岐伯曰女子七岁肾气盛齿更发长二七而天癸至任脉通大冲脉盛月事以时下天谓天真之气
降癸谓癸水名故云天癸也然冲为血海任主胞胎肾气全盛二脉流通经血渐盈应时而下所谓之月
事者平和之气常以三旬一见以象月盈则亏也若遇经脉行时最宜谨于调理将理失宜似产后一般
受病轻为宿疾重则死矣盖被惊则血气错乱经脉渐然不行运于身则为血分痨瘵等病者其时劳力
则生虚热变为疼痛之根若恚怒则气逆气逆则血逆逆于腰腿则作痛肿过期即安也且如崩漏不止
之症先因心火亢盛于是血脉泛溢以致肝实而不纳血出纳之道遂废经曰子能令母实是以肝肾之
相火挟心火之势亦从而相扇所以月事错经妄行而泛滥也若不早治渐成带下白浊白淫血枯发热
劳极之症也大抵经闭不行与夫经漏不止皆由心事不足以致月经不调久而不愈变症百出不可言
者所谓犯之微若秋毫感病重如山岳可不畏哉
劳伤气血 风冷气袭 七情 六淫 房劳
夫经者候也谓候其一身之阴阳愆伏知其安危故其来必以月太过不及皆谓之不调过于阳则
前期而来过于阴则后期而至其有乍多乍少断绝不行崩漏不止亦有阴阳盛衰寒热为邪耳巢氏云
妇女月水不调者由劳伤气血以致体虚若风冷之气克于胞内伤于冲任之脉损于太阳少阴之经冲
任之脉皆起于胞内为经络之海手太阳小肠之经手少阴心之经也此二经为表里主上为乳汁下为
月水然则月水是经脉之余若冷热调和则冲任之脉盛太阳少阴所生之血宣流根据时而下若寒温乖
适经脉则虚或有风冷之气乘之邪传之血或寒或热寒则血结温则血消故月水乍多乍少故谓之不
调也
若夫经脉不调之病盖因堕胎及产后伤血或因脾胃不和饮食少进不能生血或七情伤心气停
结故经脉不调也
余按血为气配因气而行成块者气之凝将行而痛者气之滞行后作痛者气血俱虚色淡者亦虚
错经妄行者气之乱紫者气之热黑者热之甚今人悉为风冷多误盖前之病气行则血行气止则血止
王节斋曰妇人女子经脉不行多由脾胃损伤而致者不可便认作经闭血死轻用通经破血之药遇有
此症便须审其脾如何若因饮食劳倦损伤脾胃少食恶食泄泻疼痛或因误服汗下致克药伤其中气
以致血少而不行者只宜补养脾胃盖旺则能生血而经自行矣又有饮食积滞致伤脾胃者亦宜消积
补胃若脾胃无病果有血块凝结方宜行血通经
岐伯说：女子到了七岁，肾气开始充盛，牙齿更换，头发生长。到了十四岁（二七），天癸（指促进生殖功能成熟的精微物质）到来，任脉通畅，太冲脉旺盛，月经按时来潮。所谓“天”，是指天真之气；“癸”是指癸水之名，所以称为天癸。然而，冲脉为血海，任脉主司胞胎，当肾气完全充盛，这两条经脉流通顺畅，经血逐渐充盈，应时而下。所谓的“月事”，是平和之气，通常每三十天左右来一次，以象征月亮满则亏的道理。如果在月经行期间，最应当谨慎调理，如果调护失宜，就像产后一样容易受病，轻的会留下宿疾，重的会导致死亡。因为此时若受到惊吓，会导致气血错乱，经脉逐渐不通畅，运行于身体就会形成血分痨瘵等疾病；此时若过度劳累，则产生虚热，变为疼痛的病根；如果发怒，则气机逆乱，气逆则血逆，逆于腰腿部位就会发生疼痛肿胀，过了经期就会缓解。况且像崩漏不止的症状，起初是因为心火亢盛，导致血脉泛溢，致使肝脏实证而不能收纳血液，出纳的功能于是废弛。《内经》说：“子能令母实”，因此肝肾的相火挟带心火的气势，也从而相互扇动，所以月经错乱、妄行而泛滥。如果不尽早治疗，逐渐会发展成带下、白浊、白淫、血枯、发热、劳极等症状。大抵而言，经闭不行与经漏不止，都是因为心事不足（情志内伤）导致月经不调，久治不愈，变症百出，不可胜言。所谓触犯它轻微如秋毫之末，但感病后严重如山岳，怎么可以不畏惧呢？
劳伤气血，风冷气侵袭，七情（喜、怒、忧、思、悲、恐、惊），六淫（风、寒、暑、湿、燥、火）。
所谓“经”，是候察的意思，用来候察一身阴阳的盈亏潜伏，从而知道身体的安危状况。所以月经的到来必然以月为周期，太过或不及都称为不调。过于阳则提前来潮，过于阴则推后而至。有的月经量忽多忽少，断绝不行，或者崩漏不止，这也是由于阴阳盛衰、寒热邪气干扰所致。巢元方说：妇女月经不调，是由于劳伤气血导致体质虚弱，如果风冷之气侵犯胞宫内部，损伤冲任二脉，损害太阳经和少阴经。冲脉和任脉都起于胞宫内部，是经络之海；手太阳小肠经和手少阴心经，这两条经脉互为表里，主管上部化为乳汁，下部化为月经。既然这样，月经就是经脉的余血。如果冷热调和，那么冲任二脉旺盛，太阳经和少阴经所化生的血液宣通流畅，按时而下。如果寒温失调，经脉虚弱，或者有风冷之气乘虚而入，邪气传入血中，或者寒或者热，寒则血液凝结，温则血液消散，所以月经忽多忽少，这就叫做不调。
至于经脉不调的疾病，大概是因为堕胎及产后伤血，或者因为脾胃不和、饮食减少不能生血，或者因为七情伤心、气机停结，从而导致经脉不调。
我按察认为：血由气配随气而行，形成块状的是气的凝滞；将要行经时疼痛的是气的阻滞；行经后作痛的是气血俱虚；颜色淡的也是虚证；月经错乱妄行的是气的紊乱；颜色紫的是气有热；颜色黑的是热甚。现在的人全都认为是风冷，大多误诊。前面的病症，气行则血行，气止则血止。王节斋说：妇人女子经脉不行，多由脾胃损伤导致，不可以就认定为经闭血死，轻易使用通经破血的药物。遇到这种症状，必须审察其脾脏的情况。如果是因饮食劳倦损伤脾胃，导致少食、恶食、泄泻、疼痛，或者因为误服汗下法导致克伐药物损伤中气，以致血少而不行，只适宜补养脾胃。盖脾胃旺盛就能生血，而月经自然通行。又有因饮食积滞导致损伤脾胃的，也应当消积补胃。如果脾胃没有疾病，确实有血块凝结，方才适宜行血通经。
Qibo said: When a woman reaches the age of seven, her kidney qi (Kidney Qi) becomes abundant, her teeth change, and her hair grows. At the age of fourteen (two times seven), Tian Gui (subtle substances promoting reproductive maturity) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) becomes vigorous, causing menstruation to occur on time. "Tian" refers to Heavenly True Qi; "Gui" refers to the name of Gui Water, hence it is called Tian Gui. However, the Chong Mai is the Sea of Blood, and the Ren Mai governs the fetus and uterus. When Kidney Qi is fully abundant and these two vessels flow smoothly, menstrual blood gradually fills up and flows down at the appropriate time. The so-called "Yue Shi" (Menstruation) is the Qi of peace and harmony, usually occurring once every thirty days, symbolizing the principle that when the moon is full, it begins to wane. During the menstrual period, one must be most cautious in regulation and care. If management is improper, illness may be contracted as if after childbirth; mild cases result in chronic diseases, while severe cases lead to death. For instance, if startled during this time, Qi and Blood become disordered, and the meridians gradually cease to flow, leading to conditions such as Blood-type Consumption Disease (Xue Fen Lao Zhai) throughout the body. If laboring excessively at this time, deficiency heat arises, becoming the root of pain. If angered, Qi rebels; when Qi rebels, Blood rebels. Rebellion in the waist and legs causes pain and swelling, which resolves after the menstrual period ends. Furthermore, regarding symptoms like metrorrhagia and metrostaxis (Beng Lou) that do not stop, they initially arise from Hyperactive Heart Fire (Xin Huo Kang Sheng), causing blood vessels to overflow, resulting in Liver Excess where the Liver fails to store blood, rendering the mechanisms of excretion and reception useless. The Classic states: "The child can make the mother excessive." Therefore, the Ministerial Fire (Xiang Huo) of the Liver and Kidneys, carrying the momentum of Heart Fire, fans each other, causing menstrual irregularities, erratic flow, and flooding. If not treated early, this gradually develops into leukorrhea (Dai Xia), white turbidity (Bai Zhuo), white vaginal discharge (Bai Yin), Blood Depletion (Xue Ku), fever, and extreme exhaustion (Lao Ji). Generally speaking, amenorrhea and persistent metrorrhagia are both caused by emotional insufficiency leading to menstrual irregularity. If left untreated for a long time, myriad complications arise, which cannot be fully described. To touch upon it lightly is like an autumn hair, but contracting the disease is heavy as a mountain; how can one not fear it?
Labor injuring Qi and Blood, invasion of Wind-Cold Qi, Seven Emotions (Qi Qing), Six Evils (Liu Yin).
The term "Jing" (Menstrual Period) means to observe or wait, used to observe the盈虚 (fullness and emptiness) of Yin and Yang in the entire body to know safety and danger. Thus, its arrival must follow the monthly cycle. Both excess and deficiency are termed irregular. Excess of Yang leads to early arrival; excess of Yin leads to late arrival. There are cases of fluctuating volume, cessation of flow, metrorrhagia, and metrostaxis, which are also due to the rise and fall of Yin and Yang and the pathogenic factors of Cold and Heat. Chao Yuanfang stated: Women's menstrual irregularity is caused by labor injuring Qi and Blood, leading to physical weakness. If Wind-Cold Qi attacks the interior of the uterus, damaging the Chong and Ren vessels and harming the Taiyang and Shaoyin meridians, it causes issues. The Chong and Ren vessels all originate from the interior of the uterus and are the Sea of Meridians. The Hand Taiyang Small Intestine Meridian and the Hand Shaoyin Heart Meridian are exterior-interior pairs, governing the transformation of milk upwards and menstruation downwards. Since menstruation is the surplus blood of the meridians, if Cold and Heat are harmonious, the Chong and Ren vessels are vigorous, and the blood generated by the Taiyang and Shaoyin meridians flows freely and descends on time. If Cold and Warmth are mismatched, the meridians become deficient, and if Wind-Cold Qi takes advantage, evil transmits into the blood. If Cold, blood coagulates; if Warm, blood dissipates. Thus, menstrual volume fluctuates, which is termed irregular.
As for diseases of menstrual irregularity, they are generally caused by blood injury from abortion or postpartum, or by Spleen-Stomach disharmony with reduced food intake failing to generate blood, or by Seven Emotions injuring the Heart Qi, causing stagnation, thus leading to menstrual irregularity.
I have observed: Blood is paired with Qi and moves with Qi. Formation of masses indicates Qi stagnation; pain before menstruation indicates Qi stasis; pain after menstruation indicates deficiency of both Qi and Blood; pale color indicates deficiency; erratic menstrual flow indicates Qi disorder; purple color indicates Heat in Qi; black color indicates severe Heat. Nowadays, people attribute everything to Wind-Cold, often making mistakes. In the aforementioned conditions, when Qi moves, Blood moves; when Qi stops, Blood stops. Wang Jiezhai said: Women's amenorrhea is mostly caused by Spleen-Stomach damage. One should not immediately diagnose it as amenorrhea due to dead blood and lightly use blood-invigorating and blood-breaking herbs. When encountering such symptoms, one must examine the Spleen. If the Spleen-Stomach is damaged by diet and fatigue, leading to poor appetite, aversion to food, diarrhea, and pain, or if mistaken use of sweating and purging methods damages Middle Qi with harsh drugs, causing insufficient Blood and subsequent amenorrhea, only tonifying and nourishing the Spleen-Stomach is suitable. When robust, it generates Blood, and menstruation proceeds naturally. In cases where dietary stagnation damages the Spleen-Stomach, resolving stagnation and tonifying the Stomach is also appropriate. Only if the Spleen-Stomach is healthy and there are indeed blood clots should blood-invigorating and menstruation-promoting treatments be used.