5．郑女。经将行，腹必痛，痛甚剧，量多更痛。炮附块4．5克，全当归9克，川断肉9克，全毛脊9克，菟丝子9克，生艾叶g克，延胡索9克，生麻黄4．5克，全蝎3克。共研细末，每服3克，日服3次。
6．蔡女。正值经行，骤逢拂逆，从此经少而少腹胀痛。古人谓木不条达，正对此等证候而言。全当归9克，白芍9克，丹参9克，柴胡9克，云苓12克，薄荷尖3克(后下)，甘草2．1克，生姜3片。五灵脂、香附、莪术、肉桂各6克，研末，每服1．5克。
7．沈女。前人以经后腹痛拒按属诸瘀滞，行气攻瘀，无非使局部之瘀血得以通行。今经已净，因痛而再见淡红水。丹皮炭9克，桃仁泥12克，藏红花2．4克，丹参9克，茜草9克，苏木6克，乳没各4．5克，延胡9克，炒条芩4．5克，失笑散12克(包)。
8．杨女；经行时重受寒，少腹绞痛殊甚，按之硬，是内有所积，脉弦苔白。当温通之。生麻黄3克，莪术9克，五灵脂9克，炮干姜3克，桃仁泥12克，台乌9克，延胡9克，小茴香3克，肉桂末1．8克(分2次吞)。另：白芷、川草乌各6克，共研细末，葱汁、蜜糖调敷患者痛处。9．李女。经将行，腹先痛，经色紫黑，量少。川芎、丹皮、延胡、丹参、艾叶、当归、香附、泽兰、失笑散(分2次吞)各9克，桃仁泥12克。
[按]痛经一证，皆由气血运行不畅引起，而又以寒凝、气滞为多。案中有用温补的，盖为虚寒而投；有经行重受寒，而用温通的是因为寒凝留瘀；有因瘀滞而用行血活血；有因肝气不舒而用疏肝解郁。以上6案，都是因症处方，随机应变。
1．张女。经曾停止3个月有余，因登楼闪动而下血块，从此淋沥不净，4个月有余。熟地12．0，炒当归6克，阿胶珠12克，金毛脊9克，仙鹤草15克，苎麻根12克，藏红花6克，川断9克，震灵丹；6克，(分2次吞)。二诊：漏红止，腰酸，上膈隐痛，入夜微有惊惕，皆贫血使然也。熟地12克，川断9克，党参9克，枸杞9克，酸枣仁9克，黄芪皮12克，龙眼肉9克，菟丝子12克，仙鹤草15克。
[按]此案经停3个月因虚，淋沥4个月亦因虚。一诊以熟地、阿胶补血，促进血液凝固；漏久必有瘀，故佐以红花、当归通利祛瘀；余为温肾固摄药，以收涩止漏。漏红止，腰酸乃肾虚之征；上膈隐痛，入夜惊惕，为心失血养、经脉空虚之故。二诊以补益气血药善后。震灵丹为南岳魏夫人方，药用禹余粮、赤石脂、代赭石、紫石英各120克，制乳没、五灵脂各60克，朱砂30克，依法为丸。原来用治男子真元衰惫，五劳七伤，脐腹冷痛诸症。叶天士谓其"能止能行"，为"经带妙药"。先生认为此方有固涩凝血作用，对崩漏常喜用之。
2．夏女。经淋沥，用血液凝固之药无效。再拟通涩并进之法。益母草12克，川芎6克，藏红花6克，桃仁9克，乌贼骨18克(研细末分吞)，瞿麦9克，罂粟壳12克，五味子4．5克，仙鹤草12克。二诊：药后经淋沥已净，神疲色萎，气血不足，调补之可矣。潞党参9克，全当归6克，熟地9克，陈阿胶9克，绵黄芪9克，仙鹤草12克，五味子3克，炙甘草4．5克。[按]古人有"暴崩宜补，久漏宜通"之说。通涩并进之法，是兼此两者而灵活运用的。临床实践证明，此法对经水淋沥不尽有疗效。
3．陈女。去年流产后，腹部较平素胀大，且有沉坠感。近来经淋沥不净，当予收缩子宫之属。益母草12克，制香附9克，五味子4克，川芎9克，山萸肉9克，瞿麦穗9克，生艾叶4．5克，苏木4．5克，台乌药9克，失笑散9克(分吞)。
4．吴女。行经量多如冲，经历8日，量虽减少，但淋沥不易尽，腰痛如折，良以为苦。今拟收缩子宫与增加血液凝固合剂。藏红花3克，瞿麦穗12克，杜仲9克，大川芎6克，益母草9克，川断肉9克，熟地18克，金樱子9克，生阿胶15克，藕节5只，震灵丹6克(分2次吞服)。
5．张女。经曾停2个月。既至，淋沥不易净，迄今1个月有余，腹痛则其量更加。此证据其舌、脉，当用补涩；但痛，又当和瘀。二者并用可矣。益母草9克，瞿麦穗9克，仙鹤草18克，大川芎6克，干地黄12克，生阿胶24克(烊冲)，五味子3克，金樱子9克，陈棕炭30克(煎汤代水)。[按]以上3案中，均有益母草与瞿麦穗相伍。先生认为，此二药同用，功能去瘀生新、收缩子宫，所以对月经病多用之。
6．周女。虽静卧，亦有少量之经淋沥。治此症之条件有五，而麻醉亦能止血，镇静其血管，使血行不致过速之意。罂粟壳12克，诃子肉9克，五味子4．5克，阿胶24克，牛角腮12克，熟地18克，苎麻根12克，炮附片6克，延胡索9克，香甘松9克。二诊：进药3剂，经淋沥者，静卧则止，起行复见，量仍少。药见其效，仍守原意。婴粟壳9克，五味子4．5克，阿胶18克，熟地18克，苎麻根9克，牛角鳃12克，炮附片6克，仙鹤草15克。
三诊：淋沥已净，稍感心悸、神疲，夜不安寐，予归脾丸以调之。[按]所谓"治此症之条件有五"，即补，温、凉、涩、祛瘀；这是先生治疗月经淋沥的常用方法，临床用之适当，很有效果。本案以补涩并用而收效。结合现代药理研究，罂粟壳等固涩药，具有麻醉、镇静作用。案中提出"麻醉亦能止血"，即指此而言。
7．盛女。经净后，淋沥迄今20余日，腰为之酸，酸甚量亦频；古人于此，一用固涩法，一用祛瘀法，其揆一也。益母草9克，藏红花6克，肉桂末1．5克(吞)，炮姜炭4．5克，瞿麦穗12克，小蓟12克，大川芎6克，生艾叶4．5克，仙鹤草12克，桑椹子12克，震灵丹6克(分2次吞)。
二诊：生理之经行，与病理之出血连续不断，需加区别，顷经量多而褐者，知为经行；色鲜而淋沥者，为漏下。今经行之第2日。熟地黄24克，阿胶珠18克，荆芥穗6克，川断9克，厚杜仲9克，瞿麦穗12克，桑寄生12克，小蓟9克，乌贼骨24克，十灰丸12克(分2次吞)。[按]本例患者，原系子宫出血，淋沥不净3周以上。先生初诊，作经漏论治，重用固涩祛瘀。迨复诊时，询得量多色褐，与平时月经无异，故有"今经行第二日"之说，而用药也随之作了更动。
8．陆女。经淋沥10余日，其色鲜，此当收缩其子宫。瞿麦9克，川芎6克，生茜草9克，益母草9克，苏木4。5克，炮姜炭4．5克，藏红花6克，生蒲黄6克，生艾叶6。克。
9．陈女。经淋沥1个月有余，以通涩并用之法。生阿胶12克，熟地黄15克，瞿麦9克，仙鹤草15克，益母草9克，小蓟草9克，乌贼骨18克(研细末分吞)，生茜草9克。二诊：固摄中稍加通利最妙。生阿胶12克，熟地黄15克，瞿麦9克，益母草9克，杜仲9克，川断9克，苏木6克，生茜草9克，乌贼骨15克(研细末分吞)，陈棕炭12克(包)。[按]本病例二诊时，经之淋沥者几净，故先生有"最妙"二字的案语。
10．石女。病较重之时症后，而经见淋沥不易净，为时已及两旬，腹部微痛，痛则下。此宜古人久漏当攻之法。杜红花9克，桃仁泥12克，黑荆芥6克，瞿麦9克，大川芎4．5克，延胡索9克，益母草9克，生蒲黄9克(包)，赤白芍各6克，来复丹6克(吞)。二诊：以通为止，经淋沥者量已少，亦不感腰酸、腹胀，此可固摄之。绵杜仲12克，熟地黄15克，生黄芪9克，升麻4．5克，乌贼骨30克，金毛脊9克，阿胶珠18克，川断肉9克，核桃肉9克。另：常服两仪膏。[按]初诊淋沥腹痛，为内有瘀血，非用攻法去瘀不可止。二诊诸症悉减，转用固摄为治。
11．徐女。经淋沥50余日，精神食量称是，疲劳则量多，腹痛亦然。益母草12克，大川芎6克，仙鹤草15克，藏红花6克，瞿麦穗12克，苎麻根12克。二诊：药后经量反多，多后逐渐减少，此必然者。熟地12克，阿胶12克，金毛脊9克，瞿麦12克，川断9克，苎麻根12克，仙鹤草30克，乌贼骨30克，月季花2．4克，震灵丹9克(分吞)。[按]患者药后漏止。三诊以八珍汤补益气血而善后。
12．朱女。行经量多如冲，面色不华，头眩。即当固摄，先治其急。大熟地15克，阿胶9克(烊冲)，金毛脊9克，川断9克，瞿麦9克，苎麻根12克，仙鹤草15克，党参9克，黄芪9克，陈棕12克。二诊：前方不能止，经之大下如冲，予加味胶红饮。生阿胶9克，藏红花6克，全当归9克，瞿麦9克，冬瓜子9克，仙鹤草15克，乌贼骨60克，威喜丸15克(包煎)。
三诊：经多如血冲，以胶红饮而暂止。大熟地12克，金毛脊9克，川断9克，仙鹤草15克，乌贼骨30克，元武板15克，威喜丸15克(入煎)。[按]经量多如冲，用补气摄血之法，本为治疗常规，但未获效机，乃系内有瘀热，虚中挟实之故。转予胶红饮加味，应手而效。红花本为活血祛瘀药，这里和阿胶、乌贼骨并用，使残瘀尽祛，新血自守，有断下之功，得"通因通用"之妙。
13．薛女。行经淋沥旬日，近来量多大下，因此每日清晨盗汗出，盖体力弱矣。虽腹中隐痛，不可作实证论。熟地黄18克，仙鹤草15克，牛角鳃炭9克，瞿麦9克，厚杜仲9克，阿胶珠12克，罂粟壳9克，苎麻根12克，震灵丹6克(分2次吞)。[按]经行过多，以致盗汗，出现气血两虚之象，此时即使有瘀，亦只能予补气逐瘀之法，而不可一味通瘀。此证之腹痛，乃出血后，经脉空虚之痛，必是隐隐作痛，喜按喜温，用补血药填之，痛可自定。
14．金女。经曾停止1个月。此番淋沥旬日，腰酸，量益多，虚证也。熟地黄24克，厚杜仲9克，阿胶珠12克，桑寄生12克，仙鹤草12克，金毛脊9克，煅龙骨6克(研粉分4次吞)，苎麻根9克，煅乌贼骨30克(先煎)，川断肉9克。[按]经停因之虚，即经行淋沥旬日，量多，腰酸，亦因之虚。方中用熟地、阿胶补血止血；龙骨、乌贼骨涩以固脱；仙鹤草、苎麻根强壮止血；杜仲、寄生、狗脊、川断补益奇经而治腰酸。合为填补下元、收敛止血之剂。
15．江女。经淋沥二旬有余，量少，时有时无。此因为体弱者半，因于不能静养者半。日来少腹钝痛，手不可近，痛剧则小溲亦疼，此兼有炎症之故。杭白芍9克，瞿麦9克，粉丹皮9克，象贝母9克，白薇9克，桃仁泥9克，生茜草9克，延胡索9克，生侧柏叶12克，失笑散9克(包)，甘草梢3克。小溲痛加剧用：明琥珀末，象牙屑各3克，每次各服0．9克，共分3次空腹服。[按]经淋沥二旬，必虚；少腹钝痛，必有瘀阻。此种漏下，例不宜固摄，而应宗"久漏宜通"之说，以通为止。盖宿瘀不去，新血难守，瘀去则血自循经。方以凉血、祛瘀为主，即是此意。
16．郭女。上月经凡三见，比日又值经行，量多如冲，腰酸如折。古人以经之生理属之冲、任，现代则属之内分泌、卵巢理论。虽今胜于古，治疗则虚、实、气、血四大提纲，亦自成条例。病者总是虚症，作气虚不能摄血论治。生黄芪6克，杜仲9克，川断肉9克，潞党参4．5克，生艾叶4．5克，金樱子12克，升麻2．4克，苎麻根18克，震灵丹6克(分2次吞)。
17．陈女。据现代研究，经先期者反量多，多属于卵巢黄体之变化，治之以脏器疗法。今两脉细数，所谓阴虚火旺，血热妄行。生熟地各12克，苎麻根12克，仙鹤草18克，女贞子9克；旱莲草12克，潼沙苑9克，杭白芍9克，黑山栀9克，黑大豆24克，柏子仁12克(打、包)。[按]此案月经先期而量多，从两脉细数，辨为阴虚火旺，迫血妄行。对这类患者，滋阴正所以降火，凉血正所以止血；而不宜应用补气固摄之品，与上案有别。
18．邓女。经净后又来，小溲频数，表示局部有炎症；炎症不除，其红不止。苦参片6克，鲜生地15克，苎麻根12克，黄柏2．4克，仙鹤草15克，冬青子9克，篇蓄9克，小蓟6克，生山栀12克，甘草梢4．5克，生侧柏叶30克(煎汤代水)。[按]小溲频数，有因肾虚，有因湿热。此案从药测证，可知为湿热蕴于下焦，即所谓"局部有炎症"。其经净后又来，原因亦在此。治病必求其本，凉血、清利湿热，方为本病治法之要。先生所说"炎证不除，其红不止"，殆即指出。倘见血治血，妄用止血收涩，为舍本求标，决非所宜。
5. 郑女士。月经即将来潮时，腹部必然疼痛，疼痛剧烈，经量多时疼痛更甚。炮附块4.5克，全当归9克，川断肉9克，全毛脊9克，菟丝子9克，生艾叶9克，延胡索9克，生麻黄4.5克，全蝎3克。共研成细末，每次服用3克，每日服用3次。
6. 蔡女士。正值经期，突然遭遇情绪逆乱，从此经量减少且少腹胀痛。古人所说的“木不条达”（肝气郁结不畅），正是针对此类证候而言。全当归9克，白芍9克，丹参9克，柴胡9克，云苓12克，薄荷尖3克（后下），甘草2.1克，生姜3片。五灵脂、香附、莪术、肉桂各6克，研成粉末，每次服用1.5克。
7. 沈女士。前人认为，经后腹痛且拒按属于瘀滞，采用行气攻瘀的方法，无非是为了使局部的瘀血得以通行。如今月经已净，因疼痛而再次出现淡红色液体。丹皮炭9克，桃仁泥12克，藏红花2.4克，丹参9克，茜草9克，苏木6克，乳香没药各4.5克，延胡索9克，炒黄芩4.5克，失笑散12克（包煎）。
8. 杨女士；经期时再次受寒，少腹绞痛非常严重，按压时感觉坚硬，这是体内有积滞，脉象弦，舌苔白。应当采用温通之法。生麻黄3克，莪术9克，五灵脂9克，炮干姜3克，桃仁泥12克，台乌9克，延胡索9克，小茴香3克，肉桂末1.8克（分2次吞服）。另：白芷、川草乌各6克，共研成细末，用葱汁和蜂蜜调匀敷于患者疼痛处。
9. 李女士。月经即将来潮前，腹部先痛，经色紫黑，经量少。川芎、丹皮、延胡索、丹参、艾叶、当归、香附、泽兰、失笑散（分2次吞服）各9克，桃仁泥12克。
[按语]痛经这一病症，皆由气血运行不畅引起，其中以寒凝和气滞最为多见。医案中有使用温补法的，是因为虚寒体质而投以温补；有的因经期重受寒，而用温通法，是因为寒凝导致留瘀；有的因瘀滞而用行血活血法；有的因肝气不舒而用疏肝解郁法。以上6个医案，都是根据症状处方，随机应变。
1. 张女士。月经曾停止3个多月，因登楼时闪动而下血块，从此淋漓不尽，已有4个多月。熟地黄12克，炒当归6克，阿胶珠12克，金毛脊9克，仙鹤草15克，苎麻根12克，藏红花6克，川断9克，震灵丹6克（分2次吞服）。二诊：漏红停止，腰酸，上膈隐痛，入夜微有惊惕，这都是贫血所致。熟地黄12克，川断9克，党参9克，枸杞9克，酸枣仁9克，黄芪皮12克，龙眼肉9克，菟丝子12克，仙鹤草15克。
[按语]此案例中，月经停3个月是因为虚，淋漓4个月也是因为虚。初诊以熟地黄、阿胶补血，促进血液凝固；漏久必有瘀，故佐以红花、当归通利祛瘀；其余为温肾固摄药物，以收涩止漏。漏红停止后，腰酸是肾虚的表现；上膈隐痛，入夜惊惕，是心失血养、经脉空虚的缘故。二诊以补益气血药物善后。震灵丹是南岳魏夫人的方子，药用禹余粮、赤石脂、代赭石、紫石英各120克，制乳香没药、五灵脂各60克，朱砂30克，依法制成丸剂。原本用于治疗男子真元衰惫，五劳七伤，脐腹冷痛等症。叶天士说它“能止能行”，是“经带妙药”。先生认为此方有固涩凝血作用，对崩漏常喜欢使用。
2. 夏女士。月经淋漓，使用促进血液凝固的药物无效。再拟定通涩并进的方法。益母草12克，川芎6克，藏红花6克，桃仁9克，乌贼骨18克（研细末分吞），瞿麦9克，罂粟壳12克，五味子4.5克，仙鹤草12克。二诊：服药后经淋沥已净，神疲色萎，气血不足，调补即可。潞党参9克，全当归6克，熟地黄9克，陈阿胶9克，绵黄芪9克，仙鹤草12克，五味子3克，炙甘草4.5克。[按语]古人有“暴崩宜补，久漏宜通”的说法。通涩并进的方法，是兼取这两者而灵活运用的。临床实践证明，此法对经水淋沥不尽有效。
3. 陈女士。去年流产后，腹部较平时胀大，且有沉坠感。近来经淋沥不尽，应当给予收缩子宫的药物。益母草12克，制香附9克，五味子4克，川芎9克，山萸肉9克，瞿麦穗9克，生艾叶4.5克，苏木4.5克，台乌药9克，失笑散9克（分吞）。
4. 吴女士。行经量多如冲，经历8日，量虽减少，但淋沥不易尽，腰痛如折，令人痛苦不堪。今拟定收缩子宫与增加血液凝固的合剂。藏红花3克，瞿麦穗12克，杜仲9克，大川芎6克，益母草9克，川断肉9克，熟地黄18克，金樱子9克，生阿胶15克，藕节5只，震灵丹6克（分2次吞服）。
5. 张女士。月经曾停2个月。既至，淋沥不易净，迄今1个多月，腹痛则其量更加。此证据其舌、脉，当用补涩；但痛，又当和瘀。二者并用可矣。益母草9克，瞿麦穗9克，仙鹤草18克，大川芎6克，干地黄12克，生阿胶24克（烊冲），五味子3克，金樱子9克，陈棕炭30克（煎汤代水）。[按语]以上3案中，均有益母草与瞿麦穗相伍。先生认为，此二药同用，功能去瘀生新、收缩子宫，所以对月经病多用之。
6. 周女士。虽静卧，亦有少量之经淋沥。治此症之条件有五，而麻醉亦能止血，镇静其血管，使血行不致过速之意。罂粟壳12克，诃子肉9克，五味子4.5克，阿胶24克，牛角腮12克，熟地黄18克，苎麻根12克，炮附片6克，延胡索9克，香甘松9克。二诊：进药3剂，经淋沥者，静卧则止，起行复见，量仍少。药见其效，仍守原意。婴粟壳9克，五味子4.5克，阿胶18克，熟地黄18克，苎麻根9克，牛角鳃12克，炮附片6克，仙鹤草15克。
三诊：淋沥已净，稍感心悸、神疲，夜不安寐，予归脾丸以调之。[按语]所谓“治此症之条件有五”，即补，温、凉、涩、祛瘀；这是先生治疗月经淋沥的常用方法，临床用之适当，很有效果。本案以补涩并用而收效。结合现代药理研究，罂粟壳等固涩药，具有麻醉、镇静作用。案中提出“麻醉亦能止血”，即指此而言。
7. 盛女士。经净后，淋沥迄今20余日，腰为之酸，酸甚量亦频；古人于此，一用固涩法，一用祛瘀法，其揆一也。益母草9克，藏红花6克，肉桂末1.5克（吞），炮姜炭4.5克，瞿麦穗12克，小蓟12克，大川芎6克，生艾叶4.5克，仙鹤草12克，桑椹子12克，震灵丹6克（分2次吞）。
二诊：生理之经行，与病理之出血连续不断，需加区别，顷经量多而褐者，知为经行；色鲜而淋沥者，为漏下。今经行之第2日。熟地黄24克，阿胶珠18克，荆芥穗6克，川断9克，厚杜仲9克，瞿麦穗12克，桑寄生12克，小蓟9克，乌贼骨24克，十灰丸12克（分2次吞）。[按语]本例患者，原系子宫出血，淋沥不净3周以上。先生初诊，作经漏论治，重用固涩祛瘀。迨复诊时，询得量多色褐，与平时月经无异，故有“今经行第二日”之说，而用药也随之作了更动。
8. 陆女士。经淋沥10余日，其色鲜，此当收缩其子宫。瞿麦9克，川芎6克，生茜草9克，益母草9克，苏木4.5克，炮姜炭4.5克，藏红花6克，生蒲黄6克，生艾叶6克。
9. 陈女士。经淋沥1个月有余，以通涩并用之法。生阿胶12克，熟地黄15克，瞿麦9克，仙鹤草15克，益母草9克，小蓟草9克，乌贼骨18克（研细末分吞），生茜草9克。二诊：固摄中稍加通利最妙。生阿胶12克，熟地黄15克，瞿麦9克，益母草9克，杜仲9克，川断9克，苏木6克，生茜草9克，乌贼骨15克（研细末分吞），陈棕炭12克（包）。[按语]本病例二诊时，经之淋沥者几净，故先生有“最妙”二字的案语。
10. 石女士。病较重之时症后，而经见淋沥不易净，为时已及两旬，腹部微痛，痛则下。此宜古人久漏当攻之法。杜红花9克，桃仁泥12克，黑荆芥6克，瞿麦9克，大川芎4.5克，延胡索9克，益母草9克，生蒲黄9克（包），赤白芍各6克，来复丹6克（吞）。二诊：以通为止，经淋沥者量已少，亦不感腰酸、腹胀，此可固摄之。绵杜仲12克，熟地黄15克，生黄芪9克，升麻4.5克，乌贼骨30克，金毛脊9克，阿胶珠18克，川断肉9克，核桃肉9克。另：常服两仪膏。[按语]初诊淋沥腹痛，为内有瘀血，非用攻法去瘀不可止。二诊诸症悉减，转用固摄为治。
11. 徐女士。经淋沥50余日，精神食量称是，疲劳则量多，腹痛亦然。益母草12克，大川芎6克，仙鹤草15克，藏红花6克，瞿麦穗12克，苎麻根12克。二诊：药后经量反多，多后逐渐减少，此必然者。熟地12克，阿胶12克，金毛脊9克，瞿麦12克，川断9克，苎麻根12克，仙鹤草30克，乌贼骨30克，月季花2.4克，震灵丹9克（分吞）。[按语]患者药后漏止。三诊以八珍汤补益气血而善后。
12. 朱女士。行经量多如冲，面色不华，头眩。即当固摄，先治其急。大熟地15克，阿胶9克（烊冲），金毛脊9克，川断9克，瞿麦9克，苎麻根12克，仙鹤草15克，党参9克，黄芪9克，陈棕12克。二诊：前方不能止，经之大下如冲，予加味胶红饮。生阿胶9克，藏红花6克，全当归9克，瞿麦9克，冬瓜子9克，仙鹤草15克，乌贼骨60克，威喜丸15克（包煎）。
三诊：经多如血冲，以胶红饮而暂止。大熟地12克，金毛脊9克，川断9克，仙鹤草15克，乌贼骨30克，元武板15克，威喜丸15克（入煎）。[按语]经量多如冲，用补气摄血之法，本为治疗常规，但未获效机，乃系内有瘀热，虚中挟实之故。转予胶红饮加味，应手而效。红花本为活血祛瘀药，这里和阿胶、乌贼骨并用，使残瘀尽祛，新血自守，有断下之功，得“通因通用”之妙。
13. 薛女士。行经淋沥旬日，近来量多大下，因此每日清晨盗汗出，盖体力弱矣。虽腹中隐痛，不可作实证论。熟地黄18克，仙鹤草15克，牛角鳃炭9克，瞿麦9克，厚杜仲9克，阿胶珠12克，罂粟壳9克，苎麻根12克，震灵丹6克（分2次吞）。[按语]经行过多，以致盗汗，出现气血两虚之象，此时即使有瘀，亦只能予补气逐瘀之法，而不可一味通瘀。此证之腹痛，乃出血后，经脉空虚之痛，必是隐隐作痛，喜按喜温，用补血药填之，痛可自定。
14. 金女士。经曾停止1个月。此番淋沥旬日，腰酸，量益多，虚证也。熟地黄24克，厚杜仲9克，阿胶珠12克，桑寄生12克，仙鹤草12克，金毛脊9克，煅龙骨6克（研粉分4次吞），苎麻根9克，煅乌贼骨30克（先煎），川断肉9克。[按语]经停因之虚，即经行淋沥旬日，量多，腰酸，亦因之虚。方中用熟地、阿胶补血止血；龙骨、乌贼骨涩以固脱；仙鹤草、苎麻根强壮止血；杜仲、寄生、狗脊、川断补益奇经而治腰酸。合为填补下元、收敛止血之剂。
15. 江女士。经淋沥二旬有余，量少，时有时无。此因为体弱者半，因于不能静养者半。日来少腹钝痛，手不可近，痛剧则小溲亦疼，此兼有炎症之故。杭白芍9克，瞿麦9克，粉丹皮9克，象贝母9克，白薇9克，桃仁泥9克，生茜草9克，延胡索9克，生侧柏叶12克，失笑散9克（包），甘草梢3克。小溲痛加剧用：明琥珀末，象牙屑各3克，每次各服0.9克，共分3次空腹服。[按语]经淋沥二旬，必虚；少腹钝痛，必有瘀阻。此种漏下，例不宜固摄，而应宗“久漏宜通”之说，以通为止。盖宿瘀不去，新血难守，瘀去则血自循经。方以凉血、祛瘀为主，即是此意。
16. 郭女士。上月经凡三见，比日又值经行，量多如冲，腰酸如折。古人以经之生理属之冲、任，现代则属之内分泌、卵巢理论。虽今胜于古，治疗则虚、实、气、血四大提纲，亦自成条例。病者总是虚症，作气虚不能摄血论治。生黄芪6克，杜仲9克，川断肉9克，潞党参4.5克，生艾叶4.5克，金樱子12克，升麻2.4克，苎麻根18克，震灵丹6克（分2次吞）。
17. 陈女士。据现代研究，经先期者反量多，多属于卵巢黄体之变化，治之以脏器疗法。今两脉细数，所谓阴虚火旺，血热妄行。生熟地各12克，苎麻根12克，仙鹤草18克，女贞子9克；旱莲草12克，潼沙苑9克，杭白芍9克，黑山栀9克，黑大豆24克，柏子仁12克（打、包）。[按语]此案月经先期而量多，从两脉细数，辨为阴虚火旺，迫血妄行。对这类患者，滋阴正所以降火，凉血正所以止血；而不宜应用补气固摄之品，与上案有别。
18. 邓女士。经净后又来，小溲频数，表示局部有炎症；炎症不除，其红不止。苦参片6克，鲜生地15克，苎麻根12克，黄柏2.4克，仙鹤草15克，冬青子9克，篇蓄9克，小蓟6克，生山栀12克，甘草梢4.5克，生侧柏叶30克（煎汤代水）。[按语]小溲频数，有因肾虚，有因湿热。此案从药测证，可知为湿热蕴于下焦，即所谓“局部有炎症”。其经净后又来，原因亦在此。治病必求其本，凉血、清利湿热，方为本病治法之要。先生所说“炎证不除，其红不止”，殆即指出。倘见血治血，妄用止血收涩，为舍本求标，决非所宜。
5. Ms. Zheng. Abdominal pain inevitably occurs when menstruation is about to start; the pain is severe and worsens with heavier flow. Pao Fu Kuai (Prepared Aconite Lateralis Radix) 4.5g, Quan Dang Gui (Complete Angelica Sinensis) 9g, Chuan Duan Rou (Drynariae Rhizoma) 9g, Quan Mao Ji (Complete Porcine Spine) 9g, Tu Si Zi (Cuscutae Semen) 9g, Sheng Ai Ye (Fresh Artemisia Argyi Folium) 9g, Yan Hu Suo (Corydalis Rhizoma) 9g, Sheng Ma Huang (Fresh Ephedrae Herba) 4.5g, Quan Xie (Complete Scorpio) 3g. All ingredients are ground into a fine powder. Take 3g per dose, three times daily.
6. Ms. Cai. During menstruation, she suddenly experienced emotional distress, resulting in reduced menstrual flow and distending pain in the lower abdomen. The ancient saying "Wood fails to flourish smoothly" (Liver Qi stagnation) precisely describes this syndrome. Quan Dang Gui (Complete Angelica Sinensis) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 9g, Chai Hu (Bupleuri Radix) 9g, Yun Ling (Poria) 12g, Bo He Jian (Menthae Haplocalycis Herba tip) 3g (added later), Gan Cao (Glycyrrhizae Radix et Rhizoma) 2.1g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices. Wu Ling Zhi (Trogopteri Dung) 6g, Xiang Fu (Cyperi Rhizoma) 6g, E Zhu (Curcumae Rhizoma) 6g, Rou Gui (Cinnamomi Cortex) 6g. These are ground into powder. Take 1.5g per dose.
7. Ms. Shen. Predecessors believed that post-menstrual abdominal pain with tenderness upon pressure belongs to blood stasis; using Qi-moving and stasis-attacking methods aims merely to facilitate the circulation of local blood stasis. Now that menstruation has ceased, but pale red fluid reappears due to pain. Dan Pi Tan (Moutan Cortex Carbonized) 9g, Tao Ren Ni (Persicae Semen Paste) 12g, Zang Hong Hua (Saffron) 2.4g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 9g, Qian Cao (Rubiae Cordifoliae Radix) 9g, Su Mu (Lignum Sappan) 6g, Ru Xiang (Olibanum) and Mo Yao (Myrrha) 4.5g each, Yan Hu Suo (Corydalis Rhizoma) 9g, Chao Tiao Qin (Stir-fried Scutellariae Radix) 4.5g, Shi Xiao San (Formula for Pain Relief) 12g (wrapped).
8. Ms. Yang; While menstruating, she was exposed to cold again, causing severe cramping pain in the lower abdomen that feels hard upon pressure. This indicates internal accumulation. The pulse is wiry, and the tongue coating is white. Treatment should employ warming and unblocking methods. Sheng Ma Huang (Fresh Ephedrae Herba) 3g, E Zhu (Curcumae Rhizoma) 9g, Wu Ling Zhi (Trogopteri Dung) 9g, Pao Gan Jiang (Prepared Zingiberis Rhizoma) 3g, Tao Ren Ni (Persicae Semen Paste) 12g, Tai Wu (Aucklandiae Radix) 9g, Yan Hu Suo (Corydalis Rhizoma) 9g, Xiao Hui Xiang (Foeniculi Fructus) 3g, Rou Gui Mo (Cinnamon Bark Powder) 1.8g (swallowed in two doses). Additionally: Bai Zhi (Angelicae Dahuricae Radix) and Chuan Cao Wu (Aconiti Kusnezoffii Radix) 6g each, ground into fine powder. Mix with green onion juice and honey to apply to the painful area.
9. Ms. Li. Abdominal pain precedes menstruation; the menstrual blood is dark purple and scanty. Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, Dan Pi (Moutan Cortex) 9g, Yan Hu Suo (Corydalis Rhizoma) 9g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 9g, Ai Ye (Artemisiae Argyi Folium) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Xiang Fu (Cyperi Rhizoma) 9g, Ze Lan (Lycopus Japonici Herba) 9g, Shi Xiao San (Formula for Pain Relief) 9g (swallowed in two doses), Tao Ren Ni (Persicae Semen Paste) 12g.
[Commentary] Dysmenorrhea is caused by impaired circulation of Qi and Blood, most commonly due to Cold coagulation and Qi stagnation. In these cases, warming tonification is used for deficiency-cold; warming and unblocking is used for Cold coagulation leading to stasis after heavy exposure to cold during menstruation; blood-invigorating methods are used for stasis; and liver-soothing methods are used for Liver Qi constraint. The above six cases illustrate prescribing based on symptoms and adapting to changes.
Metrorrhagia and Metrostaxis
1. Ms. Zhang. Menstruation had stopped for over 3 months. After climbing stairs and experiencing a jolt, clots were passed, followed by persistent spotting for over 4 months. Shu Di (Prepared Rehmanniae Radix) 12g, Chao Dang Gui (Stir-fried Angelicae Sinensis Radix) 6g, E Jiao Zhu (Gelatin Pill) 12g, Jin Mao Ji (Porci Spina Dorsalis) 9g, Xian He Cao (Agrimoniae Herba) 15g, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g, Zang Hong Hua (Saffron) 6g, Chuan Duan (Drynariae Rhizoma) 9g, Zhen Ling Dan (Shaking Spirit Pill) 6g (swallowed in two doses). Second visit: Spotting stopped, but there is lower back soreness, dull pain in the upper diaphragm, and slight palpitations at night, all due to anemia. Shu Di (Prepared Rehmanniae Radix) 12g, Chuan Duan (Drynariae Rhizoma) 9g, Dang Shen (Codonopsis Radix) 9g, Gou Qi (Lycii Fructus) 9g, Suan Zao Ren (Ziziphi Spinosae Semen) 9g, Huang Qi Pi (Astragali Cortex) 12g, Long Yan Rou (Longan Aril) 9g, Tu Si Zi (Cuscutae Semen) 12g, Xian He Cao (Agrimoniae Herba) 15g.
[Commentary] In this case, amenorrhea for 3 months and spotting for 4 months are both due to deficiency. The first prescription uses Shu Di and E Jiao to nourish Blood and promote coagulation; since prolonged spotting leads to stasis, Hong Hua (Carthami Flos) and Dang Gui are added to move and eliminate stasis; the remaining herbs warm the Kidney and secure containment to stop bleeding. Lower back soreness after stopping spotting indicates Kidney deficiency; upper diaphragm dull pain and night palpitations indicate Heart Blood deficiency and empty meridians. The second prescription uses Qi and Blood tonics for recovery. Zhen Ling Dan is a formula from Lady Wei of Mount Nan, containing Yu Yi Liang (Halloysit Rubrum) 120g, Chi Shi Zhi (Kaolinite) 120g, Dai Zhe Shi (Haematitum) 120g, Zi Shi Ying (Fluoritum) 120g, Zhi Ru Xiang (Processed Olibanum) 60g, Zhi Mo Yao (Processed Myrrha) 60g, and Zhu Sha (Cinnabaris) 30g, made into pills according to method. It was originally used for men with depleted Yuan Qi, five labors and seven injuries, and cold pain in the umbilical and abdominal regions. Ye Tianshi stated it "can stop and can move," calling it an "excellent medicine for menstrual disorders." Dr. Zhang believes this formula has astringent and coagulating properties and often uses it for metrorrhagia.
2. Ms. Xia. Menstrual spotting was ineffective with hemostatic agents. A new prescription combines moving and astringent methods. Yi Mu Cao (Leonuri Herba) 12g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 6g, Zang Hong Hua (Saffron) 6g, Tao Ren (Persicae Semen) 9g, Ou Hai Gu (Sepiae Endoconcha) 18g (ground fine, swallowed separately), Qu Mai (Dianthi Herba) 9g, Ying Su Ke (Papaveris Pericarpium) 12g, Wu Wei Zi (Schisandrae Chinensis Fructus) 4.5g, Xian He Cao (Agrimoniae Herba) 12g. Second visit: Spotting has cleared after medication. Fatigue and sallow complexion indicate Qi and Blood deficiency; regulation and tonification will suffice. Lu Dang Shen (Codonopsis Radix) 9g, Quan Dang Gui (Complete Angelicae Sinensis Radix) 6g, Shu Di (Prepared Rehmanniae Radix) 9g, Chen E Jiao (Aged Gelatin) 9g, Mian Huang Qi (Astragali Radix) 9g, Xian He Cao (Agrimoniae Herba) 12g, Wu Wei Zi (Schisandrae Chinensis Fructus) 3g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 4.5g. [Commentary] Ancients said "acute flooding requires tonification, chronic spotting requires moving." Combining moving and astringent methods applies both flexibly. Clinical practice proves this effective for persistent menstrual spotting.
3. Ms. Chen. After abortion last year, her abdomen became larger than usual with a bearing-down sensation. Recently, menstrual spotting persists. Medications to contract the uterus are indicated. Yi Mu Cao (Leonuri Herba) 12g, Zhi Xiang Fu (Processed Cyperi Rhizoma) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 4g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, Shan Yu Rou (Corni Fructus) 9g, Qu Mai Sui (Dianthi Herba spike) 9g, Sheng Ai Ye (Fresh Artemisiae Argyi Folium) 4.5g, Su Mu (Lignum Sappan) 4.5g, Tai Wu Yao (Aucklandiae Radix) 9g, Shi Xiao San (Formula for Pain Relief) 9g (swallowed separately).
4. Ms. Wu. Heavy menstrual flow like a rush, lasting 8 days. Although volume decreased, spotting persisted. Severe lower back pain like breaking, causing great suffering. A combined formula to contract the uterus and enhance blood coagulation is proposed. Zang Hong Hua (Saffron) 3g, Qu Mai Sui (Dianthi Herba spike) 12g, Du Zhong (Eucommiae Cortex) 9g, Da Chuan Xiong (Large Ligustici Chuanxiong Rhizoma) 6g, Yi Mu Cao (Leonuri Herba) 9g, Chuan Duan Rou (Drynariae Rhizoma) 9g, Shu Di (Prepared Rehmanniae Radix) 18g, Jin Ying Zi (Chrysanthemi Indici Fructus) 9g, Sheng E Jiao (Raw Gelatin) 15g, Ou Jie (Nelumbinis Node) 5 pieces, Zhen Ling Dan (Shaking Spirit Pill) 6g (swallowed in two doses).
5. Ms. Zhang. Menstruation stopped for 2 months. Upon resumption, spotting persisted for over 1 month. Pain increases volume. Based on tongue and pulse, tonifying and astringing is indicated; however, pain requires harmonizing stasis. Both methods combined are suitable. Yi Mu Cao (Leonuri Herba) 9g, Qu Mai Sui (Dianthi Herba spike) 9g, Xian He Cao (Agrimoniae Herba) 18g, Da Chuan Xiong (Large Ligustici Chuanxiong Rhizoma) 6g, Gan Di Huang (Dry Rehmanniae Radix) 12g, Sheng E Jiao (Raw Gelatin) 24g (melted and mixed), Wu Wei Zi (Schisandrae Chinensis Fructus) 3g, Jin Ying Zi (Chrysanthemi Indici Fructus) 9g, Chen Zong Tan (Charred Palm Fiber) 30g (decocted as water substitute). [Commentary] In the above three cases, Yi Mu Cao and Qu Mai Sui are paired. Dr. Zhang believes their combination promotes stasis removal and new tissue generation, contracting the uterus, thus frequently used for menstrual disorders.
6. Ms. Zhou. Even while resting quietly, slight menstrual spotting continues. There are five conditions for treating this symptom, including anesthesia which stops bleeding by calming blood vessels to prevent rapid flow. Ying Su Ke (Papaveris Pericarpium) 12g, He Zi Rou (Terminalia Chebulae Fructus flesh) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 4.5g, E Jiao (Gelatin) 24g, Niu Jiao Sai (Bovis Cornu et Os) 12g, Shu Di (Prepared Rehmanniae Radix) 18g, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g, Pao Fu Pian (Prepared Aconiti Lateralis Radix Preparata) 6g, Yan Hu Suo (Corydalis Rhizoma) 9g, Xiang Gan Song (Nardostachys Radix et Rhizoma) 9g. Second visit: After 3 doses, spotting stops when resting but resumes upon walking, still scanty. Medicine shows effect; maintain original intent. Ying Su Ke (Papaveris Pericarpium) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 4.5g, E Jiao (Gelatin) 18g, Shu Di (Prepared Rehmanniae Radix) 18g, Zhu Ma Gen (Boehmeriae Niveae Radix) 9g, Niu Jiao Sai (Bovis Cornu et Os) 12g, Pao Fu Pian (Prepared Aconiti Lateralis Radix Preparata) 6g, Xian He Cao (Agrimoniae Herba) 15g.
Third visit: Spotting cleared. Mild palpitations, fatigue, and insomnia at night. Gui Pi Wan (Restore the Spleen Pill) is given to regulate. [Commentary] The "five conditions for treating this symptom" refer to tonifying, warming, cooling, astringing, and removing stasis; this is Dr. Zhang's common method for menstrual spotting, effective when applied appropriately. This case achieved results by combining tonification and astringency. Modern pharmacology shows that astringents like Ying Su Ke have anesthetic and sedative effects. The mention of "anesthesia can also stop bleeding" refers to this.
7. Ms. Sheng. After menstruation ended, spotting continued for over 20 days. Lower back soreness accompanies frequent flow; ancient texts use either astringent or stasis-removing methods, both aiming at the same principle. Yi Mu Cao (Leonuri Herba) 9g, Zang Hong Hua (Saffron) 6g, Rou Gui Mo (Cinnamon Bark Powder) 1.5g (swallowed), Pao Jiang Tan (Carbonized Zingiberis Rhizoma) 4.5g, Qu Mai Sui (Dianthi Herba spike) 12g, Xiao Ji (Cirsii Herba) 12g, Da Chuan Xiong (Large Ligustici Chuanxiong Rhizoma) 6g, Sheng Ai Ye (Fresh Artemisiae Argyi Folium) 4.5g, Xian He Cao (Agrimoniae Herba) 12g, Sang Shen Zi (Mori Fructus) 12g, Zhen Ling Dan (Shaking Spirit Pill) 6g (swallowed in two doses).
Second visit: Physiological menstruation and pathological continuous bleeding need distinction. Heavy brown flow indicates menstruation; bright red spotting indicates metrorrhagia. Today is the second day of menstruation. Shu Di Huang (Rehmanniae Radix Preparata) 24g, E Jiao Zhu (Gelatin Pill) 18g, Jing Jie Sui (Schizonepetae Spica) 6g, Chuan Duan (Drynariae Rhizoma) 9g, Hou Du Zhong (Thick Eucommiae Cortex) 9g, Qu Mai Sui (Dianthi Herba spike) 12g, Sang Ji Sheng (Taxilli Herba) 12g, Xiao Ji (Cirsii Herba) 9g, Ou Hai Gu (Sepiae Endoconcha) 24g, Shi Hui Wan (Ten Ashes Pill) 12g (swallowed in two doses). [Commentary] This patient originally had uterine bleeding with spotting for over 3 weeks. Dr. Zhang initially treated it as menstrual leakage, heavily using astringents and stasis removers. At follow-up, learning that the heavy brown flow was normal menstruation, he noted "today is the second day of menstruation" and adjusted the prescription accordingly.
8. Ms. Lu. Menstrual spotting for over 10 days, bright red color. Uterine contraction is needed. Qu Mai (Dianthi Herba) 9g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 6g, Sheng Qian Cao (Raw Rubiae Cordifoliae Radix) 9g, Yi Mu Cao (Leonuri Herba) 9g, Su Mu (Lignum Sappan) 4.5g, Pao Jiang Tan (Carbonized Zingiberis Rhizoma) 4.5g, Zang Hong Hua (Saffron) 6g, Sheng Pu Huang (Raw Typhae Pollen) 6g, Sheng Ai Ye (Fresh Artemisiae Argyi Folium) 6g.
9. Ms. Chen. Menstrual spotting for over 1 month. Using combined moving and astringent methods. Sheng E Jiao (Raw Gelatin) 12g, Shu Di Huang (Rehmanniae Radix Preparata) 15g, Qu Mai (Dianthi Herba) 9g, Xian He Cao (Agrimoniae Herba) 15g, Yi Mu Cao (Leonuri Herba) 9g, Xiao Ji Cao (Cirsii Herba) 9g, Ou Hai Gu (Sepiae Endoconcha) 18g (ground fine, swallowed separately), Sheng Qian Cao (Raw Rubiae Cordifoliae Radix) 9g. Second visit: Adding mild moving action to astringency is best. Sheng E Jiao (Raw Gelatin) 12g, Shu Di Huang (Rehmanniae Radix Preparata) 15g, Qu Mai (Dianthi Herba) 9g, Yi Mu Cao (Leonuri Herba) 9g, Du Zhong (Eucommiae Cortex) 9g, Chuan Duan (Drynariae Rhizoma) 9g, Su Mu (Lignum Sappan) 6g, Sheng Qian Cao (Raw Rubiae Cordifoliae Radix) 9g, Ou Hai Gu (Sepiae Endoconcha) 15g (ground fine, swallowed separately), Chen Zong Tan (Charred Palm Fiber) 12g (wrapped). [Commentary] At the second visit, spotting was nearly cleared, hence Dr. Zhang's comment "best."
10. Ms. Shi. After a severe acute illness, menstrual spotting persisted for 20 days. Mild abdominal pain triggers discharge. Ancient methods suggest attacking stasis for chronic spotting. Du Hong Hua (Saffron) 9g, Tao Ren Ni (Persicae Semen Paste) 12g, Hei Jing Jie (Black Schizonepetae Spica) 6g, Qu Mai (Dianthi Herba) 9g, Da Chuan Xiong (Large Ligustici Chuanxiong Rhizoma) 4.5g, Yan Hu Suo (Corydalis Rhizoma) 9g, Yi Mu Cao (Leonuri Herba) 9g, Sheng Pu Huang (Raw Typhae Pollen) 9g (wrapped), Chi Shao (Red Paeoniae Radix) and Bai Shao (White Paeoniae Radix) 6g each, Lai Fu Dan (Reviving Life Pill) 6g (swallowed). Second visit: Moving stops the condition. Spotting volume decreased, no lower back soreness or abdominal distension. Astringency is now appropriate. Mian Du Zhong (Soft Eucommiae Cortex) 12g, Shu Di Huang (Rehmanniae Radix Preparata) 15g, Sheng Huang Qi (Raw Astragali Radix) 9g, Sheng Ma (Bunge's Bleedingheart) 4.5g, Ou Hai Gu (Sepiae Endoconcha) 30g, Jin Mao Ji (Porci Spina Dorsalis) 9g, E Jiao Zhu (Gelatin Pill) 18g, Chuan Duan Rou (Drynariae Rhizoma) 9g, He Tao Rou (Walnut Kernel) 9g. Additionally: Regularly take Liang Yi Gao (Two Noble Decoction). [Commentary] Initial spotting with abdominal pain indicated internal blood stasis, requiring attacking methods to remove stasis. At second visit, symptoms subsided, shifting to astringency.
11. Ms. Xu. Menstrual spotting for over 50 days. Spirit and appetite are normal. Volume increases with fatigue and abdominal pain. Yi Mu Cao (Leonuri Herba) 12g, Da Chuan Xiong (Large Ligustici Chuanxiong Rhizoma) 6g, Xian He Cao (Agrimoniae Herba) 15g, Zang Hong Hua (Saffron) 6g, Qu Mai Sui (Dianthi Herba spike) 12g, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g. Second visit: Post-medication, volume increased then gradually decreased, which is inevitable. Shu Di (Prepared Rehmanniae Radix) 12g, E Jiao (Gelatin) 12g, Jin Mao Ji (Porci Spina Dorsalis) 9g, Qu Mai (Dianthi Herba) 12g, Chuan Duan (Drynariae Rhizoma) 9g, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g, Xian He Cao (Agrimoniae Herba) 30g, Ou Hai Gu (Sepiae Endoconcha) 30g, Yue Ji Hua (Rosa Chinensis Flower) 2.4g, Zhen Ling Dan (Shaking Spirit Pill) 9g (swallowed). [Commentary] Patient's leakage stopped after medication. Third visit uses Ba Zhen Tang (Eight Treasures Decoction) to tonify Qi and Blood for recovery.
12. Ms. Zhu. Heavy menstrual flow like a rush, sallow complexion, dizziness. Immediate astringency is needed to treat the emergency. Da Shu Di (Large Prepared Rehmanniae Radix) 15g, E Jiao (Gelatin) 9g (melted and mixed), Jin Mao Ji (Porci Spina Dorsalis) 9g, Chuan Duan (Drynariae Rhizoma) 9g, Qu Mai (Dianthi Herba) 9g, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g, Xian He Cao (Agrimoniae Herba) 15g, Dang Shen (Codonopsis Radix) 9g, Huang Qi (Astragali Radix) 9g, Chen Zong (Charred Palm Fiber) 12g. Second visit: Previous formula failed to stop bleeding; heavy flow like a rush occurred. Prescribe Modified Jiao Hong Yin (Gelatin and Saffron Drink). Sheng E Jiao (Raw Gelatin) 9g, Zang Hong Hua (Saffron) 6g, Quan Dang Gui (Complete Angelicae Sinensis Radix) 9g, Qu Mai (Dianthi Herba) 9g, Dong Gua Zi (Benincasae Semen) 9g, Xian He Cao (Agrimoniae Herba) 15g, Ou Hai Gu (Sepiae Endoconcha) 60g, Wei Xi Wan (Victory Joy Pill) 15g (wrapped and decocted).
Third visit: Heavy flow like a rush temporarily stopped by Jiao Hong Yin. Da Shu Di (Large Prepared Rehmanniae Radix) 12g, Jin Mao Ji (Porci Spina Dorsalis) 9g, Chuan Duan (Drynariae Rhizoma) 9g, Xian He Cao (Agrimoniae Herba) 15g, Ou Hai Gu (Sepiae Endoconcha) 30g, Yuan Wu Ban (Testudinis Carapax et Plastrum) 15g, Wei Xi Wan (Victory Joy Pill) 15g (added to decoction). [Commentary] Heavy flow is usually treated with Qi-tonifying and Blood-holding methods, standard protocol. Lack of efficacy here was due to internal Heat-stasis and deficiency mixed with excess. Switching to modified Jiao Hong Yin yielded immediate results. Hong Hua (Carthami Flos) is typically for invigorating Blood and removing stasis; combined here with E Jiao and Ou Hai Gu, it clears residual stasis so new Blood stays, achieving hemostasis through "treating obstruction with moving methods."
13. Ms. Xue. Menstrual spotting for 10 days, recently heavy flow, causing morning night sweats due to weakness. Although there is dull abdominal pain, it should not be treated as excess. Shu Di Huang (Rehmanniae Radix Preparata) 18g, Xian He Cao (Agrimoniae Herba) 15g, Niu Jiao Sai Tan (Charred Bovis Cornu et Os) 9g, Qu Mai (Dianthi Herba) 9g, Hou Du Zhong (Thick Eucommiae Cortex) 9g, E Jiao Zhu (Gelatin Pill) 12g, Ying Su Ke (Papaveris Pericarpium) 9g, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g, Zhen Ling Dan (Shaking Spirit Pill) 6g (swallowed in two doses). [Commentary] Excessive menstruation led to night sweats, indicating Qi and Blood deficiency. Even if stasis exists, only Qi-tonifying and stasis-removing methods are suitable, not pure stasis removal. The abdominal pain here is due to empty meridians after bleeding, characterized by dull pain relieved by pressure and warmth. Tonifying Blood will settle the pain.
14. Ms. Jin. Menstruation stopped for 1 month. Now spotting for 10 days, lower back soreness, increasing volume, indicating deficiency. Shu Di Huang (Rehmanniae Radix Preparata) 24g, Hou Du Zhong (Thick Eucommiae Cortex) 9g, E Jiao Zhu (Gelatin Pill) 12g, Sang Ji Sheng (Taxilli Herba) 12g, Xian He Cao (Agrimoniae Herba) 12g, Jin Mao Ji (Porci Spina Dorsalis) 9g, Duan Long Gu (Calcined Os Draconis) 6g (ground powder, swallowed in 4 doses), Zhu Ma Gen (Boehmeriae Niveae Radix) 9g, Duan Ou Hai Gu (Calcined Sepiae Endoconcha) 30g (decocted first), Chuan Duan Rou (Drynariae Rhizoma) 9g. [Commentary] Amenorrhea was due to deficiency; now spotting for 10 days with heavy flow and back soreness is also due to deficiency. The formula uses Shu Di and E Jiao to nourish Blood and stop bleeding; Long Gu and Ou Hai Gu to astringe and secure collapse; Xian He Cao and Zhu Ma Gen to strengthen and stop bleeding; Du Zhong, Sang Ji Sheng, Gou Ji, and Chuan Duan to tonify the extraordinary vessels and treat back soreness. Together, they fill the lower Yuan and converge to stop bleeding.
15. Ms. Jiang. Menstrual spotting for over 20 days, scanty volume, intermittent. Half due to weak constitution, half due to inability to rest. Recent dull lower abdominal pain, tender to touch; severe pain causes dysuria, indicating inflammation. Hang Bai Shao (White Paeoniae Radix) 9g, Qu Mai (Dianthi Herba) 9g, Fen Dan Pi (Powdered Moutan Cortex) 9g, Xiang Bei Mu (Fritillariae Thunbergii Bulbus) 9g, Bai Wei (Cynanchi Atrati Radix) 9g, Tao Ren Ni (Persicae Semen Paste) 9g, Sheng Qian Cao (Raw Rubiae Cordifoliae Radix) 9g, Yan Hu Suo (Corydalis Rhizoma) 9g, Sheng Ce Bai Ye (Fresh Platycladi Cacumen) 12g, Shi Xiao San (Formula for Pain Relief) 9g (wrapped), Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip) 3g. For worsening dysuria: Ming Hu Po (Clear Amber) powder and Xiang Ya Xie (Ivory Scraps) 3g each, take 0.9g each time, divided into 3 doses on an empty stomach. [Commentary] Spotting for 20 days implies deficiency; dull lower abdominal pain implies stasis. Such leakage is generally unsuitable for astringency alone; instead, follow "chronic spotting requires moving" to achieve cessation through movement. If old stasis is not removed, new Blood cannot stay; once stasis is gone, Blood follows its channels. The formula focuses on cooling Blood and removing stasis.
16. Ms. Guo. Menstruation occurred three times last month. Currently menstruating again, heavy flow like a rush, lower back soreness like breaking. Ancients attributed physiological menstruation to Chong and Ren vessels; modern theory attributes it to endocrine and ovarian functions. Although modern science surpasses ancient, treatment principles of deficiency, excess, Qi, and Blood remain valid. The patient always presents deficiency; treat as Qi deficiency failing to hold Blood. Sheng Huang Qi (Raw Astragali Radix) 6g, Du Zhong (Eucommiae Cortex) 9g, Chuan Duan Rou (Drynariae Rhizoma) 9g, Lu Dang Shen (Codonopsis Radix) 4.5g, Sheng Ai Ye (Fresh Artemisiae Argyi Folium) 4.5g, Jin Ying Zi (Chrysanthemi Indici Fructus) 12g, Sheng Ma (Bunge's Bleedingheart) 2.4g, Zhu Ma Gen (Boehmeriae Niveae Radix) 18g, Zhen Ling Dan (Shaking Spirit Pill) 6g (swallowed in two doses).
17. Ms. Chen. Modern research suggests early menstruation with heavy flow relates to corpus luteum changes, treated with organotherapy. Current fine and rapid pulses indicate Yin deficiency with Fire hyperactivity and reckless Blood movement. Raw and Prepared Shu Di (Rehmanniae Radix) 12g each, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g, Xian He Cao (Agrimoniae Herba) 18g, Nu Zhen Zi (Ligustri Lucidi Fructus) 9g, Han Lian Cao (Ecliptae Herba) 12g, Tong Sha Yuan (Tussilaginis Semen) 9g, Hang Bai Shao (White Paeoniae Radix) 9g, Hei Shan Zhi (Black Gardeniae Fructus) 9g, Hei Da Dou (Black Soybean) 24g, Bai Zi Ren (Biota Seed) 12g (crushed, wrapped). [Commentary] Early menstruation with heavy flow, diagnosed via fine and rapid pulses as Yin deficiency with Fire hyperactivity forcing Blood recklessly. For such patients, nourishing Yin reduces Fire, and cooling Blood stops bleeding; Qi-tonifying and astringent agents are inappropriate, differing from the previous case.
18. Ms. Deng. Menstruation resumed after cleansing, with frequent urination indicating local inflammation; without resolving inflammation, bleeding continues. Ku Shen Pian (Sophorae Flavescentis Radix slice) 6g, Xian Sheng Di (Fresh Rehmanniae Radix) 15g, Zhu Ma Gen (Boehmeriae Niveae Radix) 12g, Huang Bo (Phellodendri Cortex) 2.4g, Xian He Cao (Agrimoniae Herba) 15g, Dong Qing Zi (Aquifolii Fructus) 9g, Pian Chu (Polygoni Avicularis Herba) 9g, Xiao Ji (Cirsii Herba) 6g, Sheng Shan Zhi (Raw Gardeniae Fructus) 12g, Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip) 4.5g, Sheng Ce Bai Ye (Fresh Platycladi Cacumen) 30g (decocted as water substitute). [Commentary] Frequent urination can be due to Kidney deficiency or Damp-Heat. From the prescription, this case indicates Damp-Heat accumulating in the Lower Jiao ("local inflammation"). The reason for bleeding after menstruation ends lies here. Treating disease requires addressing the root; cooling Blood and clearing Damp-Heat are key. Dr. Zhang's statement "without resolving inflammation, bleeding does not stop" points to this. Treating blood directly with astringents would be seeking the branch over the root, which is inadvisable.