1、帶下病【概說(shuō)】帶下，是指婦女從陰道中流出稠粘液體，如涕如睡，綿綿不斷的一種病證。因帶下的顏色不同，有白帶、黃帶、赤帶及赤白帶、五色帶等名稱。根據(jù)臨床觀察，以白帶和黃帶最為常見(jiàn)。Morbid LeukorrheaMorbid leukorrhea is a disease symptomized by persistent excessive mucous vaginal discharge.Based on different colors, the condition is classified by its colors into white, yellow, red, red-white

2、 and multicolored leukorrhea, among which white and yellow leukorrhea are commonly seen in clinic.【病因病機(jī)】（一）脾虛濕盛-飲食不節(jié)，勞倦過(guò)度，損傷脾氣，運(yùn)化失常，則水谷之精微不能上輸，反聚而為濕，流于下焦，而為帶下。（二）腎氣虧虛-素體腎氣不足，下元虧損，或孕育過(guò)多，傷及腎氣，而使帶脈失約，任脈不固，遂成帶下。（三）濕熱下注-脾虛濕盛，郁而化熱，或肝氣郁結(jié)，郁久化熱，熱與濕搏，濕熱下注，而成帶下。Etiology and Pathogenesis1. deficiency in the spl

3、een: improper diet and overstrain hinder the spleen qi from transforming and transporting nutrient particles, which accumulate in the lower energizer and turn to damp and finally leukorrhea appears.2. deficiency in the kidney: constant deficiency of kidney qi, grand multipara, dysfunctions of the Be

4、lt and Conception vessels lead to leukorrhea. 3. damp heat: the presence of excessive damp due to deficiency in the spleen, changes into heat. Prolonged stagnated liver qi may transform into heat and amalgamate with the damp. The downward infusion of damp heat turns out to be leukorrhea.【辨證】（一）脾虛證主證

5、：帶下量多，色白或淡黃，面色萎黃，精神疲倦，舌膩，脈緩弱。質(zhì)粘稠，無(wú)臭，如涕如唾，連綿納少便溏，下肢浮腫，舌淡苔白。 征候分析：脾虛失運(yùn)、水濕下陷則為帶下；脾虛中陽(yáng)不振，則納少便溏，下肢浮腫，面色不榮而呈咣白或萎黃，四肢不溫，精神疲乏；舌淡苔白膩，脈緩，均為脾虛之征。 Differentiation 1. deficiency in the spleenMain manifestations: profuse thick, white or light yellow vaginal discharge without smell, pale or sallow complexion, lass

6、itude, poor appetite and loose stools, edema in the lower limbs, pale tongue with white sticky coating, slow weak pulse.Analysis: on account of deficiency in the spleen, the downward infusion of water and damp form leukorrhea. With deficiency in the spleen, the sapped yang qi in the middle energizer

7、 gives rise to poor appetite, loose stools and edema in the lower limbs, lusterless and pale or sallow complexion, cold extremities and lassitude. Pale tongue with white sticky coating and slow pulse are signs of deficiency in the spleen. 【辨證】（二）腎虛證主證：帶下量多，質(zhì)靖而稀，淋漓不斷，腰如折，小腹發(fā)冷，小便頻數(shù)清長(zhǎng)，大便溏薄，舌淡苔薄白，脈沉。 證候

8、分析：腎陽(yáng)不足，帶脈失約，任脈不固，帶下清冷，淋漓不斷；命門(mén)火衰，不能下暖膀胱，上溫脾土，故小便清長(zhǎng)大便溏??；腰為腎之府，腎虛失榮，則腰痰如折；腎陽(yáng)虛衰，不能溫暖胞宮，則小腹有冷感舌淡；苔薄白，脈沉，為腎陽(yáng)不足之征。 Differentiation2. deficiency in the kidneyMain manifestations: profuse and continuous discharge of thin and transparent whites, severe soreness of the lower back, cold sensation in the lower

9、abdomen, frequent and excessive urine, loose stools, pale tongue with thin coating, and deep pulse.Analysis: deficiency kidney yang causes Belt and Conception vessels to slacken its restriction of essence, resulting in the continuous vaginal discharge. The dimmed fire in the Mingmen is too weak to w

10、arm up the bladder and spleen and brings on frequent urine in large volume and loose stools. Sore lower back is due to a weakened kidney that is situated here. When the weak kidney yang fails to keep the uterus warm, there appears a cold sensation in the lower abdomen. Pale tongue with thin white co

11、ating and deep pulse are signs of deficiency of the kidney yang. 【辨證】（三）濕熱證 主證：帶下色黃量多，質(zhì)粘稠，其氣穢臭，陰中瘙癢，大便于結(jié)，小便短赤，脈象濡數(shù)；舌苔黃膩；或帶下色黃兼赤，口蓑咽干，煩熱，心悸失眠，情緒急躁易怒，苔黃，脈象弦數(shù)。 證候分析：濕熱下注，帶脈失約而致帶下；濕邪挾熱，故帶下色黃稠粘且臭，陰部搔癢；濕熱內(nèi)蘊(yùn)，則大便干結(jié)，小便短赤；脈濡數(shù)，苔黃膩，均為濕熱之征。肝郁化熱，則急躁易怒，口苦咽干；熱擾營(yíng)血，血不循經(jīng)，隨帶而下，故帶下赤色；熱擾心神，故煩熱，心悸、失眠；脈弦數(shù)，苔黃，為肝經(jīng)郁熱之象。Differ

12、entiation3. Damp heatMain manifestations: sticky, viscous and stinking yellow leukorrhea in large quantity, itching in the vulva, dry stool, scanty and yellow urine, soft and rapid pulse, sticky yellow coating, or leukorrhea in reddish yellow color, bitter taste in the mouth, dry throat, irritabilit

13、y with feverish sensation, palpitation, insomnia, yellow coating, string-taut and rapid pulse.Analysis: The downgoing damp and heat hurt the Conception and Belt vessels. The pathogenic heat amalgamated with damp gives rise to the yellow color, visicosity and stench of the whites and the itching in t

14、he vulva. The internal accumulation of the pathogenic damp is the cause of dry stools and scanty yellow urine. Soft rapid pulse and yellow sticky tongue coating are signs of damp and heat. There appear irritability, bitter taste in the mouth and dry throat, when the pathogenic heat is transformed fr

15、om the stagnated liver qi. Heat in the blood causes reddish leukorrhea. When heat disturbs the mind there present irritability, feverish sensation, palpitation and insomnia. The string-taut rapid pulse and yellow coating imply accumulated heat in the Liver Meridian. 【治療】（一）脾虛證 治法：取任脈、足太陰、陽(yáng)明經(jīng)穴為主。針刺用補(bǔ)

16、法，并用灸法。以健脾利濕，調(diào)任固帶。 處方：帶脈(膽26) 氣海（任6） 白環(huán)俞(膀胱30) 陰陵泉（脾9） 足三里(胃36) 方義：陰陵泉、足三里-健脾利濕，為主穴。帶脈-固攝帶脈，主治帶下；氣海-理氣化濕，調(diào)任固帶； 白環(huán)俞-鄰近取穴，功于止帶； Treatment 1. deficiency in the spleenMethod: main points are selected from the Conception Vessel, Foot-Taiyin and Yangming Meridians. Acupuncture with the reinforcing method

17、and moxibustion is used to build up the spleen and remove damp, regulate Conception Vessel and stabilize Belt Vessel.Prescription: Daimai (GB 26), Qihai (CV 6), Baihuanshu (BL 30), Yinlingquan (SP 9), Zusanli (ST 36).Explanation: Daimai (GB 26), an intersecting point of the Belt Vessel and Foot-Shao

18、yang Meridians stabilizes the Belt Vessel and is a cure for leukorrhagia. Qihai (CV 6) regulates qi, resolves damp, adjusts the Conception Vessel and stabilizes the Belt Vessel. Baihuanshu (BL 30) is selected as an adjacent point to check leukorrhagia. Yinlingquan (SP 9) and Zusanli (ST 36), major p

19、oints in this prescription, are paired to build up the spleen and remove damp. 【治療】（二）腎虛證 治法：取任脈、足少陰經(jīng)穴為主。針刺用補(bǔ)法，并用灸法。以助陽(yáng)補(bǔ)腎，固攝任帶。 處方：腎俞(膀胱23) 關(guān)元（任4） 大赫(腎12) 帶脈(膽26) 復(fù)溜(腎7)。 方義：腎俞、關(guān)元、大赫、復(fù)溜-助陽(yáng)補(bǔ)腎，使腎能閉藏，任固帶約，則帶下可止；帶脈穴有止帶的作用。 Treatment2. deficiency in the kidneyMethod: select points mainly from the Concept

20、ion Vessel and Foot-Shaoyin Meridian. Acupuncture with the reinforcing method and moxibustion are used to promote yang qi, tonify the kidney and stabilize the Conception and Belt vessels.Prescription: Shenshu (BL 23), Guanyuan (CV 4), Dahe (KI 12), Daimai (GB 26), Fuliu (KI 7).Explanation: Shenshu (

21、BL 23), Guanyuan (CV 4), Dahe (KI 12), Daimai (GB 26), are applied together to promote yang qi and tonify the kidney so as to restore its strong function, and stabilize the Conception and Belt vessels, and finally check leukorrhagia. Daimai (GB 26) is selected aiming at leukorrhagia. 【治療】（三）濕熱證 治法：取

22、任脈、足太陰經(jīng)穴為主。針刺宜用瀉法，以清熱利濕，調(diào)任固帶。 處方：中極（任3） 次髎(膀胱32) 三陰交（脾6） 太沖(肝3) 隨證配穴；陰部搔癢：蠡溝（肝5） 帶下色赤：血海(脾10) 熱重者：曲池（大腸11） 方義：中極-瀉之可清利下焦?jié)駸?；次髎可清熱利濕，功于止帶；三陰交-健脾利濕；諸穴相配可達(dá)清熱利濕，調(diào)任固帶的作用。蠡溝-清瀉肝經(jīng)濕熱，治療陰部搔癢；血海-清瀉血熱，治療帶下色赤；曲池-清熱。Treatment3. damp heatMethod: mainly select points from the Conception Vessel and Foot-Taiyin Meridian. Acupuncture with the reducing method is employed to clear heat, remove damp, adjust the Conception Vessel and stabilize the Belt Vessel.Prescription: Zhongji (CV 3), Ciliao (BL 32), S