王 经来半月不止，有紫血块，少腹疼痛，气坠阴门，诊脉
沉涩，下午恶寒。阳陷入阴，营虚失守。法以升阳收摄其阴。
党参 熟地 黄 升麻 归身 阿胶（蒲黄炒） 冬术 白芍 柴胡 淡芩 血余炭
陆 营分有热，则经至而淋漓；卫分有寒，则脉小而迟缓。
脾为营之本，胃为卫之源。经至而舌苔反布，胸无痞闷，是胃阳虚而无气以化浊也。拟醒胃阳以摄脾阴为法。
归芍六君子加神曲。
又 经行过多，血气两衰，肝肾失固，丽翁所论包括尽矣。
然治病之道，有相机从事之权。夫舌白多痰，胃有浊也。咽干色红，阴虚而火浮也。脉细迟缓，中气不足也。
考古人肾虚有痰浊者，金水六君煎；气虚而上有浮火者，生脉四君子。合而参之，似觉不可擅易，还祈晒政。
大熟地 半夏 五味子 归身炭 陈皮 于术 茯苓 麦冬 人参 谷芽 建莲肉
又 肝肾与脾胃同治，经漏仍然不止。左脉稍觉有力，原得归、地之功；右脉更觉细微，脾气虚衰不振。
许学士谓补肾不如补脾，盖谓脾胃虚者言之。今心跳食少，心脾不足可知。经血如
漏卮不息，冲任不得不固；腹中微痛，气虚且滞，不得不补，不得不通。仿黑归脾法。
熟地炭 黄 （炒焦） 茯神 枣仁 白芍 广木香 归身炭 冬术 人参 陈皮 炙草
渊按∶既云固冲任，而无固冲任之药。仍用归脾，恐漏仍不止。古人治崩漏急证，自有专方，如血余、棕
炭、百草霜、倒挂尘等，殊有效验。且脉小迟缓，其漏未必属热，或脾肾阳虚，不
能固摄其血，尤非固而兼温不效，未可见血即以为热也。
张 营血不足，经事愆期。肝气有余，瘀凝停滞。心荡头眩，腹鸣胀满，是其征也。胀满能食，病在肝而
不在脾。拟舒肝化瘀、和营养阴方法。
金铃子 吴茱萸 当归 延胡索 陈皮 沙苑子 茯苓 香附 大麦芽 青皮
曹 经事来多去少，似崩非崩，是血虚有热也。所谓天暑地热，则经水沸溢。用白薇汤加阿胶主之。
女贞子 白薇 阿胶（米粉炒） 淡芩炭（醋炒） 黄柏 沙苑子（盐水炒） 白芍 莲心 归身炭 旱莲草
奚 肝为藏血之脏，脾为生血之源。肝气郁则营血失藏，脾气弱则生源不足。腹中结瘕，肝气所结也。
经事先期，肝血失藏也。饮食少纳，脾气弱也。便后带血，脾失统也。气弱血虚，宜
乎不孕矣。调补肝脾，则冲任充足，自然有孕。
西党参 大熟地 冬术（人乳拌） 白芍 香附（醋炒） 杜仲（盐水炒）
茯神（辰砂拌） 菟丝子 归身 木香 川断 艾叶炭 阿胶（米粉炒） 乌贼骨
丁 经事参前而色淡，淡则为虚，参前属热，是血虚而有热也。
四物汤加香附、阿胶、党参、冬术、丹皮、炮姜炭、玫瑰花。
渊按∶佐炮姜以行四物之滞，非温经也，可谓得旨。
朱 痛而经来，肝气横也。经事参前，血分热也。色黑有瘀，和而化之可也。
金铃子 延胡索 香附 当归 丹皮 山楂肉 泽兰叶 白芍 木香 茯苓 砂仁
陆 营虚发热，瘀阻经停。心中若嘈，饮食厌纳，时吐酸水，是脾胃不足而夹痰饮者也。夫心生血，脾统
血，肝藏血，胃为气血之总司。调治之方，以和脾胃为第一。脾胃健则营血自生，停饮自运，瘀凝自化。
半夏 陈皮 川连（吴萸炒） 茯神（辰砂拌） 桃仁 旋复花 新绛 丹参 野蔷薇花 白扁豆
孙 经期一载不来，大便时常秘结，每月胸中不舒数日，此肝血虚而胃气不和也。理气之方，不在平肝
而在养血；和胃之法，不在破气而在补气。气血充而肝胃自和矣。
西党参 熟地（砂仁拌） 枣仁 陈皮 归身 制半夏 丹参 于术（人乳拌炒） 茯苓 白
芍沙苑子 橘饼 谷芽
又 肝肾素亏，气郁，胃气不舒，脾阴不足。饮食知味而不能多进，经事不来，二便时常不利，肩膝酸
疼，舌苔或黄或白，此有湿热夹杂其中。补养气血之方虽稳当，然无理气化浊之品，未能奏效。今拟一方，以观验否。
制首乌 怀山药 枣仁 牛膝 焦山栀 柏子仁 茅术炭 陈皮 半夏 建莲肉
常服苡仁、红枣煮食。
某 经停，少腹痛，小溲淋塞有血缕。此肝火与瘀凝交阻，当通而导之。
龙胆草 小蓟炭 车前子 丹皮 桃仁 大黄（酒炒） 冬葵子 海金砂 延胡 焦山栀
徐 咽干干咳，全由津液之亏；内热经停，已见虚劳之候。设欲生津降火以养其阴，而饮食减少者适以伤
脾。计惟调其中气，俾饮食增而津液旺，以复其真阴之不足。盖津液生成于水谷，水谷转输于脾胃，舍此别无良法也。
白扁豆 茯苓 白芍 玉竹 炙甘草 怀山药 苡仁 金石斛 玫瑰花 枇杷叶
陆 惊恐饥饱劳碌，内伤气血。血凝气滞，经停不来，已及八月。内热食少，虑成干血劳损。
肉桂（一钱二分） 桃仁（二钱三分） 川断（一钱） 麝香（五厘） 当归（二钱五分）
大黄（醋炒，一钱三分） 砂仁（四分） 牛膝（酒炒，三钱） 乳香（去油，五分）
没药（一钱） 五灵脂（醋炒，钱半）
共研细末，分五服。每日一服，陈酒送下。
渊按∶此调经散加减法，颇得古人遗意，元气可支者用之。
徐 经行后奔走急路，冷粥疗饥，少腹疼痛连腰胁，兼及前
阴。此肝肾受伤，又被寒侵而热郁也。经云∶远行则阳气内伐，
热舍于肾。冷粥入胃，则热郁不得伸，故痛也。遵寒热错杂例，兼腹痛治法。
川连（酒炒） 炮姜炭 桂枝 白芍（吴萸三分煎汁，炒） 木通 全当
归香附 山楂炭 焦山栀 旋复花 新绛屑
王 经后少腹痛连腰股，肛门气坠，大便不通，小便赤涩热痛。拟宣肝经之郁热，通络脉之凝涩。
柴胡 川楝子 焦山栀 郁李仁 延胡索 新绛 旋复花 归尾 龙胆草 青葱管
渊按∶此经未尽而行房过度所致，乃经血乘虚入络，冲任入脉受伤也。
张 形壮，面色紫黑，经事或数月或数十日而后来，来亦色淡不多。今经行后少腹攻痛，痛在左则左股
酸而无力，痛在右亦如之。兼有淋带如膏，此瘀凝化浊，冲任失调也。通络泄浊治之。
五灵脂 香附 丹参 金铃子 延胡 当归尾 冬葵子 吴茱萸 旋复花 新绛 青葱管
何 漏下淋沥不断，少腹板痛，微寒微热，口渴不欲饮。此有瘀血着于脐下，拟化瘀生新法。
小生地 当归 丹参 桃仁泥 泽泻 延胡 旋复花 柴胡 大黄炭（酒炒） 地鳖虫（酒浸）
又 漏下淋漓，少腹板痛。化瘀和营，未能奏效。食少无力，微寒微热。治在肝脾，缓之调之。
柴胡 当归 丹参 茯苓 泽泻 赤芍 白术 香附 地鳖虫 山楂炭
某 寒热无序，脉促数，下有淋带，上则心跳，又少腹痛，大便坚，面色萎黄，血瘀之候也。虑延劳损。
大生地 桃仁 茯苓 冬葵子 当归 柏子仁 丹参 白芍
豆衣 玫瑰花
王 向有淋带，月前血崩，崩止淋滞不断，少腹板痛，脉象细数，身发
寒热，脾胃大虚。此血瘀未尽，复兼肝气夹寒也。法当通补。
鲜生地渣（姜汁炒焦） 当归炭 荆芥炭 杜仲 陈皮 生姜渣（鲜地汁炒焦） 香附炭（醋炒） 香谷芽
渊按∶鲜地、生姜互炒，名交加散，能通瘀调气，和寒热，而不伤血耗气，女科之妙方也。
陈 经行作呕，血虚肝旺也。呕止而腹中结块，经事四、五月不来，当脐跳动，疑为有孕。恐其不然，
想由瘀凝气聚与痰涎互结成块耳。《内经》肠覃、石瘕二证，状如怀子，病根皆在乎
血。虽不敢大攻，当气血兼理，仿妇科正元散法。
党参 白术 川芎 茯苓 陈皮 半夏 当归 砂仁 木香 枳壳 香附
有孕无孕，最难辨别。此症断乎非孕。服此二十余帖，至八九月而经始行。
李 妇人之病，首重调经。经事初起不来，状如怀子。以后来而略少，但腹渐大，三载有余。尚疑
有孕，岂非痴人说梦耶？《内经》谓肠覃、石瘕皆腹大如怀子，石瘕则月事不来，肠覃则
月事仍来，而提其要曰∶皆生于女子，可导而下。夫岂徒有虚文而无斯症哉！余曾见过下红白垢污如猪油
粉皮样者无数，调理得宜，亦有愈者。藉曰不然，则天下尽有高才博学之医，就有道而正焉，无烦余之多赘也。
大黄 虫丸每朝三十粒，炒大麦芽泡汤送下。
苏 石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶血当泻不泻， 以留止，日以益大，
状如怀子。此段经衣冠文物指石瘕一症，由于寒气瘀凝夹阻而成。今腹痛泄泻食少，脾胃虚
寒，肝木横逆，病延半载，元气已衰，理脾胃，兼温中下，尚恐莫及。备候主裁。
肉桂 冬术（土炒） 陈皮 木香 金铃子 诃子 茯苓 干姜 泽泻 延胡索 生熟谷芽
吴《内经》有石瘕、石水之证，多属阳气不布，水道阻塞。少腹有块坚硬者为石瘕，水气上攻而腹满者为
石水。此症初起小便不利，今反小便不禁，而腹渐胀满，是石水之象。考古石水治法，不越通阳利水，浅则
治膀胱，深则治肾，久则治脾。兹以一方备采。
四苓散去猪苓，加大腹皮、陈皮、川朴、桑白皮、乌药、桂枝、鸡内金。朝服肾气丸三钱。
仁渊曰∶妇科首重调经。夫经乃心血与肾液相合而成，为天一之真水，故名天癸；按月而下，犹月魄之有
盈虚，故名月信；不差时日，犹海水之有潮汐，故名月潮。夫月也，潮也，癸也，皆阴类也。然月魄不得日光
丽照则不明，潮汐不得阳气鼓荡则不盛，其质虽阴，其用则阳。妇人经水之盛衰，亦犹是耳。叶天士
云∶妇女以心脾为立命之本，心生血，脾统血，心气旺则阴血自足，脾气盛则统驭有权，无愆期崩塞之病。今
世医调经，动曰冲任八脉，皆言末而忘其本耳。夫冲为血海，任主胞胎，在女科原
不可不讲，而经水之所以盛衰通塞，其根源不在乎是。《内经》言奇经之于十二经，犹江河之于沟渠也。江河
充足，沟渠自盈溢。可知江河不充足，则沟渠涸竭窒塞矣。又可知江河充足，沟
渠偶有不通不足，欲通之足之亦甚易矣。能知此理，断不以通瘀养血套剂了事。即带下一证，虽有阴虚、湿热
之辨，亦莫非心脾之气不通不化而来。即 瘕、癖疝、鬼胎、肠覃等疾，虽由痰凝血滞，风寒闭塞，肝胆生阳
不能布化，其因甚多，其根亦莫非心脾郁结所致。盖男子用阳而体阴，女手用阴而体阳。男子以肾为
先天，女子以心为先天。心阳足则脾阳亦旺，阳生阴长，血气充沛，乃宜男之兆。若心阳不振，则脾阳亦弱，
肝木生生之气少布，饮食少化，聚湿生饮，肝气郁陷而逆升，为气撑饱胀，为脘痛作
呕，或错经妄行而鼻衄，或脾气下陷而崩漏，或风寒瘀污客于子门冲任，为鬼胎、石瘕，种种病情，
相引而至。盖有形之病皆属阴邪，大抵阳气不化而生，断非通瘀行血所能了事也。
Wang. Menstruation has continued for half a month without stopping, with purple blood clots in the flow, pain in the lower abdomen, and a sensation of Qi sinking to the vulva. The pulse is deep and choppy, with aversion to cold in the afternoon. This indicates Yang sinking into Yin, and Ying (Nutritive) deficiency failing to maintain control. The method should be to raise Yang and consolidate/restrain Yin.
Codonopsis Radix (Dangshen), Rehmanniae Radix Preparata (Shudihuang), Cimicifugae Rhizoma (Shengma), Angelicae Sinensis Radix (Guishen), Colla Corii Asini (Ejiao, stir-fried with Polygoni Orientalis Semen powder), Atractylodis Macrocephalae Rhizoma (Baizhu), Paeoniae Radix Alba (Baishao), Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Hominis Crinis Carbonisatus (Xuyutan).
Lu. Heat in the Ying (Nutritive) level causes menstruation to drip continuously; Cold in the Wei (Defensive) level causes the pulse to be small and slow.
The Spleen is the root of Ying (Nutritive) blood, and the Stomach is the source of Wei (Defensive) Qi. When menstruation arrives and the tongue coating spreads excessively, yet there is no chest stuffiness, it indicates Stomach Yang deficiency lacking the Qi transformation power to resolve turbidity. The proposed method is to awaken Stomach Yang to control Spleen Yin.
Guizhi Tang combined with Liujunzi Decoction plus Shenqu (Medicated Leaven).
Again. Excessive menstruation leads to dual deficiency of Qi and Blood, with Liver and Kidney failing to secure. As discussed by Li Weng, this covers the matter completely.
However, the way of treating disease allows for flexibility according to circumstances. A white tongue coating with much phlegm-damp indicates turbidity in the Stomach. Dry throat with redness indicates Yin deficiency with floating fire. A fine and slow pulse indicates insufficiency of Middle Qi.
Consulting ancients: for Kidney deficiency with phlegm-turbidity, Jinshui Liu Jun Decoction is used; for Qi deficiency with floating fire, Shengmai San combined with Sijunzi Decoction is used. Considering these together, it seems unwise to change easily. I request your correction.
Rehmanniae Radix Preparata (Shudihuang), Pinelliae Rhizoma (Banxia), Schisandrae Fructus (Wuweizi), Angelicae Sinensis Radix Carbonisata (Guishentan), Citri Reticulatae Pericarpium (Chenpi), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Ophiopogonis Radix (Maidong), Ginseng Radix (Renshen), Hordeum Vulgare Germinatum (Guyagen), Nelumbinis Semen (Jianlianrou).
Again. Treating both Liver/Kidney and Spleen/Stomach simultaneously, but uterine bleeding continues. The left pulse feels slightly forceful, benefiting from the effects of Danggui (Angelicae Sinensis Radix) and Shudihuang (Rehmanniae Radix Preparata); the right pulse feels even finer, indicating Spleen Qi deficiency and lack of vigor.
Xu Xueshi said that tonifying the Spleen is better than tonifying the Kidney, referring specifically to Spleen-Stomach deficiency. Now, palpitations and poor appetite indicate Heart-Spleen insufficiency. Uterine bleeding flows like a leaky vessel, so the Chong and Ren vessels must be secured; slight abdominal pain indicates Qi deficiency with stagnation, requiring both tonification and unblocking. Following the method of Hei Guipi Tang (Black Guipi Decoction).
Rehmanniae Radix Carbonisata (Shudihuantan), Astragali Radix (Huangqi, stir-fried until charred), Poria Cum Ramo et Wood (Fushen), Ziziphi Spinosae Semen (Zaoren), Paeoniae Radix Alba (Baishao), Costi Rhizoma (Gumuxiang), Angelicae Sinensis Radix Carbonisata (Guishentan), Atractylodis Macrocephalae Rhizoma (Baizhu), Ginseng Radix (Renshen), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma Preparata (Zhigancao).
Yuanyuan's Note: Although it speaks of securing the Chong and Ren vessels, no herbs for this purpose are used. Continuing with Guipi Tang may not stop the leakage. Ancients had specific formulas for urgent cases of metrorrhagia and metrostaxis, such as Hominis Crinis Carbonisatus (Xuyutan), Cinnamomi Cortex Carbonisatus (Zongtan), Carbonis Farris (Baicaoshuang), and Daoguachen, which are effective. Moreover, a small and slow pulse suggests the leakage may not be due to heat; it could be Spleen-Kidney Yang deficiency failing to secure blood. It is ineffective unless consolidation is combined with warming. One should not assume heat simply because of bleeding.
Zhang. Ying-Blood deficiency causes delayed menstruation. Liver Qi excess causes blood stasis to coagulate and stagnate. Restlessness, dizziness, borborygmus, and abdominal distension are signs. Distension with ability to eat indicates the disease is in the Liver, not the Spleen. The method is to soothe the Liver, resolve stasis, harmonize Ying, and nourish Yin.
Meliae Toosendan Fructus (Jinlingzi), Evodiae Fructus (Wuzhuyu), Angelicae Sinensis Radix (Danggui), Cyperi Rhizoma (Yanhusu), Citri Reticulatae Pericarpium (Chenpi), Astragali Complanati Semen (Shayuanzi), Poria (Fuling), Cyperi Rhizoma (Xiangfu), Hordeum Vulgare Germinatum (Dayamai), Citri Aurantii Fructus (Qingpi).
Cao. Menstruation is heavy at start and light at end, resembling metrorrhagia but not quite, indicating Blood deficiency with heat. As stated, "When heaven is hot and earth is warm, menstrual water boils over." Use Baiwei Tang (White Willow Bark Decoction) plus Ejiao (Colla Corii Asini).
Ligustri Lucidi Fructus (Nvzhenzi), Cephalotaxi Herba (Baiwei), Colla Corii Asini (Ejiao, stir-fried with rice flour), Scutellariae Radix Carbonisata (Huangqintan, vinegar-fried), Phellodendri Cortex (Huangbai), Astragali Complanati Semen (Shayuanzi, salt-water fried), Paeoniae Radix Alba (Baishao), Nelumbinis Plumula (Lianxin), Angelicae Sinensis Radix Carbonisata (Guishentan), Ecliptae Herba (Hanliancao).
Xi. The Liver stores Blood, and the Spleen is the source of Blood production. Liver Qi stagnation causes Ying-Blood to lose its storage; Spleen Qi weakness causes insufficient production. Abdominal masses are caused by Liver Qi knotting.
Early menstruation indicates Liver Blood failing to store. Poor appetite indicates Spleen Qi weakness. Blood after defecation indicates Spleen failing to control. Qi weakness and Blood deficiency naturally lead to infertility. Regulating and tonifying Liver and Spleen will fill the Chong and Ren vessels, leading naturally to pregnancy.
Codonopsis Radix (Dangshen), Rehmanniae Radix Preparata (Shudihuang), Atractylodis Macrocephalae Rhizoma (Baizhu, mixed with human milk), Paeoniae Radix Alba (Baishao), Cyperi Rhizoma (Xiangfu, vinegar-fried), Eucommiae Cortex (Duzhong, salt-water fried), Poria Cum Ramo et Wood (Fushen, mixed with Cinnabar), Cuscutae Semen (Tusizi), Angelicae Sinensis Radix (Guishen), Costi Rhizoma (Muxiang), Achyranthis Bidentatae Radix (Chuanduan), Zingiberis Rhizoma Preparatum (Aiyetan), Colla Corii Asini (Ejiao, stir-fried with rice flour), Sepiae Endoconcha (Wuzeigu).
Ding. Menstruation comes early and is pale; paleness indicates deficiency, coming early indicates heat. This is Blood deficiency with heat.
Siwu Tang (Four Substances Decoction) plus Xiangfu (Cyperi Rhizoma), Ejiao (Colla Corii Asini), Dangshen (Codonopsis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Moutan Cortex (Danpi), Paoyangtan (Charred Ginger), Meihua (Rose Flower).
Yuanyuan's Note: Using Paoyangtan (Charred Ginger) to move the stagnation of Siwu Tang is not for warming the menses, but shows understanding of the principle.
Zhu. Pain accompanying menstruation indicates Liver Qi transverse invasion. Early menstruation indicates heat in the Blood level. Dark color with stasis can be resolved by harmonizing and transforming.
Meliae Toosendan Fructus (Jinlingzi), Cyperi Rhizoma (Yanhusu), Cyperi Rhizoma (Xiangfu), Angelicae Sinensis Radix (Danggui), Moutan Cortex (Danpi), Crataegi Fructus (Shanzha Rou), Lycopii Herba (Zelan Ye), Paeoniae Radix Alba (Baishao), Costi Rhizoma (Muxiang), Poria (Fuling), Amomi Fructus (Sharen).
Lu. Ying deficiency causing fever, stasis blocking menstruation. Heartburn, anorexia, occasional sour regurgitation indicate Spleen-Stomach insufficiency with phlegm-fluid retention. Heart generates Blood, Spleen controls Blood, Liver stores Blood, Stomach is the general manager of Qi and Blood. The treatment priority is to harmonize Spleen and Stomach. If Spleen and Stomach are healthy, Ying-Blood generates itself, retained fluids transform, and stasis resolves.
Pinelliae Rhizoma (Banxia), Citri Reticulatae Pericarpium (Chenpi), Coptidis Rhizoma (Chuanlian, stir-fried with Evodiae Fructus), Poria Cum Ramo et Wood (Fushen, mixed with Cinnabar), Persicami Semen (Taoren), Inulae Flos (Xuanfuhua), Xinjiang (New Crimson Silk), Salviae Miltiorrhizae Radix (Danshen), Rosa Multiflora Flos (Ye Qiangweihua), Dolichoris Semen (Baibian Dou).
Sun. No menstruation for a year, frequent constipation, chest discomfort for several days each month. This is Liver Blood deficiency and Stomach Qi disharmony. For regulating Qi, the focus should be on nourishing Blood rather than calming the Liver; for harmonizing Stomach, the focus should be on tonifying Qi rather than breaking Qi. When Qi and Blood are abundant, Liver and Stomach harmonize themselves.
Codonopsis Radix (Dangshen), Rehmanniae Radix Preparata (Shudihuang, mixed with Amomi Fructus), Ziziphi Spinosae Semen (Zaoren), Citri Reticulatae Pericarpium (Chenpi), Angelicae Sinensis Radix (Guishen), Processed Pinelliae Rhizoma (Zhi Banxia), Salviae Miltiorrhizae Radix (Danshen), Atractylodis Macrocephalae Rhizoma (Baizhu, stir-fried with human milk), Poria (Fuling), Paeoniae Radix Alba (Baishao), Astragali Complanati Semen (Shayuanzi), Tangerine Peel Candy (Jubing), Hordeum Vulgare Germinatum (Guyagen).
Again. Liver and Kidney have been deficient since long ago, Qi stagnation, Stomach Qi uncomfortable, Spleen Yin insufficient. Food tastes good but cannot be eaten in large amounts, no menstruation, frequent difficulty in urination and defecation, soreness and pain in shoulders and knees, tongue coating yellow or white, indicating damp-heat intermingled. Although blood-Qi tonifying formulas are safe, without Qi-regulating and turbidity-resolving herbs, they fail to work. Now prescribing a formula to observe efficacy.
Processed Polygoni Multiflori Caulis (Zhi Shouwu), Dioscoreae Rhizoma (Huai Shanyao), Ziziphi Spinosae Semen (Zaoren), Achyranthis Bidentatae Radix (Niuxi), Gardeniae Fructus (Jiaoshanzhi), Platycodoni Semen (Baiziren), Atractylodis Rhizoma Carbonisata (Maozhutau), Citri Reticulatae Pericarpium (Chenpi), Pinelliae Rhizoma (Banxia), Nelumbinis Semen (Jianlianrou).
Regularly consume Coicis Semen (Yiren) and Jujubae Fructus (Hongzao) boiled and eaten.
Certain case. Menstrual cessation, lower abdominal pain, dysuria with blood threads. This is Liver Fire interacting with blood stasis obstruction. It should be unblocked and guided out.
Gentianae Radix (Longdancao), Cirsii Herba Carbonisata (Xiaoji Tan), Plantaginis Semen (Cheqianzi), Moutan Cortex (Danpi), Persicami Semen (Taoren), Rheum Radix et Rhizoma (Dahuang, wine-fried), Malvae Semen (Dongkuizi), Descurainiae Semen seu Lepidii Semen (Haijinsha), Cyperi Rhizoma (Yanhu), Gardeniae Fructus (Jiaoshanzhi).
Xu. Dry throat and dry cough are entirely due to fluid depletion. Internal heat causing menstrual cessation shows signs of consumptive disease. If one tries to generate fluids and descend fire to nourish Yin, reduced food intake will damage the Spleen. The only strategy is to regulate Middle Qi, so that food intake increases and fluids flourish, restoring the deficiency of True Yin. Fluids are generated from grain and water, and grain/water transport depends on Spleen and Stomach; there is no other good method.
Dolichoris Semen (Baibian Dou), Poria (Fuling), Paeoniae Radix Alba (Baishao), Polygonati Odorati Rhizoma (Yuzhu), Glycyrrhizae Radix et Rhizoma Preparata (Zhigancao), Dioscoreae Rhizoma (Huai Shanyao), Coicis Semen (Yiren), Dendrobii Caulis (Jinshihu), Rosa Rugosa (Meihua), Eriobotryae Folium (Pipaye).
Lu. Fear, hunger/fullness irregularity, and labor cause internal injury to Qi and Blood. Blood coagulation and Qi stagnation cause menstrual cessation for eight months. Internal heat and poor appetite worry about forming dry-blood consumption.
Cinnamomi Cortex (Rougui, 1 qian 2 fen), Persicami Semen (Taoren, 2 qian 3 fen), Achyranthis Bidentatae Radix (Chuanduan, 1 qian), Moschus (Shexiang, 5 li), Angelicae Sinensis Radix (Danggui, 2 qian 5 fen), Rheum Radix et Rhizoma (Dahuang, vinegar-fried, 1 qian 3 fen), Amomi Fructus (Sharen, 4 fen), Achyranthis Bidentatae Radix (Niuxi, wine-fried, 3 qian), Boswelliae Resina (Ruxiang, de-oiled, 5 fen), Myrrha (Moyao, 1 qian), Trogopterori Faeces (Wulingzhi, vinegar-fried, 1.5 qian).
Grind into fine powder, divide into five doses. Take one dose daily, washed down with aged wine.
Yuanyuan's Note: This is a modification of Tiaojing San (Regulate Menses Powder), capturing the ancient intent, suitable for those whose Yuan Qi can still support it.
Xu. After menstruation, running fast, eating cold porridge to relieve hunger, lower abdominal pain radiating to waist and hypochondrium, involving the anterior yin. This is Liver-Kidney injury, invaded by Cold with Heat depression. The Classic says: "Long travel causes Yang Qi to attack internally, Heat resides in the Kidney." Cold porridge entering the Stomach causes Heat to depress and not extend, hence pain. Following the example of mixed Cold and Heat, using abdominal pain treatment methods.
Coptidis Rhizoma (Chuanlian, wine-fried), Zingiberis Rhizoma Preparatum (Paoyangtan), Cinnamomi Ramulus (Guizhi), Paeoniae Radix Alba (Baishao, stir-fried with juice of 0.3 qian Evodiae Fructus), Akebiae Caulis (Mutong), Angelicae Sinensis Radix (Quandanggui), Cyperi Rhizoma (Xiangfu), Crataegi Fructus Carbonisata (Shanzhitan), Gardeniae Fructus (Jiaoshanzhi), Inulae Flos (Xuanfuhua), Xinjiang (New Crimson Silk shreds).
Wang. Post-menstrual lower abdominal pain radiating to waist and thighs, anal Qi sinking, constipation, dark scanty painful urination. Propose to vent Liver channel depressed heat, unblock collaterals' stagnation.
Bupleuri Radix (Chaihu), Meliae Toosendan Fructus (Chuanlianzi), Gardeniae Fructus (Jiaoshanzhi), Pruni Semen (Yuliren), Cyperi Rhizoma (Yanhusu), Xinjiang (New Crimson Silk), Inulae Flos (Xuanfuhua), Angelicae Sinensis Radix Tail (Guiwei), Gentianae Radix (Longdancao), Allii Tuberosi Bulbus (Qingcongguan).
Yuanyuan's Note: This resulted from excessive intercourse while menstruation was incomplete, causing menstrual blood to enter collaterals via deficiency, injuring Chong and Ren vessels.
Zhang. Robust physique, purple-black complexion, menstruation comes every few months or dozens of days late, light in color and scant when it comes. Now post-menstrual lower abdominal attacking pain, pain on left causes left thigh soreness/weakness, same on right. Accompanied by leukorrhea like paste. This is stasis transforming into turbidity, Chong-Ren disharmony. Treat by unblocking collaterals and draining turbidity.
Trogopterori Faeces (Wulingzhi), Cyperi Rhizoma (Xiangfu), Salviae Miltiorrhizae Radix (Danshen), Meliae Toosendan Fructus (Jinlingzi), Cyperi Rhizoma (Yanhu), Angelicae Sinensis Radix Tail (Dangguiwei), Malvae Semen (Dongkuizi), Evodiae Fructus (Wuzhuyu), Inulae Flos (Xuanfuhua), Xinjiang (New Crimson Silk), Allii Tuberosi Bulbus (Qingcongguan).
He. Continuous dripping uterine bleeding, board-like lower abdominal pain, slight chills and fever, thirst but no desire to drink. This is blood stasis fixed below the umbilicus. Method: Transform stasis and generate new.
Rehmanniae Radix (Xiaoshengdi), Angelicae Sinensis Radix (Danggui), Salviae Miltiorrhizae Radix (Danshen), Persicami Semen Paste (Taoren Ni), Alismatis Rhizoma (Zexie), Cyperi Rhizoma (Yanhu), Inulae Flos (Xuanfuhua), Bupleuri Radix (Chaihu), Rheum Radix et Rhizoma Carbonisata (Dahuangtan, wine-fried), Eupolyphaga Seu Steleophaga (Dibiechong, wine-soaked).
Again. Continuous dripping uterine bleeding, board-like lower abdominal pain. Transforming stasis and harmonizing Ying failed. Poor appetite, weakness, slight chills and fever. Treatment focuses on Liver and Spleen, gentle regulation.
Bupleuri Radix (Chaihu), Angelicae Sinensis Radix (Danggui), Salviae Miltiorrhizae Radix (Danshen), Poria (Fuling), Alismatis Rhizoma (Zexie), Paeoniae Radix Rubra (Chishao), Atractylodis Rhizoma (Baizhu), Cyperi Rhizoma (Xiangfu), Eupolyphaga Seu Steleophaga (Dibiechong), Crataegi Fructus Carbonisata (Shanzhitan).
Certain case. Chaotic chills and fever, rapid and surging pulse, leukorrhea below, palpitations above, lower abdominal pain, hard stool, sallow complexion. Signs of blood stasis. Worry about progression to consumption.
Rehmanniae Radix (Dashengdi), Persicami Semen (Taoren), Poria (Fuling), Malvae Semen (Dongkuizi), Angelicae Sinensis Radix (Danggui), Platycodoni Semen (Baiziren), Salviae Miltiorrhizae Radix (Danshen), Paeoniae Radix Alba (Baishao), Sojae Semen Album Preparatum (Douyi), Rosa Rugosa (Meihua).
Wang. Previously had leukorrhea, sudden severe uterine bleeding last month. After bleeding stopped, leukorrhea persisted, board-like lower abdominal pain, fine and rapid pulse, alternating chills and fever, great Spleen-Stomach deficiency. This is residual blood stasis combined with Liver Qi holding Cold. Method: Unblock and tonify.
Fresh Rehmanniae Radix residue (stir-fried charred with Ginger Juice), Angelicae Sinensis Radix Carbonisata (Dangguitan), Schizonepetae Spica (Jingjie Tan), Eucommiae Cortex (Duzhong), Citri Reticulatae Pericarpium (Chenpi), Fresh Ginger residue (stir-fried charred with Fresh Rehmanniae Juice), Cyperi Rhizoma Carbonisata (Xiangfutau, vinegar-fried), Fragrant Hordeum Germinatum (Xiang Guya).
Yuanyuan's Note: Stir-frying fresh Rehmanniae and Ginger together is called Jiaojia San (Interlaced Dispersion), capable of unblocking stasis, regulating Qi, harmonizing Cold and Heat, without damaging Blood or consuming Qi. It is a wonderful gynecological formula.
Chen. Vomiting during menstruation indicates Blood deficiency and Liver hyperactivity. Vomiting stops but abdominal mass forms, no menstruation for 4-5 months, pulsation at navel, suspected pregnancy. Likely not so; probably stasis, Qi aggregation, and phlegm-saliva binding into a mass. *Neijing* mentions Changqin (Intestinal Polyp) and Shijia (Stone Mass), resembling pregnancy, rooted in Blood. Dare not use strong purgatives, but should treat Qi and Blood together, following Zhengyuan San (Orthodox Origin Powder) method.
Codonopsis Radix (Dangshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Ligustici Rhizoma et Radix (Chuanxiong), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Pinelliae Rhizoma (Banxia), Angelicae Sinensis Radix (Danggui), Amomi Fructus (Sharen), Costi Rhizoma (Muxiang), Aurantii Fructus (Zhike), Cyperi Rhizoma (Xiangfu).
Distinguishing pregnancy is hardest. This case is definitely not pregnancy. After taking 20+ doses, menstruation started in the 8th or 9th month.
Li. Women's diseases prioritize regulating menstruation. Initial amenorrhea resembles pregnancy. Later periods are scant, but abdomen enlarges, lasting over 3 years. Still suspecting pregnancy? Absurd! *Neijing* states Changqin and Shijia both present with abdomen large as pregnancy. Shijia has amenorrhea, Changqin has regular menstruation. Key point: Both occur in women, can be guided downward. Have I seen discharge of red-white filth like lard or vermicelli countless times? With proper regulation, some recover. If not, let learned physicians consult experts; no need for my verbosity.
Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill), 30 pills every morning, taken with decoction of stir-fried Hordeum Vulgare Germinatum (Damaiya).
Su. Shijia (Stone Mass) arises in the uterus. Cold pathogen lodges in Zi Men (Cervical Os), closing it. Qi cannot pass, evil blood should drain but doesn't, remaining and growing daily, resembling pregnancy. This passage refers to Shijia caused by Cold pathogen, stasis, and turbidity blockage. Now abdominal pain, diarrhea, poor appetite, Spleen-Stomach deficiency-cold, Liver Wood invading transversely. Disease lasted half a year, Yuan Qi depleted. Regulating Spleen-Stomach, warming middle and descending Qi, may still be too late. Await master's decision.
Cinnamomi Cortex (Rougui), Atractylodis Macrocephalae Rhizoma (Baizhu, earth-fried), Citri Reticulatae Pericarpium (Chenpi), Costi Rhizoma (Muxiang), Meliae Toosendan Fructus (Jinlingzi), Terminalia Chebulae Fructus (Hezi), Poria (Fuling), Zingiberis Rhizoma (Ganjiang), Alismatis Rhizoma (Zexie), Cyperi Rhizoma (Yanhusu), Raw and Cooked Hordeum Germinatum (Shengshu Guya).
Wu. *Neijing* mentions Shijia and Shishui (Stone Water), mostly due to Yang Qi failure to distribute and water pathway obstruction. Hard mass in lower abdomen is Shijia; water Qi attacking upward causing abdominal fullness is Shishui. This case started with difficult urination, now incontinence, abdomen gradually distending. Signs of Shishui. Ancient treatments for Shishui involve promoting Yang and diuresis: superficially treat Bladder, deeply treat Kidney, chronically treat Spleen. Prescribing one formula for consideration.
Siling San (Five Poria Decoction) minus Zhu Ling (Polyporus), add Arecae Pericarpium (Dafupi), Citri Reticulatae Pericarpium (Chenpi), Magnoliae Officinalis Cortex (Chuanpu), Morus Albae Cortex (Sangbaipi), Linderae Radix (Wuyao), Cinnamomi Ramulus (Guizhi),鸡肉内金 (Jineijin). Take Shenqi Wan (Kidney Qi Pill) 3 qian in the morning.
Ren Yuan said: Gynecology prioritizes regulating menstruation. Menstruation is formed by Heart Blood and Kidney Essence, the True Water of Tian Yi, hence named Tiangui (Heavenly Water); it flows monthly like the moon's waxing and waning, hence named Yuexin (Monthly Trust); it arrives on time like ocean tides, hence named Yuechao (Monthly Tide). Moon, tide, Gui (10th Heavenly Stem representing Yin/Water) are all Yin categories. However, moonlight needs sun illumination to shine, tides need Yang Qi agitation to surge. Though substance is Yin, function is Yang. Women's menstrual abundance/depletion follows this. Ye Tianshi said: Women take Heart and Spleen as foundation. Heart generates Blood, Spleen controls Blood. Strong Heart Qi ensures sufficient Yin Blood, strong Spleen Qi ensures control, preventing irregular cycles, metrorrhagia, or obstruction. Modern doctors discussing menstruation always mention Chong and Ren vessels, focusing on branches and forgetting roots. Chong is Sea of Blood, Ren governs conception, important in gynecology, but the root of menstrual abundance/obstruction lies elsewhere. *Neijing* says Jing Luo (Extraordinary Vessels) are like rivers to ditches. If rivers are full, ditches overflow. If rivers are empty, ditches dry up. If rivers are full, minor ditch blockages are easy to clear. Understanding this, one would not rely on generic stasis-resolving and blood-nourishing formulas. Even leukorrhea, whether Yin deficiency or damp-heat, stems from Heart-Spleen Qi failure to transform. Even masses, hernias, ghost fetus, intestinal polyps, though caused by phlegm-stasis, wind-cold closure, Liver-Gallbladder Yang failure to distribute, many causes, the root is Heart-Spleen depression. Men use Yang with Yin body; women use Yin with Yang body. Men take Kidney as congenital root; women take Heart as congenital root. Sufficient Heart Yang strengthens Spleen Yang, Yang generates Yin, Qi and Blood abundant, favorable for conception. If Heart Yang fails, Spleen Yang weakens, Liver Wood's generating Qi scarce, poor digestion, damp-phlegm accumulates, Liver Qi depresses and rebels upward, causing bloating, epigastric pain/vomiting, erratic menstruation/nosebleeds, Spleen Qi sinking/metrorrhagia, Wind-Cold-Stasis lodging in Zi Men/Chong-Ren causing ghost fetus/Shijia. Various conditions follow. Formidable diseases belong to Yin pathogens, arising from Yang failure to transform, impossible to resolve merely by unblocking stasis and moving blood.