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Ancient saying: "Better to treat ten men than one woman." Indeed, women's diseases are twice as numerous as men's, and involve more unspoken hidden conditions. Those residing in wealthy places further conceal their faces behind curtains and cover their arms with silk; thus, the physician finds it difficult to observe and listen (Wang Wen - inspection and auscultation/olfaction), and pulse diagnosis cannot be performed carefully. Consequently, gynecology is even more difficult to practice. In my youth, I devoted myself to civil service examinations and also studied deeply into Qihuang (Traditional Chinese Medicine). Due to repeated failures in exams, I turned to prescribing medicines for the world. Over decades, I investigated origins and details, collecting ancient sages' writings and contemporary discussions, compiling the book *Li Zheng Hui Can* (Comprehensive Reference on Dysentery). Having been praised by gentlemen from all directions and urged to print it, I now consider that women's diseases are hard to treat. Therefore, I have compiled important sayings of past philosophers that I collected daily, categorized them, and bound them into a volume titled *Nü Ke Qie Yao* (Essentials of Gynecology). Consulting with several like-minded friends, they agreed that the language was concise and clear. Once this book is published, practitioners can easily verify its efficacy, and even the most difficult cases will no longer be insurmountable. It should be passed down to posterity as a resource for universal relief. Thus, disregarding my own limitations, I reluctantly had it printed.

Written by Wu Daoyuan of Meixi during the Xiaoshu solar term of the Guisi year of Qianlong, aged seventy-five.

Amenorrhea is a disease of women, primarily because women take blood as their essence. If her meridians are harmonious and regular, responding to the tides of water channels, when old blood is exhausted, new blood regenerates, conforming to the waxing and waning of nature, then all meridians throughout the body will be fluid and smooth. What disease would there be? If amenorrhea occurs, new blood stagnates and does not flow, while old blood coagulates and accumulates day by day, giving rise to various ailments. Conditions such as Blood Bi (Blood Stasis Obstruction), Wind-Blood disorders, and Heat entering the Blood Chamber often originate here. However, investigating the cause of amenorrhea requires tracing the origin. For instance, drinking water due to thirst or eating raw/cold foods during menstruation, or bathing in cold water, allows cold qi to enter internally, causing blood to stagnate and leading to amenorrhea. Alternatively, damage to blood from abortions or multiple births, consumption of blood due to prolonged tidal fever, depletion of blood from chronic night sweats, or spleen-stomach disharmony with reduced diet failing to generate blood—all these can cause amenorrhea. In obese, fair-skinned women with amenorrhea, it is likely due to damp-phlegm and fatty membranes obstructing the pathways. It is appropriate to use Zhi Shi (Immature Bitter Orange) as the sovereign herb, assisted by Cang Zhu (Atractylodes Rhizome), Ban Xia (Pinellia Tuber), Xiang Fu (Cyperus Rhizome), Wu Yao (Lindera Root), Hou Po (Magnolia Bark), Niu Xi (Achyranthes Root), Tao Ren (Peach Seed), etc., so that damp-phlegm is removed and fatty membranes open, allowing menstruation to flow naturally. In dark, thin women with amenorrhea, it is due to blood deficiency and qi stagnation. Treatment should nourish blood and regulate qi, using Dang Gui Shen (Angelica Sinensis Root), Bai Shao (White Peony Root), Ren Shen (Ginseng Root), Guang Pi (Tangerine Peel), Xiang Fu, etc., as sovereign herbs. If caused by abortion/multiple births damaging blood or tidal fever consuming blood, blood-moving agents should not be used. Instead, Si Wu Tang (Four Substances Decoction) should be the main formula, assisted by Mu Xiang (Aucklandia Root), Xiang Fu, Hou Po, Gan Cao (Licorice Root), etc., to simultaneously regulate qi; over time, menstruation will naturally resume. For amenorrhea caused by sudden anger, treatment should resolve depression and invigorate blood, using Yu Jin (Curcuma Longa Rhizome) as sovereign, assisted by Guan Gui (Cinnamon Twig), Xiang Fu, Mu Xiang, Tao Ren, Niu Xi, etc., decocted in wine. For amenorrhea caused by eating raw/cold foods, Guan Gui is sovereign, assisted by Gan Jiang (Dried Ginger), Mu Xiang, Hou Po, Xiang Fu, Hong Hua (Safflower), Dang Gui Wei (Angelica Sinensis Tail), etc. For amenorrhea caused by sitting in cold water, Fu Zi (Aconite Lateral Root) is sovereign, assisted by Guan Gui, Mu Xiang, Shan Zha (Hawthorn Fruit), Tao Ren, Dang Gui, Gan Jiang, Chuan Xiong (Sichuan Lovage Rhizome), etc. For unmarried girls reaching puberty where Tian Gui (Menstrual Fluid) has not arrived but diet is normal, it is merely insufficient qi and blood, which is common; treating other miscellaneous illnesses first will allow menstruation to flow naturally when the time comes. Some older women who never menstruate but can still conceive are called An Jing (Hidden Menstruation). They experience lower back pain at the expected time, a point previously unmentioned by ancients. When menstrual blood fails to arrive at the expected time and flows upward causing hematemesis, it is called Dao Jing (Reverse Menstruation); treat with Dang Gui Da Huang Tang (Angelica and Rhubarb Decoction). For virgins whose menstruation started but stops again at the expected time, one must assess symptoms versus non-symptoms. If complexion is unchanged, diet is normal, and there is no internal heat, it is called Xie Jing (Intermittent Menstruation), not a disease, but simply blood insufficiency. If there is sallow complexion, emaciation, and internal heat, it is Tong Lao (Childhood Consumption); if the liver pulse is wiry and extends above the cun position onto the fish belly area, it is incurable by medicine alone. Urgently arranging marriage harmonizes yin and yang, allowing menstruation to resume and illness to depart; otherwise, eight or nine out of ten will die. Cases of qi and blood deficiency present with sallow complexion, emaciation, and slight fever; even if menstruation stops for years, medication can restore it, but harsh blood-breaking drugs like Meng Chong (Blowfly), Shan Jia (Pangolin Scales), San Leng (Burreed Tuber), and E Zhu (Curcuma Zedoaria Rhizome) must be avoided. Only blood-nourishing and generating herbs should be used, modifying Si Wu Tang or Gui Pi Tang. For widows and nuns with amenorrhea due to unfulfilled desires, the method should focus on resolving depression and regulating menstruation.

Generally, female amenorrhea results from qi disharmony leading to stagnant blood circulation. Therefore, regulating menstruation must prioritize regulating qi. There are also cases of empty-cold in the Sea of Blood with cold pain in the lower abdomen, suitable for Da Wen Jing Tang (Great Warming Menses Decoction). Cases of qi and blood deficiency presenting with tidal fever, heavy headache, limb fatigue, five-palm heat, palpitations, flushed face, dry mouth, mental exhaustion, sore back/waist, and night sweats are suitable for Dan Pi San (Moutan Powder). Cases of qi and blood stagnation with abdominal masses and heavy/sore waist/legs are suitable for Tong Jing Liu He Tang (Unblocking Menses Six-Harmonies Decoction) or Hong Hua Dang Gui San (Safflower and Angelica Powder) to dispel stasis and unblock meridians. Cases of stomach qi disharmony, appearing robust but with gradually decreasing appetite, indicate that stomach qi disharmony can also cause amenorrhea; Yi Gong San (Extraordinary Power Powder) or Xiao Yao San (Free and Easy Wanderer Powder) should be taken intermittently. One aims to digest food and strengthen the spleen to restore diet and primal qi; the other harmonizes qi and blood to allow menstruation to proceed naturally. For women with bone-steaming tidal fever, cough with phlegm, and amenorrhea, if the pulse is rapid (7-8 beats per breath) and flesh/bone are emaciated, it is a fatal condition requiring no medication. Generally, men and women share similar principles.

Si Wu Tang (Four Substances Decoction)
Shu Di Huang (Prepared Rehmannia Root) Dang Gui (Angelica Sinensis Root) Bai Shao (White Peony Root) Chuan Xiong (Sichuan Lovage Rhizome)
Decoct in water and take.

Gui Pi Tang (Restore the Spleen Decoction)
Ren Shen (Ginseng Root) Bai Zhu (Atractylodes Macrocephala Rhizome, stir-fried in soil) Suan Zao Ren (Ziziphus Seed) Fu Shen (Poria with Hostwood) Huang Qi (Astragalus Root, 1.5 qian) Dang Gui (Angelica Sinensis Root) Yuan Zhi (Polygala Root, 1 qian) Mu Xiang (Aucklandia Root) Zhi Gan Cao (Honey-fried Licorice Root, 0.5 qian) Sheng Jiang (Fresh Ginger) Da Zao (Jujube)
Decoct with ginger and jujube and take.

Da Wen Jing Tang (Great Warming Menses Decoction)
Lu Rong (Deer Antler Velvet) Xiang Fu (Cyperus Rhizome) Chen Xiang (Agarwood) Bai Zhu (Atractylodes Macrocephala Rhizome) Chen Pi (Tangerine Peel) Shu Di Huang (Prepared Rehmannia Root) Dang Gui (Angelica Sinensis Root) Bai Shao (White Peony Root) Chuan Xiong (Sichuan Lovage Rhizome) Wu Zhu Yu (Evodia Fruit) Xiao Hui Xiang (Fennel Fruit) Fu Ling (Poria) Yuan Hu Suo (Corydalis Rhizome)

Dan Pi San (Moutan Powder)
Dan Pi (Moutan Cortex) Rou Gui (Cinnamon Bark) Dang Gui Wei (Angelica Sinensis Tail) Yuan Hu Suo (Corydalis Rhizome) Niu Xi (Achyranthes Root) Chi Shao (Red Peony Root) San Leng (Burreed Tuber) E Zhu (Curcuma Zedoaria Rhizome)
Decoct in water and take.

Tong Jing Liu He Tang (Unblocking Menses Six-Harmonies Decoction)
Shu Di Huang (Prepared Rehmannia Root) Bai Shao (White Peony Root) Dang Gui (Angelica Sinensis Root) Chuan Xiong (Sichuan Lovage Rhizome) Ban Xia (Pinellia Tuber) Fu Ling (Poria) Yi Mu Cao (Leonurus Herb) Bei Mu (Fritillaria Bulb) Bai Zhu (Atractylodes Macrocephala Rhizome) Zhi Mu (Anemarrhena Rhizome) Ju Hong (Aged Tangerine Peel)
Decoct in water and take.

Hong Hua Dang Gui San (Safflower and Angelica Powder)
Dang Gui (Angelica Sinensis Root) Hong Hua (Safflower) Tao Ren (Peach Seed) Yuan Hu Suo (Corydalis Rhizome) Chuan Xiong (Sichuan Lovage Rhizome) Xiao Hui Xiang (Fennel Fruit) Yu Jin (Curcuma Longa Rhizome)
Decoct in water and take.

Ru Sheng San (Like-Saint Powder) Treats persistent metrorrhagia and metrostaxis.
Zong Hui (Charred Palm Fiber) Jiang Hui (Charred Dried Ginger) Wu Mei (Mume Fruit) (5 qian each)
Decoct in water and take.

Xiao Yao San (Free and Easy Wanderer Powder) Resolves depression and regulates menstruation.
Dang Gui (Angelica Sinensis Root) Bai Shao (White Peony Root) Fu Ling (Poria) Bai Zhu (Atractylodes Macrocephala Rhizome) Gan Cao (Licorice Root) Chai Hu (Bupleurum Root) Bo He (Mint) Dan Pi (Moutan Cortex) Shan Zhi (Gardenia Fruit)

Hua Qi Wan (Transform Qi Pill)

Generally, women have stubborn temperaments. To cure illness, one must first abandon impatience. Anger damages blood, while depression generates phlegm, leading to pain or strangury. Strangury has five types, transforming into five colors. To remain healthy, menstruation must be regular. The moon corresponds to heaven, water to earth; once a month, it arrives like the tide. Pregnancy and safe delivery require smooth regulation. If menstruation is irregular, check timing: early indicates heat, late indicates cold. Heat requires cooling, cold requires warming. Blood heat requires clearing, blood deficiency requires tonifying. If illness occurs during pregnancy, protect the fetus first, then treat the illness, avoiding later disasters. Regarding postpartum care, after delivery, remove lochia first, then tonify deficiency. Tonifying too early prevents expulsion of filth, causing nausea, asthma, diarrhea, and sweating—these are the Four Evils. Even Bian Que would find them hard to treat; seeing one Evil makes recovery difficult. Careful treatment may only save life. Ten months of pregnancy end in one moment of labor; let the melon fall when ripe, do not rush. Ignorant women and foolish old nurses may force delivery irrationally, causing distress. Listen to my advice: follow this correct path. The pregnant woman's pulse should be firm and strong; fine and slightly soggy pulses threaten life. The postpartum pulse should be deep, slow, fine, and small; if surging and large, the condition will collapse. Defeated blood rushing to the heart causes confused speech, laughing, singing, or chanting Buddha names; phlegm invading the Pericardium presents similarly. Defeated blood attacking the heart causes persistent vexation; Long Chi (Dragon Tooth), Ren Shen, and Dang Gui in Shi Shen Tang (Ten-God Decoction) are effective. Phlegm invading the Pericardium causes coma with awareness; adding Huang Qin and Huang Lian to Dao Tan Tang (Phlegm-Guiding Decoction) is better. If complicated by other diseases, guard against wind-cold; avoid fried/greasy foods. If illness becomes critical, explain the difficulty. Medicine is a benevolent art; carefully examine the disease source. Zi Xuan (Fetal Distension), Zi Mao (Fetal Protrusion), Zi Fan (Fetal Vexation), Zi Xian (Fetal Convulsion) each have specific treatments. If menstruation continues during pregnancy, it is due to excess blood, called Tai Lou (Fetal Leakage). Generate depression, warm blood, tonify qi, and eliminate accumulation. If primal qi is deficient, adopt a conservative approach. For weakness with spontaneous sweating and bone-steaming, use Ren Shen, Hu, and Lian; treat according to circumstances. Divine miracles arise from careful understanding; application is always effective.