天津陈氏女，年十七岁，经通忽又半载不至。
病因 项侧生有瘰 ，服药疗治，过于咸寒，致伤脾胃，饮食减少，遂至经闭。
证候 午前微觉寒凉，日加申时，又复潮热，然不甚剧。黎明时或微出汗，咳嗽有痰，夜间
略甚，然仍无妨于安眠。饮食消化不良，较寻常减半。心中恒觉发热思食凉物，大便干燥，
三四日一行。其脉左部弦而微硬，右部脉亦近弦，而重诊无力，一息搏逾五至。
诊断 此因饮食减少，生血不足以至经闭也。其午前觉凉者，其气分亦有不足，不能乘阳气
上升之时而宣布也。至其晚间之觉热，则显为血虚之象。至于心中发热，是因阴虚生内热
也。其热上升伤肺易生咳嗽，胃中消化不良易生痰涎，此咳嗽又多痰也。其大便燥结者，因脾
胃伤损失传送之力，而血虚阴亏又不能润其肠也。左脉弦而兼硬者，心血虚损不能润肝滋肾也。
右脉弦而无力者，肺之津液胃之酸汁皆亏，又兼肺胃之气分皆不足也。拟治以资生通脉汤，复即
原方略为加减，俾与证相宜。
处方 白术（三钱炒） 生怀山药（八钱） 大甘枸杞（六钱） 龙眼肉（五钱）
生怀地黄（五钱） 玄参（四钱） 生杭芍（四钱） 生赭石（四钱轧细）
当归（四钱） 桃仁（二钱） 红花（钱半） 甘草（二钱）
共煎汤一大盅，温服。
复诊 将药连服二十余剂（随时略有加减），饮食增多，身形健壮，诸病皆愈。惟月信犹未通，
宜再注意通其月信。
处方 生水蛭（一两轧为细末） 生怀山药（半斤轧为细末）
每用山药末七钱，凉水调和煮作茶汤，加红蔗糖融化，令其适口，以之送服水蛭末六分，
一日再服，当点心用之，久则月信必通。
效果 按方服过旬日，月信果通下，从此经血调和无病。
方解 按水蛭《神农本草经》原无炙用之文，而后世本草谓若不炙即用之，得水即活，殊为荒
唐之言。尝试用此药，先用炙者无效，后改用生者，见效甚速。其性并不猛烈，惟稍有刺激
性。屡服恐于胃不宜，用山药煮粥送服，此即《金匮》硝石矾石散送以大麦粥之义也。且山
药饶有补益之力，又为寻常服食之品，以其粥送水蛭，既可防其开破伤正，且又善于调和胃腑也。
A seventeen-year-old daughter of the Chen family in Tianjin, whose menstruation had previously been regular, suddenly ceased for half a year.
Etiology A scrofula (tuberculous lymphadenitis) developed on the side of her neck. During medicinal treatment, the use of overly salty and cold-natured herbs injured the Spleen and Stomach, leading to reduced food intake, which eventually resulted in amenorrhea.
Symptoms She felt slightly chilly in the forenoon. By the Shen hour (15:00–17:00), tidal fever (fever occurring at a fixed time) recurred, though not severely. At dawn, she sometimes sweated slightly; she coughed with phlegm, which was slightly worse at night but did not disturb her sleep. Digestion was poor, with food intake reduced by half compared to normal. She constantly felt heat in the heart region and desired cool foods. Her stool was dry, passed once every three to four days. Her pulse was wiry and slightly hard on the left side, and also near-wiry on the right side, but weak upon heavy pressure, beating more than five times per breath.
Diagnosis This condition arises because reduced food intake leads to insufficient generation of blood, resulting in amenorrhea. The sensation of chilliness in the forenoon indicates insufficiency in the Qi aspect, preventing the distribution of Yang Qi during its rising phase. The sensation of heat in the evening is clearly a sign of Blood deficiency. The heat in the heart region is due to internal heat generated by Yin deficiency. This heat rises and injures the Lung, easily causing cough; indigestion in the Stomach easily generates phlegm-fluids, hence the cough with much phlegm. The dryness and constipation of the stool are due to the injury of the Spleen and Stomach, losing their power of transportation and transmission, combined with Blood deficiency and Yin depletion failing to moisten the intestines. The wiry and hard quality of the left pulse indicates that deficient Heart Blood fails to moisten the Liver and nourish the Kidney. The wiry and weak quality of the right pulse indicates a deficit of Lung fluids and Stomach acid, compounded by insufficiency in the Qi aspect of both the Lung and Stomach. I propose treating this with Zisheng Tongmai Decoction (Nourishing Life and Unblocking Vessels Decoction), making slight modifications to the original formula to suit the syndrome.
Prescription Baizhu (Stir-fried Atractylodis Rhizoma, 3 qian) Sheng Huai Shanyao (Raw Dioscoreae Hypoglaucae Rhizoma, 8 qian) Da Gan Gouqi (Large sweet Lycii Fructus, 6 qian) Longyanrou (Longan Aril, 5 qian)
Sheng Huai Dihuang (Raw Rehmanniae Radix Praeparata, 5 qian) Xuanshen (Scrophulariae Radix, 4 qian) Sheng Hangshao (Raw Paeoniae Radix Alba, 4 qian) Sheng Zheshi (Raw Haematitum, 4 qian, finely crushed)
Danggui (Angelicae Sinensis Radix, 4 qian) Taoren (Persicae Semen, 2 qian) Honghua (Carthami Flos, 1.5 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian)
Decoct together in a large cup of water, take warm.
Follow-up Visit After taking the medicine continuously for over twenty doses (with slight adjustments as needed), her food intake increased, her physique became robust, and all other ailments were cured. Only her menstruation had not yet resumed, so attention should be paid to unblocking it.
Prescription Sheng Shuizhi (Raw Hirudo, 1 liang, ground into fine powder) Sheng Huai Shanyao (Raw Dioscoreae Hypoglaucae Rhizoma, 0.5 jin, ground into fine powder)
Use 7 qian of Shanyao powder each time, mix with cold water, boil into a tea-like soup, add red brown sugar until melted and palatable, and use it to swallow 6 fen of Shuizhi powder. Take twice a day as a snack. Over time, menstruation will surely resume.
Outcome Following the prescription for ten days, menstruation indeed resumed, and from then on, menstrual blood was harmonious and free of disease.
Formula Analysis According to the *Shennong Bencao Jing* (Divine Farmer's Materia Medica), there is no original text regarding the stir-frying of Shuizhi (Hirudo). Later materia medica texts claim that if not stir-fried, it remains alive when it contacts water, which is absurd talk. I have tried using this herb; initially, the stir-fried version was ineffective, but switching to the raw version yielded rapid results. Its nature is not fierce, only slightly irritating. Frequent consumption may be unsuitable for the Stomach, so decocting Shanyao into porridge to deliver the medicine follows the principle of delivering Xiaoshi Fanshi San (Magneti Oxidatum et Vitrioli Rubri Pulvis) with barley porridge in the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet). Moreover, Shanyao possesses strong tonifying power and is a common dietary item. Using its porridge to deliver Shuizhi not only prevents the breaking and opening action from damaging healthy Qi but also effectively harmonizes the Stomach organ.