【歌】妇人带下有多般，风冷惊痰湿热寒，五脏三焦俱病此，七情六欲总相干。木乘土位因虚入，积滞胞门
作实看，损耗精神形体瘦，重亡津液肾源干。临经房事伤冲任，恚怒悲衰动肺肝，升举补中益气饮，涩败樗白固
真元。莫言久病医无效，识得枢机治不难，攻补寒温随症用，不须九转炼金丹。
【论】《素问》曰∶任脉为病，男子内结七疝，女子带下瘕聚。又曰∶脾传之肾，名曰疝瘕，小肠冤结而
痛出白，名曰白虫，出白溲。又曰小腹冤热，溲出白液，又曰思想无穷，所愿不得意，淫于外，入房太甚，发为白淫。
仲景曰∶妇人年五十，病下利，暮即发热，腹满小腹里急，手掌烦热，唇口干燥，此属带下，曾经半产，
瘀血在小腹不去，故唇口干燥也，温经汤。带下经水不利，小腹满痛，一月再见者，土瓜根散。妇人陷经漏下黑
不解，胶姜汤，一作胶艾汤。妇人小腹满如敦状，小便微难而不渴；生后者，此为水与血结在血室也，大黄甘遂汤。
妇人经水不利，下抵当汤。经闭不利，藏坚癖不止，中有干血，下白物，矾石圆。六十二种风，腹中血气刺痛，
红蓝花酒。妇人腹中痛，当归芍药散、小建中汤。
《良方》曰∶带下有五，由经行、产后风邪乘虚入内，传于脏
腑而致之，伤肝胆色如青泥。伤脾胃黄如烂瓜。伤心、小肠色如赤津。伤肺、大肠形如白涕。伤肾、膀胱黑如 血。
人有带脉横于腰间，如束带之状，因名曰带，故《难经》曰∶带脉者，起于季胁，回身一周。带脉为病，腹满腰溶溶，
若坐水中。《产宝》曰∶处女三病，一者经水初下，阴中热，或当风卧。怖三者有一，后必带下，神仙聚宝散。河间
曰∶带下由任脉湿热甚，津液溢而为带也。如火炼金，热极反兼火化，六月热极，则万物反出津而润泽。宜苦寒正治
之，有用辛温从治而愈者，辛能发散故也。丹溪曰∶赤属血，白属气，俱是胃中湿痰积痰，流而下渗入膀胱，宜
用升提，星、半、苍术、海石、黄柏、青黛、樗根皮之类。《家秘》曰∶大肠主津，小肠主液，清气上升，浊气下
降，则津液化为气血，而填骨髓，养五脏，充肌肤，何疾之有。其或七情内伤，六淫外感，阴阳乘戾，清浊不分，
逆于经遂，流于冲任，津液不能四布，何以奉心化赤而为血哉，故带下也。宜补中益气汤送青黛牡蛎鸡子清丸。
【脉】右手寸平尺浮，浮为阳，阳绝者，无子。若足冷带下，轻则漏下，重则崩中，皆心不荣血，肝不藏血所
致。带下六极之病，脉浮则肠鸣、腹满，紧则腹中痛，数则阴中生疮，弦则掣痛。尺寸俱虚者，漏血带下。带下漏
血脉浮恶寒者不治。
风
经行冲任已虚空，登厕乘凉易中风，浮缓头痛流鼻涕，急寻苍柏与辛芎。
苍柏辛芎散。
凉
多悲不乐足如冰，腰腹时疼呕带崩，六脉沉迟或虚火，按之无力是寒征。
酒煮当归丸。
惊
血去心虚易着惊，精神恍惚不和平，木乘土位脾家弱，脉动虚浮带已明。
归脾汤。
痰
脉滑肌肥气不清，湿痰下注带如顷，头眩呕哕兼麻木，多是痰涎里面生。
樗皮丸 重者小胃丹主之。
湿
脉缓肌黄脚面浮，腰胯沉重带长流，或时泄泻偏难溺，嗜卧肠鸣湿上求。
四神丸 双白丸 香附散。
热
阳盛阴虚火易升，煎熬津液丧元精，形衰脉数皮肤燥，口苦咽干耳内鸣。
三黄三白丸 白术丸。
寒
寒脉沉迟比冷轻，恶寒腹痛食难行，或时吐利吞酸水，足冷腰疼色不荣。
大温经丸。
虚
漏下多时内必虚，急宜补益莫踌躇，脉来细小芤微涩，乌骨鸡丸载古书。
乌骨鸡丸。
实
败精浊血滞胞门，气积痰凝作实论，腹内坚疼脉弦实，石瘕 癖及贲豚。
露丸。
漏带
带下如同经水来，半年三月一当灾，健脾补气兼收涩，不禁安能得受胎。
白马蹄丸 樗皮丸。
附方
地榆膏治赤白带骨立者。
针灸
三阴交穴在内踝上三寸，天枢在脐旁二寸，气海在脐下一寸半，血海二穴在膝膑上内廉，中枢在脐下四寸，
丰隆在外踝上八寸，水道在天巨下三寸。
【歌诀】妇女带下病有多种类型，由风、冷、惊、痰、湿、热、寒等邪气引起，五脏和三焦都会发生此病，七情和六欲也都与之相关。肝木乘克脾土，因正气虚弱而入内；积滞阻滞胞宫，当作实证看待。精神耗损导致形体消瘦，津液严重亏损致使肾源枯竭。经期或房事损伤冲脉和任脉，愤怒悲伤动摇肺脏和肝脏。治疗应使用升举补中益气饮，以及用樗白皮涩精固摄以巩固真元。不要说久病难医无效，只要识得病机关键，治疗就不难。攻法、补法、寒法、温法随症状选用，不需要通过九转炼丹来求取金丹。
【论述】《素问》说：任脉发病，男子体内结聚成七种疝气，女子则患带下病及瘕聚（腹内结块）。又说：脾病传变至肾，称为疝瘕，小肠冤结而痛，排出白色液体，称为白虫，从尿中排出白色分泌物。又说小腹有冤热感，小便排出白色液体。又说思虑无穷，愿望不能实现，淫念外溢，房事过度，引发白淫（指男女交合时流出的精液，或指白带异常）。张仲景说：妇女五十岁，患下利，傍晚发热，腹部胀满，小腹拘急疼痛，手掌烦热，嘴唇口舌干燥，这属于带下病范畴，曾经半产（流产），瘀血留在小腹未去，所以嘴唇口舌干燥，用温经汤。带下病导致月经不畅，小腹满痛，一个月来两次月经的，用土瓜根散。妇人陷经漏下黑色血液不止，用胶姜汤（一作胶艾汤）。妇人小腹胀满像敦（古代食器）一样，小便微难但不口渴；产后出现的，这是水和血结在血室（子宫），用大黄甘遂汤。妇人月经不畅，用抵当汤。经闭不通，脏腑内有坚癖（硬块）不止，中有干血，排出白色分泌物，用矾石丸。六种风邪引起的腹中血气刺痛，用红蓝花酒。妇人腹中痛，用当归芍药散、小建中汤。
《良方》说：带下有五种，由经期或产后风邪乘虚侵入体内，传变到脏腑而导致。伤肝胆，颜色如青泥；伤脾胃，颜色如烂瓜；伤心、小肠，颜色如赤津（红色津液）；伤肺、大肠，形状如白涕；伤肾、膀胱，颜色如黑血。人体带脉横于腰间，像束带一样，因此名为带脉，所以《难经》说：带脉，起于季胁，环绕身体一周。带脉发病，腹部胀满，腰部松软无力，好像坐在水中。《产宝》说：处女有三病，一是月经初下时阴中发热，二是吹风后卧睡，三是恐惧，这三种情况有一种，后来必然患带下病，用神仙聚宝散。刘河间说：带下是由于任脉湿热严重，津液溢出成为带下。就像火炼金，热极反而兼有火化现象，六月热极，万物反而渗出津液而润泽。宜用苦寒药正治，有用辛温药从治而痊愈的，因为辛味能发散的缘故。朱丹溪说：赤色属血，白色属气，都是胃中湿痰积痰，流向下渗入膀胱，宜用升提法，用药如半夏、天南星、苍术、海浮石、黄柏、青黛、樗根皮之类。《家秘》说：大肠主津，小肠主液，清气上升，浊气下降，则津液化为气血，从而填充骨髓，滋养五脏，充实肌肤，会有什么疾病呢？如果七情内伤，六淫外感，阴阳乖戾，清浊不分，逆乱于经络，流注于冲任二脉，津液不能四布，怎么能奉心化赤而为血呢？所以产生带下病。宜用补中益气汤送服青黛牡蛎鸡子清丸。
【脉诊】右手寸脉平，尺脉浮，浮为阳脉，阳绝者，无子。如果足冷带下，轻则漏下，重则崩中，都是心不荣血，肝不藏血所致。带下病的六极之病，脉浮则肠鸣、腹满，脉紧则腹中痛，脉数则阴中生疮，脉弦则掣痛。尺寸脉俱虚者，漏血带下。带下漏血脉浮且恶寒者，预后不良（不治）。
风证：经期冲任已空虚，登厕乘凉易中风，出现浮缓脉，头痛流鼻涕，急需使用苍柏与辛芎。方用苍柏辛芎散。
凉证：多悲不乐，双脚如冰，腰腹时常疼痛，呕吐带下崩漏，六脉沉迟或见虚火，按之无力是寒象。方用酒煮当归丸。
惊证：失血后心虚易受惊吓，精神恍惚不安，木乘土位脾家弱，脉动虚浮带下已明显。方用归脾汤。
痰证：脉滑肌肉肥盛，气不清爽，湿痰下注带下如倾，头眩呕哕兼麻木，多是痰涎内生。方用樗皮丸，重者用小胃丹主治。
湿证：脉缓肌肉发黄，脚面浮肿，腰胯沉重带下长流，有时泄泻偏难排尿，嗜卧肠鸣，从湿证求治。方用四神丸、双白丸、香附散。
热证：阳盛阴虚火易升，煎熬津液丧失元精，形体衰败脉数皮肤燥，口苦咽干耳内鸣。方用三黄三白丸、白术丸。
寒证：寒脉沉迟比冷轻，恶寒腹痛饮食难行，有时吐利吞酸水，足冷腰疼面色不荣。方用大温经丸。
虚证：漏下时间长内部必虚，急宜补益莫踌躇，脉来细小芤微涩，乌骨鸡丸载于古书。方用乌骨鸡丸。
实证：败精浊血滞于胞门，气积痰凝作实证论，腹内坚疼脉弦实，石瘕、癖及贲豚。方用露丸。
漏带：带下如同经水来，半年三月一当灾，健脾补气兼收涩，不禁安能得受胎。方用白马蹄丸、樗皮丸。
针灸：三阴交穴在内踝上三寸，天枢在脐旁二寸，气海在脐下一寸半，血海两穴在膝膑上内侧，中枢在脐下四寸，丰隆在外踝上八寸，水道在天巨下三寸。
[Verse]
Leukorrhea in women manifests in various patterns, caused by wind, cold, fright, phlegm, dampness, heat, and cold pathogens. The five zang organs and the three jiao can all be affected by this disease; seven emotions and six desires are also closely involved. Liver wood overacting on spleen earth enters due to deficiency; stagnation obstructs the uterus and should be viewed as an excess condition. Consumption of spirit leads to emaciation; severe loss of body fluids dries up the kidney source. Menstruation or sexual intercourse damages the Chong and Ren vessels; anger and sorrow disturb the lung and liver. Treatment should employ Shengju Buzhong Yiqi Yin (Elevating and Supplementing Middle Qi Decoction), and use Chubai (Cortex Phellodendri Amurensis / Pterocarpus bark) to astringe essence and consolidate true yuan. Do not say that chronic diseases are incurable; once the key mechanism is understood, treatment is not difficult. Attack, tonify, cool, and warm methods are used according to symptoms; there is no need to refine nine-turn golden elixirs.
[Dissertation]
The *Suwen* states: When the Ren vessel is diseased, men develop internal accumulations known as the seven types of hernia, while women suffer from leukorrhea and zhajuj (abdominal masses). It further states: Spleen disease transmitting to the kidney is called shanjia (hernia and mass); small intestine grievous knotting causes pain and discharge of white fluid, termed "white worm," excreted with urine. It also states: Grievous heat in the lower abdomen causes white fluid to exit with urine. It states: Endless thoughts, unfulfilled desires, external lust, and excessive sexual activity lead to "baiyin" (white turbidity/leukorrhea). Zhang Zhongjing states: A fifty-year-old woman suffering from diarrhea, evening fever, abdominal fullness, urgency and pain in the lower abdomen, vexatious heat in the palms, and dry lips and mouth belongs to the category of leukorrhea. This is because she previously suffered a miscarriage, and blood stasis remains in the lower abdomen, causing dry lips and mouth; treat with Wenjing Tang (Warming the Menses Decoction). For leukorrhea accompanied by irregular menstruation, lower abdominal fullness and pain, and menstruation occurring twice a month, use Tuguagen San (Trichosanthes Root Powder). For women with sinking menses and black leakage that does not resolve, use Jiaojiang Tang (Gelatin and Ginger Decoction, alternatively Jiao'ai Tang). For women with lower abdominal fullness like a dun (ancient vessel), slight difficulty urinating but no thirst; if occurring postpartum, this is water and blood binding in the blood chamber (uterus); treat with Dahuang Gansui Tang (Rhubarb and Kansui Decoction). For women with irregular menstruation, use Didang Tang (Lower the Great Decoction). For amenorrhea with irregularity, persistent hard masses in the viscera, dry blood inside, and discharge of white matter, use Fanshi Yuan (Alum Pill). For six types of wind causing stabbing pain in the abdomen from blood and qi, use Honglanhua Jiu (Safflower Wine). For abdominal pain in women, use Danggui Shaoyao San (Angelica and Peony Powder) or Xiao Jianzhong Tang (Minor Construct the Middle Decoction).
*Liangfang* states: There are five types of leukorrhea, caused by wind pathogens entering the interior due to deficiency during menstruation or postpartum, transmitting to the zang-fu organs. Injury to the Liver and Gallbladder results in color like green mud; injury to the Spleen and Stomach results in color like rotten melon; injury to the Heart and Small Intestine results in color like red fluid; injury to the Lung and Large Intestine resembles white nasal mucus; injury to the Kidney and Bladder results in color like black blood. The Dai vessel (Girdle Vessel) crosses horizontally at the waist, resembling a belt, hence its name. Thus, the *Nan Jing* states: The Dai vessel originates from the hypochondrium and circles the body. Disease of the Dai vessel presents with abdominal fullness and loose, weak sensation in the waist, as if sitting in water. *Chanbao* states: Virgins have three conditions: first, heat in the vagina when menstruation begins; second, lying exposed to wind; third, fear. If any one of these occurs, leukorrhea will inevitably follow; treat with Shenxian Jubao San (Immortal's Treasure-Gathering Powder). Liu Hejian states: Leukorrhea is caused by severe damp-heat in the Ren vessel, where body fluids overflow to become leukorrhea. Like fire smelting gold, extreme heat reverses into fire transformation; in the sixth month of extreme heat, all things secrete moisture. Treat with bitter-cold herbs directly; some recover using acrid-warm herbs following the method, because acrid flavors can disperse. Zhu Danxi states: Red indicates blood, white indicates qi; both are damp-phlegm accumulated in the stomach, flowing downward and infiltrating the bladder. Elevate and lift using herbs such as Banxia (Pinellia Rhizome), Tian Nanxing (Arisaema Rhizome), Cangzhu (Atractylodes Rhizome), Haishi (Fossil Shell), Huangbai (Phellodendron Bark), Qingdai (Indigo Naturalis), and Chugenpi (Bark of Pterocarpus indicus). *Jiami* states: The Large Intestine governs fluids, and the Small Intestine governs liquids. Clear qi ascends, turbid qi descends, so fluids transform into qi and blood, filling the marrow, nourishing the five zang organs, and filling the skin and muscles. What disease would there be? However, if internal injury by seven emotions, external contraction of six pathogenic factors, yin-yang rebellion, confusion of clear and turbid, reversal in meridians, and flow into the Chong and Ren vessels occur, body fluids cannot distribute to the four extremities. How can they assist the heart in transforming red to become blood? Thus, leukorrhea arises. Treat with Buzhong Yiqi Tang (Supplement the Middle and Boost Qi Decoction) administered with Qingdai Muli Jizi Qing Wan (Indigo, Oyster Shell, and Egg White Pill).
[Pulse Diagnosis]
Right hand Cun pulse is level, Chi pulse is floating. Floating indicates yang; yang exhaustion means infertility. If feet are cold with leukorrhea, mild cases present as leakage, severe cases as metrorrhagia; all are caused by the Heart failing to nourish blood and the Liver failing to store blood. In the six extremes of leukorrhea disease: floating pulse indicates borborygmus and abdominal fullness; tight pulse indicates abdominal pain; rapid pulse indicates ulcers in the vagina; wiry pulse indicates pulling pain. Empty pulses at Cun and Chi indicate blood leakage and leukorrhea. Leukorrhea with leakage, floating pulse, and aversion to cold indicates a hopeless prognosis.
Wind Syndrome: During menstruation, the Chong and Ren vessels are empty; ascending the toilet and exposing oneself to coolness easily invites wind. With a floating-slow pulse, headache, and runny nose, urgently seek Cang'er and Xinxiong. Formula: Cangbai Xinxiong San (Cangzhu, Phellodendron, Asarum, and Ligusticum Powder).
Cool Syndrome: Much sadness and unhappiness, feet like ice, intermittent pain in waist and abdomen, vomiting with leukorrhea and metrorrhagia. Six pulses are deep-slow or show deficient fire; pressing reveals weakness, indicating cold signs. Formula: Jiuzhu Danggui Wan (Wine-Processed Angelica Pill).
Fright Syndrome: Blood loss leads to Heart deficiency and easy fright; spirit is恍惚 (fluctuating/unstable) and unpeaceful. Wood overacts on Earth, Spleen is weak; pulsation is deficient-floating, confirming leukorrhea. Formula: Guipi Tang (Restore the Spleen Decoction).
Phlegm Syndrome: Slippery pulse, obese flesh, unclear qi; damp-phlegm pours downward causing profuse leukorrhea; dizziness, vomiting, numbness; mostly caused by internal generation of phlegm-fluids. Formula: Chupi Wan (Pterocarpus Bark Pill). Severe cases treated with Xiaowei Dan (Minor Stomach Pill).
Dampness Syndrome: Slow pulse, yellow flesh, edema on insteps; heavy waist and hips, continuous leukorrhea; occasional diarrhea, difficult urination, lethargy, borborygmus; seek treatment for dampness. Formulas: Sishen Wan (Four Spirits Pill), Shuangbai Wan (Double White Pill), Xiangfu San (Cyperus Powder).
Heat Syndrome: Yang excess, Yin deficiency, fire rises easily; boiling body fluids, losing original essence; emaciation, rapid pulse, dry skin, bitter taste, dry throat, tinnitus. Formulas: Sanhuang Sanbai Wan (Three Yellows Three Whites Pill), Baizhu Wan (Atractylodes Macrocephala Pill).
Cold Syndrome: Cold pulse deep-slow, lighter than cold sensations; aversion to cold, abdominal pain, poor digestion; occasional vomiting/diarrhea, acid regurgitation, cold feet, back pain, dull complexion. Formula: Dawenjing Wan (Great Warming Menses Pill).
Deficiency Syndrome: Long-term leakage implies internal deficiency; urgently tonify and supplement without hesitation. Pulse is fine, small, knifelike, minute, or choppy; Wuguji Wan (Black Bone Chicken Pill) is recorded in ancient texts. Formula: Wuguji Wan.
Excess Syndrome: Refined essence and turbid blood stagnate in the uterine gate; qi accumulation and phlegm condensation constitute excess. Hard pain in abdomen, wiry-excess pulse; shijia (stone fibroid), piji (masses), and benpeng (wandering qi). Formula: Lu Wan (Dew Pill).
Leakage and Leukorrhea: Leukorrhea flows like menstrual blood; disaster strikes every half-year or three months. Strengthen Spleen, boost Qi, and astringe; without control, how can conception occur? Formulas: Baimati Wan (White Horse Hoof Pill), Chupi Wan.
Attached Formulas: Diyugao (Sanguisorba Paste) treats red and white leukorrhea with emaciation.
Acupuncture: Sanyinjiao (SP6) is 3 cun above the medial malleolus; Tianshu (ST25) is 2 cun lateral to the umbilicus; Qihai (CV6) is 1.5 cun below the umbilicus; Xuehai (SP10) consists of two points on the medial aspect above the patella; Zhongshu (CV12 - Note: Text says Zhongshu CV4 Guanyuan usually, but text says CV4 under umbilicus 4 cun, likely referring to Guanyuan/CV4 or similar midline point, strictly translating text location) is 4 cun below the umbilicus; Fenglong (ST40) is 8 cun above the lateral malleolus; Shuidao (ST28) is 3 cun below Tianchu (likely Tianshu ST25).