脉
洪数而疾，漏下血赤白，日下数升。脉急疾者死，迟者生；紧大者死，虚小者生。
证
崩之为病，乃血大下，岂可为寒？但血去后，其人必虚，当大补气血为主。东垣专主于寒而不言热者，
亦间而有之，但不知热之多也。丹溪曰∶有虚有热，虚则不溜，热则流通。《内经》曰∶阴虚阳搏谓之崩。
崩漏之疾，亦有阴阳。若妇人年五十后，经止数年矣，忽经又
行，兼腹痛，或身热口渴者，曰崩，阴证也。若妇人年三四十后，经行三十日，涌暴不止者，阳证也，曰漏。
治
若崩漏，初不问虚实，先用四物汤加荆芥穗（灯上烧）、防风、升麻、煎服。如不止，加蒲黄炒、
白术、升麻，并诸止血药止之。
一妇人血崩，年四十以上，悲哀太甚，则心系急，肺布叶举，而上焦不通，热气在中，故血走而崩。
面黄肌瘦，慎不可服热燥之药。盖血热而流行，先以黄连解毒汤，后以凉膈散合四物汤调治最效。
西园公治一妇人，年六十二岁，患血崩不止，以黄连解毒汤四帖，后服凉膈散合四物汤，六帖即愈。姑
记以广其传。
方
二圣汤（刘嵩皋传） 治血山崩，如神。
何首乌切五钱，甘草三钱，用黄酒一碗，煎至八分取出，入刺刺芽汁一盏，同服立效。
天灵散（秘方） 治经血不止，神效。
天灵盖烧灰，每服二钱，黄酒调服，立止。
黑龙丸（秘方） 专治血崩如神，及经水过多不止者，尤效。
黑驴粪烧灰，存性为末，用面糊为丸。每服七十丸，空心黄酒送下。
断源散（胡云阁传）〔批〕（按此方专治血崩如神） 治血崩如泉流不止。
棉花子（铜器炒，烟尽为末） 每服二钱，空心黄酒调下。
荆芥四物汤 治崩漏初起，不问虚实，服之立止。
荆芥 条芩 当归 川芎 白芍 生地 香附 一方加艾叶（炒）、阿胶（炒），去香附、荆芥。
上锉，水煎温服。如不止，加防风、升麻、蒲黄（炒）、白术。
西园公加地榆，良验。
胶艾四物汤 治血崩。
阿胶（蛤粉炒珠） 艾叶（醋炒） 当归 川芎 白芍 熟地 蒲黄（炒）
黄连 黄芩 生地 栀子 地榆 白术 甘草
上锉，水煎，空心服。
子芩丸 治妇人四十九岁以后，天癸当住，每月却行，或过多不止。
条芩（四两，醋浸，纸裹煨七次） 当归（二两，酒洗）加香附（醋制，二两尤妙）
上为末，醋糊为丸，如梧桐子大。每服五七十丸，空心霹雳酒下，日进三服。
当归龙骨丸〔批〕（按此方治血崩属虚热者） 治月事失常，经水过多不止，及带下淋漓，无问新久，
赤白诸证。并孕妇恶露，胎动不要，及产后恶物不止。或大人小儿泄泻并治。
当归 白芍 白茯 黄连（各五钱） 黄柏（二两） 龙骨（一两） 槐子（五钱）
艾叶（五钱，炒） 木香（二钱半） 西园公加黄芩、白术（各五钱），累效。
丁香胶艾汤〔批〕（按此方治血崩属虚寒者） 治崩漏不止，盖心气不足，劳役及饮食不节所得。其
脉两尺俱弦洪，按之无力。其证自觉脐下如冰，求浓衣被以御其寒，白带白滑之物多，间有如屋漏水，时下
鲜血，右尺脉时微洪也。
四物汤加丁香、阿胶、艾叶，煎，空心热服。
凡血崩乃经脉错乱，不循故道，淖溢妄行。一二日不止，便有积淤之血，凝成窠臼，更药涩住，转
见增剧。宜以五积散加防风、荆芥，再加醋煎，投一二服。次进独行散，以霹雳酒下，二三服即
止；如不止，再以诸止血药治之。
脉象洪大、数而急促，阴道出血赤白相间，每日流失血量达数升。脉象急疾者预后不良（主死），脉象迟缓者预后良好（主生）；脉象紧大者预后不良（主死），脉象虚小者预后良好（主生）。
证候方面：
崩漏之病，是指大量出血，难道可以用寒凉药治疗吗？但是血液流失之后，患者必然虚弱，应当以大补气血为主要治法。李东垣专门主张用寒凉药而不言热证，这种情况偶尔也有，但他不知道热证更为多见。朱丹溪说：崩漏有虚证和热证，虚则血不固摄，热则血行流通。《黄帝内经》说：阴虚而阳脉搏击有力称为崩漏。
崩漏之疾，也分阴阳。如果妇女年过五十，月经停止数年，忽然又行经，兼有腹痛，或身体发热、口渴的，称为“崩”，属于阴证。如果妇女年过三四十岁，月经周期为三十天，突然涌出且不止的，属于阳证，称为“漏”。
治疗方面：
如果是崩漏，起初不论虚实，先用四物汤加入荆芥穗（在灯上烧焦）、防风、升麻，煎服。如果出血不止，加入炒蒲黄、白术、升麻，以及各类止血药来止血。
有一位妇女患血崩，年龄四十岁以上，因悲哀过度，导致心系拘急，肺叶张开举高，上焦气机不通，热气郁结在中焦，所以血液妄行而致崩漏。患者面色黄、肌肉消瘦，千万不可服用温热燥烈的药物。因为这是血热妄行，先用黄连解毒汤，后用凉膈散合四物汤调治最为有效。
西园公治疗一位妇女，六十二岁，患血崩不止，服用四帖黄连解毒汤后，再服用六帖凉膈散合四物汤，即痊愈。姑且记录下来以广流传。
方剂方面：
二圣汤（刘嵩皋传授） 治疗血山崩（严重血崩），效果如神。
何首乌切五钱，甘草三钱，用黄酒一碗，煎至八分，取出药液，加入刺刺芽汁一盏，同服，立见疗效。
天灵散（秘方） 治疗经血不止，效果神奇。
天灵盖（人头顶骨）烧成灰，每次服用二钱，用黄酒调服，立即止血。
黑龙丸（秘方） 专治血崩如神，以及月经量多不止者，尤为有效。
黑驴粪烧成灰，保留药性，研为细末，用面糊做成丸药。每次服用七十丸，空腹时用黄酒送下。
断源散（胡云阁传授）〔批注〕（按：此方专治血崩如神） 治疗血崩如泉水流出不止。
棉花子（用铜器炒至烟尽，研为细末） 每次服用二钱，空腹时用黄酒调下。
荆芥四物汤 治疗崩漏初起，不论虚实，服用后立即止血。
组成：荆芥、条芩、当归、川芎、白芍、生地、香附。一方加艾叶（炒）、阿胶（炒），去掉香附、荆芥。
以上药材切碎，水煎温服。如果出血不止，加防风、升麻、炒蒲黄、白术。
西园公加地榆，疗效很好。
胶艾四物汤 治疗血崩。
组成：阿胶（蛤粉炒成珠状）、艾叶（醋炒）、当归、川芎、白芍、熟地、炒蒲黄、黄连、黄芩、生地、栀子、地榆、白术、甘草。
以上药材切碎，水煎，空腹服用。
子芩丸 治疗妇女四十九岁以后，天癸（月经）应当停止，却每月仍行经，或量多不止。
组成：条芩（四两，醋浸，纸裹煨七次）、当归（二两，酒洗），加香附（醋制，二两尤佳）。
以上研为细末，醋糊做成丸药，如梧桐子大小。每次服用五七十丸，空腹用霹雳酒送下，每日进服三次。
当归龙骨丸〔批注〕（按：此方治血崩属虚热者） 治疗月事失常，经水过多不止，以及带下淋漓，无论新久，赤白带下等各种证候。并治疗孕妇恶露不尽、胎动不安，以及产后恶露不止。或大人小儿泄泻也可一并治疗。
组成：当归、白芍、白茯（茯苓）、黄连（各五钱）、黄柏（二两）、龙骨（一两）、槐子（五钱）、艾叶（五钱，炒）、木香（二钱半）。西园公加黄芩、白术（各五钱），屡试屡效。
丁香胶艾汤〔批注〕（按：此方治血崩属虚寒者） 治疗崩漏不止，这是由于心气不足，劳役及饮食不节所致。其脉象两尺部俱弦洪，重按无力。其症状自觉脐下如冰，寻求厚衣厚被以御寒，白带白滑之物多，间或有如屋漏水样的分泌物，时下鲜血，右尺脉时而微洪。
组成：四物汤加丁香、阿胶、艾叶，煎煮，空腹热服。
凡是血崩，乃是经脉错乱，不循常道，血液淖溢妄行。一二日不止，就会有积淤之血，凝成窠臼，再用药物涩止，反而会使病情加重。适宜用五积散加防风、荆芥，再加醋煎，投服一两次。随后进服独行散，用霹雳酒送下，二三服即可止血；如果还不止，再用各类止血药治疗。
Pulse
The pulse is surging, rapid, and hurried, with vaginal discharge of red and white blood, losing several sheng (a traditional unit of volume) per day. A rapid and hurried pulse indicates a fatal prognosis; a slow pulse indicates survival. A tight and large pulse indicates death; a deficient and small pulse indicates survival.
Syndrome
The disease of "Beng" (sudden heavy uterine bleeding) involves massive hemorrhage; how can it be treated with cold-natured herbs? However, after the loss of blood, the patient must become deficient, so the primary treatment should be to greatly tonify Qi and Blood. Li Dongyuan specifically emphasized cold-natured treatments without mentioning heat syndromes; while this occurs occasionally, he failed to recognize that heat syndromes are far more common. Zhu Danxi stated: "There are deficiency and heat syndromes. Deficiency leads to failure of containment, while heat leads to free flow." The *Huangdi Neijing* states: "Yin deficiency with Yang pulse striking forcefully is called Beng."
The disorder of Beng and Lou (metrorrhagia and metrostaxis) also involves Yin and Yang. If a woman over fifty years old, whose menstruation has ceased for several years, suddenly resumes menstruation accompanied by abdominal pain, or fever and thirst, it is called "Beng," which is a Yin syndrome. If a woman in her thirties or forties, with a menstrual cycle of thirty days, experiences sudden gushing and continuous bleeding, it is a Yang syndrome, called "Lou."
Treatment
For initial cases of Beng or Lou, regardless of deficiency or excess, first use Siwu Tang (Four Substances Decoction) added with Jingjie Sui (Schizonepeta Spike, charred on a lamp), Fangfeng (Saposhnikovia Root), and Shengma (Cimicifuga Rhizome), decocted and taken orally. If bleeding does not stop, add Chao Puhuang (Fried Typha Pollen), Baizhu (Atractylodes Macrocephala Rhizome), and Shengma, along with various hemostatic herbs to stop the bleeding.
A woman over forty suffered from severe uterine bleeding due to excessive grief. This caused the Heart Tie to contract, the Lung Lobes to rise, obstructing the Upper Jiao, leading to heat accumulation in the middle. Consequently, blood rushed and caused Beng. Her face was sallow and she was emaciated; hot and drying herbs must strictly be avoided. Since this is blood heat causing reckless flow, treating first with Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) and subsequently with Liangge San (Cool the Epigastrium Powder) combined with Siwu Tang is most effective.
Master Xiyuan treated a sixty-two-year-old woman suffering from continuous uterine bleeding. After four doses of Huanglian Jiedu Tang, she took six doses of Liangge San combined with Siwu Tang and was cured. I record this to spread its knowledge.
Formulas
Ersheng Tang (Transmitted by Liu Songgao) Treats severe uterine bleeding ("Blood Mountain Collapse") with miraculous effect.
He Shouwu (Polygonum Multiflorum Rhizome) sliced, 5 qian; Gancao (Licorice Root), 3 qian. Decoct with one bowl of yellow wine until reduced to 0.8 parts. Remove residue, add one cup of Ciciya juice (Juice of *Rhamnus utilis* buds), and take together for immediate effect.
Tianling San (Secret Formula) Treats continuous menstrual bleeding with miraculous effect.
Tianlinggai (Human Skull Cap) burned to ash. Take 2 qian per dose, mixed with yellow wine for immediate cessation.
Heilong Wan (Black Dragon Pill) (Secret Formula) Specifically treats uterine bleeding like a miracle, especially for excessive menstrual flow that does not stop.
Black donkey dung burned to ash, preserving its nature, ground into powder. Form pills with wheat paste. Take 70 pills per dose, swallowed with yellow wine on an empty stomach.
Duanyuan San (Source-Interrupting Powder) (Transmitted by Hu Yunge) [Commentary: This formula treats uterine bleeding with miraculous effect] Treats uterine bleeding flowing like a spring continuously.
Mianhuazi (Cotton Seed) stir-fried in a copper vessel until smoke ceases, ground into powder. Take 2 qian per dose, mixed with yellow wine on an empty stomach.
Jingjie Siwu Tang Treats early-stage Beng and Lou, stopping bleeding immediately regardless of deficiency or excess.
Ingredients: Jingjie (Schizonepeta Herb), Tiaohuangqin (Scutellaria Root), Danggui (Angelica Sinensis Radix), Chuanxiong (Ligusticum Chuanxiong Rhizome), Baishao (White Peony Root), Shengdi (Rehmannia Root). One variation adds Aiye (Mugwort Leaf, fried) and Ejiao (Donkey-hide Gelatin, fried), removing Xiangfu (Cyperus Rhizome) and Jingjie.
Crush ingredients, decoct in water, and take warm. If bleeding persists, add Fangfeng, Shengma, Chao Puhuang, and Baizhu. Master Xiyuan added Diyü (Sanguisorba Root), which proved highly effective.
Jiao'ai Siwu Tang Treats uterine bleeding.
Ingredients: Ejiao (fried with clam powder into pearls), Aiye (fried with vinegar), Danggui, Chuanxiong, Baishao, Shudi (Prepared Rehmannia Root), Chao Puhuang, Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Shengdi, Zhizi (Gardenia Fruit), Diyü, Baizhu, Gancao.
Crush ingredients, decoct in water, and take on an empty stomach.
Ziqin Wan Treats women after age forty-nine, when Tian Gui (menstrual essence) should cease, yet menstruation continues monthly or flows excessively without stopping.
Ingredients: Tiaohuangqin (4 liang, soaked in vinegar, wrapped in paper and baked seven times), Danggui (2 liang, washed in wine). Add Xiangfu (vinegar-processed, 2 liang is best).
Grind into powder, form pills with vinegar paste, size of Sophora seeds. Take 50–70 pills per dose, swallowed with Pilijiu (Thunderbolt Wine) on an empty stomach, three times daily.
Danggui Longgu Wan [Commentary: This formula treats deficiency-heat type uterine bleeding] Treats irregular menstruation, excessive menstrual flow, persistent leukorrhea, regardless of duration, including red and white discharges. Also treats postpartum lochia retention, restless fetus, and postpartum abnormal discharge. Can also treat diarrhea in adults and children.
Ingredients: Danggui, Baishao, Baifu (Poria), Huanglian (each 5 qian); Huangbo (Phellodendron Bark, 2 liang); Longgu (Fossilized Bone, 1 liang); Huaizi (Sophora Fruit, 5 qian); Aiye (5 qian, fried); Muxiang (Vladimiria Root, 2.5 qian). Master Xiyuan added Huangqin and Baizhu (each 5 qian), with repeated success.
Dingxiang Jiao'ai Tang [Commentary: This formula treats deficiency-cold type uterine bleeding] Treats continuous Beng and Lou, caused by insufficient Heart Qi, labor, and irregular diet. The pulse at both Chi positions is wiry and surging but weak upon pressure. Symptoms include feeling cold as ice below the umbilicus, seeking thick clothing/bedding for warmth, abundant white slippery leukorrhea, occasional leakage resembling roof drip-water, intermittent fresh blood discharge, and a slightly surging Right Chi pulse.
Formula: Siwu Tang added with Dingxiang (Clove), Ejiao, and Aiye. Decoct and take hot on an empty stomach.
Generally, uterine bleeding results from meridian disorder, where blood does not follow its normal path but overflows and acts recklessly. If uncontrolled for one or two days, stagnant blood accumulates and forms clots. Using only astringent herbs may worsen the condition. It is appropriate to use Wuji San (Five Accumulations Powder) added with Fangfeng and Jingjie, decocted with vinegar, administered for one or two doses. Then advance to Duxing San (Single-Action Powder) taken with Piliujiu; one to three doses usually stop the bleeding. If it persists, treat with various other hemostatic formulas.