妇人中风。七八曰。（业已热除而身凉。而复）续来寒热。发作有（一定之）时。
（因其病而问其）经水（已来而）适断者。（盖以经水断于内。而寒热发于外。虽与经
水适来者不同。而）此（症亦名）为热入血室。其血（为邪所阻。则）必结。（结于冲
任厥阴之经脉。内未入脏。外不在表。而在表里之间。乃属少阳。）故使（寒热往来）
如疟状。发作有时。（以）小柴胡汤主之。（达经脉之结。仍藉少阳之枢以转之。
俾气行而血亦不结矣。）
此为中风热入血室。经水适断者。出其方治也。盖以邪既流连于血室。而亦浸淫于
经络。若但攻其血。血虽去而邪必不尽。且恐血去而邪反得乘虚而入也。故小柴胡汤解
其热邪。而乍结之血自行矣。
（热入血室。不独中风有之。而伤寒亦然。）妇人伤寒（寒郁而）发热。（当其时）
经水适来。（过多不止。血室空虚。则热邪遂乘虚而入之也。昼为阳而主气。暮为阴而主
血。今主气之阳无病。故）昼日明
了。（主血之阴受邪。故）暮则谵语。（谵语皆非习见之事。）如见鬼状者。（医者可于
其经之适来。而定其证曰。）此为热入血室。（非阳明胃实所致也。既非阳明胃实。则
）治之（者）无（以下药）犯（其）胃气。（以）及上二焦。（一曰胃脘之阳。不可以
吐伤之。一曰胃中之汁。不可以汗伤之。惟俟其经水尽。则血室之血。复生于胃腑水谷之精。
）必自愈。
此为伤寒热入血室。经水适来者。详其证治也。师不出方。盖以热虽入而血未结。
其邪必将自解。汗之不可。下之不可。无方之治。深于治也。郭白云谓其仍与小柴胡汤。
或谓宜刺期门。犹是浅一层议论。
妇人中风。发热恶寒。（当表邪方盛之际。而）经
水适来。（盖经水乃冲任厥阴之所主。而冲任厥阴之血。又皆取资于阳明。今）得（病）
之（期。过）七（日而至）八日。（正值阳明主气之期。病邪乘隙而入。邪入于里。则
外）热除。（其）脉迟身凉和。（已离表证。惟冲任厥阴。俱循胸胁之间。故）胸胁满。
（但病不痛。与大结胸不按自痛。小结胸按之始痛分别。究其满盛。亦）如结胸（之
）状。（而且热与血搏。神明内乱。而作）谵语者。此为热入血室也。（治者握要而图。）
当刺（肝募之）期门。随其实而取之。（何以谓之实。邪盛则实也。）
此承本篇第一节。而言中风热入血室之证治也。但第一节言寒热已除而续来。此言
寒热方盛而并发。前言经水已来。而适断。此言方病经水之适来。前言血结而如疟。此
言胸胁满如结胸。前无谵语。而此有谵语。以此为别。
（然亦有不在经水适来与适断。而为热入血室者。不可不知。）阳明病。下血谵语
者。此为热入血室。（其证通身无汗。）但头（上）汗出。当刺期门。随其实而泻之。
（令通身） 然汗出者愈。
此言阳明病。亦有热入血室者。不必拘于经水之来与断也。但其证下血头汗出之独
异也。盖阳明之热。从气而之血。袭入胞宫。即下血而谵语。不必乘经水之来。而后热
邪得以入之。彼为血去而热乘其虚而后入。此为热入而血有所迫而自下也。然既入血室。
则不以阳明为主。而以冲任厥阴之血海为
主。冲任。奇脉也。又以厥阴为主。厥阴之气不通。故一身无汗。郁而求通。遂于其少阳
之腑而达之。故头上汗出。治法亦当刺期门。以泻其实。刺已。周身 然汗出。则阴之
闭者亦通。故愈。
妇人咽中（帖帖）如有炙脔。（吐之不出。吞之不下。俗谓之梅核气。病多得于七
情郁气。痰凝气阻。以）半夏浓朴汤主之。
此为痰气阻塞咽中者。出其方治也。
徐忠可云、余治王小乙咽中每噎塞。嗽不出。余以半夏浓朴汤投之即愈。后每复发。
细问之。云夜中灯下。每见晕如团五色。背脊内间酸。其人又壮盛。知其初因受寒。阴
气不足。而肝反郁热。甚则结寒微动。挟肾气上冲。咽喉塞噎也。即于此方加大剂枸杞
菊花丹皮肉桂。晕乃渐除。而咽中亦愈。故曰男子间有之。信不诬也。
半夏浓朴汤方
半夏（一升） 浓朴（三两） 茯苓（四两） 生姜（五两） 苏叶（二两）
上五味。以水一斗。煎取四升。分温四服。日三。夜一服。
妇人脏燥。（脏属阴。阴虚而火乘之。则为燥。不必拘于何脏。而既已成燥。则病证
皆同。但见其）悲伤欲哭。象如神灵所作。（现出心病。又见其）数欠（喜）伸。（现出
肾病。所以然者。五志生火。动必关心。阴脏既伤。穷必及肾是也。以）甘麦大枣汤主
之。
此为妇人脏燥。而出其方治也。麦者。肝之谷也。其色赤。得火色而入心。其气寒。
乘水气而入肾。其味甘。具土味而归脾胃。又合之甘草大枣之甘。妙能联上下水火之
气。而交会于中土也。
甘麦大枣汤方
甘草（三两） 小麦（一升） 大枣（十枚）
上三味。以水六升。煮取三升。分温三服。亦补脾气。
妇人吐涎沫。（上焦有寒饮也。）医（者不与温散。而）反下之。（则寒内入。而）
心下即痞。当先治其吐涎沫。（以）小青龙汤主之。（俾外寒内饮除。而）涎沫（可）止。
（涎沫止后。）乃治（其）痞。（亦如伤寒表解乃可攻里之例也。以）泻心汤主之。
此为吐涎沫与痞兼见。而出先后之方治也。
小青龙汤方（方见肺痈）
泻心汤方（见惊悸）
妇人之病。（所以异于男子者。以其有月经也。其因月经而致病。则有三大纲。曰）
因虚（曰）积冷（曰）结气。（三者。或单病。或兼病。或新病。或相因而为病。或偏胜而为病。病则）为
诸经水断绝。（此皆人之病根也。其曰诸者奈何。以经水有多少迟速。及逢期则病。与大
崩漏难产之后不来等证。皆可以此例之。无论病之初发。以）至（病）有历年。（大抵
气不足则生寒。气寒则）血（亦）寒（由是冷侵不去而为）积（气着不行而为）结。胞门
（为）寒（所）伤。（由外而入内。由内而达外。渐至）经络凝坚。（经水之源头受伤。
则病变无穷矣。然又有上中下之分。其病）在上（肺胃受之，若客寒而伤逆于胃口。则为）呕吐涎唾。（或寒）久（变
热。
热盛伤肺。则）成肺痈。（其）形体（之受）损（则一。而为寒为热。俨若两人之）分。（病若）在中（肝脾受之。邪气
从中）盘结。（或为）
绕脐寒疝。或（为）两胁疼痛。与（胞宫之）脏相连。（此寒之为病也。）或（邪气郁）
结（为）热中。（热郁与水寒相搏。）痛在关元。脉（现出）数（热。而身）无（溃
烂与痛痒等）疮。（其）肌（肤干燥。状）若鱼鳞。（偶逢交合）时着男子。非止女身。
（此热之为病也。所以然者。何义。盖以中者。阴阳之交也。虽胞门为寒伤则一。而中气
素寒者。以寒召寒。所谓邪从寒化是也。中气素热者。寒旋变热。所谓邪从热化是也。
病若）在下（肾脏受之也。穷而归肾。证却）未多。经候不匀。令阴（中）掣痛。少腹
恶寒。或（上）引腰脊。下根气街。气
冲急痛。膝胫疼烦。（盖以肾脏为阴之部。而冲脉与少阴之大络。并起于肾故也。甚则
）奄忽眩冒。状如厥巅。（所谓阴病者。下行极而上也。）或有忧惨。悲伤多嗔。（所谓
病在阴。则多怒及悲愁不乐也。总而言之曰。）此皆带下。非有鬼神。（言病在带脉之
下为阴。非后人以不可见之鬼神为阴也。）久则（肌肉削而）羸瘦。（气不足则）脉虚
多寒。（统计十二 九痛七害五伤三痼之）三十六病。千变万端。审脉阴阳虚实紧弦。
行其针药。治危得安。其虽同病。脉各异源。（寻其所异之处。即为探源。）子当辨记。
勿谓不然。
此言妇人诸病。所以异于男子者。全从经起也。病变不一。因人禀有阴阳。体有强
弱。时有久暂而分。起处以三大纲总冒通节。中又分出上中下以尽病变。后以此皆带下
四字。总结本节之义。至于言脉。百病皆不外阴阳虚实四个字。而又以弦紧为言者。盖
经阻之始。大概属寒。气结则为弦。寒甚则为紧。示人以二脉为主。而参之兼脉则得耳。
问曰。妇人年五十所。（七七之期已过。天癸当竭。地道不通。今）病（前阴血）
下利数十日不止。暮即发热。少腹里急。腹满。手掌烦热。唇口干燥。何也。师曰。（
前言妇人三十六病。皆病在带脉之下。）此病属带下。何以故。曾经半产。瘀血在少
腹不去。何以知之。（盖以瘀血不去。则新血不生。津液不布。）其证唇口干燥。故知
之。（况暮热掌心热。俱属阴。任主胞胎。冲为血海。二脉皆起于胞宫。而出于会阴。
正当少腹部分。冲脉挟脐上行。冲任脉虚。则少腹里急。有干血亦令腹满。其为宿瘀
之证无疑。）当以温经汤主之。
此承上节言历年血寒积结胞门之重证。而出其方治也。
尤在泾云、妇人年五十所。天癸已断。而病下利。似非因经所致矣。不知少腹旧
有积血。欲行而未得遽行。欲止而不能竟止。于是下利窘急。至数十日不止。暮即发热
者。血结在阴。阳气至暮。不得入于阴。而
反浮于外也。少腹里急腹满者。血积不行。亦阴寒在下也。手掌烦热。病在阴。掌心亦
阴也。唇口干燥。血内瘀者不外荣也。此为瘀血作利。不必治利。但去其瘀。而利自止。
吴茱萸桂枝丹皮。入血散寒而行其瘀。芎归芍药麦冬阿胶以生新血。人参甘草姜夏以
正脾气。盖瘀久者荣必衰。下多者脾必伤也。
温经汤方
吴茱萸（三两） 当归 芎 芍药 人参 桂枝 阿胶 丹皮 生姜 甘草（各
二两） 半夏（半升） 麦冬（一升）
上十二味。以水一斗。煮取三升。分温二服。亦主妇人少腹寒。久不受胎。兼治崩
中去血。或月水来过多。及至期不来。
李氏云、内经谓血气虚者。喜温而恶寒。寒则凝涩不流。温则消而去之。此汤名温
经。以瘀血得温即行也。方内皆补养气血之药。未尝以逐瘀为事。而瘀血自去者。此养
正邪自消之法也。故妇人崩淋不孕。月事不调者。并主之。
（妇人因经致病。凡三十六种。皆谓之）带下经水（因寒而瘀。）不（能如期而）
利。（以致）少腹满痛。（然既瘀而不行。则前经未畅所行。不及待后
月之正期而先至。故其）经一月再见者。（以）土瓜根散主之。
此为带下而经候不匀一月再见者。出其方治也。土瓜。即王瓜也。主驱热行瘀。佐
以虫之蠕动逐血。桂芍之调和阴阳。为有制之师。
土瓜根散方
土瓜根 芍药 桂枝 虫（各三分）
上四味。杵为散。酒服方寸匕。日三服。
寸口脉（轻按）弦而（重按）大。弦则为（阳微而递）减。大则为（外盛而中）芤。
减则（阳不自振。）为（诸）寒。芤则（阴不守中）为（中）虚。寒虚相搏。此名曰革。
（革脉不易明。以弦减芤虚形容之。则不易明者明矣。凡）妇人（得革脉。气血虚也。
内无以养脏腑。外无以充形体。）则（胎亦无以养矣。故）半产（其气不能转运而）漏
下。（用）旋复花汤（运气行血以）主之。
此为虚寒而半产漏下者。出其方治也。但此方为调气行血之用。或者病源在肝。肝
以阴脏而含少阳之气。以生化为事。以流行为用。是以虚不可补。解其郁聚。即所以补。
寒不可温。行其气血。即所以温欤。钱氏谓必是错简。半产漏下。气已下陷。焉有用
旋复花下气之理。两说俱存。候商。
旋复花汤方
旋复花（三两） 葱（十四茎） 新绛（少许）
上三味。以水三升。煎取一升。顿服之。
妇人陷经。（其血）漏下（不止。且血色）黑（亦）不解。（是瘀血不去。新血不
生。荣气腐败。然气喜温而恶寒。以）胶姜汤主之。
此为陷经而色黑者。出其方治也。方未见。林亿云、想是胶艾汤。千金胶艾汤有干
姜。似可取用。丹溪谓经淡为水。紫为热。黑为热极。彼言其变。此言其常也。
妇人少腹满如敦状。（盖少腹。胞之室也。胞为血海。有满大之象。是血蓄也。若
）小便微难而不渴。（可知其水亦蓄也。若病作于）生（产之）后者。此为水与血俱结
在血室也。（宜用水血并攻之法。以）大黄甘遂汤主之。
此为水血并结在血室。而为少腹满。大小便难。口不渴者。出其方治也。
大黄甘遂汤方
大黄（四两） 甘遂 阿胶（各二两）
上三味。以水三升。煮取一升。顿服。其血当下。
妇人经水（久闭不至者。有虚实寒热之可辨也。有行而不畅者。如一月再见之可征也。
若小腹结痛。大便黑。小便利。明知血欲行而）不（肯）利下。（不得以寻常行血
导气。调和营卫。补养冲任之法。迂阔不效。径以）抵当汤主之。
此为经水不利之属实者。出其方治也。
抵当汤方
水蛭（熬） 虻虫（熬各三十个） 桃仁（三十个） 大黄（三两酒浸）
上四味。为末。水五升煮取三升。去滓。温服一升。
A woman suffers from wind-stroke (Wind-Stroke, a disease caused by external wind pathogen). After seven or eight days, (the heat has already subsided and the body is cool, but) chills and fever recur, occurring at (fixed) intervals.
(When inquiring about the condition,) if her menstrual flow (has started and then) suddenly stops, (this is because the menses are interrupted internally while the chills and fever manifest externally. Although different from cases where menses start with the illness,) this (syndrome is also called) Heat Entering the Blood Chamber (Heat Entering the Blood Chamber, a syndrome where heat pathogen enters the uterus/blood chamber during menstruation). The blood (is obstructed by the pathogen and thus) coagulates. (It coagulates in the meridians of the Chong, Ren, and Jueyin channels. The pathogen is internal but not yet in the Zang organs, and external but not on the surface, but rather between the exterior and interior, belonging to Shaoyang.) Therefore, it causes chills and fever alternating (like malaria), occurring at fixed times. (Treat with Xiao Chai Hu Tang / Minor Bupleurum Decoction.) (This formula resolves the obstruction in the meridians, relying on the pivot function of Shaoyang to rotate the Qi mechanism, so that when Qi moves, blood does not stagnate.)
This addresses the treatment for wind-stroke with Heat Entering the Blood Chamber where menses suddenly stop. Since the pathogen lingers in the Blood Chamber and infiltrates the meridians, if one only attacks the blood, the blood may be removed but the pathogen will not be fully eliminated, and there is a risk that after the blood is lost, the pathogen might enter due to deficiency. Therefore, Xiao Chai Hu Tang resolves the heat pathogen, and the temporarily coagulated blood flows naturally.
(Heat Entering the Blood Chamber occurs not only in wind-stroke but also in cold damage.) If a woman suffers from cold damage (with cold constraint causing) fever, (and at that time) her menses are just coming (with excessive flow that does not stop, leaving the Blood Chamber empty, allowing the heat pathogen to enter due to deficiency. Day belongs to Yang and governs Qi; night belongs to Yin and governs Blood. Now, since the Yang governing Qi is unaffected, she is) clear-headed during the day. (Since the Yin governing Blood is affected by the pathogen, she) delirates at dusk. (Delirium involves seeing things not normally present.) Like seeing ghosts. (The physician can determine the syndrome based on the timing of her menses:) This is Heat Entering the Blood Chamber. (It is not caused by Yangming Stomach excess. Since it is not Yangming Stomach excess,) treatment (should) not (use purgatives to) injure (her) Stomach Qi. (Nor the Upper and Middle Jiao. One view states that the Yang Qi of the stomach cavity should not be injured by vomiting; another states that the fluids in the stomach should not be injured by sweating. Only wait until the menses end, then the blood in the Blood Chamber will regenerate from the essence of water and grain in the Stomach,) and it will heal itself.
This details the syndrome and treatment for cold damage with Heat Entering the Blood Chamber where menses are currently flowing. The Master did not prescribe a formula, likely because although heat has entered, the blood has not yet coagulated, and the pathogen will resolve spontaneously. Sweating is contraindicated, purging is contraindicated. The "treatment without a formula" reflects profound therapeutic wisdom. Guo Baiyun suggested using Xiao Chai Hu Tang again, or some suggested needling Qimen (LR14); these are still superficial discussions.
If a woman suffers from wind-stroke with fever and aversion to cold, (while the exterior pathogen is strong,) and her menses are just coming (because menses are governed by the Chong, Ren, and Jueyin channels, whose blood relies on Yangming. Now, getting sick on the seventh or eighth day coincides with the period when Yangming governs Qi. The pathogen enters the interior, so) the exterior heat subsides. (Her) pulse is slow and body temperature is normal. (Having left the exterior syndrome, but since Chong, Ren, and Jueyin all pass through the chest and hypochondrium,) there is fullness in the chest and hypochondrium. (But it is not painful, distinguishing it from Da Jie Xiong where pain occurs without pressing, and Xiao Jie Xiong where pain occurs only with pressing. Investigating the degree of fullness, it resembles) the appearance of Jie Xiong (Chest Binding). (Moreover, heat and blood contend, disturbing the Shen internally, leading to) delirium. This is Heat Entering the Blood Chamber. (The practitioner should grasp the key principle.) Needling Qimen (LR14, the Front-Mu point of the Liver) should be done, following the excess pattern to reduce it. (Why is it called excess? Because pathogen abundance constitutes excess.)
This continues from the first section of this chapter, discussing the syndrome and treatment of wind-stroke with Heat Entering the Blood Chamber. However, the first section describes chills and fever subsiding before recurring; here, chills and fever are strong and concurrent. The first section mentions menses having started and then stopping; here, menses are just starting while ill. The first section describes blood coagulation resembling malaria; here, chest and hypochondriac fullness resembles Chest Binding. The first section has no delirium; here, there is delirium. These are the distinctions.
(However, there are cases of Heat Entering the Blood Chamber not associated with menses just starting or stopping, which must be known.) In Yangming disease, if there is bleeding from the lower orifices and delirium, this is Heat Entering the Blood Chamber. (The syndrome presents with no sweat on the whole body.) Only sweat on the head (when the pathogen enters the Blood Chamber, it affects the Chong, Ren, and Jueyin blood sea. Chong and Ren are extraordinary vessels, primarily governed by Jueyin. Jueyin Qi is blocked, hence no whole-body sweat. Seeking release through its paired Shaoyang organ, sweat appears on the head. Treatment should needle Qimen to drain excess. After needling, if the whole body sweats slightly, it heals.)
This explains that Yangming disease can also involve Heat Entering the Blood Chamber, not limited to menses starting or stopping. The unique signs are lower bleeding and head sweating. Yangming heat moves from Qi to Blood, invading the uterus, causing bleeding and delirium, without needing menses to facilitate entry. Previously, heat entered after blood loss created deficiency; here, heat enters and forces blood to flow down. Once in the Blood Chamber, the focus shifts from Yangming to the Chong, Ren, and Jueyin blood sea.
If a woman feels something like a roasted meat slice stuck in her throat (spitting it out is impossible, swallowing it is difficult, commonly known as Plum Pit Qi. This disease often results from emotional depression causing phlegm stagnation and Qi obstruction), treat with Ban Xia Hou Po Tang / Pinellia and Magnolia Bark Decoction.
This provides the treatment for phlegm-Qi obstruction in the throat.
Xu Zhongke said: I treated Wang Xiaoyi who had frequent throat blockage and coughing without expectoration. I administered Ban Xia Hou Po Tang and he recovered. Later, it recurred frequently. Upon detailed inquiry, he said that under lamplight at night, he would see halos like colored balls, and felt soreness inside his spine. He was robust. I knew he initially contracted cold, leading to insufficient Yin Qi, while the Liver developed constrained heat. Severe cold binding moved slightly, carrying Kidney Qi upward, causing throat blockage. I added large doses of Gouqi, Ju Hua, Dan Pi, and Rou Gui to this formula. The halos gradually disappeared, and his throat healed. Thus, it is true that men occasionally suffer from this.
Ban Xia Hou Po Tang Formula
Ban Xia (Pinelliae Rhizoma) (1 sheng) Hou Po (Magnoliae Officinalis Cortex) (3 liang) Fu Ling (Poria) (4 liang) Sheng Jiang (Zingiberis Rhizoma Recens) (5 liang) Su Ye (Perillae Folium) (2 liang)
These five ingredients, decocted in 1 dou of water, yield 4 sheng. Divide into four warm doses. Take three times daily and once at night.
If a woman suffers from Zang Dryness (Zang belongs to Yin; Yin deficiency allows Fire to harass it, causing dryness. It is not limited to any specific Zang; once dryness forms, the syndromes are similar. If one observes) sadness and desire to cry, appearing as if possessed by spirits. (Manifesting Heart pathology, and observing) frequent yawning and stretching. (Manifesting Kidney pathology. The reason is that the Five Emotions generate Fire, moving inevitably to affect the Heart; once the Yin Zang is damaged, exhaustion reaches the Kidney. Treat with Gan Mai Da Zao Tang / Licorice, Wheat, and Jujube Decoction.)
This provides the treatment for women's Zang Dryness. Wheat is the grain of the Liver; its red color corresponds to Fire and enters the Heart; its cold nature corresponds to Water and enters the Kidney; its sweet taste corresponds to Earth and returns to the Spleen and Stomach. Combined with the sweetness of Licorice and Jujube, it skillfully connects the Qi of Water and Fire above and below, meeting in the Central Earth.
Gan Mai Da Zao Tang Formula
Gan Cao (Licorizia Radix et Rhizoma) (3 liang) Xiao Mai (Tritici Vulgaris Fructus) (1 sheng) Da Zao (Jujubae Fructus) (10 pieces)
These three ingredients, boiled in 6 sheng of water, yield 3 sheng. Divide into three warm doses. It also tonifies Spleen Qi.
If a woman vomits saliva and froth (due to cold-fluid retention in the Upper Jiao), and the physician (does not use warming dispersal methods but) instead uses purgatives (then cold enters internally, causing) immediate epigastric痞 (fullness/stagnation). One should first treat the vomiting of saliva and froth (using Xiao Qing Long Tang / Minor Blue-Green Dragon Decoction.) (To remove exterior cold and internal fluid, stopping the) froth. (After the froth stops.) Then treat the (epigastric)痞 (similar to the principle in Cold Damage that interior can be attacked only after the exterior is resolved, using) Xie Xin Tang / Drain the Epigastrium Decoction.
This provides the sequential treatment for simultaneous vomiting of saliva/froth and epigastric痞.
Xiao Qing Long Tang Formula (See Lung Abscess chapter)
Xie Xin Tang Formula (See Palpitations chapter)
Women's diseases (differ from men's because they have menstruation. Diseases caused by menstruation fall into three main categories:) Deficiency (Xu), Accumulated Cold (Ji Leng), and Stagnant Qi (Jie Qi). (These three may cause single diseases, combined diseases, new diseases, causally linked diseases, or diseases due to predominance. They lead to) cessation of various menstrual flows. (These are the roots of human disease. Why "various"? Because menstruation varies in amount and speed, and illness may occur during the cycle, or follow heavy bleeding, difficult labor, etc. Regardless of whether the illness is recent or has lasted years,) generally, Qi insufficiency generates cold; Qi cold leads to) Blood (also) cold. (Thus, cold invades and remains as) Accumulation (Qi adheres and fails to move as) Stagnation. The Bao Men (uterine gate) is (injured by) cold. (Entering from outside to inside, and from inside to outside, gradually causing) solidification of the meridians. (The source of menstruation is damaged, leading to endless variations. However, there are upper, middle, and lower divisions. Disease in the) Upper (affects Lung and Stomach; if external cold injures and rebels against the stomach opening, it causes) vomiting of saliva and sputum. (Or cold) long-standing transforms into) Heat. Heat damaging the Lung causes) Lung Abscess. (The damage to the) Body (is the same, but whether cold or heat, they seem like two different people.) Disease in the) Middle (affects Liver and Spleen. Pathogenic factors knot in the) Middle. (May cause) Cold Hernia around the navel, or (pain in both) Hypochondria, connected to the (uterine) Zang. (This is the manifestation of cold disease.) Or (pathogenic factors constrain into) Heat in the Middle. (Heat constrained contending with cold-water.) Pain at the Guan Yuan point, pulse (shows) rapidity (indicating heat, while the body has no) sores. (Skin is) dry, resembling fish scales. (Occasionally, upon intercourse,) affecting the man as well, not just the woman. (This is the manifestation of heat disease. Why? Because the Middle is the intersection of Yin and Yang. Although Bao Men injury by cold is the same, those with inherent Middle Cold attract cold, meaning the pathogen transforms via cold. Those with inherent Middle Heat transform cold into heat, meaning the pathogen transforms via heat. Disease in the) Lower (affects the Kidney. Exhaustion returns to the Kidney, symptoms are) few. Menstrual cycles are irregular, causing Yin (internal) pulling pain, aversion to cold in the lower abdomen. Or (radiating up to) waist and spine, rooting at Qi Chong, urgent pain in Qi Chong, painful annoyance in knees and shins. (Because the Kidney is the region of Yin, and the Chong Mai and the great collateral of Shaoyin Kidney both originate from the Kidney. Severely,) sudden dizziness and vertigo, resembling syncope or top-of-head affliction. (So-called Yin disease, descending to the extreme then ascending.) May have sorrow and gloom, sadness and frequent anger. (So-called disease in Yin leads to much anger and sad/unhappy emotions. In summary:) All these are Dai Xia (Dai Meridian Below) conditions, not involving ghosts or gods. (Meaning disease below the Dai meridian is Yin, not referring to invisible ghosts/gods as Yin.) Over time, (muscles waste and) emaciation occurs. (Qi insufficiency leads to) deficient pulse with much cold. (Summarizing the Thirty-Six Diseases of twelve nine pains, seven harms, five injuries, and three chronic conditions,) changing in thousands of ways. Examine the pulse for Yin/Yang, Deficiency/Excess, Tight/String-taut. Apply acupuncture and herbs, treating danger to achieve peace. Though the disease is the same, the pulse originates differently. (Finding the difference is tracing the source.) You must distinguish and record this. Do not say otherwise.
This discusses why women's diseases differ from men's, all originating from menstruation. Variations depend on individual Yin/Yang constitution, strength of body, and duration of illness. The three main categories summarize the section, divided into upper/middle/lower to exhaust variations. "All these are Dai Xia" summarizes the section. Regarding pulse, all diseases involve Yin/Yang, Deficiency/Excess, with String-taut/Tight indicating initial obstruction usually due to cold; Qi constraint makes it String-taut, severe cold makes it Tight. These two pulses are primary, supplemented by combined pulses.
Question: A woman around fifty years old. (Past the age of seven sevens, Tian Gui should be exhausted, and the earthly pathway closed. Now,) she has been suffering from (vaginal) bleeding/discharge for dozens of days without stopping, fever in the evening, urgency and tightness in the lower abdomen, abdominal fullness, vexatious heat in the palms, and dryness of lips and mouth. What is this? The Master said: (Previously stated that the Thirty-Six Diseases of women are all below the Dai meridian.) This disease belongs to Dai Xia. Why? She previously had a miscarriage, and blood stasis remains in the lower abdomen, not expelled. How do we know? (Because if blood stasis is not expelled, new blood cannot generate, and fluids cannot distribute.) Her symptom of dry lips and mouth indicates this. (Moreover, evening fever and palm heat belong to Yin. Ren governs conception, Chong is the Sea of Blood; both originate from the Uterus, exit at Huiyin, right in the lower abdomen region. Chong Mai ascends flanking the navel. Deficiency of Chong and Ren leads to lower abdominal urgency; dry blood causes abdominal fullness. Undoubtedly, this is an old blood stasis syndrome.) Treat with Wen Jing Tang / Warming the Meridians Decoction.
This continues the previous section, addressing severe cases of long-standing cold-blood accumulation in the Bao Men, providing the treatment.
You Zaijing said: A woman around fifty, Tian Gui exhausted, yet suffering vaginal bleeding, seemingly not related to menstruation. But unknown is that old accumulated blood exists in the lower abdomen, wanting to flow but unable to do so quickly, wanting to stop but unable to cease completely. Thus, urgent bleeding lasts dozens of days. Evening fever occurs because blood is knotted in Yin; Yang Qi at dusk cannot enter Yin and floats outward instead. Lower abdominal urgency and fullness result from blood accumulation failing to move, also indicating Yin-cold below. Vexatious palm heat indicates disease in Yin, and palms are Yin. Dry lips and mouth indicate blood stasis internally affecting Ying. This is bleeding caused by blood stasis; do not treat the bleeding directly, but remove the stasis, and the bleeding will stop. Wu Zhu Yu, Gui Zhi, Dan Pi enter blood to scatter cold and move stasis; Xiong, Dang Gui, Shao Yao, Mai Dong, E Jiao generate new blood; Ren Shen, Gan Cao, Sheng Jiang, Ban Zheng regulate Spleen Qi. For long-standing stasis, Ying must decline; for prolonged bleeding, Spleen must be injured.
Wen Jing Tang Formula
Wu Zhu Yu (Evodiae Fructus) (3 liang) Dang Gui (Angelicae Sinensis Radix), Xiong (Ligusticum Chuanxiong Rhizoma), Shao Yao (Paeoniae Radix Rubra), Ren Shen (Ginseng Radix), Gui Zhi (Cinnamomi Ramulus), E Jiao (Colla Corii Asini), Dan Pi (Moutan Cortex), Sheng Jiang (Zingiberis Rhizoma Recens), Gan Cao (Glycyrrhizae Radix et Rhizoma) (each 2 liang), Ban Xia (Pinelliae Rhizoma) (half sheng), Mai Dong (Ophiopogonis Radix) (1 sheng)
These twelve ingredients, boiled in 1 dou of water, yield 3 sheng. Divide into two warm doses. Also treats cold in the lower abdomen of women, infertility over a long period. Additionally treats metrorrhagia, or excessive menstrual flow, or delayed menstruation.
Li Shi said: Nei Jing states that those with deficient Blood and Qi prefer warmth and dislike cold; cold causes coagulation and stagnation, warmth causes dissolution and removal. This formula is named Warming the Meridians because blood stasis moves when warmed. The ingredients are all tonifying Blood and Qi herbs; they do not explicitly aim to expel stasis, yet stasis removes itself. This is the method of nourishing righteousness so evil dissipates. Thus, it treats metrorrhagia, infertility, and irregular menstruation in women.
(Women's diseases caused by menstruation, thirty-six types in total, are all called) Dai Xia. Menstrual flow (due to cold-induced stasis) does not (flow on time.) (Leading to) lower abdominal fullness and pain. (However, since it is stagnant and not flowing, the previous incomplete flow waits not for the next month's proper time but arrives early, thus) menstruation occurring twice in one month. (Treat with Tu Gua Gen San / Trichosanthes Root Powder.)
This provides the treatment for Dai Xia with irregular menstruation occurring twice a month. Tu Gua Gen is Wang Gua (Trichosanthes Kirilowii Radix). It drives heat and moves stasis, assisted by the crawling action of E Chong (Myodes Moschatus) to purge blood, and Gui Zhi/Shao Yao to harmonize Yin and Yang, forming a disciplined army.
Tu Gua Gen San Formula
Tu Gua Gen (Trichosanthis Radix), Shao Yao (Paeoniae Radix Rubra), Gui Zhi (Cinnamomi Ramulus), E Chong (Myodes Moschatus) (each 3 fen)
These four ingredients, pounded into powder. Take one cun bi with wine, three times daily.
The Cun Kou pulse is (lightly pressed) String-taut (Xian) and (heavily pressed) Large (Da). String-taut indicates (Yang deficiency progressing to) reduction. Large indicates (external abundance but internal) hollow (Kou). Reduction means (Yang cannot sustain itself,) constituting (various) Cold. Hollow means (Yin does not guard the center,) constituting internal Deficiency. Cold and Deficiency contend, this is named Ge (Leather) pulse. (Ge pulse is hard to clarify; describing it as Xian-reduction and Kou-deficiency clarifies it. Generally,) if a woman (obtains a Ge pulse, it indicates Blood and Qi deficiency. Internally, there is nothing to nourish the Zang organs; externally, nothing to fill the form.) Then (the fetus also lacks nourishment, thus) spontaneous abortion (where Qi cannot transport and) leakage bleeding occurs. (Treat with Xuan Fu Hua Tang / Inula Flower Decoction.) (To move Qi and Blood.)
This provides the treatment for spontaneous abortion with leakage bleeding due to deficiency-cold. This formula is used to regulate Qi and move Blood. Perhaps the disease source is in the Liver. The Liver, a Yin Zang containing Shaoyang Qi, handles transformation and generation, using flow and movement. Thus, deficiency cannot simply be tonified; resolving stagnation is tonification. Cold cannot simply be warmed; moving Qi and Blood is warming. Qian Shi considered this a misplaced text. Spontaneous abortion with leakage implies sinking Qi; how could one use Xuan Fu Hua to direct Qi downward? Both theories are preserved for discussion.
Xuan Fu Hua Tang Formula
Xuan Fu Hua (Inulae Flos) (3 liang), Cong Bai (Allii Fistulosi Bulbus) (14 stems), Xin Jiang (Safflower/Stained Silk) (a little)
These three ingredients, boiled in 3 sheng of water, yield 1 sheng. Take in one dose.
If a woman suffers from Sunken Jing (Menstrual) (with) leakage bleeding (that does not stop, and the blood color is) black (and persists.) (This is because blood stasis is not expelled, new blood does not generate, and Ying Qi rots. However, Qi prefers warmth and dislikes cold. Treat with Jiao Jiang Tang / Gelatin and Ginger Decoction.)
This provides the treatment for Sunken Jing with black blood. The formula is not seen. Lin Yi said: It is likely Jiao Ai Tang. Qian Jin Jiao Ai Tang contains Gan Jiang, which seems applicable. Dan Xi stated that pale menses indicate Water, purple indicates Heat, black indicates extreme Heat. He spoke of variation; this speaks of the constant.
If a woman's lower abdomen is full like a Dun (ancient vessel) (The lower abdomen is the chamber of the Uterus. The Uterus is the Sea of Blood; a full and large appearance indicates blood accumulation. If) urination is slightly difficult but there is no thirst. (One can know that water is also accumulating. If this occurred post-) childbirth, this is Water and Blood both knotted in the Blood Chamber. (Use a method attacking both water and blood, treating with) Da Huang Gan Sui Tang / Rhubarb and Kansui Decoction.
This provides the treatment for water and blood knotted in the Blood Chamber, causing lower abdominal fullness, difficulty in urination and defecation, and no thirst.
Da Huang Gan Sui Tang Formula
Da Huang (Rhei Radix et Rhizoma) (4 liang), Gan Sui (Kansui Radix), E Jiao (Colla Corii Asini) (each 2 liang)
These three ingredients, boiled in 3 sheng of water, yield 1 sheng. Take in one dose. The blood should be passed.
If a woman's menstruation is (long absent, presenting patterns of deficiency/excess and cold/heat that can be distinguished. There are cases of flow that is not smooth, evidenced by menstruation twice a month. If there is knotting pain in the lower abdomen, black stool, and free urination, knowing that blood wants to flow but) refuses (to flow smoothly. Do not use ordinary methods of moving blood, directing Qi, harmonizing Ying and Wei, or tonifying Chong and Ren, as these are too indirect and ineffective. Directly treat with) Di Dang Tang / Di Dang Decoction.
This provides the treatment for amenorrhea due to excess.
Di Dang Tang Formula
Shui Zhi (Hirudo) (fried), Meng Chong (Bombyx Batryticatus) (fried, 30 each), Tao Ren (Persicae Semen) (30 pieces), Da Huang (Rhei Radix et Rhizoma) (3 liang, soaked in wine)
These four ingredients, powdered. Boil in 5 sheng of water to yield 3 sheng. Remove dregs. Warm and take 1 sheng.