一妇女病。倍多于男子。其原不外经产崩带数大端。故是书篇目。虽止有九。而一切病。
皆统于是矣。
一每篇正文。皆充类至尽。似无遗症。然病变无方。或有未备者。又当临时裁度。因势
酌方。不可拘泥。岳武穆云。运用之妙。存乎一心。兵法也。亦医法也。
一崩漏虽属血病。然非专由经也。前人往往杂于经病中。非是。余故次于产后病下。
一小产原是胎前之患。不得以大产小产递及。今列于临产前者。明其病属于胎前也。
一每篇正文后。前人论说。必择至精且当。归于一是者。然后采录。期免矛盾之诮。
一所采古方。除试验获效外。其余必取方药之性味。按合所主之症。再四考订。果属针
对不爽。才敢载笔。稍觉阻碍。即弃去。虽分量多寡。亦必筹较。未敢轻心相掉。贻误将来
也。
一方有与症相合。本文及前论。却俱未引及者。亦附录备考。不肯割爱云尔。
经者常也。女子十四岁。任脉通而天癸至。任与冲遂为经脉之海。外循经络。内荣脏腑。
气血调和。营运不息。一月之间。冲任溢而行。月事以时下。此常经也。故曰。经贵乎如期。
若来时。或前或后。或多或少。或月二三至。或数月一至。皆为不调。不调则病作。甚至积
而不行。则病更作。昔人谓经至。十年无男子合则不调。未至十年。思男子合而不得。亦不
调。不调则瘀不去。新误行。或渍而入骨。或变而成肿。故云室女忧思积想在心。则经闭而
痨怯者多。然亦有因脾胃伤损者。不尽可作血凝经闭治也。只宜调养脾胃。脾气旺则能生血
而经自通。亦有因饮食停滞致伤脾胃者。宜消食健脾。若经来时。饮冷受寒。或吃酸物。以
致凝积。血因不流。当以辛温活血行气药通之。此经闭也。精神壮盛。阴血有余。偶感风寒。
或食冷物。以致气滞血凝而闭。宜以通气活血药导之。此气滞也。先天不足。或病后产后失
于调理。以致真阴亏损。火热煎熬。或阴虚火旺。肝不生血。或堕胎。及产多而亡血。或因
久患潮热。盗汗耗血。乃将成痨瘵之候矣。宜以滋阴养血清火药治之。此血枯也。故即血凝
之症。当有经闭气滞血枯三项因缘。未可概视。若专用攻伐。恐经不通而血反涸也。至如痛
经一症。乃将行经而少腹腰腿俱痛。此淤血。当于临经时血热气滞也。宜以通利活血药调之。
经病大端。不过如是。而其详则有可举者。如经水不调。所下淡色似水者。血虚也。宜四物
汤加参、 、香附。腹痛加阿胶、艾。下血色紫而成块者。热从火化而热血凝结也。或离经
畜血所致。经水必下多或作痛。宜四物加芩、连、知、柏、白芍。妇人室女月不调。血积坚
如石者。受寒也。宜和血通经汤。妇女经不调者。或由诸般气滞也。宜艾附丸。经不调先期
而来者。血热也。宜四物加芩、连。或凉血调经丸。经行先期腰腹发热者。亦血热也。宜凉
血丸。经水不调。临行时先腹痛者。气滞血实也。宜四物加延胡索、炒枳壳、蓬术、木香、
桃仁。月行时。口渴。吃水多。心痞。喜呕。不进饮食者。脾病也。宜山栀汤。妇人年二十
余。月来不匀。来时先呵欠。腹隐痛。血色紫。食少无力者。弱也。宜黄连白术汤。经来紫
黑色。一月二次。或三次。不思饮食。口干而苦。发热者。血热妄行也。宜四君子汤加生地、
当归、陈皮、麦冬、白芍、木通、甘草。经来或不来。腹痛。喜食热物者。气痛也。宜半夏
木通汤。经来时。心神不宁。四肢微热。虚劳者。曾受惊也。宜菖蒲饮。临经时。或食生冷
酸涩。至膀胱小腹疼。腹饱闷者。血偶滞也。宜破结丸。经水后期而行者。血虚有寒也。宜
四物加黄 、陈皮。或香附芎归汤。过期太甚。胶艾丸。经水过期色淡者。痰也。宜二陈汤
加川芎、当归。有痰占住血海之地。因而不来。目必渐昏。肥人多有之。是痰碍经而不行也。
宜星芎丸。经来十数日不止者。血热也。宜止血药中加山栀、柴胡。经水来而不止者。气虚
不能摄血也。宜补气固经丸。经水过多不止。平日肥壮。不发热者。体虚寒也。宜姜棕散。
经水过多不止。平日瘦弱。常发热者。由火旺也。宜龟板丸。经来不止及血崩者。血溢也。宜
必效散。妇人四十九岁。经当止。今每月却行过多。及五旬外。月事比少时更多者。血热或
血不归经也。宜芩心丸、琥珀丸。妇人室女经闭。疼痛。或成血瘕者。淤积也。宜通经丸。
经闭。或但不调。血块气痞腹痛者。气血滞也。宜调经汤。或烦热肢疼体痛。口干盗汗。嗜卧。
经不调。寒热如疟。痰嗽骨蒸者。血虚也。宜逍遥散。不愈。加味逍遥散。瘦弱人经闭者。
血气受伤。或生育多也。宜四物加红花、桃仁。又瘦人经闭者。或气滞也。宜通经丸、调经
汤。经壅。身体发虚。四肢无力。潮热骨疼者。内有气块也。宜苍术香附丸。经闭腹痛者。
内结腹痛也。宜归尾丸。经事不来者。血闭也。宜调经琥珀汤。经闭不来。或过月者。血不
调也。宜红花汤。经行后作痛者。气血虚也。宜八珍汤。妇人室女。七情伤感。至于血并。
心腹作疼。或连腹痛。或引背膂上下攻刺痛。血瘀作搐。或经不调。一切血气病也。宜延胡
索散。有血气发来似刀刮搅肠胃。及心胸刺痛欲绝者。血气冲心也。宜红花散。有游走至腰
膂俱痛者。亦血气痛也。宜蓬术散。有上气冲心。变作干血气者。血气久而不行也。宜丝瓜
散。有干血痨者。忧思积想所致也。宜月红汤。有妇人血黄者。血瘀病也。宜茄子散。其总
治经水不调。或前或后。或多或少。及一切气食等症。则惟四制香附丸。或丹参散为主。经
病之烦多若此。然而有宜小心者。妇人二三月经不行。宜用验胎法以验之。未可遽用攻伐通
利之剂也。如果验之无胎。斯可随症而通之。或至瘦弱身热。口干唇颊红色。下午尤甚。或
先微寒。乃血枯经闭。阴虚发热。将成痨瘵也。宜逍遥散。妇人之病。甚于男子。不益可信
哉。
脉法 脉经曰。左手关上脉阴虚者。足厥阴经也。妇人病苦月经不利。腰腹痛。肝
脉沉之而急。浮之亦然。女人月事不来。时亡时有。得之少时有所坠堕。尺脉滑。血气实。
妇人经脉不利。宜服大黄朴硝汤。下去经血。针关元泻之。少阴脉弱而微。微则少血。寸口
脉浮而弱。浮则为虚。弱则无血。脉来如琴弦。少腹痛。主月不利。孔窍生疮。尺脉来而断
续者。月水不利。当患小腹引腰痛。气滞上攻胸臆也。经不通。绕脐寒疝痛。其脉沉紧。此
由寒气客于血室。血凝积血为气所冲。新血与故血相搏。故痛。肾脉微涩。为不月。李 曰。
浮涩胁伤经不利。浮绝精伤与经闭。又曰。经病前后。脉软如常。寸关虽调。尺绝痛肠。沉
缓下弱。来多要防。微虚不利。间月何妨。浮沉一止。或微迟涩。居经三月。气血不别。三
月以上。经闭难当。心脾病发。关伏寸浮。心事不足。左寸沉结。又曰。肾脉沉微。气虚也。
女子崩带。经脉不调。
月水不调 陈自明曰。妇人月水不调。由风邪乘虚客于胞中。而伤冲任之脉。损手
太阳少阴之经。盖冲任之脉皆起胞中。为经血之海。与小肠心为表里。乳汁下为月水。然
月水乃经络之余。苟能调摄得宜。则经以时应矣。刘完素曰。月水不调。则风热伤于经血。
故血在内不通。或内受邪热。脾胃虚损。不能饮食。荣卫凝涩。或大肠虚。变为下利。流入
关元。致绝子嗣。李杲曰。经不调。右尺脉按之空虚。是气血俱脱大寒症。轻手其脉数疾。
举指弦紧或涩。皆阳脱症。阴火亦亡。见热症于口鼻眼。或渴。此皆阴躁阳欲去也。用升阳
举经汤。大升浮血气。补命门之下脱也。戴思恭曰。月水或前后。或多少。或欲来先病。或
来而断续。皆曰不调。和气饮加香附五分。经来或不来。皆腹痛。皆血不调也。欲调血先调
气。四物加吴萸五分。痛甚。延胡索汤。然又恐感外邪食积。宜详审。和气饮却能兼治。李
曰。以期言之。对期者。性和血足易受孕。差一二日不为害。以色言之。心主血。阴从阳。
故红为正。虽不对期。而色正者易调。或前后多少。或逾月不至。或一月再至。当归散、调
经散、单丹参散。经前后痛。通用交加地黄丸、七制香附丸。万全曰。经不调有三。一脾虚。
二冲任损伤。三痰脂凝塞。胃为水谷之海。血气之母也。惟忧愁思虑。心气受伤。则脾气失养。郁结不通。腐化不行。
饮食减少。斯有血枯血闭。及血少色淡。过期。或数月一行也。又脾为血海冲任之系。或嫉怒褊急。以伤肝气。致冲任
失
守。血气妄行。或血未行而妄合以动其血。或经未断而即合。冲任内伤。血海不固。为崩为漏。有一月再行者矣。肥硕
之人。膏脂充满。元室之户不开。或痰涎壅滞。血海之波不流。故有过期而经始行。或数月而经一行。及为浊为带为经
闭。为无子之病者矣。
月闭 陈自明曰。或醉饱入房。或劳役过度。或吐血失血。伤损肝脾。但滋其化源。其经自通。若小便不利。
头眩腰背痛。足寒时痛。久而血结于内。变为 瘕。若血水相并。脾胃虚弱。壅滞不通。变为水肿。若脾气衰弱。不能
制水。水浸肌肉。变为肿满。当益津液。大补脾胃。方可保生。张从政曰。月不通者。经曰。胞脉闭也。胞脉者属火。
而络于脬中。今气上迫肺。心气不得下通也。茶调散吐之。吐讫。玉烛散、三和汤、桂苓白术散。量虚实选用。慎勿服
峻热药。致变肺痿骨蒸潮热。咳嗽咯脓呕血喘逆。尿涩寝汗不已。渐至脉大形瘦。必不救。李杲曰。二阳之病发心脾。
女子不月。其传为风消。为息贲。死不治。妇人脾胃久虚。形羸气血衰。致经不行。病中消。胃热善食。渐瘦液枯。夫
经
者血脉津液所化。为热所烁。肌肉消瘦。时燥渴。血海枯竭。病名血枯经绝。宜泻胃之燥热。补益气血。经自行矣。此
症或经适行而有子。子不安。为胎病者有矣。或心包脉洪数。躁作。时见大便秘涩。小便虽清不利。而经闭绝。此乃血
海干枯。宜调血脉。除包络中火邪。而经自行。内经所谓小肠移热于大肠。为 瘕。为沉。脉涩不利。则月事沉滞而不
利。故云为 瘕为沉也。或因劳心。心火上炎。月事不来。安心和血泻火。经自行矣。故经云胞脉闭也。胞脉者属心而
络于胞中。
今气上迫肺。心气不得下。故月不来也。又曰。凡妇女之病。经水适断。俱作少阳治之。伤寒杂病皆同。经云。身有病
而有邪。经脉闭也。经脉闭者。尺中不至。胞脉闭者。生化源绝。二者皆血病也。厥阴主之。厥阴病则少阳病矣。治法
或实作大热。或变成痨。脉有浮中沉之不同。故药有表里和之不一。察其在气在血。定其行阴行阳。使大小得宜。轻重
各当。则可万全。此少阳一治不可不知也。朱震亨曰。阴虚。经脉久不通。尿涩体痛。四物加苍术、牛膝、陈皮、甘草。
又用苍莎丸料加苍耳、酒芍药为丸。就用前药吞下。经候微少。渐渐不通。手足烦疼渐瘦。潮热。脉微数。四物去芎、
地、加泽兰三倍、甘草半分。王伦曰。经不行。有由脾胃损伤者。不可便为经闭死血。轻用攻破药。须审脾胃如何。若
因饮食劳倦。损伤脾胃。少食恶食。泄泻疼痛。或因误服汗下攻伐药。伤其中气。致血少不行。只宜用白术为君。苓芍
为臣。佐以黄 、甘草、陈皮、麦芽、柴胡、芎、归等。脾旺自能生血。而经自行。又有饮食积滞。致损脾胃。亦宜
消积补脾。若脾胃无病。果有血结。方可行血通经。李 曰。经行时。余血一点未尽。或外被风寒。湿冷暑热。或内伤
生
冷。七情郁结。为痰为瘀。曰血滞。或经止后。用力太过。入房太甚。及食燥热。以致火动邪盛而精血衰。曰血枯。经
后被惊。血气妄行。上逆则从口鼻出。逆于身则水血相搏。变为水肿。恚怒则气血逆于腰腿心腹背胁手足间。重痛。经
行则发。过期则止。怒极伤肝。则有眩晕呕血瘰 血风疮疡等病。加之经血渗漏于其间。遂成窍穴生疮。淋沥不断。湿
热相搏。遂为崩带。血结于内。变为 瘕。凡此变症百出。不过血滞血枯而已。但血滞血枯。俱有虚热。故重则经闭不
通。以滞枯分言之。轻则经不调。止言虚与热而已。总而言之。经水不通。不出虚热痰气四症。不调亦相似。则饮食调
和。自然血气流通。更有凝滞。然后可用红花当归散、紫葳散、通经丸、导经丸之类。虚者只用当归散。通后又须养血
益阴。使津液流通。若以毒药攻逐。必死。又曰。经闭腹大。仅一月间便能动作。乃至过期不产。或腹痛。必是虫症。
雄砂丸主之。李时珍曰。经闭有有余不足二症。有余者血滞。不足者伤肝。素问云。少时有所大脱血。或醉入房中。气
郁肝
伤。故月来衰少。或不来。治之以乌贼骨四芦茹一。此正血闭不足之病也。万全曰。经闭而骨蒸潮热。脉虚。用增损八
[General Principles]
Women's diseases are twice as numerous as men's. Their origins do not exceed the four major categories: menstruation (Jing), childbirth (Chan), metrorrhagia (Beng), and leukorrhea (Dai). Therefore, although this book has only nine chapters, all diseases are encompassed within them.
The main text of each chapter strives to be exhaustive in categorization and thorough in principle, seemingly leaving no sequelae unaddressed. However, disease manifestations are variable; there may be omissions. One must exercise discretion according to the situation, adjust prescriptions based on the disease trend, and avoid rigid adherence. As Yue Fei said, "The subtlety of application lies in the mind." This applies equally to military strategy and medical practice.
Although Binglou (metrorrhagia and metrostaxis) belongs to blood disorders, it is not exclusively caused by menstruation. Predecessors often conflated it with menstrual diseases, which is incorrect. Hence, I have placed it under the chapter on postpartum diseases.
Xiaochan (miscarriage) is originally a disorder of pregnancy and should not simply be listed sequentially after Dachan (term delivery). Placing it before term delivery clarifies that its pathology belongs to the prenatal stage.
For discussions by predecessors following the main text of each chapter, only those that are refined, appropriate, and consistent with orthodox principles are selected for inclusion, to avoid contradictions.
Ancient formulas collected are included only if they have been tested and proven effective. For others, the properties and flavors of the herbs must be analyzed to ensure they match the indicated symptoms. After repeated verification, if they are precisely targeted, they are recorded. If any hesitation arises, they are discarded. Even dosages are carefully weighed to avoid misleading future practitioners.
Some formulas that match symptoms but were not cited in the main text or previous discussions are appended for reference, as I am unwilling to discard valuable resources.
[Menstruation]
"Jing" (Menstruation) refers to regularity. At age fourteen, women experience the patency of the Ren Mai (Conception Vessel) and the arrival of Tian Gui (substance promoting reproductive maturity). The Ren and Chong Mai (Penetrating Vessel) become the Sea of Meridians, circulating externally along the meridians and nourishing internally the Zang-Fu organs. When Qi and Blood are harmonious and circulate continuously, the Chong and Ren vessels overflow monthly, causing menstruation to arrive on time. This is the normal pattern. Thus, menstruation is valued for its regularity. If it arrives early or late, in large or small amounts, two or three times a month, or once every few months, it is considered irregular (Bu Tiao). Irregularity leads to disease, and if stagnation persists without flow, the condition worsens. Ancients stated that if a woman does not cohabit with a man for ten years, her menstruation becomes irregular; if she desires cohabitation but cannot attain it before ten years, it also becomes irregular. Irregularity prevents the expulsion of stasis, leading to erratic new blood flow, infiltration into bones, or formation of masses. Thus, unmarried girls suffering from worry and fixation often develop amenorrhea accompanied by consumptive weakness. However, some cases arise from Spleen-Stomach damage and should not all be treated as blood stasis amenorrhea. Treatment should focus on regulating the Spleen-Stomach; when Spleen Qi is robust, it generates Blood, and menstruation flows naturally. Some cases result from food stagnation damaging the Spleen-Stomach; treatment should involve resolving food stagnation and strengthening the Spleen. If cold drinks or sour foods during menstruation cause凝积 (coagulation/stagnation) preventing blood flow, acrid-warm herbs that invigorate blood and move Qi should be used. This is Amenorrhea (Jing Bi). In cases of robust spirit and abundant Yin-Blood, occasional exposure to wind-cold or consumption of cold foods may cause Qi stagnation and blood coagulation leading to closure; ventilating Qi and invigorating blood herbs should guide the flow. This is Qi Stagnation (Qi Zhi). Congenital deficiency, or improper regulation after illness or childbirth, leading to depletion of True Yin, scorching by fire-heat, Yin deficiency with fire hyperactivity, Liver failing to generate blood, abortion, excessive childbirth causing blood loss, or chronic tidal fever and night sweats consuming blood, are precursors to Lao Zhai (consumptive disease like tuberculosis). Treatment requires herbs that nourish Yin, tonify blood, and clear fire. This is Blood Withering (Xue Ku). Therefore, even in cases of blood coagulation, one must distinguish between amenorrhea, Qi stagnation, and blood withering; they cannot be viewed uniformly. Using only purgative methods risks blocking menstruation further and depleting blood. Regarding Dysmenorrhea (Tong Jing), pain in the lower abdomen, waist, and legs occurring just before menstruation indicates blood stasis due to heat and Qi stagnation at the onset of menses; clearing and invigorating blood herbs should regulate it.
The broad categories of menstrual diseases are as above, but details include:
If menstrual flow is pale and watery, it indicates Blood Deficiency; use Si Wu Tang (Four Substances Decoction) plus Renshen (Ginseng), [missing character, likely Huangqi/Astragalus], and Xiangfu (Cyperus Rhizome). Add Ejiao (Donkey-hide Gelatin) and Aiye (Mugwort Leaf) for abdominal pain. If the blood is purple and clotted, it indicates Heat transforming from Fire causing congealed hot blood, or retained blood outside the vessels; menstruation is heavy or painful; use Si Wu Tang plus Huangqin (Scutellaria Root), Lianzi (Lotus Plumule), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), and Baishao (White Peony Root). If a woman or girl has hard, stone-like blood accumulation due to cold, use He Xue Tong Jing Tang (Harmonize Blood and Unblock Menstruation Decoction). If irregularity is due to various Qi stagnations, use Ai Fu Wan (Mugwort and Cyperus Pill). Early menstruation indicates Blood Heat; use Si Wu Tang plus Huangqin, Lianzi, or Liang Xue Tiao Jing Wan (Cool Blood Regulate Menstruation Pill). Early menstruation with lumbar/abdominal heat also indicates Blood Heat; use Liang Xue Wan (Cool Blood Pill). Premenstrual abdominal pain indicates Qi stagnation and Blood Excess; use Si Wu Tang plus Yanhusuo (Corydalis Rhizome), Chao Zhike (Fried Aurantium Fruit), Pengzhu (Curcuma Zedoaria), Muxiang (Aucklandia Root), and Taoren (Peach Seed). Thirst, polydipsia, epigastric fullness, nausea, and anorexia during menstruation indicate Spleen Disease; use Shanzhi Tang (Gardenia Decoction). A woman in her twenties with irregular cycles, yawning at onset, dull abdominal pain, purple blood, poor appetite, and weakness indicates Deficiency; use Huanglian Baizhu Tang (Coptis and Atractylodes Macrocephala Decoction). Dark purple-black blood, frequent menstruation (2-3 times/month), anorexia, dry bitter mouth, and fever indicate Erratic Blood Flow due to Heat; use Si Jun Zi Tang (Four Gentlemen Decoction) plus Shengdi (Rehmannia Root), Danggui (Angelica Sinensis), Chenpi (Tangerine Peel), Maidong (Ophiopogon Tuber), Baishao, Mutong (Akebia Stem), and Gancao (Licorice Root). Absent or irregular periods with abdominal pain preferring warmth indicate Qi Pain; use Banxia Mutong Tang (Pinellia and Akebia Decoction). Restlessness, slight limb heat, and deficiency signs during menstruation due to prior fright indicate Shock; use Changpu Yin (Acorus Drink). Bladder/lower abdominal pain and fullness after consuming cold/sour foods during pre-menstruation indicates occasional blood stagnation; use Po Jie Wan (Break Knots Pill). Delayed menstruation indicates Blood Deficiency with Cold; use Si Wu Tang plus Huangqi (Astragalus Root) and Chenpi, or Xiangfu Xiong Gui Tang (Cyperus, Ligusticum, and Angelica Decoction). Significant delay uses Jiao Ai Wan (Colla Corii Asini and Mugwort Pill). Pale delayed menstruation indicates Phlegm; use Er Chen Tang (Two-Chen Decoction) plus Chuanxiong (Ligusticum Rhizome) and Danggui. Phlegm obstructing the Sea of Blood causes amenorrhea and blurred vision, common in obese individuals; use Xing Xiong Wan (Arisaema and Ligusticum Pill). Prolonged bleeding (>10 days) indicates Blood Heat; add Shanzhi (Gardenia Fruit) and Chaihu (Bupleurum Root) to hemostatic formulas. Non-stop flow due to Qi Deficiency failing to control blood requires Bu Qi Gu Jing Wan (Tonify Qi Secure Menstruation Pill). Heavy flow in obese, non-febrile patients indicates Body Deficiency Cold; use Jiang Zong San (Ginger and Sumac Powder). Heavy flow in thin, febrile patients indicates Fire Hyperactivity; use Guiban Wan (Turtle Shell Pill). Metrorrhagia and flooding indicate Blood Overflow; use Bi Xiao San (Extremely Effective Powder). Women aged 49+ with excessive flow despite expected cessation, or >50 with increased flow, indicate Blood Heat or Blood failing to return to its vessel; use Qin Xin Wan (Scutellaria Heart Pill) or Hupo Wan (Amber Pill). Amenorrhea with pain or blood masses (Xue Xia) indicates Stasis; use Tong Jing Wan (Unblock Menstruation Pill). Amenorrhea or irregularity with clots, Qi distension, and pain indicates Qi-Blood Stagnation; use Tiao Jing Tang (Regulate Menstruation Decoction). Irritability, limb/body pain, dry mouth, night sweats, lethargy, irregular menses, malaria-like chills/fever, phlegm cough, and bone-steaming fever indicate Blood Deficiency; use Xiao Yao San (Free and Easy Wanderer Powder), or Jia Wei Xiao Yao San if ineffective. Thin women with amenorrhea due to Qi-Blood injury or multiple births use Si Wu Tang plus Honghua (Safflower) and Taoren. Thin women with Qi stagnation use Tong Jing Wan or Tiao Jing Tang. Menstrual obstruction with body deficiency, limb weakness, tidal fever, and bone pain indicates internal Qi mass; use Cangzhu Xiangfu Wan (Atractylodes and Cyperus Pill). Amenorrhea with internal abdominal pain uses Guiwei Wan (Angelica Tail Pill). Absent menstruation (Blood Closure) uses Tiao Jing Hu Po Tang (Regulate Menstruation and Amber Decoction). Delayed/absent menstruation due to irregular blood uses Honghua Tang (Safflower Decoction). Post-menstrual pain indicates Qi-Blood Deficiency; use Ba Zhen Tang (Eight Treasures Decoction). Emotional injury causing blood pooling, heart/abdominal pain radiating to back, stabbing pain, spasms, or irregular menses (all Qi-Blood disorders) use Yanhusuo San (Corydalis Powder). Severe abdominal/chest pain resembling knife scraping indicates Qi-Blood rushing to the Heart; use Honghua San (Safflower Powder). Migratory pain to waist/back is Qi-Blood Pain; use Pengzhu San (Curcuma Zedoaria Powder). Upper rushing Qi transforming into Dry Blood Qi (chronic stagnation) uses Sigua San (Loofah Sponge Powder). Dry Blood Lao (consumption) due to worry/fixation uses Yuehong Tang (Moon Red Decoction). Blood Yellow due to stasis uses Qiezi San (Eggplant Powder). For general irregularity (early/late, heavy/light) and Qi/Food disorders, Sizhi Xiangfu Wan (Four-Processed Cyperus Pill) or Danshen San (Salvia Powder) are primary. Caution: If menstruation stops for 2-3 months, verify pregnancy first; do not use purgatives blindly. If confirmed non-pregnant, treat symptomatically. Emaciation, fever, dry mouth, red cheeks (worse in afternoon), or initial chills indicate Blood Withering Amenorrhea with Yin Deficiency Fever, precursor to Lao Zhai; use Xiao Yao San. Women's diseases are indeed more severe than men's.
[Pulse Diagnosis]
*Mai Jing* states: Deficient Yin pulse at the left Guan position indicates Foot Jueyin channel involvement. Women with difficult menstruation and lumbar/abdominal pain have a Liver pulse that is urgent on deep palpation and similarly so on superficial palpation. Amenorrhea with intermittent flow, history of falls in youth, and slippery Chi pulse indicates solid Blood-Qi; use Dahuang Puxiao Tang (Rhubarb and Mirabilite Decoction) to purge blood, and needle Guanyuan (CV4) with draining method. Weak and fine Shaoyin pulse indicates low blood; floating and weak Cun pulse indicates deficiency and lack of blood. String-like pulse with lower abdominal pain indicates menstrual difficulty and sores in orifices. Intermittent Chi pulse indicates menstrual difficulty, lower abdominal pain radiating to the lower back, and Qi stagnation attacking the chest. Obstructed menstruation with periumbilical cold hernia pain and deep-tight pulse indicates Cold pathogen invading the Blood Chamber, where coagulated blood clashes with new blood causing pain. Fine and choppy Kidney pulse indicates amenorrhea. Li Shi says: Floating and choppy pulses indicate胁 (flank) injury affecting menstruation; floating and absent pulses indicate Essence injury and amenorrhea. He adds: Before/during menstruation, if the pulse is soft and normal, but the Chi pulse is absent with intestinal pain, or deep-slow and weak below indicating heavy flow risk, or fine-deficient indicating irregular intervals, or floating/sinking stopping with fine-slow-choppy characteristics indicating Ju Jing (periodic menstruation every 3 months) due to confused Qi-Blood, then amenorrhea beyond 3 months is difficult to manage. Heart-Spleen disease manifests as hidden Guan and floating Cun. Insufficient mental energy shows as deep-knotted Left Cun. Deep-fine Kidney pulse indicates Qi Deficiency, leading to flooding, leukorrhea, and irregular menstruation.
[Irregular Menstruation]
Chen Ziming states: Irregular menstruation results from Wind-Evil invading the Uterus due to deficiency, damaging the Chong and Ren vessels and the Hand Taiyang and Shaoyin channels. These vessels originate in the Uterus, serving as the Sea of Menstrual Blood, exterior-interior related to the Small Intestine and Heart. Milk transforms into menstruation. Since menstruation is the remainder of meridians, proper care ensures timely cycles. Liu Wansu states: Wind-Heat damages blood and vessels, causing internal blockage, or internal Heat damages the Spleen-Stomach, preventing eating, causing Nutritive-Wei stagnation, or Large Intestine deficiency causes diarrhea flowing into Guanyuan, leading to infertility. Li Gao states: Irregular menstruation with empty Right Chi pulse indicates massive Qi-Blood depletion and Great Cold. Rapid pulse on light touch, wiry-tight or choppy on lifting indicates Yang collapse and loss of Yin Fire, manifesting as Heat in mouth/nose/eyes or thirst (Yin restlessness/Yang departure). Use Sheng Yang Ju Jing Tang (Raise Yang Lift Menstruation Decoction) to greatly lift floating Qi-Blood and replenish Mingmen depletion. Dai Sigong states: Variations in timing or amount, or illness before onset, or interrupted flow, are all irregular. Heqi Yin plus 5 fen Xiangfu. Abdominal pain regardless of flow indicates Blood irregularity. To regulate Blood, first regulate Qi; use Si Wu Tang plus 5 fen Wuzhuyu. Severe pain uses Yanhusuo Tang. Caution against external pathogens or food retention; Heqi Yin treats both. Li Shi states: Timing-wise, regular cycles with harmonious Qi and sufficient Blood facilitate conception; deviation of 1-2 days is harmless. Color-wise, Heart governs Blood, Yin follows Yang, so red is correct. Regular color facilitates regulation even if timing varies. Use Danggui San, Tiao Jing San, or Danshen San alone. Pain before/after menses uses Jiaohuang Di Huang Wan or Qizhi Xiangfu Wan. Wan Quan states: Three causes: 1. Spleen Deficiency, 2. Chong-Ren damage, 3. Phlegm-Lipid obstruction. The Stomach is the Sea of Food/Water and Mother of Qi-Blood. Worry/thought injures Heart Qi, starving Spleen Qi, causing stagnation, impaired digestion, reduced intake, leading to Blood Withering/Closure, scant pale blood, delayed or infrequent cycles. The Spleen connects to the Sea of Blood and Chong-Ren. Anger/narrow-mindedness injures Liver Qi, causing Chong-Ren instability and erratic Qi-Blood flow. Coitus before flow or during flow damages Chong-Ren internally, destabilizing the Sea of Blood, causing flooding/metrorrhagia or double cycles. Obese individuals with fat accumulation may have blocked uterine openings or phlegm-damp obstructing the Sea of Blood, causing delayed/infrequent cycles, turbidity, leukorrhea, amenorrhea, or infertility.
[Amenorrhea]
Chen Ziming states: Drunken sex, overwork, or hemorrhage damages Liver-Spleen; nourishing the source restores menstruation. If dysuria, dizziness, lumbar/back pain, cold/painful feet persist, internal blood coagulation forms masses. Blood-water combination with weak Spleen-Stomach causes edema. Weak Spleen failing to control water causes swelling; benefit fluids and strongly tonify Spleen-Stomach to preserve life. Zhang Congzheng states: Amenorrhea is "Uterine Pulse Closure." The Uterine Pulse belongs to Fire and connects to the bladder. Now Qi presses upward on the Lung, preventing Heart Qi from descending. Induce vomiting with Chatiao San. Then use Yuzhu San, Sanhe Tang, or Guiling Baizhu San based on deficiency/excess. Avoid harsh hot herbs to prevent Lung萎 (atrophy), bone-steaming fever, cough with pus/blood, wheezing, dysuria, night sweats, emaciation, and death. Li Gao states: Diseases of the Two Yangs originate in Heart-Spleen; women miss menses, transmitting to Feng Xiao (Wind Consumption) or Xi Ben (Breath Burden), which is fatal. Chronic Spleen-Stomach deficiency leads to emaciation, Qi-Blood decline, and amenorrhea. Middle Xiao (Middle Burner Consumption) involves Stomach Heat, polyphagia, emaciation, fluid depletion. Menstruation is transformed from blood/fluids; scorching by Heat causes muscle wasting, dryness/thirst, and Sea of Blood depletion (Xue Ku Jing Jue). Clear Stomach dryness-Heat, tonify Qi-Blood, and menstruation returns. Pregnancy during recent menses may endanger the fetus.洪数 (Surging-Rapid) Pericardium pulse with irritability, constipation, and cloudy/difficult urination with amenorrhea indicates dried Sea of Blood; regulate blood vessels and remove Pericardium Fire. *Neijing* states: Small Intestine Heat transferring to Large Intestine forms masses/depression; choppy difficult pulse indicates stagnant menstruation. Mental labor causing Heart Fire ascending stops menstruation; calm the Heart, harmonize blood, clear Fire. *Jing* states: Uterine Pulse Closure belongs to Heart connecting to Uterus. Qi pressing Lung prevents Heart Qi descent, stopping menses. Also: Discontinued menses in women should be treated as Shaoyang disorders, same as Shanghan/Zabing. *Jing* states: "Body has disease but also evil, meridian closure." Meridian closure means absent Chi pulse; Uterine Pulse closure means exhausted generation source; both are Blood disorders governed by Jueyin. Jueyin disease leads to Shaoyang disease. Treatments vary by excess/deficiency, heat/consumption, pulse depth, Qi/Blood location, Yin/Yang movement. Balance size/heaviness appropriately for safety. This Shaoyang treatment principle is crucial. Zhu Zhenheng states: Yin Deficiency with long-term obstruction, dysuria, body pain uses Si Wu Tang plus Cangzhu, Niuxi, Chenpi, Gancao. Or Cangsha Wan material plus Cang'erjiu Shaoyao pills taken with previous decoction. Scanty/obstructing menses, limb pain, emaciation, tidal fever, fine-rapid pulse: Si Wu Tang minus Chuanxiong/Shengdi, add 3x Ze Lan, 0.5 fen Gancao. Wang Lun states: Amenorrhea due to Spleen-Stomach damage should not be immediately diagnosed as dead blood; avoid harsh attacks. Assess Spleen-Stomach. Diet/fatigue damage Spleen causing poor appetite, diarrhea, pain; or mistaken sweating/purgation damaging Middle Qi causing low blood flow. Use Baizhu as Sovereign, Ling/Shao as Ministers, assisted by Huangqi, Gancao, Chenpi, Maiya, Chaihu, Chuanxiong, Danggui. Robust Spleen generates blood naturally. Food stagnation damaging Spleen requires resolving stagnation and tonifying Spleen. Only if Spleen-Stomach is healthy and blood clot exists, invigorate blood. Li Shi states: Residual blood, external wind-cold/damp-heat, internal cold/raw food, or emotional stagnation causing Phlegm/Stasis is Blood Stagnation. Overexertion/sex after menses or dry-hot foods causing Fire excess and essence depletion is Blood Withering. Shock after menses causes erratic Qi-Blood rising from nose/mouth or mixing with water causing edema. Anger reverses Qi-Blood in waist/legs/abdomen/back/sides/hands/feet causing heavy pain, starting with menses and stopping after delay. Extreme anger injures Liver causing dizziness, hematemesis, scrofula, wind-sores. Leakage causes orifice sores and continuous discharge; Damp-Heat interaction causes flooding/leukorrhea. Internal clots form masses. All variations stem from Blood Stagnation or Withering, both involving Deficient Heat. Heavy cases are closed; light cases are irregular (Deficiency/Heat). Generally, obstruction stems from Deficiency, Heat, Phlegm, Qi. Regulation improves with diet harmony. If stagnation persists, use Honghua Danggui San, Ziwei San, Tongjing Wan, Daojing Wan. Deficiency uses Danggui San. After unblocking, nourish blood and Yin to flow fluids. Poisonous purges lead to death. Abdominal distension with fetal movement within a month or delayed birth/pain indicates Parasites; Xionsha Wan is primary. Li Shizhen states: Excess is Blood Stagnation; Deficiency is Liver Injury. *Suwen* states: Major hemorrhage in youth or drunken sex causes Qi stagnation/Liver injury, leading to scant/absent menses. Treat with Hai Piao Xiao (Cuttlefish Bone) 4 parts and Lu Ru (Asparagus Root) 1 part. This addresses Blood Closure Deficiency. Wan Quan states: Amenorrhea with bone-steaming fever and deficient pulse uses Zengsun Ba...