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Xue Xinpu said: The *Neijing* states: "When food and drink enter the stomach, their essence floats and overflows, transporting upwards to the Spleen; the Spleen scatters the essence, sending it upwards to return to the Lung; the Lung regulates the water passages, transporting downwards to the Bladder; water and essence are distributed in all directions, and the five meridians run together." Master Dongyuan (Li Dongyuan) stated that the Spleen is the source of transformation and production, and the Heart commands the blood of all meridians. Indeed, these words are true. I hold that when the Heart and Spleen are harmonious and peaceful, menstruation proceeds normally. However, if internal injury by the seven emotions, external invasion by the six climatic factors, irregular diet, or improper daily routine cause deficiency and damage to the Spleen and Stomach, and reckless movement of Heart Fire occurs, menstrual irregularities will arise. For menstruation arriving early: since blood is generated from Spleen Earth, it is said that the Spleen controls blood. Generally, for blood disorders, bitter and sweet agents should be used to assist Yang Qi and generate Yin Blood. Specifically, for those arriving early due to dryness of blood in the Spleen Meridian, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) is indicated; due to stagnation in the Spleen Meridian, Guipi Tang (Restore the Spleen Decoction) is indicated; due to anger-fire in the Liver Meridian, Jiawei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction) is indicated; due to heat in the blood level, Jiawei Siwu Tang (Modified Four Substance Decoction) is indicated; due to fire movement from labor and exertion, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is indicated. For menstruation arriving late: due to blood deficiency in the Spleen Meridian, Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction) is indicated; due to blood insufficiency in the Liver Meridian, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is indicated; due to Qi deficiency and weak blood, Bazhen Tang (Eight Treasures Decoction) is indicated.

He further said: Blood is the essence of water and grain, harmonizing the five Zang organs and spreading throughout the six Fu organs. In women, it transforms upward into milk and downward into the Sea of Blood (Chong Mai). Therefore, although the Heart governs blood and the Liver stores blood, both are controlled by the Spleen and Stomach. By tonifying the Spleen and harmonizing the Stomach, blood will naturally be generated. During menstruation, bitter-cold and acrid-dispersing herbs are strictly prohibited.

Li Dongyuan said: There are three causes for amenorrhea (cessation of menstruation). When a woman's intestines and stomach have been deficient for a long time, her body becomes emaciated, and both Qi and blood decline, leading to the cessation of menstruation. Or, she suffers from "Middle Xiao" (middle consumption) with stomach heat, eating well but gradually losing weight, failing to generate fluids. Menstrual blood is transformed from blood vessels and fluids; once fluids are exhausted and scorched by heat, muscles become emaciated, dryness and thirst frequently appear, the Sea of Blood dries up, a condition named "Blood Withered Amenorrhea" (Xue Ku Jing Jue). One should drain the dryness and heat of the Stomach and tonify Qi and blood, after which menstruation will resume naturally. If conception occurs during this disease, the fetus may not develop, resulting in fetal pathology. Alternatively, if the Pericardium Collateral pulse is surging and rapid, with frequent irritability, constipation, and difficult urination, yet menstruation is completely absent, this indicates a dried-up Sea of Blood. One should regulate the blood vessels and eliminate the pathogenic fire in the Pericardium, after which menstruation will resume. Or, due to mental overwork, Heart Fire flares upward, causing amenorrhea because the Uterine Vessels are closed. The Uterine Vessels belong to the Heart and connect to the uterus. Now, Qi presses upward against the vessels, preventing Heart Qi from descending smoothly, thus causing amenorrhea. One should calm the mind, tonify blood, and drain fire, after which menstruation will resume.

Xue Lizhai said: What is amenorrhea? Menstrual water is Yin blood, governed by the Chong and Ren meridians, transforming upward into milk and downward into menstrual flow. Causes include: Spleen deficiency failing to generate blood; Spleen depression injuring and depleting blood; Stomach fire consuming blood; Spleen and Stomach damage reducing blood; Mental labor injuring the Heart and reducing blood; Anger injuring the Liver and reducing blood; Kidney Water failing to nourish the Liver and reducing blood; Lung Qi deficiency failing to move blood causing closure. Treatment methods: For Spleen deficiency, regulate and tonify; for Spleen depression, resolve depression and tonify; for Stomach fire, clear heat and tonify; for Spleen/Stomach damage, regulate and tonify; for mental labor injuring Heart blood, rest and tonify; for anger injuring the Liver, harmonize and tonify; for Lung Qi deficiency, tonify Spleen and Stomach; for Kidney deficiency, tonify Spleen and Lungs. The Classics state: Damage to the Lung benefits Qi; damage to the Heart nourishes Ying and Wei; damage to the Spleen supplements through diet, adapting to cold and warmth; damage to the Liver soothes its interior; damage to the Kidney benefits Essence. Examining carefully and treating accordingly ensures no errors.

Wang Yutai said: Xue’s general principle for treating blood withered conditions focuses on tonifying and nourishing True Yuan, expanding upon the principles of the Yishui (Zhang Yuansu) master-disciple lineage.

Fang Yuezhi said: Women's menstrual diseases include irregular menstruation and obstructed menstruation.

Within irregularity and obstruction, there are cases accompanied by pain and cases accompanied by fever, dividing them into four categories. Within irregularity, there are early arrivals and late arrivals; early arrival indicates Heat, while late arrival indicates Deficiency. Within obstruction, there is blood stasis and blood withering; blood stasis requires breaking, while blood withering requires tonifying. Within pain, there is constant pain and pre/post-menstrual pain; constant and pre-menstrual pain indicate blood accumulation, while post-menstrual pain indicates blood deficiency. Within fever, there is constant fever and menstrual fever; constant fever indicates blood deficiency with accumulation, while menstrual fever indicates blood deficiency with Heat. This divides them into eight categories. Generally, internal causes of menstrual pain are worry, thought, anger, and indignation; external causes are drinking cold liquids and exposure to cold. Anger causes Qi stagnation and obstruction. Drinking cold or exposure to cold before or after menstruation leads to incomplete expulsion of lochia. These are the origins of irregular, obstructed, painful, and febrile menstruation. Regulating Qi and breaking blood, resolving depression and tonifying deficiency, cooling blood and clearing heat—there is a method to treat these! Since Qi moves Blood, and stopping Qi stops Blood, treating blood disorders prioritizes moving Qi, using herbs like Xiangfu (Cyperus Rhizome). Heat promotes circulation, while Cold causes coagulation; therefore, treating blood disorders uses hot herbs as assistants, such as Rougui (Cinnamon Bark).