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Fang Yuezhi stated: Women regard blood as their sea (the foundation of their physiology). Women follow men and cannot act independently in all matters. Therefore, they often experience excessive worry, thought, anger, and indignation, leading to a predominance of Qi stagnation. Medical texts state: "When Qi moves, Blood moves; when Qi stops, Blood stops." Excessive worry and thought cause Qi to knot (stagnate); when Qi knots, Blood also becomes stagnant. It is also said: "When Qi is smooth, Blood is smooth; when Qi rebels, Blood rebels." Excessive anger causes Qi to rebel (rise counterflow); when Qi rebels, Blood also rebels. When Qi and Blood become knotted or rebellious within the Zang-Fu organs and meridians, menstruation becomes irregular.

Shen Zhai commented: The above six points outline the causes of irregular menstruation in women. Women rely on Blood for their physiological functions; thus, no illness takes precedence over regulating menstruation. The reasons for irregular menstruation include: coitus at inappropriate times, Yin-Yang imbalance and mutual overcoming, contraction of wind-cold external pathogens, or injury from worry, thought, depression, and anger. All these are sufficient to cause menstrual irregularities. These pathogenic mechanisms must be carefully examined.

Dai Fu'an stated: A woman's monthly menstruation should arrive on schedule, neither excessive nor deficient, much like the waxing and waning of the moon. If it arrives early or late, in large or small amounts, if illness precedes its arrival, or if it starts and then stops intermittently, all are termed "irregular menstruation." He recommended Heqi Yin (Harmonizing Qi Decoction) with added Xiangfu (Cyperus Rhizome).

Zhu Danxi stated: Menstruation arriving early indicates Blood Heat. He recommended Siwu Tang (Four Substances Decoction) with added Huangqin (Scutellaria Root), Lianzi (Lotus Plumule), and Xiangfu (Cyperus Rhizome). Menstruation arriving late indicates Blood Deficiency. He recommended Xiong (Ligusticum Rhizome), Gui (Angelica Sinensis Radix), Shen (Ginseng Radix), Zhu (Atractylodes Macrocephala Rhizome) added to Erchen Tang (Two-Aged Decoction).

Xue Lizhai commented: Early menstruation may be caused by Dryness of Blood in the Spleen Meridian, suitable for Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). It may be caused by Stagnation in the Liver Meridian, suitable for Guipi Tang (Restore the Spleen Decoction). It may be caused by Fire Anger in the Liver Meridian, suitable for Jiawei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction). It may be caused by Heat in the Blood Level, suitable for Jiawei Siwu Tang (Modified Four Substances Decoction). It may be caused by Fire stirring due to overwork, suitable for Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For late menstruation, it may be caused by Blood Deficiency in the Spleen Meridian, suitable for Renshen Yangrong Tang (Ginseng Nourishing the荣 Decoction). It may be caused by Blood Scarcity in the Liver Meridian, suitable for Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Generally, Blood is produced by the Spleen; hence, it is said that the Spleen controls Blood. For all Blood diseases, sweet and bitter agents should be used to assist Yang Qi and generate Blood.

Zhao Yangkui stated: Menstruation arriving before the expected time indicates the presence of Fire. He recommended Liuyi Wan (Six-Ingredient Pill) to nourish Kidney Water, so that Fire will naturally subside. If it arrives early and in large amounts, add Haipiaoxiao (Cuttlefish Bone), Chaihu (Bupleurum Root), and Baishao (White Peony Root) to the base formula. If it arrives every half month or ten days and persists without stopping, this belongs to Qi Deficiency, treated with Buzhong Yiqi Tang. If it arrives after the expected time, it indicates Fire Decline (Kidney Yang Deficiency); add Aiye (Mugwort Leaf) to the base formula. If it is late and pale in color, add Guizhi (Cinnamon Twig) to the base formula. This is the general principle. However, there are cases of early arrival without Fire, and late arrival with Fire. The volume varies, and one cannot rigidly adhere to fixed rules. One must observe the pulse for Slowness or Rapidity, assess the constitution for Deficiency or Excess and strength or weakness, primarily focusing on nourishing Water, and modifying according to symptoms. Purple or black blood usually indicates severe Fire Excess. There are also cases of purple-black blood due to Deficient Cold, which must not be overlooked without careful pulse and symptom examination. If the color is pale white, the absence of Fire is evident.