例七王ｘ，女，17岁。1970年1月8日初诊。月经来潮前，不慎饮冷水，致使经血不止，已三天，有大血块，浸透衣被，伴有少腹疼痛，面色苍白，四肢冰冷，卧床不起。平素月经量少。处方：当归15克炮姜9克五灵脂12克蒲黄12克生地炭12克地榆炭15克白术15克仙鹤草12克百草霜12克灶心上24克水煎两遍，兑一起，一次服下。另取好墨一块，用木炭火烧红，放醋中淬后取出，将墨用水研匀，加炮姜9克，红糖少许为引，一次服下。服药1剂，墨汁一次，流血即止，腹痛也除，又服一剂而愈。
(《刘惠民医案》）
【评按】崩漏系指阴道内持续饯出血的病证。金·张洁古谓：“崩者，倏然暴下也；漏者，淋沥不断也”。崩，出血量多而势急；漏，出血量少而势缓。二者在病程中可相互转化，有时也难以截然区分。临床以血热、气虚、血瘀为常见病因、病理。血热治以清热凉血为主；气虚宜补气摄血，血瘀当活血法瘀。并可根据不同的兼症，在治法上予以化裁变通。
例一起病因于初潮时期，因剧烈运动，冲任损伤，遂致经漏，辨证为气血虚损。钱氏以大补气血、固摄冲任为治，此属治本法。
例二为体弱、操劳而致中气下陷，治以补中益气汤加龙、牡、胶、萸以补气摄血，兼顾冲任。全方升、补、摄、固的特点相当突出。
例三脾肾阳虚，以脾病为标，肾病为本，初以健脾、固摄冲任为主，终以补肾温阳为法，在治疗过程中，药用加减变化颇合病机。
例四病已十年，除崩漏主证外，阴虚诸症明显，故治以养阴清热、安神调经为主，其中安神调经诸品，着重调肝、清热、固涩。药味精审，配伍严密。
例五以肝经郁热为主要矛盾，临床表现为月经中期出血，显示冲任已受热扰，故治以清肝疏肝法。全方寓丹栀逍遥散意，而药味则有较大出入，方以熟军炭为君，只用3克而无泻下作用，反能厚肠胃，并有清热法瘀、“通因通用”之妙，是为临床宝贵心得。其余诸品有补气和中止血之功，服药一剂而效。
例七由于经前饮冷水，致使经血不止，并有大血块。治以补血温经、法瘀止血法。疏方发挥了温、养、摄等综合疗能，并参用墨汁止血化瘀，体现了刘氏善学古人之处。
(五）其他月经病
例一裘女。初诊：阴虚血少，不能养肝，肝火上升，头昏心悸，胸闷食少，月事不调，大便艰结，舌中干黄，脉来弦数。先与调和肝胃。橹豆衣9克杭白芍9克左金丸1．5克
(包）炒川贝9克橘白络各3克炒枳壳4．5克嫩钩尖6克绿萼梅3克鲜柠檬9克二诊：调和肝胃，腻苔略薄，头昏心跳，食少，便坚未除。以前法加味。橹豆衣9克焦白芍9克左金丸1(克(包）江枳壳4石克炒川贝9克橘白络各3克姜汁炒竹茹9克绿萼梅3克方通草3克鲜柠檬9克三诊：调和肝胃已见效机。头昏、心跳诸恙均减，经水来临，血瘀并见；阴虚血亏之质，须防肝强肆疟，冲任不调。治以柔肝为法：当归身9克杭白芍9克牡丹皮6克橹豆衣9克醋炒柴胡2．4克栀子仁9克广郁金4．5克香附末6克炒白术6克
(张赞臣整理：谢利恒先生的医学经验简介，《上海中医药杂志》10：16，1964）
例二谢，女。经停四月，代偿于口鼻而出。比来腹感胀痛，色脉皆无虚象，可攻。泽兰叶9克蓬莪术9克赤芍9克川芎6克王不留行9克紫丹参9克桃仁泥12克当归9克丹皮9克粉甘草3克大黄度虫丸12克
(《章次公医案》）
例三马某，女，17岁，未婚。初诊
(1972年10月5日）：末次月经9月14日。15岁月经初潮，经期尚准。近数月来，每于经前一周，先有头晕头痛，同时伴有咽喉红肿疼痛，继而体温逐渐升高到39℃左右，精神极度烦躁不安，甚至神识昏迷，语无伦次；大便闭结不通，少腹拘急而痛，持续3～4天，至经净后精神症状才逐渐消失。如此者反复发作已数月。脉细弦而数，舌苔少、边尖红刺。阴虚内热，心肝之火内炽，痰火蒙蔽清窍，拟清上导下，用釜底抽薪法。生大黄9克龙胆草6克黑山栀6克木通6克生地24克玄参9克麦冬6克地骨皮6克黄芩6克竹叶9克7剂。二诊
(10月12日）：服上方后，大使得以通畅，心肝之火由下而夺，精神上自觉轻松愉快。当此经汛将行之前，极宜预防为主，仍宗原意，佐以清肝宣窍，上下分清之。生大黄9克黄芩9克木通6克地骨皮9克生地15克玄参9克麦冬6克姜半夏6克制南星9克郁金6克菖蒲9克礞石滚痰丸12克
(包煎）服14剂。三诊
(12月28日）：末次月经10月21比此次经汛落后7天而至，瘀色淡而不艳，但在经行之前，神情尚属稳定；经行期间，发热未作，神识清晰，一如常人。心肝之火已平，然腹部略有胀痛。脉仍细数，舌苔薄、质红，余热未清，当乘胜追击之。制大黄6克黄芩6克木通6克地骨皮9克生地18克麦冬6克玄参9克制南星9克郁金9克磁石18克(先煎）礞石18克(先煎）菖蒲9克7剂。
【评按】
例一为月经不调，兼见头昏心悸，大便艰结，由阴虚血少不能养肝，肝火上升所致；谢氏治重调和肝胃，见效后以调摄冲任、柔肝养血为洽。全案在选药和治疗层次方面均颇可取。特别是在调和肝胃中选用柠檬以下气和胃，是为药疗、食疗相结合的治法。
例二倒经
(或称“逆经”），系冲脉之气上扰，血随气上所致。洽以降逆安冲，使经循正道，这与通常所见肝经郁火或阴虚肺燥而致的逆经治法有所不同。
例三为经前期紧张症，由于患者每于经前一周先有头晕痛，咽肿痛，继则体温升高，患者烦躁甚，并见神昏、便秘等症，又以精神症状较为突出。辨证为阴虚、心肝火炽。痰热蒙蔽清窍。由于经净即退，则与外感之邪逆传心包不同。投增液承气汤加减以养阴清热，清化痰火，清上导下，是为釜底抽薪法。前后三诊，治则大致未变，复诊时加用礞石滚痰丸，有利于加强和巩固疗效，是为唐氏在立方遣药方面心思活泼之处。
(六）带下
例一余××，女，32岁，搬运工人。初诊日期：1975年5月21日。患者服长效避孕药已一年，近月来白带增多为水样。胃纳差，口淡，睡眠欠佳，尿量减少，大便两天一次，面部色素沉着明显，舌淡白，唇色亦淡，脉沉滑略弦。辨证，脾肾虚损带下。治法：健脾固肾，收敛止带。方药：菟丝子25克白术15克炙甘草10克白芍10克海螵蛸15克白芷10克岗稔根3Q克4剂。5月28日二诊：服药后带下较前大减，胃纳增进，面部色素沉着亦减轻，睡眠仍欠佳，尿正常，舌淡红，苔薄微黄，脉细滑。药已见效，按法照上方加首乌20克，续服6剂后，自带已净。
(《罗元恺医著选》）
例二王，女，37岁。带下青色，腥臭稠粘，头胀目眩，口苦胁痛，脉来弦数，舌质红，苔黄腻。症属肝经湿火下注，拟泻厥阴之火，化膀胱之湿。龙胆草6克黑栀9克炒白芍9克生甘草3克黄芩4.5克青陈皮各3克茯苓12克绵茵陈15克柴胡4.5克川萆薢9克炙白鸡冠花12克三诊：带下不多，胁痛间或有之，脉弦，苔薄黄。再拟疏肝和营，兼清余热。炒柴胡4石克、丹皮4.5克黑山栀9克当归9克制苍木4．5克茯苓12克炒白芍6克甘草2．4克薄荷纯梗4．5克郁金6克炙白鸡冠花12克
(《叶熙春医案》）
例三吴××，35岁，职工。素嗜辛辣，房室不节，以致形肉日消，迩日易怒，咽痒干咳，入夜少睡，多梦纷纭，心悸惊惕，赤白带下，头晕腰瘦，便艰，溲赤，舌质红、苔白糙，切脉二尺沉细，寸关弦数。女贞子、旱莲草、麦冬、远志、金樱子各9克阿胶、茯神、生地、杞子各12克，黄连1.8克、莲肉15克鸡子黄1枚5剂。嘱忌辛辣，禁房事。复诊：带净，寐安，唯腰膂仍感酸楚，上方去黄连，加川断9克，继投六剂，所患诸恙尽廖。
(陈予舟等整理）周兰若先生治疗带下经验介绍，江苏中医8：31，1965）
例四张ｘ。肝燥血虚，气机失调。干呕暖气，且少腹作痛：赤白带下，食入乏味。舌白胖。以和中调气治之。焦白术9克旋复花4．5克生白芍9克偎木香2．4克云苓15克当归身6克生石决明18克代储石12克绿梅花3克厚杜仲12克竹茹4．5克(沉香0．9克拌炒）橘叶4．5克陈皮4．5克佛手4．5克
(王震诒述：王芹生先生妇科经验简介，《上海中医药杂志》8：21，1963）
例五胡某，38岁，已婚。初诊
(6月23日）：曾生三胎，小产两次。1963年2月间第二次小产后，发热四月余未退，经医院注射抗菌素治疗无效。刻下胸闷潮热，腰酸肢楚，精力疲乏，带下似脓，有秽味，并时带红。经检查为盆腔炎。据述此次小产后即行避孕，月经三个月未来，小腹隐痛，阴道流出脓汁带有臭味，小白中亦混有血丝，口干潮热。脉细数，舌苔薄黄。辨证：湿热内蕴，阴虚火旺。治法：养阴清热。方药：鲜生地30克红藤15克川柏9克知母9克甘草梢4．5克淮山药9克丹皮9克茯苓9克山萸肉9克椿根皮12克复诊：上方加减，自9月底至10月15日，服用半月后，潮热消失，秽带减少，尿血亦止，腹部已感轻快，惟尚感精神疲惫，大便燥结不畅，治拟健脾固肾，兼清余邪。黄芪9克白术6克陈皮6克生地12克菟丝饼9克山萸肉9克苁蓉9克黄柏9克茯苓9克白槿花9克甘草梢4．5克
(《上海老中医经验选编》朱小南医案）
【评按】带下有二义，一是泛指妇科病；一是指阴道经常流出较多粘腻液体的病证，即王太仆所谓“女子阴中绵绵下也”。这里所指的是后者，根据其不同的颜色，有白带、黄带、赤带等多种名目，病因以脾虚、肝郁、肾虚、湿热最为多见。
例一由脾肾虚所致，白带增多如水样，胃纳差，唇舌淡。用健脾固肾、收敛止带法，其中重用岗稔根，能加强收敛止带作用，为罗氏的经验用药。
例二为湿热带下，初以龙胆泻肝汤加减以泻火化湿，次以丹栀逍遥散加减以疏肝和营，兼清余热。方中有白鸡冠花，《孙天仁集效方》谓其善治白带，也是叶氏的经验用药。
例三赤带，《妇科玉尺》云：“赤带多因心火时炽不已，久而阴血渐虚，中气渐损而下赤矣”。此案兼有房室不节，肾阴不足，故治以滋阴凉血、清心安神为大法。治法的当，立方照顾亦较全面。
例五赤白带下，由肝燥血虚，气机失调所致。治以和中调气为主，气血兼顾。其方既治带下，又疗干呕、暖气、少腹作胀诸证。标本同治，方亦灵动。
例六带下似脓，小腹隐痛，腰酸肢楚，口干潮热，症属湿热内蕴，阴虚火旺
(西医诊为盆腔炎），治以清热养阴为主，后治以健脾固肾、清理余邪等法，对盆腔炎之属湿热型者，朱氏治法可供借鉴。
(七）恶阻
例一郭××，女，成人，已婚。病历号38817
(301医院）。初诊日期：1959年6月18日。现妊娠一个半月，停经30天即有泛恶呕吐，近四天加重，不能进饮食，呕吐黄水。头晕，大便干燥，舌苔薄腻，根微黄垢，脉软滑微数。辨证：肝胃气逆，痰浊不降。治法：和肝胃，降痰浊。方药：北秫米12克清半夏9克2剂。6月20日二诊：入院后，服药仍吐，心中烦热，口干且苦，但喜热饮，胃脘作痛，少腹胀坠，舌苔淡黄腻，根微垢，脉左细弦数，右滑数，病因痰湿中阻，胃浊不克下降，治以益气温中，化痰降浊。党参3克干姜3克清半夏3克三味研未，早晚各服1.5克，月艮前再加生姜汁四滴，调和徐服。、服上药后，呕吐止，诸恙渐安，以后未再服药。
(《钱伯煊妇科医案》）
例二姜××，女，31岁。门诊简易病历。初诊日期：1974年8月21日患者闭经50天，近日来恶心、呕吐、厌食，胸闷腹胀，妊娠试验阳性，血压100/60毫米汞柱
(过去有血压偏低史）。舌质尖红，周边有齿痕。脉沉细弦。辨证：妊娠恶阻
(脾胃虚弱，冲气上逆）。洽法：健脾和胃，降逆止呕。方药：霍香9克苏梗6克陈皮6克砂仁4．5克半夏6克白术9克木香3克生姜汁20滴上方服3剂后，恶心呕吐已止，食纳增加，基本痊愈。
(《刘奉五妇科经验》
【评按】恶阻为妊娠期常见病，其所以发生呕恶、眩晕、恶闻食气者，由于胃失和降，冲脉之气上逆所致。
例一属肝胃气逆，痰浊不降。钱氏宗《内经》治法,以半夏秫米汤和肝胃、降痰浊。鉴于患者苔淡黄腻，痰浊中阻，阳气失宣，后用《金匮要略》之干姜人参半夏丸
(人参以党参代，丸剂改为散剂）以益气温中、化痰降浊而效。细绎全案，辨证精而用药简当。例二以中虚胃失和降为主要矛盾，故治宜健脾和胃，降逆止呕，由于原案掌握了此病的主要病机，其论病用药，颇堪效法。
[Background Information]
Book Title: Compilation of Verified Cases by Famous Modern and Contemporary Physicians
Chapter: Main Text (30/53)
Category: Medical Discourse
[Original Text to be Processed]
Case Seven: Wang XX, Female, 17 years old. First consultation on January 8, 1970. Before the onset of menstruation, she inadvertently drank cold water, resulting in continuous menstrual bleeding for three days, with large blood clots soaking through clothes and bedding. She experienced lower abdominal pain, pale complexion, cold limbs, and was bedridden. Her usual menstrual flow was scant. Prescription: *Danggui* (Angelicae Sinensis Radix) 15g, *Paojiang* (Prepared Ginger Rhizome) 9g, *Wulingzhi* (Trogopterori Faeces) 12g, *Puhuang* (Typhae Pollen) 12g, *Shengditan* (Charred Rehmanniae Radix) 12g, *Diyutan* (Charred Sanguisorbae Radix) 15g, *Baizhu* (Atractylodis Macrocephalae Rhizoma) 15g, *Xianhecao* (Agrimoniae Herba) 12g, *Baicaoshuang* (Herba Artemisiae Argyi Carbonisata) 12g, *Zaoxintu* (Caulis Longi Cineratus / Dragon's House Earth) 24g. Decoct twice in water, mix the decoctions, and take once. Additionally, take a piece of high-quality ink, heat it red with charcoal, quench it in vinegar, remove it, grind it evenly with water, add *Paojiang* (Prepared Ginger Rhizome) 9g and a little brown sugar as a guide, and take once. After one dose of medicine and one dose of ink juice, the bleeding stopped immediately, and the abdominal pain was relieved. After another dose, she recovered.
(From *Liu Huimin's Medical Cases*)
[Commentary]
Benglou (Metrorrhagia and Metrostaxis) refers to a syndrome of continuous vaginal bleeding. Zhang Jiegu of the Jin Dynasty said: "Beng is sudden profuse discharge; Lou is dripping without cessation." Beng indicates heavy bleeding with rapid onset; Lou indicates light bleeding with slow progression. The two can transform into each other during the disease course and are sometimes difficult to distinguish clearly. Clinically, Blood Heat, Qi Deficiency, and Blood Stasis are common etiologies and pathologies. Blood Heat is treated primarily with clearing heat and cooling blood; Qi Deficiency requires tonifying Qi to control blood; Blood Stasis requires promoting blood circulation to resolve stasis. Treatment methods can be modified according to different accompanying symptoms.
Case One: Originating from the time of menarche, severe exercise damaged the Chong and Ren meridians, leading to menstrual leakage. The pattern differentiation indicated Qi and Blood deficiency. Qian treated this by greatly tonifying Qi and Blood and securing the Chong and Ren meridians, which belongs to treating the root cause.
Case Two: Caused by weak constitution and overwork leading to sinking of Middle Qi. Treated with *Buzhong Yiqi Tang* (Spleen-Boosting and Qi-Supplementing Decoction) plus *Longgu* (Fossilized Mammalian Bones), *Muli* (Ostreae Concha), Ejiao (Donkey-Hide Gelatin), and *Yuzi* (Cornus Fructus) to tonify Qi and control blood, attending to the Chong and Ren meridians. The characteristics of lifting, tonifying, controlling, and securing in the entire prescription are quite prominent.
Case Three: Spleen and Kidney Yang Deficiency, with Spleen disease as the branch and Kidney disease as the root. Initially treated primarily with strengthening the Spleen and securing the Chong and Ren meridians, ultimately using the method of tonifying the Kidney and warming Yang. The modifications of herbs during treatment closely matched the pathology.
Case Four: The disease had lasted ten years. In addition to the main symptoms of Benglou, Yin Deficiency symptoms were obvious. Thus, treatment focused on nourishing Yin, clearing heat, calming the mind, and regulating menstruation. Among these, the items for calming the mind and regulating menstruation focused on soothing the Liver, clearing heat, and astringing. The selection of herbs was careful, and the compatibility was rigorous.
Case Five: Liver Meridian Depressed Heat was the main contradiction. Clinically manifested as mid-cycle bleeding, indicating that the Chong and Ren meridians were disturbed by heat. Thus, the treatment was clearing and soothing the Liver. The formula contained the intent of *Danzi Xiaoyao San* (Moutan and Gardenia Free and Easy Wanderer Powder), but the herb composition differed significantly. *Shujun Tan* (Charred Prepared Rhubarb) served as the sovereign herb. Used only in 3g, it had no purgative effect but instead thickened the intestines and stomach, and possessed the subtlety of clearing heat, resolving stasis, and "treating obstruction with unblocking methods" (Tong Yin Tong Yong). This represents a valuable clinical insight. The remaining herbs have the functions of tonifying Qi, harmonizing the middle, and stopping bleeding. Effect was seen after one dose.
Case Seven: Due to drinking cold water before menstruation, menstrual bleeding continued with large blood clots. The treatment was tonifying blood, warming the meridians, and resolving stasis to stop bleeding. The prescribed formula exerted comprehensive therapeutic effects of warming, nourishing, and controlling, and incorporated ink juice to stop bleeding and resolve stasis, reflecting Liu's skill in learning from ancients.
(V) Other Menstrual Disorders
Case One: Female Qiu. First Consultation: Yin Deficiency and Blood Insufficiency failing to nourish the Liver, causing Liver Fire to rise. Symptoms included dizziness, palpitations, chest tightness, poor appetite, irregular menstruation, difficult defecation, dry yellow coating in the center of the tongue, and wiry-rapid pulse. Initially treated to harmonize the Liver and Stomach. *Ludouyi* (Sojae Semen Preparatum) 9g, *Hang Baishao* (White Peony Root) 9g, *Zuojin Wan* (Left Metal Pill) 1.5g (wrapped), *Chao Chuanbei* (Stir-fried Fritillaria Bulb) 9g, *Jubailuo* (Citri Reticulatae Pericarpium and Retinervum) 3g each, *Chao Zhike* (Stir-fried Aurantium Fructus) 4.5g, *Nen Goujian* (Uncaria Ramulus cum Uncis) 6g, *Lvemei* (Green Plum Flower) 3g, Fresh Lemon 9g. Second Consultation: Harmonizing Liver and Stomach showed slight thinning of greasy coating. Dizziness, palpitations, poor appetite, and hard stool persisted. Added to previous method. *Ludouyi* 9g, *Jiao Baishao* (Scorched White Peony Root) 9g, *Zuojin Wan* 1g (wrapped), *Jiang Zhike* (Jiangxi Aurantium Fructus) 4.5g, *Chao Chuanbei* 9g, *Jubailuo* 3g each, *Jiangzhi Zhu Ru* (Ginger-processed Bamboo Shavings) 9g, *Lvemei* 3g, *Fang Tongcao* (Tetrapanatis Medulla) 3g, Fresh Lemon 9g. Third Consultation: Harmonizing Liver and Stomach showed efficacy. Dizziness and palpitations decreased. Menstruation arrived with visible blood stasis. Given the constitution of Yin Deficiency and Blood Deficiency, must prevent Liver Hyperactivity and imbalance of Chong and Ren meridians. Treated by softening the Liver: *Dangguishen* (Body of Angelicae Sinensis Radix) 9g, *Hang Baishao* 9g, *Mudanpi* (Moutan Cortex) 6g, *Ludouyi* 9g, *Cu Chaihu* (Vinegar-processed Bupleuri Radix) 2.4g, *Zhizi Ren* (Gardeniae Semen) 9g, *Guang Yujin* (Curcumae Radix) 4.5g, *Xiangfu Mo* (Cyperi Rhizoma Powder) 6g, *Chao Baizhu* 6g.
(Organized by Zhang Zanchen: Introduction to Mr. Xie Liheng's Medical Experience, *Shanghai Journal of Traditional Chinese Medicine* 10:16, 1964)
Case Two: Xie, Female. Amenorrhea for four months, compensated by bleeding from mouth and nose. Recently felt abdominal distension and pain. Complexion and pulse showed no signs of deficiency; attackable treatment is suitable. *Zelan Ye* (Lycopus Herba) 9g, *Peng Ezhu* (Curcumae Rhizoma) 9g, *Chishao* (Red Peony Root) 9g, *Chuanxiong* (Ligustici Chuanxiong Rhizoma) 6g, *Wangbuliuxing* (Vaccariae Semen) 9g, *Zi Danshen* (Salviae Miltiorrhizae Radix et Rhizoma) 9g, *Taoren Ni* (Persicae Semen Paste) 12g, *Danggui* 9g, *Danpi* 9g, *Fen Gancao* (Licorice Root) 3g, *Dahuang Zhechong Wan* (Rhubarb and Ground Beetle Pill) 12g.
(From *Zhang Cigong's Medical Cases*)
Case Three: Ma XX, Female, 17 years old, unmarried. First Consultation (October 5, 1972): Last menstrual period September 14. Menarche at 15, cycles regular. For recent months, one week before menstruation, she experiences dizziness and headache, accompanied by swollen and painful throat, followed by gradual temperature rise to around 39°C. Extreme mental irritability, even coma and incoherent speech; constipation, urgent and painful lower abdomen, lasting 3-4 days. Mental symptoms gradually disappear only after menstruation ends. This has recurred repeatedly for several months. Pulse is fine, wiry, and rapid. Tongue coating is scant, edges and tip have red prickles. Yin Deficiency with internal heat, Heart and Liver Fire blazing internally, Phlegm-Fire obscuring the clear orifices. Plan to clear the upper and guide downward, using the "drawing wood from under the cauldron" method. *Sheng Dahuang* (Raw Rhubarb) 9g, *Longdan Cao* (Gentianae Radix) 6g, *Hei Shanzhi* (Black Gardenia Fruit) 6g, *Mutong* (Akebiae Caulis) 6g, *Shengdi* (Rehmanniae Radix) 24g, *Xuanshen* (Scrophulariae Radix) 9g, *Maidong* (Ophiopogonis Radix) 6g, *Digupi* (Lycii Cortex) 6g, *Huangqin* (Scutellariae Radix) 6g, *Zhuye* (Phyllostachys Folium) 9g, 7 doses. Second Consultation (October 12): After taking the above prescription, bowel movements became smooth, Heart and Liver Fire were drained from below, feeling mentally relaxed and happy. Before the upcoming menstruation, prevention is crucial. Still adhering to the original intent, assisting with clearing Liver, opening orifices, and distinguishing upper and lower. *Sheng Dahuang* 9g, *Huangqin* 9g, *Mutong* 6g, *Digupi* 9g, *Shengdi* 15g, *Xuanshen* 9g, *Maidong* 6g, *Jiang Banxia* (Ginger-processed Pinellia Tuber) 6g, *Zhi Nanting* (Processed Arisaema Rhizoma) 9g, *Yujin* 6g, *Changpu* (Acori Tatarinowii Rhizoma) 9g, *Mengshi Gun Tan Wan* (Calamine and Phlegm-Rolling Pill) 12g (wrapped and decocted), take 14 doses. Third Consultation (December 28): Last menstrual period October 21. This cycle arrived 7 days late. Clot color was pale and not bright. Before menstruation, mental state was stable. During menstruation, no fever, clear consciousness, like normal person. Heart and Liver Fire have subsided, but slight abdominal distension and pain remain. Pulse still fine and rapid. Tongue coating thin, body red, residual heat not cleared. Should press the advantage. *Zhi Dahuang* (Prepared Rhubarb) 6g, *Huangqin* 6g, *Mutong* 6g, *Digupi* 9g, *Shengdi* 18g, *Maidong* 6g, *Xuanshen* 9g, *Zhi Nanting* 9g, *Yujin* 9g, *Cishi* (Magnetitum) 18g (decoct first), *Mengshi* 18g (decoct first), *Changpu* 9g, 7 doses.
(From *Selected Experiences of Old Shanghai TCM Physicians*, Tang Jifu's Medical Cases, organized by Cao Lingxian)
[Commentary]
Case One: Irregular menstruation, accompanied by dizziness, palpitations, and difficult defecation, caused by Yin Deficiency and Blood Insufficiency failing to nourish the Liver, leading to rising Liver Fire. Mr. Xie emphasized harmonizing the Liver and Stomach. After efficacy, he treated by regulating Chong and Ren meridians, softening the Liver, and nourishing Blood. The case is commendable in herb selection and treatment hierarchy. Especially the use of lemon to descend Qi and harmonize the Stomach while harmonizing Liver and Stomach represents a combination of medicinal and dietary therapy.
Case Two: Retrograde menstruation (also called "Reverse Menstruation"), caused by Qi of the Chong Meridian disturbing upward, with blood following Qi upward. Treated by descending rebellion and calming the Chong, allowing menstruation to follow the correct path. This differs from the usual treatment for retrograde menstruation caused by Liver Meridian Depressed Fire or Yin Deficiency with Lung Dryness.
Case Three: Premenstrual Syndrome. Since one week before menstruation, the patient experiences dizziness and headache, swollen and painful throat, followed by temperature rise, extreme irritability, coma, constipation, etc., with mental symptoms being prominent. Pattern differentiation: Yin Deficiency, blazing Heart and Liver Fire. Phlegm-Heat obscuring the clear orifices. Since symptoms subside after menstruation ends, it differs from external pathogens reversing to invade the Pericardium. Prescribed modified *Zengye Chengqi Tang* (Increase Fluids and Descend Qi Decoction) to nourish Yin, clear heat, clear and transform Phlegm-Fire, clear the upper and guide downward, which is the "drawing wood from under the cauldron" method. The treatment principles remained roughly unchanged across three consultations. Adding *Mengshi Gun Tan Wan* at the second consultation helped strengthen and consolidate efficacy, showing Mr. Tang's flexibility in prescribing.
(VI) Leukorrhea
Case One: Yu XX, Female, 32 years old, porter. First consultation date: May 21, 1975. Patient had taken long-acting contraceptives for one year. Recently, leukorrhea increased and became watery. Poor appetite, bland taste, poor sleep, reduced urine output, bowel movement once every two days, obvious facial pigmentation, pale white tongue, pale lips, deep-slippery-slightly-wiry pulse. Pattern differentiation: Spleen and Kidney Deficiency Leukorrhea. Treatment method: Strengthen Spleen, secure Kidney, astringe and stop leukorrhea. Formula: *Tusizi* (Cuscutae Semen) 25g, *Baizhu* 15g, *Zhi Gancao* (Honey-fried Licorice Root) 10g, *Baishao* 10g, *Haipiaoxiao* (Sepiae Endoconcha) 15g, *Baizhi* (Angelicae Dahuricae Radix) 10g, *Genren Gen* (Tricalybris Root) 30g, 4 doses. Second consultation on May 28: Leukorrhea greatly reduced compared to before, appetite improved, facial pigmentation also reduced, sleep still poor, urine normal, pale red tongue, thin slightly yellow coating, fine-slippery pulse. Medicine effective. Follow method and add *Shouwu* (Polygoni Multiflori Radix) 20g to the above prescription, continue taking 6 doses, then leukorrhea cleared.
(From *Selected Writings of Luo Yuankai*)
Case Two: Wang, Female, 37 years old. Leukorrhea is green, fishy odor, thick and sticky. Head distension, dizziness, bitter taste, hypochondriac pain. Pulse wiry and rapid. Tongue body red, coating yellow and greasy. Syndrome belongs to Damp-Heat/Fire of Liver Meridian pouring downward. Plan to drain Fire of Jueyin and transform Dampness of Bladder. *Longdan Cao* 6g, *Hei Zhi* (Black Gardenia Fruit) 9g, *Chao Baishao* 9g, *Sheng Gancao* 3g, *Huangqin* 4.5g, *Qing Chen Pi* (Green and Aged Tangerine Peel) 3g each, *Fuling* (Poria) 12g, *Mian Yinchén* (Artemisiae Scopariae Herba) 15g, *Chaihu* 4.5g, *Chuan Biexie* (Dioscoreae Hypoglaucae Rhizoma) 9g, *Zhi Bai Jiguanhua* (Roasted White Corpus Christi Flower) 12g. Third Consultation: Leukorrhea not much, occasional hypochondriac pain, wiry pulse, thin yellow coating. Re-plan to soothe Liver and harmonize Ying, simultaneously clearing residual heat. *Chao Chaihu* 4.5g, *Danpi* 4.5g, *Hei Shanzhi* 9g, *Danggui* 9g, *Zhi Cangzhu* (Processed Atractylodis Rhizoma) 4.5g, *Fuling* 12g, *Chao Baishao* 6g, *Gancao* 2.4g, *Bohe Chun Geng* (Pure Mint Stem) 4.5g, *Yujin* 6g, *Zhi Bai Jiguanhua* 12g.
(From *Ye Xichun's Medical Cases*)
Case Three: Wu XX, 35 years old, employee. Accustomed to spicy food, irregular sexual life, leading to daily wasting of flesh. Recently irritable, itchy throat, dry cough, less sleep at night, chaotic dreams, palpitations, startled, red and white leukorrhea, dizziness, sore waist, difficult defecation, dark urine. Tongue body red, coating white and rough. Palpation: Deep-fine pulse at both Chi positions, wiry-rapid pulse at Cun and Guan positions. *Nvzhenzi* (Ligustrum Lucidum Fruit), *Hanliancao* (Ecliptae Herba), *Maidong*, *Yuanzhi* (Polygalae Radix), *Jinyingzi* (Chrysanthemi Fructus) each 9g, *Ejiao* (Donkey-Hide Gelatin), *Fushen* (Poria with Hostwood), *Shengdi*, *Qizi* (Lycii Fructus) each 12g, *Huanglian* (Coptidis Rhizoma) 1.8g, *Lianrou* (Nelumbinis Semen) 15g, *Jizihuang* (Chicken Egg Yolk) 1, 5 doses. Advised to avoid spicy food and abstain from sexual intercourse. Follow-up: Leukorrhea cleared, sleep peaceful, only waist still feels sore. Remove *Huanglian* from above prescription, add *Chuanduan* (Dipsaci Radix) 9g, continue giving 6 doses, all ailments healed.
(Organized by Chen Yuzhou et al.: Introduction to Mr. Zhou Lanruo's Experience in Treating Leukorrhea, Jiangsu Journal of Traditional Chinese Medicine 8:31, 1965)
Case Four: Zhang XX. Liver Dryness and Blood Deficiency, Qi mechanism disorder. Dry retching, belching, and lower abdominal pain. Red and white leukorrhea, food tastes bland. Tongue white and fat. Treat by harmonizing middle and regulating Qi. *Jiao Baizhu* (Scorched Atractylodis Macrocephalae Rhizoma) 9g, *Xuanfuhua* (Inulae Flos) 4.5g, *Sheng Baishao* 9g, *Wei Muxiang* (Baked Aucklandiae Radix) 2.4g, *Yunling* (Poria) 15g, *Dangguishen* 6g, *Sheng Shijueming* (Concha Margaritifera Interior) 18g, *Daizheshi* (Haematitum) 12g, *Lvmeihua* (Green Plum Flower) 3g, *Hou Duzhong* (Eucommiae Cortex) 12g, *Zhuru* (Bamboo Shavings) 4.5g (stir-fried with 0.9g *Chenxiang*), *Juye* (Citrus Leaf) 4.5g, *Chenpi* (Citri Reticulatae Pericarpium) 4.5g, *Foshou* (Citrus Sarcodactylis Fructus) 4.5g.
(Narrated by Wang Zhenyi: Introduction to Mr. Wang Qinsheng's Gynecological Experience, *Shanghai Journal of Traditional Chinese Medicine* 8:21, 1963)
Case Five: Hu XX, 38 years old, married. First Consultation (June 23): Had three births, two miscarriages. Between February 1963 and after the second miscarriage, fever persisted for over four months, ineffective after hospital antibiotic injection. Currently chest tightness, tidal fever, sore waist, limb soreness, fatigue, leukorrhea resembling pus with foul odor, occasionally mixed with red. Diagnosed as Pelvic Inflammatory Disease by examination. Reported that contraception started immediately after this miscarriage. No menstruation for three months, dull lower abdominal pain, vaginal discharge of pus with odor, small amount of blood streaks in white discharge, dry mouth, tidal fever. Pulse fine and rapid. Tongue coating thin yellow. Pattern differentiation: Damp-Heat accumulation internally, Yin Deficiency with Fire Hyperactivity. Treatment method: Nourish Yin and clear heat. Formula: *Xian Shengdi* (Fresh Rehmanniae Radix) 30g, *Hongteng* (Sargentodoxae Caulis) 15g, *Chuanbai* (Phellodendri Chinensis Cortex) 9g, *Zhimu* (Anemarrhenae Rhizoma) 9g, *Gancaoshao* (Tip of Licorice Root) 4.5g, *Huai Shanyao* (Dioscoreae Oppositae Rhizoma) 9g, *Danpi* 9g, *Fuling* 9g, *Shanyurou* (Corni Fructus) 9g, *Chungenpi* (Toosendan Cortex) 12g. Follow-up: Modified above prescription. From end of September to October 15, took for half a month. Tidal fever disappeared, foul leukorrhea reduced, hematuria stopped, abdomen felt lighter, only still felt mentally exhausted, dry and difficult defecation. Plan to strengthen Spleen, secure Kidney, and clear residual pathogens. *Huangqi* (Astragali Radix) 9g, *Baizhu* 6g, *Chenpi* 6g, *Shengdi* 12g, *Tusibing* (Cuscutae Semen Cake) 9g, *Shanyurou* 9g, *Rongrong* (Cynomorii Herba) 9g, *Huangbai* (Phellodendri Cortex) 9g, *Fuling* 9g, *Bai Jin Hua* (Hibiscus Mutabilis Flos) 9g, *Gancaoshao* 4.5g.
(From *Selected Experiences of Old Shanghai TCM Physicians*, Zhu Xiaonan's Medical Cases)
[Commentary]
Leukorrhea has two meanings: one generally refers to gynecological diseases; the other refers to the syndrome of frequently discharging a large amount of viscous liquid from the vagina, as described by Wang Taipu as "continuous discharge from the female private parts." Here, the latter is referred to. Based on different colors, there are various names such as White Leukorrhea, Yellow Leukorrhea, Red Leukorrhea, etc. Common causes include Spleen Deficiency, Liver Depression, Kidney Deficiency, and Damp-Heat.
Case One: Caused by Spleen and Kidney Deficiency. Increased white leukorrhea like water, poor appetite, pale lips and tongue. Treated with strengthening Spleen, securing Kidney, astringing and stopping leukorrhea. Heavy use of *Genren Gen* enhances the astringent effect, which is Mr. Luo's experience herb.
Case Two: Damp-Heat Leukorrhea. Initially treated with modified *Longdan Xiegan Tang* (Gentian Liver-Draining Decoction) to drain fire and transform dampness. Subsequently treated with modified *Danzi Xiaoyao San* to soothe Liver and harmonize Ying, simultaneously clearing residual heat. The formula contains *Bai Jiguanhua*. *Sun Tianren Ji Xiao Fang* states it is good for treating white leukorrhea, which is also Mr. Ye's experience herb.
Case Three: Red Leukorrhea. *Fu Ke Yu Chi* says: "Red leukorrhea is mostly due to persistent Heart Fire, which over time gradually depletes Yin Blood and damages Middle Qi, leading to red discharge." This case also involves irregular sexual life and insufficient Kidney Yin. Thus, the major method is nourishing Yin, cooling blood, clearing Heart, and calming the mind. The treatment was appropriate, and the formula consideration was comprehensive.
Case Five: Red and white leukorrhea, caused by Liver Dryness, Blood Deficiency, and Qi mechanism disorder. Treated primarily by harmonizing middle and regulating Qi, attending to both Qi and Blood. The formula treats leukorrhea and also addresses dry retching, belching, and lower abdominal distension. Treating both root and branch, the formula is flexible.
Case Six: Leukorrhea resembling pus, dull lower abdominal pain, sore waist and limbs, dry mouth, tidal fever. Syndrome belongs to Damp-Heat accumulation internally, Yin Deficiency with Fire Hyperactivity (Western diagnosis: Pelvic Inflammatory Disease). Treated primarily with clearing heat and nourishing Yin, later with strengthening Spleen, securing Kidney, and clearing residual pathogens. For Pelvic Inflammatory Disease of the Damp-Heat type, Mr. Zhu's treatment offers reference.
(VII) Morning Sickness
Case One: Guo XX, Female, adult, married. Medical Record No. 38817 (301 Hospital). First consultation date: June 18, 1959. Currently pregnant one and a half months. Nausea and vomiting started 30 days after missed period. Aggravated for the past four days, unable to eat, vomiting yellow fluid. Dizziness, dry stool, thin greasy tongue coating, slightly yellow and dirty at root, soft-slippery-slightly-rapid pulse. Pattern differentiation: Liver-Stomach Qi Rebellion, Phlegm-Turbidity failing to descend. Treatment method: Harmonize Liver and Stomach, descend Phlegm-Turbidity. Formula: *Beishumi* (Chinese Millet) 12g, *Qing Banxia* (Clear Pinellia Tuber) 9g, 2 doses. Second Consultation on June 20: After admission, still vomiting despite medication. Restless heat in heart, dry and bitter mouth, but prefers hot drinks. Epigastric pain, lower abdominal bearing-down sensation. Tongue coating pale yellow and greasy, slightly dirty at root. Left pulse fine-wiry-rapid, right pulse slippery-rapid. Etiology: Phlegm-Damp obstructing middle, Stomach Turbidity failing to descend. Treatment method: Benefit Qi and warm middle, transform Phlegm and descend turbidity. *Dangshen* (Codonopsis Radix) 3g, *Ganjiang* (Dried Ginger Rhizome) 3g, *Qing Banxia* 3g. Grind these three into powder, take 1.5g morning and evening. Add four drops of *Shengjiangzhi* (Fresh Ginger Juice) before taking, mix well and take slowly. After taking the above medicine, vomiting stopped, all ailments gradually settled, no further medication needed.
(From *Qian Boxuan's Gynecological Medical Cases*)
Case Two: Jiang XX, Female, 31 years old. Outpatient simple medical record. First consultation date: August 21, 1974. Patient amenorrheic for 50 days. Recent nausea, vomiting, anorexia, chest tightness, abdominal distension. Pregnancy test positive. Blood pressure 100/60 mmHg (history of low blood pressure). Tongue tip red, teeth marks on sides. Pulse deep-fine-wiry. Pattern differentiation: Pregnancy Morning Sickness (Spleen-Stomach Weakness, Chong Qi Rebelling Upward). Treatment method: Strengthen Spleen and harmonize Stomach, descend rebellion and stop vomiting. Formula: *Huoxiang* (Pogostemonis Herba) 9g, *Sugeng* (Perillae Caulis) 6g, *Chenpi* 6g, *Sharen* (Amomi Fructus) 4.5g, *Banxia* 6g, *Baizhu* 9g, *Muxiang* 3g, *Shengjiangzhi* (Fresh Ginger Juice) 20 drops. After taking 3 doses of the above prescription, nausea and vomiting stopped, appetite increased, basically cured.
(From *Liu Fengwu's Gynecological Experience*)
[Commentary]
Morning sickness is a common disease during pregnancy. The occurrence of nausea, vomiting, dizziness, and aversion to food smells is due to Stomach failing to descend and Chong Meridian Qi rebelling upward.
Case One: Belongs to Liver-Stomach Qi Rebellion and Phlegm-Turbidity failing to descend. Mr. Qian followed the treatment method of *Neijing*, using *Banxia Shumi Tang* (Pinellia and Coix Seed Decoction) to harmonize Liver and Stomach and descend Phlegm-Turbidity. Given the patient's pale yellow greasy coating, Phlegm-Turbidity obstructing middle, and Yang Qi failing to diffuse, subsequently used *Ganjiang Renshen Banxia Wan* (Ginger, Ginseng, and Pinellia Pill) from *Jinkui Yaolue* (with *Dangshen* replacing *Renshen*, pill form changed to powder) to benefit Qi, warm middle, transform Phlegm, and descend turbidity, achieving efficacy. Analyzing the whole case, pattern differentiation was precise and medication concise. Case Two: Middle Deficiency and Stomach failing to harmonize/descend was the main contradiction. Thus, treatment should strengthen Spleen, harmonize Stomach, descend rebellion, and stop vomiting. Since the original case grasped the main pathology of this disease, its discussion and medication are worthy of emulation.