江南之人，十女九带。良以土地卑湿，风俗靡侈，或以思想之无穷，或属六淫之侵贼，故病者甚众。然轻者不为害，重者非药不可。带下之名，亦有数说。带脉环腰，状如束带，带失约束，白液绵绵而下，故曰带下，此一说也。带下者，妇人隐疾，不便明言，古人束裳以带，故讳言腰以下之隐疾为带下，此二说也。痢出后窍，乃邪热传于大肠；带出前阴，乃湿热注于胞中，二证大致相同，痢古称滞下，带亦即滞下也。其云带下者，滞下之误耳，此三说也。虽各不同，均有其理，但于带下之病理治法无干，可以存而不议。至言带下之病源，则《素问》以任脉为病。其文曰："任脉为病，男子内结七疝，女子带下瘕聚。"王注谓"任脉起于胞中，上过带脉，似束带状，故曰带下。"但以文义言之，不曰带脉为病，而言任脉为病，则带下之名，决非如上述带脉似束带状之义。以带下与瘕聚并言，则滞下之理似当，若以带脉不束为论，则不当引经义任脉为病之旨。然以实验所得，则带任二脉均有造成此病之可能。且普通带病亦不能限定一因，其源甚众。言病则有内因、有外因，言症则有虚有实。虚者有寒热之不同，实者有风冷、湿热之不同。更有纯虚之症，当全用填补者；纯实之症，全用攻下者。以言乎治，则温清通涩，升补攻下均可依症而施。今特分言如下。《素问》曰："思想无穷，所愿不得，意淫于外，入房太甚，发为白淫。"即白带如泉，清而腥气特重，近身即闻。其因则以"思想无穷，所愿不得"八字为总纲，而有室女与已嫁之别。意淫于外，所愿不遂，每多发于室女，以及师尼寡妇。若已嫁有夫之妇，则入房太甚而得者为多。细言之，则内因之中又分二种：意淫于外，为纯粹内因；入房太甚，为内因中之兼不内外因者矣。论治则房室太过者，以寡欲为根本解决之法。以多欲则阴精消耗，水竭泉枯，相火愈炽，火烁津液，如泉而下，不竭不止。左尺主水，右尺主火，水亏火旺，故右尺必数駃弦数。节欲之外，再以方药治之，则养阴清火、滋肾制相为一定不移之法，如六味丸、知柏八味丸、大补阴丸、三甲饮之类，均可按症取用。若脉不数而迟，不弦而弱，面色萎黄，唇口晄白，舌淡纳少，少腹作痛，腰痠冰冷，或重坠如带重物，则属虚而兼寒，又非温补不可。初则温脾，继则温肾，终则以有情血肉温补奇脉。温脾如异功、理中、香砂、豆蔻、益智之类；温肾如肾气、四神、胶姜、胶艾之类；温补奇经如鹿茸、鹿角、狗脊、巴戟、羊肉、虎骨胶之类。初起宜温，温之不应则补之，补之不应则升之，升之不应则涩之，涩之不应则非治奇经不可矣。其腰重坠而作冷者，近效附子白术汤甚效。若带下如崩欲脱，非大剂补中益气，加熟地、龙牡不为功。老年体虚者每多此症，不可不知也。若症见虚弱而有口苦咽干，五心烦热，脉数苔黄，舌绛诸象，是虚而兼热，其带必兼黄色，或赤白相杂，宜补虚之中少佐清热为用。如洋参、沙参、川斛、麦冬、天冬、莲子、玉竹、扁豆之类。一派清灵之品，补而不腻者为君，以治其虚，少佐知、柏、丹、泽、芩、连之品，一二味为佐，以治其热。其必取用苦寒者，一则以苦寒之品能清下热，一则以苦寒之质能坚阴也。若胃气强者，可用厚味，则三甲复脉、大补阴丸、知柏八味各方均可加减取用。兼赤者，丹地四物、荆芩四物、六味丸均属效方。依症进退，治无不效。此虚热带下之大要治法也。其属实症者，有风冷所致者，《圣惠方》曰："妇人带下，由受于风冷入于脬胞而成。"严用和亦云："劳伤过度，冲任虚损，风冷踞于胞络，此病所由生也。且妇人平居之时，血欲常多，气欲常少，方谓主气有源，百疾不生。倘或气倍于血，气倍生寒，血不化赤，遂成白带。"其症腰冷重坠，下半体无汗，带下清稀，子户作冷，少腹时痛，喜热畏寒，虽无虚象，实属寒邪，治非温散不可。杨仁斋谓："带下之由于风冷停宿者，官桂、干姜、细辛、白芷为要药。先散寒邪，后为封固。若初起即用温补，风冷便无出路。"可谓要言不烦。其治宜用辛温、香燥之品，燥以胜湿，温以胜寒，辛以散风也。风冷甚者，可以坐药暖之。风冷既除，再用温肾燥土之剂以善其后。如参、术、艾、附之类可也。若无风而但属湿痰胜者，其人必属体丰，体丰多痰，痰滞下流，带脉不举，带下稠浓，白滑如涕，但重不痛，脉来沉滑。宜二陈、平胃、星香、导痰之类。或用风以燥湿亦可。但治其痰，痰清而滞自减。痰滞结者，可用十枣、涤痰之类攻之，峻去其痰，源清则流自洁，此通因通用法也。药虽峻而用灵，症重者非此不效，惟少见耳。世传威喜丸为湿痰带下效方，实则黄蜡油腻，犯胃欲恶，殊不适用，惟带脉虚滑而脾有湿痰，虚多湿少者颇宜。亦当煎好去油，然后可服也。其湿热带下，带色必黄，身无虚象，但常带下，苔黄口苦，小溲短赤，宜苦辛燥湿，苦寒清热，如二妙丸之苍术、黄柏同用甚为可法。傅氏女科用苡仁、黄柏一方，以治湿热带下清灵周到，取用极效。兼赤者夹心火，心与小肠相表里，小肠为火府，宜泻小肠，用导赤散加山栀。兼青者夹肝火也，土湿木陷，肝郁不舒，郁而化火者，宜加味逍遥散，或黑防风、白芍、川楝、乌梅、左金等疏之和之。肝胆相火有余，热逼下注，症现有余者，龙胆泻肝汤、柴胡清肝饮之类泻之。湿热既除，始用清养之品，以资调理。若赤白带下已久，少腹作痛，来而甚多，体见虚弱，而气滞血不调者，用震灵丹虚实同治。气滞血凝，故用乳、没；体虚滑脱，故用禹、脂。一则涩其久带，一则温通其痛，亦一通补之良方也。而世人莫用，药肆中十九不备，妙药不传，其湮没者众矣，诚可惜哉。昔谓女科带下，有如男子白浊，均为湿热下流，非通不可。其言诚是，惟不能统治一切带下者。昔人有分白带、白浊、白淫为三症者，谓白带时时流出，清冷稠粘；白浊则随小便而来，浑浊如泔；白淫常在小便之后而来，亦不多，此男精不摄，滑而自出也。其辨白淫，另出一解，颇觉新颖。其症亦多，其因非相火旺即肾气虚。肾气虚不能摄精，相火旺亦不能摄精。至其所论白带，乃白带属虚寒者之一种耳。所论白浊，与带下之属湿热者同治而异其名，固可辨而不必辨者也。大抵湿热带下，初起宜通利，如四芩、八正、六一、分清之类，治浊者均能治带。久则伤其肾阴，纯用通剂，或致虚虚之流弊，当育阴与通利同用。猪苓之用阿胶、春泽之用人参、威喜之用黄蜡、六味之用地黄、山药，均是虚实同顾。王冰谓"壬水患其不流，葵水患其不足。"其不流者，正由不足而来，欲通其流，诚非滋其不足不可矣。此湿热带下之大略也。更有纯虚之症，宜于用补者，如脾虚者，甘温补脾，必佐升阳；肾虚者，咸温补肾，必佐涩精。肝虚者，甘酸敛肝，必兼伸木；奇经虚者，更以血肉填补，兼以介类潜之，石类镇之，咸以引之，酸以收之，苦以坚之，涩以固之，治虚之法备矣。又有纯实之证，非攻不可。带下本为通病，而更用通法，即所谓通因通用也。洁古谓湿热带下，冤结而痛者，先以十枣汤下之。子和治痰实带下，以导水禹功丸泻之。丹溪治痰滞带下，以小胃丹通之。均为治痰水结滞，纯实之症立法。若《准绳》所谓肠有败脓，淋漓不已，腥秽特甚，脐腹结痛者，当祛瘀排脓。《金匮》所谓小腹里急，腹满，曾经半产，瘀血在小腹者，宜祛瘀破蓄，则又为瘀血结滞，纯实之症立论矣。总之，纯虚之症。治不离于肝脾肾，而极于奇经；纯实之症，治不出瘀血痰结。论带至此，其大法已渐备，若再详其细则，考其变迁，则在乎博览各家之专书矣。
胎前篇
妇人胎产，列为专科，代有名家。妇科之书，浩如烟海，非能以数言尽也。《金匮》亦列妇女一门，明乎胎产之证，虽非专家，而其大旨，亦当知晓。故今所言者，乃仅释《金匮》之妇人病耳。妇人门共分三证，即妊娠、产后及杂病也。妊娠、产后均为妇人所独有，杂病治法，本同男子，惟有独为女性所有之杂病则不得不别出治法。
今先言妊娠。妊娠即胎前也。胎前之证虽多，大要不出三种。一为因胎而成病者，一为因病而伤胎者，一为病不关胎，病自病，胎自胎，而治病之法，恐有妨胎，故不得不另设治法者。胎前各证，无能出其范围者矣。
江南地区的人，十个女子中有九个患有带下病。这主要是因为当地土地低洼潮湿，风俗奢靡，或者因为思虑无穷，或者是受到风、寒、暑、湿、燥、火六淫邪气的侵袭，所以患病的人非常多。然而轻症不造成危害，重症则非用药治疗不可。关于“带下”这一名称，也有几种说法。带脉环绕腰部，形状像束带，如果带脉失去约束能力，白色液体绵绵不断地下流，所以称为带下，这是第一种说法。“带下”是妇女的隐疾，不便明说，古人用裳和带遮体，所以忌讳称腰以下的隐疾为带下，这是第二种说法。痢疾是从后窍排出，是邪热传到大肠；带下是从前阴流出，是湿热注于胞宫，这两种病症大致相同，痢疾古称滞下，带下也就是滞下。所谓“带下”，是“滞下”的误写，这是第三种说法。虽然各说不同，但都有道理，只是对带下病的病理和治疗原则没有影响，可以保留而不加议论。至于说到带下病的病源，《素问》认为是任脉生病。原文说：“任脉生病，男子体内结聚成七种疝气，女子患带下病及瘕聚。”王冰注释说：“任脉起于胞中，向上经过带脉，好像束带状，所以叫带下。”但从文义来看，不说带脉生病，而说任脉生病，那么带下的名称，决不是像上述带脉像束带那样的意思。把带下与瘕聚并列来说，那么滞下的道理似乎成立；如果以带脉不约束来论述，就不应当引用经文中任脉生病的宗旨。然而根据实验所得，带脉和任脉都有可能造成此病。而且普通的带病也不能限定为一个原因，其来源很多。言病则有内因、外因，言症状则有虚有实。虚证有寒热之不同，实证有风冷、湿热之不同。更有纯虚的症状，应当全用填补法；纯实的症状，全用攻下法。从治疗来说，温法、清法、通法、涩法、升提法、补法、攻下法都可以依据症状而施用。现在特别分述如下。《素问》说：“思虑无穷，愿望不得，意念淫乱于外，房事过度，发为白淫。”即白带如泉水涌出，清澈且腥味特重，靠近身体就能闻到。其原因以“思虑无穷，愿望不得”八个字为总纲，而有未婚少女与已婚妇女的区别。意念淫乱于外，愿望不遂，多发生于未婚少女，以及尼姑、寡妇等。如果是已婚有夫之妇，则多是因房事过度而得病。细而言之，在内因之中又分两种：意念淫乱于外，属于纯粹的内因；房事过度，属于内因中兼有不内外因的情况。论治则房事太过者，以寡欲为根本解决之法。因为多欲则阴精消耗，水枯竭泉源干涸，相火更加炽盛，火热灼烧津液，像泉水一样流出，不枯竭就不会停止。左尺脉主水，右尺脉主火，水亏火旺，所以右尺脉必然数急弦数。除了节制欲望之外，再用方药治疗，则养阴清火、滋肾制相火是不变的方法，如六味丸、知柏八味丸、大补阴丸、三甲饮等，均可按症状选用。如果脉不数而迟，不弦而弱，面色萎黄，嘴唇口角苍白，舌淡食欲少，小腹部疼痛，腰部酸痛冰冷，或有沉重下坠感如带着重物，则属于虚而兼寒，又非温补不可。起初温脾，继而温肾，最终用有情血肉之品温补奇经。温脾如异功散、理中汤、香砂六君子汤、豆蔻、益智仁之类；温肾如肾气丸、四神丸、胶姜汤、胶艾汤之类；温补奇经如鹿茸、鹿角、狗脊、巴戟天、羊肉、虎骨胶之类。初起宜用温法，温之无效则用补法，补之无效则用升提法，升提无效则用涩法，涩之无效则非治疗奇经不可了。那些腰部沉重下坠且发冷的，近效附子白术汤非常有效。如果带下如崩漏般欲脱，非大剂量补中益气汤，加入熟地黄、龙骨、牡蛎不能见效。老年体虚者多有此症，不可不知。如果症状见虚弱而有口苦咽干，五心烦热，脉数苔黄，舌绛等象，这是虚而兼热，其带下必兼黄色，或赤白相间，宜在补虚之中稍加清热之用。如西洋参、沙参、川石斛、麦冬、天冬、莲子、玉竹、扁豆之类。一派清灵之品，补而不腻作为君药，以治疗其虚，稍加知母、黄柏、丹皮、泽泻、黄芩、黄连一二味作为佐药，以治疗其热。之所以必须选用苦寒之品，一则因为苦寒之品能清下焦之热，二则因为苦寒之质能坚阴。如果胃气强盛，可用厚味之药，则三甲复脉汤、大补阴丸、知柏八味丸各方均可加减取用。兼见赤色者，丹地四物汤、荆芩四物汤、六味丸均属有效方剂。依症状进退，治疗无不有效。这是虚热型带下的大要治法。其实证者，有由风冷所致者，《圣惠方》说：“妇人带下，由受风冷侵入胞宫而成。”严用和也说：“劳伤过度，冲任虚损，风冷占据胞络，这就是病产生的原因。况且妇女平时，血欲常多，气欲常少，才谓主气有源，百病不生。倘若气倍于血，气倍生寒，血不能化为赤色，遂成白带。”其症状为腰部冷重下坠，下半身无汗，带下清稀，子宫寒冷，小腹部时常疼痛，喜热畏寒，虽然没有虚象，实属寒邪，治疗非温散不可。杨仁斋说：“带下由于风冷停积留宿的，官桂、干姜、细辛、白芷是主要药物。先散寒邪，后为封固。如果初起就用温补，风冷便没有出路。”可谓要言不烦。其治疗宜用辛温、香燥之品，燥以胜湿，温以胜寒，辛以散风。风冷严重的，可以用坐药暖之。风冷既除，再用温肾燥土之剂以善后。如人参、白术、艾叶、附子之类即可。如果没有风而只属湿痰胜者，其人必定体型肥胖，体型肥胖多痰，痰滞下流，带脉不举，带下稠浓，白滑如鼻涕，只有沉重感不痛，脉来沉滑。宜用二陈汤、平胃散、星香散、导痰汤之类。或用风药以燥湿也可以。只要治疗其痰，痰清而滞自减。痰滞结聚者，可用十枣汤、涤痰汤之类攻之，峻猛地去其痰，源头清则水流自洁，这是通因通用的方法。药虽峻猛而用法灵巧，症重者非此无效，只是少见罢了。世间流传的威喜丸是湿痰带下的有效方剂，实则黄蜡油腻，犯胃引起恶心，殊不适用，只有带脉虚滑而脾有湿痰，虚多湿少的情况颇适宜。也应当煎好后去油，然后才可服用。其湿热带下，带色必黄，身体无虚象，只是常带下，苔黄口苦，小便短赤，宜用苦辛燥湿，苦寒清热，如二妙丸中的苍术、黄柏同用甚为可取。傅氏女科用苡仁、黄柏一方，以治湿热带下清灵周到，取用极效。兼见赤色者夹心火，心与小肠相表里，小肠为火府，宜泻小肠，用导赤散加山栀。兼青色者夹肝火也，土湿木陷，肝郁不舒，郁而化火者，宜用加味逍遥散，或黑防风、白芍、川楝子、乌梅、左金丸等疏肝和解。肝胆相火有余，热逼下注，症状表现为有余者，龙胆泻肝汤、柴胡清肝饮之类泻之。湿热既除，始用清养之品，以资调理。如果赤白带下已久，小腹部作痛，发作时量多，身体见虚弱，而气滞血不调者，用震灵丹虚实同治。气滞血凝，故用乳香、没药；体虚滑脱，故用禹余粮、赤石脂。一则涩其久带，一则温通其痛，也是一通补的良方。然而世人不用，药肆中十九不备，妙药不传，湮没者众矣，诚可惜哉。昔日认为女科带下，有如男子白浊，均为湿热下流，非通利不可。这话确实正确，惟独不能统治一切带下者。昔日有人将白带、白浊、白淫分为三种症状，谓白带时时流出，清冷稠粘；白浊则随小便而来，浑浊如米泔水；白淫常在小便之后而来，也不多，这是男精不摄，滑而自出。其对白淫的辨别，另出一解，颇觉新颖。其症状也多，其因非相火旺即肾气虚。肾气虚不能摄精，相火旺亦不能摄精。至于其所论白带，乃是白带属虚寒者的一种罢了。其所论白浊，与带下之属湿热者同治而异其名，固可辨而不必辨者也。大抵湿热带下，初起宜通利，如四苓散、八正散、六一散、分清饮之类，治浊者均能治带。久则伤其肾阴，纯用通剂，或致虚虚之流弊，当育阴与通利同用。猪苓汤之用阿胶、春泽汤之用人参、威喜丸之用黄蜡、六味地黄丸之用地黄、山药，均是虚实同顾。王冰说“壬水患其不流，葵水患其不足。”其不流者，正由不足而来，欲通其流，诚非滋其不足不可矣。这是湿热带下的大略。更有纯虚之症，宜于用补者，如脾虚者，甘温补脾，必佐升阳；肾虚者，咸温补肾，必佐涩精。肝虚者，甘酸敛肝，必兼伸木；奇经虚者，更以血肉填补，兼以介类潜之，石类镇之，咸以引之，酸以收之，苦以坚之，涩以固之，治虚之法备矣。又有纯实之证，非攻不可。带下本为通病，而更用通法，即所谓通因通用也。洁古谓湿热带下，冤结而痛者，先以十枣汤下之。子和治痰实带下，以导水禹功丸泻之。丹溪治痰滞带下，以小胃丹通之。均为治痰水结滞，纯实之症立法。若《准绳》所谓肠有败脓，淋漓不已，腥秽特甚，脐腹结痛者，当祛瘀排脓。《金匮》所谓小腹里急，腹满，曾经半产，瘀血在小腹者，宜祛瘀破蓄，则又为瘀血结滞，纯实之症立论矣。总之，纯虚之症，治不离于肝脾肾，而极于奇经；纯实之症，治不出瘀血痰结。论带至此，其大法已渐备，若再详其细则，考其变迁，则在乎博览各家之专书矣。
胎前篇
妇人胎产，列为专科，代有名家。妇科之书，浩如烟海，非能以数言尽也。《金匮》亦列妇女一门，明乎胎产之证，虽非专家，而其大旨，亦当知晓。故今所言者，乃仅释《金匮》之妇人病耳。妇人门共分三证，即妊娠、产后及杂病也。妊娠、产后均为妇人所独有，杂病治法，本同男子，惟有独为女性所有之杂病则不得不别出治法。
今先言妊娠。妊娠即胎前也。胎前之证虽多，大要不出三种。一为因胎而成病者，一为因病而伤胎者，一为病不关胎，病自病，胎自胎，而治病之法，恐有妨胎，故不得不另设治法者。胎前各证，无能出其范围者矣。
In the Jiangnan region, nine out of ten women suffer from leukorrhea. This is primarily due to the low-lying and damp land, luxurious customs, endless thoughts, or invasion by the six exogenous pathogens (Wind, Cold, Summerheat, Dampness, Dryness, Fire), resulting in a high prevalence of the disease. However, mild cases are not harmful, while severe cases require medication. There are several explanations for the term "leukorrhea" (Dai Xia). The Dai Mai (Girdle Vessel) encircles the waist, resembling a belt; if it loses its restraining function, white fluid flows continuously downward, hence the name "leukorrhea," which is the first explanation. "Leukorrhea" refers to women's hidden ailments that are inconvenient to state explicitly; ancients used skirts and belts to cover themselves, so they euphemistically referred to hidden ailments below the waist as "leukorrhea," which is the second explanation. Dysentery is discharged from the posterior orifice, caused by pathogenic heat transmitting to the Large Intestine; leukorrhea is discharged from the anterior yin, caused by damp-heat pouring into the Uterus. These two conditions are roughly similar; dysentery was anciently called "Zhi Xia" (Stagnant Downward Flow), and leukorrhea is also Zhi Xia. The term "leukorrhea" is a miswriting of "Zhi Xia," which is the third explanation. Although each theory differs, all have their rationale, but they do not affect the pathology and treatment principles of leukorrhea, so they can be retained without discussion. Regarding the etiology of leukorrhea, *Su Wen* attributes it to illness of the Ren Mai (Conception Vessel). The text states: "Illness of the Ren Mai causes seven types of hernia in men and leukorrhea with masses in women." Wang Bing's commentary says: "The Ren Mai originates from the Uterus, passes upward through the Dai Mai, resembling a belt shape, hence called 'leukorrhea'." However, based on the textual meaning, since it does not say the Dai Mai is ill but rather the Ren Mai, the name "leukorrhea" certainly does not mean the Dai Mai resembles a belt. Speaking of leukorrhea alongside masses, the logic of "Zhi Xia" seems valid; if arguing from the perspective of the Dai Mai failing to restrain, one should not cite the classic principle of the Ren Mai being ill. Yet, according to experimental findings, both the Dai Mai and Ren Mai may cause this disease. Moreover, ordinary leukorrhea cannot be limited to a single cause; its sources are numerous. In terms of etiology, there are internal and external causes; in terms of symptoms, there are deficiency and excess patterns. Deficiency patterns differ in cold and heat; excess patterns differ in wind-cold and damp-heat. There are also pure deficiency syndromes requiring full tonification, and pure excess syndromes requiring full purgation. Regarding treatment, warming, clearing, unblocking, astringing, lifting, tonifying, and purging methods can all be applied according to symptoms. Now, let us discuss them separately. *Su Wen* says: "Endless thoughts, unfulfilled desires, mind indulging externally, excessive sexual intercourse lead to 'Bai Yin' (White Seminal Emission)." This manifests as white discharge flowing like a spring, clear with a strong fishy odor, detectable upon close proximity. The cause is summarized by the eight characters "endless thoughts, unfulfilled desires," with distinctions between unmarried virgins and married women. Mind indulging externally and unfulfilled desires often occur in virgins, nuns, and widows. For married women, excessive sexual intercourse is the common cause. Specifically, within internal causes, mind indulging externally is a pure internal cause, while excessive sexual intercourse is an internal cause combined with non-internal/non-external factors. In treatment, those with excessive sexual activity must fundamentally resolve the issue by reducing desire. Excessive desire consumes Yin essence, leading to dry water and枯竭 springs, causing Ministerial Fire to blaze fiercely, scorching body fluids, causing them to flow like a spring until exhausted. The left Chi pulse governs Water, and the right Chi pulse governs Fire; with Water deficiency and Fire hyperactivity, the right Chi pulse will necessarily be rapid, wiry, and frequent. Besides regulating desire, pharmacological treatment involves nourishing Yin, clearing fire, and nourishing the Kidney to control Ministerial Fire, which is an immutable method. Formulas such as Liu Wei Wan (Six-Ingredient Pill with Rehmannia), Zhi Bai Ba Wei Wan (Anemarrhena, Phellodendron, and Eight-Ingredient Pill), Da Bu Yin Wan (Great Tonify Yin Pill), and San Jia Yin (Three Shells Decoction) can be selected according to symptoms. If the pulse is slow instead of rapid, weak instead of wiry, with sallow complexion, pale lips and mouth, pale tongue, poor appetite, lower abdominal pain, sore and cold lower back, or a heavy dragging sensation as if carrying a weight, it belongs to deficiency combined with cold, requiring warming and tonification. Initially warm the Spleen, then warm the Kidney, and finally use animal-based substances to warm-tonify the extraordinary vessels. Warming the Spleen includes Yi Gong San (Extraordinary Power Powder), Li Zhong Tang (Regulate the Middle Decoction), Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomum Six-Gentlemen Decoction), Dou Kou (Cardamom), and Yi Zhi Ren (Alpinia Oxyphylla); warming the Kidney includes Shen Qi Wan (Kidney Qi Pill), Si Shen Wan (Four Spirits Pill), Jiao Jiang Tang (Gelatin and Ginger Decoction), and Jiao Ai Tang (Gelatin and Mugwort Decoction); warming the extraordinary vessels includes Deer Antler, Deer Horn, Dogspine, Morinda Officinalis, Mutton, and Tiger Bone Gelatin. Initial treatment should be warming; if ineffective, proceed to tonification; if still ineffective, to lifting; if still ineffective, to astringing; if astringing fails, treatment must focus on the extraordinary vessels. For those with heavy, cold lower back, Jin Xiao Fu Zi Bai Zhu Tang (Near-Efficacy Aconite and Atractylodes Macrocephala Decoction) is very effective. If leukorrhea is profuse like a metrorrhagia, large doses of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Prepared Rehmannia Root, Dragon Bone, and Oyster Shell are required. Elderly individuals with weak constitutions often present this syndrome, which must be known. If symptoms show weakness accompanied by bitter taste in the mouth, dry throat, five-palm heat, rapid pulse, yellow coating, and crimson tongue, it is deficiency combined with heat; the discharge will likely be yellow or mixed red and white. Treatment should involve tonifying deficiency with slight addition of heat-clearing herbs. Examples include American Ginseng, Glehnia Root, Dendrobium, Ophiopogon, Asparagus Tuber, Lotus Seed, Polygonatum Odoratum, and Dolichos Bean. A group of light and clear herbs, tonifying without cloying, serves as the sovereign herb to treat deficiency; slight additions of Anemarrhena, Phellodendron, Moutan Cortex, Alisma, Scutellaria, and Coptis Chinensis (one or two herbs) serve as minister herbs to treat heat. Bitter-cold herbs are necessary because they clear lower jiao heat and their bitter-cold nature helps to firm the Yin. If Stomach Qi is strong, rich and heavy herbs can be used, such as modifications of San Jia Fu Mai Tang (Three Shells Revive Pulse Decoction), Da Bu Yin Wan, or Zhi Bai Ba Wei Wan. If accompanied by blood, Dan Di Si Wu Tang (Moutan and Rehmannia Four-Substance Decoction), Jing Qin Si Wu Tang (Schizonepeta and Scutellaria Four-Substance Decoction), or Liu Wei Wan are effective formulas. Adjusting according to symptoms ensures efficacy. This summarizes the major treatment principles for deficiency-heat leukorrhea. For excess patterns caused by wind-cold, *Sheng Hui Fang* states: "Women's leukorrhea results from wind-cold invading the bladder and uterus." Yan Yonghe also said: "Overexertion damages Chong and Ren vessels; wind-cold occupies the uterine collaterals, giving rise to this disease. Normally, women should have more blood than Qi, ensuring a source for main Qi and preventing diseases. If Qi exceeds Blood, excess Qi generates cold, Blood fails to transform into red, resulting in white leukorrhea." Symptoms include cold and heavy lower back, no sweat on the lower half of the body, thin and clear discharge, cold uterus, intermittent lower abdominal pain, preference for warmth and aversion to cold. Although there are no deficiency signs, it is truly cold pathogen, requiring warming and dispersing. Yang Renzhai stated: "For leukorrhea caused by lingering wind-cold, Cassia Bark, Dried Ginger, Asarum, and Angelica Dahurica are key herbs. First disperse cold pathogen, then consolidate. If warming and tonifying are used initially, wind-cold has no outlet." This is concise and accurate. Treatment should use acrid-warm and aromatic-dry herbs to overcome dampness with dryness, cold with warmth, and wind with acridity. Severe wind-cold can be treated with sitz baths. After wind-cold is removed, use Kidney-warming and Spleen-drying agents to conclude treatment, such as Ginseng, Atractylodes, Mugwort, and Aconite. If there is no wind but only damp-phlegm excess, the patient is likely obese; obesity correlates with phlegm, where phlegm stagnation flows downward, Dai Mai fails to lift, discharge is thick and dense, white and slippery like sputum, heavy but painless, with a deep-slippery pulse. Er Chen Tang (Two-Cured Decoction), Ping Wei San (Calm the Stomach Powder), Xing Xiang San (Pinellia and Aucklandia Powder), or Dao Tan Tang (Guide Out Phlegm Decoction) are suitable. Wind herbs can also be used to dry dampness. Treating the phlegm clears it, reducing stagnation naturally. For phlegm-stagnation accumulation, Shi Zao Tang (Ten Jujube Decoction) or Di Tan Tang (Wash Out Phlegm Decoction) can be used to aggressively remove phlegm; clearing the source cleans the flow, employing the method of treating obstruction with unblocking (Tong Yin Tong Yong). Though the herbs are harsh, the application is clever; severe cases require this, though it is rare. The widely circulated Wei Xi Wan is considered effective for damp-phlegm leukorrhea, but its beeswax content is greasy, offending the Stomach and causing nausea, making it unsuitable. It is only appropriate for Dai Mai deficiency with slipping and Spleen damp-phlegm, where deficiency outweighs dampness. Even then, the oil must be removed after decoction before consumption. For damp-heat leukorrhea, the discharge is yellow, with no deficiency signs, but chronic discharge, yellow coating, bitter taste, and short dark urine. Acrid-dry to resolve dampness and bitter-cold to clear heat are indicated, such as using Cang Zhu and Huang Bai together in Er Miao Wan (Two Marvels Pill). Fu Shi Gynecology uses Coix Seed and Phellodendron for damp-heat leukorrhea, which is clear, thorough, and highly effective. If accompanied by blood, it involves Heart Fire; Heart and Small Intestine are exterior-interior related, and the Small Intestine is the Fire Mansion, so draining the Small Intestine with Dao Chi San (Direct Away Redness Decoction) plus Gardenia is appropriate. If accompanied by green color, it involves Liver Fire; Earth dampness traps Wood, Liver Qi stagnates and transforms into fire, so Jia Wei Xiao Yao San (Modified Free Wanderer Powder) or Black Feng Feng, White Peony, Sichuan Loranthus, Sour Plum, or Zuo Jin Wan (Left Metal Pill) for soothing and harmonizing are used. For excess Gallbladder-Liver Ministerial Fire forcing heat downward with excess symptoms, Long Dan Xie Gan Tang (Gentian Drain the Liver Decoction) or Chai Hu Qing Gan Yin (Bupleurum Clear the Liver Infusion) are used for draining. After damp-heat is cleared, light nourishing herbs are used for regulation. If red and white leukorrhea persists for a long time, with lower abdominal pain, profuse discharge during episodes, weakness, Qi stagnation, and blood disharmony, Zhen Ling Dan (Vibrating Spirit Pill) treats both deficiency and excess simultaneously. Qi stagnation and blood coagulation necessitate Frankincense and Myrrh; body deficiency and slipping necessitate Hematitite and Red Stone. One astrings chronic discharge, the other warms and unblocks pain; this is a good formula for unblocking and tonifying. Yet people rarely use it, and pharmacies seldom stock it; wonderful medicines are lost, which is truly regrettable. Previously, it was said that female leukorrhea is like male turbid urine, both caused by damp-heat flowing downward, requiring unblocking. This is correct, but cannot apply to all leukorrhea. Ancients distinguished Bai Dai (White Leukorrhea), Bai Zhuo (White Turbidity), and Bai Yin (White Seminal Emission) as three symptoms: Bai Dai flows constantly, clear, cold, thick, and sticky; Bai Zhuo comes with urination, turbid like rice wash water; Bai Yin occurs after urination, not much, representing uncontrolled seminal emission in men. Their differentiation of Bai Yin offers a novel perspective. Its symptoms are varied, caused either by Ministerial Fire hyperactivity or Kidney Qi deficiency. Kidney Qi deficiency fails to secure essence; Ministerial Fire hyperactivity also fails to secure essence. Their discussion of Bai Dai is merely one type of deficiency-cold leukorrhea. Their discussion of Bai Zhuo treats it similarly to damp-heat leukorrhea but under a different name, so distinction is optional but not mandatory. Generally, damp-heat leukorrhea initially requires unblocking and promoting diuresis, such as Si Ling San (Four Poria Powder), Ba Zheng San (Eight Correctness Powder), Liu Yi San (Six-to-One Powder), or Fen Qing Yin (Clear Separation Infusion); treatments for turbidity can also treat leukorrhea. Prolonged use injures Kidney Yin; purely using unblocking agents may lead to further deficiency, so nourishing Yin and unblocking should be used together. Zhu Ling Tang uses Donkey-hide Gelatin, Chun Ze Tang uses Ginseng, Wei Xi Wan uses Beeswax, Liu Wei Di Huang Wan uses Rehmannia and Dioscorea; all consider both deficiency and excess. Wang Bing said: "Ren Water suffers from lack of flow, Kui Water suffers from insufficiency." The lack of flow stems from insufficiency; to restore flow, it is essential to nourish the insufficiency. This summarizes damp-heat leukorrhea. For pure deficiency syndromes requiring tonification: Spleen deficiency uses sweet-warm to tonify Spleen, assisted by lifting Yang; Kidney deficiency uses salty-warm to tonify Kidney, assisted by securing essence; Liver deficiency uses sweet-acid to astringe Liver, assisted by spreading Wood; extraordinary vessel deficiency uses animal flesh to fill, assisted by shell minerals to anchor, stone minerals to suppress, salt to guide, acid to collect, bitter to firm, and astringent to secure. Methods for treating deficiency are complete. For pure excess syndromes, purging is necessary. Leukorrhea is inherently a condition of flow, yet using unblocking methods is called "treating obstruction with unblocking" (Tong Yin Tong Yong). Jie Gu said for damp-heat leukorrhea with painful entrapment, first purge with Shi Zao Tang. He Zi treated phlegm-excess leukorrhea by purging with Dao Shui Yu Gong Wan. Dan Xi treated phlegm-stagnation leukorrhea with Xiao Wei Dan. All establish laws for treating phlegm-water stagnation and pure excess. *Zhun Sheng* mentions pus in the intestines dripping endlessly with severe foul odor and umbilical/abdominal knotting pain, requiring removal of stasis and drainage of pus. *Jin Gui* mentions urgency in the lower abdomen, fullness, history of miscarriage, and blood stasis in the lower abdomen, requiring removal of stasis and breaking accumulation. These establish laws for blood stasis stagnation and pure excess. In summary, pure deficiency treatment revolves around Liver, Spleen, and Kidney, extending to extraordinary vessels; pure excess treatment involves blood stasis and phlegm accumulation. Having discussed leukorrhea up to this point, the major principles are prepared; detailing specifics and variations requires extensive study of specialized texts by various schools.
Chapter on Prenatal Care
Prenatal and postnatal care in women is listed as a specialized department, with renowned experts in every generation. Books on gynecology are as vast as the sea, impossible to summarize in a few words. *Jin Gui* also lists a section on women; understanding prenatal and postnatal conditions, even if not an expert, one should know the general principles. Therefore, what I speak of now is merely explaining the women's diseases in *Jin Gui*. The women's section is divided into three categories: pregnancy, postpartum, and miscellaneous diseases. Pregnancy and postpartum are unique to women; miscellaneous disease treatments are originally the same as for men, but for miscellaneous diseases unique to females, distinct treatment methods must be established.
Now, let us first discuss pregnancy. Pregnancy is the prenatal period. Although there are many prenatal conditions, they generally fall into three categories. One is illness caused by the fetus; one is injury to the fetus caused by illness; one is illness unrelated to the fetus, where the illness is one thing and the fetus another, but treatment methods might harm the fetus, thus requiring separate treatment approaches. No prenatal condition can escape this scope.