妇人中风。七八日。续得寒热。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。
妇人中风。其发热汗出。恶风脉缓。与男子同。第病已七八日。寒热去而续来。且发作有时。非复风邪之寒热
矣。当病经来。因病适断。以致应去未去之血。结于营分。与疟邪伏于募原。卫气会之而不行。相争为寒热者。
正同。故使如疟状。发作有时也。治宜和解。故主小柴。如热结血甚。可加丹皮、丹参。以泄热行血乎。
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。
妇人伤寒。其证亦同。第病时经水适来。血室虚而邪入之。且妇人之营卫营运。暮升而昼降。当暮升之时。挟
热邪而上扰神明。故轻则谵语。重则如见鬼状。仲景断为热入血室。恐后人误认为阳明胃热。故治之。无犯
胃气。及上二焦。为戒。
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。
发热恶寒。为中风原有之证。若妇人中风。经水适来。得之七八日。热除脉迟。身凉和。是表里俱解。何复胸腹
满如结胸状。且谵语乎。要知七八日前。发寒热时。经水适来。以其血室动、而热入之。夫血。资生于胃。藏于肝。
胸。胁为肝胃之部。血虚而邪随实于其处。虽状如结胸。不得用大小陷胸。但当刺期门以泻之。
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。
前三条。与伤寒论少阳篇。第十八、十九、二十条相同。注虽已见。因有未尽余义。故申释之。本条。亦与阳明篇。
第三十六条相同。其精义已详于该条下。故不赘。若夫宜刺宜小柴之别。以经水适来者宜刺。经水适断者
宜小柴。以经水适来。则但有热入。而未尝结其血室中之血。故血仍来。刺期门以泻去血室中之热则愈。经
水适断。则热入血室。而并结其血。故使经断。非小柴之解其热。而并因汗以散其血者。不可也。
妇人咽中如有炙脔。半夏浓朴汤主之。（千金云咽中帖帖如有炙肉者即是）
半夏浓朴汤方 半夏（一升） 浓朴（三两） 茯苓（四两） 生姜（五两） 干苏叶（二两）
上五味。以水七升。煮取四升。分温四服。日三夜一服。
妇人心境逼窄。凡忧思愤闷。则气郁于胸分而不散。故咽中如有炙脔嗳之不得出。咽之不得下者。留气之
上塞横据。而不降不散之候也。故以降逆之半夏为君。佐以开郁之浓朴。宣郁之生姜。加渗湿之茯苓。以去
郁气之根据辅。散邪之苏叶。以去郁气之勾结。则下降旁散。而留气无所容矣。
妇人脏躁。喜悲伤。欲哭。象如神灵所作。数欠伸。甘麦大枣汤主之。
甘草小麦大枣汤方 甘草（三两） 小麦（一升） 大枣（十枚）
上三味。以水六升。煮取三升。温分三服。亦补脾气。
脏指心肺而言。脏躁言脏中阳液枯干。而脏真之气。尝不能自立。而有躁急之义。故其心神肺魄。如失援失
根据。不可自支。而悲伤欲哭者。烦冤之所致也。如神灵所作。正言无故而悲伤欲哭。如有凭借之象。气失所根据。
而时引上下则欠。气自微长。而时欲外达则伸也。小麦为心之谷。大枣为肺之果。又皆甘寒甘温。而偏滋津
液者。得甘草以浮之在上。则正行心肺之间。而神魄优裕。又岂止食甘以缓其躁急乎哉。亦补脾气。义见首
卷补肝下。盖补心中之火液。既可因母以生子。而补肺中之金液。又可因子以荫母。故也。补脾。非补脾气。
当指脾中之津液。故本汤可与脾约丸为表里之剂。
妇人吐涎沫。医反下之。心下即痞。当先治其吐涎沫。小青龙汤主之。涎沫止乃治痞。泻心汤主之。
水寒之气上泛。肺受逼而失分布之用。故吐涎沫。是温之燥之。渗之泄之。始为正治。乃反欲攻下以去涎沫。
则误矣。故不特涎沫不止。而且胃阳以寒下而益虚。故痞气上塞于心下。此当先治其本病之吐涎沫。小青
龙为发汗利小便之剂。则散水行饮。而涎沫自止。然后主半夏泻心以治痞。则填膈降逆。而痞亦平矣。此
是半夏泻心。徐忠可注。为三黄泻心。误人无限。
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
止女身。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
巅。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。
人身心肺间之气。其先天从命门温温之火。历膂脊而上蒸于胸中。其后天从胃中之精悍。历脾充肺。而外
托于胸中。二者合德。而化为太和之瑞。充周遍满于胸膈。外为经络卫气鼓动之根。内司中下二焦温被之
化。且其运血养神。提精御气之妙。为有生之大宝。故曰宗气。宗气者。言虽非鼻祖。而实为宗子之义。犹之后
天离火。正位南方。所以继乾坤。而主化生万物之权者也。是气男女同贵。而尤为妇人之所更重者。虽已补
详虚劳注中。而本条所论诸症。理奥词古。苟不悉此气之根源。及其关系处。则必不能读。即读亦必不能解
也。虚即指此宗气空浅而言。盖谓妇人之病。皆因上焦如雾之气虚馁。则诸气渐寒。寒久则凡各处俱积冷
矣。如下文所谓胞门、经络、绕脐、两胁、少腹、腰脊、气街、膝胫俱是矣。夫气以充满温和。为流行之本。因虚而积
冷。虚则滞结。冷则寒结。故结气。但虚者气不运血。冷者气不温血。结者气不行血。三者得一。即能断经。非至
结气而始不月者。故曰为诸经水断绝也。至有历年。谓宗气虚至日久。其血寒积结之地。虽不止二者。即此
内而胞门寒伤。生机歇绝。外而经络凝坚。流通无气。则其经、焉得不断绝耶。以上为一段。首四句。言妇人诸
病。起于宗气上虚。成于经水下断。历年四句。又推所以经断之故。盖胞门之气。逼近血室。而司经水之总区。
经络之血。趋归血室。而为经水之原委。故两揭之耳。损指肌肤瘦削而言。分指肉轮离脱而言。膈阳上虚而
冲气犯之。则呕吐。又肺既受下寒之窘迫。则津液不布。而涎唾上泛。且肺气蜷缩而自壅。则生热而成痈。又
必至之势也。于是肺不能为脾胃行精悍以及周身。而形体之肌肤。以阴血不荣。而日损其肉轮。以阳气不
充而渐分矣。以上三句为第二段。就因虚二字而言其症。盖虚在心肺间之宗气。故见在上之症者如此。若
积冷结气。盘结在于中焦。则为绕脐寒疝者一。寒疝详本门。其或见于脐外两旁之季胁。疼痛下连肝脏者
二。以肝居至阴之下。与寒气尤为相召故也。且又有血因结而干。液因血而竭。而变为燥热之症。此亦在中
焦。故名热中。其候则拘急之痛。引于关元。又疮脉多数。今脉数无疮。正阴虚火炽之诊。且其肌肉粗若鱼鳞。
皆阴不泽阳。水不济火之候者三也。但此在上在中诸症。虽属妇人断经之候居多。然亦时着男子之亡血
失精者。非止女身所独有。又不可不知者也。若因虚而积冷结气。在于下焦。上虚则不能提挈。故一月再见。
或一行半月而来多。又上虚则不能传送。故过期不行。或行而不畅。而为不匀等病者有之。其积结在下。则
为冷拘阴沁之掣痛。及少腹中恶寒者有之。又或掣痛。后引腰脊。下引气街。以致气冲急痛。且下引之甚。至
于膝胫疼烦者有之。以膝胫属肾。疼烦者。肾气结而肾精竭之应也。至统上虚下冷而合推其症。下冷上犯。
必为奄忽眩冒。而一时不知人之状。如阴阳不相顺接之厥。而不得从厥治。如阴迸于上之巅。而不得从巅
治者有之。以积冷结气之上侮虚阳。而非真厥、真巅故也。又阳光上虚。而下阴乘之。譬之愁云郁雾。呃塞太
虚之象。故其神境中。尝若忧虞惨淡。而不胜悲伤。及烦冤而多嗔怒者有之。夫此厥巅忧惨等候。皆由上虚
失提。因而赤白带下。渐致阳愈虚而阴愈竭之症。非有鬼神凭借。使之若是也。惟此在下来多诸候。始为妇
人之所独病。而不着男子者矣。然而症则阴虚羸瘦。脉则阳虚多寒。病机变幻。尝于三十六病之中。千头万
绪。不可端拟。要不外乎阴阳二气。司诊视者。详审脉之阴阳。辨其何部正虚。何部邪实。何处脉紧气寒。何处
脉弦气削。审得在经络者。则行温针以通之散之。在胞门、绕脐、两胁、关元。等处者。则行温药以补之益之。便
可治危得安而无难。诚以病虽同症。而其致病之源各异。非审脉无以为辨症、故也。此条为女科之金针。
间曰。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。其症唇口干燥。故知之。当以温经汤主之。
温经汤方
人参 当归 芎 芍药 牡丹皮 阿胶（各二两） 麦冬（一升去心） 吴茱萸 桂枝（各二两） 半夏（半升）
甘草 生姜（各二两）
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。
伤寒金匮中。最难理会之文。莫如本条。以问意答意方意。俱似不相承贯故也。盖问语平铺。叙症错杂。觅其
所问之头绪。一难。答则丢开问中下利。劈空断为带下。又忽略问中诸症。独取唇口干燥一语。为确诊。而皆
不言其所以然之故。如半产血瘀。何以便带下。带下又何以便下利之类。又唇口干燥。亦下利伤阴之兼症。
何以便断为带下者。二难。至于断病。则曰少腹瘀血。病属带下。是在下焦矣。而诊病何以却在上焦之唇口
干燥。汤名则曰温经。谓温经以去瘀血则可。谓温经而并除带下。是何理也。又本衣冠文物以唇口干燥为的据。
投以本汤中之吴茱萸姜桂。而不虞其更干更燥。又何义耶。且问症如彼。主治如此。仲景当日。将置下利不
止等候于不问乎。抑治此而愈彼之道。将何奥旨乎。此三难也。何怪乎诸注之不能中其 窍乎哉。不知问
意。以妇人年五十所一句。谓天癸已竭。地道不通之时。撇开经血胎产。毫不着想。单重下利一病。而问其是
寒是热耳。故曰下利一症。寒热异因。各有确症。今数十日不止。大似中焦气寒。而失分理之司。下焦气虚。而
无关锁之候。然久利以发热为欲止。因阳气有起伏之机故也。乃暮即发热而利不止。则又非虚寒可断矣。
且少腹里急而下坠。腹中胀满而痞塞。又似内有阴寒之据。然手掌烦热。唇口干燥。又却似内有阳热之符。
此种下利。其或寒或热。将何推断耶。带下。以妊娠门二条按之。当就漏血之赤带而言。非指白带也。瘀血不
去。即致带下。虽详妊娠漏血注。然与妊娠、之漏血有分别者。以妊娠之血。为不得入胞胎而下从血室。此处
之带下。又肝血之络。为瘀血所阻。而不得入血室。故自下也。答意虽就诸症。层层细推。却又专从妇人着眼。
专从妇人之年五十所着眼。而断出者也。盖利至数十日。里急腹满。俱似寒因。暮即发热。手掌烦热。俱似阴
虚之热因。寒热既不应互见。且唇属脾。口属肺。唇口干燥。热利为合。又与数十日不止。及里急腹满者。尤不
应兼见。故知其平日素有赤带之病。以致脾肺不滋。故唇口干燥。血液内竭。故手掌烦热。暮即发热。血虚者。
气自寒。故利数十日不止。及里急腹满也。以其在妇人。故知其瘀血在少腹不去。以其年五十所。故知其非
目前之瘀。而为曾经半产所得之旧病也。然则不当从利为治。但行其瘀。而使血液归经。则带下可除。止其
带而使血液内润。则暮热掌热。及唇口干燥者亦解。究之血裕气温。将并数十日不止之利。及里急腹满者。
可不治而自愈矣。名之曰温经汤者。血气得寒则凝。得温则畅也。以辛温之姜桂为主。而以善降之半夏。善
敛之芍药佐之。则温下而适所以去下焦之瘀也。因瘀而肝血阻于血室之络。以致血不得由血室而外达
上供。故下陷而带下。渐成烦热干燥之候。故以芎麦之上滋者。补上焦之血。胶归之下滋者。补下焦之血。而
以善行阴阳之丹皮。分走而各注之。所以治暮热掌热。唇口干燥等候也。又血虚气寒而至于下利。究当责
之阳明之腑。故用苦温之茱萸。甘温之人参。而托以守中之甘草。则胃腑之阴阳起复。譬之大地春融冰消
雪化。田畴气暖。冰脱湿干之象。将瘀去而利亦自止矣。妇人少腹寒而不受胎。虽无血瘀。而此汤能温中
以温下。故亦主之。崩中去血。是非期而暴下。月水过多。指至期而大下。皆中寒失提。下寒失守之候。故兼取
A woman suffers from Wind-stroke (Taiyang disease caused by wind pathogen). After seven or eight days, she develops alternating chills and fever, occurring at regular intervals. Her menses happen to cease. This is Heat entering the Blood Chamber (the uterus and the sea of blood associated with the Liver channel). The blood must be congealed. Hence, it causes symptoms resembling malaria, with regular paroxysms. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment.
When a woman suffers from Wind-stroke, her symptoms of fever, sweating, aversion to wind, and a slow pulse are the same as in men. However, if the disease has persisted for seven or eight days, and the chills and fever have subsided only to return at regular intervals, this is no longer the chills and fever caused by the Wind pathogen. It is likely that she was menstruating, and the illness caused her menses to stop abruptly. Consequently, the blood that should have been discharged remains and congeals in the Ying (Nutritive) level. This is identical to how Malaria pathogens lie dormant in the Mu Yuan (semi-exterior/semi-interior region), where the Wei (Defensive) Qi attempts to interact but cannot circulate freely, leading to a struggle that produces chills and fever. Thus, it causes symptoms resembling malaria with regular paroxysms. The treatment should employ harmonizing methods; therefore, Xiao Chai Hu Tang is indicated. If the heat and blood stasis are severe, one may add Mu Dan Pi (Moutan Cortex) and Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) to clear heat and invigorate blood circulation.
When a woman suffers from Cold damage (Shanghan) with fever, and her menses happen to begin, she is lucid during the day but becomes delirious at night, seeing visions as if seeing ghosts. This is Heat entering the Blood Chamber. In treating this, do not injure the Stomach Qi or the Upper and Middle Jiao. She will recover spontaneously.
The presentation for a woman with Cold damage is similar. However, since her menses happened to begin during the illness, the Blood Chamber is empty, allowing the pathogen to enter. Furthermore, the circulation of Ying and Wei Qi in women rises at night and descends during the day. When the Qi rises at night, it carries the Heat pathogen upward to disturb the Spirit (Shen). Mildly, this causes delirium; severely, it causes visions of ghosts. Zhang Zhongjing diagnoses this as Heat entering the Blood Chamber to warn later generations against misdiagnosing it as Yangming Stomach Heat. Therefore, he advises against injuring the Stomach Qi and the Upper and Middle Jiao as a precaution.
If a woman suffers from Wind-stroke with fever and aversion to cold, and her menses happen to begin, after seven or eight days the fever subsides, the pulse becomes slow, and the body feels cool and comfortable, yet she experiences fullness in the chest and hypochondrium resembling Jie Xiong syndrome (phlegm-fluid retention in the chest), accompanied by delirium, this is Heat entering the Blood Chamber. One should puncture Qi Men (LR-14) and apply the reducing method according to the excess condition.
Fever and aversion to cold are original symptoms of Wind-stroke. If a woman with Wind-stroke happens to menstruate, and after seven or eight days the fever subsides, the pulse slows, and the body becomes cool, indicating that both exterior and interior pathogens have resolved, why would she still have chest and abdominal fullness resembling Jie Xiong syndrome and delirium? One must realize that seven or eight days prior, when chills and fever occurred, her menses had just begun. Because the Blood Chamber was active, Heat entered. Blood is generated by the Stomach and stored in the Liver. The chest and hypochondrium are the regions of the Liver and Stomach. Due to blood deficiency, the pathogen settles and accumulates in these areas. Although the appearance resembles Jie Xiong syndrome, Da Xian Xiong Tang (Major Trapping-in-the-Chest Decoction) or Xiao Xian Xiong Tang (Minor Trapping-in-the-Chest Decoction) should not be used. Instead, one should puncture Qi Men to drain the pathogen.
In Yangming disease, if there is bleeding from the lower orifices accompanied by delirium, this is Heat entering the Blood Chamber. There is only sweating on the head. Puncture Qi Men and apply the reducing method. Sweating will lead to recovery.
The first three paragraphs are identical to Articles 18, 19, and 20 of the Shaoyang Chapter in the Shanghan Lun. Although the commentary has appeared before, additional meanings remain, so they are further explained. This paragraph is also identical to Article 36 of the Yangming Chapter; its essential meaning has been detailed under that article, so no repetition is necessary. Regarding the distinction between using acupuncture versus Xiao Chai Hu Tang: when menses happen to begin, acupuncture is appropriate; when menses happen to cease, Xiao Chai Hu Tang is appropriate. When menses begin, Heat enters but does not congeal the blood in the Blood Chamber, so bleeding continues. Puncturing Qi Men drains the Heat from the Blood Chamber, leading to recovery. When menses cease, Heat enters the Blood Chamber and congeals the blood, causing the cessation of menses. Without Xiao Chai Hu Tang to resolve the Heat and induce sweating to disperse the blood, recovery is impossible.
If a woman feels as though there is a piece of roasted meat stuck in her throat, Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) is the primary treatment. (Qian Jin Fang states: "A feeling of tightness in the throat as if a piece of roasted meat were present" refers to this.)
Ban Xia Hou Po Tang Formula: Ban Xia (Pinelliae Rhizoma) - 1 sheng; Hou Po (Magnoliae Officinalis Cortex) - 3 liang; Fu Ling (Poria) - 4 liang; Sheng Jiang (Zingiberis Rhizoma Recens) - 5 liang; Zi Su Ye (Perillae Folium) - 2 liang.
Take the above five herbs, add seven sheng of water, boil to obtain four sheng. Divide into four warm doses. Take three times during the day and once at night.
Women often have a narrow mindset. Whenever they experience worry, thought, anger, or depression, Qi stagnates in the chest and does not dissipate. Thus, the throat feels as if blocked by a piece of roasted meat; belching cannot expel it, and swallowing cannot pass it. This is a sign of stagnant Qi obstructing horizontally and failing to descend or dissipate. Therefore, Ban Xia, which directs rebellious Qi downward, is used as the sovereign herb. It is assisted by Hou Po, which opens stagnation; Sheng Jiang, which disperses stagnation; Fu Ling, which leaches out dampness to remove the foundation of stagnation; and Zi Su Ye, which scatters pathogens to break the knots of stagnation. Thus, Qi descends and disperses sideways, leaving no room for stagnant Qi.
If a woman suffers from Zang Zao (Visceral Restlessness), she frequently feels sad, desires to cry, and her demeanor appears as if possessed by spirits. She yawns and stretches frequently. Gan Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction) is the primary treatment.
Gan Cao Xiao Mai Da Zao Tang Formula: Gan Cao (Glycyrrhizae Radix et Rhizoma) - 3 liang; Xiao Mai (Tritici Fructus) - 1 sheng; Da Zao (Zizyphi Fructus) - 10 pieces.
Take the above three herbs, add six sheng of water, boil to obtain three sheng. Divide into three warm doses. This formula also tonifies Spleen Qi.
"Zang" refers to the Heart and Lungs. "Zang Zao" means the Yin fluids within the viscera are dry, and the True Qi of the viscera cannot stand independently, resulting in restlessness. Thus, the Heart Spirit (Shen) and Lung Corporeal Soul (Po) feel unsupported and unable to sustain themselves, leading to sadness and crying due to grievance. Appearing as if possessed indicates spontaneous sadness and crying without an obvious cause, as if relying on something external. When Qi lacks support, it pulls up and down, causing yawning (Qi naturally lengthens); when it seeks to extend outward, it causes stretching. Wheat is the grain corresponding to the Heart; Jujube is the fruit corresponding to the Lung. Both are sweet-cold or sweet-warm and tend to nourish Yin fluids. With Gan Cao floating them upward, they circulate between the Heart and Lungs, enriching the Spirit and Po. Is this merely about eating sweet foods to alleviate restlessness? It also tonifies Spleen Qi. The rationale is seen in the first volume under "Tonifying Liver." Tonifying the Fire fluid of the Heart can generate Earth (Spleen) via the mother-child relationship, and tonifying the Metal fluid of the Lung can benefit the Mother (Heart) via the child-mother relationship. Note: "Tonifying Spleen" here refers not to Spleen Qi but to Spleen fluids. Thus, this decoction can serve as a complementary agent to Pi Yue Wan (Spleen Restriction Pill).
If a woman vomits saliva and froth, and the physician mistakenly uses purgatives, epigastric stuffiness (Pi) immediately occurs. One must first treat the vomiting of saliva and froth with Xiao Qing Long Tang (Minor Green Dragon Decoction). Once the froth stops, treat the epigastric stuffiness with Xie Xin Tang (Drain the Epigastrium Decoction).
Water-Cold Qi floats upward, forcing the Lungs to lose their function of distribution, causing the vomiting of saliva and froth. The correct treatment is to warm, dry, leach, and drain. Using purgatives to remove the froth is an error. Not only will the froth not stop, but the Stomach Yang will become more deficient due to the cold purgative, causing Pi Qi to block the epigastrium. One must first treat the root cause, the vomiting of saliva and froth. Xiao Qing Long Tang induces sweating and promotes urination, dispersing water and moving fluids, so the froth stops naturally. Then, use Ban Xia Xie Xin Tang to treat the Pi, filling the diaphragm, directing rebellious Qi downward, and resolving the stuffiness. Xu Zhongke's commentary on Ban Xia Xie Xin Tang mistakenly identifies it as San Huang Xie Xin Tang (Three Yellows Drain the Epigastrium Decoction), misleading countless people.
Women's diseases arise from deficiency, accumulated cold, and Qi stagnation, leading to the cessation of menstruation in various forms. Some cases last for years. Cold blood accumulates and congeals; the Bao Men (uterine opening) is injured by cold; meridians become凝 solid and hard. Above, there is vomiting of saliva and froth, which over time becomes Fei Yong (Lung Abscess). The body wastes away, and flesh separates. In the middle, there is coiling around the umbilicus with Han Shan (Cold Hernia), or pain in both hypochondria connecting to the viscera. Or there is heat accumulation in the center, pain at Guan Yuan (CV-4), rapid pulse without ulceration, skin rough like fish scales. This sometimes affects men, not just women. Below, there is excessive leukorrhea, irregular menstruation, pulling pain in the Yin, aversion to cold in the lower abdomen, possibly radiating to the lower back and spine, extending down to Qi Jie (Groin), urgent pain at Qi Chong (ST-30), and painful annoyance in the knees and shins. Suddenly, dizziness and vertigo occur, resembling Jue (syncope) or Dian (epilepsy). There may be sorrow, grief, and irritability. All these belong to Dai Xia (Leukorrhea/Lower Burner disorders), not ghost possession. Over time, the body becomes emaciated, the pulse is deficient and cold. The thirty-six diseases change endlessly. Examine the pulse for Yin/Yang, deficiency/excess, tight/string-taut. Apply acupuncture and herbs to treat critical conditions and achieve safety. Although the diseases may appear similar, their pulse origins differ. You must distinguish and record them. Do not say otherwise.
The Qi between the Heart and Lungs in the human body originates from the warm fire of Ming Men (Gate of Life) congenitally, traveling along the spine to steam into the chest. Postnatally, it comes from the vigorous essence of the Stomach, passes through the Spleen to fill the Lungs, and supports the exterior in the chest. These two combine to create Tai He (Great Harmony), filling the chest and diaphragm. Outwardly, it is the root for the movement of meridians and Wei Qi; inwardly, it governs the warming and covering transformations of the Middle and Lower Jiao. Its subtle ability to move blood, nourish the spirit, elevate essence, and control Qi is the great treasure of life. Thus, it is called Zong Qi (Gathering Qi). Zong Qi implies being the "patriarch" rather than the "ancestor," similar to the postnatal Li Fire positioned in the South, succeeding Qian and Kun, and holding the power to transform and generate all things. This Qi is precious in both men and women, but especially important for women. Although detailed in the Xu Lao (Deficiency and Emaciation) chapter, the profound principles and ancient language of this paragraph require understanding the source and significance of this Qi to be comprehended. "Deficiency" refers to the shallowness of this Zong Qi. Women's diseases arise because the Qi of the Upper Jiao (like mist) is deficient, causing all Qi to gradually become cold. Long-standing cold leads to accumulated cold everywhere, such as in the Bao Men, meridians, around the umbilicus, hypochondria, lower abdomen, lower back, Qi Jie, and knees/shins mentioned below. Qi requires fullness and warmth for circulation. Deficiency leads to stagnation and knotting; cold leads to freezing and knotting. Thus, Qi stagnation. Only deficiency fails to move blood; cold fails to warm blood; knotting fails to allow blood to flow. Any one of these three can stop menstruation. It is not only Qi knotting that stops menses. Hence, it causes the cessation of menstruation. "Lasting for years" means Zong Qi deficiency persists long enough that blood cold and accumulation occur. Internally, the Bao Men is injured by cold, killing vitality; externally, meridians become rigid, blocking flow. How can menstruation continue? This is the first section: the first four sentences state that women's diseases start with Upper Jiao Zong Qi deficiency and result in menstrual cessation. The next four sentences explain why menstruation ceases. Bao Men Qi is close to the Blood Chamber and governs menstruation; Meridian Blood flows to the Blood Chamber and is the source of menstruation. Hence, they are highlighted. "Sun" refers to emaciated skin; "Fen" refers to separated flesh. Diaphragmatic Yang deficiency allows Chong Qi to invade, causing vomiting. The Lungs, oppressed by lower cold, fail to distribute fluids, causing saliva/froth to float up. Lung Qi contracts and blocks itself, generating heat and forming abscesses—a inevitable progression. Thus, the Lungs cannot transport vigorous Qi from the Spleen/Stomach to the body. Skin and muscles waste due to lack of Yin blood nourishment, and separate due to lack of Yang Qi充盈. These three sentences form the second section, discussing symptoms arising from "deficiency." Deficiency lies in the Zong Qi between Heart and Lungs, hence upper symptoms. If accumulated cold and Qi knot in the Middle Jiao, it causes cold hernia around the umbilicus (1). Pain in the lateral hypochondria connecting to the Liver (2), as the Liver resides in the lowest Yin and attracts cold. Or, blood dries from knotting, fluids deplete from blood loss, transforming into dry-heat symptoms in the Middle Jiao, called "Re Zhong" (Heat in the Center). Symptoms include cramping pain radiating to Guan Yuan. A rapid pulse usually indicates ulcers; here, rapid pulse without ulcer indicates Yin deficiency and blazing fire. Rough, fish-scale-like skin indicates Yin failing to moisten Yang and Water failing to control Fire (3). Although these upper/middle symptoms often accompany menstrual cessation in women, they also occur in men with blood loss or essence depletion, not exclusively in women. If deficiency, accumulated cold, and Qi knot in the Lower Jiao, Upper deficiency fails to lift, causing menstruation twice a month or heavy flow lasting half a month. Upper deficiency fails to transport, causing delayed menstruation or irregular flow. Accumulation in the lower causes pulling pain in the Yin and cold in the lower abdomen. Pulling pain may radiate to the lower back, spine, Qi Jie, causing urgent pain at Qi Chong, and painful annoyance in knees/shins. Knees/shins belong to the Kidney; pain/annoyance indicates Kidney Qi knotting and Essence depletion. Combining Upper deficiency and Lower cold: Lower cold attacks upward, causing sudden dizziness/vertigo and unconsciousness, resembling Jue (Yin-Yang disconnect) but not treated as such. It resembles Yin rushing to the top (Dian) but not treated as such, because accumulated cold/knot harasses deficient Yang, unlike true Jue or Dian. Sunlight (Yang) is deficient above, Yin invades below, like dark clouds blocking the sky. Spiritually, this manifests as sorrow, grief, and irritability. These Jue/Dian/sorrow symptoms result from Upper deficiency failing to lift, leading to red/white leukorrhea, gradually worsening Yang deficiency and Yin exhaustion. This is not ghost possession. Only the lower symptoms (leukorrhea, etc.) are unique to women. However, symptoms show Yin deficiency and emaciation; pulses show Yang deficiency and cold. Disease mechanisms in the thirty-six diseases are complex, revolving around Yin and Yang Qi. Physicians must examine pulses for Yin/Yang, identify deficiency vs. excess, tight/cold vs. string-taut/weak. For meridian issues, use warm acupuncture to unblock and disperse. For Bao Men, umbilicus, hypochondria, Guan Yuan, use warm herbs to tonify and benefit. Critical conditions can be stabilized. Though symptoms are similar, etiologies differ; pulse examination is essential for differentiation. This paragraph is the golden needle of Gynecology.
Question: A woman around fifty years old suffers from diarrhea for dozens of days without stopping. She has evening fever, urgency and discomfort in the lower abdomen, abdominal fullness, vexatious heat in the palms, and dry lips and mouth. What is the cause? Master says: This disease belongs to Dai Xia (Leukorrhea/Lower Burner disorder).
Why? She previously had a miscarriage, and blood stasis remains in the lower abdomen. How do we know? The symptom of dry lips and mouth indicates this. Wen Jing Tang (Warming the Channels Decoction) is the primary treatment.
Wen Jing Tang Formula: Ren Shen (Ginseng Radix) - 2 liang; Dang Gui (Angelicae Sinensis Radix) - 2 liang; Chuan Xiong (Ligustici Chuanxiong Rhizoma) - 2 liang; Bai Shao (Paeoniae Radix Alba) - 2 liang; Mu Dan Pi (Moutan Cortex) - 2 liang; E Jiao (Colla Corii Asini) - 2 liang; Mai Dong (Ophiopogonis Radix, heart removed) - 1 sheng; Wu Zhu Yu (Evodiae Fructus) - 2 liang; Gui Zhi (Cinnamomi Ramulus) - 2 liang; Ban Xia (Pinelliae Rhizoma) - 0.5 sheng; Gan Cao (Glycyrrhizae Radix et Rhizoma) - 2 liang; Sheng Jiang (Zingiberis Rhizoma Recens) - 2 liang.
Take the above twelve herbs, add ten dou of water, boil to obtain three sheng. Divide into three warm doses. This formula also treats cold in the lower abdomen preventing conception, metrorrhagia (abnormal uterine bleeding), menorrhagia (heavy menstruation), and amenorrhea.
The most difficult text in Shanghan Lun and Jingui Yaolue is this paragraph, as the question, answer, and formula intent seem disconnected. The question is straightforward, but symptoms are mixed. Finding the thread is difficult (Difficulty 1). The answer ignores the diarrhea, abruptly diagnosing Dai Xia, and overlooks other symptoms, focusing solely on dry lips/mouth for diagnosis without explanation. Why does miscarriage stasis cause Dai Xia? Why does Dai Xia cause diarrhea? Dry lips/mouth could be Yin injury from diarrhea; why diagnose Dai Xia? (Difficulty 2). The disease is diagnosed as lower jiao (lower abdomen stasis/Dai Xia), yet diagnosis relies on upper jiao (lips/mouth). The formula is named "Warming the Channels." Warming channels removes stasis, but what logic warms channels to cure Dai Xia? Using acrid-warm herbs (Wu Zhu Yu, Ginger, Cinnamon) for dry lips/mouth seems counterintuitive. Did Zhang Zhongjing ignore the diarrhea? What is the profound principle of curing one by treating another? (Difficulty 3). No wonder commentators miss the point.
Understanding the question: "Woman around fifty" implies Tian Gui (menstrual essence) has exhausted, and the earthly pathway (menstruation) has stopped. Ignoring menstruation/pregnancy, the focus is on diarrhea: is it cold or heat? Diarrhea has different causes. Dozens of days suggests Middle Jiao Qi cold losing regulation, Lower Jiao Qi deficiency losing closure. Usually, fever in chronic diarrhea indicates resolution (Yang Qi rising). But evening fever with persistent diarrhea is not simple deficiency-cold. Lower abdominal urgency/fullness suggests internal Yin-cold. Yet palm heat and dry lips suggest internal Yang-heat. How to judge cold vs. heat? "Dai Xia" here refers to bloody leukorrhea (red discharge), not white. Stasis prevents proper flow, causing leakage. Unlike pregnancy bleeding (fetus not retaining blood), this is Liver blood collaterals blocked by stasis, unable to enter the Blood Chamber, thus leaking downward. The answer analyzes symptoms but focuses on the woman's age (fifty). Chronic diarrhea, urgency, fullness look cold. Evening fever, palm heat look Yin-deficiency heat. Cold and heat shouldn't mix. Lips belong to Spleen, mouth to Lungs. Dry lips/mouth fits heat diarrhea, conflicting with chronic diarrhea/urgency. Thus, she likely has chronic bloody leukorrhea, damaging Spleen/Lung Yin (dry lips/mouth) and exhausting blood (palm heat/evening fever). Blood deficiency leads to Qi cold, causing chronic diarrhea/urgency. Being a woman, stasis is in the lower abdomen. Being fifty, it's old stasis from past miscarriage. Treatment should not target diarrhea directly but move stasis to return blood to vessels, curing Dai Xia. Stopping Dai Xia moistens blood internally, resolving fever/dryness. Ultimately, abundant blood and warm Qi will heal the diarrhea and fullness spontaneously. Named "Warming the Channels" because blood congeals in cold and flows in warmth. Acrid-warm Ginger/Cinnamon are sovereign; descending Ban Xia and astringent Bai Shao assist. Warming the lower resolves stasis. Stasis blocks Liver blood in Blood Chamber collaterals, preventing upward supply, causing downward leakage and heat/dryness. Chuan Xiong/Mai Dong nourish Upper Jiao blood; E Jiao/Dang Gui nourish Lower Jiao blood. Mu Dan Pi moves Yin/Yang, distributing effects to treat fever/dryness. Diarrhea from blood deficiency/Qi cold relates to Yangming Fu. Wu Zhu Yu (bitter-warm), Ren Shen (sweet-warm), Gan Cao (neutral) restore Stomach Yin/Yang, like spring thawing ice, drying fields. Stasis removal stops diarrhea. For cold lower abdomen infertility without stasis, this formula warms middle/lower, so it is also indicated. Beng Qu (metrorrhagia) is sudden non-period bleeding; Yue Shui Guo Duo is heavy period bleeding. Both indicate Middle Cold failing to lift and Lower Cold failing to guard. Hence, included.