【歌】临病疼痛有多般，不识根源治便难，未至先疼因实积，去空觉痛是虚寒，复庵治血先调气，产宝临经
莫嗜酸，气滞风寒
兼血涩，更参脉证下汤丸。
【论】经水者，行血气，通阴阳，以荣于身者也。若外亏卫气充养，内乏荣血灌溉，而被风寒劳役，经候
欲行先身痛也。其或风冷客于胞中，而动冲任之脉，故腹痛也。
【脉】沉紧细动皆主腹痛，阳弦头痛，阴弦腹痛，肝脉若弦月水不利，腰腹疼痛，月水不通，绕脐寒疝痛。
其脉沉紧，此由血积不散，为气所冲，新血与故血相搏故痛。
腹痛
腹痛虽云冲任伤，须分气血与阴阳，风寒湿热参虚实，看脉推源用古方。
风冷∶经来冲任伤风冷，腹内绵绵痛不停，足冷脉迟频欲呕，桂枝桃核及温经。
温经汤。
寒湿∶经水如同豆汁形，腹中 痛不安宁，胫浮两尺皆沉细，四物汤煎合五苓。
血涩∶临经先有腹中疼，血涩因而即不行，渐渐痛来移趋下，调荣顺气可和平。
八物汤。
气滞∶气滞胞门经不通，腹中疼痛往来攻，脉沉走注牵腰胁，抑气延胡大有功。
食积∶妇女炎天临月经，误伤生冷忽然停，后来欲至先疼痛，琥珀延胡及胡苓。
小琥珀散。
虚痛∶经来腰腹痛悠悠，过后缘何反不休，脉弱痛绵手可按，必然血少是根由。
八珍汤加延胡、香附、炮姜。
实痛∶痛阵攻冲血不行，按之破满手难迎，便知里实宣通好，气血流行痛自平。
瓦垄子丸 玉烛散。
头痛
临经头痛着风寒，莫作寻常一样看，发表必须兼养血，一七五积自能安。
身痛
临经身痛如何断，或冒风邪气血虚，调卫祛风兼补血，古方趁痛饮堪除。
腰痛
经病如何腰亦疼，只因两肾系胞门，内经具载今拈出，化育根基在一元。
琥珀散。
失血心痛
失血心疼人罕知，只因血统在心脾，去多治本归脾好，治标先将补血脾。
【歌诀】经行疼痛的原因有多种，如果不辨明根源，治疗就难以奏效。月经未至而先出现疼痛，多因实证积滞；经期过后才感到疼痛，多属虚寒证。复庵主张治疗血病应先调理气机，《产宝》指出经期不要嗜食酸味食物。若是气机阻滞、风寒侵袭兼有血行涩滞，还需参考脉象和症状来选用汤剂或丸药。
【论述】经血的作用是运行气血，沟通阴阳，以滋养全身。如果体表卫气亏虚，不能得到充养，体内营血匮乏，无法灌溉濡润，再受到风寒侵袭或劳累过度，就会导致月经欲行时身体先出现疼痛。或者风冷之邪客居于胞宫（子宫），扰动冲脉和任脉，从而引起腹痛。
【脉诊】脉象沉、紧、细、动都主腹痛；阳脉弦主头痛，阴脉弦主腹痛；肝脉若见弦象，且伴有月水不利，则会出现腰腹疼痛、月经不通、绕脐部的寒疝痛。如果脉象沉紧，这是由于血积不散，被气机冲逆所致，新血与旧血相互搏结所以产生疼痛。
【腹痛】腹痛虽然说是冲任二脉受损，但必须分辨是气病还是血病，是阴证还是阳证，结合风寒湿热等病因以及虚实情况，通过诊察脉象推究病因，使用古方治疗。
风冷型：月经来时冲任二脉受风冷侵袭，腹内绵绵作痛不止，足部发冷，脉象迟缓，频繁想呕吐，可用桂枝汤、桃核承气汤及温经汤治疗。
温经汤。
寒湿型：经血形态如同豆汁，腹中疼痛不安宁，两尺脉浮取无力、沉取皆沉细，可用四物汤煎煮后合用五苓散。
血涩型：经期前已有腹部疼痛，因血行涩滞导致月经随即不行，疼痛逐渐加剧并向下转移，可通过调和营血、顺气的方法使病情平和。
八物汤。
气滞型：气机阻滞于胞门，导致月经不通，腹中疼痛往来攻冲，脉象沉，疼痛牵引腰胁，使用抑气延胡方大有功效。
食积型：妇女在炎夏时节正值月经期，误食生冷食物导致经血突然停止，后来欲行经前先出现疼痛，可用琥珀延胡及胡苓（此处指代含琥珀、延胡索等成分的方剂，原文为“小琥珀散”）。
小琥珀散。
虚痛型：经期腰腹部隐隐作痛，为何经期过后反而不停止？脉象虚弱，疼痛绵绵且喜按，必然原因是血少。
八珍汤加延胡索、香附、炮姜。
实痛型：疼痛阵发性攻冲，血液运行不畅，按压腹部感觉胀满坚硬，手难以迎触（拒按），可知是里实证，宜用宣通之法，气血流通后疼痛自然平息。
瓦垄子丸、玉烛散。
【头痛】经期头痛多因感受风寒，不可当作普通疾病看待，解表时必须兼顾养血，经过一个周期（一七）后积滞自能消除安宁。
【身痛】经期身体疼痛如何判断？或是冒犯风邪，或是气血虚弱，调和卫气、祛风兼补血，古方趁痛饮可以去除病痛。
[Verse] There are various causes for pain during menstruation; if the root cause is not identified, treatment will be difficult. Pain occurring before the onset of menses is due to excess accumulation, while pain felt after the flow has ceased indicates deficiency-cold. Fu An advocated regulating Qi first when treating blood disorders. The *Chanbao* (Treasured Book for Childbirth) advises against consuming sour foods during menstruation. In cases of Qi stagnation, wind-cold invasion, and concurrent blood stasis, one must refer to the pulse and symptoms to prescribe decoctions or pills.
[Dissertation] Menstrual blood functions to circulate Qi and Blood, connect Yin and Yang, and nourish the body. If external Wei Qi (Defensive Qi) is deficient and fails to provide nourishment, and internal Ying Blood (Nutritive Blood) is lacking to irrigate and moisten, combined with exposure to wind-cold or overexertion, pain in the body may occur before the menstrual flow begins. Alternatively, if wind-cold pathogens lodge in the Bao Gong (Uterus), disturbing the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel), abdominal pain ensues.
[Pulse Diagnosis] Pulse characteristics such as Chen (Deep), Jin (Tight), Xi (Fine), and Dong (Agitated) all indicate abdominal pain. A Xian (Wiry) pulse on the Yang position indicates headache, while a Xian pulse on the Yin position indicates abdominal pain. If the Liver pulse is Xian and accompanied by irregular menstruation, it manifests as lower back and abdominal pain, amenorrhea, and cold hernia pain around the umbilicus. A Chen-Jin pulse suggests that stagnant blood is not dispersing and is being rushed by Qi; the struggle between new blood and old blood causes pain.
[Abdominal Pain] Although abdominal pain is attributed to injury of the Chong and Ren vessels, one must distinguish between Qi and Blood disorders, and Yin and Yang patterns. Consider factors such as wind, cold, dampness, and heat, as well as excess and deficiency. Investigate the source through pulse diagnosis and apply ancient formulas.
Wind-Cold Type: When wind-cold invades the Chong and Ren vessels during menstruation, there is continuous, lingering abdominal pain, cold feet, a slow pulse, and frequent nausea. Treat with Guizhi Tang (Cinnamon Twig Decoction), Taohe Chengqi Tang (Peach Kernel and Salvia Decoction), or Wenjing Tang (Warming the Menses Decoction).
Wenjing Tang.
Cold-Damp Type: The menstrual blood resembles bean curd dregs, with restless abdominal pain. The Chi positions of both wrists are floating but weak upon light pressure and deep and fine upon heavy pressure. Use Siwu Tang (Four Substances Decoction) decocted and combined with Wuling San (Five-Ingredient Powder with Poria).
Blood Stasis/Obstruction Type: Abdominal pain occurs prior to menstruation, and the flow stops immediately due to sluggish blood circulation. The pain gradually intensifies and moves downward. Harmonize Ying Blood and regulate Qi to restore balance.
Bawu Tang (Eight Substances Decoction).
Qi Stagnation Type: Qi stagnates at the Bao Men (Gate of the Uterus), obstructing menstruation. Abdominal pain comes and goes, attacking inward. The pulse is Chen, and pain radiates to the waist and hypochondrium. The Yiqi Yanhu Formula is highly effective.
Food Retention Type: During summer menstruation, accidental consumption of raw/cold foods causes sudden cessation of menses. Later, pain precedes the return of the flow. Use Xiaohupo San (Small Amber Powder).
Deficiency Pain Type: Dull pain in the lower back and abdomen persists even after menstruation ends. The pulse is weak, the pain is lingering and relieved by pressure. The root cause is definitely Blood deficiency.
Shenzhen Tang (Eight Treasures Decoction) extended with Yanhu Suo (Corydalis Rhizome), Xiangfu (Cyperi Rhizoma), and Paojiang (Prepared Ginger).
Excess Pain Type: Paroxysmal attacking pain prevents blood flow. The abdomen feels full and hard upon pressure and resists touch (rebound tenderness). This indicates interior excess; promote unblocking and circulation. Once Qi and Blood flow freely, pain subsides naturally.
Walongzi Wan (Arca Shell Pill) and Yuzhu San (Jade Candle Powder).
[Headache] Headache during menstruation is often caused by wind-cold contraction. Do not treat it as an ordinary condition. Expelling the exterior pathogen must be combined with nourishing Blood. After one cycle (seven days), the accumulation will resolve naturally.
[Body Pain] How to diagnose body pain during menstruation? It may be due to wind-pathogen invasion or Qi-Blood deficiency. Harmonize Wei Qi, dispel wind, and tonify Blood. The ancient formula Chentong Yin (Seizing Pain Decoction) can eliminate these symptoms.
[Lower Back Pain] Why does the lower back hurt during menstrual disorders? Because the two Kidneys are connected to the Bao Men. This is recorded in the *Neijing* (Inner Canon) and is highlighted here, emphasizing that the foundation of reproduction lies in the Yuan Qi (Primary Qi).
Hupo San (Amber Powder).
[Heart Pain due to Blood Loss] Heart pain resulting from blood loss is rarely understood. This is because blood originates from the Heart and Spleen. For excessive blood loss, treat the root with Guipi Tang (Restore the Spleen Decoction); to treat the branch, first tonify the Heart and Spleen blood.