妇人七七四十九岁,天癸已断。若五旬以后,而月经复
行,或漏下不止,腰腹疼痛者,但当察者有热无热。有热者,宜子芩丸;无热而血虚者,宜益阴煎。若血去过多,
热随血去,冲任伤损而为漏为崩,腹痛寒热者,宜茱萸汤。肝脾伤损,血不归经者,宜归脾汤兼服逍遥散。
子芩丸
条芩(二两,醋浸一日,纸裹煨,又浸又煨七次) 当归(酒炒) 香附(醋炒,各一两)
上为末,醋糊丸,空心酒下五七十丸。
益阴煎
干地黄 知母(酒炒) 黄柏(酒炒) 龟板(炙) 砂仁 炙甘草(各一钱)
水煎,食前服。
茱萸汤
熟地黄 当归 白芍 川芎 吴茱萸(滚水泡) 人参(各一钱)
姜三片,枣二枚,水煎服。
归脾汤
人参 黄 (蜜炙) 白术(蜜炙) 茯神(各二钱) 当归 龙眼肉 远志(制) 枣仁(炒,各一钱)
木香(不见火) 甘草(炙,各五分)
姜三片,枣二枚,水煎服。
逍遥散
当归(酒洗) 白芍(酒炒) 茯苓 白术(蜜炙) 柴胡(各一钱) 甘草(炙,五分)
姜三片,水煎服。如血虚发热,小水不利,加牡丹皮,山栀仁(炒)各七分。
妇女以血为主,血旺则经调,故治妇女之病,当以经血为先。而血之所主在心,盖心主血,肝藏血,脾
统血,是心为气血之主,而脾为气血之本也。若忧虑伤心,心气虚耗不能生血,脾乃心之子,脾失所养,则不
嗜饮食,绝生化之源矣。且心虚无以制肺金来克木,而肝脏亏损则血不藏,以致经血干枯,不营经络,斯有
血枯经闭之证,宜服补心汤。
补心汤
熟地黄 当归 川芎 茯苓 陈皮 半夏(制) 桔梗 枳壳(麸炒) 前胡 甘草 干葛 苏叶 木香
人参
姜枣为引,水煎服。
妇女到了四十九岁(七七之年),天癸(指促进生殖机能成熟的物质)已经断绝。如果在五十岁以后,月经又再次来潮,或者淋漓出血不止,伴有腰腹部疼痛的,应当首先辨别是有热邪还是无热邪。有热邪的,适宜服用子芩丸;没有热邪且属于血虚的,适宜服用益阴煎。如果失血过多,热邪随着血液流失而消散,导致冲任二脉损伤而出现漏下或崩中,并伴有腹痛、寒热往来的症状,适宜服用茱萸汤。如果是肝脾受损,血液不能归经运行的,适宜服用归脾汤,并兼服逍遥散。
子芩丸
黄芩(二两,用醋浸泡一天,用纸包裹煨制,再浸泡再煨,共进行七次),当归(用酒炒制),香附(用醋炒制,各一两)。
以上药物研为细末,用醋调糊制成丸药,空腹时以酒送服五七十丸。
益阴煎
干地黄,知母(用酒炒制),黄柏(用酒炒制),龟板(炙烤),砂仁,炙甘草(各一钱)。
用水煎煮,饭前服用。
茱萸汤
熟地黄,当归,白芍,川芎,吴茱萸(用滚水泡制),人参(各一钱)。
生姜三片,大枣二枚,用水煎煮后服用。
归脾汤
人参,黄芪(用蜜炙制),白术(用蜜炙制),茯神(各二钱),当归,龙眼肉,远志(炮制),酸枣仁(炒制,各一钱),木香(不经过火炒),炙甘草(各五分)。
生姜三片,大枣二枚,用水煎煮后服用。
逍遥散
当归(用酒洗),白芍(用酒炒),茯苓,白术(用蜜炙制),柴胡(各一钱),炙甘草(五分)。
生姜三片,用水煎煮后服用。如果出现血虚发热、小便不利的情况,加牡丹皮、山栀仁(炒制)各七分。
妇女以血为本,血液旺盛则月经调和,所以治疗妇女的疾病,应当以调理经血为首要任务。而血的主宰在于心,因为心主血脉,肝藏血,脾统血,因此心是气血的主宰,而脾是气血的根本。如果忧虑过度伤及心脏,导致心气虚弱耗损而不能生血,脾作为心的子脏,失去滋养,就会食欲不振,断绝了生化血液的来源。而且心气虚弱无法制约肺金对肝木的克制,导致肝脏亏损而不能藏血,致使经血干枯,不能濡养经络,从而出现血枯经闭的症状,适宜服用补心汤。
补心汤
熟地黄,当归,川芎,茯苓,陈皮,半夏(炮制),桔梗,枳壳(麸炒),前胡,甘草,干葛,苏叶,木香,人参。
以生姜、大枣为引,用水煎煮后服用。
Women reach the age of forty-nine (seven sevens), at which point Tian Gui (substances promoting reproductive maturity) has ceased. If menstruation resumes after the age of fifty, or if bleeding continues incessantly accompanied by pain in the lower back and abdomen, one must first determine whether there is heat or no heat. For cases with heat, Ziqin Wan (Scutellaria Pill) is appropriate; for cases without heat due to blood deficiency, Yiyin Decoction (Yin-Nourishing Decoction) is appropriate. If excessive blood loss occurs, causing heat to dissipate with the blood, damaging the Chong and Ren vessels (Penetrating and Conception Vessels) leading to metrorrhagia or metrorrhagia with flooding, accompanied by abdominal pain and alternating chills and fever, Zhuyu Tang (Cornus Decoction) is appropriate. For damage to the Liver and Spleen where blood fails to return to its vessels, Guipi Tang (Restore the Spleen Decoction) should be taken, along with Xiaoyao San (Free and Easy Wanderer Powder).
Ziqin Wan
Huangqin (Radix Scutellariae, 2 liang, soaked in vinegar for one day, wrapped in paper and roasted, repeated soaking and roasting seven times), Danggui (Radix Angelicae Sinensis, stir-fried with wine), Xiangfu (Rhizoma Cyperi, stir-fried with vinegar, each 1 liang).
Grind into powder, form pills with vinegar paste, take 50-70 pills orally on an empty stomach with wine.
Yiyin Decoction
Gan Dihuang (Radix Rehmanniae Preparata), Zhimu (Cortex Anemarrhenae, stir-fried with wine), Huangbai (Cortex Phellodendri, stir-fried with wine), Guiban (Carapax et Plastrum Testudinis, roasted), Sharen (Fructus Amomi), Zhigancao (Radix Glycyrrhizae Preparata, roasted, each 1 qian).
Decoct in water, take before meals.
Zhuyu Tang
Shu Dihuang (Radix Rehmanniae Preparata), Danggui (Radix Angelicae Sinensis), Baishao (Radix Paeoniae Alba), Chuanxiong (Rhizoma Chuanxiong), Wuzhuyu (Fructus Evodiae, soaked in boiling water), Renshen (Radix Ginseng, each 1 qian).
Add three slices of Shengjiang (Rhizoma Zingiberis Recens) and two dates (Jujubae Fructus), decoct in water and take.
Guipi Tang
Renshen (Radix Ginseng), Huangqi (Radix Astragali, honey-roasted), Baizhu (Rhizoma Atractylodis Macrocephalae, honey-roasted), Fushen (Sclerotium Poriae Cum Radice, each 2 qian), Danggui (Radix Angelicae Sinensis), Longyanrou (Arillus Longan, each 1 qian), Yuanzhi (Radix Polygalae, processed), Zaoren (Semen Ziziphi Spinosae, fried, each 1 qian), Muxiang (Radix Aucklandiae, not roasted), Zhigancao (Radix Glycyrrhizae Preparata, roasted, each 5 fen).
Add three slices of Shengjiang (Rhizoma Zingiberis Recens) and two dates (Jujubae Fructus), decoct in water and take.
Xiaoyao San
Danggui (Radix Angelicae Sinensis, washed with wine), Baishao (Radix Paeoniae Alba, stir-fried with wine), Fuling (Poria, each 1 qian), Baizhu (Rhizoma Atractylodis Macrocephalae, honey-roasted), Chaihu (Radix Bupleuri, each 1 qian), Zhigancao (Radix Glycyrrhizae Preparata, roasted, 5 fen).
Add three slices of Shengjiang (Rhizoma Zingiberis Recens), decoct in water and take. If symptoms include fever due to blood deficiency and difficult urination, add Mudanpi (Cortex Moutan) and Shanzhiren (Semen Gardeniae, fried) each 7 fen.
Women are primarily governed by blood; when blood is abundant, menstruation is regulated. Therefore, treating women's diseases should prioritize regulating menstrual blood. The heart governs blood; the Heart controls blood vessels, the Liver stores blood, and the Spleen manages blood. Thus, the Heart is the master of Qi and Blood, while the Spleen is the root of Qi and Blood. If worry injures the Heart, depleting Heart Qi and impairing blood generation, the Spleen (as the child organ of the Heart) loses nourishment, leading to poor appetite and cutting off the source of blood production. Furthermore, if Heart Qi is too weak to control Lung Metal from overacting on Liver Wood, Liver deficiency results in failure to store blood. This leads to dryness and depletion of menstrual blood, preventing it from nourishing the meridians, resulting in amenorrhea due to blood exhaustion. In such cases, Buxin Tang (Nourish the Heart Decoction) is appropriate.
Buxin Tang
Shu Dihuang (Radix Rehmanniae Preparata), Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Fuling (Poria), Chenpi (Pericarpium Citri Reticulata), Banxia (Rhizoma Pinelliae, processed), Jiegeng (Radix Platycodonis), Zhike (Fructus Aurantii, bran-fried), Qianhu (Radix Peucedani), Gancao (Radix Glycyrrhizae), Gange (Radix Puerariae), Ziye (Folium Perillae), Muxiang (Radix Aucklandiae), Renshen (Radix Ginseng).
Use Shengjiang (Rhizoma Zingiberis Recens) and Jujubae Fructus as guides, decoct in water and take.