西园公不知何郡人。曾治一妇人。年六十二岁。患血崩不止。以黄连解毒汤四帖。后服
凉膈散合四物六帖。即愈。此妇因悲哀太过则心系急。肺布叶举而上焦不通。热气在中。血
走而崩。故效。
震按此即血热崩漏治法。然悲哀太过伤肺伤心。致元气暴虚而崩者。当用人参。如归脾
汤之类。断不可用凉膈散。须以脉辨之。
王汝言治一妇。患胎漏。忽血崩甚。晕去。服童便而醒。少顷复晕。急服荆芥。随醒随
晕。服止血止晕之药。不效。忽又呕吐。王以其童便药汁。满于胸膈也。即以手探吐之。末
后吐出饮食及菜碗许。询之。曰。适饭后着恼。少顷遂崩不止。因悟曰。因饱食胃气不行。
故崩甚。血既大崩。胃气益虚而不能运化。宜乎崩晕不止。而血药无效也。急宜调理脾胃。
遂用白术五钱。陈皮、麦芽各二钱煎。一服晕止。再服崩止。遂专理脾胃药十数服。胃气始
还。后加血药服之而安。若不审知食滞。而专用血崩血晕之药。岂不误哉。
震按此与食中相似。因知见病医病。不究其来历者。最误事也。
归大化之内。患崩血。昏愦。发热不寐。或谓血热妄行。投以寒剂。益甚。或谓胎成受
伤。投以止血。亦不效。乃延立斋诊之。曰。此脾虚气弱。无以统摄血耳。法当补脾而血自
止矣。用补中益气加炮姜。不数剂而效。惟终夜少睡。惊悸。另有八物汤。更不效。复叩诸
先生。曰杂矣。乃与归脾汤加炮姜以补心脾。遂如初。
震按八物汤亦气血兼补而责其杂者。以血药太多。不专主心脾也。可见用药须与证恰对
一毫假借不得。
江汝洁治叶廷杰之内。十月。病眼若合即麻痹。甚至不敢睡。屡易医。渐成崩疾。江诊
得左手三部。举之略弦。按之略大而无力。右手三部。举按俱大而无力。经曰。血虚脉大如
葱管。又曰。大而无力为血虚。又曰。诸弦为饮。又曰。弦为劳。据脉观证。盖由气血俱虚
以致气不周运而成麻痹。时医不悟而作火治。药用寒凉过多。损伤脾胃。阳气失陷而成崩
矣。以岁运言之。今岁天冲主运。风木在泉。两木符合。木盛而脾土受亏。是以土陷而行秋
冬之令。以时候言之。小雪至大雪之末。六十日有奇。太阳寒水司令。厥阴风木客气加临其
上。水火胜矣。经曰。甚则胜而不复也。其脾大虚。安得血不大下乎。且脾裹血。脾虚则血
不归经而妄下矣。法当大补脾经为先。次宜补气祛湿。可得渐愈矣。以人参三钱。黄 二钱
甘草四分。防风、荆芥、白术各一钱。陈皮八分。水煎。食远服。一剂分作三服。不数剂
而安。
震按脉大而无力。乃气虚之确据。何可指定为血虚。况麻属气虚。先哲之成言也。气虚
不能摄血则崩。参、 在所必用。惟左手脉举之略弦。似有风邪。少加荆、防。亦是。微嫌
议论拖沓。借司天运气以张大其说。反觉宽泛耳。
易思兰治一妇患崩。去血极多。用止血药。崩愈甚。卧床月余。羸瘦食少。面青爪黑。
气促痰喘。易诊之。心脉平和。肝脉弦大时一结。肺脉沉而大且有力。脾胃脉沉涩。两尺沉
而无力。曰。此气郁证也。询之。果因怒而致。乃用香附、乌药、苏梗为君。抚芎、白芷为
臣。当归、白术、神曲、甘草为佐使。服药后。顿觉神爽。诸证减半。举家欣跃。易曰未也
明日子时分。指甲变桃红色。方可救。至期甲色果红。又诊之。左三部如前。肺脉微起。
脾胃虽沉缓而不涩。两尺照旧。谓其家曰。午时血当大崩。毋得惊惶以骇病者。至期。果下
紫黑血块数枚。自此遂止。或问曰。崩。血证也。人用血药不效。公用气药而止者。何也。
易曰。崩虽在血。其源在气。气如橐 。血如波澜。血随气行。欲治其血。先调其气。然有
调气而血疾不愈者。有不调气而治血亦愈者。又何也。盖所因有不同耳。有因血而病气者。
有因气而病血者。能以脉证辨之。而治法之先后定矣。如人禀来血虚者。血虚气必盛。为咳
血潮热咽痛等证。此则以血为主。而用滋阴降火之剂。今此证时值秋令。肺脉宜浮短而反沉
大。失其令矣。有云。下手脉沉。便知是气。大者火也。气有余即是火。沉而兼大。是气郁
而不运也。况肝木至秋。脉当微弱。兹反弦大而结。肝脉结者。血积于内也。病因肝家怒火
郁结。血不归经而妄行。非因气而病血者乎。故以治气为先也。曰。指甲已黑矣。君断子时
变红
血已止矣。君断午时复来。何也。易曰。此正阴阳生长之妙也。盖血活则红。血凝则黑。
爪甲黑者。血凝而不散也。今用药以行其气。至子时一阳初动。气行则血活。故黑甲变而红
矣。至午时一阴复生。肝乃乙木。乙木生于午。肝气得令。其邪不能容。故积血于此时尽出
积出则气运血行。循环经络而病已矣。
震按此案议论通畅。大有发明。然开郁疏气之药。一服而瘀血行。新血止。必无其事。
不过此病有此理。姑存其说。以示后人。使勿墨守见血治血一法。
孙东宿治潘敬斋媳。经水不调。医投安胎之剂。越七月。经水忽大行。内有血块筋膜如
手大者一二桶。昏冒困惫。其脉右关洪滑。左寸洪数。两尺皆洪大。病交夜分。切牙乱语。
手心热。口噤。时手足皆冷。心头胀闷不快。面色青。诸医皆谓难治。孙曰无恐。此浊痰流
滞血海。以误服安胎之剂。益加其滞。血去多。故神魂无根据。痰迷心窍。故神昏语乱。其发
于夜半者。乃痰热在心包络与胆经。故每至其时而发。为之调气开痰。安神养血。可生也。
即以温胆汤加石菖蒲、酒芩、天麻、枣仁、丹参与服。其夜子丑时。切牙乱语皆减半。次日
仍与前药。每帖加竹茹五钱。临睡又与黑虎丹数粒。诸证悉去而愈。
震按此证不用脱血益气之法。其察脉审证高矣。然此时着眼在昏冒胀闷等证。非血去多
而犹不止也。温胆汤竹茹用至五钱。终系暴病。病根在痰火。误服补涩药以致崩。非久崩不
痊者比。若吾邑钱观察夫人患崩证三年。名医毕集。靡药不尝。迨后用归脾汤几数百帖。服
参无算。旋愈旋发。卒致不起。纵遇孙公。亦复何法以治之。
施笠泽治祁君万之内。崩中。服地榆、续断等药不效。施诊其脉沉而结。曰。蓄血证也
病得之天癸至而怒。祁曰然。因怒经止。半月后即患崩证。迄今一月矣。乃用桃仁、大黄
行血破瘀。或谓失血复下。不导其势耶。施曰。血随气滞。蓄积不散。壅塞隧道。溢而妄行
决壅去滞。则血自归经矣。不然。舍其本而治其末。何异下水塞流乎。服汤二剂。果下
血。天癸旋至。
〔附〕高鼓峰治一产后恶露不尽。至六七日。鲜血奔注。发热口渴。胁痛狂叫。饮食不
进。用养血及清肝行血药。无一效。高诊其脉。洪大而数。乃曰。此恶露未尽。留泊血海。
凡新化之血。皆迷失故道。不去蓄利瘀。则以妄为常。曷以御之。用醋制大黄一两。生地一
两。桃仁泥五钱。干漆三钱。浓煎饮之。或曰。产后大虚。药毋过峻否。高曰。去者自去。
生者自生。何虚之有。服后下黑血块数升。诸病如失。再用补中益气调理而痊。
震按此二案。若合符节。要皆实证也。实证易治。一攻即愈。虚证难医。屡补无功。经
云。不能治其虚。何问其余。以见能治虚者。自无难题矣。夫治虚用补。通套之法也。审其
脏
腑经络奇经。虚在何处。有无寒热湿风之兼挟。细细分别。尚或效或不效。其效者为能治。
不效者仍为不能治也。寒热湿风。古人皆有成方。而风之一字。今多忽略。内经云。卒风暴
至。则经水波涌而陇起。原与天暑地热。经水沸溢。对待为言。故古人治风入胞门。有一味
防
风丸、举卿古拜散等方。若肝风内动。则未之及。肝属风木。主藏血。因怒因郁。皆致斯病
须以逍遥散、虎潜丸、乌梅丸、补肝汤。斟酌加减。盖即肝风动血。又有挟寒、挟热、挟
瘀之分。人参、熟地、阿胶、黄连、地榆、桂、附、桃仁、柏子仁、三七、郁金等。可凭脉
证参入。总在临机权变。不得只以虚目之也。
西园公不知是哪里人。曾经治疗一位妇人，六十二岁，患血崩不止。先用黄连解毒汤四帖，随后服用凉膈散合四物汤六帖，病即痊愈。这位妇人因为悲哀过度导致心系拘急，肺叶张举而上焦不通，热气郁结在中焦，血液妄行而致崩漏，所以疗效显著。
俞震按语：这就是血热型崩漏的治疗方法。然而，如果是因为悲哀过度损伤肺心和元气，导致元气突然虚弱而崩漏的，应当用人参，比如归脾汤之类的方剂。绝对不可使用凉膈散。必须通过脉象来辨别。
王汝言治疗一位妇人，患胎漏（妊娠期阴道少量出血），忽然血崩严重，晕厥过去。服用童便后苏醒，过了一会儿又晕倒。紧急服用荆芥，也是随醒随晕。服用止血止晕的药物，没有效果。忽然又呕吐。王汝言认为这是因为童便和药汁充满胸膈所致，于是用手探喉催吐。最后吐出饮食及菜碗许多的食物。询问病情，患者说，刚才饭后生气，过了一会儿就崩漏不止。由此领悟到，因为饱食导致胃气不行，所以崩漏严重。血液大量流失后，胃气更加虚弱而不能运化，难怪崩漏和晕厥不止，而单纯的血药无效。此时应当调理脾胃。于是用白术五钱，陈皮、麦芽各二钱煎服。一服后晕厥停止，再服后崩漏停止。随后专门用调理脾胃的药十数服，胃气才恢复。后来加上补血药服用，病情安定。如果不审察是否有食滞，而专用治疗血崩血晕的药物，岂不是误事吗？
俞震按语：此案与“食中”（因饮食不当导致的类似中风症状）相似。由此可知，只见病症治病症，不探究其来源的人，最容易误事。
归大化之妻，患崩漏，昏愦，发热失眠。有人说这是血热妄行，投以寒凉药物，病情加重。有人说这是胎成受伤，投以止血药，也没有效果。于是请立斋诊治。他说：“这是脾虚气弱，无法统摄血液罢了。治法应当补脾，血液自然停止。”使用补中益气汤加炮姜，没几剂就见效。只是整夜睡眠少，惊悸，另有八物汤，更无效。再次请教各位先生，他们说用药太杂乱了。于是给予归脾汤加炮姜以补心脾，病情如初。
俞震按语：八物汤也是气血兼补却受到指责杂乱，是因为血药太多，不专主心脾。可见用药必须与证候完全对应，丝毫不能勉强凑合。
江汝洁治疗叶廷杰的妻子。十月，患病时眼睛闭合就麻痹，甚至不敢睡觉。多次更换医生，逐渐发展成崩漏。江汝洁诊得左手三部脉，轻取略弦，重按略大而无力；右手三部脉，轻取重按都大而无力。《内经》说：“血虚脉大如葱管。”又说：“大而无力为血虚。”又说：“诸弦为饮。”又说：“弦为劳损。”根据脉象观察证候，大概是由于气血俱虚，导致气不能周流运行而形成麻痹。当时的医生不明白，当作火证治疗，药用寒凉过多，损伤脾胃，阳气下陷而成崩漏。从岁运来说，今年天冲星主运，风木在泉，两木相合，木盛而脾土受亏，因此土气下陷而行秋冬之令。从时令来说，小雪到大雪末，六十多天，太阳寒水当令，厥阴风木客气加临其上，水火胜复。《内经》说：“甚则胜而不复。”其脾脏大虚，怎么能不大量下血呢？况且脾裹血，脾虚则血不归经而妄行。治法应当以大补脾经为先，其次补气祛湿，可以逐渐痊愈。用人参三钱，黄芪二钱，甘草四分，防风、荆芥、白术各一钱，陈皮八分，水煎，饭远服。一剂分作三次服，没几剂就安好了。
俞震按语：脉大而无力，是气虚的确凿证据，怎么可以指定为血虚呢？况且麻痹属于气虚，是先哲的定论。气虚不能摄血则崩，人参、黄芪在所必用。只有左手脉轻取略弦，似有风邪，稍加荆芥、防风，也是对的。只是微嫌议论拖沓，借司天运气来夸大其说，反而觉得宽泛。
易思兰治疗一位患崩漏的妇人，失血极多，用止血药，崩漏更严重。卧床一个多月，消瘦食少，面色青，指甲黑，气促痰喘。易思兰诊之，心脉平和，肝脉弦大时而一结，肺脉沉而大且有力，脾胃脉沉涩，两尺脉沉而无力。他说：“这是气郁证。”询问病情，果然因为愤怒导致。于是用香附、乌药、苏梗为君药，抚芎、白芷为臣药，当归、白术、神曲、甘草为佐使药。服药后，顿时觉得神清气爽，诸证减半，全家欣喜。易思兰说：“还没完，明天子时，指甲变桃红色，才可以救。”到了那个时间，指甲颜色果然变红。又诊之，左三部脉如前，肺脉微起，脾胃虽沉缓但不涩，两尺脉照旧。对其家人说：“午时血会大崩，不要惊慌惊吓病人。”到了那个时间，果然排出紫黑色血块数枚，从此停止。有人问：“崩漏是血证，别人用血药无效，您用气药而止住，为什么？”易思兰说：“崩漏虽然在血，其根源在气。气如风箱，血如波澜，血随气行，想要治血，先调气。但是有调气而血疾不愈的，有不调气而治血也愈的，为什么呢？因为起因不同。有因血病导致气病的，有因气病导致血病的。能通过脉证辨别，治法的先后就确定了。比如有人禀赋血虚，血虚气必盛，出现咳血、潮热、咽痛等证，这以血为主，用滋阴降火之剂。现在这个证候正值秋季，肺脉宜浮短而反沉大，违背了时令。有人说‘下手脉沉，便知是气’。大者是火，气有余即是火，沉而兼大，是气郁而不运。况且肝木至秋，脉当微弱，现在反见弦大而结。肝脉结者，血积于内。病因肝家怒火郁结，血不归经而妄行，这不是因气而病血吗？所以以治气为先。”有人说：“指甲已经黑了，您断定子时变红，血已止了；您断定午时复来，为什么？”易思兰说：“这正是阴阳生长的奥妙。血活则红，血凝则黑。爪甲黑，是血凝而不散。现在用药行气，到子时一阳初动，气行则血活，所以黑甲变红。到午时一阴复生，肝乃乙木，乙木生于午，肝气得令，邪气不能容留，所以积血在此时尽出。积出则气运血行，循环经络，病就好了。”
俞震按语：此案议论通畅，大有发明。但是开郁疏气的药，一服就瘀血行、新血止，必定没有这种事。不过是此病有此理，姑存其说，以显示后人，使其不要墨守“见血治血”这一方法。
孙东宿治疗潘敬斋的儿媳。经水不调，医生投以安胎之剂。过了七个月，经水忽然大行，内有血块筋膜如手大的一二桶，昏冒困惫。其脉右关洪滑，左寸洪数，两尺皆洪大。病发于夜半，咬牙乱语，手心热，口噤，有时手足皆冷，心头胀闷不快，面色青。众医都说难治。孙东宿说：“不用担心，这是浊痰流滞血海，因为误服安胎之剂，更加加重了停滞。血去得多，所以神魂无根据；痰迷心窍，所以神昏语乱。其发于夜半，乃是痰热在心包络与胆经，所以每至此时而发。为之调气开痰，安神养血，可以生还。”即用温胆汤加石菖蒲、酒芩、天麻、枣仁、丹参一起服用。当晚子丑时，咬牙乱语都减半。次日仍与前药，每帖加竹茹五钱。临睡又给黑虎丹数粒，诸证悉去而愈。
俞震按语：此证不用脱血益气之法，其察脉审证很高明。然而此时着眼点在昏冒胀闷等证，并非血去多而犹不止。温胆汤竹茹用至五钱，终究是暴病。病根在痰火，误服补涩药以致崩，不是久崩不愈者可比。像我邑钱观察夫人患崩证三年，名医毕集，靡药不尝，后来用归脾汤几百帖，服参无数，旋愈旋发，最终致死。即使遇到孙公，又有什么办法治疗呢？
施笠泽治疗祁君万的妻子。崩中，服地榆、续断等药无效。施笠泽诊其脉沉而结，说：“这是蓄血证。”病得天癸至而怒所致。祁某说：“对，因为愤怒经血停止，半月后就患崩证，迄今一个月了。”于是用桃仁、大黄行血破瘀。有人说失血后又用泻下药，不导其势吗？施笠泽说：“血随气滞，蓄积不散，壅塞隧道，溢而妄行。决壅去滞，则血自归经了。不然，舍其本而治其末，何异于下水塞流呢？”服汤药两剂，果然下血，天癸随即到来。
〔附〕高鼓峰治疗一产后恶露不尽，至六七日，鲜血奔注，发热口渴，胁痛狂叫，饮食不进。用养血及清肝行血药，无一效。高鼓峰诊其脉，洪大而数，于是说：“这是恶露未尽，留泊血海。凡新化之血，皆迷失故道。不去蓄利瘀，则以妄为常，何以御之？”用醋制大黄一两，生地一两，桃仁泥五钱，干漆三钱，浓煎饮之。有人说：“产后大虚，药毋过峻否？”高鼓峰说：“去者自去，生者自生，何虚之有？”服后下黑血块数升，诸病如失。再用补中益气调理而痊。
俞震按语：这两个案例，若合符节，要皆实证。实证易治，一攻即愈。虚证难医，屡补无功。《内经》云：“不能治其虚，何问其余。”以此可见能治虚者，自无难题矣。夫治虚用补，通套之法也。审其脏腑经络奇经，虚在何处，有无寒热湿风之兼挟，细细分别，尚或效或不效。其效者为能治，不效者仍为不能治也。寒热湿风，古人皆有成方，而风之一字，今多忽略。《内经》云：“卒风暴至，则经水波涌而陇起”，原与天暑地热，经水沸溢，对待为言。故古人治风入胞门，有一味防风丸、举卿古拜散等方。若肝风内动，则未之及。肝属风木，主藏血，因怒因郁，皆致斯病，须以逍遥散、虎潜丸、乌梅丸、补肝汤，斟酌加减。盖即肝风动血，又有挟寒、挟热、挟瘀之分。人参、熟地、阿胶、黄连、地榆、桂、附、桃仁、柏子仁、三七、郁金等，可凭脉证参入。总在临机权变，不得只以虚目之也。
Mr. Xiyuan, whose place of origin is unknown, once treated a sixty-two-year-old woman suffering from continuous metrorrhagia (uterine bleeding). He first prescribed four doses of Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity), followed by six doses of Liangge San (Cooling the Chest Powder) combined with Siwu Tang (Four Substance Decoction), after which she recovered. This patient’s condition was caused by excessive grief, which led to tension in the Heart system, elevation of the Lung lobes, obstruction of the Upper Jiao, and accumulation of heat in the Middle Jiao, causing blood to rush and resulting in metrorrhagia; hence the treatment was effective.
Yu Zhen commented: This illustrates the treatment method for metrorrhagia due to Blood-Heat. However, if metrorrhagia results from excessive grief damaging the Lungs and Heart, leading to a sudden deficiency of Yuan Qi (Original Qi), one should use Ren Shen (Ginseng Root), such as in Guipi Tang (Restore the Spleen Decoction). Liangge San must absolutely not be used. Differentiation must be based on the pulse.
Wang Ruyan treated a woman suffering from Tai Lou (threatened miscarriage with spotting). Suddenly, she experienced severe metrorrhagia and fainted. After consuming child’s urine (Tong Bian), she regained consciousness, but fainted again shortly after. Emergency administration of Jing Jie (Schizonepeta Twig) resulted in alternating consciousness and fainting. Hemostatic and anti-fainting medications were ineffective. She suddenly began vomiting. Wang Ruyan surmised that the child’s urine and medicinal decoction had filled the chest and diaphragm, so he induced vomiting by probing the throat with his hand. Eventually, food and vegetable matter were expelled. Upon inquiry, the patient stated she had become angry after a meal, after which the bleeding started uncontrollably. He realized that fullness of the stomach obstructed Stomach Qi, causing severe bleeding. After massive blood loss, Stomach Qi became further deficient and unable to transform and transport, explaining why bleeding and fainting persisted despite blood-regulating herbs. The priority should be regulating the Spleen and Stomach. He prescribed Bai Zhu (Atractylodes Macrocephala Rhizome) 5 qian, Chen Pi (Citrus Reticulata Peel) and Mai Ya (Hordeum Vulgare Sprout) 2 qian each, decocted in water. After one dose, fainting ceased; after the second, bleeding stopped. Subsequently, he administered more than ten doses of formulas specifically for regulating the Spleen and Stomach until Stomach Qi recovered, then added blood-nourishing herbs to stabilize the condition. If one fails to examine for food stagnation and uses only hemostatic herbs for metrorrhagia and fainting, how could this not be a mistake?
Yu Zhen commented: This case is similar to "Shi Zhong" (stroke-like symptoms caused by dietary indiscretion). Thus, treating symptoms without investigating their origin is most likely to cause errors.
Gui Dahua’s wife suffered from metrorrhagia, confusion, fever, and insomnia. Some suggested it was reckless bleeding due to Blood-Heat and administered cold-natured drugs, worsening the condition. Others suggested injury related to conception and administered hemostatics, also without effect. They then invited Lizhai for consultation. He said, “This is Spleen-Qi deficiency and weakness, failing to control and contain the blood. The method should be to tonify the Spleen, and the blood will stop naturally.” He used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Pao Jiang (Prepared Ginger Rhizome). After a few doses, there was improvement. However, she still slept little throughout the night and experienced palpitations and fright. Babawu Tang (Eight Substance Decoction) was even less effective. Consulting other physicians, they deemed the prescription too mixed. Finally, he prescribed Guipi Tang (Restore the Spleen Decoction) with Pao Jiang to tonify the Heart and Spleen, restoring her health.
Yu Zhen commented: Babawu Tang also tonifies both Qi and Blood but was criticized for being mixed because it contained too many blood-regulating herbs and did not focus primarily on the Heart and Spleen. This shows that medication must correspond precisely to the syndrome; no compromise is acceptable.
Jiang Rujié treated the wife of Ye Tingjie. In the tenth month, she suffered from numbness whenever her eyes closed, to the point where she dared not sleep. After changing doctors repeatedly, she gradually developed metrorrhagia. Jiang Rujié palpated the left hand’s three positions: slightly wiry on superficial pressure, slightly large and forceless on deep pressure. The right hand’s three positions were large and forceless on both superficial and deep pressure. The Classic states: “Blood deficiency presents with a large pulse like a scallion tube.” It also states: “Large and forceless indicates Blood deficiency.” Furthermore: “All wiry pulses indicate fluid retention,” and “Wiry indicates劳损 (chronic strain/deficiency).” Observing the pulse and symptoms, it appeared that dual deficiency of Qi and Blood led to impaired Qi circulation, causing numbness. Contemporary physicians failed to understand this and treated it as Fire, using too many cold-natured herbs, damaging the Spleen and Stomach, causing Yang Qi to sink and resulting in metrorrhagia. From the perspective of annual cosmic movements (Si Tian Yun Qi), this year Tian Chong governs the movement, with Wind Wood in the Earthly Branch position. The combination of Wood overcomes Spleen Earth, causing Earth Qi to sink and act according to Autumn/Winter patterns. Regarding seasonal timing, from Minor Snow to Major Snow (over sixty days), Solar Cold Water governs, with Jue Yin Wind Wood as the guest qi overlaying it, creating excess Water and Fire. The Classic says: “When extreme, victory occurs without return.” With such great Spleen deficiency, how could heavy bleeding not occur? Moreover, the Spleen contains blood; when Spleen is deficient, blood does not return to its vessels and flows recklessly. The treatment should prioritize greatly tonifying the Spleen Meridian, followed by tonifying Qi and dispelling dampness, leading to gradual recovery. He prescribed Ren Shen (Ginseng Root) 3 qian, Huang Qi (Astragalus Membranaceus Root) 2 qian, Gan Cao (Licorice Root) 4 fen, Fang Feng (Saposhnikovia Root) and Jing Jie (Schizonepeta Twig) and Bai Zhu (Atractylodes Macrocephala Rhizome) 1 qian each, Chen Pi (Citrus Reticulata Peel) 8 fen. Decocted in water, taken far from meals. One dose divided into three servings. After a few doses, she stabilized.
Yu Zhen commented: A large and forceless pulse is definitive evidence of Qi deficiency; how can it be designated as Blood deficiency? Numbness belongs to Qi deficiency, a established principle of ancient sages. When Qi deficiency fails to control blood, metrorrhagia occurs; Ren Shen and Huang Qi are essential. The slight wiriness on superficial pressure of the left hand suggests Wind pathogen, so adding Jing Jie and Fang Feng is appropriate. However, the discussion is somewhat verbose, borrowing Si Tian Yun Qi theories to exaggerate the argument, making it feel broad.
Yi Silan treated a woman with metrorrhagia who had lost a tremendous amount of blood. Hemostatic herbs worsened the bleeding. She lay in bed for over a month, emaciated with poor appetite, blue complexion, black nails, shortness of breath, and phlegm-wheezing. Yi Silan palpated: Heart pulse peaceful; Liver pulse wiry-large with occasional intermission; Lung pulse deep, large, and forceful; Spleen-Stomach pulse deep and choppy; both Chi (Kidney) positions deep and forceless. He said, “This is Qi Stagnation syndrome.” Inquiry confirmed it was caused by anger. He used Xiang Fu (Cyperus Rotundus Rhizome), Wu Yao (Lindera Root), and Su Geng (Perilla Stem) as Sovereign herbs; Fu Xiong (Ligusticum Chuanxiong Rhizome) and Bai Zhi (Angelica Dahurica Root) as Minister herbs; Dang Gui (Angelica Sinensis Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Shen Qu (Massa Fermentata Medicamentosa), and Gan Cao (Licorice Root) as Assistant and Envoy herbs. After taking the medicine, she immediately felt refreshed, and symptoms halved. The family rejoiced. Yi Silan said, “Not yet. At Zi hour (11 PM–1 AM) tomorrow, when the fingernails turn peach-red, rescue is possible.” At that time, the nail color indeed turned red. Re-palpation showed the left three positions unchanged, Lung pulse slightly rising, Spleen-Stomach pulse deep-slow but not choppy, Chi positions unchanged. He told the family, “At Wu hour (11 AM–1 PM), heavy bleeding will occur. Do not panic or startle the patient.” At that time, several purple-black blood clots were passed, and bleeding stopped thereafter. Someone asked, “Metrorrhagia is a Blood disorder; others failed with Blood herbs, but you succeeded with Qi herbs. Why?” Yi Silan said, “Although metrorrhagia involves Blood, its source is Qi. Qi is like a bellows; Blood is like waves. Blood follows Qi. To treat Blood, first regulate Qi. Yet some cases resolve with Qi regulation alone, while others resolve with Blood treatment without Qi regulation. Why? Because the etiology differs. Some diseases originate in Blood affecting Qi; others originate in Qi affecting Blood. By differentiating via pulse and symptoms, the sequence of treatment is determined. For example, those with congenital Blood deficiency often have vigorous Qi, presenting with coughing blood, tidal fever, sore throat, etc.; here, Blood is primary, treated with Yin-nourishing and Fire-descending formulas. This case occurred in Autumn; the Lung pulse should be floating-short but is instead deep-large, violating seasonal norms. It is said, ‘If the pulse is deep at onset, know it is Qi.’ Large indicates Fire; excess Qi is Fire. Deep and large indicates Qi stagnation and failure to circulate. Furthermore, Liver Wood in Autumn should present as weak-small; here it is wiry-large with intermission. Intermission in Liver pulse indicates Blood accumulation internally. The etiology is Liver Fire anger stagnation, causing blood to leave its vessels and flow recklessly—is this not Qi disease affecting Blood? Hence, treating Qi is prioritized.” Someone asked, “The nails were black; you predicted redness at Zi hour when bleeding stopped; you predicted recurrence at Wu hour. Why?” Yi Silan said, “This is the subtlety of Yin-Yang growth. Active Blood is red; coagulated Blood is black. Black nails indicate coagulated, un-dispersed Blood. Now, using Qi-moving herbs, at Zi hour when Yang Qi first moves, Qi movement activates Blood, so black nails turn red. At Wu hour, Yin Qi regenerates. Liver is Yi Wood, born at Wu hour. When Liver Qi receives the mandate, pathogens cannot remain, so accumulated blood is expelled at this time. Once expelled, Qi circulates Blood, cycling through meridians, curing the disease.”
Yu Zhen commented: This case’s discussion is fluent and insightful. However, it is impossible that opening stagnation and moving Qi would disperse stasis and stop new bleeding in just one dose. This merely reflects the theoretical logic of the disease; preserving the explanation serves to warn future practitioners against blindly adhering to the single method of “treating blood for blood disorders.”
Sun Dongsu treated the daughter-in-law of Pan Jingzhai. Irregular menstruation was treated with fetal-calming agents. Seven months later, menstruation suddenly became profuse, passing one or two buckets of blood clots and membranes the size of a hand. She suffered from dizziness, confusion, exhaustion. Pulse: Right Guan position large-slipping; Left Cun position large-rapid; both Chi positions large-large. Symptoms manifested at midnight: teeth grinding, confused speech, hot palms, locked jaw, cold extremities, chest distension and discomfort, blue complexion. All physicians deemed it incurable. Sun Dongsu said, “Do not fear. This is turbid phlegm flowing and stagnating in the Sea of Blood, exacerbated by mistaken fetal-calming agents. Massive blood loss leaves the Spirit without foundation; phlegm confuses the Heart orifice, causing confusion and erratic speech. Manifestation at midnight is due to Phlegm-Heat in the Pericardium and Gallbladder meridians. Regulate Qi, open phlegm, calm Spirit, nourish Blood, and she will survive.” He prescribed Wendan Tang (Warm the Gallbladder Decoction) plus Shi Chang Pu (Acorus Tatarinowii Rhizome), Jiu Qin (Wine-processed Scutellaria Root), Tian Ma (Gastrodia Elata Rhizome), Suan Zao Ren (Ziziphus Spinosa Seed), and Dan Shen (Salvia Miltiorrhiza Root). That night, during Zi-Chou hours, teeth grinding and confused speech halved. The next day, same prescription with Zhu Ru (Bambusa Textilis Caulis) increased to 5 qian per dose. Before sleep, several pills of Hei Hu Dan (Black Tiger Pill) were given. All symptoms resolved, and she recovered.
Yu Zhen commented: This case did not use the method of tonifying Qi after massive blood loss; the pulse examination and symptom assessment were excellent. However, the focus was on dizziness, confusion, and distension, not on persistent bleeding. Using 5 qian of Zhu Ru in Wendan Tang is suitable for acute illness. The root cause is Phlegm-Fire; mistaken astringent tonics caused metrorrhagia, unlike chronic non-healing metrorrhagia. Consider Madam Qian, Inspector of my county, who suffered metrorrhagia for three years. Famous physicians gathered, trying all medicines. Later, hundreds of doses of Guipi Tang and countless Ren Shen were used, with temporary relief followed by recurrence, ultimately leading to death. Even if Master Sun were present, what could he do?
Shi Lizé treated the wife of Mr. Qi Wan. Metrorrhagia did not respond to Di Yu (Sanguisorba Root) and Xu Duan (Dipsacus Root). Shi Lizé palpated a deep and knotted pulse, stating, “This is Blood Stasis syndrome.” Caused by anger during menarche. Mr. Qi confirmed, “Yes, anger stopped menstruation; half a month later, metrorrhagia began, lasting a month.” He used Tao Ren (Prunus Persica Seed) and Da Huang (Rhubarb Root) to move blood and break stasis. Someone questioned whether purgatives were appropriate after blood loss, arguing it might drain vital energy. Shi Lizé said, “Blood stagnates with Qi; accumulation does not disperse, blocking the tunnels, overflowing and flowing recklessly. Removing blockage and stagnation allows blood to return to its vessels. Otherwise, treating the branch while ignoring the root is like damming a river upstream.” After two doses of decoction, blood was passed, and menstruation resumed.
[Appendix] Gao Gugeng treated postpartum lochia不尽 (incomplete expulsion). On the sixth or seventh day, fresh blood gushed forth, accompanied by fever, thirst, hypochondriac pain, and manic screaming. Blood-nourishing and Liver-clearing blood-moving herbs were ineffective. Gao Gugeng palpated a large-rapid pulse, saying, “Lochia remains, lodged in the Sea of Blood. Newly formed blood loses its original path. Without removing stasis and promoting flow, abnormal bleeding becomes routine. How to control it?” He used Vine-processed Da Huang (Rhubarb Root) 1 liang, Sheng Di Huang (Rehmannia Glutinosa Root) 1 liang, Tao Ren paste 5 qian, Gan Xi (Cryptomeria Wood) 3 qian, decocted strongly and drunk. Someone asked, “Postpartum is severely deficient; is such strong medication not too harsh?” Gao Gugeng said, “What leaves leaves; what generates generates. Where is the deficiency?” After ingestion, several sheng of black blood clots were passed. All symptoms vanished. Subsequently, Buzhong Yiqi Tang was used for regulation, leading to recovery.
Yu Zhen commented: These two cases are identical in nature, both representing Excess syndromes. Excess syndromes are easy to treat; one attack cures them. Deficiency syndromes are difficult to cure; repeated tonification yields no merit. The Classic says, “If one cannot treat deficiency, what need to ask about the rest?” This shows that one who can treat deficiency faces no difficulties. Tonifying deficiency is a general method. One must examine the Zang-Fu organs, meridians, and extraordinary vessels to locate the deficiency and check for concurrent Cold, Heat, Dampness, or Wind. Careful differentiation may yield partial or full efficacy. Those who succeed are capable; those who fail are not. Ancient masters had established formulas for Cold, Heat, Dampness, and Wind, but Wind is often overlooked today. The Inner Classic states, “Sudden violent wind causes menstrual waters to surge and rise,” contrasting with summer heat causing boiling overflow. Thus, ancients treated Wind entering the Uterus with formulas like Yi Wei Fang Feng Wan (One-Ingredient Saposhnikovia Pill) and Ju Qing Gu Bai San. However, internal stirring of Liver Wind was rarely addressed. Liver belongs to Wind-Wood, governs Blood storage, and anger or depression cause this disease. Xiaoyao San (Free and Easy Wanderer Powder), Hu Qian Wan (Tiger Crouching Pill), Wu Mei Wan (Mume Pill), and Bugan Tang (Nourish Liver Decoction) should be used with modification. Liver Wind stirring Blood may involve concurrent Cold, Heat, or Stasis. Ren Shen, Shu Di Huang, E Jiao, Huang Lian, Di Yu, Gui Zhi, Fu Zi, Tao Ren, Bai Zi Ren, San Qi, Yu Jin, etc., can be incorporated based on pulse and symptoms. Ultimately, clinical flexibility is required; one must not view it solely as deficiency.