气热、气虚。
气虚补气，用人参、当归、黄 、川芎、升麻。
血虚者，四物汤。
血热者凉血，四物汤加黄柏炒。
经水、经候、过期而作痛者，乃虚中有热，所以作痛。
经水不及期，血热也。四物汤加黄连。
经候将来而作痛者，血实也。
桃仁 香附 黄连
过期乃血少也。
川芎 当归 带人参白术与痰药。
过期，紫黑色有块，血热也，必作痛。
四物汤加黄连、香附。
淡色过期者，乃痰多也。
二陈汤加川芎、当归。
紫色成块者，乃是热也。四物汤加黄连之类。
痰多占住血海地位，因而下多者，目必渐昏。肥人如此。
南星 苍术 香附 川芎 作丸服。
肥人不及日数而多者，痰多、血虚、有热。前方加黄连、白术。若血枯经闭者，四物汤加桃仁、红花。
躯肥脂满经闭者，导痰汤加芎连。不可服地黄，泥膈故
也。如用，以生姜汁炒。
崩之为病，乃血之大下，岂可为寒。但血去后，其人必虚，当大补气血。
东垣有治法，但不言热。其主于寒，学人宜再思之。
急则治其标。白芷汤调百草霜。
甚者，棕榈皮灰，后用四物汤加干姜调理。
因劳者，用参 带升补药。
因寒者加干姜。因热者加黄芩、参、 。
崩过多者，先服五灵脂末一服，当分寒热。五灵脂能行能止。妇人血崩用白芷、香附为丸。
白带用椒目末，又用白芷末。
一方∶用生狗头骨烧灰存性，或酒调服，或入药服之。
又方∶用五灵脂半生半熟为末，以酒调服。
气虚血虚者，皆于四物汤加人参、黄 。
漏下乃热而虚者，四物汤加黄连。
Heat in Qi, or deficiency of Qi.
For Qi deficiency, tonify Qi using Ren Shen (Ginseng Radix), Dang Gui (Angelicae Sinensis Radix), Huang Qi (Astragali Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Sheng Ma (Cimicifugae Rhizoma).
For blood deficiency, use Si Wu Tang (Four Substances Decoction).
For blood heat, employ the method of cooling blood: add Zhi Bai (Phellodendri Cortex, stir-fried) to Si Wu Tang (Four Substances Decoction).
Regarding menstruation (Jing Shui / Jing Hou), pain occurring after the expected date indicates a deficiency pattern with internal heat, which causes the pain.
Menstruation arriving before the expected date is due to blood heat. Use Si Wu Tang (Four Substances Decoction) added with Huang Lian (Coptidis Rhizoma).
Pain occurring before menstruation begins indicates a blood excess pattern.
Tao Ren (Persicae Semen), Xiang Fu (Cyperi Rhizoma), Huang Lian (Coptidis Rhizoma).
Menstruation arriving late is due to blood deficiency.
Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), combined with Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and phlegm-resolving medicines.
Late menstruation with dark purple color and clots indicates blood heat, necessarily accompanied by pain.
Use Si Wu Tang (Four Substances Decoction) added with Huang Lian (Coptidis Rhizoma) and Xiang Fu (Cyperi Rhizoma).
Late menstruation with pale color indicates excessive phlegm-dampness.
Use Er Chen Tang (Two Aged Ingredients Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix).
Purple color forming clots indicates heat. Use Si Wu Tang (Four Substances Decoction) added with Huang Lian (Coptidis Rhizoma) and similar herbs.
When excessive phlegm occupies the position of the Sea of Blood, it leads to heavy menstrual flow; consequently, vision will gradually dim. This is common in obese individuals.
Tian Nan Xing (Arisaematis Rhizoma), Cang Zhu (Atractylodis Rhizoma), Xiang Fu (Cyperi Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), prepared as pills for oral administration.
In obese individuals, heavy flow occurring before the expected days indicates excessive phlegm, blood deficiency, and heat. Add Huang Lian (Coptidis Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to the previous formula. If amenorrhea is caused by blood exhaustion, use Si Wu Tang (Four Substances Decoction) added with Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos).
For amenorrhea in individuals with a fat and fleshy constitution, use Dao Tan Tang (Phlegm-Draining Decoction) added with Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Huang Lian (Coptidis Rhizoma). Do not use Di Huang (Rehmanniae Radix) because its cloying nature obstructs the chest/stomach. If it must be used, stir-fry it with fresh ginger juice.
Beng Lou (Metrorrhagia and Metrostaxis) is characterized by massive bleeding from the uterus; how can it be treated as a cold syndrome? However, after significant blood loss, the patient inevitably becomes deficient, so one must vigorously tonify Qi and Blood.
Li Dong Yuan had treatment methods, but did not mention heat. His approach primarily focused on cold; students should reflect further on this.
In acute cases, treat the branch symptoms first. Use Bai Zhi Tang (Angelicae Dahuricae Decoction) to mix with Bai Cao Shuang (Fuliginis Carbonisatum).
In severe cases, use Zong Lu Pi Hui (Ash of Palm Fruit Peel), followed by regulation using Si Wu Tang (Four Substances Decoction) added with Gan Jiang (Zingiberis Rhizoma).
For cases caused by overwork, use Ren Shen (Ginseng Radix) combined with lifting and tonifying medicines.
For cases caused by cold, add Gan Jiang (Zingiberis Rhizoma). For cases caused by heat, add Huang Qin (Scutellariae Radix), Ren Shen (Ginseng Radix), and [Huang Qi/Astragali Radix - inferred from context].
For excessive bleeding, first administer a dose of Wu Ling Zhi Mo (Trogopterori Faeces powder); one must differentiate between cold and heat. Wu Ling Zhi (Trogopterori Faeces) has both blood-invigorating and hemostatic properties. For women's metrorrhagia, use Bai Zhi (Angelicae Dahuricae Radix) and Xiang Fu (Cyperi Rhizoma) made into pills.
For leukorrhea (white discharge), use Jiao Mu Mo (Semen Papaveris Rubrum powder) and also Bai Zhi (Angelicae Dahuricae Radix) powder.
One prescription: Burn the bone of a raw dog head until carbonized but retaining its nature; either mix with wine for oral administration or include in herbal decoctions.
Another prescription: Use Wu Ling Zhi (Trogopterori Faeces), half raw and half stir-fried, ground into powder, and taken with wine.
For Qi deficiency and blood deficiency, add Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) to Si Wu Tang (Four Substances Decoction).
Lou Xia (Persistent spotting) due to heat and deficiency uses Si Wu Tang (Four Substances Decoction) added with Huang Lian (Coptidis Rhizoma).