赵养葵曰∶冲任藏精系胞，又恃一点命门之火，为
之主宰。火旺则红，火衰则淡，火太旺则紫，火太衰则白，所以滋水更当养火。甚有干枯不通者，虽曰火
盛之极，亦不宜以苦寒药降火，只宜大补其水，从天一之源，以养之使满。又曰∶紫与黑者，多属火旺，亦
有虚寒而黑色者，不可不察。若淡白，则无火明矣。
沈尧封曰∶王宇泰以寒则凝，既行而紫黑，定非寒证，然投热药，十中尝见一二。色白无火亦属近理，
然间有不宜补火者。尝见元和一妇，经水过期十日方至，色淡。稳婆据此，投肉桂药数剂，经水来多，遍
身发黄，不能饮食，身热脉数，竟成危候。此是丹溪所谓经水淡白属气虚一证。要之临证时须细察脉象，复
参旁证，方识虚实寒热。倘有疑似证中有两说者，先用其轻剂。如色淡一证，先用补气法不效，再投补火，
庶几无误。录叶氏之说于下。叶氏曰∶血黑属热，此其常也，亦有风寒外束者，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，尺脉迟，或微而虚，或大而无力。热则尺脉洪数，或实
而有力，参之脉证为的。
王孟英按∶色淡竟有属热者，古人从未道及，须以脉证互勘自得，但不可作实热论而泻以苦寒也。更
有奇者，方氏妇产后经色渐淡，数年后竟无赤色，且亦结块，平常亦无带下，人日 羸。余诊之，脉软数，
口苦，而时有寒热。与青蒿、白薇、黄柏、柴胡、当
归、鳖甲、龟版、芍药、乌 骨、杞子、地骨皮等，出入为方，服百剂而痊。此仅见之证矣。
滑伯仁曰∶经前脐腹绞痛，寒热交作，下如黑豆汁，两尺脉涩，余皆弦急。此寒湿搏于冲任，寒湿生
浊，下如豆汁，与血交争故痛，宜辛散苦温血药。
徐蔼辉曰∶辛散血药，是川芎之类；苦温血药，是艾叶之类。
李氏曰∶经水带黄混浊者，湿痰也。
丹溪曰∶经将行而痛者，气之滞也。用香附、青皮、桃仁、黄连；或用抑气散，四物加玄胡、丹皮、条
芩。又曰∶经将来，腹中阵痛，乍作乍止者，血热气实也。四物加川连、丹皮。
徐蔼辉曰∶抑气散出严氏。系香附四两，陈皮一两、茯神、炙草一两半也。为末，每服二钱。治妇人气
盛于血，变生诸证。头晕膈满，取《内经》“高者抑之”之义。汪 庵谓是方和平可用，若补血以平阳火，
亦正治也。
丹溪又曰∶经后作痛者，气血俱虚也，宜八珍汤。
丹溪又曰∶成块者，气之凝也。
沈尧封曰∶经前腹痛，必有所滞。气滞脉必沉，寒滞脉必紧，湿滞脉必濡，兼寒兼热，当参旁证。至若
风邪由下部而入于脉中，亦能作痛，其脉乍大乍小，有时隆起。叶氏用防风、荆芥、桔梗、甘草，虚者加人
参，各一钱焙黑，取其入血分，研末酒送，神效。
尧封又曰∶经前后俱痛，病多由肝经，而其中更有不同。脉弦细者，是木气之郁，宜逍遥散及川楝、小
茴香、橘核之类；脉大者，是肝风内动；体发红块者，是肝阳外越∶俱宜温润。戴礼亭室人，向患经前后腹
痛，连及右足，体发红块，脉大，右关尺尤甚。己卯秋，予作肝风内动治。用生地四钱，炒枸杞一钱，细
石斛二钱，杜仲二钱，干淡苁蓉一钱，麦冬一钱，牛膝一钱，归身一钱五分，炒白芍一钱，服之痛止。后
于经前后服数剂，经来甚适，不服即痛，因作丸服。此方屡用有验。
赵养葵说：冲脉和任脉贮藏精气并系连子宫，又依赖命门的一点真火作为主宰。火旺则经血色红，火衰则经血色淡，火太旺则经血色紫，火太衰则经血色白，所以滋养阴水时更应当养护命门之火。甚至有因干枯而导致经闭不通的，虽然说是火势极盛，也不宜用苦寒药物来降火，只应该大补其阴水，从先天之本（天一之源）入手，滋养使阴血充盈。他又说：经血色紫与黑，多属于火旺，也有因虚寒而呈黑色的，不可不仔细辨别。如果是淡白色，那就明显是没有火了。
沈尧封说：王宇泰认为寒则凝滞，既然行经后出现紫黑色，肯定不是寒证，然而使用热药治疗，十次中偶尔能成功一两次。色白无火也属近于真理的说法，但间或有不宜补火的情况。我曾见过元和地区一位妇女，月经过期十天将来，颜色淡。稳婆据此判断，投喂肉桂类药物几剂，结果月经量增多，全身发黄，不能进食，身体发热且脉搏快，最终成了危重证候。这是朱丹溪所说的经血色淡白属于气虚的一种证候。总之临证时必须仔细诊察脉象，再参考其他伴随症状，才能识别虚实寒热。如果有疑似证候中存在两种说法难以确定的，先使用轻缓的方剂。如色淡这一证候，先用补气法无效，再投用补火法，这样才差不多不会出错。记录叶氏的说法如下。叶氏说：血色黑属于热，这是常理，也有因风寒外束导致的，十次中偶尔能遇到一两次。因为寒主收引，小腹必定经常冷痛，行经时或手足厥冷，嘴唇青、面色白，尺脉迟，或微细而虚，或大而无力。热证则尺脉洪数，或实而有力，参考脉证即可确诊。
王孟英按语：经血色淡竟然有属于热证的，古人从未提及，必须通过脉证相互参验才能自行领悟，但不可当作实热证而用苦寒药物攻泻。更有奇特的案例，方氏妇人产后经色逐渐变淡，几年后竟然没有红色，而且也有结块，平时也没有白带，人日渐消瘦。我诊察她，脉软数，口苦，时而发冷发热。给予青蒿、白薇、黄柏、柴胡、当归、鳖甲、龟版、芍药、乌骨（指乌贼骨）、枸杞子、地骨皮等药物，加减组成方剂，服用一百剂而痊愈。这只是罕见的证候罢了。
滑伯仁说：经前脐腹绞痛，寒热交替发作，下血像黑豆汁一样，两尺脉涩，其余脉象弦急。这是寒湿搏结于冲任二脉，寒湿产生浊邪，下行如豆汁，与血液交争故引起疼痛，适宜用辛散苦温的血分药治疗。
徐蔼辉说：辛散血药，是川芎之类的药物；苦温血药，是艾叶之类的药物。
朱丹溪说：月经将要来时疼痛，是气机滞涩。用香附、青皮、桃仁、黄连；或者用抑气散，即四物汤加玄胡索、牡丹皮、黄芩。他又说：月经即将来潮，腹中阵发性疼痛，忽作忽止的，是血热气实。用四物汤加川黄连、牡丹皮。
徐蔼辉说：抑气散出自严氏。由香附四两，陈皮一两，茯神，炙甘草一两半组成。研为末，每次服用二钱。治疗妇人气盛于血，变生各种证候。头晕膈满，取《内经》“高者抑之”的含义。汪昂认为此方平和可用，若补血以平抑阳火，也是正治之法。
朱丹溪又说：经血有血块的，是气机凝滞所致。
沈尧封说：经前腹痛，必然有阻滞。气滞脉必沉，寒滞脉必紧，湿滞脉必濡，兼有寒热，应当参考其他伴随症状。至于风邪由下部进入脉中，也能引起疼痛，其脉象忽大忽小，有时隆起。叶氏用防风、荆芥、桔梗、甘草，体虚者加人参，各一钱焙黑，取其入血分，研成末用酒送服，效果神奇。
尧封又说：经前经后都疼痛，病多由肝经引起，而其中又有不同。脉弦细的，是木气郁结，适宜用逍遥散及川楝子、小茴香、橘核之类的药物；脉大的，是肝风内动；体表发红块的，是肝阳外越：都适宜用温润之法。戴礼亭的妻子，向来患有经前经后腹痛，牵连到右足，体表发红块，脉大，右关尺脉尤其明显。己卯年秋天，我按肝风内动治疗。用地黄四钱，炒枸杞子一钱，细石斛二钱，杜仲二钱，干淡苁蓉一钱，麦冬一钱，牛膝一钱，归身一钱五分，炒白芍一钱，服用后疼痛停止。后来在经前经后服用几剂，月经来潮非常顺畅，不服药就会疼痛，因此制成丸药服用。这个方子多次使用都有疗效。
Zhao Yangkui stated: The Chong and Ren meridians store essence and connect to the uterus, relying on a spark of Mingmen Fire (Fire of the Gate of Life) as their master. When fire is vigorous, the menstrual blood is red; when fire is deficient, it is pale; when fire is excessively vigorous, it is purple; when fire is excessively deficient, it is white. Therefore, nourishing Yin water should also involve nurturing fire. In cases of dryness leading to amenorrhea, although it may be described as extreme fire excess, one should not use bitter-cold herbs to descend fire, but rather greatly tonify Yin water, starting from the source of Tianyi (First Heaven/Pre-heaven), to nourish until fullness is achieved. He further stated: Purple and black colors mostly belong to fire excess, but there are also cases of black color due to deficiency-cold, which must be carefully distinguished. If the color is pale white, it is clearly devoid of fire.
Shen Yaofeng said: Wang Yutai believed that cold causes stagnation; since purple-black appears after menstruation, it is definitely not a cold syndrome. However, using hot herbs succeeds only occasionally, perhaps one or two times out of ten. The idea that pale color indicates lack of fire is also reasonable, yet there are occasional cases unsuitable for warming fire. I once observed a woman in Yuanhe whose menstruation was delayed by ten days and was pale. A midwife, based on this, administered several doses of Cinnamon Twig (Rougui). Consequently, her menstrual flow became profuse, her whole body turned yellow, she lost her appetite, developed fever and rapid pulse, eventually becoming critical. This is the syndrome Zhu Danxi referred to as pale-white menstrual blood belonging to Qi deficiency. In summary, during clinical practice, one must carefully examine the pulse and refer to accompanying symptoms to identify deficiency/excess and cold/heat. If there are doubtful cases with conflicting interpretations, first use mild formulas. For instance, in the case of pale color, if Qi-tonifying methods fail, then employ fire-warming methods, thus minimizing errors. I record Ye's statement below. Ye stated: Black blood belongs to heat, which is the norm, but there are also cases caused by external wind-cold constraint, occurring occasionally, perhaps one or two times out of ten. Since cold governs contraction, the lower abdomen will often feel cold and painful; during menstruation, hands and feet may be cold, lips cyanotic, and face pale; the Chi pulse at both wrists may be slow, or fine and deficient, or large and powerless. Heat syndromes present with a surging and rapid Chi pulse, or solid and forceful. Referencing pulse and symptoms confirms the diagnosis.
Wang Mengying added in commentary: Pale menstrual color can indeed belong to heat, a point never mentioned by ancients. One must deduce this through mutual verification of pulse and symptoms, but one must not treat it as excess-heat and purge it with bitter-cold herbs. There is an even more unusual case: Mrs. Fang’s menstrual color gradually lightened after childbirth, and years later completely lacked redness, accompanied by clots. She had no leukorrhea normally and grew increasingly emaciated. Upon examination, her pulse was soft and rapid, she had a bitter taste in her mouth, and experienced alternating chills and fever. I prescribed Qinghao (Artemisiae Annuae Herba), Baiwei (Cynanchi Atrati Radix), Huangbai (Phellodendri Cortex), Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Biejia (Testudinis Carapax et Plastrum), Guiban (Testudinis Carapax et Plastrum), Shaoyao (Paeoniae Radix), Wugu (Sepiae Endoconcha), Gouqi (Lycii Fructus), Digupi (Lycii Cortex), etc., modifying the formula as needed. After taking one hundred doses, she recovered. This is merely a rare syndrome.
Hua Borun stated: Before menstruation, colicky pain in the umbilical and abdominal region occurs with alternating chills and fever, and discharge resembles black bean juice. The Chi pulses are choppy, while others are wiry and urgent. This is cold-dampness contending in the Chong and Ren meridians. Cold-dampness generates turbidity, descending like bean juice, contending with blood, hence the pain. It is suitable to use acrid-dispersing and bitter-warm blood-invigorating herbs.
Xu Aihui stated: Acrid-dispersing blood herbs refer to things like Chuanxiong (Chuanxiong Rhizoma); bitter-warm blood herbs refer to things like Aiye (Artemisiae Argyi Folium).
Li Shi stated: Menstrual blood mixed with yellow turbidity is due to damp-phlegm.
Zhu Danxi stated: Pain before menstruation begins is due to Qi stagnation. Use Xiangfu (Cyperi Rhizoma), Qingpi (Citri Reticulatae Pericarpium Viride), Taoren (Persicae Semen), Huanglian (Coptidis Rhizoma); or use Yi Qi San (Suppress Qi Powder), which is Si Wu Tang (Four Substances Decoction) plus Yanzhu (Corydalis Rhizoma), Danpi (Moutan Cortex), and Tiaoqin (Scutellariae Radix). He also stated: Intermittent abdominal pain just before menstruation, appearing and disappearing, is due to blood-heat and Qi excess. Use Si Wu Tang plus Chuanlian (Coptidis Rhizoma - *Note: Text says Chuanlian but context implies Huanglian/Coptis or similar bitter cold herb, usually Huanglian in this context, but strictly translating text as Chuanlian/Coptis*) and Danpi.
Xu Aihui stated: Yi Qi San originates from Yan Shi. It consists of Xiangfu (Cyperi Rhizoma) four liang, Chenpi (Citri Reticulatae Pericarpium) one liang, Fushen (Poria cum Radix Pini) and Zhi Gancao (Prepared Glycyrrhizae Radix) one and a half liang. Pulverized, take two qian per dose. It treats women where Qi exceeds Blood, generating various syndromes such as dizziness and chest fullness, drawing on the meaning from *Neijing*: "For those high up, suppress them." Wang Ang considered this formula peaceful and usable; tonifying Blood to calm Yang fire is also a correct treatment method.
Zhu Danxi further stated: Pain after menstruation is due to joint deficiency of Qi and Blood, suitable for Ba Zhen Tang (Eight Treasures Decoction).
Zhu Danxi further stated: Clots indicate Qi condensation.
Shen Yaofeng stated: Abdominal pain before menstruation must involve some stagnation. Qi stagnation presents with a deep pulse; cold stagnation with a tight pulse; damp stagnation with a soggy pulse. If combined with cold and heat, refer to accompanying symptoms. Furthermore, Wind pathogen entering the vessels from the lower part can also cause pain, with a pulse that fluctuates between large and small, sometimes rising. Ye used Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Jiegeng (Platycodonis Radix), and Gancao (Glycyrrhizae Radix). For deficiency, add Renshen (Ginseng Radix et Rhizoma). Each herb roasted until black, one qian, ground into powder and taken with wine, yields miraculous effects.
Yaofeng further stated: Pain both before and after menstruation mostly stems from the Liver meridian, though differences exist. A wiry and fine pulse indicates Wood Qi depression, suitable for Xiao Yao San (Free and Easy Wanderer Powder) and herbs like Chuanlianzi (Toosendan Fructus), Xiaohuixiang (Foeniculi Fructus), and Juhe (Aurantii Fructus). A large pulse indicates internal stirring of Liver Wind. Red patches on the body indicate outward floating of Liver Yang. All these require warm-moistening methods. Dai Liting’s wife suffered from abdominal pain before and after menstruation radiating to the right leg, with red patches on the body, a large pulse especially prominent at the Right Guan and Chi positions. In autumn of the Ji Mao year, I treated her for internal stirring of Liver Wind. Using Shengdi (Rehmanniae Radix Preparata) four qian, fried Gouqi (Lycii Fructus) one qian, Xi Shihu (Dendrobii Caulis) two qian, Duzhong (Eucommiae Cortex) two qian, Gan Dansongrong (Cynomorii Rubri Caulis) one qian, Maidong (Ophiopogonis Radix) one qian, Niuxi (Achyranthis Bidentatae Radix) one qian, Guishen (Angelicae Sinensis Radix) one and a half qian, fried Baishao (Paeoniae Radix Alba) one qian. Pain ceased after administration. Later, taking several doses before and after menstruation resulted in smooth menses; without medication, pain returned, so pills were made. This formula has proven effective repeatedly.