夫经水阴血也，属冲任二脉主，上为乳汁，下为月水，其为患有因脾虚而不能生血者；有因
脾郁伤而血耗损者；有因胃火而血消烁者；有因脾胃损而血少者；有因劳伤心而血少者；有
因怒伤肝而血少者；有因肾水不能生肝而血少者；有因肺气虚不能行血而闭者。治疗之法，
若脾虚而不行者，调而补之；脾郁而不行者，解而补之；胃火而不行者，清而补之；脾胃损
而不行者，调而补之；劳伤心血而不行者，静而补之；怒伤肝而不行者，和而补之；肺气虚
而不行者，补脾胃；肾虚而不行者，补脾肺。经云∶损其肺者益其气，损其心者调其荣卫，
损其脾者调其饮食，适其寒温，损其肝者缓其中，损其肾者益其精。审而治之，庶无误矣。
治验
一妇人停食，饱闷发热，或用人参养胃汤益甚，再用木香槟榔丸，泄泻吐痰，腹中成块，饮
食少思，又用二陈、黄连、浓朴之类，前症益甚，腹胀不食，月经不至。余以为中气亏损，
用补中益气加茯苓、半夏，三十余剂，脾胃健而诸症愈，又二十余剂，而经自行。前症若脾
虚不能消化饮食者，宜用六君子汤，补而消之；虚寒者，加砂仁、木香、炮姜，温而补之；
其食积成形者，以前药煎送保和丸。大抵食积痞块，症为有形，所谓邪气胜则实，真气夺则
虚，惟当养正辟邪，而积自除矣。虽然坚者削之，客者除之，胃气未虚，或可少用，若病久
虚乏者，则不宜用。
一妇人饮食后，或腹胀，或吞酸，服枳术丸，吞酸益甚，饮食日少，胸膈痞满，腿内酸痛，
畏见风寒，又服养胃汤一剂，腿内作痛，又二剂，腿浮肿，月经不行，余以为郁结所伤，脾
虚湿热下注，侵晨用四君、芎、归、二陈，午后以前汤送越鞠丸，饮食渐进，诸症渐愈。又
用归脾、八珍二汤，兼服两月余而经行。
一妇人性沉多虑，月经不行，胸满少食，或作胀，或吞酸，余以为中气虚寒，用补中益气加
砂仁、香附、煨姜二剂，胸膈和而饮食进，更以六君加芎、归、贝母、桔梗、生姜、大枣数
剂，脾胃健而经自调矣。
一妇人素有胃火，服清胃散而安。后因劳役，躁渴内热，肌肉消瘦，月经不行，此胃火消烁
阴血，用逍遥散加丹皮、炒栀，以清胃热；用八珍汤加茯苓、远志，以养脾血，而经自行矣。
一妇人久患疟，形体怯弱，内热晡热，自汗盗汗，饮食少思，月事不行，服通经丸，虚症悉
具，此因虚而致疟疾，因疟而致经闭，用补中益气及六味地黄丸，各百余剂，疟愈经自行。
一妇人久患疟，疟作则经不行，形虚脉大，头痛懒食，大便泄泻，小便淋漓，口干唇裂，内
热腹膨，皆元气下陷，相火合病，用补中益气汤治之寻愈。惟不时头痛，乃加蔓荆子而痛止
，又兼用六味地黄丸而经行。
一妇人因劳，耳鸣头痛体倦，此元气不足，用补中益气加麦门、五味而痊。三年后得子，因
饮食劳倦，前症益甚，月经不行，晡热内热，自汗盗汗，用六味地黄丸、补中益气汤顿愈。
前症若因血虚有火，用四物加山栀、柴胡；不应，八珍加前药。若气虚弱，用四君子。若怒
耳便聋或鸣者，实也，小柴胡加芎、归、山栀；虚用补中益气加山栀。若午前甚作火治，用
小柴胡加炒连、炒栀，气虚用补中益气。午后甚作血虚，用四物加白术、茯苓。若阴虚火动
，或兼痰甚作渴，必用地黄丸以壮水之主。经云∶头痛耳鸣，九窍不利，肠胃之所生也，脾
胃一虚，耳目九窍皆为之病。
一妇人胃气素弱，为哭母吐血咳嗽，发热盗汗，经水三月不行，余以为悲则伤肺，思则伤脾
，遂朝服补中益气加桔梗、贝母、知母，夕用归脾汤送地黄丸而愈。
月经属于阴血，由冲脉和任脉（主管生殖与气血的经脉）所主导，上行化为乳汁，下行成为月经。其发病原因有：因脾气虚弱而不能化生血液者；因脾脏气机郁结受损而导致血液耗损者；因胃中有火而消烁血液者；因脾胃损伤而导致血液减少者；因劳累过度伤心血而导致血液减少者；因愤怒伤肝而导致血液减少者；因肾水不足不能滋养肝脏而导致血液减少者；因肺气虚弱不能推动血液运行而导致经闭者。治疗原则是：若是脾气虚弱导致经闭不行的，应调理并补益脾气；若是脾脏气机郁结导致经闭不行的，应疏解郁结并补益脾气；若是胃火导致经闭不行的，应清泻胃火并补益脾胃；若是脾胃损伤导致经闭不行的，应调理并补益脾胃；若是劳累伤心血导致经闭不行的，应静养并补益心血；若是愤怒伤肝导致经闭不行的，应调和肝气并补益肝血；若是肺气虚弱导致经闭不行的，应补益脾胃；若是肾气虚弱导致经闭不行的，应补益脾肺。《内经》说：损伤肺脏的，要补益其气；损伤心脏的，要调和营卫（营气与卫气）；损伤脾脏的，要调节饮食，适应寒温变化；损伤肝脏的，要舒缓其情志；损伤肾脏的，要填补其精血。仔细审察病情后进行治疗，就不会出现错误了。
治验案例：
有一位妇人停食（食物停滞不消化），饱胀闷痛且发热，有人用人参养胃汤（一种益气养胃的方剂）治疗反而加重，又用木香槟榔丸（一种行气导滞的方剂），导致腹泻、吐痰，腹中出现肿块，饮食减少且食欲不振，又用二陈汤（燥湿化痰的基础方）、黄连、厚朴等药物，前面的症状更加严重，出现腹胀、不能进食，月经停止来潮。我认为这是中气（脾胃之气）亏损所致，使用补中益气汤（补中益气、升阳举陷的代表方）加茯苓、半夏，服用三十多剂后，脾胃功能恢复，各种症状痊愈；再服用二十多剂，月经自然来潮。前述症状如果是因脾虚不能消化饮食引起的，适宜用六君子汤（健脾益气、燥湿化痰）治疗，以补益兼消导；若是虚寒证，加入砂仁、木香、炮姜，以温中兼补益；若是食积形成有形之块，用上述药液煎服送服保和丸（消食导滞的方剂）。大抵食积痞块，病症表现为有形之物，所谓邪气盛则实证，真气夺则虚证，只应当养护正气、驱除邪气，积滞自然就会消除。虽然《内经》说坚硬的病邪要用削法，外来的病邪要用除法，若胃气尚未虚弱，或许可以少量使用攻伐之法，但若病程长久、身体虚乏者，则不宜使用。
有一位妇人饭后出现腹胀，或吞酸（反酸），服用枳术丸（健脾消痞的方剂）后，吞酸症状反而加重，饮食日渐减少，胸膈部痞塞满闷，大腿内侧酸痛，害怕见到风寒，又服用一剂养胃汤，大腿内侧开始疼痛，再服两剂，大腿浮肿，月经不行。我认为这是情志郁结所伤，导致脾虚湿热下注。清晨服用四君子汤（补气基础方）加川芎、当归、二陈汤，午后用前方送服越鞠丸（行气解郁的方剂），饮食逐渐增加，各种症状逐渐痊愈。后又用归脾汤（益气补血、健脾养心）和八珍汤（气血双补方）交替服用两个多月，月经来潮。
一位妇人性格沉静多思虑，月经不行，胸部胀满、食欲少，有时感觉胀气，有时吞酸。我认为这是中气虚寒，使用补中益气汤加砂仁、香附、煨姜，服用两剂后，胸膈舒畅，饮食增进；再用六君子汤加川芎、当归、贝母、桔梗、生姜、大枣，服用数剂后，脾胃健运，月经自然调顺。
一位妇人素有胃火，服用清胃散（清胃凉血方）后病情安定。后来因劳累过度，出现烦躁口渴、体内发热、肌肉消瘦，月经不行。这是胃火消烁阴血所致，使用逍遥散（疏肝健脾养血方）加牡丹皮、炒栀子，以清泻胃热；使用八珍汤加茯苓、远志，以滋养脾血，从而月经自行来潮。
一位妇人长期患有疟疾，形体怯弱，内有低热及傍晚发热，自汗（白天不因劳动而出汗）盗汗（夜间睡着出汗），饮食减少且食欲不振，月经不行。服用通经丸（活血通经方）后，虚证表现全部显现。这是因为因虚而患疟疾，因疟疾而导致经闭。使用补中益气汤及六味地黄丸（滋阴补肾方），各服用一百多剂，疟疾痊愈，月经自然来潮。
一位妇人长期患有疟疾，发作时月经不行，形体虚弱，脉象大，头痛，懒于进食，大便泄泻，小便淋漓不尽，口干唇裂，体内发热腹部膨隆。这都是元气下陷，相火（寄居于肝肾之火）合病所致，使用补中益气汤治疗很快痊愈。只是不时头痛，于是加入蔓荆子（疏散风热的药材）而头痛停止，又兼用六味地黄丸，月经来潮。
一位妇人因劳累出现耳鸣、头痛、身体疲倦，这是元气不足，使用补中益气汤加麦门冬、五味子而痊愈。三年后生育子女，因饮食不节和劳累，前面症状加重，月经不行，傍晚发热、体内发热，自汗盗汗，使用六味地黄丸、补中益气汤顿然痊愈。前述症状如果是因血虚有火引起的，用四物汤（补血调血基础方）加山栀、柴胡；若无效果，用八珍汤加前药。若是气虚弱，用四君子汤。若是因怒导致耳窍闭塞或鸣响的，属实证，用小柴胡汤（和解少阳方）加川芎、当归、山栀；虚证用补中益气汤加山栀。若是午前症状重，按火证治疗，用小柴胡汤加炒黄连、炒栀子，气虚用补中益气汤。若是午后症状重，按血虚治疗，用四物汤加白术、茯苓。若是阴虚火动，或兼痰多引起口渴，必须用地黄丸以壮水之主（滋补肾阴以制约阳气）。《内经》说：头痛耳鸣，九窍（眼、耳、鼻、口等九个孔窍）不利，是由肠胃问题产生的。脾胃一旦虚弱，耳目及九窍都会发生病变。
一位妇人胃气素来虚弱，因哭丧母亲导致吐血、咳嗽，发热盗汗，月经三个月不行。我认为悲伤损伤肺脏，思虑损伤脾脏，于是早晨服用补中益气汤加桔梗、贝母、知母，晚上用归脾汤送服地黄丸而痊愈。
Menstrual blood is Yin blood, governed by the Chong (Penetrating) and Ren (Conception) vessels. It transforms upward into milk and flows downward as menstrual water. The causes of its disorders include: deficiency of Spleen Qi failing to generate blood; damage to the Spleen due to Qi stagnation leading to blood consumption; Stomach Fire consuming and burning blood; damage to the Spleen and Stomach resulting in reduced blood; excessive labor injuring Heart Blood leading to reduction; anger injuring the Liver resulting in reduced blood; Kidney Water failing to nourish the Liver causing blood deficiency; and deficiency of Lung Qi failing to move blood, leading to amenorrhea. The treatment principles are as follows: for amenorrhea due to Spleen deficiency, regulate and tonify the Spleen; for amenorrhea due to Spleen stagnation, resolve stagnation and tonify the Spleen; for amenorrhea due to Stomach Fire, clear the Fire and tonify the Spleen/Stomach; for amenorrhea due to Spleen-Stomach damage, regulate and tonify them; for amenorrhea due to labor injuring Heart Blood, rest and tonify the Heart Blood; for amenorrhea due to anger injuring the Liver, harmonize the Liver and tonify Liver Blood; for amenorrhea due to Lung Qi deficiency, tonify the Spleen and Stomach; for amenorrhea due to Kidney deficiency, tonify the Spleen and Lungs. As stated in the classics: For lung injury, benefit its Qi; for heart injury, regulate Ying (Nutritive) and Wei (Defensive) Qi; for spleen injury, regulate diet and adapt to cold and warmth; for liver injury, soothe its interior; for kidney injury, benefit its Essence. Carefully examine and treat accordingly, and errors will be avoided.
Clinical Cases:
A woman suffered from food stagnation, presenting with fullness, oppression, fever, and heat. Treatment with Renshen Yangwei Tang (Ginseng Decoction for Nourishing the Stomach) exacerbated her condition. Subsequent use of Muxiang Binglang Wan (Pinellia and Areca Nut Pill) led to diarrhea and expectoration of phlegm, formation of abdominal masses, decreased appetite, and loss of desire for food. Further administration of Erchen Tang (Two-Cured Decoction), Huanglian (Coptis Rhizome), and Houpo (Magnolia Bark) worsened previous symptoms, resulting in abdominal distension, anorexia, and cessation of menstruation. I diagnosed this as deficiency of Middle Qi (Spleen and Stomach Qi). I prescribed Buzhong Yiqi Tang (Decoction to Supplement the Middle and Enrich the Qi) with added Fuling (Poria) and Banxia (Pinellia Tuber). After more than thirty doses, Spleen and Stomach function recovered, and all symptoms resolved. After another twenty-plus doses, menstruation resumed spontaneously. If previous symptoms were due to Spleen deficiency failing to digest food, Liujunzi Tang (Six-Gentlemen Decoction) should be used to tonify while resolving stagnation; if deficient-cold, add Sharen (Amomum Fruit), Muxiang (Aucklandia Root), and Paojiang (Prepared Ginger) to warm and tonify; if food stagnation has formed solid masses, administer Baohe Wan (Preserve Harmony Pill) with decoction. Generally, food stagnation and痞 (masses) present as tangible pathogens. "Excess pathogen leads to excess syndrome; depletion of true Qi leads to deficiency syndrome." One must nurture righteousness (healthy Qi) and repel evil (pathogens), so that accumulations will naturally dissipate. Although classics state that hard masses should be削 (reduced) and invading pathogens should be removed, if Stomach Qi is not yet weak, slight use of such methods may be acceptable. However, for chronic diseases with deficiency and exhaustion, such methods are contraindicated.
A woman experienced abdominal distension after eating or acid regurgitation. After taking Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill), acid regurgitation worsened, food intake decreased daily, chest and diaphragm felt obstructed and full, inner thighs ached, and she feared wind and cold. Taking one dose of Yangwei Tang caused pain in the inner thighs; two more doses resulted in edema of the legs and amenorrhea. I diagnosed this as injury from emotional stagnation, with Spleen deficiency leading to damp-heat sinking downward. In the morning, she took Sijunzi Tang (Four-Gentlemen Decoction) with Xiong (Ligusticum Rhizome), Gui (Angelica Sinensis Root), and Erchen Tang. In the afternoon, she took Yueju Wan (Regulate Emotions Pill) with the aforementioned decoction. Food intake gradually increased, and symptoms improved. She then alternated between Guipi Tang (Restore the Spleen Decoction) and Bazhen Tang (Eight-Treasure Decoction) for over two months, after which menstruation resumed.
A woman was quiet and prone to overthinking, suffering from amenorrhea, chest fullness, poor appetite, occasional distension, and acid regurgitation. I diagnosed this as deficiency-cold of Middle Qi. I prescribed Buzhong Yiqi Tang with Sharen, Xiangfu (Cyperus Rhizome), and Wei Jiang (Roasted Ginger). After two doses, the chest and diaphragm felt harmonious, and appetite improved. Subsequently, Liujunzi Tang with Xiong, Gui, Mumie (Fritillaria Bulb), Jiegeng (Platycodon Root), Shengjiang (Fresh Ginger), and Dazao (Jujube) was administered for several doses. With the strengthening of Spleen and Stomach, menstruation regulated itself.
A woman had a history of Stomach Fire, which was controlled by Qingwei San (Powder to Clear the Stomach). Later, due to overwork, she developed irritability, thirst, internal heat, emaciation, and amenorrhea. This was due to Stomach Fire consuming Yin blood. I used Xiaoyao San (Free and Easy Wanderer Powder) with Mudanpi (Moutan Cortex) and Chao Zhi (Stir-fried Gardenia) to clear Stomach heat; and Bazhen Tang with Fuling and Yuanzhi (Polygala Root) to nourish Spleen blood, leading to spontaneous menstruation.
A woman suffered from malaria for a long time, presenting with frailty, internal heat, afternoon tidal fever, spontaneous sweating, night sweats, poor appetite, and amenorrhea. Administration of Tongjing Wan (Menstruation-Promoting Pill) revealed all deficiency symptoms. This was malaria caused by deficiency, which in turn caused amenorrhea. I prescribed Buzhong Yiqi Tang and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), each for over a hundred doses. The malaria cured, and menstruation resumed spontaneously.
Another woman suffered from chronic malaria; menstruation ceased during attacks. She presented with physical weakness, large pulse, headache, anorexia, diarrhea, dribbling urination, dry mouth, cracked lips, internal heat, and abdominal distension. These were all signs of sinking of Yuan Qi (Original Qi) and combined disease of Xiang Huo (Ministerial Fire). I treated her with Buzhong Yiqi Tang, and she recovered quickly. For intermittent headaches, I added Manjingzi (Vitex Fruit), which stopped the pain. Combined with Liuwei Dihuang Wan, menstruation resumed.
A woman suffered from tinnitus, headache, and fatigue due to labor. This was insufficient Yuan Qi. I prescribed Buzhong Yiqi Tang with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry), and she recovered. Three years later, after childbirth, due to dietary irregularities and fatigue, previous symptoms worsened, accompanied by amenorrhea, afternoon/internal heat, and spontaneous/night sweats. Liuwei Dihuang Wan and Buzhong Yiqi Tang brought about immediate recovery. If previous symptoms were due to blood deficiency with fire, Siwu Tang (Four-Substance Decoction) with Zhizi (Gardenia) and Chaihu (Bupleurum Root) should be used; if ineffective, add these herbs to Bazhen Tang. If Qi is weak, use Sijunzi Tang. If tinnitus or deafness is caused by anger, it is an excess syndrome; use Xiao Chaihu Tang (Minor Bupleurum Decoction) with Xiong, Gui, and Zhizi; for deficiency, use Buzhong Yiqi Tang with Zhizi. If symptoms are worse in the morning, treat as fire: Xiao Chaihu Tang with Chao Lian (Stir-fried Coptis) and Chao Zhi; for Qi deficiency, use Buzhong Yiqi Tang. If symptoms are worse in the afternoon, treat as blood deficiency: Siwu Tang with Baizhu (Atractylodes Macrocephala Rhizome) and Fuling. If Yin deficiency with fire hyperactivity, or excessive phlegm causing thirst, Dihuang Wan (Rehmannia Pill) must be used to strengthen the source of Water (Kidney Yin). The classics state: Headache and tinnitus, with dysfunction of the nine orifices, originate from the intestines and stomach. Once Spleen and Stomach are weak, the ears, eyes, and nine orifices all suffer.
A woman with inherently weak Stomach Qi suffered from hematemesis, coughing, fever, and night sweats due to grieving for her mother. Menstruation had ceased for three months. I diagnosed this as grief injuring the Lungs and worry injuring the Spleen. In the morning, she took Buzhong Yiqi Tang with Jiegeng, Beimu (Fritillaria Cirrhosa Bulb), and Zhimu (Anemarrhena Rhizome); in the evening, she took Guipi Tang with Dihuang Wan (Rehmannia Pill), and she recovered.