妇人之病与男子俱同，惟经之前后，与胎产前后，当另立治法。室女闭经，久必成劳，
以天癸正旺，不应愆期也。其症发热咳嗽，及寒热往来，恶疮渐盛。如脉洪、口渴，便秘者
，为实热，宜以四物汤加红花、桃仁、大黄（醋炒、）乌药、茜草主之；脉虚、口淡、多寒、腰
腹痛、大便滑者为虚寒，宜以四物汤加肉桂、人参、大黄、桃仁、干姜主之，二症脉涩，肌
肉甲错，将成干血痨者如虻虫，水蛭攻之，但经闭即为血崩之兆，不可任意攻击，此切症类
多忧郁思虑，七情过用所致，属虚者十之六、七。《内经》云∶“二阳之病发心脾，有不得
隐曲，为女子不月。”宜以逍遥散解肝经之郁，而诸郁俱解以归脾汤补心脾之血，以治经血
之源。景岳逍遥饮心、肝、脾同治，为标本两全之道，服之良久，然后通之。
妇人经闭，照前法。师尼寡妇，寒热往来，脉上鱼际，将成痨瘵，以小柴胡汤加生地主
之，或八味逍遥散主之。
妇人经渐迟，是血海虚寒，宜以四物汤加桂、附、吴萸、人参、白术、炙草主之。经渐
早是血海挟热，宜四物汤加黄连、黄芩、阿胶、地榆、甘草主之。
愚按二症，经迟者，用归脾汤加附子、干姜，经早者加丹皮、栀子是也。
薛立斋之快捷方式
妇人赤白带下，与男子赤白浊同，俱主湿热，宜二陈汤加苍术、白术各二钱，黄柏一钱
，牡蛎粉三钱，椿根皮（醋炒）二钱，乌梅二枚去核主之。亦有用补中益气汤及六、八味丸而愈
者，宜察其脉症而消息之。
赤属血，宜加当归（醋炒二钱。）白属气，宜加黄 （盐水炒三钱。
妇人经水不调，多不能成孕，宜先审其寒热虚实，及有无忧郁，以调其经，即是种子之
法。又肥人恐子宫脂满，不能受胎，宜以四物汤去熟地，加半夏、贝母、香附各二钱，阿胶
三钱，天麻一钱主之。瘦人恐子宫干燥，不能受胎，宜四物汤加人参、麦冬、半夏、桂枝、
阿胶各一钱五分，艾叶、吴萸各五分主之。景岳育麟珠为种子良方，不可不知。
堕胎症，丹溪主于脾虚挟火，以胎系于脾，犹钟悬于梁也，故以白术补脾为主，火盛则
动其胎气，故黄芩泻火为辅。于是垂其训曰∶黄芩、白术为安胎之圣药。《达生篇》遵其法
，而立安胎方，服多效。然物虽系于梁，而力则藉于栋，巨栋屹然不动，而梁方安，故人之
两
肾，犹两栋也。如左尺弱，必以六味丸为主，右尺弱，必以八味丸为主，而阿胶、艾叶、续
断、五味子之类，于二方随宜加减，应手取效，此赵养葵先生之心法也。大抵三月、五月，
胎必应期而堕者，皆是肾虚，必以此法为上。若近时医，必谓丹皮动血，桂枝堕胎，戒而不
用。不知庸劣误人，即此等不读书，假小心之辈也。
张石顽曰∶举世皆以黄芩、白术为安胎圣药，半夏、桂附为陨胎峻剂，敦知反有安胎妙
用哉，盖子气之安危，系乎母气之有偏胜与否。若母气多火，得芩连则安，得桂附则危，母
气多痰，得芩半则安，得归地则危，母气多寒，得桂附则安，得芩连则危，务在调其偏胜，
适其寒温。世未有母气逆而胎得安者，亦未有母气安而胎反堕者。所以《金匮》有怀孕六、
七月，胎胀、腹痛、恶寒，少腹如扇，用附子汤温其脏者，不可不知。
产前嗽喘肿胀及一切杂症，俱以杂症正法医之，不必谓某药动胎，某药堕胎，疑而不用
也，《内经》云∶“有故无陨。”即此谓也。或以四物汤为主，以护其胎，则所用之药，直
入于病，绝无妨碍。观洁古六合、四物汤，凡硝黄之类无所不用，可以观古人之有识有胆也
。其方备载于《医方集解》末卷，宜熟读之。
产妇临盆，以忍痛熟睡为主，分娩自有定时，不妨缓缓以待，切勿听稳婆惊悚之言，如
交骨不开，是阴气大虚，宜加味归芎汤主之（方见《女科要旨》。
又方以桃仁一个，劈作两片，一片写“可”字，一片写“出”字，仍合之，以糊粘之，
吞下多效。
又∶胎，犹舟也，血，犹水也，水满则舟行，如血行太早，则胎干涩而难出，必以十全
大补大剂服之，如血未行，以保生无忧散主之。
又∶产后腹中 痛，诸药不效，以手重按稍止者，虚之候，必用峻剂法，羊肉汤主之
。
妇女的疾病与男子相同，只是在月经前后，以及怀孕和分娩前后，应当设立专门的治疗方法。未婚女子闭经，时间久了必然形成虚劳病，因为此时天癸（指促进生殖机能成熟的物质）正当旺盛，不应当出现经期推迟。其症状表现为发热咳嗽，以及寒热往来（忽冷忽热），恶疮逐渐增多。如果脉象洪大、口渴、便秘的，属于实热证，适宜用四物汤加红花、桃仁、大黄（醋炒）、乌药、茜草来主治；如果脉象虚弱、口淡、怕冷多寒、腰腹痛、大便稀溏滑利的，属于虚寒证，适宜用四物汤加肉桂、人参、大黄、桃仁、干姜来主治。这两种病症若见脉涩、肌肤甲错（皮肤粗糙如鳞甲），即将形成干血痨（因瘀血内结导致的慢性消耗性疾病）的情况，可以用虻虫、水蛭等破血逐瘀药攻治，但是经闭往往是血崩的先兆，不可以随意使用攻伐药物。这类病症大多由忧郁思虑、七情（喜、怒、忧、思、悲、恐、惊）过度所致，属于虚证的占十分之六、七。《内经》说：“二阳（阳明胃与大肠）的病发于心脾，如果有难以启齿的隐曲之事，会导致女子闭经。”适宜用逍遥散疏解肝经的郁滞，从而使各种郁滞都得到解除，再用归脾汤补益心脾之血，以治疗经血的源头。张景岳的逍遥饮心、肝、脾同治，是标本兼顾的方法，服用较长时间后，然后再通经。
妇女经闭，按照前面的方法治疗。师尼（出家女尼）、寡妇，出现寒热往来，脉象上鱼际（脉搏搏动延伸至大鱼际部位，多为虚阳上浮或阴竭阳越之象），即将形成痨瘵（肺结核等慢性消耗性疾病），用小柴胡汤加生地黄来主治，或者用八味逍遥散来主治。
妇女月经逐渐推迟，这是血海虚寒，适宜用四物汤加桂枝、附子、吴茱萸、人参、白术、炙甘草来主治。月经逐渐提前，这是血海挟有热邪，适宜用四物汤加黄连、黄芩、阿胶、地榆、甘草来主治。
我按语：对于这两种情况，月经推迟者，用归脾汤加附子、干姜；月经提前者，加牡丹皮、栀子，就是这样。
薛立斋的快捷疗法：
妇女赤白带下，与男子的赤白浊相同，都主要主因湿热，适宜用二陈汤加苍术、白术各二钱，黄柏一钱，牡蛎粉三钱，椿根皮（醋炒）二钱，乌梅二枚去核来主治。也有用补中益气汤及六味丸、八味丸而痊愈的，应当观察其脉症而斟酌处理。
赤色属血，适宜加当归（醋炒二钱）；白色属气，适宜加黄芪（盐水炒三钱）。
妇女经水不调，大多不能受孕，适宜先审查其寒热虚实，以及是否有忧郁，以调理月经，这就是种子（助孕）的方法。又肥胖的人恐怕子宫被脂膏充满，不能受胎，适宜用四物汤去掉熟地黄，加半夏、贝母、香附各二钱，阿胶三钱，天麻一钱来主治。瘦弱的人恐怕子宫干燥，不能受胎，适宜用四物汤加人参、麦冬、半夏、桂枝、阿胶各一钱五分，艾叶、吴茱萸各五分来主治。张景岳的育麟珠是助孕的良好方剂，不可不知道。
堕胎症，朱丹溪主张是由于脾虚挟火，因为胎系于脾，就像钟悬挂在梁上一样，所以以白术补脾为主，火盛则扰动胎气，所以用黄芩泻火为辅。于是留下训诫说：黄芩、白术是安胎的圣药。《达生篇》遵循这种方法，制定了安胎方，服用大多有效。然而物体虽然系于梁，但力量却依赖于栋（屋柱），巨大的屋柱屹立不动，梁才能安稳，所以人的两肾，就像两根屋柱。如果左尺脉弱，必须以六味丸为主；右尺脉弱，必须以八味丸为主，然后阿胶、艾叶、续断、五味子之类，在这两个方剂中随宜加减，应手取效，这是赵养葵先生的心法。大概怀孕三月、五月，胎儿必定按期堕落的，都是肾虚，必须用这种方法为上策。如果近时的医生，一定认为牡丹皮动血，桂枝堕胎，忌讳而不使用。不知道这是庸医劣医误人，就是这种不读书、假小心的那些人啊。
张石顽说：世人都把黄芩、白术当作安胎的圣药，把半夏、桂枝、附子当作堕胎的峻剂，谁知道反而有安胎的妙用呢？因为胎儿元气的安危，取决于母体元气是否有偏胜。如果母体元气多火，得到黄芩、黄连则安，得到桂枝、附子则危；母体元气多痰，得到黄芩、半夏则安，得到当归、地黄则危；母体元气多寒，得到桂枝、附子则安，得到黄芩、黄连则危，务必调治其偏胜，适应其寒温。世上没有母体元气逆乱而胎儿得以安定的，也没有母体元气安定而胎儿反而堕落的。所以《金匮要略》中有怀孕六、七月，胎胀、腹痛、恶寒，少腹像扇子扇风一样冷，用附子汤温其脏器的记载，不可不知道。
产前咳嗽气喘肿胀及一切杂症，都用杂症的正法来治疗，不必说某药动胎，某药堕胎，怀疑而不使用。《内经》说：“有故无陨”（有病则病受之，不会伤害胎儿），就是这个意思。或者以四物汤为主，用来保护胎儿，那么所使用的药物，直接作用于疾病，绝无妨碍。看洁古（张元素）的六合汤、四物汤，凡是芒硝、大黄之类的药无所不用，可以看出古人的见识和胆量。这些方剂详细记载在《医方集解》末卷，应当熟读它。
产妇临盆，以忍耐疼痛、熟睡为主，分娩自有定时，不妨缓缓等待，千万不要听信稳婆（接生婆）惊恐吓唬的话。如果交骨不开（耻骨联合分离不足，导致难产），这是阴气大虚，适宜用加味归芎汤来主治（方剂见《女科要旨》）。
另一个方子：用桃仁一个，劈成两片，一片写“可”字，一片写“出”字，仍然合在一起，用糊粘住，吞服大多有效。
又说：胎，就像船；血，就像水。水满则船行，如果血行太早，则胎干涩而难出，必须用十全大补汤的大剂量服用；如果血未行，用保生无忧散来主治。
又说：产后腹中疼痛，诸药无效，用手重按稍止的，是虚证的征候，必须用峻剂法，用羊肉汤来主治。
Women's diseases are the same as men's, except that during the periods before and after menstruation, and before and after pregnancy and childbirth, specific treatment methods should be established. Amenorrhea in unmarried women will eventually develop into consumptive disease (Lao) if prolonged, because Tian Gui (substances promoting reproductive maturation) is at its peak and menstrual delays should not occur. Symptoms include fever and cough, alternating chills and heat, and gradually worsening malignant sores. If the pulse is surging, there is thirst, and constipation, it indicates excess-heat; Siwu Tang (Four Substances Decoction) added with Honghua (Carthami Flos), Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma, vinegar-fried), Wuyao (Linderae Radix), and Qiancao (Rubiae Radix) is indicated. If the pulse is deficient, the mouth is bland, there is aversion to cold, lower back and abdominal pain, and loose stools, it indicates deficiency-cold; Siwu Tang added with Rougui (Cinnamomi Cortex), Renshen (Ginseng Radix), Dahuang, Taoren, and Ganjiang (Zingiberis Rhizoma) is indicated. In cases where both conditions present with a choppy pulse, skin rough like scales (Ji Fu Jia Cuo), and impending dry-blood Lao (chronic consumption due to blood stasis), insects such as Mengchong (Asio/Blister Beetle) and Shuzhi (Hirudo/Leech) may be used to attack the stasis. However, amenorrhea can be a precursor to metrorrhagia (blood flooding), so aggressive attacks should not be used arbitrarily. These conditions mostly arise from melancholy and overthinking, caused by excessive emotional stimulation (Seven Emotions); six or seven out of ten cases belong to deficiency. The *Neijing* states: "Diseases of the Yangming [Stomach and Large Intestine] originate from the Heart and Spleen; if there are unspoken grievances, it leads to amenorrhea in women." Xiaoyao San (Free and Easy Wanderer Powder) should be used to resolve Liver Qi stagnation, thereby resolving all types of stagnation, followed by Guipi Tang (Restore the Spleen Decoction) to tonify Heart and Spleen blood, addressing the source of menstrual blood. Zhang Jingyue’s Xiaoyao Yin treats the Heart, Liver, and Spleen simultaneously, representing a method that addresses both root and branch. After taking it for a considerable time, menstruation can then be promoted.
For amenorrhea in women, follow the previous methods. For nuns and widows presenting with alternating chills and heat and a pulse extending to the Yuji area (indicating floating yang or yin exhaustion), which suggests impending Lao Zhai (consumptive disease like tuberculosis), Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Sheng Dihuang (Rehmanniae Radix Recens) is indicated, or Bawei Xiaoyao San (Eight-Ingredient Free and Easy Wanderer Powder).
If menstruation gradually becomes delayed, this indicates deficiency-cold in the Sea of Blood; Siwu Tang added with Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Praeparata), Wuyu (Evodiae Fructus), Renshen, Baizhu (Atractylodis Macrocephalae Rhizoma), and Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) is indicated. If menstruation gradually becomes early, this indicates heat in the Sea of Blood; Siwu Tang added with Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Ejiao (Colla Corii Asini), Diyü (Sanguisorbae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) is indicated.
My commentary: For these two conditions, delayed menstruation is treated with Guipi Tang added with Fuzi and Ganjiang; early menstruation is treated by adding Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus).
Xue Lizhai’s Quick Method:
Metrorrhagia and leukorrhea in women are similar to red and white turbidity in men, primarily caused by damp-heat. Erchen Tang (Two Aged Decoction) added with Cangzhu (Atractylodis Rhizoma), Baizhu, Huangbai (Phellodendri Cortex) 1 qian, Muli (Concha Ostreae) powder 3 qian, Chun Gen Pi (Toosendan Cortex, vinegar-fried) 2 qian, and Wumei (Mume Fructus, pitted) 2 pieces is indicated. Some cases have been cured with Bushen Yiqi Tang (Tonify the Middle and Augment Qi Decoction) or Liuwei Wan (Six-Ingredient Pill) and Bawei Wan (Eight-Ingredient Pill); one must observe the pulse and symptoms to adjust accordingly.
Red discharge belongs to blood; add Danggui (Angelicae Sinensis Radix, vinegar-fried) 2 qian. White discharge belongs to qi; add Huangqi (Astragali Radix, salt-water fried) 3 qian.
Menstrual irregularities often prevent conception. One must first examine for excess/deficiency and cold/heat, and check for depression, to regulate the menses, which is the method for promoting fertility. Obese women may have a uterus filled with fat, preventing conception; Siwu Tang without Shudihuang (Rehmanniae Radix Preparata), added with Banxia (Pinelliae Rhizoma), Beimu (Fritillariae Bulbus), Xiangfu (Cyperi Rhizoma) each 2 qian, Ejiao 3 qian, and Tianma (Gastrodiae Rhizoma) 1 qian is indicated. Emaciated women may have a dry uterus, preventing conception; Siwu Tang added with Renshen, Maidong (Ophiopogonis Radix), Banxia, Guizhi, and Ejiao each 1.5 qian, and Aiye (Artemisiae Argyi Folium), Wuyu each 0.5 qian is indicated. Zhang Jingyue’s Yulin Zhu (Fertility Pearl) is an excellent formula for promoting fertility and should not be overlooked.
For spontaneous abortion, Zhu Danxi attributes it to Spleen deficiency with fire, as the fetus is anchored to the Spleen, like a bell hanging from a beam. Thus, Baizhu is used to tonify the Spleen as the primary agent, and Huangqin (Scutellariae Radix) is used to clear fire as the secondary agent, since excessive fire disturbs the fetal qi. He left the instruction: Huangqin and Baizhu are the sacred medicines for calming the fetus. The *Dasheng Pian* follows this method and established formulas for calming the fetus, which are often effective. However, although the object hangs from the beam, its stability relies on the pillar (Dong). If the main pillars stand firm, the beam is secure. Thus, the two Kidneys are like two pillars. If the Left Chi pulse is weak, Liuwei Wan (Six-Ingredient Pill) should be the primary formula; if the Right Chi pulse is weak, Bawei Wan (Eight-Ingredient Pill) should be the primary formula. Then, Ejiao, Aiye, Xuduan (Dipsaci Radix), and Wuweizi (Schisandrae Fructus) can be added or subtracted according to circumstances, yielding immediate results. This is the secret method of Mr. Zhao Yangkui. Generally, abortions occurring regularly at three or five months are due to Kidney deficiency, and this method is superior. Modern physicians, however, often claim that Mudanpi moves blood and Guizhi causes abortion, avoiding them out of caution. This ignorance harms people; such individuals are uneducated and falsely cautious.
Zhang Shiwan said: The world regards Huangqin and Baizhu as sacred medicines for calming the fetus, and Banxia, Guizhi, and Fuzi as harsh agents causing abortion. Who knows they can also have subtle uses for calming the fetus? The safety of the fetal qi depends on whether the maternal qi has excesses. If maternal qi has excessive fire, Huangqin and Huanglian (Coptidis Rhizoma) bring peace, while Guizhi and Fuzi bring danger. If maternal qi has excessive phlegm, Huangqin and Banxia bring peace, while Danggui and Dihuang bring danger. If maternal qi has excessive cold, Guizhi and Fuzi bring peace, while Huangqin and Huanglian bring danger. One must always adjust the excesses and balance the cold and heat. There is no case where maternal qi is rebellious but the fetus remains safe, nor where maternal qi is peaceful but the fetus aborts. Therefore, the *Jingui Yaolue* records using Fuzi Tang (Aconite Decoction) to warm the viscera for pregnant women at six or seven months presenting with abdominal distension, pain, aversion to cold, and a cold sensation in the lower abdomen like a fan blowing. This must be known.
For cough, asthma, swelling, and other miscellaneous conditions before delivery, treat them according to standard protocols for miscellaneous diseases. Do not hesitate to use herbs due to fears that they might disturb or cause abortion. The *Neijing* states: "If there is a disease, there is no destruction" (meaning the pathogen bears the brunt of the medicine, sparing the fetus). Using Siwu Tang as a base protects the fetus, allowing other medications to target the disease directly without harm. Observing Jiegu’s (Zhang Yuansu) Liuhe Tang and Siwu Tang, which utilize harsh substances like Xiaoshi (Natrii Sulfas) and Dahuang, shows the insight and courage of ancient physicians. These formulas are detailed in the last volume of *Yifang Ji jie* (Collection of Medical Formulas Explained) and should be studied thoroughly.
During labor, the mother should endure pain and sleep soundly. Delivery has its own timing; wait patiently. Do not listen to the frightening words of midwives. If the birth bone (pubic symphysis) does not open, it indicates severe deficiency of Yin qi; Jiawei Guixiong Tang (Modified Angelica and Ligusticum Decoction) is indicated (see *Nuke Yaozhi*).
Another formula: Take one Tao Ren (Persicae Semen), split it into two halves. Write "Ke" (Can) on one half and "Chu" (Out) on the other. Rejoin them, bind with paste, and swallow. This is often effective.
Furthermore: The fetus is like a boat; blood is like water. When water is full, the boat floats. If blood flows too early, the fetus becomes dry and difficult to deliver. In such cases, a large dose of Shiquan Dabu Tang (Perfect Fourteen-Ingredient Decoction) should be taken. If blood has not yet flowed, Baosheng Wuyou San (Protect Life and Remove Worries Powder) is indicated.
Furthermore: Postpartum abdominal pain that does not respond to various medicines but is relieved slightly by heavy pressure indicates deficiency. A strong remedy is required; Lamb Soup is indicated.