良方论曰∶妇人经水不通,则化为血,血不通,复化为水。故先因经水断绝,后至四肢
浮肿,致小便不通,名曰血分,宜用椒仁丸(夫气者水之母,血者气所化,非气无以生血,非
血无以养气。若经水不通,则血病,血病气亦病,岂有水不通而能化血乎?血不通而化水
者,乃是气壅不能化血而成水也。观椒仁丸可想矣)。若先因小便不通,后身面浮肿,致经水
不通,名曰水分,宜葶苈丸。经水不通而化为水,流走四肢,悉皆肿满,亦名血分,其证与水
证相类,实非水也,用人参丸。
薛氏曰∶按前证或因饮食起居失养,或因六淫七情失宜,以致脾胃亏损不能生发统摄,
气血乖违,行失常道。若先断经,后浮肿,此血化为水,名曰血分,宜椒仁丸治之;若先浮肿
后经水不通,此水化为血,名曰水分,宜用葶苈丸治之。此属形气不足,邪淫隧道,必用此
药,以宣导其邪,而佐以补辅元气之剂,庶使药力有所仗而行,则邪自不能容,而真气亦不
至于复伤矣。大凡月水不通,凝结于内,久而变为血瘕,血水相并,亦为水肿,(血凝成瘕,
因而致肿,当知此症)
李氏曰∶经水断而后肿,名曰血分,乃瘀血化水,闭塞胞门,比水肿更难治,但能调其
经,则水自消,小调经散、葶归丸;先浮肿,而后经水不通,名曰水分,乃脾不能制血与水,
并浮肌肉,为之虚肿,红矾丸,通用肾气丸(肾虚则水不利,而散溢妄行,故用肾气丸加减)。
水分君泽泻,加防己、葶苈、木通;血分君牡丹皮,加牛膝、红花;有经闭脚肿者,桑白皮散。
良方论述说:妇女月经停止不通,血液就会停滞;血液停滞不通,进而转化为水湿。因此,如果先是因为月经断绝,后来出现四肢浮肿,导致小便不通畅,这叫做“血分”,适宜使用椒仁丸(气是水之母,血是由气所化生,没有气就无法生成血,没有血就无法滋养气。如果月经不通,就是血病,血病则气也随之生病,难道会有水液不通却能化生为血的情况吗?血不通而化为水的现象,是由于气机壅滞不能化生血液从而形成水湿的缘故。从椒仁丸的组方就可以想见这一原理了)。如果是先因为小便不通畅,后来身体和面部浮肿,导致月经不通,这叫做“水分”,适宜使用葶苈丸。月经不通而转化为水湿,流注到四肢,全身都肿胀饱满,这也称为“血分”,其症状与水证相似,但实际上并非单纯的水邪所致,应使用人参丸。
薛氏说:按照上述病症,可能是因为饮食起居失于调养,或者六淫(风、寒、暑、湿、燥、火)七情(喜、怒、忧、思、悲、恐、惊)失调,导致脾胃亏损,不能正常生发和统摄气血,使得气血运行乖违,失去正常的轨道。如果先断经,后浮肿,这是血转化为水,叫做“血分”,适宜用椒仁丸治疗;如果先浮肿,后月经不通,这是水转化为血(此处指水湿影响血行),叫做“水分”,适宜用葶苈丸治疗。这属于形体与元气不足,邪气侵入经络隧道,必须使用这些药物来宣通疏导邪气,并辅以补益元气的药剂,这样药力才有依托而行,邪气自然无法存留,真气也不会再次受到损伤。大凡月经不通,凝结在体内,日久变成血瘕(腹内结块),血与水相互搏结,也会形成水肿。(血凝结成瘕,因而导致肿胀,应当知晓此症机理)
李氏说:月经断绝之后才出现浮肿,叫做“血分”,这是瘀血化为水湿,闭塞胞宫之门,比一般的水肿更难治疗,只要能够调理月经,水湿自然会消退,可用小调经散、葶归丸;如果先浮肿,然后月经不通,叫做“水分”,这是脾脏不能制约血液与水湿,二者并浮于肌肉之间,造成虚肿,可用红矾丸,通用肾气丸(肾虚则水液代谢不利,而散溢妄行,所以用肾气丸加减)。治疗水分证以泽泻为主药,加防己、葶苈子、木通;治疗血分证以牡丹皮为主药,加牛膝、红花;有经闭且脚肿者,用桑白皮散。
Liang Fang discusses: When a woman's menstrual flow ceases, the blood stagnates; when the blood stagnates and fails to circulate, it transforms into water-dampness. Therefore, if the condition begins with the cessation of menstruation, followed by edema of the four limbs and difficulty in urination, it is termed "Blood Division" (Xue Fen), and Jiaoren Wan (Pepper Kernel Pill) is indicated. (Qi is the mother of water, and blood is transformed from Qi. Without Qi, blood cannot be generated; without blood, Qi cannot be nourished. If menstruation is obstructed, it is a disease of blood, and a disease of blood affects Qi as well. How could there be an obstruction of water that leads to the generation of blood? The phenomenon where unobstructed blood transforms into water occurs because Qi stagnation prevents the transformation of blood, resulting in water accumulation. This principle can be inferred from the composition of Jiaoren Wan). Conversely, if the condition begins with difficulty in urination, followed by edema of the body and face, leading to the cessation of menstruation, it is termed "Water Division" (Shui Fen), and Tingli Wan (Descurainia Seed Pill) is indicated. When menstrual obstruction leads to the transformation into water-dampness, which flows to the four limbs causing generalized swelling and fullness, this is also called "Blood Division." Although its symptoms resemble those of water-dampness diseases, it is essentially not merely water; Ren Shen Wan (Ginseng Pill) should be used.
Dr. Xue states: Regarding the aforementioned conditions, they may arise from improper diet and lifestyle failing to nourish the body, or from imbalances caused by the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). This leads to Spleen-Stomach deficiency, impairing their ability to generate and control Qi and Blood, causing Qi and Blood to deviate from their normal pathways. If menstruation ceases first, followed by edema, this represents blood transforming into water, termed "Blood Division," treated with Jiaoren Wan. If edema appears first, followed by menstrual obstruction, this represents water affecting blood circulation, termed "Water Division," treated with Tingli Wan. These cases belong to insufficiency of form and Yuan Qi (Primal Qi), with pathogenic factors invading the meridians and collaterals. It is necessary to use these medications to vent and guide out the pathogens, assisted by agents that tonify and support Yuan Qi. This ensures the medicinal force has a foundation to act upon, so that pathogens cannot persist, and True Qi is not further injured. Generally, when menstruation is obstructed and coagulates internally for a long time, it transforms into a Blood Mass (Xue Jia - abdominal mass due to blood stasis). When blood and water combine, it also results in edema. (When blood coagulates to form a mass, leading to swelling, one must understand the mechanism of this syndrome.)
Dr. Li states: When edema occurs after the cessation of menstruation, it is called "Blood Division." This is due to blood stasis transforming into water-dampness, blocking the opening of the Uterus (Bao Men). It is more difficult to treat than ordinary edema. However, if the menstruation is regulated, the water-dampness will naturally resolve. Xiao Tiao Jing San (Minor Regulation of Menses Powder) and Ting Gui Wan (Tingli and Angelica Pill) are indicated. If edema appears first, followed by menstrual obstruction, it is called "Water Division." This is due to the Spleen's inability to control blood and water, causing them to float in the muscles, resulting in deficient swelling. Hong Fan Wan (Red Alum Pill) is indicated, along with the general use of Shen Qi Wan (Kidney Qi Pill). (Kidney deficiency leads to impaired water metabolism and erratic dispersion, hence Shen Qi Wan is used with modifications). For Water Division, Ze Xie (Alisma Rhizome) serves as the sovereign herb, added with Fang Ji (Stephania Root), Ting Li Zi (Descurainia Seed), and Mu Tong (Akebia Stem). For Blood Division, Mu Dan Pi (Moutan Cortex) serves as the sovereign herb, added with Niu Xi (Achyranthes Root) and Hong Hua (Carthamus Flower). For cases of amenorrhea accompanied by foot edema, Sang Bai Pi San (Mulberry Bark Powder) is used.