《医垒元戎》曰∶女子经病血崩,久而成枯者,宜涩之益之。血闭久而成竭者,宜益之破之。破血有三治,
始则四物入红花,调黄 、肉桂;次则四物入红花,调鲮鲤甲、桃仁、桂、童便,和酒煎服;末则四物入红花,
调易老没药散。
慎斋按∶以上四条,序治血崩用药之大法也。
武叔卿曰∶血藏于肝,肝气不升,则热迫于下,故血不能藏而崩也。况厥阴之经环阴器,廷孔、前阴皆属之。
荆芥升肝气,香附理肝气,条芩除内热,四物养血凉血,故能收功也。
武叔卿曰∶河间生地黄散,治经漏不止,脉虚洪,经水紫黑。夫脉虚洪者,气不足也。紫黑者,热之甚也。
黄所以补气,气盛则
生火,天冬、地骨以清气中之火。熟地所以生血,血生而不凉。尤虑妄行,故以生地、黄连凉心,芍药、甘草
缓肝益脾,柴胡升举,枸杞、地黄,又肝肾同归者也。
武叔卿曰∶凉血地黄汤,治妇人血崩不止,肾水阴虚,镇守包络相火,血走而崩。夫阴者,从阳而亟起也。
血属阴,阴不自升。故诸经之血,必随诸经之气而后升。若气有所陷,则热迫血而内崩矣,故用黄柏以清下焦
胞络之火。心者,火之主也。故以生地、黄连,治火之原;知母、黄芩,滋水之母;归尾破瘀,红花生血,所谓
去故生新也。川芎行血海之余,蔓荆凉诸经之血,升、柴、防、羌、 本、细辛诸风药,皆所以升诸经之气也。
诸经气行,则阴血不得不随之而起矣,故曰从阳亟起也,有是证者法之。
慎斋按∶血崩不止,则去血过多矣。方中风药,大半不敌生地一味,独不虑风药燥血乎。虽云升举,而血
之耗者已多,用方者酌之。
《医垒元戎》说:女子月经病导致血崩,日久造成阴血枯竭的,应当用收敛固涩的方法并加以补益。血闭阻日久造成气血衰竭的,应当先补益后破瘀通经。破血治疗分为三个阶段:初期使用四物汤加入红花,配合黄柏、肉桂调服;中期使用四物汤加入红花,配合穿山甲、桃仁、桂枝、童子尿,加酒煎煮服用;末期使用四物汤加入红花,配合罗东逸的没药散调服。
武叔卿说:血液贮藏于肝脏,肝气不能升发,则热气逼迫向下,所以血液不能藏纳而崩漏。况且足厥阴肝经环绕生殖器,廷孔(尿道口)、前阴都属于肝经所主。荆芥能升发肝气,香附能调理肝气,黄芩能清除内热,四物汤能养血凉血,所以能够取得疗效。
武叔卿说:刘河间的生地黄散,治疗月经淋漓不止,脉象虚大无力,经血颜色紫黑。所谓脉象虚大,是因为气不足。经血紫黑,是因为热邪极盛。黄芪用来补气,气旺盛则容易生火,所以用天冬、地骨皮来清泄气分中的火热。熟地黄用来生血,但血生出来如果不凉润,更担心血液妄行,所以用生地黄、黄连来清心火,芍药、甘草来舒缓肝气并补益脾气,柴胡升举阳气,枸杞、地黄则是肝肾同补的药物。
武叔卿说:凉血地黄汤,治疗妇人血崩不止,这是肾水阴虚,无法镇守包络相火,导致血液妄行而崩漏。阴血依附于阳气才能迅速升起。血液属于阴类,阴血自身不能升发。所以各条经脉的血液,必须跟随各条经脉的气机而后才能升发。如果气机下陷,则热气逼迫血液在内侧崩漏,所以用黄柏来清泄下焦胞宫经络的火邪。心是火的主宰,所以用生地黄、黄连来治火的根源;用知母、黄芩滋补肾水之母(金生水,肺为肾之母,此处指通过滋阴清热以保肾水);当归尾破瘀血,红花生新血,这就是所谓的去旧生新。川芎运行血海之余滞,蔓荆子凉各经之血,升麻、柴胡、防风、羌活、藁本、细辛等风药,都是用来升发各条经脉之气的方法。各条经脉之气运行通畅,则阴血不得不随之升起,所以说“从阳而起”。有这种证候的人,按照此法治疗。
慎斋按语:血崩不止,就会流失过多的血液。方剂中的风药,数量大半抵不过一味生地黄,难道不担心风药燥烈伤血吗?虽然说是升举阳气,但血液的耗损已经很多了,使用此方的医生请酌情考虑。
Yi Lei Yuan Rong (Fortress of Medical Records) states: For women with menstrual disorders leading to metrorrhagia (uterine bleeding), if the condition persists and leads to blood exhaustion, astringent methods should be used to consolidate and tonify. If blood stasis persists and leads to depletion, tonification should be followed by blood-breaking methods. Blood-breaking treatment has three stages: initially, Si Wu Tang (Four Substances Decoction) is combined with Hong Hua (Safflower), adjusted with Huang Bo (Phellodendron Bark) and Rou Gui (Cinnamon Bark); secondly, Si Wu Tang (Four Substances Decoction) is combined with Hong Hua (Safflower), adjusted with Ling Li Jia (Pangolin Scales), Tao Ren (Peach Kernel), Gui Zhi (Cinnamon Twig), and Tong Bian (Child's Urine), decocted with wine; finally, Si Wu Tang (Four Substances Decoction) is combined with Hong Hua (Safflower), adjusted with Luo Dongyi's Moyao San (Myrrh Powder).
Shen Zhai notes: The above three points outline the general principles for prescribing medication to treat metrorrhagia.
Wu Shuqing says: Blood is stored in the Liver. When Liver Qi fails to ascend, heat forces blood downward, causing it to fail to remain contained and resulting in metrorrhagia. Moreover, the Foot Jueyin Liver Meridian encircles the external genitalia; the urethral opening (Ting Kong) and anterior yin belong to this meridian. Jing Jie (Schizonepeta) ascends Liver Qi, Xiang Fu (Cyperi Rhizoma) regulates Liver Qi, Tiao Qin (Scutellaria Baicalensis Root) clears internal heat, and Si Wu Tang (Four Substances Decoction) nourishes and cools blood, thus achieving therapeutic success.
Wu Shuqing says: He Jian's Sheng Di Huang San (Rehmannia Root Powder) treats persistent menorrhagia with a deficient and large pulse, and dark purple menstrual blood. A deficient and large pulse indicates insufficient Qi. Dark purple color indicates severe heat. Huang Qi (Astragalus) tonifies Qi; when Qi is abundant, it may generate fire, so Tian Dong (Asparagus Root) and Di Gu Pi (Lycium Bark) are used to clear heat from the Qi level. Shu Di Huang (Prepared Rehmannia Root) generates blood, but if the generated blood is not cooled, there is fear of reckless movement. Therefore, Sheng Di Huang (Raw Rehmannia Root) and Huang Lian (Coptis Rhizome) are used to cool the Heart; Shao Yao (Peony Root) and Gan Cao (Licorice Root) soothe the Liver and benefit the Spleen; Chai Hu (Bupleurum Root) lifts Yang; Gou Qi Zi (Goji Berry) and Di Huang (Rehmannia Root) nourish both the Liver and Kidney.
Wu Shuqing says: Liang Xue Di Huang Tang (Cool Blood and Rehmannia Decoction) treats persistent metrorrhagia in women due to Kidney Water Yin Deficiency, failing to suppress the Minister Fire of the Pericardium, causing blood to rush and bleed. Yin relies on Yang to rise rapidly. Blood belongs to Yin, and Yin cannot ascend independently. Therefore, blood in all meridions must follow the Qi of those meridians to ascend. If Qi sinks, heat forces blood to burst internally, so Huang Bo (Phellodendron Bark) is used to clear fire in the Lower Jiao and Uterine Collaterals. The Heart is the master of Fire. Thus, Sheng Di Huang (Raw Rehmannia Root) and Huang Lian (Coptis Rhizome) treat the root of fire; Zhi Mu (Anemarrhena Rhizome) and Huang Qin (Scutellaria Root) nourish the mother of Water (Kidney); Dang Gui Wei (Angelica Sinensis Tail) breaks stasis, Hong Hua (Safflower) generates new blood, which is the principle of "removing the old to generate the new." Chuan Xiong (Ligusticum Rhizome) moves residual blood in the Sea of Blood; Man Jing Zi (Vernonia Fruit) cools blood in various meridians; Feng Xiao Yao Yao (Wind-dispersing herbs such as Sheng Ma, Chai Hu, Fang Feng, Qiang Huo, Xi Ben, Xi Xin) are all used to ascend the Qi of various meridians. When the Qi of all meridians circulates, Yin blood inevitably rises with it, hence the term "rising from Yang." Those with this syndrome should follow this method.
Shen Zhai notes: Persistent metrorrhagia results in excessive blood loss. In the formula, the quantity of wind-dispersing herbs largely does not match even one dose of Sheng Di Huang (Raw Rehmannia Root). Is there no concern that wind herbs might dry out the blood? Although the intent is to lift and raise, the consumption of blood is already significant. Physicians using this formula should exercise discretion.