妇科已有专书。然男女血本同原。故并论之。经云。女子二七而天癸至。任脉通。太冲脉盛。月事以时下。故
能有子。天癸者。谓先天肾中之动气。化生癸水。至者。谓至于胞中也。水为阳气所化。阳倡而阴必随之。血
者阴也。冲任主之。故应癸水。而即输血于胞中。血之应水而下。是谓以阴从阳。冲任两脉。皆起胞中。上属
阳明。阳明乃后天水谷之海。居中宫称戊土。
化气取汁。变赤为血。随冲任两脉。以下合癸水。是谓戊与癸合。男女皆然。男子主气。故血从水化而为精。
女子主血。故血从水化而为经。血是男子之精。水中有血。女子之经。血中有水。故行经前后。俱有水浆可
验。夫此水乃肾中冲阳之气所生。气亢则水竭。而血不濡。热证于是乎生矣。气寒则水冷。而血不运。寒证
于是乎生矣。故凡调血。先须调水。调水即是调气。气生于肾。而主于肺。血生于胃。而藏于肝。以血海为肝
之部分。肺金司气之制节。又为水之上源。调血调水。人当知所从事矣。故或调气中之水以滋血。或调血
中之气而利水。是女子调经之法。即凡为血证之治法。学人宜鉴观之。
血热者。水之不足也。因见行经趱前。发热口渴诸证。四物汤。加天冬麦冬黄芩花粉柴胡阿胶牛膝等药。
以滋水者濡血。或用六味地黄汤。以滋肺肾。亦能启水之源。此以滋水为养血之法也。血寒者。水不温也。
因见经水后期。黯淡清冷之状。以及凝滞疼痛兼作。四物汤。加茯苓甘草桂枝黑姜附子等药。以温水者
行气。气行则血行也。血虚者。行经太少。以及干枯淡薄。诸虚证。犹杂出难言。审系肾中天癸之水不足者。
必骨热气逆。足痿脉数。子宫干涩。经血前后。均无浆水。宜左归饮。加菟丝龟板阿胶麦冬五味苁蓉。以滋
天癸之水。审系胃虚。阳明冲任之血不足者。经水必淡。只有水浆。而少鲜血。宜炙甘草汤。养荣汤。酌而用
之。以补生血之源。而血虚可治矣。
血滞者。瘀血阻滞。因见身痛腹胀。寒热带漏。散经闭经诸证。总是瘀血阻滞其气。若无瘀血。则经自流通。
安行无恙。何缘而错杂变乱哉。凡此之类。故总以去瘀为要。四物汤。加元胡桃仁香附乳香没药主之。有
热。加黄芩黄连。有寒。加干姜附片。王清任血府逐瘀汤。膈下逐瘀汤皆宜。瘀血之甚者。非仲景土瓜根下
瘀血等汤不治。另详瘀血门。
总而论之。血气二者。原不相离。血中有气。气即是水。吾于本条。及水火气血论。已详言之。知此。则如瘀血
阻滞者。乃血阻其气。是血之咎。故破散其血而气自流通。桃仁丹皮五灵脂等。在所必用。血分有热者。乃
气分之水不足以濡血。故令血热。用栀芩等以泻火。泻火即是滋水也。血分有寒者。乃气分之水。水凝湿
滞而不化。故濡滞不流通也。吴茱萸细辛桂枝艾叶。以温水者温血。水温则气和。气和则血和。观此。可知
男子瘀血。热结寒凝。治法与此皆无异矣。观于生天癸以生血之法。则知男子滋肾养血之法。观于补阳
明以补血之原。则知男子补血之原矣。观于滋肺以养血之法。则知男子生津以养血之法。以至血热而
水凝为痰。血虚而水溢为汗。同类异情。无不毕见。
妇科已有专门著作。然而男女之血本源于同一根本，因此一并论述。《黄帝内经》说：女子到了十四岁（二七），天癸（指促进生殖功能成熟的精微物质）到来，任脉通畅，太冲脉旺盛，月经按时来潮，所以能够生育。所谓天癸，是指先天肾中的动气，化生为癸水。“至”，是指到达胞宫（子宫）。水是由阳气所化生的，阳发起则阴必然随之响应。血属于阴，由冲脉和任脉主管，因此顺应癸水，随即输血于胞中。血顺应水而下注，这叫做以阴从阳。冲脉和任脉两条经脉，都起于胞中，向上归属于阳明经。阳明经是后天水谷精微汇聚的海，位居中焦，称为戊土。它化生精气，摄取汁液，将赤色转化为血液，随着冲脉和任脉向下与癸水相合，这叫做戊土与癸水相合。男女都是如此。男子以气为主，所以血随水化为精；女子以血为主，所以血随水化为经血。男子的精中含有血，女子的经血中含有水。所以在行经的前后，都有水样分泌物可以验证。这种水乃是由肾中冲阳之气所产生。如果气亢盛则水枯竭，导致血得不到濡润，热证便由此产生。如果气寒则水冷，导致血运行不畅，寒证便由此产生。所以凡是调理血，必须先调理水；调理水也就是调理气。气生于肾而由肺主宰其节制，血生于胃而藏于肝。因为血海属于肝的管辖范围，肺金主管气的制节，又是水的上源。在调理血和水时，人们应当知道从何着手。或者通过调理气中的水来滋养血，或者通过调理血中的气来利水，这就是女子调理月经的方法。这也是所有治疗血证的原则，学习者应当仔细参考。
血热，是由于水不足引起的。表现为月经提前、发热、口渴等症状。用四物汤（由熟地黄、当归、白芍、川芎组成）加入天冬、麦冬、黄芩、天花粉、柴胡、阿胶、牛膝等药物，以滋水来濡养血液。或者使用六味地黄汤，以滋养肺肾，也能开启水源。这是以滋水作为养血的方法。
血寒，是由于水不温暖引起的。表现为月经推迟、经血色黯淡清冷，以及凝滞疼痛并见。用四物汤加入茯苓、甘草、桂枝、黑姜、附子等药物，以温水来行气，气行则血行。
血虚，表现为经血量少或过多，以及干枯淡薄等各种虚证，混杂出现难以言尽。如果确认为肾中天癸之水不足，必然伴有骨蒸潮热、气逆、足部痿软、脉数、子宫干涩，且在经前经后都没有浆水分泌。宜用左归饮（由熟地黄、山药、山茱萸、枸杞子、菟丝子、鹿角胶、龟板胶、牛膝组成）加入菟丝子、龟板、阿胶、麦冬、五味子、肉苁蓉，以滋补肾中天癸之水。如果确认为胃虚，导致阳明及冲任之血不足，经水必然淡而无血色，只有水浆而没有鲜红的血液。宜选用炙甘草汤或养荣汤，酌情使用，以补益生血的源头，这样血虚就可以治愈了。
血滞，即瘀血阻滞。表现为身体疼痛、腹胀，以及寒热夹杂带下漏血、散经、闭经等各种症状。这都是瘀血阻滞了气机。如果没有瘀血，经血自然流通，安然无恙，怎么会错杂变乱呢？凡此种种，总以去除瘀血为关键。用四物汤加入元胡、桃仁、香附、乳香、没药来主治。如果有热，加入黄芩、黄连；如果有寒，加入干姜、附片。王清任的血府逐瘀汤、膈下逐瘀汤也都适宜。瘀血严重的，非张仲景的土瓜根䗪虫丸等方剂不能治愈，另在瘀血门中详细记载。
总而言之，血和气两者，原本不可分离。血中有气，气即是水。我在本条及水火气血论中已经详细论述过。明白了这一点，就知道如瘀血阻滞者，乃是血阻碍了气，这是血的过错，所以破除消散瘀血而气自然流通。桃仁、丹皮、五灵脂等药，是必须使用的。血分有热，乃是气分中的水不足以濡养血液，从而导致血热，用栀子、黄芩等药来泻火，泻火也就是滋水。血分有寒，乃是气分中的水，因水凝湿滞而不能化生，导致濡润停滞而不流通。用吴茱萸、细辛、桂枝、艾叶来温暖水，水温则气和，气和则血和。由此可知，男子瘀血的热结寒凝，治疗方法与此没有不同。观察生成天癸以生血的方法，就知道男子滋肾养血的方法；观察补益阳明以补血之源，就知道男子补血的根本；观察滋养肺以养血的方法，就知道男子生津以养血的方法。以至于血热而水凝结为痰，血虚而水溢出为汗，同类而异情，无不全部显现出来。
Gynecology already has specialized books. However, the blood of men and women shares the same origin; therefore, they are discussed together. The *Yellow Emperor's Inner Classic* states: "When a girl reaches fourteen (two sevens), Tian Gui (a subtle substance promoting reproductive maturity) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) becomes abundant, causing menstruation to occur on schedule, thus enabling conception." What is called Tian Gui refers to the dynamic Qi within the congenital Kidney, which transforms into Gui Water. "Arrives" means reaching the Bao Zhong (uterus). Water is transformed by Yang Qi; when Yang initiates, Yin must follow. Blood belongs to Yin and is governed by the Chong and Ren vessels; thus, it responds to Gui Water and subsequently transfuses blood into the Bao Zhong. The descent of blood following water is termed "Yin following Yang." Both the Chong and Ren vessels originate from the Bao Zhong and ascend to connect with the Stomach Meridian of Foot-Yangming. The Yangming meridian is the sea of postnatal food and fluid essence, situated in the middle Jiao, referred to as Wu Earth. It transforms Qi, extracts juices, changes redness into blood, and follows the Chong and Ren vessels downward to merge with Gui Water; this is termed the combination of Wu and Gui. This applies to both men and women. Men primarily govern Qi, so blood transforms into essence along with water; women primarily govern Blood, so blood transforms into menstruation along with water. Essence in men contains blood, and menstruation in women contains water. Therefore, before and after menstruation, watery discharge can be observed as verification. This water is generated by the Chong-Yang Qi in the Kidney. If Qi is hyperactive, water dries up, leading to insufficient nourishment of blood, and heat syndromes arise therefrom. If Qi is cold, water becomes cold, leading to impaired blood circulation, and cold syndromes arise therefrom. Therefore, whenever regulating blood, one must first regulate water; regulating water is essentially regulating Qi. Qi originates in the Kidney but is controlled by the Lung. Blood is generated in the Stomach but stored in the Liver. Since the Sea of Blood falls under the jurisdiction of the Liver, and the Metal of the Lung governs the regulation of Qi and serves as the upper source of water, when regulating blood and water, one must know where to begin. One may either regulate the water within Qi to nourish Blood, or regulate the Qi within Blood to promote diuresis; this is the method for women to regulate menstruation. This principle also applies to the treatment of all blood disorders, and students should study it carefully.
Blood Heat arises from an insufficiency of Water. Symptoms include menstruation occurring early, fever, and thirst. Use Si Wu Tang (Four Substance Decoction) added with Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Huang Qin (Scutellariae Radix), Hua Fen (Trichosanthis Radix), Chai Hu (Bupleuri Radix), E Jiao (Colla Corii Asini), and Niu Xi (Achyranthis Bidentatae Radix) to nourish Water thereby moistening Blood. Alternatively, use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) to nourish the Lung and Kidney, which can also open the source of Water. This is using the method of nourishing Water to tonify Blood.
Blood Cold arises from Water not being warm. Symptoms include menstruation occurring late, with a dark, pale, clear, and cold appearance, accompanied by stagnation and pain. Use Si Wu Tang added with Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), Hei Jiang (Charred Ginger), and Fu Zi (Aconiti Lateralis Radix Praeparata) to warm Water thereby moving Qi; when Qi moves, Blood moves.
Blood Deficiency manifests as scanty or excessive menstruation, along with dryness, thinness, and various deficiency syndromes appearing mixed and difficult to describe. If confirmed as an insufficiency of Tian Gui Water in the Kidney, symptoms must include bone-steaming heat, rebellious Qi, flaccidity of the legs, rapid pulse, dryness of the uterus, and absence of watery discharge before and after menstruation. Use Zuo Gui Yin (Left Restoring Decoction) added with Tu Si Zi (Cuscutae Semen), Gui Ban (Carapax Testudinis), E Jiao (Colla Corii Asini), Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), and Rong蓉 (Cynomorii Herba) to nourish the Tian Gui Water. If confirmed as Stomach deficiency leading to insufficiency of Blood in the Yangming, Chong, and Ren vessels, menstruation will necessarily be pale, consisting only of watery discharge without fresh red blood. Use Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) or Yang Rong Tang (Nourish Ying Decoction), used judiciously, to tonify the source of blood generation, thereby curing Blood Deficiency.
Blood Stasis refers to obstruction by static blood. Symptoms include body pain, abdominal distension, mixed cold and heat with leukorrhea and metrorrhagia, irregular menstruation, and amenorrhea. All these are caused by static blood obstructing Qi flow. Without static blood, menstruation would flow naturally and smoothly; how could it become disordered? For all such cases, removing stasis is paramount. Use Si Wu Tang added with Yuan Hu (Corydalis Rhizoma), Tao Ren (Persicae Semen), Xiang Fu (Cyperi Rhizoma), Ru Xiang (Olibanum), and Mo Yao (Myrrha) as the main treatment. If there is heat, add Huang Qin (Scutellariae Radix) and Huang Lian (Coptidis Rhizoma); if there is cold, add Gan Jiang (Zingiberis Rhizoma) and Fu Pian (Prepared Aconite Slice). Wang Qingren's Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) and Ge Xia Zhu Yu Tang (Drive Out Stasis Below the Diaphragm Decoction) are also suitable. For severe static blood, only Zhang Zhongjing's Tu Gua Gen Zhe Chong Wan (Trichosanthes Root and Ground Beetle Pill) or similar decoctions can treat it; see the Static Blood chapter for details.
In summary, Blood and Qi are inseparable. There is Qi within Blood, and Qi is essentially Water. I have discussed this in detail in this section and in the Treatise on Water, Fire, Qi, and Blood. Understanding this, we know that in cases of Blood Stasis obstructing Qi, it is the fault of the Blood blocking the Qi; thus, breaking down and dispersing the Blood allows Qi to flow freely. Tao Ren (Persicae Semen), Dan Pi (Moutan Cortex), and Wu Ling Zhi (Trogopterori Faeces) are essential. Blood Heat in the Blood aspect arises because the Water in the Qi aspect is insufficient to moisten the Blood, causing Heat; using Zhi Zi (Gardeniae Fructus) and Huang Qin (Scutellariae Radix) to drain Fire is equivalent to nourishing Water. Blood Cold in the Blood aspect arises because the Water in the Qi aspect is condensed, damp, stagnant, and unable to transform, leading to stagnation and lack of flow. Using Wu Zhu Yu (Evodiae Fructus), Xi Xin (Asari Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), and Ai Ye (Artemisiae Argyi Folium) warms the Water; when Water is warm, Qi harmonizes; when Qi harmonizes, Blood harmonizes. From this, we can see that for men, the treatment methods for Heat Binding and Cold Coagulation due to Blood Stasis are no different. Observing the method of generating Tian Gui to produce Blood reveals the method for men to nourish the Kidney and tonify Blood. Observing the method of tonifying Yangming to replenish the source of Blood reveals the root of tonifying Blood for men. Observing the method of nourishing the Lung to generate Blood reveals the method for men to generate fluids to nourish Blood. Even when Blood Heat causes Water to condense into Phlegm, or Blood Deficiency causes Water to overflow as Sweat, although they are of the same category, their manifestations differ; all are fully revealed here.