妇人有怀抱甚郁，口干舌渴，呕吐吞酸，而血下崩者，人皆以火治之，时而效，时而不效，其故何也？是不识为
肝气之郁结也。夫肝主藏血，气结而血亦结，何以反至崩漏？盖肝之性急，气结则其急更甚，更急则血不能藏，故
崩不免也。治法宜以开郁为主，若徒开其郁，而不知平肝，则肝气大开，肝火更炽，而血亦不能止矣。
方用平肝开郁止血汤。
白芍（一两，醋炒） 白术（一两，土炒） 当归（一两，酒洗） 丹皮（三钱） 三七根（三钱，研末） 生地
（三钱，酒炒） 甘草（二钱） 黑芥穗（二钱） 柴胡（一钱）
水煎服。一剂呕吐止，二剂干渴除，四剂血崩愈。方中妙在白芍之平肝，柴胡之开郁，白术利腰脐，则血无积
住之虞。荆芥通经络，则血有归还之乐。丹皮又清骨髓之热。生地复清脏腑之炎。当归、三七于补血之中，以行止
血之法，自然郁结散而血崩止矣。
眉批∶此方入贯仲炭三钱更妙。
歌括∶郁结血崩病在肝，舌干口渴呕吞酸。
治宜平肝兼开郁，对症投药病可安。
平肝开郁止血汤，归芍术丹生地黄。
三七柴草黑芥穗，加贯仲炭效更彰。
妇人有升高坠落，或闪挫受伤，以致恶血下流，有如血崩之状者，若以崩治，非徒无益而又害之也。盖此症之
状，必手按之而疼痛，久之则面色萎黄，形容枯槁，乃是瘀血作祟，并非血崩可比。倘不知解瘀而用补涩，则瘀血
内攻，疼无止时，反致新血不得生，旧血无由化，死不能悟，岂不可伤哉！治法须行血以去瘀，活血以止疼，则血
自止而愈矣。
方用逐瘀止血汤。
生地（一两，酒炒） 大黄（三钱） 赤芍（三钱） 丹皮（一钱） 当归尾（五钱） 枳壳（五钱，炒） 龟版
（三钱，醋炙） 桃仁（十粒，泡炒，研）
水煎服。一剂疼轻，二剂疼止，三剂血亦全止，不必再服矣。此方之妙，妙于活血之中，佐以下滞之品，故逐
瘀如扫，而止血如神。或疑跌闪升坠，是由外而伤内，虽不比内伤之重，而既已血崩，则内之所伤，亦不为轻，何
以只治其瘀而罔顾气也？殊不知跌闪升坠，非由内伤以及外伤者可比。盖本实不拨，去其标病可耳，故曰急则治其标。
眉批∶凡跌打损伤致唾血、呕血皆宜如此治法。若血聚胃中，宜加川浓朴一钱半，姜汁炒。
歌括∶坠落闪挫致血崩，面萎形枯按之痛。
瘀血作祟是病因，活血化瘀新血生。
逐瘀止血用生地，大黄赤芍粉丹皮。
归尾枳壳炙龟版，泡炒桃仁用十粒。
妇女中有人胸怀极度抑郁，出现口干舌燥、口渴、呕吐及吞酸的症状，并且发生下部大量出血（血崩）。人们通常用清热泻火的方法治疗，有时有效，有时无效，这是什么原因呢？这是因为没有认识到这是肝气郁结所致。肝脏主司贮藏血液，气机郁结则血液也会随之凝滞，为什么反而会导致严重的崩漏呢？大概是因为肝脏的特性是急躁的，气机郁结会使这种急躁更加严重，过于急躁则血液无法被固摄贮藏，所以难免发生崩漏。治疗方法应当以疏解郁结为主，如果仅仅疏解郁结，而不知道平抑肝气，那么肝气就会过度升发，肝火更加旺盛，血液也就无法止住了。
方剂使用平肝开郁止血汤。
白芍（一两，醋炒） 白术（一两，土炒） 当归（一两，酒洗） 丹皮（三钱） 三七根（三钱，研成粉末） 生地（三钱，酒炒） 甘草（二钱） 黑芥穗（二钱） 柴胡（一钱）
用水煎服。服用一剂后呕吐停止，两剂后干渴消除，四剂后血崩痊愈。这个方剂的妙处在于白芍能平抑肝气，柴胡能疏解郁结，白术能疏通腰脐部位的气机，从而避免血液积滞的担忧。荆芥能通达经络，使血液回归正道。丹皮又能清除骨髓中的热邪。生地又能清除脏腑内的炎症。当归和三七在补血的同时，施行止血的方法，自然使得郁结消散而血崩停止。
眉批：此方加入炭制的贯众三钱效果更佳。
歌诀：郁结引起的血崩病位在肝，舌头干燥口渴呕吐吞酸。
治疗宜平抑肝气兼疏解郁结，对症用药疾病可安宁。
平肝开郁止血汤，包含当归、白芍、白术、丹皮、生地黄。
三七、柴胡、甘草、黑芥穗，加入炭制贯众疗效更显著。
妇女中有因登高坠落，或闪挫受伤，导致恶血下行，症状如同血崩一样的情况。如果按照血崩来治疗，不仅无益反而有害。因为这种病症的表现，一定是用手按压时感到疼痛，时间久了则面色萎黄，形体枯槁，这是瘀血在作祟，并不是普通的血崩可以相比的。倘若不懂得化解瘀血而使用补益收敛的药物，那么瘀血会在体内攻冲，疼痛没有尽头，反而导致新血无法生成，旧血无法化除，至死都不醒悟，这难道不可悲吗！治疗方法必须行血以去除瘀血，活血以缓解疼痛，那么血液自然会停止并痊愈。
方剂使用逐瘀止血汤。
生地（一两，酒炒） 大黄（三钱） 赤芍（三钱） 丹皮（一钱） 当归尾（五钱） 枳壳（五钱，炒） 龟版（三钱，醋炙） 桃仁（十粒，泡炒，研碎）
用水煎服。服用一剂后疼痛减轻，两剂后疼痛停止，三剂后血液完全停止，不需要再服用了。这个方剂的妙处，妙在活血之中，佐以向下导滞的药物，所以祛除瘀血如扫荡般迅速，而止血如神一般灵验。或许有人怀疑跌打闪挫坠落，是由外部伤害内部，虽然不比内伤严重，但既然已经出现类似血崩的情况，那么内部所受的损伤也不轻，为什么只治疗瘀血而不顾护气机呢？殊不知跌打闪挫坠落，不能与由内伤引起外伤的情况相比。因为根本未动摇，只需去除标病即可，所以说“急则治其标”。
眉批：凡是跌打损伤导致的吐血、呕血都适宜采用这种治疗方法。如果血液积聚在胃中，宜加入川厚朴一钱半，用姜汁炒制。
歌诀：坠落闪挫导致血崩，面色萎黄形体枯槁按压疼痛。
瘀血作祟是病因，活血化瘀使新血产生。
逐瘀止血使用生地，大黄、赤芍、丹皮。
归尾、枳壳、炙龟版，泡炒桃仁用十粒。
In women who are deeply depressed in spirit, presenting with dry mouth and tongue, thirst, vomiting, and acid regurgitation, accompanied by severe lower bleeding (metrorrhagia), people often treat it with fire-clearing methods. Sometimes effective, sometimes not, why is this? It is because they fail to recognize it as a condition caused by the stagnation of Liver Qi. The Liver stores blood; when Qi stagnates, blood also stagnates. Why does it then lead to severe metrorrhagia and uterine bleeding? This is likely due to the nature of the Liver being urgent and quick-tempered. When Qi stagnates, this urgency becomes even more pronounced. Excessive urgency prevents the blood from being stored properly, thus inevitably leading to metrorrhagia. The treatment method should primarily focus on resolving stagnation. If one merely resolves stagnation without calming the Liver, the Liver Qi will rise excessively, Liver Fire will become more intense, and the bleeding cannot be stopped.
The formula used is Pinggan Kaiyu Zhixue Tang (Calming the Liver, Resolving Stagnation, and Stopping Bleeding Decoction).
Bai Shao (Radix Paeoniae Alba, 1 liang, stir-fried with vinegar) Bai Zhu (Rhizoma Atractylodis Macrocephalae, 1 liang, stir-fried with soil) Dang Gui (Radix Angelicae Sinensis, 1 liang, washed with wine) Dan Pi (Cortex Moutan, 3 qian) San Qi Radix Notoginseng, 3 qian, ground into powder) Sheng Di Huang (Radix Rehmanniae Preparata, 3 qian, stir-fried with wine) Gan Cao (Radix Glycyrrhizae, 2 qian) Hei Jie Sui (Flos Artemisiae Argyi Carbonized, 2 qian) Chai Hu (Radix Bupleuri, 1 qian)
Decoct with water and take orally. After one dose, vomiting stops; after two doses, dryness and thirst are relieved; after four doses, metrorrhagia is cured. The brilliance of this formula lies in Bai Shao's ability to calm the Liver, Chai Hu's ability to resolve stagnation, and Bai Zhu's ability to benefit the waist and umbilical region, thereby avoiding the risk of blood accumulation. Jing Jie (Herba Schizonepetae) unblocks the collaterals, allowing blood to return to its proper course. Dan Pi clears heat from the bone marrow. Sheng Di Huang clears inflammation from the zang-fu organs. Dang Gui and San Qi employ hemostatic methods within the context of nourishing blood, naturally causing the stagnation to dissipate and the bleeding to stop.
Marginal note: Adding 3 qian of Guan Zhong Tan (Carbonized Rhizoma Cyathiulae) to this formula enhances its efficacy.
Song verse: Metrorrhagia due to stagnation resides in the Liver; dry tongue, thirst, vomiting, and acid regurgitation occur.
Treatment should calm the Liver and resolve stagnation simultaneously; administering correct medication brings peace.
Pinggan Kaiyu Zhixue Tang contains Dang Gui, Bai Shao, Bai Zhu, Dan Pi, and Sheng Di Huang.
San Qi, Chai Hu, Gan Cao, and Hei Jie Sui; adding Guan Zhong Tan makes the effect more prominent.
In women who have fallen from heights or suffered sprains and injuries, leading to the flow of evil blood downwards, resembling the appearance of metrorrhagia, treating it as simple metrorrhagia is not only useless but harmful. The symptoms of this condition must include pain upon palpation; over time, the complexion becomes sallow, and the body appears emaciated and withered. This is caused by blood stasis, which is not comparable to ordinary metrorrhagia. If one fails to resolve the stasis and instead uses tonifying and astringent herbs, the blood stasis will attack internally, causing endless pain. Consequently, new blood cannot be generated, and old blood cannot be transformed. Dying without understanding this is truly lamentable! The treatment method must promote blood circulation to remove stasis and invigorate blood to alleviate pain, so that the bleeding will naturally stop and recovery will occur.
The formula used is Zhuyu Zhixue Tang (Expelling Stasis and Stopping Bleeding Decoction).
Sheng Di Huang (Radix Rehmanniae Preparata, 1 liang, stir-fried with wine) Da Huang (Radix et Rhizoma Rhei, 3 qian) Chi Shao (Radix Paeoniae Rubra, 3 qian) Dan Pi (Cortex Moutan, 1 qian) Dang Gui Wei (Cauda Radicis Angelicae Sinensis, 5 qian) Zhi Ke (Fructus Aurantii, 5 qian, stir-fried) Gui Ban (Carapax et Plastrum Testudinis, 3 qian, stir-fried with vinegar) Tao Ren (Semen Persicae, 10 grains, soaked, stir-fried, and ground)
Decoct with water and take orally. After one dose, pain lightens; after two doses, pain stops; after three doses, bleeding completely ceases, and no further administration is needed. The brilliance of this formula lies in its combination of blood-invigorating herbs with agents that direct downward stagnation. Thus, expelling stasis is like sweeping, and stopping bleeding is miraculous. One might suspect that falls, sprains, and drops cause internal injury from external trauma. Although not as severe as internal injuries per se, since metrorrhagia has occurred, the internal damage is not light. Why treat only the stasis while ignoring Qi? It is unknown that falls, sprains, and drops differ from conditions where internal injury leads to external manifestations. Since the root remains intact, addressing the branch disease suffices. Hence, it is said: "In acute cases, treat the branch."
Marginal note: For hematemesis or hemoptysis caused by bruises and fractures, this treatment method is generally suitable. If blood accumulates in the stomach, add 1.5 qian of Chuan Niu Pu (Cortex Magnoliae Officinalis) stir-fried with ginger juice.
Song verse: Falling, spraining, and twisting cause metrorrhagia; sallow complexion, emaciation, and pain upon pressing.
Blood stasis acting as the culprit; invigorating blood and resolving stasis generates new blood.
Zhuyu Zhixue Tang uses Sheng Di Huang, Da Huang, Chi Shao, and Dan Pi.
Dang Gui Wei, Zhi Ke, and Gui Ban (stir-fried); use 10 grains of Tao Ren (soaked and stir-fried).