居经者,月事三月一至也。盖妇人之体血盛怀胎,胎孕之脉滑疾流利。《金匮》云∶寸
口卫
脉浮而大,荣反而弱(盖女子尺脉宜盛,今反见弱,是荣不足于下也。寸口卫脉浮大者,卫
气盛于上也)。浮大则气强,反弱则血少。孤阳独呼,阴不能吸,二气不停,卫强荣弱,阴
为积寒,阳为聚热,阳盛不润,经络不足,阴虚阳实,故令少血。时发洒淅,咽燥汗出,或
溲溺稠数,多唾涎沫,此令重虚。津漏液泄,故知非蓄血烦满,月禀一经,三月一来,阴盛
则泻,名曰居经。
按∶卫浮而大,右脉浮大也。荣反而弱,左脉反弱也。盖左脉主血,乃心肝肾部。右脉
主气
,乃肺脾肾部。妇人之身,气血调匀,脉来滑利,方能受孕。今荣血不足,卫气独强,是阴
衰阳旺之象,安得成胎?故虽月事不至三月,此居经之症,非孕也。宜养血调荣治之。
妇人经水将行,必泄泻三日,然后经行。其脉濡弱者,此脾虚也。脾属土属湿,经水将
动,
脾血先已流注血海,然后下流为经。脾血既亏,则虚而不能营运其湿,宜服参苓白术散(濡
弱二字足征脾虚,此脾气虚而非脾血虚也,用药当矣。而血亏不运之说欠妥)。
《产宝方》云∶经水者,行气血,通阴阳,以荣于身者也。气血盛,阴阳和,则形体通
泰。
或外亏卫气之充养,内乏荣气之灌溉,血气不足,故经候欲行,身体先痛(据此宜用十全大
补、八珍汤、人参养荣汤之类)。
按∶前症有属血虚者,有属血风者,有痰滞者,有血瘀者,所因不同。如《良方》云∶
妇人
血风,由气血不足,腠理不密,风冷乘之,以致邪正相搏,故骨节疼痛,肢体发热,口苦咽
干,此血风也。东垣云∶饮食失节,脾胃虚弱,乃血所生病,故口中津液不足。若火热来乘
土位,则肢体痛,皮肤发热,此血虚也。立斋治法∶肝经风热,用四物加羌、防、秦艽、黄
芩。肝
经血虚,逍遥散加熟地、川芎、丹皮。风湿兼痰,四物加星、半、羌活、苍术。风湿伤脾,
羌活胜湿汤。暑湿伤气,清燥汤。肝气郁脾,四君子加木香、枳壳、槟榔。瘀血流注,四物
加桃仁、红花。
Jujing (Resident Menses) refers to menstruation occurring once every three months. Generally, a woman's constitution requires abundant blood to conceive, and the pulse during pregnancy is slippery and rapid. *Jinkui Yaolue* states: The Wei pulse at Cun Kou is floating and large, while the Ying pulse is conversely weak (It is said that the Chi pulse in women should be vigorous; seeing it weak now indicates insufficient Ying blood below. A floating and large Wei pulse at Cun Kou indicates excessive Wei Qi above). Floating and large indicate strong Qi, while weakness indicates scanty Blood. Solitary Yang exhales alone, Yin cannot inhale; the two Qi do not interact harmoniously. With strong Wei and weak Ying, Yin becomes accumulated cold, and Yang becomes gathered heat. Excessive Yang fails to moisten, and the meridians are deficient. Yin deficiency with Yang excess leads to scanty blood. One may frequently experience chills, dry throat with sweating, or thick and frequent urination, along with excessive saliva and phlegm. This is termed double deficiency. As fluids leak and essence drains, it is known that this is not blood stasis causing fullness and vexation, but rather receiving one meridian cycle per month, arriving every three months. When Yin is excessive, discharge occurs, named Jujing.
Commentary: The floating and large Wei pulse refers to the right pulse being floating and large. The conversely weak Ying pulse refers to the left pulse being weak. Generally, the left pulse governs Blood, corresponding to the Heart, Liver, and Kidney regions. The right pulse governs Qi, corresponding to the Lung, Spleen, and Kidney regions. In women, when Qi and Blood are balanced and the pulse is slippery and smooth, conception can occur. Now, with insufficient Ying Blood and dominant Wei Qi, this is a sign of Yin decline and Yang flourishing; how can pregnancy be achieved? Therefore, although menstruation does not arrive until the third month, this is a symptom of Jujing, not pregnancy. Treatment should focus on nourishing Blood and regulating Ying.
When a woman's menses are about to begin, she must suffer from diarrhea for three days before menstruation starts. If the pulse is soggy and weak, this indicates Spleen Deficiency. The Spleen belongs to Earth and Dampness. When menstruation is about to move, Spleen Blood first flows into the Sea of Blood, then descends as menstrual flow. Once Spleen Blood is depleted, it becomes too weak to transport Dampness. It is appropriate to administer Shen Ling Bai Zhu San ("Soggy and weak" sufficiently proves Spleen Deficiency; this is Qi deficiency of the Spleen, not Blood deficiency, so the medication is correct. However, the theory that Blood deficiency fails to transport is questionable).
*Chanbao Fang* states: Menstruation circulates Qi and Blood, connects Yin and Yang, and nourishes the body. When Qi and Blood are abundant and Yin and Yang are harmonious, the body is smooth and healthy. If external Wei Qi lacks nourishment, or internal Ying Qi lacks irrigation, leading to insufficiency of Qi and Blood, then when menstruation is about to start, the body will ache first (Based on this, formulas such as Shiquan Dabu Tang, Bazhen Tang, or Renshen Yangrong Tang are suitable).
Commentary: The aforementioned symptoms may belong to Blood Deficiency, Blood Wind, Phlegm Stagnation, or Blood Stasis; the causes differ. As stated in *Liangfang*: Women's Blood Wind arises from insufficiency of Qi and Blood, loose interstices, and invasion by Wind-Cold, causing struggle between pathogenic and righteous factors, resulting in joint pain, limb fever, bitter taste in the mouth, and dry throat; this is Blood Wind. Dong Yuan stated: Irregular diet and weak Spleen-Stomach lead to diseases of the Blood, resulting in insufficient saliva in the mouth. If Fire-Heat attacks the Earth position, limb pain and skin fever occur; this is Blood Deficiency. Lizai's treatment methods: For Liver Meridian Wind-Heat, use Siwu Tang plus Qianghuo, Fangfeng, Qinjiao, and Huangqin. For Liver Meridian Blood Deficiency, use Xiaoyao San plus Shudi, Chuanxiong, and Mudanpi. For Wind-Dampness combined with Phlegm, use Siwu Tang plus Tian Nanxing, Banxia, Qianghuo, and Cangzhu. For Wind-Dampness injuring the Spleen, use Qianghuo Shengshi Tang. For Summerheat-Dampness injuring Qi, use Qingzao Tang. For Liver Qi stagnation injuring the Spleen, use Sijunzi Tang plus Muxiang, Zhike, and Binglang. For Blood Stasis flowing and accumulating, use Siwu Tang plus Taoren and Honghua.