妇人有带下而色黑者，甚则如黑豆汁，其气亦腥，所谓黑带也。夫黑带者，乃火热之极也，或疑火色本红，何
以成黑？谓为下寒之极或有之。殊不知火极似水，乃假象也。其症必腹中疼痛，小便时如刀刺，阴门必发肿，面色
必发红，日久必黄瘦，饮食必兼人，口中必热渴，饮以凉水，少觉宽快，此胃火太旺，与命门、膀胱、三焦之火合
而熬煎，所以熬干而变为炭色，断是火热之极之变，而非少有寒气也。此等之症，不至发狂者，全赖肾水与肺金无
病，其生生不息之气，润心济胃以救之耳，所以但成黑带之症，是火结于下而不炎于上也。治法惟以泄火为主，火
热退而湿自除矣。
方用利火汤。
大黄（三钱） 白术（五钱，土炒） 茯苓（三钱） 车前子（三钱，酒炒） 王不留行（三钱） 黄连（三钱）
栀子（三钱，炒） 知母（二钱） 石膏（五钱， ） 刘寄奴（三钱）
水煎服。一剂小便疼止而通利，二剂黑带变为白，三剂白亦少减，再三剂全愈矣。或谓此方过于迅利，殊不知
火盛之时，用不得根据违之法，譬如救火之焚，而少为迁缓，则火势延燃，不尽不止。今用黄连、石膏、栀子、知母一
派寒凉之品，入于大黄之中，则迅速扫除。而又得王不留行与刘寄奴之利湿甚急，则湿与热俱无停住之机。佐白术
以辅土、茯苓以渗湿、车前以利水，则火退水进，便成既济之卦矣。
眉批∶病愈后当节饮食，戒辛热之物，调养脾土。若恃有此方，病发即服，必伤元气矣，慎之！
歌括∶带下色黑气腥膻，腹痛小便如刀穿。
胃命三焦火俱盛，火结于下未上炎。
利火大黄石膏连，白术茯苓炒车前。
不留寄奴栀知母，火退水进黑带减。
妇女有带下颜色发黑的，甚至像黑豆汁一样，气味也腥臭，这就是所谓的黑带。黑带是由于火热到了极点造成的。有人怀疑火的本质颜色是红色，怎么会变成黑色呢？认为可能是下焦寒邪到了极点才会有这种情况。殊不知火极似水，这不过是假象罢了。这种病症必然伴有腹部疼痛，小便时像被刀刺一样痛，阴门必然肿胀，面色必然发红，日子久了必然变得面黄肌瘦，饮食量比常人加倍，口中必然感到灼热口渴，喝凉水后稍微觉得舒适爽快。这是胃火太旺，与命门、膀胱、三焦之火合在一起煎熬，所以把津液熬干而变成了炭色。这绝对是火热到了极点的变化，而不是有一点点寒气。这类病症，之所以没有发展到发狂的地步，全赖肾水和肺金没有生病，它们生生不息的气机，滋润心脏、济助胃腑来救急，所以只形成黑带的病症，是因为火结聚在下焦而不向上炎蒸。治疗方法只有以泄火为主，火热退去而湿气自然也就消除了。
方剂用利火汤。
大黄（三钱） 白术（五钱，土炒） 茯苓（三钱） 车前子（三钱，酒炒） 王不留行（三钱） 黄连（三钱）
栀子（三钱，炒） 知母（二钱） 石膏（五钱，打碎） 刘寄奴（三钱）
用水煎服。服一剂后小便疼痛停止且通畅流利，服两剂后黑带变为白色，服三剂后白带也减少，再服几剂就完全痊愈了。有人说这个方药过于迅猛厉害，殊不知火势旺盛的时候，不能用违背病情的温和方法，就像救火灾一样，如果稍微迟缓，火势就会蔓延燃烧，不烧尽是不会停止的。现在使用黄连、石膏、栀子、知母这一派寒凉的药物，配合大黄在其中，就能迅速扫除病邪。再加上王不留行和刘寄奴利湿作用非常急切，那么湿气和热气就没有停留的机会。佐以白术来辅助脾胃之气，茯苓来渗利湿气，车前子来通利水道，这样火退水进，就形成了水火既济的卦象了。
眉批：病愈后应当节制饮食，戒除辛辣温热的食物，调养脾土。如果倚仗有这个方子，病一发就服用，必然会损伤元气，务必谨慎！
歌诀：
带下颜色黑气味腥膻，腹痛小便像刀穿。
胃火、命门火、三焦火都旺盛，火结聚在下部未向上炎蒸。
利火汤中有大黄、石膏、黄连，白术、茯苓、炒车前子。
王不留行、刘寄奴、栀子、知母，火退水进黑带减轻。
Women may experience leukorrhea with a black color, even resembling the juice of black beans, with a fishy odor; this is referred to as Black Leukorrhea (Hei Dai Xia). Black leukorrhea results from extreme heat-fire. Some might doubt that since the color of fire is red, how can it become black? They might suggest it could be due to extreme cold in the lower jiao. However, they do not realize that "extreme fire resembles water" is merely an illusion. The symptoms must include abdominal pain, urination feeling like being pierced by a knife, swelling of the vaginal opening, a red complexion, and over time, emaciation with a sallow complexion. The appetite will be greater than normal, and there will be a sensation of heat and thirst in the mouth. Drinking cool water provides slight relief. This indicates excessive stomach fire combining with fire in the Mingmen (Gate of Life), Bladder, and Sanjiao (Triple Burner) to scorch and dry up fluids, turning them into a charcoal-like color. It is undoubtedly a transformation of extreme heat-fire, not involving any cold pathogen. Such cases do not progress to mania only because the Kidney Water and Lung Metal are healthy; their continuous vital energy moistens the Heart and assists the Stomach to rescue the body. Thus, the condition manifests only as black leukorrhea because the fire is knotted in the lower jiao and does not flare upward. The treatment method focuses solely on draining fire; once the heat-fire recedes, dampness will naturally disappear.
The formula used is Fire-Draining Decoction (Li Huo Tang).
Dahuang (Rhei Radix et Rhizoma, 3 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, 5 qian, stir-fried with soil) Fuling (Poria, 3 qian) Cheqianzi (Plantaginis Semen, 3 qian, stir-fried with wine) Wangbuliuxing (Vaccariae Semen, 3 qian) Huanglian (Coptidis Rhizoma, 3 qian) Zhizi (Gardeniae Fructus, 3 qian, stir-fried) Zhimu (Anemarrhenae Rhizoma, 2 qian) Shigao (Gypsum Fibrosum, 5 qian, crushed) Liu Jinu (Artemisiae Annuae Herba, 3 qian)
Decoct in water and take orally. After one dose, urinary pain stops and flow becomes smooth. After two doses, black leukorrhea turns white. After three doses, white leukorrhea also decreases significantly. A few more doses lead to complete recovery. Some argue this formula is too rapid and potent. However, when fire is rampant, gentle methods contrary to the pathology cannot be used. It is like fighting a fire; if one hesitates or delays, the flames will spread until everything is consumed. Now, using a batch of cold-cooling herbs such as Huanglian, Shigao, Zhizi, and Zhimu, combined with Dahuang, allows for rapid elimination of pathogens. Furthermore, Wangbuliuxing and Liu Jinu have urgent damp-draining effects, leaving no room for dampness and heat to stagnate. Baizhu assists the Earth element (Spleen/Stomach), Fuling percolates dampness, and Cheqianzi promotes water passage. Thus, fire recedes and water advances, achieving the hexagram of Water-Fire Ji Ji (Completion/After Completion).
Marginal Note: After recovery, one should regulate diet, avoid spicy and hot foods, and nourish the Spleen Earth. If one relies on this formula and takes it immediately upon recurrence of symptoms, vital Qi will inevitably be damaged. Be cautious!
Verse:
Leukorrhea is black with a fishy smell,
Abdominal pain and urination feel like piercing knives.
Stomach, Mingmen, and Sanjiao fires are all vigorous,
Fire knots in the lower part without flaring upward.
Fire-Draining Decoction contains Dahuang, Shigao, and Huanglian,
Baizhu, Fuling, and stir-fried Cheqianzi.
Wangbuliuxing, Liu Jinu, Zhizi, and Zhimu,
As fire recedes and water advances, black leukorrhea diminishes.