汪石山曰∶有妇人经行，必先泻二三日，然后经下，诊其脉皆濡弱，此脾虚也。脾主血，属湿，经水将动，
脾血先已流注血海，然后下流为经。脾血既亏，则虚而不能营运其湿，以参苓白术散服之，月余而经行不泻矣。
缪仲淳曰∶有月水过多，白带时下，日轻夜重，泄泻无时，亦属下多亡阴，宜作血虚论治，服四物益甚，
始悟此病正合仲景阳生阴长之法。夫经水多，白带时下，又兼泄泻，皆由阳虚陷下而然，命曰阳脱是也。日
轻夜重，盖日阳旺，而得健运之职，故血亦无凝滞之患，故日轻。夜则阴旺，而阳不得其任，失其健运之常，
血亦随滞，故夜重，以
参、术助阳之药服之。
慎斋按∶以上二条，序经行有泄泻、白带之兼证也。经行中兼见之证不一，而腹痛、发热、泄泻、白带四
证，则常有之。四证见其一，皆足以致经候不调之病，故以此序于月经不调之后。但月经不调，而不加意审治，
势必渐至于不月而经闭，有血枯之候。故即以女子不月、经闭、血枯诸论集于下，此序书之原委也，读者不可
不知。
《素问》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。
《素问》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。
慎斋按∶以上经论二条，序女子不月，一属于胞脉之闭，一属于二阳之病也。
汪石山说：有一位妇女在月经来潮前，必定先腹泻两三天，然后月经才来。诊察她的脉象都是濡弱（浮而细软，主虚证或湿证），这是脾虚的表现。脾统血，且易生湿，月经将要发动时，脾血先已流注到血海（冲脉，为十二经气血汇聚之处），然后下行成为经血。既然脾血已经亏损，就虚弱而不能运化体内的湿气，服用参苓白术散（由人参、茯苓、白术等组成，具有益气健脾、渗湿止泻功效的方剂），一个月多月后，月经来潮时就不再腹泻了。
缪仲淳说：有妇女月经量过多，白带不时下泄，白天症状轻，晚上加重，腹泻没有固定时间，这也属于下部失血导致阴液亡失，应当作为血虚来论治。起初服用四物汤（由熟地黄、当归、白芍、川芎组成，具有补血调经功效的方剂）反而病情加重，这才领悟到这个病正符合张仲景“阳生阴长”（阳气旺盛则阴血得以滋生）的治疗法则。月经量多，白带时下，又兼见腹泻，都是由阳气虚陷下坠所致，这叫做阳脱（阳气极度衰竭而外越）。白天症状轻，是因为白天阳气旺盛，脾脏得阳气帮助而恢复健运功能，所以血液也没有凝滞的病患，因此白天症状轻。到了夜晚，阴气旺盛，阳气不能胜任其职能，失去了正常的健运能力，血液也随之凝滞，所以晚上症状重，应服用人参、白术等助阳的药物进行治疗。
慎斋按语：以上两条论述，列举了月经期间伴有腹泻、白带等兼证的情况。月经期间出现的兼证不止一种，但腹痛、发热、腹泻、白带这四种症状则是常见的。出现其中任何一种症状，都足以导致月经不调的疾病，所以将这些内容排在月经不调之后。但是，如果月经不调而不加注意仔细诊治，势必逐渐发展到闭经（月经停止来潮），出现血枯（精血枯竭）的征候。因此，将关于女子闭经、经闭、血枯的各种论述收集在下面，这就是本书编排的缘由，读者不可不知道。
《素问》说：月经不来的原因，是胞脉（连接子宫的脉络）闭塞。胞脉，归属于心并联络于子宫中。如今气机上逆压迫肺脏，心气不能向下通达，所以月经不来。
《素问》说：阳明经（胃与大肠所属经脉）的疾病，发源于心和脾，如果有难以启齿的隐情或忧愁，女子就会闭经；若病情传变发展为风消（形容消瘦如被风吹干）或息奔（呼吸急促奔走状），就是死症，无法治疗。
Wang Shishan stated: There was a woman who experienced diarrhea for two or three days prior to the onset of menstruation, after which the menses would flow. Her pulse was diagnosed as soft and weak (floating and fine, indicating deficiency or dampness), which points to Spleen deficiency. The Spleen governs blood and is associated with dampness. When menstruation is about to commence, Spleen blood first flows into the Sea of Blood (Chong Mai, the reservoir of Qi and Blood from the twelve meridians) and then descends to become menstrual blood. Since the Spleen blood has been depleted, it becomes too deficient to transform and transport internal dampness. By administering Shen Ling Bai Zhu San (a decoction composed of Ginseng, Poria, Atractodes Rhizome, etc., with functions of benefiting Qi, strengthening the Spleen, draining dampness, and stopping diarrhea), after more than a month, she no longer experienced diarrhea during her menses.
Miao Zhongchun stated: In cases where menstrual flow is excessive, leukorrhea occurs intermittently, symptoms are lighter during the day and heavier at night, and diarrhea occurs without fixed timing, this also belongs to the category of Yin depletion due to loss of blood from the lower jiao. It should be treated as Blood deficiency. Initially, administering Si Wu Tang (a decoction composed of Rehmannia Root, Angelica Sinensis, White Peony Root, and Ligusticum Chuanxiong, with functions of nourishing Blood and regulating menstruation) aggravated the condition. Only then did I realize that this disease perfectly aligns with Zhang Zhongjing's principle of "Yang generating Yin" (when Yang Qi is vigorous, Yin Blood is generated). Excessive menstruation, intermittent leukorrhea, and accompanying diarrhea are all caused by Yang deficiency leading to sinking and prolapse, termed Yang collapse (extreme exhaustion and outward floating of Yang Qi). Symptoms are lighter during the day because Yang Qi is vigorous; aided by Yang, the Spleen restores its function of transformation and transportation, so there is no stagnation of Blood, hence the lighter daytime symptoms. At night, Yin Qi is vigorous, but Yang Qi cannot perform its duties, losing its normal function of transformation and transportation; consequently, Blood stagnates, resulting in heavier nighttime symptoms. Treatment should involve administering herbs that assist Yang, such as Ginseng and Atractodes Rhizome.
Shenzhai commented: The above two entries list concurrent syndromes accompanying menstruation, such as diarrhea and leukorrhea. Concurrent syndromes during menstruation are not limited to one type, but abdominal pain, fever, diarrhea, and leukorrhea are common. The occurrence of any one of these four syndromes is sufficient to cause irregular menstruation; therefore, they are listed after the section on irregular menstruation. However, if irregular menstruation is not carefully diagnosed and treated, it will inevitably progress to amenorrhea (cessation of menstruation) and signs of Blood exhaustion (depletion of essence and blood). Therefore, various discussions regarding amenorrhea, closed menses, and Blood exhaustion in women are collected below. This is the rationale behind the book's arrangement, which readers must understand.
The *Su Wen* states: The reason for absent menstruation is the closure of the Bao Mai (uterine vessels). The Bao Mai belongs to the Heart and connects to the uterus. Currently, Qi forces upward against the Lung, preventing Heart Qi from descending and communicating downward, thus causing the absence of menstruation.
The *Su Wen* states: Diseases of the Yang Ming (the meridians of the Stomach and Large Intestine) originate in the Heart and Spleen. If there are unspoken grievances or sorrows, women will experience amenorrhea. If the condition transmits and develops into "wind wasting" (emaciation as if dried by wind) or "panting rush" (rapid breathing and running sensation), it is a fatal and untreatable condition.
Shenzhai commented: The above two citations from classical texts explain the causes of amenorrhea in women: one belongs to the closure of the Bao Mai, and the other belongs to diseases of the Yang Ming meridians.