（论一首脉证合十四条方十四首）
妇人中风。七八日续来寒热。发作有时。经水适断。此为热入血室。其血必结。故使
如疟状。发作有时。小柴胡汤主之。
〔衍义〕此下四条。皆出伤寒论中。成注。七八日邪气入里之时。本无寒热而续得
寒热。经水适断者。为表邪乘虚入于血室。相搏而血结不行。经水所以断也。血
气与邪分争。致寒热如疟。而发作有时。与小柴胡以解传经之邪。
妇人伤寒发热。经水适来。昼日明了。暮则谵语。如见鬼状者。此为热入血室。治之
无犯胃气及上二焦必自愈。
〔衍义〕成注。伤寒发热者。寒已成热也。经水适来。则血室空虚。热乘虚入血室。若邪入胃。邪客于腑而争也。
暮则谵语。如见鬼状。是邪不入腑。
入于血室。而阴争也。阳盛谵语则宜下。此热入血室。不可与下药。犯其胃气。热入血室。血结寒热者。与小
柴胡汤。散邪发汗。热入血室。胸膈满。如结胸状者。可刺期门穴。此虽入而无满结。故不可刺。必自愈者。
以经行则热随血去。血下已。则邪热悉除而愈矣。发汗为犯上焦者。发汗则动卫气。卫气出上焦也。刺期门为
犯中焦者。刺期门则动荣气。荣气出中焦也。
妇人中风。发热恶寒。经水适来。得之七八日。热除脉迟。身凉和。胸胁满如结胸状。谵语者。此为热入
血室也。当刺期门。随其实而泻之。
〔衍义〕中风发热恶寒。表病也。若经水不来。表邪传里则入腑。而不入血室也。经水适来。血室空虚。至
七八日。邪传里之时。更不入腑。乘虚而入于血室。热除脉迟。身凉者。邪气内陷。而表证罢也。胸胁下满。如
结胸状。谵语者。热入血室而里实。期门者。肝之幕。肝主血。刺期门者。泻血室之热。审何经气实。更随其实
而泻之。
阳明病。下血谵语者。此为热入血室。但头汗出。当刺期门。随其实而泻之。 然汗出则愈。
〔衍义〕阳明病。热入血室。迫血下行。下血谵语。阳明法当汗。以夺血者无汗。故但头汗出也。刺期门以散血室
之
热。随其实而泻之。以除阳明之邪。热散邪除。荣卫得通。津液得复。 然汗出而解。明理论。冲是血室。妇人则随经
而入。男子由阳明而传也。
妇人咽中痛。如有炙脔。半夏浓朴汤主之。
半夏浓朴汤方 千金作胸满。心下坚。咽中帖帖如有炙肉。吐之不出。吞之不下。
半夏（一升） 浓朴（三两） 茯苓（四两） 生姜（五两） 苏叶（二两）
上五味。以水七升。煮取四升。分温四服。日三服。夜一服。
〔衍义〕上焦阳也。卫气所治。贵通利而恶闭郁。郁则津液不行而积为涎。胆以咽为使。胆主决断。气属相火。
遇七情至而不决。则火亦郁而不发。不发则焰不达。
不达则气如咽。与痰涎结聚胸中。故若炙脔。千金之病证虽异。然亦以此而致
也。用半夏等药。散郁化痰而已。
妇人脏燥。（一作躁）喜悲伤欲哭。象如神灵所作。数欠伸。甘麦大枣汤主之。
甘麦大枣汤方
甘草（三两） 小麦（一升） 大枣（十枚）
上三味。以水六升。煮取三升。分温三服。亦补脾气。
〔衍义〕内经以肺之声为哭。又曰。并于肺则悲。灵枢曰。悲哀动中则伤魂。此证因
肝虚肺并。伤其魂而然也。盖肝阳脏也。肺阴脏也。阳舒而阴惨。肝木发生之气。
不胜肃杀之邪。并之。屈而不胜。生化之火被抑。扰乱于下。故发为脏躁。变为悲
哭。所藏之魂。不得并神出入。遂致妄乱。象如神凭。木气被抑而不前。筋骨拘束
而不舒。故数作欠伸。然治相并之邪。必安之和之。用小麦养肝气止躁。甘草、大
枣之甘。以缓气之苦急。躁止急缓。则脏安而悲哭愈。然又曰亦补脾气者。乃肝
病先实脾。不惟畏其传。且脾实而肺得母气以安。庶不离位过中而复下并矣。
妇人吐涎沫。医反下之。心下痞满。当先治其吐涎沫。小青龙汤主之。涎沫止。乃治
痞。泻心汤主之。
〔衍义〕伤寒论表不解。心下有水气者。用小青龙汤解表散水也。又曰表未解。医
反下之。阳邪内陷。实则结胸。虚则心下痞。由此观之。吐涎沫者。盖由水气之为
病。因反下之为痞。吐涎沫仍在。故先以小青龙治涎沫。然后以泻心汤除心下之热痞也。
妇人之病。因虚积冷结气。为诸经水断绝。至有历年。血寒。积结胞门。寒伤经络。凝坚在上。呕吐涎唾。久成肺
痈。形体损分。在中盘结。绕脐寒疝。或两胁疼痛。与脏相连或结热中。痛在关元。脉数无疮。肌若鱼鳞。时着男
子。非只女身。在下来多。经候不匀。令阴掣痛。少腹恶寒。或引腰脊。下根气街。气冲急痛。膝胫疼烦。奄忽眩
冒。状如厥癫。或有忧惨。悲伤多嗔。此皆带下。非有鬼神。久则羸瘦。脉虚多寒。三十六病。千变万端。审脉阴
阳虚
实紧弦。行其针药。治危得安。其虽同病。脉各异源。子当辨记。勿谓不然。
〔衍义〕阴阳之运动。有上下。有中外。有归宿。有倡顺。得其道。则变化万象。各司其
用。若乖其宜。则随所适而为病。然二者之病。则以阳为主。由阳主动用以施化
者也。而阴者惟虚其体以受之生育而已。若夫邪气在阴。则凝结坚实。实则阳
不得入而施化。致生诸病不可穷已。仲景叙是数证。冷积下焦。以见变易无穷
也。所谓经水断绝。胞门寒伤。令阴掣痛。少腹恶寒。或引腰脊。下根气街。气冲急
痛。膝胫疼烦。皆由阴结下焦。阳不得入。随所着冲任之脉而为病也。呕吐涎沫。
久成肺痈者。必阴结在少阴经。其经上连于肺。水因溢上为涎沫。久迫上焦之
阳。蓄以成肺痈也。绕脐寒疝。或两胁疼痛。与脏相连者。脐在人身正中面。四脏
应之。其四脏则应于上下左右。盖是生气所出之原。五脏皆于此受之。今为冷
邪凝结。生发之气绝少。正邪相击而作寒疝。脐间冷结。连及两胁。少阳发生之
分。并为疼痛。故曰与脏相连也。或结热中。病在关元者。乃小肠火之幕也。足三
阴任脉之所会。足三阴任脉。尽为积冷于小肠。火气不折。为郁热在中。冷热相
搏。故痛在关元。脉数无疮。肌若鱼鳞者。阴不化血。无以输化生肌。滋润于外。徒
是孤阳行脉。燥消皮毛耳。奄然眩冒。状如厥癫者。冲任督阴跷之脉波突而逆。
阳乱于上。所以如尸厥癫痫。或忧惨悲伤。倘多嗔者。此在下肾肝脏阴结。而阳
不得入。精泄不固。下泄为带。魂不舒。志不宁故耳。非鬼神使之也。阴由冷积。荣
血内结。不与卫和。内外成病。求之于阴阳交变之道。不可一言而尽。仲景叙其
证。复叙为三十六病。千变万端。同脉异证。恐后人胶柱鼓瑟。而不由于阴阳变易之道也。
问曰。妇人年五十所。病下利。数十日不止。暮即发热。少腹里急。腹满。手掌烦热。唇
口干燥。何也。师曰。此病属带下。何以故。曾经半产。瘀血在少腹不去。何以知之。其
证唇口干燥。故知之。当以温经汤主之。
温经汤方
吴茱萸（三两） 当归 芎 芍药 桂枝 人参 阿胶 生姜
丹皮 甘草（各二两） 半夏（半升） 麦冬（一升去心）
上十二味。以水一斗。煮取三升。分温三服。亦止妇人少腹寒。久不受胎。兼治
崩中去血。或月水来过多。及至期不来。
〔衍义〕下利不止。病属带下。何也。妇人二七天癸至。任脉通。太冲脉盛。月事以时
下。七七太冲脉衰。天癸竭。地道不通。经水遂止。今年五十。经绝。胞门闭塞。冲任
脉不复。输泄之时。所积于血。自胞门化为带下。无所从出。大便属阴。故就大便
而下利矣。考大全良方集。是方出千金。治女人曾经小产。或带下三十六病。以
或字分为二。金匮以带下属半产瘀血。岂带下三十六病。无湿热之实邪。而尽
属于瘀血虚寒哉。盖为带脉居身形之半。凡十二经络并奇经八脉。各挟寒热
之邪。过而伤之。动其冲任。则气血为之不化。心肾为之不交。变成赤白漏下。治
之必察始感何邪。何经受害。为虚为发何状。脉见何象。令在寒暑随宜。以权变
治之可也。岂概云三十六病。尽切是方乎。终不若仲景之有原委。而可为后世
法也。盖小产是胞脉已虚。不能生新推陈。致血瘀积在下。而生发之气。起于下
焦。固藏之政。亦司下焦。下焦瘀积在下。而既结于阴。则上焦之阳不入矣。遂成
少腹里急。腹满。四藏失政。则五液时下。其阳至暮。当行于阴而不得入。独浮于
上。为发热。为掌上热。为唇口干燥。故必开痹破阴结。引阳行下。皆吴茱萸主之。
益新推陈。又芎归为臣。丹皮佐之。然推陈药固多。独用丹皮者。易老谓其能治
神志不足。血积胞中。心肾不交。非直达其处者。不能通其神志之气。用半夏以
解寒热之结。阿胶、人参补气血之不足。麦冬助丹皮。引心气入阴。又治客热唇
口干燥。桂枝、生姜发达生化之气。甘草益元气。和诸药。妇人小腹寒不受胎者。
崩中去血。皆因虚寒结阴而阳不得入耳。尽可治之。设有脉沉数。而阳乘阴者。
亦为带下不成孕。崩中去血等证。又乌可用是治之。必须脉辨也。
带下经水不利。少腹满痛。经一月再见者。土瓜根散主之。
土瓜根散方 阴 肿亦治之。
土瓜根 芍药 桂枝 虫（各二两）
上四味。杵为散。酒服方寸匕。日三服。
〔衍义〕此亦因瘀血而病者。经水即不利。一月再见之不同。皆冲任瘀血之病。土
瓜根者。能通月水。消瘀血。生津液。津生则化血也。芍药主邪气腹痛。除血痹。开
阴寒。桂枝通血脉。引阳气。 虫破血积。以消行之。非独血积冲任者有是证。肝
藏血。主化生之气。与冲任同病。而脉循阴器。任督脉亦结阴下。故皆用是汤治
之。 肿非惟男子之睾丸。妇人之阴户亦有之。多在产时瘀血。流入作痛。下坠出户也。
寸口脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。寒虚相搏。此名曰革。妇
人则半产漏下。旋复花汤主之。（方见十一卷）
〔衍义〕本文之注见前方药。本草谓旋复花主结气。胁下满。通血脉。去脏家热。葱
管亦主寒热。安胎。除肝邪。且更能主血。新绛疑是绯帛也。凡系帛皆理血。血色
红。用绛尤切于活血。肝为藏血。主生化。故冲任之脉成月事。及胞胎者。皆统属
之。三味入肝理血。除邪散结。岂非以气阳也。血阴也。气少则无阳。无阳则寒。血
虚则无阴。无阴则热。两虚相搏。以害其肝之生化欤。所以用是汤。先解其结聚
之邪也。而温补其虚寒者。必另有法矣。
妇人陷经漏下黑不解。胶姜汤注之。（方缺）
〔衍义〕气倡而血从。则百脉流动。以候其天癸。苛有邪以阻之。则血不从其气而
自陷于血海。血海者。肾主之。肾寒水也。色黑。是以漏下黑矣。犹内经所云结阴
下血也。方虽不全见。胶艾二物亦足治之。艾火皮肤灸之。尚能内入。况服之而
不自阳引入于阴乎。姜以散其阴。开通腠理。致津液行气也。
妇人少腹满如敦状。小便微难而不渴。生（恐是经字）后者。此为水与血俱结在血室也。
大黄甘遂汤主之。
大黄甘遂汤方
大黄（四两） 甘遂（二两） 阿胶（二两）
上三味。以水三升。煮取一升。顿服之。其血当下。
〔衍义〕内经谓水入经。其血乃成。则血由水化。今乃言血与水并何哉。尝思水有
清浊。清则入经化血。浊则为溺为唾。苟因气之浊乱者入之。则不能化血而为
血害。其清者。初虽为水而色白。至于坎离之变。从火化而变赤。如月之禀日光
为盈亏。与阳随动。流转上下。行诸经脉。与水性异矣。水性惟能润下。苟下流不
通。必注于泽。所以水失其道。入于肌表者。作身肿。入于筋骨者。作肢节肿。此入
于血室。故作少腹如敦状。然血室虽与膀胱异道。膀胱是行水之府。水蓄血室。
气有相感也。故膀胱之气亦不化。而小便微难矣。若小便自如而少腹如敦者。
则不谓之水并。当是他邪血积可知矣。用甘遂取其直达水停之处。大黄荡瘀
血。阿胶引为血室向导。且补其不足也。
妇入经水不利下。抵当汤主之。
抵当汤方（亦治男子膀胱满急有瘀血者）
水蛭（三十个熬） 虻虫（三十枚熬去翅足） 桃仁（二十个去皮尖） 大黄（三两酒浸）
上四味。为末。以水五升。煮取三升。去滓。温服一升。
〔衍义〕伤寒论阳明证。其人喜忘者。必有蓄血。大便黑色。抵当汤主之。发热下之
不解。六七日不大便者。有瘀血。亦宜是汤。伤寒有热。少腹满。应小便不利。今反利者。为有血也。宜抵当丸。三者
有病状而后立方。今只云经水不利下。岂遂血
蓄不通而非虚损耶。此必有蓄血情状。而出是方也。
妇人经水闭不利。脏坚癖不止。中有干血。下白物。矾石丸主之。
矾石丸方
矾石（三分烧） 杏仁（一分）
上二味。末之。炼蜜和丸。如枣核大。五内中。剧者再内之。
〔衍义〕子宫血积。不与气和。故新血不至。遂成干血。坚癖外连于户。津液不行。化
(One treatise, fourteen pulse-syndrome combinations, fourteen prescriptions)
A woman contracts Wind-Strike. After seven or eight days, alternating chills and fever recur, occurring at fixed times, and her menses happen to cease. This is Heat entering the Blood Chamber (uterus and Chong/Ren vessels), causing blood coagulation. Therefore, symptoms resembling malaria occur, with fixed timing. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
[Commentary] The following four clauses are all from the *Shanghan Lun* (Treatise on Cold Damage). Cheng Wuji's commentary: Seven or eight days is the time when pathogenic factors enter the interior. Originally there were no chills and fever, but now they persist. The cessation of menses occurs because exterior pathogens, taking advantage of deficiency, enter the Blood Chamber, contend with the blood, causing stagnation and obstruction, hence the cessation of menses. The struggle between blood/qi and pathogens leads to chills and fever resembling malaria, with fixed timing. Xiao Chai Hu Tang is given to resolve the transmitted pathogenic factors.
A woman contracts Cold Damage with fever, and her menses happen to begin. During the day she is lucid, but in the evening she experiences delirium, seeing things as if ghosts were present. This is Heat entering the Blood Chamber. Treatment should not damage the Stomach Qi, nor attack the Upper and Middle Jiao; the disease will likely resolve spontaneously.
[Commentary] Cheng Wuji's commentary: Cold Damage with fever indicates that Cold has transformed into Heat. With menses beginning, the Blood Chamber is empty, allowing Heat to enter vacuously. If pathogens enter the Stomach/Fu organs, contention occurs between pathogen and healthy qi. Evening delirium and hallucinations indicate pathogens have not entered the Fu organs but have entered the Blood Chamber, contending with Yin blood. Delirium due to Yang excess is suitable for purgation, but this is Heat entering the Blood Chamber; purgatives must not be used, as they would damage Stomach Qi. For Heat entering the Blood Chamber causing blood coagulation and alternating chills/fever, Xiao Chai Hu Tang disperses pathogens and induces sweating. For Heat entering the Blood Chamber causing chest/diaphragm fullness resembling Chest Bind (Jie Xiong), Qimen (LR14) acupuncture may be used. Here, although pathogens have entered, there is no fullness/coagulation, so acupuncture is contraindicated. "Spontaneous resolution" occurs because flowing menses carry Heat away with the blood; once menstruation ceases, pathogenic Heat is eliminated. Inducing sweat attacks the Upper Jiao, disturbing Wei Qi (Defensive Qi), which originates from the Upper Jiao. Needling Qimen attacks the Middle Jiao, disturbing Ying Qi (Nutritive Qi), which originates from the Middle Jiao.
A woman contracts Wind-Strike with fever and aversion to cold, and her menses happen to begin. After seven or eight days, the fever subsides, pulse becomes slow, body temperature normalizes, yet she has chest/hypochondriac fullness resembling Chest Bind and delirium. This is Heat entering the Blood Chamber. Qimen (LR14) should be needled, applying draining methods according to the excess patterns involved.
[Commentary] Wind-Strike with fever and aversion to cold is an exterior syndrome. If menses do not occur, exterior pathogens transmit inward to the Fu organs, not the Blood Chamber. With menses beginning, the Blood Chamber is empty. By day seven or eight, when pathogens transmit inward, they bypass the Fu organs and enter the Blood Chamber vacuously. Fever subsiding, pulse slowing, and body cooling indicate pathogens sinking inward and exterior signs resolving. Hypochondriac fullness, resemblance to Chest Bind, and delirium indicate interior excess from Heat entering the Blood Chamber. Qimen is the Front-Mu point of the Liver; the Liver stores blood. Needling Qimen drains Heat from the Blood Chamber. Identify which meridian exhibits excess and drain accordingly.
Yang Ming disease presenting with hematochezia and delirium is Heat entering the Blood Chamber. Only head sweating occurs. Qimen (LR14) should be needled, applying draining methods according to excess patterns. Generalized sweating indicates recovery.
[Commentary] In Yang Ming disease, Heat enters the Blood Chamber, forcing blood downward, causing hematochezia and delirium. Yang Ming typically requires diaphoresis, but blood loss precludes sweating, hence only head sweating. Needling Qimen disperses Heat in the Blood Chamber and drains excess to remove Yang Ming pathogens. Once Heat dissipates and pathogens are removed, Ying and Wei Qi circulate freely, fluids restore, and generalized sweating resolves the condition. *Ming Li Lun* states: The Chong Mai is the Blood Chamber; in women, pathogens enter via meridians, while in men, they transmit via Yang Ming.
A woman complains of throat pain, feeling as if a roasted meat slice is lodged there. Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) is the primary treatment.
Ban Xia Hou Po Tang Formula (Qian Jin Fang records: chest fullness, epigastric hardness, throat discomfort as if holding roasted meat, unable to spit out or swallow down.)
Ban Xia (Pinelliae Rhizoma) - 1 sheng
Hou Po (Magnoliae Officinalis Cortex) - 3 liang
Fu Ling (Poria) - 4 liang
Sheng Jiang (Zingiberis Recens Rhizoma) - 5 liang
Su Ye (Perillae Folium) - 2 liang
The above five herbs are boiled in 7 sheng of water to yield 4 sheng. Divide into four warm doses: three during the day, one at night.
[Commentary] The Upper Jiao is Yang, governed by Wei Qi, favoring free flow and disliking stagnation. Stagnation prevents fluid transformation, leading to phlegm accumulation. The Gallbladder governs the throat; it controls decision-making. Its Qi belongs to Ministerial Fire. Emotional disturbances without resolution cause Fire to stagnate. Unresolved Fire fails to ascend, causing Qi stagnation in the throat, binding with phlegm in the chest, creating the sensation of a lodged meat slice. Although Qian Jin Fang describes different symptoms, the etiology is similar. Ban Xia and other herbs disperse stagnation and transform phlegm.
A woman suffers from Zang Jiao (Visceral Restlessness), characterized by frequent sadness, desire to cry, erratic behavior resembling spirit possession, and frequent yawning/stretching. Gan Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction) is the primary treatment.
Gan Mai Da Zao Tang Formula
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 3 liang
Xiao Mai (Tritici Vulgaris Fructus) - 1 sheng
Da Zao (Ziziphi Jujubae Fructus) - 10 pieces
The above three herbs are boiled in 6 sheng of water to yield 3 sheng. Divide into three warm doses. It also tonifies Spleen Qi.
[Commentary] *Neijing* states the Lung's sound is crying, and sorrow belongs to the Lung. *Ling Shu* says sorrow damages Hun (Ethereal Soul). This syndrome arises from Liver deficiency and Lung excess damaging Hun. The Liver is a Yang Zang, the Lung a Yin Zang. Yang is expansive, Yin is constricting. Liver Wood's generating Qi cannot overcome Lung Metal's肃杀 (austere/killing) Qi. When merged, Liver Qi is suppressed, and Generating Fire is restrained, disturbing below, causing Zang Jiao and weeping. Hun cannot follow Shen normally, appearing erratic like spirit possession. Suppressed Wood Qi causes stiffness and frequent yawning/stretching. Treating such merging pathogens requires soothing and harmonizing. Wheat nourishes Liver Qi and calms restlessness; Licorice and Jujube sweeten to relieve tension. When restlessness stops and tension eases, the Zangs calm, and weeping ceases. "Tonifying Spleen Qi" refers to strengthening the Spleen when treating Liver disease to prevent transmission; a strong Spleen supports the Lung (its mother), preventing over-extension and invasion of lower regions.
A woman vomits saliva/phlegm. The physician incorrectly uses purgatives, resulting in epigastric fullness/stuffiness (Pi). First, treat the vomiting of saliva/phlegm with Xiao Qing Long Tang (Minor Blue Dragon Decoction). Once stopped, treat the Pi with Xie Xin Tang (Drain the Epigastrium Decoction).
[Commentary] *Shanghan Lun* states that when exterior signs are unresolved and Water-Qi exists in the epigastrium, use Xiao Qing Long Tang to release the exterior and scatter Water-Qi. If exterior signs remain and purgatives are wrongly used, Yang pathogens sink inward, causing Jie Xiong (excess) or Pi (deficiency). Thus, vomiting saliva/phlegm stems from Water-Qi pathology, exacerbated by purgation causing Pi. Since vomiting persists, Xiao Qing Long Tang is used first, followed by Xie Xin Tang to clear epigastric Heat-Pi.
Women's diseases arise from deficiency, accumulated Cold, and Qi stagnation, leading to amenorrhea, sometimes lasting years. Cold-blood accumulates in the Bao Men (uterine gate), damaging meridians. Cold congeals above, causing vomiting of saliva/phlegm, potentially developing into Lung Abscess over time, damaging the body. Congealing in the middle causes umbilical Cold-Colic (Han Han) or hypochondriac pain connected to Zangs. Heat congealing in the middle causes pain at Guan Yuan (CV4), rapid pulse without ulceration, and fish-scale-like dry skin. These conditions affect both men and women. Below, menstrual irregularities cause vaginal pulling pain, cold hypogastrium, radiating to the lower back/sacrum, extending to Qi Chong (ST30), causing urgent Qi Chong pain, knee/shin pain/restlessness, sudden vertigo/dizziness resembling Jue or Dian syndromes. Emotional distress, sadness, and irritability occur. These are Dai Xia (leukorrhea/gynecological disorders), not ghost influences. Chronic cases lead to emaciation, weak pulse, and cold predominance. The thirty-six diseases manifest in myriad ways. Examine pulses for Yin/Yang, deficiency/excess, tight/string-taut qualities. Apply acupuncture and herbs to restore safety. Similar diseases may have different pulse origins; distinguish and record them carefully.
[Commentary] Yin-Yang movement involves up/down, inside/outside, destination, and initiation. Following the Dao allows diverse functions; deviation causes disease. Yang dominates motion/transformation; Yin provides the vessel for reproduction. Pathogens in Yin cause solidification, blocking Yang's entry and transformation, generating endless diseases. Zhang Zhongjing describes cold accumulation in the Lower Jiao causing varied symptoms. Amenorrhea, cold-damaged Bao Men, vaginal pulling pain, cold hypogastrium, back radiation, Qi Chong pain, and knee/shin pain result from Yin congealing in the Lower Jiao, blocking Yang entry along Chong/Ren meridians. Vomiting saliva/phlegm progressing to Lung Abscess indicates Yin congealing in Shaoyin Meridian, connecting to the Lung; overflow creates saliva, pressing Upper Yang to form abscess. Umbilical Cold-Colic or hypochondriac pain connected to Zangs relates to the umbilicus corresponding to four Zangs (origin of Sheng Qi). Cold congealing depletes generating Qi, causing conflict and Cold-Colic, extending to hypochondrium (Shaoyang generation area). Heat congealing at Guan Yuan (Small Intestine Mu point, convergence of Foot Three Yin and Ren Mai) results from Cold accumulation suppressing Fire, creating mixed Cold-Heat pain. Rapid pulse without ulceration and fish-scale skin indicate Yin failing to transform blood, lacking nourishment for muscles/skin, leaving solitary Yang drying integument. Vertigo resembling Jue/Dian results from Chong/Ren/Du/Yin Qiao meridians reversing, Yang disordering above. Sadness/irritability stems from Kidney/Liver Yin congealing below, blocking Yang, insecure essence leaking as leukorrhea, Hun unsoothed, Zhi unsettled—not ghosts. Cold accumulation binds Ying Blood, disrupting harmony with Wei Qi. Zhang Zhongjing lists thirty-six diseases to warn against rigid adherence to patterns without understanding Yin-Yang dynamics.
Question: A woman around fifty suffers from diarrhea lasting dozens of days, evening fever, hypogastric urgency/fullness, palm heat, and dry lips/mouth. Why? Master replies: This belongs to Dai Xia (gynecological disorders). Why? Previous miscarriage left blood stasis in the hypogastrium. How do we know? Dry lips/mouth indicate this. Wen Jing Tang (Warm the Menses Decoction) is indicated.
Wen Jing Tang Formula
Wu Zhu Yu (Evodiae Fructus) - 3 liang
Dang Gui (Angelicae Sinensis Radix)
Chuan Xiong (Ligustici Chuanxiong Rhizoma)
Bai Shao (Paeoniae Radix Alba)
Gui Zhi (Cinnamomi Ramulus)
Ren Shen (Ginseng Radix)
E Jiao (Colla Corii Asini)
Sheng Jiang (Zingiberis Recens Rhizoma)
Mu Dan Pi (Moutan Cortex)
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 2 liang each
Ban Xia (Pinelliae Rhizoma) - 0.5 sheng
Mai Dong (Ophiopogonis Radix, heart removed) - 1 sheng
Twelve herbs boiled in 1 dou of water to yield 3 sheng. Divide into three warm doses. Also treats cold hypogastrium preventing conception, metrorrhagia, heavy menstruation, or delayed menses.
[Commentary] Diarrhea belongs to Dai Xia. At age forty-nine, Tian Gui exhausts, Chong/Ren decline, menses stop. At fifty, Bao Men closes, Chong/Ren fail to transport accumulated blood, transforming into leukorrhea. Stool being Yin, it exits via defecation. *Qian Jin Fang* treats post-miscarriage leukorrhea. *Jin Gui* links Dai Xia to miscarriage stasis. Is all leukorrhea stasis/cold-deficiency? Dai Mai encircles the body; twelve regular and eight extraordinary meridians carry Cold/Heat. Injury disrupts Chong/Ren, hindering Qi/Blood transformation and Heart-Kidney communication, causing red/white discharge. Treatment requires identifying initial pathogen, affected meridian, deficiency/excess, and pulse. Zhang Zhongjing provides comprehensive guidance. Miscarriage empties Bao Mai, failing to generate new/push out old, causing lower stasis. Generating Qi and storage function reside in Lower Jiao. Yin congealing blocks Upper Yang entry, causing hypogastric urgency/fullness. Four Zangs fail, Five Fluids descend. Evening Yang fails to enter Yin, floating upward causing fever, palm heat, dry mouth/lips. Wu Zhu Yu opens blockages, breaks Yin congealing, guides Yang down. Dang Gui/Chuan Xiong assist; Mu Dan Pi aids spirit/blood. Ban Xia resolves Cold-Heat knots; E Jiao/Ren Shen tonify Qi/Blood; Mai Dong assists Mu Dan Pi, guides Heart Qi to Yin, clears guest Heat. Gui Zhi/Sheng Jiang promote generating Qi; Gan Cao harmonizes. Cold hypogastrium/metrorrhagia stem from Cold-congealing Yin blocking Yang. Differentiate pulses; deep-rapid pulses with Yang invading Yin require different treatments.
Dai Xia with irregular menses, hypogastric fullness/pain, and menstruation occurring twice a month is treated with Tu Gua Gen San (Trichosanthes Root Powder).
Tu Gua Gen San Formula (Also treats Yin swelling)
Tu Gua Gen (Trichosanthis Radix)
Bai Shao (Paeoniae Radix Alba)
Gui Zhi (Cinnamomi Ramulus)
E Chong (Eupolyphaga/Swallow's Egg) - 2 liang each
Four herbs powdered. Take 1 cun bi with wine, three times daily.
[Commentary] This is also blood stasis disease. Irregular menses or twice-monthly bleeding stem from Chong/Ren stasis. Tu Gua Gen promotes menstruation, resolves stasis, generates fluids (fluids transform blood). Bai Shao relieves pain/blood bi. Gui Zhi unites channels, guides Yang. E Chong breaks blood accumulation. Liver stores blood, governing generation, linked to Chong/Ren and genitalia. Yin swelling affects male testes and female vulva, often from postpartum stasis.
Cunkou pulse is String-Tight (Xian) and Large (Da). Tight indicates reduction (Yang deficiency/Cold); Large indicates Hollow (Kou/Kong, Blood deficiency). Cold and Deficiency contend, named Ge (Leather) Pulse. In women, this causes miscarriage and dripping bleeding. Xuan Fu Hua Tang (Inula Flower Decoction) is indicated. (Formula in Vol. 11)
[Commentary] Commentary on formula ingredients: Xuan Fu Hua resolves Qi knots, hypochondriac fullness, unites channels, clears organ Heat. Scallion tube treats Cold/Heat, calms fetus, removes Liver pathogens, benefits blood. Xin Jiang (likely crimson silk) promotes blood circulation. Liver stores blood, governing Chong/Ren menses/pregnancy. These three herbs enter Liver, regulate blood, resolve knots. Qi is Yang, Blood is Yin. Qi deficiency causes Cold; Blood deficiency causes Heat. Dual deficiency harms Liver generation. Xuan Fu Hua Tang resolves knotting pathogens first; warming/tonifying requires other methods.
Women with sinking meridians, black dripping bleeding unrelieved, are treated with Jiao Jiang Tang. (Formula missing)
[Commentary] Qi leads, Blood follows. Pathogens obstruct, causing Blood to sink into Blood Sea (Kidney). Kidney is Cold Water, color Black, hence black bleeding. Resembles Neijing's "Jie Yin" bleeding. Though formula is incomplete, E Jiao and Ai Ye suffice. Moxibustion penetrates internally; oral administration guides Yang into Yin. Ginger disperses Yin, opens pores, promotes fluid/Qi flow.
Women with hypogastric fullness resembling a敦 (round vessel), slight difficulty urinating but no thirst, especially postpartum (or post-menstrual), have Water and Blood co-aggregated in the Blood Chamber. Da Huang Gan Sui Tang (Rhubarb and Kansui Decoction) is indicated.
Da Huang Gan Sui Tang Formula
Da Huang (Rhei Radix et Rhizoma) - 4 liang
Gan Sui (Kansui Radix) - 2 liang
E Jiao (Colla Corii Asini) - 2 liang
Three herbs boiled in 3 sheng water to yield 1 sheng. Take in one dose. Blood stool should pass.
[Commentary] Neijing states water enters channels to form blood. Why mention water/blood combination? Water has clarity/turbidity. Clear water forms blood; turbid water becomes urine/phlegm. Turbid Qi prevents blood formation, causing harm. Clear water turns red via Kan/Li transformation (Fire), circulating like moonlight. Water naturally flows down; obstruction causes swelling in tissues/joints. Entering Blood Chamber causes hypogastric fullness. Blood Chamber differs from Bladder (Water House), but Qi interaction affects Bladder Qi, causing slight urinary difficulty. If urination is normal with fullness, it is not water-blood combination but other blood stasis. Gan Sui targets water retention; Da Huang sweeps stasis; E Jiao guides to Blood Chamber and tonifies deficiency.
Women with obstructed menses are treated with Di Dang Tang (Di Dang Decoction).
Di Dang Tang Formula (Also treats men with bladder urgency due to blood stasis)
Shui Zhi (Hirudo, fried) - 30
Meng Chong (Tabanus, fried, wings/legs removed) - 30
Tao Ren (Persicae Semen, peeled) - 20
Da Huang (Rhei Radix et Rhizoma, wine-soaked) - 3 liang
Four herbs powdered. Boiled in 5 sheng water to yield 3 sheng. Strain. Take 1 sheng warm.
[Commentary] *Shanghan Lun* Yang Ming forgetfulness indicates blood stasis/black stool, treated with Di Dang Tang. Fever after purgation, constipation for 6-7 days indicates stasis, also treated here. Heat with hypogastric fullness and normal urination indicates blood stasis, treated with Di Dang Wan. These formulas follow symptom presentation. "Obstructed menses" implies stasis, not deficiency. This formula addresses specific stasis patterns.
Women with closed/irregular menses, hard abdominal masses, internal dry blood, and leukorrhea are treated with Fan Shi Wan (Alum Pill).
Fan Shi Wan Formula
Fan Shi (Alumen, calcined) - 3 parts
Xing Ren (Armeniacae Semen Amarum) - 1 part
Powdered, honey-pilled, date-seed size. Insert vaginally. Repeat if severe.
[Commentary] Uterine blood stasis disrupts Qi harmony, preventing new blood formation, creating dry blood. Hard masses connect externally; fluids fail to transform.