一妇人多怒。经行或数日。或半月方止。三年后。淋沥无期。肌体倦瘦。口干内热。盗
汗如洗。日晡热甚。用参、 、归、术、茯神、远志、枣仁、麦冬、五味、丹皮、龙眼、炙
草、柴胡、升麻。治之获愈。此证先因怒动肝火。血热妄行。后乃脾气下陷。不能摄血归源
故用前药。若胃热亡津液而经不行。宜清胃。若心火亢甚者。宜清心。若服燥药过多者。
宜养血。若病久气血衰。宜健脾胃。
震按前案治血热生风。此案治脾虚下陷。迥然不同。但前案易认。此案内热倦瘦。盗汗
口干。日晡热甚。已近痨怯病形。幸未咳嗽经停耳。若认为痨怯而用清火。则必死。
立斋曰。一妇性急。每怒非太阳耳项喉齿胸乳作痛。则胸满吞酸。吐泻少食。经行不止
此皆肝火之证。肝自病则外证见。土受克则内证作。余先以四物加白术、茯苓、柴胡、炒
栀、炒龙胆。清肝养血。次用四君子加柴胡、芍药、神曲。合左金以培土制肝。渐愈。惟月
一位妇女容易发怒。月经来潮时，有时持续数日，有时半个月才停止。三年后，经血淋漓不尽，身体疲倦消瘦，口干且体内发热，夜间盗汗如雨般流出，下午申时（15:00-17:00）发热尤为严重。使用人参、白术、当归、白术、茯苓神、远志、酸枣仁、麦冬、五味子、牡丹皮、龙眼肉、炙甘草、柴胡、升麻治疗，最终痊愈。此病证起初是因为愤怒引动肝火，导致血热妄行；后来则是脾气下陷，不能统摄血液回归本源，所以使用前面的药物。如果是胃热耗伤津液而导致月经不行，应当清胃热；如果是心火亢盛严重的，应当清心火；如果是服用过多燥热药物的，应当养血；如果是病程长久导致气血衰弱的，应当健运脾胃。
俞震按语：前一个医案治疗的是血热生风，这个医案治疗的是脾虚下陷，两者截然不同。但是前一个医案容易辨认，这个医案中患者内热、疲倦消瘦、盗汗、口干、下午发热严重，已经接近痨怯（虚劳）病的形态，幸好没有咳嗽和月经停闭的症状。如果误认为是痨怯而使用清热泻火的药物，则必然导致死亡。
薛立斋说：有一位妇女性格急躁，每次发怒不是太阳经耳部、颈部、咽喉、牙齿、胸部、乳部疼痛，就是胸满吞酸、呕吐腹泻、食欲不振、月经不止。这些都是肝火的证候。肝脏自身发病则外部症状显现，脾土受克则内部症状发作。我先用四物汤加入白术、茯苓、柴胡、炒栀子、炒龙胆草，以清肝火并养血；接着用四君子汤加入柴胡、芍药、神曲，配合左金丸以培补脾土制约肝木，病情逐渐好转。只有每个月……
A woman was prone to anger. Her menstruation would last for several days or half a month before stopping. After three years, the bleeding became incessant and prolonged. Her body became weak and emaciated, with dry mouth and internal heat, profuse night sweats like washing, and severe fever in the afternoon (Shen hour). She was treated with Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Rhizoma), Dang Gui (Angelicae Sinensis Radix), Fu Ling (Poria), Fu Shen (Poria with Hostwood), Yuan Zhi (Polygalae Radix), Suan Zao Ren (Ziziphi Spinosomi Semen), Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Mu Dan Pi (Moutan Cortex), Long Yan Rou (Longan Arillus), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Chai Hu (Bupleuri Radix), and Sheng Ma (Cimicifugae Rhizoma), resulting in recovery. This condition initially arose from anger stirring up Liver Fire, causing blood heat to move recklessly; subsequently, it involved Spleen Qi sinking, failing to control blood and return it to its source. Hence, the aforementioned herbs were used. If menstruation is absent due to Stomach Heat consuming body fluids, the Stomach should be cleared. If Heart Fire is excessively hyperactive, the Heart should be cleared. If excessive intake of drying/hot herbs has occurred, blood should be nourished. If the disease has been long-standing leading to Qi and Blood deficiency, the Spleen and Stomach should be strengthened.
Yu Zhen’s commentary: The previous case treated Wind generated by Blood Heat, whereas this case treats Sinking of Spleen Qi due to Deficiency; they are completely different. However, the previous case was easy to recognize. In this case, the patient presented with internal heat, weakness and emaciation, night sweats, dry mouth, and severe afternoon fever, resembling the pattern of Lao Que (Consumptive Disease/Tuberculosis-like syndrome). Fortunately, there was no cough or amenorrhea. If misdiagnosed as Consumptive Disease and treated with clearing heat and purging fire, death would inevitably result.
Xue Lizhai stated: A woman had an impatient temperament. Whenever she became angry, she suffered either from pain in the Taiyang channel regions (ears, neck, throat, teeth, chest, breasts) or from chest fullness, acid regurgitation, vomiting, diarrhea, poor appetite, and incessant menstruation. These are all manifestations of Liver Fire. When the Liver itself is diseased, external symptoms appear; when Earth (Spleen/Stomach) is overcome by Wood (Liver), internal symptoms arise. I first used Si Wu Tang (Four Substances Decoction) added with Bai Zhu (Atractylodis Rhizoma), Fu Ling (Poria), Chai Hu (Bupleuri Radix), Chao Zhi Zi (Fried Gardenia Fruit), and Chao Long Dan Cao (Fried Gentian Root) to clear Liver Fire and nourish Blood. Subsequently, I used Si Jun Zi Tang (Four Gentlemen Decoction) added with Chai Hu (Bupleuri Radix), Shao Yao (Paeoniae Radix), Shen Qu (Massa Medicata Fermentata), combined with Zuo Jin Wan (Left Metal Pill) to tonify Earth and restrain Liver. The condition gradually improved. Only every month...