周 自幼粪后下小白虫如蛆，肛内微痒。中年时发时止，此得之肠虚受风，宿病再为湿热迫注，遂至化 ，
延久未愈。忆友人亦于童年患此，服攻逐杀虫之剂罔效。后有人令服人乳数月，虫绝，知徒商逐虫无济也。因疏
温脏丸，用四君子汤加归、芍、薏、莲、川椒、榧实、使君子俱煨、炮姜、槟榔为末，神曲糊丸。空心白汤下，
辄效。
妇科首重孕育，孕育先在调经。《素问》曰∶女子二七天癸至，任脉通，太冲脉盛，月事以时下。言天一
之真精至，月信亦通，乃能孕子。谓之月事者，女子属阴，其血如潮，应月之盈亏，有常期者也，故谓之经。
倘一愆期，则失其常度，而诸病生焉。夫任主胞胎，冲为血海，二脉流通，脏腑之血，皆汇注于此。冲任皆奇
经，而血之生化由脾胃。若七情内损，六淫外侵，兼之饮食劳倦，致脾胃日亏，化源日薄，冲任日衰，神色日
夺，所重尤在调肝。盖妇女善郁，木失条畅，枝时萎悴，肝不藏血，经之所由不调也。然不调之中，有先期，
有后期，有错乱，有痛经，有倒经，有居经，有淋沥不断，有枯闭不通。经不准，必不受孕，然参前数日受孕
者首之。当经行，食禁生冷，药忌寒凉，以血得寒则凝涩不行，不慎禁忌，则腹痛瘕泄，亦致不调。且血随气
行，经不调多由于气，丹溪谓∶经来成块者，气之凝也；将行作痛者，气之滞也；行后作痛者，气血虚也。先
期而来者血热，后期乃至者血虚，亦无不由气也。错经妄行者，气之乱也；色淡者，虚而夹水也；紫者气之热，
黑者热甚也；乍少乍多，淋沥不断者，气不摄血也。故调经必兼气药，更若脏损经闭，则由悲伤肺，忧伤心，
思伤脾，怒伤肝，房劳伤肾。肺伤则气陷血脱，心伤则惊悸盗汗，脾伤则食减肌瘦，肝伤则发焦筋痿，肾伤则
淋带骨蒸，甚至嗽热泄泻。冲任亏败，源涸流竭，如《素问》云∶二阳之病发心脾，有不得隐曲，其在女子为
不月。夫心主血，脾统血，思虑过度，所愿不遂，郁而成损，则先经闭而后干嗽，累月经年，遂成干血劳瘵，
治难措手矣。古谓经前勿补，经后勿泻，此为经期腹痛者言之。其实调经之要，务令血气和平，自然经准受孕。
如阳太过则先期，原因有火，然虚而生火，仍当养营摄血。亦有无
火而先期，或补中气，或固肾关，不宜过用寒凉也。阴不及则后期，本属血虚，然有血热而燥瘀者，宜清补。亦
有血逆而留滞者，宜疏利，毋庸预执温补也。其阴阳乖乱，错经妄行；或由火邪搏营，迟早互见；或由经气舛
逆，口鼻上冲；务审其虚实寒热而调之。至于经期前后腹痛，虚实悬殊，经未行而先痛者，血为气滞，经通
则痛自除。经已行而犹痛者，冲脉本虚，血去则痛益甚。滞者理其气，温而行之；虚者培其营，峻以填之。
设淋沥不止，必固以摄之。亦有腹愈痛经愈多，至痛欲死者，系火搏于血，治宜行血，如芎、归等。敛血，如
芩、芍等。理脾，如苓、术等。以益母破气中之血，以延胡破血中之气，以香附开其郁，虚者加人参。理脾则
血有统，破结则火痛悉除。故调经莫如八珍汤加益母、延胡。其经闭不行，肥人多痰塞，导痰汤加川芎、川连。
瘦人多郁火，四物汤加丹皮、山栀、泽兰。因脾胃亏而食少者，旺其运纳之权。归芍异功散。因肝肾亏而骨
蒸者，壮其营阴之本。地黄汤去萸、泽，加龟板、五味子。因思虑郁损心脾者，归脾丸、小营煎。因劳嗽咳
伤肺气者，劫劳散、紫菀汤。或温养下焦，熟地、沙苑子、杜仲、龙眼、芡实、鹿角胶。或宣通奇脉，杞子、
牛膝、当归、泽兰、茯神、香附。若枯闭日久，轻用破血通经，则愈枯其枯矣。又有经后发热倦怠，两目如帛
蔽不明，此脾肾精华不能上注于目也。朝用补中益气汤，夕用地黄丸加杞子。至于七七数尽，当断不断，或因
气血有余，若已断复来者，即为崩漏。宜固摄冲脉，大补元煎加续断、阿胶、海螵蛸、菟丝。年高经或大行，
腹痛不止者危。
周姓患者自幼在排便后排出白色小虫，状如蛆虫，肛门内部轻微瘙痒。到了中年时期，症状时发时止，这是由于肠道虚弱感受风邪所致，宿疾再次受到湿热逼迫灌注，于是化为虫患，拖延日久未能痊愈。回忆我的友人也在童年患有此病，服用攻逐杀虫的药物毫无效果。后来有人建议服用人乳数月，虫子绝迹，由此可知单纯商议攻逐杀虫并无益处。因此开具温脏丸，使用四君子汤加入当归、白芍、薏苡仁、莲子、川椒、榧实（均经煨或炮制）、炮姜、槟榔，研为细末，用神曲糊制成丸剂。空腹时用白开水送服，往往见效。
妇科治疗首重孕育，而孕育的前提在于调理月经。《素问》说：女子十四岁（二七）天癸至，任脉通畅，太冲脉旺盛，月经按时来潮。意思是先天真精充足，月信也就通调，这样才能受孕生子。称之为“月事”，是因为女子属阴，其血液如潮水般涨落，顺应月亮的盈亏变化，有固定的周期，所以称为“经”。如果一旦延期，就失去了常规节度，从而产生各种疾病。任脉主司胞胎，冲脉为血海，这两条经脉流通顺畅，脏腑的血液都会汇聚注于此。冲脉和任脉都属于奇经八脉，但血液的生化来源依赖于脾胃。如果因七情内伤，六淫外侵，加上饮食不节和劳倦过度，导致脾胃日渐亏损，化源日渐薄弱，冲任日渐衰败，神色日渐憔悴，其中尤其重要的是调理肝脏。因为妇女容易情绪抑郁，肝木失去条达舒畅，枝叶时常枯萎憔悴，肝不能藏血，这就是月经不调的原因。然而在不调之中，有先期、后期、错乱、痛经、倒经、居经、淋沥不断、枯闭不通等情况。月经不准，必然无法受孕，但参考前几日受孕的情况也是首要关注的。在月经行期间，饮食禁忌生冷，药物忌用寒凉，因为血液遇到寒冷就会凝涩不行，如果不谨慎遵守禁忌，就会导致腹痛、瘕积、泄泻，也会造成月经不调。而且血随气运行，月经不调多由于气机问题，丹溪说：经血成块的，是气机凝结；将要行经时疼痛的，是气机阻滞；行经后疼痛的，是气血虚弱。先期而来的属于血热，后期才来的属于血虚，也无不与气有关。经血妄行的，是气机紊乱；颜色淡的，是虚证夹杂水湿；颜色紫的，是气分有热；颜色黑的，是热势严重；忽多忽少、淋沥不断的，是气不能摄血。所以调理月经必须兼用理气药，如果是脏腑损伤导致的经闭，则是由悲伤肺、忧伤心、思伤脾、怒伤肝、房劳伤肾引起。肺受伤则气陷血脱，心受伤则惊悸盗汗，脾受伤则食欲减退肌肉消瘦，肝受伤则头发焦枯筋脉痿软，肾受伤则淋浊带下骨蒸潮热，甚至咳嗽发热泄泻。冲任亏败，源头枯竭水流断绝，正如《素问》所说：阳明经的病发于心脾，有难以启齿的隐曲之疾，在女子身上表现为闭经。心主血，脾统血，思虑过度，愿望不能实现，郁结而成虚损，则先出现经闭而后干咳，经过几个月甚至几年，最终成为干血劳瘵，治疗就很难着手了。古人说经前不要补，经后不要泻，这是针对经期腹痛者说的。其实调理月经的关键，务必使血气平和，自然月经准时并能受孕。如果阳气太过则月经先期，原因是有火，但如果是虚而生火，仍应当滋养营血、固摄血液。也有没有火却先期的，或者补益中气，或者固护肾关，不宜过用寒凉药。阴气不及则月经后期，本属血虚，但有血热而燥瘀的，宜清补。也有血逆而留滞的，宜疏利，不必预先执着于温补。那些阴阳乖乱、经血妄行的；或者由火邪搏结营血，迟早交替出现；或者由经气逆乱，气血上冲口鼻；务必审察其虚实寒热而进行调理。至于经期前后的腹痛，虚实差别很大，经未行而先痛的，是血被气阻滞，经血通畅则疼痛自然消除。经已行而仍然痛的，是冲脉本虚，血液流失则疼痛更加严重。气滞的要理顺气机，温而行气；血虚的要培补营血，峻以填补。如果淋沥不止，必须固摄止血。也有肚子越痛经血越多，甚至痛欲死的，这是火邪搏结于血，治疗宜活血，如川芎、当归等；敛血，如黄芩、白芍等；理脾，如茯苓、白术等。用益母草破除气中之血，用延胡索破除血中之气，用香附开解郁结，虚证加人参。理顺脾气则血有所统摄，破除结聚则火热疼痛全部消除。所以调理月经莫过于八珍汤加入益母草、延胡索。对于经闭不行的，肥胖人多因痰湿堵塞，用导痰汤加川芎、黄连。瘦人多因郁火，用四物汤加牡丹皮、山栀、泽兰。因脾胃亏损而食少的，增强其运化纳受的功能，用归芍异功散。因肝肾亏损而有骨蒸潮热的，壮其营阴的根本，用地黄汤去掉山茱萸、泽泻，加入龟板、五味子。因思虑郁结损伤心脾的，用归脾丸、小营煎。因劳嗽咳嗽损伤肺气的，用劫劳散、紫菀汤。或者温养下焦，用熟地、沙苑子、杜仲、龙眼肉、芡实、鹿角胶。或者宣通奇经，用枸杞子、牛膝、当归、泽兰、茯神、香附。如果枯闭日久，轻率地使用破血通经药，则会使其更加枯槁。又有经后发热倦怠，两眼像被布遮蔽一样不明亮，这是脾肾精华不能上注于眼睛所致。早晨服用补中益气汤，晚上服用地黄丸加枸杞子。到了七七四十九岁数尽，月经应当断绝却未断绝，或者因为气血有余，如果已经断绝又复来的，就是崩漏。宜固摄冲脉，用大补元煎加续断、阿胶、海螵蛸、菟丝子。年高者月经如果大量出血，腹痛不止的，病情危重。
Zhou, a patient, had been expelling small white worms resembling maggots after defecation since childhood, accompanied by slight itching inside the anus. In middle age, the condition came and went intermittently. This was caused by intestinal deficiency allowing wind pathogen invasion; the chronic disease was again forced and injected by damp-heat, leading to the transformation of parasites. It dragged on for a long time without healing. I recall a friend who suffered from this in childhood; he took purgative and insect-killing medicines with no effect. Later, someone advised him to consume human milk for several months, after which the worms disappeared. This showed that merely discussing purgative and insect-killing methods is of no help. Therefore, I prescribed Wenzang Wan (Warm Viscera Pill), using Sijunzi Tang (Four Gentlemen Decoction) added with Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Yiyiren (Coicis Semen), Lianzi (Nelumbinis Semen), Chuanjiao (Sichuan Pepper), Feishi (Torreya Seed), Shijunzi (Quisqualis Fruit)—all roasted or processed—along with Jiangtan (Prepared Ginger) and Binglang (Areca Seed). These were ground into powder and made into pills using Shenqu paste as a binder. Taken on an empty stomach with plain warm water, it was often effective.
In gynecology, conception is prioritized, and conception depends first on regulating menstruation. The *Suwen* states: "When a girl reaches fourteen (two sevens), Tian Gui arrives, the Ren Mai (Conception Vessel) becomes unobstructed, and the Chong Mai (Penetrating Vessel) becomes abundant, causing menses to arrive on time." This means when the primordial essence is sufficient, menstrual flow becomes regular, enabling pregnancy. It is called "monthly affairs" because women belong to Yin; their blood rises and falls like tides, corresponding to the waxing and waning of the moon, having a fixed cycle, hence termed "Jing" (Menses). If there is any delay, the normal rhythm is lost, giving rise to various diseases. The Ren Mai governs the uterus, and the Chong Mai is the Sea of Blood; when these two vessels flow smoothly, blood from the Zang-Fu organs converges here. Both are extraordinary vessels, yet the generation and transformation of blood depend on the Spleen and Stomach. If internal injury from the Seven Emotions, external invasion by the Six Excesses, combined with improper diet and overwork, cause daily decline of the Spleen and Stomach, thinning the source of transformation, weakening the Chong and Ren, and diminishing complexion and spirit, particular emphasis must be placed on regulating the Liver. Women tend toward depression; if Wood fails to flourish freely, branches wither; if the Liver fails to store blood, menstruation becomes irregular. However, among irregularities, there are early periods, late periods, disorderly flow, dysmenorrhea, retrograde menstruation, periodic menstruation (once every three months), continuous dripping, and amenorrhea due to dryness. Irregular menstruation inevitably prevents conception, though one should also consider conception occurring a few days before expected dates. During menstruation, raw and cold foods must be avoided, and cold-natured herbs are contraindicated, because blood coagulates and stagnates when exposed to cold. Failure to observe these taboos leads to abdominal pain, masses, and diarrhea, also causing irregular menstruation. Moreover, blood follows Qi; irregular menstruation often stems from Qi issues. Danxi said: Clots in menstruation indicate Qi stagnation; pain before flow indicates Qi obstruction; pain after flow indicates Qi and Blood deficiency. Early periods suggest Blood Heat; late periods suggest Blood Deficiency, both related to Qi. Erratic flow indicates Chaotic Qi; pale color indicates Deficiency with Dampness; purple color indicates Qi Heat; black color indicates severe Heat; fluctuating amounts with continuous dripping indicate Qi's failure to control Blood. Thus, regulating menstruation must include Qi-regulating herbs. If amenorrhea results from organ damage, it arises from grief injuring the Lung, worry injuring the Heart, overthinking injuring the Spleen, anger injuring the Liver, and sexual excess injuring the Kidney. Lung injury causes Qi sinking and Blood loss; Heart injury causes palpitations and night sweats; Spleen injury causes poor appetite and emaciation; Liver injury causes brittle hair and flaccid sinews; Kidney injury causes leukorrhea, bone-steaming fever, and even cough with fever and diarrhea. When Chong and Ren are depleted and sources exhausted, as the *Suwen* says: "Diseases of the Two Yangs originate in the Heart and Spleen; hidden grievances exist; in women, this manifests as amenorrhea." The Heart governs Blood, and the Spleen controls Blood. Excessive thinking and unfulfilled desires lead to depression and depletion, resulting first in amenorrhea and then dry cough. Over months or years, this becomes Dry Blood Consumption Disease (Gan Xue Lao Zhai), which is difficult to treat. Ancient texts say do not tonify before menstruation and do not purge after, referring specifically to those with abdominal pain during menstruation. Actually, the key to regulating menstruation is ensuring Harmony of Qi and Blood, so that menses become regular and conception occurs naturally. If Yang is excessive, periods come early due to Fire; however, if Fire arises from Deficiency, one should nourish Ying (Nutritive) Blood and secure Blood. There are also cases of early periods without Fire, where one should tonify Middle Qi or secure the Kidney gate, avoiding excessive use of Cold/Cool herbs. If Yin is insufficient, periods come late, originally due to Blood Deficiency, but some have Blood Heat causing dryness and stasis, requiring Clearing and Tonifying. Others have Blood rebellion and stagnation, requiring Dispersion and Drainage, without prematurely adhering to Warm Tonification. For Yin-Yang disharmony and erratic flow; whether due to Fire Pathogen clashing with Ying, causing alternating timing; or due to rebellious Jing Qi rushing upward to the mouth and nose; one must examine Deficiency/Excess and Cold/Heat to regulate. Regarding abdominal pain before and after menstruation, the difference between Deficiency and Excess is significant. Pain before flow indicates Blood stagnated by Qi; once flow begins, pain ceases. Pain continuing after flow indicates inherent Chong Mai Deficiency; as Blood leaves, pain intensifies. For stagnation, regulate Qi and move with Warmth; for Deficiency, tonify Ying and fill vigorously. If dripping continues, it must be secured and controlled. Some experience worsening pain with heavier flow, even to the point of near-death; this is Fire clashing with Blood, requiring Blood-invigorating herbs like Xiong (Chuanxiong Rhizome) and Gui (Danggui). To astringe Blood, use Qin (Huangqin) and Shao (Shaoyao). To regulate Spleen, use Ling (Fuling) and Zhu (Baizhu). Use Yimucao (Leonuri Herba) to break Blood within Qi; Yanhusuo (Corydalis Rhizoma) to break Qi within Blood; Xiangfu (Cyperi Rhizoma) to open Depression; add Renshen (Ginseng Radix) for Deficiency. Regulating Spleen ensures Blood has a master; breaking knots eliminates Fire-pain. Thus, nothing regulates menstruation better than Bazhen Tang (Eight Treasures Decoction) added with Yimucao and Yanhusuo. For amenorrhea, obese individuals often have Phlegm obstruction; use Daotan Tang (Great Phlegm Decoction) added with Chuanxiong and Huanglian. Thin individuals often have Depression-Fire; use Siwu Tang (Four Substances Decoction) added with Mudanpi (Moutan Cortex), Zhizi (Gardeniae Fructus), and Zelan (Lycopus Herba). For poor appetite due to Spleen-Stomach deficiency, enhance transport and reception functions using Guixie Yigong San (Angelica and White Atractylodes Powder for Strengthening the Spleen). For bone-steaming due to Liver-Kidney deficiency, strengthen the root of Ying-Yin using Dihuang Tang (Rehmannia Decoction) removing Shanzhuyu and Zexie, adding Guiban (Testudinis Carapax et Plastrum) and Wuweizi (Schisandrae Fructus). For Heart-Spleen injury due to overthinking and depression, use Guipi Wan (Restore the Spleen Pill) or Xiaoying Jian (Minor Nourishing Decoction). For Lung-Qi injury due to labor-induced cough, use Jielao San (Rob Labor Powder) or Ziwan Tang (Aster Decoction). Or warm and nourish the Lower Jiao using Shudi (Rehmanniae Radix Preparata), Shayuanzi (Astragali Complanati Semen), Duzhong (Eucommiae Cortex), Longyanrou (Longan Aril), Qianshi (Euryales Semen), and Lujiaojiao (Colla Cornus Asini). Or unblock the Extraordinary Vessels using Gouqi (Lycii Fructus), Niuxi (Achyranthis Bidentatae Radix), Danggui, Zelan, Fushen (Poria Cum Radix), and Xiangfu. If amenorrhea persists for a long time, lightly using Blood-breaking and menstruation-inducing herbs will further deplete the body. Another symptom is fever and fatigue after menstruation, with eyes feeling covered by silk and vision unclear; this is because Spleen-Kidney essence cannot ascend to the eyes. Take Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning, and Dihuang Wan (Rehmannia Pill) with Gouqi in the evening. At forty-nine (seven sevens), menstruation should cease; if it does not, or if it stops and returns due to surplus Qi and Blood, it is Beng Lou (Metrorrhagia and Leukorrhea). One should secure the Chong Mai using Dabu Yuanjian (Great Supplement to the Origin Decoction) added with Xuduan (Dipsaci Radix), Ejiao (Colla Corii Asini), Haipiaoxiao (Sepiae Endoconcha), and Tusizi (Cuscutae Semen). In elderly women, if heavy bleeding occurs with unrelenting abdominal pain, the condition is critical.