是也。又云。张仲景所说三十六疾。皆由子脏冷热劳损。而挟带下。起于阴内。条目混漫。与诸
方不同。据巢氏此言。则本条所谓三十六疾。今无所考欤。
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。（
案沈尤所字下句。所。许同。即日晡所之所。诸家或接下句。义不通。）
〔程〕下利。当是下血。
〔鉴〕所病下利之利字。当是血字。文义相属。必是传写之讹。李 曰。妇
人年五十。则已过七七之期。任脉虚。大冲脉衰。天癸竭。地道不通时也。所病下利。据本文带下观之。当是
崩淋下血之病。盖血属阴。阴虚故发热。暮亦属阴也。任主胞胎。冲为血海。二脉皆起于胞宫。而出于会阴。
正当少腹部分。冲脉挟脐上行。故冲任脉虚。则少腹里急。有干血。亦令腹满。内经云。任脉为
病。女子带下瘕聚是也。手背为阳。掌心为阴。乃手三阴过脉之处。阴虚故掌中烦热也。阳明脉挟口环唇。与
冲脉会于气街。皆属于带脉。难经云。血主濡之。以冲脉血阻不行。则阳明津液衰少。不能濡润。故唇口干
燥。断以病属带下。以曾经半产。少腹瘀血不去。则津液不布。新血不生。此则唇口干燥之所由生也。
温经汤方
吴茱萸（三两） 当归 芎 芍药（各二两） 人参 桂枝 阿胶
牡丹皮（去心） 生姜 甘草（各二两） 半夏（半升） 麦门冬（一升去心）
上十二味。以水一斗。煮取三升。分温三服。亦主妇人
少腹寒。久不受胎。兼取崩中去血。或月水来过多。及至期不来。（取。徐沈尤。并作治。是。）
〔程〕妇人有瘀血。当用前证下瘀血汤。今妇人年五十。当天癸竭之时。又非下药所宜。故以温药
治之。以血得温即行也。经寒者温以茱萸姜桂。血虚者益以芍药归芎。气虚者补以人参甘草。血枯者润以
阿胶麦冬。半夏用以止带下。牡丹用以逐坚 。十二味为养血温经之剂。则瘀血自行。而新
血自生矣。故亦主不孕崩中。而调月水。
千金。治崩中下血。出血一斛。服之即断。或月经来过多。及过期不来。服之亦佳方。（即本方。外
台引千金。名温经汤。斛。作
斗。）和剂局方。温经汤。治冲任虚损。月候不调。或来多不断。或过期不来。或崩中去血。过多不止。又
治曾经损娠。瘀血停留。少腹急痛。发热下利。手掌烦热。唇干口燥。及治少
腹有寒。久不受胎。（即本方。医学入门。名大温经汤。）
王氏易简云。若经血不调。血脏冷痛者。当用小温经汤。
即本方。别本。以当归附子二味。等分白水煎服。不载本方。案已名小温经汤。恐非本方。
百一选方。正经汤。
于本方。去芎 甘草。加熟地黄。
带下。经水不利。少腹满痛。经一月再见者。土瓜根散
主之。（案本草纲目。土瓜条。经下。补或字。义尤明。金鉴改再作不字。非。）
〔尤〕妇人经脉流畅。应期而至。血满则下。血尽复生。如月盈则亏。月晦复 也。惟其不利。
则蓄泄失常。似通非通。欲止不止。经一月。而再见矣。少腹满痛。不利之验也。
土瓜根。主内痹瘀血月闭。 虫。蠕动逐血。桂枝芍药。行荣气而正经脉也。
土瓜根散方（〔原注〕阴 肿。亦主之。）
土瓜根 芍药 桂枝 虫（各三分）
上四味。杵为散。酒服方寸匕。日三服。
〔程〕土瓜根。破瘀血。而兼治带下。故以为君。 虫
下血闭以为臣。芍药通顺血脉以为佐。桂枝通行瘀血以为使。 疝亦凝血所成。故此方亦治 肿。
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。
〔尤〕本文已见虚劳篇中。此去男子亡血失精句。而益
之曰旋复花汤主之。盖专为妇人立法也。详本草。旋复花。
治结气去五脏间寒热。通血脉。葱。主寒热除肝邪。绛帛。入肝理血。殊与虚寒之旨不合。然而肝以阴脏。而
含少阳之气。以生化为事。以流行为用。是以虚不可补。解其郁聚。即所以补寒。不可温行其血气。即所以温
固。不可专补其血。以伤其气。亦非必先散结聚。而后温补。如赵氏魏氏之说也。
〔鉴〕此条详在伤寒论
辨脉法篇。错简在此。旋复花汤主之一句。亦必是错简。半产漏下。则气已下陷。焉有再用旋复花下气之理。
旋复花汤方
旋复花（三两） 葱（十四茎） 新绛（少许）
上三味。以水三升。煮取一升。顿服之。
妇人陷经漏下。黑不解。胶姜汤主。（〔原注〕臣亿等校诸本。
无胶姜汤方。想是妊娠中胶艾汤。○楼氏纲目云。即芎归胶艾汤。一云。加干姜一两。）
〔鉴〕李 曰。陷经漏下。谓经脉下陷。而血漏下不止。乃气不摄血也。黑不解者。瘀血不去。则
新血不生。荣气腐败也。然气血喜温恶寒。用胶姜汤。养气血则气盛血充。推陈致新。而经自调矣。按此
条文义。必有缺误。胶姜汤。方亦缺。姑采此注。以见大意。
〔尤〕陷经。下而不止之谓。黑则因寒而色瘀也。
胶姜汤。方未见。然补虚温里止漏。阿胶干姜二物已足。林亿云。恐是胶艾汤。按千金胶艾汤。有干姜。似可取用。
巢源。载五色漏下。其五曰。肾脏之色黑。漏下黑者。是肾脏之虚损。故漏下而挟黑色也。
妇人少腹满。如敦状。小便微难。而不渴。生后者。此为水与血俱结在血室也。大黄甘遂汤主之。（
如敦状。脉经作敦敦状更四字。注。要略云。满而热。案徐沈。生。改经。误。）
〔尤〕敦音对。按周礼注。盘以盛血。敦以盛食。盖古器
也。少腹满。如敦状者。言少腹有形高起。如敦之状。与内经胁下大如覆杯之文略同。小便难。病不独在
血矣。不渴。知非上焦气热不化。生后。即产后。产后得此。乃是水血并结。而病属下焦也。故以大黄下血。
甘遂逐水。加阿胶者。所以去瘀浊。而兼安养也。
案周礼。天官玉府。若合诸侯。则共珠盘玉敦。郑注。敦。盘类。古者以盘盛血。以敦盛食。尤注本
于此。又广雅。释器。HT 。盂也。尔雅释丘。郭注。敦。盂也。知本条如敦状。谓如盘盂之形也。脉经如敦
敦状。而千金云。阴交石门。主水胀水气。行皮中。小腹皮敦敦然。小便黄。则脉经似是。然如字。竟无
着落。沈云。人敦而不能起。言其下重之情也。金鉴云。敦。大也。皆于文义。不相叶。今从尤注。
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。
妇人经水不利下。抵当汤主之。（〔原注〕亦治男子膀胱满急。有瘀血者。）
〔尤〕经水不利下者。经脉闭塞而不下。比前条下而不利者。有别矣。故彼兼和利。而此专攻逐也。然
必审其脉证并实。而后用之。不然。妇人经闭。多有血枯脉绝者矣。虽养冲任。犹恐不至。而可强责之哉。
〔鉴〕妇人经水不利下。言经行不通利快畅下也。乃妇人恒有之病。不过活瘀导气。调和冲任。足以愈之。今曰
抵当汤主之。夫抵当重剂。文内无少腹结痛。大便黑。小便利。发狂善忘。寒热等证。恐药
重病轻。必有残缺错简。读者审之。
抵当汤方
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。
千金桃仁煎。治带下月经闭不通。
本方。去蛭。加朴硝五两。
千金翼。抵当汤。治妇人月水不利。腹中满。时自减。并男子膀胱满急方。
本方。去虻虫。加虎杖二两。一云虎掌。
又杏仁汤。治月水不调。或一月再来。或两月三月不来。或月前。或月后。闭塞不通。
于本方。加杏仁三十枚。（千金同。）
李氏必读。代抵当汤。行瘀血。（如血老而甚者。去归地。加蓬术。）
生地黄 当归尾 穿山甲（各三钱） 降香（一钱五分） 肉桂（去皮一钱）
桃仁（去皮尖炒二钱） 大黄（去皮三钱） 芒硝（八分）
水二钟。煎一钟。血在上食后服。血在下食前服。
张氏医通云。水蛭如无。以陵鲤甲。生漆涂炙。代之。
又代抵当丸。治虚人蓄血。宜此缓攻。
于前方。去降香。加蓬术为末。蜜丸。蓄血而上部者。丸如芥子。黄昏去枕仰卧。以津咽之。令停喉。
以搜逐瘀积。在中部食远。下部空心。俱丸如梧子。百劳水煎汤下之。汪氏医方集解同。但去降香莪术
芒硝。用玄明粉。
妇人经水闭不利。脏坚癖不止。中有干血。下白物。矾石丸主之。
〔沈〕脏。即子宫也。坚癖不止。止当作散字。坚癖不散。子宫有干血也。白物者。世谓之白带也。
〔魏〕藏坚之脏。指子宫也。脏中之脏。指阴中也。
〔尤〕脏坚癖不止者。
子脏干血。坚凝成癖。而不去也。干血不去。则新血不荣。而经闭不利矣。由是蓄泄不时。胞宫生湿。湿
复生热。所积
之血。转为湿热所腐。而成白物。时时自下。是宜先去其脏之湿热。矾石却水除热。合杏仁破结润干血也。
矾石丸方
矾石（三分烧） 杏仁（一分）
上二味。末之。炼蜜和丸。枣核大。五内中。剧者再内之。
〔程〕矾石酸涩。烧则质枯。枯涩之品。故神农经以能止白沃。亦涩以固脱之意也。杏仁者。非以止带。
以矾石质枯。佐杏仁一分。以润之。使其同蜜。易以为丸。滑润易以内阴中也。此方专治下白物而设。未
能攻坚癖下干血也。
妇人六十二种风。及腹中血气刺痛。红蓝花酒主之。
〔尤〕妇人经尽产后。风邪最易袭入腹中。与血气相搏。而作刺痛。刺痛。痛如刺也。六十二种未详。
红蓝花。苦辛温。活血止痛。得酒尤良。不更用风药者。血行而风自去耳。
红蓝花酒方（〔原注〕疑非仲景方。）
红蓝花（一两）
上一味。以酒一大升。煎减半。顿服一半。未止再服。
外台。近效。疗血晕绝不识人烦闷方。
红蓝花三两。新者佳。以无灰清酒半升。童子小便半大升。煮取一大盏。去滓候稍冷服之。
妇人良方。红蓝花酒。疗血晕绝不识人。烦闷言语错乱。恶血不尽。腹中绞痛。胎死腹中。
红蓝花一两。上为末。分二服。每服酒二盏。童子小便二盏。煮取盏半。候冷分为二服。留滓再并煎。
一方无童便。（本出肘后。○徐氏胎产方。治产后血晕。昏迷心气绝。）
妇人腹中诸疾痛。当归芍药散主之。
〔徐〕此言妇人之病。大概由血。故言诸疾痛。皆以术
苓泽归芍芎主之。谓即有因寒者。亦不过稍为加减。非真以此方概腹中诸痛也。
〔鉴〕诸疾腹痛。谓妇人腹
中诸种疾痛也。既曰诸疾痛。则寒热虚实。气食等邪。皆令腹痛。岂能以此一方。概治诸疾痛耶。当归
芍药散主之。必是错简。
当归芍药散方（见前妊娠中。）
妇人腹中痛。小建中汤主之。
〔徐〕此言妇人之病。既已由血。则虚者多。从何补起。唯有建中之法为妙。谓后天以脾胃为本。胃
和而饮食如常。则自能生血而痛止也。小建中。即桂枝汤加饴糖也。言外见当扶脾之统血。不当令借四物之类
耳。前产后附千金内补当归建中汤。正此意也。
小建中汤方（见前虚劳中。）
朱氏集验方。加味建中汤。治女人虚败腹痛。
本方中。加当归琥珀木香。
施丸端效方。大加减建中汤。治妇人胎前产后。一切产
损。月事不调。脐腹 痛。往来寒热。自汗口干烦渴。于黄 建中汤。去胶饴。加当归川芎白术。
问曰。妇人病饮食如故。烦热不能卧。而反倚息者何也。师曰此名转胞。不得溺也。以胞系了戾。故
致此病。但利小便则愈。宜肾气丸主之。（以胞以下。脉经。作此人故肌盛。头举身满。今反羸
瘦。头举中空。感胞系了戾。故致此病。但利小便则愈。宜服肾气丸。以中有茯苓故也。方在虚劳中。）
〔尤〕饮食如故。病不由中焦也。了戾与缭戾同。胞系缭戾。而不顺。则胞为之转。胞转则不得溺也。
由是下气上逆。而倚息。上气不能下通。而烦热不得卧。治以肾气者。下焦之气肾主之。肾气得理。庶缭
者顺。戾者平。而闭乃通耳。
巢源云。胞转之病。由胞为热所迫。或忍小便。俱令水气还迫于胞。屈辟不得充张。外水应入。不得入
内。溲应出不得出。内外壅胀不通。故为胞转。其状小腹急痛。不得小便。甚者至死。张仲景云。妇人本
肥盛。且举自满。全羸瘦。且举空减。胞系了戾。亦致胞转。（朱氏格致论。引妇人本肥盛云云。而
曰。其义未详。）案了。缭并音聊。缭。缠也。绕也。千金有四肢痿 缭戾等文。舒氏女科要诀云。了戾者。
绞纽也。
肾气丸方
干地黄（八两） 薯蓣（四两） 山茱萸（四两） 泽泻（三两） 茯苓（三两）
牡丹皮（三两） 桂枝 附子（炮各一两○千金翼用桂附各二两）
This is (the situation described above). It is also said that the thirty-six gynecological diseases mentioned by Zhang Zhongjing are all caused by cold and heat damage to the uterus, accompanied by leukorrhea. The disease originates from within the yin orifices, with its categories being chaotic and vague, differing from other medical texts. Based on Chao Yuanfang's statement, can the "thirty-six diseases" mentioned in this section now be unverified?
Question: A woman around fifty years old suffers from diarrhea for dozens of days without cessation, experiences fever in the evening, urgency and fullness in the lower abdomen, vexatious heat in the palms, and dryness of the lips and mouth. What is the cause? The Master said: This disease belongs to the category of leukorrhea. Why? Because she once had a miscarriage, and blood stasis remains in the lower abdomen unresolved. How do we know this? Her symptoms include dryness of the lips and mouth, thus we deduce this. She should be treated with Wen Jing Tang (Warming the Menses Decoction). (Note: Shen Mingzong attaches the character "suo" to the following sentence. "Suo" is interchangeable with "xu", referring to the time of day. Most commentators attach it to the following sentence, which makes no sense.)
[Cheng Lin] The term "diarrhea" here should be "bleeding".
[You Yi] The character "li" (diarrhea) in "suffering from diarrhea" should be "xue" (blood). The context connects logically; it must be a transcription error. Li Zhongzi says: A woman at fifty has passed the age of seven times seven (49 years). The Ren Mai (Conception Vessel) is deficient, the Chong Mai (Penetrating Vessel) is declining, Tian Gui (menstrual essence) is exhausted, and the menstrual pathway is blocked. Regarding the "diarrhea" mentioned, based on the text's reference to "leukorrhea," it should refer to metrorrhagia or menorrhagia. Blood belongs to Yin; Yin deficiency causes fever, and evening also belongs to Yin. The Ren Mai governs the womb, and the Chong Mai is the Sea of Blood. Both vessels originate from the uterus and emerge at the perineum, corresponding to the lower abdomen region. The Chong Mai ascends alongside the navel. Therefore, when the Chong and Ren vessels are deficient, there is urgency in the lower abdomen. Dry blood also causes abdominal fullness. The *Neijing* states: Disease of the Ren Mai manifests as leukorrhea and masses in women. The back of the hand is Yang, the palm is Yin, where the three Hand-Yin meridians pass. Yin deficiency causes vexatious heat in the palms. the Stomach Meridian circles the lips and meets the Chong Mai at Qichong (ST30), both connecting to the Dai Mai (Girdle Vessel). The *Nanjing* states: Blood moistens. Due to obstruction in the Chong Mai, stomach fluids are depleted and cannot moisten, causing dryness of the lips and mouth. Determining the disease as leukorrhea is because a previous miscarriage left blood stasis in the lower abdomen unresolved. This prevents fluid distribution and new blood generation, which is the origin of dry lips and mouth.
Wen Jing Tang Formula
Evodiae Fructus (3 liang), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Shao (Paeoniae Radix Alba) (each 2 liang), Ren Shen (Ginseng Radix), Gui Zhi (Cinnamomi Ramulus), E Jiao (Colla Corii Asini), Mu Dan Pi (Moutan Cortex) (remove heart), Sheng Jiang (Zingiberis Rhizoma Recens), Gan Cao (Glycyrrhizae Radix et Rhizoma) (each 2 liang), Ban Xia (Pinelliae Rhizoma) (0.5 sheng), Mai Men Dong (Ophiopogonis Radix) (1 sheng, remove heart).
These twelve ingredients are boiled in ten dou of water until three sheng remain. Divide into three warm doses. It also treats cold in the lower abdomen of women, infertility over a long period, bleeding from metrorrhagia, excessive menstruation, or amenorrhea. ("Qu" [extract] is interpreted by Xu Lingtai and Shen Mingzong as "zhi" [treat], which is correct.)
[Cheng Lin] For women with blood stasis, one should use the preceding Xia Yu Xue Tang (Drain Blood Stasis Decoction). However, a fifty-year-old woman is at the stage of Tian Gui exhaustion, making purgatives inappropriate. Thus, warming herbs are used because blood flows when warmed. Cold in the channels is warmed with Evodia, Ginger, and Cinnamon Twig; blood deficiency is nourished with Peony, Angelica, and Ligusticum; Qi deficiency is tonified with Ginseng and Licorice; blood desiccation is moistened with Donkey-hide Gelatin and Ophiopogon. Pinellia stops leukorrhea; Moutan bark removes hard accumulations. These twelve ingredients form a formula to nourish blood and warm the channels, allowing stasis to resolve and new blood to generate. Hence, it also treats infertility, metrorrhagia, and regulates menstruation.
*Qian Jin Fang* treats metrorrhagia and bleeding; if bleeding is severe (one hu), taking this stops it immediately. It is also good for excessive menstruation or delayed menses. (This is the same formula; *Waitai Miyao* cites *Qian Jin Fang* as Wen Jing Tang, using "dou" instead of "hu".) He Ji Ju Fang's Wen Jing Tang treats deficiency and damage to the Chong and Ren vessels, irregular menstruation, excessive or continuous bleeding, delayed menses, or metrorrhagia. It also treats residual stasis after miscarriage, lower abdominal urgency and pain, fever, diarrhea, vexatious heat in palms, and dry lips/mouth. It treats cold in the lower abdomen and infertility. (This is the same formula; *Yi Xue Ru Men* calls it Da Wen Jing Tang.)
Wang Shi's *Yi Jian Fang* states: If menstruation is irregular and the blood organ is cold and painful, use Xiao Wen Jing Tang (Minor Warming the Menses Decoction).
This is the same formula. Another version uses only Dang Gui and Fu Zi (Aconiti Lateralis Radix Praeparata) in equal parts boiled in water, omitting the main formula. Since it is named Xiao Wen Jing Tang, it is likely not the original formula.
*Bai Yi Xuan Fang* Zheng Jing Tang.
Based on the above formula, remove Chuan Xiong and Gan Cao, add Shu Di Huang (Rehmanniae Radix Preparata).
For leukorrhea, difficult menstruation, lower abdominal fullness and pain, and menstruation occurring twice in one month, Tu Gua Gen San (Trichosanthes Root Powder) should be used. (Note: In *Ben Cao Gang Mu*, under Trichosanthes, adding the character "huo" [or] clarifies the meaning. *Jin Jian* changed "zai" [again] to "bu" [not], which is incorrect.)
[You Yi] When a woman's meridians are smooth, menstruation arrives on schedule. When blood fills, it flows out; when empty, it regenerates, like the moon waning and waxing. When flow is obstructed, storage and discharge become abnormal, appearing open yet closed, wanting to stop yet continuing, resulting in menstruation twice in one month. Lower abdominal fullness and pain are signs of obstruction.
Tu Gua Gen (Trichosanthes Radix) treats internal obstruction, blood stasis, and amenorrhea. E Chong (Myodes) moves and drains blood. Gui Zhi and Bai Shao circulate Ying Qi and regulate the meridians.
Tu Gua Gen San Formula
([Original Note]: Also treats vulvar swelling.)
Tu Gua Gen (Trichosanthes Radix), Bai Shao, Gui Zhi, E Chong (each 3 fen).
These four ingredients are pounded into powder. Take one fang cun bi (square-inch spoonful) with wine, three times daily.
[Cheng Lin] Tu Gua Gen breaks blood stasis and treats leukorrhea, serving as the Sovereign herb. E Chong treats blood obstruction as the Minister herb. Bai Shoo smooths blood vessels as the Assistant herb. Gui Zhi promotes circulation of stasis as the Envoy herb. Hernias are also formed by coagulated blood, so this formula also treats vulvar swelling.
The pulse at Cun Kou is wiry and large. Wiry indicates reduction; large indicates hollow. Reduction indicates cold; hollow indicates deficiency. Cold and deficiency interacting is called Ge (Leather) pulse. In women, this presents as miscarriage and dripping bleeding, treated with Xuan Fu Hua Tang (Inula Flower Decoction).
[You Yi] This passage appears in the Xu Lao (Consumption) chapter. Here, the sentence about men losing blood and essence is removed, and "Xuan Fu Hua Tang" is added. It seems specifically legislated for women. According to materia medica, Xuan Fu Hua (Inulae Flos) treats qi stagnation and clears cold-heat between the five zang organs, promoting blood circulation. Cong (Allium fistulosum) treats cold-heat and eliminates liver pathogenic factors. Jiang Bo (Red silk) enters the Liver to regulate blood. This seems inconsistent with the principle of deficiency-cold. However, the Liver is a Yin organ containing Shaoyang Qi, functioning through transformation and flow. Deficiency cannot be simply tonified; resolving stagnation is a form of tonification. Cold cannot be treated by merely warming blood and Qi; rather, stabilizing is warming. One cannot solely tonify blood to injure Qi, nor must one first dissipate stagnation before warming and tonifying, as Zhao and Wei suggest.
[You Yi] This detail is found in the *Shang Han Lun · Bian Mai Fa* chapter; it is misplaced here. The phrase "Xuan Fu Hua Tang" is also likely misplaced. Miscarriage and dripping bleeding imply sinking Qi; why use Xuan Fu Hua, which directs Qi downward?
Xuan Fu Hua Tang Formula
Xuan Fu Hua (3 liang), Cong (14 stalks), Xin Jiang (a little).
These three ingredients are boiled in three sheng of water until one sheng remains. Take in one dose.
For women with sinking meridians and dripping bleeding that does not clear (dark color), Jiao Jiang Tang (Gelatin and Ginger Decoction) should be used. ([Original Note]: Chen Yi et al. checked various editions; Jiao Jiang Tang formula is missing. It is likely Jiao Ai Tang from the pregnancy section. Lou Zu's *Gang Mu* says: It is Xiong Gui Jiao Ai Tang. Another view adds Gan Jiang 1 liang.)
[Li Zhongzi] Sinking meridians and dripping bleeding mean the meridians sink and blood leaks continuously, due to Qi failing to hold blood. Dark color not clearing means stasis remains, preventing new blood generation, leading to corruption of Ying Qi. Blood and Qi prefer warmth and dislike cold. Using Jiao Jiang Tang nourishes Qi and Blood, promoting renewal and regulating menstruation. The text likely has errors, and the formula is missing. We record this note to show the general idea.
[You Yi] Sinking meridians mean downward leakage without stopping. Darkness is due to cold causing blood stasis.
The formula for Jiao Jiang Tang is unseen. However, to tonify deficiency, warm the interior, and stop leakage, E Jiao and Gan Jiang suffice. Lin Yi suggests it might be Jiao Ai Tang. *Qian Jin Fang*'s Jiao Ai Tang contains Gan Jiang, which seems applicable.
*Chao Yuan Fang* records five colors of dripping bleeding. The fifth is black, belonging to the Kidney. Black dripping bleeding indicates Kidney deficiency and damage.
If a woman's lower abdomen is full, resembling a Dun (ancient vessel), with slight difficulty urinating but no thirst, occurring after childbirth, this is water and blood binding together in the Blood Chamber. Da Huang Gan Su Tang (Rhubarb and Kansui Decoction) should be used. (*Mai Jing* reads "Dun Dun Zhuang". Note: *Yao Lue* says "full and hot". Xu Lingtai and Shen Mingzong change "sheng" [birth] to "jing" [menses], which is wrong.)
[You Yi] Dun sounds like "dui". According to *Zhou Li* commentary: Pan holds blood, Dun holds food. They are ancient vessels. Lower abdominal fullness resembling a Dun means a palpable elevation, similar to the *Neijing* description of hypochondriac fullness like an inverted cup. Difficulty urinating indicates the pathology is not solely in blood. No thirst indicates it is not upper Jiao Qi heat failing to transform. "After birth" refers to postpartum. Postpartum occurrence implies water and blood binding in the lower Jiao. Thus, Da Huang drains blood, Gan Su expels water, and E Jiao removes turbidity while nourishing.
Note: *Zhou Li · Tian Guan Yu Fu* mentions pearl pans and jade Duns for feudal lords. Zheng Xuan notes Dun is pan-like. Ancient times used pans for blood and Duns for food. You Yi's note is based on this. *Guang Ya* defines HT as a bowl. *E Ya · Shi Qiu* Guo Pu commentary defines Dun as a bowl. Thus, "resembling a Dun" means like a plate or bowl. *Mai Jing* says "Dun Dun Zhuang", and *Qian Jin* says Yin Jiao and Shi Men treat water distension, with the lower abdomen feeling heavy and urine yellow, making *Mai Jing* plausible. However, the word "ru" (like) lacks explanation. Shen says "Dun" means unable to rise, indicating heaviness. *Jin Jian* says "Dun" means large. Both seem inconsistent with the text. I follow You Yi's note.
Da Huang Gan Su Tang Formula
Da Huang (4 liang), Gan Su (2 liang), E Jiao (2 liang).
These three ingredients are boiled in three sheng of water until one sheng remains. Take in one dose. The blood should pass.
For women with obstructed menstruation, Di Dang Tang (Di Dang Decoction) should be used. ([Original Note]: Also treats men with bladder fullness/urgency due to blood stasis.)
[You Yi] Obstructed menstruation means the meridians are blocked and blood does not descend, differing from the previous case of descending but difficult flow. That case required harmonizing; this requires attacking and draining. However, one must verify the pulse and symptoms are excess before using it. Otherwise, many cases of amenorrhea involve blood depletion and pulse extinction. Even nourishing Chong and Ren may fail; how can one force treatment?
[You Yi] "Obstructed menstruation" means flow is not smooth. This is common in women. Usually, activating stasis, guiding Qi, and harmonizing Chong and Ren suffices. Saying Di Dang Tang is used is concerning. Di Dang is a heavy formula. The text lacks signs like lower abdominal knotting/pain, black stool, clear urine, mania, forgetfulness, or chills/fever. The medicine may be too strong for the illness, suggesting missing or misplaced text. Readers should examine carefully.
Di Dang Tang Formula
Shui Zhi (Leech, 30 pieces, fried), Meng Chong (Dragonfly larva, 30 pieces, fried, remove wings/legs), Tao Ren (Peach Seed, 20 pieces, remove skin/husk), Da Huang (Rhubarb Root, 3 liang, wine-soaked).
These four ingredients are powdered. Boil in five sheng of water until three sheng remain. Strain and take one sheng warm.
*Qian Jin Fang* Tao Ren Jian treats leukorrhea and amenorrhea.
This formula removes Shui Zhi and adds Po Xiao (Mirabilite) 5 liang.
*Qian Jin Yi Fang* Di Dang Tang treats difficult menstruation, abdominal fullness that fluctuates, and male bladder fullness/urgency.
This formula removes Meng Chong and adds Hu Zhang (Polygoni Cuspidati Rhizoma et Radix) 2 liang. Or Hu Zhang (Arisaema).
Also Xing Ren Tang treats irregular menstruation, occurring twice a month, or two/three months late, or early/late, blocked.
Add Xing Ren (Apricot Seed) 30 pieces to this formula. (*Qian Jin Fang* agrees).
Li Shi's *Bi Du* Dai Di Dang Tang moves blood stasis. (If blood is old/severe, remove Dang Gui and Di Huang, add E Zhu.)
Sheng Di Huang, Dang Gui Wei, Chuan Shan Jia (each 3 qian), Jiang Xiang (1.5 qian), Rou Gui (peeled, 1 qian), Tao Ren (fried, peeled, 2 qian), Da Huang (peeled, 3 qian), Mang Xiao (8 fen).
Boil in two zhong of water until one zhong remains. If blood is upper, take after meals; if lower, take before meals.
Zhang Shi's *Yi Tong* states: If Shui Zhi is unavailable, use Ling Li Jia (Soft-shelled Turtle Shell) coated with raw lacquer and roasted as a substitute.
Also Dai Di Dang Wan treats blood stasis in deficient persons, suitable for slow attack.
Remove Jiang Xiang from the previous formula, add E Zhu, powder, and make honey pills. For stasis in the upper part, make pills like mustard seeds. Lie supine without pillow at dusk, swallow with saliva to let it stay in the throat to search for stasis. For middle part, take far from meals; for lower part, take on an empty stomach. Make pills like wu zi (bayberry size). Take with Bai Lao water decoction. Wang Shi's *Yi Fang Ji Jie* agrees but removes Jiang Xiang, E Zhu, and Mang Xiao, using Xuan Ming Fen instead.
For women with closed/difficult menstruation, hard masses in the zang organs persisting, dry blood inside, and white discharge, Fan Shi Wan (Alum Pill) should be used.
[Shen Mingzong] Zang refers to the uterus. "Bu zhi" should be "bu san" (not dispersing). Hard masses not dispersing indicate dry blood in the uterus. White matter is commonly called leukorrhea.
[Wei Litong] The "hard zang" refers to the uterus. The "zang within the zang" refers to the vagina.
[You Yi] Hard masses persisting means dry blood in the uterine organ has hardened into a mass and remains. Unresolved dry blood prevents new blood nourishment, causing amenorrhea. Irregular storage and discharge lead to dampness in the uterus, which generates heat. Accumulated blood rots into damp-heat, forming white discharge. One should first clear damp-heat from the zang. Alum expels water and clears heat; combined with Apricot Seed, it breaks knots and moistens dry blood.
Fan Shi Wan Formula
Fan Shi (Alumen, 3 fen, calcined), Xing Ren (1 fen).
These two ingredients are powdered. Mix with refined honey to make pills the size of a jujube pit. Insert into the vagina. Severe cases may require re-insertion.
[Cheng Lin] Alum is sour and astringent; calcination makes it dry. Such dry/astringent substances stop white discharge in the *Shennong Ben Cao Jing*, reflecting the principle of astringency to secure collapse. Apricot Seed is not for stopping discharge but to moisten the dry Alum. Mixed with honey, it forms easy-to-insert slippery pills. This formula specifically treats white discharge and cannot break hard masses or drain dry blood.
For women affected by sixty-two types of wind and stabbing pain in the abdomen from blood and Qi, Hong Lan Hua Jiu (Safflower Wine) should be used.
[You Yi] After menstruation or postpartum, wind pathogens easily invade the abdomen, battling with blood and Qi to cause stabbing pain. "Stabbing pain" means pain like being pierced. The "sixty-two types" are unknown. Hong Lan Hua (Carthami Flos) is bitter, acrid, and warm; it invigorates blood and stops pain, especially effective with wine. No wind-dispelling herbs are needed because moving blood dispels wind.
Hong Lan Hua Jiu Formula
([Original Note]: Suspected not to be Zhang Zhongjing's formula.)
Hong Lan Hua (1 liang).
One ingredient. Boil in one da sheng of wine until half remains. Take half in one dose. If not stopped, take again.
*Waitai Miyao* Jin Xiao formula for blood晕 (fainting) with loss of consciousness and restlessness.
Hong Lan Hua 3 liang (fresh is best). Boil with half sheng of clear wine and half da sheng of child's urine until one da zhan remains. Strain and take when slightly cool.
*Fu Ren Liang Fang* Hong Lan Hua Jiu treats fainting, loss of consciousness, restlessness, confused speech, retained evil blood, colic, and dead fetus.
Hong Lan Hua 1 liang, powdered. Divide into two doses. Each dose: boil 2 zhan of wine and 2 zhan of child's urine until 1.5 zhan remains. Take cold, divided into two doses. Keep dregs and boil again. One version omits child's urine. (Originally from *Zhou Hou Bei Ji Fang*. Xu Shi's *Tai Chan Fang* treats postpartum blood fainting and coma.)
For various pains in the abdomen of women, Dang Gui Shao Yao San (Angelica and Peony Powder) should be used.
[Xu Bin] This states that women's diseases generally stem from blood. Thus, various pains are treated with this formula (Atractylodes, Poria, Alisma, Angelica, Peony, Ligusticum). Even if caused by cold, minor modifications suffice. It does not mean this single formula treats all abdominal pains.
[You Yi] "Various abdominal pains" refers to all kinds of abdominal pain in women. If it says "various pains," then cold, heat, excess, deficiency, Qi, and food pathogens all cause pain. How can one formula treat all? "Treated with Dang Gui Shao Yao San" must be misplaced text.
Dang Gui Shao Yao San Formula (See Pregnancy section above).
For abdominal pain in women, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) should be used.
[Xu Bin] Women's diseases, stemming from blood, often involve deficiency. How to tonify? The method of constructing the Middle is excellent. The posterior heaven relies on the Spleen and Stomach. If the Stomach is harmonious and appetite normal, blood generates and pain stops. Xiao Jian Zhong is Guizhi Tang plus Yi Tang (Maltose). Implicitly, one should support the Spleen's control of blood rather than relying solely on Si Wu Tang. The *Qian Jin* Nei Bu Dang Gui Jian Zhong Tang appended to postpartum sections illustrates this intent.
Xiao Jian Zhong Tang Formula (See Consumption section above).
Zhu Shi's *Ji Yan Fang* Jia Wei Jian Zhong Tang treats deficiency-induced abdominal pain in women.
Add Dang Gui, Hu Po (Amber), and Mu Xiang (Aucklandiae Radix) to this formula.
Shi Wan Duan Xiao Fang Da Jia Jian Jian Zhong Tang treats pre/post-natal injuries, irregular menstruation, umbilical/abdominal pain, alternating chills/fever, spontaneous sweating, dry mouth, and thirst.
Based on Huang Qi Jian Zhong Tang, remove Yi Tang, add Dang Gui, Chuan Xiong, and Bai Zhu.
Question: A woman suffers from normal diet but experiences vexatious heat, inability to lie flat, and reliance on sitting up to breathe. What is this? The Master said: This is called Zhuan Bao (Turning Womb), characterized by inability to urinate. It is caused by the Bao Mai (uterine ligaments) being twisted. Only by promoting urination will it heal. Shen Qi Wan (Kidney Qi Pill) should be used. (From "Bao" onwards, *Mai Jing* reads: This person was previously fleshy, head raised body full; now emaciated, head raised hollow. Feeling the Bao Mai twisted causes this disease. Promoting urination heals it. Use Shen Qi Wan because it contains Fu Ling. Formula in Consumption section.)
[You Yi] Normal diet means the disease is not in the Middle Jiao. "Lao Li" is the same as "Liao Li." Twisted Bao Mai leads to turning of the womb. Turning prevents urination. Downward Qi rebels upward, causing reliance on sitting. Upward Qi fails to descend, causing vexatious heat and insomnia. Treating with Shen Qi works because the Kidney governs lower Jiao Qi. When Kidney Qi is regulated, twisted paths straighten, and blockage opens.
*Chao Yuan Fang* states: Zhuan Bao is caused by heat forcing the bladder, or holding urine, causing water Qi to press back against the bladder, preventing expansion. External water cannot enter, urine cannot exit, causing internal/external bloating. Symptoms: lower abdominal urgency, inability to urinate, potentially fatal. Zhang Zhongjing said: Women usually fleshy feel full when lifting; emaciated feel empty when lifting. Twisted Bao Mai also causes Zhuan Bao. (Zhu Shi's *Ge Zhi Lun* quotes this but says the meaning is unclear. Note: "Liao" and "Liao" sound like "liao". Liao means entangle/wind. *Qian Jin* mentions limb flaccidity and twisting. Shu Shi's *Nu Ke Yao Jue* says: Lao Li means twisting/knotting.)
Shen Qi Wan Formula
Gan Di Huang (Rehmanniae Radix, 8 liang), Shu Yu (Dioscoreae Rhizoma, 4 liang), Shan Zhu Yu (Corni Fructus, 4 liang), Ze Xie (Alismatis Rhizoma, 3 liang), Fu Ling (Poria, 3 liang), Mu Dan Pi (3 liang), Gui Zhi (Cinnamomi Ramulus), Fu Zi (Aconiti Lateralis Radix Praeparata, fried, each 1 liang. *Qian Jin Yi Fang* uses Gui and Fu Zi each 2 liang).