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Women's diseases are the same as men's, except that during the periods before and after menstruation, and before and after pregnancy and childbirth, specific treatment methods should be established. Amenorrhea in unmarried women will eventually develop into consumptive disease (Lao) if prolonged, because Tian Gui (substances promoting reproductive maturation) is at its peak and menstrual delays should not occur. Symptoms include fever and cough, alternating chills and heat, and gradually worsening malignant sores. If the pulse is surging, there is thirst, and constipation, it indicates excess-heat; Siwu Tang (Four Substances Decoction) added with Honghua (Carthami Flos), Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma, vinegar-fried), Wuyao (Linderae Radix), and Qiancao (Rubiae Radix) is indicated. If the pulse is deficient, the mouth is bland, there is aversion to cold, lower back and abdominal pain, and loose stools, it indicates deficiency-cold; Siwu Tang added with Rougui (Cinnamomi Cortex), Renshen (Ginseng Radix), Dahuang, Taoren, and Ganjiang (Zingiberis Rhizoma) is indicated. In cases where both conditions present with a choppy pulse, skin rough like scales (Ji Fu Jia Cuo), and impending dry-blood Lao (chronic consumption due to blood stasis), insects such as Mengchong (Asio/Blister Beetle) and Shuzhi (Hirudo/Leech) may be used to attack the stasis. However, amenorrhea can be a precursor to metrorrhagia (blood flooding), so aggressive attacks should not be used arbitrarily. These conditions mostly arise from melancholy and overthinking, caused by excessive emotional stimulation (Seven Emotions); six or seven out of ten cases belong to deficiency. The *Neijing* states: "Diseases of the Yangming [Stomach and Large Intestine] originate from the Heart and Spleen; if there are unspoken grievances, it leads to amenorrhea in women." Xiaoyao San (Free and Easy Wanderer Powder) should be used to resolve Liver Qi stagnation, thereby resolving all types of stagnation, followed by Guipi Tang (Restore the Spleen Decoction) to tonify Heart and Spleen blood, addressing the source of menstrual blood. Zhang Jingyue’s Xiaoyao Yin treats the Heart, Liver, and Spleen simultaneously, representing a method that addresses both root and branch. After taking it for a considerable time, menstruation can then be promoted.

For amenorrhea in women, follow the previous methods. For nuns and widows presenting with alternating chills and heat and a pulse extending to the Yuji area (indicating floating yang or yin exhaustion), which suggests impending Lao Zhai (consumptive disease like tuberculosis), Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Sheng Dihuang (Rehmanniae Radix Recens) is indicated, or Bawei Xiaoyao San (Eight-Ingredient Free and Easy Wanderer Powder).

If menstruation gradually becomes delayed, this indicates deficiency-cold in the Sea of Blood; Siwu Tang added with Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Praeparata), Wuyu (Evodiae Fructus), Renshen, Baizhu (Atractylodis Macrocephalae Rhizoma), and Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) is indicated. If menstruation gradually becomes early, this indicates heat in the Sea of Blood; Siwu Tang added with Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Ejiao (Colla Corii Asini), Diyü (Sanguisorbae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) is indicated.

My commentary: For these two conditions, delayed menstruation is treated with Guipi Tang added with Fuzi and Ganjiang; early menstruation is treated by adding Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus).

Xue Lizhai’s Quick Method:
Metrorrhagia and leukorrhea in women are similar to red and white turbidity in men, primarily caused by damp-heat. Erchen Tang (Two Aged Decoction) added with Cangzhu (Atractylodis Rhizoma), Baizhu, Huangbai (Phellodendri Cortex) 1 qian, Muli (Concha Ostreae) powder 3 qian, Chun Gen Pi (Toosendan Cortex, vinegar-fried) 2 qian, and Wumei (Mume Fructus, pitted) 2 pieces is indicated. Some cases have been cured with Bushen Yiqi Tang (Tonify the Middle and Augment Qi Decoction) or Liuwei Wan (Six-Ingredient Pill) and Bawei Wan (Eight-Ingredient Pill); one must observe the pulse and symptoms to adjust accordingly.

Red discharge belongs to blood; add Danggui (Angelicae Sinensis Radix, vinegar-fried) 2 qian. White discharge belongs to qi; add Huangqi (Astragali Radix, salt-water fried) 3 qian.

Menstrual irregularities often prevent conception. One must first examine for excess/deficiency and cold/heat, and check for depression, to regulate the menses, which is the method for promoting fertility. Obese women may have a uterus filled with fat, preventing conception; Siwu Tang without Shudihuang (Rehmanniae Radix Preparata), added with Banxia (Pinelliae Rhizoma), Beimu (Fritillariae Bulbus), Xiangfu (Cyperi Rhizoma) each 2 qian, Ejiao 3 qian, and Tianma (Gastrodiae Rhizoma) 1 qian is indicated. Emaciated women may have a dry uterus, preventing conception; Siwu Tang added with Renshen, Maidong (Ophiopogonis Radix), Banxia, Guizhi, and Ejiao each 1.5 qian, and Aiye (Artemisiae Argyi Folium), Wuyu each 0.5 qian is indicated. Zhang Jingyue’s Yulin Zhu (Fertility Pearl) is an excellent formula for promoting fertility and should not be overlooked.

For spontaneous abortion, Zhu Danxi attributes it to Spleen deficiency with fire, as the fetus is anchored to the Spleen, like a bell hanging from a beam. Thus, Baizhu is used to tonify the Spleen as the primary agent, and Huangqin (Scutellariae Radix) is used to clear fire as the secondary agent, since excessive fire disturbs the fetal qi. He left the instruction: Huangqin and Baizhu are the sacred medicines for calming the fetus. The *Dasheng Pian* follows this method and established formulas for calming the fetus, which are often effective. However, although the object hangs from the beam, its stability relies on the pillar (Dong). If the main pillars stand firm, the beam is secure. Thus, the two Kidneys are like two pillars. If the Left Chi pulse is weak, Liuwei Wan (Six-Ingredient Pill) should be the primary formula; if the Right Chi pulse is weak, Bawei Wan (Eight-Ingredient Pill) should be the primary formula. Then, Ejiao, Aiye, Xuduan (Dipsaci Radix), and Wuweizi (Schisandrae Fructus) can be added or subtracted according to circumstances, yielding immediate results. This is the secret method of Mr. Zhao Yangkui. Generally, abortions occurring regularly at three or five months are due to Kidney deficiency, and this method is superior. Modern physicians, however, often claim that Mudanpi moves blood and Guizhi causes abortion, avoiding them out of caution. This ignorance harms people; such individuals are uneducated and falsely cautious.

Zhang Shiwan said: The world regards Huangqin and Baizhu as sacred medicines for calming the fetus, and Banxia, Guizhi, and Fuzi as harsh agents causing abortion. Who knows they can also have subtle uses for calming the fetus? The safety of the fetal qi depends on whether the maternal qi has excesses. If maternal qi has excessive fire, Huangqin and Huanglian (Coptidis Rhizoma) bring peace, while Guizhi and Fuzi bring danger. If maternal qi has excessive phlegm, Huangqin and Banxia bring peace, while Danggui and Dihuang bring danger. If maternal qi has excessive cold, Guizhi and Fuzi bring peace, while Huangqin and Huanglian bring danger. One must always adjust the excesses and balance the cold and heat. There is no case where maternal qi is rebellious but the fetus remains safe, nor where maternal qi is peaceful but the fetus aborts. Therefore, the *Jingui Yaolue* records using Fuzi Tang (Aconite Decoction) to warm the viscera for pregnant women at six or seven months presenting with abdominal distension, pain, aversion to cold, and a cold sensation in the lower abdomen like a fan blowing. This must be known.

For cough, asthma, swelling, and other miscellaneous conditions before delivery, treat them according to standard protocols for miscellaneous diseases. Do not hesitate to use herbs due to fears that they might disturb or cause abortion. The *Neijing* states: "If there is a disease, there is no destruction" (meaning the pathogen bears the brunt of the medicine, sparing the fetus). Using Siwu Tang as a base protects the fetus, allowing other medications to target the disease directly without harm. Observing Jiegu’s (Zhang Yuansu) Liuhe Tang and Siwu Tang, which utilize harsh substances like Xiaoshi (Natrii Sulfas) and Dahuang, shows the insight and courage of ancient physicians. These formulas are detailed in the last volume of *Yifang Ji jie* (Collection of Medical Formulas Explained) and should be studied thoroughly.

During labor, the mother should endure pain and sleep soundly. Delivery has its own timing; wait patiently. Do not listen to the frightening words of midwives. If the birth bone (pubic symphysis) does not open, it indicates severe deficiency of Yin qi; Jiawei Guixiong Tang (Modified Angelica and Ligusticum Decoction) is indicated (see *Nuke Yaozhi*).

Another formula: Take one Tao Ren (Persicae Semen), split it into two halves. Write "Ke" (Can) on one half and "Chu" (Out) on the other. Rejoin them, bind with paste, and swallow. This is often effective.

Furthermore: The fetus is like a boat; blood is like water. When water is full, the boat floats. If blood flows too early, the fetus becomes dry and difficult to deliver. In such cases, a large dose of Shiquan Dabu Tang (Perfect Fourteen-Ingredient Decoction) should be taken. If blood has not yet flowed, Baosheng Wuyou San (Protect Life and Remove Worries Powder) is indicated.

Furthermore: Postpartum abdominal pain that does not respond to various medicines but is relieved slightly by heavy pressure indicates deficiency. A strong remedy is required; Lamb Soup is indicated.