例一梁××,女,30岁,门诊号:081868初诊(1973年4月3日):患者自述婚前经候正常,婚后因病服药不慎,遂至长期经候失调,初起月经2~3月或6~7月一次,经量或多或少。从1971年5月29日起,月经停止。初以为有孕,未加治疗,后经妇检证实为闭经。曾先后用人工周期法及服中药除痰湿、活血通经之剂,均未获效。患者闭经后身体渐见肥胖,时有头疼胸闷心跳。脉细弱,舌胖苔白。辨证:精血不足,血虚经闭。治法:滋养精血,调理冲任。方药:柏子仁丸加味。卷柏9克泽兰9克当归尾9克川续断9克淮牛膝9克熟地21克柏子仁15克水煎服3剂。
二诊(4月7日)。患者服药后,觉少腹微疼有经来之兆。继用前法去归尾,方药:柏子仁15克卷柏9克泽兰9克川续断12克淮牛膝12克熟地黄24克水煎服3剂。三诊
(4月9日)。眼前方一剂,月经已通,经色初鲜红,后浓浊,经量正常,脉转细缓,舌红苔白。月经通而经色鲜红,是挟热之象,遂改用四物汤加味。当归12克熟地黄24克川芎9克白芍15克丹皮9克条黄芩6克川续断9克炙甘草6克3剂。以后经前三日均服柏子仁丸以巩固,经调理数月,月经恢复正常。
例二刘x,女,29岁,门诊筒易病历。初诊日期:1975年5月17日。主诉:闭经半年之久。现病史:自十六岁初潮起,月经一直稀行,每年来月经1~3次,曾行人工周期治疗,停药后又闭经,现已闭经半年,结婚6年未孕。自觉胸闷不舒,烦急易怒,胃脘胀满,胃纳减少,少寐多梦,心慌气短,头晕,心烦热,口干,身体逐渐发胖,曾经妇科检查,除子宫较小外,未发现其它异常。舌质红,脉弦滑。辨证:阴虚胃燥,冲逆经闭
(西医诊断:
(1)继发性闭经。
(2)原发性不孕症)。治法:清胃化燥,降逆调冲。方药:栝蒌24克石斛12克栀子9克连翘9克泽兰9克丹参9克瞿麦9克篇蓄12克牛膝12克益母草12克车前子9克治疗经过:6月9日服药7剂后,症状减轻,仍有烦热口干,胸闷烦急。上方去栀子、连翘、萹蓄,加枳壳6克,元参9克,麦冬9克,当归9克,继服。6月20日服药6剂后,症状减轻,于6月18日~19日行经2天,血量极少,咖啡样色。7月3日服药7剂后,症状改善不大,仍有心烦热,胸闷,舌质红,脉弦滑兼数,方药如下。栝萎30克元参9克麦冬6克生地12克白芍12克瞿麦12克车前子9克牛膝12克益母草12克栀子9克连翘9克泽兰9克丹参9克8月1日,服药后于7月19日行经6天,量仍少,诸症减轻,上方去栀子、连翘,加桃仁,红花各6克。8月30日:药后诸症消失,按月正常行经3次
(6月18日~19日,7月19日~23日,8月13日~20日)。唯经血量少,加用桃仁、红花后,经量逐渐增多,体胖稍减,现仍感口干、眠差,脉弦滑,舌暗红,仍以前方继服。9月5~9日行经,量较前稍增多,继服前方以巩固疗效。
(《刘奉五妇科经验》)
例三李姓,女,35岁。经闭十四周未通,服药未效,近有膨胀意,口渴喜饮,兼有鼻衄,又不似逆行势,腰酸痛楚颇剧,脉弦涩而实,姑予重剂通经。石决明(生、研,先煎)30克生鳖甲(先煎)15克生石膏(研,先煎)延胡索12克川牛膝12克旋复花(包煎)12克生储石15克大腹绒6克北细辛4石克川郁金12克桑上寄生30克威灵仙12克制乳没各9克桃杏仁泥备9克鸡内金12克生知柏各9克水煎兑无灰黄酒一杯,落水沉香(研细,冲服)1.5克,大黄(上“庶”包“虫”虫丸1粒(和入)。复诊:1剂药后,血遂攻破而潮,腹中骤爽。据云血色淡,黑块壅下,伴白色粘质,脉候实象已退,六位仍弦,予丸方调治。按原方量加一倍
(去黄酒,庶虫丸改为5粒),同研细末,炼蜜小丸,早晚各服6克,以橹豆衣15克煎汤分送。
(孔嗣伯整理:孔伯华医案,《中医杂志》8:547,1958)
【评按】妇女经闭,《素问》称之为“不月”、“月事不来”。临床有虚实之分。虚证多因脾虚或血虚所致。实证以气滞血瘀或寒湿凝滞较为多见。此外亦可因津液耗损、肾阴匮乏、肝劳血伤或风冷、火热、痰滞等因素引起,当根据不同的病因予以辨证施治。
例一乃经血不足、血虚经闭,治以滋养精血、调理冲任法,方用柏子仁丸
(《妇人良方》方)为主方,此方柏子仁、牛膝、川断有濡养调理冲任之功;泽兰、卷柏通调血脉;熟地以滋养阴血。药味虽少,而选品精当,一丝不杂,其效殊宏。例二为阴虚胃燥,治以清胃化燥,降逆调冲,后参入清血养阴、活血化瘀而获效。例三经闭三月余,腹鼓、鼻衄、渴饮,病属实证,孔氏以重剂通经,全方治重攻瘀破积,兼能平肝清热、降逆行气,证方相合,竟一剂而效。此案方师古法而立意颇新,堪为后学者研习。
(四)崩漏
例一患者宛xx,女,17岁,未婚。病历号47257
(广安门医院)初诊
(1962年8月18日):月经过多已三年,十四岁月经初潮时,参加剧烈运动,遂致月经淋沥不止,持续五个月之久。尔后又复停经五个月复来,周期40~60天,末次月经7月5已量多,下大血块,头晕目花,心慌失眠,倦怠无力,口干纳差,流血二十天时,曾服补气养血、止血之剂,出血至今已43天,仍未得止,面色苍白无神,舌苔薄、尖刺,脉细微数。辨证:劳伤气血,损伤冲任,不能约制经血,病久气血两虚,当防暴下而致气从血脱。治法:急以大补元气,固摄冲任。方药:朝鲜人参6克白术6克山药9克炙甘草3克熟地12克萸肉6克菟丝子9克五味子6克乌梅炭6克生龙骨15克禹余粮15克赤石脂15克伏龙肝30克
(煎汤代水)6剂。另:河车粉9克,早晚各服1.5克。二诊
(8月24日):药后,次日血止,诸恙悉减,舌苔薄白,尖刺,脉细微数。药即应病,仍从前法加减。人参6克白术6克山药9克炙甘草3克熟地12克萸肉6克五味子6克赤石脂15克禹余粮15克6剂。三诊
(8月30日))症状日见好转,舌苔薄白,脉象细软,治以补气养阴。人参6克白术6克山药9克炙甘草3克熟地12克萸肉6克五味子6克阿胶12克生牡蛎15克白芍9克5剂。后以此方加减。另河车粉60克,每日早晚各服1.5克。以后月经按期来潮,色量正常,余无不适。
(《钱伯喧妇科医案》)
例二林xx,女945岁。素体虚弱,月经量较多,因操劳以致崩漏,由于中气不足,气虚而下陷所成。当以补气摄血为主,拟予补中益气汤加阿胶10克(后入),山萸肉10克,龙骨30克(先煎),牡蛎30克(先煎),水煎服,服五剂后,崩漏渐止,嘱其再服3剂,以竟全功。
(俞慎初:补中益气汤的临床运用,《福建中医药》1:48,1981)
例三王xx,女932岁。初诊日期1963年7月23日,病历号:357565。患者一年来,月经先期而至,量多,一般约隔15~20天一潮。此次经来10日未净,量多,色鲜红有血块,伴有头晕,身倦无力,胸闷心悸,两手至肘麻木,胃纳不佳,腹胀腰酸,身腰畏寒,下肢浮肿等症状,面色皓白,舌质淡,苔薄自,脉沉缓无力,经x医院取子宫内膜检查,为增殖期子宫内膜。西医诊断为功能性子宫出血。辨证:四肢麻木,责之血虚,乃肝不养筋所致;脾阳不能制水,故见下肢浮肿,肾之精气不足,故腰冷腰酸:真阳不足,不能温运脾土,故胃纳少;脾不统血而致血不循经,故经来量多时久。先予健脾固冲,柔肝化瘀。方药:茯苓15克白术9克山药15克砂仁4.5克川断15克杜仲15克白芍24克艾叶炭9克棕炭9克香附9克泽兰9克本方以茯苓、山药、白术、砂仁健脾养胃,川断、杜仲、白芍强肝肾,重用白芍24克,有柔肝敛阴之功;并予艾叶炭、棕炭以止血,香附、泽兰以收祛瘀生新之功。二诊
(7月26日):药后经血止,身背畏寒,全身无力,纳食有所好转,微感腰酸腰疼,腹胀,下腹有时作疼。舌质灰自,苔薄白,脉沉细缓,再以温补肾阳、养血化瘀为法。方药:当归9克白芍24克香附9克川断15克吴萸6克官桂3克社仲9克牛膝9克桃仁6克赤芍9克三诊
(8月16日):前方进服12剂后,四肢麻木、腰酸,身畏寒,全身无力诸症,均有明显减轻,少腹两侧疼痛已不明显。月经周期已到,本月无经期提前现象。白带量中等,色白。舌质淡,苔薄白,脉沉缓。仍以强肝肾、活血化瘀为法。当归9克赤芍12克茯苓9克香附6克坤草12克川断9克寄生12克山药12克桃仁6克8月27日:月经于8月18日来潮,周期为35天,经来五日即止,血量、颜色均属正常。经期腹胀腹痛不明显,腰酸,肢肿已消。再以前方去桃仁、坤草,加檀香1.5克,腹皮9克。9月27日:月经已过期9日尚未来潮,微有腹胀。近三日微有恶心不适,纳可,二便如常,舌质正常,苔薄白,脉沉缓,予健脾和胃之法治之。10月15日:停经57天,恶心呕吐,尿青蛙试验阳性。舌质正常,苔薄白,脉滑,乃停药观察。后经随访,于1964年5月分娩一女婴。
(郗霈龄治验,刘琨整理:崩漏症验案一则,《中医杂志》10:15,1964)
例四孙××,女,29岁,门诊筒易病历。初诊日期:1974年3月2日。近10年来月经行经日久,每次约持续15~20天,周期也不规律,先后不定
(问隔20~70天)。未前经为:月13日至:月28日。末次月经为2月21日,至今未净、量多,色红有血块,伴有头晕,多梦,烦急,胸闷,手足心热,口干。近5个月来曾测基础体温均为单相型。某医院确诊为功能性子宫出血。舌质暗、尖红,脉弦滑。辨证:阴虚血热,冲任不固。治法:养阴清热,安冲调经。方药:青蒿9克地骨皮9克黄芩9克丹皮9克白芍9克旱莲草9克椿根白皮9克煅牡蛎24克阿胶15克侧柏炭9克治疗经过:3月13日,服药3剂后阴道出血已上。继服3付,于3月23日月经复来潮,行经6天,周期血量均恢复正常。测基础体温示双相型(提示已有徘卵)。持久疗效有待观察。
(《刘奉五妇科经验》)
例五姜××,女,24岁。1976年4月24日初诊。15岁月事初潮,经期及血量尚正常。半年多来,每于经净后十三、四天阴道有少量出血,色红、量不多,三天能净。平时夜卧不宁,心情易烦,上燥咽干,腰酸,带下色白如涕。诊为排卵期出血。面色潮红,舌尖红,苔薄白,脉弦数,现经潮第四天。辨证:肝经郁热,热扰冲任而失于固摄。治法:清肝疏肝为主。方药:炒丹皮4.5克炒荆芥4.5克青蒿梗4.5克柴胡4.5克:炒当归6克制香附6克茜草根6克海螵蛸10克夜交藤15克忍冬藤15克淡子芩9克白芍9克5剂。嘱经净后开始服。二诊
(5月8日):自照原方又服5剂。夜卧已安,带下减少,少腹隐痛已瘥,面色仍潮红,上方去忍冬藤、夜交藤,加川楝子、地骨皮各9克,5剂。三诊
(5月15日):本月未见经中期出血,心烦渐瘥,少腹偶有酸痛,入夜尚觉咽喉干燥,证系肝经郁热,久而伤阴之候。宗前法加滋养肝肾之品。青蒿梗、粉丹皮)茜草根、软柴胡各人5克全当归、杭白芍、香附各6克海螵蛸、川楝子、地骨皮各9克陈萸肉6克细生地15克5剂。五诊
(6月5日):本月经中期无出血,带下已除,续服逍遥丸、杞菊地黄丸以资巩固。
(徐荣斋治验,陈天祥整理:排卵期出血治验,《浙江中医学院报》2:47,1981)
例六姜姓,年42岁,生8胎,末次用人工流产手术后,月经初尚正常,四个月后,忽然行经过多,形成崩漏。持续五、六个月,淋漓不断,形瘦,心跳,失眠,腰酸,心中懊农。复刮子宫二次,崩量更多。西医认为必须切除子宫,方能止血、患者不愿,转请中医治疗。服补气益血止涩药多剂,未见功效,乃来先君处求治。所述症状,如头晕眼花,腰酸肢软,精神疲倦等,多属虚象。惟按其小腹,则坠隐作痛,切其脉则虚细而涩。先君认为久病血出甚多,固属虚亏,但其内尚有残余瘀滞未化,因此新血未能归经,前服补养固涩剂未能见效,关键即在虚中有实,遂处将军斩关汤方:熟军炭3克巴戟天9克仙鹤草18克茯神9克蒲黄炒阿胶9克黄芪4.5克炒当归9克白术4.5克生熟地各9克焦谷芽9克另用藏红花0.9克三七末0.9克上两味用红茶汁送服。甫服1剂,崩即停止,再经调理,恢复健康。
**Case 1: Liang XX, Female, 30 years old, Outpatient No.: 081868**
First Visit (April 3, 1973): The patient reported that her menstrual cycle was normal before marriage. After marriage, due to improper medication for an illness, she suffered from long-term menstrual irregularities. Initially, menstruation occurred every two to three months or six to seven months, with varying amounts of flow. Since May 29, 1971, menstruation had ceased. Initially thought to be pregnancy, no treatment was administered. Subsequent gynecological examination confirmed amenorrhea (cessation of menstruation). She had previously undergone artificial cycle therapy and taken Chinese herbal medicines for resolving phlegm-dampness, invigorating blood, and unblocking menstruation, without success. After the onset of amenorrhea, her body gradually became obese, accompanied by occasional headaches, chest tightness, and palpitations. Her pulse was fine and weak, and her tongue was swollen with a white coating. Syndrome differentiation: Insufficiency of essence and blood, amenorrhea due to blood deficiency. Treatment method: Nourish essence and blood, regulate the Chong and Ren meridians. Prescription: Baizi Ren Wan (Cistanche Pill) modified. *Selaginella tamariscina* (Juanbai) 9g, *Lycopus lucidus* (Zelan) 9g, *Angelica sinensis* tail (Danggui Wei) 9g, *Dipsacus asper* (Chuanxuduan) 9g, *Achyranthes bidentata* (Huainiuxi) 9g, *Rehmannia glutinosa* prepared (Shudihuang) 21g, *Biota orientalis* seed (Baiziren) 15g. Decoct in water, take orally, 3 doses.
Second Visit (April 7): After taking the medicine, the patient felt slight pain in the lower abdomen, indicating impending menstruation. Continue the previous method, removing *Angelica sinensis* tail. Prescription: *Biota orientalis* seed (Baiziren) 15g, *Selaginella tamariscina* (Juanbai) 9g, *Lycopus lucidus* (Zelan) 9g, *Dipsacus asper* (Chuanxuduan) 12g, *Achyranthes bidentata* (Huainiuxi) 12g, *Rehmannia glutinosa* prepared (Shudihuang) 24g. Decoct in water, take orally, 3 doses.
Third Visit (April 9): After one dose of the previous prescription, menstruation resumed. The initial color was bright red, later becoming turbid and dark, with normal volume. The pulse turned fine and slow; the tongue was red with a white coating. The resumption of menstruation with bright red blood indicates the presence of heat. Therefore, Siwu Tang (Four Substance Decoction) was modified. *Angelica sinensis* (Danggui) 12g, *Rehmannia glutinosa* prepared (Shudihuang) 24g, *Ligusticum chuanxiong* (Chuanxiong) 9g, *Paeonia lactiflora* (Baishao) 15g, *Moutan cortex* (Danpi) 9g, *Scutellaria baicalensis* (Huangqin) 6g, *Dipsacus asper* (Chuanxuduan) 9g, *Glycyrrhiza uralensis* roasted (Zhigancao) 6g. 3 doses. Thereafter, Baizi Ren Wan was taken three days before each period to consolidate the effect. After several months of regulation, the menstrual cycle returned to normal.
(Liu Chixuan: "Amenorrhea," published in *New Traditional Chinese Medicine*, Vol. 4, p. 23, 1963)
**Case 2: Liu X, Female, 29 years old, Outpatient Simple Medical Record.**
Date of First Visit: May 17, 1975. Chief Complaint: Amenorrhea for half a year. History of Present Illness: Since menarche at age sixteen, menstruation has been sparse, occurring only 1-3 times per year. Artificial cycle therapy was attempted, but amenorrhea recurred after stopping medication. She has now been amenorrheic for half a year and has been married for six years without conception. She complains of chest tightness and discomfort, irritability, epigastric distension, reduced appetite, insomnia with frequent dreams, palpitations, shortness of breath, dizziness, vexation with heat sensation, dry mouth, and gradual weight gain. Gynecological examination revealed only a small uterus, with no other abnormalities. Tongue was red; pulse was wiry and slippery. Syndrome differentiation: Yin deficiency with stomach dryness, counterflow of Chong meridian Qi causing amenorrhea.
(Western Diagnosis:
(1) Secondary amenorrhea.
(2) Primary infertility.)
Treatment method: Clear the stomach and resolve dryness, descend rebellious Qi and regulate the Chong meridian. Prescription: *Trichosanthes kirilowii* fruit (Gualou) 24g, *Dendrobium nobile* (Shihu) 12g, *Gardenia jasminoides* (Zhizi) 9g, *Forsythia suspensa* (Lianqiao) 9g, *Lycopus lucidus* (Zelan) 9g, *Salvia miltiorrhiza* (Danshen) 9g, *Dianthus superbus* (Qumai) 9g, *Polygonum aviculare* (Bianxu) 12g, *Achyranthes bidentata* (Niuxi) 12g, *Leonurus japonicus* (Yimucao) 12g, *Plantago asiatica* seed (Cheqianzi) 9g.
Treatment Course: On June 9, after taking 7 doses, symptoms improved, but vexation, heat, dry mouth, chest tightness, and irritability persisted. Zhizi, Lianqiao, and Bianxu were removed from the formula; Zhiqiao 6g, Xuanshen 9g, Maidong 9g, and Danggui 9g were added. Continue administration. On June 20, after taking 6 doses, symptoms improved further. Menstruation occurred on June 18-19 for 2 days, with very scant flow, coffee-colored. On July 3, after taking 7 doses, symptoms showed little improvement; vexation, heat, chest tightness persisted. Tongue was red, pulse wiry, slippery, and rapid. Prescription: *Trichosanthes kirilowii* fruit (Gualou) 30g, Scrophularia root (Xuanshen) 9g, Ophiopogon tuber (Maidong) 6g, Rehmannia root (Shengdi) 12g, White peony root (Baishao) 12g, *Dianthus superbus* (Qumai) 12g, *Plantago asiatica* seed (Cheqianzi) 9g, *Achyranthes bidentata* (Niuxi) 12g, *Leonurus japonicus* (Yimucao) 12g, *Gardenia jasminoides* (Zhizi) 9g, *Forsythia suspensa* (Lianqiao) 9g, *Lycopus lucidus* (Zelan) 9g, *Salvia miltiorrhiza* (Danshen) 9g. On August 1, after taking the medicine, menstruation lasted 6 days starting July 19, still scant, but other symptoms improved. Zhizi and Lianqiao were removed; Tao Ren (Peach Kernel) and Hong Hua (Safflower) 6g each were added. On August 30: All symptoms disappeared, and menstruation occurred normally monthly for 3 cycles (June 18-19, July 19-23, August 13-20). Due to scant flow, adding Tao Ren and Hong Hua gradually increased the volume. Obesity decreased slightly. Dry mouth and poor sleep persist; pulse is wiry and slippery, tongue is dark red. Continue with the previous prescription. Menstruation occurred September 5-9, with slightly increased volume compared to before. Continue the previous prescription to consolidate efficacy.
(*Liu Fengwu's Gynecological Experience*)
**Case 3: Surname Li, Female, 35 years old.**
Amenorrhea for fourteen weeks without response to medication. Recent sensation of abdominal distension, thirst with desire to drink, accompanied by epistaxis (nosebleed), not resembling retrograde menstruation. Severe soreness and pain in the lower back. Pulse is wiry, choppy, and excess. Prescribe a heavy dosage to unblock menstruation. *Haliotidis concha* (Sheng Jieming) 30g (raw, ground, decoct first), *Trionycis carapax et plastrum* (Sheng Biejia) 15g (decoct first), *Gypsum fibrosum* (Sheng Shigao) 30g (ground, decoct first), *Cyperi rhizoma* (Yanhusuo) 12g, *Achyranthes bidentata* (Chuan Niuxi) 12g, *Inulae flos* (Xuanfuhua) 12g (wrapped), *Haematitum* (Sheng Zhesishi) 15g, *Arecae pericarpium* (Dafurong) 6g, *Asarum heterotropoides* (Bei Xixin) 4.5g, *Curcumae radicalis* (Chuan Yujin) 12g, *Taxilli Caci* (Sangshengjisheng) 30g, *Syneilesis aconitifolia* (Weilingxian) 12g, Processed *Frankincense* and *Myrrh* (Zhi Rumen) 9g each, *Prunus persica* kernel and *Armeniacae amarum* kernel paste (Tao Xingren Ni) 9g each, *Endothelium Corneum Gigeriae Galli* (Jineijin) 12g, *Anemarrhenae rhizoma* and *Phellodendri amurensis cortex* (Sheng Zhibai) 9g each. Decoct in water, mix with 1 cup of unadulterated yellow wine. Add *Aquilariae wood* (Luoshenxiang) 1.5g (ground, taken with decoction). Take 1 pill of *Blatta orientalis* and *Rhizoma Polygoni* pill (Mengchong Wan) mixed with *Rhei radix* (Dahuang).
Follow-up: After one dose, blood broke through and flowed like a tide, bringing sudden relief to the abdomen. The blood color was pale, with black clots expelled heavily, accompanied by white viscous material. The excess signs in the pulse have subsided, but all six positions remain wiry. Prescribe a pill formula for regulation. Double the original dosage (remove yellow wine, change Mengchong Wan to 5 pills), grind together into fine powder, make honey pills, take 6g morning and evening, delivered with decoction of *Phaseolus angularis* testa (Ludouyi) 15g.
(Kong Sibai compiled: *Medical Cases of Kong Bohua*, published in *Journal of Traditional Chinese Medicine*, Vol. 8, p. 547, 1958)
[Commentary] Women's amenorrhea is referred to as "Bu Yue" or "Yue Shi Bu Lai" in the *Su Wen*. Clinically, it is divided into deficiency and excess syndromes. Deficiency syndromes are mostly caused by Spleen deficiency or Blood deficiency. Excess syndromes are more commonly due to Qi stagnation and Blood stasis or Cold-Dampness coagulation. Additionally, it can be caused by consumption of body fluids, depletion of Kidney Yin, Liver labor and Blood injury, Wind-Cold, Fire-Heat, or Phlegm stagnation. Differentiation and treatment should be based on the specific etiology.
Case 1 is amenorrhea due to insufficiency of menstrual blood and Blood deficiency. The treatment method is nourishing essence and blood and regulating the Chong and Ren meridians, using Baizi Ren Wan (*Furen Liangfang*) as the main formula. In this formula, Baiziren, Niuxi, and Chuan Duan nourish and regulate the Chong and Ren meridians; Zelan and Juanbai unblock and regulate blood vessels; Shudi nourishes Yin and blood. Although the number of herbs is small, the selection is precise and pure, yielding significant effects. Case 2 is Yin deficiency with stomach dryness. The treatment clears the stomach and resolves dryness, descends rebellious Qi and regulates the Chong meridian, later incorporating clearing blood, nourishing Yin, and invigorating blood to resolve stasis, achieving efficacy. Case 3 involves amenorrhea for over three months, abdominal distension, epistaxis, and thirst, belonging to an excess syndrome. Dr. Kong used a heavy dosage to unblock menstruation. The entire formula focuses on attacking stasis and breaking accumulation, while also calming the Liver, clearing Heat, descending rebellious Qi, and moving Qi. The syndrome and prescription matched perfectly, resulting in efficacy after just one dose. This case follows ancient methods but demonstrates innovative thinking, worthy of study by future practitioners.
**(IV) Metrorrhagia and Metrostaxis (Beng Lou)**
**Case 1: Patient Wan XX, Female, 17 years old, Unmarried. Medical Record No. 47257 (Guang'anmen Hospital)**
First Visit (August 18, 1962): Menorrhagia for three years. At menarche at age fourteen, participation in strenuous exercise led to continuous dripping bleeding lasting five months. Then, amenorrhea for another five months followed by recurrence, with a cycle of 40-60 days. The last menstruation on July 5 was heavy with large blood clots, accompanied by dizziness, blurred vision, palpitations, insomnia, fatigue, weakness, dry mouth, and poor appetite. When bleeding lasted twenty days, Qi-tonifying and Blood-nourishing hemostatic agents were taken. Bleeding has now continued for 43 days without cessation. Complexion is pale and spiritless. Tongue coating is thin with prickles at the tip. Pulse is fine, minute, and rapid. Syndrome differentiation: Labor injuring Qi and Blood, damaging the Chong and Ren meridians, failing to constrain menstrual blood. Long-standing disease leads to dual deficiency of Qi and Blood; prevent sudden profuse bleeding leading to Qi collapse following Blood loss. Treatment method: Urgently tonify Yuan Qi significantly, secure and constrain the Chong and Ren meridians. Prescription: Korean Ginseng 6g, Atractylodes macrocephala 6g, Dioscorea opposita 9g, Roasted Licorice 3g, Prepared Rehmannia 12g, Cornus officinalis 6g, Cuscuta chinensis 9g, Schisandra chinensis 6g, Charred Mume Fruit 6g, Raw Dragon Bone 15g, Lecontite 15g, Red Kaolin 15g, Fulung Liver (Vermilion Earth) 30g (decoct as water substitute), 6 doses. Additionally: Placenta Hominis powder (Heche Fen) 9g, take 1.5g morning and evening.
Second Visit (August 24): The next day after taking the medicine, bleeding stopped, and all ailments diminished. Tongue coating is thin white with prickles at the tip; pulse is fine, minute, and rapid. The medicine responded to the disease; continue with modifications of the previous method. Ginseng 6g, Atractylodes macrocephala 6g, Dioscorea opposita 9g, Roasted Licorice 3g, Prepared Rehmannia 12g, Cornus officinalis 6g, Schisandra chinensis 6g, Red Kaolin 15g, Lecontite 15g. 6 doses.
Third Visit (August 30): Symptoms improve daily. Tongue coating is thin white; pulse is fine and soft. Treatment: Tonify Qi and nourish Yin. Ginseng 6g, Atractylodes macrocephala 6g, Dioscorea opposita 9g, Roasted Licorice 3g, Prepared Rehmannia 12g, Cornus officinalis 6g, Schisandra chinensis 6g, Donkey-hide gelatin 12g, Raw Oyster Shell 15g, White Peony Root 9g. 5 doses. Subsequently, modify this formula. Additionally: Placenta Hominis powder 60g, take 1.5g morning and evening. Menstruation thereafter arrived on schedule with normal color and volume, with no other discomfort.
(*Qian Boxuan's Gynecological Cases*)
**Case 2: Lin XX, Female, 45 years old.**
Constitutionally weak, with heavy menstrual flow. Strenuous work led to metrorrhagia and metrostaxis (Beng Lou). Caused by insufficiency of Middle Qi, with Qi deficiency leading to sinking. The primary treatment should be tonifying Qi to control bleeding. Prescribe Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Donkey-hide gelatin 10g (added later), Cornus officinalis 10g, Dragon Bone 30g (decoct first), Oyster Shell 30g (decoct first). Decoct in water and take orally. After 5 doses, bleeding gradually stopped. Advised to take 3 more doses to complete the treatment.
(Yu Shenchu: "Clinical Application of Buzhong Yiqi Tang," published in *Fujian Journal of Traditional Chinese Medicine*, Vol. 1, p. 48, 1981)
**Case 3: Wang XX, Female, 32 years old. Date of First Visit: July 23, 1963. Medical Record No.: 357565.**
For the past year, menstruation has occurred early with heavy flow, generally every 15-20 days. This time, menstruation has lasted 10 days without stopping, with heavy flow, bright red color, and blood clots. Accompanied by dizziness, fatigue, chest tightness, palpitations, numbness from hands to elbows, poor appetite, abdominal distension, sore waist, cold sensation in body and waist, and edema in lower limbs. Complexion is pale white. Tongue is pale with thin white coating. Pulse is deep, slow, and forceless. Endometrial biopsy at Hospital X showed proliferative endometrium. Western diagnosis: Functional uterine bleeding. Syndrome differentiation: Numbness in four limbs is attributed to Blood deficiency, caused by the Liver failing to nourish tendons; Spleen Yang cannot control water, hence lower limb edema; insufficiency of Kidney Essence and Qi causes cold and soreness in the waist; deficiency of True Yang fails to warm and transport Spleen Earth, hence poor appetite; Spleen failing to control blood results in blood not following its vessels, hence prolonged heavy menstruation. First, strengthen the Spleen and secure the Chong meridian, soften the Liver and resolve stasis. Prescription: Poria 15g, Atractylodes macrocephala 9g, Dioscorea opposita 15g, Amomum villosum 4.5g, *Dipsacus asper* 15g, Eucommia bark 15g, White Peony Root 24g, Mugwort leaf charcoal 9g, Palm fiber charcoal 9g, Cyperus rotundus 9g, *Lycopus lucidus* 9g. This formula uses Fuling, Shanyao, Baizhu, and Sharen to strengthen the Spleen and nourish the Stomach; Chuan Duan, Duzhong, and Baishao to strengthen the Liver and Kidneys; heavy use of Baishao (24g) to soften the Liver and astringe Yin; Aiye Tan and Zongtan to stop bleeding; Xiangfu and Zelan to remove stasis and generate new blood.
Second Visit (July 26): After taking the medicine, menstrual blood stopped. Cold sensation in back and body, general weakness, improved appetite, slight soreness and pain in waist, abdominal distension, occasional lower abdominal pain. Tongue is grayish-white with thin white coating; pulse is deep, fine, and slow. Treatment: Warm and tonify Kidney Yang, nourish Blood and resolve stasis. Prescription: *Angelica sinensis* 9g, White Peony Root 24g, Cyperus rotundus 9g, *Dipsacus asper* 15g, *Evodia rutaecarpa* 6g, Cinnamon twig 3g, Eucommia bark 9g, *Achyranthes bidentata* 9g, Peach Kernel 6g, Red Peony Root 9g.
Third Visit (August 16): After taking the previous prescription for 12 doses, numbness in limbs, soreness in waist, cold sensation, and general weakness significantly improved. Pain on both sides of the lower abdomen is no longer obvious. Menstrual cycle has arrived, with no early occurrence this month. Leukorrhea is moderate in amount, white in color. Tongue is pale with thin white coating; pulse is deep and slow. Treatment: Strengthen Liver and Kidneys, invigorate Blood and resolve stasis. *Angelica sinensis* 9g, Red Peony Root 12g, Poria 9g, Cyperus rotundus 6g, *Leonurus japonicus* 12g, *Dipsacus asper* 9g, *Taxillus chinensis* 12g, Dioscorea opposita 12g, Peach Kernel 6g.
August 27: Menstruation started on August 18, cycle 35 days, lasted 5 days, volume and color normal. Abdominal distension and pain during menstruation were not obvious. Soreness in waist and edema in limbs resolved. Remove Peach Kernel and *Leonurus japonicus* from the previous formula, add Sandalwood 1.5g, Tangerine peel 9g.
September 27: Menstruation overdue by 9 days, slight abdominal distension. Mild nausea and discomfort for the past three days, good appetite, normal urination and defecation. Tongue normal, thin white coating, pulse deep and slow. Treat with strengthening Spleen and harmonizing Stomach method.
October 15: Amenorrhea for 57 days, nausea and vomiting, positive frog pregnancy test. Tongue normal, thin white coating, pulse slippery. Stop medication and observe. Follow-up later showed delivery of a female infant in May 1964.
(Xi Peiling treated, Liu Kun compiled: "A Verified Case of Metrorrhagia and Metrostaxis," published in *Journal of Traditional Chinese Medicine*, Vol. 10, p. 15, 1964)
**Case 4: Sun XX, Female, 29 years old, Outpatient Simple Medical Record.**
Date of First Visit: March 2, 1974. For the past 10 years, menstruation has lasted long, each time about 15-20 days. Cycle is irregular, varying intervals (20-70 days). Last menstruation was February 21, still not stopped, heavy flow, red color with blood clots. Accompanied by dizziness, frequent dreams, irritability, chest tightness, heat sensation in palms and soles, dry mouth. Basal body temperature measured for the past 5 months has been monophasic. Diagnosed as functional uterine bleeding at a certain hospital. Tongue is dark with red tip; pulse is wiry and slippery. Syndrome differentiation: Yin deficiency with Blood Heat, insecurity of Chong and Ren meridians. Treatment method: Nourish Yin and clear Heat, calm the Chong meridian and regulate menstruation. Prescription: Artemisia annua 9g, *Lycium barbarum* bark (Digupi) 9g, *Scutellaria baicalensis* 9g, *Moutan cortex* 9g, White Peony Root 9g, *Eclipta prostrata* 9g, *Toona sinensis* root bark 9g, Calcined Oyster Shell 24g, Donkey-hide gelatin 15g, Charred Biota Seed 9g.
Treatment Course: On March 13, after taking 3 doses, vaginal bleeding stopped. Continue taking 3 doses. Menstruation resumed on March 23, lasting 6 days, cycle and volume returned to normal. Basal body temperature showed biphasic pattern (indicating ovulation). Long-term efficacy remains to be observed.
(*Liu Fengwu's Gynecological Experience*)
**Case 5: Jiang XX, Female, 24 years old. First Visit: April 24, 1976.**
Menarche at age 15, menstrual cycle and volume were normal. For over half a year, slight vaginal bleeding occurs 13-14 days after menstruation ends, red color, small amount, stops within 3 days. Usually restless at night, easily irritable, upper body dry with sore throat, sore waist, leukorrhea white like snot. Diagnosed as ovulation bleeding. Complexion flushed, tongue tip red, thin white coating, wiry and rapid pulse. Currently on the fourth day of menstruation. Syndrome differentiation: Depression-Heat in the Liver Meridian, Heat disturbing Chong and Ren meridians leading to failure of containment. Treatment method: Primarily clear and soothe the Liver. Prescription: Fried *Moutan cortex* 4.5g, Fried Schizonepeta 4.5g, Artemisia annua stem 4.5g, Bupleurum 4.5g, Fried *Angelica sinensis* 6g, Processed Cyperus rotundus 6g, *Rubia cordifolia* root 6g, Cuttlefish bone 10g, Night-blooming Jasmine Vine 15g, Honeysuckle Vine 15g, Light Scutellaria 9g, White Peony Root 9g. 5 doses. Instructed to start taking after menstruation ends.
Second Visit (May 8): Took 5 more doses according to the original formula. Sleep is now peaceful, leukorrhea reduced, slight lower abdominal pain healed. Complexion still flushed. Remove Honeysuckle Vine and Night-blooming Jasmine Vine from the above formula, add Sichuan Loranthus and *Lycium barbarum* bark 9g each. 5 doses.
Third Visit (May 15): No mid-cycle bleeding this month, irritability gradually healed, occasional sour pain in lower abdomen, throat feels dry at night. Syndrome is Depression-Heat in the Liver Meridian, long-standing damaging Yin. Follow previous method, add herbs to nourish Liver and Kidneys. Artemisia annua stem, Powdered *Moutan cortex*, *Rubia cordifolia* root, Soft Bupleurum 4.5g each, Whole *Angelica sinensis*, Hangzhou White Peony Root, Cyperus rotundus 6g each, Cuttlefish bone, Sichuan Loranthus, *Lycium barbarum* bark 9g each, Dried Cornus officinalis 6g, Fine Rehmannia root 15g. 5 doses.
Fifth Visit (June 5): No mid-cycle bleeding this month, leukorrhea eliminated. Continue taking Xiaoyao Wan and Qiju Dihuang Wan to consolidate.
(Xu Rongzhai treated, Chen Tianxiang compiled: "Treatment Verification of Ovulation Bleeding," published in *Journal of Zhejiang College of Traditional Chinese Medicine*, Vol. 2, p. 47, 1981)
**Case 6: Surname Jiang, 42 years old, gave birth to 8 children. After the last artificial abortion surgery, menstruation was initially normal. Four months later, suddenly experienced excessive menstrual flow, forming metrorrhagia and metrostaxis (Beng Lou). Lasting five to six months, dripping continuously. Emaciated, palpitations, insomnia, sore waist, inner restlessness. Underwent uterine curettage twice, bleeding increased. Western medicine believed hysterectomy was necessary to stop bleeding. Patient refused, transferred to Traditional Chinese Medicine treatment. Took multiple doses of Qi-tonifying, Blood-nourishing, and astringent herbs without effect. Came to my father for treatment. Reported symptoms such as dizziness, blurred vision, sore waist and weak limbs, mental fatigue, etc., mostly belong to deficiency images. However, pressing the lower abdomen reveals dull pain; palpating the pulse reveals it is deficient, fine, and choppy. My father believed that although long-term blood loss constitutes deficiency, there are residual stasis and stagnation inside that have not transformed. Therefore, new blood cannot return to its vessels. Previous tonifying and astringent agents failed because the key lies in deficiency containing excess. Thus, prescribed General Breaking Through the Pass Decoction (Jiangjun Zhanguan Tang): Prepared Rhubarb 3g, Morinda officinalis 9g, Agrimony 18g, Poria cocos 9g, Lygodium spore fried with Donkey-hide gelatin 9g, Astragalus 4.5g, Fried *Angelica sinensis* 9g, Atractylodes macrocephala 4.5g, Raw and Prepared Rehmannia 9g each, Scorched Barley Sprout 9g. Additionally, Saffron 0.9g, Notoginseng powder 0.9g. These two ingredients taken with black tea juice. After just one dose, bleeding stopped immediately. After further regulation, health was restored.
(Zhu Xiaonan compiled: "Medical Achievements of Mr. Zhu Nanshan," published in *Shanghai Journal of Traditional Chinese Medicine*, Vol. 8, p. 25, 1962)