丹溪曰经水者阴血也阴必从阳故其色红禀火色也血为气之配气热则热气寒则寒气升则升
气降
则降气凝则凝气滞则滞气清则清气浊则浊上应于丹其行有常名之曰经为气之配因气而行成块
者气之凝也将行而痛者气之滞也来后作痛者气血俱虚也色淡者亦虚也而有水混之也错经妄行
者气之乱也紫者气之热也黑者热之甚也今人但见其紫者黑者作痛者成块者率指为风冷乘之而
行温热之剂祸不旋踵矣良由病源论月水之病皆曰风冷乘之宜其相习而成俗也或曰黑者北方水
之色也紫者黑之渐也非冷而何予曰经云亢则害承乃制热甚者必兼水化所以热则紫甚则黑也况
妇人性执而鄙嗜欲加倍脏腑厥阳之火无日不起非热而何若曰风冷必须外得设或有之吾恐千百
而一二也
按此论经病甚详大抵不得率指为风冷所乘者此由良方所言世俗往往因之误人故戒慎之
也然冷证外邪初感入经必痛或不痛者久则郁而变热矣且寒则凝既行而紫黑故非寒也
内经阴阳别论云阴虚阳搏谓之崩东垣曰妇人脾胃虚损致命门脉沉细而数疾或沉弦而洪大
有力
寸关脉亦然皆由脾胃有虚下陷于肾与相火相合湿热下迫经漏不止其色紫黑如夏月腐肉之臭中
有白带者脉必弦细寒作于中中有赤带者其脉洪数疾热明矣必腰痛或脐下痛临经欲行先见寒热
往来两胁急缩兼脾胃证出见或四肢困热心烦不得眠卧心下急宜大补脾胃而升举血气可一服而
愈或人故贵脱势人事疏少或先富后贫心气不足其火大炽旺于血脉之中又致脾胃饮食失节火乘
其中形质肌肉容颜似不病者此心病者不行于诊故脾胃饮食不调其证显矣而经水不时而下或适
来适断暴下不止治当先说恶死之言劝谕令拒死而心不动以大补气血之药举养脾胃微加镇坠心
火之药治其心补阴泻阳经自止矣痿论云悲哀太甚则胞络绝则阳气内动发则心下崩数溲血也故
本病曰大经空虚发则肌痹传为脉痿此之谓也、
良方论曰妇人崩中由脏腑伤损冲任血气俱虚故也冲任为经脉之海血气之行外循经络内荣脏腑
若无伤损则阴阳和平而气血调适若劳动过多致脏腑俱伤而冲任之气虚不能约制其经血故忽然
暴下或由阴阳相搏为热所乘攻伤冲任血得热则流散甚者至于昏闷其脉数疾小为顺大甚者逆
按此备言经脉致病之因本于脏腑伤损合前东垣所论极言因热因虚或悲哀七情等所致病机
殆无余蕴矣
朱丹溪说：月经是阴血。阴必然依附于阳，所以它的颜色是红色的，这是禀受了火的色泽。血是气的配偶（配合物），气热则热气盛，气寒则寒气盛；气升则血随气升，气降则血随气降；气凝滞则血凝滞，气郁结则血郁结；气清则血清，气浊则血浊。上应于心（心主血脉，其华在面，色赤），它的运行有固定的规律，称为“经”。因为它是气的配偶，所以随着气而行。形成血块的，是气的凝滞所致；将要来潮时疼痛的，是气的郁结所致；行经后疼痛的，是气血俱虚所致；颜色淡的，也是虚证，并且有水湿混杂其中；错经妄行（非时而下或量多失控）的，是气的紊乱所致；颜色紫的，是气热所致；颜色黑的，是热极所致。现在的人只见到颜色紫、黑，或者疼痛、成块的，就一概指认为是风冷侵袭所致，而使用温热的药物，灾祸立刻就会降临。这主要是由于《病源论》中论述月经病都说是风冷侵袭所致，使得人们习以为常，形成了习俗。有人问：黑色是北方水的颜色，紫色是黑色的渐进，难道不是寒冷吗？我说：《内经》说：“亢则害，承乃制”，热极严重时必然兼有水化（反兼胜己之化）的表现，所以热甚则色紫，热极则色黑。况且妇人性情固执且欲望加倍，脏腑中的厥阳之火没有一天不起的，难道不是热证吗？如果说一定是风冷，那必须是从外感受，或许会有这种情况，但我恐怕千百人中才有一两个吧。
按语：这段关于月经病的论述非常详尽，大抵不能一概指认为风冷所乘。这是由于《良方》所言被世俗往往沿袭，误导了人，所以告诫要谨慎。然而，如果是冷证，外邪初感侵入经脉，必定疼痛；如果不痛的，时间久了也会郁而化热。而且寒性凝滞，既然已经行经且颜色紫黑，所以不是寒证。
《内经·阴阳别论》说：“阴虚阳搏谓之崩。”李东垣说：妇人脾胃虚损，导致命门脉沉细而数疾，或者沉弦而洪大有力，寸部和关部的脉象也是如此。这都是因为脾胃虚弱，气机下陷于肾，与相火相结合，湿热下迫，导致经漏不止，颜色紫黑，像夏天腐烂的肉一样发臭。如果中间夹杂白带，脉象必定弦细，这是寒邪作祟于中焦；如果中间夹杂赤带，脉象洪数疾，这是热证非常明显了。必定伴有腰痛或脐下痛，临经欲行之前先见寒热往来、两胁拘急收缩，同时兼见脾胃症状出现，或者四肢困倦、心烦、不得眠卧、心下急迫。应当大补脾胃并升举血气，可以一服而愈。有的人因故尊贵而脱失权势，人事疏少，或者先富后贫，心气不足，导致心火大炽，旺盛于血脉之中，又致使脾胃饮食失调，火邪乘于其中。形体、肌肉、容颜似乎没有病态，这是因为心病者不善于诊察，所以脾胃饮食不调的症状显现出来，而月经不时而下，或者刚来即断，或者暴下不止。治疗应当先说明死亡的可怕道理，劝谕使其拒绝死亡念头而内心不动摇，用大补气血的药物以举养脾胃，微加镇坠心火的药物以治其心，补阴泻阳，经血自然停止。《痿论》说：“悲哀太甚，则胞络绝，则阳气内动，发则心下崩，数溲血也。”所以《本病》篇说：“大经空虚，发则肌痹，传为脉痿。”说的就是这种情况。
《良方》论述说：妇人崩中（暴下如注的出血）是由于脏腑伤损，冲任二脉的气血都虚弱所致。冲任二脉是十二经脉的海，气血的运行，外循经络，内荣脏腑。如果没有伤损，则阴阳和平而气血调适。如果劳动过多导致脏腑俱伤，而冲任之气虚弱，不能约束控制经血，所以忽然暴下。或者由于阴阳相搏，为热邪所乘，攻伤冲任，血得热则流散，严重到至于昏闷。其脉象数疾，小者为顺，大者为逆。
按语：这里详细说明了经脉致病的起因，根本在于脏腑伤损，结合前面李东垣的论述，极力言明因热、因虚或悲哀七情等所致的病机，几乎没有什么遗漏了。
Zhu Danxi stated: Menstrual blood is Yin blood. Yin must follow Yang; therefore, its color is red, which is endowed with the color of Fire (Huo). Blood is the companion of Qi. When Qi is hot, heat prevails; when Qi is cold, cold prevails. When Qi ascends, blood ascends; when Qi descends, blood descends. When Qi stagnates, blood stagnates; when Qi is obstructed, blood is obstructed. When Qi is clear, blood is clear; when Qi is turbid, blood is turbid. It corresponds to the Heart (Xin) above, and its movement follows a regular pattern, hence it is called "Jing" (Menstruation). Because it is the companion of Qi, it moves with Qi. The formation of clots is due to the stagnation of Qi. Pain before menstruation is due to the obstruction of Qi. Pain after menstruation is due to the deficiency of both Qi and Blood. A pale color indicates deficiency, mixed with dampness (Shi). Irregular or excessive bleeding is due to the disorder of Qi. A purple color indicates heat in Qi. A black color indicates extreme heat. Nowadays, people only see purple or black colors, pain, or clots, and generally attribute them to invasion by Wind-Cold (Feng Leng), using warm and hot remedies, which leads to immediate disaster. This is largely because the *Suwen* (Pathogenesis Treatise) attributes menstrual diseases to Wind-Cold invasion, making this a common custom. Some ask: Black is the color of Water (Shui) in the North, and purple is a gradual change from black; is it not cold? I say: The *Neijing* states, "When things reach an extreme, they cause harm; control comes from what opposes them." Extreme heat must manifest with transformations resembling Water. Thus, heat causes purple, and extreme heat causes black. Moreover, women often have stubborn natures and excessive desires, causing the Fire of Jue-Yang (Defiant Yang) in their Zang-Fu organs to rise daily. Is this not heat? If one insists it must be Wind-Cold, it must come from external exposure. Perhaps such cases exist, but I fear they are one in a thousand.
Commentary: This discussion on menstrual diseases is very detailed. Generally, one should not simply attribute these conditions to Wind-Cold invasion. This caution is issued because the statements in *Liangfang* were often followed by the secular world, misleading people. However, if it is a Cold syndrome, external pathogens initially invading the meridians will certainly cause pain. If there is no pain, over time, the pathogen will stagnate and transform into Heat. Furthermore, Cold causes coagulation; since the blood has flowed and is purple or black, it is not Cold.
The *Yin Yang Bie Lun* chapter of the *Neijing* states: "Yin deficiency with Yang pounding is called Beng (Metrorrhagia)." Li Dongyuan said: In women, Spleen-Stomach deficiency leads to a Mingmen (Gate of Life) pulse that is deep, fine, rapid, or deep, wiry, and forceful/huge, with similar characteristics at the Cun and Guan positions. All these arise from Spleen-Stomach deficiency where Qi sinks into the Kidney, combining with Ministerial Fire (Xiang Huo). Damp-Heat forces downward, causing persistent metrorrhagia with purple-black blood smelling like rotting meat in summer. If white discharge is present, the pulse is likely wiry and fine, indicating Cold in the Middle Jiao. If red discharge is present, the pulse is huge, rapid, and quick, clearly indicating Heat. There will definitely be lower back pain or umbilical pain. Before menstruation begins, there may be alternating chills and fever, tightness and contraction of the hypochondrium, accompanied by Spleen-Stomach symptoms, or four limbs fatigue, mental restlessness, insomnia, and epigastric urgency. Treatment should involve greatly tonifying the Spleen-Stomach and raising/lifting Qi and Blood, which can result in recovery after one dose. For those who lose status due to misfortune, have few social interactions, or decline from wealth to poverty, Heart Qi becomes deficient. This allows Heart Fire to blaze excessively within the blood vessels, further causing Spleen-Stomach dietary irregularities and Fire attacking the Middle Jiao. Although physical appearance seems healthy, this is because patients with Heart disease fail to recognize the diagnosis, so Spleen-Stomach dietary dysfunction symptoms become apparent, leading to irregular menstruation, sudden cessation, or profuse bleeding. Treatment should first explain the danger of death to persuade the patient to remain calm and unmoved. Use herbs to greatly tonify Qi and Blood to support the Spleen-Stomach, with slight additions of sedating herbs to subdue Heart Fire, treating the Heart by tonifying Yin and draining Yang, so menstruation stops naturally. The *Wei Lun* (Treatise on Flaccidity) states: "Excessive grief severs the Bao-Luo (Pericardium Collaterals), causing internal movement of Yang Qi, resulting in Heart Beng (collapse/bleeding) and frequent bloody urine." Thus, the *Ben Bing* chapter says: "When the Great Meridians are empty, muscle Bi (obstruction) occurs, transmitting to Mai Wei (Vascular Flaccidity)." This refers to the aforementioned condition.
*Liangfang* discusses: Metrorrhagia in women is caused by damage to Zang-Fu organs and deficiency of Qi and Blood in the Chong and Ren meridians. The Chong and Ren are the Seas of the Twelve Meridians. Qi and Blood circulate externally along the meridians and internally nourish the Zang-Fu. Without damage, Yin and Yang are harmonious, and Qi and Blood are balanced. Excessive labor damages all Zang-Fu, weakening the Qi of Chong and Ren, which cannot constrain the menstrual blood, causing sudden profuse bleeding. Alternatively, Yin and Yang struggle, attacked by Heat, damaging Chong and Ren. Blood,受热 (heated), scatters, potentially leading to fainting. The pulse is rapid and quick; a small pulse is favorable, while a large pulse is unfavorable.
Commentary: This thoroughly explains the causes of meridian diseases, rooted in Zang-Fu damage. Combined with Li Dongyuan's previous discussions, it exhaustively describes pathogenesis due to Heat, Deficiency, or emotional factors like grief, leaving little unstated.