大熟地(砂仁酒拌,九蒸九晒) 当归(酒蒸,各四两) 白芍(酒炒,三两) 川芎(酒蒸,一两
五钱) 丹参(酒蒸,三两) 茺蔚子(酒蒸,四两) 香附(醋、酒、姜汁、盐水各炒一两,四两) 白
术(陈土炒,四两)
以益母草八两,酒水各半熬膏,和炼蜜为丸,每早开水下四钱。血热者,加丹皮、生地各二两。血寒者,加浓肉桂
五钱。若不寒不热,只照本方。
(见虚劳)
调经养血之要药,其地黄须九蒸九晒,方能取效,否则滞膈生痰,妨
碍饮食,乃制药之过,非立方之罪也。血热者,加丹参、丹皮、益母草。血寒者,加桂心、
牛膝。经行而腹痛拒按者,加延胡、香附、木香。经既行而腹痛喜按者,加人参、白术。血
少色淡者,亦并加此。若腹中素有痞,饮食满闷者,本方内除熟地,专用三物加丹参、陈皮
妇人经闭,其治较易,室女经闭,其治较难。妇人胎产乳子之后,血气空虚,经水一时
不至,俟其气血渐回,而经脉自通矣。室女乃浑全之人,气血正旺,不应阻塞,其闭也,若
非血海干枯,则经脉逆转。血海枯,则内热咳嗽,鬓发焦,而成怯症;经脉逆转,则失其顺
行之常,而为吐为衄。夫血以下行为顺,上行为逆,速宜调其经脉,俾月水流通,庶几可救
;予以益母胜金丹,加牛膝主之。若其人肝经怒火炽盛者,则颈生瘰 ,或左胁刺痛,更佐
以加味逍遥散,及消瘰丸。若其人脾气虚弱,不能消化饮食,血无从生,更佐以五味异功散
若其人精神倦怠,晡热、内热,此气血两亏,无经可行,更佐以八珍汤。此治室女经闭之
良法。倘妄行霸道,破血通经,其不偾事者几希矣。
益母胜金丹(见前
加味逍遥散(见类中
消瘰丸(见瘰 门)
五味异功散 八珍汤(俱见虚劳
大熟地(用砂仁酒拌,经过九次蒸制和九次晾晒)四两,当归(用酒蒸制)四两,白芍(用酒炒制)三两,川芎(用酒蒸制)一两五钱,丹参(用酒蒸制)三两,茺蔚子(益母草的种子,用酒蒸制)四两,香附(分别用醋、酒、姜汁、盐水炒制各一两,共四两),白术(用陈土炒制)四两。
用益母草八两,以水和酒各半熬制成膏,与炼蜜混合制成丸药,每天早晨用开水送服四钱。若属血热证,加牡丹皮、生地黄各二两;若属血寒证,加肉桂五钱。若不寒不热,则只按本方服用。
(此方适用于虚劳病证)
这是调经养血的要药,其中的地黄必须经过九蒸九晒,才能发挥疗效,否则会导致胸膈痞闷、生痰,妨碍饮食,这是炮制药材的过错,不是处方的罪过。若属血热证,加丹参、牡丹皮、益母草。若属血寒证,加桂心、牛膝。月经来潮时腹痛且拒按的,加延胡索、香附、木香。月经来潮后腹痛且喜按的,加人参、白术。若因血少导致经色淡者,也一并加入这些药物。若患者腹中素有痞块,饮食后感到胀满闷塞的,本方中去掉熟地黄,专门使用三物(指白术、香附、丹参等,原文语境隐含)加丹参、陈皮。
妇女闭经,治疗相对容易;少女(未出嫁女子)闭经,治疗较为困难。妇女在怀孕、生产、哺乳之后,气血空虚,月经暂时不来,等待其气血逐渐恢复,经脉自然通畅。少女是气血充盈完整之人,气血正旺盛,不应出现阻塞。其闭经的原因,若非血海干枯,则是经脉气机逆转。血海干枯,则出现内热、咳嗽,鬓发焦枯,形成怯症(慢性虚弱性疾病);经脉逆转,则失去顺行的常态,表现为吐血或鼻衄。血液以下行为顺,上行为逆,应迅速调理经脉,使月经流通,或许可以挽救。我主张用益母胜金丹,加牛膝为主进行治疗。若其人肝经怒火炽盛,则颈部出现瘰疬(淋巴结结核),或左胁部刺痛,再辅以加味逍遥散及消瘰丸。若其人脾气虚弱,不能消化饮食,血液无从生化,再辅以五味异功散。若其人精神倦怠,午后发热、内热,这是气血两亏,无经可下,再辅以八珍汤。这是治疗少女闭经的良好方法。倘若妄行霸道之法,强行破血通经,不把事情搞砸的极少。
Prepared Rehmanniae Radix (Shu Di Huang) [Rehmanniae Radix Praeparata] four liang, processed with Amomi Fructus and wine, steamed nine times and sun-dried nine times; Dang Gui [Angelicae Sinensis Radix] four liang, steamed with wine; Bai Shao [Paeoniae Radix Alba] three liang, stir-fried with wine; Chuan Xiong [Ligustici Chuanxiong Rhizoma] one liang five qian, steamed with wine; Dan Shen [Salviae Miltiorrhizae Radix et Rhizoma] three liang, steamed with wine; Chong Wei Zi [Leonuri Fructus] four liang, steamed with wine; Xiang Fu [Cyperi Rhizoma] four liang total, stir-fried separately with vinegar, wine, ginger juice, and salt water (one liang each); Bai Zhu [Atractylodis Macrocephalae Rhizoma] four liang, stir-fried with aged soil.
Decoct eight liang of Yi Mu Cao [Leonuri Herba] with half water and half wine to make a paste, mix with refined honey to form pills. Take four qian orally with warm boiled water every morning. For blood-heat patterns, add Mu Dan Pi [Moutan Cortex] and Sheng Di Huang [Rehmanniae Radix], two liang each. For blood-cold patterns, add Rou Gui [Cinnamomi Cortex], five qian. If there is neither cold nor heat, follow the original prescription only.
(See Xu Lao [Consumption])
This is an essential herb for regulating menstruation and nourishing blood. The Di Huang [Rehmanniae Radix] must undergo nine steamings and nine dryings to be effective; otherwise, it causes chest fullness and phlegm generation, hindering appetite. This is a fault in processing, not in the prescription itself. For blood-heat patterns, add Dan Shen [Salviae Miltiorrhizae Radix et Rhizoma], Mu Dan Pi [Moutan Cortex], and Yi Mu Cao [Leonuri Herba]. For blood-cold patterns, add Gui Xin [Cinnamomi Ramulus] and Niu Xi [Achyranthis Bidentatae Radix]. For abdominal pain during menstruation that rejects pressure, add Yan Hu Suo [Corydalis Rhizoma], Xiang Fu [Cyperi Rhizoma], and Mu Xiang [Aucklandiae Radix]. For abdominal pain after menstruation that prefers pressure, add Ren Shen [Ginseng Radix et Rhizoma] and Bai Zhu [Atractylodis Macrocephalae Rhizoma]. These should also be added if blood deficiency results in pale menstrual color. If there is a pre-existing mass in the abdomen and fullness/stuffiness after eating, remove Shu Di Huang [Rehmanniae Radix Praeparata] from this formula and use specifically three substances plus Dan Shen [Salviae Miltiorrhizae Radix et Rhizoma] and Chen Pi [Citri Reticulatae Pericarpium].
Menstrual obstruction in married women is relatively easy to treat; menstrual obstruction in maiden girls is more difficult to treat. After pregnancy, childbirth, or lactation, a woman's qi and blood are deficient, and menstruation may temporarily cease; once qi and blood gradually recover, the meridians will naturally unblock. A maiden girl has complete and vigorous qi and blood, so obstruction should not occur. If obstruction occurs, it is either due to the drying up of the Blood Sea or the reversal of meridian flow. Drying of the Blood Sea leads to internal heat, coughing, scorched temples/hair, and constitutes Qie Zheng [Chronic Weakness Disease]; reversal of meridian flow loses its normal downward course, resulting in hematemesis or epistaxis. Blood flows smoothly downward; upward flow is rebellious. One must quickly regulate the meridians to ensure menstrual flow, which may save the patient. I advocate using Yi Mu Sheng Jin Wan [Motherwort Golden Pill] combined with Niu Xi [Achyranthis Bidentatae Radix] as the main treatment. If the person has excessive fire in the Liver Meridian, causing Luo Li [Scrofula/Lymph Node Tuberculosis] on the neck or stabbing pain in the left hypochondrium, supplement with Jia Wei Xiao Yao San [Modified Free and Easy Wanderer Powder] and Xiao Luo Wan [Phlegm-Nodule Resolving Pill]. If the person has Spleen Qi deficiency, unable to digest food, leading to no source for blood generation, supplement with Wu Wei Yi Gong San [Five-Ingredient Extraordinary Efficacy Powder]. If the person has mental fatigue, afternoon fever, and internal heat, indicating dual deficiency of qi and blood with no menses to flow, supplement with Ba Zhen Tang [Eight-Treasure Decoction]. This is an excellent method for treating menstrual obstruction in maiden girls. If one recklessly uses harsh methods to break blood and unblock menstruation, failure is highly likely.
Yi Mu Sheng Jin Wan [Motherwort Golden Pill] (See previous section)
Jia Wei Xiao Yao San [Modified Free and Easy Wanderer Powder] (See Lei Zhong Feng [Stroke-like Syndromes])
Xiao Luo Wan [Phlegm-Nodule Resolving Pill] (See Luo Li Men [Scrofula Section])
Wu Wei Yi Gong San [Five-Ingredient Extraordinary Efficacy Powder] Ba Zhen Tang [Eight-Treasure Decoction] (Both see Xu Lao [Consumption])