程门雪遗稿
前言：程门雪（1902-1972）：字九如，有壶公、蒲石山房、书种庐、晚学轩、补读斋诸号，婺源人。十六七岁时为名医汪莲石受业弟子，后又拜入丁甘仁门下，1921年毕业于上海中医专门学校。其学术思想，融张仲景与叶天士为一炉，学贯古今，汇通中西，为近代中医大家之一。其八篇遗稿，均为生前所未发表者。而崩漏、带下、胎前、妊娠、产后诸篇，短小精悍，内容丰富，汇而观之，直可视为一部袖珍中医妇科学。细而研之，于妇科临证诸法，大有裨益。今将其五篇妇科专著，著录于后，共同道参研。
崩漏篇
崩漏，重症也，轻者缠绵成损，重者立致殒生，其治可不审乎。昔人云：崩如山崩，忽然大下；漏如卮漏，不断淋漓。一则横决莫制，一则漫无关防，症见虽有不同，其为血之不守则一也。原其致病之由，有因脾虚不能统血者；有因热在下焦，迫血妄行者；有因元气大虚，不能收敛其血者；有因宿瘀内阻，新血不能归经而下者。因既不同，症亦各异。因其症异，而考其病因，就其病因，而酌为治法，庶几乎病无遁形，治无遗漏矣。冲任不能摄血者，当分阴阳调治。阳虚者血来必淡，肤容必晄，唇口不荣，爪甲无色，肢体畏冷，软弱不仁，热之不暖，似无感觉，腰脊痠软，畏寒尤甚，或腰冷如冰，背寒如浸，脉来沉迟而微弱。治分缓急两法：急者，益气以培生阳；缓者，温摄以固下真。以冲任阳虚，本宜温摄下元，固补奇脉，惟症势急者，阳微欲脱，变在顷刻，温摄之品，只能固补于平时，不能挽回于一瞬，若守成方，缓不济急。此时惟有回阳固气，佐以潜降，暂回欲脱之阳。待其气固阳回，徐图固补。参附、芪附、龙牡、真武为必用急用之要方也。缓者症虽阳虚，暂无脱象，当宜血肉有情之品为之主，佐以温肾填精，助阳摄纳之品为佐。固补奇经，缓图功效，多服久服，自见奇功。血肉有情如鹿角、鹿茸、羊肉、羊肾、腽肭、河车之属；益肾阳填精如苁蓉、巴戟、狗肾、故纸、骨碎补、杜仲、肉桂、茴香之类；摄纳如紫石英、赤石脂、五味、金樱、龙、牡之属。观其病情轻重，进退制方，此冲任阳虚之治法也。冲任阴虚者，血来必鲜，时时颧红，面白唇丹，外寒内热，热在骨髓，心嘈心热，腹中气冲，食过如饥，舌绛，脉来细数，或两尺数駃。血去阴伤，阴虚阳亢，涓涓不塞，五液将枯。治非育阴潜阳，凉荣清火不可。亦分轻重两法：轻者热重血鲜而多，热重于虚，凉荣清火为主，育阴滋燥佐之。凉荣如生地、白芍、桑叶、丹皮、地榆、地骨、青蒿、白薇之类；清火如知母、黄柏、黄芩、黄连、童便之类；育阴如女贞、旱莲、阿胶、天麦冬、鲍鱼之类；滋燥如麻仁、芝麻、柏子仁、鸡子黄之类。待其火热渐平，方能全用育阴之剂，以为善后。重者阴虚为甚，血鲜而少，点滴不绝，皮肤干涩，骨蒸无汗，咽干口燥，鬓发焦枯，舌绛中干，脉细数而涩。阳由阴亢，热自虚来，五液焦槁，津血皆涸。非用大剂滋阴壮水，不能制其无畏之阳光。宜大剂三甲复脉为主，而以上列育阴诸品佐之，更当复入潜阳摄纳之法，以冀挽回于万一。惟病至此者，每成不救，以其阴液已涸，而复涓漏不除，生者既难，去者不复，虽有神丹，亦奈之何哉。此冲任阴虚者之治法也。大抵阳虚者每兼脾土，多见食少不运，大便溏泻诸症，治宜兼温脾阳；阴虚者每兼肝木，多见头晕眼花，耳鸣心悸诸症，治宜兼清风木，此又一定之理也。况肝为藏血之脏，脾为统血之所，脾为后天，女子又以肝为先天，故崩漏诸症，肝脾亦为紧要之侯，肝虚则血不藏，脾虚则血不统也。纯为肝虚不藏者，当分寒热：虚热者，甘酸咸寒补之，如二至丸、丹地四物汤、阿胶鸡子黄汤之类。若兼脾虚不统者，归芍异功散、归脾汤、当归补血汤、圣愈汤之类。肝脾两虚，藏统失职，治宜并顾是也。更有进乎此者，脾为阴土，肝为刚脏，脾脏喜温而恶凉，病多偏于虚寒；肝脏喜清而恶温，病多偏于实热。每有肝实脾虚，脾寒肝热之症，肝热不藏，脾寒失统，肝实宜泻，脾虚当补者。治既兼乎二脏，尤当温清并进，寒热同投，泻实补虚，温寒清热者，少有不合，便失病机。昔人成方如胶艾四物、胶姜饮、侧柏叶汤、黄土汤之类，均为此症化裁。而交加散一方，尤为奇妙，生地凉肝热，生姜温脾寒，一寒一热，铢两悉称。其生地绞汁不煎，尤有深意，煎则凉润性减，不能散生姜之温，而行清肝之力也。昔人治崩，热用荆、芩，寒取姜、艾，以为定法，而不知二者合用，尤能立建奇勋。盖夹杂之病多，单纯之症少，故寒热并用者，治效独多耳。又有肝脾郁结之症。肝郁，木失条达者，逍遥散疏之；脾郁，阴火下流者，升阳散火汤散之。书所谓木郁达之，火郁发之，结者散之也。火为郁火，升之散之，火遂炎上之性，自不逼血妄行。若见热投凉，火愈下郁，崩愈不止矣。旧论以归脾汤为郁伤心脾之主方，加味逍遥为肝脾郁结之主方，其中均有可议。逍遥燥土升木，能治肝脾郁结，其妙处正在只用升散开发，不用降泄，方与治郁火达发之旨相合，若加丹、栀，苦寒沉降，火无上达之期，是愈益其郁，自相矛盾矣。归脾养心和肝，调营益气，自是要方，惟因郁结而经事不行者，用之极宜，无须更动，若因郁伤而崩漏不止者，则方中木香行气之品，断不可用。血既不止，而通其气，气行血行，当奔驶矣。古人谓归脾之妙，只在木香一味，得补中有行，静中有动之旨。但为闭塞之症而言，若言崩漏，则不能作如是解也。有热在下焦，逼血妄行者，其人平时必经事超前，色必紫黑，脉必弦数，其症多沸热不断，宜荆芩四物汤加贯仲炭、丹皮、藕节之类。荆芥炒黑，清荣止血，极有功效。热去则血无所逼，漏不止而自止。后以育阴柔肝清荣之品，调理自愈。古人谓暴崩漏宜温摄，久崩漏宜清通。所谓清通，即是热在下焦之症也。其言暴久，亦有分等，盖暴崩亦有宜清者，久漏亦多宜温者，惟当审症施治。大抵宜温摄者，须有虚脱之形；宜清通者，必见热盛之象。久漏不止，而无虚象，则知其漏久不止之故，必别有所因而然。若属虚症久延，必致殒其生命，即不致此，其虚弱之行，在所必见也矣。今漏久而不见虚象，当知非虚，既非虚则漏何以不止，推求原理，必属下焦有热，血海不藏，热逼而血妄行也。治此之症，自当清通为法，非谓一切久崩久漏，均可清通，惟久漏无弱象，或久崩服补摄而更剧者，方可用此。此读古人书所不宜拘泥者也。有元气大虚，气不摄血者，此症暴崩为多，其来极骤，如堤之决，如山之崩，崩至如潮，奔骤不止。崩后气喘汗出，头晕眼黑，面唇晄白，肢冷畏寒。崩症之血，其色先红后淡，纯至全为黄水。若不速治，或治不如法，即有喘脱之虞，此崩症之至急者也。盖以血随气行，气升血升，气脱血脱，元气大虚，中气不举，气既下陷，血亦随之。况气为血固，血为气恋，未崩之先，气脱则血无所固，如水无堤，岂能免于横溢，而崩遂成。既崩之后，血脱则气无所恋，如魂无依，岂能助其升举，而崩益盛。以此因缘，连环增剧，苟不为施治，非至阴阳决离，气血两脱不止。治之之法，一则由气虚而成崩，当以补气为主；二则血脱者宜益气，亦当以益气为主。可知参、芪为必需之要药。人参大补元气，黄芪补中，兼益下焦卫气，与此症极宜，惟须多用、专用，始有大力。凡治此种大症急症，药贵重贵专，轻则力薄，薄则力杂，均不中病。再当验其兼证，如纯见气血下脱之象者，宜补气为主，佐以升举固涩，升其下陷，涩其下脱也。如补中益气汤加赤石脂、禹余粮之类，重用参、芪治之。如既有气虚下脱，又兼面赤戴阳，咽干咽痛，脉洪大无根者，宜补元益气为主，育阴潜阳为佐，以血去阴伤，阴虚阳亢，若一味补气升举，与气虚固宜，与阴虚阳亢则不合。且升举为有虚阳上浮者所忌也。如生脉散用人参扶元，麦冬育阴，五味敛虚，颇为合剂，再加花龙（骨）潜恋，则更善矣。或重用黄芪至数两，而以炮姜、艾叶、侧柏、童便之类佐之，以此治前症尤佳。补元气，降虚火，引血归经，面面俱到，每有重症险象服之得效者，亦一善法也。
总之，元气大虚之症，自非峻用参、芪不可，惟须知补气之品，多助气流通，症既滑脱，稍行其气，血必不止，即参、芪亦能行气，不必乌、附、青、陈始然。故每见气虚补气而倍剧者，此则不知药性之理故耳。用时必兼固涩静恋之品，始能得力，而不致反为所用。或佐升提，或兼固涩，或附滋恋并酸收，审症而施，奏效如响。而止血引经之品，如炮姜、艾炭、黑草、棕炭、牛角腮灰、丝瓜络灰、藕炭、血余灰、釜脐墨之类，亦当佐用不缺。又有熏法，坐法以为外治，如血崩大虚厥脱者，以黄芪十数斤，煎汤置床下熏之，严闭窗户，使气不泄，药气内达，厥脱自回。稍轻能起坐者，则置净桶中坐之，热气上腾，药力亦速。更内服参附、芪附、龙牡，回阳潜阳，补元固气之剂，内外并治，亦有得生者，此许胤宗法也。有瘀血阻其新血，积而成崩者，水满则溢，堤涨则决，如《金匮》云：妇人半产后，漏下不绝，唇燥漱水，及宿有癥痼，续得漏下者。其漏下均为宿瘀阻其生化，新血不得流通，遇瘀而停，日积月累，愈聚愈多，一旦满而外溢，则为崩漏，书所谓"癥不去，血不止"者是也。其人必腹有痞块，其崩必数月一下。痞块者，宿瘀之外征也；数月一下者，以其崩乃盈科而流，必间数月，始有盈满之可能。若时时淋，则漏卮不塞，断不能盈。不能盈，亦断不成崩也。其治不必治崩，不宜止涩，但当去其宿结，宿积去则血无所阻，新血畅行，按月而下，崩不治而自止矣。此崩因宿积，治宜去瘀者之原理也。轻者桂枝大黄、桃仁承气，重者抵当汤丸、大黄蟅虫丸之类攻之。若素体虚弱，不能用攻，及无坚积不可攻者，倘余症颇同，或未来之先，先有腹痛筋掣，既崩之后，血来成块，色紫者，此气滞血凝，积久成崩，与上所述者大半相同。所不同者，一因瘀阻，一因气滞耳。甚则两目黯黑，肌肤甲错，大类干血瘀象，以气滞则血凝，亦能成瘀也。此不可攻，但当理气，气行则血自调，气不滞则血不停，血不积则崩不成。若用攻瘀，犯其无过，必多遗害。其理以一则由瘀而碍血，一则因气而停瘀。因瘀者其结坚，非攻不下；因气者其结轻，气顺即行。攻瘀者乃破其旧积，非攻其新停之血，以其新积之血，满而自下，无待于攻也。理气者乃防其复积，其已积者已从崩而下，即有余留，亦属易行，行气已足，不必用攻也。其症则因瘀者必见坚凝之象，因气者必有气滞之形。从数月一下，辨其积血成崩；从坚结有无，辨其因瘀因气，思过半矣。简言之，则因瘀而崩者，重则攻崩，轻者但宜调气。因气而凝者，则无论轻重，均以理气为先，古人谓调经以理气为主，确有深意。
带下篇
程门雪遗稿
前言：程门雪（1902-1972）：字九如，别号有壶公、蒲石山房、书种庐、晚学轩、补读斋等，婺源人。十六七岁时拜名医汪莲石为师，后又师从丁甘仁，1921年毕业于上海中医专门学校。其学术思想，融合张仲景与叶天士的学说于一体，贯通古今，汇通中西，是近代中医大家之一。他的八篇遗稿，均为生前未曾发表的作品。其中关于崩漏、带下、胎前、妊娠、产后等篇章，篇幅短小但精悍，内容丰富，汇集起来看，简直可以视为一部袖珍版的中医妇科学著作。仔细研读，对于妇科临床各种治法，大有裨益。现将其中的五篇妇科专著记录在后，供共同研讨研究。
崩漏篇
崩漏，属于重症，轻者缠绵日久导致身体亏损，重者立即危及生命，治疗怎能不审慎呢？古人说：崩如山崩，突然大量出血；漏如卮漏（古代盛酒器），淋漓不断。一种是横决无法控制，一种是漫溢没有防备，症状表现虽然不同，但其本质都是血液不能固守。探究致病的原因，有因脾虚不能统摄血液的；有因热邪在下焦，逼迫血液妄行的；有因元气大虚，不能收敛血液的；有因陈旧瘀血内阻，新血不能归入经脉而流出的。原因既然不同，症状也各异。根据症状的不同，考察病因，针对病因，斟酌治疗方法，这样病邪就无处隐藏，治疗就不会遗漏了。冲任二脉不能摄血的情况，应当分阴阳进行调治。阳虚者，血色必淡，面色必白，唇口无光泽，爪甲无色，肢体畏冷，软弱麻木，温热后仍不暖，似乎没有感觉，腰脊酸软，特别怕冷，或者腰部冷如冰，背部寒如浸水，脉象沉迟而微弱。治疗分为缓急两法：急症时，益气以培补生发之阳气；缓症时，温摄以固护下元真阳。因为冲任阳虚，本宜温摄下元，固补奇经八脉，但若病情急骤，阳气微细欲脱，变化在顷刻之间，温摄的药物，只能用于平时的固补，不能在瞬间挽回阳气，如果死守成方，缓慢的药力救不了急。此时唯有回阳固气，佐以潜降，暂时挽回欲脱的阳气。待其气固阳回，再慢慢图谋固补。参附汤、芪附汤、龙骨牡蛎、真武汤是必须紧急使用的要方。缓症者，虽然也是阳虚，但暂时没有脱证的表现，应当以血肉有情之品为主药，佐以温肾填精、助阳摄纳的药物。固补奇经，缓慢图取功效，多服久服，自然可见奇效。血肉有情之品如鹿角、鹿茸、羊肉、羊肾、腽肭脐、紫河车之类；益肾阳填精如肉苁蓉、巴戟天、狗肾、故纸（补骨脂）、骨碎补、杜仲、肉桂、茴香之类；摄纳如紫石英、赤石脂、五味子、金樱子、龙骨、牡蛎之类。观察病情的轻重，进退调整处方，这是冲任阳虚的治疗方法。冲任阴虚者，血色必鲜红，时时颧骨发红，面白唇红，外寒内热，热在骨髓，心中嘈杂烦热，腹中有气上冲，吃过饭后像饥饿一样，舌质绛红，脉象细数，或者两尺脉数而急促。血液流失导致阴伤，阴虚则阳亢，涓涓细流不止，五液将枯竭。治疗非育阴潜阳、凉营清火不可。也分为轻重两法：轻者热重血鲜且多，热重于虚，以凉营清火为主，育阴滋燥为辅。凉营如生地、白芍、桑叶、丹皮、地榆、地骨皮、青蒿、白薇之类；清火如知母、黄柏、黄芩、黄连、童便之类；育阴如女贞子、旱莲草、阿胶、天冬麦冬、鲍鱼之类；滋燥如火麻仁、芝麻、柏子仁、鸡蛋黄之类。待其火热逐渐平息，才能全用育阴的药剂，作为善后调理。重者阴虚严重，血色鲜红但量少，点滴不绝，皮肤干涩，骨蒸潮热无汗，咽干口燥，鬓发焦枯，舌绛中干，脉细数而涩。阳气因阴虚而亢奋，热自虚而来，五液焦枯，津血皆干涸。不用大剂滋阴壮水的药物，不能制约那无畏的阳光。宜以大剂三甲复脉汤为主，以上面列出的育阴诸品为佐，更应当加入潜阳摄纳的方法，以希望挽回万一。只是病至此地步的，往往难以救治，因为其阴液已经枯竭，而又淋漓不止，生的难保，去的难复，虽然有神丹妙药，又能奈何呢。这是冲任阴虚的治疗方法。大抵阳虚者常兼有脾土虚弱，多见食少不运、大便溏泻等症状，治疗宜兼温脾阳；阴虚者常兼有肝木失调，多见头晕眼花、耳鸣心悸等症状，治疗宜兼清风木，这又是一定的道理。况且肝是藏血的脏器，脾是统血的场所，脾为后天之本，女子又以肝为先天，所以崩漏诸症，肝脾也是紧要的候诊部位，肝虚则血不藏，脾虚则血不统。纯为肝虚不藏的，应当分寒热：虚热的，用甘酸咸寒之品补之，如二至丸、丹地四物汤、阿胶鸡子黄汤之类。若兼有脾虚不统的，用归芍异功散、归脾汤、当归补血汤、圣愈汤之类。肝脾两虚，藏统失职，治疗宜兼顾两者。更有进一层的情况，脾为阴土，肝为刚脏，脾脏喜温而恶凉，病多偏于虚寒；肝脏喜清而恶温，病多偏于实热。常有肝实脾虚、脾寒肝热的症状，肝热不藏，脾寒失统，肝实宜泻，脾虚当补。治疗既兼顾两脏，尤其应当温清并进，寒热同投，泻实补虚，温寒清热，稍有不当，便失去病机。古人成方如胶艾四物汤、胶姜饮、侧柏叶汤、黄土汤之类，都是为此症化裁而成。而交加散一方，尤为奇妙，生地凉肝热，生姜温脾寒，一寒一热，分量相当。其中生地绞汁不煎煮，尤有深意，煎煮则凉润之性减弱，不能散生姜之温，也不能发挥清肝之力。古人治崩漏，热证用荆芥、黄芩，寒证用生姜、艾叶，以为定法，却不知道二者合用，更能建立奇勋。因为夹杂的病多，单纯的症少，所以寒热并用的，治疗效果独多。又有肝脾郁结的症状。肝郁，木气失于条达的，用逍遥散疏解；脾郁，阴火下流的，用升阳散火汤发散。书上所谓“木郁达之，火郁发之，结者散之”。火为郁火，升之散之，火遂炎上之性，自然不逼迫血液妄行。如果见热投凉，火气更加下郁，崩漏更加不止。旧论认为归脾汤是郁伤心脾的主方，加味逍遥散是肝脾郁结的主方，其中都有可议之处。逍遥散燥土升木，能治肝脾郁结，其妙处正在只用升散开发，不用降泄，方与治郁火达发之旨相合，若加丹皮、栀子，苦寒沉降，火气无上升通达之期，这是更加增加其郁结，自相矛盾了。归脾汤养心和肝，调营益气，自是要方，惟独因郁结而导致月经不行的，使用极为适宜，无须更动，若因郁伤而导致崩漏不止的，则方中的木香行气之品，断不可用。血既已不止，再通其气，气行则血行，就会奔涌不止了。古人说归脾汤的妙处，只在木香一味，得补中有行，静中有动之旨。但这说的是闭塞之症，如果说崩漏，就不能作如是解了。有热在下焦，逼迫血液妄行的，其人平时月经必提前，颜色必紫黑，脉必弦数，症状多为沸热不断，宜用荆芩四物汤加贯众炭、丹皮、藕节之类。荆芥炒黑，清营止血，极有功效。热去则血无所逼，漏不止而自止。后用育阴柔肝清营之品，调理自愈。古人说暴崩漏宜温摄，久崩漏宜清通。所谓清通，即是热在下焦的症状。其言暴久，也有分等级，大概暴崩也有宜清的，久漏也多宜温的，只应当审症施治。大抵宜温摄的，必须有虚脱的形证；宜清通的，必定见热盛的征象。久漏不止，而没有虚象，就知道久漏不止的原因，必定另有他因而致。若属虚症久延，必致危及生命，即使不致于此，其虚弱的表现，在所必见也。现在久漏而不见虚象，应当知道非虚，既然非虚，那为什么漏不止，推求原理，必属下焦有热，血海不藏，热逼而血妄行。治疗此症，自当以清通为法，并非谓一切久崩久漏，均可清通，只有久漏无弱象，或久崩服补摄药反而加剧的，才可用此法。这是读古人书所不宜拘泥的地方。有元气大虚，气不摄血的，此症暴崩为多，其来极快，如堤坝决口，如山崩，崩至如潮，奔骤不止。崩后气喘汗出，头晕眼黑，面唇苍白，肢冷畏寒。崩症的血液，颜色先红后淡，纯至全为黄水。若不速治，或治不如法，就有喘脱的危险，这是崩症中最紧急的。大概因为血随气行，气升血升，气脱血脱，元气大虚，中气不举，气既下陷，血亦随之。况且气为血之帅，血为气之母，未崩之前，气脱则血无所固，如水无堤，岂能免于横溢，而崩遂成。既崩之后，血脱则气无所恋，如魂无依，岂能助其升举，而崩益盛。以此因缘，连环增剧，如果不施治，非至阴阳决离，气血两脱不止。治疗之法，一则由气虚而成崩，当以补气为主；二则血脱者宜益气，也当以补气为主。可知人参、黄芪为必需的要药。人参大补元气，黄芪补中气，兼益下焦卫气，与此症极宜，惟须多用、专用，始有大力。凡治此种大症急症，药贵重贵专，轻则力薄，薄则力杂，均不中病。再当验其兼证，如纯见气血下脱之象的，宜补气为主，佐以升举固涩，升其下陷，涩其下脱。如补中益气汤加赤石脂、禹余粮之类，重用参、芪治之。如既有气虚下脱，又兼面赤戴阳，咽干咽痛，脉洪大无根的，宜补元益气为主，育阴潜阳为佐，以血去阴伤，阴虚阳亢，若一味补气升举，与气虚固宜，与阴虚阳亢则不合。且升举为有虚阳上浮者所忌。如生脉散用人参扶元，麦冬育阴，五味敛虚，颇为合剂，再加花龙（骨）潜恋，则更善矣。或重用黄芪至数两，而以炮姜、艾叶、侧柏、童便之类佐之，以此治前症尤佳。补元气，降虚火，引血归经，面面俱到，每有重症险象服之得效者，也是一善法。
总之，元气大虚之症，自非峻用参、芪不可，惟须知补气之品，多助气流通，症既滑脱，稍行其气，血必不止，即参、芪亦能行气，不必乌头、附子、青皮、陈皮始然。故每见气虚补气而倍剧者，此则不知药性之理故耳。用时必兼固涩静恋之品，始能得力，而不致反为所用。或佐升提，或兼固涩，或附滋恋并酸收，审症而施，奏效如响。而止血引经之品，如炮姜、艾炭、黑草、棕炭、牛角腮灰、丝瓜络灰、藕炭、血余灰、釜脐墨之类，亦当佐用不缺。又有熏法，坐法以为外治，如血崩大虚厥脱者，以黄芪十数斤，煎汤置床下熏之，严闭窗户，使气不泄，药气内达，厥脱自回。稍轻能起坐者，则置净桶中坐之，热气上腾，药力亦速。更内服参附、芪附、龙牡，回阳潜阳，补元固气之剂，内外并治，亦有得生者，这是许胤宗的法子。有瘀血阻其新血，积而成崩的，水满则溢，堤涨则决，如《金匮》云：妇人半产后，漏下不绝，唇燥漱水，及宿有癥痼，续得漏下的。其漏下均为宿瘀阻其生化，新血不得流通，遇瘀而停，日积月累，愈聚愈多，一旦满而外溢，则为崩漏，书所谓“癥不去，血不止”的是也。其人必腹有痞块，其崩必数月一下。痞块者，宿瘀之外征也；数月一下者，以其崩乃盈科而流，必间数月，始有盈满之可能。若时时淋沥，则漏卮不塞，断不能盈。不能盈，亦断不成崩也。其治不必治崩，不宜止涩，但当去其宿结，宿积去则血无所阻，新血畅行，按月而下，崩不治而自止矣。此崩因宿积，治宜去瘀者的原理也。轻者桂枝大黄、桃仁承气汤，重者抵当汤丸、大黄蟅虫丸之类攻之。若素体虚弱，不能用攻，及无坚积不可攻者，倘余症颇同，或未来之先，先有腹痛筋掣，既崩之后，血来成块，色紫的，此气滞血凝，积久成崩，与上所述者大半相同。所不同者，一因瘀阻，一因气滞耳。甚则两目黯黑，肌肤甲错，大类干血瘀象，以气滞则血凝，亦能成瘀也。此不可攻，但当理气，气行则血自调，气不滞则血不停，血不积则崩不成。若用攻瘀，犯其无过，必多遗害。其理以一则由瘀而碍血，一则因气而停瘀。因瘀者其结坚，非攻不下；因气者其结轻，气顺即行。攻瘀者乃破其旧积，非攻其新停之血，以其新积之血，满而自下，无待于攻也。理气者乃防其复积，其已积者已从崩而下，即有余留，亦属易行，行气已足，不必用攻也。其症则因瘀者必见坚凝之象，因气者必有气滞之形。从数月一下，辨其积血成崩；从坚结有无，辨其因瘀因气，思过半矣。简言之，则因瘀而崩者，重则攻崩，轻者但宜调气。因气而凝者，则无论轻重，均以理气为先，古人谓调经以理气为主，确有深意。
带下篇
Manuscripts of Cheng Menxue
Cheng Menxue
Preface: Cheng Menxue (1902-1972): Courtesy name Jiuru, with pseudonyms such as Hugong, Pushishanfang, Shuzhonglu, Wanxue Xuan, and Budu Zhai. He was from Wuyuan. At the age of sixteen or seventeen, he became a disciple of the famous physician Wang Lianshi, and later studied under Ding Garen. He graduated from the Shanghai College of Traditional Chinese Medicine in 1921. His academic thought integrated the theories of Zhang Zhongjing and Ye Tianshi, bridging ancient and modern knowledge, and synthesizing Chinese and Western medicine, making him one of the great masters of traditional Chinese medicine in the modern era. His eight posthumous manuscripts were all unpublished during his lifetime. Among them, the chapters on Benglou (Metrorrhagia and Metrostaxis), Daixia (Leukorrhea), Taian (Antenatal care), Ren Shen (Pregnancy), and Chan Hou (Postpartum) are short yet concise, rich in content, and can be viewed as a pocket-sized monograph on gynecology in traditional Chinese medicine. A careful study of these works is highly beneficial for various clinical methods in gynecology. Herein, five of his gynecological monographs are recorded for joint research and study.
Chapter on Benglou (Metrorrhagia and Metrostaxis)
Benglou (Metrorrhagia and Metrostaxis) is a severe condition; if mild, it lingers and leads to consumptive disease; if severe, it can cause immediate death. How can treatment not be prudent? Ancients said: Benglou (Metrorrhagia) is like a mountain collapse, sudden and massive bleeding; Lou (Metrostaxis) is like a leaking vessel, continuous and dripping. One is uncontrollable outflow, the other is unguarded seepage. Although the symptoms differ, the essence is the same: blood failing to remain within its vessels. Investigating the causes of illness, there are cases due to Spleen deficiency failing to control blood; cases due to Heat in the Lower Jiao forcing blood to move recklessly; cases due to severe deficiency of Yuan Qi (Primordial Qi) failing to consolidate blood; and cases due to old Blood Stasis blocking internally, preventing new blood from returning to its channels and flowing out. Since the causes differ, the symptoms also vary. Based on the varying symptoms, investigate the etiology; addressing the etiology, determine the treatment method. Thus, the pathogen will have nowhere to hide, and treatment will be comprehensive. For cases where the Chong and Ren Mai (Penetrating and Conception Vessels) fail to control blood, treatment should differentiate between Yin and Yang. In Yang deficiency, the blood is pale, complexion is sallow, lips and mouth lack luster, nails are colorless, limbs feel cold, weakness and numbness prevail, warmth does not bring relief, sensation seems absent, lower back and spine are sore and weak, fear of cold is particularly severe, or waist feels cold as ice, back feels cold as if immersed in water, pulse is deep, slow, and weak. Treatment is divided into urgent and gradual methods: for urgent cases, tonify Qi to cultivate generating Yang; for gradual cases, warm and consolidate to secure the lower Yuan True Yang. Since Chong and Ren Yang deficiency inherently requires warming and consolidating the lower origin and securing the extraordinary vessels, when the condition is acute and Yang is faint and about to escape, changes occur in an instant. Warming and consolidating herbs can only secure during normal times but cannot reverse Yang in an instant. Adhering to fixed formulas is too slow for emergencies. At this time, only Rescuing Yang and Consolidating Qi, assisted by subduing and descending, can temporarily restore escaping Yang. Once Qi is solid and Yang returns, slowly plan for consolidation. Can Fu Tang (Ginseng and Prepared Aconite Decoction), Qi Fu Tang (Astragalus and Prepared Aconite Decoction), Long Gu (Dragon Bone) and Mu Li (Oyster Shell), and Zhen Wu Tang (True Warrior Decoction) are essential urgent prescriptions. For gradual cases, although Yang deficient, there is no immediate sign of collapse. Meat-based substances with emotional affinity (Xue Rou You Qing Zhi Pin) should be the main ingredients, assisted by herbs that warm the Kidney, fill Essence, assist Yang, and consolidate. Securing the extraordinary vessels takes effect slowly; long-term administration yields miraculous results. Substances with emotional affinity include Lu Jiao (Deer Antler), Lu Rong (Deer Antler Velvet), Lamb meat, Sheep Kidney, An Na Qi (Feline Genitalia), and He Che Da Zao (Placenta Hominis). Herbs tonifying Kidney Yang and filling Essence include Cong Rong (Cistanche), Ba Ji Tian (Morinda Root), Gou Shen (Dog Kidney), Gu Zhi (Psoralea Fruit), Gu Sui Bu (Drynaria Rhizome), Du Zhong (Eucommia Bark), Rou Gui (Cinnamon Bark), and Hui Xiang (Fennel). Consolidating agents include Zi Shi Ying (Fluorite), Chi Shi Zhi (Red Halloysite), Wu Wei Zi (Schisandra Berry), Jin Ying Zi (Cherokee Rose Hip), Long Gu (Dragon Bone), and Mu Li (Oyster Shell). Observing the severity of the condition, adjust the prescription accordingly. This is the treatment for Chong and Ren Yang deficiency. In Chong and Ren Yin deficiency, blood is bright red, malar flush occurs frequently, face is white while lips are red, exterior cold with interior heat, heat in the bone marrow, heart palpitations and heat, feeling hungry after eating, tongue is crimson, pulse is fine and rapid, or both Chi pulses are rapid and hurried. Blood loss injures Yin; Yin deficiency leads to Yang hyperactivity; droplets do not stop, Five Fluids are about to dry up. Treatment must nourish Yin, subdue Yang, cool the Ying (Nutritive Level), and clear Fire. Also divided into light and heavy methods: Light cases have more Heat than deficiency, blood is bright and abundant. Focus on cooling Ying and clearing Fire, assisting with nourishing Yin and moistening dryness. Cooling Ying agents include Sheng Di Huang (Rehmannia Root), Bai Shao (White Peony Root), Sang Ye (Mulberry Leaf), Dan Pi (Moutan Cortex), Di Yu (Sanguisorba Root), Di Gu Pi (Lycium Bark), Qing Hao (Artemisia Annua), and Bai Wei (Cynanchum Root). Clearing Fire agents include Zhi Mu (Anemarrhena Rhizome), Huang Bo (Phellodendron Bark), Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), and Tong Bian (Human Urine). Nourishing Yin agents include Nu Zhen Zi (Ligustrum Fruit), Han Lian Cao (Eclipta Herb), E Jiao (Donkey-Hide Gelatin), Tian Dong (Asparagus Tuber), Mai Dong (Ophiopogon Tuber), and Bao Yu (Abalone). Moistening dryness agents include Ma Ren (Hemp Seed), Zhi Ma (Sesame Seed), Bai Zi Ren (Biota Seed), and Ji Zi Huang (Egg Yolk). Only when Heat subsides can full doses of Yin-nourishing agents be used for recovery. Heavy cases involve severe Yin deficiency, blood is bright but scant, dripping continuously, skin is dry and rough, bone-steaming fever without sweat, dry throat and mouth, temples hair is brittle and dry, tongue is crimson and dry in the center, pulse is fine, rapid, and choppy. Yang is hyperactive due to Yin deficiency; Heat arises from deficiency; Five Fluids are scorched, Jing and Blood are exhausted. Only large doses of Yin-nourishing and Water-strengthening agents can restrain the reckless Yang. Use large doses of San Jia Fu Mai Tang (Three Shells Pulse-Reviving Decoction) as the main formula, assisted by the aforementioned Yin-nourishing herbs. Furthermore, methods of subduing Yang and consolidating should be added to hope for salvation. However, patients reaching this stage are often incurable because their Yin fluids are exhausted, and leakage continues. The living are hard to save, the lost cannot be recovered; even with divine pills, what can be done? This is the treatment for Chong and Ren Yin deficiency. Generally, Yang deficiency often involves Spleen Earth weakness, showing symptoms like poor appetite, indigestion, and loose stools; treatment should simultaneously warm Spleen Yang. Yin deficiency often involves Liver Wood imbalance, showing symptoms like dizziness, blurred vision, tinnitus, and palpitations; treatment should simultaneously soothe Liver Wind. This is a fixed principle. Moreover, the Liver stores Blood, and the Spleen controls Blood. The Spleen is the Post-Heaven Foundation, and for women, the Liver is the Pre-Heaven Foundation. Therefore, in Benglou, the Liver and Spleen are critical organs. Liver deficiency fails to store Blood; Spleen deficiency fails to control Blood. Pure Liver deficiency failing to store should be differentiated by Cold and Heat: for Deficient Heat, use sweet, sour, salty, and cold tonics, such as Er Zhi Wan (Two Solstice Pill), Dan Di Si Wu Tang (Rehmannia and Moutan Four Substance Decoction), and E Jiao Ji Zi Huang Tang (Donkey-Hide Gelatin and Egg Yolk Decoction). If accompanied by Spleen deficiency failing to control, use Gui Shao Yi Gong San (Angelica and White Peony Extraordinary Power Powder), Gui Pi Tang (Restore the Spleen Decoction), Dang Gui Bu Xue Tang (Angelica Tonify Qi Decoction), and Sheng Yu Tang (Generate Life Decoction). When both Liver and Spleen are deficient, failing in storage and control, treatment should address both. Further, the Spleen is Yin Earth, and the Liver is the Rigid Organ. The Spleen prefers warmth and dislikes cold, so diseases tend toward deficiency-cold. The Liver prefers clarity and dislikes warmth, so diseases tend toward excess-heat. There are often cases of Liver Excess and Spleen Deficiency, or Spleen Cold and Liver Heat. Liver Heat fails to store; Spleen Cold loses control. Liver Excess should be purged; Spleen Deficiency should be tonified. Treating both organs requires simultaneous warming and clearing, combining cold and hot, purging excess and tonifying deficiency, warming cold and clearing heat. Any mishap misses the pathogenesis. Ancient fixed formulas like Jiao Ai Si Wu Tang (Collagen and Mugwort Four Substance Decoction), Jiao Jiang Yin (Collagen and Ginger Drink), Ce Bai Ye Tang (Biota Leaf Decoction), and Huang Tu Tang (Yellow Earth Decoction) are modified for these conditions. The formula Jiao Jia San (Interlaced Powder) is particularly wonderful: Sheng Di Huang cools Liver Heat, Sheng Jiang warms Spleen Cold. One cold, one hot, balanced precisely. Sheng Di Huang is juiced raw without boiling, which has deep meaning; boiling reduces its cooling and moistening nature, unable to disperse Sheng Jiang's warmth or exert its Liver-clearing power. Ancients treated Benglou with Jing Jie (Schizonepeta) and Huang Qin (Scutellaria) for Heat, and Sheng Jiang (Fresh Ginger) and Ai Ye (Mugwort Leaf) for Cold, considering this a fixed rule. They did not know that using both together creates miraculous effects. Because mixed diseases are common, simple syndromes are rare; thus, combining cold and hot yields unique efficacy. There are also Liver-Spleen Qi Stagnation syndromes. Liver Qi stagnation, where Wood fails to flow freely, is treated with Xiao Yao San (Free Wanderer Powder) to soothe. Spleen Qi stagnation with sinking Yin Fire is treated with Sheng Yang San Huo Tang (Raise Yang Scatter Fire Decoction) to dissipate. As the texts say: "Stagnant Wood should be dispersed, stagnant Fire should be vented, knots should be scattered." Fire is stagnant Fire; venting and dispersing it allows its flaming nature to rise naturally, preventing it from forcing blood to move recklessly. If one uses cold herbs for Heat, Fire sinks deeper, and Benglou worsens. Old theories regard Gui Pi Tang as the main formula for Heart-Spleen injury from stagnation, and Jia Wei Xiao Yao San (Modified Free Wanderer Powder) as the main formula for Liver-Spleen stagnation. Both have debatable aspects. Xiao Yao San dries Earth and raises Wood, treating Liver-Spleen stagnation. Its brilliance lies in using only ascending and dispersing methods, avoiding descending and purging, aligning with the principle of venting stagnant Fire. Adding Dan Pi and Zhi Zi introduces bitter-cold and sinking properties, preventing Fire from rising, thereby increasing stagnation, which is contradictory. Gui Pi Tang nourishes Heart and soothes Liver, regulates Ying and tonifies Qi, and is indeed an essential formula. It is suitable for amenorrhea due to stagnation without modification. However, for Benglou caused by stagnation injury, the Qi-moving herb Mu Xiang (Aucklandia Root) in the formula must absolutely be avoided. If bleeding has not stopped, moving Qi makes Blood move, leading to torrential flow. Ancients said the妙 (wonder) of Gui Pi Tang lies in Mu Xiang, achieving movement within stillness and action within tonification. But this applies to obstruction syndromes, not Benglou. For Heat in the Lower Jiao forcing blood recklessly, the patient usually has early menstruation, dark purple-black blood, and a wiry-rapid pulse. Symptoms include continuous boiling heat. Use Jing Qin Si Wu Tang (Schizonepeta and Scutellaria Four Substance Decoction) plus Guan Zhong Tan (Charred Cibotium Rhizome), Dan Pi (Moutan Cortex), and Ou Jie (Lotus Node). Charred Jing Jie clears Ying and stops bleeding effectively. Once Heat is gone, blood has no force to move, and leakage stops spontaneously. Subsequently, treat with Yin-nourishing, Liver-softening, and Ying-cooling agents for recovery. Ancients said acute Benglou should be warmed and consolidated, while chronic Benglou should be cleared and unblocked. "Clearing and unblocking" refers to Heat in the Lower Jiao. The distinction between acute and chronic has nuances: acute Benglou may sometimes require clearing, and chronic leakage may often require warming. Treatment must be based on syndrome differentiation. Generally, warming and consolidating are indicated for signs of collapse; clearing and unblocking are indicated for signs of intense Heat. Chronic leakage without deficiency signs indicates the cause is not deficiency. If it were a chronic deficiency, it would lead to death or obvious weakness. Since there are no deficiency signs, it is not deficiency. Why does leakage persist? Tracing the principle, it must be Heat in the Lower Jiao, Blood Sea failing to store, Heat forcing blood recklessly. Treatment should focus on clearing and unblocking. This does not mean all chronic Benglou can be cleared; only chronic leakage without weakness signs, or acute Benglou worsening after taking tonifying/consolidating drugs, should use this method. This is a point not to be rigidly adhered to when reading ancient texts. For severe Yuan Qi deficiency failing to control blood, acute Benglou is common, coming suddenly like a breached dam or collapsing mountain, surging endlessly. After bleeding, there is panting, sweating, dizziness, blacking out, sallow lips, cold limbs, and fear of cold. The blood color changes from red to pale, eventually becoming yellow fluid. Without prompt treatment, or if treatment is improper, panting and collapse may occur. This is the most urgent form of Benglou. Blood follows Qi; Qi rises, Blood rises; Qi escapes, Blood escapes. Severe Yuan Qi deficiency means Middle Qi fails to lift; as Qi sinks, Blood follows. Qi commands Blood, Blood nurtures Qi. Before bleeding, Qi escape leaves Blood unsecured, like water without a dike, inevitably overflowing. After bleeding, Blood loss leaves Qi unsupported, like a soul without shelter, unable to lift, worsening the bleed. These factors create a vicious cycle. Without treatment, it leads to separation of Yin and Yang, and exhaustion of Qi and Blood. Treatment: First, since Benglou is caused by Qi deficiency, tonify Qi primarily. Second, for Blood loss, tonify Qi is also primary. Thus, Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root) are essential. Ren Shen greatly tonifies Yuan Qi; Huang Qi tonifies Middle Qi and benefits Lower Jiao Wei Qi. They suit this condition well but must be used in large, specific doses to be effective. For major emergencies, herbs must be precious and focused; light doses are weak, mixed doses are ineffective. Check accompanying syndromes: If purely showing Qi and Blood sinking/collapse, tonify Qi primarily, assist with lifting and astringing. Use Bu Zhong Yi Qi Tang (Center-Boosting and Qi-Enhancing Decoction) plus Chi Shi Zhi (Red Halloysite) and Yu Yu Liang (Yttrocopelite), heavily dosing Ren Shen and Huang Qi. If Qi deficiency with sinking is accompanied by flushed face (Floating Yang), dry/painful throat, and洪大 (Surging-Large) rootless pulse, tonify Yuan and Qi primarily, assist with nourishing Yin and subduing Yang. Blood loss injures Yin; Yin deficiency leads to Yang hyperactivity. Solely tonifying and lifting Qi suits Qi deficiency but contradicts Yin deficiency with Yang hyperactivity. Moreover, lifting is contraindicated for Floating Yang. Sheng Mai San (Generate Pulse Powder) with Ren Shen supporting Yuan, Mai Dong (Ophiopogon Tuber) nourishing Yin, and Wu Wei Zi (Schisandra Berry) astringing deficiency is appropriate. Adding Hua Long Gu (Flower Dragon Bone) further aids subduing. Or use large doses of Huang Qi (several taels) assisted by Pao Jiang (Prepared Ginger), Ai Ye (Mugwort Leaf), Ce Bai (Biota Leaf), and Tong Bian (Human Urine). This treats previous symptoms excellently, tonifying Yuan Qi, descending deficient Fire, guiding Blood back to channels. It covers all aspects and often saves critical cases. Another good method.
In summary, severe Yuan Qi deficiency requires aggressive use of Ren Shen and Huang Qi. However, note that Qi-tonifying herbs often promote Qi circulation. In sliding/collapsing syndromes, moving Qi slightly stops blood flow. Even Ren Shen and Huang Qi move Qi; it is not just Wu Tou (Aconite Root), Fu Zi (Prepared Aconite Child), Qing Pi (Green Tangerina Peel), or Chen Pi (Aged Tangerina Peel) that do so. Thus, seeing Qi deficiency worsen after tonification is due to ignorance of herb properties. When using, always combine with astringent and stabilizing herbs to gain efficacy and avoid adverse effects. Assist with lifting, or combine with astringing, or attach nourishing/astringing and sour-collecting agents. Treat according to syndrome for rapid effect. Hemostatic and channel-guiding herbs like Pao Jiang (Prepared Ginger), Ai Tan (Mugwort Charcoal), Hei Cao (Charred Licorice), Zong Tan (Palm Charcoal), Niu Jiao Sai Hui (Cow Horn Hair Ash), Si Gua Luo Hui (Luffa Fiber Ash), Ou Tan (Lotus Rhizome Charcoal), Xue Yu Hui (Burnt Hair Ash), and Fu Qi Mo (Kettle Bottom Soot) should also be used as assistants. External treatments include fumigation and sitting baths. For massive Benglou with collapse, boil several jin of Huang Qi, place the decoction under the bed to fumigate, close windows tightly to retain vapor, allowing medicinal Qi to penetrate internally, reversing collapse. For lighter cases able to sit, place in a clean bucket to sit, allowing heat and medicinal power to rise quickly. Internally administer Can Fu, Qi Fu, Long Gu, Mu Li to rescue Yang, subdue Yang, tonify Yuan, and consolidate Qi. Internal and external treatment combined can save lives. This is the method of Xu Yinzong. For Benglou caused by Blood Stasis blocking new blood accumulation, like water overflowing when full or a dike bursting when high, as stated in *Jin Gui Yao Lue*: Women with incomplete abortion having continuous leakage, dry lips desiring rinsing with water, or those with old masses developing subsequent leakage. All such leakage is due to old Stasis blocking transformation and generation, preventing new blood from circulating. Meeting Stasis, it stops, accumulating over time until full and overflowing, causing Benglou. As texts say: "If the mass is not removed, bleeding does not stop." Patients must have abdominal masses; bleeding occurs once every few months. Masses are external signs of old Stasis; occurring every few months is because Benglou flows like a pond filling step-by-step, requiring months to become full. If dripping constantly, the leak is never plugged, never full. Never full, never Benglou. Treatment should not target Benglou directly nor use astringents, but remove old knots. Once old accumulation is gone, blood has no blockage, new blood circulates freely, flows monthly, and Benglou stops spontaneously. This is the principle for Benglou due to old accumulation requiring Stasis removal. Light cases use Gui Zhi Da Huang Tang (Cinnamon Twig and Rhubarb Decoction) or Tao Ren Cheng Qi Tang (Peach Kernel Order Qi Decoction); heavy cases use Di Dang Tang/Wan (Di Dang Decoction/Pill) or Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) to attack. If constitution is weak and attack is contraindicated, or no hard accumulation exists, but other symptoms match, or before bleeding starts, there is abdominal pain and tendon twitching, and after bleeding, blood comes in clumps and is purple, this is Qi Stagnation and Blood Coagulation, accumulating over time to cause Benglou, largely similar to the above. The difference is one is due to Stasis blockage, the other to Qi Stagnation. Severe cases show dark eyes and crusty skin, resembling Dry Blood Stasis. Qi Stagnation causes Blood Coagulation, forming Stasis. Attack is contraindicated; regulate Qi instead. When Qi moves, Blood regulates; when Qi is not stagnant, Blood does not stop; when Blood does not accumulate, Benglou does not form. Using Stasis-breaking herbs here attacks no fault and causes harm. The logic: one hinders Blood via Stasis, the other stops Blood via Qi. Stasis knots are hard, requiring attack; Qi knots are light, resolving with smooth Qi. Breaking Stasis destroys old accumulation, not newly stopped Blood, as new accumulated Blood flows down when full without needing attack. Regulating Qi prevents re-accumulation; already accumulated Blood has flowed out, any remainder is easy to move. Sufficient Qi movement needs no attack. Syndromes: Stasis cases show hardness/coagulation; Qi cases show stagnation signs. Distinguish accumulated Blood Benglou by frequency (every few months); distinguish Stasis vs. Qi by presence of hardness/knots. Understanding half the problem is achieved. Briefly: Benglou due to Stasis, heavy cases attack, light cases regulate Qi. Benglou due to Qi coagulation, regardless of severity, prioritize regulating Qi. Ancients said regulating menstruation prioritizes regulating Qi, which has deep meaning.
Chapter on Daixia (Leukorrhea)