【歌】二阳之病发心脾，血海无余土已亏，气结痰凝良有说，
肝劳心损亦须知。东垣指出三焦病，学人宜将五脏推，血滞血枯当有别，通经不可浪施为。
【论】经曰∶月事不来者，胞脉闭也。胞脉者，属心而络于胞中，今气上迫肺，心气不得下通，故月事不来
也。洁古云∶宜先降心火之剂，后服五补丸、卫生汤，治脾以养其血。经曰∶二阳之病，发于心脾，有不得隐曲，
女子不月，其传为风消，为息奔者死，不治。经曰∶有病胸胁支满，妨于食，病至则先闻腥臊臭，出清液，四肢清，
目眩时时，前后血病，名曰血枯。东垣曰∶经闭不行有三，脾胃久虚，形体羸瘦，气血俱衰，以致经水断绝，或因
劳心，心火上行，月事不来，胞脉闭也，治宜安心补血，泻火则经自行，此上焦心肺有热而不行，一也。或病中消，
胃热善饥，渐瘦，津液不生，盖经乃血脉津液所化，津液既为热烁，肌肉渐瘦，时见烦渴，血海干枯，宜泻胃之燥热，
补益气血，则经自行，此中焦胃热而不行，二也。或心胞络脉洪数，时见大便闭，小便难而经水断绝，血海干枯，
治宜调血脉，除胞络中相火，则经自行，此下焦胞络热结而经不行，三也。
【脉】寸脉弦，关脉沉，是肝病也，兼主腹痛，孔窍生疮。尺脉滑，气血实，经不利。尺脉绝不至，兼主少腹
引腰痛，气攻胸臆也。少阴脉弱而微，微则少血。寸口脉浮而弱，浮则为虚，弱则无血。脉来至如琴弦者，苦少腹
痛，月水不利也。肝脉沉主月水不利，腰腹痛。尺脉来而断续者，月水不利，腹不通，绕脐痛，其脉沉紧，此由寒
气客于血室，血凝不行也。
血热
清热泻火出东垣，病属三焦必热烦，玉烛三和分上下，经水调后必调元。
三和汤 玉烛散 二气丸。
风冷
热则宜通冷则凝，腹中瘕聚结如冰，或缘劳役兼惊恐，久则
伤肝寒热增。
千金桃仁丸 露丸。
痰阻
痰滞胞门气不清，久而食少热寒生，肥人血海偏脂满，去积消痰经自行。
瓦垄丸。
血结
血结胞中病郁陶，精神减少欲成劳，寒宜三垒三方治，热用罗君血极膏。
气滞
妇女偏多执性情，哀怀隐曲不舒伸，停经大半由于此，琥珀当归效若神。
琥珀散 当归散。
心虚
婺妇宫娥及女尼，心思散耗致肝亏，须培血脉调荣卫，柏子仁丸最合宜。
茯苓补心汤。
肝劳
肝劳支满妨于食，时觉喉间有臭腥，胁痛目眩或唾血，芦茹乌贼载于经。
经闭成劳
室女停经病不轻，渐成劳瘵热寒并，急宜艾炎投符药，若得经通疾自平。
泽兰汤 柏子仁丸 生地黄丸。
劳瘵多端不等论，先须去病后调元，骨蒸冷热传尸 ，若要寻精另一门。秦艽鳖甲散、獭肝丸、北斗符、取
劳虫方、灸四花穴、腰俞。
【歌诀】
第二阳经（阳明经）的病变发源于心与脾，血海枯竭、脾胃已虚，气机郁结、痰湿凝聚确实存在说法，肝劳损和心损伤也应当知晓。李东垣指出了三焦的病症，学习者应当推究五脏的关系，血滞与血枯应当加以区别，通经的方法不可随意施用。
【论述】
《黄帝内经》说：月经不来的原因，是胞脉闭塞。胞脉属于心并联络于子宫，如今气机上逆逼迫肺脏，心气不能向下通达，所以月经不来。张洁古说：适宜先用降心火的药物，随后服用五补丸、卫生汤，通过治疗脾脏来滋养血液。《黄帝内经》说：阳明经的病变，发源于心脾，如果有难以启齿的隐情，女子就会闭经，若传变为风消（因阴虚火旺导致的消瘦）、息奔（喘息急促），则属死证，无法治疗。《黄帝内经》说：有人出现胸胁支撑胀满，妨碍饮食，发病时先闻到腥臊气味，流出清稀液体，四肢清冷，目眩头晕，大小便出血，病名叫做血枯。李东垣说：闭经有三种情况。一是脾胃长期虚弱，形体消瘦，气血俱衰，导致月经断绝；或者因为用心过度，心火上炎，月经不来，胞脉闭塞，治疗应当安心补血，泻火则月经自然通行，这是上焦心肺有热导致的不行，是第一类。二是患有中消症，胃热善饥，逐渐消瘦，津液不生，因为月经是由血脉和津液化生，津液既被热邪灼烧，肌肉逐渐消瘦，时常感到烦渴，血海干枯，适宜泻除胃中的燥热，补益气血，则月经自然通行，这是中焦胃热导致的不行，是第二类。三是心包络脉象洪数，时常大便闭塞，小便困难而月经断绝，血海干枯，治疗应当调理血脉，清除胞络中的相火，则月经自然通行，这是下焦胞络热结导致的不行，是第三类。
【脉诊】
寸脉弦，关脉沉，这是肝病，同时主腹痛，孔窍生疮。尺脉滑，表示气血实盛，但月经不利。尺脉绝而不至，同时主少腹牵引腰痛，气攻胸臆。少阴脉弱而微，微表示血少。寸口脉浮而弱，浮表示虚，弱表示无血。脉来至如琴弦者，苦于少腹痛，月经不利。肝脉沉主月经不利，腰腹痛。尺脉来而断续者，月经不利，腹部不通，绕脐痛，其脉沉紧，这是由于寒气客居于血室，血凝滞不行所致。
血热
清热泻火出自李东垣的理论，病症属于三焦必然伴有热烦，玉烛散和三和汤分为上下治疗，月经调畅后必须调理元气。方剂：三和汤、玉烛散、二气丸。
风冷
热则宜通，冷则凝滞，腹中瘕聚结成如冰，或者由于劳役兼惊恐，久则伤肝，寒热增加。方剂：千金桃仁丸、露丸。
痰阻
痰滞胞门气不清，久而食少寒热产生，肥胖之人血海偏于脂满，去除积滞、消除痰湿则月经自行。方剂：瓦垄丸。
血结
血结胞中病势郁陶，精神减少欲成劳损，寒证适宜用三垒三方治疗，热证用罗君血极膏。
气滞
妇女大多执着于性情，哀怀隐曲不得舒展，停经大半由于此原因，琥珀散和当归散效果神妙。方剂：琥珀散、当归散。
心虚
寡妇、宫女及女尼，心思散耗导致肝亏，必须培补血脉调和荣卫，柏子仁丸最合适宜。方剂：茯苓补心汤。
肝劳
肝劳导致支满妨碍饮食，时常觉得喉间有臭腥味，胁痛目眩或唾血，芦茹、乌贼骨记载于医经中。
经闭成劳
少女停经病情不轻，渐成劳瘵寒热并见，急宜艾灸投符药，若得经通疾病自平。方剂：泽兰汤、柏子仁丸、生地黄丸。
劳瘵有多种表现不等，先须去病后调元气，骨蒸冷热传尸，若要寻精另有一门。秦艽鳖甲散、獭肝丸、北斗符、取劳虫方、灸四花穴、腰俞。
[Verse]
Diseases of the Yangming (Stomach and Large Intestine channels) originate from the Heart and Spleen. When the Blood Sea is depleted and the Earth (Spleen/Stomach) is deficient, Qi stagnation and Phlegm condensation are indeed valid explanations. One must also be aware of Liver exhaustion and Heart damage. Li Dongyuan pointed out diseases of the Sanjiao (Triple Burner); students should deduce the conditions of the Five Zang organs. Blood stasis and Blood deficiency must be distinguished; methods to promote menstruation should not be applied recklessly.
[Dissertation]
The *Huangdi Neijing* states: "When menstruation does not occur, it is due to the closure of the Bao Mai (Uterine Vessels)." The Bao Mai belongs to the Heart and connects to the Uterus. Now, if Qi forces upward against the Lung, the Qi of the Heart cannot descend and communicate downward, thus menstruation does not occur. Zhang Jiegou stated: It is appropriate to first use agents that descend Heart Fire, followed by Wubu Wan (Five Tonics Pill) and Weisheng Tang (Health Preservation Decoction), treating the Spleen to nourish the Blood. The *Huangdi Neijing* states: "Diseases of the Yangming originate in the Heart and Spleen. If there are hidden difficulties or unspoken grievances, women will experience amenorrhea. If it transmits into Fengxiao (wasting-thirst due to Yin deficiency) or Xiben (panting/asthma), it is a death case, untreatable." The *Huangdi Neijing* states: "There is a condition with fullness and distension in the chest and hypochondrium, obstructing food intake. Upon onset, one first smells a fishy or foul odor, secretes clear fluid, feels cold in the four limbs, experiences dizziness, and has bleeding from the anterior and posterior orifices. This disease is named Xueku (Blood Depletion)." Li Dongyuan said: There are three types of amenorrhea. First, long-term deficiency of the Spleen and Stomach leads to emaciation, depletion of both Qi and Blood, resulting in the cessation of menstruation. Or, excessive mental labor causes Heart Fire to ascend, leading to amenorrhea and closure of the Bao Mai. Treatment should calm the mind and tonify Blood; clearing Fire will allow menstruation to resume naturally. This is the first type: non-menstruation due to Heat in the Upper Jiao (Heart and Lungs). Second, suffering from Zhongxiao (Middle Xiao/Wasting-Thirst), with Stomach Heat, hunger, gradual emaciation, and lack of Jin-Ye (Body Fluids). Since menstruation is transformed from Blood vessels and Jin-Ye, if Jin-Ye is scorched by Heat, muscles gradually waste away, accompanied by vexation and thirst, leading to the dryness of the Blood Sea. It is appropriate to drain the Dry-Heat of the Stomach and tonify Qi and Blood, allowing menstruation to resume. This is the second type: non-menstruation due to Stomach Heat in the Middle Jiao. Third, the Pericardium Collateral pulse is surging and rapid, accompanied by constipation, difficult urination, and cessation of menstruation, with a dry Blood Sea. Treatment should regulate the Blood vessels and eliminate Ministerial Fire in the Pericardium Collaterals, allowing menstruation to resume. This is the third type: non-menstruation due to Heat accumulation in the Lower Jiao Pericardium Collaterals.
[Pulse Diagnosis]
Cun (Inch) pulse is wiry, Guan (Bar) pulse is deep; this indicates Liver disease, also governing abdominal pain and sores in orifices. Chi (Cubit) pulse is slippery, indicating Excess of Qi and Blood, but unfavorable menstruation. Chi pulse absent and unreachable, also governs lower abdomen pulling lumbar pain, and Qi attacking the chest. Shaoyin pulse is weak and thready; thready indicates little Blood. Cun-kou pulse is floating and weak; floating indicates Deficiency, weak indicates no Blood. A pulse coming like a zither string indicates bitter lower abdominal pain and unfavorable menstruation. Liver pulse deep governs unfavorable menstruation and lumbar/abdominal pain. Chi pulse coming intermittently indicates unfavorable menstruation, abdominal blockage, periumbilical pain. If the pulse is deep and tight, this is due to Cold Evil lodging in the Blood Chamber, causing Blood coagulation and non-flow.
Blood Heat
Clearing Heat and draining Fire originates from Li Dongyuan's theory. Diseases belonging to the Sanjiao inevitably involve Heat and vexation. Yuzhu San (Jade Candle Powder) and Sanhe Tang (Three Harmonies Decoction) treat the upper and lower separately. After menstruation is regulated, Yuan Qi (Original Qi) must be adjusted. Formulas: Sanhe Tang, Yuzhu San, Erqi Wan.
Wind-Cold
Heat favors flow, Cold favors coagulation. Masses (Jia-Ju) form in the abdomen like ice. This may arise from labor combined with fright. Over time, it injures the Liver, increasing chills and fever. Formulas: Qianjin Taoren Wan (Thousand Gold Peach Kernel Pill), Lu Wan (Dew Pill).
Phlegm Obstruction
Phlegm obstructs the Bao Gate, making Qi unclear. Over time, appetite decreases, and chills and fever arise. In obese individuals, the Blood Sea is partially filled with fat. Removing accumulations and eliminating Phlegm allows menstruation to resume naturally. Formula: Walong Wan (Tile Kiln Pill).
Blood Coagulation
Blood coagulates in the Uterus, causing a depressive and stifling disease. Spirit decreases, approaching exhaustion. For Cold patterns, use the Three Fortresses formulas; for Heat patterns, use Luo Jun's Xuexi Gao (Blood Extinction Ointment).
Qi Stagnation
Women often adhere to their temperaments. Hidden sorrows and grievances fail to expand. Amenorrhea largely stems from this. Hupo San (Amber Powder) and Danggui San (Angelica Sinensis Powder) are as effective as divine intervention. Formulas: Hupo San, Danggui San.
Heart Deficiency
Widows, palace maids, and female nuns have scattered and consumed thoughts, leading to Liver deficiency. One must cultivate Blood vessels and harmonize Ying and Wei (Nutritive and Defensive Qi). Baizi Ren Wan (Biota Seed Pill) is most suitable. Formula: Fuling Buxin Tang (Poria Tonifying Heart Decoction).
Liver Exhaustion
Liver exhaustion causes fullness and distension obstructing food intake. One often feels a foul smell in the throat. Hypochondriac pain, dizziness, or hemoptysis are present. Luxu (Reed Rhizome) and Wuzeimao (Cuttlefish Bone) are recorded in the classics.
Amenorrhea Becoming Consumption
Virgin girls with amenorrhea face serious illness. Gradually becoming Laozai (Consumption/TB), with alternating chills and fever. Urgently apply Moxibustion and talismanic medicines. If menstruation flows, the disease will naturally subside. Formulas: Zelang Tang (Lycopus Decoction), Baizi Ren Wan, Shengdihuang Wan (Rehmannia Pill).
Laozai (Consumption) manifests in many unequal ways. First, remove the pathogen, then adjust Yuan Qi. Bone-steaming chills and fever transmit via Chuan Shi (Transmitting Corpse/Infectious Disease). To seek the essence, there is another branch. Qinjiao Biejia San (Gentiana and Turtle Shell Powder), Tagan Wan (Hyena Liver Pill), Beidou Fu (Big Dipper Talisman), Qu Laochong Fang (Formula for Extracting Labor Worms), Moxibustion on Sihua Acupoints and Yaoshu.