妇女经闭有四。一寒证。一热证。一实证。一虚证。
寒闭者。积冷结气。经水断绝。至有历年。胞门为寒所伤。经络凝坚。阴中掣痛。少腹恶寒。上引腰脊。绕脐寒
疝。或瘀血不行。留为石瘕。皆霜凝冰结之象也。用温经汤主之。或用温药下之。附子理中汤。加当归桃仁
大黄细辛牛膝肉桂。生化汤下之。尤稳。经通之后。再服肾气丸收功。
热证者。胞为血室。血室为肝之所司。肝火横逆。从胞脉上迫于心肺。心肺之气。不得下通。则发寒热。头晕
耳鸣。烦躁多怒。咳逆气上。治宜平其肝火。使肺气得下降。心血得下注。斯经通矣。当归芦荟丸。加桃仁以
攻之。丹栀逍遥散。加桃仁以和之。又曰冲任两脉。起于胞中。上属阳明。若胞中火逆。随冲任两脉上冲。头
晕颊赤。咽喉不利。发热口渴。咳逆喘息。此乃胞气上逆。合于阳明之气。而为燥动之证。法宜从阳明以折
冲逆。使火下降。斯经通矣。玉烛散治之。如脾胃素虚。不便攻治者。玉女煎。加桃仁丹皮治之。金匮麦门冬
汤。尤能逆折冲气。数方皆从阳明降气。使气下达胞中。则经自通。又有从肾中。引气下行。以通经之法。用
六味地黄汤。加知柏牛膝桃仁。此又引冲气下行隔治之法。
实证经闭者。妇人少腹如敦状。小便微难而不渴。此为水与血结在血室也。大黄甘遂汤主之。又仲景曰。
妇人伤寒。中风。经水适断。胸胁满。如结胸状。谵语者。此为热入血室也。小柴胡汤主之。妇人经闭。藏坚癖
不止者。中有干血。湿热腐变。化出白物。矾石末纳入阴户。吾谓可用土瓜根汤。加黄柏防己治之。又或小
腹结痛。大便黑色。小便不利。明知血欲行而不肯利下。宜抵当汤主之。时方可用膈下逐瘀汤。
虚证经闭者。或因失血过多。面与爪甲之色。俱浅淡黄白。血既从上而脱。更何从再注胞中。以为经水哉。
治法宜止其吐衄之血。使其下行。再补其虚。则血生而气顺。下注胞中。斯经得通矣。四物汤。加牛膝枳壳
降香郁金血余童便茯苓甘草阿胶。或因过淫精竭。肾中天癸之水不至胞中。则不能引动冲脉之血。是
为阳不倡阴。水不化血。宜滋补其水。以益天癸。左归饮主之。三才汤亦主之。或因生产过多。伤血血枯。圣
愈汤主之。或室女血枯。名为童痨。室女正当血盛之时。而乃经少血枯。以致骨蒸肌热。面色枯白。两颧发
赤。懒于饮食。皮干消瘦。咳嗽喘息。此宜大滋其血之化源。使血骤生。而诸病乃退。炙甘草汤主之。又或妇
人女子。不得隐曲。心念不遂。脾气抑郁。以致胃病。不思饮食。倦怠少神。怔忡健忘。脾不化汁。心不化赤。是
血虚而无经水。血虚则生内热。肌肉干瘦。如风之消物。故又名风消。其证难治。宜归脾汤主之。血虚则火
盛无制。心乘肺金。金气不行。不能运布。水津留于胸中。津液尽化为痰。咳嗽不已。日久成痨。经所谓传为
息贲。则不能治。谓喘息也。都气丸。加人参麦冬枣仁五味子钟乳石治之。天王补心丹亦治之。保和丸。清
燥救肺汤。皆可借治。息贲。叶氏养胃汤。加熟地五味云苓亦佳。
经血原委。已于四卷详言之。兹特就经闭大略。出其证治。化裁通变之用。则存乎其人而已。
末段所论生血之法。男女略同。治血证者。须切究之。
妇女闭经有四种情况。一是寒证。二是热证。三是实证。四是虚证。
寒性闭经，是由于积冷与气结，导致经水断绝，甚至长达数年。胞宫（子宫）受寒邪损伤，经络凝结坚固，阴部牵引作痛，少腹部怕冷，疼痛向上牵连腰脊，或绕脐出现寒疝。或者瘀血不行，停留形成石瘕（一种坚硬如石的妇科肿块），这些都是霜凝冰结般的景象。治疗用温经汤（Warm the Meridian Decoction）为主方。或者使用温药攻下，如附子理中汤（Aconite and Poria Decoction），加入当归、桃仁、大黄、细辛、牛膝、肉桂。或用生化汤（Invigorate Blood Decoction）攻下，更为稳妥。月经通畅之后，再服用肾气丸（Kidney Qi Pill）以收功。
热证闭经，胞宫为血室，血室由肝所主管。肝火横逆，从胞脉向上逼迫心肺，导致心肺之气不能下行，从而引发寒热往来、头晕耳鸣、烦躁易怒、咳嗽气逆等症状。治疗应当平抑肝火，使肺气得以下降，心血得以向下灌注，这样月经就能通畅。可用当归芦荟丸（Angelica and Aloe Pill），加入桃仁以攻逐邪气；或丹栀逍遥散（Moutan and Gardenia Xiaoyao Powder），加入桃仁以调和气血。又说冲脉和任脉，起于胞中，上行归属于阳明胃经。如果胞中火热上逆，随冲任两脉上冲，会出现头晕、脸颊发红、咽喉不利、发热口渴、咳嗽喘息等症状。这是胞气上逆，合并阳明之气，形成燥动之证。治法应当从阳明经入手以折服冲逆之气，使火气下降，这样月经就能通畅。玉烛散（Jade Candle Powder）治疗此证。如果脾胃素来虚弱，不便攻伐治疗者，可用玉女煎（Jade Woman Decoction），加入桃仁、丹皮治疗。金匮麦门冬汤（Golden Cabinet Ophiopogon Decoction），尤其能逆折冲逆之气。这几个方子都是从阳明经降气，使气下达胞中，则月经自然通畅。又有从肾中引气下行以通经的方法，用六味地黄汤（Six-Ingredient Rehmannia Decoction），加入知母、黄柏、牛膝、桃仁。这又是引导冲气下行、隔位治疗的办法。
实证闭经，表现为妇人少腹部像敦（古代盛食物的器具，形容腹部胀大坚实）一样状，小便微难但不口渴。这是水湿与瘀血结聚在血室所致。用大黄甘遂汤（Rhubarb and Coix Seed Decoction）为主方。另外张仲景说：妇人患伤寒或中风，月经刚断，出现胸胁满闷，像结胸证的样子，并有谵语（胡言乱语），这是热入血室。用小柴胡汤（Minor Bupleurum Decoction）为主方。妇人闭经，体内有坚硬的癖块不止，其中有干血，湿热腐败变化，化出白色分泌物（带下）。可将矾石末纳入阴道。我认为可用土瓜根汤（Trichosanthes Root Decoction），加入黄柏、防己治疗。或者小腹结聚疼痛，大便黑色，小便不利，明知是血液欲行但难以排出，宜用抵当汤（Di Dang Decoction）为主方。现代临床有时可用膈下逐瘀汤（Blood Stasis Expelling Decoction under the Diaphragm）。
虚证闭经，可能是因为失血过多，面部和指甲颜色都浅淡黄白。血液既然从上窍脱失，又怎能再从下面注入胞中作为经水呢？治疗方法应当先止住吐血、衄血（鼻出血等），使其血液下行，再补益其虚损，那么血液生成而气机顺调，向下注入胞中，月经就能通畅了。用四物汤（Four Substances Decoction），加入牛膝、枳壳、降香、郁金、血余炭、童便、茯苓、甘草、阿胶。或者因为房事过度导致精竭，肾中的天癸（促进生殖功能发育成熟的物质）之水不到达胞中，则不能引动冲脉之血，这叫阳不倡阴，水不化血。适宜滋补其阴水，以益天癸。用左归饮（Left Restoring Drink）为主方。三才汤（Three Talents Decoction）也可主用。或者因为生产过多，伤血导致血枯，用圣愈汤（Shengyu Decoction）为主方。或者少女血枯，名为童痨。少女正当血气旺盛之时，却月经量少血枯，导致骨蒸肌热（阴虚潮热）、面色枯白、两颧发红、懒于饮食、皮肤干燥消瘦、咳嗽喘息。这应当大滋养血化的源头，使血液迅速生成，各种病症才能消退。用炙甘草汤（Honey-Fried Licorice Decoction）为主方。或者妇女人女子，因隐曲之事不得志，心念不畅，脾气抑郁，进而导致胃病，不思饮食，倦怠少神，心悸健忘。脾不能化生汁液，心不能化赤为血，这是血虚而无经水。血虚则生内热，肌肉干瘦，如同被风吹干的物体，所以又名风消。此证难治，宜用归脾汤（Guipi Decoction）为主方。血虚则火势盛大无法制约，心火乘袭肺金，金气不行，不能运布水津，水津留于胸中，津液尽化为痰，咳嗽不已，日久成劳损。医经所谓“传为息贲”（一种积聚病，表现为喘息），则难以治疗。用都气丸（Duqi Pill），加入人参、麦冬、枣仁、五味子、钟乳石治疗。天王补心丹（Tianwang Buxin Dan）也治疗此证。保和丸（Baohe Pill）、清燥救肺汤（Clear Dryness and Rescue Lung Decoction），都可以借用来治疗。息贲证，叶氏养胃汤（Ye's Stomach-Nourishing Decoction），加入熟地、五味子、云苓也很好。
经血的原本源委，已在第四卷详细论述过。这里特别就闭经的大略情况，提出其证治方法。至于灵活化裁变通的应用，则取决于医者本人罢了。
末段所论述的生血方法，男女大致相同。治疗血证的人，必须深入探究它。
There are four types of amenorrhea in women. One is Cold Syndrome, one is Heat Syndrome, one is Excess Syndrome, and one is Deficiency Syndrome.
Cold-type amenorrhea results from accumulated cold and qi stagnation, causing the cessation of menstruation, which may last for years. The uterus (Baogong) is injured by cold pathogens, leading to coagulation and hardening of the meridians. There is pulling pain in the yin region, aversion to cold in the lower abdomen, with pain radiating upward to the waist and spine, or cold hernia encircling the navel. Alternatively, blood stasis fails to circulate, remaining as a stone-like mass (Shi Jia). These are all manifestations resembling frost condensation and ice freezing. The primary formula is Wen Jing Tang (Warm the Meridian Decoction). Alternatively, warm purgatives can be used, such as Fu Zi Li Zhong Tang (Aconite and Poria Decoction) added with Dang Gui (Angelicae Sinensis Radix), Tao Ren (Persicam Semen), Da Huang (Rhei Radix et Rhizoma), Xi Xin (Asari Radix et Rhizoma), Niu Xi (Achyranthis Bidentatae Radix), and Rou Gui (Cinnamomi Cortex). Or, Sheng Hua Tang (Invigorate Blood Decoction) can be used for purgation, which is even more stable. After menstruation resumes, Shen Qi Wan (Kidney Qi Pill) should be taken to conclude treatment.
Heat-type amenorrhea: The uterus serves as the Blood Chamber, which is governed by the Liver. Liver Fire rebels horizontally, forcing its way up through the uterine vessels to oppress the Heart and Lungs. Consequently, the Qi of the Heart and Lungs cannot descend, resulting in alternating chills and fever, dizziness, tinnitus, irritability, anger, coughing, and rebellious Qi. Treatment should aim to calm Liver Fire, allowing Lung Qi to descend and Heart Blood to flow downward, thereby restoring menstruation. Dang Gui Lu Hui Wan (Angelica and Aloe Pill) can be used, adding Tao Ren (Persicam Semen) to attack the pathogen; or Dan Zhi Xiao Yao San (Moutan and Gardenia Xiaoyao Powder) with added Tao Ren to harmonize. Furthermore, the Chong and Ren meridians originate in the uterus and ascend to connect with the Yangming Stomach channel. If fire rebels in the uterus, it rushes upward along the Chong and Ren meridians, causing dizziness, flushed cheeks, throat discomfort, fever, thirst, coughing, and wheezing. This is due to rebellious Qi in the uterus combining with Yangming Qi to form a dryness-agitation syndrome. The method should target the Yangming channel to subdue the rebellious Qi, allowing fire to descend, thus restoring menstruation. Yu Zhu San (Jade Candle Powder) treats this condition. If the Spleen and Stomach have been weak since childhood and aggressive treatment is unsuitable, Yu Nu Jian (Jade Woman Decoction) with added Tao Ren (Persicam Semen) and Dan Pi (Moutan Cortex) can be used. Jin Gui Mai Men Dong Tang (Golden Cabinet Ophiopogon Decoction) is particularly effective in reversing rebellious Qi. All these formulas act by descending Qi from the Yangming channel, directing it down to the uterus, so that menstruation naturally flows. Another method involves drawing Qi downward from the Kidneys to unblock menstruation, using Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction) added with Zhi Mu (Anemarrhenae Rhizoma), Huang Bai (Phellodendri Cortex), Niu Xi (Achyranthis Bidentatae Radix), and Tao Ren (Persicam Semen). This represents a method of guiding rebellious Qi downward via indirect treatment.
Excess-type amenorrhea presents with the lower abdomen feeling firm and distended like a Dun (ancient vessel), slight difficulty in urination but without thirst. This indicates water and blood binding together in the Blood Chamber. Da Huang Gan Sui Tang (Rhubarb and Coix Seed Decoction) is the primary formula. Additionally, Zhang Zhongjing stated: When a woman suffers from Shang Han (Cold Damage) or Feng Zhong (Wind Strike), and her menstruation has just ceased, presenting with fullness in the chest and hypochondrium resembling Jie Xiong syndrome, along with delirium, this is Rebellious Heat entering the Blood Chamber. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary formula. In cases of female amenorrhea with persistent hard masses containing dried blood, where damp-heat causes putrefaction and transformation into white discharge (leukorrhea), Fan Shi Mo (Alumen Powder) can be inserted into the vagina. I suggest Tu Gua Gen Tang (Trichosanthes Root Decoction) added with Huang Bai (Phellodendri Cortex) and Fang Ji (Stephaniae Tetrandrae Radix). Alternatively, if there is knotted pain in the lower abdomen, black stools, and difficult urination, knowing that blood desires to move but fails to discharge smoothly, Di Dang Tang (Di Dang Decoction) is appropriate. In contemporary practice, Ge Xia Zhu Yu Tang (Blood Stasis Expelling Decoction under the Diaphragm) may sometimes be used.
Deficiency-type amenorrhea may result from excessive blood loss, causing the face and nail beds to appear pale yellow-white. Since blood has already escaped from the upper orifices, how can it subsequently flow downward into the uterus to become menstrual blood? The treatment method should first stop hematemesis and epistaxis, facilitating the downward movement of blood, and then tonify the deficiency. Once blood is generated and Qi flows smoothly, flowing downward into the uterus, menstruation will resume. Si Wu Tang (Four Substances Decoction) is used, added with Niu Xi (Achyranthis Bidentatae Radix), Zhi Ke (Aurantii Fructus), Jiang Xiang (Dalbergiae Odoriferae Lignum), Yu Jin (Curcumae Longae Radix), Xue Yu Tan (Sanguis Carbonisatus), Tong Bian (Child's Urine), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), and E Jiao (Colla Corii Asini). Alternatively, due to excessive sexual activity leading to essence depletion, the Tian Gui (Heavenly Water, substances promoting reproductive function) of the Kidneys fails to reach the uterus, unable to activate the blood of the Chong Mai. This is described as Yang failing to initiate Yin, and Water failing to transform into Blood. It is suitable to nourish Yin water to benefit Tian Gui. Zuo Gui Yin (Left Restoring Drink) is the primary formula. San Cai Tang (Three Talents Decoction) can also be used. Or, due to excessive childbirth damaging blood and causing blood exhaustion, Sheng Yu Tang (Shengyu Decoction) is indicated. For virgins with blood exhaustion, termed Tong Lao (Childhood Consumption), although they are at an age when blood should be abundant, they experience scanty menstruation and blood exhaustion, leading to bone-steaming tidal fever, withered complexion, flushed malar eminences, anorexia, dry skin, emaciation, coughing, and wheezing. This requires greatly nourishing the source of blood generation to rapidly produce blood, thereby retreating various diseases. Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) is the primary formula. Or, women who suffer from unfulfilled hidden desires, leading to frustrated thoughts and depressed Spleen Qi, which subsequently affects the Stomach, causing anorexia, fatigue, lack of spirit, palpitations, and forgetfulness. The Spleen fails to transform fluids, and the Heart fails to transform red blood, resulting in blood deficiency and absence of menstruation. Blood deficiency generates internal heat, causing muscles to wither like objects blown by wind, hence also named Feng Xiao (Wind Wasting). This condition is difficult to treat; Gui Pi Tang (Guipi Decoction) is indicated. When blood deficiency leads to unrestrained Fire, Heart Fire attacks Lung Metal. Metal Qi fails to circulate, preventing the distribution of fluid reserves. Fluids remain in the chest, transforming entirely into phlegm, causing persistent coughing that eventually becomes consumption. As the classics state, "transmission leads to Xi Ben" (a type of accumulation characterized by wheezing), which is incurable. Du Qi Wan (Duqi Pill) added with Ren Shen (Ginseng Radix), Mai Dong (Ophiopogonis Radix), Zao Ren (Ziziphi Spinosae Semen), Wu Wei Zi (Schisandrae Chinensis Fructus), and Zhong Ru (Stalactitum) treats this. Tian Wang Bu Xin Dan (Emperor of Heaven's Heart-Nourishing Pill) also treats this condition. Bao He Wan (Preserve Harmony Pill), Qing Zao Jiu Fei Tang (Clear Dryness and Rescue Lung Decoction) can all be borrowed for treatment. For Xi Ben, Ye Shi Yang Wei Tang (Ye's Stomach-Nourishing Decoction) added with Shu Di Huang (Rehmanniae Radix Preparata), Wu Wei Zi (Schisandrae Chinensis Fructus), and Yun Ling (Poria) is also excellent.
The origins and details of menstrual blood have been discussed in detail in Volume Four. Here, I specifically outline the general patterns and treatments for amenorrhea. The application of flexible modification and variation depends on the practitioner.
The methods of generating blood discussed in the final paragraph are roughly the same for men and women. Those treating blood disorders must study them thoroughly.