凡女人禀赋旺，则十三岁即行，禀赋怯，则逾二七，常是禀赋赢弱，素多阴虚夜热，十八九尚未至者，必因时滋补迟婚乃佳，倘阴气未全，骤合男子，多成痨怯。若女人天癸既至，逾十年无男子合则不调。未逾十年，思男子合，亦不调。未至合男，亦不调。不调则旧血不出，新血误行，或渍而入骨，或变而为肿，或虽合而难子。合多则沥枯虚人，产乳众则枯血杀人。其言经者，谓常候也。若阳太过，则先期而至，阴不及，则后时而来，其有乍多乍少，断绝不行，崩漏不行，皆由阴阳盛衰所致，阴气乘阳，则胞寒气冷，血不营运，《经》所谓天寒地冻，水凝成冰，故令乍少，而在月后。若阳气乘阴，经水沸腾，故令乍多，而在月前。当别其阴阳，谓其气血，使不相乘，以平为期也。
妇人月水不调，有因风冷乘虚客于胞中，有伤冲任之脉。盖冲任之脉起于胞中，将息顺理则血气调和，六
淫不能为害。若劳伤气血，风冷乘之，脾胃一伤，饮食渐少，荣卫日衰，肌肤黄瘦，皆由冲任劳损。故凡经行，
最宜谨慎，否则与产后成病相类。
妇人以血为海，每因忧思忿怒郁气，气行则血行，气止则血止。忧思过度，则气结而血亦结；忿怒过度，
则气逆而血亦逆。如不及期而来者，有火也，宜六味淡水，则火自平矣；不及期而来多者，本方加海螵蛸、柴
胡、白芍、五味子。如半月或十日而来，且绵延不止，此属气虚，用补中汤；如过期而来者，火衰也，为寒、
为虚、为郁、为痰，方加艾叶、香附、半夏；如迟而色淡，本方加桂，此其略也。其间亦有不及期而无火者，
有过期而有火者。凡紫黑色者，多属火旺之甚，亦有虚寒而紫黑者；若淡白则无火明矣。然更有挟痰而淡白者，
有挟湿痰带黄而混浊者，故当兼以脉之迟数，禀之强弱辨之。
经水者，阴血也，阴必从阳，故其色红，上应于月，月满则亏，月亏则盈，其行有常，故名月经，为气之
配，随气而行，气热则热，气寒则寒，气滞则滞。成块者，气之凝也；将行而痛者，
气之滞也；行后作痛者，气血虚也；错经妄行者，气之乱也；色淡者，虚而有水混之也；紫者，气之热也；黑
者，热甚也。今人一见紫黑成块作痛，率指为风冷乘之，用温热之剂，祸不旋踵。经曰∶亢则害，承乃制。热
甚则兼水化，所以热则紫，甚则黑也。《玉机》曰∶寒则凝而不行。既行而紫黑，故知非寒也。且妇人性多忿
郁，嗜欲倍加，脏腑厥阳之火，无日不有，非热而何，当以脉辨之而自见矣。
凡寒冷外邪初感，入经必痛，久则郁而为热。且血寒则凝，既行而虽紫黑，乃非寒也。如伤寒而为病热也明矣。
有经行前脐腹绞痛如刺，寒热交作，下如黑豆汁，两尺沉涩，余皆弦急，此由下焦寒湿之邪，搏于冲任，
痛极则热，热则流通，因寒湿生浊，故下如豆汁也。宜治下焦，以辛散苦寒、血药治之。亦有血虚血涩者，以
养血药佐以顺气。
经行体痛者，盖气血盛，阴阳和则形体通畅，若外亏卫气之充养，内乏荣血之灌溉，故经行身痛也。或曰
血海有余者，时至而溢。血海不足，有时至而周身之血亦伤，故欲行而身体先痛也。至于经行后腹痛，尤属气
血俱虚，宜八珍汤；然亦有虚中有热者，宜逍遥散；亦有气滞而经行未尽者，宜四物加木香。
有经后发热倦怠，两目如帛蔽不明者，盖脾为诸阴之首，目为血脉之宗，此脾阴亏损，而五脏皆为失所不
能归明于目也，用补中汤、归脾汤专主脾胃，调补气血，目得血而自能视矣。若误以清凉明目为事，反致变生
大病。
有妇人经行必先泻二、三日，然后经下，诊其脉皆濡弱者，此脾肾两虚也。盖脾统血，经水将行，脾气营运，血海
不能渗湿固中矣。肾主禁固，月事应时而下，癸元消耗于中，而失禁固之权矣，宜以归脾加减，温补脾肾为主。若经去
过多，白带时下，日轻夜重，泄泻无时者，此阳虚下堕也，命曰脱阳，宜十全汤或补中汤主之。
妇人经闭不行者，有因脾胃久虚，形体羸弱，气血渐衰，以致经水断绝者；或因劳心过度，心火上行，不得下通府
脉，是以月事不来者；或因中消胃热，善饥渐瘦，津液不生，血海枯竭，名曰血枯经绝者；有因冷客胞门，血寒凝泣而
不下者；有因躯肥脂满，痰多占住血海地位，闭塞不行者；有因或挟寒，或挟热，而污血凝滞不行者；有因食与湿痰填
塞太阴，经闭作痛者。寒热虚实之迥然不同，总不能遁乎脉之迟数有力无力间也。
经病有月候不调者，有月候不通者，然不调不通之中有兼疼痛者，有兼发热者。不调之中，有趱前者，有退后者，
则趱前为热，退后为虚也。不通之中，有血滞者，有血枯者，则血滞宜行，血枯宜补也。疼痛之中，有常时作痛者，有
经前经后作痛者，则常时与经前作痛为血积，经后为血虚也。发热之中，有常时发热者，有经行发热者，则常时为血虚
有积，经行为血虚有热也。大抵多内因忧思忿怒，外因饮冷形寒。盖人之气血周流，忽因忧思忿怒所触，则郁结不行；
忽遇饮冷形寒，则恶露不尽，此经候不调，不通作痛，发热之所由也。调其气而行其血，开其郁而补其虚，凉其血而清
其热，气行血行，气止血止，故治血病以热药为佐，肉桂之类是也。至于大病后经闭，系属气血两虚，惟宜补脾养血，
元气充复自然经通，此不治而治也。
妇人以血为主，经行与产后一般最宜谨慎。其实若有瘀血一点未净，或被内寒湿热暑邪，或内伤生冷，或浣濯入冷；
或误食酸咸，七情郁结凝积于中，名曰血滞。或经止后用力太过，入房太甚，及服食燥热，以致火动，则邪气盛而津液
衰，名曰血枯。若经后被惊，则血气错乱妄行，逆于上则从口鼻出，逆于身则血水相搏变为水肿。恚怒则气血逆于腰腿、
心腹、背肋、手足之间重痛，经行则发，怒极伤肝则有眩晕呕血，瘰 血风疮痒等病。加之经血渗漏，遂成窍血生疮，
淋沥不断，湿热相搏为崩带。血结于内变 瘕。凡此变证百出，不过血滞与血枯而已，重则经闭不通，致成痨瘵。故犯
时微若秋毫，成患重于山岳，是以治女人诸病，必先问经也。
血枯血隔皆经闭不通之候，然枯之与隔，有如水炭。枯者竭也，血虚极矣；隔者，隔阻也，血本不虚，而或气、或
寒、或积，有所逆也。隔者，病发于暂，其症或痛或实，通之则行而愈。若枯者，其来有渐，冲任内竭，其证无形。夫
既枯矣，大宜补养阴气，未至枯竭者，气血或可渐充，如用通经峻削，枯者愈枯，毙可立待。
血滞经闭宜破者，原因饮食毒热，或暴怒凝瘀积痰，直须大黄、干漆之类推陈致新，俾旧血消而新血生也。若气旺
血枯，起于劳役忧思，自宜温和滋补。或兼有痰火湿热，尤宜清之凉之，每以肉桂为佐者。热则血行也，但不可纯用峻
药以亏阴道，惟宜补益荣卫，调和饮食，自然血气流通。苟不以根本为事，惟图峻药攻之，是求千金于乞丐矣。
有妇人生女子，年十五来诊，言十四时经水自下，今经反断，何也。缘妇人年十四时亦经水下，反以断，此为避年，
后当自下。此天一之源而来，积则一月而满，满则溢，似血而实非血也。然冲任起于胞中，男子藏精，女子系胞而为其
用者。其间又恃一点命门之火为之主宰，是以火旺则红，火衰则淡，火太旺则紫，火太衰则白，所以滋水更当养火。甚
则干涸不通者，虽曰火盛之极，亦由水虚之甚，亦不宜以苦寒之药降火，只宜大补其水，从天一之源以养之，使满，满
则自能流行而溢，万无有毒药可通之理也。
凡治病妇，当先问娠，不可仓卒。盖既有病，则娠脉不能易辨，故凡看妇人病脉，不可纯用破气行血之药，恐有娠
在疑似间也。
妇人之病，比之男子十倍难疗。十四以上阴气浮溢，百想经心，内伤五脏，月水去留前后交互，瘀血停凝中道，断
绝其中，伤堕不可具论，嗜欲过于丈夫，感病倍于男子，加以爱憎嫉妒，所以为病根深，疗之难瘥。至于尼姑寡妇独阴
无阳，悒郁而伤心脾，尤非草木易于奏功也。
有因先病而后经不调者，有经不调而后生诸病者。如先因病而后经不调，当先治病，病去则经自调。若因经不调而
后生病，当先调经，经调则病自除。
《脉经》曰∶尺脉滑，血气实，妇人经脉不利。尺脉来而断绝者，月水不利。寸关如故，尺脉绝不至者，月水不利，
当患少腹痛。肝脉沉，月水不利，主腰腹痛。
交加地黄丸
治经水不调、血块气痞、肚腹疼痛。
生 （一斤） 老生姜（一斤） 玄胡索 当归 白芍 川芎（各二两） 没药 木香（各一两） 桃仁（去皮尖）
人参（各一两五钱） 香附（半斤）
上将地黄、生姜各捣汁，以生姜汁浸地黄渣，地黄汁浸生姜渣，各以汁尽为度。次将余药为末，共作一处，日干同
为末，醋糊丸，桐子大，空心服五十丸，姜汤下。
活血散
治冲任经虚，经事不调，不拘多少前后并治。
白芍药 玄胡索 当归 川芎（各四两） 肉桂（去皮一两）
每服四钱，水煎食后热服。
四制醋附丸
治妇人女子经候不调。
香附子（去毛一斤，作四分，一分好酒浸七日，一分小便浸七日，一分盐水浸七日，一分米醋浸七日）
谷焙干为末，醋糊丸如桐子大，每服七十丸，空心食前盐酒送下，肥人根据方服，瘦人加泽兰叶、赤茯苓各二两。
按∶香附子血中元气药也，妇人假血为本，以气为用，今用香附子开郁行气，气行而血亦行矣，但气调而血枯、血
燥者用之，非徒无益也。
当归地黄丸
治妇人血气不和，月事不匀，腰腿疼痛。
当归 川芎 白芍药 熟 （各五钱） 牡丹皮 玄胡索（各二钱五分） 人参 黄 （各一钱二分半）
为末蜜丸桐子大，每服三十丸，食前米汤下。
通经丸
治妇人室女经候不通，脐腹疼痛，或成血瘕。
川椒（炒去汗） 蓬术（炒去烟） 青皮（去白） 干漆（炒去烟） 当归 干姜（炒） 大黄（炒） 桃仁（炒）
红花 桂心（各等分）
为末，将一半用米醋熬成膏，和余药，一半成剂，臼中柞之，丸桐子大、阴干，每服五十丸，醋汤温酒空心下。
通经散
治室女月水不通。
雄鼠屎一两烧存性，为末，空心温酒调下一钱神效。
血竭膏
治干血气。
锦纹大黄（酒浸晒干四两）为末，一升熬成膏，丸如鸡子大，每服一丸热酒化开，待温临卧服，大便一二行，红脉
自下，此药调经水之仙药也。
玄胡索汤
治妇人室女七情所感，血气相并，心腹疼痛，或连腰胁，甚作搐搦，一切血气经候不调。
玄胡索 赤芍药 片子姜黄 官桂（不见人） 当归（去芦） 蒲黄（各五钱） 甘草（一钱五分） 木香（不见
火） 乳香 没药（各三钱）
每服四钱，姜水煎服。如吐逆，加半夏、橘红（各五钱）
蠲痛散
治妇人血气刺痛。
荔枝核（烧存性五钱） 香附（炒一两）
为末每服二钱，淡盐汤下。
失笑散
治小肠气痛，妇人血气痛欲死者。
五灵脂 蒲黄（各等分）
为末，每服二钱，用醋一合熬药成膏，入水一盏，煎七分热服。
小柴胡汤
治妇人伤风七八日，积得寒热发作有时，经水适断，此为热
入血室，其血必结，故如疟状。
柴胡（八钱） 半夏（二钱） 人参 甘草 黄芩 生地（各三钱） 麦冬（二钱）
每服八钱，姜枣，水煎服。
治女人干血劳方
用陈麦曲（四两，火 存性）
为末，每服一两，冲黄酒下，出臭汗为验，忌面食二十一日。
凡是女性先天禀赋旺盛，月经通常在十三岁左右初潮；若禀赋虚弱，则超过十四岁（二七）才来潮。如果是体质羸弱、素来多有阴虚夜间发热的情况，到了十八九岁月经仍未来潮的，必须因时制宜进行滋补，推迟婚嫁才是上策。倘若阴气尚未充盈，就急于与男子交合，多会形成虚劳怯症。如果女性天癸（月经）已经来潮，过了十年没有与男子交合，月经就会不调；未满十年，虽有思慕男子交合之意，月经也会不调；即使未到交合之年，月经也会不调。月经不调会导致旧血排不出，新血妄行，或者渗入骨中，或者变为肿块，或者虽然交合也难以受孕。交合过多会导致精血枯竭，使身体虚弱；生育哺乳众多则会耗竭血液，危及生命。所谓“经”，是指正常的生理规律。如果阳气过盛，月经就会提前到来；阴气不足，月经就会推后到来。那些月经量忽多忽少、断绝不行、崩漏不止的情况，都是由阴阳盛衰引起的。阴气乘袭阳气，则胞宫寒冷，血液运行不畅，《黄帝内经》所说的“天寒地冻，水凝成冰”，所以导致月经量少且周期推后。如果阳气乘袭阴气，经血沸腾，所以导致月经量多且周期提前。应当辨别其阴阳，调和气血，使二者不相乘克，以平衡为准则。
妇人月经不调，有的因为风冷之邪乘虚侵入胞宫，损伤了冲脉和任脉。冲脉和任脉都起于胞宫，如果调养得当，气血调和，六淫（风、寒、暑、湿、燥、火）就不能为害。如果劳倦损伤气血，风冷乘虚而入，脾胃受损，饮食逐渐减少，营卫之气日渐衰弱，肌肤黄瘦，这都是由于冲任二脉劳损所致。所以凡是在经期，最宜谨慎，否则产生的病症与产后病相似。
妇人以血为本，如同大海。常常因为忧思、愤怒等郁结之气，气行则血行，气止则血止。忧思过度，则气机结滞而血亦结滞；愤怒过度，则气机上逆而血亦上逆。如月经不到期就来潮的，是有火，宜用六味地黄汤（此处原文作六味淡水，疑为六味地黄汤或类似滋阴降火方剂之误，依语境译为滋阴降火方），火自平复；不到期而来且量多的，在本方基础上加海螵蛸、柴胡、白芍、五味子。如半个月或十天就来潮，且绵延不止，这属于气虚，用补中益气汤；如过期才来潮的，是火衰，表现为寒、虚、郁、痰，方中加艾叶、香附、半夏；如经期迟至且血色淡，本方加桂枝，这只是大略情况。其间也有不到期而无火的，有过期而有火的。凡是血色紫黑的，多属火旺至极，也有因虚寒而呈紫黑色的；如果色淡白，则显然无火。然而更有挟带痰湿而色淡白的，有挟带湿痰而色黄混浊的，所以应当兼以脉象的迟数、体质的强弱来辨别。
经水，是阴血，阴必从阳，所以颜色发红，上对应月亮，月满则亏，月缺则盈，它的运行有常规，所以叫月经，它是气的配偶，随气而行，气热则血热，气寒则血寒，气滞则血滞。结成块的，是气机凝滞；将要行经时疼痛的，是气机阻滞；行经后疼痛的，是气血虚弱；错经妄行的，是气机紊乱；色淡的，是虚且有水湿混杂；紫色的，是气热；黑色的，是热极。现在的人一见紫黑成块作痛，就一概认为是风冷侵袭，使用温热药剂，灾祸立刻降临。《内经》说：亢盛则为害，有所制约才能正常。热极则兼有水化，所以热则色紫，极热则色黑。《玉机真藏论》说：寒则凝滞不行。既然已经行经且色紫黑，所以知道不是寒证。况且妇女性情多忿怒忧郁，嗜欲加倍，脏腑厥阳之火，无日不有，难道不是热证吗？应当通过脉象来辨别，自然清楚。
凡是寒冷外邪刚感，进入经脉必然疼痛，久了则郁结化为热。而且血寒则凝，既然行经且色紫黑，乃非寒证。如伤寒病转化为热病一样明显。有的经前脐腹绞痛如针刺，寒热交替发作，下血如黑豆汁，两尺脉沉涩，其余脉弦急，这是由下焦寒湿之邪，搏结于冲任二脉，痛极生热，热则流通，因寒湿生浊，所以下血如豆汁。应当治疗下焦，用辛散苦寒及活血药治疗。也有血虚血涩的，用养血药佐以顺气药。
经行期间身体疼痛，是因为气血旺盛，阴阳调和则形体通畅，如果外亏卫气的充养，内乏荣血的灌溉，所以经行身痛。有人说：血海有余的，时至而溢出。血海不足的，有时虽至但周身之血也受伤，所以欲行经而身体先痛。至于经行后腹痛，更属于气血俱虚，宜用八珍汤；然而也有虚中有热的，宜用逍遥散；也有气滞而经行未尽的，宜用四物汤加木香。
有的妇人经后发热倦怠，两眼如被布遮蔽不明亮，这是因为脾为诸阴之首，目为血脉之宗，这是脾阴亏损，五脏失其所养，不能明视于目，用补中益气汤、归脾汤专门调理脾胃，调补气血，目得血滋养自然能视物。如果误以为清凉明目之事，反而导致大病发生。
有的妇人经行前先腹泻二三天，然后经血下行，诊其脉皆濡弱，这是脾肾两虚。脾统血，经水将行，脾气营运，血海不能渗湿固中。肾主封藏，月事应时而下，癸水元精消耗于中，而失去封藏之权，宜用归脾汤加减，以温补脾肾为主。如果经去过多，白带时下，日轻夜重，泄泻无时的，这是阳虚下陷，名叫脱阳，宜用十全大补汤或补中益气汤主治。
妇人经闭不行的，有的因为脾胃久虚，形体羸弱，气血渐衰，以致经水断绝；有的因为劳心过度，心火上行，不得下通腑脉，所以月事不来；有的因为中消胃热，善饥渐瘦，津液不生，血海枯竭，名叫血枯经绝；有的因为冷邪客于胞门，血寒凝泣而不下来；有的因为身躯肥胖脂满，痰多占据血海地位，闭塞不行；有的因为或挟寒，或挟热，而污血凝滞不行；有的因为食积与湿痰填塞太阴，经闭作痛。寒热虚实截然不同，总不能逃脱在脉象的迟数有力无力之间。
经病有月候不调的，有月候不通的，然而在不调不通之中，有兼疼痛的，有兼发热的。不调之中，有提前的，有推后的，则提前的为热，推后的为虚。不通之中，有血滞的，有血枯的，则血滞宜行血，血枯宜补血。疼痛之中，有常时作痛的，有经前经后作痛的，则常时与经前作痛为血积，经后作痛为血虚。发热之中，有常时发热的，有经行发热的，则常时为血虚有积，经行为血虚有热。大抵多是内因忧思愤怒，外因饮冷形寒。人的气血周流，忽然因忧思愤怒触动，则郁结不行；忽然遇饮冷形寒，则恶露不尽，这就是经候不调、不通作痛、发热的原因。调其气而行其血，开其郁而补其虚，凉其血而清其热，气行血行，气止血止，所以治血病以热药为佐，肉桂之类就是。至于大病后经闭，属于气血两虚，只宜补脾养血，元气充复自然经通，这是不治而治的方法。
妇人以血为主，经行与产后一般最宜谨慎。其实如果有瘀血一点未净，或被内寒湿热暑邪侵袭，或内伤生冷，或浣濯入冷水；或误食酸咸，七情郁结凝积于中，名叫血滞。或经止后用力太过，房事太甚，及服食燥热，以致火动，则邪气盛而津液衰，名叫血枯。若经后被惊吓，则血气错乱妄行，逆于上则从口鼻出，逆于身则血水相搏变为水肿。恚怒则气血逆于腰腿、心腹、背肋、手足之间重痛，经行则发，怒极伤肝则有眩晕呕血、瘰疬、血风疮痒等疾病。加之经血渗漏，遂成窍血生疮，淋沥不断，湿热相搏为崩带。血结于内变瘕。凡此变证百出，不过是血滞与血枯而已，重则经闭不通，致成痨瘵。所以犯病时微小如秋毫，成患重于山岳，因此治疗女人诸病，必先问经。
血枯血隔都是经闭不通的证候，然而枯与隔，有如水火不同。枯者竭也，血虚极了；隔者，隔阻也，血本不虚，而是或气、或寒、或积，有所逆阻。隔者，病发于暂时，其症或痛或实，通之则行而愈。若枯者，其来有渐进，冲任内竭，其证无形。既然已枯，大宜补养阴气，未至枯竭者，气血或可渐充，如用通经峻削之药，枯者愈枯，死亡立待。
血滞经闭宜破瘀的，原因因饮食毒热，或暴怒凝瘀积痰，直须大黄、干漆之类推陈致新，使旧血消而新血生。若气旺血枯，起于劳役忧思，自宜温和滋补。或兼有痰火湿热，尤宜清之凉之，每以肉桂为佐，因为热则血行。但不可纯用峻药以亏阴道，只宜补益荣卫，调和饮食，自然血气流通。如果不以根本为事，只图用峻药攻之，是向乞丐求千金啊。
有妇人生女，年十五来诊，说十四岁时经水自下，如今经反断，为什么。原来妇人年十四时亦经水下，反以断，此为避年，后来当自行来潮。这是天一之源而来，积则一月而满，满则溢，似血而实非血也。然冲任起于胞中，男子藏精，女子系胞而为其用者。其间又恃一点命门之火为之主宰，是以火旺则红，火衰则淡，火太旺则紫，火太衰则白，所以滋水更当养火。甚则干涸不通者，虽曰火盛之极，亦由水虚之甚，也不宜以苦寒之药降火，只宜大补其水，从天一之源以养之，使满，满则自能流行而溢，万无有毒药可通之理也。
凡诊治妇人，应当先问是否怀孕，不可仓促。盖既有病，则娠脉不能易辨，故凡看妇人病脉，不可纯用破气行血之药，恐有娠在疑似间也。
妇人之病，比之男子十倍难疗。十四以上阴气浮溢，百想经心，内伤五脏，月水去留前后交互，瘀血停凝中道，断绝其中，伤堕不可具论，嗜欲过于丈夫，感病倍于男子，加以爱憎嫉妒，所以为病根深，疗之难瘥。至于尼姑寡妇独阴无阳，悒郁而伤心脾，尤非草木易于奏功也。
有因先病而后经不调者，有经不调而后生诸病者。如先因病而后经不调，当先治病，病去则经自调。若因经不调而后生病，当先调经，经调则病自除。
《脉经》说：尺脉滑，血气实，妇人经脉不利。尺脉来而断绝者，月水不利。寸关如故，尺脉绝不至者，月水不利，当患少腹痛。肝脉沉，月水不利，主腰腹痛。
交加地黄丸
治疗经水不调、血块气痞、肚腹疼痛。
生地黄（一斤） 老生姜（一斤） 玄胡索 当归 白芍 川芎（各二两） 没药 木香（各一两） 桃仁（去皮尖） 人参（各一两五钱） 香附（半斤）
上将地黄、生姜各捣汁，以生姜汁浸地黄渣，地黄汁浸生姜渣，各以汁尽为度。次将余药为末，共作一处，日晒干同为末，醋糊丸，桐子大，空心服五十丸，姜汤送下。
活血散
治疗冲任经虚，经事不调，不拘多少前后并治。
白芍药 玄胡索 当归 川芎（各四两） 肉桂（去皮一两）
每服四钱，水煎食后热服。
四制醋附丸
治疗妇人女子经候不调。
香附子（去毛一斤，分四分，一分好酒浸七日，一分小便浸七日，一分盐水浸七日，一分米醋浸七日）
谷焙干为末，醋糊丸如桐子大，每服七十丸，空心食前盐酒送下，肥人根据方服，瘦人加泽兰叶、赤茯苓各二两。
按：香附子是血中元气药也，妇人假血为本，以气为用，今用香附子开郁行气，气行而血亦行矣，但气调而血枯、血燥者用之，非徒无益也。
当归地黄丸
治疗妇人血气不和，月事不匀，腰腿疼痛。
当归 川芎 白芍药 熟地黄（各五钱） 牡丹皮 玄胡索（各二钱五分） 人参 黄芪（各一钱二分半）
为末蜜丸桐子大，每服三十丸，食前米汤下。
通经丸
治疗妇人室女经候不通，脐腹疼痛，或成血瘕。
川椒（炒去汗） 蓬术（炒去烟） 青皮（去白） 干漆（炒去烟） 当归 干姜（炒） 大黄（炒） 桃仁（炒） 红花 桂心（各等分）
为末，将一半用米醋熬成膏，和余药，一半成剂，臼中杵之，丸桐子大、阴干，每服五十丸，醋汤温酒空心下。
通经散
治疗室女月水不通。
雄鼠屎一两烧存性，为末，空心温酒调下一钱神效。
血竭膏
治疗干血气。
锦纹大黄（酒浸晒干四两）为末，一升熬成膏，丸如鸡子大，每服一丸热酒化开，待温临卧服，大便一二行，红脉自下，此药调经水之仙药也。
玄胡索汤
治疗妇人室女七情所感，血气相并，心腹疼痛，或连腰胁，甚作搐搦，一切血气经候不调。
玄胡索 赤芍药 片子姜黄 官桂（不见人） 当归（去芦） 蒲黄（各五钱） 甘草（一钱五分） 木香（不见火） 乳香 没药（各三钱）
每服四钱，姜水煎服。如吐逆，加半夏、橘红（各五钱）
蠲痛散
治疗妇人血气刺痛。
荔枝核（烧存性五钱） 香附（炒一两）
为末每服二钱，淡盐汤下。
失笑散
治疗小肠气痛，妇人血气痛欲死者。
五灵脂 蒲黄（各等分）
为末，每服二钱，用醋一合熬药成膏，入水一盏，煎七分热服。
小柴胡汤
治疗妇人伤风七八日，积得寒热发作有时，经水适断，此为热入血室，其血必结，故如疟状。
柴胡（八钱） 半夏（二钱） 人参 甘草 黄芩 生地（各三钱） 麦冬（二钱）
每服八钱，姜枣，水煎服。
In general, women with robust congenital endowment (Bingfu) typically experience menarche around age thirteen; those with weak endowment may not menstruate until after age fourteen (two sevens). If the constitution is frail and there is a history of yin deficiency with night fever, and menstruation has not occurred by age eighteen or nineteen, it is advisable to nourish the body according to the season and delay marriage. If intercourse occurs prematurely before the yin qi is fully developed, it often leads to consumption and weakness (Laoqie). Once menarche (Tianguui) has begun, if a woman does not have intercourse for ten years, her menses will become irregular. If she desires intercourse within ten years but does not engage in it, her menses will also be irregular. Even without desire, irregularity may occur. Irregular menses result in the retention of old blood and the erratic flow of new blood, which may penetrate into the bones or transform into masses/swellings, or even if intercourse occurs, conception may be difficult. Excessive intercourse depletes essence and blood, leading to debility; frequent childbirth and lactation exhaust blood and endanger life. "Jing" refers to the regular physiological rhythm. Excess yang causes early menstruation; insufficient yin causes delayed menstruation. Fluctuations in volume, amenorrhea, metrorrhagia, and flooding are all caused by the imbalance of yin and yang. When yin overcomes yang, the uterus becomes cold, and blood circulation is impaired. As stated in the *Classic*, "When heaven is cold and earth frozen, water congeals into ice," leading to scanty menses and delayed cycles. When yang overcomes yin, menstrual blood boils, causing heavy menses and early cycles. One must distinguish yin and yang, harmonize qi and blood, prevent mutual overcoming, and aim for balance.
Irregular menstruation in women can be caused by wind-cold invading the uterus due to deficiency, damaging the Chong and Ren meridians. These meridians originate in the uterus; if properly regulated, qi and blood harmonize, protecting against the six excesses (Liuyin). However, labor and fatigue damage qi and blood, allowing wind-cold to invade. Spleen and stomach injury leads to reduced appetite, declining Ying and Wei qi, yellow and emaciated skin, all due to Chong and Ren exhaustion. Therefore, caution is essential during menstruation, as complications resemble postpartum disorders.
Women are governed by blood, akin to a sea. Worry, thought, anger, and stagnation affect blood: when qi moves, blood moves; when qi stops, blood stops. Excessive worry causes qi stagnation and blood stasis; excessive anger causes qi rebellion and blood rebellion. Early menstruation indicates fire; use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) to calm fire. Early menstruation with heavy flow adds Haidamao (Cuttlefish Bone), Chaihu (Bupleurum Root), Baishao (White Peony Root), and Wuweizi (Schisandra Fruit). Menstruation every half month or ten days with prolonged bleeding indicates qi deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Delayed menstruation indicates deficient fire, presenting as cold, deficiency, stagnation, or phlegm; add Aiyè (Mugwort Leaf), Xiangfu (Cyperus Rhizome), and Banxia (Pinellia Tuber). Late menstruation with pale color adds Guizhi (Cinnamon Twig). This is a brief overview. Some cases lack fire despite early onset, or have fire despite late onset. Purple-black blood usually indicates extreme fire heat, though some cold-deficiency cases also present this way. Pale white blood clearly indicates no fire. However, pale white blood may also involve phlegm-dampness, and yellow turbid blood involves damp-phlegm. Differentiation requires pulse diagnosis (slow/fast) and assessment of constitutional strength.
Menstrual blood is yin blood, which follows yang, hence its red color, corresponding to the moon's phases. It is called "menstruation" because of its regular cycle and is paired with qi, moving with it. Heat in qi causes heat in blood; cold in qi causes cold in blood; stagnation in qi causes stagnation in blood. Clots indicate qi stagnation. Pain before menstruation indicates qi stagnation. Pain after menstruation indicates qi and blood deficiency. Erratic flow indicates qi disorder. Pale color indicates deficiency mixed with water-dampness. Purple indicates qi heat. Black indicates extreme heat. Modern practitioners often mistake purple-black clots and pain for wind-cold, using warming agents, which brings disaster. The *Classic* states: "Excess causes harm; control brings order." Extreme heat transforms into water-like characteristics, hence purple (heat) and black (extreme heat). The *Yuji* chapter says: "Cold causes stagnation." Since menstruation flows and is purple-black, it is not cold. Women often harbor anger and depression, and visceral Jue-yang fire is ever-present; thus, it is likely heat. Pulse differentiation clarifies this.
Initial external cold pathogens cause pain upon entering meridians; prolonged stagnation transforms into heat. Blood cold causes coagulation; if flowing and purple-black, it is not cold, similar to Shaoyang heat transformation. Some experience severe umbilical/abdominal cramping like stabbing before menstruation, alternating chills and fever, and discharge like black bean juice. Pulse at both Chi positions is deep and choppy; others are wiry and urgent. This is lower jiao cold-dampness binding the Chong and Ren meridians. Extreme pain generates heat, promoting flow, but cold-dampness creates turbidity, causing the discharge. Treat the lower jiao with acrid-dispersing and bitter-cold blood-invigorating herbs. For blood deficiency and涩 (astringency/stagnation), invigorate blood and regulate qi.
Body pain during menstruation occurs when wei qi fails to nourish externally and ying blood fails to irrigate internally, despite abundant blood and balanced yin-yang. Alternatively, if the Sea of Blood is deficient, systemic blood is injured when the time comes, causing pre-menstrual body pain. Post-menstrual abdominal pain indicates severe qi and blood deficiency; use Bazhen Tang (Eight-Treasure Decoction). Deficiency with heat uses Xiaoyao San (Free Wanderer Powder). Qi stagnation with incomplete menstruation uses Siwu Tang (Four-Substance Decoction) plus Muxiang (Aucklandia Root).
Post-menstrual fever and fatigue with blurred vision indicate Spleen yin deficiency. The Spleen is the head of yin organs; eyes depend on blood vessels. Spleen yin loss affects all organs, impairing vision. Use Buzhong Yiqi Tang and Guipi Tang (Restore the Spleen Decoction) to tonify spleen/stomach and nourish qi/blood. Eyes see when nourished by blood. Mistaking this for a need for cooling/clearing agents causes serious illness.
Pre-menstrual diarrhea for two to three days followed by menstruation, with soft/weak pulses, indicates Spleen and Kidney deficiency. Spleen controls blood; during menstruation, Spleen qi circulates, but the Sea of Blood cannot retain dampness. Kidney controls closure; menstrual flow depends on Gui Yuan (Kidney Essence). Consumption of essence leads to loss of closure. Use modified Guipi Tang to warm/tonify Spleen/Kidney. Heavy flow with leukorrhea, worse at night, and constant diarrhea indicates Yang collapse (Tuoyang); use Shiquan Dabu Tang (Ten-Increment Great Tonifying Decoction) or Buzhong Yiqi Tang.
Amenorrhea may result from long-term Spleen/Stomach deficiency, emaciation, and declining qi/blood. Overthinking causes Heart fire to rise, blocking lower meridians. Stomach heat (Middle Xiao) causes hunger, thinness, fluid depletion, and empty Sea of Blood (Xueku Amenorrhea). Cold pathogen in the uterus causes blood cold and stagnation. Obesity with phlegm obstructs the Sea of Blood. Cold/heat with stagnant blood blocks flow. Food/phlegm filling Taiyin causes amenorrhea with pain. Cold/heat/excess/deficiency differ greatly but are discernible via pulse speed and strength.
Menstrual disorders include irregularity and obstruction. Irregularity includes early (heat) and late (deficiency). Obstruction includes blood stasis (invigorate) and blood dryness (tonify). Pain includes constant/pre-menstrual (blood accumulation) and post-menstrual (blood deficiency). Fever includes constant (deficiency with accumulation) and pre-menstrual (deficiency with heat). Causes are internal emotional stress and external cold/drink. Emotional stress causes stagnation; cold/drink prevents lochia expulsion. Treatment regulates qi, invigorates blood, opens stagnation, tonifies deficiency, cools blood, and clears heat. Warm herbs like Rougui (Cinnamon Bark) assist blood movement. Post-illness amenorrhea due to qi/blood deficiency requires Spleen tonification and blood nourishment; recovery restores flow naturally ("treating without treating").
Women require caution during menstruation and postpartum. Residual blood stasis, internal cold/damp/heat, raw food injury, cold water exposure, or sour/salty foods cause Qi emotions to bind, creating "Blood Stasis." Forceful activity, excessive sex, or hot drugs cause "Blood Dryness." Shock causes chaotic blood flow: upward (epistaxis/hematemesis) or systemic (edema). Anger causes qi/blood rebellion in waist/legs/chest/back, worsening during menstruation. Severe liver injury causes dizziness, vomiting blood, scrofula, or pruritus. Leakage causes sores. Damp-heat causes flooding/leukorrhea. Internal knots form masses. All variations stem from Blood Stasis or Dryness. Severe cases lead to consumption. Thus, gynecological treatment always begins with questioning menstruation.
Blood Dryness and Blood Obstruction both cause amenorrhea but differ like water and charcoal. Dryness is extreme deficiency; Obstruction is blockage by qi/cold/accumulation without true deficiency. Obstruction is acute, painful/full, cured by unblocking. Dryness is chronic, formless, internal exhaustion. Tonify yin/qi/blood; avoid harsh purgatives that worsen dryness and cause death.
For Blood Stasis amenorrhea requiring breaking: caused by toxic heat or anger-induced phlegm/stasis. Use Dahuang (Rhubarb Root) and Ganqi (Drynaria/Lacquer Tree) to eliminate old and generate new. For Qi excess/Blood Dryness due to labor/worry, use mild tonification. With phlegm-fire/damp-heat, clear/cool, aided by Rougui to promote flow. Do not use harsh drugs to damage yin; nourish Ying/Wei and harmonize diet. Seeking quick fixes with harsh drugs is futile.
A fifteen-year-old girl presented with amenorrhea after menarche at fourteen. This is "Bi Nian" (Avoidance Year), where menstruation pauses then resumes spontaneously. Originating from Tianyi (One Water), it accumulates monthly. Chong/Ren originate in the uterus; Kidney Fire governs color: strong=red, weak=pale, very strong=purple, very weak=white. Nourishing water requires nurturing fire. Extreme dryness/blockage, even if attributed to extreme fire, stems from severe water deficiency. Do not use bitter-cold to suppress fire; strongly tonify water from its source. Fullness promotes flow; toxic unblocking agents are contraindicated.
Always ask about pregnancy before treating women. Sick pregnant women have ambiguous pulses. Avoid qi-breaking/blood-moving drugs if pregnancy is suspected.
Gynecological diseases are ten times harder to treat than male diseases. After age fourteen, floating yin, mental burdens, and internal organ injury disrupt menstruation, causing stasis and abortion risks. Women have stronger desires and greater disease susceptibility than men, compounded by jealousy, leading to deep-rooted conditions hard to cure. Nuns/widows with isolated yin suffer heart/spleen injury from depression, resistant to herbal remedies.
If illness precedes irregular menstruation, treat the illness first; menstruation will normalize. If irregular menstruation precedes illness, regulate menstruation first; illness will resolve.
The *Mai Jing* states: Slippery Chi pulse indicates full blood/qi and menstrual difficulty. Interrupted Chi pulse indicates menstrual difficulty. Normal Cun/Guan with absent Chi pulse indicates menstrual difficulty and lower abdominal pain. Deep Liver pulse indicates menstrual difficulty and lumbar/abdominal pain.
**Jiaojia Dihuang Wan (Interlaced Rehmannia Pill)**
Treats irregular menstruation, blood clumps, qi distension, and abdominal pain.
Sheng Dihuang (Raw Rehmannia Root, 1 jin), Lao Shengjiang (Old Ginger, 1 jin), Yanhusuo (Corydalis Rhizome), Danggui (Angelica Sinensis), Baishao (White Peony Root), Chuanxiong (Sichuan Lovage Rhizome) [2 liang each], Moyao (Myrrh), Muxiang (Aucklandia Root) [1 liang each], Taoren (Peach Seed, peeled/pitted), Renshen (Ginseng Root) [1.5 liang each], Xiangfu (Cyperus Rhizome, 0.5 jin).
Crush Rehmannia and Ginger separately for juice. Soak Rehmannia residue in Ginger juice, and Ginger residue in Rehmannia juice until exhausted. Powder remaining herbs. Mix, sun-dry, powder again. Make pills with vinegar paste, size of paulownia seeds. Take 50 pills fasting with Ginger decoction.
**Huoxue San (Invigorate Blood Powder)**
Treats Chong/Ren deficiency, irregular menstruation, regardless of timing.
Baishaoyao (White Peony Root), Yanhusuo, Danggui, Chuanxiong [4 liang each], Rougui (Cinnamon Bark, peeled, 1 liang).
Take 4 qian, decoct in water, take hot after meals.
**Sizhi Cu Fu Wan (Four-Processed Vinegar Cyperus Pill)**
Treats irregular menstruation in women/girls.
Xiangfuzi (Cyperus Rhizome, de-husked, 1 jin): Divide into four parts. Soak one part in good wine for 7 days, one in urine for 7 days, one in salt water for 7 days, one in rice vinegar for 7 days. Roast with grain, powder. Make pills with vinegar paste, size of paulownia seeds. Take 70 pills fasting before meals with salt/wine. Fat patients follow formula; thin patients add Zelan Ye (Eupatorium Leaf) and Chi Fuling (Red Poria) [2 liang each].
Note: Xiangfu regulates qi in blood. Women use blood as substance and qi as function. Xiangfu opens stagnation and moves qi, moving blood. However, if qi is regulated but blood is dry/deficient, it is useless.
**Danggui Dihuang Wan (Angelica Rehmannia Pill)**
Treats qi/blood disharmony, irregular menstruation, lumbar/leg pain.
Danggui, Chuanxiong, Baishaoyao, Shu Dihuang (Cooked Rehmannia Root) [5 qian each], Mudanpi (Tree Peony Bark), Yanhusuo [2.5 qian each], Renshen, Huangqi (Astragalus Root) [1.25 qian each].
Powder, honey pills, size of paulownia seeds. Take 30 pills before meals with rice soup.
**Tongjing Wan (Unblock Menses Pill)**
Treats amenorrhea in unmarried women, umbilical/abdominal pain, or blood masses.
Chuanjiao (Sichuan Pepper, stir-fried), Pengzhu (Curcuma Zedoaria, stir-fried), Qingpi (Green Tangerina Peel, de-white), Ganqi (Drynaria/Lacquer Tree, stir-fried), Danggui, Ganjiang (Dried Ginger, stir-fried), Dahuang (Rhubarb Root, stir-fried), Taoren (Peach Seed, stir-fried), Honghua (Safflower), Guixin (Cinnamon Heart) [equal parts].
Powder. Cook half with rice vinegar to paste. Mix with other half. Pound in mortar. Pills, size of paulownia seeds, shade-dry. Take 50 pills fasting with vinegar soup/warm wine.
**Tongjing San (Unblock Menses Powder)**
Treats amenorrhea in unmarried women.
Xiong Shushi (Male Rat Feces, 1 liang, burnt to retain nature), powder. Take 1 qian fasting with warm wine. Miraculous effect.
**Xuejie Gao (Dragon's Blood Ointment/Pill)**
Treats dry blood syndrome.
Jinwen Dahuang (Brocade-pattern Rhubarb, wine-soaked/dried, 4 liang), powder. Boil to 1 sheng paste. Pills size of chicken egg. Take 1 pill dissolved in hot wine, warm, before bed. Bowel movement 1-2 times, red menses will flow. This is an immortal herb for regulating menses.
**Yanhusuo Tang (Corydalis Decoction)**
Treats seven emotions affecting unmarried women, qi/blood conflict, heart/abdominal pain radiating to waist/flanks, spasms, and all qi/blood menstrual irregularities.
Yanhusuo, Chishaoyao (Red Peony Root), Pianzi Jianghuang (Turmeric Slice), Guanzi Gui (Official Cinnamon, unseen by humans), Danggui (de-rhizome), Puhuang (Pollen Typhae) [5 qian each], Gancao (Licorice Root, 1.5 qian), Muxiang (unseen by fire), Ruxiang (Frankincense), Moyao (Myrrh) [3 qian each].
Take 4 qian, decoct with Ginger water. For vomiting, add Banxia (Pinellia Tuber) and Juhong (Citrus Peel) [5 qian each].
**Juan Tong San (Eliminate Pain Powder)**
Treats stabbing qi/blood pain in women.
Lizhihe (Lychee Seed, burnt to retain nature, 5 qian), Xiangfu (stir-fried, 1 liang).
Powder. Take 2 qian with light salt soup.
**Shixiao San (Laugh-out-of-Pain Powder)**
Treats intestinal gas pain and severe qi/blood pain in women.
Wulingzhi (Trogopterus Dung), Puhuang [equal parts].
Powder. Take 2 qian. Boil with 1 he of vinegar to paste. Add 1 cup water, decoct to 0.7 cup, take hot.
**Xiao Chaihu Tang (Minor Bupleurum Decoction)**
Treats women with wind-cold for 7-8 days, intermittent chills/fever, sudden cessation of menstruation. Heat enters Blood Chamber, blood coagulates, resembling malaria.
Chaihu (8 qian), Banxia (2 qian), Renshen, Gancao, Huangqin (Scutellaria Root), Shengdi (Raw Rehmannia Root) [3 qian each], Maidong (Ophiopogon Root, 2 qian).
Take 8 qian with Ginger/Jujube, decoct in water.
**Formula for Female Dry Blood Consumption**
Use Chen Maiqu (Aged Wheat Qu, 4 liang, fire-roasted to retain nature).
Powder. Take 1 liang mixed with Yellow Wine. Sweating foul odor confirms efficacy. Avoid wheat noodles for 21 days.