武叔卿曰∶当归芍药汤,治妇人经脉漏下不止,其色鲜红,先因劳役,脾胃虚弱,气短气逆,自汗不止,
身热闷乱,恶见饮食,四肢倦怠,大便时溏。东垣制此方一服后,诸证悉去。大抵因劳役下血,若拘血热之说,
用四物加黄芩则不愈矣。盖血虚须兼补气,譬之血犹水也,气犹堤也,堤坚则水不横决,气固则血不妄行,自然
之理也。黄 最多,白术次之,四物兼生熟地,以陈皮、甘草、柴胡佐之。俗医不达此理,专用凉药,不知凉
药伤胃,服久则正气愈弱,血安得固,故特表而出之。
武叔卿曰∶东垣云,血脱益气,古法也。先补胃气,以助生长,故曰阳生阴长。诸甘药为之先务,举世皆
以为补气,殊不知甘能生血,此阳生阴长之理也,故先理胃气。人之一身,内谷为宝,补中益气方加神曲、黄
芩,名益胃升阳汤,以起妇人崩血之属气下陷者。
武叔卿曰∶升阳除湿汤,治女子漏下恶血,或暴崩不止。夫土陷则湿,故怠惰嗜卧。木郁则热,故气上冲。
缓为湿之微,弦为木之象,郁而不伸则热,此心火乘脾也。脉之洪大者,火在下也。胞络为相火,寄于命门,
为多血之经。病从火,心火以藏德为神,相火听命于心。三焦主气,胞络主血,故血分之火专主胞络,气分之
火专主三焦。郁则火不得遂炎上之性,迫于血分,故阴络伤也。方以苍术、升麻,发太阳阳明之湿;柴胡、防
风,达厥阴少阳之木;羌活、 本,以升举少阴太阳下部之郁,所谓下者举之也。但升散之物,过则耗气而伤
金,故又以黄 保肺,当归引血,使各有所归。甘草和气,蔓荆凉血。此四种者,又制亢害之法也。
武叔卿说:当归芍药汤,用于治疗妇人经血淋漓不尽不止,血色鲜红。这通常是因为过度劳累劳损,导致脾胃虚弱,出现气短、气逆、自汗不止、身体发热且心中烦闷扰乱、厌恶饮食、四肢倦怠无力、大便时常稀溏等症状。李东垣制定了这个方子,服用一剂后,各种症状全部消除。大抵因为劳累劳损导致的下血,如果拘泥于“血热”的说法,使用四物汤加上黄芩,则不会痊愈。这是因为血虚必须兼补气,比喻来说,血就像水,气就像堤坝,堤坝坚固则水不会泛滥横决,气固摄有力则血不会妄行乱跑,这是自然的道理。方中黄芪用量最多,白术次之,配合四物汤(包含生地黄和熟地黄),再用陈皮、甘草、柴胡来辅助。世俗医生不明白这个道理,专门使用寒凉药物,不知道寒凉药会损伤胃气,服用久了正气更加虚弱,血液怎么能固摄得住呢?所以特意阐明并指出这一点。
武叔卿说:李东垣认为,“血脱益气”是古来的法则。先补益胃气,以助益气血的生长,所以说“阳生阴长”。各种甘味药是首要任务,世人都以为甘味药只是补气,却不知道甘味也能生血,这就是“阳生阴长”的道理,所以先调理胃气。人的一身,以内谷(水谷精微)为宝,在补中益气方中加入神曲、黄芩,名为益胃升阳汤,用来治疗属于气下陷类型的妇人崩漏出血。
武叔卿说:升阳除湿汤,用于治疗女子漏下恶血,或者突然大量出血不止。脾土下陷则生湿,所以人会怠惰嗜睡。肝木郁结则化热,所以会有气上冲的感觉。脉象缓是湿邪轻微的表现,脉象弦是肝木的征象,郁结而不能舒展则产生热,这是心火乘袭脾土所致。脉象洪大的,说明火在下焦。胞络(子宫及其脉络)寄居于命门,属于相火,是多血的经脉。病由火引起,心火以藏守神明为德性,相火听从心火的命令。三焦主司气,胞络主司血,所以血分中的火专门主管胞络,气分中的火专门主管三焦。郁结则火不能顺从其炎上的本性,被迫郁于血分,所以导致阴络受伤。方中使用苍术、升麻,发散太阳经和阳明经的湿气;柴胡、防风,疏达厥阴经和少阳经的肝木之气;羌活、藁本,升举少阴经和太阳经下部郁结的气机,这就是所谓“下者举之”的方法。但是升散的药物,过量则会耗气并损伤肺金,所以又用黄芪保护肺气,当归引导血液,使气血各归其位。甘草调和气机,蔓荆子凉血。这四种药物,又是制约亢盛危害的方法。
Wu Shuqing stated: Danggui Shaoyao Tang (Angelica and Peony Decoction) is used to treat women with continuous metrorrhagia, where the blood color is bright red. This condition typically arises from overexertion and fatigue, leading to Spleen-Stomach deficiency, accompanied by shortness of breath, rebellious Qi, spontaneous sweating, fever with mental restlessness, aversion to food, limb fatigue, and loose stools. Li Dongyuan formulated this prescription; after one dose, all symptoms resolve. Generally speaking, for bleeding due to overexertion, if one adheres strictly to the theory of "Blood Heat" and uses Siwu Tang (Four Substances Decoction) added with Huangqin (Scutellaria Root), it will not be effective. This is because when Blood is deficient, Qi must also be supplemented. Metaphorically, Blood is like water, and Qi is like a dike; if the dike is firm, water does not burst forth recklessly; if Qi is consolidated, Blood does not flow recklessly. This is the natural principle. In this formula, Huangqi (Astragalus Root) is used in the largest quantity, followed by Baizhu (Atractylodes Macrocephala Rhizome). It combines Siwu Tang (which includes Shengdi Huang [Rehmannia Root] and Shudi Huang [Prepared Rehmannia Root]), assisted by Chenpi (Tangerine Peel), Gancao (Licorice Root), and Chaihu (Bupleurum Root). Unlearned physicians do not understand this principle and exclusively use cold-natured medicines, unaware that cold medicines damage Stomach Qi. Prolonged use further weakens Healthy Qi, making it impossible for Blood to be consolidated. Therefore, I specifically highlight this point.
Wu Shuqing stated: Li Dongyuan said, "Tonifying Qi in cases of Blood loss" is an ancient method. First tonify Stomach Qi to assist growth, hence it is said that "Yang generates Yin." Sweet-flavored herbs are the primary task; although the world believes sweet flavors only tonify Qi, they actually generate Blood, illustrating the principle of "Yang generating Yin." Thus, regulating Stomach Qi comes first. The human body treasures internal Grain Essence. By adding Shenqu (Medicated Leaven) and Huangqin (Scutellaria Root) to Buzhong Yiqi Tang (Midway-Boosting Qi-Supplementing Decoction), it becomes Yiwei Shengyang Tang (Stomach-Nourishing Yang-Raising Decoction), used to treat metrorrhagia in women caused by Qi sinking downward.
Wu Shuqing stated: Shengyang Chushi Tang (Yang-Raising Dampness-Removing Decoction) treats women with leukorrhea mixed with foul blood or sudden severe metrorrhagia. When Earth (Spleen) sinks, Dampness arises, leading to lethargy and a desire to lie down. When Wood (Liver) is depressed, Heat arises, leading to a sensation of Qi rushing upward. A slow pulse indicates slight Dampness; a wiry pulse indicates Wood. Depression without expansion generates Heat, which is Heart Fire invading the Spleen. A surging and large pulse indicates Fire in the Lower Jiao. The Bao Luo (Uterine Collaterals) houses Ministerial Fire and resides in the Mingmen (Gate of Life); it is a vessel abundant in Blood. Pathology stems from Fire. Heart Fire governs Spirit through its virtue of containment, while Ministerial Fire obeys Heart Fire. The Sanjiao (Triple Burner) governs Qi, and Bao Luo governs Blood. Therefore, Fire in the Blood level specifically governs Bao Luo, while Fire in the Qi level specifically governs the Sanjiao. When depressed, Fire cannot follow its nature to flare upward and is forced into the Blood level, injuring the Yin collaterals. The formula uses Cangzhu (Atractylodes Lancea Rhizome) and Shengma (Cimicifuga Rhizome) to disperse Dampness in the Taiyang and Yangming channels; Chaihu (Bupleurum Root) and Fangfeng (Saposhnikovia Root) to unblock the Jueyin and Shaoyang channels; Qianghuo (Notopterygium Rhizome) and Gaoben (Ligusticum Sinense Rhizome) to raise depression in the lower parts of the Shaoyin and Taiyang channels, which is the method of "raising what has sunk." However, ascending and dispersing substances, if overused, consume Qi and damage Metal (Lungs). Therefore, Huangqi (Astragalus Root) is used to protect the Lungs, and Danggui (Angelica Sinensis Root) guides Blood, ensuring both return to their proper places. Gancao (Licorice Root) harmonizes Qi, and Manjingzi (Vernonia Seed) cools Blood. These four agents constitute the method of restraining excessive harm.