妇人之病与男子同惟调经种子胎前产后与男子异其同者已具见于各条其异者自当别
为表着易
曰一阴一阳之谓道干道成男坤道成女男秉干道之阳其性刚而明女秉坤道之阴其性柔而晦故其
生病也大半由于七情郁结中气不能舒畅气不舒则血遂不能循行无滞气血交病因致月事失常崩
带瘕之病作冲任之脉有伤生化之机日薄是故苗而不
秀秀而不实甚至终身不孕者有之而且积忧生热积热生痰延及虚劳者有之沈谧云妇人女子
之病
常浮于男子什九其喜怒哀乐发而中节者寡欲诊问而识所因盖亦难矣经曰怒则气上喜则气缓悲
则气消恐则气下寒则气收热则气泄惊则气乱劳则气耗思则气结九气不同百病皆生于气女子善
怀气病为多气病而血未有不病者今特取妇科之要者数则详述于后
一月经不调血结经闭岐伯曰女子二七肾气盛齿更发长而天癸至任脉通太冲脉盛月事
以时下月
者以三旬一见以象月盈则亏也经常也行有常期而不失其候也内经曰饮食入胃游溢精气上输于
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东垣先生所谓脾为生化之源心统诸经之血诚哉是言也
窃谓心
脾和平则经候如常苟或七情内伤六淫外侵饮食失节起居失宜脾胃虚损心火妄动则月经不调矣
如经行头晕肝伤风动也经乃欲行腹中绞痛者血涩也夫经水阴血也属冲任二脉上为乳汁下为月
水内经云二阳之病发心脾有不得隐曲故女子不月
其传为风消又曰月事不来者胞脉闭也薜立斋云女
子不月有因脾虚而不能生血者有因脾郁伤而
血耗损者有因胃火而血消烁者有因脾胃损而血少者有因劳伤心而血少者有因怒伤肝而血少者
有
因肾水不能生肝而血少者有因肺气虚不能行血而闭者治宜察脉辨症各随其所因而调之经所谓
损其肺者益其气损其心者调其营卫损其脾者调其饮食适其寒温损其肝者缓其中损其肾者益其
精是也
一妇人血崩症状非一所感亦异经曰阴虚阳搏谓之崩又云阳络伤则血外溢阴络伤则血
内溢产实
分阴崩阳崩受热而赤谓之阳崩受冷而白谓之阴崩薛氏云有因脾胃虚损不能摄血归源或因肝经
有火血得热而下行或因肝经有风血得风而妄行或因怒动肝火血热而沸腾或因脾经郁结血伤而
不归经或因悲哀太过胞络伤而下崩治疗之法当各随其经之所病东垣丹溪诸先生云凡下血症须
用四君子以收功斯言厥有旨哉
一淋带赤白经曰任脉为病男子内结七疝女子带下瘕聚又曰脾传之肾名曰疝瘕小肠冤
结而痛出
白一名曰蛊所以为带下冤结也产宝带下三十六疾乃十二 九痛七害五伤三固谓之三十六病也
陈自明云妇人带下其名有五因经行产后风邪入胞门传于脏腑而致之肝病色HT 如青泥心病色
如红
津肺病形如白涕脾病形如烂瓜肾病黑如HT 血人有带脉横于腰间病生于此故名为带然亦不全
拘于带脉徐用诚先生云白属气赤属血东垣先生云血崩久则亡阳故白滑之物下流亦有湿痰流注
下焦或肾肝阴淫之湿胜或惊恐而木乘土位浊液下流或思慕为筋痿症之所受不同而治
亦各异也崔氏四花穴治赤白带如神撮要取中极白环俞各灸十五壮肾俞灸随年壮海藏谓带病太
阴主之灸章门穴麦粒大各三壮神效
一妇人 瘕多属血病 者坚也坚则难破瘕者假也假物成形古人有五积六聚七 八瘕
之名内
外所感不同治法亦当以类相从蛊者虫病也血病也虽内外所感其积于腹中与藏气搏结乃成龙蛇
鱼
鳖等物自有活性故名曰蛊非鼓胀无物空空之谓也当须识此经云气主嘘之血主濡之若血不流积
凝而为瘕也瘕者中虽硬而忽聚忽散多因六淫七情饮食起居动伤脏腑而成当与 癖诸症同治慎
勿妄伤元气
一妇人不孕多因七情所伤致使血衰气盛经水不调或前或后或多或少或色淡如水或紫
如血块或
崩漏带下或肚腹疼痛或子宫虚冷皆不能受孕经云冲为血海任主胞胎二经受病其在女子为不孕
故凡女子之孕育以血为主血不能自生而又以气为主欲求种子之法亦惟以培补命门顾惜阳气清
心寡欲使气血充和不求子而得子乃天地自然之道也
一妇人屡堕胎者必以气脉亏损而然而亏损之由有禀质之素弱者有年力之衰残者有忧
怒劳苦而
困
其精力者有色欲不慎而盗损其生气者此外如跌扑饮食之类皆能伤其气脉气脉有伤而胎可无恙
者非
先天最完固者不能而常人则未之有也且怀胎十月经养各有所主一月形如露珠乃太极动而生阳
天一生水谓之胚足厥阴肝脉主之经水即闭饮食稍异二月如桃花瓣乃太极静而生阴地二生火
谓
之胀足少阳胆脉主之若吐逆思食名曰恶阻有孕明矣或偏嗜一物一脏之虚如爱酸物乃肝经只
能
养胎而虚也三月如清涕先成鼻与雌雄二器乃分男女手厥阴心胞相火所主胎最易动四月始受水
精以成血脉
形象手足顺成手少阳三焦脉所主五月始受火精筋骨四肢已具毛发始生足太阴脾脉所主六
月始
受金精以成筋耳目皆成足阳明胃脉所主七月始受木精以成骨游其魂能动左手手太阴肺脉所主
八月始受土精以成皮肤九窍皆成游其魄能动右手手阳明大肠脉所主九月始受石精百节毕备三
转
其身足少阴肾脉所主十月神气备足乃足太阳膀胱脉所主惟手少阴太阳无所主者专主之官无为
而已凡堕胎多在三五七月必当审察所由而预防之
一胎漏有母气壮盛荫胎有余而血之溢者此不必治有 气薄弱胎有不能全受而血之漏
者此胎阳
本亏而生子必萎小当助其胎不必治其漏他如怒动肝火脾虚不能摄血或血热气滞或脾肾兼虚三
焦气血俱虚或劳倦伤而动血或偶因伤触动血或冲任气虚不能约制血滑易动者病各有所主也
一妇人转脬由脬为热所逼或忍小便俱令水气迫于脬屈辟不得充张外水应入不得入内溲应
出不
得出内外壅滞胀满不通故为脬转其状少阴急痛不得小便甚者至死不可治妊娠转胞者因胎长逼
迫于胞胞为所逼而侧令人数溲胞即膀胱也转胞与子淋不同小便频数点滴而痛为子淋频数出少
而不痛为转胞间有微痛终与淋异
一产难横生以儿方转身产母用力逼之太早故致儿身未顺而先露手臂但令母安然仰卧
稳婆以手
徐推儿臂下体令其正直复以中指摸其肩弗使脐带攀系即生一法令产母仰卧以小针刺儿手脚心
三五次用盐擦之手脚即缩上转身而生
一产后诸症多属于虚然亦有不虚者有全实者不可因丹溪之论执一不化陈自明云产后
恶露不止
因伤经血或内有冷气而脏腑不调故也薛立斋云有肝气热而不能主血者有肝虚不能藏血者有脾
虚不摄血胃气下陷不能统血脾经郁热而血不归源怒动肝火而血妄行肝经风邪而血沸腾又有气
血俱虚者治勿拘泥又如产后昏晕古人多云恶露乘虚上攻不知此症有二一日气脱因产时去血过
多眼闭口开手冷六脉微细是也一日血晕本由气血所致然亦有血壅痰盛形气脉气皆有余胸腹胀
痛上冲此血逆症也若胞衣不下亦有二端一因气血虚弱不能传送而别无痛胀但助其气血即下一
因血入胞中胀大而不能下以致心腹胀痛喘急急宜用药散血消胀胎衣自下又法以本妇头发搅入
喉中使之作呕则气升血散胞软亦自落矣
一妇人乳疾乳汁乃冲任气血所化故下则为经上则为乳若产后无乳由于气血之不足或
肥胖妇
人痰气壅盛乳滞不行乳肿者因儿吮乳为口气所吹致令乳汁不通壅结肿痛不急治之多成痈肿谓
之吹乳或因无儿饮乳或儿弱饮少余乳蓄结作胀或妇人血气方盛乳房作胀以致肿痛憎寒壮热不
吮通之必致成痈乳痈一症属胆胃二府热毒瓦斯血壅滞故初起肿痛发于肌表或发寒热或憎寒头
痛烦渴引冷至数日之间脓成溃窍稠脓涌出脓尽则愈若气血虚弱久不收敛则难治
一妇人阴挺是因胞络伤损或因分娩过劳或因郁热下坠或因气虚下脱阴中突出如菌如
芝或挺出数
寸痒痛牵引腰腹大都房室过度淫欲不遂多致此症治以升补固阴为主又妇人夜梦颠倒与鬼交通
由于脏腑空虚阳神不守故鬼气得以乘之其状不欲见人如有晤对时独言笑或时悲泣是也又妇人
遗尿乃心肾之气传送失度之所为也故有小便涩而流者有失禁而出不自知者有产理不顺致伤膀
胱遗尿无时又有胞寒藏冷而遗尿不禁治宜审察勿损真阴此皆妇人之病之大略也
妇女的疾病与男子相同之处，仅在于调经、助孕、胎前及产后的调理与男子不同。相同之处已在各条文中详述，不同之处自然应当另行明确阐述。
《易经》说：“一阴一阳交互作用称为道。”天道成就男性，地道成就女性。男性秉承天道的阳气，其性质刚健而光明；女性秉承地道的阴气，其性质柔顺而晦暗。因此，女性生病大多由于七情（喜、怒、忧、思、悲、恐、惊）郁结，导致中焦之气不能舒畅。气机不舒，血液便不能循行正常，产生瘀滞。气血交阻，因而导致月经失常，出现崩漏（非经期大量出血或淋漓不尽）、带下病（阴道分泌物异常）、瘕聚（腹内结块）等疾病。冲脉和任脉受损，生化之机日渐衰薄，所以有的女子发育不良，有的甚至终身不孕。而且，长期忧愁生热，积热生痰，延及虚劳病症的也有。沈谧说：“妇女女子的疾病，常常比男子多十分之九。她们喜怒哀乐能符合节制的很少，通过诊察询问来识别病因，确实很难啊。”《内经》说：“怒则气上逆，喜则气缓散，悲则气消减，恐则气下沉，寒则气收敛，热则气外泄，惊则气紊乱，劳则气耗损，思则气结滞。”这九种气机变化不同，但百病皆生于气。女子多愁善感，气病较多。气病则血没有不病的。现在特别选取妇科的几个重要方面详细叙述如下：
一、月经不调、血结、经闭
岐伯说：“女子十四岁，肾气旺盛，牙齿更换，头发生长，天癸（促进生殖机能成熟的物质）到来，任脉通畅，太冲脉盛旺，月经按时来潮。”所谓“月”，是以三十天为一个周期，象征月亮盈亏。月经有固定的周期而不失其时。《内经》说：“饮食进入胃，游溢精气，向上输送给脾；脾气散精，向上归于肺；通调水道，向下输送到膀胱。水液精微四布，五脏经脉并行。”正如东垣先生所说，脾是化生气血的源头，心统摄各经之血，这话真是对啊。我私下认为，心脾平和则月经如常。如果七情内伤，六淫（风、寒、暑、湿、燥、火）外侵，饮食不节制，起居不调，导致脾胃虚损，心火妄动，就会月经不调。例如经行时头晕，是肝伤风动所致；月经欲行时腹中绞痛，是血涩所致。经水是阴血，属于冲脉和任二脉，上行化为乳汁，下行成为月经。《内经》云：“阳明经的病发于心脾，有难以启齿的隐曲之事，所以女子不来月经。”这种病传变下去会变成消瘦的风证。又说：“月经不来的原因是胞脉闭塞。”薛立斋说：“女子不来月经，有因脾虚不能生血的，有因脾郁损伤而血耗损的，有因胃火炽盛而血被消烁的，有因脾胃受损而血少的，有因劳累伤心而血少的，有因愤怒伤肝而血少的，有因肾水不能生肝木而血少的，有因肺气虚不能行血而导致闭经的。”治疗应当察脉辨证，根据各自的原因进行调理。《内经》所谓：“损伤肺的补益其气，损伤心的调和营卫，损伤脾的调节饮食适应寒温，损伤肝的舒缓其中气，损伤肾的填补其精”，就是这个道理。
二、妇人血崩
症状不止一种，感受也不同。《内经》说：“阴虚而阳脉搏动急促称为崩。”又说：“阳络受伤则血外溢，阴络受伤则血内溢。”产后分为阴崩和阳崩。受热而血色红赤的叫阳崩，受冷而血色白的叫阴崩。薛氏说：“有因脾胃虚损不能摄血归源，或因肝经有火，血得热而下行的，或因肝经有风，血得风而妄行的，或因愤怒触动肝火，血热而沸腾的，或因脾经郁结，血伤而不能归经的，或因悲哀太过，胞络受伤而下崩的。”治疗方法应当根据各经所患的不同而定。东垣、丹溪等先生说：“凡是下血症，必须用四君子汤收功。”这话很有深意啊。
三、淋证、带下、赤白带下
《内经》说：“任脉为病，男子内结七疝，女子带下瘕聚。”又说：“脾病传于肾，名叫疝瘕。小肠冤结而痛，流出白色液体，一名曰蛊。”这就是带下病中冤结的原因。《产宝》记载带下有三十六疾，乃是十二痛、九痛、七害、五伤、三固，合称三十六病。陈自明说：“妇人带下，其名有五类。因经期或产后风邪侵入胞门，传于脏腑而致之。肝病色青如泥，心病色红如津液，肺病形如白涕，脾病形如烂瓜，肾病黑如衃血。”人有带脉横于腰间，病生于此，故名为带。但这也不完全拘泥于带脉。徐用诚先生说：“白色属气，红色属血。”东垣先生说：“血崩日久则亡阳，所以白色滑腻之物下流。”也有湿痰流注下焦，或肾肝阴淫之湿胜，或惊恐而肝木乘土位，浊液下流。病因不同，治疗也各异。崔氏的四花穴治疗赤白带下如神。撮要篇取中极穴、白环俞穴各灸十五壮，肾俞穴灸随年壮（即患者年龄数壮）。海藏谓带病由太阴主之，灸章门穴，麦粒大各三壮，神效。
四、妇人瘕聚
多属血病。“寢”者坚也，坚硬则难破；“瘕”者假也，假物成形。古人有五积、六聚、七疝、八瘕之名。内外感受不同，治法也当以类相从。“蛊”者是虫病，也是血病。虽然内外感受不同，但积聚在腹中与脏气搏结，竟像龙蛇鱼鳖等物，自有活性，故名曰蛊。这不是鼓胀那种无物空空的意思。应当认清这一点。《内经》云：“气主要嘘吸运行，血主要濡养身体。”如果血不流动，凝结而成瘕。瘕聚虽然中间硬，但忽聚忽散，多因六淫、七情、饮食、起居动伤脏腑而成。应当与癖积诸症同治，切勿妄伤元气。
五、妇人不孕
多因七情所伤，致使血衰气盛，经水不调，或提前或推后，或多或少，或颜色淡如水，或紫如血块，或崩漏带下，或肚腹疼痛，或子宫虚冷，皆不能受孕。《内经》云：“冲脉为血海，任脉主胞胎。”这两经受病，在女子表现为不孕。所以凡女子的孕育以血为主，血不能自生，而又以气为主。欲求种子之法，也只在于培补命门，顾惜阳气，清心寡欲，使气血充和，不求子而得子，这才是天地自然之道。
六、妇人屡堕胎
必然因为气脉亏损。然而亏损的原因，有禀赋体质素弱的，有年力衰残的，有忧怒劳苦困乏精力的，有色欲不慎而盗损生气的。此外如跌扑损伤、饮食不当之类，都能伤其气脉。气脉有伤而胎能无恙的，除非先天最完固者才能做到，常人则没有这种情况。况且怀胎十月，经养各有所主。一月形如露珠，乃太极动而生阳，天一生水谓之胚，足厥阴肝脉主之，经水即闭，饮食稍异。二月如桃花瓣，乃太极静而生阴，地二生火谓之胞，足少阳胆脉主之。若吐逆思食，名曰恶阻，有孕明矣。或偏嗜一物，是一脏之虚，如爱酸物乃肝经只能养胎而虚也。三月如清涕，先成鼻与雌雄二器，乃分男女，手厥阴心包相火所主，胎最易动。四月始受水精以成血脉，形象手足顺成，手少阳三焦脉所主。五月始受火精，筋骨四肢已具，毛发始生，足太阴脾脉所主。六月始受金精以成筋，耳目皆成，足阳明胃脉所主。七月始受木精以成骨，游其魂能动左手，手太阴肺脉所主。八月始受土精以成皮肤，九窍皆成，游其魄能动右手，手阳明大肠脉所主。九月始受石精，百节毕备，三转其身，足少阴肾脉所主。十月神气备足，乃足太阳膀胱脉所主。惟手少阴、太阳无所主者，专主之官无为而已。凡堕胎多在三、五、七月，必当审察所由而预防之。
七、胎漏
有母气壮盛，荫胎有余而血溢出的，此不必治。有胎气薄弱，胎有不能全受而血漏出的，此胎阳本亏，而生子必萎小，当助其胎，不必治其漏。其他如怒动肝火，脾虚不能摄血，或血热气滞，或脾肾兼虚，三焦气血俱虚，或劳倦伤而动血，或偶因伤触动血，或冲任气虚不能约制，血滑易动者，病各有所主也。
八、妇人转脬
由脬（膀胱）为热所逼，或忍小便，俱令水气迫于脬，屈辟不得充张，外水应入不得入，内溲应出不得出，内外壅滞，胀满不通，故为脬转。其状少阴急痛，不得小便，甚者至死不可治。妊娠转胞者，因胎长逼迫于胞，胞为所逼而侧，令人数溲。胞即膀胱也。转胞与子淋不同：小便频数点滴而痛为子淋；频数出少而不痛为转胞。间有微痛，终与淋异。
九、产难、横生
以儿方转身，产母用力逼之太早，故致儿身未顺而先露手臂。但令母安然仰卧，稳婆以手徐推儿臂下体，令其正直，复以中指摸其肩，弗使脐带攀系，即生。一法令产母仰卧，以小针刺儿手脚心三五次，用盐擦之，手脚即缩上转身而生。
十、产后诸症
多属于虚，然亦有不虚者，有全实者，不可因丹溪之论执一不化。陈自明云：“产后恶露不止，因伤经血，或内有冷气而脏腑不调故也。”薛立斋云：“有肝气热而不能主血者，有肝虚不能藏血者，有脾虚不摄血，胃气下陷不能统血，脾经郁热而血不归源，怒动肝火而血妄行，肝经风邪而血沸腾。又有气血俱虚者。”治勿拘泥。又如产后昏晕，古人多云恶露乘虚上攻。不知此症有二：一曰气脱，因产时去血过多，眼闭口开，手冷，六脉微细是也；一曰血晕，本由气血所致，然亦有血壅痰盛，形气脉气皆有余，胸腹胀痛上冲，此血逆症也。若胞衣不下，亦有二端：一因气血虚弱，不能传送而别无痛胀，但助其气血即下一；一因血入胞中，胀大而不能下，以致心腹胀痛喘急，宜用药散血消胀，胎衣自下。又法以本妇头发搅入喉中，使之作呕，则气升血散，胞软亦自落矣。
十一、妇人乳疾
乳汁乃冲任气血所化，故下则为经，上则为乳。若产后无乳，由于气血之不足。或肥胖妇人痰气壅盛，乳滞不行。乳肿者，因儿吮乳为口气所吹，致令乳汁不通，壅结肿痛，不急治之多成痈肿，谓之吹乳。或因无儿饮乳，或儿弱饮少，余乳蓄结作胀。或妇人血气方盛，乳房作胀，以致肿痛憎寒壮热，不吮通之，必致成痈。乳痈一症，属胆胃二府热毒瓦斯，血壅滞。故初起肿痛，发于肌表，或发寒热，或憎寒头痛，烦渴引冷。至数日之间，脓成溃窍，稠脓涌出，脓尽则愈。若气血虚弱，久不收敛，则难治。
十二、妇人阴挺
是因胞络伤损，或因分娩过劳，或因郁热下坠，或因气虚下脱，阴中突出如菌如芝，或挺出数寸，痒痛牵引腰腹。大都房室过度，淫欲不遂，多致此症。治以升补固阴为主。又妇人夜梦颠倒，与鬼交通，由于脏腑空虚，阳神不守，故鬼气得以乘之。其状不欲见人，如有晤对时独言笑，或时悲泣是也。又妇人遗尿，乃心肾之气传送失度之所为也。故有小便涩而流者，有失禁而出不自知者，有产理不顺致伤膀胱，遗尿无时，又有胞寒藏冷而遗尿不禁。治宜审察，勿损真阴。此皆妇人之病之大略也。
Women's diseases are the same as men's in general, but differ in regulating menstruation, promoting conception, prenatal care, and postpartum recovery. The similarities have been detailed in previous sections; the differences shall be explicitly stated here.
The *I Ching* (Book of Changes) states: "The interaction of one Yin and one Yang is called the Dao." The Way of Heaven creates males, and the Way of Earth creates females. Males inherit the Yang Qi of Heaven, possessing a nature that is firm and bright; females inherit the Yin Qi of Earth, possessing a nature that is soft and obscure. Therefore, women's illnesses mostly arise from the stagnation of the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright), leading to an inability of the Middle Jiao Qi to flow freely. When Qi is stagnant, Blood cannot circulate normally, resulting in stasis. The entanglement of Qi and Blood leads to menstrual irregularities, such as Bing Lou (metrorrhagia and metrostaxis), Dai Xia (leukorrhea), and Zha Ju (abdominal masses). Damage to the Chong and Ren meridians weakens the mechanism of generation and transformation, causing developmental issues or even lifelong infertility. Furthermore, prolonged sorrow generates heat, accumulated heat produces phlegm, which may extend into deficiency consumptive diseases. Shen Mi stated: "Women's diseases are often nine-tenths more frequent than men's. Few can regulate their emotions properly; diagnosing the cause through inquiry is indeed difficult." The *Neijing* says: "Anger causes Qi to rise upward; Joy causes Qi to slacken; Sorrow causes Qi to dissipate; Fear causes Qi to sink downward; Cold causes Qi to contract; Heat causes Qi to escape; Fright causes Qi to become chaotic; Labor exhausts Qi; Thought causes Qi to knot." These nine types of Qi disturbances differ, yet all diseases arise from Qi. Women are prone to emotional sensitivity, making Qi disorders common. Where there is a Qi disorder, there is invariably a Blood disorder. Herein, I will detail several key aspects of gynecology.
1. Menstrual Irregularity, Blood Stasis, and Amenorrhea
Qibo stated: "At age fourteen, a girl's Kidney Qi becomes abundant, her teeth change, hair grows, Tian Gui (substances promoting reproductive maturity) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Tai Chong Mai (Great Surge Vessel) becomes vigorous, allowing menstruation to occur on time." 'Menstruation' refers to the monthly cycle, mirroring the waxing and waning of the moon. It has a regular period without deviation. The *Neijing* states: "Food enters the Stomach, its essence floats up and is transmitted to the Spleen; the Spleen scatters the essence upward to the Lungs; [the Lungs] regulate the water passages, transmitting it downward to the Bladder. Water and essence distribute throughout, and the five meridians function together." As Mr. Dongyuan said, the Spleen is the source of Qi and Blood generation, and the Heart commands the Blood of all meridians. This is truly correct. I believe that when the Heart and Spleen are harmonious, menstruation is normal. If internal injury by the Seven Emotions, external invasion by the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), improper diet, or irregular lifestyle damages the Spleen and Stomach, causing Heart Fire to flare, menstrual irregularities occur. For instance, dizziness during menstruation indicates Liver Wind stirring due to Liver injury; abdominal cramping before menstruation indicates Blood stagnation. Menstrual blood is Yin Blood, belonging to the Chong and Ren vessels, transforming into milk upwards and menstruation downwards. The *Neijing* says: "Diseases of the Yang Ming channel originate in the Heart and Spleen; hidden grievances cause amenorrhea in women." This condition may progress to wasting with wind. It also states: "Amenorrhea is caused by the closure of the Bao Mai (Uterine Vessels)." Xue Lizhai stated: "Amenorrhea in women may result from Spleen deficiency failing to generate Blood, Spleen depression damaging Blood consumption, Stomach Fire consuming Blood, Spleen-Stomach damage reducing Blood, labor injuring the Heart reducing Blood, anger injuring the Liver reducing Blood, Kidney Water failing to nourish Liver Wood reducing Blood, or Lung Qi deficiency failing to move Blood causing closure." Treatment should involve pulse diagnosis and syndrome differentiation, addressing the specific cause. As the *Neijing* prescribes: "For Lung injury, tonify Qi; for Heart injury, harmonize Ying and Wei; for Spleen injury, regulate diet and adapt to temperature; for Liver injury, soothe the interior; for Kidney injury, replenish Essence."
2. Uterine Bleeding (Beng Lou)
Symptoms vary, and causes differ. The *Neijing* states: "Yin deficiency with rapid Yang pulse is called Beng." It also says: "Injury to Yang collaterals causes external bleeding; injury to Yin collaterals causes internal bleeding." Postpartum bleeding is classified as Yin Beng or Yang Beng. Red blood due to heat is Yang Beng; white discharge due to cold is Yin Beng. Mr. Xue stated: "Causes include Spleen-Stomach deficiency failing to control Blood return, Liver channel fire causing Blood to descend with heat, Liver channel wind causing Blood to scatter recklessly, anger stirring Liver Fire causing Blood to boil, Spleen channel depression injuring Blood preventing return, or excessive grief injuring Bao Luo causing lower bleeding." Treatment must follow the affected meridians. Mr. Dongyuan and Mr. Danxi stated: "All lower bleeding syndromes require Si Jun Zi Tang (Four Gentlemen Decoction) for resolution." This insight is profound.
3. Lin Syndrome, Leukorrhea, and Red/White Discharge
The *Neijing* states: "Ren Mai disease causes seven types of hernia in men and leukorrhea/masses in women." It also says: "Spleen disease transmitting to the Kidney is named Shan Jia. Small intestine grievance causes pain and white discharge, named Gu." This explains the grievance aspect of leukorrhea. The *Chan Bao* lists thirty-six leukorrhea disorders, comprising twelve pains, nine pains, seven harms, five injuries, and three consolidations. Chen Ziming stated: "Leukorrhea has five colors based on organ involvement after wind-pathogen invasion during menses or postpartum: Liver disease shows green like mud; Heart disease shows red like fluid; Lung disease shows white like nasal mucus; Spleen disease shows rotting melon-like texture; Kidney disease shows black like clotted blood." The Dai Mai (Girdle Vessel) crosses the waist, so diseases arising here are named Dai. However, this is not strictly limited to the Dai Mai. Mr. Xu Yongcheng stated: "White relates to Qi, Red relates to Blood." Mr. Dongyuan stated: "Prolonged blood loss depletes Yang, leading to white slippery discharge." Other causes include damp-phlegm flowing to the Lower Jiao, excess dampness from Kidney/Liver Yin, or Liver Wood overacting on Earth due to fright, causing turbid fluids to flow down. Treatments vary by cause. Cui Shi's Si Hua acupoints treat red/white discharge effectively. Acupuncture Essentials recommends moxibustion on Zhongji (CV4) and Baihuan Shu (BL30), 15 moxa cones each, and Sushan (BL23) according to age. Haizang attributed Dai disease to Tai Yin, recommending moxibustion on Zhangmen (LR13) with 3 small moxa cones per side for miraculous effect.
4. Abdominal Masses (Zhen Jia)
Mostly related to Blood disorders. 'Zhen' implies hardness, difficult to break; 'Jia' implies falsity, forming from external factors. Ancients described five accumulations, six gatherings, seven hernias, and eight masses. Causes differ internally and externally, so treatments should correspond. 'Gu' refers to parasitic worms or blood disorders where masses interact with organ Qi, resembling living creatures, hence named Gu. This differs from鼓胀 (drum distension) which is empty. One must recognize this distinction. The *Neijing* says: "Qi governs respiration/circulation; Blood governs nourishment." If Blood does not flow, it coagulates into masses. Jia masses are hard but fluctuate, often caused by Six Evils, Seven Emotions, diet, or lifestyle damaging organs. Treat similarly to Pi Ji (accumulations); do not recklessly damage Yuan Qi.
5. Infertility
Often caused by Seven Emotions damaging Qi and Blood, leading to irregular menstruation (early, late, scanty, pale, or dark/clotted), bleeding, leukorrhea, abdominal pain, or cold uterus, preventing conception. The *Neijing* states: "Chong Mai is the Sea of Blood; Ren Mai governs pregnancy." Disease in these vessels causes infertility in women. Conception relies primarily on Blood, supported by Qi. To conceive, one must tonify Ming Men (Gate of Life), preserve Yang Qi, maintain mental clarity, reduce desires, and ensure abundant, harmonious Qi and Blood. Seeking conception naturally leads to conception, following the Way of Heaven and Earth.
6. Recurrent Miscarriage
Caused by Qi and Pulse deficiency. Deficiency arises from constitutional weakness, aging, emotional/labor exhaustion, or sexual indiscretion damaging vital Qi. Falls or dietary errors also damage Qi and Pulses. Only those with perfect congenital constitution can maintain pregnancy despite such injuries; ordinary people cannot. During the ten months of gestation, different meridians govern development: Month 1, embryo forms under Foot Jueyin Liver; Month 2, fetus forms under Foot Shaoyang Gallbladder (nausea indicates pregnancy); Month 3, sex differentiation under Hand Jueyin Pericardium; Month 4, blood/vessels under Hand Shaoyang Sanjiao; Month 5, bones/limbs under Foot Taiyin Spleen; Month 6, tendons/ears/eyes under Foot Yangming Stomach; Month 7, bones/soul under Hand Taiyin Lung; Month 8, skin/orifices/ego under Hand Yangming Large Intestine; Month 9, joints/body rotation under Foot Shaoyin Kidney; Month 10, spirit complete under Foot Taiyang Bladder. Hand Shaoyin/Sun channels are not specifically governing but oversee. Miscarriages often occur in months 3, 5, and 9; prevention is crucial.
7. Threatened Abortion (Tai Lou)
If maternal Qi is strong and surplus Blood leaks, no treatment is needed. If fetal Qi is weak and cannot retain Blood, leakage occurs; the fetus will be small due to deficient Yang. Tonify the fetus rather than stop the bleeding. Other causes include Liver Fire, Spleen deficiency failing to control Blood, Heat stagnation, Spleen/Kidney dual deficiency, Three Jiao Qi/Blood deficiency, labor-induced bleeding, accidental trauma, or Chong/Ren Qi deficiency failing to constrain Blood. Each has specific causes.
8. Urinary Retention (Zhuan Pao)
Heat forcing the Pao (Bladder) or holding urine causes Water Qi to compress the Pao, preventing expansion. External water cannot enter, internal urine cannot exit, causing obstruction and distension. Symptoms include Shaoyin acute pain and inability to urinate, potentially fatal. In pregnancy, fetal growth presses on the Bao (Bladder), causing frequent urination. Differentiate from Zi Lin (painful frequent urination): Zhuan Pao is frequent, scanty, and painless; Zi Lin is painful.
9. Difficult Labor / Breech Presentation
Caused by premature pushing while the fetus turns. The arm may protrude first. Have the mother lie supine. The midwife should gently push the arm back, straighten the body, check the shoulder with the middle finger to avoid cord entanglement, and deliver. Alternatively, prick the fetus's hands/feet with a needle 3-5 times, rub with salt to induce retraction and turning.
10. Postpartum Syndromes
Most are deficiency, but some are excess. Do not rigidly follow Danxi's views. Chen Ziming stated: "Postpartum lochia continues due to meridian/blood injury or cold qi disrupting organs." Xue Lizhai stated: "Causes include Liver Heat failing to command Blood, Liver deficiency failing to store Blood, Spleen deficiency failing to control Blood, Stomach Qi sinking failing to command Blood, Spleen channel depression causing Blood non-return, anger stirring Liver Fire causing reckless Blood, Liver channel wind causing boiling Blood, or dual Qi/Blood deficiency." Treat flexibly. Postpartum fainting has two types: Qi collapse (excessive blood loss, closed eyes, open mouth, cold hands, faint pulse) and Blood fainting (Blood/phlegm congestion, full chest/abdomen, rising sensation). Placenta retention has two causes: Qi/Blood deficiency (tonify to expel) or Blood entering the placenta causing distension (disperse Blood to expel). Another method: insert the mother's hair into the throat to induce vomiting, raising Qi and dispersing Blood, softening the placenta for expulsion.
11. Breast Diseases
Milk is transformed from Chong/Ren Qi and Blood, becoming menstruation downward and milk upward. Postpartum agalactia results from Qi/Blood deficiency. Obesity with Phlegm-Qi congestion blocks milk flow. Breast swelling from infant suction/blowing causes blockage and pain, potentially becoming mastitis (Chui Ru). Retained milk or vigorous Qi/Blood causing breast distension/pain/fever also leads to mastitis if not drained. Mastitis belongs to Gallbladder/Stomach heat-toxin and Blood stasis. Initial symptoms: swelling, pain, fever/chills, thirst. After days, pus forms and drains; healing follows. If Qi/Blood is weak and healing is slow, it is difficult to treat.
12. Uterine Prolapse (Yin Ting)
Caused by Bao Luo injury, excessive delivery labor, heat sinking, or Qi deficiency sinking, causing vaginal protrusion like mushrooms, extending inches, with itching/pain radiating to waist/abdomen. Often due to excessive intercourse or unfulfilled desire. Treatment focuses on lifting, tonifying, and securing Yin. Nightmares/dreams of intercourse indicate organ emptiness and unsupervised Yang Spirit, allowing pathogenic influence. Symptoms: aversion to people, talking/laughing alone, or weeping. Enuresis results from impaired Heart/Kidney Qi transmission. Types include涩流 (scanty flow), involuntary loss, bladder injury from difficult labor, or Cold Bladder/Kidney. Examine carefully without damaging True Yin. These are the general outlines of women's diseases.