《经》曰∶悲哀太过则心系急，肺布叶举，而上焦不通，热气在中，故血走而崩也。又曰∶阴虚阳搏谓之崩。然有
得之悲哀者，七情伤心之崩也；有得之劳力者，内伤劳倦之崩也。崩者，经血卒然大至，或清或浊，或纯下瘀血，如山
之崩，势不可遏之谓也。有崩甚腹痛，人多疑恶血未尽，又见血色瘀黑，愈信恶血，不敢止截。殊不知血因经络之气而
流行，故能色鲜而不滞，若一出经络既失阳和，复无气运，犹天寒风静，水即为冰，停在腹中，便为瘀血。以瘀为恶，
又焉知瘀之不为虚冷乎。瘀而腹痛，血行则痛止，崩而腹痛，血住则痛止。芎归汤加姜、附止其血而痛自止去。以色黑
为瘀血，而尽去之，则经络中之乘虚而走者，何时而生耶。必气脱人亡而后已。甚有涎郁胸中，清气不升，故经脉壅
遏而降下，非开涎则不足以行气，非气升则血不能以归隧道。治宜二陈之类，先服后吐之，既开胸膈之痰涎，复散郁滞
之浊气，则气升浊降，血归隧道而不崩矣。
冲任为经脉之海，凡血气调适，则外循经络，内荣脏腑，经下根据时。若劳伤过极，冲任气虚不能约制经血，乃为崩
中暴下。治当大补气血，升举脾胃之气，微加镇坠心火，补阴泻阳而崩自止。若过凉剂投服，则加遏阳气于气海，经血
愈难宁静。古人多用烧干姜灰，或烧桂心灰，方书用治寒崩，非治寒也，取其散结从治法耳。然更当分阴阳而治。夫气
血，人身之阴阳也，阳主升，阴主降，阳根阴，阴根阳，一升一降循经而行，无崩漏也。若阳有余则升者胜，血出上窍；
阳不定则降者胜，血出下窍，故血随阳气而升降。阳气者，风也，风能上升，然必须东方之温风，始能升生长养也。
妇人血崩，来如潮涌，明是热势妄行，然岂可用寒治。寒则血凝泣，而热郁于中宫益深矣，治宜清补兼为升提，血
自循经，经自摄血，故宜不可骤止也，宜地黄、阿胶、芍药、麦冬、桑耳灰、木耳灰之类。久则亦多虚寒，而宜温补脾
肾者，当以脉侯之。然血症多兼用黑药者，以血者火之色也，黑者水之象也，血挟火势，令水化制之，故黑能胜红也。
《经》云∶阴虚阳搏谓之崩。盖尺脉既虚，阴血已损，寸脉搏击，虚火愈炽，火迫妄行而为之。崩皆从胞络中出也，
血久下行，已为熟经，则本宫血乏，十二经之血皆从此渗漏矣。然胞络下系于肾，上通于心，故此症实关心肾二经，宜
有阴虚阳搏之脉也。东垣用十二经引经之药，使血归十二经，然后用黑药止之。若不先服引血归经，则止血藏于何所，
势必益增泛滥无拘矣。尤宜清心绝欲，则心得拱默之德，肾得闭藏之司，肝无妄泄之害矣。
崩者，倏忽暴下也；漏者，淋沥不断也。总由劳役过度而伤中，喜怒不节而伤肝，脾虚不能统血，肝伤不能藏血，
而为崩中漏下。或悲思忧恐太甚，阳气内动，真阴愈虚，不能镇守胞络，相火迫血而崩，故宜养血安神为主，若因脾胃
气虚下陷，肾与相火相合，湿热下迫而致者，宜调理养血为主；或大小新产，遽触房事；或经水未绝，欲炽而伤血海，
皆致崩漏，并宜调气养血，于肝心脾肾则脏求之。
女子漏下恶血，或暴崩不止，多下水浆之物，皆由饮食不节，或劳倦伤脾，或心气不足。夫脾为至阴，滋荣周身者
也；心主血脉，实肾贯脾者也。二者受病，病皆在脉。脉者，血之府也；心者，脉之神也；心不主令，包络代之。心系
者，胞络命门之脉也，主月事生孕。因脾胃虚而心包乘之，故漏下血水不止，当除湿去热，用升阳除湿汤，即提阳气之
下陷，复假风药以胜其湿热之势也。若病愈，经血恶物已尽，必须以黄 、人参、甘草、当归之类补之；若经血恶物下
之不绝，因虚不能收摄者，当益脾胃，补气血，兼升兼止；因于热者，兼以清心凉血之药。
人之七情过极，则动五志之火，五志之火一甚，则经血暴下如风动水摇，火燃水沸也。治崩次第，初用止血以塞其
流，中用清热凉血以澄其源，末用补血以还其旧。若止塞其流而不澄其源，则滔天之势不能遏；若止澄其源而不复其旧，
则孤立之阳无以立。故急则治标，缓则治本，本末勿遗，前后罔紊，方可以言治。
立斋曰∶有妇人患崩，过服寒药，脾胃久虚，中病未已，寒病复起，烦渴引饮，粒米不进，昏愦时作，脉洪大而按
之微弱。此无根之火，内虚寒而外假热也，十全大补加附子而崩减，日服八味丸而愈。又有久患崩者，服四物凉血剂，
或作或止。有主降火为治，则更加腹痛、手足俱冷。此脾胃虚寒所致，先用附子理中汤，次用济生归脾、补中益气二汤
而崩愈。崩且水泻，是前后二阴之气下脱也，参苓 术佐升柴，大升大补为佳。如病患自觉寒冷如水，时欲喜暖所，下
污水色如屋漏，或多白带，脉虽洪紧而无力，或沉伏者，此属浊气郁滞冲任所致，宜以升散开结平肝为要，必兼辛散，
平以辛凉，其纯热纯寒之药俱不可用。炒黄柏、苍术、香附、抚芎、半夏、青陈皮、白芷、柴胡、肉桂、炮姜之类最宜。
凡受热而色赤者，谓之阳崩；受冷而色白者，谓之阴崩。五脏皆虚，五色随崩俱下。一脏虚，随脏见色者∶下色白
如涕，肺脏之虚冷也；色青如蓝，肝脏之虚冷也；色黄如烂瓜，脾脏之虚冷也；色赤如绛，心脏之虚冷也；色黑如肝血，
肾脏之虚冷也。五脏俱虚，五色相杂，谓之五崩。
立斋曰∶血崩兼心痛者，心主血，去血过多，心无所养以致作痛也，宜十全汤倍参术多服；如瘀血不行者，失笑散；
阴血耗散者，乌贼丸敛之。然崩为急症，漏为缓症；崩必大怒伤肝，冲动血海，或火盛之极，血热沸腾也；漏则房劳过
度，伤损冲任二脉，气虚不能约制经血，或其人平素多火，血不能安，故不时漏泄；崩宜理气降火升提，漏宜滋阴补气
养血；或兼制火也。
崩漏不止之症，先因心火亢甚，于是血脉泛溢，以致肝实而不能纳血，出纳之用遂废。《经》曰∶子能令母实。是以
肝肾之相火，上挟心火之势，从而相扇，至令月水错经妄行，无时泛溢。若不早治，变为血枯发热痨怯矣。
《经》云∶阳络伤，血外溢；阴络伤，血内溢。又云脾统血、肝藏血。故崩漏为患，因脾胃虚损，不能统血营运。
或因肝经有火，血得热而下流。或因肝经有风，血乘风而妄动，或因怒动肝火，血热沸腾。或因脾经郁热，血不归经。
或因悲哀太过，胞络伤而渗漏。治疗之法，脾胃虚弱者，四君子加芎归。脾胃虚陷者，补中汤加白芍。肝经血热者，四
物汤加柴胡、山栀。肝经风热者，加味逍遥散。若怒动肝火，亦用前药。脾经郁火者，归脾汤加山栀、柴胡、丹皮。悲
伤胞络者，四君子加升、柴、山栀。初起多从热，久则又当从寒。然阳强阴弱者，崩愈久而阴愈虚愈热，乃阴虚之假热，
不可用寒凉正治也。朱丹溪、东垣云∶凡下血证，须四君子收功。又曰∶气虚血虚，皆以四物加参 。因劳力者，参
加升麻。若大去血后，毋以脉诊，急用独参汤救之。其发热、潮热、咳嗽、脉数，乃元气虚弱，真阳不能内藏，真阴
不能内守，假热之脉也，尤宜人参。此等症候，无不由脾胃先损，故脉洪大，察其中有胃气，受补则可救。设遇寒凉，
复伤脾胃生气，反不能摄血归源，是速其危也。盖诸血症皆以胃药收功，盖脾能统血，而脾胃又为生化之源也。至于先
贵后贱，名曰脱势；始富后贫，命曰脱营。由心气不足，其火内燔血脉之中，经候不调，形体容颜似不病者，此心病不
影于胗，至于饮食不节，则病矣。凡此宜劝解，以慰其心，再以大补气血，调益脾胃，微加镇坠心火，补阴泻阳，而经
自调矣。
《脉诀》曰∶崩漏下血，脉迟小虚滑者，生疾急；大实紧数者，死；尺寸虚者，漏血；脉浮者，死，不治。
胶艾汤
治劳伤血气，冲任虚损，月水过多，淋漓不断，及妊娠调摄失宜，治气不安，或因损动漏血伤胎。
阿胶（炒） 芎 甘草（炙，各二两） 艾叶（炒，一两） 当归（二两） 熟地黄 白芍药（各四两）
每服五钱，水一钟，酒半钟煎服。
柏子仁汤
治妇人忧思过度，劳伤心经，不能藏血，遂致崩中下血不止。
鹿茸（火去毛，酒蒸烙） 香附子（炒去毛） 柏子仁（炒。各二两） 芎 茯
神（去木） 当归 小草（各一两） 甘草（炙，五钱） 川续断（一两） 阿胶（二两，炒成珠）
每服四钱，酒一钟，姜五片煎七分，空心温服。
一方
治月水不止，用阿胶炒枯为末，好酒空心调服四钱，或白汤亦可。
乌鸡丸
治妇人羸弱，血虚有热，经水不调，崩漏带下，骨蒸等疾不能成胎。
白毛乌骨公鸡（一双，重二斤半许，闭死，去毛，肠净） 艾（四两） 青蒿（四两 碎），纳一半在鸡腹，用酒坛
一个纳鸡并余艾蒿在内，用童便和水灌，令没鸡二寸许，煮绝干，取出去骨，余俱捣烂如薄饼状，焙干，研为细末。
南香附（去毛净一斤，分作四分，米泔水浸一分，童便浸一分，醋浸一分，酒浸一分，春秋一夏一冬四日取出，晒
干） 熟地黄（四两焙干） 当归（酒浸洗炒） 白芍药（酒炒） 鳖甲（醋浸炙黄色） 人参（焙） 生地黄（怀庆
者勿犯铁器） 白术（炒） 黄 （蜜炙） 川牛膝（酒炒） 牡丹皮（酒炒） 柴胡（蜜酒炒） 知母（酒炒） 贝
母（姜汁拌炒。各二两） 地骨皮 干姜（炒黄） 玄胡索 黄连（酒浸炒。各一两） 秦艽（一两五钱，蜜酒持
炒） 川芎 白茯苓（各二两五钱）
上同香附子共为细末，和鸡末，温酒或米饮下，忌煎炒辛辣之物及苋菜。
芩心丸
治妇人四十九岁以后，天癸当住，每月却衍或过多不止。
黄芩（新枝条者二两，以米醋浸七日，炙干，又浸又炙如此七次）
为末，醋糊丸，桐子大，每服七十丸，空心温酒下，日三服。
十灰丸
治崩中下血不止。
黄绢灰 马尾灰 藕节灰 艾叶灰 赤松皮灰 蒲黄灰 莲蓬灰 油发灰 棕榈灰 绵灰（各等分）
为末，醋煮糯米糊丸桐子大，每服百丸，米饮下。
备金散
治妇人血崩不止。
香附子（四两炒） 当归（一两二钱） 五灵脂（一两）
为末，每服五钱，空心淡醋汤调下，立效。丹溪云∶崩过多者，先用五灵脂末一服，当分寒热，五灵脂能行能止。
莲蓬散
治经血不止。
莲蓬烧灰存性为末。
白汤调服二钱。
《黄帝内经》说：悲哀过度会导致心脉拘急，肺叶张举，上焦气机不通，热气郁结在中焦，所以血液妄行而发生崩漏。又说：阴血亏虚而阳热亢盛搏击，称为崩漏。然而，有的崩漏是由于悲哀等七情损伤心脏所致；有的则是由于劳累过度导致内伤劳倦引起。所谓“崩”，是指经血突然大量涌出，或清稀或浑浊，或纯为瘀血，像山崩一样，势头猛烈无法遏制。
有些崩漏患者伴有剧烈腹痛，人们往往怀疑是恶血未尽，又看到血色紫黑，更加确信是瘀血，不敢使用止血药。殊不知血液依靠经络之气的推动才能正常运行，所以颜色鲜红且不凝滞。如果血液一旦离开经络，失去了阳气的温煦和气的运化，就像天寒风静时水结成冰一样，停留在腹中就成了瘀血。如果把瘀血都当作恶毒之物，一味地攻逐消散，那么那些乘虚而入的经血，何时才能再生呢？这必然会导致气脱人亡的后果。更有甚者，痰涎郁结在胸中，导致清气不能上升，经脉壅塞阻滞而经血下泄，如果不先化痰开郁就无法行气，气不升则血不能回归正常通道。治疗应当用二陈汤之类的方剂，先服用然后催吐，以开通胸膈的痰涎，疏散郁滞的浊气，这样气升浊降，血归隧道，崩漏自止。
冲脉和任脉是十二经脉的海，凡是气血调和适宜，就会外循经络，内养脏腑，月经按时来潮。如果劳伤过度，冲任之气虚弱，不能制约经血，就会发生崩中暴下。治疗应当大补气血，升举脾胃之气，稍微加入镇坠心火的药物，通过补阴泻阳使崩漏自止。如果过用寒凉药物，则会遏抑阳气于气海，使经血更难宁静。古人多用烧成灰的干姜，或烧成灰的桂心，方书中记载用于治疗寒性崩漏，其实并非单纯治寒，而是取其散结和从治（反佐）的方法罢了。然而更应当分辨阴阳进行治疗。气和血，就是人身体的阴阳，阳主升，阴主降，阳根源于阴，阴根源于阳，一升一降沿着经脉运行，就不会有崩漏。如果阳气有余，则升的力量占优势，血液从上窍溢出；阳气不定，则降的力量占优势，血液从下窍溢出，所以血随着阳气的升降而流动。阳气，就像风一样，风能上升，但必须是来自东方的温和之风，才能促进生长养育。
妇女血崩，来势如潮水汹涌，明明是热势妄行，然而难道可以用寒凉药治疗吗？如果用寒凉药，血液就会凝涩，而热邪郁结在中焦会更深。治疗应当清热与补益兼施，并配合升提之法，血液自然能循经而行，经脉自然能摄血，所以不宜骤然强行止血，宜用地黄、阿胶、芍药、麦冬、桑耳灰、木耳灰等药物。病程久了，往往多表现为虚寒，适合温补脾肾的，应当根据脉象来判断。然而血症多兼用黑色药物，因为血是火的颜色，黑是水的象征，血挟带火势，用水来克制它，所以黑色能胜过红色。
《黄帝内经》说：阴虚阳搏谓之崩。意思是尺脉既虚，说明阴血已受损，寸脉搏击有力，说明虚火愈炽，火热逼迫血液妄行而导致崩漏。崩漏都是从胞络中出来的，血液长期下行，已经变成了“熟经”（陈旧之血），本宫血乏，十二经的血液都会从这里渗漏出去。然而胞络下连于肾，上通于心，所以这个病症实际上关系到心和肾两经，因此会出现阴虚阳搏的脉象。李东垣使用十二经引经药，使血液回归十二经，然后再用黑色药物止血。如果不先服用引血归经的药，那么止住的血藏在哪里呢？势必会增加泛滥无拘的情况。尤其应当清心绝欲，使心得拱默之德（安静无为），肾得闭藏之司（封藏功能），肝无妄泄之害。
“崩”是指突然暴下；“漏”是指淋漓不断。总的原因是劳役过度损伤中气，喜怒不节损伤肝脏，脾虚不能统血，肝伤不能藏血，从而造成崩中和漏下。或者悲思忧恐太甚，阳气内动，真阴更虚，不能镇守胞络，相火逼迫血液而致崩漏，所以治疗应以养血安神为主。如果是因脾胃气虚下陷，肾与相火相合，湿热下迫而导致的，应以调理养血为主；或者是大小产后，立即接触房事；或者是月经未断，欲望强烈而损伤血海，这些都会导致崩漏，都应当调气养血，从肝、心、脾、肾四脏求治。
女子漏下恶血，或暴崩不止，多排出水样浆液，这都是由于饮食不节，或劳倦伤脾，或心气不足所致。脾是至阴之脏，滋养周身；心主血脉，充实肾脏并贯通于脾。这两者受病，病都在脉。脉是血的府库；心是脉的神明主宰；心若不主令，则由心包代行之。心系，就是胞络命门的脉，主管月经和生育。因为脾胃虚弱，心包乘虚而入，所以漏下血水不止，应当除湿去热，用升阳除湿汤，即提起下陷的阳气，再借助风药来战胜其湿热的势头。如果病愈，经血恶物已尽，必须用黄芪、人参、甘草、当归等药物补益；如果经血恶物下之不绝，是因为虚弱不能收摄，应当益脾胃，补气血，兼用升提和止血药；如果是因热引起的，兼用清心凉血的药物。
人的七情过极，就会触动五志之火，五志之火一盛，经血就暴下如风动水摇，如火燃水沸。治疗崩漏的步骤，初起用止血药以堵塞其流，中期用清热凉血药以澄清其源，后期用补血药以恢复其旧观。如果只堵塞其流而不澄清其源，则滔天之势不能遏制；如果只澄清其源而不恢复其旧，则孤立之阳无以立足。所以急则治标，缓则治本，本末勿遗，前后不乱，才可以言治疗。
薛立斋说：有个妇人患崩漏，过服寒药，导致脾胃久虚，中病未愈，寒病又起，烦渴引饮，粒米不进，昏愦时作，脉洪大但按之微弱。这是无根之火，内虚寒而外假热，用十全大补汤加附子，崩漏减轻，每日服用八味丸而痊愈。又有久患崩漏的人，服用四物汤等凉血剂，有时发作有时停止。有人主张降火治疗，结果更加腹痛、手足俱冷。这是脾胃虚寒所致，先用附子理中汤，再用济生归脾汤、补中益气汤，崩漏才愈。如果崩漏且伴水泻，是前后二阴之气下脱，用人参、茯苓、白术佐以升麻、柴胡，大升大补为佳。如果病患自觉寒冷如水，时时喜欢温暖的地方，下污水色如屋漏滴水，或多白带，脉虽洪紧但无力，或沉伏，这是浊气郁滞冲任所致，应当以升散开结平肝为要，必须兼用辛散药，平以辛凉，纯热纯寒的药物都不可用。炒黄柏、苍术、香附、抚芎、半夏、青陈皮、白芷、柴胡、肉桂、炮姜等最宜。
凡受热而血色赤的，叫阳崩；受冷而血色白的，叫阴崩。五脏皆虚，五色随崩漏俱下。一脏虚，随脏见色：下色白如涕，是肺脏虚冷；色青如蓝，是肝脏虚冷；色黄如烂瓜，是脾脏虚冷；色赤如绛，是心脏虚冷；色黑如肝血，是肾脏虚冷。五脏俱虚，五色相杂，叫五崩。
薛立斋说：血崩兼有心痛的，因为心主血，去血过多，心无所养以致作痛，宜用十全大补汤倍加人参、白术多服；如果有瘀血不行，用失笑散；阴血耗散的，用乌贼丸收敛。然而崩是急症，漏是缓症；崩必是大怒伤肝，冲动血海，或是火盛之极，血热沸腾；漏则是房劳过度，损伤冲任二脉，气虚不能约制经血，或者是其人平素多火，血不能安，故不时漏泄；崩宜理气降火升提，漏宜滋阴补气养血；或者兼制火。
崩漏不止的病症，先因心火亢盛，于是血脉泛溢，导致肝实而不能纳血，出纳之用遂废。《黄帝内经》说：子能令母实。因此肝肾的相火，上挟心火之势，从而相互煽动，致使月水错经妄行，无时泛溢。如果不早治，会变为血枯发热痨怯。
《黄帝内经》说：阳络伤，血外溢；阴络伤，血内溢。又说脾统血、肝藏血。所以崩漏为患，因脾胃虚损，不能统血营运。或因肝经有火，血得热而下流。或因肝经有风，血乘风而妄动，或因怒动肝火，血热沸腾。或因脾经郁热，血不归经。或因悲哀太过，胞络伤而渗漏。治疗之法，脾胃虚弱者，用四君子汤加川芎、当归。脾胃虚陷者，用补中益气汤加白芍。肝经血热者，用四物汤加柴胡、山栀。肝经风热者，用加味逍遥散。若因怒动肝火，也用前药。脾经郁火者，用归脾汤加山栀、柴胡、丹皮。悲伤胞络者，用四君子汤加升麻、柴胡、山栀。初起多从热论治，久则又当从寒论治。然而阳强阴弱者，崩漏越久阴越虚越热，乃阴虚之假热，不可用寒凉正治。朱丹溪、李东垣说：凡下血证，须用四君子汤收功。又说：气虚血虚，皆以四物汤加人参、黄芪。因劳力者，人参加升麻。若大去血后，不要以脉诊为准，急用独参汤救之。其发热、潮热、咳嗽、脉数，乃元气虚弱，真阳不能内藏，真阴不能内守，是假热之脉，尤宜用人参。此等症候，无不由脾胃先损，故脉洪大，察其中有胃气，受补则可救。若遇寒凉，复伤脾胃生气，反而不能摄血归源，是加速其危亡。盖诸血症皆以胃药收功，盖脾能统血，而脾胃又为生化之源也。至于先贵后贱，名叫脱势；始富后贫，名叫脱营。由心气不足，其火内燔血脉之中，经候不调，形体容颜似不病者，此心病不显于脉，至于饮食不节，则病矣。凡此宜劝解，以慰其心，再以大补气血，调益脾胃，微加镇坠心火，补阴泻阳，而经自调矣。
《脉诀》说：崩漏下血，脉迟小虚滑者，生疾急（预后不良，病势急重）；大实紧数者，死；尺寸虚者，漏血；脉浮者，死，不治。
胶艾汤
治疗劳伤血气，冲任虚损，月水过多，淋漓不断，以及妊娠调摄失宜，治气不安，或因损动漏血伤胎。
阿胶（炒） 川芎 甘草（炙，各二两） 艾叶（炒，一两） 当归（二两） 熟地黄 白芍药（各四两）
每服五钱，水一钟，酒半钟煎服。
柏子仁汤
治疗妇人忧思过度，劳伤心经，不能藏血，遂致崩中下血不止。
鹿茸（火去毛，酒蒸烙） 香附子（炒去毛） 柏子仁（炒。各二两） 川芎 茯神（去木） 当归 小草（各一两） 甘草（炙，五钱） 川续断（一两） 阿胶（二两，炒成珠）
每服四钱，酒一钟，姜五片煎七分，空心温服。
一方
治疗月水不止，用阿胶炒枯为末，好酒空心调服四钱，或白开水亦可。
乌鸡丸
治疗妇人羸弱，血虚有热，经水不调，崩漏带下，骨蒸等疾不能成胎。
白毛乌骨公鸡（一双，重二斤半许，闭死，去毛，肠净） 艾（四两） 青蒿（四两 碎），纳一半在鸡腹，用酒坛一个纳鸡并余艾蒿在内，用童便和水灌，令没鸡二寸许，煮绝干，取出去骨，余俱捣烂如薄饼状，焙干，研为细末。
南香附（去毛净一斤，分作四分，米泔水浸一分，童便浸一分，醋浸一分，酒浸一分，春秋一夏一冬四日取出，晒干） 熟地黄（四两焙干） 当归（酒浸洗炒） 白芍药（酒炒） 鳖甲（醋浸炙黄色） 人参（焙） 生地黄（怀庆者勿犯铁器） 白术（炒） 黄芪（蜜炙） 川牛膝（酒炒） 牡丹皮（酒炒） 柴胡（蜜酒炒） 知母（酒炒） 贝母（姜汁拌炒。各二两） 地骨皮 干姜（炒黄） 玄胡索 黄连（酒浸炒。各一两） 秦艽（一两五钱，蜜酒持炒） 川芎 白茯苓（各二两五钱）
上同香附子共为细末，和鸡末，温酒或米饮下，忌煎炒辛辣之物及苋菜。
芩心丸
治疗妇人四十九岁以后，天癸当住，每月却衍或过多不止。
黄芩（新枝条者二两，以米醋浸七日，炙干，又浸又炙如此七次）
为末，醋糊丸，桐子大，每服七十丸，空心温酒下，日三服。
十灰丸
治疗崩中下血不止。
黄绢灰 马尾灰 藕节灰 艾叶灰 赤松皮灰 蒲黄灰 莲蓬灰 油发灰 棕榈灰 绵灰（各等分）
为末，醋煮糯米糊丸桐子大，每服百丸，米饮下。
备金散
治疗妇人血崩不止。
香附子（四两炒） 当归（一两二钱） 五灵脂（一两）
为末，每服五钱，空心淡醋汤调下，立效。丹溪云：崩过多者，先用五灵脂末一服，当分寒热，五灵脂能行能止。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Excessive sorrow causes the heart vessels to contract, the lung lobes to expand and rise, leading to obstruction of the upper jiao (upper burner), with heat accumulating in the middle. Consequently, blood flows recklessly, resulting in metrorrhagia (sudden heavy uterine bleeding). It also states: "Yin deficiency with yang hyperactivity is called metrorrhagia." However, some cases of metrorrhagia arise from sorrow and other seven emotions damaging the heart; others result from overexertion causing internal injury and fatigue. "Metrorrhagia" refers to the sudden, massive outflow of menstrual blood, which may be clear or turbid, or purely clotted blood, resembling a landslide that is unstoppable.
Some patients with metrorrhagia experience severe abdominal pain. People often suspect that evil blood (stagnant blood) remains, and seeing the dark purple color reinforces this belief, leading them to avoid hemostatic agents. Yet, blood circulates normally due to the qi movement in the meridians, hence its fresh red color and lack of stagnation. Once blood leaves the meridians, it loses the warming influence of yang qi and the propulsion of qi. Like water freezing in cold windless weather, it stays in the abdomen and becomes stasis. If all stasis is treated as toxic and aggressively expelled, the blood that entered due to deficiency will never regenerate, inevitably leading to qi collapse and death. In more severe cases, phlegm-dampness stagnates in the chest, preventing clear qi from ascending, causing meridian obstruction and downward flow of blood. Without resolving phlegm to move qi, and without ascending qi to return blood to its proper channels, treatment should employ formulas like Er Chen Tang (Two-Cured Decoction). Administering it followed by emesis opens the chest diaphragm, disperses stagnant turbid qi, allowing qi to ascend and turbidity to descend, so blood returns to the channels and metrorrhagia stops.
The Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) are the seas of the twelve meridians. When qi and blood are harmonious, they nourish the exterior meridians and interior organs, ensuring regular menstruation. If overexertion damages the Chong and Ren vessels, their qi becomes deficient and unable to control menstrual blood, causing sudden heavy bleeding (metrorrhagia). Treatment requires substantial tonification of qi and blood, lifting spleen and stomach qi, and slightly using sedatives for heart fire, supplementing yin and draining yang to stop bleeding. Overuse of cold-natured drugs suppresses yang qi in the Qi Sea (lower abdomen), making it harder for menstrual blood to settle. Ancients often used charred dried ginger or charred cinnamon twig bark. Although recorded for treating cold-type metrorrhagia, this is not merely for cold but utilizes the method of scattering nodules and counter-treatment (paradoxical therapy). One must differentiate yin and yang. Qi and blood represent yin and yang in the body; yang ascends, yin descends; yang roots in yin, yin roots in yang. Their alternating ascent and descent along meridians prevent metrorrhagia. Excess yang leads to excessive ascent, causing bleeding from upper orifices; unstable yang leads to excessive descent, causing bleeding from lower orifices. Thus, blood follows the movement of yang qi. Yang qi is like wind; while wind rises, only the warm eastern wind promotes growth and nourishment.
Women's metrorrhagia, surging like a tide, indicates reckless heat action. Yet, can it be treated with cold? Cold causes blood to congeal and stagnate, deepening heat in the middle jiao. Treatment should combine clearing heat with tonification and lifting. Blood will then follow the meridians, and meridians will control blood. Therefore, abrupt cessation is inappropriate; instead, use Rehmanniae Radix Praeparata (Shu Di Huang), Ejiao (Donkey-hide Gelatin), Paeoniae Radix Alba (Bai Shao), Ophiopogonis Radix (Mai Dong), Auriculae Tremellae Cinis (Sang Er Hui), and Auricularia Auricula-Udae Cinis (Mu Er Hui). Long-standing cases often become deficient-cold, suitable for warming and tonifying spleen and kidney, determined by pulse diagnosis. Hemorrhagic conditions often use black-colored herbs because blood is associated with fire (red), and black represents water. Water controls fire; thus, black counters red.
The *Neijing* says: "Yin deficiency with yang hyperactivity is called metrorrhagia." This means the chi (cun-kou) pulse is weak, indicating damaged yin blood, while the cun pulse beats forcefully, indicating blazing deficient fire. Fire forces blood to flow recklessly. Metrorrhagia originates from the uterus and its connecting vessels. Chronic downward bleeding turns blood into "mature" (old) blood, depleting the uterus and causing leakage from the twelve meridians. The uterus connects downward to the kidney and upward to the heart; thus, this condition involves both heart and kidney, manifesting as yin deficiency and yang hyperactivity pulses. Li Dongyuan used guiding herbs for the twelve meridians to return blood to them, then used black herbs to stop bleeding. Without first guiding blood back, where would the stopped blood reside? It would surely increase uncontrolled flooding. One must also clear the heart and abstain from desires, allowing the heart to remain tranquil and the kidney to store essence, preventing the liver from reckless leakage.
"Beng" (collapse) refers to sudden heavy flow; "Lou" (leak) refers to continuous dripping. Both stem from overwork damaging the center, emotional imbalance injuring the liver, spleen deficiency failing to control blood, and liver injury failing to store blood. Extreme grief, worry, or fear moves internal yang, further depleting true yin, which fails to guard the uterus. Ministerial fire forces blood, causing collapse. Treatment focuses on nourishing blood and calming the spirit. If caused by spleen-stomach qi sinking combined with kidney-ministerial fire and damp-heat, focus on regulating and nourishing. Postpartum sexual activity or excessive desire during menstruation damages the sea of blood, causing collapse or leak. All require regulating qi and nourishing blood, addressing the liver, heart, spleen, and kidneys.
Vaginal discharge of foul blood or continuous heavy bleeding with watery fluid results from irregular diet, fatigue damaging the spleen, or insufficient heart qi. The spleen is the supreme yin organ nourishing the body; the heart governs blood vessels and connects to the kidney and spleen. Disease here affects the vessels. Vessels are the house of blood; the heart is the spirit of the vessels. If the heart does not command, the pericardium acts. The heart system includes the vessels of the uterus and mingmen, governing menstruation and pregnancy. Spleen-stomach weakness allows the pericardium to invade, causing continuous bloody discharge. Treat by removing dampness and heat using Sheng Yang Chu Shi Tang (Raise Yang and Remove Dampness Decoction) to lift sunken yang and use acrid-warm herbs to overcome damp-heat. After recovery, tonify with Astragali Radix (Huang Qi), Ginseng Radix (Ren Shen), Glycyrrhizae Radix (Gan Cao), and Angelicae Sinensis Radix (Dang Gui). If bleeding persists due to deficiency, tonify spleen-stomach, boost qi and blood, and combine lifting with stopping. If due to heat, add heart-clearing and blood-cooling herbs.
Extreme emotions stir the fire of the five zangs. When this fire intensifies, menstrual blood flows heavily like wind stirring water or fire boiling water. Treatment steps for metrorrhagia: first, stop bleeding to block the flow; second, clear heat and cool blood to clarify the source; third, tonify blood to restore the original state. Blocking flow without clarifying the source cannot stop the torrent; clarifying the source without restoration leaves isolated yang unsupported. Treat the branch in emergencies, the root in mild cases. Do not neglect either.
Xue Lizhai stated: A woman with metrorrhagia took too many cold drugs, causing chronic spleen-stomach deficiency. She had thirst, inability to eat, confusion, and a large, forceful pulse that was weak upon pressure. This was rootless fire with internal cold and external false heat. Use Shiquan Dabu Tang (Ten Great Tonics Decoction) plus Aconiti Lateralis Radix Praeparata (Fu Zi) to reduce bleeding, and Bawei Wan (Eight-Ingredient Pill) daily to cure. Another patient with chronic metrorrhagia took Siwu Tang (Four Substances Decoction) cooling agents, with intermittent bleeding. Someone suggested reducing fire, worsening abdominal pain and cold limbs. This was spleen-stomach deficiency-cold. First use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction), then Jisheng Guipi Tang and Buzhong Yiqi Tang to cure. If metrorrhagia accompanies watery diarrhea, qi escapes from both openings. Use Renshen (Ginseng), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Baizhu) with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) to greatly lift and tonify. If the patient feels cold, prefers warmth, passes dirty water like roof leaks, or has leukorrhea, with a large/tight but weak or deep pulse, this is turbid qi stagnating in Chong and Ren. Treat by lifting, dispersing, resolving nodules, and soothing the liver, using acrid-dispersing and cool-pacifying methods. Avoid pure hot or cold drugs. Fried Coptidis Rhizoma (Huang Lian), Atractylodis Rhizoma (Cang Zhu), Cyperi Rhizoma (Xiang Fu), Ligustici Chuanxiong Rhizoma (Chuan Xiong), Pinelliae Tuber (Ban Xia), Citri Reticulatae Pericarpium (Qing/Chen Pi), Angelicae Dahuricae Radix (Bai Zhi), Bupleuri Radix (Chai Hu), Cinnamomi Cortex (Rou Gui), and Zingiberis Rhizoma Ustus (Pao Jiang) are suitable.
Bleeding that is red due to heat is "Yang Beng"; white due to cold is "Yin Beng". Deficiency of all five zangs causes all five colors to appear. Each color corresponds to a zang: white like mucus (lung deficiency-cold); blue-green (liver deficiency-cold); yellow like rotting melon (spleen deficiency-cold); crimson (heart deficiency-cold); black like liver blood (kidney deficiency-cold). Mixed colors indicate "Wu Beng" (Five Collapses).
Xue Lizhai said: Metrorrhagia with heart pain occurs because excessive blood loss deprives the heart of nourishment. Use Shiquan Dabu Tang with increased Renshen and Baizhu. For stagnant blood, use Shixiao San (Easy Laugh Powder). For depleted yin blood, use Ouzei San (Cuttlebone Powder) to astringe. Metrorrhagia is an acute condition caused by anger injuring the liver, disturbing the sea of blood, or extreme heat boiling blood. Leukorrhea/leak is a chronic condition caused by sexual excess damaging Chong and Ren, qi deficiency failing to control blood, or inherent fire unsettling blood. Treat metrorrhagia by regulating qi, descending fire, and lifting; treat leak by nourishing yin, boosting qi, and nourishing blood.
Persistent metrorrhagia starts with excessive heart fire causing vessel overflow, leading to liver excess failing to accept blood. As the *Neijing* says: "The child makes the mother full." Liver-kidney ministerial fire joins heart fire, causing erratic menstruation. Untreated, it becomes blood depletion with consumption fever. The *Neijing* states: Injury to yang collaterals causes external bleeding; injury to yin collaterals causes internal bleeding. Spleen controls blood; liver stores blood. Metrorrhagia results from spleen-stomach deficiency failing to control blood, liver fire heating blood downward, liver wind moving blood recklessly, anger stirring liver fire, spleen depression heat, or excessive sorrow damaging the uterus. Treatments: Spleen-stomach deficiency: Sijunzi Tang (Four Gentlemen Decoction) plus Chuan Xiong and Dang Gui. Spleen-stomach sinking: Buzhong Yiqi Tang plus Bai Shao. Liver blood heat: Siwu Tang plus Chai Hu and Gardeniae Fructus (Zhi Zi). Liver wind-heat: Jiawei Xiaoyao San (Modified Free Wanderer Powder). Liver fire from anger: Same as above. Spleen depression fire: Guipi Tang plus Zhi Zi, Chai Hu, and Moutan Cortex (Dan Pi). Sorrow damaging uterus: Sijunzi Tang plus Sheng Ma, Chai Hu, and Zhi Zi. Early stages often involve heat; long-term stages involve cold. However, in yang-excess/yin-deficiency, prolonged metrorrhagia increases yin deficiency and heat (false heat), so avoid cold-natured treatments. Zhu Danxi and Li Dongyuan stated: All bleeding disorders should conclude with Sijunzi Tang. Qi and blood deficiency: Siwu Tang plus Renshen and Astragali Radix (Huang Qi). Due to labor: Add Sheng Ma. After massive blood loss, do not rely on pulse diagnosis; urgently use Danshen Tang (Single Ginseng Decoction). Fever, tidal fever, cough, and rapid pulse indicate yuan qi deficiency, failing to store true yang and yin (false heat pulse). Renshen is especially indicated. These conditions stem from initial spleen-stomach damage. If the pulse is large but contains stomach qi, it can be treated. Cold drugs damage spleen-stomach vital qi, preventing blood return, accelerating danger. All blood disorders conclude with stomach-tonifying herbs because the spleen controls blood and the spleen-stomach is the source of production. Status decline ("Tuo Shi") and poverty-induced depletion ("Tuo Ying") cause heart qi deficiency, internal fire burning vessels, irregular menstruation, though appearance seems normal. Heart disease may not show in pulse. Irregular diet causes illness. Advise comfort, then tonify qi and blood, regulate spleen-stomach, slightly sedate heart fire, supplement yin, drain yang, and regulate menstruation.
*Mai Jue* (Pulse Classic) states: For metrorrhagia, a slow, small, deficient, slippery pulse indicates serious urgency; a large, solid, tight, rapid pulse indicates death; deficient chi/cun pulses indicate leak; floating pulse indicates death, untreatable.
Jiao Ai Tang (Ejiao and Mugwort Decoction)
Treats labor-injury to qi and blood, Chong-Ren deficiency, menorrhagia, continuous dripping, improper care during pregnancy, restless qi, or trauma causing bleeding threatening the fetus.
Ingredients: Ejiao (fried), Chuan Xiong, Gan Cao (roasted, 2 liang each), Ai Ye (fried, 1 liang), Dang Gui (2 liang), Shu Di Huang, Bai Shao (4 liang each).
Dosage: 5 qian, decocted with 1 zhong water and 0.5 zhong wine.
Baizi Ren Tang (Biota Seed Decoction)
Treats women with excessive worry damaging the heart meridian, failing to store blood, causing continuous metrorrhagia.
Ingredients: Lu Rong (fire-dehaired, wine-steamed), Xiang Fu (fried, dehaired), Baizi Ren (fried, 2 liang each), Chuan Xiong, Fushen (decored), Dang Gui, Xiao Cao (1 liang each), Gan Cao (roasted, 5 qian), Chuan Xuduan (1 liang), Ejiao (fried to pearls, 2 liang).
Dosage: 4 qian, decocted with 1 zhong wine and 5 slices ginger to 0.7 zhong. Take warm on an empty stomach.
Another Formula
For continuous menstruation: Use fried-to-charcoal Ejiao powder, taken with good wine or warm water on an empty stomach (4 qian).
Wuji Wan (Black Chicken Pill)
Treats frailty, blood deficiency with heat, irregular menstruation, metrorrhagia/leukorrhea, bone-steaming fever, and infertility.
Preparation: Black-bone rooster (2.5 jin, killed naturally), mugwort (4 liang), Qing Hao (4 liang, crushed). Place half mugwort and Qing Hao inside chicken. Put in jar with remaining herbs, cover with child's urine and water (submerge chicken by 2 cun). Boil until dry. Remove bones, pound meat and herbs into paste, dry, and powder.
Herbs mixed with powder: Nan Xiang Fu (1 jin, soaked separately in rice water, urine, vinegar, wine for 4 days each season, dried), Shu Di Huang (4 liang, dried), Dang Gui (wine-soaked, washed, fried), Bai Shao (wine-fried), Bie Jia (vinegar-soaked, roasted yellow), Renshen (dried), Sheng Di Huang (Huaiqing origin, no iron), Bai Zhu (fried), Huang Qi (honey-roasted), Chuan Niu Xi (wine-fried), Mu Dan Pi (wine-fried), Chai Hu (honey-wine fried), Zhi Mu (wine-fried), Bei Mu (ginger juice fried, 2 liang each), Di Gu Pi, Gan Jiang (fried yellow), Yan Hu Suo, Huang Lian (wine-soaked fried, 1 liang each), Qin Jiao (1.5 liang, honey-wine fried), Chuan Xiong, Bai Fu Ling (2.5 liang each).
Dosage: Mix with Xiang Fu powder and chicken powder. Take with warm wine or rice drink. Avoid spicy/fried foods and amaranth.
Qin Xin Wan (Scutellaria Heart Pill)
For women after age 49, when Tian Gui should cease, but menstruation continues excessively.
Ingredients: Huang Qin (new twigs, 2 liang, soaked in rice vinegar 7 days, roasted, repeated 7 times).
Preparation: Powder, make pills with vinegar paste, size of paulownia seeds. Dosage: 70 pills, warm wine on empty stomach, 3 times daily.
Shi Hui Wan (Ten Ashes Pill)
For continuous metrorrhagia.
Ingredients: Yellow silk ash, horse tail ash, lotus node ash, mugwort ash, red pine bark ash, Puhuang ash, lotus pod ash, burnt hair ash, palm fiber ash, cotton ash (equal parts).
Preparation: Powder, make pills with vinegar-boiled glutinous rice paste, size of paulownia seeds. Dosage: 100 pills, rice drink.
Beijin San (Precious Metal Powder)
For continuous metrorrhagia.
Ingredients: Xiang Fu (fried, 4 liang), Dang Gui (1.2 liang), Wulingzhi (1 liang).
Preparation: Powder. Dosage: 5 qian, light vinegar water on empty stomach. Immediate effect. Zhu Danxi said: For excessive bleeding, first take Wulingzhi powder, differentiating cold/heat, as it moves and stops blood.
Lianpeng San (Lotus Pod Powder)
For continuous menstrual blood.
Preparation: Burn lotus pod to ash, preserve nature, powder.
Dosage: 2 qian, warm water.