准绳云∶妇人月水不断，淋沥无时，或因劳损气血，而伤冲任，或因经行而合阴阳
，皆令气虚不能摄血。若时止时行，腹痛脉沉细，此寒热邪气客于胞中，非因虚弱也。薛氏
曰∶前证若郁结伤脾，用归脾汤；恚怒伤肝，用逍遥散；肝火妄动，用加味四物汤；脾气虚
弱，用六君子汤；元气下陷，用补中益气汤；热伤元气，前汤加五味、麦门冬、炒黑黄柏。
产宝云∶男子生于寅，寅属木，阳中有阴，故男子得八数；女子生于申，申属金，
阴中有阳，故女子得七数。男以气为主，八八则卦数已尽；女以血为主，七七则卦数已终。
终则经水绝，冲任脉虚衰，天癸绝，地道不通，而无子矣。或劳伤过度，喜怒不时，经脉衰
微之际，又为邪气攻冲，所以当止不止而崩下也。许学士云∶妇人经脉过期不止，腰腹疼痛
，或七七数尽而月经下者，宜用当归散治之。
产宝云∶经水者，行血气通阴阳，以荣于身者也。气血盛，阴阳和，则形体通。或
外亏卫气之充养，内乏荣血之灌溉，血气不足，经候欲行，身体先痛也。（此论身痛）
良方云∶妇人经来腹痛，由风冷客于胞络冲任，或伤于太阳少阴经，用温经汤、桂
枝桃仁汤。若忧思气郁而血滞，用桂枝桃仁汤、地黄通经丸。若血结而成块 ，用万病丸。
丹溪云∶经水将来作痛者，血实也，一云气滞，四物汤加桃仁、香附、黄连。临行时腰
疼腹痛，乃是郁滞有瘀血，四物汤加红花、桃仁、莪术、玄胡索、木香，有热加黄芩、柴胡
（有加香附、青皮、桃仁、乌药、丹皮、小茴、五灵脂者）。经行后作痛者，血气俱虚也，以八珍汤加减服。戴氏曰∶
经事来而腹痛者，经事不来而腹
亦痛者，皆血之不调故也。欲调其血，先调其气，四物汤加吴茱萸半钱，香附子一钱；和气
饮加吴茱萸半钱亦可。痛甚者，玄胡索汤（格致工夫，更进一层）。然又恐感外邪，伤饮食致痛，痛不因血，尤宜详
审，和气饮却能兼治。因冷而积，因积而痛，宜大温经汤，冷甚者，去麦门冬不用。
汪石山治一妇人，瘦小，年二十余，经水紫色，或前或后，临行腹痛，恶寒喜热，或时
感寒，腹亦作痛，脉皆细濡近滑，两尺重按略洪而滑，此血热也，或谓恶寒如此，何谓为热
？曰∶热极似寒也。遂用酒煮黄连四两，香附、归身尾各二两，五灵脂一两，为末，粥丸，空
腹吞之而愈（此全以脉为主，不然亦非此药可愈）。一妇年二十一岁，六月经行，腹痛如刮，难忍求死。脉得细软而快，
尺则沉弱而近快，汪曰∶细软属湿，数则为热，尺沉属郁滞也。以酒煮黄连半斤，炒香附六两，五灵
脂（半炒半生）三两，归身尾二两，为末，粥丸，空心汤下三四钱，服至五六料，越九年得一
子。后屡服屡效，历十五年后，前药罔效（中病则止，不尽剂，岂可久服。经曰毋使过之，伤其正也）。汪复诊之，脉
皆洪滑无力，幸其尚有精神。汪曰
∶此非旧日比矣，旧乃郁热，今则虚寒，东垣曰，始为热中，终为寒中是也。经曰∶脉至而
从，按之不鼓，乃阴盛格阳，当作寒治，且始病时而形敛小，今则形肥大矣。书曰∶瘦人血
热，肥人血虚，岂可同一治也。所可虑者，汗大泄，而脉不为汗衰，血大崩，而脉不为血减耳（二句俱欠妥，惟伤寒
有邪，故不为汗衰者不治，此惟血脱阳无所附，故脉无力，不当言不为血减）。其痛日重夜轻，知由阳虚不能健运，
故亦凝滞而作痛。以证参脉，宜用助阳，若得脉减痛轻，方为佳兆。遂投参、 、归、术大剂，加桂、附一帖。来早再
诊，脉皆稍宁，服至二三十帖，病且愈（亦是寒凉太过，所谓以药医药也，故可服此温补之剂，三十帖愈）。盖病有始
终寒热之异，药有前后用舍不同，形有肥瘦壮少不等，岂可以一方而通治哉。
《准绳》说：妇女月经淋漓不断，没有休止的时候，有的因为劳累损伤了气血，从而伤害了冲脉和任脉；有的在行经期间进行房事，这些情况都会导致气虚不能统摄血液。如果月经时断时续，伴有腹痛、脉象沉细，这是寒热邪气侵袭胞宫所致，并非因为身体虚弱。薛己说：上述症状如果是因郁结伤脾引起的，用归脾汤治疗；因愤怒伤肝引起的，用逍遥散治疗；肝火妄动引起的，用加味四物汤治疗；脾气虚弱引起的，用六君子汤治疗；元气下陷引起的，用补中益气汤治疗；热邪损伤元气引起的，在前述方剂基础上加入五味子、麦门冬、炒黑黄柏。
《产宝》说：男子生于寅年（或寅时），寅属木，阳中有阴，所以男子以八为基数（如八八六十四岁）；女子生于申年（或申时），申属金，阴中有阳，所以女子以七为基数（如七七四十九岁）。男子以气为主，到了八八之数，卦数已尽；女子以血为主，到了七七之数，卦数已终。终结后月经停止，冲脉和任脉虚衰，天癸枯竭，生殖之道不通，就不能生育了。或者因为过度劳累损伤，喜怒无常，在经脉衰微之际，又受到邪气冲击，所以当止不止而崩漏下血。许叔微说：妇女月经过期不止，伴有腰腹疼痛，或者是七七之数已尽而月经仍来潮的，适宜用当归散治疗。
《产宝》说：月经是运行气血、沟通阴阳，以滋养身体的。气血旺盛，阴阳调和，则形体通畅。如果外卫之气不足，内营之血匮乏，气血不足，月经将要来时，身体先出现疼痛。（这是论述身体疼痛）
《良方》说：妇女经期腹痛，是因为风寒湿冷邪气客居胞络和冲任二脉，或者损伤了太阳经和少阴经，可用温经汤、桂枝桃仁汤治疗。如果是忧思气郁导致血行不畅，用桂枝桃仁汤、地黄通经丸治疗。如果是血结形成肿块，用万病丸治疗。
朱丹溪说：月经将来时作痛的，属于血实，也有说是气滞，可用四物汤加桃仁、香附、黄连。临行经时腰痛腹痛，乃是郁滞有瘀血，可用四物汤加红花、桃仁、莪术、玄胡索、木香，有热象的加黄芩、柴胡（也有加香附、青皮、桃仁、乌药、丹皮、小茴、五灵脂的）。经行结束后作痛的，是气血俱虚，用八珍汤加减服用。戴元礼说：月经来潮时腹痛的，月经不来时腹部也痛的，都是血不调和的缘故。想要调血，先要调气，可用四物汤加吴茱萸半钱，香附子一钱；和气饮加吴茱萸半钱也可以。疼痛严重的，用玄胡索汤（格致工夫，更进一层）。然而又恐怕感受外邪、饮食损伤导致疼痛，这种痛不是由血引起的，尤其需要详细审察，和气饮却能兼治。因寒冷积滞，因积滞而痛，宜用大温经汤，寒冷严重的，去掉麦门冬不用。
汪石山治疗一位妇人，身材瘦小，二十多岁，月经颜色紫暗，或提前或推后，临行经时腹痛，恶寒喜热，有时受寒，腹部也会作痛，脉象皆细濡近滑，两尺部重按略洪而滑，这是血热证。有人问：如此恶寒，怎么能说是热呢？回答说：热极似寒。于是用酒煮黄连四两，香附、当归身尾各二两，五灵脂一两，研为末，用米粥做丸，空腹吞服而痊愈（此案完全以脉象为主，否则也不是此药能治愈的）。另一位妇人二十一岁，六月行经，腹痛如刮，难以忍受求死。脉象细软而快，尺部沉弱而近快，汪石山说：细软属湿，数则为热，尺沉属郁滞。用酒煮黄连半斤，炒香附六两，五灵脂（半炒半生）三两，当归身尾二两，研为末，用米粥做丸，空腹用汤药送下三四钱，服用至五六料，过了九年才得一子。后来屡服屡效，过了十五年后，前面的药不再有效（中病即止，不吃完所有药剂，怎么可以久服。经书说不要超过限度，以免损伤正气）。汪石山再次诊治，脉象皆洪滑无力，幸好她还有精神。汪石山说：这已经不是以前的情况了，以前是郁热，现在是虚寒，李东垣说，始为热中，终为寒中。经书说：脉至而从，按之不鼓，乃阴盛格阳，当作寒证治疗，况且发病时形体瘦小，现在形体肥大了。书说：瘦人血热，肥人血虚，怎么能用同样的方法治疗呢？所担心的是，大汗出而脉不因汗出而减弱，大出血而脉不因失血而减少（这两句都不妥当，只有伤寒有邪气，故不因汗衰者不治，这里只是血脱阳无所附，故脉无力，不当说不因血减）。她的疼痛白天重晚上轻，知道是由阳虚不能健运，所以凝滞而作痛。结合症状参看脉象，适宜用助阳法，如果脉象减轻、疼痛缓解，才是好兆头。于是投用人参、[缺字]、当归、白术的大剂量，加上肉桂、附子一帖。第二天早上再诊，脉象稍安宁，服用至二三十帖，病就好了（也是因为之前寒凉太过，所谓以药医药，所以可以服用此温补之剂，三十帖痊愈）。疾病有开始和结束，寒热有差异，药物有前后使用的不同，形体有肥瘦壮少的不等，怎么能用一方通治呢。
*Zhunsheng* states: Women suffering from continuous menstruation, dripping without cessation, may have this due to fatigue damaging Qi and Blood, thereby injuring the Chong and Ren vessels. Alternatively, engaging in sexual intercourse during menstruation can also lead to Qi deficiency failing to control the blood. If the bleeding stops and starts intermittently, accompanied by abdominal pain and a deep, fine pulse, this is caused by cold-heat pathogenic factors invading the uterus, not due to weakness. Xue Ji stated: For the aforementioned symptoms, if caused by emotional stagnation injuring the Spleen, use Guipi Tang (Restore the Spleen Decoction); if caused by anger injuring the Liver, use Xiaoyao San (Free and Easy Wanderer Powder); if caused by hyperactive Liver Fire, use Jiawei Siwu Tang (Modified Four Substances Decoction); if caused by Spleen Qi deficiency, use Liujunzi Tang (Six Gentlemen Decoction); if caused by sinking of Yuan Qi (Original Qi), use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if heat injures Yuan Qi, add Wuweizi (Schisandra Fruit), Maidong (Ophiopogon Tuber), and Chaohei Huangbai (Charred Phellodendron Bark) to the previous decoctions.
*Chanbao* states: Men are born in Yin years (or hours), where Yin belongs to Wood, containing Yin within Yang; thus, men follow the number eight (e.g., cycles of eight). Women are born in Shen years (or hours), where Shen belongs to Metal, containing Yang within Yin; thus, women follow the number seven (e.g., cycles of seven). Men prioritize Qi; upon reaching the age of 8x8 (64 years), their cycle numbers are exhausted. Women prioritize Blood; upon reaching the age of 7x7 (49 years), their cycle numbers end. Once ended, menstruation ceases, the Chong and Ren vessels become deficient and weak, Tian Gui (Heavenly Water/Reproductive Essence) is exhausted, the reproductive pathway is blocked, and conception becomes impossible. Or, due to excessive labor injury and irregular emotions, when the meridians are already declining, further attack by pathogenic factors causes menstruation that should stop to continue as metrorrhagia. Xu Shuwei stated: For women with overdue menstruation that does not stop, accompanied by lower back and abdominal pain, or those who have reached the age of 49 but still menstruate, Danggui San (Angelica Powder) is appropriate.
*Chanbao* states: Menstruation circulates Qi and Blood, communicates Yin and Yang, and nourishes the body. When Qi and Blood are abundant and Yin and Yang are harmonious, the physical form is unobstructed. If external Wei Qi (Defensive Qi) lacks nourishment and internal Ying Blood (Nutritive Blood) lacks irrigation, resulting in insufficient Qi and Blood, the body may experience pain before the onset of menstruation. (This discusses body pain.)
*Liangfang* states: Abdominal pain during menstruation in women is caused by Wind-Cold-Dampness pathogens lodging in the Bao Luo (Uterine Collaterals) and Chong and Ren vessels, or injuring the Taiyang and Shaoyin meridians. Wenyang Tang (Warm the Meridians Decoction) or Guizhi Taoren Tang (Cinnamon Twig and Peach Kernel Decoction) can be used. If worry and thought cause Qi stagnation leading to Blood stasis, Guizhi Taoren Tang or Dihuang Tongjing Wan (Rehmannia Menstruation-Unblocking Pill) is used. If Blood coagulation forms masses, Wanbing Wan (Ten Thousand Diseases Pill) is used.
Zhu Danxi stated: Pain occurring before menstruation indicates Blood Excess, or sometimes Qi Stagnation; Siwu Tang (Four Substances Decoction) added with Taoren (Peach Kernel), Xiangfu (Cyperus Rhizome), and Huanglian (Coptis Rhizome) can be used. Lower back and abdominal pain during the flow of menstruation indicates stagnation with Blood Stasis; Siwu Tang added with Honghua (Safflower), Taoren, Ezhu (Curcuma Rhizome), Yanhusuo (Corydalis Rhizome), and Muxiang (Aucklandiae Radix) can be used. If there is Heat, add Huangqin (Scutellaria Root) and Chaihu (Bupleurum Root) [some add Xiangfu, Qingpi (Green Tangerine Peel), Taoren, Wuyao (Lindera Root), Danpi (Moutan Cortex), Xiaohui (Fennel Seed), and Wulingzhi (Trogopterus Dung)]. Pain occurring after menstruation indicates deficiency of both Qi and Blood; Bazhen Tang (Eight Treasures Decoction) modified can be taken. Dai Yuanli stated: Abdominal pain during menstruation, or abdominal pain when menstruation does not occur, are both due to irregular Blood. To regulate Blood, one must first regulate Qi. Siwu Tang added with Wuzhuyu (Evodia Fruit) half qian and Xiangfuzi (Cyperus Fruit) one qian can be used; Heqi Yin (Harmonizing Qi Decoction) added with Wuzhuyu half qian is also acceptable. For severe pain, Xuanhusuo Tang (Corydalis Decoction) is used. However, one must also consider pain caused by external pathogens or dietary injury, which is not due to Blood issues; such cases require careful examination, whereas Heqi Yin can treat multiple causes. For pain caused by Cold accumulation, Da Wenyang Tang (Great Warm the Meridians Decoction) is suitable. For severe Cold, Maidong should be omitted.
Wang Shishan treated a woman, small in stature, over twenty years old, with purple menstrual blood, irregular timing (early or late), abdominal pain before flow, aversion to cold preferring warmth, occasional cold invasion causing abdominal pain. Her pulse was fine, soggy, and near slippery; the two Chi positions were slightly surging and slippery upon heavy pressure, indicating Blood Heat. Someone asked: "How can this be Heat given the severe aversion to cold?" Wang replied: "Extreme Heat resembles Cold." He prescribed Jiu Zhu Huanglian (Wine-Boiled Coptis) four liang, Xiangfu and Danggui Shenwei (Danggui root tip and tail) two liang each, and Wulingzhi one liang, ground into powder, made into pills with rice congee, and swallowed on an empty stomach, resulting in cure. (This case relied entirely on pulse diagnosis; otherwise, this prescription would not have cured it.) Another woman, twenty-one years old, experienced menstruation in the sixth month with unbearable scraping-like abdominal pain. Her pulse was fine, soft, and rapid; the Chi position was deep, weak, and near rapid. Wang said: "Fine and soft indicates Dampness; rapid indicates Heat; deep Chi indicates stagnation." He prescribed Jiu Zhu Huanglian half jin, Chao Xiangfu six liang, Wulingzhi (half fried, half raw) three liang, and Danggui Shenwei two liang, ground into powder, made into pills with rice congee, taken with warm water on an empty stomach, three to four qian per dose. After five or six courses, she conceived nine years later. It remained effective for many years, but after fifteen years, the previous medicine lost efficacy. (Stop medication once the disease is addressed; do not finish all doses unnecessarily. The Classic says: Do not exceed the limit, lest you damage healthy Qi.) Wang re-examined her; the pulse was surging, slippery, and powerless, though she retained spirit. Wang said: "This is no longer the same as before. Previously it was Depressed Heat; now it is Deficiency Cold. Li Dongyuan said: Initially Heat Zhong, finally Cold Zhong." The Classic says: "When the pulse follows but does not throb under pressure, it is Yin Excess repelling Yang, and should be treated as Cold. Moreover, initially the body was thin; now it is fat." Books state: Thin people have Blood Heat; fat people have Blood Deficiency. How can they be treated identically? What is concerning is profuse sweating without the pulse weakening, or massive hemorrhage without the pulse diminishing due to blood loss. (These two statements are flawed; only in Shanghan with pathogens does the pulse not weaken with sweat indicate untreatability; here, Yang has no attachment due to Blood loss, hence the powerless pulse. It is incorrect to say the pulse does not diminish due to blood loss.) Her pain was heavier by day and lighter by night, indicating Yang Deficiency failing to move normally, leading to stagnation and pain. Correlating symptoms with the pulse, Yang-tonifying therapy is appropriate. If the pulse softens and pain lightens, it is a good sign. He administered a large dose of Renshen (Ginseng), [missing character], Danggui, and Baizhu (Atractylodes Macrocephala Rhizome), plus Rougui (Cinnamon Bark) and Fuzi (Aconite Lateral Root) for one dose. Re-examining the next morning, the pulse had calmed slightly. After twenty to thirty doses, the illness healed. (This was also because previous cold-cooling treatments were excessive, essentially treating medicine-induced pathology with medicine; thus, these warming and tonifying agents were applicable, healing in thirty doses.) Diseases have beginnings and endings, differences in Cold and Heat, and variations in drug usage over time. Physical constitutions vary in fatness, thinness, strength, and youth. How can one formula treat all?