（自制）
治血崩。不拘有瘀无瘀。气虚血虚。
蜜炙黄 （四钱） 当归（三钱） 仙居白术（二钱） 鹿角霜（二钱） 茯神（三钱）
赤芍 制香
一钱） 神曲（三钱）如腹痛有瘀者。加延胡（二钱）桃仁（十粒去皮）如气血两虚欲脱者。
加麦冬（去心三钱）远志肉
也。不宜表散。但加荆芥穗（二
加煨天麻（一钱）姜半夏（一钱五
也。切勿饮冷。慎之。加乌梅炭（
以成不治之症也。
（方见调经）
治同前症。
（方见调经）
治素有肝郁者。
（自制）
治经漏症。
熟地（六钱） 归身（三钱） 白芍（酒炒一钱） 菟丝子（炒三钱） 龙骨（二钱）
鹿角霜（三钱） 炙鳖甲（三钱） 杜仲（盐水炒二钱） 潼蒺藜（三钱） 益母草（三钱）
炙甘草（五分） 广木香（八分）
水煎。如素有症瘕者当先服神功散。继服固元煎可也。
（见调经）
（自制）
治倒经鼻衄吐血。
泽兰（二钱） 当归（三钱） 焦山栀（四钱） 阿胶（烊化三钱） 丹皮（三钱） 茜
草（一钱五分）
藕一斤。煎汤代水。或服逍遥散。加丹皮栀子。亦可治之。
治病后元气不复之症。
人参（二钱） 白术（一钱五分） 茯苓（三钱） 炙甘草（五分） 熟地（八钱） 白
芍药（二钱）
水煎。○如体热。去肉桂。加黄芩天冬（各二钱）水煎服。
崩漏之脉 究其根 。六脉实大。其症为灾。若遇暴下。立见其推。
两寸似滑。或断有胎。脉缓为吉。沉伏难栽。浮而兼代。
病必不回。缓小多愈。洪作虚栽。
倒经之脉 右寸浮洪。两尺如涩。阴火上攻。咳吐痰血。无瘀易通。下虚上乘。气必逆
冲。和缓则吉。强直者凶。热入血室。
尝思病有热入血室者。何也。读金匮要略。而知病热入血室者有五。第一条。主小柴胡。
因女子患寒热致经水适断。急提少阳之邪。勿令下陷为最。第二条。伤寒发热。经水适来。
有昼明夜剧谵语见鬼之象。恐误认为阳明实症。故云无犯胃气及上二焦之戒。第三条。中风
寒热。经水适来。七八日脉迟身凉。胸胁满。如结胸状。谵语者。显无表症。全露热入血室
之候。自当急刺期门。使知针力胜于药力也。第四条。阳明病下血谵语。但头汗出。亦为
入血室。亦刺期门。必汗出而愈。第五条。明其一症。而有别因为告。故未详辨耳。如痰涎
上潮。昏冒不知。当先除其痰。后除其热等语。所谓急者先除也。今人但知热入血室。不辨
热邪之轻重。血室之盈虚。而独以小柴胡一方。统以施治。贻害良多也观叶桂先生。于热甚
血瘀者。与桃仁承气参入山甲归尾之属。使瘀热下行也。于血舍空虚。而热邪陷入者。用犀
角地黄。加丹参木通之类。以使热下泄也。有表邪未尽者。用和解之法。至于血结胸者。有
桂枝红花汤入海蛤桃仁之品。又有瘀热为狂者。用牛黄膏之法以清之。何尝拘于小柴胡一法
也。更观案中治吴某热病十七日。因经来三日后患病。热邪乘空内陷。从蓄血如狂例治。方
用泽兰行气解毒。丹皮清血中之热。制军桃仁下瘀。兼清陷下之热。生地人中白存阴救里。
可谓法之密。治之审也。得此一隅。而三隅可反矣。余治是症最多。每以金匮立法。指南参
用。自能各适其宜焉。因近时妇女。冷暖不慎。饮食不节者居多。行经时一受外邪。即变热
入血室之症。而膏粱之人。自知保养。故病是症者尚少。藜藿之人。未能保养。故病是症者
良多。凡治妇女之病。必询及经水如何。或经水已至。即受风寒暑湿等邪。或已受风寒暑湿
等邪。致经水适来。或病及半月余而经水适至者。皆能热入血室也。如病者云。经期尚远。
亦须急治其邪。恐邪气绵延。正气必虚。致经水适及其期。而病气未尽。邪必乘虚欲入。急
当清其余邪。切勿挟杂血分之药。恐导 而入 也。余制三方。各有加减之法。以治热入血
室之症。不无小补云尔。
再论热入血室者妇人病则稍轻。室女病则更重何也。妇人体藏已疏。感邪虽入血分。易
于解散。室女体藏周密。邪入血室不易外达。治不易散。余每治是症。必问经对几日。或病
先受邪。或病后受邪。审其邪之浅。深轻重。用药之表里缓急。凡妇女经水有盛衰。经候有
迟速。或平素经行几日方尽。如经行一日。即感外邪而致者。其瘀必多。或经行将尽。适病
外邪。热虽陷入血室。其瘀必少。瘀多者正未虚。瘀少者正已虚。更问其少腹痛否。视其神
气清否。腹痛而神昏者。瘀为多。腹不痛而神清者。瘀必少。又当辨其形状若何。如言謇者。
风邪也。自汗者。亦风也。身重者。湿邪也。有寒热而无汗者。寒邪也。口渴面赤者。暑兼
湿也。又当察其脉象。脉见弦劲者病凶。脉见徐缓者病轻。迟而寒者宜温。数而热者宜清。
是症须急治。不宜缓治。略叙数言以参末议也。
（自制方）
治疗血崩。无论是否有瘀血阻滞，只要是气虚或血虚所致。
蜜炙黄芪（四钱） 当归（三钱） 仙居产白术（二钱） 鹿角霜（二钱） 茯神（三钱）
赤芍药 制香附（一钱） 神曲（三钱）。如果腹痛且有瘀血者，加延胡索（二钱）、桃仁（十粒，去皮）。如果是气血两虚欲脱者，加麦冬（去心三钱）、远志肉。也不宜使用发汗解表法，只需加荆芥穗（二钱）、煨天麻（一钱）、姜半夏（一钱五分）、乌梅炭即可。切勿饮用冷饮，务必谨慎。否则可能演变成无法医治的病症。
（此方见《调经》章节）
治疗血虚气怯（气短乏力），崩漏停止后出现赤白带下。
（此方见《调经》章节）
治疗与前症相同的病症。
（此方见《调经》章节）
治疗素来有肝气郁结的患者。
（自制方）
治疗经漏症（经期延长或非经期出血）。
熟地黄（六钱） 当归身（三钱） 白芍药（酒炒一钱） 菟丝子（炒三钱） 龙骨（二钱）
鹿角霜（三钱） 炙鳖甲（三钱） 杜仲（盐水炒二钱） 潼蒺藜（三钱） 益母草（三钱）
炙甘草（五分） 广木香（八分）
水煎服。如果素来有症瘕积聚者，应当先服用神功散，继而又服用固元煎即可。
（见《调经》章节）
（自制方）
治疗倒经、鼻衄、吐血。
泽兰（二钱） 当归（三钱） 焦山栀（四钱） 阿胶（烊化三钱） 丹皮（三钱） 茜草（一钱五分）
用藕一斤，煎汤代替水煎药。或者服用逍遥散，加入丹皮、栀子，也可以治疗。
治疗病后元气未能恢复的病症。
人参（二钱） 白术（一钱五分） 茯苓（三钱） 炙甘草（五分） 熟地黄（八钱） 白芍药（二钱）
水煎服。○如果身体发热，去掉肉桂，加入黄芩、天冬（各二钱），水煎服。
【脉诊】崩漏之脉：探究其根本原因。六脉实大，这是病情严重的征兆。如果遇到突然大量出血，立刻可以看出预后不良。两寸脉象似滑，可能有胎孕。脉缓为吉兆，脉沉伏则难以救治。脉浮且兼见代脉，病必难愈。脉缓小多能痊愈，脉洪大则是虚证的表现。
【脉诊】倒经之脉：右寸脉浮洪，两尺脉如涩。这是阴火上攻，导致咳嗽吐痰带血。如果没有瘀血容易疏通；如果是下虚而上乘，气机必然逆冲。脉象和缓则吉，脉象强直者凶。
关于热入血室：
我曾思考“热入血室”这种病症是怎么回事呢？阅读《金匮要略》，才知道病热入血室的有五类情况。第一条，主治用小柴胡汤。因为女子患寒热往来导致月经突然中断，急当提举少阳之邪，不要让它陷入体内为最上策。第二条，伤寒发热，月经刚来，有白天清醒、夜晚加重、说胡话、看见鬼怪的现象，恐怕误认为是阳明实证，所以说不要损伤胃气及上中二焦的戒律。第三条，中风寒热，月经刚来，七八天后脉迟身凉，胸胁胀满，像结胸的样子，如果有谵语，显示没有表证，完全显露出热入血室的征候，自然应当急刺期门穴，让人知道针刺的力量胜过药物。第四条，阳明病下血谵语，只有头部出汗，也是热入血室，也刺期门穴，必定出汗而痊愈。第五条，阐明其中一种症状，而有其他病因告知，所以没有详细辨析。比如痰涎上涌，昏晕不知人事，应当先祛除痰邪，后清除热邪等话语，这就是所谓紧急的情况先处理。现在的人只知道热入血室，不辨别热邪的轻重、血室的盈虚，而独独用小柴胡一方统一施治，贻害良多啊。观察叶桂先生，对于热盛血瘀者，给予桃仁承气汤参入穿山甲、当归尾之类，使瘀热下行；对于血舍空虚而热邪陷入者，用水牛角地黄汤，加丹参、木通之类，以使热邪下泄；有表邪未尽者，用和解的方法；至于血结胸者，有用桂枝红花汤加入海蛤、桃仁等品；又有瘀热导致发狂者，用牛黄膏的方法来清解。何曾拘泥于小柴胡这一种方法呢？再看医案中治疗吴某的热病十七天，因为月经来了三天后患病，热邪乘虚内陷，按照蓄血如狂的病例治疗，方剂用泽兰行气解毒，丹皮清血中之热，制大黄、桃仁下瘀，兼清陷入之热，生地、人中白存阴救里，可以说是方法严密，治疗审慎啊。得到这一个角落的例子，就可以举一反三了。我治疗这种病症最多，每每以《金匮》立法，参考指南应用，自然能各自适合其宜。因为近时的妇女，冷暖不慎，饮食不节者居多，行经时一旦受到外邪，就变成热入血室的病症。而吃精细食物的人，自己知道保养，所以得这种病的还少；吃粗劣食物的人，未能保养，所以得这种病的很多。凡是治疗妇女的病，必须询问月经情况如何。或者月经已至，即受风寒暑湿等邪气侵袭；或者已受风寒暑湿等邪气侵袭，导致月经刚好来潮；或者生病及半月左右而月经刚好来潮的，都能导致热入血室。如果病人说，经期还远，也必须紧急治疗其邪气，恐怕邪气绵延，正气必然虚弱，导致月经刚好到其时期，而病气未尽，邪气必然乘虚欲入，应当紧急清除其余留的邪气，千万不要夹杂血分的药物，恐怕引导邪气进入血分啊。我制定三个方子，各有加减之法，用来治疗热入血室的病症，不无小小的补益罢了。
再论述热入血室：妇人患病则稍轻，处女患病则更重，为什么呢？妇人的脏腑已经疏泄，感受邪气虽然进入血分，易于解散；处女的脏腑周密，邪气进入血室不易向外透达，治疗不易消散。我每次治疗这种病症，必问月经对几天了。或者是病前先受邪气，或者是病后受邪气，审察邪气的浅深、轻重，用药的表里、缓急。凡是妇女月经有盛衰，经期有快慢，或者平时月经行几天才结束。如果月经行一天，就感受外邪导致的，其瘀血必然多；或者月经将尽，适逢外邪侵袭，热虽然陷入血室，其瘀血必然少。瘀血多者正气未虚，瘀血少者正气已虚。再问其小腹是否疼痛，看其神志是否清醒。腹痛而神志昏迷的，瘀血多；腹部不痛而神志清醒的，瘀血必然少。又应当辨别其形态如何。如果说胡话的，是风邪；自汗出的，也是风邪；身体沉重的，是湿邪；有寒热而无汗的，是寒邪；口渴面红的，是暑兼湿邪。又应当观察其脉象。脉见弦劲的，病势凶险；脉见徐缓的，病势轻。脉迟而寒的宜温，脉数而热的宜清。这种病症必须紧急治疗，不宜缓慢治疗。略叙数言以供参考末议。
(Self-made prescription)
Treats metrorrhagia (uterine bleeding). Regardless of whether there is blood stasis, as long as it is caused by Qi deficiency or Blood deficiency.
Honey-fried Huangqi (Astragali Radix, four qian) Danggui (Angelicae Sinensis Radix, three qian) Baizhu from Xianju (Atractylodis Macrocephalae Rhizoma, two qian) Lujiaoshuang (Cornus Cornu Degelatinatum, two qian) Fushen (Poria with Hostwood, three qian)
Chishao (Paeoniae Radix Rubra) Zhixiangfu (Cyperi Rhizoma, one qian) Shenqu (Massa Medicata Fermentata, three qian). If abdominal pain exists with blood stasis, add Yanhusuo (Corydalis Rhizoma, two qian) and Taoren (Persicae Semen, ten kernels, peeled). If both Qi and Blood are deficient to the point of collapse, add Maidong (Ophiopogonis Radix, peeled, three qian) and Yuanzhi (Polygalae Radix).
It is not suitable to use diaphoretic methods for releasing the exterior. Simply add Jingjie Sui (Schizonepetae Spica, two qian), Wei Tianma (Gastrodiae Rhizoma, roasted, one qian), Jiang Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine, one qian five fen), and Wumei Tan (Mume Fructus Carbonized). Do not drink cold liquids; be extremely cautious. Otherwise, it may evolve into an incurable condition.
(See "Regulating Menstruation" chapter)
Treats Blood deficiency with Qi timidity (shortness of breath and fatigue), and red or white leukorrhea after metrorrhagia stops.
(See "Regulating Menstruation" chapter)
Treats the same symptoms as mentioned above.
(See "Regulating Menstruation" chapter)
Treats patients who have a history of Liver Qi stagnation.
(Self-made prescription)
Treats metrorrhagia (prolonged menstruation or intermenstrual bleeding).
Shudi (Rehmanniae Radix Preparata, six qian) Guishen (Angelicae Sinensis Radix, body part, three qian) Baishao (Paeoniae Radix Alba, wine-fried, one qian) Tusizi (Cuscutae Semen, fried, three qian) Longgu (Fossilia Ossis Mastodi, two qian)
Lujiaoshuang (Cornus Cornu Degelatinatum, three qian) Zhie Jia (Testudinis Carapax et Plastrum Praeparatum, three qian) Duzhong (Eucommiae Cortex, salt-water fried, two qian) Tongjili (Tribuli Fructus, three qian) Yimucao (Leonuri Herba, three qian)
Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, five fen) Guangmuxiang (Costi Rhizoma, eight fen)
Decoct in water. If there is a history of Zhengjia masses (abdominal masses), one should first take Shengong San, followed by Guyuan Jian.
(See "Regulating Menstruation" chapter)
(Self-made prescription)
Treats retrograde menstruation (hematemesis or epistaxis occurring during menstruation), nosebleeds, and vomiting blood.
Zelan (Lycopus Herba, two qian) Danggui (Angelicae Sinensis Radix, three qian) Jiao Shanzhi (Gardeniae Fructus charred, four qian) Ejiao (Asini Corii Colla, melted, three qian) Danpi (Moutan Cortex, three qian) Qiancao (Rubiae Cordifoliae Radix, one qian five fen)
Use one jin (approx. 500g) of Lotus Root (Nelumbinis Rhizoma), decoct in water to replace normal water for decocting the herbs. Alternatively, treat with Xiaoyao San, adding Danpi and Shanzhi.
Treats conditions where Yuan Qi (Primordial Qi) has not recovered after illness.
Renshen (Ginseng Radix, two qian) Baizhu (Atractylodis Macrocephalae Rhizoma, one qian five fen) Fuling (Poria, three qian) Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, five fen) Shudi (Rehmanniae Radix Preparata, eight qian) Baishaoyao (Paeoniae Radix Alba, two qian)
Decoct in water. ○ If the body feels hot, remove Rougui (Cinnamomi Cortex) and add Huangqin (Scutellariae Radix) and Tiandong (Asparagi Radix, each two qian), decoct in water and take.
[Pulse Diagnosis] Metrorrhagia pulse: Investigate the root cause. If all six pulses are solid and large, it indicates a severe condition. If sudden heavy bleeding occurs, the prognosis is immediately seen as poor. If the Cun positions of both wrists appear slippery, pregnancy might be present. A slow pulse is auspicious; a deep and hidden pulse is difficult to treat. A floating pulse accompanied by a Dai pulse (intermittent pulse) indicates the disease will likely not recover. A slow and small pulse often leads to recovery; a洪 (surging) pulse indicates a deficiency pattern.
[Pulse Diagnosis] Retrograde menstruation pulse: The Right Cun pulse is floating and surging; the Chi positions of both wrists feel like a涩 (choppy) pulse. This is Yin fire attacking upward, causing coughing and spitting of bloody phlegm. Without blood stasis, it is easy to clear; if lower deficiency allows upper pathogenic factors to ascend, Qi must rebel and rush upward. A harmonious and slow pulse is auspicious; a rigid pulse is ominous.
Regarding Heat Entering the Blood Chamber:
I have pondered what this condition of "Heat Entering the Blood Chamber" entails? Reading the *Jin Gui Yao Lue*, I learned that there are five types of Heat Entering the Blood Chamber. The first type is primarily treated with Xiao Chai Hu Tang. Because a woman suffers from alternating chills and fever, causing her menses to suddenly stop, one must urgently lift the Shaoyang pathogen to prevent it from sinking inward, which is the best approach. The second type involves Taiyang cold damage with fever, while menses has just begun. There are symptoms of clarity during the day and worsening at night, delirium, and hallucinations of seeing ghosts. One must fear misdiagnosing this as a Yangming excess syndrome, hence the warning against damaging Stomach Qi and the Upper and Middle Jiao. The third type involves wind-stroke with alternating chills and fever, while menses has just begun. After seven or eight days, the pulse is slow, the body is cool, there is fullness in the chest and hypochondrium resembling Jie Xiong (chest binding), and if there is delirium, it shows no exterior syndrome but fully reveals signs of Heat Entering the Blood Chamber. One should urgently puncture the Qimen acupoint, demonstrating that acupuncture power surpasses herbal power. The fourth type involves Yangming disease with bleeding and delirium, with sweating only on the head; this is also Heat Entering the Blood Chamber, and one should also puncture Qimen, resulting in cure through sweating. The fifth type elucidates one symptom while mentioning other causes, thus lacking detailed differentiation. For example, if phlegm-saliva surges upward causing coma and unconsciousness, one must first eliminate the phlegm, then clear the heat, etc. This is the principle of treating urgent matters first. Nowadays, people only know of Heat Entering the Blood Chamber without distinguishing the severity of the heat pathogen or the fullness/emptiness of the Blood Chamber, and exclusively use Xiao Chai Hu Tang for treatment, causing much harm. Observing Mr. Ye Tianshi, for cases of severe heat and blood stasis, he used Tao Ren Cheng Qi Tang combined with Shan Jia (Manis Squama) and Dang Gui Wei (Angelicae Sinensis Radix tail) to direct the stasis-heat downward. For cases where the Blood residence is empty and heat pathogen has sunk in, he used Xi Jiao Di Huang Tang added with Danshen (Salviae Miltiorrhizae Radix) and Mutong (Akebiae Caulis) to allow heat to drain downward. For cases with residual exterior pathogens, he used harmonizing methods. For cases of Blood Binding in the Chest, he used Guizhi Honghua Tang with Haige (Concha Meretricis) and Taoren. For cases of stasis-heat causing mania, he used Niuhuang Gao (Calculus Bovis Paste) to clear it. Did he ever stick solely to the Xiao Chai Hu method? Furthermore, observing the case of treating Mr. Wu's febrile disease for seventeen days: because he fell ill three days after his menses began, the heat pathogen sank inward due to emptiness. It was treated according to the model of Xu Xue (Stored Blood) causing mania. The formula used Zelan to move Qi and detoxify, Danpi to clear heat from the blood, Zhi Jun (Radix et Rhizoma Rhei Preparata) and Taoren to purge stasis and clear sunken heat, Shengdi (Rehmanniae Radix) and Renzhongbai (Urinae Humanis Depuratum) to preserve Yin and save the interior. This can be called meticulous methodology and careful treatment. From this one corner, one can infer the other three. I have treated this condition most frequently, always basing my legislation on the *Jin Gui* and referring to guidelines, ensuring each case suits its specific needs. Because modern women often neglect warmth and cold, and do not regulate their diet, many contract external pathogens during menstruation, leading to Heat Entering the Blood Chamber. Those who consume rich foods and know self-care rarely get this disease; those who eat coarse food and lack care get it frequently. Whenever treating women's diseases, one must inquire about the menstrual flow. Whether menses has arrived and been exposed to Wind-Cold, Summer-Heat, or Dampness; or whether exposure to these pathogens caused menses to arrive exactly then; or whether menses arrives around half a month into the illness—all can lead to Heat Entering the Blood Chamber. If the patient says her period is far off, one must still urgently treat the pathogen, fearing that lingering pathogens will weaken Zheng Qi, causing menses to arrive exactly when the disease qi is not yet exhausted, allowing pathogens to enter due to emptiness. One must urgently clear remaining pathogens and absolutely avoid mixing in Blood-level medications, lest they guide pathogens into the Blood level. I have formulated three prescriptions with various modifications to treat Heat Entering the Blood Chamber, hoping for some minor benefit.
Furthermore, regarding Heat Entering the Blood Chamber: married women suffer slightly less severely, while virgins suffer more severely. Why? Married women's viscera are already open/dispersed; although pathogens enter the Blood level, they are easily dispersed. Virgins' viscera are dense/tight; pathogens entering the Blood Chamber are not easily released outward, making treatment difficult to disperse. Every time I treat this condition, I must ask how many days the cycle is. Whether the pathogen was contracted before or after the illness, assessing the depth, severity, and lightness of the pathogen, and the exterior-interior, slow-fast nature of the medication. Women's menstruation varies in abundance and scarcity, and timing varies in slowness and speed. Or how many days menses normally lasts. If menses lasts only one day and external pathogens are contracted, the blood stasis will likely be abundant. If menses is about to end and external pathogens strike, even if heat sinks into the Blood Chamber, the blood stasis will likely be scant. Abundant stasis means Zheng Qi is not yet deficient; scant stasis means Zheng Qi is already deficient. Also ask if there is lower abdominal pain, and observe if the spirit/mind is clear. Abdominal pain with coma indicates abundant stasis; no abdominal pain with clear mind indicates scant stasis. One must also distinguish the physical manifestations. Speech impediment indicates Wind pathogen; spontaneous sweating also indicates Wind; heaviness of body indicates Damp pathogen; chills and fever without sweating indicate Cold pathogen; thirst and red face indicate Summer-Heat combined with Damp. One must also examine the pulse. A stringy and forceful pulse indicates a dangerous condition; a leisurely and slow pulse indicates a mild condition. Slow and cold pulses require warming; rapid and hot pulses require clearing. This condition requires urgent treatment, not delayed treatment. I briefly narrate these words for reference.