东垣云∶妇人经漏有二。或脾胃亏损，下陷于肾，肝与相火相合，湿热下迫，经漏不止
，其
色紫黑腐臭，其脉洪大沉弦，或沉而数疾，腰脐下痛，寒热往来，两胁急痛，四肢困热，心
烦不眠，宜大补脾胃而升降气血，自然愈矣(如补中益气汤加防风、芍药、炒黄柏之类)。又
有先富后贫或先贵后贱，病名脱营者，心气不足，邪火炽旺于血脉之中，由是心病传脾，火
乘土位，形质肌肉颜色不变，经水不时而下。或适来适断，暴下不止，治以大补气血之剂，
补养脾胃，微加镇坠心火之药治其心，补阴泻阳，红自止矣。痿论曰∶悲哀太甚则胞络绝，
则阳气内动，发则心下崩，数溲血也。又曰∶大经空虚，发为肌痹，传为脉痿。此之谓也。
《良方》云∶妇人冲任二脉为经脉之海，外循经脉，内荣脏腑。若阴阳和平，经事根据时
，惟
劳伤气血，俾冲任二脉不能约制，经血则忽然暴下，甚则昏闷。速当调补脾胃为主。若寸脉
微迟，为寒在上焦，则吐血衄血。尺脉微迟，为寒在下焦，则崩血便血。寸口脉弦而大，弦
则为紧，大则为芤，紧则为寒，芤则为虚，虚寒相搏，其脉为革。妇人半产漏下，赤白不止
。大抵数小为顺，洪大为逆。脉小虚滑者生，脉大紧实数者死。脉迟者生，脉急者死。又漏
血脉虚浮者，不治。
按戴复庵云∶血大至曰崩中，或清或浊，或纯下瘀血，或腐臭不堪，甚则头目昏晕，四
肢厥
冷，急宜童便调理中汤加入百草霜饮之。又有崩甚而腹痛，人多疑为恶血未尽，又见血色
瘀黑，愈信恶血之说，不敢止截。大凡血之为患，欲出未出际停在腹中，即成为瘀血难尽，
以瘀为恶血，又焉知瘀之不为虚冷?若必待瘀尽而后截之，恐并与人无之矣。况此腹痛更有
说
焉。瘀停腹痛，血通而痛止。崩行腹痛，血住而痛止。宜芎归汤加炮姜、熟附止其血而痛自
止。
薛立斋云∶经曰阴虚阳搏谓之崩。又曰∶阳络伤则是血外溢，阴络伤则血内溢。又曰脾
统血
，肝藏血。其为患有因脾胃虚损不能摄血归源，或因肝经有火，血得热而妄行，或因肝经有
风，血得风而妄动，或因怒动肝火，血热而沸腾，或因脾经郁结，脾虚而血不归经，或因悲
哀太过，胞络内绝而下崩。治疗之法，脾胃虚弱者六君子汤加芎、归、柴胡，脾胃下陷者补
中益气汤加白芍，肝经血热者加味逍遥散，脾经郁者归脾汤加柴胡。故东垣、丹溪诸先生云
∶凡下血症，须四君子汤收功。有旨哉(薛氏所论凡七条，而脾胃三条，肝经三条，胞络一
条。皆不舍柴胡、丹、芍者，以厥阴手足二经为多血藏血之所。血为热迫则不能藏，从阳亟
起，故以引起肝气，而栀、芍等收阴抑阳也。如东垣升阳举经之意，尤得其端。所定脾胃方
药，必是久病，又是出脾胃症者宜之。盖立斋治久病者多，故其立言如此。且谓四君子为血
症收功，须用则非初治之法。可知立斋得力处在此)。若夫去血后，毋以脉诊，当急用独参
汤救之。若潮热咳嗽，脉数，乃元气虚弱，假热之脉，尤当用人参温补。此等症候，无不由
脾胃先损，故脉洪大。察其有胃气能受补者则可救，苟用寒凉止血之药复伤胃气，反不能摄
血归源，是速其危也。
李东垣说：妇女经血淋漓不尽有两种情况。一种是脾胃亏损，气机下陷波及肾脏，肝与相火结合，湿热下迫，导致经血淋漓不止，血色紫黑且有腐臭味，脉象洪大沉弦，或者沉而数疾，腰部和脐下疼痛，寒热往来，两胁拘急疼痛，四肢困倦发热，心烦失眠，应当大补脾胃以升降气血，自然就会痊愈（例如使用补中益气汤加入防风、芍药、炒黄柏等药物）。另一种是曾经富贵后来贫穷，或曾经显贵后来卑微，这种病名叫“脱营”，心气不足，邪火在血脉中炽盛，由此心病传及脾脏，火邪侵犯土位，形体肌肉颜色没有变化，但月经不时而下。或者月经刚来就突然中断，或暴下不止，治疗时用大补气血的药剂，补养脾胃，稍微加入镇降心火的药物来治疗心脏，滋阴泻阳，出血自然停止。《素问·痿论》说：悲哀太过则胞络隔绝，阳气内动，发作时会出现心下崩漏，频繁小便出血的情况。又说：大经脉空虚，发为肌痹，传变为脉痿。说的就是这种情况。
《良方》说：妇女的冲脉和任脉是经脉之海，外循行于经脉，内滋养脏腑。如果阴阳平和，月经按时来潮；只有劳损伤及气血，使得冲任二脉不能约束控制，经血就会忽然暴下，甚至昏闷。此时应当迅速以调补脾胃为主。如果寸脉微迟，说明寒邪在上焦，就会出现吐血、衄血。尺脉微迟，说明寒邪在下焦，就会出现崩血、便血。寸口脉弦而大，弦意味着紧，大意味着芤（中空），紧代表寒，芤代表虚，虚寒相互搏结，其脉象表现为革脉。妇女半产（小产）后漏下，赤白带下不止。大致而言，脉象数而小为顺，洪大为逆。脉小、虚、滑者生，脉大、紧、实、数者死。脉迟者生，脉急者死。另外，漏下患者若脉象虚浮，属于不治之症。
按戴复庵说：血量极大称为“崩中”，血液或清或浊，或纯下瘀血，或腐臭难闻，严重时头目昏晕，四肢厥冷，急需用童便调理中汤加入百草霜服用。又有崩漏严重且腹痛的，人们多怀疑是恶血未尽，又见血色瘀黑，更加相信是恶血的说法，不敢止血。大凡血液为患，欲出未出之际停在腹中，就成为瘀血难以排尽，将瘀血视为恶血，又怎知瘀血不是由于虚冷造成的呢？如果一定要等到瘀血排尽后再止血，恐怕连正常的血也没有了。况且这里的腹痛还有另一种说法。瘀血停滞引起的腹痛，血通畅则疼痛停止；崩漏运行引起的腹痛，血止住则疼痛停止。适宜用芎归汤加入炮姜、熟附子来止血，疼痛自然停止。
薛立斋说：《内经》说：阴虚阳搏谓之崩。又说：阳络受伤则血液外溢，阴络受伤则血液内溢。又说：脾统血，肝藏血。其致病原因有因脾胃虚损不能摄血归源，或因肝经有火，血液受热而妄行，或因肝经有风，血液受风而妄动，或因愤怒触动肝火，血热而沸腾，或因脾经郁结，脾虚而血不归经，或因悲哀太过，胞络内绝而导致下崩。治疗方法：脾胃虚弱者用六君子汤加川芎、当归、柴胡；脾胃下陷者用补中益气汤加白芍；肝经血热者用加味逍遥散；脾经郁结者用归脾汤加柴胡。所以李东垣、朱丹溪诸位先生说：凡是血症，必须用四君子汤收功。这话很有深意啊（薛氏所论述的共有七条，其中脾胃三条，肝经三条，胞络一条。都不离开柴胡、丹皮、芍药，因为厥阴经手足两经是多血藏血之所。血液被热邪逼迫则不能收藏，从阳分急剧升起，所以用柴胡引动肝气，而用栀子、芍药等收敛阴气抑制阳亢。这如同李东垣升阳举经的意思，尤其得其要领。所确定的脾胃方药，必定是久病，又是出自脾胃症状的患者适宜使用。大概薛立斋治疗久病患者较多，所以他的言论如此。并且说四君子汤用于血症收功，使用时并非初治的方法。可知薛立斋得力之处在此）。至于失血之后，不要凭脉诊，应当紧急使用独参汤抢救。如果出现潮热咳嗽，脉数，这是元气虚弱，假热的脉象，更应当用人参温补。这些证候，无不是由脾胃先受损，所以脉象洪大。观察其有胃气能受补的可以救治，如果使用寒凉止血药物再次损伤胃气，反而不能摄血归源，这是加速其危亡。
Li Dongyuan stated: There are two types of menstrual dripping (menstrual bleeding that persists beyond the normal duration) in women. One type is caused by spleen and stomach deficiency, with qi sinking to affect the kidneys; liver and ministerial fire combine, causing damp-heat to press downward, resulting in persistent menstrual dripping. The blood color is purple-black and foul-smelling, the pulse is surging, large, deep, and wiry, or deep and rapid, accompanied by pain in the lower back and umbilical region, alternating chills and fever, tight pain in both hypochondria, heat and fatigue in the four limbs, irritability, and insomnia. Treatment should focus on greatly tonifying the spleen and stomach to regulate the ascending and descending of qi and blood, leading to natural recovery (e.g., using Buzhong Yiqi Tang [Tonify the Middle and Augment the Qi Decoction] added with Fangfeng [Saposhnikovia Root], Shaoyao [Peony Root], and Chao Huangbai [Fried Phellodendron Bark]). Another type occurs in those who were once wealthy but became poor, or once noble but became humble; this disease is named "Tuo Ying" (Depletion of Vital Energy). Heart qi is insufficient, and pathogenic fire blazes within the blood vessels. Consequently, heart disease transmits to the spleen, with fire invading the earth position. The physical form, muscles, and complexion remain unchanged, yet menstruation flows irregularly. It may present as menses starting and stopping abruptly, or sudden profuse flow unceasing. Treatment involves using formulas to greatly tonify qi and blood, nourish the spleen and stomach, and slightly add herbs to suppress heart fire to treat the heart. By nourishing yin and draining yang, the redness (bleeding) will naturally stop. The *Suwen: Wei Lun* chapter states: Excessive grief severs the Bao Luo (uterine collaterals), causing internal movement of yang qi. Upon onset, it manifests as "Xin Xia Beng" (sudden bleeding from below the heart) and frequent urination of blood. It also states: When the major meridians are empty, it develops into Ji Bi (muscle bi syndrome) and transmits to Mai Wei (vessel flaccidity syndrome). This refers to such cases.
The *Liang Fang* states: The Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) in women are the seas of the meridians, circulating externally along the meridians and nourishing internally the zang-fu organs. If yin and yang are harmonious, menstruation occurs on time. Only when labor and injury damage qi and blood, rendering the Chong and Ren vessels unable to constrain them, does menstrual blood suddenly flow profusely, potentially leading to fainting and dizziness. Immediate treatment should prioritize regulating and tonifying the spleen and stomach. If the cun (inch) pulse is slightly slow, it indicates cold in the upper jiao, manifesting as hematemesis (vomiting blood) or epistaxis (nosebleed). If the chi (cubit) pulse is slightly slow, it indicates cold in the lower jiao, manifesting as Beng Xue (metrorrhagia) or hematochezia (blood in stool). If the cunkou pulse is wiry and large, wiry implies tightness, and large implies Kou (hollow). Tightness indicates cold, and hollow indicates deficiency. Deficiency and cold clashing result in a Ge pulse (drum-taut pulse). In women with spontaneous abortion (half-birth) and continuous leakage, there is unceasing discharge of red and white fluids. Generally, a rapid and small pulse is favorable, while a surging and large pulse is unfavorable. A small, deficient, and slippery pulse indicates survival; a large, tight, solid, and rapid pulse indicates death. A slow pulse indicates survival; an urgent pulse indicates death. Furthermore, if a patient with leakage has a deficient and floating pulse, it is untreatable.
According to Dai Fu'an: Profuse bleeding is called "Beng Zhong" (Central Collapse). The blood may be clear or turbid, purely clotted blood, or foul-smelling and unbearable. Severe cases involve dizziness of the head and eyes, and cold extremities. Urgent treatment requires Tongbian Tiaoli Zhong Tang (Child Urine Regulating Middle Decoction) added with Baicaoshuang (Soot from Hundred Herbs) for consumption. In cases of severe metrorrhagia accompanied by abdominal pain, people often suspect that evil blood (stasis) remains. Seeing the dark, clotted blood further confirms this suspicion, leading to hesitation in stopping the bleeding. Generally, when blood pathology occurs, if blood stops in the abdomen before fully exiting, it becomes stasis that is difficult to eliminate completely. Mistaking stasis for "evil blood," one fails to realize that stasis may arise from deficiency and cold. If one insists on waiting for all stasis to pass before stopping the bleeding, it is feared that even the normal blood will be depleted. Moreover, there is another explanation for the abdominal pain here. Abdominal pain caused by stasis stagnation ceases when blood circulation resumes; abdominal pain caused by active metrorrhagia ceases when bleeding stops. It is appropriate to use Xiong Gui Tang (Angelica and Ligusticum Decoction) added with Pao Jiang (Roasted Ginger) and Shu Fuzi (Prepared Aconite) to stop the bleeding, after which the pain will naturally cease.
Xue Lizhai stated: The *Neijing* says: Yin deficiency with yang palpitation is termed Beng. It also states: Injury to yang collaterals causes external blood overflow; injury to yin collaterals causes internal blood overflow. It further states: The spleen controls blood, and the liver stores blood. Pathological conditions arise from: spleen and stomach deficiency failing to control blood and return it to its source; liver channel fire causing blood to act recklessly due to heat; liver channel wind causing blood to move recklessly due to wind; anger stirring liver fire, causing blood to boil due to heat; spleen channel depression/stagnation with spleen deficiency causing blood to leave its channels; or excessive grief severing the Bao Luo internally, leading to lower collapse. Treatment methods include: Liu Jun Zi Tang (Six Gentlemen Decoction) added with Chuanxiong, Danggui, and Chaihu for spleen and stomach weakness; Buzhong Yiqi Tang added with Baishao for spleen and stomach sinking; Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) for liver channel blood heat; and Guipi Tang (Restore the Spleen Decoction) added with Chaihu for spleen channel depression. Thus, masters like Li Dongyuan and Zhu Danxi said: For all blood disorders, Si Jun Zi Tang (Four Gentlemen Decoction) must be used to conclude treatment. This statement is profound (Xue's discussion comprises seven points: three regarding the spleen/stomach, three regarding the liver channel, and one regarding the Bao Luo. None omit Chaihu, Mudanpi, and Shaoyao, because the Jueyin meridians (hand and foot) are the reservoirs where blood is abundant and stored. When blood is forced by heat, it cannot be stored and rises rapidly from the yang aspect. Therefore, Chaihu is used to guide liver qi, while Zhi Zi and Shaoyao etc. are used to collect yin and suppress yang. This aligns with Li Dongyuan's concept of raising yang and lifting the meridian, capturing the essence. The spleen/stomach formulas established are suitable for chronic diseases presenting with spleen/stomach symptoms. Since Xue Lizhai treated many chronic cases, his statements reflect this. Also, stating that Si Jun Zi Tang is used to conclude blood disorder treatment implies it is not the method for initial treatment. It is evident that Xue Lizhai's strength lies here). However, after significant blood loss, do not rely on pulse diagnosis; instead, urgently use Du Shen Tang (Single Ginseng Decoction) for rescue. If tidal fever and cough appear with a rapid pulse, this indicates weak yuan qi and a false heat pulse; Ren Shen (Ginseng Root) should especially be used for warm tonification. Such syndromes invariably stem from prior spleen and stomach damage, hence the surging and large pulse. If the patient has stomach qi capable of accepting tonification, they can be saved. If cold-natured hemostatic drugs are used, damaging stomach qi again, they will fail to control blood and return it to its source, thereby accelerating their peril.