经曰∶白者属气，赤者属血。但有气血之分，而无寒热之辨。凡治此者，皆云湿热。然乎否
乎?今之治白淋者，不分寒热，多用芩连，亦一偏之见耳。妇人之疾，寒多热少，故用养荣
汤治白淋而效，以其有桂也。艾煎丸服一二料而即愈，亦此义也。总在临证时审白而治之。
至赤淋，则为热证，不服热药，内补艾煎禁用，宜服八味加芩连，而香附尤不可少，此女科
之圣药也。张景岳论崩淋之证甚悉，已载在血崩一条。其云治此病者，惟调其气血，清其内
热最允。又血淋者，月水三五一至，积数月而止者是也。若腹痛，四乌汤，恐有瘀血，未可
止也，去多不痛，善饮食者，八物汤加芩连。如饮食少进，用内补汤去参可也。或补中益气
加黄柏。凡治血淋，审其小腹痛与不痛，脾胃之实与不实，如小腹不痛，脾胃实也，可用八
物汤加芩连。脾胃不实者禁用，宜补宫汤。大抵淋证，先以治脾为主。
养荣汤（见白淫） 四乌汤（见血风） 八物汤（见经水过期）
补中益气汤
黄 白术 人参 陈皮 归身 升麻 柴胡 甘草
妇人带下一证，从腰间带脉而来，故名曰带。虽有赤白二色，终属肾虚。其病与淋相似，然
淋之所下者多散而薄，必觉腥气臭秽，带之所下者多滑，稠粘无腥秽之气，以此为辨耳。
《保命集》曰∶赤者热入小肠，白者热入大肠。原其本，皆湿热结于脉。故津液涌溢，是为
赤
白带下，本不病结，缘五经脉虚结热，屈滞于带，故脐下痛，阴中绵绵而下也。《内经》云
∶任脉为病，男子内结七疝，女子带下 瘕。王注云∶任脉自胞上过，带脉贯于脐上，故男
子内结七疝，女子带下崩中。带脉起于季胁、章门，似束带状，今湿热冤结不散，故为病也
。经曰∶脾传于肾，名曰疝瘕。小肠冤结而痛出白，名曰蛊，所以为带下冤结也。冤、屈也
，屈滞而病热不散。先以十枣汤下之，后服苦练丸，再以大元胡索散调之。热去湿除，病自
愈矣。赵仁安问用升提之法，更以二陈加白术、苍术，健脾燥湿，亦是一法。论妇人漏下赤
白，日去血数升，其脉急疾者死，迟者生。如赤白带不止，脉小虚滑者生，大紧实数者死。
罗先生所用十枣汤、神佑丸、玉烛散之类，虚者不可峻攻，实者亦当酌用。血虚，加减四物
，气虚，参、术陈皮补之，甚者固肠丸。相火动者，加黄柏，滑者，加龙骨、赤石脂，滞者
，加葵花，性燥者，加黄连，冬月少加桂附，惟在临证时随机应变。丹溪治赤白带下，与梦
遗同法。肥人有带，多是湿痰，用海石二陈，加南星、黄柏、青黛、川芎。瘦人带下，俱是
郁热，宜香附、砂仁、黄柏、青黛。如结痰白带，以小胃丹，半饥半饱时，津液下数丸，候
郁积行，即服补药调理。
苦楝丸
苦楝子（打碎酒浸） 茴香（炒） 当归
等分为末，酒糊丸，每服三十丸，空心酒下。如腰痛，四物羌活防风汤下。
十枣汤
芫花（炒黑） 甘遂 大戟（各等分）
加大枣十枚。
小胃丹
芫花（醋拌一宿，瓦器炒黑，不可焦） 甘遂（水浸半月，煮晒干） 制大黄（各一两半） 大戟
（水煮一时水洗晒干，五钱） 黄柏（炒，三两）
共为末，白术膏丸，如菔子大，临卧时津液吞下。
神佑丸
甘遂 芫花 大戟（各一两，醋炒） 大黄 白丑 青皮 陈皮 木香 槟榔（各五钱） 轻粉
（一钱）
水法丸。
血臌
妇人血臌之证，虽有因于气食而成者，然成于血者居多焉。若成于气食，腹虽胀而经不闭，
成于血者，其经必闭也。妇人血恒有余，故每月见其血而不以为病，若闭而不通，则日积充
满
。其始发之时，小腹先胀，久则上连中脘，紧胀如鼓，青筋绽露，而血臌之证成矣。其有因
产后恶血不下，逆而上升，渗入肌肤，充满于中宫，甚至上腾于面，而成充色者，是必死之
证也。
《黄帝内经》说：白带属气分病变，赤带属血分病变。但这只是气血归属的区别，并不能据此区分寒证与热证。凡是治疗这类疾病的，都说是湿热所致。果真如此吗？如今治疗白带的医生，不分寒热证型，多用黄芩、黄连等苦寒药物，这也是一种片面的见解。妇女的疾病，寒证多而热证少，所以用养荣汤（具有养血益气功效的方剂）治疗白带能取得疗效，是因为方中含有桂枝的缘故。服用艾煎丸一两剂就能痊愈，也是这个道理。关键在于临证时要仔细审察白带的性质来治疗。至于赤带，则属于热证，不能服用温热药物，内补艾煎丸禁用，适宜服用八味地黄丸加黄芩、黄连，其中香附尤为不可少，这是妇科的圣药。张景岳对崩漏和淋证的论述非常详尽，已记载在“血崩”一条中。他说治疗这种病，只有调理气血、清除内热最为妥当。另外，血淋是指月经每三十五天来一次，持续数月才停止的情况。如果伴有腹痛，使用四乌汤，恐怕有瘀血阻滞，不可急于止血；如果出血量多但不痛，且食欲良好，可用八物汤加黄芩、黄连。如果饮食减少，可用内补汤去掉人参。或者使用补中益气汤加黄柏。凡治疗血淋，要审察小腹是否疼痛，脾胃是实证还是虚证。如果小腹不痛，脾胃属实证，可用八物汤加黄芩、黄连。如果脾胃虚弱不实者禁用此法，宜用补宫汤。大抵治疗淋证，先以健脾为主。
养荣汤（见“白淫”条） 四乌汤（见“血风”条） 八物汤（见“经水过期”条）
补中益气汤
黄芪 白术 人参 陈皮 当归身 升麻 柴胡 甘草
妇人带下这一病症，是从腰间的带脉而来，所以叫作“带”。虽然有赤、白两种颜色，但最终都归属于肾虚。这种病的表现与淋证相似，然而淋证所排出的分泌物大多散漫稀薄，必定带有腥臭秽浊的气味；带下所排出的物质大多滑腻，稠粘但没有腥秽之气，以此作为鉴别点。《保命集》说：赤色带下是热邪侵入小肠，白色带下是热邪侵入大肠。推究其根本，都是湿热结聚于经脉。因此津液涌溢，形成赤白带下。这本来不是由于实邪结聚致病，而是因为五脏经脉虚弱，郁结化热，屈滞于带脉，所以脐下疼痛，阴中绵绵不断流出。《内经》说：任脉生病，男子体内结聚成七疝，女子患带下和瘕积。王冰注解说：任脉从胞宫向上经过，带脉贯穿脐上，所以男子体内结聚成七疝，女子患带下和崩中。带脉起于季胁部的章门穴，形状像束带一样，现在湿热冤结不散，所以成为疾病。经文说：脾的病传变到肾，名叫疝瘕。小肠冤结而疼痛排出白色液体，名叫蛊，这就是带下冤结的原因。“冤”就是“屈”，屈滞而病热不散。先用十枣汤攻下，然后服用苦练丸，再用大元胡索散调理。热去湿除，病自然痊愈。赵仁安问是否可以用升提的方法，再加二陈汤加白术、苍术，健脾燥湿，也是一种方法。论及妇人漏下赤白，每天失血数升，脉象急疾的会死，脉象迟缓的能生。如果赤白带下不止，脉象小、虚、滑的能生，脉象大、紧、实、数的会死。罗先生所用的十枣汤、神佑丸、玉烛散之类，虚证患者不可峻猛攻伐，实证患者也应当斟酌使用。血虚的，用加减四物汤；气虚的，用人参、白术、陈皮补益；严重的用固肠丸。相火妄动的，加黄柏；滑泄的，加龙骨、赤石脂；气滞的，加葵花；性燥的，加黄连；冬季稍加肉桂、附子，关键在于临证时随机应变。朱丹溪治疗赤白带下，方法与治梦遗相同。肥胖的人患带下，多是湿痰，用海浮石化痰的二陈汤，加南星、黄柏、青黛、川芎。瘦人患带下，都是郁热，宜用香附、砂仁、黄柏、青黛。如果是结痰导致的白带，用小胃丹，在半饥半饱时，用津液送服几丸，等到郁积消散后，再服用补药调理。
苦楝丸
苦楝子（打碎后用酒浸泡） 茴香（炒） 当归
研成细末，用酒糊制作丸药，每次服用三十丸，空腹时用酒送下。如果有腰痛，用四物羌活防风汤送下。
小胃丹
芫花（醋拌一夜，在瓦器中炒黑，不可炒焦） 甘遂（水浸半个月，煮后晒干） 制大黄（各一两半） 大戟（水煮一小时，水洗后晒干，五钱） 黄柏（炒，三两）
共研为末，用白术膏做丸，如萝卜籽大小，临睡前用津液吞服。
神佑丸
甘遂 芫花 大戟（各一两，醋炒） 大黄 白丑 青皮 陈皮 木香 槟榔（各五钱） 轻粉（一钱）
用水泛丸。
妇人血臌之证，虽然也有因气和食积而成的，但由血瘀形成的居多。如果是因气食而成，腹部虽然胀满但月经不闭止；如果是因血瘀而成，月经必然闭止。妇人的血通常有余，所以每月行经而不以为病，如果闭止不通，就会日积月累充满体内。刚开始发作时，小腹先胀，久了则向上连及中脘部，紧绷胀满如鼓状，青筋暴露，于是血臌的病症就形成了。有的因为产后恶露不下，逆而上行，渗入肌肤，充满于中焦，甚至上腾至面部，面色发红，这是必死的证候。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: White discharge belongs to Qi disorders, while red discharge belongs to Blood disorders. This distinction is merely between Qi and Blood, and does not differentiate between Cold and Heat patterns. It is often claimed that all treatments for this condition address Damp-Heat. Is this true? Currently, practitioners treating leukorrhea (white vaginal discharge) often use bitter-cold herbs such as Scutellariae Radix (Huangqin, 黄芩) and Coptidis Rhizoma (Huanglian, 黄连) without distinguishing between Cold and Heat patterns; this is a biased view. Women's diseases are predominantly Cold rather than Heat. Therefore, Yangrong Tang (Nourishing the Vigor Decoction) is effective for treating leukorrhea because it contains Cinnamomi Ramulus (Guizhi, 桂枝). Taking Ai Jian Wan (Mugwort Decoction Pills) for one or two courses can also cure it, following the same principle. The key lies in carefully examining the nature of the discharge during clinical practice. As for red discharge, it is a Heat pattern; hot-natured medicines should not be taken, and Neibu Ai Jian Wan (Internal Nourishing Mugwort Decoction Pills) is contraindicated. Instead, Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) added with Scutellariae Radix and Coptidis Rhizoma is suitable. Cyperi Rhizoma (Xiangfu, 香附) is indispensable and is considered a sacred medicine in gynecology. Zhang Jingyue discussed Bingli (metrorrhagia and leukorrhea) extensively, which has been recorded under the section on Metrorrhagia. He stated that the most appropriate treatment for this disease is to regulate Qi and Blood and clear internal Heat. Additionally, Xuelin (blood strangury) refers to menstruation occurring every thirty-five days, continuing for several months before stopping. If accompanied by abdominal pain, Siwu Tang (Four Substances Decoction) should be used; if there is likely blood stasis, bleeding should not be stopped abruptly. If there is heavy bleeding without pain and good appetite, Bayi Tang (Eight Ingredients Decoction) added with Scutellariae Radix and Coptidis Rhizoma is indicated. If food intake is reduced, Neibu Tang (Internal Nourishing Decoction) with Ginseng removed may be used. Alternatively, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Phellodendri Cortex (Huangbai, 黄柏) can be applied. When treating blood strangury, one must examine whether there is lower abdominal pain and whether the Spleen and Stomach are Excess or Deficient. If there is no lower abdominal pain and the Spleen/Stomach are Excess, Bayi Tang added with Scutellariae Radix and Coptidis Rhizoma can be used. If the Spleen/Stomach are Deficient, this formula is contraindicated; instead, Bugong Tang (Nourish the Uterus Decoction) is suitable. Generally, treating strangury focuses primarily on regulating the Spleen.
Yangrong Tang (see "Baiyin") | Siwu Tang (see "Xuefeng") | Bayi Tang (see "Jingshui Guoqi")
Buzhong Yiqi Tang
Astragali Radix (Huangqi, 黄芪) | Atractodis Rhizoma (Baizhu, 白术) | Ginseng Radix et Rhizoma (Renshen, 人参) | Citri Reticulatae Pericarpium (Chenpi, 陈皮) | Angelicae Sinensis Radix (Guishen, 归身) | Cimicifugae Rhizoma (Shengma, 升麻) | Bupleuri Radix (Chaihu, 柴胡) | Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Leukorrhea in women originates from the Dai Mai (Girdle Vessel) around the waist, hence the name. Although it presents in red and white colors, it ultimately belongs to Kidney Deficiency. Its presentation is similar to strangury, but the discharge from strangury is mostly scattered and thin, with a fishy and foul odor. In contrast, leukorrhea discharge is slippery, thick, and sticky, without a fishy or foul odor; this serves as the point of differentiation. *Baoming Ji* states: Red discharge indicates Heat entering the Small Intestine, while white discharge indicates Heat entering the Large Intestine. Tracing the root cause, both result from Damp-Heat binding in the vessels. Thus, body fluids overflow, causing red and white leukorrhea. This is not originally caused by pathogenic accumulation, but rather by deficiency in the five vessel systems leading to constrained Heat stagnating in the Dai Mai, resulting in pain below the umbilicus and continuous discharge from the vagina. The *Neijing* states: Disease of the Ren Mai (Conception Vessel) causes seven types of hernias in men and leukorrhea and masses in women. Wang Bing’s commentary notes: The Ren Mai passes upward from the uterus, and the Dai Mai crosses above the umbilicus; thus, men develop internal hernias, while women suffer from leukorrhea and metrorrhagia. The Dai Mai originates at the costal margin and Zhangmen (LR13), resembling a belt. Now, due to unresolved Damp-Heat binding, disease arises. The classics state: When Spleen disease transmits to the Kidney, it is called Hernia and Mass. Pain in the Small Intestine with binding discharging white fluid is called Gu; this explains the binding nature of leukorrhea. "Yu" means constraint; constrained stagnation leads to unresolving Heat. First, administer Shizao Tang (Ten Jujube Decoction) to purge, then take Kunlian Wan (Toosendan Fruit Pill), followed by Dahuansu San (Major Corydalis Powder) to regulate. Once Heat is cleared and Dampness removed, the disease will heal naturally. Zhao Ren'an asked about using lifting methods; adding Erchen Tang (Two Aged Things Decoction) with Atractodis Rhizoma and Atractylodis Rhizoma Macrocephalae (Cangzhu, 苍术) to strengthen the Spleen and dry Dampness is another method. Regarding women with dripping red and white discharge losing several sheng of blood daily, a rapid pulse indicates death, while a slow pulse indicates survival. If red and white discharge continues, a small, deficient, and slippery pulse indicates survival, whereas a large, tight, full, and rapid pulse indicates death. Luo Xiansheng’s use of Shizao Tang, Shenyuan Wan (Divine Protection Pill), Yuzhu San (Jade Candle Powder), etc., should not be used aggressively in Deficient cases, nor indiscriminately in Excess cases. For Blood Deficiency, use Modified Siwu Tang; for Qi Deficiency, tonify with Ginseng, Atractodis Rhizoma, and Citri Reticulatae Pericarpium; for severe cases, use Guchang Wan (Intestine-Stabilizing Pill). For hyperactive Ministerial Fire, add Phellodendri Cortex; for slipping/looseness, add Ostreae Concha (Longgu, 龙骨) and Halloysit Rubrum (Chishizhi, 赤石脂); for stagnation, add Hibisci Rosa-Sinensis Flos (Kuihua, 葵花); for dryness, add Coptidis Rhizoma; in winter, slightly add Cinnamomi Cortex (Guirou, 肉桂) and Aconiti Lateralis Radix Praeparata (Fuzi, 附子). Clinical flexibility is essential. Zhu Danxi treated red and white leukorrhea using the same method as treating nocturnal emission. Obese women with leukorrhea usually have Damp-Phlegm; use Haishi Erchen Tang (Aragonite Two Aged Things Decoction) added with Pinelliae Rhizoma (Nanxing, 南星), Phellodendri Cortex, Indigo Naturalis (Qingdai, 青黛), and Chuanxiong Rhizome. Thin women with leukorrhea usually have Depressive Heat; use Cyperi Rhizoma, Amomi Fructus Rotundus (Sharen, 砂仁), Phellodendri Cortex, and Indigo Naturalis. If leukorrhea is caused by accumulated Phlegm, use Xiaowei Dan (Small Stomach Pill); take a few pills with saliva when half-hungry, and once the accumulation moves, switch to tonic formulas for regulation.
Kunlian Wan (Toosendan Fruit Pill)
Toosendan Fructus (Kualianzi, 苦楝子) (crushed and soaked in wine) | Illicii Fructus Recursatus (Huixiang, 茴香) (stir-fried) | Angelicae Sinensis Radix
Grind into powder, make pills with wine paste. Take 30 pills per dose with wine on an empty stomach. For lower back pain, take with Siwu Qianghuo Fangfeng Tang (Four Substances, Notopterygium and Saposhnikovia Decoction).
Shizao Tang (Ten Jujube Decoction)
Genkwa Flos (Yanhua, 芫花) (stir-fried until black) | Kansui Radix (Gansui, 甘遂) | Oldenlandiae Radix (Daji, 大戟) (equal parts)
Add ten large jujubes (Zaoren, 大枣).
Xiaowei Dan (Small Stomach Pill)
Genkwa Flos (steeped in vinegar overnight, stir-fried black in earthenware, do not burn) | Kansui Radix (soaked in water for half a month, boiled and dried) | Prepared Rheum Palmatum Radix et Rhizoma (Zhida Huang, 制大黄) (each 1.5 liang) | Oldenlandiae Radix (boiled for one hour, washed and dried, 5 qian) | Phellodendri Cortex (stir-fried, 3 liang)
Grind into powder, make pills with Atractodis Rhizoma paste, size of radish seeds. Swallow with saliva before bed.
Shenyuan Wan (Divine Protection Pill)
Kansui Radix | Genkwa Flos | Oldenlandiae Radix (each 1 liang, stir-fried with vinegar) | Rheum Palmatum Radix et Rhizoma | Bunium Ternatum Semen (Baichou, 白丑) | Tangerine Peel (Qingpi, 青皮) | Tangerine Peel (Chenpi, 陈皮) | Costus Root (Muxiang, 木香) | Areca Seed (Binglang, 槟榔) (each 5 qian) | Calomelas (Qingfen, 轻粉) (1 qian)
Make pills using water method.
Blood Distension in Women
The syndrome of Blood Distension in women, although sometimes caused by Qi and Food retention, is mostly caused by Blood issues. If caused by Qi and Food, the abdomen is distended but menstruation does not stop. If caused by Blood, menstruation must cease. Women typically have abundant Blood, so monthly menstruation is not pathological. However, if blocked and unflowing, it accumulates day by day. Initially, the lower abdomen distends; later, it extends upward to the Zhongwan area, becoming tight and drum-like, with visible blue veins, forming the Blood Distension syndrome. Some cases arise from postpartum lochia failing to descend, reversing upward, infiltrating the skin and muscles, filling the middle jiao, and even rising to the face, causing a flushed complexion; this is a fatal syndrome.