妇女经闭有四。一寒证。一热证。一实证。一虚证。
寒闭者。积冷结气。经水断绝。至有历年。胞门为寒所伤。经络凝坚。阴中掣痛。少腹恶寒。上引腰脊。绕脐寒
疝。或瘀血不行。留为石瘕。皆霜凝冰结之象也。用温经汤主之。或用温药下之。附子理中汤。加当归桃仁
大黄细辛牛膝肉桂。生化汤下之。尤稳。经通之后。再服肾气丸收功。
热证者。胞为血室。血室为肝之所司。肝火横逆。从胞脉上迫于心肺。心肺之气。不得下通。则发寒热。头晕
耳鸣。烦躁多怒。咳逆气上。治宜平其肝火。使肺气得下降。心血得下注。斯经通矣。当归芦荟丸。加桃仁以
攻之。丹栀逍遥散。加桃仁以和之。又曰冲任两脉。起于胞中。上属阳明。若胞中火逆。随冲任两脉上冲。头
晕颊赤。咽喉不利。发热口渴。咳逆喘息。此乃胞气上逆。合于阳明之气。而为燥动之证。法宜从阳明以折
冲逆。使火下降。斯经通矣。玉烛散治之。如脾胃素虚。不便攻治者。玉女煎。加桃仁丹皮治之。金匮麦门冬
汤。尤能逆折冲气。数方皆从阳明降气。使气下达胞中。则经自通。又有从肾中。引气下行。以通经之法。用
六味地黄汤。加知柏牛膝桃仁。此又引冲气下行隔治之法。
实证经闭者。妇人少腹如敦状。小便微难而不渴。此为水与血结在血室也。大黄甘遂汤主之。又仲景曰。
妇人伤寒。中风。经水适断。胸胁满。如结胸状。谵语者。此为热入血室也。小柴胡汤主之。妇人经闭。藏坚癖
不止者。中有干血。湿热腐变。化出白物。矾石末纳入阴户。吾谓可用土瓜根汤。加黄柏防己治之。又或小
腹结痛。大便黑色。小便不利。明知血欲行而不肯利下。宜抵当汤主之。时方可用膈下逐瘀汤。
虚证经闭者。或因失血过多。面与爪甲之色。俱浅淡黄白。血既从上而脱。更何从再注胞中。以为经水哉。
治法宜止其吐衄之血。使其下行。再补其虚。则血生而气顺。下注胞中。斯经得通矣。四物汤。加牛膝枳壳
降香郁金血余童便茯苓甘草阿胶。或因过淫精竭。肾中天癸之水不至胞中。则不能引动冲脉之血。是
为阳不倡阴。水不化血。宜滋补其水。以益天癸。左归饮主之。三才汤亦主之。或因生产过多。伤血血枯。圣
愈汤主之。或室女血枯。名为童痨。室女正当血盛之时。而乃经少血枯。以致骨蒸肌热。面色枯白。两颧发
赤。懒于饮食。皮干消瘦。咳嗽喘息。此宜大滋其血之化源。使血骤生。而诸病乃退。炙甘草汤主之。又或妇
人女子。不得隐曲。心念不遂。脾气抑郁。以致胃病。不思饮食。倦怠少神。怔忡健忘。脾不化汁。心不化赤。是
血虚而无经水。血虚则生内热。肌肉干瘦。如风之消物。故又名风消。其证难治。宜归脾汤主之。血虚则火
盛无制。心乘肺金。金气不行。不能运布。水津留于胸中。津液尽化为痰。咳嗽不已。日久成痨。经所谓传为
息贲。则不能治。谓喘息也。都气丸。加人参麦冬枣仁五味子钟乳石治之。天王补心丹亦治之。保和丸。清
燥救肺汤。皆可借治。息贲。叶氏养胃汤。加熟地五味云苓亦佳。
经血原委。已于四卷详言之。兹特就经闭大略。出其证治。化裁通变之用。则存乎其人而已。
末段所论生血之法。男女略同。治血证者。须切究之。
There are four types of amenorrhea in women. One is Cold Syndrome, one is Heat Syndrome, one is Excess Syndrome, and one is Deficiency Syndrome.
Cold-type amenorrhea results from accumulated cold and qi stagnation, causing the cessation of menstruation, which may last for years. The uterus (Baogong) is injured by cold pathogens, leading to coagulation and hardening of the meridians. There is pulling pain in the yin region, aversion to cold in the lower abdomen, with pain radiating upward to the waist and spine, or cold hernia encircling the navel. Alternatively, blood stasis fails to circulate, remaining as a stone-like mass (Shi Jia). These are all manifestations resembling frost condensation and ice freezing. The primary formula is Wen Jing Tang (Warm the Meridian Decoction). Alternatively, warm purgatives can be used, such as Fu Zi Li Zhong Tang (Aconite and Poria Decoction) added with Dang Gui (Angelicae Sinensis Radix), Tao Ren (Persicam Semen), Da Huang (Rhei Radix et Rhizoma), Xi Xin (Asari Radix et Rhizoma), Niu Xi (Achyranthis Bidentatae Radix), and Rou Gui (Cinnamomi Cortex). Or, Sheng Hua Tang (Invigorate Blood Decoction) can be used for purgation, which is even more stable. After menstruation resumes, Shen Qi Wan (Kidney Qi Pill) should be taken to conclude treatment.
Heat-type amenorrhea: The uterus serves as the Blood Chamber, which is governed by the Liver. Liver Fire rebels horizontally, forcing its way up through the uterine vessels to oppress the Heart and Lungs. Consequently, the Qi of the Heart and Lungs cannot descend, resulting in alternating chills and fever, dizziness, tinnitus, irritability, anger, coughing, and rebellious Qi. Treatment should aim to calm Liver Fire, allowing Lung Qi to descend and Heart Blood to flow downward, thereby restoring menstruation. Dang Gui Lu Hui Wan (Angelica and Aloe Pill) can be used, adding Tao Ren (Persicam Semen) to attack the pathogen; or Dan Zhi Xiao Yao San (Moutan and Gardenia Xiaoyao Powder) with added Tao Ren to harmonize. Furthermore, the Chong and Ren meridians originate in the uterus and ascend to connect with the Yangming Stomach channel. If fire rebels in the uterus, it rushes upward along the Chong and Ren meridians, causing dizziness, flushed cheeks, throat discomfort, fever, thirst, coughing, and wheezing. This is due to rebellious Qi in the uterus combining with Yangming Qi to form a dryness-agitation syndrome. The method should target the Yangming channel to subdue the rebellious Qi, allowing fire to descend, thus restoring menstruation. Yu Zhu San (Jade Candle Powder) treats this condition. If the Spleen and Stomach have been weak since childhood and aggressive treatment is unsuitable, Yu Nu Jian (Jade Woman Decoction) with added Tao Ren (Persicam Semen) and Dan Pi (Moutan Cortex) can be used. Jin Gui Mai Men Dong Tang (Golden Cabinet Ophiopogon Decoction) is particularly effective in reversing rebellious Qi. All these formulas act by descending Qi from the Yangming channel, directing it down to the uterus, so that menstruation naturally flows. Another method involves drawing Qi downward from the Kidneys to unblock menstruation, using Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction) added with Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex), Niu Xi (Achyranthis Bidentatae Radix), and Tao Ren (Persicam Semen). This represents a method of guiding rebellious Qi downward via indirect treatment.
Excess-type amenorrhea presents with the lower abdomen feeling firm and distended like a Dun (ancient vessel), slight difficulty in urination but without thirst. This indicates water and blood binding together in the Blood Chamber. Da Huang Gan Sui Tang (Rhubarb and Coix Seed Decoction) is the primary formula. Additionally, Zhang Zhongjing stated: When a woman suffers from Shang Han (Cold Damage) or Feng Zhong (Wind Strike), and her menstruation has just ceased, presenting with fullness in the chest and hypochondrium resembling Jie Xiong syndrome, along with delirium, this is Rebellious Heat entering the Blood Chamber. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary formula. In cases of female amenorrhea with persistent hard masses containing dried blood, where damp-heat causes putrefaction and transformation into white discharge (leukorrhea), Fan Shi Mo (Alumen Powder) can be inserted into the vagina. I suggest Tu Gua Gen Tang (Trichosanthes Root Decoction) added with Huang Bai (Phellodendri Cortex) and Fang Ji (Stephaniae Tetrandrae Radix). Alternatively, if there is knotted pain in the lower abdomen, black stools, and difficult urination, knowing that blood desires to move but fails to discharge smoothly, Di Dang Tang (Di Dang Decoction) is appropriate. In contemporary practice, Ge Xia Zhu Yu Tang (Blood Stasis Expelling Decoction under the Diaphragm) may sometimes be used.
Deficiency-type amenorrhea may result from excessive blood loss, causing the face and nail beds to appear pale yellow-white. Since blood has already escaped from the upper orifices, how can it subsequently flow downward into the uterus to become menstrual blood? The treatment method should first stop hematemesis and epistaxis, facilitating the downward movement of blood, and then tonify the deficiency. Once blood is generated and Qi flows smoothly, flowing downward into the uterus, menstruation will resume. Si Wu Tang (Four Substances Decoction) is used, added with Niu Xi (Achyranthis Bidentatae Radix), Zhi Ke (Aurantii Fructus), Jiang Xiang (Dalbergiae Odoriferae Lignum), Yu Jin (Curcumae Longae Radix), Xue Yu Tan (Sanguis Carbonisatus), Tong Bian (Child's Urine), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), and E Jiao (Colla Corii Asini). Alternatively, due to excessive sexual activity leading to essence depletion, the Tian Gui (Heavenly Water, substances promoting reproductive function) of the Kidneys fails to reach the uterus, unable to activate the blood of the Chong Mai. This is described as Yang failing to initiate Yin, and Water failing to transform into Blood. It is suitable to nourish Yin water to benefit Tian Gui. Zuo Gui Yin (Left Restoring Drink) is the primary formula. San Cai Tang (Three Talents Decoction) can also be used. Or, due to excessive childbirth damaging blood and causing blood exhaustion, Sheng Yu Tang (Shengyu Decoction) is indicated. For virgins with blood exhaustion, termed Tong Lao (Childhood Consumption), although they are at an age when blood should be abundant, they experience scanty menstruation and blood exhaustion, leading to bone-steaming tidal fever, withered complexion, flushed malar eminences, anorexia, dry skin, emaciation, coughing, and wheezing. This requires greatly nourishing the source of blood generation to rapidly produce blood, thereby retreating various diseases. Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) is the primary formula. Or, women who suffer from unfulfilled hidden desires, leading to frustrated thoughts and depressed Spleen Qi, which subsequently affects the Stomach, causing anorexia, fatigue, lack of spirit, palpitations, and forgetfulness. The Spleen fails to transform fluids, and the Heart fails to transform red blood, resulting in blood deficiency and absence of menstruation. Blood deficiency generates internal heat, causing muscles to wither like objects blown by wind, hence also named Feng Xiao (Wind Wasting). This condition is difficult to treat; Gui Pi Tang (Guipi Decoction) is indicated. When blood deficiency leads to unrestrained Fire, Heart Fire attacks Lung Metal. Metal Qi fails to circulate, preventing the distribution of fluid reserves. Fluids remain in the chest, transforming entirely into phlegm, causing persistent coughing that eventually becomes consumption. As the classics state, "transmission leads to Xi Ben" (a type of accumulation characterized by wheezing), which is incurable. Du Qi Wan (Duqi Pill) added with Ren Shen (Ginseng Radix), Mai Dong (Ophiopogonis Radix), Zao Ren (Ziziphi Spinosae Semen), Wu Wei Zi (Schisandrae Chinensis Fructus), and Zhong Ru (Stalactitum) treats this. Tian Wang Bu Xin Dan (Emperor of Heaven's Heart-Nourishing Pill) also treats this condition. Bao He Wan (Preserve Harmony Pill), Qing Zao Jiu Fei Tang (Clear Dryness and Rescue Lung Decoction) can all be borrowed for treatment. For Xi Ben, Ye Shi Yang Wei Tang (Ye's Stomach-Nourishing Decoction) added with Shu Di Huang (Rehmanniae Radix Preparata), Wu Wei Zi (Schisandrae Chinensis Fructus), and Yun Ling (Poria) is also excellent.
The origins and details of menstrual blood have been discussed in detail in Volume Four. Here, I specifically outline the general patterns and treatments for amenorrhea. The application of flexible modification and variation depends on the practitioner.
The methods of generating blood discussed in the final paragraph are roughly the same for men and women. Those treating blood disorders must study them thoroughly.