各三钱，以猪蹄汤煎服。薛立斋曰∶凡妇人气血方盛，乳房作胀，或无儿饮，痛胀寒热，用麦芽二三两炒熟，水煎服之
立消。其耗散血气如此，何脾胃虚弱、饮食不消方中多用之？一云麦芽最消肾。若气血虚而乳汁自出者，宜十全大补汤。
门人问曰∶此书调经、种子、胎前三篇，引经外又参以时法，或附以新论，可谓宜古宜今，贤愚皆可共晓。而产后
一篇， 杂病一篇，全录《金匮》原文，衬以小注而串讲之，诸家杂说，姑附于后，不加一字论断。一书体例，如出两手，
何欤？
曰∶群言淆乱衷于圣。仲景后无书可读，而妇人产后，各家各逞臆说，互相议论。余所以止录《金匮》全文，如日
月一出，爝火无光。至于杂病，原与男子无异，而各家竟与男子各病外，强分出病名，转觉多事。然亦有与男子必须分
别者，《金匮》第二十二篇中，已具大要；而第八节更为纲举目张，无复剩义。其文深奥难读，余逐节衬以小注，一目了
然，则难读而易读矣。其不以新论新案赘之者，恐添蛇足也。且夫学问之道无止境也，前此不过为语下之计，今既读过
三篇，从此日新而月异，可以语上，微夫人吾谁与归？
《金匮》云∶妇人中风，七八日（业已热退而身凉，而复）续来寒热，发作有（一定之）时，（因其病而问其）经水
（已来而）适断（者，盖以经水断于内，而寒热发于外，虽与经适来者不同，而）此症（亦名）为热入血窒，其血（为
邪所阻而）必结，（结于冲、任、厥阴之经脉，内未入脏，外不在表，而在表里之间，乃属少阳。）故使（寒热往来）如
疟状，发作有（定）时，（以）小柴胡汤主之。（达经脉之结，仍借少阳之枢以转之，俾气行而血亦不结矣。）
此为中风热入血室经水适断者，出其方治也。盖以邪既流连于血室，而亦浸淫于经络，若但攻其血，血虽去而邪必
不尽，且恐血去，邪反得乘虚而入也。故以小柴胡汤解其热邪，而乍结之血自行矣。
（热入血室，不独中风有之，而伤寒亦然。）妇人伤寒（寒郁而）发热，（当其时）经水适来，（过多不止，血室空虚，
则热邪遂乘虚而入之也。昼为阳而主气，暮为阴而主血。今主气之阳无病，昼日明了，主血之阴受邪，故）暮则谵语，
（谵语皆非习见之事，）如见鬼状者，（医者可于其经之适来，而定其症。曰∶）此为热入血室，（非阳明胃实所致也，既
非
阳明胃实，则）治之（者）无（以下药）犯（其）胃气（以）及上二焦，（一曰胃脘之阳，不可以吐伤之；一曰胃中之汁，
不可以汗伤之；惟俟其经水尽，则血室之血，复生于胃腑水谷之精。）必自愈。此为伤寒热入血室、经水适来者，详其症
治也。师不出方，盖以热虽入而血未结，其邪必将自解，汗之不可，下之不可，无方治之，深于治也。郭白云谓其仍与
小柴胡汤，或谓宜刺期门，犹是浅一层议论。
妇人中风，发热恶寒，（当表邪方盛之际，）经水适来，（盖经水乃冲任厥阴之所主，而冲任厥阴之血，又皆取资于阳
明。今）得（病）之（期过）七（日，而至）八日，（正值阳明主气之期。病邪乘虚而入，邪入于里，则外）热除，（其）
脉迟，身凉和，（已离表症。惟冲任厥阴俱循胸胁之间，故）胸胁满，（但满不痛，与大结胸之不按自痛，小结胸之按而
始痛分别。究其满甚亦）如结胸（之）状，（而且热与血搏，神明内乱，而作）谵语者，此为热入血室也，（治者握要而
图，）当刺（肝募之）期门，随其实而取之。（何以谓之实邪？盛则实也。）此承本篇第一节，而言中风热入血室之症治也。
但第一节言寒热已除而续来，此言寒热方盛而并发；前言经水已来而适断，此言方病经水之适来；前言血结而如疟，此
言胸胁满如结胸；前无谵语，而此有谵语；以此为别。
（然亦有不在经水适来，与肝膜而为热入血室者，不可不知。）阳明病下血谵语者，此为热入血室，（其症通身无汗。）
但头上汗出，当刺期门，随其实而泻之，（令通身） 然汗出者愈。此言阳明病，亦有热入血室者，不必拘经水之来与断
也。但其症下血、头汗出之独异也。盖阳明之热，从气而入血，袭入胞宫，即下血而谵语，不必乘经水之来，而后热邪
得以入之。彼为血去，而热乘其虚而后入；此为热入，而血有所迫而自下也。然既入血室，则不以阳明为主，而以冲任
厥阴之气不通，故一身无汗；郁而求通，遂于其腑之少阳而达之，故头上汗出。治法亦当刺期门，以泻其实，刺已周身
然汗出，则阴之闭者亦通，故愈。
妇人咽中（帖帖然）如有炙脔，（吐之不出，吞之不下，俗谓之梅核病。多得于七情郁气，痰凝气阻。以）半夏浓朴
汤主之。此为痰气阻塞咽中者，出其方治也。徐忠可云∶余治任小乙，咽中每噎塞，咳嗽不出，余以半夏浓朴汤投之即
愈。后每复发。细问之，云∶夜中灯下，每见晕如团五色，背脊内间酸。其人又壮盛。知其初因受寒，阴气不足，而肝
反郁热，甚则结寒微动，挟肾气上冲。咽喉塞噎也。即于此方加大剂枸杞、菊花、丹皮、肉桂，晕乃渐除，而咽中亦愈。
故曰∶男子间有之，信不诬也。
妇人脏燥，（脏属阴，阴虚而火乘之则为燥，不必拘于何脏，而既已成燥，则病症皆同。但见其）悲伤欲哭，象如神
灵所作，（现出心病。又见其）数欠（善）伸，（现出肾病，所以然者，五志生火，动必关心，阴脏既伤，穷必及肾是也。
以）甘麦大枣汤主之。此为妇人脏燥而出其方治也。麦者，肝之谷也。其色赤，得火色而入心；其气寒，乘水气而入肾；
其味甘，具土味而归脾胃；又合之甘草、大枣之甘，妙能联上、下、水、火之气，而交会于中土也。
妇人吐涎沫，上焦有寒饮也。医（者不与温散，而）反下之，（则寒内入，而）心下即痞，当先治其吐涎沫，（以）
小青龙汤主之；（俾外寒内饮除，而）涎沫（可）止，（涎沫止后，）乃治（其）痞，（亦如伤寒表解，乃可攻里之例也。）
泻心汤主之。此为吐涎沫与痞兼见，而出先后之方治也。
妇人之病，（所以异于男子者，以其有月经也。其因月经而致病者，则有三大纲∶曰）因虚，（曰）积冷，（曰）结气。
（三者，或单病，或兼症，或互病，或相因而为病，或偏胜而为病。病则）为诸经水断绝，（此妇人之病根也。其曰“诸”
者奈何？以经水有多少迟速，及逢期则病，与大崩漏难产之后不来等症，皆可以此例之。无论病之初发，以）至（病）
有历年，（大抵气不足则生寒，气寒则）血（亦）寒（由是冷浸不去，而为）积（气，着而为不行）结，胞门（为）寒（所）
伤，由外而入内，由内而达外。渐至）经络凝坚。（经水之源头受伤，则病变无穷矣。然又有上中下之分。其病）在上（肺
胃受之。若客寒而伤近于胃口，则为）呕吐涎唾，（或寒）久（变热，热盛伤肺，则）成肺痈，（其）形体（之受）损（则
一，而为寒为热，俨若两人之）分。（病若）在中（肝脾受之，邪气从中）盘结，（或为）绕脐寒疝；或（为）两胁疼痛，
与（胞宫之）脏相连；（此寒之为病也。）或（邪气郁）结（为）热中，（热郁与本寒相持），痛在关元，脉（现出）数（热，
而身）无（溃烂与疼痒等）疮，（其）肌（肤干燥，状）若鱼鳞，（遇逢交合）时着男子，非止女身。（此热之为病也。所
以然者，何义？盖以中者，阴阳之交也。虽胞门为寒伤则一，而中气素寒者，以寒召寒，所谓邪从寒化是也，中气素热
者，寒旋变热，所谓邪从热化是也，病若）在下（肾脏受之也。）穷（而归肾，症却）未多，经候不匀，令阴（中）掣痛，
少腹恶寒；或上引腰脊，下根气冲，气冲急痛，膝胫疼烦。（盖以肾脉为阴之部，而冲脉与少阴之大络，并起于肾故也。
甚则）奄忽眩冒，状如厥癫；（所谓阴病者，下行极而上也。）或有忧惨，悲伤多嗔∶（所谓病在阴，则多怒及悲愁不乐也。
总而言之曰∶）此皆带下，非有鬼神。（言病在带脉之下为阴，非后人以不可见之鬼神为阴也。）久则（肌肉削而）羸瘦，
（气不足而）脉虚多寒；（统计十二症、九痛、七害、五伤、三痼之）三十六病，千变万端；审脉阴阳，虚实紧弦；行其
针药，治危得安；其病虽同，脉各异源；（导其所异之处，即为探源。）子当辨记，勿谓不然。
此言妇人诸病，所以异于男子者，全从经起也。病变不一，因人禀有阴阳、体有强弱、时有久暂而分。起处以三大
纲总冒；通节中又分出上、中、下，以尽病变；后以“此皆带下”四字，总结本节之意。至于言脉，百病皆不外阴、阳、
虚、实四个字。而又以弦紧为言者，盖经阻之始，大概属寒，即有热症，亦由寒之所变。气急则为弦，寒甚则为紧，示
人以二脉为主，而参之兼脉则得耳。
徐灵胎云∶古人名妇科谓之带下医，以其病总属于带下也。凡治妇人，必先明冲任之脉。冲脉起于气街，（在毛际两
旁。）并少阴之脉，挟挤上行至胸中而散。任脉起于中极之下，（脐下四寸。）以上毛际，循腹里，上关元。又云∶冲任脉
皆起于胞中，上循背里，为经脉之海，此皆血之所从生，而胎之所由系，而带脉为之总束也。学人能明乎带脉之病，则
本源洞悉；虽所主之病，千条万绪，可以知其所从起；更合参古人所用之方，而神明变化之，自不至于浮泛不切之弊矣。
问曰∶妇人年五十所，（七七之期已过，天癸当竭，地道不通。今）病（前阴血，）下利数十日不止，暮即发热，少
腹里急，腹满，手掌烦热，唇口干燥，何也？师曰∶（前言妇人三十六病，皆病在带脉之下。）此病属带下。何以故？曾
经半产，瘀血在少腹不去。何以知之？（盖以瘀血不去，则新血不生，津液不布。）其证唇口干燥，故知之。（况暮热、
掌心热俱属阴，任主胞胎，冲为血海，二脉皆起于胞宫，而出于会阴，正当少腹部分，冲脉挟脐上行，冲任脉虚，则少
腹里急。有干血亦令腹满，其为宿瘀之症无疑。）当以温经汤主之。此承上节，言历年血寒积结胞门之重症，而出其方治
也。尤在泾曰∶妇人年五十所，天癸已断，而病下利，似非因经所致矣。不知少腹旧有积血，欲行而未得递行，欲止而
不能竟止，于是下利窘急，至数十日不止。暮即发热者，血结在阴，阳气至暮不得入于阴，而反浮于外也。少腹里急腹
满者，血积不行，亦阴寒在下也。手掌发热，病在阴，掌心亦阴也。唇口干燥，血内瘀者不外荣也。此为瘀血作利，不
必治利，但治其瘀而利自止矣。吴萸、桂枝、丹皮，入血散寒而行其瘀；芎、归、芍药、麦冬、阿胶以生新血；人参、
甘草、姜、夏以正脾气。盖瘀久者，荣必衰；下多者，脾必伤也。
（妇人因经致病，凡三十六种，皆谓之）带下，经水（因寒而瘀）不（能如期而）利，（以致）小腹满痛，（然既瘀
而不行，则前经未畅，所行不及，待后月之正期而先至，故其）经一月再见者，以土瓜根散主之。此为带下而经候不匀、
一月再见者，出其方治也。按∶土瓜即王瓜也，主驱热行瘀，佐以 虫蠕动逐血，桂、芍之调和阴阳，为有制之节。
寸口脉（轻按）弦而（重按）大，弦则为（阳微而递）减，大则为（外盛而中）芤；减则（阳不自振，）为（诸）寒，
芤则（阴不守中，）为（中）虚；寒虚相搏，此名曰革。（革脉不易明，以弦减芤虚形容之，则不易明者明矣。凡）妇人
（妊娠及行经，必阴阳相维，而后为无病。今见此脉，）则（不能安胎而）半产（不能调经而）漏下，（以）旋复花汤主
之。此为虚寒而半产漏下者，出其方治也。但此方与虚寒之旨不合，或者病源在肝，肝以阴脏，而舍少阳之气，以生化
为事，以流行为用；是以虚不可补，解其郁聚即所以补；寒不可温，行其气血即所以温欤！钱氏谓必是错简，半产、漏
下，气已下陷，焉有用旋复花以下气之理？二说俱存候商。
妇人陷经，（其血）漏下（不止，其血色）黑（亦）不解，（是瘀血不去，新血不生，荣气腐败。然气喜温而恶寒，
以）胶姜汤主之。此为陷经而色黑者，出其方治也。方未见。林亿云∶想是胶艾汤。《千金》胶艾汤有干姜，似可取用。
丹溪谓∶经淡为水，紫为热，黑为热极，彼言其变，此言其常也。
妇人少腹满如敦状，（盖少腹，胞之室也。胞为血海，有满大之象，是血蓄也。若）小便微难而不渴，（可知其水亦
蓄也。若病作于）生（产之）后者，此为水与血俱结在血室也，（宜用水血并攻之法以治，）大黄甘遂汤主之。此为水血
并结在血室，而为少腹满、大小便难、口不渴者，出其方治也。
妇人经水（久闭不至者，有虚实寒热之可□也。又有行而不畅者，如一月再见之可征也。若少腹结痛，大便黑，小
便利，明知血欲行而）不（肯）利下，（不得以寻常行血导气、调和营卫、补养冲任之法，迂阔不效，径以）抵当汤主之。
Each at three qian, decocted and taken with pig's trotter soup. Xue Lizhai said: Whenever a woman's qi and blood are flourishing, causing breast distension and pain, or if there is no infant to suckle, resulting in pain, distension, aversion to cold, and fever, use two to three liang of malt (Mai Ya), stir-fried until cooked, decocted in water and taken; the symptoms will disappear instantly. The extent to which malt dissipates qi and blood is so great; why is it used in large quantities in formulas for spleen and stomach weakness and indigestion? One theory holds that malt most depletes kidney qi. For cases where milk flows spontaneously due to qi and blood deficiency, Shiquan Dabu Tang (Complete Ten Tonics Decoction) is appropriate.
A disciple asked: In the chapters on regulating menstruation, promoting conception, and prenatal care, this book cites classics but also incorporates seasonal methods, and some attach new theories. It can be said to be suitable for both ancient and modern times, understandable by both the wise and the foolish. However, the chapters on postpartum conditions and miscellaneous diseases completely record the original text of *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), adding only small annotations for explanation, while attaching various schools' miscellaneous comments at the end without adding a single word of judgment. The style of one book seems to come from two different hands; why is this?
The response was: When voices are confused, one should center on the Sage. After Zhang Zhongjing, there were no more books to read, and regarding women's postpartum conditions, each school indulged in subjective speculation, arguing with one another. Therefore, I only recorded the full text of *Jingui Yaolue*, like the sun and moon rising, rendering small fires powerless. As for miscellaneous diseases, they are originally no different from men's, yet each school forcibly distinguished disease names beyond those of men, which seemed superfluous. However, there are situations that must be distinguished from men's; the main outlines are already contained in Chapter 22 of *Jingui Yaolue*; and Section 8 is particularly comprehensive and clear, leaving no redundant meaning. The text is profound and difficult to read; I added small annotations section by section so that everything becomes clear at a glance, making the difficult easy. I did not add new theories or cases because I feared adding legs to a snake (superfluous detail). Moreover, the path of learning has no end. Previously, it was merely a plan for beginners; now that you have read these three chapters, day by day and month by month renewing yourself, you can discuss higher principles. If not for such people, who would I follow?
*Jingui Yaolue* states: A woman suffering from Wind-Strike (Zhongfeng) for seven or eight days (having already had her fever subside and body cool down, but then) continues to experience alternating chills and fever, occurring at (fixed) intervals. (Inquiring about her condition,) if her menstrual flow (has arrived and) just stopped (it is because the menses stopped internally, while chills and fever manifest externally; although different from cases where menses arrive during illness, this) syndrome (is also named) Heat Entering the Blood Chamber (Re Ru Xu Shi). The blood (blocked by pathogenic factors) must coagulate, (coagulating in the Chong, Ren, and Jueyin meridians; internally not entering the Zang organs, externally not on the exterior, but between interior and exterior, belonging to Shaoyang.) Thus causing (alternating chills and fever) resembling malaria, occurring at (fixed) times, treated primarily with Xiaochaihu Tang (Minor Bupleurum Decoction). (This unblocks the meridian coagulation, still borrowing the pivot of Shaoyang to rotate it, allowing qi to move so blood does not coagulate.) This provides the prescription for Wind-Strike with Heat Entering the Blood Chamber where menses just stopped. Generally, since the pathogen lingers in the Blood Chamber and infiltrates the meridians, if one only attacks the blood, although the blood may be removed, the pathogen will not be fully eliminated, and one might fear that after blood loss, the pathogen enters due to deficiency. Thus, Xiaochaihu Tang resolves the heat pathogen, and the newly coagulated blood moves freely.
(Heat Entering the Blood Chamber occurs not only in Wind-Strike but also in Cold Damage/Shanghan.) When a woman suffers from Cold Damage (cold constraint causing) fever, (at that time) her menses just arrived, (flowing excessively and not stopping, leaving the Blood Chamber empty, so the heat pathogen enters due to deficiency. Day is Yang governing Qi, night is Yin governing Blood. Now the Yang governing Qi is unaffected, so she is lucid during the day; the Yin governing Blood is affected, so) at dusk she experiences delirium (Zhenyu), (delirium is not a common occurrence,) appearing as if seeing ghosts. (The physician can determine the syndrome based on the timing of her menses. Saying:) This is Heat Entering the Blood Chamber, (not caused by Yangming Stomach Excess. Since it is not Yangming Stomach Excess, then) treatment (should not) use (purging drugs) to damage (her) Stomach Qi (and the Upper and Middle Jiao). One refers to the Yang of the Stomach epigastrium, which cannot be injured by vomiting; the other refers to the fluids in the Stomach, which cannot be injured by sweating. Only wait until the menses end, then the blood in the Blood Chamber will regenerate from the essence of water and grain in the Stomach.) It will heal itself. This details the syndrome and treatment for Cold Damage with Heat Entering the Blood Chamber where menses just arrived. The Master did not provide a formula, likely because although heat entered, blood had not coagulated, and the pathogen would resolve itself; neither sweating nor purging is applicable. Not providing a fixed formula demonstrates profound therapeutic skill. Guo Baiyun suggested using Xiaochaihu Tang again, or others suggested needling Qimen (LR14); these are shallow discussions.
When a woman suffers from Wind-Strike with fever and aversion to cold, (while the exterior pathogen is flourishing,) her menses just arrived. (Menses are governed by the Chong, Ren, and Jueyin meridians, whose blood relies on the Yangming Stomach. Now,) having had the (illness for over) seven (days, reaching) eight days, (which coincides with the period when Yangming governs Qi. The pathogen enters due to deficiency; entering the interior, the exterior) heat disappears, (the) pulse is slow, and the body is cool and harmonious, (indicating departure from exterior syndrome. However, since Chong, Ren, and Jueyin all traverse the chest and hypochondrium,) there is fullness in the chest and hypochondrium, (fullness without pain, distinct from Da Jie Xiong where pain occurs without pressing, and Xiao Jie Xiong where pain occurs only upon pressing. Ultimately, severe fullness also) resembles the state of Jie Xiong, (and because heat and blood contend, disturbing the Spirit internally, producing) delirium; this is Heat Entering the Blood Chamber. (The practitioner should grasp the key and act accordingly,) needling the (Liver Mu point) Qimen (LR14), draining according to its excess nature. (Why call it excess? Fullness constitutes excess.) This follows Section 1 of this chapter, discussing the syndrome and treatment of Wind-Strike with Heat Entering the Blood Chamber. But Section 1 describes chills and fever having subsided before recurring; here, chills and fever are flourishing concurrently; the previous text mentions menses arriving and then stopping; here, menses arrive exactly when the illness begins; the previous text mentions blood coagulation resembling malaria; here, chest/hypochondrium fullness resembles Jie Xiong; the previous text has no delirium, while this has delirium; these serve as distinctions.
(However, there are cases not occurring during menses arrival, involving the Liver capsule as Heat Entering the Blood Chamber, which must be known.) In Yangming disease, bleeding and delirium indicate Heat Entering the Blood Chamber, (with the symptom of no sweat on the whole body.) Only sweat on the head; one should needle Qimen, draining the excess, (leading to slight sweating over the whole body) for recovery. This states that Yangming disease can also involve Heat Entering the Blood Chamber, not limited to menses arrival or cessation. The unique symptoms are lower bleeding and head sweating. Generally, Yangming heat enters the blood from the Qi level, invading the Uterus, causing bleeding and delirium, without needing to wait for menses for the heat pathogen to enter. In the former case, heat enters after blood loss creates deficiency; in this case, heat enters, forcing blood to descend. However, once in the Blood Chamber, it is no longer dominated by Yangming but by the obstruction of Qi in Chong, Ren, and Jueyin, causing no sweat on the body; seeking release from stagnation, it reaches via the Fu organ associated with Shaoyang, hence head sweating. Treatment should also needle Qimen to drain excess; after needling, slight whole-body sweating indicates the closure of Yin has opened, leading to recovery.
When a woman feels as if there is a roasted meat slice stuck in her throat, (cannot spit it out, cannot swallow it down, commonly known as Plum Pit Qi/Meihe Bing. Often caused by emotional stagnation, phlegm condensation, and Qi obstruction,) treat with Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction). This provides the prescription for Phlegm-Qi obstruction in the throat. Xu Zhongke said: I treated Ren Xiaoyi, who frequently felt blocked in the throat with coughing unable to expel phlegm. I administered Banxia Houpo Tang, and he recovered. Later, it recurred repeatedly. Upon detailed inquiry, he said: Under lamplight at night, he often saw halos like colored balls, and felt soreness inside the spine. He was robust. I knew his initial cause was cold contraction, insufficient Yin Qi, causing Liver depression-heat; severely, constrained cold moved slightly, carrying Kidney Qi upward. Throat blockage ensued. I added large doses of Gouqi (Lycium Fruit), Juhua (Chrysanthemum), Danpi (Moutan Cortex), and Rougui (Cinnamon Bark) to this formula. The halos gradually disappeared, and the throat healed. Thus, it is true that men occasionally suffer from this.
For Women's Zang Dryness (Zang belongs to Yin; Yin deficiency allows Fire to invade, causing dryness. One need not fixate on which Zang; once dryness forms, symptoms are similar. Seeing only that she) feels sad and wants to cry, acting as if possessed by spirits, (manifesting Heart pathology. Also seeing frequent yawning and stretching,) treat with Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction). This provides the prescription for Women's Zang Dryness. Wheat is the grain of the Liver. Its red color corresponds to Fire and enters the Heart; its cold nature corresponds to Water and enters the Kidney; its sweet taste corresponds to Earth and returns to the Spleen and Stomach; combined with the sweetness of Licorice and Jujube, it excellently connects Upper and Lower, Water and Fire Qi, meeting in the Central Earth.
When a woman vomits saliva and froth, it indicates Cold-Fluid in the Upper Jiao. The physician (instead of warming and dispersing,) wrongly used purgatives, (causing Cold to enter internally, resulting in immediate Epigastric Oppression/Pi Syndrome. One should first treat the vomiting of saliva/froth,) using Xiaolongdan Tang (Minor Dragon Decoction); (once exterior Cold and internal Fluid are removed, and) saliva/froth (stops,) then treat (the) Pi Syndrome, (similar to the principle in Cold Damage that one attacks the interior only after the exterior is resolved.) using Xiexin Tang (Drain the Epigastrium Decoction). This provides sequential prescriptions for simultaneous Vomiting Saliva/Froth and Pi Syndrome.
Women's diseases (differ from men's because of menstruation. Those caused by menstruation fall into three main categories: Deficiency,) Accumulated Cold, (and Stagnant Qi.) (These three may occur singly, as combined symptoms, mutually interacting, sequentially causing disease, or dominating to cause disease. Disease results in) cessation of all menstrual flows, (this is the root of women's disease. Why "all"? Because menstrual flow varies in amount and speed, and illness occurring during the cycle, or amenorrhea after heavy bleeding or difficult labor, can all be categorized thus. Whether from initial onset) to (illness lasting) years, (generally, Qi insufficiency generates Cold; Qi Cold causes) Blood (to become) Cold (so Cold steeps and remains, forming) Accumulation (Qi, adhering and becoming stagnant). The Bao Men (Uterine Gate) is injured by (Cold), moving from exterior to interior, and interior to exterior. Gradually,) meridians become congealed and firm. (The source of menstrual flow is injured, leading to infinite variations in pathology. However, there are Upper, Middle, and Lower distinctions. Pathology in the) Upper affects Lung and Stomach. If external Cold injures near the stomach opening, it causes) vomiting of saliva/froth, (or Cold transforms into Heat over time; excessive Heat damages the Lung, forming Lung Abscess, damaging the) physical form equally, whether Cold or Heat, appearing as if two different people. (Pathology in the) Middle affects Liver and Spleen; pathogens knot in the middle, (possibly causing) peri-umbilical Cold Hernia; or (causing) bilateral hypochondriac pain, connected to the (Uterus/Zang); (this is Cold pathology.) Or (pathogens stagnate and transform into) Internal Heat, (Heat stagnation contends with original Cold,) pain at Guanyuan (CV4), pulse (shows) rapidity (Heat, while the body has no ulcers or itching) sores, (skin) dry like fish scales, (during intercourse) affecting the man, not just the woman. (This is Heat pathology. Why? Because the Middle is the intersection of Yin and Yang. Although Bao Men is injured by Cold equally, if Middle Qi is inherently Cold, Cold attracts Cold, termed Pathogen transforming from Cold; if Middle Qi is inherently Hot, Cold quickly transforms to Heat, termed Pathogen transforming from Heat. Pathology in the) Lower affects the Kidney. (Extremity) returns to Kidney; symptoms are few, menstrual cycles irregular, causing Yin (internal) pulling pain, aversion to cold in the lower abdomen; or pain radiating up to the waist and spine, down to Qichong (ST30), sudden pain in Qichong, painful annoyance in knees and shins. (Because the Kidney meridian is the region of Yin, and the Chong Meridian and the Great Collateral of Shaoyin Kidney both originate from the Kidney. Severely,) sudden dizziness and vertigo, resembling syncope or epilepsy; (as stated, Yin pathology descends to the extreme and rises.) There may be sorrow and gloom, sadness and frequent anger: (As stated, pathology in Yin leads to anger, sadness, and unhappiness. In summary:) These are all Dai Xia (Leukorrhea/Below-the-Belt diseases), not caused by ghosts or gods. (Meaning pathology below the Dai Meridian is Yin, not referring to invisible ghosts as Yin.) Over time, (muscles waste away,) emaciation, (Qi insufficiency leads to) deficient pulse with much Cold; (counting twelve syndromes, nine pains, seven harms, five injuries, three chronic illnesses,) thirty-six diseases, changing in thousands of ways; examine pulses for Yin/Yang, Deficiency/Excess, Tight/String-taut; apply acupuncture and herbs to cure danger and restore peace; though diseases are similar, pulse origins differ; (guiding the differences is exploring the source.) You must distinguish and remember this; do not say otherwise.
This explains that women's diverse diseases differ from men's entirely starting from menstruation. Variations depend on individual Yin/Yang constitution, strength/weakness of body, and duration of illness. It begins with three main categories; throughout the section, it divides into Upper, Middle, and Lower to exhaust pathological changes; ending with "All are Below-the-Belt" to summarize the section. Regarding pulses, all diseases relate to Yin, Yang, Deficiency, and Excess. Mentioning String-taut (Xian) and Tight (Jin) specifically: generally, initial menstrual obstruction belongs to Cold; even if Heat symptoms exist, they change from Cold. Qi urgency creates String-taut; severe Cold creates Tight. Showing these two pulses as primary, with combined pulses completing the picture.
Xu Lingtai said: Ancients called gynecology "Dai Xia Yi" (Physician of Below-the-Belt), because diseases generally belong to Below-the-Belt. To treat women, one must first understand the Chong and Ren meridians. The Chong Meridian originates at Qichong (ST30) (on both sides of the pubic hairline), runs alongside the Shaoyin Meridian, ascending through the chest and dispersing. The Ren Meridian originates below Zhongji (CV3) (four cun below the umbilicus), above the pubic hairline, following the interior of the abdomen, ascending to Guanyuan (CV4). It is also said: Chong and Ren meridians both originate in the Baozhong (Center of the Uterus), ascending along the back interior, serving as the Sea of Meridians; this is where blood is generated and fetuses are anchored, bound together by the Dai Meridian. If students understand Dai Meridian pathology, they comprehend the root; although the diseases governed are myriad, they can know their origin; combining reference to ancient prescriptions and applying divine variation, one avoids superficiality.
Question: A woman around fifty years old, (past the age of七七/Qi Qi, Tian Gui should be exhausted, and the earthly pathway closed. Now,) she suffers from (vaginal bleeding,) dripping continuously for dozens of days, fever at dusk, urgency and fullness in the lower abdomen, vexatious heat in palms, and dryness of lips and mouth. What is this? The Master said: (Previously mentioned thirty-six diseases of women all occur below the Dai Meridian.) This disease belongs to Dai Xia. Why? She previously suffered a miscarriage, and blood stasis remains in the lower abdomen. How do we know? (Because if blood stasis remains, new blood cannot generate, and body fluids do not distribute.) Her symptom of dry lips and mouth confirms this. (Moreover, dusk fever and palm heat both belong to Yin; Ren governs the fetus, Chong is the Sea of Blood; both meridians originate in the Uterus, exit at Huiyin, corresponding to the lower abdomen region; Chong ascends flanking the umbilicus; Chong and Ren deficiency causes lower abdominal urgency. Dry blood also causes abdominal fullness; undoubtedly, this is a symptom of old stasis.) Treat primarily with Wen Jing Tang (Warm the Menses Decoction). This follows the previous section, describing severe chronic Cold-Stasis binding the Bao Men, providing the prescription. You Zaijing said: A woman around fifty, Tian Gui has ceased, yet she suffers vaginal dripping; it seems unrelated to menstruation. Unknown is that old accumulated blood in the lower abdomen desires to flow but cannot pass smoothly, desires to stop but cannot cease completely, thus causing urgent dripping for dozens of days. Fever at dusk: blood stasis in Yin, Yang Qi at dusk cannot enter Yin, floating outward instead. Lower abdominal urgency and fullness: blood accumulation not moving, indicating Yin-Cold below. Palm heat: pathology in Yin, palm is also Yin. Dry lips/mouth: internal blood stasis fails to nourish Ying. This is dripping caused by blood stasis; no need to treat dripping, only treat stasis, and dripping stops naturally. Wu Zhu Yu, Gui Zhi, Dan Pi enter blood to scatter Cold and move stasis; Xiong, Dang Gui, Shao Yao, Mai Dong, E Jiao generate new blood; Ren Shen, Gan Cao, Jiang, Ban Xia rectify Spleen Qi. Generally, long-term stasis causes Ying decline; excessive dripping damages Spleen.
(Women's diseases caused by menstruation, thirty-six types in total, are all called) Dai Xia. Menstrual flow (due to Cold becoming stasis) does not (flow on time,) (resulting in) lower abdominal fullness and pain, (since stasis prevents movement, the previous cycle was not smooth, flow insufficient; waiting for the next month's proper time, it arrives early, thus) menstruation appearing twice in one month; treat with Tugua Gen San (Trichosanthes Root Powder). This provides the prescription for Dai Xia with irregular menstruation, appearing twice monthly. Note: Tugua is Wang Gua (Trichosanthes Kirilowii), mainly driving Heat and moving stasis; assisted by Di Long (Earthworm) crawling to chase blood; Gui and Shao harmonize Yin and Yang, forming a regulated rhythm.
Cunkou pulse (lightly pressed) is String-taut (Xian) and (heavily pressed) Large (Da). String-taut indicates (Yang微弱 decreasing); Large indicates (externally flourishing but internally) Kou (Hollow). Decreasing means (Yang cannot sustain itself,) constituting (various) Cold; Kou means (Yin does not guard the center,) constituting (Middle) Deficiency; Cold and Deficiency contend, this is named Ge (Leather) Pulse. (Ge pulse is hard to clarify; describing it with Xian-decreasing and Kou-deficient makes it clear. Generally,) for women (pregnancy and menstruation require Yin-Yang mutual support to be healthy. Seeing this pulse,) she (cannot secure the fetus, leading to) spontaneous abortion (cannot regulate menstruation, leading to) metrorrhagia/dripping blood, (treat with) Xuanfu Hua Tang (Inula Flower Decoction). This provides the prescription for spontaneous abortion and dripping blood due to Deficiency-Cold. However, this formula contradicts the principle of Deficiency-Cold; perhaps the pathology source is Liver. Liver is a Yin Zang but houses Shaoyang Qi, handling transformation/generation and flow/movement; thus, deficiency cannot be tonified directly; resolving stagnation is tonification; Cold cannot be warmed directly; moving Qi and Blood is warming! Qian Shi believed this must be a misplaced text. Spontaneous abortion and dripping blood imply Qi sinking; how could one use Xuanfu Hua to direct Qi downward? Both theories remain for discussion.
Women's Xian Jing (Sunken Meridian), (blood) dripping continuously, (blood color) black (also) unresolved, (is because blood stasis remains, new blood does not generate, Ying Qi rots. However, Qi likes Warmth and dislikes Cold,) treat with Jiao Jiang Tang (Gelatin and Ginger Decoction). This provides the prescription for Sunken Meridian with black color. Formula not seen. Lin Yi said: Likely Jiao Ai Tang. *Qianjin Fang*'s Jiao Ai Tang contains Gan Jiang, seemingly usable. Danxi said: Pale menses indicate Water, Purple indicates Heat, Black indicates Extreme Heat; he speaks of transformation, this speaks of normality.
Women's lower abdomen full like a Dun (ancient vessel), (Lower abdomen is the chamber of the Uterus. Uterus is the Sea of Blood; fullness/large appearance indicates Blood accumulation. If) urination is slightly difficult but no thirst, (one knows Water also accumulates. If the illness arises after) childbirth, this is Water and Blood jointly knotted in the Blood Chamber, (suitable for simultaneous attacking Water and Blood,) treat with Dahuang Gansui Tang (Rhubarb and Kansui Decoction). This provides the prescription for Water-Blood joint knotting in Blood Chamber, presenting as lower abdominal fullness, difficulty in urination/defecation, and no thirst.
Women's prolonged menstrual amenorrhea (has patterns of Deficiency/Excess, Cold/Heat that can be □. Also patterns of flow but not smooth, evidenced by twice-monthly menstruation. If lower abdominal knotted pain, black stool, free urination, clearly knowing Blood desires to move but) refuses (to flow down, (one cannot use ordinary blood-moving, Qi-directing, Ying-Wei harmonizing, Chong-Ren tonifying methods, which are too indirect and ineffective; directly use) Didang Tang (Di Dang Decoction).