温经汤（妇百三 寒痛） 交加散（妇百 结聚作痛） 醋附丸（妇百七 行滞止痛） 牛膝
散（妇九九 通经止痛） 姜黄散（妇百一 逐瘀止痛） 当归没药丸（妇百六 血瘀作痛） 玄
胡当归散（妇九八 血逆作痛） 琥珀丸（妇一三四）
崩漏不止，经乱之甚者也。盖乱则或前或后，漏则不时妄行，由漏而淋，由淋而崩，总
因血病，而但以其微甚耳。《阴阳别论》曰∶阴虚阳搏谓之崩。《百病始生篇》曰∶阳络伤
则血外溢，阴络伤则血内溢。故凡阳搏必属阴虚，络伤必致血溢。知斯二者，而崩淋之义及
治疗之法，思过半矣。惟是阴虚之说，则但伤营气，无匪阴虚而五脏之阴皆能受病，故神伤
则血无所主，病在心也；气伤则血无所从，病在肺也；意伤则不能统血摄血，病在脾也；魂
伤则不能蓄血藏血，病在肝也；志伤则不能固闭真阴，病在肾也。所以五脏皆有阴虚，五脏
皆有阳搏。故病阴虚者，单以脏气受伤，血因之而失守也；病阳搏者，兼以火居阴分，血得
热而妄行也。凡治此之法，宜审脏气，宜察阴阳。无火者，求其脏而培之补之；有火者，察
其经而清之养之。此不易之良法也。然有火者不得不清，但元气既虚，极多假热，设或不明
真假，而误用寒凉，必复伤脾胃，生气日见殆矣。先贤有云∶凡下血证，须用四君子辈以收
功。又云∶若大吐血后，毋以脉诊，当急用独参汤救之。厥旨深矣。故凡见血脱等证，必当
用甘药先补脾胃，以益发生之气。盖甘能生血，甘能养营，但使脾胃气强，则阳生阴长，而
血自归经矣，故曰脾统血治崩淋经漏之法∶若阴虚血热妄行者，宜保阴煎、加减一阴煎；
若火盛迫血妄行而无虚证者，宜徙薪饮、黄芩散加续断、丹参；若血热兼滑者，宜保阴煎、
槐榆散、生地黄汤；若肝经怒火动血者，加味四物汤；若肝经怒火动血，逆气未散者，化肝
煎，或保阴煎加减主之；若血有滞，逆而妄行者，四物汤、丹参散；若营气不足，血不能调
而妄行者，五福饮、四物汤、四君子汤、八珍汤，择宜用之；若脾气虚陷，不能收摄而脱血
者，寿脾煎、归脾汤、四君子加芎、归，再甚者，举元煎；若脾肾虚寒，兼呕兼溏泄而畏寒
者，理阴煎、五君子煎、理中汤。若阳气大虚脱陷者，四维散；若脾肾阴气不固者，固阴煎
、五阴煎、秘元煎；若肝胆气虚，不能藏血者，必多惊恐畏怯，宜五福饮、七福饮、八珍汤
；兼阳虚者，仍加姜、桂；若去血过多，血脱气竭者，当速用独参汤提握其气，以防脱绝，
或用当归补血汤；若崩淋既久，血滑不禁，宜涩宜固者，龙骨散、如圣散、七灰散之类，同
人参兼用之。凡血淋治法，大约如前。但其秽臭脉滑者多火，宜从清凉；若腥臭清寒脉细者
多寒，必须温补。其或久病则精去无穷，尾闾易竭，非大加培补不可，惟固阴煎，及十全大
补汤之类为宜。
一、崩淋之病，有暴崩者，有久崩者。暴崩者，其来骤，其治亦易；久崩者，其患深，
其治亦难。且凡血因崩去，热必渐少，少而不止，病则为淋。此等证候，未有不由忧思郁怒
，先损脾胃，次及冲任而然者。崩淋既久，真阴日亏，多致寒热咳嗽，脉见弦数或豁大等证
。此乃元气亏损、阴虚假热之脉，尤当用参、地、归、术甘温之属，以峻培本源，庶可望生
。但得胃气未败，受补可救；若不能受补，而日事清凉，以苟延目前，则终非吉兆也。
一、崩淋病，治有五脏之分，然有可分者，有不可分者。可分者，如心肺居于膈上，二
阳脏也；肝脾肾居于膈下，三阴脏也治阳者宜治其气，治阴者宜治其精，此可分之谓也。
然五脏相移，精气相错，此又其不可分者也。即如病本于心，君火受伤，必移困于脾土，故
治脾即所以治心也。病本于肺，治节失职，必残及于肾水，故治肾即所以治肺也。脾为中州
之官，水谷所司，饷道不资，必五路俱病，不究其母，则必非治脾良策。肝为将军之官，郁
怒是病，胜则伐脾，败则自困，不知强弱，则攻补不无倒施。不独此也，且五脏五气，无不
相涉，故五脏中皆有神气，皆有肺气，皆有胃气，皆有肝气，皆有肾气，而其中之或此或彼
，为利为害，各有互相倚伏之妙。故必悟藏气之大本，其强弱何在？死生之大权，其缓急何
在精气之大要，其消长何在？攻补之大法，其先后何在？斯足称慧然之明哲。若谓心以枣仁、
远志，肺以桔梗、麦冬，脾以白术、甘草，肝以青皮、芍药，肾以独活、玄参之类，是不过
肤毛之见，又安知性命之道也。诸证皆然，不止崩淋者若此。
一、妇人于四旬外，经期将断之年，多有渐见阻隔，经期不至者。当此之际，最宜防察
。若果气血和平，素无他疾，此固渐止而然，无足虑也。若素多忧郁不调之患，而见此过期
阻隔，便有崩决之兆。若隔之浅者，其崩尚轻；隔之久者，其崩必甚。此因隔而崩者也。当
预服四物、八珍之类以调之，否则恐其郁久而决，则为患滋大也。若其既崩之后，则当辨其
有火无火。有火者，因火逼血，宜保阴煎主之。无火者，因隔而决，或其有滞，当去其故而
养其新，宜调经饮先以理之，然后各因其宜，可养则养，用小营煎；可固则固，用固阴煎之
类主之。
王叔和曰∶五崩何等？曰∶白崩者，形如涕；赤崩者，形如绛津；黄崩者，形如烂瓜；
青崩者，形如蓝色；黑崩者，形如 血也。
立斋曰∶前证治法固脾胃亏损不能摄血归源者，用六君加芎、归、柴胡。若因肝经之火
而血下行，用奇效四物汤，或四物加柴、栀、苓、术。若肝经风热而血妄行，用加味逍遥散
，或小柴胡加栀、芍、丹皮。若怒动肝火而血沸腾，亦用前药。若脾经郁结而血不归经，用
归脾加柴、栀、丹皮。若悲伤胞络而血下崩，用四君加柴、栀、升麻。
附按∶大尹王天成之内久患崩，自服四物凉血之剂，或作或彻。因怒发热，其血不止，
服前药不应，乃主降火，更加胁腹大痛，手足俱冷。余曰∶此脾胃虚寒所致。先用附子理中
汤，热退痛止；又用《济生》归脾汤、补中益气汤，崩血顿愈。若泥痛无补法，则误矣。
温经汤（出自《妇人良方》卷三，主治寒性腹痛） 交加散（出自《妇人良方》卷百，主治气血结聚作痛） 醋附丸（出自《妇人良方》卷七，主治行气滞、止痛） 牛膝散（出自《妇人良方》卷九九，主治通经止痛） 姜黄散（出自《妇人良方》卷百一，主治逐瘀止痛） 当归没药丸（出自《妇人良方》卷六，主治血瘀作痛） 玄胡当归散（出自《妇人良方》卷九八，主治血逆作痛） 琥珀丸（出自《妇人良方》卷一三四）
崩漏不止，是月经紊乱中最为严重的情况。所谓“乱”，是指月经或提前或推后；所谓“漏”，是指非经期不时出血。由漏发展为淋沥不断，由淋发展为崩中大量出血，总归都是血病，只是程度轻重不同而已。《素问·阴阳别论》说：阴虚而阳脉搏动有力，称为崩。《素问·百病始生篇》说：阳络受伤则血液外溢，阴络受伤则血液内溢。所以凡是阳脉搏动，必然属于阴虚；络脉受伤，必然导致血液外溢。明白了这两点，那么崩和淋的含义以及治疗的方法，就掌握了一大半了。至于阴虚的说法，不仅指营气受损，其实五脏之阴都能受病，所以神志受伤则血无所主，病在心；气受伤则血无所从，病在肺；意受伤则不能统摄血液，病在脾；魂受伤则不能蓄藏血液，病在肝；志受伤则不能固闭真阴，病在肾。因此五脏都有阴虚，五脏都有阳搏。所以患阴虚病的，是因为脏气受伤，血因而失守；患阳搏病的，是因为火居阴分，血受热而妄行。大凡治疗此法，应当审察脏气，观察阴阳。无火的，求其受伤的脏气而培补它；有火的，察其所在的经络而清养它。这是不可改变的好方法。然而有火的固然不能不清热，但元气既然虚弱，极多假热，如果不辨真假，误用寒凉药物，必定再次损伤脾胃，生气日渐危殆。先贤曾说：凡是下血证，必须用四君子汤之类的方剂来收功。又说：如果大吐血之后，不要只看脉诊，应当紧急使用独参汤来抢救。其中的旨意很深奥啊。所以凡是见到血脱等证候，必须先用甘味药补益脾胃，以增益发生之气。因为甘能生血，甘能养营，只要使脾胃之气强健，那么阳生阴长，血自然回归经脉，所以说脾统血。治疗崩淋经漏的方法：如果是阴虚血热妄行的，宜用保阴煎、加减一阴煎；如果是火盛迫血妄行而没有虚证的，宜用徙薪饮、黄芩散加续断、丹参；如果是血热兼有滑象的，宜用保阴煎、槐榆散、生地黄汤；如果是肝经怒火动血的，用加味四物汤；如果是肝经怒火动血，且逆气未散的，用化肝煎，或者保阴煎加减主治；如果血有停滞，逆乱而妄行的，用四物汤、丹参散；如果营气不足，血不能调和而妄行的，五福饮、四物汤、四君子汤、八珍汤，择宜选用；如果是脾气虚陷，不能收摄而脱血的，用寿脾煎、归脾汤、四君子汤加川芎、当归，更严重的，用举元煎；如果是脾肾虚寒，兼有呕吐、腹泻且畏寒的，用理阴煎、五君子煎、理中汤。如果阳气大虚脱陷的，用四维散；如果脾肾阴气不固的，用固阴煎、五阴煎、秘元煎；如果肝胆气虚，不能藏血的，一定多有惊恐畏怯，宜用五福饮、七福饮、八珍汤；兼有阳虚的，仍加生姜、肉桂；如果去血过多，血脱气竭的，应当迅速使用独参汤提握其气，以防脱绝，或者用当归补血汤；如果崩淋日久，血滑不禁，宜涩宜固的，龙骨散、如圣散、七灰散之类，同人参兼用。大凡血淋治法，大约像前面所说的那样。但是气味秽臭、脉滑的多为火，宜从清凉法治；如果气味腥臭、清寒、脉细的多为寒，必须温补。如果久病则精去无穷，尾闾易竭，非大加培补不可，只有固阴煎，及十全大补汤之类为宜。
第一，崩淋之病，有暴崩者，有久崩者。暴崩者，发病急骤，治疗也容易；久崩者，患病深重，治疗也困难。而且凡是血因崩漏而去，热必逐渐减少，少而不止，病则成为淋。这种证候，没有不是由于忧思郁怒，先损伤脾胃，其次波及冲任二脉而形成的。崩淋日久，真阴日益亏损，多导致寒热咳嗽，脉见弦数或豁大等证候。这是元气亏损、阴虚假热的脉象，尤其应当用人参、地黄、当归、白术等甘温的药物，来峻补本源，才有望生存。只要胃气未败，能够接受补益，就可以救治；如果不能接受补益，却每天从事清凉之法，以苟延残喘于目前，那终究不是吉兆。
第二，崩淋病，治疗有五脏之分，但有可分的，有不可分的。可分的，比如心肺居于膈上，属二阳脏；肝脾肾居于膈下，属三阴脏。治疗阳脏宜治其气，治疗阴脏宜治其精，这就是所谓的可分。然而五脏相互传移，精气相互交错，这又是不可分的。就像病本于心，君火受伤，必然移困于脾土，所以治脾就是治心。病本于肺，治节失职，必然残及于肾水，所以治肾就是治肺。脾是中州之官，主管水谷，如果饷道（营养输送通道）不资助，必然五路俱病，不探究其母脏，就不是治脾的好策略。肝为将军之官，郁怒致病，胜则伐脾，败则自困，不知强弱，则攻补难免倒施。不仅如此，而且五脏五气，无不相互涉及，所以五脏中都有神气，都有肺气，都有胃气，都有肝气，都有肾气，而其中或此或彼，为利为害，各有互相倚伏的妙处。所以必须领悟脏气的根本，它的强弱在哪里？死生的大权，它的缓急在哪里？精气的大要，它的消长在哪里？攻补的大法，它的先后在哪里？这才称得上是慧然明白的智慧。如果说心用枣仁、远志，肺用桔梗、麦冬，脾用白术、甘草，肝用青皮、芍药，肾用独活、玄参之类，这不过是肤浅的见解，又怎知性命的大道呢。各种证候都是这样，不只是崩淋如此。
第三，妇人在四十岁以外，经期将断之年，多有渐渐出现阻隔，经期不来的情况。在这个时候，最应该防备观察。如果确实气血平和，平素没有其他疾病，这自然是渐渐停止而如此，无需担忧。如果平素多有忧郁不调的病患，而出现这种情况过期阻隔，便有崩决的征兆。如果阻隔轻微的，其崩尚轻；阻隔久的，其崩必然严重。这是因阻隔而导致崩漏。应当预先服用四物汤、八珍汤之类来调理，否则恐怕其郁积久了而决裂，则为患更加巨大。如果已经崩漏之后，则应当辨别有火无火。有火的，因火逼血，宜用保阴煎主治。无火的，因阻隔而决裂，或者其中有停滞，应当去除旧疾而滋养新血，宜用调经饮先以调理，然后各因其适宜，可以养的则养，用小营煎；可以固的则固，用固阴煎之类主治。
王叔和说：五崩是什么样子的？回答说：白崩，形状像鼻涕；赤崩，形状像绛色津液；黄崩，形状像烂瓜；青崩，形状像蓝色；黑崩，形状像凝血块的血。
立斋说：前证治法，如果是脾胃亏损不能摄血归源者，用六君子汤加川芎、当归、柴胡。如果因肝经之火而血下行，用奇效四物汤，或者四物汤加柴胡、栀子、茯苓、白术。如果肝经风热而血妄行，用加味逍遥散，或小柴胡汤加栀子、芍药、丹皮。如果怒动肝火而血沸腾，也用前面的药。如果脾经郁结而血不归经，用归脾汤加柴胡、栀子、丹皮。如果悲伤胞络而血下崩，用四君子汤加柴胡、栀子、升麻。
附按：大尹王天成的妻子久患崩漏，自行服用四物汤等凉血药剂，有时发作有时痊愈。因为发怒发热，其血不止，服用前面的药无效，于是主张降火，更加胁腹大痛，手足都冷。我说：这是脾胃虚寒所致。先用附子理中汤，热退痛止；又用《济生方》归脾汤、补中益气汤，崩血顿时痊愈。如果拘泥于痛无补法，那就错了。
Wen Jing Tang (Cinnamon Twig Decoction, from *Furen Liang Fang* Vol. 3, treating cold-type abdominal pain) Jiao Jia San (Intermingling Powder, from *Furen Liang Fang* Vol. 100, treating pain due to qi and blood stagnation) Cu Fu Wan (Vinegar-Processed Aconite Pill, from *Furen Liang Fang* Vol. 7, treating qi stagnation and pain relief) Niu Xi San (Achyranthes Root Powder, from *Furen Liang Fang* Vol. 99, treating menstrual obstruction and pain relief) Jiang Huang San (Turmeric Powder, from *Furen Liang Fang* Vol. 101, treating blood stasis removal and pain relief) Dang Gui Moyao Wan (Angelica Sinensis and Myrrh Pill, from *Furen Liang Fang* Vol. 6, treating pain due to blood stasis) Xuan Hu Dang Gui San (Corydalis and Angelica Sinensis Powder, from *Furen Liang Fang* Vol. 98, treating pain due to rebellious blood) Hu Po Wan (Amber Pill, from *Furen Liang Fang* Vol. 134)
Incessant metrorrhagia and metrostaxis represent the most severe form of menstrual irregularity. "Irregularity" refers to menstruation occurring either early or late; "metrostaxis" refers to intermittent bleeding outside the menstrual period. Metrostaxis progresses to dripping discharge, which in turn progresses to metrorrhagia with massive bleeding. Fundamentally, these are all disorders of blood, differing only in severity. The *Su Wen: Yin Yang Bie Lun* states: "Yin deficiency with vigorous yang pulse is termed metrorrhagia." The *Su Wen: Bai Bing Shi Sheng Pian* states: "Injury to yang collaterals causes external blood overflow; injury to yin collaterals causes internal blood overflow." Therefore, a vigorous yang pulse necessarily indicates yin deficiency; collateral injury inevitably leads to blood overflow. Understanding these two principles allows one to grasp more than half of the meaning of metrorrhagia and metrostaxis, as well as their treatment methods. Regarding the concept of yin deficiency, it is not merely an injury to Ying Qi (nutritive energy); rather, the yin of all five Zang organs can be affected. Thus, if Shen (spirit) is injured, blood has no master, indicating disease in the Heart; if Qi is injured, blood has no source, indicating disease in the Lung; if Yi (intellect) is injured, it cannot control and secure blood, indicating disease in the Spleen; if Hun (ethereal soul) is injured, it cannot store and hide blood, indicating disease in the Liver; if Zhi (will) is injured, it cannot secure true yin, indicating disease in the Kidney. Hence, all five Zang organs can suffer from yin deficiency and yang vigor. Therefore, in cases of yin deficiency disease, it is due to injury of Zang Qi, causing blood to lose its residence; in cases of yang vigor, it is because fire resides in the yin portion, causing blood to act recklessly due to heat. In general, the treatment for this should examine Zang Qi and observe yin and yang. If there is no fire, seek the injured Zang and tonify it; if there is fire, examine the meridian and clear and nourish it. This is an unchangeable excellent method. However, although cases with fire must be cleared, since Yuan Qi (original energy) is often deficient, false heat is very common. If one fails to distinguish between true and false heat and mistakenly uses cold-cooling herbs, it will further damage the Spleen and Stomach, causing the generating Qi to become increasingly precarious. Ancient sages said: "For all lower body bleeding syndromes, one must use formulas like Si Jun Zi Tang (Four Gentlemen Decoction) to conclude treatment." They also said: "After massive hematemesis, do not rely solely on pulse diagnosis; urgently use Du Shen Tang (Single Ginseng Decoction) to rescue." The purport here is profound. Therefore, whenever signs of blood depletion are seen, one must first use sweet-natured herbs to tonify the Spleen and Stomach, thereby benefiting the generating Qi. Sweet flavors generate blood and nourish Ying Qi. As long as Spleen and Stomach Qi is strong, Yang generates and Yin grows, and blood naturally returns to its vessels. Thus, it is said that the Spleen controls blood.
Treatment methods for metrorrhagia, metrostaxis, and leukorrhea:
If caused by yin deficiency and blood heat acting recklessly, use Bao Yin Jian (Protect the Yin Decoction) or Jia Jian Yi Yin Jian (Modified One Yin Decoction).
If caused by excessive fire forcing blood to act recklessly without deficiency signs, use Xi Xin Yin (Extinguish Fire Drink), Huang Qin San (Scutellaria Powder) plus Xu Duan (Dipsacus Root) and Dan Shen (Salvia Root).
If accompanied by blood heat and a slippery pulse, use Bao Yin Jian, Huai Yu San (Huai Hua and Zong Lu San Powder), or Sheng Di Huang Tang (Rehmannia Decoction).
If caused by liver fire moving blood, use Jia Wei Si Wu Tang (Modified Four Substances Decoction).
If caused by liver fire moving blood with unresolved rebellious Qi, use Hua Gan Jian (Transform the Liver Decoction) or modify Bao Yin Jian.
If blood is stagnant and acting recklessly due to rebellion, use Si Wu Tang (Four Substances Decoction) or Dan Shen San (Salvia Powder).
If Ying Qi is insufficient and blood cannot be regulated, leading to reckless action, choose among Wu Fu Yin (Five Blessings Drink), Si Wu Tang, Si Jun Zi Tang (Four Gentlemen Decoction), or Ba Zhen Tang (Eight Treasures Decoction) according to suitability.
If Spleen Qi is deficient and sinking, unable to secure blood leading to hemorrhage, use Shou Pi Jian (Longevity Spleen Decoction), Gui Pi Tang (Restore the Spleen Decoction), or Si Jun Zi Tang plus Chuan Xiong (Ligusticum Rhizome) and Dang Gui (Angelica Sinensis). For more severe cases, use Ju Yuan Jian (Raise the Origin Decoction).
If Spleen and Kidney are deficient and cold, accompanied by vomiting, diarrhea, and aversion to cold, use Li Yin Jian (Regulate the Yin Decoction), Wu Jun Zi Jian (Five Gentlemen Decoction), or Li Zhong Tang (Regulate the Middle Decoction).
If Yang Qi is severely deficient and collapsing, use Si Wei San (Four Cornered Powder).
If Spleen and Kidney Yin Qi is insecure, use Gu Yin Jian (Secure the Yin Decoction), Wu Yin Jian (Five Yins Decoction), or Mi Yuan Jian (Secret Origin Decoction).
If Liver and Gallbladder Qi is deficient and unable to store blood, there will likely be much fear and timidity; use Wu Fu Yin, Qi Fu Yin (Seven Blessings Drink), or Ba Zhen Tang. If accompanied by Yang deficiency, add Sheng Jiang (Fresh Ginger) and Rou Gui (Cinnamon Bark).
If blood loss is excessive, leading to blood depletion and Qi exhaustion, urgently use Du Shen Tang to grasp the Qi to prevent collapse, or use Dang Gui Bu Xue Tang (Angelica Tonifying Blood Decoction).
If metrorrhagia/metrostaxis has persisted for a long time, with slippery blood that cannot be controlled, requiring astringency and securing, use Long Gu San (Dragon Bone Powder), Ru Sheng San (Like Sage Powder), or Qi Hui San (Seven Ashes Powder), used concurrently with Ren Shen (Ginseng).
Generally, the treatment for blood metrostaxis is roughly as described above. However, foul odor and a slippery pulse indicate excess fire, requiring cooling methods; whereas fishy odor, coldness, and a fine pulse indicate cold, requiring warming and tonification. If chronic illness leads to endless loss of essence and easy depletion of the Weilu (tailgate/lower back region), massive tonification is necessary; Gu Yin Jian and Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) are suitable.
First, metrorrhagia and metrostaxis diseases include sudden metrorrhagia and chronic metrorrhagia. Sudden metrorrhagia arises abruptly and is easier to treat; chronic metrorrhagia involves deep pathology and is difficult to treat. Furthermore, when blood is lost through metrorrhagia, heat gradually diminishes. If it persists without stopping, it becomes metrostaxis. Such syndromes invariably originate from worry, thought, depression, and anger, first damaging the Spleen and Stomach, then affecting the Chong and Ren meridians. Chronic metrorrhagia and metrostaxis cause daily depletion of true Yin, often leading to alternating chills and fever, coughing, and pulses that are wiry-rapid or hollow-large. These are pulses of Yuan Qi deficiency and false heat due to Yin deficiency. One must especially use sweet-warm herbs like Ren Shen, Di Huang (Rehmannia), Dang Gui, and Bai Zhu (Atractylodes Macrocephala) to vigorously tonify the root source, so that survival may be hoped for. As long as Stomach Qi is not exhausted and can accept tonification, cure is possible; if one cannot accept tonification but continues with cooling methods to prolong life temporarily, it is ultimately an ill omen.
Second, the treatment of metrorrhagia and metrostaxis distinguishes among the five Zang organs, but some aspects are distinguishable and others are not. Distinguishable aspects: Heart and Lung reside above the diaphragm and belong to the Two Yang organs; Liver, Spleen, and Kidney reside below the diaphragm and belong to the Three Yin organs. Treating Yang organs focuses on Qi; treating Yin organs focuses on Essence. This is what is meant by distinguishable. However, the five Zang organs transfer pathogenic factors to one another, and Essence and Qi intermingle; this is the indistinguishable aspect. For example, if the disease originates in the Heart, injuring Ministerial Fire, it will inevitably burden the Spleen Earth; thus, treating the Spleen is treating the Heart. If the disease originates in the Lung, failing its regulatory function, it will inevitably damage Kidney Water; thus, treating the Kidney is treating the Lung. The Spleen is the official of the Central Plain, managing water and grain. If the supply route is not supported, all five pathways will be diseased. Without investigating the mother organ, treating the Spleen alone is not a good strategy. The Liver is the general officer; depression and anger cause disease. If victorious, it attacks the Spleen; if defeated, it traps itself. Without knowing strength and weakness, attacking and tonifying may be reversed. Moreover, the five Zang organs and five Qi are all interconnected. Thus, within each Zang organ, there is Shen Qi, Lung Qi, Stomach Qi, Liver Qi, and Kidney Qi. Their interactions, benefits, and harms have subtle mutual dependencies. Therefore, one must comprehend the root of Zang Qi: Where lies its strength? Where lies the leverage of life and death? What is the key to Essence and Qi growth and decline? What is the principle of attack and tonification sequence? Only then can one be called wisely enlightened. To say that the Heart uses Suan Zao Ren (Ziziphus Seed) and Yuan Zhi (Polygala Root), the Lung uses Jie Geng (Platycodon Root) and Mai Dong (Ophiopogon Tuber), the Spleen uses Bai Zhu and Gan Cao (Licorice Root), the Liver uses Qing Pi (Citrus Peel) and Bai Shao (White Peony Root), and the Kidney uses Du Huo (Angelica Pubescens) and Xuan Shen (Scrophularia Root)—this is merely superficial knowledge. How can one know the Way of Life and Nature? All syndromes are like this, not just metrorrhagia.
Third, women beyond forty years of age, in the years when menstruation is about to cease, often experience gradual obstruction and missed periods. At this time, vigilance is essential. If Qi and Blood are harmonious and there are no other chronic illnesses, this is simply the natural cessation of menstruation and need not be worried about. However, if the patient usually suffers from depression and irregular menstruation, and now experiences delayed obstruction, it signals impending metrorrhagia. If the obstruction is slight, the metrorrhagia will be mild; if prolonged, the metrorrhagia will be severe. This is metrorrhagia caused by obstruction. One should preemptively administer Si Wu Tang or Ba Zhen Tang to regulate it; otherwise, fearing prolonged stagnation will lead to rupture, causing greater harm. After metrorrhagia occurs, one must distinguish between presence or absence of fire. If fire is present, driven by heat forcing blood, use Bao Yin Jian. If fire is absent, caused by rupture due to obstruction or stagnation, remove the old and nourish the new; use Tiao Jing Yin (Regulate Menstruation Drink) first to regulate, then tailor the treatment: if nourishment is needed, use Xiao Ying Jian (Small Nourishing Decoction); if securing is needed, use Gu Yin Jian.
Wang Shuhe said: What are the Five Metrorrhagias? Answer: White metrorrhagia resembles mucus; Red metrorrhagia resembles dark red fluid; Yellow metrorrhagia resembles rotten melon; Blue metrorrhagia resembles blue color; Black metrorrhagia resembles clotted blood.
Li Jieyu (Lizhai) said: For the aforementioned syndromes, if treated due to Spleen and Stomach deficiency failing to secure blood to return to its source, use Liu Jun Zi Tang (Six Gentlemen Decoction) plus Chuan Xiong, Dang Gui, and Chai Hu (Bupleurum Root). If due to Liver Fire causing blood to descend, use Qi Xiao Si Wu Tang (Miraculous Efficacy Four Substances Decoction) or Si Wu Tang plus Chai Hu, Zhi Zi (Gardenia Fruit), Fu Ling (Poria), and Bai Zhu. If due to Liver Wind-Heat causing reckless blood flow, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) or Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Zhi Zi, Bai Shao, and Mu Dan Pi (Moutan Cortex). If anger moves Liver Fire causing blood to boil, use the previous prescriptions. If Spleen depression causes blood to leave its vessels, use Gui Pi Tang plus Chai Hu, Zhi Zi, and Mu Dan Pi. If grief injures the Pericardium Collateral causing lower metrorrhagia, use Si Jun Zi Tang plus Chai Hu, Zhi Zi, and Sheng Ma (Cimicifuga Rhizome).
Attached Note: The wife of Dayin Wang Tiancheng suffered from chronic metrorrhagia. She self-administered cooling-blood agents like Si Wu Tang, resulting in intermittent remission and recurrence. Due to anger and fever, her bleeding did not stop. Previous prescriptions were ineffective. The physician then advocated clearing fire, which resulted in severe hypochondriac and abdominal pain and cold extremities. I stated: This is caused by Spleen and Stomach deficiency-cold. First, use Fu Zi Li Zhong Tang (Aconite Regulate Middle Decoction); after fever subsided and pain stopped, use *Ji Sheng Fang* Gui Pi Tang and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction), resulting in immediate cessation of bleeding. If one sticks to the notion that pain has no tonification method, one errs.