妇人有经未来之前，泄水三日，而后行经者，人以为血旺之故，谁知是脾气之虚乎！夫脾统血，脾虚则不能摄
血矣；且脾属湿土，脾虚则土不实，土不实而湿更甚，所以经水将动，而脾先不固；脾经所统之血，欲流注于血海，
而湿气乘之，所以先泄水而后行经也。调经之法，不在先治其水，而在先治其血；抑不在先治其血，而在先补其气。
盖气旺而血自能生，抑气旺而湿自能除，且气旺而经自能调矣。
方用健固汤。
人参（五钱） 白茯苓（三钱） 白术（一两，土炒） 巴戟（五钱，盐水浸） 薏苡仁（三钱，炒）
水煎。连服十剂，经前不泄水矣。此方补脾气以固脾血，则血摄于气之中，脾气日盛，自能运化其湿，湿既化为
乌有，自然经水调和，又何至经前泄水哉！
眉批∶与胖人不孕参看，自得立方之妙。
歌括∶经未来时水先行，脾虚湿盛此病成。
治法不宜先治水，除湿补气法最灵。
健固汤中用人参，茯苓白术薏苡仁。
巴戟当用盐水浸，脾气日盛湿自运。
妇人有行经之前一日大便先出血者，人以为血崩之症，谁知是经流于大肠乎！夫大肠与行经之路，各有分别，
何以能入乎其中？不知胞胎之系，上通心而下通肾，心肾不交，则胞胎之血，两无所归，而心肾二经之气，不来照
摄，听其自便，所以血不走小肠而走大肠也。治法若单止大肠之血，则愈止而愈多；若击动三焦之气，则更拂乱而
不可止。盖经水之妄行，原因心肾之不交；今不使水火之既济，而徒治其胞胎，则胞胎之气无所归，而血安有归经
之日！故必大补其心与肾，使心肾之气交，而胞胎之气自不散，则大肠之血自不妄行，而经自顺矣。
方用顺经两安汤。
当归（五钱，酒洗） 白芍（五钱，酒炒） 大熟地（五钱，九蒸） 山萸肉（二钱，蒸） 人参（三钱） 白
术（五钱，土炒） 麦冬（五钱，去心） 黑芥穗（二钱） 巴戟肉（一钱，盐水浸） 升麻（四分）
水煎服。二剂大肠血止，而经从前阴出矣，三剂经止，而兼可受妊矣。此方乃大补心肝肾三经之药，全不去顾胞
胎，而胞胎有所归者，以心肾之气交也。盖心肾虚则其气两分；心肾足则其气两合，心与肾不离，而胞胎之气听命
于二经之摄，又安有妄动之形哉！然则心肾不交，补心肾可也，又何兼补夫肝木耶？不知肝乃肾之子心之母也，补
肝则肝气往来于心肾之间，自然上引心而下入于肾，下引肾而上入于心，不啻介绍之助也。此使心肾相交之一大法
门，不特调经而然也，学人其深思诸。
眉批∶若大便下血过多，精神短少，人愈消瘦，必系肝气不舒，久郁伤脾，脾伤不能统血又当分别治之。方用
补血汤∶嫩黄 二两（生熟各半），归身四钱（酒洗，炒黑），杭芍炭二钱，焦白术五钱（土炒），杜仲二钱（炒断丝），
荆芥炭二钱，姜炭二钱，引用贯仲炭一钱冲入服之，四剂必获愈，愈后减半再服二剂。经入大肠必当行经之际而大便下
血也，初病血虽错行精神必照常，若脾不统血精神即不能照常矣，用者辨之。
歌括∶大便下血行经前，经流大肠使之然。
胞胎之系通心肾，大补其气经自安。
顺经两安交心肾，归芍熟地与人参。
山萸白术麦麻芥，加入巴戟可受妊。
A woman experiences the discharge of watery fluid for three days before her menstrual period begins, followed by actual menstruation. People attribute this to excessive blood abundance, but who would know that it is actually due to Spleen Qi deficiency! The Spleen governs the containment of blood; when Spleen Qi is deficient, it cannot hold the blood. Moreover, the Spleen belongs to Wet Earth; when Spleen Qi is deficient, the Earth element becomes unstable, leading to increased dampness. Therefore, when the menstrual water is about to move, the Spleen loses its firmness first. The blood governed by the Spleen meridian intends to flow into the Sea of Blood (Uterus), but dampness takes advantage of this situation. Hence, watery discharge occurs first, followed by menstruation.
The method for regulating menstruation does not lie in treating the watery discharge first, nor in treating the blood first, but rather in tonifying Qi first. When Qi is abundant, blood is naturally generated; when Qi is abundant, dampness is naturally eliminated; and when Qi is abundant, menstruation is naturally regulated.
Use the formula Jiangu Decoction (Jiangu Tang).
Ren Shen (Ginseng Radix) - 5 qian
Bai Fu Ling (Poria) - 3 qian
Bai Zhu (Atractylodis Macrocephalae Rhizoma), stir-fried with earth - 1 liang
Ba Ji Tian (Morinda Officinalis Radix), soaked in salt water - 5 qian
Yi Yi Ren (Coicis Semen), stir-fried - 3 qian
Decoct in water. Take continuously for ten doses, and the premenstrual watery discharge will cease. This formula tonifies Spleen Qi to consolidate Spleen blood, so that blood is contained within Qi. As Spleen Qi grows daily, it naturally transforms dampness. Once dampness vanishes, menstruation harmonizes naturally, preventing premenstrual watery discharge.
Marginal Note: Compare this with the section on infertility in obese women to understand the subtlety of prescription formulation.
Rhyme Verse:
Watery discharge precedes menstruation,
Spleen deficiency and dampness excess cause this condition.
Treatment should not focus on water first,
Eliminating dampness and tonifying Qi is most effective.
Jiangu Decoction uses Ginseng,
Poria, Atractylodes, and Coix seed.
Morinda must be soaked in salt water,
As Spleen Qi strengthens, dampness transforms.
A woman experiences bleeding from the rectum one day before her menstrual period. People consider this a symptom of uterine bleeding (blood collapse), but who would know that the menstrual blood has flowed into the Large Intestine? The Large Intestine and the pathway for menstruation are distinct; how can blood enter the former? It is unknown that the ligaments of the Bao Mai (uterus and its connections) extend upward to connect with the Heart and downward to connect with the Kidney. If Heart and Kidney do not interact, the blood of the Bao Mai has nowhere to return. Since the Qi of the Heart and Kidney meridians does not come to supervise and contain it, allowing it to wander freely, the blood does not follow the normal path near the Small Intestine but instead flows into the Large Intestine.
If treatment merely attempts to stop the bleeding in the Large Intestine, the more one stops it, the more it bleeds. If one agitates the Qi of the San Jiao (Triple Burner), it causes further chaos and uncontrollable bleeding. The root cause of erratic menstrual flow is the lack of interaction between Heart and Kidney. If one does not facilitate the mutual interaction of Water and Fire (Heart and Kidney), but only treats the Bao Mai, the Qi of the Bao Mai has no source, and when will the blood return to its proper vessel? Therefore, one must greatly tonify the Heart and Kidney so that their Qi interacts. Then the Qi of the Bao Mai will not scatter, the bleeding in the Large Intestine will cease spontaneously, and menstruation will proceed smoothly.
Use the formula Shunjing Liang'an Decoction (Shunjing Liang'an Tang).
Dang Gui (Angelica Sinensis Radix), washed with wine - 5 qian
Bai Shao (Paeoniae Radix Alba), stir-fried with wine - 5 qian
Da Shu Di Huang (Rehmanniae Radix Preparata), steamed nine times - 5 qian
Shan Yu Rou (Corni Fructus), steamed - 2 qian
Ren Shen (Ginseng Radix) - 3 qian
Bai Zhu (Atractylodis Macrocephalae Rhizoma), stir-fried with earth - 5 qian
Mai Dong (Ophiopogonis Radix), heart removed - 5 qian
Hei Jie Sui (Schizonepetae Spica, charred) - 2 qian
Ba Ji Tian (Morinda Officinalis Radix), soaked in salt water - 1 qian
Sheng Ma (Cimicifugae Rhizoma) - 4 fen
Decoct in water and take orally. After two doses, rectal bleeding stops, and menstruation exits from the anterior orifice. After three doses, menstruation ceases, and conception becomes possible. This formula greatly tonifies the Heart, Liver, and Kidney meridians. It does not directly attend to the Bao Mai, yet the Bao Mai finds its归属 because the Qi of Heart and Kidney interacts. When Heart and Kidney are deficient, their Qi separates; when sufficient, their Qi merges. With Heart and Kidney united, the Qi of the Bao Mai obeys their control, preventing erratic movement.
Why supplement the Liver Wood if Heart-Kidney non-interaction is corrected by tonifying Heart and Kidney? The Liver is the son of the Kidney and the mother of the Heart. Tonifying the Liver allows Liver Qi to travel between Heart and Kidney, naturally drawing Heart Qi down to the Kidney and Kidney Qi up to the Heart, acting as an intermediary aid. This is a major method for facilitating Heart-Kidney interaction, applicable not only to regulating menstruation. Practitioners should ponder this deeply.
Marginal Note: If rectal bleeding is excessive, accompanied by diminished spirit and progressive emaciation, it indicates Liver Qi stagnation, long-term depression injuring the Spleen, and Spleen failure to contain blood. In such cases, treat separately using Bu Xue Decoction (Bu Xue Tang): Huang Qi (Astragali Radix) 2 liang (half raw, half stir-fried), Dang Gui Shen (Angelica Sinensis Radix body) 4 qian (wine-washed, charred), Hang Shao Tan (Paeoniae Radix Alba carbonized) 2 qian, Jiao Bai Zhu (Atractylodis Macrocephalae Rhizoma, charred) 5 qian (earth-stir-fried), Du Zhong (Eucommiae Cortex) 2 qian (stir-fried until silk breaks), Jing Jie Tan (Schizonepetae Spica carbonized) 2 qian, Jiang Tan (Zingiberis Rhizoma carbonized) 2 qian, Guan Zhong Tan (Cyrtomii Rhizoma carbonized) 1 qian added as a vehicle. Four doses will surely cure; after recovery, halve the dose and take two more doses. Rectal bleeding during menstruation occurs specifically during the menses. In early stages, although blood flows erratically, spirit remains normal. If Spleen fails to contain blood, spirit diminishes. Users must distinguish these conditions.
Rhyme Verse:
Rectal bleeding precedes menstruation,
Menstrual blood flowing into the Large Intestine causes this.
The Bao Mai connects to Heart and Kidney,
Greatly tonifying Qi ensures menstrual peace.
Shunjing Liang'an facilitates Heart-Kidney interaction,
Using Angelica, White Peony, Prepared Rehmannia, and Ginseng.
Add Cornus, Atractylodes, Ophiopogon, Schizonepeta, and Morinda to enable conception.