脉经曰尺脉滑血气实妇人经脉不利 少阴脉弱而微微则少血少阴脉滑而数者阴中则生疮
寸
口脉浮而弱浮则为虚弱则无血 脉来至状如琴弦若少腹痛主月水不利孔窍生疮 肝弦沉主月
水不利腰腹痛 尺脉来而断绝者月水不利 寸关调如故而尺脉绝不至者月水不利当患小腹引
腰痛气滞上攻胸臆也 经不通绕脐寒疝痛其脉沉紧此由寒气客于血室血凝不行结积血为气所
冲新血与故血相搏故痛 漏血下赤白脉迟者脉小虚滑者生急疾者大紧实数者死 暴崩下血
寸口脉微迟尺脉微弦微迟为寒在上焦但吐尔今尺脉微弦如此即小腹痛引腰脊痛者必下血也
寸口弦而大弦则为减大则为芤减则为寒芤则为虚寒虚相搏脉则为革妇人则半产漏下 尺脉急
而弦大风邪入少阴之经女子漏自下赤 漏下赤白日下血数斗脉急疾者死迟者生 尺寸脉虚者
漏血漏血脉浮不可治也
机要云赤者热入小肠白者热入大肠其本实热冤结于脉不散故为赤白带下也冤屈也结也屈
滞而病热不散先以十枣汤下之后服苦楝丸大玄胡散调下之热去湿除病自除也
按此止是论有余之证也论见下
良方论云带下起于风气寒热之所伤或产后早起不避风邪风邪之气入于胞门或中经脉流转
脏腑
而发下血名为带下若伤足厥阴肝之经其色青如泥伤手少阴心之经其色赤如红津伤手太阴肺之
经其色白形如涕伤足太阴脾之经则其色黄如烂瓜伤足少阴肾之经则色黑如 血此其因也
按此言风气寒热之所伤诸脏致证似言外邪大抵此证多有本于阴虚阳竭荣气不升经脉凝泣
卫气
下陷精气累滞于下焦奇经之分蕴积而成其病或醉饱房劳服食燥剂所致也白物如涕之状故言带
者亦
病形也经云带脉为病而得名而白者属气赤属血东垣举脉诀云崩中曰久为白带漏下多时骨木枯
言崩中者始病血崩久则血少复亡其阳故白滑之物下流不止此可见未得全拘于带脉矣详病亦有
湿痰流注于下焦或肾肝阴淫之湿胜或因惊恐而木乘土位浊液下流或思慕为筋痿内经所谓二阳
之证发心脾是也或余经湿热屈滞于少腹小腹之下而病本殊则皆为气血虚损荣卫之精气累滞而
成其病标一也前人立论殆尽病机则治法无定若戴人以带下得两手脉俱滑大而有力乃上用宣去
痰饮下以导水丸泄湿热继以淡剂渗之此为泻实也如其诸脉微细或沉紧而涩按之空虚或洪大而
涩按之无力正为元气不足阴虚筋痿虚极中寒等证东垣有补阳调经固真等例乃兼责虚也丹溪先
生治因湿痰下注用海石南星椿根皮之类较之前人下之而复吐以提其气或发中兼补补中兼利燥
中兼升发润中益气温而兼收涩之例不同盖病机有轻重浅深之异尔
《脉经》说：尺部脉搏滑利，说明血气充实；妇女经脉不通畅。少阴脉搏动微弱而无力，说明阴血不足；少阴脉搏动滑利且快速，说明阴部会生疮疡。
寸口脉搏浮而弱，浮表示虚弱，弱表示无血。脉搏来势如琴弦一般，如果伴有小腹部疼痛，主月经不通畅，孔窍处生疮。肝脉弦而沉，主月经不通畅、腰腹部疼痛。尺脉搏动中断绝者，主月经不通畅。寸部和关部脉象调和正常，但尺部脉搏完全摸不到者，主月经不通畅，应当患小腹牵引腰部疼痛，气机阻滞向上攻冲胸膈。经络不通，环绕脐部的寒疝疼痛，其脉象沉紧，这是由于寒气客居于血室，血液凝滞不行，结聚成积，血被气所冲撞，新血与旧血相互搏结，所以疼痛。漏下赤白带下，脉象迟缓的，或者脉象细小虚滑的，预后良好（可生）；脉象急疾、大紧实数的，预后不良（主死）。突然发生的崩漏下血，寸口脉搏微迟，尺脉搏动微弦。微迟表示寒邪在上焦，只会呕吐而已；现在尺脉搏动微弦如此，如果伴有小腹部疼痛牵引腰脊疼痛，必定会出现下血。寸口脉弦而大，弦表示阳气衰减，大表示中空（芤脉），衰减表示有寒，中空表示血虚，寒与虚相互搏结，脉象变为革脉，妇女则会发生半产（小产）和漏下。尺脉搏动紧急而弦，是大风邪气侵入少阴经脉，女子漏下赤色带下。漏下赤色带下，每日失血量多达数斗，脉象急疾的死亡，脉象迟缓的存活。尺寸两部脉象虚弱的，主漏血；漏血脉象浮大的，不可治疗。
《机要》说：赤色带下是热邪侵入小肠，白色带下是热邪侵入大肠。其根本原因是实热冤结于脉中不散，所以形成赤白带下。“冤”即委屈，“结”即郁结，屈滞而病热不散。先用十枣汤泻下，之后服用苦楝丸，用大玄胡散调服。热去湿除，病自然痊愈。
按语：这里只是论述有余之证，详细论述见下文。
《良方论》说：带下起因于风气、寒热所伤，或者是产后早起不避风邪，风邪之气侵入胞门，或者中于经脉，流转脏腑而发作，下血名为带下。如果损伤足厥阴肝经，其颜色青如泥；损伤手少阴心经，其颜色赤如红津；损伤手太阴肺经，其颜色白形如鼻涕；损伤足太阴脾经，则其颜色黄如烂瓜；损伤足少阴肾经，则颜色黑如瘀血。这是其病因。
按语：此言风气寒热所伤诸脏导致病症，似乎说是外邪所致。大体上此证多本于阴虚阳竭，营气不升，经脉凝涩，卫气下陷，精气累滞于下焦奇经之分，蕴积而成其病。或者是醉饱、房劳、服用燥剂所致。白色物体如鼻涕状，所以说“带”也是病形。经文说带脉为病而得名，而白色属气，赤色属血。东垣引用《脉诀》说：崩中日久成为白带。所谓崩中，开始病发为血崩，久则血少，进而亡其阳，所以白滑之物下流不止。这可见不能完全拘泥于带脉。详细的病情也有湿痰流注于下焦，或者肾肝阴淫之湿胜，或者因惊恐而木乘土位，浊液下流，或者思慕导致筋痿，《内经》所谓二阳之证发于心脾是也。或者其余经络湿热屈滞于少腹之下，虽然小腹之下病本不同，但皆为气血虚损，荣卫之精气累滞而成其病，标症是一样的。前人立论已尽，病机则治法无定。如果戴人以带下得两手脉俱滑大而有力，乃是用宣剂去痰饮，以下以导水丸泄湿热，继以淡渗之剂渗之，此为泻实法。如果诸脉微细或沉紧而涩，按之空虚，或洪大而涩，按之无力，正是元气不足、阴虚筋痿、虚极中寒等证。东垣有补阳、调经、固真等例，乃是兼责虚证。丹溪先生治疗因湿痰下注，用海石、南星、椿根皮之类。较之前人下之而复吐以提其气，或发汗中兼补，补益中兼利湿，燥湿中兼升发，润中益气，温而兼收涩的例子不同。盖因为病机有轻重浅深之异罢了。
The *Mai Jing* (Pulse Classic) states: When the Chi pulse is slippery, it indicates substantial blood and qi; in women, this may manifest as irregular menstruation. If the Shaoyin pulse is weak and faint, it indicates a deficiency of Yin blood; if the Shaoyin pulse is slippery and rapid, sores will arise in the genital region.
At the Cun position, if the pulse is floating and weak, floating indicates deficiency, and weak indicates a lack of blood. If the pulse arrives feeling like the string of a zither, accompanied by lower abdominal pain, it signifies obstructed menstruation and sores in orifices. A Liver pulse that is wiry and deep signifies obstructed menstruation and lumbar and abdominal pain. If the Chi pulse beats intermittently or ceases, it signifies obstructed menstruation. If the Cun and Guan positions are harmonious and normal, but the Chi pulse is completely imperceptible, it signifies obstructed menstruation, likely presenting with lower abdominal pain radiating to the waist, and stagnant Qi attacking upward to the chest and epigastrium. Obstruction of the meridians leads to cold hernia pain encircling the umbilicus; the pulse is deep and tight. This arises because cold pathogenic factors lodge in the Blood Chamber, causing blood coagulation and stagnation, forming accumulations. The blood is rushed by Qi, and new blood clashes with old blood, resulting in pain. In cases of metrorrhagia with red and white leukorrhea, a slow pulse, or a small, deficient, and slippery pulse, indicates survival; a rapid, large, tight, full, and rapid pulse indicates death. In sudden cases of metrorrhagia with bleeding, if the Cun Kou pulse is micro-slow and the Chi pulse is micro-wiry, micro-slow indicates Cold in the Upper Jiao, manifesting only as vomiting; however, if the Chi pulse is micro-wiry as described, and accompanied by lower abdominal pain radiating to the lumbar spine, bleeding from below is certain. If the Cun Kou pulse is wiry and large, wiry indicates decline, and large indicates hollow (Kou pulse); decline indicates Cold, and hollow indicates Deficiency. The clashing of Cold and Deficiency results in a Ge pulse; in women, this leads to spontaneous abortion and leakage bleeding. If the Chi pulse is urgent and wiry, it indicates severe Wind pathogenic factors invading the Shaoyin meridian, causing women to leak red leukorrhea. In cases of leaking red leukorrhea where daily blood loss amounts to several dou, a rapid pulse indicates death, while a slow pulse indicates survival. If both the Cun and Chi pulses are deficient, it signifies leaking blood; if the pulse for leaking blood is floating, it is incurable.
The *Ji Yao* states: Red leukorrhea indicates Heat entering the Small Intestine; white leukorrhea indicates Heat entering the Large Intestine. The root cause is excessive Heat accumulating and stagnating in the vessels without dispersing, thus forming red and white leukorrhea. "Yuan" refers to grievance, and "Jie" refers to knotting; stagnation and pathological Heat fail to dissipate. First, administer Shizao Tang to purge downward, then take Kulian Wan, taken down with Daxu Hu San. Once Heat is removed and Dampness eliminated, the disease naturally resolves.
Commentary: This section discusses only excess syndromes; detailed discussions appear later.
The *Liang Fang Lun* states: Leukorrhea originates from injuries caused by Wind pathogenic factors, Cold, and Heat, or from failing to avoid Wind pathogenic factors upon rising early after childbirth. Wind Qi enters the Bao Men (uterine gate) or invades the meridians, circulating through the Zang-Fu organs to manifest as bleeding, named leukorrhea. If the Foot Jueyin Liver meridian is injured, the color is green like mud; if the Hand Shaoyin Heart meridian is injured, the color is red like red fluid; if the Hand Taiyin Lung meridian is injured, the color is white and shaped like nasal mucus; if the Foot Taiyin Spleen meridian is injured, the color is yellow like rotten melon; if the Foot Shaoyin Kidney meridian is injured, the color is black like clotted blood. These are the causes.
Commentary: This text suggests that injuries from Wind, Cold, and Heat affecting various Zang-Fu organs cause the condition, implying external pathogens. Generally, this condition often stems from Yin Deficiency and Yang Exhaustion, where Ying Qi fails to ascend, meridians become congealed and sluggish, Wei Qi sinks downward, and Essence-Qi accumulates and stagnates in the Lower Jiao and the extraordinary meridians, accumulating to form the disease. It may also be caused by overeating and drinking, sexual fatigue, or taking drying agents. The white substance resembles mucus, hence the term "Dai" (belt) also describes the disease form. The classics state that the Dai Mai (Girdle Vessel) being diseased gives the condition its name, with white belonging to Qi and red belonging to Blood. Dong Yuan cites the *Mai Jue* stating: Long-standing Bing Zhong (sudden heavy uterine bleeding) becomes Dai Bai (white leukorrhea). What is called Bing Zhong begins as blood metrorrhagia; over time, blood becomes scarce, leading to the loss of Yang, causing white and slippery substances to flow continuously downwards. This shows that one cannot strictly adhere solely to the Dai Mai theory. Detailed pathology also includes Damp-Phlegm flowing into the Lower Jiao, or excessive Dampness from Kidney and Liver Yin excess, or Wood overacting on Earth due to fright, causing turbid fluids to flow downward, or longing leading to Sinew Withering, as mentioned in the *Nei Jing*: "Two Yang syndromes originate from Heart and Spleen." Or damp-heat from other meridians stagnates in the lower abdomen. Although the root causes in the lower abdomen differ, they all result from Qi and Blood deficiency, with accumulation and stagnation of Ying and Wei Essence-Qi, sharing the same branch manifestations. Predecessors have exhaustively discussed theories, but treatment methods vary according to the pathogenesis. For instance, if Dai Xia presents with slippery, large, and forceful pulses in both hands, Dai Ren uses Xuan agents to remove Phlegm-Fluids, Daoshui Wan to drain Damp-Heat downward, followed by bland diuretic agents to leach it out; this is a method of draining excess. If pulses are micro-fine, or deep-tight and choppy, empty upon pressure, or large-rapid and choppy, powerless upon pressure, it indicates insufficient Original Qi, Yin Deficiency with Sinew Withering, extreme Deficiency with Middle Cold, etc. Dong Yuan employs examples such as Bu Yang, Tiao Jing, and Gu Zhen, addressing deficiency. Dan Xi treated cases of Damp-Phlegm sinking downward using Hai Shi, Nan Xing, Chun Gen Pi, etc. This differs from predecessors who used purgatives followed by emetics to raise Qi, or sweating combined with tonification, tonification combined with draining, drying combined with ascending, moistening combined with benefiting Qi, warming combined with astringency. This is because pathogenesis varies in severity, lightness, superficiality, and depth.