一 孀妇，内热脯热，腹胀胁痛，肢体酸麻，不时吐痰，月经不调，带下青黄。立斋曰∶此郁怒伤损
肝脾所致。朝用归脾汤，以解脾郁，生脾气，夕用加味遣遥散以生肝血，清肝火，百余剂而愈，
崩漏之病，由冲任二脉气血两虚所致。经言∶冲脉为五脏六腑之海，脏腑皆禀焉。又言∶为十二
经之血海。以其受纳诸经之灌注，精血于此而蓄藏也。又言∶冲脉任脉，皆起
于胞中，冲脉并足少阴之经，侠脐上行，至胸中而散。任脉上循腹里，上至咽喉面目。又言∶任脉
通，太冲脉盛，月事以时下。故二脉阴阳平和。外循经络，内荣脏腑，何崩漏之有。若劳伤不能约束
经血，则忽然暴下，如山崩然，故曰崩中。崩久则成漏下不止，其症有虚有热，有虚热相兼，有
房劳致伤。虚则渗下，热则流通，伤则失职。急则治其标，宜先止其血。若因怒动肝火，而血沸为崩
漏者，加味逍遥散加减。若因肾水虚衰不能镇守胞中相火，而血走为崩漏者，保阴、左归加减。若因悲
哀太甚，则心系急而胞络绝。〔以胞脉属心，而络于胞中，即子宫。在女为血室。〕绝则上下不交，亢
阳内动，而逼血下行者，天王补心加减。若因心血不足，郁结伤脾，而血无主统者，加味归脾加减。按
沈氏云∶治崩漏，宜大补气血，调养脾胃，微加清心火肝火之药，补阴泻阳，则血自止。立斋云∶若大
失血，当急用独参汤救之。故崩漏无不由脾胃先损，故能受补者可治。若纯用寒凉止血之药，复伤脾
胃，愈不能统血，是速其危也。考《金匮》用胶艾四物汤，治妇人陷经，漏下黑不解。故东垣有属寒之
说。虽此症属虚热者多，然亦不可不察其病变之无穷焉。
广笔记方〔亦作丸服。〕治崩漏甚效。
人参 黄 〔补血以统之。〕生地 白芍〔凉血以止之。各三钱。〕麦冬〔心主血，心
清则血不妄行，五钱。〕枣仁 枸杞〔各三钱。〕杜仲〔二钱。〕续断〔肝藏血，补
肝则血有所归。二钱。〕阿胶〔血去多则补益之。但真者甚难，或用熟地，或用鳖甲、龟甲各五钱
代之，以龟通任脉，鳖入肝经，并补阴除热。〕萸肉〔二钱。〕五味〔血滑脱，则酸敛
之。〕荆芥〔血下渗，则升举之。炒，各八分。〕热甚者，可暂加地榆、槐花。
此补气益血，滋阴清热，兼酸敛升举之剂，立法周备，用故辄效。按嘉言云∶若天癸已尽，潮讯已
绝，血下有如崩漏，此为脱荣，宜大补。急用凉血清火为治。
加味逍遥散 保阴煎〔方中牛膝忌用。〕左归饮 天王补心丹 加味归脾汤〔俱见虚劳。〕
此五方皆可治崩漏，须审其因，加减取用。
脉宜微弱，不宜实大。
一位寡妇，出现体内发热、午后潮热、腹部胀满、胁肋疼痛、肢体酸痛麻木、不时咳吐痰涎、月经失调、白带呈青色或黄色等症状。薛立斋说：这是因抑郁和愤怒损伤了肝脾所致。早晨服用归脾汤（Guipi Tang, Spleen-Restoring Decoction），以疏解脾郁，生发脾气；晚上服用加味逍遥散（Jiawei Xiaoyao San, Modified Free and Easy Wanderer Plus Decoction），以滋养肝血，清泻肝火，服百余剂后痊愈。
崩漏病，是由冲脉和任脉气血两虚所导致的。医经记载：冲脉是五脏六腑之海，脏腑都禀受其气。又说：它是十二经脉的血海。因为它接纳各条经脉的灌注，精血在此蓄积储藏。又说：冲脉和任脉，都起于胞宫（uterus/子宫），冲脉伴随足少阴肾经，夹脐上行，至胸中而分散。任脉沿腹里上行，至咽喉及面目。又说：任脉通畅，太冲脉旺盛，月经就能按时来潮。所以这两条经脉阴阳平和，外循经络，内荣养脏腑，怎么会有崩漏呢？如果因劳倦损伤导致不能约束经血，就会突然大量出血，如山崩一般，所以称为“崩中”。崩证日久则转为漏下不止，其症状有虚证、有热证、有虚热夹杂、有因房劳致伤。虚证则血液渗漏下行，热证则血液流通妄行，受伤则功能失职。急症时先治其标，宜先止血。若因愤怒引动肝火，导致血沸溢而为崩漏者，用加味逍遥散加减治疗。若因肾水虚衰不能镇守胞宫中的相火，导致血妄行而为崩漏者，用保阴煎（Baoyin Jian, Nourishing Yin Decoction）或左归饮（Zuogui Yin, Left Restoring Drink）加减治疗。若因悲哀过度，导致心气紧急而胞络断绝。（因为胞脉属于心，并联络于胞中，即子宫。在女性称为血室。）断绝则上下不交，亢盛的阳气在内扰动，逼迫血液下行者，用天王补心丹（Tianwang Buxin Dan, Emperor of Heaven's Heart-Nourishing Pill）加减治疗。若因心血不足，郁结伤脾，导致血液失去主宰统摄者，用加味归脾汤加减治疗。按沈氏所说：治疗崩漏，宜大补气血，调养脾胃，微加清心火、肝火的药物，补阴泻阳，则血自止。立斋说：若大量失血，当紧急使用独参汤（Dushen Tang, Single Ginseng Decoction）救治。所以崩漏无不是由脾胃先受损，因此能够接受补益治疗的可以治愈。如果纯用寒凉止血药，反而伤害脾胃，更无法统摄血液，这是加速其危亡。考证《金匮要略》用胶艾四物汤（Jiao'ai Siwu Tang, Gelatin and Mugwort Four Substances Decoction），治疗妇人陷经，漏下黑色不止。所以东垣有属于寒证的说法。虽然此症多属虚热，但也不可不明察病变的无穷变化。
广笔记方（也可制成丸药服用）治疗崩漏非常有效。
人参（Renshen, Ginseng Radix）、黄芪（Huangqi, Astragali Radix，补血以统摄血液）、生地（Shengdi, Rehmanniae Radix）、白芍（Baishao, Paeoniae Radix Alba，凉血以止血，各三钱）、麦冬（Maidong, Ophiopogonis Radix，心主血，心清则血不妄行，五钱）、枣仁（Zaoren, Ziziphi Spinosae Semen）、枸杞（Gouqi, Lycii Fructus，各三钱）、杜仲（Duzhong, Eucommiae Cortex，二钱）、续断（Xuduan, Dipsaci Radix，肝藏血，补肝则血有所归，二钱）、阿胶（Ejiao, Asini Corii Colla，失血多则补益它。但真品很难得，可用熟地或鳖甲、龟甲各五钱代替，龟通任脉，鳖入肝经，并补阴除热）、山茱萸（Yurou, Corni Fructus，二钱）、五味子（Wuweizi, Schisandrae Chinensis Fructus，血滑脱，则用酸味收敛之）、荆芥（Jingjie, Schizonepetae Herba，血下渗，则用升举之，炒，各八分）。热势重者，可暂时加用地榆、槐花。
此方补气益血，滋阴清热，兼有酸敛和升举的作用，立法周全完备，使用往往见效。按嘉言所说：如果天癸已尽，月经已绝，下血如崩漏，此为脱荣，宜大补。紧急用凉血清火为治。
加味逍遥散、保阴煎（方中牛膝忌用）、左归饮、天王补心丹、加味归脾汤（均见虚劳篇）。
这五个方子都可以治疗崩漏，必须审察病因，加减选用。
脉象宜微弱，不宜实大。
A widow presented with internal heat, afternoon tidal fever, abdominal distension, hypochondriac pain, soreness and numbness of the limbs, occasional expectoration of phlegm, irregular menstruation, and leukorrhea that was green or yellow. Xue Lizhai stated: This is caused by depression and anger damaging the Liver and Spleen. In the morning, administer Guipi Tang (Spleen-Restoring Decoction) to resolve Spleen Qi stagnation and generate Spleen Qi; in the evening, administer Jiawei Xiaoyao San (Modified Free and Easy Wanderer Plus Decoction) to nourish Liver Blood and clear Liver Fire. After more than a hundred doses, she recovered.
The disease of Benglou (metrorrhagia and metrostaxis) is caused by deficiency of both Qi and Blood in the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel). The classics state: The Chong Mai is the Sea of the Five Zang and Six Fu Organs, and all organs receive from it. It is also said to be the Sea of Blood for the Twelve Meridians. Because it receives the infusion from various meridians, Essence and Blood are stored here. It is further stated: The Chong Mai and Ren Mai both originate from the Bao Zhong (Uterus/Cavity). The Chong Mai runs alongside the Foot-Shaoyin Kidney Meridian, flanking the umbilicus upwards, dispersing at the chest. The Ren Mai ascends along the interior of the abdomen to the throat, face, and eyes. It is also said: When the Ren Mai is unobstructed and the Tai Chong Mai is vigorous, menstruation arrives on time. Thus, these two vessels maintain Yin-Yang harmony, circulate externally through the meridians, and nourish internally the Zang-Fu organs; how could Benglou occur? If laborious injury fails to constrain the menstrual blood, sudden profuse bleeding occurs like a mountain collapse, hence termed "Bengzhong" (Central Collapse). Long-standing Beng becomes Louxia (continuous dripping), presenting as deficiency, heat, combined deficiency-heat, or injury from sexual excess. Deficiency leads to seepage downward; Heat leads to reckless flow; Injury leads to loss of function. In acute cases, treat the branch first; stop the bleeding initially. If anger stirs Liver Fire causing blood boiling and bursting into Benglou, modify Jiawei Xiaoyao San. If Kidney Water deficiency fails to control the Minister Fire in the Bao Zhong, causing blood to run wild into Benglou, modify Baoyin Jian (Nourishing Yin Decoction) or Zuogui Yin (Left Restoring Drink). If excessive grief causes the Heart Qi to become urgent and the Bao Luo (Uterine Collaterals) to sever, [since Bao Mai belongs to the Heart and connects to the Bao Zhong, i.e., the Uterus, known as the Blood Chamber in women], severance prevents upper-lower communication, hyperactive Yang moves internally, forcing blood downward; modify Tianwang Buxin Dan (Emperor of Heaven's Heart-Nourishing Pill). If Heart Blood is insufficient, stagnation injures the Spleen, and blood lacks mastery and control, modify Jiawei Guipi Tang. According to Shen Shi: Treating Benglou requires greatly tonifying Qi and Blood, regulating the Spleen and Stomach, and slightly adding herbs to clear Heart and Liver Fire, tonifying Yin and draining Yang, so the blood stops naturally. Lizhai stated: For massive hemorrhage, urgently use Dushen Tang (Single Ginseng Decoction) to rescue. Therefore, Benglou invariably involves prior damage to the Spleen and Stomach; thus, those who can accept tonification are curable. If purely using cold-cooling hemostatic drugs, it further damages the Spleen and Stomach, making it even harder to control blood, which accelerates danger. Examining *Jinkui Yaolue*, Jiaoai Siwu Tang (Gelatin and Mugwort Four Substances Decoction) is used to treat women with sinking Jing, leaking black blood that does not resolve. Hence, Dong Yuan proposed it may belong to Cold patterns. Although this condition is mostly deficiency-heat, one must not fail to observe the infinite variations of pathology.
Guangbiji Fang (also made into pills) is very effective for treating Benglou.
Renshen (Ginseng Radix), Huangqi (Astragali Radix, [tonifies Blood to control it]), Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba, [cools Blood to stop bleeding, 3 qian each)], Maidong (Ophiopogonis Radix, [Heart governs Blood; if Heart is clear, Blood does not move recklessly, 5 qian]), Zaoren (Ziziphi Spinosae Semen), Gouqi (Lycii Fructus, [3 qian each]), Duzhong (Eucommiae Cortex, [2 qian]), Xuduan (Dipsaci Radix, [Liver stores Blood; tonifying Liver ensures Blood has its return path, 2 qian]), Ejiao (Asini Corii Colla, [replenishes if much blood is lost. Genuine product is rare; substitute with Shudi or Biejia/Turtle Shell and Guijia/Tortoise Shell, 5 qian each; Turtle Shell unblocks Ren Mai, Biejia enters Liver Meridian, both tonify Yin and remove heat]), Yurou (Corni Fructus, [2 qian]), Wuweizi (Schisandrae Chinensis Fructus, [for slippery leakage, use sour astringents]), Jingjie (Schizonepetae Herba, [for seeping downward, use lifting agents, stir-fried, 8 fen each)]. If heat is severe, temporarily add Diyü (Sanguisorbae Radix) and Huaihua (Sophorae Flos).
This formula tonifies Qi and benefits Blood, nourishes Yin and clears Heat, combining sour astringency and lifting action. Its principles are comprehensive and complete, hence it is often effective. According to Jiayan: If Tiangui (Heavenly Water/Menstrual Essence) has exhausted and menstrual cycles have ceased, yet bleeding occurs like Benglou, this is Tuorong (Depletion of Glory), requiring great tonification. Urgently treat with cooling Blood and clearing Fire formulas.
Jiawei Xiaoyao San, Baoyin Jian (Niuxi is contraindicated in this formula), Zuogui Yin, Tianwang Buxin Dan, Jiawei Guipi Tang (all see under Xu Lao/Wasting-Thirst).
These five formulas can all treat Benglou; one must examine the etiology and modify/select accordingly.
The pulse should be weak and fine, not full and large.