张子和曰。十二经与奇经七脉。皆上下周流。惟带脉起少腹之侧。季胁之
下。环身一周。络腰而过。如束带之状。而冲任二脉。循腹胁。夹脐旁。传流于
气冲。属于带脉。络于督脉。冲任督三脉同。起而异行。一源而三歧。皆络带
脉。因诸经上下往来。遗热于带脉之间。客热郁抑。白物满溢。随溲而下。绵
绵不绝。是为白带。资生经载一妇。患带下。有为灸气海未效。次灸带脉穴。
在两胁季肋下一寸八分。有鬼附耳云。昨日灸亦好。只灸我不着。今灸着我。我去矣。遂愈。
刘宗浓曰。带下多本于阴虚阳竭。营气不升。经脉凝涩。卫气下陷。精气积
滞于下焦奇经之分。蕴酿而成。以带脉为病得名。亦以病形而名。白者属
气。赤者属血。多因醉饱房劳。服食燥热所至。亦有湿痰流注下焦者。肾肝
阴淫湿胜者。或惊恐而木乘土位。浊液下流。或思慕无穷。发为筋痿。所谓
二阳之病发心脾也。或余经湿热。屈滞于少腹之下。或下元虚冷。子宫湿
淫。治之之法。或下或吐。或发中兼补。补中类利。燥中兼升发。润中兼温养。
或温补。或收涩。诸例不同。亦病机之活法也。
带下一症。素问归于任脉。明堂归于带脉二穴。子和扩而充之。以带为约
束诸脉。而会合冲任督诸经。郁热淫溢。皆由带脉渗漏而下。可谓原委灿
然矣。而宗浓则本阴虚阳竭。及诸病机治法。至详且悉。比之丹溪专重湿
痰。子和单主湿热。则悬绝也。然男子遗精之外。有赤白浊。女子崩漏之外。
有赤白带。而带独重于浊者。以女子七情偏胜。抑郁为多。绵绵而下。无休
止也。须察其五脏之偏甚。所感之虚实。或清或补。或升提下陷。大抵虚多
而实少。热多而寒者。亦不乏也。故子和所论者寻其原。而宗浓所列者尽
其变。至立斋以带分五色。则又推展言之耳。
一崩带向以崩为肝虚有火。而血不能藏。带为脾虚有湿。而气不能摄。然
带症而面青脉弦。多郁怒者。能不调其肝乎。崩症而面黄脉弱。多倦怠
者。能不补其脾乎。则又在于临病变通矣。
一带症元气虚者。补中益气汤归脾汤加酒炒椿根皮最妙。真阴亏者。六
味地黄汤加酥炙鹿茸。兼肝火。加味逍遥散入椿皮。或八珍汤加椿皮。
作丸亦胜。内热者加黄芩香附。半产者入杜仲阿胶。
一带证肥人多因气虚有痰。瘦人多因血虚有火。未有不从调补而愈者。
若专主痰火。则失之矣。每见久而不止。去之过多。必致少腹重坠而痛。
肌肉消瘦。虚症毕见。骨脉为枯矣。以是知带之为物。精血所摄。所云湿
热者。乃言现症之标。而实本冲任带所至。焉可不求其原而治之哉。
治验
一儒者内室。素患带下。时作时止。后因过劳。带遂不止。腹重坠。疼痛异常。
余以补中益气汤。加肉苁蓉山茱肉杜仲牡蛎粉。数剂得减。后以八珍
丸加苁蓉杜仲椿根皮。调理而愈。
一女子带下半载。肌肉憔瘦。余以补中益气汤加酒炒椿根皮。三四十剂。
以六味地黄丸相间服之。带遂止而肌肉亦长。乃愈。
补中益气汤
人参（一钱半） 黄 （蜜炙一钱） 白术（土炒一钱半） 甘草（炙三分） 当归（一钱） 陈皮（八分） 柴
胡（三分） 升麻（三分）
姜枣水煎。加椿根皮一钱半。酒炒。腰痛。加杜仲山茱肉肉苁蓉。头风。加
本白芷各三分。湿热。加苍术黄柏各五分。泽泻七分。
张子和说：十二正经与奇经七脉，都是上下循环流动的。只有带脉起于小腹两侧、季胁之下，环绕身体一周，经过腰部，形状像束带一样。而冲脉和任脉，沿着腹部和胁部，夹在脐旁，流注到气冲穴，归属于带脉，联络于督脉。冲脉、任脉、督脉这三条经脉，起始点相同但走向不同，同源而分出三条支脉，都联络带脉。因为各条经脉上下往来，将余热遗留在带脉之间，客热郁结抑制，导致白色分泌物满溢，随着小便排出，绵绵不绝，这就是白带。《资生经》记载一位妇人患带下病，有人灸气海穴没有见效，后来灸带脉穴（位于两胁季肋下一寸八分），据说有鬼附耳说：“昨天灸也好，只是没灸到我身上；今天灸到了我，我就离开了。”于是病就好了。
刘宗浓说：带下病大多本源于阴虚阳竭，营气不能上升，经脉凝滞涩阻，卫气下陷，精气积滞在下属的奇经部位，酝酿而成。因为带脉患病而得名，也是根据病症形态命名。白色分泌物属气分病变，红色分泌物属血分病变。多因醉酒饱食、房劳过度，或服用燥热药物所致。也有湿痰流注于下焦，肾肝阴盛湿胜的情况。或因惊恐导致肝木乘克脾土，浊液下流；或因思慕无穷，发为筋痿，也就是所谓“二阳之病发心脾”。或者是其他经络湿热，屈曲停滞于小腹之下；或者是下元虚冷，子宫湿气过盛。治疗的方法，有的用攻下法，有的用催吐法，有的在发散中兼用补益，在补益中兼用渗利，在燥湿中兼用升发，在润燥中兼用温养。或者温补，或者收涩，各种方法不同，这也是病机治疗的灵活变通之法。
带下一症，《素问》将其归于任脉，《明堂》将其归于带脉二穴。张子和扩大并充实了这一理论，认为带脉约束诸脉，会合冲、任、督诸经，郁热淫溢，都是由带脉渗漏而下造成的，可以说把病因始末讲得清清楚楚了。而刘宗浓则基于阴虚阳竭及各类病机治法，阐述得极为详尽完备。比起朱丹溪专门重视湿痰，张子和单纯主张湿热，则截然不同了。然而男子除了遗精之外，还有赤白浊；女子除了崩漏之外，还有赤白带。而带下病比浊病更严重，是因为女子七情偏胜，抑郁较多，症状绵绵而下，无休止。必须察验五脏的偏盛情况，感受邪气的虚实，采用清热或补益，或升提下陷之气。大抵是虚证多而实证少，热证多而寒证也不乏。所以张子和论述的是追溯本源，而刘宗浓列举的是穷尽变化。至于李梴（立斋）将带下分为五色，则是进一步推展而言罢了。
以往认为崩漏是肝虚有火，导致血液不能藏摄；带下是脾虚有湿，导致气不能固摄。然而带下病患者如果面色青、脉弦，且多有郁怒情绪，怎能不调理肝脏呢？崩漏患者如果面色黄、脉弱，且多有倦怠感，怎能不补益脾脏呢？这又在于临证时的灵活变通。
对于元气虚弱的带下病患者，使用补中益气汤或归脾汤加酒炒椿根皮最为巧妙。真阴亏损者，使用六味地黄汤加酥炙鹿茸。兼有肝火者，使用加味逍遥散加入椿皮，或者八珍汤加椿皮，制成丸药也效果很好。内热者加黄芩、香附。半产（小产）者加入杜仲、阿胶。
带下病患者，肥胖的人多因气虚有痰，瘦弱的人多因血虚有火，没有不从调补而痊愈的。如果专门针对痰火治疗，那就失策了。常见病情迁延不止，攻伐过多，必然导致小腹沉重坠痛，肌肉消瘦，虚证全部显现，骨骼血脉枯槁。由此可知，带下之物是由精血所摄持，所谓的湿热，只是指出现症状的标象，其实根本在于冲、任、带脉受损，怎么能不探求本源而治疗呢？
医案一则：一位儒生的妻子，平时患有带下病，时好时坏。后来因为过度劳累，带下病便不止，腹部沉重坠痛，疼痛异常。我用补中益气汤，加入肉苁蓉、山茱萸、杜仲、牡蛎粉，几剂后症状减轻。后来用八珍丸加入肉苁蓉、杜仲、椿根皮，调理后痊愈。
医案二：一位女子带下病半年，肌肉憔悴消瘦。我用补中益气汤加酒炒椿根皮，服用三四十剂，与六味地黄丸交替服用，带下停止，肌肉也长起来，于是痊愈。
补中益气汤
人参（一钱半） 黄芪（蜜炙一钱） 白术（土炒一钱半） 甘草（炙三分） 当归（一钱） 陈皮（八分） 柴胡（三分） 升麻（三分）
用生姜、大枣煎水，加入椿根皮一钱半，酒炒。腰痛，加杜仲、山茱萸、肉苁蓉。头风，加藁本、白芷各三分。湿热，加苍术、黄柏各五分，泽泻七分。
Zi Hezi stated: The twelve regular meridians and the seven extraordinary vessels all circulate up and down. Only the Dai Mai (Girdle Vessel) originates from the sides of the lower abdomen, below the costal margin, encircles the body once, passes through the waist, and resembles a belt. The Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) follow the abdomen and hypochondrium, flank the umbilicus, flow into the Qichong acupoint, belong to the Dai Mai, and connect with the Du Mai (Governor Vessel). These three vessels—Chong, Ren, and Du—share the same origin but have different courses; they are one source branching into three, and all connect with the Dai Mai. Because the various meridians move up and down, they leave residual heat in the area of the Dai Mai. This pathogenic heat stagnates and suppresses, causing white discharge to overflow and pass down with urine, continuously without cessation; this is called leukorrhea (Bai Dai). *Zisheng Jing* records a case of a woman suffering from leukorrhea. Someone moxa-ed the Qihai acupoint without effect, then moxa-ed the Daipmai acupoint (located one cun eight fen below the costal margin on both sides). It was said that a spirit whispered, "Yesterday's moxibustion was good, but it did not reach me. Today it reached me, so I am leaving." Then she recovered.
Liu Zongnong stated: Leukorrhea mostly originates from Yin deficiency and Yang exhaustion, where Ying Qi (Nutritive Qi) fails to ascend, meridians become stagnant and obstructed, and Wei Qi (Defensive Qi) sinks downward. Essence and Qi accumulate in the lower jiao within the extraordinary vessels, fermenting and forming the disease. It is named after the pathology of the Dai Mai, and also named according to its clinical manifestation. White discharge pertains to Qi disorders, while red discharge pertains to Blood disorders. It is often caused by drunkenness and overeating, sexual excess, or taking dry and hot medications. There are also cases where damp-phlegm flows into the lower jiao, or Kidney and Liver Yin excess leads to dampness predominance. It may result from fright causing Liver Wood to overact on Spleen Earth, leading to turbid fluids flowing downward; or from endless longing, resulting in sinew flaccidity, which is referred to as "diseases of the two Yang organs originating from the Heart and Spleen." Alternatively, damp-heat from other meridians may stagnate in the lower abdomen; or the lower Yuan may be deficient and cold, with excessive dampness in the uterus. Treatment methods vary: some use purgation, some use emesis, some combine dispersing with tonifying, some combine tonifying with draining, some combine drying with ascending, and some combine moistening with warming. Others use warming tonification or astringency. These diverse approaches reflect the flexible application of pathogenesis principles.
Regarding leukorrhea, *Su Wen* attributes it to the Ren Mai, while *Mingtang* attributes it to the Daipmai acupoints. Zi Hezi expanded upon this, asserting that the Dai Mai constrains the other vessels and integrates the Chong, Ren, and Du meridians. Stagnant heat overflowing leaks downward through the Dai Mai, clarifying the etiology comprehensively. Liu Zongnong, however, based his discussion on Yin deficiency, Yang exhaustion, and various pathogeneses, providing extremely detailed treatments. This differs significantly from Zhu Danxi's emphasis on damp-phlegm and Zi Hezi's focus on damp-heat. However, besides spermatorrhea, men may experience red and white turbidity; besides metrorrhagia, women may experience red and white leukorrhea. Leukorrhea is considered more severe than turbidity because women are prone to emotional imbalances, particularly depression, leading to continuous, unceasing discharge. One must examine the excesses of the five Zang organs and the deficiency or excess of the pathogenic factors, employing clearing, tonifying, or lifting sunken Qi. Generally, deficiency patterns are more common than excess patterns, and heat patterns are frequent, though cold patterns are not rare. Thus, Zi Hezi traced the root cause, while Liu Zongnong exhaustively described the variations. Li Ting (Lizhai) further extended this by categorizing leukorrhea into five colors.
Traditionally, metrorrhagia was attributed to Liver deficiency with fire, causing blood to fail to be stored; leukorrhea was attributed to Spleen deficiency with dampness, causing Qi to fail to secure. However, if a leukorrhea patient presents with a green complexion and wiry pulse, indicating much depression and anger, how can the Liver not be regulated? If a metrorrhagia patient presents with a yellow complexion and weak pulse, indicating much fatigue, how can the Spleen not be tonified? This requires flexibility in clinical practice.
For leukorrhea due to Yuan Qi deficiency, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Guipi Tang (Restore the Spleen Decoction) added with wine-fried *Cotini Cortex* (Chungenpi) is most effective. For True Yin deficiency, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) added with butter-roasted *Cervi Cornu Colla* (Lurong) is used. For concurrent Liver fire, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with *Cotini Cortex*, or Bazhen Tang (Eight-Treasure Decoction) with *Cotini Cortex*, made into pills, is also effective. For internal heat, add Huangqin (Scutellaria Root) and Xiangfu (Cyperus Rhizome). For spontaneous abortion, add Duzhong (Eucommia Bark) and Ejiao (Donkey-hide Gelatin).
In leukorrhea, obese individuals often suffer from Qi deficiency with phlegm, while thin individuals often suffer from Blood deficiency with fire. None recover without regulation and tonification. Focusing solely on phlegm and fire would be a mistake. It is common to see prolonged cases where excessive purging leads to heavy, dragging pain in the lower abdomen, muscle wasting, full manifestation of deficiency symptoms, and withering of bones and vessels. Thus, leukorrhea involves the loss of essence and blood. The so-called damp-heat refers only to the branch manifestations; the root lies in the Chong, Ren, and Dai vessels. How can one treat without seeking the root?
Case 1: A scholar's wife had chronic leukorrhea, intermittent in nature. After overwork, the discharge became continuous, accompanied by heavy, dragging pain in the abdomen. I prescribed Buzhong Yiqi Tang added with Rongrong (Cistanche), Shanzhuyu (Cornus Fruit), Duzhong (Eucommia Bark), and Muli (Oyster Shell). After several doses, symptoms decreased. Subsequently, Bazhen Wan (Eight-Treasure Pill) added with Rongrong, Duzhong, and Chungenpi was used for conditioning, leading to recovery.
Case 2: A woman suffered from leukorrhea for half a year, with emaciation. I prescribed Buzhong Yiqi Tang added with wine-fried *Cotini Cortex*. After thirty to forty doses, alternating with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), the discharge stopped, muscles regained mass, and she recovered.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction):
Renshen (Ren Shen, Ginseng Radix et Rhizoma) 1.5 qian
Huangqi (Astragali Radix, Honey-fried) 1 qian
Baizhu (Atractylodis Macrocephalae Rhizoma, Soil-fried) 1.5 qian
Gancao (Glycyrrhizae Radix et Rhizoma, Roasted) 0.3 qian
Danggui (Angelicae Sinensis Radix) 1 qian
Chenpi (Citri Reticulatae Pericarpium) 0.8 qian
Chaihu (Bupleuri Radix) 0.3 qian
Shengma (Cimicifugae Rhizoma) 0.3 qian
Decoct with Ginger and Jujube. Add Chungenpi (*Cotini Cortex*) 1.5 qian, wine-fried. For lower back pain, add Duzhong, Shanzhuyu, and Rongrong. For wind-headache, add Guben (Ligustici Wallichii Rhizoma) and Baizhi (Angelicae Dahuricae Radix) 0.3 qian each. For damp-heat, add Cangzhu (Atractylodis Rhizoma) and Huangbai (Phellodendri Cortex) 0.5 qian each, and Zexie (Alismatis Rhizoma) 0.7 qian.