一切众疾与男子同，惟经水、带下、血崩、胎产等证不同，故古人另立妇人科以别之。
【歌】妇人天癸有常经，血满冲任匝月行。不及期来知是热，过期血少自分明。若然色淡因痰滞，热极多
来紫黑形。气滞临行先作痛，虚时行过腹中疼。去多不住加凉血，来少无疼大补荣。经闭要推虚实候，血枯气
隔热痰因。
【论】夫经者，常也。然冲、任二脉，为经脉之海，血气之行，外循经络，内荣脏腑，气血调适，营运不
息，一月之间，冲任血溢而行。经云∶月事以时下，此常经也。其或太过不及，或多或寡，或紫或淡，则失其
常候而为之病也，故有虚、实、冷、热之殊。善治者，必审其因而调之，复令充其元气，以复其初，斯无病患也。
按∶褚氏云∶女人天癸既至，逾十年无男子合，则不调。未逾十年，思男子合，亦不调。不调则旧血不出，
新血误行，或渍而入骨，或变而为肿。寇氏亦云∶室女经闭成劳者，多由积想在心故也。王节斋曰∶妇室经脉
不行，多因脾胃伤损，不可便作经闭血凝轻用通经破血之药。遇有此证，便须审其脾胃如何，若因饮食劳倦损
伤脾胃，少食恶食，泄泻疼痛；或因误服汗、下攻克之药，伤其中气，以致血少而不行
者，只宜补养脾胃，用白术为君，茯苓、芍药为臣，佐以黄 、甘草、陈皮、麦芽、川芎、当归、柴胡等药，
脾旺则能生血，而经自行矣。又有饮食停滞，致损脾胃者，亦宜消食补脾。若脾胃无病，果有血块凝结者，方
宜行血通经。
【脉】经曰∶寸关调如故，而尺脉绝不至者，月水不利，当患少腹引腰痛，气滞上攻胸臆也。
寸口脉浮而弱，浮则为虚，弱则无血。
关脉沉，主月水不利，腹胀满。
尺脉滑，血气实，妇人经脉不利。
少阴脉弱而微，微则血少，弱则发热。
虚
经候行过而作痛者，血气俱虚也，八珍汤。经水过期而行，血不足也，四物汤加黄 、陈皮。经水不调而
血色淡黄者，血少也，四物汤加人参、黄 、香附，腹中痛再加蕲艾、阿胶。血气受伤，或生育多而瘦弱，经
闭不行，四物汤加桃仁、红花。
四物汤
此汤为妇人、室女补血之要药也。
当归（二钱） 熟地黄（二钱） 川芎（一钱五分） 白芍药（炒，一钱五分）
上锉，一剂，水二盏，煎八分服，加减法见血证。
八珍汤
此汤大补气血两虚，一名八物汤。
白术（炒，二钱） 白茯苓（二钱） 人参（一钱五分） 甘草（炙，八分） 当归（二钱） 熟地黄（二钱）
川芎（一钱五分） 白芍药（一钱五分）
上锉，一剂，水二大钟，煎至八分，空心服。
热盛
经水不及期来者，血热也，四物汤加黄芩、黄连、柴胡、
香附。经水来而血色紫黑者，丹溪云∶血紫黑，热极从火化故也，经水去必多，或作痛，四物汤加黄芩、黄连、
黄柏，倍芍药。经水去多，十数日行不止，此血热也，三补丸加莎草根、败龟板、荆芥、生地、柴胡。
三补丸
治三焦热火之要药，使火邪退而血自清。
黄连（三钱，去毛，炒，真川者佳） 黄芩（三钱，炒） 黄柏（三钱，去皮，炒褐色）
上为极细末，蜜丸白汤下，加山栀名栀子金花丸。
四物汤（方见前。）
痰多
痰多占住血海地位，因而下多，目必渐昏，星芎丸。肥人经闭是痰隔，导痰汤加黄连、川芎。瘦人经闭
是气滞，四物汤加木香、槟榔、枳壳、香附、桃仁、红花。经水过期色淡，痰也，二陈汤加川芎、当归、贝母、
天花粉。临行腹先痛，气滞血实也，四物汤加玄胡索、蓬术、枳壳、木香、桃仁、香附。
星芎丸
治女人脂肥，痰多占住血海，因而下多者。
南星（制，四两） 苍术（甘浸，四两） 川芎（四两） 香附（童便浸三日，炒，四两）
上为细末，蒸饼糊丸绿豆大，每服百丸，白汤送下。
二陈汤
此汤治痰之都管，但引用不同，随宜斟酌。
陈皮（一钱半） 半夏（姜制，一钱） 茯苓（一钱，去皮） 甘草（炙，六分）
上锉，一剂，水二钟，生姜三片，煎至八分，空心温服。
导痰汤
即二陈汤加南星（炮一钱） 枳壳（炒，一钱）
【背景信息】
书名：明医指掌 作者：皇甫中 朝代：明 章节：妇人科 / 经候一 类别：医论
【歌诀】妇女的天癸（指促进女性生殖功能成熟的物质）有固定的周期，当血液充盈于冲脉和任脉时，每月循环一次。月经提前到来可知是热证，过期而血量少则自然分明。如果颜色淡白是因为痰湿阻滞，热极严重时经血多且呈紫黑色。气机阻滞者在经期来临前先感到疼痛，气血虚弱者在经期过后感到腹部疼痛。经血量多不止应加入凉血药物，经血量少且无疼痛者应大补营血。闭经需要推断是虚证还是实证，其成因包括血枯、气热、隔阻和痰因。
【论述】所谓“经”，即常道、规律。冲脉和任脉是十二经脉之海，气血的运行，外沿经络循行，内滋养脏腑。气血调和适宜，营运不息，一个月之间，冲任二脉的血液满溢而行经。经文说：“月事按时而下”，这是正常的生理规律。如果出现太过或不及，或多或少，或色紫或色淡，就失去了正常的征象而成为疾病，因此有虚、实、冷、热的区别。善于治疗的人，必须审察病因并加以调理，使其元气恢复如初，这样就没有病患了。
按语：褚氏说：女子天癸已至，超过十年没有与男子交合，则月经不调。未满十年，思慕男子交合，也不调。不调则旧血不出，新血误行，有的渗入骨骼，有的变为肿胀。寇氏也说：未婚少女闭经成劳损病，多由心中积存思虑所致。王节斋说：妇女经脉不行，多因脾胃损伤，不可轻易当作经闭血凝而使用通经破血的药物。遇到此类证候，必须审察脾胃状况如何，如果因饮食劳倦损伤脾胃，导致少食、厌食、泄泻、疼痛；或因误服发汗、攻下、克伐的药物，损伤中气，以致血少而不行，只宜补养脾胃，以白术为君药，茯苓、芍药为臣药，佐以黄耆、甘草、陈皮、麦芽、川芎、当归、柴胡等药，脾旺则能生血，而月经自行。又有因饮食停滞，损伤脾胃的，也宜消食补脾。如果脾胃无病，确实有血块凝结的，才适宜行血通经。
【脉诊】经文说：寸脉和关脉调和如常，而尺脉绝迹不至者，月经不利，应当患少腹牵引腰痛，气滞上攻胸臆。
寸口脉浮而弱，浮则为虚，弱则无血。
虚证：经候行经后作痛者，是血气俱虚，用八珍汤。经水过期而行，是血不足，用四物汤加黄耆、陈皮。经水不调而血色淡黄者，是血少，用四物汤加人参、黄耆、香附，腹中痛再加蕲艾、阿胶。血气受伤，或生育过多而瘦弱，经闭不行，用四物汤加桃仁、红花。
四物汤
此汤为妇女、未婚女子补血的要药。
当归（二钱） 熟地黄（二钱） 川芎（一钱五分） 白芍药（炒，一钱五分）
以上切碎，一剂，水两盏，煎至八分服用，加减法见血证篇。
八珍汤
此汤大补气血两虚，又名八物汤。
白术（炒，二钱） 白茯苓（二钱） 人参（一钱五分） 甘草（炙，八分） 当归（二钱） 熟地黄（二钱） 川芎（一钱五分） 白芍药（一钱五分）
以上切碎，一剂，水两大钟，煎至八分，空腹服用。
热盛：经水不及期来者，是血热，用四物汤加黄芩、黄连、柴胡、香附。经水来而血色紫黑者，丹溪说：血紫黑，是热极从火化故也，经血去必多，或作痛，用四物汤加黄芩、黄连、黄柏，倍用芍药。经血去多，十数日行不止，这是血热，用三补丸加莎草根、败龟板、荆芥、生地、柴胡。
三补丸
治三焦热火之要药，使火邪退而血自清。
黄连（三钱，去毛，炒，真川产者佳） 黄芩（三钱，炒） 黄柏（三钱，去皮，炒褐色）
以上研为极细末，蜜丸，白开水送下，加山栀名栀子金花丸。
四物汤（方见前。）
痰多：痰多占住血海地位，因而经下量多，目必渐昏，用星芎丸。肥人经闭是痰隔，用导痰汤加黄连、川芎。瘦人经闭是气滞，用四物汤加木香、槟榔、枳壳、香附、桃仁、红花。经水过期色淡，是痰，用二陈汤加川芎、当归、贝母、天花粉。临行腹先痛，是气滞血实，用四物汤加玄胡索、蓬术、枳壳、木香、桃仁、香附。
星芎丸
治女人脂肥，痰多占住血海，因而经下量多者。
南星（制，四两） 苍术（甘浸，四两） 川芎（四两） 香附（童便浸三日，炒，四两）
以上为细末，蒸饼糊丸绿豆大，每服百丸，白开水送下。
二陈汤
此汤治痰之总管，但引用不同，随宜斟酌。
陈皮（一钱半） 半夏（姜制，一钱） 茯苓（一钱，去皮） 甘草（炙，六分）
以上切碎，一剂，水二钟，生姜三片，煎至八分，空腹温服。
[Background Information]
Book: Ming Yi Zhi Zhang (Guiding Fingers of Famous Physicians)
Author: Huangfu Zhong
Dynasty: Ming
Chapter: Women's Diseases / Menstruation Part I
Category: Medical Theory
[Verse]
Women's Tian Gui (substances promoting reproductive maturity) follows a regular cycle. When blood fills the Chong and Ren vessels, it circulates monthly. If menstruation arrives early, it indicates Heat; if late with scant flow, it is distinctively clear. If the color is pale due to Phlegm stagnation, extreme Heat causes abundant flow with purple-black appearance. Qi stagnation causes pain before onset; Deficiency causes abdominal pain after onset. Excessive flow requires cooling Blood herbs; scant flow without pain requires tonifying Ying Blood. Amenorrhea must be differentiated as Deficiency or Excess, caused by Blood exhaustion, Qi Heat, obstruction, or Phlegm.
[Discussion]
The term "Jing" (Menstruation) refers to constancy and regularity. The Chong and Ren vessels are the seas of the twelve meridians. Qi and Blood circulate externally along the meridians and internally nourish the Zang-Fu organs. When Qi and Blood are harmonious and operational without cessation, the Chong and Ren vessels overflow with blood monthly, resulting in menstruation. The Classic states: "Menstrual flow occurs at its proper time," which is the normal pattern. If there is excess or deficiency, too much or too little, purple or pale color, the normal signs are lost, becoming disease. Thus, there are distinctions of Deficiency, Excess, Cold, and Heat. A skilled practitioner must examine the cause and regulate it, restoring the Yuan Qi to its original state, thereby eliminating illness.
Note: Chu Shi said: Once a woman's Tian Gui has arrived, if she does not cohabit with a man for over ten years, her menstruation will become irregular. If under ten years but desiring cohabitation, it also becomes irregular. Irregularity means old blood does not exit, and new blood flows erroneously; some may seep into bones, others may transform into swelling. Kou Shi also said: Amenorrhea leading to consumptive disease in unmarried girls often arises from persistent mental fixation. Wang Jiezhai said: Amenorrhea in women is often due to Spleen-Stomach damage; one should not lightly use blood-invigorating and stasis-resolving drugs. In such cases, one must examine the Spleen-Stomach. If damaged by diet and fatigue, causing poor appetite, aversion to food, diarrhea, and pain; or if damaged by erroneous use of diaphoretic, purgative, or attacking drugs, injuring Middle Qi, leading to insufficient Blood and amenorrhea, one should only tonify and nourish the Spleen-Stomach. Using Bai Zhu (Atractylodis Rhizoma) as the sovereign herb, Fu Ling (Poria) and Shao Yao (Paeoniae Radix Alba) as minister herbs, assisted by Huang Qi (Astragali Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Mai Ya (Hordei Fructus Germinatus), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Chai Hu (Bupleuri Radix). When the Spleen is robust, it generates Blood, and menstruation proceeds naturally. For cases where dietary stagnation damages the Spleen-Stomach, resolving food stagnation and tonifying the Spleen is appropriate. Only when the Spleen-Stomach is healthy and blood clumps truly exist should blood-invigorating and menstruation-promoting methods be used.
[Pulse Diagnosis]
The Classic states: If the Cun and Guan pulses are harmonious as usual, but the Chi pulse is absent, menstrual flow will be obstructed, accompanied by lower abdominal pain radiating to the lower back, and Qi stagnation attacking upward to the chest.
Cunkou pulse floating and weak: Floating indicates Deficiency; Weak indicates lack of Blood.
Guan pulse deep: Indicates menstrual obstruction and abdominal distension/fullness.
Chi pulse slippery: Indicates fullness of Qi and Blood, but menstrual obstruction in women.
Shaoyin pulse weak and fine: Fine indicates Blood Deficiency; Weak indicates Fever.
Deficiency Pattern: Pain during or after menstruation indicates simultaneous Qi and Blood Deficiency; treat with Bazhen Tang (Eight Treasure Decoction). Menstruation arriving late indicates Blood insufficiency; treat with Siwu Tang (Four Substance Decoction) plus Huang Qi and Chen Pi. Irregular menstruation with pale-yellow color indicates Blood Deficiency; treat with Siwu Tang plus Ren Shen, Huang Qi, and Xiang Fu. Add Qi Ai (Artemisiae Argyi Folium) and E Jiao (Colla Corii Asini) if abdominal pain is present. Blood and Qi injury, or emaciation due to excessive childbirth leading to amenorrhea; treat with Siwu Tang plus Tao Ren and Hong Hua.
Siwu Tang (Four Substance Decoction)
This decoction is an essential medicine for tonifying Blood in women and unmarried girls.
Dang Gui (2 qian), Shu Di Huang (2 qian), Chuan Xiong (1.5 qian), Bai Shao Yao (stir-fried, 1.5 qian).
Chop into pieces. One dose, boiled in two cups of water until reduced to 0.8 cup. Take orally. Modifications are seen in the Blood Disorders section.
Bazhen Tang (Eight Treasure Decoction)
This decoction greatly tonifies both Qi and Blood Deficiency, also known as Bay Wu Tang.
Bai Zhu (stir-fried, 2 qian), Bai Fu Ling (2 qian), Ren Shen (1.5 qian), Gan Cao (honey-fried, 0.8 qian), Dang Gui (2 qian), Shu Di Huang (2 qian), Chuan Xiong (1.5 qian), Bai Shao Yao (1.5 qian).
Chop into pieces. One dose, boiled in two large cups of water until reduced to 0.8 cup. Take on an empty stomach.
Excessive Heat: Menstruation arriving early indicates Blood Heat; treat with Siwu Tang plus Huang Qin, Huang Lian, Chai Hu, and Xiang Fu. Menstrual blood that is purple-black: Danxi stated, "Purple-black blood results from extreme Heat transforming into Fire." Flow is likely abundant or painful; treat with Siwu Tang plus Huang Qin, Huang Lian, Huang Bo, and double the amount of Shao Yao. Menstrual flow excessive for more than ten days indicates Blood Heat; treat with Sanbu Wan (Three Tonics Pill) plus Cyperi Rhizoma, Testudinis Carapax et Plastrum (prepared), Jing Jie, Sheng Di Huang, and Chai Hu.
Sanbu Wan (Three Tonics Pill)
An essential medicine for treating Triple Burner Fire-Heat, allowing Fire pathogens to retreat so Blood clears itself.
Huang Lian (3 qian, remove hairs, stir-fry, genuine Sichuan origin is best), Huang Qin (3 qian, stir-fry), Huang Bo (3 qian, remove bark, stir-fry until brown).
Grind into extremely fine powder. Make pills with honey, take with plain warm water. Adding Shan Zhi creates Zhizi Jinhua Wan (Gardenia Golden Flower Pill).
Siwu Tang (See above.)
Phlegm-Dominant: Excessive Phlegm occupying the position of the Blood Sea leads to heavy menstrual flow and gradual dimness of vision; treat with Xing Xiong Wan. Amenorrhea in obese individuals is due to Phlegm obstruction; treat with Daotan Tang (Great Phlegm-Resolving Decoction) plus Huang Lian and Chuan Xiong. Amenorrhea in thin individuals is due to Qi stagnation; treat with Siwu Tang plus Mu Xiang, Bing Lang, Zhi Ke, Xiang Fu, Tao Ren, and Hong Hua. Menstruation arriving late with pale color is due to Phlegm; treat with Erchen Tang (Two Aged Herbs Decoction) plus Chuan Xiong, Dang Gui, Bei Mu, and Tian Hua Fen. Abdominal pain before onset indicates Qi stagnation and Blood Excess; treat with Siwu Tang plus Yan Hu Suo, Peng Ze, Zhi Ke, Mu Xiang, Tao Ren, and Xiang Fu.
Xing Xiong Wan (Arisaema and Ligusticum Pill)
Treats women who are fat with excessive Phlegm occupying the Blood Sea, leading to heavy menstrual flow.
Nan Xing (processed, 4 liang), Cang Zhu (soaked in sweet liquid, 4 liang), Chuan Xiong (4 liang), Xiang Fu (steeped in child's urine for three days, stir-fried, 4 liang).
Grind into fine powder. Make pills using steamed bread paste, size of mung beans. Take 100 pills per dose with plain warm water.
Erchen Tang (Two Aged Herbs Decoction)
This decoction is the general manager for treating Phlegm; modifications depend on the guiding herbs chosen.
Chen Pi (1.5 qian), Ban Xia (ginger-processed, 1 qian), Fu Ling (1 qian, remove skin), Gan Cao (honey-fried, 0.6 qian).
Chop into pieces. One dose, boiled in two cups of water with three slices of fresh ginger until reduced to 0.8 cup. Take warm on an empty stomach.
Daotan Tang (Great Phlegm-Resolving Decoction)
Is Erchen Tang plus Nan Xing (pounded, 1 qian) and Zhi Ke (stir-fried, 1 qian).