丹溪云∶崩漏有虚有热,虚则下溜,热则通流。 气虚血虚者,皆以四物汤加参 ;因劳者,用参 加升补
药。 因寒者,用干姜;因热者
,用黄芩。漏下乃热而虚,四物汤加黄连。崩过多者,先用五灵脂末一服,当分寒热,盖五
灵脂能行能止。紫色成块者,血热,四物汤加黄连、柴胡之类。急则治其标,用白芷汤调百
草霜末,甚者棕榈灰,后用四物汤加炒黑姜调理。
经验简要治崩中等证 冷者,脉紧细,手足寒,红去淡黑或五色,当归建中加白龙
骨、血竭、附子,下紫石英丸、震灵丹,灸火。热者,脉洪,四肢温,心烦口苦,燥热血沸而
成,用黄芩汤、荆芥散,或清心莲子饮加竹沥、生地黄汁,甚者,生地黄汁磨京墨、百草
霜冷服。虚者,胶艾汤加麦门冬、鹿茸、龙骨、酸枣仁,或养荣汤加龙骨、血竭,送震灵丹。
实者,腹中痛,煮附丸、四物汤加香附子。心虚者,恍惚多梦,健忘,舌强,小便多,面红
盗汗,柏子仁汤、酸枣仁汤加龙骨、京墨、百草霜吞灵砂丹,又灵砂当归莲肉龙骨枣肉丸,
参汤送下。崩中,麝香当归;崩者,心气已散,急服龙骨灵砂等。有田妇崩中断下者,用大
芜根,酒煎,清早服(生麦中,如蓬蒿花,或云即蓟根也)。
产宝分阴崩阳崩,受热而赤,谓之阳崩;受冷而白,谓之阴崩。(按赤者血热,白者气虚。)
丹溪说:崩漏病有虚证和热证之分,虚证表现为血液下泄不止,热证表现为血液通畅奔流。气虚或血虚的,都用四物汤加入人参;因劳累引发的,用人参配合升提补益的药物。因寒邪引起的,用干姜;因热邪引起的,用黄芩。漏下(淋漓不断)属于热兼虚证,用四物汤加入黄连。崩中(大量出血)过多的,先用五灵脂粉末服用一次,应当区分寒热属性,因为五灵脂既能活血又能止血。血色紫暗且有血块的,是血热所致,用四物汤加入黄连、柴胡等药。急则治其标,用白芷汤调服百草霜粉末,病情严重的用棕榈灰,之后再用四物汤加入炒黑的干姜进行调理。
经验简要治疗中等程度的崩中证:属冷证的,脉象紧细,手足寒冷,经血色淡黑或五色杂下,用当归建中汤加入龙骨、血竭、附子,随后服用紫石英丸、震灵丹,并施以艾灸。属热证的,脉象洪大,四肢温暖,心烦口苦,由燥热血沸而成,用黄芩汤、荆芥散,或者清心莲子饮加入竹沥、生地黄汁,病情严重的,用生地黄汁磨京墨、百草霜冷服。属虚证的,用胶艾汤加入麦门冬、鹿茸、龙骨、酸枣仁,或者用养荣汤加入龙骨、血竭,送服震灵丹。属实证的,腹中疼痛,用煮附丸、四物汤加入香附子。心气虚的,出现恍惚多梦、健忘、舌体僵硬、小便频多、面色红赤、盗汗等症状,用柏子仁汤、酸枣仁汤加入龙骨、京墨、百草霜吞服灵砂丹,或者服用灵砂当归莲肉龙骨枣肉丸,用参汤送下。崩中证,可用麝香配当归;崩中者,心气已散,需急服龙骨、灵砂等药。曾有一农妇在崩中断下的情况下,使用大芜根,酒煎,清晨服用(大芜根生长在麦田中,像蓬蒿花一样,也有人说就是蓟根)。
《产宝》将阴崩和阳崩分开论述,受热而血色红的,称为阳崩;受冷而血色白的,称为阴崩。(按语:红色代表血热,白色代表气虚。)
Danxi stated: Benglou (sudden severe bleeding or persistent spotting) involves deficiency and heat patterns. Deficiency leads to downward leakage, while heat leads to uncontrolled flow. For Qi deficiency or Blood deficiency, Siwu Tang (Four Substances Decoction) is used with the addition of Renshen (Ginseng). For cases caused by overexertion, Renshen (Ginseng) combined with herbs that raise and tonify is employed. For cold-induced cases, Ganjiang (Dried Ginger) is used; for heat-induced cases, Huangqin (Scutellaria Root) is used. Spotting (Lou) resulting from heat and deficiency is treated with Siwu Tang (Four Substances Decoction) plus Huanglian (Coptis Rhizome). In cases of excessive sudden bleeding (Beng), a dose of Wulingzhi powder (Trogopterus Dung) is administered first; one must distinguish between cold and heat, as Wulingzhi (Trogopterus Dung) possesses both blood-activating and hemostatic properties. Purple blood with clots indicates blood heat, treated with Siwu Tang (Four Substances Decoction) plus Huanglian (Coptis Rhizome) and Chaihu (Bupleurum Root), among others. In acute situations, treat the branch symptoms first: use Baizhi Tang (Angelica Dahurica Decoction) to mix Baixiaoshuang powder (Soot from Burning Herbs); for severe cases, use Zonglühui (Ash of Palm Fronds). Afterwards, regulate with Siwu Tang (Four Substances Decoction) plus Chao Heijiang (Stir-fried Blackened Dried Ginger).
Experience Briefly Treating Moderate Cases of Bengzhong (Sudden Severe Bleeding):
For cold patterns: pulse is tight and fine, hands and feet are cold, menstrual blood is pale black or mixed colors. Use Danggui Jianzhong Tang (Angelica Decoction to Establish the Middle) added with Longgu (Fossilized Bones), Xuejie (Dragon's Blood), and Fuzi (Prepared Aconite Root). Follow with Zishiying Wan (Purple Quartz Pill) and Zhenling Dan (Shocking Spirit Elixir), and apply moxibustion.
For heat patterns: pulse is surging, limbs are warm, heart vexation and bitter taste in the mouth occur, caused by dryness, heat, boiling blood. Use Huangqin Tang (Scutellaria Decoction), Jingjie San (Schizonepeta Powder), or Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink) added with Zhuli (Bamboo Sap) and Sheng Dihuang Jiang (Fresh Rehmannia Juice). For severe cases, grind Jingmo (Beijing Ink) and Baixiaoshuang (Soot from Burning Herbs) into Sheng Dihuang Jiang (Fresh Rehmannia Juice) and take cold.
For deficiency patterns: use Jiao'ai Tang (Colla Corii Asini and Artemisia Decoction) added with Maimendong (Ophiopogon Tuber), Lurong (Deer Antler), Longgu (Fossilized Bones), and Suanzaoren (Ziziphus Seed). Alternatively, use Yangrong Tang (Nourish Prosperity Decoction) added with Longgu (Fossilized Bones) and Xuejie (Dragon's Blood), taken with Zhenling Dan (Shocking Spirit Elixir).
For excess patterns: abdominal pain occurs. Use Zhufu Wan (Boiled Aconite Pill) or Siwu Tang (Four Substances Decoction) added with Xiangfu (Cyperus Rhizome).
For Heart Qi deficiency: symptoms include mental confusion, frequent dreams, amnesia, stiff tongue, frequent urination, red face, and night sweats. Use Baizi Ren Tang (Biota Seed Decoction) or Suanzaoren Tang (Ziziphus Seed Decoction) added with Longgu (Fossilized Bones), Jingmo (Beijing Ink), and Baixiaoshuang (Soot from Burning Herbs), swallowing Lingsha Dan (Cinnabar Elixir). Alternatively, use Lingsha Danggui Lianrou Longgu Zaorou Wan (Cinnabar, Angelica, Lotus Seed Flesh, Fossilized Bones, and Jujube Flesh Pill), taken with Renshen Tang (Ginseng Decoction).
In Bengzhong (Sudden Severe Bleeding), use Shexiang (Musk) with Danggui (Angelica Sinensis). In Beng (Sudden Bleeding), Heart Qi has scattered; urgently administer Longgu (Fossilized Bones), Lingsha (Cinnabar), etc.
A case record mentions a peasant woman suffering from Bengzhong with interrupted discharge; she was treated with Dawugen (Great Arisaema Root), decocted in wine, taken early in the morning (Dawugen grows in wheat fields, resembling Penghao flowers; some say it is Jigen, i.e., Cirsii Radix).
The text "Chanbao" distinguishes between Yin Beng and Yang Beng. Bleeding that is red due to heat is called Yang Beng; bleeding that is white due to cold is called Yin Beng. (Commentary: Red indicates blood heat; white indicates Qi deficiency.)