经血为水谷之精气，和调于五脏，洒陈于六腑，乃能入于脉也。凡其源源而来，生化于
脾，总统于心，藏受于肝，宣布于肺，施泄于肾，以灌溉一身，在男子则化而为精，妇人则
上为乳汁，下归血海而为经脉。但使精气无损，情志调和，饮食得宜，则阳生阴长，而百脉
充实，又何不调之有？苟不知慎，则七情之伤为甚，而劳倦次之。又或为欲不谨，强弱相陵
，以致冲任不守者，亦复不少。此外则外感内伤，或医药误谬，但伤营气，无不有以致之。
凡人有衰弱多病，不耐寒暑，不胜劳役，虽先天禀弱者常有之，然有以气血方长，而纵情亏
损，或精血未满，而早为斫丧，致伤生化之源，则终身受害。此未病之先，所当深察而调之
者也。若欲调其既病，则惟虚实阴阳四者为要。丹溪曰∶先期而至者，血热也；后期而至者
，血虚也。王子亨曰∶阳太过则先期而至，阴不及则后时而来。其有乍多乍少，断绝不行，
崩漏不止，皆由阴阳盛衰所致，是固不调之大略也。然先期而至，虽曰有火，若虚而挟火，
则所重在虚，当以养营安血为主。矧亦有无火而先期者，则或补中气，或固命门，皆不宜过
用寒凉也。后期而至者，本属血虚，然亦有血热而燥瘀者，不得不为清补，有血逆而留滞者
，不得不为疏利。总之，调经之法，但欲得其和平，在详察其脉证耳。若形气脉气俱有余，
方可用清用利。然虚者极多，实者极少，故调经之要，贵在补脾胃以资血之源，养肾气以安
血之室。知斯二者，则尽善矣。若营气本虚，而不知培养，则未有不日枯而竭者，不可不察
也。凡经行之际，大忌寒凉等药，饮食亦然。
初虞世曰∶经以月至，有常也。其来过与不及，皆谓之病。若荣血亏损，不能滋养百骸
，则发落面黄，羸瘦燥热。燥气盛则金受邪，金受邪则为咳为嗽，为肺痈，为肺痿必矣。但
助胃壮气，则荣血生而经自行。若果怒气逆，经闭不行，当用行气破血之剂。
《褚氏遗书·精血篇》曰∶男子精未通而御女以通其精，则五体有不满之处，异日有难
状之疾。阴已痿而思色以降其精，则精不出而内败，小便涩而为淋。精已耗而复竭之，则大
小便牵痛，愈痛则愈便，愈便则愈痛。女人天癸既至，逾十年无男子合则不调，未逾十年，
思男子合亦不调。不调则旧血不出，新血误行，或渍而入骨，或变而为肿，后虽合而难子，
合多则沥枯虚人，产众则血枯杀人。观其精血，思过半矣。
《产宝方序论》曰∶妇人以血为基本，苟能谨于调护，则血气宣行，其神自清，月水如
期，血凝成孕。若脾胃虚弱，不能饮食，营卫不足，月经不行，肌肤黄燥，面无光泽，寒热
腹痛，难于子息，或带下崩漏，血不流行，则成瘕证。
薛立斋曰∶经云∶二阳之病发心脾，有不得隐曲，为女子不月。故心脾平和，则百骸、
五脏皆润泽，而经候如常。苟或心脾受伤，则血无所养，亦无所统，而月经不调矣。是故调经
者，当理心脾为主。丹溪先生亦曰∶先期而至者，血热也；后期而至者，血虚也。窃谓先期
而至者，有因脾经血燥，有因脾经郁火，有因肝经怒火，有因血分有热，有因劳役动火。过
期而至者，有因脾经血虚，有因肝经血虚，有因气虚血弱。主治之法，脾经血燥者，加味逍
遥散；脾经郁滞者，归脾汤；肝经怒火者，加味小柴胡汤；血分有热者，加味四物汤；劳役
动火者，补中益气汤。其过期而至者，若脾经血虚，宜人参养营汤；肝经血少，宜六味地黄
丸；气虚血弱，宜八珍汤。盖血生于脾，故云脾统血。凡血病当用苦甘之剂，以助其阳气而
生阴血，俱属不足也。大凡肝脾血燥，四物汤为主；肝脾血弱，补中益气汤为主；肝脾郁结
，归脾汤为主；肝经怒火，加味逍遥散为主。
又曰∶胃者，卫之源；脾者，荣之本。荣出中焦，卫出上焦。卫不足，益之必以辛；荣
不足，补之必以甘，甘辛相合，脾胃健而荣卫生，是以气血俱旺也。或因劳心，虚火妄动，
月经错行，宜安心补血泻火，此东垣先生治法也。
又曰∶人之少有老态，不耐寒暑，不胜劳役，四时迭病，皆因气血方长而劳心亏损，或
精血未满而早年斫丧。故其见证，难以名状。若左尺脉虚弱，或细数，是左肾之真阴不足也
，用六味丸；右尺脉迟软，或沉细而数欲绝，是命门之相火不足也，用八味丸；至于两尺微
弱，是阴阳俱虚，用十补丸。此皆滋其化源也，不可轻用黄柏、知母之类。设或六淫外侵而
见证，亦因其气内虚，而外邪溱集耳，尤宜用前药。
月经血是由饮食水谷转化而来的精气，在五脏中调和，散布于六腑，然后才能进入血脉。凡是源源不断生成的经血，其生化源于脾，统摄于心，贮藏受纳于肝，宣发布散于肺，施予排泄于肾，以此灌溉全身。在男子身上则转化为精液，在女子身上则上行为乳汁，下行归入血海而成为月经。只要精气不亏损，情志调和，饮食适宜，那么阳气生发、阴血增长，百脉就会充实，又怎么会不调呢？如果不知道谨慎保养，那么七情（喜、怒、忧、思、悲、恐、惊）的伤害最为严重，其次是劳倦过度。或者因为房事不节制，强弱相克，导致冲脉和任脉不能固守的情况，也不在少数。此外还有外感邪气和内伤因素，或者用药错误，只要损伤了营气，无不导致月经不调。凡是人体衰弱多病，不耐寒暑变化，不胜任劳役，虽然先天禀赋虚弱的人常有这种情况，但是也有气血正在生长旺盛时期，却放纵情欲造成亏损；或者精血尚未充盈，就过早地耗损，以致伤害了化生血液的源头，从而终身受害。这是在疾病发生之前，应当深入观察并加以调理的方面。如果想要调理已经发生的疾病，那么虚实阴阳四个方面是关键。朱丹溪说：月经先期而至的，是血热；月经后期而至的，是血虚。王子亨说：阳气太过则月经先期而至，阴气不足则月经后期而来。那些月经量忽多忽少，断绝不行，或者崩漏不止的，都是由阴阳盛衰所导致的，这大概是不调经的大致情况。然而月经先期而至，虽然说是因为有火，但如果属于虚证兼夹火热，那么重点在于虚证，应当以滋养营血、安固血液为主。况且也有没有火热而月经先期的，那么或者补益中气，或者固护命门，都不宜过用寒凉药物。月经后期而至，本来属于血虚，但也有因血热而燥结瘀滞的，不得不采用清补的方法；有因血逆而留滞的，不得不采用疏通利下的方法。总之，调理月经的方法，只要求得其平和，关键在于详细诊察脉象和症状。如果形体气质和脉象都表现为有余（实证），才可以采用清热或通利的方法。然而虚证极多，实证极少，所以调理月经的要领，贵在补益脾胃以资助血液的来源，养护肾气以安定血液的居所。懂得这两个方面，就尽善尽美了。如果营气本来就虚弱，却不知道培养，那么没有不日渐干枯枯竭的，不可不仔细考察。凡是在行经期间，非常忌讳使用寒凉等药物，饮食也是如此。
初虞世说：月经按月来潮，是有常度的。月经来得过多或过少，都称为病。如果营血亏损，不能滋养全身骨骼肢体，就会导致头发脱落、面色发黄、身体消瘦、干燥发热。燥气旺盛则金（肺）受到邪气侵袭，肺受邪气就会咳嗽，必然发展为肺痈或肺痿。只要帮助胃气、壮大气气，那么营血就会生成，月经自然通畅。如果是确实因怒气逆乱导致闭经，应当使用行气破血的方剂。
《褚氏遗书·精血篇》说：男子精气未通之时就与女子交合以泄精，那么身体各部分都会有不完善的地方，日后会有难以形容的疾病。阴茎已经痿软还想追求女色以泄精，那么精液排不出而在体内败坏，小便涩痛变成淋证。精液已经耗损却又进一步竭尽，那么大和小便都会牵拉疼痛，越痛越想排便，越排便越痛。女子天癸（促进生殖功能发育成熟的物质）已经到来，超过十年没有男子交合就会月经不调，未满十年，思念男子想要交合也会月经不调。月经不调则旧血不能排出，新血误行，或者渗入骨头，或者变为肿胀，后来即使交合也难以怀孕，交合过多则会沥干精气使人体虚弱，生产众多则会导致血枯杀人。观察精血的关系，思考一半以上的道理也就明白了。
《产宝方序论》说：妇女以血为基本，如果能谨慎调护，那么气血宣通运行，精神自然清爽，月经如期而至，血液凝结而成孕。如果脾胃虚弱，不能进食，营卫之气不足，月经就不行，肌肤黄燥，面无光泽，寒热腹痛，难以受孕，或者带下崩漏，血液不流通，就会形成瘕证（腹内结块）。
薛立斋说：医经说：阳明经的病发于心脾，有难以启齿的隐曲之疾，导致女子不来月经。所以心脾平和，那么全身骨骼、五脏都得到润泽，月经正常。如果心脾受伤，那么血液无所滋养，也无所统摄，月经就不调了。因此调理月经，应当以调理心脾为主。丹溪先生也说：月经先期而至的是血热；月经后期而至的是血虚。我认为月经先期而至，有的因脾经血燥，有的因脾经郁火，有的因肝经怒火，有的因血分有热，有的因劳役动火。过期而至的，有的因脾经血虚，有的因肝经血虚，有的因气虚血弱。主治的方法：脾经血燥者，用加味逍遥散；脾经郁滞者，用归脾汤；肝经怒火者，用加味小柴胡汤；血分有热者，用加味四物汤；劳役动火者，用补中益气汤。过期而至的，如果脾经血虚，宜用人参养营汤；肝经血少，宜用六味地黄丸；气虚血弱，宜用八珍汤。因为血生于脾，所以说脾统血。凡是血病应当用苦甘味的药剂，以助其阳气而生阴血，都属于不足证。大凡肝脾血燥，以四物汤为主；肝脾血弱，以补中益气汤为主；肝脾郁结，以归脾汤为主；肝经怒火，以加味逍遥散为主。
又说：胃是卫气的源头，脾是荣气的根本。荣气出于中焦，卫气出于上焦。卫气不足，补充它必须用辛味药；荣气不足，补益它必须用甘味药，甘辛相结合，脾胃健运而荣卫生成，所以气血都旺盛。或者因为劳心，虚火妄动，月经错乱，应当安心补血泻火，这是东垣先生的治疗方法。
又说：人稍微显出老态，不耐寒暑，不胜劳役，四季交替时生病，都是因为气血正在生长时劳心亏损，或者精血未满就早年耗损。所以其见证，难以名状。如果左尺脉虚弱，或者细数，这是左肾真阴不足，用六味丸；右尺脉迟软，或者沉细而数近乎消失，这是命门相火不足，用八味丸；至于两尺脉微弱，是阴阳俱虚，用十补丸。这些都是滋养生化的源头，不可轻易使用黄柏、知母之类的药物。假设是六淫（风、寒、暑、湿、燥、火）外侵而出现见证，也是因为体内气虚，外邪聚集所致，尤其适宜使用前文提到的药物。
Menstrual blood is the essence and qi transformed from food and drink. It is harmonized within the five Zang organs, distributed to the six Fu organs, and only then can it enter the vessels. The continuous flow of menstrual blood originates in its generation from the Spleen, is controlled by the Heart, stored and received by the Liver, disseminated by the Lung, and excreted by the Kidney, thereby irrigating the whole body. In men, it transforms into essence (Jing); in women, it ascends as breast milk and descends into the Sea of Blood (Chong and Ren meridians) to become menstruation. As long as essence and qi are not depleted, emotions are harmonious, and diet is appropriate, Yang generates and Yin grows, filling all vessels; how could there be irregularity? If one fails to exercise caution, injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) is most severe, followed by fatigue and overexertion. Alternatively, imprudence in sexual activity, where weakness is overcome by strength, leads to failure of the Chong and Ren meridians to maintain control, which is also common. Furthermore, external contractions and internal injuries, or medical errors that damage Ying Qi (Nutritive Qi), invariably cause such disorders. Individuals who are weak, prone to illness, intolerant of cold and heat, and unable to bear physical labor often have congenital deficiency. However, some suffer depletion due to indulgence during youth when Qi and Blood are growing, or premature exhaustion before Jing and Blood are fully mature, damaging the source of transformation and generation, resulting in lifelong harm. This is what must be carefully observed and regulated before disease occurs. To regulate established disease, the key lies in distinguishing Deficiency, Excess, Yin, and Yang. Zhu Danxi stated: Menstruation arriving early indicates Blood Heat; arriving late indicates Blood Deficiency. Wang Ziheng stated: Excessive Yang causes early arrival; insufficient Yin causes late arrival. Cases of fluctuating volume, cessation, metrorrhagia, or metrorrhagia with flooding are all caused by the rise and fall of Yin and Yang; this constitutes the general overview of menstrual irregularities. Although early arrival is often attributed to Fire, if it is a Deficiency pattern accompanied by Fire, the focus should be on Deficiency, primarily nourishing Ying Qi and stabilizing Blood. Moreover, there are cases of early arrival without Fire, where tonifying Middle Qi or securing the Gate of Vitality (Mingmen) is required, avoiding excessive use of Cold-Cooling herbs. Late arrival is fundamentally Blood Deficiency, but may also involve Dryness and Stasis due to Blood Heat, requiring Clearing and Tonification; or Blood Rebellion and stagnation, requiring Dispersion and Purging. In summary, the method of regulating menstruation seeks harmony, relying on detailed observation of pulse and symptoms. Only when both constitution and pulse indicate Excess should Clearing and Purging methods be used. Since Deficiency is very common and Excess is rare, the essence of regulating menstruation lies in tonifying the Spleen and Stomach to nourish the source of Blood, and nurturing Kidney Qi to secure the residence of Blood. Understanding these two aspects achieves perfection. If Ying Qi is inherently deficient and not cultivated, it will inevitably wither and exhaust itself; this must be carefully noted. During menstruation, Cold-Cooling medicines and foods are strictly contraindicated.
Chu Yushi said: Menstruation arrives monthly according to a fixed rhythm. Deviations in amount or timing are considered pathological. If Ying Blood is depleted and cannot nourish the bones and limbs, it manifests as hair loss, sallow complexion, emaciation, and dry heat. When Dryness is prevalent, Metal (Lung) is attacked by pathogens, leading to cough, expectoration, lung abscess (Fei Yong), or lung flaccidity (Fei Wei). Strengthening Stomach Qi and boosting Qi will generate Ying Blood and normalize menstruation. If amenorrhea is caused by rebellious Qi from anger, formulas that move Qi and break Blood stasis should be used.
The "Essence and Blood Chapter" of *Chu Shi's Remnant Books* states: If men engage in intercourse before their essence is fully developed, their bodies will remain incomplete, leading to unnamable diseases later in life. If one engages in intercourse while impotent, the essence remains inside and rots, causing painful urination resembling strangury (Lin syndrome). If essence is already exhausted and further drained, it causes pain in defecation and urination; the more painful, the more frequent the urge, and vice versa. For women, if ten years pass after the arrival of Tian Gui (Menstrual Essence) without intercourse, menstruation becomes irregular. Even within ten years, longing for intercourse can cause irregularity. Irregularity prevents old blood from exiting and causes new blood to flow erratically, potentially seeping into bones or causing swelling. Subsequent intercourse may fail to produce offspring. Excessive intercourse depletes essence and weakens the person; multiple births deplete blood and can be fatal. Observing the relationship between essence and blood reveals half the truth.
The Preface to *Chan Bao Fang* states: Women are based on Blood. With careful regulation, Qi and Blood circulate freely, spirit remains clear, menstruation is regular, and conception occurs through blood coagulation. If Spleen and Stomach are weak, appetite is poor, Ying and Wei Qi are insufficient, menstruation ceases, skin is yellow and dry, face lacks luster, there is alternating chills and fever, abdominal pain, difficulty conceiving, leukorrhea, flooding, or stagnant blood forming masses (Jia Zheng).
Xue Lizhai said: The Classics state: Diseases of the Two Yang meridians originate in the Heart and Spleen; hidden difficulties lead to amenorrhea in women. Thus, when Heart and Spleen are harmonious, the body and five Zang organs are moistened, and menstruation is normal. If Heart and Spleen are injured, Blood lacks nourishment and control, leading to irregular menstruation. Therefore, regulating menstruation should focus on regulating Heart and Spleen. Mr. Danxi also stated: Early arrival indicates Blood Heat; late arrival indicates Blood Deficiency. I believe early arrival may result from Spleen channel Blood dryness, Spleen channel depressed Fire, Liver channel angry Fire, Heat in the Blood level, or Fire stirred by labor. Late arrival may result from Spleen channel Blood Deficiency, Liver channel Blood Deficiency, or Qi Deficiency with weak Blood. Treatment methods: For Spleen channel Blood dryness, use Modified Xiao Yao San; for Spleen channel depression, use Gui Pi Tang; for Liver channel angry Fire, use Modified Xiao Chai Hu Tang; for Heat in the Blood level, use Modified Si Wu Tang; for Fire stirred by labor, use Bu Zhong Yi Qi Tang. For late arrival due to Spleen channel Blood Deficiency, use Ren Shen Yang Rong Tang; for Liver channel Blood insufficiency, use Liu Wei Di Huang Wan; for Qi Deficiency and weak Blood, use Ba Zhen Tang. Since Blood is generated by the Spleen, it is said that the Spleen controls Blood. Blood diseases require Bitter-Sweet formulas to assist Yang Qi and generate Yin Blood, as they are generally Deficiency patterns. Generally, for Liver-Spleen Blood dryness, Si Wu Tang is primary; for Liver-Spleen Blood weakness, Bu Zhong Yi Qi Tang is primary; for Liver-Spleen depression, Gui Pi Tang is primary; for Liver channel angry Fire, Modified Xiao Yao San is primary.
He also stated: The Stomach is the source of Wei Qi (Defensive Qi); the Spleen is the root of Ying Qi (Nutritive Qi). Ying Qi arises from the Middle Jiao, and Wei Qi from the Upper Jiao. Insufficient Wei Qi requires Pungent herbs for supplementation; insufficient Ying Qi requires Sweet herbs for tonification. The combination of Sweet and Pungent strengthens the Spleen and Stomach, generating Ying and Wei Qi, thus ensuring abundant Qi and Blood. If mental exertion causes erratic movement of Deficient Fire and menstrual disorder, calming the mind, nourishing Blood, and clearing Fire is indicated, following Mr. Dongyuan’s method.
He further stated: Premature aging, intolerance to cold and heat, inability to bear labor, and seasonal illnesses often stem from mental strain during youth when Qi and Blood are developing, or premature depletion before Jing and Blood are mature. Consequently, symptoms are difficult to describe. A weak or fine-rapid pulse at the Left Chi position indicates insufficiency of True Yin in the Left Kidney; treat with Liu Wei Wan. A slow-soft or deep-fine-rapid-almost-absent pulse at the Right Chi position indicates insufficiency of Ministerial Fire in the Mingmen; treat with Ba Wei Wan. A weak pulse at both Chi positions indicates dual deficiency of Yin and Yang; treat with Shi Bu Wan. These methods nourish the source of transformation. Do not lightly use herbs like Huang Bo (Phellodendron Bark) or Zhi Mu (Anemarrhena Rhizome). Even if Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) invade externally, it is because internal Qi is deficient allowing external pathogens to gather; thus, the aforementioned medicines are particularly suitable.