（参看经血胎产门）
世谓男子主气。女子主血。因谓男子血贵。女子血贱。并谓男子之血。与女子不同。而不知皆同也。其不同
者。女子有月信。男子无月信。只此不同而已矣。夫同是血也。何以女子有月信。而男子无月信哉。盖女子
主血。血属阴而下行。其行也。气运之而行也。女子以血为主。未尝不赖气以运血。气即水化。前论已详。气
血交会之所。在脐下胞室之中。男子谓之丹田。女子谓之血室。则肝肾所司。气与血之总会。气生于水而
化水。男子以气为主。故血入丹田。亦从水化。而变为水。以其内为血所化。故非清水。而极 极稠。是谓之
肾精。女子之气。亦仍能复化为水。然女子以血为主。故其气在血室之内。皆从血化。而变为血。是谓之月
信。但其血中仍有气化之水液。故月信亦名信水。且行经前后。均有淡色之水。是女子之血分。未尝不借
气分之水。以引动而营运之也。知此。则知男子之精属气属水。而其中未尝无血无火。且知女子之经。属
血属火。而其中未尝无气无水。是以男子精薄。则为血虚。女子经病。则为气滞也。问曰。男子主气。女子主
血。其中变化。诚如兹之所云矣。而女子何以必行经。男子何以不行经。答曰。经血者。血之余也。夫新生旧
除。天地自然之理。故月有盈亏。海有朝汐。女子之血。除旧生新。是满则溢。盈必亏之道。女子每月。则行经
一度。盖所以泄血之余也。血主阴而下行。所以从下泄。而为经血也。至于男子。虽无经可验。然亦必泄其
余。男子以气为主。气主阳而上行。故血余不从下泄。而随气上行。循冲任脉。上绕唇颐。生为髭须。是髭须
者。即所以泄血之余也。所以女子有月信。上遂无髭须。男子有髭须。下遂无月信。所主不同。升降各异。只
此分别而已矣。义出内经。非创论也。世谓男女血迥不同。岂知变化之道哉。夫必明气血水火变化营运
之道。始可治气血水火所生之病。女子要血循其常。男子亦要血循其常。若血失常道。即为血不循经。在
女子虽无崩带。亦不受胎。男子虽无吐衄。亦不荣体。至失常之至。则女子未有不崩带。男子未有不吐衄
者也。故女子血贵调经。男子亦贵调血。但男子吐衄。乃上行之血。女子崩带。乃下行之血。不可例论耳。然
使女子吐衄。则亦与男子无殊。男子下血。则亦与崩带无异。故是书原非妇科。而于月经胎产尤为详悉。
诚欲人触类引伸。于治血庶尽神欤。
又曰。女子胞中之血。每月一换。除旧生新。旧血即是瘀血。此血不去。便阻化机。凡为医者。皆知破血通经
矣。独于男女吐衄之证。便不知去瘀生新之法。抑思瘀血不行。则新血断无生理。观月信之去旧生新。可
以知之。即疮科治溃。亦必先化腐而后生肌。腐肉不化。则新血亦断无生理。且如有脓管者。必烂开腐肉。
取去脓管而后止。治失血者。不去瘀而求补血。何异治疮者。不化腐而求生肌哉。然又非去瘀是一事。生
新另是一事也。盖瘀血去则新血已生。新血生而瘀血自去。其间初无间隔。即如月信下行。是瘀去也。此
时新血已萌动于血海之中。故受孕焉。非月信已下多时。然后另生新血也。知此。则知以去瘀为生新之
法。并知以生新为去瘀之法。生血之机有如此者。而生血之原。则又在于脾胃。经云。中焦受气取汁。变化
而赤。是为血。今且举一可见者言之。妇人乳汁。即脾胃饮食所化。乃中焦受气所取之汁也。妇人乳汁。则
月水不行。以此汁既从乳出。便不下行变血矣。至于断乳之后。则此汁变化而赤。仍下行而为经血。人皆
知催乳须补脾胃。而不知滋血尤须补脾胃。盖血即乳也。知催乳法。便可知补血法。但调治脾胃。须分阴
阳。李东垣后。重脾胃者。但知宜补脾阳。而不知滋养脾阴。脾阳不足。水谷固不化。脾阴不足。水谷仍不化
也。譬如釜中煮饭。釜底无火固不熟。釜中无水亦不熟也。予亲见脾不思食者。用温药而反减。用凉药而
反快。予亲见催乳者。用 术鹿茸而乳多。又亲见催乳者。用 术鹿茸而乳转少。则以有宜不宜耳。是故
宜补脾阳者。虽干姜附子转能生津。宜补脾阴者。虽知母石膏。反能开胃。补脾阳法。前人已备言之。独于
补脾阴。古少发明者。予特标出。俾知一阴一阳。未可偏废。
补脾阴以开胃进食。乃吾临证悟出。而借伤寒论存津液三字为据。此外固无证据也。书既成。后得泰西
洋人医法五种。内言胃之化谷。乃胃汁化之。并有甜肉汁。苦胆汁。皆入肠胃化谷。所谓汁者。即予所谓津
液也。西医论脏腑。多言物而遗理。如此条者。实指其物。而尚不与理相背。适足以证予所论。故并志之。
（参看经血胎产门）
世人认为男子以气为主，女子以血为主。因此说男子的血珍贵，女子的血低贱。并且认为男子的血与女子的血不同，却不知道其实都是一样的。它们不同的地方，在于女子有月经，而男子没有月经，仅此一点不同罢了。同样是血，为什么女子有月经，而男子没有呢？大概因为女子以血为主，血属于阴且性质下行。血的运行，是靠气来推动的。女子虽然以血为主，但也并非不依赖气来运化血液。气是由水转化而来的，前文已经详细论述过。气与血交会的地方，在脐下胞宫之中。男子称之为丹田，女子称之为血室，这是肝和肾所主管的，是气与血的总汇之处。气生于水而化为水。男子以气为主，所以血进入丹田后，也随着水气转化，变成水。因为它在内里被血所化，所以不是清澈的水，而是极其稠厚的，这叫做肾精。女子的气，也能重新化为水。然而女子以血为主，所以她的气在血室之内，都随着血转化，变成血，这叫做月经。但是她的血中仍然含有气化而成的水液，所以月经也叫“信水”。而且在行经前后，都有淡色的水流出，这说明女子的血分，也未尝不借助气分中的水液，来引导和营运血液。明白了这一点，就知道男子的精属于气、属于水，但其中未尝没有血和火；同时也知道女子的经血属于血、属于火，但其中未尝没有气和水。因此，男子精液稀薄，就是血虚的表现；女子月经失调，就是气滞的表现。
有人问：男子主气，女子主血，其中的变化确实像上面所说的那样。那么为什么女子一定要行经，而男子不行经呢？回答说：经血，是血的盈余部分。新生旧除，是天地自然的道理。所以月亮有圆缺，大海有潮汐。女子的血，也是除旧生新，满了就会溢出，盈满必然亏损的道理。女子每个月都会行经一次，这大概是用来排泄血的盈余。血属阴且下行，所以从下部排出，成为经血。至于男子，虽然没有月经可验，但也必须排泄其盈余。男子以气为主，气属阳且上行，所以血的盈余不从下部排出，而是随着气向上运行，沿着冲脉和任脉，上绕嘴唇和面颊，生长为胡须。所以胡须，就是用来排泄血的盈余的。正因为女子有月经，所以上面就没有胡须；男子有胡须，下面就没有月经。所主导的不同，升降各异，只有这一点的分别罢了。这个义理出自《黄帝内经》，并非我的独创之论。世人说男女的血截然不同，哪里懂得变化的道理呢？一定要明白气血水火变化和营运的道理，才可以治疗由气血水火所生的疾病。女子要使血循行正常，男子也要使血循行正常。如果血违背了常道，就是血不循经。在女子，即使没有崩漏和带下病，也不能受孕；在男子，即使没有吐血和鼻衄，身体也不会得到滋养。到了失常的极致，女子就没有不出现崩漏和带下的，男子就没有不出现吐血和鼻衄的。所以女子治血贵在调经，男子治血也贵在调血。只是男子的吐血和鼻衄，是向上运行的血；女子的崩漏和带下，是向下运行的血，不能一概而论罢了。然而，如果女子出现吐血和鼻衄，那就与男子没有区别；男子出现下血，那就与崩漏和带下没有差异。所以这本书原本就不是妇科专书，但对于月经、胎产尤为详尽。确实是希望人们能触类旁通，在治疗血证方面或许能达到神妙的境界吧。
又说：女子子宫中的血，每月更换一次，除旧生新。旧血就是瘀血。这种瘀血如果不除去，就会阻碍化生新血的机能。凡是医生，都知道破血通经的方法。唯独对于男女吐血和鼻衄的病证，就不知道去瘀生新的方法。试思考一下，瘀血不行，那么新血绝对没有存活的道理。观察月经的去旧生新，就可以知道了。即使是外科治疗溃疡，也必须先化除腐肉，然后才能生肌。腐肉不化，那么新血也绝对没有存活的道理。况且如果有脓管，必须烂开腐肉，取出脓管之后才停止。治疗失血的人，不去除瘀血而只求补血，这与治疗疮疡的人，不化除腐肉而只求生肌有什么区别呢？然而，去瘀是一回事，生新又是另一回事。大概瘀血去除了，新血就已经生了；新血生了，瘀血自然就去除了。其间并没有间隔。就像月经下行，这是瘀血去除了。这个时候，新血已经在血海中萌动。所以能够受孕，并不是月经下了很久之后，另外再生出新血。明白了这一点，就知道以去瘀作为生新的方法，也知道以生新作为去瘀的方法。生血的机理就是这样，而生血的根源，则在于脾胃。《内经》说：“中焦受气取汁，变化而赤，是为血。”现在且举一个明显的例子来说明。妇女的乳汁，就是脾胃饮食所化生的，是中焦受气所取的汁液。妇女的乳汁，如果生成，月经就不行了，因为这个汁液既然从乳房排出，就不再下行变为血了。至于断奶之后，这个汁液变化变红，仍下行成为经血。人们都知道催乳需要补益脾胃，却不知道滋血更需要补益脾胃。因为血就是乳汁。懂得了催乳的方法，就知道了补血的方法。但是调理脾胃，必须区分阴阳。李东垣以后，重视脾胃的人，只知道应当补脾阳，却不知道滋养脾阴。脾阳不足，水谷固然不能消化；脾阴不足，水谷也不能消化啊。譬如锅裡煮饭，锅底没有火固然煮不熟，锅裡没有水也煮不熟。我亲眼见到脾不思食的患者，用温药反而减少食欲，用凉药反而感觉舒适。我亲眼见到催乳的人，用白术和鹿茸乳汁就多，又亲眼见到催乳的人，用白术和鹿茸乳汁反而变少。这是因为有的适宜，有的不适宜罢了。所以，适宜补脾阳的，即使是干姜、附子也能生津液；适宜补脾阴的，即使是知母、石膏反而能开胃。补脾阳的方法，前人已经讲得很完备了。唯独补脾阴的方法，古代很少发明。我特意标出，让人们知道一阴一阳，不可偏废。
补脾阴以开胃进食，是我临证悟出的，并借用《伤寒论》中“存津液”三个字作为依据。此外本来没有证据。书既已写成，后来得到了泰西（西方）人的五种医法。里面说胃的消化谷物，是靠胃汁消化的，还有甜肉汁、苦胆汁，都进入肠胃帮助消化谷物。所谓的“汁”，就是我所说的津液。西医论述脏腑，多谈论物质而遗漏了理法。像这一条，确实指出了物质，而且尚不与理法相违背，恰好足以证明我所论述的内容，所以一并记录下来。
(See the section on Menstrual Blood, Fetus, and Childbirth)
The world holds that men are primarily governed by Qi (vital energy), while women are primarily governed by Blood. Consequently, it is said that men's blood is precious, whereas women's blood is cheap. It is also believed that men's blood differs from women's blood, yet they fail to realize that they are essentially the same. The only difference lies in the fact that women have menstruation, while men do not. How can it be that both possess blood, yet only women menstruate? This is because women are primarily governed by Blood; Blood belongs to Yin and tends to descend. Its movement is driven by Qi. Although women are primarily governed by Blood, they still rely on Qi to circulate it. Qi transforms from Water, as detailed in previous discussions. The intersection of Qi and Blood occurs in the uterus below the navel. In men, this is called the Dantian (Elixir Field); in women, it is called the Blood Chamber. These are governed by the Liver and Kidney, serving as the convergence point for Qi and Blood. Qi is born from Water and transforms into Water. Since men are primarily governed by Qi, when Blood enters the Dantian, it also transforms with the Water-Qi, becoming Water. Because it is transformed internally by Blood, it is not clear water but extremely thick, which is referred to as Kidney Essence. Women's Qi can also revert to transforming into Water. However, since women are primarily governed by Blood, their Qi within the Blood Chamber transforms according to Blood, becoming Blood, which is called menstruation. Nevertheless, their Blood still contains aqueous fluids transformed by Qi, hence menstruation is also called "Trust Water" (Xin Shui). Moreover, pale-colored fluid appears before and after menstruation, indicating that women's Blood component relies on the Water component of Qi to guide and circulate it. Understanding this, one knows that men's essence belongs to Qi and Water, yet contains Blood and Fire; and women's menses belong to Blood and Fire, yet contain Qi and Water. Therefore, thin semen in men indicates Blood deficiency, while menstrual disorders in women indicate Qi stagnation.
A question arises: If men are governed by Qi and women by Blood, as described, why must women menstruate while men do not? The answer is: Menstrual blood is the surplus of Blood. The cycle of generating the new and discarding the old is the natural law of Heaven and Earth. Thus, the moon waxes and wanes, and the sea has tides. Women's Blood undergoes this process of discarding the old and generating the new; when full, it overflows, and when abundant, it declines. Women menstruate once a month to discharge this surplus. Since Blood is Yin and descends, it exits from below as menstrual blood. As for men, although they do not menstruate, they must also discharge their surplus. Men are primarily governed by Qi; Qi is Yang and ascends. Therefore, the surplus of Blood does not exit from below but ascends with Qi, following the Chong and Ren meridians, circling the lips and cheeks, and growing into facial hair. Thus, facial hair serves to discharge the surplus of Blood. Because women have menstruation, they lack facial hair above; because men have facial hair, they lack menstruation below. Their primary governance differs, and their ascending/descending dynamics vary; this is the sole distinction. This principle originates from the *Huangdi Neijing* (Yellow Emperor's Inner Canon) and is not an original theory. Those who claim men's and women's blood are radically different do not understand the principles of transformation. One must clarify the principles of transformation and circulation of Qi, Blood, Water, and Fire to treat diseases arising from them. Women must ensure Blood follows its normal course, and men must also ensure Blood follows its normal course. If Blood deviates from its normal path, it fails to follow the meridians. In women, even without metrorrhagia or leukorrhea, conception will not occur; in men, even without hematemesis or epistaxis, the body will not be nourished. At the extreme of deviation, women invariably suffer from metrorrhagia and leukorrhea, and men from hematemesis and epistaxis. Therefore, treating women's blood issues prioritizes regulating menstruation, while treating men's prioritizes regulating Blood. However, men's hematemesis and epistaxis involve Blood ascending, whereas women's metrorrhagia and leukorrhea involve Blood descending; these cannot be treated identically. Yet, if women experience hematemesis and epistaxis, it is no different from men; if men experience lower bleeding, it is no different from metrorrhagia and leukorrhea. Thus, this book is not exclusively a gynecological text, but it details menstruation, fetus, and childbirth extensively, hoping readers can draw analogies and achieve mastery in treating Blood disorders.
Furthermore, the Blood in the woman's uterus changes monthly, discarding the old and generating the new. The old Blood is Stasis. If this Stasis is not removed, it obstructs the mechanism of generating new Blood. All physicians know methods to break Stasis and unblock menstruation. Yet, regarding hematemesis and epistaxis in both men and women, they often fail to apply the method of removing Stasis to generate new Blood. Consider that if Stasis does not move, there is absolutely no hope for new Blood. Observing the discarding of old and generation of new during menstruation reveals this truth. Even in surgery for ulcers, one must first resolve putrefaction before generating flesh. If putrefaction is not resolved, new Blood cannot grow. Furthermore, if sinus tracts exist, one must excise the necrotic tissue and remove the tract before stopping. Treating hemorrhage by seeking to tonify Blood without removing Stasis is akin to treating ulcers by seeking to generate flesh without resolving putrefaction. However, removing Stasis and generating new Blood are distinct processes. When Stasis is removed, new Blood is already generated; when new Blood is generated, Stasis naturally dissipates. There is no interval between them. Just as menstruation involves the removal of Stasis, at that moment, new Blood is already stirring in the Sea of Blood, allowing for conception. It is not that new Blood is generated separately long after menstruation ceases. Understanding this, one sees that removing Stasis is a method to generate new Blood, and generating new Blood is a method to remove Stasis. The mechanism of generating Blood is thus, but its root lies in the Spleen and Stomach. The Classics state: "The Middle Jiao receives Qi and extracts juices, transforming them into red, which becomes Blood." Let us illustrate with a clear example. Women's milk is transformed from food and drink processed by the Spleen and Stomach; it is the juice extracted by the Middle Jiao receiving Qi. When women produce milk, menstruation stops because this juice exits through the breasts rather than descending to transform into Blood. After weaning, this juice transforms into red Blood and descends as menstrual blood. People know that promoting lactation requires tonifying the Spleen and Stomach, but do not realize that nourishing Blood requires even more emphasis on tonifying the Spleen and Stomach. For Blood is essentially Milk. Knowing how to promote lactation allows one to know how to tonify Blood. However, regulating the Spleen and Stomach requires distinguishing between Yin and Yang. Since Li Dongyuan, those emphasizing the Spleen and Stomach have focused on tonifying Spleen Yang, neglecting to nourish Spleen Yin. Insufficient Spleen Yang means food and water cannot digest; insufficient Spleen Yin also means food and water cannot digest. It is like cooking rice in a pot: without fire underneath, it won't cook; without water inside, it won't cook either. I have personally seen patients with poor appetite due to Spleen dysfunction who felt worse with warm herbs but better with cool herbs. I have seen cases where using Atractylodes Macrocephala Rhizome (Baizhu) and Deer Antler Velvet (Lurong) increased milk production, and others where the same herbs decreased it. This depends on suitability. Therefore, for those suitable for tonifying Spleen Yang, even Dry Ginger (Ganjiang) and Prepared Aconite Root (Fuzi) can generate fluids; for those suitable for tonifying Spleen Yin, even Anemarrhena Rhizome (Zhimu) and Gypsum Fibrosum (Shigao) can stimulate appetite. Methods for tonifying Spleen Yang have been well documented by predecessors. Rarely have ancient texts elaborated on tonifying Spleen Yin. I specifically highlight this to remind everyone that Yin and Yang should not be neglected.
Tonifying Spleen Yin to stimulate appetite was my clinical insight, supported by the three characters "preserve Body Fluids" (Cun Jin Ye) from the *Shanghan Lun* (Treatise on Cold Damage). Otherwise, there is no other evidence. After completing this book, I obtained five Western medical texts. They state that stomach digestion of food is facilitated by gastric juices, sweet pancreatic juice, and bitter bile entering the intestines. The term "juice" corresponds to what I call Body Fluids. Western medicine discusses organs focusing on matter while neglecting principles. This specific point identifies the material aspect without contradicting principles, thereby corroborating my discussion. Hence, I record it here.