31．贾女。经将行之一来复。即倦怠违和；既行，若断若续，色黑成块。此卵巢实质病。荆芥穗6克，刺蒺藜9克，秦艽9克，蚕沙9克(包)，料豆衣12克，官桂皮3克，大川芎4．5克，白归身9克，紫丹参6克，粉甘草3克。[按]经行若断若续，色黑成块，为寒客胞宫、血瘀于内所致。治用理气散寒、活血化瘀之剂以调之。
32．黄女。病者所呈面容，经后期居多半。其经之将行，少腹痛。其痛处不类常人之痛经，自觉从少腹左侧有筋脉斜走人于少腹，隐隐作痛，数年来均如此。既然经色不正常，且经净后再行，赤白相间，少腹不痛而胀，此卵巢、子宫皆病者。少腹痛时，自觉冷感。生侧柏叶15克，炒丹皮9克，苦参片6克，小茴香6克，杭白芍9克，川黄柏4．5克，苍术9克，荜茇9克，炮姜炭3克，肉桂1．5克(研末分吞)，粉萆薢9克。[按]少腹属厥阴，就其疼痛之部位与情态，可测知为厥阴经臃寒凝所致，故方中用肉桂、炮姜、小茴香等散寒解凝、镇痛；经净后再行，赤白相间，为子宫发炎所致，故方中用侧柏叶、丹皮、黄柏、苦参等凉血消炎。盖不温不足以镇其痛，不寒不足以消其炎，方药所以寒温并举。
33．胡女。经过期不至，少腹隐痛，得温罨则雷鸣，此寒与气相搏。台乌药9克，制香附9克，海南片9克，川楝子6克，官桂皮6克，淡吴萸2．4克，半硫丸4．5克，五灵脂9克，薤白头9克，佛手片6克。[按]寒与气相搏，经凝涩不行，必以散寒行气，疏通结滞治之。香附、乌药并用，乃《韩氏医通》之青囊丸为主体。案中均选用辛苦芳香之属，以温通经脉，理气行滞，恰合病机。
34．陆女。冲为血海，任主胞胎。经事久闭，冲任失职也。以汤剂调治之。当归9克，金毛脊9克，大川芎6克，巴戟天9克，菟丝子9克，杜仲9克，淮牛膝12克，川续断9克，肉桂末3克(分2次吞)，吴茱萸4．5克，炮姜炭3克，炙甘草4．5克。[按]此种闭经，属虚证，乃营血亏耗，冲任失职，化源不足所引起。前人有"八脉隶于肝肾"之说，故从益肝肾、调冲任入手。据本草记载，案中当归、狗脊、川芎、巴戟天、菟丝子、杜仲、牛膝、川断、肉桂、吴萸均能入奇经，有调补奇经作用。
35．杨女。经愆期，甚则二三月一行。此番闭止，将及3个月；行而量少色淡，腰部酸楚特甚。此证法当温补。当归9克，川芎4．5克，粉丹皮9克，吴萸2．4克，肉桂末1．2克(分2次冲入)，紫丹参9克，山萸肉9克，金毛脊9克，胡芦巴6克，炙乳没各2．4克。[按]经行量少色淡，虚寒之象；腰部酸楚，肾虚之征。用药一取温补肝肾以治其源，一取养血调经以理其流。36．王女。经恒2个月一行，有3个月一行者，且无所苦，头眩、目花而已。据其目光少神，可以测知内分泌之障碍。古人以肾开窍于目，亦有理由。生熟地各9克，淮牛膝9克，潼蒺藜9克，女贞子9克，料豆衣12克，菟丝子9克，仙鹤草12克，苎麻根12克，桑麻丸9克(分2次吞)。[按]肝肾虚弱，营阴亏损，导致月经2个月或3个月一行，故用甘润之剂以滋补肝肾。
37．柴女。经停将及两月，色脉皆现虚象，曾经两足肿，其肿在停经以后。通经药不可孟浪，寓养血于健脾之中。黄芪皮9克，潞党参9克，生白术9克，云苓12克，黑大豆18克，木瓜9克，杏仁泥9克，生熟苡仁各12克，杭芍9克，大枣9克，熟地黄12克(砂仁2．4克拌)，连皮生姜2．4克。[按]虚人停经，宜补不宜攻。用参、芪、术补气健脾，以助生化；地、芍、枣养血和营，以调月经；余药渗湿利尿，以消足肿。熟地用砂仁拌，补中寓行，滋而不腻。
38．陈女。经居将及50日，少腹胀痛，洒然恶寒，予桂枝茯苓丸；苔白，食入则胀，复入平胃散。川桂枝4．5克(后下)，粉丹皮9克，赤芍9克，云苓。9克，桃仁9克，生苍术6克，川朴2．4克(后下)，陈皮6克，粉草3克。二诊：药后腹胀差减，而胸胁攻筑作痛。古人有治血先治气之说。制香附9克，苏梗9克，旋覆花9克(包)青皮6克，川楝子9克，香甘松9克，刺蒺藜9克，沉香曲9克，佛手6克，延胡索9克，娑罗子9克。
[按]初诊用桂枝茯苓丸祛瘀散结，以治经居而少腹胀痛；洒然恶寒；用平胃散燥湿健脾宽中，以治湿困苔白，食入则胀。二诊按"治血先治气"之法，用大队疏利气机之品，以治气郁不舒引起的胸胁攻筑作痛。古有血随气行、气滞则血瘀之说，经病用气药，即取此理。
39．罗女。经事不以时下，多能影响胃障碍，今拟加味越鞠丸予之。当归9克，川芎5．4克，苍术9克，制香附9克，神曲12克，黑山栀9克，陈皮6克，山楂12克，厚朴2．1克(后下)，苏梗6克。[按]气血郁滞，月事不以时下，治必调气活血，解郁行滞，万用越鞠丸加味即是此意。所谓胃障碍，亦为气郁之征，气畅郁舒，则其障碍自除。
40．陈女。经后期已历多年，频年以体弱而更甚，既行腰酸特甚，腹亦胀，其量少，约5日而净。此卵巢实质病，可攻，但必复入营养药。全当归9克，泽兰叶9克，熟地18克，粉丹皮9克，制香附9克，杜仲9克，菟丝子9克，淮牛膝9克，独活6克，桑寄生12克。二诊：大致经先期量多；后期者量反少。上者卵巢黄体疾患，下者卵巢实质疾患。今少腹酸楚则经下少许，盖卵子无力分裂，催经药即使无力转为有力耳。全当归12克，粉丹皮9克，紫丹参9克，淡吴萸4．5克，桃仁泥12克，泽兰叶9克，淮牛膝12克，延胡9克，大川芎6克，苏木4．5克，阿胶24克(烊冲)，潞党参9克，炙甘草3克，红枣5枚。
[按]经后期，腰酸楚，是体弱所致；经行量少，腹胀，为内有瘀阻。此系虚中夹实之证，徒补无益。一诊用归、地补血和营；杜仲、菟丝、独活、寄生强健腰膝；香附、牛膝、泽兰、丹皮理气行瘀。二诊用温经汤加减，参、草、枣、归、胶补虚，吴萸温经散寒，余药调经祛瘀。
41．张女。主症在神经衰弱，易恚怒，多齿痛，皆其候也。虽最近数月，经后期旬日，其色淡而量少；比日正值经行，不但量少，其色且黑，少腹胀满不舒。此当攻补兼施之法。当归9克，熟地15克，淮牛膝9克，泽兰叶9克，五灵脂12克，紫丹参9克，炒丹皮9克，卷柏9克，桃仁泥9克，制香附9克，炮姜炭3克，川芎4．5克。[按]因子素体虚，经后期色淡量少，故用归、地补血；因正值经行，量少色黑，故用灵脂、泽兰、桃仁，丹皮等攻瘀通经，因少腹胀满不舒，故用香附、川芎、炮姜理气散寒。
42．翟女。经事凌乱，将行先淋沥旬日。生阿胶12克(烊冲)，生艾叶4．5克，菟丝子12克，熟地黄18克，牛角鳃9克，黑大豆18克，瞿麦9克，金樱子9克，潼沙苑9克。二诊：下列之属，皆有间接恢复卵巢之作用。山萸肉9克，杜仲9克，阿胶珠12克，枸杞子9克，金毛脊9克，熟地12克，菟丝饼9克，乌药9克，生艾叶4．5克，炮姜炭3克。[按]此经事凌乱，将行先淋沥旬日，为肝肾亏虚，累及冲任，故予益肝肾、调冲任之法。方中乌药，艾叶调气活血，乃取补中寓行之意。
43．陈女。经闭1年有余，体质日见丰腴，此卵巢功能退化，昨日曾见少量。全当归9克，土牛膝12克，川芎6克，卷柏9克，粉丹皮9克，制香附9克，泽兰9克，大黄廑虫丸15克(分2次吞月艮)。[按]因经闭而致体质丰腴，有"血走脾经"之说，正值经来，惟其量少，用活血通经药增加其经量。
44．王女。平素经多后期，但其量多，上月后期如故，而其量少。今又过期旬日以上，量较多而俄顷即止，自后头眩，饮食不消。考经不正常，恒能引起胃证候。香附9克，苍术9克，薤白头12克，黑山栀9克，谷麦芽．各9克，川芎6克，枳实9克，沉香曲9克，山楂肉15克[按]此用越鞠丸加枳实、薤白、谷麦芽、山楂肉等味，以舒气解郁健胃为主，是治疗经后头眩、饮食不消等胃证候的有效方剂。究其机制，一则胃健则经血有生化之源；二则气畅郁舒则月事自调。按先生经验，于此等症状，理气健胃即所以调经。
45．朱女。每月经多后期，将行每觉倦怠食减，既行色紫量多，少腹痛。今经期已届而来就诊。全当归9克，川芎6克，上肉桂末1．2克(分2次吞)，制香附g克，淡吴萸2．4克，丹皮9克，丹参9克，山楂肉12克。二诊：投温经汤加减，经水届期而至，色转鲜红，精神亦较前为佳，惟少腹痛依然阵作。予前法再进。全当归9克，川芎9克，上肉桂1．2克(冲)，郁金9克，制香附9克，白芍9克，山楂肉9克，丹皮9克，绿萼梅2．4克，艾叶9克。
46．陈女。两脉沉细欲绝，舌红苔斑剥，形日以瘠。此种舌脉，主气血俱虚，宜其经不以时下，自汗出，诸症蜂起矣。党参12克，生黄芪18克，全当归9克，白芍9克，生熟地各9克，麦冬9克，萸肉9克，枸杞9克，茯神9克，山药15克，清炙草4．5克，浮小麦15克，大枣10枚。
47．季女。据其证候十之八九是小产；少腹右侧作痛，凡痛多是子宫粘膜有胎盘残余瘀着，当排而去之。生蒲黄12克，粉丹皮9克，苏木9克，藏红花3克(另煎冲)，五灵脂9克，赤芍9克，生茜草9克，制首乌9克，川芎6克，全当归9克，炙乳没各9克。二诊：再予胶红饮加味以通之。阿胶珠15克，藏红花3克，蒲黄(半生半炒)12克，小蓟12克，茜草9克，干地黄18克，当归6克，冬瓜仁30克，藕节12克。
[按]妇科首重调经，其辨证主要根据期、量、色、质来判断寒、热、虚、实(气滞、血瘀)证。寒则温之，但温而毋燥；热者清之，但须防过寒留瘀；虚则补之，但有补气血、补肝肾(冲任)之别；瘀则消之，但不可过于峻猛，以防络伤出血过多。总之，要严格掌握辨证论治的原则，不可拘于一方一法。
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倒经
1．谢女。经停4个月，代偿于口鼻而出。经来腹感胀痛，色、脉皆无虚象，可攻。泽兰叶9克，蓬莪术9克，赤芍9克，川芎6克，王不留行9克，紫丹参9克，桃仁泥12克，当归9克，丹皮9克，粉甘草3克，大黄廑虫丸12克。[按1倒经病究其来由，乃系冲脉之气上扰，血随之逆行而致。治用攻下破血药，以降逆安冲，通其下行之路，引导月经循正道而出。
2．张女。漏红，见鼻出血而量多，病者自以经停4个月为妊娠，故不以鼻衄为倒经。生地榆9克，于地黄15克，仙鹤草9克，旱莲草9克，生侧柏叶12克，冬青子9克，栀子炭9克，干荷叶6克，白茅根1扎，蛤粉炒阿胶12克，石斛15克，黑木耳12克。
3．何女。月经愆期10日，鼻出血，此为代偿性月经。患者少腹胀痛，是为瘀阻，可用催经剂。丹皮9克，桃仁12克，当归9克，川芎6克，泽兰9克茜草6克，苏木6克，生蒲黄6克，台乌6克。[按]倒经即现代医学之代偿性月经，可由阴虚血热引起；张案即为其例。何案为瘀阻，血不循常道而致衄，故不用养阴泄热法，而用行瘀通经，俾经行而衄止。
1．宋女。麻黄之治痛经，以子宫痉挛为当，如炎症则无效。病者经后凝痛，在腹之右侧，按之亦痛。生麻黄2．4克，旋覆花9克(包)，六轴子1．5克，丹皮9克，制香附9克，粉甘草3克，延胡索9克，羌活6克，香甘松6克，桃仁泥15克。[按]经后凝痛，为寒凝不散之象，麻黄、羌活之属有温经散寒、解凝止痛作用，故可拾之。
2．吴女。经不以时下，有一月再见者，有四五十日一行者，但行必痛，其痛与经相终始。全当归9克，粉丹皮9克，官桂皮6克，失笑散12克，大川芎6克，延胡索12克，小茴香4．5克，桃仁泥12克。[按]此方为王清任少腹逐瘀汤加减而成。王氏此方，为治疗妇女痛经之名方，且能调经种子。
3．胡女。经净后之痛，多属实质上变化，如内膜炎、附件炎等。有炎症，多有热，当归芍药散。当归9克，泽泻9克，生苍术9克，大川芎4．5克，炙乳没各4．5克，杭芍9克，柴胡6克，延胡索9克，粉甘草3克。[按]此案明确地提出痛经由于炎症所引起的特点，"有炎症，多有热"，可谓一语而扼其要。当归芍药散治疗月经不调、经期腹痛，有养血、调经、缓痛的作用。参用柴胡以疏肝，元胡活血、理气，乳没散瘀止痛。
4．陈女。经已行而少腹依然胀痛者，属诸瘀凝，故其色紫黑。凡瘀滞亦有虚实之分，虚者以温运为主，实者以攻瘀为主。今患者喜热按，两脉无力，当着重温运。淡吴萸4．5克，姜半夏9克，白芍9克，党参9克，全当归9克，阿胶珠15克，川芎4．5克，丹皮9克，肉桂末2．4克(分3次吞)，清炙草3克。
31．贾女。月经即将来潮的前一天，便感到倦怠不适；月经来潮后，经血断断续续，颜色黑且有血块。这是卵巢实质性疾病。处方：荆芥穗6克，刺蒺藜9克，秦艽9克，蚕沙9克（包煎），料豆衣12克，官桂皮3克，大川芎4.5克，白归身9克，紫丹参6克，粉甘草3克。[按语]月经来潮时断断续续，颜色黑且有血块，是由于寒邪客居胞宫、血液瘀滞于内所致。治疗采用理气散寒、活血化瘀的方剂进行调理。
32．黄女。患者呈现的面容，多数属于经期延后的情况。月经将行时，少腹疼痛。这种疼痛不同于常人痛经，自觉有筋脉从少腹左侧斜向走入少腹，隐隐作痛，多年来一直如此。既然经色不正常，且月经干净后又出血，赤白相间，少腹不痛但胀满，这是卵巢和子宫都有疾病。少腹疼痛时，自觉有冷感。处方：生侧柏叶15克，炒丹皮9克，苦参片6克，小茴香6克，杭白芍9克，川黄柏4.5克，苍术9克，荜茇9克，炮姜炭3克，肉桂1.5克（研末分次吞服），粉萆薢9克。[按语]少腹属厥阴肝经，根据其疼痛的部位与情态，可以推断为厥阴经寒凝所致，所以方中使用肉桂、炮姜、小茴香等药物以散寒解凝、镇痛；月经干净后又出血，赤白相间，是由子宫发炎所致，所以方中使用侧柏叶、丹皮、黄柏、苦参等药物以凉血消炎。大概不温不足以镇压疼痛，不寒不足以消除炎症，所以方药寒温并用。
33．胡女。月经过期不至，少腹隐痛，得温热敷贴则肠鸣，这是寒邪与气机相互搏结。处方：台乌药9克，制香附9克，海南片（沉香）9克，川楝子6克，官桂皮6克，淡吴茱萸2.4克，半硫丸4.5克，五灵脂9克，薤白头9克，佛手片6克。[按语]寒邪与气机相互搏结，经血凝涩不行，必须用散寒行气、疏通结滞的方法治疗。香附、乌药并用，是以《韩氏医通》中的青囊丸为主体。案中均选用辛苦芳香的药物，以温通经脉，理气行滞，恰好符合病机。
34．陆女。冲脉为血海，任脉主胞胎。月经长期闭止，是冲任二脉功能失职。用汤剂调理治疗。处方：当归9克，金毛脊（狗脊）9克，大川芎6克，巴戟天9克，菟丝子9克，杜仲9克，淮牛膝12克，川续断9克，肉桂末3克（分2次吞服），吴茱萸4.5克，炮姜炭3克，炙甘草4.5克。[按语]这种闭经，属于虚证，是由于营血亏耗，冲任失职，化源不足所引起。前人有关于“八脉隶于肝肾”的说法，所以从益肝肾、调冲任入手。据本草记载，案中使用的当归、狗脊、川芎、巴戟天、菟丝子、杜仲、牛膝、川断、肉桂、吴茱萸都能入奇经，具有调补奇经的作用。
35．杨女。月经错期，严重时两三个月才来一次。这次闭止，将近3个月；来潮时量少色淡，腰部酸楚特别严重。此证治法应当温补。处方：当归9克，川芎4.5克，粉丹皮9克，吴茱萸2.4克，肉桂末1.2克（分2次冲入），紫丹参9克，山萸肉9克，金毛脊9克，胡芦巴6克，炙乳香没药各2.4克。[按语]经行量少色淡，是虚寒之象；腰部酸楚，是肾虚之征。用药一方面取温补肝肾以治其本源，一方面取养血调经以理其支流。
36．王女。月经恒常两个月来一次，也有三个月来一次的，而且没有痛苦，只是头晕、眼花而已。根据她目光缺乏神采，可以推测内分泌存在障碍。古人认为肾开窍于目，也是有道理的。处方：生熟地各9克，淮牛膝9克，潼蒺藜9克，女贞子9克，料豆衣12克，菟丝子9克，仙鹤草12克，苎麻根12克，桑麻丸9克（分2次吞服）。[按语]肝肾虚弱，营阴亏损，导致月经两个月或三个月来一次，所以用甘润的方剂以滋补肝肾。
37．柴女。月经停闭将近两个月，色脉皆现虚象，曾经双脚肿胀，其肿胀发生在停经之后。通经药不可鲁莽，要在健脾之中寓含养血之意。处方：黄芪皮9克，潞党参9克，生白术9克，云苓12克，黑大豆18克，木瓜9克，杏仁泥9克，生熟苡仁各12克，杭芍9克，大枣9克，熟地黄12克（用砂仁2.4克拌），连皮生姜2.4克。[按语]体虚之人停经，宜补不宜攻。用人参、黄芪、白术补气健脾，以助气血生化；用地黄、芍药、大枣养血和营，以调月经；其余药物渗湿利尿，以消除足肿。熟地用砂仁拌，是在补益中寓含行气之意，滋腻而不碍胃。
38．陈女。月经周期将近50日，少腹胀痛，洒然恶寒，给予桂枝茯苓丸；舌苔白，进食后则胀满，又加入平胃散。处方：川桂枝4.5克（后下），粉丹皮9克，赤芍9克，云苓9克，桃仁9克，生苍术6克，川朴2.4克（后下），陈皮6克，粉草3克。二诊：服药后腹胀稍减，但胸胁部攻筑作痛。古人有“治血先治气”的说法。处方：制香附9克，苏梗9克，旋覆花9克（包煎），青皮6克，川楝子9克，香甘松9克，刺蒺藜9克，沉香曲9克，佛手6克，延胡索9克，娑罗子9克。
[按语]初诊用桂枝茯苓丸祛瘀散结，以治疗月经逾期而少腹胀痛及洒然恶寒；用平胃散燥湿健脾宽中，以治疗湿困导致的舌苔白、食入则胀。二诊按照“治血先治气”的方法，用大队疏利气机的药物，以治疗气郁不舒引起的胸胁攻筑作痛。古有“血随气行、气滞则血瘀”的说法，治疗经病使用理气药，就是取这个原理。
39．罗女。月经不能按时来潮，多能影响胃部出现障碍，现在拟定加味越鞠丸给予治疗。处方：当归9克，川芎5.4克，苍术9克，制香附9克，神曲12克，黑山栀9克，陈皮6克，山楂12克，厚朴2.1克（后下），苏梗6克。[按语]气血郁滞，月经不能按时来潮，治疗必须调气活血，解郁行滞，万用越鞠丸加味正是这个意思。所谓胃障碍，也是气郁的表现，气机通畅郁结舒展，那么障碍自然消除。
40．陈女。月经后期已经经历多年，年年因为体弱而更严重，月经来潮后腰酸特别严重，腹部也胀，经量少，约5日净。这是卵巢实质性疾病，可以攻伐，但必须再配合营养药。全当归9克，泽兰叶9克，熟地18克，粉丹皮9克，制香附9克，杜仲9克，菟丝子9克，淮牛膝9克，独活6克，桑寄生12克。二诊：大致经前期量多；后期者量反而少。上者指卵巢黄体疾患，下者指卵巢实质疾患。现在少腹酸楚则经下少许，大概是卵子无力分裂，催经药即使无力转为有力罢了。处方：全当归12克，粉丹皮9克，紫丹参9克，淡吴茱萸4.5克，桃仁泥12克，泽兰叶9克，淮牛膝12克，延胡索9克，大川芎6克，苏木4.5克，阿胶24克（烊化冲服），潞党参9克，炙甘草3克，红枣5枚。
[按语]月经后期，腰酸楚，是体质虚弱所致；经行量少，腹胀，为内有瘀阻。这是虚实夹杂之证，单纯补益无益。一诊用当归、地黄补血和营；杜仲、菟丝、独活、寄生强健腰膝；香附、牛膝、泽兰、丹皮理气行瘀。二诊用温经汤加减，人参、甘草、大枣、当归、阿胶补虚，吴茱萸温经散寒，其余药物调经祛瘀。
41．张女。主症在神经衰弱，易愤怒，多齿痛，都是其表现。虽然最近几个月，月经后期十天，颜色淡且量少；近日正值经期，不但量少，颜色发黑，少腹胀满不舒。这应当采用攻补兼施的方法。处方：当归9克，熟地15克，淮牛膝9克，泽兰叶9克，五灵脂12克，紫丹参9克，炒丹皮9克，卷柏9克，桃仁泥9克，制香附9克，炮姜炭3克，川芎4.5克。[按语]因为患者素体虚弱，经后期色淡量少，所以用当归、地黄补血；因为正值经期，量少色黑，所以用五灵脂、泽兰、桃仁、丹皮等攻瘀通经；因为少腹胀满不舒，所以用香附、川芎、炮姜理气散寒。
42．翟女。月经凌乱，将行前先淋沥十天。处方：生阿胶12克（烊化冲服），生艾叶4.5克，菟丝子12克，熟地黄18克，牛角鳃9克，黑大豆18克，瞿麦9克，金樱子9克，潼沙苑9克。二诊：下列药物，皆有间接恢复卵巢功能的作用。处方：山萸肉9克，杜仲9克，阿胶珠12克，枸杞子9克，金毛脊9克，熟地12克，菟丝饼9克，乌药9克，生艾叶4.5克，炮姜炭3克。[按语]此月经凌乱，将行前先淋沥十天，是肝肾亏虚，累及冲任，所以予益肝肾、调冲任的方法。方中乌药、艾叶调气活血，是取补中寓行之意。
43．陈女。闭经1年有余，体质日渐丰腴，这是卵巢功能退化，昨日曾见少量经血。处方：全当归9克，土牛膝12克，川芎6克，卷柏9克，粉丹皮9克，制香附9克，泽兰9克，大黄廑虫丸15克（分2次吞服）。[按语]因闭经而导致体质丰腴，有“血走脾经”的说法，正值经来，惟其量少，用活血通经药增加其经量。
44．王女。平时经多后期，但其量多，上月后期如故，而其量少。现在又过期十几天以上，量较多但顷刻即止，此后头晕，饮食不消。考察月经不正常，常常能引起胃部症状。处方：香附9克，苍术9克，薤白头12克，黑山栀9克，谷麦芽各9克，川芎6克，枳实9克，沉香曲9克，山楂肉15克。[按语]此处用越鞠丸加枳实、薤白、谷麦芽、山楂肉等味，以舒气解郁健胃为主，是治疗经后头晕、饮食不消等胃部症状的有效方剂。究其机制，一则胃健则经血有生化之源；二则气畅郁舒则月经自调。据先生经验，在此等症状下，理气健胃即所以调经。
45．朱女。每月经多后期，将行时每每觉得倦怠食减，既行时色紫量多，少腹痛。现在经期已届而来就诊。处方：全当归9克，川芎6克，上肉桂末1.2克（分2次吞），制香附9克，淡吴茱萸2.4克，丹皮9克，丹参9克，山楂肉12克。二诊：投温经汤加减，经水按期而至，颜色转鲜红，精神亦较前为佳，惟少腹痛依然阵作。予前法再进。处方：全当归9克，川芎9克，上肉桂1.2克（冲服），郁金9克，制香附9克，白芍9克，山楂肉9克，丹皮9克，绿萼梅2.4克，艾叶9克。
46．陈女。两脉沉细欲绝，舌红苔斑剥，形体日渐消瘦。此种舌脉，主气血俱虚，适宜其月经不能按时来潮，自汗出，诸症蜂起。处方：党参12克，生黄芪18克，全当归9克，白芍9克，生熟地各9克，麦冬9克，山萸肉9克，枸杞9克，茯神9克，山药15克，清炙甘草4.5克，浮小麦15克，大枣10枚。
47．季女。根据其证候十之八九是小产；少腹右侧作痛，凡是疼痛多是子宫粘膜有胎盘残余瘀着，应当排出并去除它。处方：生蒲黄12克，粉丹皮9克，苏木9克，藏红花3克（另煎冲服），五灵脂9克，赤芍9克，生茜草9克，制首乌9克，川芎6克，全当归9克，炙乳香没药各9克。二诊：再予胶红饮加味以通之。处方：阿胶珠15克，藏红花3克，蒲黄（半生半炒）12克，小蓟12克，茜草9克，干地黄18克，当归6克，冬瓜仁30克，藕节12克。
[按语]妇科首重调经，其辨证主要根据期、量、色、质来判断寒、热、虚、实（气滞、血瘀）证。寒则温之，但温而毋燥；热者清之，但须防过寒留瘀；虚则补之，但有补气血、补肝肾（冲任）之别；瘀则消之，但不可过于峻猛，以防络伤出血过多。总之，要严格掌握辨证论治的原则，不可拘于一方一法。
1．谢女。月经停闭4个月，代偿于口鼻而出。经来腹感胀痛，色、脉皆无虚象，可攻。处方：泽兰叶9克，蓬莪术9克，赤芍9克，川芎6克，王不留行9克，紫丹参9克，桃仁泥12克，当归9克，丹皮9克，粉甘草3克，大黄廑虫丸12克。[按语]倒经病究其来由，乃是系冲脉之气上扰，血随之逆行而致。治用攻下破血药，以降逆安冲，通其下行之路，引导月经循正道而出。
2．张女。漏红，见鼻出血而量多，病者自以经停4个月为妊娠，故不以鼻衄为倒经。处方：生地榆9克，干地黄15克，仙鹤草9克，旱莲草9克，生侧柏叶12克，冬青子9克，栀子炭9克，干荷叶6克，白茅根1扎，蛤粉炒阿胶12克，石斛15克，黑木耳12克。
3．何女。月经愆期10日，鼻出血，此为代偿性月经。患者少腹胀痛，是为瘀阻，可用催经剂。处方：丹皮9克，桃仁12克，当归9克，川芎6克，泽兰9克，茜草6克，苏木6克，生蒲黄6克，台乌6克。[按语]倒经即现代医学之代偿性月经，可由阴虚血热引起；张案即为其例。何案为瘀阻，血不循常道而致衄，故不用养阴泄热法，而用行瘀通经，俾经行而衄止。
1．宋女。麻黄之治痛经，以子宫痉挛为当，如炎症则无效。病者经后凝痛，在腹之右侧，按之亦痛。处方：生麻黄2.4克，旋覆花9克（包煎），六轴子1.5克，丹皮9克，制香附9克，粉甘草3克，延胡索9克，羌活6克，香甘松6克，桃仁泥15克。[按语]经后凝痛，为寒凝不散之象，麻黄、羌活之属有温经散寒、解凝止痛作用，故可拾之。
2．吴女。经不以时下，有一月再见者，有四五十日一行者，但行必痛，其痛与经相终始。处方：全当归9克，粉丹皮9克，官桂皮6克，失笑散12克，大川芎6克，延胡索12克，小茴香4.5克，桃仁泥12克。[按语]此方为王清任少腹逐瘀汤加减而成。王氏此方，为治疗妇女痛经之名方，且能调经种子。
3．胡女。经净后之痛，多属实质上变化，如内膜炎、附件炎等。有炎症，多有热，用当归芍药散。处方：当归9克，泽泻9克，生苍术9克，大川芎4.5克，炙乳没各4.5克，杭芍9克，柴胡6克，延胡索9克，粉甘草3克。[按语]此案明确地提出痛经由于炎症所引起的特点，“有炎症，多有热”，可谓一语而扼其要。当归芍药散治疗月经不调、经期腹痛，有养血、调经、缓痛的作用。参用柴胡以疏肝，元胡活血、理气，乳没散瘀止痛。
4．陈女。经已行而少腹依然胀痛者，属诸瘀凝，故其色紫黑。凡瘀滞亦有虚实之分，虚者以温运为主，实者以攻瘀为主。今患者喜热按，两脉无力，当着重温运。处方：淡吴茱萸4.5克，姜半夏9克，白芍9克，党参9克，全当归9克，阿胶珠15克，川芎4.5克，丹皮9克，肉桂末2.4克（分3次吞），清炙草3克。
31. Female Jia. One day before the onset of menstruation, she felt fatigue and discomfort; after menstruation began, the flow was intermittent, dark in color, and contained clots. This is an organic disease of the ovary. Prescription: Schizonepeta Spike (Jingjie Sui) 6g, Tribulus Fruit (Ciji Li) 9g, Gentian Macrophylla Root (Qinjiao) 9g, Mulberry Silkworm Excrement (Can Sha) 9g (wrapped), Soya Bean Coat (Liaodou Yi) 12g, Cinnamon Bark (Guapi) 3g, Ligusticum Wallichii Rhizome (Chuanxiong) 4.5g, Angelica Sinensis Root (Baiguishen) 9g, Salvia Miltiorrhiza Root (Zidanshen) 6g, Licorice Root (Fengangcao) 3g. [Commentary] Intermittent menstrual flow with dark color and clots is caused by cold pathogen lodging in the uterus and blood stasis within. Treatment employs a formula to regulate qi, dispel cold, and invigorate blood to resolve stasis.
32. Female Huang. The patient's facial appearance suggests that delayed menstruation is the predominant pattern. When menstruation is about to begin, there is pain in the lower abdomen. This pain differs from typical dysmenorrhea; she feels a tendon-like sensation running obliquely from the left side of the lower abdomen into it, causing dull pain, which has persisted for years. Since the menstrual color is abnormal and bleeding recurs after the period ends, appearing as red mixed with white discharge, accompanied by distension without pain in the lower abdomen, both the ovaries and uterus are diseased. During lower abdominal pain, she feels coldness. Prescription: Live Plantago Seed (Shengcebaiye) 15g, Fried Moutan Cortex (Chaomudanpi) 9g, Sophora Flavescens Root (Kushen Pian) 6g, Fennel Fruit (Xiaohuixiang) 6g, White Peony Root (Hangbaishao) 9g, Phellodendron Amurense Bark (Chuanhuangbo) 4.5g, Atractylodes Rhizome (Cangzhu) 9g, Long Pepper Fruit (Bibo) 9g, Charred Ginger (Paojiangtan) 3g, Cinnamon Twig (Rougui) 1.5g (powdered, taken in divided doses), Dioscorea Hypoglauca Rhizome (Fenbixie) 9g. [Commentary] The lower abdomen belongs to the Jueyin Liver channel. Based on the location and nature of the pain, it can be deduced to be caused by cold stagnation in the Jueyin channel; thus, Cinnamon Twig, Charred Ginger, and Fennel Fruit are used to dispel cold, resolve stagnation, and alleviate pain. Recurrent bleeding after menstruation with red and white mixture is due to uterine inflammation; thus, Plantago Seed, Moutan Cortex, Phellodendron Bark, and Sophora Root are used to cool blood and reduce inflammation. Generally, warmth is insufficient to suppress pain, and cold is insufficient to eliminate inflammation; hence, the formula combines warming and cooling herbs.
33. Female Hu. Menstruation is overdue and has not arrived; there is dull pain in the lower abdomen, and bowel sounds occur upon warming. This indicates cold fighting with qi stagnation. Prescription: Linder Fruit (Taiwuyao) 9g, Prepared Cyperus Rhizome (Zhixiangfu) 9g, Hainan Agarwood (Hainanpian) 9g, Toosendan Fruit (Chuanlianzi) 6g, Cinnamon Bark (Guapi) 6g, Evodia Fruit (Danwuyu) 2.4g, Banliu Pill (Banliu Wan) 4.5g, Trogopterus Dung (Wulingzhi) 9g, Allium Macrostemon Bulb (Xiebeitou) 9g, Bergamot Fruit (Foushou Pian) 6g. [Commentary] Cold fighting with qi causes menstrual blood to coagulate and flow sluggishly; treatment must involve dispelling cold, moving qi, and unblocking stagnation. The combination of Cyperus Rhizome and Linder Fruit forms the basis of Qingnang Pill from *Han Shi Yi Tong*. The prescription selects pungent, bitter, and aromatic herbs to warm and unblock the meridians, regulate qi, and move stagnation, fitting the pathology perfectly.
34. Female Lu. The Chong vessel is the Sea of Blood, and the Ren vessel governs pregnancy. Prolonged amenorrhea indicates dysfunction of the Chong and Ren vessels. Treatment with decoction. Prescription: Angelica Sinensis Root (Danggui) 9g, Dogwood Ridge (Jinmaoji/Gouji) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 6g, Morinda Officinalis Root (Bajitian) 9g, Dodder Seed (Tusizi) 9g, Eucommia Bark (Duzhong) 9g, Achyranthes Bidentata Root (Huainiuxi) 12g, Teasel Root (Chuanduan) 9g, Cinnamon Twig Powder (Rougui Mo) 3g (taken in two divided doses), Evodia Fruit (Wuzhuyu) 4.5g, Charred Ginger (Paojiangtan) 3g, Honey-fried Licorice Root (Zhigancao) 4.5g. [Commentary] This type of amenorrhea is a deficiency syndrome caused by depletion of Ying blood, dysfunction of Chong and Ren vessels, and insufficient source of transformation. Ancients stated that "the Eight Extraordinary Vessels belong to the Liver and Kidney"; thus, treatment starts by tonifying Liver and Kidney and regulating Chong and Ren. According to materia medica, Danggui, Gouji, Chuanxiong, Bajitian, Tusizi, Duzhong, Niuxi, Chuanduan, Rougui, and Wuzhuyu all enter the extraordinary vessels and have the effect of regulating and tonifying them.
35. Female Yang. Menstrual cycle is irregular, sometimes occurring only once every two or three months. This time, amenorrhea has lasted nearly 3 months; when flow occurs, it is scanty and pale, with severe soreness in the waist. This syndrome requires warming and tonification. Prescription: Angelica Sinensis Root (Danggui) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 4.5g, Moutan Cortex (Fenmadanpi) 9g, Evodia Fruit (Wuyu) 2.4g, Cinnamon Twig Powder (Rougui Mo) 1.2g (mixed in, taken in two divided doses), Salvia Miltiorrhiza Root (Zidanshen) 9g, Cornus Fruit (Shanyurou) 9g, Dogwood Ridge (Jinmaoji) 9g, Fenugreek Seed (Huluba) 6g, Honey-fried Frankincense and Myrrh (Zhirumie) 2.4g each. [Commentary] Scanty and pale menstrual flow indicates deficiency-cold; soreness in the waist indicates Kidney deficiency. Medications are chosen to warm and tonify Liver and Kidney to treat the root, and to nourish blood and regulate menstruation to manage the branch.
36. Female Wang. Menstruation usually occurs every two months, sometimes every three months, without distress, except for dizziness and blurred vision. Her lackluster eyesight suggests endocrine disturbance. The ancients' view that the Kidney opens into the eyes is reasonable. Prescription: Raw and Prepared Rehmannia Root (Sheng Shudi) 9g each, Achyranthes Bidentata Root (Huainiuxi) 9g, Tribulus Fruit (Tongjili) 9g, Glossy Privet Fruit (Nvzhenzi) 9g, Soya Bean Coat (Liaodouyi) 12g, Dodder Seed (Tusizi) 9g, Agrimony Herb (Xianhecao) 12g, Ramie Root (Zhuma Gen) 12g, Sangma Pill (Sangma Wan) 9g (taken in two divided doses). [Commentary] Liver and Kidney weakness with depletion of Ying Yin leads to menstruation every two or three months; thus, sweet and moistening herbs are used to tonify Liver and Kidney.
37. Female Chai. Menstruation has stopped for nearly two months; pulse and complexion show deficiency signs. She previously had swollen feet, occurring after amenorrhea. Emmenagogues should not be used recklessly; nourishing blood should be embedded within spleen-strengthening methods. Prescription: Astragalus Skin (Huangqipi) 9g, Codonopsis Root (Luodangshen) 9g, Raw Atractylodes Rhizome (Shengbaizhu) 9g, Poria (Yunling) 12g, Black Soybean (Heidadou) 18g, Papaya Fruit (Mugua) 9g, Almond Paste (Xingrenni) 9g, Raw and Prepared Coix Seed (Sheng Shu Yiyiren) 12g each, White Peony Root (Hangshao) 9g, Jujube (Dazao) 9g, Prepared Rehmannia Root (Shudihuang) 12g (mixed with Amomum Fruit 2.4g), Fresh Ginger with Peel (Lianpi Shengjiang) 2.4g. [Commentary] Amenorrhea in deficient patients should be treated with tonification rather than attack. Codonopsis, Astragalus, and Atractylodes tonify qi and strengthen the spleen to aid transformation and generation; Rehmannia, Peony, and Jujube nourish blood and harmonize Ying to regulate menstruation; remaining herbs promote diuresis to reduce foot swelling. Mixing Prepared Rehmannia with Amomum allows movement within tonification, preventing cloying stickiness.
38. Female Chen. Menstrual cycle is nearly 50 days; lower abdominal distending pain and aversion to cold. Prescribed Guizhi Fuling Wan; white tongue coating and postprandial distension led to addition of Pingwei San. Prescription: Cinnamon Twig (Chuan Guizhi) 4.5g (added later), Moutan Cortex (Fenmadanpi) 9g, Red Peony Root (Chishao) 9g, Poria (Yunling) 9g, Peach Kernel (Taoren) 9g, Raw Atractylodes Rhizome (Sheng Cangzhu) 6g, Magnolia Bark (Chuanpu) 2.4g (added later), Tangerine Peel (Chenpi) 6g, Licorice Root (Fengcao) 3g. Second visit: Abdominal distension reduced slightly, but stabbing pain in chest and hypochondrium occurred. Ancients said "treat blood by first treating qi." Prescription: Prepared Cyperus Rhizome (Zhixiangfu) 9g, Perilla Stem (Sugeng) 9g, Inula Flower (Xuanfuhua) 9g (wrapped), Green Citrus Peel (Qingpi) 6g, Toosendan Fruit (Chuanlianzi) 9g, Indian Valerian Root (Xianggansong) 9g, Tribulus Fruit (Ciji Li) 9g, Agastache Fermented Curd (Chenxiangqu) 9g, Bergamot Fruit (Foshou) 6g, Corydalis Rhizome (Yanhusuo) 9g, Madras Leaf (Suoluozi) 9g.
[Commentary] First visit used Guizhi Fuling Wan to remove stasis and dissipate nodules to treat delayed menstruation with lower abdominal distending pain and aversion to cold; Pingwei San was used to dry dampness, strengthen spleen, and broaden the middle to treat damp encumbrance with white coating and postprandial distension. Second visit followed the principle "treat blood by first treating qi," using a large group of herbs to soothe and regulate qi mechanism to treat stabbing pain in chest and hypochondrium caused by qi depression. Ancients stated "blood follows qi; qi stagnation leads to blood stasis"; using qi-regulating herbs for menstrual diseases takes this logic.
39. Female Luo. Menstruation does not arrive on time, often affecting stomach function. Now prescribing modified Yueju Wan. Prescription: Angelica Sinensis Root (Danggui) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 5.4g, Atractylodes Rhizome (Cangzhu) 9g, Prepared Cyperus Rhizome (Zhixiangfu) 9g, Medicated Leaven (Shenqu) 12g, Gardenia Fruit (Heishanzhi) 9g, Tangerine Peel (Chenpi) 6g, Hawthorn Fruit (Shanzha) 12g, Magnolia Bark (Houpo) 2.1g (added later), Perilla Stem (Sugeng) 6g. [Commentary] Qi and blood stagnation cause irregular menstruation; treatment must regulate qi, invigorate blood, relieve depression, and move stagnation. Modified Yueju Wan embodies this intent.所谓的 "stomach disturbance" is also a sign of qi depression; when qi flows freely and depression resolves, the disturbance disappears.
40. Female Chen. Delayed menstruation has persisted for years, worsening due to frailty. After menstruation, severe lower back soreness and abdominal distension occur; flow is scanty, lasting about 5 days. This is an organic ovarian disease; attack is permissible but must be followed by nutritional support. Prescription: Angelica Sinensis Root (Quandanggui) 9g, Leaf of Land Onion (Zelan Ye) 9g, Prepared Rehmannia Root (Shudi) 18g, Moutan Cortex (Fenmadanpi) 9g, Prepared Cyperus Rhizome (Zhixiangfu) 9g, Eucommia Bark (Duzhong) 9g, Dodder Seed (Tusizi) 9g, Achyranthes Bidentata Root (Huainiuxi) 9g, Angelica Pubescens Root (Duohuo) 6g, Taxillus Branches (Sangjisheng) 12g. Second visit: Generally, early periods are heavy; late periods are light. Upper refers to corpus luteum disease; lower refers to organic ovarian disease. Now, lower abdominal soreness results in slight flow, likely because the egg lacks strength to divide; emmenagogues may transform weakness into strength. Prescription: Angelica Sinensis Root (Quandanggui) 12g, Moutan Cortex (Fenmadanpi) 9g, Salvia Miltiorrhiza Root (Zidanshen) 9g, Evodia Fruit (Danwuyu) 4.5g, Peach Kernel Paste (Taoren Ni) 12g, Leaf of Land Onion (Zelan Ye) 9g, Achyranthes Bidentata Root (Huainiuxi) 12g, Corydalis Rhizome (Yanhu) 9g, Ligusticum Wallichii Rhizome (Da Chuanxiong) 6g, Sappan Wood (Sumu) 4.5g, Donkey-hide Gelatin (Ejiao) 24g (melted and mixed), Codonopsis Root (Luodangshen) 9g, Honey-fried Licorice Root (Zhigancao) 3g, Jujube (Hongzao) 5 pieces.
[Commentary] Delayed menstruation with lower back soreness is caused by physical weakness; scanty flow and distension indicate internal stasis. This is a deficiency-excess complex syndrome; pure tonification is useless. First visit used Danggui and Dihuang to nourish blood and harmonize Ying; Duzhong, Tusizi, Duohuo, and Sangjisheng to strengthen waist and knees; Xiangfu, Niuxi, Zelan, and Danpi to regulate qi and move stasis. Second visit used modified Wenjing Tang: Renshen, Gancao, Zao, Danggui, and Ejiao to tonify deficiency; Wuyu to warm channels and dispel cold; remaining herbs to regulate menstruation and remove stasis.
41. Female Zhang. Main symptoms are neurasthenia, irritability, and frequent toothaches. Recently, menstruation was delayed by ten days, pale and scanty; currently menstruating, flow is scanty and black, with lower abdominal fullness and discomfort. Attack and tonification should be combined. Prescription: Angelica Sinensis Root (Danggui) 9g, Prepared Rehmannia Root (Shudi) 15g, Achyranthes Bidentata Root (Huainiuxi) 9g, Leaf of Land Onion (Zelan Ye) 9g, Trogopterus Dung (Wulingzhi) 12g, Salvia Miltiorrhiza Root (Zidanshen) 9g, Fried Moutan Cortex (Chaomudanpi) 9g, Serissa Japonica Herb (Juanbai) 9g, Peach Kernel Paste (Taoren Ni) 9g, Prepared Cyperus Rhizome (Zhixiangfu) 9g, Charred Ginger (Paojiangtan) 3g, Ligusticum Wallichii Rhizome (Chuanxiong) 4.5g. [Commentary] Due to constitutional deficiency, pale and scanty late-period flow is treated with Danggui and Dihuang to nourish blood; current scanty and black flow is treated with Wulingzhi, Zelan, Taoren, and Danpi to attack stasis and unblock menstruation; lower abdominal fullness is treated with Xiangfu, Chuanxiong, and Paojiangtan to regulate qi and dispel cold.
42. Female Zhai. Menstrual cycle is irregular, preceded by spotting for ten days. Prescription: Raw Donkey-hide Gelatin (Sheng Ejiao) 12g (melted and mixed), Live Mugwort Leaf (Sheng Aiye) 4.5g, Dodder Seed (Tusizi) 12g, Prepared Rehmannia Root (Shudihuang) 18g, Buffalo Horn Base (Niujiaosai) 9g, Black Soybean (Heidadou) 18g, Dianthus Caulis (Qumai) 9g, Chinese Wolfberry Fruit (Jinyingzi) 9g, Astragalus Seeds (Tongshayuan) 9g. Second visit: The following herbs indirectly restore ovarian function. Prescription: Cornus Fruit (Shanyurou) 9g, Eucommia Bark (Duzhong) 9g, Fried Donkey-hide Gelatin (Ejiao Zhu) 12g, Goji Berry (Gouqizi) 9g, Dogwood Ridge (Jinmaoji) 9g, Prepared Rehmannia Root (Shudi) 12g, Dodder Cake (Tusibi) 9g, Linder Fruit (Wuyao) 9g, Live Mugwort Leaf (Sheng Aiye) 4.5g, Charred Ginger (Paojiangtan) 3g. [Commentary] Irregular menstruation with pre-menstrual spotting for ten days is due to Liver and Kidney deficiency affecting Chong and Ren vessels; thus, tonifying Liver and Kidney and regulating Chong and Ren is employed. Wuyao and Aiye in the formula regulate qi and invigorate blood, embodying the idea of movement within tonification.
43. Female Chen. Amenorrhea for over a year; body constitution has become increasingly robust. This indicates degeneration of ovarian function; small amount of flow observed yesterday. Prescription: Angelica Sinensis Root (Quandanggui) 9g, Lesser Burdock Root (Tuniuxi) 12g, Ligusticum Wallichii Rhizome (Chuanxiong) 6g, Serissa Japonica Herb (Juanbai) 9g, Moutan Cortex (Fenmadanpi) 9g, Prepared Cyperus Rhizome (Zhixiangfu) 9g, Leaf of Land Onion (Zelan) 9g, Dahuang Zhichong Pill (Dahuang Zhichong Wan) 15g (taken in two divided doses). [Commentary] Amenorrhea leading to robust constitution relates to the saying "blood travels through the Spleen channel." With current slight flow, blood-invigorating and menstruation-unblocking herbs are used to increase flow.
44. Female Wang. Usually heavy and delayed menstruation, but last month was delayed with scanty flow. Now overdue by more than ten days; flow was relatively heavy but stopped abruptly, followed by dizziness and indigestion. Abnormal menstruation often causes gastric symptoms. Prescription: Cyperus Rhizome (Xiangfu) 9g, Atractylodes Rhizome (Cangzhu) 9g, Allium Macrostemon Bulb (Xiebeitou) 12g, Gardenia Fruit (Heishanzhi) 9g, Barley Sprout and Malt (Guyamaiya) 9g each, Ligusticum Wallichii Rhizome (Chuanxiong) 6g, Immature Bitter Orange (Zhishi) 9g, Agastache Fermented Curd (Chenxiangqu) 9g, Hawthorn Flesh (Shanzhourou) 15g. [Commentary] Yueju Wan plus Zhishi, Xiebai, Guyamaiya, and Shanzhourou primarily soothes qi, relieves depression, and strengthens the stomach; it is effective for post-menstrual dizziness and indigestion. Mechanism: first, strong stomach provides source for blood transformation; second, free-flowing qi resolves depression, regulating menstruation. According to the master's experience, regulating qi and strengthening the stomach regulates menstruation in such cases.
45. Female Zhu. Usually delayed menstruation; pre-menstrual fatigue and poor appetite; during menstruation, dark purple and heavy flow with lower abdominal pain. Presenting now at onset. Prescription: Angelica Sinensis Root (Quandanggui) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 6g, Cinnamon Twig Powder (Shang Rougui Mo) 1.2g (taken in two divided doses), Prepared Cyperus Rhizome (Zhixiangfu) 9g, Evodia Fruit (Danwuyu) 2.4g, Moutan Cortex (Danpi) 9g, Salvia Miltiorrhiza Root (Danshen) 9g, Hawthorn Flesh (Shanzhourou) 12g. Second visit: Modified Wenjing Tang resulted in timely menstruation, bright red color, and improved spirit, but paroxysmal lower abdominal pain persists. Continue previous method. Prescription: Angelica Sinensis Root (Quandanggui) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 9g, Cinnamon Twig (Shang Rougui) 1.2g (mixed in), Turmeric Tuber (Yujin) 9g, Prepared Cyperus Rhizome (Zhixiangfu) 9g, White Peony Root (Baishao) 9g, Hawthorn Flesh (Shanzhourou) 9g, Moutan Cortex (Danpi) 9g, Green Calyx Plum (Lueemei) 2.4g, Mugwort Leaf (Aiye) 9g.
46. Female Chen. Pulse deep, fine, and nearly imperceptible; red tongue with peeling coating; body wasting daily. These tongue and pulse signs indicate dual deficiency of qi and blood, explaining delayed menstruation, spontaneous sweating, and myriad symptoms. Prescription: Codonopsis Root (Dangshen) 12g, Raw Astragalus Root (Sheng Huangqi) 18g, Angelica Sinensis Root (Quandanggui) 9g, White Peony Root (Baishao) 9g, Raw and Prepared Rehmannia Root (Sheng Shudi) 9g each, Ophiopogon Tuber (Maidong) 9g, Cornus Fruit (Yurou) 9g, Goji Berry (Gouqi) 9g, Poria with Hostwood (Fushen) 9g, Chinese Yam (Shanyao) 15g, Honey-fried Licorice Root (Qingzhigancao) 4.5g, Floating Wheat (Fuxiaomai) 15g, Jujube (Dazao) 10 pieces.
47. Female Ji. Symptoms suggest miscarriage in 80-90% of cases; pain in right lower abdomen. Pain often indicates placental residue adhering to uterine mucosa, which must be expelled. Prescription: Raw Polygonum Multiflorum Spore (Sheng Puhuang) 12g, Moutan Cortex (Fenmadanpi) 9g, Sappan Wood (Sumu) 9g, Saffron Stigma (Zanghonghua) 3g (decocted separately and mixed), Trogopterus Dung (Wulingzhi) 9g, Red Peony Root (Chishao) 9g, Live Rubia Root (Sheng Qiancao) 9g, Prepared Polygonum Multiflorum Root (Zhishouwu) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 6g, Angelica Sinensis Root (Quandanggui) 9g, Honey-fried Frankincense and Myrrh (Zhirumie) 9g each. Second visit: Further treat with modified Jiaohong Yin to unblock. Prescription: Fried Donkey-hide Gelatin (Ejiao Zhu) 15g, Saffron Stigma (Zanghonghua) 3g, Polygonum Multiflorum Spore (Puhuang, half raw half fried) 12g, Small Thistle Herb (Xiaoji) 12g, Rubia Root (Qiancao) 9g, Dry Rehmannia Root (Gan Dihuang) 18g, Angelica Sinensis Root (Danggui) 6g, Winter Melon Seed (Dongguaren) 30g, Lotus Node (Oujie) 12g.
[Commentary] Gynecology prioritizes regulating menstruation; differentiation is mainly based on cycle, volume, color, and quality to determine cold, heat, deficiency, and excess (qi stagnation, blood stasis). Cold is warmed but not dried; heat is cleared but not overly chilled to avoid stasis; deficiency is tonified, distinguishing between qi/blood and Liver/Kidney (Chong/Ren); stasis is resolved but not too harshly to avoid collateral damage and excessive bleeding. Strict adherence to syndrome differentiation is essential; do not adhere rigidly to one formula or method.
Chinese Medical Treasures: Zhang Cigong's Medical Cases Vol. 3
Zhang Cigong
Retrograde Menstruation
1. Female Xie. Menstruation stopped for 4 months, compensatory bleeding from mouth and nose. Abdominal distending pain upon flow; pulse and complexion show no deficiency signs; attack is permissible. Prescription: Leaf of Land Onion (Zelan Ye) 9g, Curcuma Zedoaria Rhizome (Peng Ezhu) 9g, Red Peony Root (Chishao) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 6g, Cowherb Seed (Wangbuliuxing) 9g, Salvia Miltiorrhiza Root (Zidanshen) 9g, Peach Kernel Paste (Taoren Ni) 12g, Angelica Sinensis Root (Danggui) 9g, Moutan Cortex (Danpi) 9g, Licorice Root (Fenggancao) 3g, Dahuang Zhichong Pill (Dahuang Zhichong Wan) 12g. [Commentary] Retrograde menstruation arises from rebellious Qi of the Chong vessel, causing blood to flow upward inversely. Treatment uses purgative and blood-breaking herbs to descend rebellion, calm Chong, open the downward pathway, and guide menstruation to return to its normal course.
2. Female Zhang. Leakage of red blood with heavy epistaxis. Patient assumed 4-month amenorrhea indicated pregnancy, so did not consider epistaxis as retrograde menstruation. Prescription: Sanguisorba Root (Shengdiyuye) 9g, Dry Rehmannia Root (Gan Dihuang) 15g, Agrimony Herb (Xianhecao) 9g, Eclipta Herb (Hanliancao) 9g, Live Plantago Leaf (Shengcebaiye) 12g, Ilex Aquifolium Fruit (Dongqingzi) 9g, Charred Gardenia Fruit (Zhizitan) 9g, Dried Lotus Leaf (Ganheyeye) 6g, White Imperata Rhizome (Baimaogen) 1 bundle, Asarum-coated Donkey-hide Gelatin (Ge Fen Chao Ejiao) 12g, Dendrobium Stem (Shihu) 15g, Black Wood Ear (Heimuer) 12g.
3. Female He. Menstruation delayed by 10 days with epistaxis; this is compensatory menstruation. Patient has lower abdominal distending pain, indicating stasis; emmenagogue can be used. Prescription: Moutan Cortex (Danpi) 9g, Peach Kernel (Taoren) 12g, Angelica Sinensis Root (Danggui) 9g, Ligusticum Wallichii Rhizome (Chuanxiong) 6g, Leaf of Land Onion (Zelan) 9g, Rubia Root (Qiancao) 6g, Sappan Wood (Sumu) 6g, Raw Polygonum Multiflorum Spore (Sheng Puhuang) 6g, Linder Fruit (Taiwu) 6g. [Commentary] Retrograde menstruation is modern compensatory menstruation, often caused by Yin deficiency and blood heat; Case Zhang is an example. Case He involves stasis blocking normal flow, causing epistaxis; thus, nourishing Yin and clearing heat is avoided, instead using blood-invigorating and menstruation-unblocking herbs to stop bleeding by restoring normal flow.
Dysmenorrhea
1. Female Song. Ephedra treats dysmenorrhea when caused by uterine spasm; ineffective for inflammation. Post-menstrual cramping pain on right abdomen, tender to pressure. Prescription: Raw Ephedra Herb (Sheng Mahuang) 2.4g, Inula Flower (Xuanfuhua) 9g (wrapped), Acocynthis Seed (Liuzhouzi) 1.5g, Moutan Cortex (Danpi) 9g, Prepared Cyperus Rhizome (Zhixiangfu) 9g, Licorice Root (Fenggancao) 3g, Corydalis Rhizome (Yanhusuo) 9g, Notopterygium Rhizome (Qianghuo) 6g, Indian Valerian Root (Xianggansong) 6g, Peach Kernel Paste (Taoren Ni) 15g. [Commentary] Post-menstrual cramping indicates persistent cold stagnation; Ephedra and Notopterygium warm channels, dispel cold, resolve stagnation, and alleviate pain, making them suitable choices.
2. Female Wu. Irregular menstruation, sometimes twice a month, sometimes every 40-50 days; always painful, pain lasts throughout the period. Prescription: Angelica Sinensis Root (Quandanggui) 9g, Moutan Cortex (Fenmadanpi) 9g, Cinnamon Bark (Guapi) 6g, Shixiao San (Shixiao San) 12g, Ligusticum Wallichii Rhizome (Da Chuanxiong) 6g, Corydalis Rhizome (Yanhusuo) 12g, Fennel Fruit (Xiaohuixiang) 4.5g, Peach Kernel Paste (Taoren Ni) 12g. [Commentary] This formula is a modification of Wang Qingren's Shaofu Zhuyu Tang. It is a famous formula for dysmenorrhea and can also regulate menstruation and promote conception.
3. Female Hu. Pain after menstruation cessation often indicates organic changes like endometritis or adnexitis. Inflammation often involves heat; use Danggui Shaoyao San. Prescription: Angelica Sinensis Root (Danggui) 9g, Alisma Rhizome (Zexie) 9g, Raw Atractylodes Rhizome (Sheng Cangzhu) 9g, Ligusticum Wallichii Rhizome (Da Chuanxiong) 4.5g, Honey-fried Frankincense and Myrrh (Zhirumie) 4.5g each, White Peony Root (Hangshaoyao) 9g, Bupleurum Root (Chaihu) 6g, Corydalis Rhizome (Yanhusuo) 9g, Licorice Root (Fenggancao) 3g. [Commentary] This case clearly highlights dysmenorrhea caused by inflammation: "inflammation often involves heat." Danggui Shaoyao San treats irregular menstruation and menstrual pain by nourishing blood, regulating menstruation, and relieving pain. Bupleurum soothes Liver; Yanhu moves blood and regulates qi; Rumie disperses stasis and alleviates pain.
4. Female Chen. Lower abdominal distending pain persists after menstruation; indicates stasis and coagulation, hence dark purple-black color. Stasis has deficiency and excess types; deficiency is treated with warming and moving; excess with attacking stasis. Patient prefers heat and pressure, pulse is weak; emphasis on warming and moving. Prescription: Evodia Fruit (Danwuyu) 4.5g, Pinellia Tuber (Jiang Banxia) 9g, White Peony Root (Baishao) 9g, Codonopsis Root (Dangshen) 9g, Angelica Sinensis Root (Quandanggui) 9g, Fried Donkey-hide Gelatin (Ejiao Zhu) 15g, Ligusticum Wallichii Rhizome (Chuanxiong) 4.5g, Moutan Cortex (Danpi) 9g, Cinnamon Twig Powder (Rougui Mo) 2.4g (taken in three divided doses), Honey-fried Licorice Root (Qingzhigancao) 3g.