徐氏 血崩后继以溺血,溺血后继以白带,淋沥不已。冲任虚滑,治在固摄下元,培养奇脉。阿胶、牡蛎、
茯神、杞子、菟丝子、白芍、杜仲、续断、熟地(俱炒),蜜丸数服而固。赤带属热兼火,白带属湿兼痰,带
久不止,须补脾肾兼升提。此症由崩漏而成淋带。《脉诀》所谓崩中日久为白带,漏下干时骨髓枯也。夫肝肾
内损,自必渐及奇经,至带脉不司束固,任脉不司担承,非用摄纳。冲为血海,虚滑曷止。李先知所谓下焦有
病患难会,须用余粮、赤石脂,亦镇固之旨。
侄女 中年崩漏久愈,近忽身麻心悸,自汗肤冷,带多肢颤。阅所服方,数用阿胶、熟地。遂致食入呕满,
大便频滑。不知症属阳虚气陷,胶地滋滑,大与病情凿枘不入。拟方用半夏曲(炒)、于术(生)、牡蛎( )、
鹿角霜、潞参、茯苓、枣仁、砂仁、小麦。四服诸症悉减,去半夏曲,加杜仲、芡实、莲子、白芍、山药(俱
炒用),又数服得安。
徐氏 脉沉小数,体羸久嗽,损象已成,惊蛰后重加喘嗽,带下如注。医用补涩太过,致小溲短少,
小腹满闷,是病上加病,法在通摄兼用。潞参、茯苓、灯心、湖莲、薏米、杞子、杜仲、沙苑子(俱生用)、
山药(炒)、橘红、五味,数服诸症平,带止食加。但饥则嗽频,劳则体热,知由中气馁怯。去灯心、薏米、
杜仲、沙苑子,加黄 (炙)、甘草、饴糖、贝母、百合,数服而起。
何氏 五旬外寒从背起,督脉阳虚,带下经旬,肾真失固,多奇经主病。脉象两尺虚涩,右关滑,左
寸强,系操劳扰动心阳,
中脘停痰,时闷时热,烦嘈干呕,恍惚失寐。先用温胆汤去枳实,加茯神、栀子(炒)、一服能寐。子后便泻,
怯冷有年,阳分素亏,急须温摄,鹿角霜、杞子炭、茯神、杜仲(炒)、砂仁、潞参、龙眼肉、莲子(炒)、
一啜寒止。三剂诸症全瘳。
徐氏,先发生血崩(大量阴道出血),随后出现尿血,尿血之后又出现白带,淋漓不断。这是冲任二脉虚弱滑脱,治疗应当固摄下元,培养奇经八脉。使用阿胶、牡蛎、茯神、枸杞子、菟丝子、白芍、杜仲、续断、熟地黄(全部炒制),制成蜜丸服用数次后病情稳固。赤色带下属于热证兼火邪,白色带下属于湿证兼痰浊,带下日久不止,必须补益脾肾并配合升提之法。此症是由崩漏发展而成的淋证和带下病。《脉诀》所说的“崩中日久为白带,漏下干时骨髓枯也”,正是此理。肝肾内部受损,自然会逐渐波及奇经八脉,导致带脉不能约束固摄,任脉不能承担维系,非用摄纳之法不可。冲脉为血海,若虚而滑脱,怎能停止?李先知所说的“下焦有病患难会,须用余粮、赤石脂”,也是镇固的道理。
侄女,中年时期崩漏已久且已痊愈,近期忽然身体麻木、心悸、自汗、皮肤发冷,白带增多、四肢颤抖。查看之前服用的药方,多次使用阿胶、熟地黄。于是导致进食后呕吐胀满,大便频繁稀溏。不知道病症属于阳虚气陷,阿胶和熟地黄的滋腻滑利之性,与病情格格不入。拟定方剂使用半夏曲(炒)、于术(生)、牡蛎(煅)、鹿角霜、潞党参、茯苓、酸枣仁、砂仁、小麦。服用四剂后各种症状全部减轻,去掉半夏曲,加入杜仲、芡实、莲子、白芍、山药(全部炒用),又服用数剂得以安宁。
徐氏,脉象沉细略数,形体消瘦,长期咳嗽,虚损的征象已经形成,惊蛰节气后喘息咳嗽加重,带下如注。医生用药补涩太过,导致小便短少,小腹胀满闷痛,这是病上加病,治法应当通利与固摄兼用。使用潞党参、茯苓、灯心草、湖莲子、薏苡仁、枸杞子、杜仲、沙苑子(全部生用)、山药(炒)、橘红、五味子,服用数剂后各种症状平息,带下停止,食欲增加。但是饥饿时咳嗽频繁,劳累时身体发热,知道是由于中气气馁怯所致。去掉灯心草、薏苡仁、杜仲、沙苑子,加入黄芪(炙)、甘草、饴糖、贝母、百合,服用数剂后康复。
何氏,五十多岁,寒气从背部升起,督脉阳虚,带下持续旬日,肾真元失于固摄,多为奇经八脉主病。脉象两尺部虚涩,右关部滑,左寸部强盛,这是由于操劳扰动心阳,中脘部位停聚痰浊,时而胸闷时而发热,心烦嘈杂干呕,恍惚失眠。先用温胆汤去掉枳实,加入茯神、栀子(炒),服用一剂便能入睡。子时后腹泻,畏冷多年,阳气素来亏损,急需温补固摄,使用鹿角霜、枸杞子炭、茯神、杜仲(炒)、砂仁、潞党参、龙眼肉、莲子(炒),喝一次后寒冷停止。三剂药后各种症状全部痊愈。
Ms. Xu first experienced menorrhagia (massive vaginal bleeding), followed by hematuria, and then leukorrhea, which persisted incessantly. This indicates deficiency and slipping of the Chong and Ren vessels; treatment should focus on securing and grasping the Lower Yuan and nourishing the Extraordinary Vessels. Ejiao (Donkey-hide Gelatin), Muli (Oyster Shell), Fushen (Poria with Hostwood), Gouqizi (Goji Berry), Tusizi (Dodder Seed), Baishao (White Peony Root), Duzhong (Eucommia Bark), Xuduan (Dipsacus Root), and Shudi (Prepared Rehmannia Root) (all stir-fried) were made into honey pills. After several doses, the condition stabilized. Red leukorrhea belongs to heat combined with fire; white leukorrhea belongs to dampness combined with phlegm. If leukorrhea persists for a long time, it is necessary to tonify the Spleen and Kidney and employ lifting methods. This case developed from menorrhagia and metrorrhagia into strangury and leukorrhea. As stated in *Mai Jue* (Pulse Classic): "Menorrhagia lasting long becomes white leukorrhea; dry bleeding depletes the bone marrow." When the Liver and Kidney are internally damaged, they inevitably gradually affect the Extraordinary Vessels. When the Dai vessel fails to bind and secure, and the Ren vessel fails to support and carry, only grasping and consolidating methods can be used. The Chong vessel is the Sea of Blood; how can deficiency and slipping stop without such measures? Li Xianzhi said, "When there is disease in the Lower Jiao, it is hard to comprehend; one must use Yuliang (Hematite) and Chishizhi (Red Halloysite)," which also reflects the principle of sedation and consolidation.
Niece: In middle age, she had prolonged menorrhagia and metrorrhagia which had long healed, but recently suddenly experienced body numbness, palpitations, spontaneous sweating, cold skin, increased leukorrhea, and trembling limbs. Reviewing the prescribed formulas, A-jiao and Shu Di were used repeatedly. This led to vomiting and fullness after eating, and frequent loose stools. It was unknown that the syndrome belonged to Yang deficiency with Qi sinking; the greasy and slippery nature of A-jiao and Shu Di was completely incompatible with the condition. The proposed formula used Banxia Qu (Stir-fried Pinellia Fermented Paste), Yuzhu (Raw Atractylodes Macrocephala Rhizome), Muli (Calcined Oyster Shell), Lujiaoshuang (Deer Antler Frost), Luoshen (Luzhou Codonopsis Root), Fuling (Poria), Zaoren (Sour Jujube Seed), Sharen (Amomum Fruit), and Xiaomai (Wheat). After four doses, all symptoms subsided. Banxia Qu was removed, and Duzhong, Qianshi (Chinese Chestnut Seed), Lianzi (Lotus Seed), Baishao, and Shanyao (Chinese Yam) (all stir-fried) were added. After several more doses, she found relief.
Ms. Xu: The pulse was deep, fine, and slightly rapid. She was emaciated and suffered from chronic cough, with signs of consumptive disease already established. After the Awakening of Insects solar term, her wheezing and cough worsened, and leukorrhea flowed like water. The physician used excessive tonifying and astringent herbs, resulting in scanty urine and abdominal fullness and oppression. This is adding illness to illness; the method should combine unblocking and securing. Luzhen (Codonopsis Pilosula), Fuling, Dengxincao (Juncus Effusus Pith), Hulian (Nelumbinis Semen), Yimi (Coix Seed), Gouqizi, Duzhong, Shayuanzi (Astragali Complanati Semen) (all raw), Shanyao (stir-fried), Juhong (Citrus Reticulata Pericarpium), and Wuweizi (Schisandra Fruit) were used. After several doses, all symptoms calmed, leukorrhea stopped, and appetite increased. However, coughing occurred frequently when hungry, and body heat arose when fatigued, indicating deficiency and timidity of Middle Qi. Dengxincao, Yimi, Duzhong, and Shayuanzi were removed, and Huangqi (Roasted Astragalus Root), Gancao (Licorice Root), Yitang (Maltose), Beimu (Fritillaria Bulb), and Baihe (Lily Bulb) were added. After several doses, she recovered.
Ms. He: Over fifty years old, cold sensation started from the back, indicating Deficiency of Yang in the Du vessel. Leukorrhea lasted for ten days, and the True Essence of the Kidney failed to consolidate, suggesting diseases primarily governed by the Extraordinary Vessels. The pulse showed emptiness and choppy quality at both Chi positions, slippery at the right Guan position, and strong at the left Cun position. This resulted from labor disturbing Heart Yang, with Phlegm stagnating in the Zhongwan area, causing intermittent chest oppression and fever, mental restlessness, dry retching, trance-like states, and insomnia. First, Wendan Tang (Warm the Gallbladder Decoction) was used, removing Zhishi (Bitter Orange), adding Fushen and Zhizi (Gardenia Fruit, stir-fried). One dose allowed sleep. Diarrhea occurred after Zi hour (11 PM - 1 AM), and fear of cold had existed for years, indicating inherent deficiency of Yang. Urgent warming and securing were needed: Lujiaoshuang, Gouqizi Tan (Charred Goji Berry), Fushen, Duzhong (stir-fried), Sharen, Luzhen, Longyanrou (Longan Aril), and Lianzi (stir-fried) were administered. One sip stopped the cold. After three doses, all symptoms were completely cured.