某 温邪劫阴。带下火升。胸痞。脉小数。（温邪伤阴）
生地 阿胶 牡蛎 川斛 小麦 茯苓
某 阳明脉虚。手麻足冷身动。带下如注。用通摄方。（胃虚）
人参 桂枝木 桑螵蛸 生杜仲 归身 茯苓
又 胸中似冷。热饮乃爽。照前方去杜仲加白芍炮姜。
陈（二七） 色苍脉数。是阴不足。心中泛泛。即头晕腹痛。经水仍来。兼有带下。肝阳内扰。风木乘土。法
当酸以和阳。咸苦坚阴。（风阳乘土）
生白芍 细生地 清阿胶 牡蛎 樗根皮 黄柏
又 乌骨鸡 生地 阿胶 牡蛎 天冬 白芍 白薇 杜仲 川断 湖莲
蒋 带下不止。少腹内踝连痛。至不能伸缩。络脉不宣。最有结痈绵缠。不可不虑。医云肝气。岂
有是理。（血虚脉络滞痛）
桂枝 生沙苑 远志 当归 鹿角霜 杞子 茯苓
龚 带淋日久。脂液垂涸。奇脉俱伤。营卫亦偏。内风自动。则中焦气夺。浮肿腹膨。为寒为热矣。
暂以咸缓和阴。（液涸风动）
阿胶 牡蛎 苁蓉 柏子霜 郁李仁
袁 舌光赤。头胀身热。带下如注。此五液走泄。阳浮热蒸。当用摄剂。若与鹿角霜沙苑。仍是升
举动阳。则无效矣。（阴虚阳浮）
熟地炭 阿胶 芡实 茯苓 湖莲肉 炒山药
又 照前方去阿胶山药加桑螵蛸萸肉炭。
吴 崩带淋漓。阴从下走。晕厥汗出。阳从上冒。逢谷雨暴凶。身中阴阳不相接续。怕延虚脱。戌
亥时为剧。肝肾病治。
人参 阿胶 生龙骨 生牡蛎 五味 茯神
又 血液去则脏阴失守。神不内附。致目中妄见。非鬼祟也。当先镇阳神为主。若骤用阴药。则
有妨胃纳矣。
人参 龙骨 五味 茯苓 芡实 建莲肉
又 淋带黄白未净。五更心悸汗出。
人参 炒枸杞 五味 茯苓 芡实 湖莲肉
某（二五） 脉左细。前用通补。据述痛起。得按痛缓。八脉空虚昭然。舍此补养。恐反增剧矣。（奇脉虚）
当归 乌贼骨 紫石英 杜仲 杞子 柏子仁 沙苑 茯神
某 女科病。多倍于男子。而胎产调经为主要。淋带瘕泄。奇脉虚空。腰背脊膂牵掣似坠。而热
气反升于上。从左而起。女人以肝为先天也。医人不晓八脉之理。但指其虚。刚如桂附。柔如
地味。皆非奇经治法。先以震灵丹固之。每服一钱五分。
又 淋带瘕泄。诸液耗。必阴伤。此参附姜桂。劫阴不效。而胶地阴柔。亦不能效。盖脉隧气散不
摄。阴药沉降。徒扰其滑耳。必引之收之固之。震灵丹意。通则达下。涩则固下。惟其不受偏寒
偏热。是法效灵矣。后方常用。
人参（一钱） 鹿角霜（一钱半） 沙苑（一钱半） 桑螵蛸（三钱） 炒杞子（一钱半） 茯神
（三钱） 炙草（五分）
人参（二两隔纸烘研） 麋茸（二两切烘研） 生菟丝子（二两研） 淡补骨脂（一两半炒）
生紫石英（一两二钱） 生余粮石（一两二钱） 茯苓（一两半） 炒黑小茴（五钱） 炒黑远志（五钱）
晚服妙香三钱。
姚（二三） 自乳血耗。脉络空豁。脊膂椎髀酸 。带下不已。问下部已冷。阴虚及阳。速速断乳。不致延
劳。
人参 鹿角霜 枸杞 桑螵蛸壳 杜仲 茯苓 沙苑 白薇
徐（四十） 经漏成带。下焦畏冷。眩晕。肝脏阳升。八脉空乏。
当归 炒白芍 炒黑枸杞 杜仲 海螵蛸 炒沙苑
杨（三七） 寡居。独阴。自多愁烦思郁。加以针黹。目注凝神。阳上巅为眩晕。八脉无气。自带下下冷。
内风日动。痱疹麻木。常为隐现。以暖下柔剂和其阴阳。可得小效。
制首乌 三角胡麻 枸杞 甘菊花炭 用红枣捣丸早上服四钱。
王（二七） 产后漏淋成带。入暮溺频不爽。惊恐神呆。骨骱尽痛。是肝肾内损。渐及奇经。不司束固。是
产后虚在下。甘辛润补肝肾。不与燥药。以肾恶燥。肝忌刚也。
枸杞子（炒黑） 鹿角霜 归身 菟丝子（炒香） 生杜仲 沙苑子 茯苓 补骨脂（盐水煎淡）
某 少腹拘急。大便燥艰。淋带赤白。此属液涸。（阴阳并虚）
肉苁蓉 枸杞子 河车 当归 柏子仁 郁李仁
又 淋带年久。少腹拘急胀痛。溲不爽。大便艰涩。得泄气则胀宽。食物少纳。脘中不降。必抚摩
始下。此病久脏阴腑阳皆伤。热药难受。以通阳固阴兼之。
（早服）人参 归身 炒杞子 茯苓 麋茸 河车
暮服震灵丹二十粒。
带下者。由湿痰流注于带脉。而下浊液。故曰带下。妇女多有之。赤者属热。兼虚兼火治之。
白者属湿。兼虚兼痰治之。年久不止。补脾肾兼升提。大抵瘦人多火。肥人多痰。最要分辨。
白带。白浊。白淫三种。三者相似。而迥然各别。白带者。时常流出清冷稠粘。此下元虚损也。
白浊者。浊随小便而来。混浊如泔。此胃中浊气。渗入膀胱也。白淫者。常在小便之后。而来
亦不多。此男精不摄。滑而自出也。至于淋症。由肾虚膀胱积热所致。肾虚。则小便数。膀胱
热。则小便涩。淋有气血砂膏劳五者之殊。皆属湿热。气淋为病。小便涩滞。常有余沥不尽。
血淋为病。遇热即发。甚则溺血。痛者为血淋。不痛者为尿血。砂淋为病。阴茎中有砂石而
痛。溺不得卒出。砂出痛止是也。膏淋为病。溺浊如膏。败精结者为砂。精结散者为膏。又煮
海为盐之义。劳淋遇劳即发。痛引气冲。大约带病。惟女子有之。淋浊男女俱有。景岳云。妇
人淋带。其因有六。一心旌摇。心火不静而带下者。先当清火。宜朱砂安神丸。清心莲子饮
之类。若无邪火。但心虚带下。宜秘元煎。人参丸。茯菟丸之类。一欲事过度。滑泄不固而带
下者。宜秘元煎。苓术菟丝丸。济生固精丸之类。一人事不畅。精道逆而为浊为带者。初宜
威喜丸。久宜固阴煎之类。一湿热下流而为浊带。脉必滑数。烦渴多热。宜保阴煎。加味逍
遥散。若热甚兼淋而赤者。宜龙胆泻肝汤。一元气虚而带下者。宜寿脾煎。七福饮。十全大
补汤。若阳气虚寒。脉微涩。腹痛多寒。宜加姜附。家韭子丸。一脾肾气虚下陷多带者。宜归
脾汤。补中益气汤之类。以上淋带辨症论治。仿佛已备。语云鸳鸯绣出从君看。莫把金针
度与人。若求金针暗度。全凭叶案搜索。（秦天一）
【背景信息】
书名：《临证指南医案》 作者：叶桂（叶天士） 朝代：清代 章节：淋带篇 类别：医论
【原文翻译】
某患者，温邪劫伤阴液。出现带下病，伴有虚火上炎。胸中痞闷。脉象细数。（此为温邪损伤阴分）
处方：生地黄、阿胶、牡蛎、川石斛、小麦、茯苓。
某患者，阳明经脉气虚弱。手部麻木，足部发冷，身体颤动。带下量多如注。使用通补兼固摄的方剂治疗。（此为胃气虚弱）
处方：人参、桂枝木、桑螵蛸、生杜仲、当归身、茯苓。
复诊：胸中感觉似有寒冷感，喝热饮后感到舒适。依照前方去掉杜仲，加入白芍和炮姜。
陈某（十七岁），面色青苍，脉象数疾。这是阴血不足。心中泛泛不适，随即出现头晕腹痛。月经仍然来潮，兼有带下病。此为肝阳内扰，风木之气乘袭脾土。治法应当用酸味药以调和肝阳，咸苦味药以坚固阴精。（此为风阳乘袭脾土）
处方：生白芍、细生地、清阿胶、牡蛎、樗根皮、黄柏。
复诊：乌骨鸡、生地黄、阿胶、牡蛎、天冬、白芍、白薇、杜仲、川断、湖莲。
蒋某，带下淋漓不止。少腹疼痛牵连至内踝，甚至导致肢体不能伸缩。这是络脉不通畅，最担心形成缠绵难愈的结痈，不可不忧虑。医生说是肝气作祟，哪有这种道理？（此为血虚导致脉络滞涩而痛）
处方：桂枝、生沙苑子、远志、当归、鹿角霜、枸杞子、茯苓。
龚某，带下与淋证日久，脂液枯竭，奇经八脉均受损伤，营卫之气也偏颇。内风自动，则中焦之气被夺，出现浮肿、腹部膨隆，表现为或寒或热的症状。暂时采用咸味药缓和并滋养阴液。（此为津液枯竭，虚风内动）
处方：阿胶、牡蛎、肉苁蓉、柏子霜、郁李仁。
袁某，舌面光红无苔，头部胀满，身体发热，带下量多如注。这是五液走泄，阳气浮越，热气蒸腾。应当使用固摄的方剂。如果使用鹿角霜、沙苑子等药，仍然是升举动阳之法，那就无效了。（此为阴虚阳浮）
处方：熟地黄炭、阿胶、芡实、茯苓、湖莲肉、炒山药。
复诊：依照前方去掉阿胶和山药，加入桑螵蛸和山茱萸炭。
吴某，崩漏与带下淋漓不断。阴血从下部流失，出现晕厥、汗出。阳气从上部冒逆。正值谷雨时节，病情暴重凶险。体内阴阳之气不相接续，害怕拖延导致虚脱。在戌时、亥时（晚上7点至11点）症状加剧。从肝肾两脏进行治疗。
处方：人参、阿胶、生龙骨、生牡蛎、五味子、茯神。
复诊：血液流失则脏阴失守，神气不能内附，导致眼中出现幻觉妄见，并非鬼祟作怪。应当先以镇潜阳气、安定神志为主。如果骤然使用滋阴药物，则会妨碍胃气受纳。
处方：人参、龙骨、五味子、茯苓、芡实、建莲肉。
复诊：淋证与带下黄白色未净，五更时分心悸、汗出。
处方：人参、炒枸杞、五味子、茯苓、芡实、湖莲肉。
某患者（二十五岁），左脉细弱。之前使用通补之法，据述疼痛发作，按压后疼痛缓解。八脉空虚之象昭然若揭。若不以此法补养，恐怕反而加重病情。（此为奇经八脉虚弱）
处方：当归、乌贼骨、紫石英、杜仲、枸杞子、柏子仁、沙苑子、茯神。
某患者，妇科疾病比男子多得多，而胎产调经是主要方面。淋证、带下、癥瘕、泄泻，皆因奇经八脉虚空。腰背脊膂牵拉掣痛，感觉下坠，而热气反而升于上部，从左胁而起。女子以肝为先天。医生不懂奇经八脉的道理，只指出其虚证，刚燥的药如桂枝、附子，柔润的药如地黄、五味子，都不是治疗奇经的方法。先用震灵丹来固摄。每服一钱五分。
复诊：淋证、带下、癥瘕、泄泻，各种体液耗损，必然伤阴。此前使用的参、附、姜、桂等药，劫伤阴液且无效；而胶、地等阴柔之药，也不能见效。这是因为脉隧之气散乱不摄，阴药性质沉降，只会徒然扰乱滑泄之症。必须引导、收敛、固摄。震灵丹之意，通则达下，涩则固下。因为它不偏寒也不偏热，所以疗效神奇。后方作为常用方。
处方：人参（一钱）、鹿角霜（一钱半）、沙苑子（一钱半）、桑螵蛸（三钱）、炒枸杞子（一钱半）、茯神（三钱）、炙甘草（五分）。
另制丸药：人参（二两，隔纸烘干研粉）、麋茸（二两，切片烘干研粉）、生菟丝子（二两，研粉）、淡补骨脂（一两半，炒）、生紫石英（一两二钱）、生余粮石（一两二钱）、茯苓（一两半）、炒黑小茴香（五钱）、炒黑远志（五钱）。
晚间服用妙香散三钱。
姚某（二十三岁），因哺乳耗血，脉络空豁。脊膂椎髀酸痛，带下不已。询问下部已觉寒冷，这是阴虚及阳。必须迅速断奶，以免延成劳损。
处方：人参、鹿角霜、枸杞子、桑螵蛸壳、杜仲、茯苓、沙苑子、白薇。
徐某（四十岁），经漏转为带下。下焦畏冷，眩晕。肝脏阳气上升，八脉空乏。
处方：当归、炒白芍、炒黑枸杞子、杜仲、海螵蛸、炒沙苑子。
杨某（三十七岁），寡居，独阴无阳。自多愁烦思郁，加之从事针线活，目注凝神。阳气上巅顶导致眩晕。八脉无气，自带下而下部发冷。内风日益扰动，出现痱疹、麻木，时常隐现。用暖下、柔剂的方法来调和阴阳，可得小效。
处方：制何首乌、三角胡麻、枸杞子、甘菊花炭。用红枣捣烂制成丸药，早上服用四钱。
王某（二十七岁），产后漏淋转为带下。入夜尿频不畅。惊恐，神情呆滞。骨节尽痛。这是肝肾内损，逐渐波及奇经八脉，不能主持束固。这是产后虚损在下部。用甘辛润补肝肾的方法，不用燥药，因为肾恶燥，肝忌刚燥。
处方：枸杞子（炒黑）、鹿角霜、当归身、菟丝子（炒香）、生杜仲、沙苑子、茯苓、补骨脂（盐水煎淡）。
某患者，少腹拘急，大便干燥艰难，淋证与带下赤白相间。这属于津液枯竭。（此为阴阳并虚）
处方：肉苁蓉、枸杞子、紫河车、当归、柏子仁、郁李仁。
复诊：淋证与带下年久，少腹拘急胀痛，小便不爽，大便艰涩。得排气则腹胀宽减，食物摄入少，脘中气机不降，必须抚摸按摩才能下行。此病日久，脏阴腑阳皆受伤。热药难以耐受，采用通阳固阴兼治的方法。
（早服）人参、当归身、炒枸杞子、茯苓、麋茸、紫河车。
暮服震灵丹二十粒。
【医论总结】
带下病，是由于湿痰流注于带脉，导致下部浊液流出，所以称为带下。妇女多有此病。赤色带下属热，治疗需兼顾虚与火。白色带下属湿，治疗需兼顾虚与痰。病程长久不止者，需补脾肾兼以升提。大抵瘦人多火，肥人多痰，这一点最重要加以分辨。
白带、白浊、白淫三种病症，三者相似，但截然不同。白带，时常流出清冷、稠粘的液体，这是下元虚损所致。白浊，浊液随小便而来，混浊如米泔水，这是胃中浊气渗入膀胱所致。白淫，常在小便之后流出，量也不多，这是男精不摄，滑泄自出所致。至于淋证，由肾虚膀胱积热所致。肾虚则小便频数，膀胱热则小便涩滞。淋证有气、血、砂、膏、劳五种区别，皆属湿热范畴。气淋为病，小便涩滞，常有剩余沥不尽之感。血淋为病，遇热即发，甚则尿血，痛者为血淋，不痛者为尿血。砂淋为病，阴茎中有砂石而痛，小便不得突然排出，砂石排出后疼痛停止。膏淋为病，溺浊如膏脂，败精凝结者为砂，精结散开者为膏，就像煮海为盐的道理一样。劳淋遇劳累即发作，疼痛牵引气冲穴附近。大约带病，只有女子有之；淋浊男女俱有。张景岳说，妇人淋带的病因有六种：一是心旌摇动，心火不静而导致带下者，先当清火，宜用朱砂安神丸、清心莲子饮之类。若无邪火，仅是心虚带下，宜用秘元煎、人参丸、茯菟丸之类。二是房事过度，滑泄不固而导致带下者，宜用秘元煎、苓术菟丝丸、济生固精丸之类。三是人事不畅，精道逆乱而为浊为带者，初宜威喜丸，久宜固阴煎之类。四是湿热下流而为浊带，脉必滑数，烦渴多热，宜用保阴煎、加味逍遥散。若热甚兼淋而色赤者，宜用龙胆泻肝汤。五是元气虚而导致带下者，宜用寿脾煎、七福饮、十全大补汤。若阳气虚寒，脉微涩，腹痛多寒，宜加姜、附，或用家韭子丸。六是脾肾气虚下陷多带者，宜用归脾汤、补中益气汤之类。以上对淋带辨症论治，仿佛已经完备。俗话说“鸳鸯绣出从君看，莫把金针度与人”。若想求得金针暗度之秘，全凭搜索叶天士的医案。（秦天一评注）
[Background Information]
Book: *Lin Zheng Zhi Nan Yi An* (Guide to Clinical Practice Medical Cases)
Author: Ye Gui (Ye Tianshi)
Dynasty: Qing Dynasty
Chapter: Lin Dai (Lin and Leukorrhea)
Category: Medical Theory
[Translation]
**Case 1**
A patient, the warm pathogen has robbed the yin fluids. Presenting with leukorrhea, accompanied by rising fire (deficiency fire). Chest fullness/stuffiness. Pulse is fine and rapid. (This indicates warm pathogen damaging the yin aspect.)
Prescription: Sheng Di Huang (Raw Rehmannia Root), E Jiao (Donkey-hide Gelatin), Mu Li (Oyster Shell), Chuan Huo Shi Zhu (Dendrobium Officinale), Xiao Mai (Wheat), Fu Ling (Poria).
**Case 2**
A patient, the Yangming meridian pulse is deficient. Numbness in hands, coldness in feet, body tremors. Leukorrhea flowing like a torrent. Use a formula for unblocking and consolidating/astringing. (This indicates Stomach Qi deficiency.)
Prescription: Ren Shen (Ginseng), Gui Zhi Mu (Cinnamon Twig Wood), Sang Piao Xiao (Mantis Egg-case), Sheng Du Zhong (Eucommia Bark), Gui Shen (Angelica Sinensis Root Body), Fu Ling (Poria).
Follow-up: Chest feels somewhat cold, relieved by drinking hot liquids. Follow the previous prescription, remove Du Zhong, add Bai Shao (White Peony Root) and Pao Jiang (Prepared Ginger).
**Case 3**
Chen (Age 17), complexion is dark/greenish, pulse is rapid. This is insufficient yin. Feeling of nausea/discomfort in the heart/chest, followed by dizziness and abdominal pain. Menstruation still occurs, accompanied by leukorrhea. This is Liver Yang disturbing internally, Wind-Wood attacking Earth (Spleen/Stomach). The method should be to use sour flavors to harmonize Yang, and salty-bitter flavors to firm Yin. (This is Wind-Yang attacking Earth.)
Prescription: Sheng Bai Shao (Raw White Peony Root), Xi Sheng Di (Fine Raw Rehmannia), Qing E Jiao (Clear Donkey-hide Gelatin), Mu Li (Oyster Shell), Chu Gen Pi (Bark of Broussonetia papyrifera root), Huang Bo (Phellodendron Bark).
Follow-up: Wu Gu Ji (Black-bone Chicken), Sheng Di Huang (Raw Rehmannia), E Jiao (Donkey-hide Gelatin), Mu Li (Oyster Shell), Tian Dong (Asparagus Root), Bai Shao (White Peony Root), Bai Wei (Cynanchum Atratum Root), Du Zhong (Eucommia Bark), Chuan Duan (Dipsacus Root), Hu Lian (Lotus Seed from Lake).
**Case 4**
Jiang, leukorrhea dripping endlessly. Lower abdomen pain radiating to the medial malleolus, so severe that limbs cannot extend or flex. This is collaterals not circulating freely; most concerning is the formation of lingering abscesses/nodules, which must not be ignored. The doctor claims it is Liver Qi, but how can this be? (This is Blood deficiency causing collateral stagnation and pain.)
Prescription: Gui Zhi (Cinnamon Twig), Sheng Sha Yuan Zi (Astragalus Complanatus Seed), Yuan Zhi (Polygala Root), Dang Gui (Angelica Sinensis), Lu Jiao Shuang (Deer Antler Frost), Qi Zi (Goji Berry), Fu Ling (Poria).
**Case 5**
Gong, leukorrhea and strangury lasting long days, lipid fluids exhausted, all extraordinary vessels (Qi Jing Ba Mai) injured, Ying and Wei (Nutritive and Defensive Qi) also biased. Internal wind moves spontaneously, then Middle Jiao Qi is deprived, presenting with edema and abdominal distension, manifesting as either cold or heat. Temporarily use salty flavors to harmonize and nourish Yin. (This is fluid exhaustion and internal wind movement.)
Prescription: E Jiao (Donkey-hide Gelatin), Mu Li (Oyster Shell), Cong Rong (Cistanche Stem), Bai Zi Shuang (Platycladus Seed Frost), Yu Li Ren (Prunus Armeniaca Kernel).
**Case 6**
Yuan, tongue surface is bare and red, head distension, body heat, leukorrhea flowing like a torrent. This is the leakage of the five fluids, Yang floating, heat steaming. Should use an astringent/restraining agent. If using Lu Jiao Shuang (Deer Antler Frost) and Sha Yuan Zi (Astragalus Complanatus Seed), these are still methods that lift and move Yang, thus ineffective. (This is Yin deficiency with floating Yang.)
Prescription: Shu Di Tan (Charred Prepared Rehmannia), E Jiao (Donkey-hide Gelatin), Qian Shi (Euryale Seed), Fu Ling (Poria), Hu Lian Rou (Lotus Seed Flesh), Chao Shan Yao (Stir-fried Dioscorea Rhizome).
Follow-up: Follow the previous prescription, remove E Jiao and Shan Yao, add Sang Piao Xiao (Mantis Egg-case) and Yu Rou Tan (Charred Cornus Fruit).
**Case 7**
Wu, metrorrhagia and leukorrhea dripping continuously. Yin flows downward, leading to syncope and sweating. Yang冒 (rises/mounts) from above. Coinciding with Grain Rain solar term, the condition is violent and ominous. Yin and Yang within the body fail to connect. Fear of extending into deficiency collapse. Symptoms worsen during Xu and Hai hours (7 PM - 11 PM). Treat from Liver and Kidney perspectives.
Prescription: Ren Shen (Ginseng), E Jiao (Donkey-hide Gelatin), Sheng Long Gu (Raw Dragon Bone/Fossilized Bones), Sheng Mu Li (Raw Oyster Shell), Wu Wei Zi (Schisandra Berry), Fu Shen (Poria with Hostwood).
Follow-up: Loss of blood means Zang Yin fails to hold fast, Spirit does not attach internally, leading to visual hallucinations, not ghostly influences. Should first focus on calming Yang and Spirit. If suddenly using Yin-nourishing drugs, it will hinder Stomach intake.
Prescription: Ren Shen (Ginseng), Long Gu (Dragon Bone), Wu Wei Zi (Schisandra Berry), Fu Ling (Poria), Qian Shi (Euryale Seed), Jian Lian Rou (Nymphaea Alba Seed Flesh).
Follow-up: Strangury and leukorrhea yellow/white not yet cleared, palpitations and sweating at dawn (5-7 AM).
Prescription: Ren Shen (Ginseng), Chao Gou Qi (Stir-fried Goji Berry), Wu Wei Zi (Schisandra Berry), Fu Ling (Poria), Qian Shi (Euryale Seed), Hu Lian Rou (Lotus Seed Flesh).
**Case 8**
A patient (Age 25), Left pulse is fine/thin. Previously used tonifying-unblocking method. According to report, pain starts, relieved by pressure. The emptiness of the Eight Extraordinary Vessels is evident. Without this tonification, fear it will worsen. (This is deficiency of the Extraordinary Vessels.)
Prescription: Dang Gui (Angelica Sinensis), Ou Ze Gu (Cuttlefish Bone), Zi Shi Ying (Purple Quartz), Du Zhong (Eucommia Bark), Qi Zi (Goji Berry), Bai Zi Ren (Platycladus Seed), Sha Yuan Zi (Astragalus Complanatus Seed), Fu Shen (Poria with Hostwood).
**Case 9**
A patient, gynecological diseases are much more frequent than in men, with pregnancy/birth and menstruation regulation as primary concerns. Strangury, leukorrhea, masses, diarrhea, all due to emptiness of the Extraordinary Vessels. Waist/back/spine pulling and dragging sensation, while heat qi rises upward, starting from the left. Women regard Liver as their先天 (primary foundation/innate basis). Doctors who do not understand the theory of the Eight Extraordinary Vessels only point out deficiency. Rigid drugs like Gui (Cinnamon) and Fu (Aconite), soft drugs like Di (Rehmannia) and Wei (Schisandra), are all not methods for treating the Chong Mai/Dai Mai etc. First use Zhen Ling Dan to consolidate. Take 1.5 qian per dose.
Follow-up: Strangury, leukorrhea, masses, diarrhea, various fluids consumed, inevitably injuring Yin. Previous use of Shen (Ginseng), Fu (Aconite), Jiang (Ginger), Gui (Cinnamon) robbed Yin and was ineffective; whereas Jiao (Gelatin) and Di (Rehmannia) are too cloying/heavy and also failed. Because the pulse tunnels have scattered Qi failing to control, Yin drugs are sinking in nature, merely disturbing the slipping/leaking. Must guide, collect, and consolidate. The intent of Zhen Ling Dan: unblocking reaches down, astringing secures below. It is neither excessively cold nor hot, hence effective and miraculous. The following prescription is commonly used.
Prescription: Ren Shen (1 qian), Lu Jiao Shuang (1.5 qian), Sha Yuan Zi (1.5 qian), Sang Piao Xiao (3 qian), Chao Qi Zi (1.5 qian), Fu Shen (3 qian), Zhi Cao (0.5 qian).
Another pill formula: Ren Shen (2 liang, baked between paper and ground), Mi Rong (Deer Antler Velvet, 2 liang, sliced, baked, ground), Sheng Tu Si Zi (2 liang, ground), Dan Bu Gu Zhi (1.5 liang, stir-fried), Sheng Zi Shi Ying (1.2 liang), Sheng Yu Liang Shi (1.2 liang), Fu Ling (1.5 liang), Chao Hei Xiao Hui (0.5 liang), Chao Hei Yuan Zhi (0.5 liang).
Evening dose: Miao Xiang San (3 qian).
**Case 10**
Yao (Age 23), self-breastfeeding consumes blood, collaterals are empty/hollow. Spine/hip ache, leukorrhea unceasing. Asked about lower part feeling cold, this is Yin deficiency affecting Yang. Quickly stop breastfeeding to avoid chronic consumption/labor injury.
Prescription: Ren Shen (Ginseng), Lu Jiao Shuang (Deer Antler Frost), Gou Qi (Goji Berry), Sang Piao Xiao Ke (Mantis Egg-case Shell), Du Zhong (Eucommia Bark), Fu Ling (Poria), Sha Yuan Zi (Astragalus Complanatus Seed), Bai Wei (Cynanchum Atratum Root).
**Case 11**
Xu (Age 40), menstrual leakage becomes leukorrhea. Lower Jiao fears cold, vertigo. Liver Yang rises, Eight Extraordinary Vessels are empty/lacking.
Prescription: Dang Gui (Angelica Sinensis), Chao Bai Shao (Stir-fried White Peony), Chao Hei Gou Qi (Stir-fried Blackened Goji), Du Zhong (Eucommia Bark), Hai Piao Xiao (Cuttlefish Bone), Chao Sha Yuan Zi (Stir-fried Astragalus Complanatus Seed).
**Case 12**
Yang (Age 37), widowed, solitary Yin. Prone to worry, annoyance, overthinking. Plus needlework, focusing eyes and spirit. Yang rises to vertex causing vertigo. Eight Extraordinary Vessels lack Qi, accompanied by cold leukorrhea. Internal wind moves daily, presenting as febrile rashes, numbness, often appearing intermittently. Use warming-lower and softening agents to harmonize Yin and Yang, may achieve slight effect.
Prescription: Zhi Shou Wu (Prepared Fleeceflower Root), San Jiao Hu Ma (Triangular Sesame), Gou Qi (Goji Berry), Gan Ju Hua Tan (Charred Chrysanthemum Flower). Make pills with Red Dates, take 4 qian in the morning.
**Case 13**
Wang (Age 27), postpartum leakage/strangury becomes leukorrhea. Evening frequent urination, unsatisfactory. Fright, dull spirit. Bone joints all painful. This is Liver/Kidney internal damage, gradually involving Extraordinary Vessels, failing to bind and secure. This is postpartum deficiency located in the lower part. Use sweet-acrid moistening tonification for Liver/Kidney, do not use drying drugs, because Kidney dislikes dryness, Liver avoids rigidity.
Prescription: Gou Qi Zi (Goji Berry, blackened), Lu Jiao Shuang (Deer Antler Frost), Gui Shen (Angelica Root Body), Tu Si Zi (Dodder Seed, fragrant stir-fried), Sheng Du Zhong (Raw Eucommia), Sha Yuan Zi (Astragalus Complanatus Seed), Fu Ling (Poria), Bu Gu Zhi (Psoralea Fruit, boiled in salt water until light).
**Case 14**
A patient, lower abdomen tightness/constriction, dry and difficult stool, strangury and leukorrhea red/white mixed. This belongs to fluid exhaustion. (This is simultaneous deficiency of Yin and Yang.)
Prescription: Rou Cong Rong (Cistanche Stem), Gou Qi Zi (Goji Berry), He Che (Placenta/Human Placenta), Dang Gui (Angelica Sinensis), Bai Zi Ren (Platycladus Seed), Yu Li Ren (Apricot Kernel).
Follow-up: Strangury and leukorrhea for years, lower abdomen tight/painful distension, urination unsatisfactory, stool hard/dry. Passing gas relieves distension, food intake is low, epigastric Qi does not descend, requires massage to move. This disease long-standing, Zang Yin and Fu Yang both injured. Hot drugs are hard to tolerate. Combine unblocking Yang and securing Yin.
(Evening/Morning split):
(Morning): Ren Shen (Ginseng), Gui Shen (Angelica Root Body), Chao Qi Zi (Stir-fried Goji), Fu Ling (Poria), Mi Rong (Deer Antler Velvet), He Che (Placenta).
(Evening): Zhen Ling Dan (20 pills).
**Medical Theory Summary**
Leukorrhea arises from damp-phlegm flowing into the Dai Mai (Girdling Vessel), causing turbid fluids to flow downward, hence called "Dai Xia" (Below the Belt). Women suffer from this frequently. Red leukorrhea belongs to Heat, treat considering both deficiency and fire. White leukorrhea belongs to Dampness, treat considering both deficiency and phlegm. For those lasting many years without cessation, tonify Spleen and Kidney and combine with lifting strategies. Generally, thin people tend toward Fire, fat people tend toward Phlegm; this distinction is crucial.
White Leukorrhea (Bai Dai), White Turbidity (Bai Zhuo), and White Seminal Emission (Bai Yin) are three conditions. They appear similar but are distinctly different.
White Leukorrhea: Fluids flow out constantly, clear, cold, thick, and sticky. This is due to deficiency/collapse of the Lower Yuan (Kidney/Essence).
White Turbidity: Turbid fluid comes with urine, cloudy like rice wash water. This is turbid Qi from the Stomach seeping into the Bladder.
White Seminal Emission: Often occurs after urination, volume is small. This is failure to control male essence, sliding and leaking out spontaneously.
Regarding Strangury (Lin Zheng), it is caused by Kidney deficiency and accumulated heat in the Bladder. Kidney deficiency leads to frequent urination; Bladder heat leads to difficult/retarded urination. Strangury differs into five types: Qi, Blood, Stone, Paste/Grease, and Labor. All belong to Damp-Heat.
Qi Strangury: Urination is obstructed/stagnant, often with residual drops.
Blood Strangury: Flares up when exposed to heat, even hematuria. Painful is Blood Strangury; painless is Hematuria.
Stone Strangury: Stones in the penis cause pain, urine cannot exit abruptly. Pain stops when stones pass.
Paste/Grease Strangury: Urine is turbid like grease. Coagulated bad essence forms stones; dispersed essence forms paste. Like boiling sea water to make salt.
Labor Strangury: Flares up upon exertion, pain radiates to the Qi Chong acupoint.
Generally, leukorrhea exists only in women; strangury/turbidity exists in both sexes. Jingyue (Zhang Jingyue) stated there are six causes for female strangury/leukorrhea:
1. Heart spirit agitation, Heart Fire restless causing leukorrhea: First clear fire, use Zhu Sha An Shen Wan (Cinnabar Calming Spirit Pill), Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction). If no evil fire, just Heart deficiency leukorrhea, use Mi Yuan Jian (Secret Origin Decoction), Ren Shen Wan (Ginseng Pill), Fu Tu Wan (Poria Dodder Pill).
2. Excessive sexual activity, slippery leakage insecure causing leukorrhea: Use Mi Yuan Jian, Ling Zhu Tu Si Wan, Ji Sheng Gu Jing Wan.
3. Sexual dissatisfaction, essence pathway reversed becoming turbid/leukorrhea: Initially Wei Xi Wan, long-term Gu Yin Jian.
4. Damp-Heat flowing downward becoming turbid/leukorrhea, pulse slippery-rapid, vexation/thirst/heat: Use Bao Yin Jian, Jia Wei Xiao Yao San. If heat severe with strangury and red color, use Long Dan Xie Gan Tang.
5. Yuan Qi deficiency causing leukorrhea: Use Shou Pi Jian, Qi Fu Yin, Shi Quan Da Bu Tang. If Yang Qi deficiency-cold, pulse micro-slippery, abdominal pain with cold, add Jiang (Ginger) and Fu (Aconite), or Jia Jiu Zi Wan.
6. Spleen/Kidney Qi deficiency sinking causing much leukorrhea: Use Gui Pi Tang, Bu Zhong Yi Qi Tang.
The above differentiation and treatment of strangury/leukorrhea seem complete. As the saying goes, "The embroidered mandarin ducks are shown to you, but the golden needle is not passed on." To seek the secret of the hidden golden needle, one must search Ye's cases thoroughly. (Commentary by Qin Tianyi)