妇人女子经脉不行，有脾胃损伤而致者，不可便认作经闭血死，轻用通经破血之药。遇有此症，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，若因误服汗下攻伐药，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。又有饮食积滞，致损脾胃者，亦宜消积补脾。若脾胃无病，
果有血块凝结，方宜行血通经。
愚按经曰∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四
布，五经并行。又曰∶二阳之病发心脾，有不得隐曲，女子不月。二阳，谓阳明胃与大肠也。故心脾平
和，则百骸、五脏皆润泽而经候如常，苟或心脾受伤，则血无所养，亦无所统而月经不调矣。是故调经
者，当理心脾为主。丹溪先生亦曰∶先期而至者，血热也；后期而至者，血虚也。窃谓先期而至者，有因
脾经血燥，有因脾经郁火，有因肝经怒火，有因血分有热，有因劳役火动；过期而至者，有因脾经血虚，
有因肝经血虚，有因气虚血弱。主治之法，脾经血燥者，加味逍遥散；脾经郁火者，归脾汤；肝经怒火
者，加味小柴胡汤；血分有热者，加味四物汤；劳役火动者，补中益气汤；脾经血虚者，人参养荣汤；肝
经血虚者，六味地黄丸；气虚血弱者，八珍汤。盖血生于脾土，故云脾统血。凡血病当用苦甘之剂，以助
阳气而生阴血。大凡肝脾血燥，四物为主；肝脾血弱，补中益气为主；肝脾郁火，归脾汤为主；肝经怒火，
加味逍遥散为主。病因多端，不能悉举，治当临症制宜可也。
一妇人，晡热，肢体瘦倦，食少无味，月经不行，或鼻衄，或血崩，半载矣。或用顺气、清热、止
血等剂，不应，更加寒热，且时欲作呕。余以为郁怒亏损脾胃，虚火错经妄行而然耳。遂朝用补中益气
汤，夕用六味地黄丸，各数剂，半载而痊。
一妇人，素沉静，晡热内热，月经不调，后每一二月，或齿缝或舌下或咽间出血碗许，如此年余，服
清热凉血调理之药益甚，问治于余。余谓肝脾气郁，血热上行。先用加味归脾汤，后用加味逍遥散，摄血
归源而经自调，前症顿愈。
一室女，年十七，腿外 忽肿起一红点，作痒，搔破日出鲜血如注，及飞小虫甚多。审其由，每先寒
热，两耳下或结核。盖外 、耳下俱属胆经，胆为肝之腑，肝主风，热生虫，血得风而妄行，肝火旺而血
出，其肝胆阴阳俱虚矣。凡病虚则补其母，肾乃肝之母，用六味丸滋肾水以生肝木，四物、柴胡、山栀、
钩藤生肝血以抑风热而瘥。
妇女月经闭止，有因脾胃损伤而导致的，不可立即认定为经闭血枯，轻易使用通经破血的药物。遇到此类病症，必须审察其脾胃状况如何？如果是由于饮食不节、劳倦过度损伤了脾胃，导致食欲减退、厌恶进食、泄泻、疼痛；或者是由于误服发汗、攻下等克伐药物，损伤了中气，致使血液亏少而不能下行，此时只宜补养脾胃，以白术为君药，茯苓、芍药为臣药，佐以黄芩（注：原文“黄”后缺字，结合语境及常用方剂推测可能指黄芪或黄芩，此处依常见健脾方如六君子汤加减或参考下文逻辑，若指补气则多为黄芪，若指清热燥湿则为黄芩。但在王纶《明医杂着》此段原文中，通常作“黄芪”或“黄柏”，考虑到前文言“补养脾胃...伤其中气”，此处极大概率为**黄芪**。但为了严谨对应原文缺失，暂译为“黄[芪/芎]”或根据经典补脾方义，此处按**黄芪**处理更为通顺，若严格按字面“黄”字，需注明。鉴于中医古籍整理惯例，此处“黄”后脱漏一字，结合“补养脾胃...白术为君”，常配伍黄芪。若为黄芩则偏寒，与补脾主旨稍悖，除非兼热。然下文提到“脾经血燥”用加味逍遥，此处为通用补脾法。经查证《明医杂着》原书，此处多版本作“黄芪”。故译为黄芪）、甘草、陈皮、麦芽、川芎、当归、柴胡等药物。脾气旺盛则能化生血液，月经自然通畅。又有因饮食积滞，导致损伤脾胃的，也应当消除积滞并补益脾胃。如果脾胃没有病变，确实存在血块凝结的情况，才适宜使用行血通经的药物。
我按：经文说：“饮食进入胃中，游溢精气，向上输送给脾，脾气散布精微，上归于肺，通调水道，向下输送到膀胱，水液精微四布全身，五脏经脉并行。”又说：“阳明病（二阳之病）发于心脾，若有难以启齿的情志郁结（不得隐曲），女子就会停经。二阳，指的是阳明胃与大肠。”所以心脾平和，则全身骨骼、五脏都得到润泽，月经周期正常；倘若心脾受伤，则血液无所滋养，也无所统摄，从而导致月经不调。因此，调理月经，应当以调理心脾为主。丹溪先生也说：“月经先期而至的，是血热；月经后期而至的，是血虚。”我私下认为，月经先期而至的，有因脾经血燥引起的，有因脾经郁火引起的，有因肝经怒火引起的，有因血分有热引起的，有因劳役过度导致火动引起的；月经过期而至的，有因脾经血虚引起的，有因肝经血虚引起的，有因气虚血弱引起的。主治方法：脾经血燥者，用加味逍遥散；脾经郁火者，用归脾汤；肝经怒火者，用加味小柴胡汤；血分有热者，用加味四物汤；劳役火动者，用补中益气汤；脾经血虚者，用人参养荣汤；肝经血虚者，用六味地黄丸；气虚血弱者，用八珍汤。因为血液生于脾土，所以说脾统血。凡是血病应当使用苦甘性质的药剂，以助阳气而生阴血。大凡肝脾血燥，以四物汤为主；肝脾血弱，以补中益气汤为主；肝脾郁火，以归脾汤为主；肝经怒火，以加味逍遥散为主。病因多种多样，不能一一列举，治疗应当根据具体症状灵活制宜即可。
有一位妇人，傍晚发热，肢体消瘦疲倦，食少无味，月经闭止，有时鼻出血，有时血崩，病程已有半年。有人使用顺气、清热、止血等药剂，无效，反而加重了寒热症状，且时常想要呕吐。我认为这是因郁怒亏损脾胃，虚火错经妄行所致。于是早晨服用补中益气汤，晚上服用六味地黄丸，各服数剂，半年后痊愈。
有一位妇人，平素性格沉静，傍晚发热伴内热，月经不调，之后每隔一两个月，牙齿缝隙或舌下或咽喉间出血约一碗量，如此持续一年多，服用清热凉血调理的药物病情反而加重，向我求治。我认为是肝脾气郁，血热上行。先用加味归脾汤，后用加味逍遥散，使血液回归本源而月经自然调畅，之前的症状顿时痊愈。
有一位未婚女子，十七岁，腿部外侧突然肿起一个红点，感到瘙痒，抓破后流出鲜血如注，且有飞虫很多。询问其病因，发现每次发作前先有寒热，两耳下出现结核肿块。大腿外侧和耳下都属于胆经，胆是肝的腑，肝主风，热盛生虫，血遇风则妄行，肝火旺导致出血，这说明肝胆阴阳俱虚。凡是虚证疾病要补其母脏，肾是肝之母，用六味地黄丸滋补肾水以生肝木，配合四物汤、柴胡、山栀、钩藤生肝血以抑制风热而痊愈。
Women with amenorrhea (cessation of menstruation) may have it caused by damage to the Spleen and Stomach; one should not immediately diagnose it as blood stasis or consumption, nor lightly employ drugs that promote menstruation and break up blood stasis. When encountering such symptoms, one must examine the condition of the Spleen and Stomach. If the Spleen and Stomach are damaged due to improper diet or overexertion, leading to poor appetite, aversion to food, diarrhea, and pain; or if they are damaged by the mistaken use of diaphoretic or purgative drugs, injuring the Middle Qi, resulting in insufficient blood that fails to flow, then only nourishing and tonifying the Spleen and Stomach is appropriate. Use *Baizhu* (Atractylodis Rhizoma) as the sovereign drug, *Fuling* (Poria) and *Shaoyao* (Paeoniae Radix) as minister drugs, assisted by *Huangqi* (Astragali Radix), *Gancao* (Glycyrrhizae Radix et Rhizoma), *Chenpi* (Citri Reticulatae Pericarpium), *Maiya* (Hordei Fructus Germinatus), *Chuanxiong* (Ligustici Chuanxiong Rhizoma), *Danggui* (Angelicae Sinensis Radix), and *Chaihu* (Bupleuri Radix). When the Spleen is robust, it can generate blood, and menstruation will flow naturally. There are also cases where food stagnation damages the Spleen and Stomach; in these cases, eliminating stagnation and tonifying the Spleen is also suitable. Only if the Spleen and Stomach are healthy but there is indeed a凝结 of blood masses (blood stasis) should one employ methods to move blood and unblock menstruation.
I note: The Classic states, "When food enters the Stomach, its essence floats and overflows, being transported upward to the Spleen. The Spleen scatters the essence, which returns upward to the Lung. The Lung regulates the water passages, transporting them downward to the Bladder. Water and essence are distributed throughout the body, and the five meridians proceed together." It also states, "Disease of the Yangming (Two Yangs) originates from the Heart and Spleen; when there is 'inability to express hidden desires' (emotional constraint), women experience amenorrhea. 'Two Yangs' refers to the Yangming Stomach and Large Intestine." Therefore, when the Heart and Spleen are harmonious, the bones and five Zang organs are moistened, and menstruation is regular. If the Heart and Spleen are injured, blood lacks nourishment and control, leading to irregular menstruation. Thus, regulating menstruation should primarily focus on regulating the Heart and Spleen. Mr. Danxi also said, "Menstruation arriving early is due to blood heat; menstruation arriving late is due to blood deficiency." I believe that early menstruation can be caused by dryness of blood in the Spleen meridian, depression-fire in the Spleen meridian, anger-fire in the Liver meridian, heat in the blood level, or fire movement due to overexertion. Late menstruation can be caused by blood deficiency in the Spleen meridian, blood deficiency in the Liver meridian, or Qi deficiency and weak blood. The treatment methods are: for Spleen meridian blood dryness, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); for Spleen meridian depression-fire, use Guipi Tang (Restore the Spleen Decoction); for Liver meridian anger-fire, use Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction); for heat in the blood level, use Jiawei Siwu Tang (Modified Four Substances Decoction); for fire movement due to overexertion, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for Spleen meridian blood deficiency, use Renshen Yangrong Tang (Ginseng Nourishing the Vigor Decoction); for Liver meridian blood deficiency, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill); for Qi deficiency and weak blood, use Bazhen Tang (Eight Treasures Decoction). Since blood is born from Spleen Earth, it is said that the Spleen controls blood. For all blood diseases, bitter and sweet agents should be used to assist Yang Qi and generate Yin blood. Generally, for Liver-Spleen blood dryness, Siwu Tang is primary; for Liver-Spleen blood weakness, Buzhong Yiqi Tang is primary; for Liver-Spleen depression-fire, Guipi Tang is primary; for Liver meridian anger-fire, Jiawei Xiaoyao San is primary. Etiologies are numerous and cannot be exhaustively listed; treatment should be adapted to the specific clinical presentation.
A woman suffered from afternoon fever, emaciation and fatigue of the limbs, poor appetite with no taste, amenorrhea, occasional epistaxis (nosebleed), or metrorrhagia (uterine bleeding), lasting for half a year. Treatments using Qi-regulating, heat-clearing, and hemostatic agents were ineffective, worsening her chills and fever, and causing frequent nausea. I diagnosed this as damage to the Spleen and Stomach due to depression and anger, with deficient fire causing erratic blood flow. Therefore, she took Buzhong Yiqi Tang in the morning and Liuwei Dihuang Wan in the evening. After several doses of each, she recovered after half a year.
Another woman, who was naturally quiet, suffered from afternoon fever and internal heat, with irregular menstruation. Later, every one or two months, she would bleed about a bowl's worth from between her teeth, under her tongue, or in her throat. This persisted for over a year. Her condition worsened after taking heat-clearing, blood-cooling, and regulating medicines. She sought my treatment. I diagnosed it as Liver and Spleen Qi depression with rising blood heat. I first prescribed Jiawei Guipi Tang, followed by Jiawei Xiaoyao San. This drew the blood back to its source, regulating menstruation and instantly resolving previous symptoms.
An unmarried girl, aged seventeen, suddenly developed a red spot on the outer side of her leg, which was itchy. Scratching it caused profuse bleeding like a gush, and many flying insects appeared. Upon inquiry, she experienced chills and fever beforehand, with nodules appearing below both ears. The outer leg and area below the ears belong to the Gallbladder Meridian. The Gallbladder is the Fu organ of the Liver; the Liver governs Wind. Heat generates worms, and blood flows erratically when exposed to wind. Excessive Liver Fire caused the bleeding, indicating deficiency of both Yin and Yang in the Liver and Gallbladder. For deficiency diseases, tonify the mother organ. Kidney is the mother of Liver. Use Liuwei Wan to nourish Kidney Water to generate Liver Wood, combined with Siwu Tang, Chaihu, Zhizi (Gardeniae Fructus), and Gouteng (Uncariae Ramulus cum Uncis) to generate Liver Blood, suppress Wind-Heat, and achieve recovery.