加味地骨皮饮 六神汤
经来身热有表发,内热地骨加胡连,经后六神加 骨,逍遥理脾而清肝。
【注】经来发热有表邪证者,用前桂枝四物等汤发之。若内热者,用地骨皮饮加胡连
清之,名加味地骨皮饮。经后发热,乃血虚内热,用四物汤加黄 、地骨皮补而凉之,名六
神汤。若脾虚肝热,用逍遥散理脾而清肝。
逍遥散(方见前)
羌桂四物汤 黄 建中汤
经来身痛有表发,无表四物羌桂枝,经后血多黄 建, 桂芍草枣姜饴。
【注】经来时身体痛疼,若有表证者,酌用前麻黄四物、桂枝四物等汤以发之。若无
表证者,乃血脉壅阻也,宜用四物汤加羌活、桂枝以疏通经络,名羌桂四物汤。若经行后
或血去过多者,乃血虚不荣也,宜用黄 建中汤以补之,其方即小建中汤(桂枝、白芍、
甘草、姜、枣、饴糖)加黄 也。
当归建中汤 加味乌药散 琥珀散
经后腹痛当归建,经前胀痛气为殃,加味乌药汤乌缩,延草木香香附榔。血凝碍气疼过胀,本事
琥珀散最良,棱莪丹桂延乌药,寄奴当归芍地黄。
【注】经后腹痛或去血过多,乃血虚也。宜用当归建中汤补之,其方即小建中汤加当
归也,经前腹胀痛,乃血气凝滞。若胀过于痛,是气滞其血也,宜用加味乌药汤开之,其
方即乌药、缩砂、延胡索、甘草、木香、香附、槟榔也。若痛过于胀,是血凝碍气也,宜
用琥珀散破之,其方即三棱、莪术、丹皮、官桂、延胡索、乌药、刘寄奴、当归、赤芍、生
地黄也。
大温经汤 吴茱萸汤
胞虚寒病大温经,来多期过小腹痛,归芎芍草人参桂,吴丹胶半麦门冬。不虚胞受风寒病,吴茱萸
汤更加风, 细干姜茯苓木,减去阿胶参芍芎。
【注】凡胞中虚寒,一切经病,皆因经水来多,胞虚受寒所致。或因受寒过期不行,小
腹冷痛者,宜用大温经汤,即当归、川芎、白芍、炙草、人参、肉桂、吴茱萸、丹皮、阿
胶、半夏、麦门冬也。若胞中不虚,惟受风寒为病,宜吴茱萸汤。根据大温经汤方更加防
风、 本、细辛、干姜、茯苓、木香,减去阿胶、人参、白芍药、川芎,即是吴茱萸汤
也。
月经期间身体发热且伴有表证者,需发散表邪;若为内热,则在地骨皮饮中加入胡黄连。月经结束后发热,可用六神汤(即四物汤加黄芪、地骨皮)以补虚清热;若属脾虚肝热,则用逍遥散调理脾胃并清泻肝火。
【注释】月经来潮时发热且兼有表邪的证候,使用前述桂枝四物汤等方剂进行发汗解表。若是内热,则使用地骨皮饮加入胡黄连以清热,称为加味地骨皮饮。月经后发热,属于血虚引起的内热,使用四物汤加入黄芪、地骨皮以滋补并凉血,称为六神汤。若是脾虚导致肝热,使用逍遥散调理脾胃并清肝。
逍遥散(方剂见前文)
月经期间身体疼痛且伴有表证者,需发散表邪;若无表证,则用四物汤加羌活、桂枝。月经后若失血过多,用黄芪建中汤治疗,该方由桂枝、白芍、甘草、生姜、大枣、饴糖组成。
【注释】月经来潮时身体疼痛,若有表证,酌情使用前文麻黄四物汤、桂枝四物汤等方剂以发汗解表。若无表证,则是血脉壅滞阻塞,适宜使用四物汤加入羌活、桂枝以疏通经络,称为羌活桂枝四物汤。若月经行经后或失血过多,则是血虚不能濡养肢体,适宜使用黄芪建中汤以补益,其方即为小建中汤(桂枝、白芍、甘草、生姜、大枣、饴糖)加入黄芪而成。
月经后腹痛用当归建中汤,月经前胀痛多因气滞所致。加味乌药汤由乌药、缩砂仁、延胡索、木香、香附、槟榔组成。若血凝阻碍气机运行,疼痛超过胀感,使用《本事方》中的琥珀散最为良效,该方由三棱、莪术、丹皮、官桂、延胡索、乌药、刘寄奴、当归、赤芍、生地黄组成。
【注释】月经后腹痛或因失血过多,属于血虚。适宜使用当归建中汤以补益,其方即为小建中汤加入当归。月经前腹胀痛,属于气血凝滞。若胀感超过痛感,是气滞导致血行不畅,适宜使用加味乌药汤以行气开郁,其方由乌药、缩砂仁、延胡索、甘草、木香、香附、槟榔组成。若痛感超过胀感,是血凝阻碍气机运行,适宜使用琥珀散以破血逐瘀,其方由三棱、莪术、丹皮、官桂、延胡索、乌药、刘寄奴、当归、赤芍、生地黄组成。
胞宫虚寒所致的疾病适用大温经汤,症状表现为经量多、经期短、小腹冷痛。方剂包含当归、川芎、白芍、甘草、人参、肉桂、吴茱萸、丹皮、阿胶、半夏、麦门冬。若胞宫不虚,仅受风寒侵袭致病,适用吴茱萸汤。此方在大温经汤基础上增加防风、藁本、细辛、干姜、茯苓、木香,减去阿胶、人参、白芍、川芎,即为吴茱萸汤。
【注释】凡是胞宫中虚寒,一切月经疾病,皆因经血量多,导致胞宫空虚而受寒所致。或因受寒导致经期推迟不行,小腹冷痛者,适宜使用大温经汤,即当归、川芎、白芍、炙甘草、人参、肉桂、吴茱萸、丹皮、阿胶、半夏、麦门冬。若胞宫不虚,只是受风寒致病,适宜使用吴茱萸汤。根据大温经汤方剂,更加入防风、藁本、细辛、干姜、茯苓、木香,减去阿胶、人参、白芍药、川芎,即是吴茱萸汤。
Jiawei Digupi Yin (Modified Cortex Lycii Decoction), Liushen Tang (Six-God Decoction)
When body heat occurs during menstruation accompanied by exterior syndrome, the exterior pathogen should be dispersed. If it is internal heat, add Coptidis Rhizoma (Huanglian, 黄连) to Cortex Lycii Decoction (Digupi Yin, 地骨皮饮). For fever after menstruation, use Liushen Tang (Four-Substance Decoction plus Astragali Radix and Cortex Lycii) to tonify deficiency and clear heat. If spleen deficiency leads to liver heat, use Xiaoyao San (Free and Easy Wanderer Powder) to regulate the spleen and clear the liver.
[Note] For fever during menstruation with exterior pathogen syndrome, use previously mentioned Guizhi Siwu Tang (Cinnamon Twig Four-Substance Decoction) etc. to induce sweating and release the exterior. If it is internal heat, use Digupi Yin added with Coptidis Rhizoma to clear heat, named Jiawei Digupi Yin (Modified Cortex Lycii Decoction). Fever after menstruation is due to blood deficiency causing internal heat; use Siwu Tang (Four-Substance Decoction) added with Astragali Radix and Cortex Lycii to tonify and cool the blood, named Liushen Tang. If spleen deficiency causes liver heat, use Xiaoyao San to regulate the spleen and clear the liver.
Xiaoyao San (Formula seen in previous section)
Qianggui Siwu Tang (Notopterygii and Cinnamomi Ramulus Four-Substance Decoction), Huangqi Jianzhong Tang (Astragalus Middle-Joint Preserving Decoction)
When body pain occurs during menstruation accompanied by exterior syndrome, the exterior should be dispersed. Without exterior syndrome, use Siwu Tang added with Notopterygii Rhizoma (Qianghuo, 羌活) and Cinnamomi Ramulus (Guizhi, 桂枝). After menstruation, if excessive blood loss occurs, use Huangqi Jianzhong Tang. This formula consists of Cinnamomi Ramulus, Paeoniae Radix Alba, Glycyrrhizae Radix et Rhizoma, Zingiberis Rhizoma Recens, Ziziphi Jujubae Fructus, and Maltose.
[Note] When body pain occurs during menstruation, if there is an exterior syndrome, use Ma Huang Siwu Tang (Ephedra Four-Substance Decoction) or Guizhi Siwu Tang to induce sweating and release the exterior. If there is no exterior syndrome, it is due to obstruction of blood vessels and collaterals; use Siwu Tang added with Notopterygii Rhizoma and Cinnamomi Ramulus to unblock the meridians, named Qianggui Siwu Tang. If after menstruation or due to excessive blood loss, it is due to blood deficiency failing to nourish the body; use Huangqi Jianzhong Tang to tonify. Its formula is Xiao Jianzhong Tang (Cinnamomi Ramulus, Paeoniae Radix Alba, Glycyrrhizae Radix et Rhizoma, Zingiberis Rhizoma Recens, Ziziphi Jujubae Fructus, Maltose) added with Astragali Radix.
Danggui Jianzhong Tang (Angelica Sinensis Middle-Joint Preserving Decoction), Jiawei Wuyao San (Modified Lindera Powder), Hupo San (Amber Powder)
For abdominal pain after menstruation, use Danggui Jianzhong Tang. For distension and pain before menstruation, qi stagnation is the cause. Jiawei Wuyao Tang contains Linderae Radix, Amomi Fructus Rotundus, Corydalis Rhizoma, Aucklandiae Radix, Cyperi Rhizoma, and Arecae Semen. If blood coagulation obstructs qi movement, and pain exceeds distension, use Hupo San from *Ben Shi Fang* (Essential Prescriptions for Rescue), which is most effective. It contains Curcumae Radix, Curcumae Longae Rhizoma, Moutan Cortex, Cinnamomi Cortex, Corydalis Rhizoma, Linderae Radix, Persicariae Herba, Angelicae Sinensis Radix, Paeoniae Rubra Radix, and Rehmanniae Radix Recens.
[Note] Abdominal pain after menstruation or due to excessive blood loss is due to blood deficiency. Use Danggui Jianzhong Tang to tonify; its formula is Xiao Jianzhong Tang added with Angelicae Sinensis Radix. Distension and pain before menstruation is due to qi and blood stagnation. If distension exceeds pain, it is qi stagnation affecting blood flow; use Jiawei Wuyao Tang to open and relieve stagnation. Its formula is Linderae Radix, Amomi Fructus Rotundus, Corydalis Rhizoma, Glycyrrhizae Radix et Rhizoma, Aucklandiae Radix, Cyperi Rhizoma, and Arecae Semen. If pain exceeds distension, it is blood coagulation obstructing qi; use Hupo San to break blood stasis. Its formula is Curcumae Radix, Curcumae Longae Rhizoma, Moutan Cortex, Cinnamomi Cortex, Corydalis Rhizoma, Linderae Radix, Persicariae Herba, Angelicae Sinensis Radix, Paeoniae Rubra Radix, and Rehmanniae Radix Recens.
Da Wenjing Tang (Great Warming the Menses Decoction), Wuzhuyu Tang (Evodia Decoction)
For diseases of uterine deficiency-cold, use Da Wenjing Tang. Symptoms include heavy menstrual flow, short cycle, and cold pain in the lower abdomen. The formula contains Angelicae Sinensis Radix, Chuanxiong Rhizome, Paeoniae Radix Alba, Prepared Glycyrrhizae Radix et Rhizoma, Ginseng Radix, Cinnamomi Cortex, Evodiae Fructus, Moutan Cortex, Colla Corii Asini, Pinelliae Rhizoma Preparatum, and Ophiopogonis Radix. If the uterus is not deficient but affected only by wind-cold, use Wuzhuyu Tang. Based on Da Wenjing Tang, add Saposhnikoviae Radix, Ligustici Wallichii Rhizoma, Asari Radix et Rhizoma, Zingiberis Rhizoma, Poria, and Aucklandiae Radix; remove Colla Corii Asini, Ginseng Radix, Paeoniae Radix Alba, and Chuanxiong Rhizome, which constitutes Wuzhuyu Tang.
[Note] All menstrual disorders caused by uterine deficiency-cold result from heavy menstrual flow leading to uterine emptiness and susceptibility to cold. Or, due to cold invasion causing delayed menstruation with cold pain in the lower abdomen, use Da Wenjing Tang: Angelicae Sinensis Radix, Chuanxiong Rhizome, Paeoniae Radix Alba, Prepared Glycyrrhizae Radix et Rhizoma, Ginseng Radix, Cinnamomi Cortex, Evodiae Fructus, Moutan Cortex, Colla Corii Asini, Pinelliae Rhizoma Preparatum, and Ophiopogonis Radix. If the uterus is not deficient but merely affected by wind-cold, use Wuzhuyu Tang. According to Da Wenjing Tang, add Saposhnikoviae Radix, Ligustici Wallichii Rhizoma, Asari Radix et Rhizoma, Zingiberis Rhizoma, Poria, and Aucklandiae Radix; remove Colla Corii Asini, Ginseng Radix, Paeoniae Radix Alba, and Chuanxiong Rhizome, which forms Wuzhuyu Tang.