病原
妇人杂病，亦血分病也。妇人杂病，岂异男子之脏腑经络乎？然不止妊娠产后另立病名，而杂病亦分篇
者，正缘妇人血分之杂病迥不同于男子凡几，故必出此篇之论法。其他杂病，同于男子者尚多，则可赅于前诸
篇之中，不必赘及矣。何也？妇人妊娠，其血在胞养胎；产后，其血旧者泄尽，新者化乳，一定之理也。至平
居无孕之时，血分之枯荣，全视乎经行之进退通闭，故为病大半感于经血来去之候。经来血室开，经去血室虚，
开者邪易入，虚者邪易乘也。阳邪入而血伤热，则漏下；阴邪入而血伤寒，则经闭。无不于此肇端焉！此妇人
杂病，必关血分，而另立一篇，于妊娠、产后合为三大法门也。（魏荔彤）
论难易
谚云∶宁治十男子，莫治一妇人。此谓妇人之病不易治也。何也？不知妇人之病，本与男子同，而其情
则与男子异。盖以妇人幽居多郁，情性偏拗，或有怀不能畅遂，或有病不可告人，或信师巫，或畏药饵，故染
着坚牢，而治之有不易耳。此其情之使然也。然尚有人事之难，如黄帝论曰∶凡治病须察其形气色泽。又曰∶
诊病之道，观人勇怯、骨肉、皮肤。此治病之大则也。今富贵之家，居奥室之中，处帷幔之内，复有以绵帕蒙
其手者，既不能行望色之神，又不能尽切脉之巧。使脉有弗合，未免多问，
问之觉繁，必谓医学不精。不知问亦非易，非医之善者不能也。望、闻、问、切，欲于四者去其三，吾恐神医
不神矣。世之通患若此，此妇人之治所以不易也。（张景岳）
验手法
妇女深居闺阁，密护屏帏，不能望见颜色，但须验其手腕之色泽，苍白肥瘠已见一斑。至肌之滑涩，理之
疏密，肉之坚软，筋之粗细，骨之大小，爪之刚柔，指之肥瘦，掌之浓薄，尺之寒热，及乎动静之安危，气息
之微盛，更合之以脉，参之以证，则气血之虚实、情性之刚柔、形体之劳逸、服食之精粗、病苦之逆顺，皆了
然心目矣。（张路玉）
寡妇师尼
宋褚澄疗师尼、寡妇，别制方。盖此二种寡居，独阴无阳，欲心萌而不遂，是以阴阳交争，乍寒乍热，形
类疟状，久则为劳。《史记》载济北王侍人韩女，病腰痛寒热。仓公诊曰∶病得之欲男子不可得也。何以知之？
诊得肝脉弦出寸口，是以知之。盖男子以精为主，妇人以血为主。男子精盛则思室，妇人血盛则怀胎。厥阴脉
弦出寸口，则阴盛可知。褚氏之言有谓矣。（《东医宝鉴》）
寡妇师尼，郁抑成病，其证乍寒乍热，面赤心烦，自汗体痛，肝脉弦出寸口，治宜柴胡抑肝汤、抑阴地黄
丸、越鞠丸。（《医方类聚》）
热入血室
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。○妇人伤寒发热，经水适来，昼日明了，暮则谵语，如见鬼状，此为热入血室，治之无犯胃气
及上二焦，必自愈。○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，当刺期门，随其实而取之。○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， 然汗出者愈。（《金匮》）
妇人伤寒，有热入血室之证。血室即血海，冲任之脉所系，为藏精受胎之所。因经行之期，而犯伤寒之邪，
则热邪乘虚袭入，与血相搏。夫肝藏魂，血室虚，则魂无所根据，肝受热邪，则为谵语，为见鬼，肝之魂不能安
也。治惟清热行血，甚则桃仁承气，微则生地、丹皮、桃仁、红花、赤芍、五灵脂、甘草、木通、丹参之属，
不可拘执小柴胡汤之定例。夫小柴胡一方，乃治伤寒邪传少阳，和解表里之药，非专治热入血室之药也。方中
虽有柴胡发表、黄芩退热，然半夏行痰，为血家所忌；人参补气，非血热所宜。今人一遇热入血室之证，便用
小柴胡汤，曰我遵仲景也。岂知仲景第一条云妇人中风，寒热发作有时，形如疟状。明属少阳经见证，故曰小
柴胡汤主之。则小柴胡汤原为少阳经设也。至后三条，但云必自愈，云当刺期门，又云随其实而泻之。并无小
柴胡汤主之一语，则知小柴胡汤只治少阳如疟之证，非治热入血室之证也。今人不玩仲景前后原文，漫谓妇人
热入血室，辄用小柴胡汤，岂不可嗤耶！凡治妇人热入血室之病，有寒热发作有时如疟状者，则小柴胡汤可用
也。然须加入桃仁、丹皮、五灵脂以行其血，如无寒热如疟之证，则小柴胡汤断不可用。举世懵懵，特表而出
之。（萧慎斋）
考热入血室，《金匮》有四法，今人一遇是证，不辨热入之轻重、血室之盈亏，遽投小柴胡汤，贻害必多。
要之，热甚而血瘀者，与桃仁承气及山甲、归尾之属。血舍空而热陷者，用犀角地黄加丹参、木通之属。表邪
未尽者，则当合乎和解。热轻而清药过投，气机致钝者，不妨借温通为使。血结胸，有桂枝红花汤参入海蛤、
桃仁之治；昏狂甚，进牛黄膏，调入清气化结之煎，复有两解气血燔蒸之玉女法；热甚阴伤，有育阴养气之复
脉法。审证制方，毋拘乎柴胡一法也。（《临证指南》）
咽中炙脔
妇人咽中如有炙脔，半夏浓朴汤主之。（《金匮》）
炙脔，譬如干肉也。《千金》所谓咽中帖帖如有炙肉，吐之不出，吞之不下者是也。此病不因肠胃，故
不碍饮食、二便；不因表邪，故无骨痛寒热。乃气为积寒所伤，不与血和，血中之气溢而浮于咽中，得水湿之
气，而凝结难移。妇人血分受寒，多积冷结气，最易得此病。药用半夏浓朴汤者，半夏降逆，浓朴散结，生姜、
茯苓宣至高之滞而下其湿，苏叶味辛气香，色紫性温，能入阴和血。气与血和，不复上浮矣。（徐忠可）
阴吹
胃气下泄，阴吹而正喧，此谷气之实也，膏发煎导之。（《金匮》）
胃气下泄，不由大肠而出浊道，乃由小肠而出清道，则气不足而无所收摄也，故令下阴作吹，而其声且
喧闻于外。此虽为胃中谷气之实，而其实胃中正气之衰。治以膏发煎导之，无乃令大便气通，而胃气纵然下泄，
必由浊道而出，不致乱乾清道。阴中吹气，贻人听闻之义而已。（魏荔彤）
阴吹一证，古书不多见，惟《金匮》云∶胃气下泄，阴吹而正喧，此谷气之实也，膏发煎导之。夫阴器
属厥阴部位，精窍通冲任之脉，尿窍通小肠之路，气道不从此出，安得有声而喧？盖由肝肾亏于下，肺气亏于
上，致阳明胃气不能鼓舞上行，而亏于中，下走阴器，直入精窍而出，岂同大肠失气，《经》谓浊阴出下窍者
可比耶？常见虚损之辈，久咳经阻，胃气不升，往往多有此患。言乎肾，则气不摄可知；言乎肝，则气不平可
知；言乎肺，则气不主可知。是以上咳下吹，气窍相通，阴器隐隐有声。足见精血之亏，元气之弱，根本摇摇
矣。夫阳明为多气多血之海，与冲任血海之脉同声相应，下为经而上为乳，变化取汁，血气之实也。喧闻户外，
胃气之虚也。魏氏云∶此虽谷气之实，其实胃气之衰。斯言极中长沙秘旨。如必谓谷气实，而引导浊气从大肠
出，纵胃气下泄必由浊道，而不致乱乾清道，是错认溺窍为病也。第胃气下泄前阴之膀胱，何异下泄后阴之大肠？
终无补于病情。且
肾主开阖，为生气之原；阴气属肝，主疏泄之令。今胃气下走，岂寻常之药可以奏功？必须培补肝肾以固肺金，
生精益血以助真气。若阳分多亏，补中、归脾之属可投；阴分多亏，六味、左归之属可用；阴阳两亏，八味、
右归之属可服。耗气败血之药，非治也。倘不咳而窍有声者，较咳而窍有声者为稍轻，逍遥、六味皆合法也。虽
然，膀胱有下窍而无上口，胃气何由下泄？其从精窍而来，不待辨而自明。男子从无，妇人常有，无非窍空而
妄泄。况谷道后通，而前阴之吹者有之；谷道后秘，而前阴不吹者有之。谷气实，胃气安得下泄？仲景膏发煎
导引之法，其说似属难明。即令胃气从溺窍下泄，小盒饭随气而共出，何吹时惟有声而无溺？则溺窍而来之说，
更属无据。要之，胃气者，乃水谷之精气，上输于脾，脾气散精，上归于肺，与肾中生气互根。得毋因其人水
谷之真气衰弱，而以脂膏益血之品从阴引阳，填补冲任，不使气陷于子宫，直走精门，未可知也。（《会心录》）
阴吹，乃妇人恒有之疾，然多隐忍不言，以故方书不载，医不加察。《金匮》明言胃气下泄，谷气之实，
所以腹中喧响，则气从前阴吹出，第用猪膏发煎之治，难于推测。余治一妇，经闭三月，少腹痛彻心而见前证，
与失笑散，一服，瘀血大下，遂不复作。又治一妇，小产后寒热腹痛，亦见前证，与炮黑楂肉，黑糖为丸，用
伏龙肝水煎独参汤送下三钱，结粪大下。再进，瘀血续行，前证顿止。始悟猪膏发煎乃为逐瘀而设也。（《张氏医通》）
按∶“膏发煎导之”五字当是衍文。“此谷气之实也”之下，当有“长服诃黎勒丸”之六字。后阴下气，
谓之气利，用诃黎勒散。前阴下气，谓之阴吹，用诃黎勒丸。文义始属，药病亦对。盖诃黎勒丸，以诃黎勒固
下气之虚，以浓朴、陈皮平谷气之实，亦相允合。（《医宗金鉴》）
脏燥
妇人脏燥，悲伤欲哭，象如神灵所作，数欠伸，甘麦大枣汤主之。（《金匮》）
妇人脏燥者，无所感触，悲哭无常，象如神灵所作，乃血虚而津亡，脏空而发燥之证也。其为证，又数欠
伸，师早知其血虚之津亡，由于气虚之胃阳亡矣。欠伸者，倦怠之象，非阳气不足、精神不振，无此证也。主
之以甘麦大枣汤补中益胃之外，无他法也。脏燥由于血虚，世医孰不竞言滋阴养血，抑知阴盛而津愈枯，阳衰
而阴愈燥，师言之固凿凿也乎。（魏荔彤）
交肠
交肠之证，大小便易位而出。因醉饱不节，大怒不解，以致脏气乖乱，不循常度。当吐以提其气，使阑门
得司泌别而清浊自分，宜五苓散、调气散各一钱，阿胶末一钱，白汤调服。（《证治准绳》）
选案
交肠一证，虽见于方书，而世罕见。詹石匠妇，产后五、六日，恶露不行，腹胀喘满，大便从前阴出。缘
素嗜烟酒，又因产时受惊。余以芎归汤加莪术、肉桂、炒山楂，一服，恶露通，小便如常。又陆圣祥女，四岁，
新秋患痢，粪出前阴，作冷热不调治，与五苓散送香连丸，二剂而愈。又钱吉甫女，年十三，体肥痰盛，因邻
居被盗，发热头痛，呕逆面青，六脉弦促，便溺易位。此因惊气乱，痰袭窍端，与四七汤下滚痰丸，开通痰气
而安。（《证治准绳》）
交肠一证，大小二便易位而出，若交易然。古用五苓治之，专为通前阴而设也。此证闭在后阴，二便俱从
前阴而出，拟之交肠，诚似是而实非。况交肠乃暴病骤然而气乱于中，此乃久病以渐而血枯于内，有毫厘千里
之不同。原夫疾之所始，始于忧思结而伤脾。脾统血者也，脾伤则血不能统摄，而错出下行，乃误认为崩漏，
以凉血清火为治，则脱出转多。血尽然后气乱，气乱然后水谷舍故趋新，舍宽趋隘，江汉两渠，并归一路，身
中为之大乱。势必大肠之故道复通，乃可拨乱返治。又况水谷由胃入肠，
另有幽门泌别清浊，今以渗血之故，酿为谷道，是幽门辟为坦径矣，尚可用五苓再辟之乎？（喻嘉言）
一妇患休息痢二年，怀孕时，犹坐努，产后，大便自前阴出。予曰∶大小便并出前阴，非肠交也。不自肠
痈致病，非肠溃也。大便日夜十余次，前出十之七，后出十之三，是大肠易位，而小肠犹故道也。大肠易位者，
必由临产用力而就前阴，产后不归谷道，轻车熟路，久而成惯。欲归谷道，当先实肠，肠实则水谷自分，多服
补中汤，大气转旋，糟粕自返本位矣。（许宣治）
前阴诸疾
妇人阴寒，温中坐药，蛇床散主之。○少阴脉滑而数，阴中生疮蚀烂者，野狼牙汤洗之。（《金匮》）
妇女患阴疮者，其类不一，大约皆由七情郁火，损伤肝脾，又兼湿热下注也。亦有月后行房，秽浊渍流阴
道，遂生疳疮，与男子 精疮略同。治用黄丹、枯矾、 蓄、 本、硫磺、荆芥、蛇床子、蛇壳，共为细末，
先煎荆芥、蛇床子汤洗拭，香油调涂之。○又有阴中KT 疮，痛痒如虫行状，脓水淋沥，皆由心神烦郁，脾胃虚
弱，以致血气留滞。治当补心养胃，外以药洗之（宜塌肿汤）、塞之（宜雄黄蛇蜕散）。其或生虫，痒不可忍，
用蛇床子汤洗拭，外以药糁之（宜铜绿散）；或用梓树皮末、枯矾、麝香敷之。○又有阴肿，因胞络素虚，风
邪乘于阴部。若气血虚弱则补之（宜补中汤）；若肝经湿热则清之（宜龙胆泻肝汤）。或阴户肿痛不闭，寒热
尿涩（宜加味逍遥散，外用枳橘熨法）；或肿已消，户仍不闭（宜补中汤）；或阴中作痛（宜四物汤加柴胡、
山栀、丹皮、龙胆草）；或小水淋沥，腹中如有一物，攻动胀痛（宜逍遥散加柴胡、山栀、车前子）；或肿痛
【病因】
妇女的杂病，本质上也是血分方面的疾病。妇女的杂病，难道与男子的脏腑经络有什么不同吗？然而，除了妊娠和产后专门设立病名外，杂病也单独分篇论述，正是因为妇女血分方面的杂病与男子大不相同，所以必须通过这一篇的论法来阐述。其他与男子相同的杂病，大多可以概括在前面的各篇之中，不必再赘述了。为什么呢？妇女在妊娠期间，血液在胞宫滋养胎儿；产后，旧的血液排尽，新的血液转化为乳汁，这是确定的道理。至于平时没有怀孕的时候，血分的枯荣全取决于月经的进退通闭，所以患病大半是在月经来去的时候感受邪气所致。月经来时血室开放，月经去后血室空虚，开放的容易让邪气侵入，空虚的容易让邪气乘虚而入。阳邪侵入而损伤血液导致血热，就会引起漏下（非经期阴道出血）；阴邪侵入而损伤血液导致血寒，就会引起经闭。没有不是从这里开始发病的！这就是妇女杂病必然关乎血分，所以单独设立一篇，与妊娠、产后合为三大法门的原因。（魏荔彤）
【论难易】
谚语说：“宁可治疗十个男子，也不愿治疗一个妇人。”这是说妇人的病不容易治疗。为什么呢？不知道妇人的病，根本原理与男子相同，但她们的情志却与男子不同。大概因为妇女幽居深闺，多有郁结，性情偏执拗，有的心事不能畅达，有的病痛不可告人，有的迷信巫师，有的畏惧服药，所以病情顽固难愈，治疗起来就不容易了。这是情志使然。然而还有人事上的困难，如黄帝所说：“凡是治病必须观察病人的形体、气色、光泽。”又说：“诊病的道理，要观察人的勇敢或怯懦、骨骼肌肉、皮肤状况。”这是治病的大原则。现在富贵人家，居住在深室之中，处在帷幔之内，还有人用绵帕蒙住手（不让医生切脉），既然不能进行望色的高超诊断，又不能充分施展切脉的技巧。如果脉象有不符合常规的地方，难免要多问，问多了觉得繁琐，必定会说医术不精。却不知道问诊也不容易，不是医术高明的医生是做不到的。望、闻、问、切四诊，想要去掉其中三项，我恐怕即使是神医也会变得不神了。世间的通病就是这样，这就是妇人的病之所以不容易治疗的原因。（张景岳）
【验手法】
妇女深居闺阁，严密遮挡屏风帷帐，不能看到她们的面色，只需要查验她们手腕处的色泽，苍老还是白嫩，肥胖还是消瘦，就已经可见一斑了。至于皮肤的滑润或粗糙，纹理的疏密，肌肉的坚硬或松软，筋脉的粗细，骨骼的大小，指甲的刚硬或柔韧，手指的肥瘦，手掌的厚薄，尺肤（前臂内侧皮肤）的寒热，以及动静姿态的安全与否，气息的微弱或旺盛，再结合脉象，参酌症状，那么气血的虚实、性情的刚柔、形体的劳逸、饮食的精粗、病苦的顺逆，都能在心目中了然于胸了。（张路玉）
【寡妇师尼】
宋代褚澄治疗师尼、寡妇，另外制定了方剂。大概这两种人寡居独处，独阴无阳，欲望萌动而不能实现，因此阴阳交争，忽冷忽热，症状类似疟疾，时间久了就会变成劳损。《史记》记载济北王的侍妾韩女，患腰痛伴寒热。仓公诊断说：“这病是因为想要男子但不能得到所致。”怎么知道的呢？诊得肝脉弦急且超出寸口部位，因此知道是此病。大概男子以精为主，女子以血为主。男子精盛则思慕房事，女子血盛则容易怀胎。厥阴肝脉弦急且超出寸口，说明阴气过盛。褚氏的说法是有道理的。（《东医宝鉴》）
寡妇和师尼，因抑郁而成病，症状表现为忽冷忽热，面红心烦，自汗身体疼痛，肝脉弦急且超出寸口，治疗适宜用柴胡抑肝汤、抑阴地黄丸、越鞠丸。（《医方类聚》）
【热入血室】
妇女患中风症七八天，接着出现寒热往来，发作有定时，月经恰好中断，这是热邪陷入血室，血液必然凝结，所以症状像疟疾一样，发作有定时，用小柴胡汤主治。○妇女患伤寒发热，月经恰好来潮，白天神志清楚，晚上则胡言乱语，好像看见鬼怪一样，这是热邪陷入血室，治疗时不要侵犯胃气及上二焦（上焦、中焦），一定会自愈。○妇女患中风，发热恶寒，月经恰好来潮，得了七八天，热退，脉迟，身体凉爽平和，但胸胁胀满，像结胸证的样子，且有胡言乱语的，这是热邪陷入血室，应当针刺期门穴，根据其实证情况泻之。○患阳明病，下血且胡言乱语的，这是热邪陷入血室，只有头部出汗，应当针刺期门穴，根据其实证情况泻之，全身濈然汗出就会痊愈。（《金匮要略》）
妇女患伤寒，有热入血室的证候。血室即血海，由冲脉、任脉所系管，是藏精受胎的场所。因为在行经期间，感染了伤寒邪气，热邪乘虚袭入，与血相搏结。肝藏魂，血室空虚，则魂无所依附，肝受热邪，就会出现胡言乱语、见鬼的症状，这是因为肝之魂不能安宁。治疗只需清热行血，严重的用桃仁承气汤，轻微的用地黄、丹皮、桃仁、红花、赤芍、五灵脂、甘草、木通、丹参之类的药物，不可以拘泥于小柴胡汤这一固定成例。小柴胡汤一方，本是治疗伤寒邪气传入少阳，和解表里的药物，并非专门治疗热入血室的药物。方中虽然有柴胡发表、黄芩退热，但半夏化痰，是血证患者所忌讳的；人参补气，不适合血热的情况。现在的人一遇到热入血室的证候，就用小柴胡汤，说我是遵循张仲景的教导。哪里知道张仲景第一条说妇女中风，寒热发作有时，症状像疟疾。明确属于少阳经见证，所以说用小柴胡汤主治。那么小柴胡汤原本是为少阳经设立的。至于后面三条，只说“必自愈”，说“当刺期门”，又说“随其实而泻之”。并没有“小柴胡汤主之”这句话，由此可知小柴胡汤只治疗少阳经像疟疾一样的证候，并不是治疗热入血室的证候。现在的人不玩味张仲景前后的原文，随意说妇人热入血室，就辄用的小柴胡汤，岂不可笑！凡是治疗妇人热入血室病，有寒热发作有时像疟疾一样的，那么小柴胡汤可以使用。但是必须加入桃仁、丹皮、五灵脂来行血，如果没有寒热像疟疾一样的证候，那么小柴胡汤绝对不可使用。举世之人懵懂无知，特意标举出来加以阐明。（萧慎斋）
考证热入血室，《金匮要略》有四种治法，现在的人一遇到这个证候，不辨别热邪入侵的轻重、血室的盈亏，就匆忙投用小柴胡汤，贻害必然很多。总之，热盛而血瘀的，给予桃仁承气汤及穿山甲、当归尾之类的药物。血舍空虚而热邪陷入的，用犀角地黄汤加丹参、木通之类的药物。表邪未尽的，则应当合乎和解之法。热轻而清热药过用，导致气机迟钝的，不妨借用温通药作为引导。血结胸，有桂枝红花汤参入海蛤、桃仁的治疗；昏狂严重的，进服牛黄膏，调入清气化结的煎剂，又有两解气血燔蒸的玉女煎法；热盛伤阴的，有育阴养气的复脉法。审察证候制定方剂，不要拘泥于柴胡一法。（《临证指南医案》）
【咽中炙脔】
妇女感觉咽喉中有像烤肉块一样的异物感，用半夏厚朴汤主治。（《金匮要略》）
炙脔，就像干肉一样。《千金方》所说的咽喉中贴贴如有烤肉，吐不出来，吞不下去的就是这种病。这个病不关乎肠胃，所以不影响饮食和二便；不关乎表邪，所以没有骨痛寒热。这是气被积寒所伤，不与血调和，血中的气溢出而浮于咽喉，遇到水湿之气，凝结难以移动。妇女血分受寒，多积冷结气，最容易得这个病。药用半夏厚朴汤的原因在于：半夏降逆，厚朴散结，生姜、茯苓宣通至高部位的滞气并下行湿气，苏叶味辛气香，色紫性温，能入阴分和血。气与血调和，就不再上浮了。（徐忠可）
【阴吹】
胃气向下泄漏，从前阴排气且声音喧闹，这是由于谷气实盛所致，用猪膏发煎导引治疗。（《金匮要略》）
胃气向下泄漏，不由大肠排出浊物，而是由小肠排出清道，则是气不足而无所收摄，所以令前阴作吹，而且声音甚至喧响到外面。这虽然说是胃中谷气的实盛，但其实质是胃中正气的衰弱。治疗用猪膏发煎导引，无非是让大便通畅，即使胃气向下泄漏，也必然由浊道（后阴）而出，不至于扰乱清道（前阴）。所谓阴中吹气，让人听到的意思罢了。（魏荔彤）
阴吹这一证候，古书中不多见，只有《金匮要略》说：“胃气下泄，阴吹而正喧，此谷气之实也，膏发煎导之。”阴器属于厥阴部位，精窍连通冲任之脉，尿窍连通小肠之路，气道如果不从此处出，怎么能有声而喧闹呢？大概是由于肝肾亏虚于下，肺气亏虚于上，导致阳明胃气不能鼓舞上行，而亏虚于中，向下走向阴器，直入精窍而出，这难道同大肠失气，《内经》所说的“浊阴出下窍”可以相比吗？常见虚损的人，久咳经阻，胃气不升，往往多有这个病患。说到肾，则气不摄可知；说到肝，则气不平可知；说到肺，则气不主可知。所以上咳下吹，气窍相通，阴器隐隐有声。足见精血的亏虚，元气的虚弱，根本摇摇欲坠了。阳明是多气多血的海洋，与冲任血海之脉同声相应，下为经而上为乳，变化取汁，是血气的实盛。喧响到户外，是胃气的虚衰。魏氏说：“这虽然是谷气的实盛，其实是胃气的衰弱。”这话极中长沙（张仲景）的秘旨。如果一定说是谷气实，而引导浊气从大肠出，纵然胃气下泄必由浊道，而不致扰乱清道，这是错认溺窍为病位。只是胃气下泄到前阴的膀胱，何异于下泄到后阴的大肠？终究对病情没有帮助。况且肾主开阖，是生气的源头；阴气属肝，主疏泄的命令。现在胃气下走，难道是寻常的药物可以奏效的吗？必须培补肝肾以固护肺金，生精益血以助真气。如果阳分多亏，补中益气汤、归脾汤之类的可以投用；阴分多亏，六味地黄丸、左归丸之类的可用；阴阳两亏，八味丸、右归丸之类的可服。耗气败血的药物，不是治疗方法。如果不咳嗽而窍有声的，比咳嗽而窍有声的要稍轻，逍遥散、六味地黄丸都合法度。虽然如此，膀胱有下窍而无上口，胃气如何下泄？它从精窍而来，不用辨而自明。男子从无此病，妇人常有，无非是窍空而妄泄。况且谷道在后通畅，而前阴有吹气的；谷道在后闭塞，而前阴不吹气的。谷气实，胃气怎么会下泄？仲景猪膏发煎导引的方法，其说法似乎难以明白。即使胃气从溺窍下泄，小便应该随气一起出来，为什么吹气时惟有声而没有小便流出？那么从溺窍而来的说法，更属无据。总之，胃气，是水谷的精气，上输于脾，脾气散精，上归于肺，与肾中生气互根。莫非是因为其人水谷的真气衰弱，而以脂膏益血的物品从阴引阳，填补冲任，不让气陷于子宫，直走精门，也未可知吧。（《会心录》）
阴吹，是妇人常有的疾病，但大多隐忍不言，所以方书不载，医生不加考察。《金匮要略》明确说胃气下泄，谷气实，所以腹中喧响，于是气从前阴吹出，只用猪膏发煎治疗，难于推测。我治疗过一个妇人，闭经三个月，少腹痛彻心并出现前证，给予失笑散，一服后，瘀血大下，随即不再发作。又治疗过一个妇人，小产后寒热腹痛，也出现前证，给予炮黑山楂肉，黑糖为丸，用伏龙肝水煎独参汤送下三钱，结粪大下。再进服，瘀血续行，前证顿止。这才领悟到猪膏发煎是为逐瘀而设的。（《张氏医通》）
按：“膏发煎导之”五个字应该是衍文。“此谷气之实也”之下，应该有“长服诃黎勒丸”这六个字。后阴下气，称为气利，用诃黎勒散。前阴下气，称为阴吹，用诃黎勒丸。文义才通顺，药病也对应。盖诃黎勒丸，以诃黎勒固下气之虚，以厚朴、陈皮平谷气之实，也相吻合。（《医宗金鉴》）
【脏燥】
妇女脏燥，悲伤想哭，症状像神灵附体一样，频繁打哈欠伸懒腰，用甘麦大枣汤主治。（《金匮要略》）
妇女脏燥，没有受到什么感触，悲哭无常，症状像神灵附体一样，这是血虚而津液亡失，脏腑空虚而发燥的证候。它的症状，又是频繁打哈欠伸懒腰，老师早就知道这是血虚津亡，由于气虚胃阳亡失所致。打哈欠伸懒腰，是倦怠的表现，如果不是阳气不足、精神不振，不会有这个证候。主治用甘麦大枣汤补中益胃之外，没有其他方法。脏燥由于血虚，世间的医生谁不竞相说滋阴养血，却不知阴盛而津液更枯，阳衰而阴更燥，老师的言论确实确凿无疑啊。（魏荔彤）
【交肠】
交肠的证候，大小便位置互换而出。因为醉酒饱食不节制，大怒不解，导致脏气乖乱，不循常度。应当用吐法以提举其气，使阑门能够司职泌别清浊而清浊自分，适宜五苓散、调气散各一钱，阿胶末一钱，白开水调服。（《证治准绳》）
【选案】
交肠一证，虽然在方书中见到，但世间罕见。詹石匠的妻子，产后五六天，恶露不行，腹胀喘满，大便从前阴出。因为她素来嗜好烟酒，又因生产时受惊。我用芎归汤加莪术、肉桂、炒山楂，一服后，恶露通，小便如常。又陆圣祥的女儿，四岁，新秋患痢疾，粪便出前阴，当作冷热不调治疗，给予五苓散送服香连丸，二剂而愈。又钱吉甫的女儿，十三岁，体胖痰盛，因邻居被盗，发热头痛，呕逆面青，六脉弦促，便溺易位。这是因为惊气扰乱，痰邪袭击窍端，给予四七汤送服滚痰丸，开通痰气而安。（《证治准绳》）
交肠一证，大小二便位置互换而出，如同交易一样。古代用五苓散治疗，专为通利前阴而设。这个证候闭塞在后阴，二便都从前阴而出，拟名为交肠，诚然是似是而非。况且交肠是暴病骤然发生而气乱于中，这个是久病逐渐发展而血枯于内，有毫厘千里的不同。推究疾病的起始，始于忧思结聚而伤脾。脾统血，脾伤则血不能统摄，而错出下行，于是误认为崩漏，以凉血清火为治，则脱出更多。血尽然后气乱，气乱然后水谷舍弃故道趋向新道，舍弃宽路趋向窄路，江汉两条渠，并归一路，身体为之大乱。势必大肠的故道重新通畅，才可以拨乱反正。况且水谷由胃入肠，另有幽门泌别清浊，现在因为渗血的原因，酿为谷道，是幽门辟为坦途了，还可以再用五苓散再开辟吗？（喻嘉言）
一个妇人患休息痢二年，怀孕时，还坐草用力努责，产后，大便自前阴出。我说：“大小便并出前阴，不是肠交。不是由肠痈致病，也不是肠溃烂。大便日夜十余次，前出十分之七，后出十分之三，是大肠易位，而小肠还是故道。大肠易位的，必然是由临产用力而趋向前阴，产后不归谷道，轻车熟路，久而久之成为习惯。想要回归谷道，应当先实肠，肠实则水谷自分，多服补中益气汤，大气转旋，糟粕自然返回本位了。”（许宣治）
【前阴诸疾】
妇女外阴寒冷，用温中坐药，蛇床散主治。○少阴脉滑而数，阴中生疮蚀烂的，用野狼牙汤清洗。（《金匮要略》）
妇女患阴疮的，类别不一，大约都是由七情郁火，损伤肝脾，又兼湿热下注所致。也有月经过后行房，秽浊渍流阴道，遂生疳疮，与男子的精疮大致相同。治疗用黄丹、枯矾、萹蓄、藁本、硫磺、荆芥、蛇床子、蛇壳，共为细末，先煎荆芥、蛇床子汤洗拭，香油调涂。○又有阴中结核疮，痛痒如虫行状，脓水淋沥，皆由心神烦郁，脾胃虚弱，以致血气留滞。治疗应当补心养胃，外用药物清洗（宜塌肿汤）、塞入（宜雄黄蛇蜕散）。或者生虫，痒不可忍，用蛇床子汤洗拭，外用药物撒敷（宜铜绿散）；或者用梓树皮末、枯矾、麝香敷之。○又有阴肿，因胞络素虚，风邪乘于阴部。若气血虚弱则补之（宜补中益气汤）；若肝经湿热则清之（宜龙胆泻肝汤）。或者阴户肿痛不闭合，寒热尿涩（宜加味逍遥散，外用枳橘熨法）；或者肿已消，户仍不闭合（宜补中益气汤）；或者阴中作痛（宜四物汤加柴胡、山栀、丹皮、龙胆草）；或者小便淋沥，腹中好像有一物，攻动胀痛（宜逍遥散加柴胡、山栀、车前子）；或者肿痛
[Etiology]
Women's miscellaneous diseases are essentially disorders of the Blood aspect. Are women's miscellaneous diseases different from men's in terms of Zang-Fu organs and meridians? However, besides establishing specific disease names for pregnancy and postpartum conditions, miscellaneous diseases are also discussed in a separate chapter precisely because women's miscellaneous diseases involving the Blood aspect differ significantly from those of men. Therefore, it is necessary to present this chapter's theories and methods. Other miscellaneous diseases that are similar to men's can be encompassed within the previous chapters and need not be reiterated. Why is this? During pregnancy, blood nourishes the fetus in the Bao Gong (uterus); after childbirth, old blood is discharged, and new blood transforms into milk; this is a fixed principle. As for times when there is no pregnancy, the withering and flourishing of the Blood depend entirely on the progression, obstruction, or patency of menstruation. Thus, most illnesses arise during the onset or cessation of menstruation. When menstruation comes, the Xue Shi (Blood Chamber) opens; when it goes, the Xue Shi becomes deficient. An open state allows pathogens to enter easily, and a deficient state allows pathogens to take advantage. If Yang pathogens enter and damage the Blood causing Heat, leakage bleeding occurs; if Yin pathogens enter and damage the Blood causing Cold, amenorrhea results. All such conditions originate here! This is why women's miscellaneous diseases must concern the Blood aspect and are established as a separate chapter, forming three major categories along with pregnancy and postpartum conditions. (Wei Litong)
[On Difficulty]
The proverb says: "Better to treat ten men than one woman." This refers to the difficulty of treating women's diseases. Why? It is unknown that women's diseases are fundamentally the same as men's, but their emotional states differ. Generally, women live in seclusion and often suffer from depression; their temperaments may be stubborn. Some have desires that cannot be fulfilled, some have ailments they cannot disclose, some believe in shamans, and some fear medication. Consequently, the disease takes deep root and is difficult to treat. This is due to their emotions. However, there are also difficulties arising from social circumstances. As Huang Di stated: "In treating any disease, one must observe the patient's form, Qi, color, and luster." He also said: "The way to diagnose disease is to observe whether the person is courageous or timid, their bone structure and muscles, and their skin." These are the great principles of treatment. Now, people of wealth live in inner chambers, behind curtains, and even cover their hands with silk pads (preventing pulse diagnosis). Since one cannot perform divine observation of color nor fully utilize the skill of pulse taking, if the pulse seems inconsistent, one inevitably asks more questions. Asking too much seems tedious, leading to accusations of poor medical skill. Yet, questioning is not easy; only skilled physicians can do it well. To remove three out of the four diagnostic methods (Inspection, Auscultation/Olfaction, Inquiry, Palpation), I fear even a divine physician would lose their efficacy. Such is the common plight of the world, which explains why women's diseases are so difficult to treat. (Zhang Jingyue)
[Examination Techniques]
Women reside deeply in their quarters, hidden behind screens and curtains, so their facial complexion cannot be seen. One must examine the color of their wrists; whether pale or ruddy, fat or thin, gives a glimpse of their condition. Regarding the smoothness or roughness of the skin, the density of pores, the firmness or softness of flesh, the thickness of sinews, the size of bones, the hardness or flexibility of nails, the plumpness or leanness of fingers, the thickness of palms, the coldness or warmth of the Chi region (inner forearm), and the safety or danger indicated by movement and stillness, as well as the weakness or strength of breath, combined with pulse diagnosis and symptom analysis, one can clearly understand the deficiency or excess of Qi and Blood, the rigidity or gentleness of temperament, the labor or rest of the body, the coarseness or refinement of diet, and the favorable or unfavorable nature of the illness. (Zhang Luyu)
[Widows and Nuns]
Song Dynasty physician Chu Cheng treated nuns and widows with specially formulated prescriptions. These two groups live in widowhood, possessing solitary Yin without Yang. Their sexual desire arises but is unfulfilled, leading to a struggle between Yin and Yang, alternating chills and fever, resembling malaria. Over time, this becomes consumption (Lao disease). The *Records of the Grand Historian* records Han Nu, a attendant of King Jibei, suffering from lower back pain and alternating chills and fever. Cang Gong diagnosed her, saying: "This disease arises from desiring a man but being unable to obtain one." How did he know? He felt the Liver pulse was wiry and extended beyond the Cun position at the wrist. Thus, he knew. Men are primarily governed by Essence (Jing), while women are primarily governed by Blood. When men's Essence is abundant, they crave sexual intercourse; when women's Blood is abundant, they conceive. A wiry Liver pulse extending beyond the Cun position indicates an excess of Yin. Chu's words have merit. (*Dongui Bogam*)
Widows and nuns develop diseases due to depression. Symptoms include alternating chills and fever, red face, mental restlessness, spontaneous sweating, and body pain. The Liver pulse is wiry and extends beyond the Cun position. Treatment should utilize Chai Hu Yi Gan Tang (Bupleurum Liver-Suppressing Decoction), Yi Yin Di Huang Wan (Yin-Suppressing Rehmannia Pill), or Yue Ju Wan (Pill for Relieving Depression). (*Yi Fang Lei Ju*)
[Heat Entering the Blood Chamber]
If a woman suffers from Wind-Cold for seven or eight days and subsequently develops alternating chills and fever occurring at regular intervals, and her menses happen to cease, this is Heat entering the Blood Chamber. The Blood will surely congeal, causing symptoms like malaria with regular paroxysms. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. ○ If a woman suffers from Cold Damage with fever, and her menses happen to begin, she is clear-minded during the day but delirious at night, seeing ghosts. This is Heat entering the Blood Chamber. Treat it without violating the Stomach Qi or the Upper and Middle Jiao; it will heal itself. ○ If a woman suffers from Wind-Cold with fever and aversion to cold, and her menses happen to begin, and after seven or eight days the fever subsides, the pulse becomes slow, and the body feels cool and harmonious, yet she has fullness and oppression in the chest and hypochondrium resembling Jie Xiong (Chest Binding) syndrome, accompanied by delirium, this is Heat entering the Blood Chamber. One should puncture Qi Men (LR14) and drain according to the Excess pattern. ○ In Yang Ming disease, if there is bleeding and delirium, this is Heat entering the Blood Chamber. There is only sweating on the head. One should puncture Qi Men (LR14) and drain according to the Excess pattern. If generalized sweating ensues, she will heal. (*Jin Gui Yao Lue*)
Women with Cold Damage may present with Heat entering the Blood Chamber. The Blood Chamber is the Sea of Blood, connected to the Chong and Ren meridians, and is the place where Essence is stored and conception occurs. Because the pathogen invades during menstruation, Heat pathogens invade the deficiency and contend with the Blood. The Liver stores the Hun (Ethereal Soul). When the Blood Chamber is deficient, the Hun has no foundation. When the Liver receives Heat pathogens, it causes delirium and hallucinations ("seeing ghosts") because the Hun cannot settle. Treatment requires clearing Heat and moving Blood. For severe cases, Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) is used; for mild cases, herbs like Sheng Di Huang (Rehmannia Root), Mu Dan Pi (Moutan Bark), Tao Ren (Peach Kernel), Hong Hua (Safflower), Chi Shao (Red Peony Root), Wu Ling Zhi (Trogopterus Feces), Gan Cao (Licorice), Mu Tong (Akebia Stem), and Dan Shen (Salvia Root) are appropriate. One must not rigidly adhere to Xiao Chai Hu Tang as a fixed rule. Xiao Chai Hu Tang is originally for Cold Damage where the pathogen has transmitted to the Shaoyang meridian to harmonize the exterior and interior; it is not specifically for Heat entering the Blood Chamber. Although it contains Chai Hu (Bupleurum) to release the exterior and Huang Qin (Scutellaria) to clear Heat, Ban Xia (Pinellia) resolves phlegm and is contraindicated in Blood disorders; Ren Shen (Ginseng) tonifies Qi and is unsuitable for Blood Heat. Nowadays, upon encountering Heat entering the Blood Chamber, people immediately use Xiao Chai Hu Tang, claiming to follow Zhong Jing (Zhang Zhongjing). They fail to realize that Zhong Jing's first clause describes Wind-Cold with alternating chills and fever resembling malaria, which clearly belongs to the Shaoyang meridian pattern, hence Xiao Chai Hu Tang is indicated. Thus, Xiao Chai Hu Tang was originally established for the Shaoyang meridian. The subsequent three clauses only say "will heal itself," "should puncture Qi Men," and "drain according to the Excess." None mention "Xiao Chai Hu Tang is the main treatment." Therefore, Xiao Chai Hu Tang treats only the Shaoyang-like-malaria pattern, not Heat entering the Blood Chamber. People who do not study Zhong Jing's original text carefully and casually use Xiao Chai Hu Tang for all Heat entering the Blood Chamber cases are laughable. For women's Heat entering the Blood Chamber with alternating chills and fever resembling malaria, Xiao Chai Hu Tang can be used, but Tao Ren, Mu Dan Pi, and Wu Ling Zhi must be added to move Blood. Without the malaria-like pattern, Xiao Chai Hu Tang must absolutely not be used. The world is ignorant of this; I highlight it here. (Xiao Shenzhai)
Regarding Heat entering the Blood Chamber, *Jin Gui* presents four methods. Today, practitioners encounter this pattern and, without distinguishing the severity of Heat or the fullness/emptiness of the Blood Chamber, hastily administer Xiao Chai Hu Tang, causing much harm. In summary: For severe Heat with Blood stasis, use Tao Ren Cheng Qi Tang plus Shan Jia (Pangolin Scales) and Gui Wei (Angelica Sinensis Tail). For empty Blood residence with陷陷 (sinking) Heat, use Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) plus Dan Shen and Mu Tong. For unresolved exterior pathogens, harmonization is appropriate. For mild Heat over-treated with cooling herbs causing sluggish Qi mechanism, warm and unblocking agents may be borrowed as guides. For Blood binding in the Chest, Gui Zhi Hong Hua Tang (Cinnamon Twig and Safflower Decoction) combined with Hai Ge (Clam Shell) and Tao Ren is used. For severe confusion and mania, Niu Huang Gao (Calculus Bovis Paste) mixed with Qing Qi Hua Jie decoction is advanced. For burning Qi and Blood, Yu Nu Jian (Jade Woman Decoction) resolves both. For severe Heat damaging Yin, Fu Mai Tang (Restore the Pulse Decoction) nourishes Yin and tonifies Qi. Formulate based on the pattern; do not restrict yourself to the Chai Hu method alone. (*Lin Zheng Zhi Nan*)
[Meat Lump in Throat]
If a woman feels as if there is a roasted meat lump in her throat, Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) is the main treatment. (*Jin Gui Yao Lue*)
"Zhi Luan" refers to dried meat. As described in *Qian Jin*, it is the sensation of having meat stuck in the throat, impossible to spit out or swallow. This disease does not involve the intestines or stomach, so it does not hinder eating or bowel/bladder movements. It does not involve exterior pathogens, so there is no bone pain or chills/fever. It arises because Qi is injured by accumulated Cold and fails to harmonize with Blood. Qi from the Blood overflows and floats to the throat. Encountering Dampness and Water Qi, it condenses and becomes difficult to move. Women whose Blood aspect suffers from Cold often accumulate Cold and Qi stagnation, making them prone to this disease. The reason for using Ban Xia Hou Po Tang is: Ban Xia directs rebellious Qi downward; Hou Po disperses nodules; Sheng Jiang (Fresh Ginger) and Fu Ling (Poria) disseminate stagnation in the high regions and descend Dampness; Su Ye (Perilla Leaf) is pungent, aromatic, purple, and warm, entering the Yin to harmonize Blood. When Qi and Blood harmonize, they no longer float upward. (Xu Zhongke)
[Yin Blowing]
When Stomach Qi leaks downward, causing "Yin Blowing" (flatulence from the vagina) with loud noise, this is due to the excess of Grain Qi. It should be guided by Gao Fa Jian (Fat and Hair Decoction). (*Jin Gui Yao Lue*)
Stomach Qi leaking downward does not exit via the large intestine (turbid pathway) but exits via the small intestine (clear pathway). This indicates Qi deficiency and lack of containment, causing the external genitalia to emit gas with audible noise. Although this is described as the excess of Grain Qi in the Stomach, its essence is the deficiency of Righteous Qi in the Stomach. Treatment uses Gao Fa Jian to guide it, aiming to facilitate bowel movement so that even if Stomach Qi leaks downward, it exits via the turbid pathway (anus) and does not disturb the clear pathway (vagina). The term "Yin blowing" implies the sound being heard externally. (Wei Litong)
The syndrome of Yin Blowing is rarely seen in ancient texts, except for the statement in *Jin Gui*: "Stomach Qi leaks downward, Yin blows and makes noise, this is the excess of Grain Qi, guide with Gao Fa Jian." The external genitalia belong to the Jueyin region. The spermatic aperture connects to the Chong and Ren meridians; the urinary aperture connects to the Small Intestine pathway. If Qi does not exit from here, how can there be noise? It is likely due to Kidney and Liver deficiency below and Lung Qi deficiency above, causing Yangming Stomach Qi to fail to inspire upward, becoming deficient in the middle, descending to the external genitalia, and directly entering the spermatic aperture to exit. This is not comparable to intestinal gas loss, where "Turbid Yin exits the lower orifice." Commonly, those with deficiency consumptions, chronic cough, and obstructed menses, where Stomach Qi does not ascend, often suffer from this. Regarding the Kidney, Qi fails to control; regarding the Liver, Qi is unbalanced; regarding the Lung, Qi fails to govern. Thus, upper cough and lower blowing, Qi apertures connect, and the external genitalia make faint sounds. This shows the deficiency of Essence and Blood, and the weakness of Yuan Qi, with the root trembling. Yangming is the sea of abundant Qi and Blood, resonating with the Chong and Ren Sea of Blood. Below it forms menstruation, above it transforms into milk; changing juice represents the abundance of Qi and Blood. Noise audible outside indicates Stomach Qi deficiency. Wei said: "Although this is the excess of Grain Qi, it is actually the decline of Stomach Qi." This hits the secret intent of Changsha (Zhang Zhongjing) perfectly. If one insists that Grain Qi is excess and guides turbid Qi from the large intestine, ensuring Stomach Qi exits via the turbid pathway without disturbing the clear pathway, this mistakes the urinary aperture as the disease site. Merely leaking Stomach Qi to the anterior bladder orifice is no different from leaking to the posterior anal orifice; it ultimately helps no condition. Moreover, the Kidney controls opening and closing and is the source of generating Qi; Yin belongs to the Liver and controls dispersion and descent. Now that Stomach Qi descends, can ordinary medicines achieve success? One must tonify the Liver and Kidney to secure Lung Metal, generate Essence and nourish Blood to assist True Qi. If Yang deficiency predominates, Bu Zhong Yi Qi Tang or Gui Pi Tang may be used; if Yin deficiency predominates, Liu Wei Di Huang Wan or Zuo Gui Wan may be used; if both Yin and Yang are deficient, Ba Wei Wan or You Gui Wan may be taken. Herbs that consume Qi and ruin Blood are not treatments. If there is sound from the aperture without coughing, it is slightly lighter than with coughing; Xiao Yao San and Liu Wei Di Huang Wan are both appropriate. Nevertheless, the bladder has a lower orifice but no upper entrance; how does Stomach Qi leak downward? That it comes from the spermatic aperture is self-evident without debate. Men never have this; women often do, simply due to empty apertures and wrongful discharge. Furthermore, if the anal passage is open posteriorly, blowing from the anterior occurs; if the anal passage is closed posteriorly, no anterior blowing occurs. If Grain Qi is excess, how can Stomach Qi leak downward? Zhong Jing's method of guiding with Gao Fa Jian seems hard to explain. Even if Stomach Qi leaks from the urinary aperture, urine should exit with the Qi, yet why is there only sound and no urine during blowing? Thus, the theory of urinary aperture origin is baseless. In short, Stomach Qi is the refined Qi of water and grain, transported up to the Spleen, dispersed by Spleen Qi, returned up to the Lung, and rooted in the generating Qi of the Kidney. Could it be that due to the weakness of the person's true Qi from water and grain, lipid and blood-nourishing substances are used to draw Yang from Yin, filling the Chong and Ren, preventing Qi from sinking into the uterus and walking directly to the spermatic gate? This is possible. (*Hui Xin Lu*)
Yin Blowing is a constant ailment for women, but they often endure it in silence without speaking, so prescription books do not record it, and doctors do not examine it closely. *Jin Gui* clearly states Stomach Qi leaks downward, Grain Qi is excess, causing abdominal rumbling, so Qi blows from the anterior yin. Using only Zhu Gao Fa Jian (Pig Fat and Hair Decoction) is hard to deduce. I treated one woman who had amenorrhea for three months, lower abdominal pain piercing the heart, presenting with this syndrome. I gave Shi Xiao San (Quick Relief Powder); after one dose, large amounts of stagnant Blood were discharged, and the syndrome did not recur. I treated another woman who had chills, fever, and lower abdominal pain after a miscarriage, also presenting with this syndrome. I gave charred Hawthorn fruit pills made with Brown Sugar, delivered with Du Shen Tang (Single Ginseng Decoction) brewed with Fu Long Gan (Dragon's House Earth). After large stools of hardened feces passed, and subsequent doses moved stagnant Blood, the syndrome stopped instantly. I then realized Zhu Gao Fa Jian was designed to expel stasis. (*Zhang Shi Yi Tong*)
Note: The five characters "Gao Fa Jian dao zhi" (guide with Gao Fa Jian) are likely interpolations. After "Ci Gu Qi zhi shi ye" (this is the excess of Grain Qi), the six characters "Chang fu He Li Le Wan" (long-term服用 of Chebula Pill) should exist. Downward gas from the posterior orifice is called Qi Li (Qi Diarrhea), treated with He Li Le San. Downward gas from the anterior orifice is called Yin Chui (Yin Blowing), treated with He Li Le Wan. Only then does the text make sense, and the medicine match the disease. He Li Le Wan uses He Li Le to secure deficiency of downward Qi, and Hou Po, Chen Pi to balance the excess of Grain Qi, which is consistent. (*Yi Zong Jin Jian*)
[Visceral Dryness]
When women suffer from Zang Dryness, they feel sad and want to cry, acting as if possessed by spirits, frequently yawning and stretching. Gan Mai Da Zao Tang (Sweet Wheat, Licorice, and Jujube Decoction) is the main treatment. (*Jin Gui Yao Lue*)
Women's Visceral Dryness involves no external trigger, yet they cry uncontrollably, appearing spirit-possessed. This is a syndrome of Blood deficiency and fluid exhaustion, where the viscera are empty and dry. The symptom of frequent yawning and stretching indicates fatigue. The Master long ago knew that Blood deficiency and fluid exhaustion stem from Qi deficiency and the loss of Stomach Yang. Yawning and stretching are signs of fatigue; without insufficient Yang Qi and low spirit, this symptom would not occur. Besides using Gan Mai Da Zao Tang to tonify the Middle and benefit the Stomach, there is no other method. Visceral Dryness stems from Blood deficiency. Physicians nowadays compete to speak of nourishing Yin and Blood, unaware that excessive Yin leads to drier fluids, and declining Yang leads to drier Yin. The Master's words are indeed solid. (Wei Litong)
[Jiao Chang (Intercrossing Intestines)]
The syndrome of Jiao Chang involves the exchange of positions for urination and defecation. It arises from irregularities in drinking and eating, and unresolved anger, causing Zang Qi to become chaotic and deviate from normal patterns. Emetic therapy should be used to lift the Qi, allowing the Lan Men (diaphragm between stomach and intestines) to function in separating clear and turbid, so clear and turbid divide themselves. Wu Ling San (Five Ingredient Powder with Poria) and Tiao Qi San (Regulate Qi Powder), each 1 qian, mixed with 1 qian of Ejiao (Donkey-Hide Gelatin) powder, taken with warm water, is suitable. (*Zheng Zhi Zhun Sheng*)
[Selected Cases]
The syndrome of Jiao Chang appears in prescription books but is rare in practice. The wife of Mason Zhan suffered from retained lochia five or six days postpartum, with abdominal distension and wheezing, and defecated from the anterior orifice. Because she habitually enjoyed tobacco and alcohol, and was frightened during delivery, I used Xiong Gui Tang (Ligusticum and Angelica Decoction) plus E Zhu (Curcuma Zedoaria), Rou Gui (Cinnamon Bark), and fried Shan Zha (Hawthorn). After one dose, lochia flowed, and urination returned to normal. Also, Lu Shengxiang's daughter, aged four, suffered from dysentery in early autumn, with feces exiting the anterior orifice. Treated as cold-heat imbalance with Wu Ling San delivering Xiang Lian Wan (Fragrant Coptis Pill), she healed in two doses. Also, Qian Jifu's daughter, aged thirteen, was obese with abundant phlegm. Due to a neighbor's robbery, she had fever, headache, vomiting, and a blue face. The six pulses were wiry and rapid, with excretion and urination exchanged. This was due to fright disrupting Qi and Phlegm attacking the apertures. Si Qi Tang (Four Substances Decoction) delivered Gun Tan Wan (Rolling Phlegm Pill) opened the Phlegm-Qi and brought peace. (*Zheng Zhi Zhun Sheng*)
The syndrome of Jiao Chang involves the exchange of positions for urination and defecation, like trading. Anciently, Wu Ling San was used, specifically designed to unblock the anterior orifice. This case involved blockage in the posterior orifice, with both urination and defecation exiting the anterior orifice. Naming it Jiao Chang is superficially plausible but fundamentally incorrect. Moreover, Jiao Chang is an acute disease with sudden Qi chaos in the middle; this case is a chronic disease with gradual Blood depletion inside, differing by miles. The disease originated from sorrow and worry knotting and injuring the Spleen. The Spleen governs Blood; when injured, Blood cannot be controlled and flows erratically downward. It was mistaken for Beng Lou (metrorrhagia and leukorrhea) and treated with cooling and clearing herbs, causing more discharge. After Blood was exhausted, Qi became chaotic. Chaotic Qi caused water and grain to abandon the old path for the new, abandoning the wide for the narrow, merging the Yangtze and Han rivers into one channel, causing great disorder in the body. It is necessary for the Large Intestine's old path to reopen to restore order. Furthermore, water and grain enter the Stomach and Intestines; there is another Hui Men (Pylorus) separating clear and turbid. Now, due to bleeding, the Hui Men has become a thoroughfare. Can Wu Ling San be used again to open it? (Yu Jiayan)
A woman suffered from intermittent dysentery for two years. During pregnancy, she still strained. Postpartum, feces exited from the anterior orifice. I said: "Both urination and defecation exiting the anterior orifice is not Chang Jiao (Intestine Crossing). It is not caused by intestinal abscess, nor intestinal ulceration. Defecating more than ten times a day, seven parts anterior and three parts posterior, means the Large Intestine has changed position, while the Small Intestine remains in its original path. The Large Intestine changes position because of straining during delivery towards the anterior orifice. Postpartum, it does not return to the anal canal. Taking the easy road becomes a habit. To return to the anal canal, one must first firm the intestines. When the intestines are firm, water and grain separate naturally. Taking Bu Zhong Yi Qi Tang frequently rotates the Great Qi, and waste returns to its original position." (Xu Xuanzhi)
[Diseases of the Anterior Orifice]
For women with cold in the external genitalia, warm internal sitz baths using She Chuang San (Cnidium Powder) are the main treatment. ○ If the Shaoyin pulse is slippery and rapid, and ulcers erode and rot in the vagina, Ye Lang Ya Tang (Wild Wolf Tooth Decoction) is used for washing. (*Jin Gui Yao Lue*)
Women suffering from vulvar ulcers present in various types, generally caused by Fire from Seven Emotions stagnation, damaging the Liver and Spleen, compounded by Damp-Heat pouring downward. Some occur after intercourse after menstruation, where filth infiltrates the vagina, generating chancre-like sores, similar to men's seminal sores. Treatment uses Huang Dan (Minium), Ku Fan (Alum), Pian Xu (Polygonum Aviculare), Gao Ben (Ligusticum Wallichii), Liu Huang (Sulfur), Jing Jie (Schizonepeta), She Chuang Zi (Cnidium Fruit), and She Ke (Snake Shell), ground into fine powder. First wash and wipe with Jing Jie and She Chuang Zi decoction, then apply mixed with Sesame Oil. ○ There are also nodular sores in the vagina, painful and itchy like insects crawling, with dripping pus and water, all caused by mental restlessness and Spleen-Stomach weakness, leading to Qi and Blood stagnation. Treatment should tonify the Heart and nourish the Stomach, with external washing (using Ta Zhong Tang) and insertion (using Xiong Huang She Tui San). If parasites cause unbearable itching, wash with She Chuang Zi decoction and apply external powder (using Tong Lv San); or apply Zhishe Bark powder, Alum, and Musk. ○ There is also vulvar swelling due to inherent weakness of the Bao Luo (uterine ligaments) and Wind pathogens invading the genital area. If Qi and Blood are weak, tonify (using Bu Zhong Yi Qi Tang); if Liver Meridian Damp-Heat exists, clear it (using Long Dan Xie Gan Tang). Or vulvar swelling and pain with incomplete closure, chills, fever, and difficult urination (use Jia Wei Xiao Yao San, external Zhi Ju Ironing Method); or swelling subsided but closure remains incomplete (use Bu Zhong Yi Qi Tang); or pain in the vagina (use Si Wu Tang plus Chai Hu, Shan Zhi, Dan Pi, Long Dan Cao); or dribbling urination, feeling of a mass in the abdomen moving and causing distending pain (use Xiao Yao San plus Chai Hu, Shan Zhi, Che Qian Zi); or swelling and pain...