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1. Continuous dripping of menstrual blood is called "Lou" (Leukorrhea/Menorrhagia with prolonged duration), while sudden massive bleeding is called "Beng" (Metrorrhagia/Uterine hemorrhage). Purple-black clots with pain belong to Blood Stasis and Heat; long-standing cases are often due to damage to the Ren Mai (Conception Vessel) and Chong Mai (Penetrating Vessel). Spleen Qi deficiency fails to control blood, leading to sinking of Middle Qi; violent anger injures the Liver, causing blood to flow recklessly. In clinical practice, one must investigate the etiology and carefully differentiate between deficiency and excess. Deficiency is treated with tonification, stasis with resolution, and heat with clearing.

[Note] After menstruation, if bleeding continues in a dripping manner without cessation, it is named "Jing Lou" (Menstrual Leaking). If menstrual blood suddenly flows out massively without stopping, it is named "Jing Beng" (Menstrual Hemorrhage). If the color is purple-black forming clots, accompanied by distending pain in the abdomen and hypochondrium, it belongs to Blood Stasis and Heat. If it persists for a long time, or if there is excessive blood loss without clots or pain, it is mostly caused by injury to the Chong and Ren meridians. Furthermore, worry and overthinking injure the Spleen, where Spleen deficiency fails to hold blood; there are cases of Middle Qi sinking failing to consolidate blood; and cases of violent anger injuring the Liver, where the Liver fails to store blood, causing blood to flow recklessly. At the time of clinical examination, one must carefully examine the cause and distinguish meticulously. For deficiency, tonify; for stasis, resolve; for heat, clear. If the treatment is appropriate, recovery will naturally follow.

Jingqin Siwu Decoction
2. For Beng and Lou with excessive blood loss, use Jiao'ai Siwu Decoction; for cases with predominant heat, use Zhibai Siwu Decoction; for cases with slight heat, use Jingqin Siwu Decoction to harmonize. For Lou with scanty, obstructed flow, which belongs to Blood Stasis, use Siwu Decoction plus Xiangfu (Cyperus Rhizome), Taoren (Peach Kernel), and Honghua (Carthamus Flower) to break stasis. For initial Beng with distending pain, which belongs to Blood Coagulation, use Hupo San (Amber Powder) to attack and dispel. For long-standing Beng and Lou with Qi and Blood deficiency and injury to Chong and Ren, use Bazhen Tang (Eight Treasure Decoction), Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction), or Renshen Yangrong Tang (Ginseng Nourishing Vigor Decoction) to greatly tonify and nourish. If injured by overthinking affecting the Spleen, use Guipi Tang (Restore the Spleen Decoction); if injured by anger affecting the Liver, use Xiaoyao San (Free and Easy Wanderer Powder) plus fried Xiangfu and Qingpi (Aurantium Peel) to level the Liver.

[Note] For Beng and Lou with excessive blood loss, use Jiao'ai Siwu Decoction to tonify. If heat is predominant, use Zhibai Siwu Decoction to clear heat. If heat is slight, use Jingqin Siwu Decoction to harmonize. If leakage is scanty and obstructed, this belongs to Blood Stasis; use Siwu Decoction plus Xiangfu, Taoren, and Honghua to break stasis. If hemorrhage begins with distending pain, this belongs to Blood Coagulation; use Hupo San to attack. For long-standing Beng and Lou where Qi and Blood are already deficient and Chong and Ren are damaged, use Bazhen Tang, Shiquan Dabu Tang, or Renshen Yangrong Tang to tonify the damage according to circumstances. If the Spleen is injured by overthinking, use Guipi Tang to tonify. If the Liver is injured by rage, use Xiaoyao San plus fried Xiangfu and Qingpi to level.
(Jiao'ai Siwu Decoction, Siwu Decoction, Hupo San, Shiquan Dabu Tang, Renshen Yangrong Tang, Guipi Tang, Xiaoyao San - formulas are all found in the preceding Harmonizing Menstruation Collection of Formulas.)

Buzhong Yiqi Tang, Yiwei Shengyang Tang
3. For sinking Qi, use Buzhong Yiqi Tang to lift; [this formula consists of] Baoyuan Tang plus Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium). Yiwei Shengyang Tang is Buzhong Yiqi Tang plus Huangqin (Scutellariae Radix) and Shenqu (Massa Medicata Fermentata). If abdominal pain occurs, add Baishao (Paeoniae Radix Alba); if heat exists, use Huangqin; if no heat, use Rougui (Cinnamomi Cortex) to regulate. Cough indicates Lung Heat, so reduce the dosage of Renshen (Ginseng Radix).

[Note] For long-standing Beng and Lou, where the Spleen is injured and appetite is poor, Middle Qi sinks, and cannot carry blood upward, use Buzhong Yiqi Tang and Shengyang Yigang Tang to raise Yang. Buzhong Yiqi Tang... [Note: The original text simplifies the composition here, referring to previous context], essentially derived from Baoyuan Tang plus Shengma, Chaihu, Danggui, Baizhu, and Chenpi. Yiwei Shengyang Tang is Buzhong Yiqi Tang plus Huangqin and Shenqu. If there is abdominal pain, add Baishao; if there is heat, use Huangqin; if there is no heat, use Rougui for regulation. Cough is due to Lung Heat, so reduce Renshen.

Tiaojing Shengyang Chushi Tang
4. For bleeding mixed with water/watery diarrhea where constitution is not severely weak, use Tiaojing Shengyang Chushi Tang. This formula consists of Huangqi (Astragali Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shengma, Chaihu, Danggui, Cangzhu (Atractylodis Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Gaoben (Ligustici Rhizoma et Radix), Manjingzi (Vernoniae Fructus), and Fangfeng (Saposhnikoviae Radix). Use wind-dispelling herbs first to overcome dampness. If the constitution and Qi are weak, add Renshen and Chenpi, combining with Buzhong Yiqi Tang to tonify the Middle and overcome dampness.

[Note] For Beng and Lou with bloody discharge mixed with watery stool, or watery diarrhea once or twice a day, where the physical form and Qi are not severely weak, use Tiaojing Shengyang Chushi Tang. Its formula consists of Huangqi, Gancao, Shengma, Chaihu, Danggui, Cangzhu, Qianghuo, Duhuo, Gaoben, Manjingzi, and Fangfeng. Utilize wind-dispelling herbs to first overcome the dampness. If the physical form and Qi are weak, then add Renshen and Chenpi, combining with Buzhong Yiqi Tang to tonify the Middle and overcome dampness.

Shixiao San, Diyukujiu Jian
5. For "Sha Xue" (killing blood) with heart pain, use Shixiao San; composed of Puhuang (Lygodii Spora) and Wulingzhi (Trogopterori Faeces), it stabilizes pain. For unceasing Beng hemorrhage to prevent slipping/depletion, use Diyukujiu Jian (Diyu decocted in vinegar).

[Note] Severe heart and abdominal pain accompanying Beng hemorrhage is named "Sha Xue". Heart pain is due to stagnant blood not dispersing; use Shixiao San. Its formula consists of Puhuang and Wulingzhi. First stabilize the pain; after pain ceases, treat according to symptoms. If Beng hemorrhage continues despite tonification, one must guard against slipping/depletion; use one liang of Diyü (Sanguisorbae Radix), decocted in vinegar, exposed overnight, taken warm the next morning to stop bleeding immediately. After stopping, treat according to symptoms. This is named Diyukujiu Jian.