【歌】阴虚阳搏谓之崩,恚怒忧思风热乘,阴络受伤血内溢,脾家亏损外奔腾,悲哀太过心胞绝,涎滞中焦
气不增,更有阴阳崩两说,须参脉症可为凭。
【论】经曰∶阴虚阳搏谓之崩。又曰∶悲哀太过则心系急,肺布叶举而上焦不通,热气在中,故血走而崩也。
忽然大下谓之崩,淋沥不止谓之漏也。
【脉】仲景曰∶寸口脉微而缓,微者,卫气疏,疏则其肤空。缓者,胃弱不实,则谷消而水化。谷入于胃,脉
道乃行,水入于经,其血乃成。荣盛则其肤必疏,三焦绝经,名曰血崩。寸口脉弦而大,弦则为减,大则为芤,减
者为寒,芤则为虚,虚寒相搏,此名曰革,男子则亡血失精,妇人则半产漏下。尺脉急而弦大,风邪入少阴之经,
女子则漏下赤白。漏血不止,脉小虚滑者生,大紧实数者死,日下赤白数升,脉急疾者死,迟者生,浮者不治。
阴虚阳搏
尺脉虚微阴不足,寸如弦急阳有余,必然失血崩中症,四物
阿胶黑地榆。漏久而虚者,黑地黄丸。
劳伤冲任
冲任原来主月经,络伤血溢不留停,备金散子宜调服,大剂芎归极有灵。
涎郁胸膈
痰涎凝滞郁胸中,壅遏经隧气不通,血不归经因漏下,备金抑气可收功。
风热乘肝
风热乘肝血妄行,头痛胁痛目羞明,莎柴四物焦荆芥,一服教君疾自平。
乌金散。
思虑伤脾
忧愁思虑总伤脾,倦怠贪眠食不思,坤土卑监难摄血,归脾加减最相宜。
暴怒伤阴
怒气伤肝血不藏,忽然崩下甚 徨,青皮香附炮焦黑,白芍芎归及地黄。
元气下陷
血脱多时气必虚,阳生阴长理相宜,肝能生血调脾胃,归草升柴参术 。
补中益气汤。
【歌诀】阴虚而阳脉搏动称为崩漏,因愤怒、忧愁、思虑以及风热之邪侵袭所致。阴络受损则血液在内溢出,脾气亏损则血液在外奔腾。悲哀过度会导致心包经气绝断,痰涎停滞于中焦导致气机不能增长。此外还有关于阴阳两种类型的崩漏说法,必须参考脉象和症状作为依据。
【论述】医经说:阴虚而阳脉搏动称为崩漏。又说:悲哀过度会使心系拘急,肺叶布展上举而导致上焦气机不通,热气郁结在中焦,因此血液妄行而发生崩漏。突然大量出血称为“崩”,淋漓不断称为“漏”。
【脉诊】张仲景说:寸口脉微而缓,微脉表示卫气疏泄,疏泄则肌肤腠理空虚。缓脉表示胃气虚弱不实,则水谷消化而化为津液。谷物进入胃中,脉道才能运行;水液进入经脉,血液才能生成。营血旺盛则肌肤必然疏松,三焦经络隔绝,这叫做血崩。寸口脉弦而大,弦脉表示阳气衰减,大脉表示中空如芤,衰减者为寒证,芤脉则为虚证,虚与寒相互搏结,这叫做革脉,男子会出现亡血失精,妇人会出现小产及漏下不止。尺脉急而弦大,是风邪侵入少阴经,女子会出现赤白带下漏血。漏血不止,若脉象小、虚、滑者预后良好(生);若脉象大、紧、实、数者预后不良(死)。每日下注赤白血液数升,若脉象急疾者预后不良(死),若脉象迟缓者预后良好(生),若脉象浮者难以治愈。
阴虚阳搏:尺脉虚微表示阴气不足,寸脉如弦急表示阳气有余,必然出现失血、崩中的症状,可用四物汤加阿胶、黑地榆治疗。若漏下日久且体虚者,用黑地黄丸。
劳伤冲任:冲任二脉原本主管月经,络脉受伤血液溢出而不留滞,宜服用备金散子进行调理,大剂量的川芎、当归方剂极为灵验。
痰涎郁滞胸膈:痰涎凝滞郁结在胸中,壅塞阻碍经络导致气机不通,血液不回归经脉因而漏下,服用备金抑气汤可收效。
风热乘肝:风热侵袭肝脏导致血液妄行,出现头痛、胁痛、畏光羞明等症状,可用莎草根、柴胡、四物汤加炒荆芥,一服即可使疾病平复。另有乌金散。
思虑伤脾:忧愁思虑总会损伤脾脏,出现倦怠、贪睡、食欲不振等症状,脾土卑监(功能低下)难以统摄血液,使用归脾汤加减最为适宜。
暴怒伤阴:怒气损伤肝脏导致血液不能藏守,突然发生崩下令人惊慌,可用青皮、香附(炮制后焦黑)、白芍、川芎、当归及地黄治疗。
元气下陷:失血时间较长,气必然虚弱,阳生阴长的道理是相适宜的,肝能生血并调理脾胃,可用甘草、升麻、柴胡、人参、白术等药。即补中益气汤。
[Verse] Yin deficiency with pulsating Yang pulse is termed Bing (sudden heavy uterine bleeding). It is caused by anger, sorrow, overthinking, and invasion of wind-heat. Injury to the Yin collaterals causes blood to overflow internally; deficiency of Spleen Qi causes blood to surge externally. Excessive grief leads to the exhaustion of the Pericardium channel; phlegm-fluid retention in the Middle Jiao prevents Qi from increasing. Furthermore, there are two theories regarding Bing based on Yin and Yang; one must refer to the pulse and symptoms as evidence.
[Discussion] The Classics state: "Yin deficiency with pulsating Yang pulse is termed Bing." It also states: "Excessive grief makes the Heart tie tense, causing the lungs' leaves to spread and rise, leading to obstruction of the Upper Jiao and heat qi stagnating in the middle, thus causing blood to flow wildly resulting in Bing." Sudden heavy bleeding is called Bing; dripping continuously without stopping is called Lou (prolonged spotting).
[Pulse Diagnosis] Zhang Zhongjing said: If the Cun Kou pulse is faint and slow, a faint pulse indicates loose Wei Qi (Defensive Qi), which means the skin pores are empty. A slow pulse indicates weak Stomach Qi lacking solidity, meaning food and water are digested and transformed. When grain enters the Stomach, the pulse channels circulate; when water enters the meridians, blood is formed. When Ying Blood (Nutritive Blood) is abundant, the skin becomes loose; when the San Jiao (Triple Burner) meridians are severed, it is named Blood Bing. If the Cun Kou pulse is wiry and large, wiry indicates reduction (deficiency), and large indicates hollow like a leek stalk (Kou pulse). Reduction signifies cold, and Kou signifies deficiency. Deficiency and cold clashing together is named Ge pulse. In men, it results in loss of blood and essence; in women, it results in miscarriage and continuous leaking. If the Chi pulse is urgent, wiry, and large, wind pathogen has entered the Shaoyin meridian, and women will experience leaking of red and white discharge. If leaking blood does not stop, a small, deficient, and slippery pulse indicates survival; a large, tight, solid, and rapid pulse indicates death. If several sheng of red and white blood are discharged daily, an urgent and rapid pulse indicates death, while a slow pulse indicates survival; a floating pulse indicates untreatable condition.
Yin Deficiency with Pulsating Yang: A deficient and faint Chi pulse indicates insufficient Yin; a wiry and urgent Cun pulse indicates excess Yang. This inevitably leads to blood loss and Bing syndrome. Use Si Wu Tang (Four Substances Decoction) plus Ejiao (Donkey-hide Gelatin) and Hei Di Yu (Charred Cortex Paeoniae Rubrae). For prolonged leaking with deficiency, use Hei Huang Di Wan (Black Yellow Earth Pill).
Labor and Injury to Chong and Ren: The Chong and Ren vessels originally govern menstruation. Injury to collaterals causes blood to overflow without stagnation. Be Jin San Zi (Prepared Gold Powder) should be taken for regulation; a large dose of Xiong Gui (Ligusticum and Angelica) formula is extremely effective.
Phlegm-Fluid Retention in Chest and Diaphragm: Phlegm-fluid stagnation and depression in the chest obstruct the meridians and block Qi flow. Blood fails to return to its vessels, causing leaking. Bei Jin Yi Qi Tang (Prepare Gold Regulating Qi Decoction) can achieve success.
Wind-Heat Invading Liver: Wind-heat invading the Liver causes blood to run wild, presenting with headache, hypochondriac pain, and photophobia. Use Suo Chen (Cyperus), Chai Hu (Bupleurum), Si Wu Tang (Four Substances Decoction), plus fried Jing Jie (Schizonepeta). One dose will calm the disease. Also, Wu Jin San (Black Gold Powder).
Overthinking Damaging Spleen: Worry and overthinking always damage the Spleen, leading to fatigue, drowsiness, and poor appetite. The Spleen Earth, being low and supervisory (weak), fails to control blood. Gui Pi Tang (Restore the Spleen Decoction) with modifications is most suitable.
Violent Anger Damaging Yin: Anger damages the Liver, causing blood to fail to be stored. Sudden heavy bleeding occurs, causing panic. Use Qing Pi (Citrus Peel), Xiang Fu (Cyperus Rhizome - charred black), Bai Shao (White Peony Root), Xiong Gui (Ligusticum and Angelica), and Di Huang (Rehmannia).
Yuan Qi Sinking: Prolonged blood loss inevitably leads to Qi deficiency. The principle of Yang generating Yin is appropriate. The Liver generates blood and regulates the Spleen and Stomach. Use Gan Cao (Licorice), Sheng Ma (Cimicifuga), Chai Hu (Bupleurum), Ren Shen (Ginseng), and Zhu Ru (Atractylodes). That is, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).