经云∶“女子七七而天癸绝。”有年未至七七而经水先断者，人以为血枯经闭也，谁知是心肝脾之气郁乎！使
其血枯，安能久延于人世。医见其经水不行，妄谓之血枯耳，其实非血之枯，乃经之闭也。且经原非血也，乃天一
之水，出自肾中，是至阴之精而有至阳之气，故其色赤红似血，而实非血，所以谓之天癸。世人以经为血，此千古
之误，牢不可破，倘果是血，何不名之曰血水，而曰经水乎！经水之名者，原以水出于肾，乃癸干之化，故以名之。
无如世人沿袭而不深思其旨，皆以血视之。然则经水早断，似乎肾水衰涸。吾以为心肝脾气之郁者，盖以肾水之生，
原不由于心肝脾，而肾水之化，实有关于心肝脾。使水位之下无土气以承之，则水滥灭火，肾气不能化；火位之下
无水气以承之，则火炎铄金，肾气无所生；木位之下无金气以承之，则木妄破土，肾气无以成。倘心肝脾有一经之
郁，则其气不能入于肾中，肾之气即郁而不宣矣。况心肝脾俱郁，即肾气真足而无亏，尚有茹而难吐之势。矧肾气
本虚，又何能盈满而化经水外泄耶！经曰“亢则害”，此之谓也。此经之所以闭塞有似乎血枯，而实非血枯耳。治
法必须散心肝脾之郁，而大补其肾水，仍大补其心肝脾之气，则精溢而经水自通矣。
方用益经汤。
大熟地（一两，九蒸） 白术（一两，土炒） 山药（五钱，炒） 当归（五钱，酒洗） 白芍（三钱，酒炒） 生
枣仁（三钱，捣碎） 丹皮（二钱） 沙参（三钱） 柴胡（一钱） 杜仲（一钱，炒黑） 人参（二钱）
水煎。连服八剂而经通矣，服三十剂而经不再闭，兼可受孕。此方心肝脾肾四经同治药也。妙在补以通之，散
以开之；倘徒补则郁不开而生火，徒散则气益衰而耗精；设或用攻坚之剂，辛热之品，则非徒无益，而又害之矣。
眉批∶善医者，只用眼前纯和之品，而大病尽除；不善医者，立异矜奇，不惟无效，反致百病丛生。凡用药
杂乱，假金石为上品者，戒之！戒之！
歌括∶年未七七经水断，心肝脾气郁不宣。
肾气不能化生成，大补肾水益精原。
益经熟地沙人参，归芍白术丹枣仁。
柴胡山药杜仲炭，同治心肝与脾肾。
《黄帝内经》说：“女子到了四十九岁（七七之年），天癸就会枯竭。”如果有年纪还没到四十九岁，月经却先停止的，人们都以为是血枯导致的经闭，哪里知道这是心、肝、脾三脏的气机郁结所致呢！如果是真正的血枯，怎么能长久地存活于人世呢？医生见到她月经不行，就胡乱说是血枯罢了，其实并不是血液枯竭，而是经络闭塞。况且月经原本就不是血，它是来自天一之水的物质，出自肾中，是至阴的精微物质却蕴含至阳之气，所以它的颜色赤红像血，但实际上不是血，因此称之为天癸。世人把月经当作血，这是千古以来的错误，根深蒂固难以破除。如果月经真的是血，为什么不叫它“血水”，而叫它“经水”呢？“经水”这个名字的由来，是因为水出于肾，是天干中癸水的化生，所以用这个名字来称呼它。无奈世人沿袭旧说而不深思其中的旨意，都把月经看作血。既然这样，那么月经早断，表面上看似乎是肾水衰败枯竭。但我认为，这是因为心、肝、脾三脏气机郁结的缘故。因为肾水的生成，原本不直接来源于心、肝、脾，但肾水的化生与排泄，确实与心、肝、脾有关。如果水位之下没有土气来承载制约，就会导致水泛滥而灭火，肾气无法化生；火位之下如果没有水气来承载制约，就会导致火炎上灼伤肺金，肾气无所滋生；木位之下如果没有金气来承载制约，就会导致木气妄动破土，肾气无以成就。倘若心、肝、脾中有一脏气机郁结，那么它们的气就不能进入肾中，肾的气机就会郁滞而不能宣通。更何况心、肝、脾三脏都郁结，即使肾气真正充足而没有亏损，也会有只容纳而难排出的态势。何况肾气本来虚弱，又怎么能充盈并化生月经外泄呢！《内经》说“亢盛则有害”，说的就是这个道理。这就是月经之所以闭塞看起来像血枯，但实际上并非血枯的原因。治疗方法必须疏散心、肝、脾的郁结，同时大补肾水，并且大补心、肝、脾的气，那么精液满溢，月经自然通畅了。
方剂使用益经汤。
大熟地黄（一两，经过九次蒸制） 白术（一两，土炒） 山药（五钱，炒） 当归（五钱，酒洗） 白芍（三钱，酒炒） 生酸枣仁（三钱，捣碎） 牡丹皮（二钱） 沙参（三钱） 柴胡（一钱） 杜仲（一钱，炒黑） 人参（二钱）
用水煎服。连续服用八剂后月经就会通畅，服用三十剂后月经不再闭塞，并且还可以受孕。这个方子是同时治疗心、肝、脾、肾四经的药物。妙处在于通过补益来达到疏通的目的，通过疏散来达到开解的效果；如果单纯进补，则郁结不能打开而生出火热；如果单纯疏散，则气更加衰弱而耗损精气；假如使用攻坚破积的药剂或辛热性质的药物，则不仅没有益处，反而会造成伤害。
眉批：善于治病的医生，只用眼前平和纯正的药物，就能使大病尽除；不善于治病的医生，标新立异、夸耀奇特，不仅无效，反而导致各种疾病丛生。凡是用药杂乱无章，假托金石类药物为上乘的，一定要警惕啊！一定要警惕啊！
歌诀：年纪未到七七之时月经断，心肝脾气郁结不得宣散。
肾气不能化生精血之源，大补肾水以增益精原。
益经汤中有熟地、沙参、人参，当归、白芍、白术、丹皮、酸枣仁。
柴胡、山药、炒黑的杜仲炭，共同治疗心、肝、脾与肾。
The *Yellow Emperor's Inner Canon* states: "When a woman reaches the age of forty-nine (seven sevens), Tian Gui will cease." If menstruation ceases before this age, people generally attribute it to blood deficiency leading to amenorrhea. However, who would know that this is actually caused by Qi stagnation in the Heart, Liver, and Spleen? If it were true blood deficiency, how could one survive for long? Physicians seeing the cessation of menstruation rashly diagnose it as blood deficiency. In reality, it is not a depletion of blood, but a blockage of the menses. Moreover, menstrual blood is originally not blood; it is a substance derived from the Water of Tian Yi, originating from the Kidneys. It is the essence of extreme Yin yet contains the Qi of extreme Yang. Therefore, its color is red like blood, but it is essentially not blood, which is why it is called Tian Gui. The common belief that menstruation is blood is an error lasting for millennia, deeply rooted and hard to break. If menstruation were truly blood, why is it not named "Blood Water" but rather "Menstrual Water"? The name "Menstrual Water" originates because water comes from the Kidneys and is the transformation of the Heavenly Stem Gui (Water). Thus, it is named accordingly. Unfortunately, people have followed this tradition without deep reflection, viewing menstruation merely as blood. Consequently, early cessation of menstruation seems superficially like the exhaustion of Kidney Water. I believe, however, that this is due to the stagnation of Qi in the Heart, Liver, and Spleen. Although the generation of Kidney Water does not directly stem from the Heart, Liver, and Spleen, its transformation and regulation are indeed related to them. If there is no Earth Qi below the Water level to support and control it, water will flood and extinguish fire, preventing the transformation of Kidney Qi; if there is no Water Qi below the Fire level to support it, fire will blaze and scorch Metal, leaving no source for Kidney Qi; if there is no Metal Qi below the Wood level to support it, Wood will act recklessly and break through Earth, making it impossible for Kidney Qi to form. If even one of the Heart, Liver, or Spleen suffers from Qi stagnation, their Qi cannot enter the Kidneys, causing Kidney Qi to become stagnant and unable to circulate freely. Furthermore, if the Heart, Liver, and Spleen are all stagnant, even if Kidney Qi is truly sufficient and undiminished, there will be a tendency to retain rather than discharge. How much more so when Kidney Qi is inherently deficient, how can it be full enough to transform and excrete menstrual blood? As the *Inner Canon* says, "Excess leads to harm," which refers to this situation. This is why menstruation becomes blocked, appearing like blood deficiency, but is actually not so. The treatment method must involve dispersing the stagnation of the Heart, Liver, and Spleen, while greatly tonifying Kidney Water, and also greatly tonifying the Qi of the Heart, Liver, and Spleen. Then, when essence overflows, menstruation will naturally flow smoothly.
Prescribe Yi Jing Tang (Benefit Menses Decoction).
Shu Di Huang (Rehmanniae Radix Praeparata, 1 liang, steamed nine times) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 liang, stir-fried with soil) Shan Yao (Dioscoreae Rhizoma, 5 qian, stir-fried) Dang Gui (Angelicae Sinensis Radix, 5 qian, washed with wine) Bai Shao (Paeoniae Radix Alba, 3 qian, stir-fried with wine) Sheng Zao Ren (Ziziphi Spinosomi Semen, 3 qian, crushed) Dan Pi (Moutan Cortex, 2 qian) Sha Shen (Glehniae Radix or Adenophorae Radix, 3 qian) Chai Hu (Bupleuri Radix, 1 qian) Du Zhong (Eucommiae Cortex, 1 qian, stir-fried until black) Ren Shen (Ginseng Radix et Rhizoma, 2 qian)
Decoct in water. Take consecutively for eight doses, and menstruation will resume; take for thirty doses, and menstruation will not close again, and conception becomes possible. This formula treats the Heart, Liver, Spleen, and Kidney meridians simultaneously. Its brilliance lies in using tonification to achieve unblocking, and dispersion to achieve opening; if one only tonifies, stagnation remains unresolved and generates heat; if one only disperses, Qi becomes further depleted and essence is consumed; if aggressive breaking agents or pungent-hot substances are used, it will not only be ineffective but also harmful.
Marginal Note: A skilled physician uses only pure and harmonious remedies readily available, thereby eliminating major diseases; an unskilled physician seeks novelty and eccentricity, achieving nothing but generating myriad illnesses. Beware of those who use chaotic prescriptions and falsely regard mineral drugs as superior! Beware! Beware!
Verse:
Before the age of seven sevens, menstruation stops,
Heart, Liver, and Spleen Qi stagnate, unable to disperse.
Kidney Qi fails to transform and generate,
Greatly tonify Kidney Water to benefit the essence source.
Yi Jing Tang contains Shu Di, Sha Shen, and Ren Shen,
Along with Dang Gui, Bai Shao, Bai Zhu, Dan Pi, and Zao Ren.
Chai Hu, Shan Yao, and Charred Du Zhong together treat
The Heart, Liver, Spleen, and Kidney.