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Li Taisu stated: Benorrhoea (sudden heavy uterine bleeding) is an acute condition, while metrorrhagia (irregular prolonged uterine bleeding) is a chronic disease. Benorrhoea is necessarily caused by severe anger injuring the Liver, stirring up the Sea of Blood (Chong Mai), or extreme excess of fire causing blood heat to boil and surge. Metrorrhagia results from excessive sexual activity damaging the Chong and Ren vessels, where Qi deficiency fails to control menstrual blood, or due to the patient's inherent internal heat causing blood instability, leading to intermittent leakage. Treatment for benorrhoea should focus on regulating Qi, descending fire, and lifting; treatment for metrorrhagia should focus on nourishing Yin, tonifying Qi, and nourishing Blood, possibly combined with controlling fire.

Fang Yuezhi said: Blood belongs to Yin. When quiet, it circulates within the meridians to nourish the interior; when agitated, it flows erratically. Therefore, extreme emotional disturbances cause the Five Zang Spirits to become hyperactive, resulting in sudden profuse menstrual bleeding that persists, known as "Beng Zhong" (Central Collapse). The treatment method involves: initially using hemostasis to stop the flow (treat the branch); secondly using clearing heat and cooling blood to clarify the source (treat the root); and finally using blood tonification to restore the original state (recovery). If one only stops the flow without clarifying the source, the torrential force cannot be contained. If one only clarifies the source without restoring the original state, the floating solitary Yang will have no foundation to ascend, which must be carefully considered.

Shen Zhai commented: Methods for treating benorrhoea include eliminating stasis, using cold/cooling agents to descend fire, astringents to secure collapse, strong lifting methods, strengthening Spleen and Stomach, tonifying Qi and Blood, and warming the Lower Jiao, among others. Fang’s three-stage method (Initial, Middle, Final) has the flaw of reversing the proper order. I propose that the Middle stage should be treated as the Initial stage, the Initial stage as the Final stage, and the Final stage as the Middle stage, thereby avoiding mismanagement.

Xue Lizhai said: Humans rely on the Spleen and Stomach as their foundation, receiving grains and transforming them into essence and fine nutrients. The clear portion enters Ying (Nutritive) Qi, and the turbid portion enters Wei (Defensive) Qi. Through this process, Yin and Yang are generated, functioning like a bellows (Tuoyue). Humans rely on Earth (Spleen/Stomach) to nourish the body; losing it leads to withered limbs. Li Dongyuan argued that self-injury through diet, compounded by physicians' frequent misuse of purgatives, causes Clear Qi to sink and Turbid Qi to fail to descend, leading to distension. Thus, the Yang Qi of the Stomach chamber fails to lift, sinking into the Middle Jiao. One should use Buzhong Yiqi Tang to allow Turbid Qi to descend, ensuring natural recovery. If benorrhoea or metrorrhagia occurs after overeating, it damages Spleen Qi, causing it to sink into the Kidney, combining with Minister Fire to create damp-heat pressing downward. It is appropriate to use sweet-warm formulas to regulate and tonify the Spleen and Stomach, so that blood returns to its vessels. If cold/cooling agents are mistakenly used, damaging Stomach Qi, blood cannot be controlled and returned to the vessels. Li Dongyuan stated: For all lower bleeding conditions, one must conclude treatment with Six Gentlemen Decoction (Sijunzi Tang); this holds profound significance. These approaches treat the disease from the fundamental source of the Spleen and Stomach, which must not be ignored.

Shen Zhai commented: The above four points outline the general principles for treating benorrhoea and metrorrhagia.