仲景云∶问妇人年五十所,病下利数十日不止,暮即发热,小腹里急,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,瘀血在小腹不去。何以知之?其
证唇口干燥,故知之。当以温经汤主之。(方见调经门)(问下痢而以半产,瘀血在腹,又曰属带下,然非仲景之言
不能信。如暮热小腹急满,为瘀血在内则可,以掌热烦燥口干,而用温经药,则人皆难之。况此汤有肉桂、半夏、吴茱
萸,谁肯信服)
大全云∶妇人小便白浊白淫者,皆由心肾不交养,水火不升降,或因劳伤于肾,肾
气虚冷故也。肾主水而开窍在阴,阴为溲便之道,胞冷肾损,故有白浊白淫。(据此宜属寒,今皆主热)
李氏曰∶白淫,盖缘思想无穷,所愿不得,意淫于外,入房太甚,发为筋痿,久为白淫
症
白淫之所自。筋痿者,宗筋也,惟久为淫纵者有之。若妇人则无宗筋,岂其窍道一也?
究其所因,似亦不悖,故此数方,与治久浊同法)
。谓白物淫如白精之状,不可误作白带,过服热药。又有日夜流津,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,诚难治疗,用平补镇心丹;因思伤脾胃者,四
七汤下白丸子或归脾汤;痞闷少食者,沉香降气汤;因劳伤肾气,心肾不交者,金锁正元丹
、小菟丝子丸、威喜丸。
薛氏曰∶前证若元气下陷,用补中益气汤;脾胃亏损,六君子加升麻柴胡;脾经郁结,
归脾加黄柏、山栀;肝经怒火,龙胆泻肝汤;虚则用加味逍遥散(怒火有虚实,实者泻之,故用龙胆,虚者补之,
故用逍遥,以逍遥有归、芍养血也),宜与带下参看主治。
一妇人善怒,或小腹痞闷,或寒热往来,或小便频数,时下白淫,药久不愈,面青口苦
。予以为积愤而不能发散所致(若论积愤,当用木郁达之之法),用龙胆泻肝汤而愈,用加味逍遥散、八珍汤而安。
Zhang Zhongjing said: Inquired about a woman around fifty years of age who suffered from diarrhea for dozens of days without cessation, experiencing fever in the evening, urgency and tightness in the lower abdomen, abdominal fullness, heat and irritability in the palms, and dryness of the lips and mouth. What is this disease? The physician replied: This disease belongs to Dai Xia (Leukorrhea). Why? Because she once had a miscarriage, leaving blood stasis in the lower abdomen that has not been expelled. How do we know this? Based on the symptom of dry lips and mouth, we can deduce this. It should be treated primarily with Wen Jing Tang (Warming the Menses Decoction). (Formula see Menstrual Regulation Section) (Critique: Asking about dysentery but linking it to miscarriage and abdominal blood stasis, and calling it Dai Xia, would be hard to believe if not spoken by Zhang Zhongjing. For instance, evening fever and lower abdominal urgency/fullness can be attributed to internal blood stasis; however, palm heat, irritability, and dry mouth treated with warming menses herbs are difficult for people to accept. Moreover, this decoction contains Cinnamon Twig, Pinellia Rhizome, and Evodia Fruit, who would trust it?)
Da Quan says: Leukorrhea (Bai Zhuo) or seminal emission (Bai Yin) in women are all caused by the failure of Heart and Kidney to nourish each other, and the inability of Water and Fire energies to ascend and descend properly, or due to labor injuring the Kidney, resulting in Kidney Qi deficiency and cold. The Kidney governs water and opens into the yin organs; the yin organs are the pathway for urination and defecation. When the uterus is cold and the Kidney is damaged, Bai Zhuo and Bai Yin occur. (Based on this, it should belong to Cold syndrome, yet now it is mostly attributed to Heat.)
Li says: Bai Yin is likely caused by endless thoughts, unfulfilled desires, mental wandering outside, and excessive sexual intercourse, leading to Sinew Flaccidity (Jin Wei), which over time becomes Bai Yin. Jin Wei refers to the Zong Jin (major sinews/genitals), occurring only in those who have indulged excessively in lust over a long period. If it is a woman, she does not have Zong Jin; how can her orifice be the same? Investigating the cause, it seems not contradictory, so these several formulas follow the same method as treating chronic Bai Zhuo. It refers to white discharge overflowing, resembling white semen, which must not be mistaken for regular leukorrhea, nor treated with excessive hot medicines. There is also daily flow of fluid, like clear rice wash water, or like sticky glue, called Bai Beng (White Collapse), which is largely similar to Bai Yin. It is mostly caused by excessive worry and thought, truly difficult to treat. Use Ping Bu Zhen Xin Dan (Calm the Heart Pill); if spleen and stomach are injured by thought, use Si Qi Tang administered with Bai Wan Zi or Gui Pi Tang; if there is stuffiness and poor appetite, use Chen Xiang Jiang Qi Tang; if kidney qi is injured by labor and heart-kidney non-interaction occurs, use Jin Suo Zheng Yuan Dan, Xiao Tu Si Zi Wan, or Wei Xi Wan.
Xue says: For the aforementioned conditions, if primordial qi sinks, use Bu Zhong Yi Qi Tang; if spleen and stomach are deficient, use Liu Jun Zi Tang plus Schizonepeta and Bupleurum; if spleen meridian depression/stagnation exists, use Gui Pi Tang plus Phellodendron Bark and Gardenia Fruit; if liver meridian fire anger exists, use Long Dan Xie Gan Tang; for deficiency syndromes, use Jia Wei Xiao Yao San (Fire anger has excess and deficiency aspects; excess is purged, hence Long Dan Xie Gan Tang; deficiency is tonified, hence Xiao Yao San, because Xiao Yao San contains Angelica Root and Peony Root to nourish blood). It should be referenced alongside the treatment principles for Dai Xia.
A certain woman was prone to anger, sometimes experiencing lower abdominal stuffiness, alternating chills and fever, frequent urination, and occasional Bai Yin. Medications failed to cure her after a long time; her complexion was green, and her mouth tasted bitter. I considered this caused by accumulated resentment that could not be dispersed (If discussing accumulated resentment, the method of "releasing wood stagnation" should be applied). Thus, I used Long Dan Xie Gan Tang to cure her, and then used Jia Wei Xiao Yao San and Ba Zhen Tang to stabilize her condition.