香附子（醋煮，四两） 桃仁（去皮尖） 牡丹皮 大黄（蒸） 当归（各一两） 川芎
红花（各半两）
瓦龙子（ ，醋煮一昼夜，二两）
上炊饼为丸，如桐子大。空心温酒下三、五十丸。
三神丸 治室女血气相搏，腹中刺痛，痛引心端，经行涩少，或经事不调，以致疼痛。
橘红（二两） 玄胡索（去皮，醋煮） 当归（去芦，酒浸锉，略炒，各一两）
上为细末，酒煮米糊为丸，如梧桐子大，每服七十丸，加至百丸，空心艾汤送下，米
饮亦得。
〔垣〕柴胡丁香汤 治妇人年三十岁，临经预先脐腰痛，甚则腹中亦痛，经缩二三日。
柴胡 羌活 丁香 全蝎 当归身 生地黄
上都作一服，水四盏，煎至一盏，去渣稍热，食前服。
没药除痛散 逐寒邪，疗腹痛。
蓬术（炮，一两） 当归（焙） 玄胡索 五灵指 肉桂（去粗皮） 良姜（炒）
蒲黄（炒） 甘草（炙） 没药（各半两）
上为末，每服五钱，温酒调服。
〔娄〕一妇人三十岁，每因浴后必用冷水淋通身，又尝大惊，遂患经来时必先少腹
大痛，口吐涎水，然后经行，行后又吐水二日，其痛直至六七日经水止时方住，百药不
效。予诊其脉，寸滑大而弦，关、尺皆弦大而急，尺小于关，关小于寸，所谓前大后小
也。遂用香附三两，半夏二两，茯苓、黄芩各一两半，枳实、玄胡、牡丹皮、人参、当
归、白术、桃仁各一两，黄连七钱，川楝、远志、甘草各半两，桂三钱，茱萸一钱半，分
十五帖，水煎，入生姜汁两蚬壳热服，后用热汤洗浴得微汗乃已。忌当风坐卧，手足见
水，并吃生冷，服三十帖全愈。半年后，又因惊忧，前病复举，腰腹时痛，小便淋闭，心
惕惕跳，惊悸。予意其表已解，病独在里。先与灸少冲、劳宫、昆仑、三阴交止悸定痛，次
用桃仁承气大下之，下后用香附三两，蓬术、当归身各一两半，三棱、玄胡索、桂、大黄、
青皮，俱醋制，青木香、 香、滑石、木通、桃仁各一两，乌药、甘草、缩砂、槟榔、苦
楝肉各半两，木香、吴茱萸各二钱，分作二十帖，入新取牛膝湿者二钱，生姜五片，用
荷叶汤煎服，服讫渐安。
上行血例。
加味乌沉汤 治妇人经水欲来，脐腹 痛。
乌药 缩砂 木香 玄胡索（各一两） 香附（炒去毛，二两） 甘草（一两半）
上细锉，每服七钱，水一盏半，生姜三片，煎至七分，不拘时温服。
上抑气例。
〔薛〕一妇人经行腹痛，食则呕吐，肢体倦怠，发热作渴。此乃素禀气血不足，用
八珍汤二十余帖而愈。后生子二年而经不行，前证仍作，服八珍汤、逍遥散百余剂方愈。（八
珍汤即杂病虚劳门八物汤。）
上补虚例。
〔汪〕一妇人瘦小，年二十余，经水紫色，或前或后，临行腹痛，恶寒喜热，或时
感寒，腹亦作痛，脉皆细濡近滑，两尺重按略洪而滑，此血热也。或谓恶寒如此，何谓
为热？曰∶热极似寒也。遂用酒煮黄连四两，香附、归身尾各二两，五灵指一两，为末，粥
丸，空腹吞之而愈。一妇年二十一岁，六月经行，腹痛如刮，难忍求死，脉得细软而
驶，尺则沉弱而近驶，汪曰∶细软属湿，数则为热，尺沉属郁滞也。以酒煮黄连半斤，炒
香附六两，五灵脂半炒半生三两，归身尾二两，为末粥丸，空心汤下三四钱。服至五六
料，越九年得一子。又越四年，经行两月不断，腹中微痛，又服前丸而愈。续后经行六
七日，经止则流清水，腹中微痛，又服前丸而痛亦止。又经住只有七八日，若至行时或
大行五六日，续则适来适断，或微红，或淡红，行后常流清水，小腹大痛，渐连遍身，胸
背腰腿骨里皆痛，自巳至酉乃止，痛则遍身
冷热，汗大出，汗止痛减，尚能饮食，自始痛至今，历十五年，前药屡服屡效，今罔效
者何也？汪复诊之，脉皆洪滑无力，幸其尚有精神。汪曰∶此非旧日比矣。旧乃郁热，今
则虚寒。东垣曰，始为热中，终为寒中是也。经曰，脉至而从，按之不鼓，乃阴盛隔阳，当
作寒治。且始病时而形敛小，今则形肥大矣。医书曰，瘦人血热，肥人气虚，岂可同一治
耶？所可虑者，汗大泄而脉不为汗衰，血大崩而脉不为血减耳。其痛日重夜轻，知由阳
虚不能健运。故亦凝滞而作痛。以证参脉，宜用助阳，若得脉减痛轻，方为佳兆。遂投参、
、归、术大剂，加桂、附，一帖，来早再诊，脉皆稍宁，服至二三十帖，时当二月至
五月，病且愈，盖病有始终寒热之异，药有前后用舍不同，形有肥瘦壮少不等，岂可以
一方而通治哉。
〔丹〕经过后而作痛者，乃虚中有热，所以作痛。
新荷姐头痛口干，经行后身痛，腰甚痛。
生地黄 白术 芍药（各一钱） 芎 归身尾（各五分） 黄柏（炒） 甘草（炙，各三分）
上用水入少酒，煎服。
按∶经后腹痛为虚明甚。若脉不数，证无头热，未可断其为热也。无热八珍为宜，有
热逍遥为宜。
上寒热例。
〔发热〕
吴茭山治一妇经血过多，五心烦热，日晡潮热，诸药不效，以四物加胡黄连，三服
而愈。
薛新甫治一妇人发热口干，月经不调，两腿无力，服祛风渗湿之剂，腿痛体倦，二膝
浮肿，经事不通。薛作肝脾肾三经血虚火燥证，名鹤膝风。用六味、八味二丸，兼服两
月，形体渐健，饮食渐进，膝肿渐消，不半载而痊。前证若脾肾虚寒，腿足软痛，或足
膝枯细，用八味丸。若饮食过多，腿足或臀内酸胀，或浮肿作痛，用补中益气加茯苓、半
夏主之。一妇人经候过期，发热倦怠，或用四物、黄连之类，反两月一度，且少而成
块，又用峻药通之，两目如帛所蔽。薛曰∶脾为诸阴之首，目为血脉之宗，此脾伤五脏皆
为失所，不能归于目矣。遂用补中益气、济生归脾二汤，专主脾胃，年余寻愈。一妇
人月事未期而至，发热自汗，服清热止汗之剂，反作渴头痛，手掉身麻，此因肝经风热，
用柴胡、炒芩、连、炒山栀、归、芍、生地、丹皮各一钱，参、 、苓、术各一钱五分，川
芎七分，甘草五分，二剂其汗全止，更以补中益气而愈。凡发热久者，阳气亦自病，须
调补之。一妇人气血素虚，经行不调，饮食少思，日晡热甚，用十全大补加山茱萸、山
药、丹皮、麦门冬、五味子而愈。次年秋，患寒热，或用清脾饮而元气愈弱，仍以前药而
愈。一妇人素勤苦，冬初患咳嗽发热，久而吐血、盗汗，经水两三月一至，遍身作痛。
或用化痰降火药，口噤筋挛，此血虚而药益损耳。用加减八味丸及补中益气加麦门、五
味、山药治之，年余而痊。
〔寒热〕
经水适来适断者，或有往来寒热者，先服小柴胡汤以去其寒热，后以四物汤和之。
〔本〕妇人血脉不调，往来寒热，状如劳倦。
当归 川芎 甘草 黄 官桂（去粗皮，各一两） 熟地黄 白术 白芍药（各二两）
柴胡 阿胶（各半两）
为细末，每服五钱，枣一枚，水煎空心温服。白汤点服亦得。常服不生带下，调血
脉，养子宫，终身无病。
太仓公治一女，病腰背痛，寒热。众医皆以为寒热也。公诊之曰∶内寒月事不下也。
即窜以药，旋下，病已。病得之欲男子不可得也。所以知其病者，诊其脉时，切之肾脉
也啬而不属，啬而不属者其来难坚，故曰月不下。肝脉弦出左口，故曰欲男子不可得也。
盖男子以精为主，妇人以血为主，男子精盛
则思室，女子月盛则怀胎。夫肝，摄血者也。厥阴弦出寸部，又上鱼际，则阴血盛可知矣。
（别详师尼寡妇条内。）
薛新甫治一妇人耳内或耳后项侧作痛，寒热口苦，月经不调，此肝火气滞而血凝，用
小柴胡加山栀、川芎、丹皮治之，诸证悉退。月事不行而寒热者，详经闭门。
〔热入血室〕
〔良〕妇人伤寒伤风发热，经水适来，昼则安静，暮则谵语，有如疟状，此为热入血室。
治者无犯胃气及上二焦，宜服小柴胡汤。若脉迟身凉，当刺期门穴，下针病入五吸停针，良久，徐
徐出针。凡针期门穴，必泻勿补。肥人二寸，瘦人寸半也。
〔薛〕前证若因劳役，或怒气发热，适遇经行而患前证者，亦用小柴胡汤加生地黄
治之。血虚，用四物加柴胡。若病既愈而热未已，或元气素弱，并用补中益气汤。脾气素郁，用
济生归脾汤。血气素虚，用十全大补汤。
许学士治一妇病伤寒发寒热，遇夜则如见鬼状，经六七日忽然昏塞，涎响如引锯，牙关紧急，
瞑目不知人，病势危困。许视之曰∶得病之初，曾值月经来否？其家云∶经水方来，病作而经遂止，
得一二日发寒热，昼虽静，夜则有鬼祟，从日昨不省人事。许曰∶此乃热入血室证。仲景云，妇人中
风，发热恶寒，经水适来，昼则明了，暮则谵语，如见鬼状，发作有时，此名热入血室。医者不晓，
以刚剂与之，逐致胸膈不利，涎潮上脘，喘急息高，昏冒不知人。当先化其痰，后除其热。乃急以一呷
散投之，两时顷，涎下得睡，省人事；次授以小柴胡汤加生地黄，三服而热除，不汗而自解矣。一
妇人患热入血室证，医者不识，用补血调气药治之，数日遂成血结胸。或勤用前药，许公曰∶小
柴胡已迟，不可行也。无已，刺期门穴斯可矣。予不能针，请善针者治之。如言而愈。或问∶热
入血室，何为而成结胸也？许曰∶邪气传入经络，与正气相搏，上下流行，遇经水适来适断，邪气乘
虚入于血室，血为邪所迫，上入肝经，肝受邪则谵语而见鬼，复入膻中，则血结于胸中矣。何以言之？
妇人平居，水养木，血养肝。方未受孕，则下行之为月水，既孕则中蓄之以养胎，及已产则上壅之
以为乳，皆血也。今邪逐血并归于肝经，聚于膻中，结于乳下，故手触之则痛，非药可及，故当刺
期门也。
虞恒德治一少妇，夏月行经得伤寒似疟，谵语狂乱，诸医皆以伤寒内热，投双解散、解
毒汤服之，大汗如雨，反如风状，次以牛黄丸金石之药，愈投愈剧。一日延虞诊视，脉弦而大，
伤在前，伤寒在后。今伤寒得汗虽已，内伤则尚存故也。因细问之，患者曰∶正行经时，因饮食后
多汗，用冷水抹身，因得此证。方知冷水外闭其汗，内阻其血，邪热入室，经血未尽，血得邪热，乍
静乍乱，寒热谵语，掉眩类风，须得玉烛散下之而愈。下后谵语已定，次以四物、小柴胡汤调理，
五日热退身凉，其患遂瘳。
《衍义》云∶一妇人温病已十二日，诊之其脉六七至而涩，寸稍大，尺稍小，发寒热，
头赤口干，不了了，耳聋。问之，病数日经水乃行，此属少阳热入血室也，若治不对病，
则必死。乃按其证与小柴胡汤服之，二日，又与小柴胡汤加官桂、干姜一日，寒热遂止。又
云∶脐下急痛，又与抵当丸微利，脐下痛痊，身渐凉，脉渐匀，尚不了了，乃复与小柴胡
汤。次日，但胸中热躁，口鼻干，又少与调胃承气汤，不得利。次日心下痛，又与大陷
胸汤半服，利三行。次日虚烦不宁，时妄有所见，复狂言，虽知其尚有燥屎，以其极虚，
不敢攻之，遂与竹叶汤去其烦热，其夜大便自通，至晚两次，中有燥屎数枚，而狂言虚
烦尽解。但咳嗽唾沫，此肺虚也。若不治，恐乘虚而成肺痿，遂与小柴胡汤去人参、大枣、
生姜，加干姜五味子汤，一日咳减，二日而病悉愈。以上皆用仲景方。
薛立斋治一妇人经行，感冒风寒，日间安静，至夜谵语，用小柴胡加生地治之顿安。
但内热头晕，用补中益气加蔓荆子而愈。后因恼怒，寒热谵语，胸胁胀痛，小便频数，月
经先期，此是肝火血热妄行，用加味逍遥加生地黄而愈。一妇人因怒，寒热头痛谵语，
日晡至夜益甚，而经暴至。盖肝藏血，此怒动火而血妄行，用加味逍遥散加生地黄治之，
神思顿清。但食少体倦，月经未已。盖脾统血，此脾气虚，不能摄血，用补中益气治之，
月经渐止。一妇人怀抱素郁，感冒经行谵语，服发散之剂不应，用寒凉降火，前证益
甚，更加月经不止，肚腹作痛，呕吐不食，痰涎自出。此脾胃虚寒，用香砂六君，脾胃渐
健，诸证渐退，又用归脾汤而全愈。
加味小柴胡汤 治妇人伤风，续得寒热，发作有时，经水适断，此为热入血室，其血
必结，致如疟状。
柴胡（三钱） 半夏 黄芩（各二钱） 生地黄 人参（各一钱半） 甘草（半钱）
作一服，水二盅，姜五片，枣二枚，煎一盅，不拘时服。
干姜柴胡汤 治妇人伤寒，经脉方来，热入血室，寒热如疟，或狂言见鬼。
柴胡（一钱） 桂枝（三分） 栝蒌根（五分） 牡蛎（ ） 干姜（炮） 甘草（炒，各三分）
上水煎服，汗出而愈。
海蛤散 治妇人伤寒，血结胸膈，宜服此药，及针期门穴。
海蛤 滑石（ ，水飞） 甘草（各五钱） 芒硝（一两）
上为末，每服二钱，用鸡子清调下。小肠通利，其结血自散。更用桂枝红花汤发其
汗则愈。（方见。）
〔泄泻〕
[Xiangfu Pill]
Cyperi Rhizoma (boiled in vinegar, 4 liang), Persicae Semen (skin and tip removed), Moutan Cortex, Rhei Radix et Rhizoma (steamed), Angelicae Sinensis Radix (each 1 liang), Chuanxiong Rhizoma, Carthami Flos (each 0.5 liang).
Dracois Os (calcined, boiled in vinegar for a full day and night, 2 liang).
Grind the above herbs into fine powder, use steamed wheat bun dough as a binder to make pills, size of Sophora japonica seeds. Take 30-50 pills with warm wine on an empty stomach.
[Sanshen Pill]
Treats unmarried women with qi and blood stagnation, stabbing pain in the abdomen radiating to the epigastrium, scanty or irregular menstruation causing pain.
Citri Reticulatae Pericarpium (2 liang), Corydalis Rhizoma (skin removed, boiled in vinegar), Angelicae Sinensis Radix (rhizome removed, soaked in wine, chopped, lightly stir-fried, each 1 liang).
Grind into fine powder, use wine-boiled rice paste as a binder to make pills, size of Sophora japonica seeds. Take 70 pills per dose, up to 100 pills, taken with mugwort decoction on an empty stomach; rice water is also acceptable.
[Li Dongyuan's Chaihu Dingxiang Decoction]
Treats a 30-year-old woman with premenstrual umbilical and lumbar pain, extending to abdominal pain if severe, with menstruation delayed by two to three days.
Bupleuri Radix, Notopterygii Rhizoma et Radix, Caryophylli Flos, Scorpio, Angelicae Sinensis Radix (body), Rehmanniae Radix Recens.
Combine all as one dose, add four bowls of water, decoct to one bowl, strain, and take slightly warm before meals.
[Moyao Tongue-Pain Dispelling Powder]
Expels cold pathogens, treats abdominal pain.
Curcumae Longae Rhizoma (processed, 1 liang), Angelicae Sinensis Radix (baked), Corydalis Rhizoma, Psoraleae Fructus (Wulingzhi), Cinnamomi Cortex, Alpiniae Officinarum Rhizoma (stir-fried), Polygoni Multiflori Semen (stir-fried), Glycyrrhizae Radix et Rhizoma (honey-fried), Myrrha (each 0.5 liang).
Grind into powder, take 5 qian per dose, mixed with warm wine.
[Lou Quanshan's Case]
A 30-year-old woman always used cold water to shower her whole body after bathing, and once suffered great fright. She developed severe lower abdominal pain before menstruation, vomiting saliva, followed by menstruation, then vomiting water for two more days. Pain persisted until menstruation stopped after 6-7 days. All medicines failed. Her pulse was slippery, large, and wiry at the Cun position; string-taut, large, and rapid at Guan and Chi positions; Chi smaller than Guan, Guan smaller than Cun. This is "large front, small back." I prescribed Cyperi Rhizoma (3 liang), Pinelliae Rhizoma (2 liang), Poria (1.5 liang), Scutellariae Radix (1.5 liang), Imperatae Rhizoma (1 liang), Corydalis Rhizoma (1 liang), Moutan Cortex (1 liang), Ginseng Radix (1 liang), Angelicae Sinensis Radix (1 liang), Atractylodis Macrocephalae Rhizoma (1 liang), Persicae Semen (1 liang), Coptidis Rhizoma (7 qian), Toosendan Fructus (0.5 liang), Polygalae Radix (0.5 liang), Glycyrrhizae Radix et Rhizoma (0.5 liang), Cinnamomi Ramulus (3 qian), Evodiae Fructus (1.5 qian). Divided into 15 doses, decocted in water with ginger juice (two clam shells worth), taken hot. Afterward, she took a hot bath to induce slight sweating, which cured her. Avoid drafts, contact of hands/feet with cold water, and raw/cold foods. After 30 doses, she was fully recovered. Six months later, due to fright and worry, the old disease recurred with waist/abdominal pain, dysuria, palpitations, and anxiety. I deduced the exterior syndrome had resolved, leaving only interior pathology. I first moxa Shaochong (HT9), Laogong (PC8), Kunlun (BL60), and Sanyinjiao (SP6) to calm palpitations and stop pain. Then I used Taoren Chengqi Tang to purge vigorously. After purging, I prescribed Cyperi Rhizoma (3 liang), Curcumae Zedoariae Rhizoma (1.5 liang), Angelicae Sinensis Radix (body) (1.5 liang), Sparganii Rhizoma (1 liang), Corydalis Rhizoma (1 liang), Cinnamomi Ramulus (1 liang), Rhei Radix et Rhizoma (1 liang), Citri Paradisi Exocarpium (1 liang), Aquilariae Aromaticae Lignum (1 liang), Aucklandiae Radix (1 liang), Talcum (1 liang), Akebiae Caulis (1 liang), Persicae Semen (1 liang), Linderae Radix (0.5 liang), Glycyrrhizae Radix et Rhizoma (0.5 liang), Amomi Fructus Rotundus (0.5 liang), Arecae Semen (0.5 liang), Meliae Cortex (0.5 liang), Aucklandiae Radix (2 qian), Evodiae Fructus (2 qian). Divided into 20 doses, added fresh wet Achyranthis Bidentatae Radix (2 qian), ginger slices (5 pieces), decocted in lotus leaf soup. Gradually stabilized.
This belongs to the method of promoting upward blood circulation.
[Jiawei Wuchen Tang]
Treats women with umbilical and abdominal pain as menstruation approaches.
Linderae Radix, Amomi Fructus Rotundus, Aucklandiae Radix, Corydalis Rhizoma (each 1 liang), Cyperi Rhizoma (stir-fried, hair removed, 2 liang), Glycyrrhizae Radix et Rhizoma (1.5 liang).
Finely chop, take 7 qian per dose, add 1.5 bowls of water and 3 slices of ginger, decoct to 0.7 bowl, take warm anytime.
This belongs to the method of suppressing qi.
[Xue Ji's Case]
A woman experienced abdominal pain during menstruation, vomiting upon eating, limb fatigue, fever, and thirst. This was due to inherent deficiency of qi and blood. She was cured with Bazhen Tang (Eight Treasures Decoction) for over 20 doses. Two years after childbirth, menstruation ceased, and previous symptoms returned. She was cured after taking Bazhen Tang and Xiaoyao San (Free and Easy Wanderer Powder) for over 100 doses. (Bazhen Tang is the Baywu Tang in the Deficiency and Consumption section.)
This belongs to the method of tonifying deficiency.
[Wang Ji's Case]
A slender woman in her twenties had purple menstrual blood, irregular timing (early or late), abdominal pain before menstruation, aversion to cold but preference for heat, occasional cold invasion causing abdominal pain. Pulse was fine, soft, near slippery; both Chi pulses were slightly surging and slippery when pressed heavily. This indicates blood heat. Some asked: How can it be heat if she fears cold so much? I replied: Extreme heat resembles cold. I prescribed Coptidis Rhizoma (wine-boiled, 4 liang), Cyperi Rhizoma (2 liang), Angelicae Sinensis Radix (tips and tails) (2 liang), Psoraleae Fructus (1 liang), ground into powder, made into pills with congee, taken on an empty stomach. Cured.
Another 21-year-old woman had menstrual pain like scraping, unbearable, seeking death. Pulse was fine, soft, and rapid; Chi was deep, weak, and near rapid. Wang said: Fine and soft indicates dampness; rapid indicates heat; deep Chi indicates stagnation. I prescribed Coptidis Rhizoma (wine-boiled, 0.5 jin), Cyperi Rhizoma (stir-fried, 6 liang), Psoraleae Fructus (half stir-fried, half raw, 3 liang), Angelicae Sinensis Radix (tips and tails) (2 liang), ground into powder, made into pills with congee, taken with broth on an empty stomach, 3-4 qian per dose. After 5-6 courses, she conceived after nine years. Four years later, menstruation lasted two months continuously with mild abdominal pain; previous pills cured it. Later, menstruation lasted 6-7 days, then clear fluid flowed with mild pain; previous pills stopped pain. Then menstruation lasted only 7-8 days, sometimes heavy for 5-6 days then stopping abruptly, or light red/pale red, flowing clear fluid after, with severe lower abdominal pain spreading to the whole body, chest, back, waist, legs, and bones from Si hour to You hour. Pain caused alternating hot/cold sensations, profuse sweating, pain relief after sweating, appetite maintained. This lasted 15 years. Previous medicines worked repeatedly, but now failed. Wang re-examined: Pulse was surging, slippery, and powerless, but spirit remained. Wang said: This is no longer the same as before. Previously it was stagnant heat; now it is deficiency-cold. Li Dongyuan said: Starts as heat-center, ends as cold-center. The Classic says: Pulse follows but does not drum when pressed, indicating yin excess blocking yang, treat as cold. Initially, the body was thin; now it is fat. Medical texts say: Thin people have blood heat; fat people have qi deficiency. How can they be treated the same? The concern is that profuse sweating does not weaken the pulse, and massive bleeding does not reduce the pulse. Pain is heavier by day, lighter by night, indicating yang deficiency failing to transport, leading to stagnation and pain. Combining signs and pulse, use yang-assisting methods. If pulse weakens and pain lessens, it is a good sign. I prescribed large doses of Ginseng Radix, Astragali Radix, Angelicae Sinensis Radix, Atractylodis Macrocephalae Rhizoma, plus Cinnamomi Ramulus and Aconiti Lateralis Radix Praeparata. One dose, re-examined next morning: pulse calmed. After 20-30 doses (Feb-May), illness nearly resolved. Diseases differ in initial/final heat/cold; medicines differ in application; bodies differ in fat/thin/sturdy/weak. How can one formula treat all?
[Zhu Danxi's Discussion]
Pain after menstruation is deficiency with internal heat, hence pain.
[Headache and Dry Mouth Case]
Xinhejie had headache and dry mouth, body pain after menstruation, especially severe waist pain.
Rehmanniae Radix, Atractylodis Macrocephalae Rhizoma, Paeoniae Radix Alba (each 1 qian), Chuanxiong Rhizoma, Angelicae Sinensis Radix (tips and tails) (each 5 fen), Phellodendri Cortex (stir-fried), Glycyrrhizae Radix et Rhizoma (honey-fried) (each 3 fen).
Decoct in water with a little wine.
Note: Post-menstrual abdominal pain is clearly deficiency. If pulse is not rapid and there is no head heat, do not diagnose as heat. Use Bazhen Tang if no heat; Xiaoyao San if heat.
This belongs to the treatment of cold-heat syndromes.
[Fever]
Wu Jiaoshan treated a woman with excessive menstrual bleeding, five-palm heat, afternoon tidal fever, unresponsive to other drugs. Cured with Siwu Tang plus Picrorhizae Rhizoma (Huhuanglian) in three doses.
Xue Xinpu treated a woman with fever, dry mouth, irregular menstruation, weak legs. After taking wind-dispelling and damp-draining drugs, she developed leg pain, fatigue, bilateral knee swelling, and amenorrhea. Xue diagnosed Liver-Spleen-Kidney blood deficiency with fire dryness, named "Crane Knee Wind." Used Liuwei Dihuang Wan and Shenqi Dihuang Wan for two months. Body strengthened, appetite improved, knee swelling subsided. Cured in half a year. For spleen/kidney deficiency-cold with soft/sore legs or thin knees, use Shenqi Dihuang Wan. For overeating causing leg/buttock soreness/swelling/pain, use Buzhong Yiqi Tang plus Poria and Pinelliae Rhizoma.
A woman with delayed menstruation, fever, fatigue, took Siwu Tang and Huanglian, resulting in bi-monthly periods, scanty and clotted. Harsh purgatives caused blurred vision. Xue said: Spleen is the head of all yin; eyes are the congregation of blood vessels. Spleen injury causes all organs to lose nourishment, unable to reach the eyes. Used Buzhong Yiqi Tang and Jisheng Guipi Tang to focus on spleen/stomach. Cured in over a year.
A woman with early menstruation, fever, spontaneous sweating, took heat-clearing/sweat-stopping drugs, resulting in thirst, headache, tremors, numbness. Diagnosed as Liver channel wind-heat. Used Chaihu, stir-fried Huangqin, Huanglian, stir-fried Zhizi, Danggui, Shaoyao, Shengdi, Mudanpi (each 1 qian), Renshen, Huangqi, Fuling, Baizhu (each 1.5 qian), Chuanxiong (0.7 qian), Gancao (0.5 fen). Two doses stopped sweating; Buzhong Yiqi Tang completed cure. Prolonged fever damages yang; must tonify.
A woman with inherent qi/blood deficiency, irregular menstruation, poor appetite, severe afternoon fever. Cured with Shiquan Dabu Tang plus Shanzhuyu, Shanyao, Mudanpi, Maidong, Wuweizi. Next autumn, chills/fever occurred; Qingpi Yin weakened qi further; previous medicine cured her.
A hardworking woman had cough/fever in early winter, progressing to hemoptysis, night sweats, menstruation every 2-3 months, body pain. Phlegm-resolving/fire-clearing drugs caused lockjaw and spasms (blood deficiency worsened by drugs). Used Jiawei Shenqi Dihuang Wan and Buzhong Yiqi Tang plus Maidong, Wuweizi, Shanyao. Cured in over a year.
[Cold-Heat]
When menstruation starts and stops suddenly, or with alternating chills and fever, first give Xiao Chai Hu Tang to resolve chills/fever, then Siwu Tang to harmonize.
[Zhang Zhongjing's Text]
Women with irregular blood vessels, alternating chills and fever, resembling exhaustion.
Danggui, Chuanxiong, Gancao, Huangqi, Guigui (bark removed, each 1 liang), Shudihuang, Baizhu, Shaoyao (each 2 liang), Chaihu, Ejiao (each 0.5 liang).
Grind to powder, take 5 qian per dose with one jujube, decoct in water, take warm on empty stomach. White water administration is also acceptable. Regular use prevents leukorrhea, regulates blood vessels, nourishes uterus, ensures lifelong health.
Tai Cang Gong treated a girl with back/waist pain and chills/fever. Other doctors diagnosed chills/fever. Tai Cang Gong diagnosed internal cold causing amenorrhea. Applied herbal fumigation, menstruation immediately flowed, disease cured. Cause: desire for men unfulfilled. Diagnosis based on Kidney pulse being choppy and disconnected (difficult/hard flow indicates amenorrhea); Liver pulse wiry emerging left mouth (desire for men unfulfilled). Men prioritize essence; women prioritize blood. Abundant essence leads to sexual desire; abundant menses lead to pregnancy. Liver controls blood. Jueyin pulse wiry at Cun and reaching fish border indicates abundant yin-blood. (See details in Nun/Widow section.)
Xue Xinpu treated a woman with ear/post-ear/neck side pain, chills/fever, bitter taste, irregular menstruation. Diagnosed as Liver fire, qi stagnation, blood coagulation. Treated with Xiao Chai Hu Tang plus Zhizi, Chuanxiong, Mudanpi. Symptoms resolved. Amenorrhea with chills/fever: see "Menstrual Door Closed" section.
[Heat Entering Blood Chamber]
[Zhang Zhongjing's Text]
Women with Shanghan/Shangfeng fever, menstruation just started, quiet by day, delirious by night, malaria-like. This is Heat Entering Blood Chamber. Do not violate Stomach qi or Upper/Middle Jiao. Give Xiao Chai Hu Tang. If pulse is slow and body cool, puncture Qimen acupoint. Insert needle, hold for five breaths, wait, remove slowly. Always drain Qimen, never tonify. Deep insertion 2 cun for fat, 1.5 cun for thin.
[Xue Ji's Case]
If previous symptoms arise from labor or anger-induced fever coinciding with menstruation, use Xiao Chai Hu Tang plus Shengdi. For blood deficiency, use Siwu Tang plus Chaihu. If illness resolves but fever persists, or inherent yuan qi is weak, use Buzhong Yiqi Tang. For inherent spleen qi depression, use Jisheng Guipi Tang. For inherent qi/blood deficiency, use Shiquan Dabu Tang.
Xu Xueshi treated a woman with Shanghan chills/fever, seeing ghosts at night. After 6-7 days, sudden coma, loud phlegm rattle, locked jaw, unconscious, critical condition. Xu asked: Did menstruation start at onset? Family: Menstruation just started, illness began, menstruation stopped. Chills/fever for 1-2 days, quiet by day, ghosts by night, unconscious since yesterday. Xu diagnosed Heat Entering Blood Chamber. Zhang Zhongjing: Women with wind-stroke, fever/chills, menstruation just started, clear by day, delirious/seeing ghosts by night, periodic attacks. Doctors using harsh/dry drugs caused chest oppression, phlegm flooding upper jiao, wheezing, coma. Must resolve phlegm first, then clear heat. Urgently gave Yiya San. After 2 hours, phlegm drained, slept, regained consciousness. Then gave Xiao Chai Hu Tang plus Shengdi. Three doses cleared fever, resolved without sweating.
Another woman with Heat Entering Blood Chamber misdiagnosed, treated with blood-tonifying/qi-regulating drugs, developed Blood Binding Chest in days. Xu said: Xiao Chai Hu Tang is too late. Must puncture Qimen. I cannot needle, asked a skilled acupuncturist. Cured. Question: Why does Heat Entering Blood Chamber become Binding Chest? Answer: Pathogen enters meridians, fights righteous qi, moves up/down. Coincides with menstruation starting/stopping. Pathogen enters Blood Chamber via deficiency. Blood forced by pathogen enters Liver channel. Liver affected causes delirium/ghosts. Reaches Danzhong, blood binds in chest. Women normally water nourishes wood, blood nourishes liver. Unpregnant: blood flows down as menses. Pregnant: stored to nourish fetus. Postpartum: rises to form milk. All are blood. Now pathogen drives blood to Liver, gathers at Danzhong, binds below breasts. Touching causes pain, beyond drug reach, hence puncture Qimen.
Yu Hengde treated a young woman with summer menstruation Shanghan resembling malaria, delirium/manic behavior. Doctors treated as Shanghan internal heat with Shuangjie San/Jiedu Tang. Profuse sweating, resembled wind-stroke. Then Niuhuang Wan/mineral drugs worsened condition. Yu diagnosed: Pulse wiry-large. Injury first, Shanghan second. Sweat resolved Shanghan, but internal injury remains. Patient said: During menstruation, ate, sweated heavily, wiped body with cold water. Cold water closed sweat externally, blocked blood internally. Pathogenic heat entered chamber. Incomplete menses + heat = fluctuating calm/chaos, chills/fever/delirium, tremors/dizziness resembling wind. Must use Yuzhu San to purge. After purging, delirium settled. Then Siwu Tang + Xiao Chai Hu Tang to regulate. Five days later, fever subsided, body cooled, cured.
[Yanyi] states: Woman with Wenbing 12 days. Pulse 6-7 beats per respiration, choppy. Cun slightly large, Chi slightly small. Chills/fever, red head, dry mouth, confusion, deafness. Menstruation started days after illness. Shaoyang Heat Entering Blood Chamber. Wrong treatment leads to death. Gave Xiao Chai Hu Tang. Two days later, added Guigui/Ganjiang for one day. Chills/fever stopped.
Also: Lower abdominal urgency/pain. Gave Didang Wan for mild purgation. Pain resolved, body cooled, pulse normalized, still confused. Gave Xiao Chai Hu Tang again. Next day: chest heat/restlessness, dry nose/mouth. Gave Wei Chengqi Tang (small dose), no stool. Next day: epigastric pain. Gave Daxiongtang (half dose), three stools. Next day: deficiency vexation, hallucinations, wild speech. Knew dry feces remained, but too deficient to purge. Gave Zhuye Tang to remove heat/vexation. Night: bowel movement, two stools, several dry feces. Delirium/vexation resolved. Cough/phlegm remained (lung deficiency). Without treatment, risk lung萎 (withering). Gave Xiao Chai Hu Tang minus Renshen/Dazao/Shengjiang, plus Ganjiang/Wuweizi. Cough reduced in one day, cured in two. All used Zhang Zhongjing's formulas.
Xue Lizhai treated a woman with menstruation, caught wind-cold. Quiet by day, delirious by night. Xiao Chai Hu Tang plus Shengdi brought instant relief. Internal heat/dizziness treated with Buzhong Yiqi Tang plus Manjingzi. Later, anger caused chills/fever/delirium, chest/flank distension/pain, frequent urination, early menstruation. Liver fire/blood heat reckless flow. Jiawei Xiaoyao San plus Shengdi cured.
Another woman, anger-induced chills/fever/headache/delirium, worse at dusk/night, sudden heavy menstruation. Liver stores blood; anger moves fire, blood flows recklessly. Jiawei Xiaoyao San plus Shengdi cleared mind. Poor appetite/fatigue, menstruation continued. Spleen controls blood; spleen qi deficiency fails to control blood. Buzhong Yiqi Tang stopped menstruation gradually.
Another woman, inherent depression, caught wind-cold during menstruation, delirious. Dispersants failed. Cold/cooling/fire-clearing worsened symptoms, continuous menstruation, abdominal pain, vomiting/anorexia, spontaneous phlegm. Spleen/stomach deficiency-cold. Xiangsha Liujun Zi Tang strengthened spleen/stomach, symptoms receded. Guipi Tang completed cure.
[Jiawei Xiao Chai Hu Tang]
Treats women with wind-stroke, subsequent chills/fever, periodic attacks, menstruation just stopped. Heat Entering Blood Chamber, blood must bind, malaria-like.
Chaihu (3 qian), Banxia, Huangqin (each 2 qian), Shengdi, Renshen (each 1.5 qian), Gancao (0.5 qian).
One dose, water 2 zhong, ginger 5 slices, jujube 2 pieces, decoct to 1 zhong, take anytime.
[Ganjiang Chaihu Tang]
Treats women with Shanghan, menstruation just starting, Heat Entering Blood Chamber, chills/fever like malaria, or wild speech/seeing ghosts.
Chaihu (1 qian), Guizhi (3 fen), Gualougen (5 fen), Muli (calcined), Ganjiang (processed), Gancao (stir-fried) (each 3 fen).
Decoct in water, sweat out to cure.
[Haige San]
Treats women with Shanghan, blood binding chest/diaphragm. Take this medicine and puncture Qimen.
Haige, Huashi (calcined, water-flown), Gancao (each 5 qian), Mangxiao (1 liang).
Grind to powder, take 2 qian mixed with egg white. Small intestine unblocks, bound blood disperses. Follow with Guizhi Honghua Tang to induce sweat for cure. (Formula seen previously.)
[Diarrhea]