其人体瘠,性躁,善怒,善烦,脉浮数,口渴,潮热骨蒸,便秘,溲赤,时或气逆,此乃大烁血室,冲气上逆也。
火盛者气亦必虚,《经》所谓∶“壮火食气”,是也。故治之之道,必壮水之主,以制阳光。而尤宜辅以助气涩精之味也。
与加味傅氏两地汤。
大生地 元参 麦冬肉 粉丹皮 女贞子 贯众炭 生白芍 地骨皮 阿胶 金樱子 炒淮药 木耳炭 生潞党
白术(制)
(〔批〕以上两种治法与崩证无异。然未成崩者,服药少而易效,已成崩者服药多而功迟也。)
经水后期,色紫而少,甚或有块者,此属肾亏水涸,肝郁生火也。以其少,故知肾虚;以其紫,故知有火;以其后
期,或有块,故知肝郁。其人必多烦怒,体瘦,脉数,按之濡涩,舌深绛,而便难也。治法以傅氏两地汤,加象贝母、
竹茹、青蒿之属。
大生地 元参 麦冬肉 象贝母 白归身 石决明 生白芍 阿胶 地骨皮 炒竹茹 炙青蒿
经水后期,色紫而多,气滞也。但利其气,勿壮水而泄火。(〔批〕此证火乃郁火,非实火也。气本滞,若又壮水泄
火,必致寒凝瘀秘之忧。)
制白术 陈皮 延胡索 杭芍炭 象贝母 白茯苓 木香 炒当归 杭甘菊 炙龟版
(〔批〕惟此条为后期正病正治,上二条皆变局也。)
经水后期,色淡而少,甚或有块者,气血虚寒也。但温补而通之。
炒当归 川芎 炙党参 炙甘草 怀牛膝 制白术 姜炭 淡吴萸 蕲艾叶 大熟地
The patient is emaciated, irritable, prone to anger and vexation. The pulse is floating and rapid (Chong Shu), accompanied by thirst, tidal fever (Chao Re) with bone-steaming sensation (Gu Zheng), constipation, dark scanty urine, and occasional rebellious Qi (Qi Ni). This indicates severe scorching of the Blood Chamber (Xue Shi) and rebellious Qi of the Chong Mai (Penetrating Vessel).
When Fire is excessive, Qi must also be deficient, as stated in the *Classic*: "Excessive Fire consumes Qi" (Zhuang Huo Shi Qi). Therefore, the treatment principle must be to tonify the source of Water (Kidney Yin) to control the excessive Yang (Zhuang Shui Zhi Zhu, Yi Zhi Yang Guang). It is especially appropriate to assist with herbs that tonify Qi and astringe Essence.
Administer Modified Fu's Liang Di Decoction (Jia Wei Fu Shi Liang Di Tang).
Sheng Di Huang (Rehmanniae Radix Preparata), Xuan Shen (Scrophulariae Radix), Mai Dong (Ophiopogonis Tuber), Mu Dan Pi (Moutan Cortex), Nu Zhen Zi (Ligustri Lucidi Fructus), Guan Zhong Tan (Cyatheae Spadix Carbonized), Bai Shao (Paeoniae Radix Alba), Di Gu Pi (Lycii Cortex), E Jiao (Colla Corii Asini), Jin Ying Zi (Rosae Laevigatae Fructus), Chai Huai Yao (Dioscoreae Rhizoma Stir-fried), Mu Er Tan (Auriculariae Auriculae Carbonized), Sheng Lu Dang Shen (Codonopsis Radix Raw), Bai Zhu (Atractylodis Macrocephalae Rhizoma Prepared).
([Comment] The above two treatment methods are identical to those for Metrorrhagia (Beng Zheng). However, for cases not yet developed into Metrorrhagia, fewer doses yield quick results; for cases already developed into Metrorrhagia, more doses are needed and efficacy is slower.)
Menstruation arriving late, with purple color and scanty flow, or even containing clots, belongs to Kidney Deficiency with depletion of Water, and Liver Stagnation generating Fire. Scanty flow indicates Kidney Deficiency; purple color indicates Fire; late arrival or clots indicate Liver Stagnation. The person is likely vexed and angry, emaciated, with a rapid pulse that is soft and choppy upon deep pressure, a deep crimson tongue, and difficult defecation. The treatment method uses Fu's Liang Di Decoction, added with Xiang Bei Mu (Fritillariae Thunbergii Bulbus), Zhu Ru (Bambusae Caulis in Taeniam), and Qing Hao (Artemisiae Annuae Herba).
Sheng Di Huang (Rehmanniae Radix Preparata), Xuan Shen (Scrophulariae Radix), Mai Dong (Ophiopogonis Tuber), Xiang Bei Mu (Fritillariae Thunbergii Bulbus), Gui Shen (Angelicae Sinensis Radix), Shi Jue Ming (Haliotidis Concha), Bai Shao (Paeoniae Radix Alba), E Jiao (Colla Corii Asini), Di Gu Pi (Lycii Cortex), Chao Zhu Ru (Bambusae Caulis in Taeniam Stir-fried), Zhi Qing Hao (Artemisiae Annuae Herba Honey-fried).
Menstruation arriving late, with purple color and abundant flow, is due to Qi Stagnation (Qi Zhi). One should only promote the movement of Qi, without nourishing Water or draining Fire. ([Comment] The Fire in this condition is Depressed Fire (Yu Huo), not Excess Fire. Since Qi is stagnant, using methods to nourish Water and drain Fire will inevitably lead to Cold Coagulation and Stasis Obstruction.)
Zhi Bai Zhu (Atractylodis Macrocephalae Rhizoma Prepared), Chen Pi (Citri Reticulatae Pericarpium), Yan Hu Suo (Corydalis Rhizoma), Hang Shao Tan (Paeoniae Radix Alba Carbonized), Xiang Bei Mu (Fritillariae Thunbergii Bulbus), Bai Fu Ling (Poria), Mu Xiang (Aucklandiae Radix), Chao Dang Gui (Angelicae Sinensis Radix Stir-fried), Hang Gan Ju (Chrysanthemi Flos), Zhi Gui Ban (Testudinis et Plastrum Honey-fried).
([Comment] Only this clause represents the standard treatment for the standard presentation of late menstruation; the previous two clauses represent variations.)
Menstruation arriving late, with pale color and scanty flow, or even containing clots, is due to Qi and Blood Deficiency with Cold. One should only warm, tonify, and unblock.
Chao Dang Gui (Angelicae Sinensis Radix Stir-fried), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Zhi Dang Shen (Codonopsis Radix Honey-fried), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Honey-fried), Huai Niu Xi (Achyranthis Bidentatae Radix), Zhi Bai Zhu (Atractylodis Macrocephalae Rhizoma Prepared), Jiang Tan (Zingiberis Rhizoma Carbonized), Dan Wu Zhu Yu (Evodiae Fructus), Qi Ai Ye (Artemisiae Argyi Folium), Shu Di Huang (Rehmanniae Radix Preparata).