妇人因情欲房室，以致经脉不调者，其病皆在肾经，此证最多，所当辨而治之。
凡欲念不遂，沉思积郁，心脾气结，致伤冲任之源，而肾气日消，轻则或早或迟，重则
渐成枯闭，此宜兼治心脾肾，以逍遥饮、秘元煎之类主之。若或欲火炽盛，以致真阴日溃者
，宜保阴煎、滋阴八味丸之类主之。若房室纵肆不慎者，必伤冲任之流，而肾气不守，治须
扃固命门，宜固阴煎、秘元煎之类主之。若左肾真阴不足，而经脉不调者，宜左归饮、左归
丸、六味地黄丸之类主之。若右肾真阳不足，而经有不调者，宜右归饮、右归丸、八味地黄
丸之类主之。若思郁不解致病者，非得情舒愿遂，多难取效；房室不慎致病者，使非勇于节
欲，亦难全恃药饵也。
经行腹痛，证有虚实。实者，或因寒滞，或因血滞，或因气滞，或因热滞；虚者，有因
血虚，有因气虚。然实痛者，多痛于未行之前，经通而痛自减；虚痛者，于既行之后，血去
而痛未止，或血去而痛益甚。大都可按可揉者为虚，拒按拒揉者为实。有滞无滞，于此可察
。但实中有虚，虚中亦有实，此当于形气禀质，兼而辨之，当以意察，言不能悉也。
凡妇人经期有气逆作痛，全滞而不虚者，须顺其气，宜调经饮主之，甚者如排气饮之类
亦可用。若血瘀不行，全滞无虚者，但破其血，宜通瘀煎主之。若气血俱滞者，宜失笑散主
之。若寒滞于经，或因外寒所逆，或素日不慎寒凉，以致凝结不行，则留聚为痛而无虚者，
须去其寒，宜调经饮加姜、桂、吴茱萸之类主之，或和胃饮亦可酌用。若血热血燥，以致滞
涩不行而作痛者，宜加味四物汤，或用保阴煎去续断加减主之。以上五证，但察其有滞无虚
，方是真实；若或兼虚，弗得任行克伐。
凡妇人经行作痛，挟虚者多，全实者少，即如以可按拒按及经前经后辨虚实，固其大法
也。然有气血本虚，而血未得行者，亦每拒按，故于经前亦常有此证，此以气虚血滞，无力
流通而然。但察其形证脉息，凡涉虚弱不足，而经滞作痛者，惟用决津煎、五物煎加减主之
，其效如神，或用四神散之类亦可。若痛在经后者，多由血虚，当用大小营煎，随宜加减治
之，或四物、八珍俱可用，然必察其寒热虚实以为佐使，自无不效。其有余滞未行者，惟决
津煎为妙。凡妇人但遇经期则必作痛，或食则呕吐，肢体困倦，或兼寒热者，是必素禀气血
不足，止宜八珍汤、大营煎之类。若虚而寒甚者，宜理阴煎，渐加培补，久必自愈。有因带
浊多而虚痛者，亦宜大、小营煎，随其寒热，加佐使主之。
立斋曰∶前证若风寒伤脾者，六君加炮姜；思虑伤血者，四物加参术；思虑伤气者，归
脾加柴栀；郁怒伤血者，归脾、逍遥兼服。
妇女因情欲或房事不当，导致月经紊乱的病症，其病位都在肾经。这种证候最为常见，应当仔细辨证后进行治疗。
凡是思虑欲望不能实现，沉思积郁，导致心脾之气结滞，从而损伤冲任二脉的源头，致使肾气日渐消损。轻则出现月经提前或推后，重则逐渐发展为经血枯竭、闭经。这种情况适宜同时调理心、脾、肾三脏，以逍遥饮、秘元煎等方剂为主治。如果欲望之火炽盛，导致真阴日渐耗损溃败的，适宜用保阴煎、滋阴八味丸等方剂主治。如果是房事放纵不加谨慎的，必然损伤冲任之流，导致肾气不固守，治疗必须扃固命门（即稳固肾阳根本），适宜用固阴煎、秘元煎等方剂主治。如果是左肾真阴不足，导致经脉不调的，适宜用左归饮、左归丸、六味地黄丸等方剂主治。如果是右肾真阳不足，导致月经不调的，适宜用右归饮、右归丸、八味地黄丸等方剂主治。如果是因思虑郁结不解而致病的，如果不解除情志束缚、满足心愿，大多难以见效；如果是因房事不慎而致病的，如果不勇于节制欲望，也难以完全依赖药物治愈。
经期腹痛，证候有虚证和实证之分。实证，可能是因为寒邪凝滞，可能是因为血行瘀滞，可能是因为气机阻滞，可能是因为热邪阻滞；虚证，有因为血虚的，有因为气虚的。然而实痛，多在月经来潮之前疼痛，经血通畅后疼痛自然减轻；虚痛，在月经行经之后，血液流失但疼痛未停止，或者血液流失后疼痛更加剧烈。大体上，可以按压、揉按缓解疼痛的是虚证，拒绝按压、揉按的是实证。是否有邪气阻滞，通过这一点可以察知。但是实中可能兼有虚，虚中也可能兼有实，这应当结合患者的形体气质和禀赋体质来综合辨别，需要用心体察，言语难以详尽说明。
凡是妇女经期因气逆作痛，完全是气滞而没有虚象的，必须顺理其气，适宜用调经饮主治，严重的如排气饮等也可使用。如果是血瘀不行，完全是血滞而无虚象的，只需破血化瘀，适宜用通瘀煎主治。如果是气血俱滞的，适宜用失笑散主治。如果是寒邪凝滞于经脉，或因外感寒邪侵袭，或平素不慎寒凉饮食，导致凝结不通，停留聚积而疼痛且无虚象的，必须祛除寒邪，适宜用调经饮加生姜、肉桂、吴茱萸等主治，或者和胃饮也可酌情使用。如果是血热血燥，导致涩滞不行而作痛的，适宜用加味四物汤，或用保阴煎去掉续断进行加减主治。以上五种证候，只有察明确实有阻滞而无虚象，才是真实的实证；如果兼有虚象，不得任意使用攻伐类药物。
凡是妇女经期腹痛，挟带虚证的较多，纯实证的较少。即使像通过是否可按压以及经前经后来辨别虚实，虽然是基本法则。但是有气血本已虚弱，而血液尚未畅行的，也常常表现为拒绝按压，所以在经前也常有此证，这是因气虚血滞，无力推动血液流通所致。只要察知患者的形证脉息，凡是涉及虚弱不足的，以及因经血阻滞而作痛的，只需用决津煎、五物煎加减主治，效果神奇，或者用四神散等也可。如果疼痛发生在月经行经之后，多由血虚引起，应当用大营煎、小营煎，根据情况加减治疗，或者四物汤、八珍汤都可以使用，但必须察明寒热虚实作为佐使药配合，自然没有不有效的。如果有其余的阻滞未消除的，只有决津煎最为巧妙。凡是妇女每逢经期必定作痛，或者进食则呕吐，肢体困倦，或者兼有寒热症状的，这一定是素日禀赋气血不足，只适宜用八珍汤、大营煎等。如果是虚而寒邪严重的，适宜用理阴煎，逐渐加以培补，时间久了必然自愈。有因白带浊多而导致虚痛的，也适宜用大营煎、小营煎，根据其寒热情况，加入佐使药主治。
薛立斋说：上述证候如果是风寒损伤脾气的，用六君子汤加炮姜；如果是思虑损伤血分的，用四物汤加人参、白术；如果是思虑损伤气分的，用归脾汤加柴胡、栀子；如果是郁怒损伤血分的，归脾汤与逍遥散兼服。
Women whose menstruation is irregular due to emotional desires or improper sexual activity, the pathology lies in the Kidney Meridian. This syndrome is very common and must be differentiated and treated accordingly.
Whenever desires are unfulfilled, leading to deep contemplation and accumulated depression, causing Qi stagnation in the Heart and Spleen, the source of the Chong and Ren vessels is damaged, and Kidney Qi gradually diminishes. Mild cases may present with early or delayed menstruation, while severe cases may gradually develop into amenorrhea (absence of menstruation) due to depletion. In such cases, it is appropriate to treat the Heart, Spleen, and Kidney simultaneously, primarily using formulas such as Xiaoyao Yin (Free and Easy Wanderer Decoction) or Miyuan Jian (Secret Origin Decoction). If desire fire is blazing, causing daily erosion of True Yin, Baoyin Jian (Preserve Yin Decoction) or Ziyin Bawei Wan (Nourish Yin Eight-Ingredient Pill) should be used. If sexual activity is unrestrained and careless, it inevitably damages the flow of the Chong and Ren vessels, causing Kidney Qi to fail to hold fast. Treatment must secure the Gate of Life (Mingmen), primarily using Guyin Jian (Secure Yin Decoction) or Miyuan Jian. If True Yin of the Left Kidney is insufficient, leading to menstrual irregularity, Zuogui Yin (Left Return Decoction), Zuogui Wan (Left Return Pill), or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) are appropriate. If True Yang of the Right Kidney is insufficient, leading to menstrual irregularity, Yougui Yin (Right Return Decoction), Yougui Wan (Right Return Pill), or Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) are appropriate. For diseases caused by unresolved mental depression, unless emotional constraints are lifted and wishes fulfilled, efficacy is difficult to achieve; for diseases caused by careless sexual behavior, unless one courageously restricts sexual desire, reliance on medicinal herbs alone is unlikely to succeed.
Abdominal pain during menstruation presents as either Deficiency (Xu) or Excess (Shi). Excess patterns may result from Cold stagnation, Blood stasis, Qi stagnation, or Heat stagnation; Deficiency patterns may result from Blood deficiency or Qi deficiency. Generally, Excess pain occurs before menstruation begins and subsides once the flow is established; Deficiency pain occurs after menstruation has started, persisting despite blood loss, or even intensifying after blood loss. Broadly speaking, pain that can be relieved by pressure or massage indicates Deficiency, whereas pain that rejects pressure or massage indicates Excess. The presence or absence of stagnation can be observed through this method. However, Excess may contain Deficiency, and Deficiency may contain Excess; these must be differentiated by considering the patient's physical constitution and innate endowment, requiring careful observation beyond mere words.
For women experiencing abdominal pain during menstruation due to Qi reversal, where there is complete stagnation without Deficiency, Qi must be regulated, primarily using Tiaojing Yin (Regulate Menstruation Decoction); for severe cases, Paixi Jian (Expel Gas Decoction) may also be used. If Blood stasis prevents flow, with complete stagnation and no Deficiency, only blood-breaking methods are needed, primarily using Tongyu Jian (Unblock Stasis Decoction). If both Qi and Blood are stagnant, Shixiao San (Laughing Without Pain Powder) is appropriate. If Cold stagnates in the meridians, whether due to external Cold invasion or habitual exposure to cold/dampness, leading to coagulation and stagnation causing pain without Deficiency, Cold must be dispelled, primarily using Tiaojing Yin added with Shengjiang (Fresh Ginger), Rougui (Cinnamon Bark), and Wuzhuyu (Evodia Fruit); Hewei Yin (Harmonize Stomach Decoction) may also be considered. If Blood Heat and dryness cause stagnation and pain, Jiawei Siwu Tang (Modified Four Substances Decoction) or Baoyin Jian minus Xuduan (Dioscorea Hypoglauca) with modifications should be used. For the above five Excess patterns, only when stagnation is confirmed without Deficiency is it a true Excess pattern; if Deficiency is present, harsh purgative or attacking methods must not be used indiscriminately.
In general, menstrual abdominal pain involves Deficiency more often than pure Excess. Although distinguishing Deficiency and Excess via tenderness to pressure and timing (pre- vs. post-menstruation) is a fundamental rule, there are cases where innate Qi and Blood are deficient, yet Blood has not yet flowed smoothly, resulting in rejection of pressure even before menstruation. This is due to Qi deficiency and Blood stagnation, lacking the power to circulate freely. By observing physical signs, symptoms, and pulse, if weakness is evident and pain is associated with menstrual stagnation, Juejin Jian (Resolve Vessel Decoction) or Wuwu Jian (Five Elements Decoction) with modifications should be used, yielding miraculous results; Sishen San (Four Divine Powder) may also be used. If pain occurs after menstruation, it is mostly due to Blood deficiency; Daying Jian (Great Camp Decoction) or Xiaoying Jian (Small Camp Decoction) should be used with modifications, or Siwu Tang (Four Substances Decoction) and Bazhen Tang (Eight Treasures Decoction) may be employed, provided that Cold/Heat and Deficiency/Excess are assessed to select appropriate adjuvant herbs, ensuring efficacy. For residual stagnation, Juejin Jian is particularly effective. For women who invariably experience pain during menstruation, accompanied by vomiting after eating, limb fatigue, or alternating chills and fever, this indicates innate insufficiency of Qi and Blood; only Bazhen Tang or Daying Jian should be used. For Deficiency with severe Cold, Liyin Jian (Regulate Yin Decoction) should be used to gradually tonify and nourish, leading to spontaneous recovery over time. For Deficiency pain associated with excessive leukorrhea, Daying Jian or Xiaoying Jian should be used, adding adjuvant herbs based on Cold/Heat differentiation.
Xue Lizai stated: For the aforementioned conditions, if Wind-Cold damages the Spleen, use Liujunzi Tang plus Paojiang (Roasted Ginger); if Overthinking damages Blood, use Siwu Tang plus Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala); if Overthinking damages Qi, use Guipi Tang plus Chaihu (Bupleurum) and Zhizi (Gardenia); if Frustration/Anger damages Blood, combine Guipi Tang with Xiaoyao San.