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Ye Xilin's *Zhang Fu* (Palm Manual) states: The transmission of medicine originates from Huangdi (Yellow Emperor) and Shennong (Divine Farmer). The beginning of gynecology starts with Bian Que. He served as a doctor for women's leukorrhea in Handan, as recorded by Sima Qian. Hua Tuo transmitted the *Chan Bao* (Precious Prescriptions for Childbirth), which includes the Yufeng San (Wind-Relieving Powder). Although pathological mechanisms are diverse, Chao Yuanfang's theoretical discussions are the most detailed, as they concern essential blood and essence. Chu Shizhong's (Chu Suiliang) surviving writings are also excellent. Conditions such as heat entering the Blood Chamber (Xue Shi), Zang Zao (Organ Dryness with sorrowful mood), and Yin Chui (vaginal flatulence caused by downward leakage of Stomach Qi) could only be distinguished by Zhang Zhongjing (the Grandee of Changsha). Regarding thirty-six types of gynecological diseases, and the miraculous pivot of transforming female to male, who else but Sun Simiao (the True Man) could achieve this? In the Tang Dynasty, Bai Minzhong visited Zan Yin, collected 378 verified prescriptions, and compiled them into *Chan Bao*. In the Song Dynasty, Guo Jizhong supplemented Li Shisheng of Puyang's twenty-one treatises on childbirth to create *Chan Fang*. Chen Ziming's compilation of *Da Quan* (Complete Works) holds the greatest merit; Xue Lizhai's contributions to *Yi An* (Medical Records) are substantial. Gao Bin engraved *Bian Chan Xu Zhi* (Necessary Knowledge for Easy Childbirth), and Du Ben authored *Chan Yu Bao Qing* (Precious Celebration of Childbearing). Zhu Danxi's *Bai Wen* (Hundred Questions) is worth transmitting, and Chen Wuyi's *San Yin* (Three Causes) should be read. Collecting all merits, Wang Yutai's *Nu Ke Zhun Sheng* (Standard for Gynecology) analyzes various formulas clearly, while Wu Shuqing's *Ji Yin Gang Mu* (Outline of Women's Medicine) has complete discussions on classics and methods, strictly inheriting family secrets. Dongyuan (Li Dongyuan) and Hejian (Liu Wansu) each have famous sayings; Chunfu Yangkui also has many profound meanings. All these books should be recited and studied; when treating clinically, one will naturally explore the profound mysteries. Learning requires thinking and discrimination; do not refuse to work ten times harder than others. From understanding one corner of tonifying, purging, cooling, and warming, one can infer the rest. When merit and practice are full, one may hope to reach Mount Qingcheng (immortality); if lazy for too long, one will grow old white-haired without achievement.

Li Dongyuan treated a woman over thirty years old. After every bath, she would splash cold water on her body. She had also suffered a great fright. Consequently, whenever her menstruation arrived, she experienced severe lower abdominal pain first, followed by vomiting saliva. After menstruation ceased, she vomited water for three days, and the pain doubled. It did not stop until six or seven days later when menstruation ended. Various medicines were ineffective. Her pulse was slippery, large, and wiry at the Cun (inch) position, and wiry, large, and urgent at the Guan (bar) and Chi (cubit) positions. The Chi position was smaller than Guan, and Guan smaller than Cun. This is what is called "large in front, small in back." He prescribed Xiang Fu (Cyperus Rhizome) 3 liang, Ban Xia (Pinellia Tuber) 2 liang, Fu Ling (Poria) and Huang Qin (Scutellaria Root) 1.5 liang each, Zhi Shi (Immature Bitter Orange), Yan Hu Suo (Corydalis Rhizome), Dan Pi (Moutan Cortex), Ren Shen (Ginseng Root), Dang Gui (Angelica Sinensis Root), Bai Zhu (Atractylodes Rhizome), and Tao Ren (Peach Seed) 1 liang each, Huang Lian (Coptis Rhizome) 7 qian, Chuan Lian Zi (Sichuan Chinaberry Seed), Yuan Zhi (Polygala Root), and Gan Cao (Licorice Root) 5 qian each, Gui Zhi (Cinnamon Twig) 3 qian, Wu Zhu Yu (Evodia Fruit) 1.5 qian. Divided into fifteen doses, taken hot with ginger juice (two clam shells). Afterwards, she bathed in hot water until slight sweating occurred. She was advised to avoid sitting or lying in drafts, letting hands and feet touch water, and eating raw/cold foods. After taking thirty doses, she was completely cured. Half a year later, due to fright and worry, the disease relapsed with occasional waist and abdominal pain, dysuria, and palpitations/fearfulness. Inferring that the exterior syndrome was resolved and the disease was solely in the interior, he first moxa-ed Shaochong (HT9), Laogong (PC8), Kunlun (BL60), and Sanyinjiao (SP6) to stop palpitations and pain. Then he used Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) to purge vigorously. After purging, he used Cu Xiang Fu (Vinegar-processed Cyperus) 3 liang, Cu Peng Zhu (Vinegar-processed Curcuma Zedoaria Rhizome) and Dang Gui Shen (Angelica Sinensis Root Head) 1.5 liang each, Cu San Leng (Vinegar-processed Burreed Tuber), Yan Hu Suo, Cu Da Huang (Vinegar-processed Rheum Rhizome), Cu Qing Pi (Vinegar-processed Tangerine Peel), Qing Mu Xiang (Aucklandiae Radix), Hui Xiang (Fennel Fruit), Hua Shi (Talcum), Mu Tong (Akebia Caulis), and Tao Ren 1 liang each, Wu Yao (Lindera Root), Gan Cao, Sha Ren (Amomum Fruit), Bing Lang (Areca Seed), and Ku Lian (Chinaberry Root Bark) 5 qian each, Mu Xiang (Costus Root) and Wu Zhu Yu 2 qian each. Divided into twenty doses, taken with fresh wet Niu Xi (Achyranthes Root) 2 qian and five slices of Sheng Jiang (Fresh Ginger), decocted in Lotus Leaf Soup. She was cured.

Yu Zhen commented: Illness caused by splashing cold water seems suitable for warming meridians and dispersing cold. Relapse due to fright and worry seems suitable for regulating qi and calming the spirit. Yet previously, cold herbs outweighed hot ones. Subsequently, moxa-ing heart, pericardium, bladder, and spleen acupoints stopped palpitations and pain. After pain stabilized, using Tao Ren Cheng Qi Tang to purge vigorously is very unusual legislation. Moreover, Ren Shen was used before but not after, and after vigorous purging, twenty doses of San Leng, E Zhu, Tao Ren, Da Huang, Qing Pi, Bing Lang, etc., were used. It is like a grandmaster playing chess, unimaginable. This is indeed beyond the reach of physicians in the late Ming and early Qing dynasties.

Zhu Danxi treated a forty-eight-year-old woman. She had leukorrhea, thirst, heavy menstruation. Initially, the blood was black, later pale. She felt fatigued with poor appetite and tightness above the umbilicus. He prescribed Bai Zhu (Atractylodes Macrocephala Rhizome) 1.5 qian, Hong Hua (Carthamus Flower), Chen Pi (Tangerine Peel) the size of a bean, Bai Shao (White Peony Root) 1 qian each, Mu Tong (Akebia Caulis), Zhi Ke (Bitter Orange) 0.5 qian each, Huang Qin (Scutellaria Root), Sha Ren (Amomum Fruit), Zhi Gan Cao (Prepared Licorice Root) 0.3 qian each. Decocted in soup to take with Bao He Wan (Preserve Harmony Pill) 30 pills and Yi Qing Wan (Suppress Green Pill) 30 pills.

Yu Zhen commented: Black blood initially, pale later indicates root deficiency with branch heat. Heavy flow plus fatigue and poor appetite clearly shows deficiency. Why no tonics? Referring to the case of the fifteen-year-old girl below, this treatment method seems imperfect. Perhaps her pulse was wiry, large, and rapid? The following two cases, one like yellow paste, one like black bean juice, were formulated very appropriately.

A woman had pale menstrual blood like yellow paste, with stomach and abdomen discomfort (tsao za). This was due to Spleen-Stomach damp-phlegm. Er Chen Tang (Two-Cured Decoction) combined with Si Wu Tang (Four Substance Decoction), added with Xi Xin (Asarum Root) and Cang Zhu (Atractylodes Rhizome). A few doses stopped it.

A woman had menstrual blood flowing like black bean juice. This was wind-heat in the collaterals. Si Wu Tang added with Huang Qin, Huang Lian (Coptis Rhizome), Jing Jie Sui (Schizonepeta Spike), and Man Jing Zi (Vernonia Fruit). A few doses cleared the blood and changed the color.

A fifteen-year-old girl had a wiry and large pulse, not rapid. She was obese, fatigued in early summer, with heavy menstruation. This was weak constitution and insufficient Qi failing to control blood. Bai Zhu 1.5 qian, Sheng Huang Qi (Raw Astragalus Root), Chen Pi 1 qian each, Ren Shen 5 qian, Chao Huang Bo (Stir-fried Phellodendron Bark) 0.3 qian.

A woman over forty had irregular menstruation, abdominal pain during flow, and dripping discharge for three to four days after flow, consisting of foul fluid. She had thirst, sallow complexion, fatigue, and weakness. Bai Zhu 1 liang, Dang Gui Shen Wei (Angelica Root Head and Tail), Chen Pi 0.7 liang each, Huang Lian 3 qian, Mu Tong 2 qian, Sheng Huang Qi, Huang Qin 2 qian each, Zhi Gan Cao 1 qian. Divided into eight doses, taken with Wu Ling Zhi Wan (Trogopterus Dung Pill) 40 pills before meals.

Yu Zhen commented: In this case, Bai Zhu, Huang Lian, Dang Gui Shen, and Dang Gui Wei were used best. Huang Qi and Huang Qin were too light; the use of Wu Ling Zhi Pill was good.

A woman in her twenties was obese, with chest fullness and anorexia. She lay down until Wei hour (1-3 PM), drank a bowl of thin porridge, then vomited half a bowl of water, and continued lying down. Menstruation had stopped for three months. Previous flow was black. At Chen hour (7-9 AM), Cun and Guan pulses were slippery and forceful; at afternoon, Guan was slippery, Cun was not. Inquiry revealed it resulted from eating while angry. Bai Zhu 1.5 liang, Hou Po (Magnolia Bark), Huang Lian, Zhi Shi 1 liang each, Ban Xia, Fu Ling, Chen Pi, Shan Zha (Hawthorn Fruit), Ren Shen, Hua Shi 0.8 liang each, Sha Ren, Xiang Fu, Tao Ren 0.5 liang each, Hong Hua 2 qian. Divided into ten doses, one dose daily, each with ginger juice (two clam shells). Every three days, slightly purge with Shen You Wan (Divine Protection Pill) and Shen Mi Chen Xiang Wan (Mysterious Musk Agarwood Pill). By the twelfth day, vomiting stopped, diet gradually increased, and by the fortieth day, she recovered fully.

Yu Zhen commented: Vomiting half a bowl of water after one bowl of porridge, unable to rise, almost mistaken for severe deficiency. The differentiation lies in chest fullness and previous black menstrual blood. This is internal fire and food stagnation,郁结 (stagnating) into damp-heat. Upper: fluid retention; Lower: blood stasis. Excess syndrome resembling deficiency. Slippery and forceful Cun/Guan at Chen hour: Chen is when Qi and Blood enter the Stomach; Stomach fullness extends to Upper Jiao. Afternoon only Guan slippery shows Stomach excess. The formula mainly eliminates phlegm, food, breaks Qi, and invigorates blood, adding Huang Lian and Hua Shi to clear damp-heat, still combining Ren Shen to boost Stomach Qi so drugs can circulate. Ginger juice opens pathways and treats vomiting. This is a disciplined army, undefeated. However, there was concern that the disease was deep and medicine shallow. Purging lightly every three days strikes the enemy's nest, uprooting the disease.

Lu Cangzhou treated an unmarried girl with amenorrhea. Physicians could not diagnose her. Her abdomen was large as if pregnant. Her complexion and pulse were strange. He said, "Your illness is not from strange dreams, but possessed by spirits." She did not answer, went to her room, and whispered to her maid, "Last summer I cooled off under a temple corridor. At dusk, passing the Wood God shrine, my heart moved. That night I dreamed of a man like the one I saw at dusk, who intimately approached me in my bedroom. Thus I became ill. I am ashamed to tell anyone. The doctor is right." The maid told Lu. Lu said, "Her face turns red and white alternately due to shame. Pulse changes large and small due to spiritual influence. The cause matches complexion and pulse. Though severe, it causes no suffering." He used Tao Ren Jian (Peach Kernel Decoction) to expel blood clots resembling pig liver, about six or seven pieces, each with holes like fish eyes. The disease was cured.

Yu Zhen commented: This is Ghost Fetus (Gui Tai), easy to identify. Only saying "cause matches pulse/complexion, though severe, no suffering" is a secret technique. Tao Ren Jian is harsh, but necessary to cure this disease.

Yu Zirong treated a widow whose depression formed illness, stopping menstruation. Her body felt hot as if roasting. Suddenly she vomited blood like a spring. Doctors used hemostatics without effect. They switched to grinding fresh Mao Gen Cao (Imperata Rhizome) juice, thickly ground Chen Xiang (Agarwood), taken up to 5 qian. Daily, strong vinegar was stored in a bottle, heated on fire, and the vapor inhaled through both nostrils. Blood then descended, vomiting stopped, and menstruation resumed.

Yu Zhen commented: This is Reverse Menstruation (Dao Jing). Descending Qi makes blood descend. Mao Gen juice is excellent. Especially clever is steaming nose with hot vinegar. If menstruation reverses, life is possible; if menstruation dries up, death is certain.

Shi Shan treated a thin woman in her twenties. Menstrual blood was purple, early or late. Abdominal pain before flow, aversion to cold, preference for warmth. Sometimes catching cold causes abdominal pain. Pulse was fine, soggy, near slippery. Both Chi positions slightly large and slippery upon heavy pressure. Wang Ji said, "Blood heat." Some asked, "How can it be heat with such aversion to cold?" Answered, "Extreme heat resembles cold." He used wine-boiled Huang Lian 4 liang, Xiang Fu, Dang Gui Shen Wei 2 liang each, Wu Ling Zhi 1 liang, powdered, made into pills with congee, taken on empty stomach. Cured.

Yu Zhen commented: Pulse fine/soggy/near slippery, Chi slightly large/slippery without rapidity, hard to recognize as major heat. Yet heavy Huang Lian cured it. Master Wang truly has mastery over his fingers.

A twenty-one-year-old woman in June had menstrual pain like scraping, unbearable. Pulse was fine, soft, and rapid. Chi was deep, weak, and near rapid. Wang Ji said, "Fine/soft indicates dampness, rapid indicates heat, deep Chi indicates stagnation." Wine-boiled Huang Lian 8 liang, stir-fried Xiang Fu 6 liang, Wu Ling Zhi (half fried, half raw) 3 liang, Dang Gui Shen Wei 2 liang, powdered, pill with congee, taken on empty stomach with warm water, 3-4 qian. After 5-6 courses, nine years later, she bore a son. Four years later, menstruation lasted two months continuously with mild abdominal pain, cured by previous pills. Later, menstruation lasted 6-7 days, then clear fluid flowed with mild pain, cured again. Then menstruation lasted only 7-8 days. When flow came, sometimes heavy for 5-6 days, then intermittent, slightly red or pale red, often followed by clear fluid. Severe lower abdominal pain radiating to whole body, chest, back, waist, legs, bones all hurt, from Si hour to You hour. Pain caused whole-body cold/heat, profuse sweating, pain relieved by sweat, yet able to eat. Over fifteen years, previous pills worked repeatedly, now ineffective. Why? Wang re-examined: Pulse all large, slippery, and powerless. Fortunately, she still had spirit. Wang said, "This is different from before. Previously depression-heat, now deficiency-cold. Dongyuan said: 'Starts as Heat Middle, ends as Cold Middle.' Classic says: 'Pulse follows but does not drum when pressed, indicating Yin excess repelling Yang,' treat as cold. Also, originally thin/small, now fat/large. Medical books say: 'Thin people have blood heat, fat people have Qi deficiency.' How can same treatment apply? Worrisome is profuse sweating/pulse not declining, massive bleeding/pulse not decreasing. Pain heavier by day/lighter by night indicates Yang deficiency failing to transport, causing stagnation pain. Combining symptom and pulse, tonify Yang. If pulse decreases and pain lightens, it is auspicious." He prescribed large dose of Ren Shen, Huang Qi, Dang Gui, Bai Zhu, added Gui Zhi and Fu Zi. One dose, re-examined next morning, pulse calmed. After 20-30 doses, in February, cured by May. Disease changes from heat to cold; medicine usage differs; body types vary. One formula cannot treat all.

Yu Zhen commented: Fine/soft/rapid is damp-heat; Large/slippowerless is deficiency-cold. Key to pulse diagnosis. Wang's postscript is crucial for treatment. However, previous Huang Lian was excessive; long-term use without change is inadvisable.

A woman always had diarrhea for three days before menstruation. Pulse was soggy and weak. "Spleen deficiency. Spleen governs blood and dampness. Before menstruation moves, Spleen blood flows to Sea of Blood, then downflows as menses. Spleen blood deficient, fails to transport dampness." Made Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Powder), 2 qian per dose, mixed with rice drink 2-3 times daily. Over a month, menstruation stopped accompanying diarrhea.

A woman over forty, tall and frail, irregular menstruation. Right pulse floating, soft, large; Left pulse deficient, soft, small, near rapid. Usually diarrhea before menstruation. April: caught wind cough, bathed with herbal soup, sweated heavily, diarrhea for one month. June: bathed again, malaria 6-7 times. Malaria stopped but mind unclear. End of August: heavy menstruation, leukorrhea, diarrhea, right foot pain. Old ankle sprain pain extended to buttocks, legs, waist, ribs, sacrum, calf, neck, left tendons pulling pain. Coughing caused waist pain like knife stabbing. Lighter by day, heavier by night, crying out. Fortunately pain subsided slightly, diet normal. Heavy menstruation, leukorrhea, day-light/night-heavy diarrhea suggests Lower Loss leading to Yin exhaustion, treat as Blood deficiency. But Si Wu Tang (Four Substance Decoction) for pain worsened it. September, Wang re-examined, realized this fits Zhongjing's principle "Yang generates, Yin grows." Heavy menstruation, leukorrhea, diarrhea all due to Yang deficiency sinking. Day-light/night-heavy: Day Yang strong, transports well, blood not stagnant, lighter by day. Night Yin strong, Yang fails to transport, blood stagnates, heavier by night. Used Ren Shen and Bai Zhu to tonify Yang, 6-7 doses, pain decreased. This is a variation of disease/treatment, recorded thus.

Yu Zhen commented: Previous case logic easy to understand, this case pulse easily seen as deficiency. Near rapid plus leg pain resembles damp-heat. But chronic diarrhea/malaria/heavy menses/leukorrhea clearly suits Ren/Bai Zhu. Why call treatment unusual?

A woman over forty, solid appearance, often difficult breech birth, irregular menstruation, occasional whole-body joint pain, poor appetite, fatigue, spontaneous sweating. Wang diagnosed: Both hands pulse non-responsive, but Right Guan faintly moving upon light pressure. Suspected pulse out of position, checked Jing Qu and Lie Que acupoints, still non-responsive, very strange. Asked husband: "During pregnancy, doctors said no pulse. Took Ba Wu Tang (Eight Substance Decoction), luckily easy birth, got one son." Wang said, "Constitutional non-responsive pulse, nothing strange. World events infinite, hard to measure by common rules. Mai Jing says only describes norms. No pulse in both hands doesn't harm life or pregnancy. Can Mai Jing cover all?"

Yu Zhen commented: Many have one hand no pulse, few have both. This is likely meridian constriction in womb/swaddling, not disease. Shi Shan diagnosed another woman with no Left pulse, moving at Yang Xi/Pian Li points, i.e., Reversed Guan Pulse (Fan Guan Mai). Wang said, "Left pulse out of position, disease hard to know by pulse." Indeed Fan Guan usually large/sliding, extendable, insufficient for diagnosis. Zhu Danxi treated a woman with chronic malaria, poor appetite, amenorrhea, no pulse in both hands. Gave San Hua Shen You Wan (Three-Flower Divine Protection Pill) 10+ pills daily, swallowed with saliva. Over a month, appetite returned, pulse appeared. Half month later pulse healthy, one month later menstruation started. This is disease-caused no pulse, not congenital.

A woman postpartum had continuous menstruation, red/white/pale, over eight months. Sallow-white face, irritable, dizzy, weak legs. Doctors used Ren Shen tonics, condition worsened. Astringents ineffective. Wang diagnosed: Right pulse soggy/weak/powerless, Left slightly large/rapid. "Right weakness not disease, Left excess makes Right seem weak. Focus on Left, treat with Cooling Blood agents." Sheng Di (Rehmannia Root), Bai Shao, Bai Zhu 1 qian each, Huang Qin, E Jiao (Donkey-hide Gelatin), Dang Gui 0.8 fen each, Chen Pi, Xiang Fu, Chuan Xiong (Sichuan Lovage Rhizome), Chun Gen Pi (Toona Bark), Fu Ling 0.6 fen each, Chai Hu (Bupleurum Root), Gan Cao 0.5 fen each. Decocted, 20+ doses cured.

Yu Zhen commented: Right pulse weak, Wang focused on Left excess, different selection. Said "Right weakness not disease," meaning pale/dripping menses, sallow face/dizziness/weak legs not caused by Right weakness. Wang likely because Ren/Shen worsened condition, Right pulse unreliable, usually focuses on Left with Cooling Blood agents.

Also treated a woman over thirty, childless. Wang diagnosed: Pulse nearly harmonious, Chi large/slippery. "Uterine heat, Blood Sea unstable." Husband confirmed: "Menstruation comes immediately after intercourse." Prescribed Danxi Da Bu Wan (Danxi Great Tonification Pill) added Shan Zhu Yu (Cornus Fruit), Bai Long Gu (Fossilized Bone) to astringe internally. External: Hair ash, Bai Fan (Alum), Huang Lian, Wu Bei Zi (Gallnut) powdered, applied to private parts. Cured and conceived.

Xue Lizhai treated a woman bleeding and painful during intercourse. Applied/took Cooling Blood/Pain-relieving agents, frequent heavy bleeding. Liver injured failing to store blood, Spleen injured failing to control blood. Bu Zhong Yi Qi Tang (Tonify Middle Augment Qi Decoction) and Gui Pi Tang (Restore the Spleen Decoction) cured. Externally: Hair ash, green cloth, burnt to ash, applied.

Another relative similar symptoms. Pulse both Chi deep/slow/choppy. Tonify Blood/Disperse Cold agents failed. Checked Qian Jin Fang (Thousand Golden Prescriptions), used She Chuang Zi San (Cnidarius Powder) wrapped in silk, inserted twice. Cured.

Yu Zhen commented: Three cases, same disease, different treatments. Disease judged by pulse. First case no pulse recorded, but Cooling agents failed, so Tonification was only option. Understood by intuition.

Another woman delayed menstruation, fever, fatigue. Used Si Wu, Huang Lian, etc.,反而 (instead) menstruated once every two months, scanty/clotted. Used harsh purgatives, eyes covered like silk. Xue said, "Spleen is head of all Yin, Eyes are gathering of blood vessels. Spleen injured, Five Organs lose their place, cannot return to eyes." Used Bu Zhong Yi Qi and Ji Sheng Gui Pi Decoctions, focusing on Spleen/Stomach. Cured in over a year.

Yu Zhen commented: This case has heavenly insight. Not tonifying Spleen/Stomach but using Blood/Cooling drugs for eyes would lead to death soon.

A forty-year-old woman, labor caused heel heat/pain. Xue identified extreme Yin-Blood deficiency, urgently used Sheng Yu Tang (Holy Rescue Decoction), cured. Later whole-body itching, mistakenly took Wind-dispelling drugs, fever, convulsions, Liver pulse large/rapid. Liver Blood deficiency with Fire excess generating Wind. Tian Zhu Dan Xing (Buddha's Hand Star) pills, taken with Si Wu, Mai Dong (Ophiopogon Root), Wu Wei Zi (Schisandra Berry), Qin, Lian, Zhi Gan Cao, Shan Zhi Zi (Gardenia Fruit), Chai Hu decoction. Cured.