妇人有经水过多，行后复行，面色萎黄，身体倦怠，而困乏愈甚者，人以为血热有余之故，谁知是血虚而不归
经乎！夫血旺始经多，血虚当经缩。今日血虚而反经多，是何言与？殊不知血归于经，虽旺而经亦不多；血不归经，
虽衰而经亦不少，世之人见经水过多，谓是血之旺也，此治之所以多错耳。倘经多果是血旺，自是健壮之体，须当
一行即止，精力如常，何至一行后而再行，而困乏无力耶！惟经多是血之虚，故再行而不胜其困乏，血损精散，骨中
髓空，所以不能色华于面也。治法宜大补血而引之归经，又安有行后复行之病哉！
方用加减四物汤。
大熟地（一两，九蒸） 白芍（三钱，酒炒） 当归（五钱，酒洗） 川芎（二钱，酒洗） 白术（五钱，土炒）
黑芥穗（三钱） 山萸（三钱，蒸） 续断（一钱） 甘草（一钱）
水煎服。四剂而血归经矣。十剂之后，加人参三钱，再服十剂，下月行经，适可而止矣。夫四物汤乃补血之神
品，加白术、荆芥，补中有利；加山萸、续断，止中有行；加甘草以调和诸品，使之各得其宜，所以血足而归经，归
经而血自静矣。
眉批∶荆芥穗炭能引血归经。方妙极不可轻易加减。
歌括∶经水过多行复行，面黄体倦色不荣。
病非血热有余故，血不归经此病生。
加减四物地芍并，归芎白术与黑荆。
山萸续断生甘草，数服血自归经程。
Women presenting with menorrhagia (excessive menstrual flow), where bleeding recurs after the period has seemingly ended, accompanied by a sallow complexion and physical fatigue that progressively worsens, are often mistakenly attributed to excess blood-heat. However, this is actually due to blood deficiency failing to return to the vessels! When blood is abundant, menstrual flow is heavy; when blood is deficient, menstrual flow should be scant. How can it be that blood deficiency results in excessive flow? It must be understood that if blood returns to the vessels, even an abundance of blood will not result in heavy menstruation; conversely, if blood fails to return to the vessels, even a deficiency of blood will not result in light menstruation. The common observation that heavy menstruation indicates blood abundance is the primary reason for therapeutic errors. If heavy menstruation were truly due to blood abundance, the patient would necessarily be robust, with bleeding stopping after one episode and energy levels remaining normal. Why would there be recurrent bleeding followed by exhaustion and weakness? Only blood deficiency causes heavy menstruation, leading to an inability to withstand the fatigue of recurrent bleeding. As blood is depleted and essence scatters, bone marrow becomes empty, resulting in a lack of luster on the face. The treatment method should involve significantly tonifying blood and guiding it back into the vessels, thereby eliminating the condition of recurrent bleeding.
The formula used is Modified Siwu Decoction (Four Substance Decoction).
Prepared Rehmannia Root (Shu Di Huang) [Rehmanniae Radix Praeparata] (1 liang, steamed nine times); White Peony Root (Bai Shao) [Paeoniae Radix Alba] (3 qian, stir-fried with wine); Angelica Sinensis Root (Dang Gui) [Angelicae Sinensis Radix] (5 qian, washed with wine); Szechuan Lovage Rhizome (Chuan Xiong) [Ligustici Chuanxiong Rhizoma] (2 qian, washed with wine); Atractylodes Macrocephala Rhizome (Bai Zhu) [Atractylodis Macrocephalae Rhizoma] (5 qian, stir-fried with soil); Charred Schizonepeta Spike (Hei Jie Sui) [Schizonepetae Spica] (3 qian); Cornus Fruit (Shan Yu Rou) [Corni Fructus] (3 qian, steamed); Dipsacus Root (Xu Duan) [Dipsaci Radix] (1 qian); Licorice Root (Gan Cao) [Glycyrrhizae Radix et Rhizoma] (1 qian).
Decoct in water and take orally. After four doses, blood will return to the vessels. After ten doses, add Ginseng Root (Ren Shen) [Panacis Ginseng Radix] (3 qian) and continue for another ten doses. By the next month's menstruation, stop taking the medicine once appropriate. Siwu Decoction is a divine preparation for tonifying blood. Adding Bai Zhu and Jing Jie provides benefit within tonification; adding Shan Yu Rou and Xu Duan provides movement within hemostasis; adding Gan Cao harmonizes the ingredients, allowing each to function appropriately. Thus, blood becomes sufficient and returns to the vessels, and once returned, blood naturally calms.
Marginal Note: Charred Schizonepeta Spike (Jing Jie Sui Tan) can guide blood back into the vessels. This formula is extremely ingenious and should not be altered lightly.
Rhyme Verse:
Menstrual flow excessive, recurring again and again,
Sallow face, body tired, luster lacking.
This disease is not caused by excess blood-heat,
But by blood failing to return to the vessels.
Modified Siwu uses Di Huang, Shao Yao, Dang Gui, Chuan Xiong, Bai Zhu, and Charred Jing Jie.
Add Shan Yu Rou, Xu Duan, and raw Gan Cao,
After several doses, blood naturally returns to its course.