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A woman, whose husband had been away for business for a long time without returning, developed chills and fever (aversion to cold and heat), and her menstruation lasted ten days before stopping. After taking herbs that clear fire and cool blood, she instead developed tidal fever (fever that comes and goes like the tide) and internal heat, spontaneous sweating (sweating during daytime activity), and night sweats (sweating during sleep), with menstruation becoming frequent.

I said: Heat-induced sweating indicates deficiency of Qi and Blood; frequent menstruation indicates deficiency of the Liver and Spleen. She was cured using Guipi Tang (Restore the Spleen Decoction) and Liuwei Wan (Six-Ingredient Pill with Rehmannia).

A released palace maid, over thirty years old, suffered from pain in both hips. The skin color remained unchanged, but there was pain during urination and defecation resembling strangury (painful urinary dysfunction), which was particularly severe when using the toilet. This was caused by stagnant blood infiltrating the "tunnels" (meridians or channels), resulting from a disharmony between male and female Yin-Yang. It was difficult to treat. Later, the area ulcerated and failed to heal, and she subsequently died from Luoli (scrofula/cervical lymphadenitis). This woman was related to the Tang family in my hometown. Mr. Tang was often away for business, showing that this woman harbored long-term depression at home, and upon leaving the palace, her desires were unfulfilled, leading to this illness. Thus, it is evident that scrofula and flowing abscesses are caused by damage to Qi and Blood due to the Seven Emotions (joy, anger, worry, thought, sadness, fear, fright), and aggressive purging methods should obviously not be used. According to the "Chapter on Essence and Blood": "Once a woman's Tian Gui (menstrual essence) has arrived, if more than ten years pass without cohabitation with a man, menstruation will become irregular. If less than ten years have passed, longing for cohabitation with a man will also cause irregular menstruation. Irregular menstruation means old blood does not exit, and new blood flows erroneously; it may ulcerate into the bone, or transform into a swelling. Even if cohabitation occurs, conception may be difficult; excessive cohabitation depletes fluids and weakens the person; bearing many children depletes blood and can be fatal." Observing the state of essence and blood reveals half the truth.

A maiden, seventeen years old, suffered from a persistent genital ulcer. Her Tian Gui had not yet commenced. She presented with tidal fever, cough, and poor appetite with little desire to eat. Someone suggested using Tongjing Wan (Menstruation-Promoting Pill). I said: Cases presenting with tidal fever and irregular menstruation are difficult to treat. Fortunately, her pulse was not choppy (se), and she did not have tidal fever, so it was still treatable. By nourishing Qi and Blood and benefiting body fluids, her menstruation would regulate itself naturally. Confused by the desire for quick effects, she still used the pill. I said: This is not the correct treatment. This is a harsh preparation that greatly assists Yang Fire. Yin Blood will flow recklessly when exposed to it, and the Spleen and Stomach will become increasingly deficient. Indeed, her menstruation started but could not stop, her food intake decreased further, and tidal fever worsened, ultimately leading to death.

Xue Lizhai said: Lijie pain (severe joint pain) may be due to irregular diet and lifestyle, or improper handling of the Seven Emotions and Six Evils (wind, cold, summer-heat, dampness, dryness, fire), leading to Spleen-Stomach deficiency, loose Cou Li (skin pores and interstitial spaces), and invasion by external pathogens. It may also be due to internal movement of Liver Fire and consumption of Liver Blood; manifesting as limb pain, difficulty extending joints, sudden cramping pain, or wandering pain without fixed location; or internal heat, afternoon fever, spontaneous sweating, night sweats, irregular menstruation, and lack of taste in food. For treatment: if due to Wind Evil, use Xiao Xuming Tang (Minor Continue Life Decoction). For wandering pain, use Loulu San (Rhinacanthus Powder). For bone and joint pain, use Sisheng Wan (Four Living Ingredients Pill). For damp-heat pain, use Xiaozao Tang (Dryness-Dispersing Decoction). If accompanied by phlegm, assist with Erchen Tang (Two-Aged Decoction). For Liver Fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) plus Qianghuo (Notopterygii Rhizoma) and Chuanxiong (Chuanxiong Rhizoma). For Spleen Depression, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction) plus Qianghuo and Chuanxiong. For Blood Deficiency, use Siwu Tang (Four Substances Decoction) plus Qianghuo and Chuanxiong. For Qi Deficiency, use Sijunzi Tang (Four Gentlemen Decoction) plus Qianghuo and Chuanxiong. For combined Qi and Blood Deficiency, use Bazhen Tang (Eight Treasures Decoction) plus Qianghuo and Chuanxiong. For early menstruation with pain, Jiawei Xiaoyao San is primary. For delayed menstruation with pain, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is primary. Generally, pain that cannot bear pressure indicates excess of both Pathogenic Qi and Healthy Qi; pain that relieves with pressure indicates deficiency of both. Pain arising from labor indicates Healthy Qi deficiency; pain from dietary indiscretion indicates Spleen-Stomach deficiency; pain from anger indicates Liver Fire; pain during menstruation indicates Blood Deficiency. All these cases prioritize consolidating Healthy Qi, assisted by herbs treating the disease.

Medical Cases

A woman suffered from spontaneous sweating, night sweats, fever worsening in the late afternoon, fatigue, poor appetite, irregular menstruation, and copious sputum for two years. Her whole body ached, worsening on cloudy, rainy, or windy days. Using Xiao Xuming Tang stopped the pain. Using Buzhong Yiqi Tang and Jiawei Guipi Tang for over thirty doses led to recovery. Symptoms such as spontaneous sweating are caused by depression damaging Spleen Qi, preventing it from distributing nourishment to the Zang-Fu organs. Therefore, the aforementioned two decoctions were used, focusing specifically on the Spleen and Stomach. Using cold-cooling herbs to clear fire, or Qi-regulating and phlegm-resolving methods would further damage the generating Qi, often leading to untreatable conditions.

A woman, due to anger, experienced heavy menstruation, fever, thirst, a tightly closed and small left eye, head and neck tremors, limb convulsions, and whole-body pain. This was anger stirring Liver Fire, with Liver Blood deficiency generating internal Wind. Using Jiawei Xiaoyao San plus Gouteng (Uncariae Ramulus cum Uncis) resolved the symptoms gradually over several doses. She was then stabilized using Bazhen Tang for regulation.

A woman suffered from Lijie pain, fever, thirst, poor appetite, and delayed menstruation. Various medicines were ineffective. Her pulse was surging (Hong) but fine (Xi) upon deep pressure. Using Fuzi Bawu Tang (Aconite Eight-Substance Decoction) for four doses stopped the pain. Jiawei Xiaoyao Tang restored Healthy Qi, and Liuwei Wan regulated menstruation.

A woman, obese and prone to internal heat, had early menstruation and gout. She suffered from significant swelling and pain in the lower body, frequent urination, heaviness of the body, and a slow pulse. The condition belonged to Wind-Dampness with Blood Deficiency and Heat. First, using Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness) for four doses gradually relieved swelling and pain. Using Qingzao Tang (Clear Dryness Decoction) for several doses cleared the urine. Using Jiawei Xiaoyao San for over ten doses gradually resolved internal heat. Due to food stagnation, fever and pain persisted, along with facial and ocular edema. Using Liujunzi Tang (Six Gentlemen Decoction) plus Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) led to recovery. Anger later caused abdominal distension, chills, fever, and vomiting, indicating Wood insulting Earth (Liver attacking Spleen). Using the previous prescription plus Zhizi (Gardeniae Fructus) and Muxiang (Aucklandiae Radix) brought stability. Only a sensation of descending in the lower abdomen, resembling the urge to defecate, indicated Spleen Qi sinking, which was cured with Buzhong Yiqi Tang. Later, due to labor and anger, she experienced vomiting of phlegm, whole-body swelling and pain, and sudden onset of menstruation with chills and fever. Using Liujunzi Tang plus Chaihu and Zhizi supported Healthy Qi and cleared Liver Fire, resolving swelling, pain, and vomiting. Using Buzhong Yiqi Tang lifted Yang Qi and strengthened Ying Qi, completely curing the menstrual chills and fever.