李氏曰∶凡崩中下带,或用升提,如升阳调经汤;或用收涩,如伏龙肝散、白芷散。然
暂止而终不止者,盖卫司开阖,而为荣血之主,脾胃为血海水液之会,卫气与胃气俱虚,则
血液无所约制(格理之言),是以古方有用桂枝汤加附子以固卫气者(不善用古方者,每非古方,苟能解之,
便自能用),四君子汤加草果、丁香、木香,以
燥水健脾者;或用理中汤加陈皮、半夏,或单半夏丸用芎归汤煎下;或补中益气汤、平胃散
,皆补卫浓脾,使气血自循故辙,而不专于收涩以劫夺之也。(收涩劫夺,皆是奇兵,用奇合宜,便是正法。此盖重在
正治,然亦有可奇者,不可偏废也)
方氏曰∶妇人赤白带下,多是怒气伤肝。夫肝属木,脾属土,肝邪乘脾,木气克土,则
脾受伤而有湿(木郁不伸,便以生湿),湿而生热,热则流通,所以滑浊之物,渗入膀胱,从小便而出也(阑
门既能泌别清浊,则滑浊之物,未必皆为渗透入膀胱,而从溺道出也,如绞肠病,岂由膀胱来耶)。丹溪作湿
热,而用苦寒之药治之者,是矣。虽然,古人曾有用辛温治之而愈者,不知苦寒之药,正治
之法也,辛温之药,从治之法也。盖湿热怫郁于内,肚腹疼痛,赤白带下,非辛温从治,而
能开散之乎?然湿热未曾怫郁,但止赤白带下,不若用苦寒正治之为当也。(读此论乃见今古治法不悖,则丹溪
之言,亦补先贤未备之旨)
李氏说:凡是崩漏(非经期大量阴道出血)和带下病,有的采用升提法,如使用升阳调经汤;有的采用收涩法,如使用伏龙肝散、白芷散。然而,如果症状暂时停止但最终仍不止止,这是因为卫气(行于脉外,具有防御、固摄作用的气)主管开阖,是营血(行于脉中,具有营养作用的气)的主宰,脾胃是水谷精微和血液生成的汇聚之处。当卫气和胃气都虚弱时,血液就失去了约束控制,所以古方中有用桂枝汤加附子来巩固卫气的(不善于运用古方的人,往往否定古方,如果能理解其原理,自然就能灵活运用),有四君子汤加草果、丁香、木香,用来燥湿健脾的;或者用理中汤加陈皮、半夏,或者单用半夏丸,用芎归汤煎服送下;或者用补中益气汤、平胃散,这些都是为了补益卫气、厚养脾胃,使气血自然回归正常轨道,而不是专门依靠收涩药来强行劫夺止血。(收涩和劫夺止血,都属于奇兵,使用得当就是正法。这里重在阐述正治法,但奇法也有可取之处,不可偏废。)
方氏说:妇女赤白带下,多是因为怒气伤肝。肝属木,脾属土,肝气邪盛侵犯脾土,木气克制土气,导致脾受伤而生湿(肝气郁结不能舒展,就会产生湿气),湿气产生热,热则使气血流通,所以浑浊滑腻的物质,渗入膀胱,从小便排出(阑门小肠部位既能分辨清浊,那么滑浊之物未必都是渗透进入膀胱,并从尿道排出的,比如绞肠痧这种病,难道是从膀胱来的吗?)。丹溪将其归结为湿热,并使用苦寒药物治疗,这是正确的。虽然如此,古人也曾有用辛温药物治疗而痊愈的案例,不知道苦寒药物是正治之法,辛温药物是从治之法。因为湿热郁结在体内,导致肚腹疼痛,赤白带下,如果不是用辛温从治法,怎么能发散开郁结呢?然而,如果湿热尚未郁结,仅仅表现为赤白带下,不如用苦寒正治法更为恰当。(读这篇论述才能看到古今治法并不违背,那么丹溪的话,也补充了先贤未详尽的宗旨。)
Li stated: For metrorrhagia (heavy uterine bleeding outside the menstrual period) and leukorrhea, some treatments employ lifting methods, such as Shengyang Tiaojing Tang (Ascending Yang Regulating Menstruation Decoction); others employ astringent methods, such as Fulonggan San (Dragon's House Earth Powder) or Baizhi San (Angelicae Dahuricae Powder). However, if symptoms cease temporarily but ultimately persist, it is because Wei Qi (Defensive Qi, which circulates outside the vessels and governs opening and closing) controls the aperture and serves as the master of Ying Blood (Nutritive Blood, which circulates within the vessels). The Spleen and Stomach are the convergence point for fluids and blood. When both Wei Qi and Stomach Qi are deficient, blood loses its constraint and control. Therefore, ancient formulas included using Guizhi Tang (Cinnamon Twig Decoction) with Fuzi (Aconiti Lateralis Radix Praeparata) to consolidate Wei Qi; Si Junzi Tang (Four Gentlemen Decoction) with Caoguo (Tsaoko Cardamomi Fructus), Dingxiang (Caryophylli Flos), and Muxiang (Aucklandiae Radix) to dry dampness and strengthen the Spleen; or Lizhong Tang (Regulate the Middle Decoction) with Chenpi (Citri Reticulatae Pericarpium) and Banxia (Pinelliae Rhizoma), or simply Banxia Wan (Pinellia Pill) taken with Xionggui Tang (Ligusticum and Angelica Decoction) as a decoctant; or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Pingwei San (Calm the Stomach Powder). All these aim to tonify Wei Qi and enrich the Spleen, allowing Qi and Blood to return to their normal pathways, rather than relying solely on astringents to forcibly arrest discharge. (Astringency and forcible arrest are considered unorthodox tactics; when used appropriately, they become orthodox methods. This passage emphasizes orthodox treatment, yet acknowledges that unorthodox methods have their place and should not be neglected.)
Fang stated: Female leukorrhea (red and white vaginal discharge) is often caused by anger injuring the Liver. The Liver belongs to Wood, and the Spleen belongs to Earth. When pathogenic factors from the Liver invade the Spleen, Wood overacts upon Earth, causing injury to the Spleen and generating Dampness (when Liver Qi stagnates and fails to extend, it generates Dampness). Dampness generates Heat, and Heat promotes circulation, so turbid and slippery substances seep into the Bladder and exit via urination. (The Lanmen [Gate between Small Intestine and Large Intestine] can separate clear from turbid; thus, turbid substances do not necessarily all seep into the Bladder and exit through the urethra. For instance, does intestinal colic originate from the Bladder?). Danxi attributed this to Damp-Heat and treated it with bitter-cold herbs, which was correct. Nevertheless, there are cases in ancient texts where patients were cured using acrid-warm herbs. It is important to understand that bitter-cold herbs represent the Orthodox Method (Zheng Zhi), while acrid-warm herbs represent the Contrary Method (Cong Zhi). Because Damp-Heat is constrained and stagnant internally, causing abdominal pain and red/white leukorrhea, how else could one disperse the constraint without using the acrid-warm Contrary Method? However, if Damp-Heat has not yet become constrained and the symptom is merely red/white leukorrhea, it is more appropriate to use the bitter-cold Orthodox Method. (Reading this discussion reveals that ancient and modern treatment methods are not contradictory; thus, Danxi's words also supplement the incomplete principles of the sages.)