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Menstruation flows incessantly. This is due to heat in the blood level (Xue Fen). The Spleen Qi is still deficient. Use Xiaoyao San (Free and Easy Wanderer Powder) with doubled doses of Baizhu (Atractylodis Rhizoma), Fuling (Poria), and Chenpi (Citri Reticulatae Pericarpium). Concurrently administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Jiu Chao Shaoyao (Wine-fried Paeoniae Radix Alba). Both taken together, the condition resolved.

A woman suffered from irregular menstruation, afternoon fever (Bure Re), internal heat, reduced appetite, emaciation, frequent urination. After taking Ji Yin Wan (Nourish Yin Pill), her menstruation ceased. She developed edema of the four limbs and urinary retention. I said, "This is a disorder of the Blood Level." In the morning, use Jiaoren Wan (Pepper Kernel Pill); in the evening, use Guipi Tang (Restore the Spleen Decoction). Gradually improved. Later, replace Jiaoren Ren with Renshen Wan (Ginseng Pill). After more than two months, nearly cured. Specifically using Guipi Tang for over fifty doses resulted in full recovery.

Another woman had irregular menstruation and scanty urine. Someone used clearing-heat and separating-turbidity agents, leading to difficult urination. After more than three months, she developed generalized and facial edema and amenorrhea. I said, "This is a disorder of the Water Level." Thus, in the morning use Tingli Wan (Descurainiae Semen Pill); in the evening, Guipi Tang. Gradually improved. Then use Renshen Wan intermittently until cured. Regarding the above two cases, many have died from using diuretic agents for Spleen deficiency with water qi accumulation.

Yu Zhen's commentary: Xue Lizhai was skilled in warm tonification. Aggressive draining methods were not his strength. In these three cases, the first reflects his characteristic style. The latter two fully follow the treatment methods of Chen's Liang Fang. The Jiaoren Wan contains harsh and toxic substances such as Yuanhua (Kadupul Flower), Qingdai (Indigo Naturalis), Banmao (Mylabris), and Xinbi (Arsenic Trioxide). He boldly used them. Although assisted by Guipi Tang, the toxicity was potent and highly risky. Even Tingli Wan and Renshen Wan are not mild formulas. Yet both illnesses were cured. It is like a famous general who knows when to attack or defend, use unorthodox or orthodox tactics, always holding the winning strategy, navigating danger as if it were flat ground.

A woman suffered from internal heat and thirst, reduced appetite. Near the left side of her abdomen, a mass initially like an egg gradually grew to about four cun. Menstruation occurred once every three months. Her limbs were emaciated, and her teeth and cheeks resembled sores. The pulse was surging, rapid, and deficient, especially at the Left Guan position. This is a pattern of Liver and Spleen Qi stagnation and knotting. Apply Awei Gao (Asafoetida Plaster) externally. In the forenoon, use Buzhong Yiqi Tang; in the afternoon, Jiawei Guipi Tang (Modified Restore the Spleen Decoction). After about two months, Liver fire slightly subsided, and Spleen Earth slightly strengthened. Continue with the previous decoction to deliver Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). In the afternoon, use Xiaoyao San to deliver Guipi Wan. Another month later, daily use Lulu Wan (Aloe Pill) made of Dagongcao (Terminalia Chebula Retusa Fruit), Qingdai, Lulu (Aloe), Zhusha (Cinnabar), and Shexiang (Moschus), each one qian. Separately, dry Bu (Toad) and Dagongcao in equal proportions, calcined to preserve nature, ground into powder, one liang. Mix with the aforementioned drugs, grind together, make pills with steamed dough the size of hemp seeds. Take twice daily. In the empty stomach, take with Xiaoyao San; in the late afternoon, take with Guipi Tang. Fortunately, she was diligent in avoiding illness. After more than a year of regulation, she recovered.

Yu Zhen's commentary: Ancient formulas for treating abdominal masses include Lulu Wan, using Lulu, Huanglian (Coptidis Rhizoma), Huhuanglian (Coptidis Rhizoma var. chinensis), Muxiang (Aucklandiae Radix), Wuyi (Chrysanthemi Indici Flos), and Qingpi (Citri Reticulatae Pericarpium Viride), each five qian. Danggui (Angelicae Sinensis Radix), Fuling, and Chenpi, each one liang five qian. Zhi Gancao (Prepared Licorice Root), seven qian. Made into pills with rice paste. It treats infantile malnutrition with abdominal masses, emaciation, fever, reduced appetite, dry mouth and thirst, sores on teeth and cheeks. This formula is largely similar to the one above, and the symptoms described are identical. *Ji Yin Gang Mu* notes that it is suitable for children with infantile malnutrition and abdominal distension, doubting its suitability for women, suggesting it was erroneously included. Now, seeing this case, we know the compiler did not err.

Sun Dongsu treated the daughter-in-law of Magistrate Ma. Every time her menstrual period arrived, a swelling would appear beside the uterus (Zihu). It was swollen but painless. After three to five days, punctured with a silver hairpin, releasing about a cup of white pus, after which it subsided. Flesh regenerated without plasters, leaving no scar. It flared up only during menstruation, located variably above, below, left, or right, but never far from the uterus. Treated by internal and external medicine specialists for years without effect, leading to infertility. She consulted Sun. After pondering for two days, he realized: "This is damp-phlegm from the Middle Jiao flowing down with the menstrual blood, obstructing the uterus. As the blood flows, phlegm coagulates, transforming into pus. Originally not toxin, hence painless." Use Bai Luosi Ke (White Conch Shell) calcined as the sovereign herb. Nanxing (Arisaematis Rhizoma Preparatum) and Banxia (Pinelliae Rhizoma Preparatum) as ministers. Chaihu (Bupleuri Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) as assistants. Make pills with flour paste. Take morning and evening. Cured.

Yu Zhen's commentary: Master Sun's insight is unsurpassable. "Originally not toxin, hence painless" is also a profound statement derived from investigating things.

[Appendix] A widow was weak. Every time her menses arrived, her voice became hoarse. Shen Yaofeng said: "The collaterals of the Liver and Kidney connect upwards to the Lung. When essence and blood flow downward, the Lung becomes dry, causing hoarseness." Used Dihuang (Rehmanniae Radix), Tiandong (Asparagi Rhizoma), Roucongrong (Cynomorii Herba), and Danggui Shen (Angelicae Sinensis Radix Radix) to greatly tonify essence and blood. The condition worsened. Added Xixin (Asari Radix et Rhizoma), five fen. To unblock the Jueyin and Shaoyin collaterals. Upon entering the mouth, the voice immediately returned. Later regulated with Bawei Wan (Eight-Ingredient Pill). Menstruation arrived without hoarseness.

Yu Zhen's commentary: People today call menstruation Tian Gui (Heavenly Water). This is incorrect. The *Classic of Internal Medicine* states: "At fourteen, a girl's Tian Gui arrives, the Ren Mai becomes patent, and the Chong Mai becomes abundant, so menstruation occurs on time." It also says: "At sixteen, a boy's Kidney Qi becomes abundant, Tian Gui arrives, and essence overflows and ejaculates." If Tian Gui were menstruation, do men have it? By its name, it refers to the True Water of Heaven Yi, the source of essence and blood. Generally, both men and women possess essence. The *I Ching* says: "Male and female unite their essence," which is credible. However, identifying Tian Gui as essence is also inappropriate. If Tian Gui were essence, it should not say "essence overflows and ejaculates." Later scholars discussing conception proposed theories like "Yang essence and Yin blood, arriving first and second," which are also erroneous. Have you ever seen a woman bleed during sexual intercourse? Bleeding during intercourse is a pathology. How can it wrap essence, or be wrapped by essence? Roughly speaking, when mutual passion is high and all pulses converge, Tian Gui and the essence of man and woman arrive together. Only then does it enter the Ren Mai to form a fetus. Male or female fetuses depend on the strength, weakness, fullness, or emptiness of the couple's Tian Gui. The Ren Mai and Du Mai both originate from the Huiyin point where the anterior and posterior orifices meet. The Du Mai governs all Yang meridians; the Ren Mai governs all Yin meridians. The Ren Mai belongs to the Foot Shaoyin; the Chong Mai belongs to the Foot Yangming. It is said that the Chong is the Sea of Blood, and the Ren governs the womb. The *Classic* states: "The anterior orifice is the convergence of the Zong Jin (General Tendons), converging at Qichong, with Yangming as its leader. The essence of water and grain from Yangming transforms into blood to irrigate the Taichong. When the Taichong Mai is abundant, menstruation occurs on time." Once pregnant, blood gathers to nourish the fetus and cannot irrigate the Taichong, so menstruation stops. From this analysis, "Ren Mai becomes patent and Tian Gui arrives" versus "Chong Mai becomes abundant and menstruation flows" are clearly two distinct phenomena.