岐伯曰∶女子二七而天癸至，任脉通，太冲脉盛，月事以时下，则有子。盖任主胞胎，
通以阴道之泰也；冲为血海，盛则气血俱盛也。妇人肾气全盛，冲任周流，如月之亏盈，
应期行止，而有常度，曰调。遇交合则有子矣。否则三五错踪，皆所谓不调也。不调则百病变
生，甚至不治，孕暇言乎？经曰∶二阳之病发心脾，有不得隐曲，女子不月，其传为风消，其
传为息贲者，死不治。况心属阳而主血，脾裹血以行气。若月经不通，未必不由心事不足，思
虑伤脾，有所劳倦，谷气不输，肺金失养，肾水无滋，经血津液，日以枯涸，以致三五不调，
渐至绝闭，虚损内热，骨蒸劳瘵之证作，而卒至于难治也。所以养心则血生，健脾则气布。二
者胥和，则气畅血行。而调经之要，斯其至矣，复何患之有？且夫行经之时，亦必保之如产，
远房劳，戎浴洗，毋过于寒热喜怒。一有失中，疾病随起。调治之法，如气郁血虚，潮热黄瘦，
而经不调者，以丹桂散、香附丸之类主之；气虚血热先期而来，过多不止者，以镇经汤、固
经丸之属治之；过期不来，腰腹胀痛者，以促经汤、红花
散之属行之；湿痰麻木者，术附丸燥之。至于虚实寒热，更详脉法，抑何有经之不正，而孕之不
育乎？
一、经闭绝不通者，血枯也。
四物汤倍当归加红花、桃仁、牛膝；热加黄芩，寒加肉桂。
一、经水不及期而行者，血热也。
四物汤加生地黄、黄芩、黄连；肥人兼痰，药加苍术、半夏、香附子。
一、经水常过期而行者，血少也。
瘦人多是血虚，倍四物汤加当归、熟地黄、黄芩、白术、甘草，少佐以红花、桃仁。
肥人大概气虚挟痰，四物汤去地黄，合二陈汤加参、 、香附。
一、经过期而色淡者，挟虚有痰，因水以混之也。
四物汤倍当归、地黄，合二陈汤煎服。
一、经将来腹中作痛者，血气实。此血欲行而气滞也。
四物汤加香附、桃仁、红花、玄胡、青皮、牡丹皮、木香，甚者加莪术、大黄。热加
黄芩、柴胡。
一、行经后作痛者，血气虚也。
八珍汤宜服。血虚者，倍当归、地黄；寒加干姜；气虚加人参。
一、肥盛妇人，月经不通，或二月、三月一行，由痰多躯脂满闭。
宜导痰汤加当归、黄连、香附、苍白术之类。
一、有虚热经少不来，或来过多。
四物汤加黄芩之类。
一、经水或来或断，发热发寒。
四物汤合小柴胡煎服。
一、经行三五日后，腹中绵绵作痛者，盖血因气滞而未尽也。
宜四物汤加木香、槟榔之属。
一、妇人血病以当归为主，肥白者必合参 ，瘦黑者必合生地黄、香附。
一、妇人之病，不可全外于气，盖血因气使，人鲜知之。气畅则血和，一定之理也。
一、带下赤白带者，因胃中痰积流下，渗入膀胱，治法宜散湿导痰清热为主。以
二陈汤加苍白术，或加升麻、柴胡以升之，或用吐法以提之。白者属气，赤者属血。血虚加
芎归，气虚加参术。
一、瘦人带下，热之所致。如泉本清，火熬之即浊。宜以滑石、樗皮、川芎、海石、
青黛之类。
一、血崩证有因虚，有因热。虚则下陷，热则流通。视其缓急，分标本而治之，庶得王
霸之经权也。缓用四物汤加条芩、附子；急以立效散、神效丸之属。
一、血脏虚冷，崩中下血，宜四物汤加阿胶、黄芩、参 。东垣谓崩带下久，有属于
寒，不可一途而谓。
一、妇肥盛而无子者，由痰多脂膜闭塞子宫。宜行湿燥痰之剂，更服顺坤丹、降生丹之
类即孕。
一、瘦人无子，因血虚子宫干涩，不能配取精气。宜养血滋阴。人多不审寒热，悉谓子
宫虚冷，概以乌附辛热之药煎熬，气血愈亏，祸不旋踵，孕安得乎？
Qibo said: When a girl reaches fourteen years of age, Tian Gui (the substance promoting reproductive maturity) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) becomes abundant. Her menstruation occurs at regular intervals, enabling her to conceive. The Ren Mai governs the uterus; its patency signifies harmonious Qi and Blood in the genital tract. The Chong Mai is the Sea of Blood; its abundance indicates sufficient Qi and Blood. When a woman’s Kidney Qi is fully mature, the Qi and Blood of the Chong and Ren vessels circulate throughout the body like the waxing and waning of the moon, occurring at fixed times with regular rhythm. This regularity is termed "harmonious" (Tiao). If intercourse occurs during this state, conception ensues. Otherwise, irregular cycles constitute "disharmony" (Bu Tiao). Disharmony gives rise to various pathologies, potentially becoming incurable, let alone achieving pregnancy. As stated in the *Neijing*: "Diseases of the Yangming channels originate from the Heart and Spleen; involving hidden distress, women may experience amenorrhea. If it transmits to become Feng Xiao (wasting due to wind-heat), or Xi Ben (asthmatic distension), it is a death syndrome, incurable." Moreover, the Heart belongs to Yang and governs Blood, while the Spleen envelops Blood to facilitate Qi movement. Menstrual obstruction may stem from emotional distress damaging the Spleen through overthinking, fatigue impairing the transformation of Gu Qi (food essence), leading to malnourishment of Lung Metal and lack of nourishment for Kidney Water. Consequently, menstrual blood and body fluids dry up daily, causing irregular cycles that gradually progress to amenorrhea, accompanied by deficiency heat, bone-steaming consumption, and other consumptive diseases, ultimately becoming difficult to treat. Therefore, nourishing the Heart generates Blood, and strengthening the Spleen distributes Qi. When both are harmonized, Qi flows freely and Blood moves smoothly. This is the essence of regulating menstruation; what else could there be to worry about? During menstruation, one must protect the body as if postpartum, avoiding sexual exertion, bathing, and extremes of cold, heat, joy, or anger. Any imbalance will promptly induce disease. Treatment methods include: for Qi stagnation and Blood deficiency presenting with tidal fever, sallow complexion, and irregular menstruation, use Dan Gui San (Cinnamon Pill) or Xiang Fu Wan (Cyperus Pill); for Qi deficiency and Blood heat causing early, excessive, and prolonged menstruation, use Zhen Jing Tang (Menstruation-Calming Decoction) or Gu Jing Wan (Menstruation-Securing Pill); for delayed menstruation with lower abdominal and lumbar distension and pain, use Cu Jing Tang (Menstruation-Promoting Decoction) or Hong Hua San (Carthamus Powder); for damp-phlegm causing numbness, use Zhu Fu Wan (Atractylodes and Aconite Pill) to dry dampness. Regarding excess, deficiency, cold, and heat, pulse diagnosis must be detailed. How can irregular menstruation fail to result in infertility?
1. Amenorrhea with complete obstruction indicates Blood exhaustion.
Si Wu Tang (Four Substances Decoction) with doubled Dang Gui (Angelicae Sinensis Radix), plus Hong Hua (Carthami Flos), Tao Ren (Persicae Semen), and Niu Xi (Achyranthis Bidentatae Radix). For heat, add Huang Qin (Scutellariae Radix); for cold, add Rou Gui (Cinnamomi Cortex).
2. Premature menstruation indicates Blood heat.
Si Wu Tang (Four Substances Decoction) with Sheng Di Huang (Rehmanniae Radix), Huang Qin (Scutellariae Radix), and Huang Lian (Coptidis Rhizoma). In obese patients with phlegm, add Cang Zhu (Atractylodis Rhizoma), Ban Xia (Pinelliae Rhizoma), and Xiang Fu Zi (Cyperi Rhizoma).
3. Delayed menstruation indicates Blood deficiency.
Thin individuals often suffer from Blood deficiency; double Si Wu Tang (Four Substances Decoction) and add Dang Gui (Angelicae Sinensis Radix), Shu Di Huang (Prepared Rehmanniae Radix), Huang Qin (Scutellariae Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Gan Cao (Glycyrrhizae Radix), with small amounts of Hong Hua (Carthami Flos) and Tao Ren (Persicae Semen).
Obese individuals generally have Qi deficiency with phlegm; remove Di Huang from Si Wu Tang (Four Substances Decoction), combine with Er Chen Tang (Two-Cured Decoction), and add Ren Shen (Ginseng Radix), [missing character], and Xiang Fu (Cyperi Rhizoma).
4. Delayed menstruation with pale color indicates deficiency with phlegm, mixed with water-dampness.
Si Wu Tang (Four Substances Decoction) with doubled Dang Gui (Angelicae Sinensis Radix) and Di Huang (Rehmanniae Radix), combined with Er Chen Tang (Two-Cured Decoction) for decoction and ingestion.
5. Abdominal pain preceding menstruation indicates Excess of Qi and Blood. This is Blood attempting to flow but obstructed by Qi stagnation.
Si Wu Tang (Four Substances Decoction) with Xiang Fu (Cyperi Rhizoma), Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Yan Hu Suo (Corydalis Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Mu Dan Pi (Moutan Cortex), and Mu Xiang (Aucklandiae Radix). In severe cases, add E Zhu (Curcumae Rhizoma) and Da Huang (Rhei Radix et Rhizoma). For heat, add Huang Qin (Scutellariae Radix) and Chai Hu (Bupleuri Radix).
6. Abdominal pain after menstruation indicates Deficiency of Qi and Blood.
Ba Zhen Tang (Eight-Treasure Decoction) is suitable. For Blood deficiency, double Dang Gui (Angelicae Sinensis Radix) and Di Huang (Rehmanniae Radix); for cold, add Gan Jiang (Zingiberis Rhizoma); for Qi deficiency, add Ren Shen (Ginseng Radix).
7. Obese women with amenorrhea, or menstruation occurring every two or three months, suffer from obstruction due to excessive phlegm and adipose tissue filling the body.
Use Dao Tan Tang (Phlegm-Guiding Decoction) with Dang Gui (Angelicae Sinensis Radix), Huang Lian (Coptidis Rhizoma), Xiang Fu (Cyperi Rhizoma), and Cang/Bai Zhu (Atractylodis Rhizoma/Macrocephalae Rhizoma).
8. Scanty menstruation or amenorrhea due to deficient heat, or excessive bleeding.
Si Wu Tang (Four Substances Decoction) with Huang Qin (Scutellariae Radix).
9. Intermittent menstruation with alternating fever and chills.
Si Wu Tang (Four Substances Decoction) combined with Xiao Chai Hu Tang (Minor Blue Green Dragon Decoction) for decoction and ingestion.
10. Dull abdominal pain three to five days into menstruation indicates residual Blood due to Qi stagnation.
Si Wu Tang (Four Substances Decoction) with Mu Xiang (Aucklandiae Radix) and Bing Lang (Arecae Semen).
11. For gynecological Blood disorders, Dang Gui (Angelicae Sinensis Radix) is primary. For pale, obese women, combine with Ren Shen (Ginseng Radix) and [missing character]; for dark, thin women, combine with Sheng Di Huang (Rehmanniae Radix) and Xiang Fu (Cyperi Rhizoma).
12. Gynecological diseases cannot ignore Qi, as Blood follows Qi’s movement—a principle often overlooked. Harmonious Qi ensures harmonious Blood.
13. Leukorrhea with red and white discharge results from Phlegm accumulation in the Stomach flowing downward and infiltrating the Bladder. Treatment should focus on dispersing dampness, guiding out phlegm, and clearing heat. Use Er Chen Tang (Two-Cured Decoction) with Cang/Bai Zhu (Atractylodis Rhizoma/Macrocephalae Rhizoma), or add Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) to lift, or use emesis to raise. White discharge relates to Qi; red discharge relates to Blood. For Blood deficiency, add Xiong Gui (Chuanxiong and Dang Gui); for Qi deficiency, add Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma).
14. Leukorrhea in thin individuals is caused by heat. Like clear spring water turning turbid when boiled by fire. Use Hua Shi (Talcum), Chu Pi (Stemonae Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Hai Shi (Aragonitum), and Qing Dai (Indigo Naturalis).
15. Metrorrhagia (blood flooding) can be due to deficiency or heat. Deficiency causes sinking; heat causes hyperflow. Treat based on urgency, distinguishing root and branch, to master therapeutic flexibility. For mild cases, use Si Wu Tang (Four Substances Decoction) with Tiao Qin (Scutellariae Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata); for acute cases, use Li Xiao San (Instant Effect Powder) or Shen Xiao Wan (Divine Effect Pill).
16. Cold uterus with metrorrhagia and hematochezia. Use Si Wu Tang (Four Substances Decoction) with E Jiao (Asini Corii Colla), Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix), and [missing character]. Dong Yuan noted that chronic leukorrhea and metrorrhagia may involve cold; do not assume all cases are similar.
17. Infertility in obese women is due to excessive phlegm and adipose tissue obstructing the uterus. Use damp-dispersing and phlegm-drying formulas, followed by Shun Kun Dan (Harmonize Female Elixir) or Jiang Sheng Dan (Descend Birth Elixir) to achieve pregnancy.
18. Infertility in thin women is due to Blood deficiency causing uterine dryness, preventing conception. Nourish Blood and Yin. Many fail to distinguish cold and heat, assuming uterine cold and indiscriminately using hot drugs like Wu Tou (Aconiti Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata). This further depletes Qi and Blood, leading to immediate disaster, making pregnancy impossible.