一妇人经候黑血凝结成块，左厢有血瘕，水泻不止，谷食有时一化，有时不化。至今
岁四月，血块暴下，并水注俱作，是前后二阴有形之血，脱竭于下，既久，经候尤不调，
水泻日见三两行，食罢心烦不快，饮食减少，甚至瘦弱。东垣先生曰∶夫圣人治病，必本
四时升降浮沉之理，权变之宜。若不本四时，以顺为逆，非其治也。且治之大法，必先岁
气，无伐天和。无盛盛，无虚虚，遗人夭殃。无致邪，无失正，绝人长命。故圣人云∶阳
盛阴虚，下之则愈，汗之则死。阴盛阳虚，汗之则愈，下之则死。大抵圣人立法，各自有
义。且如升阳或发散之剂，是助春夏之阳气，令其上升，乃泻秋冬收藏殒杀寒凉之气，此
病是也。当用此法治之，乃升降浮沉之至理也。夫天地之气，以升降浮沉乃从四时，如
治病逆之则杀人矣。故经云∶顺天者昌，逆天者亡。可不畏哉。夫人之身亦有天地四时
之气，不可止认在外，人体亦同天地也。今经漏不止，是前阴之气血已下脱矣。水泻又
数年不愈，是后阴之气血又下陷矣。后阴者，主有形之物也，前阴者，精气之门户，俱下
竭是病患周身之气常行秋冬之令。阴主杀，此等收藏之病是也。阳生阴长，春夏是也。在
人身之中，令气升浮者，谷气上行是也。既病则周身血气皆不生长，谷气又不升，其肌
肉消少，是两仪之气，俱将绝矣。既下元二阴俱脱，血气消竭，假令当日元是热证，令
下焦久脱，已化为寒矣。此病久沉久降，寒湿太胜，当急救之。泻寒以热，除湿以燥，大
升大举，以助生长，补养气血，不致偏枯。圣人立治之法，云湿气大胜，以所胜助之，助
甲风木上升是也。故经云∶风胜湿，是以所胜平之也。当调和胃气，次用白术之类，以
燥其湿而滋元气。如其不止，后用风药以风胜湿，此之谓也。此药便是大举大升，以助
春夏二湿之久陷下之至治也。又一本云∶此病次用四物，随湿证加减。
〔大〕独圣散 治妇人血崩不止。
用防风去芦，不以多少，为细末，酒煮白面清调下二钱，空心食前，日二服，更以
面作糊，酒投之极验。
治血崩 夏枯草为细末，每服二钱，米
饮调下，无时服。
〔千〕治崩中不止。芎 八两，清酒五升，煎至二升半，分三服。不耐者，徐徐
进之。（《衍义》云∶芎不可久服，令人暴死。）
上大举大升之剂，治崩脉沉弦而洪，或沉细而数者，皆胃气下陷也。或崩而又久泻
者，亦胃气下陷也。故举之、升之，其病愈也。
〔养血行气〕
加减四物汤 治室女二七天癸至，亦有当时未至而后至者，亦有卒然暴下，淋沥不
止至有若崩漏者，失血过多，变生诸证，悉宜服之。
川芎 熟地黄（洗焙） 川当归（去芦，酒润、切焙） 白芍药（各一两） 香附子（炒
去毛，一两半）
上 咀，每服四钱，水一盏半，生姜五片，煎至七分，去滓食前温服。如血色鲜而
不止者，去熟地黄加生地黄煎服。
〔补中去积〕
丁未年冬，郭大方来说，其妻经水暴崩不止，先曾殒身失血，自后一次经数日而来，
今次不止。其人心窄，性急多惊，以予料之，他日必因心气不足，饮食失节得之。大方曰
容。到彼诊得掌中寒，脉沉细而缓，间而沉数，九窍微不利，四肢无力，上喘气短促，口
鼻气皆不调，果有心气不足，饮食失节，脾胃虚弱之证。胃脘当心而痛，左胁下急缩有
积，当脐有动气，腹中鸣下气，大便难，诸虚证极多，不能尽录。拟先治其本，余证可
以皆去。与安心定志，镇坠其惊。调和脾胃，大益元气。补其血脉，养其心神。以大热之
剂，去其冬寒凝在皮肤内。少加生地黄，去命门相火。不令四肢痿弱。黄 当归人参汤。
黄 人参 麻黄（不去节，实表闭汗） 黄连（镇心惊，各一钱） 当归（一钱半）
草豆蔻（七分） 神曲（消食，去脾胃寒） 桂枝（必先岁气，无伐天和也）
陈皮（各五分） 杏仁（九个，研如泥） 生地黄（三分，去肾火，大去冬月相火之旺）
上为粗末，水三大盏，先煮麻黄数沸，去滓入前药，同煎至一大盏，于巳午之前，食
消尽服之。其胃脘痛乃胃上有客寒，与大热药草豆蔻丸一十五丸，其痛立止。再与肝之
积药，除其积之根源而愈。
地黄丸 治足三阴亏损，经行数日不止，或兼带下无子。
熟地黄（自制） 山茱萸肉 芜荑仁 白芍药（微炒） 代赭石（各一两） 干姜（炮）
白僵蚕（炒） 浓朴（姜制，各三钱）
上为末，蜜丸桐子大。每服五十丸，空心温酒下，日三服。
上虚挟积滞而崩。尝治一老妇人血崩不止，流流不绝，满床皆血，起床不得者三月
矣，腹满如孕。予作虚挟痰积污血治之，用四物四两，参、术各一两，甘草半两以治虚；
香附三两，半夏一两半，茯苓、陈皮、枳实、缩砂、玄胡各一两，以破痰积污血。分二十
帖，每帖煎干，加荷叶、侧柏叶汤再煎服之，服尽良愈，今再不发，神效。
〔凉剂〕
〔素〕阴虚阳搏，谓之崩。
〔垣〕凉血地黄汤 治妇人血崩不止，肾水阴虚，不能镇守包络相火，故血走而崩也。
生地黄 当归尾（各半钱） 黄连 黄柏 知母 本 川芎 升麻（各二分）
红花（少许） 柴胡 防风 川羌话 黄芩 细辛 荆芥穗 蔓荆子 甘草（炙，各一分）
咀作一服，水三盏，煎至一盏，去滓空心稍热服。
足太阴脾之经中血海二穴，在膝膑上内廉白肉际二寸中，治女子漏中恶血，月事不
调，逆气腹胀，其脉缓者是也，灸三壮。足少阴肾之经中阴谷二穴，在膝内辅骨后大筋
下小筋上，按之应手，屈膝取之，治膝如锥不得屈伸，舌纵涎流，烦逆溺难，少腹急引
阴痛，股内痛，妇人漏下不止，腹胀满不得息，小便黄，如蛊，女子如妊身，可灸三壮。
〔大〕小蓟汤 治崩漏不止，色明如水，
得温则烦闷者，此阳伤于阴，令人下血。当补其阴。脉数疾小者顺，大者逆。
小蓟茎叶（研取汁） 生地黄（研取汁，各一盏） 白术（半两，锉）
上三件，入水一盏，煎减一半，去滓温服。
芎 酒 治崩中昼夜不止，医不能治。
芎 （一两） 生地黄汁（一盏）
上用酒五盏，煮芎 一盏，去滓，下地黄汁再煎二三沸，分为三服。
治崩中去血不止。
大小蓟根（五两） 白茅根（三两）
上二味细切，用酒五升，煮取四升，去渣分四服。
〔丹〕漏下乃热兼虚，四物加黄连。
奇效四物汤 治有热，久患血崩。
当归（头尾俱用） 白芍药 大川芎 熟地黄（洗焙） 大艾叶 阿胶（蛤粉炒如珠子）
黄芩（去黑者，各半两）
上锉碎，每服四钱，水一盏半，生姜五片，煎七分，空心温服。
有一医疗血崩，往 咀药铺市药，其方则四物汤加阿胶、大艾也。就铺分作八服，又
为铺索黄芩半两，加入药内。铺家亦医者，曰∶此药何为加黄芩？医曰∶非汝所知，吾与此
药，正以黄芩为主。夫心主血，血得热则行，得寒则止。病者一服而愈，服至八服，至
今无恙。又见数妇血崩者，亦用此。医以黄连解毒汤加大艾治，无不效者，又当量其虚
实用之。
〔云〕金华散 治血室有热，崩下不止，服温药不效者。
延胡索 瞿麦穗 当归 干姜 牡丹皮（各一两） 石膏（二两） 桂心（别研） 威灵仙（各七钱半）
蒲黄（半两）
上为细末，每服三钱，水一盏半，空心温服，日二。
治崩中下血方 崩中药多是用止血药及补血药，惟此方治阳乘阴，所谓天暑地热，经
水沸溢者。
黄芩（不以多少）
上为细末，每服一钱，霹雳酒调下。一方∶荆芥煎汤下。近朝有王御医直夜，有
一宫女血如山崩，其时暑月，药笥中只有大顺散两帖，以冷水调服，旋即奏效。以此知
医者要在权变也。
治漏下五色，亦治呕血，令人黄瘦虚弱。
上用地榆三两，锉碎，以醋一升，煮十余沸，去滓，食前稍热服一合。《本草》注
云∶地榆主带下十二病。一曰多赤，二曰多白，三曰月水不通，四曰阴蚀，五曰子脏坚，
六曰子门 ，七曰合阴阳患痛，八曰小腹寒痛，九曰子门闭，十曰子宫冷，十一曰梦与
鬼交，十二曰五脏不定。一方∶竹叶水煎服代茶，甚解热。
〔丹〕经水多去不能住，以三补丸加莎根、龟板、金毛狗脊。（三补丸者，芩、连、柏也。）
〔子和〕孟官人母，年五十余，血崩一载，佥用泽兰丸、黑神散、保安丸、白薇散
补之，不效。戴人见之曰∶天癸已尽，本不当下血，盖血得热而流散，非寒也。夫女子
血崩，多因大悲哭，悲甚则肺叶布，心系为之急，血不禁而下崩。《内经》曰∶阴虚阳搏
谓之崩。阴脉不足，阳脉有余，数则内崩，血乃下流。举世以虚损治之，莫有知其非者，可
服大剂，大剂者，黄连解毒汤是也。次以香附二两炒，白芍药二两焙，当归二两焙，三
味同为细末，水调下。又服摈榔丸，不旬日而安。西园公治一妇人年六十二岁，血崩
不止，投黄连解毒汤四帖后，服凉膈散合四物，六帖即愈。此妇因悲哀太过，则心闷急，
肺布叶举而上焦不通，热气在中，血走而崩，故效。
〔薛〕一妇人年将七十，素有肝脾之证，每作则饮食不进，或胸膈不利，或中脘作痛，
或大便作泻，或小便不利。余用逍遥散加山栀、茯神、远志、木香而愈。后忧女孀居，不时吐紫血，
其病每作，先倦怠而后发热。经曰∶积忧伤肺，积思伤脾。肺布叶举，是令子母俱病，不能摄血归经而致
前证。遂以前药加炒黑黄连三分，吴茱萸二分，顿愈。复因怒吐赤血甚多，躁渴垂死，此血脱也，法
当补气。乃用人参一两，苓、术、当归各三钱，陈皮、炮黑干姜各二钱，炙草、木香各一钱，一
剂顿止。一妇人年六十四，久郁怒，头痛寒热，春间乳内时痛，服流气饮之类益甚，不时有血如经行。
又大惊恐，饮食不进，夜寐不宁，乳肿及两胁， 痛如炙，午后色赤。余以为肝脾郁火血燥，先以逍遥散
加酒炒黑龙胆一钱，山栀一钱半，二剂，肿痛顿退，又二剂而全消。再用归脾加炒栀、贝母，诸证
悉愈。一妇人因怒，崩血久不已，面青黄而或赤，此肝木制脾土而血虚也。用小柴胡合四物，以清肝火，生
肝血。又用归脾、补中二汤，以益脾气，生肝血而瘥。此证若因肝经有风热而血不宁者，用防风一味
为丸，以兼证之药煎送。或肝经火动而血不宁者，用条芩炒为丸，以兼证之药煎送，无有不效。一妇
人性急，每怒非太阳、耳、项、喉，齿、胸乳作痛，则胸满吞酸，吐泻少食，经行不止。此皆肝火之证，
肝自病则外证见，土受克则内证作。若自病见，用四物加白术、茯苓、柴胡、炒栀、炒龙胆。若内证作，用
四君子加柴胡、芍药、神曲、吴茱萸、炒过黄连，诸证渐愈。惟月经不止，是血分有热，脾气尚虚，以
逍遥散倍用白术、茯苓、陈皮，又以补中益气加酒炒芍药，兼服而调。
〔温剂〕
〔垣〕丁香胶艾汤 治崩漏不止。盖心气不足，劳役及饮食不节所得，经隔少时，其脉两尺俱弦紧而
洪，按之无力。其证自觉脐下如冰，求浓衣被以御其寒，白带白滑之物虽多，间下如屋漏水，下时有
鲜血不多，右尺脉时微洪。屋漏水多，暴下者是，急弦脉，为寒多。而洪脉时见，乃热少。合而言之，急
弦者，北方寒水多也。洪脉时出者，命门包络之火也。黑物多，赤物少，合现房漏水之状也。
川芎 丁香（各四分） 熟地黄（以泻大洪脉） 白芍药（各三分） 阿胶（炒，六分，另后入）
当归身（一钱二分） 生艾叶（一钱，后入）
为细末，作一服，水二盏，煎至五沸，去滓，入胶、艾再上火煎至一大盏，空心，宿食消尽带热
服，三服效。
〔大〕治血崩
熟艾（如鸡子大） 阿胶（半两） 干姜（一钱）
上粗末，用水五盏，先煎艾叶、姜至二盏半，入胶消，温分二服，空心服。
芎 汤 （一名芎 温中汤。）治带下漏血不止，及风虚冷热，劳损冲任，月水不调，崩
中暴下，腰重里急，淋沥不断；及产后失血过多，虚羸腹痛；或妊娠胎动不安，下血，连日小便
频数，肢体烦倦，头运目暗，不欲饮食。
芎 黄 芍药 干地黄 吴茱萸 甘草（各二两） 当归 干姜（各一两）
上 咀，以水一斗，煮取三升，分三服。若月经后因有赤白不止者，除地黄、茱萸，加
杜仲、人参各二两。
断下汤 治冲任气虚，崩中漏下，经脉不调，每遇月候将来，脐腹腰脚先痛，渐减
饮食，四肢乏力及带下，三十六疾，悉能疗之。
人参（去芦） 熟地黄（洗焙） 艾叶（醋炒，各一两） 乌贼骨（烧灰） 当归（酒洗，各二两）
川芎（七钱） 干姜（炮，半两） 阿胶（蛤粉炒成珠，七钱半）
上 咀，每服五钱，水一盏半，煎至七分，去滓食前温服。
治崩漏方
四物汤（一两） 人参（二钱） 吴茱萸（一钱）
A woman presented with menstrual blood that was black, coagulated into clots, and had a blood mass (abdominal lump) in the left hypochondrium. She suffered from incessant watery diarrhea, where food digestion was inconsistent—sometimes digesting, sometimes not. By April of this year, blood clots suddenly discharged in large amounts, accompanied by watery stools. This indicated that the tangible blood from the anterior and posterior orifices had been depleted below for a long time, causing further irregularity in menstruation. The watery diarrhea occurred two to three times daily. After meals, she felt irritable and uncomfortable, with reduced appetite, eventually leading to emaciation and weakness. Mr. Dongyuan said: "The sage treats diseases based on the principles of ascending, descending, floating, and sinking according to the four seasons, adapting to changes. If one does not follow the four seasons and turns順 (shun, compliance) into nì (nì, opposition), it is not correct treatment. The general principle of treatment requires first understanding the annual qi, without disrupting the harmonious qi of heaven and humanity. Do not exacerbate excess conditions, do not worsen deficiency conditions, lest you bring about premature death. Do not aid pathogenic factors, do not damage righteous qi, lest you cut short life. Thus, the sage says: In cases of yang excess and yin deficiency, purgation leads to recovery, while sweating leads to death. In cases of yin excess and yang deficiency, sweating leads to recovery, while purgation leads to death. Generally, the laws established by the sages have their own rationale. For instance, agents that raise yang or disperse are used to assist the yang qi of spring and summer, allowing it to ascend, thereby draining the cold and storing qi of autumn and winter. This disease falls into this category. It should be treated with this method, which represents the ultimate principle of ascending, descending, floating, and sinking. The qi of heaven and earth follows the four seasons through these movements; opposing them in treatment can be fatal. Thus, the classics state: 'Those who follow heaven prosper; those who oppose heaven perish.' Should we not revere this? The human body also possesses the qi of heaven, earth, and the four seasons; it cannot be assumed that this qi exists only externally, as the human body mirrors heaven and earth. Currently, the menstrual leakage is unceasing, indicating that the qi and blood of the anterior orifice have descended and escaped. The watery diarrhea has persisted for years, indicating that the qi and blood of the posterior orifice have sunk. The posterior orifice governs tangible substances, while the anterior orifice is the gateway of essence and qi. Both are depleted downwards, meaning the qi of the patient's entire body is operating under the influence of autumn and winter. Yin governs killing/destruction; such diseases of storage are characteristic of this. Yang generates and yin grows, corresponding to spring and summer. Within the human body, the ascent and floating of qi are driven by the upward movement of grain qi. Since illness has set in, the blood and qi throughout the body fail to grow, and grain qi fails to ascend. Muscle mass decreases, indicating that the qi of the Two Powers (Yin and Yang) are nearing extinction. With the lower origin and both orifices depleted, and blood and qi exhausted, even if the original condition was heat, prolonged depletion in the lower jiao transforms it into cold. This disease has been deep and sinking for a long time, with excessive cold-dampness. Immediate rescue is required. Use hot herbs to drain cold, and drying herbs to remove dampness. Greatly lift and raise to assist growth, nourish blood and qi, preventing hemiplegia. The sage's therapeutic law states: When dampness is excessively strong, assist it with the overcoming element, aiding the Jia Wood wind to ascend. Thus, the classics say: 'Wind overcomes dampness,' using the overcoming element to pacify it. One should first harmonize stomach qi, then use herbs like Atractylodis Rhizoma (Baizhu) to dry dampness and nourish primordial qi. If bleeding persists, subsequently use wind-dispersing herbs to overcome dampness. This medicine represents great lifting and raising, the supreme treatment for assisting the prolonged sinking of dampness in spring and summer. Another version states: For this disease, subsequently use Siwu Tang, adjusting according to dampness patterns.
[D] Dusheng San treats incessant metrorrhagia in women.
Use Fangfeng (Saposhnikoviae Radix) with the radix removed, in any quantity, ground into fine powder. Mix with clear liquor made from boiled wheat flour and take 2 qian. Take on an empty stomach before meals, twice daily. Further, make a paste from flour and administer with wine for extreme efficacy.
To treat metrorrhagia:
Process Prunella Vulgaris (Xiakucao) into fine powder. Take 2 qian each time, mixed with rice water, at any time.
[Qian] To treat metrorrhagia (Bengzhong):
Chuanxiong (Ligustici Chuanxiong Rhizoma) 8 liang, clear wine 5 sheng. Decoct until 2.5 sheng remains. Divide into three doses. For those intolerant, administer slowly. (Yanyi states: Ligustici Chuanxiong Rhizoma should not be taken for long periods, as it may cause sudden death.)
The aforementioned great-lifting and great-raising agents treat metrorrhagia with a pulse that is deep, wiry, and surging, or deep, fine, and rapid, all indicating sinking of stomach qi. Or if metrorrhagia is accompanied by chronic diarrhea, it is also due to sinking of stomach qi. Therefore, lifting and raising will cure the disease.
[Nourishing Blood and Regulating Qi]
Modified Siwu Tang treats young unmarried women whose Tian Gui arrives at age fourteen. Some arrive late, some suddenly discharge heavily, dripping incessantly resembling metrorrhagia. Due to excessive blood loss transforming into various syndromes, this formula is suitable for all.
Chuanxiong (Ligustici Chuanxiong Rhizoma), Shu Dihuang (Prepared Rehmanniae Radix, washed and dried), Chuan Danggui (Angelicae Sinensis Radix, radix removed, moistened with wine, sliced and dried), Baishao (Paeoniae Radix Alba, 1 liang each), Xiangfu (Cyperi Rhizoma, fried and fuzz removed, 1.5 liang).
Cut into pieces. Each dose: 4 qian, 1.5 sheng of water, 5 slices of fresh ginger. Decoct to 0.7 sheng. Strain and take warm before meals. If the blood color is bright red and bleeding continues, remove Shu Dihuang and add Sheng Dihuang (Raw Rehmanniae Radix) to decoct.
[Supplementing and Removing Accumulation]
In the winter of Dingwei year, Guo Dafang reported that his wife suffered from sudden heavy metrorrhagia. She had previously miscarried and lost blood. Subsequently, her menstruation came after several days, and this time it did not stop. His wife was narrow-minded, impatient, and easily startled. I deduced that she would later suffer from insufficient heart qi and irregular diet. Upon examination, her palms were cold, pulse deep, fine, and slow, occasionally deep and rapid. Her nine orifices were slightly obstructed, limbs weak, breathing short and panting, mouth and nose breath irregular. Indeed, there were signs of insufficient heart qi, irregular diet, and spleen-stomach weakness. Pain at the epigastrium center, tightness and accumulation in the left hypochondrium, pulsation at the umbilicus, borborygmus and flatulence, difficult defecation, and many deficiency syndromes too numerous to record. I planned to treat the root first, so other symptoms could be resolved. Provide peace of mind and stabilize spirit, suppress fright. Harmonize spleen and stomach, greatly benefit primordial qi. Nourish blood vessels, calm heart spirit. Use a great-hot agent to dispel winter cold congealed in the skin. Add a small amount of Sheng Dihuang to clear Mingmen ministerial fire, preventing limb flaccidity. Huangqi Danggui Renshen Tang.
Huangqi (Astragali Membranacei Radix), Renshen (Ginseng Radix), Mahuang (Ephedrae Herba, nodes not removed, to secure exterior and close sweat), Huanglian (Coptidis Rhizoma, to calm heart and suppress fright, 1 qian each), Danggui (Angelicae Sinensis Radix, 1.5 qian), Caodoukou (Cardamomi Fructus, 0.7 qian), Shenqu (Massa Medicata Fermentata, to digest food and remove spleen-stomach cold), Guizhi (Cinnamomi Ramulus, must respect seasonal qi and not harm heavenly harmony), Chenpi (Citri Reticulatae Pericarpium, 0.5 qian each), Xingren (Armeniacae Semen Amarum, 9 grains, ground to paste), Sheng Dihuang (Raw Rehmanniae Radix, 0.3 qian, to clear kidney fire and greatly eliminate winter ministerial fire).
Grind into coarse powder. Use 3 sheng of water. First boil Mahuang for a few boils, discard dregs, add remaining herbs, and decoct together to 1 sheng. Take before Si/Wu hours (9 AM - 1 PM) after food digestion is complete. The epigastric pain was due to external cold in the stomach; administer 15 pills of Caodoukou Wan (Cardamom Pill) with great-hot properties, and pain stops immediately. Then administer liver-accumulation resolving herbs to remove the root of the accumulation and achieve cure.
Dihuang Wan treats deficiency of the three yin meridians of the foot, menstruation lasting several days without stopping, or accompanied by leukorrhea and infertility.
Zizhi Shu Dihuang (Homemade Prepared Rehmanniae Radix), Shanzhuyu (Corni Fructus), Wuyiren (Alpiniae Katsumadai Semen), Baishao (Paeoniae Radix Alba, lightly fried), Daizheshi (Ochrei Haematitatis, 1 liang each), Ganjiang (Zingiberis Rhizoma, processed), Baijiangcan (Bombyx Batryticatus, fried), Houpo (Magnoliae Officinalis Cortex, ginger-processed, 3 qian each).
Grind into powder, make honey pills the size of paulownia seeds. Take 50 pills each time, with warm wine on an empty stomach, three times daily.
Above describes deficiency complicated by stagnation causing metrorrhagia. I once treated an elderly woman with incessant metrorrhagia, flowing continuously, filling the bed with blood, unable to rise for three months, abdomen full as if pregnant. I treated it as deficiency complicated by phlegm-stasis and foul blood. Used Siwu Tang 4 liang, Renshen and Baizhu 1 liang each, Gancao 0.5 liang to treat deficiency; Xiangfu 3 liang, Banxia 1.5 liang, Fuling, Chenpi, Zhishi, Suansha, Yanhusuo 1 liang each to break phlegm-stasis and foul blood. Divided into 20 doses. Each dose decocted until dry, then added He Ye (Nelumbinis Folium) and Ce Bai Ye (Platycladi Cacumen) soup and decocted again. After finishing, she recovered well and has not relapsed; miraculous effect.
[Cooling Agents]
[Su] Yin deficiency with yang surging is called metrorrhagia.
[Yuan] Liangxue Dihuang Tang treats women with incessant metrorrhagia due to kidney water yin deficiency, failing to control the pericardium ministerial fire, causing blood to rush and bleed.
Sheng Dihuang (Raw Rehmanniae Radix), Dangguiwei (Angelicae Sinensis Radix tail, 0.5 qian each), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Bencao (Ligustici Wallichii Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shengma ( Cimicifugae Rhizoma, 0.2 qian each), Honghua (Carthami Flos, a little), Chaihu (Bupleuri Radix), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), Xixin (Asari Radix et Rhizoma), Jingjie Sui (Schizonepetae Spica), Manjingzi (Vittariae Spora), Gancao (Licorice Root, roasted, 0.1 qian each).
Cut into pieces for one dose. Use 3 sheng of water, decoct to 1 sheng. Strain and take warm on an empty stomach.
Xuehai (Sea of Blood) acupoint, located in the Foot-Taiyin Spleen meridian, 2 cun above the knee cap on the medial white flesh margin. Treats women with uterine bleeding of evil blood, irregular menstruation, reverse qi, abdominal distension, with a slow pulse. Moxibustion: 3 moxa cones.
Yingu (Yin Valley) acupoint, located in the Foot-Shaoyin Kidney meridian, behind the medial condyle of the tibia, between the large tendon and small tendon. Press to feel response, flex knee to locate. Treats knee pain like a awl unable to flex/extend, tongue relaxation with drooling, irritability, difficult urination, lower abdominal urgency pulling to genital pain, thigh inner pain, women with incessant uterine bleeding, abdominal fullness unable to breathe, yellow urine, resembling gu poisoning, women feeling pregnant. Moxibustion: 3 moxa cones.
[D] Xiaoji Tang treats metrorrhagia and metrostaxis unceasing, blood color bright like water, becoming irritable when warmed. This indicates yang damaged by yin, causing lower bleeding. One should tonify yin. Pulse rapid and small is favorable; large is unfavorable.
Xiaoji (Stellariae Herba) stems and leaves (juiced), Sheng Dihuang (Raw Rehmanniae Radix, juiced, 1 sheng each), Baizhu (Atractylodis Macrocephalae Rhizoma, 0.5 liang, sliced).
Mix the three items with 1 sheng of water, decoct until half remains. Strain and take warm.
Chuanxiong Wine treats metrorrhagia day and night unceasing, untreatable by physicians.
Chuanxiong (Ligustici Chuanxiong Rhizoma, 1 liang), Sheng Dihuang juice (1 sheng).
Use 5 sheng of wine, boil Chuanxiong until 1 sheng remains. Strain, add Sheng Dihuang juice, boil 2-3 more times. Divide into three doses.
To treat continuous blood loss from metrorrhagia.
Da Xiaoji (Stellariae Herba) roots, Bai Mao Gen (Imperatae Rhizoma, 5 liang and 3 liang respectively).
Cut finely. Use 5 sheng of wine, decoct to 4 sheng. Strain and divide into four doses.
[Dan] Metrostaxis is heat combined with deficiency; Siwu Tang plus Huanglian.
Qixiao Siwu Tang treats heat and chronic metrorrhagia.
Danggui (Angelicae Sinensis Radix, head and tail used), Baishao (Paeoniae Radix Alba), Da Chuanxiong (Ligustici Chuanxiong Rhizoma), Shu Dihuang (Prepared Rehmanniae Radix, washed and dried), Da Ai Ye (Artemisiae Argyi Folium), Ejiao (Donkey-hide Gelatin, fried with clam powder into pearls), Huangqin (Scutellariae Radix, remove black parts, 0.5 liang each).
Cut into pieces. Each dose: 4 qian, 1.5 sheng of water, 5 slices of fresh ginger. Decoct to 0.7 sheng. Take warm on an empty stomach.
A physician treating metrorrhagia went to a pharmacy to buy herbs. The prescription was Siwu Tang plus Ejiao and Da Ai Ye. The shop divided it into eight doses. The physician asked the shopkeeper for 0.5 liang of Huangqin to add. The shopkeeper, also a physician, asked why add Huangqin? The physician said: "You do not understand. Huangqin is the main herb in this prescription. The heart governs blood; blood flows with heat and stops with cold." The patient recovered after one dose. After eight doses, she remained healthy. I saw several women with metrorrhagia also treated with this. Physicians using Huanglian Jiedu Tang plus Da Ai Ye found it effective. One must assess deficiency and excess to apply appropriately.
[Yun] Jinhua San treats heat in the blood chamber with incessant metrorrhagia, ineffective with warm herbs.
Yanhusuo (Corydalis Rhizoma), Qumai Sui (Dianthi Spica), Danggui (Angelicae Sinensis Radix), Ganjiang (Zingiberis Rhizoma), Mudan Pi (Moutan Cortex, 1 liang each), Shigao (Gypsum Fibrosum, 2 liang), Guixin (Cinnamomi Cortex, separately ground), Weilingxian (Smilacis Glabrae Rhizoma, 0.75 liang each), Puhuang (Typhae Pollen, 0.5 liang).
Grind into fine powder. Take 3 qian each time, with 1.5 sheng of water, warm on an empty stomach, twice daily.
Formula to treat metrorrhagia with lower bleeding. Most formulas for metrorrhagia use hemostatic and blood-nourishing herbs. Only this formula treats yang invading yin, described as 'sky heat and earth heat causing menstrual water to boil over.'
Huangqin (Scutellariae Radix, any quantity).
Grind into fine powder. Take 1 qian each time, mixed with Pili Jiu (Thunderbolt Wine). Another method: mix with Jingjie decoction. Recently, Imperial Physician Wang on night duty had a palace maid suffering from mountain-like metrorrhagia during summer. His medicine box contained only two doses of Dashun San. Mixed with cold water and administered, it took effect immediately. This shows physicians must adapt to circumstances.
To treat metrostaxis with five colors, also treats hematemesis, causing jaundice, emaciation, and weakness.
Use Diyü (Sanguisorbae Radix) 3 liang, cut finely. Boil with 1 sheng of vinegar for ten boils. Strain. Take 1 he of the liquid, slightly warm, before meals. Bencao notes: Diyü treats twelve types of leukorrhea. 1. Excessive red discharge. 2. Excessive white discharge. 3. Amenorrhea. 4. Genital erosion. 5. Hard uterus. 6. Closed cervical os. 7. Pain during intercourse. 8. Lower abdominal cold pain. 9. Cervical closure. 10. Cold uterus. 11. Dreams of sexual intercourse with ghosts. 12. Unstable five zang organs. Another method: Decoct Zhu Ye (Bambusae Folium) in water to drink as tea, very effective for clearing heat.
[Dan] Menstrual flow excessive and unable to stop: Sanbu Wan plus Suogen (Iris Tectori Rhizoma), Guiban (Testudinis Carapax et Plastrum), Jinmao Gouji (Cibotii Rhizoma). (Sanbu Wan consists of Huangqin, Huanglian, Huangbai).
[Zihe] Mother of Official Meng, over fifty years old, suffered from metrorrhagia for one year. All physicians used Zelany Wan, Heishen San, Bao'an Wan, Baiwei San to tonify, but ineffective. Dairen examined her and said: "Tian Gui has ended; bleeding should not occur. Blood flows and scatters due to heat, not cold. Women's metrorrhagia is often caused by severe grief/crying. Severe grief causes lung lobes to spread, heart ties to tighten, blood uncontrollably descends and bursts. Neijing states: 'Yin deficiency with yang surging is called metrorrhagia.' Yin pulse deficient, yang pulse excessive, rapid pulse indicates internal bursting, blood flows down. The world treats this as deficiency consumption, none knowing it is wrong. One can take a large dose; the large dose is Huanglian Jiedu Tang. Next, fry 2 liang of Xiangfu, bake 2 liang of Baishao, bake 2 liang of Danggui. Grind three herbs into fine powder, mix with water and take. Also take Binglang Wan. Within ten days, she was stable. Master Xiyuan treated a sixty-two-year-old woman with incessant metrorrhagia. After four doses of Huanglian Jiedu Tang, she took Liangge San combined with Siwu Tang. Six doses cured her. This woman suffered excessive sorrow, causing heart oppression and urgency, lung lobes spreading, upper jiao blocked, heat trapped inside, blood rushing and bursting. Hence the efficacy."
[Xue] A woman nearly seventy years old, chronically suffering from liver-spleen syndromes. Attacks caused loss of appetite, chest/diaphragm discomfort, epigastric pain, diarrhea, or difficult urination. I used Xiaoyao San plus Zhizi, Fushen, Yuanzhi, Muxiang, and she recovered. Later, worried widow, occasionally vomited purple blood. Each attack began with fatigue followed by fever. Classics state: "Accumulated sorrow damages lungs, accumulated thought damages spleen." Lung lobes spreading causes mother-daughter organs to both suffer, failing to control blood returning to vessels, causing previous symptoms. I added 0.3 qian of charcoal-fried Huanglian and 0.2 qian of Wuzhuyu to the previous formula, and she recovered instantly. Later, due to anger, she vomited large amounts of red blood, restless, thirsty, near death. This is blood loss; law dictates tonifying qi. I used 1 liang of Renshen, 3 qian each of Fuling, Baizhu, Danggui, 2 qian each of Chenpi, charred Ganjiang, 1 qian each of Zhi Cao, Muxiang. One dose stopped it. A sixty-four-year-old woman, chronic depression/anger, headache, chills/fever, breast pain in spring, taking Liqi Yin worsened symptoms, occasional bleeding like menstruation. Then great fear, loss of appetite, restless sleep, breast swelling and hypochondriac pain, burning pain, red complexion in afternoon. I diagnosed liver-spleen depressed fire and blood dryness. First used Xiaoyao San plus 1 qian alcohol-fried Longdan, 1.5 qian Zhizi. Two doses reduced swelling/pain, two more doses eliminated it completely. Then used Guipi Tang plus fried Zhizi, Beimu, all symptoms resolved. A woman, due to anger, had prolonged metrorrhagia, face green-yellow or red. This is liver wood controlling spleen earth causing blood deficiency. Used Xiao Chai Hu Tang combined with Siwu Tang to clear liver fire and generate liver blood. Then used Guipi Tang and Buzhong Yiqi Tang to benefit spleen qi, generate liver blood, and recover. If this syndrome is due to wind-heat in liver meridian disturbing blood, use Fangfeng alone as pills, taken with decoction for accompanying symptoms. If liver fire moves disturbing blood, use fried Tiaohuangqin as pills, taken with decoction for accompanying symptoms. No ineffectiveness. A woman with quick temper, upon anger, suffers pain in Taiyang, ear, neck, throat, teeth, chest/breasts, OR chest fullness, acid regurgitation, vomiting/diarrhea, low appetite, incessant menstruation. These are all liver fire syndromes. Liver self-disease shows external symptoms; earth受克 (controlled) shows internal symptoms. If self-disease appears, use Siwu Tang plus Baizhu, Fuling, Chaihu, fried Zhizi, fried Longdan. If internal symptoms appear, use Sijunzi Tang plus Chaihu, Shaoyao, Shenqu, Wuzhuyu, fried Huanglian. Symptoms gradually improve. Only incessant menstruation indicates heat in blood level and still-deficient spleen qi. Use Xiaoyao Tang doubling Baizhu, Fuling, Chenpi, and simultaneously take Buzhong Yiqi Tang plus alcohol-fried Shaoyao to regulate.
[Warm Agents]
[Yuan] Dingxiang Jiao'ai Tang treats metrorrhagia and metrostaxis unceasing. Due to insufficient heart qi, labor, and irregular diet. After a short interval, pulse both Chi positions are wiry, tight, and surging, powerless on pressure. Patient feels cold below umbilicus like ice, seeks thick clothes/quilts to ward off cold. Although abundant white slippery leukorrhea, occasionally drops like roof leak, sometimes small amount of bright red blood. Right Chi pulse occasionally slightly surging. Roof-leak type is heavy, sudden discharge. Rapid wiry pulse indicates much cold. Surging pulse appearing occasionally indicates slight heat. Combined, rapid wiry indicates much northern cold water. Surging pulse indicates Mingmen/pericardium fire. Black discharge more than red matches roof-leak appearance.
Chuanxiong (Ligustici Chuanxiong Rhizoma), Dingxiang (Caryophylli Flos, 0.4 qian each), Shu Dihuang (Prepared Rehmanniae Radix, to drain surging pulse), Baishao (Paeoniae Radix Alba, 0.3 qian each), Ejiao (Donkey-hide Gelatin, fried, 0.6 qian, added later separately), Dangguishen (Angelicae Sinensis Radix root, 1.2 qian), Sheng Aiye (Fresh Artemisiae Argyi Folium, 1 qian, added later).
Grind into fine powder for one dose. Use 2 sheng of water, boil five times. Strain, add gelatin and ai ye, boil again to 1 sheng. Take warm on empty stomach after overnight food digestion. Three doses effective.
[D] Treat metrorrhagia
Shu Aiye (Processed Artemisiae Argyi Folium, size of chicken egg), Ejiao (Donkey-hide Gelatin, 0.5 liang), Ganjiang (Zingiberis Rhizoma, 1 qian).
Coarse powder. Use 5 sheng of water. First boil ai ye and ginger to 2.5 sheng. Dissolve gelatin. Take warm, divided into two doses, on empty stomach.
Chuanxiong Tang (also named Chuanxiong Wenzhong Tang) treats leukorrhea with continuous leaking blood, wind-deficiency cold-heat, lao sun (chronic depletion) of Chong and Ren meridians, irregular menstruation, sudden metrorrhagia, heavy waist with urgency, dripping unceasing; postpartum excessive blood loss, emaciated abdominal pain; or pregnancy fetal restlessness, lower bleeding, frequent urination for days, limb fatigue, dizziness/blurred vision, loss of appetite.
Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqi (Astragali Membranacei Radix), Shaoyao (Paeoniae Radix), Gan Dihuang (Dry Rehmanniae Radix), Wuzhuyu (Evodiae Fructus), Gancao (Licorice Root, 2 liang each), Danggui (Angelicae Sinensis Radix), Ganjiang (Zingiberis Rhizoma, 1 liang each).
Cut into pieces. Use 1 dou of water, decoct to 3 sheng. Divide into three doses. If after menstruation red/white discharge continues, remove Dihuang and Wuzhuyu, add Duzhong and Renshen 2 liang each.
Duania Tang treats Chong-Ren qi deficiency, metrorrhagia/metrostaxis, irregular menstruation. Before each period, pain in umbilicus/abdomen/waist/legs, gradual reduction of appetite, limb weakness, leukorrhea. Cures thirty-six diseases.
Renshen (Ginseng Radix, radix removed), Shu Dihuang (Prepared Rehmanniae Radix, washed/dried), Aiye (Artemisiae Argyi Folium, vinegar-fried, 1 liang each), Wubeigu (Sepiae Endoconcha, burnt to ash), Danggui (Angelicae Sinensis Radix, wine-washed, 2 liang each), Chuanxiong (Ligustici Chuanxiong Rhizoma, 0.7 qian), Ganjiang (Zingiberis Rhizoma, processed, 0.5 liang), Ejiao (Donkey-hide Gelatin, fried with clam powder into pearls, 0.75 liang).
Cut into pieces. Each dose: 5 qian, 1.5 sheng of water. Decoct to 0.7 sheng. Strain and take warm before meals.
Formula to treat metrorrhagia/metrostaxis
Siwu Tang (1 liang), Renshen (Ginseng Radix, 2 qian), Wuzhuyu (Evodiae Fructus, 1 qian).