香附子（醋煮，四两） 桃仁（去皮尖） 牡丹皮 大黄（蒸） 当归（各一两） 川芎
红花（各半两）
瓦龙子（ ，醋煮一昼夜，二两）
上炊饼为丸，如桐子大。空心温酒下三、五十丸。
三神丸 治室女血气相搏，腹中刺痛，痛引心端，经行涩少，或经事不调，以致疼痛。
橘红（二两） 玄胡索（去皮，醋煮） 当归（去芦，酒浸锉，略炒，各一两）
上为细末，酒煮米糊为丸，如梧桐子大，每服七十丸，加至百丸，空心艾汤送下，米
饮亦得。
〔垣〕柴胡丁香汤 治妇人年三十岁，临经预先脐腰痛，甚则腹中亦痛，经缩二三日。
柴胡 羌活 丁香 全蝎 当归身 生地黄
上都作一服，水四盏，煎至一盏，去渣稍热，食前服。
没药除痛散 逐寒邪，疗腹痛。
蓬术（炮，一两） 当归（焙） 玄胡索 五灵指 肉桂（去粗皮） 良姜（炒）
蒲黄（炒） 甘草（炙） 没药（各半两）
上为末，每服五钱，温酒调服。
〔娄〕一妇人三十岁，每因浴后必用冷水淋通身，又尝大惊，遂患经来时必先少腹
大痛，口吐涎水，然后经行，行后又吐水二日，其痛直至六七日经水止时方住，百药不
效。予诊其脉，寸滑大而弦，关、尺皆弦大而急，尺小于关，关小于寸，所谓前大后小
也。遂用香附三两，半夏二两，茯苓、黄芩各一两半，枳实、玄胡、牡丹皮、人参、当
归、白术、桃仁各一两，黄连七钱，川楝、远志、甘草各半两，桂三钱，茱萸一钱半，分
十五帖，水煎，入生姜汁两蚬壳热服，后用热汤洗浴得微汗乃已。忌当风坐卧，手足见
水，并吃生冷，服三十帖全愈。半年后，又因惊忧，前病复举，腰腹时痛，小便淋闭，心
惕惕跳，惊悸。予意其表已解，病独在里。先与灸少冲、劳宫、昆仑、三阴交止悸定痛，次
用桃仁承气大下之，下后用香附三两，蓬术、当归身各一两半，三棱、玄胡索、桂、大黄、
青皮，俱醋制，青木香、 香、滑石、木通、桃仁各一两，乌药、甘草、缩砂、槟榔、苦
楝肉各半两，木香、吴茱萸各二钱，分作二十帖，入新取牛膝湿者二钱，生姜五片，用
荷叶汤煎服，服讫渐安。
上行血例。
加味乌沉汤 治妇人经水欲来，脐腹 痛。
乌药 缩砂 木香 玄胡索（各一两） 香附（炒去毛，二两） 甘草（一两半）
上细锉，每服七钱，水一盏半，生姜三片，煎至七分，不拘时温服。
上抑气例。
〔薛〕一妇人经行腹痛，食则呕吐，肢体倦怠，发热作渴。此乃素禀气血不足，用
八珍汤二十余帖而愈。后生子二年而经不行，前证仍作，服八珍汤、逍遥散百余剂方愈。（八
珍汤即杂病虚劳门八物汤。）
上补虚例。
〔汪〕一妇人瘦小，年二十余，经水紫色，或前或后，临行腹痛，恶寒喜热，或时
感寒，腹亦作痛，脉皆细濡近滑，两尺重按略洪而滑，此血热也。或谓恶寒如此，何谓
为热？曰∶热极似寒也。遂用酒煮黄连四两，香附、归身尾各二两，五灵指一两，为末，粥
丸，空腹吞之而愈。一妇年二十一岁，六月经行，腹痛如刮，难忍求死，脉得细软而
驶，尺则沉弱而近驶，汪曰∶细软属湿，数则为热，尺沉属郁滞也。以酒煮黄连半斤，炒
香附六两，五灵脂半炒半生三两，归身尾二两，为末粥丸，空心汤下三四钱。服至五六
料，越九年得一子。又越四年，经行两月不断，腹中微痛，又服前丸而愈。续后经行六
七日，经止则流清水，腹中微痛，又服前丸而痛亦止。又经住只有七八日，若至行时或
大行五六日，续则适来适断，或微红，或淡红，行后常流清水，小腹大痛，渐连遍身，胸
背腰腿骨里皆痛，自巳至酉乃止，痛则遍身
冷热，汗大出，汗止痛减，尚能饮食，自始痛至今，历十五年，前药屡服屡效，今罔效
者何也？汪复诊之，脉皆洪滑无力，幸其尚有精神。汪曰∶此非旧日比矣。旧乃郁热，今
则虚寒。东垣曰，始为热中，终为寒中是也。经曰，脉至而从，按之不鼓，乃阴盛隔阳，当
作寒治。且始病时而形敛小，今则形肥大矣。医书曰，瘦人血热，肥人气虚，岂可同一治
耶？所可虑者，汗大泄而脉不为汗衰，血大崩而脉不为血减耳。其痛日重夜轻，知由阳
虚不能健运。故亦凝滞而作痛。以证参脉，宜用助阳，若得脉减痛轻，方为佳兆。遂投参、
、归、术大剂，加桂、附，一帖，来早再诊，脉皆稍宁，服至二三十帖，时当二月至
五月，病且愈，盖病有始终寒热之异，药有前后用舍不同，形有肥瘦壮少不等，岂可以
一方而通治哉。
〔丹〕经过后而作痛者，乃虚中有热，所以作痛。
新荷姐头痛口干，经行后身痛，腰甚痛。
生地黄 白术 芍药（各一钱） 芎 归身尾（各五分） 黄柏（炒） 甘草（炙，各三分）
上用水入少酒，煎服。
按∶经后腹痛为虚明甚。若脉不数，证无头热，未可断其为热也。无热八珍为宜，有
热逍遥为宜。
上寒热例。
〔发热〕
吴茭山治一妇经血过多，五心烦热，日晡潮热，诸药不效，以四物加胡黄连，三服
而愈。
薛新甫治一妇人发热口干，月经不调，两腿无力，服祛风渗湿之剂，腿痛体倦，二膝
浮肿，经事不通。薛作肝脾肾三经血虚火燥证，名鹤膝风。用六味、八味二丸，兼服两
月，形体渐健，饮食渐进，膝肿渐消，不半载而痊。前证若脾肾虚寒，腿足软痛，或足
膝枯细，用八味丸。若饮食过多，腿足或臀内酸胀，或浮肿作痛，用补中益气加茯苓、半
夏主之。一妇人经候过期，发热倦怠，或用四物、黄连之类，反两月一度，且少而成
块，又用峻药通之，两目如帛所蔽。薛曰∶脾为诸阴之首，目为血脉之宗，此脾伤五脏皆
为失所，不能归于目矣。遂用补中益气、济生归脾二汤，专主脾胃，年余寻愈。一妇
人月事未期而至，发热自汗，服清热止汗之剂，反作渴头痛，手掉身麻，此因肝经风热，
用柴胡、炒芩、连、炒山栀、归、芍、生地、丹皮各一钱，参、 、苓、术各一钱五分，川
芎七分，甘草五分，二剂其汗全止，更以补中益气而愈。凡发热久者，阳气亦自病，须
调补之。一妇人气血素虚，经行不调，饮食少思，日晡热甚，用十全大补加山茱萸、山
药、丹皮、麦门冬、五味子而愈。次年秋，患寒热，或用清脾饮而元气愈弱，仍以前药而
愈。一妇人素勤苦，冬初患咳嗽发热，久而吐血、盗汗，经水两三月一至，遍身作痛。
或用化痰降火药，口噤筋挛，此血虚而药益损耳。用加减八味丸及补中益气加麦门、五
味、山药治之，年余而痊。
〔寒热〕
经水适来适断者，或有往来寒热者，先服小柴胡汤以去其寒热，后以四物汤和之。
〔本〕妇人血脉不调，往来寒热，状如劳倦。
当归 川芎 甘草 黄 官桂（去粗皮，各一两） 熟地黄 白术 白芍药（各二两）
柴胡 阿胶（各半两）
为细末，每服五钱，枣一枚，水煎空心温服。白汤点服亦得。常服不生带下，调血
脉，养子宫，终身无病。
太仓公治一女，病腰背痛，寒热。众医皆以为寒热也。公诊之曰∶内寒月事不下也。
即窜以药，旋下，病已。病得之欲男子不可得也。所以知其病者，诊其脉时，切之肾脉
也啬而不属，啬而不属者其来难坚，故曰月不下。肝脉弦出左口，故曰欲男子不可得也。
盖男子以精为主，妇人以血为主，男子精盛
则思室，女子月盛则怀胎。夫肝，摄血者也。厥阴弦出寸部，又上鱼际，则阴血盛可知矣。
（别详师尼寡妇条内。）
薛新甫治一妇人耳内或耳后项侧作痛，寒热口苦，月经不调，此肝火气滞而血凝，用
小柴胡加山栀、川芎、丹皮治之，诸证悉退。月事不行而寒热者，详经闭门。
〔热入血室〕
〔良〕妇人伤寒伤风发热，经水适来，昼则安静，暮则谵语，有如疟状，此为热入血室。
治者无犯胃气及上二焦，宜服小柴胡汤。若脉迟身凉，当刺期门穴，下针病入五吸停针，良久，徐
徐出针。凡针期门穴，必泻勿补。肥人二寸，瘦人寸半也。
〔薛〕前证若因劳役，或怒气发热，适遇经行而患前证者，亦用小柴胡汤加生地黄
治之。血虚，用四物加柴胡。若病既愈而热未已，或元气素弱，并用补中益气汤。脾气素郁，用
济生归脾汤。血气素虚，用十全大补汤。
许学士治一妇病伤寒发寒热，遇夜则如见鬼状，经六七日忽然昏塞，涎响如引锯，牙关紧急，
瞑目不知人，病势危困。许视之曰∶得病之初，曾值月经来否？其家云∶经水方来，病作而经遂止，
得一二日发寒热，昼虽静，夜则有鬼祟，从日昨不省人事。许曰∶此乃热入血室证。仲景云，妇人中
风，发热恶寒，经水适来，昼则明了，暮则谵语，如见鬼状，发作有时，此名热入血室。医者不晓，
以刚剂与之，逐致胸膈不利，涎潮上脘，喘急息高，昏冒不知人。当先化其痰，后除其热。乃急以一呷
散投之，两时顷，涎下得睡，省人事；次授以小柴胡汤加生地黄，三服而热除，不汗而自解矣。一
妇人患热入血室证，医者不识，用补血调气药治之，数日遂成血结胸。或勤用前药，许公曰∶小
柴胡已迟，不可行也。无已，刺期门穴斯可矣。予不能针，请善针者治之。如言而愈。或问∶热
入血室，何为而成结胸也？许曰∶邪气传入经络，与正气相搏，上下流行，遇经水适来适断，邪气乘
虚入于血室，血为邪所迫，上入肝经，肝受邪则谵语而见鬼，复入膻中，则血结于胸中矣。何以言之？
妇人平居，水养木，血养肝。方未受孕，则下行之为月水，既孕则中蓄之以养胎，及已产则上壅之
以为乳，皆血也。今邪逐血并归于肝经，聚于膻中，结于乳下，故手触之则痛，非药可及，故当刺
期门也。
虞恒德治一少妇，夏月行经得伤寒似疟，谵语狂乱，诸医皆以伤寒内热，投双解散、解
毒汤服之，大汗如雨，反如风状，次以牛黄丸金石之药，愈投愈剧。一日延虞诊视，脉弦而大，
阳俱病，岂不口干舌黑，况脉不数，病体扪之或热或静，其腹急痛，意必有内
伤在前，伤寒在后。今伤寒得汗虽已，内伤则尚存故也。因细问之，患者曰∶正行经时，因饮食后
多汗，用冷水抹身，因得此证。方知冷水外闭其汗，内阻其血，邪热入室，经血未尽，血得邪热，乍
静乍乱，寒热谵语，掉眩类风，须得玉烛散下之而愈。下后谵语已定，次以四物、小柴胡汤调理，
五日热退身凉，其患遂瘳。
《衍义》云∶一妇人温病已十二日，诊之其脉六七至而涩，寸稍大，尺稍小，发寒热，
头赤口干，不了了，耳聋。问之，病数日经水乃行，此属少阳热入血室也，若治不对病，
则必死。乃按其证与小柴胡汤服之，二日，又与小柴胡汤加官桂、干姜一日，寒热遂止。又
云∶脐下急痛，又与抵当丸微利，脐下痛痊，身渐凉，脉渐匀，尚不了了，乃复与小柴胡
汤。次日，但胸中热躁，口鼻干，又少与调胃承气汤，不得利。次日心下痛，又与大陷
胸汤半服，利三行。次日虚烦不宁，时妄有所见，复狂言，虽知其尚有燥屎，以其极虚，
不敢攻之，遂与竹叶汤去其烦热，其夜大便自通，至晚两次，中有燥屎数枚，而狂言虚
烦尽解。但咳嗽唾沫，此肺虚也。若不治，恐乘虚而成肺痿，遂与小柴胡汤去人参、大枣、
生姜，加干姜五味子汤，一日咳减，二日而病悉愈。以上皆用仲景方。
薛立斋治一妇人经行，感冒风寒，日间安静，至夜谵语，用小柴胡加生地治之顿安。
但内热头晕，用补中益气加蔓荆子而愈。后因恼怒，寒热谵语，胸胁胀痛，小便频数，月
经先期，此是肝火血热妄行，用加味逍遥加生地黄而愈。一妇人因怒，寒热头痛谵语，
日晡至夜益甚，而经暴至。盖肝藏血，此怒动火而血妄行，用加味逍遥散加生地黄治之，
神思顿清。但食少体倦，月经未已。盖脾统血，此脾气虚，不能摄血，用补中益气治之，
月经渐止。一妇人怀抱素郁，感冒经行谵语，服发散之剂不应，用寒凉降火，前证益
甚，更加月经不止，肚腹作痛，呕吐不食，痰涎自出。此脾胃虚寒，用香砂六君，脾胃渐
健，诸证渐退，又用归脾汤而全愈。
加味小柴胡汤 治妇人伤风，续得寒热，发作有时，经水适断，此为热入血室，其血
必结，致如疟状。
柴胡（三钱） 半夏 黄芩（各二钱） 生地黄 人参（各一钱半） 甘草（半钱）
作一服，水二盅，姜五片，枣二枚，煎一盅，不拘时服。
干姜柴胡汤 治妇人伤寒，经脉方来，热入血室，寒热如疟，或狂言见鬼。
柴胡（一钱） 桂枝（三分） 栝蒌根（五分） 牡蛎（ ） 干姜（炮） 甘草（炒，各三分）
上水煎服，汗出而愈。
海蛤散 治妇人伤寒，血结胸膈，宜服此药，及针期门穴。
海蛤 滑石（ ，水飞） 甘草（各五钱） 芒硝（一两）
上为末，每服二钱，用鸡子清调下。小肠通利，其结血自散。更用桂枝红花汤发其
【背景信息】
书名：证治准绳·女科 作者：王肯堂 朝代：明 章节：经候总论(3/4) 类别：妇儿
香附子（用醋煮，四两） 桃仁（去皮和尖） 牡丹皮 大黄（蒸制） 当归（各一两） 川芎
红花（各半两）
瓦龙子（煅烧，用醋煮一昼夜，二两）
以上药物制成炊饼样药丸，大小如梧桐子。空腹时用温酒送服三、五十丸。
三神丸 治疗未婚女子血气相搏结，腹中刺痛，疼痛牵引至心窝部，月经行经不畅量少，或月经周期不调，从而导致疼痛。
橘红（二两） 玄胡索（去皮，用醋煮） 当归（去芦头，用酒浸泡后切碎，略炒，各一两）
以上药物研为细末，用酒煮米糊制作成丸，大小如梧桐子大，每次服用七十丸，可加至一百丸，空腹时用艾叶汤送下，喝米饮也可以。
〔李东垣〕柴胡丁香汤 治疗三十岁妇女，在月经来潮前预先出现脐部和腰部疼痛，严重时腹部也痛，月经推迟两三天。
柴胡 羌活 丁香 全蝎 当归身 生地黄
以上药物作为一剂服用，加水四盏，煎煮至一盏，滤去药渣，稍热时，饭前服用。
没药除痛散 驱逐寒邪，治疗腹痛。
蓬术（炮制，一两） 当归（焙干） 玄胡索 五灵脂 肉桂（去除粗皮） 良姜（炒）
蒲黄（炒） 甘草（炙） 没药（各半两）
以上药物研为粉末，每次服用五钱，用温酒调服。
〔娄全善〕一位三十岁的妇人，每次洗澡后必定用冷水淋遍全身，又曾受大惊吓，于是患上月经来时必先少腹剧烈疼痛，口吐涎水，然后才行经，行经后又吐水两天，疼痛直到六七天经血停止时才停止，各种药物都无效。我诊察她的脉象，寸脉滑大而弦，关脉、尺脉皆弦大而急，尺脉小于关脉，关脉小于寸脉，这就是所说的“前大后小”。于是使用香附三两，半夏二两，茯苓、黄芩各一两半，枳实、玄胡索、牡丹皮、人参、当归、白术、桃仁各一两，黄连七钱，川楝子、远志、甘草各半两，桂枝三钱，吴茱萸一钱半，分为十五帖，用水煎煮，加入生姜汁两蚬壳量，趁热服用，之后用热水洗浴使其微微出汗病就好了。忌讳对着风坐卧，手足接触水，并吃生冷食物，服用三十帖后完全痊愈。半年后，又因惊吓忧虑，旧病复发，腰腹时常疼痛，小便淋漓闭塞，心中惊恐跳动，惊悸。我推测其表证已解，病独在于里。先用灸法针刺少冲、劳宫、昆仑、三阴交穴以止悸定痛，接着用桃仁承气汤猛烈攻下，攻下后使用香附三两，蓬术、当归身各一两半，三棱、玄胡索、桂枝、大黄、青皮，都用醋制，青木香、木香、滑石、木通、桃仁各一两，乌药、甘草、缩砂仁、槟榔、苦楝皮各半两，木香、吴茱萸各二钱，分为二十帖，加入新取的湿牛膝二钱，生姜五片，用荷叶汤煎服，服完后逐渐安宁。
这是活血的医案。
加味乌沉汤 治疗妇人月经将要来潮时，脐腹部疼痛。
乌药 缩砂仁 木香 玄胡索（各一两） 香附（炒去毛，二两） 甘草（一两半）
以上药物细细切碎，每次服用七钱，加水一盏半，生姜三片，煎煮至七分，不拘时候温服。
这是理气的医案。
〔薛己〕一位妇人月经期间腹痛，进食则呕吐，肢体倦怠，发热口渴。这是因为素来禀赋气血不足，使用八珍汤二十余帖而痊愈。后来生子两年后月经不行，之前的症状仍然发作，服用八珍汤、逍遥散百余剂才痊愈。（八珍汤即杂病虚劳门中的八物汤。）
这是补虚的医案。
〔汪机〕一位瘦小的妇人，二十多岁，经血颜色紫暗，月经或提前或推后，临行经时腹痛，恶寒喜热，有时感受寒邪，腹部也作痛，脉象皆细濡近滑，两尺脉重按略洪而滑，这是血热。有人问：如此恶寒，怎么能说是热呢？我说：热极似寒。于是用酒煮黄连四两，香附、当归身尾各二两，五灵脂一两，研为粉末，用米粥制作药丸，空腹吞服而痊愈。另一位二十一岁的妇人，六月行经，腹痛如刮，难以忍受求死，脉象细软而数，尺脉沉弱而近数，汪机说：细软属湿，数则为热，尺脉沉属郁滞。用酒煮黄连半斤，炒香附六两，五灵脂半炒半生三两，当归身尾二两，研为粉末用粥制作药丸，空腹用汤药送下三四钱。服用到五六料，过了九年得到一个儿子。又过了四年，月经行经两个月不停，腹中微痛，又服用前面的药丸而痊愈。随后月经行经六七天，经血停止则流出清水，腹中微痛，又服用前面的药丸疼痛也停止。又过不久月经只持续七八天，如果到了行经时或大量行经五六天，接着就突然来突然断，或颜色微红，或淡红，行经后常流清水，小腹剧烈疼痛，渐渐牵连遍身，胸背腰腿骨节里面都痛，从巳时到酉时才停止，疼痛时遍身忽冷忽热，大汗出，汗出后疼痛减轻，还能饮食，从开始疼痛到现在，历经十五年，前面的药多次服用多次有效，现在为什么无效了呢？汪机再次诊察，脉象皆洪滑无力，幸好她还有精神。汪机说：这已经不是以前的情况了。以前是郁热，现在是虚寒。李东垣说，始为热中，终为寒中。《内经》说，脉至而从，按之不鼓，乃阴盛隔阳，应当当作寒证治疗。而且起初患病时形体瘦小，现在形体肥大了。医书说，瘦人血热，肥人气虚，怎么可以用同样的方法治疗呢？所担心的是，大汗泄而脉不因汗而衰，大出血而脉不因血减而已。疼痛白天重晚上轻，知道是由于阳虚不能健运。所以也凝滞而作痛。结合证候参看脉象，适宜用助阳的方法，如果得到脉减痛轻，才是好兆头。于是投用人参、黄芪、当归、白术的大剂量方，加上桂枝、附子，一帖，第二天早上再诊，脉象皆稍安宁，服用到二三十帖，当时正值二月至五月，病几乎痊愈，因为病有始终寒热的不同，药有前后使用的取舍不同，形体有肥瘦壮少的不等，怎么可以用一方通治呢？
新荷姐头痛口干，月经行身后身痛，腰痛甚。
生地黄 白术 芍药（各一钱） 川芎 当归身尾（各五分） 黄柏（炒） 甘草（炙，各三分）
以上药物用水加少许酒，煎服。
按语：经后腹痛为虚证非常明显。如果脉不数，证候无头热，不可断定其为热证。无热证用八珍汤为宜，有热证用逍遥散为宜。
这是寒热证的医案。
〔发热〕
吴茭山治疗一位妇人经血过多，五心烦热，日晡时潮热，各种药物无效，用四物汤加胡黄连，三服而愈。
薛新甫治疗一位妇人发热口干，月经不调，两腿无力，服用祛风渗湿的药物，导致腿痛体倦，双膝浮肿，经事不通。薛己认为是肝脾肾三经血虚火燥证，命名为鹤膝风。使用六味地黄丸、八味地黄丸两个丸药，兼服两个月，形体逐渐健壮，饮食逐渐增加，膝肿逐渐消退，不到半年而痊愈。前面的证候如果是脾肾虚寒，腿足软痛，或足膝枯细，用八味丸。如果饮食过多，腿足或臀部内侧酸胀，或浮肿作痛，用补中益气汤加茯苓、半夏主治。一位妇人月经过期，发热倦怠，有人用四物汤、黄连之类的药物，反而变成两个月一次，且量少而成块，又用峻猛药物通经，导致两眼像被帛布遮蔽一样模糊。薛己说：脾为诸阴之首，目为血脉之宗，这是脾伤五脏皆为失所，不能归于目矣。于是用补中益气汤、济生归脾汤二汤，专主脾胃，一年多寻得痊愈。一位妇人月事未到期而至，发热自汗，服用清热止汗的药物，反而作渴头痛，手抖身麻，这是因为肝经风热，用柴胡、炒黄芩、黄连、炒山栀、当归、芍药、生地、丹皮各一钱，人参、黄芪、茯苓、白术各一钱五分，川芎七分，甘草五分，二剂其汗全止，再用补中益气汤而痊愈。凡是发热久者，阳气也会生病，必须调补。一位妇人素来气血虚弱，月经不调，饮食少思，日晡时热甚，用十全大补汤加山茱萸、山药、丹皮、麦门冬、五味子而痊愈。次年秋天，患寒热，有人用清脾饮而元气更弱，仍用前面的药而痊愈。一位妇人素来勤劳辛苦，冬初患咳嗽发热，久而吐血、盗汗，经水两三月一至，遍身作痛。有人用化痰降火药，导致口噤筋挛，这是血虚而药物更加损伤。用加减八味丸及补中益气汤加麦门冬、五味子、山药治疗，一年多而痊愈。
〔寒热〕
经水刚好来刚好断的时候，或者有往来寒热症状的，先服用小柴胡汤以去除其寒热，后用四物汤调和。
〔张仲景〕妇人血脉不调，往来寒热，状如劳倦。
当归 川芎 甘草 黄芪 官桂（去除粗皮，各一两） 熟地黄 白术 白芍药（各二两）
柴胡 阿胶（各半两）
研为细末，每次服用五钱，大枣一枚，水煎空腹温服。白开水点服也可以。常服不生带下，调血脉，养子宫，终身无病。
太仓公治疗一女，病腰背痛，寒热。众医生都认为是寒热证。太仓公诊察说：内寒月事不下也。随即用药熨贴，月经随即下行，病好了。这个病是因为想要男子却得不到所致。之所以知道这个病，诊察脉象时，切按肾脉涩而不连续，涩而不连续者其来势艰难坚硬，所以说月经不下。肝脉弦出左口，所以说想要男子却得不到。大概男子以精为主，妇人以血为主，男子精盛则思室，女子月盛则怀胎。肝，是统摄血的脏器。厥阴脉弦出寸部，又上鱼际，则阴血盛可知矣。（别详师尼寡妇条内。）
薛新甫治疗一位妇人耳内或耳后项侧作痛，寒热口苦，月经不调，这是肝火气滞而血凝，用小柴胡汤加山栀、川芎、丹皮治疗，诸证悉退。月事不行而寒热的，详见经闭门。
〔热入血室〕
〔张仲景〕妇人伤寒伤风发热，经水刚好来，白天则安静，傍晚则谵语，有如疟疾症状，此为热入血室。
治疗者不要侵犯胃气及上二焦，适宜服用小柴胡汤。如果脉迟身凉，应当刺期门穴，下针病入五吸停针，良久，徐徐出针。凡针刺期门穴，必须泻勿补。肥人进针二寸，瘦人进针寸半。
〔薛己〕前面的证候如果是因为劳役，或怒气发热，刚好遇到经行而患前面证候的，也用小柴胡汤加生地黄治疗。血虚，用四物汤加柴胡。如果病既愈而热未已，或元气素弱，并用补中益气汤。脾气素郁，用济生归脾汤。血气素虚，用十全大补汤。
许学士治疗一位妇人病伤寒发寒热，遇夜则如见鬼状，经过六七天忽然昏塞，涎响如拉锯，牙关紧急，闭目不知人，病势危困。许学士视之曰：得病之初，曾值月经来否？其家属说：经水刚来，病作而经遂止，得一二日发寒热，白天虽静，夜晚则有鬼祟，从昨天起不省人事。许学士说：此乃热入血室证。仲景说，妇人中风，发热恶寒，经水刚好来，白天则明了，傍晚则谵语，如见鬼状，发作有时，此名热入血室。医生不懂，用刚烈药剂给她，导致胸膈不利，涎潮上脘，喘急息高，昏冒不知人。应当先化其痰，后除其热。于是急忙以一呷散投之，两个时辰左右，涎下得睡，省人事；接着授以小柴胡汤加生地黄，三服而热除，不汗而自解矣。一位妇人患热入血室证，医生不认识，用补血调气药治疗，数日遂成血结胸。或者勤用前面的药，许公说：小柴胡已迟，不可行也。不得已，刺期门穴斯可矣。我不能针，请善于针灸的人治疗。照做而愈。有人问：热入血室，为何而成结胸也？许学士说：邪气传入经络，与正气相搏，上下流行，遇经水刚好来刚好断，邪气乘虚入于血室，血为邪所迫，上入肝经，肝受邪则谵语而见鬼，复入膻中，则血结于胸中矣。何以言之？妇人平居，水养木，血养肝。方未受孕，则下行之为月水，既孕则中蓄之以养胎，及已产则上壅之以为乳，皆血也。今邪逐血并归于肝经，聚于膻中，结于乳下，故手触之则痛，非药可及，故当刺期门也。
虞恒德治疗一位少妇，夏月行经得伤寒似疟，谵语狂乱，众医生都以伤寒内热，投双解散、解毒汤服之，大汗如雨，反如风状，次以牛黄丸金石之药，愈投愈剧。一日延虞诊视，脉弦而大，阳俱病，岂不口干舌黑，况脉不数，病体扪之或热或静，其腹急痛，意必有内伤在前，伤寒在后。今伤寒得汗虽已，内伤则尚存故也。因细问之，患者曰：正行经时，因饮食后多汗，用冷水抹身，因得此证。方知冷水外闭其汗，内阻其血，邪热入室，经血未尽，血得邪热，乍静乍乱，寒热谵语，掉眩类风，须得玉烛散下之而愈。下后谵语已定，次以四物汤、小柴胡汤调理，五日热退身凉，其患遂瘳。
《衍义》云：一妇人温病已十二日，诊之其脉六七至而涩，寸稍大，尺稍小，发寒热，头赤口干，不了了，耳聋。问之，病数日经水乃行，此属少阳热入血室也，若治不对病，则必死。乃按其证与小柴胡汤服之，二日，又与小柴胡汤加官桂、干姜一日，寒热遂止。又说：脐下急痛，又与抵当丸微利，脐下痛痊，身渐凉，脉渐匀，尚不了了，乃复与小柴胡汤。次日，但胸中热躁，口鼻干，又少与调胃承气汤，不得利。次日心下痛，又与大陷胸汤半服，利三行。次日虚烦不宁，时妄有所见，复狂言，虽知其尚有燥屎，以其极虚，不敢攻之，遂与竹叶汤去其烦热，其夜大便自通，至晚两次，中有燥屎数枚，而狂言虚烦尽解。但咳嗽唾沫，此肺虚也。若不治，恐乘虚而成肺痿，遂与小柴胡汤去人参、大枣、生姜，加干姜五味子汤，一日咳减，二日而病悉愈。以上皆用仲景方。
薛立斋治疗一位妇人经行，感冒风寒，日间安静，至夜谵语，用小柴胡加生地治之顿安。但内热头晕，用补中益气加蔓荆子而愈。后因恼怒，寒热谵语，胸胁胀痛，小便频数，月经先期，这是肝火血热妄行，用加味逍遥散加生地黄而痊愈。一位妇人因怒，寒热头痛谵语，日晡至夜益甚，而经暴至。盖肝藏血，此怒动火而血妄行，用加味逍遥散加生地黄治疗，神思顿清。但食少体倦，月经未已。盖脾统血，此脾气虚，不能摄血，用补中益气汤治疗，月经渐止。一位妇人怀抱素郁，感冒经行谵语，服发散之剂不应，用寒凉降火，前证益甚，更加月经不止，肚腹作痛，呕吐不食，痰涎自出。这是脾胃虚寒，用香砂六君子汤，脾胃渐健，诸证渐退，又用归脾汤而全愈。
加味小柴胡汤 治疗妇人伤风，续得寒热，发作有时，经水刚好断，此为热入血室，其血必结，致如疟状。
柴胡（三钱） 半夏 黄芩（各二钱） 生地黄 人参（各一钱半） 甘草（半钱）
作一服，水二盅，姜五片，枣二枚，煎一盅，不拘时服。
干姜柴胡汤 治疗妇人伤寒，经脉刚来，热入血室，寒热如疟，或狂言见鬼。
柴胡（一钱） 桂枝（三分） 栝蒌根（五分） 牡蛎（煅） 干姜（炮） 甘草（炒，各三分）
以上用水煎服，汗出而愈。
海蛤散 治疗妇人伤寒，血结胸膈，适宜服此药，及针期门穴。
海蛤 滑石（煅，水飞） 甘草（各五钱） 芒硝（一两）
以上研为粉末，每次服用二钱，用鸡子清调下。小肠通利，其结血自散。更用桂枝红花汤发其
[Background Information]
Book: Zhengzhi Zhunsheng · Nuke (Standardized Treatment for Women's Diseases)
Author: Wang Kentang
Dynasty: Ming
Chapter: General Discussion on Menstruation (3/4)
Category: Gynecology and Pediatrics
Cyperi Rhizoma (cooked with vinegar, 4 liang), Persicae Semen (skin and tip removed), Moutan Cortex, Rheum Radix et Rhizoma (steamed), Angelicae Sinensis Radix (each 1 liang), Chuanxiong Rhizoma, Carthami Flos (each 0.5 liang).
Haliotidis Concha (calcined, cooked with vinegar for a full day and night, 2 liang).
Grind the above herbs into powder and mix with steamed wheat cake to make pills, sized like Sophora japonica seeds. Take 30-50 pills with warm wine on an empty stomach.
Sanshen Wan (Three Gods Pill)
Indications: For unmarried women suffering from Qi and Blood stagnation, causing stabbing pain in the abdomen that radiates to the epigastrium, scanty or irregular menstruation leading to pain.
Citri Reticulatae Pericarpium Viride (2 liang), Corydalis Rhizoma (skin removed, cooked with vinegar), Angelicae Sinensis Radix (rhizome removed, soaked in wine, chopped, lightly stir-fried, each 1 liang).
Grind the above into fine powder, mix with rice paste boiled in wine to make pills, sized like Sophora japonica seeds. Take 70 pills per dose, increasing to 100 pills. Take with Artemisia argyi decoction on an empty stomach; rice gruel is also acceptable.
[Li Dongyuan] Chaihu Dingxiang Tang (Bupleurum and Clove Decoction)
Indications: For women aged thirty experiencing premenstrual pain in the umbilical and lumbar regions, which may extend to the abdomen, with menstruation delayed by two to three days.
Bupleuri Radix, Notopterygii Rhizoma et Radix, Caryophylli Flos, Scorpio, Angelicae Sinensis Radix (body only), Rehmanniae Radix Recens.
Combine as one dose, add four cups of water, decoct to one cup, remove dregs, and take slightly warm before meals.
Moyao Tongtong San (Myrrh Pain-Relieving Powder)
Actions: Expels Cold pathogens, treats abdominal pain.
Curcumae Longae Rhizoma (processed, 1 liang), Angelicae Sinensis Radix (baked), Corydalis Rhizoma, Trogopteri Dung, Cinnamomi Cortex (remove coarse bark), Alpiniae Officinarum Rhizoma (stir-fried), Poria, Glycyrrhizae Radix et Rhizoma (honey-fried), Myrrha (each 0.5 liang).
Grind into powder. Take 5 qian per dose, mixed with warm wine.
[Lou Quanshan] A thirty-year-old woman always used cold water to wash her entire body after bathing and once suffered severe fright. Consequently, she developed severe lower abdominal pain before menstruation, salivation, followed by menstruation, and continued salivation for two days after menstruation. The pain lasted six to seven days until menstruation stopped. Various medicines were ineffective. I palpated her pulse: the Cun position was slippery, large, and wiry; the Guan and Chi positions were wiry, large, and rapid. The Chi pulse was smaller than the Guan, and the Guan was smaller than the Cun, known as "large anteriorly and small posteriorly." I prescribed Cyperi Rhizoma (3 liang), Pinelliae Rhizoma (2 liang), Poria (1.5 liang), Scutellariae Radix (1.5 liang), Aurantii Fructus Immaturus (1 liang), Corydalis Rhizoma (1 liang), Moutan Cortex (1 liang), Ginseng Radix (1 liang), Angelicae Sinensis Radix (1 liang), Atractylodis Macrocephalae Rhizoma (1 liang), Persicae Semen (1 liang), Coptidis Rhizoma (7 qian), Toosendan Fructus (0.5 liang), Polygala Radix (0.5 liang), Glycyrrhizae Radix et Rhizoma (0.5 liang), Cinnamomi Ramulus (3 qian), Evodiae Fructus (1.5 qian). Divide into fifteen doses. Decoct with water, add ginger juice (two clam shells), and take hot. Afterwards, bathe in hot water until slight sweating occurs, and the disease resolves. Avoid sitting or lying in drafts, contact of hands and feet with water, and consumption of raw/cold foods. After thirty doses, she was completely cured. Six months later, due to fright and worry, the previous illness recurred with intermittent waist and abdominal pain, dysuria, palpitations, and anxiety. I deduced that the exterior syndrome had resolved, and the pathology was solely interior. First, I moxa-ed Shaochong (HT 9), Laogong (PC 8), Kunlun (BL 60), and Sanyinjiao (SP 6) to calm palpitations and relieve pain. Then, I administered Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) to purge vigorously. After purging, I prescribed Cyperi Rhizoma (3 liang), Curcumae Zedoariae Rhizoma (1.5 liang), Angelicae Sinensis Radix (body only, 1.5 liang), Sparganii Rhizoma (1 liang), Corydalis Rhizoma (1 liang), Cinnamomi Ramulus (1 liang), Rheum Radix et Rhizoma (1 liang), Citri Reticulatae Pericarpium (1 liang), Aquilariae Lignum Resinatum (1 liang), Bletillae Rhizoma (1 liang), Smilacis Glabrae Rhizoma (1 liang), Linderae Radix (0.5 liang), Glycyrrhizae Radix et Rhizoma (0.5 liang), Amomi Fructus Rotundus (0.5 liang), Arecae Semen (0.5 liang), Meliae Cortex (0.5 liang), Aucklandiae Radix (2 qian), Evodiae Fructus (2 qian). Divide into twenty doses. Add fresh Achyranthes Radix (2 qian) and five slices of ginger. Decoct with lotus leaf decoction. After taking it, she gradually stabilized.
This is a case of promoting blood circulation.
Jiawei Wuchen Tang (Modified Wu-Chen Decoction)
Indications: For women experiencing umbilical and abdominal pain just before menstruation.
Linderae Radix, Amomi Fructus Rotundus, Aucklandiae Radix, Corydalis Rhizoma (each 1 liang), Cyperi Rhizoma (stir-fried, de-haired, 2 liang), Glycyrrhizae Radix et Rhizoma (1.5 liang).
Finely chop the above. Take 7 qian per dose with 1.5 cups of water and three slices of ginger. Decoct to 0.7 cups. Take warm at any time.
This is a case of regulating Qi.
[Xue Ji] A woman experienced abdominal pain during menstruation, vomiting after eating, limb fatigue, fever, and thirst. This was due to innate deficiency of Qi and Blood. She was cured after taking Bazhen Tang (Eight Treasure Decoction) for over twenty doses. Two years after giving birth, her menstruation ceased, and the previous symptoms returned. She was cured after taking Bazhen Tang and Xiaoyao San (Free and Easy Wanderer Powder) for over a hundred doses. (Bazhen Tang is the same as Bayiwu Tang in the Deficiency and Consumption chapter.)
This is a case of tonifying deficiency.
[Wang Ji] A thin woman in her twenties had purple menstrual blood, irregular cycles (early or late), abdominal pain before menstruation, aversion to cold with preference for warmth, and occasional cold invasion causing abdominal pain. Her pulses were fine, soggy, and nearly slippery. The Chi pulses were slightly large and slippery when pressed heavily. This indicates Heat in the Blood. Someone asked: How can this be Heat if there is such aversion to cold? I replied: Extreme Heat mimics Cold. I prescribed Coptidis Rhizoma (wine-boiled, 4 liang), Cyperi Rhizoma (2 liang), Angelicae Sinensis Radix (body and tail, 2 liang), Trogopteri Dung (1 liang), ground into powder and made into pills with congee. She took them on an empty stomach and was cured. Another twenty-one-year-old woman had severe scraping-like abdominal pain during menstruation in June, unbearable to the point of wishing for death. Her pulse was fine, soft, and rapid; the Chi pulse was deep, weak, and near-rapid. Wang Ji said: Fine and soft indicates Dampness; rapid indicates Heat; deep Chi indicates Stagnation. I prescribed Coptidis Rhizoma (wine-boiled, 0.5 jin), Cyperi Rhizoma (stir-fried, 6 liang), Trogopteri Dung (half stir-fried, half raw, 3 liang), Angelicae Sinensis Radix (body and tail, 2 liang), ground into powder and made into pills with congee. Take 3-4 qian with warm water on an empty stomach. After five to six courses, she conceived nine years later. Four years later, her menstruation lasted two months continuously with mild abdominal pain. She took the previous pills and recovered. Subsequently, her menstruation lasted six to seven days, followed by clear fluid discharge and mild abdominal pain. Taking the previous pills stopped the pain. Later, her cycle shortened to seven or eight days. Sometimes heavy flow lasted five to six days, then suddenly stopped; sometimes light red or pale red flow, followed by clear fluid discharge. Severe lower abdominal pain spread to the whole body, including chest, back, waist, legs, and bones, from Si hour to You hour. During pain, she experienced alternating hot and cold sensations, profuse sweating, which relieved the pain. She could still eat. This had lasted fifteen years. Previous medicines worked repeatedly but failed now. Wang Ji re-palpated: pulses were large, slippery, and powerless, but she still had spirit. Wang Ji said: This is no longer the same as before. Previously it was Stagnant Heat; now it is Deficiency Cold. Li Dongyuan said: Initially Heat in the Middle, finally Cold in the Middle. The Classic says: If the pulse follows but does not throb under pressure, it is Yin Excess blocking Yang, treat as Cold. Also, initially she was thin; now she is fat. Medical texts say: Thin people have Blood Heat; fat people have Qi Deficiency. How can they be treated the same? The concern is that profuse sweating does not weaken the pulse, and massive bleeding does not reduce the pulse. Pain heavier by day and lighter by night indicates Yang Deficiency failing to move Qi, causing stagnation and pain. Combining symptoms and pulse, Yang-tonification is appropriate. If the pulse softens and pain lessens, it is a good sign. I prescribed a large dose of Ginseng Radix, Astragali Radix, Angelicae Sinensis Radix, and Atractylodis Macrocephalae Rhizoma, plus Cinnamomi Ramulus and Aconiti Lateralis Radix Praeparata. After one dose, re-examined next morning, pulses calmed slightly. After twenty to thirty doses, during February to May, the disease nearly resolved. Diseases differ in initial and final Cold/Heat; medicines differ in timing and selection; bodies differ in fat/thin/sturdy/frail. One formula cannot treat all.
[Zhu Danxi] Pain occurring after menstruation is due to Deficiency with Heat, hence the pain.
Xinhejie had headache and dry mouth, body pain after menstruation, and severe lower back pain.
Rehmanniae Radix, Atractylodis Macrocephalae Rhizoma, Paeoniae Radix Alba (each 1 qian), Chuanxiong Rhizoma, Angelicae Sinensis Radix (body and tail, each 0.5 qian), Phellodendri Cortex (stir-fried), Glycyrrhizae Radix et Rhizoma (honey-fried, each 0.3 qian).
Decoct with water and a little wine.
Note: Abdominal pain after menstruation is clearly Deficiency. If the pulse is not rapid and there is no head heat, do not diagnose as Heat. Use Bazhen Tang if no Heat; use Xiaoyao San if there is Heat.
This is a case of Cold and Heat.
[Fever]
Wu Jiaoshan treated a woman with excessive menstrual bleeding, five-palm heat, afternoon tidal fever. Various medicines failed. He used Siwu Tang (Four Substance Decoction) plus Picrorhizae Rhizoma. Three doses cured her.
Xue Xinpu treated a woman with fever, dry mouth, irregular menstruation, and weak legs. After taking wind-dispelling and damp-draining medicines, she developed leg pain, fatigue, and bilateral knee swelling, with amenorrhea. Xue Ji diagnosed Liver, Spleen, and Kidney Blood Deficiency with Fire Dryness, named "Crane Knee Wind" (Genu Valgum with swelling). He used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Shenqi Dihuang Wan (Eight-Ingredient Pill with Rehmannia) for two months. Her physique strengthened, appetite improved, and knee swelling subsided. She recovered in less than half a year. If the previous symptoms were due to Spleen/Kidney Yang Deficiency with soft/painful legs or thin knees, use Shenqi Dihuang Wan. If caused by overeating with sore/swollen legs or buttocks, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Poria and Pinelliae Rhizoma. A woman with delayed menstruation, fever, and fatigue took Siwu Tang and Huanglian, resulting in bi-monthly, scanty, clotted menses. Harsh purgatives blurred her vision. Xue Ji said: The Spleen is the head of all Yin; the eyes are the gathering of blood vessels. Spleen injury causes all organs to lose their nourishment, unable to reach the eyes. He used Buzhong Yiqi Tang and Jisheng Guipi Tang, focusing on the Spleen and Stomach, curing her in over a year. A woman with early menstruation, fever, and spontaneous sweating took cooling/sweat-stopping medicines, resulting in thirst, headache, hand tremors, and body numbness due to Liver Wind-Heat. He used Chaihu, stir-fried Huangqin, Huanglian, stir-fried Zhizi, Danggui, Baishao, Shengdi, Mudanpi (each 1 qian), Renshen, Huangqi, Fuling, Baizhu (each 1.5 qian), Chuanxiong (0.7 qian), Gancao (0.5 qian). Two doses stopped sweating; Buzhong Yiqi Tang completed the cure. Prolonged fever damages Yang Qi, requiring tonification. A woman with innate Qi/Blood deficiency, irregular menses, poor appetite, and severe afternoon fever was cured by Shiquan Dabu Tang (Ten Great Tonics Decoction) plus Corni Fructus, Dioscoreae Rhizoma, Moutan Cortex, Ophiopogonis Radix, and Schisandrae Fructus. Next autumn, she had chills and fever; Qingpi Yin weakened her further. Returning to the previous medicine cured her. A hardworking woman developed cough and fever in early winter, progressing to hemoptysis, night sweats, and irregular menstruation (every 2-3 months) with body pain. Phlegm-resolving and fire-clearing medicines caused lockjaw and tendon contraction due to Blood Deficiency worsened by drugs. She was cured by Jiawei Shenqi Dihuang Wan and Buzhong Yiqi Tang plus Ophiopogonis, Schisandra, and Dioscorea over a year.
[Chills and Fever]
When menstruation starts and stops abruptly, accompanied by alternating chills and fever, first administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) to resolve chills and fever, then harmonize with Siwu Tang.
[Zhang Zhongjing] Women with irregular blood vessels experience alternating chills and fever, resembling fatigue.
Danggui, Chuanxiong, Gancao, Huangqi, Guigui (remove bark, each 1 liang), Shudihuang, Baizhu, Baishao (each 2 liang), Chaihu, Ejiao (each 0.5 liang).
Grind into powder. Take 5 qian with one jujube, decocted in water, taken warm on an empty stomach. White water administration is also acceptable. Regular use prevents leukorrhea, regulates blood vessels, nourishes the uterus, and ensures lifelong health without disease.
Cai Huan Gong (Tai Cang Gong) treated a girl with lower back pain and chills/fever. Other doctors diagnosed chills/fever. Cai Huan Gong diagnosed internal Cold causing amenorrhea. He applied herbal compresses, and menstruation flowed immediately, curing the disease. The cause was unfulfilled desire for a man. Diagnosis: Kidney pulse was choppy and discontinuous, indicating difficult and firm flow, hence amenorrhea. Liver pulse emerged wirily from the left Cun, indicating unfulfilled desire for a man. Men prioritize Jing (Essence); women prioritize Blood. When male Essence is abundant, he desires sexual intercourse; when female Menses are abundant, she conceives. The Liver controls Blood. Jueyin pulse wirily emerging at Cun and reaching Yuji indicates abundant Yin Blood. (See details in the Nun/Widow section.)
Xue Xinpu treated a woman with pain in/behind the ear and neck side, chills/fever, bitter taste, and irregular menstruation. This was Liver Fire with Qi Stagnation and Blood Coagulation. He treated with Xiao Chai Hu Tang plus Zhizi, Chuanxiong, and Mudanpi. All symptoms resolved. Amenorrhea with chills/fever: see "Menstrual Door Closed" section.
[Heat Entering the Blood Chamber]
[Zhang Zhongjing] Women with Shanghan (Cold Damage) or Shangfeng (Wind Strike) develop fever while menstruating. They are quiet during the day but delirious at night, resembling malaria. This is Heat Entering the Blood Chamber.
Do not violate Stomach Qi or the Upper and Middle Jiaos. Administer Xiao Chai Hu Tang. If the pulse is slow and the body is cool, puncture Qimen (LR 14). Retain the needle for five breaths, wait, then slowly withdraw. Always reduce, never tonify, at Qimen. Depth: 2 cun for fat individuals, 1.5 cun for thin individuals.
[Xue Ji] If the previous condition arises from overwork or anger-induced fever coinciding with menstruation, use Xiao Chai Hu Tang plus Shengdi. For Blood Deficiency, use Siwu Tang plus Chaihu. If the disease resolves but fever persists, or if Yuan Qi is inherently weak, use Buzhong Yiqi Tang. For inherent Spleen Qi Stagnation, use Jisheng Guipi Tang. For inherent Qi/Blood Deficiency, use Shiquan Dabu Tang.
Xu Xueshi treated a woman with Shanghan chills/fever, seeing ghosts at night. After six to seven days, she became comatose with loud phlegm rales, trismus, and unconsciousness. Xu asked if menstruation occurred at onset. Family confirmed menses started, stopped with illness onset, followed by chills/fever, daytime quietness, nighttime hallucinations, and recent coma. Xu diagnosed Heat Entering the Blood Chamber. Zhang Zhongjing states: Women with Wind Strike, fever/chills, and concurrent menstruation are clear by day, delirious/hallucinating by night. Doctors mistakenly used harsh medicines, causing chest oppression, phlegm flooding the Upper Jiao, wheezing, and coma. First resolve phlegm, then clear heat. He urgently administered Yiha San. After two hours, phlegm drained, she slept, and regained consciousness. Then gave Xiao Chai Hu Tang plus Shengdi. Three doses cleared fever without sweating. Another woman with Heat Entering the Blood Chamber was misdiagnosed and treated with Blood-tonifying/Qi-regulating medicines, developing Blood Binding Chest. Xu said: Xiao Chai Hu Tang was too late. Puncture Qimen. I cannot needle; please ask a skilled acupuncturist. She recovered as advised. Question: Why does Heat Entering the Blood Chamber lead to Chest Binding? Answer: Pathogen enters meridians, fights Righteous Qi, circulates up/down. With concurrent menstruation, pathogen enters Blood Chamber via deficiency. Blood is forced upward into Liver Meridian. Liver pathogen causes delirium/hallucinations. Pathogen enters Danzhong, causing Blood Binding in the Chest. Normally, Water nourishes Wood, Blood nourishes Liver. Unpregnant, Blood flows down as Menses. Pregnant, Blood stores to nourish Fetus. Postpartum, Blood rises to form Milk. All are Blood. Now, Pathogen drives Blood to Liver, gathers at Danzhong, binds below breasts. Touch causes pain; medicine cannot reach, so puncture Qimen.
Yu Hengde treated a young woman who contracted Shanghan-like malaria during summer menstruation, with delirium and madness. Doctors treated as Shanghan Internal Heat with Shuangjie San and Jiedu Tang, causing profuse sweating and wind-like symptoms. Niuhuang Wan and mineral medicines worsened it. Yu palpated: wiry and large pulse, Yang positions diseased. Dry mouth/black tongue expected, but pulse not rapid. Body felt hot or cool, acute abdominal pain. Suspected prior Internal Injury followed by Shanghan. Shanghan resolved with sweat, but Internal Injury remained. Patient revealed she sweated heavily after eating during menstruation and wiped herself with cold water. Cold water closed pores externally and blocked Blood internally. Pathogenic Heat entered the chamber. Unfinished Menses + Pathogenic Heat = alternating calm/madness, chills/fever, delirium, dizziness resembling wind. Must purge with Yuzhu San. After purging, delirium settled. Harmonize with Siwu Tang and Xiao Chai Hu Tang. Fever subsided in five days.
Yanyi states: A woman with Wenbing (Warm Disease) for twelve days had a pulse of 6-7 beats per breath, choppy, Cun slightly large, Chi slightly small, chills/fever, red head, dry mouth, confusion, deafness. Menses started days after illness onset. This is Shaoyang Heat Entering the Blood Chamber. Incorrect treatment leads to death. Treated with Xiao Chai Hu Tang. After two days, added Guigui and Ganjiang for one day; chills/fever stopped. Umbilical urgency: given Didang Wan for mild purgation. Umbilical pain resolved, body cooled, pulse normalized, but confusion persisted. Given Xiao Chai Hu Tang again. Next day: chest heat/restlessness, dry nose/mouth. Given slight Tiaowei Chengqi Tang, no stool. Next day: epigastric pain. Given half dose of Daxiongxiong Tang, three stools. Next day: deficiency vexation, hallucinations,狂言. Knew dry feces remained, but patient extremely deficient, dared not purge. Given Zhuye Tang to remove vexation/heat. Night: bowel movement, two stools containing dry feces. Delirium/vexation resolved. Cough with saliva remains: Lung Deficiency. Untreated, may become Fei Wei (Lung萎). Given Xiao Chai Hu Tang minus Renshen, Dazao, Shengjiang, plus Ganjiang and Wuzhi. Cough reduced in one day, cured in two. All used Zhang Zhongjing's formulas.
Xue Lizhai treated a woman with menstruation, caught cold/wind. Quiet by day, delirious by night. Treated with Xiao Chai Hu Tang plus Shengdi, instantly relieved. Internal heat/dizziness treated with Buzhong Yiqi Tang plus Manjingzi. Later, anger caused chills/fever, delirium, chest/flank distension/pain, frequent urination, early menstruation. Liver Fire/Blood Heat forcing blood recklessly. Treated with Jiawei Xiaoyao San plus Shengdi, cured. Another woman, angry, had chills/fever, headache, delirium, worsening from afternoon to night, sudden heavy menses. Liver stores Blood; anger moves Fire, blood runs recklessly. Treated with Jiawei Xiaoyao San plus Shengdi, mind cleared. Poor appetite/fatigue, menses ongoing. Spleen controls Blood; Spleen Qi Deficiency fails to control blood. Treated with Buzhong Yiqi Tang, menses stopped. A woman with chronic depression, caught cold during menstruation, delirious. Dispersing medicines failed. Cooling/fire-clearing worsened symptoms, prolonged menses, abdominal pain, vomiting, no appetite, spontaneous phlegm. Spleen/Stomach Deficiency Cold. Treated with Xiangsha Liujun Zi Tang, Spleen/Stomach strengthened, symptoms receded. Finally, Guipi Tang cured her.
Jiawei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction)
Indications: Women with Wind Strike, subsequent chills/fever with periodic attacks, menstruation just stopped. This is Heat Entering the Blood Chamber, Blood must bind, resembling malaria.
Chaihu (3 qian), Banxia, Huangqin (each 2 qian), Shengdi, Renshen (each 1.5 qian), Gancao (0.5 qian).
One dose, two bowls of water, five slices of ginger, two jujubes. Decoct to one bowl. Take at any time.
Ganjiang Chaihu Tang (Dried Ginger and Bupleurum Decoction)
Indications: Women with Shanghan, menstruation just starting, Heat Entering the Blood Chamber, chills/fever like malaria, or delirium/seeing ghosts.
Chaihu (1 qian), Guizhi (0.3 qian), Gualou Gen (0.5 qian), Muli (calcined), Ganjiang (processed), Gancao (stir-fried, each 0.3 qian).
Decoct in water. Cure achieved with sweating.
Haige San (Clam Shell Powder)
Indications: Women with Shanghan, Blood Binding in Chest/Diaphragm. Take this medicine and puncture Qimen.
Haige, Huashi (calcined, water-floated), Gancao (each 5 qian), Mangxiao (1 liang).
Grind into powder. Take 2 qian mixed with egg white. Small Intestine becomes free, bound Blood disperses. Further use Guizhi Honghua Tang to induce sweating...