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A certain patient presented with a weak and powerless pulse, fever with sweating, chronic cough leading to coldness of the body, and food intake reduced by more than half. This is evidently an internal damage resulting in *Lao* (consumptive disease). It is strictly contraindicated to use cold and cooling herbs to clear heat and treat the cough. For now, employ the *Jianzhong* method (a method to strengthen the Middle Jiao and harmonize the Spleen and Stomach). Hope that the patient can increase food intake and have menstruation resume, so that regulation and care are still possible.

Guizhi (Cinnamon Twig) (5 fen), Sheng Baishao (Raw White Peony Root) (1.5 qian), Zhi Cao (Honey-fried Licorice Root) (5 fen), Zaorou (Date Flesh) (3 qian), Yitang (Maltose) (2 qian), Guishen (Radix Angelicae Sinensis, root portion) (1.5 qian).

Cheng (19 years old): Suffering from *Ganxue Lao* (Dry Blood Consumptive Disease), where all vessels are withered and dry, gradually progressing to a critical state. The pulse was diagnosed once in March, and I dismissed the case face-to-face. I am not a confused quack; I will not follow routine practices and cause harm.

Yimu Wan (Motherwort Pill) taken morning and evening, 2-3 qian each time.

A certain patient: Deficiency of Ying (Nutritive) blood causing alternating chills and fever, hemoptysis (coughing up blood), and amenorrhea.

Danggui (Radix Angelicae Sinensis), Chao Baishao (Stir-fried White Peony Root), Danshen (Radix Salviae Miltiorrhizae), Zaoren (Semen Ziziphi Spinosae), Yuanzhi (Radix Polygalae), Fuling (Poria), Zhi Cao (Honey-fried Licorice Root), Guangpi (Exocarpium Citri Reticulatae), Guiyuanrou (Arillus Longan).

Gu (31 years old): Tidal fever with menstrual obstruction, pulse is wiry and rapid. The Ying blood is steamed by alternating cold and heat, cutting off the mechanism of circulation. This becomes *Ganxue Lao Zhai* (severe consumptive disease due to dry blood), which is no minor ailment.

Guizhi (Cinnamon Twig) (3 fen), Baishao (White Peony Root) (1.5 qian), Ejiao (Donkey-hide Gelatin) (1.5 qian), Shengdi (Rehmannia Root) (3 qian), Zhi Cao (Honey-fried Licorice Root) (4 fen), Maidong (Ophiopogon Tuber) (1.5 qian), Dama Ren (Hemp Seed) (1 qian).

Zhu (Female): In her youth, Tian Gui (menstrual essence) has not yet arrived. Spring Yang rises and moves, causing alternating chills/fever and epistaxis (nosebleed). Usually suffers from lower back pain after urination. Her hearing and vision are very sharp. However, her congenital constitution is thin; Yin essence is inherently difficult to fill and easily depleted. There is much concern about *Dao Jing* (retrograde menstruation).

Male Wugujì (Black-bone Chicken), Shengdi (Rehmannia Root), Sheng Baishao (Raw White Peony Root), Fushen (Poria with Hostwood), Tiandong (Asparagus Tuber), Zhimu (Anemarrhenae Rhizoma), Niuxi (Achyranthes Root), Chongweizi (Leonurus Fruit), Nvzhenzi (Ligustrum Lucidum Fruit), Ejiao (Donkey-hide Gelatin).

All herbs except Ejiao are decocted twice in water. The chicken is cleaned of feathers, wings, and feet. Separately, boil one bowl of Tongbian (child's urine), four bowls of Qinghao juice (Artemisia Annua Juice), two bowls of Chunjiu (pure wine), and one bowl of Mi Cu (rice vinegar). Simmer together. Then add the previous herbal decoction to reduce into a paste. Finally, incorporate Ejiao. Warm and stew before taking 5 qian.

Zhang: Seventeen years old, Tian Gui has not arrived. Coughing and blood loss constitute a severe case of *Dao Jing* (retrograde menstruation). First, use methods to smooth Qi and guide blood downward.

Xiangmo (Powder of Aquilaria Wood), Yujin (Rhizoma Curcumae), Gouteng (Uncaria Ramulus cum Uncis), Danpi (Moutan Cortex), Suzi (Pericarpium Vaccariae), Chao Shanzha (Stir-fried Hawthorn Fruit), Hei Shanzhi (Charred Gardenia Fruit).

Second visit: Disturbance of Qi rushing upward, choking cough and blood loss.

Jizihuang (Egg Yolk), Ejiao (Donkey-hide Gelatin), Xian Shengdi (Fresh Rehmannia Root), Tiandong (Asparagus Tuber), Sheng Baishao (Raw White Peony Root), Chao Banxi (Stir-fried Banxia - *Note: Text likely refers to a specific preparation*).

Third visit: Pulse is fine and rapid, abdominal pain, Heat in Ying level, menstruation blocked.

Renshen (Ginseng Radix), Tiandong (Asparagus Tuber), Xian Shengdi (Fresh Rehmannia Root), Baishao (White Peony Root), Danshen (Salvia Root).

Mix in 3 fen of Hupo Mo (Amber Powder).

The *I Ching* states: The Dao of Qian creates males, the Dao of Kun creates females. Females belong to Yin and prioritize Blood. Therefore, gynecological treatment first emphasizes regulating menstruation. "Jing" means constancy. Like tides having their time, like the moon waxing and waning, without missing its period, it is called Jing Shui (Menstrual Water). Also called Yue Shi (Monthly Affairs) or Yue Xin (Monthly Trust). The *Neijing* says: When the Chong Mai (Penetrating Vessel) is abundant, monthly affairs descend on time. Jingyue said: The Chong Mai is the Sea of the Five Zang and Six Fu organs; the blood of these organs all converges to the Chong Mai. Thus, the Chong Mai is the root of menstruation. However, the transformation of Blood and Qi originates from Grain and Water (diet). Abundant grain and water lead to abundant Blood and Qi; deficient grain and water lead to deficient Blood and Qi. Thus, the Sea of Grain and Water lies in the Yangming (Stomach). It is seen that the blood of the Chong Mai is entirely transformed from Yangming grain and water. And the Stomach Qi of Yangming is the root of the Chong Mai. Therefore, the root of menstruation lies in the Chong Mai, relies on Stomach Qi, and ultimately on the source of transformation in the Heart and Spleen. The Heart governs Blood, the Spleen controls Blood, the Liver stores Blood. Any injury to the Heart, Spleen, or Liver can cause diseases of the meridians. The *Neijing* says: Diseases of the Two Yang (Yangming) originate in the Heart and Spleen. If there is inability to express hidden desires, females will not menstruate. If this transmits to become Feng Xiao (Wind Emaciation), or transmits to become Xi Ben (Gasping Accumulation), it is a death case, untreatable. "Bude Yinqu" refers to unfulfilled sexual desire, causing disease in the Heart and Spleen. Feng Xiao refers to fever and emaciation, as the Stomach governs muscles. Xi Ben refers to gasping rising upward, as Stomach Qi rebels upward. Although it says disease originates in Heart and Spleen, it actually emphasizes Stomach Qi, because the Heart is the Mother of the Stomach, and the Stomach is the Interior-Exterior partner of the Spleen. The *Neijing* also says: One who suffers from fullness and distension in the chest and hypochondrium, obstructing food intake, and upon onset, first smells fishy and foul odors, secretes clear fluids, spits blood first, has cold limbs, dizziness, and frequent bleeding from front and back passages. The disease is named Xue Ku (Blood Dryness). This results from massive blood loss in youth, or intercourse while drunk, leading to exhaustion of Qi and injury to the Liver, thus causing menstrual scarcity or cessation. Treat with Si Wuie Gu Yi Ru (Four parts Cuttlebone, One part Rubia/Radix Rubiae). Combine the two substances, form pills using Quelian (Quail Egg), size of small beans. Take five pills after meals, drink Bao Yu Zhi (Cuttlefish/Bay Fish Broth) to benefit the intestines and heal liver injury. This passage emphasizes "Qi Exhaustion and Liver Injury" as the core principle. Chest and hypochondrium are the Liver region; fullness/distension indicates Liver disease; obstructing food indicates Wood evil invading Earth; smelling fishy/foul at onset indicates Spleen Earth being oppressed by Wood evil, revealing Liver excess qi; secreting clear fluids indicates Spleen deficiency failing to transform fluids; spitting blood indicates Spleen injury failing to control circulating blood; cold limbs indicate Yang deficiency failing to reach extremities; dizziness indicates insufficient Yang allowing Water to overflow into meridians; bleeding from front/back indicates Yin injury causing blood to overflow into collaterals. Xue Ku implies dry blood inside, blood not returning to vessels, knotting in the Bao Men (uterus). This is indeed caused by lack of restraint in youth, exhausting Qi and injuring the Liver, leading to menstrual scarcity or absence. Treatment uses four parts Wuie Gu (Cuttlebone), salty taste entering Kidney, warm nature reaching Liver; paired with one part Ru (Rubia), pungent to disperse internal wind, warm to remove bad blood. Combined, they break old blood and generate new. Pills with Quelian egg for warming, tonifying Yang, and regulating uterine essence/blood. Taking five pills after meals ensures slow descent to Lower Jiao, focusing power. Drinking Bao Yu Zhi clears intestinal filth and harmonizes liver injury; its foul odor assists Cuttlebone in dispelling accumulated blood. The *Jingui Yaolue* details menstrual regulation extensively. Later sages like Wang Jiezhai and Xue Lizhai discussed symptoms thoroughly and prescribed formulas precisely, serving as models. I will not elaborate further. Observing Mr. Ye's cases, the Eight Extraordinary Vessels are crucial, but secondarily, regulating the Liver is most important. Because females take the Liver as their先天 (Constitutional Foundation); Yin nature tends to congeal and easily stagnate; stagnation leads to Qi blockage and Blood stasis; Liver disease inevitably harms Spleen/Stomach. Thus, secondary emphasis is on Spleen/Stomach. Others include: nourishing Blood deficiency, cooling Blood heat, unblocking Blood stasis, dispersing Qi stagnation, tonifying Qi weakness. For untreatable cases, he stated it directly. Truly a master of his generation, a clear mirror for gynecology. Students should regard this as a model. By referencing the *Neijing*, Zhang Zhongjing, and other sages' cases, one's learning will advance daily to the pinnacle. (Commentary by Qin Tianyi)

Xu's Commentary: Women's diseases, aside from menstrual and leukorrheal disorders, are treated similarly to men's. But menstrual and leukorrheal diseases belong entirely to the Chong and Ren vessels. Treating Chong and Ren relies entirely on nourishing Blood. Hence, ancient prescriptions always prioritized Blood-tonifying herbs. Most of this case analysis also prioritizes nourishing Blood, but fails to address the key variations. This is likely due to lacking specialized training in gynecology.