妇人四旬四十一岁，气血两虚，脾胃并弱，饮食少思，四肢无力，月经不调，或腰酸腹胀，或断或续，
赤白带下，身作寒热者，八珍益母丸主之。
八珍益母丸
人参 白术（蜜炙） 茯苓 川芎（各一两） 当归（酒洗） 熟地黄（各二两） 炙甘草（五钱）
白芍（醋炒，一两五钱） 益母草（四两）（五六月采取，止用上半截带叶者，不见铁器，晒干研为末）
上为末，蜜丸弹子大，空心白汤调化一丸。若急欲取放，以酒调化服。如脾胃虚寒多滞者，加砂仁
（姜汁炒）一
两；腹中胀闷者，加山楂肉（饭上蒸熟）一两；多郁者，加香附（酒制）一两。
妇人四十二三岁，经闭不通，或非时血下，淋沥不止；或忽然暴下、崩漏不已；或块或条，疼痛难忍。
此阴阳相反，血热妄行，一失调理，最难得痊，百中得医三四。急服和经汤，补经汤（方见二十五六岁经证）。
和经汤
当归 茯神 黄芩 香附 白术（蜜炙） 淮山药（炒，各一钱） 白芍（二钱五分） 酸枣仁 白芷
蒲黄（炒） 阿胶（炒） 陈皮（去白） 小茴（各八分） 甘草（五分）
生姜三片，水煎，空心热服。如服一二剂不止，即去香附、陈皮，小茴只用四分。
妇人四十四五岁，经水闭塞郁久成崩。但当察其有火无火，有火者，因火逼血，致血妄行，甚则为崩为
漏，宜服保阴煎。无火者，因经阻滞，积久成崩，治宜去滞生新，先服调经饮，以清理之。然后见其可养，则
用小营煎以养之。见其可固，则用固阴煎以固之。
保阴煎
生地黄 熟地黄 芍药（各一钱） 川续断 黄芩 山药（炒） 黄柏（各八分） 生甘草（五分）
水一钟半，煎七分，食远温服。如血虚血滞，筋骨肿痛者，加当归二钱；气滞而痛者，去熟地黄，加
陈皮，香附各
八分；血脱血滑者，加地榆八分，或乌梅一个。
调经饮
当归（二钱） 牛膝 香附（各一钱二分） 山楂 青皮 茯苓（各一钱）
水一钟半，煎七分，食远服。如兼胀闷者，加浓朴一钱；气滞者，加乌药一钱；小腹痛，加小茴一钱。
小营煎
当归 熟地黄 芍药（酒炒） 山药（炒） 枸杞（各二钱） 炙甘草（一钱）
水二钟，煎七分，食远温服。如营虚兼寒者，去芍药，加生姜一钱；气滞有痛者，加香附一钱，引而行之。
固阴煎
人参 熟地黄 山药（炒） 菟丝子（炒，各一钱） 山茱萸（八分） 远志（制） 炙甘草（五分）
五味子（七粒）
水一钟半，煎七分，食远服。如阴虚微热，而经血不固者，加川续断一钱；肝肾血虚，小腹疼痛，而血
不归经者，加当归一二钱；气陷不固者，加升麻五分（炒）。
When a woman reaches around forty-one years of age, both Qi and Blood are deficient, and the Spleen and Stomach functions are simultaneously weak. She may experience poor appetite, weakness in the four limbs, irregular menstruation, or symptoms such as soreness and distension in the lower back and abdomen. Her menses may be intermittent, accompanied by red and white leukorrhea, and alternating sensations of cold and heat. The Ba Zhen Yi Mu Wan (Eight Treasures Motherwort Pill) is indicated for treatment.
Ba Zhen Yi Mu Wan (Eight Treasures Motherwort Pill)
Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Rhizoma Praeparatum cum Melle), Fu Ling (Poria), Chuan Xiong (Ligustici Chuanxiong Rhizoma) [each 1 liang]; Dang Gui (Angelicae Sinensis Radix) [washed with wine], Shu Di Huang (Rehmanniae Radix Praeparata) [each 2 liang]; Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) [5 qian]; Bai Shao (Paeoniae Radix Alba) [stir-fried with vinegar, 1.5 liang]; Yi Mu Cao (Leonuri Herba) [4 liang] (Harvested in the fifth or sixth lunar month; use only the upper half with leaves, avoid contact with iron, dry and grind into powder).
Grind the above ingredients into powder, mix with honey to form pills the size of a bullet. Take one pill dissolved in plain warm water on an empty stomach. If rapid effect is desired, dissolve and take with wine. If there is deficiency-cold of the Spleen and Stomach with much stagnation, add Sha Ren (Amomi Fructus) [stir-fried with ginger juice] 1 liang; if abdominal distension and fullness occur, add Shan Zha Rou (Crataegi Fructus) [steamed over rice] 1 liang; if there is much emotional depression, add Xiang Fu (Cyperi Rhizoma) [processed with wine] 1 liang.
When a woman reaches forty-two or forty-three years of age, menstruation may cease and not flow, or non-menstrual bleeding may occur, dripping continuously; or sudden profuse bleeding may occur, with metrorrhagia and metrostaxis unceasing; or blood clots or strips may be discharged, accompanied by unbearable pain. This indicates an opposition of Yin and Yang, with Heat in the Blood causing reckless movement. Once regulation is lost, recovery is difficult; only three or four out of one hundred cases may be cured. Emergency administration of He Jing Tang (Harmonizing Menses Decoction) and Bu Jing Tang (Tonifying Menses Decoction) (see formula for menstruation at twenty-five to twenty-six years) is required.
He Jing Tang (Harmonizing Menses Decoction)
Dang Gui (Angelicae Sinensis Radix), Fu Shen (Poria with Hostwood), Huang Qin (Scutellariae Radix), Xiang Fu (Cyperi Rhizoma), Bai Zhu (Atractylodis Rhizoma Praeparatum cum Melle), Huai Shan Yao (Dioscoreae Rhizoma) [stir-fried, each 1 qian]; Bai Shao (Paeoniae Radix Alba) [2.5 qian]; Suan Zao Ren (Ziziphi Spinosae Semen), Bai Zhi (Angelicae Dahuricae Radix), Pu Huang (Typhae Pollen) [stir-fried], E Jiao (Colla Corii Asini) [stir-fried], Chen Pi (Citri Reticulatae Pericarpium) [white pith removed], Xiao Hui Xiang (Foeniculi Fructus) [each 8 fen]; Gan Cao (Glycyrrhizae Radix et Rhizoma) [5 fen].
Add three slices of Sheng Jiang (Zingiberis Rhizoma Recens), decoct in water, and take hot on an empty stomach. If bleeding does not stop after one or two doses, remove Xiang Fu and Chen Pi, and reduce Xiao Hui Xiang to 4 fen.
When a woman reaches forty-four or forty-five years of age, prolonged obstruction of menstruation may lead to metrorrhagia due to stagnation. One must observe whether there is Fire or no Fire. If there is Fire, it is because Fire forces the Blood to move recklessly, leading to severe metrorrhagia and metrostaxis; Bao Yin Jian (Preserve Yin Decoction) is appropriate. If there is no Fire, it is because menstrual blockage has accumulated over time to cause metrorrhagia; treatment should focus on removing stagnation and generating new Blood. First, administer Tiao Jing Yin (Regulating Menses Drink) to clear and purify. Then, if nourishment is indicated, use Xiao Ying Jian (Minor Nourishing Decoction) to nourish. If consolidation is indicated, use Gu Yin Jian (Consolidate Yin Decoction) to consolidate.
Bao Yin Jian (Preserve Yin Decoction)
Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Rehmanniae Radix Praeparata), Shao Yao (Paeoniae Radix) [each 1 qian]; Chuan Xu Duan (Dipsaci Radix), Huang Qin (Scutellariae Radix), Shan Yao (Dioscoreae Rhizoma) [stir-fried], Huang Bo (Phellodendri Cortex) [each 8 fen]; Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) [5 fen].
Decoct in 1.5 zhong of water until reduced to 0.7 zhong; take warm well after meals. If there is Blood deficiency with stagnation, and swelling and pain in the sinews and bones, add Dang Gui (Angelicae Sinensis Radix) 2 qian; if there is Qi stagnation with pain, remove Shu Di Huang and add Chen Pi (Citri Reticulatae Pericarpium) and Xiang Fu (Cyperi Rhizoma) each 8 fen; if there is Blood loss with slipping, add Di Yu (Sanguisorbae Radix) 8 fen, or one Wu Mei (Mume Fructus).
Tiao Jing Yin (Regulating Menses Drink)
Dang Gui (Angelicae Sinensis Radix) [2 qian]; Niu Xi (Achyranthis Bidentatae Radix), Xiang Fu (Cyperi Rhizoma) [each 1.2 qian]; Shan Zha (Crataegi Fructus), Qing Pi (Citri Reticulatae Pericarpium Viride), Fu Ling (Poria) [each 1 qian].
Decoct in 1.5 zhong of water until reduced to 0.7 zhong; take well after meals. If accompanied by distension and fullness, add Hou Po (Magnoliae Officinalis Cortex) 1 qian; if there is Qi stagnation, add Wu Yao (Litseae Fructus) 1 qian; if there is lower abdominal pain, add Xiao Hui Xiang (Foeniculi Fructus) 1 qian.
Xiao Ying Jian (Minor Nourishing Decoction)
Dang Gui (Angelicae Sinensis Radix), Shu Di Huang (Rehmanniae Radix Praeparata), Shao Yao (Paeoniae Radix) [stir-fried with wine], Shan Yao (Dioscoreae Rhizoma) [stir-fried], Gou Qi Zi (Lycii Fructus) [each 2 qian]; Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) [1 qian].
Decoct in 2 zhong of water until reduced to 0.7 zhong; take warm well after meals. If Ying (Nutritive) deficiency is combined with Cold, remove Shao Yao and add Sheng Jiang (Zingiberis Rhizoma Recens) 1 qian; if there is Qi stagnation with pain, add Xiang Fu (Cyperi Rhizoma) 1 qian to guide the action.
Gu Yin Jian (Consolidate Yin Decoction)
Ren Shen (Ginseng Radix), Shu Di Huang (Rehmanniae Radix Praeparata), Shan Yao (Dioscoreae Rhizoma) [stir-fried], Tu Si Zi (Cuscutae Semen) [stir-fried, each 1 qian]; Shan Zhu Yu (Corni Fructus) [8 fen]; Yuan Zhi (Polygalae Radix) [processed], Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) [5 fen]; Wu Wei Zi (Schisandrae Chinensis Fructus) [7 grains].
Decoct in 1.5 zhong of water until reduced to 0.7 zhong; take well after meals. If there is slight Heat from Yin deficiency, and menstrual blood is not consolidated, add Chuan Xu Duan (Dipsaci Radix) 1 qian; if there is Liver and Kidney Blood deficiency, lower abdominal pain, and blood not returning to its vessels, add Dang Gui (Angelicae Sinensis Radix) 1-2 qian; if there is Qi sinking without consolidation, add Sheng Ma (Ephedrae Herba? No, Cimicifugae Rhizoma - *Correction: Sheng Ma is Cimicifugae Rhizoma*) [Note: WHO term for Sheng Ma is Cimicifugae Rhizoma] 5 fen [stir-fried].