寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

The Womb

Po

한글  ·  Pinyin Bao

胞門

The form of the womb 胞形象

胞者, 一名赤宮, 一名丹田, 一名命門. 男子藏精施化, 婦人繫胞有孕, 俱爲生化之源. 非五行也, 非水, 亦非火. 此天地之異名也, 象坤土之生萬物也. 《東垣》 ○內經曰, 胞者, 藏於陰而象於地, 名曰奇恒之府. 註曰, 奇異於恒常之六府也. ○婦人胎之所居, 名曰子宮, 亦曰胞門. 《東垣》

The womb is called by three names: the Vermilion Palace, the Cinnabar Field, and the Life Gate. In a man it stores the essence and dispenses its transformations; in a woman the pregnancy is tethered there and she conceives — in both, it is the source of engendering and transformation. It is not among the five phases; it is not Water, and it is not Fire either. This is another name for Heaven and Earth, imaging Kun Earth in its bringing forth of the ten thousand things (Dongwon 東垣). — The Inner Classic says: the womb is stored within the Yin and images the Earth; it is named an extraordinary bowel. The commentary: extraordinary, that is, differing from the six ordinary bowels. — In a woman, the place where the pregnancy dwells is called the palace of the child, and also the gate of the womb.
Clinical note The chapter opens by refusing to file its subject. The womb belongs to no phase, is neither Water nor Fire, and is classed among the 'extraordinary bowels' — the organs that do not fit the standard sixfold scheme. And in the same breath Dongyuan gives it to both sexes: the same structure that carries a pregnancy in a woman stores and dispenses essence in a man. A physiology that begins by naming what its categories cannot hold.

Dongwon 東垣 · Naegyeong 內經

胞, 一名丹田, 一名關元 穴名. 在臍下三寸, 方圓四寸, 着脊梁兩腎間中央赤是也. 左靑右白, 上黃下黑. 三寸法三光, 四寸法四時, 五色法五行. 兩腎間名大海, 而貯其血氣. 亦名大中極, 言取人身之上下四向最爲中也. 《資生》 ○胞一名子宮. 胞有寒則無子. 《仲景》 ○衝脉ㆍ任脉, 皆起於胞中, 上循腹裏, 爲經絡之海. 《靈樞》

The womb is also called the Cinnabar Field and the Gate Origin — the name of a point —. It lies three inches below the navel, four inches square and round, set against the spine between the two kidneys: the red thing at the center. Green on the left, white on the right, yellow above, black below. The three inches take their law from the three luminaries, the four inches from the four seasons, the five colors from the five phases. The space between the two kidneys is named the Great Sea, and it stores the Blood and Qi there. It is also called the Great Middle Pole, meaning that of all the body's ups and downs and four directions, this is the very center (Jasaeng 資生). — The womb is also called the palace of the child; if the womb holds cold, there are no children (Junggyeong 仲景). — The Penetrating vessel and the Conception vessel both rise from within the womb, run upward along the inside of the abdomen, and are the sea of the channels and network vessels. (Yeongchu 靈樞)
Clinical note An anatomy written in two registers at once — measurements a hand could verify (three inches below the navel, between the kidneys, against the spine) and a cosmology laid over them (three for the luminaries, four for the seasons, five colors for the phases). Zhongjing's single line in the middle is the one that governs the clinic: a cold womb bears no children, which is why so much of the fertility pharmacy that follows is warm.

Jasaeng 資生 · Junggyeong 仲景 · Yeongchu 靈樞

The womb is the chamber of Blood 胞爲血室

內經曰, 女子二七, 天癸至, 任脉通, 大衝脉盛, 月事以時下, 故有子. 註曰, 癸謂壬癸北方水干名也. 任脉ㆍ衝脉, 皆奇經脉也. 衝任流通, 經血漸盈, 應時而下. 天眞之氣降, 與之從事, 故云天癸也. 然衝爲血海, 任主胞胎, 二者相資, 故能有子. 所以謂之月事者, 平和之氣, 常以三旬而一見也, 故愆期者謂之有病. 《良方》

The Inner Classic says: at twice seven years the Heavenly Water arrives in a girl, the Conception vessel opens through, the great Penetrating vessel grows exuberant, the monthly affair descends in its season — and so she can bear children. The commentary: gui names the northern Water stem of the ren-gui pair. The Conception and Penetrating vessels are both extraordinary vessels; when they flow through, the channel Blood gradually fills and descends in its due time. The true Qi of Heaven comes down and takes part in it — hence it is called the Heavenly Water. The Penetrating vessel is the sea of Blood and the Conception vessel governs the womb and the pregnancy; the two supply one another, and so a child can be had. As for calling it the monthly affair: the peaceful and harmonious Qi appears regularly once in three ten-day periods — and therefore one who misses the term is said to have an illness.
Clinical note The classical account of menarche, and the closing line is the chapter's working definition of menstrual disorder: the cycle is the appearance of harmonious Qi at its appointed term, so a cycle off its term is by definition an illness. Note also what the tradition calls the phenomenon — Heavenly Water, 天癸, the same character used for the northern water stem. Not a discharge but a descent of something belonging to the sky.

Naegyeong 內經 · Yangbang 良方

衝脉爲血海, 諸經朝會. 男子則運而行之, 女子則停而止之. 男旣運行, 故無積而不滿, 女旣停止, 故有積而能滿. 滿者以時而溢, 謂之信, 卽月水也, 以象月盈則虧也. 《入門》

The Penetrating vessel is the sea of Blood, where all the channels come to court. In a man it is carried onward and moved; in a woman it halts and is stayed. The man's being moved onward, there is no accumulation and it does not fill; the woman's being stayed, there is accumulation and it can fill. What is full overflows in its season — and this is called the trust: that is, the monthly water, imaged on the moon, which having waxed then wanes.
Clinical note The loveliest etymology in the chapter: the classical word for the menses is 信, the character for trust, honesty, a message that arrives as promised. What is regular can be relied upon, and the tradition names the cycle after its reliability rather than after blood. The moon image completes it — fullness is not a state to maintain but a phase that must be allowed to wane.

Immun 入門

Pulse signs 脉法

少陰脉微而遲, 微則無精, 遲則陰中寒, 澁則血不來, 此爲居經, 三月一來. 《脉經》 ○寸關調如故, 而尺脉絶不至者, 月水不利. ○尺脉滑, 血氣實也, 婦人經脉不利. ○脉來狀如琴絃, 若小腹痛, 主月水不利, 孔竅生瘡. 《脉經》 ○婦人漏下赤白, 日下血數升, 脉急疾者死, 遲者生. ○婦人漏下赤白不止, 脉小虛滑者生, 大緊實數者死. 《脉經》 ○帶下之脉, 宜遲滑, 忌浮虛. 《醫鑑》

A lesser-Yin pulse faint and slow: faint, there is no essence; slow, there is cold within the Yin; rough, and the Blood does not come — this is the abiding cycle, which comes once in three months (Maekgyeong 脉經). — Where the inch and bar are regulated as usual but the cubit pulse is cut off and does not arrive, the monthly water is not free. — A slippery cubit pulse means Blood and Qi are replete: in a woman, the menstrual vessels are not free. — A pulse arriving like a taut zither string, with pain in the lower abdomen, governs an unfree monthly water and sores arising at the orifices. — In a woman with red and white spotting, several doe of blood descending in a day: a pulse urgent and racing means death, a slow one means life. — In unceasing red and white spotting: a pulse small, vacuous, and slippery means life; large, tight, replete, and rapid means death (Maekgyeong 脉經). — In vaginal discharge the pulse should be slow and slippery; floating and vacuous is to be feared. (Uigam 醫鑑)
Clinical note The cubit position again carries the reproductive news, as it did in the Women's chapter — but here the prognostic entries stand out. In heavy bleeding the tradition reads the pulse's speed as the deciding sign, urgent and racing being the grave one. Whatever the mechanism assumed, the observation is sound: a racing pulse in someone bleeding heavily is the finding that still empties a modern ward's corridor.

Maekgyeong 脉經 · Uigam 醫鑑

The monthly cycle 月候

婦人年二七, 天癸至, 七七, 天癸竭. 通行則陰陽和合, 始能生子. 行年十四歲當時, 二十歲不行, 命如風燭, 有病發則死. 間有不死, 百中無一, 亦令一生多病, 未嘗一日安裕. 然有四季行亦可. 又有一年一次者, 亦不甚佳. 或一生不循正道而行者, 晩年有僻疾則難治. 《得效》

In a woman, at twice seven years the Heavenly Water arrives; at seven times seven, it is exhausted. When it flows through, Yin and Yang join in harmony and she can begin to bear children. It should come at fourteen; if by twenty it has not come, the life is like a candle in the wind, and should illness break out she dies. Now and then one does not die, but not one in a hundred — and even then she is made ill through her life and has never a single easy day. Yet there are those in whom it comes once a season, and that will do; and there are those in whom it comes once a year, which is not very good either. And in one who all her life does not follow the proper course, a hidden illness in later years will be hard to treat.
Clinical note The two poles of the reproductive life, fourteen and forty-nine, given as the tradition's standard span. The passage's alarm about primary amenorrhea reads as extreme, and its prognosis is overstated — but the underlying observation, that a cycle which never establishes itself signals something systemic rather than local, is one modern medicine shares. Note the tolerance in the middle: a cycle arriving once a season is accepted as workable. The source's remarks elsewhere linking the timing of menarche to a girl's temperament belong to the social judgments of its era, not to medicine, and are not carried over here.

Deukhyo 得效

經水者, 陰血也. 陰必從陽, 故禀火色也. 血爲氣之配, 氣熱則熱, 氣寒則寒, 氣升則升, 氣降則降, 氣凝則凝, 氣滯則滯, 氣淸則淸, 氣濁則濁. 往往見有成塊者, 氣之凝也. 將行而痛者, 氣之滯也. 行後作痛者, 氣血俱虛也. 色淡者亦虛也, 而有水渾之也. 錯經妄行者, 氣之亂也. 紫者, 氣之熱也. 黑者, 熱之甚也. 今人但見其紫者ㆍ黑者ㆍ作痛者ㆍ成塊者, 率指爲風冷, 而行溫熱之劑, 禍不旋踵矣. 《丹心》 ○心主血, 故以色紅爲正. 月候雖不對期, 而色正者易調. 《入門》

The menstrual water is Yin Blood. Yin must follow Yang, and so it takes on the color of Fire. Blood is the consort of Qi: the Qi hot, it is hot; the Qi cold, it is cold; the Qi rising, it rises; the Qi descending, it descends; the Qi congealing, it congeals; the Qi stagnant, it stagnates; the Qi clear, it is clear; the Qi turbid, it is turbid. Where clots are seen, the Qi has congealed. Pain as it is about to flow is Qi stagnation; pain after it has flowed is Qi and Blood both vacuous. Pale color is likewise vacuity, with water muddying it. Flowing out of its channel and at random is Qi in disorder. Purple is heat in the Qi; black is heat at its worst. Yet people today, seeing only that it is purple, or black, or painful, or clotted, class it all as wind cold and administer warm hot preparations — and the disaster follows before they can turn on their heel (Dansim 丹心). — The Heart governs the Blood, and so red is the correct color. Even where the cycle does not keep to its term, one whose color is correct is easily regulated. (Immun 入門)
Clinical note The chapter's central teaching, and its central warning. Every quality of the flow — clotted, painful before, painful after, pale, purple, black — is read as a report on the Qi behind it, which makes the menstrual history a diagnostic instrument rather than a complaint. And then Danxi turns on his colleagues: dark blood and clots and cramping do not mean cold, and treating them with warming drugs brings disaster faster than you can turn around. Purple and black, he insists, are heat. It is the sharpest correction in the chapter, aimed at exactly the reflex a practitioner is most likely to have.

Dansim 丹心 · Immun 入門

Treating flooding and spotting 崩漏治法

血崩, 乃經血錯亂, 淖溢妄行. 遽止則便有積瘀, 凝成窠臼, 不止則又恐昏暈. 必先服五靈脂末 一錢, 溫酒調下, 其性能行血止血. 然後用五積散 方見寒門, 加防風ㆍ荊芥, 入醋煎服. 一二貼後, 再服五靈脂散, 去故生新. 如更不止, 乃用五灰ㆍ十灰丸. ○經水過多, 宜固經丸. ○崩漏多因心氣所使而下, 故貴奪勢ㆍ先富後貧, 皆是也, 宜開鬱四物湯.

Blood flooding is the menstrual Blood in disorder, brimming over and moving at random. Stop it abruptly and there is at once pooled stasis congealing into a lodged hollow; do not stop it and one fears fainting. One must first take 1 don of powdered flying-squirrel droppings stirred into warm wine, its nature being able to move the Blood and stop the Blood alike. Then use Ojeok-san — formula in the Cold chapter — with saposhnikovia and schizonepeta added, decocted with vinegar; after a packet or two, take the flying-squirrel powder again, to remove the old and engender the new. If still it does not stop, then use the Five Ashes and the Ten Ashes Pill. — For menstrual water in excess: Gogyeong-hwan 固經丸. — Flooding and spotting mostly descends at the direction of the Heart Qi — one once noble whose power has been taken away, one once rich and afterward poor, these are all such cases: Gaeulsamul-tang 開鬱四物湯.
Clinical note A staged protocol for heavy bleeding, and the staging is the intelligence in it: move first, then treat, then move again to clear what the stopping left behind, with the ash formulas held in reserve for what will not stop at all. And the section closes by returning to the cause the chapter takes most seriously — bleeding that follows a reversal of fortune, for which it prescribes a formula whose name means to open what is bound. The Womb chapter ends as it has run throughout: reading the cycle as a report on a life.

Donguibogam · Po

The cycle ceasing and returning 經斷復行

婦人四十九歲已後, 天癸當住, 每月却行, 或過多不止, 宜芩心丸ㆍ子芩丸ㆍ當歸散.

After a woman's forty-ninth year the Heavenly Water should have stopped; if instead it flows every month, or flows in excess and will not cease, Geumsim-hwan 芩心丸, Jageum-hwan 子芩丸, and Danggwi-san 當歸散 are appropriate.
Clinical note Bleeding after the cycle should have closed, given its own section and its own small shelf — and every formula on it is built on scutellaria, because the chapter reads this bleeding as heat rather than as weakness. Modern practice takes the same finding very seriously for a different reason: postmenopausal bleeding needs evaluation to exclude endometrial disease. The classical and the contemporary agree at least on this, that it is never to be ignored.

Donguibogam · Po

Acupuncture and moxibustion 鍼灸法

月經斷絶, 取中極ㆍ三陰交ㆍ腎兪ㆍ合谷ㆍ四滿ㆍ三里. 《綱目》 ○崩漏不止, 取血海ㆍ陰谷ㆍ三陰交ㆍ行間ㆍ大衝ㆍ中極. 《綱目》 ○赤白帶, 取中極ㆍ腎兪ㆍ氣海ㆍ三陰交ㆍ章門ㆍ行間. ○經斷久, 忽大崩下, 取豊隆ㆍ石門ㆍ天樞ㆍ中脘ㆍ氣海. 《綱目》

For the menses cut off: CV3 Jungguk, SP6 Sameumgyo, BL23 Sinsu, LI4 Hapgok, KI14 Saman, and ST36 Samni (Gangmok 綱目). — For unceasing flooding and spotting: SP10 Hyeolhae, KI10 Eumgok, SP6 Sameumgyo, LR2 Haenggan, LR3 Daechung, and CV3 Jungguk (Gangmok 綱目). — For red and white discharge: CV3 Jungguk, BL23 Sinsu, CV6 Gihae, SP6 Sameumgyo, LR13 Jangmun, and LR2 Haenggan. — Where the cycle has long been closed and suddenly there is great flooding: ST40 Punglyung, CV5 Seongmun, ST25 Cheonchu, CV12 Jungwan, and CV6 Gihae. (Gangmok 綱目)
Clinical note The needle's version of the chapter, and SP6 Sameumgyo appears in three of the four prescriptions — the crossing point of the three leg Yin channels, which is as close as the point repertoire comes to naming a menstrual master point. Note the last entry's different company: sudden flooding long after the cycle has closed is treated through the stomach and phlegm points rather than the Blood points, the chapter reading it as a different event altogether.

Gangmok 綱目

赤白帶, 帶脉穴灸之最奇. 一女患此, 灸此穴, 鬼附身云, 灸着我, 我卽去, 俄而卽差. ○崔氏四花穴, 治帶下如神. 《綱目》

For red and white discharge, moxa at the Girdling Vessel point GB26 is most marvelous. A woman suffered from this; moxa was applied at this point, and a ghost possessing her said, 'You have burned me — I am going,' and shortly she was well. — Cui's Four Flowers points treat vaginal discharge like a spirit.
Clinical note A case report from a world where illness could still speak in its own voice. Whatever one makes of the ghost, the record beneath it is straightforward: a woman with chronic discharge, moxa at the girdling-vessel point, and recovery — and the point chosen is the one named for the very vessel that classical theory holds responsible for the complaint. The case is preserved for what it says about how symptoms and their explanations were narrated, not as an account of what happened.

Gangmok 綱目

The form and color of the menses 月候形色

經色紫者, 風也. 四物湯 方見血門, 加防風ㆍ白芷ㆍ荊芥. ○黑者, 熱甚也. 成塊色紫黑者, 血熱也. 四物湯, 加黃芩ㆍ黃連ㆍ香附子. ○淡白者, 虛也. 芎歸湯 方見婦人, 加人參ㆍ黃芪ㆍ白芍藥ㆍ香附子. ○淡者, 有水渾之也. 二陳湯 方見痰飮, 加川芎ㆍ當歸. 一云, 色淡者, 氣血俱虛, 宜八物湯. ○如烟塵水者, 如屋漏水者, 如豆汁者, 或帶黃者, 濕痰也. 二陳湯, 加秦芃ㆍ防風ㆍ蒼朮. 一云, 如黑豆汁者, 四物湯, 加芩連. ○成塊色不變者, 氣滯也. 四物湯, 加香附子ㆍ玄胡索ㆍ枳殼ㆍ陳皮. ○通用百子附歸丸 方見婦人ㆍ琥珀調經丸.

Menses purple in color: wind. Samul-tang 四物湯 — formula in the Blood chapter — with saposhnikovia, angelica dahurica, and schizonepeta added. — Black: heat at its worst. Clotted and purple-black: Blood heat — Samul-tang with scutellaria, coptis, and cyperus added. — Pale white: vacuity. Gunggwi-tang — formula in the Women's chapter — with ginseng, astragalus, white peony, and cyperus added. — Thin and pale: water is muddying it. Ijin-tang 二陳湯 — formula in the Phlegm-Rheum chapter — with cnidium and Korean angelica added; one account says pale color is Qi and Blood both vacuous, and Palmul-tang is appropriate. — Like sooty water, like water leaking from a roof, like bean broth, or tinged yellow: damp phlegm. Ijin-tang with gentiana macrophylla, saposhnikovia, and atractylodes added; one account says that what resembles black bean broth takes Samul-tang with scutellaria and coptis. — Clotted but unchanged in color: Qi stagnation. Samul-tang with cyperus, corydalis, bitter orange husk, and tangerine peel added. — For general use: Baekjabugwi-hwan 百子附歸丸 — formula in the Women's chapter — and Hobakjogyeong-hwan 琥珀調經丸.
Clinical note The chapter's most immediately usable page: a color chart, with a formula attached to each entry. What matters is that the modifications, not the base, carry the diagnosis — Four Substances runs beneath purple, black, and clotted alike, and what changes is the three or four herbs added on top. The similes for damp phlegm are the sort only bedside description produces: sooty water, water leaking from a roof, bean broth. Note the arrangement's implicit rule, that color reports on temperature and consistency reports on movement.

Immun 入門 · Dansim 丹心

The method of harmonizing the Blood 和血治法

心主血, 故以色紅爲正. 月候雖不對期, 而色正者易調. 《入門》

The Heart governs the Blood, and so red is the correct color. Even where the cycle does not keep to its term, one whose color is correct is easily regulated.
Clinical note A single line that sets the treatment order for everything in this section: color before calendar. A cycle off its dates with healthy blood is a straightforward case; correct dates with dark, clotted, or washed-out blood is not. The tradition is reading the quality of the flow as the better report on the state underneath, and the timing as the thing that will follow once that is right.

Immun 入門

婦人經水少, 不如前者, 何也. 師曰, 曾經下利, 若汗出小便利, 亡其津液, 故令經水反少也. 設經下多於前者, 有所苦困, 當言恐大便難, 身復無汗也. 《脉經》

A woman's menstrual water is scant, less than before — why? The master said: she has had diarrhea before this, or sweating with free urination, and has lost her fluids — hence the menstrual water is on the contrary scant. And if the menses come down more heavily than before, there being some distress, one should say: it is to be feared that the stool is difficult and the body again without sweat.
Clinical note A question-and-answer that reasons about the cycle as one outlet among several. Fluid lost through diarrhea, sweat, or urine leaves less for the menses; fluid not leaving by stool or sweat leaves more. The menstrual volume is being read not as a local matter but as the balance of everything else the body has done that month — which is why the classical intake asks about bowels and sweating before it asks about the flow.

Maekgyeong 脉經

The cycle not regulated 月候不調

月候不調之由, 或前或後, 或多或少. 凡行後作痛者, 虛也. 少而淡者, 血虛也. 多者, 氣虛也. 其將行作痛及凝塊不散者, 滯也. 紫黑色者, 滯而挾熱也. 《丹心》

The cycle goes unregulated in this way: coming early or coming late, in excess or scant. In general, pain after the flow is vacuity. Scant and pale is Blood vacuity; excessive is Qi vacuity. Pain as it is about to flow, and clots that will not disperse, is stagnation. Purple-black in color is stagnation carrying heat with it.
Clinical note Five findings, five verdicts, and one rule that organizes them all: pain before the flow is fullness, pain after it is emptiness. The other clause worth pausing on is that heavy flow is read as Qi vacuity — the Qi being what holds Blood in its vessels, so that too much coming out means too little holding it in. Not a conclusion a purely mechanical account would reach, and one that matches what tonifying formulas actually do for heavy cycles.

Dansim 丹心

月候不調之中, 有兼疼痛者, 有兼發熱者. 其不調之中, 有趲前者, 有退後者, 則趲前爲熱, 退後爲虛也. 疼痛之中, 有常時作痛者, 有經前經後作痛者, 則常時與經前作痛者爲血積, 經後爲血虛也. 發熱之中, 有常時發熱者, 有經行發熱者, 則常時爲血虛有積, 經行爲血虛有熱. 《丹心》

Among unregulated cycles, some carry pain with them and some carry heat effusion. Among the irregularities, some run ahead of the term and some fall behind it: running ahead is heat, falling behind is vacuity. Among the pains, some come at all times and some come before or after the menses: pain at all times and pain before the menses are Blood accumulation, pain after is Blood vacuity. Among the heat effusions, some come at all times and some come with the flow: at all times is Blood vacuity with accumulation, with the flow is Blood vacuity with heat.
Clinical note A decision tree in a single paragraph, and its branching questions are exactly the ones a modern menstrual history asks: early or late, painful when, feverish when. Danxi's sorting is by timing rather than severity throughout — a cycle that runs early is hot, one that runs late is empty, and pain locates itself relative to the flow. Answer three questions about the calendar and the pattern names itself.

Dansim 丹心

The method of regulating the Blood 調血治法

經水將來, 腹中陣痛, 乃氣血俱實也, 宜淸熱調血湯. ○經水過期不行, 乃血虛也, 宜通經四物湯. 又四物湯, 加黃芪ㆍ陳皮ㆍ升麻ㆍ人參. ○月候不調, 通用調經散ㆍ煮附丸ㆍ墨附丸ㆍ四製香附丸ㆍ七製香附丸. 《入門》

Waves of pain within the abdomen as the menstrual water is about to come: this is Qi and Blood both replete — Cheongyeoljohyeol-tang 淸熱調血湯 is appropriate. — Menstrual water past its term and not flowing: this is Blood vacuity — Tonggyeongsamul-tang 通經四物湯 is appropriate; also Samul-tang 四物湯 with astragalus, tangerine peel, cimicifuga, and ginseng added. — For a cycle that is not regulated, in general use: Jogyeong-san 調經散, Jabu-hwan 煮附丸, Meokbu-hwan 墨附丸, Sajehyangbu-hwan 四製香附丸, and Chiljehyangbu-hwan 七製香附丸.
Clinical note The regulating shelf, and its organizing principle is repletion against vacuity — pain before the flow gets breakers, a flow that never arrives gets builders with lifting herbs added. Note what the four general-use pills have in common: every one is cyperus, processed a different number of ways. The tradition's answer to an irregular cycle was one herb prepared four ways, which is a statement about what it thought was usually wrong — not a shortage of substance but a failure of movement.

Immun 入門

The Blood stopped 血閉

女子十四歲, 衝任脉盛而血自下. 若過期不通, 則宜紅花當歸散ㆍ血極膏 方見上ㆍ三神丸ㆍ牡丹皮湯ㆍ通經丸, 或四物湯 方見血門, 加蓬朮ㆍ桃仁ㆍ牡丹皮ㆍ玄胡索ㆍ紅花. ○治月經不行, 結塊疼痛, 四物湯加蓬朮ㆍ官桂 各等分, 剉煎服. 《丹心》 ○治肝脾怒鬱, 月經不通, 卽歸脾湯加柴胡ㆍ山梔仁 各一錢, 水煎服. 《良方》

At fourteen a girl's Penetrating and Conception vessels grow exuberant and the Blood descends of itself. If it passes its term and does not come through, then Honghwadanggwi-san, Hyeolgeuk-go — formula above —, Samsin-hwan, Mokdanpi-tang, and Tonggyeong-hwan 通經丸 are appropriate — or Samul-tang 四物湯 — formula in the Blood chapter — with curcuma, peach kernel, moutan bark, corydalis, and safflower added. — For menses that do not flow, with a bound lump and pain: Samul-tang with curcuma and cassia added in equal parts, cut and decocted (Dansim 丹心). — For anger and constraint in Liver and Spleen with the menses not coming through: that is, Gwibi-tang with bupleurum and gardenia added, 1 don each, decocted in water and taken (Yangbang 良方).
Clinical note Three causes and three answers, and it is the last that shows the tradition at its most modern: menses stopped by anger and constraint, treated with Restore the Spleen Decoction plus two coursing herbs. Not a breaking formula at all — the reasoning being that when the cycle stops because the person is under strain, forcing it open treats the wrong thing. That the chapter files a mood among the causes of amenorrhea, and prescribes accordingly, is one of its more durable observations.

Dansim 丹心 · Yangbang 良方

衝脉ㆍ任脉, 皆起於胞中, 爲血之海. 血澁不行, 則成瘕作痛. ○任脉爲病, 男子爲七疝, 女子爲瘕聚. 《難經》 ○月事不行, 血結成瘕, 宜歸朮破癥湯ㆍ增味四物湯ㆍ四物調經湯ㆍ立效散ㆍ地黃通經丸.

The Penetrating and Conception vessels both rise from within the womb and are the sea of Blood. When the Blood is rough and does not move, concretions form and pain arises. — When the Conception vessel is diseased, in a man it becomes the seven kinds of bulging, in a woman gatherings and concretions (Nangyeong 難經). — Where the monthly affair does not flow and the Blood has bound into a concretion: Gwichulpajing-tang 歸朮破癥湯, Jeungmisamul-tang 增味四物湯, Samuljogyeong-tang 四物調經湯, Iphyo-san 立效散, and Jihwangtonggyeong-hwan 地黃通經丸.
Clinical note The chapter's account of how a mass forms: the two vessels that rise from the womb are the sea of Blood, and Blood that will not move in that sea congeals into something with edges. The Classic of Difficulties gives the male and female versions of one vessel's failure, which is the kind of symmetry this tradition looks for. What a modern clinic would investigate with imaging, the classical text reasons about as stalled circulation — and treats, accordingly, by trying to get it moving again.

Nangyeong 難經 · Donguibogam · Po

The method of freeing the Blood 通血治法

治室女經候不調, 腹痛. 橘紅 二兩, 玄胡索(醋製)ㆍ當歸(酒炒) 各一兩. 右爲末, 酒糊和丸梧子大, 艾醋湯下百丸. 《丹心》 ○治室女經閉, 咳嗽發熱. 當歸ㆍ牡丹皮 各一錢半, 白芍藥ㆍ生乾地黃ㆍ陳皮ㆍ白朮ㆍ香附子 各一錢, 川芎ㆍ柴胡ㆍ黃芩 各七分, 甘草 四分. 右剉, 作一貼, 水煎服.

For an unmarried woman whose cycle is unregulated, with abdominal pain: red tangerine peel 2 nyang; vinegar-processed corydalis and wine-fried Korean angelica, 1 nyang each — powdered, bound with a wine paste into pills the size of parasol-tree seeds, 100 pills taken with a mugwort-and-vinegar decoction (Dansim 丹心). — For an unmarried woman with the menses closed, coughing and effusing heat: Korean angelica and moutan bark, 1.5 don each; white peony, dried raw rehmannia, tangerine peel, white atractylodes, and cyperus, 1 don each; cnidium, bupleurum, and scutellaria, 7 fun each; licorice 4 fun — cut, made into one packet, decocted in water and taken.
Clinical note The second entry is worth reading twice: menses closed, with cough and fever. The chapter is describing the young woman whose cycle has stopped as part of a wasting illness rather than as a local problem — and it treats her with builders and coursers rather than with the breaking pills of the previous section. The distinction between a cycle obstructed and a cycle that has nothing left to release runs through this whole chapter, and it is the distinction that decides whether one opens or fills.

Dansim 丹心 · Donguibogam · Po

The Blood dried up 血枯

經閉不行有三. 一者, 胃弱形瘦, 氣血衰, 津液不生, 而致經水斷絶, 名曰血枯經絶. ○二者, 心包脉洪數, 時見躁作, 大小便不利, 而經水閉絶, 乃血海乾枯, 此下焦胞脉熱結也. ○三者, 或因勞心, 心火上行, 月事不來者, 胞脉閉也, 此上焦心肝肺熱結也. 《東垣》

The menses being closed and not flowing is of three kinds. First: the stomach is weak and the form thin, Qi and Blood have waned, the fluids are not engendered, and so the menstrual water is cut off — this is named Blood dried up and the menses severed. — Second: the pericardium pulse is surging and rapid, agitation appears from time to time, stool and urine are not free, and the menstrual water is closed off — this is the sea of Blood run dry, a heat bind in the womb vessels of the lower burner. — Third: through taxing the mind, the Heart fire runs upward and the monthly affair does not come — the womb vessels are closed. This is a heat bind of Heart, Liver, and Lung in the upper burner.
Clinical note Three amenorrheas, and the tradition's care in separating them still pays. The first is undernourishment — a thin frame, a weak stomach, nothing left to make blood from. The second is heat below, with a racing pulse and constipation. The third begins in the mind and closes the cycle from above. Only the first is emptiness; the other two are obstruction of different kinds — and confusing them is how a patient who needed feeding gets purged instead.

Dongwon 東垣

世有室女童男, 積想在心, 思慮過度, 多致勞損. 男子則神色先散, 女子則月水先閉. 盖憂愁思慮則傷心, 而血逆竭, 故神色先散, 月水先閉. 且心病不能養脾, 故不嗜食. 脾虛則金虧, 故發嗽. 腎水絶則木氣不榮, 而四肢乾痿, 故多怒, 鬢髮焦, 筋骨痿. 若五藏傳遍則死矣. 《良方》

There are unmarried women and young men in the world whose longing accumulates in the heart and whose thinking passes all measure, and it often brings them to taxation detriment. In a man the spirit and complexion scatter first; in a woman the monthly water closes first. For worry, sorrow, and brooding damage the Heart, and the Blood counterflows and is exhausted — hence the scattered complexion, hence the closed menses. Further, the Heart being ill cannot nourish the Spleen, and so there is no relish for food; the Spleen vacuous, the Metal is diminished, and so a cough breaks out; the Kidney water severed, the Wood Qi does not flourish, the four limbs wither and wilt — hence much anger, scorched hair at the temples, sinews and bones wilting. And if it passes through all five viscera, the person dies.
Clinical note The chapter's most striking passage, and one of the classical canon's clearest accounts of a psychosomatic cascade — grief and unmet longing damaging the Heart, which stops feeding the Spleen, which stops nourishing the Lung, and so on around the cycle of the five phases until the whole system is involved. What it describes in a young woman — amenorrhea, loss of appetite, cough, wasting, irritability — is recognizable, and its insistence that the first cause is a state of mind rather than a state of the uterus is why the treatment that follows is not a breaking formula.

Yangbang 良方

二陽之病, 月事不來, 先瀉心火, 血自下, 亦用上藥. 《潔古》 ○氣上迫肺, 月事不來, 宜導痰降火, 則心氣下通而月事來, 宜通經湯. 《丹心》 ○先賢治血閉之法, 皆主於補血瀉火. 補血者, 四物湯, 瀉火者, 調胃承氣湯, 卽玉燭散也. ○胃弱血枯經斷, 宜補中益氣湯 方見內傷, 加川芎ㆍ生地黃ㆍ天花粉. ○宜三和湯ㆍ玉燭散, 次服五補元 方見虛勞.

In the illness of the two Yang, the monthly affair does not come: first drain the Heart fire, and the Blood descends of itself — the medicines above are used here also (Gyeolgo 潔古). — Where Qi presses upward on the Lung and the monthly affair does not come, one should abduct the phlegm and down the fire; then the Heart Qi passes downward and the menses come — Tonggyeong-tang 通經湯 is appropriate (Dansim 丹心). — The method of the earlier worthies for treating a closed cycle was in every case to supplement the Blood and drain the fire: for supplementing the Blood, Samul-tang 四物湯; for draining the fire, Jowiseunggi-tang — which together are Okchok-san 玉燭散. — For a weak stomach with the Blood dried and the menses severed: Bojungikgi-tang 補中益氣湯 — formula in the Internal Damage chapter — with cnidium, raw rehmannia, and trichosanthes root added. — Samhwa-tang 三和湯 and Okchok-san are appropriate, followed by Obo-won 五補元 — formula in the Vacuity Taxation chapter —.
Clinical note The treatment logic follows the three causes exactly. Fire above gets drained so the Blood can fall; phlegm pressing the Lung gets moved so the Heart Qi can descend; and a weak stomach with nothing to make blood from gets Bojungikgi-tang — the internal-damage doctrine reaching into the womb chapter to say that the cycle stopped because the person is not being fed. Note the formula name Okchok-san, Jade Candle Powder: the Four Substances joined to a purgative, building and draining in one cup, which is the whole 'supplement the Blood, drain the fire' principle in a single prescription.

Gyeolgo 潔古 · Dansim 丹心 · Donguibogam · Po

Flooding and spotting 崩漏

內經曰, 陰虛陽搏, 謂之崩. 註曰, 陰脉不足, 陽脉盛搏, 則內崩而血流下也. ○非時血下, 淋瀝不止, 謂之漏下. 忽然暴下, 若山崩然, 謂之崩中. 《入門》 ○悲哀太甚則胞絡絶, 胞絡絶則陽氣內動, 發則心下崩, 數溲血也. 《丹心》 ○盖悲哀則心系急, 肺布葉擧而上焦不通, 榮衛不散, 熱氣在中, 故胞絡絶而陽氣內鼓動, 發則心下崩, 數溲血也. 心下崩, 謂心包內崩而下血也. 《入門》

The Inner Classic says: the Yin vacuous and the Yang beating against it is called flooding. The commentary: the Yin vessels being insufficient and the Yang vessels exuberantly beating, there is flooding within and the Blood flows down. — Blood descending out of its season, dribbling without cease, is called spotting; suddenly pouring down as a mountain collapses is called flooding. — When grief is too great the womb's network vessel is severed; severed, the Yang Qi stirs within, and when it breaks out there is collapse below the heart and frequent bloody urination (Dansim 丹心). — For grief tightens the heart's cord, the lung's lobes spread and lift so that the upper burner does not pass through, construction and defense do not disperse, and heat Qi stays in the middle — hence the womb's network vessel is severed and the Yang Qi drums within. 'Collapse below the heart' means the pericardium collapses within and blood descends. (Immun 入門)
Clinical note The two words are distinguished by their tempo — spotting dribbles out of season, flooding comes down like a hillside giving way — and the tradition's most-quoted line on the subject makes grief a cause of hemorrhage. Whatever one makes of the mechanism, the observation that acute grief can be followed by heavy uterine bleeding is the sort of thing attentive clinicians have gone on reporting.

Naegyeong 內經 · Dansim 丹心 · Immun 入門

崩漏不止有三. 一者, 脾胃虛損, 下陷於腎, 與相火相合, 濕熱下迫, 經漏不止. 其色紫黑, 如夏月腐肉之臭, 中有白帶, 脉沈細疾數, 或沈弦洪大, 其熱明矣. 或腰痛, 或臍下痛. 宜大補脾胃而升擧血氣. ○二者, 或故貴奪勢, 或先富後貧, 心氣不足, 其火大熾, 旺於血脉之中, 又飮食失節, 其容顔似不病者. 此心病者, 不行於診, 其經水不時而下, 或適來適斷, 或暴下不止. 當先說惡死之言, 令心不動, 以大補氣血之藥擧養脾胃, 微加鎭墜心火之藥, 補陰瀉陽. ○三者, 悲哀太甚則胞絡絶. 《東垣》

Unceasing flooding and spotting is of three kinds. First: the Spleen and Stomach are vacuously damaged and sink down into the Kidney, joining with the minister fire, so that damp heat presses downward and the spotting does not stop. Its color is purple-black, with the smell of meat rotted in summer, and there is white discharge within it; the pulse is sunken, fine, racing and rapid, or sunken, wiry, surging and large — the heat is plain. There may be lumbar pain or pain below the navel. One should greatly supplement the Spleen and Stomach and raise up the Blood and Qi. — Second: someone once noble whose power has been taken away, or once rich and afterward poor, the Heart Qi insufficient and its fire blazing greatly, exuberant within the blood vessels — and with meals also out of measure, though the face looks like that of a person not ill. This is an illness of the Heart, which does not show itself in the examination: the menstrual water descends out of season, now coming and now stopping, or pouring down without cease. One should first speak with them of what is dreadful in death, so that the heart is not stirred; then with medicines that greatly supplement Qi and Blood, raise and nourish the Spleen and Stomach, adding a little of what settles and weighs down the Heart fire — supplementing the Yin and draining the Yang. — Third: when grief is too great, the womb's network vessel is severed.
Clinical note Three causes, and the second is unlike anything else in this chapter. Dongyuan describes a patient whose bleeding follows a reversal of fortune — status lost, wealth gone — and warns that she will look well and that the examination will show nothing, because the illness is in the Heart. His first instruction is not a herb but a conversation: talk with her, until the heart is no longer stirring, and only then prescribe. It is a seventeenth-century record of counselling being ordered as the opening move of treatment, for bleeding whose cause the physician located in a life rather than a body.

Dongwon 東垣

Vaginal discharge 帶下

任脉爲病, 女子帶下瘕聚. 註曰, 任脉自胞上過帶脉, 貫於臍上, 故爲帶下. 帶脉起于季肋章門 穴名, 似束帶狀. 今濕熱寃結不散, 故爲病也. 寃者, 結也, 屈也 — 屈滯而病也. ○赤者, 熱入小腸, 白者, 熱入大腸. 原其本, 皆濕熱結于脉, 故津液涌溢, 是爲赤白帶下. ○小腹寃熱, 結於任脉, 自胞上而過帶脉, 出於大小腸之分, 溲出白液, 淋瀝以下, 故曰帶下. 與赤白濁一般, 但不痛耳. 《入門》

When the Conception vessel is diseased, in a woman there is vaginal discharge and gatherings and concretions. The commentary: the Conception vessel rises from the womb, passes the Girdling vessel, and threads upward past the navel — hence 'discharge below the girdle.' The Girdling vessel arises at the free ribs at LR13 Jangmun — the name of a point —, in the fashion of a belt drawn round. Now damp heat is bound up and does not disperse, and so there is illness. To be bound up is to be knotted, to be bent — bent and stalled, and thence ill. — Red is heat entering the small intestine; white is heat entering the large intestine. Trace it to its root and both are damp heat bound in the vessels, so that the fluids surge and overflow: this is red and white discharge. — Heat bound up in the lower abdomen, knotted in the Conception vessel, rises from the womb past the Girdling vessel and issues at the division of the large and small intestines; a white fluid passes out, dribbling downward — hence 'discharge below the girdle.' It is the same as red and white turbidity, only without the pain.
Clinical note The name itself is anatomy: the Girdling vessel runs round the waist like a belt, and what escapes below it is 'discharge below the girdle.' The etymological aside is worth keeping — the character for the binding of damp heat means knotted and bent, a thing stalled by being folded. And the closing comparison is clinically useful: the same as turbidity in a man, distinguished by the absence of pain, which is still the question that separates a discharge from an infection worth worrying about.

Naegyeong 內經 · Immun 入門