〔保〕妇人童幼天癸未行之间，皆属少阴，天癸既行，皆属厥阴，天癸既绝，乃属
太阴经也。治胎产之病从厥阴者，是祖气生化之原也。厥阴与少阳相表里，故治法无犯
胃气及上二焦，为三禁，不可汗、不可下、不可利小便。若发汗者同伤寒下早之证，利大
便则脉数而已动于脾，利小便则内亡津液，胃中枯燥。制药之法，能不犯此三禁，则荣卫
自和，而寒热止矣。外则和于荣卫，则内调于清便，先将此法为初治，次后详而论之。见
证消息，同坏证伤寒，为之缓治。或小便不利，大便秘结，或积热于肠胃之间，或已成
痿，或散血气而为浮肿。盖产理多门，故曰同伤寒坏证。如发渴而用白虎，气弱而用黄
，血刺痛而用当归，腹痛而加芍药，以上例证，不犯三禁，谓产后之久病也。若产后
暴病，又不可拘也。如产后热入血室者，用桃仁承气、抵当汤等药，胃坚燥者，大承气
不可以泄药言之。产后世人多用乌金、四物汤，是不分四时之寒热，不分血气之虚实，盲
然一概用药，如此而愈加增剧，是误也。大抵产病，天行则增损柴胡，杂症则加减四物；
又春夏从柴胡，秋冬从四物。药性寒热，病证虚实，不可不察也。四物汤常宜服饵，今
立四时增损法于后。
〔养血〕
四物汤 益荣卫，滋气血。治月水不调，脐腹 痛；妇人经病，或前或后，或多或少，
疼痛不一，腰足腹中痛；或崩中漏下，或半产恶露过多，或停留不出；妊娠腹痛下血，胎
不安；产后血块不散，或亡血过多，恶露不止。四物汤加茱萸煎服。若入阳脏，少使茱
萸，阴脏多使茱萸。一方加香附。熟地黄（补血。如脐下痛非此不能除，乃通肾经之药也。）
川芎（治风，泄肝木。如血虚头痛，非此不能除，乃通肝经之药也）
芍药（和血理脾。如腹中虚痛，非此不能除，乃通脾经之药也。）
当归（和血。如血刺痛，刺如刀割，非此不能除，乃通心经之药也）
上为粗末，水煎服。
春倍川芎（一曰春，二曰脉弦，三曰头痛。）
夏倍芍药（一曰夏，二曰脉洪，三曰泄。）
秋倍地黄（一曰秋，二曰脉涩，三曰血虚。）
冬倍当归（一曰冬，二曰脉沉，三曰寒而不食。）
若春则防风四物，加防风倍川芎。若夏则黄芩四物，加黄芩倍芍药。若秋则门
冬四物，加天门冬倍地黄。若冬则桂枝四物，加桂枝倍当归。若血虚而腹痛，微汗
而恶风，四物加术、桂，谓之腹痛六合。若风眩运，加秦艽、羌活，谓之风六合。
若气虚弱，起则无力， 然而倒，加浓朴、陈皮，谓之气六合。（气不足而用泄气之药，可乎？当
以参、 易之。）若发热而烦，不能睡卧者，加黄连。栀子，谓之热六合。若虚寒脉微自
汗，气难布息，清便自调，加干姜、附子，谓之寒六合。若中湿，身沉重无力，身凉微
汗，加白术、茯苓，谓之湿六合。若妇人筋骨肢节疼，及头痛、脉弦、憎寒如疟，宜
治风六合。或伤损气血，乘虚而晕者，四物汤四两、羌活、防风各一两。若血气上冲
心腹，胁下满闷，宜治气六合∶四物汤四两、木香、槟榔各一两。若脐下虚冷，腹痛及腰脊间
闷痛，宜玄胡六合∶（小腹痛同用。）四物汤四两、玄胡、苦楝各一两，碎炒焦。若气冲经脉，
故月事频并，脐下多痛，宜芍药六合∶四物汤四两、芍药倍加、黄 一两。若经事欲行，脐腹
绞痛，临经痛者，血涩也，宜八物汤∶四物汤四两、玄胡、槟榔、苦楝碎、炒焦、木香各
一两。若妇人血虚，心腹 痛不可忍者，去地黄，加干姜，名四神汤。补下元，加干姜
半两，甘草七分。气筑小腹痛，加玄胡索煎服。若腹中刺痛，恶物不下，倍加当归、芍药。
若腹痛作声，经脉不快，加熟地黄一倍，添桂心半倍煎。经行腹痛，腰背痛，加芸苔、牛膝、
红花、吴茱萸、 、甘草、银器、灯心、热服。若经水涩少，宜四物汤内加葵花煎；又加红
花、血见愁。若经水少而色和者，四物汤加热地黄、当归各一两。若经水暴下，四物
汤内加黄芩。若腹痛加黄连。如夏月不去黄芩。若经水如黑豆汁者，加黄芩、黄连各
一两。若经水过多，别无余证，宜黄芩六合汤∶四物汤四两、黄芩、白术各一两。
经血淋漓不断，加干瑞莲房，炒、入药。阴阳交合，经脉行，加赤石脂、黄 、肉桂、
百草霜、藕节，败棕灰、肉豆蔻、当归、木香、龙骨、白术、茯苓、地榆。若经水适
来适断，或有寒热往来者，先服小柴胡汤去其寒热，后以四物汤和之。如寒热不退，勿
服四物，是谓变证，表邪犹在，不能效也。根据前论中变证，随证用药调治。若血崩者，加
生地黄、蒲黄。补血住崩，加百草霜，棕灰、首绵灰、蒲黄炒过、龙骨、白姜。血
成片，加地黄、藕节。黑血片，人参、白术。若血脏虚冷。崩中去血过多，加阿胶、艾。
月水不调，血崩，或多少。或前后，呕逆心膨，陈艾。黄 。若赤白带下，宜香桂六
合，四物汤四两，桂枝、香附各五钱。四物汤为细末，炼蜜丸梧子大，空心米饮下三
四十丸，治年高妇人白带良验。白淫浊，龙骨、地黄、当归。五色，研麝香、好酒。
鲜红，温酒、盐汤。带下，加肉桂、蒲黄、百草霜、甘草、黑豆、白术、玄胡索、白姜、龙
骨，空心盐酒下。白带，加白龙骨酒下。若妇人血积者，加广术、京三棱、桂、干漆，
炒烟尽，各一两。若经血凝滞，腹内血气作疼，加广术、官桂，等分用之。王石肤云∶
熟地黄滞血，安能止痛。不若以五灵脂代之。血滞不通，加桃仁、红花各二钱半。经闭，
加枳壳、大黄、荆芥、黄芩、青皮、滑石、木通、瞿麦、海金沙、山栀子、车前子。血
寒，加甘草、乌梅、柴胡、桃柳枝。月经久闭，加肉桂、甘草、黄 、姜钱、枣子、木
通、红花。月水不通，加野苎根、牛膝、红花、苏木、旧酒、水同煎。血气不调，加
吴茱萸一两、甘草半两。四物汤加甘草半两，为细末，炼蜜丸，每两作八丸，酒、醋
共半盏，煎汤同化调下，名当归煎。去败血，生好血。如人行五里，再进一服，无时。
若虚热病，四物汤与参苏饮相合，名补心汤主之。添柴胡名五神汤，大能补虚退虚热。
潮热加黄芩、地骨皮，柴胡。一方加柴胡、干葛、黄芩、人参。虚热口干，加麦门冬、
黄芩一两。虚渴，加人参、干葛、乌梅、栝蒌根。虚而多汗，加 牡蛎、麻黄根各半
两。虚寒潮热，加柴胡、地骨皮、白术、茯苓、甘草、秦艽、知母、黄芩、麦芽、贝母、
人参、乌梅、枣子。若四肢肿痛，不能举动，宜与苍术各半汤主之。若大便燥结，四
物汤与调胃承气汤各半，名玉烛散主之。若流湿润燥，宜四物理中各半汤。若气血
俱虚，四物与四君子汤各半，名八珍汤主之。加缩砂仁保胎气，令人有子。若热加黄芩。
若因热生风者，加川芎、柴胡、防风。一方无。血气劳，加荆芥、柴胡。血风两胁筑
痛，或盘肠成块，加大黄、荜茇、乳香。血弱生风，四肢痹疼，行步艰难，加人参，乳
香、没药、麝香、甘草、五灵脂、羌独活、防
风、荆芥、地龙、南星、白附子、泽兰，为末，蜜丸。木瓜盐汤下。血风膨胀，加甘
草、木香、枳壳、马兜铃、葶苈、紫苏、藿香、地黄，空心服。脏腑秘，加大黄、桃
仁。滑泄，加官桂、附子。虚泻，加人参、川芎、白芷、蒲黄、炒阿胶、白术、茱
萸、续断、干姜、附子、肉桂、黄 、赤石脂、甘草，蜜丸。盐梅汤下。呕加白术、人
参。一方有生姜。呕吐不止，加藿香、白术半两，人参二钱半。呕逆饮食不入，加白
术、乳香、甘草、人参、缩砂、益智仁、胡椒。若咳嗽，加桑白皮、半夏、人参，生
姜、北五味子、甘草。感风劳嗽，加款冬花，知母、阿胶、半夏、麻黄、甘草、马兜
铃、黄芩、杏仁、柴胡、姜钱、诃子、乌梅。若发寒热，加干生姜、牡丹皮、柴胡。一方
加芍药。如寒热往来，加炮干姜、牡丹皮各一分。若平常些少虚眩，肢体瘦倦，月信不
通，只用生姜、薄荷。此是妇人常服之药，盖味寡而性缓，效迟而功深。若大渴，加知
母、石膏。若水停心下，微吐逆者，加猪苓、茯苓、防己。若心腹胀满，加枳壳、青
皮。虚汗，加麻黄根。汗多，加浮麦。大便下血。四肢寒，膨胀，肠胃有风，槐花、积
壳、漏芦、荆芥、木香、白鸡冠花、木通、红内消、紫草、石榴皮、陈皮、青皮、黄芩、甘
草、白茅根、槐角。肠风下血，加槐角、槐花、枳壳、荆芥、黄芩、大腹皮、红内消、地
榆、石楠叶、白鸡冠花、为散煎，一半为末，空心、盐汤、旧酒调下。鼻衄吐血，加竹
青、蒲黄、藕节、半夏、丁香、诃子、桂花、红枣、飞罗面、白茅根、蚌粉。若头昏项
强，加人参、黄芩。若虚寒似伤寒者，加人参、柴胡、防风。若虚烦不得睡，加竹叶、人
参。若诸痛有湿者，四物与白术相半，加天麻、茯苓、穿山甲，用酒煎服。治老人风
秘，加青皮等分，煎服。治疮疾，荆芥酒煎常服。奶痈，加连翘、茨菰子、红内消、
白芷、菰片、荆芥、牛膝，山蜈蚣、乳香、没药、漏芦、生地黄。赤眼头风疾，加薄荷、
清茶。赤眼生风，加防风、黄芩。风疮赤肿，加荆芥、牛蒡子、何首乌、甘草、防
风、羌活、地黄、盐、酒。脚肿，加大腹皮、赤小豆、茯苓皮、生姜皮。若妇人伤
寒，汗下后饮食减少，血虚者，宜八物汤，四物汤四两、黄 、白术、茯苓、甘草各一两。
若妊娠伤寒，中风表虚自汗，头痛项强，身热恶寒，脉浮而弱，太阳经病，宜表虚六合
汤∶四物汤四两、桂枝、地骨皮各七钱。若妊娠伤寒，头痛身热无汗，脉浮紧，太阳经
病，宜表实六合∶四物汤四两、麻黄、细辛各半两。若妊娠伤寒，中风湿之气，肢节
烦疼，脉浮而热，头痛，此太阳标病也，宜风湿六合汤∶四物汤四两、防风、苍术各七
钱。若妊娠伤寒，下后过经不愈，温毒发斑如锦纹，宜升麻六合∶四物汤四两、升麻、
连翘各七钱。若妊娠伤寒，胸胁满痛，脉弦，少阳头昏、项强，宜柴胡六合∶四物汤
四两、柴胡、黄芩各七钱。若妊娠伤寒，大便硬、小便赤，气满而脉沉数，阳明太阳本
病也，急下之，宜大黄六合∶四物汤四两。大黄半两。桃仁（十个，去皮尖，麸炒。）
若妊娠伤寒，汗下后咳嗽不止，宜人参六合汤∶四物汤四两、人参、五味子各半两。若
妊娠伤寒，汗下后虚痞胀满者，阳明本虚也，宜浓朴六合汤，亦治咳嗽喘满。四物汤四两、浓
朴、枳实麸炒，各半两。若妊娠伤寒，汗下后不得眠者，宜栀子六合汤∶四物汤四两、
栀子、黄芩各半两。若妊娠伤寒、身热大渴，蒸蒸而烦，脉长而大者，宜石膏六合∶四
物汤四两，石膏。知母各半两。若妊娠伤寒，小便不利，太阳本病，宜茯苓六合汤∶四
物汤四两、茯苓，泽泻各半两。若妊娠伤寒，太阳本病，小便赤如血状者，宜琥珀六
合汤，四物汤四两、琥珀、茯苓各半两。若妊娠伤寒，汗下后血漏不止，胎气损者，宜
胶艾六合汤∶四物汤四两、阿胶、艾各半两。一方加甘草，同上。一方加干姜、甘草、黄
。若妊娠伤寒，四肢拘急，身凉微汗，腹中痛，脉沉而迟，少阴病也，宜附子六合汤∶
四物汤四两、附子、炮去皮脐，桂各半两。若妊娠伤寒蓄血证，不宜堕胎药下之，宜四
物大黄汤∶四物汤四两，生地黄、大黄酒浸，各半两。四物与麻黄、桂枝、白虎、柴胡、
理中、四逆、茱萸、承气、凉膈等，皆可作各半汤，不能殚述，此易老用药大略也。
安胎及漏胎下血，加阿胶、大艾、甘草、蒲黄炒过。若胎动不安，下血不止，每服加
艾叶五七片，更加葱白、阿胶末、黄 ，减四味之半，当归只用小半。如疾势甚者，以
四味各半两，细锉，以水四盏，熟艾一块，如鸡子大，阿胶五七片，煎至二盏半，去滓，分
作四服，一日令尽。一方加粉草、干姜、黄 ，日二三服，至二腊。以一七日为一腊。
胎前产后，每日可一二服。亦治血痢不止，腹痛难忍，宜加阿胶。艾叶煎服，名六物汤。如
气虚血海不调不妨。一方∶四物加黄 、柏叶、阿胶、甘草、续断，平常经血淋沥不断，
或多或少，或赤或白，非时漏下，多服有效。
受胎小肠气痛，加木香、怀香；胎前嗽，加枳壳，甘草、款冬、知母、马兜铃、半夏、木
通、葶苈、人参、苦梗、麦门冬。胎气冲肝，腰脚痹，行步艰难，加枳壳、木通、连
翘、荆芥、地黄、羌、独、山栀、甘草、灯心、空心服。妊娠心烦，加竹茹一块。如有
败血，则用当归近上节，白芍药以赤易，熟地黄以生者。妊娠作恶，生寒面青，不思
饮食，惟悴，加陈皮、枳壳、白术、茯苓、甘草。损孕下血不止，头痛、寒热、耳鸣，气
血劳伤所致，加黄芩、荆芥、生地黄、赤芍药、生姜。临产小腹紧痛，加红花、滑石、
甘草、灯心、葵子。产后恶露，腹痛不止，加桃仁、苏木、牛膝。产后腹痛，血块攻
[Bao Shi] For women in their childhood and youth, before the onset of Tian Gui (menstruation), diseases generally belong to the Shaoyin channel. After Tian Gui has begun to flow, diseases generally belong to the Jueyin channel. After Tian Gui has ceased, diseases generally belong to the Taiyin channel. When treating pregnancy and postpartum diseases from the perspective of the Jueyin channel, it is because this is the source of the transformation and generation of ancestral Qi. The Jueyin channel and the Shaoyang channel are exteriorly-interiorly related; therefore, treatment methods must not violate Stomach Qi and the Upper and Middle Jiao. These constitute the "Three Prohibitions": no sweating, no purgation, and no promoting urination. If sweating is induced, it resembles the condition of premature purgation in Cold Damage (Shanghan). Promoting bowel movements disturbs the Spleen even if the pulse is rapid. Promoting urination leads to the loss of body fluids internally and dryness in the Stomach. The principle of preparing medicines is that if these three prohibitions are not violated, Ying and Wei (Nutritive and Defensive Qi) will naturally harmonize, and chills and fever will cease. Externally harmonizing Ying and Wei allows for internal regulation of clear and turbid excretions. This method should be used as an initial treatment, followed by detailed discussion. Adjusting based on observed symptoms is similar to treating damaged syndromes in Cold Damage, employing a缓 (gentle/moderate) approach. Conditions may include difficulty in urination, constipation, accumulation of heat in the intestines and stomach, development of flaccidity syndromes, or edema caused by scattered Qi and Blood. Because the physiology of childbirth involves many pathways, it is said to be similar to damaged syndromes in Cold Damage. For example, use Baihu Tang (White Tiger Decoction) for thirst, Ren Shen (Ginseng Root) or Huang Qi (Astragalus Root) for weak Qi, Dang Gui (Angelica Sinensis Root) for stabbing blood pain, and Shao Yao (Peony Root) for abdominal pain. These examples do not violate the three prohibitions and refer to chronic illnesses after childbirth. However, acute illnesses after childbirth should not be constrained by these rules. For instance, in cases where heat enters the Blood Chamber after childbirth, use Taoren Chengqi Tang (Peach Kernel and Rhubarb Decoction) or Didang Tang (Definite Conquest Decoction). In cases of hard and dry Stomach, Dachengqi Tang (Major Order the Qi Decoction) cannot simply be discussed as a purgative. People often use Wujin Tang (Black Gold Decoction) and Siwu Tang (Four Substances Decoction) after childbirth without distinguishing the cold and heat of the four seasons or the deficiency and excess of Qi and Blood. Blindly administering medicine in this manner exacerbates the condition, which is an error. Generally, for postpartum diseases, if affected by seasonal pathogens, modify Chaihu formulas; for miscellaneous diseases, modify Siwu Tang. Spring and summer favor Chaihu formulas, while autumn and winter favor Siwu Tang. The cold and hot nature of drugs and the deficiency and excess of syndromes must not be overlooked. Siwu Tang is suitable for regular consumption. The following describes the method of modification according to the four seasons.
[Nourishing Blood]
Siwu Tang (Four Substances Decoction): Benefits Ying and Wei, nourishes Qi and Blood. Treats irregular menstruation, umbilical and abdominal pain; menstrual disorders where flow is early or late, heavy or light, with varying pains, pain in the waist, feet, and abdomen; metrorrhagia and metrostaxis (profuse bleeding or spotting between periods); excessive lochia after miscarriage, or retained lochia that fails to discharge; abdominal pain and bleeding during pregnancy with fetal unrest; postpartum blood stasis masses that do not dissipate, excessive blood loss, or continuous lochia. Siwu Tang with Cornus officinalis fruit (Shanzhuyu) decocted and taken orally. If the constitution is Yang-dominant, use less Shanzhuyu; if Yin-dominant, use more Shanzhuyu. Another prescription adds Cyperi Rhizoma (Xiangfu).
Prepared Rehmannia Root (Shu Dihuang): Nourishes Blood. Essential for eliminating pain below the umbilicus; it is a herb that enters the Kidney channel.
Sichuan Lovage Rhizome (Chuanxiong): Treats wind, disperses Liver Wood stagnation. Essential for eliminating headache due to Blood deficiency; it is a herb that enters the Liver channel.
Peony Root (Shaoyao): Harmonizes Blood and regulates the Spleen. Essential for eliminating empty pain in the abdomen; it is a herb that enters the Spleen channel.
Angelica Sinensis Root (Danggui): Harmonizes Blood. Essential for eliminating stabbing blood pain, sharp as if cut by a knife; it is a herb that enters the Heart channel.
Grind the above into coarse powder, decoct with water, and take orally.
In Spring, double the amount of Chuanxiong (1. Spring, 2. Wiry pulse, 3. Headache.)
In Summer, double the amount of Shaoyao (1. Summer, 2. Surging pulse, 3. Diarrhea.)
In Autumn, double the amount of Dihuang (1. Autumn, 2. Choppy pulse, 3. Blood deficiency.)
In Winter, double the amount of Danggui (1. Winter, 2. Deep pulse, 3. Cold and anorexia.)
If Spring, use Fangfeng Siwu Tang (Siwu Tang with Saposhnikovia Root), adding Fangfeng and doubling Chuanxiong. If Summer, use Huangqin Siwu Tang (Siwu Tang with Scutellaria Root), adding Huangqin and doubling Shaoyao. If Autumn, use Tianmendong Siwu Tang (Siwu Tang with Asparagus Root), adding Tianmendong and doubling Dihuang. If Winter, use Guizhi Siwu Tang (Siwu Tang with Cinnamon Twig), adding Guizhi and doubling Danggui. If Blood deficiency with abdominal pain, slight sweating, and aversion to wind, add Atractylodes Macrocephala Rhizome (Baizhu) and Guizhi to Siwu Tang, called Abdominal Pain Liuhe Tang (Six-Harmony Decoction). If dizziness due to wind, add Gentiana Macrophylla Root (Qinjiao) and Notopterygium Rhizome (Qianghuo), called Wind Liuhe Tang. If Qi deficiency with weakness upon rising and vertigo, add Magnolia Bark (Houpo) and Tangerine Peel (Chenpi), called Qi Liuhe Tang. (Is it appropriate to use Qi-draining herbs for Qi deficiency? One should use Ren Shen (Ginseng Root) and Fu Ling (Poria) instead.) If fever with irritability and insomnia, add Coptis Rhizome (Huanglian) and Gardenia Fruit (Zhizi), called Heat Liuhe Tang. If deficiency-cold with faint pulse, spontaneous sweating, and difficult breathing, but normal urination and defecation, add Dried Ginger (Ganjiang) and Prepared Aconite Root (Fuzi), called Cold Liuhe Tang. If dampness invasion with heavy body, weakness, cool skin, and slight sweating, add Baizhu and Fu Ling, called Dampness Liuhe Tang. If a woman suffers from pain in bones, sinews, limbs, and joints, headache, wiry pulse, and chills resembling malaria, treat with Wind Liuhe Tang. If Qi and Blood injury causes fainting due to deficiency, use Siwu Tang 4 liang, Qianghuo and Fangfeng 1 liang each. If Qi and Blood rush upward to the heart and abdomen causing fullness and oppression in the hypochondrium, treat with Qi Liuhe Tang: Siwu Tang 4 liang, Aquilaria Wood (Muxiang) and Areca Seed (Binglang) 1 liang each. If deficiency-cold below the umbilicus with abdominal pain and stuffy pain in the lower back and spine, use Yanyhusuo Liuhe Tang: (Same for lower abdominal pain) Siwu Tang 4 liang, Corydalis Rhizome (Yanyhusuo) and Chinaberry Seed (Kulian) 1 liang each, crushed and stir-fried until scorched. If Qi rushes through the meridians causing frequent menstruation and much pain below the umbilicus, use Shaoyao Liuhe Tang: Siwu Tang 4 liang, double Shaoyao, and Huangqin 1 liang. If menstruation is about to start with colicky pain in the umbilical and abdominal region, indicating stagnant Blood, use Bawu Tang: Siwu Tang 4 liang, Yanyhusuo, Binglang, Kulian (crushed and stir-fried scorched), and Muxiang 1 liang each. If a woman with Blood deficiency suffers unbearable heart and abdominal pain, remove Dihuang and add Ganjiang, named Sishen Tang. To tonify the Lower Yuan, add Ganjiang half liang and Gancao (Licorice Root) 7 fen. For Qi attacking lower abdominal pain, add Yanyhusuo and decoct. If stabbing pain in the abdomen with failure to pass foul matter, double Danggui and Shaoyao. If abdominal pain produces sounds and meridians are unsmooth, double Shu Dihuang and add Guixin (Cinnamon Heart) half amount and decoct. For menstrual cramps with lower back pain, add Rapeseed (Yuntai), Achyranthes Root (Niuxi), Safflower (Honghua), Evodia Fruit (Wuzhuyu), Ginger, Gancao, Silver Ware, and Juncus Effusus (Dengxin), take hot. If menstrual flow is scanty and涩 (choppy/stagnant), add Sunflower (Kuihua) to Siwu Tang; also add Honghua and Xuejianchou. If menstrual flow is scanty but color is normal, add Hot Dihuang and Danggui 1 liang each to Siwu Tang. If menorrhagia occurs, add Huangqin to Siwu Tang. If abdominal pain, add Huanglian. Do not remove Huangqin in summer. If menstrual blood looks like black bean juice, add Huangqin and Huanglian 1 liang each. If menstrual flow is excessive without other symptoms, use Huangqin Liuhe Tang: Siwu Tang 4 liang, Huangqin and Baizhu 1 liang each. For continuous dripping of menstrual blood, add dried Lotus Seed Pod (Lianfang), stir-fried and added to the medicine. During intercourse or menstruation, add Red Kaolin (Chishizhi), Huangqi, Cinnamon Bark (Rougui), Baocaoshuang (Charred Grass Ash), Lotus Node (Oujie), Charred Palm Fiber (Baizonghui), Nutmeg (Roudoukou), Danggui, Muxiang, Dragon Bone (Longgu), Baizhu, Fu Ling, and Sanguisorba Root (Diyu). If menstruation starts and stops abruptly with alternating chills and fever, first administer Xiaochaihu Tang (Minor Bupleurum Decoction) to resolve chills and fever, then harmonize with Siwu Tang. If chills and fever persist, do not take Siwu Tang; this is a changed syndrome where pathogenic factors remain in the exterior, so it will not be effective. According to the previous discussion on changed syndromes, adjust medication based on symptoms. For metrorrhagia, add Raw Rehmannia Root (Sheng Dihuang) and Polygonum Multiflorum Vine (Puhuang). To tonify Blood and stop bleeding, add Baocaoshuang, Zonghui, Shumianhui (Ash of First Cotton), stir-fried Puhuang, Longgu, and Baijiang (White Ginger). For clots of blood, add Dihuang and Oujie. For dark blood clots, add Ren Shen and Baizhu. If the Blood Organ is deficient and cold with excessive bleeding from metrorrhagia, add Ejiao (Donkey-hide Gelatin) and Ai Ye (Mugwort Leaf). For irregular menstruation, metrorrhagia, varying amounts, timing, vomiting, and epigastric distension, add Chen Ai (Aged Mugwort) and Huangqi. For red and white leukorrhea, use Xianggui Liuhe Tang: Siwu Tang 4 liang, Guizhi and Xiangfu 5 qian each. Grind Siwu Tang into fine powder, make pills with refined honey the size of wu zi (loquat seeds), take 30-40 pills with rice drink on an empty stomach; this effectively treats leukorrhea in elderly women. For white turbid discharge, add Longgu, Dihuang, and Danggui. For five-colored discharge, grind Moschus (Shexiang) and take with good wine. For bright red discharge, take with warm wine or salt water. For leukorrhea, add Rougui, Puhuang, Baocaoshuang, Gancao, Black Soybean (Heidou), Baizhu, Yanyhusuo, Baijiang, and Longgu, take with salt wine on an empty stomach. For white leukorrhea, take with White Longgu and wine. For blood accumulation in women, add Ezhu (Curcuma Rhizome), Sanleng (Sparganium Rhizome), Guizhi, and Ganqi (Dry Lacquer), stir-fried until smoke ceases, 1 liang each. For stagnant menstrual blood causing abdominal pain from Qi and Blood, add Ezhu and Guigui (Cassia Twig), use equal parts. Wang Shifu said: Shu Dihuang is cloying and stagnates Blood, how can it relieve pain? It is better to replace it with Wulingzhi (Trogopterus Feces). For blood stasis obstruction, add Taoren (Peach Kernel) and Honghua 2.5 qian each. For amenorrhea, add Zhike (Bitter Orange), Dahuang (Rhubarb Root), Jingjie (Schizonepeta Spike), Huangqin, Qingpi (Green Tangerine Peel), Huashi (Talcum), Mutong (Akebia Stem), Qumai (Dianthus Herb), Jinshasha (Desert Sand Grain), Shanzhizi (Gardenia Seed), Cheqianzi (Plantago Seed). For Blood Cold, add Gancao, Wumei (Mume Fruit), Chaihu (Bupleurum Root), Tao Liuzhi (Peach and Willow Branches). For long-term amenorrhea, add Rougui, Gancao, Huangqi, Jiangqian (Ginger Slice), Zaozi (Jujube), Mutong, and Honghua. For blocked menstruation, add Yezhu Gen (Wild Ramie Root), Niuxi, Honghua, Sumu (Sappan Wood), old wine, and water, decoct together. For disharmonious Qi and Blood, add Wuzhuyu 1 liang and Gancao half liang. Siwu Tang with Gancao half liang, ground to fine powder, made into pills with refined honey, 8 pills per liang, dissolve and take with wine and vinegar half cup decocted together, named Danggui Jian. Removes bad Blood, generates good Blood. Take another dose after walking for five li, at any time. For deficiency-heat disease, combine Siwu Tang with Renshen Su Yin (Ginseng and Perilla Drink), named Buxin Tang. Adding Chaihu makes Wushen Tang, greatly tonifying deficiency and clearing deficiency-heat. For tidal fever, add Huangqin, Digupi (Groundsel Root), and Chaihu. Another formula adds Chaihu, Ge Gen (Kudzu Root), Huangqin, and Ren Shen. For deficiency-heat with dry mouth, add Maidong (Ophiopogon Tuber) and Huangqin 1 liang. For deficiency-thirst, add Ren Shen, Ge Gen, Wumei, and Gualougen (Trichosanthes Root). For deficiency with profuse sweating, add Du Mu Li (Calcined Oyster Shell) and Mahuang Gen (Ephedra Root) half liang each. For deficiency-chills and tidal fever, add Chaihu, Digupi, Baizhu, Fu Ling, Gancao, Qinjiao, Zhimu (Anemarrhena Rhizome), Huangqin, Maiya (Sprouted Barley), Beimu (Fritillaria Bulb), Ren Shen, Wumei, and Zaozi. For swollen and painful limbs unable to move, use Cangzhu Gehalf Tang (Half Cangzhu Decoction). For dry and hard stool, combine Siwu Tang and Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) equally, named Yuzhu San (Jade Candle Powder). For draining dampness and drying dryness, use Silwu Lizhong Gehalf Tang (Half Siwu and Lizhong Decoction). For combined Qi and Blood deficiency, combine Siwu Tang and Sijunzi Tang (Four Gentlemen Decoction) equally, named Bazhen Tang (Eight Treasures Decoction). Add Sharen (Amomum Fruit) to protect fetal Qi and enable conception. If heat, add Huangqin. If wind generated by heat, add Chuanxiong, Chaihu, and Fangfeng. One formula excludes one herb. For Qi and Blood exhaustion, add Jingjie and Chaihu. For Blood Wind causing stabbing pain in both hypochondria or coiled intestine masses, add Dahuang, Bibo (Long Pepper Fruit), and Rushing Xiang (Frankincense). For Blood weakness generating wind causing bi-pain in limbs and difficulty walking, add Ren Shen, Rushing Xiang, Moyao (Myrrh), Shexiang (Musk), Gancao, Wulingzhi, Qianghuo, Duhuo (Angelica Pubescens Root), Fangfeng, Jingjie, Dilong (Earthworm), Nanxing (Arisaema Rhizome), Baifuzi (Typhonium Rhizome), Zelán (Leonurus Herb), grind to powder, make pills with honey. Take with Papaya Salt Water. For Blood Wind distension, add Gancao, Muxiang, Zhike, Madouling (Aristolochia Stem), Tingli (Periploca Seed), Zisu (Perilla Leaf), Huoxiang (Patchouli Leaf), and Dihuang, take on an empty stomach. For organ and bowel constipation, add Dahuang and Taoren. For slippery diarrhea, add Guigui and Fuzi. For deficiency diarrhea, add Ren Shen, Chuanxiong, Baizhi (Angelica Dahurica Root), Puhuang, stir-fried Ejiao, Baizhu, Zhuyu (Cornus Fruit), Xuduan (Dipsacus Root), Ganjiang, Fuzi, Rougui, Huangqi, Chishizhi, and Gancao, make pills with honey. Take with Sour Plum Soup. For vomiting, add Baizhu and Ren Shen. One formula includes Shengjiang (Fresh Ginger). For persistent vomiting, add Huoxiang and Baizhu half liang, Ren Shen 2.5 qian. For retching and inability to eat, add Baizhu, Rushing Xiang, Gancao, Ren Shen, Sharen, Yizhiren (Alpinia Oxyphylla Fruit), and Hujiao (Pepper). For cough, add Sangbaipi (Mulberry Root Bark), Banxia (Pinellia Tuber), Ren Shen, Shengjiang, Bei Wuweizi (Schisandra Berry), and Gancao. For wind-induced consumptive cough, add Kuandonghua (Coltsfoot Flower), Zhimu, Ejiao, Banxia, Mahuang, Gancao, Madouling, Huangqin, Xingren (Apricot Seed), Chaihu, Jiangqian, Hezi (Chebulic Myrobalan), and Wumei. If chills and fever occur, add Gan Shengjiang (Dried Fresh Ginger), Mudanpi (Tree Peony Bark), and Chaihu. One formula adds Shaoyao. If alternating chills and fever, add Pao Ganjiang (Stir-fried Dried Ginger) and Mudanpi 1 fen each. For mild deficiency vertigo, emaciation, fatigue, and amenorrhea, use only Shengjiang and Bohe (Mint). This is a common medicine for women, with mild flavor and gentle nature, slow effect but profound merit. For extreme thirst, add Zhimu and Shigao (Gypsum). For fluid retention under the heart with slight nausea, add Zhuling (Polyporus), Fu Ling, and Fangji (Stephania Root). For epigastric and abdominal fullness, add Zhike and Qingpi. For spontaneous sweating, add Mahuang Gen. For profuse sweating, add Fumai (Floating Wheat). For hematochezia, cold limbs, distension, and wind in intestines/stomach, use Huaihua (Sophora Flower), Zhike, Loulu (Leuzea Root), Jingjie, Muxiang, Bai Jiguan Hua (White Chicken Comb Flower), Mutong, Hongneixiao (Red Internal Eliminator), Zicao (Arnebia Root), Shiliupi (Pomegranate Peel), Chenpi, Qingpi, Huangqin, Gancao, Baimaogen (Imperata Rhizome), and Huaijiao (Sophora Fruit). For intestinal wind bleeding, add Huaijiao, Huaihua, Zhike, Jingjie, Huangqin, Dafupi (Areca Peel), Hongneixiao, Diyuan, Shinanye (Nandina Leaf), and Bai Jiguan Hua, grind to powder and decoct, take half as powder on an empty stomach with salt water and old wine. For epistaxis and hematemesis, add Zhuqing (Bamboo Green), Puhuang, Oujie, Banxia, Dingxiang (Clove), Hezi, Guihua (Osmanthus Flower), Hongzao (Red Date), Feiluomian (Fine Flour), Baimaogen, and Bangfen (Concha Tridacnae). For dizziness and stiff neck, add Ren Shen and Huangqin. For deficiency-cold resembling Cold Damage, add Ren Shen, Chaihu, and Fangfeng. For deficiency irritability and insomnia, add Zhuye (Bamboo Leaf) and Ren Shen. For various pains with dampness, combine Siwu Tang and Baizhu equally, add Tianma (Gastrodia Rhizome), Fu Ling, and Chuanshanjia (Pangolin Scale), decoct with wine. For elderly wind-constipation, add Qingpi equal parts, decoct and take. For sores, decoct Jingjie in wine and take regularly. For breast abscess, add Lianqiao (Forsythia Fruit), Cizu (Zantedeschia Corm), Hongneixiao, Baizhi, Gupian (Zantedeschia Slice), Jingjie, Niuxi, Shanwugong (Centipede), Rushing Xiang, Moyao, Loulu, and Sheng Dihuang. For red eyes and head wind disease, add Bohe and Qingcha (Clear Tea). For red eyes with wind, add Fangfeng and Huangqin. For wind sores with red swelling, add Jingjie, Niubangzi (Arctium Seed), Heshouwu (Polygonum Multiflorum Root), Gancao, Fangfeng, Qianghuo, Dihuang, salt, and wine. For foot swelling, add Dafupi, Chi Xiaodou (Adzuki Bean), Fulingpi (Poria Skin), and Shengjiangpi (Fresh Ginger Skin). If a woman has Cold Damage, reduced diet after sweating and purging, and Blood deficiency, use Bawu Tang: Siwu Tang 4 liang, Huangqi, Baizhu, Fu Ling, and Gancao 1 liang each. If pregnant with Cold Damage, wind-stroke with exterior deficiency and spontaneous sweating, headache, stiff neck, fever, aversion to cold, floating and weak pulse, Taiyang channel disease, use Biaoxu Liuhe Tang (Exterior Deficiency Six-Harmony Decoction): Siwu Tang 4 liang, Guizhi and Digupi 7 qian each. If pregnant with Cold Damage, headache, fever, no sweat, floating tight pulse, Taiyang channel disease, use Biaoshi Liuhe Tang (Exterior Excess Six-Harmony Decoction): Siwu Tang 4 liang, Mahuang and Xixin (Asarum Root) half liang each. If pregnant with Cold Damage, invaded by wind-dampness, painful limbs, floating hot pulse, headache, this is a Taiyang manifest disease, use Fengshi Liuhe Tang (Wind-Damp Six-Harmony Decoction): Siwu Tang 4 liang, Fangfeng and Cangzhu 7 qian each. If pregnant with Cold Damage, unresolved after purgation past the meridian stage, warm toxin causing rash like brocade patterns, use Shengma Liuhe Tang (Cimicifuga Six-Harmony Decoction): Siwu Tang 4 liang, Shengma (Cimicifuga Rhizome) and Lianqiao 7 qian each. If pregnant with Cold Damage, chest and hypochondriac fullness/pain, wiry pulse, Shaoyang dizziness/stiff neck, use Chaihu Liuhe Tang (Bupleurum Six-Harmony Decoction): Siwu Tang 4 liang, Chaihu and Huangqin 7 qian each. If pregnant with Cold Damage, hard stool, red urine, abdominal fullness, deep rapid pulse, Yangming-Taiyang root disease, purge urgently, use Dahuang Liuhe Tang (Rhubarb Six-Harmony Decoction): Siwu Tang 4 liang, Dahuang half liang, Taoren 10 pieces (skin and tip removed, bran-fried). If pregnant with Cold Damage, persistent cough after sweating and purging, use Renshen Liuhe Tang (Ginseng Six-Harmony Decoction): Siwu Tang 4 liang, Ren Shen and Wuweizi (Schisandra Berry) half liang each. If pregnant with Cold Damage, deficiency bloating/fullness after sweating and purging, Yangming root deficiency, use Houpo Liuhe Tang (Magnolia Six-Harmony Decoction), also treats cough and wheezing. Siwu Tang 4 liang, Houpo and Zhishi (Immature Bitter Orange) bran-fried, half liang each. If pregnant with Cold Damage, insomnia after sweating and purging, use Zhizi Liuhe Tang (Gardenia Six-Harmony Decoction): Siwu Tang 4 liang, Zhizi and Huangqin half liang each. If pregnant with Cold Damage, high fever, extreme thirst, steaming irritability, long and large pulse, use Shigao Liuhe Tang (Gypsum Six-Harmony Decoction): Siwu Tang 4 liang, Shigao and Zhimu half liang each. If pregnant with Cold Damage, difficulty urinating, Taiyang root disease, use Fuling Liuhe Tang (Poria Six-Harmony Decoction): Siwu Tang 4 liang, Fu Ling and Zexie (Alisma Rhizome) half liang each. If pregnant with Cold Damage, Taiyang root disease, urine red like blood, use Hupo Liuhe Tang (Amber Six-Harmony Decoction): Siwu Tang 4 liang, Hupo (Amber) and Fu Ling half liang each. If pregnant with Cold Damage, continuous bleeding after sweating and purging, damaging fetal Qi, use Jiaoai Liuhe Tang (Ejiao Six-Harmony Decoction): Siwu Tang 4 liang, Ejiao and Ai Ye half liang each. One formula adds Gancao, same as above. One formula adds Ganjiang, Gancao, and Huangqi. If pregnant with Cold Damage, limb spasms, cool skin with slight sweating, abdominal pain, deep slow pulse, Shaoyin disease, use Fuzi Liuhe Tang (Aconite Six-Harmony Decoction): Siwu Tang 4 liang, Fuzi (prepared, skin and脐 removed) and Guizhi half liang each. If pregnant with Cold Damage and blood stasis syndrome, do not use abortifacients, use Siwu Dahuang Tang (Siwu and Rhubarb Decoction): Siwu Tang 4 liang, Sheng Dihuang and Dahuang (wine-soaked) half liang each. Siwu Tang can be combined equally with Mahuang, Guizhi, Baihu, Chaihu, Lizhong, Sini, Zhuyu, Chengqi, Liangge, etc., to make half-decoctions, too numerous to list. This is the general principle of Yi Lao's (Zhang Yuansu) medication.
For securing the fetus and stopping leakage bleeding, add Ejiao, Da Ai (Large Mugwort), Gancao, and stir-fried Puhuang. If fetal movement insecurity with continuous bleeding, add 5-7 Ai Ye leaves per dose, plus Congbai (Scallion White), Ejiao powder, and Huangqi, reduce the four main ingredients by half, use only a small amount of Danggui. If the condition is severe, use half liang of each of the four ingredients, finely chopped, with 4 cups of water, a piece of cooked Ai Ye the size of a chicken egg, and 5-7 pieces of Ejiao, decoct to 2.5 cups, strain, divide into 4 doses, finish in one day. One formula adds Fencao (Powdered Licorice), Ganjiang, and Huangqi, take 2-3 times daily, up to two "La" periods. One "La" is seven days. Before and after childbirth, take 1-2 doses daily. Also treats persistent bloody dysentery with unbearable abdominal pain, add Ejiao and Ai Ye decocted, named Liwu Tang (Six Substances Decoction). If Qi deficiency and Blood Sea disharmony allow, one formula: Siwu Tang plus Huangqi, Boye (Privet Leaf), Ejiao, Gancao, and Xuduan; for normal dripping menstrual blood, varying amounts, red or white, non-time leakage, taking more is effective.
For conception-related Small Intestine Qi pain, add Muxiang and Huaixiang; for pre-natal cough, add Zhike, Gancao, Kuandong, Zhimu, Madouling, Banxia, Mutong, Tingli, Ren Shen, Kugen (Platycodon Root), and Maidong. For fetal Qi rushing to Liver causing numbness in waist/legs and difficulty walking, add Zhike, Mutong, Lianqiao, Jingjie, Dihuang, Qianghuo, Duhuo, Shanzhi, Gancao, and Dengxin, take on empty stomach. For pregnancy restlessness, add Zhuru (Bamboo Shavings) one piece. If there is bad blood, use the upper section of Danggui, replace Shaoyao with Red Shaoyao, and use Raw Dihuang. For pregnancy nausea, chills, blue face, anorexia, and exhaustion, add Chenpi, Zhike, Baizhu, Fu Ling, and Gancao. For threatened abortion with continuous bleeding, headache, chills/fever, tinnitus caused by Qi/Blood exhaustion, add Huangqin, Jingjie, Sheng Dihuang, Chi Shaoyao (Red Peony Root), and Shengjiang. For labor approaching with tight lower abdominal pain, add Honghua, Huashi, Gancao, Dengxin, and Kui Zi (Sunflower Seed). For postpartum lochia with persistent abdominal pain, add Taoren, Sumu, and Niuxi. For postpartum abdominal pain with blood masses attacking