《良方》云∶妇人月水不利，由于劳伤气血，体虚而风冷客于胞内，伤于冲任之脉故也
。若
寸脉弦，关脉沉(弦与沉主气病，滑为实)，是肝病也，兼主腹痛孔窍生疮。尺脉滑，关脉实
，是气滞也。并主小腹引腰痛，气攻胸膈也。
按立斋云∶前症属肝胆二经，盖肝胆相为表里，多因恚怒所伤。若本经风热用补肝散，
血虚四物汤加枣仁，肾水不足用六味丸。
《产宝方》云∶女子以血为主，七七则卦数已终，终则经水绝，冲任脉虚衰，天癸绝，
地道
不通而无子矣。或伤劳过度，喜怒不时，经脉衰微之余，又为邪气攻冲，所以当止不止而崩
漏也。须分所感而治之。
薛立斋云∶前若肝肾虚热用许学士当归散，肝血虚热四物加柴胡、山栀、丹皮，肝火内
动小
柴胡加山栀、丹皮，肝火血燥加味逍遥散，脾经郁火加味归脾汤，肝脾郁火归脾逍遥兼服，
肝肾亏损归脾、六味兼服，仍与月经不调参用。
洁古云∶女子月事不来者，先泻心火，血自下也。《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，死不治。二阳者，阳明也。阳明胃病，心脾受之
，心主血，心病则血不流。脾主味，脾病则味不化，味不化则精不足，故其病不能隐曲。脾
土已亏则风邪胜而气愈消矣。经又曰∶月事不来者，胞脉闭也。胞脉属于心，络于胞中。今
气上迫肺，心气不得下通，故月不时来。
李东垣云∶经闭不行有三。或脾胃久虚，形体羸弱，气血俱虚而致经水断绝不来。或病
中消
，胃热善食，肌瘦，津液不生。夫经者，血脉津液所化，津液既绝，为热所烁，肌肉渐瘦，
时见燥渴，血海枯竭，名曰血枯。经闭宜泻，胃土燥热，补益气血，经自行矣(此中焦脾胃
之病)。或心胞络脉洪数，时见燥热，大便闭涩，小便虽清不利，而红水闭绝不行，此乃血
海干枯，宜调血脉，除胞络中火邪，而经自行矣(此下焦胞络热结也)。或因劳心火动而赤液
竭，或因忧思气结而胞脉闭，气上迫肺，心气不得下通，故月事不来，宜先服降心火之剂，
后用养脾血之药而自来矣(此上焦心肺热结也)。
泻心火、养脾血是从本文之义，愚谓当原隐曲推解。盖人有隐情曲意则气郁而不畅。不
畅则
心气不开，脾气不化，水谷日少，不能变现气血，以入二阳之血海矣。血海无余，所以不月
也。传为风消者，阳明主肌肉，血不足则肌肉不荣。其不消瘦乎!风之名，火之化也，故当
根不得隐曲上看乃有本。
据此论当有四症，如胃热、胞络热、劳心热三症皆有，宜泻火养血是也。而所言脾胃久
虚致
经水断绝一症，又当以补脾为主，岂得舍而勿论耶?盖水入经，其血乃生，谷入于胃，脉道
乃行。水去荣散，谷清卫亡，况脾统诸经之血，而以久虚之脾胃以致气血俱衰者，可不为之
补益乎?即此以分虚实，明是四症无疑。而楼全善补乃遗补虚一症，何欤?
按立斋云∶经水者，阴血也，属冲任二脉。上为乳汁，下为月水。
其为患，有因脾虚而不能生血者，调而补之。脾郁而不能行血者，解而补
之。胃火而血消烁者，清血补之。脾胃损而血少者，温而补之。劳伤心血而不能行者，逸而
补之。怒伤肝气而不能行者，和而补之，肺气虚而不行者，补脾胃。肾气虚而不行者，补脾
肺。经云∶损其肺者益其气，损其心者调其荣卫，损其脾者调其饮食、适其寒温，损其肝者
缓其中，损其肾者益其精。当参而治之，庶无误矣。
《良方》说：妇女月经不畅，是由于劳倦损伤气血，身体虚弱导致风冷之邪侵入胞宫，伤害了冲脉和任脉的缘故。如果寸脉呈弦象，关脉呈沉象（弦脉与沉脉主气病，滑脉主实证），这是肝病，同时主要伴有腹痛、孔窍生疮的症状。尺脉滑，关脉实，这是气机阻滞。这些都主要表现为小腹牵引腰痛，气攻冲胸膈部位。
按语：薛立斋说：上述病症属于肝胆二经，因为肝胆互为表里，多因愤怒情绪所伤。如果是本经风热，用补肝散；血虚用四物汤加酸枣仁；肾水不足用六味丸。
《产宝方》说：女子以血为本，到了七七四十九岁，卦数已尽，终结则月经停止，冲任脉虚衰，天癸枯竭，地道不通而不能生育。或者因过度劳累，喜怒无常，在经脉衰微之余，又受邪气攻冲，所以该止不住而崩漏。必须区分所感受的病因进行治疗。
薛立斋说：前述情况若属肝肾虚热，用许学士当归散；肝血虚热用四物汤加柴胡、山栀、丹皮；肝火内动用小柴胡汤加山栀、丹皮；肝火血燥用加味逍遥散；脾经郁火用加味归脾汤；肝脾郁火归脾汤与逍遥散兼服；肝肾亏损归脾汤与六味丸兼服，仍与月经不调参合治疗。
洁古说：女子月经不来的，先泻心火，血自然下行。《内经》说：二阳的病发于心脾，有难以言说的隐情曲意，女子不来月经，其传变为风消，其传变为息贲，死不治。二阳，就是阳明。阳明胃病，心脾受累，心主血，心病则血不流通。脾主味，脾病则味不化，味不化则精不足，所以其病不能隐曲。脾土已亏则风邪胜而气愈消矣。经又说：月事不来的，是胞脉闭塞。胞脉属于心，络于胞中。现在气上迫肺，心气不得下通，所以月经不时来潮。
李东垣说：经闭不行有三种情况。或者是脾胃久虚，形体羸弱，气血俱虚而导致经水断绝不来。或者是病中消渴，胃热善食，肌瘦，津液不生。夫经者，血脉津液所化，津液既绝，为热所烁，肌肉渐瘦，时见燥渴，血海枯竭，名叫血枯。经闭宜泻，胃土燥热，补益气血，经自行矣（这是中焦脾胃的病）。或者是心包络脉洪数，时见燥热，大便闭涩，小便虽清不利，而红水闭绝不行，这是血海干枯，宜调血脉，除胞络中火邪，而经自行矣（这是下焦胞络热结也）。或者因劳心火动而赤液竭，或因忧思气结而胞脉闭，气上迫肺，心气不得下通，所以月事不来，宜先服降心火之剂，后用养脾血之药而自来矣（这是上焦心肺热结也）。
泻心火、养脾血是从本文之义，我认为应当从“隐曲”推解。盖人有隐情曲意则气郁而不畅。不畅则心气不开，脾气不化，水谷日少，不能变现气血，以入二阳之血海矣。血海无余，所以不月也。传为风消者，阳明主肌肉，血不足则肌肉不荣。其不消瘦乎！风之名，火之化也，故当根不得隐曲上看乃有本。
据此论当有四症，如胃热、胞络热、劳心热三症皆有，宜泻火养血是也。而所言脾胃久虚致经水断绝一症，又当以补脾为主，岂得舍而勿论耶？盖水入经，其血乃生，谷入于胃，脉道乃行。水去荣散，谷清卫亡，况脾统诸经之血，而以久虚之脾胃以致气血俱衰者，可不为之补益乎？即此以分虚实，明是四症无疑。而楼全善补乃遗补虚一症，何欤？
按语：薛立斋说：经水是阴血，属冲任二脉。上为乳汁，下为月水。
其为患，有因脾虚而不能生血者，调而补之。脾郁而不能行血者，解而补之。胃火而血消烁者，清血补之。脾胃损而血少者，温而补之。劳伤心血而不能行者，逸而补之。怒伤肝气而不能行者，和而补之，肺气虚而不行者，补脾胃。肾气虚而不行者，补脾肺。经云：损其肺者益其气，损其心者调其荣卫，损其脾者调其饮食、适其寒温，损其肝者缓其中，损其肾者益其精。当参而治之，庶无误矣。
According to *Liang Fang* (Good Prescriptions): Women's irregular menstruation is caused by labor injuring Qi and Blood, leading to a weak constitution where Wind-Cold pathogens invade the Uterus (Zang Gong), damaging the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel). If the Cun (Inch) pulse is Wiry (Xian) and the Guan (Bar) pulse is Deep (Chen) (Wiry and Deep pulses indicate Qi disorders, while Slippery indicates Excess), this is a Liver disorder, primarily accompanied by abdominal pain and sores in orifices. If the Chi (Cubit) pulse is Slippery and the Guan pulse is Full/Excess, this is Qi stagnation. These conditions mainly manifest as lower abdominal pain radiating to the waist, with Qi attacking the chest and diaphragm.
Commentary: Xue Lizhai states that the aforementioned symptoms belong to the Liver and Gallbladder meridians, as they are interior-exterior partners, often injured by anger. If it is Wind-Heat in the meridian itself, use Bu Gan San (Liver-Nourishing Powder); for Blood deficiency, use Si Wu Tang (Four Substance Decoction) with Suan Zao Ren (Ziziphus Seed); for insufficiency of Kidney Water, use Liu Wei Wan (Six-Ingredient Pill).
According to *Chan Bao Fang* (Prescriptions for Childbirth): Women prioritize Blood. At age forty-nine (seven sevens), the hexagram numbers are complete; upon completion, menstruation ceases, the Chong and Ren vessels become deficient and weak, Tian Gui (Heavenly Water) is exhausted, the Earthly Way is blocked, and conception becomes impossible. Or, due to excessive labor, irregular emotions of joy and anger, after the meridians have weakened, if attacked by pathogenic factors, bleeding may occur when it should stop, resulting in metrorrhagia and metrostaxis. Treatment must distinguish the specific pathogen.
Xue Lizhai states: If the aforementioned condition involves Deficient-Heat of the Liver and Kidneys, use Xu Xueshi Dang Gui San (Bai Sabin's Angelica Powder); for Liver Blood Deficient-Heat, use Si Wu Tang (Four Substance Decoction) added with Chai Hu (Bupleurum Root), Shan Zhi (Gardenia Fruit), and Dan Pi (Moutan Cortex); for internal stirring of Liver Fire, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Shan Zhi and Dan Pi; for Liver Fire causing Blood Dryness, use Jia Wei Xiao Yao San (Modified Free Wanderer Powder); for Stagnant Fire of the Spleen Meridian, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction); for Liver-Spleen Stagnant Fire, take Gui Pi Tang and Xiao Yao San together; for Liver-Kidney depletion, take Gui Pi Tang and Liu Wei Wan together, still used in conjunction with treatments for irregular menstruation.
Jie Gu states: For women whose menses do not arrive, first drain Heart Fire, and the Blood will flow naturally. The *Nei Jing* (Inner Canon) says: Diseases of Er Yang (Two Yangs) originate in the Heart and Spleen. With hidden grievances and unspoken distress, women cease menstruating. Its transmission leads to Feng Xiao (Wind Emaciation), and its further transmission leads to Xi Ben (Breathful Accumulation), which is incurable and fatal. Er Yang refers to Yang Ming. Yang Ming stomach disease affects the Heart and Spleen. The Heart governs Blood; Heart disease causes Blood stagnation. The Spleen governs taste/flavor; Spleen disease causes failure to transform flavors. Failure to transform flavors leads to insufficiency of Essence, hence the inability to harbor hidden feelings. When Spleen Earth is depleted, Wind pathogens prevail, and Qi diminishes further. The Classics also state: Menses not arriving is due to closure of Bao Mai (Uterine Vessels). Bao Mai belongs to the Heart and connects to Bao Zhong (Center of the Uterus). Now, Qi presses upward against the Lung, preventing Heart Qi from descending smoothly, thus causing irregular menstruation.
Li Dongyuan states: There are three types of amenorrhea. First, long-standing Spleen-Stomach deficiency, emaciated physique, and deficiency of both Qi and Blood lead to cessation of menses. Second, during illness, Xiao Ke (Wasting-Thirst) occurs; Stomach Heat causes good appetite but thinness, and fluids are not generated. Menses are transformed from blood vessels and body fluids. Once fluids are exhausted and scorched by Heat, muscles gradually waste away, dryness and thirst appear intermittently, the Sea of Blood dries up, named Xue Ku (Blood Depletion). Amenorrhea should be treated by purging; if Stomach Earth is dry and hot, tonifying Qi and Blood will allow menses to resume naturally (this is a Middle Jiao Spleen-Stomach disorder). Third, the Pericardium Collateral vessels are Surging and Rapid, with intermittent dry heat, constipation, clear but difficult urination, and cessation of menstrual blood. This is dryness of the Sea of Blood; one should regulate blood vessels, remove Fire pathogens from the Pericardium collaterals, and menses will resume naturally (this is Lower Jiao Pericardium collateral Heat binding). Fourth, mental labor stirs Fire, depleting red fluids; or worry and thought knot Qi, closing Bao Mai. Qi presses upward against the Lung, preventing Heart Qi from descending, so menses do not come. One should first administer agents to descend Heart Fire, then use medicines to nourish Spleen Blood, and menses will return naturally (this is Upper Jiao Heart-Lung Heat binding).
Draining Heart Fire and nourishing Spleen Blood aligns with the meaning of this text. I believe we should deduce from "hidden grievances." When people have hidden feelings and twisted intentions, Qi becomes stagnant and unsmooth. Unsmoothness prevents Heart Qi from opening and Spleen Qi from transforming. Daily intake of water and grain decreases, unable to transform into Qi and Blood to enter the Sea of Blood of Er Yang. With no surplus in the Sea of Blood, menstruation stops. Transmission to Feng Xiao: Yang Ming governs muscles; insufficient Blood means muscles lack nourishment. How can there be no emaciation! The name "Wind" is the transformation of Fire; thus, one must trace back to the root of "inability to express hidden grievances" to find the origin.
Based on this discussion, there should be four syndromes. If Gastric Heat, Pericardium Collateral Heat, and Mental Labor Heat all exist, purging Fire and nourishing Blood is appropriate. However, regarding the syndrome of long-standing Spleen-Stomach deficiency causing amenorrhea, treatment should focus on tonifying the Spleen. How can this be ignored? Water entering the meridians generates Blood; grain entering the Stomach allows vessel pathways to flow. If Water departs and Ying (Nutrient) scatters, Grain clears and Wei (Defensive) perishes. Moreover, the Spleen commands the Blood of all meridians. Should we not tonify those whose Qi and Blood decline due to long-standing Spleen-Stomach deficiency? Distinguishing Excess and Deficiency based on this clearly indicates four syndromes without doubt. Why did Lou Quanshan omit the deficiency-tonifying syndrome in his supplementation?
Commentary: Xue Lizhai states: Menstrual blood is Yin Blood, belonging to the Chong and Ren vessels. Upward it becomes milk; downward it becomes menses.
Pathologies arise from: Spleen deficiency failing to generate Blood—regulate and tonify; Spleen stagnation failing to move Blood—resolve and tonify; Stomach Fire consuming Blood—clear Blood and tonify; Spleen-Stomach damage with little Blood—warm and tonify; Mental labor injuring Heart Blood failing to move—rest and tonify; Anger injuring Liver Qi failing to move—harmonize and tonify; Lung Qi deficiency failing to move—tonify Spleen and Stomach; Kidney Qi deficiency failing to move—tonify Spleen and Lungs. The Classics say: Damage the Lung, benefit its Qi; damage the Heart, regulate Ying and Wei; damage the Spleen, regulate diet and adjust cold/warmth; damage the Liver, soothe its center; damage the Kidney, benefit its Essence. Refer to these when treating, to avoid error.