【脉】 经脉不行者。血生于心，因忧愁思虑则伤心，心气停结，故血闭不行。
左寸沉结，宜调心气、通心经，使血生而自通。或因堕胎，或产多，共血先少而后不通。
此为血枯，脉两尺弱小，宜生血。
【因证】 血随气行，结为块，日渐长，宜散之。
久发盗汗，致血脉干枯而经不通，宜补血。是汗出于心，血生于心，血与汗出也。
久患潮热，则血枯燥。盖血为热所消，寒热去则血自生。脾胃不和，饮食减少，则血不
生。血者，饮食所化。经云∶二阳之病发心脾，女子不月。
血为气引而行。血之来而先有病，皆气之患也；来而后有病者，皆血之虚也；病出意外
，皆血之热也。
【治】 将来作痛，乃气实也，桃仁、红花、香附、枳壳、川连。
不及期者，乃血热也，四物加川连。
过期有二，乃血少与痰多也。血少，芎、归、参，紫黑成块加连；痰多，色淡也，肥人
多有，二陈加苍术、香附、川芎。
闭而不行，乃虚而热；来成块，乃气之滞；错经妄行，乃气之乱。
【脉】 洪数而疾。漏血下赤白，日下数升。脉急疾者死，迟者生；紧大者死，
虚小者生。
【因治】 热，血热则流；虚，虚则下溜。盖阴虚阳搏谓之崩。由脾胃有亏，气
下陷于肾，与相火相合，湿热下迫。脉洪而疾，先见寒热往来，心烦不得眠，治宜大补脾胃
而升其血气。
盖心气不足，其火大炽，在于血脉之中，致脾胃有亏，火乘其中，形容似不病者，此心
病也。治法同前，微加镇坠心火之药，补阴泻阳，经自止矣。
盖肾心真阴虚，不能镇守包络相火，故血走而崩也，是气血俱虚，为大寒之证；轻手其
脉数疾，举指弦紧或涩，皆阳脱也；阴火亦云或渴，此皆阴燥。宜温之、补之、升之。
脾胃者，血气之根本，周荣滋身；心者，血之府；脉者，人之神。俱不足，则生火故也
。
【治】 升阳散火除湿。羌活、防风、升麻、柴胡、川芎；凉血泻相火，生地、
黄连、黄柏
、黄芩、知母；和血补血，酒洗当归、黄 。胃口客寒，当心痛，加草豆蔻、炒曲；气短，
加参、术；冬寒，加麻黄、桂枝；血气俱脱，大寒证，加附子、肉桂；不止，加阿胶、艾叶
，或加丁香、干姜。
四物加荆芥穗、发灰，治血不止如神。单味蒲黄炒黑，亦妙。
治标方 急则治其标。凡药须炒黑，血见黑则止。白芷汤调棕榈灰，后用四物汤
加姜调治；五灵脂末亦可；凌霄花末，酒下。
治本方 四物汤。黄连，热则加之；参、 ，虚加之；干姜，寒则加之；黄芩，
热则加之。
胎漏方 血虚有热。
地黄（生一半，熟一半） 白术（一两） 黄芩（炒） 枳壳（各半两）
煎汤，调下地黄末。
[Pulse] Amenorrhea (absence of menstruation). Blood is generated by the Heart. Excessive worry and overthinking damage the Heart, causing Heart Qi stagnation and knotting, thus leading to blood closure and obstruction.
A deep and knotted pulse at the left Cun position indicates the need to regulate Heart Qi and unblock the Heart Meridian, allowing blood generation and natural flow. Alternatively, due to abortion or multiple childbirths, there may be initial slight bleeding followed by complete obstruction.
This constitutes Blood Depletion (Blood Withering), characterized by weak and small pulses at both Chi positions, requiring blood tonification.
[Etiology and Syndrome] Blood moves with Qi; when it knots into masses, they grow day by day, requiring dispersal.
Chronic night sweats lead to dryness of blood vessels and amenorrhea, requiring blood tonification. This is because sweat originates from the Heart and blood is generated by the Heart; blood and sweat share the same source.
Chronic tidal fever causes blood dryness. Since blood is consumed by heat, once the cold-heat symptoms resolve, blood naturally regenerates. Spleen-Stomach disharmony and reduced food intake prevent blood generation. Blood is transformed from dietary essence. The Classic states: "Diseases of the Two Yang (Stomach and Large Intestine) originate in the Heart and Spleen, resulting in amenorrhea in women."
Blood is guided by Qi. Pathology present before menstruation arises from Qi disorders; pathology appearing after menstruation begins stems from Blood deficiency; unexpected pathological changes are due to Blood Heat.
[Treatment] Pain anticipated before menstruation indicates excess Qi, treated with Tao Ren (Peach Kernel), Hong Hua (Safflower), Xiang Fu (Cyperus Rhizome), Zhi Ke (Aurantium Fruit), and Huang Lian (Coptis Rhizome).
Early menstruation indicates Blood Heat, treated with Si Wu Tang (Four Substances Decoction) plus Huang Lian.
Delayed menstruation has two causes: Blood deficiency and Phlegm abundance. For Blood deficiency, use Xiong Qiong (Ligusticum Rhizome), Dang Gui (Angelica Sinensis), and Ren Shen (Ginseng); if blood is dark purple and clotted, add Huang Lian. For Phlegm abundance, the blood color is pale, common in obese individuals, treated with Er Chen Tang (Two Aged Things Decoction) plus Cang Zhu (Atractylodes Rhizome), Xiang Fu, and Chuan Xiong.
Closed menstruation without flow indicates deficiency with heat; flow with clots indicates Qi stagnation; erratic and profuse bleeding indicates Qi chaos.
[Pulse] A surging, rapid, and hurried pulse. Leukorrhea mixed with blood (red and white discharge) flowing down several sheng daily. A rapid and hurried pulse indicates death; a slow pulse indicates survival. A tight and large pulse indicates death; a deficient and small pulse indicates survival.
[Etiology and Treatment] Heat causes blood flow to continue; deficiency causes blood to leak downward. Yin deficiency with Yang pounding is termed Ben Beng (Metrorrhagia and Metrostaxis). Due to Spleen-Stomach impairment, Qi sinks into the Kidney, combining with Minister Fire to create damp-heat pressing downward. A surging and rapid pulse, preceded by alternating chills and fever, restlessness, and insomnia, requires major tonification of the Spleen-Stomach to raise Qi and Blood.
Insufficient Heart Qi leads to blazing Heart Fire within the blood vessels, impairing the Spleen-Stomach where fire attacks the middle. Though the appearance seems healthy, this is a Heart disease. Treat as above, slightly adding herbs to suppress Heart Fire, tonifying Yin and draining Yang, so menstruation stops naturally.
Deficiency of True Yin in the Kidney and Heart fails to control the Minister Fire of the Pericardium, causing blood to scatter and result in Ben Beng. This is a severe Cold syndrome of combined Qi and Blood deficiency. Light pressure reveals a rapid, hurried, string-tight, or choppy pulse, indicating Yang collapse. Yin fire may also manifest as thirst, all signs of Yin dryness. Treatment requires warming, tonifying, and raising.
The Spleen-Stomach is the root of Qi and Blood, nourishing the whole body; the Heart is the mansion of Blood; the vessels are the spirit of humans. Deficiency in all three generates fire.
[Treatment] Raise Yang, disperse fire, and remove dampness: Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root), Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root), Chuan Xiong (Ligusticum Rhizome); Cool blood and drain minister fire: Sheng Di Huang (Rehmannia Root), Huang Lian, Huang Bo (Phellodendron Bark), Huang Qin (Scutellaria Root), Zhi Mu (Anemarrhena Rhizome); Harmonize and tonify blood: Jiu Xi Dang Gui (Wine-washed Angelica Sinensis), Huang Qi (Astragalus Root). For stomach cold invading causing heart pain, add Cao Dou Kou (Black Cardamom Seed) and Chao Qu (Fried Medicated Leaven); for shortness of breath, add Ren Shen and Bai Zhu (Atractylodes Macrocephala Rhizome); for winter cold, add Ma Huang (Ephedra Stem) and Gui Zhi (Cinnamon Twig); for Qi and Blood collapse with severe cold, add Fu Zi (Aconite Lateral Root) and Rou Gui (Cinnamon Bark); for persistent bleeding, add E Jiao (Donkey-hide Gelatin) and Ai Ye (Mugwort Leaf), or Ding Xiang (Clove) and Gan Jiang (Dried Ginger).
Si Wu Tang plus Jing Jie Sui (Schizonepeta Spike) and Fa Hui (Hair Charcoal) treats persistent bleeding miraculously. Single herb Pu Huang (Typha Pollen) stir-fried until black is also excellent.
Treating the Branch (Acute Stage): Treat the branch in emergencies. All herbs must be charred; blood stops upon seeing black. Mix Zong Lu Hui (Date Palm Spadix Ash) with Bai Zhi (Angelica Dahurica Root) decoction, followed by Si Wu Tang with ginger. Wu Ling Zhi (Trogopterus Dung) powder is also effective. Ling Xiao Hua (Campsis Flower) powder taken with wine.
Treating the Root (Chronic Stage): Si Wu Tang. Add Huang Lian for heat; Ren Shen and Huang Qi for deficiency; Gan Jiang for cold; Huang Qin for heat.
Tai Lou (Threatened Miscarriage with Bleeding) Formula: Blood deficiency with heat.
Di Huang (Rehmannia Root): half raw, half cooked, 1 liang; Bai Zhu: 1 liang; Huang Qin (fried): 0.5 liang; Zhi Ke: 0.5 liang.
Decoct in water, take with Di Huang powder.