王叔和曰∶五崩何等类?师曰∶白崩者形如涕,赤崩者形如绛,黄崩者形如烂瓜,青崩者形如蓝色,黑崩
者形如 血。
齐仲甫曰∶受热而色赤者,谓之阳崩。受冷而色白者,谓之阴崩。五脏皆虚,五色随崩俱下。一脏虚,随
脏见色而下。其色白如涕,知肺脏之虚冷也。其色青如蓝,知肝脏之虚冷也。其色黄如烂瓜,知脾脏之虚冷也。
其色赤如绛,知心脏之虚冷也。其色黑形如肝血,知肾脏之虚冷也。五脏俱虚,五色相杂,谓之五崩。
龚云林曰:崩漏之证,有阴阳。若妇人年五十后,经止数年,忽然又行,兼腹痛,或身热口渴者曰崩,此
阴证也。若妇人年三十四十后,经行三十日,涌暴不止者曰漏,此阳证也。
慎斋按∶以上二条,序崩漏有阴阳、五色、五脏之见证也。
陈良甫曰∶妇人血崩心痛,名曰杀血心痛,由心脾血虚也。若小产去血过多而心痛者,亦虚也。用乌贼骨
炒末,醋汤下失笑散。
薛立斋曰∶血崩兼心痛者,心主血,去血过多,心无所养,以致作痛,十全汤倍参、术多服。如瘀血不行
者,失笑散。阴血耗散者,乌贼丸收敛之。
慎斋按∶以上二条,序血崩有兼心痛之证也。
许叔微曰∶治下血不止,成五色崩漏,香附是妇人仙药,醋炒为末,久服为佳。又曰∶女人以气血为主,不
知因气不先理,然后血脉不顺,即生崩带诸证。抑气散、异香四神散,大有奥理。
慎斋按∶香附味辛气温,能行十二经八脉,为血中耗气之药。妇人虚寒,气郁不舒,用之固宜。若阴虚血
热,有口干燥渴,骨蒸,五心烦热等证,而必谓妇人之仙药以用之,未免抱薪救火矣。慎之。
王叔和说:五崩(指带下病中颜色分为五种的重症)各是什么形态?老师回答说:白崩的形态像鼻涕,赤崩的形态像深红色的液体,黄崩的形态像腐烂的瓜,青崩的形态像蓝色的液体,黑崩的形态像肝血。
齐仲甫说:受热邪而颜色发红的,称为阳崩(属热证的崩漏)。受寒邪而颜色发白的,称为阴崩(属寒证的崩漏)。五脏都虚弱时,五色会随崩漏一同下行。某一脏虚弱时,就会显现该脏对应的颜色并下行。如果颜色白如鼻涕,可知是肺脏虚冷。如果颜色青如蓝色,可知是肝脏虚冷。如果颜色黄如烂瓜,可知是脾脏虚冷。如果颜色红如绛色,可知是心脏虚冷。如果颜色黑形如肝血,可知是肾脏虚冷。如果五脏都虚弱,五色混杂,就称为五崩。
龚云林说:崩漏(非经期阴道大量出血或淋漓不断)这一病症,有阴阳之分。如果妇女年过五十后,月经停止数年,忽然又行经,兼有腹痛,或者身体发热、口渴的,称为崩,这属于阴证。如果妇女年过三四十岁后,月经周期为三十天,突然涌出且不止的,称为漏,这属于阳证。
慎斋按语:以上两条,叙述了崩漏在阴阳、五色、五脏方面的见证表现。
陈良甫说:妇女患血崩(阴道大量出血)伴随心痛,名为杀血心痛,这是由于心脾两脏血虚所致。如果是小产后因失血过多而导致心痛的,也属于虚证。治疗可用乌贼骨炒成粉末,用醋汤送服失笑散(由蒲黄、五灵脂组成的方剂,具有活血祛瘀、止痛功效)。
薛立斋说:血崩兼有心痛的,因为心主血脉,失血过多导致心脏失去滋养,从而引起疼痛,应服用十全汤(由八珍汤加黄芪、肉桂组成,具有温补气血功效),增加人参、白术的用量,多服几次。如果有瘀血阻滞不行的,使用失笑散。如果是阴血耗散的情况,使用乌贼丸进行收敛固涩。
许叔微说:治疗下血不止,形成五色崩漏,香附是女性的仙药,用醋炒后研成粉末,长期服用效果很好。他又说:女人以气血为主,如果不先调理气机,然后血脉就不顺畅,就会产生崩漏、带下等各种证候。抑气散、异香四神散这两个方子,蕴含着深奥的道理。
慎斋按语:香附味辛性温,能通行十二经脉和奇经八脉,是容易耗伤气血的药物。妇女如果体质虚寒,气机郁结不畅,使用它是适宜的。但如果妇女阴虚血热,出现口干燥渴、骨蒸潮热、五心烦热等症状,却一定要称它为妇人的仙药来使用,那无异于抱薪救火。务必谨慎。
Wang Shuhe said: What are the forms of the Five Beng (severe leukorrhea characterized by five distinct colors)? The Master replied: In White Beng, the discharge resembles mucus; in Red Beng, it resembles dark red fluid; in Yellow Beng, it resembles rotten melon; in Cyan Beng, it resembles blue liquid; and in Black Beng, it resembles liver blood.
Qi Zhongfu said: When affected by heat pathogen resulting in red color, it is called Yang Beng (hemorrhage due to heat syndrome). When affected by cold pathogen resulting in white color, it is called Yin Beng (hemorrhage due to cold syndrome). When all five Zang organs are deficient, the five colors descend together with the hemorrhage. If one Zang organ is deficient, the corresponding color appears and descends. If the color is white like mucus, it indicates deficiency-cold of the Lung Zang. If the color is cyan like blue, it indicates deficiency-cold of the Liver Zang. If the color is yellow like rotten melon, it indicates deficiency-cold of the Spleen Zang. If the color is red like crimson, it indicates deficiency-cold of the Heart Zang. If the color is black resembling liver blood, it indicates deficiency-cold of the Kidney Zang. When all five Zang organs are deficient and the five colors mix, it is called Five Beng.
Gong Yunlin said: The syndromes of Beng and Lou (profuse uterine bleeding or prolonged spotting) have Yin and Yang distinctions. If a woman over fifty years old, whose menstruation has ceased for several years, suddenly resumes bleeding accompanied by abdominal pain, or fever and thirst, this is called Beng, which belongs to Yin syndrome. If a woman over thirty or forty years old, whose menstrual cycle is thirty days, experiences sudden gushing that does not stop, this is called Lou, which belongs to Yang syndrome.
Shenzhai commented: The above two passages describe the manifestations of Beng and Lou regarding Yin-Yang, five colors, and five Zang organs.
Chen Liangfu said: When a woman suffers from severe uterine bleeding accompanied by heart pain, it is named Sha Xue Xin Tong (Heart Pain Caused by Blood Loss), due to deficiency of blood in the Heart and Spleen. If heart pain occurs after miscarriage due to excessive blood loss, it is also a deficiency syndrome. Treatment involves using Cuttlefish Bone (Hai Piao Xiao, 海螵蛸) stir-fried into powder, taken with vinegar water along with Shixiao San (Pain-Relieving Powder).
Xue Lizhai said: When severe uterine bleeding is accompanied by heart pain, since the Heart governs blood vessels, excessive blood loss causes the Heart to lose nourishment, leading to pain. One should take Shiquan Tang (Ten Complete Decoction), increasing the dosage of Ginseng Root (Renshen, 人参) and Atractylodes Rhizome (Baizhu, 白术), and take it frequently. If blood stasis is not moving, use Shixiao San. If Yin-blood is scattered and depleted, use Wutou Wan (Cuttlefish Pill) to astringe and consolidate.
Shenzhai commented: The above two passages describe the syndrome of severe uterine bleeding accompanied by heart pain.
Xu Shwei said: To treat continuous lower bleeding forming Five Color Beng and Lou, Cyperi Rhizoma (Xiangfu, 香附) is the immortal herb for women. Stir-fried with vinegar and ground into powder, long-term consumption is excellent. He also said: Women rely primarily on Qi and Blood. If Qi is not regulated first, then the blood vessels will not flow smoothly, giving rise to various syndromes such as Beng, Lou, and Dai (leukorrhea). Yiqi San (Qi-Suppressing Powder) and Yixiang Sishen San contain profound principles.
Shenzhai commented: Cyperi Rhizoma is acrid and warm in nature, capable of circulating through the Twelve Meridians and Eight Extraordinary Vessels, but it is an herb that can consume Qi and Blood. It is suitable for women with deficiency-cold constitution and stagnant Qi that fails to diffuse. However, if a woman has Yin-deficiency with blood-heat, presenting symptoms such as dry mouth and throat, bone-steaming tidal fever, and five-palm heat, yet insists on calling it the "immortal herb for women" and using it indiscriminately, this is akin to carrying firewood to put out a fire. One must be cautious.