东垣云，丁未年冬郭大方来说，其妻经水暴崩不止，先曾损身失血，自后一次经数日而来
，今次不止。其人心窄性急多惊，以予料之，必因心气不足，饮食失节得之。大方曰∶容到
彼诊，得掌中寒，脉沉细而缓，间有沉数，九窍微不利，四肢无力，上喘气短促，口鼻气皆
不调，果有心气不足，饮食失节（审证细密，自是老手），脾胃虚弱之证，胃脘当心而痛，在胁下急缩有积（前是虚，
此是实），当脐有动气，腹中鸣，下气，大便难，诸虚证极多，不能尽录。拟先治其本，余证可以皆去。与安
心定志，镇坠其惊，调和脾胃，大益元气，补其血脉，养其心神（此节尤妙尤难），以大热之剂，去其冬寒。
凝在皮肤，少加生地黄去命门相火，不令四肢痿弱，制黄 当归人参汤。
丹溪云∶涎郁胸中，清气不升，故经脉壅遏而降下，非开涎不足以行气（又得一种见解，人尝谓丹溪先生善
治痰，然哉），非气升则血不
能归隧道，此论血泄之义甚明。盖开胸膈浊涎，则清气升，清气升则血归隧道不崩矣，故其
症或腹满如孕，或脐腹绞痛，或血结成片，或血出则快，止则闷，或脐上动。其治法
宜开结痰、行滞气、消污血。
良方云∶妇人血崩而心痛甚，名曰杀血心痛，由心脾血虚也。若小产去血过多，而
心痛甚者亦然。用乌贼鱼骨炒为末，醋汤调下。失笑散亦效。（既云心脾血虚，自当并补，乃不为治本，即用乌贼、失
笑以治标何耶）
薛氏曰∶前证若阴血耗散，用乌贼丸收敛之；若瘀血不散，用失笑散行散之；若心血虚
弱，用芎归汤补养之；若郁结伤血，用归脾汤调补之。（论解得当，至云心血虚，止用芎、归，似未尽善，观后案便得
要旨）
一妇人血崩兼心痛三年矣，诸药不应，每痛甚，虚证悉具，面色萎黄。余曰∶心主血。
盖由去血过多，心无所养，以致作痛，宜用十全大补汤，参术倍之。三十余剂稍愈，百余剂痊
愈。
李东垣说，丁未年冬天，郭大方来讲述，他的妻子月经突然暴崩不止，此前曾有过因身体损伤而失血的情况，从那以后每次月经几天就来一次，这次却淋漓不尽。他妻子心胸狭窄、性情急躁且容易受惊。根据我的推测，这一定是因为心气不足，加上饮食不节制所致。郭大方说：“等到我去那里诊治时，发现她手掌发凉，脉象沉细而缓，偶尔出现沉数脉，九窍轻微不通利，四肢无力，上气喘促气短，口鼻呼吸都不调畅，果然有心气不足、饮食失节（辨证细致周密，确实是老练的手笔）、脾胃虚弱的证候，胃脘当心部位疼痛，胁下拘急收缩且有积滞（前面是虚证，这里是实证），肚脐周围有搏动感，腹中鸣响，排气多，大便困难，各种虚证极多，无法全部记录。打算先治疗其根本，其余症状自然可以消除。给予安心定志、镇惊安神、调和脾胃、大补元气、滋补血脉、滋养心神（这一部分尤其精妙且难能可贵）的方法，用大热性质的药剂，去除冬季寒邪凝滞在皮肤的情况，稍加生地黄以制约命门相火，防止四肢痿弱，制定黄耆当归人参汤。”
朱丹溪说：痰涎郁结在胸中，导致清气不能上升，所以经脉壅塞阻滞而血液下行，不开除痰涎就无法使气机运行（这是一种独特的见解，人们常说朱丹溪先生善于治疗痰证，确实如此），如果气机不升则血液不能回归正常的脉道，这个论述对血泄的道理非常明白。大概是因为开通胸膈的浊痰，清气就能上升，清气上升则血液回归脉道而不致崩漏了，所以症状有时像怀孕一样腹部胀满，或者脐腹绞痛，或者血液结成块状，或者出血时感觉痛快，停止时感到胸闷，或者脐上有搏动感。治疗方法应当是开通结聚之痰、运行停滞之气、消除污浊之血。
《良方》说：妇女血崩且心痛剧烈，名叫“杀血心痛”，这是由于心脾两脏血虚引起的。如果是小产失血过多而导致心痛剧烈的，也是同样的道理。使用乌贼鱼骨炒成粉末，用醋汤送服。失笑散也有效。（既然说是心脾血虚，自然应当同时进补，却不治本，只用乌贼骨和失笑散来治标，这是为什么呢？）
薛己说：前面的病症如果是阴血耗散，就用乌贼丸来收敛；如果是瘀血不散，就用失笑散来行散；如果是心血虚弱，就用芎归汤来补养；如果是郁结损伤血液，就用归脾汤来调补。（解释得当，但说到心血虚只使用川芎、当归，似乎不够完善，看了后面的医案就能掌握要领。）
有一个妇人血崩兼带心痛三年了，各种药物都没有效果，每次疼痛剧烈时，虚证表现全都具备，面色萎黄。我说：心主血。大概是因为失血过多，心脏得不到滋养，从而导致疼痛，应该使用十全大补汤，将人参和白术加倍用量。服用三十多剂后稍微好转，服用一百多剂后痊愈。
Li Dongyuan stated: In the winter of the Dingwei year, Guo Dafang came to report that his wife suffered from sudden and severe menorrhagia (abnormal uterine bleeding). Previously, she had lost blood due to physical injury. Since then, her menstruation occurred every few days, but this time it did not stop. His wife was narrow-minded, impatient, and prone to fright. Based on my estimation, this must be caused by insufficient Heart Qi and irregular diet. Guo Dafang said: "When I went there for diagnosis, I found her palms cold, with a deep, fine, and slow pulse, occasionally showing a deep and rapid quality. Her nine orifices were slightly obstructed, her limbs were weak, she experienced upper body asthma and shortness of breath, and both mouth and nose breathing were irregular. Indeed, there were signs of insufficient Heart Qi, irregular diet (the syndrome differentiation was meticulous, truly the work of an experienced practitioner), and Spleen-Stomach weakness. There was pain in the epigastrium at the heart's location, tightness and contraction in the hypochondrium with accumulation (previously deficiency, now excess), pulsation around the umbilicus, borborygmus in the abdomen, excessive flatulence, difficulty in defecation, and numerous other deficiency syndromes which could not all be recorded. I planned to treat the root first, so that the remaining symptoms would resolve. The treatment aimed to calm the mind and stabilize the will, suppress fright, harmonize the Spleen and Stomach, greatly benefit Yuan Qi, tonify blood vessels, and nourish the Heart Spirit (this section is particularly brilliant and difficult). Using large doses of hot-natured herbs to dispel winter cold congealed in the skin, with a small addition of Sheng Di Huang (Rehmanniae Radix) to control Mingmen Fire and prevent limb flaccidity, I formulated Huangqi Danggui Renshen Tang."
Zhu Danxi stated: Phlegm-fluids stagnating in the chest prevent Clear Qi from ascending, causing the meridians to become congested and blood to descend. Without opening the phlegm, Qi cannot circulate (this offers another perspective; people often say Master Zhu Danxi was skilled in treating phlegm, which is true). If Qi does not ascend, blood cannot return to the normal vessels. This discussion clearly explains the mechanism of blood leakage. Generally, by clearing turbid phlegm from the chest and diaphragm, Clear Qi ascends; once Clear Qi ascends, blood returns to the vessels and hemostasis occurs. Therefore, symptoms may include abdominal fullness resembling pregnancy, colicky pain in the umbilical and abdominal regions, blood clots forming, relief during bleeding but oppression when stopped, or pulsation above the umbilicus. The treatment method should involve resolving accumulated phlegm, moving stagnant Qi, and eliminating foul blood.
Liang Fang stated: When women suffer from metrorrhagia accompanied by severe cardiac pain, it is called "Killing Blood Cardiac Pain," caused by deficiency of blood in the Heart and Spleen. Similarly, if excessive blood loss after miscarriage leads to severe cardiac pain, the condition is the same. Use cuttlefish bone (Hai Piao Xiao) stir-fried into powder, taken with vinegar water. Shixiao San is also effective. (Since it is stated as Heart-Spleen blood deficiency, one should naturally tonify both roots; why use only Hai Piao Xiao and Shixiao San to treat the branch?)
Xue Ji stated: For the aforementioned conditions, if Yin blood is depleted and scattered, use Wuzei Wan to consolidate; if stasis blood does not disperse, use Shixiao San to move and dissipate it; if Heart blood is deficient and weak, use Xiong Gui Tang to tonify and nourish; if depression damages blood, use Guipi Tang to regulate and tonify. (The explanation is appropriate, but stating that for Heart blood deficiency one uses only Chuanxiong and Danggui seems incomplete; understanding the following case reveals the essential principle.)
A woman suffered from metrorrhagia combined with cardiac pain for three years. Various medicines failed to respond. Whenever the pain was severe, all deficiency signs were present, and her complexion was sallow. I said: The Heart governs blood. It is likely that due to excessive blood loss, the Heart lacked nourishment, leading to pain. One should use Shiquan Dabu Tang, doubling the dosage of Renshen and Baizhu. After more than thirty doses, she improved slightly; after more than one hundred doses, she recovered completely.