汪石山曰∶妇人属阴,以血为本。但人肖天地,阴常不足,妇人加乳哺月经之耗,是以妇人血病者多。夫
月经者,津液血脉所成。苟荣卫和,经候自然应期。如月之盈亏,不失常度,故曰月经。苟气血一忤,则或先或
后,多寡不匀,或闭绝不行而百病生,必须分因而治。如真水亏败,阳火内炽,血海枯竭,经绝不通者,宜补
养阴血,则经自行。如寒客胞门,子户凝泣,血不通,为 瘕之候者,宜散寒逐瘀,则经自行。但血乃气之配,
其升降寒热虚实,一从乎气。是以气热则血
热而色紫,气寒则血寒而色凝,气升而血逆而上出,气陷则血随而下崩。此调经莫先于养血,养血莫先于调气也。
方约之曰∶妇人以血用事,气行则无病。故古人治妇人病,多用香附、砂仁、木香、青皮、枳壳者,行气故
也。凡妇人病,多是气血郁结,故治以开郁行气为主。郁开气行,而月候自调,诸病自瘥矣。
叶以潜曰∶女子经候不调,多主耗气益血之说。但血为气配,气热则热,气寒则寒,气升则升,气降则降,
气行则行,气滞则滞。如果郁火气盛于血,而致经不调者,方可单用香附丸、抑气散加木香、槟榔,以开郁行
气。若气乱则调,气冷则温,气虚则补,男女一般。阳生则阴长,气衰则血亦弱,岂可专耗其气。但其间有夫
妇不和,婢外家志不得伸,常有郁气而致经水不调,又当审顺逆以治之而已。
汪石山说:妇人属阴,以血为根本。但人效法天地,阴气常显不足,妇人又加上哺乳和月经的消耗,所以患血病的妇人很多。所谓月经,是由津液和血脉化生而成的。如果营卫调和,月经自然会按时来潮,像月亮的盈亏一样,不违背常规法度,所以称为“月经”。如果气血稍有逆乱,就会导致月经或提前或推后,经量或多或少的不均,或者闭经不通从而引发各种疾病,必须分辨病因进行治疗。如果是真阴亏损败坏,阳火在内炽盛,导致血海枯竭,经血闭绝不通的,应当补养阴血,那么月经自然能通行。如果是寒邪客居胞门,子宫凝滞涩痛,血液不通,出现瘕积征候的,应当散寒逐瘀,那么月经自然能通行。但是血是气的配偶,血的升降、寒热、虚实,完全取决于气。所以气热则血热而颜色紫暗,气寒则血寒而颜色凝滞,气升则血逆而上行出血,气陷则血随之下陷崩漏。因此,调理月经没有比养血更重要的,而养血没有比调气更优先的。
方约之说:妇人以血为主要功能物质,气机运行通畅就没有疾病。所以古人治疗妇人病,多用香附、砂仁、木香、青皮、枳壳这些药物,是因为它们能行气的原因。大凡妇人病,多是气血郁结所致,所以治疗以开郁行气为主。郁结解开,气机运行,那么月经自然调和,各种疾病自然痊愈了。
叶以潜说:女子月经不调,多主张耗气益血的说法。但血是气的配偶,气热则血热,气寒则血寒,气升则血升,气降则血降,气行则血行,气滞则血滞。如果是郁火之气盛于血分,而导致月经不调的,才可以单独使用香附丸、抑气散加木香、槟榔,来开郁行气。如果气乱则调理气机,气冷则温煦,气虚则补益,男女都是一样的道理。阳气生长则阴血随之增长,气衰则血也虚弱,怎么能专门耗损其气呢?只是其中有的因为夫妻不和,婢女或外家志向不得伸展,常有郁气而导致经水不调,这又应当审察顺逆情况来治疗罢了。
Wang Shishan stated: Women belong to Yin and take blood as their root. However, humans emulate Heaven and Earth, where Yin is often insufficient; women additionally suffer consumption from nursing and menstruation, thus many women suffer from blood diseases. Menstrual blood (Jingyue) is formed from body fluids (Jinye) and blood vessels. If Ying and Wei (Nutritive and Defensive Qi) are harmonious, menstruation will naturally occur on schedule, like the waxing and waning of the moon, without deviating from its regular measure, hence it is called "Menstrual Blood." If Qi and Blood encounter even slight disorder, menstruation may come early or late, with unequal volume, or become amenorrheic (Bi Jue), giving rise to various diseases; one must differentiate the cause and treat accordingly. In cases of depletion of True Water (Zhen Shui, referring to Kidney Yin) with internal blazing of Yang Fire, leading to exhaustion of the Sea of Blood (Xue Hai) and cessation of menstruation, one should tonify and nourish Yin Blood, so that menstruation will flow naturally. In cases where Cold pathogens lodge in the uterine gate (Bao Men), causing coagulation and stasis in the uterus (Zi Hu), resulting in blood obstruction and signs of mass formations (Jia), one should disperse Cold and expel Stasis, so that menstruation will flow naturally. However, Blood is the companion of Qi; its ascending/descending, cold/heat, deficiency/excess all follow Qi. Thus, if Qi is hot, Blood becomes hot and dark purple; if Qi is cold, Blood becomes cold and congealed; if Qi ascends, Blood rebels and flows upward (hemorrhage); if Qi sinks, Blood follows and collapses downward (metrorrhagia). Therefore, regulating menstruation prioritizes nourishing Blood, and nourishing Blood prioritizes regulating Qi.
Fang Yuezhi stated: Women function primarily through Blood; when Qi moves freely, there is no disease. Hence, ancient physicians treating women's diseases frequently used Cyperi Rhizoma (Xiangfu), Amomi Fructus Rotundus (Sharen), Aucklandiae Radix (Muxiang), Citri Reticulatae Pericarpium (Qingpi), and Aurantii Fructus Immaturus (Zhike) because these herbs promote Qi movement. Most women's diseases stem from Qi and Blood stagnation; therefore, treatment focuses on resolving stagnation and promoting Qi circulation. Once stagnation is resolved and Qi circulates, menstruation will regulate itself, and various ailments will heal.
Ye Yiqian stated: For irregular menstruation in women, there is often a theory advocating the depletion of Qi and augmentation of Blood. However, Blood is the companion of Qi; if Qi is hot, Blood is hot; if Qi is cold, Blood is cold; if Qi ascends, Blood ascends; if Qi descends, Blood descends; if Qi moves, Blood moves; if Qi stagnates, Blood stagnates. Only in cases where stagnant Fire dominates the Blood level, causing irregular menstruation, can one solely use Xiangfu Wan (Cyperi Pill) or Yi Qi San (Suppress Qi Powder) augmented with Aucklandiae Radix (Muxiang) and Arecae Semen (Binglang) to resolve stagnation and move Qi. If Qi is chaotic, regulate it; if Qi is cold, warm it; if Qi is deficient, tonify it—this applies equally to men and women. When Yang grows, Yin increases; when Qi declines, Blood also weakens. How can one merely deplete Qi? Nevertheless, in some cases, disharmony between husband and wife, or the frustration of maidservants or relatives, leads to persistent Qi stagnation causing irregular menstruation; in such instances, one must examine the patterns of compliance and rebellion to treat them appropriately.