〔良〕岐伯曰∶女子七岁肾气盛，齿更发长。二七而天癸至，任脉通，太冲脉盛，月
事以时下。天谓天真之气，癸谓壬癸之水。壬为阳水，配丁而化木。癸为阴水，合戊而化
火。故曰∶水火者，阴阳之征兆也。女子阴类，故得癸焉。冲为血海，任主胞胎，二脉
流通，经血渐盈，应时而下，天真气降，与之从事，故曰天癸也。常以三旬一见，以像
月盈则亏，不失其期，又名月信也。若遇经行，最宜谨慎，否则与产后证相类。若被惊
恐劳役，则血气错乱，经脉不行，多致劳瘵等疾。若逆于头面肢体之间，则重痛不宁。若
怒气伤肝，则头晕、胁痛、呕血，而瘰 、痈疡。若经血内渗，则窍穴淋沥无已。凡此六
淫外侵，而变证百出，犯时微若秋毫，成患重如山岳，可不畏哉。
〔薛〕血者，水谷之精气也，和调五脏，洒陈六腑，在男子则化为精，在妇人上为乳
汁，下为血海。故虽心主血，肝藏血，亦皆统摄于脾，补脾和胃，血自生矣。凡经行之
际，禁用苦寒、辛散之药，饮食亦然。
〔良〕妇人月水不调，由风邪乘虚客于胞中，而伤冲任之脉，损手太阳、少阴之经。
盖冲任之脉，皆起于胞中，为经络之海，与手太阳小肠、手少阴心经为表里，上为乳汁，
下为月水。然月水为经络之余，苟能调摄得宜，则经应以时矣。
〔薛〕经曰∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下
输膀胱，水精四布，五经并行。东垣先生谓脾为生化之原，心统诸经之血，诚哉是言也。
窃谓心脾平和，则经候如常，苟或七情内伤，六淫外侵，饮食失节，起居失宜，脾胃虚损，
心火妄动，则月经不调矣。有先期而至者，有后期而至者，其说详见后条。盖血生于脾土，
故云脾统血。凡血病当用苦甘之剂，以助阳气而生阴血也。
〔辨色〕
〔丹〕经水者，阴血也，阴必从阳，故其色红，禀火色也。血为气之配，气热则热，
气寒则寒，气升则升，气降则降，气凝则凝，气滞则滞，气清则清，气浊则浊。往往见有
成块者，气之凝也。将行而痛者，气之滞也。来后作痛者，气血俱虚也。色淡者，亦虚也，
而有水混之也。错经妄行者，气之乱也。紫者，气之热也。黑者，热之甚也。今人但见
其紫者、黑者、作痛者、成块者，率指为风冷，而行温热之剂，则祸不旋踵矣。良由
《病源》论月水诸病，皆曰风冷秉之，宜其相习而成俗也。或曰∶黑，北方水色也。紫淡
于黑，非冷而何？予曰∶经曰亢则害，承乃制，热甚者必兼水化，所以热则紫，甚则黑
也。况妇人性执而见鄙，嗜欲加倍，脏腑厥阳之火，无日不起，非热而何？若曰风冷，必
须外得，设或有之，盖千百一二者也。（冷证外邪初感，入经必痛。或不痛者，久则郁而
变热矣。且寒则凝，既行而紫黑，故非寒也。）
〔海〕四物加黄芩黄连汤 治经水如黑豆汁。
四物汤（四两） 黄芩 黄连（各一两）
上为末，醋糊丸服。
〔丹〕月经黑，口渴倦怠，形短色黑，脉不匀似数。
赤芍药 香附米（各半两） 黄柏（炒） 黄芩（各三钱） 甘草（二钱）
上为末，醋糊丸，白汤下五六十丸。
永康胡八娘子，二十岁。二月经事不来，忽行，小腹痛，有块，血紫色。
白芍药 白术 陈皮（各半两） 黄芩 川芎 木通（各二钱） 甘草（炙，少许）
何孺人，气滞血涩，脉不涩，经不调，或前或后，紫色，口苦，两大腿外 麻木，有
时痒，生疮，大便秘滞。
麻子仁 桃仁 芍药（各二两） 枳壳 白术 归头 威灵仙 诃子肉 生地黄 陈皮
（各五钱） 大黄（ ，七钱）
各为末，粥丸如桐子大，白汤下五六十丸。
〔丹〕经水色淡者，气血俱虚也，宜八物汤之类。八物者，四物、四君子也。如兼
它证，随证加药。
〔楼〕妇人年四十八，因有白带，口渴，月经多，初血黑色，后来血淡，倦怠食少，脐
上急。
白术（一钱半） 白芍药 陈皮（各一钱） 木通 枳壳 黄芩（各五分） 缩砂仁
甘草（炙，各三分） 红花（豆许）
上煎汤下保和丸三十丸、抑青丸二十丸。
〔审多少〕
妇人病多是月经乍多乍少，或前或后，将发疼痛，医者不审，一例呼为经病。不知阳
胜阴，阴胜阳，所以服药无效。盖阴气乘阳，则包藏寒气，血不营运，经所谓天寒地冻，水
凝成冰，故令乍少而在月后。若阳气乘阴，则血流散溢，经所谓天暑地热，经水沸溢，故
令乍多而在月前。当和血气，平阴阳，斯为福也。
阳胜阴，月候多者，当归饮。
当归饮 抑阳助阴，调理经脉。
当归（微炒） 地黄（酒蒸，焙） 川芎 白术 白芍药 黄芩（各等分）
每服三钱，水一盏半，煎至八分，空心温服。
阴胜阳，月候少者，七沸汤。
七沸汤 治荣卫虚，经水愆期，或多或少，腹痛。
当归 川芎 白芍药 蓬术 熟地黄 川姜 木香（各等分）
每服四钱，水一盏半。煎至八分，温服。
经水过多为虚热，为气虚不能摄血。
〔海〕四物加黄芩白术汤 治经水过多。
四物汤（四两） 黄芩 白术（各一两）
〔丹〕经水过多。
黄芩（炒） 芍药（炒） 龟板（炙，各一两） 椿树根皮（七钱半） 黄柏（炒，三钱）
香附（二钱半）
上为末，酒糊丸，空心白汤下五六十丸。
〔丹〕一妇人脉弦而大，不数，形肥。初夏时倦怠，月经来时多。此禀受弱，气不
足摄血，故行多。
白术（一钱半） 黄 （生） 陈皮（各一钱） 人参（五分） 甘草（炙，三分）
经水涩少，为虚为涩，虚则补之，涩则濡之。
〔海〕四物加葵花汤 治经水涩少。
四物汤（四两） 葵花（一两） 一方∶又加红花、血见愁。
四物汤加熟地黄当归汤 治经水少而色和。
四物汤（四两） 熟地黄 当归（各一两）
〔脉〕师曰∶有一妇人来诊，言经水少，不如前者，何也？师曰∶曾更下利，若汗出小便
利者可。何以故？师曰∶亡其津液，故令经水反少。设经下多于前者，当所苦困，当言恐大便难，身
无复汗也。
〔先期后期〕
王子亨曰∶经者，常候也。谓候其一身之阴阳愆伏，知其安危，故每月一至。太过不及，皆为
不调。阳太过则先期而至，阴不及则后时而来，其有乍多乍少，断绝不行，崩漏不止，皆由阴阳
衰盛所致。
〔丹〕经不及期者血热，四物汤加黄连。肥人不及日数而多痰者，血虚有热，南星、白
术、苍术、黄连、香附、川芎作丸。
〔薛〕先期而至者，有因脾经血燥者，宜加味逍遥散。有因脾经郁滞者，宜归脾汤
（方见杂病健忘门。）有因肝经怒火者，宜加味小柴胡汤。（方见伤寒少阳病。）有因血分有热
者，宜加味四物汤。（即四物加柴胡、丹皮、山栀。）有因劳役火动者，宜补中益气汤。（方
见杂病劳倦门。）
先期汤 治经水先期而来，宜凉血固经。
生地黄 川当归 白芍药（各二钱） 黄柏 知母（各一钱） 条芩 黄连 川芎
阿胶（炒，各八分） 艾叶 香附 炙甘草（各七分）
水二盅，煎一盅，食煎温服。
金匮土瓜根散 治带下经水不利，小腹满痛，经一月再见者。
土瓜根 芍药 桂枝 虫（各七钱半）
上四味，杵为散，酒服方寸匕，日三服。
按∶仲景此方，乃破坚下血之剂，则经不及期有汗血者矣，前论所未及也。欲知汗
血有无，须以小腹满痛与不满痛别之。
〔丹〕经水过期血少，川芎、当归、人参、白术与痰药。过期色淡者，痰多也，二
陈汤加芎、归。过期色紫有块，血热也，必作痛，四物汤加香附、黄连。
〔薛〕过期而至者，有因脾经血虚者，宜人参养荣汤。有因肝经血少者，宜六味地
黄丸。有因气虚血弱者，宜八珍汤。（三方并见杂病虚劳门。）
过期饮 治经水过期不行，乃血虚气滞之故，法当补血行气。
熟地黄 白芍药 当归 香附（各二钱） 川芎（一钱） 红花（七分） 桃仁泥（六分）
蓬莪术
木通（各五分） 甘草 肉桂（各四分）
水二盅，煎一盅，食前温服。
滋血汤 治妇人心肺虚损，血脉虚弱，月水过期。
人参 山药 黄 （各一钱） 白茯苓（去皮） 川芎 当归 白芍药 熟地黄（各一钱半）
上作一服，水二盅，煎至一盅，食前服。
〔脉〕师曰∶脉微血气俱虚，年少者亡血也。乳子下利为可。否者，此为居经，三
月一来。师曰∶寸口脉微而涩，微则卫气不足，涩则血气无余。卫不足，其息短，其形
躁。血不足，其形逆，荣卫俱虚，言语谬误。趺阳脉浮而涩，涩则卫气虚，虚则短气，咽
燥而口苦，胃气涩则失液。少阴脉微而迟，微则无精，迟则阴中寒，涩则血不来，此为居
经，三月一来。问曰∶妇人妊娠三月，师脉之，言此妇人非躯，今月经当下，其脉何类？
何以别之？师曰∶寸口脉卫浮而大，荣反而弱，浮大则气强，反弱则少血，孤阳独呼，阴
不能吸，二气不停，卫降荣竭，阴为积寒，阳为聚热，阳盛不润，经络不足，阴虚阳往，（一
作实。）故令少血，时发洒淅，咽燥汗出，或溲稠数，多唾涎沫，此令重虚，津液漏泄，故
知非躯。蓄烦满血，月禀一经，三月一来，阴盛则泻，名曰居经。（谓右脉浮大，左脉反弱也。）
〔调经平剂〕
简易方当归散 治经脉不匀，或三四月不行，或一月再至。
当归 川芎 白芍药（炒） 黄芩（炒，各一两） 白术 山茱萸肉（一两半）
上为细末，空心温酒调下二钱，日三服。如冷去黄芩，加肉桂一两。
人参养血丸 （《和剂》）治女人禀受素弱，血气虚损。常服补冲任，调经候，暖下元，生
血气。
乌梅肉（三两） 熟地黄（五两） 当归（二两） 人参 川芎 赤芍药 蒲黄（炒，各一两）
上为细末，炼蜜丸梧子大。每服八十丸，温酒米饮任下。
逍遥散 （《和剂》）治血虚烦热，月水不调，脐腹胀痛，痰嗽潮热。
当归 白术 白芍药 柴胡 茯苓（各一两） 甘草（炙，半两）
上 咀，每服半两，入姜、薄荷叶煎服。薛新甫加牡丹皮，山栀炒各五分，名加味逍遥散。
《神巧万全方》无当归、芍药、甘草，有人参、黄 各等分。
增损四物汤 治月事不调，心腹疼痛，补血温经，驻颜。
川芎 当归 芍药 熟地黄 牡丹皮 白术（各一钱半） 地骨皮（一钱）
上作一服，用水二盅，煎至一盅，食前服。
《济生方》论曰∶《内经》云，百病皆生于气。经有所谓七气，有所谓九气。喜、怒、
忧、思、悲，恐、惊者，七气也。七情之外，益之以寒热二证，而为九气也。气之为病，男
子妇人皆有之，惟妇人血气为患尤甚。盖人身血随气行，气一壅滞，则血与气并，或月
事不调，心腹作痛。或月事将行，预先作痛。或月事已行，淋沥不断，心腹作痛。或遵腰
胁，或引背膂，上下攻刺。吐逆不食，甚则手足搐搦，状类惊痫。或作寒热，或为 瘕，
肌肉消瘦。非特不能受孕，久而不治，转而为瘵疾者多矣。
戴复庵云∶妇人每月经水应期而下，不使有余，犹太阴之缺也。其有或先或后，或
少或多，或欲来先病，或遇来而断续，皆谓之不调。和气饮加香附子半钱，兼咽独附丸。
升麻和气饮（见杂病水肿门。）
澹寮煮附丸 治经候不调，血气刺痛，腹胁膨胀，头晕恶心，崩漏带下，并宜服之。
香附子（擦去皮，不以多少，米醋浸一日，用瓦铫煮令醋尽。）
上醋糊为丸，梧子大，日干，每五十丸淡醋汤下。
一方∶香附一斤，艾叶四两，当归二两，制同。名艾附丸。
沉香降气散 顺气道，通血脉。
乌药 木香 香附子 缩砂仁 甘草（各等分）
上为细末，每服二钱，空心盐汤调下。
严氏抑气散 治妇人气盛于血，变生诸证，头晕膈满。
香附子（四两） 茯神 甘草（炙，各一两） 陈皮（二两）
上为末，每二钱，食前沸汤调下。
绀珠正气天香汤 治妇人一切气，气上凑心，心胸攻筑，胁肋刺痛，月水不调。
台乌药（二钱） 香附子（八钱） 陈皮 苏叶（各一钱） 干姜（半钱）
上 咀，每七、八钱，水煎服。
上抑气例。
煮附丸醋制，佐以当归，则气中之血药也。今世以童便、酒、醋、盐水四制，而以
四物佐之，皆本于此，人人知之，故不着。气郁多者，宜于杂病气证门中选用，不必拘此。
东垣益胃升阳汤 治妇人经候不调，或血脱后脉弱食少，水泄日二三行。
黄 （二钱） 白术（三钱） 炒曲（一钱半） 当归身 陈皮 炙甘草 人参（各一钱）
升麻 柴胡（各半钱） 黄芩（半钱，秋去之）
上 咀，每服半两，水煎。腹痛加芍药，嗽去人参。
补中益气汤 治妇人、室女经候不调，脉微食少，体倦或热。（方见杂病首册劳倦门。）
四君子汤 六君子汤（方见杂病首册虚劳门。）
上补气例。
〔调经暖剂〕
[Note by Wang Bing] Qibo said: When a girl reaches seven years of age, the Qi of the Kidney becomes abundant, her teeth change, and her hair grows. At fourteen (two sevens), Tian Gui arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) becomes vigorous, causing menstruation to occur on time. "Tian" refers to the True Heaven Qi; "Gui" refers to the Water of Ren and Gui (Kidney Water). Ren belongs to Yang Water and pairs with Ding to transform into Wood. Gui belongs to Yin Water and combines with Wu to transform into Fire. Therefore, it is said that Water and Fire are the omens of Yin and Yang. Women belong to the Yin category, so they receive "Gui". The Chong Mai is called the Sea of Blood, and the Ren Mai governs the uterus. When these two vessels have smooth circulation, menstrual blood gradually fills up and flows down on time. When the True Heaven Qi descends and cooperates with it, it is called "Tian Gui". Usually, it comes once every thirty days, resembling the moon waxing and waning, never missing its schedule, hence also called "Yue Xin" (Monthly Trust). During menstruation, one must be most cautious; otherwise, the condition may resemble postpartum disorders. If subjected to fright or overexertion, Qi and Blood will become chaotic, meridians will fail to circulate, often leading to consumptive diseases like Lao Zhai. If menstrual blood rebels upwards towards the head, face, and limbs, it causes severe pain and restlessness. If anger injures the Liver, symptoms such as dizziness, hypochondriac pain, hematemesis, Luoli (scrofula), and abscesses may occur. If menstrual blood渗 (seeps) inward, it leads to continuous dripping from the orifices. All these scenarios, if accompanied by invasion of the Six Exogenous Pathogens, result in myriad complications. Although the initial symptoms may be slight as an autumn hair, the resulting illness can be heavy as a mountain. How can one not revere this?
[Note by Xue Ji] Blood is the essence extracted from water and grain. It harmonizes the Five Zang organs and distributes to the Six Fu organs. In men, it transforms into Essence; in women, it goes upward to become breast milk and downward to gather in the Sea of Blood. Thus, although the Heart governs Blood and the Liver stores Blood, both are controlled by the Spleen. By tonifying the Spleen and harmonizing the Stomach, Blood will naturally generate. During menstruation, bitter-cold and acrid-dispersing medicines should be strictly avoided, and diet should follow the same principle.
[Note by Wang Bing] Irregular menstruation in women is caused by Wind Pathogen invading the Uterus due to deficiency, damaging the Ren and Chong vessels, and injuring the Hand-Taiyang Small Intestine Meridian and Hand-Shaoyin Heart Meridian. Since the Ren and Chong vessels originate in the Uterus and serve as the Sea of Meridians, they are exterior-interior related to the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart meridians, transforming upward into breast milk and downward into menstruation. Menstrual blood is merely the surplus of the meridians. If properly regulated, menstruation will occur on time.
[Note by Xue Ji] The medical classics state: Food enters the Stomach, its essence floats and overflows, transporting upward to the Spleen. The Spleen scatters the essence, which returns upward to the Lung. The Lung regulates the water passages, transporting downward to the Bladder. Water essence distributes throughout the body, and the Five Meridians run together. Mr. Li Dongyuan stated that the Spleen is the source of transformation and production, and the Heart governs the blood of all meridians. This is indeed true. I believe that when the Heart and Spleen are peaceful, menstruation is normal. However, if internal injury from the Seven Emotions, external invasion of the Six Evils, irregular diet, or improper lifestyle cause Spleen-Stomach deficiency and reckless movement of Heart Fire, menstruation becomes irregular. Some arrive early, some late; detailed explanations are provided later. Since Blood is born from Spleen Earth, it is said that the Spleen controls Blood. For blood diseases, bitter and sweet agents should be used to assist Yang Qi and generate Yin Blood.
[Distinguishing Color]
[Note by Zhu Danxi] Menstrual blood is Yin Blood. Yin must follow Yang, hence its red color, inheriting the hue of Fire. Blood is the companion of Qi. If Qi is hot, Blood is hot; if Qi is cold, Blood is cold; if Qi ascends, Blood ascends; if Qi descends, Blood descends; if Qi coagulates, Blood coagulates; if Qi stagnates, Blood stagnates; if Qi is clear, Blood is clear; if Qi is turbid, Blood is turbid. Often, clots are seen, which is due to Qi coagulation. Pain before menstruation indicates Qi stagnation. Pain after menstruation indicates deficiency of both Qi and Blood. Pale color indicates deficiency mixed with dampness. Erratic flow indicates Qi chaos. Purple color indicates Qi heat. Black color indicates extreme heat. Nowadays, people see purple, black, painful, or clotted menstrual blood and uniformly attribute it to Wind-Cold, administering warm-hot remedies, bringing disaster swiftly. This is largely because *Zhubing Yuanhou Lun* attributes all menstrual diseases to Wind-Cold, leading to habitual acceptance. One might say: Black is the color of Water in the North. Purple is lighter than black; is it not cold? I say: The classics state that excess brings harm, and control brings balance. Extreme heat necessarily involves Water transformation. Thus, heat causes purple, and extreme heat causes black. Moreover, women are stubborn and short-sighted, with doubled desires. The Jue-Yang Fire in their viscera rises daily; how can it not be heat? If it were Wind-Cold, it must come from outside. Even if it does, it is rare (one in a thousand). (Cold syndromes from initial external invasion cause pain upon entering the meridians. If there is no pain, stagnation turns to heat over time. Cold causes coagulation; since the flow is purple and black, it is not cold.)
[Note by Shi Junzi] Siwu Tang plus Huangqin and Huanglian Decoction treats menstrual blood looking like black bean juice.
Siwu Tang (4 liang), Huangqin (1 liang), Huanglian (1 liang).
Grind into powder, make pills with vinegar paste, and take.
[Note by Zhu Danxi] Menstrual blood is black, with thirst, fatigue, short stature, dark complexion, and an uneven, rapid-like pulse.
Chishao Yao (0.5 liang), Xiangfu Mi (0.5 liang), Huangbai (stir-fried), Huangqin (3 qian each), Gancao (2 qian).
Grind into powder, make pills with vinegar paste, take 50-60 pills with warm water.
Hu Baniang of Yongkang, aged twenty. Her second month's menstruation was absent, then suddenly appeared with lower abdominal pain and clots, purple blood.
Baishao Yao, Baizhu, Chenpi (0.5 liang each), Huangqin, Chuanxiong, Mutong (2 qian each), Gancao (roasted, a little).
Ruru He, with Qi stagnation and sluggish Blood, but non-sluggish pulse. Irregular menstruation, sometimes early, sometimes late, purple color, bitter taste in mouth, numbness and occasional itching on the outer thighs, sores, and constipation.
Maziren, Taoren, Shaoyao (2 liang each), Zhike, Baizhu, Guitou, Weilingxian, Hezirou, Shengdihuang, Chenpi (5 qian each), Dahuang (roasted, 7 qian).
Grind each into powder, make pills like tung seeds with congee, take 50-60 pills with warm water.
[Note by Zhu Danxi] Pale menstrual blood indicates deficiency of both Qi and Blood. Use formulas like Bayu Tang. Bayu consists of Siwu Tang and Sijunzi Tang. Add herbs according to accompanying symptoms.
[Note by Lou Quanshan] A forty-eight-year-old woman had leukorrhea, thirst, heavy menstruation. Initially black blood, later pale blood, fatigue, poor appetite, and urgency above the navel.
Baizhu (1.5 qian), Baishao Yao, Chenpi (1 qian each), Mutong, Zhike, Huangqin (0.5 fen each), Suosharen, Gancao (roasted, 0.3 fen each), Honghua (size of a soybean).
Decoct and take with 30 Baohe Wan pills and 20 Yiqing Wan pills.
[Assessing Quantity]
Women's diseases often involve fluctuating menstrual volume (too much or too little) or timing (early or late) with pre-menstrual pain. Doctors who do not examine carefully label it simply as a menstrual disorder, unaware of whether Yang overcomes Yin or Yin overcomes Yang, rendering medication ineffective. When Yin Qi overcomes Yang, cold accumulates in the uterus, Blood fails to circulate, akin to "cold heaven and frozen earth, water turning to ice," causing scanty periods delayed until after the month. When Yang Qi overcomes Yin, Blood flows and overflows, akin to "hot heaven and warm earth, menstrual water boiling over," causing excessive periods arriving before the month. One must harmonize Qi and Blood and balance Yin and Yang for health.
Yang overcoming Yin (Excessive Periods): Danggui Yin.
Danggui Yin suppresses Yang heat, nourishes Yin, and regulates meridians.
Danggui (lightly stir-fried), Dihuang (wine-steamed, dried), Chuanxiong, Baizhu, Baishao Yao, Huangqin (equal parts).
Take 3 qian per dose, decoct 1.5 cups of water to 0.8 cup, take warm on an empty stomach.
Yin overcoming Yang (Scanty Periods): Qifei Tang.
Qifei Tang treats deficiency of Ying and Wei, delayed menstruation with variable volume and abdominal pain.
Danggui, Chuanxiong, Baishao Yao, Pengzhu, Shudihuang, Chuangjiang, Muxiang (equal parts).
Take 4 qian per dose, decoct 1.5 cups of water to 0.8 cup, take warm.
Excessive menstruation indicates Deficient Heat or Qi deficiency failing to control Blood.
[Note by Shi Junzi] Siwu Tang plus Huangqin and Baizhu Decoction treats excessive menstruation.
Siwu Tang (4 liang), Huangqin (1 liang), Baizhu (1 liang).
[Note by Zhu Danxi] Excessive menstruation.
Huangqin (stir-fried), Shaoyao (stir-fried), Guiban (roasted, 1 liang each), Chunshugenpi (7.5 qian), Huangbai (stir-fried, 3 qian), Xiangfu (2.5 qian).
Grind into powder, make pills with wine paste, take 50-60 pills with warm water on an empty stomach.
[Note by Zhu Danxi] A woman with a wiry and large, non-rapid pulse, obese physique. Fatigued in early summer, heavy menstruation. This indicates weak constitution and insufficient Qi to control Blood.
Baizhu (1.5 qian), Huangqi (raw), Chenpi (1 qian each), Renshen (0.5 fen), Gancao (roasted, 0.3 fen).
Sluggish and scanty menstruation indicates Deficiency or Sluggishness. Tonify deficiency; moisten sluggishness.
[Note by Shi Junzi] Siwu Tang plus Kuihua Decoction treats scanty menstruation.
Siwu Tang (4 liang), Kuihua (1 liang). Alternative: add Honghua and Xuejianchou.
Siwu Tang plus Shudihuang and Danggui Decoction treats scanty menstruation with normal color.
Siwu Tang (4 liang), Shudihuang (1 liang), Danggui (1 liang).
[Pulse Diagnosis] The Master said: A woman consulted, saying her menstruation is less than before. Why? The Master said: She previously had diarrhea, sweating, or frequent urination. Why? Because she lost Body Fluids, causing menstruation to decrease. If menstruation were heavier than before, she would feel exhausted and complain of difficult defecation and lack of sweat.
[Early and Late]
Wang Ziheng said: Menstruation is a regular sign, reflecting the盈 (fullness) and 伏 (hidden state) of Yin and Yang in the body, indicating safety or danger, thus occurring monthly. Excess or deficiency constitutes irregularity. Yang excess causes early arrival; Yin deficiency causes late arrival. Fluctuations, cessation, or metrorrhagia are all caused by the decline or exuberance of Yin and Yang.
[Note by Zhu Danxi] Early menstruation indicates Blood Heat; use Siwu Tang plus Huanglian. Obese patients with early periods and phlegm have Blood deficiency with Heat; use Nanxing, Baizhu, Cangzhu, Huanglian, Xiangfu, Chuanxiong as pills.
[Note by Xue Ji] Early arrival may be due to: Dryness in Spleen Blood (use Jiawei Xiaoyao San); Stagnation in Spleen (use Guipi Tang [see Forgetfulness]); Liver Fire (use Jiawei Xiao Chai Hu Tang [see Shaoyang Syndrome]); Heat in Blood aspect (use Jiawei Siwu Tang [Siwu plus Chaihu, Danpi, Zhizi]); or Fire from overexertion (use Buzhong Yiqi Tang [see Fatigue]).
Xianqi Tang treats early menstruation, cooling Blood and stabilizing the menses.
Shengdihuang, Chuan Danggui, Baishao Yao (2 qian each), Huangbai, Zhimu (1 qian each), Tiaoqin, Huanglian, Chuanxiong, Ejiao (roasted, 0.8 fen each), Aiye, Xiangfu, Zhigancao (0.7 fen each).
Decoct 2 cups of water to 1 cup, take warm after meals.
Jinkui Tugua Gen San treats leukorrhea, difficult menstruation, lower abdominal fullness/pain, and menstruation occurring twice a month.
Tugua Gen, Shaoyao, Guizhi, Zhechong (0.75 qian each).
Grind into powder, take 1 cun bi with wine, three times daily.
Note: Zhang Zhongjing's formula breaks hardness and purges blood, addressing menstruation with bleeding from skin/sweat, which previous texts missed. Differentiate by lower abdominal pain/fullness.
[Note by Zhu Danxi] Delayed and scanty menstruation: Use Chuanxiong, Danggui, Renshen, Baizhu with phlegm-resolving drugs. Delayed with pale color indicates Phlegm; use Erchen Tang plus Chuanxiong and Danggui. Delayed with purple color and clots indicates Blood Heat with pain; use Siwu Tang plus Xiangfu and Huanglian.
[Note by Xue Ji] Late arrival may be due to: Spleen Blood deficiency (use Renshen Yangrong Tang); Liver Blood deficiency (use Liuwei Dihuang Wan); or Qi and Blood weakness (use Bazhen Tang [all see Consumptive Disease]).
Guoqi Yin treats delayed menstruation due to Blood deficiency and Qi stagnation, requiring Blood tonification and Qi movement.
Shudihuang, Baishao Yao, Danggui, Xiangfu (2 qian each), Chuanxiong (1 qian), Honghua (0.7 fen), Taoren paste (0.6 fen), Peng'e Zhu, Mutong (0.5 fen each), Gancao, Rougui (0.4 fen each).
Decoct 2 cups of water to 1 cup, take warm before meals.
Zixue Tang treats Heart-Lung deficiency and weak Blood vessels causing delayed menstruation.
Renshen, Shanyao, Huangqi (1 qian each), Baifuling (peeled), Chuanxiong, Danggui, Baishao Yao, Shudihuang (1.5 qian each).
One dose, decoct 2 cups of water to 1 cup, take before meals.
[Pulse Diagnosis] The Master said: Micro pulse indicates Qi and Blood deficiency. In youth, this may be blood loss. Diarrhea during lactation is acceptable. Otherwise, it is called Ju Jing (residing menstruation), coming once every three months. The Master said: Cun Kou pulse micro and choppy means Wei Qi deficiency and Blood/Qi exhaustion. Wei deficiency causes short breath and restlessness. Blood deficiency causes reversal of form, verbal errors, and combined Ying-Wei deficiency. Zu Yang pulse floating and choppy indicates Wei Qi deficiency, short breath, dry throat/bitter mouth, and Stomach Qi stagnation losing fluids. Shao Yin pulse micro and slow indicates lack of Essence, cold in the vagina, and stopped Blood, also called Ju Jing (every three months). Question: A pregnant woman at three months has a pulse suggesting menstruation should start. How to distinguish? Answer: Cun Kou pulse shows Wei floating and large, Ying reverse and weak. Floating/large means strong Qi; weak means little Blood. Solitary Yang calls out, Yin cannot absorb. Qi and Blood stop descending/consuming. Yin becomes accumulated cold, Yang becomes gathered heat. Yang excess lacks moisture, meridians are deficient. Yin deficiency allows Yang to go (or fill), causing little Blood, chills, dry throat, sweating, thick/frequent urine, salivation. This is double deficiency with fluid leakage, proving not pregnancy. Accumulated烦满 blood follows one meridian per month, coming every three months. Yin excess causes discharge, named Ju Jing. (Right pulse floating/large, left pulse reverse/weak).
[Regulating Agents - Neutral]
Simple Formula Danggui San treats irregular menstruation, absent for 3-4 months or recurring within a month.
Danggui, Chuanxiong, Baishao Yao (fried), Huangqin (fried, 1 liang each), Baizhu, Shanzhuyu (1.5 liang).
Grind fine, take 2 qian with warm wine on empty stomach, three times daily. Remove Huangqin if cold, add Rougui (1 liang).
Renshen Yangxue Wan (*Heji*) treats weak constitution and Qi/Blood deficiency. Tonifies Chong/Ren, regulates menses, warms lower origin, generates Blood/Qi.
Wumei Rou (3 liang), Shudihuang (5 liang), Danggui (2 liang), Renshen, Chuanxiong, Chishaoyao, Puhuang (fried, 1 liang each).
Grind fine, honey pills. Take 80 pills with warm wine or rice drink.
Xiaoyao San (*Heji*) treats Blood deficiency with irritability/heat, irregular menses, abdominal distension/pain, phlegm cough, tidal fever.
Danggui, Baizhu, Baishao Yao, Chaihu, Fuling (1 liang each), Zhigancao (0.5 liang).
Cinchona, take 0.5 liang with ginger and mint leaves. Xue Xinpu added Mudanpi and fried Zhizi (0.5 fen each), named Jiawei Xiaoyao San. *Shenqiao Wanquan Fang* lacks Danggui, Shaoyao, Gancao, adds Renshen and Huangqi equally.
Zengsun Siwu Tang treats irregular menses, heart/abdominal pain, tonifies Blood, warms meridians, preserves youth.
Chuanxiong, Danggui, Shaoyao, Shudihuang, Mudanpi, Baizhu (1.5 qian each), Digupi (1 qian).
One dose, decoct 2 cups of water to 1 cup, take before meals.
*Jisheng Fang* states: *Neijing* says all diseases arise from Qi. There are Seven Qi and Nine Qi. Joy, Anger, Worry, Thought, Grief, Fear, Fright are Seven Qi. Adding Cold and Heat makes Nine Qi. Qi disease affects both sexes, but women suffer more due to Blood/Qi. Blood follows Qi; stagnation causes Blood-Qi binding, irregular menses, abdominal pain. Pre-menstrual pain, prolonged dripping, pain radiating to waist/flanks/back, vomiting, convulsions, chills/fever, masses, emaciation. Infertility ensues, eventually becoming consumptive disease.
Dai Fu'an said: Menstruation should be timely, not excessive, like the waning moon. Variations in timing/volume or interruption are irregularities. Heqi Yin plus Xiangfu (0.5 qian), plus Dufu Wan. Shengma Heqi Yin (see Edema).
Danliao Zhufu Wan treats irregular menses, stabbing pain, abdominal/flank distension, dizziness/nausea, metrorrhagia/leukorrhea.
Xiangfu (skin removed, soaked in rice vinegar for one day, boiled in clay pot until vinegar is gone).
Make pills with vinegar paste, tung seed size, sun-dry. Take 50 pills with light vinegar soup.
Alternative: Xiangfu (1 jin), Aiyè (4 liang), Danggui (2 liang), processed similarly. Named Aifu Wan.
Chenxiang Jiangqi San smooths Qi pathway, unblocks vessels.
Wuyao, Muxiang, Xiangfu, Suosharen, Gancao (equal parts).
Grind fine, take 2 qian with salt water on empty stomach.
Yan Shi Yiqi San treats Qi exceeding Blood, various symptoms, dizziness/chest fullness.
Xiangfu (4 liang), Fushen, Zhigancao (roasted, 1 liang each), Chenpi (2 liang).
Grind, take 2 qian with boiling water before meals.
Ganzhu Zhengqi Tianxiang Tang treats all Qi disorders, Qi rushing to heart, chest oppression, flank stabbing pain, irregular menses.
Tai Wuyao (2 qian), Xiangfu (8 qian), Chenpi, Suyè (1 qian each), Ganjiang (0.5 qian).
Cinchona, take 7-8 qian, decoct in water.
Above are Qi-regulating examples.
Zhufu Wan processed with vinegar and Danggui addresses Blood within Qi. Modern methods use child's urine, wine, vinegar, salt water (four processes) with Siwu Tang. Qi stagnation cases should select from Qi disorders section.
Dongyuan Yiwei Shengyang Tang treats irregular menses, weak pulse/poor appetite after blood loss, watery diarrhea 2-3 times daily.
Huangqi (2 qian), Baizhu (3 qian), Chaoqu (1.5 qian), Dangguishen, Chenpi, Zhigancao, Renshen (1 qian each), Shengma, Chaihu (0.5 fen each), Huangqin (0.5 fen, remove in autumn).
Cinchona, take 0.5 liang, decoct. Add Shaoyao for pain, remove Renshen for cough.
Buzhong Yiqi Tang treats irregular menses in women/girls, weak pulse/poor appetite, fatigue/fever. (See Fatigue).
Sijunzi Tang, Liujunzi Tang. (See Consumptive Disease).
Above are Qi-tonifying examples.
[Regulating Agents - Warm]