经曰。女子二七。天癸至。任脉通。太冲脉盛。月事以时下。七七。任脉虚。太冲
脉衰少。天癸竭。地道不通。灵枢曰。妇人有余于气。不足于血。月下。数脱血。
任冲并伤。又曰。二阳之病发心脾。有不得隐曲。女子不月。其传为风消。为
息贲者。不治。由是观之。天癸者。天一所生之水也。月事者。月属阴。其盈亏
应潮汐。犹女子之月信也。任冲二脉。皆起于会阴。为经脉之海。故女子月
事。以三经主之。经何以言二阳之病发心脾。则女子不月。盖二阳者。乃指
足阳明而非手阳明。足阳明者。胃也。心为之母。脾为之助。胃乃水谷之海。
病则饮食少衰。而水谷不荣。以女子心思偏执。心不生血。而月事衰少。心
火偏盛。而月事暴下。脾不统血。而月事过多。脾阴不足。而月事早绝。皆谓
之不月。先期过期。血崩经闭。不以时下也。其传为风消者。风属肝木。病善
怒。木有余。则脾益不足。故肌肉消瘦。其传为息贲者。土不生金。心火乘之。
故肺气喘促。而为不治之候也。明乎此而知天癸者。先天所禀之血脉。而
冲任为之蓄泄。心脾者。后天所生之血脉。而阳明为之灌溉。故先天不足
者。滋其肾阴。后天不足者。调其心脾。其理虽殊。而实一致。治法有能外之者哉。
一妇人多思虑。损伤于脾。月水过多。归脾汤主之。兼郁火。先期而至。加柴胡山栀牡丹皮。
一妇人多怒伤肝。经水或前或后。或发寒热。或内热口苦。脉弦数。小柴胡
汤加当归香附。如月水衰少。四物汤加香附续断。月水过多。四物汤加香附阿胶白术茯苓。
一妇人劳役所伤。面黄唇白。四肢乏力。经水过多。或暴下不止。补中益气
汤。加阿胶珠炮姜炭。五味子。经水衰少。十全大补汤。八珍汤。人参养荣汤。
一妇人阴虚火动。禀赋素弱。或骨蒸烦热。用加味逍遥散。间进六味丸。或
八珍汤加秦艽条芩香附阿胶之属。
一妇人气滞血凝。经水过期。至则腹痛。乃下焦有寒也。四物汤加吴茱萸桃仁肉桂牛膝泽兰香附。
一妇人肥盛多痰。经行过多。六君子汤加归芍阿胶。或腰痛。八珍汤加杜仲山茱肉。
一妇人虚寒。脾不统血。补中益气汤加姜附山茱肉。兼进八味丸加五味
子。或八珍汤加阿胶蕲艾。
一妇人心火炽甚。烦热脉数。经水过多。加味归脾汤加麦门冬。或清心莲子饮加山栀。
一妇人临经。感冒风寒。参苏饮加减。寒热往来。名热入血室。小柴胡汤加
丹皮生地。脉不数。加当归香附。兼停食仍与内消。
一妇人临经感气。经反凝滞。逍遥散加木香广皮香附。去白术。或入抚芎。
一妇人临经。因饮冷水。凝结不行。平胃散加芎归。如久而不行。少腹胀痛。
四物汤加肉桂牛膝茯苓广皮。
一妇人受暑热。经水过多。清暑益气汤。虚者生脉散。实者香薷饮。
一妇人饮食不运。或失饥伤饱。血暴下崩。先理中气。使食转化。后与补脾。
一妇人血虚有火。月经耗损。渐至不通。日渐羸瘦。而生潮热。慎毋以毒药
通之。宜用柏子仁丸泽兰汤。
一妇人去血过多。恶寒发热。作渴烦躁。用人参二两。枣十枚。水煎服。
一师尼寡妇室女。乍寒乍热。肝脉弦长而出鱼际。用生地黄丸。
附时珍月经辨
李时珍曰。女人之经。一月一行。其常也。或先或后。或通或塞。其病也复
有变常。而古人并未言及者。不可不知。有行期只吐血衄血。或眼耳出
血者。是谓逆行。有三月一行者。是谓居经。俗名按季。有一年一行者。是
谓避年。有一生不行而受胎者。是谓暗经。有受胎之后。月月行经。而产
子者。是谓盛胎。俗名垢胎。有受胎数月。血忽大下。而胎不陨者。是谓漏
胎。此虽以气血有余不足言。而亦异于常矣。女子二七天癸至。七七天
癸绝。其常也。有女年十二十三而产子。如楮记室所载平江苏达卿女。
十二受孕者。有妇年五十六十而产子。如辽史所载亟普妻。生二男一
女者。此又异常之尤者也。业医者之于此类。恐亦宜留心焉。
归脾汤
人参 白术（土炒） 茯神 黄 （蜜炙） 枣仁（炒研各二钱） 远志（甘草汤净焙） 当归（各一钱） 木香 甘
草（炙各五分） 龙眼肉（七枚）
姜枣水煎。加柴胡山栀牡丹皮。名加味归脾汤。
逍遥散
白术（土炒） 茯苓 当归 白芍药（酒炒） 柴胡（各一钱） 炙甘草（三分）
姜水煎。加山栀牡丹皮。名加味逍遥散。
八珍汤
人参 白术（土炒） 熟地黄 当归 茯苓（各一钱） 白芍药（酒炒一钱） 川芎（五分） 炙甘草（三分）
姜枣水煎。
四物汤
当归（一钱） 熟地黄（一钱） 白芍药（酒炒一钱） 川芎（五分）
水煎。
六君子汤
人参 白术（土炒） 茯苓 半夏 陈皮（各一钱） 炙甘草（三分）
姜枣水煎。
清心莲子饮
黄芩 人参 麦门冬 莲肉 柴胡 地骨皮 车前子（焙各一钱）
水煎。
柏子仁丸
柏子仁（焙研） 牛膝（酒拌） 卷柏（各半两） 泽兰 续断（酒炒各二两） 熟地黄（三两）
为末。入地黄膏。丸桐子大。每服三十丸。空心米饮下。
泽兰汤
泽兰（三两） 当归（酒拌一两） 白芍药（酒炒一两） 甘草（五钱）
为粗末。每服五钱。水煎服。
生地黄丸
生地黄（一两酒拌杵膏） 秦艽 黄芩 柴胡（各五钱） 赤芍药（一两）
上为细末。入地黄膏。加炼蜜少许。糊丸。每服三十丸。乌梅汤下。日进二服。
The ancient texts state: At the age of fourteen (two sevens), a girl's Tian Gui (substances promoting reproductive maturity) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Tai Chong Mai (Thoroughfare Vessel) becomes abundant, allowing menstruation to occur on schedule. By the age of forty-nine (seven sevens), the Ren Mai becomes deficient, the Tai Chong Mai declines, Tian Gui is exhausted, and menstruation ceases. The *Ling Shu* states that women have an excess of Qi but a deficiency of Blood; due to monthly menstruation and repeated blood loss, both the Ren Mai and Chong Mai are injured. It further states that diseases of the "Two Yang" (referring to the Foot-Yangming Stomach Meridian) originate in the Heart and Spleen. If there are hidden difficulties or emotional constraints, the woman may experience amenorrhea. If the condition transmits to become "Feng Xiao" (wind consumption, characterized by emaciation due to Liver fire consuming Yin) or "Xi Ben" (asthma with distension, characterized by rebellious Lung Qi), it becomes incurable. From this, we understand that Tian Gui is the water generated by congenital Kidney essence; menstruation belongs to Yin, its waxing and waning corresponding to the tides like the lunar cycle, similar to a woman's menstrual regularity. Both the Ren Mai and Chong Mai originate at Huiyin (CV-1) and are regarded as the Sea of Channels; thus, menstruation is governed by these three vessels. Why does the text say that diseases of the Two Yang originating in the Heart and Spleen cause amenorrhea? This is because "Two Yang" refers specifically to the Foot-Yangming Stomach Meridian, which corresponds to the Stomach. The Heart is the mother organ, and the Spleen provides assistance. The Stomach is the Sea of Water and Grain; when diseased, appetite decreases, and nutrients fail to nourish the body. Due to excessive mental preoccupation common in women, the Heart fails to generate Blood, leading to scanty menstruation. If Heart Fire is hyperactive, menstruation may flow profusely. If the Spleen fails to control Blood, menstruation may be excessive. If Spleen Yin is insufficient, menstruation may cease early. All these conditions are termed "Bu Yue" (irregular menstruation). This includes early periods, delayed periods, metrorrhagia, and amenorrhea, all failing to occur on time. "Feng Xiao" involves Wind belonging to Liver Wood; patients are prone to anger. Excessive Liver Wood further injures Spleen Earth, causing muscle emaciation. "Xi Ben" occurs when Earth fails to generate Metal, and Heart Fire attacks Lung Metal, causing pulmonary asthma and becoming an incurable syndrome. Understanding this reveals that Tian Gui is the congenital blood vessel system, stored and discharged by the Chong and Ren Mai; the Heart and Spleen constitute the acquired blood vessel system, irrigated by the Yangming Stomach Meridian. Therefore, for congenital deficiency, one nourishes Kidney Yin; for acquired deficiency, one regulates the Heart and Spleen. Although the principles differ, the essence is consistent. Are there any treatment methods that can transcend this framework?
Case 1: A woman suffered from excessive worry, injuring the Spleen, resulting in heavy menstruation. She was treated with Guipi Tang (Restore the Spleen Decoction). If accompanied by constrained Fire causing early periods, add Chai Hu (Bupleuri Radix), Shan Zhi (Gardeniae Fructus), and Mu Dan Pi (Moutan Cortex).
Case 2: A woman injured her Liver through anger, causing irregular menstruation (early or late), alternating chills and fever, internal heat, bitter taste, and a wiry-rapid pulse. She was treated with Xiaochaihu Tang (Minor Bupleurum Decoction) plus Dang Gui (Angelicae Sinensis Radix) and Xiang Fu (Cyperii Rhizoma). If menstruation was scanty, use Siwu Tang (Four Substances Decoction) plus Xiang Fu and Xu Duan (Dipsaci Radix). If menstruation was excessive, use Siwu Tang plus Xiang Fu, E Jiao (Colla Corii Asini), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Fu Ling (Poria).
Case 3: A woman was injured by overwork, presenting with sallow complexion, pale lips, and limb weakness, with excessive or sudden profuse menstruation. She was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Ejiao Zhu (Charred Donkey-Hide Gelatin), Pao Jiang Tan (Charred Ginger), and Wu Wei Zi (Schisandrae Fructus). For scanty menstruation, use Shiquan Dabu Tang (Ten Significant Tonifying Decoction), Bazhen Tang (Eight Treasures Decoction), or Renshen Yangrong Tang (Ginseng Nourishing the Vigor Decoction).
Case 4: A woman had Yin deficiency with hyperactive Fire and a weak constitution, experiencing bone-steaming fever and irritability. She was treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), intermittently taking Liuwei Wan (Six-Ingredient Rehmannia Pill). Alternatively, use Bazhen Tang plus Qin Jiao (Gentianae Macrophyllae Radix), Huang Qin (Scutellariae Radix), Xiang Fu, and Ejiao.
Case 5: A woman had Qi stagnation and Blood coagulation, causing delayed menstruation with abdominal pain upon onset, indicating Cold in the Lower Jiao. She was treated with Siwu Tang plus Wu Zhu Yu (Evodiae Fructus), Tao Ren (Persicae Semen), Rou Gui (Cinnamomi Cortex), Niu Xi (Achyranthis Bidentatae Radix), Ze Lan (Lycopersici Herba), and Xiang Fu.
Case 6: A woman was obese with much phlegm, experiencing excessive menstruation. She was treated with Liujunzi Tang (Six Gentlemen Decoction) plus Dang Gui, Bai Shao (Paeoniae Radix Alba), and Ejiao. If she had lower back pain, use Bazhen Tang plus Du Zhong (Eucommiae Cortex) and Shan Zhu Yu (Corni Fructus).
Case 7: A woman had deficiency-Cold and Spleen failure to control Blood. She was treated with Buzhong Yiqi Tang plus Gan Jiang (Zingiberis Rhizoma), Fu Zi (Aconiti Lateralis Radix Praeparata), and Shan Zhu Yu. Intermittently take Bawei Wan (Eight-Ingredient Pill) plus Wu Wei Zi. Alternatively, use Bazhen Tang plus Ejiao and Qi Ai (Artemisiae Argyi Folium).
Case 8: A woman had blazing Heart Fire, irritability, rapid pulse, and excessive menstruation. She was treated with Jiawei Guipi Tang plus Mai Men Dong (Ophiopogonis Tuber). Alternatively, use Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction) plus Shan Zhi.
Case 9: A woman contracted Wind-Cold during her period. She was treated with Sansu Yin (Ginseng and Perilla Decoction) modified. If she experienced alternating chills and fever, it was named Re Ru Xue Shi (Heat Entering the Blood Chamber), treated with Xiaochaihu Tang plus Mu Dan Pi and Sheng Di Huang (Rehmanniae Radix). If the pulse was not rapid, add Dang Gui and Xiang Fu. If food stagnation was present, use digestive methods.
Case 10: A woman contracted Qi stagnation during her period, causing menstrual blood to stagnate. She was treated with Xiaoyao San plus Mu Xiang (Aucklandiae Radix), Guang Pi (Citri Reticulatae Pericarpium), and Xiang Fu, removing Bai Zhu. Or add Fu Xiong (Chuanxiong Rhizoma).
Case 11: A woman drank cold water during her period, causing menstrual blood to congeal and stop. She was treated with Pingwei San (Peaceful Stomach Powder) plus Chuan Xiong and Dang Gui. If it persisted for a long time with lower abdominal distension and pain, use Siwu Tang plus Rou Gui, Niu Xi, Fu Ling, and Guang Pi.
Case 12: A woman contracted Summerheat, causing excessive menstruation. She was treated with Qingshu Yiqi Tang (Clear Heat and Augment Qi Decoction). For deficiency patterns, use Shengmai San (Generate the Pulse Powder); for excess patterns, use Xiangru Yin (Elsholtzia Decoction).
Case 13: A woman had impaired digestion due to diet, or injury from hunger/fullness, resulting in sudden severe bleeding. First regulate the Middle Qi to facilitate food transformation, then tonify the Spleen.
Case 14: A woman had Blood deficiency with Fire, causing menstrual depletion progressing to amenorrhea, gradual emaciation, and tidal fever. Do not use harsh purgatives to induce menstruation. Use Baizi Ren Wan (Biota Seed Pill) or Zelan Tang (Lycopersicum Decoction).
Case 15: A woman lost excessive blood, presenting with aversion to cold, fever, thirst, and restlessness. She was treated with two liang of Renshen (Ginseng Radix) and ten dates, decocted in water.
Case 16: A nun, widow, or virgin presented with alternating chills and fever, and a wiry-long Liver pulse extending beyond the radial styloid process. She was treated with Sheng Dihuang Wan (Rehmannia Pill).
Appendix: Li Shizhen's Discussion on Menstruation
Li Shizhen stated: A woman's menstruation occurring once a month is the normal state. Early or late occurrence, or patency versus obstruction, constitutes pathology. There are also variations from the norm not mentioned by ancients, which must be known. Some women experience epistaxis, hematemesis, or bleeding from eyes/ears during their period; this is called Ni Xing (Retrograde Menstruation). Some menstruate once every three months; this is called Ju Jing (Residential Menstruation), commonly known as seasonal menstruation. Some menstruate once a year; this is called Bi Nian (Avoiding the Year). Some never menstruate throughout life yet conceive; this is called An Jing (Hidden Menstruation). Some menstruate monthly after conception until childbirth; this is called Sheng Tai (Abundant Fetus), commonly known as Gou Tai (Dirt Fetus). Some experience sudden heavy bleeding several months into pregnancy without miscarriage; this is called Lou Tai (Leaking Fetus). Although these are explained by excess or deficiency of Qi and Blood, they deviate from the norm. Tian Gui arriving at fourteen and ceasing at forty-nine is normal. However, some girls give birth at twelve or thirteen, such as the daughter of Su Daqing from Pingjiang recorded by Chu Jishi, who conceived at twelve. Some women give birth at fifty or sixty, such as the wife of Ji Pu recorded in the History of Liao, who bore two sons and one daughter. These are extreme abnormalities. Medical practitioners should pay attention to such cases.
Guipi Tang Formula
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried in soil), Fushen (Poria with Hostwood), Huangqi (Astragali Radix, honey-roasted), Suanzaoren (Ziziphi Spinosae Semen, stir-fried and crushed, 2 qian each), Yuanzhi (Polygalae Radix, cleaned and roasted in licorice broth), Danggui (Angelicae Sinensis Radix, 1 qian each), Muxiang (Aucklandiae Radix), Gancao (Licorice Radix, roasted, 5 fen each), Longyanrou (Longan Aril, 7 pieces).
Decoct with ginger and jujube. Adding Chai Hu, Shan Zhi, and Mu Dan Pi creates Jiawei Guipi Tang (Modified Restore the Spleen Decoction).
Xiaoyao San Formula
Baizhu (stir-fried in soil), Fuling (Poria), Danggui, Baishaoyao (Paeoniae Radix Alba, wine-fried), Chaihu (Bupleuri Radix, 1 qian each), Zhigancao (Prepared Licorice Radix, 3 fen).
Decoct with water and ginger. Adding Shan Zhi and Mu Dan Pi creates Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).
Bazhen Tang Formula
Renshen, Baizhu (soil-fried), Shudihuang (Prepared Rehmanniae Radix), Danggui, Fuling (1 qian each), Baishaoyao (wine-fried, 1 qian), Chuanxiong (5 fen), Zhigancao (3 fen).
Decoct with ginger and jujube.
Siwu Tang Formula
Danggui (1 qian), Shudihuang (1 qian), Baishaoyao (wine-fried, 1 qian), Chuanxiong (5 fen).
Decoct with water.
Liujunzi Tang Formula
Renshen, Baizhu (soil-fried), Fuling, Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium, 1 qian each), Zhigancao (3 fen).
Decoct with ginger and jujube.
Qingxin Lianzi Yin Formula
Huangqin (Scutellariae Radix), Renshen, Ma mendong (Ophiopogonis Tuber), Lianrou (Nelumbinis Semen), Chaihu, Digupi (Lycii Cortex), Cheqianzi (Plantaginis Semen, roasted, 1 qian each).
Decoct with water.
Baizi Ren Wan Formula
Baiziren (Biotae Semen, roasted and crushed), Niuxi (Achyranthis Bidentatae Radix, mixed with wine), Juanbai (Selaginellae Herba, half liang each), Zelan (Lycopersici Herba), Xuduan (Dipsaci Radix, wine-fried, 2 liang each), Shudihuang (Prepared Rehmanniae Radix, 3 liang).
Grind into powder, mix with Rehmannia paste, and form pills the size of tung tree seeds. Take thirty pills per dose with rice water on an empty stomach.
Zelan Tang Formula
Zelan (3 liang), Danggui (mixed with wine, 1 liang), Baishaoyao (wine-fried, 1 liang), Gancao (5 qian).
Grind into coarse powder. Take five qian per dose, decoct in water, and drink.
Sheng Dihuang Wan Formula
Shengdihuang (Raw Rehmanniae Radix, mixed with wine and pounded into paste, 1 liang), Qinjiao (Gentianae Macrophyllae Radix), Huangqin (Scutellariae Radix), Chaihu (Bupleuri Radix, 5 qian each), Chishaoyao (Red Paeonia Root, 1 liang).
Grind into fine powder, mix with Rehmannia paste and a little refined honey, and form pill dough. Take thirty pills per dose with sour plum decoction, twice daily.