朱丹溪曰∶经水者，阴血也。阴必从阳，故其色红，禀火色。血为气之配，气热则热，气寒则寒，气滞则
滞。为气之配，因气而行。见有成块者，气之凝也。将行而痛者，气之滞也。来后作痛者，气血俱虚也。错经
妄行者，气之乱也。色淡者，虚而有水混之也。紫者，气之热也。黑者，热甚也。今人见紫黑成块作痛，率
指为风冷乘之，用温热剂，祸不旋踵。经云∶亢则害，承乃制。热甚必兼水化，故热则紫，甚则黑也。且妇人
性多忿郁，嗜欲倍加，脏腑厥阳之火，无日不有，非热而何？若以风冷，必须外感，即或有之，亦千百而一二也。
叶氏曰∶血黑属热，丹溪之论善矣。然有风寒外乘者，十中尝见一二。盖寒主收引，小腹必常冷痛，经行
时，或手足厥冷，唇青面白，尺迟或微而虚，或大而无力。热则尺洪数，或实有力，参之脉证为的。
《准绳》按∶冷证外邪初感，入经必痛，或不痛者，久则郁而变热。且血寒则凝，既行而紫黑，故非寒也。
朱丹溪曰∶经水不调，而水色淡白者，气虚也，宜参、术、归、芍、黄 、香附之属。经水过期而紫黑成
块者，血热而实也，必作痛，宜四物加黄连、香附。经水过多而淡色者，痰多也，二陈加芎、归。
薛立斋按∶经水过期而至，有因脾经血虚者，宜人参养荣汤。有因肝经血少者，宜六味丸。有因气虚血弱
者，宜八珍汤。
朱丹溪说：月经水，属于阴血。阴必须依附于阳，所以它的颜色是红的，这是禀受了火的色泽。血是气的配偶（配合物），气热则血热，气寒则血寒，气滞则血滞。因为作为气的配偶，血随着气而运行。见到有血块的，是气的凝滞所致。月经将行时疼痛的，是气机阻滞所致。月经结束后疼痛的，是气血都虚弱所致。经血妄行、错乱的，是气机紊乱所致。颜色淡的，是虚证且有水湿混杂其中。颜色紫的，是气热所致。颜色黑的，是热势极盛所致。现在的人见到经血紫黑、成块且疼痛，一概指认为是风冷之邪侵袭身体，使用温热性质的药剂治疗，灾祸立刻就会降临。《内经》说：亢盛至极就会产生危害，需要有制约才能平衡。热势极盛必然兼有水化的表现，所以热则色紫，热极则色黑。况且妇人性格多忿怒抑郁，嗜欲加倍增加，脏腑中厥阳之火，没有一天不存在的，这难道不是热证吗？如果说是风冷，必须是外感引起，即使有这样的情况，也是千百人中才有一二个。
叶氏说：经血黑色属于热证，丹溪的论述是很好的。然而也有风寒外邪侵袭的情况，十个人中偶尔能见到一两个。大概寒邪主收敛牵引，小腹必定经常冷痛，月经来潮时，或者手足冰冷，嘴唇发青、面色苍白，尺脉迟或微弱而虚，或者脉大但无力。如果是热证，尺脉洪大数急，或者实而有力，参考脉象和症状来判断才是准确的。
《医学准绳六要》按语：冷证如果是外邪初感，侵入经脉必定疼痛，如果不痛的，时间久了也会郁结而变为热证。而且血寒则凝结，既然已经排出且呈紫黑色，所以不属于寒证。
朱丹溪说：月经不调，且经血色淡白的，是气虚，适宜用人参、白术、当归、白芍、黄芪、香附这类药物。月经过期且紫黑成块的，是血热而实证，必定伴有疼痛，适宜用四物汤加入黄连、香附。月经量过多且颜色淡的，是痰多所致，适宜用二陈汤加入川芎、当归。
薛立斋按语：月经过期才来的，有因为脾经血虚的，适宜用人参养荣汤。有因为肝经血少的，适宜用六味丸。有因为气虚血弱的，适宜用八珍汤。
Zhu Danxi said: Menstrual blood is Yin blood. Yin must follow Yang; therefore, its color is red, inheriting the hue of Fire. Blood is the companion of Qi; if Qi is hot, blood becomes hot; if Qi is cold, blood becomes cold; if Qi is stagnant, blood becomes stagnant. As the companion of Qi, blood moves with Qi. The presence of clots indicates stagnation of Qi. Pain occurring just before menstruation indicates stagnation of Qi mechanism. Pain occurring after menstruation indicates deficiency of both Qi and Blood. Irregular or erratic menstrual flow indicates chaos in Qi mechanism. Pale color indicates deficiency mixed with dampness. Purple color indicates heat in Qi. Black color indicates extreme heat. Nowadays, when people see purple-black clots accompanied by pain, they generally attribute it to invasion by wind-cold and use warm-tonic formulas, leading to immediate disaster. The *Classic of Medicine* states: "When things reach an extreme, they become harmful; only through control can balance be maintained." Extreme heat inevitably involves transformation into Water characteristics; thus, heat results in purple color, and extreme heat results in black color. Moreover, women often have tendencies toward anger and depression, and their desires are doubled. The fire of Jue-Yang (Defiant Yang) in the Zang-Fu organs exists every day; how could this not be a Heat syndrome? If it were wind-cold, it must be due to external contraction. Even if such cases exist, they occur in only one or two out of a thousand.
Ye Shi said: Black menstrual blood belongs to Heat; Danxi's discussion is excellent. However, there are cases of external wind-cold invasion, which I encounter once or twice in ten. Generally, Cold governs contraction and pulling, so the lower abdomen must always feel cold and painful. During menstruation, hands and feet may be cold, lips cyanotic, and face pale. The Chi pulse at the cun-kou position may be slow (Chi), faint, or weak and deficient, or large but forceless. In Heat syndromes, the Chi pulse is surging (Hong) and rapid (Shu), or solid and forceful. One must refer to both pulse and symptoms for an accurate diagnosis.
*Zhunsheng* commentary: When a Cold syndrome is initially contracted from external pathogens, invasion into the meridians causes pain. If there is no pain initially, prolonged stagnation will transform into Heat. Furthermore, Cold Blood coagulates; since the blood has been discharged and appears purple-black, it does not belong to Cold.
Zhu Danxi said: For irregular menstruation with pale-white blood color, it is Qi deficiency, suitable for herbs such as Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Huangqi (Astragalus Root), and Xiangfu (Cyperus Rhizome). For delayed menstruation with purple-black clots, it is Excess Heat in Blood, necessarily accompanied by pain, suitable for Siwu Tang (Four Substances Decoction) added with Huanglian (Coptis Rhizome) and Xiangfu (Cyperus Rhizome). For excessive menstruation with pale color, it is due to abundant Phlegm, suitable for Erchen Tang (Two Aged Ingredients Decoction) added with Chuanxiong (Ligusticum Rhizome) and Danggui (Angelica Sinensis Root).
Xue Lizhai commentary: Delayed menstruation may be caused by Blood deficiency in the Spleen Meridian, suitable for Renshen Yangrong Tang (Ginseng Nourishing Ying Decoction). It may be caused by Blood insufficiency in the Liver Meridian, suitable for Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). It may be caused by Qi deficiency and Blood weakness, suitable for Bazhen Tang (Eight Treasures Decoction).