经义
悲哀太甚，则胞络绝，阳气内动，发为心下崩，数溲血也。（《素问》）
论证
崩如山冢 崩，言其血之横决莫制也；漏如漏卮难塞，言其血之漫无关防也。原其致病之由∶有因冲任
不能摄血者；有因肝不藏血者；有因脾不统血者；有因热在下焦，迫血妄行者；有因元气大虚，不能收敛其血
者；又有瘀血内阻，新血不能归经而下者。（《临证指南》）
崩漏有虚、有实、有寒、有热。虚者主于血虚、气虚、阴虚、阳虚。实者主于污瘀恶血、痰涎郁滞。虚
则为寒、为冷。实则为火、为热。○崩本血病，而有气虚者，血脱气亦脱也。阴阳相维，互为其根。阴血大下，
阳不能维，当以无形之气生有形之血。（萧慎斋）
血大至曰崩，或清、或浊、或纯下瘀血。更有崩甚腹痛者，人多疑恶血未尽；又见血色瘀黑，不敢止截。
凡血欲出未出之际，停在腹中，即成瘀血。以瘀为恶，又焉知瘀之不为虚冷者乎？○瘀而腹痛，血行则痛止；
崩而腹痛，血住则痛止。（戴复庵）
热则流通之说，俗解大谬。流通者，流通于经络之中，非流通使下行也。盖血随气行，气旺则周流不息，
血即随之而周行于身。故欲止崩漏，当使血归经，欲血归经，当先补气。气属阳，得温暖则阳回气旺，故曰热
则流通。若气虚而寒，则凝涩矣。凝涩则不能流行周身，涓涓不断，而成漏下之证。（吴天士）
论治
妇人陷经，漏下黑不解，胶姜汤主之。（《金匮》）
陷经者，谓经血下陷，即今之漏下、崩中病也。黑不解，不成文。胶姜汤，方亦缺。（《医宗金鉴》）
臣亿等校诸本无胶姜汤方，想是妊娠中胶艾汤。（魏荔彤）
暴崩暴漏，宜温宜补；久漏久崩，宜清宜通。（《临证指南》）
治崩之法∶有消逐污血者；有寒凉降火者；有收涩固脱者；有大升大降者；有扶脾健胃者；有补气补血
者；有温暖下焦者。种种不一。（萧慎斋）
崩为急证，漏是缓病。崩是大怒伤肝，冲动血海，或火盛血热沸腾；漏则房劳过度，损伤冲任，气虚不
能约制经血，或多火而血不安。崩宜理气降火，兼佐升提；漏宜滋阴，培养气血，兼佐制火。（李太素）
血属阴，静则循经荣内，动则错经妄行，故七情过极，则五志亢甚。经血暴下，谓之崩中。初用止血，
以塞其流；中用清血，以澄其源；末用补血，以复其旧。若止塞其流而不澄其源，则滔天之势不可遏；若止澄
其源而不复其旧，则孤阳无所根据。（方约之）
血崩之证，为卫弱营盛，治当扶阳抑阴。然不可峻补其阳，
恐药之热气胜，而反助其阳盛也；亦不可直抑其阴，恐药之寒气胜，而又益其阳虚也。（程扶生）
崩淋之病，有暴崩者，有久崩者。暴崩者，其来骤，其治易；久崩者，其患深，其治难。凡血因崩去，势
必渐少，少而不止，病则为淋。此由忧思郁怒，先损脾胃，次及冲任而然。崩淋既久，真阴日亏，多致寒热咳
嗽，脉见弦数豁大。此乃元气亏损，阴虚假热。当用参、术、归、地甘温之属，峻培本源，但得胃气未败，受
补可救。若不能受补，而日事清凉，苟延目前，终非吉兆。（张景岳）
崩中多用止血补血药不效，此阳乘于阴，所谓天暑地热，经水沸溢是也。心主血，血得热则行，得寒则止。（许叔微）
血藏于肝，肝气不升，则热迫于下，血不能藏，而趋于下。况厥阴之经脉环阴器，廷孔、前阴皆属之。荆
芥升肝气，香附理脾气，条芩除内热，四物养血，故能收功。（武叔卿）
崩证药多用醋炒者，醋能收敛故也。（王节斋）
脉候
阴虚阳搏，谓之崩。（《素问》）
《经》云∶阴虚者，尺脉虚浮也。阳搏者，寸脉弦急也。是为阴血不足，阳邪有余。（武叔卿）
【经文依据】
过度悲哀，会导致胞络（子宫及其脉络）气血阻滞，阳气在内扰动，从而引发心下崩漏，表现为频繁小便并伴有出血。（《素问》）
【病理论述】
“崩”如同山冢崩塌，形容经血横决、无法控制；“漏”如同破漏的器皿难以堵塞，形容经血漫溢、没有约束。探究其致病原因：有的因为冲脉和任脉不能固摄血液；有的因为肝脏不能藏血；有的因为脾脏不能统摄血液；有的因为热邪在下焦，逼迫血液妄行；有的因为元气极度虚弱，不能收敛血液；还有因为瘀血在体内阻滞，新血不能回归经脉而下行。（《临证指南医案》）
崩漏有虚证、实证、寒证、热证之分。虚证主要涉及血虚、气虚、阴虚、阳虚。实证主要涉及污秽瘀血、痰涎郁滞。虚证表现为寒、冷。实证表现为火、热。○崩漏本质是血病，但伴有气虚的情况，是因为血脱导致气也随之脱失。阴阳相互维系，互为根本。阴血大量流失，阳气无法维系，应当通过无形之气来化生有形之血。（萧慎斋）
血液大量涌出称为“崩”，血色或清稀、或浑浊、或纯为瘀血。更有崩漏严重且伴有腹痛者，人们常怀疑恶血未尽；又见血色瘀黑，不敢使用止血药。凡血液欲出未出之际，停留在腹中，就会形成瘀血。人们认为瘀血是恶物，又怎知瘀血并非由虚冷所致呢？○因瘀血导致的腹痛，血液运行通畅则疼痛停止；因崩漏导致的腹痛，血液止住则疼痛停止。（戴复庵）
“热则流通”的说法，世俗理解大错特错。“流通”是指血液在经络中流通，并非指让血液向下流通。大概血液随气而行，气旺盛则周流不息，血液随之在全身周行。所以想要止住崩漏，应当使血液回归经脉；想要血液回归经脉，应当先补气。气属阳，得到温暖则阳气回复、气机旺盛，所以说“热则流通”。如果气虚而寒，血液就会凝涩。凝涩则不能流行于周身，涓涓不断，就形成了漏下的病症。（吴天士）
【治疗论述】
妇人陷经证，漏下黑色血液不止，用胶姜汤主治。（《金匮要略》）
陷经，是指经血下陷，即现在的漏下、崩中病。黑色不止，文意不通。胶姜汤，方剂也缺失。（《医宗金鉴》）
臣亿等校勘各版本均无胶姜汤方，猜想可能是妊娠期间的胶艾汤。（魏荔彤）
暴崩暴漏，宜用温补法；久漏久崩，宜用清通法。（《临证指南医案》）
治疗崩漏的方法：有消除逐除污血的；有寒凉降火的；有收涩固脱的；有大升大降的；有扶脾健胃的；有补气补血的；有温暖下焦的。种种方法不一。（萧慎斋）
崩漏是急症，漏下是缓病。崩漏多因大怒伤肝，冲动血海，或火盛血热沸腾；漏下则多因房劳过度，损伤冲任，气虚不能制约经血，或多火而血不安宁。崩漏宜理气降火，兼佐升提之法；漏下宜滋阴，培养气血，兼佐制火之法。（李太素）
血属阴，静则循经滋养内部，动则错经妄行，所以七情过极，则五志亢盛。经血暴下，称为崩中。初期用止血药，以堵塞其流；中期用清血药，以澄清其源；后期用补血药，以恢复旧观。如果只堵塞其流而不澄清其源，则滔天之势不可遏制；如果只澄清其源而不恢复旧观，则孤阳无所依附。（方约之）
血崩之证，属于卫弱营盛，治疗应当扶助阳气、抑制阴邪。然而不可峻补其阳，恐怕药物的热气胜，反而助长其阳盛；也不可直抑其阴，恐怕药物的寒气胜，而又加重其阳虚。（程扶生）
崩淋之病，有暴崩者，有久崩者。暴崩者，发病急骤，治疗容易；久崩者，病患深重，治疗困难。凡是血液因崩漏而去，势必逐渐减少，少而不止，病则转为淋证。这是由于忧思郁怒，先损伤脾胃，进而波及冲任所致。崩淋日久，真阴日渐亏损，多导致寒热咳嗽，脉象见弦数豁大。这是元气亏损，阴虚假热。应当用人参、白术、当归、地黄等甘温药物，峻培本源，只要胃气未败，能够受补即可救治。如果不能受补，而每日从事清凉疗法，苟延残喘，终究不是吉兆。（张景岳）
崩中多用止血补血药无效，这是因为阳乘于阴，所谓天暑地热，经水沸溢是也。心主血，血得热则行，得寒则止。（许叔微）
血藏于肝，肝气不升，则热迫于下，血不能藏，而趋于下。况且厥阴经脉环绕阴器，廷孔、前阴皆属之。荆芥能升肝气，香附能理脾气，黄芩能除内热，四物汤能养血，故能收功。（武叔卿）
崩证用药多用醋炒者，因为醋能收敛的缘故。（王节斋）
【脉候诊断】
阴虚阳搏，称为崩。（《素问》）
《内经》说：阴虚者，尺脉虚浮也。阳搏者，寸脉弦急也。这是阴血不足，阳邪有余的表现。（武叔卿）
[Scriptural Basis]
Excessive grief causes the blockage of blood and qi in the Bao Luo (uterine meridians), leading to internal movement of Yang Qi, which manifests as "Xin Xia Beng" (subepigastric metrorrhagia), characterized by frequent urination with hematuria. (*Su Wen*)
[Pathogenesis Discussion]
"Beng" (flood) is like the collapse of a mountain mound, describing blood gushing uncontrollably; "Lou" (leak) is like an unstoppered leaking vessel, describing blood oozing without restraint. Investigating the causes of disease: some cases arise because the Chong and Ren vessels fail to control blood; some due to the Liver's failure to store blood; some due to the Spleen's failure to manage blood; some due to heat in the Lower Jiao forcing blood to move recklessly; some due to severe deficiency of Yuan Qi failing to consolidate blood; and others due to intra-abdominal blood stasis preventing new blood from returning to the meridians and flowing downward. (*Lin Zheng Zhi Nan*)
Metrorrhagia and metrostaxis present as deficiency, excess, cold, or heat patterns. Deficiency patterns primarily involve Blood deficiency, Qi deficiency, Yin deficiency, and Yang deficiency. Excess patterns primarily involve foul blood stasis and phlegm-fluid stagnation. Deficiency manifests as cold and chilliness. Excess manifests as fire and heat. ○ Metrorrhagia is fundamentally a blood disorder, but when accompanied by Qi deficiency, it indicates that blood loss leads to Qi collapse. Yin and Yang sustain each other and are roots of one another. When Yin blood is massively lost, Yang cannot sustain it; thus, formless Qi must be used to generate formed blood. (Xiao Shenzhai)
Massive blood flow is called "Beng"; the blood may be clear, turbid, or purely stasis. In cases where severe Beng is accompanied by abdominal pain, people often suspect that foul blood has not been fully expelled; seeing dark, clotted blood, they dare not use hemostatic agents. When blood attempts to exit but remains, staying in the abdomen, it forms stasis. People regard stasis as harmful, yet how do they know stasis is not caused by deficiency-cold? ○ Abdominal pain due to stasis stops when blood circulation resumes; abdominal pain due to Beng stops when bleeding ceases. (Dai Fu'an)
The saying "heat promotes circulation" is largely misunderstood by laypeople. "Circulation" refers to flow within the meridians, not promoting downward flow. Blood follows Qi; when Qi is vigorous, it circulates ceaselessly, and blood follows in its journey throughout the body. Therefore, to stop metrorrhagia, one must make blood return to the meridians; to make blood return to the meridians, one must first tonify Qi. Qi belongs to Yang; warmth restores Yang and strengthens Qi, hence "heat promotes circulation." If Qi is deficient and cold prevails, blood becomes stagnant and sluggish. Stagnation prevents circulation throughout the body, resulting in continuous dripping, forming the syndrome of Lou Xia (chronic leakage). (Wu Tianshi)
[Treatment Discussion]
For women with Xian Jing syndrome (sunken meridians), presenting with black metrorrhagia that does not resolve, Jiao Jiang Tang is indicated. (*Jin Gui Yao Lue*)
Xian Jing refers to sunken menstrual blood, i.e., current Lou Xia and Beng Zhong syndromes. "Black does not resolve" is grammatically incomplete. The formula for Jiao Jiang Tang is also missing. (*Yi Zong Jin Jian*)
Chen Yi et al. collated various editions and found no formula for Jiao Jiang Tang; it is likely Jiao Ai Tang used during pregnancy. (Wei Litong)
Acute Beng and acute Lou should be treated with warming and tonifying methods; chronic Lou and chronic Beng should be treated with clearing and unblocking methods. (*Lin Zheng Zhi Nan*)
Methods for treating Beng and Lou include: eliminating foul blood; using cold-cooling herbs to descend fire; using astringents to secure and prevent collapse; using major ascending and descending techniques; supporting the Spleen and strengthening the Stomach; tonifying Qi and Blood; and warming the Lower Jiao. There are many such methods. (Xiao Shenzhai)
Beng is an acute condition, while Lou is a chronic disease. Beng often results from anger injuring the Liver, disturbing the Sea of Blood, or excessive fire causing blood heat to boil; Lou results from excessive sexual activity damaging the Chong and Ren vessels, Qi deficiency failing to constrain menstrual blood, or excessive fire causing blood unrest. Beng requires regulating Qi and descending fire, assisted by lifting methods; Lou requires nourishing Yin, cultivating Qi and Blood, assisted by controlling fire. (Li Taisu)
Blood belongs to Yin; when still, it follows meridians to nourish the interior; when moving, it flows recklessly out of course. Thus, extreme emotional disturbances cause hyperactivity of the Five Wills. Sudden massive menstrual bleeding is called Beng Zhong. Initially, use hemostatics to block the flow; secondly, use blood-clearing agents to clarify the source; finally, use blood-tonics to restore the original state. If only blocking the flow without clarifying the source, the torrential force cannot be stopped; if only clarifying the source without restoring the original state, lone Yang will have no foundation. (Fang Yue Zhi)
In cases of blood flooding, the pattern is weak Wei (Defensive) Qi and abundant Ying (Nutritive) Blood; treatment should support Yang and suppress Yin. However, one must not strongly tonify Yang, fearing the hot nature of the drugs might exacerbate Yang excess; nor should one directly suppress Yin, fearing the cold nature of the drugs might worsen Yang deficiency. (Cheng Fusheng)
Beng Lin syndromes include acute Beng and chronic Beng. Acute Beng arrives suddenly and is easier to treat; chronic Beng involves deep pathology and is difficult to treat. As blood is lost through Beng, volume inevitably decreases gradually. If this scanty flow persists, the disease transforms into Lin syndrome. This arises from worry, thought, depression, and anger, first damaging the Spleen and Stomach, then affecting the Chong and Ren vessels. Chronic Beng Lin depletes True Yin daily, often leading to alternating chills and fever, coughing, and a wiry, rapid, large, and hollow pulse. This represents Yuan Qi depletion and false heat due to Yin deficiency. One should use sweet-warm herbs like Ginseng, Atractylodes, Angelica Sinensis, and Rehmannia to vigorously cultivate the root. As long as Stomach Qi remains intact and can accept tonification, rescue is possible. If the patient cannot tolerate tonification, and one merely employs cooling therapies to prolong life temporarily, it is ultimately an ill omen. (Zhang Jingyue)
Treating Beng Zhong with hemostatic and blood-tonifying herbs is often ineffective because Yang invades Yin, analogous to summer heat and earth heat causing menstrual water to boil over. The Heart governs Blood; blood moves with heat and stops with cold. (Xu Shuwei)
Blood is stored in the Liver. If Liver Qi fails to ascend, heat forces downward, and blood cannot be stored, flowing downward instead. Moreover, the Jueyin meridian circles the external genitalia; Ting Kong and the anterior yin belong to it. Jingjie (Schizonepeta) ascends Liver Qi, Xiangfu (Cyperus) regulates Spleen Qi, Huangqin (Scutellaria) clears internal heat, and Si Wu Tang nourishes blood, thus achieving success. (Wu Shuqing)
Medications for Beng are often stir-fried with vinegar because vinegar has astringent properties. (Wang Jiezhai)
[Pulse Diagnosis]
Yin deficiency with Yang pulsation is called Beng. (*Su Wen*)
The Classics state: Yin deficiency presents as a deficient and floating Chi (Cun Kou) pulse. Yang pulsation presents as a wiry and urgent Guan (Cun Kou) pulse. This indicates insufficient Yin blood and excess Yang pathogenic factors. (Wu Shuqing)