《素问》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，故
有子。”
《灵枢》曰∶“冲脉起于胞中，出于气街，前行于胸，伏行于背，上出颃颡，渗灌诸阳，下入于足，
注诸经，为十二经脉之海，其出入偕少阴经以行，故为血海。”
凡室女从幼经水未至，面色如故，饮食如常，名为石女，不在经闭成劳内论，不须服药。亦有年大
自通而受孕者。
凡室女诸病，以调经为先，理气为要，每遇经至，切戒气恼，否则有症瘕之患。
室女经闭成劳，不可投通血桃仁之类，当用生血四物之剂。若骨蒸、潮热、咳嗽，脉七八至，视其
肌肉消瘦之甚，药之无益。
室女经水先通后闭有二∶饮食如故，面色不黄，名曰歇，非病也，不须服药；如面黄身热，不
食，此因积想沉思，气郁不遂，致血枯竭而月水先闭，多成劳损，名曰童劳，非药可治，此症阴阳不和，急
于配合，夫妇成欢即愈，否则十死八九，宜服补中益气汤加知、柏、生地，如咳嗽，加五味、门冬之类。
【补中益气汤】人参 黄 白术 陈皮 升麻 柴胡 当归 炙甘草 生姜 大枣
室女经闭不通，五心烦热，宜四圣散。
【四圣散】桃仁 当归 红花 牛膝
室女经水淋漓不断者，宜琥珀黑龙丹。
【琥珀黑龙丹】五灵脂 当归 地黄 川芎 良姜
入砂锅内，用赤石脂、纸筋、盐泥封固，火 红，去火候冷，取去黑色，研细入后药∶
百草霜 乳香 生硫黄 琥珀 花蕊石
上五味研细入前药，和匀，用醋煮糊为丸。每服时用炭火 红，投入姜汁内浸淬，以酒、童便调服。
寡妇尼姑经闭，乃独阴无阳，志欲不遂，是以阴阳交争，乍寒乍热，全类温疟，久则成劳，肝脉弦
出寸口，比男十倍难治。当开郁为先，后乃调经生血，然亦生死参半，盖由男子精盛则思室，女子血盛
则欲动也。
娼妇经闭由劳郁所致，但娼妇本无经闭之理，间或有之，乃为元气未足即被男子所伤，宜服补血养气之药。
经水过期而来，有血虚、血寒、血滞、血热。血虚者，腹不痛，微微身热，宜生血调气，用八物汤
加香附，或四物汤加黄 、升麻、陈皮。
【八物汤】人参 茯苓 当归 白芍 白术 甘草 地黄 川芎
【四物汤】地黄 当归 芍药 川芎
血寒者，宜四物汤加木香、香附、陈皮、甘草、红花，或用归附丸、艾煎丸。
【归附丸】香附 童便 醋
煎至四分之一，下艾叶，煮干取出，捣烂入后药∶
当归（酒浸） 地黄（酒浸） 川芎
醋、酒糊为丸。
【艾煎丸】吴茱萸（泡淡） 当归 熟地 白芍 石菖蒲 川芎 人参 艾叶 橘红
如恶心呕吐，加丁香、半夏、生姜。
血滞者腰腹疼痛，胸膈饱满，宜四物汤加醋炒香附、延胡索。
腹不痛者为血热，宜四物汤加黄连、香附。
过期而来，并色淡者，此痰多血少也，宜补血豁痰，治以川芎、当归、生地合二陈，或加参、 、阿胶。
【二陈汤】橘红 半夏 茯苓 甘草
肥人过期是气虚挟痰也，以二四汤去熟地，加香附、参、 ，或二陈加芎、归、苍、附、南星。
【二四汤】橘红 半夏 茯苓 甘草 熟地 当归 川芎 芍药
瘦人过期是热多血少也，宜四物加归、地、甘、 ，少佐桃仁、红花。
经水过期不调，或一二月不至，或三四月不行，用艾煎丸、醋附丸主之。
【醋附丸】香附（醋浸透）
醋糊丸淡盐汤下。
加艾、当归，如前法，治症同，名艾附丸。
若经水过期，骨蒸发热更兼白带者，宜四物加杜仲、续断、巴戟、丹皮、柴胡、香附、白术、地骨皮。
经水先期而来者，有血热、有气伤血海，血热者腹多不痛，乃是火也，宜服凉血地黄汤，或四物汤
加芩、连、柴胡、香附，或加黄柏、知母、陈皮为丸。
【凉血地黄汤】生地 黄连 升麻 细辛 当归
黄芩 柴胡 本 红花 黄柏 防风 蔓荆子 川芎 知母 羌活 荆芥 甘草
肥人亦兼痰治之。
虚热者，宜逍遥散、补中益气汤加知母、黄柏。
【逍遥散】白术 当归 柴胡 甘草 茯苓 白芍 薄荷
加煨姜一片，水煎服。
气伤血海者，宜大用芎归之剂，盖此证以肚腹痛为别∶若泻、腹中冷痛，用五个散；干嗽者，逍遥散治之。
【五个散】陈皮 甘草 枳壳 川芎 大腹皮 浓朴 桔梗 白芍 半夏 香附 紫苏 白芷 茯苓
藿香 麻黄 干姜 肉桂
经水如不及期而来者，有火也，宜以六味地黄丸滋水，则火自平矣；如不及期而来多者，本方加海螵
蛸、柴胡、白芍；如半月或十日而来，且绵延不止，此属气虚，用补中汤；如过期而来者，火衰也，本方
加艾叶；如迟而色淡者，本方加桂。此其大略也。其间亦有不及期而无火者，有过期而有火者，多寡不
同，不可拘于一定，当察脉之迟数，视禀之虚实、强弱，但以滋水为主，随证加减。凡紫与黑色者多属火
旺之甚，亦有虚寒而紫黑者，不可不察脉审证，若淡白则无火明矣。
【六味地黄丸】熟地 山药 茯苓 山萸肉 泽泻 丹皮
经水来脐腹绞痛，时作时止，乃气郁血滞，宜四乌汤。
【四乌汤】当归 香附 陈皮 甘草 川芎 乌药 白芍
经水欲行脐腹绞痛，乃血涩故也，以四物汤加延胡索、槟榔、川楝子、木香治之。
经水临行误食冷物，血气阻遏，脐腹刺痛，宜服当归须散。
【当归须散】当归须 桃仁 香附 赤芍 乌药 红花 苏木 肉桂 甘草
酒、水煎服。
临经腹痛，以四物汤加延胡索、丹皮、陈皮。如痛甚者，豆淋酒；痛缓者，童便淋酒。
【豆淋酒法】以黑豆炒焦投入酒中
经水行后，腹痛绵绵不止，虽曰虚寒宜补，然气亦能作痛，若一概补之，不益痛乎！须视受补与
否？如不受补者，以四物加陈皮；如受补者，以八物加香附，血虚者倍参、 ，挟寒者加干姜，血行气滞
者加艾。若经净后腰腹疼痛者，此血虚也，宜服八珍散，以白芍易赤芍，白术易砂仁；如觉腹冷，加肉
桂。
【八珍散】与前八物汤同
经水过期紫黑有二∶有气血混并而成紫黑者，有块痛是也；有血热而成紫黑色者，腹不痛是也，统
以四物加连、附治之。
经水过期而似鱼脑者，痰多血少也。有绿黄如泥土者，血寒气虚也。其黄绿者宜暖经和血，忌用凉
剂；其淡白者，宜补血导痰，以二陈加芎、归、参、 、胶、地。
经水涩少不快，宜四物加红花、葵花，如经水行微少、或胀或疼，宜四物加延胡索、白芷，醋煎。
经水过多，以六合汤或胶艾汤治之。
【六合汤】生地 白芍 归身 川芎 黄芩 白芷
【胶艾汤】阿胶 熟地 川芎 艾叶 当归 白芍
如去血过多，神气倦怠者，宜增减四物汤。
【增减四物汤】人参 当归 白芍 干姜 川芎 甘草
如去血过多，心神不安，言语不常，宜宁心膏、胶艾汤。
【宁心膏】辰砂 枣仁 琥珀 人参 茯神 乳香
上为末，每服一钱，浓煎枣子、灯心汤。或作丸，薄荷汤下。
因气不和，致血不能流转而经不调、脐腹疼痛者，是血凝气结，其脉沉紧，宜温经汤。
【温经汤】人参 当归 白芍 延胡索 肉桂 川芎 牛膝 蓬术 丹皮 甘草
气滞血凝者，腰腹刺痛，宜桂枝桃仁汤、通经六合汤。
【桂枝桃仁汤】桂枝 桃仁 生地 芍药 人参 甘草
加枣子煎。
【通经六合汤】生地黄 当归 赤芍 川芎 蓬术 肉桂
经水凝滞，心腹疼痛者，宜琥珀散、佛手散治之。
【琥珀散】熟地 赤芍 肉桂 三棱 当归 丹皮 延胡索 蓬术 乌药 蒲黄 刘寄奴 琥珀
为末，酒调服。
【佛手散】川芎 当归
水、酒各半煎服。
经闭腹满疼痛，发热恶寒者，宜凌霄花散、牡丹皮散。
【凌霄花散】凌霄花 当归 桂枝 红花 刘寄奴 赤芍 延胡索 丹皮 白芷
酒半盏，再入红花煎。
【牡丹皮散】当归 红花 肉桂 蓬术 赤芍 丹皮 苏木 延胡索 鬼箭羽 干漆 没药（另研）
陈皮 乌药 甘草
室女经闭成劳，脐腹瘕痛，宜牛膝散或通经丸。
【牛膝散】当归 丹皮 肉桂 桃仁 川芎 赤石 延胡索 牛膝 木香
水、酒煎。
【通经丸】肉桂 大黄（煨） 干漆（研碎炒令烟尽为度） 青皮 川乌（泡去皮） 川椒 蓬术
干姜 桃仁 红花 当归
上为末，蜜丸，每服三十丸，淡醋汤下。
经水涩少，渐渐不通，潮热瘦弱者，宜四物汤倍加泽兰治之。
淤血凝积，经候不调，时时作痛，腰膝重疼，小腹坚硬者，宜红花当归散。
【红花当归散】红花 牛膝 刘寄奴 肉桂 当归 紫葳 苏木 白芍 白芷 甘草
酒煎服。
妇人胃气不调，亦能使经经岁不通，体壮实，但饮食减少者是也，宜服逍遥散以消食理脾，使饮食
进而元气足，后以和其血气，则经水自行矣。
经沉滞不调，脐腹刺痛，或前或后，或多或少，或一月不至，或一月两至，宜服佛手散，或三神丸。
【三神丸】当归 橘红 延胡索（酒炒）
为末，酒糊丸，空腹艾醋汤下。
妇人月水不调，或前或后，或淋漓不断，断后复来，状若泻水，腹中坚痛，或闭塞不来，宜服桃仁散。
【桃仁散】人参 川芎 赤芍 丹皮 牛膝 肉桂 当归 生地 泽兰 蒲黄 桃仁 半夏 生姜 甘草
经水不调，或来多不节，或过月不行，或崩血不止，宜大温经汤。
【大温经汤】人参 肉桂 川芎 白芍 天冬 阿胶 吴茱萸 当归 丹皮 甘草 半夏 生姜
经水适来适断，日晡往来寒热如疟状，或痰嗽，宜先服小柴胡汤，后服四物汤。若泄泻，去黄
芩，加白术、茯苓；如自汗，减柴胡，加黄 ；如寒热皮肤冷，加桂枝；如腹冷，加肉桂，如咳嗽，加五味。
【小柴胡汤】柴胡 人参 黄芩 半夏 甘草 生姜 大枣
阴虚潮热，渐成骨蒸，宜逍遥散，或牡丹皮散。
月水或前或后，崩漏，赤白带下，每遇经行，小腹急痛，头眩，饮食少进，气闷者，宜加减吴茱萸汤。
【加减吴茱萸汤】吴茱萸 干姜 当归 防风 茯苓 肉桂 细辛 丹皮 桔梗 木香 门冬 半夏 甘草
加姜、枣煎服。
经水不调，脐腹冷痛，恶心，胀满，至晚则剧者，宜四乌汤、姜黄散，或艾煎丸。
【姜黄散】姜黄 川芎 肉桂 蓬术 丹皮 红花 当归 赤芍 延胡索
水煎，入酒少许。
形体黑瘦，经水不调者，子宫无血故也，养其阴则自然经至矣。
肥人经水不调，乃湿痰也，去其痰，则经自调矣，宜二四汤，或导痰汤入芎、归、连、地（必用姜
汁炒，恐泥膈也）。
【导痰汤】半夏 茯苓 枳壳 南星 甘草 陈皮 姜
经水不调，脐腹冷痛，宜牛膝散；若经水不利，时觉冷痛，寒热往来者，宜异攻散。
【异攻散】丹皮 肉桂 川芎 乌药 白芷 芍药 干姜 当归 延胡索 桔梗 生姜
水、酒煎服。
妇人血枯经闭，有因胃气虚，水谷难化，津液不生，而血虚不来者；有因少时吐衄，崩漏大脱血，
气亦不足者；有因潮热骨蒸，不生津液，而经水闭绝者；有因房劳多产，枯竭于内，而经不通者。以上四
者，总名血枯。
若脾虚胃消善食，黄瘦而不生血，月水全闭者，宜补中益气汤加川芎、生地、天花粉。
气血俱虚，潮热骨蒸，宜十全大补汤，加酒黄柏、牛膝。
【十全大补汤】人参 白术 茯苓 甘草 黄 熟地 当归 白芍 川芎 肉桂 生姜 大枣
心肾俱虚，咳嗽一、二声无痰，夜热盗汗，肌体瘦弱，饮食减少，卧则恍惚，异梦不常，微咳，痰
中有红丝者，名曰脉痿，宜劫劳散。
【劫劳散】人参 黄 茯苓 半夏 甘草 熟地 当归 白芍 阿胶 五味子
每服二钱，水盏半，加姜三片，枣子三枚，煎八分，日进三服。
经水断后，身热谵语，日哺尤甚，宜小柴胡汤。
经水先断，后小便不通，四肢浮肿，名曰血分，此症难治，宜小调经汤。
【小调经汤】当归 白术 肉桂 赤芍 没药 细辛 麝香
上为末，每服二钱，姜汁调或酒下。
若先小便闭，后致经水不通，四肢浮肿，名曰水分，此病易愈，宜葶苈丸。
【葶苈丸】葶苈子 续随子 干姜
上为末，枣肉为丸，桐子大，煎竹叶汤送下七丸。
如大便去，减续、葶，加白术为丸。
或问∶论调经以滋水为主，不须补血，何也？曰∶经曰∶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，故有子。天者天一之真，癸者壬癸之水，月者水之精，以一月而
盈，盈则昃。女人经水一月以时而下，能有子；不以时下，或过期，或不及，皆为病，病则不能有子。所
以必须调经，调经必须滋水为主。又问曰∶同一红色，非血而何？曰∶女人系胞之所而养经之处，养之
一月而行，行则虚矣；以时交感，以虚而受，人若有孕，此水即化为乳而不月。乳之色白也，何谓血乎？
The *Suwen* (Basic Questions) states: "When a girl reaches seven years of age, her Kidney Qi becomes abundant, her deciduous teeth are replaced, and her hair grows long; at fourteen (two times seven), Tian Gui (the substance promoting reproductive function) arrives, the Ren Mai (Conception Vessel) becomes unobstructed, the Chong Mai (Penetrating Vessel) becomes vigorous, menstruation occurs on time, and thus she is capable of conceiving."
The *Lingshu* (Spiritual Pivot) states: "The Chong Mai originates in the Bao Zhong (uterus), emerges from the Qigateway acupoint (Stomach 30), moves forward to the chest, runs deeply along the back, emerges upward at the Xiangsang (posterior nasal cavity/pharynx), seeps and irrigates all Yang meridians, descends into the foot, and pours into all meridians. It is the Sea of the Twelve Meridians. It travels alongside the Shaoyin Meridian, hence it is called the Sea of Blood."
For unmarried girls whose menstruation has never arrived from childhood, with normal complexion and diet, they are termed "Shi Nu" (Stone Girls). This does not fall under the category of amenorrhea leading to consumptive disease (Lao), and no medication is required. There are also cases where menstruation begins naturally at an older age, followed by pregnancy.
For various ailments in unmarried girls, regulating menstruation should be prioritized, with regulating Qi as the key. Whenever menstruation occurs, one must strictly avoid anger and emotional disturbance; otherwise, there is a risk of developing Zheng Jia (abdominal masses).
In cases of amenorrhea leading to consumptive disease in unmarried girls, blood-invigorating and stasis-resolving herbs like Tao Ren (Peach Kernel) should not be administered. Instead, formulas for generating blood, such as Si Wu Tang (Four Substance Decoction), should be used. If symptoms include bone-steaming fever, tidal fever, cough, a rapid pulse (7-8 beats per respiration), and severe emaciation, medication will be of no benefit.
There are two types of amenorrhea following initial regular menstruation in unmarried girls:
1. Diet remains normal, complexion is not sallow; this is called "Xie" (Rest/Intermittence), not a disease, requiring no medication.
2. Sallow complexion, body heat, loss of appetite; this results from excessive rumination and emotional depression causing Qi stagnation, leading to blood exhaustion and early cessation of menstruation. This often develops into Lao (consumption), termed "Tong Lao" (Virgin Consumption), which is difficult to treat with medicine alone. This condition involves disharmony of Yin and Yang. Urgent marriage and harmonious sexual relations can lead to recovery; otherwise, eight or nine out of ten may die. The appropriate prescription is Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Zhi Mu (Anemarrhena Rhizome), Huang Bo (Phellodendron Bark), and Sheng Di Huang (Rehmannia Root). If cough is present, add Wu Wei Zi (Schisandra Fruit) and Mai Dong (Ophiopogon Tuber).
[Bu Zhong Yi Qi Tang] Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Dang Gui (Angelicae Sinensis Radix), Zhi Gan Cao (Prepared Licorice Root), Sheng Jiang (Fresh Ginger), Da Zao (Jujubae Fructus).
For unmarried girls with amenorrhea accompanied by five-palm heat (heat sensation in palms, soles, and chest), Si Sheng San (Four Saints Powder) is indicated.
[Si Sheng San] Tao Ren (Persicae Semen), Dang Gui (Angelicae Sinensis Radix), Hong Hua (Carthami Flos), Niu Xi (Achyranthis Bidentatae Radix).
For unmarried girls with prolonged, dripping menstrual bleeding, Hu Po Hei Long Dan (Amber Black Dragon Pill) is indicated.
[Hu Po Hei Long Dan] Wu Ling Zhi (Trogopteri Dung), Dang Gui (Angelicae Sinensis Radix), Di Huang (Rehmanniae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Liang Jiang (Galangali Rhizoma).
Place the above ingredients in a clay pot, seal tightly with Chi Shi Zhi (Halloysitum Rubrum), paper paste, and salt mud. Fire until red-hot, remove from fire, let cool, discard blackened parts, and grind fine. Add the following: Bai Cao Shuang (Soot), Ru Xiang (Frankincense), Sheng Liu Huang (Native Sulfur), Hu Po (Amber), Hua Rui Shi (Porphyroclastite).
Grind these five ingredients finely and mix with the previous powder. Use vinegar and starch paste to make pills. To take, heat a pill over charcoal until red, quench in fresh ginger juice, and administer with wine and child's urine.
Amenorrhea in widows and nuns arises from solitary Yin without Yang, and unfulfilled desires, causing conflict between Yin and Yang, manifesting as alternating chills and fever, resembling Wen Nue (Warm Malaria). Prolonged, it becomes Lao. The Liver pulse is wiry and extends beyond the Cun position, making it ten times harder to treat than in men. Treatment should first focus on resolving stagnation, then regulating menstruation and generating blood. However, survival rates are only fifty-fifty, likely because men with abundant Jing (Essence) desire sex, while women with abundant blood experience sexual arousal.
Amenorrhea in prostitutes is caused by fatigue and stagnation. Although prostitutes typically do not suffer from amenorrhea, if it occurs, it is due to insufficient Yuan Qi being damaged by men. Tonifying blood and Qi is appropriate.
Delayed menstruation can be due to Blood Deficiency, Blood Cold, Blood Stagnation, or Blood Heat.
- Blood Deficiency: No abdominal pain, slight body heat. Regenerate blood and regulate Qi using Ba Wu Tang (Eight Substance Decoction) plus Xiang Fu (Cyperus Rhizome), or Si Wu Tang plus Huang Qi, Sheng Ma, and Chen Pi.
[Ba Wu Tang] Ren Shen, Fu Ling (Poria), Dang Gui, Bai Shao (White Peony Root), Bai Zhu, Gan Cao (Licorice Root), Di Huang, Chuan Xiong.
[Si Wu Tang] Di Huang, Dang Gui, Shao Yao (Peony Root), Chuan Xiong.
- Blood Cold: Si Wu Tang plus Mu Xiang (Aucklandiae Radix), Xiang Fu, Chen Pi, Gan Cao, Hong Hua. Or Gui Fu Wan (Cyperus Pill) or Ai Jian Wan (Mugwort Decoction Pill).
[Gui Fu Wan] Xiang Fu, Tong Bian (Child's Urine), Cu (Vinegar).
Decoct to one-quarter volume, add Ai Ye (Artemisiae Argyi Folium), boil dry, remove, pound into paste, and add: Dang Gui (soaked in wine), Di Huang (soaked in wine), Chuan Xiong. Make pills with vinegar and wine paste.
[Ai Jian Wan] Wu Zhu Yu (Evodiae Fructus, soaked to reduce pungency), Dang Gui, Shu Di (Prepared Rehmannia Root), Bai Shao, Shi Chang Pu (Acori Tatarinowii Rhizoma), Chuan Xiong, Ren Shen, Ai Ye, Ju Hong (Citri Reticulatae Pericarpium).
If nausea/vomiting occurs, add Ding Xiang (Caryophylli Flos), Ban Xia (Pinelliae Rhizoma), Sheng Jiang.
- Blood Stagnation: Waist and abdominal pain, chest fullness. Si Wu Tang plus Vinegar-fried Xiang Fu and Yan Hu Suo (Corydalis Rhizoma).
- Blood Heat (no abdominal pain): Si Wu Tang plus Huang Lian (Coptidis Rhizoma) and Xiang Fu.
Delayed menstruation with pale color indicates Phlegm excess and Blood deficiency. Tonify blood and resolve phlegm using Chuan Xiong, Dang Gui, Sheng Di Huang combined with Er Chen Tang (Two-Cured Decoction), or add Ren Shen, Huang Qi, and E Jiao (Donkey-hide Gelatin).
[Er Chen Tang] Ju Hong, Ban Xia, Fu Ling, Gan Cao.
Obese individuals with delayed menstruation have Qi deficiency with Phlegm dampness. Use Er Si Tang minus Shu Di, plus Xiang Fu, Ren Shen, Huang Qi; or Er Chen Tang plus Chuan Xiong, Dang Gui, Cang Zhu (Atractylodis Rhizoma), Xiang Fu, Nan Xing (Arisaematis Rhizoma).
[Er Si Tang] Ju Hong, Ban Xia, Fu Ling, Gan Cao, Shu Di, Dang Gui, Chuan Xiong, Shao Yao.
Thin individuals with delayed menstruation have Heat excess and Blood deficiency. Si Wu Tang plus Dang Gui, Di Huang, Gan Cao, Huang Qi, with small amounts of Tao Ren and Hong Hua.
Irregular delayed menstruation (1-2 months or 3-4 months delay) is treated with Ai Jian Wan or Cu Fu Wan (Vinegar Cyperus Pill).
[Cu Fu Wan] Xiang Fu (soaked in vinegar).
Make pills with vinegar paste, take with light salt water.
Adding Ai Ye and Dang Gui creates Ai Fu Wan, with similar indications.
If delayed menstruation is accompanied by bone-steaming fever and leukorrhea, use Si Wu Tang plus Du Zhong (Eucommiae Cortex), Xu Duan (Dipsaci Radix), Ba Ji Tian (Morinda Officinalis Root), Mu Dan Pi (Moutan Cortex), Chai Hu, Xiang Fu, Bai Zhu, and Gu Pi (Lycii Cortex).
Early menstruation can be due to Blood Heat or Qi injury to the Blood Sea.
- Blood Heat: Usually no abdominal pain, attributed to Fire. Use Liang Xue Di Huang Tang (Cool Blood Rehmannia Decoction) or Si Wu Tang plus Huang Qin (Scutellariae Radix), Huang Lian, Chai Hu, Xiang Fu. Or make pills with Huang Bo, Zhi Mu, and Chen Pi.
[Liang Xue Di Huang Tang] Sheng Di Huang, Huang Lian, Sheng Ma, Xi Xin (Asari Radix et Rhizoma), Dang Gui, Huang Qin, Chai Hu, Ben Cao (Ligustici Radix), Hong Hua, Huang Bo, Fang Feng (Saposhnikoviae Radix), Man Jing Zi (Viticis Fructus), Chuan Xiong, Zhi Mu, Qiang Huo (Notopterygii Rhizoma et Radix), Jing Jie (Schizonepetae Spica), Gan Cao.
Obese patients also require treatment for Phlegm.
- Deficient Heat: Xiao Yao San (Free and Easy Wanderer Powder) or Bu Zhong Yi Qi Tang plus Zhi Mu and Huang Bo.
[Xiao Yao San] Bai Zhu, Dang Gui, Chai Hu, Gan Cao, Fu Ling, Bai Shao, Bo He (Menthae Haplocalycis Herba).
Add one piece of roasted ginger, decoct in water.
- Qi Injury to Blood Sea: Use large doses of Chuan Xiong and Dang Gui. Differentiate by abdominal pain:
- With diarrhea and cold abdominal pain: Wu Ge San (Five Ingredients Powder).
- With dry cough: Xiao Yao San.
[Wu Ge San] Chen Pi, Gan Cao, Zhi Ke (Aurantii Fructus), Chuan Xiong, Da Fu Pi (Arecae Pericarpium), Hou Po (Magnoliae Officinalis Cortex), Jie Geng (Platycodonis Radix), Bai Shao, Ban Xia, Xiang Fu, Zi Su (Perillae Folium), Bai Zhi (Angelicae Dahuricae Radix), Fu Ling, Huo Xiang (Agastaches Herba), Ma Huang (Ephedrae Herba), Gan Jiang (Zingiberis Rhizoma), Rou Gui (Cinnamomi Cortex).
Menstruation arriving before schedule indicates Fire. Use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to nourish Water, thereby calming Fire.
- If early and heavy: Add Hai Piao Xiao (Sepiae Endochroma), Chai Hu, Bai Shao.
- If every 10-15 days and continuous: Qi deficiency, use Bu Zhong Tang.
- If delayed: Fire decline, add Ai Ye.
- If late and pale: Add Gui Zhi (Cinnamon Twig).
Generally, observe pulse speed and constitution. Purple/dark colors indicate strong Fire (or deficient cold); pale white indicates no Fire.
[Liu Wei Di Huang Wan] Shu Di Huang, Shan Yao (Dioscoreae Rhizoma), Fu Ling, Shan Zhu Yu (Corni Fructus), Ze Xie (Alismatis Rhizoma), Dan Pi.
Menstrual cramping in the umbilical/abdominal region, intermittent, indicates Qi stagnation and Blood stasis. Use Si Wu Tang modified (Si Wu Tang here refers to a specific formula listed below, distinct from the standard Four Substances, containing Wu Yao).
[Si Wu Tang (Cramp Formula)] Dang Gui, Xiang Fu, Chen Pi, Gan Cao, Chuan Xiong, Wu Yao (Linderae Radix), Bai Shao.
Menstrual cramps before flow indicates sluggish Blood. Treat Si Wu Tang plus Yan Hu Suo, Bing Lang (Arecae Semen), Chuan Lian Zi (Toosendan Fructus), Mu Xiang.
Cold food ingested just before menstruation causes Blood/Qi obstruction and stabbing pain. Use Dang Gui Xu San (Danggui Mustache Powder).
[Dang Gui Xu San] Dang Gui Xu (Danggui root hairs), Tao Ren, Xiang Fu, Chi Shao (Red Peony Root), Wu Yao, Hong Hua, Su Mu (Sappan Lignum), Rou Gui, Gan Cao.
Decoct in wine and water.
Menstrual pain: Si Wu Tang plus Yan Hu Suo, Mu Dan Pi, Chen Pi. Severe pain: Dou Lin Jiu (Bean-dripping Wine). Mild pain: Tong Bian Lin Jiu (Child's urine-dripping Wine).
[Dou Lin Jiu Method] Stir-fry black beans until charred, drop into wine.
Post-menstrual lingering pain: Although often deficient-cold requiring tonification, Qi stagnation can also cause pain. Blind tonification may worsen pain. Assess tolerance:
- Intolerant: Si Wu Tang plus Chen Pi.
- Tolerant: Ba Wu Tang plus Xiang Fu. Increase Ren Shen/Huang Qi for Blood deficiency; add Gan Jiang for Cold; add Ai Ye for Blood flow with Qi stagnation.
Post-menstrual waist/abdominal pain indicates Blood deficiency. Use Ba Zhen San (Eight Treasures Powder), substituting Bai Shao for Chi Shao and Bai Zhu for Sha Ren (Amomi Fructus). Add Rou Gui if abdomen feels cold.
[Ba Zhen San] Same as Ba Wu Tang above.
Delayed menstruation with purple/black color:
1. Qi and Blood mixing: Clots and pain.
2. Blood Heat: Purple/black, no pain.
Both treated with Si Wu Tang plus Huang Lian and Xiang Fu.
Delayed menstruation resembling fish brain indicates Phlegm excess/Blood deficiency. Green/yellow like soil indicates Blood Cold/Qi deficiency. Green/yellow requires warming meridians and harmonizing blood (avoid cooling agents). Pale white requires tonifying blood and guiding out phlegm (Er Chen Tang plus Chuan Xiong, Dang Gui, Ren Shen, Huang Qi, E Jiao, Di Huang).
Scanty, slow menstruation: Si Wu Tang plus Hong Hua and Kui Hua (Sunflower Seed). Scanty with distension/pain: Si Wu Tang plus Yan Hu Suo and Bai Zhi, decocted in vinegar.
Excessive menstruation: Liu He Tang (Six Harmonies Decoction) or Jiao Ai Tang (Gelatin and Mugwort Decoction).
[Liu He Tang] Sheng Di Huang, Bai Shao, Dang Gui Shen (Body of Angelica), Chuan Xiong, Huang Qin, Bai Zhi.
[Jiao Ai Tang] E Jiao, Shu Di, Chuan Xiong, Ai Ye, Dang Gui, Bai Shao.
Excessive blood loss with fatigue: Zeng Jian Si Wu Tang (Modified Four Substances Decoction).
[Zeng Jian Si Wu Tang] Ren Shen, Dang Gui, Bai Shao, Gan Jiang, Chuan Xiong, Gan Cao.
Excessive blood loss with restlessness and abnormal speech: Ning Xin Gao (Heart-Calming Paste) or Jiao Ai Tang.
[Ning Xin Gao] Chen Sha (Cinnabar), Zao Ren (Ziziphi Spinosae Semen), Hu Po, Ren Shen, Fu Shen (Poria with Hostwood), Ru Xiang.
Grind to powder, take 1 qian, decoct jujubes and Deng Xin Cao (Junci Medullae) strongly. Or make pills, take with Bo He decoction.
Qi disharmony causing Blood stasis, irregular menstruation, and abdominal pain with deep/tight pulse: Wen Jing Tang (Warm the Meridians Decoction).
[Wen Jing Tang] Ren Shen, Dang Gui, Bai Shao, Yan Hu Suo, Rou Gui, Chuan Xiong, Niu Xi, E Zhu (Curcumae Rhizoma), Dan Pi, Gan Cao.
Qi stagnation and Blood coagulation with stabbing waist/abdominal pain: Gui Zhi Tao Ren Tang (Cinnamon Twig and Peach Kernel Decoction) or Tong Jing Liu He Tang (Unblocking Meridians Six Harmonies Decoction).
[Gui Zhi Tao Ren Tang] Gui Zhi, Tao Ren, Sheng Di, Shao Yao, Ren Shen, Gan Cao. Decoct with jujubes.
[Tong Jing Liu He Tang] Sheng Di Huang, Dang Gui, Chi Shao, Chuan Xiong, E Zhu, Rou Gui.
Blood stagnation with heart/abdominal pain: Hu Po San (Amber Powder) or Fo Shou San (Buddha's Hand Powder).
[Hu Po San] Shu Di, Chi Shao, Rou Gui, San Leng (Sparganii Rhizoma), Dang Gui, Dan Pi, Yan Hu Suo, E Zhu, Wu Yao, Pu Huang (Typhae Pollen), Liu Ji Nu (Hyperici Herba), Hu Po. Take with wine.
[Fo Shou San] Chuan Xiong, Dang Gui. Decoct half water, half wine.
Amenorrhea with abdominal fullness/pain, fever/chills: Ling Xiao Hua San (Campsis Flower Powder) or Mu Dan Pi San.
[Ling Xiao Hua San] Ling Xiao Hua (Campsis Grandiflora Flower), Dang Gui, Gui Zhi, Hong Hua, Liu Ji Nu, Chi Shao, Yan Hu Suo, Dan Pi, Bai Zhi. Decoct in half cup wine with additional Hong Hua.
[Mu Dan Pi San] Dang Gui, Hong Hua, Rou Gui, E Zhu, Chi Shao, Dan Pi, Su Mu, Yan Hu Suo, Gui Jian Yu (Ardisiae Caulifloris Ramulus), Gan Qi (Drynariae Rhizoma / Catechu? Context implies Drynaria or similar resinous herb, usually Gan Qi refers to Catechu but in gynecology often Drynaria or similar; text says Gan Qi), Mo Yao (Myrrha, separate grind), Chen Pi, Wu Yao, Gan Cao.
Virgin amenorrhea with consumptive signs and abdominal masses: Niu Xi San or Tong Jing Wan.
[Niu Xi San] Dang Gui, Dan Pi, Rou Gui, Tao Ren, Chuan Xiong, Chi Shi Zhi, Yan Hu Suo, Niu Xi, Mu Xiang. Decoct in water/wine.
[Tong Jing Wan] Rou Gui, Da Huang (Rhubarb, baked), Gan Qi (smoked until smoke ceases), Qing Pi (Citri Reticulatae Viride Pericarpium), Chuan Wu (Aconiti Radix, soaked peeled), Chuan Jiao (Sichuan Pepper), E Zhu, Gan Jiang, Tao Ren, Hong Hua, Dang Gui. Honey pills, 30 pills with light vinegar water.
Scanty, gradually stopping menstruation with tidal fever/emaciation: Si Wu Tang with doubled Ze Lan (Leonurus Herba).
Blood stasis accumulation, irregular menstruation, pain, heavy waist/knees, hard lower abdomen: Hong Hua Dang Gui San.
[Hong Hua Dang Gui San] Hong Hua, Niu Xi, Liu Ji Nu, Rou Gui, Dang Gui, Zi Wei (Campsis Radix), Su Mu, Bai Shao, Bai Zhi, Gan Cao. Decoct in wine.
Stomach Qi disharmony causing year-long amenorrhea in robust individuals with reduced appetite: Xiao Yao San to digest food and strengthen Spleen. Once Yuan Qi is sufficient, harmonize Blood/Qi to restore menstruation.
Sluggish, irregular menstruation with stabbing pain, varying frequency/amount: Fo Shou San or San Shen Wan.
[San Shen Wan] Dang Gui, Ju Hong, Yan Hu Suo (wine-fried). Powder, wine paste pills, take with mugwort-vinegar water on empty stomach.
Irregular menstruation, dripping, returning after stop, watery appearance, hard abdominal pain, or blockage: Tao Ren San.
[Tao Ren San] Ren Shen, Chuan Xiong, Chi Shao, Dan Pi, Niu Xi, Rou Gui, Dang Gui, Sheng Di, Ze Lan, Pu Huang, Tao Ren, Ban Xia, Sheng Jiang, Gan Cao.
Irregular menstruation, heavy/unregulated, missed periods, or metrorrhagia: Da Wen Jing Tang (Great Warm the Meridians Decoction).
[Da Wen Jing Tang] Ren Shen, Rou Gui, Chuan Xiong, Bai Shao, Tian Dong (Asparagi Radix), E Jiao, Wu Zhu Yu, Dang Gui, Dan Pi, Gan Cao, Ban Xia, Sheng Jiang.
Menstruation stops and starts, afternoon chills/fever like malaria, or cough: First Xiao Chai Hu Tang, then Si Wu Tang.
- Diarrhea: Remove Huang Qin, add Bai Zhu, Fu Ling.
- Spontaneous sweating: Reduce Chai Hu, add Huang Qi.
- Chills/cold skin: Add Gui Zhi.
- Cold abdomen: Add Rou Gui.
- Cough: Add Wu Wei Zi.
[Xiao Chai Hu Tang] Chai Hu, Ren Shen, Huang Qin, Ban Xia, Gan Cao, Sheng Jiang, Da Zao.
Yin deficiency with tidal fever/bone-steaming: Xiao Yao San or Mu Dan Pi San.
Irregular menstruation, metrorrhagia, leukorrhea, lower abdominal cramps during menses, dizziness, poor appetite, chest stuffiness: Jia Jian Wu Zhu Yu Tang.
[Jia Jian Wu Zhu Yu Tang] Wu Zhu Yu, Gan Jiang, Dang Gui, Fang Feng, Fu Ling, Rou Gui, Xi Xin, Dan Pi, Jie Geng, Mu Xiang, Men Dong (Ophiopogon Tuber), Ban Xia, Gan Cao. Decoct with ginger/jujube.
Irregular menstruation, cold abdominal pain, nausea, blooming worse at night: Si Wu Tang (Cramp Formula), Jiang Huang San, or Ai Jian Wan.
[Jiang Huang San] Jiang Huang (Curcuma Longa Rhizoma), Chuan Xiong, Rou Gui, E Zhu, Dan Pi, Hong Hua, Dang Gui, Chi Shao, Yan Hu Suo. Decoct in water with little wine.
Dark/thin body with irregular menstruation indicates uterine Blood deficiency. Nourish Yin to restore menstruation.
Obese individuals with irregular menstruation have Damp-Phlegm. Resolve Phlegm to regulate menstruation. Use Er Si Tang or Dao Tan Tang (Guide Out Phlegm Decoction) plus Chuan Xiong, Dang Gui, Huang Lian, Di Huang (stir-fried with ginger juice to prevent cloying the chest).
[Dao Tan Tang] Ban Xia, Fu Ling, Zhi Ke, Nan Xing, Gan Cao, Chen Pi, Jiang.
Irregular menstruation with cold abdominal pain: Niu Xi San. Irregular menstruation with cold pain and alternating chills/fever: Yi Gong San.
[Yi Gong San] Dan Pi, Rou Gui, Chuan Xiong, Wu Yao, Bai Zhi, Shao Yao, Gan Jiang, Dang Gui, Yan Hu Suo, Jie Geng, Sheng Jiang. Decoct in water/wine.
Blood Withering Amenorrhea has four causes:
1. Stomach Qi deficiency, poor digestion, lack of fluids/Blood.
2. History of hematemesis/epistaxis or massive hemorrhage, Qi deficiency.
3. Tidal fever/bone-steaming, lack of fluids.
4. Excessive sexual activity/multiple births, internal depletion.
All termed Blood Withering.
Spleen deficiency with good appetite but emaciation and total amenorrhea: Bu Zhong Yi Qi Tang plus Chuan Xiong, Sheng Di, Tian Hua Fen.
Qi and Blood deficiency with tidal fever/bone-steaming: Shi Quan Da Bu Tang (Ten Great Tonics Decoction) plus wine-processed Huang Bo and Niu Xi.
[Shi Quan Da Bu Tang] Ren Shen, Bai Zhu, Fu Ling, Gan Cao, Huang Qi, Shu Di, Dang Gui, Bai Shao, Chuan Xiong, Rou Gui, Sheng Jiang, Da Zao.
Heart and Kidney deficiency with dry cough, night sweats, emaciation, poor appetite, restlessness, vivid dreams, mild cough with blood streaks: Mai Wei (Vein Atrophy). Use Jie Lao San (Rob Consumptive Disease Powder).
[Jie Lao San] Ren Shen, Huang Qi, Fu Ling, Ban Xia, Gan Cao, Shu Di, Dang Gui, Bai Shao, E Jiao, Wu Wei Zi. Take 2 qian, 1.5 cups water, 3 slices ginger, 3 jujubes, decoct to 0.8 cup, 3 times daily.
Amenorrhea followed by fever and delirium (worse in afternoon): Xiao Chai Hu Tang.
Amenorrhea followed by urinary retention and limb edema: Xue Fen (Blood Division). Difficult to treat. Use Xiao Tiao Jing Tang.
[Xiao Tiao Jing Tang] Dang Gui, Bai Zhu, Rou Gui, Chi Shao, Mo Yao, Xi Xin, She Xiang (Musk). Powder, 2 qian with ginger juice or wine.
Urinary retention followed by amenorrhea and limb edema: Shui Fen (Water Division). Easier to treat. Use Ting Li Wan.
[Ting Li Wan] Ting Li Zi (Descurainiae/Semen Lepidii), Xu Sui Zi (Euphorbiae Lathyridis Semen), Gan Jiang. Powder, jujube paste pills, size of paulownia seeds. Take 7 pills with bamboo leaf decoction.
If stool is loose, remove Xu Sui Zi and Ting Li Zi, add Bai Zhu.
Q: Why regulate menstruation by nourishing Water rather than Blood?
A: The Classics state: "Girl at 7, Kidney Qi abundant... at 14, Tian Gui arrives... menstruation on time... capable of conception." Tian refers to True One, Gui refers to Ren/Gui Water. Moon is essence of Water, waxes and wanes monthly. Women's menstruation follows this lunar cycle. If irregular (early/late), it is disease, preventing conception. Thus, regulation requires nourishing Water as the primary method.
Q: But it is red, isn't it Blood?
A: The uterus nourishes the channels. After one month of nourishment, it flows, leaving emptiness. Timely intercourse allows conception. If pregnant, this fluid transforms into Milk (white) and menstruation stops. Since Milk is white, how can we call it Blood?