凡妇人室女，月经暂来忽去，迟早无期，此则痨瘵之渐机也。智者不可以其近浅而忽之。
其始由于失期，其终遂至闭绝。午后发热，咳嗽吐红，或干咳嗽，或咳痰饮，烦躁不宁，不能
平睡。二便不利，六脉细数，此皆不可救之证也。今见室女十五六步以上者，天癸初至数月半
年，或至或断，忽然不通，发热咳嗽，饮食无味，速用调理养血和脾，庶可获愈。今医不察，
竟用破血通经辛热之药，及耗气血，益火伤脾，遂无痊日。此证盖起于脾脏，思虑感伤，气血失
度，所以经至不能如期也，甚至不通，是由内火蒸烁，元气亦耗，则必死矣。善医者，当先调脾
以养血，切勿竟用辛燥助火之味，如香附，须些少佐之，抚芎亦不敢多用。姜、桂、香砂、玄
胡、莪术、乌药、菖蒲等破耗之药，不可轻用。如犯此类，多致不救。为良医者其深察之。
（《集验》）调卫养荣汤 治妇人室女一切月经不调，或先或后，或绝闭不通，憎寒壮热，
口苦无味，饮食少思，连声咳嗽，烦躁头眩，渐成痨证者，此药主之。
陈皮 白术 当归 生地黄 沙参 麦门冬（各一钱） 牡丹皮 地骨皮（各八分） 桔梗
柴胡梢（各五分） 谷芽（一钱） 甘草（四分）
上水煎，加莲子、姜、枣。痰中见血加侧柏枝煎，早晚服。
烦躁口干者加炒山栀，倍麦门冬。胁下胀疼加青皮、川芎。胸膈满闷加黄连，姜炒枳实，
去麦冬、地骨。夜出盗汗加黄连、黄 ，去柴胡、桔梗。大便闭结加桃仁，倍当归。咳嗽不已
加栝蒌、阿胶。头眩、头痛加天麻、川芎。小水不利加木通、茯苓。烦渴不利加滑石，倍麦
门冬。
（《局方》）琼玉膏 治月经不通，烦热咳嗽。
（《良方》）当归膏 治月经不调，血虚烦热，后期而至。（方见咳嗽门。）
加味八珍汤、归神汤（并治前证，方见梦交门。）
For all women and unmarried girls, if menstruation temporarily starts and then suddenly stops, or comes early or late without a fixed schedule, this is the initial stage of *Lao Zhai* (chronic consumptive disease). Wise individuals should not ignore it because it appears superficial or mild.
Initially caused by irregular cycles, it eventually leads to complete amenorrhea. Symptoms include afternoon fever, coughing with hemoptysis, or dry cough, or coughing up phlegm-fluids, restlessness and agitation, inability to lie flat to sleep. Difficulty in urination and defecation, with fine and rapid pulses in all six positions, are all signs of incurable conditions. Currently, for unmarried girls aged fifteen or sixteen and above, whose *Tian Gui* (the essence related to reproductive maturity, referring to menstruation) has just begun and presents irregularly over several months or half a years, sometimes coming and sometimes stopping, followed by sudden cessation accompanied by fever, cough, and loss of appetite, one should promptly use methods to regulate, nourish blood, and harmonize the spleen, so that recovery may be achieved. Modern physicians, failing to examine carefully, actually employ pungent and hot herbs that break blood and promote menstruation, thereby depleting qi and blood, aggravating internal fire, and damaging the spleen, leading to no hope of recovery. This condition generally originates from the Spleen organ; excessive worry causes injury, leading to imbalance of qi and blood, so menstruation fails to arrive on time, or even ceases completely. This is due to internal fire steaming and scorching, consuming yuan qi (original qi), which inevitably leads to death. A skilled physician should first regulate the spleen to nourish blood, and must absolutely avoid using pungent, warm, and drying herbs that assist fire, such as Xiangfu (Cyperus Rhizome), which should only be used in small amounts as an adjunct, and Fuxiong (Chuanxiong Rhizome) should not be used in large doses. Herbs such as Ginger, Cinnamon Twig, Sha Ren (Amomum Fruit), Yuan Hu Suo (Corydalis Rhizome), E Zhu (Curcuma Rhizome), Wu Yao (Lindera Root), and Chang Pu (Acorus Rhizome), which break and deplete, should not be lightly employed. Violating these categories often results in untreatable cases. Good physicians should investigate this deeply.
From *Ji Yan*: Tiaowei Yangrong Decoction (Regulate Defense and Nourish Ying Decoction) treats all menstrual irregularities in women and unmarried girls, whether early or late, or complete amenorrhea, aversion to cold with high fever, bitter taste in mouth and lack of flavor, poor appetite, continuous coughing, restlessness, dizziness, gradually developing into Lao syndrome; this decoction is indicated.
Chenpi (Citrus Reticulatae Pericarpium), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Sheng Dihuang (Rehmanniae Radix), Shashen (Glehniae Radix), Maimendong (Ophiopogonis Radix) (each 1 qian); Mudanpi (Moutan Cortex), Digupi (Bark of Lycii Root) (each 8 fen); Jiegeng (Platycodonis Radix), Chaihu Shao (Radix Bupleuri caulis tip) (each 5 fen); Guya (Hordei Fructus Germinatus) (1 qian); Gancao (Glycyrrhizae Radix et Rhizoma) (4 fen).
Decoct with water, add Lianzi (Nelumbinis Semen), Shengjiang (Zingiberis Rhizoma Recens), and Zaoju (Jujubae Fructus). If blood is seen in phlegm, add Ce Bai Zhi (Platycladi Cacumen) to decoct; take morning and evening.
For restlessness and dry mouth, add Chao Shanzhi (Gardeniae Fructus stir-fried) and double the dose of Maimendong. For distension and pain under the ribs, add Qingpi (Citri Reticulatae Pericarpium Viride) and Chuanxiong (Ligustici Chuanxiong Rhizoma). For fullness and oppression in chest and diaphragm, add Huanglian (Coptidis Rhizoma) and Zhishi (Aurantii Fructus) stir-fried with ginger; remove Maimendong and Digupi. For night sweats, add Huanglian and Huangbo (Phellodendri Cortex); remove Chaihu and Jiegeng. For constipation, add Taoren (Persicae Semen) and double Danggui. For persistent cough, add Gualou (Trichosanthis Fructus) and Ejiao (Colla Corii Asini). For dizziness and headache, add Tianma (Gastrodiae Rhizoma) and Chuanxiong. For difficult urination, add Mutong (Akebiae Caulis) and Fuling (Poria). For irritability, thirst, and difficult urination, add Huashi (Talcum) and double Maimendong.
From *Ju Fang*: Qiongyu Gao (Jade Pearl Paste) treats amenorrhea, irritability, heat, and cough.
From *Liang Fang*: Danggui Gao (Angelica Paste) treats menstrual irregularity, blood deficiency with irritability and heat, and delayed menstruation. (Formula see Section on Cough.)
Jiawei Bazhen Tang (Modified Eight-Treasure Decoction) and Guishen Tang (Nourish Spirit Decoction) (both treat the aforementioned syndromes; formulas see Section on Nocturnal Emission/Sleep Intercourse).