妇人有带下而色青者,甚则绿如绿豆汁,稠粘不断,其气腥臭,所谓青带也。夫青带乃肝经之湿热。肝属木,
木色属青,带下流如绿豆汁,明明是肝木之病矣。但肝木最喜水润,湿亦水之积,似湿非肝木之所恶,何以竟成青
带之症?不知水为肝木之所喜,而湿实肝木之所恶,以湿为土之气故也。以所恶者合之所喜必有违者矣。肝之性既
违,则肝之气必逆。气欲上升,而湿欲下降,两相牵掣,以停住于中焦之间,而走于带脉,遂从阴器而出。其色青
绿者,正以其乘肝木之气化也。逆轻者,热必轻而色青;逆重者,热必重而色绿。似乎治青易而治绿难,然而均无
所难也。解肝木之火,利膀胱之水,则青绿之带病均去矣。
方用加减逍遥散。
茯苓(五钱) 白芍(酒炒,五钱) 甘草(生用,五钱) 柴胡(一钱) 茵陈(三钱) 陈皮(一钱)
栀子(三钱,炒)
水煎服。二剂而色淡,四剂而青绿之带绝,不必过剂矣。夫逍遥散之立法也,乃解肝郁之药耳,何以治青带若
斯其神与?盖湿热留于肝经,因肝气之郁也,郁则必逆,逍遥散最能解肝之郁与逆。郁逆之气既解,则湿热难留,
而又益之以茵陈之利湿,栀子之清热,肝气得清,而青绿之带又何自来!此方之所以奇而效捷也。倘仅以利湿清热
治青带,而置肝气于不问,安有止带之日哉!
眉批∶脾土喜燥而恶湿,土病湿则木必乘之,木又为湿土之气所侮,故肝亦病,逍遥散减去当归妙极。
歌括∶带下色青甚绿稠,原因肝经湿热留。
利膀胱水解肝火,青绿两带自可瘳。
青带加减逍遥散,柴胡茯苓白芍甘。
陈皮茵陈炒栀子,利湿清热亦舒肝。
妇女有白带呈青色,甚至绿得像绿豆汁一样,质地稠厚黏腻、淋漓不断,气味腥臭,这就是所谓的“青带”。青带是由于肝经湿热所致。肝在五行中属木,木的颜色为青,带下流出如绿豆汁,这显然是肝木的病变。但是,肝木最喜欢水的滋润,而湿也是水的积聚,看似湿并非肝木所厌恶的,为什么竟然形成了青带的病症呢?不知道水虽然是肝木所喜欢的,但湿实际上是肝木所厌恶的,因为湿是土(脾)之气的原因。用肝木所厌恶的东西去结合它喜欢的东西,必然会产生违背和冲突。肝的本性既然受到违背,那么肝的气机必然上逆。气想要上升,而湿邪想要下降,两者相互牵制,停滞在中焦之间,进而流注到带脉,最终从阴器排出。其颜色呈现青绿色,正是因为它受到了肝木气化特性的影响。气逆较轻的,热邪也轻,所以颜色偏青;气逆较重的,热邪也重,所以颜色偏绿。看起来治疗青色带下容易,治疗绿色带下难,然而其实都没有什么困难。只要清解肝木的火邪,通利膀胱的水湿,那么青色和绿色的带下病都能去除。
方剂使用加减逍遥散。
茯苓(五钱) 白芍(酒炒,五钱) 甘草(生用,五钱) 柴胡(一钱) 茵陈(三钱) 陈皮(一钱)
栀子(三钱,炒)
用水煎服。服用两剂后颜色变淡,四剂后青绿色的带下完全停止,不需要再过量服用。逍遥散的立法宗旨,本是疏解肝郁的药物,为什么治疗青带能如此神奇呢?这是因为湿热留滞于肝经,是由于肝气郁结所致,郁结则必然导致气逆,逍遥散最能解除肝气的郁结与上逆。郁结和气逆得到解除后,湿热就难以留存,再加上加入茵陈来利湿,栀子来清热,肝气得清,那么青绿色的带下又从哪里产生呢!这就是此方奇妙且疗效迅速的原因。如果仅仅利用利湿清热的方法治疗青带,而不管肝气的问题,怎么会有停止带下的日子呢!
眉批:脾土喜欢干燥而厌恶湿气,脾土患病受湿困则肝木必会乘虚侵袭,肝木又被湿土之气所侮,所以肝脏也会生病,逍遥散减去当归非常巧妙。
歌括:带下色青甚绿稠,原因肝经湿热留。
利膀胱水解肝火,青绿两带自可瘳。
青带加减逍遥散,柴胡茯苓白芍甘。
陈皮茵陈炒栀子,利湿清热亦舒肝。
Women may experience leukorrhea that is greenish in color, and in severe cases, it resembles mung bean juice, being thick, sticky, continuous, and having a fishy, foul odor. This is referred to as "Green Leukorrhea" (Qing Dai). Green leukorrhea is caused by damp-heat in the Liver meridian. The Liver belongs to Wood in the Five Elements, and the color of Wood is green. Leukorrhea flowing like mung bean juice clearly indicates a pathology of Liver Wood. However, Liver Wood delights in the nourishment of Water, and Dampness is also an accumulation of Water. It seems that Dampness is not what Liver Wood dislikes; why does it form the syndrome of Green Leukorrhea? It is unknown that while Water is what Liver Wood likes, Dampness is actually what Liver Wood dislikes, because Dampness is the Qi of Earth (Spleen). Combining what is disliked with what is liked inevitably leads to conflict. Since the nature of the Liver is violated, the Qi of the Liver must become rebellious (counterflow). Qi desires to ascend, while Dampness desires to descend; these two forces pull against each other, stagnating in the Middle Jiao, and then flowing into the Dai Mai (Girdle Vessel), finally exiting from the genitalia. The color being greenish-blue is precisely due to its undergoing the Qi transformation of Liver Wood. When the counterflow is mild, the Heat is mild, and the color is green; when the counterflow is severe, the Heat is severe, and the color is blue-green. It seems that treating green leukorrhea is easy and treating blue-green leukorrhea is difficult, yet there is no difficulty in either. By clearing the Fire of Liver Wood and promoting the water flow of the Bladder, both green and blue-green leukorrhea can be eliminated.
The formula used is Modified Xiaoyao San (Free and Easy Wanderer Powder).
Fuling (Poria) (5 qian), Baishao (White Peony Root) (stir-fried with wine, 5 qian), Gancao (Licorice Root) (used raw, 5 qian), Chaihu (Bupleurum Root) (1 qian), Yichen (Artemisiae Scopariae Herba) (3 qian), Chenpi (Citri Reticulatae Pericarpium) (1 qian), Zhizi (Gardeniae Fructus) (3 qian, stir-fried).
Decoct with water and take orally. After two doses, the color becomes pale; after four doses, the green-blue leukorrhea ceases completely, and no further doses are necessary. The principle of Xiaoyao San is to resolve Liver constraint (depression); why does it treat Green Leukorrhea so miraculously? This is because damp-heat remains in the Liver meridian due to Liver Qi constraint. Constraint inevitably leads to counterflow, and Xiaoyao San is most effective at resolving Liver constraint and counterflow. Once the constrained and counterflowing Qi is resolved, damp-heat cannot remain easily. Furthermore, adding Yichen to promote dampness drainage and Zhizi to clear heat, the Liver Qi becomes clear, and how could green-blue leukorrhea arise! This is why this formula is miraculous and efficacious. If one merely treats Green Leukorrhea with dampness-draining and heat-clearing methods while ignoring the Liver Qi, how could the leukorrhea ever stop!
Marginal Note: Spleen Earth prefers dryness and dislikes dampness. When Spleen Earth is diseased by dampness, Liver Wood will surely invade it. Liver Wood is also bullied by the damp-Earth Qi, so the Liver also becomes diseased. Removing Danggui (Angelica Sinensis) from Xiaoyao San is extremely ingenious.
Verse:
Leukorrhea green, even blue-green, thick and dense,
Caused by damp-heat lingering in the Liver meridian.
Promote Bladder water, clear Liver fire,
Green and blue-green discharges will naturally heal.
Modified Xiaoyao San for Green Leukorrhea,
Chaihu, Fuling, Baishao, Gancao.
Chenpi, Yichen, stir-fried Zhizi,
Drain dampness, clear heat, and soothe the Liver.