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Wang Shuhe said: A question was asked: A woman suffers from a disease resembling mania (dian疾), accompanied by dizziness and faintness (yumao), occurring more than twenty times a day. The physician palpated the pulse and instead diagnosed it as leukorrhea (daixia). All symptoms matched the physician's diagnosis. What is the characteristic of this pulse, and how can it be distinguished? The physician replied: The cunkou (inch position) pulse is soft and tight (ru er jin). A soft pulse indicates deficient yang qi; a tight pulse indicates cold in the ying (nutrient) blood. Deficient yang leads to weak wei (defensive) qi; blood exhaustion with coagulation and cold causes disharmony between yin and yang, allowing pathogenic factors to combine with ying and wei qi. This disease originated in youth when sexual intercourse occurred during menstruation. Prolonged and excessive activity stimulated the Mingmen gate, causing blood loss through menstruation and bodily deficiency, while all vessels expanded. The Zhongji point felt the movement of yang, and slight wind triggered cold due to deficiency, combining with ying and wei qi. Cold accumulated in the Dantian, surged upward, rushing into the chest and diaphragm, covering the mouth with fluids, with saliva overflowing from the stomach. The condition resembled counterflow qi (jueqi) surging, with heat in the thighs. Crude physicians misdiagnosed it as mania and applied moxibustion, causing the condition to worsen significantly.

Chen Cangqi said: If sexual intercourse occurs during menstruation, essence and blood collide, entering the Ren Mai (Conception Vessel) and remaining in the uterus (baozhong), resulting in abdominal masses. The condition resembles Fuliang (a type of abdominal mass), with frequent and difficult urination. This is called "Jijing" (accumulated essence). This is one of the three prohibitions for women regarding sexual conduct.

The Yuanbing Ji states: When a woman engages in sexual intercourse during her menstrual period, she may injure the blood collaterals, often leading to prolonged dripping of menstrual blood, commonly known as "Xuesha Lin" (blood sand strangury). Treatment usually involves harmonizing qi and blood so that the zang-fu organs function peacefully, and menstruation will stop naturally.

Shenzhou commented: The above three passages describe three conditions caused by sexual intercourse during menstruation: mania and dizziness, Fuliang masses, and prolonged menstrual bleeding. Generally, if a woman has sexual intercourse after her menstrual blood has completely cleared, the essence and blood can condense and gather to conceive a fetus. However, if intercourse occurs while menstruation is just starting without abstinence, retained blood cannot exit, and accumulated essence collides with it, causing various disorders. This is an error people easily make; physicians must thoroughly understand these pathological mechanisms.

Shenzhou commented: From the discussion by Attendant Physician Chu on "intercourse at improper times" up to this point, the content is divided into seventeen sections, all attributing irregular menstruation to specific causes. The following section begins to outline the general principles for regulating menstruation.

Li Shi said: Women's menstrual cycles flow smoothly; if there are no abnormal symptoms, pregnancy can occur. However, if accompanied by tidal fever and abdominal pain, or severe cases involving coughing, sweating, vomiting, or diarrhea, and tidal sweating, the blood becomes further depleted. Sweating, coughing, and vomiting cause qi to ascend; diarrhea causes body fluids to drain posteriorly; pain causes accumulation in the center. Therefore, diseases must be removed first before nourishing blood and regulating menstruation. Among these, tidal fever and pain are particularly common ailments for women. When blood stagnation accumulates deeply into the bone marrow, it becomes bone-steaming consumption. Blood stasis and瘀 (stasis) contend with newly generated daily blood, causing pain. Blood dryness fails to nourish the bones, causing internal steaming heat. Blood dryness leads to excessive fire in the uterine collaterals, or combines with phlegm, qi stagnation, or food retention; exposure to cold causes pain. All these diseases obstruct regular menstruation; one must eliminate the disease first before regulating menstruation.