干地黄、桑耳、白术、赤石脂、矾石、附
子、人参、蒲黄、防风。名大牛角 散。崩中去赤白。或如豆汁。千金伏龙肝汤。膀胱虚伤。不
能摄血。而崩下不止者。单方用新丝绵烧灰为末。空心酒调一钱。或鸡子黄蘸食。数日必效。崩
血经年不止者。用香附二两炒黑。莲房五枚烧存性。为细末。空心陈酒调下二钱。或用陈棕榈烧
灰存性。黑糖调。酒下一钱。即止。此劫法也。崩漏过多。服补泻药皆不效者。用黄牛角 存
性。空心酒服二三钱。虚寒血色稀淡者。同鹿茸 服尤效。盖牛属坤土益脾。角 走肝主血。神
农本经云。下闭血瘀血。补女人带下血崩。燔之酒服。宗 曰。烧灰主妇人血崩。大便下血。血
痢虚人。独参、保元皆可送下。此血脱益气之良法也。古方有用白马蹄烧灰存性酒服方寸匙者。
有用桑树上耳烧灰酒服者。皆千金决也。又用五灵脂生炒各半酒服者。此大伤中气。虽藜藿亦难
轻试。崩证多用醋炒荆芥、升麻。醋能收敛故也。血崩日久。纯下臭黄水。或带紫黑筋块腥秽不
堪者不治。腹满不能饮食。不受参、术补益者不治。服大剂补中。人参每日服至两许不应。反加
寒热口燥。面目足胫浮肿者不治。瘀污崩脱。少腹不疼。后变阴户肿突。痛如刀割者。死期迫矣。
〔诊〕漏下赤白。日下血数升。脉急疾者死。迟者生。漏下赤白不止。脉小虚滑者生。数盛者
死。漏下脉弦劲者死。涩涩不调。按之不来者死。下血脉虚者。脉浮者。俱不治。然峻实其下。
亦有得生者。寸口脉迟。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。
薛立斋治一妇。久患血崩。肢体消瘦。饮食到口。但闻腥臊。口出津液。强食少许。腹中作
胀。此血枯之证。用八珍汤。四乌 骨一 茹丸兼服。两月经行而愈。
一妇老年患崩。诸药罔效。身热肢痛。头晕涕出。吐痰少食。众作火治。转致绝粒数日。仅
存呼吸。诊之。乃脾肾虚寒。用生料八味丸一剂。翌早遂索粥。再剂热减痛止。服八味丸。愈后
因劳役忧怒。至夏崩复作。胸饱发热脊痛。腰不可转。神气怫郁。脉洪无伦。按之微弱。此无根
之火。内真寒而外假热也。以十全大补加附子。一剂晕止。崩血渐减。日服八味丸而愈。
汪石山治一妇。年逾四十。形色苍紫。忽病血崩。医者或用凉血。或用止涩。俱罔效。诊之
六脉皆沉涩而缓。按之无力。乃胃病非血病也。当用甘温之剂健脾理胃。使胃气上腾。血循经络。
则无复崩矣。遂用补中益气多加参、 。兼
服参苓白术散而愈。
失血心痛 妇人血崩而心痛甚。名曰失血心痛。心主血。心脾血虚。无以荣养。故痛如刀刺。
崩甚则痛甚。崩缓则痛缓。若小产去血过多而心痛甚者亦然。若小腹喜按而下淡色血水。为阴血
耗散。先用乌 骨炒为末。醋汤调下收敛之。次与补中益气汤升举之。若小腹中有块而按之作痛。
血色红紫。中有结块。为瘀血不散。先用失笑散。后与十全大补峻补之。若心脾血弱。或郁结伤
血。用归脾汤调补之。
经闭不行 经水阴血也。属冲任二脉。上为乳汁。下为血水。其为患。有因脾盛不能生血。
或郁结伤脾而血损者。有因冒火而血烁者。有因劳伤心神而血耗者。有因积怒伤肝而血闭者。有
因肾水不能生肝而血少者。有因肺气虚伤。不能统血而经不行者。治疗之法。损其肺者。益其气。
损其心者。调其营卫。损其脾胃者。调其饮食。适其寒温。损其肝者。缓其中。损其肾者。益其
精。审而治之。庶无误矣。室女妇人诸病。以调经为先。调经以理气为要。盖气不和则血不流。
效经闭。然其证不一。小腹疼痛。血海虚寒也。或潮热头目昏沉。肢体劳倦。五心须热。怔忡面
赤。口燥唇裂。盗汗身疼者。血气虚损也。并宜温经汤。腹中结块。腰腿重痛。及少腹痛如锥刺
者。瘀血凝满也。四物加肉桂、蓬术。貌本壮实。饮食减少者。胃气不调也。盖胃气不和。亦令
经水不调。逍遥散下归附丸。经水三月不至。其脉右浮大而左反弱。其经当下。此为居经。非妊
也。当抑气养血。又经水绝后。一朝而圊血。二三日不止者。不须治。当自止。经水常五日至者
五日愈。下利而经断者。利止自来。盖下利则亡津液。故经绝。利止津液复。经当自下。若脉微
涩者。虽二三月不行。非胎。当养血。经自行。以脉涩故知非胎也。经水不通而逆行者。或吐血。
或衄血。或唾血。或血腥。通宜四
物加韭汁、童便。甚则从虚劳例。用巽顺丸、乌骨鸡丸治之。室女经水既来而复不通。其说有三。
面色不黄。饮食如故。身不热者。名歇。非病也。不须药。面黄肌瘦身热。为虚劳。诊其肝脉。
弦出寸口鱼际。非药所能治。急与婚配。自然经行而愈。药则加味逍遥散。干咳。用蜜制白术、
橘皮、生姜。又有气血不足。面黄肌瘦。身热不甚者。不可用桃仁、红花通血药。宜六味丸去山
茱萸加麦门冬。兼进异功散调补之。妇人经闭不通。视其脉不足。当补气血。四物汤加参、 、
术、草之类。脉有余而气相并者。四乌汤加肉桂、橘皮之类。妇人经候渐少。以致不通。手足骨
肉烦疼。日渐羸瘦而生潮热。其脉微数。此阴虚血弱。阳往乘之。当养血益阴。慎勿以毒药攻之。
女人虚羸。有鬼胎 块。经候不通等证。当随证辨治。丹方有服芫花下黑物而效者。苟非实证。
未可轻试也。妇人月经不利。脐下气胀。上攻欲呕不得睡。加减四物汤。或用当归身一两。穿山
甲炒、蒲黄各五钱。辰砂一钱。麝香少许。共为细末。食前热酒调下二钱。妇女骨蒸痰嗽。诊其
脉七八至。或细而数。视其肌肉消瘦之极。面反娇赤者。此必死候。更加泄泻喘逆。不能右卧者。
死期尤促。若室女经水不调。尤当开郁为主。室女年及笄。天癸不至而色不黄。饮食如故。此名
Cinnamon Bark (Rougui). Menstruation delayed. Stabbing pain in the chest, hypochondrium, waist, and abdomen. Deficient floating sensation with aversion to cold and shivering. This is due to the decline of the Chong and Ren meridians, and deficiency-cold of the Zang organs. Use Wen Jing Tang (Warm the Menses Decoction) with modifications. For all cases where Qi rushes upward to the heart, causing attacking and pounding pain in the heart and abdomen, stabbing pain in the hypochondrium, and irregular menstruation, use Cyperi Rhizoma (Xiangfu) 3 qian, Linderae Semen (Wuyao) 1 qian, Citri Reticulatae Pericarpium (Chenpi) and Perillae Folium (Suye) each 6 fen, Zingiberis Rhizoma Recens (Ganjiang) 4-5 fen, decocted and taken orally. If the menstrual blood is purple-black and accompanied by abdominal pain, it is due to the binding of Qi and Blood. If there is no abdominal pain, it is due to Blood heat. If the color is pale red, it is due to Blood deficiency. The timing will invariably be inaccurate. For those with abdominal pain, use Si Wu Tang (Four Substances Decoction) plus Curcumae Aestivae Rhizoma (Pengzhu) and Coptidis Rhizoma (Chuanlian). For those without pain, add only Coptidis Rhizoma (Chuanlian). For those with pale color, use Zeng Sun Si Wu Tang (Modified Four Substances Decoction). If the color resembles yellow浆 water, with a chaotic feeling in the chest and epigastrium as if surging with water, it is due to damp-phlegm in the Stomach. Use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Cinnamon Bark (Rougui), Aquilegiae Radix (Muxiang), and Atractylodis Rhizoma (Cangzhu). For those who have previously suffered from diarrhea, if sweating occurs and urination is free, it indicates the loss of Body Fluids, hence the menstruation becomes scanty. Tonify the Spleen and harmonize the Stomach; Blood will generate naturally. During menstruation, bitter-cold and acrid-dispersing medicines are contraindicated. Diet should also be observed accordingly. If menstruation does not stop, and the Left Chi pulse is empty upon pressing, it indicates the depletion of both Qi and Blood. A light touch reveals a rapid and hurried pulse; lifting reveals a wiry-tight or choppy quality. This signifies Yang collapse and Yin exhaustion. Heat symptoms may appear in the mouth, eyes, nose, or thirst may occur; this is called Yin restlessness, indicating that Yang is about to depart first. Urgently use Da Jian Zhong Tang (Great Construct the Middle Decoction), or use Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) to send Shen Qi Wan (Kidney Qi Pill) to tonify the lower depletion of the Mingmen (Gate of Life). If phlegm is abundant and obstructs the Sea of Blood, leading to excessive bleeding, the eyes will gradually dim. This is common in obese individuals. Use Arisaematis Rhizoma (Nanxing), Atractylodis Rhizoma (Cangzhu), Ligustici Chuanxiong Rhizoma (Chuanxiong), and Cyperi Rhizoma (Xiangfu) made into pills for oral administration. In obese individuals, if menstruation occurs before the expected date and is excessive, it is due to abundant phlegm, Blood deficiency, and heat. Use the aforementioned pill formula plus Coptidis Rhizoma (Huanglian) and Atractylodis Macrocephalae Rhizoma (Baizhu). For those who are corpulent and overeat, leading to irregular menstruation, it is due to damp-phlegm. Use Atractylodis Rhizoma (Cangzhu), Pinelliae Rhizoma (Banxia), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Baizhu), Cyperi Rhizoma (Xiangfu), Alismatis Rhizoma (Zexie), Ligustici Chuanxiong Rhizoma (Xiong), and Angelicae Sinensis Radix (Gui). If body fat is abundant but menstruation is absent, use Dao Tan Tang (Guide Out Phlegm Decoction) plus Coptidis Rhizoma (Chuanlian) and Ligustici Chuanxiong Rhizoma (Chuanxiong). Do not use Si Wu Tang because Rehmanniae Radix Preparata (Dihuang) is cloying and obstructs the diaphragm. For amenorrhea due to Blood exhaustion, use Si Wu Tang (Four Substances Decoction) plus Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), and Cinnamon Twig (Guizhi). Strictly avoid Persicae Semen (Taoren) and Carthami Flos (Honghua). For cases caused by constrained fire, alternate between Xiao Yao San (Free and Easy Wanderer Powder) and Gui Pi Tang (Restore the Spleen Decoction). For Yin deficiency with blocked meridians, astringent urination, and body pain, use Si Wu Tang (Four Substances Decoction) with doubled Paeoniae Radix Alba (Shaoyao), plus Cinnamon Twig (Guizhi), Moutan Cortex (Danpi), Cyperi Rhizoma (Xiangfu), and Glycyrrhizae Radix et Rhizoma (Gancao). The management during menstruation is similar to postpartum care. Improper management leads to severe disease. If startled, Qi and Blood become disordered, gradually stopping flow. Or it reverses upward and exits through the mouth and nose, or reverses within the body becoming a Blood-type consumption disease. If labor was excessive at that time, deficient heat arises, which also becomes the root of pain. If constrained anger causes Qi reversal, Qi reversal causes Blood stasis in the waist, legs, heart, abdomen, back, and hypochondrium. During menstruation, pain is severe and heavy. After the period passes, it resolves. If extreme anger injures the Liver, dizziness and vomiting occur. Combined with Blood not following its vessels, it becomes dripping and unceasing. All such cases: contracting Wind leads to Wind disease; contracting Cold leads to Cold disease. If untreated for a long time, metrorrhagia, leukorrhea, Seven Excesses and Eight Accumulations (Qi Ba Jia Xia) all arise from this.
Xue Lizhai treated a woman with a mass in the abdomen that attacked upward intermittently, sometimes making sounds when painful, acid regurgitation, chest fullness and stifling, irregular menstruation, and difficult urination. Her complexion was mixed green and yellow, lasting for more than two years. This was Liver and Spleen Qi stagnation. Prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) plus Ligustici Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Gui), Bupleuri Radix (Chaihu), stir-fried Coptidis Rhizoma (Chuanlian), Aquilegiae Radix (Muxiang), and Evodiae Fructus (Wuzhuyu) for two doses. Then administered Gui Pi Tang (Restore the Spleen Decoction) sending down Lu Hui Wan (Aloe Pill). After a month, the Liver and Spleen harmonized and symptoms subsided. Then used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Poria (Fuling) and Moutan Cortex (Danpi). With robust Middle Qi, menstruation regulated itself.
He also treated a middle-aged woman who was naturally irritable. Initially, due to difficulty digesting food and irregular menstruation, she took Qi-regulating and phlegm-resolving medicines, which instead caused abdominal distension and diarrhea. Adding Linderae Semen (Wuyao) and Curcumae Aestivae Rhizoma (Pengzhu) worsened the abdominal distension. Adding Polyporus (Zhuling) and Alismatis Rhizoma (Zexie) led to phlegm-wheezing, shortness of breath, cold limbs, swelling of the head, face, and limbs, with pitting edema. The pulse was deep and fine, especially at the Right Cun position. This indicated deficiency-cold of Spleen and Lung Qi, unable to regulate water passages and transport them downward to the Bladder. The function of seepage and excretion failed, and the transformative Qi did not move. As Dong Yuan said: "Water and drink accumulate like mud in rain-soaked earth." With gentle wind and warm sun, water and dampness leave, Yang transforms, and all things grow naturally. Pleased that the symptoms and pulse corresponded, he prescribed Jia Jian Shen Qi Wan (Modified Kidney Qi Pill). Urination immediately flowed. After several doses, half the swelling and fullness subsided, limbs warmed, and she could turn herself over. Finally, cured with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Aquilegiae Radix (Muxiang), Cinnamon Twig (Guizhi), and Zingiberis Rhizoma Ustus (Paojiang).
Metrorrhagia and Metrostaxis (Beng Lou): The Classic states: "Yin deficiency and Yang pulsation constitute Beng." It also states: "Injury to Yin collaterals causes internal hemorrhage." And: "The Spleen controls Blood; the Liver stores Blood." The harm of Beng can be due to: Spleen-Stomach deficiency failing to control Blood; Liver channel fire causing reckless Blood heat movement; anger stirring Liver fire causing Blood heat boiling; Spleen channel constraint causing Blood not returning to its vessels; grief injuring the Bao Luo (Uterine network) causing Blood Beng and lower depletion. Treatment methods: For Spleen-Stomach weakness, Liu Jun Zi Tang (Six Gentlemen Decoction) plus Ligustici Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Gui), and Bupleuri Radix (Chaihu). For Spleen-Stomach sinking, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus wine-fried Paeoniae Radix Alba (Baishao). For Liver channel Blood heat, Si Wu Tang (Four Substances Decoction) plus Bupleuri Radix (Chaihu), Gardeniae Fructus (Shanzhi), and Moutan Cortex (Danpi). For Liver channel furious fire, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Gardeniae Fructus (Shanzhi), Paeoniae Radix (Shaoyao), and Moutan Cortex (Danpi). For Spleen channel constrained fire, Gui Pi Tang (Restore the Spleen Decoction) plus Gardeniae Fructus (Shanzhi). Thus, ancient sages said: "For all lower hemorrhage syndromes, one must conclude treatment with Si Jun Zi Tang (Four Gentlemen Decoction)." This statement has profound meaning. After massive blood loss, do not rely solely on pulse diagnosis. Urgently use Du Shen Tang (Single Ginseng Decoction) plus Angelicae Sinensis Radix (Danggui) to save the patient. Fever, tidal fever, cough, and rapid pulse indicate weak Yuan Qi and false heat pulses. Ginseng should particularly be added. Such syndromes always originate from prior Spleen-Stomach damage. Although the pulse is洪大 (surging and large), if Stomach Qi is present within, tonification can save. Mistakenly using cold-cool medicines further damages Spleen-Stomach generating Qi, causing Blood to fail to return to its source. For sudden severe Beng with continuous bleeding, it is Blood not returning to its vessels; Yin Blood follows the trend of Yang excess and leaks recklessly downward. If body heat without pain, use Xiao Yao San (Free and Easy Wanderer Powder) plus Prepared Rehmanniae Radix (Shudi) and Ligustici Chuanxiong Rhizoma (Chuanxiong). If ineffective, this is Blood heat boiling. Use Si Wu Tang (Four Substances Decoction) plus Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Cinnamon Twig (Guizhi). According to Dong Yuan, there are two types of persistent metrorrhagia, both caused by Spleen-Stomach deficiency sinking into the Kidney, combining with Minister Fire, and damp-heat pressing downward. The color is purple-black, smelling foul like rotting flesh in summer. If accompanied by white discharge, the pulse must be wiry and fine, indicating Cold hidden inside. If accompanied by red discharge, the pulse is surging and rapid, clearly indicating heat. There must be lower back pain or umbilical pain. Before menstruation, alternating chills and fever, tightness and contraction of both hypochondria, combined with Spleen-Stomach symptoms, or heat in limbs, irritability preventing sleep, urgency in the heart. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Poria (Fuling) and Paeoniae Radix (Shaoyao) to greatly tonify Spleen-Stomach and regulate Qi and Blood ascent/descent; one dose can cure. Or, if status changes from noble to humble, rich to poor, Heart Qi is insufficient, and fire blazes wildly in the blood vessels. Physical appearance and muscle color seem healthy; this is a Heart disease. Menstruation comes irregularly, starts and stops suddenly, or flows heavily and continuously. Treatment should first involve speaking of death to persuade and discuss, making her fear death so the Heart remains still. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) sending down An Shen Wan (Calming Spirit Pill) to tonify Spleen-Stomach and suppress Heart fire. Further use Ren Shen Yang Rong Tang (Ginseng Nourishing Vigor Decoction) to nourish Yin and control Yang; menstruation will stop naturally. Sudden severe Beng with abdominal pain has two types: Blood stasis and Empty pain. For Blood stasis, the body feels cold, and the pulse is wiry. For empty pain, there is no cold; the lower abdomen prefers hot pressure, and the pulse is weak and faint. Blood stasis should be removed; empty pain should be tonified. Due to internal injury, if the lower abdomen does not hurt, use Ba Wu Tang (Eight Substances Decoction) plus Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian). If painful, use Si Wu Tang (Four Substances Decoction) plus Curcumae Aestivae Rhizoma (Ezhu). For elderly women with Beng, the method is untreatable; treatment is also futile. For irregular menstruation, Blood-Qi forming masses, metrorrhagia and metrostaxis, this is deficiency-cold of the Sea of Blood, contracting external Wind-Cold, knotting and not dispersing. Use Cu Jian San (Vinegar-Fried Powder) plus Moschus (Shexiang). For Blood deficiency and Qi damage, or coagulated masses, Seven Excesses and Eight Accumulations (Qi Ba Jia Xia), upper reversal causes vomiting, lower discharge of five colors. Use Jin Gui Wen Jing Tang (Jin Gui Warm the Menses Decoction) plus Ginger and Cinnamon, decocted with Mugwort and wine, taken warm. For women with Beng who do not respond to previous medicines, it is Fire. Use San Bu Wan (Three Tonifying Pill), which is San Huang Wan (Three Yellows Pill) minus Rheum Palmatum (Dahuang), using Phellodendri Cortex (Huangbai). If Wind enters the Bao Gate, suddenly bursting with fresh red blood, use Yi Wei Fang Feng Wan (Single Wind-Proof Pill) sent down with Jin Gui Xuan Fu Hua Tang (Jin Gui Inula Flower Decoction). If Wind-Heat enters the Liver channel, Beng with fever and burning palms, use Yi Wei Zi Qin Wan (Single Scutellaria Pill) sent down with Xiao Jian Zhong Tang (Small Construct the Middle Decoction). Dripping Beng due to Chong-Ren decline and deficiency-cold of Zang-Fu organs. Use Qian Jin Fu Ling Bu Xin Tang (Thousand Gold Poria Tonifying Heart Decoction). If lower abdomen urgent pain with red-white discharge, use Ai Jian Wan (Mugwort-Decocted Pill). If excessive blood loss leading to Qi-Blood deficiency and limb fatigue, use Zeng Sun Si Wu Tang (Modified Four Substances Decoction). Even with much blood loss, occasionally having Beng with watery discharge and fresh red blood, use Si Wu Tang (Four Substances Decoction) plus Amomi Fructus Rotundus (Dingxiang), Colla Corii Asini (Ejiao), Artemisiae Argyi Folium (Aiye), Cyperi Rhizoma (Xiangfu), and Moutan Cortex (Danpi). For hemorrhage, Beng, white discharge, and heavy menstruation, use Si Wu Tang (Four Substances Decoction) plus Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Colla Corii Asini (Ejiao), Artemisiae Argyi Folium (Aiye), and Toosendan Fructus (Chungenpi). For excessive blood loss with deficiency-consumption fever and phlegm, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Poria (Fuling) and Pinelliae Rhizoma (Banxia). If heat, add little Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian). (Original missing) Add Linderae Semen (Wuyao) and Cassiae Ramulus (Guixin). If dry mouth, remove Cimicifugae Rhizoma (Shengma) and add prepared Puerariae Radix (Weige Gen).
Dong Yuan discussed Beng and Lou without mentioning heat; his main focus was on Cold. Even if heat symptoms exist, they are deficient heat. Treating with cold medicines causes Blood stasis to congeal more and menstrual blood to flow more incessantly. Regulate with Si Wu Tang (Four Substances Decoction) plus Zingiberis Rhizoma Ustus (Paojiang). For cases due to labor, use Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) with ascending and tonifying medicines. For severe Beng with abdominal pain, people often suspect evil blood is not exhausted. Seeing dark瘀 blood color confirms this suspicion, daring not to stop it immediately. Generally, when Blood is harmed, at the moment before exiting, staying in the abdomen, it becomes瘀 color. It is not necessarily瘀 heat. How do we know瘀 is not deficiency-cold? If one waits until瘀 blood is clean before stopping, fearing the person will perish too. Furthermore, abdominal pain has another explanation: accumulation causing pain stops when Blood flows; Beng causing pain stops when Blood stays. Qian Jin treats Beng, lin, and leukorrhea. Five Bens with heat disease causing lower bleeding, cold-heat lower bleeding, intercourse during menstruation causing lower bleeding, raising heavy objects during menstruation injuring Ren Mai causing lower bleeding, postpartum organ opening with smooth menstruation causing lower bleeding. For exterior excess and interior deficiency diseases, use Xiao Niu Jiao Ci San (Small Buffalo Horn Tip Powder). If Beng bleeding continues, remove Yu Liang Shi (Yu Liangshi), Zingiberis Rhizoma (Ganjiang), Black Bone (Wugu), Long Gu (Longgu), and Adzuki Bean (Chixiaodou) from this formula. Add Glycyrrhizae Radix et Rhizoma (Gancao), Sanguisorbae Radix (Diyu), Cirsii Herba (Xiaoji Gen), Salviae Miltiorrhizae Radix (Danshen), Rehmanniae Radix (Di Huang), Ligustici Chuanxiong Rhizoma (Chuanxiong), Red Kaolin (Chishizhi), Testudinis Carapax et Plastrum (Guijia), and Biota Semen (Baizi Ren). Named Jiao Ci Lu Rong San (Horn Tip Deer Antler Powder). For accumulated Cold causing continuous Beng bleeding, lower back pain, heavy limbs, extreme deficiency, remove Deer Antler (Lurong), Colla Corii Asini (Ejiao), Black Bone (Wugu), and Adzuki Bean (Chixiaodou) from Xiao Niu Jiao Ci San. Add Rehmanniae Radix (Di Huang), Auricularia Judae (Sanger), Atractylodis Macrocephalae Rhizoma (Baizhu), Red Kaolin (Chishizhi), Alum (Fanshi), Aconiti Lateralis Radix Preparata (Fuzi), Ginseng Radix et Rhizoma (Renshen), Polygoni Multiflori Caulis (Puhuang), and Saposhnikoviae Radix (Fangfeng). Named Da Niu Jiao Ci San (Great Buffalo Horn Tip Powder). For Beng with red-white discharge or bean-jelly-like substance, use Qian Jin Fu Long Gan Tang (Thousand Dragon Liver Decoction). For Bladder deficiency injury unable to control Blood, causing continuous Beng, use a single prescription: burn new silk floss to ash, make into powder, take 1 qian with empty-stomach wine. Or dip egg yolk in it and eat. Effective in a few days. For Beng lasting years, use 2 liang of stir-fried black Cyperi Rhizoma (Xiangfu) and 5 lotus seedpods burned to retain nature, made into fine powder. Take 2 qian with empty-stomach aged wine. Or use aged palm fronds burned to ash, mixed with brown sugar, take 1 qian with wine to stop. This is a劫 (rob/capture) method. For excessive Beng and Lou where tonifying and purgative medicines fail, use Yellow Buffalo Horn Tip (Niujiaoci) retained nature, take 2-3 qian with empty-stomach wine. For deficiency-cold with thin pale blood color, taking with Deer Antler Tip (Lurongci) is even more effective. Ox belongs to Kun Earth benefiting Spleen; Horn Tip travels to Liver governing Blood. Shennong Ben Cao Jing says: "Resolves closed瘀 blood, tonifies women's leukorrhea and blood Beng. Burn and take with wine." Zong [author] says: "Ash primarily treats women's blood Beng, lower intestinal bleeding, bloody dysentery in deficient persons. Single Ginseng or Bao Yuan can send it down. This is an excellent method for Qi supplementation after Blood loss." Ancient formulas used White Horse Hoof burned to ash taken with wine. Or Ear fungus from Mulberry tree burned to ash taken with wine. Both are Qian Jin decisions. Also using Trogopterori Faeces (Wulingzhi) raw and stir-fried equally taken with wine. This severely damages Middle Qi; even coarse food is hard to lightly test. Beng syndromes mostly use vinegar-fried Schizonepetae Spica (Jingjie) and Cimicifugae Rhizoma (Shengma) because vinegar can astringe. For long-standing blood Beng, purely discharging foul yellow water, or with purple-black fibrous clumps and unbearable fishy filth, is untreatable. Abdominal fullness unable to eat, unable to accept Ginseng and Atractylodes tonification, is untreatable. Taking large doses of Bu Zhong, Ginseng taken daily up to 1 liang without response, adding chills/fever, dry mouth, facial and leg edema, is untreatable.瘀污 (filthy瘀) Beng with no lower abdominal pain, later changing to protruding vulva swelling, cutting pain, death is imminent.
[Diagnosis] Discharge of red-white blood, losing several sheng per day, rapid pulse means death; slow pulse means survival. Continuous red-white discharge, small-deficient-slipping pulse means survival; numerous-full pulse means death. Wiry-tough pulse means death. Choppy and irregular, not coming upon pressing means death. Lower bleeding with deficient pulse, floating pulse, both untreatable. However, firmly solidifying the lower part can also lead to survival. Cun Kou pulse slow indicates Cold in Upper Jiao, causing hematemesis and epistaxis. Chi pulse slightly slow indicates Cold in Lower Jiao, causing Beng and melena. Generally, small-rapid is favorable; surging-large is adverse. The general principle is to regulate and tonify Spleen-Stomach as the main approach.
Xue Lizhai treated a woman suffering from chronic blood Beng. Limbs emaciated. Food reaching the mouth smelled fishy and rank. Saliva flowed from the mouth. Forced eating a little caused abdominal distension. This was Blood exhaustion syndrome. Used Ba Zhen Tang (Eight Treasures Decoction) and Si Wu Gu Yi Ru Wan (Four Substances Bone and Cartilage Pill) concurrently. After two months, menstruation resumed and she was cured.
An elderly woman suffered from Beng; all medicines were ineffective. Body heat, limb pain, dizziness, runny nose, expectoration, poor appetite. Others treated as Fire, leading to fasting for several days, barely breathing. Diagnosis revealed Spleen-Kidney deficiency-cold. One dose of Sheng Liao Ba Wei Wan (Raw Material Eight Flavor Pill) resulted in asking for porridge the next morning. Two doses reduced heat and stopped pain. Continued taking Ba Wei Pill. After recovery, due to labor and worry/anger, Beng recurred in summer. Chest fullness, fever, spine pain, inability to turn waist, depressed spirit, surging pulse without measure, weak upon pressing. This was Rootless Fire, true Cold inside and false Heat outside. Used Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) plus Aconiti Lateralis Radix Preparata (Fuzi). One dose stopped dizziness, Beng gradually reduced. Daily Ba Wei Pill cured her.
Wang Shishan treated a woman over forty, dark purple complexion, suddenly suffering blood Beng. Doctors used cooling-blood or astringent medicines, all ineffective. Pulse: all six positions deep, choppy, and slow, powerless upon pressing. This was Stomach disease, not Blood disease. Should use sweet-warm medicines to tonify Spleen and regulate Stomach, allowing Stomach Qi to ascend, Blood to follow meridians, and Beng to cease. Prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with extra Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi). Concurrently took Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) and was cured.
Loss of Blood Heartache: Women with severe heartache due to blood Beng are named Loss of Blood Heartache. The Heart governs Blood. Heart-Spleen Blood deficiency fails to nourish, thus pain like knife stabbing. Severe Beng means severe pain; mild Beng means mild pain. Similarly for miscarriage with excessive blood loss and severe heartache. If lower abdomen prefers pressure and discharges pale bloody water, it is Yin Blood consumption. First use Black Bone (Wugu) stir-fried to powder, taken with vinegar water to astringe. Then use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to lift. If a mass in lower abdomen hurts upon pressing, blood color red-purple with clots, it is unresolved Blood stasis. First use Shi Xiao San (Pain-Relieving Powder), then use Shi Quan Da Bu Tang (Ten Significant Tonifying Decoction) to strongly tonify. If Heart-Spleen Blood is weak or constraint injures Blood, use Gui Pi Tang (Restore the Spleen Decoction) to regulate and tonify.
Amenorrhea: Menstrual water is Yin Blood, belonging to Chong and Ren meridians. Upward it becomes milk, downward it becomes menstrual water. Causes include: Spleen excess unable to generate Blood; constraint injuring Spleen damaging Blood; exposure to fire scorching Blood; labor exhausting Heart spirit consuming Blood; accumulated anger injuring Liver closing Blood; Kidney Water unable to generate Liver causing Blood scarcity; Lung Qi deficiency failing to control Blood stopping menstruation. Treatment: Damage Lung, benefit Qi. Damage Heart, regulate Ying and Wei. Damage Spleen-Stomach, regulate diet, adjust cold/warmth. Damage Liver, soothe its center. Damage Kidney, benefit Essence. Carefully treat, lest errors occur. For maidens and women, regulating menstruation is primary; regulating Qi is key. Since Qi disharmony prevents Blood flow, leading to amenorrhea. Symptoms vary: Lower abdominal pain indicates Sea of Blood deficiency-cold. Or tidal fever, heavy head/eyes, limb fatigue, five-center heat, palpitations, red face, dry mouth/lips, night sweats, body pain indicates Qi-Blood deficiency. All suitable for Wen Jing Tang (Warm the Menses Decoction). Masses in abdomen, heavy/painful waist/legs, stabbing lower abdominal pain indicates Blood stasis congestion. Use Si Wu Tang (Four Substances Decoction) plus Cinnamon Twig (Guizhi) and Curcumae Aestivae Rhizoma (Pengzhu). Originally robust but decreased appetite indicates Stomach Qi disharmony. Disharmonious Stomach Qi also causes irregular menstruation. Use Xiao Yao San (Free and Easy Wanderer Powder) sending down Gui Fu Wan (Angelica and Cinnamon Pill). If menstruation does not come for three months, Right pulse floating-large and Left weak, menstruation should flow. This is Ju Jing (Resident Menses), not pregnancy. Suppress Qi and nourish Blood. If menstruation stops, then suddenly defecates blood, continuing 2-3 days, no need to treat; it will stop naturally. Normal 5-day menstruation heals in 5 days. Diarrhea stopping menstruation: when diarrhea stops, menstruation returns naturally. Diarrhea loses Body Fluids, hence menstruation stops. When fluids recover, menstruation flows. If pulse is micro-choppy, though not flowing for 2-3 months, it is not pregnancy; nourish Blood, menstruation flows naturally. Choppy pulse indicates non-pregnancy. If menstrual flow is blocked and reverses upward, causing hematemesis, epistaxis, spitting blood, or bloody sputum, generally use Si Wu Tang (Four Substances Decoction) plus Chinese Leek Juice (Jiu Zhi) and Child's Urine (Tong Bian). Severe cases follow deficiency-consumption examples, using Xun Shun Wan (Submissive Smooth Pill) or Wu Gu Ji Wan (Black Bone Chicken Pill). For maidens whose menstruation comes then stops again, three explanations: Face not yellow, normal diet, no body heat, named Xie (Rest), not disease, no medicine needed. Yellow face, emaciated, body heat indicates deficiency-consumption. Diagnose Liver pulse: wiry emerging from Cun Kou Yu Ji, not curable by medicine. Urgently arrange marriage; menstruation will naturally flow and heal. Medicine: Modified Xiao Yao San. Dry cough: honey-processed Atractylodis Macrocephalae Rhizoma (Baizhu), Citri Reticulatae Pericarpium (Jupi), Zingiberis Rhizoma (Shengjiang). Also Qi-Blood deficiency, yellow face, emaciated, slight body heat: do not use Persicae Semen (Taoren) and Carthami Flos (Honghua) blood-invigorators. Suitable for Liu Wei Wan (Six Flavor Pill) removing Cornus Officinalis Fructus (Shanzhuyu) plus Ophiopogonis Radix (Maidong). Concurrently advance Yi Gong San (Extraordinary Ability Powder) to regulate and tonify. For women with amenorrhea, if pulse is deficient, tonify Qi and Blood. Si Wu Tang (Four Substances Decoction) plus Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), and Glycyrrhizae Radix et Rhizoma (Gancao). If pulse is excessive and Qi binds, Si Wu Tang (Four Substances Decoction) plus Cinnamon Twig (Guizhi) and Citri Reticulatae Pericarpium (Jupi). For women with gradually decreasing menstruation leading to blockage, painful limbs/bones/muscles, daily emaciation and tidal fever, micro-rapid pulse, this is Yin deficiency and Blood weakness, Yang invading. Nourish Blood and benefit Yin. Do not attack with toxic drugs. Women with deficiency-emaciation, Ghost Fetus masses, amenorrhea, etc., treat according to syndrome. Alchemical formulas using Genkwa Flos (Yuanhua) to expel black matter are effective. Unless excess syndrome, do not lightly test. For women with difficult menstruation, lower umbilical Qi distension, attacking upward causing nausea and insomnia, use Jia Jian Si Wu Tang (Modified Four Substances Decoction). Or use Angelicae Sinensis Radix (Dangshen) 1 liang, Stir-fried Pangolin Scale (Chuanshanjia) and Lygodii Spora (Puhuang) each 5 qian, Cinnabar (Chensha) 1 qian, Moschus (Shexiang) a little. Make fine powder, take 2 qian with hot wine before meals. For women with bone-steaming phlegm-cough, pulse 7-8 beats, or fine-rapid, muscles extremely emaciated, face surprisingly rosy, this is certain death sign. Plus diarrhea, wheezing, inability to lie on right side, death is imminent. For maidens with irregular menstruation, primarily open constraint. Maiden reaching puberty, Tian Gui not arriving, face not yellow, normal diet, this is named...