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Women who experience sudden abdominal pain and hematemesis one or two days before the onset of menstruation are often thought by others to be caused by extreme heat-fire. However, who would know that this is actually due to the rebellion of Liver Qi! The nature of the Liver is most urgent and rigid; it should be guided smoothly rather than opposed. When smooth, Qi remains tranquil; when rebellious, Qi becomes agitated. Blood follows Qi in its movement and cessation: when Qi is tranquil, blood is tranquil; when Qi is agitated, blood moves recklessly. One need not be surprised by this phenomenon. Some might ask: If menstrual blood rebels in the Kidney rather than the Liver, why does it follow the blood's reckless flow and emerge from the mouth? Is this because the Liver fails to store blood? Or is it because the Kidney fails to grasp Qi? In fact, the fire of Shaoyin (Kidney) rushes like a galloping horse. When it receives the direct upward rush of Liver Fire, its momentum is extremely swift, causing menstrual blood to transform into hematemesis with great ease. It is not necessary for the Liver to fail in storing blood to cause hematemesis. However, this type of hematemesis differs from that caused by other meridians. Generally, hematemesis from various meridians results from internal injury, whereas hematemesis due to menstrual rebellion is caused by the overflow and agitation of menstrual blood internally. Although the symptoms are vastly different, the underlying mechanism of Qi rebellion is the same. The treatment method seems to favor calming the Liver to smooth Qi, rather than tonifying essence to nourish the Kidney. Nevertheless, although menstrual rebellion leading to hematemesis does not severely deplete blood, the recurrent episodes inevitably damage Kidney Qi significantly. Therefore, it is appropriate to employ methods to smooth Qi within the context of tonifying the Kidney.

The formula used is Shunjing Tang (Smooth Menstruation Decoction).
Danggui (Radix Angelicae Sinensis, 5 qian, washed with wine), Dushudi (Radix Rehmanniae Preparata, 5 qian, steamed nine times), Baishao (Radix Paeoniae Alba, 2 qian, stir-fried with wine), Danpi (Cortex Moutan, 5 qian), Bai Fuling (Poria, 3 qian), Shashen (Radix Glehniae, 3 qian), Hei Jiesui (Fructus Schisandrae Carbonized, 3 qian).
Decoct in water and take orally. After one dose, hematemesis stops; after two doses, menstruation becomes regular; after ten doses, it will not recur. This formula employs herbs that guide blood back to its vessels within the context of tonifying the Kidney and regulating menstruation. This is a method of harmonizing blood, which actually embodies the principle of smoothing Qi. When Liver Qi does not rebel, Kidney Qi naturally flows smoothly. Once Kidney Qi is smooth, how can menstrual rebellion occur?

Marginal Note: Hematemesis in young women occurs frequently and should not be treated as a consumptive disease (Lao Zheng). If treated as such, Liver Qi will become even more rebellious, turning a non-consumptive condition into a consumptive one. Adding Qiancao (Radix Rubiae, 1 qian) and Huainiu Xi (Radix Achyranthis Bidentatae, 8 fen) to the formula is particularly effective.

Verse:
Abdominal pain and bloody vomit before menses,
Mistaking it for heat-fire is absurd.
Liver Qi stagnates, menstruation rebels upward,
Treatment should smooth Qi and tonify Kidney.
Shunjing uses Danggui and Shudi,
Baishao, Danpi, Fuling, Shashen, and Jiesui aid.
One dose stops vomiting, two regulate menses,
Ten doses taken continuously ensure lasting health.