一妇人，因夫经商久不归，发寒热，月经旬日方止。服降火凉血，反潮热内热，自汗盗汗，月经频数。
余曰∶热汗，气血虚也；经频，肝脾虚也，用归脾汤、六味丸而愈。
一放出宫人，年逾三十，两胯作痛，肉色不变，大小便中作痛如淋，登厕尤痛。此瘀血渍入隧道为患，
乃男女失合之症也，难治。后溃不敛，又患瘰 而殁。此妇为吾乡汤氏外家，汤为商常在外，可见此妇在内久怀
忧郁，及出外又不能如愿，是以致生此症。愈见瘰 流注，乃七情气血损伤，不可用攻伐皎然矣。按“精血篇”
云∶女人天癸既至，逾十年无男子合，则不调。未逾十年，思男子合，亦不调。不调则旧血不出，新血误行，
或溃而入骨，或变而为肿，或虽合而难子，合多则沥枯虚人，产乳众则血枯杀人。观其精血，思过半矣。
一室女，年十七， 久不愈，天癸未通，发热咳嗽，饮食少思，或欲用通经丸。余曰∶此症潮热经候不调
者，不治。所喜脉不涩，且不潮热，尚可治。但养气血，益津液，其经自行。惑于速效，仍用之。余曰∶非其
治也，此乃 悍之剂，大助阳火，阴血得之则妄行，脾胃得之则愈虚。经果通而不止，饮食愈少，更加潮热，
遂致不救。
薛立斋曰∶历节痛，或因饮食起居失节，或因七情六淫失宜，以致脾胃亏损，腠理不密，外邪所侵，或
为肝火内动，肝血耗损；或为肢体疼痛；或为肢节难伸；或为卒然掣痛；或为走痛无常；或内热晡热；自汗盗
汗；或经候不调，饮食不甘。其治法，属风邪者，小续命汤。走注疼痛者，漏芦散。骨
节疼痛者，四生丸。湿热痛者，消燥汤。兼痰，佐以二陈。肝火者，加味逍遥加羌活、川芎。脾郁者，加味
归脾加羌活、川芎。血虚者，四物加羌活、川芎。气虚者，四君加羌活，川芎。气血俱虚者，八珍加羌活、川
芎，月经先期而痛者，加味逍遥散为主。月经过期而痛者，补中益气为主。大抵痛而不敢按者，属病气元气俱
实也；手按而痛缓者，病气元气俱虚也。若劳役而作痛者，元气虚也；饮食失宜而作痛者，脾胃虚也；恼怒而
作痛者，肝火也；经行而作痛者，血虚也。凡此皆固元气为主，而佐以治病之药。
医案
一妇人，自汗盗汗，发热晡热，体倦少食，月经不调，吐痰甚多，二年矣。遍身作痛，天阴风雨益甚。
用小续命汤而痛止，用补中益气、加味归脾二汤，三十余剂而愈。自汗等症，皆郁结伤损脾气，不能输养诸脏所
致。故用前二汤。专主脾胃。若用寒凉降火，理气化痰，复伤生气，多致不起。
一妇人，因怒月经去多，发热作渴，左目紧小，头项动摇，四肢抽搐，遍身疼痛。此怒动肝火，肝血
虚而内生风，用加味逍遥散加钩藤，数剂诸证渐愈，又用八珍汤调理而安。
一妇人，历节作痛，发热作渴，饮食少思，月经过期，诸
药不应，脉洪大，按之微细。用附子八物，四剂而痛止，用加味逍遥散而元气复，六味丸而月经调。
一妇人，体肥胖，素内热，月经先期，患痛风，下体微肿痛甚，小便频数，身重脉缓，症属风湿而血虚有
热。先用羌活胜湿汤四剂，肿痛渐愈。用清燥汤数剂，小便渐清。用加味逍遥十余剂，内热渐愈。为饮食
停滞，发热仍痛，面目浮肿，用六君子加升柴而愈。又因怒气小腹痞闷，寒热呕吐，此木侮脾土，用前药加山栀、
木香而安。惟小腹下坠，似欲去后，此脾气下陷，用补中益气而愈。后因劳役怒气，作呕吐痰，遍身肿痛，月经忽
来寒热，用六君加柴胡、山栀，以扶元气、清肝火，肿痛呕吐悉退。用补中益气以升阳气、健
营气，月经寒热悉瘥。
一位妇人，因为丈夫经商长期不回家，出现怕冷发热的症状，月经十天才能结束。服用降火凉血的药物后，反而出现潮热、内热、自汗和盗汗，月经变得频繁。
我说：热汗是气血虚弱所致；月经频繁是肝脾虚弱所致，使用归脾汤和六味丸而痊愈。
一位被放出的宫女，年龄超过三十岁，两侧胯部疼痛，皮肤颜色没有变化，大小便时疼痛如同淋证，上厕所时疼痛更加剧烈。这是瘀血渗入隧道造成的祸患，属于男女阴阳失和的病症，难以治疗。后来溃烂无法愈合，又患上瘰疬（颈部淋巴结结核）而死。这位妇人是我家乡汤家的外戚，汤某经常在外经商，可见这位妇人长期在家心怀忧郁，出宫后又不能如愿以偿，因此导致生此病。由此可见，瘰疬流注是由于七情（喜、怒、忧、思、悲、恐、惊）损伤气血所致，不可使用攻伐之法，这是显而易见的。按《精血篇》所说：“女子天癸（指月经）既已来潮，若超过十年没有男子交合，则月经不调。未满十年，思念男子交合，也会月经不调。月经不调则旧血排不出，新血误行，或者溃烂深入骨骼，或者变为肿块，或者虽然交合但难以怀孕，交合过多则津液枯竭使人体虚弱，生育众多则血液枯竭致人死亡。”观察其精血的变化，道理就明白大半了。
一位未婚少女，年龄十七岁，阴部溃疡久治不愈，天癸尚未通畅，伴有发热咳嗽，饮食减少不想进食，有人想用通经丸。我说：这种症状表现为潮热且月经不调的，属于难治之症。所幸脉象不涩，且没有潮热，还可以治疗。只要调养气血，补充津液，月经自然会来。患者因迷惑于速效，仍然使用了该药。我说：这不是正确的治疗方法，这是峻猛的药物，会大大助长阳火，阴血遇到它就会妄行，脾胃遇到它会更加虚弱。结果月经果然通了但止不住，饮食越来越少，加上潮热，最终导致死亡。
薛立斋说：历节痛（关节剧烈疼痛），可能是因为饮食起居没有节制，也可能是因为七情六淫（风、寒、暑、湿、燥、火六种外感病邪）处理不当，导致脾胃亏损，腠理（皮肤毛孔及肌肉间隙）不紧密，外邪入侵，或者是肝火在内发动，肝血耗损；或者表现为肢体疼痛；或者表现为关节难以伸展；或者表现为突然抽筋样疼痛；或者表现为游走性疼痛无常处；或者表现为内热、午后发热；自汗盗汗；或者月经不调，饮食无味。其治疗方法，属于风邪的，用小续命汤。走注疼痛（疼痛游走不定）的，用漏芦散。骨节疼痛的，用四生丸。湿热痛的，用消燥汤。兼有痰的，佐以二陈汤。肝火的，用加味逍遥散加羌活、川芎。脾郁的，用加味归脾汤加羌活、川芎。血虚的，用四物汤加羌活、川芎。气虚的，用四君子汤加羌活、川芎。气血都虚的，用八珍汤加羌活、川芎。月经先期且疼痛的，以加味逍遥散为主。月经过期且疼痛的，以补中益气汤为主。大抵疼痛而不敢按压的，属于病气和元气都实证；用手按压而疼痛缓解的，属于病气和元气都虚证。如果是劳累后发作疼痛的，是元气虚；饮食不当而发作疼痛的，是脾胃虚；恼怒后发作疼痛的，是肝火；经期发作疼痛的，是血虚。凡此种种都以固护元气为主，辅以治病之药。
医案
一位妇人，自汗盗汗，发热午后加重，身体疲倦，食欲少，月经不调，吐痰很多，已有两年。全身疼痛，阴雨风雨天更加严重。用小续命汤使疼痛停止，用补中益气汤和加味归脾汤两个方剂，三十多剂后痊愈。自汗等症状，都是因郁结损伤脾气，不能输养各脏腑所致。所以使用前两个方剂，专门主治脾胃。如果使用寒凉降火、理气化痰的方法，会再次损伤生气机，大多导致不治。
一位妇人，因为愤怒导致月经量多，发热口渴，左眼紧闭变小，头项动摇，四肢抽搐，全身疼痛。这是愤怒触动肝火，肝血虚而生内风，使用加味逍遥散加钩藤，几剂后各种症状逐渐痊愈，又用八珍汤调理而安定。
一位妇人，历节疼痛，发热口渴，饮食减少不想进食，月经过期，各种药物无效，脉象洪大，重按微细。使用附子八物汤，四剂后疼痛停止，使用加味逍遥散使元气恢复，使用六味丸使月经调顺。
一位妇人，身体肥胖，平时体内有热，月经先期，患痛风，下身轻微肿痛严重，小便频数，身体沉重脉缓，病症属于风湿且血虚有热。先用羌活胜湿汤四剂，肿痛逐渐痊愈。用清燥汤几剂，小便逐渐清澈。用加味逍遥散十余剂，内热逐渐痊愈。因饮食停滞，发热仍痛，面目浮肿，用六君子汤加升麻、柴胡而痊愈。又因怒气导致小腹痞闷，寒热呕吐，这是木气侮犯脾土，用前药加山栀、木香而安定。只有小腹下坠，似有大便感，这是脾气下陷，用补中益气汤而痊愈。后来因劳累和愤怒，出现呕吐痰涎，全身肿痛，月经忽来伴寒热，用六君子汤加柴胡、山栀，以扶助元气、清肝火，肿痛呕吐全部消退。用补中益气汤以提升阳气、健运营气，月经寒热全部治愈。
A woman, whose husband had been away for business for a long time without returning, developed chills and fever (aversion to cold and heat), and her menstruation lasted ten days before stopping. After taking herbs that clear fire and cool blood, she instead developed tidal fever (fever that comes and goes like the tide) and internal heat, spontaneous sweating (sweating during daytime activity), and night sweats (sweating during sleep), with menstruation becoming frequent.
I said: Heat-induced sweating indicates deficiency of Qi and Blood; frequent menstruation indicates deficiency of the Liver and Spleen. She was cured using Guipi Tang (Restore the Spleen Decoction) and Liuwei Wan (Six-Ingredient Pill with Rehmannia).
A released palace maid, over thirty years old, suffered from pain in both hips. The skin color remained unchanged, but there was pain during urination and defecation resembling strangury (painful urinary dysfunction), which was particularly severe when using the toilet. This was caused by stagnant blood infiltrating the "tunnels" (meridians or channels), resulting from a disharmony between male and female Yin-Yang. It was difficult to treat. Later, the area ulcerated and failed to heal, and she subsequently died from Luoli (scrofula/cervical lymphadenitis). This woman was related to the Tang family in my hometown. Mr. Tang was often away for business, showing that this woman harbored long-term depression at home, and upon leaving the palace, her desires were unfulfilled, leading to this illness. Thus, it is evident that scrofula and flowing abscesses are caused by damage to Qi and Blood due to the Seven Emotions (joy, anger, worry, thought, sadness, fear, fright), and aggressive purging methods should obviously not be used. According to the "Chapter on Essence and Blood": "Once a woman's Tian Gui (menstrual essence) has arrived, if more than ten years pass without cohabitation with a man, menstruation will become irregular. If less than ten years have passed, longing for cohabitation with a man will also cause irregular menstruation. Irregular menstruation means old blood does not exit, and new blood flows erroneously; it may ulcerate into the bone, or transform into a swelling. Even if cohabitation occurs, conception may be difficult; excessive cohabitation depletes fluids and weakens the person; bearing many children depletes blood and can be fatal." Observing the state of essence and blood reveals half the truth.
A maiden, seventeen years old, suffered from a persistent genital ulcer. Her Tian Gui had not yet commenced. She presented with tidal fever, cough, and poor appetite with little desire to eat. Someone suggested using Tongjing Wan (Menstruation-Promoting Pill). I said: Cases presenting with tidal fever and irregular menstruation are difficult to treat. Fortunately, her pulse was not choppy (se), and she did not have tidal fever, so it was still treatable. By nourishing Qi and Blood and benefiting body fluids, her menstruation would regulate itself naturally. Confused by the desire for quick effects, she still used the pill. I said: This is not the correct treatment. This is a harsh preparation that greatly assists Yang Fire. Yin Blood will flow recklessly when exposed to it, and the Spleen and Stomach will become increasingly deficient. Indeed, her menstruation started but could not stop, her food intake decreased further, and tidal fever worsened, ultimately leading to death.
Xue Lizhai said: Lijie pain (severe joint pain) may be due to irregular diet and lifestyle, or improper handling of the Seven Emotions and Six Evils (wind, cold, summer-heat, dampness, dryness, fire), leading to Spleen-Stomach deficiency, loose Cou Li (skin pores and interstitial spaces), and invasion by external pathogens. It may also be due to internal movement of Liver Fire and consumption of Liver Blood; manifesting as limb pain, difficulty extending joints, sudden cramping pain, or wandering pain without fixed location; or internal heat, afternoon fever, spontaneous sweating, night sweats, irregular menstruation, and lack of taste in food. For treatment: if due to Wind Evil, use Xiao Xuming Tang (Minor Continue Life Decoction). For wandering pain, use Loulu San (Rhinacanthus Powder). For bone and joint pain, use Sisheng Wan (Four Living Ingredients Pill). For damp-heat pain, use Xiaozao Tang (Dryness-Dispersing Decoction). If accompanied by phlegm, assist with Erchen Tang (Two-Aged Decoction). For Liver Fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Qianghuo (Notopterygii Rhizoma) and Chuanxiong (Chuanxiong Rhizoma). For Spleen Depression, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction) plus Qianghuo and Chuanxiong. For Blood Deficiency, use Siwu Tang (Four Substances Decoction) plus Qianghuo and Chuanxiong. For Qi Deficiency, use Sijunzi Tang (Four Gentlemen Decoction) plus Qianghuo and Chuanxiong. For combined Qi and Blood Deficiency, use Bazhen Tang (Eight Treasures Decoction) plus Qianghuo and Chuanxiong. For early menstruation with pain, Jiawei Xiaoyao San is primary. For delayed menstruation with pain, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is primary. Generally, pain that cannot bear pressure indicates excess of both Pathogenic Qi and Healthy Qi; pain that relieves with pressure indicates deficiency of both. Pain arising from labor indicates Healthy Qi deficiency; pain from dietary indiscretion indicates Spleen-Stomach deficiency; pain from anger indicates Liver Fire; pain during menstruation indicates Blood Deficiency. All these cases prioritize consolidating Healthy Qi, assisted by herbs treating the disease.
Medical Cases
A woman suffered from spontaneous sweating, night sweats, fever worsening in the late afternoon, fatigue, poor appetite, irregular menstruation, and copious sputum for two years. Her whole body ached, worsening on cloudy, rainy, or windy days. Using Xiao Xuming Tang stopped the pain. Using Buzhong Yiqi Tang and Jiawei Guipi Tang for over thirty doses led to recovery. Symptoms such as spontaneous sweating are caused by depression damaging Spleen Qi, preventing it from distributing nourishment to the Zang-Fu organs. Therefore, the aforementioned two decoctions were used, focusing specifically on the Spleen and Stomach. Using cold-cooling herbs to clear fire, or Qi-regulating and phlegm-resolving methods would further damage the generating Qi, often leading to untreatable conditions.
A woman, due to anger, experienced heavy menstruation, fever, thirst, a tightly closed and small left eye, head and neck tremors, limb convulsions, and whole-body pain. This was anger stirring Liver Fire, with Liver Blood deficiency generating internal Wind. Using Jiawei Xiaoyao San plus Gouteng (Uncariae Ramulus cum Uncis) resolved the symptoms gradually over several doses. She was then stabilized using Bazhen Tang for regulation.
A woman suffered from Lijie pain, fever, thirst, poor appetite, and delayed menstruation. Various medicines were ineffective. Her pulse was surging (Hong) but fine (Xi) upon deep pressure. Using Fuzi Bawu Tang (Aconite Eight-Substance Decoction) for four doses stopped the pain. Jiawei Xiaoyao Tang restored Healthy Qi, and Liuwei Wan regulated menstruation.
A woman, obese and prone to internal heat, had early menstruation and gout. She suffered from significant swelling and pain in the lower body, frequent urination, heaviness of the body, and a slow pulse. The condition belonged to Wind-Dampness with Blood Deficiency and Heat. First, using Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness) for four doses gradually relieved swelling and pain. Using Qingzao Tang (Clear Dryness Decoction) for several doses cleared the urine. Using Jiawei Xiaoyao San for over ten doses gradually resolved internal heat. Due to food stagnation, fever and pain persisted, along with facial and ocular edema. Using Liujunzi Tang (Six Gentlemen Decoction) plus Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) led to recovery. Anger later caused abdominal distension, chills, fever, and vomiting, indicating Wood insulting Earth (Liver attacking Spleen). Using the previous prescription plus Zhizi (Gardeniae Fructus) and Muxiang (Aucklandiae Radix) brought stability. Only a sensation of descending in the lower abdomen, resembling the urge to defecate, indicated Spleen Qi sinking, which was cured with Buzhong Yiqi Tang. Later, due to labor and anger, she experienced vomiting of phlegm, whole-body swelling and pain, and sudden onset of menstruation with chills and fever. Using Liujunzi Tang plus Chaihu and Zhizi supported Healthy Qi and cleared Liver Fire, resolving swelling, pain, and vomiting. Using Buzhong Yiqi Tang lifted Yang Qi and strengthened Ying Qi, completely curing the menstrual chills and fever.