行，而汗自止，非补药所能效也。以龙荟丸日进三次，月余经止，汗热稍轻。前丸日进一次，又一月，大至，
淋漓五日，症全瘳矣。
王肯堂治一妇，寡居郁结成疾，经事不行，体热如炙。忽吐血若泉涌，或用止血药不效。令以茆花根捣汁，
浓磨沉香，服至五钱许。日以酽醋贮瓶内，火上炙热，气熏两鼻孔，血始得降下，吐血不复作，经事乃行。（此
亦逆经症。雄按∶沉香岂可服至五钱？不若以童便、桃仁、醋制大黄下之。）
吕东庄治曹远思内人，月水不至四月矣。腹痛不止，饮食少进，医作胎病治。吕曰∶此郁血也。然气禀
怯弱，当补而行之。用八珍汤三大剂，果下血块升许，腹痛犹未除也。以大剂养荣等药调理而痛除食进。
（与立斋一案略同。）
黄履素曰∶予媳申氏多郁怒，忽患不月，腹渐大，疑有妊。医者视之，亦以为妊也。十余月弗产，诸症渐
见，乃始疑之。医者亦以为蓄血之症，时有欲下之者，众议以为体弱不能胜，止可暗消。于是久用行血调血之
剂，而不敢用下血之药，竟勿效。厥后医药杂投，遂致不起。一日偶阅《震泽纪闻》载盛启东治宫妃一案，大
为悔悼。（案载江篁南《名医类案》血门。）
南山妇人，年三十八，于九月二十三日月经行，比前过后十日，得草药以败血海，为下胎之谋，数服血下，
因此腹痛，小腹下有块如碗大，不可按，汤熨则痛稍定，大小便抽痛，小便涩，大便略下少赤积垢，食不进，
口略渴，发热。此胃气为草药所败，加以受伤之血，妄行而不得泄，所以为病。砂仁、甘草、川芎、黄芩各三
分，滑石一钱五分，牛膝二钱，桃仁七粒，水酒煎服。
黄师文治子才婢子，得面热病，每一面热至赤且痒，闷绝。曰∶此经候来时，尝为火所逼也。问之，曰∶
无之。已而思曰∶昨者经候来，适为孺人粘衣服，伛偻曝日中，其昏如烈火炙，以孺人趣其物，不敢已，由是
面遂热。黄曰∶是也。以四物汤加防风获瘥。
孙文垣治一妇，经不行者三月，大便泻，腹胀嘈杂，吐酸水，时下白带，常恶心，自谓有孕。脉之曰∶此
脾经有湿热，心经有瘀血也。与二陈汤加白术、泽泻、猪苓、酒连、茱萸、滑石、麦芽、山楂，泻止胀宽，
经行腰腹作痛。以川芎三钱，当归五钱，香附、丹参、桃仁各一钱服之，口中吐黑血甚多，且有如脓者。改用
四物汤加丹皮、丹参、桃仁、红花、滑石调理而痊。
从孙妇程氏，年甫三旬，产五次，今则经闭不行者八年，肌肉则丰肥于昔，饮食又倍于昔，精采则艳美于
昔，腹柔不坚，略无所谓病者。或用四物汤、元胡、丹皮之剂，千余服矣。至三棱、莪术、干漆、桃仁、苏木
之类，遍尝不应。诊之，六脉缓大有力，曰∶此脾湿生痰，脂满子宫，徒行血、活血、破血无益也。以平胃散
加滑石、桃仁、黄连、姜黄、丹参、南星、半夏，作丸服之，半年而经行，次年生子，后又连生一子一女。（雄
按∶此等证，如脉平和者，不必服药。）
薛立斋治一妇人，性善怒，发热，经水非过期则不及，肢体倦怠，饮食少思，而颤振，此脾气不足，肝经
血少而火盛也。午前以调中益气汤加茯苓、贝母送六味丸，午后以逍遥散送六味丸，两月余而愈。
一妇人年五十，内热晡热，经水两三月一至。此血虚有热，用逍遥散加山茱萸治之而愈。后有痰作渴，
或小便不调，或头晕白带，用六味而安。
按∶五十之年，经宜止矣。此不当在经水血虚之门，或五字乃四字之讹耳。
一妇人月经不调，晡热内热，饮食少思，肌体消瘦，小便频数。或用清热生血之剂，月经不行，四肢浮肿，
小便淋沥，朝用《金匮》加减肾气丸，夕用归脾汤，渐愈。又用八珍汤，两月全愈。
陆养愚治董龙山夫人，胸膈不舒，大便不实，或时去血，或时去积，经期或先或后，或多或少，参差作痛，
养血健脾俱不效。饮食既少，肌肉亦瘦，晚不能食，食则饱胀，不能安卧。脉之，沉弦而滑，右关尤甚，曰∶沉
为气滞，弦为留饮，滑为痰凝。经之不调，便之不实，腹之胀痛，皆痰积为之也。乃合清气化痰丸，二陈汤送
下，数剂，大便去痰积若干，遂不胀不疼。改用六君子汤数剂，而大便坚。后以调气养荣汤间服，经调而孕。
施凤岗室人，素嗜五辛，三孕皆不育，年三十，即月事不行将及二载，胸腹作痛，行走无定，或数日一发，
或一日二三发。服养血行血之药，身体时热，肌肤渐瘦。或谓补血不补气，无阳则独阴不生，用参、 、白术、
肉桂、芎、归数剂，痰中见血，便燥兼血。脉之，两手举按皆数，左关散而弦，右关数而实，两尺数而沉涩，
曰∶此血虚不待言，然脉症皆火象也。惟清其热，则血得所养，而经自行矣。或谓寒则凝，热则行，今以清火
疗血闭何也？曰∶寒凝热行者，盖谓无大病者言之也。经不云乎？二阳之病发心脾，有不得隐曲，女子不月，
其传为风消，传为息贲者死。王太仆曰二阳，胃与大肠也。二经有热，心脾受之，以致消肌烁肉，上气喘逆。
今病者素嗜辛辣，岂非肠胃有热乎？今已移之心脾，月久不行，肌肉消削，是传为风消。幸不喘咳，未至息贲
耳。复投温热，是抱薪救火，经所谓赞其复翼其胜也。法当先清脾胃积热，使心气下降，绩以养血滋阴济之，
则水泉通而流不绝也。用三黄汤加山栀、丹皮、生地、白芍，十剂痰红便血俱减。更以前方加芎、归，十剂而
月事通矣。后以六味丸料加知、柏、紫河车一具，服之即孕。
陆祖愚治吴君采室，平日血虚有火，生一女已七岁，不再孕。忽经候两月不行，以为孕也。偶胸腹不快，
投安胎养血之剂，反小肚作痛，经行如崩，去血多而痛不止，足膝逆冷，气短奄奄。或以为小产，用芎、归、
元胡、姜、桂等，血不止而痛愈甚，咽喉燥痛，吞吐有妨。脉之，沉细而实，按之有力，用炒莲、白芍、丹皮、
花粉、当归、炒栀、楂肉、阿胶，煎令徐徐吞下。次早，喉腹之痛俱愈，足膝反温暖。后用归、芍、参、苓、
地黄、丹皮、木香以行其滞而渐愈。
一妇经后凝血成块在左，泄泻不止，完谷不化，血块暴下如注，臭秽难堪。经候不调，脾胃因而下损。且
经漏不止，前阴之气血已脱。泄泻不止，后阴之气血下陷。总是热症，而下焦久脱，亦化于寒矣。泻寒以热，
泻湿以燥，宜大升大举，以助肝木生发升长。遂以柴胡、升麻各五分，炙草、陈皮、归身、黄 各一钱，人参、
神曲各钱半，白术二钱，黄芩少许，进二帖，水煎热服而愈。
一妇经水不调，未来先痛，行后又痛，用人参、炙草、川芎、肉桂、丹皮酒洗各五钱，白术、茯苓各一两
半，当归酒洗、白芍酒炒、益母草酒洗蜜拌各一两，白芷、木香各三钱，糊丸。
一妇人经前作痛，且有白带，用十全大补汤加元胡索、益母草、木香而安。
张路玉治薛氏妇，每经行必先作泻二三日，其脉左关尺弦细如丝，右关上小驶而滑。服姜、桂、萸、附则
大渴，泄泻转剧。服苓、泽、车前则目暗如盲。此肝血虚寒而脾胃有伏火也。俟经将行作泻时，朝用理中加黄
连作汤，服五六剂，暮与加减八味丸加紫石英，作丸常服。不终剂而数年之疾顿除。
立斋治一妇人，晡热，肢体瘦倦，食少无味，月经不行，或鼻衄，或血崩，半载矣。或用顺气清热止血等
剂，不应，更加寒热，且时欲作呕。此为郁怒亏损，脾胃虚火，错经妄行而然耳。遂朝用补中益气汤，夕用六
味地黄丸各数帖，半载而痊。
一妇人素沉静，晡热内热，月经不调，后每一二月，或齿缝，或舌下，或咽间出血碗许，如此年余，服清
热凉血，调理之药益甚。此肝脾气郁，血热上行。先用加味归脾汤，后用加味逍遥散，摄血归源，而经自调，
前症顿愈。
陈自明治一妇人，月经过期不至，腹内作痛。服破血行气之剂不效。与神仙追毒丸一粒，服之而瘥。（方见蛊门。）
立斋治一妇人，因经水多，服涩药止之，致腹作痛，以失笑散二服而瘳。五灵脂、蒲黄俱炒，等分，每服
二三钱，醋一合，熬成膏，入水一盏，煎七分，食前热服。又用加味逍遥散，数剂而经调。
一妇人经水不调，两月一至，或三月一至，四肢微肿，饮食少思，日晡发热，此脾土气血皆虚也。须先用
壮脾胃、养气血之剂，饮食进，则浮肿自消，气血充，则经自调矣。彼以为缓，乃用峻剂，先通月经。果腹
疼，泻不止，致遍身浮肿，饮食愈少，殁于木旺之月。
褚氏云∶月水不通，久则血结于内生块，变为血瘕，亦作血症。血水相并，壅塞不通，脾胃虚弱，变为
水肿。所以然者，脾候身之肌肉，象于土，土主克于水。水血既并，脾气衰弱，不能克消，致水气流溢，
浸渍肌肉，故肿满也。观此，岂宜用克伐之剂？
有女人月事退出，皆作禽兽之形，欲来伤人。先将绵塞阴户，乃顿服没药末一两，白汤调下，即愈。（《奇疾方》。）
朱丹溪治一妇人，积痰经不行，夜则谵妄。以栝蒌子一钱，黄连半钱，吴茱萸十粒，桃仁五个，红曲末些
少，砂仁三钱，山楂一钱。上末之，以生姜研炊饼丸。（《治法》。）
一妇人阴虚，经脉久不通，小便短涩，身体疼痛。以四物汤加苍术、牛膝、陈皮、生甘草，又用苍莎丸加
苍耳、酒芍为丸，煎前汤送下。（同上。）
一妇人两月经不行，腹痛发热。但行血凉血，经行自愈。用四物汤加黄芩、红花、桃仁、香附、元胡索之
类。（同上。）
一妇人寡居，经事久不行，腹满少食，小腹时痛，形弱身热。当归酒浸、熟地姜炒、香附各一钱，白芍、
川芎、陈皮各七分半，黄柏炒、知母炒、浓朴姜制、元胡索半钱，白术二钱，生甘草、大腹皮各三钱，红花
豆酒浸，桃仁九个。上 咀，水煎。（同上。）
陈良甫治罗姓女人，每遇经行时则脐与小腹下痛不可忍，服药无效。以桂枝桃仁汤愈。自后再发，一投而
瘥。桂枝、白芍、生地黄各二钱，桃仁七枚去皮尖，甘草一钱，姜水煎。（《大全良方》。）
立斋治一妇人，性沉多虑，月经不行，胸满少食，或作胀，或吞酸，以为中气虚寒。用补中益气加砂仁、
香附、煨姜，二剂胸膈和而饮食进。更以六君加芎、归、贝母、桔梗、生姜、大枣数剂，脾胃健而经自调矣。
一妇人因怒伤，不思饮食，发热倦怠，骨肉酸疼，羸瘦而黄，经水积渐不行，颈间结核，以逍遥散、八珍
汤治之，少可。彼自误服水蛭等药，血气愈虚，遂致不起。良甫云∶忧愁思虑则伤心，心伤则血逆竭，血逆竭
则神色先散，而月水闭。火既受病，不能荣养其子，故不嗜食。子虚则金气亏，故咳。咳则水气绝，木气不充，
故四肢干。又云∶经候微少，渐渐不通，手足骨肉烦痛，日渐羸瘦潮热，其脉微数，此由气虚血弱，阳往乘之。
少水不能灭盛火，故火逼水涸亡津液。当养血益阴，用柏子丸，泽兰汤为主，勿遽通之。
钱国实曰∶吴江黄启元妻刘氏，生平洁净，自十七行经，每年一度，生二子一女。又武林陈氏媳，每季行
经一次，七年方受一胎，生二子二女。皆尝延医之，此妇禀赋之异，非按月而行之。
徐孟阳母叶氏，八九，经仍不断，体浓无病。然甚忧之，以问钱，钱曰∶经云阴生于阳，阳之数七，故妇
人七七经断无子。汝母禀浓之极，经出理之外矣。后寿至九九而终。（雄按∶余治许培之大母，年逾七秋，
泛水仍行，亦血气充盈，而非病也。后寿亦逾大耋。）
钱国宾云∶余游兰溪，时逢端阳，友人宴于花园，谈及邑中篾匠孙二之妻，年三十生四子一女，自来无经。
余以戏言，未信。适妇货篮至，客皆笑曰∶此妇是也。余即问之，妇云；不知经为何物。夫妇人经候，经者常
也；候者，候一月之阴阳也。若潮候应乎天时，真气相与流通，所以女子二七天癸至，月水如期。凡女人受孕
经止者，平日所生气血，以养积而为经。血热则经早，血少则经迟。血盛则七七仍经，血衰则五七外经止。受
孕则所生气血，皆以养胎。胎生血上为乳，乳止血下为经。元门采真，退经为乳两说，则经乳一耳。经本于肾，
旺于冲任二脉。冲为血海，任为胞胎。此妇无经者，乃冲脉与人禀赋不同，任脉与人乳子则一样。《素问》曰∶
人之心偏，则作事不定。人之下眼眶窄，则胆小。五脏各有禀赋外候，以此理推自明。（尝观书云∶人之道根深
浓者，其元关坚固，男子则不易输泄，女子则月事行。此皆久修苦炼之徒，功行未成，复生人道，而仗宿世修
养之力，故禀赋之浓，不与常人同。此说最为有理。钱公反复说，究未指明其所以然，殊为可笑。）
蒋仲芳治姚生妇，年二十五，其月事或半年，或三月方得一至，温补调治二载转剧。诊之，脉来微涩，外
症口干唇燥，手足心热，曰∶后期古法主寒，然其兼症热也。因热耗血，血少故后期耳。遂用大剂生地、当归
为主，佐以条芩、山栀、白芍、川芎、丹皮、泽兰、知母、鳖甲，六剂后则经准，一月后而孕矣。（雄按∶古法
(Prior text omitted) The sweating stops naturally; this is not something that tonifying medicines can achieve. Administer Longhui Wan (Dragon Gallbladder Pill) three times daily for over a month, after which menstruation ceased and the fever and sweating symptoms slightly alleviated. The dosage of the previous pill was reduced to once daily; after another month, heavy menstruation occurred, lasting five days with dripping flow, and the condition was completely cured.
Wang Kentang treated a woman who fell ill due to depression from living as a widow. Her menstruation had stopped, and her body felt hot as if roasted by fire. Suddenly, she vomited blood like a gushing spring. Hemostatic medicines were ineffective. He instructed her to take juice extracted from crushed *Imperatae Rhizoma* (Mao Hua Gen, 茅花根) mixed with finely ground powder of *Aquilariae Lignum Resinatum* (Chen Xiang, 沉香), consuming approximately five qian. Daily, strong vinegar was stored in a bottle and heated over fire; the vapor was inhaled through both nostrils. Only then did the bleeding subside, hematemesis ceased, and menstruation resumed. (This is also a case of retrograde menstruation. Note: How could *Aquilariae Lignum Resinatum* be taken up to five qian? It would be better to use fresh urine, *Persicae Semen* (Tao Ren, 桃仁), and rhubarb processed with vinegar to purge.)
Lu Dongzhuang treated the wife of Cao Yuansi, whose menstruation had been absent for four months. She suffered from continuous abdominal pain and poor appetite. Physicians treated it as a pregnancy-related disease. Lu stated, "This is stagnant blood. However, her constitution is weak; we must tonify before promoting circulation." Three large doses of Bazhen Tang (Eight Treasure Decoction) were administered, resulting in the expulsion of blood clumps weighing about one sheng, but abdominal pain persisted. Subsequently, large doses of Yangrong herbs were used for regulation, leading to the resolution of pain and improvement in appetite.
Huang Lusù said, "My daughter-in-law, Shen Shi, suffered from much depression and anger. She suddenly developed amenorrhea, and her abdomen gradually enlarged, raising suspicion of pregnancy. The physician examined her and also believed it was pregnancy. After more than ten months without delivery, various symptoms gradually appeared, leading to doubt. The physician also diagnosed it as a blood accumulation syndrome. At that time, some advocated using purgatives, but the consensus was that her weak constitution could not withstand them, so only gentle dissipation was advised. Thus, blood-moving and regulating agents were used for a long time, while harsh blood-purging drugs were avoided, yet there was no effect. Later, miscellaneous medicines were administered indiscriminately, leading to her death. One day, I accidentally read in *Zhenze Jiwen* a case of Sheng Qidong treating a palace consort, and I deeply regretted and mourned. (The case is recorded in Jiang Huangnan's *Famous Medical Cases*, Blood Section.)"
A woman from Nanshan, aged thirty-eight, had her menstruation on September 23rd, ten days later than usual. She took herbal medicine intended to damage the blood sea and induce abortion. After several doses, bleeding occurred, causing abdominal pain. A hard mass the size of a bowl formed below the lower abdomen, which could not be pressed; heat application provided slight relief. There was pulling pain during urination and defecation, urinary difficulty, passage of a small amount of dark red fecal debris, poor appetite, slight thirst, and fever. This was caused by the stomach qi being damaged by the herbal medicine, combined with injured blood moving recklessly without discharge. The prescription consisted of Amomum fruit (Sha Ren, 砂仁), licorice root (Gan Cao, 甘草), *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎), and *Scutellaria Baicalensis Root* (Huang Qin, 黄芩), each 3 fen; Talcum (Hua Shi, 滑石) 1.5 qian; *Achyranthes Bidentata Root* (Niu Xi, 牛膝) 2 qian; and seven *Persicae Semen* (Tao Ren, 桃仁). Decocted with water and wine.
Huang Shiwen treated the maid of Zicai, who suffered from facial heat. Each time her face became hot, red, and itchy, she would faint. He said, "This is because when her menstruation came, she was previously exposed to fire/heat." Upon questioning, she denied it. After a moment, she recalled, "Yesterday, during my menstruation, the mistress was drying clothes in the sun, bending over. I felt faint as if roasted by fierce fire. Because the mistress urged me to work, I dared not stop, and since then my face has been hot." Huang said, "Indeed." She recovered using Siwu Tang (Four Substance Decoction) added with Saposhnikovia root (Fang Feng, 防风).
Sun Wen Yuan treated a woman who had not menstruated for three months. She had diarrhea, abdominal distension and discomfort, acid regurgitation, occasional leukorrhea, and frequent nausea. She believed herself to be pregnant. Pulse diagnosis revealed damp-heat in the Spleen channel and blood stasis in the Heart channel. Erchen Tang (Two Aged Decoction) was prescribed with additions of Atractylodes macrocephala (Bai Zhu, 白术), Alisma (Ze Xie, 泽泻), Polyporus (Zhu Ling, 猪苓), wine-fried Coptis (Jiu Lian, 酒连), Cornus officinalis (Zhu Yu, 茱萸), Talcum (Hua Shi, 滑石), Barley sprout (Mai Ya, 麦芽), and Hawthorn (Shan Zha, 山楂). After diarrhea stopped and distension eased, menstruation began with waist and abdominal pain. A formula containing *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎) 3 qian, *Angelica Sinensis Root* (Dang Gui, 当归) 5 qian, Cyperus rotundus (Xiang Fu, 香附), Salvia miltiorrhiza (Dan Shen, 丹参), and *Persicae Semen* (Tao Ren, 桃仁) each 1 qian was administered. She vomited a large amount of black blood and pus-like material. The treatment was changed to Siwu Tang (Four Substance Decoction) added with Moutan bark (Dan Pi, 丹皮), Salvia miltiorrhiza (Dan Shen, 丹参), *Persicae Semen* (Tao Ren, 桃仁), Safflower (Hong Hua, 红花), and Talcum (Hua Shi, 滑石) for regulation until recovery.
The wife of my grandson's younger brother, Cheng Shi, was just thirty years old. Having given birth five times, she had experienced amenorrhea for eight years. Her muscles were fatter than before, her appetite doubled, and her complexion was more beautiful than ever. Her abdomen was soft and not hard, and she felt hardly ill. She had taken over a thousand doses of formulas containing Siwu Tang (Four Substance Decoction), Corydalis (Yan Hu Suo, 元胡), and Moutan bark (Dan Pi, 丹皮). She had tried all manner of blood-breaking herbs like Curcuma zedoaria (San Leng, 三棱), Curcuma phaeocaulis (E Zhu, 莪术), dry lacquer (Gan Qi, 干漆), *Persicae Semen* (Tao Ren, 桃仁), and *Bixa Orellana Seed* (Su Mu, 苏木) without effect. Pulse diagnosis showed six pulses that were slow, large, and forceful. He said, "This is spleen dampness generating phlegm, with fat filling the uterus. Merely moving, invigorating, or breaking blood is of no benefit." Pingwei San (Calm the Stomach Powder) was modified with Talcum (Hua Shi, 滑石), *Persicae Semen* (Tao Ren, 桃仁), Coptis (Huang Lian, 黄连), Turmeric (Jiang Huang, 姜黄), Salvia miltiorrhiza (Dan Shen, 丹参), Arisaema (Nan Xing, 南星), and Pinellia (Ban Xia, 半夏), made into pills. After half a year, menstruation resumed. She gave birth the following year and subsequently had another son and daughter. (Note: For such cases, if the pulse is peaceful, medication is unnecessary.)
Xue Lizhai treated a woman who was prone to anger, had fever, and irregular menstruation (either delayed or early). She had limb fatigue, poor appetite, and tremors. This was deficiency of Spleen qi, insufficient Liver blood, and excessive fire. In the morning, Tiaozhong Yiqi Tang (Regulate Middle and Boost Qi Decoction) added with Poria (Fu Ling, 茯苓) and Fritillaria (Bei Mu, 贝母) was used to deliver Liuwei Wan (Six Ingredient Pill with Rehmannia). In the afternoon, Xiaoyao San (Free and Easy Wanderer Powder) was used to deliver Liuwei Wan (Six Ingredient Pill with Rehmannia). She recovered after over two months.
A fifty-year-old woman had internal heat and evening tidal fever, with menstruation occurring every two to three months. This was blood deficiency with heat. Xiaoyao San (Free and Easy Wanderer Powder) added with Cornus officinalis (Shan Zhu Yu, 山茱萸) was used, and she recovered. Later, she developed phlegm and thirst, or irregular urination, or dizziness and leukorrhea, which were stabilized with Liuwei Wan (Six Ingredient Pill with Rehmannia).
Note: At age fifty, menstruation should have ceased. This case does not belong in the 'Blood Deficiency of Menstruation' category; perhaps the character 'five' (wu) is an error for 'four' (si).
A woman with irregular menstruation had evening and internal heat, poor appetite, emaciation, and frequent urination. Someone used heat-clearing and blood-nourishing agents, but menstruation did not occur, limbs swelled, and urination was dribbling. In the morning, Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet) was used, and in the evening, Guipi Tang (Restore the Spleen Decoction) was administered. She gradually improved. Later, Bazhen Tang (Eight Treasure Decoction) was used, and she fully recovered in two months.
Lu Yangyu treated the wife of Dong Longshan, who had chest and diaphragm discomfort, loose stools, occasional bleeding, and occasional passage of accumulated matter. Her menstrual cycle varied in timing and volume, with irregular pain. Blood-nourishing and Spleen-strengthening treatments were ineffective. With poor intake and muscle wasting, she could not eat at night; eating caused fullness and insomnia. Pulse diagnosis showed deep, wiry, and slippery pulses, especially at the right Guan position. He said, "Deep indicates qi stagnation, wiry indicates retained fluid, and slippery indicates phlegm condensation. Irregular menstruation, loose stools, and abdominal distension/pain are all caused by phlegm accumulation." Qingqi Huatan Wan (Clear Qi and Resolve Phlegm Pill) was combined with Erchen Tang (Two Aged Decoction) taken orally. After several doses, significant phlegm accumulation was passed in stool, and distension/pain ceased. Liujunzi Tang (Six Gentlemen Decoction) was used for several doses to firm the stool. Later, Tiaoqi Yangrong Tang (Regulate Qi and Nourish Vigor Decoction) was taken intermittently, leading to regulated menstruation and pregnancy.
The wife of Shi Fenggang was accustomed to spicy foods. She had three pregnancies that did not survive. At age thirty, her menstruation had been absent for nearly two years. She had chest and abdominal pain, walking restlessness, with episodes occurring every few days or several times a day. Blood-nourishing and blood-moving medicines caused intermittent fever and gradual emaciation. Some suggested that nourishing blood without tonifying qi means lacking Yang, so solitary Yin cannot generate life. They used Ginseng, [missing character], Atractylodes macrocephala (Bai Zhu, 白术), Cinnamon bark (Rou Gui, 肉桂), *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎), and *Angelica Sinensis Root* (Dang Gui, 当归) for several doses. This resulted in blood in phlegm and dry stools with blood. Pulse diagnosis showed rapid pulses upon lifting and pressing in both hands; left Guan was scattered and wiry; right Guan was rapid and excess; both Chi positions were rapid, deep, and choppy. He said, "Blood deficiency is evident, but the pulse and symptoms indicate fire. Only by clearing the heat will the blood be nourished, and menstruation will resume naturally." Someone asked, "Cold causes coagulation, heat causes flow. Why treat blood closure with cooling fire?" He replied, "Cold coagulation and heat flow apply to those without major illness. Does not the Classic say? Disease of the Two Yangs originates in the Heart and Spleen; having hidden grievances, women do not menstruate. If it transmits to Wind Wasting or Panting Accumulation, death ensues. Wang Tapu stated that Two Yangs refer to the Stomach and Large Intestine. Heat in these two channels affects the Heart and Spleen, leading to muscle wasting and panting. Since this patient loves spicy food, isn't there heat in the intestines and stomach? Now it has transferred to the Heart and Spleen, menstruation has been absent for a long time, and muscles are wasted; this is Wind Wasting. Fortunately, there is no panting/cough, so it has not reached Panting Accumulation. Re-administering warming herbs is like adding firewood to save a fire, assisting the pathogen. The method should first clear accumulated heat in the Spleen and Stomach, allowing Heart qi to descend, followed by nourishing blood and yin. Then the water source will flow continuously." Sanhuang Tang (Three Yellow Decoction) added with Gardenia (Shan Zhi, 山栀), Moutan bark (Dan Pi, 丹皮), Rehmannia glutinosa (Sheng Di, 生地), and White Peony Root (Bai Shao, 白芍) was used for ten doses, reducing bloody phlegm and bloody stools. The same formula added with *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎) and *Angelica Sinensis Root* (Dang Gui, 当归) for ten doses restored menstruation. Later, Liuwei Wan (Six Ingredient Pill with Rehmannia) ingredients added with Anemarrhena (Zhi Mu, 知母), Phellodendron (Huang Bai, 黄柏), and a human placenta (Zi He Che, 紫河车) were taken, resulting in immediate pregnancy.
Lu Zuyu treated the wife of Wu Juncai, who usually had blood deficiency with fire. She had borne a daughter seven years ago and had not conceived again. Suddenly, menstruation was absent for two months, suspected to be pregnancy. Occasional chest/abdominal discomfort led to the administration of fetal-calming and blood-nourishing agents, which instead caused lower abdominal pain, heavy menstrual bleeding like a flood, prolonged pain, cold feet/knees, and shortness of breath. Some thought it was a miscarriage and used *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎), *Angelica Sinensis Root* (Dang Gui, 当归), Corydalis (Yan Hu Suo, 元胡), Ginger, and Cinnamon. Bleeding continued, pain worsened, throat became dry/painful, and swallowing was difficult. Pulse diagnosis showed deep, fine, and solid pulses, forceful upon pressure. Fried lotus seeds, White Peony Root (Bai Shao, 白芍), Moutan bark (Dan Pi, 丹皮), Trichosanthes root (Hua Fen, 花粉), *Angelica Sinensis Root* (Dang Gui, 当归), fried Gardenia (Chao Zhi, 炒栀), Hawthorn flesh (Zha Rou, 楂肉), and Donkey-hide gelatin (E Jiao, 阿胶) were decocted and swallowed slowly. By the next morning, throat and abdominal pain resolved, and feet/knees became warm. Later, *Angelica Sinensis Root* (Dang Gui, 当归), White Peony Root (Bai Shao, 白芍), Ginseng (Ren Shen, 人参), Poria (Fu Ling, 茯苓), Rehmannia (Di Huang, 地黄), Moutan bark (Dan Pi, 丹皮), and Aucklandia (Mu Xiang, 木香) were used to move stagnation, leading to gradual recovery.
A woman had blood clots forming on the left side after menstruation, accompanied by incessant diarrhea with undigested food. Sudden profuse discharge of bloody clumps with foul odor. Irregular menstruation damaged the Spleen and Stomach downwards. Continuous uterine bleeding depleted qi and blood from the anterior opening. Incessant diarrhea caused sinking of qi and blood from the posterior opening. Although originally a heat syndrome, prolonged depletion in the lower jiao transformed into cold. To treat cold diarrhea, heat herbs are used; to treat damp diarrhea, drying herbs are used. Great ascending and lifting methods are needed to assist the Liver wood's growth and rising. Chai Hu (Bupleurum root, 柴胡) and Sheng Ma (Cimicifuga rhizome, 升麻) each 5 fen, roasted licorice (Zhi Cao, 炙草), Tangerine peel (Chen Pi, 陈皮), *Angelica Sinensis Root* (Gui Shen, 归身), and Astragalus (Huang Qi, 黄芪) each 1 qian, Ginseng (Ren Shen, 人参) and Medicated Leaven (Shen Qu, 神曲) each 1.5 qian, Atractylodes macrocephala (Bai Zhu, 白术) 2 qian, and a little *Scutellaria Baicalensis Root* (Huang Qin, 黄芩) were administered for two doses, decocted in water and taken hot, resulting in cure.
A woman with irregular menstruation had pain before and after flow. Ginseng (Ren Shen, 人参), roasted licorice (Zhi Cao, 炙草), *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎), Cinnamon bark (Rou Gui, 肉桂), and Moutan bark (Dan Pi, 丹皮) wine-washed each 5 qian; Atractylodes macrocephala (Bai Zhu, 白术) and Poria (Fu Ling, 茯苓) each 1.5 liang; *Angelica Sinensis Root* (Dang Gui, 当归) wine-washed, White Peony Root (Bai Shao, 白芍) wine-fried, and Motherwort (Yi Mu Cao, 益母草) wine-washed and honey-mixed each 1 liang; Angelica dahurica (Bai Zhi, 白芷) and Aucklandia (Mu Xiang, 木香) each 3 qian were made into paste pills.
A woman with pre-menstrual pain and leukorrhea was relieved using Shiquan Dabu Tang (Ten Complete Tonifying Decoction) added with Corydalis (Yan Hu Suo, 元胡), Motherwort (Yi Mu Cao, 益母草), and Aucklandia (Mu Xiang, 木香).
Zhang Luyu treated Mrs. Xue, who always had diarrhea for two to three days before menstruation. Her pulse was wiry and thin as a thread at the left Guan and Chi positions, and slightly larger and slippery at the right Guan. Taking Ginger, Cinnamon, Cornus, and Aconite caused extreme thirst and worsened diarrhea. Taking Alisma, Poria, and Plantago seed caused blindness. This was Liver blood deficiency with cold and latent fire in the Spleen/Stomach. When diarrhea occurred just before menstruation, Lizhong Tang (Regulate the Middle Decoction) added with Coptis (Huang Lian, 黄连) was taken in the morning for five to six doses. At night, Jiajian Bawei Wan (Modified Eight Flavor Pill) added with Purple Quartz (Zi Shi Ying, 紫石英) was taken as pills regularly. The chronic disease of several years was cured within one course.
Lizhai treated a woman with evening fever, emaciated and fatigued limbs, poor appetite, amenorrhea, epistaxis, or metrorrhagia for half a year. Shunqi Qingre Zhixue agents were ineffective, worsening chills/fever and causing nausea. This was due to depression/anger damaging the Spleen/Stomach, with deficient fire causing erratic bleeding. In the morning, Buzhong Yiqi Tang (Boost the Middle and Augment Qi Decoction) was used; in the evening, Liuwei Dihuang Wan (Six Ingredient Pill with Rehmannia) was used for several doses. She recovered in half a year.
A quiet woman had evening/internal fever, irregular menstruation, and then every one to two months, bleeding from gums, under the tongue, or throat, about a bowl each time, for over a year. Heat-clearing and blood-cooling regulators worsened the condition. This was Liver/Spleen qi stagnation with upward-rising blood heat. Jiawei Guipi Tang (Modified Restore the Spleen Decoction) was used first, followed by Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) to draw blood back to its source, regulating menstruation and curing previous symptoms.
Chen Ziming treated a woman with delayed menstruation and abdominal pain. Blood-breaking and qi-moving agents were ineffective. One pill of Shenxian Zhuidu Wan (Divine Pursuit of Poison Pill) was administered, resulting in recovery. (Formula seen in Gu section.)
Lizhai treated a woman who, due to heavy menstruation, took astringent herbs to stop it, causing abdominal pain. Shixiao San (Painless Powder) for two doses cured it. Trogopterus dung (Wu Ling Zhi, 五灵脂) and Spore of Typha (Pu Huang, 蒲黄) were both stir-fried, equal parts. Take 2-3 qian per dose, add one he of vinegar, boil into a paste, add one cup of water, decoct to 70%, and take hot before meals. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) was used for several doses to regulate menstruation.
A woman with irregular menstruation (every two or three months) had mild limb swelling, poor appetite, and evening fever. This was deficiency of Spleen earth qi and blood. Tonifying Spleen/Stomach and nourishing qi/blood agents should be used first. Once appetite improves, edema resolves; once qi/blood fills, menstruation regulates. She considered this too slow and used harsh agents to open menstruation first. This caused abdominal pain, incessant diarrhea, generalized edema, further decreased appetite, and death in the Wood-dominant month.
Chu Shi said: Prolonged amenorrhea leads to blood congealing into masses inside, becoming blood ji (accumulations), or blood syndromes. Blood and water merge, blocking flow. Weak Spleen/Stomach transforms into edema. The reason is that the Spleen governs muscles and corresponds to Earth, which controls Water. When water and blood merge, Spleen qi weakens and cannot control/dissolve, causing water qi to overflow and soak muscles, leading to swelling/fullness. Given this, how can attacking/depleting agents be appropriate?
A woman's menstrual discharge took the form of birds/beasts, wanting to attack people. Cotton was first inserted into the vagina, then one liang of Myrrh powder was taken at once with warm water, resulting in immediate cure. (*Qiji Fang*.)
Zhu Danxi treated a woman with phlegm accumulation causing amenorrhea and nighttime delirium. Trichosanthes seed (Gua Lou Zi, 栝蒌子) 1 qian, Coptis (Huang Lian, 黄连) 0.5 qian, Evodia (Wu Zhu Yu, 吴茱萸) 10 grains, *Persicae Semen* (Tao Ren, 桃仁) 5 grains, a little Red Yeast Rice (Hong Qu, 红曲) powder, Amomum fruit (Sha Ren, 砂仁) 3 qian, and Hawthorn (Shan Zha, 山楂) 1 qian. These were powdered, mixed with ginger juice and steamed rice dough to make pills. (*Zhifa*.)
A woman with yin deficiency had prolonged amenorrhea, scanty/difficult urination, and body pain. Siwu Tang (Four Substance Decoction) added with Atractylodes lancea (Cang Zhu, 苍术), *Achyranthes Bidentata Root* (Niu Xi, 牛膝), Tangerine peel (Chen Pi, 陈皮), and raw licorice (Sheng Gan Cao, 生甘草) was used. Cangsha Wan (Cangsha Pill) added with Xanthium (Cang Er, 苍耳) and wine-processed White Peony Root (Jiu Shao, 酒芍) was made into pills, delivered with the previous decoction. (Same source.)
A woman with amenorrhea for two months had abdominal pain and fever. Promoting blood circulation and cooling blood would allow menstruation to resume naturally. Siwu Tang (Four Substance Decoction) added with *Scutellaria Baicalensis Root* (Huang Qin, 黄芩), Safflower (Hong Hua, 红花), *Persicae Semen* (Tao Ren, 桃仁), Cyperus rotundus (Xiang Fu, 香附), and Corydalis (Yan Hu Suo, 元胡) was used. (Same source.)
A widowed woman had prolonged amenorrhea, abdominal fullness, poor appetite, occasional lower abdominal pain, weakness, and low-grade fever. *Angelica Sinensis Root* (Dang Gui, 当归) wine-soaked, prepared Rehmannia (Shu Di, 熟地) ginger-fried, and Cyperus rotundus (Xiang Fu, 香附) each 1 qian; White Peony Root (Bai Shao, 白芍), *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎), and Tangerine peel (Chen Pi, 陈皮) each 0.75 qian; Phellodendron (Huang Bai, 黄柏) fried, Anemarrhena (Zhi Mu, 知母) fried, Magnolia bark (Hou Po, 厚朴) ginger-processed, and Corydalis (Yan Hu Suo, 元胡) 0.5 qian; Atractylodes macrocephala (Bai Zhu, 白术) 2 qian; raw licorice (Sheng Gan Cao, 生甘草) and Areca petiole (Da Fu Pi, 大腹皮) each 3 qian; Safflower (Hong Hua, 红花) bean-wine soaked, nine *Persicae Semen* (Tao Ren, 桃仁). Coarsely chopped, decocted in water. (Same source.)
Chen Liangfu treated a woman surnamed Luo, who suffered unbearable pain in the umbilicus and lower abdomen during menstruation, unresponsive to medicine. Guizhi Tao Ren Tang (Cinnamon Twig and Peach Kernel Decoction) cured it. Recurrences were cured with a single dose. Cinnamon twig (Gui Zhi, 桂枝), White Peony Root (Bai Shao, 白芍), and Raw Rehmannia (Sheng Di, 生地黄) each 2 qian; seven peeled/cored *Persicae Semen* (Tao Ren, 桃仁); licorice (Gan Cao, 甘草) 1 qian. Decocted with ginger water. (*Daquan Liangfang*.)
Lizhai treated a woman who was taciturn and overthinking, with amenorrhea, chest fullness, poor appetite, distension, or acid regurgitation, diagnosed as Middle Qi deficiency and cold. Buzhong Yiqi Tang (Boost the Middle and Augment Qi Decoction) added with Amomum fruit (Sha Ren, 砂仁), Cyperus rotundus (Xiang Fu, 香附), and roasted ginger (Wei Jiang, 煨姜) for two doses harmonized the chest/diaphragm and improved appetite. Liujunzi Tang (Six Gentlemen Decoction) added with *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎), *Angelica Sinensis Root* (Dang Gui, 当归), Fritillaria (Bei Mu, 贝母), Platycodon (Jie Geng, 桔梗), Ginger, and Jujube for several doses strengthened the Spleen/Stomach, regulating menstruation naturally.
A woman injured by anger had loss of appetite, fever, fatigue, bone/muscle soreness, emaciation, yellowish complexion, gradually stopping menstruation, and neck lumps. Xiaoyao San (Free and Easy Wanderer Powder) and Bazhen Tang (Eight Treasure Decoction) provided slight relief. She mistakenly took leeches etc., further depleting qi/blood, leading to death. Liangfu said: Worry and thinking damage the Heart; Heart damage causes blood reversal and exhaustion. Exhaustion scatters spirit and closes menstruation. Fire disease fails to nourish its child (Earth/Spleen), causing poor appetite. Spleen deficiency weakens Metal/Lung, causing cough. Cutoff of water qi fails to fill Wood/Liver, causing dry limbs. Also: Scanty menstruation gradually ceasing, painful limbs/bones, daily emaciation/tidal fever, with fine-rapid pulse, is due to qi/blood deficiency with Yang invading. Little water cannot extinguish raging fire, so fire forces water dry, destroying fluids. Nourish blood and benefit yin, using Baizi Wan (Seed Cypress Pill) and Zelang Tang (Leuzea Decoction) as main treatments; do not rush to open menstruation.
Qian Guoshi said: Liu Shi, wife of Huang Qiyuan in Wujiang, was very clean. Menstruation started at seventeen, occurring once a year, bearing two sons and one daughter. Chen Shi's daughter-in-law in Wulin had menstruation once a quarter, conceiving only once every seven years, bearing two sons and two daughters. Both consulted physicians. This woman's unique constitution differs from monthly menstruation.
Ye Shi, mother of Xu Mengyang, aged eighty-nine, still had menstruation, was obese and healthy. She was very worried and asked Qian. Qian said: The Classic states Yin is born from Yang, the number of Yang is seven, so women cease menstruation at seven sevens (49) and cannot conceive. Your mother's constitution is extremely robust; menstruation here is beyond normal principles. She lived to ninety-nine. (Note: I treated Grandmother of Xu Peizhi, over seventy, still having menstruation with edema; this was also abundant qi/blood, not disease. She also lived past old age.)
Qian Guobin said: I traveled to Lanxi during Dragon Boat Festival. Friends feasted in a garden, discussing Sun Er, a bamboo weaver's wife, aged thirty, who had four sons and one daughter but never had menstruation. I joked, disbelieving. A woman selling baskets arrived; guests laughed, saying she was the one. I asked her; she said she didn't know what menstruation was. Regarding female menstruation, 'Jing' (Menstruation) means constant; 'Hou' means waiting for the monthly Yin/Yang balance. Like tides responding to heavenly timing, true qi circulates freely. Thus, at fourteen (two sevens), Tian Gui arrives, and menstruation comes on schedule. Women who conceive stop menstruation because the generated qi/blood is used to nourish the accumulating fetus. Heat blood causes early periods; deficient blood causes late periods. Abundant blood allows menstruation even after forty-nine; declining blood stops it after thirty-five. During pregnancy, all generated qi/blood nourishes the fetus. Fetal blood rises to become milk; if milk production stops, it descends as menstruation. Daoist theories on extracting truth and transforming menstruation into milk suggest they are essentially the same. Menstruation originates in the Kidney, flourishing in the Chong and Ren vessels. Chong is the Sea of Blood; Ren governs conception. This woman lacks menstruation because her Chong vessel constitution differs from others, while her Ren vessel functions normally for nursing children. *Suwen* says: If the heart is biased, actions are unstable. If lower eye sockets are narrow, courage is small. Each organ has constitutional external signs; reasoning from this makes it clear. (I once read: Those with deep roots and thick essence have solid Yuan Guan. Men do not easily leak; women menstruate. These are cultivators who failed to complete their practice, reborn in the human realm relying on past cultivation power, hence their robust constitution differs from ordinary people. This explanation is most reasonable. Mr. Qian repeated this but failed to explain the cause clearly, which is ridiculous.)
Jiang Zhongfang treated the wife of Yao Sheng, aged twenty-five. Her menstruation came every six months or three months. Warm-tonifying regulation for two years worsened the condition. Pulse was slightly choppy. External symptoms: dry mouth/lips, hot palms/soles. He said: Late periods traditionally indicate cold, but her accompanying symptoms are heat. Heat consumes blood, causing scarcity and thus late periods. Large doses of Rehmannia (Sheng Di, 生地) and *Angelica Sinensis Root* (Dang Gui, 当归) were used as main herbs, assisted by Scutellaria (Tiao Qin, 条芩), Gardenia (Shan Zhi, 山栀), White Peony Root (Bai Shao, 白芍), *Ligusticum Chuanxiong Rhizome* (Chuan Xiong, 川芎), Moutan bark (Dan Pi, 丹皮), Leuzea (Ze Lan, 泽兰), Anemarrhena (Zhi Mu, 知母), and Turtle shell (Bie Jia, 鳖甲). After six doses, menstruation became regular; one month later, she conceived. (Note: Ancient methods...)