妇人面色青黄。肢体消瘦。心战腰酸。时下浊物。其物黄赤青白黯黑并下。是带脉之血。伤损而成。故名曰
带证。古法又分白浊一条。谓带下是带脉为病。其色污杂。白浊则是心脾肾三经为病。其色纯白。而所用
之方。仍相仿佛。其实同一病也。皆是带脉为病。吾为指明曰。白浊五带。所下似血非血。乃胞中之水也。此
水清则为天癸。以济经血。前论详矣。此水浊则为白浊。为五带。水浊而血因以浊矣。盖带脉下系胞宫。中
束人身。居身之中央。属于脾经。脾经土气冲和。则带脉宁洁。而胞中之水清和。是以行经三日后。即有胞
水。黄明如金。是肾中天癸之水。得带脉脾土之制。而见黄润之色。乃种子之的候。无病之月信也。若脾土
失其冲和。不能制水。带脉受伤。注于胞中。因发带证。白浊污杂。治宜和脾以利水。治脾即是治带。治带即
治水也。观肾着汤。用白术。治腰痛如带五千钱者。肾著名汤。明言是肾中水邪。着于带脉。故从脾治之。以
土治水。而带脉自愈矣。即此可知女子带证。是水不清。浊证仍是水不清。不必强分。总以和脾利水为主。
胃苓汤主之。挟热者去桂枝。加黄芩黄连黄柏。夹寒者。加细辛吴萸。夫脾土郁蒸。湿气腐化。变生五带。赤
白污浊。理脾解郁。宜逍遥散。加防己木通主之。热加丹皮栀子黄柏。寒加台乌药艾叶砂仁。以上所论。虽
未尽带浊之治。然已得法门。学人推而广之。遇热证则硝黄甘遂。未必非宜。遇寒证则参术 附。尤所必
用。以及寒热错杂。皆可随证制方。有纸笔不能尽传者。在医师之自悟也。
崩漏者。非经期而下血之谓也。少者名曰漏下。多则名为血崩。行经而去血过多。如水之流不能止者。亦
是血崩。古名崩中。谓血乃中州脾土所统摄。脾不摄血。是以崩溃。名曰崩中。示人治崩。必治中州也。月经
名曰信水。以五行惟土主信。土旺则月水有信。土虚则失信而漏下。甚则崩中矣。治法总以治脾为主。或
劳倦伤脾。或思虑饥饱伤脾。脾虚不摄。宜用归脾汤。加艾叶阿胶灶心土。大虚者。宜十全大补汤。加阿胶
续断升麻炮姜枣仁山萸肉。再用鱼肚鹿角霜莲米姜盐炖食。以调养之。黄 糯米当归煎服。亦大补气
血。六君子养荣汤。炙甘草汤。皆脾经补益之药。可以加减用之。凡是崩中。此为正治。又有治肝以治脾之
贼者。肝经怒火妄动。木郁克土。火扰而血不宁。其人善怒头痛。口苦目眩。胁腹胀满。六脉弦数。与脾经虚
寒之证。显有不同。宜归脾汤。加丹皮栀子柴胡白芍麦冬五味子。补脾土。清肝火。两面俱到。或用丹栀逍
遥散。加牡蛎阿胶蒲黄。
谨按。带漏虽是水病。而亦有夹瘀血者。以血阻气滞。因生带浊。小调经汤。随寒热加减治之。崩中虽是血
病。而实则因气虚也。气下陷。则水随而泻。水为血之倡。气行则水行。水行则血行。宜服补气之药。以升其
水。水升则血升矣。补中益气治之。
合崩带观之。一是水病。一是血病。女子男子。皆有血与水之病。宜通观之。
妇女面色青黄，肢体消瘦，心中战栗，腰膝酸软，时常排出浑浊分泌物。这些分泌物颜色有黄、赤、青、白、黯黑等混杂而下，这是带脉之血受损而形成的病症，所以称为“带证”。
古代医法又单独列出一条“白浊”，认为“带下”是带脉患病，其分泌物颜色污杂；而“白浊”则是心、脾、肾三经患病，其分泌物颜色纯白。虽然所用方剂大致相似，但其实属于同一种病。我明确指出：无论是白浊还是五色带下，所排出的物质看似像血而非血，实际上是胞宫中的水液。这种水液清澈时称为“天癸”，用来滋养经血，前文已有详细论述。这种水液浑浊时则成为白浊或五色带下，水液浑浊导致血液也随之浑浊。因为带脉向下连接胞宫，中部约束人身，位于身体中央，归属于脾经。脾经的土气冲和调顺，则带脉安宁洁净，胞宫中的水液清和，所以在行经三天后，就会有胞宫之水流出，黄色明亮如金，这是肾中“天癸”之水，受到带脉和脾土的制约，从而呈现出黄润的颜色，这是受孕的最佳时机，也是无病时的正常月经。如果脾土失去冲和之气，不能制约水液，导致带脉受伤，水液注入胞宫，因而引发带证，出现白浊污杂的情况。治疗应当调和脾胃以利水湿，治疗脾脏即是治疗带脉，治疗带脉即是治疗水液。观察《肾着汤》，使用白术，治疗腰痛感觉像带着五千枚铜钱一样沉重，肾着汤明确说明这是肾中的水邪停留在带脉，所以从脾脏论治，以土制水，带脉自然痊愈。由此可知，女子的带证，是水液不清澈；男子的浊证，同样是水液不清澈，不必强行区分，总以调和脾胃、利水湿为主。主方用胃苓汤。兼有热象的，去掉桂枝，加入黄芩、黄连、黄柏；兼有寒象的，加入细辛、吴茱萸。如果是脾土郁结蒸腾，湿气腐化，变生五色带下，赤白污杂，应当理脾解郁，宜用逍遥散，加防己、木通为主方。热象重的加牡丹皮、栀子、黄柏；寒象重的加台乌药、艾叶、砂仁。以上所论述的，虽然未能详尽涵盖所有带浊的治疗方法，但已经掌握了法门。学习者可以推演推广，遇到热证时，使用硝石、大黄、甘遂未必不适宜；遇到寒证时，使用人参、白术、附子，更是必须使用的。以及寒热错杂的情况，都可以随证处方。有些内容纸笔无法完全传达，在于医师的自我领悟。
崩漏，是指非经期出血的症状。量少者称为“漏下”，量多者称为“血崩”。行经期间出血过多，像水流一样无法止住，也称为血崩。古时候称为“崩中”，意思是血液由中焦脾土统摄，脾虚不能统摄血液，所以发生崩溃，称为崩中，以此提示人们治疗崩中必须治理中焦脾土。月经称为“信水”，因为五行中只有土主“信”，土气旺盛则月经有信期，土气虚弱则失信而漏下，严重时则发生崩中。治疗方法总以治疗脾脏为主。如果是劳累疲倦损伤脾脏，或者思虑过度、饥饱失常损伤脾脏，导致脾虚不能统摄血液，宜用归脾汤，加艾叶、阿胶、灶心土。大虚者，宜用十全大补汤，加阿胶、续断、升麻、炮姜、枣仁、山萸肉。再用鱼鳔、鹿角霜、莲子、生姜、盐炖食来调养。用黄耆、糯米、当归煎服，也能大补气血。六君子养荣汤、炙甘草汤，都是脾经补益的药物，可以加减使用。凡是崩中，这是正治法。还有通过治疗肝脏来治疗脾脏之“贼”的方法。肝经怒火妄动，木郁克土，火扰导致血液不安宁，患者容易发怒、头痛、口苦、目眩、胁肋腹部胀满，六脉弦数，这与脾经虚寒的证候明显不同。宜用归脾汤，加牡丹皮、栀子、柴胡、白芍、麦冬、五味子，补脾土，清肝火，两面兼顾。或者用丹栀逍遥散，加牡蛎、阿胶、蒲黄。
谨按：带下和漏下虽然是水液病变，但也有夹杂瘀血的情况，因为血阻气滞，因而产生带浊，用小调经汤，随寒热加减治疗。崩中虽然是血病，但实际上是因为气虚。气下陷，则水液随之泻下，水为血的先导，气行则水行，水行则血行，宜服用补气药物，以提升水液，水液上升则血液也随之上升，用补中益气汤治疗。
Women presenting with a greenish-yellow complexion, emaciated limbs, palpitations (heart trembling), and soreness/weakness of the waist and knees, who discharge turbid secretions intermittently. These discharges vary in color—yellow, red, green, white, dark, and black—and are mixed together. This condition arises from damage to the blood of the Dai Mai (Girdle Vessel) and is therefore named "Dai Syndrome" (Leukorrhea).
Ancient methods further distinguished a category called "White Turbidity." It was believed that leukorrhea is a disease of the Dai Mai, characterized by impure and mixed colors, whereas white turbidity is a disease of the Heart, Spleen, and Kidney meridians, characterized by pure white color. Although the formulas used are similar, they essentially stem from the same pathology. I clarify that both white turbidity and the five-colored leukorrhea involve discharges that resemble blood but are not blood; rather, they are fluids from the Bao Zhong (Uterus/Womb). When this fluid is clear, it is called Tian Gui (Heavenly Water/Menstrual Essence), which nourishes menstrual blood, as detailed in previous discussions. When this fluid becomes turbid, it manifests as white turbidity or the five-colored leukorrhea; the turbidity of the fluid leads to the turbidity of the blood. The Dai Mai connects downward to the uterus and binds the body centrally, located in the middle of the torso, and belongs to the Spleen meridian. When the Earth Qi of the Spleen meridian is harmonious and mild, the Dai Mai remains clean and tranquil, and the fluids in the uterus are clear and harmonious. Consequently, three days after menstruation, uterine fluid appears, yellow and bright like gold. This is the Tian Gui water from the Kidney, regulated by the Earth of the Dai Mai and Spleen, manifesting a yellow and moist color, indicating the optimal time for conception and representing normal menstruation in a healthy state. If the Spleen Earth loses its harmony and fails to control water, damaging the Dai Mai, water pours into the uterus, triggering Dai Syndrome with white turbidity and impurity. Treatment should focus on harmonizing the Spleen to promote diuresis. Treating the Spleen is treating the Dai Mai, and treating the Dai Mai is treating the water. Observing Shen Zhuo Tang (Kidney Fixation Decoction), which uses Bai Zhu (Atractylodis Macrocephalae Rhizoma) to treat lower back pain feeling as heavy as carrying five thousand coins: Shen Zhuo Tang explicitly states that this is water evil in the Kidney adhering to the Dai Mai, thus treated via the Spleen, using Earth to control Water, thereby healing the Dai Mai naturally. From this, we know that women's Dai Syndrome is caused by unclear water; men's turbidity is also due to unclear water. There is no need to force a distinction; the primary approach is always to harmonize the Spleen and promote diuresis. The main formula is Wei Ling Tang (Stomach and Pingwei Decoction). For cases with heat, remove Gui Zhi (Cinnamomi Ramulus) and add Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), and Huang Bo (Phellodendri Cortex). For cases with cold, add Xi Xin (Asari Radix) and Wu Zhu Yu (Evodiae Fructus). If Spleen Earth stagnation generates steaming dampness, leading to putrefaction and transformation into five-colored leukorrhea with red and white impurities, one should regulate the Spleen and resolve stagnation, using Xiao Yao San (Free and Easy Wanderer Powder) with Fang Ji (Stephaniae Tetrandrae Radix) and Mu Tong (Akebiae Caulis) as the main addition. For heat, add Dan Pi (Moutan Cortex), Zhi Zi (Gardeniae Fructus), and Huang Bo. For cold, add Tai Wu Yao (Linderæ Semen), Ai Ye (Artemisiae Argyi Folium), and Sha Ren (Amomi Fructus). Although the above discussion does not exhaustively cover all treatments for leukorrhea and turbidity, it provides the fundamental method. Students should extrapolate and expand upon this: for heat syndromes, using Xiao Shi (Natrii Sulfas), Da Huang (Rhei Radix et Rhizoma), and Gan Sui (Kansui Radix) may be appropriate; for cold syndromes, using Ren Shen (Ginseng Radix), Bai Zhu, and Fu Zi (Aconiti Lateralis Radix Praeparata) is essential. For mixed cold and heat patterns, formulas can be adjusted according to the syndrome. Some nuances cannot be fully conveyed by paper and pen; it depends on the physician's self-realization.
Beng Lou (Metrorrhagia and Metrostaxis) refers to bleeding outside the menstrual period. Scanty bleeding is called "Lou Xia" (Dripping Down), while profuse bleeding is called "Xue Beng" (Blood Collapse). Excessive bleeding during menstruation, resembling an unceasing flow of water, is also termed Xue Beng. In ancient times, this was called "Beng Zhong" (Collapse in the Middle), implying that blood is controlled by the Spleen Earth of the Middle Jiao. Since the Spleen fails to control the blood, collapse occurs, hence the name "Beng Zhong," indicating that treating Beng requires treating the Middle Jiao (Spleen). Menstrual blood is called "Xin Shui" (Trustworthy Water) because among the Five Elements, only Earth governs "Trust." When Earth Qi is robust, menstruation is regular; when Earth Qi is deficient, trust is lost, leading to dripping or collapse. The treatment principle always focuses on the Spleen. Whether due to fatigue injuring the Spleen, or excessive worry/dietary irregularities injuring the Spleen, resulting in deficiency and failure to control blood, Gui Pi Tang (Restore the Spleen Decoction) should be used, added with Ai Ye (Artemisiae Argyi Folium), E Jiao (Colla Corii Asini), and Zao Xin Tu (Furnace Hearth Earth). For severe deficiency, Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) should be used, added with E Jiao, Xu Duan (Dipsaci Radix), Sheng Ma (Cimicifugae Rhizoma), Pao Jiang (Zingiberis Rhizoma Praeparatum), Suan Zao Ren (Ziziphi Spinosae Semen), and Shan Yu Rou (Corni Fructus). Additionally, stewed consumption of Yu Du (Fish Bladder), Lu Jiao Shuang (Deer Antler Frost), Lian Mi (Nelumbinis Semen), Ginger, and Salt aids recovery. Decoction of Huang Qi (Astragali Radix), Nuomi (Glutinous Rice), and Dang Gui (Angelicae Sinensis Radix) also greatly tonifies Qi and Blood. Liu Jun Zi Yang Rong Tang (Six Gentlemen Nourishing Youth Decoction) and Zhi Gan Cao Tang (Prepared Licorice Decoction) are tonifying herbs for the Spleen meridian and can be used with modifications. For all cases of Beng Zhong, this is the standard treatment. Another approach involves treating the Liver to address the "Thief" of the Spleen. If Liver Fire moves recklessly, Wood stagnation overacts on Earth, and Fire disturbs causing blood instability, the patient may exhibit irritability, headache, bitter taste, vertigo, hypochondriac and abdominal distension, with wiry and rapid pulses throughout. This differs significantly from Spleen deficiency-cold patterns. One may use Gui Pi Tang added with Dan Pi, Zhi Zi, Chai Hu (Bupleuri Radix), Bai Shao (Paeoniae Radix Alba), Mai Dong (Ophiopogonis Radix), and Wu Wei Zi (Schisandrae Fructus) to tonify Spleen Earth and clear Liver Fire, addressing both aspects. Alternatively, use Dan Zhi Xiao Yao San (Moutan and Gardenia Free and Easy Wanderer Powder) added with Mu Li (Ostreae Concha), E Jiao, and Pu Huang (Typhae Pollen).
Note: Although Dai and Lou are primarily water disorders, they may also involve stasis blood obstructing Qi, leading to turbidity. Xiao Tiao Jing Tang (Minor Regulating Menses Decoction) should be used with modifications for cold or heat. Although Beng is a blood disorder, it is fundamentally due to Qi deficiency. When Qi sinks, water follows and drains. Water is the forerunner of blood; when Qi moves, water moves; when water moves, blood moves. Therefore, Qi-tonifying herbs should be taken to raise the water; once water rises, blood rises. Treat with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
Observing Beng and Dai together: one is a water disorder, the other a blood disorder. Both men and women suffer from blood and water diseases and should be viewed comprehensively.