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Women whose menstruation arrives late and in large amounts are often considered to have Blood Deficiency. However, it is not necessarily Blood Deficiency! The quantity of late-arriving menstruation varies significantly and cannot be generalized.

When menstruation arrives late and is scanty, it indicates Cold-Blood Deficiency; when it arrives late but is abundant, it indicates Cold-Blood Excess. The source of menstruation lies in the Kidney, while blood from the Zang-Fu organs flows into it. Thus, during menstruation, blood from all meridities gathers to supplement it. Because the menstrual flow opens the "gate" without allowing for rapid closure, blood from other meridities escapes through the gaps. Once this blood is lost, a state of deficiency ensues. The treatment principle should involve tonification combined with warming and dispersing methods. One must not assume that all cases of late menstruation are due to deficiency alone.

Prescribe Warming Meridians and Astringing Blood Decoction (Wen Jing She Xue Tang):
Rehmanniae Radix Preparata (Shu Di Huang) 30g, prepared by steaming nine times; Paeoniae Radix Alba (Bai Shao) 30g, stir-fried with wine; Chuanxiong Rhizoma (Chuan Xiong) 15g, washed with wine; Atractylodis Macrocephalae Rhizoma (Bai Zhu) 15g, stir-fried with earth; Bupleuri Radix (Chai Hu) 1.5g; Schisandrae Fructus (Wu Wei Zi) 0.9g; Dipsaci Radix (Xu Duan) 3g; Cinnamomi Cortex (Rou Gui) 1.5g, remove coarse bark and grind.
Decoct in water and take orally. After three doses, the menstruation will regulate. This formula greatly tonifies the Essence and Blood of the Liver, Kidney, and Spleen. Rou Gui dispels Cold, and Chai Hu resolves stagnation. It embodies tonification with dispersion, ensuring dispersion does not consume Qi; and tonification with draining, ensuring draining does not damage Yin. Thus, tonification is beneficial, and warming achieves success. It is a miraculous medicine for regulating menstruation and an elixir for astringing blood. It is suitable for all cases of late menstruation. If Yuan Qi (Original Qi) is insufficient, add Ren Shen (Ginseng Root) 3–6g.

Verse:
Late menstruation stems from Cold-Blood; distinguish by volume.
Scanty indicates Deficiency, abundant indicates Excess; treat with tonification and warming dispersion.
Wen Jing She Xue uses Rou Gui, Bai Zhu, Chuan Xiong, and Wu Wei Zi.
Add Chai Hu, Xu Duan, and Shu Di Huang; add Ren Shen to tonify deficient Original Qi.

Women experiencing irregular, intermittent menstruation, arriving either early or late without a fixed schedule, are often diagnosed with Qi and Blood Deficiency. In reality, this is due to Liver Qi Stagnation! Menstruation originates from the Kidney, and the Liver is the "child" organ of the Kidney. When Liver Qi stagnates, Kidney Qi also stagnates. Kidney Qi stagnation leads to obstructed Qi mechanism, causing the intermittency or irregularity of menstruation—this reflects the Kidney's obstruction or patency. Some argue that Liver Qi stagnation does not necessarily affect Kidney Qi to such a degree. However, one must understand the interdependence of mother and child organs: if the child is diseased, the mother feels concern; if Liver Qi is stagnant, Kidney Qi remains attached. The opening and closing of Liver Qi correspond to the retention and departure of Kidney Qi, leading to these symptoms causally. Therefore, there is no doubt about this connection. The treatment method should soothe Liver Qi stagnation, which simultaneously resolves Kidney Qi stagnation. Once the stagnation in both Liver and Kidney is resolved, menstruation will naturally return to its regular cycle.

Prescribe Ding Jing Decoction (Ding Jing Tang):
Cuscutae Semen (Tu Si Zi) 30g, stir-fried with wine; Paeoniae Radix Alba (Bai Shao) 30g, stir-fried with wine; Angelicae Sinensis Radix (Dang Gui) 30g, washed with wine; Rehmanniae Radix Preparata (Shu Di Huang) 15g, prepared by steaming nine times; Dioscoreae Rhizoma (Shan Yao) 15g, stir-fried; Poria (Fu Ling) 9g; Schizonepetae Spica (Jing Jie Sui); Bupleuri Radix (Chai Hu) 1.5g.
Decoct in water and take orally. After two doses, menstruation ceases; after four doses, the cycle becomes regular. This formula soothes the Qi of the Liver and Kidney; it is not a drug for unblocking menstruation. It tonifies the Essence of the Liver and Kidney; it is not a diuretic. When Liver and Kidney Qi are soothed, menstruation flows freely; when Liver and Kidney Essence is robust, fluid metabolism improves. This approach of "treating by not directly treating" is truly superior to conventional treatment.

Marginal Note: The above three discussions on regulating menstruation are clear, and the prescriptions are subtle. However, clinical efficacy may be compromised by external pathogens or internal injuries. For external pathogenic invasion, add Perillae Folium (Su Ye) 3g. For internal injury to digestion, add Massae Medicata Fermentata (Shen Qu) 6g (stir-fried). For food stagnation from meat consumption, additionally add Crataegi Fructus (Shan Zha) 6g (stir-fried). Use according to clinical judgment. If Liver Qi depression is severe, use Xiao Yao San as the primary formula; for heat signs, add Gardeniae Fructus Carbonis (Zhi Zi Tan) and Moutan Cortex (Dan Pi), forming Modified Xiao Yao San.

Verse:
Irregular early and late menstruation; do not doubt Liver Meridian Stagnation.
Treatment should soothe Liver Qi; once the child organ opens, the mother follows.
Ding Jing Tang contains Tu Si Zi, Bai Shao, Dang Gui, and Shu Di Huang.
With Fu Ling, Shan Yao, Chai Hu, and Jing Jie, several doses will prevent delayed cycles.