灰以渗于下。然后用四物加延胡索散。凉血和经之药是也。
来止腹痛 张从政曰。经来腹痛。由风冷客于胞络冲任。或伤手太阳少阴经。用温经汤、桂枝桃仁汤。若忧思
气郁而血滞。桂枝桃仁汤、地黄通经丸。若血结成块。万病丸。刘完素曰。气冲经脉。月事频并。脐下痛。芍药六合汤。
若经欲来。脐腹绞痛。八物汤。朱震亨曰。经候过而作痛者。乃虚中有热也。经将来作疼者。血实也。四物加桃仁、黄
连、香附。临行腰疼腹痛。乃郁滞有瘀血。四物加红花、桃仁、蓬术、延胡、木香、香附。发热加黄芩、柴胡。紫色成
块者热也。四物加黄连、柴胡。经行微少。或胀或疼。四肢痛。四物加延胡、没药、白芷为末。淡醋汤下。经不调。心
腹疼痛。只用芎、归二味。名君臣散。经欲行。脐腹绞痛。四物加延胡、槟榔、苦楝、木香减半。又曰。月候不调之中。
有兼疼痛者。或常时痛。或经前痛。血积也。或经后痛。血虚也。有兼发热者。或常时热积也。或经来时热。血虚有热
也。王肯堂曰。仲景治带下。月水不利。小腹满痛。经一月再见者。土瓜根散主之。此散乃破坚下血之剂。观此则经不
及期。有因瘀血者矣。前论所未及也。然欲知瘀血。须以小腹满痛为凭。又曰。经水者。行气血。通阴阳。以荣于身者
也。或外亏卫气之充养。内乏荣血之灌溉。血气不足。经候欲行。身体先痛也。张介宾曰。凡经期有气逆作痛。全滞而
不虚者。须顺气。宜调经饮。甚者。排气饮。气血俱滞。失笑散。若寒滞于经。或因外寒所逆。或平日不慎寒凉。致凝
聚作痛。而无虚者。须祛寒。宜调经饮加姜、桂、吴萸。或和胃饮。若血热血燥。滞涩不行作痛。加味四物汤。或
保阴煎去续断、加减。以上诸症。但察其有滞无虚。方是真实。若兼虚不得任行克伐。若痛在经后。多由血虚。八珍汤。
然必察其寒热虚实以为佐使。自效。其有余滞未行者。决津煎最妙。若但遇经期。则必作痛。或食则呕吐。肢体困倦。
或兼寒热。是必素禀不足。八珍汤。虚而寒甚者。理阴煎渐加培补。久必愈。有因带浊多而虚痛者。大营煎。随寒热加
佐使主之。
血色痛块 朱震亨曰。经水阴血也。阴必从阳。故其色红。禀火色也。血为气配。其成块者。气之凝也。将行
而痛。气之滞也。来后作痛。气血俱虚也。色淡亦虚也。错经妄行。气乱也。紫者气热也。黑者热甚也。人但见紫黑痛
块。率为风冷。而用温热。必败。夫热甚者必兼水化。所以热则紫。甚则黑也。李 曰。色紫风也。黑者热甚也。淡白
虚也。或挟痰停水混之也。如烟尘水。如屋漏水。如豆汁。或带黄混浊模糊者。湿痰也。成块作片。色不变。气滞也。
或风冷乘之也。色紫黑。血热也。大概紫者。四物加白芷、荆、防。黑者。四物加香附、芩、连。淡白者。古芎归汤加
参、 、白芍、香附。有痰。二陈加芎、归。如烟尘。二陈加秦艽、防风、苍术。如豆汁。四物加芩连。成块。
四物加香附、延胡、陈皮、枳壳。通用琥珀调经丸。
热入血室 李杲曰。昼则明了。夜则谵语。热入血室。无犯胃气及上二焦。不治自愈。甚则四顺饮子。桃仁承
气汤。症相似。当不妨用之。罗天益曰。热入血室而成结胸。由邪气传入经络。与主气相搏。上下流行。遇经适来适断。
邪乘虚入于血室。血为邪迫入于肝经。肝受邪。则谵语见鬼。复入膻中。则血结于胸。何则。妇人平日水养木。血养肝。
未孕为月水。既孕则养胎。既产则为乳。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。李 曰。妇女伤寒。寒热似疟。经水适断者。亦名热入血室。其血必结而不行。小柴胡汤。或黄
龙汤。加丹皮、桃仁。妇人此症最多。切忌汗下。若见喜忘如狂。腹满泉清。当以淋血法治之。又不可拘于不下也。男
女均有此。男由阳明而传。女人则随经而入。武之望曰。邪入血分。则发在暮。且谵语属胃经者多。恐误犯之。故仲景
云。无犯胃气也。又曰。凡经行后似疟谵语。便是热入血室。又曰。经水适来适断。或有往来寒热者。先服小柴胡以去
其寒热。后以四物汤和之。又曰。潮热有时为内伤为虚。无时为外感为实。虚者大温经汤。热者四物加芩连。骨蒸者大
胡连丸。五心潮者四物加黄连、胡黄连。经前潮热血虚有滞。逍遥散加丹皮、桃仁、延胡。经后潮热血虚有热。逍遥散
去柴胡加生地、地骨皮。此方加减。为退热圣药。
室女寡妇师尼 李 曰。女子十四月至。必近二十方可配。阴气不易成也。或恣食咸酸热燥。致气血上壅不通。
红花当归散、大黄膏、紫葳散。如逾年未下。或年未及而思男。思伤心血。火炎脾亏。肺烁肾枯。而血闭成痨者难治。
四物加柴、芩。逍遥散加芩、连、山栀。以养血凉血。降火柏子仁丸亦妙。因怒逆者。四制香附丸加黄芩、生地。因惊
者。抱胆丸。又曰。寡妇郁闷百端。或想夫。或门户不支。或望子孙。心火频炽。加之饮食浓味。遂成痰火。其症恶风
体倦。乍寒乍热。面赤心烦自汗。肝脉弦长。当抑肝之阴气。柴胡抑肝汤、抑阴地黄丸、越鞠丸。贫苦食淡者。四制香
附丸。每日上午。神思昏愦。怕见明处。恶闻人声。至午后方可。及头昏腹痛惊惕。稍涉劳动。及经来时尤剧。此不得
遂志也。宜清神养荣四物汤。加人参、茯神、陈皮、柴胡、羌活、甘草、香附。万全曰。愆期未嫁之女。偏房失宠之外家。
寡居之妇。庵院之尼。欲动不能遂。感愤不得言。多有经闭之疾。含羞强忍。不欲人知。致成痨瘵难治者。宜四制香
附丸、参术大补丸。攻补兼行。庶几可瘳。此七情之变。难以法治者也。张介宾曰。张氏云。室女月不行。切不可用青
蒿等凉药。医家多以室女为血热。故以凉药解之。殊不知血得热则行。冷则凝。不可不知。若经微少。渐渐不通。手足
骨肉烦疼。日渐羸瘦。渐生痨热。其脉微数。此由阴虚血弱。阳往乘之。少水不能灭盛火。火逼水涸。耗亡津液。治当
养血益阴。毋以毒药通之。宜柏子仁丸、泽兰汤。罗天益曰。宋褚澄疗师尼寡妇。别制方者。盖有谓也。此二种寡居。
独阴无阳。欲心萌而多不遂。是以阴阳交争。乍寒乍热。全类温疟。久则为痨瘵也。武之望曰。师尼寡妇之痨。专主肝
经。以相火寄于肝也。男女之欲。皆从此出。观天地之气始于春。则知欲火之动亦由于肝也。鸟兽孳尾亦然。故治此者。
当以柴胡汤为法。
The grayish powder permeates the lower jiao. Subsequently, Siwu Tang (Four Substance Decoction) combined with Yanhusuo (Corydalis Rhizome) is administered. These are herbs that cool blood and harmonize menstruation.
Abdominal pain during menstruation: Zhang Congzheng stated that abdominal pain occurring during menstruation is caused by wind-cold pathogenic factors lodging in the Bao Luo (uterine collaterals), Chong and Ren meridians, or damaging the Hand-Taiyang Small Intestine Meridian and Hand-Shaoyin Heart Meridian. Treatment may employ Wenjing Tang (Warming the Menses Decoction) or Guizhi Taoren Tang (Cinnamon Twig and Peach Kernel Decoction). If melancholy and worry cause qi stagnation leading to blood stasis, Guizhi Taoren Tang or Dihuang Tongjing Wan (Rehmannia Menstruation-Unblocking Pill) may be used. If blood coagulates into masses, Wanbing Wan (Myriad Diseases Pill) is indicated. Liu Wansu stated that when qi rushes through the meridians, menstruation occurs frequently, accompanied by pain below the umbilicus; Shaoyao Liuhe Tang (Peony Six-Harmony Decoction) is prescribed. If severe cramping pain occurs in the umbilical and abdominal regions just before menstruation begins, Bawu Tang (Eight-Ingredient Decoction) is used. Zhu Zhenheng stated that pain arising after menstruation ends indicates deficiency with internal heat. Pain beginning before menstruation arrives indicates blood excess. In such cases, Siwu Tang (Four Substance Decoction) combined with Taoren (Peach Kernel), Huanglian (Coptis Rhizome), and Xiangfu (Cyperus Rhizome) is employed. Lower back and abdominal pain at the onset of menstruation indicates qi stagnation and blood stasis. Siwu Tang (Four Substance Decoction) combined with Honghua (Safflower), Taoren (Peach Kernel), Ezhu (Curcuma Zedoaria Rhizome), Yanhu (Corydalis Rhizome), Muxiang (Aucklandia Root), and Xiangfu (Cyperus Rhizome) is prescribed. If fever is present, add Huangqin (Scutellaria Root) and Chaihu (Bupleurum Root). Purple-colored menstrual blood forming clots indicates heat; Siwu Tang (Four Substance Decoction) combined with Huanglian (Coptis Rhizome) and Chaihu (Bupleurum Root) is used. Scanty menstruation, accompanied by distension or pain, and limb pain, is treated with Siwu Tang (Four Substance Decoction) combined with Yanhu (Corydalis Rhizome), Moyao (Myrrh), and Baizhi (Angelica Dahurica Root) ground into powder, taken with weak vinegar decoction. For irregular menstruation with heart and abdominal pain, only Xiong (Ligusticum Rhizome) and Gui (Angelica Sinensis Root) are used, named Junchen San (Monarch-Minister Powder). Severe cramping pain in the umbilical and abdominal regions just before menstruation begins is treated with Siwu Tang (Four Substance Decoction) combined with Yanhu (Corydalis Rhizome), Binglang (Areca Seed), Kelian (Melia Azedarach Bark), and Muxiang (Aucklandia Root), with reduced dosages. Furthermore, among irregular menstruations accompanied by pain, pain occurring at any time or before menstruation indicates blood accumulation; pain after menstruation indicates blood deficiency. Regarding accompanying fever, constant fever indicates heat accumulation, while fever during menstruation indicates blood deficiency with heat. Wang Kentang stated that Zhang Zhongjing treated leukorrhea, irregular menstruation, fullness and pain in the lower abdomen, and menstruation occurring twice a month using Tugua Gen San (Trichosanthes Root Powder). This formula breaks firmness and promotes blood discharge. From this, it can be seen that early menstruation can be caused by blood stasis, a point not covered in previous discussions. However, to identify blood stasis, fullness and pain in the lower abdomen must be the criterion. He further stated that menstruation functions to circulate qi and blood, connect yin and yang, and nourish the body. If external Wei Qi (Defensive Qi) is insufficiently nourished, and internal Ying Blood (Nutritive Blood) lacks irrigation, causing qi and blood deficiency, the body may experience pain prior to the onset of menstruation. Zhang Jingbin stated that for menstrual pain caused by qi reversal with complete obstruction but no deficiency, regulating qi is necessary, preferably using Tiaojing Yin (Regulating Menses Decoction). For severe cases, Paixi Yin (Dispersing Qi Decoction) is used. For simultaneous qi and blood stagnation, Shixiao San (Instantly Effective Powder) is indicated. If cold stagnates in the meridians due to external cold invasion or habitual exposure to cold, causing coagulation and pain without deficiency, dispelling cold is required, using Tiaojing Yin (Regulating Menses Decoction) added with Shengjiang (Fresh Ginger), Rougui (Cinnamon Bark), and Wuyu (Evodia Fruit), or Hewei Yin (Harmonizing Stomach Decoction). For pain due to hot blood and dryness causing stagnation, Jiawei Siwu Tang (Modified Four Substance Decoction) or Baoyin Jian (Preserve Yin Decoction) with Xu Duan (Dipsacus Root) removed and modifications applied is suitable. For all the above symptoms, if stagnation is present without deficiency, it represents the true pathology. If deficiency is also present, harsh purgative or dispersing methods cannot be tolerated. Pain occurring after menstruation is mostly due to blood deficiency, treated with Bazhen Tang (Eight Treasure Decoction). One must observe cold, heat, deficiency, and excess to select appropriate adjuvant herbs for efficacy. For residual stagnation preventing flow, Juejin Jian (Decoction for Crossing the River) is excellent. If pain inevitably occurs during menstruation, accompanied by vomiting after eating, limb fatigue, or alternating chills and fever, it indicates congenital insufficiency, treated with Bazhen Tang (Eight Treasure Decoction). For severe deficiency with cold, Liyin Jian (Nourishing Yin Decoction) should be gradually used to tonify, leading to recovery over time. For pain due to excessive leukorrhea and deficiency, Daying Jian (Great Camp Decoction) is used, modified according to cold or heat.
Blood color and clots: Zhu Zhenheng stated that menstrual blood is yin blood. Yin follows yang, hence its red color, inheriting the hue of fire. Blood is paired with qi; clots form due to qi condensation. Pain before flow indicates qi stagnation; pain after flow indicates qi and blood deficiency. Pale color also indicates deficiency. Irregular bleeding indicates qi chaos. Purple color indicates qi heat; black color indicates severe heat. People often see purple-black clots and uniformly attribute them to wind-cold, using warming herbs, which will surely damage the condition. Severe heat necessarily involves water transformation (kidney water controlling fire); thus, heat causes purple color, and extreme heat causes black. Li Gao stated that purple color indicates wind, black indicates severe heat, and pale white indicates deficiency or mixing with phlegm and retained water. Like smoke-dust water, like leaking roof water, like bean juice, or yellow turbid and blurred, indicates damp-phlegm. Clots forming sheets with unchanged color indicate qi stagnation or wind-cold invasion. Purple-black color indicates blood heat. Generally, for purple color, Siwu Tang (Four Substance Decoction) is added with Baizhi (Angelica Dahurica Root), Jingjie (Schizonepeta Spike), and Fangfeng (Saposhnikovia Root). For black color, Siwu Tang (Four Substance Decoction) is added with Xiangfu (Cyperus Rhizome), Huangqin (Scutellaria Root), and Huanglian (Coptis Rhizome). For pale white color, Gu Xiong Gui Tang (Ancient Ligusticum and Angelica Decoction) is added with Renshen (Ginseng Root), [missing character, likely Huangqi], Baishao (White Peony Root), and Xiangfu (Cyperus Rhizome). For phlegm, Erchen Tang (Two-Aged Decoction) is added with Xiong (Ligusticum Rhizome) and Gui (Angelica Sinensis Root). For smoke-dust appearance, Erchen Tang (Two-Aged Decoction) is added with Qinjiao (Gentiana Macrophylla Root), Fangfeng (Saposhnikovia Root), and Cangzhu (Atractylodes Rhizome). For bean juice appearance, Siwu Tang (Four Substance Decoction) is added with Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome). For clots, Siwu Tang (Four Substance Decoction) is added with Xiangfu (Cyperus Rhizome), Yanhu (Corydalis Rhizome), Chenpi (Tangerine Peel), and Zhike (Aurantii Fructus Immaturus). Hupo Tiaojing Wan (Amber Menstruation-Regulating Pill) is universally applicable.
Heat entering the Blood Chamber: Li Dongyuan stated that clarity during the day and delirium at night indicate Heat Entering the Blood Chamber. Do not violate the Stomach Qi or the Upper Two Jiaos; it heals spontaneously. For severe cases, Sishun Yinzi (Four Smooth Infusion) or Tao Ren Cheng Qi Tang (Peach Kernel Bowel-Draining Decoction) may be used if symptoms are similar. Luo Tianyi stated that Heat Entering the Blood Chamber resulting in Chest Binding occurs when pathogenic factors enter the meridians, contend with the host qi, and circulate up and down. When menstruation has just started or stopped, pathogens enter the Blood Chamber due to deficiency. Blood is forced by pathogens into the Liver Meridian. The Liver receiving pathogens leads to delirium and hallucinations. If pathogens re-enter the Danzhong (Conception Vessel area), blood binds in the chest. Why? Women normally use water to nourish liver wood and blood to nourish the liver. Before pregnancy, this manifests as menstruation; during pregnancy, it nourishes the fetus; after birth, it becomes milk—all are forms of blood. Now, pathogens chase the blood, returning to the Liver Meridian, gathering at Danzhong, and binding below the breasts, causing pain upon touch. Medicines cannot reach here, so Qimen (LR14) acupuncture is indicated. Li Gao stated that women with typhoid presenting with malaria-like chills and fever, where menstruation has just stopped, is also called Heat Entering the Blood Chamber. The blood must be bound and not flowing; Xiao Chai Hu Tang (Minor Bupleurum Decoction) is used. Or Huang Long Tang (Yellow Dragon Decoction) added with Mudan Pi (Moutan Cortex) and Taoren (Peach Kernel). This condition is most common in women; sweating and purging methods are strictly contraindicated. If forgetfulness, mania-like behavior, abdominal fullness, and clear urine occur, treat with blood-draining methods. Do not rigidly adhere to avoiding purgatives. Both men and women can have this; in men, it transmits via the Yangming channel; in women, it enters via the meridians. Wu Zhiwang stated that when pathogens enter the blood level, onset occurs in the evening. Delirium mostly belongs to the Stomach Meridian, fearing violation of Stomach Qi, hence Zhang Zhongjing said "do not violate Stomach Qi." He also stated that post-menstrual malaria-like chills/fever and delirium indicate Heat Entering the Blood Chamber. If menstruation has just started/stopped with alternating chills and fever, first administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) to remove chills and fever, then harmonize with Siwu Tang (Four Substance Decoction). Timed tidal fever indicates internal injury and deficiency; non-timed tidal fever indicates external contraction and excess. Deficiency is treated with Da Wenjing Tang (Major Warming the Menses Decoction); heat is treated with Siwu Tang (Four Substance Decoction) added with Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome). Bone-steaming fever is treated with Da Hulian Wan (Major Coptis Pill). Five-palm tidal heat is treated with Siwu Tang (Four Substance Decoction) added with Huanglian (Coptis Rhizome) and Huhuanglian (Coptis Chinensis Rhizome). Pre-menstrual tidal heat with blood deficiency and stagnation is treated with Xiaoyao San (Free and Easy Wanderer Powder) added with Mudan Pi (Moutan Cortex), Taoren (Peach Kernel), and Yanhu (Corydalis Rhizome). Post-menstrual tidal heat with blood deficiency and heat is treated with Xiaoyao San (Free and Easy Wanderer Powder) minus Chaihu (Bupleurum Root), added with Shengdi (Rehmannia Root) and Digupi (Lycium Bark). Modifications of this formula are sacred medicines for reducing fever.
Virgins, Widows, Nuns: Li Gao stated that girls' menstruation begins around age fourteen, but marriage is best near twenty, as yin qi is not yet fully mature. Indulgence in salty, sour, hot, and dry foods causes qi and blood to congest upward and block flow. Honghua Danggui San (Safflower and Angelica Powder), Dahuang Gao (Rhubarb Paste), or Ziwei San (Bignonia Powder) are used. If menstruation does not start after a year, or if desire arises before age of consent, worrying about men damages heart blood, fire flares and spleen fails, lungs scorch and kidneys wither, leading to blood closure and consumption disease, which is difficult to treat. Siwu Tang (Four Substance Decoction) added with Chaihu (Bupleurum Root) and Huangqin (Scutellaria Root), or Xiaoyao San (Free and Easy Wanderer Powder) added with Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Zhizi (Gardenia Fruit) nourish blood, cool blood, and descend fire. Baorenu Wan (Biota Seed Pill) is also excellent. For anger-induced qi reversal, Sizhi Xiangfu Wan (Four-Processed Cyperus Pill) added with Huangqin (Scutellaria Root) and Shengdi (Rehmannia Root) is used. For fright, Baodan Wan (Gallbladder-Embracing Pill) is indicated. Widows suffer from myriad depressions, missing husbands, household burdens, or longing for descendants, causing frequent heart fire flare-ups. Combined with rich diet, this forms phlegm-fire. Symptoms include aversion to wind, fatigue, alternating chills and fever, flushed face, vexation, and spontaneous sweating. The liver pulse is string-long; suppressing liver yin qi with Chaihu Yigan Tang (Bupleurum Liver-Calming Decoction), Yinyin Dihuang Wan (Yin-Nourishing Rehmannia Pill), or Yueju Wan (Resolving Depression Pill) is appropriate. For poor individuals eating bland food, Sizhi Xiangfu Wan (Four-Processed Cyperus Pill) is used. In the morning, mental confusion, fear of bright light, and aversion to human voices occur, improving after noon. Dizziness, abdominal pain, and fright worsen with slight labor or during menstruation. This results from unfulfilled desires. Qing Shen Yang Rong Siwu Tang (Clear Spirit and Nourish Prosperity Four-Substance Decoction) added with Renshen (Ginseng Root), Fushen (Poria with Hostwood), Chenpi (Tangerine Peel), Chaihu (Bupleurum Root), Qianghuo (Notopterygium Rhizome), Gancao (Licorice Root), and Xiangfu (Cyperus Rhizome) is suitable. Wan Quan stated that delayed-marriage virgins, neglected concubines, widows, and nuns often suffer from amenorrhea due to unfulfilled desires and suppressed indignation. Keeping shame and enduring silently leads to consumptive disease, which is hard to treat. Sizhi Xiangfu Wan (Four-Processed Cyperus Pill) and Shenzhu Dabu Wan (Ginseng and Atractylodes Great Tonifying Pill) attack and tonify simultaneously, offering hope of cure. These changes from the seven emotions are difficult to treat with medicine alone. Zhang Jingbin cited Zhang Shi: For virgins with absent menstruation, cooling herbs like Qinghao (Artemisia Annua Herb) must never be used. Physicians often assume blood heat in virgins and use cooling herbs. They do not know that blood flows with heat and congeals with cold. If menstruation becomes scanty and gradually stops, with irritability in limbs and bones, wasting away, and developing consumption heat with a faint rapid pulse, this is due to yin deficiency and blood weakness, allowing yang to invade. Little water cannot extinguish raging fire; fire forces water dry, consuming fluids. Treatment should nourish blood and benefit yin, not use toxic drugs to force flow. Baorenu Wan (Biota Seed Pill) or Zelan Tang (Eclipta Decoction) are suitable. Luo Tianyi noted that Song dynasty physician Chu Cheng formulated special prescriptions for nuns and widows because these two groups live in isolation, possessing only yin without yang. Awakened desires go unfulfilled, causing yin-yang contention, alternating chills and fever resembling warm malaria, eventually becoming consumptive disease. Wu Zhiwang stated that consumption in nuns and widows specifically targets the Liver Meridian, as ministerial fire resides in the liver. Human desires originate here. Observing that heaven and earth qi begins in spring, one knows desire fire moves due to the liver. Animal reproduction is similar. Therefore, treatment should follow the method of Chaihu Tang (Bupleurum Decoction).