某 脉弱无力。发热汗出。久咳形冷。减食过半。显然内损成劳。大忌寒凉清热治嗽。姑与建中
法。冀得加谷经行。犹可调摄。
桂枝（五分） 生白芍（一钱半） 炙草（五分） 枣肉（三钱） 饴糖（二钱） 归身（一钱半）
程（十九） 干血劳病。百脉枯槁。渐至危笃。三月间诊脉一次。当面告辞。余非愦愦医流。不肯
因循误事。
益母丸早晚服二三钱。
某 营虚寒热。咳血。经闭。
当归 炒白芍 丹参 枣仁 远志 茯苓 炙草 广皮 桂圆肉
顾（三一） 潮热经阻。脉来弦数。营血被寒热交蒸。断其流行之机。即为干血劳瘵。非小恙也。
桂枝（三分） 白芍（一钱半） 阿胶（一钱半） 生地（三钱） 炙草（四分） 麦冬（一钱半）
大麻仁（一钱）
朱（女） 冲年天癸未至。春阳升动。寒热衄血。平昔溺后腰痛。耳目甚聪明。先天质薄。阴本难充易
亏。最多倒经之虑。（倒经）
雄乌骨鸡 生地 生白芍 茯神 天冬 知母 牛膝 茺蔚子 女贞子 阿胶
诸药除阿胶用水煎汁二次。其乌鸡去毛及翅足。另以童便一碗。青蒿汁四碗。醇酒二
碗。米醋一碗。同煮。再加入前药汁收膏。入阿胶收。炖暖服五钱。
张 十七岁天癸不至。咳嗽失血。乃倒经重症。先以顺气导血。
降香末 郁金 钩藤 丹皮 苏子 炒山楂 黑山栀
又 震动气冲。咳呛失血。
鸡子黄 阿胶 鲜生地 天冬 生白芍 炒半膝
又 脉细数。腹痛。营热。经不通。
人参 天冬 鲜生地 白芍 丹参
调入琥珀末三分
易曰。干道成男。坤道成女。女子属阴。以血为主。故女科治法。首重调经。经。常也。如潮汐之
有信。如月之盈亏。不愆其期。故曰经水。又曰月事。又曰月信。内经云。太冲脉盛。月事以时
下。景岳云。冲为五脏六腑之海。脏腑之血。皆归冲脉。可见冲脉为月经之本也。然血气之
化。由于水谷。水谷盛。则血气亦盛。水谷衰。则血气亦衰。是水谷之海。又在阳明。可见冲脉
之血。又总由阳明水谷所化。而阳明胃气。又为冲脉之本也。故月经之本。所重在冲脉。所
重在胃气。所重在心脾生化之源耳。心主血。脾统血。肝藏血。凡伤心伤脾伤肝者。均能为
经脉之病。内经曰。二阳之病发心脾。有不得隐曲。女子不月。其传为风消。其传为息贲者。
死不治。不得隐曲。言情欲不遂。而病发心脾也。风消者。发热消瘦。胃主肌肉也。息贲者。喘
息上奔。胃气上逆也。此虽言病发心脾。而实重在胃气。因心为胃之母。胃为脾之腑也。内
经又曰。有病胸胁支满者。妨于食。病至则先闻腥臊臭。出清液。先唾血。四肢清。目眩。时时
前后血。病名血枯。此得之年少时。有所大脱血。若醉入房中。气竭肝伤。故月事衰少不来
也。治之以四乌 骨一 茹。二物并合之。丸以雀卵。大如小豆。以五丸为后饭。饮以鲍鱼
汁。利肠中及伤肝也。此段经文。全重在气竭肝伤四字。为通节之纲旨。胸胁。肝部也。支满。
肝病也。妨于食。木邪凌土也。病则先闻腥臊臭。脾喜芳香。今脾土为木邪凌虐。病则先闻
腥臊。乃肝之旺气也。出清液。脾虚不能敷化水精也。先唾血。脾伤不能统运营血也。四肢
清。阳衰不能傍达四末也。目眩。阳不充而水上溢于经也。前后血。阴受伤而血内溢于络
也。血枯。内有干血。血不归经。而结胞门也。良由年少不禁。气竭肝伤而致。月事衰少。或不
来也。治以乌 骨四分。取其味咸走肾。性温达肝。配以 茹一分。取其辛散内风。温去恶
血。二物并合。功专破宿生新。丸以雀卵。取其温补助阳。能调子脏精血。以五丸为后饭者。
先药后饭。使药徐行下焦。力贵专功。五丸不为少也。饮以鲍鱼汁。利肠垢。和肝伤。取其臭
秽之味。佐乌 骨而辟宿积之血也。金匮要略言调经之法甚详。后世如王节斋薛立斋
诸贤。论症透彻。用方精切。俱可为程序。兹不具赘。今观叶先生案。奇经八脉。固属扼要。其
次最重调肝。因女子以肝为先天。阴性凝结。易于拂郁。郁则气滞血亦滞。木病必妨土。故
次重脾胃。余则血虚者养之。血热者凉之。血瘀者通之。气滞者疏之。气弱者补之。其不治
之症。直言以告之。诚一代之良工。女科之明鉴。学人当奉为典型。更能参考内经仲景。及
诸贤案论。自然学业日进。登峰造极矣。（秦天一）
徐评 妇人之疾。除经带之外。与男子同治。而经带之疾。全属冲任。治冲任之法。全在养血。故
古人立方无不以血药为主者。案中大段亦养血为先。而未能说着变化。盖未得女科专门传授也。
某患者脉象虚弱无力，发热且出汗，长期咳嗽导致身体发冷，食欲减少超过一半。这显然是内部亏损形成了劳损（虚劳），绝对禁忌使用寒凉药物来清热止咳。暂且采用建中法（建立中气、调和脾胃的治疗方法）。希望患者能够增加饮食摄入并恢复月经来潮，这样还可以进行调理养护。
桂枝（五分） 生白芍（一钱半） 炙甘草（五分） 枣肉（三钱） 饴糖（二钱） 当归身（一钱半）
程姓患者（十九岁），患有干血劳病（因瘀血内停、阴血枯竭导致的虚劳病），百脉枯槁，逐渐发展到危重程度。三月间诊察了一次脉象，当面告知辞去治疗。我并非昏聩庸医，不会因循守旧而耽误病情。
益母丸早晚服用二三钱。
当归 炒白芍 丹参 酸枣仁 远志 茯苓 炙甘草 广陈皮 桂圆肉
顾姓患者（三十一岁），午后潮热且月经阻滞，脉象弦数。营血被寒热邪气交替蒸灼，断绝了气血流行的机制，这就变成了干血劳瘵（严重的慢性消耗性疾病），不是小病。
桂枝（三分） 白芍（一钱半） 阿胶（一钱半） 生地（三钱） 炙甘草（四分） 麦冬（一钱半） 大麻仁（一钱）
朱姓女患者，正值青春期天癸（指与月经有关的物质或功能）尚未到来。春季阳气升动，出现寒热往来和鼻出血。平时小便后腰痛，耳目非常灵敏，但先天体质薄弱，阴精本来难以充盈且容易亏损。最多担心发生倒经（月经逆行从口鼻而出）的忧虑。
雄乌骨鸡 生地 生白芍 茯神 天冬 知母 牛膝 茺蔚子 女贞子 阿胶
所有药物除了阿胶用水煎煮两次取汁外，将乌鸡去毛及翅足，另外用童便一碗、青蒿汁四碗、纯酒二碗、米醋一碗，共同煮制。再加入前面的药汁收膏，最后加入阿胶收膏。炖热后服用五钱。
张姓患者十七岁，天癸未到，咳嗽失血，这是倒经的重症。先用顺气导血的方法。
又诊：震动气冲，呛咳失血。
鸡蛋黄 阿胶 鲜生地 天冬 生白芍 炒半膝（注：此处原文可能有误，通常指炒半夏或特定炮制品，依原文保留）
调入琥珀末三分
《易经》说：乾道成就男性，坤道成就女性。女子属阴，以血为主。所以妇科治疗方法，首要重视调经。经，就是常道。就像潮汐有信期，像月亮有盈亏，不违背其期限，所以叫经水。又叫月事，又叫月信。《内经》说：太冲脉旺盛，月事按时下行。景岳说：冲脉是五脏六腑之海，脏腑的血，都归聚于冲脉。可见冲脉是月经的根本。然而气血的化生，源于水谷。水谷充足，则气血也旺盛；水谷衰少，则气血也衰少。所以水谷之海（胃），又在阳明经。可见冲脉的血，又总由阳明水谷所化生。而阳明的胃气，又是冲脉的根本。所以月经的根本，关键在于冲脉，关键在于胃气，关键在于心脾生化之源。心主血，脾统血，肝藏血。凡是伤心、伤脾、伤肝的，都能导致经脉的疾病。《内经》说：二阳（阳明胃与大肠）的病发于心脾，有不能宣泄隐曲之情欲的情况，女子就会不来月经。这种病传变下去成为风消（发热消瘦），传变下去成为息贲（喘息上奔），就是死证，无法治愈。所谓“不得隐曲”，是说情欲不遂，从而病发于心脾。风消，是指发热消瘦，因为胃主肌肉。息贲，是指喘息上奔，因为胃气上逆。这里虽然说是病发于心脾，但实际上重在胃气，因为心是胃之母，胃是脾之腑。《内经》又说：有病胸胁支撑胀满的，妨碍进食，发病时先闻到腥臊臭味，流出清稀液体，先唾血，四肢清冷，目眩，时常大小便出血。病名叫血枯。这是由于年少时，有过大量失血，或者醉酒后行房，导致气竭肝伤，所以月事衰少甚至不来。治疗用四乌鲗骨一茹藘（即海螵蛸与茜草）。两味药合在一起，用雀卵做丸，大小如小豆，以五丸为饭后服，用鲍鱼汁送服。目的是利肠中及伤肝。这段经文，全重在“气竭肝伤”四字，是全节的纲领主旨。胸胁，是肝的部位；支满，是肝病；妨于食，是木邪凌犯土（肝木克脾土）；发病先闻腥臊臭，脾喜芳香，现在脾土被木邪凌虐，发病先闻腥臊，这是肝的旺气；出清液，是脾虚不能敷布化生水精；先唾血，是脾伤不能统运营血；四肢清，是阳衰不能旁达四肢末端；目眩，是阳不充而水上溢于经脉；前后血，是阴受伤而血内溢于络脉。血枯，内有干血，血不归经，而结聚在胞门。确实是由于年少时不知节制，气竭肝伤而导致。月事衰少，或是不来。治疗用乌鲗骨四分，取其味咸走肾，性温达肝；配以茹藘一分，取其辛散内风，温去恶血。两药合并，功效专门在于破除宿血、生出新血。用雀卵做丸，取其温补助阳，能调摄子宫精血。以五丸为饭后服，是先服药后吃饭，使药力缓慢下行至下焦，力量贵在专功，五丸并不算少。饮用鲍鱼汁，是为了利肠垢，调和肝伤，取其臭秽的味道，辅助乌鲗骨来辟除宿积之血。《金匮要略》言调经之法非常详细，后世如王节斋、薛立斋等贤人，论述病症透彻，使用方剂精切，都可以作为程序规范。这里不再赘述。如今看叶先生的医案，奇经八脉固然属于扼要之处，其次最重调肝。因为女子以肝为先天，阴性凝结，易于拂郁，郁则气滞血亦滞，木病必妨害土，所以其次重视脾胃。其余则是血虚者养之，血热者凉之，血瘀者通之，气滞者疏之，气弱者补之。对于不治之症，直言告知。诚然是一代良工，女科的明鉴。学人应当奉为典型。如果能参考《内经》、《仲景》及诸贤医案论述，自然学业日进，登峰造极矣。（秦天一评）
徐评：妇人的疾病，除了经带之外，与男子同治。而经带的疾病，全属于冲任二脉。治疗冲任的方法，全在于养血。所以古人立方无不以血药为主。医案中大部分也是以养血为先，但未能说到变化的关键。大概是没有得到女科专门传授的缘故。
A certain patient presented with a weak and powerless pulse, fever with sweating, chronic cough leading to coldness of the body, and food intake reduced by more than half. This is evidently an internal damage resulting in *Lao* (consumptive disease). It is strictly contraindicated to use cold and cooling herbs to clear heat and treat the cough. For now, employ the *Jianzhong* method (a method to strengthen the Middle Jiao and harmonize the Spleen and Stomach). Hope that the patient can increase food intake and have menstruation resume, so that regulation and care are still possible.
Guizhi (Cinnamon Twig) (5 fen), Sheng Baishao (Raw White Peony Root) (1.5 qian), Zhi Cao (Honey-fried Licorice Root) (5 fen), Zaorou (Date Flesh) (3 qian), Yitang (Maltose) (2 qian), Guishen (Radix Angelicae Sinensis, root portion) (1.5 qian).
Cheng (19 years old): Suffering from *Ganxue Lao* (Dry Blood Consumptive Disease), where all vessels are withered and dry, gradually progressing to a critical state. The pulse was diagnosed once in March, and I dismissed the case face-to-face. I am not a confused quack; I will not follow routine practices and cause harm.
Yimu Wan (Motherwort Pill) taken morning and evening, 2-3 qian each time.
A certain patient: Deficiency of Ying (Nutritive) blood causing alternating chills and fever, hemoptysis (coughing up blood), and amenorrhea.
Danggui (Radix Angelicae Sinensis), Chao Baishao (Stir-fried White Peony Root), Danshen (Radix Salviae Miltiorrhizae), Zaoren (Semen Ziziphi Spinosae), Yuanzhi (Radix Polygalae), Fuling (Poria), Zhi Cao (Honey-fried Licorice Root), Guangpi (Exocarpium Citri Reticulatae), Guiyuanrou (Arillus Longan).
Gu (31 years old): Tidal fever with menstrual obstruction, pulse is wiry and rapid. The Ying blood is steamed by alternating cold and heat, cutting off the mechanism of circulation. This becomes *Ganxue Lao Zhai* (severe consumptive disease due to dry blood), which is no minor ailment.
Guizhi (Cinnamon Twig) (3 fen), Baishao (White Peony Root) (1.5 qian), Ejiao (Donkey-hide Gelatin) (1.5 qian), Shengdi (Rehmannia Root) (3 qian), Zhi Cao (Honey-fried Licorice Root) (4 fen), Maidong (Ophiopogon Tuber) (1.5 qian), Dama Ren (Hemp Seed) (1 qian).
Zhu (Female): In her youth, Tian Gui (menstrual essence) has not yet arrived. Spring Yang rises and moves, causing alternating chills/fever and epistaxis (nosebleed). Usually suffers from lower back pain after urination. Her hearing and vision are very sharp. However, her congenital constitution is thin; Yin essence is inherently difficult to fill and easily depleted. There is much concern about *Dao Jing* (retrograde menstruation).
Male Wugujì (Black-bone Chicken), Shengdi (Rehmannia Root), Sheng Baishao (Raw White Peony Root), Fushen (Poria with Hostwood), Tiandong (Asparagus Tuber), Zhimu (Anemarrhenae Rhizoma), Niuxi (Achyranthes Root), Chongweizi (Leonurus Fruit), Nvzhenzi (Ligustrum Lucidum Fruit), Ejiao (Donkey-hide Gelatin).
All herbs except Ejiao are decocted twice in water. The chicken is cleaned of feathers, wings, and feet. Separately, boil one bowl of Tongbian (child's urine), four bowls of Qinghao juice (Artemisia Annua Juice), two bowls of Chunjiu (pure wine), and one bowl of Mi Cu (rice vinegar). Simmer together. Then add the previous herbal decoction to reduce into a paste. Finally, incorporate Ejiao. Warm and stew before taking 5 qian.
Zhang: Seventeen years old, Tian Gui has not arrived. Coughing and blood loss constitute a severe case of *Dao Jing* (retrograde menstruation). First, use methods to smooth Qi and guide blood downward.
Xiangmo (Powder of Aquilaria Wood), Yujin (Rhizoma Curcumae), Gouteng (Uncaria Ramulus cum Uncis), Danpi (Moutan Cortex), Suzi (Pericarpium Vaccariae), Chao Shanzha (Stir-fried Hawthorn Fruit), Hei Shanzhi (Charred Gardenia Fruit).
Second visit: Disturbance of Qi rushing upward, choking cough and blood loss.
Jizihuang (Egg Yolk), Ejiao (Donkey-hide Gelatin), Xian Shengdi (Fresh Rehmannia Root), Tiandong (Asparagus Tuber), Sheng Baishao (Raw White Peony Root), Chao Banxi (Stir-fried Banxia - *Note: Text likely refers to a specific preparation*).
Third visit: Pulse is fine and rapid, abdominal pain, Heat in Ying level, menstruation blocked.
Renshen (Ginseng Radix), Tiandong (Asparagus Tuber), Xian Shengdi (Fresh Rehmannia Root), Baishao (White Peony Root), Danshen (Salvia Root).
Mix in 3 fen of Hupo Mo (Amber Powder).
The *I Ching* states: The Dao of Qian creates males, the Dao of Kun creates females. Females belong to Yin and prioritize Blood. Therefore, gynecological treatment first emphasizes regulating menstruation. "Jing" means constancy. Like tides having their time, like the moon waxing and waning, without missing its period, it is called Jing Shui (Menstrual Water). Also called Yue Shi (Monthly Affairs) or Yue Xin (Monthly Trust). The *Neijing* says: When the Chong Mai (Penetrating Vessel) is abundant, monthly affairs descend on time. Jingyue said: The Chong Mai is the Sea of the Five Zang and Six Fu organs; the blood of these organs all converges to the Chong Mai. Thus, the Chong Mai is the root of menstruation. However, the transformation of Blood and Qi originates from Grain and Water (diet). Abundant grain and water lead to abundant Blood and Qi; deficient grain and water lead to deficient Blood and Qi. Thus, the Sea of Grain and Water lies in the Yangming (Stomach). It is seen that the blood of the Chong Mai is entirely transformed from Yangming grain and water. And the Stomach Qi of Yangming is the root of the Chong Mai. Therefore, the root of menstruation lies in the Chong Mai, relies on Stomach Qi, and ultimately on the source of transformation in the Heart and Spleen. The Heart governs Blood, the Spleen controls Blood, the Liver stores Blood. Any injury to the Heart, Spleen, or Liver can cause diseases of the meridians. The *Neijing* says: Diseases of the Two Yang (Yangming) originate in the Heart and Spleen. If there is inability to express hidden desires, females will not menstruate. If this transmits to become Feng Xiao (Wind Emaciation), or transmits to become Xi Ben (Gasping Accumulation), it is a death case, untreatable. "Bude Yinqu" refers to unfulfilled sexual desire, causing disease in the Heart and Spleen. Feng Xiao refers to fever and emaciation, as the Stomach governs muscles. Xi Ben refers to gasping rising upward, as Stomach Qi rebels upward. Although it says disease originates in Heart and Spleen, it actually emphasizes Stomach Qi, because the Heart is the Mother of the Stomach, and the Stomach is the Interior-Exterior partner of the Spleen. The *Neijing* also says: One who suffers from fullness and distension in the chest and hypochondrium, obstructing food intake, and upon onset, first smells fishy and foul odors, secretes clear fluids, spits blood first, has cold limbs, dizziness, and frequent bleeding from front and back passages. The disease is named Xue Ku (Blood Dryness). This results from massive blood loss in youth, or intercourse while drunk, leading to exhaustion of Qi and injury to the Liver, thus causing menstrual scarcity or cessation. Treat with Si Wuie Gu Yi Ru (Four parts Cuttlebone, One part Rubia/Radix Rubiae). Combine the two substances, form pills using Quelian (Quail Egg), size of small beans. Take five pills after meals, drink Bao Yu Zhi (Cuttlefish/Bay Fish Broth) to benefit the intestines and heal liver injury. This passage emphasizes "Qi Exhaustion and Liver Injury" as the core principle. Chest and hypochondrium are the Liver region; fullness/distension indicates Liver disease; obstructing food indicates Wood evil invading Earth; smelling fishy/foul at onset indicates Spleen Earth being oppressed by Wood evil, revealing Liver excess qi; secreting clear fluids indicates Spleen deficiency failing to transform fluids; spitting blood indicates Spleen injury failing to control circulating blood; cold limbs indicate Yang deficiency failing to reach extremities; dizziness indicates insufficient Yang allowing Water to overflow into meridians; bleeding from front/back indicates Yin injury causing blood to overflow into collaterals. Xue Ku implies dry blood inside, blood not returning to vessels, knotting in the Bao Men (uterus). This is indeed caused by lack of restraint in youth, exhausting Qi and injuring the Liver, leading to menstrual scarcity or absence. Treatment uses four parts Wuie Gu (Cuttlebone), salty taste entering Kidney, warm nature reaching Liver; paired with one part Ru (Rubia), pungent to disperse internal wind, warm to remove bad blood. Combined, they break old blood and generate new. Pills with Quelian egg for warming, tonifying Yang, and regulating uterine essence/blood. Taking five pills after meals ensures slow descent to Lower Jiao, focusing power. Drinking Bao Yu Zhi clears intestinal filth and harmonizes liver injury; its foul odor assists Cuttlebone in dispelling accumulated blood. The *Jingui Yaolue* details menstrual regulation extensively. Later sages like Wang Jiezhai and Xue Lizhai discussed symptoms thoroughly and prescribed formulas precisely, serving as models. I will not elaborate further. Observing Mr. Ye's cases, the Eight Extraordinary Vessels are crucial, but secondarily, regulating the Liver is most important. Because females take the Liver as their先天 (Constitutional Foundation); Yin nature tends to congeal and easily stagnate; stagnation leads to Qi blockage and Blood stasis; Liver disease inevitably harms Spleen/Stomach. Thus, secondary emphasis is on Spleen/Stomach. Others include: nourishing Blood deficiency, cooling Blood heat, unblocking Blood stasis, dispersing Qi stagnation, tonifying Qi weakness. For untreatable cases, he stated it directly. Truly a master of his generation, a clear mirror for gynecology. Students should regard this as a model. By referencing the *Neijing*, Zhang Zhongjing, and other sages' cases, one's learning will advance daily to the pinnacle. (Commentary by Qin Tianyi)
Xu's Commentary: Women's diseases, aside from menstrual and leukorrheal disorders, are treated similarly to men's. But menstrual and leukorrheal diseases belong entirely to the Chong and Ren vessels. Treating Chong and Ren relies entirely on nourishing Blood. Hence, ancient prescriptions always prioritized Blood-tonifying herbs. Most of this case analysis also prioritizes nourishing Blood, but fails to address the key variations. This is likely due to lacking specialized training in gynecology.