凡血色有辨，固可以察虚实，亦可以察寒热。若血浓而多者，血之盛也；色淡而少者，血之衰也。此固大
概之易知者也。至于紫黑之辨，其证有如冰炭，而人多不解，误亦甚矣。盖紫与黑相近，今人但见紫色之血，
不分虚实，便谓内热之甚，不知紫赤鲜红浓而成片成条者，是皆新血妄行，多由内热。紫而兼黑，或散或薄，
沉黑色败者，多以真气内损，必属虚寒。由此而甚，则或如屋漏水，或如腐败之宿血，是皆紫黑之变象也。
此肝脾
大损，阳气大陷之证，当速用甘温，如理阴煎、理中汤、归脾汤、四味回阳饮、补中益气汤之类，单救脾土，
则陷者举，脱者固，元气渐复，病无不愈。若尽以紫色作热证，则无不随药而毙矣。凡肠 便血之属，无不皆
然。学人于此，最有不可忽者。
理阴煎（见血寒经迟）
理中汤（见血虚经乱）
归脾汤（见经不调）
四味回阳饮（见《新方八阵·热阵》）治元阳虚脱，危在顷刻者。
人参（一、二两） 制附子（二、三钱） 炙甘草（一、二钱） 炮干姜（二、三钱）
水二钟，武火（即较旺之火）煎七、八分，温服，徐徐饮之。
补中益气汤（见经不调）
《评热病论》曰∶“月事不来者，胞脉闭也。胞脉者，属心而络于胞中，今气上迫肺，心气不得下通，
故月事不来也。”
《阴阳别论》曰∶“二阳之病发心脾，有不得隐曲，女子不月。其传为风消，其传为息奔者，死不治。”
《邪气脏腑病形篇》曰∶“肾脉微涩为不月。”
血枯之与血隔，本自不同，盖隔者，阻隔也；枯者，枯竭也。阻隔者，因邪气之隔滞，血有所逆也。枯
竭者，因冲任之亏败，源断其流也。凡妇女病损，至旬月半载之后，则未有不闭经者。正因阴竭，所以血枯，
枯之为义，无血而然。故或以羸弱，或以困倦，或以咳嗽，或以夜热，或以食饮减少，或以亡血失血，
及一切无胀、无痛、无阻、无隔，而经有久不至者，即无非血
枯经闭之候。欲其不枯，无如养营；欲以通之，无如克之。但使雪消，则春水自来，血盈则经脉自至，源泉混
混，又孰有能阻之者？奈何今之为治者，不论有滞无滞，多兼开导之药，其有甚者，则专以桃仁、红花之类
通利为事，岂知血滞者可通，血枯者不可通也。血既枯矣，而复通之，则枯者愈枯，其与榨干汁者何异？为不
知枯字之义耳，为害不小，无或蹈此弊也。此之治法，当与前血虚、肾虚二条察而用之。
寇宗 曰∶夫人之生，以血气为本，人之病，未有不先伤其血气者。若室女童男，积想在心，思虑过度，
多致劳损。男子则神色消散，女子则月水先闭。盖忧愁思虑则伤心，而血逆气竭，神色先散，月水先闭。且心
病不能养脾，故不嗜食。脾虚则金亏，故发嗽。肾水绝则木气不荣，而四肢干痿，故多怒，鬓发焦，筋骨痿。
若五脏传遍，则必至于死。此一种于劳中最难治。盖病起于五脏之中，无有已期，药力不可及也。
若或自能改易心志，然后用药扶接，如此则可得九死一生。举此为例，其余诸方，可按脉与证而治之。
张氏云∶室女月水久不行，切不可用青蒿等凉药。医家多以为室女血热，故以凉药解之，殊不
知血得热则行，冷则凝。《养生必用方》言之甚详。此说大有理，不可不知。若经候微少，渐渐不
通，手足骨肉烦疼，日渐羸瘦，渐生潮热，其脉微数，此由阴虚血弱，阳往乘之，少水不能减盛火，火逼水
涸，耗亡津液。治当养血益阴，慎毋以毒药通之。宜用柏子仁丸、泽兰汤。
柏子仁丸（见《妇人规古方》）治血虚有火，月经耗损渐至不通，日渐羸瘦而生潮热，慎勿以毒药
通之，宜柏子仁丸。
柏子仁（炒研） 牛膝（酒拌） 卷柏（各半两） 泽兰叶 续断（各二两） 熟地黄（三两，酒拌蒸烂杵膏）
上为末，入地黄膏加炼蜜丸桐子大，每服百余丸，空心米饮下。
泽兰汤（见《妇人规古方》）治劳怯经闭。
泽兰叶（二钱） 当归 芍药（炒各一钱） 甘草（炙五分）
用水煎服。
立斋曰∶夫经水，阴血也。属冲任二脉主。上为乳汁，下为月水。其为患，有因脾胃虚不能生血而不行
者，调而补之；有因脾郁伤血，耗损而不行者，解而补之。有因胃火血消烁而不行者，清而补之；有因劳伤心
血，少而不行者，静而补之；有因肾水亏不能生肝血而闭者，补脾肺；有因肺气虚不能行血而闭者，补脾胃。
经曰∶“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。
五谷入胃，化以为血，以荣四末，内养五脏六腑。若服苦寒之剂，复伤胃气，必致不起。
凡是经血的颜色都有辨别之处，既可以用来观察虚证和实证，也可以用来观察寒证和热证。如果血色浓稠且量多，这是血气旺盛的表现；如果血色淡白且量少，这是血气衰弱的表现。这当然是大致容易知晓的道理。至于紫色和黑色的辨别，其病机如同冰炭般截然不同，但人们大多不理解，误治的情况也非常严重。因为紫色与黑色相近，现在的人只要见到紫色的血，不分虚实，就认为是内热极盛，却不知道紫赤色、鲜红色、浓稠且成片成条的血，都是新血妄行，多由内热引起。而紫色兼带黑色，或者散漫稀薄、沉滞黑败的血，多是因为真气内部受损，必定属于虚寒证。由此进一步发展，就会出现像屋漏水一样的点滴淋漓，或者像腐败的宿血一样，这些都是紫黑血的变象。这是肝脾大损、阳气下陷的证候，应当迅速使用甘温的药物，如理阴煎、理中汤、归脾汤、四味回阳饮、补中益气汤之类，单独挽救脾土，那么下陷的阳气就能提升，脱失的气血就能固摄，元气逐渐恢复，疾病没有不痊愈的。如果完全把紫色当作热证治疗，那么没有不随着服药而死亡的。凡是肠风便血等情况，没有不是这样的。学习中医的人在这一点上，最不可忽视。
理阴煎（参见“血寒经迟”章节）
理中汤（参见“血虚经乱”章节）
归脾汤（参见“经不调”章节）
四味回阳饮（参见《新方八阵·热阵》），治疗元阳虚脱，危急在顷刻之间的情况。
人参（一两或二两） 制附子（二钱或三钱） 炙甘草（一钱或二钱） 炮干姜（二钱或三钱）
用水两钟，用武火（即较旺的火）煎至七八分，温服，慢慢饮用。
补中益气汤（参见“经不调”章节）
《评热病论》说：“月经不来的，是胞脉闭塞。胞脉，连接心脏并络于子宫，现在气机上迫于肺，心气不能向下通达，所以月经不来。”
《阴阳别论》说：“阳明经的病发于心脾，有难以启齿的隐情，女子就会停经。如果传变为风消（形容消瘦如被风吹干），传变为息奔（呼吸急促奔冲），就是死证，无法治疗。”
《邪气脏腑病形篇》说：“肾脉微涩，表示闭经。”
血枯与血隔，本来就不相同。所谓“隔”，是阻隔的意思；所谓“枯”，是枯竭的意思。阻隔者，是因为邪气阻隔停滞，血液运行逆乱。枯竭者，是因为冲任二脉亏败，源头断绝了血流。凡是妇女患病损耗，到了几个月甚至半年的之后，就没有不闭经的。正是因为阴液枯竭，所以血枯，枯的含义，就是因为无血而然。所以有的表现为身体羸弱，有的表现为困倦乏力，有的表现为咳嗽，有的表现为夜间发热，有的表现为饮食减少，有的表现为亡血或失血，以及一切没有胀满、没有疼痛、没有阻滞、没有阻隔，而月经很久不来的，无非都是血枯经闭的症状。想要它不枯竭，没有比滋养营血更好的方法；想要让它通畅，没有比克制（指克制耗伤、固本培元，此处语境实指通过滋补使其自然通利，而非攻伐通利，原文‘克之’在此处结合上下文‘欲其不枯...雪消则春水自来’应理解为通过滋养达到自然通利的效果，或者指克制导致枯竭的因素，但后文强调不可通利，故此处译为通过滋养使其充盈从而自然通利更为准确，参考后文‘血盈则经脉自至’）的方法。只要像冰雪消融那样，春天的水流自然会来，血液充盈了，经脉自然就会通畅，源泉混混不绝，又有谁能阻挡呢？奈何现在的治疗者，不论是否有瘀滞，大多兼用开导通利的药物，其中严重的，专门以桃仁、红花之类的药物进行通利，哪里知道血滞的可以通利，血枯的却不可以通利。血液已经枯竭了，如果再强行通利，那么枯竭的会更加枯竭，这和榨干汁液有什么区别？这是因为不知道‘枯’字的含义罢了，危害不小，不要重蹈这种弊端。这里的治疗方法，应当与前文的血虚、肾虚两条仔细考察后使用。
寇宗奭说：“人的生存，以血气为根本，人的疾病，没有不先损伤血气的。如果是未婚男女，积想在心中，思虑过度，多导致劳损。男子则神色消散，女子则月经先闭。因为忧愁思虑会伤心，导致血逆气竭，神色先散，月经先闭。而且心病不能养脾，所以不喜欢进食。脾虚则肺气亏损，所以发生咳嗽。肾水枯竭则肝木之气不得荣养，而四肢干枯痿软，所以容易发怒，鬓发焦黄，筋骨痿弱。如果五脏传遍，就必然导致死亡。这一种病在劳损中最难治疗。因为病起于五脏之中，没有结束的期限，药力也达不到。如果患者自己能改变心志，然后用药扶持接续，这样才可以得到九死一生的机会。举这个例子为例，其余的各种方剂，可以根据脉象和证候来治疗。”
张氏说：“室女月经长久不行，切不可使用青蒿等凉性药物。医家多认为室女血热，所以用凉药解之，殊不知血得热则运行，得冷则凝滞。《养生必用方》对此言之甚详。这种说法很有道理，不可不知道。如果经血量微少，渐渐不通，手足骨肉烦疼，日渐消瘦，渐渐产生潮热，脉象微数，这是由于阴虚血弱，阳气乘虚而入，少水不能抑制盛火，火逼迫水液枯竭，耗亡津液。治疗应当养血益阴，千万不要用毒药通利。适宜使用柏子仁丸、泽兰汤。”
柏子仁丸（参见《妇人规古方》），治疗血虚有火，月经耗损渐渐至不通，日渐消瘦而生潮热，千万不要用毒药通利，适宜用柏子仁丸。
柏子仁（炒研） 牛膝（酒拌） 卷柏（各半两） 泽兰叶 续断（各二两） 熟地黄（三两，酒拌蒸烂捣成膏）
以上药物研为末，加入地黄膏和炼蜜制成梧桐子大小的丸药，每次服用一百多丸，空腹米汤送下。
泽兰汤（参见《妇人规古方》），治疗劳怯经闭。
泽兰叶（二钱） 当归 芍药（炒各一钱） 甘草（炙五分）
用水煎服。
薛立斋说：“经水，是阴血。由冲任二脉主导。上行成为乳汁，下行成为月经。它的病患，有因为脾胃虚弱不能生血而不行的，调理并补益它；有因为脾郁伤血，耗损而不行的，疏解并补益它。有因为胃火灼烁血液而不行的，清热并补益它；有因为劳损伤心血，量少而不行的，静养并补益它；有因为肾水亏虚不能生肝血而闭经的，补益脾肺；有因为肺气虚不能行血而闭经的，补益脾胃。
经文说：‘损伤肺的，要益其气；损伤心的，要调和营卫；损伤脾的，要调节饮食，适应寒温；损伤肝的，要舒缓其中气；损伤肾的，要益其精。’仔细审察并治疗，才差不多不会出错。
五谷进入胃，化生为血，以营养四肢末端，向内滋养五脏六腑。如果服用苦寒的药物，再次损伤胃气，必然导致无法救治。”
Any variation in the color of menstrual blood can be distinguished, serving not only to differentiate deficiency (Xu) and excess (Shi) patterns but also cold (Han) and heat (Re) patterns. If the blood is thick and abundant, it indicates an abundance of blood; if the blood is pale and scanty, it indicates a depletion of blood. These are generally obvious principles. However, regarding the distinction between purple and black colors, the pathological mechanisms are as contradictory as ice and charcoal, yet most people fail to understand this, leading to frequent misdiagnoses. Since purple and black are similar, nowadays people see purple blood and, without distinguishing between deficiency and excess, immediately attribute it to extreme internal heat. They do not realize that bright red or purplish-red blood that is thick and forms clots or strips represents new blood flowing recklessly, mostly caused by internal heat. Conversely, blood that is purple mixed with black, or is scattered and thin, appearing dark and decayed, is mostly due to damage to the true Qi internally and must belong to a deficiency-cold pattern. If this condition worsens, the blood may appear like dripping water from a leaking roof or like rotten old blood; these are all variations of purple-black blood manifestations. This syndrome represents severe damage to the Liver and Spleen and a sinking of Yang Qi. One should promptly use sweet-warm formulas, such as Li Yin Jian (Cinnamon Twig and Rehmannia Decoction), Li Zhong Tang (Regulate the Middle Decoction), Gui Pi Tang (Restore the Spleen Decoction), Si Wei Hui Yang Yin (Four-Ingredient Decoction to Restore Yang), or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). By solely rescuing the Earth element (Spleen), the sunken Qi will be lifted, and the escaping Qi will be secured. As the Yuan Qi gradually recovers, the disease will surely heal. If one treats all purple-colored blood as a heat syndrome, death will inevitably follow the medication. This principle applies equally to conditions such as intestinal wind and hematochezia. Students of medicine must not overlook this point.
Li Yin Jian (See "Blood Cold and Delayed Menses")
Li Zhong Tang (See "Blood Deficiency and Menstrual Disorder")
Gui Pi Tang (See "Irregular Menses")
Si Wei Hui Yang Yin (See *Xin Fang Ba Zhen · Re Zhen*), used for critical cases of primordial Yang deficiency and collapse occurring suddenly.
Ren Shen (Ginseng Radix et Rhizoma) (1–2 liang), Zhi Fu Zi (Prepared Aconiti Lateralis Radix) (2–3 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) (1–2 qian), Pao Gan Jiang (Roasted Zingiberis Rhizoma) (2–3 qian).
Boil two zhong of water over strong fire until reduced to seven or eight fen. Take warm, drinking slowly.
Bu Zhong Yi Qi Tang (See "Irregular Menses")
The *Ping Re Bing Lun* states: "When menstruation ceases, it is due to the closure of the Bao Mai (Uterine Vessels). The Bao Mai connects to the Heart and networks into the Bao Zhong (Uterus). Now, if Qi forces upward against the Lung, the Qi of the Heart cannot descend smoothly, thus menstruation ceases."
The *Yin Yang Bie Lun* states: "Diseases of the Two Yang meridians originate in the Heart and Spleen. There is a hidden distress that cannot be voiced; in women, this leads to amenorrhea. If it transmits to become 'Feng Xiao' (wasting away like dried leaves blown by wind) or 'Xi Ben' (rushing breath/palpitations), it is a fatal and untreatable condition."
The *Xie Qi Zang Fu Bing Xing Pian* states: "A faint and choppy Kidney pulse indicates amenorrhea."
Blood Ku (Depletion) and Blood Ge (Obstruction) are fundamentally different. "Ge" means obstruction; "Ku" means exhaustion. Obstruction arises from pathogenic factors blocking stagnation, causing blood to flow retrograde. Exhaustion arises from the failure of the Chong and Ren meridians, where the source of flow is cut off. For any woman suffering from chronic illness lasting months or half a year, amenorrhea is inevitable. Precisely because Yin is exhausted, blood becomes depleted. The meaning of "Ku" implies a state of having no blood. Thus, symptoms may include emaciation, fatigue, cough, night fever, reduced appetite, history of blood loss, or simply prolonged absence of menstruation without distension, pain, blockage, or obstruction—all constitute signs of Blood Ku Amenorrhea. To prevent depletion, nothing is better than nourishing Ying (Nutritive) Qi; to restore flow, nothing is better than [nourishing to allow natural flow]. Just as snow melts and spring water flows naturally, when blood is abundant, the meridians will open spontaneously. With a surging source, who could possibly obstruct it? Yet, contemporary practitioners, regardless of whether there is stagnation or not, often add herbs to guide and unblock. In severe cases, they rely exclusively on promoting circulation with herbs like Tao Ren (Persicae Semen) and Hong Hua (Carthami Flos). Do they not know that while blood stasis can be unblocked, blood depletion cannot? If blood is already depleted and one forcibly unblocks it, the depletion will worsen. What difference is there from squeezing dry juice from a dried fruit? This harm stems from ignorance of the meaning of "Ku." One must avoid this error. The treatment method here should be examined in conjunction with the preceding sections on Blood Deficiency and Kidney Deficiency.
Kou Zongshi stated: "Human life is based on Blood and Qi. Diseases invariably begin by damaging Blood and Qi. For unmarried men and women, persistent thoughts and excessive worry often lead to consumptive disorders. In men, spirit and luster dissipate; in women, menstruation closes first. Worry and anxiety injure the Heart, causing blood rebellion and Qi exhaustion, leading to dissipated spirit and closed menstruation. Furthermore, Heart disease fails to nourish the Spleen, resulting in poor appetite. Spleen deficiency leads to Lung Metal deficiency, causing cough. When Kidney Water is exhausted, Liver Wood loses its nourishment, leading to dry and flaccid limbs, irritability, scorched hair, and weak sinews and bones. If the disease spreads through all five Zang organs, death is certain. This type of disorder is among the most difficult to treat among consumptive diseases. Because the pathology originates within the five Zang organs, there is no clear endpoint, and medicinal force cannot reach it. If the patient can change their mindset, followed by medicinal support, there is still a chance of survival out of ten. Taking this as an example, other prescriptions can be applied according to pulse and syndrome differentiation."
Zhang Shi stated: "For unmarried girls with long-standing amenorrhea, Qing Hao (Artemisiae Annuae Herba) and other cooling herbs must strictly be avoided. Many physicians assume unmarried girls have blood heat and use cooling herbs to resolve it, failing to realize that blood moves with heat and coagulates with cold. *Yang Sheng Bi Yong Fang* explains this in detail. This theory is highly reasonable and must be understood. If menses become scanty and gradually cease, accompanied by restlessness and pain in the hands, feet, bones, and muscles, progressive emaciation, and tidal fever, with a faint and rapid pulse, this is due to Yin deficiency and blood weakness, allowing Yang to invade. Little water cannot extinguish a raging fire; the fire逼 (forces) the water to dry up, consuming body fluids. Treatment should focus on nourishing blood and benefiting Yin. Do not use toxic drugs to force flow. Bai Zi Ren Wan (Biota Seed Pill) or Ze Lan Tang (Lycopus Decoction) are appropriate."
Bai Zi Ren Wan (See *Fu Ren Gui Ancient Formulas*), used for blood deficiency with fire, where menstruation is gradually consumed and ceases, accompanied by progressive emaciation and tidal fever. Do not use toxic drugs to force flow; Bai Zi Ren Wan is suitable.
Bai Zi Ren (Biotae Semen, stir-fried and ground), Niu Xi (Achyranthis Bidentatae Radix, soaked in wine), Juan Bai (Selaginellae Herba) (each 0.5 liang), Ze Lan Ye (Lycopi Herba), Xu Duan (Dipsaci Radix) (each 2 liang), Shu Di Huang (Rehmanniae Radix Praeparata, 3 liang, steamed with wine until soft and mashed into paste).
Grind the above into powder, mix with the Rehmannia paste and refined honey, and form pills the size of tung tree seeds. Take over 100 pills per dose, swallowed with rice water on an empty stomach.
Ze Lan Tang (See *Fu Ren Gui Ancient Formulas*), used for amenorrhea due to consumption and debility.
Ze Lan Ye (Lycopi Herba) (2 qian), Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba, stir-fried) (each 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) (0.5 qian).
Decoct in water and take orally.
Xue Li-zhai stated: "Menstrual blood is Yin blood, governed by the Chong and Ren meridians. It transforms upward into milk and downward into menstruation. Its disorders arise from various causes: those caused by Spleen-Stomach deficiency failing to generate blood require regulation and tonification; those caused by Spleen depression injuring blood and causing depletion require resolution and tonification; those caused by Stomach fire consuming blood require clearing and tonification; those caused by labor injuring Heart blood and reducing volume require quietude and tonification; those caused by Kidney Water deficiency failing to generate Liver blood and causing closure require tonifying the Spleen and Lung; those caused by Lung Qi deficiency failing to move blood and causing closure require tonifying the Spleen and Stomach.
The Classics state: 'For lung injury, augment Qi; for heart injury, harmonize Ying and Wei; for spleen injury, regulate diet and adapt to temperature; for liver injury, soothe the interior; for kidney injury, benefit Essence.' Carefully examine and treat accordingly, and errors will be avoided.
The five grains enter the Stomach and transform into blood, nourishing the four extremities and internally supporting the five Zang and six Fu organs. If bitter-cold agents are taken, further damaging Stomach Qi, recovery will be impossible."