阴虚生内热,阳盛生外热,阴虚即血虚不能维阳而潮热有时,阳盛乃邪盛留连经络而发热无已时,邪传胆府
则寒热往来,邪陷血室则发热而且必语妄,热传阳明则热盛于中而神昏多汗,外热虽潮,语妄特甚。热传血分则
热煽厥阴而潮热虽微语妄一如阳明,是为热入血室,至于血瘀血枯,无论有邪无邪,皆能令女子潮热。
尺脉洪大阳陷入阴,寸大尺衰阴虚阳盛,血虚脉虚,血枯脉涩,涩大血瘀,洪数热蒸。
虚证主以逍遥散,实证主以龙胆泻肝汤,邪在胆分小柴胡汤随证加减,邪陷血室小柴胡汤加生地、丹皮,
热伏阳明白虎汤加柴胡、生地,热甚加栀、丹、川、连,热入血室四物加柴胡、栀、丹。
逍遥散
治血虚潮热月事不调,脉弦虚者。
柴胡(五分) 白芍(一钱半,汤炒) 甘草(五分) 当归(二钱) 白术(一钱半,炒) 茯苓
(一钱半) 荷叶(三钱)
水煎去渣温服。
血虚不能维阴而阳郁不伸,故潮热有时,月事涩少不调焉。当归养血脉以荣冲任,白芍敛营阴以和肝脾,
柴胡疏腠解郁,甘草和胃缓中,白术健脾土以生血,茯苓清治节以和中,加以荷叶之升阳和胃,水煎温服,务使
经血内充,则虚阳退藏而潮热自解,何患经水涩少月事不调乎。
地骨皮散
治血风气虚,寒热经少,脉弦虚浮者。
地骨皮(一两) 柴胡(五钱) 桑皮(五钱) 前胡(三钱) 人参(六钱) 黄 (一两,蜜炙)
五茄(一两) 白芍(一两,炒) 枳壳(一两,炒) 炙草(一两) 桂心(五钱) 茯苓(一两)
为散生姜三片,水煎三钱温服。
血风气虚,营卫不振,故寒热无时,经水涩少不行焉。人参扶元以通血脉,黄 补气以益卫阳,前胡散风解表,
柴胡疏腠达
邪,白芍敛营阴以资冲任,桂心温营血以散外邪,地骨皮清肌退热,桑白皮清肺肃金,炙草缓中和胃,枳壳化滞
宽胸,茯苓清治节,五茄理经络,生姜温卫气以散外邪也。煎散温服,俾气充邪解,则营卫调而寒热解,经水可
无涩少不行之患矣。
柴胡散
治寒热经少,体瘦肢节疼痛,脉数弦浮软涩者。
柴胡(五钱) 黄 (一两,蜜炙) 鳖甲(二两,醋炙) 白术(一两,炒) 麦冬(一两,去心)
人参(一两) 生地(三两) 赤芍(一两) 赤苓(一两) 桔梗(五钱) 枳壳(五钱,炒) 甘草(一两,炒)
地骨皮(一两) 桑皮(一两)
为散生姜一片水煎三钱,去渣服。
邪郁经府,经久不解而气虚邪陷,故寒热经少体瘦肢节疼痛焉。其原始于任劳多郁,伤气滞血而邪得留恋不
解耳。人参扶元补气,黄 补中托邪,生地滋阴生血,赤芍破血散滞,柴胡疏腠理以达邪,白术健脾土以强胃,鳖
甲滋肝阴兼散结气,麦冬润肺燥兼清心火,桑白皮清肺气,地骨皮退肌热,桔梗清咽利膈,赤苓渗湿和营,枳壳
泻滞气以宽胸,甘草缓中州以和胃,生姜温卫气而散外邪也。煎三钱温服,使郁散气充,则邪得外解而寒热自除,
肢节疼痛无不退,何体瘦经少之足患哉。
阴虚导致内热,阳盛导致外热。阴虚即是血虚,不能维系阳气,因此潮热有定时;阳盛则是邪气亢盛,留连于经络,因此发热无休止之时。邪气传入胆腑,则出现寒热往来;邪气陷入血室,则发热并且必然伴有胡言乱语、神志妄动;热邪传入阳明经,则体内热势炽盛,出现神志昏蒙、多汗,虽然体表发热如潮,但胡言乱语、神志妄动尤为严重。热邪传入血分,则煽动厥阴肝经,虽然潮热轻微,但胡言乱语与阳明病一样严重,这称为热入血室。至于血瘀或血枯,无论是否有外邪,都能导致女子出现潮热。
尺脉洪大,表示阳气陷入阴分;寸脉大而尺脉衰,表示阴虚阳盛。血虚则脉象虚弱,血枯则脉象涩滞,涩而大提示血瘀,洪数提示热蒸。
血瘀应当用破血逐瘀的方法治疗,血虚应当用补益的方法治疗,血热应当用清凉的方法解除,血枯应当用滋润的方法调养。
虚证以逍遥散为主方,实证以龙胆泻肝汤为主方,邪气在胆分用小柴胡汤随证加减,邪陷血室用小柴胡汤加生地黄、牡丹皮,热伏阳明用白虎汤加柴胡、生地黄,热甚加栀子、牡丹皮、川芎、黄连,热入血室用四物汤加柴胡、栀子、牡丹皮。
逍遥散:治疗血虚引起的潮热和月经不调,脉象弦而虚者。
组成:柴胡(五分)、白芍(一钱半,开水烫炒)、甘草(五分)、当归(二钱)、白术(一钱半,炒)、茯苓(一钱半)、荷叶(三钱)。
煎服法:水煎,去渣,温服。
机理:血虚不能维系阴液,导致阳气郁结不得舒展,所以潮热有定时,月经量少且不调。当归滋养血脉以荣养冲任二脉,白芍收敛营阴以调和肝脾,柴胡疏解腠理、解除郁结,甘草调和胃气、缓解急迫,白术健脾土以生化血液,茯苓清利治节以和中焦,加上荷叶升发阳气、调和胃气,水煎温服,务必使经血在内充盈,则虚阳退藏而潮热自然解除,何必担心经水涩少、月经不调呢?
地骨皮散:治疗血风气虚,寒热无常,月经量少,脉象弦、虚、浮者。
组成:地骨皮(一两)、柴胡(五钱)、桑白皮(五钱)、前胡(三钱)、人参(六钱)、黄芪(一两,蜜炙)、五加皮(一两)、白芍(一两,炒)、枳壳(一两,炒)、炙甘草(一两)、桂心(五钱)、茯苓(一两)。
煎服法:研为散剂,每次取三钱,加生姜三片,水煎,温服。
机理:血风气虚,营卫之气不振,所以寒热发作无定时,月经量少且不行。人参扶助元气以通血脉,黄芪补气以增益卫阳,前胡疏散风邪、解表,柴胡疏解腠理、透达邪气,白芍收敛营阴以资助冲任,桂心温养营血以驱散外邪,地骨皮清肌退热,桑白皮清肺肃降肺气,炙甘草缓急和中、调和胃气,枳壳化除滞气、宽胸,茯苓清利治节,五加皮调理经络,生姜温煦卫气以散外邪。将散剂煎煮温服,使正气充盛、邪气得解,则营卫调和而寒热解除,月经也就没有量少不行的隐患了。
柴胡散:治疗寒热无常、月经量少,身体消瘦、肢节疼痛,脉象数、弦、浮、软、涩者。
组成:柴胡(五钱)、黄芪(一两,蜜炙)、鳖甲(二两,醋炙)、白术(一两,炒)、麦冬(一两,去心)、人参(一两)、生地黄(三两)、赤芍(一两)、赤茯苓(一两)、桔梗(五钱)、枳壳(五钱,炒)、甘草(一两,炒)、地骨皮(一两)、桑白皮(一两)。
煎服法:研为散剂,每次取三钱,加生姜一片,水煎,去渣服用。
机理:邪气郁结于经脉府络,经久不解且气虚邪陷,所以出现寒热、月经量少、身体消瘦、肢节疼痛。其起因在于过度劳累和多忧思,损伤气机、阻滞血行,导致邪气留恋不解。人参扶助元气、补气,黄芪补中气、托举邪气外出,生地黄滋阴生血,赤芍破血散滞,柴胡疏解腠理以透达邪气,白术健脾土以强健胃气,鳖甲滋肝阴兼散结气,麦冬润肺燥兼清心火,桑白皮清肺气,地骨皮退肌热,桔梗清咽利膈,赤茯苓渗湿和营,枳壳泻滞气以宽胸,甘草缓中州以和胃,生姜温煦卫气而散外邪。煎煮三钱温服,使郁结解散、正气充盛,则邪气得以外解而寒热自除,肢节疼痛无不消退,又何必担忧身体消瘦、月经量少呢?
Yin deficiency generates internal heat, while Yang excess generates external heat. Yin deficiency implies blood deficiency, which fails to maintain Yang, resulting in tidal fever with a fixed timing; Yang excess means pathogenic factors are abundant and lingering in the meridians, causing continuous fever without cessation. When pathogens transmit to the Gallbladder Fu-organ, alternating chills and fever occur; when pathogens sink into the Blood Chamber (Xueshi), fever occurs accompanied by delirious speech and mental confusion. When heat transmits to the Yangming channel, intense heat accumulates internally, leading to mental stupor and profuse sweating; although the external fever is tidal, delirious speech and mental confusion are particularly severe. When heat transmits to the Blood level, it stirs up the Jueyin Liver channel; although the tidal fever is mild, delirious speech is as severe as in Yangming disease, which is termed "heat entering the Blood Chamber." As for blood stasis or blood exhaustion, regardless of the presence or absence of pathogens, both can cause tidal fever in women.
A full and large pulse at the Chi position indicates Yang sinking into Yin; a large pulse at the Cun position with a weak Chi position indicates Yin deficiency and Yang excess. Blood deficiency presents with a deficient pulse; blood exhaustion presents with a choppy pulse; a choppy and large pulse indicates blood stasis; a full and rapid pulse indicates steaming heat.
Blood stasis should be treated by resolving and purging; blood deficiency should be treated by tonifying; blood heat should be cooled and resolved; blood exhaustion should be moistened and nourished.
For deficiency syndromes, Xiaoyao San (Free Wanderer Powder) is the primary formula; for excess syndromes, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) is the primary formula. For pathogens in the Gallbladder aspect, Xiaochaihu Tang (Minor Bupleurum Decoction) is used with modifications according to symptoms. For pathogens sinking into the Blood Chamber, Xiaochaihu Tang is modified with Shengdi Huang (Rehmanniae Radix) and Mudan Pi (Moutan Cortex). For heat lurking in Yangming, Baihu Tang (White Tiger Decoction) is modified with Chai Hu (Bupleuri Radix) and Shengdi Huang. If heat is severe, Zhi Zi (Gardeniae Fructus), Mudan Pi, Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Lian Qiao (Forsythiae Fructus - *Note: Text says 'Chuan, Lian', likely referring to Chuan Lian Zi or similar, but standard interpretation often links 'Lian' to Lian Qiao or Huang Lian. Given context of clearing heat, Huang Lian Coptidis Rhizoma is probable, but strictly following text 'Chuan, Lian'. Let's assume Chuan Xiong and Huang Lian based on common pairings in heat clearing, or simply transliterate if ambiguous. However, 'Chuan' usually refers to Chuan Xiong in blood formulas, but here it's heat. 'Lian' is likely Huang Lian. Let's use Chuan Xiong and Huang Lian as per common clinical practice for this specific modification pattern in ancient texts, or stick to literal. Actually, 'Chuan, Lian' in this context of heat often implies Chuan Lian Zi (Swietenia Semen) or Chuan Xiong + Huang Lian. Given 'Zhi, Dan, Chuan, Lian', it's likely Zhi Zi, Mu Dan Pi, Chuan Xiong, Huang Lian. I will translate as Chuan Xiong and Huang Lian.*) and Huang Lian (Coptidis Rhizoma). For heat entering the Blood Chamber, Siwu Tang (Four Substances Decoction) is modified with Chai Hu, Zhi Zi, and Mudan Pi.
**Xiaoyao San (Free Wanderer Powder)**
Treats tidal fever and irregular menstruation caused by blood deficiency, with a string-like and deficient pulse.
Ingredients: Chai Hu (Bupleuri Radix) (5 fen), Baishao (Paeoniae Radix Alba) (1.5 qian, stir-fried after scalding with boiling water), Gancao (Glycyrrhizae Radix et Rhizoma) (5 fen), Danggui (Angelicae Sinensis Radix) (2 qian), Baizhu (Atractylodis Macrocephalae Rhizoma) (1.5 qian, stir-fried), Fuling (Poria) (1.5 qian), Heye (Nelumbinis Folium) (3 qian).
Preparation: Decoct in water, remove dregs, and take warm.
Mechanism: Blood deficiency fails to maintain Yin, causing Yang to stagnate and fail to extend, thus tidal fever occurs with fixed timing, and menstruation is scanty and irregular. Danggui nourishes the blood vessels to enrich the Chong and Ren vessels; Baishao astringes Ying-Yin to harmonize the Liver and Spleen; Chai Hu disperses the interstices and resolves stagnation; Gancao harmonizes the Stomach and relieves urgency; Baizhu strengthens the Spleen Earth to generate blood; Fuling clears the governance nodes to harmonize the middle; adding Heye to raise Yang and harmonize the Stomach. Decoct in water and take warm. Ensure that menstrual blood fills internally, then deficient Yang retreats and hides, and tidal fever resolves naturally. Why worry about scanty menstruation and irregular cycles?
**Digupi San (Solomon's Seal Bark Powder)**
Treats blood and Qi deficiency with wind, intermittent chills and fever, scanty menstruation, with a string-like, deficient, and floating pulse.
Ingredients: Digupi (Cortici Lycii Radicis) (1 liang), Chai Hu (Bupleuri Radix) (5 qian), Sangbai Pi (Mori Cortex) (5 qian), Qian Hu (Peucedani Radix) (3 qian), Renshen (Ginseng Radix et Rhizoma) (6 qian), Huangqi (Astragali Radix) (1 liang, honey-fried), Wuqia (Acanthopanacis Cortex) (1 liang), Baishao (Paeoniae Radix Alba) (1 liang, stir-fried), Zhike (Aurantii Fructus Immaturus) (1 liang, stir-fried), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) (1 liang), Guixin (Cinnamomi Ramulus) (5 qian), Fuling (Poria) (1 liang).
Preparation: Grind into powder. Take 3 qian, add 3 slices of fresh ginger, decoct in water, and take warm.
Mechanism: Blood and Qi deficiency with wind causes Ying and Wei Qi to be unvigorous, so chills and fever occur without fixed timing, and menstruation is scanty and obstructed. Renshen supports Yuan-Qi to unblock blood vessels; Huangqi tonifies Qi to benefit Wei-Yang; Qian Hu disperses wind and releases the exterior; Chai Hu opens the interstices to guide out pathogens; Baishao astringes Ying-Yin to support the Chong and Ren vessels; Guixin warms Ying-Blood to scatter external pathogens; Digupi clears the muscle layer and reduces fever; Sangbai Pi clears the Lung and descends Metal; Zhigancao moderates urgency, harmonizes the middle, and benefits the Stomach; Zhike transforms stagnation and widens the chest; Fuling clears the governance nodes; Wuqia regulates the meridians; fresh ginger warms Wei-Qi to scatter external pathogens. Decoct the powder and take warm. When Qi is sufficient and pathogens are resolved, Ying and Wei become harmonized, chills and fever resolve, and menstruation will not suffer from scarcity or obstruction.
**Chaihu San (Bupleurum Powder)**
Treats intermittent chills and fever, scanty menstruation, emaciation, pain in limbs and joints, with a rapid, string-like, floating, soft, and choppy pulse.
Ingredients: Chai Hu (Bupleuri Radix) (5 qian), Huangqi (Astragali Radix) (1 liang, honey-fried), Biejia (Testudinis Carapax et Plastrum) (2 liang, vinegar-fried), Baizhu (Atractylodis Macrocephalae Rhizoma) (1 liang, stir-fried), Maidong (Ophiopogonis Tuber) (1 liang, heart removed), Renshen (Ginseng Radix et Rhizoma) (1 liang), Shengdi Huang (Rehmanniae Radix) (3 liang), Chishao (Paeoniae Radix Rubra) (1 liang), Chiling (Poria with Red Host) (1 liang), Jiegeng (Platycodonis Radix) (5 qian), Zhike (Aurantii Fructus Immaturus) (5 qian, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma) (1 liang, stir-fried), Digupi (Cortici Lycii Radicis) (1 liang), Sangbai Pi (Mori Cortex) (1 liang).
Preparation: Grind into powder. Take 3 qian, add 1 slice of fresh ginger, decoct in water, remove dregs, and take.
Mechanism: Pathogens stagnate in the meridians and Fu-organs, persisting for a long time without resolution, combined with Qi deficiency and pathogen sinking, leading to chills and fever, scanty menstruation, emaciation, and pain in limbs and joints. The origin lies in overwork and excessive worry, damaging Qi and stagnating Blood, allowing pathogens to linger unresolved. Renshen supports Yuan-Qi and tonifies Qi; Huangqi tonifies the Middle and pushes pathogens out; Shengdi Huang nourishes Yin and generates Blood; Chishao breaks blood stasis and dissipates stagnation; Chai Hu opens the interstices to guide out pathogens; Baizhu strengthens Spleen Earth to strengthen the Stomach; Biejia nourishes Liver Yin and dissipates nodules; Maidong moistens the Lung and clears Heart Fire; Sangbai Pi clears Lung Qi; Digupi reduces muscle heat; Jiegeng clears the throat and benefits the diaphragm; Chiling leaches out dampness and harmonizes Ying; Zhike drains stagnant Qi to widen the chest; Gancao moderates the Central State to harmonize the Stomach; fresh ginger warms Wei-Qi and scatters external pathogens. Decoct 3 qian and take warm. When stagnation is dispersed and Qi is sufficient, pathogens are resolved externally, chills and fever are eliminated, limb and joint pains recede, and why worry about emaciation and scanty menstruation?