物柴胡汤。热甚。服此不平者。加干姜灰神效。经闭发热咽燥。唇干脉实者。四物凉膈散。张介宾曰。血枯血隔本不同。
盖隔者阻隔。枯者枯竭。阻隔者邪气隔滞。血有所逆也。枯竭者冲任亏败。源断其流也。凡妇女病损。至旬月半载之间。
未有不经闭者。正因阴竭所以血枯。枯之为义。无血而然。故或羸弱。或困倦。或咳嗽。或血热。或饮食减少。或亡血
失血。及一切无胀无痛无阻无隔。而经有久不至者。皆血枯经闭之候。欲其不枯。无如养荣。欲以通之。无如充之。（此
诚要义）但使血行。则经脉自至。乃医者不论有滞无滞。多兼开导之药。其有甚者。则专以桃仁、红花之类通利为事。
岂知血滞者可通。血枯者不可通乎。是宜知之矣。
经血暴下 成无己曰。妇人年及五十以上。经血暴下者。妇人经血终于七七之数。数外暴下。内经曰。火主暴
速。亦因暴喜暴怒忧结惊恐之致。切不可作冷病治。用峻热药。必死。止可用黄连解毒汤。以清于上。更用莲壳灰、棕
柴胡汤。若热势极盛，服用此方后病情未平复的，加入干姜灰有显著疗效。月经闭止且伴有发热、咽喉干燥、嘴唇干裂、脉象实大的，使用四物凉膈散。张介宾说：血枯与血隔原本不同。
所谓“隔”，是指阻隔；所谓“枯”，是指枯竭。阻隔是由于邪气阻滞，导致血液运行逆乱；枯竭则是冲任二脉亏损败坏，源头断绝了血流。凡是妇女患病损耗，在十天到半年之间，没有不出现月经闭止的。正是因为阴液枯竭所以导致血枯。枯的含义，是因为无血而形成的。所以有的身体瘦弱，有的困倦乏力，有的咳嗽，有的血热，有的饮食减少，有的失血或大出血，以及一切没有胀满、疼痛、阻滞、阻隔症状，而月经长久不来的，都是血枯经闭的征候。想要使血不枯竭，不如滋养营血；想要使其通畅，不如充盈血液。（这确实是关键要义）只要使血液运行，那么经脉自然就会来潮。然而医生不论是否有瘀滞，大多兼用开导疏通的药物。其中严重的，则专门以桃仁、红花之类药物进行通利治疗。哪里知道血滞的可以疏通，血枯的却不可强行疏通呢？这是应当知晓的。
经血暴下 成无己说：妇人年龄到了五十岁以上，经血突然大量下行的，因为妇人的经血在七七四十九岁之数时终结。超出这个年龄突然下行，《内经》说：火性主暴速。这也是由于突然大喜、大怒、忧结、惊恐等原因导致的。切不可当作冷病治疗，使用峻烈的热药，必然致死。只能使用黄连解毒汤，以清上焦之火；更用莲壳灰、棕……
Chaihu Tang (Bupleurum Decoction). If the heat is severe and taking this prescription does not bring relief, adding calcined dried ginger root (Ganjiang Hui) yields miraculous effects. For amenorrhea accompanied by fever, dry throat, dry lips, and a full pulse, Siwu Liangge San (Four Substances Cool the Chest Powder) is used. Zhang Jiebin stated: Blood deficiency (Xueku) and blood obstruction (Xuege) are fundamentally different.
"Obstruction" refers to blockage; "deficiency" refers to exhaustion. Obstruction is caused by pathogenic factors stagnating, leading to rebellious flow of blood. Exhaustion results from the depletion and failure of the Chong and Ren vessels, where the source of blood flow is cut off. In cases of women's diseases involving damage, within a period of ten days to half a year, amenorrhea invariably occurs. This is precisely because yin exhaustion leads to blood deficiency. The meaning of "deficiency" arises from the absence of blood. Thus, some present with emaciation, some with fatigue, some with cough, some with blood-heat, some with reduced appetite, some with hemorrhage or loss of blood, and all those without distension, pain, stagnation, or blockage, yet whose menstruation has been absent for a long time, are signs of amenorrhea due to blood deficiency. To prevent deficiency, nothing is better than nourishing Ying (nutritive Qi); to promote flow, nothing is better than replenishing [blood]. (This is indeed a crucial principle.) As long as blood circulation is restored, the menses will naturally arrive. However, physicians often indiscriminately add herbs that open and guide [flow], regardless of whether there is stagnation or not. In severe cases, they focus exclusively on promoting flow using substances like Tao Ren (Peach Seed) and Hong Hua (Safflower). How could they know that blood stagnation can be unblocked, but blood deficiency cannot be forcibly promoted? This is something one must understand.
Sudden Profuse Menstrual Bleeding Cheng Wuji said: When women reach the age of fifty or above, sudden profuse menstrual bleeding occurs because a woman's menses should end at the number of seven sevens (49 years). Sudden bleeding beyond this number, according to the *Neijing* (Inner Canon), is attributed to Fire, which governs suddenness and speed. It may also result from sudden joy, anger, sorrowful constraint, or fright. One must absolutely not treat it as a cold syndrome using harsh hot medicines, as this will certainly lead to death. Instead, only Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) should be used to clear heat in the upper jiao, followed by lotus seedpod ash, palm fiber ash...