【歌】妇人何故有崩中?只为劳伤任与冲。经为气虚无约制,故令暴下若山崩。因寒因热因劳损,带补兼
升自有功。
【论】夫妇人气血调和,则经水根据期而来,何崩漏之有?若劳动过极,脏腑俱伤,冲任之脉气虚,不能约
制其经血,故忽然暴下,若山崩然,故曰崩中。丹溪云∶血崩证有因劳损而致者,有挟热者,有挟寒者,有因
气血不足者之不同,当辨明而治之。
【脉】经曰∶妇人漏血下赤白,日下血数升,脉急数者死,迟者生。妇人漏下赤白不休,脉小虚滑者生,
大紧实数者死。
劳损
因劳损冲任脉虚,血非时下,脐腹冷痛,崩中脉迟,伏龙肝散。先因劳役,脾胃虚损,气短气逆,自汗身
热,懒食,大便或泄或秘,体倦无力,崩中不止,当归芍药汤。劳损气血,参、 、当归带升提之药治之。
伏龙肝散
治劳伤气血,冲任脉虚,以致崩中不止。
伏龙肝(一两) 赤石脂(一两) 麦门冬(一两) 甘草(炙,半两) 川芎(三两) 当归(七钱) 干姜
(七钱) 桂(半两) 艾叶(三两) 熟地黄(四两)
上,每服四钱,水煎服。
当归芍药汤
治崩漏不止,气短气逆,自汗乏力。
黄 (一钱,蜜炙) 白术(一钱,炒) 甘草(炙,一钱) 苍术(一钱,米泔浸,晒干,炒) 白芍药
(一钱) 熟地黄(五分) 陈皮(五分) 当归身(三分,酒洗) 生地黄(三分) 柴胡(二分)
上,用水煎服。
虚而挟热
气血两虚,四物汤加参、 。崩不止,小蓟汤、荆芥散、如圣散之类选而用之。血虚甚者,四物汤加焦姜。
崩不止,香白芷、百草霜、棕榈灰之属。肾虚不能镇相火而崩,凉血地黄汤。阳盛阴虚,血热沸溢,黄芩汤。
经漏下血,脉虚洪,其血紫黑,此热极反兼水化制之,故紫色成块,热之极也,生地黄散或四物汤加黄芩、黄
连、黄柏、知母。
四物汤(方见前经候条下。)
小蓟汤
治气血两虚,内热太甚,崩中不止。
小蓟茎叶汁(一盏) 生地黄汁(一盏) 白术(半两)
入水一盏,煎至半盏,温服。
荆芥散
治女人崩中不止。
荆芥(一味,不拘多寡,于麻油灯上烧灰存性)
末之,每三钱,童便下。
如圣散
治血山崩。
棕榈(一两, 存性) 乌梅(一两, ) 干姜(一两五钱, )
上为末,每服二钱,乌梅酒调下,空心时服。
生地黄散
治女人经漏下血,脉洪,血色紫黑成块。
生地黄(一钱) 熟地黄(一钱) 枸杞子(一钱) 天门冬(去心,一钱) 柴胡(八分) 黄连(去毛,
一钱) 白芍药(八分) 地骨皮(去骨,一钱) 甘草(七分) 黄芩(一钱) 黄 (一钱,蜜炙)
下血加地榆(一钱)
上锉,作一剂,水二大钟,煎至一钟,空心温服。
凉血地黄汤
治因阴虚不能镇守相火,以致崩漏。
黄芩(三分,炒) 荆芥(三分) 蔓荆子(三分) 黄柏(二分,盐水炒褐色) 知母(二分,酒炒)
本(二分) 细辛(二分) 川芎(二分) 黄连(一钱,炒) 羌活(五分) 柴胡(三分) 升麻(三分)
防风(三分) 生地黄(钱半) 当归(五分) 甘草(五分) 红花(二分)
锉一剂,水二盏,煎八分,空心温服。
黄芩汤
治内热,凉血分。
黄芩(炒,二钱) 芍药(炒,钱半) 甘草(一钱)
锉一剂,水煎服。
挟寒湿
崩挟寒湿,升麻除湿汤。崩中,脐腹冷痛,脉迟弱,身、寒,伏龙肝散。
升麻除湿汤
治漏下恶血,由饮食失节,水湿所致。
羌活(一钱) 柴胡(一钱,去毛) 苍术(一钱,泔浸) 黄 (一钱,蜜炙) 防风(一钱,去芦) 甘
草(炙,一钱) 升麻(一钱) 本(一钱) 蔓荆子(七分)
独活(五分) 当归(五分)
锉一剂,水煎服。
伏龙肝散(方见前。)
【歌诀】
妇女为何会出现崩中(指阴道大量出血,来势急骤)?只因为劳累损伤了任脉与冲脉。月经因气虚而失去约束控制,所以突然大量下血,如同山崩一样。无论是因寒、因热还是因劳损引起,采用补益兼升提的方法自有功效。
【论述】
夫妇人的气血调和,那么月经就会按时来潮,哪里会有崩漏呢?如果劳动过度,导致脏腑都受到损伤,冲脉和任脉的气虚,不能约束控制经血,所以突然大量下血,像山崩一样,因此称为崩中。丹溪说:血崩证有因劳损引起的,有挟带热邪的,有挟带寒邪的,有因气血不足的,情况各不相同,应当辨别清楚后进行治疗。
【脉诊】
医经上说:妇人漏下赤白相间的血液,每天失血量达数升,如果脉象急数的是死证,脉象迟缓的是生证。妇人漏下赤白不止,脉象小、虚、滑的是生证,脉象大、紧、实、数的则是死证。
劳损
因劳损导致冲任脉虚,非经期出血,脐腹部冷痛,崩中脉迟,用伏龙肝散治疗。先前因过度劳累,脾胃虚弱受损,气短气逆,自汗身体发热,不想进食,大便或泄泻或便秘,身体疲倦无力,崩中不止,用当归芍药汤治疗。劳损气血,用人参、黄芪、当归配合具有升提作用的药物治疗。
伏龙肝散
治疗因劳伤气血,冲任脉虚,导致崩中不止。
伏龙肝(一两) 赤石脂(一两) 麦门冬(一两) 甘草(炙,半两) 川芎(三两) 当归(七钱) 干姜(七钱) 桂枝(半两) 艾叶(三两) 熟地黄(四两)
以上药物,每次服用四钱,用水煎服。
当归芍药汤
治疗崩漏不止,气短气逆,自汗乏力。
黄芪(一钱,蜜炙) 白术(一钱,炒) 甘草(炙,一钱) 苍术(一钱,米泔水浸泡,晒干,炒) 白芍药(一钱) 熟地黄(五分) 陈皮(五分) 当归身(三分,酒洗) 生地黄(三分) 柴胡(二分)
以上药物,用水煎服。
虚而挟热
气血两虚,用四物汤加人参、黄芪。崩中不止,选用小蓟汤、荆芥散、如圣散等方剂。血虚严重的,在四物汤中加入焦姜。崩中不止,可用香白芷、百草霜、棕榈灰之类。肾虚不能制约相火而导致崩漏,用凉血地黄汤。阳盛阴虚,血热沸腾溢出,用黄芩汤。经血漏下,脉象虚洪,血色紫黑,这是热极反而兼有水化来制约它,所以紫色成块,是热到了极点,用生地黄散或四物汤加黄芩、黄连、黄柏、知母。
四物汤(方剂见前月经条下。)
小蓟汤
治疗气血两虚,内热太甚,崩中不止。
小蓟茎叶汁(一盏) 生地黄汁(一盏) 白术(半两)
加入水一盏,煎至半盏,温服。
荆芥散
治疗妇女崩中不止。
荆芥(一味,不限多少,在麻油灯上烧成灰保留药性)
研末,每次三钱,用童子尿送服。
如圣散
治疗血山崩(指阴道大量出血)。
棕榈(一两,煅存性) 乌梅(一两,煅存性) 干姜(一两五钱,煅存性)
以上研为末,每次服用二钱,用乌梅酒调下,空腹时服用。
生地黄散
治疗妇女经血漏下,脉洪,血色紫黑成块。
生地黄(一钱) 熟地黄(一钱) 枸杞子(一钱) 天门冬(去心,一钱) 柴胡(八分) 黄连(去毛,一钱) 白芍药(八分) 地骨皮(去骨,一钱) 甘草(七分) 黄芩(一钱) 黄芪(一钱,蜜炙)
下血严重加地榆(一钱)
以上切碎,作为一剂,用水两大钟,煎至一钟,空腹温服。
凉血地黄汤
治疗因阴虚不能镇守相火,导致崩漏。
黄芩(三分,炒) 荆芥(三分) 蔓荆子(三分) 黄柏(二分,盐水炒至褐色) 知母(二分,酒炒) 藁本(二分) 细辛(二分) 川芎(二分) 黄连(一钱,炒) 羌活(五分) 柴胡(三分) 升麻(三分) 防风(三分) 生地黄(钱半) 当归(五分) 甘草(五分) 红花(二分)
切碎一剂,用水两盏,煎至八分,空腹温服。
黄芩汤
治疗内热,清凉血分。
黄芩(炒,二钱) 芍药(炒,钱半) 甘草(一钱)
切碎一剂,用水煎服。
挟寒湿
崩中挟带寒湿,用升麻除湿汤。崩中,脐腹冷痛,脉迟弱,身体沉重寒冷,用伏龙肝散。
升麻除湿汤
治疗漏下恶血,由饮食不节制,水湿所致。
羌活(一钱) 柴胡(一钱,去毛) 苍术(一钱,泔水浸泡) 黄芪(一钱,蜜炙) 防风(一钱,去芦头) 甘草(炙,一钱) 升麻(一钱) 藁本(一钱) 蔓荆子(七分) 独活(五分) 当归(五分)
切碎一剂,用水煎服。
伏龙肝散(方剂见前文。)
[Verse]
Why do women suffer from Ben Zhong (sudden, massive uterine bleeding)? It is solely due to labor-induced injury to the Ren and Chong vessels. When Qi is deficient, it fails to constrain the menses, causing sudden profuse discharge resembling a landslide. Whether caused by Cold, Heat, or labor damage, employing tonification combined with lifting methods yields efficacy.
[Discussion]
When a woman's Qi and Blood are harmonious, menstruation arrives on schedule; how could there be Ben (flooding) or Lou (leaking)? If physical exertion is excessive, the Zang-Fu organs are all injured, and the Qi of the Chong and Ren vessels becomes deficient, failing to constrain the menstrual blood. Consequently, sudden profuse bleeding occurs, like a landslide, hence termed "Ben Zhong." Danxi stated: Cases of blood flooding vary; some arise from labor damage, some involve Heat, some involve Cold, and some result from Qi and Blood deficiency. These must be differentiated and treated accordingly.
[Pulse Diagnosis]
The Classics state: In women with leukorrhea mixed with blood (Chen Bai), losing several sheng daily, a rapid and tense pulse indicates death, while a slow pulse indicates survival. In women with continuous Chen Bai leakage, a small, deficient, and slippery pulse indicates survival, whereas a large, tight, full, and rapid pulse indicates death.
Labor Damage
Due to labor damage causing deficiency in the Chong and Ren vessels, non-menstrual bleeding occurs accompanied by cold pain in the umbilical and abdominal regions, and a slow pulse in Ben Zhong; treat with Fulonggan San. Previously, due to overwork causing Spleen and Stomach deficiency and damage, presenting with shortness of breath, rebellious Qi, spontaneous sweating, feverish sensation, anorexia, alternating diarrhea and constipation, fatigue, and weakness, with continuous Ben Zhong; treat with Danggui Shaoyao Tang. For labor-damaged Qi and Blood, treat with Renshen (Ginseng Radix), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix) combined with herbs that have lifting properties.
Fulonggan San
Treats continuous Ben Zhong caused by labor-induced Qi and Blood injury and deficiency of the Chong and Ren vessels.
Fulonggan (Dragon's House Soil, 1 liang) Chishizhi (Halloysitum Rubrum, 1 liang) Maimendong (Ophiopogonis Radix, 1 liang) Gancao (Licorice Root, honey-fried, 0.5 liang) Chuanxiong (Ligustici Chuanxiong Rhizoma, 3 liang) Danggui (Angelicae Sinensis Radix, 7 qian) Ganjiang (Zingiberis Rhizoma, 7 qian) Guizhi (Cinnamomi Ramulus, 0.5 liang) Aiyè (Artemisiae Argyi Folium, 3 liang) Shudihuang (Rehmanniae Radix Praeparata, 4 liang)
Grind into powder. Take 4 qian per dose, decoct in water and drink.
Danggui Shaoyao Tang
Treats continuous Ben and Lou, shortness of breath, rebellious Qi, spontaneous sweating, and fatigue.
Huangqi (Astragali Radix, 1 qian, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian, stir-baked) Gancao (Licorice Root, 1 qian, honey-fried) Cangzhu (Atractylodis Rhizoma, 1 qian, soaked in rice wash water, dried, stir-baked) Baishaoyao (Paeoniae Radix Alba, 1 qian) Shudihuang (Rehmanniae Radix Praeparata, 5 fen) Chenpi (Citri Reticulatae Pericarpium, 5 fen) Dangguishen (Body of Angelicae Sinensis Radix, 3 qian, wine-rinsed) Shengdihuang (Rehmanniae Radix, 3 fen) Chaihu (Bupleuri Radix, 2 fen)
Decoct in water and drink.
Deficiency with Accompanying Heat
For dual deficiency of Qi and Blood, use Siwu Tang added with Renshen (Ginseng Radix) and Huangqi (Astragali Radix). For continuous Ben Zhong, select from Xiaojitang (Small Thistle Decoction), Jinghesan (Schizonepeta Powder), Rushengsan (Like-Sage Powder), etc. For severe Blood deficiency, add Jiaojiang (Scorched Ginger) to Siwu Tang. For continuous Ben Zhong, use Xiangbaizhi (Aucklandiae Radix), Baicaoshuang (Soot from Hundred Herbs), Zonglühui (Ash of Palm Fronds), etc. If Kidney deficiency fails to control Minister Fire leading to Ben Zhong, use Liangxue Dihuang Tang (Cool Blood Rehmannia Decoction). If Yang is excess and Yin is deficient, causing boiling and overflow of hot Blood, use Huangqin Tang (Scutellaria Decoction). For menstrual leakage with a deficient and surging pulse, and purple-black clotted blood, this indicates extreme Heat counteracting with Water transformation, resulting in purple clots; this is extreme Heat. Use Shengdihuang San (Rehmannia Powder) or Siwu Tang added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma).
Siwu Tang (See formula under previous Menstrual Conditions section.)
Xiaojitang
Treats continuous Ben Zhong due to dual deficiency of Qi and Blood and severe internal Heat.
Xiaoji Jingyezhi (Juice of Small Thistle Stem and Leaf, 1 zhan) Shengdihuangzhi (Juice of Fresh Rehmannia Root, 1 zhan) Baizhu (Atractylodis Macrocephalae Rhizoma, 0.5 liang)
Add 1 zhan of water, decoct until half a zhan remains, take warm.
Jinghesan
Treats continuous Ben Zhong in women.
Jingjie (Schizonepetae Spica, one ingredient, amount unrestricted, burn to ash over a sesame oil lamp retaining its nature)
Grind into powder. Take 3 qian per dose, swallow with urine from an uncircumcised boy.
Rushengsan
Treats Xueshan Beng (Mountain of Blood Flooding).
Zonglv (Arecae Catenuatae Pericarpium, 1 liang, calcined retaining nature) Wumei (Mume Fructus, 1 liang, calcined retaining nature) Ganjiang (Zingiberis Rhizoma, 1.5 liang, calcined retaining nature)
Grind into powder. Take 2 qian per dose, mix with Wumei wine and take on an empty stomach.
Shengdihuang San
Treats menstrual leakage in women with a surging pulse and purple-black clotted blood.
Shengdihuang (Fresh Rehmannia Root, 1 qian) Shudihuang (Prepared Rehmannia Root, 1 qian) Gouqizi (Lycii Fructus, 1 qian) Tianmendong (Asparagi Radix, heart removed, 1 qian) Chaihu (Bupleuri Radix, 8 fen) Huanglian (Coptidis Rhizoma, hairs removed, 1 qian) Baishaoyao (Paeoniae Radix Alba, 8 fen) Digupi (Lycii Cortex, bone removed, 1 qian) Gancao (Licorice Root, 7 fen) Huangqin (Scutellariae Radix, 1 qian) Huangqi (Astragali Radix, 1 qian, honey-fried)
If bleeding is heavy, add Diyü (Sanguisorbae Radix, 1 qian).
Cut into pieces as one dose. Add two large zhong of water, decoct to one zhong, take warm on an empty stomach.
Liangxue Dihuang Tang
Treats Ben and Lou caused by Yin deficiency failing to restrain Minister Fire.
Huangqin (Scutellariae Radix, 3 fen, stir-baked) Jingjie (Schizonepetae Spica, 3 fen) Manjingzi (Viticis Semen, 3 fen) Huangbai (Phellodendri Cortex, 2 fen, salt-water fried to brown) Zhimu (Anemarrhenae Rhizoma, 2 fen, wine-fried) Bencao (Ligustici Wallichii Rhizoma, 2 fen) Xixin (Asari Radix et Rhizoma, 2 fen) Chuanxiong (Ligustici Chuanxiong Rhizoma, 2 fen) Huanglian (Coptidis Rhizoma, 1 qian, stir-baked) Qianghuo (Notopterygii Rhizoma et Radix, 5 fen) Chaihu (Bupleuri Radix, 3 fen) Shengma (Cimicifugae Rhizoma, 3 fen) Fangfeng (Saposhnikoviae Radix, 3 fen) Shengdihuang (Fresh Rehmannia Root, 1.5 qian) Danggui (Angelicae Sinensis Radix, 5 fen) Gancao (Licorice Root, 5 fen) Honghua (Carthami Flos, 2 fen)
Cut into pieces as one dose. Add two zhan of water, decoct to eight fen, take warm on an empty stomach.
Huangqin Tang
Treats internal Heat, cooling the Blood level.
Huangqin (Scutellariae Radix, 2 qian, stir-baked) Shaoyao (Paeoniae Radix, 1.5 qian, stir-baked) Gancao (Licorice Root, 1 qian)
Cut into pieces as one dose, decoct in water and drink.
Cold-Dampness Accompanying
Ben Zhong accompanying Cold-Dampness: use Shengma Chushi Tang (Magnolia Flower Damp-Expelling Decoction). Ben Zhong with cold pain in the umbilical/abdominal region, slow and weak pulse, heavy body, and aversion to cold: use Fulonggan San.
Shengma Chushi Tang
Treats leakage of foul blood caused by irregular diet and water-dampness.
Qianghuo (Notopterygii Rhizoma et Radix, 1 qian) Chaihu (Bupleuri Radix, 1 qian, remove hairs) Cangzhu (Atractylodis Rhizoma, 1 qian, soak in rice wash water) Huangqi (Astragali Radix, 1 qian, honey-fried) Fangfeng (Saposhnikoviae Radix, 1 qian, remove rhizome head) Gancao (Licorice Root, 1 qian, honey-fried) Shengma (Cimicifugae Rhizoma, 1 qian) Bencao (Ligustici Wallichii Rhizoma, 1 qian) Manjingzi (Viticis Semen, 7 fen) Duhuo (Angelicae Pubescentis Radix, 5 fen) Danggui (Angelicae Sinensis Radix, 5 fen)
Cut into pieces as one dose, decoct in water and drink.
Fulonggan San (Formula seen previously.)