戴复庵曰∶赤白带下,皆因七情内伤,或下元虚冷,感非一端。大率下白带多,间有下赤带者,并宜顺气散,
吞镇灵丹,佐艾附丸。带下不止,成 羸者,四物加牡蛎,下固肠丸。
李氏曰∶带下有虚寒,带腥臭者,因小水淋沥不已,或崩中暴下,或产后去血过多,以致阴亏阳竭,荣气不
升,经脉凝泣,卫气下陷,精气累滞下焦,蕴积而成,白滑如涕,下流腥臭者,黄 建中汤去桂,加当归。
慎斋按∶以上六条,序妇人带下属风冷寒邪为病也。妇人带下,不止风冷邪干。自《圣惠方》以风冷入脬
络立论,巢氏以下诸家,遂无异议。岂知病邪之感不一,故以张子和湿热之论序后,当令湿热诸论参治,庶无
偏失也。
《产宝百问》曰∶未嫁女子有三病,何也?曰∶女子一病经水初下,阴中必热,或当风卧,或乘凉饮冷;
二病太冲脉盛则内热,以冷水浇洗之;三病或见丹下惊怖,或因郁怒悲哀之气击搏。三者一有所犯,后必有带
下之疾。
娄全善曰∶未嫁之女,月经初下,止而即浴以冷水,或热而当风,此室女病带下之由也。有家之妇,阴阳
过多,即伤胞络,风邪乘虚而入,胞络触冷,遂成秽液,与血水相混而下也。产后带下,由亡血过多则气脱,
伤动胞络,玉门未闭,外风袭体虚,风冷乘之,冷与热搏,则成液而下。
慎斋按∶以上二条,序室女与妇人带下之病,所感有三证之分,不外风冷客邪之伤也。
戴复庵说:赤带和白带,都是因为七情内伤,或者下元虚冷,致病原因不单一。大体上下白带较多,偶尔有下赤带的,都适宜服用顺气散,吞服镇灵丹,配合艾附丸。如果带下不止,导致身体消瘦羸弱的,用四物汤加牡蛎,服用固肠丸。
李氏说:带下有虚寒证,白带腥臭的,是因为小便淋漓不尽,或者崩中暴下(非经期大量出血),或者产后失血过多,导致阴液亏损、阳气衰竭,营气不能上升,经脉凝滞涩涩不畅,卫气下陷,精气停滞在下焦,蕴积而成病。白带白滑像鼻涕一样,流出时带有腥臭味,用黄建中汤去掉桂枝,加入当归。
慎斋按语:以上六条,叙述了妇人带下属于风冷寒邪致病的道理。妇人的带下,不仅仅是风冷邪气干扰。自从《圣惠方》以风冷侵入胞络立论以来,巢元方以下各家,都没有异议。哪里知道病邪的感受并不单一,所以将张子和关于湿热的论述排在后面,应当让湿热诸种理论参合治疗,才不会有偏颇失误。
《产宝百问》说:未出嫁的女子有三种病,是什么?回答说:第一种病是女子月经初来,阴中必然发热,有的对着风躺卧,有的乘凉喝冷饮;第二种病是太冲脉旺盛导致体内发热,用冷水浇洗;第三种病是或者见到丹毒惊吓恐怖,或者因为郁怒悲哀之气冲击搏击。这三种情况只要有一种触犯,后来必定会有带下的疾病。
娄全善说:未出嫁的女儿,月经刚来,停止后就洗冷水澡,或者天热时对着风,这是室女得带下病的原因。有家室的妇女,房事过多,就会损伤胞络,风邪乘虚而入,胞络受到寒冷刺激,于是形成秽浊液体,与血水混合而下。产后带下,是由于失血过多导致气脱,损伤胞络,玉门(阴道口)未闭合,外风侵袭体虚之身,风冷乘虚而入,冷与热搏结,就形成液体而下。
Dai Fu'an stated: Both red and white leukorrhea are caused by internal injury from the seven emotions, or deficiency-cold of the lower origin; the causes are not singular. Generally, white discharge is more common, while red discharge occurs occasionally. For both, it is appropriate to use Shunqi San (Regulate Qi Powder), swallow Zhenling Dan (Sedating Spirit Pill), and assist with Aifu Wan (Mugwort and Ligusticum Pill). If leukorrhea persists and leads to emaciation, use Siwu Tang (Four Substances Decoction) added with Oyster Shell (Mu Li), and administer Guchang Wan (Intestine-Securing Pill).
Li stated: In cases of leukorrhea with deficiency-cold, where the discharge is fishy and odorous, it is due to persistent dribbling of urine, sudden profuse uterine bleeding (Bengzhong), or excessive blood loss postpartum. This results in yin depletion and yang exhaustion, failure of Ying (Nutritive) Qi to ascend, stagnation and sluggishness of the meridians, sinking of Wei (Defensive) Qi, and accumulation of essence and turbidity in the lower jiao. The resulting discharge is white, slippery like phlegm, and flows out with a fishy odor. Treat with Huangjianzhong Tang (Yellow Middle-Jiao Replenishing Decoction), removing Cinnamon Twig (Guizhi), and adding Angelica Sinensis (Danggui).
Shenzhai commented: The above six passages describe leukorrhea in women as caused by wind-cold pathogenic factors. Women's leukorrhea is not solely caused by wind-cold interference. Since *Taiping Shenghui Fang* established the theory that wind-cold invades the uterine collaterals, scholars following Chao Yuanfang held no dissenting views. However, one must recognize that pathogenic factors vary. Therefore, Zhang Hezi’s theories on damp-heat are placed subsequently, allowing for integrated treatment with damp-heat theories to avoid bias and error.
*Chanbao Baiwen* (Hundred Questions on Childbirth Treasures) stated: There are three diseases affecting unmarried girls. What are they? First, when menstruation first begins, the vagina becomes hot; if one lies exposed to wind or drinks cold beverages while cooling down, this constitutes the first disease. Second, when the Taichong Meridian is vigorous, causing internal heat, if one washes with cold water, this is the second disease. Third, if one experiences fright and terror upon seeing carbuncles, or is struck by qi of depression, anger, or sorrow, this is the third disease. If any of these three conditions are violated, leukorrhea will inevitably develop later.
Lou Quanshan stated: For unmarried girls, if they bathe in cold water immediately after menstruation stops, or expose themselves to wind when hot, this is the cause of leukorrhea in virgins. For married women, excessive sexual activity injures the uterine collaterals; wind pathogens enter through the deficiency. When the uterine collaterals are touched by cold, turbid fluid forms and mixes with blood and water to flow downward. Postpartum leukorrhea arises from excessive blood loss leading to Qi collapse and injury to the uterine collaterals. With the vaginal opening (Yumen) still unsealed, external wind attacks the deficient body; wind-cold penetrates, and cold combats with heat, forming fluid that flows downward.
Shenzhai commented: The above two passages describe leukorrhea in virgins and married women. Although the contracted pathogens differ among three types of syndromes, they all fundamentally stem from injuries caused by wind-cold exogenous pathogens.