带下赤白皆湿热,脐腹痛甚湿热结;
经曰∶小腹冤热,溲出白液。冤者,湿热屈抑凝滞,结于任脉,自胞上而过带脉,出于大、小肠之分,淋
沥以下,故曰带下,赤属血,白属气。其证∶头昏目眩,口苦舌干,咽嗌,大便或闭或溏,小便涩,皆热证也,
如赤白痢浊一般,但不痛耳。间有痛者,湿热怫郁,甚则肚腹引痛。妇人服食燥热,性行乖戾,以致肝旺脾亏
而生湿热,热则流通,古人有用导水丸下之,继以淡剂渗之,或苦楝丸、大玄胡索散调之。如脐腹痛者,暂以辛
温开导,如大温经汤,补经固真汤、龟柏姜栀丸是也。
热多瘦妇必潮烦,
瘦人多热,脉数,外证潮烦,乃阴虚火盛也,芩柏樗皮丸。带不止者,用地骨皮一两,生地五两,酒十盏,
煎至三盏,分三次服;或白芷散、单益母丸。白带兼痛风者,二陈汤加苍、柏、南星、牛膝、川芎;兼头风鼻
涕者,苍柏辛芎散;兼七情者,侧柏樗皮丸。
湿胜肥黄痰作孽;
肥人多湿,身黄脾缓,阴户如水,或痛,白带,升阳燥湿汤、四物固真丹。湿痰流下,渗入膀胱,宜二
陈汤加二术、升麻、柴胡,或苍柏樗皮丸。如结痰白带,淋沥不已者,先以小胃丹,半饥半饱,津液下数丸。
候郁积开,服芩术芍葵丸。通用五芩散合四物汤,或单樗白皮炒为末,酒糊丸,血虚加四物汤;气虚加参、术、
陈皮;火动加黄柏;滑久加龙骨、赤石脂;性躁加黄连;腹痛加干姜。
间有虚寒带臭腥,阴中冷痛何曾歇;
虚因月水淋沥不已,或崩中暴下,或产后去血过多,以致阴亏阳竭,荣气不升,经脉凝泣,卫气下陷,
精气累滞于下焦,蕴积而成,白滑如涕,下流腥臭者,黄 建中汤去桂,加当归,水煎吞苦楝丸。久不止,脐
腹引阴冷痛者,东垣固真丸;虚中有火者,补经固真汤、大乌鸡丸。常用∶气虚,四君子汤;血虚,四物汤。有
火加黄柏,有寒加桂、附。寒始因亡血,复亡其阳,阳气虚极,带下腥臭,多悲不乐,附桂汤;腹痛阴冷者,四物
汤加桂、附。常用酒煮当归丸、小乌鸡丸、螽斯丸,琥珀调经丸。
外感风邪传各经,
风邪入于胞门,或中经脉,流传脏腑。若伤肝经,青如泥色;心经,赤如红津;肺经,白形如涕;脾经,
黄如烂瓜;肾经,黑如衄血。宜胃风汤,或五积散去麻黄主之。通用单地榆散。
一种白淫思虑切;
思想无穷,所愿不得,意淫于外,入房太甚,发为筋痿,久为白淫,谓白物淫如白精之状,不可误作白
带,过服热药。又有日夜流津,如清米泔,或如 胶者,谓之白崩,与白淫大同,多忧思过度所致,诚难治疗,
宜平补镇心丹。因思伤脾胃者,四七汤下白丸子,或归脾汤;痞闷少食者,沉香降气汤;因劳伤肾气,心肾不交
者,金锁正元丹、小菟丝子丸、威喜丸、硫苓丸。
室女胎产法相同,
室女经水初下,一时惊悸,或浴以冷水,或当风取凉,故经水止而即患带下,宜琥珀朱砂丸。孕妇带下,
全是湿热,宜芩术樗皮丸。平时阴阳过多,及产后亡血下虚,风邪乘虚入于胞络,宜暖宫丸加姜、附、吴萸,
或黄 建中汤去桂,加当归,水煎吞苦楝丸。
补卫调脾循故辙。
凡崩中带下,或用升提,如升阳调经汤;或用收涩,如伏龙肝散、白芷散。然暂止而终不止者,盖卫司开
阖,而为荣血之主,脾胃为血海水液之会,卫气与胃气俱虚,则血液无所约制。是以古方有用桂枝汤加附子,
以固卫气者;四君子汤加草果、丁香、木香,以燥水健脾
者;或用理中汤加陈皮、半夏;或单半夏丸,用芎、归煎汤下;或补中益气汤、平胃散。皆补卫浓脾,使气血
自循故辙,而不专于收涩以劫夺之也。
带下病中,赤色和白色分泌物皆由湿热引起;若伴有严重的脐腹部疼痛,则是湿热郁结所致。
《黄帝内经》说:“小腹冤热(指湿热郁滞于小腹产生的烦热感),小便排出白色液体。”所谓“冤”,是指湿热屈曲压抑、凝滞不通,结聚在任脉,从胞宫向上经过带脉,出于大肠和小肠的分界处,淋漓而下,所以称为带下病。其中,赤色属血分病变,白色属气分病变。
其症状表现为:头晕目眩,口苦舌干,咽喉不适,大便或闭塞或稀溏,小便涩痛,这些都是热证的表现,就像赤白痢疾的浊液一样,只是没有腹痛罢了。偶尔有腹痛的情况,是因为湿热郁遏,严重时会导致肚腹牵引作痛。
妇女如果食用燥热食物,性情乖戾暴躁,导致肝气旺盛而脾气亏损,从而产生湿热。热邪性质流通,古人有用导水丸攻下积滞,继以淡渗利湿之剂治疗,或者用苦楝丸、大玄胡索散调理。如果出现脐腹部疼痛,暂时使用辛温开导的方法,如大温经汤、补经固真汤、龟柏姜栀丸等。
热邪多且形体消瘦的妇女必然出现午后潮热烦躁。
瘦人多热,脉象数急,外部症状为午后潮热烦躁,这是阴虚火盛的表现,可用芩柏樗皮丸。
带下不止者,可用地骨皮一两,生地黄五两,酒十盏,煎煮至三盏,分三次服用;或者用白芷散、单味益母草制成的益母丸。
白带兼有痛风者,用二陈汤加苍术、黄柏、天南星、牛膝、川芎;兼有头风、鼻流清涕者,用苍柏辛芎散;兼有情志不畅(七情内伤)者,用侧柏樗皮丸。
湿气胜则身体肥胖发黄,痰湿作祟。
肥人多湿,身体发黄,脾虚缓弱,阴户流水,或有疼痛,白带增多,可用升阳燥湿汤、四物固真丹。
湿痰流注下行,渗入膀胱,宜用二陈汤加白术、苍术、升麻、柴胡,或者用苍柏樗皮丸。
如果是结痰导致的白带,淋漓不尽的,先用小胃丹,在半饥半饱时,用津液送服几丸。
等到郁积开通后,再服用芩术芍葵丸。
通用方剂可用五苓散合四物汤,或者单用椿白皮炒成粉末,用酒糊制成丸药。血虚者加四物汤;气虚者加人参、白术、陈皮;火旺者加黄柏;滑脱日久者加龙骨、赤石脂;性情急躁者加黄连;腹痛者加干姜。
间或有虚寒型带下,气味腥臭,阴中冷痛从未停止过。
虚证是因为月经淋漓不尽,或者崩中暴下(大量出血),或者产后失血过多,导致阴血亏虚、阳气衰竭,营气不能上升,经脉凝涩,卫气下陷,精气累滞在下焦,蕴积而成。白带滑腻如鼻涕,流出时有腥臭味,可用黄芪建中汤去掉桂枝,加入当归,水煎后吞服苦楝丸。
久治不愈,脐腹牵引阴部冷痛者,用东垣固真丸;虚证中有火热者,用补经固真汤、大乌鸡丸。
常用方法:气虚用四君子汤;血虚用四物汤。有火加黄柏,有寒加肉桂、附子。
寒证始因亡血,又亡其阳,阳气极度虚弱,带下腥臭,多悲伤不乐,用附桂汤;腹痛阴冷者,用四物汤加肉桂、附子。
常用方剂有酒煮当归丸、小乌鸡丸、螽斯丸、琥珀调经丸。
外感风邪传变至各经络。
风邪侵入胞门,或者中于经脉,流传至脏腑。
如果损伤肝经,带下青色如泥色;心经,赤色如红津;肺经,白色如鼻涕;脾经,黄色如烂瓜;肾经,黑色如衄血。
宜用胃风汤,或者五积散去麻黄为主进行治疗。通用方为单味地榆散。
一种白淫症,多由思虑过度引起。
思想无穷无尽,愿望不得实现,意念淫乱于外,房事太甚,发为筋痿,日久成为白淫,指白色物质淫溢,状如白精,不可误作白带而过服热药。
又有日夜流津,像清米泔水,或者像胶冻一样的,称为白崩,与白淫大同小异,多由忧思过度所致,确实难以治疗,宜用平补镇心丹。
因思虑损伤脾胃者,用四七汤送服白丸子,或者归脾汤;痞闷少食者,用沉香降气汤;因劳损伤肾气,心肾不交者,用金锁正元丹、小菟丝子丸、威喜丸、硫苓丸。
未婚女子及产妇的治疗方法相同。
未婚女子月经初来,一时惊悸,或者用冷水洗澡,或者当风取凉,导致经血停止而立即患带下病,宜用琥珀朱砂丸。
孕妇带下,全是湿热引起,宜用芩术樗皮丸。
平时阴阳房事过多,以及产后失血下虚,风邪乘虚侵入胞络,宜用暖宫丸加生姜、附子、吴茱萸,或者黄芪建中汤去桂枝,加当归,水煎后吞服苦楝丸。
遵循补卫气、调脾胃的旧法。
凡是崩中和带下病,或者用升提法,如升阳调经汤;或者用收涩法,如伏龙肝散、白芷散。
然而暂时止住但最终不止的,因为卫气主管开阖,是荣血的主宰,脾胃是水谷精微和血液汇聚之处,卫气和胃气都虚弱,则血液无所约束控制。
因此古方有用桂枝汤加附子,以巩固卫气的;有四君子汤加草果、丁香、木香,以燥湿健脾的;或者用理中汤加陈皮、半夏;或者单用半夏丸,用川芎、当归煎汤送服;或者用补中益气汤、平胃散。
这些都是为了补卫气、厚脾胃,使气血自然回归正常轨道,而不专门依靠收涩药物来强行劫夺收敛。
In leukorrhea, both red and white discharges are caused by damp-heat; if accompanied by severe pain in the umbilical and abdominal regions, it indicates the accumulation of damp-heat.
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Oppressive heat in the lower abdomen, with white fluid excreted from the urine." The term "oppressive" (Yuan) refers to damp-heat being constrained, suppressed, coagulated, and stagnant, accumulating in the Ren Mai (Conception Vessel), passing upward from the uterus through the Dai Mai (Girdle Vessel), emerging at the junction of the Large Intestine and Small Intestine, dripping down continuously, hence termed leukorrhea. Red discharge belongs to the Blood level, while white discharge belongs to the Qi level.
Its symptoms include: dizziness and vertigo, bitter taste in the mouth and dry tongue, throat discomfort, constipation or loose stools, and astringent urination; these are all signs of Heat syndromes, resembling the turbid discharge of dysentery with red and white stool, but without abdominal pain. Occasionally, there is pain due to the stagnation of damp-heat; when severe, it causes radiating pain in the abdomen.
If women consume drying and heating foods, or have irritable and perverse temperaments, leading to Hyperactive Liver Qi and Spleen Deficiency, damp-heat is generated. Since Heat has a flowing nature, ancient practitioners used Dao Shui Wan (Water-Guiding Pill) to purge accumulation, followed by bland diuretic agents, or regulated with Ku Lian Wan (Toosendan Fruit Pill) or Da Xuan Hu Suo San (Large Corydalis Powder). If umbilical and abdominal pain occurs, temporarily use acrid-warm guiding methods, such as Da Wen Jing Tang (Great Warming the Menses Decoction), Bu Jing Gu Zhen Tang (Tonifying the Menses and Securing the True Decoction), or Gui Bai Jiang Zhi Wan (Tortoise Bark, Phellodendron, Ginger, and Gardenia Pill).
Women who are thin and have excessive Heat will inevitably experience tidal fever and irritability.
Thin people tend to have Heat; their pulse is rapid, and external symptoms include tidal fever and irritability, indicating Yin Deficiency with Fire Hyperactivity. Use Qin Bai Chu Pi Wan (Phellodendron, Cortex Alstoniae, and Scutellaria Pill).
For persistent leukorrhea, use one tael of Gu Pi (Cortex Lycii, Dogwood Root Bark), five taels of Di Huang (Rehmannia Root), and ten cups of wine; decoct until three cups remain, divided into three doses. Alternatively, use Bai Zhi San (Angelica Dahurica Powder) or Yi Mu Dan Wan (Motherwort Monarch Pill).
For leukorrhea accompanied by wind-damp bi syndrome, use Er Chen Tang (Two-Cured Decoction) plus Cang Zhu (Atractodes Rhizome), Huang Bo (Phellodendron Bark), Nan Xing (Arisaema Rhizoma Preparatum), Niu Xi (Achyranthes Root), and Chuan Xiong (Ligusticum Rhizome); for accompanying head wind and nasal discharge, use Cang Bai Xin Xiong San (Cang Zhu, Huang Bo, Angelica Dahurica, and Ligusticum Powder); for emotional disturbances (Seven Emotions), use Ce Bai Chu Pi Wan (Biota Tops and Cortex Alstoniae Pill).
Excess Dampness leads to obesity and yellowing, with Phlegm-Dampness causing trouble.
Obese people tend to have Dampness; they present with yellowish skin, Spleen deficiency with flaccidity, watery discharge from the vagina, possibly with pain, and increased leukorrhea. Use Sheng Yang Zao Shi Tang (Raising Yang and Drying Dampness Decoction) or Si Wu Gu Zhen Dan (Four Substances Securing the True Elixir).
When Damp-Phlegm flows downward and infiltrates the Bladder, use Er Chen Tang (Two-Cured Decoction) plus Bai Zhu (Atractodes Macrocephala Rhizome), Cang Zhu (Atractodes Rhizome), Sheng Ma (Cimicifugae Rhizome), and Chai Hu (Bupleuri Radix), or Cang Bai Chu Pi Wan (Cang Zhu, Huang Bo, and Cortex Alstoniae Pill).
For leukorrhea caused by accumulated Phlegm with continuous dripping, first use Xiao Wei Dan (Minor Stomach Elixir), taken in small quantities with saliva between meals. After the stagnation opens, administer Qin Shu Shao Kui Wan (Scutellaria, Atractodes, Paeonia, and Hibiscus Pill).
A general formula is Wu Ling San (Five-Ingredient Powder with Poria) combined with Si Wu Tang (Four Substances Decoction), or simply using Chou Bai Pi (Cortex Alstoniae Scholaris) roasted and powdered, made into pills with wine paste. For Blood Deficiency, add Si Wu Tang (Four Substances Decoction); for Qi Deficiency, add Ren Shen (Ginseng Root), Bai Zhu (Atractodes Macrocephala Rhizome), and Chen Pi (Citrus Reticulatae Pericarpium); for Fire Hyperactivity, add Huang Bo (Phellodendron Bark); for chronic slipping/leakage, add Long Gu (Fossilized Bones) and Chi Shi Zhi (Halloysitum Rubrum); for irritability, add Huang Lian (Coptidis Rhizome); for abdominal pain, add Gan Jiang (Zingiberis Rhizoma).
Occasionally, there is Leukorrhea due to Deficiency-Cold with a fishy odor, and cold pain in the yin region that never ceases.
Deficiency arises from prolonged menstrual bleeding, sudden heavy uterine bleeding (Beng Zhong), or excessive blood loss postpartum, leading to Yin/Blood depletion and Yang exhaustion. Ying Qi fails to ascend, meridians become stagnant, and Wei Qi sinks. Essence and Qi accumulate in the Lower Jiao, fermenting and forming slippery white discharge like mucus, which flows out with a fishy odor. Use Huang Qi Jian Zhong Tang (Astragalus Decoction for Building the Middle) removing Gui Zhi (Cinnamon Twig), adding Dang Gui (Angelica Sinensis Root), decocted in water, and swallowed with Ku Lian Wan (Toosendan Fruit Pill).
For long-standing cases with radiating cold pain in the umbilical and abdominal regions affecting the yin, use Dong Yuan Gu Zhen Wan (Dong Yuan's Pill to Secure the True). For Deficiency with internal Heat, use Bu Jing Gu Zhen Tang (Tonifying the Menses and Securing the True Decoction) or Da Wu Ji Wan (Great Black Chicken Pill).
Commonly used: Si Jun Zi Tang (Four Gentlemen Decoction) for Qi Deficiency; Si Wu Tang (Four Substances Decoction) for Blood Deficiency. Add Huang Bo (Phellodendron Bark) for Heat; add Gui Zhi (Cinnamon Twig) and Fu Zi (Prepared Aconite Lateral Root) for Cold.
Cold syndrome originates from blood loss followed by Yang loss, resulting in extreme Yang Deficiency, fishy-smelling leukorrhea, and sadness/lack of joy. Use Fu Gui Tang (Aconite and Cinnamon Decoction). For abdominal pain and yin coldness, use Si Wu Tang (Four Substances Decoction) plus Gui Zhi (Cinnamon Twig) and Fu Zi (Prepared Aconite Lateral Root).
Commonly used formulas include Jiu Zhu Dang Gui Wan (Wine-Processed Angelica Pill), Xiao Wu Ji Wan (Small Black Chicken Pill), Zhong Si Wan (Locust Pill), and Hu Po Tiao Jing Wan (Amber Regulating Menses Pill).
External Wind Pathogens transmit to various meridians.
Wind pathogens enter the Bao Men (Uterine Gate) or strike the meridians, spreading to the Zang-Fu organs.
If the Liver Meridian is injured, the discharge is green like mud; Heart Meridian, red like red fluid; Lung Meridian, white like mucus; Spleen Meridian, yellow like rotting melon; Kidney Meridian, black like epistaxis blood.
Use Wei Feng Tang (Stomach Wind Decoction) or Wu Ji San (Five Accumulations Powder) removing Ma Huang (Ephedra Herb) as the main treatment. A general formula is Dan Di Yu San (Single Sanguisorba Powder).
One type is Bai Yin (White Seminal Discharge) caused by excessive thinking.
Endless thoughts, unfulfilled desires, and mental lustfulness, combined with excessive sexual activity, lead to Sinew Flaccidity, which over time becomes Bai Yin. This refers to white, excessive discharge resembling semen. It must not be mistaken for leukorrhea, nor treated with hot medicines.
Another condition involves day-and-night flow of clear fluids, like rice wash water or jelly-like substance, called Bai Beng (White Collapse). It is similar to Bai Yin, mostly caused by excessive worry and thought, and is indeed difficult to treat. Use Ping Bu Zhen Xin Dan (Leveling and Tonifying the Heart Calming Spirit Elixir).
For Spleen/Stomach injury due to thought, use Si Qi Tang (Four Seven Decoction) to deliver Bai Wan Zi (White Pills), or Gui Pi Tang (Restore the Spleen Decoction); for chest fullness and poor appetite, use Chen Xiang Jiang Qi Tang (Aquilaria Descending Qi Decoction); for Kidney Qi injury due to fatigue with Heart-Kidney non-interaction, use Jin Suo Zheng Yuan Dan (Golden Lock Correcting Origin Elixir), Xiao Tu Si Zi Wan (Small Dodder Seed Pill), Wei Xi Wan (Wei Xi Pill), or Liu Ling Wan (Sulfur and Poria Pill).
The methods for virgins and postpartum women are the same.
For virgins whose menstruation has just started, if startled or palpitations occur, or if they bathe in cold water or cool themselves in the wind, causing menstruation to stop and immediately develop leukorrhea, use Hu Po Zhu Sha Wan (Amber and Cinnabar Pill).
Leukorrhea in pregnant women is entirely due to damp-heat; use Qin Shu Chu Pi Wan (Scutellaria, Atractodes, and Cortex Alstoniae Pill).
For those with excessive sexual intercourse normally, or postpartum blood loss and deficiency where Wind pathogens invade the Bao Luo (Uterine Collaterals) due to deficiency, use Nuan Gong Wan (Warming the Uterus Pill) plus Sheng Jiang (Fresh Ginger), Fu Zi (Prepared Aconite Lateral Root), and Wu Zhu Yu (Evodia Fruit), or Huang Qi Jian Zhong Tang (Astragalus Decoction for Building the Middle) removing Gui Zhi (Cinnamon Twig), adding Dang Gui (Angelica Sinensis Root), decocted in water, and swallowed with Ku Lian Wan (Toosendan Fruit Pill).
Follow the traditional path of tonifying Wei Qi and regulating the Spleen.
For both Beng Zhong (uterine bleeding) and leukorrhea, either use lifting methods, such as Sheng Yang Tiao Jing Tang (Raising Yang and Regulating Menses Decoction); or use astringent methods, such as Fu Long Gan San (Dragon's House Earth Powder) or Bai Zhi San (Angelica Dahurica Powder).
However, if the condition stops temporarily but recurs, it is because Wei Qi governs opening and closing and is the master of Ying/Blood, while the Spleen and Stomach are the meeting place of blood and body fluids. When both Wei Qi and Stomach Qi are deficient, blood lacks restraint.
Therefore, ancient formulas used Gui Zhi Tang (Cinnamon Twig Decoction) plus Fu Zi (Prepared Aconite Lateral Root) to consolidate Wei Qi; Si Jun Zi Tang (Four Gentlemen Decoction) plus Cao Guo (Tsaoko Cardamom Fruit), Ding Xiang (Caryophylli Flos), and Mu Xiang (Aucklandiae Radix) to dry dampness and strengthen the Spleen; or Li Zhong Tang (Regulate the Middle Decoction) plus Chen Pi (Citrus Reticulatae Pericarpium) and Ban Xia (Pinelliae Rhizoma Preparatum); or single Ban Xia Wan (Pinellia Pill) delivered with Chuan Xiong (Ligusticum Rhizome) and Dang Gui (Angelica Sinensis Root) decoction; or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Ping Wei San (Peaceful Stomach Powder).
All these aim to tonify Wei Qi and thicken the Spleen, allowing Qi and Blood to return to their normal pathways, rather than relying solely on astringents to forcibly seize and constrict.