方约之曰∶妇人以血为海。妇人从于人，凡事不得专行。每多忧思忿怒，郁气居多。书云∶气行则血行，
气止则血止。忧思过度则气结，气结则血亦结。又云∶气顺则血顺，气逆则血逆。忿怒过度则气逆，气逆则血
亦逆。气血结逆于脏腑经络，而经于是乎不调矣。
慎斋按∶以上六条，序妇人经水不调之由也。妇人以血用事，故病莫先于调经。而经之所以不调者，或本
于合非其时，或属于阴阳相胜。或感于风冷外邪，或伤于忧思郁怒。皆足以致经候不调之故，此病机之不可
不察者也。
戴复庵曰∶妇人每月经水应期而下，不使有余，犹太阴之缺，其有或先或后，或多或少，或欲来先病，或
遇来而断续，皆谓之不调，和气饮加香附。
朱丹溪曰∶经水先期而至者，血热也，四物加芩、连、香附。后期而至者，血虚也，芎、归、参、术加二陈。
薛立斋按∶先期而至，有因脾经血燥，宜加味逍遥散。有因肝经郁滞，宜归脾汤。有因肝经怒火，宜加
味小柴胡汤。有因血分有热，宜加味四物汤。有因劳役火动，宜补中汤。如过期而至，有因脾经血虚，宜人参养
荣汤。有因肝经血少，宜六味丸。盖血生于脾，故云脾统血。凡血病当用甘苦之剂，以助阳气而生血也。
赵养葵曰∶经水如不及期而来者，有火也，宜以六味丸滋水，则火自平矣。如不及期而来多者，本方加海
螵蛸、柴胡、白芍。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，本方加艾叶。如迟而色淡者，本方加桂。此其大略也。其间亦有不及期而无
火者，有过期而有火者，多寡不同，不可拘于一定。当察脉之迟数，视禀之虚实强弱，但以滋水为主，随证加
减。凡紫与黑色者，多属火旺之甚。亦有虚寒而紫黑者，不可不察脉审证。若淡白，则无火明矣。
方约之说：妇女以血为根本（如同大海般充盈）。妇女依附于丈夫，凡事不能独自决断行事。因此常常多有忧思和愤怒，导致气机郁结的情况居多。医书说：气行则血行，气止则血止。忧思过度会导致气机郁结，气机郁结则血液也随之凝滞。又说：气顺则血顺，气逆则血逆。愤怒过度会导致气机上逆，气机上逆则血液也随之上逆。气血在脏腑经络中发生郁结或逆乱，月经因此就不调了。
慎斋按语：以上六条内容，叙述了妇女月经不调的原因。妇女以血为主要生理基础，所以疾病没有比调理月经更优先的。而月经之所以不调，有的是因为不合时宜的房事所致，有的是因为阴阳失衡相克所致，有的是因为感受风冷等外邪所致，有的是因为忧思郁怒内伤所致。这些都足以导致月经失调的原因，这是病机中不可不仔细审察的地方。
戴复庵说：妇女每个月的月经应该按时来潮，不多不少，就像月亮有缺有圆一样。如果有的提前或推后，量多或少，或者想来的时候先生病，或者正在来时中断断续续，都称为月经不调，可用和气饮加入香附治疗。
朱丹溪说：月经提前的，是血热，用四物汤加入黄芩、黄连、香附。月经推迟的，是血虚，用川芎、当归、人参、白术加入二陈汤治疗。
薛立斋按语：月经提前来的，有因脾经血燥引起的，宜用加味逍遥散。有因肝经气机郁滞引起的，宜用归脾汤。有因肝经怒火引起的，宜用加味小柴胡汤。有因血分有热引起的，宜用加味四物汤。有因劳累过度导致虚火妄动引起的，宜用补中益气汤。如果是月经推迟来的，有因脾经血虚引起的，宜用人参养荣汤。有因肝经血少引起的，宜用六味地黄丸。大概血由脾所生，所以说脾统血。凡是血病应当使用甘苦味的药物，以助阳气而生血。
赵养葵说：月经不到期就来的，是有火，宜用六味地黄丸滋补肾水，则火自然平息。如果不到期就来且量多的，在原方基础上加海螵蛸、柴胡、白芍。如果半个月或十天就来，并且绵延不止，这属于气虚，用补中益气汤。如果过了期才来的，是火衰（肾阳不足），原方加艾叶。如果迟来且颜色淡的，原方加桂枝。这是大致的情况。其中也有不到期但没有火的，有过期但有火的，多少不同，不能拘泥于一定的规律。应当观察脉象的迟数，查看体质的虚实强弱，主要以滋补肾水为主，随证加减。凡是经血呈紫色或黑色的，大多属于火旺得很厉害。也有因虚寒而呈紫黑色的，不可不仔细诊察脉象和症状。如果是淡白色的，那么没有火是明显的了。
Fang Yuezhi stated: Women regard blood as their sea (the foundation of their physiology). Women follow men and cannot act independently in all matters. Therefore, they often experience excessive worry, thought, anger, and indignation, leading to a predominance of Qi stagnation. Medical texts state: "When Qi moves, Blood moves; when Qi stops, Blood stops." Excessive worry and thought cause Qi to knot (stagnate); when Qi knots, Blood also becomes stagnant. It is also said: "When Qi is smooth, Blood is smooth; when Qi rebels, Blood rebels." Excessive anger causes Qi to rebel (rise counterflow); when Qi rebels, Blood also rebels. When Qi and Blood become knotted or rebellious within the Zang-Fu organs and meridians, menstruation becomes irregular.
Shen Zhai commented: The above six points outline the causes of irregular menstruation in women. Women rely on Blood for their physiological functions; thus, no illness takes precedence over regulating menstruation. The reasons for irregular menstruation include: coitus at inappropriate times, Yin-Yang imbalance and mutual overcoming, contraction of wind-cold external pathogens, or injury from worry, thought, depression, and anger. All these are sufficient to cause menstrual irregularities. These pathogenic mechanisms must be carefully examined.
Dai Fu'an stated: A woman's monthly menstruation should arrive on schedule, neither excessive nor deficient, much like the waxing and waning of the moon. If it arrives early or late, in large or small amounts, if illness precedes its arrival, or if it starts and then stops intermittently, all are termed "irregular menstruation." He recommended Heqi Yin (Harmonizing Qi Decoction) with added Xiangfu (Cyperus Rhizome).
Zhu Danxi stated: Menstruation arriving early indicates Blood Heat. He recommended Siwu Tang (Four Substances Decoction) with added Huangqin (Scutellaria Root), Lianzi (Lotus Plumule), and Xiangfu (Cyperus Rhizome). Menstruation arriving late indicates Blood Deficiency. He recommended Xiong (Ligusticum Rhizome), Gui (Angelica Sinensis Radix), Shen (Ginseng Radix), Zhu (Atractylodes Macrocephala Rhizome) added to Erchen Tang (Two-Aged Decoction).
Xue Lizhai commented: Early menstruation may be caused by Dryness of Blood in the Spleen Meridian, suitable for Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). It may be caused by Stagnation in the Liver Meridian, suitable for Guipi Tang (Restore the Spleen Decoction). It may be caused by Fire Anger in the Liver Meridian, suitable for Jiawei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction). It may be caused by Heat in the Blood Level, suitable for Jiawei Siwu Tang (Modified Four Substances Decoction). It may be caused by Fire stirring due to overwork, suitable for Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For late menstruation, it may be caused by Blood Deficiency in the Spleen Meridian, suitable for Renshen Yangrong Tang (Ginseng Nourishing the荣 Decoction). It may be caused by Blood Scarcity in the Liver Meridian, suitable for Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Generally, Blood is produced by the Spleen; hence, it is said that the Spleen controls Blood. For all Blood diseases, sweet and bitter agents should be used to assist Yang Qi and generate Blood.
Zhao Yangkui stated: Menstruation arriving before the expected time indicates the presence of Fire. He recommended Liuyi Wan (Six-Ingredient Pill) to nourish Kidney Water, so that Fire will naturally subside. If it arrives early and in large amounts, add Haipiaoxiao (Cuttlefish Bone), Chaihu (Bupleurum Root), and Baishao (White Peony Root) to the base formula. If it arrives every half month or ten days and persists without stopping, this belongs to Qi Deficiency, treated with Buzhong Yiqi Tang. If it arrives after the expected time, it indicates Fire Decline (Kidney Yang Deficiency); add Aiye (Mugwort Leaf) to the base formula. If it is late and pale in color, add Guizhi (Cinnamon Twig) to the base formula. This is the general principle. However, there are cases of early arrival without Fire, and late arrival with Fire. The volume varies, and one cannot rigidly adhere to fixed rules. One must observe the pulse for Slowness or Rapidity, assess the constitution for Deficiency or Excess and strength or weakness, primarily focusing on nourishing Water, and modifying according to symptoms. Purple or black blood usually indicates severe Fire Excess. There are also cases of purple-black blood due to Deficient Cold, which must not be overlooked without careful pulse and symptom examination. If the color is pale white, the absence of Fire is evident.