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14. Abdominal pain occurring after menstruation indicates deficiency of Qi and Blood; abdominal pain occurring before menstruation indicates stagnation of Qi and Blood. Qi stagnation primarily causes abdominal distension, while blood stasis primarily causes pain. One must further distinguish between cold and heat patterns, as well as deficiency and excess conditions.
[Note] Whenever abdominal pain occurs during the menstrual period, pain appearing after menstruation belongs to deficiency of Qi and Blood; pain appearing before menstruation belongs to stagnation of Qi and Blood. If it is due to Qi stagnation affecting blood, there will be more distension. If it is due to blood stasis affecting Qi, there will be more pain. One must carefully examine the cause of the distension and pain, and treat according to whether it is caused by deficiency, excess, cold, or heat.

15. Diarrhea during menstruation is due to Spleen deficiency; duck-like loose stools with cold pain indicate Cold-Dampness; weak Stomach function or injury from drinking water often leads to vomiting; dietary injury inevitably causes pain and vomiting of undigested food.
[Note] Diarrhea occurring during menstruation is caused by Spleen deficiency. If the stool is like "duck diarrhea" (thin and watery) accompanied by cold pain, this is a Cold-Dampness pattern. Vomiting during menstruation is due to weak Stomach Qi. If saliva and phlegm-fluids are vomited, it indicates injury from fluids (drinking). If food is vomited, it indicates dietary injury. However, those with dietary injury mostly experience pain and vomit food, whereas those with fluid injury do not experience pain but vomit saliva and fluids.

16. Retrograde menstruation leading to hematemesis or abnormal bleeding leading to metrorrhagia is caused by heat damaging the Yin and Yang collaterals, causing blood to move recklessly. If blood loss is excessive, heat leaves with the blood, so tonification should be the primary treatment. If blood volume is low but heat signs have not subsided, although the body is deficient, clearing heat should still be the primary treatment.
[Note] When women's menstrual blood flows retrogradely upward, manifesting as hematemesis or epistaxis, or flows abnormally downward manifesting as metrorrhagia, all are due to excessive heat. Damage to the Yin collaterals causes blood to flow downward resulting in metrorrhagia; damage to the Yang collaterals causes blood to flow upward resulting in hematemesis or epistaxis. If blood loss is excessive, heat dissipates along with the blood, and treatment should focus on tonification. If blood volume is scanty but heat has not yet diminished, despite the deficiency, treatment should still focus on clearing heat.

17. Excessive menstrual flow that is clear, thin, and pale indicates Qi deficiency failing to control blood; thick, sticky, and deep red blood indicates excess heat; accompanying leukorrhea with foul odor indicates Damp-Heat putrefaction; if the form is clear with a fishy odor, it results from Dampness, Blood Stasis, Cold, and Deficiency.
[Note] Menstrual flow that is excessive, clear, thin, and pale-red is due to Qi deficiency failing to hold the blood. If the blood is thick, sticky, and deep red, it indicates excess heat. If accompanied by red and white vaginal discharge before or after menstruation, with foul-smelling discharge at the time, this is due to Damp-Heat decomposition. If the form is clear with a fishy odor, it is transformed by Dampness, Blood Stasis, Cold, and Deficiency.