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[Verse] There are various causes for pain during menstruation; if the root cause is not identified, treatment will be difficult. Pain occurring before the onset of menses is due to excess accumulation, while pain felt after the flow has ceased indicates deficiency-cold. Fu An advocated regulating Qi first when treating blood disorders. The *Chanbao* (Treasured Book for Childbirth) advises against consuming sour foods during menstruation. In cases of Qi stagnation, wind-cold invasion, and concurrent blood stasis, one must refer to the pulse and symptoms to prescribe decoctions or pills.

[Dissertation] Menstrual blood functions to circulate Qi and Blood, connect Yin and Yang, and nourish the body. If external Wei Qi (Defensive Qi) is deficient and fails to provide nourishment, and internal Ying Blood (Nutritive Blood) is lacking to irrigate and moisten, combined with exposure to wind-cold or overexertion, pain in the body may occur before the menstrual flow begins. Alternatively, if wind-cold pathogens lodge in the Bao Gong (Uterus), disturbing the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel), abdominal pain ensues.

[Pulse Diagnosis] Pulse characteristics such as Chen (Deep), Jin (Tight), Xi (Fine), and Dong (Agitated) all indicate abdominal pain. A Xian (Wiry) pulse on the Yang position indicates headache, while a Xian pulse on the Yin position indicates abdominal pain. If the Liver pulse is Xian and accompanied by irregular menstruation, it manifests as lower back and abdominal pain, amenorrhea, and cold hernia pain around the umbilicus. A Chen-Jin pulse suggests that stagnant blood is not dispersing and is being rushed by Qi; the struggle between new blood and old blood causes pain.

[Abdominal Pain] Although abdominal pain is attributed to injury of the Chong and Ren vessels, one must distinguish between Qi and Blood disorders, and Yin and Yang patterns. Consider factors such as wind, cold, dampness, and heat, as well as excess and deficiency. Investigate the source through pulse diagnosis and apply ancient formulas.

Wind-Cold Type: When wind-cold invades the Chong and Ren vessels during menstruation, there is continuous, lingering abdominal pain, cold feet, a slow pulse, and frequent nausea. Treat with Guizhi Tang (Cinnamon Twig Decoction), Taohe Chengqi Tang (Peach Kernel and Salvia Decoction), or Wenjing Tang (Warming the Menses Decoction).
Wenjing Tang.

Cold-Damp Type: The menstrual blood resembles bean curd dregs, with restless abdominal pain. The Chi positions of both wrists are floating but weak upon light pressure and deep and fine upon heavy pressure. Use Siwu Tang (Four Substances Decoction) decocted and combined with Wuling San (Five-Ingredient Powder with Poria).

Blood Stasis/Obstruction Type: Abdominal pain occurs prior to menstruation, and the flow stops immediately due to sluggish blood circulation. The pain gradually intensifies and moves downward. Harmonize Ying Blood and regulate Qi to restore balance.
Bawu Tang (Eight Substances Decoction).

Qi Stagnation Type: Qi stagnates at the Bao Men (Gate of the Uterus), obstructing menstruation. Abdominal pain comes and goes, attacking inward. The pulse is Chen, and pain radiates to the waist and hypochondrium. The Yiqi Yanhu Formula is highly effective.

Food Retention Type: During summer menstruation, accidental consumption of raw/cold foods causes sudden cessation of menses. Later, pain precedes the return of the flow. Use Xiaohupo San (Small Amber Powder).

Deficiency Pain Type: Dull pain in the lower back and abdomen persists even after menstruation ends. The pulse is weak, the pain is lingering and relieved by pressure. The root cause is definitely Blood deficiency.
Shenzhen Tang (Eight Treasures Decoction) extended with Yanhu Suo (Corydalis Rhizome), Xiangfu (Cyperi Rhizoma), and Paojiang (Prepared Ginger).

Excess Pain Type: Paroxysmal attacking pain prevents blood flow. The abdomen feels full and hard upon pressure and resists touch (rebound tenderness). This indicates interior excess; promote unblocking and circulation. Once Qi and Blood flow freely, pain subsides naturally.
Walongzi Wan (Arca Shell Pill) and Yuzhu San (Jade Candle Powder).

[Headache] Headache during menstruation is often caused by wind-cold contraction. Do not treat it as an ordinary condition. Expelling the exterior pathogen must be combined with nourishing Blood. After one cycle (seven days), the accumulation will resolve naturally.

[Body Pain] How to diagnose body pain during menstruation? It may be due to wind-pathogen invasion or Qi-Blood deficiency. Harmonize Wei Qi, dispel wind, and tonify Blood. The ancient formula Chentong Yin (Seizing Pain Decoction) can eliminate these symptoms.

[Lower Back Pain] Why does the lower back hurt during menstrual disorders? Because the two Kidneys are connected to the Bao Men. This is recorded in the *Neijing* (Inner Canon) and is highlighted here, emphasizing that the foundation of reproduction lies in the Yuan Qi (Primary Qi).
Hupo San (Amber Powder).

[Heart Pain due to Blood Loss] Heart pain resulting from blood loss is rarely understood. This is because blood originates from the Heart and Spleen. For excessive blood loss, treat the root with Guipi Tang (Restore the Spleen Decoction); to treat the branch, first tonify the Heart and Spleen blood.