14.腹痛经后气血弱, 痛在经前气血凝, 气滞腹胀血滞痛, 更审虚实
寒热情.
【注】凡经来腹痛, 在经后痛, 则为气血虚弱; 经前痛, 则为气血凝
滞.若因气滞血者, 则多胀满. 因血滞气者, 则多疼痛. 更当审其凝
滞作胀痛之故, 或因虚, 因实, 因寒, 因热而分治之也.
15.经行泄泻是脾虚, 鸭溏清痛乃寒湿, 胃弱饮伤多呕饮, 食伤必痛
吐其食.
【注】经行泄泻, 乃脾虚也. 若鸭溏冷痛, 是寒湿也. 经行呕吐, 是
胃弱也. 若呕出涎饮, 则是伤饮. 若吐出食物, 则是伤食. 然伤食者
多痛而吐食, 伤饮者, 不痛而呕饮也.
16.逆行吐血错行崩, 热伤阴阳络妄行, 血多热去当用补, 血少虽虚
须主清.
【注】妇女经血逆行上, 为吐血衄血, 及错行下为崩血者, 皆因热盛
也.伤阴络则下行为崩, 伤阳络则上行为吐衄也. 若去血过多, 则热
随血去, 当以补为主. 如血少热尚未减, 虽虚仍当以清为主也.
17.多清浅淡虚不摄, 稠粘深红热有余, 兼带时下湿热秽, 形清腥秽
冷湿虚.
【注】经水过多, 清稀浅红, 乃气虚不能摄血也. 若稠粘深红, 则为
热盛有余. 或经之前后兼赤白带, 而时下臭秽, 乃湿热腐化也. 若形
清腥秽, 乃湿瘀寒虚所化也.
14. 月经结束后腹痛，是因为气血虚弱；月经来潮前腹痛，是因为气血凝滞。气机阻滞主要导致腹胀，血行瘀滞主要导致疼痛，还需进一步辨别是寒证还是热证，以及虚实的性质。
【注】凡是经期出现腹痛，如果在经后疼痛，属于气血虚弱；如果在经前疼痛，属于气血凝滞。如果是因气滞导致血行不畅，则多表现为胀满；如果是因血滞导致气机受阻，则多表现为疼痛。更应当仔细审查导致胀痛的原因，根据是由于虚、实、寒、热中的哪一种情况，分别进行治疗。
15. 经期泄泻是由于脾虚，大便像鸭粪一样清稀且伴有冷痛的是寒湿证，胃气虚弱或饮水过多常引起呕吐，饮食损伤必然导致疼痛并吐出未消化的食物。
【注】经期发生泄泻，是脾虚所致。如果大便像鸭溏（稀薄如鸭粪）且伴有冷痛，这是寒湿证。经期呕吐，是胃气虚弱所致。如果呕吐出涎液和痰饮，则是伤于水饮。如果吐出食物，则是伤于饮食。然而，伤食的人大多伴有疼痛并吐出食物，而伤饮的人，通常不疼痛而是呕吐出涎饮。
16. 经血逆行导致吐血或错行导致崩漏，是因为热邪损伤了阴络和阳络导致血液妄行。如果失血过多，热随血去，应当以补益为主；如果血量少但热象仍未减退，虽然身体虚弱，仍应以清热为主。
【注】妇女经血不循常道而逆行向上，表现为吐血或鼻衄，或者错行向下表现为崩中出血的，都是因为热盛所致。热邪损伤阴络，则血液下行导致崩漏；热邪损伤阳络，则血液上行导致吐血或鼻衄。如果失血过多，热邪会随着血液的流失而消退，治疗应当以补益为主。如果血量少但热邪尚未减退，虽然身体处于虚弱状态，仍然应当以清热为主。
17. 经量过多且颜色清稀浅淡，是气虚不能固摄血液；经血稠粘且颜色深红，是热邪有余；兼有白带时下且气味臭秽，是湿热腐化所致；若经血形态清稀且有腥臭味，是湿瘀、寒邪与虚损共同作用的结果。
【注】经水量多，颜色清稀、浅红，是气虚不能统摄血液所致。如果经血稠粘、颜色深红，则是热盛有余。如果在月经前后兼有赤白带下，且当下排出物气味臭秽，这是湿热腐败化生所致。如果经血形态清稀且有腥臭味，这是由湿邪、瘀血、寒邪和虚损所化生的。
14. Abdominal pain occurring after menstruation indicates deficiency of Qi and Blood; abdominal pain occurring before menstruation indicates stagnation of Qi and Blood. Qi stagnation primarily causes abdominal distension, while blood stasis primarily causes pain. One must further distinguish between cold and heat patterns, as well as deficiency and excess conditions.
[Note] Whenever abdominal pain occurs during the menstrual period, pain appearing after menstruation belongs to deficiency of Qi and Blood; pain appearing before menstruation belongs to stagnation of Qi and Blood. If it is due to Qi stagnation affecting blood, there will be more distension. If it is due to blood stasis affecting Qi, there will be more pain. One must carefully examine the cause of the distension and pain, and treat according to whether it is caused by deficiency, excess, cold, or heat.
15. Diarrhea during menstruation is due to Spleen deficiency; duck-like loose stools with cold pain indicate Cold-Dampness; weak Stomach function or injury from drinking water often leads to vomiting; dietary injury inevitably causes pain and vomiting of undigested food.
[Note] Diarrhea occurring during menstruation is caused by Spleen deficiency. If the stool is like "duck diarrhea" (thin and watery) accompanied by cold pain, this is a Cold-Dampness pattern. Vomiting during menstruation is due to weak Stomach Qi. If saliva and phlegm-fluids are vomited, it indicates injury from fluids (drinking). If food is vomited, it indicates dietary injury. However, those with dietary injury mostly experience pain and vomit food, whereas those with fluid injury do not experience pain but vomit saliva and fluids.
16. Retrograde menstruation leading to hematemesis or abnormal bleeding leading to metrorrhagia is caused by heat damaging the Yin and Yang collaterals, causing blood to move recklessly. If blood loss is excessive, heat leaves with the blood, so tonification should be the primary treatment. If blood volume is low but heat signs have not subsided, although the body is deficient, clearing heat should still be the primary treatment.
[Note] When women's menstrual blood flows retrogradely upward, manifesting as hematemesis or epistaxis, or flows abnormally downward manifesting as metrorrhagia, all are due to excessive heat. Damage to the Yin collaterals causes blood to flow downward resulting in metrorrhagia; damage to the Yang collaterals causes blood to flow upward resulting in hematemesis or epistaxis. If blood loss is excessive, heat dissipates along with the blood, and treatment should focus on tonification. If blood volume is scanty but heat has not yet diminished, despite the deficiency, treatment should still focus on clearing heat.
17. Excessive menstrual flow that is clear, thin, and pale indicates Qi deficiency failing to control blood; thick, sticky, and deep red blood indicates excess heat; accompanying leukorrhea with foul odor indicates Damp-Heat putrefaction; if the form is clear with a fishy odor, it results from Dampness, Blood Stasis, Cold, and Deficiency.
[Note] Menstrual flow that is excessive, clear, thin, and pale-red is due to Qi deficiency failing to hold the blood. If the blood is thick, sticky, and deep red, it indicates excess heat. If accompanied by red and white vaginal discharge before or after menstruation, with foul-smelling discharge at the time, this is due to Damp-Heat decomposition. If the form is clear with a fishy odor, it is transformed by Dampness, Blood Stasis, Cold, and Deficiency.