经行腹痛，证有虚实。实者或因寒滞，或因血滞，或因气滞，或因热滞；虚者有因血虚，有因气虚。
然实痛者，多痛于未行之前，经通而痛自减；虚痛者，于既行之后，血去而痛未止，或
血去而痛益甚；大都可按、可揉者为虚；拒按、拒揉者为实。有滞无滞，于此可察。但实中有
虚，虚中亦有实，此当
于形气禀质兼而辨之。当以察意，言不能悉也。
凡妇人经期有气逆作痛，全滞而不虚者，须顺其气，宜调经饮主之。甚者如排气饮之类亦可用。
调经饮（见《新方八阵·因阵》）治妇人经脉阻滞，气逆不调，多痛而实者。
当归（三、五钱） 牛膝（二钱） 山楂（一、二钱） 香附（二钱） 青皮 茯苓（各一钱半）
水二钟，煎七分，食远服。如因不避生冷而寒滞其血者，加肉桂、吴茱萸之类；如兼胀闷者，加浓朴一
钱，或砂仁亦可∶如气滞者，加乌药二钱，或痛在小腹者，加小茴香一钱半。
排气饮（见《新方八阵·和阵》）治气逆食滞胀痛等证。
陈皮（一钱五分） 木香（七分或一钱） 藿香（一钱五分） 香附（二钱） 枳壳（一钱五分） 泽泻
（二钱） 乌药（二钱） 浓朴（一钱）
水一钟，煎七分，热服。如食滞者，加山楂、麦芽各二钱，如寒滞者，加焦干姜、吴茱萸、肉桂之属；
如气逆之甚者，加白芥子、沉香、青皮、槟榔之属；如呕而兼痛者，加半夏、丁香之属；如痛在小腹者，
加小茴香；如兼疝者，加荔枝核，煨熟捣碎用二三钱。
若血瘀不行，全滞无虚者，但破其血，宜通瘀煎主之。
通瘀煎（见《新方八阵·因阵》）治妇人气滞血积，经脉不利，痛极拒按，及产后瘀血实痛，
并男妇血逆血厥等证。
归尾（三、五钱） 山楂 香附 红花（新者炒黄各二钱） 乌药（一、二钱） 青皮（钱半）
木香（七分） 泽泻（钱半）
水二钟，煎七分，加酒一、二小钟，食前服。兼寒滞者，加肉桂一钱，或吴茱萸五分；火盛内热，血燥不
行者，加炒栀子一、二钱；微热血虚者，加芍药二钱；血虚涩滞者，加牛膝；血瘀不行者，加桃仁三十粒，去
皮尖用，或加苏木、玄胡索之类；瘀极而大便结燥者，加大黄一、二、三钱，或加芒硝、蓬术（即蓬莪
术）亦可。
若气血俱滞者，宜失笑散主之。
失笑散（见《妇人规古方》）治妇人心痛气刺不可忍，及产后儿枕蓄血，恶血上攻疼痛，并治小肠气痛。
五灵脂（净者） 蒲黄（等分俱炒）
上为末，每服二、三钱，用酒煎，热服。一方用好醋一杓熬成膏，再入水一钟，煎至七分，热服。一方
用醋糊和丸龙眼大，每服一丸，以童便和水各半钟，煎七分，温服。按∶此方若用以止痛，蒲黄宜减半，若用
止血，则宜等分，或灵脂减半亦可。
若寒滞于经，或因外寒所逆，或素日不慎寒凉，以致凝结不行，则留聚为痛而无虚者，须去其寒，宜调经
饮加姜、桂、吴茱萸之类主之。或和胃饮亦可酌用。
调经饮（见上三段）
和胃饮（见《新方八阵·和阵》）治寒湿伤脾，霍乱吐泻，及痰饮水气，胃脘不清，呕恶胀满腹痛等
证。此即平胃散之变方也。凡呕吐等证，多有胃气虚者，一闻苍术之气，亦能动呕，故以干姜代之。
陈皮 浓朴（各一钱半） 干姜（炮一、二钱） 炙甘草（一钱）
水一钟半，煎七分，温服。此方凡藿香、木香、丁香、茯苓、半夏、扁豆、砂仁、泽泻之类，皆可随宜增
用之。若胸腹有滞而兼时气寒热者，加柴胡。
若血热血燥，以致滞涩不行而作痛者，宜加味四物，或用保阴煎去续断加减主之。
薛氏 加味四物汤（见经不调）
保阴煎（见血热经早）
以上五证，但察其有滞无虚，方是真实，若或兼
虚，弗得任行克伐。
凡妇人经行作痛，挟虚者多，全实者少。即如以可按、拒按，及经前、经后辨虚实，固其大法也。然有气
血本虚，而血未得行者，亦每拒按。故于经前亦常有此证。此以气虚血滞，无力流通而然。但察其形证脉息。
凡涉虚弱不足，而经滞作痛者，惟用决津煎、五物煎加减主之，其效如神。或用四神散之类亦可。
决津煎（见《新方八阵·因阵》）治妇人血虚经滞，不能流畅而痛极者。当以水济水，若江河一缺，
而积垢皆去，宜此汤随证加减主之。此用补为泻之神剂也。如气虚者，宜少用香附、陈皮之类，甚者不用亦可。
当归（三、五钱或一两） 泽泻（一钱半） 牛膝（二钱） 肉桂（一、二、三钱） 熟地（二、三钱
或五、七钱或不用亦可） 乌药（一钱，如气虚者不用亦可）
水二钟，煎七、八分，食前服。如呕恶者，加焦姜一、二钱。如阴滞不行者，非加附子不可。如气滞而痛
胀者，加香附一、二钱，或木香七、八分。如血滞血涩者，加酒炒红花一、二钱。如小腹不暖而痛者，加吴茱
萸七、八分。如大便结涩者，加肉苁蓉一至三钱，或者以山楂代之。
五物煎（见血寒论外方）
四神散（见血寒论外方）
若痛在经后者，多由血虚，当用大、小营煎随宜加减主之。或四物、八珍俱可用。然必察其寒热虚实，以
为佐使，自无不效。其有余滞未行者，惟决津煎为妙。
大营煎（见血热经早）
小营煎（见血虚经乱）
四物汤（见经不调）
八珍汤（见经不调）
决津煎（见上段）
凡妇人但遇经期则必作痛，或食则呕吐，肢体困倦，或兼寒热者，是必素禀气血不足，止宜八珍汤、大
营煎之类。若虚而寒甚者，宜理阴煎渐加培补，久必自愈。有因带浊多而虚痛者，亦宜大、小营煎，随其寒
热，加佐使主之。
理阴煎（见血寒经迟）
立斋曰∶“前证若风寒伤脾者，六君加炮姜；思虑伤血者，四物加参、术；思虑伤气者，归脾加柴、栀；
郁怒伤血者，归脾、逍遥兼服。”
六君子汤（见《古方八阵·补阵》）治脾、胃虚弱，饮食少思，或久患疟痢，或食饮难化，或呕
吐吞酸，或咳嗽喘促。若虚火等证，须加炮姜，其功尤速。
人参 白术（炒） 茯苓（各二钱） 炙甘草（一钱） 陈皮 半夏（各一钱五分）
加姜、枣，水煎服，或加粳米百粒。
四物汤（见经不调）
归脾汤（见经不调）
《元戎》逍遥散（见《古方八阵·补阵》）治肝、脾血虚，及郁怒伤肝，少血目暗，发热胁痛等证。
当归 芍药 白术 茯神 甘草 柴胡（各等分）
上姜水煎服。
Abdominal pain during menstruation presents as either deficiency (Xu) or excess (Shi) syndromes. Excess syndromes may arise from cold stagnation, blood stagnation, Qi stagnation, or heat stagnation; deficiency syndromes arise from blood deficiency or Qi deficiency.
However, pain of the excess type often occurs before menstruation begins and subsides naturally once menstrual flow is established; pain of the deficiency type occurs after menstruation has started, persisting despite blood loss, or even intensifying after blood loss. Generally, pain that can be pressed or rubbed for relief indicates deficiency; pain that rejects pressure or rubbing indicates excess. The presence or absence of stagnation can be observed through this distinction. Nevertheless, excess may contain elements of deficiency, and deficiency may contain elements of excess; thus, differentiation must be made by comprehensively considering the patient's physical constitution and innate endowment. This requires careful observation and cannot be fully explained by words alone.
For women experiencing abdominal pain during menstruation due to rebellious Qi, where there is complete stagnation without deficiency, the Qi must be regulated smoothly. The primary formula indicated is Tiaojing Yin (Regulate Menses Decoction). For severe cases, formulas such as Paixi Yin (Expel Stagnation Decoction) may also be used.
Tiaojing Yin (see *Xin Fang Ba Zhen · Yin Zhen*) treats menstrual stagnation with rebellious and disordered Qi, characterized by severe pain and excess syndrome.
Dang Gui (3-5 qian), Niuxi (2 qian), Shanzha (1-2 qian), Xiangfu (2 qian), Qingpi, Fuling (each 1.5 qian).
Decoct two zhong of water until reduced to 0.7 zhong; take after meals. If cold stagnation in the blood results from exposure to cold or raw foods, add Rougui or Wuzhuyu. If distension and fullness are present, add Houpo (1 qian) or Sharen. If Qi stagnation is predominant, add Wuyao (2 qian); if pain is located in the lower abdomen, add Xiaohuixiang (1.5 qian).
Paixi Yin (see *Xin Fang Ba Zhen · He Zhen*) treats symptoms such as distension and pain caused by rebellious Qi and food stagnation.
Chenpi (1.5 qian), Muxiang (0.7 or 1 qian), Huoxiang (1.5 qian), Xiangfu (2 qian), Zhike (1.5 qian), Zexie (2 qian), Wuyao (2 qian), Houpo (1 qian).
Decoct one zhong of water until reduced to 0.7 zhong; take hot. If food stagnation is present, add Shanzha and Maiya (each 2 qian). If cold stagnation is present, add Jiao Ganjiang, Wuzhuyu, or Rougui. If rebellious Qi is severe, add Baijiezi, Chenxiang, Qingpi, or Binglang. If vomiting accompanies pain, add Banxia or Dingxiang. If pain is in the lower abdomen, add Xiaohuixiang. If hernia is present, add Litchi He (roasted, crushed, 2-3 qian).
If blood stasis prevents flow, presenting as complete stagnation without deficiency, blood-breaking methods should be employed. The primary formula is Tongyu Jian (Unblock Stasis Decoction).
Tongyu Jian (see *Xin Fang Ba Zhen · Yin Zhen*) treats Qi stagnation and blood accumulation causing obstructed meridians, extreme pain with rejection of pressure, postpartum real pain due to blood stasis, as well as blood rebellion and blood syncope in both men and women.
Guiwei (3-5 qian), Shanzha, Xiangfu, Honghua (fresh, stir-fried until yellow, each 2 qian), Wuyao (1-2 qian), Qingpi (1.5 qian), Muxiang (0.7 qian), Zexie (1.5 qian).
Decoct two zhong of water until reduced to 0.7 zhong; add 1-2 small zhong of wine; take before meals. If accompanied by cold stagnation, add Rougui (1 qian) or Wuzhuyu (0.5 qian). If fire is excessive with internal heat causing dry, stagnant blood, add Chao Zhizi (1-2 qian). If slightly hot with blood deficiency, add Shaoyao (2 qian). If blood deficiency causes astringent stagnation, add Niuxi. If blood stasis prevents flow, add Taoren (30 kernels, peeled and tip removed) or Sumu, Yansuhu. If stasis is extreme with dry, constipated stool, add Dahuang (1-3 qian) or Mangxiao, Pengzhu (Peng'e Zhu).
If both Qi and blood are stagnant, Shixiao San (Laughing Dispersal Powder) is indicated.
Shixiao San (see *Furen Gui Gu Fang*) treats unbearable stabbing heart pain in women, postpartum uterine lochia retention (Erzhen), pain from attacking foul blood, and intestinal Qi pain.
Wulingzhi (purified), Puhuang (equal parts, stir-fried).
Grind into powder. Take 2-3 qian per dose, decocted in wine, taken hot. Another method: boil good vinegar into a paste, add one zhong of water, decoct to 0.7 zhong, take hot. Another method: mix with vinegar paste into pills the size of longan seeds. Take one pill per dose, decocted in half a zhong of child's urine and half a zhong of water to 0.7 zhong, take warm. Note: To stop pain, reduce Puhuang by half; to stop bleeding, use equal parts, or reduce Wulingzhi by half.
If cold stagnates in the meridians due to external cold invasion or neglect of avoiding cold/raw foods, leading to coagulation and stagnation causing pain without deficiency, cold must be dispelled. Tiaojing Yin added with Jiang (Ginger), Rougui, and Wuzhuyu is indicated. Hewei Yin may also be considered.
Tiaojing Yin (see above sections).
Hewei Yin (see *Xin Fang Ba Zhen · He Zhen*) treats spleen injury by cold-dampness, cholera-like vomiting and diarrhea, phlegm-fluids and water qi, unclear stomach region, vomiting, nausea, distension, fullness, and abdominal pain. This is a modification of Pingwei San. Since vomiting often involves deficient stomach Qi, and the aroma of Cangzhu may induce vomiting, Ganjiang is substituted.
Chenpi, Houpo (each 1.5 qian), Ganjiang (stir-fried, 1-2 qian), Zhi Gancao (1 qian).
Decoct 1.5 zhong of water until reduced to 0.7 zhong; take warm. Huoxiang, Muxiang, Dingxiang, Fuling, Banxia, Bian Dou, Sharen, Zexie, etc., may be added as appropriate. If chest/abdominal stagnation is accompanied by seasonal cold-heat, add Chaihu.
If heat-blood and dryness cause astringent stagnation and pain, Jiawei Siwu Tang or Baoyin Jian (removing Xuduan) with modifications is indicated.
Xue Shi Jiawei Siwu Tang (see Irregular Menstruation).
Baoyin Jian (see Early Menstruation due to Heat-Blood).
Regarding the above five syndromes, only when stagnation is present without deficiency is it a true excess syndrome. If deficiency is present, do not recklessly use draining or attacking methods.
In general, menstrual pain in women is mostly mixed with deficiency, rarely purely excess. While distinguishing deficiency/excess via tenderness/rejection of pressure and pre/post-menstrual timing is a major principle, those with inherent Qi and blood deficiency but unflowing blood may also reject pressure, occurring frequently before menstruation. This results from Qi deficiency and blood stagnation lacking the power to circulate. Observe the physical signs and pulse.
For weakness and insufficiency causing menstrual stagnation and pain, only Juejin Jian and Wuwu Jian with modifications are effective. Si Shen San may also be used.
Juejin Jian (see *Xin Fang Ba Zhen · Yin Zhen*) treats blood deficiency with menstrual stagnation causing extreme pain due to inability to flow smoothly. It acts like replenishing water to clear silt from a river; it is a miraculous agent using tonification to promote drainage. For Qi deficiency, use less Xiangfu and Chenpi, or omit them if severe.
Dang Gui (3-5 qian or 1 liang), Zexie (1.5 qian), Niuxi (2 qian), Rougui (1-3 qian), Shudi (2-3 qian or 5-7 qian, or omit), Wuyao (1 qian, omit if Qi deficient).
Decoct two zhong of water until reduced to 0.7-0.8 zhong; take before meals. If vomiting/nausea, add Jiao Jiang (1-2 qian). If Yin stagnation prevents flow, Fuzi is essential. If Qi stagnation causes pain and distension, add Xiangfu (1-2 qian) or Muxiang (0.7-0.8 qian). If blood stagnation/dryness, add Jiu Chao Honghua (1-2 qian). If lower abdomen is cold and painful, add Wuzhuyu (0.7-0.8 qian). If stool is dry and difficult, add Roushoucong (1-3 qian) or substitute with Shanzha.
Wuwu Jian (see External Formulas for Cold-Blood Discussion).
Si Shen San (see External Formulas for Cold-Blood Discussion).
Pain occurring after menstruation is mostly due to blood deficiency. Daying Jian and Xiaoying Jian with modifications are indicated. Siwu Tang and Bazhen Tang are also usable. However, one must observe cold/heat and deficiency/excess to select adjuvant and guiding herbs; efficacy will follow. For residual stagnation, Juejin Jian is superior.
Daying Jian (see Early Menstruation due to Heat-Blood).
Xiaoying Jian (see Menstrual Disorder due to Blood Deficiency).
Siwu Tang (see Irregular Menstruation).
Bazhen Tang (see Irregular Menstruation).
Juejin Jian (see previous section).
For women who inevitably experience pain during menstruation, possibly with vomiting after eating, limb fatigue, or alternating chills and fever, this indicates innate insufficiency of Qi and blood. Only Bazhen Tang or Daying Jian are suitable. If deficiency with severe cold exists, Liyin Jian should be used gradually to tonify; self-healing will occur over time. For deficiency pain with excessive turbid leukorrhea, Daying Jian or Xiaoying Jian with adjuvants based on cold/heat is indicated.
Liyin Jian (see Late Menstruation due to Cold-Blood).
Li Zhijai stated: "For the aforementioned syndromes: if wind-cold injures the spleen, use Liu Jun Zi Tang with Pao Jiang; if worry injures blood, use Siwu Tang with Renshen and Baizhu; if worry injures Qi, use Guipi Tang with Chaihu and Zhizi; if depression/anger injures blood, combine Guipi Tang and Xiaoyao San."
Liu Jun Zi Tang (see *Gu Fang Ba Zhen · Bu Zhen*) treats spleen/stomach weakness, poor appetite, chronic malaria/dysentery, indigestion, vomiting/acid regurgitation, cough, and wheezing. For deficiency-fire syndromes, adding Pao Jiang accelerates efficacy.
Renshen, Baizhu (stir-fried), Fuling (each 2 qian), Zhi Gancao (1 qian), Chenpi, Banxia (each 1.5 qian).
Add Jiang (Ginger) and Zao (Jujube), decoct in water; or add 100 grains of Jing Mi (Rice).
Siwu Tang (see Irregular Menstruation).
Guipi Tang (see Irregular Menstruation).
*Yuan Rong* Xiaoyao San (see *Gu Fang Ba Zhen · Bu Zhen*) treats liver/spleen blood deficiency, liver injury from depression/anger, dim vision due to blood deficiency, fever, and hypochondriac pain.
Dang Gui, Shaoyao, Baizhu, Fushen, Gancao, Chaihu (equal parts).
Decoct in ginger water.