至四十九而天癸绝，其所绝者天癸水也，其流行之血不见其亏，故不须四物汤补血，补血兼不得滋水，滋
水必兼补血，故必以六味丸滋水。何也？盖血乃后天饮食入胃，游溢精气而成，以为流行之用。若经水乃
冲任所主，人身中有奇经八脉，俱属肾经无形之脉，其冲任者，奇经之二，其脉起于胞中，为经脉之海，
与手太阳、手少阴为表里，上为乳汁，下为月水，女人独禀此水以为生生之原，与男子二八之精同气，从
天一之源而来，精则一月而满，满则溢，似血实非血也。
冲任起于胞中，男于藏精，女子系胞，其间又恃一点命门之火为之主宰。火旺则红，火衰则淡，火
太旺则紫，火太衰则白。所以，滋水更当养火，甚有干涸不通者，虽曰火盛之极，亦不宜以苦寒之药降
火，只宜大补其水──天一之原。以养之使满，满则溢，万无有毒药可通之理！此调经之法类如此。
凡血崩之疾当分阴阳而治，气血人身之阴阳也。阳主升，阴主降，阳根阴，阴根阳，一升一降，
循经而行，无崩漏也。若阳有余则升者胜，血出上窍；阳不足则降者胜，血出下窍。总之血随阳气而升降，阳
气者风也，风能上升，然必须东方之温风始能升，故用助风益气。凡气虚不能摄血而崩者，其人必面白、
尺脉虚大、食饮无味，久病者有之。
崩漏，有血虚，有惊忧，有怒气，有热搏，有劳伤。经血忽下者，名曰崩漏。其为病，须审腹痛、
腹不痛。如腹痛，当分虚实之异，缓急之殊，若淤血者，体必作寒；空痛者，少腹喜按也。淤血则当去，
空痛则当补。缓则治其本，急则治其标。经曰∶崩中日久为白带，漏若多时骨髓枯。脉小虚滑可治，急疾
紧数难痊。凡治崩漏，宜大补气血与养脾胃，微加镇逐心火之药以治之，补阴泻阳其患自愈矣。
经水妄行及血崩不止，宜黄柏散，或凉血地黄丸。
【黄柏散】地黄 柏叶 黄芩 蒲黄 当归 艾叶 伏龙肝 干姜
因热崩下者，宜胶艾四物汤加黄芩，或黄连解毒汤加艾叶。
【黄连解毒汤】黄连 栀子 黄芩 黄柏
崩漏纯血，乃脾弱气逆也。如身热，宜当归芍药汤。
【当归芍药汤】当归 白芍 陈皮 甘草 黄 白术 柴胡 苍术
若崩而脉紧无力，脐下如冰，白滑间有如屋漏水者，宜胶艾汤加青皮、炮姜炭、蒲黄、黄 ，或丁香胶艾汤。
【丁香胶艾汤】丁香 阿胶 艾叶 四物汤
若气血俱虚，以四物汤加人参、黄 ，或平补散，或大温经汤，治之即愈。
【平补散】阿胶 椿树花 熟地 川芎 艾叶 蒲黄 白芍 当归 地榆
若因气虚而下，宜四物加参、 、白术、升麻、蒲黄、香附。
若崩中过极，心神恍惚，宜茯苓补心汤。
【茯苓补心汤】人参 熟地 当归 白芍 茯苓 紫苏 川芎
用米饮汤煎服。
若崩漏连日不止，宜荆芥散、如圣散、黄柏
散、立效散，或四物汤加黄芩、荆芥，或胶艾四物汤加黄芩、槐花。若少腹刺痛，艾煎丸主之。
【荆芥散】荆芥
用麻油少许以灯草燃灯，烧荆芥焦色为末，童便调服。
【如圣散】棕榈 干姜 乌梅
并烧炭存性，用乌梅酒调下。
【立效散】当归 莲蓬壳 红花 茅花 白棉花
用白棉纸包好，以火 之存性为末，开水送下。
若崩漏昼夜不止，或经年不愈，诸药不效，急则治其标，宜白芷、香附、百草霜；缓则治其本，宜
四物汤加芩、连、参、 、姜、附，又四物汤加荆芥、黄芩止血尤效，或香附、莲房灰、米饮汤送下，
或以十灰丸，或以五灵脂烧存性为末，乌梅汤下。
【十灰丸】黄绢 艾叶 莲房 棕榈 马尾 蒲黄 油发 绵 藕节 赤松皮
上十味各烧存性为末，醋糊为丸，米饮汤下。
肾虚不能镇守相火，如暴崩、下血不止腹不痛者，宜服凉血地黄汤，或八物汤内加芩、连。
因内伤所致，腹不痛者，宜凉血地黄汤；如腹痛者，宜大剂四物汤治之，后用补宫汤。
【补宫汤】当归 熟地 阿胶 艾叶 川芎 白芍 地榆 白术 甘草
老年血崩腹不痛者，宜八物汤加芩、连、柏叶，此乃急则救标之意，必当先理脾胃为主。
若少年血崩腹痛，实者多，虚者少，虽崩，当服四乌汤。
若年高血崩腹痛，有余者少，不足者多，虽痛，宜眼十全大补汤。
By the age of forty-nine, Tian Gui (Heavenly Water, referring to reproductive essence/fluids) ceases. What ceases is the water of Tian Gui; the circulating blood does not appear to be deficient, therefore there is no need to use Siwu Tang (Four Substances Decoction) to tonify blood. Tonifying blood without simultaneously nourishing Kidney Water is ineffective; since nourishing Water inherently involves tonifying Blood, one must necessarily use Liuwei Wan (Six-Ingredient Pill with Rehmannia) to nourish Water. Why? Because Blood is formed from post-heaven dietary intake entering the Stomach, where its essence and qi are diffused and circulated for bodily use. However, menstrual blood is governed by the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel). The human body possesses eight extraordinary vessels, all belonging to the invisible meridians of the Kidney channel. Among them, the Chong and Ren vessels are two of these extraordinary vessels; their meridians originate in the Bao Zhong (uterus/womb), serving as the Sea of Meridians, and are exterior-interior related to the Hand-Taiyang Small Intestine Meridian and Hand-Shaoyin Heart Meridian. Upward they transform into milk, downward into menstruation. Women alone possess this water as the origin of life, sharing the same qi as the essence generated in men at the age of sixteen (two times eight years), originating from Tian Yi (One from Heaven, the primordial source). Essence fills monthly and overflows when full; it resembles blood but is not ordinary blood.
The Chong and Ren vessels originate in the Bao Zhong; in men, it stores essence, and in women, it connects to the uterus. Within this space, a spark of Fire from the Mingmen (Gate of Life) serves as the master. If Fire is vigorous, the color is red; if Fire is weak, the color is pale; if Fire is excessively vigorous, the color is purple; if Fire is excessively weak, the color is white. Therefore, when nourishing Water, one must also nurture Fire. In cases of extreme dryness leading to obstruction, although it may seem like extreme Fire excess, bitter-cold herbs should not be used to purge Fire. Instead, one should greatly tonify the original Water—the source of Tian Yi. By nourishing it until it is full, it will overflow naturally; there is absolutely no rationale for using toxic drugs to force patency! This is generally how methods for regulating menstruation work.
For diseases of metrorrhagia (profuse uterine bleeding), treatment must distinguish between Yin and Yang. Qi and Blood represent the Yin and Yang of the human body. Yang governs ascending, Yin governs descending; Yang roots in Yin, and Yin roots in Yang. Ascending and descending follow the meridians, preventing metrorrhagia and leukorrhea. If Yang is excessive, the ascending force prevails, and blood exits from upper orifices; if Yang is insufficient, the descending force prevails, and blood exits from lower orifices. In summary, Blood rises and falls following Yang Qi. Yang Qi is like wind; wind can ascend, but only the warm wind from the East can truly ascend. Thus, one should use herbs that assist wind and benefit Qi. For those whose Qi deficiency fails to control Blood causing metrorrhagia, the patient typically presents with a pale complexion, a large and empty Chi pulse (Kidney pulse), and lack of taste in food and drink, often seen in chronic illnesses.
Metrorrhagia and metrostaxis (spotting) arise from Blood deficiency, fright/worry, anger, heat binding, or劳伤 (labor injury/overexertion). Sudden profuse discharge of menstrual blood is called Metrorrhagia/Metrostaxis. Diagnosis requires examining whether there is abdominal pain or not. If there is abdominal pain, one must differentiate between deficiency and excess, and urgency versus slowness. If caused by Blood stasis, the body will feel cold; if it is an empty pain, the lower abdomen prefers pressure. Blood stasis should be dispelled; empty pain should be tonified. In slow cases, treat the root; in urgent cases, treat the branch. The Classics state: "Metrorrhagia lasting long turns into leukorrhea; metrostaxis lasting long causes marrow depletion." A pulse that is small, deficient, and slippery indicates curability; a pulse that is rapid, tight, and wiry indicates difficulty in recovery. Generally, treating metrorrhagia/metrostaxis requires greatly tonifying Qi and Blood while nourishing the Spleen and Stomach, slightly adding herbs to calm and subdue Heart Fire. Nourishing Yin and purging Yang will lead to spontaneous healing.
For erratic menstruation and continuous metrorrhagia, Huangbai San (Phellodendron Powder) or Liangxue Dihuang Wan (Cooling Blood Rehmannia Pill) are suitable.
[Huangbai San] Shu Di Huang (Rehmanniae Radix Preparata), Ce Bai Ye (Biota Top Leaf), Huang Qin (Scutellariae Radix), Pu Huang (Typhae Pollen), Dang Gui (Angelicae Sinensis Radix), Ai Ye (Artemisiae Argyi Folium), Fu Long Gan (Caulis Argillae Ustae), Gan Jiang (Zingiberis Rhizoma Preparatum).
For metrorrhagia due to Heat, Jiao'ai Siwu Tang (Donkey-hide Gelatin and Four Substances Decoction) added with Huang Qin, or Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) added with Ai Ye, is suitable.
[Huanglian Jiedu Tang] Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex).
Pure blood in metrorrhagia/metrostaxis indicates Spleen weakness and rebellious Qi. If accompanied by fever, Danggui Shaoyao Tang (Angelica and Peony Decoction) is suitable.
[Danggui Shaoyao Tang] Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chai Hu (Bupleuri Radix), Cang Zhu (Atractylodis Rhizoma).
If metrorrhagia presents with a tight yet powerless pulse, a sensation of ice below the umbilicus, and clear, slippery leukorrhea resembling dripping roof water, Jiao'ai Tang (Donkey-hide Gelatin Decoction) added with Qing Pi (Citri Reticulatae Pericarpium Viride), Pao Jiang Tan (Carbonized Zingiberis Rhizoma), Pu Huang (Typhae Pollen), and Huang Qi (Astragali Radix), or Dingxiang Jiao'ai Tang (Clove and Donkey-hide Gelatin Decoction), is suitable.
[Dingxiang Jiao'ai Tang] Ding Xiang (Caryophylli Flos), E Jiao (Asini Corii Colla), Ai Ye (Artemisiae Argyi Folium), Siwu Tang (Four Substances Decoction).
If both Qi and Blood are deficient, Siwu Tang added with Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix), or Pingbu San (Balanced Tonification Powder), or Da Wenjing Tang (Great Warming of the Menses Decoction), can be used for cure.
[Pingbu San] E Jiao (Asini Corii Colla), Chunshuhua (Toonae Flor), Shu Di Huang (Rehmanniae Radix Preparata), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Ai Ye (Artemisiae Argyi Folium), Pu Huang (Typhae Pollen), Bai Shao (Paeoniae Radix Alba), Dang Gui (Angelicae Sinensis Radix), Di Yu (Sanguisorbae Radix).
If bleeding occurs due to Qi deficiency, Siwu Tang added with Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Sheng Ma (Cimicifugae Rhizoma), Pu Huang (Typhae Pollen), and Xiang Fu (Cyperi Rhizoma) is suitable.
If metrorrhagia is extremely severe, causing mental confusion and vagueness, Fuling Buxin Tang (Poria and Heart-Nourishing Decoction) is suitable.
[Fuling Buxin Tang] Ren Shen (Ginseng Radix), Shu Di Huang (Rehmanniae Radix Preparata), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Fu Ling (Poria), Zi Su (Perillae Folium), Chuan Xiong (Ligustici Chuanxiong Rhizoma).
Decoct and take with Mi Yin Tang (Rice Drink).
If metrorrhagia/metrostaxis continues for days without cessation, Jingjie San (Schizonepeta Powder), Rusheng San (Like-Sage Powder), Huangbai San (Phellodendron Powder), Lixiao San (Instant Effect Powder), or Siwu Tang added with Huang Qin (Scutellariae Radix) and Jing Jie (Schizonepetae Herba), or Jiao'ai Siwu Tang added with Huang Qin (Scutellariae Radix) and Huai Hua (Sophorae Flos), are suitable. If there is stabbing pain in the lower abdomen, Ai Jian Wan (Moxa Decoction Pill) is indicated.
[Jingjie San] Jing Jie (Schizonepetae Herba).
Burn Jing Jjie to charcoal using a lamp wick dipped in a little sesame oil, grind into powder, and take with Tongbian (Child's Urine).
[Rusheng San] Zonglv (Palmae Cum Ramulis et Folii), Gan Jiang (Zingiberis Rhizoma Preparatum), Wu Mei (Mume Fructus).
Charcoalize all ingredients preserving their nature, and take with Wu Mei Jiu (Mume Wine).
[Lixiao San] Dang Gui (Angelicae Sinensis Radix), Lianpengke (Nelumbinis Pistillum), Hong Hua (Carthami Flos), Maohua (Imperatae Flor), Baianhua (Gossypii Herba).
Wrap in white cotton paper, roast/fire-treat to preserve nature, grind into powder, and take with boiling water.
If metrorrhagia/metrostaxis persists day and night, or lasts for years unresponsive to various medicines, treat the branch urgently with Baizhi (Angelicae Dahuricae Radix), Xiang Fu (Cyperi Rhizoma), and Baicaoshuang (Carbonized Herb Ash); treat the root slowly with Siwu Tang added with Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Gan Jiang (Zingiberis Rhizoma Preparatum), and Fu Zi (Aconiti Lateralis Radix Preparata). Alternatively, Siwu Tang added with Jing Jie (Schizonepetae Herba) and Huang Qin (Scutellariae Radix) stops bleeding effectively; or take Xiang Fu (Cyperi Rhizoma), Lianfang Hui (Ash of Lotus Pod), and Mi Yin Tang (Rice Drink). Or use Shihui Wan (Ten Ashes Pill), or burn Lingzhi (Trogopterori Faeces) to preserve nature, grind into powder, and take with Wu Mei Tang (Mume Decoction).
[Shihui Wan] Huang Juan (Yellow Silk), Ai Ye (Artemisiae Argyi Folium), Lianfang (Nelumbinis Pistillum), Zonglv (Palmae Cum Ramulis et Folii), Mawei (Equi Cauda Pilus), Pu Huang (Typhae Pollen), Youfa (Carbonized Human Hair), Mian (Cotton), Ou Jie (Nelumbinis Rhizomatis Node), Chisongpi (Pinus Massoniana Cortex).
Charcoalize each of the ten ingredients, preserve nature, grind into powder, make pills with Vinegar Paste, and take with Rice Drink.
If Kidney Deficiency fails to anchor Minister Fire, presenting as sudden violent metrorrhagia with continuous bleeding but no abdominal pain, Liangxue Dihuang Tang (Cooling Blood Rehmannia Decoction) or Babaw Tang (Eight Substance Decoction) added with Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma) is suitable.
If caused by internal injury with no abdominal pain, Liangxue Dihuang Tang (Cooling Blood Rehmannia Decoction) is suitable; if there is abdominal pain, Da Ji Siwu Tang (Large Dose Four Substances Decoction) is suitable, followed by Bugong Tang (Uterus-Nourishing Decoction).
[Bugong Tang] Dang Gui (Angelicae Sinensis Radix), Shu Di Huang (Rehmanniae Radix Preparata), E Jiao (Asini Corii Colla), Ai Ye (Artemisiae Argyi Folium), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Shao (Paeoniae Radix Alba), Di Yu (Sanguisorbae Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma).
For elderly patients with metrorrhagia and no abdominal pain, Babaw Tang (Eight Substance Decoction) added with Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Ce Bai Ye (Biota Top Leaf) is suitable. This addresses the urgent branch symptoms; however, regulating the Spleen and Stomach must be the primary focus.
For young patients with metrorrhagia and abdominal pain, Excess patterns are more common than Deficiency. Even with bleeding, Siwu Tang (Four Substances Decoction) should be taken.
For elderly patients with metrorrhagia and abdominal pain, Deficiency patterns are more common than Excess. Even with pain, Shiquan Dabu Tang (Complete Great Tonification Decoction) should be taken.