丹溪曰无子之因多起于父气之不足岂可独归罪于母血之虚寒况母之血病奚止虚与寒而已
哉然
古方治妇人无子惟秦桂丸一方其性热其辞确今之欲得子者率皆服之无疑夫求子于阴血何至轻
用热剂耶或曰春气温和则物生冬气寒凛则物消不假热剂何由子脏得暖而成胎予曰诗言妇人和
平则乐有子和则血气不争平则阴阳不乖今得此丸经血必转紫黑渐成衰少或先或后始则饮食骤
进久则口苦舌干阴阳不平血气不和焉能成胎纵使有成子亦多病以其能损真阴也郑宪史子生七
个月得淋(云云见淋 门)
谨按妇人无子多因经血不调或阴虚血少积聚痰气嗜欲等致种种不同奚止虚与寒而已然经
寒者
亦有之但不可例为常法尔是以先生论此戒后人不得病机之的者斯药勿妄行也况无子之因亦岂
止于妇室者如东垣云李和叔问中年以来得一子至一岁之后身生红丝瘤不救后三四子至一二岁
皆病瘤而宛何缘至此疾翌日思之谓曰汝乃肾中伏火精气中多有红丝以气相传生子故有此疾俗
名胎瘤是也汝试视之果如其言遂以滋肾丸数服以泻肾中火邪补真阴不足忌酒辛热之物其妻与
六味地黄丸以养阴血受胎五月之后以黄芩白术二味作散啖五七服后生子至三岁前证不复作今
已年壮噫合观先生以上所论则其旨深矣
局方四物汤治冲任虚损月水不调脐腹 痛
当归 川芎 白芍药 熟地黄(各等分)
上 咀每半两水煎服
按此手足太阴厥阴药也
逍遥散治血虚烦热月水不调脐腹胀痛痰嗽潮热
甘草(炙半两) 当归 茯苓 白芍 白术 柴胡(各一两)
上 咀每半两入姜薄荷叶煎服
按此足三阳三阴药也散血中湿热之剂
胶艾汤治劳伤血气冲任虚损月水过多淋漓不断
阿胶(炒) 川芎 甘草(炙各二两) 当归 艾叶(炒各三两) 熟地黄 白芍(各四两)
上 咀每半两水煎
按此温经补血之药也厥阴例
良方温经汤治妇人血海虚寒月水不利
当归 川芎 芍药 桂心 牡丹皮 莪术(各半两) 人参 甘草 牛膝(各一两)
上 咀每五钱水煎服
姜黄散治血脏久冷月水不调脐腹刺痛
当归 牡丹皮 延胡(各二两) 芍药(三两) 川芎 红花 桂心 莪术(各一两) 川姜
黄(四两)
上为末每一钱水煎服酒同煎
按此二方通经之剂破血之药非止于温经也脏冷气血滞者可用姑存之
加减四物汤
经候微少渐渐不通手足烦疼渐瘦生潮热脉微数本方去地黄川芎加泽兰叶三倍甘草半分
经候过多本方去熟地黄加生地黄
经行身热脉数头昏本方加柴胡黄芩各半两
经行微少或胀或疼四肢疼痛加延胡没药白芷与本方等淡醋汤调下末子
经候不调心腹 痛只用芎归二味名君臣散
鹿茸丸治冲任虚损又为风寒所乘尺脉微小甚者可灸关元穴
鹿茸(炙) 赤石脂 禹余粮(各一两) 续断(二两) 柏叶 附子(炮) 熟地黄 当归(
酒浸) 艾叶
上为末酒糊丸梧子大每五十丸空心温酒下
按此足少阴厥阴药也今人多用之故收入治血虚湿胜带下甚捷
元戎加味四物汤
气充经脉故月事频并脐下多痛本方加芍药
经欲行脐腹绞痛本方加玄胡槟榔苦楝木香
经水过多本方加黄芩白术
经水涩少本方加葵花红花
经水适来适断或有往来寒热宜先服小柴胡去寒热后以物汤和之
丹溪加味四物汤
经候过而作疼血气俱虚也宜本方对四君子汤服之
经候将来作痛者血实也本方加桃仁黄连香附
经水不及期血热也本方加黄连
过期血少也本方加参术带痰加半夏陈皮
过期紫黑有块者血热也必作痛本方加香附黄连过期而淡色者痰多也芎归二味合二陈汤服
紫色成块者热也本方加黄连柴胡
肥人不及日数而多痰者多血虚有热本方加香附南星半夏黄连白术
瘦人血枯经闭者本方加桃仁红花或越鞠丸(方见血门)
简易当归散治经候不匀或三四月不行或一月再至或妇人天癸过期经脉不调
当归 川芎 白芍 黄芩 白术(各半两) 山茱萸肉(一两半)
上为末每二钱空心温酒调下日三次
按此足厥阴少阴药也
宝鉴生地黄丸治妇人血实厥阴脉弦而长病恶风体倦乍寒乍热面赤心忪或时自汗如伤寒状
宜服抑阴药
生地黄 柴胡 秦艽 黄芩(各半两) 芍药(一两)
上末蜜丸梧子大每三十丸乌梅汤吞下日三次
按此手足少阴太阴足太阳药也
谨按以上诸方皆调理法也然血分成水气肠覃等证详见各门兹不备录大抵经病实者破之结
者散之虚者补之要在适事为故也
丹溪先生说:无子的原因多起于父亲精气不足,怎么能只归罪于母亲血虚寒呢?况且母亲的血病哪里止于虚和寒而已呢?然而古方治疗妇人无子只有秦桂丸一方,它的药性热,言辞确切。现在想要得子的人,都服用它,毫无疑问。但是求子于阴血,何至于轻率使用热剂呢?有人说:春天气候温和则万物生长,冬天气候寒冷则万物消亡,不借助热剂,子宫怎能温暖而受孕?我说:《诗经》说妇人平和则快乐,有子和顺则血气不争,平和则阴阳不乖乱。现在得到此丸,经血必然转为紫黑色,逐渐衰少,或先或后。开始饮食突然增加,久了口苦舌干,阴阳不平,血气不和,怎么能成胎?纵使有成胎的,也多生病,因为它能损伤真阴。郑宪史的儿子七个月时得了淋证(详见淋门)。
谨按:妇人无子多因经血不调,或阴虚血少、积聚痰气、嗜欲等导致,种种不同,哪里止于虚与寒而已?然而经血寒的也有,但不可作为常规法则。所以先生论述此点,告诫后人不得病机确切的,不要妄用此药。况且无子的原因又岂止在妇人方面?如东垣先生说:李和叔问中年以来得一子,到一岁之后身上生红丝瘤,不能救治。后来三四生子,到一二岁都病瘤,为什么会有这种疾?第二天思考后对他说:“你是肾中伏火,精气中多有红丝,以气相传生子,所以有此疾。”俗名胎瘤。你试着看看,果然像他说的。于是用滋肾丸几服以泻肾中火邪,补真阴不足,忌酒辛热之物。他的妻子用六味地黄丸以养阴血,受胎五月之后,用黄芩、白术二味作散吃五七服,后来生子至三岁前证不再发作。现在已经年壮。唉!综合观看先生以上所论,其旨意深远啊。
局方四物汤治冲任虚损,月水不调,脐腹疼痛。
当归、川芎、白芍药、熟地黄(各等分)。
上为粗末,每半两,水煎服。
按:这是手足太阴、厥阴的药。
逍遥散治血虚烦热,月水不调,脐腹胀痛,痰嗽潮热。
甘草(炙半两)、当归、茯苓、白芍、白术、柴胡(各一两)。
上为粗末,每半两,入姜、薄荷叶煎服。
按:这是足三阳、三阴的药,是散血中湿热之剂。
胶艾汤治劳伤血气,冲任虚损,月水过多,淋漓不断。
阿胶(炒)、川芎、甘草(炙各二两)、当归、艾叶(炒各三两)、熟地黄、白芍(各四两)。
上为粗末,每半两,水煎。
按:这是温经补血之药,属厥阴例。
良方温经汤治妇人血海虚寒,月水不利。
当归、川芎、芍药、桂心、牡丹皮、莪术(各半两)、人参、甘草、牛膝(各一两)。
上为粗末,每五钱,水煎服。
姜黄散治血脏久冷,月水不调,脐腹刺痛。
当归、牡丹皮、延胡索(各二两)、芍药(三两)、川芎、红花、桂心、莪术(各一两)、川姜黄(四两)。
上为末,每一钱,水煎服,酒同煎。
按:这两方是通经之剂,破血之药,不止于温经。脏冷气血滞者可用,姑且存录。
加减四物汤
经候微少,渐渐不通,手足烦疼,渐瘦,生潮热,脉微数。本方去地黄、川芎,加泽兰叶三倍,甘草半分。
经候过多。本方去熟地黄,加生地黄。
经行身热,脉数,头昏。本方加柴胡、黄芩各半两。
经行微少,或胀或疼,四肢疼痛。加延胡索、没药、白芷,与本方等量,淡醋汤调下末子。
经候不调,心腹疼痛。只用芎、归二味,名君臣散。
鹿茸丸治冲任虚损,又为风寒所乘,尺脉微小,甚者可灸关元穴。
鹿茸(炙)、赤石脂、禹余粮(各一两)、续断(二两)、柏叶、附子(炮)、熟地黄、当归(酒浸)、艾叶。
上为末,酒糊丸梧子大,每五十丸,空心温酒下。
按:这是足少阴、厥阴的药。今人多用之,故收入。治血虚湿胜带下甚捷。
元戎加味四物汤
气充经脉,故月事频并,脐下多痛。本方加芍药。
经欲行,脐腹绞痛。本方加玄胡索、槟榔、苦楝、木香。
经水过多。本方加黄芩、白术。
经水涩少。本方加葵花、红花。
经水适来适断,或有往来寒热。宜先服小柴胡汤去寒热,后以元戎加味四物汤和之。
丹溪加味四物汤
经候过而作疼,血气俱虚也。宜本方对四君子汤服之。
经候将来作痛者,血实也。本方加桃仁、黄连、香附。
经水不及期,血热也。本方加黄连。
过期血少也。本方加参、术。带痰加半夏、陈皮。
过期紫黑有块者,血热也,必作痛。本方加香附、黄连。过期而淡色者,痰多也。芎、归二味合二陈汤服。
紫色成块者,热也。本方加黄连、柴胡。
肥人不及日数而多痰者,多血虚有热。本方加香附、南星、半夏、黄连、白术。
瘦人血枯经闭者。本方加桃仁、红花,或越鞠丸(方见血门)。
简易当归散治经候不匀,或三四月不行,或一月再至,或妇人天癸过期,经脉不调。
当归、川芎、白芍、黄芩、白术(各半两)、山茱萸肉(一两半)。
上为末,每二钱,空心温酒调下,日三次。
按:这是足厥阴、少阴的药。
宝鉴生地黄丸治妇人血实,厥阴脉弦而长,病恶风,体倦,乍寒乍热,面赤,心忪,或时自汗,如伤寒状。宜服抑阴药。
生地黄、柴胡、秦艽、黄芩(各半两)、芍药(一两)。
上为末,蜜丸梧子大,每三十丸,乌梅汤吞下,日三次。
按:这是手足少阴、太阴,足太阳的药。
谨按:以上诸方皆调理法也。然血分成水气、肠覃等证,详见各门,兹不备录。大抵经病实者破之,结者散之,虚者补之,要在适事为故也。
Danxi stated: The causes of infertility often stem from the insufficiency of the father's essence and qi. How can one solely blame the mother's deficiency and coldness of blood? Moreover, disorders of maternal blood are not limited to deficiency and cold alone. However, among ancient prescriptions for treating female infertility, there is only one formula, Qin Gui Wan (Qin Cinnamon Pill), which has a hot nature and its description is precise. Nowadays, those seeking conception invariably take it without doubt. Yet, when seeking conception through yin blood, why resort lightly to hot agents? Some argue: In spring, the climate is mild, so things grow; in winter, the climate is biting cold, so things perish. Without hot agents, how can the uterus become warm enough to conceive? I say: The *Classic of Poetry* states that when a woman is peaceful, she finds joy; when there is harmony with her husband, blood and qi do not contend, and peace ensures yin and yang do not deviate. If one takes this pill now, menstrual blood will likely turn purple-black, gradually diminish, and become irregular in timing. Initially, appetite may increase suddenly, but later, bitterness in the mouth and dryness of the tongue will occur. With disharmony of yin and yang, and disordered blood and qi, how can conception occur? Even if conception does happen, the offspring will likely be prone to illness because such agents damage true yin. For instance, Vice-Administrator Zheng’s son developed stranguria (see Stranguria section) at seven months old.
In careful observation: Female infertility is mostly due to irregular menstruation, or caused by yin deficiency with scanty blood, accumulations, phlegm-qi stagnation, excessive desires, etc., presenting in various ways, not merely deficiency and cold. Although some cases involve cold menstruation, this cannot be treated as a universal rule. Therefore, Mr. Danxi discusses this to warn future practitioners: unless the pathogenesis is clearly identified, do not recklessly administer this medicine. Furthermore, infertility is not solely a female issue. As Dongyuan stated: Li Heshu asked about having a son in middle age who, after one year of age, developed red-thread tumors on his body and could not be saved. Subsequent children also developed tumors between one and two years of age. Why did this disease arise? After pondering the next day, he said to him: "You have latent fire in the kidney; your essence and qi contain much red thread. Transmitted via qi to the child, this results in the disease." This is commonly known as fetal tumor. Upon examination, it was indeed as described. He then administered Zishen Wan (Kidney Nourishing Pill) several doses to drain the fire evil in the kidney and tonify insufficient true yin, while advising avoidance of alcohol and pungent-hot foods. His wife took Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish yin and blood. Five or seven doses of a powder made from Huangqin (Scutellariae Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) were taken five to seven times after conception for five months. The child was born healthy, and before reaching three years of age, the previous symptoms did not recur. Now he is strong and healthy. Alas! Synthesizing Mr. Danxi’s above discussions reveals profound principles.
Ju Fang Siwu Tang (Four Substance Decoction from the Imperial Medical Bureau) treats deficiency and damage to Chong and Ren vessels, irregular menstruation, and pain in the umbilical and abdominal regions.
Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma), Baishaoyao (Paeoniae Radix Alba), Shudihuang (Rehmanniae Radix Praeparata) (equal parts).
Coarsely powdered. Take 15g, decoct in water, and take orally.
Note: This acts on the Hand and Foot Taiyin and Jueyin meridians.
Xiaoyao San (Free and Easy Wanderer Powder) treats blood deficiency with vexatious heat, irregular menstruation, distending pain in the umbilical and abdominal regions, phlegmatic cough, and tidal fever.
Gancao (Glycyrrhizae Radix et Rhizoma) (honey-fried, 15g), Danggui (Angelicae Sinensis Radix), Fuling (Poria), Baishao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma), Chaihu (Bupleuri Radix) (each 30g).
Coarsely powdered. Take 15g, decoct with fresh ginger and mint leaves, and take orally.
Note: This acts on the Foot Shaoyang, Taiyang, Yangming, Taiyin, Shaoyin, and Jueyin meridians. It is an agent to dissipate damp-heat in the blood.
Jiao Ai Tang (Donkey-hide Gelatin and Moxa Decoction) treats labor-induced injury to blood and qi, deficiency and damage to Chong and Ren vessels, menorrhagia, and continuous dripping.
Ejiao (Colla Corii Asini) (stir-fried), Chuanxiong (Chuanxiong Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) (honey-fried, each 60g), Danggui (Angelicae Sinensis Radix), Aiyè (Artemisiae Argyi Folium) (stir-fried, each 90g), Shudihuang (Rehmanniae Radix Praeparata), Baishao (Paeoniae Radix Alba) (each 120g).
Coarsely powdered. Take 15g, decoct in water, and take orally.
Note: This is an agent to warm the meridians and tonify blood, following the Jueyin pattern.
Liangfang Wenjing Tang (Warming the Meridians Decoction from Excellent Prescriptions) treats deficiency-cold of the Blood Sea in women, leading to dysmenorrhea or oligomenorrhea.
Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix), Guixin (Cinnamomi Cortex), Mudanpi (Moutan Cortex), Ezhu (Curcumae Rhizoma) (each 15g), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Niuxi (Achyranthis Bidentatae Radix) (each 30g).
Coarsely powdered. Take 15g, decoct in water, and take orally.
Jianghuang San (Turmeric Powder) treats long-standing cold of the Blood Viscera, irregular menstruation, and stabbing pain in the umbilical and abdominal regions.
Danggui (Angelicae Sinensis Radix), Mudanpi (Moutan Cortex), Yanhusuo (Corydalis Rhizoma) (each 60g), Shaoyao (Paeoniae Radix) (90g), Chuanxiong (Chuanxiong Rhizoma), Honghua (Carthami Flos), Guixin (Cinnamomi Cortex), Ezhu (Curcumae Rhizoma) (each 30g), Chuanjiang Huang (Curcumae Longae Rhizoma) (120g).
Powdered. Take 3g, decoct in water, and take orally, preferably with wine.
Note: These two formulas are agents to unblock menstruation and break blood stasis, going beyond merely warming the meridians. They can be used for cold viscera with stagnation of qi and blood. Recorded here for reference.
Modified Siwu Tang
For scanty menstruation gradually becoming amenorrhea, vexatious pain in hands and feet, gradual emaciation, tidal fever, and faint rapid pulse: Remove Dihuag and Chuanxiong from the base formula, add Sanze Lan Ye (Epimedii Folium? Note: Text says Ze Lan Ye - Lycopodium Herba) three times the amount, and Gancao (Glycyrrhizae Radix et Rhizoma) half a qian.
For excessive menstruation: Remove Shudihuang from the base formula, add Shengdihuang (Rehmanniae Radix).
For fever during menstruation, rapid pulse, and dizziness: Add Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix), each half liang.
For scanty menstruation with distension or pain, and limb pain: Add Yanhusuo (Corydalis Rhizoma), Moyao (Olibanum), and Baizhi (Angelicae Dahuricae Radix) in equal amounts to the base formula. Take the powder mixed with light vinegar soup.
For irregular menstruation with heart and abdominal pain: Use only Xionggui (Chuanxiong and Danggui), named Junchen San (Monarch-Minister Powder).
Lurong Wan (Deer Antler Pill) treats deficiency and damage to Chong and Ren vessels, compounded by wind-cold invasion, with minute and weak chi pulse. Severe cases may require moxibustion on Guan Yuan (CV4).
Lurong (Cornu Cervi Pantotrichum) (roasted), Chishizhi (Halloysitum Rubrum), Yuyuliang (Hematitum), Xuduan (Dipsaci Radix), Baiye (Platycladi Cacumen), Fuzi (Aconiti Lateralis Radix Praeparata) (processed), Shudihuang (Rehmanniae Radix Praeparata), Danggui (Angelicae Sinensis Radix) (soaked in wine), Aiyè (Artemisiae Argyi Folium).
Powdered, bound with wine paste into pills the size of wu zi (loquat seeds). Take 50 pills on an empty stomach with warm wine.
Note: This acts on the Foot Shaoyin and Jueyin meridians. It is widely used today, hence included. It is very effective for leukorrhea due to blood deficiency and dampness excess.
Yuanrong Jiawei Siwu Tang (Yuanrong Modified Four Substance Decoction)
When qi fills the meridians, menstruation occurs frequently with lower abdominal pain: Add Shaoyao (Paeoniae Radix) to the base formula.
When menstruation is about to start with severe cramping pain in the umbilical and abdominal regions: Add Yanhusuo (Corydalis Rhizoma), Binglang (Arecae Semen), Kulian (Meliae Cortex), and Muxiang (Aucklandiae Radix) to the base formula.
For excessive menstrual flow: Add Huangqin (Scutellariae Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) to the base formula.
For scanty and sluggish menstrual flow: Add Kuihua (Helianthi Annuus Flos) and Honghua (Carthami Flos) to the base formula.
If menstruation starts and stops abruptly, or with alternating chills and fever: First administer Xiaochaihu Tang (Minor Bupleurum Decoction) to resolve chills and fever, then harmonize with Yuanrong Jiawei Siwu Tang.
Danxi Jiawei Siwu Tang (Danxi Modified Four Substance Decoction)
Pain occurring after menstruation indicates joint deficiency of blood and qi: Take the base formula together with Sijunzi Tang (Four Gentlemen Decoction).
Pain occurring before menstruation indicates blood excess: Add Taoren (Persicae Semen), Huanglian (Coptidis Rhizoma), and Xiangfu (Cyperi Rhizoma) to the base formula.
Menstruation arriving ahead of schedule indicates blood heat: Add Huanglian (Coptidis Rhizoma) to the base formula.
Late menstruation with scanty blood: Add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) to the base formula. If accompanied by phlegm, add Banxia (Pinelliae Rhizoma) and Chenpi (Citri Reticulatae Pericarpium).
Late menstruation with purple-black clots indicates blood heat,必定 accompanied by pain: Add Xiangfu (Cyperi Rhizoma) and Huanglian (Coptidis Rhizoma) to the base formula. Late menstruation with pale color indicates much phlegm: Combine Xionggui (Chuanxiong and Danggui) with Erchen Tang (Two-Aged Phlegm Resolving Decoction).
Purple color with clots indicates heat: Add Huanglian (Coptidis Rhizoma) and Chaihu (Bupleuri Radix) to the base formula.
Obese individuals with early menstruation and much phlegm often have blood deficiency with heat: Add Xiangfu (Cyperi Rhizoma), Nanxing (Arisaematis Rhizoma cum Bile), Banxia (Pinelliae Rhizoma), Huanglian (Coptidis Rhizoma), and Baizhu (Atractylodis Macrocephalae Rhizoma) to the base formula.
Emaciated individuals with blood exhaustion and amenorrhea: Add Taoren (Persicae Semen) and Honghua (Carthami Flos) to the base formula, or Yueju Wan (Yueju Pill) (see Blood section).
Simple Danggui San (Angelica Powder) treats irregular menstruation, whether absent for three to four months, recurring twice a month, or post-menopausal irregular bleeding.
Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba), Huangqin (Scutellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 15g), Shanzhuyu Rou (Corni Fructus) (45g).
Powdered. Take 6g on an empty stomach with warm wine, three times daily.
Note: This acts on the Foot Jueyin and Shaoyin meridians.
Baojian Shengdi Huang Wan (Shengdi Huang Pill from Treasure Mirror) treats blood excess in women, wiry and long Jueyin pulse, aversion to wind, fatigue, alternating chills and fever, flushed face, palpitations, or spontaneous sweating resembling typhoid conditions. It is suitable to use yin-suppressing agents.
Shengdihuang (Rehmanniae Radix), Chaihu (Bupleuri Radix), Qinjiao (Gentianae Macrophyllae Radix), Huangqin (Scutellariae Radix) (each 15g), Shaoyao (Paeoniae Radix) (30g).
Powdered, bound with honey into pills the size of wu zi. Take 30 pills swallowed with sour plum soup, three times daily.
Note: This acts on the Hand and Foot Shaoyin and Taiyin, and Foot Taiyang meridians.
Careful Observation: All the above formulas belong to regulation methods. However, conditions such as fluid retention and intestinal polyps arising from blood disorders are detailed in their respective sections and are not listed here. Generally, for menstrual diseases, excess patterns are broken down, stagnation is dispersed, and deficiency patterns are tonified. The key lies in appropriateness to the specific situation.