《上古天真论》曰∶“女子二七天癸至，任脉通，太冲脉盛，月事以时下，故有子。”盖天癸者，言后天
之阴气，阴气足而月事通，是即所谓月经也。正以女体属阴，其气应月。月以三旬而一虚，经以三旬而一至，
月月如期，经常不变，故谓之月经，又谓之月信。夫经者常也，一有不调，则失其常度，而诸病见矣。然经本
阴血，何脏无之？惟脏腑之血，皆归冲脉，而冲为五脏六腑之血海。故经言太冲脉盛，则月事以时下，此可
见冲脉为月经之本也。然血气之化，由于水谷，水谷盛则血气亦盛，水谷衰则血气亦衰。而水谷之海，又在阳
明。考之《痿论》曰∶“阳明者，五脏六腑之海，主润宗筋，宗筋主束骨而利机关也。冲
脉者，经脉之海也。主渗灌溪谷，与阳明合于宗筋，阴阳
总宗筋之会，会于气街，而阳明为之长。”是以男精女血，皆由前阴而降。此可见冲脉之血，又总由
阳明水谷之所化。而阳明胃气，又为经脉之本也。故月经之本，所重在冲脉；所重在胃气；所重在心脾生化之
源耳。其他如七情、六淫、饮食、起居之失宜者，无非皆心脾胃气之贼。何者当顾、何者当去？学人于此，当
知所从矣。
女人以血为主，血旺则经调而子嗣。身体之盛衰，无不肇端于此。故治妇人之病，当以经血为
先。而血之所主，在古方书皆言心主血、肝藏血、脾统血。故凡伤心、伤脾、伤肝者，均能为经脉之病。又
曰∶肾为阴中之阴，肾主闭藏；肝为阴中之阳，肝主疏泄。二脏俱有相火，其系上属于心，故心火一动，则相
火翕然从之，多致血不静而妄行，此固一说。然相火动而妄行者有之，由火之盛也；若中气脱陷及门户不固而
妄行者亦有之，此由脾肾之虚，不得尽言为火也。再如∶气道逆而不行者有之，由肝之滞也；若精血败而不
行者亦有之，此由真阴之枯竭。其证极多，不得误认为滞也。是固心、脾、肝、肾四脏之病，而独于肺脏多不
言及，不知血之行与不行，无不由气。如《经脉别论》曰∶“饮入于胃，游溢精气，上输于脾，脾气散精，上
归于肺，通调水道，下输膀胱。水精四布，五经并行，合于四时、五行、阴阳，揆度以为常也。”此言由胃达
脾，由脾达肺，而后传布诸经。故血脱者当益气，血滞者当调气。气主于肺，其义可知。是皆诸经之当辨者如
此。然其微甚本末，则犹有当辨者。盖其病之肇端，则
或由思虑，或由郁怒，或以积劳，或以六淫饮食。多起于心、肺、肝、脾四脏，及其甚也，则四脏相移，
必归脾肾。盖阳分日亏，则饮食日减，而脾气、胃气竭矣；阴分日亏，则精血日涸，而冲任肾气竭矣。故
予曰∶阳邪之至，害必归阴，五脏之伤，穷必及肾。此源流之必然，即治疗之要着。故凡治经脉之病，或
其未甚，则宜解初病，而先其所因。若其已剧，则必计所归，而专当顾本。甚至脾、肾大伤，泉源日涸，
由色淡而短少，由短少而断绝，此其枯竭已甚也。昧者无知，由云积血而通之、破
之，祸不旋踵矣。
《上古天真论》中说：“女子到了十四岁，天癸（指促进生殖机能成熟的物质）到来，任脉通畅，太冲脉旺盛，月经按时来潮，因此能够生育。”所谓天癸，是指后天的阴气，阴气充足则月经通畅，这就是所谓的月经。正因为女性身体属阴，其生理节律与月亮相应。月亮每三十天经历一次盈亏变化，月经也是每三十天左右来潮一次，每月如期而至，规律不变，所以称为月经，又被称为月信。经，意为常道、规律，一旦不调，就失去了正常的规律，各种疾病就会随之出现。然而，月经本质上是阴血，哪一脏没有血呢？只是脏腑之血，都汇聚于冲脉，而冲脉是五脏六腑血液汇聚的海穴。所以说太冲脉旺盛，月经就能按时来潮，由此可见冲脉是月经的根本。
但是，气血的化生来源于水谷精微，水谷充足则气血也旺盛，水谷匮乏则气血也衰弱。而受纳水谷的海穴，在于阳明胃经。考察《痿论》说：“阳明经，是五脏六腑的海穴，主要滋润宗筋（泛指前阴部的筋脉），宗筋主管约束骨骼并利于关节运动。冲脉，是十二经脉的海穴，主要渗透灌溉肌肉间隙，与阳明经会合于宗筋，阴阳总汇于宗筋，会合于气街穴，而阳明经在其中起主导作用。”因此，男子的精液和女子的血液，都是从前阴排出的。由此可见，冲脉中的血液，归根结底是由阳明胃经所化的水谷精微转化而来。而阳明胃气，又是经脉的根本。所以，月经的根本，关键在于冲脉；关键在于胃气；关键在于心脾生化气血的源头。其他的如七情（喜、怒、忧、思、悲、恐、惊）、六淫（风、寒、暑、湿、燥、火）、饮食、起居不当等因素，无非都是损害心脾胃气的贼邪。哪些应当顾护，哪些应当去除？学习中医的人在此应当知道取舍了。
女人以血为主，血液旺盛则月经调畅并能孕育子嗣。身体的盛衰，无不由此开始。所以治疗妇女的疾病，应当以调理经血为先。而血的主宰，在古代医书中都说心主血、肝藏血、脾统血。所以凡是伤心、伤脾、伤肝的，都能导致经脉病变。又说：肾为阴中之阴，肾主闭藏；肝为阴中之阳，肝主疏泄。这两脏都含有相火（寄居于肝肾之火），其经络上属于心，所以心火一动，相火便随之翕然兴起，多导致血液不宁静而妄行，这固然是其中一种说法。然而，相火妄动而致出血的，是由于火势过盛；如果是中气下陷及门户不固而导致的出血，则是由于脾肾虚弱，不能一概归咎于火。再比如：气机逆乱而不行的情况有，这是由于肝气郁滞；如果是精血败坏而不行的情况也有，这是由于真阴枯竭。这类证候极多，不能误认为是气滞。这确实是心、脾、肝、肾四脏的病变，唯独很少提及肺脏，却不知道血的运行与否，无不与气有关。如《经脉别论》说：“饮食物进入胃中，溢出精气，向上输送给脾，脾气散布精微，向上归于肺，通调水道，向下输送到膀胱。水精四布，五经并行，配合四时、五行、阴阳的变化，作为常态来衡量。”这是说由胃达脾，由脾达肺，然后传播到各条经脉。所以血脱者应当益气，血滞者应当调气。气主要由肺所主，其中的道理可以明白了。这些都是各条经脉应当辨析的地方。然而病情的轻重本末，还有应当辨析之处。大概疾病的起始，或者由于思虑过度，或者由于抑郁愤怒，或者由于积劳成疾，或者由于六淫侵袭和饮食不当。大多起于心、肺、肝、脾四脏，等到病情严重了，则四脏相互传变，最终必然归结于脾肾。因为阳分日渐亏损，则饮食日渐减少，脾气、胃气就会衰竭；阴分日渐亏损，则精血日渐枯竭，冲任二脉及肾气就会衰竭。所以我说道：阳邪入侵，危害必然归结于阴分；五脏受伤，穷尽必然波及肾脏。这是源流上的必然规律，也就是治疗的关键要点。所以凡是治疗经脉的疾病，如果病情尚不严重，应当解除初起的病邪，并先追究病因；如果病情已经严重，则必须考虑病势的归宿，专门顾护根本。甚至脾、肾大伤，水源日渐枯竭，表现为经色淡红且量少，由量少发展到断绝，这是枯竭非常严重的表现。无知的人，却说是瘀血积聚而用通利、破血的方法治疗，灾祸立刻就会降临。
The *Lingshu: Shanggu Tianzhen Lun* (Treatise on the Natural Truth of Antiquity) states: "When a girl reaches fourteen years of age, Tiangui (substances promoting reproductive maturation) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) flourishes. Menstruation occurs at regular intervals, thus enabling conception." By "Tiangui," it refers to postnatal Yin Qi (vital energy associated with Yin). When Yin Qi is sufficient, menstruation flows smoothly; this is what is meant by menstruation. Precisely because the female body belongs to Yin, its physiological rhythm corresponds to the moon. The moon undergoes a cycle of waxing and waning every thirty days, and menstruation also arrives approximately every thirty days. It comes monthly as scheduled, maintaining a constant regularity, hence it is called "Menstruation" (Yue Jing), also known as "Monthly Trust" (Yue Xin). "Jing" implies constancy or regularity. Once irregular, it loses its normal measure, and various diseases manifest. However, menstruation is fundamentally Yin Blood. Which Zang organ does not possess blood? It is merely that the blood of all Zang and Fu organs converges into the Chong Mai, which serves as the Sea of Blood for the Five Zang and Six Fu organs. Therefore, the text mentions that when the Chong Mai flourishes, menstruation occurs on time. This demonstrates that the Chong Mai is the root of menstruation.
Nevertheless, the transformation of Qi and Blood depends on Grain and Water (nutrients from food and drink). Abundant nutrients lead to abundant Qi and Blood; deficient nutrients lead to deficient Qi and Blood. The Sea of Grain and Water lies in the Yangming Stomach Channel. Examining the *Fei Lun* (Treatise on Flaccidity), it says: "The Yangming channel is the Sea of the Five Zang and Six Fu organs; it primarily moistens the Zong Jin (general term for tendons/membranes around the genitalia). The Zong Jin binds bones and facilitates joint movement. The Chong Mai is the Sea of the Meridians; it primarily infiltrates and irrigates the muscle spaces. It joins with the Yangming at the Zong Jin. Yin and Yang converge at the Zong Jin, meeting at the Qijie acupoint, with the Yangming taking the lead." Thus, male essence and female blood are both discharged from the anterior orifice. From this, we can see that the blood in the Chong Mai ultimately derives from the transformation of Grain and Water by the Yangming Stomach. And the Stomach Qi of Yangming is the root of the meridians. Therefore, regarding the root of menstruation, emphasis lies on the Chong Mai; emphasis lies on Stomach Qi; and emphasis lies on the source of transformation generated by the Heart and Spleen. Other factors such as emotional disturbances (Seven Emotions), pathogenic influences (Six Exogenous Factors), improper diet, and irregular lifestyle are nothing but thieves damaging the Qi of the Heart, Spleen, and Stomach. What should be protected and what should be eliminated? Students of medicine must understand how to proceed in this regard.
Women are governed by Blood. When Blood is robust, menstruation is regulated, and fertility is achieved. The flourishing or decline of the body invariably begins here. Therefore, in treating women's diseases, regulating menstrual blood should be the priority. Regarding the governance of Blood, ancient medical texts state that the Heart governs Blood, the Liver stores Blood, and the Spleen controls Blood. Thus, any injury to the Heart, Spleen, or Liver can cause meridian disorders. It is further stated: The Kidney is Yin within Yin and governs closure and storage; the Liver is Yang within Yin and governs dispersion and free flow. Both organs contain Xiang Huo (Ministerial Fire). Their channels connect upward to the Heart. Therefore, when Heart Fire stirs, Ministerial Fire rises vigorously with it, often causing Blood to become restless and bleed recklessly. This is indeed one perspective. However, while reckless bleeding due to stirring Ministerial Fire exists (caused by excessive Fire), there are also cases of reckless bleeding due to sinking of Middle Qi and failure of the orifices to secure, which stem from Spleen and Kidney deficiency. These cannot be entirely attributed to Fire. Furthermore, there are cases where the Qi mechanism is reversed and blocked, caused by Liver stagnation; and there are cases where Essence and Blood are degenerated and fail to flow, caused by exhaustion of True Yin. Such syndromes are numerous and must not be mistakenly identified as mere stagnation. These are indeed diseases of the Heart, Spleen, Liver, and Kidney, yet rarely mention the Lung. One fails to realize that the movement or immobility of Blood is inseparable from Qi. As the *Jingmai Bie Lun* (Separate Discussion on Meridians) states: "Drinking enters the Stomach, overflowing with essence and Qi, which is transported upward to the Spleen. The Spleen scatters the essence, sending it upward to return to the Lung. The Lung regulates water passages, transporting them downward to the Bladder. Water essence distributes in four directions, flowing through the five meridians, harmonizing with the Four Seasons, Five Elements, and Yin-Yang, serving as the standard for measurement." This describes the pathway from Stomach to Spleen, from Spleen to Lung, and then spreading to other meridians. Therefore, in cases of Blood depletion, one should tonify Qi; in cases of Blood stagnation, one should regulate Qi. Since Qi is primarily governed by the Lung, the principle is clear. These are the aspects of various meridians that require differentiation. However, regarding the severity, origin, and details, further differentiation is necessary. Generally, the onset of disease may arise from overthinking, depression/anger, chronic fatigue, or exposure to exogenous pathogens and dietary indiscretion. Most originate in the Heart, Lung, Liver, and Spleen. When the condition worsens, these four organs transmit the pathology, eventually converging on the Spleen and Kidney. If Yang levels decline daily, food intake decreases, leading to exhaustion of Spleen and Stomach Qi. If Yin levels decline daily, Essence and Blood dry up, leading to exhaustion of the Chong/Ren vessels and Kidney Qi. Hence, I say: When Yang pathogens arrive, harm inevitably returns to Yin; when the Five Zang are damaged, the extremity inevitably involves the Kidney. This is the inevitable course of origin and flow, and thus the key point of treatment. Therefore, when treating meridian diseases, if the condition is not severe, one should resolve the initial pathogen and address the primary cause first. If the condition is already critical, one must consider the destination of the disease and focus specifically on protecting the root. Even if the Spleen and Kidney are severely damaged, and the source dries up daily, manifesting as pale, scanty menses progressing to amenorrhea, this indicates extreme exhaustion. Ignorant practitioners, lacking knowledge, may claim it is accumulated blood and treat it with methods to promote flow or break stasis, bringing disaster upon themselves immediately.