证
夫经水阴血也，属冲任二脉，主上为乳汁，下为月水。其为患有因脾虚而不能生血者，有因脾郁伤而血耗
损者，有因胃火而血销烁者，有因脾胃损而血少者，有因劳伤身而血少者，有因怒伤肝而血少者，有因
肾水不能生肝而血少者。有因肺气虚不能行血而闭者。治疗之法∶若脾虚而不能行者，调而补之；脾
郁而不行者，解而补之；胃火而不行者，清而补之；脾胃损而不行者，调而补之；劳伤心血而不行者，静
而补之；肺气虚而不行者，补脾胃；肾水虚而不行者，补肾肝。经云∶损其肺者，益其气；损其心者，调其
荣卫；损其脾者，调其饮食，适其寒温；损其肝者缓其中；损其肾者，益其精。审而治之，庶无误矣。
丹溪曰∶经闭不通，或因堕胎，及多产伤血，或因久患潮热烁血，或因久出盗汗耗血，或因脾胃不
和，饮食少进，而不生血。治宜生血补血，除热调胃之剂，随证用之。或因七情伤心，心气留结，
故血闭而不行，宜调心气，通心经，使血生而经自行矣。
治
节斋曰∶经脉不通，多有脾胃损伤而致者，不可便认作经闭血死，轻用通经破血之药。遇有此证，便
须审其脾胃如何。若因饮食劳倦，损伤脾胃，少食恶食，泄泻疼痛，或因误服汗下攻克之药，伤其中气，以
致血少而不行者，只宜补养脾胃，用白术、茯苓、芍药为臣，使以黄 、甘草、陈皮、麦芽、当归、柴胡
等药。脾旺则能生血，而经自行矣。又有饮食积滞，致使脾胃者，亦宜消积补脾。
若脾胃无病，果有血块凝结，方宜行血通经。
方
通经汤（刘近川方）
当归 川芎 白芍 生地 大黄 官桂 浓朴 枳壳 枳实 黄芩 苏木 红花 乌梅（一个）
生姜（三片） 枣（一枚）
水煎温服。
二黄散（秘方） 治妇人室女经脉不通，服之如神。
大黄（烧，存性） 生地黄（各三钱）
上为末，作一服，空心好酒调下。
通经散（方上异人传）
斑蝥（去头、足） 大黄（酒浸，三钱） 藿香（少许）
上斑蝥量疾远近轻重用之。如一年，壮者，用七八个，每服七八分；弱者，五六个，每服五六分。如五
六个月，壮者，五六个，每服五六分；弱者，四五个，每服四五分。俱为末，未服之先，以
热水嗽口令净，即食枣三四枚，将药用温酒一钟调服，再食枣三四枚，静卧勿令人搅扰。待腹疼二三阵，
其经即行。如腹不疼，再进一服，立通。忌气恼、生冷油腻，后服平胃散，以复胃气也。
神应丹（秘方）〔批〕（按此方治经闭属实热者） 治妇人经脉不行，五心烦
热，口燥咽干，颊赤心怯，潮热，胸膈不利，减食多渴，咳嗽，唾稠痰。
大黄（二两，腊二两，煮干，晒） 血竭（五钱） 桃仁（五钱） 红花（五钱）
上为末，和匀酒糊为丸，如梧桐子大，辰砂为衣。每服七十丸，空心用醇酒送下。
通经调气汤 治妇人经闭不通，并发热咳嗽。
当归（酒浸，一两） 生地（酒浸，一两） 川芎（一两） 白芍（酒浸，一两） 柴胡
（八钱） 香附（便制，一两） 丹皮（八钱） 生芩（六钱） 黄柏（炒，六钱） 桃仁（一两）
知母（便炒，八钱） 牛膝（酒浸，八钱） 红花（二钱）
上锉十剂，水煎，空心一服，食远一服。
加味八物汤 治经闭属虚热者。
即四君合四物，加柴胡、黄芩、小茴、香附是也。腹痛，加玄胡索、枳壳、干漆。呕吐恶心，加良姜、
砂仁。手足麻痹恶寒，加肉桂。咳嗽，加杏仁、五味子、款冬花。
归末破瘕汤 治妇人经水不通，腹中积块疼痛。
归尾（酒洗，一钱） 赤芍（一钱） 白芍（一钱） 青皮（一钱） 乌药（七分） 香附
（醋炒，钱半） 三棱（一钱） 莪术（醋煮，一钱） 官桂（五分） 苏木（五分） 红花（五分）
上锉一剂，水煎，入酒一钟，空心服。
血竭散（秘方） 治妇人血瘕作痛，脐下胀满，月经不行，发热体倦。
当归（八分） 桂心（六分） 芍药（炒，六分） 玄胡索（炒，四分） 血竭（六分） 蒲黄（炒，六分）
上为末，每服二钱，空心酒调下。
通经丸 治经闭不通，及血块疼痛。
归尾 枣仁（去皮尖） 大黄（煨） 丹皮 干漆（炒烟尽） 肉桂（各一两） 三
棱（五钱） 莪术（醋炒） 牛膝（各一两） 麝香（八分）
上为末，皂角五钱，芫花二钱，水煮糊为丸，如梧桐子大。每服五十丸，米汤送下。
破血金丹（秘方）〔批〕（按此方治经闭腹有血块者） 治妇人月经不通，腹痛有块者。
香附（十两，醋制） 艾叶（四两，焙干） 当归（二两，酒浸一宿，醋煮焙干） 红花
（一两，焙干） 桃仁（一两，去皮尖）
上为末，醋糊为丸。每服二钱，淡醋汤送下，早晚各一服，经通药止。
一醉饮（刘桐川传）
托盘科根，锉一大剂，黄酒两碗煎至一碗，空心热服，汗出至足者立愈。
通经秘方
用大船上多年灰条，不拘多少，用炭火烧通红，淬入好烧酒内，取出待干为末。每服三钱，好酒调下，
空心服；第二服，红花酒调下；第三服，大黄酒调下。三次要见红，如神。
芫花散（秘方） 治妇人虚羸有鬼胎， 块，经候不通。
芫花根三两，炒黄色为末。每服一钱，桃仁煎汤调下，当下恶物，神效。
无极丸〔批〕（按此方治经闭专治之剂） 治妇人血块气疼，有爬床席，十指出血。
锦纹大黄（四两，每两用酒、醋、童便，盐水各煮七次，俱晒干）
上合作一处，蒸之，晒干，又蒸又晒，如此七次为末。用当归、熟地各一两半，浓煎汁一碗，煮糊为
丸，如梧桐子大。每遇心疼气痛，用小茴香炒研七分，煎汤送下三十丸。有块者，一月之内，下
小小血粒，自此除根不痛，经脉不行，红花汤下。
Symptoms
Menstrual blood belongs to Yin blood and is governed by the Chong (Penetrating) and Ren (Conception) vessels. It transforms upward into milk and downward into menstruation. The causes of its disorders include: spleen deficiency failing to generate blood; spleen depression causing injury and blood consumption; stomach fire consuming and scorching blood; spleen and stomach damage leading to reduced blood; physical exhaustion from overwork reducing blood; anger injuring the liver and reducing blood; kidney water failing to nourish the liver, resulting in reduced blood; and lung Qi deficiency failing to move blood, leading to amenorrhea. The treatment principles are as follows: for spleen deficiency failing to move blood, regulate and tonify; for spleen depression failing to move blood, resolve depression and tonify; for stomach fire failing to move blood, clear heat and tonify; for spleen and stomach damage failing to move blood, regulate and tonify; for labor damaging heart blood failing to move blood, rest and tonify; for lung Qi deficiency failing to move blood, tonify the spleen and stomach; for kidney water deficiency failing to move blood, tonify the liver and kidneys. The *Classic* states: "If the lung is damaged, benefit its Qi; if the heart is damaged, harmonize Ying and Wei; if the spleen is damaged, regulate diet and adapt to cold and warmth; if the liver is damaged, soothe its interior; if the kidney is damaged, benefit its essence." Carefully examine and treat accordingly, and errors will likely be avoided.
Zhu Danxi said: Amenorrhea may be caused by abortion or multiple births damaging blood; by chronic tidal fever scorching blood; by chronic night sweats consuming blood; by disharmony of the spleen and stomach with poor dietary intake failing to generate blood. Treatment should employ agents that generate and tonify blood while clearing heat and regulating the stomach, selected according to the syndrome. Alternatively, it may be caused by the seven emotions injuring the heart, causing heart Qi to stagnate and knot, thus blocking blood flow. In such cases, regulate heart Qi and unblock the Heart meridian so that blood generates and menstruation flows naturally.
Treatment Methods
Mr Jiezhai stated: Menstrual obstruction is often caused by spleen and stomach damage. One must not immediately diagnose it as "amenorrhea with dead blood" and lightly use drugs that unblock menstruation and break blood stasis. When encountering this condition, one must examine the state of the spleen and stomach. If it is due to dietary irregularities and fatigue damaging the spleen and stomach, leading to poor appetite, aversion to food, diarrhea, and pain, or due to the mistaken use of diaphoretic, purgative, or attacking drugs that damage middle Qi, resulting in blood deficiency and failure to flow, only tonifying and nourishing the spleen and stomach is appropriate. Use Atractylodis Rhizoma (Baizhu), Poria (Fuling), and Paeoniae Radix Alba (Shaoyao) as principal herbs, with Astragali Radix (Huangqi), Glycyrrhizae Radix et Rhizoma (Gancao), Citri Reticulatae Pericarpium (Chenpi), Malto (Maita), Angelicae Sinensis Radix (Danggui), and Bupleuri Radix (Chaihu) as guiding herbs. When spleen Qi is robust, it can generate blood, and menstruation will flow naturally. Another cause is food stagnation obstructing the spleen and stomach; in such cases, eliminate stagnation and tonify the spleen.
If the spleen and stomach are healthy and there are indeed blood clumps congealing, then it is appropriate to use blood-invigorating and menstruation-unblocking drugs.
Formulas
Tongjing Tang (Unblocking Menstruation Decoction) [Formula by Liu Jinchuan]
Angelicae Sinensis Radix (Danggui), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Paeoniae Radix Alba (Baishao), Rehmanniae Radix (Shengdi), Rheum Palmatum Radix et Rhizoma (Dahuang), Cinnamomi Ramulus (Guangui), Magnoliae Officinalis Cortex (Noupu), Aurantii Fructus Immaturus (Zhike), Aurantii Fructus (Zhishi), Scutellariae Radix (Huangqin), Sappan Lignum (Sumu), Carthami Flos (Honghua), Mume Fructus (Wumei, one piece), Zingiberis Rhizoma Recens (Shengjiang, three slices), Jujubae Fructus (Zao, one piece).
Decoct in water and take warm.
Erhuang San (Two Yellows Powder) [Secret Formula] Treats menstrual obstruction in women and maidens; effective as if by magic.
Rheum Palmatum Radix et Rhizoma (Dahuang, roasted to retain efficacy), Rehmanniae Radix (Shengdihuang) (each 3 qian).
Grind into powder. Take as a single dose, mixed with good wine on an empty stomach.
Tongjing San (Unblocking Menstruation Powder) [Transmitted by a Stranger]
Mylabris (Banmao, remove head and feet), Rheum Palmatum Radix et Rhizoma (Dahuang, soaked in wine, 3 qian), Agastache Herba (Huoxiang, a small amount).
Use Mylabris (Banmao) according to the duration and severity of the disease. For a duration of one year, in strong constitutions, use 7-8 insects, taking 7-8 fen per dose; in weak constitutions, use 5-6, taking 5-6 fen per dose. For a duration of 5-6 months, in strong constitutions, use 5-6, taking 5-6 fen per dose; in weak constitutions, use 4-5, taking 4-5 fen per dose. Grind all into powder. Before taking, rinse mouth thoroughly with hot water, then eat 3-4 jujubes. Mix the medicine with one cup of warm wine and take it, then eat another 3-4 jujubes. Lie quietly without disturbance. After 2-3 episodes of abdominal pain, menstruation will commence. If there is no abdominal pain, take another dose, and flow will immediately resume. Avoid anger, raw/cold, and greasy foods. Afterwards, take Pingwei San to restore stomach Qi.
Shenyang Dan (Divine Response Pill) [Secret Formula] [Note: This formula treats amenorrhea due to excess-heat.] Treats menstrual obstruction in women, five-palm heat, dry mouth and throat, red cheeks, timidity of the heart, tidal fever, chest and diaphragm discomfort, reduced appetite with excessive thirst, cough, and thick phlegm.
Rheum Palmatum Radix et Rhizoma (Dahuang, 2 liang, made in the twelfth lunar month, boiled until dry, sun-dried), Hematites (Xuejie, 5 qian), Persicae Semen (Taoren, 5 qian), Carthami Flos (Honghua, 5 qian).
Grind into powder, mix evenly, and form pills using wine paste, sized like sophora seeds. Coat with Cinnabar (Chensha). Take 70 pills per dose, washed down with strong wine on an empty stomach.
Tongjing Tiaoqi Tang (Unblocking Menstruation and Regulating Qi Decoction) Treats menstrual obstruction in women accompanied by fever and cough.
Angelicae Sinensis Radix (Danggui, wine-soaked, 1 liang), Rehmanniae Radix (Shengdi, wine-soaked, 1 liang), Ligusticum Chuanxiong Rhizoma (Chuanxiong, 1 liang), Paeoniae Radix Alba (Baishao, wine-soaked, 1 liang), Bupleuri Radix (Chaihu, 8 qian), Cyperi Rhizoma (Xiangfu, prepared with urine, 1 liang), Moutan Cortex (Danpi, 8 qian), Scutellariae Radix (Shengqin, 6 qian), Phellodendri Cortex (Huangbai, stir-fried, 6 qian), Persicae Semen (Taoren, 1 liang), Anemarrhenae Rhizoma (Zhimu, stir-fried with urine, 8 qian), Achyranthis Bidentatae Radix (Niuxi, wine-soaked, 8 qian), Carthami Flos (Honghua, 2 qian).
Cut into ten doses. Decoct in water. Take one dose on an empty stomach and one dose well after meals.
Jiawei Bawu Tang (Modified Eight Substances Decoction) Treats amenorrhea due to deficient-heat.
This is Si Jun Zi Tang combined with Si Wu Tang, plus Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Foeniculum Vulgare Fructus (Xiaohui), and Cyperi Rhizoma (Xiangfu). For abdominal pain, add Corydalis Rhizoma (Yanyhusuo), Aurantii Fructus Immaturus (Zhike), and Drynariae Rhizoma (Ganqi). For vomiting and nausea, add Alpiniae Officinarum Rhizoma (Liangjiang) and Amomi Fructus Rotundus (Sharen). For numbness in hands and feet with aversion to cold, add Cinnamomi Cortex (Rougui). For cough, add Armeniacae Semen Amarum (Xingren), Schisandrae Fructus (Wuweizi), and Farfarae Flos (Kuandonghua).
Guimo Poja Tang (Return End Breaking Masses Decoction) Treats menstrual obstruction in women with abdominal masses and pain.
Angelicae Sinensis Radix Caudex (Guiwei, wine-washed, 1 qian), Paeoniae Rubra Radix (Chishao, 1 qian), Paeoniae Radix Alba (Baishao, 1 qian), Citri Reticulatae Pericarpium Viride (Qingpi, 1 qian), Linderae Radix (Wuyao, 7 fen), Cyperi Rhizoma (Xiangfu, vinegar-stir-fried, 1.5 qian), Sparganii Rhizoma (Sanleng, 1 qian), Curcumae Rhizoma (Ezhu, vinegar-boiled, 1 qian), Cinnamomi Ramulus (Guangui, 5 fen), Sappan Lignum (Sumu, 5 fen), Carthami Flos (Honghua, 5 fen).
Cut into one dose. Decoct in water, add one cup of wine, and take on an empty stomach.
Xuejie San (Blood Red Powder) [Secret Formula] Treats blood masses in women causing pain, lower abdominal fullness, menstrual obstruction, fever, and fatigue.
Angelicae Sinensis Radix (Danggui, 8 fen), Cinnamomi Cortex (Guixin, 6 fen), Paeoniae Radix (Shaoyao, stir-fried, 6 fen), Corydalis Rhizoma (Yanyhusuo, stir-fried, 4 fen), Hematites (Xuejie, 6 fen), Sparganii Spora (Puhuang, stir-fried, 6 fen).
Grind into powder. Take 2 qian per dose, mixed with wine on an empty stomach.
Tongjing Wan (Unblocking Menstruation Pill) Treats menstrual obstruction and pain from blood clots.
Angelicae Sinensis Radix Caudex (Guiwei), Ziziphi Spinosae Semen (Zaoren, remove skin and tip), Rheum Palmatum Radix et Rhizoma (Dahuang, baked), Moutan Cortex (Danpi), Drynariae Rhizoma (Ganqi, stir-fried until smoke ceases), Cinnamomi Cortex (Rougui) (each 1 liang), Sparganii Rhizoma (Sanleng, 5 qian), Curcumae Rhizoma (Ezhu, vinegar-stir-fried), Achyranthis Bidentatae Radix (Niuxi) (each 1 liang), Moschus (Shexiang, 8 fen).
Grind into powder. Use Gleditsiae Sinensis Fructus (Sajiao, 5 qian) and Genkwa Flos (Yuanhua, 2 qian), boil in water to make a paste for pills, sized like sophora seeds. Take 50 pills per dose, washed down with rice soup.
Po Xue Jin Dan (Golden Pill for Breaking Blood) [Secret Formula] [Note: This formula treats amenorrhea with abdominal blood clots.] Treats menstrual obstruction in women with abdominal pain and masses.
Cyperi Rhizoma (Xiangfu, 10 liang, vinegar-prepared), Artemisiae Argyi Folium (Aiyi, 4 liang, baked dry), Angelicae Sinensis Radix (Danggui, 2 liang, soaked in wine overnight, boiled in vinegar, baked dry), Carthami Flos (Honghua, 1 liang, baked dry), Persicae Semen (Taoren, 1 liang, remove skin and tip).
Grind into powder, form pills using vinegar paste. Take 2 qian per dose, washed down with light vinegar soup, morning and evening each. Stop medication once menstruation flows.
Yi Zui Yin (One Drunken Drink) [Transmitted by Liu Tongchuan]
Root of Panax Notoginseng (Pan Tao Ke Gen - *Note: Text says 'Pan Tao Ke', likely referring to a specific root or typo for Sanqi/Panax, translated literally as Pan Tao Ke Root*), cut into a large dose. Decoct in two bowls of yellow wine until one bowl remains. Take hot on an empty stomach. Recovery is immediate if sweating reaches the feet.
Secret Formula for Unblocking Menstruation
Use ash-straw (Huitiao) from old ships, any amount. Burn red-hot with charcoal, quench in good liquor, remove, dry, and grind into powder. Take 3 qian per dose, mixed with good wine, on an empty stomach. For the second dose, use Carthami Flos (Honghua) wine. For the third dose, use Rheum Palmatum Radix et Rhizoma (Dahuang) wine. After three doses, bleeding should appear; effect is miraculous.
Yuanhua San (Genkwa Powder) [Secret Formula] Treats emaciated women with "ghost fetus," abdominal masses, and menstrual obstruction.
Genkwa Flos (Yuanhua) root, 3 liang, stir-fried until yellow, ground into powder. Take 1 qian per dose, mixed with decoction of Persicae Semen (Taoren). It will expel evil matter; effect is divine.
Wuji Wan (Pill of No Limit) [Note: This formula is specifically for treating amenorrhea.] Treats blood clots and Qi pain in women, including symptoms of crawling on bedsheets and bleeding from fingertips.
Brocade-patterned Rheum Palmatum Radix et Rhizoma (Jinwen Dahuang, 4 liang). Each liang is boiled seven times each in wine, vinegar, child's urine, and salt water, then sun-dried.
Combine all, steam, sun-dry, steam again, sun-dry again, repeating this process seven times, then grind into powder. Use Angelicae Sinensis Radix (Danggui) and Prepared Rehmanniae Radix (Shudi), each 1.5 liang, decoct strongly to obtain one bowl of juice, use to make pill paste, sized like sophora seeds. Whenever experiencing heart pain or Qi pain, stir-fry and grind Foeniculum Vulgare Fructus (Xiaohui), 7 fen, decoct in water, and take 30 pills with the soup. For those with masses, within one month, small blood particles will be expelled, eliminating the root cause and stopping pain. If menstruation still does not flow, take with Carthami Flos (Honghua) decoction.