月经之至如潮汐之往来，不愆其期，故谓之月经，亦谓之月信。以通阴阳，以行血气，以荣养于一身，盖血
气充满，阴阳和平则经候调而形体盛，旧血不去，新血不生也。若外亏卫气之充捍而邪客于表，内乏营血之灌溉
而邪着于里，邪之所凑，留而不去则血气暗伤，经候错乱，将行之际在表则身先疼痛，在里则小腹疼痛，或蓄热或
凝寒，寒者色必紫，热者色必鲜，血虚者色必淡，血瘀者多作块，然血为气配，随气而行，块血亦有气滞者，阴
从阳化也，至阳极似阴，紫黑亦有血热者，若挟水挟痰，经必异色。
寒凝紧盛，迟细虚寒，热结于血或洪或数，血少挟热弦数涩芤，水停沉细，滑必痰凝，风冷脉浮，沉则气滞。
经前腹痛，气血之滞。经后刺疼，血室之虚。
血热者，清之凉之，血瘀者，破之利之，寒者宜温宜散，虚者宜补宜培，痰凝搜涤，水停决壅，风宜疏风理血，
气宜调理肝脾。
痛经在表主以趁痛散，在里主以八物汤，血滞换赤芍，挟瘀加桃仁，血热加栀丹，血寒加姜桂，血虚四
物汤，肝郁逍遥散，肾虚地黄汤。
趁痛散
治经行恶寒身痛，脉浮细涩者。
附子（一两，炮） 防风（一两） 白芍（一两半，酒炒） 当归（二两） 虎骨（一两）
白芷（一两） 白术（一两半，炒） 茯苓（一两） 续断（一两） 本（一两） 甘草（五钱）
为散生姜三片，大枣三枚，煎服三钱。
营卫两虚，外邪留恋而内干冲任，故必恶寒身痛然后经行。附子扶阳以御外寒，白芍建中以实卫气，当归
养血以通冲脉，白芍敛阴以滋任脉，虎骨追风，续断续筋雄络， 本散太阳之邪，白芷散阳明之邪，防风散风于
表，甘草缓中于里，茯苓清治节，姜枣和营卫也。为散煎服，使外邪解散，则冲任调和而经行一如常度，何患恶
寒身痛之不除哉。
八物汤
治经行脐腹绞痛，脉弦涩者。
熟地（五钱） 当归（二钱） 白芍（一钱半，酒炒） 川芎（一钱） 槟榔（一钱） 木香（一钱）
延胡（一钱半，酒炒） 苦楝（一钱半，酒炒）
水煎去渣温服。
血亏气滞，挟湿热而内干冲任，故脐腹作痛，然后经行。熟地补血滋肾，当归养血荣肝，白芍敛阴以调冲
任，川芎活血以通血海，槟榔破滞气于三阴，木香调诸气于六腑，苦楝泻湿热，延胡行血滞。水煎温服，使血气调和，
则湿热自化而天癸自行，何脐腹绞痛之不除哉。
乌药汤
治经行气滞疼痛，脉沉涩者。
乌药（一钱） 香附（二钱，炒） 木香（一钱） 当归（二钱） 甘草（五分）
水煎去渣温服。
经气凝滞，经血涩少，不能输化于经，故满腹作痛，然后经行焉。乌药顺九天之气，香附行厥阴之经，木香
调中气，甘草缓中州，当归养血脉以濡润于经也。水煎温服，使滞化气行，则经络调和而经候如常，何气滞痛经
之不除哉。
姜黄散
治血冷血凝腹痛经愆脉紧涩者。
姜黄（一两） 白芍（一两，酒炒） 官桂（一两） 川芎（一两） 延胡（一两，酒炒） 丹皮（一两）
红花（六钱） 当归（二两） 蓬术（六钱）
为散，酒煮三钱温服。
血凝寒结于冲任而滞于胞门，故脐腹紧痛经候不调焉。姜黄散血气之滞，白芍敛阴血之耗，寒凝久则郁热生，
既用官桂以温经散寒，既需丹皮以凉血化热，川芎行血海以调经，延胡化血滞以通经，蓬术破气消坚，当归养经
荣脉，红花活血以行经水也。为散以散之，酒煮以行之，使凝寒顿散，则血结自消而脐腹紧痛无不退，月候愆期
无不调矣。
痛经琥珀散
治月经壅滞，心腹疼痛不可忍，脉牢者。
三棱（一两） 蓬术（一两） 寄奴（一两） 赤芍（一两） 地黄（一两） 丹皮（一两） 当归（二两）
蒲黄（一两） 官桂（一两） 菊花（一两）
棱赤蓬奴五物同黑豆一升，生姜片半 ，醋四升，煮豆烂，焙干入下五品为散，每服二、三钱，酒煮温下。
血气坚凝，月经壅滞，故经水来时先心腹疼痛不可忍焉。三
棱破气中之血，蓬术破血中之气，二味均破气破血为攻实削坚之剂，苟无实结不可轻试。蒲黄破瘀血以通经，赤
芍散血滞以泻火，熟地滋暗耗之阴，寄奴破逗留之血，当归养血脉以荣经，丹皮凉血热以散滞，官桂温经化气，
菊花散热凉肝，黑豆平补肾脏，生姜温散壅结也。醋以丸之，酒以行之，使血气壅滞顿散，则月经自无闭塞之患，
何经水来时先心腹疼痛之不可忍哉。
经验方
治脐腹疼痛，月经不调脉数者。
木通（一钱半） 赤芍（一钱半） 灵脂（一钱半）
醋一杯，酒三杯煎服。
心气不降，血积于肝，故小水不快而脐腹疼痛，月经不调焉。木通降心火以通利小便，赤芍泻肝火以行散
积血，灵脂乃浊秽之物， 能破血以降浊阴也。醋以收之，酒以行之，务使积血消散，则腹痛自除而溺窍通利，
小便无不快，月经无不调矣。
The arrival of menstruation is like the ebb and flow of tides, not deviating from its regular cycle; therefore it is called "Jingyue" (Menstruation) or also referred to as "Yuexin" (Monthly Trust). Its function is to connect Yin and Yang, circulate Blood and Qi, and nourish the entire body. Generally, when Blood and Qi are abundant and Yin and Yang are in harmony, the menstrual cycle will be regulated and the physical form vigorous; if old Blood does not depart, new Blood cannot be generated. If external Wei Qi (Defensive Qi) is deficient and unable to defend, pathogenic factors will lodge on the exterior; if internal Ying Blood (Nutritive Blood) is lacking and unable to irrigate, pathogenic factors will adhere to the interior. Wherever pathogenic factors gather and remain without departing, they secretly injure Blood and Qi, causing menstrual irregularities. At the time when menstruation is about to occur, if the pathology is at the exterior, pain precedes in the body; if the pathology is at the interior, pain occurs in the lower abdomen. There may be accumulation of Heat or congealing of Cold. In Cold patterns, the color must be purple; in Heat patterns, the color must be bright red; in Blood deficiency patterns, the color must be pale; in Blood stasis patterns, there are often clots. However, Blood requires the pairing of Qi and moves with Qi; even clotted Blood can be caused by Qi stagnation, which is the principle of Yin transforming according to Yang. When Yang reaches its extreme, it resembles Yin; purple-black color can also indicate Blood Heat. If accompanied by Water retention or Phlegm turbidity, the menstrual blood color will necessarily be abnormal.
Cold congealing presents with a tight and vigorous pulse; slow and fine pulses indicate Deficiency Cold; Heat binding in Blood presents with either surging or rapid pulses; Blood deficiency with Heat presents with wiry, rapid, choppy, or hollow pulses; Water retention presents with deep and fine pulses; a slippery pulse indicates Phlegm congealing; Wind-Cold presents with a floating pulse; a deep pulse indicates Qi stagnation. Abdominal pain before menstruation is due to Qi and Blood stagnation. Stabbing pain after menstruation is due to emptiness of the Blood Chamber (Uterus).
For Blood Heat, clear and cool; for Blood stasis, break and promote circulation; for Cold, warm and disperse; for Deficiency, tonify and cultivate; for Phlegm congealing, search and purge; for Water retention, resolve and unblock obstructions; for Wind, disperse Wind and regulate Blood; for Qi stagnation, regulate Liver and Spleen.
For dysmenorrhea located at the exterior, primarily use Chen Tong San (Catch Pain Powder); for those located at the interior, primarily use Ba Wu Tang (Eight Substance Decoction). For Blood stagnation, replace with Chi Shao (Red Peony Root); for accompanied stasis, add Tao Ren (Peach Seed); for Blood Heat, add Zhi Zi (Gardenia Fruit) and Mu Dan Pi (Moutan Bark); for Blood Cold, add Jiang (Dried Ginger) and Gui (Cinnamon Twig); for Blood Deficiency, use Si Wu Tang (Four Substance Decoction); for Liver Qi Stagnation, use Xiao Yao San (Free and Easy Wanderer Powder); for Kidney Deficiency, use Di Huang Tang (Rehmannia Decoction).
Chen Tong San (Catch Pain Powder)
Treats chills and body pain during menstruation with a floating, fine, and choppy pulse.
Fu Zi (Prepared Aconite Lateralis Radix), 1 liang, processed; Fang Feng (Saposhnikovia Root), 1 liang; Bai Shao (White Peony Root), 1.5 liang, stir-fried with wine; Dang Gui (Angelica Sinensis Radix), 2 liang; Hu Gu (Tiger Bone), 1 liang; Bai Zhi (Angelica Dahurica Root), 1 liang; Bai Zhu (Atractylodes Macrocephala Rhizome), 1.5 liang, stir-fried; Fu Ling (Poria), 1 liang; Xu Duan (Dipsacus Root), 1 liang; Ben Cao (Ligusticum Wallichii Rhizome), 1 liang; Gan Cao (Licorice Root), 5 qian.
Grind into powder. Take 3 qian per dose, decocted with 3 slices of fresh ginger and 3 jujubes.
When Ying and Wei are both deficient, external pathogens linger and internally disturb the Chong and Ren meridians, so menstruation only occurs after chills and body pain appear. Fu Zi supports Yang to resist external cold; Bai Shao establishes the middle to solidify Wei Qi; Dang Gui nourishes Blood to unblock the Chong Mai (Penetrating Vessel); Bai Shao astringes Yin to moisten the Ren Mai (Conception Vessel); Hu Gu pursues wind; Xu Duan reconnects sinews and strong collaterals; Ben Cao disperses pathogenic factors of the Taiyang channel; Bai Zhi disperses pathogenic factors of the Yangming channel; Fang Feng disperses wind at the exterior; Gan Gan moderates the middle at the interior; Fu Ling clears the governance mechanism (Lung); Ginger and Jujube harmonize Ying and Wei. Taken as a powder decoction, this causes external pathogens to dissipate, then Chong and Ren harmonize and menstruation proceeds normally. Why worry about the persistence of chills and body pain?
Ba Wu Tang (Eight Substance Decoction)
Treats colicky pain in the umbilical and abdominal region during menstruation with a wiry and choppy pulse.
Shu Di Huang (Prepared Rehmannia Root), 5 qian; Dang Gui (Angelica Sinensis Radix), 2 qian; Bai Shao (White Peony Root), 1.5 qian, stir-fried with wine; Chuan Xiong (Ligusticum Chuanxiong Rhizome), 1 qian; Bing Lang (Areca Seed), 1 qian; Mu Xiang (Aucklandia Root), 1 qian; Yan Hu Suo (Corydalis Rhizome), 1.5 qian, stir-fried with wine; Ku Lian Pi (Melia Cortex), 1.5 qian, stir-fried with wine.
Decoct in water, remove dregs, and take warm.
Blood deficiency and Qi stagnation, accompanied by Damp-Heat internally disturbing the Chong and Ren meridians, cause pain in the umbilical and abdominal region before menstruation begins. Shu Di Huang tonifies Blood and nourishes the Kidney; Dang Gui nourishes Blood and enriches the Liver; Bai Shao astringes Yin to regulate Chong and Ren; Chuan Xiong invigorates Blood to unblock the Blood Sea (Chong Mai); Bing Lang breaks stagnation in the Three Yin meridians; Mu Xiang regulates Qi in the Six Fu organs; Ku Lian Pi drains Damp-Heat; Yan Hu Suo moves Blood stagnation. Decocted in water and taken warm, this harmonizes Blood and Qi, causing Damp-Heat to transform naturally and Tian Gui (Menstrual Essence) to flow spontaneously. Why worry about the persistence of colicky pain in the umbilical and abdominal region?
Wu Yao Tang (Lindera Decoction)
Treats Qi stagnation pain during menstruation with a deep and choppy pulse.
Wu Yao (Lindera Root), 1 qian; Xiang Fu (Cyperus Rhizome), 2 qian, stir-fried; Mu Xiang (Aucklandia Root), 1 qian; Dang Gui (Angelica Sinensis Radix), 2 qian; Gan Cao (Licorice Root), 5 fen.
Decoct in water, remove dregs, and take warm.
Menstrual Qi is condensed and stagnant, menstrual Blood is scanty and sluggish, unable to transport and transform within the channels, causing fullness and pain in the abdomen before menstruation begins. Wu Yao follows the Qi of Heaven; Xiang Fu circulates through the Jueyin channel; Mu Xiang regulates Middle Qi; Gan Cao moderates the Central State; Dang Gui nourishes Blood vessels to moisten the channels. Decocted in water and taken warm, this resolves stagnation and promotes Qi movement, harmonizing the meridians and regulating the menstrual cycle. Why worry about the persistence of Qi stagnation dysmenorrhea?
Jiang Huang San (Turmeric Powder)
Treats abdominal pain due to Cold Blood and Blood congealing, irregular menstruation, with a tight and choppy pulse.
Jiang Huang (Curcuma Longa Rhizome), 1 liang; Bai Shao (White Peony Root), 1 liang, stir-fried with wine; Guan Gui (Cinnamon Twig), 1 liang; Chuan Xiong (Ligusticum Chuanxiong Rhizome), 1 liang; Yan Hu Suo (Corydalis Rhizome), 1 liang, stir-fried with wine; Mu Dan Pi (Moutan Bark), 1 liang; Hong Hua (Carthamus Flower), 6 qian; Dang Gui (Angelica Sinensis Radix), 2 liang; E Zhu (Curcuma Zedoaria Rhizome), 6 qian.
Grind into powder. Take 3 qian per dose, decocted with wine, take warm.
Blood congeals and Cold binds in the Chong and Ren meridians, stagnating in the Bao Men (Uterine Gate), causing tightness and pain in the umbilical/abdominal region and irregular menstruation. Jiang Huang dissipates Qi and Blood stagnation; Bai Shao astringes consumption of Yin Blood. Prolonged Cold congealing generates constrained Heat; since Guan Gui is used to warm channels and dispel Cold, Mu Dan Pi is needed to cool Blood and transform Heat. Chuan Xiong moves the Blood Sea to regulate menstruation; Yan Hu Suo transforms Blood stagnation to unblock menstruation; E Zhu breaks Qi and eliminates hardness; Dang Gui nourishes channels and enriches vessels; Hong Hua invigorates Blood to promote menstrual flow. Made into powder to dissipate, decocted with wine to promote, this causes sudden dissipation of Congealed Cold, so Blood knots naturally resolve and tightness/pain in the umbilical/abdominal region recedes, while delayed menstruation becomes regular.
Tong Jing Hu Po San (Dysmenorrhea Amber Powder)
Treats menstrual obstruction with unbearable heart and abdominal pain, with a firm pulse.
San Leng (Burreed Tuber), 1 liang; E Zhu (Curcuma Zedoaria Rhizome), 1 liang; Ji Nu (Lysimachia Herb), 1 liang; Chi Shao (Red Peony Root), 1 liang; Di Huang (Rehmannia Root), 1 liang; Mu Dan Pi (Moutan Bark), 1 liang; Dang Gui (Angelica Sinensis Radix), 2 liang; Pu Huang (Typha Pollen), 1 liang; Guan Gui (Cinnamon Twig), 1 liang; Ju Hua (Chrysanthemum Flower), 1 liang.
San Leng, Chi Shao, E Zhu, and Ji Nu are boiled together with one sheng of black beans, half a jin of fresh ginger slices, and four sheng of vinegar until the beans are soft. They are then dried and roasted, added to the remaining five substances, and ground into powder. Take 2-3 qian per dose, decocted with wine, take warm.
When Blood and Qi are hard and condensed, and menstruation is obstructed, unbearable heart and abdominal pain occurs before the menstrual flow starts. San Leng breaks Blood within Qi; E Zhu breaks Qi within Blood. These two are agents that break both Qi and Blood, used for attacking excess and reducing hardness; they should not be tried lightly without excess knots. Pu Huang breaks stasis to unblock menstruation; Chi Shao disperses Blood stagnation to drain Fire; Shu Di Huang nourishes Yin consumed secretly; Ji Nu breaks lingering Blood; Dang Gui nourishes Blood vessels to enrich channels; Mu Dan Pi cools Blood Heat to dissipate stagnation; Guan Gui warms channels and transforms Qi; Ju Hua dissipates heat and cools the Liver; Black beans peacefully tonify the Kidney; Fresh ginger warms and disperses obstructions. Vinegar is used to astringe, wine to promote. This causes sudden dissipation of Qi and Blood obstruction, so menstruation will naturally have no risk of blockage. Why worry about unbearable heart and abdominal pain before menstrual flow starts?
Experience Formula
Treats umbilical/abdominal pain, irregular menstruation with a rapid pulse.
Mu Tong (Akebia Stem), 1.5 qian; Chi Shao (Red Peony Root), 1.5 qian; Ling Zhi (Trogopterus Dung), 1.5 qian.
Decoct with one cup of vinegar and three cups of wine.
Heart Qi fails to descend, Blood accumulates in the Liver, causing difficult urination and umbilical/abdominal pain, leading to irregular menstruation. Mu Tong descends Heart Fire to promote free flow of urine; Chi Shao drains Liver Fire to move and scatter accumulated Blood; Ling Zhi is a turbid substance that can break Blood to descend Turbid Yin. Vinegar is used to astringe, wine to promote. Ensure accumulated Blood dissipates, then abdominal pain removes itself, the urinary orifice opens freely, urination becomes smooth, and menstruation becomes regular.