10．杨女。曾经大崩，表示血液凝固力减退；崩止，月经愆期。此番停止2个月，最近3日来，有少量之淋沥，少腹沉坠。催经药不宜用，当强壮剂恢复卵巢功能。熟地黄15克，破故纸9克，白归身9克，枸杞子9克，山萸肉9克，巴戟天9克，生艾叶4．5克，金毛脊9克，炮姜炭4．5克，杜仲9克，震灵丹6克(分3次吞服)。[按]经行不畅，可用通经药；有大崩病史，则催经药不宜用。方药重在调补冲任，恢复卵巢功能，以使经之当行者自行。
11．丁女。经过期旬日，不见腰酸腹胀，即无攻之证候。登高则呼吸为之不平匀，而心动悸，脉虽不细，但甚数。凡此皆一派虚象。全当归12克，潞党参9克，白术9克，云苓9克，阿胶珠15克，熟地黄18克，白芍6克，炙甘草3克，川芎6克，杞子9克。二诊：经已见，腹痛则其色淡，腹不痛则色正常，而其腹胀殊甚。全当归9克，制香附9克，青皮9克，破故纸9克，大川芎6克，吴萸4．5克，延胡9克，肉豆蔻9克，炮姜炭4．5克。[按]初诊见一派虚象，治用八珍汤加味。二诊腹痛、腹胀殊甚，为寒郁气滞之征，故寓理气于温补之中。12．刘女。连续3次流产。此番经停四旬余，带下频，孕之与否，不能肯定。但头目晕眩，不能支持，四肢麻，胸次窒闷不得息。经西医诊断为心脏病。以其脉之表现，确实不误。心脏病者，如怀孕，确有危险。当归9克，制香附9克，怀牛膝12克，紫丹参9克，粉甘草4．5克，川芎9克，吴茱萸4．5克，赤白芍各9克，杜红花6克。二诊：四药而经见，但头目为之眩晕。心脏患者，原忌猛攻；不攻之，又难达通经之目的。当归9克，淮牛膝15克，萸肉9克，肉桂0；9克，制首乌12克，党参12克，杜仲9克，泽兰9克，桃仁15克，杜红花9克，炙甘草3克。
三诊：经虽见，其色为桃红而质粘，但淋沥不得充分排泄。以其两脉之不鼓指，虽见腹胀，仍忌猛攻。当归15克，黑丑6克，山萸肉9克，熟地15克，炮附块6克，炙甘草4．5克，香附9克，三棱9克，巴戟9克，川芎9克，炮姜炭4．5克。[按]本系体弱，又患心脏病，月经闭止，不攻则经不行，攻之虚损正气，是谓两难。一诊予活血通经方，服后经行不畅；二诊在益气养血药中，加桃、红、泽兰以通瘀行经；三诊在补益强壮剂中辅以黑丑、三棱以消瘀活血。均为攻补兼施之计。
13．王女。平素经先期，掌心热，阴虚肝热不能藏血也。地黄12克.牛膝9克，山药9克，萸肉9克，阿胶9克，丹皮9克，泽泻9克，赤苓9克，车前子12克，炒续断9克，女贞子12克，旱莲草15克。
14．董女。经行先期而少腹胀，色淡如赤豆水，手足不温。先期属血热之说不可泥。淡吴萸4．5克，山萸肉9克，阿胶珠15克，菟丝子9克，巴戟9克，制香附9克，补骨脂9克，艾叶9克，台乌药9克，清炙草3克。
15．沈女。经先期，如在旬日左右，是病态；仅二三日，无碍也。8年来，梦熊无征。其主因正在后：面色萎黄，一也；经将行，先腰酸腹痛，二也；带下频频，则头眩目暗，三也。今经将行。全当归9克，破故纸9克，熟地黄18克，肉豆蔻9克，肉桂末1．2克(分吞)，淡吴萸4．5克，大川芎6克，厚杜仲9克，丹皮4．5克，炮姜炭3克。[按]梦熊无征，即未能怀孕之意。从案中所列三条主因，可知为精血不足，冲任虚寒所致。值此月经将行之际，先予温宫调经之方以调之，冲任既调，则孕育有望。
16．王女。经先期而量多，一来复，仍色鲜不净，面容与脉皆不足。古人有肝脾不能藏统之说。当归6克，阿胶珠12克，潞党参9克，五味子4．5克，川芎6克，'熟地12克，炮姜炭3克，川断肉9克，桑寄生12克，茯神12克，震灵丹6克(分2次吞)。[按l肝主藏血，脾主统血。肝脾失统摄之职，致月经量多。其治疗不宜用凉血之晶，只宜用益气养血、补益肝脾之方以温摄之。
17．杨女。距离上次经行仅有半月，少腹痛，侧卧则痛更甚，脉有数意。数者，表示某处有炎症。樗皮12克；黄柏9克，生茜草9克，侧柏叶9克，苦参片6克，象贝母9克，云茯苓9克，琥珀3克(研冲)。[按]先生常说："经来脉快，多属炎症之象。"
18．朱女。经先期，淋沥半月，其量多，其色或鲜或紫。此症起于产后，已历数年。腹不痛而腰脊酸，加凝固血液与收缩子宫之属。益母草12克，生茜草9克，仙鹤草12克，熟地15克，大川芎6克，杜红花4．5克，苎麻根12克，桑寄生12克。另：乌贼骨18克，研末，分3次吞。[按]用茜草、仙鹤草、熟地、苎麻根、乌贼骨以增加血液之凝固；益母草、川芎、红花以收缩子宫，可起到压迫止血的作用；桑寄生补益肝肾而治腰酸。因无腹痛之症，无需用较多的祛瘀药。
19．葛女。今经先期半月，既行，必半月始净。如此者半年有余。其量少。其色或鲜或淡。乌贼骨15克(研吞)，牛角劳（角+思）炭12克(包)，阿胶珠12克，菟丝饼12克，苎麻根12克，桑寄生12克，熟地12克，旱莲草12克。另：人参胎产金丹4粒，分2次服。二诊：两药后，而淋沥止。带下频，仍是宿疾。干地黄15克，杭白芍6克，山萸肉9克，淮山药12克，桑椹子12克，菟丝子9克，金樱子12克，冬青子9克。
20．唐女。上月经行因郁怒而阻，回下黄水数日。此番经逾旬日而行，将行少腹酸胀，腰酸如折；始则淋漓，继则大血块色黑，腰酸所苦如故。原来经之生理虽在卵巢、，亦受神经系之支配。古人调经多用疏肝，即此理也。醋炒柴胡6克，小茴香6克，香甘松6克，大川芎6克，延胡9克，旅覆花9克(包)，川楝子9克，失笑散12克(包)，香元皮6克，炒丹皮9克，肉桂末1．8克(分3次吞)，半硫丸6克(分2次吞)。
二诊：经已净，少腹左侧作痛，其脐下按之痛更甚，此输卵管炎之象。带下多而粘。生侧柏叶30克(煎汤代水)，白芍9克，生麻黄3克，樗皮9克，白薇9克，羌活4．5克，杏仁泥12克，延胡索9克，失笑散12克(包)，粉甘草3克。[按]此案一诊，因气郁不舒，致宿瘀内阻，经行不畅，故先从理气调经着手。二诊因带下多而粘，少腹及脐下作痛，辨其为输卵管炎，故用清下焦湿热之品以消炎；用麻黄、羌活者非为解表，乃取其，温经镇痛之用。
21．叶女。感冒经事适来，经量少者不忌辛温，多者必忌。川桂枝3克(后下)，川芎4．5克，刺蒺黎9克，前柴胡4．5克(各)，白芷6克，酒淋黑大豆12克，荆芥4．5克，晚蚕沙9克(包)，生艾叶4．5克，白芥子6克，粉甘草2．4克。[按]-血得温则行。经期服用辛温之属能使经量增多。此患者感冒经事适来。使用辛温剂者，殆因经量少而不为所忌。
22．某女。经淋沥，当攻、当止之鉴别：①当考其经过中量之多寡；②腰酸腹痛之有无；③经之颜色如何。益母草12克，泽兰9克，延胡9克，苏木6克，蒲黄9克(包)，桃仁12克，五灵脂9克(包)，生艾叶6克。[按]此案列举治疗经淋沥之三个鉴别要点，示人注意审证用药。一般说来，经淋沥量涩少，腰酸、腹痛，经色紫黑，为有瘀之象，可攻；经淋沥量多，无腰酸、腹，痛，经色鲜红，为无瘀之象，当止。然病情千变万化，不可固执一端，倘虚实互见，又当取通涩并用之法。
23．钱女。季春流产后，血大下如崩，曾经晕厥，虽未濒于危殆，以此血液亏耗，难以恢复。夏天经曾一见，迄于今兹。征以面容之惨淡，心之动悸，攻是无益。全当归9克，阿胶珠15克，枸杞子9克，潞党参12克，山萸肉9克，熟地黄18克，旱莲草9克，抱本神12克，谷麦芽各9克。另：两仪膏24克，每服1匙，日2次，开水冲服。[按]大崩致虚，经不行，源于血之枯，故用补益气血之剂治之，而气血充沛则经自行。
24．姚女。一月经三见，小腹胀，胀甚量益多；据其色脉，胶艾汤不相当。炒丹皮9克，生地12克，小蓟15克，旱莲草15克，生茜草9克，地榆炭9克，冬青子9克，炒银花12克，藕节炭(4只)，黑荆芥6克，川黄柏3克，夏枯草9克。二诊：服药后，经色仍鲜，腹胀，量多亦如故，今易其法。阿胶珠12克，益母草9克，小蓟12克，瞿麦9克，生蒲黄9克，生艾叶6克，生茜草9克，干地黄12克，黑荆芥6克。[按]初诊因月经色鲜，先生用凉血止血法。二诊不见效果，乃改用胶艾汤加减以温经祛瘀止血。迨至三诊，月经果净，少腹作胀也消失，终以四物汤加减善后。由此可知，临床用药，贵在随症应变。
25．戴女。5年前，因经停3个月，用攻剂，大下如冲；冲止，体弱而行经量少，色黑，将行腹隐痛。今行经第5日，以温经汤调之。当归9克，杭白芍6克，肉桂末1．5克(分吞)，丹皮6克，吴茱萸4．5克，阿胶珠12．0克，炮姜炭4．5克，潞党参9克，川芎4．5克，姜半夏6克，炒麦冬6克，清炙草3克。[按]行经量少色黑，'为内有瘀阻之象，当祛瘀；将行腹隐痛，为冲任虚寒之象，当散寒；曾经大下如冲而致体弱，当补气血。温经汤温经散寒、养血祛瘀，正为合拍。此方为温经汤全方，而以肉桂易桂枝，以炮姜易生姜，意欲增强温经、散寒、镇痛作用。26．曾女。经行，量少，腹胀，兼泛清水，温之。淡吴萸4．5克，乌药6克，官桂皮9克，炮姜炭4．5克，生艾叶6克，荜茇9克，姜半夏6克，旋覆花12克(包)。I按]泛吐清水，中寒之象；腹胀，乃气寒凝聚所致。散其寒则清水可止，理其气则腹胀可消。气顺寒散，经行自多。此案调经不用血药，而寻其致病之源。
27．宋女。28日而经见，此不能以先期目之；量少色淡，则是病态。其人形瘦，亦无腰酸、腹胀，此虚象也，不能以卵巢失职，下部充血论。古人于斯，多用温剂，虽与内分泌无关，但可以唤起体力，振奋功能。淡吴萸4．5克，上官桂1．5克(研吞)，党参9克，补骨脂9克，熟地15克，全当归9克，阿胶珠15克，粉丹皮9克，炮姜4．5克，炙甘草3克。[按]患者去年曾经血崩，今量少色淡，故先生投以温补之剂。
28．孙女。以古人之概念，经之色黑而有块者，以为下焦虚寒，多用温药。此类药，刺激卵巢功能一也；流畅血液循环，二也；强壮体力，尚其余事。淡吴萸6克，炮姜炭4．5克，仙灵脾9克，炒丹皮12克，生艾叶4．5克，肉桂末1．5克，破故纸9克，大川芎6克，党参9克，当归9克，制香附9克，炙甘草3克，来复丹6克(分2次吞)。[按]经之色黑为下焦虚寒，治用温运之剂，补其阳气之虚，理其寒凝之滞。然亦有经之色黑属热者，尤当参合脉证，细加分辨。来复丹出自《局方》，由硫黄、硝石、玄精石、五灵脂、青陈皮等组成，能温肾下气，化痰、血、食积之滞，为治伏暑泄泻之要药。此处先生借用为温散下焦虚寒，治寒凝之瘀滞。
29．王女。属于内分泌患者之经后期，植物性药，本无大效。仲景多用动物、虫类。熟地黄18克，杭白芍9克，醋炒柴胡9克，泽兰9克，全当归12克，大川芎6克，川桂枝4．5克，粉丹皮9克。另立丸方于下：地鳖虫15克(连头足翅)，藏红花6克，晚蚕沙12克，虻虫9克(连头足翅)，两头尖15克，当归30克，五灵脂15克，炙鳖甲24克，鸡血藤24克。共研细末，蜜泛为丸，如桐子大，每服20粒，日2次。[按]月经后期有虚有实，虚者当补，实者当通。此案用虫类药为主，化瘀通经。汤药以四物养血，柴胡调畅气机，桂枝、泽兰、丹皮和营祛瘀，合为养血调经方。丸方以地鳖虫、虻虫为主，配合红花、蚕沙、两头尖、五灵脂、鳖甲消瘀散结，当归、鸡血藤养血。寓消瘀于养血之中。制为蜜丸，缓图功效。
30．周女。往日经过期不至，恒见崩中。今腹胀而腰酸，攻之不可；调整卵巢功能，斯可矣。全当归9克，补骨脂9克，炮姜炭3克，官桂皮4．5克，大川芎6克，巴戟天9克，淡吴萸4．5克，升麻4．5克，清炙草4．5克，来复丹6克(分2次吞)。二诊：强壮剂只能间接恢复卵巢功能，假使经之须通者，则其力缓。往日经后时，大崩，攻补兼施可矣。桃仁承气加参归法。党参9克，川桂枝3克，生枳实9克，制川朴3克，全当归9克，桃仁泥12克，生川军6克。[按]月经过期不至，有腰酸、腹胀之症，本可攻之，因有崩漏宿疾，攻之恐有崩变，则攻法又不可。初诊以暖宫升陷、活血调经之方，服后经未行。二诊乃用攻补兼施之法，以参、归补气养血，桂枝、桃仁、生军活血消瘀通经，枳、朴疏理气机。
10．杨女。曾经发生过严重的崩漏（大量非经期阴道出血），表现为血液凝固能力减退；崩漏停止后，月经周期紊乱。这次停经两个月，最近三天有少量淋漓不尽的出血，小腹部有沉重下坠感。此时不宜使用催经药，应当用强壮剂来恢复卵巢功能。处方：熟地黄15克，补骨脂9克，当归身9克，枸杞子9克，山茱萸9克，巴戟天9克，生艾叶4.5克，金毛狗脊9克，炮姜炭4.5克，杜仲9克，震灵丹6克（分三次吞服）。[按语]月经行而不畅时，可以使用通经药；但有严重崩漏病史者，则不宜使用催经药。此方重在调理补益冲任二脉，恢复卵巢功能，使月经该来时自然来潮。
11．丁女。月经推迟十天，如果没有腰酸腹胀等症状，就没有攻伐（泻实）的指征。登高时呼吸不均匀，且伴有心悸，脉象虽然不细，但非常快速。凡此种种都是一派虚象。处方：全当归12克，党参9克，白术9克，茯苓9克，阿胶珠15克，熟地黄18克，白芍6克，炙甘草3克，川芎6克，枸杞子9克。二诊：月经已来，腹痛时血色淡，不痛时血色正常，但腹胀非常严重。处方：全当归9克，制香附9克，青皮9克，补骨脂9克，大川芎6克，吴茱萸4.5克，延胡索9克，肉豆蔻9克，炮姜炭4.5克。[按语]初诊见一派虚象，治疗使用八珍汤加味。二诊时腹痛、腹胀非常严重，这是寒邪郁结、气机阻滞的表现，所以在温补之中寓含理气之法。
12．刘女。连续三次流产。这次月经停止四十多天，白带频繁，是否怀孕不能确定。但是头晕目眩，身体虚弱难以支撑，四肢麻木，胸部窒闷无法呼吸。经西医诊断为心脏病。从脉象表现来看，诊断确实无误。心脏病患者如果怀孕，确有危险。处方：当归9克，制香附9克，怀牛膝12克，紫丹参9克，粉甘草4.5克，川芎9克，吴茱萸4.5克，赤芍和赤白芍各9克，杜红花6克。二诊：服用四剂药后经血来潮，但头晕目眩加重。心脏病患者，原本忌讳猛烈的攻伐药物；如果不攻伐，又难以达到通经的目的。处方：当归9克，淮牛膝15克，山茱萸9克，肉桂0.9克，制何首乌12克，党参12克，杜仲9克，泽兰9克，桃仁15克，杜红花9克，炙甘草3克。
三诊：月经虽来，颜色呈桃红色且质地粘稠，但淋漓不尽，排泄不充分。因为两手脉象都不鼓指（无力），虽然有腹胀，仍然忌讳猛烈攻伐。处方：当归15克，黑丑6克，山茱萸9克，熟地黄15克，炮附块6克，炙甘草4.5克，香附9克，三棱9克，巴戟天9克，川芎9克，炮姜炭4.5克。[按语]本病人体质虚弱，又患有心脏病，月经闭止，不攻伐则经血不行，攻伐则损伤正气，这是两难局面。一诊给予活血通经方，服药后经行不畅；二诊在益气养血药中，加入桃仁、红花、泽兰以通瘀行经；三诊在补益强壮剂中辅以黑丑、三棱以消瘀活血。这都是攻补兼施的策略。
13．王女。平时月经提前，掌心发热，这是阴虚肝热导致不能藏血。处方：地黄12克，牛膝9克，山药9克，山茱萸9克，阿胶9克，牡丹皮9克，泽泻9克，赤茯苓9克，车前子12克，炒续断9克，女贞子12克，旱莲草15克。
14．董女。月经提前且小腹胀，血色淡如赤豆水，手足不温暖。“月经提前属于血热”的说法不可拘泥。处方：淡吴茱萸4.5克，山茱萸9克，阿胶珠15克，菟丝子9克，巴戟天9克，制香附9克，补骨脂9克，艾叶9克，台乌药9克，清炙甘草3克。
15．沈女。月经提前，如果在十天左右，是病态；仅提前二三日，无碍。八年来，未能怀孕。其主要原因有三：一是面色萎黄；二是月经将行时，先出现腰酸腹痛；三是白带频繁，导致头晕眼花。现在月经即将来潮。处方：全当归9克，补骨脂9克，熟地黄18克，肉豆蔻9克，肉桂末1.2克（分次吞服），淡吴茱萸4.5克，大川芎6克，厚杜仲9克，牡丹皮4.5克，炮姜炭3克。[按语]“梦熊无征”，即未能怀孕的意思。从案中所列三条主要原因可知，这是由于精血不足，冲任二脉虚寒所致。值此月经将行之时，先给予温宫调经的方剂进行调理，冲任既已调和，则孕育有望。
16．王女。月经提前且量多，来了一次之后，仍然血色鲜红不净，面容和脉象都显得不足。古人有肝脾不能藏血、统血的理论。处方：当归6克，阿胶珠12克，党参9克，五味子4.5克，川芎6克，熟地黄12克，炮姜炭3克，川断肉9克，桑寄生12克，茯神12克，震灵丹6克（分两次吞服）。[按语]肝主藏血，脾主统血。肝脾失去统摄之职，导致月经量多。其治疗不宜使用凉血药物，只宜用益气养血、补益肝脾的方剂以温摄之。
17．杨女。距离上次月经仅有半个月，小腹痛，侧卧则疼痛更甚，脉象有数急之意。数脉，表示某处有炎症。处方：樗白皮12克，黄柏9克，生茜草9克，侧柏叶9克，苦参片6克，象贝母9克，云茯苓9克，琥珀3克（研碎冲服）。[按语]先生常说：“月经来潮时脉快，多属炎症之象。”
18．朱女。月经提前，淋漓半月，量多，血色或鲜或紫。此症起于产后，已历数年。腹部不痛而腰脊酸，加上具有凝固血液与收缩子宫作用的药物。处方：益母草12克，生茜草9克，仙鹤草12克，熟地黄15克，大川芎6克，杜红花4.5克，苎麻根12克，桑寄生12克。另：乌贼骨18克，研成粉末，分三次吞服。[按语]使用茜草、仙鹤草、熟地、苎麻根、乌贼骨以增加血液凝固性；益母草、川芎、红花以收缩子宫，可起到压迫止血的作用；桑寄生补益肝肾而治疗腰酸。因为没有腹痛症状，无需使用较多的祛瘀药。
19．葛女。这次月经提前半月，既已行经，必须半个月才能干净。如此情况半年有余。量少，血色或鲜或淡。处方：乌贼骨15克（研碎吞服），牛角劳（角+思）炭12克（包煎），阿胶珠12克，菟丝饼12克，苎麻根12克，桑寄生12克，熟地黄12克，旱莲草12克。另：人参胎产金丹4粒，分两次服用。二诊：服用两剂药后，淋漓出血停止。白带频繁，仍是旧疾。处方：干地黄15克，杭白芍6克，山茱萸9克，淮山药12克，桑椹子12克，菟丝子9克，金樱子12克，冬青子9克。
20．唐女。上个月因郁怒导致经血受阻，随后流出黄水数日。这次月经超过十天来潮，将行时小腹部酸胀，腰酸如折断一般；开始是淋漓不尽，继而出血大块色黑，腰酸痛苦依旧。原来月经的生理虽然与卵巢有关，但也受神经系统的支配。古人调经常多用疏肝法，就是这个道理。处方：醋炒柴胡6克，小茴香6克，香甘松6克，大川芎6克，延胡索9克，旋覆花9克（包煎），川楝子9克，失笑散12克（包煎），香元皮6克，炒牡丹皮9克，肉桂末1.8克（分三次吞服），半硫丸6克（分两次吞服）。
二诊：月经已净，小腹部左侧作痛，脐下按压时疼痛更甚，这是输卵管炎的表现。白带多且粘稠。处方：生侧柏叶30克（煎汤代水），白芍9克，生麻黄3克，樗白皮9克，白薇9克，羌活4.5克，杏仁泥12克，延胡索9克，失笑散12克（包煎），粉甘草3克。[按语]此案一诊，因气郁不舒，导致宿瘀内阻，经行不畅，故先从理气调经着手。二诊因带下多而粘，少腹及脐下作痛，辨其为输卵管炎，故用清利下焦湿热的药物以消炎；使用麻黄、羌活并非为了发汗解表，而是取其温经镇痛的作用。
21．叶女。感冒时月经适逢来潮，经量少者不忌辛温药物，量多者必忌。处方：川桂枝3克（后下），川芎4.5克，刺蒺藜9克，前柴胡4.5克（各），白芷6克，酒淋黑大豆12克，荆芥4.5克，晚蚕沙9克（包煎），生艾叶4.5克，白芥子6克，粉甘草2.4克。[按语]血得温则运行通畅。经期服用辛温类药物能使经量增多。此患者感冒且月经适逢来潮。使用辛温剂，大概是因为经量少而不被禁忌。
22．某女。月经淋漓不尽，当区分攻伐（祛瘀）还是止涩：①要考察过程中经量的多少；②有无腰酸腹痛；③经血的颜色如何。处方：益母草12克，泽兰9克，延胡索9克，苏木6克，蒲黄9克（包煎），桃仁12克，五灵脂9克（包煎），生艾叶6克。[按语]此案列举了治疗月经淋漓的三个鉴别要点，提示人们注意审证用药。一般来说，经淋漓量涩少，伴有腰酸、腹痛，经色紫黑，是有瘀血之象，可以攻伐；经淋漓量多，无腰酸、腹痛，经色鲜红，是无瘀血之象，应当止涩。然而病情千变万化，不可固执一端，倘若虚实互见，又当采用通涩并用的方法。
23．钱女。季春时节流产后，大量出血如崩漏，曾经晕厥，虽未濒临危殆，但因血液亏耗，难以恢复。夏天月经曾来过一次，至今未来。根据面容惨淡、心悸等表现，攻伐是无益的。处方：全当归9克，阿胶珠15克，枸杞子9克，党参12克，山茱萸9克，熟地黄18克，旱莲草9克，抱石莲（或类似安神药，原文为抱本神，疑为笔误或特定用法，此处保留原意或译为安神药，结合上下文多为养心安神，暂译作安神药/抱本神）12克，谷芽麦芽各9克。另：两仪膏24克，每次服一匙，每日两次，开水冲服。[按语]大崩导致虚损，经血不行，源于血液枯竭，故用补益气血的药剂治疗，而气血充沛则经血自行来潮。
24．姚女。一个月来三次月经，小腹胀，胀得越厉害量越多；根据其色脉，胶艾汤不相适宜。处方：炒牡丹皮9克，生地黄12克，小蓟15克，旱莲草15克，生茜草9克，地榆炭9克，冬青子9克，炒金银花12克，藕节炭4只，黑荆芥6克，川黄柏3克，夏枯草9克。二诊：服药后，经色仍鲜红，腹胀，量多也如故，现在改变治法。处方：阿胶珠12克，益母草9克，小蓟12克，瞿麦9克，生蒲黄9克，生艾叶6克，生茜草9克，干地黄12克，黑荆芥6克。[按语]初诊因月经色鲜，先生使用凉血止血法。二诊不见效果，乃改用胶艾汤加减以温经祛瘀止血。等到三诊，月经果然干净，少腹胀也消失，最终用四物汤加减善后。由此可知，临床用药，贵在随症应变。
25．戴女。5年前，因停经3个月，使用了攻伐药剂，大量出血如冲决；冲决停止后，体质虚弱而行经量少，色黑，将行时腹部隐痛。现在行经第5日，用温经汤调理。处方：当归9克，杭白芍6克，肉桂末1.5克（分次吞服），牡丹皮6克，吴茱萸4.5克，阿胶珠12.0克，炮姜炭4.5克，党参9克，川芎4.5克，姜半夏6克，炒麦冬6克，清炙甘草3克。[按语]行经量少色黑，是内有瘀阻之象，应当祛瘀；将行时腹部隐痛，是冲任虚寒之象，应当散寒；曾经大量出血如冲决而导致体弱，应当补气血。温经汤能温经散寒、养血祛瘀，正为合拍。此方为温经汤全方，而以肉桂代替桂枝，以炮姜代替生姜，意图增强温经、散寒、镇痛作用。
26．曾女。行经，量少，腹胀，兼有泛吐清水，用温法。处方：淡吴茱萸4.5克，乌药6克，官桂皮9克，炮姜炭4.5克，生艾叶6克，荜茇9克，姜半夏6克，旋覆花12克（包煎）。[按语]泛吐清水，是中寒之象；腹胀，乃是气寒凝聚所致。散其寒则清水可止，理其气则腹胀可消。气顺寒散，经行自多。此案调经不用血药，而寻找致病之源。
27．宋女。28天来月经，这不能视为提前；量少色淡，则是病态。其人形体瘦弱，也无腰酸、腹胀，这是虚象，不能以卵巢失职、下部充血来论断。古人在这种情况下，多用温剂，虽然与内分泌无关，但可以唤起体力，振奋功能。处方：淡吴茱萸4.5克，上官桂1.5克（研碎吞服），党参9克，补骨脂9克，熟地黄15克，全当归9克，阿胶珠15克，粉牡丹皮9克，炮姜4.5克，炙甘草3克。[按语]患者去年曾经血崩，现量少色淡，故先生投以温补之剂。
28．孙女。以古人的概念，经血色黑而有块者，认为是下焦虚寒，多用温药。这类药，刺激卵巢功能是一方面；流畅血液循环，是另一方面；强壮体力，尚属其余之事。处方：淡吴茱萸6克，炮姜炭4.5克，淫羊藿9克，炒牡丹皮12克，生艾叶4.5克，肉桂末1.5克，补骨脂9克，大川芎6克，党参9克，当归9克，制香附9克，炙甘草3克，来复丹6克（分两次吞服）。[按语]经血色黑为下焦虚寒，治疗用温运之剂，补其阳气之虚，理其寒凝之滞。然而也有经血色黑属热者，尤当参合脉证，细加分辨。来复丹出自《太平惠民和剂局方》，由硫黄、硝石、玄精石、五灵脂、青陈皮等组成，能温肾下气，化痰、血、食积之滞，为治伏暑泄泻的要药。此处先生借用它来温散下焦虚寒，治疗寒凝之瘀滞。
29．王女。属于内分泌失调患者的经后期，植物药，本来没有太大疗效。张仲景多用动物、虫类药。处方：熟地黄18克，杭白芍9克，醋炒柴胡9克，泽兰9克，全当归12克，大川芎6克，川桂枝4.5克，粉牡丹皮9克。另立丸方如下：地鳖虫15克（连头足翅），藏红花6克，晚蚕沙12克，虻虫9克（连头足翅），两头尖15克，当归30克，五灵脂15克，炙鳖甲24克，鸡血藤24克。共研细末，蜜泛为丸，如梧桐子大，每次服20粒，每日2次。[按语]月经后期有虚有实，虚者当补，实者当通。此案用虫类药为主，化瘀通经。汤药以四物汤养血，柴胡调畅气机，桂枝、泽兰、丹皮和营祛瘀，合为养血调经方。丸方以地鳖虫、虻虫为主，配合红花、蚕沙、两头尖、五灵脂、鳖甲消瘀散结，当归、鸡血藤养血。寓消瘀于养血之中。制成蜜丸，缓慢图取功效。
30．周女。往日月经过期不至，常发生崩中。现在腹胀而腰酸，攻伐不可；调整卵巢功能，才可以。处方：全当归9克，补骨脂9克，炮姜炭3克，官桂皮4.5克，大川芎6克，巴戟天9克，淡吴茱萸4.5克，升麻4.5克，清炙甘草4.5克，来复丹6克（分两次吞服）。二诊：强壮剂只能间接恢复卵巢功能，假如月经需要通利者，则其力缓。往日经后时常大崩，攻补兼施就可以了。桃仁承气汤加人参当归法。处方：党参9克，川桂枝3克，生枳实9克，制厚朴3克，全当归9克，桃仁泥12克，生大黄6克。[按语]月经过期不至，有腰酸、腹胀之症，本可攻伐，因有崩漏宿疾，攻伐恐有崩变，则攻法又不可行。初诊以暖宫升陷、活血调经之方，服药后经未行。二诊乃用攻补兼施之法，以人参、当归补气养血，桂枝、桃仁、生大黄活血消瘀通经，枳实、厚朴疏理气机。
10. Female Patient Yang. Previously suffered from severe metrorrhagia (heavy non-menstrual vaginal bleeding), indicating reduced blood coagulability; after the bleeding stopped, her menstrual cycle became irregular. This time, amenorrhea lasted for two months. For the past three days, there has been scanty, dripping discharge, accompanied by a heavy, bearing-down sensation in the lower abdomen. Emenagogues are not suitable at this time; instead, tonic agents should be used to restore ovarian function. Prescription: Shu Di Huang (Prepared Rehmannia Root) 15g, Po Gu Zhi (Psoralea Fruit) 9g, Bai Gui Shen (Dangshen Angelica Sinensis Root) 9g, Gou Qi Zi (Goji Berry) 9g, Shan Yu Rou (Cornus Fruit) 9g, Ba Ji Tian (Morinda Root) 9g, Sheng Ai Ye (Fresh Mugwort Leaf) 4.5g, Jin Mao Ji (Cibotium Rhizome) 9g, Pao Jiang Tan (Charred Ginger) 4.5g, Du Zhong (Eucommia Bark) 9g, Zhen Ling Dan (Thunder Spirit Pill) 6g (to be swallowed in three divided doses). [Commentary] When menstruation is unsmooth, emenagogues can be used; however, for those with a history of severe metrorrhagia, emenagogues are contraindicated. This prescription focuses on regulating and tonifying the Chong and Ren meridians to restore ovarian function, allowing menstruation to occur naturally when due.
11. Female Patient Ding. Menstruation was delayed by ten days. Without symptoms such as soreness or distension in the waist and abdomen, there are no indications for purgative treatment. Climbing high causes uneven breathing and palpitations. Although the pulse is not fine, it is very rapid. All these signs indicate a pattern of deficiency. Prescription: Quan Dang Gui (Whole Angelica Sinensis Root) 12g, Lu Dang Shen (Codonopsis Root) 9g, Bai Zhu (Atractylodes Macrocephala Rhizome) 9g, Yun Ling (Poria) 9g, E Jiao Zhu (Donkey-hide Gelatin Beads) 15g, Shu Di Huang (Prepared Rehmannia Root) 18g, Bai Shao (White Peony Root) 6g, Zhi Gan Cao (Honey-fried Licorice Root) 3g, Chuan Xiong (Sichuan Lovage Rhizome) 6g, Qi Zi (Goji Berry) 9g. Second Visit: Menstruation has started. The blood color is pale when abdominal pain is present, and normal when pain-free, but abdominal distension is severe. Prescription: Quan Dang Gui 9g, Zhi Xiang Fu (Processed Cyperus Rhizome) 9g, Qing Pi (Tangerine Peel) 9g, Po Gu Zhi 9g, Da Chuan Xiong 6g, Wu Yu (Evodia Fruit) 4.5g, Yan Hu 9g, Rou Dou Kou (Nutmeg) 9g, Pao Jiang Tan 4.5g. [Commentary] In the first visit, seeing a pattern of deficiency, treatment used Ba Zhen Tang (Eight Treasure Decoction) with modifications. In the second visit, severe abdominal pain and distension indicated cold stagnation and qi obstruction, so qi-regulating herbs were incorporated into the warming and tonifying strategy.
12. Female Patient Liu. History of three consecutive spontaneous abortions. Menstruation has been absent for over forty days. Leukorrhea is frequent. Pregnancy cannot be confirmed. However, she suffers from dizziness, extreme weakness, numbness in the limbs, and chest oppression with dyspnea. Diagnosed with heart disease by Western medicine. Her pulse confirms this diagnosis. Pregnancy poses significant risks for patients with heart disease. Prescription: Dang Gui 9g, Zhi Xiang Fu 9g, Huai Niu Xi (Achyranthes Root) 12g, Zi Dan Shen (Salvia Miltiorrhiza Root) 9g, Fen Gan Cao (Licorice Root) 4.5g, Chuan Xiong 9g, Wu Zhu Yu (Evodia Fruit) 4.5g, Chi Shao and Bai Shao (Red and White Peony Roots) 9g each, Du Hong Hua (Safflower) 6g. Second Visit: Menstruation started after four doses, but dizziness worsened. Patients with heart disease generally contraindicate harsh purgatives; yet, without purgation, achieving patency of menstruation is difficult. Prescription: Dang Gui 9g, Huai Niu Xi 15g, Yu Rou (Cornus Fruit) 9g, Rou Gui (Cinnamon Bark) 0.9g, Zhi Shou Wu (Polygonum Multiflorum Root) 12g, Dang Shen 12g, Du Zhong 9g, Ze Lan (Lycopus Herb) 9g, Tao Ren (Peach Kernel) 15g, Du Hong Hua 9g, Zhi Gan Cao 3g.
Third Visit: Menstruation has started, with a peach-red color and viscous texture, but discharge is incomplete and lingering. Both pulses are weak and do not beat forcefully against the fingers. Despite abdominal distension, harsh purgation is still contraindicated. Prescription: Dang Gui 15g, Hei Chou (Black Morning Glory Seed) 6g, Shan Yu Rou 9g, Shu Di Huang 15g, Pao Fu Kuai (Prepared Aconite Child Root) 6g, Zhi Gan Cao 4.5g, Xiang Fu 9g, San Leng (Burreed Tuber) 9g, Ba Ji 9g, Chuan Xiong 9g, Pao Jiang Tan 4.5g. [Commentary] The patient is constitutionally weak and suffers from heart disease. Amenorrhea requires intervention; not purging prevents menstruation, while purging damages righteous qi. This is a dilemma. The first visit used a blood-activating and menstruation-promoting formula, resulting in unsmooth flow. The second visit added Tao Ren, Hong Hua, and Ze Lan to Qi Yi Yang Xue (Tonify Qi and Nourish Blood) herbs to resolve stasis and promote flow. The third visit added Hei Chou and San Leng to Bu Yi Qiang Zhuang (Tonifying and Strengthening) herbs to eliminate stasis. These are all strategies of simultaneous attacking and tonifying.
13. Female Patient Wang. Normally experiences early menstruation with hot palms. This indicates Yin deficiency with Liver heat failing to store blood. Prescription: Di Huang (Rehmannia Root) 12g, Niu Xi (Achyranthes Root) 9g, Shan Yao (Chinese Yam) 9g, Yu Rou (Cornus Fruit) 9g, E Jiao (Donkey-hide Gelatin) 9g, Dan Pi (Moutan Bark) 9g, Ze Xie (Alisma Rhizome) 9g, Chi Ling (Red Poria) 9g, Che Qian Zi (Plantago Seed) 12g, Chao Xu Duan (Fried Dogtail Root) 9g, Nu Zhen Zi (Privet Fruit) 12g, Han Lian Cao (Eclipta Herb) 15g.
14. Female Patient Dong. Early menstruation with lower abdominal distension. Blood color is pale like red bean water, and hands and feet are cold. The theory that "early menstruation belongs to blood heat" should not be rigidly applied. Prescription: Dan Wu Yu (Light Evodia Fruit) 4.5g, Shan Yu Rou 9g, E Jiao Zhu 15g, Si Zi Zi (Dodder Seed) 9g, Ba Ji 9g, Zhi Xiang Fu 9g, Bu Gu Zhi (Psoralea Fruit) 9g, Ai Ye (Mugwort Leaf) 9g, Tai Wu Yao (Lindera Root) 9g, Qing Zhi Cao (Honey-fried Licorice Root) 3g.
15. Female Patient Shen. Menstruation is early by about ten days, which is pathological; an advance of only two or three days is harmless. For eight years, she has failed to conceive ("Meng Xiong Wu Zheng"). The main causes are: first, sallow complexion; second, lower back soreness and abdominal pain precede menstruation; third, frequent leukorrhea causing dizziness and blurred vision. Now, menstruation is approaching. Prescription: Quan Dang Gui 9g, Po Gu Zhi 9g, Shu Di Huang 18g, Rou Dou Kou 9g, Rou Gui Mo (Cinnamon Bark Powder) 1.2g (swallowed in divided doses), Dan Wu Yu 4.5g, Da Chuan Xiong 6g, Hou Du Zhong (Thick Eucommia Bark) 9g, Dan Pi 4.5g, Pao Jiang Tan 3g. [Commentary] "Meng Xiong Wu Zheng" means failure to conceive. From the three main causes listed, it is evident that this is due to insufficiency of essence and blood, and deficiency-cold of the Chong and Ren meridians. At this time when menstruation is approaching, a formula to warm the uterus and regulate menstruation is given first. Once the Chong and Ren are regulated, conception becomes hopeful.
16. Female Patient Wang. Early menstruation with heavy flow. After one cycle, the blood remains bright red and does not stop. Complexion and pulse indicate insufficiency. Ancient texts state that the Liver fails to store blood and the Spleen fails to control it. Prescription: Dang Gui 6g, E Jiao Zhu 12g, Lu Dang Shen 9g, Wu Wei Zi (Schisandra Fruit) 4.5g, Chuan Xiong 6g, Shu Di Huang 12g, Pao Jiang Tan 3g, Chuan Duan Rou (Dipsacus Root) 9g, Sang Ji Sheng (Taxillus Stem) 12g, Fu Shen (Poria with Hostwood) 12g, Zhen Ling Dan 6g (swallowed in two divided doses). [Commentary] The Liver stores blood, and the Spleen controls it. Loss of their controlling function leads to heavy menstruation. Treatment should not use cooling-blood agents but rather formulas that tonify Qi and nourish blood, and tonify the Liver and Spleen to warm and secure.
17. Female Patient Yang. Only half a month since the last menstruation. Lower abdominal pain, worse when lying on the side. Pulse shows rapidity. Rapidity indicates inflammation in some area. Prescription: Chu Pi (Swietenia Bark) 12g, Huang Bo (Phellodendron Bark) 9g, Sheng Qian Cao (Raw Rubia Root) 9g, Ce Bai Ye (Biota Top Leaf) 9g, Ku Shen Pian (Sophora Root Slice) 6g, Xiang Bei Mu (Fritillaria Thunbergii Bulb) 9g, Yun Fu Ling (Poria) 9g, Hu Po (Amber) 3g (powdered and taken with decoction). [Commentary] The Master often said: "A rapid pulse during menstruation usually indicates inflammation."
18. Female Patient Zhu. Early menstruation with dripping discharge lasting half a month. Volume is large, color varies between bright red and purple. This condition started postpartum and has persisted for years. No abdominal pain, but soreness in the lower back and spine. Add herbs that coagulate blood and contract the uterus. Prescription: Yi Mu Cao (Motherwort Herb) 12g, Sheng Qian Cao 9g, Xian He Cao (Agrimony Herb) 12g, Shu Di Huang 15g, Da Chuan Xiong 6g, Du Hong Hua 4.5g, Zhu Ma Gen (Ramie Root) 12g, Sang Ji Sheng 12g. Additionally: Ou Mei Gu (Cuttlefish Bone) 18g, powdered, swallowed in three divided doses. [Commentary] Qian Cao, Xian He Cao, Shu Di, Zhu Ma Gen, and Ou Mei Gu are used to increase blood coagulability. Yi Mu Cao, Chuan Xiong, and Hong Hua contract the uterus, providing compressive hemostasis. Sang Ji Sheng tonifies the Liver and Kidneys to treat back soreness. Since there is no abdominal pain, fewer blood-invigorating herbs are needed.
19. Female Patient Ge. Menstruation is early by half a month. Once started, it takes half a month to clear. This has persisted for over half a year. Volume is small, color varies between bright and pale. Prescription: Ou Mei Gu 15g (powdered and swallowed), Niu Jiao Lao Tan (Charred Buffalo Horn) 12g (wrapped decoction), E Jiao Zhu 12g, Tu Si Bing (Dodder Seed Cake) 12g, Zhu Ma Gen 12g, Sang Ji Sheng 12g, Shu Di Huang 12g, Han Lian Cao 12g. Additionally: Ren Shen Tai Chan Jin Dan (Ginseng Fetal Birth Golden Pill) 4 pills, taken in two divided doses. Second Visit: After two doses, dripping stopped. Frequent leukorrhea remains a chronic issue. Prescription: Gan Di Huang (Dry Rehmannia Root) 15g, Hang Bai Shao (Hangzhou White Peony Root) 6g, Shan Yu Rou 9g, Huai Shan Yao 12g, Sang Shen Zi (Mulberry Fruit) 12g, Tu Si Zi 9g, Jin Ying Zi (Cherokee Rose Hip) 12g, Dong Qing Zi (Ilex Fructus) 9g.
20. Female Patient Tang. Last month, menstruation was obstructed due to anger and depression, followed by yellow discharge for several days. This time, menstruation came after more than ten days. Approaching menstruation caused sour distension in the lower abdomen and severe lower back soreness as if broken. Initially dripping, then passing large black clots. Lower back soreness persists. Physiologically, menstruation involves the ovaries but is also controlled by the nervous system. Ancients often used Liver-soothing methods to regulate menstruation, based on this principle. Prescription: Cu Chao Chai Hu (Vinegar-fried Bupleurum Root) 6g, Xiao Hui Xiang (Fennel Fruit) 6g, Xiang Gan Song (Nardostachys Rhizome) 6g, Da Chuan Xiong 6g, Yan Hu 9g, Lv Fu Hua (Inula Flower) 9g (wrapped), Chuan Lian Zi (Melia Fruit) 9g, Shi Xiao San (Pain-Stopping Powder) 12g (wrapped), Xiang Yuan Pi (Citrus Peel) 6g, Chao Dan Pi 9g, Rou Gui Mo 1.8g (swallowed in three divided doses), Ban Shou Wan (Half-Sulfur Pill) 6g (swallowed in two divided doses).
Second Visit: Menstruation has cleared. Pain in the left lower abdomen, worse upon pressing below the umbilicus, indicates salpingitis. Leukorrhea is abundant and viscous. Prescription: Sheng Ce Bai Ye (Fresh Biota Top Leaf) 30g (decocted as water substitute), Bai Shao 9g, Sheng Ma Huang (Ephedra Herb) 3g, Chu Pi 9g, Bai Wei (Cynanchum Root) 9g, Qiang Huo (Notopterygium Rhizome) 4.5g, Xing Ren Ni (Apricot Seed Paste) 12g, Yan Hu Suo 9g, Shi Xiao San 12g (wrapped), Fen Gan Cao 3g. [Commentary] In the first visit, qi stagnation caused internal residual stasis and unsmooth menstruation, so treatment began with regulating qi and menstruation. In the second visit, abundant viscous leukorrhea and pain in the lower abdomen and below the umbilicus were diagnosed as salpingitis. Thus, herbs clearing damp-heat from the Lower Jiao were used for anti-inflammatory effects. Ma Huang and Qiang Huo were not used for releasing the exterior, but for their ability to warm meridians and relieve pain.
21. Female Patient Ye. Caught a cold just as menstruation started. If flow is light, acrid-warm herbs are not contraindicated; if heavy, they are. Prescription: Chuan Gui Zhi (Cassia Twig) 3g (added later), Chuan Xiong 4.5g, Ci Ji Li (Tribulus Fruit) 9g, Qian Chai Hu (Bupleurum Root) 4.5g (each), Bai Zhi (Angelica Dahurica Root) 6g, Jiu Lin Hei Da Dou (Wine-treated Black Soybean) 12g, Jing Jie (Schizonepeta Spike) 4.5g, Wan Can Sha (Silkworm Excrement) 9g (wrapped), Sheng Ai Ye 4.5g, Bai Jie Zi (Mustard Seed) 6g, Fen Gan Cao 2.4g. [Commentary] Blood moves freely with warmth. Taking acrid-warm herbs during menstruation can increase flow. This patient had a cold coinciding with menstruation. Acrid-warm agents were likely used because the flow was light, avoiding contraindication.
22. Female Patient [Name Unknown]. Differentiating between purgation and astringency for dripping menstruation: ① Assess the volume throughout the process; ② Check for presence of lower back soreness and abdominal pain; ③ Observe the color of the blood. Prescription: Yi Mu Cao 12g, Ze Lan 9g, Yan Hu 9g, Su Mu (Sappan Wood) 6g, Pu Huang (Typha Pollen) 9g (wrapped), Tao Ren 12g, Wu Ling Zhi (Trogopterus Dung) 9g (wrapped), Sheng Ai Ye 6g. [Commentary] This case lists three key differentiating points for treating dripping menstruation, emphasizing careful syndrome differentiation. Generally, scanty, astringent dripping with lower back soreness, abdominal pain, and dark purple-black blood indicates stasis, warranting purgation. Scanty, abundant dripping without soreness/pain and bright red blood indicates no stasis, warranting astringency. However, conditions vary; if deficiency and excess coexist, simultaneous purgation and astringency should be employed.
23. Female Patient Qian. Post-abortion in late spring, massive bleeding like metrorrhagia, accompanied by syncope. Although not critical, blood depletion makes recovery difficult. Menstruation occurred once in summer but has not returned since. Pale complexion and palpitations indicate that purgation is useless. Prescription: Quan Dang Gui 9g, E Jiao Zhu 15g, Gou Qi Zi 9g, Lu Dang Shen 12g, Shan Yu Rou 9g, Shu Di Huang 18g, Han Lian Cao 9g, Bao Ben Shen (An Shen Herb) 12g, Gu Ya and Mai Ya (Barley and Millet Sprouts) 9g each. Additionally: Liang Yi Gao (Two Principles Paste) 24g, one spoonful per dose, twice daily, taken with boiled water. [Commentary] Severe metrorrhagia leads to deficiency. Amenorrhea stems from blood exhaustion. Therefore, Qi and Blood tonics are used; when Qi and Blood are abundant, menstruation resumes naturally.
24. Female Patient Yao. Three menstrual periods in one month. Lower abdominal distension increases volume. Based on color and pulse, Jiao Ai Tang is inappropriate. Prescription: Chao Dan Pi 9g, Sheng Di Huang (Rehmannia Root) 12g, Xiao Ji (Cirsium Herb) 15g, Han Lian Cao 15g, Sheng Qian Cao 9g, Di Yu Tan (Sanguisorba Charcoal) 9g, Dong Qing Zi 9g, Chao Yin Hua (Honeysuckle Flower) 12g, Ou Jie Tan (Lotus Node Charcoal) 4 pieces, Hei Jing Jie (Black Schizonepeta) 6g, Chuan Huang Bo 3g, Xia Ku Cao (Prunella Spike) 9g. Second Visit: After medication, blood remains bright, distension persists, and volume is unchanged. Change method. Prescription: E Jiao Zhu 12g, Yi Mu Cao 9g, Xiao Ji 12g, Qu Mai (Persicaria Herb) 9g, Sheng Pu Huang 9g, Sheng Ai Ye 6g, Sheng Qian Cao 9g, Gan Di Huang 12g, Hei Jing Jie 6g. [Commentary] In the first visit, due to bright blood color, the Master used cooling-blood and hemostatic methods. In the second visit, lacking efficacy, he switched to modified Jiao Ai Tang to warm meridians, dispel stasis, and stop bleeding. By the third visit, menstruation cleared, and abdominal distension disappeared. Finally, Si Wu Tang (Four Substance Decoction) with modifications was used for consolidation. This illustrates the importance of adapting medication to changing symptoms.
25. Female Patient Dai. Five years ago, amenorrhea for three months was treated with purgatives, causing massive bleeding like a flood. After stopping, she became weak with scanty, black menstruation and dull lower abdominal pain before onset. Now on day 5 of menstruation, treated with Wen Jing Tang (Warm the Meridians Decoction). Prescription: Dang Gui 9g, Hang Bai Shao 6g, Rou Gui Mo 1.5g (swallowed in divided doses), Dan Pi 6g, Wu Zhu Yu 4.5g, E Jiao Zhu 12.0g, Pao Jiang Tan 4.5g, Lu Dang Shen 9g, Chuan Xiong 4.5g, Jiang Ban Xia (Ginger-processed Pinellia Tuber) 6g, Chao Mai Dong (Fried Ophiopogon Tuber) 6g, Qing Zhi Gan Cao 3g. [Commentary] Scanty, black menstruation indicates internal stasis, requiring stasis removal. Dull pain before onset indicates deficiency-cold of Chong and Ren, requiring cold dispersion. Previous massive bleeding caused weakness, requiring Qi and Blood tonification. Wen Jing Tang warms meridians, dispels cold, nourishes blood, and removes stasis, fitting perfectly. This is the full Wen Jing Tang formula, substituting Rou Gui for Gui Zhi and Pao Jiang for Sheng Jiang to enhance warming, cold-dispersing, and analgesic effects.
26. Female Patient Zeng. Menstruation is scanty with abdominal distension and regurgitation of clear fluid. Treat with warming. Prescription: Dan Wu Yu 4.5g, Wu Yao (Lindera Root) 6g, Guan Gui Pi (Cinnamon Bark) 9g, Pao Jiang Tan 4.5g, Sheng Ai Ye 6g, Bi Bo (Long Pepper Fruit) 9g, Jiang Ban Xia 6g, Xuan Fu Hua (Inula Flower) 12g (wrapped). [Commentary] Regurgitation of clear fluid indicates Middle Jiao cold. Abdominal distension results from cold condensing Qi. Dispelling cold stops fluid regurgitation; regulating Qi resolves distension. With smooth Qi and dispersed cold, menstruation will naturally increase. This case regulates menstruation without using blood-moving herbs, seeking the root cause.
27. Female Patient Song. Menstruation occurs every 28 days, which is not early. Scanty, pale blood indicates pathology. She is thin, without lower back soreness or abdominal distension, indicating deficiency. It cannot be attributed to ovarian dysfunction or pelvic congestion. Ancients often used warming agents here. Though unrelated to endocrinology, they can revive vitality and stimulate function. Prescription: Dan Wu Yu 4.5g, Shang Guan Gui (Cinnamon Bark) 1.5g (powdered and swallowed), Dang Shen 9g, Bu Gu Zhi 9g, Shu Di Huang 15g, Quan Dang Gui 9g, E Jiao Zhu 15g, Fen Dan Pi 9g, Pao Jiang 4.5g, Zhi Gan Cao 3g. [Commentary] The patient had metrorrhagia last year. Current scanty, pale flow led the Master to prescribe warming and tonifying agents.
28. Female Patient Sun. According to ancient concepts, dark blood with clots indicates Lower Jiao deficiency-cold, treated with warming herbs. Such herbs stimulate ovarian function, improve blood circulation, and strengthen the body. Prescription: Dan Wu Yu 6g, Pao Jiang Tan 4.5g, Xian Ling Pi (Epimedium Herb) 9g, Chao Dan Pi 12g, Sheng Ai Ye 4.5g, Rou Gui Mo 1.5g, Po Gu Zhi 9g, Da Chuan Xiong 6g, Dang Shen 9g, Dang Gui 9g, Zhi Xiang Fu 9g, Zhi Gan Cao 3g, Lai Fu Dan (Reviving Life Pill) 6g (swallowed in two divided doses). [Commentary] Dark menstrual blood indicates Lower Jiao deficiency-cold. Treatment uses warming and moving agents to tonify Yang deficiency and resolve cold stagnation. However, dark blood can also indicate heat; pulse and symptoms must be carefully differentiated. Lai Fu Dan, from *Ju Fang*, contains Sulfur, Niter, etc., warming the Kidney, directing Qi downward, and resolving phlegm, blood, and food stagnation. Here, it is borrowed to warm and disperse Lower Jiao deficiency-cold and cold-stagnant stasis.
29. Female Patient Wang. For endocrine-related late menstruation, plant-based herbs have limited effect. Zhang Zhongjing often used animal and insect drugs. Prescription: Shu Di Huang 18g, Hang Bai Shao 9g, Cu Chao Chai Hu 9g, Ze Lan 9g, Quan Dang Gui 12g, Da Chuan Xiong 6g, Chuan Gui Zhi 4.5g, Fen Dan Pi 9g. Additional Pill Formula: Di Die Chong (Ground Beetle) 15g (with head, legs, wings), Zang Hong Hua (Safflower) 6g, Wan Can Sha 12g, Meng Chong (Blue Bottle Fly Larva) 9g (with head, legs, wings), Liang Tou Jian (Rhizoma Belamcandae) 15g, Dang Gui 30g, Wu Ling Zhi 15g, Zhi Bie Jia (Cooked Turtle Shell) 24g, Ji Xue Teng (Spatholobus Stem) 24g. Powdered finely, honey-pelled into pills the size of tung seeds. Take 20 pills, twice daily. [Commentary] Late menstruation can be deficiency or excess. Deficiency requires tonification; excess requires unblocking. This case primarily uses insect drugs to invigorate blood and unblock menstruation. The decoction uses Si Wu Tang to nourish blood, Chai Hu to soothe Qi, and Gui Zhi, Ze Lan, Dan Pi to harmonize Ying and remove stasis, forming a blood-nourishing and menstruation-regulating formula. The pill uses Di Die Chong and Meng Chong with Hong Hua, Can Sha, Liang Tou Jian, Wu Ling Zhi, and Bie Jia to resolve stasis and dissipate nodules, supported by Dang Gui and Ji Xue Teng to nourish blood. Stasis resolution is embedded within blood nourishment. Honey pills allow for slow, gradual effect.
30. Female Patient Zhou. Previously experienced delayed menstruation often leading to metrorrhagia. Now abdominal distension and lower back soreness. Purgation is contraindicated; adjusting ovarian function is necessary. Prescription: Quan Dang Gui 9g, Bu Gu Zhi 9g, Pao Jiang Tan 3g, Guan Gui Pi 4.5g, Da Chuan Xiong 6g, Ba Ji Tian 9g, Dan Wu Yu 4.5g, Sheng Ma (Cimicifuga Rhizome) 4.5g, Qing Zhi Gan Cao 4.5g, Lai Fu Dan 6g (swallowed in two divided doses). Second Visit: Tonics indirectly restore ovarian function but act slowly if menstruation needs to be promoted. Given her history of post-menstrual metrorrhagia, simultaneous attacking and tonifying is appropriate. Tao Ren Cheng Qi Tang plus Ren Shen and Dang Gui method. Prescription: Dang Shen 9g, Chuan Gui Zhi 3g, Sheng Zhi Shi (Immature Bitter Orange) 9g, Zhi Chuan Po (Processed Magnolia Bark) 3g, Quan Dang Gui 9g, Tao Ren Ni (Peach Kernel Paste) 12g, Sheng Jun (Raw Rhubarb) 6g. [Commentary] Delayed menstruation with lower back soreness and abdominal distension could be purged, but due to history of metrorrhagia, purging risks worsening bleeding. First visit used warming uterus, lifting Qi, and activating blood to regulate menstruation, but menstruation did not start. Second visit used simultaneous attacking and tonifying: Ren Shen and Dang Gui tonify Qi and blood; Gui Zhi, Tao Ren, and Sheng Jun invigorate blood, resolve stasis, and unblock menstruation; Zhi Shi and Chuan Po regulate Qi mechanism.