过期饮
21.过期血滞物桃红, 附莪桂草木香通, 血虚期过无胀热, 双和圣愈
及养荣.
【注】经水过期不至, 因血气凝滞胀痛者, 用过期饮, 其方即四物汤
加桃仁, 红花, 香附, 莪术, 肉桂, 甘草, 木香, 木通也. 若过期不
至,并不胀痛者, 乃无血可行, 是血虚也, 宜用双和饮, 圣愈汤, 人
参养荣汤.
加味地骨皮饮 六神汤
22.经来身热有表发, 内热地骨加胡连, 经后六神加耆骨, 逍遥理脾
而清肝.
【注】经来发热有表邪证者, 用前桂枝四物等汤发之. 若内热者, 用
地骨皮饮加胡连清之, 名加味地骨皮饮. 经后发热, 乃血虚内热, 用
四物汤加黄耆, 地骨皮补而凉之, 名六神汤. 若脾虚肝热, 用逍遥散
理脾而清肝.
逍遥散方见前.
羌桂四物汤 黄耆建中汤
23.经来身痛有表发, 无表四物羌桂枝, 经后血多黄耆建, 耆桂芍草
枣姜饴.
【注】经来时身体痛疼, 若有表证者, 酌用前麻黄四物, 桂枝四物等
汤以发之. 若无表证者, 乃血脉壅阻也, 宜用四物汤加羌活, 桂枝以
疏通经络, 名羌桂四物汤. 若经行后或血去过多者, 乃血虚不荣也,
宜用黄耆建中汤以补之, 其方即小建中汤──桂枝, 白芍, 甘草, 姜
,枣, 饴糖加黄耆也.
Guoqi Yin (Decoction for Delayed Menstruation)
21. For menstrual delay caused by blood stasis, use Tao Hong Si Wu Tang (Four Substance Decoction with Peach Kernel and Safflower) combined with Fuzi (Aconite Lateral Root), Ezhu (Curcuma Zedoaria Rhizome), Rougui (Cinnamon Bark), Gancao (Licorice Root), Muxiang (Aucklandiae Radix), and Mutong (Akebiae Caulis) to unblock Qi and Blood. If the period is delayed without distension or heat, it indicates Blood Deficiency; Shuanghe Yin (Double Harmony Decoction), Shengyu Tang (Sage One Decoction), or Renshen Yangrong Tang (Ginseng Nourishing the Nutritive Qi Decoction) should be used.
[Note] When menstruation is delayed due to Qi and Blood stagnation causing distension and pain, Guoqi Yin is indicated. This formula consists of Siwu Tang (Four Substance Decoction) added with Taoren (Peach Kernel), Honghua (Carthami Flos), Xiangfu (Cyperi Rhizoma), Ezhu (Curcumae Rhizoma), Rougui (Cinnamomi Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Muxiang (Aucklandiae Radix), and Mutong (Akebiae Caulis). If menstruation is delayed without distension or pain, it signifies that there is no Blood available to flow, indicating Blood Deficiency. In such cases, Shuanghe Yin (Double Harmony Decoction), Shengyu Tang (Sage One Decoction), and Renshen Yangrong Tang (Ginseng Nourishing the Nutritive Qi Decoction) are appropriate.
Jiawei Digupi Yin (Modified Gardenia Root Bark Decoction), Liushen Tang (Six Deities Decoction)
22. For fever during menstruation accompanied by exterior syndrome, add Hulian (Coptidis Rhizoma) to Digupi Yin (Gardenia Root Bark Decoction); for fever after menstruation, add Huangqi (Astragali Radix) and Digupi (Gardeniae Radix) to Liushen Tang (Six Deities Decoction); Xiaoyao San (Free and Easy Wanderer Powder) regulates the Spleen and clears Liver Heat.
[Note] For fever during menstruation with exterior pathogenic factors, formulas such as Guizhi Siwu Tang (Cinnamon Twig Four Substance Decoction) mentioned previously should be used to induce sweating and release the exterior. For internal heat, Digupi Yin (Gardenia Root Bark Decoction) with added Hulian (Coptidis Rhizoma) is used to clear heat, named Jiawei Digupi Yin (Modified Gardenia Root Bark Decoction). Fever after menstruation results from Blood Deficiency causing internal heat; Siwu Tang (Four Substance Decoction) added with Huangqi (Astragali Radix) and Digupi (Gardeniae Radix) is used to tonify and cool, named Liushen Tang (Six Deities Decoction). For Spleen Deficiency with Liver Heat, Xiaoyao San (Free and Easy Wanderer Powder) is used to regulate the Spleen and clear the Liver.
The formula for Xiaoyao San (Free and Easy Wanderer Powder) is found in the previous section.
Qianggui Siwu Tang (Notopterygium and Cinnamon Twig Four Substance Decoction), Huangqi Jianzhong Tang (Astragalus Establishing the Middle Decoction)
23. For body aches during menstruation with exterior syndrome, induce sweating; without exterior syndrome, use Siwu Tang (Four Substance Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) and Guizhi (Cinnamomi Ramulus); after menstruation, if excessive blood loss occurs, use Huangqi Jianzhong Tang (Astragalus Establishing the Middle Decoction) to tonify, which consists of Huangqi (Astragali Radix), Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Dazao (Ziziphi Jujubae Fructus), Shengjiang (Zingiberis Rhizoma Recens), and Yitang (Maltose).
[Note] During menstruation, if body aches occur with exterior syndrome, formulas such as Mahuang Siwu Tang (Ephedra Four Substance Decoction) or Guizhi Siwu Tang (Cinnamon Twig Four Substance Decoction) mentioned previously should be used appropriately to induce sweating and release the exterior. Without exterior syndrome, the condition is due to obstruction of the blood vessels; Siwu Tang (Four Substance Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) and Guizhi (Cinnamomi Ramulus) is indicated to unblock the meridians, named Qianggui Siwu Tang (Notopterygium and Cinnamon Twig Four Substance Decoction). After menstruation, or if excessive blood has been lost, the condition is Blood Deficiency failing to nourish the body; Huangqi Jianzhong Tang (Astragalus Establishing the Middle Decoction) is indicated to tonify. This formula is Xiao Jianzhong Tang (Minor Establishing the Middle Decoction)—composed of Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Shengjiang (Zingiberis Rhizoma Recens), Dazao (Ziziphi Jujubae Fructus), and Yitang (Maltose)—with added Huangqi (Astragali Radix).